%0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e67370 %T Greater Improvements in Vaccination Outcomes Among Black Young Adults With Vaccine-Resistant Attitudes in the United States South Following a Digital Health Intervention: Latent Profile Analysis of a Randomized Control Trial %A Mancuso,Noah %A Michaels,Jenna %A Browne,Erica N %A Maragh-Bass,Allysha C %A Stocks,Jacob B %A Soberano,Zachary R %A Bond,C Lily %A Yigit,Ibrahim %A Comello,Maria Leonora G %A Larsen,Margo Adams %A Muessig,Kathryn E %A Pettifor,Audrey %A Hightow-Weidman,Lisa B %A Budhwani,Henna %A Stoner,Marie C D %K COVID-19 %K mHealth %K African American and Black %K young adults %K vaccination %K mobile health %D 2025 %7 16.4.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Negative attitudes toward vaccines and suboptimal vaccination rates among African American and Black (Black) Americans have been well documented, due to a history of medical racism and human rights violations in the United States. However, digital health interventions (DHI) have been shown to address racial disparities in several health outcomes, such as cardiovascular disease, HIV, and maternal health. The Tough Talks COVID (TT-C) study was a randomized controlled trial of a DHI designed to empower Black young adults in the United States South to make informed, autonomous decisions about COVID-19 vaccine uptake by addressing structural barriers and misinformation about vaccines. Objective: Our objective was to identify subgroups of Black young adults with various vaccine attitudes at baseline and determine the subgroups for which the TT-C DHI was most impactful. Methods: Black young adults aged 18‐29 years in Alabama, Georgia, and North Carolina who were unvaccinated or insufficiently vaccinated against COVID-19 completed three online surveys over three months (N=360). Latent profile analysis was used to identify subgroups based on general vaccine attitudes at baseline, including hesitancy, confidence, knowledge, conspiracy beliefs, and mistrust. Logistic regression was used to examine the associations between latent profiles and vaccine uptake, and linear regression was used to examine changes in vaccine attitudes at three months post-randomization. Modification of the TT-C DHI’s effects was assessed by latent profiles. Results: Three latent profiles emerged: vaccine-receptive (n=124), vaccine-neutral (n=155), and vaccine-resistant (n=81). Political affiliation, income, social support, and recent flu vaccination differed significantly between the three subgroups (P<.05). Vaccine uptake was not significantly different by subgroup, and the TTC-DHI did not have differing effects on uptake across subgroups. However, the DHI had the strongest effect—with statistically significant measures of association (P<.05) and interaction P values (P<.10)—among the baseline vaccine-resistant and vaccine-neutral subgroups compared to the vaccine-receptive subgroups at three months in improving vaccine hesitancy, confidence, and conspiracy beliefs at three months: vaccine-resistant difference: −0.40 (−0.76 to −0.37), 0.39 (0.02 to 0.75), and −0.47 (−0.86 to −0.09); vaccine neutral difference: −0.36 (−0.52 to −0.19), 0.35 (0.18 to 0.51), and −0.24 (−0.44 to −0.03). The DHI had no effects on these outcomes among the vaccine-receptive subgroup. Conclusions: Our findings revealed subgroups of Black young adults in the United States South with different vaccination attitudes, for which the TT-C intervention had differing effects. Black young adults who are vaccine-resistant or vaccine-neutral may experience larger gains from a digital vaccine intervention. Future work aimed at improving vaccination outcomes could target these populations to maximize resource efficiency and drive the greatest improvements in vaccine outcomes. Trial Registration: ClinicalTrials.gov NCT05490329; https://clinicaltrials.gov/study/NCT05490329 %R 10.2196/67370 %U https://publichealth.jmir.org/2025/1/e67370 %U https://doi.org/10.2196/67370 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63693 %T Testing a Machine Learning–Based Adaptive Motivational System for Socioeconomically Disadvantaged Smokers (Adapt2Quit): Protocol for a Randomized Controlled Trial %A Kamberi,Ariana %A Weitz,Benjamin %A Flahive,Julie %A Eve,Julianna %A Najjar,Reem %A Liaghat,Tara %A Ford,Daniel %A Lindenauer,Peter %A Person,Sharina %A Houston,Thomas K %A Gauvey-Kern,Megan E %A Lobien,Jackie %A Sadasivam,Rajani S %+ Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, United States, 1 774 317 1539, Ariana.Kamberi@umassmed.edu %K smoking cessation %K mHealth %K socioeconomically disadvantaged, biochemical verification %K machine learning %D 2025 %7 16.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Individuals who are socioeconomically disadvantaged have high smoking rates and face barriers to participating in smoking cessation interventions. Computer-tailored health communication, which is focused on finding the most relevant messages for an individual, has been shown to promote behavior change. We developed a machine learning approach (the Adapt2Quit recommender system), and our pilot work demonstrated the potential to increase message relevance and smoking cessation effectiveness among individuals who are socioeconomically disadvantaged. Objective: This study protocol describes our randomized controlled trial to test whether the Adapt2Quit recommender system will increase smoking cessation among individuals from socioeconomically disadvantaged backgrounds who smoke. Methods: Individuals from socioeconomically disadvantaged backgrounds who smoke were identified based on insurance tied to low income or from clinical settings (eg, community health centers) that provide care for low-income patients. They received text messages from the Adapt2Quit recommender system for 6 months. Participants received daily text messages for the first 30 days and every 14 days until the end of the study. Intervention participants also received biweekly texting facilitation messages, that is, text messages asking participants to respond (yes or no) if they were interested in being referred to the quitline. Interested participants were then actively referred to the quitline by study staff. Intervention participants also received biweekly text messages assessing their current smoking status. Control participants did not receive the recommender messages but received the biweekly texting facilitation and smoking status assessment messages. Our primary outcome is the 7-day point-prevalence smoking cessation at 6 months, verified by carbon monoxide testing. We will use an inverse probability weighting approach to test our primary outcome. This involves using a logistic regression model to predict nonmissingness, calculating the inverse probability of nonmissingness, and using it as a weight in a logistic regression model to compare cessation rates between the two groups. Results: The Adapt2Quit study was funded in April 2020 and is still ongoing. We have completed the recruitment of individuals (N=757 participants). The 6-month follow-up of all participants was completed in November 2024. The sample consists of 64% (486/757) female participants, 35% (265/757) Black or African American individuals, 51.1% (387/757) White individuals, and 16% (121/757) Hispanic or Latino individuals. In total, 52.6% (398/757) of participants reported having a high school education or being a high school graduate; 70% (529/757) smoked their first cigarette within 30 minutes of waking, and half (379/757, 50%) had stopped smoking for at least one day in the past year. Moreover, 16.6% (126/757) had called the quitline before study participation. Conclusions: We have recruited a diverse sample of individuals who are socioeconomically disadvantaged and designed a rigorous protocol to evaluate the Adapt2Quit recommender system. Future papers will present our main analysis of the trial. Trial Registration: ClinicalTrials.gov NCT04720625; https://clinicaltrials.gov/study/NCT04720625 International Registered Report Identifier (IRRID): DERR1-10.2196/63693 %R 10.2196/63693 %U https://www.researchprotocols.org/2025/1/e63693 %U https://doi.org/10.2196/63693 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65207 %T Experiences of Wheelchair Users With Spinal Cord Injury With Self-Tracking and Commercial Self-Tracking Technology (“In Our World, Calories Are Very Important”): Qualitative Interview Study %A Mylonopoulou,Vasiliki %A Cerna,Katerina %A Weilenmann,Alexandra %A Rost,Mattias %A Holmlund,Tobias %+ , Applied IT, University of Gothenburg, Forskningsgången 6, Gothenburg, 417 56, Sweden, 46 0702517497, vasiliki.mylonopoulou@gu.se %K wheelchair %K spinal cord injury %K tracking %K self-tracking %K wellness technology %K calories %K health inequalities %K inclusive design in mobile health %K design %K lifestyle app %K artificial intelligence %K AI %D 2025 %7 15.4.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Commercial wearable and mobile wellness apps and devices have become increasingly affordable and ubiquitous. One of their aims is to assist the individual wearing them in adopting a healthier lifestyle through tracking and visualizing their data. Some of these devices and apps have a wheelchair mode that indicates that they are designed for different types of bodies (eg, wheelchair users with spinal cord injury [SCI]). However, research focuses mainly on designing and developing new condition-specific self-tracking technology, whereas the experiences of wheelchair users with SCI using self-tracking technology remain underexplored. Objective: The objectives of this study were to (1) provide a comprehensive overview of the literature in the field of self-tracking technology and wheelchair users (as a basis for the study), (2) present the self-tracking needs of wheelchair users with SCI, and (3) present their experiences and use of commercial self-tracking technology. Methods: We conducted semistructured interviews with wheelchair users with SCI to understand their experiences with self-tracking and self-tracking technologies, their self-tracking needs, and how they changed before and after the injury. The interviews were thematically analyzed using an inductive approach. Results: Our findings comprised three themes: (1) being a wheelchair user with SCI, (2) reasons for self-tracking, and (3) experiences with self-tracking technologies and tools. The last theme comprised 3 subthemes: self-tracking technology use, trust in self-tracking technology, and calorie tracking. Conclusions: In the Discussion section, we present how our findings relate to the literature and discuss the lack of trust in commercial self-tracking technologies regarding calorie tracking, as well as the role of wheelchair users with SCI in the design of commercial self-tracking technology. %M 40233356 %R 10.2196/65207 %U https://humanfactors.jmir.org/2025/1/e65207 %U https://doi.org/10.2196/65207 %U http://www.ncbi.nlm.nih.gov/pubmed/40233356 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e72037 %T Enhancing Self-Management Support Apps for Spinal Cord Injury: The Missing Role of Caregivers %A Pessoa,Cheila %K mobile phone %K mHealth %K eHealth %K telemedicine %K telehealth %K spinal cord injury %K self-management %K internet-based intervention %K World Wide Web %K systematic review %K caregiver %D 2025 %7 14.4.2025 %9 %J JMIR Mhealth Uhealth %G English %X %R 10.2196/72037 %U https://mhealth.jmir.org/2025/1/e72037 %U https://doi.org/10.2196/72037 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e55433 %T Exploring the Potential of a Digital Intervention to Enhance Couple Relationships (the Paired App): Mixed Methods Evaluation %A Aicken,Catherine %A Gabb,Jacqui %A Di Martino,Salvatore %A Witney,Tom %A Lucassen,Mathijs %+ Faculty of Arts & Social Sciences, The Open University, Walton Hall, Milton Keynes, MK7 6BJ, United Kingdom, jacqui.gabb@open.ac.uk %K digital intervention %K couple relationships %K romantic relationships %K relationship quality %K app %K digital technology %K couples %K internet-based intervention %K evaluation research %K mobile phone %D 2025 %7 14.4.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the effects of poor relationship quality on individuals’, couples’, and families’ well-being, help seeking often does not occur until problems arise. Digital interventions may lower barriers to engagement with preventive relationship care. The Paired app, launched in October 2020, aims to strengthen and enhance couple relationships. It provides daily questions, quizzes, tips, and detailed content and facilitates in-app sharing of question and quiz responses and tagged content between partners. Objective: To explore the potential of mobile health to benefit couple relationships and how it may do this, we examined (1) Paired’s impact on relationship quality and (2) its mechanisms of action. Methods: This mixed methods evaluation invited Paired subscribers to complete (1) brief longitudinal surveys over 3 months (n=440), (2) a 30-item web-based survey (n=745), and (3) in-depth interviews (n=20). For objective 1, survey results were triangulated to determine associations between relationship quality measures and the duration and frequency of Paired use, and qualitative data were integrated to provide explanatory depth. For objective 2, mechanisms of action were explored using a dominant qualitative approach. Results: Relationship quality improved with increasing duration and frequency of Paired use. Web-based survey data indicate that the Multidimensional Quality of Relationship Scale score (representing relationship quality on a 0-10 scale) was 35.5% higher (95% CI 31.1%-43.7%; P=.002), at 7.03, among people who had used Paired for >3 months compared to 5.19 among new users (≤1 wk use of Paired), a trend supported by the longitudinal data. Of those who had used Paired for >1 month, 64.3% (330/513) agreed that their relationship felt stronger since using the app (95% CI 60.2%-68.4%), with no or minimal demographic differences. Regarding the app’s mechanisms of action, interview accounts demonstrated how it prompted and habituated meaningful communication between partners, both within and outside the app. Couples made regular times in their day to discuss the topics Paired raised. Daily questions were sometimes lighthearted and sometimes concerned topics that couples might find challenging to discuss (eg, money management). Interviewees valued the combination of fun and seriousness. It was easier to discuss challenging topics when they were raised by the “neutral” app, rather than during stressful circumstances or when broached by 1 partner. Engagement seemed to be enhanced by users’ experience of relationship benefits and by the app’s design. Conclusions: This study demonstrates proof of concept, showing that Paired may have the potential to improve relationship quality over a relatively short time frame. Positive relationship practices became embedded within couples’ daily routines, suggesting that relationship quality improvements might be sustained. Digital interventions can play an important role in the relationship care ecosystem. The mixed methods design enabled triangulation and integration, strengthening our findings. However, app users were self-selecting, and methodological choices impact our findings’ generalizability. %R 10.2196/55433 %U https://mhealth.jmir.org/2025/1/e55433 %U https://doi.org/10.2196/55433 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64023 %T Efficacy of a Personalized Mobile Health Intervention (BedTime) to Increase Sleep Duration Among Short-Sleeping Patients With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial %A Ban,Yuki %A Waki,Kayo %A Nakada,Ryohei %A Isogawa,Akihiro %A Miyoshi,Kengo %A Waki,Hironori %A Kato,Shunsuke %A Sawaki,Hideaki %A Murata,Takashi %A Hirota,Yushi %A Saito,Shuichiro %A Nishikage,Seiji %A Tone,Atsuhito %A Seno,Mayumi %A Toyoda,Masao %A Kajino,Shinichi %A Yokota,Kazuki %A Tsurutani,Yuya %A Yamauchi,Toshimasa %A Nangaku,Masaomi %A Ohe,Kazuhiko %+ Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, 7 Chome-3-1 Hongo, Bunkyo City, Tokyo, 113-8654, Japan, 81 358009129, kwaki-tky@m.u-tokyo.ac.jp %K digital therapeutics %K behavior change %K Theory of Planned Behavior %K sleep duration %K type 2 diabetes %K randomized controlled trial %D 2025 %7 14.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: A strong association exists between sleep duration and glycemic control in patients with type 2 diabetes (T2D), yet convincing evidence of a causal link remains lacking. Improving sleep is increasingly emphasized in clinical T2D treatment guidance, highlighting the need for effective, scalable sleep interventions that can affordably serve large populations through mobile health (mHealth). Objective: This study aims to pilot an intervention that extends sleep duration by modifying bedtime behavior, assessing its efficacy among short-sleeping (≤6 hours per night) patients with T2D, and establishing robust evidence that extending sleep improves glycemic control. Methods: This randomized, single-blinded, multicenter study targets 70 patients with T2D from 9 institutions in Japan over a 12-week intervention period. The sleep extension intervention, BedTime, is developed using the Theory of Planned Behavior (TPB) and focuses on TPB’s constructs of perceived and actual behavioral control (ABC). The pilot intervention combines wearable actigraphy devices with SMS text messaging managed by human operators. Both the intervention and control groups will use an actigraphy device to record bedtime, sleep duration, and step count, while time in bed (TIB) will be assessed via sleep diaries. In addition, the intervention group will receive weekly bedtime goals, daily feedback on their bedtime performance relative to those goals, identify personal barriers to an earlier bedtime, and select strategies to overcome these barriers. The 12-week intervention period will be followed by a 12-week observational period to assess the sustainability of the intervention’s effects. The primary outcome is the between-group difference in the change in hemoglobin A1c (HbA1c) at 12 weeks. Secondary outcomes include other health measures, sleep metrics (bedtime, TIB, sleep duration, total sleep time, and sleep quality), behavioral changes, and assessments of the intervention’s usability. The trial commenced on February 8, 2024, and is expected to conclude in February 2025. Results: Patient recruitment ended on August 29, 2024, with 70 participants enrolled. The intervention period concluded on December 6, 2024, and the observation period ended on February 26, 2025, with 70 participants completing the observation period. The data analysis is currently underway, and results are expected to be published in July 2025. Conclusions: This trial will provide important evidence on the causal link between increased sleep duration and improved glycemic control in short-sleeping patients with T2D. It will also evaluate the efficacy of our bedtime behavior change intervention in extending sleep duration, initially piloted with human operators, with the goal of future implementation via an mHealth smartphone app. If proven effective, this intervention could be a key step toward integrating sleep-focused mHealth into the standard treatment for patients with T2D in Japan. Trial Registration: Japan Registry of Clinical Trials jRCT1030230650; https://jrct.niph.go.jp/latest-detail/jRCT1030230650 International Registered Report Identifier (IRRID): DERR1-10.2196/64023 %M 40228289 %R 10.2196/64023 %U https://www.researchprotocols.org/2025/1/e64023 %U https://doi.org/10.2196/64023 %U http://www.ncbi.nlm.nih.gov/pubmed/40228289 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e67381 %T Impact of Conversational and Animation Features of a Mental Health App Virtual Agent on Depressive Symptoms and User Experience Among College Students: Randomized Controlled Trial %A Six,Stephanie %A Schlesener,Elizabeth %A Hill,Victoria %A Babu,Sabarish V %A Byrne,Kaileigh %K depression %K mental health app %K virtual agents %K cognitive behavioral therapy %K conversational agents %K virtual agent %K animations %K college student %K CBT %K ANOVA %K randomized controlled trial %K depressive symptoms %K mental disorder %K mental illness %K user experience %K mHealth %K digital health %D 2025 %7 11.4.2025 %9 %J JMIR Ment Health %G English %X Background: Numerous mental health apps purport to alleviate depressive symptoms. Strong evidence suggests that brief cognitive behavioral therapy (bCBT)-based mental health apps can decrease depressive symptoms, yet there is limited research elucidating the specific features that may augment its therapeutic benefits. One potential design feature that may influence effectiveness and user experience is the inclusion of virtual agents that can mimic realistic, human face-to-face interactions. Objective: The goal of the current experiment was to determine the effect of conversational and animation features of a virtual agent within a bCBT-based mental health app on depressive symptoms and user experience in college students with and without depressive symptoms. Methods: College students (N=209) completed a 2-week intervention in which they engaged with a bCBT-based mental health app with a customizable therapeutic virtual agent that varied in conversational and animation features. A 2 (time: baseline vs 2-week follow-up) × 2 (conversational vs non-conversational agent) × 2 (animated vs non-animated agent) randomized controlled trial was used to assess mental health symptoms (Patient Health Questionnaire-8, Perceived Stress Scale-10, and Response Rumination Scale questionnaires) and user experience (mHealth App Usability Questionnaire, MAUQ) in college students with and without current depressive symptoms. The mental health app usability and qualitative questions regarding users’ perceptions of their therapeutic virtual agent interactions and customization process were assessed at follow-up. Results: Mixed ANOVA (analysis of variance) results demonstrated a significant decrease in symptoms of depression (P=.002; mean [SD]=5.5 [4.86] at follow-up vs mean [SD]=6.35 [4.71] at baseline), stress (P=.005; mean [SD]=15.91 [7.67] at follow-up vs mean [SD]=17.02 [6.81] at baseline), and rumination (P=.03; mean [SD]=40.42 [12.96] at follow-up vs mean [SD]=41.92 [13.61] at baseline); however, no significant effect of conversation or animation was observed. Findings also indicate a significant increase in user experience in animated conditions. This significant increase in animated conditions is also reflected in the user’s ease of use and satisfaction (F(1, 201)=102.60, P<.001), system information arrangement (F(1, 201)=123.12, P<.001), and usefulness of the application (F(1, 201)=3667.62, P<.001). Conclusions: The current experiment provides support for bCBT-based mental health apps featuring customizable, humanlike therapeutic virtual agents and their ability to significantly reduce negative symptomology over a brief timeframe. The app intervention reduced mental health symptoms, regardless of whether the agent included conversational or animation features, but animation features enhanced the user experience. These effects were observed in both users with and without depressive symptoms. Trial Registration: Open Science Framework B2HX5; https://doi.org/10.17605/OSF.IO/B2HX5 %R 10.2196/67381 %U https://mental.jmir.org/2025/1/e67381 %U https://doi.org/10.2196/67381 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e54753 %T Sociodemographic Differences in Logins and Engagement With the Electronic Health Coach Messaging Feature of a Mobile App to Support Opioid and Stimulant Use Recovery: Results From a 1-Month Observational Study %A Filiatreau,Lindsey M %A Szlyk,Hannah %A Ramsey,Alex T %A Kasson,Erin %A Li,Xiao %A Zhang,Zhuoran %A Cavazos-Rehg,Patricia %+ Division of Infectious Diseases, School of Medicine, Washington University in St Louis, 620 S Taylor Ave, St Louis, MO, 63110, United States, 1 3142737579, flindsey@wustl.edu %K substance misuse %K substance use recovery %K opioid use disorder %K stimulant use disorder %K uptake %K engagement %K mHealth %K digital health intervention %K sociodemographic %K mobile app %K stimulant use %K observational study %K mobile health %K smartphone %K St. Louis %K eCoach messaging %K Wilcoxon rank-sum tests %K Pearson chi-square %K recovery %K app %D 2025 %7 10.4.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health apps can serve as a critical tool in supporting the overall health of uninsured and underinsured individuals and groups who have been historically marginalized by the medical community and may be hesitant to seek health care. However, data on uptake and engagement with specific app features (eg, in-app messaging) are often lacking, limiting our ability to understand nuanced patterns of app use. Objective: This study aims to characterize sociodemographic differences in uptake and engagement with a smartphone app (uMAT-R) to support recovery efforts in a sample of individuals with opioid and stimulant use disorders in the Greater St. Louis area. Methods: We enrolled individuals into the uMAT-R service program from facilities providing recovery support in the Greater St. Louis area between January 2020 and April 2022. Study participants were recruited from service project enrollees. We describe the number of logins and electronic health coach (eCoach) messages participants sent in the first 30 days following enrollment using medians and IQRs and counts and proportions of those who ever (vs never) logged in and sent their eCoach a message. We compare estimates across sociodemographic subgroups, by insurance status, and for those who did and did not participate in the research component of the project using Wilcoxon rank-sum tests and Pearson chi-square tests. Results: Of all 695 participants, 446 (64.2%) logged into uMAT-R at least once during the 30 days following enrollment (median 2, IQR 0-8 logins). Approximately half of those who logged in (227/446) used the eCoach messaging feature (median 1, IQR 0-3 messages). Research participants (n=498), who could receive incentives for app engagement, were more likely to log in and use the eCoach messaging feature compared to others (n=197). Younger individuals, those with higher educational attainment, and White, non-Hispanic individuals were more likely to log in at least once compared to their counterparts. The median number of logins was higher among women, and those who were younger, employed, and not on Medicaid compared to their counterparts. Among those who logged in at least once, younger individuals and those with lower educational attainment were more likely to send at least one eCoach message compared to others. Conclusions: Mobile apps are a viable tool for supporting individuals in recovery from opioid and stimulant use disorders. However, older individuals, racial and ethnic minorities, and those with lower educational attainment may need additional login support, or benefit from alternative mechanisms of recovery support. In addition, apps may need to be tailored to achieve sustained engagement (ie, repeat logins) among men, and individuals who are older, unemployed, or on Medicaid. Older individuals and those with higher educational attainment who may be less likely to use eCoach messaging features could benefit from features tailored to their preferences. %M 40210205 %R 10.2196/54753 %U https://mhealth.jmir.org/2025/1/e54753 %U https://doi.org/10.2196/54753 %U http://www.ncbi.nlm.nih.gov/pubmed/40210205 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e69873 %T A Novel Just-in-Time Intervention for Promoting Safer Drinking Among College Students: App Testing Across 2 Independent Pre-Post Trials %A Chow,Philip I %A Smith,Jessica %A Saini,Ravjot %A Frederick,Christina %A Clark,Connie %A Ritterband,Maxwell %A Halbert,Jennifer P %A Cheney,Kathryn %A Daniel,Katharine E %A Ingersoll,Karen S %K alcohol %K college students %K smartphone intervention %K binge drinking %K safe drinking %D 2025 %7 10.4.2025 %9 %J JMIR Hum Factors %G English %X Background: Binge drinking, which is linked to various immediate and long-term negative outcomes, is highly prevalent among US college students. Behavioral interventions delivered via mobile phones have a strong potential to help decrease the hazardous effects of binge drinking by promoting safer drinking behaviors. Objective: This study aims to evaluate the preliminary efficacy of bhoos, a novel smartphone app designed to promote safer drinking behaviors among US college students. The app offers on-demand educational content about safer alcohol use, provides dynamic feedback as users log their alcohol consumption, and includes an interactive drink tracker that estimates blood alcohol content in real time. Methods: The bhoos app was tested in 2 independent pre-post studies each lasting 4 weeks, among US college students aged 18‐35 years. The primary outcome in both trials was students’ self-reported confidence in using protective behavioral strategies related to drinking, with self-reported frequency of alcohol consumption over the past month examined as a secondary outcome. Results: In study 1, bhoos was associated with increased confidence in using protective behavioral strategies. Students also endorsed the high usability of the app and reported acceptable levels of engagement. Study 2 replicated findings of increased confidence in using protective behavioral strategies, and demonstrated a reduction in the self-reported frequency of alcohol consumption. Conclusions: Bhoos is a personalized, accessible, and highly scalable digital intervention with a strong potential to effectively address alcohol-related behaviors on college campuses. %R 10.2196/69873 %U https://humanfactors.jmir.org/2025/1/e69873 %U https://doi.org/10.2196/69873 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e66439 %T Effects of Using a Smart Bassinet on the Mental Health of Military-Affiliated Pregnant Women: Protocol for a Randomized Controlled Sleep Health and Mood in Newly Expectant Military Mothers (SHINE) Trial %A Okun,Michele L %A Payne,Jennifer L %A Osborne,Lauren M %A Feliciano,Leilani %A Lac,Andrew %+ University of Colorado Colorado Springs, 1420 Austin Bluffs Parkway, Osborne A408, Colorado Springs, CO, 80918, United States, 1 4123028030, mokun@uccs.edu %K maternal health %K postpartum %K pregnancy %K sleep %K infant %K depression %K anxiety %K smart bassinet %K intervention %K prevention %K military %D 2025 %7 10.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Postpartum mood and anxiety disorders (PMADs) are higher among pregnant military service women (26%) and military spouses (12.2%) compared to the civilian population (10%-15%). This is partly due to military-specific factors, including deployment, which are known to increase risk. Important risk factors for PMADs include sleep disturbances, defined as sleep deprivation, insomnia, or poor sleep quality, which are more are common among military-affiliated pregnant women. Objective: This study describes a protocol for a new randomized controlled trial that aims to ameliorate the risk for PMADs through improving infant sleep or maternal sleep during the first 6 postdelivery months in a sample of military-affiliated women. Methods: This study is a 6-month, parallel-arm, randomized controlled trial. Pregnant women (N=342) in the third trimester will be randomized at 1:1 ratio to use a smart bassinet (SB) or a standard commercially available bassinet (HALO BassiNest Swivel Sleeper 3.0; traditional bassinet [TB]) for up to 6 months after delivery. Participants will have their infants sleep in the bassinet, complete monthly web-based questionnaires, and record sleep data with diary and actigraphy for both the participants and their infants for 1 week each postpartum month. Blood samples will also be collected at baseline (late pregnancy) and at 3 months and 6 months post partum to assess immune functioning. The primary outcomes for this study will be postpartum mood (depressive and anxiety symptoms) and infant and maternal sleep. In addition, we are evaluating whether SB has a significant impact on immune functioning—a marker that physiologically connects sleep and mood symptoms. Results: Recruitment for this study began in January 2025. Six separate mixed 2 (treatment vs control) × 6 (assessment period) multivariate analysis of variance and analysis of variance models will be conducted to test the hypotheses that SB will have a greater impact on infant and maternal sleep than TB, SB will be associated with a greater reduction in postpartum mood symptoms than TB, and immune system function will be less dysregulated in birthing individuals using SB compared to those using TB. Lastly, we will evaluate whether the elevated risk demonstrated by previously identified postpartum depression epigenetic biomarkers in the TTC9B and HP1BP3 genes can be modified with an SB. We hypothesize that the elevated risk will be reduced in SB compared to that in TB. Conclusions: At the conclusion of this project, we will have gained a thorough understanding of the capability of SB to positively affect infant and maternal sleep compared to the traditional sleep arrangement and its impact on maternal mood through 6 months post partum in military-affiliated women. The promotion of sleep health in both mothers and infants may be an accessible and amenable method to prevent PMADs. Trial Registration: ClinicalTrials.gov NCT06544941; https://clinicaltrials.gov/study/NCT06544941 International Registered Report Identifier (IRRID): PRR1-10.2196/66439 %M 40209215 %R 10.2196/66439 %U https://www.researchprotocols.org/2025/1/e66439 %U https://doi.org/10.2196/66439 %U http://www.ncbi.nlm.nih.gov/pubmed/40209215 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e68936 %T Digital Health Intervention on Awareness of Vaccination Against Influenza Among Adults With Diabetes: Pragmatic Randomized Follow-Up Study %A Fundoiano-Hershcovitz,Yifat %A Lee,Felix %A Stanger,Catherine %A Breuer Asher,Inbar %A Horwitz,David L %A Manejwala,Omar %A Liska,Jan %A Kerr,David %+ Dario Health, Ofek 8, 5 Tarshish St, Caesarea, 3079821, Israel, 972 0525296979, yifat@dariohealth.com %K digital health %K diabetes management %K influenza vaccination %K flu vaccination awareness %K mobile health %D 2025 %7 10.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Diabetes mellitus significantly increases the risk of severe complications from influenza, necessitating targeted vaccination efforts. Despite vaccination being the most effective preventive measure, coverage remains below the World Health Organization’s targets, partly due to limited awareness among patients. This study evaluated a digital health intervention aimed at improving influenza vaccination rates among adults with diabetes. Objective: This study aimed to demonstrate the effectiveness of digital health platforms in increasing vaccination rates among people with diabetes and to emphasize the impact of tailored messaging frequency on patient engagement and health behavior change. We hypothesized that digital tools providing empirical evidence of increased health risk awareness can effectively drive preventive actions. Methods: The study leveraged the Dario (Dario Health Corp) digital health platform to retrospectively analyze data from 64,904 users with diabetes assigned by the platform into three groups: (1) Group A received previously studied monthly flu nudge messages; (2) Group B received an adapted intervention with 2-3 monthly messages; (3) Group C served as the control with no intervention. Surveys were conducted at baseline, 3 months, and 6 months to assess vaccination status, awareness of influenza risks, and recollection of educational content. Statistical analyses, including logistic regression, chi-square tests, and t tests, were used to evaluate differences between groups. Results: Out of 64,904 users, 8431 completed the surveys. Vaccination rates were 71.0% in group A, 71.9% in group B, and 70.5% in group C. Group B showed significantly higher awareness of influenza risks compared with the control group odds ratio (OR; OR 1.35, 95% CI 1.12-1.63; P=.001), while group A did not (OR 1.10, 95% CI 0.92-1.32; P=.27). Recollection of educational content was also higher in groups A (OR 1.29, 95% CI 1.07-1.56; P=.008) and B (OR 1.92, 95% CI 1.59-2.33; P<.001) compared with the control. In addition, a significant correlation between awareness and vaccination rates was found only in group B (χ2(df=1)=6.12, P=.01). Conclusions: The adapted digital intervention (group B) effectively increased awareness of influenza risks and recollection of educational content, which correlated with the higher trend in vaccination rates. This study demonstrates the potential of digital health tools to enhance influenza vaccination among people with diabetes by improving risk awareness and education. Further research should focus on optimizing these interventions to achieve significant improvements in vaccination uptake and overall public health outcomes. Trial Registration: ClinicalTrials.gov NCT06840236; https://clinicaltrials.gov/study/NCT06840236 %M 40209214 %R 10.2196/68936 %U https://www.jmir.org/2025/1/e68936 %U https://doi.org/10.2196/68936 %U http://www.ncbi.nlm.nih.gov/pubmed/40209214 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e53133 %T Development of a Mobile Intervention for Procrastination Augmented With a Semigenerative Chatbot for University Students: Pilot Randomized Controlled Trial %A Lee,Seonmi %A Jeong,Jaehyun %A Kim,Myungsung %A Lee,Sangil %A Kim,Sung-Phil %A Jung,Dooyoung %+ Graduate School of Health Science and Technology, Ulsan National Institute of Science and Technology, UNIST-gil 50, Ulsan, 44919, Republic of Korea, 82 522174010, dooyoung@unist.ac.kr %K procrastination %K chatbot %K generative model %K semigenerative model %K time management %K cognitive behavioral therapy %K psychological assessment %K intervention engagement %K emotional support %K user experience %K mobile intervention %K artificial intelligence %K AI %D 2025 %7 10.4.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Procrastination negatively affects university students’ academics and mental health. Traditional time management apps lack therapeutic strategies like cognitive behavioral therapy to address procrastination’s psychological aspects. Therefore, we developed and integrated a semigenerative chatbot named Moa into a to-do app. Objective: We intended to determine the benefits of the Moa-integrated to-do app over the app without Moa by verifying behavioral and cognitive changes, analyzing the influence of engagement patterns on the changes, and exploring the user experience. Methods: The developed chatbot Moa guided users over 30 days in terms of self-observation, strategy establishment, and reflection. The architecture comprised response-generating and procrastination factor–detection algorithms. A pilot randomized controlled trial was conducted with 85 participants (n=37, 44% female; n=48, 56% male) from a university in South Korea. The control group used a to-do app without Moa, whereas the treatment group used a fully automated Moa-integrated app. The Irrational Procrastination Scale, Pure Procrastination Scale, Time Management Behavior Scale, and the Perceived Stress Scale were examined using linear mixed models with repeated measurements obtained before (T0) and after (T1) 1-month use and after 2-month use (T2) to assess the changes in irrational procrastination, pure procrastination, time management and behavior, academic self-regulation, and stress. Intervention engagement, divided into “high,” “middle” and “low” clusters, was quantified using app access and use of the to-do list and grouped using k-means clustering. In addition, changes in the psychological scale scores between the control and treatment groups were analyzed within each cluster. User experience was quantified based on the usability, feasibility, and acceptability of and satisfaction with the app, whereas thematic analysis explored the users’ subjective responses to app use. Results: In total, 75 participants completed the study. The interaction of time × procrastination was significant during the required use period (P=.01). The post hoc test indicated a significant improvement from T0 to T1 in the Time Management Behavior Scale and Perceived Stress Scale scores only in the treatment group (P<.001 and P=.009). The changes in Pure Procrastination Scale score after the required use period were significant in all clusters except for the low cluster of the control group. The high cluster in the treatment group exhibited a significant change in the Irrational Procrastination Scale after Bonferroni correction (P=.046). Usability was determined to be good in the treatment group (mean score 72.8, SD 16.0), and acceptability was higher than in the control group (P=.03). Evaluation of user experience indicated that only the participants in the treatment group achieved self-reflection and experienced an alliance with the app. Conclusions: The chatbot-integrated app demonstrated greater efficacy in influencing user behavior providing psychological support. It will serve as a valuable tool for managing procrastination and stress together. Trial Registration: Clinical Research Information Service (CRIS) KCT0009056; https://tinyurl.com/yc84tedk %M 40208664 %R 10.2196/53133 %U https://mhealth.jmir.org/2025/1/e53133 %U https://doi.org/10.2196/53133 %U http://www.ncbi.nlm.nih.gov/pubmed/40208664 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67166 %T Efficacy of a Personalized mHealth App in Improving Micronutrient Supplement Use Among Pregnant Women in Karachi, Pakistan: Parallel-Group Randomized Controlled Trial %A Vadsaria,Khadija %A Nuruddin,Rozina %A Mohammed,Nuruddin %A Azam,Iqbal %A Sayani,Saleem %+ Department of Community Health Sciences, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan, 92 34930051 ext 4833, rozina.nuruddin@aku.edu %K calcium %K folic acid %K iron %K mobile health intervention %K micronutrient deficiencies %K Pakistan %K pregnancy %K supplement use %K vitamin D %K artificial intelligence %D 2025 %7 9.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Micronutrient deficiencies in folate, ferritin, calcium, and vitamin D are common during pregnancy in low- and middle-income countries, often due to inadequate diets. Micronutrient supplementation can address this need, whereas innovative awareness strategies in antenatal practices could enhance supplement use compliance. Objective: We evaluated the efficacy of a personalized mobile health (mHealth) intervention, hypothesizing a 30% improvement in supplement use in the intervention group compared to a conventional face-to-face counseling group. Methods: In an unblinded randomized controlled trial, we enrolled 306 first-trimester pregnant women from Aga Khan University Hospital between January 2020 and September 2021 who owned smartphones with internet connection. Women on regular medications or with dietary restrictions or critical illnesses were excluded. The intervention group received personalized micronutrient supplement use coaching through an mHealth app (PurUmeed Aaghaz) as thrice-a-week push messages and tailored recommendations over a 24-week period. The comparison group received standard face-to-face counseling at 6, 12, 18, and 24 weeks after enrollment. Baseline sociodemographic, obstetrics, anthropometric, dietary, and lifestyle data were collected through face-to-face interviews. At each follow-up, participants reported their weekly use of folic acid, iron, calcium, and vitamin D supplements, scored as 0 (daily), 1.5 (4-6 times weekly), and 3 (≤3 times weekly). Scores were summed to calculate the cumulative supplement use score (CSUS; 0-12), with higher scores indicating greater inadequacy. Every fourth woman was invited for biochemical micronutrient assessment. Data were analyzed using Stata (version 14), with random-effects linear and logistic panel regression to compare CSUS and supplement use between the 2 groups from baseline to endline. Results: Of 153 participants per group, 107 (69.9%) in the intervention and 125 (81.7%) in the nonintervention group completed the study. After 24 weeks, the intervention group showed a greater but insignificant reduction in mean CSUS compared to the nonintervention group (β=–.27, 95% CI −0.65 to 0.12; P=.17). Daily supplement use improved by 20% versus 22.4% for folic acid, 11.2 times versus 2.1 times for iron, 1.2 times versus 14.2 times for calcium, and 3 times versus 1.3 times for vitamin D in the intervention versus nonintervention group, respectively. Multivariable analysis showed higher, though insignificant, odds of sufficient folic acid (adjusted odds ratio [aOR] 1.26, 95% CI 0.68-2.36; P=.46) and iron (aOR 1.31, 95% CI 0.95-1.81; P=.10) use in the intervention group, whereas vitamin D use was significantly higher (aOR 1.88, 95% CI 1.43-2.47; P<.001). Calcium intake improved in the nonintervention group (aOR 0.59, 95% CI 0.44-0.79; P<.001). Anemia decreased in the intervention group, whereas ferritin, calcium, and vitamin D deficiencies persisted or worsened, particularly in the nonintervention group. Conclusions: An appropriately implemented mHealth intervention can improve antenatal vitamin D supplementation. Affordable, accessible, and personalized counseling through mHealth could ameliorate micronutrient status during pregnancy. Trial Registration: ClinicalTrials.gov NCT04216446; https://clinicaltrials.gov/study/NCT04216446 %M 40203301 %R 10.2196/67166 %U https://www.jmir.org/2025/1/e67166 %U https://doi.org/10.2196/67166 %U http://www.ncbi.nlm.nih.gov/pubmed/40203301 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64174 %T A New Mobile App to Train Attention Processes in People With Traumatic Brain Injury: Logical and Ecological Content Validation Study %A Laverdière,Roxanne %A Jackson,Philip L %A Banville,Frédéric %+ , Department of Health Sciences, Université du Québec à Rimouski, 300, allée des Ursulines, Rimouski, QC, G5L 3A1, Canada, 1 418 723 1986 ext 1931, frederic_banville@uqar.ca %K mobile app %K attention training %K cognitive remediation %K mindfulness %K psychometric properties %K content validation %D 2025 %7 9.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Attention is at the base of more complex cognitive processes, and its deficits can significantly impact safety and health. Attention can be impaired by neurodevelopmental and acquired disorders. One validated theoretical model to explain attention processes and their deficits is the hierarchical model of Sohlberg and Mateer. This model guides intervention development to improve attention following an acquired disorder. Another way to stimulate attention functions is to engage in the daily practice of mindfulness, a multicomponent concept that can be explained by the theoretical model of Baer and colleagues. Mobile apps offer great potential for practicing mindfulness daily as they can easily be used during daily routines, thus facilitating transfer. Laverdière and colleagues have developed such a mobile app called Focusing, which is aimed at attention training using mindfulness-inspired attentional exercises. However, this app has not been scientifically validated. Objective: This research aims to analyze the logical content validity and ecological content validity of the Focusing app. Methods: Logical content validation was performed by 7 experts in neuropsychology and mindfulness. Using an online questionnaire, they determined whether the content of the attention training app exercises is representative of selected constructs, namely the theoretical model of attention by Sohlberg and Mateer and the theoretical model of mindfulness by Baer and colleagues. A focus group was subsequently held with the experts to discuss items that did not reach consensus in order to change or remove them. Ecological content validation was performed with 10 healthy adults. Participants had to explore all sections of the app and assess the usability, relevance, satisfaction, quality, attractiveness, and cognitive load associated with each section of the app, using online questionnaires. Results: Logical content validation results demonstrated a high content validity index (CVI) of the attention training app. Excellent scores (CVI ≥0.78) in both the attention and mindfulness models were obtained for all exercises in the app, except 2 exercises. One of these exercises was subsequently modified to include expert feedback, and one was removed. Regarding ecological content validation, the results showed that workload, quality, user experience, satisfaction, and relevance of the app were adequate. The Mobile Application Rating Scale questionnaire showed an average quality rating between 3.75/5 (SD 0.41) (objective quality) and 3.65/5 (SD 0.36) (subjective quality), indicating acceptable quality. The mean global attractiveness rating from the AttrakDiff questionnaire was 2.36/3 (SD 0.57), which represents one of the strengths of the app.  Conclusions: Logical and ecological content validation showed that Focusing is theoretically valid, with a high level of agreement among experts and healthy participants. This tool can be tested to train attention processes after a neurological insult such as traumatic brain injury. %M 40202789 %R 10.2196/64174 %U https://formative.jmir.org/2025/1/e64174 %U https://doi.org/10.2196/64174 %U http://www.ncbi.nlm.nih.gov/pubmed/40202789 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65268 %T Effect of a WeChat-Based Hybrid Intervention on the Adaptation Outcomes of People Living With HIV/AIDS: Pilot Randomized Controlled Trial %A Wang,Honghong %A Qin,Ziqi %A Li,Yixuan %A Duan,Yuqiong %A Lu,Qiaoyue %A Xiao,Xueling %+ Xiangya School of Nursing, Central South University, No. 172 Tongzipo Road, Changsha, 410083, China, 86 15286826132, xuelingxiao93@hotmail.com %K HIV/AIDS %K quality of life %K acceptance of illness %K mental health %K randomized controlled trial %K mobile phone %D 2025 %7 3.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: People living with HIV/AIDS face multiple challenges that collectively impede their adaptation outcomes. These outcomes include quality of life (QoL), acceptance of illness, mental health (including symptoms of anxiety and depression), and antiretroviral therapy (ART) adherence. While existing evidence addresses specific challenges, it often overlooks the interactions among the various problems people living with HIV/AIDS encounter. The comprehensive-task disease management framework and positive self-management framework provide a theoretical basis for understanding the adaptation process. A culturally tailored, theory-based intervention may be necessary and effective in facilitating better adaptation outcomes for people living with HIV/AIDS. Objective: This study aimed to evaluate the effect of a hybrid intervention called AiCare (Adaptation intervention with Comprehensive-task disease management framework to achieve renormal life) on improving QoL, acceptance of illness, mental health (anxiety and depression), and ART adherence among people living with HIV/AIDS in China. Methods: We conducted a 2-arm randomized controlled trial, recruiting 92 people living with HIV/AIDS from an HIV clinic in Hunan, China. Participants were randomly assigned in a 1:1 ratio to either the control group (receiving standard care) or the intervention group (receiving AiCare in addition to standard care). All analyses were performed from an intention-to-treat perspective. Sociodemographic and HIV-specific clinical characteristics, along with key adaptation outcomes—including QoL, acceptance of illness, mental health (anxiety and depression), and ART adherence—were assessed at baseline (T0), post intervention (T1), and 3 months post intervention (T2). We used generalized estimating equation models and difference-in-difference analysis to evaluate the interventions’ effects. Results: The difference-in-difference model showed that at T1, the intervention group experienced significant improvements compared to the control group. QoL increased by 6.35 (95% CI 2.62-10.93, P=.001), acceptance of illness improved by 4.49 (95% CI 2.29-6.68, P<.001), and anxiety decreased by 2.15 (95% CI 1.19-3.11; P=.01). At T2, the intervention group’s improvement in QoL was not statistically significant (β 3.62, 95% CI –1.53 to 8.77; P=.17). However, acceptance of illness remained significantly improved by 3.65 (95% CI 1.22-6.08; P=.003), and anxiety decreased by 1.58 (95% CI 0.42-2.74; P=.007). No significant changes were observed in depression or ART adherence between the intervention and control groups. Feedback regarding the AiCare program indicated its acceptability and feasibility. Conclusions: The AiCare program demonstrated promising effects in improving disease adaptation outcomes among people living with HIV/AIDS, notably in enhancing QoL, fostering acceptance of illness, and mitigating anxiety symptoms. These findings underscore the hybrid program’s potential clinical utility to facilitate the adaptation of people living with HIV/AIDS. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400087255; https://www.chictr.org.cn/showproj.html?proj=220729 %M 39988931 %R 10.2196/65268 %U https://www.jmir.org/2025/1/e65268 %U https://doi.org/10.2196/65268 %U http://www.ncbi.nlm.nih.gov/pubmed/39988931 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e68242 %T Innovating Care for Postmenopausal Women Using a Digital Approach for Pelvic Floor Dysfunctions: Prospective Longitudinal Cohort Study %A Pereira,Ana P %A Janela,Dora %A Areias,Anabela C %A Molinos,Maria %A Tong,Xin %A Bento,Virgílio %A Yanamadala,Vijay %A Atherton,Jennesa %A Dias Correia,Fernando %A Costa,Fabíola %K women's health %K pelvic floor muscle training %K physical therapy %K menopause %K digital therapeutics %K biofeedback %K mobile phone %D 2025 %7 2.4.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: The menopause transition is a significant life milestone that impacts quality of life and work performance. Among menopause-related conditions, pelvic floor dysfunctions (PFDs) affect ∼40%‐50% of postmenopausal women, including urinary or fecal incontinence, genito-pelvic pain, and pelvic organ prolapse. While pelvic floor muscle training (PFMT) is the primary treatment, access barriers leave many untreated, advocating for new care delivery models. Objective: This study aims to assess the outcomes of a digital pelvic program, combining PFMT and education, in postmenopausal women with PFDs. Methods: This prospective, longitudinal study evaluated engagement, safety, and clinical outcomes of a remote digital pelvic program among postmenopausal women (n=3051) with PFDs. Education and real-time biofeedback PFMT sessions were delivered through a mobile app. The intervention was asynchronously monitored and tailored by a physical therapist specializing in pelvic health. Clinical measures assessed pelvic floor symptoms and their impact on daily life (Pelvic Floor Impact Questionnaire–short form 7, Urinary Impact Questionnaire–short form 7, Colorectal-Anal Impact Questionnaire–short form 7, and Pelvic Organ Prolapse Impact Questionnaire–short form 7), mental health, and work productivity and activity impairment. Structural equation modeling and minimal clinically important change response rates were used for analysis. Results: The digital pelvic program had a high completion rate of 77.6% (2367/3051), as well as a high engagement and satisfaction level (8.6 out of 10). The safety of the intervention was supported by the low number of adverse events reported (21/3051, 0.69%). The overall impact of pelvic floor symptoms in participants’ daily lives decreased significantly (−19.55 points, 95% CI −22.22 to −16.88; P<.001; response rate of 59.5%, 95% CI 54.9%-63.9%), regardless of condition. Notably, nonwork-related activities and productivity impairment were reduced by around half at the intervention-end (−18.09, 95% CI −19.99 to −16.20 and −15.08, 95% CI −17.52 to −12.64, respectively; P<.001). Mental health also improved, with 76.1% (95% CI 60.7%-84.9%; unadjusted: 97/149, 65.1%) and 54.1% (95% CI 39%-68.5%; unadjusted: 70/155, 45.2%) of participants with moderate to severe symptomatology achieving the minimal clinically important change for anxiety and depression, respectively. Recovery was generally not influenced by the higher baseline symptoms’ burden in individuals with younger age, high BMI, social deprivation, and residence in urban areas, except for pelvic health symptoms where lower BMI levels (P=.02) and higher social deprivation (P=.04) were associated with a steeper recovery. Conclusions: This study demonstrates the feasibility, safety, and positive clinical outcomes of a fully remote digital pelvic program to significantly improve PFD symptoms, mental health, and work productivity in postmenopausal women while enhancing equitable access to personalized interventions that empower women to manage their condition and improve their quality of life. Trial Registration: ClinicalTrials.gov NCT05513417; https://clinicaltrials.gov/study/NCT05513417 %R 10.2196/68242 %U https://mhealth.jmir.org/2025/1/e68242 %U https://doi.org/10.2196/68242 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e64098 %T Digital Health Resilience and Well-Being Interventions for Military Members, Veterans, and Public Safety Personnel: Environmental Scan and Quality Review %A Allen,Rashell R %A Malik,Myrah A %A Aquin,Carley %A Herceg,Lucijana %A Brémault-Phillips,Suzette %A Sevigny,Phillip R %+ School and Clinical Child Psychology, Faculty of Education, University of Alberta, 1121-87 Avenue, Edmonton, AB, T6G2G5, Canada, 1 7804920415, wozniak@ualberta.ca %K public safety personnel %K veteran %K military member %K web-based program %K resources %K resilience %K mobile app %K quality review %K well-being %K military %K environmental %K review %D 2025 %7 1.4.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Accessible mental health care, delivered via mobile apps or web-based services, may be essential for military members, public safety personnel (PSP), and veterans, as they report numerous barriers to seeking in-person care and are at an increased risk for a number of psychological disorders. Objective: We aimed to identify, describe, and evaluate apps, resource banks (RBs), and web-based programs (WBPs), referred to as digital mental health interventions (DMHIs), recommended for military members, PSP, and veterans. A multidimensional and multisystemic view of resilience and well-being were maintained throughout this environmental scan. Methods: Information was gathered from a comprehensive review of peer-reviewed literature, a Google search, and a targeted search of websites relevant to the study populations. DMHIs aimed at supporting resilience or well-being were included in the review, including those published in peer-reviewed articles, and those offered to these populations without research or literature backing their use. Results: In total, 69 DMHIs were identified in this study, including 42 apps, 19 RBs, and 8 WBPs, and were described based on 3 questions related to purpose, strategies, and evidence from the adapted Mobile App Rating Scale and the Mobile App Rating Scale. Each WBP and RB was then reviewed via the adapted Mobile App Rating Scale and each app via the Alberta Rating Index for Apps (ARIA). Overall, 24 (35%) of the DMHIs were recommended for military members, 20 (29%) for PSP, and 41 (59%) for veterans. The most common aim across apps, RBs, and WBPs was to increase happiness and well-being, and the most common strategies were advice, tips, and skills training. In total, 2 apps recommended for military members—PTSD Coach and Virtual Hope Box—received a high rating on the ARIA subscales and have also been trialed in pilot randomized control trial (RCT) and RCT evaluations, respectively, with positive initial results. Similarly, 2 apps recommended for PSP—PeerConnect and R2MR—have been trialed in non-RCT studies, with partially positive outcomes or little to no contradictory evidence and received a high rating on the ARIA. Finally, 2 apps recommended for veteran populations—PTSD Coach and VetChange—received high ratings on the ARIA and have been trialed via pilot-RCT and RCT studies, respectively, with positive outcomes. Conclusions: In conclusion, there is a need for efficacy and effectiveness trials for DMHIs for military members, PSP, and veterans to ensure that they are effectively meeting the population’s needs. While there appears to be many promising DMHIs, further research is needed before these interventions continue to be promoted as effective and widely distributed. %M 40168068 %R 10.2196/64098 %U https://mhealth.jmir.org/2025/1/e64098 %U https://doi.org/10.2196/64098 %U http://www.ncbi.nlm.nih.gov/pubmed/40168068 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67539 %T Effectiveness of the Safe Step Digital Exercise Program to Prevent Falls in Older Community-Dwelling Adults: Randomized Controlled Trial %A Pettersson,Beatrice %A Lundin-Olsson,Lillemor %A Skelton,Dawn A %A Liv,Per %A Zingmark,Magnus %A Rosendahl,Erik %A Sandlund,Marlene %+ , Department of Community Medicine and Rehabilitation, Umeå University, Universitetstorget 4, Umeå, 90187, Sweden, 46 907865224, beatrice.pettersson@umu.se %K geriatric medicine %K aging %K accidental falls %K independent living %K exercise therapy %K fall prevention %K electronic health %K mobile health %K preventive medicine %K self-management %K effectiveness %K randomized controlled trial %K older adults %K digital technology %D 2025 %7 31.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Falls among older adults are a significant public health issue due to their high incidence, severe consequences, and substantial economic impact. Exercise programs incorporating balance and functional exercises have been shown to reduce fall rates, but adherence and scaling up the interventions remain challenges. Digital technology offers a promising avenue to deliver this type of exercise, potentially improving exercise adherence and enabling self-management of exercise in the aging population. Objective: This study aims to assess the effectiveness of the Safe Step app, a self-managed, unsupervised, home-based digital exercise program, in reducing fall rates or fall risk in community-dwelling older adults. Additional aims were to describe fall-related injuries in both the exercise and control groups, study attrition, and adherence to the Safe Step exercise program. Methods: Community-dwelling individuals, aged 70 years or older, who had experienced falls or a decline in balance in the past year were randomized to either an exercise group using the Safe Step app combined with educational videos, or a control group receiving educational videos alone. Both interventions lasted for 1 year. Information regarding fall events was self-reported monthly through questionnaires. Exercise adherence was monitored through questionnaires every third month. Negative binomial and logistic regression estimated the incidence rate ratio of fall rate and the risk ratio (RR) of experiencing falls, respectively. Fall-related injuries, study attrition, and exercise adherence were reported descriptively. Results: In total, 1628 people were enrolled in the study, 79% were women, and the mean age was 75.8 (SD 4.4) years (range 70-94 years). The intention-to-treat analysis showed no significant difference in fall rates between the exercise and control groups after 12 months (2.21 falls per person-year in the exercise group and 2.41 in the control group; incidence rate ratio 0.92, 95% CI 0.76-1.11; P=.37). The risk of experiencing at least 1 fall was significantly lower (11%) in the exercise group compared to the control group (53% vs 59.6%; RR 0.89, 95% CI 0.80-0.99; P=.03). No differences were observed regarding the risk of 2 or more falls (34.1% in the exercise group, 37.1% in the control group; RR 0.92, 95% CI 0.79-1.06; P=.23). Injurious fall rates were similar between the exercise and control group. During the trial, 161 (20%) participants from the exercise group and 63 (8%) from the control group formally withdrew. The proportion of exercise group participants meeting the 90-minute weekly exercise goal was 12.7%, 13.4%, 8.6%, and 9.1% at 3, 6, 9, and 12 months, respectively. Conclusions: Access to a self-managed unsupervised digital exercise program can be an effective component of a primary fall prevention strategy for community-dwelling older adults. Further research is needed to explore the mediating factors that influence the outcomes and develop strategies that enhance adherence for optimal impact in this population. Trial Registration: ClinicalTrials.gov NCT03963570; https://clinicaltrials.gov/study/NCT03963570 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-036194 %M 40163860 %R 10.2196/67539 %U https://www.jmir.org/2025/1/e67539 %U https://doi.org/10.2196/67539 %U http://www.ncbi.nlm.nih.gov/pubmed/40163860 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64384 %T User Experience With a Personalized mHealth Service for Physical Activity Promotion in University Students: Mixed Methods Study %A Wittmar,Silke %A Frankenstein,Tom %A Timm,Vincent %A Frei,Peter %A Kurpiers,Nicolas %A Wölwer,Stefan %A Schäfer,Axel Georg Meender %+ Faculty of Social Work and Health, HAWK University of Applied Sciences and Arts Hildesheim/Holzminden/Göttingen, Goschentor 1, Hildesheim, 31134, Germany, 49 5121881369, silke.wittmar@hawk.de %K usability testing %K health promotion %K exercise %K smartphone app %K mHealth %K physical activity %K user experience %K user %K university student %K undergraduate %K college %K student %K mixed methods %K physical fitness %K digital intervention %K mobile health %K promote %K engagement %K mobile phone %D 2025 %7 28.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Regular physical activity (PA) is known to offer substantial health benefits, including improved physical fitness, reduced risk of disease, enhanced psychological well-being, and better cognitive performance. Despite these benefits, many university students fail to meet recommended PA levels, risking long-term health consequences. Objective: This study evaluated the user experience (UX) of futur.move, a digital intervention aimed at promoting PA among university students. The service delivers personalized, evidence-based content to foster sustained engagement in PA. Methods: A mixed methods approach was used to evaluate the prototype of futur.move. UX assessments included on-site and online user tests, standardized questionnaires, and online focus groups. A total of 142 university students participated, with 23 joining additional focus groups. Each participant tested the service for 30 minutes. Quantitative data were collected using the User Experience Questionnaire and analyzed descriptively, followed by correlation analysis with variables such as PA level, age, gender, and experience with PA apps. Qualitative insights were gathered from transcribed focus group discussions and analyzed using content-structuring, qualitative content analysis. Quantitative findings were cross-validated with qualitative data. Results: The UX received positive ratings across 4 User Experience Questionnaire scales (range –3 to +3; higher numbers indicate positive UX): attractiveness (median 1.67, IQR 1.04-2.17), perspicuity (median 1.5, IQR 0.5-2), stimulation (median 1.5, IQR 1-2), and novelty (median 1.25, IQR 0.5-2). Weak correlations were found between adherence to World Health Organization guidelines for PA and the perspicuity subscale (η=0.232, P=.04), and between age and the perspicuity (Kendall τb=0.132, P=.03) and stimulation subscales (Kendall τb=0.144, P=.02), and a moderate correlation was found between gender and the novelty subscale (η=0.363, P=.004). Critical feedback from focus group discussions highlighted issues with manual data entry. Qualitative findings aligned with the quantitative results, emphasizing students’ appreciation for the personalized, diverse content and social networking features of futur.move. Conclusions: futur.move demonstrates favorable UX and aligns with student needs, particularly through its personalized content and social features. Improvements should focus on reducing manual data entry and enhancing feature clarity, particularly for the features “your condition” and “goal setting.” While correlations between UX ratings and demographic variables were weak to moderate, they warrant further investigation to better address the diverse target audience. The feedback from the students serves as a basis for further adapting the service to their needs and expectations. Future work will involve coding an advanced prototype and conducting a longitudinal study to assess its impact on PA behavior and sustained engagement. %M 40153787 %R 10.2196/64384 %U https://formative.jmir.org/2025/1/e64384 %U https://doi.org/10.2196/64384 %U http://www.ncbi.nlm.nih.gov/pubmed/40153787 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 9 %N %P e58124 %T Acceptability of a Web-Based Health App (PortfolioDiet.app) to Translate a Nutrition Therapy for Cardiovascular Disease in High-Risk Adults: Mixed Methods Randomized Ancillary Pilot Study %A Kavanagh,Meaghan E %A Chiavaroli,Laura %A Quibrantar,Selina M %A Viscardi,Gabrielle %A Ramboanga,Kimberly %A Amlin,Natalie %A Paquette,Melanie %A Sahye-Pudaruth,Sandhya %A Patel,Darshna %A Grant,Shannan M %A Glenn,Andrea J %A Ayoub-Charette,Sabrina %A Zurbau,Andreea %A Josse,Robert G %A Malik,Vasanti S %A Kendall,Cyril W C %A Jenkins,David J A %A Sievenpiper,John L %+ Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, C. David Naylor Building, Room 201, 6 Queen’s Park Crescent, Toronto, ON, M5S 3H2, Canada, 1 416 867 3732, john.sievenpiper@utoronto.ca %K diet %K apps %K dietary app %K Portfolio Diet %K dietary portfolio %K cholesterol reduction %K cardiovascular disease %K eHealth %K usability %K acceptability %D 2025 %7 28.3.2025 %9 Original Paper %J JMIR Cardio %G English %X Background: The Portfolio Diet is a dietary pattern for cardiovascular disease (CVD) risk reduction with 5 key categories including nuts and seeds; plant protein from specific food sources; viscous fiber sources; plant sterols; and plant-derived monounsaturated fatty acid sources. To enhance implementation of the Portfolio Diet, we developed the PortfolioDiet.app, an automated, web-based, multicomponent, patient-facing health app that was developed with psychological theory. Objective: We aimed to evaluate the effect of the PortfolioDiet.app on dietary adherence and its acceptability among adults with a high risk of CVD over 12 weeks. Methods: Potential participants with evidence of atherosclerosis and a minimum of one additional CVD risk factor in an ongoing trial were invited to participate in a remote web-based ancillary study by email. Eligible participants were randomized in a 1:1 ratio using a concealed computer-generated allocation sequence to the PortfolioDiet.app group or a control group for 12 weeks. Adherence to the Portfolio Diet was assessed by weighed 7-day diet records at baseline and 12 weeks using the clinical Portfolio Diet Score, ranging from 0 to 25. Acceptability of the app was evaluated using a multifaceted approach, including usability through the System Usability Scale ranging from 0 to 100, with a score >70 being considered acceptable, and a qualitative analysis of open-ended questions using NVivo 12. Results: In total, 41 participants were invited from the main trial to join the ancillary study by email, of which 15 agreed, and 14 were randomized (8 in the intervention group and 6 in the control group) and completed the ancillary study. At baseline, adherence to the Portfolio Diet was high in both groups with a mean clinical Portfolio Diet Score of 13.2 (SD 3.7; 13.2/25, 53%) and 13.7 (SD 5.8; 13.7/25, 55%) in the app and control groups, respectively. After the 12 weeks, there was a tendency for a mean increase in adherence to the Portfolio Diet by 1.25 (SD 2.8; 1.25/25, 5%) and 0.19 (SD 4.4; 0.19/25, 0.8%) points in the app and control group, respectively, with no difference between groups (P=.62). Participants used the app on average for 18 (SD 14) days per month and rated the app as usable (System Usability Scale of mean 80.9, SD 17.3). Qualitative analyses identified 4 main themes (user engagement, usability, external factors, and added components), which complemented the quantitative data obtained. Conclusions: Although adherence was higher for the PortfolioDiet.app group, no difference in adherence was found between the groups in this small ancillary study. However, this study demonstrates that the PortfolioDiet.app is considered usable by high-risk adults and may reinforce dietitian advice to follow the Portfolio Diet when it is a part of a trial for CVD management. Trial Registration: ClinicalTrials.gov NCT02481466; https://clinicaltrials.gov/study/NCT02481466 %M 40152922 %R 10.2196/58124 %U https://cardio.jmir.org/2025/1/e58124 %U https://doi.org/10.2196/58124 %U http://www.ncbi.nlm.nih.gov/pubmed/40152922 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e65863 %T Interactive Effects of Weight Recording Frequency and the Volume of Chat Communication With Health Care Professionals on Weight Loss in mHealth Interventions for Noncommunicable Diseases: Retrospective Observational Study %A Hagiwara,Yuta %A Adachi,Takuji %A Kanai,Masashi %A Shimizu,Kotoe %A Ishida,Shinpei %A Miki,Takahiro %K weight change %K behavior modification %K health care communication %K weight recording %K chat communication %K text communication %K health care professionals %K weight loss %K mHealth %K mobile health %K app %K digital health %K smartphone %K mobile health intervention %K noncommunicable disease %K NCD %K weight loss outcome %K obesity %K overweight %K retrospective study %K observational study %K cerebrovascular disease %K cardiovascular disease %K lifestyle modification %K mobile phone %D 2025 %7 27.3.2025 %9 %J Interact J Med Res %G English %X Background: Mobile health (mHealth) apps are increasingly used for health promotion, particularly for managing noncommunicable diseases (NCDs) through behavior modification. Understanding the factors associated with successful weight loss in such interventions can improve program effectiveness. Objective: This study examined factors influencing weight change and the relationship between weight recording frequency and chat volume with health care professionals on weight loss in individuals with obesity and NCDs. Methods: The participants had obesity (BMI ≥25 kg/m²) and were diagnosed with NCDs (eg, hypertension, diabetes, dyslipidemia). The program included 12 telephone consultations with health care professionals. Only participants who completed the full 6-month program, including all 12 telephone consultations, and provided an end-of-study weight were included in the analysis. The primary outcome was the rate of weight change, defined as the percentage change in weight from the initial period (first 14 days) to the final period (2 weeks before the last consultation), relative to the initial weight. The key independent variables were proportion of days with weight recording and chat communication volume (total messages exchanged). An interaction term between these variables was included to assess moderation effects in the regression analysis. The volume of communication was measured as the total number of messages exchanged, with each message, regardless of who sent it, being counted as 1 interaction. Health care staffs were instructed to send a single scheduled chat message per week following each biweekly phone consultation. These scheduled messages primarily included personalized feedback, reminders, and motivational support. In addition, providers responded to participant-initiated messages at any time during the program. Furthermore, 1 professional responded to each participant. Hierarchical multiple regression and simple slope analyses were conducted to identify relationships and interactions among these variables. Results: The final analysis of this study included 2423 participants. Significant negative associations were found between the rate of weight change and baseline BMI (β=−.10; P<.001), proportion of days with weight recording (β=−.017; P<.001), and communication volume (β=−.193; P<.001). The interaction between proportion of days with weight recording and chat frequency also showed a significantly negative effect on weight change (β=−.01; P<.001). Simple slope analysis showed that when the proportion of days with weight recording was +1 SD above the mean, frequent chats were associated with greater weight reduction (slope=−0.60; P<.001), whereas no significant effect was observed at −1 SD (slope=−0.01; P=.94) Conclusions: The findings suggest that both the proportion of days with weight recording and communication volume independently and interactively influence weight change in individuals with obesity and NCDs. %R 10.2196/65863 %U https://www.i-jmr.org/2025/1/e65863 %U https://doi.org/10.2196/65863 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60092 %T Effectiveness of an mHealth- and School-Based Health Education Program for Salt Reduction (EduSaltS) in China: Cluster Randomized Controlled Trial Within Scale-Up %A Wang,Naibo %A Wang,Chen %A Zhang,Puhong %A Li,Yinghua %A He,Feng J %A Li,Li %A Li,Yuan %A Luo,Rong %A Wan,Dezhi %A Xu,Lewei %A Deng,Lifang %A Wu,Lei %+ School of Public Health, Jiangxi Provincial Key Laboratory of Disease Prevention and Public Health, Jiangxi Medical College, Nanchang University, No. 461 Ba Yi Avenue, Donghu District, Jiangxi Province, Nanchang, 330006, China, 86 18970813850, leiwu@ncu.edu.cn %K school-based health education %K EduSaltS %K mobile health %K salt reduction %K cluster randomized trial %D 2025 %7 27.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Globally, cardiovascular diseases are leading causes of mortality and disability, with hypertension being a major risk factor. Reducing salt intake and blood pressure are among the most cost-effective health promotion strategies. While mobile health (mHealth)– and school-based salt reduction interventions have proven effective in trials, their impact when scaled up in real-world contexts remains uncertain. Objective: We evaluated the effectiveness of the real-world implementation of an mHealth- and school-based health education scale-up program to reduce salt intake (EduSaltS [mHealth and school-based education program to reduce salt intake scaling up in China]). Methods: A parallel cluster randomized controlled trial was conducted from April 2022 to July 2023 across 20 schools in 2 districts and 2 counties within Ganzhou City, Jiangxi Province, China. Schools were randomized 1:1 to intervention or control groups within each district or county. One third-grade class per school and 26 students per class were randomly sampled. One parent, or alternative family member (aged 18-75 years, residing with the student), of each student was invited to join. The EduSaltS intervention, spanning over 1 academic year, incorporated both app-based health education courses and offline salt reduction activities, with participation monitored through the backend management system. The intervention’s effectiveness was assessed by comparing changes in salt intake and blood pressure between groups from baseline to 1-year follow-up using surveys, physical examination, and 24-hour urine tests. Results: Of 524 children (boys: n=288, 54.96%; age: mean 9.16, SD 0.35 years) and 524 adults (men: n=194, 37.02%; age: mean 40.99, SD 11.04 years) who completed the baseline assessments in 10 intervention and 10 control schools, 13 (2.48%) children and 47 (8.97%) adults were lost to follow-up. All schools and participants showed satisfactory intervention adherence. Measured differences in schoolchildren’s salt intake, systolic blood pressure, and diastolic blood pressure, between the intervention and control schools, were –0.24 g/day (95% CI –0.82 to 0.33), –0.68 mm Hg (95% CI –2.32 to 0.95), and –1.37 mm Hg (95% CI –2.79 to 0.06), respectively. For adults, the intervention group’s salt intake decreased from 9.0 (SE 0.2) g/day to 8.3 (SE 0.2) g/day post intervention. Adjusted changes in the intervention (vs control) group in salt intake, systolic blood pressure, and diastolic blood pressure were –1.06 g/day (95% CI –1.81 to –0.30), –2.26 mm Hg (95% CI –4.26 to –0.26), and –2.33 mm Hg (95% CI –3.84 to –0.82), respectively. Conclusions: The EduSaltS program, delivered through primary schools with a child-to-parent approach, was effective in reducing salt intake and controlling blood pressure in adults, but its effects on children were not significant. While promising for nationwide scaling, further improvements are needed to ensure its effectiveness in reducing salt intake among schoolchildren. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400079893; https://tinyurl.com/4maz7dyv (retrospectively registered); Chinese Clinical Trial Registry ChiCTR2000039767; https://tinyurl.com/5n6hc4s2 %M 40017342 %R 10.2196/60092 %U https://www.jmir.org/2025/1/e60092 %U https://doi.org/10.2196/60092 %U http://www.ncbi.nlm.nih.gov/pubmed/40017342 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59953 %T Mobile Health Tool to Capture Social Determinants of Health and Their Impact on HIV Treatment Outcomes Among People Who Use Drugs: Pilot Feasibility Study %A Gicquelais,Rachel E %A Conway,Caitlin %A Vjorn,Olivia %A Genz,Andrew %A Kirk,Gregory %A Westergaard,Ryan %K HIV %K drug use %K social determinants of health %K mobile health %K mHealth %K smartphone %D 2025 %7 26.3.2025 %9 %J JMIR Form Res %G English %X Background: Active substance use, food or housing insecurity, and criminal legal system involvement can disrupt HIV care for people living with HIV and opioid use disorder (OUD). These social determinants of health are not routinely captured in clinical settings. Objective: We evaluated whether real-time reports of social and behavioral factors using a smartphone app could predict viral nonsuppression and missed care visits to inform future mobile health interventions. Methods: We enrolled 59 participants from the AIDS Linked to the Intravenous Experience (ALIVE) Study in Baltimore, Maryland, into a 12-month substudy between February 2017 and October 2018. Participants were eligible if they had OUD and had either a measured HIV RNA ≥1000 copies/mL or a ≥1-month lapse in antiretroviral therapy in the preceding 2 years. Participants received a smartphone and reported HIV medication adherence, drug use or injection, and several disruptive life events, including not having a place to sleep at night, skipping a meal due to lack of income, being stopped by police, being arrested, or experiencing violence on a weekly basis, through a survey on a mobile health app. We described weekly survey completion and investigated which factors were associated with viral nonsuppression (HIV RNA ≥200 copies/mL) or a missed care visit using logistic regression with generalized estimating equations adjusted for age, gender, smartphone comfort, and drug use. Results: Participants were predominantly male (36/59, 61%), Black (53/59, 90%), and had a median of 53 years old. At baseline, 16% (6/38) were virally unsuppressed. Participants completed an average of 23.3 (SD 16.3) total surveys and reported missing a dose of antiretroviral therapy, using or injecting drugs, or experiencing any disruptive life events on an average of 13.1 (SD 9.8) weekly surveys over 1 year. Reporting use of any drugs (adjusted odds ratio [aOR] 2.3, 95% CI 1.4‐3.7), injecting drugs (aOR 2.3, 95% CI 1.3‐3.9), and noncompletion of all surveys (aOR 1.6, 95% CI 1.1‐2.2) were associated with missing a scheduled care visit over the subsequent 30 days. Missing ≥2 antiretroviral medication doses within 1 week was associated with HIV viral nonsuppression (aOR 3.7, 95% CI: 1.2‐11.1) in the subsequent 30 days. Conclusions: Mobile health apps can capture risk factors that predict viral nonsuppression and missed care visits among people living with HIV who have OUD. Using mobile health tools to detect sociobehavioral factors that occur prior to treatment disengagement may facilitate early intervention by health care teams. %R 10.2196/59953 %U https://formative.jmir.org/2025/1/e59953 %U https://doi.org/10.2196/59953 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69828 %T Evaluating a Digital Health Tool Designed to Improve Low Sexual Desire in Women: Mixed-Methods Implementation Science Study %A Brotto,Lori A %A Stephenson,Kyle R %A Marshall,Nisha %A Balvan,Mariia %A Okara,Yaroslava %A Mahar,Elizabeth A %+ Department of Obstetrics and Gynaecology, University of British Columbia, 2775 Laurel Street, Department of Gynaecology, Vancouver, BC, V5Z1M9, Canada, 1 6048754111 ext 68898, lori.brotto@ubc.ca %K implementation science %K sexual interest/arousal disorder (SIAD) %K sexuality %K internet interventions %K online therapy %K telehealth %K online interventions %K web-based therapeutic programs/interventions %K online CBT/MBT treatment %K female sexual dysfunction %K eHealth %D 2025 %7 25.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexual health difficulties affect up to 30% of women, with desire and arousal problems being the most prevalent. While cognitive behavioral therapy and mindfulness-based therapy are effective treatments, access is limited by barriers such as specialist shortages, cost, and embarrassment. Web-based interventions offer a potential solution by providing self-paced, cost-effective treatments. eSense, a digital health program, offers cognitive behavioral therapy and mindfulness-based therapy skills targeted to women with low sexual desire, and previous trials find eSense to be highly feasible and efficacious. Objective: The goal of the present implementation science study was to use the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance of Implementation) framework to assess the integration of eSense into several sexual health clinics. We chose the RE-AIM framework because it addresses both dissemination (eg, reach) and implementation of an intervention. Methods: A total of 14 specialty clinics participated, and we report on the reported experiences of those clinics in implementing eSense. We also examined responses from 12 women on waitlists to receive sex therapy or sexual medicine care. Results: Per clinic outcomes, all aspects of implementation (reach, effectiveness, adoption, implementation, and maintenance) were in the moderate to high range for clinics, reporting that offering eSense helped them overcome negative feelings associated with their long clinic waitlists. The majority expressed a need for eSense and could see how it overcame the limitations of traditional therapy. Nearly all expressed a wish to continue offering eSense to patients after the implementation study was complete. One caveat was that half of the clinics noted cost as a key issue for future implementation, and one-third noted that the administrative burden of implementing eSense as a standard of care may be challenging. For individual users, the majority expressed an interest in knowing more about eSense and a desire to use eSense, though most of these did not complete the program in its entirety. Users experienced a significant improvement in sex-related distress with no clinically meaningful change in other outcomes and a high level of satisfaction with eSense. Most also reported doing things differently in their sexual lives after participating in eSense. Conclusions: We found that eSense demonstrates potential as a digital intervention for sexual difficulties for women, particularly concerning its moderate implementation outcomes and also because of its ability to reduce sexual distress. Future studies should address the barriers identified for broader adoption of eSense in clinical settings. Trial Registration: ClinicalTrials.gov NCT05168371; https://clinicaltrials.gov/study/NCT05168371 %M 40132194 %R 10.2196/69828 %U https://www.jmir.org/2025/1/e69828 %U https://doi.org/10.2196/69828 %U http://www.ncbi.nlm.nih.gov/pubmed/40132194 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e64826 %T Informatics Interventions for Maternal Morbidity: Scoping Review %A Inderstrodt,Jill %A Stumpff,Julia C %A Smollen,Rebecca C %A Sridhar,Shreya %A El-Azab,Sarah A %A Ojo,Opeyemi %A Bowns,Brendan %A Haggstrom,David A %+ Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd., Indianapolis, IN, 46202, United States, 1 3176903316, ji3@iu.edu %K scoping review %K maternal morbidity %K medical informatics %K clinical informatics %K mother %K pregnant %K perinatal %K GDM %K preeclampsia %K maternity %K gestational diabetes mellitus %D 2025 %7 25.3.2025 %9 Review %J Interact J Med Res %G English %X Background: Women have been entering pregnancy less healthy than previous generations, placing them at increased risk for pregnancy complications. One approach to ensuring effective monitoring and treatment of at-risk women is designing technology-based interventions that prevent maternal morbidities and treat perinatal conditions. Objective: This scoping review evaluates what informatics interventions have been designed and tested to prevent and treat maternal morbidity. Methods: MEDLINE, Embase, and Cochrane Library were searched to identify relevant studies. The inclusion criteria were studies that tested a medical or clinical informatics intervention; enrolled adult women; and addressed preeclampsia, gestational diabetes mellitus (GDM), preterm birth, Centers for Disease Control and Prevention–defined severe maternal morbidity, or perinatal mental health conditions. Demographic, population, and intervention data were extracted to characterize the technologies, conditions, and populations addressed. Results: A total of 80 studies were identified that met the inclusion criteria. Many of the studies tested for multiple conditions. Of these, 73% (60/82) of the technologies were tested for either GDM or perinatal mental health conditions, and 15% (12/82) were tested for preeclampsia. For technologies, 32% (28/87) of the technologies tested were smartphone or tablet applications, 26% (23/87) were telehealth interventions, and 14% (12/87) were remote monitoring technologies. Of the many outcomes measured by the studies, almost half (69/140, 49%) were patient physical or mental health outcomes. Conclusions: Per this scoping review, most informatics interventions address three conditions: GDM, preeclampsia, and mental health. There may be opportunities to treat other potentially lethal conditions like postpartum hemorrhage using proven technologies such as mobile apps. Ample gaps in the literature exist concerning the use of informatics technologies aimed at maternal morbidity. There may be opportunities to use informatics for lesser-targeted conditions and populations. %M 40132184 %R 10.2196/64826 %U https://www.i-jmr.org/2025/1/e64826 %U https://doi.org/10.2196/64826 %U http://www.ncbi.nlm.nih.gov/pubmed/40132184 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 17 %N %P e57084 %T Real-World Data on Alcohol Consumption Behavior Among Smartphone Health Care App Users in Japan: Retrospective Study %A Eguchi,Kana %A Kubota,Takeaki %A Koyanagi,Tomoyoshi %A Muto,Manabu %+ Department of Informatics, Graduate School of Informatics, Kyoto University, Yoshida-Hommachi, Sakyo-ku,, Kyoto, 606-8501, Japan, 81 75 753 3369, kana.eguchi@ieee.org %K alcohol consumption %K individual behavior %K mobile health %K mobile health app %K mobile health care app log-based survey %K real-world data %K RWD %K RWD analysis %K smartphone health care app %K surveillance system %K health care app %D 2025 %7 25.3.2025 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Although many studies have used smartphone apps to examine alcohol consumption, none have clearly delineated long-term (>1 year) consumption among the general population. Objective: The objective of our study is to elucidate in detail the alcohol consumption behavior of alcohol drinkers in Japan using individual real-world data. During the state of emergency associated with the COVID-19 outbreak, the government requested that people restrict social gatherings and stay at home, so we hypothesize that alcohol consumption among Japanese working people decreased during this period due to the decrease in occasions for alcohol consumption. This analysis was only possible with individual real-world data. We also aimed to clarify the effects of digital interventions based on notifications about daily alcohol consumption. Methods: We conducted a retrospective study targeting 5-year log data from January 1, 2018, to December 31, 2022, obtained from a commercial smartphone health care app (CALO mama Plus). First, to investigate the possible size of the real-world data, we investigated the rate of active users of this commercial smartphone app. Second, to validate the individual real-world data recorded in the app, we compared individual real-world data from 9991 randomly selected users with government-provided open data on the number of daily confirmed COVID-19 cases in Japan and with nationwide alcohol consumption data. To clarify the effects of digital interventions, we investigated the relationship between 2 types of notification records (ie, “good” and “bad”) and a 3-day daily alcohol consumption log following the notification. The protocol of this retrospective study was approved by the Ethics Committee of the Kyoto University Graduate School and Faculty of Medicine (R4699). %M 40131328 %R 10.2196/57084 %U https://ojphi.jmir.org/2025/1/e57084 %U https://doi.org/10.2196/57084 %U http://www.ncbi.nlm.nih.gov/pubmed/40131328 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e65498 %T Feasibility and Usability of an Artificial Intelligence—Powered Gamification Intervention for Enhancing Physical Activity Among College Students: Quasi-Experimental Study %A Gao,Yanan %A Zhang,Jinxi %A He,Zhonghui %A Zhou,Zhixiong %K physical activity %K gamification %K artificial intelligence %K digital health %K digital intervention %K feasibility study %D 2025 %7 24.3.2025 %9 %J JMIR Serious Games %G English %X Background: Physical activity (PA) is vital for physical and mental health, but many college students fail to meet recommended levels. Artificial intelligence (AI)-powered gamification interventions through mobile app have the potential to improve PA levels among Chinese college students. Objective: This study aimed to assess the feasibility and usability of an AI-powered gamification intervention. Methods: A quasi-experimental study spanning 2 months was conducted on a sample of college students aged 18 to 25 years old from 18 universities in Beijing. PA data were recorded using the ShouTi Fitness app, and participant engagement was evaluated through surveys. User satisfaction was gauged through the System Usability Scale, while the intervention’s feasibility was assessed through Spearman rank correlation analysis, Mann-Whitney tests, and additional descriptive analyses. Results: As of July 2023, we enrolled 456 college students. In total, 18,073 PA sessions were recorded, with men completing 8068 sessions and women completing 10,055 sessions. The average PA intensity was 7 metabolic equivalent of energy (MET)s per session. Most participants preferred afternoon sessions and favored short-duration sessions, with men averaging 66 seconds per session and women 42 seconds. The System Usability Scale score for the intervention based on app is 65.2. Users responded positively to the integration of AI and gamification elements, including personalized recommendations, action recognition, smart grouping, dynamic management, collaborative, and competition. Specifically, 341 users (75%) found the AI features very interesting, 365 (80%) were motivated by the gamification elements, 364 (80%) reported that the intervention supported their fitness goals, and 365 (80%) considered the intervention reliable. A significant positive correlation was observed between the duration of individual PA and intervention duration for men (ρ=0.510, P<.001), although the correlation was weaker for women (ρ=0.258, P=.046). However, the frequency of PA declined after 35 days. Conclusions: This study provides pioneering evidence of the feasibility and usability of the AI-powered gamification intervention. While adherence was successfully demonstrated, further studies or interventions are needed to directly assess the impact on PA levels and focus on optimizing long-term adherence strategies and evaluating health outcomes. %R 10.2196/65498 %U https://games.jmir.org/2025/1/e65498 %U https://doi.org/10.2196/65498 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e56296 %T Application of Behavior Change Techniques and Rated Quality of Smoking Cessation Apps in China: Content Analysis %A Hong,Qiumian %A Wei,Shuochi %A Duoliken,Hazizi %A Jin,Lefan %A Zhang,Ning %K smoking cessation %K behavior change techniques %K mobile application %K content analysis %K China %D 2025 %7 24.3.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Smoking cessation apps are increasingly being used to help smokers quit smoking. In China, whether behavioral science–based techniques are being incorporated into smoking cessation apps remains unknown. Objectives: This study aims to describe the usage of behavior change techniques (BCTs) among smoking cessation apps available in China and to evaluate the relationship between BCT utilization and the quality of available smoking cessation apps. Methods: We searched eligible smoking cessation apps twice on September 12 and October 4, 2022. We coded them with BCTs and assessed their quality by the Mobile App Rating Scale (MARS) and rating score in the App Store. We described the quality of each app (ie, engagement, function, esthetic, and information) and the BCTs used within it, as well as the amount and proportion of all BCTs used. Correlation analysis and linear regression analysis were used to assess the association between the number of BCTs used and the quality of apps. Results: Nine apps were included in the final analyses. The average number of BCTs being used was 11.44 (SD 2.57), ranging from 5 to 29. Only 1 app used more than 20 BCTs. The most frequently used BCTs were providing feedback on current smoking behavior (9/9, 100%), prompting review of goals (8/9, 88.89%), prompting self-monitoring of one’s smoking behavior (7/9, 77.78%), and assessing current and past smoking behavior (7/9, 77.78%). The most commonly used BCTS specifically focus on behavior, including BM (B refers to behavior change, M focuses on addressing motivation; 4.44/11, 40.36%) and BS (B refers to behavior change, S refers to maximizing self-regulatory capacity or skills; 3.78/11, 34.36%). The average score of MARS for the apps was 3.88 (SD 0.38), ranging from 3.29 to 4.46, which was positively correlated with the number of BCTs used (r=0.79; P=.01). Specifically, more usage of BCTs was associated with higher engagement score (β=.74; P=.02; R2=0.52) and higher information score (β=.76; P=.02; R2=0.52). Conclusions: The quality of smoking cessation apps assessed by MARS was correlated with the number of BCTs used. However, overall, the usage of BCTs was insufficient and imbalanced, and the apps demonstrated low quality of engagement and information dimensions. Coordinated efforts from policy makers, technology companies, health behavior professionals, and health care providers should be made to reduce tobacco consumption and to develop high-quality, widely accessible, and effective smoking cessation apps to help smokers quit smoking. %R 10.2196/56296 %U https://mhealth.jmir.org/2025/1/e56296 %U https://doi.org/10.2196/56296 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56975 %T Effectiveness of Digital Lifestyle Interventions on Depression, Anxiety, Stress, and Well-Being: Systematic Review and Meta-Analysis %A Brinsley,Jacinta %A O'Connor,Edward J %A Singh,Ben %A McKeon,Grace %A Curtis,Rachel %A Ferguson,Ty %A Gosse,Georgia %A Willems,Iris %A Marent,Pieter-Jan %A Szeto,Kimberley %A Firth,Joseph %A Maher,Carol %+ Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, 108 North Terrace, Adelaide, 5000, Australia, 61 8 8302 6558, jacinta.brinsley@unisa.edu.au %K depression %K anxiety %K stress %K well-being %K mental health %K lifestyle intervention %K physical activity %K sleep %K diet %K digital health %K mobile phone %D 2025 %7 20.3.2025 %9 Review %J J Med Internet Res %G English %X Background: There is a growing body of robust evidence to show that lifestyle behaviors influence mental health outcomes. Technology offers an accessible and cost-effective implementation method for interventions, yet the study of the effectiveness of interventions to date has been specific to the mode of delivery, population, or behavior. Objective: The primary aim of this review was to comprehensively evaluate the effectiveness of digital lifestyle interventions for improving symptoms of depression, anxiety, stress, and well-being as coprimary outcomes in adults. The secondary aim was to explore the technological, methodological, intervention-specific, and population-specific characteristics that were associated with major changes in mental health outcomes. Methods: A systematic search was conducted across the MEDLINE, CINAHL, Embase, Emcare, PsycINFO, and Scopus databases to identify studies published between January 2013 and January 2023. Randomized controlled trials of lifestyle interventions (physical activity, sleep, and diet) that were delivered digitally; reported changes in symptoms of depression, anxiety, stress, or well-being in adults (aged ≥18 years); and were published in English were included. Multiple authors independently extracted data, which was evaluated using the 2011 Levels of Evidence from the Oxford Centre for Evidence-Based Medicine. Inverse-variance random-effects meta-analyses were used for data analysis. The primary outcome was the change in symptoms of depression, anxiety, stress, and well-being as measured by validated self-report of clinician-administered outcomes from pre- to postintervention. Subgroup analyses were conducted to determine whether results differed based on the target lifestyle behavior, delivery method, digital features, design features, or population characteristics. Results: Of the 14,356 studies identified, 61 (0.42%) were included. Digital lifestyle interventions had a significant small-to-medium effect on depression (standardized mean difference [SMD] −0.37; P<.001), a small effect on anxiety (SMD −0.29; P<.001) and stress (SMD −0.17; P=.04), and no effect on well-being (SMD 0.14; P=.15). Subgroup analyses generally suggested that effects were similar regardless of the delivery method or features used, the duration and frequency of the intervention, the population, or the lifestyle behavior targeted. Conclusions: Overall, these results indicate that delivering lifestyle interventions via a range of digital methods can have significant positive effects on depression (P<.001), anxiety (P<.001), and stress (P=.04) for a broad range of populations, while effects on well-being are inconclusive. Future research should explore how these interventions can be effectively implemented and embedded within health care with a concerted focus on addressing digital health equity. Trial Registration: PROSPERO CRD42023428908; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023428908 %M 40112295 %R 10.2196/56975 %U https://www.jmir.org/2025/1/e56975 %U https://doi.org/10.2196/56975 %U http://www.ncbi.nlm.nih.gov/pubmed/40112295 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64459 %T A Brief Cognitive Behavioral Therapy–Based Digital Intervention for Reducing Hazardous Alcohol Use in South Korea: Development and Prospective Pilot Study %A Kwon,Manjae %A Moon,Daa Un %A Kang,Minjae %A Jung,Young-Chul %K alcohol %K hazardous alcohol use %K digital intervention %K cognitive behavioral therapy %K mobile apps %K prevention %K therapy-based %K cognitive behavioral %K alcohol use %K South Korea %K prospective pilot study %K pilot study %K alcohol consumption %K death %K disability %K chronic medical condition %K digital health interventions %K traditional treatment methods %K Korean %K hazardous drinking %K acceptability %K feasibility %K smartphone app %K alcohol use disorder %K psychiatric symptoms %K mobile phone %D 2025 %7 19.3.2025 %9 %J JMIR Form Res %G English %X Background: Alcohol consumption is a leading cause of death and disability worldwide, associated with numerous acute and chronic medical conditions. Digital health interventions offer a promising solution to overcome barriers associated with traditional treatment methods, providing accessible, scalable, and cost-effective means to support individuals in reducing hazardous drinking. Objective: This pilot study aims to evaluate the feasibility, acceptability, and preliminary efficacy of the Sober smartphone app in individuals with hazardous alcohol use. Methods: This single-group, pre- and postpilot study included 20 participants with risky alcohol use, identified using the Alcohol Use Disorder Identification Test. Participants used the Sober app for 4 weeks, incorporating cognitive behavioral therapy–based interventions. Feasibility was assessed by study and session completion rates, acceptability by participant satisfaction and perceived usefulness, and preliminary efficacy by changes in alcohol consumption and psychiatric symptoms. Semistructured interviews with participants and clinicians provided qualitative perspectives on the app’s usability, efficacy, and areas for improvement. Results: Of the 20 enrolled participants, 17 completed the study. The app demonstrated high feasibility with an 85% (17/20) study completion rate, and 59% (10/17) completed all cognitive behavioral therapy sessions. Participants reported positive acceptability, with average satisfaction and usefulness ratings of 3.8 and 3.7 of 5, respectively. Preliminary efficacy outcomes showed significant improvements: abstinence days increased from 67% to 85% (z=−3.17; P=.002), heavy drinking episodes decreased from 3.3 to 1.9 (t16=−2.97; P=.003), and total alcohol consumption reduced from 456.8 to 195.9 mL (t16=3.16; P=.002). Alcohol Use Disorder Identification Test scores dropped from 17.5 to 10.7 (t16=4.51; P<.001). Additionally, depression (Patient Health Questionnaire-9) scores decreased from 5.8 to 4.4 (t16=2.91; P=.01), and anxiety (Generalized Anxiety Disorder-7) scores from 3.4 to 2.1 (z=−2.80; P=.005). No adverse events were reported. Qualitative analysis found participants valued daily logging but noted usability issues, while clinicians called for tailored goals, enhanced communication features, and age-specific content. Conclusions: The mobile app Sober shows promise as an effective tool for reducing hazardous alcohol consumption and improving related psychiatric symptoms. The study demonstrated high feasibility and positive acceptability, with significant preliminary efficacy in reducing alcohol use. Qualitative findings provided actionable evidence for refining the app’s usability and clinical integration. Further research through a randomized controlled trial is warranted to confirm these findings and optimize the app’s features and content. Trial Registration: ClinicalTrials.gov NCT06502756; https://clinicaltrials.gov/study/NCT06502756 %R 10.2196/64459 %U https://formative.jmir.org/2024/1/e64459 %U https://doi.org/10.2196/64459 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e55379 %T Proximal Effects of a Just-in-Time Adaptive Intervention for Smoking Cessation With Wearable Sensors: Microrandomized Trial %A Vinci,Christine %A Sutton,Steve K %A Yang,Min-Jeong %A Jones,Sarah R %A Kumar,Santosh %A Wetter,David W %+ , Moffitt Cancer Center, 12902 Magnolia Dr., Tampa, FL, 33612, United States, 1 813 745 5421, Christine.vinci@moffitt.org %K smoking cessation %K mindfulness %K ecological momentary assessment %K micro-randomized trial %K Just-in-Time Adaptive Intervention %K JITAI %K EMA %K ecological momentary %K smoking %K smokers %K quitting %K cessation %K meditation %K mind body %K sensors %K motivational %K tobacco %K nicotine %K NRT %K counseling %K wearables %K abstinence %K stress %K craving %K adaptive intervention %K mobile phone %D 2025 %7 19.3.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Tobacco use remains the leading preventable cause of morbidity and mortality in the United States. Novel interventions are needed to improve smoking cessation rates. Mindfulness-based interventions (MBIs) for cessation address tobacco use by increasing awareness of the automatic nature of smoking and related behaviors (eg, reactivity to triggers for smoking) from a nonjudgmental stance. Delivering MBIs for smoking cessation via innovative technologies allows for flexibility in the timing of intervention delivery, which has the potential to improve the efficacy of cessation interventions. Research shows MBIs target key mechanisms in the smoking cessation process and can be used to minimize drivers of smoking lapse. Objective: This single-arm study investigated the impact of mindfulness-based strategies and motivational messages on proximal outcomes, collected via ecological momentary assessment (EMA), relevant to tobacco abstinence via a microrandomized trial. This approach allows for the evaluation of intervention content on proximal outcomes (eg, reduced negative affect) that are thought to impact positive distal outcomes (eg, smoking abstinence). Methods: All participants were motivated to quit smoking, and the intervention they received included nicotine replacement therapy, brief individual counseling, and a 2-week Just-in-Time Adaptive Intervention (JITAI) with wearable sensors. Throughout the JITAI period, a single strategy was randomly pushed (vs not) multiple times per day through the smartphone application. An EMA next assessed negative affect, positive affect, mindfulness, abstinence self-efficacy, motivation to quit, craving, and smoking motives. The primary analyses evaluated differences in EMA outcomes (proximal) for when a strategy was pushed versus not pushed. Additional analyses evaluated changes in similar outcomes collected from surveys at the baseline and end-of-treatment visits. Results: Participants (N=38) were 63% (24/38) female, 18% (7/38) Hispanic or Latino, and 29% (11/38) African American. They had an average age of 49 years and smoked an average of 15 (SD 7.9) cigarettes per day. Results indicated that receiving the JITAI significantly reduced proximal negative affect in the second (and final) week of the intervention. Self-reports provided at baseline and end of treatment showed significant decreases in perceived stress, automaticity of smoking and craving, and a significant increase in abstinence self-efficacy. Increases in abstinence self-efficacy significantly predicted abstinence. Conclusions: To our knowledge, this is the first study to test the proximal impact of a mindfulness-based JITAI on key variables associated with smoking cessation. Our primary finding was that negative affect was lower following the completion of a strategy (vs when no strategy was delivered) in the final week of the JITAI. Among a larger sample size, future research should extend the length of the intervention to further evaluate the impact of the JITAI, as well as include a comparison condition to further evaluate how each component of the intervention uniquely impacts outcomes. Trial Registration: ClinicalTrials.gov NCT03404596; https://clinicaltrials.gov/study/NCT03404596 %M 40106803 %R 10.2196/55379 %U https://mhealth.jmir.org/2025/1/e55379 %U https://doi.org/10.2196/55379 %U http://www.ncbi.nlm.nih.gov/pubmed/40106803 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e63148 %T Preferences for Mobile Apps That Aim to Modify Alcohol Use: Thematic Content Analysis of User Reviews %A Kirouac,Megan %A Gillezeau,Christina %K alcohol mobile app %K mHealth %K alcohol use disorder %K user-centered design %K alcohol %K user-centered %K user %K reviews %K usefulness %K mobile health app %K content analysis %K drinking %K health tool %D 2025 %7 19.3.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Nearly one-third of adults in the United States will meet criteria for alcohol use disorder in their lifetime, yet fewer than 10% of individuals who meet for alcohol use disorder criteria will receive treatment for it. Mobile health (mHealth) applications (apps) have been suggested as a potential mechanism for closing this treatment gap, yet there is a wide variety of quality and integrity within these apps, leading to potential harms to users. Objectives: The aim of this paper is to systematically record and qualitatively examine user reviews or mHealth apps to identify features in the existing apps that may impact usefulness and adoption of them. Methods: The researchers used Apple App and Google Play stores to identify mHealth apps that were focused on modifying alcohol use and treating common comorbidities. Apps that were free without in-app purchases and provided multiple features for users were included. User reviews from the apps were downloaded and coded using content analysis. Results: A total of 425 unique apps were found in our search. Of these, the majority of apps (n=301) were excluded from the present analyses for not focusing on reducing alcohol-related concerns (eg, many apps were for purchasing alcohol). Eight apps were identified and had user reviews downloaded. The apps examined in this study were VetChange, SMART, DrinkCoach, SayingWhen, AlcoStat, Celebrate Recovery, TryDry, and Construction Industry Helpline. A total of 370 reviews were downloaded and 1353 phrases were coded from those reviews into a total of 11 codes. The 5 most common themes identified were praise (498 counts coded; 36.831%), tools (150 counts coded; 11.062%), suggestions for improvement (118 counts coded; 8.756%), criticism (105 counts coded; 7.768%), and tracking (104 counts coded; 7.724%). Conclusions: The current findings suggest that alcohol mobile app users broadly found the apps helpful in reducing their drinking or meeting their drinking goals. Users were able to identify features that they liked or found helpful in the apps, as well as provide concrete feedback about features that they would like included or improved. Specifically, flexible and expansive tracking features and comprehensive whole health tools were cited as valuable and desired. App developers and those looking to expand access to and uptake of alcohol reduction apps may find these user reviews helpful in guiding their app development. %R 10.2196/63148 %U https://mhealth.jmir.org/2025/1/e63148 %U https://doi.org/10.2196/63148 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e69264 %T Evaluation of a Smartphone-Based Weight Loss Intervention with Telephone Support for Merchant Women With Obesity in Côte d'Ivoire: Protocol for a Randomized Controlled Trial %A Usui,Rui %A Aomori,Maki %A Kanamori,Shogo %A Watabe,Setsuko %A Sehi,Bi Tra Jamal %A Kawano,Kei %A Kanoya,Yuka %+ Department of Nursing, Shonan University of Medical Science, 27, Yamatecho, Naka-ku, Yokohama, Kanagawa, 231-0862, Japan, 81 45 222 0810, usuir@yokohama-cu.ac.jp %K West Africa %K sub-Saharan Africa %K obesity %K noncommunicable diseases %K mHealth %K mobile health %K eHealth %K randomized controlled trial %K Côte d'Ivoire %K weight loss program %D 2025 %7 18.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The obesity rate among women in Côte d'Ivoire is rising, particularly in urban areas. Merchantry is the leading occupation for women in the country, and merchant women face a high risk of obesity owing to their sedentary lifestyle. A previous survey indicated that the obesity rate among merchant women was 30%, double the national average. Furthermore, 82.2% of merchant women with obesity were unaware of their condition, and 40.1% expressed no interest in losing weight. While most weight loss programs target individuals ready to lose weight, community interventions should also address those with minimal readiness. Additionally, low-cost weight-loss interventions that do not require health professionals are needed in countries with limited medical resources. Smartphones could offer a cost-effective solution as they enable self-monitoring and remote communication. Objective: This study will evaluate a low-cost smartphone-based intervention that targets individuals who are not ready to lose weight without the involvement of health professionals. Methods: The intervention will run for 6 months, and its efficacy will be assessed in an unblinded, parallel-group, randomized controlled trial with 108 participants per group. All direct interventions for participants in this study will be carried out by staff without medical qualifications. The intervention group will receive weighing scales and be encouraged to record their weight with a smartphone app. Health education will be provided via weekly group messages and monthly phone calls. The evaluation will be conducted face-to-face. The primary outcome will be the weight change, and the secondary outcome will be differences in body fat percentage, abdominal circumference, and stage of behavioral change in weight loss behaviors from baseline to 3, 6, and 12 months. Results: In accordance with this protocol, the recruitment of participants started on August 26, 2024. A total of 216 participants were allocated, with 108 in the intervention group and 108 in the control group. The baseline survey began on November 15, 2024, and is currently ongoing as of the end of November 2024. Conclusions: This study will be the first in sub-Saharan African countries to implement a smartphone app-based weight loss program in sub-Saharan Africa that does not require direct intervention by health care professionals but specifically targets communities. Furthermore, if the effectiveness of this program is confirmed, it has the potential to serve as a low-cost sustainable weight loss model at the policy level. International Registered Report Identifier (IRRID): DERR1-10.2196/69264 %M 40101743 %R 10.2196/69264 %U https://www.researchprotocols.org/2025/1/e69264 %U https://doi.org/10.2196/69264 %U http://www.ncbi.nlm.nih.gov/pubmed/40101743 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e67972 %T Acceptability and Preliminary Efficacy of a Novel Web-Based Physical Activity for the Heart (PATH) Intervention Designed to Promote Physical Activity in Adults With Obesity: Protocol for a Pilot Randomized Controlled Trial %A Kariuki,Jacob %A Burke,Lora %A Erickson,Kirk %A Sereika,Susan %A Paul,Sudeshna %A Cheng,Jessica %A Biza,Heran %A Abdirahman,Amjad %A Wilbraham,Katherine %A Milton,Heather %A Brown,Cornelius %A Sells,Matthew %A Osei Baah,Foster %A Wells,Jessica %A Chandler,Rasheeta %A Barone Gibbs,Bethany %+ Emory University, 1520 Clifton Rd, Atlanta, GA, 30322, United States, 1 4047272353, jacob.kariuki@emory.edu %K obesity %K physical activity %K cardiometabolic risk, body positivity, cardiovascular fitness, self-efficacy %D 2025 %7 18.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Even in the absence of weight loss, any level of physical activity (PA) can reduce the risk of cardiovascular disease among individuals with obesity. However, these individuals face multifaceted barriers that reduce their motivation and engagement in PA. They prefer programs that are convenient, fun to engage in, and feature people who they can relate to. Yet, there is a paucity of PA interventions that are designed to incorporate these preferences. We designed the web-based PA for The Heart (PATH) intervention to address this gap. Objective: This study aimed to describe the protocol of a study that aims to examine the acceptability and preliminary efficacy of PATH intervention among insufficiently active adults with obesity aged at least 18 years. Methods: This is a 6-month pilot randomized controlled trial (RCT), using a parallel design with 1:1 allocation to intervention or control group. The PATH intervention group is given access to the PATH platform, but the resources each participant can access are tailored according to their baseline fitness level. Control group receives a self-help PA handout. Both groups self-monitor their PA using Fitbit (Google) and have Zoom (Zoom Video Communications) meetings twice a month with either the health coach (intervention) or study coordinator (control). The outcomes at 6-months include acceptability, changes in PA, and cardiometabolic risk from baseline to 6-months. Results: We screened 763 individuals for eligibility and 89 participants were enrolled and randomized to the intervention (45/504, 50.6%) and control arms (44/504, 49.4%). The average age was 48.7 (SD 12.17) years, and most participants were female (81/504, 90.1%), Black (45/504, 50.6%), and non-Hispanic (83/504, 93.3%). No systematic differences in baseline characteristics were observed between the study arms. The 6-month intervention is currently underway, and the completion of follow-up data collection is expected in February 2025, with results to be published soon after. Conclusions: The PATH intervention offers a promising, evidence-based approach to overcoming the barriers that have hindered previous PA programs for adults with obesity. It can support new and existing programs to foster long-term maintenance of health-enhancing PA. Trial Registration: ClinicalTrials.gov NCT05803304; https://clinicaltrials.gov/study/NCT05803304 International Registered Report Identifier (IRRID): DERR1-10.2196/67972 %M 40101744 %R 10.2196/67972 %U https://www.researchprotocols.org/2025/1/e67972 %U https://doi.org/10.2196/67972 %U http://www.ncbi.nlm.nih.gov/pubmed/40101744 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66294 %T Digital Physical Activity and Sedentary Behavior Interventions for Community-Living Adults: Umbrella Review %A Russell,Eilidh %A Kirk,Alison %A Dunlop,Mark D %A Hodgson,William %A Patience,Mhairi %A Egan,Kieren %+ , Department of Computer and Information Sciences, University of Strathclyde, 26 Richmond Street, Glasgow, G1 1XH, United Kingdom, 44 01415524400, eilidh.russell.2017@uni.strath.ac.uk %K physical activity %K sedentary behavior %K digital health interventions %K behavior change %K theoretical frameworks %K umbrella review %K mobile phone %K community-living adults %D 2025 %7 18.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Digital interventions hold significant potential for improving physical activity (PA) and reducing sedentary behavior (SB) in adults. Despite increasing interest, there remain surprising gaps in the current knowledge of how best to deliver these interventions, including incorporating appropriate theoretical frameworks and behavior change techniques. Following numerous systematic reviews, there is now significant potential for umbrella reviews to provide an overview of the current evidence. Objective: This umbrella review aimed to explore digital PA and SB interventions for community-living adults across effectiveness, key components, and methodological quality. Methods: This review followed the Joanna Briggs Institute framework for umbrella reviews. Key search terms were developed iteratively, incorporating physical and sedentary activity alongside digital interventions. We searched 7 online databases (Web of Science Core Collection, CINAHL, APA PsycINFO, Inspec, the Cochrane Library, MEDLINE [Ovid], and PROSPERO) alongside gray literature databases. Information was extracted and tabulated from each included article on intervention effectiveness, key components, and content acknowledging both the digital and human elements. The study quality was appraised using A Measurement Tool to Assess systematic Reviews 2 (AMSTAR 2). The corrected covered area method was used to assess the overlap of primary studies included in the systematic reviews. All relevant research findings were extracted and reported. Results: Search terms identified 330 articles, of which 5 (1.5%) met the inclusion criteria. The most common PA outcomes identified were daily steps, moderate-to-vigorous PA, total PA, and PA change. Reviews with meta-analysis reported that digital interventions improved multiple PA outcomes (daily steps, moderate-to-vigorous PA time, and total PA time). However, findings from the remaining systematic reviews were mixed. Similarly, the findings for SB were contrasting. Regarding intervention components, monitor- and sensor-only intervention delivery methods were most frequently implemented. Eleven theoretical frameworks were identified, with social cognitive theory being the most prominent theory. In total, 28 different behavior change techniques were reported, with goal setting, self-monitoring, feedback, and social support being the most frequently used. All 5 systematic reviews were of low or critically low quality, each incorporating unique primary studies (corrected covered area=0%). Conclusions: This umbrella review highlights the potential of digital interventions to increase PA and reduce SB among community-living adults. However, the disparate nature of current academic knowledge means potentially efficacious research may not realistically translate to real work impact. Our review identified a lack of consensus around outcomes and components at both individual (eg, difficult to collate and compare findings) and multiple study (poor reported quality of systematic reviews) levels. Collective, concerted action is required to standardize outcomes and improve systematic review reporting to optimize future learning around digital interventions to increase PA and reduce SB in community-living adults, including traditionally overlooked populations, like informal carers. Trial Registration: PROSPERO CRD42023450773; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023450773 %M 40100250 %R 10.2196/66294 %U https://www.jmir.org/2025/1/e66294 %U https://doi.org/10.2196/66294 %U http://www.ncbi.nlm.nih.gov/pubmed/40100250 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70982 %T Digital Wellness Programs in the Workplace: Meta-Review %A Amirabdolahian,Saeed %A Pare,Guy %A Tams,Stefan %+ , Research Chair in Digital Health, HEC Montréal, 3000 Cote-Ste-Catherine Road, Montreal, QC, H3T 2A7, Canada, 1 514 340 6812, guy.pare@hec.ca %K digital wellness programs %K corporate wellness %K health interventions %K efficacy %K acceptability %K meta-review %K mHealth %K eHealth %D 2025 %7 14.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Corporate wellness programs are increasingly using digital technologies to promote employee health. Digital wellness programs (DWPs) refer to initiatives that deliver health interventions through digital tools. Despite a growing body of evidence on DWPs, the literature remains fragmented across multiple health domains. Objective: This study aims to provide a comprehensive synthesis of existing research on the efficacy (eg, impact on employee’s physical health, mental well-being, behavioral changes, and absenteeism) and acceptability (eg, engagement, perceived usefulness, and adoption) of employer-provided DWPs. Specifically, we aim to map the extent, range, and nature of research on this topic; summarize key findings; identify gaps; and facilitate knowledge dissemination. Methods: We conducted a meta-review of studies published between 2000 and 2023. We adopted a database-driven search approach, including the MEDLINE, PsycINFO, ProQuest Central, and Web of Science Core Collection databases. The inclusion criteria consisted of (1) review articles; (2) publications in English, French, or German; (3) studies reporting on digital health interventions implemented in organizations; (4) studies reporting on nonclinical or preclinical employee populations; and (5) studies assessing the efficacy and acceptability of employer-provided DWPs. We performed a descriptive numerical summary and thematic analysis of the included studies. Results: Out of 593 nonduplicate studies screened, 29 met the inclusion criteria. The most investigated health domains included mental health (n=19), physical activity (n=8), weight management (n=6), unhealthy behavior change (n=4), and sleep management (n=2). In total, 24 reviews focused on the efficacy of DWPs, primarily in relation to health-related outcomes (eg, stress and weight), while fewer reviews addressed organization-related outcomes (eg, burnout and absenteeism). Four reviews explored the mechanisms of action, and 3 assessed the acceptability of DWPs using various measures. Overall, the findings support the efficacy and acceptability of DWPs, although significant gaps persist, particularly regarding the durability of outcomes, the role of technology, and the causal mechanisms underlying behavioral change. Conclusions: While DWPs show promise across a variety of health domains, several aspects of their effectiveness remain underexplored. Practitioners should capitalize on existing evidence of successful DWPs while acknowledging the limitations in the literature. %M 40085840 %R 10.2196/70982 %U https://www.jmir.org/2025/1/e70982 %U https://doi.org/10.2196/70982 %U http://www.ncbi.nlm.nih.gov/pubmed/40085840 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e64664 %T Use of Wearable Transdermal Alcohol Sensors for Monitoring Alcohol Consumption After Detoxification With Contingency Management: Pilot Randomized Feasibility Trial %A Brobbin,Eileen %A Drummond,Colin %A Parkin,Stephen %A Deluca,Paolo %+ King's College London, 4 Windswor Walk, Denmark Hill, London, SE5 8BB, United Kingdom, 44 07758287265, eileen.brobbin@kcl.ac.uk %K alcohol %K alcohol dependence %K alcohol monitoring %K alcohol treatment %K contingency management %K transdermal alcohol sensor %K transdermal technology %K wearable %K wearable alcohol biosensor %D 2025 %7 14.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Wearable transdermal alcohol sensor (TAS) devices generate continuous data on alcohol consumption through the indiscernible sweat vapors on the skin. This continuous alcohol monitoring capability could provide a new method for alcohol services to monitor service users at various stages of their alcohol treatment. Objective: We aimed to assess the feasibility of using a TAS as part of alcohol treatment with alcohol service users using the device with or without contingency management (CM). Methods: A feasibility study was conducted of a convenience sample of 29 current service users from 3 South London alcohol services. Participants were randomized into either a control (treatment as usual) or CM group (treatment as usual+CM). We assessed the feasibility of enrollment, participation, device tampering and return, and device wearability and the accuracy of data capture. These data were reported descriptively where appropriate, the groups were compared, and alcohol self-report data were compared to the transdermal alcohol concentration to assess accuracy. Results: A total of 34 individuals were approached, and 32 (94%) were enrolled and randomized (n=17, 53% to the control group and n=15, 47% to the CM group) over 5 months. In total, 3 participants withdrew (n=2, 67% from the control group and n=1, 33% from the CM group). There was a total of 203 meetings arranged (29 participants × 7 meetings), and 185 (91.1%) were attended. Only 1 of the 29 participants (3%) admitted to turning the TAS off to avoid monitoring. There were some issues with the TAS not functioning properly and not being able to be cleaned. Removals were recorded, but the definition of TAS removal may need to be improved for future trials. There was a high TAS return rate (28/29, 97% of the participants returned the TAS). Secondary outcomes suggest that the BACtrack Skyn remains an accurate tool to monitor alcohol consumption compared to self-report data and that it is acceptable to wearers over 2 weeks, with many participants (27/28, 96%) answering that they would wear it again and for longer but that the CM procedure could be made clearer. Conclusions: The delivery of CM via a TAS was feasible in this study, but recommendations for a future larger trial include that the study design should be changed to provide an operationalized rather than manual method of checking whether TAS data meet CM criteria. This would reduce researcher burden and researcher and participant time. Current recruitment and research meeting design seem suitable for a future larger trial. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) ISRCTN46845361; https://www.isrctn.com/ISRCTN46845361 %M 40085839 %R 10.2196/64664 %U https://humanfactors.jmir.org/2025/1/e64664 %U https://doi.org/10.2196/64664 %U http://www.ncbi.nlm.nih.gov/pubmed/40085839 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65228 %T Digital Cognitive Behavioral Therapy–Based Treatment for Insomnia, Nightmares, and Posttraumatic Stress Disorder Symptoms in Survivors of Wildfires: Pilot Randomized Feasibility Trial %A Isaac,Fadia %A Klein,Britt %A Nguyen,Huy %A Watson,Shaun %A Kennedy,Gerard A %+ Institute of Health and Wellbeing, Federation University Australia, University Drive, Mt Helen, Victoria, 3350, Australia, 61 353276717, fadia.isaac@hotmail.com %K insomnia %K nightmares %K posttraumatic stress disorder %K PTSD %K wildfires %K cognitive behavioral therapy for insomnia %K CBTi %K exposure, relaxation, and rescripting therapy %K ERRT %K Sleep Best-i %K mobile health %K mHealth %K digital health %K computer %K eHealth %K bushfires %D 2025 %7 14.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Symptoms of insomnia, nightmares, and trauma are highly prevalent. However, there are significant barriers to accessing evidence-based treatments for these conditions, leading to poor mental health outcomes. Objective: This pilot trial evaluated the feasibility of a 4-week, digital self-paced intervention combining cognitive behavioral therapy for insomnia and exposure, relaxation, and rescripting therapy for nightmares in survivors of wildfires from Australia, Canada, and the United States. Methods: Study participants were recruited between May 2023 and December 2023 through social media platforms, workshops, conferences, and radio interviews. Participants had to meet at least one of the following criteria: a score of ≥8 on the Insomnia Severity Index, a score of ≥3 on the Nightmare Disorder Index, or a score of ≥31 on the PTSD Checklist for DSM-5. In total, 30 survivors of wildfires were allocated to either the treatment group (n=16, 53%) or the waitlist control group (n=14, 47%) in a sequential manner. Participants’ ages ranged from 18 to 79 years, with a mean age of 52.50 (SD 16.26) years. The cohort consisted of 63% (19/30) female and 37% (11/30) male participants. Participants also completed self-report secondary outcome measures, including the Generalized Anxiety Disorder–7, the Patient Health Questionnaire–9, and the Pittsburgh Sleep Quality Index, via the HealthZone digital platform. Assessments were conducted at baseline, the posttreatment time point, and the 3-month follow-up, with the waitlist group undergoing an additional assessment at the pretreatment time point, after 4 weeks of waiting and before crossing over to treatment. This study used intention-to-treat analysis as a primary analysis and per-protocol analysis as a secondary analysis. Results: Mixed-effects linear regression models and difference-in-differences analyses were used to assess the intervention’s effects. The intention-to-treat analysis revealed significant improvements over time (main effect of time), with a 1.64-point reduction (P=.001) on the Nightmare Disorder Index and 10.64-point reduction (P=.009) on the PTSD Checklist for DSM-5 at the postintervention time point. No significant changes were observed in insomnia symptoms. On the secondary measures, there was an interaction effect of condition × time, with a 2.22-point reduction (P<.001) on the Pittsburgh Sleep Quality Index, and a main effect of time, with a 6.48-point reduction (P<.001) on the Patient Health Questionnaire–9. No changes were detected on the Generalized Anxiety Disorder–7. The per-protocol analysis yielded comparable results for both the primary and secondary measures. Conclusions: The findings of this pilot trial demonstrated a reduction in nightmares and trauma symptoms. Future research studies should aim at evaluating the intervention in a more definitive trial with a larger sample size. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000415606; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385054 %M 40085843 %R 10.2196/65228 %U https://humanfactors.jmir.org/2025/1/e65228 %U https://doi.org/10.2196/65228 %U http://www.ncbi.nlm.nih.gov/pubmed/40085843 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66580 %T Association of Digital Health Interventions With Maternal and Neonatal Outcomes: Systematic Review and Meta-Analysis %A Wang,Jianing %A Tang,Nu %A Jin,Congcong %A Yang,Jianxue %A Zheng,Xiangpeng %A Jiang,Qiujing %A Li,Shengping %A Xiao,Nian %A Zhou,Xiaojun %+ Department of Maternal and Child Information Management, Women and Children's Hospital of Chongqing Medical University, No.120 Longshan Road, Yubei District, Chonqing, 401147, China, 86 23 6723 2442, 1186440689@qq.com %K digital health %K telemedicine %K telehealth %K mobile health %K mHealth %K mobile phone %K intervention %K meta-analysis %K pregnant women %K systematic review %D 2025 %7 14.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Gestational weight gain (GWG) is crucial to maternal and neonatal health, yet many women fail to meet recommended guidelines, increasing the risk of complications. Digital health interventions offer promising solutions, but their effectiveness remains uncertain. This study evaluates the impact of such interventions on GWG and other maternal and neonatal outcomes. Objective: This study aimed to investigate the effect of digital health interventions among pregnant women and newborns. Methods: A total of 2 independent researchers performed electronic literature searches in the PubMed, Embase, Web of Science, and Cochrane Library databases to identify eligible studies published from their inception until February 2024; an updated search was conducted in August 2024. The studies included randomized controlled trials (RCTs) related to maternal and neonatal clinical outcomes. The Revised Cochrane risk-of-bias tool for randomized trials was used to examine the risk of publication bias. Stata (version 15.1; StataCorp) was used to analyze the data. Results: We incorporated 42 pertinent RCTs involving 148,866 participants. In comparison to the routine care group, GWG was markedly reduced in the intervention group (standardized mean difference–0.19, 95% CI –0.25 to –0.13; P<.001). A significant reduction was observed in the proportion of women with excessive weight gain (odds ratio [OR] 0.79, 95% CI 0.69-0.91; P=.001), along with an increase in the proportion of women with adequate weight gain (OR 1.33, 95% CI 1.10-1.64; P=.003). Although no significant difference was reported for the proportion of individuals below standardized weight gain, there is a significant reduction in the risk of miscarriage (OR 0.66, 95% CI 0.46-0.95; P=.03), preterm birth (OR 0.8, 95% CI 0.75-0.86; P<.001), as well as complex neonatal outcomes (OR 0.93, 95% CI 0.87-0.99; P=.02). Other maternal and fetal outcomes were not significantly different between the 2 groups (all P>.05). Conclusions: The findings corroborate our hypothesis that digitally facilitated health care can enhance certain facets of maternal and neonatal outcomes, particularly by mitigating excessive weight and maintaining individuals within a reasonable weight gain range. Therefore, encouraging women to join the digital health team sounds feasible and helpful. Trial Registration: PROSPERO CRD42024564331; https://tinyurl.com/5n6bshjt %M 40085842 %R 10.2196/66580 %U https://www.jmir.org/2025/1/e66580 %U https://doi.org/10.2196/66580 %U http://www.ncbi.nlm.nih.gov/pubmed/40085842 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e66637 %T Healthy Mom Zone Adaptive Intervention With a Novel Control System and Digital Platform to Manage Gestational Weight Gain in Pregnant Women With Overweight or Obesity: Study Design and Protocol for a Randomized Controlled Trial %A Downs,Danielle Symons %A Pauley,Abigail M %A Rivera,Daniel E %A Savage,Jennifer S %A Moore,Amy M %A Shao,Danying %A Chow,Sy-Miin %A Lagoa,Constantino %A Pauli,Jaimey M %A Khan,Owais %A Kunselman,Allen %+ Department of Kinesiology, Pennsylvania State University, 378 N Burrowes, 266 Recreation Building, University Park, PA, 16802, United States, 1 814 863 0456, dsd11@psu.edu %K pregnancy %K gestational weight gain %K physical activity %K healthy eating %K overweight %K obesity %K intervention %D 2025 %7 13.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Regulating gestational weight gain (GWG) in pregnant women with overweight or obesity is difficult, particularly because of the narrow range of recommended GWG for optimal health outcomes. Given that many pregnant women show excessive GWG and considering the lack of a “gold standard” intervention to manage GWG, there is a timely need for effective and efficient approaches to regulate GWG. We have enhanced the Healthy Mom Zone (HMZ) 2.0 intervention with a novel digital platform, automated dosage changes, and personalized strategies to regulate GWG, and our pilot study demonstrated successful recruitment, compliance, and utility of our new control system and digital platform. Objective: The goal of this paper is to describe the study protocol for a randomized controlled optimization trial to examine the efficacy of the enhanced HMZ 2.0 intervention with the new automated control system and digital platform to regulate GWG and influence secondary maternal and infant outcomes while collecting implementation data to inform future scalability. Methods: This is an efficacy study using a randomized controlled trial design. HMZ 2.0 is a multidosage, theoretically based, and individually tailored adaptive intervention that is delivered through a novel digital platform with an automated link of participant data to a new model-based predictive control algorithm to predict GWG. Our new control system computes individual dosage changes and produces personalized physical activity (PA) and energy intake (EI) strategies to deliver just-in-time dosage change recommendations to regulate GWG. Participants are 144 pregnant women with overweight or obesity randomized to an intervention (n=72) or attention control (n=72) group, stratified by prepregnancy BMI (<29.9 vs ≥30 kg/m2), and they will participate from approximately 8 to 36 weeks of gestation. The sample size is based on GWG (primary outcome) and informed by our feasibility trial showing a 21% reduction in GWG in the intervention group compared to the control group, with 3% dropout. Secondary outcomes include PA, EI, sedentary and sleep behaviors, social cognitive determinants, adverse pregnancy and delivery outcomes, infant birth weight, and implementation outcomes. Analyses will include descriptive statistics, time series and fixed effects meta-analytic approaches, and mixed effects models. Results: Recruitment started in April 2024, and enrollment will continue through May 2027. The primary (GWG) and secondary (eg, maternal and infant health) outcome results will be analyzed, posted on ClinicalTrials.gov, and published after January 2028. Conclusions: Examining the efficacy of the novel HMZ 2.0 intervention in terms of GWG and secondary outcomes expands the boundaries of current GWG interventions and has high clinical and public health impact. There is excellent potential to further refine HMZ 2.0 to scale-up use of the novel digital platform by clinicians as an adjunct treatment in prenatal care to regulate GWG in all pregnant women. International Registered Report Identifier (IRRID): DERR1-10.2196/66637 %M 40080809 %R 10.2196/66637 %U https://www.researchprotocols.org/2025/1/e66637 %U https://doi.org/10.2196/66637 %U http://www.ncbi.nlm.nih.gov/pubmed/40080809 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 6 %N %P e65001 %T A Hybrid Deep Learning–Based Feature Selection Approach for Supporting Early Detection of Long-Term Behavioral Outcomes in Survivors of Cancer: Cross-Sectional Study %A Huang,Tracy %A Ngan,Chun-Kit %A Cheung,Yin Ting %A Marcotte,Madelyn %A Cabrera,Benjamin %+ Worcester Polytechnic Institute, 100 Institute Rd, Worcester, MA, 01609, United States, 1 (508) 831 5000, cngan@wpi.edu %K machine learning %K data driven %K clinical domain–guided framework %K survivors of cancer %K cancer %K oncology %K behavioral outcome predictions %K behavioral study %K behavioral outcomes %K feature selection %K deep learning %K neural network %K hybrid %K prediction %K predictive modeling %K patients with cancer %K deep learning models %K leukemia %K computational study %K computational biology %D 2025 %7 13.3.2025 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: The number of survivors of cancer is growing, and they often experience negative long-term behavioral outcomes due to cancer treatments. There is a need for better computational methods to handle and predict these outcomes so that physicians and health care providers can implement preventive treatments. Objective: This study aimed to create a new feature selection algorithm to improve the performance of machine learning classifiers to predict negative long-term behavioral outcomes in survivors of cancer. Methods: We devised a hybrid deep learning–based feature selection approach to support early detection of negative long-term behavioral outcomes in survivors of cancer. Within a data-driven, clinical domain–guided framework to select the best set of features among cancer treatments, chronic health conditions, and socioenvironmental factors, we developed a 2-stage feature selection algorithm, that is, a multimetric, majority-voting filter and a deep dropout neural network, to dynamically and automatically select the best set of features for each behavioral outcome. We also conducted an experimental case study on existing study data with 102 survivors of acute lymphoblastic leukemia (aged 15-39 years at evaluation and >5 years postcancer diagnosis) who were treated in a public hospital in Hong Kong. Finally, we designed and implemented radial charts to illustrate the significance of the selected features on each behavioral outcome to support clinical professionals’ future treatment and diagnoses. Results: In this pilot study, we demonstrated that our approach outperforms the traditional statistical and computation methods, including linear and nonlinear feature selectors, for the addressed top-priority behavioral outcomes. Our approach holistically has higher F1, precision, and recall scores compared to existing feature selection methods. The models in this study select several significant clinical and socioenvironmental variables as risk factors associated with the development of behavioral problems in young survivors of acute lymphoblastic leukemia. Conclusions: Our novel feature selection algorithm has the potential to improve machine learning classifiers’ capability to predict adverse long-term behavioral outcomes in survivors of cancer. %M 40080820 %R 10.2196/65001 %U https://bioinform.jmir.org/2025/1/e65001 %U https://doi.org/10.2196/65001 %U http://www.ncbi.nlm.nih.gov/pubmed/40080820 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60436 %T Coach-Assisted eHealth With Group or Individual Support for Employees With Obesity: Randomized Controlled Trial on Weight, Body Composition, and Health Metrics %A Männistö,Siniriikka A %A Pietiläinen,Kirsi H %A Muotka,Joona %A Suojanen,Laura-Unnukka %A Lappalainen,Raimo %A Korpela,Riitta %+ HealthyWeightHub, Endocrinology, Abdominal Center, Helsinki University Hospital and University of Helsinki, Tukholmankatu 8F, Helsinki, 00290, Finland, 358 442351020, siniriikka.mannisto@helsinki.fi %K eHealth %K weight loss %K acceptance and commitment therapy %K weight-neutral %K Healthy Weight Coaching %K occupational health %K digital health %K body composition %K obesity %K psychobehavioral %K intervention %K health care %K metabolic health %K physiological change %D 2025 %7 12.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Acceptance and commitment therapy provides a psychobehavioral framework feasible for digital and hybrid weight loss interventions. In face-to-face studies, group-based interventions yield more favorable outcomes than individual interventions, but the effect of the intervention form has not been studied in combination with eHealth. Objective: This study investigated whether a minimal, 3-session group or individual enhancement could provide additional benefits compared to an eHealth-only intervention when assessing weight, body composition, and laboratory metrics in a sample of occupational health patients with obesity. Methods: This study was a randomized controlled trial with a 12-month intervention, followed by a 12-month follow-up period without additional support (March 2021 to March 2023). Recruited from occupational health care for Finnish municipal employees, 111 working-age adults with a BMI of 30-40 kg/m2 were randomized to 1 of the 3 treatment arms: eHealth, eHealth+group, or eHealth+individual. All treatment arms received a web-administrated, coach-assisted eHealth program based on acceptance and commitment therapy, and additionally, the eHealth+group and eHealth+individual arms received 3 remotely facilitated group or individual meetings with their designated coach. The participants were assessed for weight, body composition, blood pressure, and laboratory measurements at 0-, 6-, 12-, and 24-month time points. Applying estimated means to decrease bias caused by dropouts, generalized estimating equations were used to study the differences between the 3 groups over time. Results: There were no between-group differences in primary measurements of weight change or categorical weight change. Secondary outcomes also did not show changes attributable to the intervention arm. Across the entire sample, the total weight loss was 1.5% during the intervention, with 18% (20/111) of the participants attaining a ≥5% weight loss. Sustained at follow-up, waist circumference decreased, and high-density lipoprotein cholesterol increased slightly. The participants completed, on average, 58.6% of the eHealth program. Conclusions: There were no differences in weight or other somatic health variables between the eHealth arm and intervention combining eHealth with minimal group or individual enhancement. Despite a modest overall weight loss, the intervention shows promise in improving body composition and metabolic health. Moving forward, further research is needed to determine if there is a threshold where face-to-face meetings provide additional benefits in hybrid interventions. Moreover, there is a need to explore for whom and under what conditions eHealth and hybrid models may be most effective. Trial Registration: ClinicalTrials.gov NCT04785586; https://clinicaltrials.gov/study/NCT04785586 %M 40073400 %R 10.2196/60436 %U https://www.jmir.org/2025/1/e60436 %U https://doi.org/10.2196/60436 %U http://www.ncbi.nlm.nih.gov/pubmed/40073400 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e60844 %T Longitudinal Associations Between Adolescents’ mHealth App Use, Body Dissatisfaction, and Physical Self-Worth: Random Intercept Cross-Lagged Panel Study %A Gulec,Hayriye %A Muzik,Michal %A Smahel,David %A Dedkova,Lenka %+ Interdisciplinary Research Team on Internet and Society, Faculty of Social Studies, Masaryk University, Joštova 10, Brno, 602 00, Czech Republic, 420 549 494 99, hayriyegulec@uludag.edu.tr %K mHealth app %K body dissatisfaction %K physical self-worth %K random intercept cross-lagged panel model %K RI-CLPM %K longitudinal study %K adolescent %D 2025 %7 11.3.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Longitudinal investigation of the association between mobile health (mHealth) app use and attitudes toward one’s body during adolescence is scarce. mHealth apps might shape adolescents’ body image perceptions by influencing their attitudes toward their bodies. Adolescents might also use mHealth apps based on how they feel and think about their bodies. Objective: This prospective study examined the longitudinal within-person associations between mHealth app use, body dissatisfaction, and physical self-worth during adolescence. Methods: The data were gathered from a nationally representative sample of Czech adolescents aged between 11 and 16 years (N=2500; n=1250, 50% girls; mean age 13.43, SD 1.69 years) in 3 waves with 6-month intervals. Participants completed online questionnaires assessing their mHealth app use, physical self-worth, and body dissatisfaction at each wave. The mHealth app use was determined by the frequency of using sports, weight management, and nutritional intake apps. Physical self-worth was assessed using the physical self-worth subscale of the Physical Self Inventory-Short Form. Body dissatisfaction was measured with the items from the body dissatisfaction subscale of the Eating Disorder Inventory-3. The random intercept cross-lagged panel model examined longitudinal within-person associations between the variables. A multigroup design was used to compare genders. Due to the missing values, the final analyses used data from 2232 adolescents (n=1089, 48.8% girls; mean age 13.43, SD 1.69 years). Results: The results revealed a positive within-person effect of mHealth app use on the physical self-worth of girls: increased mHealth app use predicted higher physical self-worth 6 months later (β=.199, P=.04). However, this effect was not consistent from the 6th to the 12th month: a within-person increase in using apps in the 6th month did not predict changes in girls’ physical self-worth in the 12th month (β=.161, P=.07). Regardless of gender, the within-person changes in the frequency of using apps did not influence adolescents’ body dissatisfaction. In addition, neither body dissatisfaction nor physical self-worth predicted app use frequency at the within-person level. Conclusions: This study highlighted that within-person changes in using mHealth apps were differentially associated with adolescents’ body-related attitudes. While increased use of mHealth apps did not influence body dissatisfaction across genders, it significantly predicted higher physical self-worth in adolescent girls 6 months later. A similar association was not observed among boys after 6 months. These findings indicate that using mHealth apps is unlikely to have a detrimental impact on adolescents’ body dissatisfaction and physical self-worth; instead, they may have a positive influence, particularly in boosting the physical self-worth of adolescent girls. %M 40068159 %R 10.2196/60844 %U https://mental.jmir.org/2025/1/e60844 %U https://doi.org/10.2196/60844 %U http://www.ncbi.nlm.nih.gov/pubmed/40068159 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e60156 %T Transcultural Adaptation, Validation, Psychometric Analysis, and Interpretation of the 22-Item Thai Senior Technology Acceptance Model for Mobile Health Apps: Cross-Sectional Study %A Buawangpong,Nida %A Siviroj,Penprapa %A Pinyopornpanish,Kanokporn %A Sirikul,Wachiranun %+ Department of Community Medicine, Faculty of Medicine, Chiang Mai University, 110 Intrawarorot road, Sriphum, Mueng, Chiang Mai, 50200, Thailand, 66 53935472, wachiranun.sir@cmu.ac.th %K STAM %K senior technology acceptance model %K validity %K reliability %K mHealth %K older adult %K technology acceptance %K mobile health %K app %K transcultural adaptation %K psychometric analysis %K geriatrics %K cross-sectional study %K Thai %K theory analysis %K Cronbach α %K McDonald ω %K quality of life %K well-being %K social media %K telehealth %K health informatics %K eHealth %K mobile phone %D 2025 %7 11.3.2025 %9 Original Paper %J JMIR Aging %G English %X Background: The rapid advancement of technology has made mobile health (mHealth) a promising tool to mitigate health problems, particularly among older adults. Despite the numerous benefits of mHealth, assessing individual acceptance is required to address the specific needs of older people and promote their intention to use mHealth. Objective: This study aims to adapt and validate the senior technology acceptance model (STAM) questionnaire for assessing mHealth acceptance in the Thai context. Methods: In this cross-sectional study, we adapted the original, 38-item, English version of the STAM using a 10-point Likert scale for mHealth acceptability among the Thai population. We translated the mHealth STAM into Thai using forward and backward translation. A total of 15 older adults and experts completed the pilot questionnaire and were interviewed to assess its validity. The pilot items of the Thai mHealth STAM were then reworded and revised for better comprehension and cross-cultural compatibility. The construct validity of the Thai mHealth STAM was evaluated by a multidimensional approach, including exploratory and confirmatory factor analysis and nonparametric item response theory analysis. Discriminative indices consisting of sensitivity, specificity, and area under the receiver operating characteristic (AUROC) were used to determine appropriate banding and discriminant validity for the intention to use mHealth. Internal consistency was assessed using Cronbach α and McDonald ω coefficients. Results: Out of the 1100 participants with a mean age of 62.3 (SD 8.8) years, 360 (32.7%) were adults aged 45-59 years, and 740 (67.3%) were older adults aged 60 years and older. Of the 40-item pilot questionnaire, exploratory factor analysis identified 22 items with factor loadings >0.4 across 7 principal components, explaining 91.45% of the variance. Confirmatory factor analysis confirmed that 9-dimensional sets of 22 items had satisfactory fit indices (comparative fit index=0.976, Tucker-Lewis index=0.968, root mean square error of approximation=0.043, standardized root mean squared residual=0.044, and R2 for each item>0.30). The score banding D (low≤151, moderate 152-180, and high≥181) was preferred as the optimal 22-item Thai mHealth STAM cutoff score based on the highest sensitivity of 89% (95% CI 86.1%-91.5%) and AUROC of 72.4% (95% CI 70%-74.8%) for predicting the intention to use mHealth. The final Thai mHealth STAM, consisting of 22 items, exhibited remarkable internal consistency, as evidenced by a Cronbach α of 0.88 (95% CI 0.87-0.89) and a McDonald ω of 0.85 (95% CI 0.83-0.87). For all 22 items, the corrected item-total correlations ranged between 0.26 and 0.71. Conclusions: The 22-item Thai mHealth STAM demonstrated satisfactory psychometric properties in both validity and reliability. The questionnaire has the potential to serve as a practical questionnaire in assessing the acceptance and intention to use mHealth among pre-older and older adults. %M 40068149 %R 10.2196/60156 %U https://aging.jmir.org/2025/1/e60156 %U https://doi.org/10.2196/60156 %U http://www.ncbi.nlm.nih.gov/pubmed/40068149 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55844 %T Effects of a Mobile Health Intervention Based on Behavioral Integrated Model on Cognitive and Behavioral Changes in Gestational Weight Management: Randomized Controlled Trial %A Zhou,Meng %A Wang,Li %A Deng,Ying %A Ge,Jinjin %A Zhao,Shiqi %A You,Hua %+ Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, China, 86 13382772548, youhua98@163.com %K cognition %K health behavior %K information-motivation-behavioral skills model %K mobile health %K psychological models %K pregnant woman %K randomized controlled trial %K mobile phone %D 2025 %7 10.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The key to gestational weight management intervention involves health-related behaviors, including dietary and exercise management. Behavioral theory-based interventions are effective in improving health-related behaviors. However, evidence for mobile health interventions based on specific behavioral theories is insufficient and their effects have not been fully elucidated. Objective: This study aimed to examine the effects of a gestational mobile health intervention on psychological cognition and behavior for gestational weight management, using an integrated behavioral model as the theoretical framework. Methods: This study was conducted in a tertiary maternity hospital and conducted as a single-blind randomized controlled trial (RCT) in Changzhou, Jiangsu Province, China. Using the behavioral model, integrated with the protection motivation theory and information–motivation–behavioral skills model (PMT-IMB model), the intervention group received a mobile health intervention using a self-developed app from 14 to 37 gestational weeks, whereas the control group received routine guidance through the application. Psychological cognition and behaviors related to weight management during pregnancy were the main outcomes, which were measured at baseline, and at the second and third trimesters of pregnancy using a self-designed questionnaire. Generalized estimation and regression equations were used to compare the outcome differences between the intervention and control groups. Results: In total, 302 (302/360, 83.9%) participants underwent all measurements at 3 time points (intervention group: n=150; control group: n=152). Compared with the control group, the intervention group had significantly higher scores for information, perceived vulnerability, response cost, and exercise management in the second trimester, while their scores for perceived vulnerability, response cost, and diet management were significantly higher in the third trimester. The results of repeated measures analysis revealed that, in psychological cognition, the information dimension exhibited both the time effects (T3 β=3.235, 95% CI 2.859-3.611; P<.001) and the group effects (β=0.597, 95% CI 0.035-1.158; P=.04). Similarly, response costs demonstrated both the time effects (T3 β=0.745, 95% CI 0.199-1.291; P=.008) and the group effects (β=1.034, 95% CI 0.367-1.700; P=.002). In contrast, perceived vulnerability solely exhibited the group effects (β=0.669, 95% CI 0.050-1.288; P=.03). Regarding weight management behaviors, both time (T3 β=6, 95% CI 4.527-7.473; P<.001) and group (β=2.685, 95% CI 0.323-5.047; P=.03) had statistically significant impacts on the total points. Furthermore, the exercise management dimension also demonstrated both the time effects (T3 β=3.791, 95% CI 2.999-4.584; P<.001) and the group effects (β=1.501, 95% CI 0.232-2.771; P=.02). Conclusions: The intervention program was effective in increasing psychological cognitions in terms of information, perceived vulnerability, and response costs, as well as promoting healthy behaviors among Chinese pregnant women. This study provides new evidence supporting the effectiveness of mobile intervention based on behavioral science theory in gestational weight management. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100043231; https://www.chictr.org.cn/showproj.html?proj=121736 %M 40063942 %R 10.2196/55844 %U https://www.jmir.org/2025/1/e55844 %U https://doi.org/10.2196/55844 %U http://www.ncbi.nlm.nih.gov/pubmed/40063942 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e52544 %T Benefits and Barriers to mHealth in Hypertension Care: Qualitative Study With German Health Care Professionals %A May,Susann %A Muehlensiepen,Felix %A Wengemuth,Eileen %A Seifert,Frances %A Heinze,Martin %A Bruch,Dunja %A Spethmann,Sebastian %+ Brandenburg Medical School Theodor Fontane, Center for Health Services Research, Faculty of Health Sciences, Seebad 82/83, Rüdersdorf, 15562, Germany, 49 3391 39 145 91, susann.may@mhb-fontane.de %K hypertension %K mHealth apps %K digital health %K physicians %K nurses %K HCP %K qualitative interviews %K health care professional %K cardiologists %K mHealth %K Germany %K general practitioners %K blood pressure monitoring %K qualitative study %K qualitative content analysis %D 2025 %7 10.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital health technologies, particularly mobile health (mHealth) apps and wearable devices, have emerged as crucial assets in the battle against hypertension. By enabling lifestyle modifications, facilitating home blood pressure monitoring, and promoting treatment adherence, these technologies have significantly enhanced hypertension treatment. Objective: This study aims to explore the perspectives of health care professionals (HCPs) regarding the perceived benefits and barriers associated with the integration of mHealth apps into routine hypertension care. Additionally, strategies for overcoming these barriers will be identified. Methods: Through qualitative analysis via semistructured interviews, general practitioners (n=10), cardiologists (n=14), and nurses (n=3) were purposefully selected between October 2022 and March 2023. Verbatim transcripts were analyzed using qualitative content analysis. Results: The results unveiled 3 overarching themes highlighting the benefits of mHealth apps in hypertension care from the perspective of HCPs. First, these technologies possess the potential to enhance patient safety by facilitating continuous monitoring and early detection of abnormalities. Second, they can empower patients, fostering autonomy in managing their health conditions, thereby promoting active participation in their care. Lastly, mHealth apps may provide valuable support to medical care by offering real-time data that aids in decision-making and treatment adjustments. Despite these benefits, the study identified several barriers hindering the seamless integration of mHealth apps into hypertension care. Challenges predominantly revolved around data management, communication contexts, daily routines, and system handling. HCPs underscored the necessity for structural and procedural modifications in their daily practices to effectively address these challenges. Conclusions: In conclusion, the effective usage of digital tools such as mHealth apps necessitates overcoming various obstacles. This entails meeting the information needs of both HCPs and patients, tackling interoperability issues to ensure seamless data exchange between different systems, clarifying uncertainties surrounding reimbursement policies, and establishing the specific clinical benefits of these technologies. Active engagement of users throughout the design and implementation phases is crucial for ensuring the usability and acceptance of mHealth apps. Moreover, enhancing knowledge accessibility through the provision of easily understandable information about mHealth apps is essential for eliminating barriers and fostering their widespread adoption in hypertension care. Trial Registration: German Clinical Trials Register DRKS00029761; https://drks.de/search/de/trial/DRKS00029761 International Registered Report Identifier (IRRID): RR2-10.3389/fcvm.2022.1089968 %M 40063928 %R 10.2196/52544 %U https://humanfactors.jmir.org/2025/1/e52544 %U https://doi.org/10.2196/52544 %U http://www.ncbi.nlm.nih.gov/pubmed/40063928 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64239 %T Evaluation of the MyFertiCoach Lifestyle App for Subfertile Couples: Single-Center Evaluation of Augmented Standard Care %A Smeenk,Jesper %A Smit,Ellen %A Jacobs,Marc %A van Rooij,Ilse %+ Elisabeth TweeSteden Ziekenhuis, Doctor Deelenlaan 5, Tilburg, 5042 AD, The Netherlands, 31 (013) 221 00 00, j.smeenk@etz.nl %K fertility %K mHealth %K pregnancy %K lifestyle %K app %K smartphone %D 2025 %7 10.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Many couples undergoing fertility treatment face multiple lifestyle risk factors that lower their chances of achieving pregnancy. The MyFertiCoach (MFC) app was designed as an integrated lifestyle program featuring modules on healthy weight management, nutrition, exercise, quitting smoking, reducing alcohol and drug use, and managing stress. We hypothesized that supplementing standard care with the MFC app would improve lifestyle outcomes. Objective: This study aims to assess the impact of the MFC app on changing multiple lifestyle habits in women seeking fertility treatment. The primary outcome is the change in the total risk score (TRS) at 3- and six-month follow-ups. The TRS is calculated for each individual as the sum of all risk scores per behavior (eg, vegetable/fruit/folic acid intake, smoking, and alcohol use) at 3 and 6 months. A higher TRS indicates unhealthier nutrition and lifestyle habits and a lower likelihood of achieving pregnancy. The secondary endpoints include changes in BMI, activity score, preconception dietary risk score, distress score (eg, perceived burden), smoking habits, alcohol intake, and program adherence. Methods: This retrospective, observational, single-center evaluation included patients between January 1, 2022, and December 31, 2023. Subfertile female patients aged 18-43 years and their partners, who were referred to a gynecologist, were invited to participate in online lifestyle coaching via the MFC app. The gynecologist selected relevant lifestyle modules based on the results of integrated screening questionnaires. We used (hierarchical) linear mixed models (LMMs) to estimate changes in outcomes. For missing data patterns deemed missing not at random, joint modeling was applied. Statistical significance was set at P≤.05, with methods in place to maintain the same false-positive rate. Results: A total of 1805 patients were invited to participate in the evaluation, with an average of 737 (40.83%) completing the screening questionnaire at baseline. For the TRS, 798 (44.21%) patients were included at baseline, of whom 517 (64.8%) involved their partner. On average, 282 of 744 (37.9%) patients submitted at least one follow-up questionnaire. Patients rated the app above average (n=137, median score of 7 on a 1-10 scale) on days 7 and 14. The TRS decreased by an average of 1.5 points (P<.001) at T3 and T6 compared with baseline, a clinically meaningful improvement. All secondary outcomes showed statistically significant positive changes for patients who used a relevant lifestyle module (P<.001). Most improvements were achieved by 3 months and remained significant at 6 months (P<.001), except for alcohol intake (P<.53). These findings were consistent across both LMMs and joint models. Conclusions: Our evaluation of a mobile health app integrated into standard care demonstrates immediate and clinically meaningful improvements in key lifestyle parameters among women seeking to become pregnant. Additional scientific research is needed to identify the causal pathways leading to sustained effectiveness. To maintain and enhance these outcomes, further tailoring of patient-specific programs is essential. %M 40063944 %R 10.2196/64239 %U https://formative.jmir.org/2025/1/e64239 %U https://doi.org/10.2196/64239 %U http://www.ncbi.nlm.nih.gov/pubmed/40063944 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60102 %T Optimizing Engagement With a Smartphone App to Prevent Violence Against Adolescents: Results From a Cluster Randomized Factorial Trial in Tanzania %A Janowski,Roselinde %A Cluver,Lucie D %A Shenderovich,Yulia %A Wamoyi,Joyce %A Wambura,Mwita %A Stern,David %A Clements,Lily %A Melendez-Torres,G J %A Baerecke,Lauren %A Ornellas,Abigail %A Chetty,Angelique Nicole %A Klapwijk,Jonathan %A Christine,Laetitia %A Mukabana,Ateamate %A Te Winkel,Esmee %A Booij,Anna %A Mbosoli,Gervas %A Lachman,Jamie M %+ Department of Social Policy and Intervention, University of Oxford, Barnett House, 32-37 Wellington Square, Oxford, OX1 2ER, United Kingdom, 44 01865270325, roselinde.janowski@spi.ox.ac.uk %K digital health %K engagement %K parenting %K adolescents %K low- and middle-income country %K violence against children %K Multiphase Optimization Strategy %K randomized factorial experiment %K mobile phone %D 2025 %7 10.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Violence and abuse exert extensive health, social, and economic burdens on adolescents in low- and middle-income countries. Digital parenting interventions are promising for mitigating risks at scale. However, their potential for public health impact hinges on meaningful engagement with the digital platform. Objective: The objective of this study was to evaluate the impact of 3 intervention design and implementation factors aimed at increasing engagement with a noncommercialized, offline-first smartphone app for caregivers of adolescents in Tanzania, in partnership with the United Nations Children’s Fund, the World Health Organization, and the Tanzanian national government. Methods: Following Multiphase Optimization Strategy (MOST) principles, we conducted a 2×2×2 cluster randomized factorial trial involving caregivers of adolescents aged 10 to 17 years. Caregivers were recruited by community representatives from 16 urban and periurban communities (ie, clusters) in the Mwanza region of Tanzania. Each cluster was randomized to 1 of 2 levels of each factor: guidance (self-guided or guided via facilitator-moderated WhatsApp groups), app design (structured or unstructured), and preprogram digital support (basic or enhanced). Primary outcomes were automatically tracked measures of engagement (app launches, modules completed, and home practice activities reviewed), with secondary outcomes including modules started, time spent in the app, and positive behaviors logged. Generalized linear mixed-effects models assessed the impact of experimental factors on engagement. Results: Automatically tracked engagement data from 614 caregivers were analyzed, of which 205 (33.4%) were men. Compared to self-guided participants, receiving guidance alongside the app led to significantly more app launches (mean ratio [MR] 2.93, 95% CI 1.84-4.68; P<.001), modules completed (MR 1.29, 95% CI 1.05-1.58; P=.02), modules started (MR 1.20, 95% CI 1.02-1.42; P=.03), time spent in the app (MR 1.45, 95% CI 1.39-1.51; P<.001), and positive behavior logs (MR 2.73, 95% CI 2.07-3.60; P<.001). Compared to the structured design, unstructured design use resulted in significantly more modules completed (MR 1.49, 95% CI 1.26-1.76; P<.001), home practice activity reviews (MR 7.49, 95% CI 5.19-10.82; P<.001), modules started (MR 1.27, 95% CI 1.06-1.52; P=.01), time spent in the app (MR 1.84, 95% CI 1.70-1.99; P<.001), and positive behavior logs (MR 55.68, 95% CI 16.48-188.14; P<.001). While analyses did not detect an effect of enhanced digital support on directly observed engagement, the combination of enhanced digital support and guidance positively influenced engagement across a range of outcomes. Conclusions: This study is the first to systematically optimize engagement with a digital parenting intervention in a low- and middle-income country. Our findings offer important learnings for developing evidence-based, scalable digital interventions in resource-constrained settings. Trial Registration: Pan-African Clinical Trial Registry PACTR202210657553944; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24051 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-023-15989-x %M 40063069 %R 10.2196/60102 %U https://www.jmir.org/2025/1/e60102 %U https://doi.org/10.2196/60102 %U http://www.ncbi.nlm.nih.gov/pubmed/40063069 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e59660 %T Applying AI in the Context of the Association Between Device-Based Assessment of Physical Activity and Mental Health: Systematic Review %A Woll,Simon %A Birkenmaier,Dennis %A Biri,Gergely %A Nissen,Rebecca %A Lutz,Luisa %A Schroth,Marc %A Ebner-Priemer,Ulrich W %A Giurgiu,Marco %+ Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Hertzstrasse 16, Karlsruhe, 76187, Germany, 49 721 608 ext 41974, simon.woll@kit.edu %K machine learning %K mental health %K wearables %K physical behavior %K artificial intelligence %K mobile phone %K smartphone %D 2025 %7 6.3.2025 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Wearable technology is used by consumers worldwide for continuous activity monitoring in daily life but more recently also for classifying or predicting mental health parameters like stress or depression levels. Previous studies identified, based on traditional approaches, that physical activity is a relevant factor in the prevention or management of mental health. However, upcoming artificial intelligence methods have not yet been fully established in the research field of physical activity and mental health. Objective: This systematic review aims to provide a comprehensive overview of studies that integrated passive monitoring of physical activity data measured via wearable technology in machine learning algorithms for the detection, prediction, or classification of mental health states and traits. Methods: We conducted a review of studies processing wearable data to gain insights into mental health parameters. Eligibility criteria were (1) the study uses wearables or smartphones to acquire physical behavior and optionally other sensor measurement data, (2) the study must use machine learning to process the acquired data, and (3) the study had to be published in a peer-reviewed English language journal. Studies were identified via a systematic search in 5 electronic databases. Results: Of 11,057 unique search results, 49 published papers between 2016 and 2023 were included. Most studies examined the connection between wearable sensor data and stress (n=15, 31%) or depression (n=14, 29%). In total, 71% (n=35) of the studies had less than 100 participants, and 47% (n=23) had less than 14 days of data recording. More than half of the studies (n=27, 55%) used step count as movement measurement, and 44% (n=21) used raw accelerometer values. The quality of the studies was assessed, scoring between 0 and 18 points in 9 categories (maximum 2 points per category). On average, studies were rated 6.47 (SD 3.1) points. Conclusions: The use of wearable technology for the detection, prediction, or classification of mental health states and traits is promising and offers a variety of applications across different settings and target groups. However, based on the current state of literature, the application of artificial intelligence cannot realize its full potential mostly due to a lack of methodological shortcomings and data availability. Future research endeavors may focus on the following suggestions to improve the quality of new applications in this context: first, by using raw data instead of already preprocessed data. Second, by using only relevant data based on empirical evidence. In particular, crafting optimal feature sets rather than using many individual detached features and consultation with in-field professionals. Third, by validating and replicating the existing approaches (ie, applying the model to unseen data). Fourth, depending on the research aim (ie, generalization vs personalization) maximizing the sample size or the duration over which data are collected. %M 40053765 %R 10.2196/59660 %U https://mhealth.jmir.org/2025/1/e59660 %U https://doi.org/10.2196/59660 %U http://www.ncbi.nlm.nih.gov/pubmed/40053765 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e63805 %T An Actor-Partner Interdependence Mediation Model for Assessing the Association Between Health Literacy and mHealth Use Intention in Dyads of Patients With Chronic Heart Failure and Their Caregivers: Cross-Sectional Study %A Jin,Xiaorong %A Zhang,Yimei %A Zhou,Min %A Mei,Qian %A Bai,Yangjuan %A Hu,Qiulan %A Wei,Wei %A Zhang,Xiong %A Ma,Fang %K chronic heart failure %K caregivers %K health literacy %K mHealth %K actor-partner interdependence mediation model %K mobile health %D 2025 %7 6.3.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Chronic heart failure (CHF) has become a serious threat to the health of the global population. Self-management is the key to treating CHF, and the emergence of mobile health (mHealth) has provided new ideas for the self-management of CHF. Despite the many potential benefits of mHealth, public utilization of mHealth apps is low, and poor health literacy (HL) is a key barrier to mHealth use. However, the mechanism of the influence is unclear. Objective: The aim of this study is to explore the dyadic associations between HL and mHealth usage intentions in dyads of patients with CHF and their caregivers, and the mediating role of mHealth perceived usefulness and perceived ease of use in these associations. Methods: This study had a cross-sectional research design, with a sample of 312 dyads of patients with CHF who had been hospitalized in the cardiology departments of 2 tertiary care hospitals in China from March to October 2023 and their caregivers. A general information questionnaire, the Chinese version of the Heart Failure-Specific Health Literacy Scale, and the mHealth Intention to Use Scale were used to conduct the survey; the data were analyzed using the actor-partner interdependence mediation model. Results: The results of the actor-partner interdependent mediation analysis of HL, perceived usefulness of mHealth, and mHealth use intention among patients with CHF and their caregivers showed that all of the model’s actor effects were valid (β=.26‐0.45; P<.001), the partner effects were partially valid (β=.08‐0.20; P<.05), and the mediation effects were valid (β=.002‐0.242, 95% CI 0.003‐0.321; P<.05). Actor-partner interdependent mediation analyses of HL, perceived ease of use of mHealth, and mHealth use intention among patients with CHF and caregivers showed that the model’s actor effect partially held (β=.17‐0.71; P<.01), the partner effect partially held (β=.15; P<.01), and the mediation effect partially held (β=.355‐0.584, 95% CI 0.234‐0.764; P<.001). Conclusions: Our study proposes that the HL of patients with CHF and their caregivers positively contributes to their own intention to use mHealth, suggesting that the use of mHealth by patients with CHF can be promoted by improving the HL of patients and caregivers. Our findings also suggest that the perceived usefulness of patients with CHF and caregivers affects patients’ mHealth use intention, and therefore patients with CHF and their caregivers should be involved throughout the mHealth development process to improve the usability of mHealth for both patients and caregivers. This study emphasizes the key role of patients’ perception that mHealth is easy to use in facilitating their use of mHealth. Therefore, it is recommended that the development of mHealth should focus on simplifying operational procedures and providing relevant operational training according to the needs of the patients when necessary. %R 10.2196/63805 %U https://mhealth.jmir.org/2025/1/e63805 %U https://doi.org/10.2196/63805 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e58715 %T Preadolescent Children Using Real-Time Heart Rate During Moderate to Vigorous Physical Activity: A Feasibility Study %A Lu,Lincoln %A Jake-Schoffman,Danielle E %A Lavoie,Hannah A %A Agharazidermani,Maedeh %A Boyer,Kristy Elizabeth %+ LearnDialogue Lab, Computer and Information Science and Engineering, University of Florida, 1889 Museum Road, Gainesville, FL, 32611, United States, 1 352 392 1133, lincolnlu@ufl.edu %K smartphone app %K physical activity %K heart rate %K wearable sensors %K youth %K commercial wearable device %K Garmin %K mobile phone %D 2025 %7 6.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Given the global burden of insufficient physical activity (PA) in children, effective behavioral interventions are needed to increase PA levels. Novel technologies can help expand the reach and accessibility of these programs. Despite the potential to use heart rate (HR) to target moderate- to vigorous-intensity PA (MVPA), most HR research to date has focused on the accuracy of HR devices or used HR for PA surveillance rather than as an intervention tool. Furthermore, most commercial HR sensors are designed for adults, and their suitability for children is unknown. Further research about the feasibility and usability of commercial HR devices is required to understand how children may use HR during PA. Objective: This study aimed to explore the use of a chest-worn HR sensor paired with a real-time HR display as an intervention tool among preadolescent children and the usability of a custom-designed app (Connexx) for viewing real-time HR. Methods: We developed Connexx, an HR information display app with an HR analytics portal to view HR tracking. Children were recruited via flyers distributed at local public schools, word of mouth, and social media posts. Eligible participants were children aged 9 to 12 years who did not have any medical contraindications to MVPA. Participants took part in a single in-person study session where they monitored their own HR using a commercial HR sensor, learned about HR, and engaged in a series of PAs while using the Connexx app to view their real-time HR. We took field note observations about participant interactions with the HR devices. Participants engaged in a semistructured interview about their experience using Connexx and HR during PA and completed the System Usability Scale (SUS) about the Connexx app. Study sessions were audio and video recorded and transcribed verbatim. Results: A total of 11 participants (n=6, 55% male; n=9, 82%, non-Hispanic White) with an average age of 10.4 (SD 1.0) years were recruited for the study. Data from observations, interviews, and SUS indicated that preadolescent children can use real-time HR information during MVPA. Observational and interview data indicated that the participants were able to understand their HR after a basic lesson and demonstrated the ability to make use of their HR information during PA. Interview and SUS responses demonstrated that the Connexx app was highly usable, despite some accessibility challenges (eg, small display font). Feedback about usability issues has been incorporated into a redesign of the Connexx app, including larger, color-coded fonts for HR information. Conclusions: The results of this study indicate that preadolescent children understood their HR data and were able to use it in real time during PA. The findings suggest that future interventions targeting MVPA in this population should test strategies to use HR and HR monitoring as direct program targets. %M 40053729 %R 10.2196/58715 %U https://humanfactors.jmir.org/2025/1/e58715 %U https://doi.org/10.2196/58715 %U http://www.ncbi.nlm.nih.gov/pubmed/40053729 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60486 %T Feasibility and Links Between Emotions, Physical States, and Eating Behavior in Patients After Metabolic Bariatric Surgery: Experience Sampling Study %A Kuipers,Ellen A M %A Timmerman,Josien G %A van Det,Marc J %A Vollenbroek-Hutten,Miriam M R %+ Department of Surgery, Hospital Group Twente, Zilvermeeuw 1, Almelo, 7609 PP, The Netherlands, 31 620024496, el.kuipers@zgt.nl %K feasibility %K experience sampling methodology %K metabolic bariatric surgery %K eating behavior %K positive and negative affect %K physical states %K contextual factors %K mobile phone %D 2025 %7 5.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Lifestyle modification is essential to achieve and maintain successful outcomes after metabolic bariatric surgery (MBS). Emotions, physical states, and contextual factors are considered important determinants of maladaptive eating behavior, emphasizing their significance in understanding and addressing weight management. In this context, experience sampling methodology (ESM) offers promise for measuring lifestyle and behavior in the patient’s natural environment. Nevertheless, there is limited research on its feasibility and association among emotions and problematic eating behavior within the population after MBS. Objective: This study aimed to examine the feasibility of ESM in the population after MBS regarding emotions, physical states, contextual factors, and problematic eating behavior, and to explore the temporal association among these variables. Methods: An experience sampling study was conducted in which participants rated their current affect (positive and negative), physical states (disgust, boredom, fatigue, and hunger), contextual factors (where, with whom, and doing what), and problematic eating behavior (ie, grazing, dietary relapse, craving, and binge eating) via smartphone-based ESM questionnaires at 6 semirandom times daily for 14 consecutive days. Feasibility was operationalized as the study’s participation rate and completion rate, compliance in answering ESM questionnaires, and response rates per day. At the end of the study period, patients reflected on the feasibility of ESM in semistructured interviews. Generalized estimation equations were conducted to examine the temporal association between emotions, physical states, contextual factors, and problematic eating behavior. Results: In total, 25 out of 242 participants consented to participate, resulting in a study participation rate of 10.3%. The completion rate was 83%. Overall compliance was 57.4% (1072/1868), varying from 13% (11/84) to 89% (75/84) per participant. Total response rates per day decreased from 65% (90/138) to 52% (67/130) over the 14-day study period. According to the interviews, ESM was considered feasible and of added value. Temporal associations were found for hunger and craving (odds ratio 1.04, 95% CI 1.00-1.07; P=.03), and for positive affect and grazing (odds ratio 1.61, 95% CI 1.03-2.51; P=.04). Conclusions: In this exploratory study, patients after MBS were not amenable to participate. Only a small number of patients were willing to participate. However, those who participated found it feasible and expressed satisfaction with it. Temporal associations were identified between hunger and craving, as well as between positive affect and grazing. However, no clear patterns were observed among emotions, physical states, context, and problematic eating behaviors. %M 40053719 %R 10.2196/60486 %U https://formative.jmir.org/2025/1/e60486 %U https://doi.org/10.2196/60486 %U http://www.ncbi.nlm.nih.gov/pubmed/40053719 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67386 %T Internet-Based Cognitive Behavioral Therapy for Preventing Postpartum Depressive Symptoms Among Pregnant Individuals With Depression: Multicenter Randomized Controlled Trial in China %A Duan,Chen-Chi %A Zhang,Chen %A Xu,Hua-Lin %A Tao,Jing %A Yu,Jia-Le %A Zhang,Dan %A Wu,Shan %A Zeng,Xiu %A Zeng,Wan-Ting %A Zhang,Zhi-Yin %A Dennis,Cindy-Lee %A Liu,Han %A Wu,Jia-Ying %A Mol,Ben Willem J %A Huang,He-Feng %A Wu,Yan-Ting %+ Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, No.419, Fangxie Rd, Shanghai, 200000, China, 86 17321218018, yanting_wu@163.com %K antenatal depression %K postpartum depression %K internet-based cognitive behavioral therapy %K randomized controlled trial %D 2025 %7 4.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Women are particularly vulnerable to depression during pregnancy, which is one of the strongest risk factors for developing postpartum depression (PPD). Addressing antenatal depressive symptoms in these women is crucial for preventing PPD. However, little is known about the effectiveness of internet-based cognitive behavioral therapy (ICBT) in preventing PPD in this high-risk group. Objective: This study aims to evaluate the short- and long-term effects of ICBT in preventing PPD among women with antenatal depressive symptoms. Methods: Participants were screened for antenatal depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) and randomly allocated (1:1) to either the ICBT group (receiving weekly online modules starting antenatally and continuing into early postpartum) or the control group (observed without treatment). Follow-up assessments were conducted up to 12 months postpartum, and data were analyzed using generalized estimating equations. The primary outcome was the prevalence of depressive symptoms at 6 weeks postpartum. A subgroup analysis based on the severity of antenatal depressive symptoms was also performed. The secondary outcomes included the long-term effects of ICBT on maternal depression, as well as its impact on anxiety, sleep quality, social support, parenting stress, co-parenting relationships, and infant development. Results: Between August 2020 and September 2021, 300 pregnant individuals were recruited from 5 centers across China. No significant differences were observed in depressive symptoms at 6 weeks postpartum (P=.18) or at any longer-term follow-up time points (P=.18). However, a post hoc subgroup analysis showed that participants with antenatal EPDS scores of 10-12 in the ICBT group had a lower risk of developing depression during the first year postpartum (odds ratio 0.534, 95% CI 0.313-0.912; P=.02), but this was not observed for participants with more severe depression. Additionally, this subgroup demonstrated higher levels of co-parenting relationships (P=.02). Conclusions: Among individuals with antenatal depression, ICBT did not prevent the development of PPD. However, ICBT may be a preferable option for those with mild to moderate antenatal depressive symptoms. Future research is needed to explore modifications to ICBT to address more severe depressive symptoms. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000033433; https://www.chictr.org.cn/showproj.html?proj=54482 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-022-06728-5 %M 40053801 %R 10.2196/67386 %U https://www.jmir.org/2025/1/e67386 %U https://doi.org/10.2196/67386 %U http://www.ncbi.nlm.nih.gov/pubmed/40053801 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e60185 %T Effect of a Gamified Family-Based Exercise Intervention on Adherence to 24-Hour Movement Behavior Recommendations in Preschool Children: Single-Center Pragmatic Trial %A Legarra-Gorgoñon,Gaizka %A García-Alonso,Yesenia %A Ramírez-Vélez,Robinson %A Alonso-Martínez,Loreto %A Izquierdo,Mikel %A Alonso-Martínez,Alicia M %K children %K gamification %K exercise %K physical fitness %K domains of physical activity %K game %K fitness %K child %K family-based %K exercise program %K randomized controlled trial %K strength %D 2025 %7 4.3.2025 %9 %J JMIR Serious Games %G English %X Background: Adherence to 24-hour movement behavior recommendations, including physical activity (PA), sedentary time, and sleep, is essential for the healthy development of preschool children. Gamified family-based interventions have shown the potential to improve adherence to these guidelines, but evidence of their effectiveness among children is limited. Objective: This study aimed to evaluate the effectiveness of a gamified family-based exercise intervention in promoting adherence to 24-hour movement behavior recommendations among preschool-aged children. Methods: This 12-week study is a single-center, pragmatic randomized controlled trial that included 80 preschool children (56% boys) and their families, who were randomly assigned to either the gamification group (n=40) or the control group (n=40). The “3, 2, 1 Move on Study” incorporates family-oriented physical activities and gamification techniques to increase PA domains, reduce sedentary behavior, and improve sleep patterns. The primary outcome was to increase moderate to vigorous PA (MVPA) by 5 minutes/day, as measured by accelerometer at follow-up. Accelerometer-determined daily time spent (PA domains, sedentary behavior, and sleep), physical fitness (cardiorespiratory, speed-agility, muscular, physical fitness z-score), basic motor competencies (self-movement and object movement), and executive function (memory, cognitive flexibility, and inhibitory control) were also included as secondary outcomes. Results: The 71 participants included in the per-protocol analyses (32 girls, 45%; 39 boys, 55%) had a mean (SD) age of 5.0 (0.5) years. Change in MVPA per day after the intervention (12 weeks) increased in both groups by +25.3 (SD 24.6) minutes/day in the gamification group and +10.0 (SD 31.4) minutes/day in the routine care group, but no significant between-group differences were observed (8.62, 95% CI –5.72 to 22.95 minutes/day, ηp2=.025; P=.23). The analysis of secondary outcomes showed significant between-group mean differences in the change in physical behaviors derived from the accelerometers from baseline to follow-up of 26.44 (95% CI 8.93 to 43.94) minutes/day in favor of light PA (ηp2=.138; P=.01) and 30.88 (95% CI 4.36 to 57.41) minutes/day in favor of total PA, which corresponds to a large effect size (ηp2=.087; P=.02). Likewise, the gamification group substantially increased their score in standing long jump and physical fitness z-score from baseline (P<.05). Conclusions: In the “3, 2, 1 Move on Study,” a gamified intervention showed a modest but relevant increase in MVPA and other domains of 24-hour movement behavior among preschool-aged children. Therefore, gamified family-based interventions may provide a viable alternative to improve adherence to 24-hour movement behavior recommendations. Trial Registration: ClinicalTrials.gov NCT05741879; https://clinicaltrials.gov/study/NCT05741879?tab=history %R 10.2196/60185 %U https://games.jmir.org/2025/1/e60185 %U https://doi.org/10.2196/60185 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55592 %T Utilization and Experiences of Using Quit Now, a Nicotine and Tobacco Smoking Cessation Website: Thematic Analysis %A Salaheddin,Tala %A Sharma,Ramona H %A Fajardo,Marcela %A Panter,Cameron %A De Souza,Lauren %A Matano,Sheila Kanyevu %A Struik,Laura %+ Doctor of Medicine Program, Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada, 1 6048222211, talasala@student.ubc.ca %K smoking cessation %K user experiences %K nicotine %K vaping %K web-based %K Google Analytics %K thematic analysis %K digital health %K nicotine replacement therapy %K quit attempts %K tobacco %K British Columbia %K behavioral support %K pharmacotherapy %K qualitative interview %K cessation support %K QuitNow %K mobile health %K mHealth %K intervention %D 2025 %7 4.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: British Columbia residents have access to a program called QuitNow that provides behavioral support and information about pharmacotherapy to nicotine and tobacco users. Web- or computer-based smoking cessation programs have been shown to yield an abstinence rate about 1.5 times higher when compared to a control. Although quantitative evidence reveals significant promise for web-based services like QuitNow, there is very little qualitative evidence available. Understanding website utilization and the experiences of end users is key to contextualizing the effectiveness of web-based cessation services and providing directions for enhancing these services. Objective: This qualitative interview study aims to delve into users’ utilization and experiences of QuitNow, which is supplemented by Google Analytics data. Methods: We interviewed 10 QuitNow users using semistructured interviews to understand what they liked the most and the least about QuitNow. We transcribed these interviews and conducted an inductive thematic analysis using NVivo (QSR International) software to extract common themes about user experiences. We also gathered utilization metrics via Google Analytics (n=13,856 users) to understand which aspects of QuitNow were used the most and which were used the least during the study period. Results: Thematic analysis yielded four major themes: (1) barriers to information access reduce opportunities to take action, (2) lack of clarity around pharmacological options is discouraging, (3) hearing from others is an important part of the journey, and (4) recognizing own agency throughout the quit process. These themes provided context and support for the Google Analytics data, which showed that end user activity, measured by indicators such as page views and average time spent on each page, was highest on pages about how to quit (10,393 page views), pharmacology information (1999 page views), and the community forum (11,560 page views). Conclusions: Results of this study point to several important implications for improving the website, as well as directions for enhancing cessation support services in general. %M 40053769 %R 10.2196/55592 %U https://www.jmir.org/2025/1/e55592 %U https://doi.org/10.2196/55592 %U http://www.ncbi.nlm.nih.gov/pubmed/40053769 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e60096 %T Understanding Appropriation of Digital Self-Monitoring Tools in Mental Health Care: Qualitative Analysis %A de Thurah,Lena %A Kiekens,Glenn %A Weermeijer,Jeroen %A Uyttebroek,Lotte %A Wampers,Martien %A Bonnier,Rafaël %A Myin-Germeys,Inez %K digital self-monitoring %K technology appropriation %K experience sampling method %K mental health care %K mental health %K self-monitoring %K digital health %K adoption %K implementation %K thematic %K usability %K interview %K experience %K attitude %K opinion %K perception %K perspective %K acceptance %D 2025 %7 3.3.2025 %9 %J JMIR Hum Factors %G English %X Background: Digital self-monitoring tools, such as the experience sampling method (ESM), enable individuals to collect detailed information about their mental health and daily life context and may help guide and support person-centered mental health care. However, similar to many digital interventions, the ESM struggles to move from research to clinical integration. To guide the implementation of self-monitoring tools in mental health care, it is important to understand why and how clinicians and clients adopted, adapted, and incorporated these tools in practice. Objective: Therefore, this study examined how clinicians and clients within a psychiatric center appropriated an ESM-based self-monitoring tool within their therapy. Methods: Twelve clinicians and 24 clients participated in the piloting of the ESM tool, IMPROVE. After utilizing the tool, 7 clinicians and 11 clients took part in semistructured interviews. A thematic framework analysis was performed focusing on participants’ prior knowledge and expectations, actual use in practice, and potential future use of ESM tools. Results: Many participants experienced that the ESM tool provided useful information about clients’ mental health, especially when clinicians and clients engaged in collaborative data interpretation. However, clinicians experienced several mismatches between system usability and their technical competencies, and many clients found it difficult to comply with the self-assessments. Importantly, most participants wanted to use digital self-monitoring tools in the future. Conclusions: Clinicians’ and clients’ choice to adopt and integrate self-monitoring tools in their practice seems to depend upon the perceived balance between the added benefits and the effort required to achieve them. Enhancing user support or redesigning ESM tools to reduce workload and data burden could help overcome implementation barriers. Future research should involve end users in the development of ESM self-monitoring tools for mental health care and further investigate the perspectives of nonadopters. %R 10.2196/60096 %U https://humanfactors.jmir.org/2025/1/e60096 %U https://doi.org/10.2196/60096 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64661 %T Identifying Food Preferences and Malnutrition in Older Adults in Care Homes: Co-Design Study of a Digital Nutrition Assessment Tool %A Connelly,Jenni %A Swingler,Kevin %A Rodriguez-Sanchez,Nidia %A Whittaker,Anna C %+ Faculty of Health Sciences and Sport, University of Stirling, 3a74a Cottrell Building, Stirling, FK9 4LA, United Kingdom, 44 1786 466399, jenni.connelly1@stir.ac.uk %K ageing %K digital technology %K dietary measurement %K care homes %K co-design %K dietary intake %K food diary %D 2025 %7 3.3.2025 %9 Original Paper %J JMIR Aging %G English %X Background: Malnutrition is a challenge among older adults and can result in serious health consequences. However, the dietary intake monitoring needed to identify malnutrition for early intervention is affected by issues such as difficulty remembering or needing a dietitian to interpret the results. Objective: This study aims to co-design a tool using automated food classification to monitor dietary intake and food preferences, as well as food-related symptoms and mood and hunger ratings, for use in care homes. Methods: Participants were 2 separate advisory groups and 2 separate sets of prototype testers. The testers for the first prototype were 10 community-dwelling older adults based in the Stirlingshire area in Scotland who noted their feedback on the tool over 2 weeks in a food diary. The second set of testers consisted of 14 individuals (staff: n=8, 57%; and residents: n=6, 43%) based in 4 care homes in Scotland who provided feedback via interview after testing the tool for a minimum of 3 days. In addition, 130 care home staff across the United Kingdom completed the web-based survey on the tool’s needs and potential routes to pay for it; 2 care home managers took part in follow-up interviews. Data were collected through food diaries, a web-based survey, audio recordings and transcriptions of focus groups and interviews, and research notes. Systematic text condensation was used to describe themes across the different types of data. Results: Key features identified included ratings of hunger, mood, and gastrointestinal symptoms that could be associated with eating specific foods, as well as a traffic light system to indicate risk. Issues included staff time, Wi-Fi connectivity, and the accurate recognition of pureed food and fortified meals. Different models for potential use and commercialization were identified, including peer support among residents to assist those considered less able, staff-only use of the tool, care home–personalized database menus for easy meal photo selection, and targeted monitoring of residents considered to be at the highest risk using the traffic light system. Conclusions: The tool was deemed useful for monitoring dietary habits and associated symptoms, but necessary design improvements were identified. These should be incorporated before formal evaluation of the tool as an intervention in this setting. Co-design was vital to help make the tool fit for the intended setting and users. %M 40053797 %R 10.2196/64661 %U https://aging.jmir.org/2025/1/e64661 %U https://doi.org/10.2196/64661 %U http://www.ncbi.nlm.nih.gov/pubmed/40053797 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e55603 %T Evaluation of the Clear Fear Smartphone App for Young People Experiencing Anxiety: Uncontrolled Pre– and Post–Follow-Up Study %A Samele,Chiara %A Urquia,Norman %A Edwards,Rachel %A Donnell,Katie %A Krause,Nihara %+ , stem4, Connect House, 133-137 Alexandra Road, Wimbledon, London, SW19 7JY, United Kingdom, 44 7956396375, dr.nihara.krause@stem4.org.uk %K mental health %K anxiety %K depression %K emotional and behavioral difficulties %K mobile phone app %K cognitive behavioral therapy %K digital tool %K young people %K mobile phone %D 2025 %7 28.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health apps are proving to be an important tool for increasing access to psychological therapies early on, particularly with rising rates of anxiety and depression in young people. Objective: We aimed to assess the usability, acceptability, safety, and effectiveness of a new app, Clear Fear, developed to help young people manage symptoms of anxiety using the principles of cognitive behavioral therapy. Methods: The Clear Fear app was developed to provide cognitive behavioral strategies to suit anxiety disorders. An uncontrolled pre– and post–follow-up design over a 9-week period was used to assess the app and its effects. This study comprised 3 phases: baseline (stage 1), post–app familiarization phase (stage 2), and follow-up (stage 3). Eligible participants were aged between 16 and 25 years with mild to moderate anxiety but not currently receiving treatment or in contact with specialist mental health services or using other interventions or apps to help monitor or manage their mental health. A community sample was recruited via advertisements, relevant websites, and social media networks. Eligible participants completed standardized self-report tools and questionnaires at each study stage. These measured probable symptoms of anxiety (7-item Generalized Anxiety Disorder scale) and depression (Mood and Feelings Questionnaire); emotional and behavioral difficulties (Strengths and Difficulties Questionnaire); and feedback on the usability, accessibility, and safety of the app. Mean scores at baseline and follow-up were compared using paired 2-tailed t tests or Wilcoxon signed rank tests. Qualitative data derived from open-ended questions were coded and entered into NVivo (version 10) for analysis. Results: A total of 48 young people entered the study at baseline, with 37 (77%) completing all outcome measures at follow-up. The sample was mostly female (37/48, 77%). The mean age was 20.1 (SD 2.1) years. In total, 48% (23/48) of the participants reached the threshold for probable anxiety disorder, 56% (27/48) had positive scores for probable depression, and 75% (36/48) obtained a total score of “very high” on the Strengths and Difficulties Questionnaire for emotional and behavioral difficulties. The app was well received, offering reassurance, practical and immediate help to manage symptoms, and encouragement to seek help, and was generally found easy to use. A small minority (3/48, 6%) found the app difficult to navigate. The Clear Fear app resulted in statistically significant reductions in probable symptoms of anxiety (t36=2.6, 95% CI 0.41-3.53; P=.01) and depression (z=2.3; P=.02) and behavioral and emotional difficulties (t47=4.5, 95% CI 3.67-9.65; P<.001), representing mostly medium to large standardized effect sizes. Conclusions: The Clear Fear app was found to be usable, acceptable, safe, and effective in helping manage symptoms of anxiety and depression and emotional and behavioral difficulties. %M 40053764 %R 10.2196/55603 %U https://formative.jmir.org/2025/1/e55603 %U https://doi.org/10.2196/55603 %U http://www.ncbi.nlm.nih.gov/pubmed/40053764 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e56066 %T A Narrative Review to Identify Promising Approaches for Digital Health Interventions to Support Emotion Regulation for Adolescents With Attention-Deficit/Hyperactivity Disorder %A Murray,Aja Louise %A Thye,Melissa %A Obsuth,Ingrid %A Cai,Shufang %A Lui,Michael %A Orr,Corina %A Saravanan,Anusha %+ Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, United Kingdom, 44 0131 650 3455, aja.murray@ed.ac.uk %K attention-deficit/hyperactivity disorder %K ADHD %K digital health intervention %K adolescence %K emotion regulation %K emotion dysregulation %K mobile phone %K emotion %K teens %K youths %K narrative review %K support %K development %K design %K regulation %K young people %K evaluation %K neurodiversity %K neurodivergent %K attention deficit %K neurodiverse %K neuroscience %K mental health %K digital mental health %D 2025 %7 27.2.2025 %9 Viewpoint %J JMIR Ment Health %G English %X Emotion regulation difficulties affect many adolescents with attention-deficit/hyperactivity disorder (ADHD), and previous research has highlighted a need for accessible interventions to support them in this domain, especially in real-life contexts. Digital health interventions (DHIs) can be embedded in adolescents’ daily lives and thus offer considerable promise for meeting this need. However, there is a lack of information to guide the development of suitable emotion regulation DHIs for this population. The goal of this study is, therefore, to identify recommendations to guide the development of emotion regulation DHIs for adolescents with ADHD. This narrative review synthesizes diverse relevant evidence to inform their development, including promising therapeutic approaches and components and relevant design and development considerations. We find that there is very little direct evidence of “what works” for emotion regulation DHIs and emotion regulation interventions more generally for adolescents with ADHD; however, we identify promising therapeutic approaches for new DHIs. We also recommend following a co-design or coproduction approach with adolescents with ADHD, including exploring elements designed to motivate and engage young people to support sustained adherence. We conclude that DHIs are a promising approach for emotion regulation interventions for adolescents with ADHD, could draw on a range of existing therapeutic approaches, and should be co-designed with users themselves. %M 40053767 %R 10.2196/56066 %U https://mental.jmir.org/2025/1/e56066 %U https://doi.org/10.2196/56066 %U http://www.ncbi.nlm.nih.gov/pubmed/40053767 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59165 %T The Application of Preventive Medicine in the Future Digital Health Era %A De la Torre,Katherine %A Min,Sukhong %A Lee,Hyobin %A Kang,Daehee %+ Department of Preventive Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 2 740 8509, sukhongmin@snu.ac.kr %K preventive medicine %K personalized prevention %K digital health technology %K digital health %K artificial intelligence %K wearable devices %K telemedicine %D 2025 %7 27.2.2025 %9 Viewpoint %J J Med Internet Res %G English %X A number of seismic shifts are expected to reshape the future of medicine. The global population is rapidly aging, significantly impacting the global disease burden. Medicine is undergoing a paradigm shift, defining and diagnosing diseases at earlier stages and shifting the health care focus from treating diseases to preventing them. The application and purview of digital medicine are expected to broaden significantly. Furthermore, the COVID-19 pandemic has further accelerated the shift toward predictive, preventive, personalized, and participatory (P4) medicine, and has identified health care accessibility, affordability, and patient empowerment as core values in the future digital health era. This “left shift” toward preventive care is anticipated to redefine health care, emphasizing health promotion over disease treatment. In the future, the traditional triad of preventive medicine—primary, secondary, and tertiary prevention—will be realized with technologies such as genomics, artificial intelligence, bioengineering and wearable devices, and telemedicine. Breast cancer and diabetes serve as case studies to demonstrate how these technologies such as personalized risk assessment, artificial intelligence–assisted and app-based technologies, have been developed and commercialized to provide personalized preventive care, identifying those at a higher risk and providing instructions and interventions for healthier lifestyles and improved quality of life. Overall, preventive medicine and the use of advanced technology will hold great potential for improving health care outcomes in the future. %M 40053712 %R 10.2196/59165 %U https://www.jmir.org/2025/1/e59165 %U https://doi.org/10.2196/59165 %U http://www.ncbi.nlm.nih.gov/pubmed/40053712 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66807 %T Capturing Everyday Parental Feeding Practices and Eating Behaviors of 3- to 5-Year-Old Children With Avid Eating Behavior: Ecological Momentary Assessment Feasibility and Acceptability Study %A Pickard,Abigail %A Edwards,Katie %A Farrow,Claire %A Haycraft,Emma %A Blissett,Jacqueline %K pediatric %K paediatric %K child %K child eating %K parent feeding %K parent %K ecological momentary assessment %K mHealth %K mobile health %K mobile app %K application %K smartphone %K digital %K digital health %K digital technology %K digital intervention %D 2025 %7 27.2.2025 %9 %J JMIR Form Res %G English %X Background: The wide use of smartphones offers large-scale opportunities for real-time data collection methods such as ecological momentary assessment (EMA) to assess how fluctuations in contextual and psychosocial factors influence parents’ feeding practices and feeding goals, particularly when feeding children with high food approaches. Objective: The main objectives of this study were to (1) assess parents/caregivers’ compliance with EMA procedures administered through a smartphone app and (2) estimate the criterion validity of the EMA to capture children’s eating occasions and parents’ feeding practices. Participant adherence, technological challenges, and data quality were used to provide an overview of the real-time dynamics of parental mood, feeding goals, and contextual factors during eating occasions. Methods: Parents in the United Kingdom with a child aged 3 to 5 years who exhibit avid eating behavior were invited to participate in a 10-day EMA study using a smartphone app. Of the 312 invited participants, 122 (39%) parents initiated the EMA study, of which 118 (96.7%) completed the full EMA period and the follow-up feasibility and acceptability survey. Results: Of those parents who completed the EMA study, 104 (87.4%) parents provided at least 7 “full” days of data (2 signal surveys and 1 event survey), despite 51 parents (43.2%) experiencing technical difficulties. The parents received notifications for morning surveys (69.9% response rate), 3 daily mood surveys (78.7% response rate), and an end-of-day survey (84.6% response rate) on each of the 10 days. Over the EMA period, a total of 2524 child eating/food request surveys were self-initiated by the participants on their smartphones, an average of 2.1 times per day per parent (SD 0.18; min=1.7, max=2.3). The majority of parents felt that the surveys made them more aware of their feelings (105/118, 89%) and activities (93/118, 79%). The frequency of daily food requests estimated by parents at baseline was significantly correlated with the frequency of food requests reported daily during the EMA period (r=0.483, P<.001). However, the number of daily food requests per day estimated at baseline (mean 4.5, SD 1.5) was significantly higher than the number of food requests reported per day during the EMA period (mean 3.7, SD 1.1), (t116=18.8, P<.001). Conclusions: This paper demonstrates the feasibility of employing EMA to investigate the intricate interplay between parental mood, feeding goals, contextual factors, and feeding practices with children exhibiting an avid eating behavior profile. However, the use of EMA needs to be carefully developed and tested with parents’ involvement to ensure successful data collection. International Registered Report Identifier (IRRID): RR2-10.2196/55193 %R 10.2196/66807 %U https://formative.jmir.org/2025/1/e66807 %U https://doi.org/10.2196/66807 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e64527 %T Comparative Effectiveness of Wearable Devices and Built-In Step Counters in Reducing Metabolic Syndrome Risk in South Korea: Population-Based Cohort Study %A Joung,Kyung-In %A An,Sook Hee %A Bang,Joon Seok %A Kim,Kwang Joon %K wearable devices %K built-in step counters %K mobile health %K public health intervention %K physical activity %K health behavior %K metabolic syndrome %K population-based %K cohort study %K South Korea %K mobile health technologies %K effectiveness %K activity tracker %K mobile app %K retrospective %K logistic regression %K mHealth %K digital health %K mobile phone %D 2025 %7 25.2.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Mobile health technologies show promise in addressing metabolic syndrome, but their comparative effectiveness in large-scale public health interventions remains unclear. Objective: This study aims to compare the effectiveness of wearable devices (wearable activity trackers) and mobile app–based activity trackers (built-in step counters) in promoting walking practice, improving health behaviors, and reducing metabolic syndrome risk within a national mobile health care program operated by the Korea Health Promotion Institute. Methods: This retrospective cohort study analyzed data from 46,579 participants in South Korea’s national mobile health care program (2020‐2022). Participants used wearable devices for 12 weeks, after which some switched to built-in step counters. The study collected data on demographics, health behaviors, and metabolic syndrome risk factors at baseline, 12 weeks, and 24 weeks. Outcomes included changes in walking practice, health behaviors, and metabolic syndrome risk factors. Metabolic syndrome risk was assessed based on 5 factors: blood pressure, fasting glucose, waist circumference, triglycerides, and high-density lipoprotein cholesterol. Health behaviors included low-sodium diet preference, nutrition label reading, regular breakfast consumption, aerobic physical activity, and regular walking. To address potential selection bias, propensity score matching was performed, balancing the 2 groups on baseline characteristics including age, gender, education level, occupation, insurance type, smoking status, and alcohol consumption. Results: Both wearable activity tracker and built-in step counter groups exhibited significant improvements across all evaluated outcomes. The improvement rates for regular walking practice, health behavior changes, and metabolic syndrome risk reduction were high in both groups, with percentages ranging from 45.2% to 60.8%. After propensity score matching, both device types showed substantial improvements across all indicators. The built-in step counter group demonstrated greater reductions in metabolic syndrome risk compared to the wearable device group (odds ratio [OR] 1.20, 95% CI 1.05‐1.36). No significant differences were found in overall health behavior improvements (OR 0.95, 95% CI 0.83‐1.09) or walking practice (OR 0.84, 95% CI 0.70‐1.01) between the 2 groups. Age-specific subgroup analyses revealed that the association between built-in step counters and metabolic syndrome risk reduction was more pronounced in young adults aged 19‐39 years (OR 1.35, 95% CI 1.09‐1.68). Among Android use subgroups, built-in step counters were associated with a higher reduction in health risk factors (OR 1.20, 95% CI 1.03‐1.39). Conclusions: Both wearable devices and built-in step counters effectively reduced metabolic syndrome risk in a large-scale public health intervention, with built-in step counters showing a slight advantage. The findings suggest that personalized device recommendations based on individual characteristics, such as age and specific health risk factors, may enhance the effectiveness of mobile health interventions. Future research should explore the mechanisms behind these differences and their long-term impacts on health outcomes. %R 10.2196/64527 %U https://mhealth.jmir.org/2025/1/e64527 %U https://doi.org/10.2196/64527 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56230 %T Improving Maternal Mental Health and Weight Control With a Mindfulness Blended Care Approach: Insights From a Randomized Controlled Trial %A Hassdenteufel,Kathrin %A Müller,Mitho %A Abele,Harald %A Brucker,Sara Yvonne %A Graf,Johanna %A Zipfel,Stephan %A Bauer,Armin %A Jakubowski,Peter %A Pauluschke-Fröhlich,Jan %A Wallwiener,Markus %A Wallwiener,Stephanie %+ Department of Obstetrics and Gynecology, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Heidelberg, 69120, Germany, 49 15238492062, Kathrin.hassdenteufel@med.uni-heidelberg.de %K peripartum mental health %K digital intervention %K depression %K anxiety %K personal coaching %K ehealth %K pregnancy %K maternal mental health %K weight gain %K mindfulness-based intervention %K coaching %K randomized controlled clinical trial %K postpartum %K treatment %K electronic %K effectiveness %K women %K digital intervention %D 2025 %7 24.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Perinatal maternal mental health problems, such as depression and anxiety, are highly prevalent during pregnancy and post partum. Electronic mindfulness-based interventions (eMBIs) are a promising treatment option, which can be provided in a low-threshold, cost-effective manner. However, research underscores the fact that face-to-face coaching sessions are more effective than solely digital methods. A blended care approach (eMBI with direct face-to-face coaching) could amplify the therapeutic impact on maternal mental health and weight gain during the perinatal period. Objective: We investigated whether combining an eMBI intervention with face-to-face personal support significantly improves maternal mental health, and whether the intervention can influence weight gain in affected women during pregnancy. Methods: A community-based sample of 460 pregnant women with a singleton pregnancy who screened positive for depression was enrolled in a multicenter randomized controlled trial (RCT) including the University Hospitals of Heidelberg and Tübingen as well as more than 200 gynecological practices within the state of Baden-Württemberg in Germany between February 2019 and October 2020. Participating women were randomized 1:1 to the control group (CG) or intervention group (IG) that received access to an 8-week pregnancy-adapted eMBI between the 29th and 36th gestational week. In a subanalysis, we grouped participants in those receiving only the initial face-to-face coaching session at recruitment (no personal coaching) and those with ≥2 personal coaching sessions. Primary outcome measures were severity of depressive symptoms using the Edinburgh Postnatal Depression Scale, anxiety using the State-Trait Anxiety Inventory, the Pregnancy-Related Anxiety Questionnaire, the Freiburg Mindfulness Inventory, and the Patient Health Questionnaire; secondary outcome measure, BMI. Results: In the final sample, 137 CG women and 102 IG women received only one coaching session, whereas 37 CG women and 40 IG women received at least 2 (mean 2.3, SD 0.7) coaching sessions. The analyses were adjusted for significant confounders. The IG’s mindfulness scores increased significantly (F1.873,344.619=4.560, P=.01, η²=0.024, ω²=0.012) regardless of coaching frequency. Both general anxiety (F12,129=2.361, P=.01, η²=0.0180, ω²=0.100) and depression symptoms (F4.758, 699.423=3.033, P=.01, η²=0.020, ω²=0.009) were significantly lower in the group that received ≥2 coaching sessions than in the no-personal-coaching group. In the group receiving ≥2 coaching sessions, BMI generally was lower in the IG than in the CG (F3.555,444.416=4.732, P=.002, η²=0.036, ω²=0.013). Conclusions: Adding a minimal amount of PC to the digital eMBI increased mindfulness and decreased birth-related anxiety, symptoms of depression, and anxiety in at-risk pregnant women. Favorable effects on gestational weight gain were found in the respective IGs, the strongest effect being within the PC group. This blended digital health approach amplifies the effectiveness of the digital intervention. Trial Registration: German Clinical Trials Register DRKS00017210; https://www.drks.de/search/de/trial/DRKS00017210 %M 39992700 %R 10.2196/56230 %U https://www.jmir.org/2025/1/e56230 %U https://doi.org/10.2196/56230 %U http://www.ncbi.nlm.nih.gov/pubmed/39992700 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e68667 %T Combining Ecological Momentary Assessment and Social Network Analysis to Study Youth Physical Activity and Environmental Influences: Protocol for a Mixed Methods Feasibility Study %A Prochnow,Tyler %A Dunton,Genevieve F %A de la Haye,Kayla %A Pollack Porter,Keshia M %A Lee,Chanam %+ Department of Health Behavior, School of Public Health, Texas A&M University, 212 Adriance Lab, College Station, TX, 77843, United States, 1 2629450275, tprochnow@tamu.edu %K physical activity %K youth %K social environment %K built environment %K ecological momentary assessment %K social network analysis %K phenotypes %K accelerometry %K GPS %D 2025 %7 21.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical activity (PA) is crucial for youth health, but up to 74% of adolescents fail to meet recommended levels, especially during summer when structured supports associated with school are not available. The social and built environments significantly influence youth PA; yet, their complex interactions remain poorly understood. This study aims to evaluate the feasibility of combining ecological momentary assessment (EMA) and social network analysis to examine bidirectional influences among youth PA, built environments, and social networks during summer. Objective: The objectives are to (1) evaluate the feasibility and acceptability of the combined EMA and Social Network Analysis protocol, and (2) identify phenotypes using person-level, microtemporal, and dynamic overlap between social and built environments. Methods: This mixed methods feasibility study with an exploratory observational component will recruit 120 youth aged 12 years to 15 years from an urban school district in Central Texas, US. Participants will first complete a baseline survey to report their general social network patterns and environmental perceptions. Then participants will wear an ActiGraph LEAP accelerometer and respond to EMA prompts via smartphone for 7 days. EMA will assess real-time perceptions of social networks and surrounding built environments, which will be time-matched with accelerometer-assessed PA data. GPS coordinates will be collected with each EMA prompt to assess features of the built environment. Follow-up semistructured interviews will assess protocol acceptability. Results: This study has been funded by the National Heart, Lung, and Blood Institute. Data collection is expected in the summers of 2025, 2026, and 2027. Conclusions: This innovative approach combines EMA, SNA, accelerometry, and GPS data to provide unprecedented insights into the dynamic interplay between social networks, built environments, and youth PA during summer. Findings will inform the development of more targeted, effective interventions to promote PA among youth. While limitations include potential participant burden and generalizability, the study’s strengths in capturing real-time, contextualized data make it a valuable contribution to understanding youth PA determinants. International Registered Report Identifier (IRRID): PRR1-10.2196/68667 %M 39984166 %R 10.2196/68667 %U https://www.researchprotocols.org/2025/1/e68667 %U https://doi.org/10.2196/68667 %U http://www.ncbi.nlm.nih.gov/pubmed/39984166 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65214 %T Behavior Change Support Systems for Self-Treating Procrastination: Systematic Search in App Stores and Analysis of Motivational Design Archetypes %A Kirchner-Krath,Jeanine %A Schmidt-Kraepelin,Manuel %A Schmähl,Katharina %A Schütz,Christoph %A Morschheuser,Benedikt %A Sunyaev,Ali %+ Department of Economics and Management, Karlsruhe Institute of Technology, Kaiserstraße 89, Karlsruhe, D-76133, Germany, 49 72160844062, manuel.schmidt-kraepelin@kit.edu %K procrastination %K mobile apps %K cluster analysis %K motivational design %K persuasive technology %K behavior change support systems %K behavior change techniques %K mobile health %K mHealth %K mobile phone %K artificial intelligence %K AI %D 2025 %7 20.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The phenomenon of procrastination refers to an individual’s conscious decision to postpone the completion of tasks despite being aware of its adverse consequences in the future. Extant research in this field shows that procrastination is associated with increased levels of anxiety and stress and the likelihood of developing depression and calls for the development of suitable interventions that support individuals in making lasting positive changes to their procrastination behaviors. In parallel, practice has produced a plethora of behavior change support systems (BCSSs) that aim to provide a low-threshold, accessible alternative to in-person therapeutic approaches. Most of these BCSSs can be considered motivational BCSSs that combine functional, utilitarian components with hedonic and eudaimonic design elements to empower self-treatment. Although early studies have suggested the potential benefits of such BCSSs, research on understanding their specific design characteristics and support of individuals in self-treating procrastination is still in its infancy. Objective: In response to this gap between practice and research, we aimed to analyze and systemize the multitude of practical design efforts in motivational BCSSs for the self-treatment of procrastination and identify the main design archetypes that have emerged. Methods: We conducted a 3-step research approach. First, we identified 127 behavior change support apps for procrastination through a systematic screening process in the German and US Apple App Store and Google Play Store. Second, we systematically coded the identified apps in terms of the behavior change techniques targeted by their functional design and hedonic or eudaimonic design elements. Third, we conducted a 2-step cluster analysis to identify archetypes of motivational design in behavior change support apps to combat procrastination. Results: A variety of motivational designs have been developed and implemented in practice, and our analysis identified five main archetypes: (1) structured progress monitor, (2) self-improvement guide, (3) productivity adventure, (4) emotional wellness coach, and (5) social focus companion. The identified archetypes target different psychological determinants of procrastination and successfully use a variety of hedonic and eudaimonic design elements that extend beyond the current state of research. Conclusions: The results of our study provide a foundation for future research endeavors that aim to examine the comparative effects of motivational design archetypes and develop more effective interventions tailored to individual needs. For practitioners, the findings reveal the contemporary design space of motivational BCSSs to support the self-treatment of procrastination and may serve as blueprints that can guide the design of future systems. For individuals seeking support and health professionals treating procrastination, our study systemizes the landscape of apps, thereby facilitating the selection of one that best aligns with the patient’s individual needs. %M 39977017 %R 10.2196/65214 %U https://www.jmir.org/2025/1/e65214 %U https://doi.org/10.2196/65214 %U http://www.ncbi.nlm.nih.gov/pubmed/39977017 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e65451 %T Parental Perceptions of Priorities and Features for a Mobile App to Promote Healthy Lifestyle Behaviors in Preschool Children: Mixed Methods Evaluation %A Thompson,Jessica R %A Weber,Summer J %A Mulvaney,Shelagh A %A Goggans,Susanna %A Brown,Madeline %A Faiola,Anthony %A Maamari,Lynn %A Hull,Pamela C %+ , Department of Health Policy and Administration, The Pennsylvania State University, 601E Ford Building, University Park, PA, 16802-1503, United States, 1 8148638129, jrthompson@psu.edu %K mHealth %K childhood obesity %K mixed methods %K pediatric %K healthy lifestyle behaviors %K preschool children %K mobile application %K diet %K physical activity %K exercise %K media use %K sleep %K development %K semi-structured interviews %K healthy eating %K parents %K caregivers %D 2025 %7 19.2.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parents of preschool-aged children are a key focus for interventions to shape healthy lifestyle behaviors and support risk reduction for obesity from an early age. In light of limited existing evidence on the use of mobile technology to promote healthy lifestyle behaviors among young children, we sought to gather parental priorities regarding a mobile app focused on guided goal setting across the domains of diet, physical activity, media use, and sleep. Objective: The purpose of this study was to explore the priorities and needs of parents of 2- to 5-year-old children to guide developing the content and features of a mobile app aimed at promoting healthy lifestyle behaviors using a novel convergent mixed methods approach. Methods: From November to December 2021, we invited parents or guardians in Kentucky to complete a series of web-based concept mapping activities and semistructured interviews (total N=30). Using 2 lists of items focused on (1) parental priorities (content areas) and (2) application features, we asked participants to conduct concept mapping procedures for each list: a web-based sorting activity, where participants grouped items together into thematic piles that made sense to them, and a rating activity, where participants rated each item on a 5-point Likert-type scale. The qualitative interviews were transcribed verbatim, coded, and then analyzed by constant comparative analysis to identify themes. We used the quantitative findings from the concept mapping process to triangulate the resulting themes from the qualitative interviews and generate possible app content areas and features. Results: The concept mapping results resulted in two 3-cluster concept maps. For parental priorities, participants identified the clusters Creating Healthy Eating Habits, Forming Boundaries, and Building Good Relationships; for app features, participant clusters included Eating Healthy, Using the App, and Setting Goals. The interview themes also represented those 2 domains. Overall, the participants indicated that the top priorities were general health and wellbeing, routine and setting boundaries, and food and healthy eating when it comes to building healthy behaviors among their preschool-aged children. Parents indicated that quick, easy, and child-friendly recipes, goal tracking, and the use of tips and notifications were the features they valued most. Conclusions: This study contributes to the understanding of what parents or caregivers of young children want from mobile apps, in both content and features, to support building healthy behaviors and routines. The findings can inform future research on the development and evaluation of existing or new mobile apps. Specific app features identified to meet family needs should be designed closely with a diverse set of families and tested using rigorous designs to identify the mechanisms of action that mobile apps may use for efficacious healthy parenting outcomes. %M 39970437 %R 10.2196/65451 %U https://pediatrics.jmir.org/2025/1/e65451 %U https://doi.org/10.2196/65451 %U http://www.ncbi.nlm.nih.gov/pubmed/39970437 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57512 %T Nomophobia, Psychopathology, and Smartphone-Inferred Behaviors in Youth With Depression: Longitudinal Study %A Zhang,Tianyi %A Camargo,Andres %A Schmaal,Lianne %A Kostakos,Vassilis %A D'Alfonso,Simon %+ School of Computing and Information Systems, University of Melbourne, Level 4, Melbourne Connect (Building 290), Melbourne, 3010, Australia, 61 449930128, tianyiz4@student.unimelb.edu.au %K mobile sensing %K nomophobia %K digital phenotyping %K depression %K mental health %K smartphone use %K personal sensing %K behavior analysis %K machine learning %K mobile health %K mobile phone %D 2025 %7 19.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphones have become an indispensable part of people’s lives, and the fear of being without them, what has been termed “no mobile phone phobia” (nomophobia), is a growing phenomenon. The rise of problematic smartphone use highlights the urgent need to explore the intricate relationship between smartphones and human behavior. However, the connections between nomophobia, mental health indicators, smartphone use patterns, and daily activities remain largely underexplored. Objective: This study aimed to explore the relationship between young adults with depression and smartphones and investigate nomophobia by analyzing data obtained from a pilot study of depression in a youth cohort. Exploring nomophobia can enhance our understanding of the dynamics between young adults and smartphone use, potentially empowering them to manage and regulate their smartphone use more effectively. Methods: During an 8-week period, data collected via smartphone sensors, such as locations and screen status, were gathered from a cohort of 41 individuals diagnosed with major depressive disorder. In addition to passive-sensing smartphone data, the study collected ecological momentary assessments and psychometric measures, including the Nomophobia Questionnaire, which formed the basis of our investigation. We explored statistical associations among smartphone-derived behavioral features, psychometric indicators, and nomophobia. In addition, we used behavioral and psychometric data to develop regression models demonstrating the prediction of nomophobia levels. Results: Our findings revealed that the level of nomophobia was positively associated with depression and negative affect, lower geolocation movements, and higher comfort with smartphone sensing. The exploratory predictive linear regression models demonstrated the feasibility of predicting an individual’s Nomophobia Questionnaire score based on their smartphone sensing data. These models effectively used input features derived from both a combination of smartphone sensing data and psychometric measures and from smartphone sensing data alone. Conclusions: Our work is the first to explore the relationship between nomophobia and smartphone sensor data. It provides valuable insights into the predictors of nomophobia level, contributing to the understanding of the relationship between smartphones and human behavior and paving the way for future studies. %M 39969982 %R 10.2196/57512 %U https://formative.jmir.org/2025/1/e57512 %U https://doi.org/10.2196/57512 %U http://www.ncbi.nlm.nih.gov/pubmed/39969982 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63209 %T Assessing the Effectiveness of Digital Health Behavior Strategies on Type 2 Diabetes Management: Systematic Review and Network Meta-Analysis %A Li,Min %A Liu,Shiyu %A Yu,Binyang %A Li,Ning %A Lyu,Aili %A Yang,Haiyan %A He,Haiyan %A Zhang,Na %A Ma,Jingru %A Sun,Meichen %A Du,Hong %A Gao,Rui %+ School of Nursing, Health Science Center, Xi 'an Jiaotong University, 74 Yanta West Road, Xi 'an, 710061, China, 86 18966606582, gaorui@xjtu.edu.cn %K T2DM %K type 2 diabetes mellitus %K digital health interventions %K behavior strategy %K strategy combinations %K effectiveness %K network meta-analysis %D 2025 %7 14.2.2025 %9 Review %J J Med Internet Res %G English %X Background: Various mobile technologies and digital health interventions (DHIs) have been developed for type 2 diabetes mellitus (T2DM) management. Strategies are crucial for ensuring the effectiveness of DHIs. However, there is currently a lack of categorization and summarization of the strategies used in DHIs for T2DM. Objective: This study aims to (1) identify and categorize the strategies used in DHIs for T2DM management; (2) assess the effectiveness of these DHI strategies; and (3) compare and rank the efficacy of different strategy combinations on glycated hemoglobin A1c (HbA1c) levels, fasting blood glucose (FBG) levels, BMI, and weight loss. Methods: Relevant randomized controlled trials (RCTs) were extracted from PubMed, Web of Science, and Scopus databases. Three rounds of screening and selection were conducted. The strategies were identified and categorized based on the principles of behavior change techniques and behavior strategies. The synthesis framework for the assessment of health IT was used to structure the evaluation of the DHI strategies qualitatively. A network meta-analysis was performed to compare the efficacy of different strategy combinations. The data quality was assessed using the Cochrane Risk of Bias tool. Results: A total of 52 RCTs were included, identifying 63 strategies categorized into 19 strategy themes. The most commonly used strategies were guide, monitor, management, and engagement. Most studies reported positive or mixed outcomes for most indicators based on the synthesis framework for the assessment of health IT. Research involving a medium or high number of strategies was found to be more effective than research involving a low number of strategies. Of 52 RCTs, 27 (52%) were included in the network meta-analysis. The strategy combination of communication, engagement, guide, and management was most effective in reducing HbA1c levels (mean difference [MD] –1.04, 95% CI –1.55 to –0.54), while the strategy combination of guide, management, and monitor was effective in reducing FBG levels (MD –0.96, 95% CI –1.86 to –0.06). The strategy combination of communication, engagement, goal setting, management, and support was most effective for BMI (MD –2.30, 95% CI –3.16 to –1.44) and weight management (MD –6.50, 95% CI –8.82 to –4.18). Conclusions: Several DHI strategy combinations were effective in reducing HbA1c levels, FBG levels, BMI, and weight in T2DM management. Health care professionals should be encouraged to apply these promising strategy combinations in DHIs during clinical care. Future research should further explore and optimize the design and implementation of strategies. Trial Registration: PROSPERO CRD42024544629; https://tinyurl.com/3zp2znxt %M 39951722 %R 10.2196/63209 %U https://www.jmir.org/2025/1/e63209 %U https://doi.org/10.2196/63209 %U http://www.ncbi.nlm.nih.gov/pubmed/39951722 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e68251 %T Telehealth-Based vs In-Person Aerobic Exercise in Individuals With Schizophrenia: Comparative Analysis of Feasibility, Safety, and Efficacy %A Kimhy,David %A Ospina,Luz H %A Wall,Melanie %A Alschuler,Daniel M %A Jarskog,Lars F %A Ballon,Jacob S %A McEvoy,Joseph %A Bartels,Matthew N %A Buchsbaum,Richard %A Goodman,Marianne %A Miller,Sloane A %A Stroup,T Scott %K schizophrenia %K psychosis %K exercise %K aerobic fitness %K VO2max %K telehealth %K telemedicine %K COVID-19 %K clinical trial %K safety %K maximum oxygen consumption %D 2025 %7 14.2.2025 %9 %J JMIR Ment Health %G English %X Background: Aerobic exercise (AE) training has been shown to enhance aerobic fitness in people with schizophrenia. Traditionally, such training has been administered in person at gyms or other communal exercise spaces. However, following the advent of the COVID-19 pandemic, many clinics transitioned their services to telehealth-based delivery. Yet, at present, there is scarce information about the feasibility, safety, and efficacy of telehealth-based AE in this population. Objective: To examine the feasibility, safety, and efficacy of trainer-led, at-home, telehealth-based AE in individuals with schizophrenia. Methods: We analyzed data from the AE arm (n=37) of a single-blind, randomized clinical trial examining the impact of a 12-week AE intervention in people with schizophrenia. Following the onset of the COVID-19 pandemic, the AE trial intervention transitioned from in-person to at-home, telehealth-based delivery of AE, with the training frequency and duration remaining identical. We compared the feasibility, safety, and efficacy of the delivery of trainer-led AE training among participants undergoing in-person (pre–COVID-19; n=23) versus at-home telehealth AE (post–COVID-19; n=14). Results: The telehealth and in-person participants attended a similar number of exercise sessions across the 12-week interventions (26.8, SD 10.2 vs 26.1, SD 9.7, respectively; P=.84) and had similar number of weeks with at least 1 exercise session (10.4, SD 3.4 vs 10.6, SD 3.1, respectively; P=.79). The telehealth-based AE was associated with a significantly lower drop-out rate (telehealth: 0/14, 0%; in-person: 7/23, 30.4%; P=.04). There were no significant group differences in total time spent exercising (telehealth: 1246, SD 686 min; in-person: 1494, SD 580 min; P=.28); however, over the 12-week intervention, the telehealth group had a significantly lower proportion of session-time exercising at or above target intensity (telehealth: 33.3%, SD 21.4%; in-person: 63.5%, SD 16.3%; P<.001). There were no AE-related serious adverse events associated with either AE delivery format. Similarly, there were no significant differences in the percentage of participants experiencing minor or moderate adverse events, such as muscle soreness, joint pain, blisters, or dyspnea (telehealth: 3/14, 21%; in-person: 5/19, 26%; P>.99) or in the percentage of weeks per participant with at least 1 exercise-related adverse event (telehealth: 31%, SD 33%; in-person: 40%, SD 33%; P=.44). There were no significant differences between the telehealth versus in-person groups regarding changes in aerobic fitness as indexed by maximum oxygen consumption (VO2max; P=.27). Conclusions: Our findings provide preliminary support for the delivery of telehealth-based AE for individuals with schizophrenia. Our results indicate that in-home telehealth-based AE is feasible and safe in this population, although when available, in-person AE appears preferable given the opportunity for social interactions and the higher intensity of exercises. We discuss the findings’ clinical implications, specifically within the context of the COVID-19 pandemic, as well as review potential challenges for the implementation of telehealth-based AE among people with schizophrenia. %R 10.2196/68251 %U https://mental.jmir.org/2025/1/e68251 %U https://doi.org/10.2196/68251 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56251 %T Changing User Experience of Wearable Activity Monitors Over 7 Years: Repeat Cross-Sectional Survey Study %A Beckett,Darcy %A Curtis,Rachel %A Szeto,Kimberley %A Maher,Carol %+ Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, 5000, Australia, 61 08 8302 ext 6558, carol.maher@unisa.edu.au %K cross-sectional survey %K activity tracker %K user experience %K physical activity %K sleep %K diet %K health behaviour %K wearable activity trackers %K cohort %K Apple %K Fitbit %K preferences %K reliability %K accessibility %K lifestyle %K mobile phone %D 2025 %7 13.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Lifestyle behaviors, including physical inactivity, sedentary behavior, poor sleep, and unhealthy diet, significantly impact global population health. Wearable activity trackers (WATs) have emerged as tools to enhance health behaviors; however, their effectiveness and continued use depend on their user experience. Objective: This study aims to explore changes in user experiences, preferences, and perceived impacts of WATs from 2016 to 2023. Methods: We conducted a cross-sectional online survey among an international cohort of adults (n=475, comprising 387 current and 88 former WAT users). Results were compared with a 2016 cross-sectional online survey (n=237, comprising 200 current and 37 former WAT users) using descriptive statistics and chi-square tests. The survey examined brand preference, feature usefulness, motivations, perceived health behavior change, social sharing behaviors, and technical issues. Results: In 2023, Apple (210/475, 44%) and Fitbit (101/475, 21%) were the most commonly used devices, compared with the 2016 survey where Fitbit (160/237, 68%) and Garmin devices (39/237, 17%) were most common. The median usage duration in 2023 was 18 months, significantly longer than the 7 months reported in 2016, with most users planning ongoing use. Users in both survey years reported greater improvements in physical activity than diet or sleep, despite lower improvement in physical activity in 2023 compared with 2016, contrasted with greater perceived improvements in diet and sleep. Social media sharing of WAT data notably rose to 73% (283/387) in 2023 from 35% (70/200) in 2016. However, reports of technical issues and discomfort increased, alongside a decrease in overall positive experiences. There was also a noticeable shift in discontinuation reasons, from having learned everything possible in 2016 to dissatisfaction in 2023. Conclusions: The study highlights significant shifts in WAT usage, including extended use and evolving preferences for brands and features. The rise in social media sharing indicates a deeper integration of WATs into everyday life. However, user feedback points to a need for enhanced design and functionality despite technological progress. These findings illustrate WAT’s potential in health promotion, emphasizing the need for user-focused design in diverse populations to fully realize their benefits in enhancing health behaviors. %M 39946694 %R 10.2196/56251 %U https://www.jmir.org/2025/1/e56251 %U https://doi.org/10.2196/56251 %U http://www.ncbi.nlm.nih.gov/pubmed/39946694 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60256 %T Effects of Individualized Follow-Up With an App Postcardiac Rehabilitation: Five-Year Follow-Up of a Randomized Controlled Trial %A Lunde,Pernille %A Bye,Asta %A Grimsmo,Jostein %A Pripp,Are Hugo %A Ritschel,Vibeke %A Jarstad,Even %A Nilsson,Birgitta Blakstad %+ Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet – Oslo Metropolitan University, PB 4, St. Olavs plass, Oslo, 0130, Norway, 47 48063537, plunde@oslomet.no %K mHealth %K cardiac rehabilitation %K mobile phone app %K smartphone %K lifestyle %D 2025 %7 13.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Adherence to healthy behaviors initiated or adapted during cardiac rehabilitation (CR) remains a significant challenge, with few patients meeting guideline standards for secondary prevention. The use of mobile health (mHealth) interventions has been proposed as a potential solution to improve adherence to healthy behaviors after CR. In particular, app-based interventions have shown promise due to their ability to provide monitoring and feedback anytime and anywhere. Growing evidence supports the use of apps in post-CR settings to enhance adherence. In 2020, we demonstrated that individualized follow-up via an app increased adherence to healthy behaviors 1 year after CR. However, it remains uncertain whether these effects persist once the follow-up is discontinued. Objective: This study aims to evaluate the long-term effects of individualized follow-up using an app, assessed 4 years after the intervention. Methods: A single-blinded multicenter randomized controlled trial was conducted. Patients were recruited from 2 CR centers in eastern Norway. The intervention group (IG) received individualized follow-up through an app for 1 year, while the control group (CG) received usual care. After the 1-year follow-up, the app-based follow-up was discontinued for the IG, and both groups were encouraged to maintain or improve their healthy behaviors based on their individual risk profiles. The primary outcome was the difference in peak oxygen uptake (VO2peak). The secondary outcomes included exercise performance, body weight, blood pressure, lipid profile, exercise habits, health-related quality of life, health status, cardiac events, and physical activity. Linear mixed models for repeated measurements were used to analyze differences between groups. All tests were 2-sided, and P values ≤0.05 were considered statistically significant. Results: At the 5-year follow-up, 101 out of the initial 113 randomized participants were reassessed. Intention-to-treat analyses, using a mixed model for repeated measurements, revealed a statistically significant difference (P=.04) in exercise habits in favor of the IG, with a mean difference of 0.67 (95% CI 0.04-1.29) exercise sessions per week. Statistically significant differences were also observed in triglycerides (mean difference 0.40, 95% CI 0.00-0.79 mmol/l, P=.048) and walking (P=.03), but these were in favor of the CG. No differences were found between the groups for other evaluated outcomes. Conclusions: Most of the benefits derived from the app-based follow-up diminished by 4 years after the intervention. Although the IG reported statistically significantly higher levels of exercise, this did not translate into improved VO2peak or exercise performance. Our study highlights the need for follow-up from health care providers to enhance adherence to healthy behaviors in the long term following CR. Trial Registration: ClinicalTrials.gov NCT03174106; https://clinicaltrials.gov/ct2/show/NCT03174106 (original study protocol) and NCT05697120; https://clinicaltrials.gov/ct2/show/NCT05697120 (updated study protocol) %M 39946716 %R 10.2196/60256 %U https://www.jmir.org/2025/1/e60256 %U https://doi.org/10.2196/60256 %U http://www.ncbi.nlm.nih.gov/pubmed/39946716 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 9 %N %P e66852 %T Evaluating the Quality, Content Accuracy, and User Suitability of mHealth Prenatal Care Apps for Expectant Mothers: Critical Assessment Study %A Asadollahi,Fateme %A Ebrahimzadeh Zagami,Samira %A Eslami,Saeid %A Latifnejad Roudsari,Robab %+ Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Qarashi Building, Central Office of the University, Daneshgah Street, Mashhad, 91388-13944, Iran, 98 9370400607, rlatifnejad@yahoo.com %K pregnancy %K prenatal care %K mobile health apps %K mHealth %K women’s health %K health care providers %K quality assessment %K content evaluation %K suitability assessment %K digital health %K smartphones %K eHealth %K telehealth %K telemedicine %K health promotion %K technology %K functionality %K systematic search %D 2025 %7 13.2.2025 %9 Original Paper %J Asian Pac Isl Nurs J %G English %X Background: The proliferation of health apps in the digital health landscape has created significant opportunities for health promotion, particularly during pregnancy. However, despite the widespread distribution and popularity of pregnancy mobile apps, there are limited data on their quality and content. Objective: This study aimed to evaluate the quality, content accuracy, and suitability of the most popular and freely available Persian mobile health (mHealth) apps for prenatal care in expectant mothers. Methods: Through a systematic search, a total of 199 apps were screened from available app stores using the search term “pregnancy app” until July 2023. Inclusion criteria were apps in the Farsi language, freely available, downloaded more than 10,000 times, and designed for pregnant women. Ultimately, 9 apps met these criteria. These apps were downloaded onto mobile phones and assessed by 2 independent reviewers using the Mobile App Rating Scale (MARS), the Coverage and Depth of Information Checklist, and the Suitability Assessment of Materials (SAM). Statistical analyses explored relationships between app quality metrics and user ratings. Results: The 9 apps evaluated had an average MARS score of 3.55 (SD 0.61) out of 5. Aesthetics (mean 4.02, SD 0.45) and Functionality (mean 4.11, SD 0.36) scored the highest, followed by Engagement (mean 3.29, SD 0.53) and Information (mean 3.09, SD 0.48). User star ratings did not strongly correlate with MARS scores (r=0.38, P>.05). Regarding health information coverage, 6 out of 9 (66.7%) apps were rated as poor, and 3 (33.3%) as adequate. For SAM, 4 (44.4%) apps were rated as superior and 5 (55.6%) as adequate. No app received a poor score. Conclusions: The study underscores the need for improved standards in pregnancy app development to enhance educational efficacy and user satisfaction. Health care providers should recommend high-quality pregnancy apps with appropriate content to ensure effective health promotion. These findings contribute to understanding the current landscape of pregnancy apps and highlight areas for future research and regulatory attention. Trial Registration: PROSPERO CRD42023461605; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=461605 %M 39946714 %R 10.2196/66852 %U https://apinj.jmir.org/2025/1/e66852 %U https://doi.org/10.2196/66852 %U http://www.ncbi.nlm.nih.gov/pubmed/39946714 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e56533 %T Assessment of Environmental, Sociocultural, and Physiological Influences on Women’s Toileting Decisions and Behaviors Using “Where I Go”: Pilot Study of a Mobile App %A Smith,Abigail R %A Mueller,Elizabeth R %A Lewis,Cora E %A Markland,Alayne %A Smerdon,Caroline %A Smith,Ariana L %A Sutcliffe,Siobhan %A Wyman,Jean F %A Low,Lisa Kane %A Miller,Janis M %A , %K ecological momentary assessment %K time location factors %K voiding diary %K voiding behaviors %K population studies %K mobile application %K app %K bladder health %K data collection tool %K decision support %D 2025 %7 12.2.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Little is known about women’s decisions around toileting for urination and how those decisions influence moment-to-moment behaviors to manage bladder needs. The new smartphone app “Where I Go” captures such nuanced and granular data in real-world environments. Objective: This study aims to describe participant engagement with “Where I Go”, variation in novel parameters collected, and readiness for the data collection tool’s use in population-based studies. Methods: “Where I Go” has three components: (1) real-time data, (2) short look-back periods (3‐4 h), and (3) event location (GPS recorded at each interaction). The sample size was 44 women. Recording of real-time toileting events and responding to look-back questions was measured over 2 days of data collection. The participant’s self-entered location descriptions and the automatic GPS recordings were compared. Results: A total of 44 women with an average age of 44 (range 21-85) years interacted with the app. Real-time reporting of at least 1 toileting event per day was high (38/44, 86%, on day 1 and 40/44, 91%, on day 2) with a median of 5 (IQR 3-7 on day 1 and IQR 3-8 on day 2) toileting events recorded each day. Toileting most commonly occurred at home (85/140, 61%, on day 1 and 129/171, 75%, on day 2) due to a need to go (114/140, 66%, on day 1 and 153/171, 74%, on day 2). The most common reasons for delaying toileting were “work duties” (33/140, 21%, on day 1 and 21/171, 11%, on day 2) and “errands or traveling” (19/140, 12%, on day 1 and 19/171, 10%, on day 2). Response to at least 1 look-back notification was similarly high (41/44, 93%, on day 1 and 42/44, 95%, on day 2), with number of responses higher on average on day 2 compared with day 1 (mean on day 1=3.2, 95% CI 3.0-3.5; mean on day 2=4.3, 95% CI 3.9-4.7; P<.001). Median additional toileting events reported on the look-back survey were 1 (IQR 1-2) and 2 (IQR 1-2) on days 1 and 2, respectively. Overall concordance between self-reported location recording and GPS was 76% (188/247). Participants reported lower urge ratings when at home versus away when reporting real-time toileting (median rating 61, IQR 41-84 vs 72, IQR 56-98), and daily fluid intake showed a small to medium positive correlation with toileting frequency (day 1 r=0.3, day 2 r=0.24). Toileting frequency reported in “Where I Go” showed a small positive correlation with the frequency item from the International Consultation on Incontinence Questionnaire (r=0.31 with day 1 toileting frequency and r=0.21 with day 2 toileting frequency). Conclusions: “Where I Go” has potential to increase the understanding of factors that affect women’s toileting decisions and long-term bladder health. We anticipate its use as a data collection tool in population-based studies. International Registered Report Identifier (IRRID): RR2-10.2196/54046 %R 10.2196/56533 %U https://mhealth.jmir.org/2025/1/e56533 %U https://doi.org/10.2196/56533 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e51271 %T An Explanation Interface for Healthy Food Recommendations in a Real-Life Workplace Deployment: User-Centered Design Study %A De Croon,Robin %A Segovia-Lizano,Daniela %A Finglas,Paul %A Vanden Abeele,Vero %A Verbert,Katrien %K food recommender systems %K personalized nutrition %K healthy eating %K human-computer interaction %K real-life deployment %K food catering %K meal recommendations %K nutritional profile %K transparency %D 2025 %7 11.2.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Despite widespread awareness of healthy eating principles, many individuals struggle to translate this knowledge into consistent, sustainable dietary change. Food recommender systems, increasingly used in various settings, offer the potential for personalized guidance and behavior change support. However, traditional approaches may prioritize user preferences or popularity metrics without sufficiently considering long-term nutritional goals. This can inadvertently reinforce unhealthy eating patterns. Emerging research suggests that incorporating explanations into recommender systems can increase transparency, promote informed decision-making, and potentially influence food choices. Yet, the effectiveness of explanations in promoting healthy choices within complex, real-world food environments remain largely unexplored. Objective: This study aims to investigate the design, implementation, and preliminary evaluation of a food recommender system that integrates explanations in a real-world food catering application. We seek to understand how such a system can promote healthy choices while addressing the inherent tensions between user control, meal variety, and the need for nutritionally sound recommendations. Specifically, our objectives are to (1) identify and prioritize key design considerations for food recommenders that balance personalization, nutritional guidance, and user experience; and (2) conduct a proof-of-principle study in a real-life setting to assess the system’s effect on user understanding, trust, and potentially on dietary choices. Methods: An iterative, user-centered design process guided the development and refinement of the system across 4 phases: (Phase 0) an exploratory qualitative study (N=26) to understand stakeholder needs and initial system impressions, (Phases 1 and 2) rapid prototyping in real-life deployments (N=45 and N=16, respectively) to iteratively improve usability and features, and (Phase 3) a proof-of-principle study with employees (N=136) to evaluate a set of design goals. We collected a mix of data, including usage logs, pre- and post-study questionnaires, in-app feedback, and a pre- and post–Food Frequency Questionnaire to establish nutritional profiles. Results: Although we experienced a high drop-out (77% after 7 weeks), motivated and remaining participants valued personalization features, particularly the ability to configure allergies and lifestyle preferences. Explanations increased understanding of recommendations and created a sense of control, even when preferences and healthy options did not fully align. However, a mismatch persisted between individual preferences and nutritionally optimal recommendations. This highlights the design challenge of balancing user control, meal variety, and the promotion of healthy eating. Conclusions: Integrating explanations into personalized food recommender systems might be promising for supporting healthier food choices and creating a more informed understanding of dietary patterns. Our findings could highlight the importance of balancing user control with both the practical limitations of food service settings and the need for nutritionally sound recommendations. While fully resolving the tension between immediate preferences and long-term health goals is an ongoing challenge, explanations can play a crucial role in promoting more conscious decision-making. %R 10.2196/51271 %U https://mhealth.jmir.org/2025/1/e51271 %U https://doi.org/10.2196/51271 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60495 %T mHealth App to Promote Healthy Lifestyles for Diverse Families Living in Rural Areas: Usability Study %A Perez Ramirez,Alejandra %A Ortega,Adrian %A Stephenson,Natalie %A Muñoz Osorio,Angel %A Kazak,Anne %A Phan,Thao-Ly %+ Center For Healthcare Delivery Science, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, United States, 1 302 358 5968, alejandra.perezramirez@nemours.org %K obesity %K user testing %K mHealth %K mobile health %K Spanish %K child %K rural population %D 2025 %7 11.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile Integrated Care for Childhood Obesity is a multicomponent intervention for caregivers of young children with obesity from rural communities that was developed in collaboration with community, parent, and health care partners. It includes community programming to promote healthy lifestyles and address social needs and health care visits with an interdisciplinary team. A digital mobile health platform—the Healthy Lifestyle (Nemours Children’s Health) dashboard—was designed as a self-management tool for caregivers to use as part of Mobile Integrated Care for Childhood Obesity. Objective: This study aimed to improve the usability of the English and Spanish language versions of the Healthy Lifestyle dashboard. Methods: During a 3-phased approach, usability testing was conducted with a diverse group of parents. In total, 7 mothers of children with obesity from rural communities (average age 39, SD 4.9 years; 4 Spanish-speaking and 3 English-speaking) provided feedback on a prototype of the dashboard. Participants verbalized their thoughts while using the prototype to complete 4 tasks. Preferences on the dashboard icon and resource page layout were also collected. Testing was done until feedback reached saturation and no additional substantive changes were suggested. Qualitative and quantitative data regarding usability, acceptability, and understandability were analyzed. Results: The dashboard was noted to be acceptable by 100% (N=7) of the participants. Overall, participants found the dashboard easy to navigate and found the resources, notifications, and ability to communicate with the health care team to be especially helpful. However, all (N=4) of the Spanish-speaking participants identified challenges related to numeracy (eg, difficulty interpreting the growth chart) and literacy (eg, features not fully available in Spanish), which informed iterative refinements to make the dashboard clearer and more literacy-sensitive. All 7 participants (100%) selected the same dashboard icon and 71% (5/7) preferred the final resource page layout. Conclusions: Conducting usability testing with key demographic populations, especially Spanish-speaking populations, was important to developing a mobile health intervention that is user-friendly, culturally relevant, and literacy-sensitive. %M 39932772 %R 10.2196/60495 %U https://formative.jmir.org/2025/1/e60495 %U https://doi.org/10.2196/60495 %U http://www.ncbi.nlm.nih.gov/pubmed/39932772 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e58917 %T Just-In-Time Adaptive Interventions to Promote Behavioral Health: Protocol for a Systematic Review %A Henry,Lauren M %A Blay-Tofey,Morkeh %A Haeffner,Clara E %A Raymond,Cassandra N %A Tandilashvili,Elizabeth %A Terry,Nancy %A Kiderman,Miryam %A Metcalf,Olivia %A Brotman,Melissa A %A Lopez-Guzman,Silvia %+ Emotion and Development Branch, National Institute of Mental Health, 9000 Rockville Pike, Building 15K, Bethesda, MD, 20892, United States, 1 301 480 3895, lauren.henry@nih.gov %K just-in-time adaptive interventions %K JITAI %K behavioral health %K systematic review %K behavior change %K health outcomes %K accessibility %K digital treatment delivery %K mobile phone %D 2025 %7 11.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The goal of just-in-time adaptive interventions (JITAIs) is to use mobile, digital tools to provide individuals with personalized interventions at the optimal time and in the optimal context. Accordingly, JITAIs are promising for advancing accessible, equitable, and evidence-based treatment for behavioral health. To guide future inquiry in this space, a review of the literature is needed to describe the state of research on JITAIs for behavioral health. Objective: This study aims to systematically review the literature to describe the landscape of existing JITAIs for behavioral health at any stage of intervention development. In addition, conditional upon a sufficiently homogeneous literature, we will conduct meta-analyses to investigate the effectiveness of JITAIs for promoting distal outcomes (here, aspects of behavioral health) and proximal outcomes (eg, emotion regulation). Methods: This systematic review is being conducted in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols). We developed our search strategy and executed the literature search in collaboration with biomedical librarians; 5 databases (PubMed, Embase, Cochrane Library, Web of Science: Core Collection, and APA PsycINFO) were searched, and results were managed using EndNote 20 (Clarivate). We are screening (title, abstract, and full text) all records in duplicate in Covidence according to eligibility criteria. Data items will be extracted, and risk of bias will be assessed in duplicate from the included articles in Covidence. We will summarize JITAI characteristics in tables and text. We will conduct meta-analyses for the distal and proximal outcomes conditional upon sufficient homogeneity in subgroups. Moderation (conditional upon sufficient heterogeneity of outcomes) and mediation (ie, whether changes in proximal outcomes mediate the relation between JITAIs and distal outcomes) will be conducted as appropriate. We will investigate publication bias and use the Grading of Recommendations Assessment, Development and Evaluation to characterize the quality of evidence of our estimates. Results: The search strategy was developed between July 2023 and November 2023. The literature search was executed between November 2023 and December 2023. Title and abstract screening began in December 2023, and full-text screening began in May 2024. Data extraction and analyses have not begun. Conclusions: Here, we propose a systematic review to assess the state of the literature on JITAIs for behavioral health. The insights derived from this study will describe the literature on JITAIs in promoting behavioral health, reinforce JITAI definitions, clarify JITAI elements, and inform the next steps in JITAI research. International Registered Report Identifier (IRRID): PRR1-10.2196/58917 %M 39932763 %R 10.2196/58917 %U https://www.researchprotocols.org/2025/1/e58917 %U https://doi.org/10.2196/58917 %U http://www.ncbi.nlm.nih.gov/pubmed/39932763 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65128 %T Smartphone-Based Telemonitoring for Better Oral Health With Toothbrushes: 6-Month Randomized Controlled Trial %A Kim,Jaeyeon %A Choi,Yiseul %A Song,Yoolbin %A Park,Wonse %+ Department of Advanced General Dentistry, Yonsei University College of Dentistry, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 8990, wonse@yuhs.ac %K clinical studies %K clinical trials %K oral hygiene %K plaque %K plaque biofilms %K halitosis %K microbiome %D 2025 %7 10.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: A toothbrush device that telemonitors toothbrushing is a technologically advanced solution providing personalized feedback on toothbrushing habits and oral hygiene. These devices integrate smartphone apps to enhance oral health compliance through dental professional feedback. Objective: This 6-month prospective randomized controlled trial aimed to compare the clinical effectiveness, defined as improved oral hygiene measured by plaque reduction and halitosis control, of an interactive telemonitoring toothbrush (ITT), an oscillating-rotating power toothbrush (ORT), and a manual toothbrush (MT). Methods: Participants were recruited offline from the Department of Advanced General Dentistry at Yonsei University Dental Hospital, South Korea. A total of 150 participants were randomly assigned to 3 groups (50 participants each): (1) an ITT connected to a smartphone app providing real-time feedback and weekly dental professional reviews, (2) an ORT with smartphone-based guidance requiring participants to send weekly brushing records via screenshots, and (3) an MT with a brushing diary for review. Data collection occurred in clinical settings. Primary outcomes included plaque reduction measured using the Simple Hygiene Score (SHS), while secondary outcomes included plaque reduction measured using the Turesky modification of the Quigley-Hein plaque index (QHI), reductions in halitosis, and changes in oral microbiota. All outcomes were assessed at baseline and 1 month, 3 months, and 6 months. Results: A total of 150 participants completed the study. Over 6 months, the SHS increased in the MT group (mean 3.16, SD 4.86 to mean 5.66, SD 5.20) but significantly decreased in the ITT group (mean 3.47, SD 5.50 to mean 2.27, SD 3.82; P=.004). Similarly, QHI decreased more in the ITT group (mean 1.79, SD 0.72 to mean 0.85, SD 0.63) than in the ORT (P<.001) and MT (P<.001) groups. Regarding microbiota, there were no significant differences in high-risk periodontal microbiota or the ratio of caries-risk to anticaries microbiota between the ITT and ORT groups. However, in the MT group, the ratio of caries-risk microbiota was significantly higher at the 3-month (P<.001) and 6-month (P=.005) recalls than at baseline and at the 3-month (P=.048) and 6-month (P=.03) recalls than at the 1-month recall. Poststudy questionnaires indicated that 45 of 50 ITT participants (92%) and 37 of 50 ORT participants (76%) reported improved brushing ability. The most effective feature in the ITT group was brushing training, while participants in the ORT group cited the brushing guide as most useful (P<.001). Satisfaction scores were higher in the ORT group (mean 7.90, SD 1.21) than in the ITT group (mean 7.15, SD 1.66; P=.004). The number of brushing events decreased significantly in the ORT group (P=.02), while brushing duration increased in the MT group (P=.01). Conclusions: ITTs enable better oral hygiene management than MTs through dental professional feedback. However, further studies are needed to optimize feedback intervals and improve long-term adherence. Trial Registration: Clinical Research Information Service (CRIS), Republic of Korea, KCT0009094; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=26110&search_page=L %M 39928944 %R 10.2196/65128 %U https://www.jmir.org/2025/1/e65128 %U https://doi.org/10.2196/65128 %U http://www.ncbi.nlm.nih.gov/pubmed/39928944 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e62776 %T NutriDiary, a Smartphone-Based Dietary Record App: Description and Usability Evaluation %A Klasen,Linda %A Koch,Stefanie Anna Julia %A Benz,Maike Elena %A Conrad,Johanna %A Alexy,Ute %A Blaszkiewicz,Konrad %A Andone,Ionut %A Nöthlings,Ute %K dietary assessment %K food record %K barcode scanning %K app %K mobile phone %D 2025 %7 10.2.2025 %9 %J JMIR Hum Factors %G English %X Background: Repeated applications of short-term dietary assessment instruments are recommended for estimating usual dietary intake. For this purpose, NutriDiary, a smartphone app for collecting weighed dietary records (WDRs) in the German population, was developed. Objective: We aim to describe NutriDiary and evaluate its usability and acceptability. Methods: NutriDiary was developed as a WDR, allowing users to enter food items via text search, barcode scanning, or free text entry. The sample for the evaluation study included 74 participants (n=51, 69% female, aged 18‐64 years), including 27 (37.5%) experts and 47 (63.5%) laypersons (including n=22, 30%, nutrition students). Participants completed a 1-day WDR and entered a predefined sample meal (n=17 foods) the following day by using NutriDiary. An evaluation questionnaire was answered from which the system usability scale (SUS) score (0‐100) was calculated. A backward selection procedure (PROC REG in SAS; SAS Institute) was used to identify potential predictors for the SUS score (age, sex, status [expert or laypersons], and operating system [iOS or Android]). Results: The median SUS score of 75 (IQR 63‐88) indicated good usability. Age was the only characteristic identified as a potential predictor for a lower SUS score (P<.001). The median completion time for an individual WDR was 35 (IQR 19‐52) minutes. Older participants took longer to enter the data than younger ones (18‐30 y: median 1.5, IQR 1.1‐2.0 min/item vs 45‐64 y: median 1.8, IQR 1.3‐2.3 min/item). Most participants expressed a preference for NutriDiary over the traditional paper-based method. Conclusions: Good usability and acceptability make NutriDiary promising for use in epidemiological studies. %R 10.2196/62776 %U https://humanfactors.jmir.org/2025/1/e62776 %U https://doi.org/10.2196/62776 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e64747 %T An App-Based Intervention With Behavioral Support to Promote Brisk Walking in People Diagnosed With Breast, Prostate, or Colorectal Cancer (APPROACH): Process Evaluation Study %A Kennedy,Fiona %A Smith,Susan %A Beeken,Rebecca J %A Buck,Caroline %A Williams,Sarah %A Martin,Charlene %A Lally,Phillippa %A Fisher,Abi %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E7HB, United Kingdom, 44 2076791722, abigail.fisher@ucl.ac.uk %K cancer %K physical activity %K process evaluation %K randomized controlled trial %K intervention %K app %K habit %D 2025 %7 10.2.2025 %9 Original Paper %J JMIR Cancer %G English %X Background: The APPROACH pilot study explored the feasibility and acceptability of an app (NHS Active 10) with brief, habit-based, behavioral support calls and print materials intended to increase brisk walking in people diagnosed with cancer. Objective: Following UK Medical Research Council guidelines, this study assessed the implementation of the intervention, examined the mechanisms of impact, and identified contextual factors influencing engagement. Methods: Adults (aged ≥18 y) with breast, prostate, or colorectal cancer who reported not meeting the UK guidelines for moderate-to-vigorous physical activity (≥150 min/wk) were recruited from a single hospital site in Yorkshire, United Kingdom. They were randomly assigned to the intervention or control (usual care) arm and assessed via quantitative surveys at baseline (time point 0 [T0]) and 3-month follow-up (time point 1 [T1]) and qualitative exit interviews (36/44, 82%) at T1. The process evaluation included intervention participants only (n=44). Implementation was assessed using data from the T1 questionnaire exploring the use of the intervention components. The perceived usefulness of the app, leaflet, and behavioral support call was rated from 0 to 5. Behavioral support calls were recorded, and the fidelity of delivery of 25 planned behavior change techniques was rated from 0 to 5 using an adapted Dreyfus scale. Mechanisms of impact were identified by examining T0 and T1 scores on the Self-Reported Behavioural Automaticity Index and feedback on the leaflet, app, call, and planner in the T1 questionnaire and qualitative interviews. Contextual factors influencing engagement were identified through qualitative interviews. Results: The implementation of the intervention was successful: 98% (43/44) of the participants received a behavioral support call, 78% (32/41) reported reading the leaflet, 95% (39/41) reported downloading the app, and 83% (34/41) reported using the planners. The mean perceived usefulness of the app was 4.3 (SD 0.8) in participants still using the app at T1 (n=33). Participants rated the leaflet (mean 3.9, SD 0.6) and the behavioral support call (mean 4.1, SD 1) as useful. The intended behavior change techniques in the behavioral support calls were proficiently delivered (overall mean 4.2, SD 1.2). Mechanisms of impact included habit formation, behavioral monitoring, and support and reassurance from the intervention facilitator. Contextual factors impacting engagement included barriers, such as the impact of cancer and its treatment, and facilitators, such as social support. Conclusions: The APPROACH intervention was successfully implemented and shows promise for increasing brisk walking, potentially through promoting habit formation and enabling self-monitoring. Contextual factors will be important to consider when interpreting outcomes in the larger APPROACH randomized controlled trial. International Registered Report Identifier (IRRID): RR2-10.1186/s40814-022-01028-w %M 39928926 %R 10.2196/64747 %U https://cancer.jmir.org/2025/1/e64747 %U https://doi.org/10.2196/64747 %U http://www.ncbi.nlm.nih.gov/pubmed/39928926 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58434 %T Assessing the Uses, Benefits, and Limitations of Digital Technologies Used by Health Professionals in Supporting Obesity and Mental Health Communication: Scoping Review %A Kearns,Amanda %A Moorhead,Anne %A Mulvenna,Maurice %A Bond,Raymond %+ Life and Health Sciences, Institute for Nursing and Health Research, Ulster University, 2-24 York Street, Belfast, BT15 1AP, United Kingdom, 44 7706848477, kearns-a7@ulster.ac.uk %K digital communication %K digital technology %K digital transformation %K health professional %K mental health %K obesity %K complex needs %K artificial intelligence %K AI %K PRISMA %D 2025 %7 10.2.2025 %9 Review %J J Med Internet Res %G English %X Background: Obesity and mental health issues present interconnected public health challenges that impair physical, social, and mental well-being. Digital technologies offer potential for enhancing health care communication between health professionals (HPs) and individuals living with obesity and mental health issues, but their effectiveness is not fully understood. Objective: This scoping review aims to identify and understand the different types of technologies used by HPs in supporting obesity and mental health communication. Methods: A comprehensive scoping review, which followed a validated methodology, analyzed studies published between 2013 and 2023 across 8 databases. The data extraction focused on HPs’ use of communication technologies, intervention types, biopsychosocial considerations, and perceptions of technology use. The review was guided by the following research question: “What are the uses, benefits, and limitations of digital technologies in supporting communication between HPs and persons living with obesity and mental health issues?” Results: In total, 8 studies—featuring web-based platforms, social media, synchronous video calls, telephone calls, automated SMS text messaging, and email—met the inclusion criteria. Technologies such as virtual learning collaborative dashboards and videoconferencing, supported by automated SMS text messaging and social media (Facebook and WhatsApp groups), were commonly used. Psychologists, dietitians, social workers, and health coaches used digital tools to facilitate virtual appointments, diet and mental health monitoring, and motivational and educational support through group therapy, 1-on-1 sessions, and hybrid models. Benefits included enhanced access to care and engagement, personalized digital cognitive behavioral therapy, perceived stigma reduction, privacy, and improved physical health outcomes in weight reduction. However, improvements in mental health outcomes were not statistically significant in studies reporting P values (P≥.05). The limitations included engagement difficulties due to conflicting personal family and work commitments; variable communication mode preferences, with some preferring in-person sessions; and misinterpretations of SMS text messaging prompts. Conflicts arose from cultural and individual differences, weight stigma, and confusion over HP roles in obesity and mental health care. Conclusions: Digital technologies have diversified the approaches HPs can take in delivering education, counseling, and motivation to individuals with obesity and mental health issues, facilitating private, stigma-reduced environments for personalized care. While the interventions were effective in obesity management, the review revealed a shortfall in addressing mental health needs. This highlights an urgent need for digital tools to serve as media for a deeper engagement with individuals’ complex biopsychosocial needs. The integration of data science and technological advancements offers promising avenues for tailored digital solutions. The findings advocate the importance of continued innovation and adaptation in digital health care communication strategies, with clearer HP roles and an interdisciplinary, empathetic approach focused on individual needs. %M 39928923 %R 10.2196/58434 %U https://www.jmir.org/2025/1/e58434 %U https://doi.org/10.2196/58434 %U http://www.ncbi.nlm.nih.gov/pubmed/39928923 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60559 %T A Digital Behavior Change Intervention for Health Promotion for Adults in Midlife: Protocol for a Multidimensional Assessment Study %A Soleymani,Dagmar %A Pougheon-Bertrand,Dominique %A Gagnayre,Rémi %+ , Health Promotion and Prevention Division, Santé publique France, 12 rue due Val d'Osne, Saint-Maurice, 94415, France, 33 0171482134, dagmar.soleymani@santepubliquefrance.fr %K digital behavior change intervention %K assessment protocol %K middle-aged adults %K health promotion %K user account %K mixed assessments %K health information technologies %D 2025 %7 7.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: To support lifelong health promotion and disease prevention, Santé publique France studied the methodology for building a social marketing scheme with a digital intervention targeting middle-aged adults, specifically socioeconomically disadvantaged groups. The digital intervention aims to encourage people aged 40-55 years to look after their health in the short and medium terms by adopting small actions relating to 8 health determinants: nutrition, physical activity, smoking, alcohol, stress, cognitive health, sleep, and environmental health. In the long term, the intervention intends to prevent frailty and reduce the burden of multimorbidities in older age, particularly for lower socioeconomic groups. Objective: This study aims to measure behavior changes among registered users of the future website. The protocol assesses the impact of the website based on users’ implementation of small actions relating to the 8 health determinants. Specifically, it intends to evaluate the website’s performance in terms of engaging a specific population, triggering behavior change, raising awareness about a multifactorial approach to health, and encouraging user interaction with the website’s resources. Methods: The methodology is based on clinical assessments developed alongside the website according to the functionalities offered to registered users in their personalized space. The assessment tool design draws on logic models for digital interventions, and their consistency for digital applications is verified. The target audience is clearly defined from the outset. The protocol sets out a 3-step assessment: upon registration, after 3 weeks of use, and after 10 weeks of use (end of assessment). Users are divided into 2 groups (socioeconomically disadvantaged users and others) to characterize differences and make corrections. The protocol uses a mixed assessment approach based on website traffic and user login data. Specific and identifiable behavior changes are documented by monitoring the same individuals from T0 to T2, using verbatim comments to classify them into profiles and conducting semistructured individual interviews with a sample of users. Results: The protocol creates a multidimensional assessment of digital intervention, showing that during a given timeline, interactions with users can reveal their capabilities, opportunities, and motivations to adopt healthy lifestyles. The protocol’s principles were integrated into the development of a personal account to assess users’ behavior changes. Given the delayed launch of the website, no recruitment or effects analysis of the protocol took place. Conclusions: As no multidimensional assessment protocol is currently available for digital behavior change interventions, our methods reveal that the different framework stages can strengthen the effect measurement, consolidate the choice of assumptions used within the logic model and steer the digital intervention toward action while reducing the burden of information. The suitability of the assessment protocol remains to be evaluated given the delayed launch of the website. International Registered Report Identifier (IRRID): PRR1-10.2196/60559 %M 39919300 %R 10.2196/60559 %U https://www.researchprotocols.org/2025/1/e60559 %U https://doi.org/10.2196/60559 %U http://www.ncbi.nlm.nih.gov/pubmed/39919300 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64739 %T Description of Weight-Related Content and Recommended Dietary Behaviors for Weight Loss Frequently Reposted on X (Twitter) in English and Japanese: Content Analysis %A Oono,Fumi %A Matsumoto,Mai %A Ogata,Risa %A Suga,Mizuki %A Murakami,Kentaro %+ , Department of Nutritional Epidemiology and Shokuiku, National Institutes of Biomedical Innovation, Health, and Nutrition, 7 Chome-6-8 Saitoasagi, Ibaraki, Osaka, 567-0085, Japan, 81 663841124, m-matsumoto@nibiohn.go.jp %K social networking service %K X, Twitter %K web-based health information %K dieting %K weight loss %K content analysis %K digital health %K weight control %K weight %K social media %K diet %K dietary behavior %K obesity %K eating disorders %K public perceptions %D 2025 %7 7.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Both obesity and underweight are matters of global concern. Weight-related content frequently shared on social media can reflect public recognition and affect users’ behaviors and perceptions. Although X (Twitter) is a popular social media platform, few studies have revealed the content of weight-related posts or details of dietary behaviors for weight loss shared on X. Objective: This study aims to describe body weight–related content frequently reposted on X, with a particular focus on dietary behaviors for weight loss, in English and Japanese. Methods: We collected English and Japanese X posts related to human body weight having over 100 reposts in July 2023 using an application programming interface tool. Two independent researchers categorized the contents of the posts into 7 main categories and then summarized recommended weight loss strategies. Results: We analyzed 815 English and 1213 Japanese posts. The most popular main category of the content was “how to change weight” in both languages. The Japanese posts were more likely to mention “how to change weight” (n=571, 47.1%) and “recipes to change weight” (n=114, 9.4%) than the English posts (n=195, 23.9% and n=10, 1.2%, respectively), whereas the English posts were more likely to mention “will or experience to change weight” (n=167, 20.5%), “attitudes toward weight status” (n=78, 9.6%), and “public health situation” (n=44, 5.4%) than Japanese posts. Among 146 English and 541 Japanese posts about weight loss strategies, the predominant strategies were diet (n=76, 52.1% in English and n=170, 31.4% in Japanese) and physical activities (n=56, 38.4% and n=295, 54.5%, respectively). The proportion of posts mentioning both diet and physical activity was smaller in Japanese (n=62, 11.5%) than in English (n=31, 21.2%). Among 76 English and 170 Japanese posts about dietary behaviors for weight loss, more than 60% of posts recommended increasing intakes of specific nutrients or food groups in both languages. The most popular dietary component recommended to increase was vegetables in both English (n=31, 40.8%) and Japanese (n=48, 28.2%), followed by protein and fruits in English and grains or potatoes and legumes in Japanese. Japanese posts were less likely to mention reducing energy intake; meal timing or eating frequency; or reducing intakes of specific nutrients or food groups than the English posts. The most popular dietary component recommended to decrease was alcohol in English and confectioneries in Japanese. Conclusions: This study characterized user interest in weight management and suggested the potential of X as an information source for weight management. Although weight loss strategies related to diet and physical activity were popular in both English and Japanese, some differences in the details of the strategies were present, indicating that X users are exposed to different information in English and Japanese. %M 39918849 %R 10.2196/64739 %U https://www.jmir.org/2025/1/e64739 %U https://doi.org/10.2196/64739 %U http://www.ncbi.nlm.nih.gov/pubmed/39918849 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e53566 %T Adapting a Mobile Health App for Smoking Cessation in Black Adults With Anxiety Through an Analysis of the Mobile Anxiety Sensitivity Program Proof-of-Concept Trial: Qualitative Study %A Cheney,Marshall K %A Alexander,Adam C %A Garey,Lorra %A Gallagher,Matthew W %A Hébert,Emily T %A Vujanovic,Anka A %A Kezbers,Krista M %A Matoska,Cameron T %A Zvolensky,Michael J %A Businelle,Michael S %+ Department of Health and Exercise Science, University of Oklahoma, 1401 Asp Ave, Norman, OK, 73019, United States, 1 4053255211, marshall@ou.edu %K cultural tailoring %K tailoring %K African American %K black %K smoking cessation %K mHealth %K smartphone application %K just in time adaptive intervention %K qualitative %K formative evaluation %K app %K application %K anxiety %K adult %K qualitative analysis %K smoking %K mobile phone %K tobacco %D 2025 %7 7.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: At least half of smokers make a serious quit attempt each year, but Black adults who smoke are less likely than White adults who smoke to quit smoking successfully. Black adults who smoke and have high anxiety sensitivity (an individual difference factor implicated in smoking relapse and culturally relevant to Black adults) are even less successful. The Mobile Anxiety Sensitivity Program for Smoking (MASP) is a smoking cessation smartphone app culturally tailored to Black adults who smoke to increase smoking cessation rates by targeting anxiety sensitivity. Objective: This study examined the acceptability and feasibility of the MASP smartphone app following a 6-week pilot test through postintervention qualitative interviews. Methods: The MASP smoking cessation app was adapted from an evidence-based app by adding culturally tailored narration and images specific to the Black community, educational content on tobacco use in the Black community and the role of menthol, culturally tailored messages, and addressing tobacco use and racial discrimination. The MASP app was piloted with 24 adults with high anxiety sensitivity who identified as Black, smoked daily, and were not currently using medications or psychotherapy for smoking cessation. At the end of the 6-week pilot test, 21/24 participants (67% female; 95.2% non-Hispanic; mean age=47.3 years; 43% college educated; 86% single or separated) completed an audio-recorded semistructured interview assessing the acceptability and utility of the app, individual experiences, barriers to use, the cultural fit for Black adults who wanted to quit smoking, and identified areas for improvement. Transcribed interviews were coded using NVivo (Lumivero), and then analyzed for themes using an inductive, use-focused process. Results: Most participants (17/21, 81%) had smoked for more than 20 years and 29% (6/21) of them smoked more than 20 cigarettes daily. Participants felt the MASP app was helpful in quitting smoking (20/21, 95%) and made them more aware of smoking thoughts, feelings, and behaviors (16/19, 84%). Half of the participants (11/21, 52%) thought the combination of medication and smartphone app gave them the best chance of quitting smoking. Themes related to participant experiences using the app included establishing trust and credibility through the recruitment experience, providing personally tailored content linked to evidence-based stress reduction techniques, and self-reflection through daily surveys. The culturally tailored material increased app relevance, engagement, and acceptability. Suggested improvements included opportunities to engage with other participants, more control over app functions, and additional self-monitoring functions. Conclusions: Adding culturally tailored material to an evidence-based mobile health (mHealth) intervention could increase the use of smoking cessation interventions among Black adults who want to quit smoking. Qualitative interviews provide mHealth app developers important insights into how apps can be improved before full study implementation and emphasize the importance of getting feedback from the target population throughout the development process of mHealth interventions. Trial Registration: ClinicalTrials.gov NCT04838236; https://clinicaltrials.gov/ct2/show/NCT04838236 %M 39918847 %R 10.2196/53566 %U https://formative.jmir.org/2025/1/e53566 %U https://doi.org/10.2196/53566 %U http://www.ncbi.nlm.nih.gov/pubmed/39918847 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55541 %T Smartphone-Based Intervention Targeting Norms and Risk Perception Among University Students with Unhealthy Alcohol Use: Secondary Mediation Analysis of a Randomized Controlled Trial %A Studer,Joseph %A Cunningham,John A %A Schmutz,Elodie %A Gaume,Jacques %A Adam,Angéline %A Daeppen,Jean-Bernard %A Bertholet,Nicolas %+ Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 23A, Lausanne, 1011, Switzerland, 41 213149033, joseph.studer@chuv.ch %K brief intervention %K alcohol use %K mechanism of action %K mediation analysis %K personalized feedback %K smartphone app %K students %K Switzerland %K mobile phone %K mediation %K feedback %K student %K health risk %K drinking %K drinker %K support %K feedback intervention %D 2025 %7 6.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Many digital interventions for unhealthy alcohol use are based on personalized normative feedback (PNF) and personalized feedback on risks for health (PFR). The hypothesis is that PNF and PFR affect drinkers’ perceptions of drinking norms and risks, resulting in changes in drinking behaviors. This study is a follow-up mediation analysis of the primary and secondary outcomes of a randomized controlled trial testing the effect of a smartphone-based intervention to reduce alcohol use. Objective: This study aimed to investigate whether perceptions of drinking norms and risks mediated the effects of a smartphone-based intervention to reduce alcohol use. Methods: A total of 1770 students from 4 higher education institutions in Switzerland (mean age 22.35, SD 3.07 years) who screened positive for unhealthy alcohol use were randomized to receive access to a smartphone app or to the no-intervention control condition. The smartphone app provided PNF and PFR. Outcomes were drinking volume (DV) in standard drinks per week and the number of heavy drinking days (HDDs) assessed at baseline and 6 months. Mediators were perceived drinking norms and perceived risks for health measured at baseline and 3 months. Parallel mediation analyses and moderated mediation analyses were conducted to test whether (1) the intervention effect was indirectly related to lower DV and HDDs at 6 months (adjusting for baseline values) through perceived drinking norms and perceived risks for health at 3 months (adjusting for baseline values) and (2) the indirect effects through perceived drinking norms differed between participants who overestimated or who did not overestimate other people’s drinking at baseline. Results: The intervention’s total effects were significant (DV: b=–0.85, 95% bootstrap CI –1.49 to –0.25; HDD: b=–0.44, 95% bootstrap CI –0.72 to –0.16), indicating less drinking at 6 months in the intervention group than in the control group. The direct effects (ie, controlling for mediators) were significant though smaller (DV: b=–0.73, 95% bootstrap CI –1.33 to –0.16; HDD: b=–0.39, 95% bootstrap CI –0.66 to –0.12). For DV, the indirect effect was significant through perceived drinking norms (b=–0.12, 95% bootstrap CI –0.25 to –0.03). The indirect effects through perceived risk (for DV and HDD) and perceived drinking norms (for HDD) were not significant. Results of moderated mediation analyses showed that the indirect effects through perceived drinking norms were significant among participants overestimating other people’s drinking (DV: b=–0.17, 95% bootstrap CI –0.32 to –0.05; HDD: b=–0.08, 95% bootstrap CI –0.15 to –0.01) but not significant among those not overestimating. Conclusions: Perceived drinking norms, but not perceived risks, partially mediated the intervention’s effect on alcohol use, confirming one of its hypothesized mechanisms of action. These findings lend support to using normative feedback interventions to discourage unhealthy alcohol use. Trial Registration: ISRCTN Registry 10007691; https://doi.org/10.1186/ISRCTN10007691 %M 39914807 %R 10.2196/55541 %U https://www.jmir.org/2025/1/e55541 %U https://doi.org/10.2196/55541 %U http://www.ncbi.nlm.nih.gov/pubmed/39914807 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e50662 %T The Effect of Nutritional Mobile Apps on Populations With Cancer: Systematic Review %A Ng,Krystal Lu Shin %A Munisamy,Murallitharan %A Lim,Joanne Bee Yin %A Alshagga,Mustafa %+ Division of Biomedical Sciences, Faculty of Science and Engineering, University of Nottingham Malaysia Campus, Jalan Broga, Semenyih, 43500, Malaysia, 60 172306490, krystal_1224@hotmail.com %K cancer %K mobile app %K nutrition %K body composition %K quality of life %K mobile health %K mHealth %K diet %K intervention %K mobile phone %K PRISMA %D 2025 %7 5.2.2025 %9 Review %J JMIR Cancer %G English %X Background: Limited access to nutrition support among populations with cancer is a major barrier to sustainable and quality cancer care. Increasing use of mobile health in health care has raised concerns about its validity and health impacts. Objective: This systematic review aimed to determine the effectiveness of commercial or cancer-specific nutritional mobile apps among people living with cancer. Methods: A systematic search of the CENTRAL, Embase, PubMed (MEDLINE), and Scopus databases was carried out in May 2024. All types of intervention studies were included, except observational studies, gray literature, and reference lists of key systematic reviews. Studies were eligible for inclusion if they involved (1) patients with or survivors of cancer and (2) nutrition-related mobile apps. Studies were excluded if the nutrition intervention was not delivered via mobile app or the app intervention was accompanied by dietary counseling. The review process was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Risk of Bias 2 and Risk of Bias in Nonrandomized Studies tools were used to assess the study quality. The Cochrane Review Manager (version 5.4) software was used to synthesize the results of the bias assessment. Results: A total of 13 interventions were included, comprising 783 adults or teenagers with cancer. Most studies focused on breast cancer (6/13, 46%), overweight (6/13, 46%), and survivors (9/13, 69%). Data on anthropometry and body composition (7/13, 54%; 387 participants), nutritional status (3/13, 23%; 249 participants), dietary intake (7/13, 54%; 352 participants), and quality of life (6/13, 46%; 384 participants) were gathered. Experimental groups were more likely to report significant improvements in body weight or composition, dietary compliance, nutritional status, and quality of life than control groups. Conclusions: Although mobile app platforms are used to deliver nutrition interventions, the evidence for long-term efficacy, particularly in populations with cancer, remains elusive. More robust randomized controlled trials with larger sample sizes, as well as more homogeneous population characteristics and outcome measures, are warranted. Trial Registration: PROSPERO CRD42023330575; https://tinyurl.com/55v56yaj %M 39908548 %R 10.2196/50662 %U https://cancer.jmir.org/2025/1/e50662 %U https://doi.org/10.2196/50662 %U http://www.ncbi.nlm.nih.gov/pubmed/39908548 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e63428 %T The Effects of MyChoices and LYNX Mobile Apps on HIV Testing and Pre-Exposure Prophylaxis Use by Young US Sexual Minority Men: Results From a National Randomized Controlled Trial %A Biello,Katie B %A Mayer,Kenneth H %A Scott,Hyman %A Valente,Pablo K %A Hill-Rorie,Jonathan %A Buchbinder,Susan %A Ackah-Toffey,Lucinda %A Sullivan,Patrick S %A Hightow-Weidman,Lisa %A Liu,Albert Y %+ Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Box G-S121-2, Providence, RI, 02912, United States, 1 4018633082, katie_biello@brown.edu %K HIV testing %K adolescents %K sexual minority men %K mobile apps %K pre-exposure prophylaxis %K youths %K randomized controlled trial %K sexual minority %K United States %K efficacy %K LYNX %K MyChoices %K sociodemographic %K behavioral health %K HIV prevention %K HIV infection %K HIV care %K transmission %K public health %K mHealth %K mobile phones %D 2025 %7 5.2.2025 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Young sexual minority men have among the highest rates of HIV in the United States; yet, the use of evidence-based prevention strategies, including routine HIV testing and pre-exposure prophylaxis (PrEP), remains low. Mobile apps have enormous potential to increase HIV testing and PrEP use among young sexual minority men. Objective: This study aims to assess the efficacy of 2 theory- and community-informed mobile apps—LYNX (APT Mobility) and MyChoices (Keymind)—to improve HIV testing and PrEP initiation among young sexual minority men. Methods: Between October 2019 and May 2022, we implemented a 3-arm, parallel randomized controlled trial in 9 US cities to test the efficacy of the LYNX and MyChoices apps against standard of care (SOC) among young sexual minority men (aged 15-29 years) reporting anal sex with cisgender male or transgender female in the last 12 months. Randomization was 1:1:1 and was stratified by site and participant age; there was no masking. The co-primary outcomes were self-reported HIV testing and PrEP initiation over 6 months of follow-up. Results: A total of 381 young sexual minority men were randomized. The mean age was 22 (SD 3.2) years. Nearly one-fifth were Black, non-Hispanic (n=67, 18%), Hispanic or Latino men (n=67, 18%), and 60% identified as gay (n=228). In total, 200 (53%) participants resided in the Southern United States. At baseline, participants self-reported the following: 29% (n=110) had never had an HIV test and 85% (n=324) had never used PrEP. Sociodemographic and behavioral characteristics did not differ by study arm. Compared to SOC (n=72, 59%), participants randomized to MyChoices (n=87, 74%; P=.01) were more likely to have received at least 1 HIV test over 6 months of follow-up; those randomized to LYNX also had a higher proportion of testing (n=80, 70%) but it did not reach the a priori threshold for statistical significance (P=.08). Participants in both MyChoices (n=23, 21%) and LYNX (n=21, 20%) arms had higher rates of starting PrEP compared to SOC (n=19, 16%), yet these differences were not statistically significant (P=.52). Conclusions: In addition to facilitating earlier treatment among those who become aware of their HIV status, given the ubiquity of mobile apps and modest resources required to scale this intervention, a 25% relative increase in HIV testing among young sexual minority men, as seen in this study, could meaningfully reduce HIV incidence in the United States. Trial Registration: ClinicalTrials.gov NCT03965221; https://clinicaltrials.gov/study/NCT03965221 %M 39908084 %R 10.2196/63428 %U https://publichealth.jmir.org/2025/1/e63428 %U https://doi.org/10.2196/63428 %U http://www.ncbi.nlm.nih.gov/pubmed/39908084 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e57201 %T Evaluating the Effectiveness of InsightApp for Anxiety, Valued Action, and Psychological Resilience: Longitudinal Randomized Controlled Trial %A Amo,Victoria %A Lieder,Falk %+ Max Planck Institute for Intelligent Systems, Max-Planck-Ring 8, Tübingen, 72076, Germany, 49 15730645508, victoria.amo@tuebingen.mpg.de %K ecological momentary intervention %K serious game %K mindfulness-based intervention %K acceptance and commitment therapy %K cognitive behavioral therapy %K metacognition %K stress %K anxiety %K mobile phone %D 2025 %7 4.2.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Anxiety disorders are among the most prevalent mental disorders, and stress plays a significant role in their development. Ecological momentary interventions (EMIs) hold great potential to help people manage stress and anxiety by training emotion regulation and coping skills in real-life settings. InsightApp is a gamified EMI and research tool that incorporates elements from evidence-based therapeutic approaches. It is designed to strengthen people’s metacognitive skills for coping with challenging real-life situations and embracing anxiety and other emotions. Objective: This randomized controlled trial aims to examine the effectiveness of InsightApp in (1) improving individuals’ metacognitive strategies for coping with stress and anxiety and (2) promoting value-congruent action. It also evaluates how long these effects are retained. This experiment advances our understanding of the role of metacognition in emotional and behavioral reactivity to stress. Methods: We conducted a randomized controlled trial with 228 participants (completion rate: n=197, 86.4%; mean age 38, SD 11.50 years; age range 20-80 years; female: n=101, 52.6%; and White: n=175, 91.1%), who were randomly assigned to either the treatment or the active placebo control group. During the 1-week intervention phase, the treatment group engaged with InsightApp, while participants in the control group interacted with a placebo version of the app that delivered executive function training. We assessed the differences between the 2 groups in posttest and follow-up assessments of mental health and well-being while controlling for preexisting differences. Moreover, we used a multilevel model to analyze the longitudinal data, focusing on the within-participant causal effects of the intervention on emotional and behavioral reactivity to daily stressors. Specifically, we measured daily anxiety, struggle with anxiety, and value-congruent action. Results: The intervention delivered by InsightApp yielded mixed results. On one hand, we found no significant posttest scores on mental health and well-being measures directly after the intervention or 7 days later (all P>.22). In contrast, when confronted with real-life stress, the treatment group experienced a 15% lower increase in anxiety (1-tailed t test, t197=–2.4; P=.009) and a 12% lower increase in the struggle with anxiety (t197=–1.87; P=.031) than the control group. Furthermore, individuals in the treatment group demonstrated a 7% higher tendency to align their actions with their values compared to the control group (t197=3.23; P=.002). After the intervention period, InsightApp’s positive effects on the struggle with anxiety in reaction to stress were sustained, and increased to an 18% lower reactivity to stress (t197=–2.84; P=.002). Conclusions: As our study yielded mixed results, further studies are needed to obtain an accurate and reliable understanding of the effectiveness of InsightApp. Overall, our findings tentatively suggest that guiding people to apply adaptive metacognitive strategies for coping with real-life stress daily with a gamified EMI is a promising approach that deserves further evaluation. Trial Registration: OSF Registries osf.io/k3b5d; https://osf.io/k3b5d %M 39904504 %R 10.2196/57201 %U https://mental.jmir.org/2025/1/e57201 %U https://doi.org/10.2196/57201 %U http://www.ncbi.nlm.nih.gov/pubmed/39904504 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e58026 %T Effect of an Internet-Based Pilates Telerehabilitation Intervention in People With Multiple Sclerosis: Protocol for a Randomized Controlled Trial %A Tacchino,Andrea %A Ponzio,Michela %A Confalonieri,Paolo %A Leocani,Letizia %A Inglese,Matilde %A Centonze,Diego %A Cocco,Eleonora %A Gallo,Paolo %A Paolicelli,Damiano %A Rovaris,Marco %A Sabattini,Loredana %A Tedeschi,Gioacchino %A Prosperini,Luca %A Patti,Francesco %A Sessa,Edoardo %A Pedrazzoli,Elisabetta %A Battaglia,Mario Alberto %A Brichetto,Giampaolo %+ Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, Genoa, 16149, Italy, 39 0102713812, andrea.tacchino@aism.it %K exergame %K MS-FIT %K Pilates %K Kinect %K multiple sclerosis %K exercise %K physical activity %K leisure time physical activity %K Timed Up and Go %D 2025 %7 3.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical activity (PA) has been recommended in multiple sclerosis (MS) to maintain good physical fitness and mental health, reduce the severity of symptoms and risk of relapse, and improve quality of life. Pilates has been suggested as an ideal PA to manage physical, cognitive, and psychological symptoms of MS and a useful method to maintain and improve balance and gait. Objective: This paper presents the protocol for a study that aims to evaluate the efficacy on the physical domain (specifically balance and gait) of a home-based, self-managed PA intervention delivered through the MS-FIT exergame (HELAGLOBE Società a responsabilità limitata). In addition, measures of cognitive performance, quality of life, and well-being will be considered. Methods: This is a 2-arm, multicenter, randomized controlled trial with 3 assessment points (baseline, 12 weeks postintervention, and 6 weeks follow-up). People with MS with mild disability, low risk of falling, preserved cognitive functions, and low anxiety and depression are potential eligible participants. The experimental group (MS-FIT) will self-administer the MS-FIT exergame at home in addition to their leisure-time physical activities. MS-FIT is an internet- and Pilates-based tool that uses the Microsoft Kinect Sensor V2. Participants in the control group will only have access to their leisure-time physical activities. Participants in the MS-FIT group will train at home with MS-FIT for 12 weeks and will be required to perform the exercises for a total of 30 minutes/day for at least 3 days/week. The primary outcome is the Timed Up and Go, a test designed to assess walking. We will also administer additional tests for motor function (visual analog scale 0-10, Timed 25-Foot Walk, Ambulation Index, 2-minute walk test, Twelve Item Multiple Sclerosis Walking Scale, Nine-Hole Peg Test), cognition (Brief International Cognitive Assessment for Multiple Sclerosis), fatigue (Modified Fatigue Impact Scale), quality of life (Multiple Sclerosis Quality of Life-54), well-being (Psychological Well-Being Scales), and PA (International Physical Activity Questionnaire and Minnesota Leisure Time Physical Activity Questionnaire). Acceptance and satisfaction with the intervention received (Client Satisfaction Questionnaire and an adapted version of the Tele-healthcare Satisfaction Questionnaire – Wearable Technology) and subjective impressions of changes in performance (Patients’ Global Impression of Change) will also be assessed. Results: Recruitment for the trial started on March 16, 2022, and the first participant was randomized the same day. Data analysis and results are expected to be published in 2025. Conclusions: Pilates has proven beneficial in several neurological diseases such as MS. With this study, we will provide evidence for the use in clinical practice of a digital tool for self-administered Pilates exercises at home as a complement to rehabilitation and for the continuity of care in MS. Trial Registration: ClinicalTrials.gov NCT04011579; https://tinyurl.com/2p9n4d2t International Registered Report Identifier (IRRID): DERR1-10.2196/58026 %M 39899835 %R 10.2196/58026 %U https://www.researchprotocols.org/2025/1/e58026 %U https://doi.org/10.2196/58026 %U http://www.ncbi.nlm.nih.gov/pubmed/39899835 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e62738 %T Development of Chatbot-Based Oral Health Care for Young Children and Evaluation of its Effectiveness, Usability, and Acceptability: Mixed Methods Study %A Pupong,Kittiwara %A Hunsrisakhun,Jaranya %A Pithpornchaiyakul,Samerchit %A Naorungroj,Supawadee %K chatbot %K conversational agents %K tele-dentistry %K oral health behavior %K in-person toothbrushing %K hands-on %K children %K covid-19 %K oral health education %K development. %D 2025 %7 3.2.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Chatbots are increasingly accepted in public health for their ability to replicate human-like communication and provide scalable, 24/7 services. The high prevalence of dental caries in children underscores the need for early and effective intervention. Objective: This study aimed to develop the 30-Day FunDee chatbot and evaluate its effectiveness, usability, and acceptability in delivering oral health education to caregivers of children aged 6 to 36 months. Methods: The chatbot was created using the artificial intelligence (AI) chatbot behavior change model, integrating behavioral change theories into content designed for 3‐5 minutes of daily use over 30 days. A pre-post experimental study was conducted from December 2021 to February 2022 in Hat Yai District, Songkhla Province, and Maelan District, Pattani Province, Thailand. Fifty-eight caregivers completed a web-based structured questionnaire at baseline and 2 months post baseline to evaluate knowledge, protection motivation theory-based perceptions, and tooth-brushing practices. Usability was assessed via chatbot logfiles and a web-based questionnaire at 2 months post baseline. Acceptability was evaluated through three methods: (1) open-ended chatbot interactions on day 30, (2) a web-based structured questionnaire at 2 months post baseline, and (3) semistructured telephone interviews with 15 participants 2 weeks post intervention. Participants for interviews were stratified by adherence levels and randomly selected from Hatyai and Maelan districts. All self-reported variables were measured on a 5-point Likert scale (1=lowest, 5=highest). Results: The chatbot was successfully developed based on the 4 components of the AI chatbot behavior change model. Participants had a mean age of 34.5 (SD 8.6) years. The frequency of tooth brushing among caregivers significantly improved, increasing from 72.4% at baseline to 93.1% two months post baseline (P=.006). Protection motivation theory-based perceptions also showed significant improvement, with mean scores rising from 4.0 (SD 0.6) at baseline to 4.5 (SD 0.6) two months post baseline (P<.001). The chatbot received high ratings for satisfaction (4.7/5, SD 0.6) and usability (4.7/5, SD 0.5). Participants engaged with the chatbot for an average of 24.7 (SD 7.2) days out of 30. Caregivers praised the chatbot’s content quality, empathetic communication, and multimedia design, but noted the intervention’s lengthy duration and messaging system as limitations. Conclusions: The 30-Day FunDee chatbot effectively enhanced caregivers’ perceptions of oral health care and improved tooth-brushing practices for children aged 6‐36 months. High user satisfaction and engagement demonstrate its potential as an innovative tool for oral health education. These findings warrant further validation through large-scale, randomized controlled trials. Trial Registration: Thai Clinical Trials Registry Tctr20210927004; https://www.thaiclinicaltrials.org/show/Tctr20210927004 %R 10.2196/62738 %U https://pediatrics.jmir.org/2025/1/e62738 %U https://doi.org/10.2196/62738 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e69311 %T Evaluating the Impact of Pharmacotherapy in Augmenting Quit Rates Among Hispanic Adults in an App-Delivered Smoking Cessation Intervention: Secondary Analysis of a Randomized Controlled Trial %A Santiago-Torres,Margarita %A Mull,Kristin E %A Sullivan,Brianna M %A Cupertino,Ana Paula %A Salloum,Ramzi G %A Triplette,Matthew %A Zvolensky,Michael J %A Bricker,Jonathan B %+ Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Avenue North, Seattle, WA, 98109, United States, 1 206 667 4780, msantiag@fredhutch.org %K acceptance and commitment therapy %K Hispanic or Latino %K iCanQuit %K QuitGuide %K smartphone apps %K smoking cessation %K mobile phone %D 2025 %7 31.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Hispanic adults receive less advice to quit smoking and use fewer evidence-based smoking cessation treatments compared to their non-Hispanic counterparts. Digital smoking cessation interventions, such as those delivered via smartphone apps, provide a feasible and within-reach treatment option for Hispanic adults who smoke and want to quit smoking. While the combination of pharmacotherapy and behavioral interventions are considered best practices for smoking cessation, its efficacy among Hispanic adults, especially alongside smartphone app–based interventions, is uncertain. Objective: This secondary analysis used data from a randomized controlled trial that compared the efficacy of 2 smoking cessation apps, iCanQuit (based on acceptance and commitment therapy) and QuitGuide (following US clinical practice guidelines), to explore the association between pharmacotherapy use and smoking cessation outcomes among the subsample of 173 Hispanic participants who reported on pharmacotherapy use. Given the randomized design, we first tested the potential interaction of pharmacotherapy use and intervention arm on 12-month cigarette smoking abstinence. We then examined whether the use of any pharmacotherapy (ie, nicotine replacement therapy [NRT], varenicline, or bupropion) and NRT alone augmented each app-based intervention efficacy. Methods: Participants reported using pharmacotherapy on their own during the 3-month follow-up and cigarette smoking abstinence at the 12-month follow-up via web-based surveys. These data were used (1) to test the interaction effect of using pharmacotherapy to aid smoking cessation and intervention arm (iCanQuit vs QuitGuide) on smoking cessation at 12 months and (2) to test whether the use of pharmacotherapy to aid smoking cessation augmented the efficacy of each intervention arm to help participants successfully quit smoking. Results: The subsample of Hispanic participants was recruited from 30 US states. They were on average 34.5 (SD 9.3) years of age, 50.9% (88/173) were female, and 56.1% (97/173) reported smoking at least 10 cigarettes daily. Approximately 22% (38/173) of participants reported using pharmacotherapy to aid smoking cessation at the 3-month follow-up, including NRT, varenicline, or bupropion, with no difference between intervention arms. There was an interaction between pharmacotherapy use and intervention arm that marginally influenced 12-month quit rates at 12 months (P for interaction=.053). In the iCanQuit arm, 12-month missing-as-smoking quit rates were 43.8% (7/16) for pharmacotherapy users versus 28.8% (19/16) for nonusers (odds ratio 2.21, 95% CI 0.66-7.48; P=.20). In the QuitGuide arm, quit rates were 9.1% (2/22) for pharmacotherapy users versus 21.7% (15/69) for nonusers (odds ratio 0.36, 95% CI 0.07-1.72; P=.20). Results were similar for the use of NRT only. Conclusions: Combining pharmacotherapy to aid smoking cessation with a smartphone app–based behavioral intervention that teaches acceptance of cravings to smoke (iCanQuit) shows promise in improving quit rates among Hispanic adults. However, this combined approach was not effective with the US clinical guideline–based app (QuitGuide). Trial Registration: ClinicalTrials.gov NCT02724462; https://clinicaltrials.gov/study/NCT02724462 International Registered Report Identifier (IRRID): RR2-10.1001/jamainternmed.2020.4055 %R 10.2196/69311 %U https://formative.jmir.org/2025/1/e69311 %U https://doi.org/10.2196/69311 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e53188 %T Latinx and White Adolescents’ Preferences for Latinx-Targeted Celebrity and Noncelebrity Food Advertisements: Experimental Survey Study %A Bragg,Marie A %A Lutfeali,Samina %A Gabler,Daniela Godoy %A Quintana Licona,Diego A %A Harris,Jennifer L %+ Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, United States, 1 6465012717, marie.bragg@nyulangone.org %K Latinx %K Hispanic %K adolescents %K marketing %K celebrities %K Spanish %K advertisements %K products %K brands %K food %K unhealthy %K beverages %K diet %K nutrition %K consumers %K intention %K purchasing %K attitudes %K perceptions %K preferences %K youth %D 2025 %7 31.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Exposure to food advertisements is a major driver of childhood obesity, and food companies disproportionately target Latinx youth with their least healthy products. This study assessed the effects of food and beverage advertisements featuring Latinx celebrities versus Latinx noncelebrities on Latinx and White adolescents. Objective: This web-based within-subjects study aims to assess the effects of food and beverage advertisements featuring Latinx celebrities versus Latinx noncelebrities on Latinx and White adolescents’ preferences for the advertisements and featured products. Methods: Participants (N=903) were selected from a volunteer sample of adolescents, aged 13-17 years, who self-identified as Latinx or White, had daily internet access, and could read and write in English. They participated in a web-based Qualtrics study where each participant viewed 8 advertisements for novel foods and beverages, including 4 advertisements that featured Latinx celebrities and the same 4 advertisements that featured Latinx noncelebrities (matched on all other attributes), in addition to 2 neutral advertisements (featuring bland, nontargeted products and did not feature people). Primary outcomes were participants’ ratings of 4 advertisements for food and beverage brands featuring a Latinx celebrity and the same 4 advertisements featuring a Latinx noncelebrity. Multilevel linear regression models compared the effects of celebrities and differences between Latinx and White participants on attitudes (advertisement likeability; positive affect; and brand perceptions) and behavioral intentions (consumption; social media engagement—“liking;” following; commenting; tagging a friend). Results: Latinx (n=436; 48.3%) and White (n=467; 51.7%) participants rated advertisements featuring Latinx celebrities more positively than advertisements featuring noncelebrities on attitude measures except negative affect (Ps≤.002), whereas only negative affect differed between Latinx and White participants. Two of the 5 behavioral intention measures differed by celebrity advertisement status (P=.02; P<.001). Additionally, the interaction between celebrity and participant ethnicity was significant for 4 behavioral intentions; Latinx, but not White, participants reported higher willingness to consume the product (P<.001), follow brands (P<.001), and tag friends (P<.001). While White and Latinx adolescents both reported higher likelihoods of “liking” advertisements on social media endorsed by Latinx celebrities versus noncelebrities, the effect was significantly larger among Latinx adolescents (P<.01). Conclusions: This study demonstrates the power of Latinx celebrities in appealing to both Latinx and White adolescents but may be particularly persuasive in shaping behavioral intentions among Latinx adolescents. These findings suggest an urgent need to reduce celebrity endorsements in ethnically targeted advertisements that promote unhealthy food products to communities disproportionately affected by obesity and diabetes. The food industry limits food advertising to children ages 12 years and younger, but industry self-regulatory efforts and policies should expand to include adolescents and address disproportionate marketing of unhealthy food to Latinx youth and celebrity endorsements of unhealthy products. %M 39889276 %R 10.2196/53188 %U https://www.jmir.org/2025/1/e53188 %U https://doi.org/10.2196/53188 %U http://www.ncbi.nlm.nih.gov/pubmed/39889276 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e69771 %T An mHealth Intervention With Financial Incentives to Promote Smoking Cessation and Physical Activity Among Black Adults: Protocol for a Feasibility Randomized Controlled Trial %A Alexander,Adam %A Businelle,Michael %A Cheney,Marshall %A Cohn,Amy %A McNeill,Lorna %A Short,Kevin %A Frank-Pearce,Summer %A Bradley,David %A Estrada,Kimberly %A Flores,Iván %A Fronheiser,Jack %A Kendzor,Darla %+ University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 (405) 965 05, Adam-Alexander@ouhsc.edu %K African American %K Black %K mobile health %K mHealth %K smartphone app %K smoking cessation %K physical activity, mobile phone %D 2025 %7 31.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Black adults in the United States experience disproportionately high rates of tobacco- and obesity-related diseases, driven in part by disparities in smoking cessation and physical activity. Smartphone-based interventions with financial incentives offer a scalable solution to address these health disparities. Objective: This study aims to assess the feasibility and preliminary efficacy of a mobile health intervention that provides financial incentives for smoking cessation and physical activity among Black adults. Methods: A total of 60 Black adults who smoke (≥5 cigarettes/d) and are insufficiently physically active (engaging in <150 min of weekly moderate-intensity physical activity) will be randomly assigned to either HealthyCells intervention (incentives for smoking abstinence only) or HealthyCells+ intervention (incentives for both smoking abstinence and daily step counts). Participants will use study-provided smartphones, smartwatches, and carbon monoxide monitors for 9 weeks (1 wk prequit date through 8 wk postquit date). Feasibility will be evaluated based on recruitment rates, retention, and engagement. The primary outcomes include carbon monoxide–verified, 7-day smoking abstinence at 8 weeks postquit date and changes in average daily step count. Feasibility benchmarks include a recruitment rate of ≥5 participants per month, a retention rate of ≥75%, and a smoking abstinence rate of ≥20% at 8 weeks postquit date. Expected increases in physical activity include a net gain of 500 to 1500 steps per day compared to baseline. Results: Recruitment is expected to begin in February 2025 and conclude by September 2025, with data analysis completed by October 2025. Conclusions: This study will evaluate the feasibility of a culturally tailored mobile health intervention combining financial incentives for smoking cessation and physical activity promotion. Findings will inform the design of larger-scale trials to address health disparities through scalable, technology-based approaches. Trial Registration: ClinicalTrials.gov NCT05188287; https://clinicaltrials.gov/ct2/show/NCT05188287 International Registered Report Identifier (IRRID): PRR1-10.2196/69771 %M 39888657 %R 10.2196/69771 %U https://www.researchprotocols.org/2025/1/e69771 %U https://doi.org/10.2196/69771 %U http://www.ncbi.nlm.nih.gov/pubmed/39888657 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58164 %T Investigating the Efficacy of the Web-Based Common Elements Toolbox (COMET) Single-Session Interventions in Improving UK University Student Well-Being: Randomized Controlled Trial %A Lambert,Jeffrey %A Loades,Maria %A Marshall,Noah %A Higson-Sweeney,Nina %A Chan,Stella %A Mahmud,Arif %A Pile,Victoria %A Maity,Ananya %A Adam,Helena %A Sung,Beatrice %A Luximon,Melanie %A MacLennan,Keren %A Berry,Clio %A Chadwick,Paul %+ Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 1225 385249, m.e.loades@bath.ac.uk %K Common Elements Toolbox %K mental well-being %K online interventions %K single-session interventions %K university students %D 2025 %7 31.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health problems in university students are associated with many negative outcomes, yet there is a gap between need and timely access to help. Single-session interventions (SSIs) are designed to be scalable and accessible, delivering core evidence-based intervention components within a one-off encounter. Objective: COMET (Common Elements Toolbox) is an online self-help SSI that includes behavioral activation, cognitive restructuring, gratitude, and self-compassion. COMET has previously been evaluated in India, Kenya, and the United States with promising results. This study tests the acceptability, appropriateness, perceived utility, and efficacy of COMET among UK university students during the peripandemic period. Methods: We conducted a randomized controlled trial evaluating the efficacy of COMET compared with a control group, with 2- and 4-week follow-ups. Outcome variables were subjective well-being, depression severity, anxiety severity, positive affect, negative affect, and perceived stress. We also measured intervention satisfaction immediately after completion of COMET. All UK university students with access to the internet were eligible to participate and were informed of the study online. The data were analyzed using linear mixed models and reported in accordance with the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist. Results: Of the 831 people screened, 468 participants were randomized to a condition, 407 completed the postintervention survey, 147 returned the 2-week follow-up survey, 118 returned the 4-week follow-up survey, and 89 returned both. Of the 239 randomized, 212 completed COMET. Significant between-group differences in favor of the COMET intervention were observed at 2-week follow-ups for subjective well-being (Warwick-Edinburgh Mental Well-Being Scale; mean difference [MD] 1.39, 95% CI 0.19-2.61; P=.03), depression severity (9-item Patient Health Questionnaire; MD –1.31, 95% CI –2.51 to –0.12; P=.03), and perceived stress (4-item Perceived Stress Scale; MD –1.33, 95% CI –2.10 to –0.57; P<.001). Overall, participants were satisfied with COMET, with the majority endorsing the intervention and its modules as acceptable, appropriate, and exhibiting high utility. The self-compassion module was most often reported as the participants’ favorite module and the behavioral activation module was their least favorite. Qualitative analysis revealed that participants found COMET generally accessible, but too long, and experienced immediate and long-term beneficial effects. Conclusions: This study demonstrated high engagement with the COMET intervention, along with preliminary short-term efficacy. Almost all participants completed the intervention, but study attrition was high. Participant feedback indicated a high level of overall satisfaction with the intervention, with perceived accessibility, immediate benefits, and potential long-term impact being notable findings. These findings support the potential value of COMET as a mental health intervention and highlight important areas for further improvement. Trial Registration: ClinicalTrials.gov NCT05718141; https://clinicaltrials.gov/ct2/show/NCT05718141 %M 39888663 %R 10.2196/58164 %U https://www.jmir.org/2025/1/e58164 %U https://doi.org/10.2196/58164 %U http://www.ncbi.nlm.nih.gov/pubmed/39888663 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54216 %T Self-Guided Smartphone App (Vimbo) for the Reduction of Symptoms of Depression and Anxiety in South African Adults: Pilot Quantitative Single-Arm Study %A Steyn,Sherrie %A Slabbert,Meggan %+ Vimbo Health SA (Pty) Ltd, 20 Riverclub Mews, 7 Sycamore Avenue, Riverclub, Sandton, 2191, South Africa, 27 63 861 6780, sherrie@vimbohealth.com %K treatment gap %K mental health %K health %K depression %K anxiety %K South Africa %K CBT %K cognitive behavioral therapy %K app-based intervention %K mobile health %K mental health app %K smartphone %K mobile phone %D 2025 %7 30.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Barriers to mental health assessment and intervention have been well documented within South Africa, in both urban and rural settings. Internationally, evidence has emerged for the effectiveness of technology and, specifically, app-based mental health tools and interventions to help overcome some of these barriers. However, research on digital interventions specific to the South African context and mental health is limited. Objective: This pilot study investigated the feasibility of using an app (Vimbo) to treat symptoms of anxiety and depression in South African adults recruited from a community sample. The Vimbo app is a self-guided, cognitive behavioral therapy–based digital intervention for common mental health difficulties developed for the South African context. Methods: This pilot study used a naturalistic, single-arm design testing the Vimbo app over 12 weeks, from October 2020 to February 2021. Participants were recruited through the South African Depression and Anxiety Group and social media advertisements online. A 2-week retention period was used to allow for a minimum of 2 datasets. App usage and engagement metrics were extracted directly from the back end of the app. Based on the model, researchers expected many users to discontinue usage when their symptom levels entered a healthy range. Pre-post review of symptom levels was used to reflect on clinical recovery status at discontinuation after the retention period. Results: A total of 218 applicants met study eligibility criteria and were invited to download the Vimbo app. Of these, 52% (114/218) of the participants registered with the app, who indicated multiple variances of depression and anxiety symptoms ranging in severity from mild to severe. Two participants users withdrew from the study. Moreover, 69% (77/112) of users were retained, including 8 who had technical issues with their treatment. When comparing broad uptake across all interested participants, chi-square analysis indicated significantly reduced uptake in participants identifying as “unemployed but seeking employment” (χ24=10.47; N=251; P=.03). When considering app usage for the entire cohort (n=69, excluding participants with technical issues), there was a mean of 72.87 (SD 71.425) total module pages read, a mean of 30% (SD 29.473%) of prescribed content completed, and a mean of 19.93 (SD 27.517) times engaging with tools and skills. Conclusions: Our findings support the case for continued exploration of app-based interventions for treating depression and anxiety in South Africa. Developing strategies to increase access and improve intervention uptake may prove essential to helping mobile health interventions make as significant an impact as possible. Future research should include a randomized controlled trial with a larger sample to further assess the efficacy of app-based interventions in treating mental health difficulties in South Africa. %M 39883938 %R 10.2196/54216 %U https://formative.jmir.org/2025/1/e54216 %U https://doi.org/10.2196/54216 %U http://www.ncbi.nlm.nih.gov/pubmed/39883938 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54392 %T Web-Based Exercise and Nutrition Intervention to Improve Leg Muscle Strength and Physical Functioning in Older Adults: Pre-Post Pilot Study %A Dorhout,Berber Gijsbertha %A Wezenbeek,Nick %A de Groot,Lisette C P G M %A Grootswagers,Pol %K web-based lifestyle intervention %K resistance exercise %K protein intake %K muscle strength %K muscle mass %K older adults %K web-based exercise %K nutrition %K exercise %K resistance training %K sarcopenia %D 2025 %7 30.1.2025 %9 %J JMIR Form Res %G English %X Background: The lifestyle intervention ProMuscle, which combines resistance exercise and an increased protein intake, was effective in improving muscle strength, muscle mass, and physical functioning in older adults. However, due to a growing shortage of health care professionals, the rapidly growing aging population cannot be personally guided in the future. Therefore, Uni2Move, a scalable web-based variant of ProMuscle, was designed to reach larger groups of older adults without putting additional burden on health care professionals. Objective: The current study investigated the effects of a web-based lifestyle intervention on muscle strength, protein intake, and physical functioning in healthy older adults. In addition, we conducted a qualitative study to gather key insights of the participants involved, as little is known about older adults’ perceptions of web-based lifestyle interventions. Methods: A pre-post pilot study was conducted in the Netherlands. In the 24-week intervention, 19 healthy adults aged >55 years were included. They performed resistance training at home twice a week for 24 weeks via web-based workout videos. Videos (45‐60 minutes) were recorded by the fitness trainer and mainly focused on training leg muscles. In addition, older adults were advised on increasing protein intake via two web-based consultations by a dietitian in the first 12 weeks and via an e-learning course in the second 12 weeks. Intervention adherence and acceptance was measured in week 25. The 1 repetition maximum knee extension strength, repeated chair rise test, and protein intake were measured at baseline, week 13, and week 25. Linear mixed models were used to test differences over time. Semistructured interviews were used to gather experiences of participants. Atlas.ti version 22 was used to analyze the interviews. Results: The mean age of participants (n=19) at baseline was 69 (SD 7) years. The 1 repetition maximum knee extension strength and repeated chair rise test improved significantly during the 24-week intervention with a mean difference of 7.0 kg (95% CI 4.8-9.3; P<.001) and −1.2 seconds (95% CI −1.7 to −0.6; P<.001), respectively. Total protein intake per day did not change, whereas protein intake during breakfast had increased significantly after 13 weeks with a mean difference of 6.9 g (95% CI 1.1-12.7; P=.01). Qualitative research revealed that advantages of the program included no need to travel and exercising in their own environment. Disadvantages were the lack of physical interaction and no corrections by the trainer. Conclusions: The results of the web-based exercise and nutrition intervention Uni2Move indicate potential improvements of muscle strength and physical functioning in healthy middle-aged and older adults. Providing such lifestyle interventions on the internet could reach an increased number of older adults, providing the opportunity to contribute to the health and independence of the rapidly growing aging population. %R 10.2196/54392 %U https://formative.jmir.org/2025/1/e54392 %U https://doi.org/10.2196/54392 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e60708 %T The Effects of Self-Monitoring Using a Smartwatch and Smartphone App on Stress Awareness, Self-Efficacy, and Well-Being–Related Outcomes in Police Officers: Longitudinal Mixed Design Study %A de Vries,Herman Jaap %A Delahaij,Roos %A van Zwieten,Marianne %A Verhoef,Helen %A Kamphuis,Wim %K wearable electronic devices %K ecological momentary assessment %K psychological stress %K psychological well-being %K awareness %K self-efficacy %K occupational medicine %K emergency responders %K well-being %K psychological %K efficacy %K stress %K wearables %K wearable device %K smartwatch %K smartphone app %K app %K sensor %K sensor technology %K police officers %K questionnaire %K stress awareness %K stress management %D 2025 %7 28.1.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Wearable sensor technologies, often referred to as “wearables,” have seen a rapid rise in consumer interest in recent years. Initially often seen as “activity trackers,” wearables have gradually expanded to also estimate sleep, stress, and physiological recovery. In occupational settings, there is a growing interest in applying this technology to promote health and well-being, especially in professions with highly demanding working conditions such as first responders. However, it is not clear to what extent self-monitoring with wearables can positively influence stress- and well-being–related outcomes in real-life conditions and how wearable-based interventions should be designed for high-risk professionals. Objective: The aim of this study was to investigate (1) whether offering a 5-week wearable-based intervention improves stress- and well-being–related outcomes in police officers and (2) whether extending a basic “off-the-shelf” wearable-based intervention with ecological momentary assessment (EMA) questionnaires, weekly personalized feedback reports, and peer support groups improves its effectiveness. Methods: A total of 95 police officers from 5 offices participated in the study. The data of 79 participants were included for analysis. During the first 5 weeks, participants used no self-monitoring technology (control period). During the following 5 weeks (intervention period), 41 participants used a Garmin Forerunner 255 smartwatch with a custom-built app (comparable to that of the consumer-available wearable), whereas the other 38 participants used the same system, but complemented by daily EMA questionnaires, weekly personalized feedback reports, and access to peer support groups. At baseline (T0) and after the control (T1) and intervention (T2) periods, questionnaires were administered to measure 15 outcomes relating to stress awareness, stress management self-efficacy, and outcomes related to stress and general well-being. Linear mixed models that accounted for repeated measures within subjects, the control and intervention periods, and between-group differences were used to address both research questions. Results: The results of the first analysis showed that the intervention had a small (absolute Hedges g=0.25‐0.46) but consistent effect on 8 of 15 of the stress- and well-being–related outcomes in comparison to the control group. The second analysis provided mixed results; the extended intervention was more effective than the basic intervention at improving recovery after work but less effective at improving self-efficacy in behavior change and sleep issues, and similarly effective in the remaining 12 outcomes. Conclusions: Offering a 5-week wearable-based intervention to police officers can positively contribute to optimizing their stress-related, self-efficacy, and well-being–related outcomes. Complementing the basic “off-the-shelf” wearable-based intervention with additional EMA questionnaires, weekly personalized feedback reports, and peer support groups did not appear to improve the effectiveness of the intervention. Future work is needed to investigate how different aspects of these interventions can be tailored to specific characteristics and needs of employees to optimize these effects. %R 10.2196/60708 %U https://mhealth.jmir.org/2025/1/e60708 %U https://doi.org/10.2196/60708 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e62782 %T Role of Tailored Timing and Frequency Prompts on the Efficacy of an Internet-Delivered Stress Recovery Intervention for Health Care Workers: Randomized Controlled Trial %A Nomeikaite,Auguste %A Gelezelyte,Odeta %A Böttche,Maria %A Andersson,Gerhard %A Kazlauskas,Evaldas %+ Center for Psychotraumatology, Institute of Psychology, Vilnius University, Room 203, 29 MK Čiurlionio St, Vilnius, LT-03100, Lithuania, 370 52667615, auguste.nomeikaite@fsf.vu.lt %K internet interventions %K mental health %K stress %K health care workers %K short message service %K cognitive behavioral therapy %K internet-delivered cognitive behavioral therapy %K psychotherapy %K randomized %K controlled trial %K engagement %K SMSl worker %K usage %K occupational health %K provider %K prompt %K message %D 2025 %7 28.1.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Prompts offer a promising strategy to promote client engagement in internet-delivered cognitive behavioral therapy (ICBT). However, if the prompts do not meet the needs of clients, they can potentially be more obtrusive rather than helpful. Objective: The aim of this study was to test if prompts tailored based on timing and frequency, aligned with preintervention goal setting, can increase usage and the efficacy of a therapist-supported ICBT stress recovery intervention for health care workers. Methods: The 2-arm randomized controlled trial included 87 health care workers (99% female, aged 19-68 years: mean 39.61, SD 11.49): 43 in the standard intervention group and 44 in the tailored prompts group. The primary outcome measure was the Recovery Experiences Questionnaire, and the secondary outcomes were the Perceived Stress Scale-4, the Patient Health Questionnaire-4, and the World Health Organization-5 Well-Being Index. The self-report data were collected before the intervention (September 2022), postintervention (October 2022), and 6-month follow-up (May 2023). Results: The results showed that tailored prompts, although appreciated by the majority (39/40, 98%), did not improve intervention usage indicators, such as the number of logins (t85=–0.91; P=.36), modules opened (t83.57=–1.47; P=.15), modules completed (t85=–0.71; P=.48), exercises completed (t85=–1.05; P=.30), or the time spent using the program (χ22=1.1; P=.57). Similarly, tailored prompts did not increase the effects of the intervention in terms of stress recovery skills (Cohen d ranging from 0.31 to 0.85), perceived stress (d=–0.08; –0.70), depression (d=–0.11; –0.38), anxiety (d=–0.32; –0.64), or psychological well-being (d=0.26; 0.46). In addition, the standard intervention group showed greater long-term stress recovery effects than the group using the internet-delivered intervention supplemented by tailored prompts (β=–0.24, P=.03). Conclusions: Although the study confirmed the efficacy of the program, the merits of tailored prompts in ICBT for stress recovery were not supported. Future research is needed to test the effects of the stress recovery intervention supplemented by goal setting and tailored prompts. Trial Registration: ClinicalTrials.gov NCT05553210; https://clinicaltrials.gov/study/NCT05553210 %M 39874572 %R 10.2196/62782 %U https://mental.jmir.org/2025/1/e62782 %U https://doi.org/10.2196/62782 %U http://www.ncbi.nlm.nih.gov/pubmed/39874572 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62944 %T Exploring the Use of Smartwatches and Activity Trackers for Health-Related Purposes for Children Aged 5 to 11 years: Systematic Review %A Thompson,Lauren %A Charitos,Sydney %A Bird,Jon %A Marshall,Paul %A Brigden,Amberly %+ University of Bristol, 1 Cathedral Square, Trinity Street, Bristol, BS1 5DD, United Kingdom, 44 01173746653, lauren.thompson@bristol.ac.uk %K children %K systematic review %K wearable activity trackers %K smartwatches %K feasibility %K mobile phone %D 2025 %7 27.1.2025 %9 Review %J J Med Internet Res %G English %X Background:  Digital health interventions targeting behavior change are promising in adults and adolescents; however, less attention has been given to younger children. The proliferation of wearables, such as smartwatches and activity trackers, that support the collection of and reflection on personal health data highlights an opportunity to consider novel approaches to supporting health in young children (aged 5-11 y). Objective:  This review aims to investigate how smartwatches and activity trackers have been used across child health interventions (for children aged 5-11 y) for different health areas, specifically to identify the population characteristics of those being targeted, describe the characteristics of the devices being used, and report the feasibility and acceptability of these devices for health-related applications with children. Methods: We searched 10 databases (CINAHL, Embase, ACM Digital Library, IEEE Xplore, Cochrane Library, PsycINFO, Web of Science, PubMed, Scopus, and MEDLINE) to identify relevant literature in March 2023. The inclusion criteria for studies were as follows: (1) peer-reviewed, empirical studies; (2) published in English; (3) involved a child aged 5 to 11 years using a smartwatch for health-related purposes. Two researchers independently screened articles to assess eligibility. One researcher extracted data relating to the 3 aims and synthesized the results using narrative and thematic synthesis. Results:  The database searches identified 3312 articles, of which 15 (0.45%) were included in this review. Three (20%) articles referred to the same intervention. In 77% (10/13) of the studies, the devices were used to target improvements in physical activity. Other applications included using smartwatches to deliver interventions for emotional regulation and asthma management. In total, 9 commercial devices were identified, many of which delivered minimal data feedback on the smartwatch or activity tracker, instead relying on a partner app running on a linked parental smartphone with greater functionality. Of the 13 studies, 8 (62%) used devices designed for adults rather than children. User feedback was positive overall, demonstrating the acceptability and feasibility of using these devices with children. However, the studies often lacked a child-focused approach, with 3 (23%) studies gathering user feedback only from parents. Conclusions:  Interventions involving smartwatches and activity trackers for children aged 5 to 11 years remain limited, primarily focusing on enhancing physical activity, with few studies investigating other health applications. These devices often provide limited data feedback and functionality to support children’s independent engagement with the data, relying on paired smartphone apps managed by caregivers, who control access and facilitate children’s interaction with the data. Future research should adopt child-centered methods in the design and evaluation of these technologies, integrating children’s perspectives alongside their caregivers, to ensure that they are not only feasible and acceptable but also meaningful and effective for young children. Trial Registration: PROSPERO CRD42022373813, https://tinyurl.com/4kxu8zss %M 39870369 %R 10.2196/62944 %U https://www.jmir.org/2025/1/e62944 %U https://doi.org/10.2196/62944 %U http://www.ncbi.nlm.nih.gov/pubmed/39870369 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64718 %T Internet-Based Dementia Prevention Intervention (DementiaRisk): Protocol for a Randomized Controlled Trial and Knowledge Translation %A Levinson,Anthony J %A Ayers,Stephanie %A Clark,Sandra %A Woodburn,Rebekah %A Dobbins,Maureen %A Duarte,Dante %A Grad,Roland %A Kates,Nick %A Marr,Sharon %A Oliver,Doug %A Papaioannou,Alexandra %A Saperson,Karen %A Siu,Henry %A Strudwick,Gillian %A Sztramko,Richard %A Neil-Sztramko,Sarah %+ McMaster University, 1280 Main Street West, Hamilton, ON, L8S4L8, Canada, 1 905 525 9140, levinsa@mcmaster.ca %K web-based intervention %K internet %K eHealth %K dementia risk %K dementia prevention %K Alzheimer disease %K education and training %K clinical trial %K knowledge translation %K public health %K health literacy %K e-learning %D 2025 %7 27.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Research has shown that engaging in a range of healthy lifestyles or behavioral factors can help reduce the risk of developing dementia. Improved knowledge of modifiable risk factors for dementia may help engage people to reduce their risk, with beneficial impacts on individual and public health. Moreover, many guidelines emphasize the importance of providing education and web-based resources for dementia prevention. Internet-based interventions may be effective, but few have been studied rigorously or widely disseminated. We created DementiaRisk, an award-winning, web- and email-based education platform for the public focused on modifiable risk factors, featuring multimedia e-learning and email “microlearning” content, to help raise awareness and improve knowledge of actions to reduce dementia risk. Objective: This protocol describes a randomized controlled trial to (1) evaluate whether exposure to DementiaRisk changes knowledge of dementia risk factors, intention to engage in risk reduction activities, and health behaviors related to dementia risk reduction and to (2) explore qualitative aspects including participants’ engagement and satisfaction with the intervention and barriers and facilitators to use. Methods: Using a sequential explanatory mixed methods design, this study conducts a quantitative analysis followed by a qualitative inquiry to evaluate outcomes and feasibility. In total, 485 participants will be recruited on the web and randomly assigned to 2 groups: one accessing DementiaRisk and the other receiving alternative e-learning on mild cognitive impairment. Assessments will be delivered on the web at baseline (T1), at 4 weeks (T2), and at 2 months after the intervention (T3). Knowledge will be assessed using items from the Dementia Knowledge Assessment Scale, intentions to engage in risk reduction activities will be assessed using items in line with current evidence, and health behaviors related to dementia risk reduction will be assessed using items from the Godin-Shephard Leisure Time Physical Activity Questionnaire along with additional questions related to a range of health status domains. Outcomes and feasibility will be assessed using the Information Assessment Method for patients and consumers. A linear mixed effects model will be used to examine the relationship between each outcome score by group and time point. Results: This study was approved by the Hamilton Integrated Research Ethics Board on August 24, 2022 (project ID 14886) and received funding in February 2023. Recruitment took place from March 28, 2023, to April 28, 2023, with the final participants completing the intervention by August 18, 2023. Analyses and interpretation of data are ongoing. Conclusions: DementiaRisk is a readily scalable, technology-enhanced solution for dementia prevention education. It has been designed using evidence-based principles of multimedia learning. It has the potential to scale and spread widely using the open internet, so it may be able to reach a wider audience than traditional in-person educational interventions. Trial Registration: ClinicalTrials.gov NCT05383118; https://clinicaltrials.gov/study/NCT05383118 International Registered Report Identifier (IRRID): DERR1-10.2196/64718 %M 39869903 %R 10.2196/64718 %U https://www.researchprotocols.org/2025/1/e64718 %U https://doi.org/10.2196/64718 %U http://www.ncbi.nlm.nih.gov/pubmed/39869903 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63564 %T LoVE4MUM Mobile App to Prevent Postpartum Depression: Protocol for a Pilot Randomized Controlled Trial %A Kamarudin,Siti Sabrina %A Idris,Idayu Badilla %A Sharip,Shalisah %A Ahmad,Norfazilah %+ Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Malaysia, 60 91455887 ext 5888, idayubadilla.idris@ukm.edu.my %K postpartum depression %K mHealth intervention %K mobile phone %K prevention %K self-guided %K virtual engagement %K engagement %K maternal %K protocol %K randomized controlled trial %K postpartum %K depression %K maternal %K well-being %K mobile health %K preventive care %K mobile app %K mental health literacy %K postpartum care %D 2025 %7 27.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Postpartum depression remains a significant concern, posing substantial challenges to maternal well-being, infant health, and the mother-infant bond, particularly in the face of barriers to traditional support and interventions. Previous studies have shown that mobile health (mHealth) interventions offer an accessible means to facilitate early detection and management of mental health issues while at the same time promoting preventive care. Objective: This study aims to evaluate the effectiveness of the Leveraging on Virtual Engagement for Maternal Understanding & Mood-enhancement (LoVE4MUM) mobile app, which was developed based on the principles of cognitive behavioral therapy and psychoeducation and serves as an intervention to prevent postpartum depression. Methods: This single-blinded, pilot randomized controlled trial includes 64 mothers recruited from the postnatal ward and randomized using a 1:1 ratio to receive either postpartum care (treatment as usual) or postpartum care (treatment as usual) plus the self-guided LoVE4MUM mobile app. The primary outcome is the effectiveness of the mobile app at improving postpartum depression. Secondary outcomes are changes in the mental health literacy score and negative automatic thoughts, which are collected using a self-reported questionnaire. Results: Patient recruitment began on September 1, 2024. As of January 1, 2025, recruitment was successfully completed, with a total of 72 participants enrolled: 36 in the intervention group and 36 in the control group . The final results are anticipated to be available by March 2025, and publication is expected by the end of 2025. Conclusions: By examining the LoVE4MUM app alongside standard postpartum care, this pilot randomized controlled trial seeks to offer preliminary evidence on the potential of mHealth tools to improve maternal mental health as well as to reduce postpartum depression symptoms. The findings are expected to contribute to the future development of effective, accessible, and scalable interventions for mothers. Trial Registration: ClinicalTrials.gov NCT06366035; https://clinicaltrials.gov/study/NCT06366035 International Registered Report Identifier (IRRID): PRR1-10.2196/63564 %M 39869891 %R 10.2196/63564 %U https://www.researchprotocols.org/2025/1/e63564 %U https://doi.org/10.2196/63564 %U http://www.ncbi.nlm.nih.gov/pubmed/39869891 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e63348 %T Exploring the Feasibility of a 5-Week mHealth Intervention to Enhance Physical Activity and an Active, Healthy Lifestyle in Community-Dwelling Older Adults: Mixed Methods Study %A Daniels,Kim %A Vonck,Sharona %A Robijns,Jolien %A Quadflieg,Kirsten %A Bergs,Jochen %A Spooren,Annemie %A Hansen,Dominique %A Bonnechère,Bruno %+ , Centre of Expertise in Care Innovation, Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Guffenslaan 39, Hasselt, 3500, Belgium, 32 485763451, kim.daniels@pxl.be %K mobile health %K mHealth %K feasibility %K physical activity %K older adults %K health promotion %K usability %K mobile phone %D 2025 %7 27.1.2025 %9 Original Paper %J JMIR Aging %G English %X Background: Advancements in mobile technology have paved the way for innovative interventions aimed at promoting physical activity (PA). Objective: The main objective of this feasibility study was to assess the feasibility, usability, and acceptability of the More In Action (MIA) app, designed to promote PA among older adults. MIA offers 7 features: personalized tips, PA literacy, guided peer workouts, a community calendar, a personal activity diary, a progression monitor, and a chatbot. Methods: Our study used a mixed methods approach to evaluate the MIA app’s acceptability, feasibility, and usability. First, a think-aloud method was used to provide immediate feedback during initial app use. Participants then integrated the app into their daily activities for 5 weeks. Behavioral patterns such as user session duration, feature use frequency, and navigation paths were analyzed, focusing on engagement metrics and user interactions. User satisfaction was assessed using the System Usability Scale, Net Promoter Score, and Customer Satisfaction Score. Qualitative data from focus groups conducted after the 5-week intervention helped gather insights into user experiences. Participants were recruited using a combination of web-based and offline strategies, including social media outreach, newspaper advertisements, and presentations at older adult organizations and local community services. Our target group consisted of native Dutch-speaking older adults aged >65 years who were not affected by severe illnesses. Initial assessments and focus groups were conducted in person, whereas the intervention itself was web based. Results: The study involved 30 participants with an average age of 70.3 (SD 4.8) years, of whom 57% (17/30) were female. The app received positive ratings, with a System Usability Scale score of 77.4 and a Customer Satisfaction Score of 86.6%. Analysis showed general satisfaction with the app’s workout videos, which were used in 585 sessions with a median duration of 14 (IQR 0-34) minutes per day. The Net Promoter Score was 33.34, indicating a good level of customer loyalty. Qualitative feedback highlighted the need for improvements in navigation, content relevance, and social engagement features, with suggestions for better calendar visibility, workout customization, and enhanced social features. Overall, the app demonstrated high usability and satisfaction, with near-daily engagement from participants. Conclusions: The MIA app shows significant potential for promoting PA among older adults, evidenced by its high usability and satisfaction scores. Participants engaged with the app nearly daily, particularly appreciating the workout videos and educational content. Future enhancements should focus on better calendar visibility, workout customization, and integrating social networking features to foster community and support. In addition, incorporating wearable device integration and predictive analytics could provide real-time health data, optimizing activity recommendations and health monitoring. These enhancements will ensure that the app remains user-friendly, relevant, and sustainable, promoting sustained PA and healthy behaviors among older adults. Trial Registration: ClinicalTrials.gov NCT05650515; https://clinicaltrials.gov/study/NCT05650515 %M 39869906 %R 10.2196/63348 %U https://aging.jmir.org/2025/1/e63348 %U https://doi.org/10.2196/63348 %U http://www.ncbi.nlm.nih.gov/pubmed/39869906 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69080 %T Digital Gaming and Subsequent Health and Well-Being Among Older Adults: Longitudinal Outcome-Wide Analysis %A Nakagomi,Atsushi %A Ide,Kazushige %A Kondo,Katsunori %A Shiba,Koichiro %+ Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoicho, Inage-ku, Chiba, 2638522, Japan, 81 432903177 ext 3177, anakagomi0211@gmail.com %K digital gaming %K older adults %K flourishing %K well-being %K physical activity %K social engagement %K mobile phone %D 2025 %7 27.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital gaming has become increasingly popular among older adults, potentially offering cognitive, social, and physical benefits. However, its broader impact on health and well-being, particularly in real-world settings, remains unclear. Objective: This study aimed to evaluate the multidimensional effects of digital gaming on health and well-being among older adults, using data from the Japan Gerontological Evaluation Study conducted in Matsudo City, Chiba, Japan. Methods: Data were drawn from 3 survey waves (2020 prebaseline, 2021 baseline, and 2022 follow-up) of the Japan Gerontological Evaluation Study, which targets functionally independent older adults. The exposure variable, digital gaming, was defined as regular video game play and was assessed in 2021. In total, 18 outcomes across 6 domains were evaluated in 2022; domain 1—happiness and life satisfaction, domain 2—physical and mental health, domain 3—meaning and purpose, domain 4—character and virtue, domain 5—close social relationships, and domain 6—health behavior. Furthermore, 10 items from the Human Flourishing Index were included in domains 1-5, with 2 items for each domain. Overall flourishing was defined as the average of the means across these 5 domains. In addition, 7 items related to domains 2, 5, and 6 were assessed. The final sample consisted of 2504 participants aged 65 years or older, with questionnaires containing the Human Flourishing Index randomly distributed to approximately half of the respondents (submodule: n=1243). Consequently, we used 2 datasets for analysis. We applied targeted maximum likelihood estimation to estimate the population average treatment effects, with Bonferroni correction used to adjust for multiple testing. Results: Digital gaming was not significantly associated with overall flourishing or with any of the 5 domains from the Human Flourishing Index. Although initial analyses indicated associations between digital gaming and participation in hobby groups (mean difference=0.12, P=.005) as well as meeting with friends (mean difference=0.076, P=.02), these associations did not remain significant after applying the Bonferroni correction for multiple testing. In addition, digital gaming was not associated with increased sedentary behavior or reduced outdoor activities. Conclusions: This study provides valuable insights into the impact of digital gaming on the health and well-being of older adults in a real-world context. Although digital gaming did not show a significant association with improvements in flourishing or in the individual items across the 5 domains, it was also not associated with increased sedentary behavior or reduced outdoor activities. These findings suggest that digital gaming can be part of a balanced lifestyle for older adults, offering opportunities for social engagement, particularly through hobby groups. Considering the solitary nature of gaming, promoting social gaming opportunities may be a promising approach to enhance the positive effects of digital gaming on well-being. %M 39869904 %R 10.2196/69080 %U https://www.jmir.org/2025/1/e69080 %U https://doi.org/10.2196/69080 %U http://www.ncbi.nlm.nih.gov/pubmed/39869904 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66769 %T The Development of an Instagram Reel-Based Bystander Intervention Message Among College Students: Formative Survey and Mixed Methods Pilot Study %A Couto,Leticia %K bystander intervention %K message development %K sexual health %K college %K student %K sexual violence %K bystander %K reel-based %K Instagram %K social media %K short message %K formative research %K mixed methods %K social norms %K perceived behavior %K qualitative %K behavioral health %K digital health %D 2025 %7 27.1.2025 %9 %J JMIR Form Res %G English %X Background: Bystander intervention is a common method to address the ubiquitous issue that is sexual violence across college campuses. Short messages that incentivize bystander intervention behavior can be another tool to fight sexual violence. Objective: This study aimed to conduct formative research surrounding social norms and bystander barriers to pilot and develop Instagram (Meta) reel-based messages addressing bystander intervention among college students. Methods: The first step was to conduct a formative survey to identify peer norms and actual behavior of the intended population. Once that data were collected, a mixed methods message pilot was conducted by a survey where participants randomly saw 5 of the 12 messages developed, assessing them for credibility, perceived message effect, and intended audience. Results: The formative survey was conducted among 195 college students from the same institution, and the pilot test was conducted among 107 college students. The formative survey indicated a discrepancy between perceived peer behavior and actual behavior of the participants in all 3 measures, allowing for the development of normative messaging. The pilot testing indicated the credibility was acceptable (eg, mean 3.94, SD 1.15 on a 5-point scale) as well as the perceived message effect (eg, mean 4.26, SD 0.94 on a 5-point scale). Intended audiences were also identified and reached. Qualitative results indicated that the messages may have lacked credibility, although the quantitative results suggest otherwise. Conclusions: Participants understood the messages concerned bystander intervention, and perceived message effects results indicated the messages to be effective in assisting bystander intervention engagement by normative messaging. Messages were considered credible and reached the intended audience. The qualitative results provided further insights on how the messages can be adapted before being tested for effects. Future research should focus on further adapting the messages and testing their effects among the studied population. %R 10.2196/66769 %U https://formative.jmir.org/2025/1/e66769 %U https://doi.org/10.2196/66769 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e67213 %T Body Fat and Obesity Rates, Cardiovascular Fitness, and the Feasibility of a Low-Intensity Non–Weight-Centric Educational Intervention Among Late Adolescents: Quasi-Experimental Study %A Zuair,Areeg %A Alhowaymel,Fahad M %A Jalloun,Rola A %A Alzahrani,Naif S %A Almasoud,Khalid H %A Alharbi,Majdi H %A Alnawwar,Rayan K %A Alluhaibi,Mohammed N %A Alharbi,Rawan S %A Aljohan,Fatima M %A Alhumaidi,Bandar N %A Alahmadi,Mohammad A %K adolescent obesity %K macronutrient education %K cardiovascular fitness %K body composition %K health literacy %K body image %K macronutrient %K educational %K obesity %K weight %K overweight %K fitness %K nutrition %K diet %K patient education %K student %K school %K youth %K adolescent %K teenager %K metabolic %K eating %K physical activity %K exercise %D 2025 %7 24.1.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Obesity rates among Saudi adolescents are increasing, with regional variations highlighting the need for tailored interventions. School-based health programs in Saudi Arabia are limited and often emphasize weight and body size, potentially exacerbating body image dissatisfaction. There is limited knowledge on the feasibility of non–weight-centric educational programs in Saudi Arabia and their effects on health behaviors and body image. Objectives: This study aimed to (1) assess the prevalence of obesity using BMI-for-age z score (BAZ) and fat percentage among Saudi adolescents; (2) evaluate key health behaviors, cardiovascular fitness, and health literacy; and (3) assess the feasibility and impact of a low-intensity, non–weight-centric educational intervention designed to improve knowledge of macronutrients and metabolic diseases, while examining its safety on body image discrepancies. Methods: A quasi-experimental, pre-post trial with a parallel, nonequivalent control group design was conducted among 95 adolescents (58 boys and 37 girls; mean age 16.18, SD 0.53 years) from 2 public high schools in Medina City, Saudi Arabia. Participants were randomly assigned to either the weight-neutral Macronutrient + Non-Communicable Diseases Health Education group or the weight-neutral Macronutrient Health Education group. Anthropometry (BAZ and fat percentage), cardiovascular fitness, physical activity, and eating behaviors were measured at baseline. Independent t tests and χ² tests were conducted to compare group differences, and a 2-way mixed ANOVA was used to evaluate the effect of the intervention on macronutrient knowledge and body image discrepancies. A total of 69 participants completed the postintervention assessments. Results: The prevalence of overweight and obesity based on BAZ was 37.9% (36/95), while 50.5% (48/95) of participants were classified as overfat or obese based on fat percentage. Students with normal weight status were significantly more likely to have had prior exposure to health education related to metabolic diseases than students with higher weight status (P=.02). The intervention significantly improved macronutrient-metabolic knowledge (F1,64=23.452; P<.001), with a large effect size (partial η²=0.268). There was no significant change in students’ body image from pre- to postintervention (P=.70), supporting the safety of these weight-neutral programs. The intervention demonstrated strong feasibility, with a recruitment rate of 82.6% and a retention rate of 72.6%. Conclusions: This study reveals a high prevalence of obesity among Saudi adolescents, particularly when measured using fat percentage. The significant improvement in knowledge and the nonimpact on body image suggest that a non–weight-centric intervention can foster better health outcomes without exacerbating body image dissatisfaction. Region-specific strategies that prioritize metabolic health and macronutrient education over weight-centric messaging should be considered to address both obesity and body image concerns in adolescents. %R 10.2196/67213 %U https://pediatrics.jmir.org/2025/1/e67213 %U https://doi.org/10.2196/67213 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e57255 %T Feature Selection for Physical Activity Prediction Using Ecological Momentary Assessments to Personalize Intervention Timing: Longitudinal Observational Study %A Kumar,Devender %A Haag,David %A Blechert,Jens %A Niebauer,Josef %A Smeddinck,Jan David %K digital health %K behavior change %K tailoring %K personalization %K adaptive systems %K ecological momentary assessments %K sensing %K questionnaires %K machine learning %K feature selection %K situated research %K physical activity %K implementation intentions %K barriers %K intention-behavior gap %K artificial intelligence %K AI %K well-being %K user assessment %K survey %K self-efficacy %K stress %K mood %K emotions %K mobile phone %D 2025 %7 24.1.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: There has been a surge in the development of apps that aim to improve health, physical activity (PA), and well-being through behavior change. These apps often focus on creating a long-term and sustainable impact on the user. Just-in-time adaptive interventions (JITAIs) that are based on passive sensing of the user’s current context (eg, via smartphones and wearables) have been devised to enhance the effectiveness of these apps and foster PA. JITAIs aim to provide personalized support and interventions such as encouraging messages in a context-aware manner. However, the limited range of passive sensing capabilities often make it challenging to determine the timing and context for delivering well-accepted and effective interventions. Ecological momentary assessment (EMA) can provide personal context by directly capturing user assessments (eg, moods and emotions). Thus, EMA might be a useful complement to passive sensing in determining when JITAIs are triggered. However, extensive EMA schedules need to be scrutinized, as they can increase user burden. Objective: The aim of the study was to use machine learning to balance the feature set size of EMA questions with the prediction accuracy regarding of enacting PA. Methods: A total of 43 healthy participants (aged 19‐67 years) completed 4 EMA surveys daily over 3 weeks. These surveys prospectively assessed various states, including both motivational and volitional variables related to PA preparation (eg, intrinsic motivation, self-efficacy, and perceived barriers) alongside stress and mood or emotions. PA enactment was assessed retrospectively via EMA and served as the outcome variable. Results: The best-performing machine learning models predicted PA engagement with a mean area under the curve score of 0.87 (SD 0.02) in 5-fold cross-validation and 0.87 on the test set. Particularly strong predictors included self-efficacy, stress, planning, and perceived barriers, indicating that a small set of EMA predictors can yield accurate PA prediction for these participants. Conclusions: A small set of EMA-based features like self-efficacy, stress, planning, and perceived barriers can be enough to predict PA reasonably well and can thus be used to meaningfully tailor JITAIs such as sending well-timed and context-aware support messages. %R 10.2196/57255 %U https://mhealth.jmir.org/2025/1/e57255 %U https://doi.org/10.2196/57255 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 11 %N %P e58183 %T Medical Students’ Acceptance of Tailored e–Mental Health Apps to Foster Their Mental Health: Cross-Sectional Study %A Grüneberg,Catharina %A Bäuerle,Alexander %A Karunakaran,Sophia %A Darici,Dogus %A Dörrie,Nora %A Teufel,Martin %A Benson,Sven %A Robitzsch,Anita %K eHealth %K medical education %K medical students %K tailored interventions %K UTAUT %K intention to use %K e–mental health apps %K app %K foster %K cross-sectional study %K mental health problems %K physician %K well-being %K mobile apps %K acceptance %K assessment %K mental health apps %D 2025 %7 24.1.2025 %9 %J JMIR Med Educ %G English %X Background: Despite the high prevalence of mental health problems among medical students and physicians, help-seeking remains low. Digital mental health approaches offer beneficial opportunities to increase well-being, for example, via mobile apps. Objective: This study aimed to assess the acceptance, and its underlying predictors, of tailored e–mental health apps among medical students by focusing on stress management and the promotion of personal skills. Methods: From November 2022 to July 2023, a cross-sectional study was conducted with 245 medical students at the University of Duisburg-Essen, Germany. Sociodemographic, mental health, and eHealth-related data were assessed. The Unified Theory of Acceptance and Use of Technology (UTAUT) was applied. Differences in acceptance were examined and a multiple hierarchical regression analysis was conducted. Results: The general acceptance of tailored e–mental health apps among medical students was high (mean 3.72, SD 0.92). Students with a job besides medical school reported higher acceptance (t107.3=–2.16; P=.03; Padj=.027; Cohen d=4.13) as well as students with higher loads of anxiety symptoms (t92.4=2.36; P=.02; Padj=.03; Cohen d=0.35). The t values were estimated using a 2-tailed t test. Regression analysis revealed that acceptance was significantly predicted by anxiety symptoms (β=.11; P=.045), depressive symptoms (β=–.11; P=.05), internet anxiety (β=–.12; P=.01), digital overload (β=.1; P=.03), and the 3 UTAUT core predictors—performance expectancy (β=.24; P<.001), effort expectancy (β=.26; P<.001), and social influence (β=.43; P<.001). Conclusions: The high acceptance of e–mental health apps among medical students and its predictors lay a valuable basis for the development and implementation of tailored e–mental health apps within medical education to foster their mental health. More research using validated measures is needed to replicate our findings and to further investigate medical students’ specific needs and demands regarding the framework of tailored e–mental health apps. %R 10.2196/58183 %U https://mededu.jmir.org/2025/1/e58183 %U https://doi.org/10.2196/58183 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e47837 %T mHealth-Based Diabetes Prevention Program for Chinese Mothers With Abdominal Obesity: Randomized Controlled Trial %A Huang,Qinyuan %A Zhong,Qinyi %A Zeng,Yanjing %A Li,Yimeng %A Wiley,James %A Wang,Man Ping %A Chen,Jyu-Lin %A Guo,Jia %+ Xiangya School of Nursing, Central South University, No.172 Tongzipo Road, Yuelu District, Changsha, 410013, China, 86 13875947418, guojia621@163.com %K type 2 diabetes %K mHealth %K obesity %K prevention %K mothers %D 2025 %7 24.1.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Among people with abdominal obesity, women are more likely to develop diabetes than men. Mobile health (mHealth)–based technologies provide the flexibility and resource-saving opportunities to improve lifestyles in an individualized way. However, mHealth-based diabetes prevention programs tailored for busy mothers with abdominal obesity have not been reported yet. Objective: The aim of this study is to evaluate the feasibility and acceptability of an mHealth-based diabetes prevention program and its preliminary efficacy in reducing weight-related variables, behavioral variables, psychological variables, and diabetes risk among Chinese mothers with abdominal obesity over 6 months. Methods: A randomized controlled trial was conducted at health management centers in 2 tertiary hospitals in Changsha, China. The mHealth group (n=40) received 12 weekly web-based lifestyle modification modules for diabetes prevention, 6 biweekly individualized health education messages based on their goal settings, and a Fitbit tracker. The control group (n=40) received 12 weekly web-based general health education modules, 6 biweekly general health education messages, and a Fitbit tracker. Data were collected at baseline, 3 months, and 6 months on the feasibility and acceptability outcomes, weight-related variables (waist circumference and BMI), diabetes risk scores, glycemic levels, behavioral variables (daily step count, active minutes, fruit and vegetable intake, calorie consumption, and sleep duration), and psychological variables (self-efficacy and social support for physical activity and diet, perceived stress, and quality of life). Generalized estimating equations were used for data analysis. Results: Approximately 85% (68/80) of the participants completed 6 months of follow-up assessments. Regarding the feasibility and acceptance of the program in the mHealth group, the average number of modules reviewed was 7.9 out of 12, and the satisfaction score was 4.37 out of 5. Significant improvements at 6 months between the intervention and control groups were found in waist circumference (β=–2.24, 95% CI –4.12 to –0.36; P=.02), modifiable diabetes risk scores (β=–2.5, 95% CI –4.57 to –0.44; P=.02), daily steps (β=1.67, 95% CI 0.06-3.29; P=.04), self-efficacy for physical activity (β=1.93, 95% CI 0.44-3.43; P=.01), social support for physical activity (β=2.27, 95% CI 0.80-3.74; P=.002), and physical health satisfaction (β=0.82, 95% CI 0.08-1.55; P=.03). No differences were found in BMI, total diabetes risk score, daily active minutes, daily intake of fruits and vegetables, sleep duration, daily calorie consumption, self-efficacy, and social support for diet (P>.05). Conclusions: This study addresses the potential role of tailored lifestyle interventions based on mHealth technology by offering tailored web-based health modules and health information in managing diabetes risk among mothers with abdominal obesity. The mHealth diabetes prevention program provides a flexible, customized, and resource-saving model for busy mothers. Future research could further explore the efficacy improvement on dietary behaviors to better serve the health care needs of this population. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400090554; https://www.chictr.org.cn/showproj.html?proj=226411 %M 39854072 %R 10.2196/47837 %U https://mhealth.jmir.org/2025/1/e47837 %U https://doi.org/10.2196/47837 %U http://www.ncbi.nlm.nih.gov/pubmed/39854072 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68031 %T Improving Mental Health and Well-Being Through the Paradym App: Quantitative Study of Real-World Data %A Metaxa,Athina Marina %A Liverpool,Shaun %A Eisenstadt,Mia %A Pollard,John %A Carlsson,Courtney %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, United Kingdom, 30 6930228210, athina.metaxa@hmc.ox.ac.uk %K well-being %K awareness %K mental health %K formative %K mobile phone %K well-being %K apps %K quantitative evaluation %K real-world data %K emotional well-being %K pre-post %K single arm %K quantitative data %D 2025 %7 23.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: With growing evidence suggesting that levels of emotional well-being have been decreasing globally over the past few years, demand for easily accessible, convenient, and affordable well-being and mental health support has increased. Although mental health apps designed to tackle this demand by targeting diagnosed conditions have been shown to be beneficial, less research has focused on apps aiming to improve emotional well-being. There is also a dearth of research on well-being apps structured around users’ lived experiences and emotional patterns and a lack of integration of real-world evidence of app usage. Thus, the potential benefits of these apps need to be evaluated using robust real-world data. Objective: This study aimed to explore usage patterns and preliminary outcomes related to mental health and well-being among users of an app (Paradym; Paradym Ltd) designed to promote emotional well-being and positive mental health. Methods: This is a pre-post, single-arm evaluation of real-world data provided by users of the Paradym app. Data were provided as part of optional built-in self-assessments that users completed to test their levels of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder Questionnaire-7), life satisfaction (Satisfaction With Life Scale), and overall well-being (World Health Organization-5 Well-Being Index) when they first started using the app and at regular intervals following initial usage. Usage patterns, including the number of assessments completed and the length of time between assessments, were recorded. Data were analyzed using within-subjects t tests, and Cohen d estimates were used to measure effect sizes. Results: A total of 3237 app users completed at least 1 self-assessment, and 787 users completed a follow-up assessment. The sample was diverse, with 2000 users (61.8%) being located outside of the United States. At baseline, many users reported experiencing strong feelings of burnout (677/1627, 41.6%), strong insecurities (73/211, 34.6%), and low levels of thriving (140/260, 53.8%). Users also experienced symptoms of depression (mean 9.85, SD 5.55) and anxiety (mean 14.27, SD 6.77) and reported low levels of life satisfaction (mean 12.14, SD 7.42) and general well-being (mean 9.88, SD 5.51). On average, users had been using the app for 74 days when they completed a follow-up assessment. Following app usage, small but significant improvements were reported across all outcomes of interest, with anxiety and depression scores improving by 1.20 and 1.26 points on average, respectively, and life satisfaction and well-being scores improving by 0.71 and 0.97 points, respectively. Conclusions: This real-world data analysis and evaluation provided positive preliminary evidence for the Paradym app’s effectiveness in improving mental health and well-being, supporting its use as a scalable intervention for emotional well-being, with potential applications across diverse populations and settings, and encourages the use of built-in assessments in mental health app research. %M 39848610 %R 10.2196/68031 %U https://formative.jmir.org/2025/1/e68031 %U https://doi.org/10.2196/68031 %U http://www.ncbi.nlm.nih.gov/pubmed/39848610 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63126 %T Applications of Large Language Models in the Field of Suicide Prevention: Scoping Review %A Holmes,Glenn %A Tang,Biya %A Gupta,Sunil %A Venkatesh,Svetha %A Christensen,Helen %A Whitton,Alexis %+ Black Dog Institute, University of New South Wales, Sydney, Hospital Road, Randwick, 2031, Australia, 61 290659046, a.whitton@unsw.edu.au %K suicide %K suicide prevention %K large language model %K self-harm %K artificial intelligence %K AI %K PRISMA %D 2025 %7 23.1.2025 %9 Review %J J Med Internet Res %G English %X Background: Prevention of suicide is a global health priority. Approximately 800,000 individuals die by suicide yearly, and for every suicide death, there are another 20 estimated suicide attempts. Large language models (LLMs) hold the potential to enhance scalable, accessible, and affordable digital services for suicide prevention and self-harm interventions. However, their use also raises clinical and ethical questions that require careful consideration. Objective: This scoping review aims to identify emergent trends in LLM applications in the field of suicide prevention and self-harm research. In addition, it summarizes key clinical and ethical considerations relevant to this nascent area of research. Methods: Searches were conducted in 4 databases (PsycINFO, Embase, PubMed, and IEEE Xplore) in February 2024. Eligible studies described the application of LLMs for suicide or self-harm prevention, detection, or management. English-language peer-reviewed articles and conference proceedings were included, without date restrictions. Narrative synthesis was used to synthesize study characteristics, objectives, models, data sources, proposed clinical applications, and ethical considerations. This review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) standards. Results: Of the 533 studies identified, 36 (6.8%) met the inclusion criteria. An additional 7 studies were identified through citation chaining, resulting in 43 studies for review. The studies showed a bifurcation of publication fields, with varying publication norms between computer science and mental health. While most of the studies (33/43, 77%) focused on identifying suicide risk, newer applications leveraging generative functions (eg, support, education, and training) are emerging. Social media was the most common source of LLM training data. Bidirectional Encoder Representations from Transformers (BERT) was the predominant model used, although generative pretrained transformers (GPTs) featured prominently in generative applications. Clinical LLM applications were reported in 60% (26/43) of the studies, often for suicide risk detection or as clinical assistance tools. Ethical considerations were reported in 33% (14/43) of the studies, with privacy, confidentiality, and consent strongly represented. Conclusions: This evolving research area, bridging computer science and mental health, demands a multidisciplinary approach. While open access models and datasets will likely shape the field of suicide prevention, documenting their limitations and potential biases is crucial. High-quality training data are essential for refining these models and mitigating unwanted biases. Policies that address ethical concerns—particularly those related to privacy and security when using social media data—are imperative. Limitations include high variability across disciplines in how LLMs and study methodology are reported. The emergence of generative artificial intelligence signals a shift in approach, particularly in applications related to care, support, and education, such as improved crisis care and gatekeeper training methods, clinician copilot models, and improved educational practices. Ongoing human oversight—through human-in-the-loop testing or expert external validation—is essential for responsible development and use. Trial Registration: OSF Registries osf.io/nckq7; https://osf.io/nckq7 %M 39847414 %R 10.2196/63126 %U https://www.jmir.org/2025/1/e63126 %U https://doi.org/10.2196/63126 %U http://www.ncbi.nlm.nih.gov/pubmed/39847414 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e68372 %T Assessing and Enhancing Nutrition and Physical Activity Environments in Early Childhood Education and Care Centers: Scoping Review of eHealth Tools %A Hayek,Joyce %A Dickson,Kelsi %A Lafave,Lynne M Z %+ Department of Health and Physical Education, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB, T3E 6K6, Canada, 1 403 440 5967, llafave@mtroyal.ca %K eHealth %K early childhood educators %K ECE %K early childhood education and care %K ECEC %K knowledge synthesis %K digital technology %K health technology %K digital public health %K eating %K diet %D 2025 %7 22.1.2025 %9 Review %J JMIR Pediatr Parent %G English %X Background: Early childhood is a critical period for shaping lifelong health behaviors, making early childhood education and care (ECEC) environments ideal for implementing nutrition and physical activity interventions. eHealth tools are increasingly utilized in ECEC settings due to their accessibility, scalability, and cost-effectiveness, demonstrating promise in enhancing educators’ practices. Despite the potential effectiveness of these eHealth approaches, a comprehensive collection of available evidence on eHealth tools designed to assess or support best practices for nutrition or physical activity in ECECs is currently lacking. Objective: The primary objective of this scoping review is to map the range of available eHealth tools designed to assess or deliver interventions aimed at improving nutrition or physical activity in ECEC settings, while evaluating their components, theoretical foundations, and effectiveness. Methods: This scoping review adhered to the Joanna Briggs Institute methodology, in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. The objectives, inclusion criteria, and methods for this review were predefined and specified. Eligibility criteria were (1) early childhood educators (population); (2) eHealth (digital) technologies, such as websites, smartphone apps, emails, and social media; and (3) tools designed to assess or deliver interventions aimed at improving best practices for nutrition, physical activity, or both within ECEC settings (context). A search was conducted across 5 electronic databases (PubMed, Scopus, CINAHL Plus, ERIC, and Embase) to identify white literature, and 3 electronic databases (ProQuest, Google Scholar, and targeted Google search), along with hand-searching of reference lists, were used to identify gray literature. All literature was reported in English or French, with the search extending until May 2024. Separate data charting tools were used for white and gray literature. Results: The search strategy identified 3064 results for white literature, yielding 2653 unique citations after duplicates were removed. Full texts for 65 citations were retrieved and screened for inclusion, resulting in 30 studies eligible for data extraction and analysis. The most common study design was a randomized controlled trial, comprising 16 studies (53%). The largest proportion of studies were conducted in the United States (11 studies, 37%). In total, 19 eHealth tools were identified, targeting nutrition (8 tools, 42%), physical activity (5 tools, 26%), or both nutrition and physical activity (6 tools, 32%). All tools were web based (19 tools, 100%). The gray literature search yielded 1054 results, of which 17 were moved to full-text screening, and 7 met the eligibility criteria for data extraction and analysis. The tools identified in the gray literature originated in Canada (4 tools, 57%) and the United States (3 tools, 43%). The majority targeted nutrition (4 tools, 57%) and were primarily web based (6 tools, 86%), with 1 mobile app (1 tool, 14%). Conclusions: This scoping review mapped the available eHealth tools designed to improve nutrition or physical activity environments in ECEC settings, highlighting the growing emphasis on web-based tools and the need for psychometric testing. Future research should systematically evaluate the effectiveness of these tools, particularly those addressing both nutrition and physical activity, to identify the key factors that contribute to long-term behavior change. Trial Registration: Open Science Framework XTRNZ; https://osf.io/xtrnz International Registered Report Identifier (IRRID): RR2-10.2196/52252 %R 10.2196/68372 %U https://pediatrics.jmir.org/2025/1/e68372 %U https://doi.org/10.2196/68372 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e56310 %T Attitudes of German General Practitioners Toward eHealth Apps for Dementia Risk Reduction: Qualitative Interview Study %A Schultz,Adrian %A Luppa,Melanie %A Bleckwenn,Markus %A Riedel-Heller,Steffi G %A Zuelke,Andrea %+ Institute of Social Medicine, Occupational Health and Public Health, Leipzig University, Philipp Rosenthal Str. 55, Leipzig, 04103, Germany, 49 03419715483, andrea.zuelke@medizin.uni-leipzig.de %K eHealth %K dementia %K primary care %K lifestyle %K risk factor %K older adults %K prevention %K brain health %D 2025 %7 22.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: eHealth interventions constitute a promising approach to disease prevention, particularly because of their ability to facilitate lifestyle changes. Although a rather recent development, eHealth interventions might be able to promote brain health and reduce dementia risk in older adults. Objective: This study aimed to explore the perspective of general practitioners (GPs) on the potentials and barriers of eHealth interventions for brain health. Understanding the perspective of GPs allows us to identify chances and challenges for implementing eHealth apps for dementia risk reduction. Methods: We conducted semistructured expert interviews with 9 GPs working in an outpatient setting in and near Leipzig, Germany. Data were fully transcribed and analyzed using a process model of qualitative content analysis with codes and categories being constructed inductively and deductively. Results: We found generally favorable but balanced views of eHealth apps for brain health. Eight themes were identified and elaborated on in the data as follows: “addressing dementia,” “knowledge about dementia,” “need for information,” “potential for prevention,” “chances for apps for prevention,” “development of apps for prevention,” and “barriers of apps for prevention.” GPs talked mostly about how and when to address dementia and the requirements for their use of eHealth apps for dementia prevention. GPs stated that they only addressed dementia once abnormalities were already present or less frequently when a patient or relative expressed a direct wish, while individual dementia risk or standardized diagnostic during routine check-ups were mentioned much less frequently. According to GPs, knowledge about dementia in patients was low; therefore, patients expressed little need for information on dementia risk factors and prevention in GP practices. Most patients wished for quick information regarding diagnostics, treatment options, and progression of the disease. GPs mentioned a lack of overview of the available eHealth apps and their content. They also expressed a fear of inducing health anxiety when talking to patients about risk factors and prevention. Conclusions: GPs want patients to receive relevant and individualized information. Prerequisites for the use of eHealth apps for dementia prevention were app characteristics related to design and content. GPs need to address dementia more routinely, assess relevant risk factors, and aid patients in a preventive role. Concerns were expressed over limited effectiveness, overwhelming patients, limited use in clinical practice, and only targeting patients with an already low risk of dementia. %M 39841983 %R 10.2196/56310 %U https://formative.jmir.org/2025/1/e56310 %U https://doi.org/10.2196/56310 %U http://www.ncbi.nlm.nih.gov/pubmed/39841983 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63567 %T Development of an eHealth Intervention Including Self-Management for Reducing Sedentary Time in the Transition to Retirement: Participatory Design Study %A Hultman,Lisa %A Eklund,Caroline %A von Heideken Wågert,Petra %A Söderlund,Anne %A Lindén,Maria %A Elfström,Magnus L %+ Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Box 883, Västerås/Eskilstuna, 721 23, Sweden, 46 21 48 06 901, lisa.hultman@mdu.se %K behavior change intervention %K adherence %K integrated behavior change model %K autonomous motivation %K affective determinants %D 2025 %7 20.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Having a great amount of sedentary time is common among older adults and increases with age. There is a strong need for tools to reduce sedentary time and promote adherence to reduced sedentary time, for which eHealth interventions have the potential to be useful. Interventions for reducing sedentary time in older adults have been found to be more effective when elements of self-management are included. When creating new eHealth interventions, accessibility and effectiveness can be increased by including end users as co-designers in the development process. Objective: The aim was to explore the desired features of an eHealth intervention including self-management for reducing sedentary time and promoting adherence to reduced sedentary time in older adults transitioning from working life to retirement. Further, the aim was to develop a digital prototype of such an eHealth intervention. Methods: The study used the participatory design approach to include end users, researchers, and a web designer as equal partners. Three workshops were conducted with 6 older adults transitioning to retirement, 2 researchers, and 1 web designer. Thematic analysis was used to analyze the data from the workshops. Results: Participants expressed a desire for an easy-to-use eHealth intervention, which could be accessed from mobile phones, tablets, and computers, and could be individualized to the user. The most important features for reducing sedentary time were those involving finding joyful activities, setting goals, and getting information regarding reduced sedentary time. Participants expressed that the eHealth intervention would need to first provide the user with knowledge regarding sedentary time, then offer features for measuring sedentary time and for setting goals, and lastly provide support in finding joyful activities to perform in order to avoid being sedentary. According to the participants, an eHealth intervention including self-management for reducing sedentary time in older adults in the transition to retirement should be concise, accessible, and enjoyable. A digital prototype of such an eHealth intervention was developed. Conclusions: The developed eHealth intervention including self-management for reducing sedentary time in older adults transitioning to retirement is intended to facilitate behavior change by encouraging the user to participate in autonomously motivated activities. It uses several behavior change techniques, such as goal setting and action planning through mental contrasting and implementation intention, as well as shaping knowledge. Its active components for reducing sedentary time can be explained using the integrated behavior change model. Further research is needed to evaluate the feasibility and effectiveness of the eHealth intervention. %M 39832361 %R 10.2196/63567 %U https://formative.jmir.org/2025/1/e63567 %U https://doi.org/10.2196/63567 %U http://www.ncbi.nlm.nih.gov/pubmed/39832361 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64427 %T Feasibility, User Acceptance, and Outcomes of Using a Cancer Prehabilitation App for Exercise: Pilot Cohort Study %A Zhang,Fuquan %A Bang,Deepali %A Visperas,Christine Alejandro %A Tun,Mon Hnin %A Tay,San San %K cancer prehabilitation %K mobile app %K technology %K feasibility %K acceptance %K cancer %K prehabilitation %K mHealth %K exercise %K application %K app %K mobile application %K reliability %K smartphone app %K sustainability %K effectiveness %K older patients %K older adults %K elderly %D 2025 %7 20.1.2025 %9 %J JMIR Form Res %G English %X Background: The efficacy of cancer prehabilitation programs is supported by international reviews and meta-analyses. Technology has been deployed in cancer prehabilitation to address challenges such as access or limited resources. This study evaluated the feasibility, user acceptance, safety, and program outcomes of a newly developed mobile app for cancer prehabilitation. The app integrates with Singapore’s existing health care mobile app, Health Buddy, and provides instructional videos for prescribed exercises. Objective: The objectives of this study were to investigate the feasibility, user experience, safety, and outcomes of a mobile app for cancer prehabilitation within a hospital-associated, home-based, multimodal cancer prehabilitation program. Methods: This retrospective study analyzed the records of patients enrolled in the cancer prehabilitation program from September 1, 2022, to March 30, 2023. Patients who participated in the prehabilitation program (n=63) were categorized into 2 groups: those prescribed the app (n=41) and those who were not (n=22). There was further subgroup analysis of those who were prescribed: app users (n=25) versus those who were non-app users (n=16). Demographics, Fried Frailty Phenotype, prehabilitation duration, app use, and functional outcome measures (6-minute walk test [6MWT], 30-second sit-to-stand test [STS], timed up and go test [TUG], and Hospital Anxiety and Depression Scale [HADS]) were collected. Compliance was determined by the completion of prescribed exercises and the accuracy of executing these exercises, with a high compliance rate considered to be at 80% or more. Baseline characteristics and preoperative outcomes were compared between the groups. User satisfaction was assessed through surveys among app users (n=25). Results: Among 63 patients, 41 (65.1%) patients were prescribed the app, of which 22 (34.9%) patients were users. No significant differences in preoperative functional improvements were observed between app users and nonusers (6MWT: P=.60; STS: P=.81; TUG: P=.53; HADS: P=.36), or between those prescribed and not prescribed the app (6MWT: P=.94; STS: P=.26; TUG: P=.39; HADS: P=.62). However, high compliance rates (80%) were observed among app users. Patient satisfaction with the app was high (>90%), with positive feedback on ease of use and technical reliability. Baseline measures revealed significantly lower functional scores and higher mean frailty scores in the nonprescribed group. Conclusions: This preliminary study demonstrates the acceptability, feasibility, and safety of Singapore’s first smartphone app for exercise prescription in cancer prehabilitation. Lower baseline functional outcome measures and a higher mean frailty score in the unprescribed group have implications for the selection process and patient participation. Further studies should include strategies to enhance patients’ readiness for technology, sustainability, and effectiveness in older patients. %R 10.2196/64427 %U https://formative.jmir.org/2025/1/e64427 %U https://doi.org/10.2196/64427 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58265 %T A Mindfulness-Based App Intervention for Pregnant Women: Qualitative Evaluation of a Prototype Using Multiple Case Studies %A Rizzi,Silvia %A Pavesi,Maria Chiara %A Moser,Alessia %A Paolazzi,Francesca %A Marchesoni,Michele %A Poggianella,Stefania %A Gadotti,Erik %A Forti,Stefano %+ Digital Health Research, Centre for Digital Health & Wellbeing, Fondazione Bruno Kessler, Via Sommarive 18, Trento, 38123, Italy, 39 0461312415, srizzi@fbk.eu %K mindfulness %K promoting well-being %K pregnancy %K eHealth %K mHealth %K mobile apps %K development %K usability %K user-centered design %K well-being %K maternal health %K digital health %K intervention %K design %K preliminary testing %K technology-based %K interview %K multidisciplinary approach %K mother %K women %K WhatsApp %K email %K midwife %D 2025 %7 17.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Pregnancy is a complex period characterized by significant transformations. How a woman adapts to these changes can affect her quality of life and psychological well-being. Recently developed digital solutions have assumed a crucial role in supporting the psychological well-being of pregnant women. However, these tools have mainly been developed for women who already present clinically relevant psychological symptoms or mental disorders. Objective: This study aimed to develop a mindfulness-based well-being intervention for all pregnant women that can be delivered electronically and guided by an online assistant with wide reach and dissemination. This paper aimed to describe a prototype technology-based mindfulness intervention’s design and development process for pregnant women, including the exploration phase, intervention content development, and iterative software development (including design, development, and formative evaluation of paper and low-fidelity prototypes). Methods: Design and development processes were iterative and performed in close collaboration with key stakeholders (N=15), domain experts including mindfulness experts (n=2), communication experts (n=2), and psychologists (n=3), and target users including pregnant women (n=2), mothers with young children (n=2), and midwives (n=4). User-centered and service design methods, such as interviews and usability testing, were included to ensure user involvement in each phase. Domain experts evaluated a paper prototype, while target users evaluated a low-fidelity prototype. Intervention content was developed by psychologists and mindfulness experts based on the Mindfulness-Based Childbirth and Parenting program and adjusted to an electronic format through multiple iterations with stakeholders. Results: An 8-session intervention in a prototype electronic format using text, audio, video, and images was designed. In general, the prototypes were evaluated positively by the users involved. The questionnaires showed that domain experts, for instance, positively evaluated chatbot-related aspects such as empathy and comprehensibility of the terms used and rated the mindfulness traces present as supportive and functional. The target users found the content interesting and clear. However, both parties regarded the listening as not fully active. In addition, the interviews made it possible to pick up useful suggestions in order to refine the intervention. Domain experts suggested incorporating auditory components alongside textual content or substituting text entirely with auditory or audiovisual formats. Debate surrounded the inclusion of background music in mindfulness exercises, with opinions divided on its potential to either distract or aid in engagement. The target users proposed to supplement the app with some face-to-face meetings at crucial moments of the course, such as the beginning and the end. Conclusions: This study illustrates how user-centered and service designs can be applied to identify and incorporate essential stakeholder aspects in the design and development process. Combined with evidence-based concepts, this process facilitated the development of a mindfulness intervention designed for the end users, in this case, pregnant women. %M 39625414 %R 10.2196/58265 %U https://formative.jmir.org/2025/1/e58265 %U https://doi.org/10.2196/58265 %U http://www.ncbi.nlm.nih.gov/pubmed/39625414 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56601 %T Development and Evaluation of a Mindfulness-Based Mobile Intervention for Perinatal Mental Health: Randomized Controlled Trial %A Park,Sehwan %A Cho,Hee Young %A Park,Jin Young %A Chung,Kyungmi %A Jhung,Kyungun %+ Department of Psychiatry, Catholic Kwandong University International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, 25, Simgok-ro 100 Beon-gil, Incheon, 22711, Republic of Korea, 82 1090563807, kyungun12@gmail.com %K anxiety %K perinatal mental health %K depression %K mobile health care %K mindfulness %K mobile phone %D 2025 %7 17.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Perinatal mental health problems, such as anxiety, stress, and depression, warrant particularly close monitoring and intervention, but they are often unaddressed in both obstetric and psychiatric clinics, with limited accessibility and treatment resources. Mobile health interventions may provide an effective and more accessible solution for addressing perinatal mental health. Development and evaluation of a mobile mental health intervention specifically for pregnant women are warranted. Objective: This study aimed to evaluate the effectiveness of a 4-week, self-administered mobile mindfulness intervention in reducing anxiety, depression, and stress, and improving emotional well-being, maternal-fetal attachment, and mindfulness skills in a general population of pregnant women. Methods: Pregnant women were recruited and randomized to an intervention or a wait-list control group. The intervention group participated in a self-administered 4-week smartphone-based mindfulness program. Anxiety, depression, and stress were assessed as primary outcomes at baseline and postintervention. Secondary outcomes were mental health well-being, maternal-fetal attachment, and skills of mindfulness. The usability of the mobile intervention was also evaluated. Results: A total of 133 pregnant women were randomly assigned to the intervention (n=66) or the control group (n=67). The overall dropout rate was 30% (39/133). Anxiety scores of the intervention group significantly decreased from baseline to postintervention (P=.03, Wilcoxon Signed-Rank test), whereas no significant changes were observed in the control group. Depression and stress scores showed no significant changes. Emotional well-being significantly improved in the intervention group (P=.01). Improvements were observed in maternal-fetal attachment, particularly in attributing characteristics to the fetus (P=.003) and in differentiating the self from the fetus (P=.006). Mindfulness awareness also showed significant improvement (P=.008). Significant between-group effects were identified for mindfulness awareness (P=.006) and attributing characteristics to the fetus (P=.002). After applying the false discovery rate corrections, within-group improvements in emotional well-being, maternal-fetal attachment, and mindfulness awareness remained significant, while between-group differences for emotional well-being and differentiation were not significant. Conclusions: A mobile mindfulness program effectively reduced anxiety and improved emotional well-being, maternal-fetal attachment, and mindfulness awareness in the general population of pregnant women. Mobile interventions may offer a cost-effective and feasible method for promoting perinatal mental health. Trial Registration: Clinical Research Information Service KCT0007166; https://tinyurl.com/458vfc4r %M 39823585 %R 10.2196/56601 %U https://www.jmir.org/2025/1/e56601 %U https://doi.org/10.2196/56601 %U http://www.ncbi.nlm.nih.gov/pubmed/39823585 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60382 %T A Live Video Resiliency Dyadic Intervention for Persons With Dementia and Their Care-Partners Early After Diagnosis: Protocol for Open Pilot of Resilient Together for Dementia %A McCage,Sydney %A Walker,Kristin %A Cornelius,Talea %A Parker,Robert A %A Dams-O'Connor,Kristen %A Dickerson,Brad %A Ritchie,Christine %A Vranceanu,Ana-Maria %A Bannon,Sarah %+ Brain Injury Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, 5 E 98th Street, Annex B-12, New York, NY, 10029, United States, 1 212 241 6866, sarah.bannon@mountsinai.org %K dementia %K dyad %K emotional distress %K intervention %K diagnosis %K telehealth %K resilient %K dyadic intervention %K care-partner %K Alzheimer’s disease %K ADRD %K psychosocial %K depression %D 2025 %7 15.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alzheimer disease and related dementias (ADRDs) are increasingly common progressive conditions that have a substantial impact on individuals and their primary care partners—together described as a dyad. The stressors experienced by dyad members at around the time of ADRD diagnosis commonly produce clinically elevated emotional distress (ie, depression and anxiety symptoms), which can become chronic and negatively impact health, relationships, and the overall quality of life. Dyads commonly report unmet needs for early support to address these challenges early after diagnosis. Objective: This study is part of a larger study that has the primary objective to develop, adapt, and establish the feasibility of Resilient Together for Dementia (RT-ADRD), a novel dyadic skills-based intervention aimed at preventing chronic emotional distress early after diagnosis. The present study protocol describes an open pilot of the RT-ADRD intervention. This study will allow the study team to gather feedback on intervention components, administration of study measures, issues within general protocol, and perceptions about live video interventions prior to a larger feasibility trial. Methods: All study procedures will be conducted on the web (via phone and health care system–supported videoconferencing) to optimize accessibility, inclusion, and representativeness. Eligible dyads will include couples (up to N=10) referred from Mount Sinai Hospital (MSH) clinics within 3 months of an ADRD diagnosis. Dyads will be referred by their diagnosing clinicians (eg, neurologists, geriatricians, and neuropsychologists) and screened for eligibility. Eligible dyads will have at least one member who exhibits clinically elevated emotional distress and will demonstrate capacity to consent to research participation on a standardized assessment. Consenting dyads will complete baseline assessments of emotional distress, quality of life, relationship functioning, and resiliency skills. Dyads will then participate in 6 weekly RT-ADRD sessions together (30-60 minutes each). After the conclusion of the intervention, dyad members will complete posttest assessments with similar measures as the pretest. Finally, dyads will participate together in a single 60-minute exit interview to gather information on intervention content and procedures to refine the intervention before a pilot feasibility trial. Results: This study has been approved by the MSH institutional review board and is registered on ClinicalTrials.gov (NCT06421545). We anticipate that the study will be completed by late 2024. Conclusions: We will use these results to administer changes and develop procedures for a pilot feasibility trial of RT-ADRD relative to a minimally enhanced control condition. Our study will allow us to gather comprehensive information on proposed RT-ADRD procedures and content and the best ways of delivering prevention-focused interventions to reduce the potential for chronic emotional distress stemming from ADRDs. International Registered Report Identifier (IRRID): DERR1-10.2196/60382 %M 39814366 %R 10.2196/60382 %U https://www.researchprotocols.org/2025/1/e60382 %U https://doi.org/10.2196/60382 %U http://www.ncbi.nlm.nih.gov/pubmed/39814366 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e53971 %T Smoking Cessation Smartphone App for Nondaily Smoking With Telephone Onboarding: Proof-of-Concept Randomized Controlled Trial %A Hoeppner,Bettina B %A Siegel,Kaitlyn R %A Futter,Allison E %A Finley-Abboud,Diadora %A Williamson,Alivia C %A Kahler,Christopher W %A Park,Elyse R %A Hoeppner,Susanne S %+ Health through Flourishing (HtF) program, Department of Psychiatry, Massachusetts General Hospital, 125 Nashua St, 4th Fl., Boston, MA, 02114, United States, 1 617 643 198, bhoeppner@mgh.harvard.edu %K mobile health %K mHealth %K smoking cessation %K nondaily smoking %K smartphone %K smoking %K positive psychology %K mobile phone %D 2025 %7 15.1.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nondaily smoking is a widespread and increasingly prevalent pattern of use. To date, no effective treatment approach for nondaily smoking has been identified. Objective: This study aimed to conduct an unblinded randomized controlled trial to evaluate proof-of-concept markers of the Smiling instead of Smoking (SiS) app, a smartphone app for smoking cessation, designed specifically for people who smoke less than daily, within the framework of positive psychology. Methods: Overall, 226 adults who smoke less than daily were recruited on the web and asked to undertake a quit attempt while using assigned smoking cessation support materials. Participants were randomly assigned to 1 of 3 materials: the SiS smartphone app, the National Cancer Institute’s smartphone app QuitGuide (QG), or the National Cancer Institute’s smoking cessation brochure, “Clearing the Air” (CtA). All participants engaged in a 15-minute scripted onboarding phone call and were introduced to their support materials to use for the next 7 weeks. Follow-up self-assessment web surveys were sent 2, 6, 12, and 24 weeks after participants’ initially chosen quit date (ie, 1 week after onboarding). The primary outcome for this study was self-efficacy to remain abstinent from smoking at treatment end. Secondary outcomes assessed treatment acceptability, treatment feasibility (eg, number of days of app use, time spent using app, and use of smoking cessation strategies), and secondary proof-of-concept efficacy outcomes (eg, positive affect, craving, and attitudes toward smoking). Smoking outcomes (ie, 30-day point prevalence abstinence and smoking reduction) were also assessed. Results: Results indicated a significant effect of treatment on the primary outcome, where SiS participants (n=80) reported higher self-efficacy to abstain from smoking at the end of treatment than the 2 control groups (QG: n=75; P=.02; Cohen d=0.40 and CtA: n=71; P=.007; Cohen d=0.50). This effect was also significant on both self-efficacy subscales (ie, internal cues and external cues) with effect sizes ranging from Cohen d=0.34 to 0.50 across the pairwise comparisons. The SiS app group also reported lower craving (QG: P=.005; Cohen d=–0.57 and CtA: P=.005; Cohen d=–0.57) and higher positive affect than QG (QG: P=.01; Cohen d=0.44 and CtA: P=.05; Cohen d=0.38); attitudes toward smoking were largely similar across groups. Treatment acceptability was comparable across groups (P values for all groups >.05; Cohen d range 0.06-0.23). Treatment feasibility measures indicated that participants used the SiS app on 33 out of 49 days, for 35 to 40 minutes per week, resulting in greater use of smoking cessation strategies than QG (QG: P=.04; Cohen d=0.38 and CtA: P=.16; Cohen d=0.24). Conclusions: These findings provide strong evidence for the conceptual underpinnings of the SiS app, and thereby provide compelling justification for conducting a large-scale randomized controlled trial that can test the effectiveness of the SiS app on smoking cessation. Trial Registration: ClinicalTrials.gov NCT04672239; https://clinicaltrials.gov/study/NCT04672239 International Registered Report Identifier (IRRID): RR2-10.2196/40867 %M 39814363 %R 10.2196/53971 %U https://mhealth.jmir.org/2025/1/e53971 %U https://doi.org/10.2196/53971 %U http://www.ncbi.nlm.nih.gov/pubmed/39814363 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65122 %T Weight Loss Patterns and Outcomes Over 12 Months on a Commercial Weight Management Program (CSIRO Total Wellbeing Diet Online): Large-Community Cohort Evaluation Study %A Hendrie,Gilly A %A Baird,Danielle L %A James-Martin,Genevieve %A Brindal,Emily %A Brooker,Paige G %+ Commonwealth Scientific and Industrial Research Organisation, PO Box 10041, Adelaide, 5000, Australia, 61 883050662, gilly.hendrie@csiro.au %K obesity %K obesity management %K weight loss %K internet-based intervention, weight management %D 2025 %7 15.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: A greater understanding of the effectiveness of digital self-management programs and their ability to support longer-term weight loss is needed. Objective: This study aimed to explore the total weight loss and patterns of weight loss of CSIRO (Commonwealth Scientific and Industrial Research Organisation) Total Wellbeing Diet Online members during their first 12 months of membership and examine the patterns of platform use associated with greater weight loss. Methods: Participants were Australian adults who joined the program between October 2014 and June 2022 and were classified as longer-term members, meaning they completed at least 12 weeks of the program, had baseline and 12-week weight data, and had a paid membership of ≥1 year (N=24,035). Weight loss and percentage of starting body weight loss were calculated at 3, 6, 9, and 12 months using 3 statistical approaches: (1) multiple imputations method, (2) all available data, and (3) complete data only. Among members with complete data (6602/24,035, 27.5%), patterns of weight loss and gain were examined, and how this related to total weight loss and platform use was explored. Results: Members were mostly female (19,972/24,035, 83.09%), aged 31 to 50 years (9986/24,035, 41.5%) or 51 to 70 years (12,033/24,035, 50.06%), and most members were classified as overweight or obese (23,050/24,035, 95.9%). Using multiple imputations, the average estimated weight loss was 5.9 (SE 0.0245) kg at 12 weeks, 6.7 (SE 0.0348) kg at 6 months, 6.2 (SE 0.0400) kg at 9 months, and 5.5 (SE 0.0421) kg at 12 months. At 12 months, more than half the members (12,573/24,035, 52.3%) were at least 5% below their starting body weight and 1 in 4 (5865/24,035, 24.4%) were at least 10% below their starting body weight. In the subsample with complete data, the average weight loss at 12 months was 7.8 kg. The most common (961/6602, 14.56% members) weight loss pattern over the first 12 months was 6 months of weight loss, followed by 6 months of weight maintenance. This group had an average weight loss of 10.6 kg at 12 months (11.9% of their starting body weight). In a subgroup of participants who consistently lost weight over the 12-month period (284/6602, 4.3% of the sample), weight loss reached up to 22.3 kg (21.7% of their starting body weight). Weekly platform use was positively associated with total weight loss (r=0.287; P<.001). Members who used the platform >30 times per week (approximately >4 times/d) were more likely to lose weight in the first 6 months of the program. Conclusions: This commercial weight loss program was shown to be effective, with 1 in 2 members achieving clinically significant results after 1 year. Greater engagement with the platform was associated with consecutive periods of weight loss and greater weight loss success overall. %R 10.2196/65122 %U https://www.jmir.org/2025/1/e65122 %U https://doi.org/10.2196/65122 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e58912 %T Pervasive Games for Sexual Health Promotion: Scoping Literature Review %A Rubio,Claudio %A Besoain,Felipe %+ Department of Interactive Visualization and Virtual Reality, Faculty of Engineering, University of Talca, 2 norte #685, Talca, 3460000, Chile, 56 2201687 ext 2687, fbesoain@utalca.cl %K serious games %K promotion %K ubiquitous technologies %K healthy behaviors %K HIV %K sexually transmitted infection %K STI %K scoping review %K mobile phone %D 2025 %7 15.1.2025 %9 Review %J JMIR Serious Games %G English %X Background: Serious games play a fundamental role in promoting safe sexual behaviors. This medium has great potential for promoting healthy behaviors that prevent potential risk factors, such as sexually transmitted infections, and promote adherence to sexual health treatments, such as antiretroviral therapy. The ubiquity of mobile devices enhances access to such tools, increasing the effectiveness of video games as agents of change. Objective: In this scoping review, we aimed to (1) identify the extent to which pervasive games have been used in the field of sexual health, (2) determine the theories used in the design and evaluation of pervasive games for sexual health, (3) identify the methods used to evaluate pervasive games for sexual health, and (4) explore the reported benefits of using pervasive games for sexual health. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) methodology, we conducted a comprehensive literature search in the Web of Science, Scopus, IEEE Xplore, and ACM databases for articles published between January 1, 2000, and August 4, 2024. Included articles were published in English between 2000 and 2024 and involved the design, implementation, or evaluation of a ubiquitous video game focused on promoting safe sexual behaviors, with qualitative and/or quantitative results based on theory-based techniques and ubiquitous technologies. Review articles, conference papers, or books without available data or quantitative or qualitative results were excluded. Results: We screened 521 of 612 articles (85.1%) after removing duplicates. After the title and abstract review, 51 (9.8%) articles were assessed for eligibility, and 30 (5.8%) articles meeting the criteria were studied and evaluated in depth. The results suggested that the use of pervasive video games has a positive impact on promoting safe sexual behaviors. This is enhanced by the effectiveness of theory-based techniques and the use of mobile technologies as developmental factors that drive the gaming experience. The results indicated that this domain is a growing field that should not be ignored. Conclusions: The literature showed that pervasive video games have been effective in promoting safe sexual behaviors. Substantial growth has been seen in scientific community interest in researching this domain; nevertheless, there is still much to work on. In this context, we advocate for the standardization of design, implementation, and experimentation as essential phases in creating video game experiences. These 3 fundamental aspects are critical in the development of video game–based studies to ensure the reproducibility of experiments. %M 39813670 %R 10.2196/58912 %U https://games.jmir.org/2025/1/e58912 %U https://doi.org/10.2196/58912 %U http://www.ncbi.nlm.nih.gov/pubmed/39813670 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58460 %T Testing a Web-Based Interactive Comic Tool to Decrease Obesity Risk Among Racial and Ethnic Minority Preadolescents: Randomized Controlled Trial %A Leung,May May %A Mateo,Katrina F %A Dublin,Marlo %A Harrison,Laura %A Verdaguer,Sandra %A Wyka,Katarzyna %+ Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, United States, 1 6176363676, maymay.leung@tufts.edu %K childhood obesity %K preadolescents %K racial and ethnic minority populations %K dietary behaviors %K BMI %K digital health %D 2025 %7 15.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Childhood obesity prevalence remains high, especially in racial and ethnic minority populations with low incomes. This epidemic is attributed to various dietary behaviors, including increased consumption of energy-dense foods and sugary beverages and decreased intake of fruits and vegetables. Interactive, technology-based approaches are emerging as promising tools to support health behavior changes. Objective: This study aimed to assess the feasibility and acceptability of Intervention INC (Interactive Nutrition Comics for Urban, Minority Preadolescents), a 6-chapter web-based interactive nutrition comic tool. Its preliminary effectiveness on diet-related psychosocial variables and behaviors was also explored. Methods: A total of 89 Black or African American and Hispanic preadolescents with a mean age of 10.4 (SD 1.0) years from New York City participated in a pilot 2-group randomized study, comprising a 6-week intervention and a 3-month follow-up (T4) period. Of the 89 participants, 61% were female, 62% were Black, 42% were Hispanic, 53% were overweight or obese, and 34% had an annual household income of 0.90; n=36), with a small number of “good” (ICCs>0.75; n=2), “moderate” (ICCs=0.5-0.75; n=3), or “poor” (ICCs<0.5; n=1) ICC values. Reliability decreased at night, particularly for coding ethnic group and social interactions, but remained mostly “excellent” or “good.” Intrarater reliability within a single coder after a 2-week interval was “excellent” for all but 1 code, with 1 “good” ICC value for assessing vigorous physical activity, indicating that the coder could reproduce similar results over time. Intrarater reliability was generally similar during the day and night, apart from ICC values for coding ethnic group, which reduced from “excellent” to “good” at night. Intercept surveys with 86 public space users found that only 5 (5.8%) participants noticed the cameras used for this study. Importantly, all 5 said that they did not alter their behavior as a result of noticing these cameras, therefore, indicating no evidence of reactivity. Conclusions: Camera-based observation methods are more reliable than in-person observations and do not produce participant reactivity often associated with self-report methods. This method requires less time for data collection and coding, while allowing for safe nighttime observation without the risk to research staff. This research is a significant first step in demonstrating the potential for camera-based methods to improve natural experimental studies of real-world environmental interventions. It also provides a rigorous foundation for developing more scalable automated computer vision algorithms for assessing human behaviors. %M 39680427 %R 10.2196/66049 %U https://publichealth.jmir.org/2024/1/e66049 %U https://doi.org/10.2196/66049 %U http://www.ncbi.nlm.nih.gov/pubmed/39680427 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 5 %N %P e65506 %T Effect of a Web-Based Heartfulness Program on the Mental Well-Being, Biomarkers, and Gene Expression Profile of Health Care Students: Randomized Controlled Trial %A Thimmapuram,Jayaram %A Patel,Kamlesh D %A Bhatt,Deepti %A Chauhan,Ajay %A Madhusudhan,Divya %A Bhatt,Kashyap K %A Deshpande,Snehal %A Budhbhatti,Urvi %A Joshi,Chaitanya %+ WellSpan Health, 1001 S George St, York, PA, 17403, United States, 1 7174956027, jthimmapuram@wellspan.org %K heartfulness %K meditation %K stress %K anxiety %K depression %K interleukins %K gene expression %K dehydroepiandrosterone %K DHEA %K gene %K mental health %K meditation %K randomized study %K web-based program %K mental well-being %K well-being %K mental %K health care students %K student %K mRNA %K messenger ribonucleic acid %K youth %K young adults %K web-based %K biomarker %K RNA %K bioinformatics %K randomized %K statistical analysis %K nursing %K physiotherapy %K pharmacy %D 2024 %7 16.12.2024 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: Health care students often experience high levels of stress, anxiety, and mental health issues, making it crucial to address these challenges. Variations in stress levels may be associated with changes in dehydroepiandrosterone sulfate (DHEA-S) and interleukin-6 (IL-6) levels and gene expression. Meditative practices have demonstrated effectiveness in reducing stress and improving mental well-being. Objective: This study aims to assess the effects of Heartfulness meditation on mental well-being, DHEA-S, IL-6, and gene expression profile. Methods: The 78 enrolled participants were randomly assigned to the Heartfulness meditation (n=42, 54%) and control (n=36, 46%) groups. The participants completed the Perceived Stress Scale (PSS) and Depression Anxiety Stress Scale (DASS-21) at baseline and after week 12. Gene expression with messenger RNA sequencing and DHEA-S and IL-6 levels were also measured at baseline and the completion of the 12 weeks. Statistical analysis included descriptive statistics, paired t test, and 1-way ANOVA with Bonferroni correction. Results: The Heartfulness group exhibited a significant 17.35% reduction in PSS score (from mean 19.71, SD 5.09 to mean 16.29, SD 4.83; P<.001) compared to a nonsignificant 6% reduction in the control group (P=.31). DASS-21 scores decreased significantly by 27.14% in the Heartfulness group (from mean 21.15, SD 9.56 to mean 15.41, SD 7.87; P<.001) while it increased nonsignificantly by 17% in the control group (P=.04). For the DASS-21 subcomponents—the Heartfulness group showed a statistically significant 28.53% reduction in anxiety (P=.006) and 27.38% reduction in stress (P=.002) versus an insignificant 22% increase in anxiety (P=.02) and 6% increase in stress (P=.47) in the control group. Further, DHEA-S levels showed a significant 20.27% increase in the Heartfulness group (from mean 251.71, SD 80.98 to mean 302.74, SD 123.56; P=.002) compared to an insignificant 9% increase in the control group (from mean 285.33, SD 112.14 to mean 309.90, SD 136.90; P=.10). IL-6 levels showed a statistically significant difference in both the groups (from mean 4.93, SD 1.35 to mean 3.67, SD 1.0; 28.6%; P<.001 [Heartfulness group] and from mean 4.52, SD 1.40 to mean 2.72, SD 1.74; 40%; P<.001 [control group]). Notably, group comparison at 12 weeks revealed a significant difference in perceived stress, DASS-21 and its subcomponents, and IL-6 (all P<.05/4). The gene expression profile with messenger RNA sequencing identified 875 upregulated genes and 1539 downregulated genes in the Heartfulness group compared to baseline, and there were 292 upregulated genes and 1180 downregulated genes in the Heartfulness group compared to the control group after the intervention. Conclusions: Heartfulness practice was associated with decreased depression, anxiety, and stress scores and improved health measures in DHEA-S and IL-6 levels. The gene expression data point toward possible mechanisms of alleviation of symptoms of stress, anxiety and depression. Trial Registration: ISRCTN Registry ISRCTN82860715; https://doi.org/10.1186/ISRCTN82860715 %M 39680432 %R 10.2196/65506 %U https://bioinform.jmir.org/2024/1/e65506 %U https://doi.org/10.2196/65506 %U http://www.ncbi.nlm.nih.gov/pubmed/39680432 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e58920 %T Exploring and Predicting HIV Preexposure Prophylaxis Adherence Patterns Among Men Who Have Sex With Men: Randomized Controlled Longitudinal Study of an mHealth Intervention in Western China %A Lin,Bing %A Li,Jiayan %A Liu,Jiaxiu %A He,Wei %A Pan,Haiying %A Zhong,Xiaoni %K preexposure prophylaxis %K adherence %K trajectory analysis %K men who have sex with men %K mHealth %K mobile health %K mHealth intervention %K decision tree %D 2024 %7 12.12.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Preexposure prophylaxis (PrEP) is an effective strategy to reduce the risk of HIV infection. However, the efficacy of PrEP is highly dependent on adherence. Meanwhile, adherence changes over time, making it difficult to manage effectively. Objective: Our study aimed to explore and predict the patterns of change in PrEP adherence among men who have sex with men (MSM) and evaluate the impact of the WeChat-based reminder intervention on adherence, thus providing more information for PrEP implementation strategies. Methods: From November 2019 to June 2023, in a randomized controlled longitudinal study of the PrEP demonstration project in Western China (Chongqing, Sichuan, and Xinjiang) based on a mobile health (mHealth) reminder intervention, participants were randomly divided into reminder and no-reminder groups, with those in the reminder group receiving daily reminders based on the WeChat app. Participants were followed up and self-reported their medication adherence every 12 weeks for a total of 5 follow-up visits. We used the growth mixture model (GMM) to explore potential categories and longitudinal trajectories of adherence among MSM, and patterns of change in PrEP adherence were predicted and evaluated based on the decision tree. Results: A total of 446 MSM were included in the analysis. The GMM identified 3 trajectories of adherence: intermediate adherence group (n=34, 7.62%), low adherence ascending group (n=126, 28.25%), and high adherence decline group (n=286, 64.13%). We included 8 variables that were significant in the univariate analysis in the decision tree prediction model. We found 4 factors and 8 prediction rules, and the results showed that HIV knowledge score, education attainment, mHealth intervention, and HIV testing were key nodes in the patterns of change in adherence. After 10-fold cross-validation, the final prediction model had an accuracy of 75%, and the classification accuracy of low and intermediate adherence was 78.12%. Conclusions: The WeChat-based reminder intervention was beneficial for adherence. A short set of questions and prediction rules, which can be applied in future large-scale validation studies, aimed at developing and validating a short adherence assessment tool and implementing it in PrEP practices among MSM. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900026414; https://www.chictr.org.cn/showproj.html?proj=35077 %R 10.2196/58920 %U https://mhealth.jmir.org/2024/1/e58920 %U https://doi.org/10.2196/58920 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53873 %T Research Trends on Metabolic Syndrome in Digital Health Care Using Topic Modeling: Systematic Search of Abstracts %A Lee,Kiseong %A Chung,Yoongi %A Kim,Ji-Su %+ Department of Nursing, Chung-Ang University, 84, Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea, Seoul, 06974, Republic of Korea, 82 028205991, jisu80@cau.ac.kr %K metabolic syndrome %K digital health care %K topic modeling %K text network analysis %K research trends %K topic modeling %K prevention %K management %K telemedicine %K wearable %K devices %K apps %K applications %K methodological %K cardiovascular disease %D 2024 %7 12.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Metabolic syndrome (MetS) is a prevalent health condition that affects 20%-40% of the global population. Lifestyle modification is essential for the prevention and management of MetS. Digital health care, which incorporates technologies like wearable devices, mobile apps, and telemedicine, is increasingly becoming integral to health care systems. By analyzing existing research trends in the application of digital health care for MetS management, this study identifies gaps in current knowledge and suggests avenues for future research. Objective: This study aimed to identify core keywords, topics, and research trends concerning the use of digital health care in the management of MetS. Methods: A systematic search of abstracts from peer-reviewed papers was conducted across 6 academic databases. Following eligibility screening, 162 abstracts were selected for further analysis. The methodological approach included text preprocessing, text network analysis, and topic modeling using the BERTopic algorithm. Results: Analysis of the 162 selected abstracts yielded a keyword network comprising 1047 nodes and 34,377 edges. The top 5 core keywords were identified as “MetS,” “use,” “patient,” “health,” and “intervention.” We identified 12 unique topics, with topic 1 focusing on the use of telehealth for self-management of diabetes. The diversity of the 12 topics reflected various aspects of digital health care, including telehealth for diabetes management, electronic health records for MetS complications, and wearable devices for monitoring metabolic status. Research trends showed an expanding field of precision medicine driven by the demand for tailored interventions and the significant impact of the COVID-19 pandemic. Conclusions: By analyzing past research trends and extracting data from scholarly databases, this study has provided valuable insights that can guide future investigations in the field of digital health care and MetS management. %M 39666378 %R 10.2196/53873 %U https://www.jmir.org/2024/1/e53873 %U https://doi.org/10.2196/53873 %U http://www.ncbi.nlm.nih.gov/pubmed/39666378 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e51701 %T Uncovering the Top Nonadvertising Weight Loss Websites on Google: A Data-Mining Approach %A Almenara,Carlos A %A Gulec,Hayriye %+ School of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Av. Alameda San Marcos 11, Lima, 15067, Peru, 51 3133333 ext 2803, carlos.almenara@upc.pe %K consumer health informatics %K cyberattack risk %K data mining %K Google %K information seeking %K weight loss %K online health information %K website analysis %K digital health %K internet search %D 2024 %7 11.12.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Online weight loss information is commonly sought by internet users, and it may impact their health decisions and behaviors. Previous studies examined a limited number of Google search queries and relied on manual approaches to retrieve online weight loss websites. Objective: This study aimed to identify and describe the characteristics of the top weight loss websites on Google. Methods: This study gathered 432 Google search queries collected from Google autocomplete suggestions, “People Also Ask” featured questions, and Google Trends data. A data-mining software tool was developed to retrieve the search results automatically, setting English and the United States as the default criteria for language and location, respectively. Domain classification and evaluation technologies were used to categorize the websites according to their content and determine their risk of cyberattack. In addition, the top 5 most frequent websites in nonadvertising (ie, nonsponsored) search results were inspected for quality. Results: The results revealed that the top 5 nonadvertising websites were healthline.com, webmd.com, verywellfit.com, mayoclinic.org, and womenshealthmag.com. All provided accuracy statements and author credentials. The domain categorization taxonomy yielded a total of 101 unique categories. After grouping the websites that appeared less than 5 times, the most frequent categories involved “Health” (104/623, 16.69%), “Personal Pages and Blogs” (91/623, 14.61%), “Nutrition and Diet” (48/623, 7.7%), and “Exercise” (34/623, 5.46%). The risk of being a victim of a cyberattack was low. Conclusions: The findings suggested that while quality information is accessible, users may still encounter less reliable content among various online resources. Therefore, better tools and methods are needed to guide users toward trustworthy weight loss information. %M 39661980 %R 10.2196/51701 %U https://infodemiology.jmir.org/2024/1/e51701 %U https://doi.org/10.2196/51701 %U http://www.ncbi.nlm.nih.gov/pubmed/39661980 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60760 %T Prevalence and Independent Predictors of Anxiety and Depression Among Elementary and High School Educators: Cross-Sectional Study %A Agyapong,Belinda %A Brett-MacLean,Pamela %A Orimalade,Adedamola %A Dias,Raquel da Luz %A Wei,Yifeng %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, 4-142A Katz Group Centre for Research, 11315- 87 Ave NW, Edmonton, AB, T6G 2H5, Canada, 1 7804928560, bagyapon@ualberta.ca %K generalized anxiety disorder %K major depressive disorder %K resilience %K stress %K Wellness4Teachers %K teachers %K prevalence %K predictors %D 2024 %7 11.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Globally, anxiety and depression are primary contributors to work disability and impact the mental and physical well-being of educators. Objective: This study aims to determine the prevalence and independent predictors of likely generalized anxiety disorder (GAD) and likely major depressive disorder (MDD) among teachers in the Canadian provinces of Newfoundland and Labrador, Alberta, and Nova Scotia. Methods: The study used a cross-sectional design. Educators from the 3 Canadian provinces participated by completing a web-based survey after enrolling in the Wellness4Teachers program, a free, self-subscription, daily, supportive SMS text messaging initiative. The program was launched at the beginning of the 2022-2023 academic year, and all teachers in the 3 provinces were eligible to enroll. Likely GAD and likely MDD among subscribers were assessed using the Generalized Anxiety Disorder-7 scale and the Patient Health Questionnaire-9, respectively. Data analysis was conducted using SPSS (version 28.0). Results: Of the 1912 Wellness4Teachers subscribers, 763 (39.9%) completed the survey. The prevalence of likely MDD was 55.7% (425/763) and that of likely GAD was 46% (349/759). After controlling for all other variables in the regression model, participants who reported high stress were 7.24 times more likely to experience MDD (odds ratio [OR] 7.24, 95% CI 4.22-12.42) and 7.40 times more likely to experience GAD (OR 7.40, 95% CI 4.63-11.80) than those with mild to moderate stress. Participants with emotional exhaustion were 4.92 times more likely to experience MDD (OR 4.92, 95% CI 3.01-8.05) and 4.34 times more likely to experience GAD (OR 4.34, 95% CI 2.47-7.62) than those without. Moreover, respondents with a lack of professional accomplishment were 2.13 times as likely to have MDD symptoms (OR 2.13, 95% CI 1.41-3.23) and 1.52 times more likely to experience GAD symptoms (OR 1.524, 95% CI 1.013-2.293) than those without. Similarly, respondents with low resilience were 1.82 times more likely to have likely MDD than those with normal to high resilience (OR 1.82, 95% CI 1.24-2.66). In addition, respondents with low resilience were 3.01 times more likely to experience likely GAD than those with normal to high resilience (OR 3.01, 95% CI 2.03-7.62). Participants with >20 years of teaching experience were 0.28 times less likely to experience GAD symptoms than those with ≤5 years of teaching experience (OR 0.28, 95% CI 0.12-0.64). Sociodemographic and work-related variables did not independently predict likely GAD and likely MDD. Conclusions: This study underscores the need for governments and policy makers in the education sector to implement comprehensive mental health support programs. Addressing the unique stressors faced by educators, reducing emotional exhaustion, and enhancing resilience are crucial steps toward mitigating anxiety and depression, promoting educators’ well-being, and improving the quality of educational delivery. International Registered Report Identifier (IRRID): RR2-10.2196/37934. %M 39528340 %R 10.2196/60760 %U https://formative.jmir.org/2024/1/e60760 %U https://doi.org/10.2196/60760 %U http://www.ncbi.nlm.nih.gov/pubmed/39528340 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e65095 %T Analysis of Physical Activity Using Wearable Health Technology in US Adults Enrolled in the All of Us Research Program: Multiyear Observational Study %A Singh,Rujul %A Tetrick,Macy K %A Fisher,James L %A Washington,Peter %A Yu,Jane %A Paskett,Electra D %A Penedo,Frank J %A Clinton,Steven K %A Benzo,Roberto M %+ Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Suite 200, 3650 Olentangy River Road, Columbus, OH, 43124, United States, 1 614 293 3675, roberto.benzo@osumc.edu %K Physical Activity Guidelines for Americans %K accelerometry %K All of Us Research Program %K wearable activity monitors %K health equity %K multiyear activity tracking %K activity intensity estimation %K US adult population %K sociodemographic determinants of physical activity %K physical activity %K wearables %K United States %K older adults %K observational studies %K longitudinal setting %K sociodemographic determinants %K physical activity data %K Fitbit data %K step-based method %K adherence %D 2024 %7 10.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: To date, no studies have examined adherence to the 2018 Physical Activity Guidelines for Americans (PAGA) in real-world longitudinal settings using objectively measured activity monitoring data. This study addresses this gap by using commercial activity monitoring (Fitbit) data from the All of Us dataset. Objective: The primary objectives were to describe the prevalence of adherence to the 2018 PAGA and identify associated sociodemographic determinants. Additionally, we compared 3 distinct methods of processing physical activity (PA) data to estimate adherence to the 2008 PAGA. Methods: We used the National Institutes of Health’s All of Us dataset, which contains minute-level Fitbit data for 13,947 US adults over a 7-year time span (2015-2022), to estimate adherence to PAGA. A published step-based method was used to estimate metabolic equivalents and assess adherence to the 2018 PAGA (ie, ≥150 minutes of moderate- to vigorous-intensity PA per week). We compared the step-based method, the heart rate–based method, and the proprietary Fitbit-developed algorithm to estimate adherence to the 2008 PAGA. Results: The average overall adherence to the 2018 PAGA was 21.6% (3006/13,947; SE 0.4%). Factors associated with lower adherence in multivariate logistic regression analysis included female sex (relative to male sex; adjusted odds ratio [AOR] 0.66, 95% CI 0.60-0.72; P<.001); BMI of 25.0-29.9 kg/m2 (AOR 0.53, 95% CI 0.46-0.60; P<.001), 30-34.9 kg/m2 (AOR 0.30, 95% CI 0.25-0.36; P<.001), or ≥35 kg/m2 (AOR 0.13, 95% CI 0.10-0.16; P<.001; relative to a BMI of 18.5-24.9 kg/m2); being aged 30-39 years (AOR 0.66, 95% CI 0.56-0.77; P<.001), 40-49 years (AOR 0.79, 95% CI 0.68-0.93; P=.005), or ≥70 years (AOR 0.74, 95% CI 0.62-0.87; P<.001; relative to being 18-29 years); and non-Hispanic Black race or ethnicity (AOR 0.63, 95% CI 0.50-0.79; P<.001; relative to non-Hispanic White race or ethnicity). The Fitbit algorithm estimated that a larger percentage of the sample (10,307/13,947, 73.9%; 95% CI 71.2-76.6) adhered to the 2008 PAGA compared to the heart rate method estimate (4740/13,947, 34%; 95% CI 32.8-35.2) and the step-based method (1401/13,947, 10%; 95% CI 9.4-10.6). Conclusions: Our results show significant sociodemographic differences in PAGA adherence and notably different estimates of adherence depending on the algorithm used. These findings warrant the need to account for these disparities when implementing PA interventions and the need to establish an accurate and reliable method of using commercial accelerometers to examine PA, particularly as health care systems begin integrating wearable device data into patient health records. %M 39658010 %R 10.2196/65095 %U https://www.jmir.org/2024/1/e65095 %U https://doi.org/10.2196/65095 %U http://www.ncbi.nlm.nih.gov/pubmed/39658010 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e59708 %T Functions of Smartphone Apps and Wearable Devices Promoting Physical Activity: Six-Month Longitudinal Study on Japanese-Speaking Adults %A Konishi,Naoki %A Oba,Takeyuki %A Takano,Keisuke %A Katahira,Kentaro %A Kimura,Kenta %+ Human Informatics and Interaction Research Institute, The National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1 Higashi, Tsukuba, Ibaraki, 305-8566, Japan, 81 50 3522 4500, keisuke.takano@aist.go.jp %K mHealth %K mobile health %K smartphone app %K physical activity %K wearable activity tracker %K longitudinal design %K wearable %K Japan %K health promotion %D 2024 %7 10.12.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone apps and wearable activity trackers are increasingly recognized for their potential to promote physical activity (PA). While studies suggest that the use of commercial mobile health tools is associated with higher PA levels, most existing evidence is cross-sectional, leaving a gap in longitudinal data. Objective: This study aims to identify app-use patterns that are prospectively associated with increases in and maintenance of PA. The primary objective was to test whether continued app use is linked to adherence to the recommended PA levels (ie, 23 metabolic equivalent task [MET] hours per week for adults or 10 MET hours/week for individuals aged >65 years) during a follow-up assessment. The secondary objective was to explore which functions and features of PA apps predict changes in PA levels. Methods: A 2-wave longitudinal survey was conducted, with baseline and follow-up assessments separated by 6 months. A total of 20,573 Japanese-speaking online respondents participated in the baseline survey, and 16,286 (8289 women; mean age 54.7 years, SD 16.8 years) completed the follow-up. At both time points, participants reported their current PA levels and whether they were using any PA apps or wearables. Each participant was classified into 1 of the following 4 categories: continued users (those using apps at both the baseline and follow-up; n=2150, 13.20%), new users (those who started using apps before the follow-up; n=1462, 8.98%), discontinued users (those who had used apps at baseline but not at follow-up; n=1899, 11.66%), and continued nonusers (those who had never used apps; n=10,775, 66.16%). Results: The majority of continued users (1538/2150, 71.53%) either improved or maintained their PA at the recommended levels over 6 months. By contrast, discontinued users experienced the largest reduction in PA (−7.95 MET hours/week on average), with more than half failing to meet the recommended levels at the follow-up (n=968, 50.97%). Analyses of individual app functions revealed that both energy analysis (eg, app calculation of daily energy expenditure) and journaling (eg, users manually entering notes and maintaining an exercise diary) were significantly associated with increases in PA. Specifically, energy analysis was associated with an odds ratio (OR) of 1.67 (95% CI 1.05-2.64, P=.03), and journaling had an OR of 1.76 (95% CI 1.12-2.76, P=.01). By contrast, individuals who maintained the recommended PA levels at the follow-up were more likely to use the goal setting (OR 1.73, 95% CI 1.21-2.48, P=.003), sleep information (OR 1.66, 95% CI 1.03-2.68, P=.04), and blood pressure recording (OR 2.05, 95% CI 1.10-3.83, P=.02) functions. Conclusions: The results highlight the importance of continued app use in both increasing and maintaining PA levels. Different app functions may contribute to these outcomes, with features such as goal setting and journaling playing a key role in increasing PA, while functions related to overall health, such as sleep tracking and blood pressure monitoring, are more associated with maintaining high PA levels. %M 39658011 %R 10.2196/59708 %U https://mhealth.jmir.org/2024/1/e59708 %U https://doi.org/10.2196/59708 %U http://www.ncbi.nlm.nih.gov/pubmed/39658011 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e53401 %T An Ecological Momentary Assessment Approach of Environmental Triggers in the Role of Daily Affect, Rumination, and Movement Patterns in Early Alcohol Use Among Healthy Adolescents: Exploratory Study %A Prignitz,Maren %A Guldner,Stella %A Lehmler,Stephan Johann %A Aggensteiner,Pascal-M %A Nees,Frauke %A , %+ Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J 5, Mannheim, 68159, Germany, 49 62117036313, maren.prignitz@zi-mannheim.de %K alcohol use %K adolescence %K affect %K rumination %K ecological momentary assessment %K geospatial measures %D 2024 %7 10.12.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adolescence is a period characterized by an increased susceptibility to developing risky alcohol consumption habits. This susceptibility can be influenced by social and situational factors encountered in daily life, which, in conjunction with emotions and thoughts, contribute to behavioral patterns related to alcohol use even in the early stages of alcohol experimentation, when initial experiences with alcohol are formed, and regular consumption is still evolving. Objective: This study aimed to examine the association between detailed behavioral and movement patterns, along with emotional and cognitive factors, and the early onset of alcohol use in the everyday lives of adolescents. Methods: A total of 65 healthy adolescents (33 male, twenty-nine 14-year-olds, and thirty-six 16-year-olds) underwent mobile-based ecological momentary assessments on alcohol (once a day at 9 AM, assessing alcohol use the day before), positive and negative affect, craving, rumination, and social context (6 prompts/day at 9 AM, 11 AM, 2 PM, 4 PM, 6 PM and 8 PM), type of day (weekdays or weekends, with weekend including Fridays, Saturdays, and Sundays), and using geospatial measures (specifically roaming entropy and number and type of trigger points for alcohol use met) over 14 days. After adjusting for a compliance rate of at least 50%, 52 participants (26 male and twenty-four 14-year-olds) were included in the analyses. Results: Generalized linear multilevel models revealed that higher positive affect (b=0.685, P=.007), higher rumination (b=0.586, P=.02), and a larger movement radius (roaming entropy) (b=8.126, P=.02) were positively associated with alcohol use on the same day. However, social context (b=–0.076, P=.90), negative affect (b=–0.077, P=.80), or potential trigger points (all P>.05) did not show significant associations. Alcohol use varied depending on the type of day, with more alcohol use on weekends (b=1.082, P<.001) and age (t50=–2.910, P=.005), with 16-year-olds (mean 1.61, SD 1.66) reporting more days of alcohol consumption than 14-year-olds (mean 0.548, SD 0.72). Conclusions: Our findings support previously identified factors as significant contributors to very early and low levels of alcohol consumption through fine-grained analysis of daily behaviors. These factors include positive affect, rumination, weekend days, and age. In addition, we emphasize that exploratory environmental movement behavior (roaming entropy) is also significantly associated with adolescent alcohol use, highlighting its importance as an additional factor. %M 39657181 %R 10.2196/53401 %U https://mhealth.jmir.org/2024/1/e53401 %U https://doi.org/10.2196/53401 %U http://www.ncbi.nlm.nih.gov/pubmed/39657181 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60677 %T A Gender-Informed Smoking Cessation App for Women: Protocol for an Acceptability and Feasibility Study %A Melamed,Osnat C %A Mehra,Kamna %A Panda,Roshni %A Minian,Nadia %A Veldhuizen,Scott %A Zawertailo,Laurie %A Buckley,Leslie %A Maslej,Marta %A Greaves,Lorraine %A Brabete,Andreea C %A Rose,Jonathan %A Ratto,Matt %A Selby,Peter %+ INTREPID Lab, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J1H4, Canada, 1 4165358501 ext 36019, osnat.melamed@camh.ca %K smoking cessation %K mHealth %K co-development %K feasibility %K smoking %K mobile app %K cigarette smoking %K tobacco cessation %K gender-informed design %K app design %K women's health %K behavior change %K health behavior change %K mobile phone %D 2024 %7 10.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tobacco smoking remains the leading preventable cause of death and disease among women. Quitting smoking offers numerous health benefits; however, women tend to have less success than men when attempting to quit. This discrepancy is partly due to sex- and gender-related factors, including the lower effectiveness of smoking cessation medication and the presence of unique motives for smoking and barriers to quitting among women. Despite the gendered nature of smoking, most smoking cessation apps are gender-neutral and fail to address women’s specific needs. Objective: This study aims to test the acceptability and feasibility of a smartphone app that delivers gender-informed content to support women in quitting smoking. Methods: We co-developed a smoking cessation app specifically tailored for women, named My Change Plan-Women (MCP-W). This app builds upon our previous gender-neutral app, MCP, by retaining its content grounded in behavioral change techniques aimed at supporting tobacco reduction and cessation. This includes goal setting for quitting, identifying triggers to smoking, creating coping strategies, tracking cigarettes and cravings, and assessing financial savings from quitting smoking. The MCP-W app contains additional gender-informed content that acknowledges barriers to quitting, such as coping with stress, having smokers in one’s social circle, and managing unpleasant emotions. This content is delivered through testimonials and animated videos. This study is a prospective, single-group, mixed methods investigation in which 30 women smokers will trial the app for a period of 28 days. Once participants provide informed consent, they will complete a baseline survey and download the app on their smartphones. After 28 days, participants will complete follow-up surveys. Acceptability will be assessed using the Theoretical Framework of Acceptability, which evaluates whether participants perceive the app as helpful in changing their smoking. The app will be deemed acceptable if the majority of participants rate it as such, and feasible if the majority of the participants use it for at least 7 days. Furthermore, after the 28-day trial period, participants will complete a semistructured interview regarding their experience with the app and suggestions for improvement. Results: Development of the MCP-W app was completed in September 2023. Participant recruitment for testing of the app commenced in February 2024 and was completed in July 2024. We will analyze the data upon completion of data collection from all 30 participants. We expect to share the results of this acceptability trial in the middle of 2025. Conclusions: Offering smoking cessation support tailored specifically to address the unique needs of women through a smartphone app represents a novel approach. This study will test whether women who smoke perceive this approach to be acceptable and feasible in their journey toward smoking cessation. International Registered Report Identifier (IRRID): DERR1-10.2196/60677 %M 39433391 %R 10.2196/60677 %U https://www.researchprotocols.org/2024/1/e60677 %U https://doi.org/10.2196/60677 %U http://www.ncbi.nlm.nih.gov/pubmed/39433391 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e63078 %T Feasibility and Efficacy of a Novel Mindfulness App Used With Matcha Green Tea in Generally Healthy Adults: Randomized Controlled Trial %A Tanaka-Kanegae,Ryohei %A Yamada,Koji %A Cook,Chad M %A Blonquist,Traci M %A Taggart,Kristen D %A Hamada,Koichiro %+ Saga Nutraceuticals Research Institute, Otsuka Pharmaceutical Co Ltd, 5006-5 Aza Higashiyama, Omagari, Yoshinogari-cho, Kanzaki-gun, Saga, 842-0195, Japan, 81 952521522, tanaka.ryohei@otsuka.jp %K mindfulness %K guided tea meditation %K meditation %K matcha %K green tea %K mobile app %K smartphone %K stress %K mood %K mHealth %K mobile health %K well-being %K wellness %D 2024 %7 10.12.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mindfulness practices, such as breathing meditation (BM), reduce stress and enhance mood. One such practice is mindful eating, where a practitioner focuses on the five senses while eating or drinking. A novel set of prototypes has been developed, incorporating principles of mindful eating. These prototypes include matcha green tea and a mobile app that provides audio guidance for meditation during the preparation and consumption of the beverage (hereafter referred to as guided tea meditation [GTM]). Objective: This study assessed the feasibility and efficacy of GTM, evaluating meditation time, frequency, and prototype acceptability over 8 weeks, alongside changes in stress and mood. Additionally, other benefits of GTM were explored. Methods: A comparator group was established in which participants performed traditional BM without an app or audio guide (active control). This unblinded randomized controlled trial involved 100 healthy American volunteers (n=49 GTM, n=51 BM). During the 8-week study period, participants were encouraged to perform either GTM or BM for 10 minutes daily. The meditation activity was self-reported the following day. Only the GTM group assessed the prototype acceptability. The Perceived Stress Scale-10 was used to measure stress levels, while the Two-Dimensional Mood Scale was used to evaluate mood changes. Other meditation benefits were explored using a questionnaire. All questionnaires were presented and completed via an app. An intention-to-treat analysis was performed. Results: No significant between-group differences were found in total meditation time (P=.15) or frequency (P=.36). However, the weekly time and frequency of the GTM group remained above 50 minutes per week and 4 days per week, respectively. Over half of the GTM participants (≥28/49, ≥57%) accepted the prototype. The GTM group exhibited significant stress reductions at weeks 4 and 8 (both P<.001), similar to the BM group. Improvements in mood metrics were observed after a single GTM session on days 1 and 56, similar to the BM group. Moreover, increases in premeditation scores for relaxed and calm from day 1 to day 56 were significantly higher for the GTM group (P=.04 and .048, respectively). The majority of participants (≥25/49, ≥51%) assigned to GTM experienced positive changes in happiness, time management, quality of life, relationships, sleep, and work performance as they continued meditating. However, no significant between-group differences were found in these exploratory outcomes (P>.08). Conclusions: We believe that GTM exhibits good feasibility. Meanwhile, GTM reduced stress, improved mood, and let the practitioners feel other benefits, similar to BM. Long-term practitioners of GTM may even feel more relaxed and calmer in the state of premeditation than those who practice BM. Trial Registration: ClinicalTrials.gov NCT05832645; https://clinicaltrials.gov/study/NCT05832645 %M 39657179 %R 10.2196/63078 %U https://mhealth.jmir.org/2024/1/e63078 %U https://doi.org/10.2196/63078 %U http://www.ncbi.nlm.nih.gov/pubmed/39657179 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50041 %T Tracked Physical Activity Levels Before and After a Change in Incentive Strategy Among UK Adults Using a Rewards App: Retrospective Quasi-Experimental Study %A McCarthy,Hannah %A Potts,Henry W W %A Fisher,Abigail %+ University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 20 7679 2000, h.potts@ucl.ac.uk %K mHealth %K rewards %K incentives %K physical activity %K smartphone %K apps %K mobile apps %K app-based intervention %K behavior change %K exercise %D 2024 %7 10.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Financial incentives delivered via apps appear to be effective in encouraging physical activity. However, the literature on different incentive strategies is limited, and the question remains whether financial incentives offer a cost-effective intervention that could be funded at the population level. Objective: This study aimed to explore patterns of tracked physical activity by users of an incentive-based app before and after a change in incentive strategy. A business decision to alter the incentives in a commercially available app offered a natural experiment to explore GPS-tracked data in a retrospective, quasi-experimental study. The purpose of this exploratory analysis was to inform the design of future controlled trials of incentives delivered via an app to optimize their usability and cost-effectiveness. Methods: Weekly minutes of tracked physical activity were explored among a sample of 1666 participants. A Friedman test was used to determine differences in physical activity before and after the change in incentive strategies. Post hoc Wilcoxon tests were used to assess minutes of physical activity in the 2 weeks before and after the change. A secondary analysis explored longitudinal patterns of physical activity by plotting the mean and median minutes of physical activity from 17 weeks before and 13 weeks after the change in incentive strategy. CIs were calculated using bias-corrected bootstraps. Demographics were also explored in this way. Results: There were significant differences in the weekly minutes of activity before and after the change in incentive strategy (Friedman χ22=42, P<.001). However, a longitudinal view of the data showed a more complex and marked variation in activity over time that undermined the conclusions of the before/after analysis. Conclusions: Short-term before-and-after observational studies of app-tracked physical activity may result in misleading conclusions about the effectiveness of incentive strategies. Longitudinal views of the data show that important fluctuations are occurring over time. Future studies of app-tracked physical activity should explore such variations by using longitudinal analyses and accounting for possible moderating variables to better understand what an effective incentive might be, for whom, and at what cost. %M 39657165 %R 10.2196/50041 %U https://formative.jmir.org/2024/1/e50041 %U https://doi.org/10.2196/50041 %U http://www.ncbi.nlm.nih.gov/pubmed/39657165 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55243 %T Effects of 10 Weeks of Walking With Mobile Step-Tracking Apps on Body Composition, Fitness, and Psychological State in Adolescents Who Are Overweight and Obese: Randomized Controlled Trial %A Mateo-Orcajada,Adrián %A Ponce-Ramírez,Cristina M %A Abenza-Cano,Lucía %A Vaquero-Cristóbal,Raquel %+ Facultad de Deporte, Universidad Católica de Murcia (UCAM), Avenida de los Jerónimos, Murcia, 30107, Spain, 34 968 278 824, labenza@ucam.edu %K adolescents %K obesity %K physical activity %K overweight %K mobile app %K physical education %D 2024 %7 10.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent decades, physical activity intervention programs have been developed to reduce overweight and obesity in adolescents. However, this population is considered hard to reach in physical activity programs due to lack of adherence and poor results. Interventions with mobile phones in the adolescent population with normal weight have shown benefits, so this line of research may provide benefits in adolescents with overweight or obesity, although it has not yet been explored in the scientific literature. Objective: This study aims to determine the changes produced by a 10-week intervention promoted during school lessons on physical education using step tracker mobile apps in out-of-school hours on physical activity, adherence to the Mediterranean diet, body composition, and the physical condition of adolescents who are overweight and obese, and to analyze the changes achieved by the 10-week intervention on the psychological state of adolescents who are overweight and obese. Methods: The study was based on a randomized controlled trial with an initial sample of 50 adolescents aged between 12 and 16 years (from the first to the fourth years of compulsory secondary education), whose body composition, physical activity level, physical condition, and psychological state were measured. Participants were divided into an experimental group (EG) and a control group (CG), where the EG performed a series of walking steps with a mobile app in their free time outside physical education classes. Adolescents in the CG continued to perform their physical activities as normal but did not use any mobile apps. Inclusion in the EG and CG was randomized, and the researchers were blinded. Results: An increase was found in the EG in corrected arm girth (mean difference –0.46; P=.05), curl-up repetitions (mean difference –6.35; P=.02) and push-up repetitions (mean difference –2.27; P=.04) after the intervention. In the CG, there was a significant increase in hip girth (mean difference –1.37; P=.05), corrected thigh girth (mean difference –1.28; P=.04), and muscle mass (mean difference –0.87; P=.04), as well as a significant decrease in competence (mean difference 3.08; P=.03). The covariates gender and age showed an effect on corrected arm girth (gender: P=.04), curl-up repetitions (gender: P=.04) and push-up repetitions (gender: P=.04) in the EG; while in the CG it affected corrected thigh girth (gender: P=.04), adherence to the Mediterranean diet (gender: P=.04 and age: P=.047) competence (gender: P=.04 and age: P=.04) and relatedness (gender: P=.05 and age: P=.04). No significant differences were found when comparing changes in the CG and EG. Conclusions: A 10-week program of mobile app use by adolescents who are overweight and obese for physical activity outside of school hours does not appear effective in producing improvements in body composition, physical fitness, or adequate psychological state as it does not appear to significantly increase physical activity. Trial Registration: ClinicalTrials.gov NCT06089876; http://clinicaltrials.gov/ct2/show/NCT06089876 %M 39656510 %R 10.2196/55243 %U https://www.jmir.org/2024/1/e55243 %U https://doi.org/10.2196/55243 %U http://www.ncbi.nlm.nih.gov/pubmed/39656510 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e63143 %T Optimizing a Novel Smartphone App to Prevent Postpartum Depression Adapted From an Evidence-Based Cognitive Behavioral Therapy Program: Qualitative Study %A Lewkowitz,Adam K %A Guillen,Melissa %A Ursino,Katrina %A Baker,Rackeem %A Lum,Liana %A Battle,Cynthia L %A Ware,Crystal %A Ayala,Nina K %A Clark,Melissa %A Ranney,Megan L %A Miller,Emily S %A Guthrie,Kate M %K cognitive behavioral therapy %K mothers and babies program %K digital health %K postpartum depression %K smartphone application %K FRAME for intervention adaptation %K Framework for Modification and Adaptation %K behavioral therapy %K mental health apps %D 2024 %7 9.12.2024 %9 %J JMIR Hum Factors %G English %X Background: Low-income pregnant patients are at high risk of postpartum depression (PPD). Mothers and Babies (MB) is a cognitive behavioral therapy–based program that prevents up to 50% of de novo PPD when provided in person to low-income Spanish- and English-speaking people who are pregnant without depression. MB is limited by the need for trained personnel to support it. Transforming MB into a smartphone app may mitigate this key barrier. Objective: We aimed to use qualitative data from target end users to create and optimize MBapp, a novel app centered on the MB program. Methods: Draft wireframes of MBapp were created in English and Spanish with cognitive behavioral therapy–based modules adapted from MB. These wireframes included several features shown previously to sustain app engagement: (1) push notifications delivered at participant-preferred times; (2) text-, graphic-, and video-based content; and (3) gamification with digital rewards for app engagement. English- or Spanish-speaking individuals with public health insurance who were between 32 weeks gestation and 6 months post partum and owned smartphones were eligible to consent for individual in-depth interviews. Individuals with prior or current depression were excluded. Interviews were recorded, transcribed, and analyzed using deductive and inductive codes to characterize opinions about MBapp and perceptions of challenges and facilitators of use of MBapp or other perinatal or mental health apps. End user feedback led to major modifications to the wireframes. Each of these changes was categorized according to the FRAME (Framework for Modification and Adaptation), an established method of systematically reporting adaptations and modifications to evidence-based interventions via end user feedback. Recruitment ceased with content saturation, defined as 3 successive participants providing only positive feedback on MBapp’s wireframe, without further suggestions for improvement. Results: A total of 25 interviews were completed. Participants were racially and ethnically diverse, generally representing our target end user population, and 48% (n=12) of interviews were conducted in Spanish. Participants’ suggestions to improve MBapp were categorized within the FRAME as adaptations that improved either content or context to optimize reach, retention, engagement, and fit for end users. Specifically, the following features were added to MBapp secondary to end user feedback: (1) audio narration; (2) “ask a clinician” nonurgent questions; (3) on-demand module summaries accessible upon module completion; and (4) choice to defer assessments and start the next module. Participants also provided insights into features of perinatal or mental health apps they found appealing or unappealing to understand preferences, challenges, and negotiables or nonnegotiables for MBapp. Conclusions: Adapting MBapp to incorporate end users’ perspectives optimized our digital PPD prevention intervention, ideally increasing its appeal to future users. Our team’s next steps will confirm that MBapp is a feasible, acceptable intervention among English- and Spanish-speaking perinatal people at risk of PPD. %R 10.2196/63143 %U https://humanfactors.jmir.org/2024/1/e63143 %U https://doi.org/10.2196/63143 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e59588 %T An eHealth Intervention to Improve Quality of Life, Socioemotional, and Health-Related Measures Among Older Adults With Multiple Chronic Conditions: Randomized Controlled Trial %A Gustafson Sr,David H %A Mares,Marie-Louise %A Johnston,Darcie %A Vjorn,Olivia J %A Curtin,John J %A Landucci,Gina %A Pe-Romashko,Klaren %A Gustafson Jr,David H %A Shah,Dhavan V %+ Center for Health Enhancement Systems Studies, University of Wisconsin–Madison, 4111 Mechanical Engineering, 1513 University Ave, Madison, WI, 53706, United States, 1 608 890 1440, gina.landucci@wisc.edu %K eHealth %K telemedicine %K aged %K geriatrics %K multiple chronic conditions %K social support %K quality of life %K primary care %K mobile phone %K smartphone %D 2024 %7 6.12.2024 %9 Original Paper %J JMIR Aging %G English %X Background: In the United States, over 60% of adults aged 65 years or older have multiple chronic health conditions, with consequences that include reduced quality of life, increasingly complex but less person-centered treatment, and higher health care costs. A previous trial of ElderTree, an eHealth intervention for older adults, found socioemotional benefits for those with high rates of primary care use. Objective: This study tested the effectiveness of an ElderTree intervention designed specifically for older patients with multiple chronic conditions to determine whether combining it with primary care improved socioemotional and physical outcomes. Methods: In a nonblinded randomized controlled trial, 346 participants recruited from primary care clinics were assigned 1:1 to the ElderTree intervention or an attention control and were followed for 12 months. All participants were aged 65 years or older and had electronic health record diagnoses of at least three of 11 chronic conditions. Primary outcomes were mental and physical quality of life, psychological well-being (feelings of competence, connectedness, meaningfulness, and optimism), and loneliness. Tested mediators of the effects of the study arm (ElderTree vs active control) on changes in primary outcomes over time were 6-month changes in health coping, motivation, feelings of relatedness, depression, and anxiety. Tested moderators were sex, scheduled health care use, and number of chronic conditions. Data sources were surveys at baseline and 6 and 12 months comprising validated scales, and continuously collected ElderTree usage. Results: At 12 months, 76.1% (134/176) of ElderTree participants were still using the intervention. There was a significant effect of ElderTree (vs control) on improvements over 12 months in mental quality of life (arm × timepoint interaction: b=0.76, 95% CI 0.14-1.37; P=.02; 12-month ∆d=0.15) but no such effect on the other primary outcomes of physical quality of life, psychological well-being, or loneliness. Sex moderated the effects of the study arm over time on mental quality of life (b=1.33, 95% CI 0.09-2.58; P=.04) and psychological well-being (b=1.13, 95% CI 0.13-2.12; P=.03), with stronger effects for women than men. The effect of the study arm on mental quality of life was mediated by 6-month improvements in relatedness (α=1.25, P=.04; b=0.31, P<.001). Analyses of secondary and exploratory outcomes showed minimal effects of ElderTree. Conclusions: Consistent with the previous iteration of ElderTree, the current iteration designed for older patients with multiple chronic conditions showed signs of improving socioemotional outcomes but no impact on physical outcomes. This may reflect the choice of chronic conditions for inclusion, which need not have impinged on patients’ physical quality of life. Two ongoing trials are testing more specific versions of ElderTree targeting older patients coping with (1) chronic pain and (2) greater debilitation owing to at least 5 chronic conditions. Trial Registration: ClinicalTrials.gov NCT03387735; https://clinicaltrials.gov/study/NCT03387735 International Registered Report Identifier (IRRID): RR2-10.2196/25175 %M 39642938 %R 10.2196/59588 %U https://aging.jmir.org/2024/1/e59588 %U https://doi.org/10.2196/59588 %U http://www.ncbi.nlm.nih.gov/pubmed/39642938 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56407 %T Text Messaging to Extend School-Based Suicide Prevention: Pilot Randomized Controlled Trial %A Pisani,Anthony R %A Wyman,Peter A %A Cero,Ian %A Kelberman,Caroline %A Gurditta,Kunali %A Judd,Emily %A Schmeelk-Cone,Karen %A Mohr,David %A Goldston,David %A Ertefaie,Ashkan %+ Department of Psychiatry, University of Rochester Medical Center, University of Rochester, 301 Crittenden Blvd, Rochester, NY, 14627, United States, 1 585 507 7177, anthony_pisani@urmc.rochester.edu %K suicide prevention %K text messaging %K self-violence %K self-harm %K suicidal behavior %K randomized controlled trial %K adolescent %K teenager %K student %K school %K United States %K Text4Strength %K help-seeking attitude %K coping %K awareness %K depression %K mood disorder %K mental health %D 2024 %7 6.12.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Suicide is the third-leading cause of death among US adolescents aged 10-19 years, and about 10% attempt suicide each year. School-based universal prevention may reduce youth suicidal behavior. Sources of Strength uses a peer leader network diffusion model to promote healthy norms across a school population. A key challenge within schoolwide programs is reaching a large and diverse array of students, especially those less engaged with their peers. Motivated by this challenge, we developed and field-tested Text4Strength—a program of automated text messages targeting help-seeking attitudes and norms, social coping resources, and emotion regulation skills. Objective: This study conducted a pilot randomized controlled trial of Text4Strength in 1 high school as an extension of an ongoing schoolwide program (Sources of Strength), to test its impact on targets that have the potential to reduce suicidal behavior. Methods: Students at an upstate New York high school (N=223) received 1-2 text messages per week for 9 weeks, targeting strategies for coping with difficult feelings and experiences through clarifying emotions and focusing on positive affect concepts, awareness, and strengthening of youth-adult relationships; and positive help-seeking norms, skills, and resources. Surveys were administered at baseline, immediately post intervention and 3 months after texting ended. We measured proximal intervention targets (methods of coping during stressful events, ability to make sense of their own emotions, feelings of powerlessness during emotion management and recovery, relations with trusted adults at school, and help-seeking behaviors), symptoms and suicide ideation, and student replies to messages. Results: No significant effects were observed for any outcome at either follow-up time point. Results showed that if there is a true (but undetected) intervention effect, it is small. Students with fewer friend nominations did not interact any more or less with the text messages. Exploratory moderation analyses observed no interaction between the intervention condition and the number of friends or baseline suicide ideation at any time point. Conclusions: In contrast to a promising previous field test, these results suggest that Text4Strength is unlikely to have impacted the outcomes of interest and that undetected moderate or large effects can be ruled out with high confidence. Although motivated by the need to reach more isolated students, students with fewer friends did not engage more or show a greater effect than other participants. This study was conducted in a single high school that was already implementing Sources of Strength, so the bar for showing a distinct effect from texting alone was high. Many further channels for reaching youth through private messaging remain unexplored. Alternative delivery systems should be investigated, such as embedding messaging in gaming chat systems and other media. More sophisticated systems drawing on chatbots may also achieve better outcomes. Trial Registration: ClinicalTrials.gov NCT03145363; https://clinicaltrials.gov/study/NCT03145363 %M 39642360 %R 10.2196/56407 %U https://mental.jmir.org/2024/1/e56407 %U https://doi.org/10.2196/56407 %U http://www.ncbi.nlm.nih.gov/pubmed/39642360 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e53280 %T The Use of a Digital Well-Being App (Stay Strong App) With Indigenous People in Prison: Randomized Controlled Trial %A Perdacher,Elke %A Kavanagh,David %A Sheffield,Jeanie %A Dale,Penny %A Heffernan,Edward %+ Queensland Forensic Mental Health Service, Level 5, 270 Roma Street, Brisbane, Queensland, 4000, Australia, 61 7 3837 5820, elke.perdacher@health.qld.gov.au %K First Nations %K Indigenous %K digital mental health %K e-mental health %K mental health %K social and emotional well-being %K SEWB %K prisoner %K prison %D 2024 %7 6.12.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Indigenous Australians in custody experience much greater rates of poor mental health and well-being than those of the general community, and these problems are not adequately addressed. Digital mental health strategies offer innovative opportunities to address the problems, but little is known about their feasibility in or impact on this population. Objective: This study aims to conduct a pilot trial evaluating the impact of adding the Stay Strong app to mental health and well-being services for Indigenous women and men in custody. The trial compared immediate and 3-month delayed use of the app by the health service, assessing its effects on well-being, empowerment, and psychological distress at 3 and 6 months after the baseline. Methods: Indigenous participants were recruited from 3 high-security Australian prisons from January 2017 to September 2019. The outcome measures assessed well-being (Warwick-Edinburgh Mental Wellbeing Scale), empowerment (Growth and Empowerment Measure [GEM]—giving total, 14-item Emotional Empowerment Scale, and 12 Scenarios scores), and psychological distress (Kessler Psychological Distress Scale). Intention-to-treat effects on these outcomes were analyzed using linear mixed models. Results: Substantial challenges in obtaining ethical and institutional approval for the trial were encountered, as were difficulties in timely recruitment and retention due to staff shortages and the release of participants from prison before follow-up assessments and an inability to follow up with participants after release. A total of 132 prisoners (age: mean 33, SD 8 y) were randomized into either an immediate (n=82) or a delayed treatment (n=52) group. However, only 56 (42.4%) could be assessed at 3 months and 37 (28%) at 6 months, raising questions concerning the representativeness of the results. Linear improvements over time were seen in all outcomes (GEM total: Cohen d=0.99; GEM 14-item Emotional Empowerment Scale: Cohen d=0.94; GEM 12 Scenarios: Cohen d=0.87; Warwick-Edinburgh Mental Wellbeing Scale: Cohen d=0.76; Kessler Psychological Distress Scale: Cohen d=0.49), but no differential effects for group or the addition of the Stay Strong app were found. Conclusions: We believe this to be Australia’s first evaluation of a digital mental health app in prison and the first among Indigenous people in custody. While the study demonstrated that the use of a well-being app within a prison was feasible, staff shortages led to delayed recruitment and a consequent low retention, and significant beneficial effects of the app’s use within a forensic mental health service were not seen. Additional staff resources and a longer intervention may be needed to allow a demonstration of satisfactory retention and impact in future research. Trial Registration: ANZCTR ACTRN12624001261505; https://www.anzctr.org.au/ACTRN12624001261505.aspx %M 39642362 %R 10.2196/53280 %U https://mental.jmir.org/2024/1/e53280 %U https://doi.org/10.2196/53280 %U http://www.ncbi.nlm.nih.gov/pubmed/39642362 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e59610 %T Influencing Factors and Implementation Pathways of Adherence Behavior in Intelligent Personalized Exercise Prescription: Qualitative Study %A Xu,Xuejie %A Zhang,Guoli %A Xia,Yuxin %A Xie,Hui %A Ding,Zenghui %A Wang,Hongyu %A Ma,Zuchang %A Sun,Ting %+ School of Nursing, Bengbu Medical University, Number 2600, Donghai Avenue, Bengbu, 233030, China, 86 18005529759, cangwuge21@163.com %K exercise prescription %K adherence behavior %K qualitative %K influence factors %K Transtheoretical Model %K multiple motivations of behavior %D 2024 %7 5.12.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Personalized intelligent exercise prescriptions have demonstrated significant benefits in increasing physical activity and improving individual health. However, the health benefits of these prescriptions depend on long-term adherence. Therefore, it is essential to analyze the factors influencing adherence to personalized intelligent exercise prescriptions and explore the intrinsic relationship between individual behavioral motivation and adherence. This understanding can help improve adherence and maximize the effectiveness of such prescriptions. Objective: This study aims to identify the factors influencing adherence behavior among middle-aged and older community residents who have been prescribed personalized exercise regimens through an electronic health promotion system. It also explores how these factors affect the initiation and maintenance of adherence behavior. Methods: We used purposive sampling to conduct individual, face-to-face semistructured interviews based on the Transtheoretical Model (TTM) with 12 middle-aged and older community residents who had been following personalized exercise regimens for 8 months. These residents had received detailed exercise health education and guidance from staff. The interviews were recorded, transcribed verbatim, and analyzed using NVivo software through grounded theory. We then applied the TTM and multibehavioral motivation theory to analyze the factors influencing adherence. Additionally, the relationship between behavioral motivations and adherence was explored. Results: Using the behavior change stages of the TTM, open coding yielded 21 initial categories, which were then organized into 8 main categories through axial coding: intrinsic motivation, extrinsic motivation, benefit motivation, pleasure motivation, achievement motivation, perceived barriers, self-regulation, and optimization strategies. Selective coding further condensed these 8 main categories into 3 core categories: “multitheory motivation,” “obstacle factors,” and “solution strategies.” Using the coding results, a 3-level model of factors influencing adherence to intelligent personalized exercise prescriptions was developed. Based on this, an implementation path for promoting adherence to intelligent personalized exercise prescriptions was proposed by integrating the model with the TTM. Conclusions: Adherence to personalized exercise prescriptions is influenced by both facilitating factors (eg, multibehavioral motivation, optimization strategies) and obstructive factors (eg, perceived barriers). Achieving and maintaining adherence is a gradual process, shaped by a range of motivations and factors. Personalized solutions, long-term support, feedback mechanisms, and social support networks are essential for promoting adherence. Future efforts should focus on enhancing adherence by strengthening multibehavioral motivation, optimizing solutions, and addressing barriers to improve overall adherence. %M 39636668 %R 10.2196/59610 %U https://mhealth.jmir.org/2024/1/e59610 %U https://doi.org/10.2196/59610 %U http://www.ncbi.nlm.nih.gov/pubmed/39636668 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50664 %T Effectiveness of an Internet-Based Self-Help Acceptance and Commitment Therapy Program on Medical Students’ Mental Well-Being: Follow-Up Randomized Controlled Trial %A Wang,Difan %A Lin,Bingyan %A Zhang,Shuangxi %A Xu,Wei %A Liu,Xinying %+ Faculty of Psychology, Beijing Normal University, 19 Xinjiekouwai Street Haidian District, Beijing, 100875, China, 86 010 66939114, livingxw@163.com %K internet-delivered self-help acceptance and commitment therapy %K depression %K anxiety %K stress %K psychological inflexibility %K obsessive-compulsive symptoms %K medical students %K iACT 2.0 program %D 2024 %7 4.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Psychological distress is a growing problem among medical students worldwide. This highlights the need for psychological interventions to focus on mental health and improve well-being in this population. Objective: This study developed an internet-based, self-help, acceptance and commitment therapy program (iACT 2.0), aiming to examine its effectiveness in reducing depression, anxiety, stress, psychological inflexibility (PI), and obsessive-compulsive symptoms (OCSs) among medical students. Methods: A total of 520 Chinese postgraduate medical students were randomly assigned to either an iACT 2.0 intervention group (n=260; six online lessons, once every 5 days) or a control condition (n=260; without intervention). Participants completed questionnaires including the 21-item Depression Anxiety Stress Scale, the revised Obsessive-Compulsive Inventory, and the Multidimensional Psychological Flexibility Inventory at the preintervention (T1), postintervention (T2), and 1-month follow-up time points (T3). No therapist support was provided during the 1-month iACT 2.0 intervention period. Data were collected via an online platform and analyzed using repeated-measures ANOVA. Results: Participants in the intervention group demonstrated a significant decrease in depression, anxiety, stress, PI, and OCSs compared to the control group after the intervention (F=22.9-672.04, all P<.001). Specifically, the intervention group showed significant reductions in all measured outcomes from the preintervention to postintervention time point and at the 1-month follow-up (all P<.001). In contrast, no significant changes were observed in the control group over the same period (all P>.05). The groups did not differ significantly at baseline (all P>.05). Significant differences were noted at both the postintervention and follow-up time points (all P<.001). Conclusions: This study demonstrated that the newly developed iACT 2.0 was effective in reducing depression, anxiety, stress, PI, and OCSs. Notably, the positive effects of the intervention persisted at the 1-month follow-up. This program can offer a useful addition to existing mental illness treatment and lead to improvements in clinical and psychotherapy planning while simultaneously reducing the burden on traditional counseling and services. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300070725; https://tinyurl.com/2h75wx8n %M 39631061 %R 10.2196/50664 %U https://www.jmir.org/2024/1/e50664 %U https://doi.org/10.2196/50664 %U http://www.ncbi.nlm.nih.gov/pubmed/39631061 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e66430 %T Psychedelic Art and Implications for Mental Health: Randomized Pilot Study %A Peng,Mary L %A Monin,Joan %A Ovchinnikova,Polina %A Levi,Amanda %A McCall,Terika %+ Department of Orthopedics and Sports Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States, 1 (617) 355 6021, marypeng@hms.harvard.edu %K digital art %K mental health %K psychedelic art %K well-being %K pilot trial %K digital health tool %K art therapy %D 2024 %7 3.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychedelic art (PA) emerged in the 1960s during the psychedelic era; then characterized by visuals induced by the ingestion of psychedelic drugs, it is now an art form known for its vibrant colors, distorted forms, and intricate patterns. Building upon the existing research on art viewing as an effective means to improving physiological and psychological well-being, viewing PA is postulated to evoke positive emotions and provide a meditative experience, contributing to improved mental well-being. Objective: This study aims to investigate how digitally rendered PA influences viewers’ perceived emotional, mental, and physical states compared to imagery of natural scenery, offering insights into potential applications in mental health care and well-being. Methods: Overall, 102 participants age 18 to 35 years were randomly assigned to either the experimental group viewing 300 seconds of PA imagery (50/102, 49%) or the control group viewing 300 seconds of scenic imagery (52/102, 51%), after which every participant completed a survey that gathered qualitative data on the perceived impact of viewing their given imagery on their physical, mental, and emotional states through open-ended questions. Thematic analysis was conducted to identify the patterns of experiences reported by the participants. Results: Qualitative analysis unveiled a greater intensity and diversity of emotional, mental, and physical impacts induced by PA compared to natural scenery, including the sense of relaxation and peace, anxiety and stress alleviation, joy, thrill and sense of euphoria, sensations of awe and wonder, hypnotizing effect, holistic meditative effect, provocation of creative thoughts, induced hyperawareness of bodily states, and transitions from induced overstimulation or anxious thoughts to feelings of calmness. Conclusions: The preliminary findings of this study suggest that PA is a rich and complex form of visual art that has the potential to facilitate healing and promote well-being and mental health. PA presents promising avenues for integration into mental health care, therapeutic practices, digital health, health care environment, and medical research. %M 39626224 %R 10.2196/66430 %U https://formative.jmir.org/2024/1/e66430 %U https://doi.org/10.2196/66430 %U http://www.ncbi.nlm.nih.gov/pubmed/39626224 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e53248 %T Predicting Depressive Symptoms Using GPS-Based Regional Data in Germany With the CORONA HEALTH App During the COVID-19 Pandemic: Cross-Sectional Study %A Edler,Johanna-Sophie %A Winter,Michael %A Steinmetz,Holger %A Cohrdes,Caroline %A Baumeister,Harald %A Pryss,Rüdiger %+ Mental Health Research Unit, Department of Epidemiology and Health Monitoring, Robert Koch Institute, PO Box 650261, Berlin, 12101, Germany, 49 1723842979, johannasophie.edler@gmail.com %K depression %K COVID-19 %K mobile phone %K geographic information systems %K GPS-based data %K mobile applications %K mental health %D 2024 %7 3.12.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Numerous studies have been conducted to predict depressive symptoms using passive smartphone data, mostly integrating the GPS signal as a measure of mobility. Environmental factors have been identified as correlated with depressive symptoms in specialized studies both before and during the pandemic. Objective: This study combined a data-based approach using passive smartphone data to predict self-reported depressive symptoms with a wide range of GPS-based environmental factors as predictors. Methods: The CORONA HEALTH app was developed for the purpose of data collection, and this app enabled the collection of both survey and passive data via smartphone. After obtaining informed consent, we gathered GPS signals at the time of study participation and evaluated depressive symptoms in 249 Android users with the Patient Health Questionnaire-9. The only GPS-based data collected were the participants’ location at the time of the questionnaire, which was used to assign participants to the nearest district for linking regional sociodemographic data. Data collection took place from July 2020 to February 2021, coinciding with the COVID-19 pandemic. Using GPS data, each dataset was linked to a wide variety of data on regional sociodemographic, geographic, and economic characteristics describing the respondent’s environment, which were derived from a publicly accessible database from official German statistical offices. Moreover, pandemic-specific predictors such as the current pandemic phase or the number of new regional infections were matched via GPS. For the prediction of individual depressive symptoms, we compared 3 models (ie, ridge, lasso, and elastic net regression) and evaluated the models using 10-fold cross-validation. Results: The final elastic net regression model showed the highest explained variance (R2=0.06) and reduced the dataset from 121 to 9 variables, the 3 main predictors being current COVID-19 infections in the respective district, the number of places in nursing homes, and the proportion of fathers receiving parental benefits. The number of places in nursing homes refers to the availability of care facilities for the elderly, which may indicate regional population characteristics that influence mental health. The proportion of fathers receiving parental benefits reflects family structure and work-life balance, which could impact stress and mental well-being during the pandemic. Conclusions: Passive data describing the environment contributed to the prediction of individual depressive symptoms and revealed regional risk and protective factors that may be of interest without their inclusion in routine assessments being costly. %M 39625745 %R 10.2196/53248 %U https://www.i-jmr.org/2024/1/e53248 %U https://doi.org/10.2196/53248 %U http://www.ncbi.nlm.nih.gov/pubmed/39625745 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58682 %T An Image-Recognition Dietary Assessment App for Adolescents With Obesity: Pilot Randomized Controlled Trial %A Oei,Krista %A Choi,Elizabeth EY %A Bar-Dayan,Alisa %A Stinson,Jennifer N %A Palmert,Mark R %A Alfonsi,Jeffrey E %A Hamilton,Jill %+ Division of Endocrinology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada, 1 4168131500, krista.oei@sickkids.ca %K obesity %K weight management %K dietary assessment %K nutrition %K adolescent %K digital health app %K mHealth %K mobile health %K image recognition %K teens %K weight %K youth %K diet %K dietary %K dietary app %K usability %K feasibility %K pilot randomized controlled trial %K obesity management %K nutritional %K user %K patient engagement %K mobile phone %D 2024 %7 2.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescence is a period of increased susceptibility to developing obesity-related health issues due to poor eating patterns and increased sedentary behaviors. Recommendations for pediatric obesity management include dietary assessments. However, adolescents often avoid food logging through traditional methods. The use of image-recognition dietary assessment apps in adolescents with obesity is not well studied. Eating for Wellness (E4W) is a mobile app that determines the nutritional content of meals from photos and incorporates nutritional goal setting. Nutritional data can be displayed for health care providers (HCPs) via the Clinician Portal, while the data are presented to the user in a manner that minimizes the focus on calorie counting. Objective: This study aims to evaluate the usability and feasibility of E4W, a mobile health app designed to improve dietary intake in adolescents with obesity attending an obesity clinic, using a phased approach. Methods: The overall study was conducted in 2 phases to refine and evaluate E4W. In Phase 1, usability was tested through 3 iterative cycles of patient interviews. A total of 14 patient participants, aged 12-18 years with a BMI≥97th percentile, were included. Participants performed standardized scenario-based tasks in E4W and provided feedback on the app. Two iterative cycles were conducted for HCPs (n=4). Refinements were made during each cycle based on issues encountered and feedback provided. In Phase 2, a pilot randomized controlled trial of 32 adolescents (16 adolescents enrolled in the experimental group for 1 month, and 16 controls enrolled for 1 month) was completed. Both groups met with their dietitian at baseline, midstudy, and 1 month following their baseline visit to discuss goals and eating patterns. The control group was instructed to take photos of all intake using their default phone camera, without access to E4W, while those in the experimental group received full access to E4W. The primary outcome was the feasibility of implementation. Secondary outcomes examined overall change in dietary intake and achievement of nutritional goals. Results: Usability testing demonstrated that E4W and the Clinician Portal were easy to use, efficient, and well-liked by patients and HCPs. Feasibility testing revealed high patient acceptability scores. However, significant technical challenges were encountered. Although the use of E4W did not significantly impact patient engagement (control: mean 0.9, SD 0.7; experimental: mean 1.7, SD 1.9; P=.14), there were outliers in the experimental group with very high engagement and improved self-reported efficacy. Overall, there was no improvement in dietary intake, although assessment was hindered by poor adherence to traditional methods of food logging. Conclusions: E4W and the Clinician Portal were well-received by patients and HCPs. Further research is warranted and planned to determine if E4W can improve dietary intake and achievement of nutritional goals in adolescents with obesity. Trial Registration: ClinicalTrials.gov NCT05548868; https://clinicaltrials.gov/study/NCT05548868 %M 39621405 %R 10.2196/58682 %U https://formative.jmir.org/2024/1/e58682 %U https://doi.org/10.2196/58682 %U http://www.ncbi.nlm.nih.gov/pubmed/39621405 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e60949 %T Development and Evaluation of 4 Short, Animated Videos for Women in Midlife Promoting Positive Health Behaviors: Survey Study %A Hammarberg,Karin %A Bandyopadhyay,Mridula %A Nguyen,Hau %A Cicuttini,Flavia %A Stanzel,Karin Andrea %A Brown,Helen %A Hickey,Martha %A Fisher,Jane %+ School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Rd, Melbourne, 3004, Australia, 61 418306023, karin.hammarberg@monash.edu %K health promotion %K healthy aging %K self-management %K midlife %K menopause %K internet %K video %K animation %K survey %K questionnaire %K education %K women %K gynecology %D 2024 %7 2.12.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Health and health behaviors in midlife are important determinants of healthy aging. There is evidence of unmet needs for health-promoting information for women from culturally and linguistically diverse backgrounds and women with low literacy. Objective: This study aimed to (1) develop accessible short, animated videos viewable and downloadable from YouTube aimed at promoting positive health behaviors in women in midlife and (2) evaluate their accessibility, acceptability, understanding, and usability and whether this was influenced by the level of education or socioeconomic disadvantage. Methods: In collaboration with a video production company, a multidisciplinary team of academics and health professionals developed 2 short, animated videos on self-management of menopause health and 2 promoting joint health. Their accessibility, acceptability, understanding, and usability to women were evaluated in an anonymous web-based survey. Results: A total of 490 women viewed the videos and responded to the survey. Of these, 353 (72%) completed all questions. Almost all (from 321/353, 91% to 334/363, 92%) agreed that the information in the videos was “very easy to understand.” The proportions reporting that all or some of the information in the video was new to them varied between videos from 36% (137/386) to 66% (233/353), the reported likelihood of using the practical tips offered in the videos varied from 70% (271/386) to 89% (331/373), and between 61% (235/386) and 70% (263/373) of respondents stated that they would recommend the videos to others. Education-level group comparisons revealed few differences in opinions about the videos, except that women with lower education were more likely than those with higher education to state that they would recommend the 2 joint health videos to others (36/45, 80% vs 208/318, 65%; P=.051 for video 3; and 36/44, 80% vs 197/309, 64%; P=.04 for video 4). There were no differences between women living in the least advantaged areas (Socioeconomic Indexes for Areas quintile areas 1 and 2) and those living in the most advantaged areas (Socioeconomic Indexes for Areas quintile areas 3, 4, and 5) in their responses to any of the questions about the 4 videos. Conclusions: Most women found the videos easy to understand, learned something new from watching them, planned to use the practical tips they offered, and were likely to recommend them to other women. This suggests that short, animated videos about health self-management strategies in midlife to improve the chance of healthy aging are perceived as accessible, acceptable, easy to understand, and useful by women. %M 39621404 %R 10.2196/60949 %U https://www.i-jmr.org/2024/1/e60949 %U https://doi.org/10.2196/60949 %U http://www.ncbi.nlm.nih.gov/pubmed/39621404 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50835 %T Understanding Morning Emotions by Analyzing Daily Wake-Up Alarm Usage: Longitudinal Observational Study %A Oh,Kyue Taek %A Ko,Jisu %A ­Jin,Nayoung %A Han,Sangbin %A Yoon,Chan Yul %A Shin,Jaemyung %A Ko,Minsam %+ Department of Human-Computer Interaction, University of Hanyang, ERICA Campus, 55 Hanyangdeahak-ro, Sangnok-gu, Ansan, Gyeonggi-do, 15588, Republic of Korea, 82 31 400 1071, minsam@hanyang.ac.kr %K morning emotion %K wake-up alarm usage %K morning context %K emotion monitoring %K longitudinal observational study %D 2024 %7 29.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Morning emotions can significantly affect daily wellness. While many studies have analyzed daily survey responses to identify factors influencing morning emotions, these methods require additional time and effort from individuals for emotional monitoring. Objective: This study aims to identify daily alarm usage patterns related to morning emotions. Methods: We recruited 373 users of the Alarmy app (DelightRoom) in the United States and South Korea and surveyed their demographics and usual behaviors related to morning emotions. Participants described their morning emotions over a 2-week period, during which we collected daily alarm app logs. We used a generalized estimating equation (GEE) method to identify factors affecting morning emotions. Results: The findings indicate that varied alarm usage is related to morning emotions. Alarm set time was positively associated with feelings of peacefulness and refreshment in the morning, while task-based alarms were related to nervousness. The time taken to deactivate the alarm after it rang was negatively correlated with happiness. In addition, usual behaviors and demographic factors were found to be related to morning emotions, consistent with previous studies. Conclusions: The study reveals that daily alarm usage is related to morning emotions, suggesting that daily alarm logs can supplement survey methods to facilitate daily emotion monitoring. %M 39612499 %R 10.2196/50835 %U https://humanfactors.jmir.org/2024/1/e50835 %U https://doi.org/10.2196/50835 %U http://www.ncbi.nlm.nih.gov/pubmed/39612499 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55736 %T Biomarkers of Response to Internet-Based Psychological Interventions: Systematic Review %A Gotti,Giulia %A Gabelli,Chiara %A Russotto,Sophia %A Madeddu,Fabio %A Courtet,Philippe %A Lopez-Castroman,Jorge %A Zeppegno,Patrizia %A Gramaglia,Carla Maria %A Calati,Raffaella %+ Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, U6 Building, Room 3129, Milan, 20126, Italy, 39 3477752087, raffaella.calati@unimib.it %K biomarker %K cognitive behavioral therapy %K internet-based intervention %K systematic review %K psychological intervention %K mental health intervention %K meta analysis %K psychiatric %K blood glucose %K mindfulness %K stress management %K immune response %K smoking %K cortisol %D 2024 %7 29.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Internet-based psychological interventions provide accessible care to a wide range of users, overcoming some obstacles—such as distance, costs, and safety—that might discourage seeking help for mental issues. It is well known that psychological treatments and programs affect the body, as well as the mind, producing physiological changes that ought to be considered when assessing the efficacy of the intervention. However, the literature investigating changes in biomarkers specifically after internet-based psychological and mental health interventions has not yet extensively inquired into this topic. Objective: This systematic review aims to provide a synthesis of literature examining the effects of internet-based psychological interventions—targeting both clinical (mental and physical) and nonclinical conditions—on biomarkers. A secondary aim was to evaluate whether the biomarkers’ variations were related to a complementary modification of the psychological or physical symptoms or to a general improvement of the participants’ well-being. Methods: This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement. A literature search was performed through 3 databases (PubMed, PsycINFO, and Scopus). Studies examining changes in biomarkers before and after internet-based psychological interventions or programs targeting both clinical and nonclinical samples were included, with no exclusion criteria concerning mental or physical conditions. Results: A total of 24 studies fulfilled the inclusion criteria. These studies involved individuals with psychiatric or psychological problems (n=6, 25%), those with organic or medical diseases (n=10, 42%), and nonclinical populations (n=8, 33%). Concerning psychiatric or psychological problems, cognitive behavioral therapy (CBT) and CBT-informed interventions showed partial effectiveness in decreasing glycated hemoglobin blood glucose level (n=1) and chemokines (n=1) and in increasing connectivity between the default-mode network and the premotor or dorsolateral prefrontal cortex (n=1). Among individuals with organic or medical diseases, studies reported a significant change in cardiac or cardiovascular (n=3), inflammatory (n=2), cortisol (n=2), glycated hemoglobin (n=2), and immune response (n=1) biomarkers after CBT and CBT-informed interventions, and mindfulness and stress management interventions. Lastly, mindfulness, CBT and CBT-informed interventions, and music therapy succeeded in modifying immune response (n=2), cortisol (n=1), α amylase (n=1), posterior cingulate cortex reactivity to smoking cues (n=1), and carbon monoxide (n=1) levels in nonclinical populations. In some of the included studies (n=5), the psychological intervention or program also produced an improvement of the mental or physical condition of the participants or of their general well-being, alongside significant variations in biomarkers; CBT and CBT-informed interventions proved effective in reducing both psychological (n=2) and physical symptoms (n=2), while a mindfulness program successfully lowered cigarette consumption in a nonclinical sample (n=1). Conclusions: Although further evidence is required, we hope to raise awareness on the potential impact of internet-based interventions on biomarkers related to mental and physical health. %M 39612489 %R 10.2196/55736 %U https://www.jmir.org/2024/1/e55736 %U https://doi.org/10.2196/55736 %U http://www.ncbi.nlm.nih.gov/pubmed/39612489 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57205 %T Messenger App–Based Information Provision for Promoting Social Participation to Enhance Well-Being Among Community-Dwelling Adults: Randomized Controlled Trial %A Nakagomi,Atsushi %A Abe,Noriyuki %A Chen,Yu-Ru %A Ide,Kazushige %A Kobayashi,Shuhei %A Hanazato,Masamichi %A Kondo,Katsunori %+ Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoicho, Inage Ward, Chiba, 263-8522, Japan, 81 43 251 1111, anakagomi0211@gmail.com %K messenger app %K event information %K happiness %K social participation %K messenger %K app %K well-being %K adults %K aging %K randomized controlled trial %K RCT %K information technology %K social activity %K Japan %K urban community %K health information %K control group %K multivariable regression %K life satisfaction %K digital intervention %K community-dwelling %D 2024 %7 29.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Engaging in social activities, interacting with peers, and participating in community events may promote health and well-being. Recently, interventions leveraging information and communications technology have emerged as potent tools for promoting social connections and well-being. Particularly, messenger apps have become an integral part of our daily lives, facilitating communication, information dissemination, and social interaction. However, there remains a gap in the literature regarding the utilization of widely adopted messenger apps for this purpose. Objective: This study aimed to evaluate the impact of messenger app–based information provision aimed at promoting social participation on the enhancement of subjective well-being among Japanese community-dwelling adults. Methods: A 2-arm, parallel-group randomized controlled trial was conducted from October 2022 to January 2023 in the Kashiwa-no-ha campus area, Japan—an urban community with active local events. A total of 358 community-dwelling adults who use messenger apps daily were recruited for the study. Of these, 235 (65.6%) participants completed the follow-up survey. Participants were randomly assigned to either the intervention group, receiving the health benefits of social participation and information about local events or spots via a messenger app, or the control group, receiving general health information. The primary outcome was subjective happiness after the intervention, measured on an 11-point scale ranging from 0 (Unhappy) to 10 (Happy). Secondary outcomes included life satisfaction, meaning of life, purpose in life, and participation in local events. The outcomes were analyzed with t tests (2-tailed) and multivariable regression based on the intention-to-treat method. Results: After the intervention, the intervention group reported a mean happiness score of 7.7 (SD 1.7), while the control group reported a score of 7.5 (SD 2.0), with no statistically significant difference (P=.40). Multivariable linear regression analysis adjusted for baseline outcome values and covariates showed that the coefficient of the intervention for life satisfaction was 0.30 (95% CI –0.07 to 0.68; P=.12), while that for meaning of life was 0.33 (95% CI –0.03 to 0.70; P=.07). There was no significant difference in event participation rates between the 2 groups during the study period (P=.22). However, 82.2% (102/124) of the intervention group acknowledged the utility of the event information provided. Conclusions: Messenger app–based information provision did not yield a significant increase in subjective happiness, while there was a positive but not significant trend in life satisfaction. The findings underscore the need for more intensive intervention in future studies to harness the potential of digital interventions. Trial Registration: UMIN Clinical Trials Registry UMIN000049047; https://tinyurl.com/2zzrrae8 %M 39612209 %R 10.2196/57205 %U https://www.jmir.org/2024/1/e57205 %U https://doi.org/10.2196/57205 %U http://www.ncbi.nlm.nih.gov/pubmed/39612209 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56598 %T High-Frequency Cognitive Control Training for Depression: Case Report %A Vander Zwalmen,Yannick %A Hoorelbeke,Kristof %A Demeester,David %A Koster,Ernst H W %+ Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium, 32 92649107, y.vander.zwalmen@ugent.be %K cognitive control training %K CCT %K cognitive function %K depression %K recurrence %K relapse %K prevention %K case report %K working memory %K memory training %K task performance %K digital health %D 2024 %7 29.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cognitive control training (CCT) has gained attention in recent years as a preventative intervention in the context of major depressive disorder. To date, uncertainty exists around the working mechanisms of CCT and how its effects unfold overtime. Objective: This study aimed to examine cognitive and affective transfer effects following an unusually high number of training sessions. Methods: This case report presents data of a participant completing a large amount of training sessions (n=55) over the course of 1 year in 2 training phases: 10 initial sessions, followed by 45 additional sessions. Reliable change indices were calculated for several self-report questionnaires, measuring cognitive and affective functioning. Results: Cognitive task performance suggests improved cognitive functioning after training (accuracy scores increased from 43/181, 24% at baseline to 110/181, 61% shortly after training), which was maintained at follow-up (accuracy scores around 50%). Reliable change indices suggest a decrease in depressive symptoms (Beck Depression Inventory-II score decreased from 23 at baseline to 3 following initial training). Similarly, burnout symptoms following CCT showed a similar decrease. Maladaptive emotion regulation strategies displayed high variability, decreasing after periods of training but increasing when no training was performed. However, no changes in repetitive negative thinking were observed. Thematic analysis from an in-depth interview focusing on CCT adherence and user experience pointed to the importance of independency and accessibility of CCT in perceived agency, as well as the need for clear feedback mechanisms following training. Conclusions: Training task performance indicates further increases in performance beyond typical amounts of training sessions (10-20 sessions), hinting that more sessions could be beneficial for continued improvement in cognitive functioning. In line with previous research, CCT decreased depressive symptomatology. However, its effects on emotion regulation remain unclear. Further mechanistic studies into the temporal unfolding of CCT effects are necessary to investigate potential working mechanisms. Trial Registration: ClinicalTrials.gov NCT05166798; https://clinicaltrials.gov/study/NCT05166798 %M 39612206 %R 10.2196/56598 %U https://formative.jmir.org/2024/1/e56598 %U https://doi.org/10.2196/56598 %U http://www.ncbi.nlm.nih.gov/pubmed/39612206 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e56951 %T Evaluating the Impact of a Daylight-Simulating Luminaire on Mood, Agitation, Rest-Activity Patterns, and Social Well-Being Parameters in a Care Home for People With Dementia: Cohort Study %A Turley,Kate %A Rafferty,Joseph %A Bond,Raymond %A Mulvenna,Maurice %A Ryan,Assumpta %A Crawford,Lloyd %K digital health %K dementia %K dynamic lighting %K sensors %K circadian rhythm %K daylight %K wellbeing %K mood %K agitation %K sleep %K social wellbeing %K care home %K older adults %K elderly %K cardiac %K psychological %K monitoring %D 2024 %7 29.11.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Living with a diagnosis of dementia can involve managing certain behavioral and psychological symptoms. Alongside cognitive decline, this cohort expresses a suppression in melatonin production which can negatively influence their alignment of sleep or wake timings with the 24 hour day and night cycle. As a result, their circadian rhythms become disrupted. Since daylight has the capacity to stimulate the circadian rhythm and humans spend approximately 90% of their time indoors, research has shifted toward the use of indoor lighting to achieve this same effect. This type of lighting is programmed in a daylight-simulating manner; mimicking the spectral changes of the sun throughout the day. As such, this paper focuses on the use of a dynamic lighting and sensing technology used to support the circadian rhythm, behavioral and psychological symptoms, and well-being of people living with dementia. Objective: This study aimed to understand how dynamic lighting, as opposed to static lighting, may impact the well-being of those who are living with dementia. Methods: An ethically approved trial was conducted within a care home for people with dementia. Data were collected in both quantitative and qualitative formats using environmentally deployed radar sensing technology and the validated QUALIDEM (Quality of Life for People With Dementia) well-being scale, respectively. An initial 4 weeks of static baseline lighting was used before switching out for 12 weeks of dynamic lighting. Metrics were collected for 11 participants on mood, social interactions, agitation, sense of feeling, and sleep and rest-activity over a period of 16 weeks. Results: Dynamic lighting showed significant improvement with a moderate effect size in well-being parameters including positive affect (P=.03), social isolation (P=.048), and feeling at home (P=.047) after 5‐10 weeks of dynamic lighting exposure. The results also highlight statistically significant improvements in rest-activity–related parameters of interdaily stability (P<.001), intradaily variation (P<.001), and relative amplitude (P=.03) from baseline to weeks 5‐10, with the effect propagating for interdaily stability at weeks 10‐16 as well (P<.001). Nonsignificant improvements are also noted for sleep metrics with a small effect size; however, the affect in agitation does not reflect this improvement. Conclusions: Dynamic lighting has the potential to support well-being in dementia, with seemingly stronger influence in earlier weeks where the dynamic lighting initially follows the static lighting contrast, before proceeding to aggregate as marginal gains over time. Future longitudinal studies are recommended to assess the additional impact that varying daylight availability throughout the year may have on the measured parameters. %R 10.2196/56951 %U https://mhealth.jmir.org/2024/1/e56951 %U https://doi.org/10.2196/56951 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60762 %T Sleep Treatment Education Program for Cancer Survivors: Protocol for an Efficacy Trial %A Bice,Briana L %A Michaud,Alexis L %A McCormick,Katherine G %A Miklos,Eva M %A Descombes,Indiana D %A Medeiros-Nancarrow,Cheryl %A Zhou,Eric S %A Recklitis,Christopher J %+ Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, MA, United States, 1 6175828260, christopher_recklitis@dfci.harvard.edu %K insomnia %K mood %K cancer survivors %K online interventions %K protocol %K cognitive behavioral therapy %K CBT %K cognitive behavioral therapy for insomnia %K CBTI %K digital health %K sleep disorders %K sleep treatment education program %K STEP-1 %D 2024 %7 28.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer survivors are at increased risk for chronic insomnia, even years after treatment completion. As insomnia is associated with a variety of long-term health consequences, access to insomnia treatment is critically important for the survivor population. Cognitive behavioral therapy for insomnia (CBTI) is the recommended first-line treatment for insomnia but remains largely unavailable to survivors. Treatment barriers include geographic limitations, a shortage of trained providers, and demanding treatment regimens. Designed with these limitations in mind, the Sleep Treatment Education Program (STEP-1) delivers components of CBTI in a low-intensity educational intervention delivered online. Objective: This is a phase II pilot randomized controlled trial. The primary aims are to test the efficacy of STEP-1 to improve (1) insomnia symptoms and (2) mood in cancer survivors compared to a control condition. The secondary aims will (1) explore participant factors associated with clinically significant response, (2) evaluate acceptability of the control intervention, (3) explore feasibility of delivering individualized coaching sessions for participants who do not have a significant response to STEP-1, and (4) describe participants’ satisfaction with STEP-1 and suggestions for improvement. Methods: This 2-arm randomized controlled trial enrolled 70 off-treatment cancer survivors aged 40-89 years with clinically significant insomnia. Participants are randomized to receive either the STEP-1 intervention or control condition (relaxation education); interventions are delivered in one-on-one, synchronous, virtual videoconference sessions by trained interventionists. The STEP-1 intervention presents educational information on the development of insomnia after cancer and offers suggestions for improving insomnia symptoms based on the CBTI elements of sleep hygiene, stimulus control, and cognitive restructuring. With the interventionist, participants review the suggestions and develop a personalized sleep action plan for implementation. The relaxation education session provides information on the potential benefits of relaxation and how to independently access online relaxation exercises. The Insomnia Severity Index is used to measure insomnia symptoms, and the Profile of Mood States Short Form is used to measure mood at baseline and 4 and 8 weeks after intervention. The primary end point is change in the Insomnia Severity Index score at 8 weeks, and the secondary end point is change in mood symptoms (Profile of Mood States Short Form) at 8 weeks. Results: This trial was funded in July 2022. Enrollment and data collection began in February 2023 and concluded in October 2024, with 70 participants enrolled. The analysis will begin in fall 2024, and the results are expected in winter 2025. Conclusions: Trial results will determine if STEP-1 effects go beyond those that could be attributed to placebo and other nonspecific treatment factors. Should results support the efficacy of STEP-1 to improve mood and insomnia symptoms, we anticipate developing efficacy and implementation trials of STEP-1 in larger and more diverse samples. Trial Registration: ClinicalTrials.gov NCT05519982; https://clinicaltrials.gov/study/NCT05519982 International Registered Report Identifier (IRRID): DERR1-10.2196/60762 %M 39608001 %R 10.2196/60762 %U https://www.researchprotocols.org/2024/1/e60762 %U https://doi.org/10.2196/60762 %U http://www.ncbi.nlm.nih.gov/pubmed/39608001 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59539 %T Wearables and Smartphones for Tracking Modifiable Risk Factors in Metabolic Health: Protocol for a Scoping Review %A Brügger,Victoria %A Kowatsch,Tobias %A Jovanova,Mia %+ School of Medicine, University of St. Gallen, St. Jakob-Strasse 21, St. Gallen, 9000, Switzerland, 41 712243200, mia.jovanova@unisg.ch %K wearable %K smartphone %K mHealth %K metabolic disease %K lifestyle %K physiological %K risk factor %K mobile phone %D 2024 %7 28.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Metabolic diseases, such as cardiovascular diseases and diabetes, contribute significantly to global mortality and disability. Wearable devices and smartphones are increasingly used to track and manage modifiable risk factors associated with metabolic diseases. However, no established guidelines exist on how to derive meaningful signals from these devices, often hampering cross-study comparisons. Objective: This study aims to systematically overview the current empirical literature on how wearables and smartphones are used to track modifiable (physiological and lifestyle) risk factors associated with metabolic diseases. Methods: We will conduct a scoping review to overview how wearable and smartphone-based studies measure modifiable risk factors related to metabolic diseases. We will search 5 databases (Scopus, Web of Science, PubMed, Cochrane Central Register of Controlled Trials, and SPORTDiscus) from 2019 to 2024, with search terms related to wearables, smartphones, and modifiable risk factors associated with metabolic diseases. Eligible studies will use smartphones or wearables (worn on the wrist, finger, arm, hip, and chest) to track physiological or lifestyle factors related to metabolic diseases. We will follow the reporting guideline standards from PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and the JBI (Joanna Briggs Institute) guidance on scoping review methodology. Two reviewers will independently screen articles for inclusion and extract data using a standardized form. The findings will be synthesized and reported qualitatively and quantitatively. Results: Data collection is expected to begin in November 2024; data analysis in the first quarter of 2025; and submission to a peer-reviewed journal by the second quarter of 2025. We expect to identify the degree to which wearable and smartphone-based studies track modifiable risk factors collectively (versus in isolation), and the consistency and variation in how modifiable risk factors are measured across existing studies. Conclusions: Results are expected to inform more standardized guidelines on wearable and smartphone-based measurements, with the goal of aiding cross-study comparison. The final report is planned for submission to a peer-reviewed, indexed journal. This review is among the first to systematically overview the current landscape on how wearables and smartphones measure modifiable risk factors associated with metabolic diseases. International Registered Report Identifier (IRRID): PRR1-10.2196/59539 %M 39608004 %R 10.2196/59539 %U https://www.researchprotocols.org/2024/1/e59539 %U https://doi.org/10.2196/59539 %U http://www.ncbi.nlm.nih.gov/pubmed/39608004 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54420 %T Recruitment for Voluntary Video and Mobile HIV Testing on Social Media Platforms During the COVID-19 Pandemic: Cross-Sectional Study %A Chiou,Piao-Yi %A Tsao,Wei-Wen %A Li,Chia-Lin %A Yu,Jheng-Min %A Su,Wen-Han %A Liu,Zhi-Hua %A He,Cheng-Ru %A Chang,Yu-Chun %A Tsai,Yi-Hsuan %+ School of Nursing, National Taiwan University College of Medicine, No. 2-1, Xuzhou Rd., Zhongzheng Dist.,, Taipei, 10051, Taiwan, 886 0935883722 ext 288427, purechiou2@gmail.com %K COVID-19 %K HIV testing %K mobile health %K risk-taking behavior %K social media %K video %K mobile phone %D 2024 %7 28.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic prompted social distancing policies and caused misinformation that hindered in-person HIV screening for high-risk groups. Social media platforms provide additional options for voluntary counseling and testing (VCT) for HIV, overcoming these limitations. However, there is a lack of data on HIV testing recruitment through social media platforms and its outcomes during the pandemic. Objective: This study aimed to measure the rate of face-to-face mobile and video VCT conducted after recruitment through social media platforms and friend referrals during the pandemic and compare the geographic distribution, risk feature targeting, testing outcome, and cost between the 2 models. Methods: Data were collected from March 3 to December 31, 2021, during the COVID-19 outbreak in Taiwan. Participants engaging in unprotected sex were recruited. After one-on-one message discussions through the platforms, the well-trained research assistants provided mobile or video VCT based on the participants’ availability. Primary outcomes were completion rate, testing results, and CD4 count. Secondary outcomes included demographic and HIV risk-taking and protective features from a questionnaire. Selection bias was controlled by adjusting for the testing site (Taipei vs non-Taipei) using univariable multinomial logistic regression. Results: This study gathered 5142 responses on the social media platforms, recruiting 1187 participants. Video VCT had a completion rate of 31.8% (207/651), higher than mobile VCT’s 21.8% (980/4491). Both rates were higher than those before the COVID-19 pandemic. Recruitment through friend referrals, instant messaging apps (eg, Line [LY Corporation]), and geosocial dating apps (eg, Hornet [Queer Networks Inc], Grindr [Grindr LLC], and Gsland [Tien-Hao Tsai]) resulted in higher acceptance and completion rates than social networks (eg, Facebook [Meta], X [formerly Twitter], and Instagram [Meta]). Mobile VCT had higher recruitment among urban residents and screening density, while video VCT reached a broader geographic area. The mobile group was more likely to have had more than 10 sexual partners (odds ratio [OR] 1.92, 95% CI 1.05-3.50; P=.03), history of sex work (OR 4.19, 95% CI 1.68-10.43; P=.002), and sexually transmitted diseases (OR 2.23, 95% CI 1.18-4.23; P=.01) within the past 3 months. The video group was more likely to meet sexual partners through social media. The HIV-positive rate in the mobile group was 0.7% (7/973) with an average CD4 count of 460/μL, while in the video group, it was 1% (2/205) with an average CD4 count of 347/μL, indicating a later diagnosis. Both positivity rates were higher than those before the COVID-19 pandemic, with no significant difference between the groups. The video group cost US $54.68 per participant, slightly higher than the US $50.36 for the mobile group. Conclusions: Recruiting through social media platforms that facilitate one-on-one message discussions can effectively target high-risk groups for mobile and video VCT. This approach should be integrated into the current screening model to enhance HIV case finding. %M 39607762 %R 10.2196/54420 %U https://www.jmir.org/2024/1/e54420 %U https://doi.org/10.2196/54420 %U http://www.ncbi.nlm.nih.gov/pubmed/39607762 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54248 %T Predicting Early Dropout in a Digital Tobacco Cessation Intervention: Replication and Extension Study %A Yu,Linda Q %A Amato,Michael S %A Papandonatos,George D %A Cha,Sarah %A Graham,Amanda L %+ Innovations Center, Truth Initiative, 900 G St NW Fourth Floor, Washington, DC, 20001, United States, 1 2024545938, agraham@truthinitiative.org %K digital interventions %K attrition %K engagement %K dropout %K tobacco %K smoking %K cessation %K mobile health %K internet %K mobile phone %D 2024 %7 27.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Detecting early dropout from digital interventions is crucial for developing strategies to enhance user retention and improve health-related behavioral outcomes. Bricker and colleagues proposed a single metric that accurately predicted early dropout from 4 digital tobacco cessation interventions based on log-in data in the initial week after registration. Generalization of this method to additional interventions and modalities would strengthen confidence in the approach and facilitate additional research drawing on it to increase user retention. Objective: This study had two research questions (RQ): RQ1—can the study by Bricker and colleagues be replicated using data from a large-scale observational, multimodal intervention to predict early dropout? and RQ2—can first-week engagement patterns identify users at the greatest risk for early dropout, to inform development of potential “rescue” interventions? Methods: Data from web users were drawn from EX, a freely available, multimodal digital intervention for tobacco cessation (N=70,265). First-week engagement was operationalized as any website page views or SMS text message responses within 1 week after registration. Early dropout was defined as having no subsequent engagement after that initial week through 1 year. First, a multivariate regression model was used to predict early dropout. Model predictors were dichotomous measures of engagement in each of the initial 6 days (days 2-7) following registration (day 1). Next, 6 univariate regression models were compared in terms of their discrimination ability to predict early dropout. The sole predictor of each model was a dichotomous measure of whether users had reengaged with the intervention by a particular day of the first week (calculated separately for each of 2-7 days). Results: For RQ1, the area under the receiver operating characteristic curve (AUC) of the multivariate model in predicting dropout after 1 week was 0.72 (95% CI 0.71-0.73), which was within the range of AUC metrics found in the study by Bricker and colleagues. For RQ2, the AUCs of the univariate models increased with each successive day until day 4 (0.66, 95% CI 0.65-0.67). The sensitivity of the models decreased (range 0.79-0.59) and the specificity increased (range 0.48-0.73) with each successive day. Conclusions: This study provides independent validation of the use of first-week engagement to predict early dropout, demonstrating that the method generalizes across intervention modalities and engagement metrics. As digital intervention researchers continue to address the challenges of low engagement and early dropout, these results suggest that first-week engagement is a useful construct with predictive validity that is robust across interventions and definitions. Future research should explore the applicability and efficiency of this model to develop interventions to increase retention and improve health behavioral outcomes. %M 39602788 %R 10.2196/54248 %U https://www.jmir.org/2024/1/e54248 %U https://doi.org/10.2196/54248 %U http://www.ncbi.nlm.nih.gov/pubmed/39602788 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e59145 %T Effects of a Digital Therapeutic Adjunct to Eating Disorder Treatment on Health Care Service Utilization and Clinical Outcomes: Retrospective Observational Study Using Electronic Health Records %A Palacios,Jorge E %A Erickson-Ridout,Kathryn K %A Paik Kim,Jane %A Buttlaire,Stuart %A Ridout,Samuel %A Argue,Stuart %A Tregarthen,Jenna %+ Bright Therapeutics, 304 Moultrie St, San Francisco, CA, 94110, United States, 1 6504047098, jorge.palacios@brighttherapeutics.com %K digital therapeutics %K app-augmented therapy %K eating disorders %K health care utilization %K costs %K real-world data %K depression %K emergency department %K outpatient care %K eating %K treatment %K therapy %K retrospective analysis %K electronic health record %K patient %K app %K outpatient %D 2024 %7 27.11.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: The need for scalable solutions facilitating access to eating disorder (ED) treatment services that are efficient, effective, and inclusive is a major public health priority. Remote access to synchronous and asynchronous support delivered via health apps has shown promise, but results are so far mixed, and there are limited data on whether apps can enhance health care utilization. Objective: This study aims to examine the effects of app-augmented treatment on clinical outcomes and health care utilization for patients receiving treatment for an ED in outpatient and intensive outpatient levels of care. Methods: Recovery Record was implemented in outpatient and intensive outpatient services in a California-based health maintenance organization. We examined outcomes for eligible patients with ED by comparing clinical and service utilization medical record data over a 6-month period after implementation with analogous data for the control group in the year prior. We used a logistic regression model and inverse-weighted estimates of the probability of treatment to adjust for treatment selection bias. Results: App-augmented treatment was associated with a significant decrease in emergency department visits (P<.001) and a significant increase in outpatient treatment utilization (P<.001). There was a significantly larger weight gain for patients in low-weight categories (ie, underweight, those with anorexia, or those with severe anorexia) with app-augmented treatment (treatment effect: 0.74, 0.25, and 0.35, respectively; P=.02), with a greater percentage of patients moving into a higher BMI class (P=.01). Conclusions: Integrating remote patient engagement apps into ED treatment plans can have beneficial effects on both clinical outcomes and service utilization. More research should be undertaken on long-term efficacy and cost-effectiveness to further explore the impact of digital health interventions in ED care. %M 39602804 %R 10.2196/59145 %U https://mental.jmir.org/2024/1/e59145 %U https://doi.org/10.2196/59145 %U http://www.ncbi.nlm.nih.gov/pubmed/39602804 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e63732 %T A Personalized, Transdiagnostic Smartphone App (Mello) Targeting Repetitive Negative Thinking for Depression and Anxiety: Qualitative Analysis of Young People’s Experience %A Valentine,Lee %A Arnold,Chelsea %A Nicholas,Jennifer %A Castagnini,Emily %A Malouf,Jessi %A Alvarez-Jimenez,Mario %A Bell,Imogen H %+ Orygen, 35 Poplar Rd, Melbourne, 3052, Australia, 61 9966 9100, lee.valentine@orygen.org.au %K repetitive negative thinking %K rumination %K anxiety %K depression %K mobile app %K just-in-time adaptive interventions %K youth mental health %K adolescent %K mobile phone %D 2024 %7 27.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The increasing rates of mental health challenges among young people highlight an urgent need for accessible and effective treatment. However, current mental health systems face unprecedented demand, leaving most young people globally with unmet mental health needs. Smartphones present a promising solution to this issue by offering in-the-moment support through innovative just-in-time adaptive interventions, which provide support based on real-time data. Objective: This study explores young people’s experiences with Mello, a just-in-time adaptive intervention that focuses on the transdiagnostic mechanism of repetitive negative thinking (RNT), a significant factor contributing to youth depression and anxiety. Methods: Semistructured qualitative interviews were conducted with 15 participants aged 16 to 25 years, all of whom had previously participated in a pilot randomized controlled trial of Mello. Of the 15 participants, 9 (60%) identified as women, 4 (27%) as men (including 1 transgender man), and 2 (13%) as nonbinary. Interviews focused on participants’ experiences with the Mello app, factors influencing engagement, perceived benefits and limitations, and suggestions for future improvements. Thematic analysis was used to analyze the data. Results: The analysis identified three superordinate themes: Mello as a tool for intentional reflection; doing therapy your own way; and barriers to engagement during low mood, anxiety, and RNT. Theme 1 explored young people’s experiences of how the app facilitated active management of negative thoughts and supported the development of reflective habits, contrasting with their typical strategies of avoidance or resistance. Theme 2 highlighted the value of the app’s self-guided nature, with a particular focus on its flexibility and accessibility, particularly when compared to traditional face-to-face therapy. Finally, theme 3 addressed barriers to engagement, particularly during emotionally difficult times, with participants reporting feeling “stuck” in their negative thoughts. To mitigate these challenges, participants suggested incorporating gamification elements, such as progress-tracking visuals, to enhance motivation and increase engagement with the app. Conclusions: Our findings underscored the value of Mello in promoting intentional engagement and reflection with RNT, consistent with prior research that emphasizes the effectiveness of tailored interventions. Although some users valued the self-guided nature of the application, others encountered difficulties with motivation. Future research should explore strategies to enhance engagement for young people with low mood and motivation, such as co-design methodologies, advanced personalization features, and gamification techniques. %M 39602793 %R 10.2196/63732 %U https://www.jmir.org/2024/1/e63732 %U https://doi.org/10.2196/63732 %U http://www.ncbi.nlm.nih.gov/pubmed/39602793 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53140 %T Preferences of Individuals With Obesity for Online Medical Consultation in Different Demand Scenarios: Discrete Choice Experiments %A Hu,Yaolin %A Wang,Jian %A Zhou,Jianbo %A Gu,Yuanyuan %A Nicholas,Stephen %A Maitland,Elizabeth %+ School of Economics, Peking University, No. 5 Yiheyuan Road, Haidian District, Beijing, 100871, China, 86 13522596266, huyaolin@pku.edu.cn %K online medical consultation %K obesity %K discrete choice experiments %K telehealth %K telemedicine %D 2024 %7 27.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Obesity is a unique chronic disease, with China having the largest number of people living with overweight and obesity in the world. There has been little research from the demand perspective for online medical consultation (OMC) by individuals living with obesity. With the growing demand for obesity OMC, especially due to the emergence of new pharmacotherapies, such as glucagon-like peptide-1 receptor agonists, individuals living with obesity are seeking both advice on obesity management and the prescription of obesity drugs. Therefore, our demand scenarios defined 2 OMC motivations to manage obesity: “For-Drugs” use and “For-Advice” use. Objective: This study aims to assess and compare the preferences for For-Drugs and For-Advice OMC among individuals living with obesity in China. Methods: Following the International Society for Pharmacoeconomics and Outcomes Research’s checklist and comprising 400 participants assigned to the For-Drugs scenario and 400 to the For-Advice scenario, the For-Drugs and For-Advice preferences were estimated through discrete choice experiments. The groups in the 2 scenarios followed a similar distribution, and the 2 different demand scenarios shared the same discrete choice experiment design, comprising 16 choice sets with 6 representative attributes. Mixed logit modeling was used to estimate the willingness to pay and relative importance scores. Results: Doctors with well-known and general expert titles, versus ordinary doctors; doctors from high-level, provincial, tertiary, and municipal hospitals, versus lower-level county hospitals; less waiting time; and lower OMC fees were preferred in both the For-Drugs and For-Advice scenarios. The differences between the 2 scenarios lay in the consultation format, consultation duration, and the relative importance of consultation duration versus waiting time. The For-Advice group preferred telephone consultations, while the For-Drugs group did not; the For-Drugs group preferred longer consultation duration (β=.029), while the For-Advice group preferred shorter consultation duration (β=–.030); and the For-Drugs group rated consultation duration higher than waiting time, while the For-Advice group rated the waiting time as more important than consultation duration. Combined with our qualitative research, the differences can be explained by the different consultation needs in the 2 scenarios, where longer patient consultations were preferred by the For-Drugs patients who sought detailed advice on drug side effects, while quick and direct responses were preferred by the For-Advice participants. Conclusions: By revealing user preferences on costs, doctors’ titles and hospital level, wait time, and consultation duration and format, our research informs OMC platforms, OMC regulators, and doctors on market segmentation and service differentiation strategies. %M 39602197 %R 10.2196/53140 %U https://www.jmir.org/2024/1/e53140 %U https://doi.org/10.2196/53140 %U http://www.ncbi.nlm.nih.gov/pubmed/39602197 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e49443 %T An Evaluation of the Effect of App-Based Exercise Prescription Using Reinforcement Learning on Satisfaction and Exercise Intensity: Randomized Crossover Trial %A Doherty,Cailbhe %A Lambe,Rory %A O’Grady,Ben %A O’Reilly-Morgan,Diarmuid %A Smyth,Barry %A Lawlor,Aonghus %A Hurley,Neil %A Tragos,Elias %K reinforcement learning %K exercise therapy %K personal satisfaction %K satisfaction %K physiotherapy %K physical therapy %K exercise intensity %K mobile apps %K randomized controlled trial %K crossover trial %K apps %K exercise %K physical activity %K mobile phone %D 2024 %7 26.11.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: The increasing prevalence of sedentary lifestyles has prompted the development of innovative public health interventions, such as smartphone apps that deliver personalized exercise programs. The widespread availability of mobile technologies (eg, smartphone apps and wearable activity trackers) provides a cost-effective, scalable way to remotely deliver personalized exercise programs to users. Using machine learning (ML), specifically reinforcement learning (RL), may enhance user engagement and effectiveness of these programs by tailoring them to individual preferences and needs. Objective: The primary aim was to investigate the impact of the Samsung-developed i80 BPM app, implementing ML for exercise prescription, on user satisfaction and exercise intensity among the general population. The secondary objective was to assess the effectiveness of ML-generated exercise programs for remote prescription of exercise to members of the public. Methods: Participants were randomized to complete 3 exercise sessions per week for 12 weeks using the i80 BPM mobile app, crossing over weekly between intervention and control conditions. The intervention condition involved individualizing exercise sessions using RL, based on user preferences such as exercise difficulty, selection, and intensity, whereas under the control condition, exercise sessions were not individualized. Exercise intensity (measured by the 10-item Borg scale) and user satisfaction (measured by the 8-item version of the Physical Activity Enjoyment Scale) were recorded after the session. Results: In total, 62 participants (27 male and 42 female participants; mean age 43, SD 13 years) completed 559 exercise sessions over 12 weeks (9 sessions per participant). Generalized estimating equations showed that participants were more likely to exercise at a higher intensity (intervention: mean intensity 5.82, 95% CI 5.59‐6.05 and control: mean intensity 5.19, 95% CI 4.97‐5.41) and report higher satisfaction (RL: mean satisfaction 4, 95% CI 3.9-4.1 and baseline: mean satisfaction 3.73, 95% CI 3.6-3.8) in the RL model condition. Conclusions: The findings suggest that RL can effectively increase both the intensity with which people exercise and their enjoyment of the sessions, highlighting the potential of ML to enhance remote exercise interventions. This study underscores the benefits of personalized exercise prescriptions in increasing adherence and satisfaction, which are crucial for the long-term effectiveness of fitness programs. Further research is warranted to explore the long-term impacts and potential scalability of RL-enhanced exercise apps in diverse populations. This study contributes to the understanding of digital health interventions in exercise science, suggesting that personalized, app-based exercise prescriptions may be more effective than traditional, nonpersonalized methods. The integration of RL into exercise apps could significantly impact public health, particularly in enhancing engagement and reducing the global burden of physical inactivity. Trial Registration: ClinicalTrials.gov NCT06653049; https://clinicaltrials.gov/study/NCT06653049 %R 10.2196/49443 %U https://mhealth.jmir.org/2024/1/e49443 %U https://doi.org/10.2196/49443 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e62715 %T Efficacy of a Mobile App–Based Behavioral Intervention (DRIVEN) to Help Individuals With Unemployment-Related Emotional Distress Return to Work: Protocol for a Randomized Controlled Trial %A Danielson,Elizabeth C %A Saturday,Mystie %A Leonard,Sarah %A Levit,Alexandra %A Graham,Andrea K %A Marquez,Melissa %A Alperin,Keith %A Shankman,Stewart A %A Griffith,James W %+ Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, United States, 1 7737023858, james.griffith@bsd.uchicago.edu %K unemployment %K wellness %K depression %K job stress %K job distress %K career coaching %K coaching %K mhealth %K ehealth %K job-seeking %K mobile app %K behavioral intervention %K %D 2024 %7 26.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Employment plays an important role in the maintenance of mental and physical health. Losing a job creates emotional distress, which can, in turn, interfere with effective job seeking. Thus, a program for job seekers that provides support for both the logistics of job seeking as well as emotional distress may help people find employment and improve emotional well-being. Objective: This study aims to test the efficacy of the 6-week intervention for job seekers in a randomized controlled trial. Methods: This is a parallel-assignment randomized control trial comparing a 6-week return-to-work intervention versus job seeking as usual for a stratified sample of job seekers (n=150). The intervention will be delivered through a mobile phone app and scheduled video counseling sessions with a job coach. Assessments will be taken weekly during the intervention as well as 8 and 16 weeks later. The intervention and control group procedures will be administered remotely, allowing the study to take place in several regions of the United States. Eligible participants will be adults aged 18 to 65 years, currently unemployed, and actively searching for work. Participants will be recruited from 7 major metropolitan areas in the United States using online advertisements on Craigslist. The primary outcome measure is the Job Search Behavior Scale, which has 2 subscales, preparatory job search behavior and active job search behavior. Employment status will also be assessed throughout the trial. A mixed-model regression analysis will be used to compare job searching behavior in the intervention group versus the control group. A time-to-event analysis (ie, survival analysis) will be used to compare employment status in the 2 experimental groups. Secondary outcomes will also be evaluated, including job search self-efficacy and mental health-related outcomes such as anxiety and depression. Results: This study started on August 7, 2023, and as of June 2024, we have enrolled 140 participants. Enrollment began in August 2023 and will conclude by October 2024. Half of the participants (75/150, 50%) will be assigned to the intervention arm while the other half (75/150, 50%) will be assigned to the control arm, job seeking as usual. Conclusions: The findings from this study will determine the efficacy of a mobile app–based intervention that uses both job training and psychological techniques on job seeking and employment outcomes. This first trial of Distress Return-to-Work Intervention (DRIVEN) will provide important information about blended support techniques for unemployed individuals, determine the usefulness of mobile apps to address large-scale mental health outcomes, and improve our understanding of the relationship between depression and unemployment status. Trial Registration: ClinicalTrials.gov NCT06026280; https://clinicaltrials.gov/study/NCT06026280 International Registered Report Identifier (IRRID): DERR1-10.2196/62715 %M 39589786 %R 10.2196/62715 %U https://www.researchprotocols.org/2024/1/e62715 %U https://doi.org/10.2196/62715 %U http://www.ncbi.nlm.nih.gov/pubmed/39589786 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60670 %T Optimizing Compassion Training in Medical Trainees Using an Adjunct mHealth App: A Preliminary Single-Arm Feasibility and Acceptability Study %A Wooldridge,Jennalee S %A Soriano,Emily C %A Chu,Gage %A Shirazi,Anaheed %A Shapiro,Desiree %A Patterson,Marta %A Kim,Hyun-Chung %A Herbert,Matthew S %+ Mental Health Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, United States, 1 6194978326, m1herbert@health.ucsd.edu %K mobile phone %K compassion %K empathy %K mHealth %K mobile health %K medical student %K medical resident %K mHealth app %K app %K medical trainee %K training %K feasibility %K acceptability %K pilot %K mindfulness %K self-compassion %K smartphone app %K compassion %K applicability %D 2024 %7 26.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: While structured compassion training programs have shown promise for increasing compassion among medical trainees, a major challenge is applying the concepts and practices taught during the program into the complex, dynamic, time-pressured, and often hectic hospital workplace. Objective: The purpose of this pilot study was to examine the feasibility, acceptability, and preliminary effects of Compassion Coach, a mobile health (mHealth) smartphone app designed to bolster a 6-week mindfulness and self-compassion training program for medical trainees. Methods: In Compassion Coach, notifications to remind, encourage, and measure the perceived impact of informal mindfulness and compassion practices taught during the program were delivered at 7 AM, 12 PM, and 7 PM, respectively, 3 times per week over the course of the training program. The app also contained a library of guided audio formal mindfulness and compassion practices to allow quick and easy access. In this pilot study, we collected data from 29 medical students and residents who downloaded Compassion Coach and completed surveys assessing perceived effectiveness and acceptability. Engagement with the Compassion Coach app was passively tracked through notification response rate and library resource access over time. Results: The average response rate to notifications was 58% (SD 29%; range 12%-98%), with a significant decline over time (P=.009; odds ratio 0.98, 95% CI 0.96-0.99). Across all participants and occasions, the majority agreed the informal practices prompted by Compassion Coach helped them feel grounded and centered (110/150, 73%), improved compassion (29/41, 71%), reduced burnout (106/191, 56%), and improved their mood (133/191, 70%). In total, 16 (55%) of the 29 participants accessed guided audio recordings on average 3 (SD 3.4) times throughout the program. At the posttreatment time point, most participants (13/18, 72%) indicated that Compassion Coach helped them engage in compassion practices in daily life, and half (9/18, 50%) indicated that Compassion Coach helped improve interactions with patients. Conclusions: Overall, preliminary results of Compassion Coach are encouraging and suggest the integration of a smartphone app with an ongoing mindfulness and self-compassion training program may bolster the effects of the program on medical trainees. However, there was variability in engagement with Compassion Coach and perceived helpfulness. Additional research is indicated to optimize this novel mHealth approach and conduct a study powered to formally evaluate effects. %M 39589766 %R 10.2196/60670 %U https://formative.jmir.org/2024/1/e60670 %U https://doi.org/10.2196/60670 %U http://www.ncbi.nlm.nih.gov/pubmed/39589766 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e57964 %T Experiences of a Digital Behavior Change Intervention to Prevent Weight Gain and Promote Risk-Reducing Health Behaviors for Women Aged 18 to 35 Years at Increased Risk of Breast Cancer: Qualitative Interview Study %A Hawkes,Rhiannon E %A Pegington,Mary %A Davies,Alan %A Mueller,Julia %A Howell,Anthony %A Evans,D Gareth %A Howell,Sacha J %A French,David P %A Harvie,Michelle %+ Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 0161 275 2584, rhiannon.hawkes@manchester.ac.uk %K breast cancer %K health behavior %K weight gain %K weight control %K BMI %K app %K acceptability %K feasibility %D 2024 %7 25.11.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Breast cancer is the most common form of cancer in women. Adult weight gain and modifiable health behaviors, including smoking, alcohol intake, and lack of physical activity, are well-known risk factors. Most weight gain in women occurs between the ages of 18 and 35 years. Digital interventions have the potential to address logistical challenges that arise in reaching women in this age range. We designed a digital intervention targeting weight gain prevention and other modifiable health behaviors for young women at increased risk of breast cancer. Women aged 18 to 35 years were recruited to this single-arm intervention study over 2 months to test the acceptability and usability of the intervention, which comprised a group welcome event held via videoconferencing, app, and private Facebook group. Objective: This nested qualitative substudy explored women’s views and experiences of being part of the digital health intervention to inform future intervention development for a feasibility study. Methods: A total of 20 women aged 23 to 35 years who were at increased risk of breast cancer were interviewed via telephone within 1 month after completing the intervention, between February 2023 and March 2023. The women were asked about their experiences of the digital intervention and the extent to which it may have influenced their health behaviors. Data were analyzed thematically and organized using the framework approach. Results: The interviews lasted for a median of 37 (IQR 30-46) minutes. Overall, the women perceived the digital health intervention comprising education, tracking, and support to be acceptable for weight gain prevention. In total, 4 themes were generated. A “missed opportunity” in breast cancer prevention services encompasses the lack of services that currently exist for young women at increased risk of breast cancer. The pros and cons of being part of a community encompasses the divergent views that the women had regarding engaging with other women at increased risk. The importance of an interactive app focuses on features that the women would want from the app to promote engagement with the intervention. The different wants and needs of different age groups highlights that an intervention such as this one would need to be customizable to suit the needs of women at different life stages. Conclusions: There is an unmet need in prevention services for young women aged 18 to 35 years at increased risk of breast cancer. The women perceived the app to be an acceptable intervention for weight gain prevention but emphasized that the intervention would need to be customizable to meet the needs of different age groups within the group of women aged 18 to 35 years. The digital intervention could be a scalable behavior change strategy for UK family history clinics. %M 39586077 %R 10.2196/57964 %U https://cancer.jmir.org/2024/1/e57964 %U https://doi.org/10.2196/57964 %U http://www.ncbi.nlm.nih.gov/pubmed/39586077 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55639 %T Embedding Technology-Assisted Parenting Interventions in Real-World Settings to Empower Parents of Children With Adverse Childhood Experiences: Co-Design Study %A Aldridge,Grace %A Wu,Ling %A Seguin,Joshua Paolo %A Robinson,Jennifer %A Battaglia,Elizabeth %A Olivier,Patrick %A Yap,Marie B H %+ Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Level 5, 18 Innovation Walk, Clayton Campus, Clayton, 3800, Australia, 61 3 9905 0723, marie.yap@monash.edu %K co-design %K service design %K intervention %K digital technology %K parenting %K children %K technology %K parenting program %K health care services %K adverse childhood experience %K ACE %K mental disorder %K innovate %K social services %K community health %K evidence-based %K parenting intervention %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adverse childhood experiences are strongly associated with mental disorders in young people. Parenting interventions are available through community health settings and can intervene with adverse childhood experiences that are within a parent’s capacity to modify. Technology can minimize common barriers associated with engaging in face-to-face parenting interventions. However, families experiencing adversity face unique barriers to engaging with technology-assisted parenting interventions. Formative research using co-design methodology to provide a deep contextual understanding of these barriers can help overcome unique barriers and ensure these families can capitalize on the benefits of technology-assisted parenting interventions. Objective: This study aims to innovate the parenting support delivered by a community health and social service with technology by adapting an existing, evidence-based, technology-assisted parenting intervention. Methods: Staff (n=3) participated in dialogues (n=2) and co-design workshops (n=8) exploring needs and preferences for a technology-assisted parenting intervention and iteratively developing a prototype intervention (Parenting Resilient Kids [PaRK]-Lite). Parents (n=3) received PaRK-Lite and participated in qualitative interviews to provide feedback on their experience and PaRK-Lite’s design. Results: PaRK-Lite’s hybrid design leverages simple and familiar modes of technology (podcasts) to deliver intervention content and embeds reflective practice into service provision (microcoaching) to enhance parents’ empowerment and reduce service dependency. A training session, manuals, session plans, and templates were also developed to support the delivery of microcoaching. Feedback data from parents overall indicated that PaRK-Lite met their needs, suggesting that service providers can play a key role in the early phases of service innovation for parents. Conclusions: The co-designed technology-assisted parenting intervention aims to offer both parents and clinicians a novel and engaging resource for intervening with maladaptive parenting, contributing to efforts to respond to childhood adversity and improve child mental health. Future research in the field of human-computer interaction and health service design can consider our findings in creating engaging interventions that have a positive impact on the well-being of children and families. %M 39576676 %R 10.2196/55639 %U https://formative.jmir.org/2024/1/e55639 %U https://doi.org/10.2196/55639 %U http://www.ncbi.nlm.nih.gov/pubmed/39576676 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50710 %T Health Perceptions and Practices of a Telewellness Fitness Program: Exploratory Case Study %A Ahumada-Newhart,Veronica %A Wood,Taffeta %A Satake,Noriko %A Marcin,James P %K telehealth %K telewellness %K online fitness %K health equity %K community health %K group exercise %K mobile phone %K mobile device %D 2024 %7 21.11.2024 %9 %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, many people lacked access to group fitness opportunities due to elevated risk of infection, lockdown, and closure of exercise facilities. Additionally, many people experienced higher than average rates of mental health burden (eg, anxiety and stress). To help address these needs, an existing in-person community exercise class, taught by a faculty member from an academic medical center, transitioned to an online synchronous (OS) physical fitness class via the Zoom (Zoom Video Communications) videoconferencing platform. As such, the instructor advertised the OS fitness classes through an existing email list of community members and university faculty, staff, students, or alumni email listservs. This telewellness intervention sought to create a sense of community, build social support, and promote physical and mental wellness during the COVID-19 pandemic. Objective: Our aim was to determine the perceived mental and physical health benefits of attending an OS fitness class for community members, including health care workers. We also assessed the use and functionality of related technologies necessary for delivering and attending the fitness classes. Methods: An online survey questionnaire was created and tested to collect quantitative and qualitative data for an exploratory study. Data were collected to evaluate the fitness class, motivation, perceived health benefits, and related technologies. A convenience sample of people who had participated in the OS fitness classes was recruited for this study via an emailed recruitment flyer. Results: A total of 51 participants accessed and completed the survey questionnaire. Survey participants consisted of 28 of 51 (55%) with a university affiliation, 17 of 51 (33%) with no university affiliation, and 6 of 51 (12%) who declined to state. The largest group of participants reporting full-time employment (18/51, 35%) also reported university affiliation with the academic medical center. In this group, 13 of 51 (25%) participants reported full-time employment, university affiliation, and doctoral degrees. High overall exercise class satisfaction was observed in the survey responses (mean 4.0, SD 1). Data analyses revealed significant perceived value of both mental and physical health benefits as motivating factors for participating in the OS fitness class. Challenges were identified as not being able to receive individual feedback from the instructor and the inability of some participants to see if they were in sync with the rest of the class. Conclusions: Results provide preliminary support for the use of online videoconferencing fitness platforms to promote wellness and facilitate group exercise in the community during times of high infection risk. Future studies should continue to explore perceived benefits, mental and physical wellness, best practices, and the design of related technologies. %R 10.2196/50710 %U https://formative.jmir.org/2024/1/e50710 %U https://doi.org/10.2196/50710 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e64681 %T Mobile App for Improving the Mental Health of Youth in Out-of-Home Care: Development Study Using an Intervention Mapping Approach %A Park,Jinyoung %A Lee,Jungeun %A Noh,Dabok %+ College of Nursing, Eulji University, 553 Sanseong-daero, Sujeong-gu, Seongnam-si, Gyeonggi-do, 13135, Republic of Korea, 82 31 740 7415, daboknoh@eulji.ac.kr %K out-of-home youth %K mental health intervention %K mobile app %K intervention mapping %K youth %K mental health %K mHealth %K mobile health %K app %K interview %K need %K focus group %K emotion %K emotional %K young adult %K independent living %K emotional support %K tool %K emotion regulation %K user %K app usage %D 2024 %7 21.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Youth in out-of-home care encounter substantial mental health challenges because of the absence of stable family and social support systems. Their vulnerability is heightened by trauma, neglect, and abuse. They struggle, especially when transitioning to independent living, coping with loneliness, anxiety, and pressure. Objective: This study aimed to develop a mobile app with high accessibility and long-term continuous effects to support independent living and improve mental health among youth in out-of-home care. The approach used was the systematic and step-by-step intervention mapping (IM) framework. Methods: The program was created using the IM framework and had 6 steps. Drawing from data from individual and focus group interviews and literature reviews, we developed a logical model of the problem. We established program outcomes and objectives, defining performance objectives and variable determinants. We identified theoretical and evidence-based methods that influence determinants. The app design integrated these methods into practical applications, allowing for the creation of self-management and emotional support tools. The development process included ongoing discussions between app designers and the research team to ensure that user needs and preferences were addressed. Results: Individual interviews and focus group discussions revealed challenges in managing daily routines and regulating emotions. The program design was based on the transtheoretical model, social cognitive theory, and elaboration likelihood model. Key features included goal setting, structured routines, emotion recognition flashcards, character models demonstrating emotion regulation strategies, verbal persuasion, and self-monitoring tools to support habit formation and emotion regulation. An implementation plan was developed to facilitate the app’s adoption, execution, and maintenance, while an evaluation plan was established, including app usage analytics, user logs, and feedback surveys. A randomized controlled trial will be conducted to assess the app’s impact on mental health outcomes, focusing on reducing anxiety and depressive symptoms, improving emotion regulation, and enhancing daily living skills. Conclusions: The IM framework was beneficial in developing a mobile app to enhance the mental health of youth in out-of-home care. The study produced a program grounded in theory and evidence that caters to the needs of these individuals. Further research should aim to verify the app’s effectiveness in real-world settings and refine it continuously based on user input. %M 39571152 %R 10.2196/64681 %U https://humanfactors.jmir.org/2024/1/e64681 %U https://doi.org/10.2196/64681 %U http://www.ncbi.nlm.nih.gov/pubmed/39571152 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56999 %T Presenting and Evaluating a Smartwatch-Based Intervention for Smoking Relapse (StopWatch): Feasibility and Acceptability Study %A Stone,Chris %A Essery,Rosie %A Matthews,Joe %A Naughton,Felix %A Munafo,Marcus %A Attwood,Angela %A Skinner,Andy %+ School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, United Kingdom, 44 01174555910, chris.stone@bristol.ac.uk %K smoking %K smoking cessation %K passive detection %K just-in-time intervention %K JITAI %K relapse prevention %K relapse %K smartwatch %K wearable technology %K wearable %K mobile health %K mHealth %K mobile phone %D 2024 %7 21.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the benefits of smoking cessation, maintaining abstinence during a quit attempt is difficult, and most attempts result in relapse. Innovative, evidence-based methods of preventing relapse are needed. We present a smartwatch-based relapse prevention system that uses passive detection of smoking to trigger just-in-time smoking cessation support. Objective: This study aims to evaluate the feasibility of hosting just-in-time smoking cessation support on a smartwatch and the acceptability of the “StopWatch” intervention on this platform. Methods: The person-based approach for intervention development was used to design the StopWatch smoking relapse prevention intervention. Intervention delivery was triggered by an algorithm identifying hand movements characteristic of smoking from the smartwatch’s motion sensors, and the system-generated intervention messages (co-designed by smokers) were delivered on the smartwatch screen. A total of 18 smokers tested the intervention over a 2-week period, and at the end of this period, they provided qualitative feedback on the acceptability of both the intervention and the smartwatch platform. Results: Participants reported that the smartwatch intervention increased their awareness of smoking and motivated them to quit. System-generated intervention messages were generally felt to be relevant and timely. There were some challenges with battery life that had implications for intervention adherence, and the bulkiness of the device and the notification style reduced some participants’ acceptability of the smartwatch platform. Conclusions: Our findings indicate our smoking relapse prevention intervention and the use of a smartwatch as a platform to host a just-in-time behavior change intervention are both feasible and acceptable to most (12/18, 66%) participants as a relapse prevention intervention, but we identify some concerns around the physical limitations of the smartwatch device. In particular, the bulkiness of the device and the battery capacity present risks to adherence to the intervention and the potential for missed detections. We recommend that a longer-term efficacy trial be carried out as the next step. %M 39570656 %R 10.2196/56999 %U https://formative.jmir.org/2024/1/e56999 %U https://doi.org/10.2196/56999 %U http://www.ncbi.nlm.nih.gov/pubmed/39570656 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51714 %T Effectiveness of Digital Health Interventions in Promoting Physical Activity Among College Students: Systematic Review and Meta-Analysis %A Bi,Siyuan %A Yuan,Junfeng %A Wang,Yanling %A Zhang,Wenxin %A Zhang,Luqin %A Zhang,Yongjuan %A Zhu,Rui %A Luo,Lin %+ School of Physical Education, Guizhou Normal University, Huaxi District, University Town, Siya Road, Guiyang, 550025, China, 86 86751983, 460022831@gznu.edu.cn %K digital health intervention %K college students %K physical activity behavior %K steps %K light intensity physical activity %K moderate to vigorous physical activity %K sedentary behavior %K knowledge synthesis %K systematic review %K meta-analysis %K physical activity %K eHealth %K digital health %K mobile phone %D 2024 %7 20.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Recent studies offer conflicting conclusions about the effectiveness of digital health interventions in changing physical activity behaviors. In addition, research focusing on digital health interventions for college students remains relatively scarce. Objective: This study aims to examine the impact of digital health interventions on physical activity behaviors among college students, using objective measures as outcome indicators. Methods: In accordance with the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive literature search was conducted across several databases, including MEDLINE (PubMed), Web of Science, Cochrane Library, and EBSCO (CINAHL Plus with full text), to identify relevant intervention studies published up to June 6, 2023. The inclusion criteria specified studies that examined the quantitative relationships between digital health interventions and physical activity among adults aged 18 years to 29 years, focusing on light physical activity (LPA), moderate to vigorous physical activity (MVPA), sedentary time (ST), or steps. Non–randomized controlled trials were excluded. The quality of the studies was assessed using the Cochrane Risk of Bias tool. Results were synthesized both narratively and quantitatively, where applicable. When sufficient homogeneity was found among studies, a random-effects model was used for meta-analysis to account for variability. Results: In total, 8 studies, encompassing 569 participants, were included in the analysis. The primary outcomes measured were LPA, MVPA, ST, and steps. Among these studies, 3 reported on LPA, 5 on MVPA, 5 on ST, and 3 on steps. The meta-analysis revealed a significant increase in steps for the intervention group compared with the control group (standardized mean difference [SMD] 0.64, 95% CI 0.37-0.92; P<.001). However, no significant differences were observed between the intervention and control groups regarding LPA (SMD –0.08, 95% CI –0.32 to 0.16; P=.51), MVPA (SMD 0.02, 95% CI –0.19 to 0.22; P=.88), and ST (SMD 0.03, 95% CI –0.18 to 0.24; P=.78). Conclusions: Digital health interventions are effective in increasing steps among college students; however, their effects on LPA, MVPA, and sedentary behavior are limited. Trial Registration: PROSPERO CRD42024533180; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=533180 %M 39566049 %R 10.2196/51714 %U https://www.jmir.org/2024/1/e51714 %U https://doi.org/10.2196/51714 %U http://www.ncbi.nlm.nih.gov/pubmed/39566049 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e57352 %T The Effect of Young People–Assisted, Individualized, Motion-Based Video Games on Physical, Cognitive, and Social Frailty Among Community-Dwelling Older Adults With Frailty: Randomized Controlled Trial %A Wong,Arkers Kwan Ching %A Zhang,Melissa Qian %A Bayuo,Jonathan %A Chow,Karen Kit Sum %A Wong,Siu Man %A Wong,Bonnie Po %A Liu,Bob Chung Man %A Lau,David Chi Ho %A Kowatsch,Tobias %K frailty %K gaming intervention %K motion-based %K video games %K older adults %K gerontology %K geriatrics %K randomized controlled trial %K RCT %K physical fitness %K adolescents %K young people–assisted %K eHealth literacy %K well-being %K therapists %K youth volunteers %K social support %K exergames %K gamification %K active games %K physical activity %D 2024 %7 20.11.2024 %9 %J JMIR Serious Games %G English %X Background: The aging population highlights the need to maintain both physical and psychological well-being. Frailty, a multidimensional syndrome, increases vulnerability to adverse outcomes. Although physical exercise is effective, adherence among older adults with frailty is often low due to barriers. Motion-based video games (MBVGs) may enhance motivation and engagement. Objective: This study aims to evaluate the effect of individualized exercise programs that combine MBVGs, intergenerational support, and therapeutic frameworks on physical, cognitive, and social frailty outcomes in community-dwelling older adults. Methods: This randomized controlled trial was conducted from March 2022 to October 2023 across 6 community centers in Hong Kong. Participants aged 60 years and above with mild neurocognitive disorder were recruited, screened, and randomly assigned to either an intervention (n=101) or control group (n=101). The intervention included an 18-week program with 12 supervised exercise sessions utilizing motion-based technology, led by occupational therapists and assisted by youth volunteers. Data were collected at baseline (T1) and postintervention (T2), focusing on physical, cognitive, and social frailty outcomes, as well as client-related metrics. Statistical analyses were performed using SPSS, with significance set at P<.05. Results: A total of 202 participants were recruited, with a mean age of 78.8 years (SD 7.8). Both groups showed improvements in balance from T1 to T2, with a significant time effect (β=−0.63, P=.03). The intervention group demonstrated enhancements in hand strength and BMI, but no statistically significant between-group differences were observed. The intervention group also exhibited significant improvements in cognitive function (β=2.43, P<.001), while the control group’s scores declined. Short-term memory improved for both groups, with no significant differences noted. Both groups experienced a reduction in depression levels, with a significant within-group effect at T2 (β=−1.16, P=.001). Improvements in social connectedness and eHealth literacy were observed in both groups, with the latter showing a significant within-group effect at T2 (β=3.56, P=.002). No significant effects were found for social isolation, physical activities, or quality of life. Conclusions: The growing aging population necessitates innovative strategies to support aging in place. Results indicated statistically significant improvements only in BMI and cognition, while other outcomes such as loneliness, balance, and eHealth literacy showed positive trends but lacked significance. Despite the limitations observed, particularly regarding the role of volunteer support and the diverse needs of community-dwelling older adults, the findings contribute to the foundation for future research aimed at enhancing biopsychosocial outcomes. Future studies should explore tailored interventions that consider individual preferences and abilities, as well as evaluate specific components of motion-based video games to optimize their effectiveness. Trial Registration: ClinicalTrials.gov NCT05267444; https://clinicaltrials.gov/study/NCT05267444 %R 10.2196/57352 %U https://games.jmir.org/2024/1/e57352 %U https://doi.org/10.2196/57352 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60037 %T An Investigation of the Feasibility and Acceptability of Using a Commercial DASH (Dietary Approaches to Stop Hypertension) App in People With High Blood Pressure: Mixed Methods Study %A Alnooh,Ghadah %A AlTamimi,Jozaa Z %A Williams,Elizabeth A %A Hawley,Mark S %+ Centre for Assistive Technology and Connected Healthcare, School of Medicine and Population Health, University of Sheffield, The Innovation Centre, 217 Portobello, Sheffield, S1 4DP, United Kingdom, 44 1142222000, mark.hawley@sheffield.ac.uk %K hypertension %K blood pressure %K Dietary Approaches to Stop Hypertension %K DASH diet %K self-efficacy %K mobile health %K mHealth %K Saudi Arabia %K mobile phone %D 2024 %7 19.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of smartphone apps for dietary self-management among patients with high blood pressure is becoming increasingly common. Few commercially available DASH (Dietary Approaches to Stop Hypertension) diet apps have the potential to be effective, and only a few of these have adequate security and privacy measures. In previous studies, we identified 2 high-quality apps that are likely effective and safe. One of these, the Noom app, was selected as the most suitable app for use in the Saudi Arabian context based on health care professionals’ and patients’ preferences. Objective: This study aims to determine the feasibility and acceptability of using the Noom app to support DASH diet self-management among people with high blood pressure in Saudi Arabia. Methods: This mixed methods study evaluated the feasibility and acceptability of using the Noom app among people with high blood pressure in Riyadh, Saudi Arabia. Fourteen participants with high blood pressure were recruited and asked to use the app for 8 weeks. The quantitative outcome measures were DASH diet adherence and self-efficacy. Feasibility and acceptability were assessed during and after the intervention via the Noom diet-tracking engagement questionnaire, the System Usability Scale, and semistructured interviews. Results: Most participants (8/13, 62%) logged their meals for 3 to 5 days a week; the frequency of logging increased over time. Snacks were the foods they most often forgot to log. The interviews revealed four main themes: (1) acceptance, (2) app usability, (3) technical issues, and (4) suggestions for improvement. Most participants found the Noom app acceptable, and most had no difficulties integrating it into their daily routines. The results of this feasibility study provided insights into the app’s educational content, some of which was deemed unsuitable for Saudi Arabian users. App usability was identified as a critical theme: the app and its database were easy to use, convenient, and valuable to most of the participants. Despite this, some of the participants reported difficulties in identifying some foods because of a lack of local options on the app. Technical issues included the app freezing or responding slowly. Most participants also suggested developing an Arabic version of the app and simplifying the method of food logging. The participants showed some improvement in self-efficacy and adherence to the DASH diet, although these improvements were not statistically significant. The mean self-efficacy score increased from 18 (SD 4.7) to 20 (SD 6.3), and the mean DASH diet score increased from 3.4 (SD 1.4) to 4.3 (SD 1.1). Conclusions: The app was feasible and acceptable among the participants who completed the study. Further studies are needed to examine the potential of smartphone apps in promoting adherence to the DASH diet and their impact on blood pressure among individuals with hypertension in Saudi Arabia. %M 39561360 %R 10.2196/60037 %U https://formative.jmir.org/2024/1/e60037 %U https://doi.org/10.2196/60037 %U http://www.ncbi.nlm.nih.gov/pubmed/39561360 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53236 %T Investigating the Effectiveness of Technology-Based Distal Interventions for Postpartum Depression and Anxiety: Systematic Review and Meta-Analysis %A Brocklehurst,Sarah P %A Morse,Alyssa R %A Cruwys,Tegan %A Batterham,Philip J %A Leach,Liana %A Robertson,Alysia M %A Sahib,Aseel %A Burke,Colette T %A Nguyen,Jessica %A Calear,Alison L %+ Centre for Mental Health Research, The Australian National University, 63 Eggleston Road, Acton, Canberra, 2601, Australia, 61 2 6125 8406, alison.calear@anu.edu.au %K postpartum %K depression %K anxiety %K birth %K adoptive %K parents %K mobile phone %D 2024 %7 19.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Postpartum anxiety and depression are common in new parents. While effective interventions exist, they are often delivered in person, which can be a barrier for some parents seeking help. One approach to overcoming these barriers is the delivery of evidence-based self-help interventions via websites, smartphone apps, and other digital media. Objective: This study aims to evaluate the effectiveness of technology-based distal interventions in reducing or preventing symptoms of postpartum depression or anxiety in male and female birth and adoptive parents, explore the effectiveness of technology-based distal interventions in increasing social ties, and determine the level of adherence to and satisfaction with technology-based distal interventions. Methods: A systematic review and series of meta-analyses were conducted. Three electronic bibliographic databases (PsycINFO, PubMed, and Cochrane Library) were searched for randomized controlled trials evaluating technology-based distal interventions for postpartum depression or anxiety in birth and adoptive parents. Searches were updated on August 1, 2023, before conducting the final meta-analyses. Data on trial characteristics, effectiveness, adherence, satisfaction, and quality were extracted. Screening and data extraction were conducted by 2 reviewers. Risk of bias was assessed using the Joanna Briggs Institute quality rating scale for randomized controlled trials. Studies were initially synthesized qualitatively. Where possible, studies were also quantitatively synthesized through 5 meta-analyses. Results: Overall, 18 articles met the inclusion criteria for the systematic review, with 14 (78%) providing sufficient data for a meta-analysis. A small significant between-group effect on depression favored the intervention conditions at the postintervention (Cohen d=–0.28, 95% CI –0.41 to –0.15; P<.001) and follow-up (Cohen d=–0.27, 95% CI –0.52 to –0.02; P=.03) time points. A small significant effect on anxiety also favored the intervention conditions at the postintervention time point (Cohen d=–0.29, 95% CI –0.48 to –0.10; P=.002), with a medium effect at follow-up (Cohen d=–0.47, 95% CI –0.88 to –0.05; P=.03). The effect on social ties was not significant at the postintervention time point (Cohen d=0.04, 95% CI –0.12 to 0.21; P=.61). Effective interventions tended to be web-based cognitive behavioral therapy programs with reminders. Adherence varied considerably between studies, whereas satisfaction tended to be high for most studies. Conclusions: Technology-based distal interventions are effective in reducing symptoms of postpartum depression and anxiety in birth mothers. Key limitations of the reviewed evidence include heterogeneity in outcome measures, studies being underpowered to detect modest effects, and the exclusion of key populations from the evidence base. More research needs to be conducted with birth fathers and adoptive parents to better ascertain the effectiveness of interventions in these populations, as well as to further assess the effect of technology-based distal interventions on social ties. Trial Registration: PROSPERO CRD42021290525; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=290525 %M 39561361 %R 10.2196/53236 %U https://www.jmir.org/2024/1/e53236 %U https://doi.org/10.2196/53236 %U http://www.ncbi.nlm.nih.gov/pubmed/39561361 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e67749 %T Author's Reply: Expanding the Scope: Reflections on Digital Smoking Cessation Strategies for Diverse Age Groups %A Fahey,Margaret C %+ Department of Psychology, Middle Tennessee State University, Academic Classroom Building, Murfreesboro, TN, 37130, United States, 1 615 898 5949, mfahey@mtsu.edu %K digital smoking cessation %K age group comparisons %K behavioral health intervention %K older adult %K cigarette %K tobacco %K quitting %K telehealth %K behavioral health %K public health %D 2024 %7 18.11.2024 %9 Letter to the Editor %J J Med Internet Res %G English %X %R 10.2196/67749 %U https://www.jmir.org/2024/1/e67749 %U https://doi.org/10.2196/67749 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e65929 %T Expanding the Scope: Reflections on Digital Smoking Cessation Strategies for Diverse Age Groups %A Wei,Bin %A Hu,Xin %A Wu,XiaoRong %+ The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi, 330000, China, 86 13617093259, wxr98021@126.com %K digital smoking cessation %K age group comparisons %K behavioral health interventions %K older adults %K digital cessation treatment %K cigarettes %K tobacco %K quit %K telehealth %K behavioral health %K public health %D 2024 %7 18.11.2024 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 39556825 %R 10.2196/65929 %U https://www.jmir.org/2024/1/e65929 %U https://doi.org/10.2196/65929 %U http://www.ncbi.nlm.nih.gov/pubmed/39556825 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55088 %T An Online Multimodal Food Data Exploration Platform for Specific Population Health: Development Study %A Yang,Lin %A Guo,Zhen %A Xu,Xiaowei %A Kang,Hongyu %A Lai,Jianqiang %A Li,Jiao %+ Institute of Medical Information and Library, Chinese Academy of Medical Sciences/Peking Union Medical College, No. 3, Yabao Rd, Chaoyang District, Beijing, 100020, China, 86 18618461596, li.jiao@imicams.ac.cn %K Chinese food data %K multimodal knowledge graph %K online platform %K population health promotion %K health promotion %K nutrients %K diet %K pregnant women %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Nutrient needs vary over the lifespan. Improving knowledge of both population groups and care providers can help with healthier food choices, thereby promoting population health and preventing diseases. Providing evidence-based food knowledge online is credible, low cost, and easily accessible. Objective: This study aimed to develop an online multimodal food data exploration platform for easy access to evidence-based diet- and nutrition-related data. Methods: We developed an online platform named Food Atlas in collaboration with a multidisciplinary expert group from the National Institute for Nutrition and Health and Peking Union Medical College Hospital in China. To demonstrate its feasibility for Chinese food for pregnant women, a user-friendly and high-quality multimodal food knowledge graph was constructed, and various interactions with graph-structured data were developed for easy access, including graph-based interactive visualizations, natural language retrieval, and image-text retrieval. Subsequently, we evaluated Food Atlas from both the system perspective and the user perspective. Results: The constructed multimodal food knowledge graph contained a total of 2011 entities, 10,410 triplets, and 23,497 images. Its schema consisted of 11 entity types and 26 types of semantic relations. Compared with 5 other online dietary platforms (Foodwake, Boohee, Xiachufang, Allrecipes, and Yummly), Food Atlas offers a distinct and comprehensive set of data content and system functions desired by target populations. Meanwhile, a total of 28 participants representing 4 different user groups were recruited to evaluate its usability: preparing for pregnancy (n=8), pregnant (n=12), clinicians (n=5), and dietitians (n=3). The mean System Usability Scale index of our platform was 82.5 (SD 9.94; range 40.0-82.5). This above-average usability score and the use cases indicated that Food Atlas is tailored to the needs of the target users. Furthermore, 96% (27/28) of the participants stated that the platform had high consistency, illustrating the necessity and effectiveness of health professionals participating in online, evidence-based resource development. Conclusions: This study demonstrates the development of an online multimodal food data exploration platform and its ability to meet the rising demand for accessible, credible, and appropriate evidence-based online dietary resources. Further research and broader implementation of such platforms have the potential to popularize knowledge, thereby helping populations at different life stages make healthier food choices. %M 39547662 %R 10.2196/55088 %U https://formative.jmir.org/2024/1/e55088 %U https://doi.org/10.2196/55088 %U http://www.ncbi.nlm.nih.gov/pubmed/39547662 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50963 %T Effectiveness of the Offer of the Smoke Free Smartphone App Compared With No Intervention for Smoking Cessation: Pragmatic Randomized Controlled Trial %A Jackson,Sarah %A Kale,Dimitra %A Beard,Emma %A Perski,Olga %A West,Robert %A Brown,Jamie %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, United Kingdom, 44 2076795634, s.e.jackson@ucl.ac.uk %K randomized controlled trial %K smartphone app %K smoking cessation %K digital intervention %K tobacco %K mobile phone %D 2024 %7 15.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital technologies offer the potential for low-cost, scalable delivery of interventions to promote smoking cessation. Objective: We aimed to evaluate the effectiveness of the offer of Smoke Free—an evidence-informed, widely used app—for smoking cessation versus no support. Methods: In this 2-arm randomized controlled trial, 3143 motivated adult smokers were recruited online between August 2020 and April 2021 and randomized to receive an offer of the Smoke Free app plus follow-up (intervention arm) versus follow-up only (comparator arm). Both groups were shown a brief message at the end of the baseline questionnaire encouraging them to make a quit attempt. The primary outcome was self-reported 6-month continuous abstinence assessed 7 months after randomization. Secondary outcomes included quit attempts in the first month post randomization, 3-month continuous abstinence assessed at 4 months, and 6-month continuous abstinence at 7 months among those who made a quit attempt. The primary analysis was performed on an intention-to-treat (ITT) analysis basis. Sensitivity analyses included (1) restricting the intervention group to those who took up the offer of the app, (2) using complete cases, and (3) using multiple imputation. Results: The effective follow-up rate for 7 months was 41.9%. The primary analysis showed no evidence of a benefit of the intervention on rates of 6-month continuous abstinence (intervention 6.8% vs comparator 7.0%; relative risk 0.97, 95% CI 0.75-1.26). Analyses of all secondary outcomes also showed no evidence of a benefit. Similar results were observed on complete cases and using multiple imputation. When the intervention group was restricted to those who took up the offer of the app (n=395, 25.3%), participants in the intervention group were 80% more likely to report 6-month continuous abstinence (12.7% vs 7.0%; relative risk 1.80, 95% CI 1.30-2.45). Equivalent subgroup analyses produced similar results on the secondary outcomes. These differences persisted after adjustment for key baseline characteristics. Conclusions: Among motivated smokers provided with very brief advice to quit, the offer of the Smoke Free app did not have a detectable benefit for cessation compared with follow-up only. However, the app increased quit rates when smokers randomized to receive the app downloaded it. Trial Registration: ISRCTN ISRCTN85785540; https://www.isrctn.com/ISRCTN85785540 International Registered Report Identifier (IRRID): RR2-https://onlinelibrary.wiley.com/doi/full/10.1111/add.14652 %M 39546331 %R 10.2196/50963 %U https://www.jmir.org/2024/1/e50963 %U https://doi.org/10.2196/50963 %U http://www.ncbi.nlm.nih.gov/pubmed/39546331 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47774 %T Machine Learning Methods to Personalize Persuasive Strategies in mHealth Interventions That Promote Physical Activity: Scoping Review and Categorization Overview %A Brons,Annette %A Wang,Shihan %A Visser,Bart %A Kröse,Ben %A Bakkes,Sander %A Veltkamp,Remco %+ Department of Information and Computing Sciences, Utrecht University, Princetonplein 5, Utrecht, 3584 CC, Netherlands, 31 621156976, R.C.Veltkamp@uu.nl %K artificial intelligence %K exercise %K mobile app %K adaptive %K tailoring %K supervised learning %K reinforcement learning %K recommender system %D 2024 %7 15.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Although physical activity (PA) has positive effects on health and well-being, physical inactivity is a worldwide problem. Mobile health interventions have been shown to be effective in promoting PA. Personalizing persuasive strategies improves intervention success and can be conducted using machine learning (ML). For PA, several studies have addressed personalized persuasive strategies without ML, whereas others have included personalization using ML without focusing on persuasive strategies. An overview of studies discussing ML to personalize persuasive strategies in PA-promoting interventions and corresponding categorizations could be helpful for such interventions to be designed in the future but is still missing. Objective: First, we aimed to provide an overview of implemented ML techniques to personalize persuasive strategies in mobile health interventions promoting PA. Moreover, we aimed to present a categorization overview as a starting point for applying ML techniques in this field. Methods: A scoping review was conducted based on the framework by Arksey and O’Malley and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) criteria. Scopus, Web of Science, and PubMed were searched for studies that included ML to personalize persuasive strategies in interventions promoting PA. Papers were screened using the ASReview software. From the included papers, categorized by the research project they belonged to, we extracted data regarding general study information, target group, PA intervention, implemented technology, and study details. On the basis of the analysis of these data, a categorization overview was given. Results: In total, 40 papers belonging to 27 different projects were included. These papers could be categorized in 4 groups based on their dimension of personalization. Then, for each dimension, 1 or 2 persuasive strategy categories were found together with a type of ML. The overview resulted in a categorization consisting of 3 levels: dimension of personalization, persuasive strategy, and type of ML. When personalizing the timing of the messages, most projects implemented reinforcement learning to personalize the timing of reminders and supervised learning (SL) to personalize the timing of feedback, monitoring, and goal-setting messages. Regarding the content of the messages, most projects implemented SL to personalize PA suggestions and feedback or educational messages. For personalizing PA suggestions, SL can be implemented either alone or combined with a recommender system. Finally, reinforcement learning was mostly used to personalize the type of feedback messages. Conclusions: The overview of all implemented persuasive strategies and their corresponding ML methods is insightful for this interdisciplinary field. Moreover, it led to a categorization overview that provides insights into the design and development of personalized persuasive strategies to promote PA. In future papers, the categorization overview might be expanded with additional layers to specify ML methods or additional dimensions of personalization and persuasive strategies. %M 39546334 %R 10.2196/47774 %U https://www.jmir.org/2024/1/e47774 %U https://doi.org/10.2196/47774 %U http://www.ncbi.nlm.nih.gov/pubmed/39546334 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58363 %T A Novel Web App for Dietary Weight Management: Development, Implementation, and Usability Study %A Oliveira,Ashleigh %A Wolff,John %A Alfouzan,Nouf %A Yu,Jin %A Yahya,Asma %A Lammy,Kayla %A Nakamura,Manabu T %+ Division of Nutritional Sciences, University of Illinois at Urbana Champaign, 905 S Goodwin Ave, Urbana, IL, 61801, United States, 1 217 333 1267, oliveira.ashleigh@gmail.com %K health application %K weight loss %K behavior change technique %K BCT %K online weight loss program %K weight monitoring %K meal planning %K sustainable weight loss %K dietary fiber %K mHealth %K mobile health %D 2024 %7 11.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Online weight loss programs have ambiguous efficacy. There is a growing body of evidence that weight loss programs when combined with apps have better outcomes; however, many apps lack an evidence-based approach to dietary changes for weight loss and do not rely on a theoretical framework for behavior change. Objective: This study aimed to describe the development and the preliminary usability and acceptability testing of a web app that uses behavior change techniques (BCTs) to support users of a comprehensive online weight loss program. Methods: The weight loss program intervention components were nutrient and weight tracking charts that needed a remotely accessible and online format. The app was designed by nutrition researchers and developers in a collaborative effort. A review of BCTs in weight loss and web apps was performed as well as an assessment of user needs to inform the initial prototype. A preliminary app prototype, version 1.0, was provided to participants of a weight loss trial (N=30) to assess for feasibility of its use. A full app prototype, version 2.0, was feasibility and acceptability tested by trial participants (n=11) with formal feedback by Likert-scale survey and open-ended questions. In the final round of testing, a user group of scientists and developers (n=11) was selected to provide a structured 3-month review through which the group met weekly for collective feedback sessions. Results: The process resulted in a fully developed web app, MealPlot, by the Applied Research Institute, for meal planning and weight tracking that can be used by weight loss users and health professionals to track their patients. MealPlot includes a weight chart, a protein-fiber chart, and a chat feature. In addition, MealPlot has 2 distinct platforms, 1 for weight loss users and 1 for health professionals. Selected BCTs for incorporation into the app were goal setting, feedback, problem-solving, self-monitoring, and social support. Version 1.0 was used successfully to provide a functioning, online weight chart over the course of a 1-year trial. Version 2.0 provided a functional weight chart and meal planning page, but 8 out of 11 participants indicated MealPlot was difficult to use. Version 3.0 was developed based on feedback and strategies provided from user group testing. Conclusions: The web app, MealPlot, was developed to improve outcomes and functionality of an online weight loss program by providing a remote method of tracking weight, food intake, and connecting users to health professionals for consistent guidance that is not otherwise available in a traditional in-person health care setting. The final version 3.0 of the web app will be refined based on findings of a review study gathering feedback from health professionals and from actual weight loss users who are part of a clinical weight loss trial. %M 39527795 %R 10.2196/58363 %U https://formative.jmir.org/2024/1/e58363 %U https://doi.org/10.2196/58363 %U http://www.ncbi.nlm.nih.gov/pubmed/39527795 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e59908 %T A New Research Model for Artificial Intelligence–Based Well-Being Chatbot Engagement: Survey Study %A Yang,Yanrong %A Tavares,Jorge %A Oliveira,Tiago %+ NOVA Information Management School (NOVA IMS), Universidade Nova de Lisboa, Campus de Campolide, Lisboa, 1070-312, Portugal, 351 213 828 610, 20220021@NOVAIMS.UNL.PT %K artificial intelligence–based chatbot %K AI-based chatbot %K mental well-being %K intention to engage %K engagement behavior %K theoretical models %K mobile phone %D 2024 %7 11.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Artificial intelligence (AI)–based chatbots have emerged as potential tools to assist individuals in reducing anxiety and supporting well-being. Objective: This study aimed to identify the factors that impact individuals’ intention to engage and their engagement behavior with AI-based well-being chatbots by using a novel research model to enhance service levels, thereby improving user experience and mental health intervention effectiveness. Methods: We conducted a web-based questionnaire survey of adult users of well-being chatbots in China via social media. Our survey collected demographic data, as well as a range of measures to assess relevant theoretical factors. Finally, 256 valid responses were obtained. The newly applied model was validated through the partial least squares structural equation modeling approach. Results: The model explained 62.8% (R2) of the variance in intention to engage and 74% (R2) of the variance in engagement behavior. Affect (β=.201; P=.002), social factors (β=.184; P=.007), and compatibility (β=.149; P=.03) were statistically significant for the intention to engage. Habit (β=.154; P=.01), trust (β=.253; P<.001), and intention to engage (β=.464; P<.001) were statistically significant for engagement behavior. Conclusions: The new extended model provides a theoretical basis for studying users’ AI-based chatbot engagement behavior. This study highlights practical points for developers of AI-based well-being chatbots. It also highlights the importance of AI-based well-being chatbots to create an emotional connection with the users. %M 39527812 %R 10.2196/59908 %U https://humanfactors.jmir.org/2024/1/e59908 %U https://doi.org/10.2196/59908 %U http://www.ncbi.nlm.nih.gov/pubmed/39527812 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56437 %T Virtual Coach–Guided Online Acceptance and Commitment Therapy for Chronic Pain: Pilot Feasibility Randomized Controlled Trial %A Reilly,Erin D %A Kelly,Megan M %A Grigorian,Hannah L %A Waring,Molly E %A Quigley,Karen S %A Hogan,Timothy P %A Heapy,Alicia A %A Drebing,Charles E %A Volonte,Matias %A Kathawalla,Ummul-Kiram %A Robins,Hannah E %A Bernice,Katarina %A Bickmore,Timothy %+ Mental Illness Research, Education, and Clinical Center, Veteran Affairs Bedford Healthcare System, Department of Veteran Affairs, 200 Springs Road, Bedford, MA, 01730, United States, 1 781 687 4191, erin.reilly@va.gov %K chronic pain %K randomized controlled trial %K usability %K acceptance and commitment therapy %K embodied conversational agent %K veterans %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Veterans are disproportionately affected by chronic pain, with high rates of pain diagnoses (47%-56%) and a 40% higher rate of prevalence of severe pain than nonveterans. This is often accompanied by negative functional outcomes and higher mortality. Combined with research suggesting medical treatments for chronic pain are often insufficient, there is an urgent need for nonmedical pain self-management programs. An interactive online platform to deliver an efficacious treatment for chronic pain such as acceptance and commitment therapy (ACT) could be a valuable option to assist veterans with pain care at home. Objective: This study aims to evaluate the virtual coach–guided Veteran ACT for Chronic Pain (VACT-CP) online program compared to a waitlist and treatment as usual (WL+TAU) control group through a small pilot feasibility randomized controlled trial. The primary aim was to evaluate the feasibility and acceptability of VACT-CP and study procedures, such as ease of recruitment, treatment receptivity, attrition and retention, sustained participation, system usability, and assessment of trial procedures. Secondary aims explored differences in the VACT-CP and WL+TAU groups on pre- and posttest (week 7) outcome measures for pain, mental health, functioning, and ACT processes. Methods: Veterans with chronic pain were recruited and randomized to either the VACT-CP (n=20) or the WL+TAU (n=22) group in a parallel group trial design. Self-report surveys were administered to participants at baseline (week 0), at the intervention midpoint (week 3), immediately after the intervention (week 7), and at the 1-month follow-up (week 11). We used Wilcoxon signed rank tests with the intention-to-treat sample to describe changes in secondary outcomes from pre- to postintervention within each group. Results: Study procedures showed good feasibility related to recruitment, enrollment, randomization, and study completion rates. Participants reported that VACT-CP was easy to use (System Usability Scale: mean 79.6, SD 12.8; median 82.5, IQR 70-87.5); they completed an average of 5 of the 7 total VACT-CP modules with high postintervention satisfaction rates. Qualitative feedback suggested a positive response to program usability, content tailoring, veteran centeredness, and perceived impact on pain management. Although the pilot feasibility trial was not powered to detect differences in clinical outcomes and significant findings should be interpreted with caution, the VACT-CP group experienced significant increases in chronic pain acceptance (P<.001) and decreases in depressive symptoms (P=.03). Conclusions: VACT-CP showed encouraging evidence of feasibility, usability, and acceptance, while also providing promising initial results in improving a key process in ACT for chronic pain—chronic pain acceptance—after online program use. A full-scale efficacy trial is needed to assess changes in clinical outcomes. Trial Registration: ClinicalTrials.gov NCT03655132; http://clinicaltrials.gov/ct2/show/NCT03655132 International Registered Report Identifier (IRRID): RR2-10.2196/45887 %M 39514264 %R 10.2196/56437 %U https://formative.jmir.org/2024/1/e56437 %U https://doi.org/10.2196/56437 %U http://www.ncbi.nlm.nih.gov/pubmed/39514264 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56201 %T Facilitating Thought Progression to Reduce Depressive Symptoms: Randomized Controlled Trial %A Yatziv,Shai-Lee %A Pedrelli,Paola %A Baror,Shira %A DeCaro,Sydney Ann %A Shachar,Noam %A Sofer,Bar %A Hull,Sunday %A Curtiss,Joshua %A Bar,Moshe %+ The Leslie and Susan Gonda Brain Science Center, Bar- Ilan University Building number 901, Ramat-Gan, 5290002, Israel, 972 35317795, moshe.bar@biu.ac.il %K depression %K cognitive neuroscience %K facilitating thought progression %K FTP %K mobile phone %K digital health %K gamification %K depression symptoms %K randomized controlled trial %K RCT %K app %K depressive disorder %K web-based platforms %K effectiveness %D 2024 %7 7.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The constant rise in the prevalence of major depressive disorder calls for new, effective, and accessible interventions that can rapidly and effectively reach a wide range of audiences. Recent developments in the digital health domain suggest that dedicated online platforms may potentially address this gap. Focusing on targeting ruminative thought, a major symptomatic hallmark of depression, in this study we hypothesized that delivering a digital health–based intervention designed to systematically facilitate thought progression would substantially alleviate depression. Objective: The study aims to investigate the efficacy of a novel digital intervention on the reduction of depressive symptoms. This intervention was designed as an easy-to-use gamified app specifically aimed to facilitate thought progression through intense practicing of associative, semantically broad, fast, and creative thought patterns. Methods: A randomized clinical trial was conducted, comparing changes in depression symptoms between participants who used the app in the intervention group (n=74) and waitlist control group (n=27) over the course of 8 weeks. All participants filled out a battery of clinical questionnaires to assess the severity of depression at baseline and 4 and 8 weeks after starting the study. These primarily included the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Patient Health Questionnaire-9 as well as the Positive Affect Negative Affect Scale-Negative Affect Score, Ruminative Response Scale, and Symptoms of Depression Questionnaire. Additional questionnaires were implemented to assess anxiety, positive affect, anhedonia, and quality of life. Results: The results indicate that across multiple clinical measurements, participants in the intervention group who played the gamified app showed greater and faster improvement in depressive symptoms compared with their waitlist control counterparts. The difference between the groups in MADRS improvement was –7.01 points (95% CI –10.72 to –3.29; P<.001; Cohen d=0.67). Furthermore, the difference in improvement between groups persisted up to 4 weeks posttrial (MADRS differences at week 12: F49,2=6.62; P=.003; ηp2=0.21). At the end of the trial, participants who played the app showed high interest in continuing using the app. Conclusions: The results demonstrate that a gamified app designed to facilitate thought progression is associated with improvement in depressive symptoms. Given its innovative and accessibility features, this gamified method aiming to facilitate thought progression may successfully complement traditional treatments for depression in the future, providing a safe and impactful way to enhance the lives of individuals experiencing depression and anxiety. Trial Registration: ClinicalTrials.gov NCT05685758; https://clinicaltrials.gov/study/NCT05685758 %M 39350528 %R 10.2196/56201 %U https://www.jmir.org/2024/1/e56201 %U https://doi.org/10.2196/56201 %U http://www.ncbi.nlm.nih.gov/pubmed/39350528 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e59897 %T Exploring the Needs of People With Chronic Low Back Pain and Health Care Professionals for mHealth Devices to Support Self-Managed Physical Activity and Pain: User-Centered Design Approach %A Berger,Mathilde %A Deblock-Bellamy,Anne %A Chèze,Laurence %A Robert,Thomas %A Desrosiers,Julie J %A Christe,Guillaume %A Bertrand,Anne Martine %+ Department of Occupational Therapy, University of Applied Sciences and Arts Western Switzerland (HETSL | HES-SO), Chemin des Abeilles 14, Lausanne, 1010, Switzerland, 41 (0)216510330, mathilde.berger@hetsl.ch %K chronic low back pain %K needs %K self-management %K physical activity %K mobile health %K mHealth %K user-centered design %D 2024 %7 7.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Chronic low back pain (CLBP) is a major economic and social problem worldwide. Despite the variety of recommended treatments, long-term self-management of this condition is complex and requires the development of innovative interventions. Mobile health (mHealth) technologies hold great promise for the management of chronic pain, particularly to support physical activity. However, their implementation is challenged by a lack of user compliance and limited engagement, which may be due to insufficient consideration of the needs of potential users during development. Objective: This study aims to explore the needs of people with CLBP and health care professionals regarding mHealth technologies to support self-managed physical activity, and to delineate design recommendations based on identified needs. Methods: A participatory study was conducted using a 3-phase, user-centered design approach: needs investigation with a group of experts in a workshop (phase 1), needs exploration with end users in focus groups (phase 2), and validation of needs using Delphi questionnaires followed by the development of a set of recommendations (phase 3). Results: A total of 121 people with CLBP, expert patients, health care professionals, rehabilitation researchers, and biomechanical engineers participated in this study. The results indicated how technology could help people with CLBP overcome their difficulties with managing physical activity. Specific needs were formulated concerning device objectives, expected strategies, functionalities, technical features, conditions of use, and potential facilitators and barriers to use. These needs were validated by consensus from the potential end users and translated into design recommendations. Conclusions: This study provides design recommendations for the development of an mHealth device specifically adapted for people with CLBP. %M 39509701 %R 10.2196/59897 %U https://humanfactors.jmir.org/2024/1/e59897 %U https://doi.org/10.2196/59897 %U http://www.ncbi.nlm.nih.gov/pubmed/39509701 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e63296 %T Risk Perception and Knowledge Following a Social Game–Based Tobacco Prevention Program for Adolescents: Pilot Randomized Comparative Trial %A Khalil,Georges %A Ramirez,Erica %A Khan,Meerah %A Zhao,Bairu %A Ribeiro,Nuno %A Balian,Patrick %+ Department of Health Outcomes and Biomedical Informatics, University of Florida, Malachowsky Hall for Data Science and Information Technology, 1889 Museum Rd, Suite 7000, Gainesville, FL, 32603, United States, 1 3526279467, gkhalil@ufl.edu %K tobacco prevention %K vaping %K combustible tobacco %K risk perception %K adolescent %K games %K social interaction %D 2024 %7 5.11.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Adolescence is a critical developmental stage that is particularly vulnerable to the initiation of tobacco use. Despite the well-documented health risks associated with tobacco use, it remains prevalent among adolescents. Games for health are a promising strategy for tobacco prevention, using experiential and social learning theories to enhance engagement and improve behavior change. Objective: This pilot study aims to (1) compare the social game–based program Storm-Heroes to a nonsocial program regarding adolescents’ personal and social experiences and (2) examine how these experiences predict higher tobacco knowledge and perceived risks of vaping and conventional tobacco use. Methods: In a cluster-randomized comparative design, 4 after-school sites (N=79 adolescents) were recruited in person and randomized in a single-blinded format to 1 of 2 interventions: the social game Storm-Heroes (44/79, 56%) or the nonsocial program A Smoking Prevention Interactive Experience (ASPIRE; 35/79, 44%). A study team member supervised both interventions. Data were collected at baseline, immediate follow-up, and a 1.5-month follow-up (45/74, 61% retained). Repeated measures mixed effects models were conducted. Results: A total of 45 participants continued until the 1.5-month follow-up. Participants in the Strom-Heroes group were more likely to increase their perceived risk of vaping (B=0.40; P<.001), perceived risk of conventional tobacco use (B=0.35; P=.046), and tobacco knowledge (B=1.63; P<.001) than those in the control condition. The usability level of the program was related to a higher perceived risk of vaping (B=0.16; P=.003) and conventional tobacco use (B=0.16; P=.02) by follow-up. Attention to the program was also related to higher perceived risk of vaping (B=0.12; P=.002) and conventional tobacco use (B=0.14; P<.001). Distraction was not related to either perceived risk of vaping (P=.15) or perceived risk of conventional tobacco use (P=.71). In contrast, both more attention (B=0.60; P<.001) and less distraction (B=–0.37; P<.001) were related to higher tobacco knowledge. Conclusions: The increased perceived risk of vaping and conventional tobacco among Storm-Heroes participants aligns with the program’s goals of improving participants’ awareness of the risks associated with tobacco use and their tobacco knowledge. However, distraction weakened the effect of the program on tobacco knowledge, indicating that emphasis needs to be placed on minimizing distraction for better outcomes. With the results of this study, researchers can work to advance the current version of Storm-Heroes and amplify engagement in the program to improve its potential for preventing adolescents’ initiation of tobacco use. Trial Registration: ClinicalTrials.gov NCT02703597; https://clinicaltrials.gov/study/NCT02703597 %M 39499912 %R 10.2196/63296 %U https://games.jmir.org/2024/1/e63296 %U https://doi.org/10.2196/63296 %U http://www.ncbi.nlm.nih.gov/pubmed/39499912 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e58127 %T Mobile Apps for the Personal Safety of At-Risk Children and Youth: Scoping Review %A Bowen-Forbes,Camille %A Khondaker,Tilovatul %A Stafinski,Tania %A Hadizadeh,Maliheh %A Menon,Devidas %+ Health Technology and Policy Unit, School of Public Health, Edmonton Clinic Health Academy, 11405 St 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada, 1 587 712 2086, bowenfor@ualberta.ca %K children %K youth %K personal safety apps %K smartphones %K mobile apps %K violence %K bullying %K suicide prevention %K youth support %K homeless support %K mobile phone %D 2024 %7 5.11.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Personal safety is a widespread public health issue that affects people of all demographics. There is a growing interest in the use of mobile apps for enhancing personal safety, particularly for children and youth at risk, who are among the most vulnerable groups in society. Objective: This study aims to explore what is known about the use of mobile apps for personal safety among children and youth identified to be “at risk.” Methods: A scoping review following published methodological guidelines was conducted. In total, 5 databases (Scopus, SocINDEX, PsycINFO, Compendex, and Inspec Archive) were searched for relevant scholarly articles published between January 2005 and October 2023. The gray literature was searched using Google and Google Scholar search engines. The results were reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. For summarizing the features and users’ experiences of the apps, a published framework for evaluating the quality of mobile health apps for youth was used. Results: A total of 1986 articles were identified, and 41 (2.1%) were included in the review. Nine personal safety apps were captured and categorized into 4 groups based on the goals of the apps, as follows: dating and sexual violence prevention (n=4, 44% of apps), bullying and school violence prevention (n=2, 22% of apps), self-harm and suicide prevention (n=2, 22% of apps), and homeless youth support (n=1, 11% of apps). Of the 41 articles, 25 (61%) provided data solely on app descriptions and features, while the remaining 16 (39%) articles provided data on app evaluations and descriptions. Outcomes focused on app engagement, users’ experiences, and effectiveness. Four articles reported on app use, 3 (75%) of which reported relatively high app use. Data on users’ experience were obtained from 13 studies. In general, participants found the app features to be easy to use and useful as educational resources and personal safety tools. Most of the views were positive. Negative perceptions included redundancy of app features and a lack of usefulness. Five apps were evaluated for effectiveness (n=2, 40% dating and sexual violence prevention; n=2, 40% self-harm and suicide prevention; and n=1, 20% bullying and school violence prevention) and were all associated with a statistically significant reduction (P=.001 to .048) in harm or risk to participants at the 95% CI. Conclusions: Although many personal safety apps are available, few studies have specifically evaluated those designed for youth. However, the evidence suggests that mobile safety apps generally appear to be beneficial for reducing harm to at-risk children and youth without any associated adverse events. Recommendations for future research have been made to strengthen the evidence and increase the availability of effective personal safety apps for children and youth. %M 39499918 %R 10.2196/58127 %U https://mhealth.jmir.org/2024/1/e58127 %U https://doi.org/10.2196/58127 %U http://www.ncbi.nlm.nih.gov/pubmed/39499918 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57433 %T Accuracy Standards of Wearable Technologies for Assessment of Soccer Kicking: Protocol for a Systematic Literature Review %A Palucci Vieira,Luiz H %A Clemente,Filipe Manuel %A Chang Marquez,Felipe Armando %A Rea Olivares,Walter Manuel %A Vargas Villafuerte,Kelly R %A Carpes,Felipe P %+ Grupo de investigación en Tecnología aplicada a la Seguridad ocupacional, Desempeño y Calidad de vida (GiTaSyC), Facultad de Ingeniería y Arquitectura, Universidad César Vallejo (UCV), Av Argentina 1795, Campus Callao, Callao, 07001, Peru, 51 (1)2024342, lpaluccivi@ucv.edu.pe %K skill-related performance %K shooting %K team sports %K sports engineering %K measurement error %K validity %K reliability %K quality control %D 2024 %7 4.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Wearable technology is widely applied in performance monitoring, an integral part of sports and exercise sciences. The kick movement in soccer exemplifies a sports technique that could benefit from appropriate biomechanics assessment methodologies. However, the accuracy of wearables in quantifying soccer kick mechanics, particularly under field conditions, remains unclear. Objective: This study aims to present a protocol for a systematic review to discuss the measurement properties (validity, reliability, and/or accuracy aspects) of wearable technology systems explicitly used to measure ball-kicking features in soccer. Methods: This review protocol was preregistered in the Open Science Framework. A total of 2 authors will perform searches in major electronic databases using specific keyword combinations in PubMed, Physical Therapy and Sports Medicine, Web of Science, ProQuest, IEEE Xplore, EBSCOHost, and Scopus. Following a specific population, intervention, comparison, outcome framework (population: soccer players and/or collected human data in a football-related environment; intervention: at least 1 wearable used; comparator: criterion measures, repeated testing sessions and/or actual values; outcome: ball kicking data), studies will be screened based on predetermined inclusion and exclusion criteria. The methodological quality of the included studies will be assessed using the “consensus-based standards for the selection of health measurement instruments” checklist (in studies concerning validity or reliability) or the “quality assessment of diagnostic accuracy studies” tool (in studies concerning accuracy). Data extraction will be conducted to determine the level of evidence according to the “best evidence synthesis method,” and an evidence gap map will be constructed. The Cohen κ coefficient will be used to estimate the interevaluator agreement. Results: This ongoing systematic review has completed database searches and is currently in the screening phase. Depending on the number and consistency of studies, results may be presented by meta-analysis or qualitative synthesis, with subgroup analyses considering factors such as gender, age, and playing level. The final results are expected by July 2024, with manuscript submission anticipated by November 2024. Conclusions: Our study will provide a comprehensive summary of the highest level of evidence available on the use of wearables for the assessment of soccer kick mechanics, providing practical guidance for athletes and sports sciences professionals regarding the validity and reliability aspects of using wearable technology to measure ball-kicking features in soccer. Trial Registration: OSF registries https://osf.io/zm3j6 International Registered Report Identifier (IRRID): DERR1-10.2196/57433 %M 39496307 %R 10.2196/57433 %U https://www.researchprotocols.org/2024/1/e57433 %U https://doi.org/10.2196/57433 %U http://www.ncbi.nlm.nih.gov/pubmed/39496307 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54565 %T User Views on Online Sexual Health Symptom Checker Tool: Qualitative Research %A King,Alicia Jean %A Bilardi,Jade Elissa %A Towns,Janet Mary %A Maddaford,Kate %A Fairley,Christopher Kincaid %A Chow,Eric P F %A Phillips,Tiffany Renee %+ School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 580 Swanston Street, Carlton, Melbourne, 3053, Australia, 61 93416266, aking@mshc.org.au %K sexual health %K sexually transmitted diseases %K risk assessment %K risk factors %K smartphone apps %K help-seeking behavior %K health literacy %K information seeking behavior %D 2024 %7 4.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Delayed diagnosis and treatment of sexually transmitted infections (STIs) contributes to poorer health outcomes and onward transmission to sexual partners. Access to best-practice sexual health care may be limited by barriers such as cost, distance to care providers, sexual stigma, and trust in health care providers. Online assessments of risk offer a novel means of supporting access to evidence-based sexual health information, testing, and treatment by providing more individualized sexual health information based on user inputs. Objective: This developmental evaluation aims to find potential users’ views and experiences in relation to an online assessment of risk, called iSpySTI (Melbourne Sexual Health Center), including the likely impacts of use. Methods: Individuals presenting with urogenital symptoms to a specialist sexual health clinic were given the opportunity to trial a web-based, Bayesian-powered tool that provides a list of 2 to 4 potential causes of their symptoms based on inputs of known STI risk factors and symptoms. Those who tried the tool were invited to participate in a once-off, semistructured research interview. Descriptive, action, and emotion coding informed the comparative analysis of individual cases. Results: Findings from interviews with 14 people who had used the iSpySTI tool support the superiority of the online assessment of STI risk compared to existing sources of sexual health information (eg, internet search engines) in providing trusted and probabilistic information to users. Additionally, potential users reported benefits to their emotional well-being in the intervening period between noticing symptoms and being able to access care. Differences in current and imagined urgency of health care seeking and emotional impacts were found based on clinical diagnosis (eg, non-STI, curable and incurable but treatable STIs) and whether participants were born in Australia or elsewhere. Conclusions: Online assessments of risk provide users experiencing urogenital symptoms with more individualized and evidence-based health information that can improve their health care–seeking and provide reassurance in the period before they can access care. %R 10.2196/54565 %U https://formative.jmir.org/2024/1/e54565 %U https://doi.org/10.2196/54565 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58622 %T Couple-Focused Smartphone Intervention to Reduce Problem Drinking: Pilot Randomized Control Trial %A Gustafson Sr,David H %A Gustafson Jr,David H %A Mares,Marie-Louise %A Johnston,Darcie C %A Vjorn,Olivia J %A Curtin,John J %A Epstein,Elizabeth E %A Bailey,Genie L %+ Center for Health Enhancement Systems Studies, University of Wisconsin–Madison, Mechanical Engineering, Room 4127, 1513 University Ave, Madison, WI, 53706, United States, 1 608 890 2615, dcjohnston@wisc.edu %K alcohol use disorder %K AUD %K mHealth %K mobile health %K mobile phone %K smartphone %K couple therapy %K Comprehensive Health Enhancement Support System %K A-CHESS %K Alcohol Behavioral Couple Therapy %K ABCT %D 2024 %7 1.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use disorder is among the most pervasive substance use disorders in the United States, with a lifetime prevalence of 30%. Recommended treatment options include evidence-based behavioral interventions; smartphone-based interventions confer a number of benefits such as portability, continuous access, and stigma avoidance; and research suggests that interventions involving couples may outperform those for patients only. In this context, a behavioral intervention delivered to couples through smartphones may serve as an effective adjunct to alcohol use disorder treatment. Objective: This pilot study aimed to (1) evaluate the feasibility of comparing a patient-only (Addiction version of the Comprehensive Health Enhancement Support System; A-CHESS) versus a couple-focused (Partner version of the Comprehensive Health Enhancement Support System; Partner-CHESS) eHealth app for alcohol misuse delivered by smartphone, (2) assess perceptions about and use of the 2 apps, and (3) examine initial indications of differences in primary clinical outcomes between patient groups using the 2 apps. Broadly, these aims serve to assess the feasibility of the study protocol for a larger randomized controlled trial. Methods: A total of 33 romantic couples were randomized to 6 months of A-CHESS app use (active treatment control) or Partner-CHESS app use (experimental). Couples comprised a patient with current alcohol use disorder (25/33, 76% male) and a romantic partner (26/33, 79% female). Patients and partners in both arms completed outcome measure surveys at 0, 2, 4, and 6 months. Primary outcomes were patients’ percentage of days with heavy drinking and percentage of days with any drinking, measured by timeline follow back. Secondary outcomes included app use and perceptions, and multiple psychosocial variables. Results: At 6 months, 78% (14/18) of Partner-CHESS patients and 73% (11/15) of A-CHESS patients were still using the intervention. The apps were rated helpful on a 5-point scale (1=not at all helpful, 5=extremely helpful) by 89% (29/33) of both Partner-CHESS patients (mean 3.7, SD 1) and partners (mean 3.6, SD 0.9) and by 87% (13/15) of A-CHESS patients (mean 3.1, SD 0.9). At 6 months, Partner-CHESS patients had a nonsignificantly lower percentage of days with heavy drinking compared with A-CHESS patients (β=–17.4, 95% CI –36.1 to 1.4; P=.07; Hedges g=–0.53), while the percentage of drinking days was relatively equal between patient groups (β=–2.1, 95% CI –24.8 to 20.7; P=.85; Hedges g=–0.12). Conclusions: Initial results support the feasibility of evaluating patient-only and couple-focused, smartphone-based interventions for alcohol misuse. Results suggest that both interventions are perceived as helpful and indicate maintained engagement of most participants for 6 months. A future, fully powered trial is warranted to evaluate the relative effectiveness of both interventions. Trial Registration: ClinicalTrials.gov NCT04059549; https://clinicaltrials.gov/ct2/show/NCT04059549 %M 39486022 %R 10.2196/58622 %U https://formative.jmir.org/2024/1/e58622 %U https://doi.org/10.2196/58622 %U http://www.ncbi.nlm.nih.gov/pubmed/39486022 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60183 %T Efficacy of a Wearable Activity Tracker With Step-by-Step Goal-Setting on Older Adults’ Physical Activity and Sarcopenia Indicators: Clustered Trial %A Ho,Mu-Hsing %A Peng,Chi-Yuan %A Liao,Yung %A Yen,Hsin-Yen %+ School of Gerontology and Long-term Care, College of Nursing, Taipei Medical University, 250 Wuxing St, Taipei City, 11031, Taiwan, 886 2 2736 1661 ext 6326, yenken520@gmail.com %K behavioral change technique %K chronic disease prevention %K health promotion %K mHealth %K sedentary behavior %K smartwatch %D 2024 %7 1.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Smart wearable technology has potential benefits for promoting physical activity and preventing sarcopenia. Objective: The purpose of this study was to explore the efficacy of a wearable activity tracker with 2-stage goal-setting for daily steps on older adults’ physical activity and sarcopenia indicators. Methods: The study used a clustered trial design and was conducted in March to June 2022. Participants were community-dwelling adults older than 60 years who were recruited from 4 community centers in Taipei City. The intervention was designed with 2-stage goals set to 5000 steps/day in the first 4 weeks and 7500 steps/day in the final 4 weeks while wearing a commercial wearable activity tracker. Data were collected by self-reported questionnaires, a body composition analyzer, a handle grip tester, and 5 sit-to-stand tests. Results: All 27 participants in the experimental group and 31 participants in the control group completed the 8-week intervention. Total and light-intensity physical activities, skeletal muscle index, and muscle strength increased, while sedentary time, BMI, and the waist circumference of participants decreased in the experimental group, with significant group-by-time interactions compared to the control group. Conclusions: A wearable activity tracker with gradual goal-setting is an efficient approach to improve older adults’ physical activity and sarcopenia indicators. Smart wearable products with behavioral change techniques are recommended to prevent sarcopenia in older adult populations. %M 39486024 %R 10.2196/60183 %U https://www.jmir.org/2024/1/e60183 %U https://doi.org/10.2196/60183 %U http://www.ncbi.nlm.nih.gov/pubmed/39486024 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54171 %T Assessment of Acceptability, Usage, and Impact on Caregivers of Children With Autism’s Stress and Mindfulness: Multiple-Method Feasibility Study of the 5Minutes4Myself App’s Mindfulness Module %A Larson,Elizabeth %A Mattie,Rebecca L %A Riffkin,Sophia A %K autism %K caregiver %K activities %K mindfulness %K mobile application %K stress %K wellness %K app %K application %K usage %K children %K developmental disability %K usability %K acceptability %K meditation %K wellness application %D 2024 %7 31.10.2024 %9 %J JMIR Hum Factors %G English %X Background: Caregiver wellness programs need to be easily accessible to address caregivers’ constraints to participation. Objective: We aimed to assess the feasibility of 5Minutes4Myself app’s mindfulness module (usability, usage, and impact on caregivers’ levels of mindfulness and perceived stress). Methods: Before and after participation in the 5Minutes4Myself program, 15 participants were asked to complete the Perceived Stress Scale (PSS) and Five Facet Mindfulness Questionnaire (FFMQ). Data on the usage of app-delivered meditations were collected electronically via the app, and app usability was rated on the Modified System Usability Scale. Analyses assessed participants’ frequency of use of app-delivered meditations, app usability, and changes in participants’ stress and mindfulness post intervention. Results: Overall, participants completed 10.9 minutes of mindfulness meditations per week and rated the app 76.7, indicating above-average usability. Related samples t tests (2-tailed) found that group PSS (t10=1.20, P=.26) and FFMQ (t10=−1.57, P=.15) pre- or postintervention mean scores were not significantly different. However, a visualization of pre- and post-PSS and mindfulness scores suggested there was a group of responders who had decreased stress with increased mindfulness. This was confirmed via an individual change analysis. The effect size of the FFMQ scores (d=0.47) suggests there may be treatment effects with a larger sample. A hierarchical multiple regression analysis examined the degree mindfulness impacted perceived stress; 20% of the variance in participants’ perceived stress could be attributed to increases in self-rated mindfulness (P=.04) when controlling for preintervention stress levels. Conclusions: Caregivers found the app highly usable and on average used low-dose levels of mindfulness meditations (10 min/wk). For responders, increased mindfulness was related to stress reduction to population-based levels. Trial Registration: ClinicalTrials.gov NCT03771001; https://clinicaltrials.gov/study/NCT03771001 %R 10.2196/54171 %U https://humanfactors.jmir.org/2024/1/e54171 %U https://doi.org/10.2196/54171 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e52383 %T Sensors for Smoking Detection in Epidemiological Research: Scoping Review %A Favara,Giuliana %A Barchitta,Martina %A Maugeri,Andrea %A Magnano San Lio,Roberta %A Agodi,Antonella %+ Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Via Santa Sofia 87, Catania, 95123, Italy, 39 0953782183, agodia@unict.it %K smoking %K tobacco smoke %K smoke exposure %K cigarette smoking %K wearable sensor %K public health %D 2024 %7 30.10.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The use of wearable sensors is being explored as a challenging way to accurately identify smoking behaviors by measuring physiological and environmental factors in real-life settings. Although they hold potential benefits for aiding smoking cessation, no single wearable device currently achieves high accuracy in detecting smoking events. Furthermore, it is crucial to emphasize that this area of study is dynamic and requires ongoing updates. Objective: This scoping review aims to map the scientific literature for identifying the main sensors developed or used for tobacco smoke detection, with a specific focus on wearable sensors, as well as describe their key features and categorize them by type. Methods: According to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) protocol, an electronic search was conducted on the PubMed, MEDLINE, and Web of Science databases, using the following keywords: (“biosensors” OR “biosensor” OR “sensors” OR “sensor” OR “wearable”) AND (“smoking” OR “smoke”). Results: Among a total of 37 studies included in this scoping review published between 2012 and March 2024, 16 described sensors based on wearable bands, 15 described multisensory systems, and 6 described other strategies to detect tobacco smoke exposure. Included studies provided details about the design or application of wearable sensors based on an elastic band to detect different aspects of tobacco smoke exposure (eg, arm, wrist, and finger movements, and lighting events). Some studies proposed a system composed of different sensor modalities (eg, Personal Automatic Cigarette Tracker [PACT], PACT 2.0, and AutoSense). Conclusions: Our scoping review has revealed both the obstacles and opportunities linked to wearable devices, offering valuable insights for future research initiatives. Tackling the recognized challenges and delving into potential avenues for enhancement could elevate wearable devices into even more effective tools for aiding smoking cessation. In this context, continuous research is essential to fine-tune and optimize these devices, guaranteeing their practicality and reliability in real-world applications. %M 39476379 %R 10.2196/52383 %U https://mhealth.jmir.org/2024/1/e52383 %U https://doi.org/10.2196/52383 %U http://www.ncbi.nlm.nih.gov/pubmed/39476379 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57839 %T Evaluating the Impact of a Game (Inner Dragon) on User Engagement Within a Leading Smartphone App for Smoking Cessation: Randomized Controlled Trial %A White,Justin S %A Toussaert,Séverine %A Raiff,Bethany R %A Salem,Marie K %A Chiang,Amy Yunyu %A Crane,David %A Warrender,Edward %A Lyles,Courtney R %A Abroms,Lorien C %A Westmaas,J Lee %A Thrul,Johannes %+ Department of Health Law, Policy and Management, Boston University School of Public Health, Talbot Building - 249W, 715 Albany Street, Boston, MA, 02118, United States, 1 617 358 1916, juswhite@bu.edu %K smoking cessation %K mobile app %K games for health %K gamification %K engagement %K randomized controlled trial %K mobile phone %D 2024 %7 30.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphone apps are a convenient, low-cost approach to delivering smoking cessation support to large numbers of individuals. Yet, the apps are susceptible to low rates of user engagement and retention. Objective: This study aims to test the effects of a new game module (called Inner Dragon) integrated into Smoke Free (23 Limited), a leading smoking cessation app with established efficacy. The primary outcomes measured user engagement with the app. Methods: A 2-arm, parallel-group, randomized controlled trial was conducted in the United States with an 8-week follow-up. Adult individuals who smoked ≥1 cigarettes daily and planned to quit smoking within 7 days were recruited and randomized (N=500), with equal allocation. Both groups received free access to the original Smoke Free app with “core” features of its smoking cessation program (eg, a diary and craving log). The treated group received additional access to the integrated Inner Dragon game that incorporated several game mechanics designed to increase user engagement. User engagement outcomes were the number of unique app sessions, average minutes per session, days with a session, and program adherence. Self-reported and verified smoking abstinence and app satisfaction were also assessed. The main analysis estimated the intention-to-treat effect of access to Inner Dragon on each outcome. Further analyses assessed effect modification by participant characteristics and the association of intensity of game use with program adherence and abstinence. Results: Overall, user engagement was greater for treated versus control participants: they had 5.3 more sessions of Smoke Free (mean 29.6, SD 36.5 sessions vs mean 24.3, SD 37.9 sessions; P=.06), 0.8 more minutes per session (mean 6.9, SD 5.4 min vs mean 6.1, SD 5.2 min; P=.047), and 3.4 more days with a session (mean 14.3, SD 15.3 days vs mean 11.9, SD 14.3 days; P=.03). Program adherence, based on the number of times core features of the original Smoke Free app were used, was higher for treated versus control participants (mean 29.4, SD 41.3 times vs mean 22.6, SD 35.6 times; P=.03). Self-reported 7-day and 30-day point-prevalence abstinence and verified 7-day point-prevalence abstinence at 8 weeks did not significantly differ by study group. The mean repeated 1-day prevalence of quitting was higher among the treated group versus the control group (mean 17.3%, SD 25.6 vs mean 12.4%, SD 21.3; P=.01). App satisfaction and the motivation to (stay) quit did not differ by study group. Higher intensity of game use was associated with increased program adherence and self-reported abstinence. Conclusions: Findings suggest that the Inner Dragon game increased user engagement and program adherence. Additional refinements to the game design may clarify whether the game increases abstinence rates. Overall, it is feasible to deploy games and gamification to enhance user engagement in existing smoking cessation interventions. Trial Registration: ClinicalTrials.gov NCT05227027; https://clinicaltrials.gov/study/NCT05227027 %M 39475840 %R 10.2196/57839 %U https://www.jmir.org/2024/1/e57839 %U https://doi.org/10.2196/57839 %U http://www.ncbi.nlm.nih.gov/pubmed/39475840 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50378 %T Efficacy of a Multimodal Digital Behavior Change Intervention on Lifestyle Behavior, Cardiometabolic Biomarkers, and Medical Expenditure: Protocol for a Randomized Controlled Trial %A Howard-Wilson,Sakeina %A Ching,Jack %A Gentile,Sherri %A Ho,Martin %A Garcia,Alex %A Ayturk,Didem %A Lazar,Peter %A Hammerquist,Nova %A McManus,David %A Barton,Bruce %A Bird,Steven %A Moore,John %A Soni,Apurv %+ Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 (774) 455 6571, sakeina.howard-wilson2@umassmed.edu %K health behavior %K fitness %K digital devices %K lifestyle change %K cardiovascular disease %K chronic disease %K physical activity %K nutrition %K sleep %K mindfulness %D 2024 %7 30.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The US Preventive Services Task Force recommends providers offer individualized healthy behavior interventions for all adults, independent of their risk of cardiovascular disease. While strong evidence exists to support disease-specific programs designed to improve multiple lifestyle behaviors, approaches to adapting these interventions for a broader population are not well established. Digital behavior change interventions (DBCIs) hold promise as a more generalizable and scalable approach to overcome the resource and time limitations that traditional behavioral intervention programs face, especially within an occupational setting. Objective: We aimed to evaluate the efficacy of a multimodal DBCI on (1) self-reported behaviors of physical activity, nutrition, sleep, and mindfulness; (2) cardiometabolic biomarkers; and (3) chronic disease–related medical expenditure. Methods: We conducted a 2-arm randomized controlled trial for 12 months among employees of an academic health care facility in the United States. The intervention arm received a scale, a smartphone app, an activity tracker, a video library for healthy behavior recommendations, and an on-demand health coach. The control arm received standard employer-provided health and wellness benefits. The primary outcomes of the study included changes in self-reported lifestyle behaviors, cardiometabolic biomarkers, and chronic disease–related medical expenditure. We collected health behavior data via baseline and quarterly web-based surveys, biometric measures via clinic visits at baseline and 12 months, and identified relevant costs through claims datasets. Results: A total of 603 participants were enrolled and randomized to the intervention (n=300, 49.8%) and control arms (n=303, 50.2%). The average age was 46.7 (SD 11.2) years, and the majority of participants were female (80.3%, n=484), White (85.4%, n=504), and non-Hispanic (90.7%, n=547), with no systematic differences in baseline characteristics observed between the study arms. We observed retention rates of 86.1% (n=519) for completing the final survey and 77.9% (n=490) for attending the exit visit. Conclusions: This study represents the largest and most comprehensive evaluation of DBCIs among participants who were not selected based on their underlying condition to assess its impact on behavior, cardiometabolic biomarkers, and medical expenditure. Trial Registration: ClinicalTrials.gov NCT04712383; https://clinicaltrials.gov/study/NCT04712383 International Registered Report Identifier (IRRID): RR1-10.2196/50378 %M 39475852 %R 10.2196/50378 %U https://www.researchprotocols.org/2024/1/e50378 %U https://doi.org/10.2196/50378 %U http://www.ncbi.nlm.nih.gov/pubmed/39475852 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55239 %T Initial Evaluation of Acceptability, Engagement, and Effectiveness of the MO App to Provide Tailored and Comprehensive Support for Smoking Cessation: Development and Usability Study %A Zhou,Shuo %A Brunetta,Paul %A Silvasstar,Joshva %A Feldman,Greg %A Oromi,Nicolas %A Bull,Sheana %+ Department of Communication Studies, School of Communication and System Health Lab, Hong Kong Baptist University, 913, No. 5 Hereford Rd, KL, Hong Kong, China (Hong Kong), 852 34118230, shuozhou@hkbu.edu.hk %K smoking cessation %K tobacco %K mobile phone app %K mHealth %K mobile health %K iterative design %K feasibility %K acceptability %K engagement %K efficacy %K mobile phone %D 2024 %7 29.10.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the growing availability of smoking cessation apps, low engagement and cessation rates have remained a significant challenge. To address this issue, we used a user-centered design to iteratively develop a mobile app (MO) to provide comprehensive, tailored, and evidence-based content to support smokers in their quitting journey. Objective: This study examined the acceptability, use, and preliminary efficacy of the MO app for smoking cessation. Specifically, we sought to understand smokers’ preferred features, engagement, and satisfaction with MO; identify concerns in using the app and ways to improve the app; and evaluate its smoking cessation outcomes. Methods: Through 3 cohorts, we recruited 10, 12, and 85 adult smokers who attempted to quit smoking to pilot-test the MO app between December 2019 and July 2022. Participants were instructed to complete a baseline survey, interact with the app for 6 weeks, and fill in a postsurvey at week 6. Participants in cohort 3 completed an additional postsurvey at week 12. Participants’ app use was tracked and analyzed. The primary outcome measures were participants’ 7-day point prevalence abstinence at 6 and 12 weeks. Results: Participants reported high levels of satisfaction with the MO app across all 3 cohorts, rating it between 4.40 and 4.76 on a scale of 5 for acceptability. Users engaged with app activities for an average of 89 to 159 times over 35 days. The most liked features of the app included “quit plan,” “tracking,” “reminders and notifications,” “MOtalks,” and “motivational quotes.” The 7-day point prevalence abstinence rate of the modified intention to treat population in cohort 3 was 58% at 6 weeks and 52% at 12 weeks. Those who interacted more frequently with app features and engaged with more diverse activities were more likely to maintain abstinence at weeks 6 and 12. For each additional time logged into the app, the odds of staying abstinent at week 12 increased by 5% (odds ratio [OR] 1.05, 95% CI 1.01-1.08). Participants who earned >5000 points during app use also had higher odds of quitting at both 6 weeks (OR 3.12, 95% CI 1.25-7.75) and 12 weeks (OR 4.65, 95% CI 1.83-11.76), compared with those who earned <5000 points. Conclusions: Our study demonstrated that MO is a feasible mobile phone app with high acceptability and usability and can effectively deliver smoking cessation support to individuals who want to quit. Implications for developing and evaluating mobile phone apps for smoking cessation are discussed. %M 39471372 %R 10.2196/55239 %U https://mhealth.jmir.org/2024/1/e55239 %U https://doi.org/10.2196/55239 %U http://www.ncbi.nlm.nih.gov/pubmed/39471372 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56882 %T A Tailored Postpartum eHealth Physical Activity Intervention for Individuals at High Risk of Postpartum Depression—the POstpartum Wellness Study (POW): Protocol and Data Overview for a Randomized Controlled Trial %A Ramsey,Maya %A Oberman,Nina %A Quesenberry Jr,Charles P %A Kurtovich,Elaine %A Gomez Chavez,Lizeth %A Chess,Aaloni %A Brown,Susan Denise %A Albright,Cheryl L %A Bhalala,Mibhali %A Badon,Sylvia E %A Avalos,Lyndsay A %+ Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Dr., Pleasanton, CA, 94588, United States, 1 5108210300, Lyndsay.A.Avalos@kp.org %K postpartum depression %K depression %K eHealth %K online workout videos %K exercise videos %K physical activity %K wellness %K health promotion %K digital interventions %D 2024 %7 29.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Postpartum depression (PPD) is associated with significant health consequences for the parent and child. Current recommendations for PPD prevention require intense health care system resources. Evidence-based interventions for PPD prevention that do not further burden the health care system are needed. Evidence suggests that physical activity (PA) can generally reduce depressive symptoms. Technology-based interventions may help decrease common barriers to PA. Objective: This study aims to report the protocol and provide a data overview of the POstpartum Wellness study (POW)—an effectiveness trial evaluating whether an eHealth PA intervention tailored for postpartum individuals increased PA and decreased depressive symptoms among individuals at high PPD risk. Methods: This remote parallel-group randomized controlled trial included postpartum individuals with a history of depression or at least moderate current depressive symptoms not meeting the PPD diagnostic threshold and with low PA levels from an integrated health care delivery system. Participants were randomized to an eHealth PA intervention or usual care. The intervention group received access to a library of web-based workout videos designed for postpartum individuals, which included interaction with their infants. At baseline and follow-up (3 and 6 months), PA was measured using questionnaires and a wrist-worn accelerometer. Depressive symptoms were measured using the Patient Health Questionnaire-8 (PHQ-8). Data were collected to assess exploratory outcomes of sleep, perceived stress, anxiety, parent-infant bonding, and infant development. Results: The study was funded in January 2020. Participants were enrolled via REDCap (Research Electronic Data Capture) or telephonically between November 2020 and September 2022; data collection ended in April 2023. Randomized participants (N=99) were 4 months post partum at baseline with moderately severe depressive symptoms (mean PHQ-8 score 12.6, SD 2.2). Intervention (n=50) and usual care (n=49) groups had similar sociodemographic characteristics, months post partum, baseline depressive symptoms, number of children at home, and prepregnancy PA levels. Retention in assessments was ≥66% for questionnaires and ≥48% for accelerometry, with modest differences by group. At 3-month follow-up, 73 of 99 (74%) participants (intervention: 35/50, 70%; usual care: 38/49, 78%) completed questionnaires; 53 of 99 (54%) wore the accelerometer for 7 days (27 of 50 (54%) intervention, 26 of 49 (53%) usual care). At 6-month follow-up, 66 of 99 (67%) participants (30 of 50 (60%) intervention, 36 of 49 (73%) usual care) completed questionnaires and 43 of 99 (43%) wore the accelerometer for 7 days (21 of 50 (42%) intervention, 22 of 49 (45%) usual care). Data analysis is completed, and a manuscript with these findings is currently under review for publication. Conclusions: The POW trial evaluates the effectiveness of an eHealth PA intervention for improving depressive symptoms and increasing PA among postpartum individuals at high PPD risk. Results have implications for the design and delivery of behavioral interventions among vulnerable patients. Trial Registration: ClinicalTrials.gov NCT04414696; https://clinicaltrials.gov/ct2/show/NCT04414696 International Registered Report Identifier (IRRID): DERR1-10.2196/56882 %M 39470705 %R 10.2196/56882 %U https://www.researchprotocols.org/2024/1/e56882 %U https://doi.org/10.2196/56882 %U http://www.ncbi.nlm.nih.gov/pubmed/39470705 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e47104 %T Mobile-Based Platform With a Low-Calorie Dietary Intervention Involving Prepackaged Food for Weight Loss for People With Overweight and Obesity in China: Half-Year Follow-Up Results of a Randomized Controlled Trial %A Wang,Xi %A Wang,Suyuan %A Zhong,Lingyu %A Zhang,Chenghui %A Guo,Yanhong %A Li,Mingxia %A Zhao,Li %A Ji,Shuming %A Pan,Junjie %A Wu,Yunhong %K weight loss %K obesity %K body fat %K food replacement product %K meal replacement %K weight %K obese %K RCT %K randomized %K mHealth %K mobile health %K mobile app %K mobile application %K mobile phone %D 2024 %7 28.10.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Obesity is a rapidly increasing health problem in China, causing massive economic and health losses annually. Many techniques have emerged to help people with obesity better adhere to intervention programs and achieve their weight loss goals, including food replacement and internet-delivered weight loss consultations. Most studies on weight loss interventions mainly focused on the change in body weight or BMI; however, body fat, especially visceral fat mass, is considered the main pathogenic factor in obesity. In China, more reliable evidence is required on this topic. Moreover, it is unclear whether an integrated weight loss program combining food replacement products, mobile app-based platforms, and daily body composition monitoring using a wireless scale is useful and practical in China. Objective: In this 2-arm, parallel-designed, randomized study, we explored the effectiveness and safety of the Metawell (Weijian Technologies Inc) weight loss program in China, which combines prepackaged biscuits, a wireless scale, and a mobile app. Methods: Participants in the intervention group were guided to use food replacement products and a scale for weight loss and monitoring, whereas participants in the control group received printed material with a sample diet and face-to-face education on weight loss at enrollment. The intervention lasted for 3 months, and follow-up visits were conducted at months 3 and 6 after enrollment. Dual-energy x-ray absorptiometry and quantitative computed tomography were used to assess body fat. A multilevel model for repeated measurements was used to compare differences between the 2 groups. Results: In total, 220 patients were randomly assigned to intervention (n=110) and control (n=110) groups. Participants in the intervention group had significantly greater decreases in BMI, total body fat, visceral adipose area, and subcutaneous adipose area (all P<.001) than those in the control group. However, the rate of change in lean mass was not significantly different between the 2 groups (P=.62). Further, 35 participants in the intervention group reported adverse events. Constipation was the most frequently reported adverse event (11/110), followed by dizziness (6/110), hypoglycemia (4/110), fatigue (3/110), and gastritis (3/35). Conclusions: The Metawell program was effective for weight loss. After the intervention, participants in the intervention group lost more body weight and body fat while retaining muscle mass than those in the control group. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900021630; https://www.chictr.org.cn/showproj.html?proj=36183 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-048106 %R 10.2196/47104 %U https://mhealth.jmir.org/2024/1/e47104 %U https://doi.org/10.2196/47104 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57376 %T Outcomes of a Comprehensive Mobile Vaping Cessation Program in Adults Who Vape Daily: Cohort Study %A Marler,Jennifer D %A Fujii,Craig A %A Utley,MacKenzie T %A Balbierz,Daniel J %A Galanko,Joseph A %A Utley,David S %+ Pivot Health Technologies, Inc, 1010 Commercial St, Suite C, San Carlos, CA, 94070, United States, 1 4082145545, marler@pivot.co %K app %K digital health %K mobile health %K mHealth %K mobile apps %K smartphone %K vaping %K vaping cessation %K mobile phone %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, e-cigarettes, or vapes, are the second most commonly used tobacco product. Despite abundant smartphone app–based cigarette cessation programs, there are few such programs for vaping and even fewer supporting data. Objective: This exploratory, prospective, single-arm, remote cohort study of the Pivot vaping cessation program assessed enrollment and questionnaire completion rates, participant engagement and retention, changes in attitudes toward quitting vaping, changes in vaping behavior, and participant feedback. We aimed to establish early data to inform program improvements and future study design. Methods: American adults aged ≥21 years who vaped daily, reported ≥5 vape sessions per day, and planned to quit vaping within 6 months were recruited on the web. Data were self-reported via app- and web-based questionnaires. Outcomes included engagement and retention (ie, weeks in the program, number of Pivot app openings, and number of messages sent to the coach), vaping attitudes (ie, success in quitting and difficulty staying quit), vaping behavior (ie, quit attempts, Penn State Electronic Cigarette Dependence Index, 7- and 30-day point-prevalence abstinence [PPA], and continuous abstinence [defined as ≥7-day PPA at 12 weeks+30-day PPA at 26 weeks+0 vaping sessions since 12 weeks]), and participant feedback. Results: In total, 73 participants onboarded (intention-to-treat sample); 68 (93%) completed the 12- and 26-week questionnaires (completer samples). On average, participants were active in Pivot for 13.8 (SD 7.3) weeks, had 87.3 (SD 99.9) app sessions, and sent 37.6 (SD 42.3) messages to their coach over 26 weeks. Mean success in quitting and difficulty staying quit (scale of 1-10) improved from baseline to 12 weeks—4.9 (SD 2.9) to 7.0 (SD 3.0) and 4.0 (SD 2.8) to 6.2 (SD 3.1), respectively (P<.001 in both cases). Most participants (64/73, 88%) made ≥1 quit attempt. At 26 weeks, intention-to-treat 7-day PPA, 30-day PPA, and continuous abstinence rates were 48% (35/73), 45% (33/73), and 30% (22/73), respectively. In total, 45% (33/73) of the participants did not achieve 7-day PPA at 26 weeks; their mean Penn State Electronic Cigarette Dependence Index score decreased from baseline (13.9, SD 3.1) to 26 weeks (10.8, SD 4.5; mean change –3.2, SD 3.9; P<.001); 48% (16/33) of these participants improved in the e-cigarette dependence category. At 2 weeks, 72% (51/71) of respondents reported that using Pivot increased their motivation to quit vaping; at 4 weeks, 79% (55/70) reported using Pivot decreased the amount they vaped per day. Conclusions: In this first evaluation of Pivot in adult daily vapers, questionnaire completion rates were >90%, average program engagement duration was approximately 14 weeks, and most participants reported increased motivation to quit vaping. These and early cessation outcomes herein suggest a role for Pivot in vaping cessation and will inform associated future study and program improvements. %M 39331522 %R 10.2196/57376 %U https://formative.jmir.org/2024/1/e57376 %U https://doi.org/10.2196/57376 %U http://www.ncbi.nlm.nih.gov/pubmed/39331522 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e52295 %T Mobile App–Assisted Parent Training Intervention for Behavioral Problems in Children With Autism Spectrum Disorder: Pilot Randomized Controlled Trial %A Lee,JooHyun %A Lim,JaeHyun %A Kang,Soyeon %A Kim,Sujin %A Jung,So Yoon %A Kim,Sujin %A Hong,Soon-Beom %A Park,Yu Rang %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 0222282493, yurangpark@yuhs.ac %K autism spectrum disorder %K parent training program %K parent education %K behavioral problems %K child behavior %K mobile app %K feasibility %K mHealth %K evidence-based parent training %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In children with autism spectrum disorder (ASD), problem behaviors play a dysfunctional role, causing as much difficulty with daily living and adjustment as the core symptoms. If such behaviors are not effectively addressed, they can result in physical, economic, and psychological issues not only for the individual but also for family members. Objective: We aimed to develop and evaluate the feasibility of a mobile app–assisted parent training program for reducing problem behaviors in children with ASD. Methods: This open-label, single-center, randomized controlled trial was conducted among parents of children with ASD aged 36-84 months. Participants were recruited from the Department of Psychiatry at Seoul National University Hospital. Participants were randomly assigned (1:1) by a blinded researcher. Randomization was performed using a stratified block randomization (with a block size of 4). Parents in the intervention group completed the mobile app–assisted parent training program at home over a 12-week period. They continued to receive their usual nondrug treatment in addition to the mobile app–assisted parent training program. The control group continued to receive their usual nonpharmaceutical treatment for 12 weeks without receiving the parent training program intervention. The primary outcome measure was the median change in the Korean Child Behavior Checklist (K-CBCL) scores from before to after the intervention. Lower scores on the K-CBCL indicated a decrease in overall problem behavior. Results: Between November 9, 2022, and December 8, 2022, 64 participants were enrolled. Overall, 42 children (intervention group median age: 49, IQR 41-52.5 months; control group median age: 49, IQR 42-58 months) of the participants joined the program. The intervention group included 20 (48%) participants and the control group included 22 (52%) participants. In the intervention group, the K-CBCL total scores showed a decrease after the intervention, with a median difference of –0.5 (95% CI –4.5 to 3). Pervasive developmental disorder scores also showed a decrease, with a median difference of –2.1 (95% CI –8.5 to 2.5). However, there was no significant difference in Clinical Global Impression–Severity of Illness scores after the intervention for both the control and intervention groups. Scores on the Korean version of the Social Communication Questionnaire showed a further decrease after the intervention in the intervention group (median difference –2, 95% CI –4 to 1). Caregivers’ stress evaluated using the Korean Parenting Stress Index Fourth Edition–Short Form did not show any significant differences between the control and intervention groups. There were no adverse events related to study participation. Conclusions: The findings demonstrated the feasibility of using mobile devices for evidence-based parent training to reduce problem behaviors in children with ASD. Mobile devices’ accessibility and flexibility may provide a viable alternative for offering early intervention for problem behaviors in children with ASD. Trial Registration: CRIS KCT0007841; https://cris.nih.go.kr/cris/search/detailSearch.do?&seq=23112 %M 39466295 %R 10.2196/52295 %U https://humanfactors.jmir.org/2024/1/e52295 %U https://doi.org/10.2196/52295 %U http://www.ncbi.nlm.nih.gov/pubmed/39466295 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e60209 %T Assessment of Wearable Device Adherence for Monitoring Physical Activity in Older Adults: Pilot Cohort Study %A Ding,Huitong %A Ho,Kristi %A Searls,Edward %A Low,Spencer %A Li,Zexu %A Rahman,Salman %A Madan,Sanskruti %A Igwe,Akwaugo %A Popp,Zachary %A Burk,Alexa %A Wu,Huanmei %A Ding,Ying %A Hwang,Phillip H %A Anda-Duran,Ileana De %A Kolachalama,Vijaya B %A Gifford,Katherine A %A Shih,Ludy C %A Au,Rhoda %A Lin,Honghuang %K physical activity %K remote monitoring %K wearable device %K adherence %K older adults %D 2024 %7 25.10.2024 %9 %J JMIR Aging %G English %X Background: Physical activity has emerged as a modifiable behavioral factor to improve cognitive function. However, research on adherence to remote monitoring of physical activity in older adults is limited. Objective: This study aimed to assess adherence to remote monitoring of physical activity in older adults within a pilot cohort from objective user data, providing insights for the scalability of such monitoring approaches in larger, more comprehensive future studies. Methods: This study included 22 participants from the Boston University Alzheimer’s Disease Research Center Clinical Core. These participants opted into wearing the Verisense watch as part of their everyday routine during 14-day intervals every 3 months. Eighteen continuous physical activity measures were assessed. Adherence was quantified daily and cumulatively across the follow-up period. The coefficient of variation was used as a key metric to assess data consistency across participants over multiple days. Day-to-day variability was estimated by calculating intraclass correlation coefficients using a 2-way random-effects model for the baseline, second, and third days. Results: Adherence to the study on a daily basis outperformed cumulative adherence levels. The median proportion of adherence days (wearing time surpassed 90% of the day) stood at 92.1%, with an IQR spanning from 86.9% to 98.4%. However, at the cumulative level, 32% (7/22) of participants in this study exhibited lower adherence, with the device worn on fewer than 4 days within the requested initial 14-day period. Five physical activity measures have high variability for some participants. Consistent activity data for 4 physical activity measures might be attainable with just a 3-day period of device use. Conclusions: This study revealed that while older adults generally showed high daily adherence to the wearable device, consistent usage across consecutive days proved difficult. These findings underline the effectiveness of wearables in monitoring physical activity in older populations and emphasize the ongoing necessity to simplify usage protocols and enhance user engagement to guarantee the collection of precise and comprehensive data. %R 10.2196/60209 %U https://aging.jmir.org/2024/1/e60209 %U https://doi.org/10.2196/60209 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54673 %T Factors Related to mHealth App Use Among Japanese Workers: Cross-Sectional Survey %A Ozaki,Itsuko %A Nishijima,Mariko %A Shibata,Eiji %A Zako,Yuri %A Chiang,Chifa %+ Graduate School of Nursing, Nagoya City University, 1-4-7 Aoi, Higashi-ku, Nagoya, 461-0004, Japan, 81 52 982 7343, itsuko@med.nagoya-cu.ac.jp %K mHealth %K mobile health %K mobile health apps %K prevalence %K health promotion %K health management %K Japanese worker %K Japan %K cross-sectional survey %K disease management %K app users %K physical activity %D 2024 %7 25.10.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Health care providers can make health guidance more effective by using mobile health technologies such as health apps. Although health care providers need to know who uses health apps, existing studies have yielded inconsistent results. Objective: The aim of the study was (1) to clarify the prevalence and patterns of health app use to improve health behaviors for preventing lifestyle-related diseases among Japanese workers and (2) to identify the associations among demographic characteristics, health behavior, and internet use and health app use by gender. Methods: Data were collected from a cross-sectional internet survey in 2023. In total, 2200 participants were included, with an even distribution of men and women in each age group aged 20 to 60 years. The participants were workers with smartphones and reported their gender, age, residence area, marital status, education, employment status, occupation, work pattern, diseases under treatment, health checkups, health guidance, health behaviors, internet use duration, and number of devices used. We asked about current and previous health app use for 1 month. A multivariate logistic regression analysis was conducted by gender. Results: Of the participants, 472 (21.5%) and 189 (8.6%) were current and previous health app users, respectively. Most current and previous health app users used features that record and track their physical activity and other health behaviors. Health app users—both men and women—were more likely to have health checkups (odds ratio [OR] 1.53, 95% CI 1.12-2.11 and OR 1.51, 95% CI 1.10-2.07, respectively), receive health guidance (OR 2.01, 95% CI 1.47-2.74 and OR 1.86, 95% CI 1.32-2.62, respectively), engage in regular physical activity (OR 2.57, 95% CI 1.91-3.47 and OR 1.94, 95% CI 1.41-2.67, respectively), use the internet for 120-179 minutes per day (OR 1.76, 95% CI 1.13-2.75 and OR 1.70, 95% CI 1.12-2.57, respectively), and were less likely to be older (50-59 years: OR 0.54, 95% CI 0.33-0.88 and OR 0.40, 95% CI 0.25-0.6, respectively, and 60-69 years: OR 0.37, 95% CI 0.22-0.62 and OR 0.47, 95% CI 0.28-0.77, respectively). According to gender, male health app users were more likely to be married (OR 1.69, 95% CI 1.23-2.33) and less likely to work in the security, agriculture, forestry, fishing, manufacturing, or transportation industries (OR 0.62, 95% CI 0.41-0.95). Female health app users were more likely to have a university education or higher (OR 1.55, 95% CI 1.061-2.26), maintain an appropriate body weight (OR 1.52, 95% CI 1.10-2.11), and use 3 or more devices (OR 2.13, 95% CI 1.41-3.23). Conclusions: Physical activity and health guidance are strong predictors of app use. Health care providers should assess the target populations’ preferences for app use based on their characteristics, support their app use, and enhance the effectiveness of health guidance. %M 39454195 %R 10.2196/54673 %U https://humanfactors.jmir.org/2024/1/e54673 %U https://doi.org/10.2196/54673 %U http://www.ncbi.nlm.nih.gov/pubmed/39454195 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56376 %T Cadence-Based Pedometer App With Financial Incentives to Enhance Moderate-to-Vigorous Physical Activity: Development and Single-Arm Feasibility Study %A Hayashi,Kosuke %A Imai,Hiromitsu %A Oikawa,Ichiro %A Ishihara,Yugo %A Wakuda,Hirokazu %A Miura,Iori %A Uenohara,Shingo %A Kuwae,Asuka %A Kai,Megumi %A Furuya,Ken'ichi %A Uemura,Naoto %+ Department of Clinical Pharmacology and Therapeutics, Oita University, 1-1 Idaigaoka, Hasama-Machi, Yufu, 8795593, Japan, 81 975865952, khayashi@oita-u.ac.jp %K physical activity %K behavioral economics %K pedometer %K arm %K cadence %K app %K public health %K walk %K Google Fit %K heart points %K exercise %K mobile phone %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: High levels of physical activity are key to improving health outcomes, yet many people fail to take action. Using pedometers to target steps per day and providing financial incentives is a simple and scalable approach to promoting public health. However, conventional pedometers do not account for “intensity” and “duration,” making it challenging to efficiently increase people’s moderate-to-vigorous physical activity (MVPA), which is expected to improve health outcomes. Based on these rationales, we developed a smartphone app that sets step cadence as a goal (defined as a daily challenge of walking more than 1500 steps in 15 minutes twice a day, which is a heuristic threshold for moderate physical activity) and provides financial incentive when the challenge is met. Objective: This study aimed to evaluate the feasibility of our novel app and explore whether its use can increase users’ daily MVPA. Methods: A single-arm pre-post study evaluated the feasibility and efficacy of the app. A total of 15 participants used app 1 (an app without financial incentives) for the first period (4 weeks) and then switched to app 2 (an app with financial incentives) for the second period (4 weeks). The primary outcome was the difference between the first and second periods in the number of successful challenge attempts per week. Secondary outcomes were differences between the first and second periods in daily steps and distance walked. Exploratory outcomes included the difference between the first and second periods in daily “heart points” as measured by Google Fit, a publicly available app that measures users’ daily MVPA. Results: The number of successful challenge attempts per week increased significantly compared to the first period (5.6 times per week vs 0.7 times per week; P<.001). Although not statistically significant, there was a trend toward an increase in the mean steps per day and distance walked per day (6586 steps per day vs 5950 steps per day; P=.19; and 4.69 km per day vs 3.85 km per day; P=.09, respectively). An exploratory end point examining daily MVPA by “heart points” collected from Google Fit also showed a significant increase compared to the first period (22.7 points per day vs 12.8 points per day; P=.02). Conclusions: Our app using step cadence as a goal and providing financial incentives seemed feasible and could be an effective app to increase users’ daily MVPA. Based on the results of this study, we are motivated to conduct a confirmatory study with a broader and larger number of participants. Trial Registration: UMIN 000050518; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000057420 %M 39447165 %R 10.2196/56376 %U https://formative.jmir.org/2024/1/e56376 %U https://doi.org/10.2196/56376 %U http://www.ncbi.nlm.nih.gov/pubmed/39447165 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e60961 %T Preparing for the Implementation of Long-Acting Injectable Cabotegravir for HIV Pre-Exposure Prophylaxis Within the Brazilian Public Health System (ImPrEP CAB Brasil): Qualitative Study %A Pimenta,M Cristina %A Torres,Thiago Silva %A Hoagland,Brenda %A Cohen,Mirian %A Mann,Claudio Gruber %A Jalil,Cristina M %A Carvalheira,Eduardo %A Freitas,Lucilene %A Fernandes,Nilo %A Castanheira,Debora %A Benedetti,Marcos %A Moreira,Julio %A Simpson,Keila %A Trefiglio,Roberta %A O’Malley,Gabrielle %A Veloso,Valdilea G %A Grinsztejn,Beatriz %+ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av Brasil 4365 Manguinhos, Rio de Janeiro, RJ 21040-900, Brazil, 55 21 38659623, thiago.torres@ini.fiocruz.br %K pre-exposure prophylaxis %K PrEP %K implementation %K public health system %K cabotegravir %K HIV prevention %K Latin America %K long-acting PrEP %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although long-acting, injectable cabotegravir (CAB-LA) pre-exposure prophylaxis (PrEP) has proven efficacious for HIV prevention in clinical trials, research is needed to guide effective implementation in real-world settings. Formative work with community members and health care providers (HCPs) is important to provide insight into the needs and contexts of specific populations and reveal potential barriers and facilitators for implementation projects. Objective: We aimed to describe the results from formative work to develop an implementation package for CAB-LA PrEP within the ImPrEP CAB Brasil study. Methods: ImPrEP CAB Brasil is an implementation study of same-day delivery of CAB-LA PrEP for young sexual and gender minority (SGM) groups (aged 18-30 years) in 6 existing oral PrEP public health clinics. We conducted formative research to prepare for the implementation of ImPrEP CAB Brasil through community mobilization, process mapping with HCPs with experience in CAB-LA, and focus group discussions (FGDs) with young SGM groups (n=92) and HCPs (n=20) to identify initial perceptions of facilitators and barriers for CAB-LA PrEP implementation, refine the mobile health (mHealth) educational tool, and evaluate the acceptability of using a text message appointment reminder intervention through WhatsApp. FGDs were recorded, transcribed, systematically coded, and analyzed with thematic categorization by trained researchers using a qualitative data analysis program ATLAS.ti (version 7). Results: A community mobilization team comprising 34 SGM community leaders collaborated in creating a prototype for an mHealth educational tool and contributed to the planning of peer education activities. We created 3 process maps for each site to describe the initial visit, follow-up visits, and laboratory flow. The main challenge identified for same-day CAB-LA PrEP delivery was the extended duration of clinic visits due to the numerous laboratory tests and HIV counseling steps required. Proposed solutions included having point-of-care HIV rapid tests instead of laboratory tests and additional counseling staff. Barriers for CAB-LA PrEP implementation identified through FGDs were the training of HCPs, support for adherence to injection appointments, and stigma or discrimination against SGM groups and persons using PrEP. The mHealth educational tool and WhatsApp reminders were highly acceptable by SGM groups and HCPs, indicating their potential to support PrEP choice and adherence. Content analysis on the cultural appropriateness of the language and overall clarity of the material contributed to the refinement of the mHealth tool. Conclusions: Structured formative work with SGM persons and HCPs generated important refinements to context-specific materials and plans to launch ImPrEP CAB Brasil in public health clinics. Ongoing implementation monitoring will use the process maps to identify additional barriers and potential solutions to same-day delivery of CAB-LA PrEP. Summative evaluations are needed to measure the effectiveness of the mHealth educational tool to support PrEP choice and the use of WhatsApp appointment reminders. %M 39446416 %R 10.2196/60961 %U https://publichealth.jmir.org/2024/1/e60961 %U https://doi.org/10.2196/60961 %U http://www.ncbi.nlm.nih.gov/pubmed/39446416 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e52866 %T Outcomes of Providing Children Aged 7-12 Years With Access to Evidence-Based Anxiety Treatment Via a Standalone Digital Intervention Using Immersive Gaming Technology: Real-World Evaluation %A Gee,Brioney %A Teague,Bonnie %A Laphan,Andrew %A Clarke,Tim %A Coote,Georgianna %A Garner,Jessica %A Wilson,Jon %K anxiety %K children %K young people %K exposure therapy %K graded exposures %K cognitive behavioural therapy %K digital intervention %K mobile app %K gaming %K real-world evaluation %K gaming technology %K real-world implementation %D 2024 %7 22.10.2024 %9 %J JMIR Ment Health %G English %X Background: Anxiety disorders are among the most common mental health conditions in childhood, but most children with anxiety disorders do not access evidence-based interventions. The delivery of therapeutic interventions via digital technologies has been proposed to significantly increase timely access to evidence-based treatment. Lumi Nova (BfB Labs Limited) is a digital therapeutic intervention designed to deliver evidence-based anxiety treatment for those aged 7‐12 years through a mobile app incorporating immersive gaming technology. Objective: We aimed to evaluate the real-world impact of providing access to Lumi Nova through UK National Health Service–funded mental health services. Methods: We analyzed precollected anonymized data routinely captured through the implementation of Lumi Nova from children aged 7‐12 years, who lived in the United Kingdom and had the opportunity to use the intervention for at least 1 week over an 18-month period. Engagement indices included whether the game key was activated, number of unique sessions, time spent engaging, and number of “challenges” completed. Clinical outcomes were assessed using the Goal-Based Outcomes measure and Child Outcome Rating Scale. Demographic data were analyzed to assess the health equality implications of Lumi Nova. Results: Of 1029 eligible families invited to use Lumi Nova, 644 (62.5%) activated their game key, of whom 374 (58.1%) completed at least one in-game graded exposure challenge. The median number of unique sessions was 6 (IQR 3‐12) and the median time spent engaging with the intervention was 42 (IQR 15‐79) minutes. For the subset of young people with paired outcomes, there were statistically significant small to medium improvements in goal-based outcome scores (n=224; t223=5.78, P<.001; d=0.37, 95% CI 0.25‐0.52) and Child Outcome Rating Scale scores (n=123; t122=5.10, P<.001; d=0.46, 95% CI 0.27‐0.65) between the first and last data points. Two in 5 young people’s scores reflected a change that would be considered reliable. Analysis of demographic characteristics tentatively suggested that children from ethnic minority backgrounds and those living in the most deprived neighbourhoods may be less likely to access Lumi Nova, but children from socioeconomically deprived areas were more likely to successfully complete a challenge once they accessed the intervention (P=.02). However, the level of missing data and small number of children in some demographic groups limited meaningful statistical comparisons. Conclusions: This study provides initial evidence that Lumi Nova may be associated with improved outcomes for those aged 7‐12 years seeking anxiety treatment in real-world settings. However, the lack of a control comparator group and information about concurrent treatments accessed by the young people, in addition to substantial attrition, limited the analysis that could be conducted and confidence in the conclusions drawn. %R 10.2196/52866 %U https://mental.jmir.org/2024/1/e52866 %U https://doi.org/10.2196/52866 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52302 %T Technology-Supported Physical Activity and Its Potential as a Tool to Promote Young Women’s Physical Activity and Physical Literacy: Systematic Review %A Watson-Mackie,Kimberley %A Arundell,Lauren %A Lander,Natalie %A McKay,Fiona H %A Jerebine,Alethea %A Venetsanou,Fotini %A Barnett,Lisa M %+ School of Health and Social Development, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, kwatsonm@deakin.edu.au %K physical literacy %K young women %K girls %K adolescents %K technology %K mobile %K digital %K fitness %K exercise %K physical activity %K technology-supported %K systematic review %K digital health %K eHealth %K health informatics %K mobile phone %D 2024 %7 18.10.2024 %9 Review %J J Med Internet Res %G English %X Background: Despite the known benefits of physical activity (PA), rates of engagement in PA remain low globally. Low engagement in PA among young women can impact their health. Technology-supported PA may increase PA and physical literacy (PL; skills that can support PA) among young women. Objective: This systematic review aims to investigate the (1) associations between technology-supported PA and PA levels, (2) associations between technology-supported PA and PL levels, and (3) types of technology-supported PA that are associated with higher levels of PA engagement among young women aged 13 to 24 years. This age range was chosen as it includes two transitional periods characterized by decreases in PA. Methods: We searched 6 databases: Applied Science and Technology Source, Education Source, Embase, MEDLINE Complete, Global Health, and SPORTDiscus. Eligible studies were original research published in English between January 1, 2010, and April 24, 2024; focused on young women; and involving either technology-supported PA interventions or research exploring the correlation between technology and PA and PL. The findings of the review were presented descriptively. Study quality was assessed using the JBI Critical Appraisal tools. There were no deviations from the registered protocol. Results: In total, 23 (0.1%) studies (10,233 participants) from 23,609 records were included: randomized controlled trials (n=9, 39%), nonrandomized or retrospective observational studies (n=9, 39%), and cross-sectional studies (n=5, 22%). Of the 23 studies, 12 (52%) focused on young adults (aged ≥19 y), 9 (39%) involved adolescents (aged <19 y), and 2 (9%) focused on both groups. Nine studies (39%) were theory based. Common types of technology-supported PA were interactive websites or social media platforms (10/23, 43%), wearable fitness trackers (4/23, 17%), and mobile apps (4/23, 17%). PA or PL were predominantly self-reported (18/23, 78%). A total of 53 PA outcomes were measured: 36% (19/53) reported a positive impact on PA from mobile apps (9/15; 60% of analyses), interactive websites or social media platforms (8/27; 30% of analyses) and wearable fitness trackers (2/11; 18% of analyses). The impact on PL was weak (2/7; 29% of analyses). Eight studies (35%) were rated high, 7 (30%) medium, and 8 (35%) low in quality. Conclusions: There was limited evidence that technology-supported PA improved young women’s PA or PL. The evidence was limited by poor study quality and a lack of theoretical frameworks. In addition, little information was provided on the designs of the technology used. Future interventions seeking to improve young women’s PA and PL should focus on the development of mobile apps underpinned by behavior change theory and addressing whole domains of PL rather than specific elements. Given that technology continues to rapidly advance, further studies are needed to demonstrate the impact of technology-supported PA in improving PA and PL among young women. %M 39423006 %R 10.2196/52302 %U https://www.jmir.org/2024/1/e52302 %U https://doi.org/10.2196/52302 %U http://www.ncbi.nlm.nih.gov/pubmed/39423006 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e58403 %T Digital Health Innovations for Screening and Mitigating Mental Health Impacts of Adverse Childhood Experiences: Narrative Review %A White,Brianna M %A Prasad,Rameshwari %A Ammar,Nariman %A Yaun,Jason A %A Shaban-Nejad,Arash %K digital health %K digital technology %K digital intervention %K digital health technology %K artificial intelligence %K machine learning %K adverse childhood experience %K ACE %K positive childhood experiences %K children’s mental health %K mental health %K mental illness %K mental disorder %K pediatric mental health %K disease surveillance %D 2024 %7 16.10.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Exposures to both negative and positive experiences in childhood have proven to influence cardiovascular, immune, metabolic, and neurologic function throughout an individual’s life. As such, adverse childhood experiences (ACEs) could have severe consequences on health and well-being into adulthood. Objective: This study presents a narrative review of the use of digital health technologies (DHTs) and artificial intelligence to screen and mitigate risks and mental health consequences associated with ACEs among children and youth. Methods: Several databases were searched for studies published from August 2017 to August 2022. Selected studies (1) explored the relationship between digital health interventions and mitigation of negative health outcomes associated with mental health in childhood and adolescence and (2) examined prevention of ACE occurrence associated with mental illness in childhood and adolescence. A total of 18 search papers were selected, according to our inclusion and exclusion criteria, to evaluate and identify means by which existing digital solutions may be useful in mitigating the mental health consequences associated with the occurrence of ACEs in childhood and adolescence and preventing ACE occurrence due to mental health consequences. We also highlighted a few knowledge gaps or barriers to DHT implementation and usability. Results: Findings from the search suggest that the incorporation of DHTs, if implemented successfully, has the potential to improve the quality of related care provisions for the management of mental health consequences of adverse or traumatic events in childhood, including posttraumatic stress disorder, suicidal behavior or ideation, anxiety or depression, and attention-deficit/hyperactivity disorder. Conclusions: The use of DHTs, machine learning tools, natural learning processing, and artificial intelligence can positively help in mitigating ACEs and associated risk factors. Under proper legal regulations, security, privacy, and confidentiality assurances, digital technologies could also assist in promoting positive childhood experiences in children and young adults, bolstering resilience, and providing reliable public health resources to serve populations in need. %R 10.2196/58403 %U https://pediatrics.jmir.org/2024/1/e58403 %U https://doi.org/10.2196/58403 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49802 %T Comparing a Digital Health Check With Traditional Nurse-Led Health Examinations Among Long-Term Unemployed Individuals: Comparison Study %A Raussi,Venla %A Kujala,Sari %A Hörhammer,Iiris %A Savolainen,Kaisa %A Autio,Reija %A Koskela,Tuomas %+ Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere, 33520, Finland, 358 403564154, venla.raussi@tuni.fi %K chronic illnesses %K eHealth %K health care services %K lifestyle %K long-term unemployment %K digital health check %K primary prevention %K risk assessment %K risk factors %K prevention %K screening %D 2024 %7 16.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: A digital health check can be used to screen health behavior risks in the population, help health care professionals with standardized risk estimation for their patients, and motivate a patient to change unhealthy behaviors. Long-term unemployed individuals comprise a particular subgroup with an increased risk of lifestyle-related diseases. Objective: This study aims to investigate the clinical utility of a general digital health examination, the STAR Duodecim Health Check and Coaching Program (STAR), which was developed in Finland, in the targeted screening of long-term unemployed individuals. For this purpose, we compared health challenges identified by a digital health check with those identified by a nurse during a face-to-face health check for unemployed individuals. Methods: In this comparison study, 49 unemployed participants attending a health check were recruited from two Finnish primary health care centers. The participants used STAR and attended a nurse’s health check. Data were collected by surveys with multiple-choice and open-ended questions from the participants, nurses, and a study assistant who observed the session. The nurses were asked to name the three most significant health challenges for each participant. These health challenges were categorized into health challenges corresponding to STAR and these were compared with each other. Percentages of agreement between STAR and nurses were calculated. Sensitivity and specificity, as well as Cohen κ with P values and CIs, were computed for agreement. Results: STAR identified a total of 365 health challenges, an average of 7.4 (SD 2.5) health challenges per participant (n=49). The nurses named a total of 160 health challenges (n=47). In 53% (95% CI 38.1-67.9; n=25) of cases, STAR identified all categorized health challenges named by nurses. In 64% (95% CI 48.5-77.3; n=30) of cases, STAR identified at least 2/3 of the health challenges identified by nurses. Cohen κ was 0.877 (P<.001) for alcohol, indicating almost perfect agreement, and 0.440 (P<.001) for smoking and 0.457 (P=.001) for cholesterol, indicating moderate agreement. STAR left a total of 89 health challenges, an average of 1.8 (SD 1.1) per participant, uncategorized because STAR lacked an answer to the question or questions required for the classification of a certain health challenge. The participants did not always add information on their blood pressure (n=36, 74%), cholesterol (n=22, 45%), and waist circumference (n=15, 31%). Conclusions: In conclusion, STAR identified most of the health challenges identified by nurses but missed some essential ones. Participants did not have information on measurements, such as blood pressure and cholesterol values, which are pivotal to STAR in assessing cardiovascular risks. Using the tool for screening or as a part of a traditional health check with necessary measurements and dialog with health care professionals may improve the risk assessments and streamline the health checks of unemployed individuals. International Registered Report Identifier (IRRID): RR2-10.2196/27668 %M 39412874 %R 10.2196/49802 %U https://www.jmir.org/2024/1/e49802 %U https://doi.org/10.2196/49802 %U http://www.ncbi.nlm.nih.gov/pubmed/39412874 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60434 %T Intention to Use a Mental Health App for Menopause: Health Belief Model Approach %A Martin-Key,Nayra A %A Funnell,Erin L %A Benacek,Jiri %A Spadaro,Benedetta %A Bahn,Sabine %+ Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223 334151, sb209@cam.ac.uk %K menopause %K menopause transition %K mental health %K perimenopause %K women’s health %K psychological framework %K symptom tracking %K app usage %K app %K Health Belief Model %D 2024 %7 16.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Menopause presents a period of heightened vulnerability for mental health issues. Despite this, mental health screening is not consistently integrated into menopausal health care, and access to psychological interventions is limited. Digital technologies, such as web and smartphone apps, may offer a way to facilitate and improve mental health care provision throughout menopause. However, little is known about potential users’ intention to use such technologies during this critical phase of life. Objective: To examine the factors that impact the intention of potential users to use a mental health app during menopause, we used the Health Belief Model (HBM), a psychological framework widely used to understand and predict individuals’ health-related behaviors. Methods: An online survey was generated. Convenience sampling was used, with participants recruited via social media and email, through relevant foundations and support groups, and by word of mouth. Structural equation modeling with maximum likelihood estimation was conducted to explore whether the factor structure of the HBM is a good fit for predicting the intention to use a mental health app for menopause. A Cronbach α value of .05 was used for determining statistical significance. Results: A total of 1154 participants commenced the survey, of which 82.49% (n=952) completed at least 97% of the survey. Of these, 86.76% (n=826) expressed that their menopausal symptoms had negatively affected their mental health, and went on to answer questions regarding their experiences and interest in using a web or smartphone app for mental health symptoms related to menopause. Data from this subgroup (N=826) were analyzed. In total, 74.09% (n=612) of respondents sought online help for mental health symptoms related to menopause. The most common topics searched for were symptom characteristics (n=435, 52.66%) and treatment or therapy options (n=210, 25.42%). Psychoeducation (n=514, 62.23%) was the most desired mental health app feature, followed by symptom tracking (n=499, 60.41%) and self-help tips (n=469, 56.78%). In terms of the intention to use a mental health app, the Satorra-Bentler–scaled fit statistics indicated a good fit for the model (χ2278=790.44, P<.001; comparative fit index=0.933, root mean square error of approximation=0.047, standardized root mean square residual=0.056), with cues to action emerging as the most significant predictor of intention (β=.48, P<.001). This was followed by perceived barriers (β=–.25, P<.001), perceived susceptibility (β=.15, P<.001), and perceived benefits (β=.13, P<.001). Perceived severity (β=.01, P=.869) and self-efficacy (β=.03, P=.286) were not significantly associated with behavioral intention. Conclusions: This study reveals important factors that influence the intention to use a mental health app during menopause. It emphasizes the need to address barriers to app usage, while highlighting the impact of credible endorsements and psychoeducation. Furthermore, the study underscores the significance of improving accessibility for users with lower digital literacy or limited resources. %M 39412868 %R 10.2196/60434 %U https://formative.jmir.org/2024/1/e60434 %U https://doi.org/10.2196/60434 %U http://www.ncbi.nlm.nih.gov/pubmed/39412868 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e57439 %T Smartphone Screen Time Characteristics in People With Suicidal Thoughts: Retrospective Observational Data Analysis Study %A Karas,Marta %A Huang,Debbie %A Clement,Zachary %A Millner,Alexander J %A Kleiman,Evan M %A Bentley,Kate H %A Zuromski,Kelly L %A Fortgang,Rebecca G %A DeMarco,Dylan %A Haim,Adam %A Donovan,Abigail %A Buonopane,Ralph J %A Bird,Suzanne A %A Smoller,Jordan W %A Nock,Matthew K %A Onnela,Jukka-Pekka %K smartphone %K mobile apps %K mobile health %K screen time %K suicidal thoughts and behavior %K suicidal %K app %K observational data %K data analysis study %K monitor %K survey %K psychiatric %K screen %K mental health %K feasibility %K suicidal ideation %K mobile phone %D 2024 %7 11.10.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Smartphone-based monitoring in natural settings provides opportunities to monitor mental health behaviors, including suicidal thoughts and behaviors. To date, most suicidal thoughts and behaviors research using smartphones has primarily relied on collecting so-called “active” data, requiring participants to engage by completing surveys. Data collected passively from smartphone sensors and logs may offer an objectively measured representation of an individual’s behavior, including smartphone screen time. Objective: This study aims to present methods for identifying screen-on bouts and deriving screen time characteristics from passively collected smartphone state logs and to estimate daily smartphone screen time in people with suicidal thinking, providing a more reliable alternative to traditional self-report. Methods: Participants (N=126; median age 22, IQR 16-33 years) installed the Beiwe app (Harvard University) on their smartphones, which passively collected phone state logs for up to 6 months after discharge from an inpatient psychiatric unit (adolescents) or emergency department visit (adults). We derived daily screen time measures from these logs, including screen-on time, screen-on bout duration, screen-off bout duration, and screen-on bout count. We estimated the mean of these measures across age subgroups (adults and adolescents), phone operating systems (Android and iOS), and monitoring stages after the discharge (first 4 weeks vs subsequent weeks). We evaluated the sensitivity of daily screen time measures to changes in the parameters of the screen-on bout identification method. Additionally, we estimated the impact of a daylight time change on minute-level screen time using function-on-scalar generalized linear mixed-effects regression. Results: The median monitoring period was 169 (IQR 42‐169) days. For adolescents and adults, mean daily screen-on time was 254.6 (95% CI 231.4-277.7) and 271.0 (95% CI 252.2-289.8) minutes, mean daily screen-on bout duration was 4.233 (95% CI 3.565-4.902) and 4.998 (95% CI 4.455-5.541) minutes, mean daily screen-off bout duration was 25.90 (95% CI 20.09-31.71) and 26.90 (95% CI 22.18-31.66) minutes, and mean daily screen-on bout count (natural logarithm transformed) was 4.192 (95% CI 4.041-4.343) and 4.090 (95% CI 3.968-4.213), respectively; there were no significant differences between smartphone operating systems (all P values were >.05). The daily measures were not significantly different for the first 4 weeks compared to the fifth week onward (all P values were >.05), except average screen-on bout in adults (P value = .018). Our sensitivity analysis indicated that in the screen-on bout identification method, the cap on an individual screen-on bout duration has a substantial effect on the resulting daily screen time measures. We observed time windows with a statistically significant effect of daylight time change on screen-on time (based on 95% joint confidence intervals bands), plausibly attributable to sleep time adjustments related to clock changes. Conclusions: Passively collected phone logs offer an alternative to self-report measures for studying smartphone screen time characteristics in people with suicidal thinking. Our work demonstrates the feasibility of this approach, opening doors for further research on the associations between daily screen time, mental health, and other factors. %R 10.2196/57439 %U https://mhealth.jmir.org/2024/1/e57439 %U https://doi.org/10.2196/57439 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50748 %T Technology-Based Interventions in Tobacco Use Treatment Among People Who Identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native: Scoping Review %A Hichborn,Emily %A Turner,Avery %A Moore,Sarah %A Gauthier,Phoebe %A Bell,Kathleen %A Montgomery,LaTrice %A Boggis,Jesse %A Lambert-Harris,Chantal %A Saunders,Elizabeth %A Dallery,Jesse %A McLeman,Bethany %A Marsch,Lisa %+ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Suite 315, 46 Centerra Parkway, Lebanon, NH, 03766, United States, 1 603 646 7000, Emily.G.Hichborn@KU.Edu %K health disparities %K underrepresented %K social determinants of health %K tobacco use %K technology-based interventions %K scoping review %K mobile phone %D 2024 %7 10.10.2024 %9 Review %J J Med Internet Res %G English %X Background: Although tobacco use has significantly declined in the general population, traditional tobacco use treatment uptake and success rates remain disproportionately low among people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native. Technology-based interventions (TBIs) for tobacco use are promising alternatives to traditional tobacco use treatments. Objective: This scoping review aims to investigate the extent to which the use of digital TBIs in tobacco use treatment research promotes health equity among people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native. Methods: This scoping review identifies US-based studies (between January 2000 and March 2021) that enlist TBIs for tobacco use treatment and include people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native at ≥50% of the sample when combined; features studies that are also race and ethnicity conscious; and highlights health equity–promoting insights from included studies. Results: In 85% (22/26) of the studies, the largest proportion of the sample was African American/Black, most participants had low socioeconomic status, and recruitment was most commonly from medical settings. In total, 58% (15/26) of the studies were race and ethnicity conscious, and 67% (10/15) of these studies sought to partner with potential end users. An array of TBIs were represented; however, SMS text messaging was most prevalent. Most TBIs were combined with other evidence-based intervention components (eg, nicotine replacement therapy). Approximately one-third of the studies (8/26, 31%) required participants to have their own device or internet access. The majority were underpowered to detect substantial differences. Conclusions: The modest number of studies, particularly for persons who identify as Hispanic/Latina/o and American Indian/Alaska Native, demonstrates the limited application of TBIs for tobacco use and that additional research is needed to determine the extent to which TBIs for tobacco use promote health equity among these populations. International Registered Report Identifier (IRRID): RR2-10.2196/34508 %M 39388699 %R 10.2196/50748 %U https://www.jmir.org/2024/1/e50748 %U https://doi.org/10.2196/50748 %U http://www.ncbi.nlm.nih.gov/pubmed/39388699 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e52424 %T Nutrition-Related Mobile Apps in the Spanish App Stores: Quality and Content Analysis %A Fernandez-Lazaro,Cesar I %A Santamaría,Gema %A Fernandez Milano,Annika %A Martin-Vergel,Maria I %A Fernandez-Lazaro,Diego %K mobile apps %K mHealth %K mobile health %K app %K nutritional %K nutrition %K dietary %K eating %K diet %K food %K lifestyle %K Spain %K Spanish %K chronic diseases %K chronic %K review %K quality %K MARS %K Mobile App Rating Scale %K uMARS %K user version of the Mobile App Rating Scale %K assessment %K mobile phone %D 2024 %7 4.10.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps represent accessible and cost-effective tools to improve nutrition and prevent chronic diseases. However, most of these apps have been characterized as having limited functionality, raising concerns about their effectiveness, acceptability, and efficacy. Objective: The aims of the study were to assess the quality of popular nutrition-related app platforms in Spain and to describe their characteristics and functionalities. Methods: We screened apps providing information on dietary advice, food advice, and nutritional content in the Apple App Store and Google Play Store in Spain from March 2 to March 16, 2024. Apps with a star rating of ≥4 (of 5 stars), those available in Spanish, those that were free of charge, those last updated after January 2022, those with >500 reviews, and those with >500,000 downloads were included. The quality of apps was assessed using the user version of the Mobile App Rating Scale (uMARS). General characteristics and nutritional, health, and market-related functionalities of the nutrition-related apps were described. Correlations among total and uMARS sections, star ratings, and number of reviews and downloads were evaluated. Results: Among the 1460 apps identified in the search, 42 apps met the criteria. The majority of these (n=20, 48%) aimed at recording and analyzing food intake, followed by those providing nutritional plans or diets (n=9, 21%), advising on healthy habits (n=7, 17%), and offering recipes (n=6, 14%). The most prevalent nutritional functionalities offered were recording and monitoring body measurements (n=30, 71%), food tracking (n=26, 62%), and dietary analysis (n=25, 60%), whereas nutrition education was less common (n=16, 38%). Among market-related functionalities, advertisements were the most common among the study apps (n=30, 71%), followed by the option of sharing on social media (n=29, 69%) and customizable reminders (n=26, 62%). Sharing the recorded information in the app with health professionals was infrequent (n=1, 2%). The mean (SD) total uMARS score (maximum 5 points) was 3.78 (0.35), while the mean (SD) uMARS scores for functionality, aesthetics, engagement, and information were 4.21 (0.38), 3.94 (0.54), 3.51 (0.46), and 3.48 (0.44), respectively. Lower mean scores were observed for the subjective quality (mean 2.65, SD 0.56) and perceived impact (mean 3.06, SD 0.67). Moderate to strong positive significant correlations were mostly observed between total uMARS and section-specific uMARS scores, while the correlations between the uMARS section scores were mostly moderate positive. Total uMARS scores were very weakly correlated with user rating, number of reviews, and number of downloads. Conclusions: The quality of popular nutrition-related app platforms in Spain was acceptable, with observed remarkable differences between sections. The majority of the apps were appealing due to their user-friendly interfaces. Only a few apps, however, provided dietary structure analysis or nutritional education. Further research is needed to assess the long-term impact of these apps on users. %R 10.2196/52424 %U https://mhealth.jmir.org/2024/1/e52424 %U https://doi.org/10.2196/52424 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45461 %T Impact of a Self-Autonomous Evaluation Station and Personalized Training Algorithm on Quality of Life and Physical Capacities in Sedentary Adults: Randomized Controlled Trial %A Le Mat,Yann %A Casali,Corentin %A Le Mat,Franck %A Féasson,Léonard %A Foschia,Clément %A Géry,Mathias %A Rossi,Jérémy %A Millet,Guillaume Y %+ Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité, F-42023, 10 rue de Tréfilerie, Saint Etienne, 42100, France, 33 0477421875, yann.lemat@univ-st-etienne.fr %K physical activity %K sedentary behavior %K quality of life %K mobile health %K health-related interventions %K mobile app %K mobile phone %D 2024 %7 4.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical inactivity is a major risk factor for noncommunicable diseases and a leading cause of premature death. The World Health Organization (WHO) recommends at least 150 minutes of moderate intensity physical activity (PA) weekly, regardless of age, gender, or personal habits. However, in both sports performance and clinical settings, personalized training (PT) regimens have shown superior efficacy over general guidelines. Objective: We hypothesized that an automatic PT program, informed by initial physical evaluations, would increase overall quality of life, quality of sleep, and physical capabilities and reduce fatigue and depression compared with adherence to WHO recommendations. Methods: This 5-month, randomized, single-blinded controlled trial involved 112 sedentary or minimally active participants, divided randomly into PT and free training (FT) groups. Physical capabilities and subjective measures such as quality of life, sleep, depression, and fatigue were evaluated for both groups. After 1 month, both groups were asked to perform 150 minutes of PA per week for 4 months; the PT group could either follow a “virtual coach” on a mobile app to follow some personalized PA or do what they would like, while the FT group was to follow the general PA recommendations of the WHO. Results: We did not find any group×time interaction for PA duration or intensity, physical qualities, and subjective measures. However, considering both groups together, there was a significant pretest and posttest time effect for duration of PA (18.2 vs 24.5 min/d of PA; P<.001), intensity (2.36 vs 3.11; P<.001), and workload (46.8 vs 80.5; P<.001). Almost all physical qualities were increased pretest and posttest (ie, estimated VO2max 26.8 vs 29 mL min–1 kg–1; P<.001; flexibility 25.9 vs 26.9 cm; P=.049; lower limb isometric forces 328 vs 347 N m; P=.002; reaction time 0.680 vs 0.633 s; P<.001; power output on cyclo-ergometer 7.63 vs 7.82 W; P<.003; and balance for the left and right leg 215 vs 163 mm2; P<.003 and 186 vs 162 mm2; P=.048, respectively). Finally, still considering the PT and FT groups together, there were significant pretest to posttest improvements in the mental component of quality of life using the 12-item Short Form Health Survey (41.9 vs 46.0; P<.006), well-being using the Warwick-Edinburgh Mental Well-Being Scale (48.3 vs 51.7; P<.002), depression using the Center for Epidemiologic Studies Depression Scale (15.5 vs 11.5; P=.02), and fatigue using the Functional Assessment of Chronic Illness Therapy–Fatigue (37.1 vs 39.5; P=.048). Conclusions: The individualized training was not more effective than the general recommendations. A slight increase in PA (from 18 to 24 min/d) in sedentary or poorly active people is enough for a significant increase in physical capabilities and a significant improvement in quality of life, well-being, depression, and fatigue. Trial Registration: ClinicalTrials.gov NCT04998266; https://clinicaltrials.gov/study/NCT04998266 %M 39365990 %R 10.2196/45461 %U https://formative.jmir.org/2024/1/e45461 %U https://doi.org/10.2196/45461 %U http://www.ncbi.nlm.nih.gov/pubmed/39365990 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55921 %T Preferences Regarding Information Strategies for Digital Mental Health Interventions Among Medical Students: Discrete Choice Experiment %A Vomhof,Markus %A Bau,Jessica Tabea %A Hüter,Pia %A Stehl,Stefan %A Haastert,Burkhard %A Loerbroks,Adrian %A Icks,Andrea %A Calo,Stella Teresa %A Schuster,Luca %A Pischke,Claudia R %A Kairies-Schwarz,Nadja %A Angerer,Peter %A Apolinário-Hagen,Jennifer %+ Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany, 49 211 8106557, jessica.bau@hhu.de %K preferences %K digital mental health %K medical students %K innovation diffusion %K technology acceptance %K health information %D 2024 %7 4.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health interventions (DMHIs) are capable of closing gaps in the prevention and therapy of common mental disorders. Despite their proven effectiveness and approval for prescription, use rates remain low. The reasons include a lack of familiarity and knowledge as well as lasting concerns. Medical students were shown to have a comparatively higher risk for common mental disorders and are thus an important target group for raising awareness about DMHIs. At best, knowledge is already imparted during medical school using context-sensitive information strategies. Yet, little is known about medical students’ information preferences regarding DMHIs. Objective: This study aims to explore information preferences for DMHIs for personal use among medical students in Germany. Methods: A discrete choice experiment was conducted, which was developed using an exploratory sequential mixed methods research approach. In total, 5 attributes (ie, source, delivery mode, timing, recommendation, and quality criteria), each with 3 to 4 levels, were identified using formative research. Data were analyzed using logistic regression models to estimate preference weights and the relative importance of attributes. To identify subgroups of students varying in information preferences, we additionally performed a latent class analysis. Results: Of 309 participants, 231 (74.8%) with reliable data were included in the main analysis (women: 217/309, 70.2%; age: mean 24.1, SD 4.0 y). Overall, the conditional logit model revealed that medical students preferred to receive information about DMHIs from the student council and favored being informed via social media early (ie, during their preclinic phase or their freshman week). Recommendations from other students or health professionals were preferred over recommendations from other users or no recommendations at all. Information about the scientific evidence base was the preferred quality criterion. Overall, the timing of information was the most relevant attribute (32.6%). Latent class analysis revealed 2 distinct subgroups. Class 1 preferred to receive extensive information about DMHIs in a seminar, while class 2 wanted to be informed digitally (via email or social media) and as early as possible in their studies. Conclusions: Medical students reported specific needs and preferences regarding DMHI information provided in medical school. Overall, the timing of information (early in medical education) was considered more important than the information source or delivery mode, which should be prioritized by decision makers (eg, members of faculties of medicine, universities, and ministries of education). Study findings suggest general and subgroup-specific information strategies, which could be implemented in a stepped approach. Easily accessible digital information may promote students’ interest in DMHIs in the first step that might lead to further information-seeking behavior and the attendance of seminars about DMHIs in the second step. %M 39365652 %R 10.2196/55921 %U https://formative.jmir.org/2024/1/e55921 %U https://doi.org/10.2196/55921 %U http://www.ncbi.nlm.nih.gov/pubmed/39365652 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56606 %T Assessing the Effectiveness of an mHealth Intervention to Support Men Who Have Sex With Men Engaging in Chemsex (Budd): Single-Case and Pre-Post Experimental Design Study %A Herrijgers,Corinne %A Verboon,Peter %A Florence,Eric %A Vandebosch,Heidi %A Poels,Karolien %A Platteau,Tom %+ Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerpen, 2000, Belgium, 32 033455656, cherrijgers@itg.be %K mobile health %K chemsex %K men who have sex with men %K MSM %K harm reduction %K behavioral change %K self-efficacy %K risk behavior %K sexual health %K digital intervention %K health education %K mobile phone %D 2024 %7 4.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: This study focuses on the Budd app, a mobile health intervention designed for gay, bisexual, and other men who have sex with men who participate in chemsex. Chemsex, the use of psychoactive drugs in a sexual context, presents substantial health risks including increased HIV transmission and mental health issues. Addressing these risks requires innovative interventions tailored to the unique needs of this population. Objective: This study aims to evaluate the effectiveness of the Budd app in promoting drug harm reduction practices among its users, focusing on knowledge, behavioral intention, risk behavior awareness, and self-efficacy. Methods: The study used a mixed methods approach, combining a single-case experimental design and a pre-post study. A total of 10 participants from an outpatient clinic were recruited, and each attended the clinic 3 times. During the first visit, participants installed a restricted version of the Budd app, which allowed them to report daily mood and risk behavior after chemsex sessions. Phase A (baseline) lasted at least 2 weeks depending on chemsex participation. In the second visit, participants gained full access to the Budd app, initiating phase B (intervention). Phase B lasted at least 6 weeks, depending on chemsex participation, with identical data input as phase A. Participants completed pre- and postintervention surveys assessing behavioral determinants during the first and third visit. Results: The study observed an increased knowledge about chemsex substances postintervention, with a mean percentage improvement in knowledge scores of 20.59% (SD 13.3%) among participants. Behavioral intention and self-efficacy showed mixed results, with some participants improving while others experienced a decrease. There was also a variable impact on awareness of risk behavior, with half of the participants reporting a decrease postintervention. Despite these mixed results, the app was generally well-received, with participants engaging with the app’s features an average of 50 times during the study. Conclusions: The Budd app showed effectiveness in enhancing knowledge about chemsex substances among gay, bisexual, and other men who have sex with men. However, its impact on safe dosing behavior, behavioral intention, self-efficacy, and risk behavior awareness was inconsistent. These findings suggest that while educational interventions can increase knowledge, translating this into behavioral change is more complex and may require more participants, a longer follow-up period, and additional strategies and support mechanisms. %M 39365642 %R 10.2196/56606 %U https://formative.jmir.org/2024/1/e56606 %U https://doi.org/10.2196/56606 %U http://www.ncbi.nlm.nih.gov/pubmed/39365642 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55815 %T A Digital Sexual Health Intervention for Urban Adolescent and Young Adult Male Emergency Department Patients: User-Centered Design Approach %A Chernick,Lauren S. %A Bugaighis,Mona %A Daylor,Victoria %A Hochster,Daniel %A Rosen,Evan %A Schnall,Rebecca %A Stockwell,Melissa S %A Bell,David L. %+ Columbia University Irving Medical Center, 3959 Broadway, New York, NY, United States, 1 2123059825, lc2243@cumc.columbia.edu %K sexual health %K adolescent health %K sex education %K emergency medicine %K health planning %K sexual behavior %K SMS text messaging %K mHealth %K mobile app %K condom use %K user-centered design %D 2024 %7 4.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents and young adults frequently present to the emergency department (ED) for medical care and continue to have many unmet sexual health needs. Digital interventions show promise to improve adolescent and young adult sexual health; yet, few interventions focus on male ED patients, despite their infrequent use of contraceptives and rising rates of sexually transmitted infections. Objective: This paper describes the design and development of Dr. Eric (Emergency Room Interventions to Improve Care), a digital app focused on promoting condom use among sexually active adolescent and young adult male ED patients. Methods: This study followed 4 phases of app development, which were based on user-centered design and the software development lifecycle. In phase 1, define, we explored our target population and target health problem (infrequent condom use among male ED patients) by collecting key stakeholder input and conducting in-depth interviews with male patients and urban ED medical providers. In phase 2, discover, we partnered with a digital product agency to explore user experience and digital strategy. In phase 3, design, we refined Dr. Eric’s content, a 5-part sexual health educational module and a 10-week SMS text messaging program that focuses on condom use and partner communication about effective contraceptives. We conducted semistructured interviews with male adolescent and young adults to gather feedback on the app and perform usability testing, editing the app after each interview. We also interviewed informatics experts to assess the usability of a high-fidelity prototype. Interviews were recorded and analyzed via descriptive thematic analysis; informatic expert feedback was categorized by Nielsen’s heuristic principles. In phase 4, develop, we created the technical architecture and built a responsive web app. These findings were gathered leading to the final version of the digital Dr. Eric program. Results: Using data and key stakeholder input from phases 1 and 2, we iteratively created the Dr. Eric prototype for implementation in the ED setting. Interviews with 8 adolescent and young adult male ED patients suggested that users preferred (1) straightforward information, (2) a clear vision of the purpose of Dr. Eric, (3) open-ended opportunities to explore family planning goals, (4) detailed birth control method information, and (5) games presenting novel information with rewards. Five usability experts provided heuristic feedback aiming to improve the ease of use of the app. These findings led to the final version of Dr. Eric. Conclusions: Following these mobile health development phases, we created a digital sexual health mobile health intervention incorporating the principles of user experience and interface design. Dr. Eric needs further evaluation to assess its efficacy in increasing condom use among adolescent and young adult male ED patients. Researchers can use this framework to form future digital health ED-based digital interventions. %M 39365657 %R 10.2196/55815 %U https://formative.jmir.org/2024/1/e55815 %U https://doi.org/10.2196/55815 %U http://www.ncbi.nlm.nih.gov/pubmed/39365657 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51025 %T Feasibility and Engagement of a Mobile App Preparation Program (Kwit) for Smoking Cessation in an Ecological Context: Quantitative Study %A Bustamante Perez,Luz Adriana %A Romo,Lucia %A Zerhouni,Oulmann %+ Laboratoire EA 4430-Clinique Psychanalyse Developpement, Department of Psychology, University of Paris Nanterre, 200 avenue de la République, Nanterre, 92001, France, 33 783192547, adriana.bustamante93@gmail.com %K smoking cessation %K digital intervention %K behavior change techniques %K attrition rate %K mobile app %K preparation program %K motivation %K quit smoking %K ecological settings %K mobile phone %D 2024 %7 2.10.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health apps can facilitate access to effective treatment and therapeutic information services. However, the real-world effectiveness of mobile apps for smoking cessation and their potential impact in everyday settings remain unclear. Objective: In an ecological context, this study aimed to estimate the engagement rate of a mobile app–based smoking cessation preparation program and its potential impact on users’ willingness, ability, and readiness to quit smoking. Methods: A total of 2331 “organic users” (ie, users who discover and install a mobile app on their own, without any prompts) chose 1 of 2 program versions of the mobile app (Kwit): the basic version or the premium version. Both versions were identical in design, with 4 more evidence-based content items and strategies in the premium version. Outcomes were analyzed based on automated data registered in the app (engagement rate, motivation to quit, motivation type, motivation levels, and satisfaction level). Mann-Whitney and χ2 tests were used to compare the results of both groups. Results: As expected, in the ecological context, a high dropout rate was observed at different moments. A significant difference was observed between the 2 versions (n=2331; χ21=5.4; P=.02), with a proportionally higher engagement rate in the premium version (premium=4.7% vs basic=2%). Likewise, differences were also observed between the 2 groups in terms of reasons to quit (n=2331; χ24=19; P≤.001; V=0.08), motivation type (n=2331; χ27=14.7; P=.04), and motivation level. Users of the app’s premium version more frequently reported “well-being” (23.3% vs 17.9%) and “planning a pregnancy” (7.4% vs 4.4%) as their primary reasons for quitting smoking compared to those with the basic version. Moreover, they reported being more likely to be driven in the smoking cessation process by intrinsic motivation (premium=28% vs basic=20.4%), as well as feeling significantly more willing (z score=156,055; P≤.001; Cohen d=0.15), able (z score=172,905; P=.04; Cohen d=0.09), and ready (z score=166,390; P=.005; Cohen d=0.12) to stop smoking than users who had the basic version before completion of the preparation program. Among participants who finished each version of the program (premium: 9/189, 4.8%; basic: 47/2142, 2.19%), significant improvements in motivation levels were observed in both groups, although in different areas for each group (willingness levels for the premium group and ability for the basic group). Conclusions: These results suggest that even in ecological contexts where engagement rates are meager, the Kwit preparation program can address ambivalence by increasing willingness to change, self-confidence, and readiness to quit among its users, especially those who feel less able to do so. Further development and evaluations are needed to better understand determinants for regular mobile health apps. %M 39357053 %R 10.2196/51025 %U https://mhealth.jmir.org/2024/1/e51025 %U https://doi.org/10.2196/51025 %U http://www.ncbi.nlm.nih.gov/pubmed/39357053 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56355 %T Self-Care Program as a Tool for Alleviating Anxiety and Loneliness and Promoting Satisfaction With Life in High School Students and Staff: Randomized Survey Study %A Iyer,Priya %A Iyer,Lina %A Carter,Nicole %A Iyer,Ranjani %A Stirling,Amy %A Priya,Lakshmi %A Sriraman,Ushma %+ Department of Education, Heartfulness Institute, 2200 Goldenrod Ln, San Ramon, CA, 94582, United States, 1 2482559635, ranjani.heartfulness@gmail.com %K Heartfulness, anxiety, loneliness, high school, satisfaction with life %K self-care %K develop %K stress %K stress management %K effectiveness %K life satisfaction %K students %K student %K support %K web-based program %K time management %K educational %K mental health %K tool %K tools %D 2024 %7 30.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 global pandemic has led to a marked increase in anxiety levels, significantly affecting the well-being of individuals worldwide. In response to this growing concern, interventions aimed at enhancing social-emotional skills and promoting mental health are more crucial than ever. Objective: This global study aimed to examine the effectiveness of a self-care program on anxiety, loneliness, and satisfaction with life in high school students and staff in a randomized, waitlist control trial with baseline and postintervention assessments. Methods: The 4-week web-based self-care program, offered by the Heartfulness Institute, is designed to develop social-emotional skills through stress management and self-observation. The web-based program was a positive intervention that offered support to the students and staff to build specific skills, such as reflection, observation, positivity, time management, and goal setting. In this study, the sample consisted of a total of 203 high school students and staff randomized into a control waitlisted group (students: n=57 and staff: n=45) and a Heartfulness group (students: n=57 and staff: n=44) from 3 schools. Both the groups completed web-based surveys at weeks 0, 4, and 8, assessing their anxiety, loneliness, and satisfaction with life scores using Generalized Anxiety Disorder-7 Scale (GAD-7 and Severity Measure for Generalized Anxiety Disorder—Child Age 11-17), Satisfaction With Life scale (SWLS) and Satisfaction With Life Scale-Child (SWLS-C), and the University of California, Los Angeles (UCLA) Loneliness Scale. Survey responses were each individually analyzed using repeated measures ANOVA. Results: The study received institutional review board approval on February 3, 2022. Participant recruitment lasted from the approval date until March 30, 2022. The 4-week program for the Heartfulness group started on April 4, 2024. There was a significant 3-way interaction among time, group, and school showing a decrease in anxiety and loneliness scores and an increase in satisfaction-with-life scores (P<.05). In students in the Heartfulness group, there was strong evidence to suggest a significant mean difference in GAD-7, SWLS, and UCLA scores between week 0 and week 4 at all schools (P<.001). In staff in the Heartfulness group, there was strong evidence to suggest a significant mean difference in GAD-7, SWLS, and UCLA scores between week 0 and week 4 at all schools (P<.001). Conclusions: The pandemic brought severe educational and social changes that triggered a decline in mental health in schools. This study showed the effectiveness of noninvasive self-care tools used digitally to significantly decrease anxiety and loneliness scores and increase satisfaction of life scores in the participants. Trial Registration: ClinicalTrials.gov NCT05874232; https://clinicaltrials.gov/ct2/show/NCT05874232 %M 39047180 %R 10.2196/56355 %U https://formative.jmir.org/2024/1/e56355 %U https://doi.org/10.2196/56355 %U http://www.ncbi.nlm.nih.gov/pubmed/39047180 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e64196 %T Effects of a Mobile App to Promote Social Participation on Older Adults: Randomized Controlled Trial %A Kawaguchi,Kenjiro %A Nakagomi,Atsushi %A Ide,Kazushige %A Kondo,Katsunori %+ Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoicho, Inage, Chiba, 263-8522, Japan, 81 90 7596 8742, kawaguchikenjiro@chiba-u.jp %K gerontology %K geriatrics %K older adults %K elderly %K older people %K community dwelling older adult %K aging %K social participation %K walking %K mHealth %K apps %K smartphone %K digital health %K digital technology %K digital interventions %K physical activity %K exercise %D 2024 %7 30.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Social participation is crucial for healthy aging, improving physical and mental health, cognitive function, and quality of life among older adults. However, social participation tends to decline with age due to factors like loss of social networks and health issues. Mobile health apps show promise in promoting healthy behaviors among older adults, but their effectiveness in increasing social participation remains understudied. Objective: This randomized controlled trial aimed to evaluate the efficacy of a mobile app called Encouragement of Social Participation (ESP, “Shakai Sanka no Susume;” Hitachi) in promoting social participation and physical activity among community-dwelling older adults. Methods: The study recruited 181 community-dwelling adults aged 60 years or older from 2 municipalities in Japan and through a web-based research panel. Participants were randomly assigned to either the intervention group (n=87), which used the ESP app for 12 weeks, or the control group (n=94), which used only Google Fit. The ESP app incorporated features such as self-monitoring of social participation, personalized feedback, gamification elements, and educational content. Primary outcomes were changes in social participation frequency over the previous 2 months and changes in step counts, measured at baseline and week 12. Secondary outcomes included changes in specific types of social activities and subjective well-being. Data were analyzed using analysis of covariance and linear mixed-effects models. Results: The intervention group showed a significantly greater increase in social participation frequency compared with the control group (adjusted difference 3.03; 95% CI 0.17-5.90; P=.04). Specifically, the intervention group demonstrated higher frequencies of participation in hobbies (adjusted difference: 0.82; 95% CI 0.01-1.63) and cultural clubs (adjusted difference 0.65; 95% CI 0.07-1.23) compared with the control group. However, there were no significant differences in weekly step counts between the groups. Subgroup analyses suggested potentially larger effects among participants who were older than 70 years, female, had lower educational attainment, and were recruited from community settings, although only females and the lower educational attainment subgroups demonstrated 95% CIs that did not encompass zero. Conclusions: The ESP mobile app effectively promoted social participation among community-dwelling older adults, particularly in hobbies and cultural club activities. However, it did not significantly impact physical activity levels as measured by step counts. These findings suggest that mobile apps can be valuable tools for encouraging social engagement in older populations, potentially contributing to healthy aging. Future research should focus on optimizing app features to maintain long-term engagement and exploring strategies to enhance physical activity alongside social participation. Trial Registration: University Medical Information Network Clinical Trial Registry UMIN000049045; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055781 %M 39348180 %R 10.2196/64196 %U https://www.jmir.org/2024/1/e64196 %U https://doi.org/10.2196/64196 %U http://www.ncbi.nlm.nih.gov/pubmed/39348180 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54119 %T Just-in-Time Adaptive Interventions for Behavior Change in Physiological Health Outcomes and the Use Case for Knee Osteoarthritis: Systematic Review %A Fiedler,Janis %A Bergmann,Matteo Reiner %A Sell,Stefan %A Woll,Alexander %A Stetter,Bernd J %+ Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, Karlsruhe, 76131, Germany, 49 721 608 46978, janis.fiedler@kit.edu %K eHealth %K application %K applications %K digital health %K digital technology %K digital intervention %K digital interventions %K physical activity %K sedentary behavior %K sedentary lifestyle %K pain %K physical function %K quality of life %K knee osteoarthritis %K osteopathy %K bone %K arthritis %K mobile phone %K individualization %D 2024 %7 27.9.2024 %9 Review %J J Med Internet Res %G English %X Background: The prevalence of knee osteoarthritis (KOA) in the adult population is high and patients profit from individualized therapy approaches. Just-in-time adaptive interventions (JITAIs) are upcoming digital interventions for behavior change. Objective: This systematic review summarizes the features and effectiveness of existing JITAIs regarding important physiological health outcomes and derives the most promising features for the use case of KOA. Methods: The electronic databases PubMed, Web of Science, Scopus, and EBSCO were searched using keywords related to JITAIs, physical activity (PA), sedentary behavior (SB), physical function, quality of life, pain, and stiffness. JITAIs for adults that focused on the effectiveness of at least 1 of the selected outcomes were included and synthesized qualitatively. Study quality was assessed with the Quality Assessment Tool Effective Public Health Practice Project. Results: A total of 45 studies with mainly weak overall quality were included in this review. The studies were mostly focused on PA and SB and no study examined stiffness. The design of JITAIs varied, with a frequency of decision points from a minute to a day, device-based measured and self-reported tailoring variables, intervention options including audible or vibration prompts and tailored feedback, and decision rules from simple if-then conditions based on 1 variable to more complex algorithms including contextual variables. Conclusions: The use of frequent decision points, device-based measured tailoring variables accompanied by user input, intervention options tailored to user preferences, and simple decision rules showed the most promising results in previous studies. This can be transferred to a JITAI for the use case of KOA by using target variables that include breaks in SB and an optimum of PA considering individual knee load for the health benefits of patients. %M 39331951 %R 10.2196/54119 %U https://www.jmir.org/2024/1/e54119 %U https://doi.org/10.2196/54119 %U http://www.ncbi.nlm.nih.gov/pubmed/39331951 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e53778 %T Generation of Backward-Looking Complex Reflections for a Motivational Interviewing–Based Smoking Cessation Chatbot Using GPT-4: Algorithm Development and Validation %A Kumar,Ash Tanuj %A Wang,Cindy %A Dong,Alec %A Rose,Jonathan %K motivational interviewing %K smoking cessation %K therapy %K automated therapy %K natural language processing %K large language models %K GPT-4 %K chatbot %K dialogue agent %K reflections %K reflection generation %K smoking %K cessation %K ChatGPT %K smokers %K smoker %K effectiveness %K messages %D 2024 %7 26.9.2024 %9 %J JMIR Ment Health %G English %X Background: Motivational interviewing (MI) is a therapeutic technique that has been successful in helping smokers reduce smoking but has limited accessibility due to the high cost and low availability of clinicians. To address this, the MIBot project has sought to develop a chatbot that emulates an MI session with a client with the specific goal of moving an ambivalent smoker toward the direction of quitting. One key element of an MI conversation is reflective listening, where a therapist expresses their understanding of what the client has said by uttering a reflection that encourages the client to continue their thought process. Complex reflections link the client’s responses to relevant ideas and facts to enhance this contemplation. Backward-looking complex reflections (BLCRs) link the client’s most recent response to a relevant selection of the client’s previous statements. Our current chatbot can generate complex reflections—but not BLCRs—using large language models (LLMs) such as GPT-2, which allows the generation of unique, human-like messages customized to client responses. Recent advancements in these models, such as the introduction of GPT-4, provide a novel way to generate complex text by feeding the models instructions and conversational history directly, making this a promising approach to generate BLCRs. Objective: This study aims to develop a method to generate BLCRs for an MI-based smoking cessation chatbot and to measure the method’s effectiveness. Methods: LLMs such as GPT-4 can be stimulated to produce specific types of responses to their inputs by “asking” them with an English-based description of the desired output. These descriptions are called prompts, and the goal of writing a description that causes an LLM to generate the required output is termed prompt engineering. We evolved an instruction to prompt GPT-4 to generate a BLCR, given the portions of the transcript of the conversation up to the point where the reflection was needed. The approach was tested on 50 previously collected MIBot transcripts of conversations with smokers and was used to generate a total of 150 reflections. The quality of the reflections was rated on a 4-point scale by 3 independent raters to determine whether they met specific criteria for acceptability. Results: Of the 150 generated reflections, 132 (88%) met the level of acceptability. The remaining 18 (12%) had one or more flaws that made them inappropriate as BLCRs. The 3 raters had pairwise agreement on 80% to 88% of these scores. Conclusions: The method presented to generate BLCRs is good enough to be used as one source of reflections in an MI-style conversation but would need an automatic checker to eliminate the unacceptable ones. This work illustrates the power of the new LLMs to generate therapeutic client-specific responses under the command of a language-based specification. %R 10.2196/53778 %U https://mental.jmir.org/2024/1/e53778 %U https://doi.org/10.2196/53778 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e59469 %T Controlled and Real-Life Investigation of Optical Tracking Sensors in Smart Glasses for Monitoring Eating Behavior Using Deep Learning: Cross-Sectional Study %A Stankoski,Simon %A Kiprijanovska,Ivana %A Gjoreski,Martin %A Panchevski,Filip %A Sazdov,Borjan %A Sofronievski,Bojan %A Cleal,Andrew %A Fatoorechi,Mohsen %A Nduka,Charles %A Gjoreski,Hristijan %+ Emteq Ltd., Science Park Square, Brighton, BN1 9SB, United Kingdom, 44 1273 769251, simon.stankoski@emteqlabs.com %K chewing detection %K eating detection %K smart glasses %K automatic dietary monitoring %K eating behavior %D 2024 %7 26.9.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The increasing prevalence of obesity necessitates innovative approaches to better understand this health crisis, particularly given its strong connection to chronic diseases such as diabetes, cancer, and cardiovascular conditions. Monitoring dietary behavior is crucial for designing effective interventions that help decrease obesity prevalence and promote healthy lifestyles. However, traditional dietary tracking methods are limited by participant burden and recall bias. Exploring microlevel eating activities, such as meal duration and chewing frequency, in addition to eating episodes, is crucial due to their substantial relation to obesity and disease risk. Objective: The primary objective of the study was to develop an accurate and noninvasive system for automatically monitoring eating and chewing activities using sensor-equipped smart glasses. The system distinguishes chewing from other facial activities, such as speaking and teeth clenching. The secondary objective was to evaluate the system’s performance on unseen test users using a combination of laboratory-controlled and real-life user studies. Unlike state-of-the-art studies that focus on detecting full eating episodes, our approach provides a more granular analysis by specifically detecting chewing segments within each eating episode. Methods: The study uses OCO optical sensors embedded in smart glasses to monitor facial muscle activations related to eating and chewing activities. The sensors measure relative movements on the skin’s surface in 2 dimensions (X and Y). Data from these sensors are analyzed using deep learning (DL) to distinguish chewing from other facial activities. To address the temporal dependence between chewing events in real life, we integrate a hidden Markov model as an additional component that analyzes the output from the DL model. Results: Statistical tests of mean sensor activations revealed statistically significant differences across all 6 comparison pairs (P<.001) involving 2 sensors (cheeks and temple) and 3 facial activities (eating, clenching, and speaking). These results demonstrate the sensitivity of the sensor data. Furthermore, the convolutional long short-term memory model, which is a combination of convolutional and long short-term memory neural networks, emerged as the best-performing DL model for chewing detection. In controlled laboratory settings, the model achieved an F1-score of 0.91, demonstrating robust performance. In real-life scenarios, the system demonstrated high precision (0.95) and recall (0.82) for detecting eating segments. The chewing rates and the number of chews evaluated in the real-life study showed consistency with expected real-life eating behaviors. Conclusions: The study represents a substantial advancement in dietary monitoring and health technology. By providing a reliable and noninvasive method for tracking eating behavior, it has the potential to revolutionize how dietary data are collected and used. This could lead to more effective health interventions and a better understanding of the factors influencing eating habits and their health implications. %M 39325528 %R 10.2196/59469 %U https://mhealth.jmir.org/2024/1/e59469 %U https://doi.org/10.2196/59469 %U http://www.ncbi.nlm.nih.gov/pubmed/39325528 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56691 %T Long-Term Effects of Internet-Based Cognitive Behavioral Therapy on Depression Prevention Among University Students: Randomized Controlled Factorial Trial %A Nakagami,Yukako %A Uwatoko,Teruhisa %A Shimamoto,Tomonari %A Sakata,Masatsugu %A Toyomoto,Rie %A Yoshida,Kazufumi %A Luo,Yan %A Shiraishi,Nao %A Tajika,Aran %A Sahker,Ethan %A Horikoshi,Masaru %A Noma,Hisashi %A Iwami,Taku %A Furukawa,Toshi A %K iCBT %K depression prevention %K student mental health %K factorial randomized controlled trial %K mobile phone %D 2024 %7 24.9.2024 %9 %J JMIR Ment Health %G English %X Background: Internet-based cognitive behavioral therapy (iCBT) shows promise in the prevention of depression. However, the specific iCBT components that contribute to its effectiveness remain unclear. Objective: We aim to evaluate the effects of iCBT components in preventing depression among university students. Methods: Using a smartphone cognitive behavioral therapy (CBT) app, we randomly allocated university students to the presence or absence of 5 different iCBT components: self-monitoring, behavioral activation, cognitive restructuring, assertiveness training, and problem-solving. The active intervention lasted 8 weeks but the app remained accessible through the follow-up. The primary outcome was the onset of a major depressive episode (MDE) between baseline and the follow-up after 52 weeks, as assessed with the computerized World Health Organization Composite International Diagnostic Interview. Secondary outcomes included changes in the 9-item Patient Health Questionnaire, 7-item General Anxiety Disorder, and CBT Skills Scale. Results: During the 12-month follow-up, 133 of 1301 (10.22%) participants reported the onset of an MDE. There were no significant differences in the incidence of MDEs between the groups with or without each component (hazard ratios ranged from 0.85, 95% CI 0.60‐1.20, for assertiveness training to 1.26, 95% CI 0.88‐1.79, for self-monitoring). Furthermore, there were no significant differences in the changes on the 9-item Patient Health Questionnaire, 7-item General Anxiety Disorder, or for CBT Skills Scale between component allocation groups. However, significant reductions in depression and anxiety symptoms were observed among all participants at the 52-week follow-up. Conclusions: In this study, we could not identify any specific iCBT components that were effective in preventing depression or the acquisition of CBT skills over the 12-month follow-up period, but all participants with and without intervention of each iCBT component demonstrated significant improvements in depressive and anxiety symptoms. Further research is needed to explore the potential impact of frequency of psychological assessments, nonspecific intervention effects, natural change in the mental state, and the baseline depression level. Trial Registration: UMINCTR UMIN000031307; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000035735 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2719-z %R 10.2196/56691 %U https://mental.jmir.org/2024/1/e56691 %U https://doi.org/10.2196/56691 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53759 %T Smartphone-Based Digital Peer Support for a Walking Intervention Among Public Officers in Kanagawa Prefecture: Single-Arm Pre- and Postintervention Evaluation %A Okamoto,Masumi %A Saito,Yoshinobu %A Nakamura,Sho %A Nagasawa,Makoto %A Shibuya,Megumi %A Nagasaka,Go %A Narimatsu,Hiroto %+ Graduate School of Health Innovation, Kanagawa University of Human Services, Research Gate Building Tonomachi 2-A, 3-25-10 Tonomachi, Kawasaki-ku, Kawasaki, 210-0821, Japan, 81 44 589 8100, hiroto-narimatsu@umin.org %K digital health %K mhealth %K ehealth %K smartphone app %K smartphone application %K peer support %K digital peer support %K social support %K group intervention %K physical activity %K health promotion %K behavior change %K apps %K step counting %K workplace health %D 2024 %7 24.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital peer support, defined as peer support delivered through technology such as smartphone apps, may be promising to promote activity in the form of step counts. Interactions among users have a positive impact on retention rates, and apps with social elements show significant improvements in daily step count. However, the feasibility of digital peer support in promoting physical activity (PA) is unknown; therefore, its effectiveness on step count and the clinical implications remain unconfirmed. Objective: This study aimed to assess the feasibility of digital peer support over a 3-month intervention period using the retention rate as the outcome. Moreover, changes in daily step count and physical measurements were compared between pre- and postintervention. Methods: The study design was a 3-month 1-arm intervention with participants from local government offices in Kanagawa, Japan. We used an available smartphone app, Minchalle, as the tool for the group intervention. Participants were required to report their daily step count to a maximum of 5 members composed exclusively of study participants. The primary outcome was the retention rate. Secondary outcomes included daily step count, the rate of achieving daily step goals, physical measurements, and lifestyle characteristics. Descriptive statistics and the Pearson coefficient were used to examine the relationship between goal achievement and step count, as well as changes in step count and various variables including physical measurements. Results: Of the 63 participants, 62 completed the intervention. The retention rate was 98% (62/63). The average daily step count during the intervention was 6993 (SD 2328) steps, an 1182-step increase compared with the count observed 1 week before the intervention began. The rate of achieving the daily step count during the intervention was 53.5% (SD 26.2%). There was a significant correlation (r=0.27, P=.05) between achieving daily step goals and increasing daily step count. Comparative analyses showed that changes in weight (68.56, SD 16.97 kg vs 67.30, SD 16.86 kg; P<.001), BMI (24.82, SD 4.80 kg/m2 vs 24.35, SD 4.73 kg/m2; P<.001), somatic fat rate (28.50%, SD 7.44% vs 26.58%, SD 7.90%; P=.005), systolic blood pressure (130.42, SD 17.92 mm Hg vs 122.00, SD 15.06 mm Hg; P<.001), and diastolic blood pressure (83.24, SD 13.27 mm Hg vs 77.92, SD 11.71 mm Hg; P=.002) were significantly different before and after the intervention. Similarly, the daily amount of PA significantly improved from 5.77 (SD 3.81) metabolic equivalent (MET)–hours per day to 9.85 (SD 7.84) MET-hours per day (P<.001). Conclusions: This study demonstrated that digital peer support is feasible for maintaining a high retention rate and can, therefore, effectively promote PA. It can be a promising tool to improve daily step count, subjective PA, and clinical outcomes, such as weight and somatic fat rate. Trial Registration: UMIN Clinical Trials Registry UMIN000042520; https://tinyurl.com/46c4nm8z %M 39316793 %R 10.2196/53759 %U https://formative.jmir.org/2024/1/e53759 %U https://doi.org/10.2196/53759 %U http://www.ncbi.nlm.nih.gov/pubmed/39316793 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51273 %T The Use of Noncommercial Parent-Focused mHealth Interventions for Behavioral Problems in Youth: Systematic Review %A Magnuson,Katherine I %A Li,Kexin %A Beuley,Grace %A Ryan-Pettes,Stacy R %+ Department of Psychology and Neuroscience, Baylor University, Baylor Sciences Building, 101 Bagby Ave, Waco, TX, 76706, United States, 1 (254) 710 2961, katherine.magnuson@childrens.com %K behavioral parent training %K mobile health %K mHealth %K mobile app %K adolescent %K substance use %K child mental health condition %K mobile phone %D 2024 %7 24.9.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The rates of substance use among adolescents are alarmingly high, and current treatment options lack integration of parent-focused interventions, despite evidence that effective parenting practices can mediate treatment outcomes for adolescents involved in substance use. Accessibility and other barriers to parental interventions may be mitigated through mobile health (mHealth); however, few mHealth platforms target substance use behaviors for adolescents through the implementation of behavioral parent training strategies. Objective: This study seeks to review current mHealth platforms within empirical literature that are designed to increase effective parenting through behavioral parent training techniques. Because of the paucity of mHealth modalities that use parenting strategies to target substance use in adolescents, the objective was expanded to include mHealth platforms addressing behavior problems among youth, given that parent-targeted treatments for these clinical presentations overlap with those for adolescent substance use. Overall, the systematic review was conducted to inform the development of mHealth apps for parents of youth involved in substance use, improve accessibility, and better align with parental needs. Methods: This systematic review was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method to select relevant articles across several databases. Each study was assessed for relevance and inclusion. Each study was reviewed for demographics, delivery medium, intervention status as stand-alone treatment or as an enhancement to treatment, mobile device used, mental health condition targeted, intervention type, underlying intervention theory, behavior change theory applied in design, behavior change techniques, parent training techniques, youth outcomes, parent outcomes, visual design, content, and features. Results: Overall, 11 studies were included. Nearly all studies (9/11, 82%) predominantly sampled female caregivers. Most of the studies (6/11, 55%) integrated social learning theory. Only a few of the studies (2/11, 18%) discussed the embedded behavior change theories, whereas all the studies (11/11, 100%) used at least one behavior change technique to encourage change in parental behaviors. Many of the studies (7/11, 64%) tailored design features to the end user. Of the various behavioral parent training techniques, nearly all studies (10/11, 91%) included the skill of strengthening the parent-child relationship. A preliminary evaluation of treatment outcomes suggests a positive impact of parent-targeted mHealth interventions. When reported, the effect sizes for treatment ranged from Cohen d=0.38 to Cohen d=1.58 for youth and from Cohen d=0.13 to Cohen d=2.59 for parents. Conclusions: Although features and techniques were referenced, only a few of the studies provided specific information related to behavior change theory (2/11, 18%), visual design (2/11, 18%), and the translation of parent-targeted interventions to mHealth platforms. Such information would be useful for the development of mHealth apps. Preliminary outcomes for youth and parents are encouraging, but future studies should consider conducting a meta-analysis as the body of studies grows to determine aggregate statistical findings. %M 39316435 %R 10.2196/51273 %U https://mhealth.jmir.org/2024/1/e51273 %U https://doi.org/10.2196/51273 %U http://www.ncbi.nlm.nih.gov/pubmed/39316435 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53101 %T Dose-Response Associations of Internet Use Time and Internet Addiction With Depressive Symptoms Among Chinese Children and Adolescents: Cross-Sectional Study %A Li,Juanjuan %A Sun,Weidi %A Luo,Zeyu %A Liu,Yi %A Huang,Xuanyin %A Jiang,Denan %A Li,Shuting %A Meng,Jia %A Gu,Fang %A Zhang,Ronghua %A Song,Peige %K internet use %K internet addiction %K depression %K children %K adolescents %K China %K depressive symptoms %D 2024 %7 23.9.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Children’s lives are increasingly mediated by digital technologies, yet evidence regarding the associations between internet use and depression is far from comprehensive and remains unclear. Objective: This study aimed to investigate the dose-response association between internet use, including use time and addiction behaviors, and depressive symptoms among children and adolescents in Zhejiang Province. Methods: Data were collected from a school-based health survey China Common Disease and Risk Factor Surveillance Among Students, encompassing 21,336 students in Zhejiang Province. The daily internet use time, internet addiction (IA) behaviors, and depressive symptoms were assessed with questionnaires. Logistic regression models were used to explore the associations of internet use time and IA behaviors with depressive symptoms among children and adolescents. Restricted cubic spline curves were used to determine the dose-response associations. Results: A total of 6225 (29.2%) students had depressive symptoms. Compared to those reporting no internet use, boys using the internet for >2 hours/day (odds ratio [OR] 1.53, 95% CI 1.34‐1.74) and girls using internet for 1.1‐2 hours/day (OR 1.22, 95% CI 1.06‐1.39) and >2 hours/day (OR 1.70, 95% CI 1.50‐1.93) were at higher risks of depressive symptoms. A significant J-shaped association was identified between internet use time and depressive symptoms among children and adolescents, especially in boys and primary school students (nonlinear P values were .006, .003, and <.001, respectively). Increased IA behaviors were associated with a higher odd of depressive symptoms (1 IA behavior: OR 2.01, 95% CI 1.83‐2.21; 2 IA behaviors: 2.91, 95% CI 2.57‐3.29; and ≥3 IA behaviors: 4.72, 95% CI 4.26‐5.22). A positive nonlinear association between the number of IA behaviors and depressive symptoms was found in total population, girls, and primary school students (nonlinear P values were .02, .002, .007, respectively). Conclusions: Findings suggested that excessive internet use time and IA behaviors were significantly associated with an increased risk of depressive symptoms, highlighting the importance of interventions to regulate and educate about adequate internet use during childhood and adolescence. %R 10.2196/53101 %U https://publichealth.jmir.org/2024/1/e53101 %U https://doi.org/10.2196/53101 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e50289 %T Effect of a Web-Based Nutritional and Physical Activity Intervention With Email Support (the EDDY Program) on Primary School Children’s BMI Z-Score During the COVID-19 Pandemic: Intervention Study %A Gansterer,Alina %A Moliterno,Paula %A Neidenbach,Rhoia %A Ollerieth,Caroline %A Czernin,Sarah %A Scharhag,Juergen %A Widhalm,Kurt %K childhood obesity %K BMI %K prevention intervention %K physical activity %K nutrition %K nutritional %K school-based %K web-based %K COVID-19 %K diet %K child %K childhood %K children %K pediatric %K pediatrics %K weight %K obesity %K obese %K exercise %K school %K student %K students %K youth %D 2024 %7 19.9.2024 %9 %J JMIR Pediatr Parent %G English %X Background: COVID-19 mitigation measures enhanced increases in children’s weight and BMI due to decreased physical activity and increased energy intake. Overweight and obesity were major worldwide problems before the pandemic, and COVID-19 increased their severity even more. High BMI directly correlates with health disadvantages including cardiovascular diseases, musculoskeletal disorders, and mental health diseases. Therefore, it is vitally important to develop counteracting interventions to maintain children’s health during exceptional situations like pandemics. However, worldwide data from such interventions are limited, and to our knowledge, no suitable study has been carried out during the pandemic in Austria. Objective: This study was conducted to examine a 15-week web-based intervention with email support, the EDDY (Effect of Sports and Diet Trainings to Prevent Obesity and Secondary Diseases and to Influence Young Children’s Lifestyle) program and the effect of nutritional education and physical activity on children’s BMI z-score during the COVID-19 pandemic in Vienna, Austria. Methods: The intervention consisted of 3 weekly videos—2 physical activity and 1 nutritional education video, respectively—and a biweekly email newsletter for the parents. This study was conducted in a Viennese primary school from February to June 2021 by a team of physicians, nutritionists, and sports scientists, including both professionals and students. The study population included an intervention group (who received web-based nutritional and physical activity training) and a control group (who received no intervention), comprising in total 125 children aged 8 to 11 years. Due to COVID-19 mitigation measures, the control group was a comparative group observed during the prior school year (2019-2020). Anthropometric measurements were obtained before and after the intervention in both groups. Results: Due to a high dropout rate (n=57, 45.6%) because of the mitigation measures, there were 41 children in the intervention group and 27 in the control group. At baseline, the BMI z-score was 1.0 (SD 1.1) in the intervention group and 0.6 (SD 1.2) in the control group (P=.17). After the study period, the BMI z-score decreased by 0.06 (SD 0.21) in the intervention group, whereas it increased by 0.17 (SD 0.34) in the control group (P<.001). Comparing the change in BMI z-scores within BMI categories in the intervention group and control group revealed a statistically significant difference in the normal-weight children (P=.006). Further results showed that the decrease in BMI z-score was significant in the intervention group among both boys (P=.004) and girls (P=.01). Conclusions: A web-based intervention with combined nutritional education and physical activity training might be an adequate tool to lessen the enhanced increase in body weight during a pandemic. Therefore, additional studies with greater sample sizes and different locations are needed. As the implementation of such intervention programs is essential, further studies need to be established rapidly. %R 10.2196/50289 %U https://pediatrics.jmir.org/2024/1/e50289 %U https://doi.org/10.2196/50289 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e51366 %T Engagement, Acceptability, and Effectiveness of the Self-Care and Coach-Supported Versions of the Vira Digital Behavior Change Platform Among Young Adults at Risk for Depression and Obesity: Pilot Randomized Controlled Trial %A Weiner,Lauren S %A Crowley,Ryann N %A Sheeber,Lisa B %A Koegler,Frank H %A Davis,Jon F %A Wells,Megan %A Funkhouser,Carter J %A Auerbach,Randy P %A Allen,Nicholas B %+ Ksana Health, 2288 Alder Street, Eugene, OR, 97405, United States, 1 541 912 2883, lauren.weiner@ksanahealth.com %K depression %K behavioral activation %K digital health %K mental health %K behavior change %K mobile sensing %K anxiety %K health coaching %K mobile phone %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Adolescence and early adulthood are pivotal stages for the onset of mental health disorders and the development of health behaviors. Digital behavioral activation interventions, with or without coaching support, hold promise for addressing risk factors for both mental and physical health problems by offering scalable approaches to expand access to evidence-based mental health support. Objective: This 2-arm pilot randomized controlled trial evaluated 2 versions of a digital behavioral health product, Vira (Ksana Health Inc), for their feasibility, acceptability, and preliminary effectiveness in improving mental health in young adults with depressive symptoms and obesity risk factors. Methods: A total of 73 participants recruited throughout the United States were randomly assigned to use Vira either as a self-guided product (Vira Self-Care) or with support from a health coach (Vira+Coaching) for 12 weeks. The Vira smartphone app used passive sensing of behavioral data related to mental health and obesity risk factors (ie, activity, sleep, mobility, and language patterns) and offered users personalized insights into patterns of behavior associated with their daily mood. Participants completed self-reported outcome measures at baseline and follow-up (12 weeks). All study procedures were completed via digital communications. Results: Both versions of Vira showed strong user engagement, acceptability, and evidence of effectiveness in improving mental health and stress. However, users receiving coaching exhibited more sustained engagement with the platform and reported greater reductions in depression (Cohen d=0.45, 95% CI 0.10-0.82) and anxiety (Cohen d=0.50, 95% CI 0.13-0.86) compared to self-care users. Both interventions also resulted in reduced stress (Vira+Coaching: Cohen d=–1.05, 95% CI –1.57 to –-0.50; Vira Self-Care: Cohen d=–0.78, 95% CI –1.33 to –0.23) and were perceived as useful and easy to use. Coached users also reported reductions in sleep-related impairment (Cohen d=–0.51, 95% CI –1.00 to –0.01). Moreover, participants increased their motivation for and confidence in making behavioral changes, with greater improvements in confidence among coached users. Conclusions: An app-based intervention using passive mobile sensing to track behavior and deliver personalized insights into behavior-mood associations demonstrated feasibility, acceptability, and preliminary effectiveness for reducing depressive symptoms and other mental health problems in young adults. Future directions include (1) optimizing the interventions, (2) conducting a fully powered trial that includes an active control condition, and (3) testing mediators and moderators of outcome effects. Trial Registration: ClinicalTrials.gov NCT05638516; https://clinicaltrials.gov/study/NCT05638516 %M 39298763 %R 10.2196/51366 %U https://mental.jmir.org/2024/1/e51366 %U https://doi.org/10.2196/51366 %U http://www.ncbi.nlm.nih.gov/pubmed/39298763 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58288 %T Testing the Effectiveness of a Mobile Smartphone App Designed to Improve the Mental Health of Junior Physicians: Protocol for a Randomized Controlled Trial %A Lai,Lauren %A Sanatkar,Samineh %A Mackinnon,Andrew %A Deady,Mark %A Petrie,Katherine %A Lipscomb,Rosie %A Counson,Isabelle %A Francis-Taylor,Rohan %A Dean,Kimberlie %A Harvey,Samuel %+ Black Dog Institute, Hospital Rd, Randwick, 2031, Australia, 61 9382 4530, lauren.lai@blackdog.org.au %K junior physicians %K digital mental health %K smartphone app %K depression %K mobile phone %D 2024 %7 19.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Shift (Black Dog Institute) is the first mobile health smartphone app created to support the mental health of junior physicians. Junior physicians experience demanding work conditions, leading to high levels of psychological distress and burnout. However, they are often concerned about the potential career impacts of seeking mental health support. The confidentiality and ease of access of digital interventions may be particularly suited to address these concerns. The Shift app provides therapeutic and psychoeducational content and strategies contextualized for the specific needs of physicians in training. App content includes information on mental health, help seeking, mindfulness, and common workplace-related concerns of junior physicians. Objective: This study aims to test, at scale, the effectiveness of Shift among junior physicians working in Australia using a randomized controlled trial design. The primary aim is to examine whether junior physicians using Shift experience a reduction in depressive symptoms compared with a waitlist control group. The secondary aim is to examine whether the app intervention group experiences improvements in anxiety, work and social functioning, help seeking, quality of life, and burnout compared with the control group. Methods: A total of 778 junior physicians were recruited over the internet through government and nongovernment medical organizations across Australia, as well as through paid social media advertisements. They were randomly allocated to one of 2 groups: (1) the intervention group, who were asked to use the Shift app for a period of 30 days, or (2) the waitlist control group, who were placed on a waitlist and were asked to use the app after 3 months. Participants completed psychometric measures for self-assessing mental health and wellbeing outcomes, with assessments occurring at baseline, 1 month after completing the baseline period, and 3 months after completing the baseline period. Participants in the waitlist control group were asked to complete an additional web-based questionnaire 1 month after receiving access to the app or 4 months after completing the baseline survey. Participants took part in the study on the internet; the study was completely automated. Results: The study was funded from November 2022 to December 2024 by the New South Wales Ministry of Health. Data collection for the study occurred between January and August 2024, with 780 participants enrolling in the study during this time. Data analysis is underway; the effectiveness of the intervention will be estimated on an intention-to-treat basis using a mixed-model, repeated measures analysis. Results are expected to be submitted for publication in 2025. Conclusions: To the best of our knowledge, this is the first randomized controlled trial to examine the effectiveness of a mobile health smartphone app specifically designed to support the mental health of junior physicians. Trial Registration: Australia and New Zealand Clinical Trials Registry ACTRN12623000664640; https://tinyurl.com/7xt24dhk International Registered Report Identifier (IRRID): DERR1-10.2196/58288 %M 39298756 %R 10.2196/58288 %U https://www.researchprotocols.org/2024/1/e58288 %U https://doi.org/10.2196/58288 %U http://www.ncbi.nlm.nih.gov/pubmed/39298756 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e58714 %T Requirement Analysis of Different Variants of a Measurement and Training Station for Older Adults at Risk of Malnutrition and Reduced Mobility: Focus Group Study %A Happe,Lisa %A Sgraja,Marie %A Quinten,Vincent %A Förster,Mareike %A Diekmann,Rebecca %+ Junior Research Group “Nutrition and Physical Function in Older Adults”, Department of Health Services Research, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, Oldenburg, 26127, Germany, 49 441 798 2354, lisa.happe@uol.de %K gerontechnology %K physical activity %K diet %K technical assistance system %K health data %K qualitative research %D 2024 %7 17.9.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Demographic change is leading to an increasing proportion of older people in the German population and requires new approaches for prevention and rehabilitation to promote the independence and health of older people. Technical assistance systems can offer a promising solution for the early detection of nutritional and physical deficits and the initiation of appropriate interventions. Such a system should combine different components, such as devices for assessing physical and nutritional status, educational elements on these topics, and training and feedback options. The concept is that the whole system can be used independently by older adults (aged ≥70 years) for monitoring and early detection of problems in nutrition or physical function, as well as providing opportunities for intervention. Objective: This study aims to develop technical and digital elements for a measurement and training station (MuTs) with an associated app. Through focus group discussions, target group requirements, barriers, and favorable components for such a system were identified. Methods: Older adults (aged ≥70 years) were recruited from a community-based setting as well as from a geriatric rehabilitation center. Focus group interviews were conducted between August and November 2022. Following a semistructured interview guideline, attitudes, requirements, preferences, and barriers for the MuTs were discussed. Discussions were stimulated by videos, demonstrations of measuring devices, and participants’ ratings of the content presented using rankings. After conducting 1 focus group in the rehabilitation center and 2 in the community, the interview guide was refined, making a more detailed discussion of identified elements and aspects possible. The interviews were recorded, transcribed verbatim, and analyzed using content analysis. Results: A total of 21 older adults (female participants: n=11, 52%; mean age 78.5, SD 4.6 years) participated in 5 focus group discussions. There was a strong interest in the independent measurement of health parameters, such as pulse and hand grip strength, especially among people with health problems who would welcome feedback on their health development. Participants emphasized the importance of personal guidance and interaction before using the device, as well as the need for feedback mechanisms and personalized training for everyday use. Balance and coordination were mentioned as preferred training areas in a MuTs. New training options that motivate and invite people to participate could increase willingness to use the MuTs. Conclusions: The target group is generally open and interested in tracking and optimizing diet and physical activity. A general willingness to use a MuTs independently was identified, as well as a compelling need for guidance and feedback on measurement and training to be part of the station. %M 39288403 %R 10.2196/58714 %U https://aging.jmir.org/2024/1/e58714 %U https://doi.org/10.2196/58714 %U http://www.ncbi.nlm.nih.gov/pubmed/39288403 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e44368 %T Psychological Health and Wellness and the Impact of a Supportive Text Messaging Program (Wellness4MDs) Among Physicians and Medical Learners in Canada: Protocol for a Longitudinal Study %A Shalaby,Reham %A Agyapong,Belinda %A Dias,Raquel %A Obuobi-Donkor,Gloria %A Adu,Medard K %A Spicer,Sharron %A Yanchar,Natalie L %A Agyapong,Vincent I O %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 780 215 7771, agyapong@ualberta.ca %K wellness %K doctors %K Canada %K depression %K burnout %K anxiety %K supportive text messages %K eHealth %D 2024 %7 16.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Burnout, anxiety, and depression continue to affect physicians, postgraduate medical trainees, and medical students globally and in Canada particularly after the COVID-19 pandemic. Objective: The primary goal of this project is to design, implement, monitor, and evaluate a daily supportive SMS text messaging program (Wellness4MDs, Global Psychological e-Health Foundation). The program aims to reduce the prevalence and severity of burnout, anxiety, and depression symptoms among physicians, postgraduate medical trainees, and medical students in Canada. Methods: This longitudinal study represents a multistakeholder, mixed methods, multiyear implementation science project. Project evaluation will be conducted through a quantitative prospective longitudinal approach using a paired sample comparison, a naturalistic cross-sectional controlled design, and satisfaction surveys. Prevalence estimates for psychological problems would be based on baseline data from self-completed validated rating scales. Additional data will be collected at designated time points for paired comparison. Outcome measures will be assessed using standardized rating scales, including the Maslach Burnout Inventory for burnout symptoms, the 9-item Patient Health Questionnaire for depression symptoms, the 7-item Generalized Anxiety Disorder scale for anxiety symptoms, and the World Health Organization–Five Well-Being Index. Results: The project launched in the last quarter of 2023, and program evaluation results will become available within 36 months. The Wellness4MDs program is expected to reduce the prevalence and severity of psychological problems among physicians in Canada and achieve high subscriber satisfaction. Conclusions: The results from the Wellness4MDs project evaluation will provide key information regarding the effectiveness of daily supportive SMS text messages and links to mental health resources on these mental health parameters in Canadian physicians, postgraduate trainees, and medical students. Information will be useful for informing policy and decision-making concerning psychological interventions for physicians in Canada. International Registered Report Identifier (IRRID): PRR1-10.2196/44368 %M 39283660 %R 10.2196/44368 %U https://www.researchprotocols.org/2024/1/e44368 %U https://doi.org/10.2196/44368 %U http://www.ncbi.nlm.nih.gov/pubmed/39283660 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56939 %T Designing a Culturally Relevant Digital Skin Cancer Prevention Intervention for Hispanic Individuals: Qualitative Exploration %A Niu,Zhaomeng %A Rivera,Yonaira M %A Lozada,Carolina %A Hudson,Shawna V %A Penedo,Frank J %A Manne,Sharon L %A Heckman,Carolyn J %+ Department of Health Informatics, Rutgers School of Health Professions, 675 Hoes Lane West, 826F, Piscataway, NJ, 08854, United States, 1 5093393076, zhaomeng.niu@rutgers.edu %K skin cancer %K prevention %K Hispanic %K sun protection %K skin self-examination %K intervention %K qualitative %K interviews %K health care provider %K community leader %K mobile-based %D 2024 %7 12.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In the past 2 decades, melanoma incidence among Hispanic individuals has risen by 20%. The mortality rate of Hispanic individuals is higher than that for non-Hispanic White individuals. Skin cancer can largely be prevented with regular sun protection, and skin cancer outcomes can be improved through early detection, for example, by skin self-examination. Alarmingly, Hispanic individuals are less aware of the symptoms and harms of skin cancers, tend to have misperceptions regarding the risks and benefits of skin cancer prevention behaviors, and engage in less sun protection behaviors than non-Hispanic White individuals. Objective: This study aimed to use a community-engaged approach and conduct both group and individual interviews among Hispanic individuals and relevant key stakeholders to explore the potential design of a mobile-based skin cancer prevention intervention for Hispanic individuals. Methods: This study used a qualitative design (focus groups and individual interviews). Participants were recruited from local community organizations’ social media, local events, and contact lists (eg, email). Zoom interviews were conducted to examine whether Hispanic individuals would be interested in a mobile-based skin cancer intervention and to explore their preferences and suggestions to inform skin cancer prevention intervention design. Results: Five focus groups (2 in Spanish and 3 in English) among self-identified Hispanic individuals (n=34) and 15 semistructured, in-depth individual interviews among key stakeholders (health care providers and community leaders; eg, dermatologist, nurse practitioner, licensed social worker, and church leader) were conducted. The main themes and subthemes emerging from the group discussions and individual interviews were organized into the following categories: intervention platform, delivery frequency and format, message design, engagement plan, and activities. WhatsApp and Facebook were identified as suitable platforms for the intervention. Messages including short videos, visuals (eg, images and photographs), and simple texts messages were preferred. Recommendations for message design included personalized messages, personal stories and narratives, culturally relevant design (eg, incorporating family values), and community-trusted sources. Potential engagement and retention recommendations were also discussed. Additional details and exemplar quotes of each theme and subtheme are described. Conclusions: This study provides important insights and directions for the design of a mobile, digital skin cancer intervention to modify Hispanic individuals’ sun protection and skin self-examination behaviors to help improve skin cancer outcomes. Insights gathered from community leaders and health care providers provided valuable additions to the community-derived data. Leveraging popular digital platforms among Hispanic individuals such as WhatsApp or Facebook could be a promising approach to skin cancer prevention. Recommendations from the community included the use of concise videos, illustrative images, clear text messages, tailored communications, narratives featuring personal experiences, designs that reflect cultural significance, and information from sources that are trusted by the community, which provided useful strategies for future intervention design among Hispanic individuals. %M 39265165 %R 10.2196/56939 %U https://formative.jmir.org/2024/1/e56939 %U https://doi.org/10.2196/56939 %U http://www.ncbi.nlm.nih.gov/pubmed/39265165 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e56502 %T A Voice-Activated Device Exercise and Social Engagement Program for Older Adult–Care Partner Dyads: Pilot Clinical Trial and Focus Group Study Evaluating the Feasibility, Use, and Estimated Functional Impact of EngAGE %A Huisingh-Scheetz,Megan %A Nicholson III,Roscoe F %A Shervani,Saira %A Smith,Chelsea %A Danilovich,Margaret %A Finch,Laura %A Montoya,Yadira %A Hawkley,Louise C %+ Department of Medicine, University of Chicago, 5841 South Maryland Ave., Suite W707, MC 6098, Chicago, IL, 60637, United States, 1 7737028311, megan.huisingh-scheetz@bsd.uchicago.edu %K voice-activated device %K voice-activated devices %K frailty %K frail %K weak %K weakness %K technology %K activity %K physical activity %K exercise %K exercising %K caregiver %K caregivers %K caregiving %K caretaker %K caretakers %K caretaking %K care-giver %K care-givers %K care-giving %K care-taker %K care-takers %K care-taking %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K voice activation %K digital health %K technology %K exercises %K online exercises %K participatory design %K new devices %K health devices %K technology development %K mobile phone %D 2024 %7 12.9.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Maintaining exercise is essential for healthy aging but difficult to sustain. EngAGE is a socially motivated exercise program delivered over a voice-activated device that targets older adult–care partner dyads. Objective: This 10-week pilot study aimed to assess EngAGE feasibility and use, obtain user experience feedback, and estimate potential impact on function. Methods: In total, 10 older adults aged ≥65 years were recruited from an independent living residence together with their self-identified care partners. EngAGE delivered National Institute on Aging Go4Life exercises to older adults daily, while care partners received progress reports and prompts to send encouraging messages that were read aloud by the device to the older adult. Older adults’ use was tracked, and physical function was assessed at baseline and follow-up. Follow-up focus group data provided qualitative feedback. Results: On average, participants completed 393.7 individual exercises over the 10-week intervention period or 39.4 exercises/wk (range 48-492, median 431, IQR 384-481, SD 112.4) without injury and used EngAGE on an average of 41 of 70 days or 4.1 d/wk (range 7-66, median 51, IQR 23-56, and SD 21.2 days). Mean grip strength increased nonsignificantly by 1.3 kg (preintervention mean 26.3 kg, SD 11.0; postintervention mean 27.6 kg, SD 11.6; P=.34), and 4 of 10 participants improved by a minimal clinically important difference (MCID) of 2.5 kg. Further, the time for 5-repeated chair stands significantly reduced by 2.3 seconds (preintervention mean 12, SD 3.6 s; postintervention mean 9.7, SD 2.7 s; P=.02), and 3 of 9 participants improved by an MCID of –2.3 seconds. Furthermore, 3-meter usual walk performance was brisk at baseline (mean 2.1, SD 0.4 s) and decreased by 0.1 seconds (postintervention 2, SD 0.4 s; P=.13), although 5 of 9 participants improved by a MCID of 0.05 m/s. Qualitative results showed perceived benefits, favored program features, and areas for improvement. Conclusions: We present a pilot study of a new voice-activated device application customized to older adult users that may serve as a guide to other technology development for older adults. Our pilot study served to further refine the application and to inform a larger trial testing EngAGE’s impact on functional outcomes, a necessary step for developing evidence-based technology tools. %M 39265155 %R 10.2196/56502 %U https://aging.jmir.org/2024/1/e56502 %U https://doi.org/10.2196/56502 %U http://www.ncbi.nlm.nih.gov/pubmed/39265155 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e48974 %T Toward Tailoring Just-in-Time Adaptive Intervention Systems for Workplace Stress Reduction: Exploratory Analysis of Intervention Implementation %A Suh,Jina %A Howe,Esther %A Lewis,Robert %A Hernandez,Javier %A Saha,Koustuv %A Althoff,Tim %A Czerwinski,Mary %+ Microsoft Research, 1 Microsoft Way, Redmond, WA, 98052, United States, 1 4254211584, jinsuh@microsoft.com %K workplace stress %K just-in-time %K just-in-time adaptive intervention %K JITAI %K engagement %K microintervention %K stress reduction %K psychotherapy %D 2024 %7 12.9.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Integrating stress-reduction interventions into the workplace may improve the health and well-being of employees, and there is an opportunity to leverage ubiquitous everyday work technologies to understand dynamic work contexts and facilitate stress reduction wherever work happens. Sensing-powered just-in-time adaptive intervention (JITAI) systems have the potential to adapt and deliver tailored interventions, but such adaptation requires a comprehensive analysis of contextual and individual-level variables that may influence intervention outcomes and be leveraged to drive the system’s decision-making. Objective: This study aims to identify key tailoring variables that influence momentary engagement in digital stress reduction microinterventions to inform the design of similar JITAI systems. Methods: To inform the design of such dynamic adaptation, we analyzed data from the implementation and deployment of a system that incorporates passively sensed data across everyday work devices to send just-in-time stress reduction microinterventions in the workplace to 43 participants during a 4-week deployment. We evaluated 27 trait-based factors (ie, individual characteristics), state-based factors (ie, workplace contextual and behavioral signals and momentary stress), and intervention-related factors (ie, location and function) across 1585 system-initiated interventions. We built logistical regression models to identify the factors contributing to momentary engagement, the choice of interventions, the engagement given an intervention choice, the user rating of interventions engaged, and the stress reduction from the engagement. Results: We found that women (odds ratio [OR] 0.41, 95% CI 0.21-0.77; P=.03), those with higher neuroticism (OR 0.57, 95% CI 0.39-0.81; P=.01), those with higher cognitive reappraisal skills (OR 0.69, 95% CI 0.52-0.91; P=.04), and those that chose calm interventions (OR 0.43, 95% CI 0.23-0.78; P=.03) were significantly less likely to experience stress reduction, while those with higher agreeableness (OR 1.73, 95% CI 1.10-2.76; P=.06) and those that chose prompt-based (OR 6.65, 95% CI 1.53-36.45; P=.06) or video-based (OR 5.62, 95% CI 1.12-34.10; P=.12) interventions were substantially more likely to experience stress reduction. We also found that work-related contextual signals such as higher meeting counts (OR 0.62, 95% CI 0.49-0.78; P<.001) and higher engagement skewness (OR 0.64, 95% CI 0.51-0.79; P<.001) were associated with a lower likelihood of engagement, indicating that state-based contextual factors such as being in a meeting or the time of the day may matter more for engagement than efficacy. In addition, a just-in-time intervention that was explicitly rescheduled to a later time was more likely to be engaged with (OR 1.77, 95% CI 1.32-2.38; P<.001). Conclusions: JITAI systems have the potential to integrate timely support into the workplace. On the basis of our findings, we recommend that individual, contextual, and content-based factors be incorporated into the system for tailoring as well as for monitoring ineffective engagements across subgroups and contexts. %M 39264703 %R 10.2196/48974 %U https://mental.jmir.org/2024/1/e48974 %U https://doi.org/10.2196/48974 %U http://www.ncbi.nlm.nih.gov/pubmed/39264703 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58344 %T Effectiveness of a Parent-Based eHealth Intervention for Physical Activity, Dietary Behavior, and Sleep Among Preschoolers: Protocol for a Randomized Controlled Trial %A Zhou,Peng %A Song,Huiqi %A Lau,Patrick W C %A Shi,Lei %A Wang,Jingjing %+ Department of Sport, Physical Education and Health, Faculty of Arts and Social Sciences, Hong Kong Baptist University, Room AAB 1103, 11/F, Academic and Administration Building, Baptist University Road Campus, Kowloon Tong, Hong Kong, China (Hong Kong), 852 93774078, wclau@hkbu.edu.hk %K physical activity %K dietary behavior %K sleep %K electronic health %K eHealth %K preschoolers %K parenting %D 2024 %7 12.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Preschoolers’ lifestyles have become physically inactive and sedentary, their eating habits have become unhealthy, and their sleep routines have become increasingly disturbed. Parent-based interventions have shown promise to improve physical activity (PA), improve dietary behavior (DB), and reduce sleep problems among preschoolers. However, because of the recognized obstacles of face-to-face approaches (eg, travel costs and time commitment), easy access and lower costs make eHealth interventions appealing. Previous studies that examined the effectiveness of parent-based eHealth for preschoolers’ PA, DB, and sleep have either emphasized 1 variable or failed to balance PA, DB, and sleep modules and consider the intervention sequence during the intervention period. There is an acknowledged gap in parent-based eHealth interventions that target preschoolers raised in Chinese cultural contexts. Objective: This study aims to investigate the effectiveness of a parent-based eHealth intervention for PA, DB, and sleep problems among Chinese preschoolers. Methods: This 2-arm, parallel, randomized controlled trial comprises a 12-week intervention with a 12-week follow-up. A total of 206 parent-child dyads will be randomized to either an eHealth intervention group or a control group. Participants allocated to the eHealth intervention group will receive 12 interactive modules on PA, DB, and sleep, with each module delivered on a weekly basis to reduce the sequence effect on variable outcomes. The intervention is grounded in social cognitive theory. It will be delivered through social media, where parents can obtain valid and updated educational information, have a social rapport, and interact with other group members and facilitators. Participants in the control group will receive weekly brochures on PA, DB, and sleep recommendations from kindergarten teachers, but they will not receive any interactive components. Data will be collected at baseline, 3 months, and 6 months. The primary outcome will be preschoolers’ PA. The secondary outcomes will be preschoolers’ DB, preschoolers’ sleep duration, preschoolers’ sleep problems, parents’ PA, parenting style, and parental feeding style. Results: Parent-child dyads were recruited in September 2023. Baseline and posttest data collection occurred from October 2023 to March 2024. The follow-up data will be obtained in June 2024. The results of the study are expected to be published in 2025. Conclusions: The parent-based eHealth intervention has the potential to overcome the barriers of face-to-face interventions and will offer a novel approach for promoting a healthy lifestyle among preschoolers. If this intervention is found to be efficacious, the prevalence of unhealthy lifestyles among preschoolers may be alleviated at a low cost, which not only has a positive influence on the health of individuals and the well-being of the family but also reduces the financial pressure on society to treat diseases caused by poor lifestyle habits. Trial Registration: ClinicalTrials.gov NCT06025019; https://clinicaltrials.gov/study/NCT06025019 International Registered Report Identifier (IRRID): DERR1-10.2196/58344 %M 39264108 %R 10.2196/58344 %U https://www.researchprotocols.org/2024/1/e58344 %U https://doi.org/10.2196/58344 %U http://www.ncbi.nlm.nih.gov/pubmed/39264108 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54215 %T Racial and Ethnic Differences in Mobile App Use for Meeting Sexual Partners Among Young Men Who Have Sex With Men and Young Transgender Women: Cross-Sectional Study %A Risher,Kathryn %A Janulis,Patrick %A McConnell,Elizabeth %A Motley,Darnell %A Serrano,Pedro Alonso %A Jackson,Joel D %A Brown,Alonzo %A Williams,Meghan %A Mendez,Daniel %A Phillips II,Gregory %A Melville,Joshua %A Birkett,Michelle %K young men who have sex with men and young transgender women %K hookup or dating apps %K sexual partners %K race and ethnicity %K race %K ethnicity %K mobile app %K racial bias %K sexual partner %K young %K transgender %K Chicago %K United States %K online %K dating app %K racism %K analysis %K youth %K social network %K hookup %K black %K Hispanic %K Tinder %K Grindr %K Scruff %K sexual mixing patterns %K sexual patterns %K sexual pattern %K sexually transmitted infection %K sexually transmitted infections %D 2024 %7 11.9.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Young men who have sex with men and young transgender women (YMSM-YTW) use online spaces to meet sexual partners with increasing regularity, and research shows that experiences of racism online mimics the real world. Objective: We analyzed differences by race and ethnicity in web-based and mobile apps used to meet sexual partners as reported by Chicago-based YMSM-YTW in 2016‐2017. Methods: A racially and ethnically diverse sample of 643 YMSM-YTW aged 16‐29 years were asked to name websites or mobile apps used to seek a sexual partner in the prior 6 months, as well as provide information about sexual partnerships from the same period. We used logistic regression to assess the adjusted association of race and ethnicity with (1) use of any website or mobile apps to find a sexual partner, (2) use of a “social network” to find a sexual partner compared to websites or mobile apps predominantly used for dating or hookups, (3) use of specific websites or mobile apps, and (4) reporting successfully meeting a sexual partner online among website or mobile app users. Results: While most YMSM-YTW (454/643, 70.6%) used websites or mobile apps to find sexual partners, we found that Black non-Hispanic YMSM-YTW were significantly less likely to report doing so (comparing White non-Hispanic to Black non-Hispanic: adjusted odds ratio [aOR] 1.74, 95% CI 1.10‐2.76). Black non-Hispanic YMSM-YTW were more likely to have used a social network site to find a sexual partner (comparing White non-Hispanic to Black non-Hispanic: aOR 0.20, 95% CI 0.11‐0.37), though this was only reported by one-third (149/454, 32.8%) of all app-using participants. Individual apps used varied by race and ethnicity, with Grindr, Tinder, and Scruff being more common among White non-Hispanic YMSM-YTW (93/123, 75.6%; 72/123, 58.5%; and 30/123, 24.4%, respectively) than among Black non-Hispanic YMSM-YTW (65/178, 36.5%; 25/178, 14%; and 4/178, 2.2%, respectively) and Jack’d and Facebook being more common among Black non-Hispanic YMSM-YTW (105/178, 59% and 64/178, 36%, respectively) than among White non-Hispanic YMSM-YTW (6/123, 4.9% and 8/123, 6.5%, respectively). Finally, we found that while half (230/454, 50.7%) of YMSM-YTW app users reported successfully meeting a new sexual partner on an app, Black non-Hispanic YMSM-YTW app users were less likely to have done so than White non-Hispanic app users (comparing White non-Hispanic to Black non-Hispanic: aOR 2.46, 95% CI 1.50‐4.05). Conclusions: We found that Black non-Hispanic YMSM-YTW engaged with websites or mobile apps and found sexual partners systematically differently than White non-Hispanic YMSM-YTW. Our findings give a deeper understanding of how racial and ethnic sexual mixing patterns arise and have implications for the spread of sexually transmitted infections among Chicago’s YMSM-YTW. %R 10.2196/54215 %U https://publichealth.jmir.org/2024/1/e54215 %U https://doi.org/10.2196/54215 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54005 %T Assessment of a Pilot Program for Remote Support on Mental Health for Young Physicians in Rural Settings in Peru: Mixed Methods Study %A De la Cruz-Torralva,Kelly %A Escobar-Agreda,Stefan %A Riega López,Pedro %A Amaro,James %A Reategui-Rivera,C Mahony %A Rojas-Mezarina,Leonardo %+ Unidad de Telesalud, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Av Grau 755, Cercado de Lima, 15001, Peru, 51 619 7000 ext 4650, priegal@unmsm.edu.pe %K telemedicine %K screening %K treatment %K mental health %K suicide %K depression %K anxiety %K alcoholism %K physicians %K rural areas %K Peru %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine-based interventions show promise in addressing mental health issues among rural populations, yet evidence regarding their impact among the health care workforce in these contexts remains limited. Objective: This study aimed to evaluate the characteristics and the responses and perceptions of recently graduated physicians who work in rural areas of Peru as part of the Servicio Rural Urbano Marginal en Salud (Rural-Urban Marginal Health Service [SERUMS], in Spanish) toward a telehealth intervention to provide remote orientation and accompaniment in mental health. Methods: A mixed methods study was carried out involving physicians who graduated from the Universidad Nacional Mayor de San Marcos and participated in the Mental Health Accompaniment Program (MHAP) from August 2022 to February 2023. This program included the assessment of mental health conditions via online forms, the dissemination of informational materials through a website, and, for those with moderate or high levels of mental health issues, the provision of personalized follow-up by trained personnel. Quantitative analysis explored the mental health issues identified among physicians, while qualitative analysis, using semistructured interviews, examined their perceptions of the services provided. Results: Of 75 physicians initially enrolled to the MHAP, 30 (41.6%) opted to undergo assessment and use the services. The average age of the participants was 26.8 (SD 1.9) years, with 17 (56.7%) being female. About 11 (36.7%) reported have current or previous mental health issues, 17 (56.7%) indicating some level of depression, 14 (46.7%) indicated some level of anxiety, 5 (16.6%) presenting a suicidal risk, and 2 (6.7%) attempted suicide during the program. Physicians who did not use the program services reported a lack of advertising and related information, reliance on personal mental health resources, or neglect of symptoms. Those who used the program expressed a positive perception regarding the services, including evaluation and follow-up, although some faced challenges accessing the website. Conclusions: The MHAP has been effective in identifying and managing mental health problems among SERUMS physicians in rural Peru, although it faced challenges related to access and participation. The importance of mental health interventions in this context is highlighted, with recommendations to improve accessibility and promote self-care among participants. %M 39255480 %R 10.2196/54005 %U https://formative.jmir.org/2024/1/e54005 %U https://doi.org/10.2196/54005 %U http://www.ncbi.nlm.nih.gov/pubmed/39255480 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50356 %T Real-World Outcomes of a Digital Behavioral Coaching Intervention to Improve Employee Health Status: Retrospective Observational Study %A Abdul Aziz,Amani Fadzlina %A Ong,Tiffanie %+ Naluri Hidup Sdn Bhd, 22, Persiaran Damansara Endah, Bukit Damansara, Kuala Lumpur, 50490, Malaysia, 60 123072922, tiffanie@naluri.life %K digital behavioral coaching %K chronic disease management %K digital health %K mHealth %K workplace interventions %K mobile phone %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic noncommunicable diseases (NCDs) account for major disability and premature mortality worldwide, with low- and middle-income countries being disproportionately burdened. Given the negative impact of NCDs on employee performance and work productivity, there is a rising need for stakeholders to identify effective workplace solutions that can improve employee health outcomes. As the workplace becomes more dispersed post pandemic, digital behavioral coaching offers a scalable, personalized, and cost-effective method of managing chronic disease risk factors among employees. Objective: This study aimed to retrospectively evaluate the impact of a digital behavioral coaching program on year-to-year changes in employee health status in a cohort of Indonesian employees. Methods: This retrospective real-world exploratory analysis of secondary health data followed 774 employees of an Indonesian company who completed company-sponsored health screenings between 2021 and 2022 and were given access to Naluri (Naluri Hidup Sdn Bhd), a holistic digital therapeutics platform offering digital behavioral health coaching and self-help tools. Participants were retrospectively classified as those who received active coaching (n=177), passive coaching (n=108), and no coaching (n=489). Linear mixed-effects models were used to evaluate the year-to-year changes in health outcomes across the 3 employee groups, with post hoc analyses evaluating within-group differences between the 2 time points and between-group differences at follow-up. Results: Significant time×group interaction effects were detected for body weight, BMI, hemoglobin A1c, low-density lipoprotein, total cholesterol, and systolic and diastolic blood pressure. Post hoc pairwise comparisons revealed significant improvements in hemoglobin A1c (mean difference [Mdiff]=–0.14, P=.008), high-density lipoprotein (Mdiff=+2.14, P<.001), and total cholesterol (Mdiff=–11.45, P<.001) for employees in the Active Coaching group between 2021 and 2022, with the other 2 groups reporting deteriorations in multiple health outcomes throughout the 2 time points. At follow-up, those who received active coaching between 2021 and 2022 reported significantly lower body weight (P<.001), BMI (P=.001), low-density lipoprotein (P=.045), and total cholesterol (P<.001) than the No Coaching group. Conclusions: This study demonstrates real-world outcomes and implications supporting the use of workplace digital behavioral coaching in improving employee health status. Given the rising burden of NCDs in the Southeast Asian region, our findings underscore the role that workplace digital health interventions can play in preventing and managing chronic disease risk factors. %M 39255013 %R 10.2196/50356 %U https://mhealth.jmir.org/2024/1/e50356 %U https://doi.org/10.2196/50356 %U http://www.ncbi.nlm.nih.gov/pubmed/39255013 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55207 %T The Impact of Air Pollution Information on Individuals’ Exercise Behavior: Empirical Study Using Wearable and Mobile Devices Data %A Yang,Yang %A Goh,Khim-Yong %A Teo,Hock Hai %A Tan,Sharon Swee-Lin %+ School of Business and Management, Royal Holloway, University of London, Egham Hill, Egham, TW20 0EX, United Kingdom, 44 1784 434 455, y.yang@rhul.ac.uk %K air pollution %K information sources %K exercise activity %K wearable and mobile devices %K econometric analysis %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical exercise and exposure to air pollution have counteracting effects on individuals’ health outcomes. Knowledge on individuals’ real-time exercise behavior response to different pollution information sources remains inadequate. Objective: This study aims to examine the extent to which individuals avoid polluted air during exercise activities in response to different air pollution information sources. Methods: We used data on individuals’ exercise behaviors captured by wearable and mobile devices in 83 Chinese cities over a 2-year time span. In our data set, 35.99% (5896/16,379) of individuals were female and 64% (10,483/16,379) were male, and their ages predominantly ranged from 18 to 50 years. We further augmented the exercise behavior data with air pollution information that included city-hourly level measures of the Air Quality Index and particulate matter 2.5 concentration (in µg/m3), and weather data that include city-hourly level measures of air temperature (ºC), dew point (ºC), wind speed (m/s), and wind direction (degrees). We used a linear panel fixed effect model to estimate individuals’ exercise-aversion behaviors (ie, running exercise distance at individual-hour, city-hour, or city-day levels) and conducted robustness checks using the endogenous treatment effect model and regression discontinuity method. We examined if alternative air pollution information sources could moderate (ie, substitute or complement) the role of mainstream air pollution indicators. Results: Our results show that individuals exhibit a reduction of running exercise behaviors by about 0.50 km (or 7.5%; P<.001) during instances of moderate to severe air pollution, and there is no evidence of reduced distances in instances of light air pollution. Furthermore, individuals’ exercise-aversion behaviors in response to mainstream air pollution information are heightened by different alternative information sources, such as social connections and social media user-generated content about air pollution. Conclusions: Our results highlight the complementary role of different alternative information sources of air pollution in inducing individuals’ aversion behaviors and the importance of using different information channels to increase public awareness beyond official air pollution alerts. %M 39255029 %R 10.2196/55207 %U https://mhealth.jmir.org/2024/1/e55207 %U https://doi.org/10.2196/55207 %U http://www.ncbi.nlm.nih.gov/pubmed/39255029 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e59243 %T Smart Device Ownership and Use of Social Media, Wearable Trackers, and Health Apps Among Black Women With Hypertension in the United States: National Survey Study %A Kalinowski,Jolaade %A Bhusal,Sandesh %A Pagoto,Sherry L %A Newton Jr,Robert %A Waring,Molly E %+ Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd Unit 1058, Storrs, CT, 06269, United States, 1 203 251 8421, jolaade.kalinowski@uconn.edu %K Black women %K Black %K women %K tracker %K trackers %K wearable %K wearables %K hypertension %K hypertensive %K cardiology %K cardiovascular %K blood pressure %K social media %K technology %K usage %K digital health %K eHealth %K tablet %K mHealth %K mobile health %K app %K apps %K applications %K survey %K surveys %K questionnaire %K questionnaires %K Health Information National Trends Survey %K HINTS %D 2024 %7 9.9.2024 %9 Research Letter %J JMIR Cardio %G English %X The majority of Black women with hypertension in the United States have smartphones or tablets and use social media, and many use wearable activity trackers and health or wellness apps, digital tools that can be used to support lifestyle changes and medication adherence. %M 39250778 %R 10.2196/59243 %U https://cardio.jmir.org/2024/1/e59243 %U https://doi.org/10.2196/59243 %U http://www.ncbi.nlm.nih.gov/pubmed/39250778 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e58974 %T Empathic Conversational Agent Platform Designs and Their Evaluation in the Context of Mental Health: Systematic Review %A Sanjeewa,Ruvini %A Iyer,Ravi %A Apputhurai,Pragalathan %A Wickramasinghe,Nilmini %A Meyer,Denny %+ School of Health Sciences, Swinburne University of Technology, PO Box 218, John Street, Hawthorn, 3122, Australia, 61 422587030, rsanjeewa@swin.edu.au %K conversational agents %K chatbots %K virtual assistants %K empathy %K emotionally aware %K mental health %K mental well-being %D 2024 %7 9.9.2024 %9 Review %J JMIR Ment Health %G English %X Background: The demand for mental health (MH) services in the community continues to exceed supply. At the same time, technological developments make the use of artificial intelligence–empowered conversational agents (CAs) a real possibility to help fill this gap. Objective: The objective of this review was to identify existing empathic CA design architectures within the MH care sector and to assess their technical performance in detecting and responding to user emotions in terms of classification accuracy. In addition, the approaches used to evaluate empathic CAs within the MH care sector in terms of their acceptability to users were considered. Finally, this review aimed to identify limitations and future directions for empathic CAs in MH care. Methods: A systematic literature search was conducted across 6 academic databases to identify journal articles and conference proceedings using search terms covering 3 topics: “conversational agents,” “mental health,” and “empathy.” Only studies discussing CA interventions for the MH care domain were eligible for this review, with both textual and vocal characteristics considered as possible data inputs. Quality was assessed using appropriate risk of bias and quality tools. Results: A total of 19 articles met all inclusion criteria. Most (12/19, 63%) of these empathic CA designs in MH care were machine learning (ML) based, with 26% (5/19) hybrid engines and 11% (2/19) rule-based systems. Among the ML-based CAs, 47% (9/19) used neural networks, with transformer-based architectures being well represented (7/19, 37%). The remaining 16% (3/19) of the ML models were unspecified. Technical assessments of these CAs focused on response accuracies and their ability to recognize, predict, and classify user emotions. While single-engine CAs demonstrated good accuracy, the hybrid engines achieved higher accuracy and provided more nuanced responses. Of the 19 studies, human evaluations were conducted in 16 (84%), with only 5 (26%) focusing directly on the CA’s empathic features. All these papers used self-reports for measuring empathy, including single or multiple (scale) ratings or qualitative feedback from in-depth interviews. Only 1 (5%) paper included evaluations by both CA users and experts, adding more value to the process. Conclusions: The integration of CA design and its evaluation is crucial to produce empathic CAs. Future studies should focus on using a clear definition of empathy and standardized scales for empathy measurement, ideally including expert assessment. In addition, the diversity in measures used for technical assessment and evaluation poses a challenge for comparing CA performances, which future research should also address. However, CAs with good technical and empathic performance are already available to users of MH care services, showing promise for new applications, such as helpline services. %M 39250799 %R 10.2196/58974 %U https://mental.jmir.org/2024/1/e58974 %U https://doi.org/10.2196/58974 %U http://www.ncbi.nlm.nih.gov/pubmed/39250799 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e53907 %T Evaluating a Mobile App Supporting Evidence-Based Parenting Skills: Thematic Analysis of Parent Experience %A Hodson,Nathan %A Woods,Peter %A Solano,Juan Luque %A Talbot,Charlotte %A Giacco,Domenico %K digital microintervention %K parenting app %K product management %K parent %K parents %K parenting %K app %K apps %K usability %K acceptability %K family %K families %K interview %K interviews %K pediatric %K pediatrics %K child %K children %K youths %K experience %K experiences %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K acceptance %K behavior %K behaviors %K disruptive behavior %K thematic analysis %D 2024 %7 5.9.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Disruptive behavior disorders are among the most common disorders of childhood, and evidence-based parenting programs are the first-line treatment. Digital microinterventions have been proposed as one possible means of supporting parenting style change by giving parents in-the-moment advice about how to respond to challenging behavior. Until now, no digital microintervention supporting evidence-based parenting skills programs has been evaluated. Objective: The aim of this study is to evaluate the subjective experience of parents using a digital microintervention to support evidence-based parenting skills, with particular attention to acceptability, usability, family relationships, and parents’ values. Methods: We conducted serial interviews with 11 parents of 33 children before and after spending 3 weeks using an app including 3 digital microinterventions. Parents were recruited via local authorities in the Midlands region of the United Kingdom. Previous participation in a parenting program was an inclusion criterion. Interviews explored family composition; child behavior problems; and experience of using the mobile app, including barriers to use. Thematic analysis was conducted from a user-centered design perspective, and illustrative case vignettes were produced. Results: Many parents used the app in ways that helped them rather than strictly following the instructions they were given. Parents described a range of barriers to using the app including practical problems and failure to change child behavior. Parents and children responded in a variety of ways to the use of the phone, with many wholeheartedly embracing the convenience of technology. Case vignettes illustrate the uniqueness of each family’s experience. Conclusions: Parents’ use of a mobile app supporting evidence-based parenting skills is difficult to predict due to the unique challenges each family encounters. Many parents found it an acceptable and helpful addition to family life, but increased personalization is likely to be key to supporting parents. Future digital microintervention developers should keep in mind that parents are likely to use the app pragmatically rather than following instructions, may struggle to use a complex app under pressure, and are likely to hold complex feelings about parenting with an app. %R 10.2196/53907 %U https://pediatrics.jmir.org/2024/1/e53907 %U https://doi.org/10.2196/53907 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56396 %T Breaking Down Barriers to a Suicide Prevention Helpline: Web-Based Randomized Controlled Trial %A Van der Burgt,Margot C A %A Mérelle,Saskia %A Brinkman,Willem-Paul %A Beekman,Aartjan T F %A Gilissen,Renske %K barrier reduction intervention %K suicidal ideation %K self-help %K suicide prevention helpline %K randomized controlled trial %K help-seeking %K suicide %K RCT %K self-test %K effectiveness %K prevention %K middle-aged %K behavioral %K attitudinal %K website visitors %K website visitor %K website %K men %K suicide prevention %D 2024 %7 5.9.2024 %9 %J JMIR Ment Health %G English %X Background: Every month, around 3800 people complete an anonymous self-test for suicidal thoughts on the website of the Dutch suicide prevention helpline. Although 70% score high on the severity of suicidal thoughts, <10% navigate to the web page about contacting the helpline. Objective: This study aimed to test the effectiveness of a brief barrier reduction intervention (BRI) in motivating people with severe suicidal thoughts to contact the suicide prevention helpline, specifically in high-risk groups such as men and middle-aged people. Methods: We conducted a fully automated, web-based, randomized controlled trial. Respondents with severe suicidal thoughts and little motivation to contact the helpline were randomly allocated either to a brief BRI, in which they received a short, tailored message based on their self-reported barrier to the helpline (n=610), or a general advisory text (care as usual as the control group: n=612). Effectiveness was evaluated using both behavioral and attitudinal measurements. The primary outcome measure was the use of a direct link to contact the helpline after completing the intervention or control condition. Secondary outcomes were the self-reported likelihood of contacting the helpline and satisfaction with the received self-test. Results: In total, 2124 website visitors completed the Suicidal Ideation Attributes Scale and the demographic questions in the entry screening questionnaire. Among them, 1222 were randomized into the intervention or control group. Eventually, 772 respondents completed the randomized controlled trial (intervention group: n=369; control group: n=403). The most selected barrier in both groups was “I don’t think that my problems are serious enough.” At the end of the trial, 33.1% (n=122) of the respondents in the intervention group used the direct link to the helpline. This was not significantly different from the respondents in the control group (144/403, 35.7%; odds ratio 0.87, 95% CI 0.64‐1.18, P=.38). However, the respondents who received the BRI did score higher on their self-reported likelihood of contacting the helpline at a later point in time (B=0.22, 95% CI 0.12‐0.32, P≤.001) and on satisfaction with the self-test (B=0.27, 95% CI 0.01‐0.53, P=.04). For male and middle-aged respondents specifically, the results were comparable to that of the whole group. Conclusions: This trial was the first time the helpline was able to connect with high-risk website visitors who were hesitant to contact the helpline. Although the BRI could not ensure that those respondents immediately used the direct link to the helpline at the end of the trial, it is encouraging that respondents indicated that they were more likely to contact the helpline at a later point in time. In addition, this low-cost intervention provided greater insight into the perceived barriers to service. Follow-up research should be focused on identifying the added value of other components (eg, video or photo material) in the BRI and increasing its effectiveness, especially for men and middle-aged people. Trial Registration: ClinicalTrials.gov NCT05458830; https://clinicaltrials.gov/study/NCT05458830 International Registered Report Identifier (IRRID): RR2-10.2196/41078 %R 10.2196/56396 %U https://mental.jmir.org/2024/1/e56396 %U https://doi.org/10.2196/56396 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e54509 %T Reliability Issues of Mobile Nutrition Apps for Cardiovascular Disease Prevention: Comparative Study %A Ho,Dang Khanh Ngan %A Chiu,Wan-Chun %A Kao,Jing-Wen %A Tseng,Hsiang-Tung %A Lin,Cheng-Yu %A Huang,Pin-Hsiang %A Fang,Yu-Ren %A Chen,Kuei-Hung %A Su,Ting-Ying %A Yang,Chia-Hui %A Yao,Chih-Yuan %A Su,Hsiu-Yueh %A Wei,Pin-Hui %A Chang,Jung-Su %K mobile apps %K mHealth %K dietary assessment %K validity %K cardiovascular disease prevention %K app %K apps %K applications %K application %K nutrition %K cardiovascular %K nutrients %K fitness %K diet %K mobile health %D 2024 %7 4.9.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Controlling saturated fat and cholesterol intake is important for the prevention of cardiovascular diseases. Although the use of mobile diet-tracking apps has been increasing, the reliability of nutrition apps in tracking saturated fats and cholesterol across different nations remains underexplored. Objective: This study aimed to examine the reliability and consistency of nutrition apps focusing on saturated fat and cholesterol intake across different national contexts. The study focused on 3 key concerns: data omission, inconsistency (variability) of saturated fat and cholesterol values within an app, and the reliability of commercial apps across different national contexts. Methods: Nutrient data from 4 consumer-grade apps (COFIT, MyFitnessPal-Chinese, MyFitnessPal-English, and LoseIt!) and an academic app (Formosa FoodApp) were compared against 2 national reference databases (US Department of Agriculture [USDA]–Food and Nutrient Database for Dietary Studies [FNDDS] and Taiwan Food Composition Database [FCD]). Percentages of missing nutrients were recorded, and coefficients of variation were used to compute data inconsistencies. One-way ANOVAs were used to examine differences among apps, and paired 2-tailed t tests were used to compare the apps to national reference data. The reliability across different national contexts was investigated by comparing the Chinese and English versions of MyFitnessPal with the USDA-FNDDS and Taiwan FCD. Results: Across the 5 apps, 836 food codes from 42 items were analyzed. Four apps, including COFIT, MyFitnessPal-Chinese, MyFitnessPal-English, and LoseIt!, significantly underestimated saturated fats, with errors ranging from −13.8% to −40.3% (all P<.05). All apps underestimated cholesterol, with errors ranging from −26.3% to −60.3% (all P<.05). COFIT omitted 47% of saturated fat data, and MyFitnessPal-Chinese missed 62% of cholesterol data. The coefficients of variation of beef, chicken, and seafood ranged from 78% to 145%, from 74% to 112%, and from 97% to 124% across MyFitnessPal-Chinese, MyFitnessPal-English, and LoseIt!, respectively, indicating a high variability in saturated fats across different food groups. Similarly, cholesterol variability was consistently high in dairy (71%-118%) and prepackaged foods (84%-118%) across all selected apps. When examining the reliability of MyFitnessPal across different national contexts, errors in MyFitnessPal were consistent across different national FCDs (USDA-FNDSS and Taiwan FCD). Regardless of the FCDs used as a reference, these errors persisted to be statistically significant, indicating that the app’s core database is the source of the problems rather than just mismatches or variances in external FCDs. Conclusions: The findings reveal substantial inaccuracies and inconsistencies in diet-tracking apps’ reporting of saturated fats and cholesterol. These issues raise concerns for the effectiveness of using consumer-grade nutrition apps in cardiovascular disease prevention across different national contexts and within the apps themselves. %R 10.2196/54509 %U https://mhealth.jmir.org/2024/1/e54509 %U https://doi.org/10.2196/54509 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58627 %T Best Practices for Designing and Testing Behavioral and Health Communication Interventions for Delivery in Private Facebook Groups: Tutorial %A Pagoto,Sherry %A Lueders,Natalie %A Palmer,Lindsay %A Idiong,Christie %A Bannor,Richard %A Xu,Ran %A Ingels,Spencer %+ Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States, 1 860 486 5917, sherry.pagoto@uconn.edu %K social media %K Facebook %K behavioral intervention %K health communication %K Facebook groups %D 2024 %7 4.9.2024 %9 Tutorial %J JMIR Form Res %G English %X Facebook, the most popular social media platform in the United States, is used by 239 million US adults, which represents 71% of the population. Not only do most US adults use Facebook but they also spend an average of 40 minutes per day on the platform. Due to Facebook’s reach and ease of use, it is increasingly being used as a modality for delivering behavioral and health communication interventions. Typically, a Facebook-delivered intervention involves creating a private group to deliver intervention content for participants to engage with asynchronously. In many interventions, a counselor is present to facilitate discussions and provide feedback and support. Studies of Facebook-delivered interventions have been conducted on a variety of topics, and they vary widely in terms of the intervention content used in the group, use of human counselors, group size, engagement, and other characteristics. In addition, results vary widely and may depend on how well the intervention was executed and the degree to which it elicited engagement among participants. Best practices for designing and delivering behavioral intervention content for asynchronous delivery in Facebook groups are lacking, as are best practices for engaging participants via this modality. In this tutorial, we propose best practices for the use of private Facebook groups for delivery and testing the efficacy of behavioral or health communication interventions, including converting traditional intervention content into Facebook posts; creating protocols for onboarding, counseling, engagement, and data management; designing and branding intervention content; and using engagement data to optimize engagement and outcomes. %M 39231426 %R 10.2196/58627 %U https://formative.jmir.org/2024/1/e58627 %U https://doi.org/10.2196/58627 %U http://www.ncbi.nlm.nih.gov/pubmed/39231426 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e59659 %T Accelerometer-Based Physical Activity and Health-Related Quality of Life in Korean Adults: Observational Study Using the Korea National Health and Nutrition Examination Survey %A Han,Sujeong %A Oh,Bumjo %A Kim,Ho Jun %A Hwang,Seo Eun %A Kim,Jong Seung %+ Department of Family Medicine, SMG-SNU Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea, 82 2 870 2681, atenae68@nate.com %K Health-Related Quality of Life (HRQoL) %K physical activity %K Accelerometer %K Korea National Health and Nutrition Examination Survey (KNHANES) %K mobile phone %D 2024 %7 3.9.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Health-related quality of life (HRQoL) reflects an individual's perception of their physical and mental health over time. Despite numerous studies linking physical activity to improved HRQoL, most rely on self-reported data, limiting the accuracy and generalizability of findings. This study leverages objective accelerometer data to explore the association between physical activity and HRQoL in Korean adults. Objective: The objective of this study is to analyze the relationship between objectively measured physical activity using accelerometers and HRQoL among Korean adults, aiming to inform targeted interventions for enhancing HRQoL through physical activity. Methods: This observational study included 1298 participants aged 19-64 years from the Korea National Health and Nutrition Examination Survey (KNHANES) VI, who wore an accelerometer for 7 consecutive days. HRQoL was assessed using the EQ-5D questionnaire, and physical activity was quantified as moderate-to-vigorous physical activity accelerometer-total (MVPA-AT) and accelerometer-bout (MVPA-AB). Data were analyzed using logistic regression to determine the odds ratio (ORs) for low HRQoL, adjusting for socioeconomic variables and mental health factors. Results: Participants with higher HRQoL were younger, more likely to be male, single, highly educated, employed in white-collar jobs, and had higher household incomes. They also reported less stress and better subjective health status. The high HRQoL group had significantly more participants meeting MVPA-AB ≥600 metabolic equivalents (P<.01). Logistic regression showed that participants meeting MVPA-AB ≥600 metabolic equivalents had higher odds of high HRQoL (OR 1.55, 95% CI 1.11-2.17). Adjusted models showed consistent results, although the association weakened when adjusting for mental health factors (OR 1.45, 95% CI 1.01-2.09). Conclusions: The study demonstrates a significant association between HRQoL and moderate to vigorous physical activity sustained for at least 10 minutes, as measured by accelerometer. These findings support promoting physical activity, particularly sustained moderate to vigorous activity, to enhance HRQoL. Further interventional studies focusing on specific physical activity domains such as occupational, leisure-time, and commuting activities are warranted. %M 39226099 %R 10.2196/59659 %U https://humanfactors.jmir.org/2024/1/e59659 %U https://doi.org/10.2196/59659 %U http://www.ncbi.nlm.nih.gov/pubmed/39226099 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e60052 %T Ecological Momentary Assessment of Alcohol Marketing Exposure, Alcohol Use, and Purchases Among University Students: Prospective Cohort Study %A Zhang,Min Jin %A Luk,Tzu Tsun %A Ho,Sai Yin %A Wang,Man Ping %A Lam,Tai Hing %A Cheung,Yee Tak Derek %+ School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 5/F, Academic Building 3 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 39176652, derekcheung@hku.hk %K alcohol marketing %K drinking %K ecological momentary assessment %K health behaviors %K young adults %K mobile phone %D 2024 %7 3.9.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The relationships between alcohol marketing exposure, alcohol use, and purchase have been widely studied. However, prospective studies examining the causal relationships in real-world settings using mobile health tools are limited. Objective: We used ecological momentary assessment (EMA) to examine both the within-person– and between-person–level effects of alcohol marketing exposure on any alcohol use, amount of alcohol use, any alcohol purchase, and frequency of alcohol purchase among university students. Methods: From January to June 2020, we conducted a prospective cohort study via EMA among university students in Hong Kong who reported current drinking. Over 14 consecutive days, each participant completed 5 fixed-interval, signal-contingent EMAs daily via a smartphone app. Each EMA asked about the number and types of alcohol marketing exposures, the amount and types of alcohol used, and whether any alcohol was purchased, all within the past 3 hours. We used 2-part models, including multilevel logistic regressions and multilevel gamma regressions, to examine if the number of alcohol marketing exposure was associated with subsequent alcohol use and alcohol purchase. Results: A total of 49 students participated, with 33% (16/49) being male. The mean age was 22.6 (SD 2.6) years. They completed 2360 EMAs (completion rate: 2360/3430, 68.8%). Participants reported exposure to alcohol marketing in 5.9% (140/2360), alcohol use in 6.1% (145/2360), and alcohol purchase in 2.4% (56/2360) of all the EMAs. At the between-person level, exposure to more alcohol marketing predicted a higher likelihood of alcohol use (adjusted odd ratio [AOR]=3.51, 95% CI 1.29-9.54) and a higher likelihood of alcohol purchase (AOR=4.59, 95% CI 1.46-14.49) the following day. Exposure to more alcohol marketing did not increase the amount of alcohol use or frequency of alcohol purchases the following day in participants who used or purchased alcohol. At the within-person level, exposure to more alcohol marketing was not associated with a higher likelihood of alcohol use, amount of alcohol use, higher likelihood of alcohol purchase, or frequency of alcohol purchases the following day (all Ps>.05). Each additional exposure to alcohol marketing within 1 week predicted an increase of 0.85 alcoholic drinks consumed in the following week (adjusted B=0.85, 95% CI 0.09-1.61). On days of reporting alcohol use, the 3 measures for alcohol marketing receptivity were not associated with more alcohol use or purchase (all Ps>.05). Conclusions: By using EMA, we provided the first evidence for the effect of alcohol marketing exposure on initiating alcohol use and purchase in current-drinking university students. Our findings provide evidence of the regulation of alcohol marketing for the reduction of alcohol use and purchase among young adults. %M 39226102 %R 10.2196/60052 %U https://mhealth.jmir.org/2024/1/e60052 %U https://doi.org/10.2196/60052 %U http://www.ncbi.nlm.nih.gov/pubmed/39226102 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57236 %T Adapting and Evaluating a Brief Advice Tobacco Cessation Intervention in High-reach, Low-resource Settings in India: Protocol for a Cluster Randomized Controlled Trial %A Mahtani,Sitara L %A Viswanath,Kasisomayajula %A Gupte,Himanshu A %A Mandal,Gauri %A Jagiasi,Dinesh %A Chawla,Ratandeep %A D'Costa,Marina %A Xuan,Ziming %A Minsky,Sara %A Ramanadhan,Shoba %+ Dana-Farber Cancer Institute, 450 Brookline Avenue, LW, 6th Floor, Boston, MA, 02215, United States, 1 617 582 9487, sitara_mahtani@dfci.harvard.edu %K tobacco use Cessation %K India %K resource-limited settings %K task-shifting %K counseling %K nonprofit organizations %K dental health services %K tuberculosis %K social media %K mobile app %D 2024 %7 3.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: About 1.35 million deaths annually are attributed to tobacco use in India. The main challenge, given the magnitude of tobacco use and limited resources, is delivering cessation support at scale, low cost, and through a coordinated cross-system effort; one such example being brief advice interventions. However, highly credentialed staff to identify and counsel tobacco users are scarce. Task-shifting is an important opportunity for scaling these interventions. Objective: The LifeFirst SWASTH (Supporting Wellbeing among Adults by Stopping Tobacco Habit) program—adapted from the LifeFirst program (developed by the Narotam Sekhsaria Foundation, Mumbai, India)—is a tobacco cessation program focusing on lower-socioeconomic status patients in Mumbai receiving private health care. This parallel-arm, cluster randomized controlled trial investigates whether the LifeFirst SWASTH program increases tobacco cessation rates in low-resource, high-reach health care settings in Mumbai. Methods: This study will target tuberculosis-specific nongovernmental organizations (NGOs), dental clinics, and NGOs implementing general health programs serving lower-socioeconomic status patients. Intervention arm patients will receive a pamphlet explaining tobacco’s harmful effects. Practitioners will be trained to deliver brief cessation advice, and interested patients will be referred to a Narotam Sekhsaria Foundation counselor for free telephone counseling for 6 months. Control arm patients will receive the same pamphlet but not brief advice or counseling. Practitioners will have a customized mobile app to facilitate intervention delivery. Practitioners will also have access to a peer network through WhatsApp. The primary outcome is a 30-day point prevalence abstinence from tobacco. Secondary outcomes for patients and practitioners relate to intervention implementation. Results: The study was funded in June 2020. Due to the COVID-19 pandemic, the study experienced some delays, and practitioner recruitment commenced in November 2023. As of July 2024, all practitioners have been recruited, and practitioner recruitment and training are complete. Furthermore, 36% (1687/4688) of patients have been recruited. Conclusions: It is hypothesized that those patients who participated in the LifeFirst SWASTH program will be more likely to have been abstinent from tobacco for 30 consecutive days by the end of 6 months or at least decreased their tobacco use. LifeFirst SWASTH, if found to be effective in terms of cessation outcomes and implementation, has the potential to be scaled to other settings in India and other low- and middle-income countries. The study will be conducted in low-resource settings and will reach many patients, which will increase the impact if scaled. It will use task-shifting and an app that can be tailored to different settings, also enabling scalability. Findings will build the literature for translating evidence-based interventions from high-income countries to low- and middle-income countries and from high- to low-resource settings. Trial Registration: ClinicalTrials.gov NCT05234983; https://clinicaltrials.gov/study/NCT05234983 International Registered Report Identifier (IRRID): DERR1-10.2196/57236 %M 39225384 %R 10.2196/57236 %U https://www.researchprotocols.org/2024/1/e57236 %U https://doi.org/10.2196/57236 %U http://www.ncbi.nlm.nih.gov/pubmed/39225384 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56962 %T A Clinician and Electronic Health Record Wearable Device Intervention to Increase Physical Activity in Patients With Obesity: Formative Qualitative Study %A Ayyaswami,Varun %A Subramanian,Jeevarathna %A Nickerson,Jenna %A Erban,Stephen %A Rosano,Nina %A McManus,David D %A Gerber,Ben S %A Faro,Jamie M %+ Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 508 856 3898 ext 63898, varun.ayyaswami@umassmed.edu %K remote patient monitoring %K physical activity %K electronic health record %K wearable device %K patient monitoring %K health monitoring %K health monitor %K patient monitor %K remote patient monitor %K exercise %K exercises %K electronic health records %K patient record %K health record %K health records %K wearable devices %D 2024 %7 2.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The number of individuals using digital health devices has grown in recent years. A higher rate of use in patients suggests that primary care providers (PCPs) may be able to leverage these tools to effectively guide and monitor physical activity (PA) for their patients. Despite evidence that remote patient monitoring (RPM) may enhance obesity interventions, few primary care practices have implemented programs that use commercial digital health tools to promote health or reduce complications of the disease. Objective: This formative study aimed to assess the perceptions, needs, and challenges of implementation of an electronic health record (EHR)–integrated RPM program using wearable devices to promote patient PA at a large urban primary care practice to prepare for future intervention. Methods: Our team identified existing workflows to upload wearable data to the EHR (Epic Systems), which included direct Fitbit (Google) integration that allowed for patient PA data to be uploaded to the EHR. We identified pictorial job aids describing the clinical workflow to PCPs. We then performed semistructured interviews with PCPs (n=10) and patients with obesity (n=8) at a large urban primary care clinic regarding their preferences and barriers to the program. We presented previously developed pictorial aids with instructions for (1) providers to complete an order set, set step-count goals, and receive feedback and (2) patients to set up their wearable devices and connect them to their patient portal account. We used rapid qualitative analysis during and after the interviews to code and develop key themes for both patients and providers that addressed our research objective. Results: In total, 3 themes were identified from provider interviews: (1) providers’ knowledge of PA prescription is focused on general guidelines with limited knowledge on how to tailor guidance to patients, (2) providers were open to receiving PA data but were worried about being overburdened by additional patient data, and (3) providers were concerned about patients being able to equitably access and participate in digital health interventions. In addition, 3 themes were also identified from patient interviews: (1) patients received limited or nonspecific guidance regarding PA from providers and other resources, (2) patients want to share exercise metrics with the health care team and receive tailored PA guidance at regular intervals, and (3) patients need written resources to support setting up an RPM program with access to live assistance on an as-needed basis. Conclusions: Implementation of an EHR-based RPM program and associated workflow is acceptable to PCPs and patients but will require attention to provider concerns of added burdensome patient data and patient concerns of receiving tailored PA guidance. Our ongoing work will pilot the RPM program and evaluate feasibility and acceptability within a primary care setting. %M 39221852 %R 10.2196/56962 %U https://formative.jmir.org/2024/1/e56962 %U https://doi.org/10.2196/56962 %U http://www.ncbi.nlm.nih.gov/pubmed/39221852 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e54252 %T Examining a Fully Automated Mobile-Based Behavioral Activation Intervention in Depression: Randomized Controlled Trial %A Santopetro,Nicholas %A Jones,Danielle %A Garron,Andrew %A Meyer,Alexandria %A Joyner,Keanan %A Hajcak,Greg %K digital intervention %K digital health %K digital application %K digital applications %K mobile health %K mHealth %K automation %K automate %K automated %K behavioral activation %K BA %K BA intervention %K depression %K depressed %K depressive %K depressive symptoms %K anhedonia %K anhedonia symptoms %K anxiety %K anxious %K anxiety symptoms %K adults %K adult %K psychiatry %K psych %K psychology %K major depressive disorder %K MDD %D 2024 %7 30.8.2024 %9 %J JMIR Ment Health %G English %X Background: Despite significant progress in our understanding of depression, prevalence rates have substantially increased in recent years. Thus, there is an imperative need for more cost-effective and scalable mental health treatment options, including digital interventions that minimize therapist burden. Objective: This study focuses on a fully automated digital implementation of behavioral activation (BA)—a core behavioral component of cognitive behavioral therapy for depression. We examine the efficacy of a 1-month fully automated SMS text message–based BA intervention for reducing depressive symptoms and anhedonia. Methods: To this end, adults reporting at least moderate current depressive symptoms (8-item Patient Health Questionnaire score ≥10) were recruited online across the United States and randomized to one of three conditions: enjoyable activities (ie, BA), healthy activities (ie, an active control condition), and passive control (ie, no contact). Participants randomized to enjoyable and healthy activities received daily SMS text messages prompting them to complete 2 activities per day; participants also provided a daily report on the number and enjoyment of activities completed the prior day. Results: A total of 126 adults (mean age 32.46, SD 7.41 years) with current moderate depressive symptoms (mean score 16.53, SD 3.90) were recruited. Participants in the enjoyable activities condition (BA; n=39) experienced significantly greater reductions in depressive symptoms compared to participants in the passive condition (n=46). Participants in both active conditions—enjoyable activities and healthy activities (n=41)—reported reduced symptoms of anxiety compared to those in the control condition. Conclusions: These findings provide preliminary evidence regarding the efficacy of a fully automated digital BA intervention for depression and anxiety symptoms. Moreover, reminders to complete healthy activities may be a promising intervention for reducing anxiety symptoms. Trial Registration: ClincalTrials.gov NCT06492824; https://clinicaltrials.gov/study/NCT06492824 %R 10.2196/54252 %U https://mental.jmir.org/2024/1/e54252 %U https://doi.org/10.2196/54252 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56119 %T Web-Based Coping Skills Training and Coach Support for Women Living With a Partner With an Alcohol Use Disorder: Randomized Controlled Trial %A Rychtarik,Robert G %A Danaher,Brian G %A McGillicuddy,Neil B %A Tyler,Milagra S %A Barrick,Christopher %A Leong,Florence %A Kosty,Derek B %+ Department of Psychiatry and Clinical and Research Institute on Addictions, University at Buffalo, The State University of New York, 1021 Main Street, Buffalo, NY, 14203, United States, 1 7168872591, rgr@buffalo.edu %K alcohol use disorder %K AUD %K spouses %K coping skills training %K eHealth %K coaching %K telehealth %K web-based %K women %K randomized controlled trial %K RCT %K mobile phone %D 2024 %7 29.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Individuals living with a partner with an alcohol use disorder (AUD) can experience significant psychological distress and use health care more than those without a partner with an AUD. However, the prevailing treatment system’s focus on the partner and personal barriers limit these individuals from getting help for themselves. Preliminary work on a self-directed, web-based coping skills training program, Stop Spinning My Wheels (SSMW), shows promise in broadening available treatments for this population. In this study, we conducted a robust evaluation of SSMW primary outcomes. Objective: The study aims to test whether women with a partner with an AUD assigned to SSMW experienced a greater reduction in negative affect (depression and anger) (1) than a usual web care (UWC) control and (2) with brief phone coach support (SSMW+coach) rather than without (SSMW only) and (3) whether baseline negative affect moderated treatment effects. Methods: Women (mean age 45.7, SD 10.8 years; Black: 17/456, 3.7%; White: 408/456, 89.5%) were randomized to SSMW only, SSMW+coach, or UWC. Depression (Beck Depression Inventory–II) and anger (State-Trait Anger Expression Inventory 2–State Anger) were assessed at baseline, 12-week posttest, and 6- and 12-month follow-ups. Results: Participants in all conditions decreased in depression from baseline to posttest and from baseline to follow-up; SSMW-only and SSMW+coach participants decreased in anger, but UWC participants did not. Compared to UWC participants, SSMW-only participants experienced greater anger reduction (P=.03), and SSMW+coach participants experienced a greater reduction in depression (P<.001) from baseline to posttest. However, from baseline to follow-up, only a greater, but not statistically significant (P=.052), reduction in anger occurred in SSMW+coach compared to UWC. Although the SSMW conditions did not differ from each other in negative affect outcomes (P=.06-.57), SSMW+coach had higher program engagement and satisfaction (all P<.004). Baseline negative affect did not moderate effects, although remission from baseline clinically relevant depressive symptoms (Beck Depression Inventory≥14) was higher in SSMW only (33/67, 49%; odds ratio 2.13, 95% CI 1.05-4.30; P=.03) and SSMW+coach (46/74, 62%; odds ratio 3.60, 95% CI 1.79-7.23; P<.001) than in UWC (21/67, 31%); remission rates did not differ between the SSMW conditions (P=.12). Conclusions: The results partially supported the hypotheses. The SSMW conditions had earlier effects than UWC, but positive change in UWC mitigated the hypothesized long-term SSMW-UWC differences. The results highlight the importance of incorporating active controls in web-based clinical trials. Although SSMW+coach showed benefits over SSMW only on engagement and satisfaction measures and in the number needed to treat (5.6 for SSMW only; 3.2 for SSMW+coach), the SSMW conditions were comparable and superior to UWC on depressive symptom remission levels. Overall, SSMW with or without a coach can reduce clinically meaningful distress and add to available treatment options for this large, underserved group. Trial Registration: ClinicalTrials.gov NCT02984241; https://www.clinicaltrials.gov/study/NCT02984241 %M 39208412 %R 10.2196/56119 %U https://www.jmir.org/2024/1/e56119 %U https://doi.org/10.2196/56119 %U http://www.ncbi.nlm.nih.gov/pubmed/39208412 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59013 %T Digital Health Applications (DiGAs) on a Fast Track: Insights From a Data-Driven Analysis of Prescribable Digital Therapeutics in Germany From 2020 to Mid-2024 %A Goeldner,Moritz %A Gehder,Sara %+ Working Group for Data-Driven Innovation, Hamburg University of Technology, Am Schwarzenberg-Campus 4, Hamburg, 21073, Germany, 49 40428784777, moritz.goeldner@tuhh.de %K digital health application %K DiGA %K data-driven analysis %K clinical evidence %K health economics %K positive care effect %K medical benefit %K patient-relevant structural and procedural improvements %K pSVV %K digital health care act %D 2024 %7 29.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: This study aimed to analyze the rapidly evolving ecosystem of digital health applications (Digitale Gesundheitsanwendung; DiGAs) in Germany, spurred by the 2019 Digital Healthcare Act. With over 73 million people in Germany now having access to DiGAs, these prescribable digital health apps and web-based applications represent a substantial stride in health care modernization, supporting both patients and health care providers with digital solutions for disease management and care improvement. Objective: Through a data-driven approach, this research aimed to unpack the complexities of DiGA market dynamics, economic factors, and clinical evidence, offering insights into their impact over the past years. Methods: The analysis draws from a range of public data sources, including the DiGA directory, statutory health insurance reports, app store feedback, and clinical study results. Results: As of July 1, 2024, there are 56 DiGAs listed by the Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte), divided into 35 permanently and 21 preliminarily listed applications. Our findings reveal that a majority of DiGAs extend beyond the intended 1-year period to achieve permanent listing, reflecting the extensive effort required to demonstrate clinical efficacy. Economic analysis uncovered a dynamic pricing landscape, with initial prices ranging from approximately €200 to €700 (€1=US $1.07), averaging at a median of €514 for a 3-month DiGA prescription. Following negotiations or arbitration board decisions, prices typically see a 50% reduction, settling at a median of €221. Prescription data offer valuable insights into DiGA acceptance, with total prescriptions jumping from around 41,000 in the first period to 209,000 in the latest reporting period. The analysis of the top 15 DiGAs, representing 82% of the total prescriptions, shows that these best-performing apps receive from a minimum of 8 to a maximum of 77 daily prescriptions, with native apps and early market entrants achieving higher rates. Clinical evidence from all 35 permanently listed DiGAs indicates a uniform preference for randomized controlled trials to validate primary end points, with no noteworthy use of alternative study designs encouraged in the Digital Healthcare Act and related regulations. Moreover, all evaluated DiGAs focused on medical benefits, with health status improvement as a key end point, suggesting an underuse of patient-relevant structural and procedural improvement in demonstrating health care impact. Conclusions: This study highlights the growth and challenges within the DiGA sector, suggesting areas for future research, such as the exploration of new study designs and the potential impact of patient-relevant structural and procedural improvements. For DiGA manufacturers, the strategic advantage of early market entry is emphasized. Overall, this paper underscores the evolving landscape of digital health, advocating for a nuanced understanding of digital health technology integration in Germany and beyond. %M 39208415 %R 10.2196/59013 %U https://www.jmir.org/2024/1/e59013 %U https://doi.org/10.2196/59013 %U http://www.ncbi.nlm.nih.gov/pubmed/39208415 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52919 %T Expectations and Preferences for Digital Cessation Treatment: Multimethods Study Among Older Adults Who Smoke Cigarettes %A Fahey,Margaret C %A Carpenter,Mathew J %A O'Neal,Riley %A Pebley,Kinsey %A Schick,Melissa R %A Ware,Emily %A Toll,Benjamin A %A Dahne,Jennifer %+ Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, United States, 1 6158389307, mfahey@mtsu.edu %K older adults %K digital health %K digital cessation treatment %K smoking cessation %K digital cessation %K treatment %K smoke %K cigarettes %K cigarette %K tobacco %K adults %K elderly %K older person %K older people %K aging %K smoking %K smoke %K quit %K quitting %K questionnaire %K telehealth %K treatment %K treatments %K behavioral health %K public health %K mobile phone %D 2024 %7 28.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: To address enduring age-related tobacco disparities, it is critical to promote cessation treatment among older adults (aged 65+ years). Digital health platforms offer opportunities for wide dissemination of evidence-based behavioral cessation support. However, existing digital cessation treatments are not tailored to unique aging-related needs and preferences, resulting in low uptake. Detailed information is needed about how to best adapt these treatments for this age group. Objective: We aimed to collect detailed, hypothesis-generating information about expectations and preferences for cessation digital treatment among older adults who smoke cigarettes. Methods: Semistructured interviews were conducted with adults aged 65+ years currently smoking or who had quit within the past month. Interviews included open-ended questions regarding prior experiences with digital health platforms and expectations and preferences for cessation treatment via various modalities (app-delivered, texting-based, or videoconferencing counseling). Interviews also elicited questions regarding digital modalities that integrated social components (app-delivered social forums and group videoconferencing counseling). Using an iterative, team-based approach, the thematic analysis identified meaningful themes. Interviews were supplemented with quantitative measures assessing sociodemographics, digital literacy, and physical health symptoms. Results: Participants (12/20, 60% men; 15/20, 75% White; 4/20, 20% Black or African American; 1/20, 5% Asian) were currently smoking (17/20, 85%) or had recently quit (3/20, 15%). Thematic analysis identified 3 meaningful themes across all digital modalities: convenience, accessibility, and personalization. Expected benefits of digital platforms included convenient treatment access, without reliance on transportation. Participants preferred treatments to be personalized and deliver content or strategies beyond standard education. Most (17/20, 85%) were unfamiliar with cessation apps but found them appealing given the potential for offering a novel quitting strategy. App ease of use (eg, easy navigation) was preferred. Half (10/20, 50%) would try a texting-based intervention, with many preferring texting with a counselor rather than automated messaging. Most (17/20, 85%) would use videoconferencing and expected this modality to deliver better quality counseling than via telephone. Expected videoconferencing challenges included looking presentable onscreen, technological difficulties, and privacy or security. Videoconferencing was regarded as the most personalized digital treatment, yet benefits unique to app-delivered and texting-based treatments included anonymity and access to treatment 24/7. Participants expected integrating social components into digital treatment to be useful for quit success and social connection, yet were concerned about possible interpersonal challenges. Conclusions: Because a long history of quit attempts and familiarity with standard quitting advice is common among older adults who smoke cigarettes, digital platforms might offer appealing and novel strategies for cessation that are accessible and convenient. Overall, this population was open to trying digital cessation treatments and would prefer that these platforms prioritize ease of use and personalized content. These findings challenge the bias that older adults are uninterested or unwilling to engage with digital treatments for behavioral health. %M 39196628 %R 10.2196/52919 %U https://www.jmir.org/2024/1/e52919 %U https://doi.org/10.2196/52919 %U http://www.ncbi.nlm.nih.gov/pubmed/39196628 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58735 %T Framework Development for Reducing Attrition in Digital Dietary Interventions: Systematic Review and Thematic Synthesis %A Wang,Jian %A Mahe,Jinli %A Huo,Yujia %A Huang,Weiyuan %A Liu,Xinru %A Zhao,Yang %A Huang,Junjie %A Shi,Feng %A Li,Zhihui %A Jiang,Dou %A Li,Yilong %A Perceval,Garon %A Zhao,Lindu %A Zhang,Lin %+ Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Room 805, 8th Floor, Building 2, Sangtian Island Science and Technology Innovation Park, No. 1, Huayun Road, Suzhou, China, 86 13426423807, lin.zhang2@monash.edu %K thematic synthesis %K attrition rate %K dropout %K behavior change theory %K digital dietary intervention %K digital health %K mHealth %K eHealth %K mobile apps %K email %D 2024 %7 27.8.2024 %9 Review %J J Med Internet Res %G English %X Background: Dietary behaviors significantly influence health outcomes across populations. Unhealthy diets are linked to serious diseases and substantial economic burdens, contributing to approximately 11 million deaths and significant disability-adjusted life years annually. Digital dietary interventions offer accessible solutions to improve dietary behaviors. However, attrition, defined as participant dropout before intervention completion, is a major challenge, with rates as high as 75%-99%. High attrition compromises intervention validity and reliability and exacerbates health disparities, highlighting the need to understand and address its causes. Objective: This study systematically reviews the literature on attrition in digital dietary interventions to identify the underlying causes, propose potential solutions, and integrate these findings with behavior theory concepts to develop a comprehensive theoretical framework. This framework aims to elucidate the behavioral mechanisms behind attrition and guide the design and implementation of more effective digital dietary interventions, ultimately reducing attrition rates and mitigating health inequalities. Methods: We conducted a systematic review, meta-analysis, and thematic synthesis. A comprehensive search across 7 electronic databases (PubMed, MEDLINE, Embase, CENTRAL, Web of Science, CINAHL Plus, and Academic Search Complete) was performed for studies published between 2013 and 2023. Eligibility criteria included original research exploring attrition in digital dietary interventions. Data extraction focused on study characteristics, sample demographics, attrition rates, reasons for attrition, and potential solutions. We followed ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and used RStudio (Posit) for meta-analysis and NVivo for thematic synthesis. Results: Out of the 442 identified studies, 21 met the inclusion criteria. The meta-analysis showed mean attrition rates of 35% for control groups, 38% for intervention groups, and 40% for observational studies, with high heterogeneity (I²=94%-99%) indicating diverse influencing factors. Thematic synthesis identified 15 interconnected themes that align with behavior theory concepts. Based on these themes, the force-resource model was developed to explore the underlying causes of attrition and guide the design and implementation of future interventions from a behavior theory perspective. Conclusions: High attrition rates are a significant issue in digital dietary interventions. The developed framework conceptualizes attrition through the interaction between the driving force system and the supporting resource system, providing a nuanced understanding of participant attrition, summarized as insufficient motivation and inadequate or poorly matched resources. It underscores the critical necessity for digital dietary interventions to balance motivational components with available resources dynamically. Key recommendations include user-friendly design, behavior-factor activation, literacy training, force-resource matching, social support, personalized adaptation, and dynamic follow-up. Expanding these strategies to a population level can enhance digital health equity. Further empirical validation of the framework is necessary, alongside the development of behavior theory–guided guidelines for digital dietary interventions. Trial Registration: PROSPERO CRD42024512902; https://tinyurl.com/3rjt2df9 %M 39190910 %R 10.2196/58735 %U https://www.jmir.org/2024/1/e58735 %U https://doi.org/10.2196/58735 %U http://www.ncbi.nlm.nih.gov/pubmed/39190910 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58726 %T Deceptively Simple yet Profoundly Impactful: Text Messaging Interventions to Support Health %A Suffoletto,Brian %+ Department of Emergency Medicine, Stanford University, 3145 Porter Drive Wing B, Palo Alto, CA, 94035, United States, 1 412 901 6892, suffbp@stanford.edu %K SMS intervention %K behavior %K intervention %K review %K text messaging %K SMS %K interventions %K behaviors %K behaviour %K behaviours %K effectiveness %K development %K impact %K narrative review %K physical activity %K diet %K weight loss %K mental health %K substance use %K meta-analysis %K chatbot %K chatbots %K large language model %K LLM %K large language models %K mobile phone %D 2024 %7 27.8.2024 %9 Viewpoint %J J Med Internet Res %G English %X This paper examines the use of text message (SMS) interventions for health-related behavioral support. It first outlines the historical progress in SMS intervention research publications and the variety of funds from US government agencies. A narrative review follows, highlighting the effectiveness of SMS interventions in key health areas, such as physical activity, diet and weight loss, mental health, and substance use, based on published meta-analyses. It then outlines advantages of text messaging compared to other digital modalities, including the real-time capability to collect information and deliver microdoses of intervention support. Crucial design elements are proposed to optimize effectiveness and longitudinal engagement across communication strategies, psychological foundations, and behavior change tactics. We then discuss advanced functionalities, such as the potential for generative artificial intelligence to improve user interaction. Finally, major challenges to implementation are highlighted, including the absence of a dedicated commercial platform, privacy and security concerns with SMS technology, difficulties integrating SMS interventions with medical informatics systems, and concerns about user engagement. Proposed solutions aim to facilitate the broader application and effectiveness of SMS interventions. Our hope is that these insights can assist researchers and practitioners in using SMS interventions to improve health outcomes and reducing disparities. %M 39190427 %R 10.2196/58726 %U https://www.jmir.org/2024/1/e58726 %U https://doi.org/10.2196/58726 %U http://www.ncbi.nlm.nih.gov/pubmed/39190427 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e55905 %T Exploring the Psychological Effects and Physical Exertion of Using Different Movement Interactions in Casual Exergames That Promote Active Microbreaks: Quasi-Experimental Study %A Berglund,Aseel %A Orädd,Helena %+ Department of Computer and Information Science, Linköping University, Campus Valla, B-house, Linköping, 58329, Sweden, 46 0732703862, aseel.berglund@liu.se %K physical activity %K exergames %K casual exergames %K enjoyment %K exertion %K motion-based games %D 2024 %7 26.8.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Prolonged sedentary behavior, such as sitting or reclining, has consistently been identified as a stand-alone risk factor for heightened cardiometabolic risk and overall mortality. Conversely, interrupting sedentary periods by incorporating short, active microbreaks has been shown to mitigate the negative effects of sedentary behavior. Casual exergames, which mix elements of casual gaming with physical activity, are one prospective intervention to reduce sedentary behavior because they require physical exertion. Casual exergames have shown promise in fostering emotional and physical advantages when played in specific circumstances. However, little research exists on how different types of movement interactions impact the psychological effects as well as the physical exertion of playing casual exergames. Objective: The primary aim of this work was to explore the psychological effects and physical exertion of playing casual exergames lasting 2 minutes. More precisely, the investigation focused on comparing upper body and full body movement interactions. In addition, the work examined variations in body positions, considering both standing and seated positions during upper body movement interactions. Methods: Two casual exergames were developed and investigated through 2 quasi-experimental studies. In study 1, we investigated how players’ perceptions of control, exertion, and immersion were affected by using upper body as opposed to full body exergame controllers when playing casual exergames. In study 2, we investigated differences in positive affect, performance, enjoyment, and exertion when playing casual exergames with upper body movement interactions in seated and standing positions. Results: Study 1 showed that perceived control was significantly higher for upper body movement interactions than for full body movement interactions (P=.04), but there were no significant differences regarding perceived exertion (P=.15) or immersion (P=.66). Study 2 showed that positive affect increased significantly for both standing (P=.003) and seated (P=.001) gameplay. The participants in the standing gameplay group showed slightly higher actual exertion; however, there were no differences between the groups in terms of positive affect, perceived exertion, enjoyment, or performance. Conclusions: Casual exergames controlled by upper body movement interactions in seated gameplay can produce similar psychological effects and physical exertion as upper body movement interactions in standing gameplay and full body movement interactions. Therefore, upper body and seated casual exergames should not be overlooked as a suitable microbreak activity. %M 39186776 %R 10.2196/55905 %U https://games.jmir.org/2024/1/e55905 %U https://doi.org/10.2196/55905 %U http://www.ncbi.nlm.nih.gov/pubmed/39186776 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e59475 %T Telebehavioral Health for Caregivers of Children With Behavioral Health Needs to Address Caregiver Strain: Cohort Study %A Loo,Theoren %A Altman,Myra %A Grodberg,David %A La Guardia,Jennifer %A Bravata,Dena %+ Brightline, 175 Forest Avenue, Palo Alto, CA, 94301, United States, 1 6086225153, theoloo55@gmail.com %K adolescent %K child %K caregiver %K family health %K resilience %K psychological %K mental health %K pediatric %K pediatrics %K paediatric %K paediatrics %K children %K youth %K adolescents %K teen %K teens %K teenager %K teenagers %K strain %K burden %K caregiving %K caregivers %K carer %K carers %K informal care %K family care %K spousal care %K telehealth %K telemedicine %K technology-enabled %K mobile phone %D 2024 %7 26.8.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Behavioral health conditions among children have worsened over the past decade. Caregivers for children with behavioral health conditions are at risk for two types of caregiver strain: (1) an objective strain, that results directly from the child’s condition and (2) subjective strain, that arises from the caregiver’s feelings regarding these events. Objective: This study aimed to evaluate the impact of a technology-enabled pediatric and family behavioral health service on caregivers’ strain among a commercially insured population. We also explore the common symptom clusters of caregiver strain to better understand the caregiver presentation to inform future care planning. Methods: We examined changes in caregiver strain using the Caregiver Strain Questionnaire-Short Form 7 over the course of their child’s web-based behavioral health care between 2021 and 2023 using a pre-post study design. Common caregiver strain symptom clusters were identified using Ward hierarchical agglomerative clustering. Results: The majority of children were White 60.8% (1002/1647), female 53.6% (882/1647), and aged between 5 and 9 years (33.7%, 555/1647). Families fall broadly into 4 groups based on what drives caregiver strain the most, namely those experiencing (1) disrupted family relationships and time interruption, (2) missed work, (3) worried about their child’s future and feeling tired and sad, and (4) financial strain. Caregiver strain, which was associated with the child’s disease severity (P<.001), decreased significantly in all therapeutic groups. Conclusions: Web-based family-oriented behavioral health care can improve caregiver strain and reduce family and time disruptions, missed work, and financial strain. Sources of caregiver strain vary and may be overlooked when relying on the conventional scoring of the Caregiver Strain Questionnaire-Short Form 7. %M 39186369 %R 10.2196/59475 %U https://pediatrics.jmir.org/2024/1/e59475 %U https://doi.org/10.2196/59475 %U http://www.ncbi.nlm.nih.gov/pubmed/39186369 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55254 %T Establishing a Consensus-Based Framework for the Use of Wearable Activity Trackers in Health Care: Delphi Study %A Szeto,Kimberley %A Arnold,John %A Horsfall,Erin Marie %A Sarro,Madeline %A Hewitt,Anthony %A Maher,Carol %+ Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Perfomance, University of South Australia, GPO Box 2471, Adelaide, 5001, Australia, 61 (08) 8302 2283, kimberley.szeto@mymail.unisa.edu.au %K wearable activity tracker %K health care %K physical activity %K sedentary behavior %K wearable %K wearables %K wearable tracker %K tracker %K wearable technology %K support %K exercise %K prevention %K management %K monitor %K promote %K survey %K utility %D 2024 %7 23.8.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity (PA) plays a crucial role in health care, providing benefits in the prevention and management of many noncommunicable diseases. Wearable activity trackers (WATs) provide an opportunity to monitor and promote PA in various health care settings. Objective: This study aimed to develop a consensus-based framework for the optimal use of WATs in health care. Methods: A 4-round Delphi survey was conducted, involving a panel (n=58) of health care professionals, health service managers, and researchers. Round 1 used open-response questions to identify overarching themes. Rounds 2 and 3 used 9-point Likert scales to refine participants’ opinions and establish consensus on key factors related to WAT use in health care, including metrics, device characteristics, clinical populations and settings, and software considerations. Round 3 also explored barriers and mitigating strategies to WAT use in clinical settings. Insights from Rounds 1-3 informed a draft checklist designed to guide a systematic approach to WAT adoption in health care. In Round 4, participants evaluated the draft checklist’s clarity, utility, and appropriateness. Results: Participation rates for rounds 1 to 4 were 76% (n=44), 74% (n=43), 74% (n=43), and 66% (n=38), respectively. The study found a strong interest in using WATs across diverse clinical populations and settings. Key metrics (step count, minutes of PA, and sedentary time), device characteristics (eg, easy to charge, comfortable, waterproof, simple data access, and easy to navigate and interpret data), and software characteristics (eg, remote and wireless data access, access to multiple patients’ data) were identified. Various barriers to WAT adoption were highlighted, including device-related, patient-related, clinician-related, and system-level issues. The findings culminated in a 12-item draft checklist for using WATs in health care, with all 12 items endorsed for their utility, clarity, and appropriateness in Round 4. Conclusions: This study underscores the potential of WATs in enhancing patient care across a broad spectrum of health care settings. While the benefits of WATs are evident, successful integration requires addressing several challenges, from technological developments to patient education and clinician training. Collaboration between WAT manufacturers, researchers, and health care professionals will be pivotal for implementing WATs in the health care sector. %M 39178034 %R 10.2196/55254 %U https://mhealth.jmir.org/2024/1/e55254 %U https://doi.org/10.2196/55254 %U http://www.ncbi.nlm.nih.gov/pubmed/39178034 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59993 %T Reducing Alcohol Misuse and Promoting Treatment Initiation Among Veterans Through a Brief Internet-Based Intervention: Protocol for a Randomized Controlled Trial %A Pedersen,Eric R %A Davis,Jordan P %A Hummer,Justin F %A Bouskill,Kathryn %A Buch,Keegan D %A Shute,Ireland M %A Fitzke,Reagan E %A Tran,Denise D %A Neighbors,Clayton %A Saba,Shaddy %+ Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, Los Angeles, CA, 90089, United States, 1 3234424046, eric.pedersen@med.usc.edu %K military %K mental health %K substance use %K mobile %K PTSD %K posttraumatic stress disorder %K drinking %K mobile intervention %K digital intervention %K alcohol %K alcohol misuse %K veterans %K young adults %K depression %K alcohol use %K veteran health %K veteran %D 2024 %7 22.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young adult veterans who served after the September 11 attacks on the United States in 2001 (ie, post-9/11) are at heightened risk for experiencing behavioral health distress and disorders including hazardous drinking, posttraumatic stress disorder, and depression. These veterans often face significant barriers to behavioral health treatment, and reaching them through brief mobile phone–based interventions may help reduce drinking and promote treatment engagement. Objective: Following a successful pilot study, this randomized controlled trial (RCT) aims to further test the efficacy of a brief (ie, single session) mobile phone–delivered personalized normative feedback intervention enhanced with content to promote treatment engagement. Methods: We will conduct an RCT with 800 post-9/11 young adult veterans (aged 18 to 40 years) with potentially hazardous drinking and who have not recently received treatment for any behavioral health problems. Participants will be randomly assigned to the personalized intervention or a control condition with resources for seeking care. The personalized normative feedback module in the intervention focuses on the correction of misperceived norms of peer alcohol use and uses empirically informed approaches to increase motivation to address alcohol use and co-occurring behavioral health problems. Past 30-day drinking, alcohol-related consequences, and treatment-seeking behaviors will be assessed at baseline and 3, 6, 9, and 12 months post intervention. Sex, barriers to care, posttraumatic stress disorder, depression, and severity of alcohol use disorder symptoms will be explored as potential moderators of outcomes. Results: We expect recruitment to be completed within 6 months, with data collection taking 12 months for each enrolled participant. Analyses will begin within 3 months of the final data collection point (ie, 12 months follow-up). Conclusions: This RCT will evaluate the efficacy of a novel intervention for non–treatment-seeking veterans who struggle with hazardous drinking and possible co-occurring behavioral health problems. This intervention has the potential to improve veteran health outcomes and overcome significant barriers to treatment. Trial Registration: ClinicalTrials.gov NCT04244461; https://clinicaltrials.gov/study/NCT04244461 International Registered Report Identifier (IRRID): DERR1-10.2196/59993 %M 39173142 %R 10.2196/59993 %U https://www.researchprotocols.org/2024/1/e59993 %U https://doi.org/10.2196/59993 %U http://www.ncbi.nlm.nih.gov/pubmed/39173142 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54604 %T Multicomponent Support Program for Secondary Prevention of Stroke Using Digital Health Technology: Co-Design Study With People Living With Stroke or Transient Ischemic Attack %A Silvera-Tawil,David %A Cameron,Jan %A Li,Jane %A Varnfield,Marlien %A Allan,Liam P %A Harris,Mitch %A Lannin,Natasha A %A Redd,Christian %A Cadilhac,Dominique A %+ Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, 158-164 Hawkesbury Road, Westmead, Sydney, 2145, Australia, 61 2 9372 4282, david.silvera@csiro.au %K mobile app %K stroke %K transient ischemic attack %K health service delivery %K mobile health %K mHealth %K mobile phone %D 2024 %7 22.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Few individuals (<2%) who experience a stroke or transient ischemic attack (TIA) participate in secondary prevention lifestyle programs. Novel approaches that leverage digital health technology may provide a viable alternative to traditional interventions that support secondary prevention in people living with stroke or TIA. To be successful, these strategies should focus on user needs and preferences and be acceptable to clinicians and people living with stroke or TIA. Objective: This study aims to co-design, with people with lived experience of stroke or TIA (referred to as consumers) and clinicians, a multicomponent digital technology support program for secondary prevention of stroke. Methods: A consumer user needs survey (108 items) was distributed through the Australian Stroke Clinical Registry and the Stroke Association of Victoria. An invitation to a user needs survey (135 items) for clinicians was circulated via web-based professional forums and national organizations (eg, the Stroke Telehealth Community of Practice Microsoft Teams Channel) and the authors’ research networks using Twitter (subsequently rebranded X, X Corp) and LinkedIn (LinkedIn Corp). Following the surveys, 2 rounds of user experience workshops (design and usability testing workshops) were completed with representatives from each end user group (consumers and clinicians). Feedback gathered after each round informed the final design of the digital health program. Results: Overall, 112 consumers (male individuals: n=63, 56.3%) and 54 clinicians (female individuals: n=43, 80%) responded to the survey; all items were completed by 75.8% (n=85) of consumers and 78% (n=42) of clinicians. Most clinicians (46/49, 94%) indicated the importance of monitoring health and lifestyle measures more frequently than current practice, particularly physical activity, weight, and sleep. Most consumers (87/96, 90%) and clinicians (41/49, 84%) agreed that providing alerts about potential deterioration in an individual’s condition were important functions for a digital program. Intention to use a digital program for stroke prevention and discussing the data collected during face-to-face consultations was high (consumers: 79/99, 80%; clinicians 36/42, 86%). In addition, 7 consumers (male individuals: n=5, 71%) and 9 clinicians (female individuals: n=6, 67%) took part in the user experience workshops. Participants endorsed using a digital health program to help consumers manage stroke or TIA and discussed preferred functions and health measures in a digital solution for secondary prevention of stroke. They also noted the need for a mobile app that is easy to use. Clinician feedback highlighted the need for a customizable clinician portal that captures individual consumer goals. Conclusions: Following an iterative co-design process, supported by evidence from user needs surveys and user experience workshops, a consumer-facing app that integrates wearable activity trackers and a clinician web portal were designed and developed to support secondary prevention of stroke. Feasibility testing is currently in progress to assess acceptability and use. %M 39172512 %R 10.2196/54604 %U https://www.jmir.org/2024/1/e54604 %U https://doi.org/10.2196/54604 %U http://www.ncbi.nlm.nih.gov/pubmed/39172512 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e59560 %T Self-Administered Interventions Based on Natural Language Processing Models for Reducing Depressive and Anxiety Symptoms: Systematic Review and Meta-Analysis %A Villarreal-Zegarra,David %A Reategui-Rivera,C Mahony %A García-Serna,Jackeline %A Quispe-Callo,Gleni %A Lázaro-Cruz,Gabriel %A Centeno-Terrazas,Gianfranco %A Galvez-Arevalo,Ricardo %A Escobar-Agreda,Stefan %A Dominguez-Rodriguez,Alejandro %A Finkelstein,Joseph %+ Department of Biomedical Informatics, School of Medicine, University of Utah, 421 Wakara Way, Salt Lake City, UT, 84108, United States, 1 (801) 581 4080, mahony.reategui@utah.edu %K natural language processing %K depression %K anxiety %K systematic review %K artificial intelligence %K AI %D 2024 %7 21.8.2024 %9 Review %J JMIR Ment Health %G English %X Background: The introduction of natural language processing (NLP) technologies has significantly enhanced the potential of self-administered interventions for treating anxiety and depression by improving human-computer interactions. Although these advances, particularly in complex models such as generative artificial intelligence (AI), are highly promising, robust evidence validating the effectiveness of the interventions remains sparse. Objective: The aim of this study was to determine whether self-administered interventions based on NLP models can reduce depressive and anxiety symptoms. Methods: We conducted a systematic review and meta-analysis. We searched Web of Science, Scopus, MEDLINE, PsycINFO, IEEE Xplore, Embase, and Cochrane Library from inception to November 3, 2023. We included studies with participants of any age diagnosed with depression or anxiety through professional consultation or validated psychometric instruments. Interventions had to be self-administered and based on NLP models, with passive or active comparators. Outcomes measured included depressive and anxiety symptom scores. We included randomized controlled trials and quasi-experimental studies but excluded narrative, systematic, and scoping reviews. Data extraction was performed independently by pairs of authors using a predefined form. Meta-analysis was conducted using standardized mean differences (SMDs) and random effects models to account for heterogeneity. Results: In all, 21 articles were selected for review, of which 76% (16/21) were included in the meta-analysis for each outcome. Most of the studies (16/21, 76%) were recent (2020-2023), with interventions being mostly AI-based NLP models (11/21, 52%); most (19/21, 90%) delivered some form of therapy (primarily cognitive behavioral therapy: 16/19, 84%). The overall meta-analysis showed that self-administered interventions based on NLP models were significantly more effective in reducing both depressive (SMD 0.819, 95% CI 0.389-1.250; P<.001) and anxiety (SMD 0.272, 95% CI 0.116-0.428; P=.001) symptoms compared to various control conditions. Subgroup analysis indicated that AI-based NLP models were effective in reducing depressive symptoms (SMD 0.821, 95% CI 0.207-1.436; P<.001) compared to pooled control conditions. Rule-based NLP models showed effectiveness in reducing both depressive (SMD 0.854, 95% CI 0.172-1.537; P=.01) and anxiety (SMD 0.347, 95% CI 0.116-0.578; P=.003) symptoms. The meta-regression showed no significant association between participants’ mean age and treatment outcomes (all P>.05). Although the findings were positive, the overall certainty of evidence was very low, mainly due to a high risk of bias, heterogeneity, and potential publication bias. Conclusions: Our findings support the effectiveness of self-administered NLP-based interventions in alleviating depressive and anxiety symptoms, highlighting their potential to increase accessibility to, and reduce costs in, mental health care. Although the results were encouraging, the certainty of evidence was low, underscoring the need for further high-quality randomized controlled trials and studies examining implementation and usability. These interventions could become valuable components of public health strategies to address mental health issues. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023472120; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023472120 %M 39167795 %R 10.2196/59560 %U https://mental.jmir.org/2024/1/e59560 %U https://doi.org/10.2196/59560 %U http://www.ncbi.nlm.nih.gov/pubmed/39167795 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e53794 %T Skill Enactment Among University Students Using a Brief Video-Based Mental Health Intervention: Mixed Methods Study Within a Randomized Controlled Trial %A Jackson,Hayley M %A Batterham,Philip J %A Calear,Alison L %A Ohan,Jeneva L %A Farrer,Louise M %+ Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, 63 Eggleston Road, Acton ACT, 2601, Australia, 61 416913323, hayley.jackson@anu.edu.au %K university students %K young people %K internet %K computer-assisted therapy %K engagement %K skill enactment %K depression %K anxiety %K randomized controlled trial %K mobile phone %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health problems are common among university students, yet many students do not seek professional help. Digital mental health interventions can increase students’ access to support and have been shown to be effective in preventing and treating mental health problems. However, little is known about the extent to which students implement therapeutic skills from these programs in everyday life (ie, skill enactment) or about the impact of skill enactment on outcomes. Objective: This study aims to assess the effects of a low-intensity video-based intervention, Uni Virtual Clinic Lite (UVC-Lite), in improving skill enactment relative to an attention-control program (primary aim) and examine whether skill enactment influences symptoms of depression and anxiety (secondary aim). The study also qualitatively explored participants’ experiences of, and motivations for, engaging with the therapeutic techniques. Methods: We analyzed data from a randomized controlled trial testing the effectiveness of UVC-Lite for symptoms of depression and anxiety among university students with mild to moderate levels of psychological distress. Participants were recruited from universities across Australia and randomly assigned to 6 weeks of self-guided use of UVC-Lite (243/487, 49.9%) or an attention-control program (244/487, 50.1%). Quantitative data on skill enactment, depression, and anxiety were collected through baseline, postintervention, and 3- and 6-month follow-up surveys. Qualitative data were obtained from 29 intervention-group participants through open-ended questions during postintervention surveys (n=17, 59%) and semistructured interviews (n=12, 41%) after the intervention period concluded. Results: Mixed model repeated measures ANOVA demonstrated that the intervention did not significantly improve skill enactment (F3,215.36=0.50; P=.68). Skill enactment was also not found to influence change in symptoms of depression (F3,241.10=1.69; P=.17) or anxiety (F3,233.71=1.11; P=.35). However, higher levels of skill enactment were associated with lower symptom levels among both intervention and control group participants across time points (depression: F1,541.87=134.61; P<.001; anxiety: F1,535.11=73.08; P<.001). Inductive content analysis confirmed low levels of skill enactment among intervention group participants. Participants were motivated to use techniques and skills that were perceived to be personally relevant, easily integrated into daily life, and that were novel or had worked for them in the past. Conclusions: The intervention did not improve skill enactment or mental health among students with mild to moderate psychological distress. Low adherence impacted our ability to draw robust conclusions regarding the intervention’s impact on outcomes. Factors influencing skill enactment differed across individuals, suggesting that it may be necessary to tailor therapeutic skills and engagement strategies to the individual user. Theoretically informed research involving collaboration with end users is needed to understand the processes underlying skill enactment in digital mental health interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000375853; https://tinyurl.com/7b9ar54r %M 39167783 %R 10.2196/53794 %U https://mental.jmir.org/2024/1/e53794 %U https://doi.org/10.2196/53794 %U http://www.ncbi.nlm.nih.gov/pubmed/39167783 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e54684 %T Feasibility and Acceptability of a Mobile Game to Support Smoking Cessation: Repeated Measures Study %A Goodwin,Shelby %A Nastasi,Jessica A %A Newman,Schyler T %A Rapoza,Darion %A Raiff,Bethany R %+ Department of Psychology, College of Science and Mathematics, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, United States, 1 856 256 4500 ext 53782, raiff@rowan.edu %K mHealth %K mobile health %K smoking cessation %K video game intervention %K mobile phone %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Approximately half of smokers attempt to quit, but 90% of these attempts fail. Video game–based interventions have the potential to address common barriers to evidence-based smoking cessation treatment, including high cost, lack of health care access, and low engagement. Objective: The purpose of this study was to evaluate the feasibility and acceptability of a video game–based smoking cessation intervention called Inspired and its impact on the 7-day smoking point prevalence at the 30-day follow-up. Methods: US adults (n=48) were recruited via the web to use Inspired on their smartphones for 7 weeks. The object of the game was to defend a healing tree against attackers. Levels of the game were unlocked twice daily when participants self-reported the number of cigarettes they smoked since the previous entry. Completion of the levels awarded players in-game currency, which could strengthen in-game abilities. Participants received additional in-game rewards to aid gameplay by submitting either smoking self-reports only or self-reports indicating abstinence, determined through random assignment. In addition, participants completed a web-based survey at intake, week 4, week 7, and the 30-day follow-up. Results: Of the 48 participants, who had an average age of 39.8 (SD 10.7) years, 27 (56%) were female, 4 (8%) Hispanic, 37 (77%) White, and 27 (56%) employed; 26 (54%) earned 0.97 in all cases). Participants also showed good treatment engagement and satisfaction, with 43% (46/107) of participants fully completing the intervention during the course of the study and 96% (79/82) indicating that the intervention was worth their time. Conclusions: Previous research has shown excellent clinical outcomes for self-guided ICBT accompanied by discussion forums and good engagement with those forums. Although clinical outcomes in our study were excellent across conditions, engagement with the forum was poor, in contrast to previous research. We discuss several possible interpretations of this finding (eg, related to the population under study or the design of the forum). Our findings highlight a need for more research evaluating the impact of online discussion forums and other strategies for improving outcomes and engagement in self-guided ICBT and other digital mental health interventions. Trial Registration: ClinicalTrials.gov NCT05145582; https://clinicaltrials.gov/study/NCT05145582 %M 39141899 %R 10.2196/59699 %U https://www.jmir.org/2024/1/e59699 %U https://doi.org/10.2196/59699 %U http://www.ncbi.nlm.nih.gov/pubmed/39141899 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51932 %T Evaluating the Effects of a Self-Help Mobile Phone App on Worry and Rumination Experienced by Young Adults: Randomized Controlled Trial %A Edge,Daniel %A Watkins,Edward %A Newbold,Alexandra %A Ehring,Thomas %A Frost,Mads %A Rosenkranz,Tabea %+ Mood Disorders Centre, School of Psychology, University of Exeter, Washington Singer Building Perry Road, Washington Singer Laboratories, Exeter, EX4 4QG, United Kingdom, 44 01392724621, de292@exeter.ac.uk %K worry %K rumination %K repetitive negative thinking %K prevention-mechanism %K well-being %K depression %K anxiety %K mobile-based interventions %K mobile phone %K mobile health application %K app %K application %D 2024 %7 13.8.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Delivery of preventative interventions via mobile phone apps offers an effective and accessible way to address the global priority of improving the mental health of adolescents and young adults. A proven risk factor for anxiety and depression is elevated worry and rumination, also known as repetitive negative thinking (RNT). Objective: This was a prevention mechanism trial that aimed to investigate whether an RNT-targeting self-help mobile phone app (MyMoodCoach) reduces worry and rumination in young adults residing in the United Kingdom. A secondary objective was to test whether the app reduces symptoms of anxiety and depression and improves well-being. Methods: A web-based, single-blind, 2-arm parallel-group randomized controlled trial was conducted with 236 people aged between 16 and 24 years, who self-reported high levels of worry or rumination. Eligible participants were randomized to an active intervention group (usual practice, plus up to 6 weeks of using the RNT-targeting mobile app, n=119) or a waitlist control group (usual practice with no access to the app until after 6 weeks, n=117). The primary outcome was changes in worry and rumination 6 weeks after randomization. Secondary outcomes included changes in well-being and symptoms of anxiety and depression after 6 weeks and changes in all measures after 12 weeks. Results: Participants randomly allocated to use the RNT-targeting self-help app showed significantly lower levels of rumination (mean difference –2.92, 95% CI –5.57 to –0.28; P=.03; ηp2=0.02) and worry (mean difference –3.97, 95% CI –6.21 to –1.73; P<.001; ηp2=0.06) at 6-week follow-up, relative to the waitlist control. Similar differences were observed for well-being (P<.001), anxiety (P=.03), and depression (P=.04). The waitlist control group also showed improvement when given access to the app after 6 weeks. Improvements observed in the intervention group after 6 weeks of using the app were maintained at the 12-week follow-up point. Conclusions: The MyMoodCoach app had a significant positive effect on worry and rumination, well-being, anxiety, and depression in young adults, relative to waitlist controls, providing proof-of-principle that an unguided self-help app can effectively reduce RNT. This app, therefore, has potential for the prevention of anxiety and depression although longer-term effects on incidence need to be directly evaluated. Trial Registration: ClinicalTrials.gov NCT04950257; https://www.clinicaltrials.gov/ct2/show/NCT04950257 International Registered Report Identifier (IRRID): RR2-10.1186/s12888-021-03536-0 %M 39137411 %R 10.2196/51932 %U https://mhealth.jmir.org/2024/1/e51932 %U https://doi.org/10.2196/51932 %U http://www.ncbi.nlm.nih.gov/pubmed/39137411 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e52166 %T A Novel Approach for Improving Gait Speed Estimation Using a Single Inertial Measurement Unit Embedded in a Smartphone: Validity and Reliability Study %A Lee,Pei-An %A Yu,Wanting %A Zhou,Junhong %A Tsai,Timothy %A Manor,Brad %A Lo,On-Yee %K smartphone app %K gait speed %K dual-task walking %K validity %K reliability %K mobile phone %D 2024 %7 13.8.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Gait speed is a valuable biomarker for mobility and overall health assessment. Existing methods to measure gait speed require expensive equipment or personnel assistance, limiting their use in unsupervised, daily-life conditions. The availability of smartphones equipped with a single inertial measurement unit (IMU) presents a viable and convenient method for measuring gait speed outside of laboratory and clinical settings. Previous works have used the inverted pendulum model to estimate gait speed using a non–smartphone-based IMU attached to the trunk. However, it is unclear whether and how this approach can estimate gait speed using the IMU embedded in a smartphone while being carried in a pants pocket during walking, especially under various walking conditions. Objective: This study aimed to validate and test the reliability of a smartphone IMU–based gait speed measurement placed in the user’s front pants pocket in both healthy young and older adults while walking quietly (ie, normal walking) and walking while conducting a cognitive task (ie, dual-task walking). Methods: A custom-developed smartphone application (app) was used to record gait data from 12 young adults and 12 older adults during normal and dual-task walking. The validity and reliability of gait speed and step length estimations from the smartphone were compared with the gold standard GAITRite mat. A coefficient-based adjustment based upon a coefficient relative to the original estimation of step length was applied to improve the accuracy of gait speed estimation. The magnitude of error (ie, bias and limits of agreement) between the gait data from the smartphone and the GAITRite mat was calculated for each stride. The Passing-Bablok orthogonal regression model was used to provide agreement (ie, slopes and intercepts) between the smartphone and the GAITRite mat. Results: The gait speed measured by the smartphone was valid when compared to the GAITRite mat. The original limits of agreement were 0.50 m/s (an ideal value of 0 m/s), and the orthogonal regression analysis indicated a slope of 1.68 (an ideal value of 1) and an intercept of −0.70 (an ideal value of 0). After adjustment, the accuracy of the smartphone-derived gait speed estimation improved, with limits of agreement reduced to 0.34 m/s. The adjusted slope improved to 1.00, with an intercept of 0.03. The test-retest reliability of smartphone-derived gait speed was good to excellent within supervised laboratory settings and unsupervised home conditions. The adjustment coefficients were applicable to a wide range of step lengths and gait speeds. Conclusions: The inverted pendulum approach is a valid and reliable method for estimating gait speed from a smartphone IMU placed in the pockets of younger and older adults. Adjusting step length by a coefficient derived from the original estimation of step length successfully removed bias and improved the accuracy of gait speed estimation. This novel method has potential applications in various settings and populations, though fine-tuning may be necessary for specific data sets. %R 10.2196/52166 %U https://mhealth.jmir.org/2024/1/e52166 %U https://doi.org/10.2196/52166 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56250 %T Adaptation of a Theory-Based Mobile App to Improve Access to HIV Prevention Services for Transgender Women in Malaysia: Focus Group Study %A Gautam,Kamal %A Shrestha,Roman %A Dlamini,Sihlelelwe %A Razali,Belle %A Paudel,Kiran %A Azwa,Iskandar %A Saifi,Rumana %A Toh,YuHang %A Justin Lim,Hazriq %A Sutherland,Ryan %A Restar,Arjee %A Phanuphak,Nittaya %A Wickersham,Jeffrey A %+ Department of Internal Medicine, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06511, United States, 1 2037374158, jeffrey.wickersham@yale.edu %K HIV %K AIDS %K pre-exposure prophylaxis %K PrEP %K mobile health %K mHealth %K transgender women %K Malaysia %K mobile phone %D 2024 %7 13.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Globally, transgender women have been disproportionately affected by the HIV epidemic, including in Malaysia, where an estimated 11% of transgender women are living with HIV. Available interventions designed specifically to meet transgender women’s needs for HIV prevention are limited. Mobile health, particularly smartphone mobile apps, is an innovative and cost-effective strategy for reaching transgender women and delivering interventions to reduce HIV vulnerability. Objective: This study aims to adapt a theory-based mobile health HIV prevention smartphone app, HealthMindr, to meet the unique needs of transgender women in Malaysia. We conducted theater testing of the HealthMindr app with transgender women and key stakeholders and explored barriers to transgender women’s uptake of HIV pre-exposure prophylaxis (PrEP). Methods: From February to April 2022, a total of 6 focus group (FG) sessions were conducted with 29 participants: 4 FG sessions with transgender women (n=18, 62%) and 2 FG sessions with stakeholders (n=11, 38%) providing HIV prevention services to transgender women in Malaysia. Barriers to PrEP uptake and gender-affirming care services among transgender women in Malaysia were explored. Participants were then introduced to the HealthMindr app and provided a comprehensive tour of the app’s features and functions. Participants provided feedback on the app and on how existing features should be adapted to meet the needs of transgender women, as well as any features that should be removed or added. Each FG was digitally recorded and transcribed. Transcripts were coded inductively using Dedoose software (version 9.0.54; SocioCultural Research Consultants, LLC) and analyzed to identify and interpret emerging themes. Results: Six subthemes related to PrEP barriers were found: stigma and discrimination, limited PrEP knowledge, high PrEP cost, accessibility concerns, alternative prevention methods, and perceived adverse effects. Participants suggested several recommendations regarding the attributes and app features that would be the most useful for transgender women in Malaysia. Adaptation and refinement of the app were related to the attributes of the app (user interface, security, customizable colors, themes, and avatars), feedback, and requests for additional mobile app functional (appointment booking, e-consultation, e-pharmacy, medicine tracker, mood tracker, resources, and service site locator) and communication (peer support group, live chat, and discussion forum) features. Conclusions: The results reveal that multifaceted barriers hinder PrEP uptake and use among transgender women in Malaysia. The findings also provide detailed recommendations for successfully adapting the HealthMindr app to the context of Malaysian transgender women, with a potential solution for delivering tailored HIV prevention, including PrEP, and increasing accessibility to gender-affirming care services. %M 39137407 %R 10.2196/56250 %U https://formative.jmir.org/2024/1/e56250 %U https://doi.org/10.2196/56250 %U http://www.ncbi.nlm.nih.gov/pubmed/39137407 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53598 %T A Transdiagnostic Video-Based Internet Intervention (Uni Virtual Clinic-Lite) to Improve the Mental Health of University Students: Randomized Controlled Trial %A Farrer,Louise M %A Jackson,Hayley M %A Gulliver,Amelia %A Calear,Alison L %A Leach,Liana %A Hasking,Penelope %A Katruss,Natasha %A Batterham,Philip J %+ Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, 63 Eggleston Rd, Canberra, 2601, Australia, 61 6125 8859, louise.farrer@anu.edu.au %K university students %K internet-based intervention %K randomized controlled trial %K mental health %K transdiagnostic %D 2024 %7 13.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Numerous studies have demonstrated the effectiveness of digital interventions for improving the mental health of university students. However, low rates of engagement with these interventions are an ongoing challenge and can compromise effectiveness. Brief, transdiagnostic, web-based video interventions are capable of targeting key mental health and related issues affecting university students and may be more engaging and accessible for this population. Objective: This study used a 2-arm randomized controlled trial to evaluate the effectiveness of Uni Virtual Clinic-Lite (UVC-Lite), a fully automated, transdiagnostic, web-based video intervention, relative to an attention-control condition. The primary outcomes were symptoms of depression and generalized anxiety disorder. The secondary outcomes included psychological distress, social anxiety symptoms, body appreciation, quality of life, well-being, functioning, general self-efficacy, academic self-efficacy, and help seeking. Program use (intervention uptake and engagement) and satisfaction were also assessed. Methods: University students (n=487) with mild to moderate symptoms of distress were recruited from universities across Australia and randomly allocated to receive access to the UVC-Lite intervention or an attention-control condition targeting general health for a period of 6 weeks. UVC-Lite includes 12 modules, each comprising a brief animated video and an accompanying exercise. Of the 12 modules, 7 also included a brief symptom screening quiz. Outcomes were assessed at baseline, postintervention, and 3- and 6-months postintervention. Results: The primary and secondary outcomes were analyzed on an intention-to-treat basis using mixed models repeated measures ANOVA. The intervention was not found to be effective relative to the control condition on any of the primary or secondary outcomes. While 67.9% (114/168) of participants accessed at least 1 module of the intervention, module completion was extremely low. Subgroup analyses among those who engaged with the program (completed at least 1 video) and those with higher baseline distress (Distress Questionnaire-5 score ≥15) did not reveal any differences between the conditions over time. However, uptake (accessing at least 1 video) and engagement (completing at least 1 video) were higher among those with higher baseline symptoms. Satisfaction with the intervention was high. Conclusions: The UVC-Lite intervention was not effective relative to a control program, although it was associated with high satisfaction among students and was not associated with symptom deterioration. Given the challenges faced by universities in meeting demand for mental health services, flexible and accessible interventions such as UVC-Lite have the potential to assist students to manage symptoms of mental health problems. However, low uptake and engagement (particularly among students with lower levels of symptomatology) are significant challenges that require further attention. Future studies should examine the effectiveness of the intervention in a more highly symptomatic sample, as well as implementation pathways to optimize effective engagement with the intervention. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000375853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380146 %M 39137012 %R 10.2196/53598 %U https://www.jmir.org/2024/1/e53598 %U https://doi.org/10.2196/53598 %U http://www.ncbi.nlm.nih.gov/pubmed/39137012 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e51570 %T Development and Implementation of Postdischarge Text Messages to Adolescents With Suicidal Thoughts and Behaviors Through Caring Contacts: Implementation Study %A Thomas,Glenn V %A Camacho,Elena %A Masood,Fatimah A %A Huang,Yungui %A Valleru,Jahnavi %A Bridge,Jeffrey A %A Ackerman,John %+ Behavioral Health Services, Nationwide Children’s Hospital, 444 Butterfly Gardens Dr., 2nd Fl., Columbus, OH, 43215, United States, 1 6143550814, John.Ackerman@nationwidechildrens.org %K mental health %K suicide prevention %K adolescent %K caring contacts %K mHealth %K Zero Suicide %K quality improvement %K care transitions %K safety plan %K behavioral health %K mobile phone %D 2024 %7 13.8.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Youth suicide is a pressing public health concern, and transitions in care after a suicidal crisis represent a period of elevated risk. Disruptions in continuity of care and emotional support occur frequently. “Caring contacts” validating messages post discharge have the potential to enhance connections with patients and have been shown to improve outcomes. More recently, positive outcomes have been noted using caring contact text messages (SMS and MMS), which hold promise for engaging patients in a pediatric setting, but there are few studies describing the large-scale implementation of such an approach. Objective: This study aims to describe the process of developing and implementing automated caring contacts within a quality improvement framework, using a standardized series of supportive texts and images, for adolescents discharged from high-acuity programs at a large midwestern pediatric hospital. We describe lessons learned, including challenges and factors contributing to success. Methods: We implemented the caring contacts intervention in 3 phases. Phase 1 entailed developing supportive statements and images designed to promote hope, inclusivity, and connection in order to create 2 sets of 8 text messages and corresponding images. Phase 2 included piloting caring contacts manually in the hospital’s Psychiatric Crisis Department and Inpatient Psychiatry Unit and assessing the feasibility of implementation in other services, as well as developing workflows and addressing legal considerations. Phase 3 consisted of implementing an automated process to scale within 4 participating hospital services and integrating enrollment into the hospital’s electronic medical records. Process outcome measures included staff compliance with approaching and enrolling eligible patients and results from an optional posttext survey completed by participants. Results: Compliance data are presented for 4062 adolescent patients eligible for caring contacts. Overall, 88.65% (3601/4062) of eligible patients were approached, of whom 52.43% (1888/3601) were enrolled. In total, 94.92% (1792/1888) of enrolled participants completed the program. Comparisons of the patients eligible, approached, enrolled, and completed are presented. Primary reasons for eligible patients declining include not having access to a mobile phone (686/1705, 40.23%) and caregivers preferring to discuss the intervention at a later time (754/1705, 44.22%). The majority of patients responding to the optional posttext survey reported that the texts made them feel moderately to very hopeful (219/264, 83%), supported (232/264, 87.9%), that peers would be helped by these texts (243/264, 92%), and that they would like to keep receiving texts given the option (227/264, 86%). Conclusions: This study describes the successful implementation of automated postdischarge caring contacts texts to scale with an innovative use of images and demonstrates how a quality improvement methodology resulted in a more effective and efficient process. This paper also highlights the potential for technology to enhance care for at-risk youth and create more accessible, inclusive, and sustainable prevention strategies. %M 39137019 %R 10.2196/51570 %U https://pediatrics.jmir.org/2024/1/e51570 %U https://doi.org/10.2196/51570 %U http://www.ncbi.nlm.nih.gov/pubmed/39137019 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e52310 %T Prediction of Hearing Help Seeking to Design a Recommendation Module of an mHealth Hearing App: Intensive Longitudinal Study of Feature Importance Assessment %A Angonese,Giulia %A Buhl,Mareike %A Kuhlmann,Inka %A Kollmeier,Birger %A Hildebrandt,Andrea %+ Psychological Methods and Statistics Lab, Department of Psychology, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstraße 114-118, Oldenburg, 26129, Germany, 49 0441 798 4629, giulia.angonese@uni-oldenburg.de %K hearing loss %K mobile health %K mHealth %K older adults %K help seeking %K mobile study %K machine learning %K supervised classification %K feature importance %K profiling %K mobile phone %D 2024 %7 12.8.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile health (mHealth) solutions can improve the quality, accessibility, and equity of health services, fostering early rehabilitation. For individuals with hearing loss, mHealth apps might be designed to support the decision-making processes in auditory diagnostics and provide treatment recommendations to the user (eg, hearing aid need). For some individuals, such an mHealth app might be the first contact with a hearing diagnostic service and should motivate users with hearing loss to seek professional help in a targeted manner. However, personalizing treatment recommendations is only possible by knowing the individual’s profile regarding the outcome of interest. Objective: This study aims to characterize individuals who are more or less prone to seeking professional help after the repeated use of an app-based hearing test. The goal was to derive relevant hearing-related traits and personality characteristics for personalized treatment recommendations for users of mHealth hearing solutions. Methods: In total, 185 (n=106, 57.3% female) nonaided older individuals (mean age 63.8, SD 6.6 y) with subjective hearing loss participated in a mobile study. We collected cross-sectional and longitudinal data on a comprehensive set of 83 hearing-related and psychological measures among those previously found to predict hearing help seeking. Readiness to seek help was assessed as the outcome variable at study end and after 2 months. Participants were classified into help seekers and nonseekers using several supervised machine learning algorithms (random forest, naïve Bayes, and support vector machine). The most relevant features for prediction were identified using feature importance analysis. Results: The algorithms correctly predicted action to seek help at study end in 65.9% (122/185) to 70.3% (130/185) of cases, reaching 74.8% (98/131) classification accuracy at follow-up. Among the most important features for classification beyond hearing performance were the perceived consequences of hearing loss in daily life, attitude toward hearing aids, motivation to seek help, physical health, sensory sensitivity personality trait, neuroticism, and income. Conclusions: This study contributes to the identification of individual characteristics that predict help seeking in older individuals with self-reported hearing loss. Suggestions are made for their implementation in an individual-profiling algorithm and for deriving targeted recommendations in mHealth hearing apps. %M 39133539 %R 10.2196/52310 %U https://humanfactors.jmir.org/2024/1/e52310 %U https://doi.org/10.2196/52310 %U http://www.ncbi.nlm.nih.gov/pubmed/39133539 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47116 %T The Impact of a Gamified Intervention on Daily Steps in Real-Life Conditions: Retrospective Analysis of 4800 Individuals %A Mazéas,Alexandre %A Forestier,Cyril %A Harel,Guillaume %A Duclos,Martine %A Chalabaev,Aïna %+ Laboratoire Sport et Environnement Social (SENS), Université Grenoble Alpes, 1741 Rue de la Piscine, Grenoble, 38000, France, 33 476635081, alexandre.mazeas@univ-grenoble-alpes.fr %K behavior change %K daily steps %K exercise %K gamification %K intervention %K mHealth %K mobile health %K mobile phone %K physical activity %K real world data %K retrospective %K self-determination theory %K step %K steps %D 2024 %7 12.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital interventions integrating gamification features hold promise to promote daily steps. However, results regarding the effectiveness of this type of intervention are heterogeneous and not yet confirmed in real-life contexts. Objective: This study aims to examine the effectiveness of a gamified intervention and its potential moderators in a large sample using real-world data. Specifically, we tested (1) whether a gamified intervention enhanced daily steps during the intervention and follow-up periods compared to baseline, (2) whether this enhancement was higher in participants in the intervention than in nonparticipants, and (3) what participant characteristics or intervention parameters moderated the effect of the program. Methods: Data from 4819 individuals who registered for a mobile health Kiplin program between 2019 and 2022 were retrospectively analyzed. In this intervention, participants could take part in one or several games in which their daily step count was tracked, allowing individuals to play with their overall activity. Nonparticipants were people who registered for the program but did not take part in the intervention and were considered as a control group. Daily step counts were measured via accelerometers embedded in either commercial wearables or smartphones of the participants. Exposure to the intervention, the intervention content, and participants’ characteristics were included in multilevel models to test the study objectives. Results: Participants in the intervention group demonstrated a significantly greater increase in mean daily steps from baseline than nonparticipants (P<.001). However, intervention effectiveness depended on participants’ initial physical activity. The daily steps of participants with <7500 baseline daily steps significantly improved from baseline both during the Kiplin intervention (+3291 daily steps) and the follow-up period (+945 daily steps), whereas participants with a higher baseline had no improvement or significant decreases in daily steps after the intervention. Age (P<.001) and exposure (P<.001) positively moderated the intervention effect. Conclusions: In real-world settings and among a large sample, the Kiplin intervention was significantly effective in increasing the daily steps of participants from baseline during intervention and follow-up periods compared to nonparticipants. Interestingly, responses to the intervention differed based on participants’ initial steps, with the existence of a plateau effect. Drawing on the insights of self-determination theory, we can assume that the effect of gamification could depend of the initial motivation and activity of participants. %M 39133533 %R 10.2196/47116 %U https://www.jmir.org/2024/1/e47116 %U https://doi.org/10.2196/47116 %U http://www.ncbi.nlm.nih.gov/pubmed/39133533 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52428 %T Feasibility and Acceptability of a Mobile Health Exercise Intervention for Inactive Adults: 3-Arm Randomized Controlled Pilot Trial %A Dawson,Jacqueline Kiwata %A Ede,Alison %A Phan,Madeleine %A Sequeira,Alec %A Teng,Hsiang-Ling %A Donlin,Ayla %+ Department of Physical Therapy, California State University, Long Beach, ET-130, 1250 Bellflower Boulevard, Long Beach, CA, 90840, United States, 1 5629857139, jacqueline.dawson@csulb.edu %K digital health %K physical activity %K user experience %K heart rate monitor %K group exercise %K mHealth %K wearable %K group exercise %K feasibility %K acceptability %K mobile health %K mobile health exercise %K exercise %K adults %K randomized controlled trial %K exercise program %K support %K wearables %K screening %K effectiveness %K videoconference %D 2024 %7 9.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Objective monitoring of self-directed physical activity (PA) is a common approach used in both fitness and health settings to promote exercise behavior, but adherence has been poor. Newer mobile health (mHealth) technologies could be a cost-effective approach to broadening accessibility and providing support for PA behavior change; yet, the optimal method of delivery of such interventions is still unclear. Objective: This study aimed to determine the feasibility and acceptability of an mHealth exercise intervention delivered in combination with objective monitoring in 3 ways: health education emails, asynchronous exercise videos, or synchronous videoconference exercise classes. Methods: Physically inactive (<30 min/wk) adults (cisgender women aged 31.5, SD 11.3 years, cisgender men aged 34.1, SD 28.9 years, and nonbinary individuals aged 22.0, SD 0 years) were randomized (1:1:1) to 8 weeks of increasing PA behavioral support: level 1 (health education+objective monitoring, n=26), level 2 (asynchronous contact, level 1+prerecorded exercise videos, n=30), or level 3 (synchronous contact, level 1+videoconference group exercise, n=28). Participants used a heart rate monitor during exercise and a mobile app for interaction. Primary outcomes were feasibility (accrual, retention, and adherence) and acceptability (user experience survey). Secondary outcomes assessed at baseline and 8 weeks included resting heart rate, self-reported PA, and quality of life. The exercise dose was evaluated throughout the intervention. Results: Between August 2020 and August 2021, 204 adults were screened for eligibility. Out of 135 eligible participants, 84 (62%) enrolled in the study. Retention was 50% (13/26) in level 1, 60% (18/30) in level 2 and 82% (23/28) in level 3, while adherence was 31% (8/26) in level 1, 40% (12/30) in level 2 and 75% (21/28) in level 3. A total of 83% (70/84) of the study sample completed the intervention, but low response rates (64%, 54/84) were observed postintervention at week-8 assessments. Program satisfaction was highest in participants receiving exercise videos (level 2, 80%, 8/10) or exercise classes (level 3, 80%, 12/15), while only 63% (5/8) of level 1 reported the program as enjoyable. Level 3 was most likely to recommend the program (87%, 13/15), compared to 80% (8/10) in level 2 and 46% (5/8) in level 1. Self-reported PA significantly increased from baseline to intervention in level 3 (P<.001) and level 2 (P=.003), with no change in level 1. Level 3 appeared to exercise at higher doses throughout the intervention. Conclusions: Only the videoconference exercise class intervention met feasibility criteria, although postintervention response rates were low across all groups. Both videoconference and prerecorded videos had good acceptability, while objective monitoring and health education alone were not feasible or acceptable. Future studies are needed to examine the effectiveness of videoconference exercise interventions on health-related outcomes during nonpandemic times and how asynchronous interventions might maximize adherence. Trial Registration: ClinicalTrials.gov NCT05192421; https://clinicaltrials.gov/study/NCT05192421 %R 10.2196/52428 %U https://formative.jmir.org/2024/1/e52428 %U https://doi.org/10.2196/52428 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53145 %T Remote Exercise Training Intervention During the COVID-19 Pandemic: Randomized Controlled Trial %A Philippi,Keito F A %A Zeier,Peter %A Brahmer,Alexandra %A Neuberger,Elmo W I %A Sandner,Magdalena %A Hagenah,Matthias %A Porten,Thilo %A Lenz,Regina %A Ochmann,David T %A Wedekink,Florian %A Wischhusen,Jörg %A Lutz,Beat %A Lieb,Klaus %A Wessa,Michèle %A Simon,Perikles %+ Department of Sports Medicine, Disease Prevention and Rehabilitation, Institute of Sports Science, Johannes Gutenberg-University Mainz, Albert-Schweitzer-Straße 22, Mainz, 55128, Germany, 49 6131 3923531, simonpe@uni-mainz.de %K physical exercise %K web-based %K COVID-19 %K lockdown %K aerobic capacity %K depression %K feasibility %K aerobic %K anxiety %K randomized controlled trial %K prepandemic cohort %K mental health %K pandemic %K remote exercise %K intervention %K pre-COVID-19 %K lockdown cohort %K pandemic-related %K adult %K adults %D 2024 %7 8.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Societal measures to contain the spread of COVID-19 (eg, lockdown and contact restrictions) have been associated with decreased health and well-being. A multitude of prepandemic studies identified the beneficial effects of physical exercise on both physical and mental health. Objective: We report on the feasibility of a remote physical exercise intervention and its stress-buffering potential in 2 untrained cohorts: a pre–COVID-19 cohort that completed the intervention in 2019 and a lockdown cohort that started the intervention shortly before pandemic-related restrictions were implemented. Methods: In a randomized controlled trial, participants were assigned to either an intervention group (IG; pre–COVID-19 cohort: n=7 and lockdown cohort: n=9) or a control group (CG; pre–COVID-19 cohort: n=6 and lockdown cohort: n=6). IG participants received weekly individualized training recommendations delivered via web-based support. The intervention period was initially planned for 8 weeks, which was adhered to in the pre–COVID-19 cohort (mean 8.3, SD 0.5 weeks) but was extended to an average of 17.7 (SD 2.0) weeks in the lockdown cohort. Participants’ health parameters were assessed before and after the intervention: aerobic capacity was measured as peak oxygen uptake (VO2peak) via cardiopulmonary exercise testing. Depressive symptoms were scored via the depression subscale of the Brief Symptom Inventory-18. Results: Dropout rates were low in both cohorts in the IG (pre–COVID-19 cohort: n=0, 0% and lockdown cohort: n=2, 16.7%) and the CG (pre–COVID-19 cohort: n=0, 0% and lockdown cohort: n=2, 20%). The mean adherence to the training sessions of the IG for both cohorts was 84% (pre–COVID-19 cohort: SD 5.5% and lockdown cohort: SD 11.6%). Aligned rank transform ANOVAs in the lockdown cohort indicated deterioration of VO2peak and depressive symptoms from before to after the intervention in the CG but no longitudinal changes in the IG. Analyses in the pre–COVID-19 cohort revealed significant increases in VO2peak for the IG compared to the CG (P=.04) but no intervention effects on depressive symptoms. Conclusions: With low dropout rates and high adherence, the remote intervention was feasible for healthy adults under regular conditions and in the face of pandemic-related stressors. Moreover, our results hint at a stress-buffering effect as well as a buffering of a lockdown-induced deconditioning of remote physical exercise interventions in the pandemic scenario, which can be used in future studies to overcome equally stressful periods of life. However, due to limited statistical power, these findings should be replicated in similar scenarios. Trial Registration: German Clinical Trials Register DRKS00018078; https://drks.de/search/en/trial/DRKS00018078 %M 39116428 %R 10.2196/53145 %U https://www.jmir.org/2024/1/e53145 %U https://doi.org/10.2196/53145 %U http://www.ncbi.nlm.nih.gov/pubmed/39116428 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e51716 %T Assessing the Short-Term Efficacy of Digital Cognitive Behavioral Therapy for Insomnia With Different Types of Coaching: Randomized Controlled Comparative Trial %A Chan,Wai Sze %A Cheng,Wing Yee %A Lok,Samson Hoi Chun %A Cheah,Amanda Kah Mun %A Lee,Anna Kai Win %A Ng,Albe Sin Ying %A Kowatsch,Tobias %+ Department of Psychology, The University of Hong Kong, Room 627, the Jockey Club Tower, Pokfulam, Hong Kong, Hong Kong, China (Hong Kong), 852 39172295, chanwais@hku.hk %K insomnia %K cognitive behavioral therapy %K digital intervention %K mobile health %K mHealth %K chatbot-based coaching %K human support %K mobile phone %D 2024 %7 7.8.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Digital cognitive behavioral therapy for insomnia (dCBTi) is an effective intervention for treating insomnia. The findings regarding its efficacy compared to face-to-face cognitive behavioral therapy for insomnia are inconclusive but suggest that dCBTi might be inferior. The lack of human support and low treatment adherence are believed to be barriers to dCBTi achieving its optimal efficacy. However, there has yet to be a direct comparative trial of dCBTi with different types of coaching support. Objective: This study examines whether adding chatbot-based and human coaching would improve the treatment efficacy of, and adherence to, dCBTi. Methods: Overall, 129 participants (n=98, 76% women; age: mean 34.09, SD 12.05 y) whose scores on the Insomnia Severity Index [ISI] were greater than 9 were recruited. A randomized controlled comparative trial with 5 arms was conducted: dCBTi with chatbot-based coaching and therapist support (dCBTi-therapist), dCBTi with chatbot-based coaching and research assistant support, dCBTi with chatbot-based coaching only, dCBTi without any coaching, and digital sleep hygiene and self-monitoring control. Participants were blinded to the condition assignment and study hypotheses, and the outcomes were self-assessed using questionnaires administered on the web. The outcomes included measures of insomnia (the ISI and the Sleep Condition Indicator), mood disturbances, fatigue, daytime sleepiness, quality of life, dysfunctional beliefs about sleep, and sleep-related safety behaviors administered at baseline, after treatment, and at 4-week follow-up. Treatment adherence was measured by the completion of video sessions and sleep diaries. An intention-to-treat analysis was conducted. Results: Significant condition-by-time interaction effects showed that dCBTi recipients, regardless of having any coaching, had greater improvements in insomnia measured by the Sleep Condition Indicator (P=.003; d=0.45) but not the ISI (P=.86; d=–0.28), depressive symptoms (P<.001; d=–0.62), anxiety (P=.01; d=–0.40), fatigue (P=.02; d=–0.35), dysfunctional beliefs about sleep (P<.001; d=–0.53), and safety behaviors related to sleep (P=.001; d=–0.50) than those who received digital sleep hygiene and self-monitoring control. The addition of chatbot-based coaching and human support did not improve treatment efficacy. However, adding human support promoted greater reductions in fatigue (P=.03; d=–0.33) and sleep-related safety behaviors (P=.05; d=–0.30) than dCBTi with chatbot-based coaching only at 4-week follow-up. dCBTi-therapist had the highest video and diary completion rates compared to other conditions (video: 16/25, 60% in dCBTi-therapist vs <3/21, <25% in dCBTi without any coaching), indicating greater treatment adherence. Conclusions: Our findings support the efficacy of dCBTi in treating insomnia, reducing thoughts and behaviors that perpetuate insomnia, reducing mood disturbances and fatigue, and improving quality of life. Adding chatbot-based coaching and human support did not significantly improve the efficacy of dCBTi after treatment. However, adding human support had incremental benefits on reducing fatigue and behaviors that could perpetuate insomnia, and hence may improve long-term efficacy. Trial Registration: ClinicalTrials.gov NCT05136638; https://www.clinicaltrials.gov/study/NCT05136638 %M 39110971 %R 10.2196/51716 %U https://mental.jmir.org/2024/1/e51716 %U https://doi.org/10.2196/51716 %U http://www.ncbi.nlm.nih.gov/pubmed/39110971 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53134 %T Effectiveness and User Experience of a Smoking Cessation Chatbot: Mixed Methods Study Comparing Motivational Interviewing and Confrontational Counseling %A He,Linwei %A Basar,Erkan %A Krahmer,Emiel %A Wiers,Reinout %A Antheunis,Marjolijn %+ Department of Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Dante Building, D407, Warandelaan 2, Tilburg, 5037AB, Netherlands, 31 644911989, l.he_1@tilburguniversity.edu %K chatbot %K smoking cessation %K counseling %K motivational interviewing %K confrontational counseling %K user experience %K engagement %D 2024 %7 6.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Cigarette smoking poses a major public health risk. Chatbots may serve as an accessible and useful tool to promote cessation due to their high accessibility and potential in facilitating long-term personalized interactions. To increase effectiveness and acceptability, there remains a need to identify and evaluate counseling strategies for these chatbots, an aspect that has not been comprehensively addressed in previous research. Objective: This study aims to identify effective counseling strategies for such chatbots to support smoking cessation. In addition, we sought to gain insights into smokers’ expectations of and experiences with the chatbot. Methods: This mixed methods study incorporated a web-based experiment and semistructured interviews. Smokers (N=229) interacted with either a motivational interviewing (MI)–style (n=112, 48.9%) or a confrontational counseling–style (n=117, 51.1%) chatbot. Both cessation-related (ie, intention to quit and self-efficacy) and user experience–related outcomes (ie, engagement, therapeutic alliance, perceived empathy, and interaction satisfaction) were assessed. Semistructured interviews were conducted with 16 participants, 8 (50%) from each condition, and data were analyzed using thematic analysis. Results: Results from a multivariate ANOVA showed that participants had a significantly higher overall rating for the MI (vs confrontational counseling) chatbot. Follow-up discriminant analysis revealed that the better perception of the MI chatbot was mostly explained by the user experience–related outcomes, with cessation-related outcomes playing a lesser role. Exploratory analyses indicated that smokers in both conditions reported increased intention to quit and self-efficacy after the chatbot interaction. Interview findings illustrated several constructs (eg, affective attitude and engagement) explaining people’s previous expectations and timely and retrospective experience with the chatbot. Conclusions: The results confirmed that chatbots are a promising tool in motivating smoking cessation and the use of MI can improve user experience. We did not find extra support for MI to motivate cessation and have discussed possible reasons. Smokers expressed both relational and instrumental needs in the quitting process. Implications for future research and practice are discussed. %M 39106097 %R 10.2196/53134 %U https://www.jmir.org/2024/1/e53134 %U https://doi.org/10.2196/53134 %U http://www.ncbi.nlm.nih.gov/pubmed/39106097 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e49576 %T Using Wearables to Study Biopsychosocial Dynamics in Couples Who Cope With a Chronic Health Condition: Ambulatory Assessment Study %A Pauly,Theresa %A Lüscher,Janina %A Wilhelm,Lea Olivia %A Amrein,Melanie Alexandra %A Boateng,George %A Kowatsch,Tobias %A Fleisch,Elgar %A Bodenmann,Guy %A Scholz,Urte %+ Department of Gerontology, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada, 1 778 782 7834, theresa_pauly@sfu.ca %K couples %K wearables %K type II diabetes %K heart rate %K biopsychosocial dynamics %K physiological linkage %K mobile health %K technology %K social support %K chronic disease %K usability %K utility %K mHealth %D 2024 %7 5.8.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Technology has become an integral part of our everyday life, and its use to manage and study health is no exception. Romantic partners play a critical role in managing chronic health conditions as they tend to be a primary source of support. Objective: This study tests the feasibility of using commercial wearables to monitor couples’ unique way of communicating and supporting each other and documents the physiological correlates of interpersonal dynamics (ie, heart rate linkage). Methods: We analyzed 617 audio recordings of 5-minute duration (384 with concurrent heart rate data) and 527 brief self-reports collected from 11 couples in which 1 partner had type II diabetes during the course of their typical daily lives. Audio data were coded by trained raters for social support. The extent to which heart rate fluctuations were linked among couples was quantified using cross-correlations. Random-intercept multilevel models explored whether cross-correlations might differ by social contexts and exchanges. Results: Sixty percent of audio recordings captured speech between partners and partners reported personal contact with each other in 75% of self-reports. Based on the coding, social support was found in 6% of recordings, whereas at least 1 partner self-reported social support about half the time (53%). Couples, on average, showed small to moderate interconnections in their heart rate fluctuations (r=0.04-0.22). Couples also varied in the extent to which there was lagged linkage, that is, meaning that changes in one partner’s heart rate tended to precede changes in the other partner’s heart rate. Exploratory analyses showed that heart rate linkage was stronger (1) in rater-coded partner conversations (vs moments of no rater-coded partner conversations: rdiff=0.13; P=.03), (2) when partners self-reported interpersonal contact (vs moments of no self-reported interpersonal contact: rdiff=0.20; P<.001), and (3) when partners self-reported social support exchanges (vs moments of no self-reported social support exchange: rdiff=0.15; P=.004). Conclusions: Our study provides initial evidence for the utility of using wearables to collect biopsychosocial data in couples managing a chronic health condition in daily life. Specifically, heart rate linkage might play a role in fostering chronic disease management as a couple. Insights from collecting such data could inform future technology interventions to promote healthy lifestyle engagement and adaptive chronic disease management. International Registered Report Identifier (IRRID): RR2-10.2196/13685 %M 39102683 %R 10.2196/49576 %U https://mhealth.jmir.org/2024/1/e49576 %U https://doi.org/10.2196/49576 %U http://www.ncbi.nlm.nih.gov/pubmed/39102683 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53811 %T Perceived Benefit and Satisfaction With a Tablet Computer and an Emergency Smartwatch by Older Adults and Their Relatives: Prospective Real-World Pilot Study %A Wiegel,Patrick %A Fotteler,Marina Liselotte %A Kohn,Brigitte %A Mayer,Sarah %A Verri,Filippo Maria %A Dallmeier,Dhayana %A Denkinger,Michael %K assistive technology %K older adults %K caregiver %K benefits %K usability %K gerontechnology %D 2024 %7 2.8.2024 %9 %J JMIR Hum Factors %G English %X Background: Assistive technologies (ATs) have the potential to promote the quality of life and independent living of older adults and, further, to relieve the burden of formal and informal caregivers and relatives. Technological developments over the last decades have led to a boost of available ATs. However, evidence on the benefits and satisfaction with ATs in real-world applications remains scarce. Objective: This prospective, real-world, pilot study tested the perceived benefit and satisfaction with different ATs in the real-world environment. Methods: Community-dwelling adults aged ≥65 and their relatives tested a tablet computer with a simplified interface or a smartwatch with programmable emergency contacts for 8 weeks in their everyday life. Perceived benefits and satisfaction with ATs were assessed by all older adults and their relatives using different assessment tools before and after the intervention. Outcome measures included the Technology Usage Inventory, Quebec User Evaluation of Satisfaction with Assistive Technology 2.0, and Canadian Occupational Performance Measure. Results: A total of 17 older adults (tablet computer: n=8, 47% and smartwatch: n=9, 53%) and 16 relatives (tablet computer: n=7, 44% and smartwatch: n=9, 56%) were included in the study. The number of participants that were frail (according to the Clinical Frailty Scale) and received care was higher in the smartwatch group than in the tablet computer group. Older adults of the smartwatch group reported higher technology acceptance (Technology Usage Inventory) and satisfaction (Quebec User Evaluation of Satisfaction with Assistive Technology 2.0) scores than those of the tablet computer group, although the differences were not significant (all P>.05). In the tablet computer group, relatives had significantly higher ratings on the item intention to use than older adults (t12.3=3.3, P=.006). Identified everyday issues with the Canadian Occupational Performance Measure included contact/communication and entertainment/information for the tablet computer, safety and getting help in emergency situations for the smartwatch, and the usability of the AT for both devices. While the performance (t8=3.5, P=.008) and satisfaction (t8=3.2, P=.01) in these domains significantly improved in the smartwatch group, changes in the tablet computer group were inconsistent (all P>.05). Conclusions: This study highlights the remaining obstacles for the widespread and effective application of ATs in the everyday life of older adults and their relatives. While the results do not provide evidence for a positive effect regarding communication deficits, perceived benefits could be shown for the area of safety. Future research and technical developments need to consider not only the preferences, problems, and goals of older adults but also their relatives and caregivers to improve the acceptability and effectiveness of ATs. %R 10.2196/53811 %U https://humanfactors.jmir.org/2024/1/e53811 %U https://doi.org/10.2196/53811 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53562 %T Automated Behavioral Coding to Enhance the Effectiveness of Motivational Interviewing in a Chat-Based Suicide Prevention Helpline: Secondary Analysis of a Clinical Trial %A Pellemans,Mathijs %A Salmi,Salim %A Mérelle,Saskia %A Janssen,Wilco %A van der Mei,Rob %+ Department of Mathematics, Vrije Universiteit Amsterdam, De Boelelaan 1111, Amsterdam, 1081 HV, Netherlands, 31 20 5987700, m.j.pellemans@vu.nl %K motivational interviewing %K behavioral coding %K suicide prevention %K artificial intelligence %K effectiveness %K counseling %K support tool %K online help %K mental health %D 2024 %7 1.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: With the rise of computer science and artificial intelligence, analyzing large data sets promises enormous potential in gaining insights for developing and improving evidence-based health interventions. One such intervention is the counseling strategy motivational interviewing (MI), which has been found effective in improving a wide range of health-related behaviors. Despite the simplicity of its principles, MI can be a challenging skill to learn and requires expertise to apply effectively. Objective: This study aims to investigate the performance of artificial intelligence models in classifying MI behavior and explore the feasibility of using these models in online helplines for mental health as an automated support tool for counselors in clinical practice. Methods: We used a coded data set of 253 MI counseling chat sessions from the 113 Suicide Prevention helpline. With 23,982 messages coded with the MI Sequential Code for Observing Process Exchanges codebook, we trained and evaluated 4 machine learning models and 1 deep learning model to classify client- and counselor MI behavior based on language use. Results: The deep learning model BERTje outperformed all machine learning models, accurately predicting counselor behavior (accuracy=0.72, area under the curve [AUC]=0.95, Cohen κ=0.69). It differentiated MI congruent and incongruent counselor behavior (AUC=0.92, κ=0.65) and evocative and nonevocative language (AUC=0.92, κ=0.66). For client behavior, the model achieved an accuracy of 0.70 (AUC=0.89, κ=0.55). The model’s interpretable predictions discerned client change talk and sustain talk, counselor affirmations, and reflection types, facilitating valuable counselor feedback. Conclusions: The results of this study demonstrate that artificial intelligence techniques can accurately classify MI behavior, indicating their potential as a valuable tool for enhancing MI proficiency in online helplines for mental health. Provided that the data set size is sufficiently large with enough training samples for each behavioral code, these methods can be trained and applied to other domains and languages, offering a scalable and cost-effective way to evaluate MI adherence, accelerate behavioral coding, and provide therapists with personalized, quick, and objective feedback. %M 39088244 %R 10.2196/53562 %U https://www.jmir.org/2024/1/e53562 %U https://doi.org/10.2196/53562 %U http://www.ncbi.nlm.nih.gov/pubmed/39088244 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51957 %T Exploring the Relationship Between Instagram Use and Self-Criticism, Self-Compassion, and Body Dissatisfaction in the Spanish Population: Observational Study %A Varaona,Andrea %A Alvarez-Mon,Miguel Angel %A Serrano-Garcia,Irene %A Díaz-Marsá,Marina %A Looi,Jeffrey C L %A Molina-Ruiz,Rosa M %+ Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, C/19, Carretera Madrid-Barcelona, Km 33,600, Alcalá de Henares, 28805, Spain, 34 918854503, maalvarezdemon@icloud.com %K Instagram %K self-compassion %K self-esteem %K self-criticism %K self-worth %K body dissatisfaction %K dissatisfaction %K satisfaction %K appearance %K psychological %K social media %K body %K mental health %K mental wellbeing %K Spain %K Spanish %K Hispanic %K depression %K depressive %K usage %K correlation %K association %D 2024 %7 1.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The widespread use of online social networks, particularly among the younger demographic, has catalyzed a growing interest in exploring their influence on users’ psychological well-being. Instagram (Meta), a visually oriented platform, has garnered significant attention. Prior research has consistently indicated that Instagram usage correlates with heightened levels of perfectionism, body dissatisfaction, and diminished self-esteem. Perfectionism is closely linked to self-criticism, which entails an intense self-scrutiny and is often associated with various psychopathologies. Conversely, self-compassion has been linked to reduced levels of perfectionism and stress, while fostering greater positive affect and overall life satisfaction. Objective: This study investigates the relationship between Instagram usage (time of use and content exposure) and users’ levels of self-compassion, self-criticism, and body dissatisfaction. Methods: This study comprised 1051 adult participants aged between 18 and 50 years, either native to Spain or residing in the country for at least a decade. Each participant completed a tailored questionnaire on Instagram usage, along with abbreviated versions of the Self-Compassion Scale, the Body Shape Questionnaire, and the Depressive Experiences Questionnaire, spanning from January 23 to February 25, 2022. Results: A positive correlation was observed between daily Instagram usage and self-criticism scores. Participants of all age groups who spent over 3 hours per day on Instagram exhibited higher self-criticism scores than users who spent less than 1 hour or between 1 and 3 hours per day. Contrary to previous findings, no significant relationship was detected between Instagram usage time and levels of self-compassion or body dissatisfaction. Furthermore, content centered around physical appearance exhibited a positive correlation with self-criticism and body dissatisfaction scores. Among younger participants (aged 18-35 years), those who primarily viewed beauty or fashion content reported higher self-criticism scores than those consuming science-related content. However, this association was not significant for participants aged 35-50 years. Conversely, individuals who predominantly engaged with sports or fitness or family or friends content exhibited higher levels of body dissatisfaction than those focusing on science-related content. No significant associations were observed between self-compassion scores and daily Instagram usage or most-viewed content categories. Conclusions: The findings of this study underscore the considerable impact of Instagram usage on self-criticism and body dissatisfaction—2 variables known to influence users’ psychological well-being and be associated with various symptoms and psychological disorders. %M 39088263 %R 10.2196/51957 %U https://www.jmir.org/2024/1/e51957 %U https://doi.org/10.2196/51957 %U http://www.ncbi.nlm.nih.gov/pubmed/39088263 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56827 %T Smartphone-Based Smoking Cessation Intervention (OKquit) for Oklahoma Tobacco Helpline Users: Protocol for a Randomized Controlled Trial %A Businelle,Michael %A Becerra,Jessica %A Witten,Carl %A Chen,Sixia %A Kezbers,Krista %A Beebe,Laura A %A Kendzor,Darla E %+ TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 4052718001 ext 50460, michael-businelle@ouhsc.edu %K smoking cessation %K helpline %K just-in-time adaptive intervention %K mobile application %K smartphone-based %K mobile health %K tobacco %D 2024 %7 1.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tobacco quitlines provide effective resources (eg, nicotine replacement therapy, smoking cessation counseling, and text and web-based support) for those who want to quit smoking in the United States. However, quitlines reach approximately only 1%-3% of people who smoke each year. Novel, smartphone-based, and low-burden interventions that offer 24/7 access to smoking cessation resources that are tailored to current readiness to quit may increase appeal, reach, and effectiveness of smoking cessation interventions. Objective: This study will examine the efficacy of OKquit, a low-burden smartphone-based app for smoking cessation. Methods: Approximately 500 people who smoke cigarettes and access the Oklahoma Tobacco Helpline (OTH) will be randomized to receive standard OTH care (SC) or SC plus the novel OKquit smartphone app for smoking cessation (OKquit). All participants will use a smartphone app to complete study surveys (ie, baseline, 27 weekly surveys, brief daily check-ins, and 27-week follow-up). Upon completion of daily check-ins and weekly surveys, participants will receive either trivia type messages (SC) or messages that are tailored to current readiness to quit smoking and currently experienced lapse triggers (OKquit). In addition, those assigned to receive the OKquit app will have access to on-demand smoking cessation content (eg, quit tips, smoking cessation medication tips). It is hypothesized that participants assigned to OKquit will be more likely to achieve biochemically verified 7-day point prevalence abstinence than those assigned to SC at 27 weeks post enrollment. In addition, participants who use more OTH resources (eg, more cessation coaching sessions completed) or more OKquit resources (eg, access more quit tips) will have greater biochemically verified smoking cessation rates. Results: Data collection began in September 2022 and final follow-ups are expected to be completed by May 2025. Conclusions: Data from this randomized controlled trial will determine whether the OKquit smartphone app combined with OTH care will increase smoking cessation rates over standard OTH care alone. If successful, OKquit could provide tailored intervention content at a fraction of the cost of traditional interventions. Furthermore, this type of low-burden intervention may offer a way to reach underserved populations of adults who smoke and want to quit. Trial Registration: ClinicalTrials.gov NCT05539209; https://clinicaltrials.gov/study/NCT05539209 International Registered Report Identifier (IRRID): DERR1-10.2196/56827 %M 39088254 %R 10.2196/56827 %U https://www.researchprotocols.org/2024/1/e56827 %U https://doi.org/10.2196/56827 %U http://www.ncbi.nlm.nih.gov/pubmed/39088254 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50479 %T Effectiveness of Mobile App Interventions to Improve Periodontal Health: Protocol for a Systematic Review and Meta-Analysis %A Musa,Reem %A Elamin,Dalia %A Barrie,Robert %A Kimmie-Dhansay,Faheema %+ Department of Community Dentistry, Faculty of Dentistry, University of Western Cape, Fransie, Francie Van Zijl Dr, Cape Town, 7500, South Africa, 27 0847177976, dr.reemmusa@gmail.com %K mobile app %K periodontal health %K text messages %K application %K effectiveness %K physical well-being %K mental well-being %K social well-being %K oral hygiene %K oral disease %K disease prevention %K periodontal %K health education %K systematic review %D 2024 %7 31.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Periodontal health plays a key role as a shared reference point for evaluating periodontal diseases and identifying significant treatment outcomes. Providing adequate instruction and enhancing the motivation of patients to maintain proper oral hygiene are crucial factors for successful periodontal treatment, with self-performed regular oral hygiene identified as a critical factor in improving the outcomes of treatment for periodontal diseases. Recently, mobile health (mHealth) solutions, especially mobile apps, have emerged as valuable tools for self-management in chronic diseases such as periodontal disease, providing essential health education and monitoring capabilities. However, the use of mHealth apps for periodontal health is complex owing to various interacting components such as patient behavior, socioeconomic status, and adherence to oral hygiene practices. Existing literature has indicated positive effects of mHealth on oral health behaviors, knowledge, attitude, practice, plaque index score, and gingivitis reduction. However, there has been no systematic review of mobile apps specifically targeting patients with periodontal disease. Understanding the design and impact of mHealth apps is crucial for creating high-quality apps. Objective: The aim of this systematic review and meta-analysis is to evaluate the effectiveness of existing mobile apps in promoting periodontal health. Methods: A comprehensive search strategy will be performed in multiple electronic databases (PubMed, EBSCOhost, CINAHL Plus, Dentistry & Oral Sciences, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials) with the following keywords in the title/abstract: “mobile application,” “mobile health,” “mHealth,” “telemedicine,” “periodontal health,” “periodontitis,” and “text message.” Only randomized controlled trials will be included that assessed the following outcomes to measure periodontal health improvement: gingival index, bleeding index, periodontal pocket depth, and clinical attachment loss. Covidence will be used for data collection, and a PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) flowchart will be used to describe the selection process of the included, identified, and excluded studies. The Confidence in Network Meta-Analysis approach will be used for meta-analysis of the extracted data from the included studies. Results: This review will not require ethical approval since no primary data will be included. As of July 2024, a total of 83 articles retrieved from various databases have been imported to Covidence with 13 articles deemed eligible for inclusion in the review. The review is currently ongoing and is expected to be complete by the end of 2024 with the results published in early 2025. Conclusions: This systematic review and meta-analysis will contribute to developing mobile apps with enhanced criteria to improve periodontal clinical outcomes. The review emphasizes the importance of mHealth and preventing periodontal disease, which can set the stage for informed global health care strategies. Trial Registration: PROSPERO CRD42022340827; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=340827 International Registered Report Identifier (IRRID): DERR1-10.2196/50479 %M 39083769 %R 10.2196/50479 %U https://www.researchprotocols.org/2024/1/e50479 %U https://doi.org/10.2196/50479 %U http://www.ncbi.nlm.nih.gov/pubmed/39083769 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58174 %T Assessing the Effectiveness of eHealth Interventions to Manage Multiple Lifestyle Risk Behaviors Among Older Adults: Systematic Review and Meta-Analysis %A Shi,Beibei %A Li,Guangkai %A Wu,Shuang %A Ge,Hongli %A Zhang,Xianliang %A Chen,Si %A Pan,Yang %A He,Qiang %+ School of Physical Education, Shandong University, 17922 Jingshi Road, Lixia District, Shandong Province, Jinan, 250061, China, 86 0531 88395374, hq@sdu.edu.cn %K eHealth %K lifestyle risk behaviors %K older adults %K multiple health behavior change %K mobile phone %D 2024 %7 31.7.2024 %9 Review %J J Med Internet Res %G English %X Background: Developing adverse lifestyle behaviors increases the risk of a variety of chronic age-related diseases, including cardiovascular disease, obesity, and Alzheimer disease. There is limited evidence regarding the effectiveness of eHealth-based multiple health behavior change (MHBC) interventions to manage lifestyle risk behaviors. Objective: The purpose of this systematic evaluation was to assess the effectiveness of eHealth MHBC interventions in changing ≥2 major lifestyle risk behaviors in people aged ≥50 years. Methods: The literature search was conducted in 6 electronic databases—PubMed, Embase, Web of Science, Scopus, Cochrane Library, and SPORTDiscus—from inception to May 1, 2024. Eligible studies were randomized controlled trials of eHealth interventions targeting ≥2 of 6 behaviors of interest: alcohol use, smoking, diet, physical activity (PA), sedentary behavior, and sleep. Results: A total of 34 articles with 35 studies were included. eHealth-based MHBC interventions significantly increased smoking cessation rates (odds ratio 2.09, 95% CI 1.62-2.70; P<.001), fruit intake (standardized mean difference [SMD] 0.18, 95% CI 0.04-0.32; P=.01), vegetable intake (SMD 0.17, 95% CI 0.05-0.28; P=.003), self-reported total PA (SMD 0.22, 95% CI 0.02-0.43; P=.03), and objectively measured moderate to vigorous PA (SMD 0.25, 95% CI 0.09-0.41; P=.002); in addition, the interventions decreased fat intake (SMD –0.23, 95% CI –0.33 to –0.13; P<.001). No effects were observed for alcohol use, sedentary behavior, or sleep. A sensitivity analysis was conducted to test the robustness of the pooled results. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. Conclusions: eHealth-based MHBC interventions may be a promising strategy to increase PA, improve diet, and reduce smoking among older adults. However, the effect sizes were small. Further high-quality, older adult–oriented research is needed to develop eHealth interventions that can change multiple behaviors. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023444418; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023444418 %M 39083787 %R 10.2196/58174 %U https://www.jmir.org/2024/1/e58174 %U https://doi.org/10.2196/58174 %U http://www.ncbi.nlm.nih.gov/pubmed/39083787 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57777 %T Sustainable Lifestyle Among Office Workers (the SOFIA Study): Protocol for a Cluster Randomized Controlled Trial %A Bälter,Katarina %A King,Abby C %A Fritz,Johanna %A Tillander,Annika %A Halling Ullberg,Oskar %+ Division of Public Health, School of Health, Care and Social Welfare, Mälardalen University, Universitetsplan 1, Västerås, 721 23, Sweden, 46 0736620898, katarina.balter@mdu.se %K diet %K physical activity %K work life %K health promotion %K climate change %K sustainable lifestyle %K citizen science %K Our Voice %D 2024 %7 31.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Society is facing multiple challenges, including lifestyle- and age-related diseases of major public health relevance, and this is of particular importance when the general population, as well as the workforce, is getting older. In addition, we are facing global climate change due to extensive emissions of greenhouse gases and negative environmental effects. A lifestyle that promotes healthy life choices as well as climate and environmentally friendly decisions is considered a sustainable lifestyle. Objective: This study aims to evaluate if providing information about a sustainable lifestyle encourages individuals to adopt more nutritious dietary habits and increase physical activity, as compared to receiving information solely centered around health-related recommendations for dietary intake and physical activity by the Nordic Nutrition Recommendations and the World Health Organization. Novel features of this study include the use of the workplace as an arena for health promotion, particularly among office workers—a group known to be often sedentary at work and making up 60% of all employees in Sweden. Methods: The Sustainable Office Intervention (SOFIA) study is a 2-arm, participant-blinded, cluster randomized controlled trial that includes a multilevel sustainable lifestyle arm (intervention arm, n=19) and a healthy lifestyle arm (control arm, n=14). The eligibility criteria were being aged 18-65 years and doing office work ≥20 hours per week. Both intervention arms are embedded in the theoretically based behavioral change wheel method. The intervention study runs for approximately 8 weeks and contains 6 workshops. The study focuses on individual behavior change as well as environmental and policy features at an organizational level to facilitate or hinder a sustainable lifestyle at work. Through implementing a citizen science methodology within the trial, the participants (citizen scientists) collect data using the Stanford Our Voice Discovery Tool app and are involved in analyzing the data, formulating a list of potential actions to bring about feasible changes in the workplace. Results: Participant recruitment and data collection began in August 2022. As of June 2024, a total of 37 participants have been recruited. The results of the pilot phase are expected to be published in 2024 or 2025. Conclusions: Given the ongoing climate change, negative environmental effects, and the global epidemic of metabolic diseases, a sustainable lifestyle among office workers holds important potential to help in counteracting this trend. Thus, there is an urgent unmet need to test the impact of a sustainable lifestyle on food intake, physical activity, and environmental and climate impacts in a worksite-based randomized controlled trial. This study protocol responds to a societal need by addressing multilevel aspects, including individual behavior changes as well as environmental and organizational changes of importance for the successful implementation of sustainable lifestyle habits in an office setting. International Registered Report Identifier (IRRID): DERR1-10.2196/57777 %M 39083333 %R 10.2196/57777 %U https://www.researchprotocols.org/2024/1/e57777 %U https://doi.org/10.2196/57777 %U http://www.ncbi.nlm.nih.gov/pubmed/39083333 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51537 %T Current Use and Discrepancies in the Adoption of Health-Related Internet of Things and Apps Among Working Women in Japan: Large-Scale, Internet-Based, Cross-Sectional Survey %A Sasayama,Kiriko %A Nishimura,Etsuko %A Yamaji,Noyuri %A Ota,Erika %A Tachimori,Hisateru %A Igarashi,Ataru %A Arata,Naoko %A Yoneoka,Daisuke %A Saito,Eiko %+ Sustainable Society Design Center, Graduate School of Frontier Sciences, The University of Tokyo, 5-1-5, Kashiwanoha, Kashiwa-shi, Chiba, Kashiwa, 277-8561, Japan, 81 471 36 4581, esaito@edu.k.u-tokyo.ac.jp %K women's health %K IoT %K mHealth %K mobile health %K app %K apps %K application %K applications %K decision tree %K internet survey %K women %K health %K adoption %K Internet of Things %K survey %K surveys %K management %K working women %K worker %K workers %K employee %K employees %K occupational health %K job %K jobs %K working %K employed %K usage %D 2024 %7 31.7.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Demographic changes and a low birth rate have led to a workforce shortage in Japan. To address this issue, the government has promoted engagement of female employment. However, increased female employment can impact women's health. Using Internet of Things (IoT) and apps to manage women's health has gained attention, but few studies have focused on working women. Objective: This study aimed to clarify the current situation of working women and their use of IoT or apps to manage their health. Methods: A large-scale, nationwide internet survey was conducted among 10,000 female participants aged from 20 years to 64 years in Japan. Participants were recruited from a marketing research company’s active survey panel of 5.24 million members. The survey included questions about health status, sociodemographic factors, psychological characteristics, and the use of IoT or apps for health management. We compared perceived health status and reasons for current IoT use using t tests and assessed participant characteristics that predicted IoT use using the C5.0 decision tree algorithm. Ethical approval was granted by St. Luke's International University. Results: Among participants, 14.6% (1455/10,000) currently used IoT or apps, 7% (695/10,000) used them previously, and 78.5% (7850/10,000) had never used them. Current users (42.7 years old) were older than past users (39.7 years old). Discrepancies were observed between participants’ perceived health problems and the purpose for using IoT or apps, with 21.3% (2130/10,000) of all women reporting they experienced menstrual symptoms or disorders but only 3.5% (347/10,000) used IoT or apps to manage the same symptom. On the other hand, current users were more likely to use IoT or apps to manage nutrition-related problems such as underweight or obesity (405/1455, 27.8%). Device use was highest among current users, with 87.3% (1270/1455) using smartphones, 19.7% (287/1455) using smartwatches, and 13.3% (194/1455) using PCs. Decision tree analysis identified 6 clusters, the largest consisting of 81.6% (5323/6523) of non-IoT users who did not exercise regularly, while pregnant women were more likely to use IoT or apps. Conclusions: Our findings highlight the idea that woman with particular health problems (ie, menstrual symptoms or disorders and premenstrual syndrome) have lower use of IoT or apps, suggesting an unmet need for IoT and apps in specific areas. %M 39083338 %R 10.2196/51537 %U https://publichealth.jmir.org/2024/1/e51537 %U https://doi.org/10.2196/51537 %U http://www.ncbi.nlm.nih.gov/pubmed/39083338 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54723 %T Impact of a Health Coach–Led, Text-Based Digital Behavior Change Intervention on Weight Loss and Psychological Well-Being in Patients Receiving a Procedureless Intragastric Balloon Program: Prospective Single-Arm Study %A Sacher,Paul M %A Fulton,Emily %A Rogers,Victoria %A Wilson,Julia %A Gramatica,Marco %A Dent,Jennifer E %A Aarts,Edo O %A Eccleston,David %A Greve,Jan Willem %A Palm-Meinders,Inge %A Chuttani,Ram %+ Allurion Technologies Inc, 11 Huron Dr, Natick, MA, 01760, United States, 1 508 647 4000, psacher@icloud.com %K intragastric balloon %K obesity %K behavior change %K health coaching %K digital health %K weight management %K well-being %K mobile phone %D 2024 %7 31.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health interventions show promise for weight management. However, few text-based behavior change interventions have been designed to support patients receiving intragastric balloons, and none have simultaneously evaluated weight loss, psychological well-being, and behavior change despite the crucial interplay of these factors in weight management. Objective: This study aims to assess whether a health coach–led, asynchronous, text-based digital behavior change coaching intervention (DBCCI) delivered to participants receiving an intragastric balloon and its aftercare program was feasible and acceptable to participants and supported improved outcomes, including weight loss, psychological well-being, and lifestyle behavior change conducive to weight loss maintenance. Methods: This 12-month, single-arm prospective study enrolled adults aged 21 to 65 years with BMI ≥27 kg/m2 receiving a procedureless intragastric balloon (PIGB) at 5 bariatric clinics in the United Kingdom and the Netherlands. Participants received the DBCCI and the clinic-led PIGB aftercare program (remotely delivered) for 6 months after PIGB placement and then no intervention for an additional 6 months. The DBCCI was an evidence-based, personalized intervention wherein health coaches supported participants via exchanged asynchronous in-app text-based messages. Over the 12-month study, we assessed percentage of total body weight loss and psychological well-being via self-administered validated questionnaires (Warwick-Edinburgh Mental Wellbeing Scale, Generalized Anxiety Disorder Scale, Impact of Weight on Quality of Life–Lite–Clinical Trials Version, Loss of Control Over Eating Scale–Brief, Weight Efficacy Lifestyle Questionnaire–Short Form, and Barriers to Being Active Quiz). Participant engagement with and acceptability of the intervention were assessed via self-reported surveys. Results: Overall, 107 participants (n=96, 89.7% female; mean baseline BMI 35.4, SD 5.4 kg/m2) were included in the analysis. Mean total body weight loss was 13.5% (SEM 2.3%) at the end of the DBCCI and 11.22% (SEM 2.3%) at the 12-month follow-up (P<.001). Improvements were observed for all psychological well-being measures throughout the 12 months except for the Generalized Anxiety Disorder Scale (improvement at month 1) and Barriers to Being Active Quiz (improvements at months 3 and 6). Surveys showed high levels of engagement with and acceptability of the DBCCI. Conclusions: This study provides evidence that the health coach–led, asynchronous, text-based DBCCI was engaging and acceptable to participants with overweight and obesity. The DBCCI, delivered alongside the PIGB and its aftercare program, supported improved weight loss outcomes and psychological well-being versus baseline and was associated with lifestyle behavior changes known to help achieve and maintain long-term weight loss and improved health outcomes. Follow-up findings suggest a potential need for longer-term, more intense coaching to focus on weight loss maintenance and support ongoing self-coaching. This could be achieved by leveraging generative artificial intelligence to provide ongoing automated behavior change coaching support to augment human-led care. Trial Registration: ClinicalTrials.gov NCT05884606; https://clinicaltrials.gov/study/NCT05884606 %M 39083340 %R 10.2196/54723 %U https://formative.jmir.org/2024/1/e54723 %U https://doi.org/10.2196/54723 %U http://www.ncbi.nlm.nih.gov/pubmed/39083340 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51206 %T Physical Activity, Body Composition, and Fitness Variables in Adolescents After Periods of Mandatory, Promoted or Nonmandatory, Nonpromoted Use of Step Tracker Mobile Apps: Randomized Controlled Trial %A Mateo-Orcajada,Adrián %A Vaquero-Cristóbal,Raquel %A Mota,Jorge %A Abenza-Cano,Lucía %+ Research Group Movement Sciences and Sport (MS&SPORT), Department of Physical Activity and Sport, Faculty of Sport Sciences, University of Murcia, C. Argentina 19, San Javier, Murcia, 30720, Spain, 34 868 88 86 84, raquel.vaquero@um.es %K body composition %K detraining %K new technologies %K physical education subject %K physical fitness %K youth %D 2024 %7 30.7.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: It is not known whether an intervention made mandatory as a physical education (PE) class assignment and aimed at promoting physical activity (PA) in adolescents can create a healthy walking habit, which would allow further improvements to be achieved after the mandatory and promoted intervention has been completed. Objective: The aims of this study were to (1) investigate whether, after a period of using a step tracker mobile app made mandatory and promoted as a PE class assignment, adolescents continue to use it when its use is no longer mandatory and promoted; (2) determine whether there are changes in the PA level, body composition, and fitness of adolescents when the use of the app is mandatory and promoted and when it is neither mandatory nor promoted; and (3) analyze whether the covariates maturity status, gender, and specific app used can have an influence. Methods: A total of 357 students in compulsory secondary education (age: mean 13.92, SD 1.91 y) participated in the study. A randomized controlled trial was conducted consisting of 2 consecutive 10-week interventions. Participants’ PA level, body composition, and fitness were measured at baseline (T1), after 10 weeks of mandatory and promoted app use (T2), and after 10 weeks of nonmandatory and nonpromoted app use (T3). Each participant in the experimental group (EG) used 1 of 4 selected step tracker mobile apps after school hours. Results: The results showed that when the use of the apps was neither mandatory nor promoted as a PE class assignment, only a few adolescents (18/216, 8.3%) continued the walking practice. After the mandatory and promoted intervention period (T1 vs T2), a decrease in the sum of 3 skinfolds (mean difference [MD] 1.679; P=.02) as well as improvements in the PA level (MD –0.170; P<.001), maximal oxygen uptake (MD –1.006; P<.001), countermovement jump test (MD –1.337; P=.04), curl-up test (MD –3.791; P<.001), and push-up test (MD –1.920; P<.001) in the EG were recorded. However, the changes between T1 and T2 were significantly greater in the EG than in the control group only in the PA level and curl-up test. Thus, when comparing the measurements taken between T1 and T3, no significant changes in body composition (P=.07) or fitness (P=.84) were observed between the EG and the control group. The covariates maturity status, gender, and specific app used showed a significant effect in most of the analyses performed. Conclusions: A period of mandatory and promoted use of step tracker mobile apps benefited the variables of body composition and fitness in adolescents but did not create a healthy walking habit in this population; therefore, when the use of these apps ceased to be mandatory and promoted, the effects obtained disappeared. Trial Registration: ClinicalTrials.gov NCT06164041; https://clinicaltrials.gov/study/NCT06164041 %M 39079110 %R 10.2196/51206 %U https://mhealth.jmir.org/2024/1/e51206 %U https://doi.org/10.2196/51206 %U http://www.ncbi.nlm.nih.gov/pubmed/39079110 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48964 %T The Acceptability, Engagement, and Feasibility of Mental Health Apps for Marginalized and Underserved Young People: Systematic Review and Qualitative Study %A Bear,Holly Alice %A Ayala Nunes,Lara %A Ramos,Giovanni %A Manchanda,Tanya %A Fernandes,Blossom %A Chabursky,Sophia %A Walper,Sabine %A Watkins,Edward %A Fazel,Mina %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, United Kingdom, 44 01865 6182, holly.bear@psych.ox.ac.uk %K adolescent mental health %K marginalized groups %K smartphone apps %K engagement %K implementation science %K mobile app %K smartphone %K mobile health %K mHealth %K mental health %K challenges %K acceptability %K young %K effectiveness %K mobile phone %D 2024 %7 30.7.2024 %9 Review %J J Med Internet Res %G English %X Background: Smartphone apps may provide an opportunity to deliver mental health resources and interventions in a scalable and cost-effective manner. However, young people from marginalized and underserved groups face numerous and unique challenges to accessing, engaging with, and benefiting from these apps. Objective: This study aims to better understand the acceptability (ie, perceived usefulness and satisfaction with an app) and feasibility (ie, the extent to which an app was successfully used) of mental health apps for underserved young people. A secondary aim was to establish whether adaptations can be made to increase the accessibility and inclusivity of apps for these groups. Methods: We conducted 2 sequential studies, consisting of a systematic literature review of mental health apps for underserved populations followed by a qualitative study with underserved young male participants (n=20; age: mean 19). Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases was conducted in 2021. The search yielded 18,687 results, of which 14 articles met the eligibility criteria. Results: The included studies comprised a range of groups, including those affected by homelessness, having physical health conditions, living in low- and middle-income countries, and those with sexual and gender minority identities. Establishing and maintaining user engagement was a pervasive challenge across mental health apps and populations, and dropout was a reported problem among nearly all the included studies. Positive subjective reports of usability, satisfaction, and acceptability were insufficient to determine users’ objective engagement. Conclusions: Despite the significant amount of funding directed to the development of mental health apps, juxtaposed with only limited empirical evidence to support their effectiveness, few apps have been deliberately developed or adapted to meet the heterogeneous needs of marginalized and underserved young people. Before mental health apps are scaled up, a greater understanding is needed of the types of services that more at-risk young people and those in limited-resource settings prefer (eg, standard vs digital) followed by more rigorous and consistent demonstrations of acceptability, effectiveness, and cost-effectiveness. Adopting an iterative participatory approach by involving young people in the development and evaluation process is an essential step in enhancing the adoption of any intervention, including apps, in “real-world” settings and will support future implementation and sustainability efforts to ensure that marginalized and underserved groups are reached. Trial Registration: PROSPERO CRD42021254241; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=254241 %M 39078699 %R 10.2196/48964 %U https://www.jmir.org/2024/1/e48964 %U https://doi.org/10.2196/48964 %U http://www.ncbi.nlm.nih.gov/pubmed/39078699 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57938 %T Changes in the Frequency of Actions Associated With Mental Health During Online Treatment: Analysis of Demographic and Clinical Factors %A Bisby,Madelyne %A Staples,Lauren %A Dear,Blake %A Titov,Nickolai %+ MindSpot Clinic, MQ Health, Macquarie University, 16 University Avenue, Sydney, 2109, Australia, 61 298508724, madelyne.bisby@mq.edu.au %K anxiety %K depression %K daily actions %K treatments %K personalization %K mental health %K digital treatment %K analysis %K clinical factors %K questionnaire %K depression symptoms %K anxiety symptoms %K patients %K Australian %K Australia %K digital psychology service %K psychology %K symptom severity %K severity %D 2024 %7 25.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Specific daily actions (eg, goal setting, meaningful activities) are associated with mental health. Performing specific daily actions at a higher frequency is associated with significantly lower baseline symptoms of depression and anxiety, as well as better psychological treatment outcomes for depression and anxiety. Objective: This study explored how the frequency of specific daily actions associated with mental health may differ prior to, during, and following treatment according to demographic and clinical characteristics. Methods: Using a sample of 448 patients from an Australian national digital psychology service, we examined baseline differences in daily action frequency and changes in daily action frequency during a digital psychological treatment according to demographic and clinical subgroups. A total of 5 specific types of daily actions were measured using the Things You Do Questionnaire: healthy thinking, meaningful activities, goals and plans, healthy habits, and social connections. Results: The frequency of daily actions differed according to employment status (largest P=.005) and educational level (largest P=.004). Daily action frequency was lower in those participants with more severe or chronic depression or anxiety symptoms (largest P=.004). Participants reported larger increases in how often they did these daily actions from baseline to midtreatment compared to mid- to posttreatment. Depression duration (P=.01) and severity (P<.001) were associated with differences in how daily action frequency changed during treatment. Conclusions: The findings of this study support continued research exploring the relationship between daily actions and mental health, how this relationship might differ between individuals, and the clinical potential of supporting individuals to increase the frequency of daily actions to improve mental health. %M 39052998 %R 10.2196/57938 %U https://formative.jmir.org/2024/1/e57938 %U https://doi.org/10.2196/57938 %U http://www.ncbi.nlm.nih.gov/pubmed/39052998 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53450 %T A Web-Based Resilience-Enhancing Program to Improve Resilience, Physical Activity, and Well-being in Geriatric Population: Randomized Controlled Trial %A Wu,Yi-Chen %A Shen,Shu-Fen %A Chen,Liang-Kung %A Tung,Heng-Hsin %+ Department of Nursing,National Yang Ming Chiao Tung University, No.155, Sec.2, Li-Nong Street, Pei-Tao district 112, Taipei, 11221, Taiwan, 886 0953005831, shannontung719@gmail.com %K geriatric population %K community-dwelling older adult %K web-based resilience-enhancing program %K resilience %K physical activity %K well-being %K pandemic. %D 2024 %7 25.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Resilience is a protective factor in healthy aging, helping to maintain and recover physical and mental functions. The Resilience in Illness Model has proven effective in fostering resilience and well-being. Physical activity is crucial for older adults’ independence and well-being, even as aging causes a progressive decline. Additionally, older adults face challenges such as spousal loss and physical disability, making preventive intervention strategies necessary. Objective: This study aims to develop and evaluate a web-based program to enhance resilience, physical activity, and well-being among community-dwelling older adults. Additionally, we aim to gather feedback on the program’s strengths and limitations. Methods: A 4-week resilience-enhancing program was created, incorporating role-play and talk-in-interaction and focusing on 3 key skills: coping, control belief, and manageability. The program included scenarios such as becoming widowed and suffering a stroke, designed to engage older adults. A pilot test preceded the intervention. As a result of the COVID-19 pandemic, the program shifted from in-person to web-based sessions. A single-blind, parallel-group, randomized controlled trial was conducted. Participants aged over 65 years were recruited offline and randomly assigned to either an intervention or control group. A certified resilience practitioner delivered the program. Outcomes in resilience, physical activity, and well-being were self-assessed at baseline (T0), 4 weeks (T1), and 12 weeks (T2) after the program. A mixed methods approach was used to evaluate feedback. Results: A web-based participatory program enhancing 3 skills—coping, control belief, and manageability for resilience—was well developed. Among 96 participants, 63 were randomized into the intervention group (n=31) and the control group (n=32). The mean age in the intervention group was 69.27 (SD 3.08) years and 74.84 (SD 6.23) years in the control group. Significant between-group differences at baseline were found in age (t45.6=–4.53, P<.001) and physical activity at baseline (t61=2.92, P=.005). No statistically significant between-group differences over time were observed in resilience (SE 7.49, 95% CI –10.74 to 18.61, P=.60), physical activity (SE 15.18, 95% CI –24.74 to 34.74, P=.74), and well-being (SE 3.74, 95% CI –2.68 to 11.98, P=.21) after controlling for baseline differences. The dropout rate was lower in the intervention group (2/31, 6%) compared with the control group (5/32, 16%). Moreover, 77% (24/31) of participants in the intervention group completed the entire program. Program feedback from the participants indicated high satisfaction with the web-based format and mentorship support. Conclusions: This study demonstrated that a web-based resilience-enhancing program is appropriate, acceptable, feasible, and engaging for community-dwelling older adults. The program garnered enthusiasm for its potential to optimize resilience, physical activity, and well-being, with mentorship playing a crucial role in its success. Future studies should aim to refine program content, engagement, and delivery methods to effectively promote healthy aging in this population. Trial Registration: ClinicalTrials.gov NCT05808491; https://clinicaltrials.gov/ct2/show/NCT05808491 %M 39052335 %R 10.2196/53450 %U https://www.jmir.org/2024/1/e53450 %U https://doi.org/10.2196/53450 %U http://www.ncbi.nlm.nih.gov/pubmed/39052335 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54272 %T Technology-Assisted Mental Health Intervention Delivered by Frontline Workers at Community Doorsteps for Reducing Anxiety and Depression in Rural Pakistan: Protocol for the mPareshan Mixed Methods Implementation Trial %A Rabbani,Fauziah %A Nafis,Javeria %A Akhtar,Samina %A Khan,Muhammad Shahid %A Sayani,Saleem %A Siddiqui,Amna %A Siddiqi,Sameen %A Merali,Zul %+ Department of Community Health Sciences, Aga Khan University, Stadium Road, Karachi, 3500, Pakistan, 92 2134864864, fauziah.Rabbani@aku.edu %K anxiety %K depression %K feasibility %K mental health %K health workers %K mPareshan app %K implementation research %D 2024 %7 23.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a dearth of specialized mental health workforce in low- and middle-income countries. Use of mobile technology by frontline community health workers (CHWs) is gaining momentum in Pakistan and needs to be explored as an alternate strategy to improve mental well-being. Objective: The aim of this study is to assess the feasibility, acceptability, and usefulness of an app-based counseling intervention delivered by government lady health workers (LHWs) to reduce anxiety and depression in rural Pakistan. Methods: Project mPareshan is a single-arm, pre- and posttest implementation research trial in Badin District, Sindh, using mixed methods of data collection executed in 3 phases (preintervention, intervention, and postintervention). In the preintervention phase, formative qualitative assessments through focus group discussions and in-depth interviews assess the acceptability and appropriateness of intervention through perceptions of all concerned stakeholders using a specific interview guide. A REDCap (Research Electronic Data Capture)-based baseline survey using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 Scale (GAD-7) determines the point prevalence of depression and anxiety among consenting men and women older than 18 years. Individuals with mild and moderate anxiety and depression are identified as screen positives (SPs) and are eligible for mPareshan app–based intervention. Mental health literacy of health workers is improved through customized training adapting the World Health Organization’s Mental Health Gap Action Programme guide 2.0. The intervention (mPareshan app) consists of tracking, counseling, and referral segments. The tracking segment facilitates participant consent and enrollment while the referral segment is used by LHWs to transfer severe cases to the next level of specialist care. Through the counseling segment, identified SPs are engaged during LHWs’ routine home visits in 6 face-to-face 20-minute counseling sessions over 6 months. Each session imparts psychoeducation through audiovisual aids, breathing exercises, and coping skills to reduce stress. Clinical and implementation outcomes include change in mean anxiety and depression scores and identification of facilitators and barriers in intervention uptake and rollout. Results: At the time of this submission (April 2024), we are analyzing the results of 366 individuals who participated in the baseline prevalence survey, the change in knowledge and skills of 72 health workers who took the mPareshan training, change in anxiety and depression scores of 98 SPs recruited for app-based counseling intervention, and perceptions of stakeholders pre- and postintervention gathered through 8 focus group discussions and 18 in-depth interviews. Conclusions: This trial will assess the feasibility of early home-based mental health screening, counseling, and prompt referrals by frontline health workers to reduce anxiety and depression in the community. The study findings will set the stage for integrating mental health into primary health care. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12622000989741; https://tinyurl.com/5n844c8z International Registered Report Identifier (IRRID): DERR1-10.2196/54272 %M 39042878 %R 10.2196/54272 %U https://www.researchprotocols.org/2024/1/e54272 %U https://doi.org/10.2196/54272 %U http://www.ncbi.nlm.nih.gov/pubmed/39042878 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e39779 %T Design, Develop, and Pilot-Test a Digital Platform to Enhance Student Well-Being: Protocol for a Mixed-Methods Study %A Joshi,Ashish %A Kaur,Kamalpreet %A Bhatt,Ashruti %A Surapaneni,Krishna Mohan %A Grover,Ashoo %A Pandya,Apurva Kumar %+ School of Public Health, University of Memphis, 236 Robison Hall, Memphis, TN, 38152, United States, 1 443 570 6018, ashish1875@gmail.com %K well-being %K students %K digital interventions %K social support %K family demands %K mental well-being %D 2024 %7 23.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Well-being is a multidimensional concept and has been extended to many areas. Student well-being has garnered attention over the last decade due to concerns that have been raised. Digital health interventions have the potential to enhance and improve student well-being. Objective: The objective of the study is to design, develop, and pilot-test a digital health platform to enhance student well-being. Methods: A sample size of 5000 participants will be recruited across Gujarat and Tamil Nadu, India. Students will be enrolled from Parul University in Vadodara, Gujarat, as well as Panimalar Medical College Hospital and Research Institute, Panimalar Engineering College, Panimalar Institute of Technology, and Panimalar College of Nursing in Chennai, Tamil Nadu. Current undergraduate and graduate students consenting to participate will be recruited using convenience sampling from these institutes. The study will collect baseline data to construct the student well-being index. Based on the risk profile, a random subset of the population will be provided access to the digital health intervention, which will deliver tailored interactive messages addressing the various dimensions of well-being among undergraduate and graduate students. The eligible study participants will be aged 18 years and older, enrolled in these institutes, and willing to give their consent to participate in the study. Results: The proposed research is an unfunded study. The enrollment of the individuals in the study began in October 2022. Data gathered will be analyzed using SAS (version 9.3; SAS Institute) and results will be reported as 95% CIs and P values. Conclusions: The proposed study will help to determine the factors affecting well-being among college students and help in designing digital health interventions to improve the well-being of undergraduate and graduate students. International Registered Report Identifier (IRRID): PRR1-10.2196/39779 %M 39042879 %R 10.2196/39779 %U https://www.researchprotocols.org/2024/1/e39779 %U https://doi.org/10.2196/39779 %U http://www.ncbi.nlm.nih.gov/pubmed/39042879 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54064 %T Applying Digital Technology to Understand Human Experiences of Climate Change Impacts on Food Security and Mental Health: Scoping Review %A Bhawra,Jasmin %A Elsahli,Nadine %A Patel,Jamin %+ CHANGE Research Lab, School of Occupational and Public Health, Faculty of Community Services, Toronto Metropolitan University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada, 1 416 979 5000 ext 553466, jasmin.bhawra@torontomu.ca %K climate change %K digital health %K ecoanxiety %K environmental hazards %K food security %K mental health %K scoping review %K smartphone apps %K digital apps %K mobile health %K mobile phone %D 2024 %7 23.7.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: The global impact of climate change ranges from intense heatwaves to extreme weather events that endanger entire ecosystems and people’s way of life. Adverse climate change events place undue stress on food and health systems, with consequences for human food security and mental health status. Ubiquitous digital devices, such as smartphones, have the potential to manage existing and emerging climate-related crises, given their ability to enable rapid response, instant communication, and knowledge sharing. Objective: This scoping review aimed to identify digital apps being used to capture or address climate change impacts on food security and mental health to inform the development of a digital citizen science initiative. Methods: A scoping review was conducted using 3 peer-reviewed databases (PubMed, IEEE Xplore, and Web of Science) and manual gray literature searches of relevant organizational (ie, governmental and nonprofit) websites to identify articles and reports published between January 2012 and July 2023. Three separate searches were conducted in each database to identify digital apps focused on climate change and (1) food security, (2) mental health, and (3) food security and mental health. Two reviewers conducted initial screening, with a third reviewer resolving any discrepancies. Articles focused on climate change impacts on wildlife or agriculture (ie, not human food security) were excluded. Full-text screening was conducted for shortlisted articles, and a final data abstraction table was generated, summarizing key app features, contextual factors, and participant involvement. Results: From the 656 records screened, 14 digital apps met the inclusion criteria. The food security apps (n=7, 50%) aimed to capture traditional knowledge to preserve food systems, conduct food security assessments, and aid users in decreasing food insecurity risk. The mental health apps (n=7, 50%) assessed climate change–related stress and provided users with coping strategies following adverse weather events. No digital apps examined the intersection of climate change, food security, and mental health. Key app features included user-to-user communication (n=5, 36%), knowledge databases (n=5, 36%), data collection and analysis (n=3, 21%), gamification (n=1, 7%), and educational resources (n=2, 14%) to address climate change impacts on food security or mental health. In total, 3 approaches to participant involvement were used across studies, including contributory (n=1, 7%), collaborative (n=1, 7%), and cocreative (n=1, 7%) approaches, to ensure the relevance and use of digital apps. Conclusions: Most digital apps identified provided a service to citizens to either prevent adverse climate change–related health impacts or manage these effects following an acute event or a natural disaster. The capacity of ubiquitous digital tools to enable near real-time communication, the involvement of various stakeholder groups, and their ability to share relevant educational resources in a timely manner are important for developing tailored climate change adaptation and mitigation strategies across jurisdictions. %M 39042453 %R 10.2196/54064 %U https://publichealth.jmir.org/2024/1/e54064 %U https://doi.org/10.2196/54064 %U http://www.ncbi.nlm.nih.gov/pubmed/39042453 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51307 %T Mobile App Intervention to Reduce Substance Use, Gambling, and Digital Media Use in Vocational School Students: Exploratory Analysis of the Intervention Arm of a Randomized Controlled Trial %A Grahlher,Kristin %A Morgenstern,Matthis %A Pietsch,Benjamin %A Gomes de Matos,Elena %A Rossa,Monika %A Lochbühler,Kirsten %A Daubmann,Anne %A Thomasius,Rainer %A Arnaud,Nicolas %+ German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre Hamburg-Eppendorf, Martinistr 52, Hamburg, 20246, Germany, 49 40741059307, n.arnaud@uke.de %K prevention %K vocational students %K adolescents %K mobile intervention %K voluntary commitment %K substance use %K internet-related problems %K mobile phone %K adolescent %K youths %K student %K students %K use %D 2024 %7 23.7.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: During adolescence, substance use and digital media exposure usually peak and can become major health risks. Prevention activities are mainly implemented in the regular school setting, and youth outside this system are not reached. A mobile app (“Meine Zeit ohne”) has been developed specifically for vocational students and encourages participants to voluntarily reduce or abstain from a self-chosen addictive behavior including the use of a substance, gambling, or a media-related habit such as gaming or social media use for 2 weeks. Results from a randomized study indicate a significant impact on health-promoting behavior change after using the app. This exploratory study focuses on the intervention arm of this study, focusing on acceptance and differential effectiveness. Objective: The aims of this study were (1) to examine the characteristics of participants who used the app, (2) to explore the effectiveness of the mobile intervention depending on how the app was used and depending on participants’ characteristics, and (3) to study how variations in app use were related to participants’ baseline characteristics. Methods: Log data from study participants in the intervention group were analyzed including the frequency of app use (in days), selection of a specific challenge, and personal relevance (ie, the user was above a predefined risk score for a certain addictive behavior) of challenge selection (“congruent use”: eg, a smoker selected a challenge related to reducing or quitting smoking). Dichotomous outcomes (change vs no change) referred to past-month substance use, gambling, and media-related behaviors. The relationship between these variables was analyzed using binary, multilevel, mixed-effects logistic regression models. Results: The intervention group consisted of 2367 vocational students, and 1458 (61.6%; mean age 19.0, SD 3.5 years; 830/1458, 56.9% male) of them provided full data. Of these 1458 students, 894 (61.3%) started a challenge and could be included in the analysis (mean 18.7, SD 3.5 years; 363/894, 40.6% female). Of these 894 students, 466 (52.1%) were considered frequent app users with more than 4 days of active use over the 2-week period. The challenge area most often chosen in the analyzed sample was related to social media use (332/894, 37.1%). A total of 407 (45.5%) of the 894 students selected a challenge in a behavioral domain of personal relevance. The effects of app use on outcomes were higher when the area of individual challenge choice was equal to the area of behavior change, challenge choice was related to a behavior of personal relevance, and the individual risk of engaging in different addictive behaviors was high. Conclusions: The domain-specific effectiveness of the program was confirmed with no spillover between behavioral domains. Effectiveness appeared to be dependent on app use and users’ characteristics. Trial Registration: German Clinical Trials Register DRKS00023788; https://tinyurl.com/4pzpjkmj International Registered Report Identifier (IRRID): RR2-10.1186/s13063-022-06231-x %M 39042436 %R 10.2196/51307 %U https://mhealth.jmir.org/2024/1/e51307 %U https://doi.org/10.2196/51307 %U http://www.ncbi.nlm.nih.gov/pubmed/39042436 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e57318 %T Conversational Chatbot for Cigarette Smoking Cessation: Results From the 11-Step User-Centered Design Development Process and Randomized Controlled Trial %A Bricker,Jonathan B %A Sullivan,Brianna %A Mull,Kristin %A Santiago-Torres,Margarita %A Lavista Ferres,Juan M %+ Division of Public Health Sciences, Fred Hutch Cancer Center, 1100 Fairview Avenue N, Seattle, WA, 98109, United States, 1 206 667 5074, jbricker@fredhutch.org %K chatbot %K conversational agent %K conversational agents %K digital therapeutics %K smoking cessation %K development %K develop %K design %K smoking %K smoke %K smokers %K quit %K quitting %K cessation %K chatbots %K large language model %K LLM %K LLMs %K large language models %K addict %K addiction %K addictions %K mobile phone %D 2024 %7 23.7.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Conversational chatbots are an emerging digital intervention for smoking cessation. No studies have reported on the entire development process of a cessation chatbot. Objective: We aim to report results of the user-centered design development process and randomized controlled trial for a novel and comprehensive quit smoking conversational chatbot called QuitBot. Methods: The 4 years of formative research for developing QuitBot followed an 11-step process: (1) specifying a conceptual model; (2) conducting content analysis of existing interventions (63 hours of intervention transcripts); (3) assessing user needs; (4) developing the chat’s persona (“personality”); (5) prototyping content and persona; (6) developing full functionality; (7) programming the QuitBot; (8) conducting a diary study; (9) conducting a pilot randomized controlled trial (RCT); (10) reviewing results of the RCT; and (11) adding a free-form question and answer (QnA) function, based on user feedback from pilot RCT results. The process of adding a QnA function itself involved a three-step process: (1) generating QnA pairs, (2) fine-tuning large language models (LLMs) on QnA pairs, and (3) evaluating the LLM outputs. Results: We developed a quit smoking program spanning 42 days of 2- to 3-minute conversations covering topics ranging from motivations to quit, setting a quit date, choosing Food and Drug Administration–approved cessation medications, coping with triggers, and recovering from lapses and relapses. In a pilot RCT with 96% three-month outcome data retention, QuitBot demonstrated high user engagement and promising cessation rates compared to the National Cancer Institute’s SmokefreeTXT text messaging program, particularly among those who viewed all 42 days of program content: 30-day, complete-case, point prevalence abstinence rates at 3-month follow-up were 63% (39/62) for QuitBot versus 38.5% (45/117) for SmokefreeTXT (odds ratio 2.58, 95% CI 1.34-4.99; P=.005). However, Facebook Messenger intermittently blocked participants’ access to QuitBot, so we transitioned from Facebook Messenger to a stand-alone smartphone app as the communication channel. Participants’ frustration with QuitBot’s inability to answer their open-ended questions led to us develop a core conversational feature, enabling users to ask open-ended questions about quitting cigarette smoking and for the QuitBot to respond with accurate and professional answers. To support this functionality, we developed a library of 11,000 QnA pairs on topics associated with quitting cigarette smoking. Model testing results showed that Microsoft’s Azure-based QnA maker effectively handled questions that matched our library of 11,000 QnA pairs. A fine-tuned, contextualized GPT-3.5 (OpenAI) responds to questions that are not within our library of QnA pairs. Conclusions: The development process yielded the first LLM-based quit smoking program delivered as a conversational chatbot. Iterative testing led to significant enhancements, including improvements to the delivery channel. A pivotal addition was the inclusion of a core LLM–supported conversational feature allowing users to ask open-ended questions. Trial Registration: ClinicalTrials.gov NCT03585231; https://clinicaltrials.gov/study/NCT03585231 %M 38913882 %R 10.2196/57318 %U https://mhealth.jmir.org/2024/1/e57318 %U https://doi.org/10.2196/57318 %U http://www.ncbi.nlm.nih.gov/pubmed/38913882 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e59496 %T Feasibility and Preliminary Effects of a Social Media–Based Peer-Group Mobile Messaging Smoking Cessation Intervention Among Chinese Immigrants who Smoke: Pilot Randomized Controlled Trial %A Jiang,Nan %A Zhao,Ariel %A Rogers,Erin S %A Cupertino,Ana Paula %A Zhao,Xiaoquan %A Cartujano-Barrera,Francisco %A Siu,Katherine %A Sherman,Scott E %+ Department of Population Health, New York University Grossman School of Medicine, 17th Fl, 180 Madison Ave, New York, NY, 10016, United States, 1 646 501 3553, Nan.Jiang@nyulangone.org %K smoking cessation %K tobacco %K mHealth %K social media %K Chinese American %K immigrant %K smoking %K smoker %K mobile messaging %K randomized controlled trial %K tobacco use %K feasibility %K acceptability %K nicotine replacement therapy %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chinese immigrants experience significant disparities in tobacco use. Culturally adapted tobacco treatments targeting this population are sparse and the use is low. The low use of these treatment programs is attributed to their exclusive focus on individuals who are ready to quit and the wide range of barriers that Chinese immigrants face to access these programs. To support Chinese immigrant smokers at all levels of readiness to quit and address their access barriers, we developed the WeChat Quit Coach, a culturally and linguistically appropriate WeChat (Tencent Holdings Limited)–based peer group mobile messaging smoking cessation intervention. Objective: This study aims to assess the feasibility, acceptability, and preliminary effects of WeChat Quit Coach. Methods: We enrolled a total of 60 Chinese immigrant smokers in 2022 in New York City for a pilot randomized controlled trial (RCT) and a single-arm pilot test. The first 40 participants were randomized to either the intervention arm (WeChat Quit Coach) or the control arm (self-help print material) using 1:1 block randomization stratified by sex. WeChat Quit Coach lasted 6 weeks, featuring small peer groups moderated by a coach, daily text messages with text questions, and chat-based instant messaging support from the coach in response to peer questions. The next 20 participants were enrolled in the single-arm pilot test to further assess intervention feasibility and acceptability. All 60 participants were offered a 4-week supply of complimentary nicotine replacement therapy. Surveys were administered at baseline and 6 weeks, with participants in the pilot RCT completing an additional survey at 6 months and biochemical verification of abstinence at both follow-ups. Results: Of 74 individuals screened, 68 (92%) were eligible and 60 (88%) were enrolled. The majority of participants, with a mean age of 42.5 (SD 13.8) years, were male (49/60, 82%) and not ready to quit, with 70% (42/60) in the precontemplation or contemplation stage at the time of enrollment. The pilot RCT had follow-up rates of 98% (39/40) at 6 weeks and 93% (37/40) at 6 months, while the single-arm test achieved 100% follow-up at 6 weeks. On average, participants responded to daily text questions for 25.1 days over the 42-day intervention period and 23% (9/40) used the chat-based instant messaging support. Most participants were satisfied with WeChat Quit Coach (36/39, 92%) and would recommend it to others (32/39, 82%). At 6 months, self-reported 7-day point prevalence abstinence rates were 25% (5/20) in the intervention arm and 15% (3/20) in the control arm, with biochemically verified abstinence rates of 25% (5/20) and 5% (1/20), respectively. Conclusions: WeChat Quit Coach was feasible and well-received by Chinese immigrants who smoke and produced promising effects on abstinence. Large trials are warranted to assess its efficacy in promoting abstinence in this underserved population. Trial Registration: ClinicalTrials.gov NCT05130788; https://clinicaltrials.gov/study/NCT05130788 %M 39037756 %R 10.2196/59496 %U https://mhealth.jmir.org/2024/1/e59496 %U https://doi.org/10.2196/59496 %U http://www.ncbi.nlm.nih.gov/pubmed/39037756 %0 Journal Article %@ 2291-5222 %I %V 12 %N %P e49393 %T The Impact of User Engagement With Exposure Components on Posttraumatic Stress Symptoms in an mHealth Mobile App: Secondary Analysis of a Randomized Controlled Trial %A Davis,C Adrian %A Miller,Madeleine %A McLean,Carmen P %K posttraumatic stress disorder %K PTSD %K mHealth apps %K user engagement %K mHealth interventions %K digital interventions %K veterans %D 2024 %7 18.7.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Mobile mental health apps are a cost-effective option for managing mental health problems, such as posttraumatic stress disorder (PTSD). The efficacy of mobile health (mHealth) apps depends on engagement with the app, but few studies have examined how users engage with different features of mHealth apps for PTSD. Objective: This study aims to examine the relationship between app engagement indices and PTSD symptom reduction using data from an unblinded pilot randomized controlled trial of “Renew” (Vertical Design), an exposure-based app for PTSD with and without coaching support. Because exposure is an effective approach for treating PTSD, we expected that engagement with exposure activities would be positively related to symptom reduction, over and above overall app usage. Methods: Participants were veterans (N=69) with clinically significant PTSD symptoms who were recruited online using Facebook advertisements and invited to use the Renew app as often as they wanted over a 6-week period. Participants completed screening and assessments online but provided informed consent, toured the app, and completed feedback interviews via telephone. We assessed users’ self-reported PTSD symptoms before and after a 6-week intervention period and collected app usage data using a research-instrumented dashboard. To examine overall app engagement, we used data on the total time spent in the app, the number of log-in days, and the number of points that the user gained in the app. To examine engagement with exposure components, we used data on total time spent completing exposure activities (both in vivo and imaginal), the number of in vivo exposure activities completed, and the number of characters written in response to imaginal exposure prompts. We used hierarchical regression analyses to test the effect of engagement indices on change in PTSD symptoms. Results: Usage varied widely. Participants spent an average of 166.09 (SD 156.52) minutes using Renew, over an average of 14.7 (SD 10.71) mean log-in days. Engagement with the exposure components of the app was positively associated with PTSD symptom reduction (F6,62=2.31; P=.04). Moreover, this relationship remained significant when controlling for overall engagement with the app (ΔF3,62=4.42; P=.007). The number of characters written during imaginal exposure (β=.37; P=.009) and the amount of time spent completing exposure activities (β=.36; P=.03) were significant contributors to the model. Conclusions: To our knowledge, this is the first study to show a relationship between symptom improvement and engagement with the active therapeutic components of an mHealth app (ie, exposure) for PTSD. This relationship held when controlling for overall app use, which suggests that it was engagement with exposure, specifically, that was associated with symptom change. Future work to identify ways of promoting greater engagement with self-guided exposure may help improve the effectiveness of mHealth apps for PTSD. Trial Registration: ClinicalTrials.gov NCT04155736; https://clinicaltrials.gov/ct2/show/NCT04155736 %R 10.2196/49393 %U https://mhealth.jmir.org/2024/1/e49393 %U https://doi.org/10.2196/49393 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e42319 %T Evaluating the Acceptability of the Drink Less App and the National Health Service Alcohol Advice Web Page: Qualitative Interview Process Evaluation %A Oldham,Melissa %A Dina,Larisa-Maria %A Loebenberg,Gemma %A Perski,Olga %A Brown,Jamie %A Angus,Colin %A Beard,Emma %A Burton,Robyn %A Field,Matt %A Greaves,Felix %A Hickman,Matthew %A Kaner,Eileen %A Michie,Susan %A Munafò,Marcus R %A Pizzo,Elena %A Garnett,Claire %+ Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 20 7679 883, m.oldham@ucl.ac.uk %K alcohol reduction %K digital intervention %K acceptability %K mobile health %K mHealth %K mobile phone %D 2024 %7 18.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The extent to which interventions are perceived as acceptable to users impacts engagement and efficacy. Objective: In this study, we evaluated the acceptability of (1) the smartphone app Drink Less (intervention) and (2) the National Health Service (NHS) alcohol advice web page (usual digital care and comparator) among adult drinkers in the United Kingdom participating in a randomized controlled trial evaluating the effectiveness of the Drink Less app. Methods: A subsample of 26 increasing- and higher-risk drinkers (Alcohol Use Disorders Identification Test score≥8) assigned to the intervention group (Drink Less; n=14, 54%; female: n=10, 71%; age: 22-72 years; White: n=9, 64%) or usual digital care group (NHS alcohol advice web page; n=12, 46%; female: n=5, 42%; age: 23-68 years: White: n=9, 75%) took part in semistructured interviews. The interview questions were mapped on to the 7 facets of acceptability according to the Theoretical Framework of Acceptability: affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Alongside these constructs, we also included a question on perceived personal relevance, which previous research has linked to acceptability and engagement. Framework and thematic analysis of data was undertaken. Results: The Drink Less app was perceived as being ethical, easy, user-friendly, and effective for the period the app was used. Participants reported particularly liking the tracking and feedback sections of the app, which they reported increased personal relevance and which resulted in positive affect when achieving their goals. They reported no opportunity cost. Factors such as negative affect when not meeting goals and boredom led to disengagement in the longer term for some participants. The NHS alcohol advice web page was rated as being easy and user-friendly with no opportunity costs. However, the information presented was not perceived as being personally relevant or effective in changing drinking behavior. Most participants reported neutral or negative affect, most participants thought the alcohol advice web page was accessible, and some participants reported ethical concerns around the availability of suggested resources. Some participants reported that it had acted as a starting point or a signpost to other resources. Participants in both groups discussed motivation to change and contextual factors such as COVID-19 lockdowns, which influenced their perceived self-efficacy regardless of their assigned intervention. Conclusions: Drink Less appears to be an acceptable digital intervention among the recruited sample. The NHS alcohol advice web page was generally considered unacceptable as a stand-alone intervention among the recruited sample, although it may signpost and help people access other resources and interventions. %M 39024575 %R 10.2196/42319 %U https://www.jmir.org/2024/1/e42319 %U https://doi.org/10.2196/42319 %U http://www.ncbi.nlm.nih.gov/pubmed/39024575 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e53831 %T Patterns of Skin Picking in Skin Picking Disorder: Ecological Momentary Assessment Study %A Gallinat,Christina %A Moessner,Markus %A Wilhelm,Maximilian %A Keuthen,Nancy %A Bauer,Stephanie %+ Center for Psychotherapy Research, University Hospital Heidelberg, Bergheimer Straße 54, Heidelberg, 69115, Germany, 49 6221567876, christina.gallinat@med.uni-heidelberg.de %K skin picking disorder %K ecological momentary assessment %K EMA %K body-focused repetitive behavior %K obsessive-compulsive spectrum %K skin %K dermatology %K mental health %K assessment %K mobile phone %D 2024 %7 18.7.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Skin picking disorder (SPD) is an understudied mental illness that is classified as a body-focused repetitive behavior disorder. Literature suggests that pathological skin picking is strongly integrated into the daily lives of affected individuals and may involve a high degree of variability in terms of episode characteristics, frequency, and intensity. However, existing data on the phenomenology of SPD are limited and typically involve retrospective assessments, which may fail to accurately capture the behavior’s variability. Objective: This study aimed to investigate skin picking in the daily lives of individuals with SPD by using ecological momentary assessment (EMA). The first aim focused on the description of skin picking patterns (eg, characteristics, intensity, and distribution of episodes and urges), and the second aim explored differences in characteristics and patterns between automatic and focused skin picking. Methods: Participants were recruited online and underwent a web-based screening, a diagnostic telephone interview, and a comprehensive online self-report questionnaire before participating in an EMA protocol. The latter included 10 consecutive days with 7 pseudorandom, time-contingent assessments per day between 8 AM and 10 PM. The EMA questionnaire assessed the current skin picking urge, the occurrence of the behavior, and a detailed assessment of the episodes’ characteristics (eg, length, intensity, and consciousness) if applicable. Results: The final sample consisted of 57 participants, who completed at least 70% of the scheduled assessments (n=54, 94.7% female: mean age 29.3, SD 6.77 years). They completed 3758 EMAs and reported 1467 skin picking episodes. Skin picking occurred frequently (mean 2.57, SD 1.12 episodes per day and person) in relatively short episodes (10-30 min; 10 min: nepisodes=642, 43.8%; 20 min: nepisodes=312, 21.3%; 30 min: nepisodes=217, 14.8%), and it was distributed quite evenly throughout the day and across different days of the week. Focused and automatic episodes were relatively balanced across all reported episodes (focused: nepisodes=806, 54.9%) and over the course of the day. The analyses showed statistically significant differences between self-reported triggers for the different styles. Visual or tactile cues and the desire to pick the skin were more important for the focused style (visual or tactile cues: mean focused style [Mf]=4.01, SD 0.69 vs mean automatic style [Ma]=3.47, SD 0.99; P<.001; SMD=0.64; desire to pick: Mf=2.61, SD 1.06 vs Ma=1.94, SD 1.03; P<.001; SMD=0.82), while boredom and concentration problems were more prominent in automatic skin picking (boredom: Mf=1.69, SD 0.89 vs Ma=1.84, SD 0.89; P=.03; SMD=–0.31; concentration problems: Mf=2.06, SD 0.87 vs Ma=2.31, SD 1.06; P=.006; SMD=–0.41). Conclusions: These results contribute to an enhanced understanding of the phenomenology of SPD using a more rigorous assessment methodology. Our findings underscore that picking can impact affected persons multiple times throughout their daily lives. Trial Registration: German Clinical Trials Register DRKS00025168; https://tinyurl.com/mr35pdwh %M 39024568 %R 10.2196/53831 %U https://www.i-jmr.org/2024/1/e53831 %U https://doi.org/10.2196/53831 %U http://www.ncbi.nlm.nih.gov/pubmed/39024568 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55094 %T Wearable Data From Subjects Playing Super Mario, Taking University Exams, or Performing Physical Exercise Help Detect Acute Mood Disorder Episodes via Self-Supervised Learning: Prospective, Exploratory, Observational Study %A Corponi,Filippo %A Li,Bryan M %A Anmella,Gerard %A Valenzuela-Pascual,Clàudia %A Mas,Ariadna %A Pacchiarotti,Isabella %A Valentí,Marc %A Grande,Iria %A Benabarre,Antoni %A Garriga,Marina %A Vieta,Eduard %A Young,Allan H %A Lawrie,Stephen M %A Whalley,Heather C %A Hidalgo-Mazzei,Diego %A Vergari,Antonio %+ School of Informatics, University of Edinburgh, Informatics Forum, 10 Crichton St, Newington, Edinburgh, EH89AB, United Kingdom, 44 131 651 5661, filippo.corponi@ed.ac.uk %K mood disorder %K time-series classification %K wearable %K personal sensing %K deep learning %K self-supervised learning %K transformer %D 2024 %7 17.7.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Personal sensing, leveraging data passively and near-continuously collected with wearables from patients in their ecological environment, is a promising paradigm to monitor mood disorders (MDs), a major determinant of the worldwide disease burden. However, collecting and annotating wearable data is resource intensive. Studies of this kind can thus typically afford to recruit only a few dozen patients. This constitutes one of the major obstacles to applying modern supervised machine learning techniques to MD detection. Objective: In this paper, we overcame this data bottleneck and advanced the detection of acute MD episodes from wearables’ data on the back of recent advances in self-supervised learning (SSL). This approach leverages unlabeled data to learn representations during pretraining, subsequently exploited for a supervised task. Methods: We collected open access data sets recording with the Empatica E4 wristband spanning different, unrelated to MD monitoring, personal sensing tasks—from emotion recognition in Super Mario players to stress detection in undergraduates—and devised a preprocessing pipeline performing on-/off-body detection, sleep/wake detection, segmentation, and (optionally) feature extraction. With 161 E4-recorded subjects, we introduced E4SelfLearning, the largest-to-date open access collection, and its preprocessing pipeline. We developed a novel E4-tailored transformer (E4mer) architecture, serving as the blueprint for both SSL and fully supervised learning; we assessed whether and under which conditions self-supervised pretraining led to an improvement over fully supervised baselines (ie, the fully supervised E4mer and pre–deep learning algorithms) in detecting acute MD episodes from recording segments taken in 64 (n=32, 50%, acute, n=32, 50%, stable) patients. Results: SSL significantly outperformed fully supervised pipelines using either our novel E4mer or extreme gradient boosting (XGBoost): n=3353 (81.23%) against n=3110 (75.35%; E4mer) and n=2973 (72.02%; XGBoost) correctly classified recording segments from a total of 4128 segments. SSL performance was strongly associated with the specific surrogate task used for pretraining, as well as with unlabeled data availability. Conclusions: We showed that SSL, a paradigm where a model is pretrained on unlabeled data with no need for human annotations before deployment on the supervised target task of interest, helps overcome the annotation bottleneck; the choice of the pretraining surrogate task and the size of unlabeled data for pretraining are key determinants of SSL success. We introduced E4mer, which can be used for SSL, and shared the E4SelfLearning collection, along with its preprocessing pipeline, which can foster and expedite future research into SSL for personal sensing. %M 39018100 %R 10.2196/55094 %U https://mhealth.jmir.org/2024/1/e55094 %U https://doi.org/10.2196/55094 %U http://www.ncbi.nlm.nih.gov/pubmed/39018100 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56749 %T Rationale, Design, and Baseline Characteristics of Participants in the Health@NUS mHealth Augmented Cohort Study Examining Student-to-Work Life Transition: Protocol for a Prospective Cohort Study %A Chua,Xin Hui %A Edney,Sarah Martine %A Müller,Andre Matthias %A Petrunoff,Nicholas A %A Whitton,Clare %A Tay,Zoey %A Goh,Claire Marie Jie Lin %A Chen,Bozhi %A Park,Su Hyun %A Rebello,Salome A %A Low,Alicia %A Chia,Janelle %A Koek,Daphne %A Cheong,Karen %A van Dam,Rob M %A Müller-Riemenschneider,Falk %+ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building (MD1), 12 Science Drive 2, #10-01, Singapore, 117549, Singapore, 65 6601 3122, falk.m-r@nus.edu.sg %K wearable %K wearables %K movement behaviors %K university students %K mHealth %K cohort study %K data collection %K well-being %K young adults %K health behaviors %K physical health %K Singapore %K biometric assessment %K questionnaire %K Fitbit %K smartwatch %K smartphone app %K app %K application %K sleep %K dietary data %K diet %K dietary %K psychological distress %K distress %K mobile phone %D 2024 %7 17.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Integration of mobile health data collection methods into cohort studies enables the collection of intensive longitudinal information, which gives deeper insights into individuals’ health and lifestyle behavioral patterns over time, as compared to traditional cohort methods with less frequent data collection. These findings can then fill the gaps that remain in understanding how various lifestyle behaviors interact as students graduate from university and seek employment (student-to-work life transition), where the inability to adapt quickly to a changing environment greatly affects the mental well-being of young adults. Objective: This paper aims to provide an overview of the study methodology and baseline characteristics of participants in Health@NUS, a longitudinal study leveraging mobile health to examine the trajectories of health behaviors, physical health, and well-being, and their diverse determinants, for young adults during the student-to-work life transition. Methods: University students were recruited between August 2020 and June 2022 in Singapore. Participants would complete biometric assessments and questionnaires at 3 time points (baseline, 12-, and 24-month follow-up visits) and use a Fitbit smartwatch and smartphone app to continuously collect physical activity, sedentary behavior, sleep, and dietary data over the 2 years. Additionally, up to 12 two-week-long bursts of app-based ecological momentary surveys capturing lifestyle behaviors and well-being would be sent out among the 3 time points. Results: Interested participants (n=1556) were screened for eligibility, and 776 participants were enrolled in the study between August 2020 and June 2022. Participants were mostly female (441/776, 56.8%), of Chinese ethnicity (741/776, 92%), undergraduate students (759/776, 97.8%), and had a mean BMI of 21.9 (SD 3.3) kg/m2, and a mean age of 22.7 (SD 1.7) years. A substantial proportion were overweight (202/776, 26.1%) or obese (42/776, 5.4%), had indicated poor mental well-being (World Health Organization-5 Well-Being Index ≤50; 291/776, 37.7%), or were at higher risk for psychological distress (Kessler Psychological Distress Scale ≥13; 109/776, 14.1%). Conclusions: The findings from this study will provide detailed insights into the determinants and trajectories of health behaviors, health, and well-being during the student-to-work life transition experienced by young adults. Trial Registration: ClinicalTrials.gov NCT05154227; https://clinicaltrials.gov/study/NCT05154227 International Registered Report Identifier (IRRID): DERR1-10.2196/56749 %M 39018103 %R 10.2196/56749 %U https://www.researchprotocols.org/2024/1/e56749 %U https://doi.org/10.2196/56749 %U http://www.ncbi.nlm.nih.gov/pubmed/39018103 %0 Journal Article %@ 2291-9279 %I %V 12 %N %P e58411 %T Effect of Elastic Resistance on Exercise Intensity and User Satisfaction While Playing the Active Video Game BoxVR in Immersive Virtual Reality: Empirical Study %A Polechoński,Jacek %A Przepiórzyński,Alan %A Polechoński,Piotr %A Tomik,Rajmund %K virtual reality %K VR %K game %K gaming %K immersive %K immersion %K health-related physical activity %K physical activity %K exercise %K active video games %K attractiveness %K enjoyment scale %K enjoyment %K serious games %K elastic resistance %K resistance %D 2024 %7 16.7.2024 %9 %J JMIR Serious Games %G English %X Background: One of the main contemporary forms of physical activity (PA) involves exercises and games in an immersive virtual reality (VR) environment, which allows the user to practice various forms of PA in a small space. Unfortunately, most of the currently available VR games and workout applications are mostly based on upper body movements, especially the arms, which do not guarantee sufficiently high exercise intensity and health benefits. Therefore, it is worth seeking solutions to help increase the exercise load during PA in VR. Objective: The main aim of this study was to evaluate the effect of elastic arm resistance in the form of latex resistance bands of different elasticity levels on the intensity of students’ PA while playing the BoxVR game. We further assessed the satisfaction of this form of exercise and its associations with PA intensity. Methods: A total of 21 healthy and physically fit men (mean age 22.5, SD 2.0 years) were included in the study. The tests consisted of 3 10-minute games. One game was run with no load and the other two were run with 1.5-meter latex resistance bands (low and high resistance). The order of the tests was randomized and the participants rested for 20 minutes after each exercise. Exercise intensity was estimated using objective (heart rate monitoring) and subjective (Borg scale) methods. The Physical Activity Enjoyment Scale was used to assess satisfaction with the PA. The effect of elastic resistance on exercise intensity and user enjoyment was estimated using ANOVA for repeated measures. Results: The ANOVA results indicated that incorporation of elastic resistance caused a significant change (F2,40=20.235, P<.001; η²p=0.503) in the intensity of PA in VR, which was low while playing without resistance and then increased to a moderate level with additional resistance. The use of elastic bands also changed participants’ perceptions of the enjoyment of exercise in VR (F2,40=9.259, P<.001; η²p=0.316). The students rated their satisfaction with PA in VR on a 7-point scale highly and similarly when exercising without an upper limb load (mean 6.19, SD 0.61) and with slight elastic resistance (mean 6.17, SD 0.66), whereas their satisfaction declined significantly (mean 5.66, SD 0.94) when incorporating a higher load. Conclusions: The intensity of PA among students playing the BoxVR game is at a relatively low level. With the added resistance of elastic bands attached to the upper limbs, the intensity of the exercise increased to a moderate level, as recommended for obtaining health benefits. Participants rated the enjoyment of PA in VR highly. The use of slight elastic resistance did not negatively affect satisfaction with the BoxVR game, although user satisfaction declined with a higher load. Further research should be undertaken to increase the effectiveness of exercise in VR so that regular users can enjoy the health benefits. %R 10.2196/58411 %U https://games.jmir.org/2024/1/e58411 %U https://doi.org/10.2196/58411 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e43931 %T Identifying Person-Specific Drivers of Depression in Adolescents: Protocol for a Smartphone-Based Ecological Momentary Assessment and Passive Sensing Study %A Ng,Mei Yi %A Frederick,Jennifer A %A Fisher,Aaron J %A Allen,Nicholas B %A Pettit,Jeremy W %A McMakin,Dana L %+ Department of Psychology and Center for Children and Families, Florida International University, 11200 SW 8th St AHC4-457, Miami, FL, 33199, United States, 1 305 348 9920, meiyi.ng@fiu.edu %K adolescents %K depression %K idiographic assessment %K network modeling %K treatment personalization %K ecological momentary assessment %K mobile sensing %K digital phenotyping %K actigraphy %K smartphones %D 2024 %7 16.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescence is marked by an increasing risk of depression and is an optimal window for prevention and early intervention. Personalizing interventions may be one way to maximize therapeutic benefit, especially given the marked heterogeneity in depressive presentations. However, empirical evidence that can guide personalized intervention for youth is lacking. Identifying person-specific symptom drivers during adolescence could improve outcomes by accounting for both developmental and individual differences. Objective: This study leverages adolescents’ everyday smartphone use to investigate person-specific drivers of depression and validate smartphone-based mobile sensing data against established ambulatory methods. We describe the methods of this study and provide an update on its status. After data collection is completed, we will address three specific aims: (1) identify idiographic drivers of dynamic variability in depressive symptoms, (2) test the validity of mobile sensing against ecological momentary assessment (EMA) and actigraphy for identifying these drivers, and (3) explore adolescent baseline characteristics as predictors of these drivers. Methods: A total of 50 adolescents with elevated symptoms of depression will participate in 28 days of (1) smartphone-based EMA assessing depressive symptoms, processes, affect, and sleep; (2) mobile sensing of mobility, physical activity, sleep, natural language use in typed interpersonal communication, screen-on time, and call frequency and duration using the Effortless Assessment of Risk States smartphone app; and (3) wrist actigraphy of physical activity and sleep. Adolescents and caregivers will complete developmental and clinical measures at baseline, as well as user feedback interviews at follow-up. Idiographic, within-subject networks of EMA symptoms will be modeled to identify each adolescent’s person-specific drivers of depression. Correlations among EMA, mobile sensor, and actigraph measures of sleep, physical, and social activity will be used to assess the validity of mobile sensing for identifying person-specific drivers. Data-driven analyses of mobile sensor variables predicting core depressive symptoms (self-reported mood and anhedonia) will also be used to assess the validity of mobile sensing for identifying drivers. Finally, between-subject baseline characteristics will be explored as predictors of person-specific drivers. Results: As of October 2023, 84 families were screened as eligible, of whom 70% (n=59) provided informed consent and 46% (n=39) met all inclusion criteria after completing baseline assessment. Of the 39 included families, 85% (n=33) completed the 28-day smartphone and actigraph data collection period and follow-up study visit. Conclusions: This study leverages depressed adolescents’ everyday smartphone use to identify person-specific drivers of adolescent depression and to assess the validity of mobile sensing for identifying these drivers. The findings are expected to offer novel insights into the structure and dynamics of depressive symptomatology during a sensitive period of development and to inform future development of a scalable, low-burden smartphone-based tool that can guide personalized treatment decisions for depressed adolescents. International Registered Report Identifier (IRRID): DERR1-10.2196/43931 %M 39012691 %R 10.2196/43931 %U https://www.researchprotocols.org/2024/1/e43931 %U https://doi.org/10.2196/43931 %U http://www.ncbi.nlm.nih.gov/pubmed/39012691 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51216 %T Deconstructing Fitbit to Specify the Effective Features in Promoting Physical Activity Among Inactive Adults: Pilot Randomized Controlled Trial %A Takano,Keisuke %A Oba,Takeyuki %A Katahira,Kentaro %A Kimura,Kenta %+ Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1 Higashi, Tsukuba, Ibaraki, 305-8566, Japan, 81 298491456, keisuke.takano@aist.go.jp %K wearable activity tracker %K mHealth %K mobile health %K motivation %K physical activity %K lifestyle %K smartwatch %K wearables %K Fitbit %K exercise %K fitness %K BCT %K behavior change technique %K behavior change %K motivation %K adherence %K engagement %D 2024 %7 12.7.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable activity trackers have become key players in mobile health practice as they offer various behavior change techniques (BCTs) to help improve physical activity (PA). Typically, multiple BCTs are implemented simultaneously in a device, making it difficult to identify which BCTs specifically improve PA. Objective: We investigated the effects of BCTs implemented on a smartwatch, the Fitbit, to determine how each technique promoted PA. Methods: This study was a single-blind, pilot randomized controlled trial, in which 70 adults (n=44, 63% women; mean age 40.5, SD 12.56 years; closed user group) were allocated to 1 of 3 BCT conditions: self-monitoring (feedback on participants’ own steps), goal setting (providing daily step goals), and social comparison (displaying daily steps achieved by peers). Each intervention lasted for 4 weeks (fully automated), during which participants wore a Fitbit and responded to day-to-day questionnaires regarding motivation. At pre- and postintervention time points (in-person sessions), levels and readiness for PA as well as different aspects of motivation were assessed. Results: Participants showed excellent adherence (mean valid-wear time of Fitbit=26.43/28 days, 94%), and no dropout was recorded. No significant changes were found in self-reported total PA (dz<0.28, P=.40 for the self-monitoring group, P=.58 for the goal setting group, and P=.19 for the social comparison group). Fitbit-assessed step count during the intervention period was slightly higher in the goal setting and social comparison groups than in the self-monitoring group, although the effects did not reach statistical significance (P=.052 and P=.06). However, more than half (27/46, 59%) of the participants in the precontemplation stage reported progress to a higher stage across the 3 conditions. Additionally, significant increases were detected for several aspects of motivation (ie, integrated and external regulation), and significant group differences were identified for the day-to-day changes in external regulation; that is, the self-monitoring group showed a significantly larger increase in the sense of pressure and tension (as part of external regulation) than the goal setting group (P=.04). Conclusions: Fitbit-implemented BCTs promote readiness and motivation for PA, although their effects on PA levels are marginal. The BCT-specific effects were unclear, but preliminary evidence showed that self-monitoring alone may be perceived demanding. Combining self-monitoring with another BCT (or goal setting, at least) may be important for enhancing continuous engagement in PA. Trial Registration: Open Science Framework; https://osf.io/87qnb/?view_only=f7b72d48bb5044eca4b8ce729f6b403b %M 38996332 %R 10.2196/51216 %U https://mhealth.jmir.org/2024/1/e51216 %U https://doi.org/10.2196/51216 %U http://www.ncbi.nlm.nih.gov/pubmed/38996332 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45422 %T The Effects of a Complex Interactive Multimodal Intervention on Personalized Stress Management Among Health Care Workers in China: Nonrandomized Controlled Study %A Liu,Wenhua %A Wang,Quan %A Zheng,Danli %A Mei,Junhua %A Lu,Jiajia %A Chen,Guohua %A Wang,Wei %A Ding,Fengfei %+ Department of Pharmacology, School of Basic Medical Science, Shanghai Medical College, Fudan University, No.130 Dong An Road, Xu hui district, Shanghai, 20032, China, 86 13476255813, Fengfei_ding@fudan.edu.cn %K multimodal intervention %K stress management %K health care workers %K perceived stress %K autonomic nervous system %K stress %K management %K mental health %K engagement %K human support %K physiological stress %K psychological stress %K social network %K mobile phone %D 2024 %7 12.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Health care workers (HCWs) frequently face multiple stressors at work, particularly those working night shifts. HCWs who have experienced distress may find it difficult to adopt stress management approaches, even if they are aware of the effects of stress and coping processes. Therefore, an individualized intervention may be required to assist distressed HCWs in bridging the “knowledge-practice” gap in stress management and effectively alleviating stress symptoms. Objective: The main objective of this research was to compare the effects of a complex interactive multimodal intervention (CIMI) to self-guided stress management interventions on stress symptoms of distressed HCWs, as measured by physiological (heart rate variability), psychological (perceived stress, mental distress, and subjective happiness), and sleep disorder (fatigue and sleepiness) indicators. Methods: We conducted a nonrandomized, controlled study in 2 Chinese general hospitals. The participants in this study were 245 HCWs who fulfilled at least 1 of the 3 dimensions on the Depression, Anxiety, and Stress Scale. All eligible individuals were required to complete a questionnaire and wear a 24-hour Holter device to determine the physiological signs of stress as indexed by heart rate variability at both baseline and after the intervention. The CIMI group received a 12-week online intervention with 4 components—mobile stress management instruction, a web-based WeChat social network, personalized feedback, and a nurse coach, whereas the control group simply received a self-guided intervention. Results: After a 12-week intervention, the Perceived Stress Scale (PSS) scores reduced significantly in the CIMI group (mean difference [MD] –5.31, 95% CI –6.26 to –4.37; P<.001) compared to the baseline levels. The changes in PSS scores before and after the intervention exhibited a significant difference between the CIMI and control groups (d=–0.64; MD –4.03, 95% CI –5.91 to –2.14; P<.001), and the effect was medium. In terms of physiological measures, both the control group (MD –9.56, 95% CI –16.9 to –2.2; P=.01) and the CIMI group (MD –8.45, 95% CI –12.68 to –4.22; P<.001) demonstrated a significant decrease in the standard deviation of normal-to-normal intervals (SDNN) within the normal clinical range; however, there were no significant differences between the 2 groups (d=0.03; MD 1.11, 95% CI –7.38 to 9.59; P=.80). Conclusions: The CIMI was an effective intervention for improving sleep disorders, as well as parts of the psychological stress measures in distressed HCWs. The findings provide objective evidence for developing a mobile stress management intervention that is adaptable and accessible to distressed HCWs, but its long-term effects should be investigated in future research. Trial Registration: ClinicalTrials.gov NCT05239065; https://clinicaltrials.gov/ct2/show/NCT05239065 %M 38996333 %R 10.2196/45422 %U https://www.jmir.org/2024/1/e45422 %U https://doi.org/10.2196/45422 %U http://www.ncbi.nlm.nih.gov/pubmed/38996333 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e62891 %T Authors’ Reply: The Power of Collaboration in Facilitating Mobile Technology Adoption in Health Care %A Tong,Huong Ly %A Rakic,Severin %A Al-Hazzaa,Hazzaa M %A Alqahtani,Saleh A %+ The World Bank Group, J5-068, 1818 H Street NW, Washington, DC, 20433, United States, 1 2024585552, srakic@worldbank.org %K mobile apps %K fitness trackers %K SMS %K SMS text messaging %K physical activity %K exercise %K sedentary behavior %K Middle East %K Africa, Northern %K movement %K physical inactivity %K smartphone %K mobile phone %K mobile health %K mHealth %K digital health %K behavior change %K intervention %D 2024 %7 8.7.2024 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 38976872 %R 10.2196/62891 %U https://www.jmir.org/2024/1/e62891 %U https://doi.org/10.2196/62891 %U http://www.ncbi.nlm.nih.gov/pubmed/38976872 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60350 %T The Power of Collaboration in Facilitating Mobile Technology Adoption in Health Care %A Fan,Weijing %A Liu,Guobin %+ Department of Peripheral Vascular Surgery, Institute of Surgery of Traditional Chinese Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Zhangheng road 528, Shanghai, 201203, China, 86 15800885533, 15800885533@163.com %K social workers %K government %K mobile technology %K mobile apps %K fitness trackers %K SMS %K SMS text messaging %K physical activity %K exercise %K sedentary behavior %K Middle East %K Africa %K movement %K physical inactivity %K smartphone %K mobile phone %K mobile health %K mHealth %K digital health %K behavior change %K intervention %D 2024 %7 8.7.2024 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 38976864 %R 10.2196/60350 %U https://www.jmir.org/2024/1/e60350 %U https://doi.org/10.2196/60350 %U http://www.ncbi.nlm.nih.gov/pubmed/38976864 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48802 %T Technology-Based Music Interventions to Reduce Anxiety and Pain Among Patients Undergoing Surgery or Procedures: Systematic Review of the Literature %A Park,Sunghee %A Lee,Sohye %A Howard,Sheri %A Yi,Jeeseon %+ College of Nursing & Sustainable Health Research Institute, Gyeongsang National University, 816-15 Jinjudae-ro, Jinju, 52727, Republic of Korea, 82 55 772 8252, jy772@gnu.ac.kr %K technology %K music intervention %K anxiety %K pain %D 2024 %7 8.7.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Hospitalized patients undergoing surgery or procedures may experience negative symptoms. Music is a nonpharmacological complementary approach and is used as an intervention to reduce anxiety, stress, and pain in these patients. Recently, music has been used conveniently in clinical situations with technology devices, and the mode of providing music is an important factor in technology-based music interventions. However, many reviews have focused only on the effectiveness of music interventions. Objective: We aimed to review randomized controlled trials (RCTs) of technology-based music interventions for reducing anxiety and pain among patients undergoing surgery or procedures. We examined the clinical situation, devices used, delivery methods, and effectiveness of technology-based music interventions in primary articles. Methods: The search was performed in the following 5 electronic databases: PubMed, MEDLINE (OvidSP), CINAHL complete, PSYCINFO, and Embase. This systematic review focused on technology-based music interventions. The following articles were included: (1) RCTs, (2) studies using interactive technology (eg, smartphones, mHealth, tablets, applications, and virtual reality), (3) empirical studies reporting pain and anxiety outcomes, and (4) English articles published from 2018 to 2023 (as of January 18, 2023). The risk of bias was assessed using the Cochrane Risk of Bias tool version 2. Results: Among 292 studies identified, 21 met the inclusion criteria and were included. Of these studies, 9 reported that anxiety scores decreased after music interventions and 7 reported that pain could be decreased before, during, and after procedures. The methodology of the music intervention was important to the results on anxiety and pain in the clinical trials. More than 50% (13/21, 62%) of the studies included in this review allowed participants to select themes themselves. However, it was difficult to distinguish differences in effects depending on the device or software used for the music interventions. Conclusions: Technology-based music interventions could help reduce anxiety and pain among patients undergoing surgery or procedures. The findings of this review could help medical teams to choose a practical methodology for music interventions. Future studies should examine the effects of advanced technology-based music interventions using smart devices and software that promote interactions between medical staff and patients. %M 38976863 %R 10.2196/48802 %U https://mhealth.jmir.org/2024/1/e48802 %U https://doi.org/10.2196/48802 %U http://www.ncbi.nlm.nih.gov/pubmed/38976863 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58063 %T A Novel mHealth App for Smokers Living With HIV Who Are Ambivalent About Quitting Smoking: Formative Research and Randomized Feasibility Study %A McClure,Jennifer B %A Heffner,Jaimee L %A Krakauer,Chloe %A Mun,Sophia %A Catz,Sheryl L %+ Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1360, Seattle, WA, 98101, United States, 1 206 287 2737, Jennifer.B.McClure@kp.org %K HIV %K tobacco %K nicotine %K smoking cessation %K mobile health %K mHealth %K motivation %K ambivalence %K app %K mobile phone %D 2024 %7 8.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: More people who smoke and are living with HIV now die from tobacco-related diseases than HIV itself. Most people are ambivalent about quitting smoking and want to quit someday but not yet. Scalable, effective interventions are needed to motivate and support smoking cessation among people ambivalent about quitting smoking (PAQS) who are living with HIV. Objective: This study aims to develop an app-based intervention for PAQS who are living with HIV and assess its feasibility, acceptability, and potential impact. Results of this study will inform plans for future research and development. Methods: In phase 1, PAQS living with HIV (n=8) participated in user-centered design interviews to inform the final intervention app design and recruitment plan for a subsequent randomized pilot study. In phase 2, PAQS living with HIV were randomized to either a standard care control app or a similar experimental app with additional content tailored for PAQS and those with HIV. Participants were followed for 3 months. Feasibility focused on recruitment, retention, and participants’ willingness to install the app. The study was not powered for statistical significance. Indices of acceptability (satisfaction and use) and impact (smoking behavior change and treatment uptake) were assessed via automated data and self-report among those who installed and used the app (n=19). Results: Recruitment for both study phases was a challenge, particularly via web-based and social media platforms. Enrollment success was greater among people living with HIV recruited from a health care provider and research registry. Once enrolled, retention for the phase 2 randomized study was good; 74% (14/19) of the participants completed the 3-month follow-up. Phase 1 findings suggested that PAQS living with HIV were receptive to using an app-based intervention to help them decide whether, when, and how to stop smoking, despite not being ready to quit smoking. Phase 2 findings further supported this conclusion based on feedback from people who agreed to use an app, but group differences were observed. Indices of acceptability favored the experimental arm, including a descriptively higher mean number of sessions and utilization badges. Similarly, indices of potential impact were descriptively higher in the experimental arm (proportion reducing smoking, making a quit attempt, or calling free tobacco quitline). No participants in either arm quit smoking at the 3-month follow-up. Conclusions: On the basis of this formative work, PAQS living with HIV may be receptive to using a mobile health–based app intervention to help them decide whether, when, or how to stop using tobacco. Indices of acceptability and impact indicate that additional research and development are warranted. Trial Registration: ClinicalTrials.gov NCT05339659; https://clinicaltrials.gov/study/NCT05339659 %M 38976321 %R 10.2196/58063 %U https://formative.jmir.org/2024/1/e58063 %U https://doi.org/10.2196/58063 %U http://www.ncbi.nlm.nih.gov/pubmed/38976321 %0 Journal Article %@ 2369-2960 %I %V 10 %N %P e54623 %T Improving Parental Health Literacy in Primary Caregivers of 0- to 3-Year-Old Children Through a WeChat Official Account: Cluster Randomized Controlled Trial %A Li,Yun %A Xiao,Qiuli %A Chen,Min %A Jiang,Chunhua %A Kang,Shurong %A Zhang,Ying %A Huang,Jun %A Yang,Yulin %A Li,Mu %A Jiang,Hong %K health literacy %K WeChat %K cluster randomized controlled trial %K RCT %K randomized %K controlled trial %K controlled trials %K parental %K parenting %K parents %K parent %K China %K Chinese %K mHealth %K mobile health %K app %K apps %K applications %K pediatric %K pediatrics %K paediatric %K paediatrics %K infant %K infants %K infancy %K baby %K babies %K neonate %K neonates %K neonatal %K newborn %K newborns %K toddler %K toddlers %D 2024 %7 4.7.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Parental health literacy is important to children’s health and development, especially in the first 3 years. However, few studies have explored effective intervention strategies to improve parental literacy. Objective: This study aimed to determine the effects of a WeChat official account (WOA)–based intervention on parental health literacy of primary caregivers of children aged 0-3 years. Methods: This cluster randomized controlled trial enrolled 1332 caregiver-child dyads from all 13 community health centers (CHCs) in Minhang District, Shanghai, China, between April 2020 and April 2021. Participants in intervention CHCs received purposefully designed videos via a WOA, which automatically recorded the times of watching for each participant, supplemented with reading materials from other trusted web-based sources. The contents of the videos were constructed in accordance with the comprehensive parental health literacy model of WHO (World Health Organization)/Europe (WHO/Europe). Participants in control CHCs received printed materials similar to the intervention group. All the participants were followed up for 9 months. Both groups could access routine child health services as usual during follow-up. The primary outcome was parental health literacy measured by a validated instrument, the Chinese Parental Health Literacy Questionnaire (CPHLQ) of children aged 0-3 years. Secondary outcomes included parenting behaviors and children’s health outcomes. We used the generalized linear mixed model (GLMM) for data analyses and performed different subgroup analyses. The β coefficient, risk ratio (RR), and their 95% CI were used to assess the intervention’s effect. Results: After the 9-month intervention, 69.4% (518/746) of caregivers had watched at least 1 video. Participants in the intervention group had higher CPHLQ total scores (β=2.51, 95% CI 0.12-4.91) and higher psychological scores (β=1.63, 95% CI 0.16-3.10) than those in the control group. The intervention group also reported a higher rate of exclusive breastfeeding (EBF) at 6 months (38.9% vs 23.44%; RR 1.90, 95% CI 1.07-3.38) and a higher awareness rate of vitamin D supplementation for infants younger than 6 months (76.7% vs 70.5%; RR 1.39, 95% CI 1.06-1.82). No significant effects were detected for the physical score on the CPHLQ, breastfeeding rate, routine checkup rate, and children’s health outcomes. Furthermore, despite slight subgroup differences in the intervention’s effects on the total CPHLQ score and EBF rate, no interaction effect was observed between these subgroup factors and intervention factors. Conclusions: Using a WHO literacy model–based health intervention through a WOA has the potential of improving parental health literacy and EBF rates at 6 months. However, innovative strategies and evidence-based content are required to engage more participants and achieve better intervention outcomes. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000031711; https://www.chictr.org.cn/showproj.aspx?proj=51740 %R 10.2196/54623 %U https://publichealth.jmir.org/2024/1/e54623 %U https://doi.org/10.2196/54623 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55663 %T Effect of a Smartphone App (S-Check) on Actual and Intended Help-Seeking and Motivation to Change Methamphetamine Use Among Adult Consumers of Methamphetamine in Australia: Randomized Waitlist-Controlled Trial %A Siefried,Krista J %A Bascombe,Florence %A Clifford,Brendan %A Liu,Zhixin %A Middleton,Peter %A Kay-Lambkin,Frances %A Freestone,Jack %A Herman,Daniel %A Millard,Michael %A Steele,Maureen %A Acheson,Liam %A Moller,Carl %A Bath,Nicky %A Ezard,Nadine %+ The National Centre for Clinical Research on Emerging Drugs, University of New South Wales, UNSW Randwick Campus, 22/32 King Street, Randwick, 2031, Australia, 61 2 9065 7808, krista.siefried@svha.org.au %K methamphetamine %K smartphone app %K behavior change %K help-seeking %K motivation to change %K mHealth %K mobile health %K app %K apps %K application %K applications %K smartphone %K smartphones %K motivation %K motivational %K RCT %K randomized %K controlled trial %K controlled trials %K drug %K drugs %K substance use %K engagement %K substance abuse %K mobile phone %D 2024 %7 3.7.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Interventions are required that address delays in treatment-seeking and low treatment coverage among people consuming methamphetamine. Objective: We aim to determine whether a self-administered smartphone-based intervention, the “S-Check app” can increase help-seeking and motivation to change methamphetamine use, and determine factors associated with app engagement. Methods: This study is a randomized, 28-day waitlist-controlled trial. Consenting adults residing in Australia who reported using methamphetamine at least once in the last month were eligible to download the app for free from Android or iOS app stores. Those randomized to the intervention group had immediate access to the S-Check app, the control group was wait-listed for 28 days before gaining access, and then all had access until day 56. Actual help-seeking and intention to seek help were assessed by the modified Actual Help Seeking Questionnaire (mAHSQ), modified General Help Seeking Questionnaire, and motivation to change methamphetamine use by the modified readiness ruler. χ2 comparisons of the proportion of positive responses to the mAHSQ, modified General Help Seeking Questionnaire, and modified readiness ruler were conducted between the 2 groups. Logistic regression models compared the odds of actual help-seeking, intention to seek help, and motivation to change at day 28 between the 2 groups. Secondary outcomes were the most commonly accessed features of the app, methamphetamine use, feasibility and acceptability of the app, and associations between S-Check app engagement and participant demographic and methamphetamine use characteristics. Results: In total, 560 participants downloaded the app; 259 (46.3%) completed eConsent and baseline; and 84 (32.4%) provided data on day 28. Participants in the immediate access group were more likely to seek professional help (mAHSQ) at day 28 than those in the control group (n=15, 45.5% vs n=12, 23.5%; χ21=4.42, P=.04). There was no significant difference in the odds of actual help-seeking, intention to seek help, or motivation to change methamphetamine use between the 2 groups on the primary logistic regression analyses, while in the ancillary analyses, the imputed data set showed a significant difference in the odds of seeking professional help between participants in the immediate access group compared to the waitlist control group (adjusted odds ratio 2.64, 95% CI 1.19-5.83, P=.02). For participants not seeking help at baseline, each minute in the app increased the likelihood of seeking professional help by day 28 by 8% (ratio 1.08, 95% CI 1.02-1.22, P=.04). Among the intervention group, a 10-minute increase in app engagement time was associated with a decrease in days of methamphetamine use by 0.4 days (regression coefficient [β] –0.04, P=.02). Conclusions: The S-Check app is a feasible low-resource self-administered intervention for adults in Australia who consume methamphetamine. Study attrition was high and, while common in mobile health interventions, warrants larger studies of the S-Check app. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000534189; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377288&isReview=true %M 38959499 %R 10.2196/55663 %U https://mhealth.jmir.org/2024/1/e55663 %U https://doi.org/10.2196/55663 %U http://www.ncbi.nlm.nih.gov/pubmed/38959499 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50186 %T mHealth Apps for Dementia, Alzheimer Disease, and Other Neurocognitive Disorders: Systematic Search and Environmental Scan %A Ali,Suad %A Alizai,Hira %A Hagos,Delal Jemal %A Rubio,Sindy Ramos %A Calabia,Dale %A Serrano Jimenez,Penelope %A Senthil,Vinuu Aarif %A Appel,Lora %+ Faculty of Health, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100, lora.appel@yorku.ca %K dementia %K Alzheimer disease %K mHealth %K mobile health %K apps %K lifestyle behaviors %K mobile phone %D 2024 %7 3.7.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Lifestyle behaviors including exercise, sleep, diet, stress, mental stimulation, and social interaction significantly impact the likelihood of developing dementia. Mobile health (mHealth) apps have been valuable tools in addressing these lifestyle behaviors for general health and well-being, and there is growing recognition of their potential use for brain health and dementia prevention. Effective apps must be evidence-based and safeguard user data, addressing gaps in the current state of dementia-related mHealth apps. Objective: This study aims to describe the scope of available apps for dementia prevention and risk factors, highlighting gaps and suggesting a path forward for future development. Methods: A systematic search of mobile app stores, peer-reviewed literature, dementia and Alzheimer association websites, and browser searches was conducted from October 19, 2022, to November 2, 2022. A total of 1044 mHealth apps were retrieved. After screening, 152 apps met the inclusion criteria and were coded by paired, independent reviewers using an extraction framework. The framework was adapted from the Silberg scale, other scoping reviews of mHealth apps for similar populations, and background research on modifiable dementia risk factors. Coded elements included evidence-based and expert credibility, app features, lifestyle elements of focus, and privacy and security. Results: Of the 152 apps that met the final selection criteria, 88 (57.9%) addressed modifiable lifestyle behaviors associated with reducing dementia risk. However, many of these apps (59/152, 38.8%) only addressed one lifestyle behavior, with mental stimulation being the most frequently addressed. More than half (84/152, 55.2%) scored 2 points out of 9 on the Silberg scale, with a mean score of 2.4 (SD 1.0) points. Most of the 152 apps did not disclose essential information: 120 (78.9%) did not disclose expert consultation, 125 (82.2%) did not disclose evidence-based information, 146 (96.1%) did not disclose author credentials, and 134 (88.2%) did not disclose their information sources. In addition, 105 (69.2%) apps did not disclose adherence to data privacy and security practices. Conclusions: There is an opportunity for mHealth apps to support individuals in engaging in behaviors linked to reducing dementia risk. While there is a market for these products, there is a lack of dementia-related apps focused on multiple lifestyle behaviors. Gaps in the rigor of app development regarding evidence base, credibility, and adherence to data privacy and security standards must be addressed. Following established and validated guidelines will be necessary for dementia-related apps to be effective and advance successfully. %M 38959029 %R 10.2196/50186 %U https://mhealth.jmir.org/2024/1/e50186 %U https://doi.org/10.2196/50186 %U http://www.ncbi.nlm.nih.gov/pubmed/38959029 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55964 %T Human Factors in AI-Driven Digital Solutions for Increasing Physical Activity: Scoping Review %A Gabarron,Elia %A Larbi,Dillys %A Rivera-Romero,Octavio %A Denecke,Kerstin %+ Department of Education, ICT and Learning, Østfold University College, B R A Veien 4, Halden, 1757, Norway, 47 94863460, elia.gabarron@hiof.no %K machine learning %K ML %K artificial intelligence %K AI %K algorithm %K algorithms %K predictive model %K predictive models %K predictive analytics %K predictive system %K practical model %K practical models %K deep learning %K human factors %K physical activity %K physical exercise %K healthy living %K active lifestyle %K exercise %K physically active %K digital health %K mHealth %K mobile health %K app %K apps %K application %K applications %K digital health %K digital technology %K digital intervention %K digital interventions %K smartphone %K smartphones %K PRISMA %D 2024 %7 3.7.2024 %9 Review %J JMIR Hum Factors %G English %X Background: Artificial intelligence (AI) has the potential to enhance physical activity (PA) interventions. However, human factors (HFs) play a pivotal role in the successful integration of AI into mobile health (mHealth) solutions for promoting PA. Understanding and optimizing the interaction between individuals and AI-driven mHealth apps is essential for achieving the desired outcomes. Objective: This study aims to review and describe the current evidence on the HFs in AI-driven digital solutions for increasing PA. Methods: We conducted a scoping review by searching for publications containing terms related to PA, HFs, and AI in the titles and abstracts across 3 databases—PubMed, Embase, and IEEE Xplore—and Google Scholar. Studies were included if they were primary studies describing an AI-based solution aimed at increasing PA, and results from testing the solution were reported. Studies that did not meet these criteria were excluded. Additionally, we searched the references in the included articles for relevant research. The following data were extracted from included studies and incorporated into a qualitative synthesis: bibliographic information, study characteristics, population, intervention, comparison, outcomes, and AI-related information. The certainty of the evidence in the included studies was evaluated using GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Results: A total of 15 studies published between 2015 and 2023 involving 899 participants aged approximately between 19 and 84 years, 60.7% (546/899) of whom were female participants, were included in this review. The interventions lasted between 2 and 26 weeks in the included studies. Recommender systems were the most commonly used AI technology in digital solutions for PA (10/15 studies), followed by conversational agents (4/15 studies). User acceptability and satisfaction were the HFs most frequently evaluated (5/15 studies each), followed by usability (4/15 studies). Regarding automated data collection for personalization and recommendation, most systems involved fitness trackers (5/15 studies). The certainty of the evidence analysis indicates moderate certainty of the effectiveness of AI-driven digital technologies in increasing PA (eg, number of steps, distance walked, or time spent on PA). Furthermore, AI-driven technology, particularly recommender systems, seems to positively influence changes in PA behavior, although with very low certainty evidence. Conclusions: Current research highlights the potential of AI-driven technologies to enhance PA, though the evidence remains limited. Longer-term studies are necessary to assess the sustained impact of AI-driven technologies on behavior change and habit formation. While AI-driven digital solutions for PA hold significant promise, further exploration into optimizing AI’s impact on PA and effectively integrating AI and HFs is crucial for broader benefits. Thus, the implications for innovation management involve conducting long-term studies, prioritizing diversity, ensuring research quality, focusing on user experience, and understanding the evolving role of AI in PA promotion. %M 38959064 %R 10.2196/55964 %U https://humanfactors.jmir.org/2024/1/e55964 %U https://doi.org/10.2196/55964 %U http://www.ncbi.nlm.nih.gov/pubmed/38959064 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55831 %T Digital Interventions to Modify Skin Cancer Risk Behaviors in a National Sample of Young Adults: Randomized Controlled Trial %A Heckman,Carolyn J %A Mitarotondo,Anna %A Lin,Yong %A Khavjou,Olga %A Riley,Mary %A Manne,Sharon L %A Yaroch,Amy L %A Niu,Zhaomeng %A Glanz,Karen %+ Rutgers Cancer Institute, 120 Albany St, New Brunswick, NJ, 08901, United States, 1 732 235 8830, ch842@rutgers.edu %K skin cancer prevention %K sun protection %K sun exposure %K digital intervention %K social media %K young adults %K sun %K skin cancer %K prevention %K cancer %K randomized controlled trial %K Facebook %K Instagram %K engagement %K behavior %K protection %K skin %K sunscreen %D 2024 %7 2.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Young adults engage in behaviors that place them at risk for skin cancer. Dissemination of digital health promotion interventions via social media is a potentially promising strategy to modify skin cancer risk behaviors by increasing UV radiation (UVR) protection and skin cancer examinations. Objective: This study aimed to compare 3 digital interventions designed to modify UVR exposure, sun protection, and skin cancer detection behaviors among young adults at moderate to high risk of skin cancer. Methods: This study was a hybrid type II effectiveness-implementation randomized controlled trial of 2 active interventions, a digital skin cancer risk reduction intervention (UV4.me [basic]) compared with an enhanced version (UV4.me2 [enhanced]), and an electronic pamphlet (e-pamphlet). Intervention effects were assessed over the course of a year among 1369 US young adults recruited primarily via Facebook and Instagram. Enhancements to encourage intervention engagement and behavior change included more comprehensive goal-setting activities, ongoing proactive messaging related to previously established mediators (eg, self-efficacy) of UVR exposure and protection, embedded incentives for module completion, and ongoing news and video updates. Primary outcome effects assessed via linear regression were UVR exposure and sun protection and protection habits. Secondary outcome effects assessed via logistic regression were skin self-exams, physician skin exams, sunscreen use, indoor tanning, and sunburn. Results: The active interventions increased sun protection (basic: P=.02; enhanced: P<.001) and habitual sun protection (basic: P=.04; enhanced P=.01) compared with the e-pamphlet. The enhanced intervention increased sun protection more than the basic one. Each active intervention increased sunscreen use at the 3-month follow-up (basic: P=.03; enhanced: P=.01) and skin self-exam at 1 year (basic: P=.04; enhanced: P=.004), compared with the e-pamphlet. Other intervention effects and differences between the Basic and Enhanced Intervention effects were nonsignificant. Conclusions: The active interventions were effective in improving several skin cancer risk and skin cancer prevention behaviors. Compared with the basic intervention, the enhanced intervention added to the improvement in sun protection but not other behaviors. Future analyses will explore intervention engagement (eg, proportion of content reviewed). Trial Registration: ClinicalTrials.gov NCT03313492; http://clinicaltrials.gov/ct2/show/NCT03313492 %M 38954433 %R 10.2196/55831 %U https://www.jmir.org/2024/1/e55831 %U https://doi.org/10.2196/55831 %U http://www.ncbi.nlm.nih.gov/pubmed/38954433 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e57863 %T The Effect of an mHealth Self-Monitoring Intervention (MI-BP) on Blood Pressure Among Black Individuals With Uncontrolled Hypertension: Randomized Controlled Trial %A Buis,Lorraine R %A Kim,Junhan %A Sen,Ananda %A Chen,Dongru %A Dawood,Katee %A Kadri,Reema %A Muladore,Rachelle %A Plegue,Melissa %A Richardson,Caroline R %A Djuric,Zora %A McNaughton,Candace %A Hutton,David %A Robert,Lionel P %A Park,Sun Young %A Levy,Phillip %+ Department of Family Medicine, University of Michigan, 1018 Fuller St., Ann Arbor, MI, 48104, United States, 1 734 998 7120, buisl@umich.edu %K blood pressure %K hypertension %K mobile health %K mHealth %K mobile phone %K smartphone %D 2024 %7 28.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hypertension is one of the most important cardiovascular disease risk factors and affects >100 million American adults. Hypertension-related health inequities are abundant in Black communities as Black individuals are more likely to use the emergency department (ED) for chronic disease–related ambulatory care, which is strongly linked to lower blood pressure (BP) control, diminished awareness of hypertension, and adverse cardiovascular events. To reduce hypertension-related health disparities, we developed MI-BP, a culturally tailored multibehavior mobile health intervention that targeted behaviors of BP self-monitoring, physical activity, sodium intake, and medication adherence in Black individuals with uncontrolled hypertension recruited from ED and community-based settings. Objective: We sought to determine the effect of MI-BP on BP as well as secondary outcomes of physical activity, sodium intake, medication adherence, and BP control compared to enhanced usual care control at 1-year follow-up. Methods: We conducted a 1-year, 2-group randomized controlled trial of the MI-BP intervention compared to an enhanced usual care control group where participants aged 25 to 70 years received a BP cuff and hypertension-related educational materials. Participants were recruited from EDs and other community-based settings in Detroit, Michigan, where they were screened for initial eligibility and enrolled. Baseline data collection and randomization occurred approximately 2 and 4 weeks after enrollment to ensure that participants had uncontrolled hypertension and were willing to take part. Data collection visits occurred at 13, 26, 39, and 52 weeks. Outcomes of interest included BP (primary outcome) and physical activity, sodium intake, medication adherence, and BP control (secondary outcomes). Results: We obtained consent from and enrolled 869 participants in this study yet ultimately randomized 162 (18.6%) participants. At 1 year, compared to the baseline, both groups showed significant decreases in systolic BP (MI-BP group: 22.5 mm Hg decrease in average systolic BP and P<.001; control group: 24.1 mm Hg decrease and P<.001) adjusted for age and sex, with no significant differences between the groups (time-by-arm interaction: P=.99). Similar patterns where improvements were noted in both groups yet no differences were found between the groups were observed for diastolic BP, physical activity, sodium intake, medication adherence, and BP control. Large dropout rates were observed in both groups (approximately 60%). Conclusions: Overall, participants randomized to both the enhanced usual care control and MI-BP conditions experienced significant improvements in BP and other outcomes; however, differences between groups were not detected, speaking to the general benefit of proactive outreach and engagement focused on cardiometabolic risk reduction in urban-dwelling, low-socioeconomic-status Black populations. High dropout rates were found and are likely to be expected when working with similar populations. Future work is needed to better understand engagement with mobile health interventions, particularly in this population. Trial Registration: ClinicalTrials.gov NCT02955537; https://clinicaltrials.gov/study/NCT02955537 International Registered Report Identifier (IRRID): RR2-10.2196/12601 %R 10.2196/57863 %U https://mhealth.jmir.org/2024/1/e57863 %U https://doi.org/10.2196/57863 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54892 %T A Digital Microintervention Supporting Evidence-Based Parenting Skills: Development Study Using the Agile Scrum Methodology %A Hodson,Nathan %A Woods,Peter %A Sobolev,Michael %A Giacco,Domenico %+ Price School of Public Policy, University of Southern California, 650 Childs Way, Los Angeles, CA, 90089, United States, 1 2133480086, nathan.hodson@warwick.ac.uk %K parenting %K child behavior %K mental health %K app development %K digital %D 2024 %7 28.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Conduct disorder increases risks of educational dropout, future mental illness, and incarceration if untreated. First-line treatment of conduct disorder involves evidence-based parenting skills programs. Time-outs, a frequent tool in these programs, can be effective at improving behavior, and recent apps have been developed to aid this process. However, these apps promote the use of time-outs in inconsistent or developmentally inappropriate ways, potentially worsening behavior problems. Digital microinterventions like these apps could guide parents through high-quality time-outs in the moment, but current time-out apps lack features promoting adherence to the evidence-based best practice. Agile scrum is a respected approach in the software development industry. Objective: We aimed to explore the feasibility of using the agile scrum approach to build a digital microintervention to help parents deliver an evidence-based time-out. Methods: The agile scrum methodology was used. Four sprints were conducted. Figma software was used for app design and wireframing. Insights from 42 expert stakeholders were used during 3 sprint reviews. We consulted experts who were identified from councils around the Midlands region of the United Kingdom and charities through personal contacts and a snowballing approach. Results: Over 4 development sprints from August 2022 to March 2023, the app was iteratively designed and refined based on consultation with a diverse group of 42 experts who shared their knowledge about the content of common parenting programs and the challenges parents commonly face. Modifications made throughout the process resulted in significant app enhancements, including tailored timer algorithms and enhanced readability, as well as an onboarding zone, mindfulness module, and pictorial information to increase inclusivity. By the end of the fourth sprint, the app was deemed ready for home use by stakeholders, demonstrating the effectiveness of our agile scrum development approach. Conclusions: We developed an app to support parents to use the evidence-based time-out technique. We recommend the agile scrum approach to create mobile health apps. Our experience highlights the valuable role that frontline health and social care professionals, particularly those working with vulnerable families, can play as experts in scrum reviews. There is a need for research to both evaluate the impact of digital microinterventions on child behavioral change and also create digital microinterventions that cater to non–English speakers and individuals who participate in parenting programs in settings outside the United Kingdom. %M 38941594 %R 10.2196/54892 %U https://formative.jmir.org/2024/1/e54892 %U https://doi.org/10.2196/54892 %U http://www.ncbi.nlm.nih.gov/pubmed/38941594 %0 Journal Article %@ 2368-7959 %I JMIR Mental Health %V 11 %N %P e50535 %T The Efficacy of Web-Based Cognitive Behavioral Therapy With a Shame-Specific Intervention for Social Anxiety Disorder: Randomized Controlled Trial %A Wen,Xu %A Gou,Mengke %A Chen,Huijing %A Kishimoto,Tomoko %A Qian,Mingyi %A Margraf,Jürgen %A Berger,Thomas %K social anxiety disorder %K web-based cognitive behavioral therapy %K shame intervention %K mediating effects %K shame experience %D 2024 %7 27.6.2024 %9 %J JMIR Ment Health %G English %X Background: Social anxiety disorder (SAD) is one of the most prevalent psychological disorders and generally co-occurs with elevated shame levels. Previous shame-specific interventions could significantly improve outcomes in social anxiety treatments. Recent review suggests that integrating a more direct shame intervention could potentially increase the effectiveness of cognitive behavioral therapy. Web-based cognitive behavioral therapy (WCBT) has proven efficacy, sustaining benefits for 6 months to 4 years. Previous evidence indicated that shame predicted the reduction of social anxiety and mediated between engagements in exposure and changes in social anxiety during WCBT. Objective: This study aimed to design a shame intervention component through a longitudinal study and conduct a randomized controlled trial to investigate the effectiveness of a shame intervention component in reducing social anxiety symptoms and shame experience in a clinical sample of people with SAD. Methods: The development of a shame intervention component was informed by cognitive behavioral principles and insights from longitudinal data that measured the Experience of Shame Scale (ESS), the Coping Styles Questionnaire, and the Social Interaction Anxiety Scale (SIAS) in 153 participants. The psychoeducation, cognitive construct, and exposure sections were tailored to focus more on shame-related problem-solving and self-blame. A total of 1220 participants were recruited to complete questionnaires, including the ESS, the SIAS, the Social Phobia Scale (SPS), and diagnostic interviews. Following a 2-round screening process, 201 participants with SAD were randomly assigned into a shame WCBT group, a normal WCBT group, and a waiting group. After the 8-week WCBT intervention, the participants were asked to complete posttest evaluations, including the ESS, SIAS and SPS. Results: Participants in the shame WCBT group experienced significant reductions in shame levels after the intervention (ESS: P<.001; ηp2=0.22), and the reduction was greater in the shame intervention group compared to normal WCBT (P<.001; mean deviation −12.50). Participants in both the shame WCBT and normal WCBT groups experienced significant reductions in social anxiety symptoms (SIAS: P<.001; ηp2=0.32; SPS: P<.001; ηp2=0.19) compared to the waiting group after intervention. Furthermore, in the experience of social interaction anxiety (SIAS), the shame WCBT group showed a higher reduction compared to the normal WCBT group (P<.001; mean deviation −9.58). Problem-solving (SE 0.049, 95% CI 0.025-0.217) and self-blame (SE 0.082, 95% CI 0.024-0.339) mediated the effect between ESS and SIAS. Conclusions: This is the first study to design and incorporate a shame intervention component in WCBT and to validate its efficacy via a randomized controlled trial. The shame WCBT group showed a significant reduction in both shame and social anxiety after treatment compared to the normal WCBT and waiting groups. Problem-solving and self-blame mediated the effect of shame on social anxiety. In conclusion, this study supports previous findings that a direct shame-specific intervention component could enhance the efficacy of WCBT. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300072184; https://www.chictr.org.cn/showproj.html?proj=152757 %R 10.2196/50535 %U https://mental.jmir.org/2024/1/e50535 %U https://doi.org/10.2196/50535 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e54634 %T Long-Term Efficacy of a Mobile Mental Wellness Program: Prospective Single-Arm Study %A McCallum,Meaghan %A Baldwin,Matthew %A Thompson,Paige %A Blessing,Kelly %A Frisch,Maria %A Ho,Annabell %A Ainsworth,Matthew Cole %A Mitchell,Ellen Siobhan %A Michaelides,Andreas %A May,Christine N %+ Academic Research, Noom, Inc, 450 West 33rd Street, New York City, NY, 10001, United States, 1 8882665071, meaghanm@noom.com %K mHealth %K psychological distress %K Noom Mood %K digital mental wellness programs %K mobile phone %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Rising rates of psychological distress (symptoms of depression, anxiety, and stress) among adults in the United States necessitate effective mental wellness interventions. Despite the prevalence of smartphone app–based programs, research on their efficacy is limited, with only 14% showing clinically validated evidence. Our study evaluates Noom Mood, a commercially available smartphone-based app that uses cognitive behavioral therapy and mindfulness-based programming. In this study, we address gaps in the existing literature by examining postintervention outcomes and the broader impact on mental wellness. Objective: Noom Mood is a smartphone-based mental wellness program designed to be used by the general population. This prospective study evaluates the efficacy and postintervention outcomes of Noom Mood. We aim to address the rising psychological distress among adults in the United States. Methods: A 1-arm study design was used, with participants having access to the Noom Mood program for 16 weeks (N=273). Surveys were conducted at baseline, week 4, week 8, week 12, week 16, and week 32 (16 weeks’ postprogram follow-up). This study assessed a range of mental health outcomes, including anxiety symptoms, depressive symptoms, perceived stress, well-being, quality of life, coping, emotion regulation, sleep, and workplace productivity (absenteeism or presenteeism). Results: The mean age of participants was 40.5 (SD 11.7) years. Statistically significant improvements in anxiety symptoms, depressive symptoms, and perceived stress were observed by week 4 and maintained through the 16-week intervention and the 32-week follow-up. The largest changes were observed in the first 4 weeks (29% lower, 25% lower, and 15% lower for anxiety symptoms, depressive symptoms, and perceived stress, respectively), and only small improvements were observed afterward. Reductions in clinically relevant anxiety (7-item generalized anxiety disorder scale) and depression (8-item Patient Health Questionnaire depression scale) criteria were also maintained from program initiation through the 16-week intervention and the 32-week follow-up. Work productivity also showed statistically significant results, with participants gaining 2.57 productive work days from baseline at 16 weeks, and remaining relatively stable (2.23 productive work days gained) at follow-up (32 weeks). Additionally, effects across all coping, sleep disturbance (23% lower at 32 weeks), and emotion dysregulation variables exhibited positive and significant trends at all time points (15% higher, 23% lower, and 25% higher respectively at 32 weeks). Conclusions: This study contributes insights into the promising positive impact of Noom Mood on mental health and well-being outcomes, extending beyond the intervention phase. Though more rigorous studies are necessary to understand the mechanism of action at play, this exploratory study addresses critical gaps in the literature, highlighting the potential of smartphone-based mental wellness programs to lessen barriers to mental health support and improve diverse dimensions of well-being. Future research should explore the scalability, feasibility, and long-term adherence of such interventions across diverse populations. %M 38935946 %R 10.2196/54634 %U https://mhealth.jmir.org/2024/1/e54634 %U https://doi.org/10.2196/54634 %U http://www.ncbi.nlm.nih.gov/pubmed/38935946 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e54945 %T A Chatbot-Delivered Stress Management Coaching for Students (MISHA App): Pilot Randomized Controlled Trial %A Ulrich,Sandra %A Lienhard,Natascha %A Künzli,Hansjörg %A Kowatsch,Tobias %+ School of Applied Psychology, Zurich University of Applied Sciences, Pfingstweidstrasse 96, Zurich, 8005, Switzerland, 41 58 934 ext 8451, sandra.ulrich@zhaw.ch %K conversational agent %K mobile health %K mHealth %K smartphone %K stress management %K lifestyle %K behavior change %K coaching %K mobile phone %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Globally, students face increasing mental health challenges, including elevated stress levels and declining well-being, leading to academic performance issues and mental health disorders. However, due to stigma and symptom underestimation, students rarely seek effective stress management solutions. Conversational agents in the health sector have shown promise in reducing stress, depression, and anxiety. Nevertheless, research on their effectiveness for students with stress remains limited. Objective: This study aims to develop a conversational agent–delivered stress management coaching intervention for students called MISHA and to evaluate its effectiveness, engagement, and acceptance. Methods: In an unblinded randomized controlled trial, Swiss students experiencing stress were recruited on the web. Using a 1:1 randomization ratio, participants (N=140) were allocated to either the intervention or waitlist control group. Treatment effectiveness on changes in the primary outcome, that is, perceived stress, and secondary outcomes, including depression, anxiety, psychosomatic symptoms, and active coping, were self-assessed and evaluated using ANOVA for repeated measure and general estimating equations. Results: The per-protocol analysis revealed evidence for improvement of stress, depression, and somatic symptoms with medium effect sizes (Cohen d=−0.36 to Cohen d=−0.60), while anxiety and active coping did not change (Cohen d=−0.29 and Cohen d=0.13). In the intention-to-treat analysis, similar results were found, indicating reduced stress (β estimate=−0.13, 95% CI −0.20 to −0.05; P<.001), depressive symptoms (β estimate=−0.23, 95% CI −0.38 to −0.08; P=.003), and psychosomatic symptoms (β estimate=−0.16, 95% CI −0.27 to −0.06; P=.003), while anxiety and active coping did not change. Overall, 60% (42/70) of the participants in the intervention group completed the coaching by completing the postintervention survey. They particularly appreciated the quality, quantity, credibility, and visual representation of information. While individual customization was rated the lowest, the target group fitting was perceived as high. Conclusions: Findings indicate that MISHA is feasible, acceptable, and effective in reducing perceived stress among students in Switzerland. Future research is needed with different populations, for example, in students with high stress levels or compared to active controls. Trial Registration: German Clinical Trials Register DRKS 00030004; https://drks.de/search/en/trial/DRKS00030004 %M 38922677 %R 10.2196/54945 %U https://mhealth.jmir.org/2024/1/e54945 %U https://doi.org/10.2196/54945 %U http://www.ncbi.nlm.nih.gov/pubmed/38922677 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55722 %T Applying Meaning and Self-Determination Theory to the Development of a Web-Based mHealth Physical Activity Intervention: Proof-of-Concept Pilot Study %A Hooker,Stephanie A %A Crain,A Lauren %A Muegge,Jule %A Rossom,Rebecca C %A Pronk,Nicolaas P %A Pasumarthi,Dhavan Prasad %A Kunisetty,Gopikrishna %A Masters,Kevin S %+ Division of Research and Evaluation, HealthPartners Institute, 8170 33rd Ave S MS21112R, Minneapolis, MN, 55425, United States, 1 9529675056, stephanie.a.hooker@healthpartners.com %K physical activity %K midlife %K digital health %K SMS text messaging %K theory-based %K meaning in life %K mobile phone %D 2024 %7 25.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Meaning in life is positively associated with health, well-being, and longevity, which may be partially explained by engagement in healthier behaviors, including physical activity (PA). However, promoting awareness of meaning is a behavior change strategy that has not been tested in previous PA interventions. Objective: This study aims to develop, refine, and pilot-test the Meaningful Activity Program (MAP; MAP to Health), a web-based mobile health PA intervention, theoretically grounded in meaning and self-determination theory, for insufficiently active middle-aged adults. Methods: Following an iterative user-testing and refinement phase, we used a single-arm double baseline proof-of-concept pilot trial design. Participants included 35 insufficiently active adults in midlife (aged 40-64 years) interested in increasing their PA. After a 4-week baseline period, participants engaged in MAP to Health for 8 weeks. MAP to Health used a web-based assessment and just-in-time SMS text messaging to individualize the intervention; promote meaning salience; support the basic psychological needs of autonomy, competence, and relatedness; and increase PA. Participants completed measures of the hypothesized mechanisms of behavior change, including meaning salience, needs satisfaction, and autonomous motivation at pretest (−4 weeks), baseline (0 weeks), midpoint (4 weeks), and posttest (8 weeks) time points, and wore accelerometers for the study duration. At the end of the intervention, participants completed a qualitative interview. Mixed models compared changes in behavioral mechanisms during the intervention to changes before the intervention. Framework matrix analyses were used to analyze qualitative data. Results: Participants were aged 50.8 (SD 8.2) years on average; predominantly female (27/35, 77%); and 20% (7/35) Asian, 9% (3/35) Black or African American, 66% (23/35) White, and 6% (2/35) other race. Most (32/35, 91%) used MAP to Health for ≥5 of 8 weeks. Participants rated the intervention as easy to use (mean 4.3, SD 0.8 [out of 5.0]) and useful (mean 4.3, SD 0.6). None of the hypothesized mechanisms changed significantly during the preintervention phase (Cohen d values <0.15). However, autonomy (P<.001; Cohen d=0.76), competence (P<.001; Cohen d=0.65), relatedness (P=.004; Cohen d=0.46), autonomous motivation (P<.001; Cohen d=0.37), and meaning salience (P<.001; Cohen d=0.40) increased significantly during the intervention. Comparison of slopes before the intervention versus during the intervention revealed that increases during the intervention were significantly greater for autonomy (P=.002), competence (P<.001), and meaning salience (P=.001); however, slopes were not significantly different for relatedness (P=.10) and autonomous motivation (P=.17). Qualitative themes offered suggestions for improvement. Conclusions: MAP to Health was acceptable to participants, feasible to deliver, and associated with increases in the target mechanisms of behavior change. This is the first intervention to use meaning as a behavior change strategy in a PA intervention. Future research will test the efficacy of the intervention in increasing PA compared to a control condition. %M 38917457 %R 10.2196/55722 %U https://formative.jmir.org/2024/1/e55722 %U https://doi.org/10.2196/55722 %U http://www.ncbi.nlm.nih.gov/pubmed/38917457 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e55100 %T Digital and Hybrid Pediatric and Youth Mental Health Program Implementation Challenges During the Pandemic: Literature Review With a Knowledge Translation and Theoretical Lens Analysis %A Lyzwinski,Lynnette %A Mcdonald,Sheila %A Zwicker,Jennifer %A Tough,Suzanne %+ Department of Paediatrics, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr, Calgary, AB, T2N4N1, Canada, 1 403 220 6843, Lynnette.Lyzwinski@ucalgary.ca %K mental health %K knowledge translation %K KT %K flourishing %K youth %K teenagers %K mindfulness %K positive psychology %K telehealth %K implementation %K knowledge dissemination %K pandemic %K COVID-19 %K service delivery %D 2024 %7 25.6.2024 %9 Review %J JMIR Pediatr Parent %G English %X Background: The pandemic brought unprecedented challenges for child and youth mental health. There was a rise in depression, anxiety, and symptoms of suicidal ideation. Objective: The aims of this knowledge synthesis were to gain a deeper understanding of what types of mental health knowledge translation (KT) programs, mental health first aid training, and positive psychology interventions were developed and evaluated for youth mental health. Methods: We undertook a literature review of PubMed and MEDLINE for relevant studies on youth mental health including digital and hybrid programs undertaken during the pandemic (2020-2022). Results: A total of 60 studies were included in this review. A few KT programs were identified that engaged with a wide range of stakeholders during the pandemic, and a few were informed by KT theories. Key challenges during the implementation of mental health programs for youth included lack of access to technology and privacy concerns. Hybrid web-based and face-to-face KT and mental health care were recommended. Providers required adequate training in using telehealth and space. Conclusions: There is an opportunity to reduce the barriers to implementing tele–mental health in youth by providing adequate technological access, Wi-Fi and stationary internet connectivity, and privacy protection. Staff gained new knowledge and training from the pandemic experience of using telehealth, which will serve as a useful foundation for the future. Future research should aim to maximize the benefits of hybrid models of tele–mental health and face-to-face sessions while working on minimizing the potential barriers that were identified. In addition, future programs could consider combining mental health first aid training with hybrid digital and face-to-face mental health program delivery along with mindfulness and resilience building in a unified model of care, knowledge dissemination, and implementation. %M 38916946 %R 10.2196/55100 %U https://pediatrics.jmir.org/2024/1/e55100 %U https://doi.org/10.2196/55100 %U http://www.ncbi.nlm.nih.gov/pubmed/38916946 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48298 %T Improvement and Maintenance of Clinical Outcomes in a Digital Mental Health Platform: Findings From a Longitudinal Observational Real-World Study %A Roos,Lydia G %A Sagui-Henson,Sara J %A Castro Sweet,Cynthia %A Welcome Chamberlain,Camille E %A Smith,Brooke J %+ Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90024, United States, 1 8435446005, lroos@mednet.ucla.edu %K digital mental health %K employee health %K depression %K anxiety %K well-being %K mobile phone %D 2024 %7 24.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital mental health services are increasingly being provided by employers as health benefit programs that can improve access to and remove barriers to mental health care. Stratified care models, in particular, offer personalized care recommendations that can offer clinically effective interventions while conserving resources. Nonetheless, clinical evaluation is needed to understand their benefits for mental health and their use in a real-world setting. Objective: This study aimed to examine the changes in clinical outcomes (ie, depressive and anxiety symptoms and well-being) and to evaluate the use of stratified blended care among members of an employer-sponsored digital mental health benefit. Methods: In a large prospective observational study, we examined the changes in depressive symptoms (9-item Patient Health Questionnaire), anxiety symptoms (7-item Generalized Anxiety Disorder scale), and well-being (5-item World Health Organization Well-Being Index) for 3 months in 509 participants (mean age 33.9, SD 8.7 years; women: n=312, 61.3%; men: n=175, 34.4%; nonbinary: n=22, 4.3%) who were newly enrolled and engaged in care with an employer-sponsored digital mental health platform (Modern Health Inc). We also investigated the extent to which participants followed the recommendations provided to them through a stratified blended care model. Results: Participants with elevated baseline symptoms of depression and anxiety exhibited significant symptom improvements, with a 37% score improvement in depression and a 29% score improvement in anxiety (P values <.001). Participants with baseline scores indicative of poorer well-being also improved over the study period (90% score improvement; P=.002). Furthermore, over half exhibited clinical improvement or recovery for depressive symptoms (n=122, 65.2%), anxiety symptoms (n=127, 59.1%), and low well-being (n=82, 64.6%). Among participants with mild or no baseline symptoms, we found high rates of maintenance for low depressive (n=297, 92.2%) and anxiety (n=255, 86.7%) symptoms and high well-being (n=344, 90.1%). In total, two-thirds of the participants (n=343, 67.4%) used their recommended care, 16.9% (n=86) intensified their care beyond their initial recommendation, and 15.7% (n=80) of participants underused care by not engaging with the highest level of care recommended to them. Conclusions: Participants with elevated baseline depressive or anxiety symptoms improved their mental health significantly from baseline to follow-up, and most participants without symptoms or with mild symptoms at baseline maintained their mental health over time. In addition, engagement patterns indicate that the stratified blended care model was efficient in matching individuals with the most effective and least costly care while also allowing them to self-determine their care and use combinations of services that best fit their needs. Overall, the results of this study support the clinical effectiveness of the platform for improving and preserving mental health and support the utility and effectiveness of stratified blended care models to improve access to and use of digitally delivered mental health services. %M 38913405 %R 10.2196/48298 %U https://mhealth.jmir.org/2024/1/e48298 %U https://doi.org/10.2196/48298 %U http://www.ncbi.nlm.nih.gov/pubmed/38913405 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56357 %T Interactive Electronic Pegboard for Enhancing Manual Dexterity and Cognitive Abilities: Instrument Usability Study %A Chien,Shih-Ying %A Wong,Alice MK %A Wu,Ching-Yi %A Beckman,Sara L %+ Department of Industrial Design, Chang Gung University, No.259, Wen-Hwa 1st Road, Kweishan, Taoyuan, 333, Taiwan, 886 3 2118800 ext 5669, shihying@mail.cgu.edu.tw %K interactive electronic pegboard %K stroke %K hand dexterity %K cognitive rehabilitation %K system %D 2024 %7 21.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Strokes pose a substantial health burden, impacting 1 in 6 people globally. One-tenth of patients will endure a second, often more severe, stroke within a year. Alarmingly, a younger demographic is being affected due to recent lifestyle changes. As fine motor and cognitive issues arise, patient disability as well as the strain on caregivers and health care resources is exacerbated. Contemporary occupational therapy assesses manual dexterity and cognitive functions through object manipulation and pen-and-paper recordings. However, these assessments are typically isolated, which makes it challenging for therapists to comprehensively evaluate specific patient conditions. Furthermore, the reliance on one-on-one training and assessment approaches on manual documentation is inefficient and prone to transcription errors. Objective: This study examines the feasibility of using an interactive electronic pegboard for stroke rehabilitation in clinical settings. Methods: A total of 10 patients with a history of stroke and 10 healthy older individuals were recruited. With a limit of 10 minutes, both groups of participants underwent a series of challenges involving tasks related to manual operation, shape recognition, and color discrimination. All participants underwent the Box and Block Test and the Purdue Pegboard Test to assess manual dexterity, as well as an array of cognitive assessments, including the Trail Making Test and the Mini-Mental Status Examination, which served as a basis to quantify participants’ attention, executive functioning, and cognitive abilities. Results: The findings validate the potential application of an interactive electronic pegboard for stroke rehabilitation in clinical contexts. Significant statistical differences (P<.01) were observed across all assessed variables, including age, Box and Block Test results, Purdue Pegboard Test outcomes, Trail Making Test-A scores, and Mini-Mental Status Examination performance, between patients with a history of stroke and their healthy older counterparts. Functional and task testing, along with questionnaire interviews, revealed that patients with a history of stroke demonstrated prolonged completion times and slightly inferior performance. Nonetheless, most patients perceived the prototype as user-friendly and engaging. Thus, in the context of patient rehabilitation interventions or the evaluation of patient cognition, physical functioning, or manual dexterity assessments, the developed pegboard could potentially serve as a valuable tool for hand function, attention, and cognitive rehabilitation, thereby mitigating the burden on health care professionals. Conclusions: Health care professionals can use digital electronic pegboards not only as a precise one-on-one training tool but also as a flexible system that can be configured for online or offline, single-player or multiplayer use. Through data analysis, a more informed examination of patients’ cognitive and functional issues can be conducted. Importantly, patient records will be fully retained throughout practices, exercises, or tests, and by leveraging the characteristics of big data, patients can receive the most accurate rehabilitation prescriptions, thereby assisting them in obtaining optimal care. %M 38904991 %R 10.2196/56357 %U https://humanfactors.jmir.org/2024/1/e56357 %U https://doi.org/10.2196/56357 %U http://www.ncbi.nlm.nih.gov/pubmed/38904991 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49077 %T Nutrients and Foods Recommended for Blood Pressure Control on Twitter in Japan: Content Analysis %A Terada,Marina %A Okuhara,Tsuyoshi %A Yokota,Rie %A Kiuchi,Takahiro %A Murakami,Kentaro %+ Department of Health Communication, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, 81 358006549, marimomo@g.ecc.u-tokyo.ac.jp %K Twitter %K food %K nutrition %K misinformation %K salt %K content analysis %K hypertension %K blood pressure %K sodium %K salt reduction %D 2024 %7 20.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Management and prevention of hypertension are important public health issues. Healthy dietary habits are one of the modifiable factors. As Twitter (subsequently rebranded X) is a digital platform that can influence public eating behavior, there is a knowledge gap regarding the information about foods and nutrients recommended for blood pressure control and who disseminates them on Twitter. Objective: This study aimed to investigate the nature of the information people are exposed to on Twitter regarding nutrients and foods for blood pressure control. Methods: A total of 147,898 Japanese tweets were extracted from January 1, 2022, to December 31, 2022. The final sample of 2347 tweets with at least 1 retweet was manually coded into categories of food groups, nutrients, user characteristics, and themes. The number and percentage of tweets, retweets, and themes in each category were calculated. Results: Of the 2347 tweets, 80% (n=1877) of tweets mentioned foods, which were categorized into 17 different food groups. Seasonings and spices, including salt, were most frequently mentioned (1356/1877, 72.2%). This was followed by vegetable and fruit groups. The 15 kinds of nutrients were mentioned in 1566 tweets, with sodium being the largest proportion at 83.1% (n=1301), followed by potassium at 8.4% (n=132). There was misinformation regarding salt intake for hypertension, accounting for 40.8% (n=531) of tweets referring to salt, including recommendations for salt intake to lower blood pressure. In total, 75% (n=21) of tweets from “doctors” mentioned salt reduction is effective for hypertension control, while 31.1% (n=74) of tweets from “health, losing weight, and beauty-related users,” 25.9% (n=429) of tweets from “general public,” and 23.5% (n=4) tweets from “dietitian or registered dietitian” denied salt reduction for hypertension. The antisalt reduction tweets accounted for 31.5% (n=106) of the most disseminated tweets related to nutrients and foods for blood pressure control. Conclusions: The large number of tweets in this study indicates a high interest in nutrients and foods for blood pressure control. Misinformation asserting antisalt reduction was posted primarily by the general public and self-proclaimed health experts. The number of tweets from nutritionists, registered dietitians, and doctors who were expected to correct misinformation and promote salt reduction was relatively low, and their messages were not always positive toward salt reduction. There is a need for communication strategies to combat misinformation, promote correct information on salt reduction, and train health care professionals to effectively communicate evidence-based information on this topic. %M 38901016 %R 10.2196/49077 %U https://www.jmir.org/2024/1/e49077 %U https://doi.org/10.2196/49077 %U http://www.ncbi.nlm.nih.gov/pubmed/38901016 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e46303 %T Digital Smoking Cessation Intervention for Cancer Survivors: Analysis of Predictors and Moderators of Engagement and Outcome Alongside a Randomized Controlled Trial %A Andree,Rosa %A Mujcic,Ajla %A den Hollander,Wouter %A van Laar,Margriet %A Boon,Brigitte %A Engels,Rutger %A Blankers,Matthijs %+ Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Da Costakade 45, Utrecht, 3521 VS, Netherlands, 31 30 29 59 267, randree@trimbos.nl %K smoking cessation %K cancer survivors %K engagement %K digital intervention %K eHealth %K smoking %K intervention %K randomized controlled trial %K predictor %K RCT %K smoking %K smoker %K addict %K cessation %K quit %K cancer %K oncology %D 2024 %7 20.6.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Recent studies have shown positive, though small, clinical effects of digital smoking cessation (SC) interventions for cancer survivors. However, research on associations among participant characteristics, intervention engagement, and outcomes is limited. Objective: This study aimed to explore the predictors and moderators of engagement and outcome of MyCourse-Quit Smoking (in Dutch: “MijnKoers-Stoppen met Roken”), a digital minimally guided intervention for cancer survivors. Methods: A secondary analysis of data from the randomized controlled trial was performed. The number of cigarettes smoked in the past 7 days at 6-month follow-up was the primary outcome measure. We analyzed interactions among participant characteristics (11 variables), intervention engagement (3 variables), and outcome using robust linear (mixed) modeling. Results: In total, 165 participants were included in this study. Female participants accessed the intervention less often than male participants (B=–11.12; P=.004). A higher Alcohol Use Disorders Identification Test score at baseline was associated with a significantly higher number of logins (B=1.10; P<.001) and diary registrations (B=1.29; P<.001). A higher Fagerström Test for Nicotine Dependence score at baseline in the intervention group was associated with a significantly larger reduction in tobacco use after 6 months (B=–9.86; P=.002). No other associations and no moderating effects were found. Conclusions: Overall, a limited number of associations was found between participant characteristics, engagement, and outcome, except for gender, problematic alcohol use, and nicotine dependence. Future studies are needed to shed light on how this knowledge can be used to improve the effects of digital SC programs for cancer survivors. Trial Registration: Netherlands Trial register NTR6011/NL5434; https://onderzoekmetmensen.nl/nl/trial/22832 %R 10.2196/46303 %U https://cancer.jmir.org/2024/1/e46303 %U https://doi.org/10.2196/46303 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50248 %T Effectiveness of a Multifaceted Mobile Health Intervention (Multi-Aid-Package) in Medication Adherence and Treatment Outcomes Among Patients With Hypertension in a Low- to Middle-Income Country: Randomized Controlled Trial %A Arshed,Muhammad %A Mahmud,Aidalina %A Minhat,Halimatus Sakdiah %A Lim,Poh Ying %A Zakar,Rubeena %+ Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Serdang, 43400, Malaysia, 60 397692416, aidalina@upm.edu.my %K mobile health %K mHealth %K intervention %K medication adherence %K hypertension %K low- to middle-income country %K effectiveness %K randomized controlled trial %K Pakistan %K drug adherence %K tool %K mHealth module %K self-efficacy %K systolic blood pressure %K feedback %D 2024 %7 19.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The high prevalence of uncontrolled hypertension in Pakistan is predominantly attributed to poor medication adherence. As more than 137 million people in Pakistan use cell phones, a suitable mobile health (mHealth) intervention can be an effective tool to overcome poor medication adherence. Objective: We sought to determine whether a novel mHealth intervention is useful in enhancing antihypertensive therapy adherence and treatment outcomes among patients with hypertension in a low- to middle-income country. Methods: A 6-month parallel, single-blinded, superiority randomized controlled trial recruited 439 patients with hypertension with poor adherence to antihypertensive therapy and access to smartphones. An innovative, multifaceted mHealth intervention (Multi-Aid-Package), based on the Health Belief Model and containing reminders (written, audio, visual), infographics, video clips, educational content, and 24/7 individual support, was developed for the intervention group; the control group received standard care. The primary outcome was self-reported medication adherence measured using the Self-Efficacy for Appropriate Medication Adherence Scale (SEAMS) and pill counting; the secondary outcome was systolic blood pressure (SBP) change. Both outcomes were evaluated at baseline and 6 months. Technology acceptance feedback was also assessed at the end of the study. A generalized estimating equation was used to control the covariates associated with the probability of affecting adherence to antihypertensive medication. Results: Of 439 participants, 423 (96.4%) completed the study. At 6 months post intervention, the median SEAMS score was statistically significantly higher in the intervention group compared to the controls (median 32, IQR 11 vs median 21, IQR 6; U=10,490, P<.001). Within the intervention group, there was an increase in the median SEAMS score by 12.5 points between baseline and 6 months (median 19.5, IQR 5 vs median 32, IQR 11; P<.001). Results of the pill-counting method showed an increase in adherent patients in the intervention group compared to the controls (83/220, 37.2% vs 2/219, 0.9%; P<.001), as well as within the intervention group (difference of n=83, 37.2% of patients, baseline vs 6 months; P<.001). There was a statistically significant difference in the SBP of 7 mmHg between the intervention and control groups (P<.001) at 6 months, a 4 mmHg reduction (P<.001) within the intervention group, and a 3 mmHg increase (P=.314) within the controls. Overall, the number of patients with uncontrolled hypertension decreased by 46 in the intervention group (baseline vs 6 months), but the control group remained unchanged. The variables groups (adjusted odds ratio [AOR] 1.714, 95% CI 2.387-3.825), time (AOR 1.837, 95% CI 1.625-2.754), and age (AOR 1.618, 95% CI 0.225-1.699) significantly contributed (P<.001) to medication adherence. Multi-Aid-Package received a 94.8% acceptability score. Conclusions: The novel Multi-Aid-Package is an effective mHealth intervention for enhancing medication adherence and treatment outcomes among patients with hypertension in a low- to middle-income country. Trial Registration: ClinicalTrials.gov NCT04577157; https://clinicaltrials.gov/study/NCT04577157 %M 38896837 %R 10.2196/50248 %U https://mhealth.jmir.org/2024/1/e50248 %U https://doi.org/10.2196/50248 %U http://www.ncbi.nlm.nih.gov/pubmed/38896837 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e50503 %T Web-Based, Human-Guided, or Computer-Guided Transdiagnostic Cognitive Behavioral Therapy in University Students With Anxiety and Depression: Randomized Controlled Trial %A Koelen,Jurrijn %A Klein,Anke %A Wolters,Nine %A Bol,Eline %A De Koning,Lisa %A Roetink,Samantha %A Van Blom,Jorien %A Boutin,Bruno %A Schaaf,Jessica %A Grasman,Raoul %A Van der Heijde,Claudia Maria %A Salemink,Elske %A Riper,Heleen %A Karyotaki,Eirini %A Cuijpers,Pim %A Schneider,Silvia %A Rapee,Ronald %A Vonk,Peter %A Wiers,Reinout %+ Department of Developmental Psychology, University of Amsterdam, P.O.Box 15916, 1001 NK, Amsterdam, Netherlands, 31 20 5256842, r.w.h.j.wiers@uva.nl %K internet-based cognitive behavioral intervention %K iCBT %K university students %K transdiagnostic %K human guidance %K technological guidance %D 2024 %7 19.6.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Internet-based cognitive behavioral interventions (iCBTs) are efficacious treatments for depression and anxiety. However, it is unknown whether adding human guidance is feasible and beneficial within a large educational setting. Objective: This study aims to potentially demonstrate the superiority of 2 variants of a transdiagnostic iCBT program (human-guided and computer-guided iCBT) over care as usual (CAU) in a large sample of university students and the superiority of human-guided iCBT over computer-guided iCBT. Methods: A total of 801 students with elevated levels of anxiety, depression, or both from a large university in the Netherlands were recruited as participants and randomized to 1 of 3 conditions: human-guided iCBT, computer-guided iCBT, and CAU. The primary outcome measures were depression (Patient Health Questionnaire) and anxiety (Generalized Anxiety Disorder scale). Secondary outcomes included substance use–related problems (Alcohol Use Disorder Identification Test and Drug Abuse Screening Test—10 items). Linear mixed models were used to estimate the effects of time, treatment group, and their interactions (slopes). The primary research question was whether the 3 conditions differed in improvement over 3 time points (baseline, midtreatment, and after treatment) in terms of depression and anxiety symptoms. Results were analyzed according to the intention-to-treat principle using multiple imputation. Patients were followed exploratively from baseline to 6 and 12 months. Results: In both short-term and long-term analyses, the slopes for the 3 conditions did not differ significantly in terms of depression and anxiety, although both web-based interventions were marginally more efficacious than CAU over 6 months (P values between .02 and .03). All groups showed significant improvement over time (P<.001). For the secondary outcomes, only significant improvements over time (across and not between groups) were found for drug use (P<.001). Significant differences were found in terms of adherence, indicating that participants in the human-guided condition did more sessions than those in the computer-guided condition (P=.002). Conclusions: The transdiagnostic iCBT program offers a practical, feasible, and efficacious alternative to usual care to tackle mental health problems in a large university setting. There is no indication that human guidance should be preferred over technological guidance. The potential preference of human support also depends on the scale of implementation and cost-effectiveness, which need to be addressed in future trials. Trial Registration: International Clinical Trials Registry Platform NL7328/NTR7544; https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON26795 %M 38896474 %R 10.2196/50503 %U https://mental.jmir.org/2024/1/e50503 %U https://doi.org/10.2196/50503 %U http://www.ncbi.nlm.nih.gov/pubmed/38896474 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52494 %T Adapting an Efficacious Peer-Delivered Physical Activity Program for Survivors of Breast Cancer for Web Platform Delivery: Protocol for a 2-Phase Study %A Pinto,Bernardine M %A Patel,Ashwin %A Ostendorf,Danielle M %A Huebschmann,Amy G %A Dunsiger,Shira I %A Kindred,Madison M %+ College of Nursing, University of South Carolina, 1601 Greene Street, Rm 302B, Columbia, SC, 29208, United States, 1 8037779272, Pintob@mailbox.sc.edu %K physical activity adoption %K web platform %K breast cancer survivors %K design %K implementation %K cost-effectiveness %K mobile phone %D 2024 %7 19.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Interventions promoting physical activity (PA) among survivors of cancer improve their functioning, reduce fatigue, and offer other benefits in cancer recovery and risk reduction for future cancer. There is a need for interventions that can be implemented on a wider scale than that is possible in research settings. We have previously demonstrated that a 3-month peer-delivered PA program (Moving Forward Together [MFT]) significantly increased the moderate to vigorous PA (MVPA) of survivors of breast cancer. Objective: Our goal is to scale up the MFT program by adapting an existing peer mentoring web platform, Mentor1to1. InquistHealth’s web platform (Mentor1to1) has demonstrated efficacy in peer mentoring for chronic disease management. We will partner with InquisitHealth to adapt their web platform for MFT. The adaptation will allow for automating key resource-intensive components such as matching survivors with a coach via the web-based peer mentoring platform and collecting key indexes to prepare for large-scale implementation. The aim is to streamline intervention delivery, assure fidelity, and improve survivor outcomes. Methods: In phase 1 of this 2-phase study, we will interview 4 peer mentors or coaches with experience in delivering MFT and use their feedback to create Mentor1to1 web platform adapted for MFT (webMFT). Next, another 4 coaches will participate in rapid, iterative user-centered testing of webMFT. In phase 2, we will conduct a randomized controlled trial by recruiting and training 10 to 12 coaches from cancer organizations to deliver webMFT to 56 survivors of breast cancer, who will be assigned to receive either webMFT or MVPA tracking (control) for 3 months. We will assess effectiveness with survivors’ accelerometer-measured MVPA and self-reported psychosocial well-being at baseline and 3 months. We will assess implementation outcomes, including acceptability, feasibility, and program costs from the perspective of survivors, coaches, and collaborating organizations, as guided by the expanded Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Results: As of September 2023, phase 1 of the study was completed, and 61 survivors were enrolled in phase 2. Using newer technologies for enhanced intervention delivery, program management, and automated data collection has the exciting promise of facilitating effective implementation by organizations with limited resources. Adapting evidence-based MFT to a customized web platform and collecting data at multiple levels (coaches, survivors, and organizations) along with costs will provide a strong foundation for a robust multisite implementation trial to increase MVPA and its benefits among many more survivors of breast cancer. Conclusions: The quantitative and qualitative data collected from survivors of cancer, coaches, and organizations will be analyzed to inform a future larger-scale trial of peer mentoring for PA delivered by cancer care organizations to survivors. Trial Registration: ClinicalTrials.gov NCT05409664; https://clinicaltrials.gov/study/NCT05409664 International Registered Report Identifier (IRRID): DERR1-10.2196/52494 %M 38896452 %R 10.2196/52494 %U https://www.researchprotocols.org/2024/1/e52494 %U https://doi.org/10.2196/52494 %U http://www.ncbi.nlm.nih.gov/pubmed/38896452 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55842 %T Digital Phenotyping of Geriatric Depression Using a Community-Based Digital Mental Health Monitoring Platform for Socially Vulnerable Older Adults and Their Community Caregivers: 6-Week Living Lab Single-Arm Pilot Study %A Song,Sunmi %A Seo,YoungBin %A Hwang,SeoYeon %A Kim,Hae-Young %A Kim,Junesun %+ Department of Health and Environmental Science, Undergraduate School, Korea University, 661 B-Hana Science Building, Seongbuk-gu, Seoul, 02841, Republic of Korea, 82 2 3290 5689, junokim@korea.ac.kr %K depression %K monitoring system %K IoT %K AI %K wearable device %K digital mental health phenotyping %K living lab %K senior care %K Internet of Things %K artificial intelligence %D 2024 %7 17.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the increasing need for digital services to support geriatric mental health, the development and implementation of digital mental health care systems for older adults have been hindered by a lack of studies involving socially vulnerable older adult users and their caregivers in natural living environments. Objective: This study aims to determine whether digital sensing data on heart rate variability, sleep quality, and physical activity can predict same-day or next-day depressive symptoms among socially vulnerable older adults in their everyday living environments. In addition, this study tested the feasibility of a digital mental health monitoring platform designed to inform older adult users and their community caregivers about day-to-day changes in the health status of older adults. Methods: A single-arm, nonrandomized living lab pilot study was conducted with socially vulnerable older adults (n=25), their community caregivers (n=16), and a managerial social worker over a 6-week period during and after the COVID-19 pandemic. Depressive symptoms were assessed daily using the 9-item Patient Health Questionnaire via scripted verbal conversations with a mobile chatbot. Digital biomarkers for depression, including heart rate variability, sleep, and physical activity, were measured using a wearable sensor (Fitbit Sense) that was worn continuously, except during charging times. Daily individualized feedback, using traffic signal signs, on the health status of older adult users regarding stress, sleep, physical activity, and health emergency status was displayed on a mobile app for the users and on a web application for their community caregivers. Multilevel modeling was used to examine whether the digital biomarkers predicted same-day or next-day depressive symptoms. Study staff conducted pre- and postsurveys in person at the homes of older adult users to monitor changes in depressive symptoms, sleep quality, and system usability. Results: Among the 31 older adult participants, 25 provided data for the living lab and 24 provided data for the pre-post test analysis. The multilevel modeling results showed that increases in daily sleep fragmentation (P=.003) and sleep efficiency (P=.001) compared with one’s average were associated with an increased risk of daily depressive symptoms in older adults. The pre-post test results indicated improvements in depressive symptoms (P=.048) and sleep quality (P=.02), but not in the system usability (P=.18). Conclusions: The findings suggest that wearable sensors assessing sleep quality may be utilized to predict daily fluctuations in depressive symptoms among socially vulnerable older adults. The results also imply that receiving individualized health feedback and sharing it with community caregivers may help improve the mental health of older adults. However, additional in-person training may be necessary to enhance usability. Trial Registration: ClinicalTrials.gov NCT06270121; https://clinicaltrials.gov/study/NCT06270121 %M 38885033 %R 10.2196/55842 %U https://mhealth.jmir.org/2024/1/e55842 %U https://doi.org/10.2196/55842 %U http://www.ncbi.nlm.nih.gov/pubmed/38885033 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50557 %T Web-Based Tool Designed to Encourage Supplemental Nutrition Assistance Program Use in Urban College Students: Usability Testing Study %A Li,Catherine Yan Hei %A Platkin,Charles %A Chin,Jonathan %A Khan,Asia %A Bennett,Jaleel %A Speck,Anna %A Nielsen,Annette %A Leung,May May %+ Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, United States, 1 617 636 3676, maymay.leung@tufts.edu %K SNAP %K SNAP eligibility screening %K food insecurity %K college students %K web-based tool %K think-aloud %K system usability %K user experience %K student %K college %K chronic health %K stress %K anxiety %K barrier %K technology %K tool %K Supplemental Nutrition Assistance Program %K usability %D 2024 %7 13.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Food insecurity continues to be a risk for college students in the United States. It is associated with numerous problems, such as chronic health conditions, increased stress and anxiety, and a lower grade point average. After COVID-19, the Supplemental Nutrition Assistance Program (SNAP) benefits were extended to college-aged students; however, there were some barriers to participation, which persisted such as lack of perceived food insecurity risk, lack of knowledge regarding the SNAP application process, the complexity of determining eligibility, and stigma associated with needing social assistance. A technology-enhanced tool was developed to address these barriers to SNAP enrollment and encourage at-risk college students to apply for SNAP. Objective: The purpose of this study was to test the usability and acceptability of a web-based SNAP screening tool designed for college-aged students. Methods: College students aged 18-25 years were recruited to participate in 2 rounds of usability testing during fall 2022. Participants tested the prototype of a web-based SNAP screener tool using a standardized think-aloud method. The usability and acceptability of the tool were assessed using a semistructured interview and a 10-item validated System Usability Scale questionnaire. Audio recordings and field notes were systematically reviewed by extracting and sorting feedback as positive or negative comments. System Usability Scale questionnaire data were analyzed using the Wilcoxon signed rank test and sign test. Results: A total of 12 students (mean age 21.8, SD 2.8 years; n=6, 50% undergraduate; n=11, 92% female; n=7, 58% Hispanic or Black or African American; n=9, 78% low or very low food security) participated in both rounds of user testing. Round 1 testing highlighted overall positive experiences with the tool, with most participants (10/12) stating that the website fulfills its primary objective as a support tool to encourage college students to apply for SNAP. However, issues related to user interface design, navigation, and wording of some questions in the screening tool were noted. Key changes after round 1 reflected these concerns, including improved design of response buttons and tool logo and improved clarity of screening questions. The overall system usability showed slight, but not statistically significant, improvement between round 1 and round 2 (91.25 vs 92.50; P=.10, respectively). Conclusions: Overall usability findings suggest that this web-based tool was highly usable and acceptable to urban college students and could be an effective and appealing approach as a support tool to introduce college students to the SNAP application process. The findings from this study will inform further development of the tool, which could eventually be disseminated publicly among various college campuses. %M 38869926 %R 10.2196/50557 %U https://formative.jmir.org/2024/1/e50557 %U https://doi.org/10.2196/50557 %U http://www.ncbi.nlm.nih.gov/pubmed/38869926 %0 Journal Article %@ 2291-5222 %I %V 12 %N %P e54946 %T Engagement in mHealth-Prompted Self-Measured Blood Pressure Monitoring Among Participants Recruited From a Safety-Net Emergency Department: Secondary Analysis of the Reach Out Trial %A Skolarus,Lesli E %A Lin,Chun Chieh %A Mishra,Sonali %A Meurer,William %A Dinh,Mackenzie %A Whitfield,Candace %A Bi,Ran %A Brown,Devin %A Oteng,Rockefeller %A Buis,Lorraine R %A Kidwell,Kelley %K hypertension %K self-measured blood pressure %K mobile health %K blood pressure %K emergency %K blood pressure monitoring %K risk factor %K cardiovascular %K cardiovascular disease %K utilization %K feedback %K care %K systolic blood pressure %K emergency department %K mHealth %K health disparities %K engagement %D 2024 %7 12.6.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Hypertension, a key modifiable risk factor for cardiovascular disease, is more prevalent among Black and low-income individuals. To address this health disparity, leveraging safety-net emergency departments for scalable mobile health (mHealth) interventions, specifically using text messaging for self-measured blood pressure (SMBP) monitoring, presents a promising strategy. This study investigates patterns of engagement, associated factors, and the impact of engagement on lowering blood pressure (BP) in an underserved population. Objective: We aimed to identify patterns of engagement with prompted SMBP monitoring with feedback, factors associated with engagement, and the association of engagement with lowered BP. Methods: This is a secondary analysis of data from Reach Out, an mHealth, factorial trial among 488 hypertensive patients recruited from a safety-net emergency department in Flint, Michigan. Reach Out participants were randomized to weekly or daily text message prompts to measure their BP and text in their responses. Engagement was defined as a BP response to the prompt. The k-means clustering algorithm and visualization were used to determine the pattern of SMBP engagement by SMBP prompt frequency—weekly or daily. BP was remotely measured at 12 months. For each prompt frequency group, logistic regression models were used to assess the univariate association of demographics, access to care, and comorbidities with high engagement. We then used linear mixed-effects models to explore the association between engagement and systolic BP at 12 months, estimated using average marginal effects. Results: For both SMBP prompt groups, the optimal number of engagement clusters was 2, which we defined as high and low engagement. Of the 241 weekly participants, 189 (78.4%) were low (response rate: mean 20%, SD 23.4) engagers, and 52 (21.6%) were high (response rate: mean 86%, SD 14.7) engagers. Of the 247 daily participants, 221 (89.5%) were low engagers (response rate: mean 9%, SD 12.2), and 26 (10.5%) were high (response rate: mean 67%, SD 8.7) engagers. Among weekly participants, those who were older (>65 years of age), attended some college (vs no college), married or lived with someone, had Medicare (vs Medicaid), were under the care of a primary care doctor, and took antihypertensive medication in the last 6 months had higher odds of high engagement. Participants who lacked transportation to appointments had lower odds of high engagement. In both prompt frequency groups, participants who were high engagers had a greater decline in BP compared to low engagers. Conclusions: Participants randomized to weekly SMBP monitoring prompts responded more frequently overall and were more likely to be classed as high engagers compared to participants who received daily prompts. High engagement was associated with a larger decrease in BP. New strategies to encourage engagement are needed for participants with lower access to care. Trial Registration: ClinicalTrials.gov NCT03422718; https://clinicaltrials.gov/study/NCT03422718 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04340-z %R 10.2196/54946 %U https://mhealth.jmir.org/2024/1/e54946 %U https://doi.org/10.2196/54946 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55578 %T Effectiveness of Mobile-Based Progressive and Fixed Physical Activity on Depression, Stress, Anxiety, and Quality of Life Outcomes Among Adults in South Korea: Randomized Controlled Trial %A Lee,Ye Hoon %A Kim,Hyungsook %A Hwang,Juhee %A Noh,Sihyeon %+ Department of Data Science, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea, 82 222204751, khsook12@hanyang.ac.kr %K depressive symptoms %K mental health %K mobile-based exercise %K non–face-to-face physical activity %K progressive exercise %K mobile phone %D 2024 %7 12.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Depression acts as a significant obstacle to the overall well-being of individuals. Given the significant consequences, timely recognition and proactive steps to manage symptoms of depression become essential. Such actions not only reduce personal distress but also play a crucial role in reducing its far-reaching impact on society as a whole. Objective: In response to this concern, the objective of this study was to explore the use of mobile-based interventions as a possible remedy. More specifically, this study aimed to investigate the effectiveness of 2 types of physical activity (PA), progressive and fixed, within a mobile-based app on depression, perceived stress, anxiety, physical health, and psychological health, aiming to contribute to the optimization of mental health benefits. Methods: Participants (N=60; mean age 25.29, SD 6.10 years) were recruited using a combination of web-based and offline methods, and the study lasted for 8 weeks. The baseline and posttest questionnaires were administered to all participants. The participants were randomly assigned to 1 of the 3 groups: progressive group (n=20; performing mobile-based progressive PA), fixed group (n=20; performing mobile-based fixed intensity PA), and control group C (n=20). Data analysis involved comparing scores between the experimental and control groups using a one-way ANOVA, paired sample t tests (2-tailed), and repeated measures ANOVA with a 3 (group)×2 (time) design. Results: The findings revealed significant improvements in mental health indicators among participants engaged in both fixed and progressive PA groups compared with the control group. However, the fixed PA group demonstrated more significant reductions in symptoms. Specifically, the progressive PA group showed significant reductions in depression (F1,36=6.941; P=.01; ηp2=0.16) and perceived stress (F1,36=5.47; P=.03; ηp2=0.13), while the fixed PA group exhibited significant reductions in depression (F1,37=5.36; P=.03; ηp2=0.12), perceived stress (F1,37=7.81; P=.008; ηp2=0.17), and general anxiety disorder (F1,37=5.45; P=.03; ηp2=0.13) compared with the control group. Conclusions: This study underscores the potential of mobile-based PA in improving mental health outcomes. The findings offer significant insights for mental health professionals and researchers aiming to optimize mental well-being through innovative mobile therapies. Trial Registration: Clinical Research Information Service KCT0009100; https://tinyurl.com/mr33fmur %M 38865705 %R 10.2196/55578 %U https://mhealth.jmir.org/2024/1/e55578 %U https://doi.org/10.2196/55578 %U http://www.ncbi.nlm.nih.gov/pubmed/38865705 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e55283 %T Web-Based Therapist-Guided Mindfulness-Based Cognitive Behavioral Therapy for Body Dysmorphic Disorder: Pilot Randomized Controlled Trial %A Kerry,Camrie %A Mann,Prabhdeep %A Babaei,Nazanin %A Katz,Joel %A Pirbaglou,Meysam %A Ritvo,Paul %+ School of Kinesiology and Health Sciences, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada, 1 416 580 8021, camrie@yorku.ca %K body dysmorphic disorder %K BDD %K dysmorphophobia %K obsessive-compulsive and related disorders %K OCD %K internet-delivered cognitive behavior therapy %K iCBT %K cognitive behavior therapy %K mindfulness-based cognitive therapy %K mindfulness %K eMental health %K randomized controlled trial %D 2024 %7 12.6.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Internet-based cognitive behavioral therapy (CBT) and stand-alone mindfulness meditation interventions are gaining empirical support for a wide variety of mental health conditions. In this study, we test the efficacy of web-based therapist-guided mindfulness-based cognitive behavioral therapy (CBT-M) for body dysmorphic disorder (BDD), a psychiatric disorder characterized by preoccupations with perceived defects in appearance. Objective: This study aims to determine whether CBT-M for BDD delivered on the web is feasible and acceptable and whether mindfulness meditation adds to CBT treatment effects for BDD. Methods: In this 8-week, 2-arm, parallel pilot randomized controlled trial, n=28 adults (aged between 18 and 55 years) were randomly allocated to an experimental group (web-based therapist-guided CBT-M) or a control group (web-based therapist-guided CBT). Study retention, accrual, and intervention adherence were assessed, along with self-report measures for BDD, depression, anxiety, and pain intensity taken at baseline and postintervention. Results: This study was feasible to implement and deemed acceptable by participants. After 8 weeks, significant improvements were found on all outcome measures for both treatment groups, and large between-group effect sizes favoring CBT-M were found for BDD symptom severity (d=–0.96), depression (d=–1.06), pain severity (d=–1.12), and pain interference (d=–1.28). However, linear mixed models demonstrated no significant differences between the groups over 8 weeks. Conclusions: The results suggest that mindfulness meditation may add to beneficial web-based CBT treatment effects for BDD. An adequately powered randomized control trial of web-based CBT-M is warranted. Trial Registration: ClinicalTrials.gov NCT05402475, http://clinicaltrials.gov/ct2/show/NCT05402475 %M 38865704 %R 10.2196/55283 %U https://mental.jmir.org/2024/1/e55283 %U https://doi.org/10.2196/55283 %U http://www.ncbi.nlm.nih.gov/pubmed/38865704 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54739 %T A Multicomponent Intervention (POSSIBLE) to Improve Perceived Risk for HIV Among Black Sexual Minority Men: Feasibility and Preliminary Effectiveness Pilot Study %A Dangerfield II,Derek T %A Anderson,Janeane N %A Wylie,Charleen %A Bluthenthal,Ricky %A Beyrer,Chris %A Farley,Jason E %+ Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue NW #308, Washington, DC, 20037, United States, 1 6673555188, ddanger2@gwu.edu %K pre-exposure prophylaxis %K PrEP %K sexual health %K peers %K apps %K community %K mobile phone %K HIV %K sexual minority %K minority communities %K minority %K Black %K African American %K peers %K patient education %K self-monitoring %K treatment adherence %K treatment participation %K community %K community health %K mobile health %K digital health %K digital technology %K digital interventions %K smartphones %D 2024 %7 11.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Increased pre-exposure prophylaxis (PrEP) use is urgently needed to substantially decrease HIV incidence among Black sexual minority men. Low perceived risk for HIV (PRH) is a key unaddressed PrEP barrier for Black sexual minority men. Peers and smartphone apps are popular intervention tools to promote community health behaviors, but few studies have used these together in a multicomponent strategy. Therefore, we designed a multicomponent intervention called POSSIBLE that used an existing smartphone app called PrEPme (Emocha Mobile Health, Inc) and a peer change agent (PCA) to increase PRH as a gateway to PrEP. Objective: This paper aims to describe the feasibility and preliminary impact of POSSIBLE on PRH and willingness to accept a PrEP referral among Black sexual minority men. Methods: POSSIBLE was a theoretically guided, single-group, 2-session pilot study conducted among Black sexual minority men from Baltimore, Maryland between 2019 and 2021 (N=69). POSSIBLE integrated a PCA and the PrEPme app that allows users to self-monitor sexual risk behaviors and chat with the in-app community health worker to obtain PrEP service information. PRH was assessed using the 8-item PRH scale before and after baseline and follow-up study visits. At the end of each study visit, the PCA referred interested individuals to the community health worker to learn more about PrEP service options. Results: The average age of participants was 32.5 (SD 8.1, range 19-62) years. In total, 55 (80%) participants were retained for follow-up at month 1. After baseline sessions, 29 (42%) participants were willing to be referred to PrEP services, 20 (69%) of those confirmed scheduled appointments with PrEP care teams. There were no statistically significant differences in PRH between baseline and follow-up visits (t122=–1.36; P=.17). Conclusions: We observed no statistically significant improvement in PRH between baseline and month 1. However, given the high retention rate and acceptability, POSSIBLE may be feasible to implement. Future research should test a statistically powered peer-based approach on PrEP initiation among Black sexual minority men. Trial Registration: ClinicalTrials.gov NCT04533386; https://clinicaltrials.gov/study/NCT04533386 %M 38861707 %R 10.2196/54739 %U https://humanfactors.jmir.org/2024/1/e54739 %U https://doi.org/10.2196/54739 %U http://www.ncbi.nlm.nih.gov/pubmed/38861707 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49669 %T Just-in-Time Adaptive Intervention for Stabilizing Sleep Hours of Japanese Workers: Microrandomized Trial %A Takeuchi,Hiroki %A Ishizawa,Tetsuro %A Kishi,Akifumi %A Nakamura,Toru %A Yoshiuchi,Kazuhiro %A Yamamoto,Yoshiharu %+ Graduate School of Education, The University of Tokyo, Bunkyo-ku Hongo 7-3-1, Tokyo, 113-8654, Japan, 81 03 5841 3981, takeuchi@p.u-tokyo.ac.jp %K objective push-type sleep feedback %K stability of habitual sleep behaviors %K just-in-time adaptive intervention %K microrandomized trial %K mobile phone %D 2024 %7 11.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Sleep disturbance is a major contributor to future health and occupational issues. Mobile health can provide interventions that address adverse health behaviors for individuals in a vulnerable health state in real-world settings (just-in-time adaptive intervention). Objective: This study aims to identify a subpopulation with vulnerable sleep state in daily life (study 1) and, immediately afterward, to test whether providing mobile health intervention improved habitual sleep behaviors and psychological wellness in real-world settings by conducting a microrandomized trial (study 2). Methods: Japanese workers (n=182) were instructed to collect data on their habitual sleep behaviors and momentary symptoms (including depressive mood, anxiety, and subjective sleep quality) using digital devices in a real-world setting. In study 1, we calculated intraindividual mean and variability of sleep hours, midpoint of sleep, and sleep efficiency to characterize their habitual sleep behaviors. In study 2, we designed and conducted a sleep just-in-time adaptive intervention, which delivered objective push-type sleep feedback messages to improve their sleep hours for a subset of participants in study 1 (n=81). The feedback messages were generated based on their sleep data measured on previous nights and were randomly sent to participants with a 50% chance for each day (microrandomization). Results: In study 1, we applied hierarchical clustering to dichotomize the population into 2 clusters (group A and group B) and found that group B was characterized by unstable habitual sleep behaviors (large intraindividual variabilities). In addition, linear mixed-effect models showed that the interindividual variability of sleep hours was significantly associated with depressive mood (β=3.83; P=.004), anxiety (β=5.70; P=.03), and subjective sleep quality (β=−3.37; P=.03). In study 2, we found that providing sleep feedback prolonged subsequent sleep hours (increasing up to 40 min; P=.01), and this effect lasted for up to 7 days. Overall, the stability of sleep hours in study 2 was significantly improved among participants in group B compared with the participants in study 1 (P=.001). Conclusions: This is the first study to demonstrate that providing sleep feedback can benefit the modification of habitual sleep behaviors in a microrandomized trial. The findings of this study encourage the use of digitalized health intervention that uses real-time health monitoring and personalized feedback. %M 38861313 %R 10.2196/49669 %U https://www.jmir.org/2024/1/e49669 %U https://doi.org/10.2196/49669 %U http://www.ncbi.nlm.nih.gov/pubmed/38861313 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56373 %T An App-Based Physical Activity Intervention in Community-Dwelling Chinese-, Tagalog-, and Vietnamese-Speaking Americans: Single-Arm Intervention Study %A Nguyen,Antony %A Yu,Filmer %A Park,Linda G %A Fukuoka,Yoshimi %A Wong,Ching %A Gildengorin,Ginny %A Nguyen,Tung T %A Tsoh,Janice Y %A Jih,Jane %+ Division of General Internal Medicine, University of California San Francisco, 490 Illinois Street, San Francisco, CA, 94158, United States, 1 4158857563, jane.jih@ucsf.edu %K physical activity %K mHealth %K mobile health %K mobile app %K Asian Americans %K physical activity tracker %K mobile phone %K app %K apps %K application %K applications %K app-based %K intervention %K interventions %K community-dwelling %K tracker %K trackers %K pilot study %K feasibility %K acceptability %K cultural %K culturally %K linguistic %K linguistically %K evidence-based %K community-based %K sociodemographic %K lifestyle %K Chinese %K Vietnamese %K Filipino %K adult %K adults %K multicomponent %K multilingual %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical inactivity is associated with adverse health outcomes among Asian Americans, who exhibit the least adherence to physical activity guidelines compared with other racial and ethnic groups. Mobile app–based interventions are a promising approach to promote healthy behaviors. However, there is a lack of app-based interventions focused on improving physical activity among Asian Americans whose primary language is not English. Objective: This pilot study aimed to assess the feasibility and acceptability of a 5-week intervention using a culturally and linguistically adapted, evidence-based mobile phone app with an accelerometer program, to promote physical activity among Chinese-, Tagalog-, or Vietnamese-speaking Americans. Methods: Participants were recruited through collaborations with community-based organizations. The intervention was adapted from a 12-month physical activity randomized controlled trial involving the app and accelerometer for English-speaking adults. Sociodemographic characteristics, lifestyle factors, and physical measurements were collected at the baseline visit. A 7-day run-in period was conducted to screen for the participants who could wear a Fitbit One (Fitbit LLC) accelerometer and complete the app’s daily step diary. During the 4-week intervention period, participants wore the accelerometer and reported their daily steps in the app. Participants also received daily messages to reinforce key contents taught during an in-person educational session, remind them to input steps, and provide tailored feedback. Feasibility measures were the percentage of eligible participants completing the run-in period and the percentage of participants who used the app diary for at least 5 out of 7 days during the intervention period. We conducted poststudy participant interviews to explore overall intervention acceptability. Results: A total of 19 participants were enrolled at the beginning of the study with a mean age of 47 (SD 13.3; range 29-70) years, and 58% (n=11) of them were female. Of the participants, 26% (n=5) were Chinese, 32% (n=6) were Vietnamese, and 42% (n=8) were Filipino. All participants met the run-in criteria to proceed with the intervention. Adherence to the app diary ranged from 74% (n=14) in week 2 to 95% (n=18) in week 4. The daily average steps per week from accelerometers increased each week from 8451 (SD 3378) steps during the run-in period to 10,930 (SD 4213) steps in week 4. Participants reported positive experiences including an increased motivation to walk and the enjoyment of being able to monitor their physical activity. Conclusions: This is the first pilot study of a multicomponent intervention and evidence-based mobile phone app to promote physical activity among Asian Americans who use apps in traditional Chinese, Tagalog, or Vietnamese, which demonstrated high feasibility and acceptability. Future work focused on multilingual mobile apps to address disparities in physical inactivity among Asian Americans should be considered. %M 38857065 %R 10.2196/56373 %U https://formative.jmir.org/2024/1/e56373 %U https://doi.org/10.2196/56373 %U http://www.ncbi.nlm.nih.gov/pubmed/38857065 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45469 %T App Engagement as a Predictor of Weight Loss in Blended-Care Interventions: Retrospective Observational Study Using Large-Scale Real-World Data %A Lehmann,Marco %A Jones,Lucy %A Schirmann,Felix %+ Oviva AG, Dortustraße 48, Potsdam, 14467, Germany, 49 3055572034, marco.lehmann@oviva.com %K obesity %K weight loss %K blended-care %K digital health %K real-world data %K app engagement %K mHealth %K mobile health %K technology engagement %K weight management %K mobile phone %D 2024 %7 7.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Early weight loss is an established predictor for treatment outcomes in weight management interventions for people with obesity. However, there is a paucity of additional, reliable, and clinically actionable early predictors in weight management interventions. Novel blended-care weight management interventions combine coach and app support and afford new means of structured, continuous data collection, informing research on treatment adherence and outcome prediction. Objective: Against this backdrop, this study analyzes app engagement as a predictor for weight loss in large-scale, real-world, blended-care interventions. We hypothesize that patients who engage more frequently in app usage in blended-care treatment (eg, higher logging activity) lose more weight than patients who engage comparably less frequently at 3 and 6 months of intervention. Methods: Real-world data from 19,211 patients in obesity treatment were analyzed retrospectively. Patients were treated with 3 different blended-care weight management interventions, offered in Switzerland, the United Kingdom, and Germany by a digital behavior change provider. The principal component analysis identified an overarching metric for app engagement based on app usage. A median split informed a distinction in higher and lower engagers among the patients. Both groups were matched through optimal propensity score matching for relevant characteristics (eg, gender, age, and start weight). A linear regression model, combining patient characteristics and app-derived data, was applied to identify predictors for weight loss outcomes. Results: For the entire sample (N=19,211), mean weight loss was –3.24% (SD 4.58%) at 3 months and –5.22% (SD 6.29%) at 6 months. Across countries, higher app engagement yielded more weight loss than lower engagement after 3 but not after 6 months of intervention (P3 months<.001 and P6 months=.59). Early app engagement within the first 3 months predicted percentage weight loss in Switzerland and Germany, but not in the United Kingdom (PSwitzerland<.001, PUnited Kingdom=.12, and PGermany=.005). Higher age was associated with stronger weight loss in the 3-month period (PSwitzerland=.001, PUnited Kingdom=.002, and PGermany<.001) and, for Germany, also in the 6-month period (PSwitzerland=.09, PUnited Kingdom=.46, and PGermany=.03). In Switzerland, higher numbers of patients’ messages to coaches were associated with higher weight loss (P3 months<.001 and P6 months<.001). Messages from coaches were not significantly associated with weight loss (all P>.05). Conclusions: Early app engagement is a predictor of weight loss, with higher engagement yielding more weight loss than lower engagement in this analysis. This new predictor lends itself to automated monitoring and as a digital indicator for needed or adapted clinical action. Further research needs to establish the reliability of early app engagement as a predictor for treatment adherence and outcomes. In general, the obtained results testify to the potential of app-derived data to inform clinical monitoring practices and intervention design. %M 38848556 %R 10.2196/45469 %U https://www.jmir.org/2024/1/e45469 %U https://doi.org/10.2196/45469 %U http://www.ncbi.nlm.nih.gov/pubmed/38848556 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56003 %T Smartphone-Based Survey and Message Compliance in Adults Initially Unready to Quit Smoking: Secondary Analysis of a Randomized Controlled Trial %A Ulm,Clayton %A Chen,Sixia %A Fleshman,Brianna %A Benson,Lizbeth %A Kendzor,Darla E %A Frank-Pearce,Summer %A Neil,Jordan M %A Vidrine,Damon %A De La Torre,Irene %A Businelle,Michael S %+ TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 405 271 8001, michael-businelle@ouhsc.edu %K just-in-time adaptive intervention %K tailored messaging %K smoking cessation %K mobile health %K survey compliance %K phase-based model %K smoking %K smoker %K survey %K smokers %K messaging %K smartphone %K efficacy %K pilot randomized controlled trial %K adult smokers %K linear regression %K age %K intervention engagement %K engagement %D 2024 %7 7.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Efficacy of smartphone-based interventions depends on intervention content quality and level of exposure to that content. Smartphone-based survey completion rates tend to decline over time; however, few studies have identified variables that predict this decline over longer-term interventions (eg, 26 weeks). Objective: This study aims to identify predictors of survey completion and message viewing over time within a 26-week smoking cessation trial. Methods: This study examined data from a 3-group pilot randomized controlled trial of adults who smoke (N=152) and were not ready to quit smoking within the next 30 days. For 182 days, two intervention groups received smartphone-based morning and evening messages based on current readiness to quit smoking. The control group received 2 daily messages unrelated to smoking. All participants were prompted to complete 26 weekly smartphone-based surveys that assessed smoking behavior, quit attempts, and readiness to quit. Compliance was operationalized as percentages of weekly surveys completed and daily messages viewed. Linear regression and mixed-effects models were used to identify predictors (eg, intervention group, age, and sex) of weekly survey completion and daily message viewing and decline in compliance over time. Results: The sample (mean age 50, SD 12.5, range 19-75 years; mean years of education 13.3, SD 1.6, range 10-20 years) was 67.8% (n=103) female, 74.3% (n=113) White, 77% (n=117) urban, and 52.6% (n=80) unemployed, and 61.2% (n=93) had mental health diagnoses. On average, participants completed 18.3 (71.8%) out of 25.5 prompted weekly surveys and viewed 207.3 (60.6%) out of 345.1 presented messages (31,503/52,460 total). Age was positively associated with overall weekly survey completion (P=.003) and daily message viewing (P=.02). Mixed-effects models indicated a decline in survey completion from 77% (114/148) in the first week of the intervention to 56% (84/150) in the last week of the intervention (P<.001), which was significantly moderated by age, sex, ethnicity, municipality (ie, rural/urban), and employment status. Similarly, message viewing declined from 72.3% (1533/2120) in the first week of the intervention to 44.6% (868/1946) in the last week of the intervention (P<.001). This decline in message viewing was significantly moderated by age, sex, municipality, employment status, and education. Conclusions: This study demonstrated the feasibility of a 26-week smartphone-based smoking cessation intervention. Study results identified subgroups that displayed accelerated rates in the decline of survey completion and message viewing. Future research should identify ways to maintain high levels of interaction with mobile health interventions that span long intervention periods, especially among subgroups that have demonstrated declining rates of intervention engagement over time. Trial Registration: ClinicalTrials.gov NCT03405129; https://clinicaltrials.gov/ct2/show/NCT03405129 %M 38848557 %R 10.2196/56003 %U https://formative.jmir.org/2024/1/e56003 %U https://doi.org/10.2196/56003 %U http://www.ncbi.nlm.nih.gov/pubmed/38848557 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51708 %T Six-Month Outcomes of a Theory- and Technology-Enhanced Physical Activity Intervention for Latina Women (Pasos Hacia La Salud II): Randomized Controlled Trial %A Connell Bohlen,Lauren %A Dunsiger,Shira I %A von Ash,Tayla %A Larsen,Britta A %A Pekmezi,Dori %A Marquez,Becky %A Benitez,Tanya J %A Mendoza-Vasconez,Andrea %A Hartman,Sheri J %A Williams,David M %A Marcus,Bess H %+ Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S121-8, Providence, RI, 02912, United States, 1 4018636559, lauren_bohlen@brown.edu %K digital health %K web-based intervention %K exercise %K social support %K behavior change intervention %K support %K Latina women %K women %K Latina %K physical activity %K barrier %K aerobic %K remote intervention %K text message %K behavior change %K behavior %D 2024 %7 6.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: More than half (55%) of Latina women do not meet aerobic physical activity (PA) guidelines, and frequently cite time, childcare, and transportation as barriers to PA. In addition to linguistic adaptations for this population, successful PA interventions for Latina women addressed these barriers through remote intervention delivery approaches (eg, mail, phone, or web delivery). Objective: We aimed to evaluate 6-month outcomes of a randomized trial comparing a Spanish-language, individually tailored, web-delivered PA intervention (original) to an enhanced version with text messages and additional features (enhanced). Further, we evaluated if increases in PA at 6 months were moderated by baseline activity status. Methods: In total, 195 Latina women aged 18-65 years participated in a trial comparing the efficacy of the enhanced versus original interventions at initiating PA behavior change. We examined minutes per week of accelerometer-measured PA in the enhanced versus original arms, and the proportion of each arm meeting aerobic PA guidelines (150 min/wk at 6 mo). For moderator analyses, participants were classified as inactive (0 min/wk) or low active (1-90 min/wk) at baseline, measured via the 7 Day Physical Activity Recall interview. Results: PA increased from 19.7 (SD 47.9) minutes per week at baseline to 46.9 (SD 66.2) minutes per week at 6 months in the enhanced arm versus 20.6 (SD 42.7) minutes per week to 42.9 (SD 78.2) minutes per week in the original arm (P=.78). Overall, 30% (31/103) of the enhanced group met aerobic PA guidelines at 6 months, compared to 21% (19/92) of the original group (odds ratio [OR] 1.75, 95% CI 0.87-3.55). Baseline PA (inactive vs low active) moderated treatment effects on PA. For inactive participants, there were no group differences at 6 months (b=7.1; SE 22.8; P=.75), while low-active participants increased more in enhanced than original (b=72.5; SE 27.9; P=.01). For low-active participants, 45% (46/103) of the enhanced group met PA guidelines at 6 months, versus 20% (18/92) of the original arm (OR 3.29, 95% CI 1.05-11.31). For inactive participants, there were no group differences (25/103, 24% vs n=19/92, 21% for enhanced vs original, respectively; OR 1.28, 95% CI 0.54-3.06). Conclusions: Intervention effects were conditional on baseline PA. For low-active Latina women, the enhanced intervention was more effective at increasing PA. Additional tailored intervention enhancements may be necessary to increase PA for inactive Latina women. Trial Registration: ClinicalTrials.gov NCT03491592; https://www.clinicaltrials.gov/study/NCT03491592 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-022-06575-4 %M 38842930 %R 10.2196/51708 %U https://www.jmir.org/2024/1/e51708 %U https://doi.org/10.2196/51708 %U http://www.ncbi.nlm.nih.gov/pubmed/38842930 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53406 %T Digital Lifestyle Interventions for Young People With Mental Illness: A Qualitative Study Among Mental Health Care Professionals %A Sawyer,Chelsea %A Carney,Rebekah %A Hassan,Lamiece %A Bucci,Sandra %A Sainsbury,John %A Lovell,Karina %A Torous,John %A Firth,Joseph %+ Division of Psychology and Mental Health, University of Manchester, 3.005 Jean Mcfarlane Building, Manchester, M13 9PL, United Kingdom, 44 161 306 7811, Joseph.firth@manchester.ac.uk %K digital health %K behavior change %K mental health care professionals %K physical health %K lifestyle intervention %K qualitative %K thematic analysis %K service optimization %K mobile phone %D 2024 %7 5.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Given the physical health disparities associated with mental illness, targeted lifestyle interventions are required to reduce the risk of cardiometabolic disease. Integrating physical health early in mental health treatment among young people is essential for preventing physical comorbidities, reducing health disparities, managing medication side effects, and improving overall health outcomes. Digital technology is increasingly used to promote fitness, lifestyle, and physical health among the general population. However, using these interventions to promote physical health within mental health care requires a nuanced understanding of the factors that affect their adoption and implementation. Objective: Using a qualitative design, we explored the attitudes of mental health care professionals (MHCPs) toward digital technologies for physical health with the goal of illuminating the opportunities, development, and implementation of the effective use of digital tools for promoting healthier lifestyles in mental health care. Methods: Semistructured interviews were conducted with MHCPs (N=13) using reflexive thematic analysis to explore their experiences and perspectives on using digital health to promote physical health in youth mental health care settings. Results: Three overarching themes from the qualitative analysis are reported: (1) motivation will affect implementation, (2) patients’ readiness and capability, and (3) reallocation of staff roles and responsibilities. The subthemes within, and supporting quotes, are described. Conclusions: The use of digital means presents many opportunities for improving the provision of physical health interventions in mental health care settings. However, given the limited experience of many MHCPs with these technologies, formal training and additional support may improve the likelihood of implementation. Factors such as patient symptomatology, safety, and access to technology, as well as the readiness, acceptability, and capability of both MHCPs and patients to engage with digital tools, must also be considered. In addition, the potential benefits of data integration must be carefully weighed against the associated risks. %M 38837191 %R 10.2196/53406 %U https://humanfactors.jmir.org/2024/1/e53406 %U https://doi.org/10.2196/53406 %U http://www.ncbi.nlm.nih.gov/pubmed/38837191 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50957 %T The Influence of Incentive-Based Mobile Fitness Apps on Users’ Continuance Intention With Gender Moderation Effects: Quantitative and Qualitative Study %A Faizah,Aaya %A Hardian,Alifah Fatimah Azzahra %A Nandini,Rania Devina %A Handayani,Putu Wuri %A Harahap,Nabila Cyldea %+ Faculty of Computer Science, University of Indonesia, Kampus UI, Depok, 16424, Indonesia, 62 217863419, Putu.wuri@cs.ui.ac.id %K incentive %K fitness %K mobile fitness apps %K gender %K continuance usage intention %K Indonesia %K mobile phone %D 2024 %7 5.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: A survey conducted by McKinsey & Company reported that, as of May 2022, as many as 26% of Indonesians had recently started to engage actively in physical activity, 32% undertook regular physical activity, and 9% exercised intensely. The Fourth Industrial Revolution has spurred the rapid development of mobile fitness apps (MFAs) used to track people’s sports activities. However, public interest in using these apps for any length of time is still relatively low. Objective: In this study, we aimed to determine the effect of incentives (eg, self-monitoring, social support, platform rewards, and external influence) on the use of MFAs and the moderating effect of gender on users’ continuance usage intention. Methods: The study used a mixed methods approach. Quantitative data were collected through a web-based questionnaire and qualitative data from interviews with 30 respondents. The quantitative data, collected from 379 valid responses, were processed using covariance-based structural equation modeling. The qualitative data were processed using thematic analysis. The MFAs included in this research were those used as sports or physical activity trackers, such as Apple Fitness, Strava, Nike Run Club, and Fita. Results: The results of the data analysis show that 3 groups of incentives, namely, self-monitoring, platform rewards, and external influence (with the exception of social support), affect the perceived usefulness of these apps. Gender was also shown to moderate user behavior in relation to physical activity. The study showed that women were more likely to be motivated to exercise by social and external factors, while men paid greater attention to the tracking features of the app and to challenges and rewards. Conclusions: This research contributes to the field of health promotion by providing guidance for MFA developers. %M 38837199 %R 10.2196/50957 %U https://humanfactors.jmir.org/2024/1/e50957 %U https://doi.org/10.2196/50957 %U http://www.ncbi.nlm.nih.gov/pubmed/38837199 %0 Journal Article %@ 2561-7605 %I %V 7 %N %P e53020 %T Characterizing Walking Behaviors in Aged Residential Care Using Accelerometry, With Comparison Across Care Levels, Cognitive Status, and Physical Function: Cross-Sectional Study %A Mc Ardle,Ríona %A Taylor,Lynne %A Cavadino,Alana %A Rochester,Lynn %A Del Din,Silvia %A Kerse,Ngaire %K residential aged care facility %K cognitive dysfunction %K mobility limitation %K accelerometry %K physical activity %K aged residential care %D 2024 %7 4.6.2024 %9 %J JMIR Aging %G English %X Background: Walking is important for maintaining physical and mental well-being in aged residential care (ARC). Walking behaviors are not well characterized in ARC due to inconsistencies in assessment methods and metrics as well as limited research regarding the impact of care environment, cognition, or physical function on these behaviors. It is recommended that walking behaviors in ARC are assessed using validated digital methods that can capture low volumes of walking activity. Objective: This study aims to characterize and compare accelerometry-derived walking behaviors in ARC residents across different care levels, cognitive abilities, and physical capacities. Methods: A total of 306 ARC residents were recruited from the Staying UpRight randomized controlled trial from 3 care levels: rest home (n=164), hospital (n=117), and dementia care (n=25). Participants’ cognitive status was classified as mild (n=87), moderate (n=128), or severe impairment (n=61); physical function was classified as high-moderate (n=74) and low-very low (n=222) using the Montreal Cognitive Assessment and the Short Physical Performance Battery cutoff scores, respectively. To assess walking, participants wore an accelerometer (Axivity AX3; dimensions: 23×32.5×7.6 mm; weight: 11 g; sampling rate: 100 Hz; range: ±8 g; and memory: 512 MB) on their lower back for 7 days. Outcomes included volume (ie, daily time spent walking, steps, and bouts), pattern (ie, mean walking bout duration and alpha), and variability (of bout length) of walking. Analysis of covariance was used to assess differences in walking behaviors between groups categorized by level of care, cognition, or physical function while controlling for age and sex. Tukey honest significant difference tests for multiple comparisons were used to determine where significant differences occurred. The effect sizes of group differences were calculated using Hedges g (0.2-0.4: small, 0.5-0.7: medium, and 0.8: large). Results: Dementia care residents showed greater volumes of walking (P<.001; Hedges g=1.0-2.0), with longer (P<.001; Hedges g=0.7-0.8), more variable (P=.008 vs hospital; P<.001 vs rest home; Hedges g=0.6-0.9) bouts compared to other care levels with a lower alpha score (vs hospital: P<.001; Hedges g=0.9, vs rest home: P=.004; Hedges g=0.8). Residents with severe cognitive impairment took longer (P<.001; Hedges g=0.5-0.6), more variable (P<.001; Hedges g=0.4-0.6) bouts, compared to those with mild and moderate cognitive impairment. Residents with low-very low physical function had lower walking volumes (total walk time and bouts per day: P<.001; steps per day: P=.005; Hedges g=0.4-0.5) and higher variability (P=.04; Hedges g=0.2) compared to those with high-moderate capacity. Conclusions: ARC residents across different levels of care, cognition, and physical function demonstrate different walking behaviors. However, ARC residents often present with varying levels of both cognitive and physical abilities, reflecting their complex multimorbid nature, which should be considered in further work. This work has demonstrated the importance of considering a nuanced framework of digital outcomes relating to volume, pattern, and variability of walking behaviors among ARC residents. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001827224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376298&isReview=true %R 10.2196/53020 %U https://aging.jmir.org/2024/1/e53020 %U https://doi.org/10.2196/53020 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50783 %T Effects of the “AI-TA” Mobile App With Intelligent Design on Psychological and Related Symptoms of Young Survivors of Breast Cancer: Randomized Controlled Trial %A Jiang,Lulu %A Xu,Jiehui %A Wu,Yanwei %A Liu,Yanyan %A Wang,Xiyi %A Hu,Yun %+ School of Nursing, Shanghai Jiao Tong University, No.277 Chongqing South Roud, Huangpu District, Shanghai, 200025, China, 86 021 63546078, huyunsy@shsmu.edu.cn %K mobile app %K artificial intelligence %K interactivity %K breast cancer %K psychological symptoms %K self-efficacy %K social support %K quality of life %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Young women often face substantial psychological challenges in the initial years following cancer diagnosis, leading to a comparatively lower quality of life than older survivors. While mobile apps have emerged as potential interventions, their effectiveness remains inconclusive due to the diversity in intervention types and variation in follow-up periods. Furthermore, there is a particular dearth of evidence regarding the efficacy of these apps’ intelligent features in addressing psychological distress with these apps. Objective: This study aims to evaluate the effectiveness of a mobile app with intelligent design called “AI-TA” on cancer-related psychological health and ongoing symptoms with a randomized controlled design. Methods: Women aged 18 to 45 years diagnosed with breast cancer were randomly assigned to the intervention or control group. The intervention was AI-TA, which included 2-way web-based follow-up every 2 weeks. Both intention-to-treat (ITT) and per-protocol (PP) analyses employed repeated measurement analysis of variance. The participants’ background features, primary outcomes (psychological distress and frequency, self-efficacy, and social support), and secondary outcomes (quality of life) were measured using multiple instruments at 3 time points (baseline, 1-month intervention, and 3-month intervention). Results: A total of 124 participants were randomly allocated to the control group (n=62, 50%) or intervention group (n=62, 50%). In total, 92.7% (115/124) of the participants completed the intervention. Significant improvements in psychological symptoms (Memorial Symptom Assessment Scale-Short Form) were observed in the ITT group from baseline to 1-month intervention relative to the control group (ITT vs control: 1.17 vs 1.23; P<.001), which persisted at 3-month follow-up (ITT vs control: 0.68 vs 0.91; P<.001). Both the ITT and PP groups exhibited greater improvements in self-efficacy (Cancer Behavior Inventory-Brief Version) than the control group at 1-month (ITT vs PP vs control: 82.83 vs 77.12 vs 65.35; P<.001) and 3-month intervention (ITT vs PP vs control: 92.83 vs 89.30 vs 85.65; P<.001). However, the change in social support (Social Support Rating Scale) did not increase significantly until 3-month intervention (ITT vs control: 50.09 vs 45.10; P=.002) (PP vs control: 49.78 vs 45.10; P<.001). All groups also experienced beneficial effects on quality of life (Functional Assessment of Cancer Therapy-Breast), which persisted at 3-month follow-up (P<.001). Conclusions: The intelligent mobile app AI-TA incorporating intelligent design shows promise for reducing psychological and cancer-related symptoms among young survivors of breast cancer. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200058823; https://www.chictr.org.cn/showproj.html?proj=151195 %M 38833298 %R 10.2196/50783 %U https://mhealth.jmir.org/2024/1/e50783 %U https://doi.org/10.2196/50783 %U http://www.ncbi.nlm.nih.gov/pubmed/38833298 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e44443 %T Mental Wellness Self-Care in Singapore With mindline.sg: A Tutorial on the Development of a Digital Mental Health Platform for Behavior Change %A Weng,Janice Huiqin %A Hu,Yanyan %A Heaukulani,Creighton %A Tan,Clarence %A Chang,Julian Kuiyu %A Phang,Ye Sheng %A Rajendram,Priyanka %A Tan,Weng Mooi %A Loke,Wai Chiong %A Morris,Robert J T %+ MOH Office for Healthcare Transformation, 1 Maritime Square, Harbourfront Centre, Singapore, 099253, Singapore, 65 66793209, creighton.heaukulani@moht.com.sg %K digital mental health %K artificial intelligence %K AI %K AI chatbot %K digital therapeutics %K mental health %K mental wellness %K mobile phone %D 2024 %7 4.6.2024 %9 Tutorial %J J Med Internet Res %G English %X Background: Singapore, like the rest of Asia, faces persistent challenges to mental health promotion, including stigma around unwellness and seeking treatment and a lack of trained mental health personnel. The COVID-19 pandemic, which created a surge in mental health care needs and simultaneously accelerated the adoption of digital health solutions, revealed a new opportunity to quickly scale innovative solutions in the region. Objective: In June 2020, the Singaporean government launched mindline.sg, an anonymous digital mental health resource website that has grown to include >500 curated local mental health resources, a clinically validated self-assessment tool for depression and anxiety, an artificial intelligence (AI) chatbot from Wysa designed to deliver digital therapeutic exercises, and a tailored version of the website for working adults called mindline at work. The goal of the platform is to empower Singapore residents to take charge of their own mental health and to be able to offer basic support to those around them through the ease and convenience of a barrier-free digital solution. Methods: Website use is measured through click-level data analytics captured via Google Analytics and custom application programming interfaces, which in turn drive a customized analytics infrastructure based on the open-source platforms Titanium Database and Metabase. Unique, nonbounced (users that do not immediately navigate away from the site), engaged, and return users are reported. Results: In the 2 years following launch (July 1, 2020, through June 30, 2022), the website received >447,000 visitors (approximately 15% of the target population of 3 million), 62.02% (277,727/447,783) of whom explored the site or engaged with resources (referred to as nonbounced visitors); 10.54% (29,271/277,727) of those nonbounced visitors returned. The most popular features on the platform were the dialogue-based therapeutic exercises delivered by the chatbot and the self-assessment tool, which were used by 25.54% (67,626/264,758) and 11.69% (32,469/277,727) of nonbounced visitors. On mindline at work, the rates of nonbounced visitors who engaged extensively (ie, spent ≥40 seconds exploring resources) and who returned were 51.56% (22,474/43,588) and 13.43% (5,853/43,588) over a year, respectively, compared to 30.9% (42,829/138,626) and 9.97% (13,822/138,626), respectively, on the generic mindline.sg site in the same year. Conclusions: The site has achieved desired reach and has seen a strong growth rate in the number of visitors, which required substantial and sustained digital marketing campaigns and strategic outreach partnerships. The site was careful to preserve anonymity, limiting the detail of analytics. The good levels of overall adoption encourage us to believe that mild to moderate mental health conditions and the social factors that underly them are amenable to digital interventions. While mindline.sg was primarily used in Singapore, we believe that similar solutions with local customization are widely and globally applicable. %M 38833294 %R 10.2196/44443 %U https://www.jmir.org/2024/1/e44443 %U https://doi.org/10.2196/44443 %U http://www.ncbi.nlm.nih.gov/pubmed/38833294 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54728 %T Daily Time-Use Patterns and Quality of Life in Parents: Protocol for a Pilot Quasi-Experimental, Nonrandomized Controlled Trial Using Ecological Momentary Assessment %A Altweck,Laura %A Schmidt,Silke %A Tomczyk,Samuel %+ Department Health and Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Str 13, Greifswald, 17487, Germany, 49 3834 420 ext 3813, laura.altweck@uni-greifswald.de %K time-use %K well-being %K parents %K ecological momentary assessment %K feasibility %K health-related quality of life %K ambulatory assessment %K work-family conflict %K gender roles %K mixed-methods %K sex differences %K stress %D 2024 %7 31.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The gender gap in time use and its impact on health and well-being are still prevalent. Women work longer hours than men when considering both paid and unpaid (eg, childcare and chores) work, and this gender disparity is particularly visible among parents. Less is known about factors that could potentially mediate or moderate this relationship (eg, work-family conflict and gender role beliefs). Ecological momentary assessment (EMA) allows for the documentation of changes in momentary internal states, such as time use, stress, or mood. It has shown particular validity to measure shorter-term activities (eg, unpaid work) and is thus useful to address gender differences. Objective: The feasibility of the daily EMA surveys in a parent sample will be examined. The associations between time use, well-being, and stress will be examined, along with potential moderating and mediating factors such as gender, gender role beliefs, and work-family conflict. Finally, the act of monitoring one’s own time use, well-being, and stress will be examined in relation to, for example, the quality of life. Methods: We conducted a quasi-experimental, nonrandomized controlled trial with 3 data collection methods, namely, online questionnaires, EMA surveys, and qualitative interviews. The intervention group (n=64) will participate in the online questionnaires and EMA surveys, and a subsample of the intervention group (n=6-17) will also be invited to participate in qualitative interviews. Over a period of 1 week, participants in the intervention group will answer daily EMA surveys (4 times per day). In contrast, the control group (n=17) will only participate in the online questionnaires at baseline and after 1 week. The following constructs were surveyed: sociodemographic background (eg, age, gender, and household composition; baseline questionnaire); mediators and moderators (eg, gender role beliefs and work-family conflict; baseline and follow-up questionnaires); well-being, quality of life, and trait mindfulness (baseline and follow-up questionnaires); momentary activity and well-being, as well as state mindfulness (EMA); and feasibility (baseline and follow-up questionnaires as well as interviews). We anticipate that participants will regard the daily EMA as feasible. Particular daily time-use patterns (eg, high paid and unpaid workload) are expected to be related to lower well-being, higher stress, and health-related quality of life. These associations are expected to be moderated and mediated by factors such as gender, gender role beliefs, work-family conflict, and social support. Participants in the intervention group are expected to show higher values of mindfulness, well-being, health-related quality of life, and lower stress. Results: Patient recruitment started in November 2023 and ended in mid April 2024. Data analysis commenced in mid April 2024. Conclusions: This study aims to provide valuable insights into the feasibility of using EMAs and the potential benefits of activity tracking in various aspects of daily life. Trial Registration: Open Science Framework 8qj3d; https://osf.io/8qj3d International Registered Report Identifier (IRRID): PRR1-10.2196/54728 %M 38820576 %R 10.2196/54728 %U https://www.researchprotocols.org/2024/1/e54728 %U https://doi.org/10.2196/54728 %U http://www.ncbi.nlm.nih.gov/pubmed/38820576 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e46895 %T Characterizing Longitudinal Patterns in Cognition, Mood, And Activity in Depression With 6-Week High-Frequency Wearable Assessment: Observational Study %A Cormack,Francesca %A McCue,Maggie %A Skirrow,Caroline %A Cashdollar,Nathan %A Taptiklis,Nick %A van Schaik,Tempest %A Fehnert,Ben %A King,James %A Chrones,Lambros %A Sarkey,Sara %A Kroll,Jasmin %A Barnett,Jennifer H %+ Cambridge Cognition, Tunbridge Court, Bottisham, Cambridge, CB25 9TU, United Kingdom, 44 7961910560, jasmin.kroll@camcog.com %K cognition %K depression %K digital biomarkers %K ecological momentary assessment %K mobile health %K remote testing %D 2024 %7 31.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Cognitive symptoms are an underrecognized aspect of depression that are often untreated. High-frequency cognitive assessment holds promise for improving disease and treatment monitoring. Although we have previously found it feasible to remotely assess cognition and mood in this capacity, further work is needed to ascertain the optimal methodology to implement and synthesize these techniques. Objective: The objective of this study was to examine (1) longitudinal changes in mood, cognition, activity levels, and heart rate over 6 weeks; (2) diurnal and weekday-related changes; and (3) co-occurrence of fluctuations between mood, cognitive function, and activity. Methods: A total of 30 adults with current mild-moderate depression stabilized on antidepressant monotherapy responded to testing delivered through an Apple Watch (Apple Inc) for 6 weeks. Outcome measures included cognitive function, assessed with 3 brief n-back tasks daily; self-reported depressed mood, assessed once daily; daily total step count; and average heart rate. Change over a 6-week duration, diurnal and day-of-week variations, and covariation between outcome measures were examined using nonlinear and multilevel models. Results: Participants showed initial improvement in the Cognition Kit N-Back performance, followed by a learning plateau. Performance reached 90% of individual learning levels on average 10 days after study onset. N-back performance was typically better earlier and later in the day, and step counts were lower at the beginning and end of each week. Higher step counts overall were associated with faster n-back learning, and an increased daily step count was associated with better mood on the same (P<.001) and following day (P=.02). Daily n-back performance covaried with self-reported mood after participants reached their learning plateau (P=.01). Conclusions: The current results support the feasibility and sensitivity of high-frequency cognitive assessments for disease and treatment monitoring in patients with depression. Methods to model the individual plateau in task learning can be used as a sensitive approach to better characterize changes in behavior and improve the clinical relevance of cognitive data. Wearable technology allows assessment of activity levels, which may influence both cognition and mood. %M 38819909 %R 10.2196/46895 %U https://mental.jmir.org/2024/1/e46895 %U https://doi.org/10.2196/46895 %U http://www.ncbi.nlm.nih.gov/pubmed/38819909 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47515 %T Comparison of the Working Alliance in Blended Cognitive Behavioral Therapy and Treatment as Usual for Depression in Europe: Secondary Data Analysis of the E-COMPARED Randomized Controlled Trial %A Doukani,Asmae %A Quartagno,Matteo %A Sera,Francesco %A Free,Caroline %A Kakuma,Ritsuko %A Riper,Heleen %A Kleiboer,Annet %A Cerga-Pashoja,Arlinda %A van Schaik,Anneke %A Botella,Cristina %A Berger,Thomas %A Chevreul,Karine %A Matynia,Maria %A Krieger,Tobias %A Hazo,Jean-Baptiste %A Draisma,Stasja %A Titzler,Ingrid %A Topooco,Naira %A Mathiasen,Kim %A Vernmark,Kristofer %A Urech,Antoine %A Maj,Anna %A Andersson,Gerhard %A Berking,Matthias %A Baños,Rosa María %A Araya,Ricardo %+ Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 020 7636 8636 ext 2463, asmae.doukani@lshtm.ac.uk %K blended psychotherapy %K cognitive behavioral therapy %K depression %K digital mental health interventions %K psychotherapy %K mental health %K program usability %K therapeutic alliance %K usability heuristics %K working alliance %D 2024 %7 31.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Increasing interest has centered on the psychotherapeutic working alliance as a means of understanding clinical change in digital mental health interventions in recent years. However, little is understood about how and to what extent a digital mental health program can have an impact on the working alliance and clinical outcomes in a blended (therapist plus digital program) cognitive behavioral therapy (bCBT) intervention for depression. Objective: This study aimed to test the difference in working alliance scores between bCBT and treatment as usual (TAU), examine the association between working alliance and depression severity scores in both arms, and test for an interaction between system usability and working alliance with regard to the association between working alliance and depression scores in bCBT at 3-month assessments. Methods: We conducted a secondary data analysis of the E-COMPARED (European Comparative Effectiveness Research on Blended Depression Treatment versus Treatment-as-usual) trial, which compared bCBT with TAU across 9 European countries. Data were collected in primary care and specialized services between April 2015 and December 2017. Eligible participants aged 18 years or older and diagnosed with major depressive disorder were randomized to either bCBT (n=476) or TAU (n=467). bCBT consisted of 6-20 sessions of bCBT (involving face-to-face sessions with a therapist and an internet-based program). TAU consisted of usual care for depression. The main outcomes were scores of the working alliance (Working Alliance Inventory-Short Revised–Client [WAI-SR-C]) and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) at 3 months after randomization. Other variables included system usability scores (System Usability Scale-Client [SUS-C]) at 3 months and baseline demographic information. Data from baseline and 3-month assessments were analyzed using linear regression models that adjusted for a set of baseline variables. Results: Of the 945 included participants, 644 (68.2%) were female, and the mean age was 38.96 years (IQR 38). bCBT was associated with higher composite WAI-SR-C scores compared to TAU (B=5.67, 95% CI 4.48-6.86). There was an inverse association between WAI-SR-C and PHQ-9 in bCBT (B=−0.12, 95% CI −0.17 to −0.06) and TAU (B=−0.06, 95% CI −0.11 to −0.02), in which as WAI-SR-C scores increased, PHQ-9 scores decreased. Finally, there was a significant interaction between SUS-C and WAI-SR-C with regard to an inverse association between higher WAI-SR-C scores and lower PHQ-9 scores in bCBT (b=−0.030, 95% CI −0.05 to −0.01; P=.005). Conclusions: To our knowledge, this is the first study to show that bCBT may enhance the client working alliance when compared to evidence-based routine care for depression that services reported offering. The working alliance in bCBT was also associated with clinical improvements that appear to be enhanced by good program usability. Our findings add further weight to the view that the addition of internet-delivered CBT to face-to-face CBT may positively augment experiences of the working alliance. Trial Registration: ClinicalTrials.gov NCT02542891, https://clinicaltrials.gov/study/NCT02542891; German Clinical Trials Register DRKS00006866, https://drks.de/search/en/trial/DRKS00006866; Netherlands Trials Register NTR4962, https://www.onderzoekmetmensen.nl/en/trial/25452; ClinicalTrials.Gov NCT02389660, https://clinicaltrials.gov/study/NCT02389660; ClinicalTrials.gov NCT02361684, https://clinicaltrials.gov/study/NCT02361684; ClinicalTrials.gov NCT02449447, https://clinicaltrials.gov/study/NCT02449447; ClinicalTrials.gov NCT02410616, https://clinicaltrials.gov/study/NCT02410616; ISRCTN Registry ISRCTN12388725, https://www.isrctn.com/ISRCTN12388725?q=ISRCTN12388725&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10; ClinicalTrials.gov NCT02796573, https://classic.clinicaltrials.gov/ct2/show/NCT02796573 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-016-1511-1 %M 38819882 %R 10.2196/47515 %U https://www.jmir.org/2024/1/e47515 %U https://doi.org/10.2196/47515 %U http://www.ncbi.nlm.nih.gov/pubmed/38819882 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e52386 %T Engagement With a Relaxation and Mindfulness Mobile App Among People With Cancer: Exploratory Analysis of Use Data and Self-Reports From a Randomized Controlled Trial %A Schläpfer,Sonja %A Schneider,Fabian %A Santhanam,Prabhakaran %A Eicher,Manuela %A Kowatsch,Tobias %A Witt,Claudia M %A Barth,Jürgen %+ Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Sonneggstrasse 6, Zurich, 8091, Switzerland, 41 44 255 94 51, sonja.schlaepfer@usz.ch %K mobile health %K mHealth %K digital health %K eHealth %K smartphone %K mobile phone %K implementation %K adherence %K self-guided %K unguided %K fully automated %K conversational agent %K chatbot %K behavior change %K tailoring %K self-care %K cancer %K app development %D 2024 %7 31.5.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Mobile health (mHealth) apps offer unique opportunities to support self-care and behavior change, but poor user engagement limits their effectiveness. This is particularly true for fully automated mHealth apps without any human support. Human support in mHealth apps is associated with better engagement but at the cost of reduced scalability. Objective: This work aimed to (1) describe the theory-informed development of a fully automated relaxation and mindfulness app to reduce distress in people with cancer (CanRelax app 2.0), (2) describe engagement with the app on multiple levels within a fully automated randomized controlled trial over 10 weeks, and (3) examine whether engagement was related to user characteristics. Methods: The CanRelax app 2.0 was developed in iterative processes involving input from people with cancer and relevant experts. The app includes evidence-based relaxation exercises, personalized weekly coaching sessions with a rule-based conversational agent, 39 self-enactable behavior change techniques, a self-monitoring dashboard with gamification elements, highly tailored reminder notifications, an educational video clip, and personalized in-app letters. For the larger study, German-speaking adults diagnosed with cancer within the last 5 years were recruited via the web in Switzerland, Austria, and Germany. Engagement was analyzed in a sample of 100 study participants with multiple measures on a micro level (completed coaching sessions, relaxation exercises practiced with the app, and feedback on the app) and a macro level (relaxation exercises practiced without the app and self-efficacy toward self-set weekly relaxation goals). Results: In week 10, a total of 62% (62/100) of the participants were actively using the CanRelax app 2.0. No associations were identified between engagement and level of distress at baseline, sex assigned at birth, educational attainment, or age. At the micro level, 71.88% (3520/4897) of all relaxation exercises and 714 coaching sessions were completed in the app, and all participants who provided feedback (52/100, 52%) expressed positive app experiences. At the macro level, 28.12% (1377/4897) of relaxation exercises were completed without the app, and participants’ self-efficacy remained stable at a high level. At the same time, participants raised their weekly relaxation goals, which indicates a potential relative increase in self-efficacy. Conclusions: The CanRelax app 2.0 achieved promising engagement even though it provided no human support. Fully automated social components might have compensated for the lack of human involvement and should be investigated further. More than one-quarter (1377/4897, 28.12%) of all relaxation exercises were practiced without the app, highlighting the importance of assessing engagement on multiple levels. %M 38819907 %R 10.2196/52386 %U https://cancer.jmir.org/2024/1/e52386 %U https://doi.org/10.2196/52386 %U http://www.ncbi.nlm.nih.gov/pubmed/38819907 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e56184 %T Digital Peer-Supported App Intervention to Promote Physical Activity Among Community-Dwelling Older Adults: Nonrandomized Controlled Trial %A Tabira,Kento %A Oguma,Yuko %A Yoshihara,Shota %A Shibuya,Megumi %A Nakamura,Manabu %A Doihara,Natsue %A Hirata,Akihiro %A Manabe,Tomoki %+ Sports Medicine Research Center, Keio University, 4-1-1 Hiyoshi, Kohoku-ku, Yokohama, Kanagawa, 223-0061, Japan, 81 45 566 1090, yoguma@keio.jp %K physical activity %K physical function %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K aged %K digital peer support app %K mHealth %K mobile health %K app %K apps %K application %K applications %K eHealth %K peer support %K exercise %K mobile phone %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Aging %G English %X Background: The use of mobile apps has promoted physical activity levels. Recently, with an increasing number of older adults accessing the internet, app-based interventions may be feasible in older populations. Peer support–based interventions have become a common method for promoting health-related behavior change. To our knowledge, the feasibility of using digital peer support apps (DPSAs) to increase physical activity among older adults and its impact on physical activity and physical function have not been investigated. Objective: This study aims to assess the feasibility of using DPSAs in older adults and to assess changes in physical activity and physical function in DPSA users. Methods: We conducted a nonrandomized controlled trial of older adults aged ≥65 years. We recruited participants for 2 distinct 12-week programs designed to increase physical activity. Participants could choose between an intervention group (app program and exercise instruction) or a control group (exercise instruction only). DPSA creates a group chat for up to 5 people with a common goal, and participants anonymously post to each other in the group. Once a day, participants posted a set of their step counts, photos, and comments on a group chat box. The intervention group used the DPSA after receiving 2 face-to-face lectures on its use. The participants were characterized using questionnaires, accelerometers, and physical function assessments. The feasibility of the DPSA was assessed using retention and adherence rates. Physical activity was assessed using accelerometers to measure the daily step count, light intensity physical activity, moderate to vigorous intensity physical activity (MVPA), and sedentary behavior. Physical function was assessed using grip strength and the 30-second chair-stand test. Results: The participants in the intervention group were more frequent users of apps, were more familiar with information and communication technology, and had a higher baseline physical activity level. The retention and adherence rates for the DPSA intervention were 88% (36/41) and 87.7%, respectively, indicating good feasibility. Participants in the intervention group increased their step count by at least 1000 steps and their MVPA by at least 10 minutes using the DPSA. There was a significant difference in the interaction between groups and intervention time points in the daily step count and MVPA (step count, P=.04; duration of MVPA, P=.02). The DPSA increased physical activity, especially in older adults with low baseline physical activity levels. Conclusions: The feasibility of DPSA was found to be good, with the intervention group showing increases in daily steps and MVPA. The effects of DPSA on step count, physical activity, and physical function in older adults with low baseline physical activity should be investigated using randomized controlled trials. %M 38814686 %R 10.2196/56184 %U https://aging.jmir.org/2024/1/e56184 %U https://doi.org/10.2196/56184 %U http://www.ncbi.nlm.nih.gov/pubmed/38814686 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56561 %T MyPEEPS Mobile App for HIV Prevention Among Transmasculine Youth: Adaptation Through Community-Based Feedback and Usability Evaluation %A Adedoja,Dorcas %A Kuhns,Lisa M %A Radix,Asa %A Garofalo,Robert %A Brin,Maeve %A Schnall,Rebecca %+ Columbia University School of Nursing, 560 W. 168th Street, New York City, NY, 10032, United States, 1 2123426886, rb897@columbia.edu %K HIV %K mobile app %K transgender men %K transmasculine %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Transgender men and transmasculine youth are at high risk for acquiring HIV. Growing research on transgender men demonstrates increased HIV risk and burden compared with the general US population. Despite biomedical advancements in HIV prevention, there remains a dearth of evidence-based, sexual health HIV prevention interventions for young transgender men. MyPEEPS (Male Youth Pursuing Empowerment, Education, and Prevention around Sexuality) Mobile is a web-based app that builds on extensive formative community–informed work to develop an evidence-based HIV prevention intervention. Our study team developed and tested the MyPEEPS Mobile intervention for 13- to 18-year-old cisgender young men in a national randomized controlled trial, which demonstrated efficacy to reduce sexual risk in the short term—at 3-month follow-up. Trans men and transmasculine youth resonated with basic HIV educational information and sexual scenarios of the original MyPEEPS app for cisgender men, but recognized the app's lack of transmasculine specificity. Objective: The purpose of this study is to detail the user-centered design methods to adapt, improve the user interface, and enhance the usability of the MyPEEPS Mobile app for young transgender men and transmasculine youth. Methods: The MyPEEPS Mobile app for young transgender men was adapted through a user-centered design approach, which included an iterative review of the adapted prototype by expert advisors and a youth advisory board. The app was then evaluated through a rigorous usability evaluation. Results: MyPEEPS Mobile is among the first mobile health interventions developed to meet the specific needs of young transgender men and transmasculine youth to reduce HIV risk behaviors. While many of the activities in the original MyPEEPS Mobile were rigorously developed and tested, there was a need to adapt our intervention to meet the specific needs and risk factors among young transgender men and transmasculine youth. The findings from this study describe the adaptation of these activities through feedback from a youth advisory board and expert advisors. Following adaptation of the content, the app underwent a rigorous usability assessment through an evaluation with experts in human-computer interaction (n=5) and targeted end users (n=20). Conclusions: Usability and adaptation findings demonstrate that the MyPEEPS Mobile app is highly usable and perceived as potentially useful for targeting HIV risk behaviors in young transgender men and transmasculine youth. %M 38814701 %R 10.2196/56561 %U https://formative.jmir.org/2024/1/e56561 %U https://doi.org/10.2196/56561 %U http://www.ncbi.nlm.nih.gov/pubmed/38814701 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51408 %T Feasibility and Acceptability of a Health App Platform Providing Individuals With a Budget to Purchase Preselected Apps to Work on Their Health and Well-Being: Quantitative Evaluation Study %A Willemsen,Romy Fleur %A Chavannes,Niels Henrik %A Aardoom,Jiska Joëlle %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, Netherlands, 31 615174812, r.f.willemsen@lumc.nl %K acceptability %K accessible %K adoption %K application %K design %K ehealth %K engagement %K evaluation study %K feasibility %K health app platform %K health apps %K health empowerment %K prevention %K public health %K uptake %K user-friendly %K users %K wellbeing %D 2024 %7 29.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The potential of health apps for health promotion and disease prevention is widely recognized. However, uptake is limited due to barriers individuals face in finding suitable and trustworthy apps, such as the overwhelming amount of available health apps. Therefore, the health app platform “FitKnip” was developed, enabling individuals to purchase preselected, trustworthy health apps with a budget of 100 euros (a currency exchange rate of EUR €1=US $1.0831 is applicable). The platform aimed to empower individuals to improve their health and vitality, ultimately supporting a more healthy society. Objective: The primary aim of this study was to evaluate the health app platform in terms of feasibility and acceptability. Potential effects on health empowerment and health outcomes were secondarily explored. Methods: This quantitative study was part of a mixed methods study with a prospective pre-post interventional design. We collected web-based user data, and self-reported web-based questionnaires were collected over 5 measurements over an 8-month period. Use statistics were tracked on the platform, including the number of purchased apps and euros spent per user registered within the health app platform. We measured the user-friendliness of the health app platform using the System Usability Scale (SUS) and satisfaction using the Client Satisfaction Questionnaire–8 (CSQ-8) and several 10-point Likert items. We asked participants to indicate, on a scale from 1 (not at all) to 10 (completely), how much the health app platform contributed to various areas related to health empowerment. We assessed health-related quality of life by the 12-item Short-Form Health Survey (SF-12) and one’s perceived level of stress by the 10-item Perceived Stress Scale (PSS-10). Results: A total of 1650 participants were included, of whom 42% (685/1650) bought at least 1 app. The majority of those purchased one app (244/685, 35.6%). The health app platform was rated as user-friendly (SUS mean 66.5, SD 20.7; range 66.5-70.0), and the acceptability of the health app platform was moderate (CSQ-8 mean 20.0, SD 1.5; range 19.6-20.0). Results furthermore showed that participants were generally satisfied to highly satisfied with the ease of the payment system to purchase apps on the platform (median 8, IQR 7-10), the look and feel of the platform (median 7, IQR 6-8), as well as the provided budget of 100 euros (median 9, IQR 7-10). Participants were less satisfied with the amount (median 6, IQR 4-7) and diversity (median 6, IQR 4-7) of apps offered on the platform. Conclusions: A health app platform is a promising initiative to enhance public health. Feasibility and acceptability are critical for success, as they ensure that such a platform is accessible, user-friendly, and meets end users’ needs and preferences. This can help to increase uptake, engagement, and ultimately the platform’s adoption and effectiveness. %M 38809585 %R 10.2196/51408 %U https://formative.jmir.org/2024/1/e51408 %U https://doi.org/10.2196/51408 %U http://www.ncbi.nlm.nih.gov/pubmed/38809585 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53321 %T Prevalence and Factors Associated With Willingness to Sustain Pandemic-Induced Digital Work in the General Population and Moderating Effects of Screen Hours: Cross-Sectional Study %A Li,Jiaying %A Fong,Daniel Yee Tak %A Ho,Mandy Man %A Choi,Edmond Pui Hang %A Lok,Kris Yuet Wan %A Lee,Jung Jae %A Duan,WenJie %A Wong,Janet Yuen Ha %A Lin,Chia-Chin %+ School of Nursing, The University of Hong Kong, 5/F, Academic Building 3 Sassoon Road, Pokfulam, Hong Kong SAR, 999077, China (Hong Kong), 852 39176645, dytfong@hku.hk %K COVID-19 pandemic %K digital work %K willingness to sustain %K screen time %K general population %D 2024 %7 28.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The pandemic has accelerated digital work transformation, yet little is known about individuals’ willingness to sustain such digital modes and its associated factors. A better understanding of this willingness and its drivers is crucial for guiding the development of future digital work infrastructure, training programs, and strategies to monitor and prevent related health issues. Objective: This study aims to quantify the general population’s willingness to sustain pandemic-induced digital work, identify its associated factors, and examine how screen time moderates these relationships. Methods: A cross-sectional study was conducted targeting Hong Kong residents aged ≥18 years who have increased engagement in digital work since the pandemic. Data were collected through self-reported, web-based surveys. Descriptive statistics determined prevalence rates, while structured multiphase logistic regression identified associated factors and explored the moderating effects of screen hour levels. Results: This unfunded study enrolled 1014 participants from May 2 to June 24, 2022, and completed data analysis within 3 months after data collection. A total of 391 (38.6%; 95% CI 35.6%-41.6%) participants expressed willingness to sustain digital work. Positive factors associated with this willingness included being an employee (odds ratio [OR] 3.12, 95% CI 1.59-6.45; P=.001), being health professionals (OR 3.32, 95% CI 1.49-7.82; P=.004), longer screen hours (OR 1.09, 95% CI 1.03-1.15; P=.002), and higher depression levels (OR 1.20, 95% CI 1.01-1.44; P=.04). Conversely, negatively associated factors included older age (OR 0.87, 95% CI 0.81-0.94; P=.001), extroversion (OR 0.66, 95% CI 0.51-0.86; P=.002), higher eHealth literacy (OR 0.96, 95% CI 0.93-0.98; P<.001), perceived greater susceptibility to COVID-19 (OR 0.84, 95% CI 0.74-0.96; P=.009), residence in a high-severity COVID-19 community (OR 0.73, 95% CI 0.63-0.84; P<.001), having infected individuals in the immediate social circle (OR 0.64, 95% CI 0.46-0.88; P=.006), higher BMI (OR 0.94, 95% CI 0.90-0.99; P=.02), feelings of being out of control (OR 0.96, 95% CI 0.93-0.98; P=.002), and higher fear of COVID-19 (OR 0.96, 95% CI 0.94-0.98; P=.001). In addition, a moderating effect of screen hour level (high: >8 h/d; low: ≤8 h/d) influenced the association among 10 factors related to willingness to sustain pandemic-induced digital work, including age, education level, household size, needs for regular medical care, BMI, frequency of both vigorous and moderate physical activities, perceived COVID-19 severity, immediate social circle COVID-19 presence, and fear of COVID-19 (all P values for interaction <.05). Conclusions: The substantial willingness of the general population to sustain digital work after the pandemic highlights the need for robust telework infrastructure, thorough monitoring of adverse health outcomes, and the potential to expand telehealth services among this group. The identification of factors influencing this willingness and the moderating role of screen hours inform the development of personalized strategies to enhance digital work acceptance where needed. %M 38805704 %R 10.2196/53321 %U https://www.jmir.org/2024/1/e53321 %U https://doi.org/10.2196/53321 %U http://www.ncbi.nlm.nih.gov/pubmed/38805704 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e51916 %T The Effect of an AI-Based, Autonomous, Digital Health Intervention Using Precise Lifestyle Guidance on Blood Pressure in Adults With Hypertension: Single-Arm Nonrandomized Trial %A Leitner,Jared %A Chiang,Po-Han %A Agnihotri,Parag %A Dey,Sujit %+ Electrical and Computer Engineering Department, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, United States, 1 8587220467, jjleitne@ucsd.edu %K blood pressure %K hypertension %K digital health %K lifestyle change %K lifestyle medicine %K wearables %K remote patient monitoring %K artificial intelligence %K AI %K mobile phone %D 2024 %7 28.5.2024 %9 Original Paper %J JMIR Cardio %G English %X Background: Home blood pressure (BP) monitoring with lifestyle coaching is effective in managing hypertension and reducing cardiovascular risk. However, traditional manual lifestyle coaching models significantly limit availability due to high operating costs and personnel requirements. Furthermore, the lack of patient lifestyle monitoring and clinician time constraints can prevent personalized coaching on lifestyle modifications. Objective: This study assesses the effectiveness of a fully digital, autonomous, and artificial intelligence (AI)–based lifestyle coaching program on achieving BP control among adults with hypertension. Methods: Participants were enrolled in a single-arm nonrandomized trial in which they received a BP monitor and wearable activity tracker. Data were collected from these devices and a questionnaire mobile app, which were used to train personalized machine learning models that enabled precision lifestyle coaching delivered to participants via SMS text messaging and a mobile app. The primary outcomes included (1) the changes in systolic and diastolic BP from baseline to 12 and 24 weeks and (2) the percentage change of participants in the controlled, stage-1, and stage-2 hypertension categories from baseline to 12 and 24 weeks. Secondary outcomes included (1) the participant engagement rate as measured by data collection consistency and (2) the number of manual clinician outreaches. Results: In total, 141 participants were monitored over 24 weeks. At 12 weeks, systolic and diastolic BP decreased by 5.6 mm Hg (95% CI −7.1 to −4.2; P<.001) and 3.8 mm Hg (95% CI −4.7 to −2.8; P<.001), respectively. Particularly, for participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 9.6 mm Hg (95% CI −12.2 to −6.9; P<.001) and 5.7 mm Hg (95% CI −7.6 to −3.9; P<.001), respectively. At 24 weeks, systolic and diastolic BP decreased by 8.1 mm Hg (95% CI −10.1 to −6.1; P<.001) and 5.1 mm Hg (95% CI −6.2 to −3.9; P<.001), respectively. For participants starting with stage-2 hypertension, systolic and diastolic BP decreased by 14.2 mm Hg (95% CI −17.7 to −10.7; P<.001) and 8.1 mm Hg (95% CI −10.4 to −5.7; P<.001), respectively, at 24 weeks. The percentage of participants with controlled BP increased by 17.2% (22/128; P<.001) and 26.5% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The percentage of participants with stage-2 hypertension decreased by 25% (32/128; P<.001) and 26.5% (27/102; P<.001) from baseline to 12 and 24 weeks, respectively. The average weekly participant engagement rate was 92% (SD 3.9%), and only 5.9% (6/102) of the participants required manual outreach over 24 weeks. Conclusions: The study demonstrates the potential of fully digital, autonomous, and AI-based lifestyle coaching to achieve meaningful BP improvements and high engagement for patients with hypertension while substantially reducing clinician workloads. Trial Registration: ClinicalTrials.gov NCT06337734; https://clinicaltrials.gov/study/NCT06337734 %M 38805253 %R 10.2196/51916 %U https://cardio.jmir.org/2024/1/e51916 %U https://doi.org/10.2196/51916 %U http://www.ncbi.nlm.nih.gov/pubmed/38805253 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54375 %T Digital Behavior Change Intervention Designs for Habit Formation: Systematic Review %A Zhu,Yujie %A Long,Yonghao %A Wang,Hailiang %A Lee,Kun Pyo %A Zhang,Lie %A Wang,Stephen Jia %+ School of Design, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong, China (Hong Kong), 852 2766 5478, stephen.j.wang@polyu.edu.hk %K habit formation %K digital health %K digital behavior change interventions design %K behavior change techniques %K physical activity %K mobile phone %D 2024 %7 24.5.2024 %9 Review %J J Med Internet Res %G English %X Background: With the development of emerging technologies, digital behavior change interventions (DBCIs) help to maintain regular physical activity in daily life. Objective: To comprehensively understand the design implementations of habit formation techniques in current DBCIs, a systematic review was conducted to investigate the implementations of behavior change techniques, types of habit formation techniques, and design strategies in current DBCIs. Methods: The process of this review followed the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. A total of 4 databases were systematically searched from 2012 to 2022, which included Web of Science, Scopus, ACM Digital Library, and PubMed. The inclusion criteria encompassed studies that used digital tools for physical activity, examined behavior change intervention techniques, and were written in English. Results: A total of 41 identified research articles were included in this review. The results show that the most applied behavior change techniques were the self-monitoring of behavior, goal setting, and prompts and cues. Moreover, habit formation techniques were identified and developed based on intentions, cues, and positive reinforcement. Commonly used methods included automatic monitoring, descriptive feedback, general guidelines, self-set goals, time-based cues, and virtual rewards. Conclusions: A total of 32 commonly design strategies of habit formation techniques were summarized and mapped to the proposed conceptual framework, which was categorized into target-mediated (generalization and personalization) and technology-mediated interactions (explicitness and implicitness). Most of the existing studies use the explicit interaction, aligning with the personalized habit formation techniques in the design strategies of DBCIs. However, implicit interaction design strategies are lacking in the reviewed studies. The proposed conceptual framework and potential solutions can serve as guidelines for designing strategies aimed at habit formation within DBCIs. %M 38787601 %R 10.2196/54375 %U https://www.jmir.org/2024/1/e54375 %U https://doi.org/10.2196/54375 %U http://www.ncbi.nlm.nih.gov/pubmed/38787601 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54145 %T Evaluation of the Parkinson’s Remote Interactive Monitoring System in a Clinical Setting: Usability Study %A Bridges,Bronwyn %A Taylor,Jake %A Weber,John Thomas %+ School of Pharmacy, Memorial University, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada, 1 709 864 7261, jweber@mun.ca %K Parkinson disease %K usability %K remote monitoring %K motor examination %K movement disorders %K thematic analysis %K System Usability Scale %K mobile phone %D 2024 %7 24.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The fastest-growing neurological disorder is Parkinson disease (PD), a progressive neurodegenerative disease that affects 10 million people worldwide. PD is typically treated with levodopa, an oral pill taken to increase dopamine levels, and other dopaminergic agonists. As the disease advances, the efficacy of the drug diminishes, necessitating adjustments in treatment dosage according to the patient’s symptoms and disease progression. Therefore, remote monitoring systems that can provide more detailed and accurate information on a patient’s condition regularly are a valuable tool for clinicians and patients to manage their medication. The Parkinson’s Remote Interactive Monitoring System (PRIMS), developed by PragmaClin Research Inc, was designed on the premise that it will be an easy-to-use digital system that can accurately capture motor and nonmotor symptoms of PD remotely. Objective: We performed a usability evaluation in a simulated clinical environment to assess the ease of use of the PRIMS and determine whether the product offers suitable functionality for users in a clinical setting. Methods: Participants were recruited from a user sign-up web-based database owned by PragmaClin Research Inc. A total of 11 participants were included in the study based on the following criteria: (1) being diagnosed with PD and (2) not being diagnosed with dementia or any other comorbidities that would make it difficult to complete the PRIMS assessment safely and independently. Patient users completed a questionnaire that is based on the Movement Disorder Society–sponsored revision of the Unified Parkinson’s Disease Rating Scale. Interviews and field notes were analyzed for underlying themes and topics. Results: In total, 11 people with PD participated in the study (female individuals: n=5, 45%; male individuals: n=6, 55%; age: mean 66.7, SD 7.77 years). Thematic analysis of the observer’s notes revealed 6 central usability issues associated with the PRIMS. These were the following: (1) the automated voice prompts are confusing, (2) the small camera is problematic, (3) the motor test exhibits excessive sensitivity to the participant’s orientation and position in relation to the cameras, (4) the system poses mobility challenges, (5) navigating the system is difficult, and (6) the motor test exhibits inconsistencies and technical issues. Thematic analysis of qualitative interview responses revealed four central themes associated with participants’ perspectives and opinions on the PRIMS, which were (1) admiration of purpose, (2) excessive system sensitivity, (3) video instructions preferred, and (4) written instructions disliked. The average system usability score was calculated to be 69.2 (SD 4.92), which failed to meet the acceptable system usability score of 70. Conclusions: Although multiple areas of improvement were identified, most of the participants showed an affinity for the overarching objective of the PRIMS. This feedback is being used to upgrade the current PRIMS so that it aligns more with patients’ needs. %M 38787603 %R 10.2196/54145 %U https://humanfactors.jmir.org/2024/1/e54145 %U https://doi.org/10.2196/54145 %U http://www.ncbi.nlm.nih.gov/pubmed/38787603 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e54412 %T Examining the Effects of a Brief, Fully Self-Guided Mindfulness Ecological Momentary Intervention on Empathy and Theory-of-Mind for Generalized Anxiety Disorder: Randomized Controlled Trial %A Zainal,Nur Hani %A Newman,Michelle G %+ Department of Psychology, National University of Singapore, 9 Arts Link, Singapore, 117572, Singapore, 65 917 767 7088, hanizainal@nus.edu.sg %K empathy %K theory-of-mind %K mindfulness %K ecological momentary intervention %K generalized anxiety disorder %K randomized controlled trial %K mobile phone %D 2024 %7 24.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: The utility of brief mindfulness ecological momentary interventions (EMIs) to improve empathy and theory-of-mind has been underinvestigated, particularly in generalized anxiety disorder (GAD). Objective: In this randomized controlled trial, we aimed to examine the efficacy of a 14-day, fully self-guided, mindfulness EMI on the empathy and theory-of-mind domains for GAD. Methods: Adults (aged ≥18 y) diagnosed with GAD were randomized to a mindfulness EMI (68/110, 61.8%) or self-monitoring app (42/110, 38.2%) arm. They completed the Interpersonal Reactivity Index self-report empathy measure and theory-of-mind test (Bell-Lysaker Emotion Recognition Task) at prerandomization, postintervention, and 1-month follow-up (1MFU) time points. Hierarchical linear modeling was conducted with the intent-to-treat principle to determine prerandomization to postintervention (pre-post intervention) and prerandomization to 1MFU (pre-1MFU) changes, comparing the mindfulness EMI to self-monitoring. Results: Observed effects were generally stronger from pre-1MFU than from pre-post intervention time points. From pre-post intervention time points, the mindfulness EMI was more efficacious than the self-monitoring app on fantasy (the ability to imagine being in others’ shoes; between-intervention effect size: Cohen d=0.26, P=.007; within-intervention effect size: Cohen d=0.22, P=.02 for the mindfulness EMI and Cohen d=−0.16, P=.10 for the self-monitoring app). From pre-1MFU time points, the mindfulness EMI, but not the self-monitoring app, improved theory-of-mind (a window into others’ thoughts and intentions through abstract, propositional knowledge about their mental states, encompassing the ability to decipher social cues) and the fantasy, personal distress (stress when witnessing others’ negative experiences), and perspective-taking (understanding others’ perspective) empathy domains. The effect sizes were small to moderate (Cohen d=0.15-0.36; P<.001 to P=.01) for significant between-intervention effects from pre-1MFU time points. Furthermore, the within-intervention effect sizes for these significant outcomes were stronger for the mindfulness EMI (Cohen d=0.30-0.43; P<.001 to P=.03) than the self-monitoring app (Cohen d=−0.12 to 0.21; P=.001 to P>.99) from pre-1MFU time points. No between-intervention and within-intervention effects on empathic concern (feeling affection, compassion, and care when observing others in distress, primarily attending to their emotional well-being) were observed from pre-post intervention and pre-1MFU time points. Conclusions: The brief mindfulness EMI improved specific domains of empathy (eg, fantasy, personal distress, and perspective-taking) and theory-of-mind with small to moderate effect sizes in persons with GAD. Higher-intensity, self-guided or coach-facilitated, multicomponent mindfulness EMIs targeting the optimization of social relationships are likely necessary to improve the empathic concern domain in this population. Trial Registration: ClinicalTrials.gov NCT04846777; https://clinicaltrials.gov/study/NCT04846777 %M 38787613 %R 10.2196/54412 %U https://mental.jmir.org/2024/1/e54412 %U https://doi.org/10.2196/54412 %U http://www.ncbi.nlm.nih.gov/pubmed/38787613 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50446 %T Evaluating a New Digital App–Based Program for Heart Health: Feasibility and Acceptability Pilot Study %A Lockwood,Kimberly G %A Kulkarni,Priya R %A Paruthi,Jason %A Buch,Lauren S %A Chaffard,Mathieu %A Schitter,Eva C %A Branch,OraLee H %A Graham,Sarah A %+ Lark Health, 809 Cuesta Dr, Suite B #1033, Mountain View, CA, 94040, United States, 1 5033801340, kimberly.lockwood@lark.com %K digital health %K cardiovascular disease %K artificial intelligence %K AI %K acceptability and feasibility %K pilot study %K lifestyle coaching %K mobile phone %D 2024 %7 24.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cardiovascular disease (CVD) is the leading cause of death in the United States, affecting a significant proportion of adults. Digital health lifestyle change programs have emerged as a promising method of CVD prevention, offering benefits such as on-demand support, lower cost, and increased scalability. Prior research has shown the effectiveness of digital health interventions in reducing negative CVD outcomes. This pilot study focuses on the Lark Heart Health program, a fully digital artificial intelligence (AI)–powered smartphone app, providing synchronous CVD risk counseling, educational content, and personalized coaching. Objective: This pilot study evaluated the feasibility and acceptability of a fully digital AI-powered lifestyle change program called Lark Heart Health. Primary analyses assessed (1) participant satisfaction, (2) engagement with the program, and (3) the submission of health screeners. Secondary analyses were conducted to evaluate weight loss outcomes, given that a major focus of the Heart Health program is weight management. Methods: This study enrolled 509 participants in the 90-day real-world single-arm pilot study of the Heart Health app. Participants engaged with the app by participating in coaching conversations, logging meals, tracking weight, and completing educational lessons. The study outcomes included participant satisfaction, app engagement, the completion of screeners, and weight loss. Results: On average, Heart Health study participants were aged 60.9 (SD 10.3; range 40-75) years, with average BMI indicating class I obesity. Of the 509 participants, 489 (96.1%) stayed enrolled until the end of the study (dropout rate: 3.9%). Study retention, based on providing a weight measurement during month 3, was 80% (407/509; 95% CI 76.2%-83.4%). Participant satisfaction scores indicated high satisfaction with the overall app experience, with an average score of ≥4 out of 5 for all satisfaction indicators. Participants also showed high engagement with the app, with 83.4% (408/489; 95% CI 80.1%-86.7%) of the sample engaging in ≥5 coaching conversations in month 3. The results indicated that participants were successfully able to submit health screeners within the app, with 90% (440/489; 95% CI 87%-92.5%) submitting all 3 screeners measured in the study. Finally, secondary analyses showed that participants lost weight during the program, with analyses showing an average weight nadir of 3.8% (SD 2.9%; 95% CI 3.5%-4.1%). Conclusions: The study results indicate that participants in this study were satisfied with their experience using the Heart Health app, highly engaged with the app features, and willing and able to complete health screening surveys in the app. These acceptability and feasibility results provide a key first step in the process of evidence generation for a new AI-powered digital program for heart health. Future work can expand these results to test outcomes with a commercial version of the Heart Health app in a diverse real-world sample. %M 38787598 %R 10.2196/50446 %U https://formative.jmir.org/2024/1/e50446 %U https://doi.org/10.2196/50446 %U http://www.ncbi.nlm.nih.gov/pubmed/38787598 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e40689 %T Digital Phenotyping for Stress, Anxiety, and Mild Depression: Systematic Literature Review %A Choi,Adrien %A Ooi,Aysel %A Lottridge,Danielle %+ School of Computer Science, Faculty of Science, University of Auckland, 38 Princes Street, Auckland, 1010, New Zealand, 64 9 373 7599 ext 82930, d.lottridge@auckland.ac.nz %K digital phenotyping %K passive sensing %K stress %K anxiety %K depression %K PRISMA %K Preferred Reporting Items for Systematic Reviews and Meta-Analyses %K mobile phone %D 2024 %7 23.5.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Unaddressed early-stage mental health issues, including stress, anxiety, and mild depression, can become a burden for individuals in the long term. Digital phenotyping involves capturing continuous behavioral data via digital smartphone devices to monitor human behavior and can potentially identify milder symptoms before they become serious. Objective: This systematic literature review aimed to answer the following questions: (1) what is the evidence of the effectiveness of digital phenotyping using smartphones in identifying behavioral patterns related to stress, anxiety, and mild depression? and (2) in particular, which smartphone sensors are found to be effective, and what are the associated challenges? Methods: We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) process to identify 36 papers (reporting on 40 studies) to assess the key smartphone sensors related to stress, anxiety, and mild depression. We excluded studies conducted with nonadult participants (eg, teenagers and children) and clinical populations, as well as personality measurement and phobia studies. As we focused on the effectiveness of digital phenotyping using smartphones, results related to wearable devices were excluded. Results: We categorized the studies into 3 major groups based on the recruited participants: studies with students enrolled in universities, studies with adults who were unaffiliated to any particular organization, and studies with employees employed in an organization. The study length varied from 10 days to 3 years. A range of passive sensors were used in the studies, including GPS, Bluetooth, accelerometer, microphone, illuminance, gyroscope, and Wi-Fi. These were used to assess locations visited; mobility; speech patterns; phone use, such as screen checking; time spent in bed; physical activity; sleep; and aspects of social interactions, such as the number of interactions and response time. Of the 40 included studies, 31 (78%) used machine learning models for prediction; most others (n=8, 20%) used descriptive statistics. Students and adults who experienced stress, anxiety, or depression visited fewer locations, were more sedentary, had irregular sleep, and accrued increased phone use. In contrast to students and adults, less mobility was seen as positive for employees because less mobility in workplaces was associated with higher performance. Overall, travel, physical activity, sleep, social interaction, and phone use were related to stress, anxiety, and mild depression. Conclusions: This study focused on understanding whether smartphone sensors can be effectively used to detect behavioral patterns associated with stress, anxiety, and mild depression in nonclinical participants. The reviewed studies provided evidence that smartphone sensors are effective in identifying behavioral patterns associated with stress, anxiety, and mild depression. %M 38780995 %R 10.2196/40689 %U https://mhealth.jmir.org/2024/1/e40689 %U https://doi.org/10.2196/40689 %U http://www.ncbi.nlm.nih.gov/pubmed/38780995 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54586 %T A Web-Based Intervention to Support the Mental Well-Being of Sexual and Gender Minority Young People: Mixed Methods Co-Design of Oneself %A Brown,Katherine %A Lucassen,Mathijs F G %A Núñez-García,Alicia %A Rimes,Katharine A %A Wallace,Louise M %A Samra,Rajvinder %+ Centre for Research in Psychology and Sports Science, School of Life and Medical Sciences, University of Hertfordshire, College Lane, Hatfield, AL109AB, United Kingdom, 44 1707 284 615, k.brown25@herts.ac.uk %K sexual minority %K gender minority %K lesbian, gay, bisexual, transgender, queer %K LGBTQ+ %K mental well-being %K support %K intervention %K resilience %K digital %K co-design %K sexual and gender minority youth %K SGMY %K mobile phone %D 2024 %7 21.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual and gender minority youth are at greater risk of compromised mental health than their heterosexual and cisgender peers. This is considered to be due to an increased burden of stigma, discrimination, or bullying resulting in a heightened experience of daily stress. Given the increasing digital accessibility and a strong preference for web-based support among sexual and gender minority youth, digital interventions are a key means to provide support to maintain their well-being. Objective: This paper aims to explicate the co-design processes and underpinning logic of Oneself, a bespoke web-based intervention for sexual and gender minority youth. Methods: This study followed a 6-stage process set out by Hagen et al (identify, define, position, concept, create, and use), incorporating a systematic scoping review of existing evidence, focus groups with 4 stakeholder groups (ie, sexual and gender minority youth, professionals who directly support them, parents, and UK public health service commissioners), a series of co-design workshops and web-based consultations with sexual and gender minority youth, the appointment of a digital development company, and young adult sexual and gender minority contributors to create content grounded in authentic experiences. Results: Oneself features a welcome and home page, including a free accessible to all animation explaining the importance of using appropriate pronouns and the opportunity to create a user account and log-in to access further free content. Creating an account provides an opportunity (for the user and the research team) to record engagement, assess users’ well-being, and track progress through the available content. There are three sections of content in Oneself focused on the priority topics identified through co-design: (1) coming out and doing so safely; (2) managing school, including homophobic, biphobic, or transphobic bullying or similar; and (3) dealing with parents and families, especially unsupportive family members, including parents or caregivers. Oneself’s content focuses on identifying these as topic areas and providing potential resources to assist sexual and gender minority youth in coping with these areas. For instance, Oneself drew on therapeutic concepts such as cognitive reframing, stress reduction, and problem-solving techniques. There is also a section containing relaxation exercises, a section with links to other recommended support and resources, and a downloads section with more detailed techniques and strategies for improving well-being. Conclusions: This study contributes to research by opening up the black box of intervention development. It shows how Oneself is underpinned by a logic that can support future development and evaluation and includes diverse co-designers. More interactive techniques to support well-being would be beneficial for further development. Additional content specific to a wider range of intersecting identities (such as care-experienced Asian sexual and gender minority youth from a minority faith background) would also be beneficial in future Oneself developments. International Registered Report Identifier (IRRID): RR2-10.2196/31036 %M 38772025 %R 10.2196/54586 %U https://formative.jmir.org/2024/1/e54586 %U https://doi.org/10.2196/54586 %U http://www.ncbi.nlm.nih.gov/pubmed/38772025 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e49050 %T A Web-Based Intervention Using "Five Ways to Wellbeing" to Promote Well-Being and Mental Health: Randomized Controlled Trial %A Prydz,Monica Beer %A Czajkowski,Nikolai Olavi %A Eilertsen,Maja %A Røysamb,Espen %A Nes,Ragnhild Bang %+ Promenta Research Centre, Department of Psychology, University of Oslo, Forskningsveien 3 a, PO Box 1020, Oslo, 0315, Norway, 47 95856400, m.b.prydz@psykologi.uio.no %K well-being %K mental health promotion %K intervention %K web based %K low cost %K broad outreach %K framework %K web-based intervention %K randomized controlled trial %K effectiveness %D 2024 %7 20.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Compromised well-being and mental health problems pose a significant threat to individuals and societies worldwide. Resource-intensive psychological treatments alone cannot alleviate this burden. There is a need for low-cost, evidence-based interventions aimed at preventing illness and promoting well-being. Five activity domains appear to be linked with well-being promotion across populations: connecting with others, being active, taking notice, learning, and being generous/giving. The activities mentioned are part of the Five Ways to Wellbeing framework and the web-based intervention Five Ways to Wellbeing for All (5waysA). Objective: This randomized controlled trial aims to test the effects of the 5waysA intervention, a web-based, low-cost, well-being–promoting measure targeting the general population. To date, the Five Ways to Wellbeing framework has not been tested in this specific format. The 5waysA intervention comprises 2 webinars and SMS text message reminders delivered over a 10-week period. Methods: In 2021, a total of 969 study participants from various regions across Norway were openly recruited through a web page. They were then randomly assigned to either an intervention group or 1 of 2 waiting list control groups, namely, active or passive. Self-reported life satisfaction (Satisfaction With Life Scale [SWLS]), flourishing (Flourishing Scale [FS]), positive emotions, anxiety, and depression symptoms (Hopkins Symptom Checklist-8 [HSCL-8]) were assessed before the intervention, at 4 weeks into the intervention, and 1-2 weeks after the intervention (over 10 weeks). Data analysis was conducted using linear mixed (multilevel) models. Results: After 10 weeks, 453 participants (171 in the intervention group and 282 in the waiting list control group) were assessed on outcome variables, with a dropout rate of 53.2% (516/969). Results revealed a significantly greater increase in the intervention group compared with the controls for SWLS (b=0.13, 95% CI 0.03-0.23; P=.001), FS (b=0.19, 95% CI 0.08-0.30; P=.001), positive emotions (b=0.43, 95% CI 0.27-0.60; P<.001), and these factors combined into a global well-being measure (b=0.28, CI 0.16-0.39; P<.001). Effect sizes (Cohen d) for the well-being outcomes ranged from 0.30 to 0.49. In addition, a significant decrease in anxiety and depressive symptoms was observed (b=–0.17, 95% CI –0.30 to –0.04; P=.001) with an effect size (Cohen d) of –0.20. Conclusions: The findings suggest that the web-based 5waysA intervention could serve as an effective approach for enhancing well-being and mental health within the general population. This study offers individuals, policy makers, and local stakeholders an accessible and potentially cost-effective well-being intervention that could be easily implemented. Trial Registration: ClinicalTrials.gov NCT04784871; https://clinicaltrials.gov/study/NCT04784871 %M 38767958 %R 10.2196/49050 %U https://mental.jmir.org/2024/1/e49050 %U https://doi.org/10.2196/49050 %U http://www.ncbi.nlm.nih.gov/pubmed/38767958 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55731 %T The Impact of Behavior Change Counseling Delivered via a Digital Health Tool Versus Routine Care Among Adolescents With Obesity: Pilot Randomized Feasibility Study %A Kepper,Maura %A Walsh-Bailey,Callie %A Miller,Zoe M %A Zhao,Min %A Zucker,Kianna %A Gacad,Angeline %A Herrick,Cynthia %A White,Neil H %A Brownson,Ross C %A Foraker,Randi E %+ Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Dr, St. Louis, MO, 63130, United States, 1 3149350142, kepperm@wustl.edu %K digital health %K obesity %K clinical care %K adolescents %K physical activity %K diet %K clinical trial %D 2024 %7 17.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Youth overweight and obesity is a public health crisis and increases the risk of poor cardiovascular health (CVH) and chronic disease. Health care providers play a key role in weight management, yet few tools exist to support providers in delivering tailored evidence-based behavior change interventions to patients. Objective: The goal of this pilot randomized feasibility study was to determine the feasibility of implementing the Patient-Centered Real-Time Intervention (PREVENT) tool in clinical settings, generate implementation data to inform scale-up, and gather preliminary effectiveness data. Methods: A pilot randomized clinical trial was conducted to examine the feasibility, implementation, and preliminary impact of PREVENT on patient knowledge, motivation, behaviors, and CVH outcomes. The study took place in a multidisciplinary obesity management clinic at a children’s hospital within an academic medical center. A total of 36 patients aged 12 to 18 years were randomized to use PREVENT during their routine visit (n=18, 50%) or usual care control (n=18, 50%). PREVENT is a digital health tool designed for use by providers to engage patients in behavior change education and goal setting and provides resources to support change. Patient electronic health record and self-report behavior data were collected at baseline and 3 months after the intervention. Implementation data were collected via PREVENT, direct observation, surveys, and interviews. We conducted quantitative, qualitative, and mixed methods analyses to evaluate pretest-posttest patient changes and implementation data. Results: PREVENT was feasible, acceptable, easy to understand, and helpful to patients. Although not statistically significant, only PREVENT patients increased their motivation to change their behaviors as well as their knowledge of ways to improve heart health and of resources. Compared to the control group, PREVENT patients significantly improved their overall CVH and blood pressure (P<.05). Conclusions: Digital tools can support the delivery of behavior change counseling in clinical settings to increase knowledge and motivate patients to change their behaviors. An appropriately powered trial is necessary to determine the impact of PREVENT on CVH behaviors and outcomes. Trial Registration: ClinicalTrials.gov NCT06121193; https://www.clinicaltrials.gov/study/NCT06121193 %M 38758581 %R 10.2196/55731 %U https://formative.jmir.org/2024/1/e55731 %U https://doi.org/10.2196/55731 %U http://www.ncbi.nlm.nih.gov/pubmed/38758581 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56198 %T An Internet-Based Intervention to Increase the Ability of Lesbian, Gay, and Bisexual People to Cope With Adverse Events: Single-Group Feasibility Study %A Isbășoiu,Andreea Bogdana %A Sava,Florin Alin %A Larsen,Torill M B %A Anderssen,Norman %A Rotaru,Tudor-Stefan %A Rusu,Andrei %A Sălăgean,Nastasia %A Tulbure,Bogdan Tudor %+ Department of Psychology, West University of Timisoara, 4 Vasile Parvan Bvd., Timisoara, 300223, Romania, 40 256592270, florin.sava@e-uvt.ro %K acceptance and commitment therapy %K anxiety %K depression %K PTSD %K LGBTQ+ %K online interventions %K transdiagnostic %K prevention %D 2024 %7 15.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people are at higher risk of mental health problems due to widespread hetero- and cisnormativity, including negative public attitudes toward the LGBTQ+ community. In addition to combating social exclusion at the societal level, strengthening the coping abilities of young LGBTQ+ people is an important goal. Objective: In this transdiagnostic feasibility study, we tested a 6-week internet intervention program designed to increase the ability of nonclinical LGBTQ+ participants to cope with adverse events in their daily lives. The program was based on acceptance and commitment therapy principles. Methods: The program consists of 6 web-based modules and low-intensity assistance for homework provided by a single care provider asynchronously. The design was a single-group assignment of 15 self-identified LGB community members who agreed to participate in an open trial with a single group (pre- and postintervention design). Results: Before starting the program, participants found the intervention credible and expressed high satisfaction at the end of the intervention. Treatment adherence, operationalized by the percentage of completed homework assignments (32/36, 88%) was also high. When we compared participants’ pre- and postintervention scores, we found a significant decrease in clinical symptoms of depression (Cohen d=0.44, 90% CI 0.09-0.80), social phobia (d=0.39, 90% CI 0.07-0.72), and posttraumatic stress disorder (d=0.30, 90% CI 0.04-0.55). There was also a significant improvement in the level of self-acceptance and behavioral effectiveness (d=0.64, 90% CI 0.28-0.99) and a significant decrease in the tendency to avoid negative internal experiences (d=0.38, 90% CI 0.09-0.66). The level of general anxiety disorder (P=.11; d=0.29, 90% CI –0.10 to 0.68) and alcohol consumption (P=.35; d=–0.06, 90% CI –0.31 to 0.19) were the only 2 outcomes for which the results were not statistically significant. Conclusions: The proposed web-based acceptance and commitment therapy program, designed to help LGBTQ+ participants better manage emotional difficulties and become more resilient, represents a promising therapeutic tool. The program could be further tested with more participants to ensure its efficacy and effectiveness. Trial Registration: ClinicalTrials.gov NCT05514964; https://clinicaltrials.gov/study/NCT05514964 %M 38749024 %R 10.2196/56198 %U https://formative.jmir.org/2024/1/e56198 %U https://doi.org/10.2196/56198 %U http://www.ncbi.nlm.nih.gov/pubmed/38749024 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58326 %T Examining the Effectiveness of Interactive Webtoons for Premature Birth Prevention: Protocol for a Randomized Controlled Trial %A Kim,Sun-Hee %A De Gagne,Jennie C %+ College of Nursing, Research Institute of Nursing Science, Daegu Catholic University, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea, 82 536504831, sunhee421@cu.ac.kr %K cartoon %K cartoons %K webtoon %K webtoons %K story %K stories %K storytelling %K preterm %K infant %K infants %K infancy %K baby %K babies %K neonate %K neonates %K neonatal %K newborn %K newborns %K perception %K perceptions %K web-based %K satisfaction %K client satisfaction %K clinical trial protocol %K education %K health belief model %K web-based intervention %K premature birth %K prevention and control %K prevention %K premature %K maternal %K pregnant %K pregnancy %K randomized controlled feasibility trials %K self-efficacy %K women %K randomized %K controlled trial %K controlled trials %K birth %K mobile phone %D 2024 %7 15.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Premature birth poses significant health challenges globally, impacting infants, families, and society. Despite recognition of its contributing factors, efforts to reduce its incidence have seen limited success. A notable gap exists in the awareness among women of childbearing age (WCA) regarding both the risks of premature birth and the preventative measures they can take. Research suggests that enhancing health beliefs and self-management efficacy in WCA could foster preventive health behaviors. Interactive webtoons offer an innovative, cost-effective avenue for delivering engaging, accessible health education aimed at preventing premature birth. Objective: This protocol describes a randomized controlled trial to assess the effectiveness and feasibility of a novel, self-guided, web-based intervention—Pregnancy Story I Didn’t Know in Interactive Webtoon Series (PSIDK-iWebtoons)—designed to enhance self-management efficacy and promote behaviors preventing premature birth in WCA. Methods: Using an explanatory sequential mixed methods design, this study first conducts a quantitative analysis followed by a qualitative inquiry to evaluate outcomes and feasibility. Participants are randomly assigned to 2 groups: one accessing the PSIDK-iWebtoons and the other receiving Pregnancy Story I Didn’t Know in Text-Based Information (PSIDK-Texts) over 3 weeks. We measure primary efficacy through the self-management self-efficacy scale for premature birth prevention (PBP), alongside secondary outcomes including perceptions of susceptibility, severity, benefits, and barriers based on the health belief model for PBP and PBP intention. Additional participant-reported outcomes are assessed at baseline, the postintervention time point, and the 4-week follow-up. The feasibility of the intervention is assessed after the end of the 3-week intervention period. Outcome analysis uses repeated measures ANOVA for quantitative data, while qualitative data are explored through content analysis of interviews with 30 participants. Results: The study received funding in June 2021 and institutional review board approval in October 2023. Both the PSIDK-iWebtoons and PSIDK-Texts interventions have been developed and pilot-tested from July to November 2023, with the main phase of quantitative data collection running from November 2023 to March 2024. Qualitative data collection commenced in February 2024 and will conclude in May 2024. Ongoing analyses include process evaluation and data interpretation. Conclusions: This trial will lay foundational insights into the nexus of interactive web-based interventions and the improvement of knowledge and practices related to PBP among WCA. By demonstrating the efficacy and feasibility of a web-based, interactive educational tool, this study will contribute essential evidence to the discourse on accessible and scientifically robust digital platforms. Positive findings will underscore the importance of such interventions in fostering preventive health behaviors, thereby supporting community-wide efforts to mitigate the risk of premature births through informed self-management practices. Trial Registration: Korea Disease Control and Prevention Agency (KDCA) KCT0008931; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=25857 International Registered Report Identifier (IRRID): DERR1-10.2196/58326 %M 38748471 %R 10.2196/58326 %U https://www.researchprotocols.org/2024/1/e58326 %U https://doi.org/10.2196/58326 %U http://www.ncbi.nlm.nih.gov/pubmed/38748471 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e49189 %T The Google Health Digital Well-Being Study: Protocol for a Digital Device Use and Well-Being Study %A McDuff,Daniel %A Barakat,Andrew %A Winbush,Ari %A Jiang,Allen %A Cordeiro,Felicia %A Crowley,Ryann %A Kahn,Lauren E %A Hernandez,John %A Allen,Nicholas B %+ Google, 1600 Amphitheatre Parkway, Unit D, Mountain View, CA, 94043, United States, 1 6176060531, dmcduff@google.com %K digital %K health %K well-being %K mobile %K google health %K digital health %K well-being %K mhealth %K digital device %K smartphone %D 2024 %7 14.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The impact of digital device use on health and well-being is a pressing question. However, the scientific literature on this topic, to date, is marred by small and unrepresentative samples, poor measurement of core constructs, and a limited ability to address the psychological and behavioral mechanisms that may underlie the relationships between device use and well-being. Recent authoritative reviews have made urgent calls for future research projects to address these limitations. The critical role of research is to identify which patterns of use are associated with benefits versus risks and who is more vulnerable to harmful versus beneficial outcomes, so that we can pursue evidence-based product design, education, and regulation aimed at maximizing benefits and minimizing the risks of smartphones and other digital devices. Objective: The objective of this study is to provide normative data on objective patterns of smartphone use. We aim to (1) identify how patterns of smartphone use impact well-being and identify groups of individuals who show similar patterns of covariation between smartphone use and well-being measures across time; (2) examine sociodemographic and personality or mental health predictors and which patterns of smartphone use and well-being are associated with pre-post changes in mental health and functioning; (3) discover which nondevice behavior patterns mediate the association between device use and well-being; (4) identify and explore recruitment strategies to increase and improve the representation of traditionally underrepresented populations; and (5) provide a real-world baseline of observed stress, mood, insomnia, physical activity, and sleep across a representative population. Methods: This is a prospective, nonrandomized study to investigate the patterns and relationships among digital device use, sensor-based measures (including both behavioral and physiological signals), and self-reported measures of mental health and well-being. The study duration is 4 weeks per participant and includes passive sensing based on smartphone sensors, and optionally a wearable (Fitbit), for the complete study period. The smartphone device will provide activity, location, phone unlocks and app usage, and battery status information. Results: At the time of submission, the study infrastructure and app have been designed and built, the institutional review board of the University of Oregon has approved the study protocol, and data collection is underway. Data from 4182 enrolled and consented participants have been collected as of March 27, 2023. We have made many efforts to sample a study population that matches the general population, and the demographic breakdown we have been able to achieve, to date, is not a perfect match. Conclusions: The impact of digital devices on mental health and well-being raises important questions. The Digital Well-Being Study is designed to help answer questions about the association between patterns of smartphone use and well-being. International Registered Report Identifier (IRRID): DERR1-10.2196/49189 %M 38743938 %R 10.2196/49189 %U https://www.researchprotocols.org/2024/1/e49189 %U https://doi.org/10.2196/49189 %U http://www.ncbi.nlm.nih.gov/pubmed/38743938 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59208 %T How to Enhance Adherence in Patients with Nonalcoholic Fatty Liver Disease: A Thought-Provoking Issue %A Liu,Chunlan %A Zhou,Run %A Shi,Junping %+ Department of Infectious Disease and Hepatology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University Jinhua Road Campus, 120 Jinhua Road, Hangzhou, 311121, China, 86 13957121199, 20131004@hznu.edu.cn %K NAFLD %K adherence %K digital therapeutics %K lifestyle modification %K mobile health %K nonalcoholic fatty liver disease %K self-management %K randomized controlled trial %D 2024 %7 14.5.2024 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 38743941 %R 10.2196/59208 %U https://www.jmir.org/2024/1/e59208 %U https://doi.org/10.2196/59208 %U http://www.ncbi.nlm.nih.gov/pubmed/38743941 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56138 %T An e-Learning Course to Train General Practitioners in Planetary Health: Pilot Intervention Study %A Tourrette,Cédric %A Tostain,Jean-Baptiste %A Kozub,Eva %A Badreddine,Maha %A James,Julia %A Noraz,Aurore %A De Choudens,Charlotte %A Moulis,Lionel %A Duflos,Claire %A Carbonnel,Francois %+ Desbrest Institute of Epidemiology and Public Health, Montpellier University, INSERM, Campus Sante, IURC, 641 Avenue du Doyen Gaston Giraud, Montpellier, 34093, France, 33 684014834, francois.carbonnel@umontpellier.fr %K planetary health %K One Health %K medical education %K environmental health %K education %K e-learning %K general practitioner %K pilot study %K climate change %K training %K environmental %K e-learning module %K behavior change %K ecosystem %K questionnaire %K behavior %K self-assessment %K e-learning intervention %K environment %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: According to the World Health Organization, climate and ecological emergencies are already major threats to human health. Unabated climate change will cause 3.4 million deaths per year by the end of the century, and health-related deaths in the population aged ≥65 years will increase by 1540%. Planetary health (PH) is based on the understanding that human health and human civilization depend on flourishing natural systems and the wise stewardship of those natural systems. Health care systems collectively produce global emissions equivalent to those of the fifth largest country on earth, and they should take steps to reduce their environmental impact. Primary care in France accounts for 23% of greenhouse gas emissions in the health care sector. General practitioners (GPs) have an important role in PH. The course offers first-year GP residents of the Montpellier-Nîmes Faculty of Medicine a blended-learning course on environmental health. An e-learning module on PH, lasting 30 to 45 minutes, has been introduced in this course. Objective: The objective of this study was to assess the impact of the e-learning module on participants’ knowledge and behavior change. Methods: This was a before-and-after study. The module consisted of 3 parts: introduction, degradation of ecosystems and health (based on the Intergovernmental Panel on Climate Change report and planetary limits), and ecoresponsibility (based on the Shift Project report on the impact of the health care system on the environment). The questionnaire used Likert scales to self-assess 10 points of knowledge and 5 points of PH-related behavior. Results: A total of 95 participants completed the pre- and posttest questionnaires (response rate 55%). The mean scores for participants’ pretest knowledge and behaviors were 3.88/5 (SD 0.362) and 3.45/5 (SD 0.705), respectively. There was no statistically significant variation in the results according to age or gender. The pretest mean score of participants who had already taken PH training was statistically better than those who had not taken the PH training before this course (mean 4.05, SD 0.16 vs mean 3.71, SD 0.374; P<.001). Conclusions: The PH module of the Primary Care Environment and Health course significantly improved self-assessment knowledge scores and positively modified PH behaviors among GP residents. Further work is needed to study whether these self-declared behaviors are translated into practice. %M 38743463 %R 10.2196/56138 %U https://formative.jmir.org/2024/1/e56138 %U https://doi.org/10.2196/56138 %U http://www.ncbi.nlm.nih.gov/pubmed/38743463 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e50982 %T Predicting the Effectiveness of a Mindfulness Virtual Community Intervention for University Students: Machine Learning Model %A El Morr,Christo %A Tavangar,Farideh %A Ahmad,Farah %A Ritvo,Paul %A , %+ School of Health Policy and Management, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 426 736 2100 ext 22053, elmorr@yorku.ca %K machine learning %K virtual community %K virtual care %K mindfulness %K depression %K anxiety %K stress %K students %K online %K randomized controlled trial %K Canada %K virtual %K artificial intelligence %K symptoms %K behavioral therapy %K sociodemographic %K mindfulness video %K online video %D 2024 %7 13.5.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Students’ mental health crisis was recognized before the COVID-19 pandemic. Mindfulness virtual community (MVC), an 8-week web-based mindfulness and cognitive behavioral therapy program, has proven to be an effective web-based program to reduce symptoms of depression, anxiety, and stress. Predicting the success of MVC before a student enrolls in the program is essential to advise students accordingly. Objective: The objectives of this study were to investigate (1) whether we can predict MVC’s effectiveness using sociodemographic and self-reported features and (2) whether exposure to mindfulness videos is highly predictive of the intervention’s success. Methods: Machine learning models were developed to predict MVC’s effectiveness, defined as success in reducing symptoms of depression, anxiety, and stress as measured using the Patient Health Questionnaire-9 (PHQ-9), the Beck Anxiety Inventory (BAI), and the Perceived Stress Scale (PSS), to at least the minimal clinically important difference. A data set representing a sample of undergraduate students (N=209) who took the MVC intervention between fall 2017 and fall 2018 was used for this secondary analysis. Random forest was used to measure the features’ importance. Results: Gradient boosting achieved the best performance both in terms of area under the curve (AUC) and accuracy for predicting PHQ-9 (AUC=0.85 and accuracy=0.83) and PSS (AUC=1 and accuracy=1), and random forest had the best performance for predicting BAI (AUC=0.93 and accuracy=0.93). Exposure to online mindfulness videos was the most important predictor for the intervention’s effectiveness for PHQ-9, BAI, and PSS, followed by the number of working hours per week. Conclusions: The performance of the models to predict MVC intervention effectiveness for depression, anxiety, and stress is high. These models might be helpful for professionals to advise students early enough on taking the intervention or choosing other alternatives. The students’ exposure to online mindfulness videos is the most important predictor for the effectiveness of the MVC intervention. Trial Registration: ISRCTN Registry ISRCTN12249616; https://www.isrctn.com/ISRCTN12249616 %M 38578872 %R 10.2196/50982 %U https://www.i-jmr.org/2024/1/e50982 %U https://doi.org/10.2196/50982 %U http://www.ncbi.nlm.nih.gov/pubmed/38578872 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e44973 %T Effect of Adding Personalized Instant Messaging Apps to a Brief Smoking Cessation Model in Community Smokers in Hong Kong: Pragmatic Randomized Clinical Trial %A Wu,Yongda Socrates %A Cheung,Yee Tak Derek %A Lee,Jay Jung Jae %A Wong,Carlos King Ho %A Ho,Sai Yin %A Li,William Ho Cheung %A Yao,Ying %A Lam,Tai Hing %A Wang,Man Ping %+ School of Nursing, The University of Hong Kong, 5/F, Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 39176636, mpwang@hku.hk %K instant messaging %K text messaging %K chatting %K smoking cessation %K COVID-19 %K community smoker %D 2024 %7 13.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: While text messaging has proven effective for smoking cessation (SC), engagement in the intervention remains suboptimal. Objective: This study aims to evaluate whether using more interactive and adaptive instant messaging (IM) apps on smartphones, which enable personalization and chatting with SC advisors, can enhance SC outcomes beyond the provision of brief SC advice and active referral (AR) to SC services. Methods: From December 2018 to November 2019, we proactively recruited 700 adult Chinese daily cigarette users in Hong Kong. Participants were randomized in a 1:1 ratio. At baseline, all participants received face-to-face brief advice on SC. Additionally, they were introduced to local SC services and assisted in selecting one. The intervention group received an additional 26 personalized regular messages and access to interactive chatting through IM apps for 3 months. The regular messages aimed to enhance self-efficacy, social support, and behavioral capacity for quitting, as well as to clarify outcome expectations related to cessation. We developed 3 sets of messages tailored to the planned quit date (within 30 days, 60 days, and undecided). Participants in the intervention group could initiate chatting with SC advisors on IM themselves or through prompts from regular messages or proactive inquiries from SC advisors. The control group received 26 SMS text messages focusing on general health. The primary outcomes were smoking abstinence validated by carbon monoxide levels of <4 parts per million at 6 and 12 months after the start of the intervention. Results: Of the participants, 505/700 (72.1%) were male, and 450/648 (69.4%) were aged 40 or above. Planning to quit within 30 days was reported by 500/648 (77.2%) participants, with fewer intervention group members (124/332, 37.3%) reporting previous quit attempts compared with the control group (152/335, 45.4%; P=.04). At the 6- and 12-month follow-ups (with retention rates of 456/700, 65.1%, and 446/700, 63.7%, respectively), validated abstinence rates were comparable between the intervention (14/350, 4.0%, and 19/350, 5.4%) and control (11/350, 3.1% and 21/350, 6.0%) groups. Compared with the control group, the intervention group reported greater utilization of SC services at 12 months (RR 1.26, 95% CI 1.01-1.56). Within the intervention group, engaging in chat sessions with SC advisors predicted better validated abstinence at 6 months (RR 3.29, 95% CI 1.13-9.63) and any use of SC services (RR 1.66, 95% CI 1.14-2.43 at 6 months; RR 1.67, 95% CI 1.26-2.23 at 12 months). Conclusions: An IM-based intervention, providing support and assistance alongside brief SC advice and AR, did not yield further increases in quitting rates but did encourage the utilization of SC services. Future research could explore whether enhanced SC service utilization leads to improved long-term SC outcomes. Trial Registration: ClinicalTrials.gov NCT03800719; https://clinicaltrials.gov/ct2/show/NCT03800719 %M 38739429 %R 10.2196/44973 %U https://www.jmir.org/2024/1/e44973 %U https://doi.org/10.2196/44973 %U http://www.ncbi.nlm.nih.gov/pubmed/38739429 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e54007 %T Veteran Experiences With an mHealth App to Support Measurement-Based Mental Health Care: Results From a Mixed Methods Evaluation %A Higashi,Robin T %A Etingen,Bella %A Richardson,Eric %A Palmer,Jennifer %A Zocchi,Mark S %A Bixler,Felicia R %A Smith,Bridget %A McMahon,Nicholas %A Frisbee,Kathleen L %A Fortney,John C %A Turvey,Carolyn %A Evans,Jennifer %A Hogan,Timothy P %+ Peter O’Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, United States, 1 (214) 648 3645, Robin.Higashi@UTSouthwestern.edu %K measurement-based care %K mobile health app %K mental health %K veteran %K mHealth %K support %K mixed-methods evaluation %K digital health %D 2024 %7 10.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health conditions are highly prevalent among US veterans. The Veterans Health Administration (VHA) is committed to enhancing mental health care through the integration of measurement-based care (MBC) practices, guided by its Collect-Share-Act model. Incorporating the use of remote mobile apps may further support the implementation of MBC for mental health care. Objective: This study aims to evaluate veteran experiences with Mental Health Checkup (MHC), a VHA mobile app to support remote MBC for mental health. Methods: Our mixed methods sequential explanatory evaluation encompassed mailed surveys with veterans who used MHC and follow-up semistructured interviews with a subset of survey respondents. We analyzed survey data using descriptive statistics. We then compared responses between veterans who indicated having used MHC for ≥3 versus <3 months using χ2 tests. We analyzed interview data using thematic analysis. Results: We received 533 surveys (533/2631, for a 20% response rate) and completed 20 interviews. Findings from these data supported one another and highlighted 4 key themes. (1) The MHC app had positive impacts on care processes for veterans: a majority of MHC users overall, and a greater proportion who had used MHC for ≥3 months (versus <3 months), agreed or strongly agreed that using MHC helped them be more engaged in their health and health care (169/262, 65%), make decisions about their treatment (157/262, 60%), and set goals related to their health and health care (156/262, 60%). Similarly, interviewees described that visualizing progress through graphs of their assessment data over time motivated them to continue therapy and increased self-awareness. (2) A majority of respondents overall, and a greater proportion who had used MHC for ≥3 months (versus <3 months), agreed/strongly agreed that using MHC enhanced their communication (112/164, 68% versus 51/98, 52%; P=.009) and rapport (95/164, 58% versus 42/98, 43%; P=.02) with their VHA providers. Likewise, interviewees described how MHC helped focus therapy time and facilitated trust. (3) However, veterans also endorsed some challenges using MHC. Among respondents overall, these included difficulty understanding graphs of their assessment data (102/245, 42%), not receiving enough training on the app (73/259, 28%), and not being able to change responses to assessment questions (72/256, 28%). (4) Interviewees offered suggestions for improving the app (eg, facilitating ease of log-in, offering additional reminder features) and for increasing adoption (eg, marketing the app and its potential advantages for veterans receiving mental health care). Conclusions: Although experiences with the MHC app varied, veterans were positive overall about its use. Veterans described associations between the use of MHC and engagement in their own care, self-management, and interactions with their VHA mental health providers. Findings support the potential of MHC as a technology capable of supporting the VHA’s Collect-Share-Act model of MBC. %M 38728684 %R 10.2196/54007 %U https://mental.jmir.org/2024/1/e54007 %U https://doi.org/10.2196/54007 %U http://www.ncbi.nlm.nih.gov/pubmed/38728684 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e52369 %T Feasibility and Acceptability of a Mobile App–Based TEAM-CBT (Testing Empathy Assessment Methods–Cognitive Behavioral Therapy) Intervention (Feeling Good) for Depression: Secondary Data Analysis %A Bisconti,Nicholas %A Odier,Mackenzie %A Becker,Matthew %A Bullock,Kim %+ PGSP-Stanford PsyD. Consortium, 401 Quarry Rd, Palo Alto, CA, 94304, United States, 1 6506449946, nbisco@stanford.edu %K depression %K mobile health %K mHealth %K cognitive behavioral therapy %K mobile phone %D 2024 %7 10.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: The Feeling Good App is an automated stand-alone digital mobile mental health tool currently undergoing beta testing with the goal of providing evidence-informed self-help lessons and exercises to help individuals reduce depressive symptoms without guidance from a mental health provider. Users work through intensive basic training (IBT) and ongoing training models that provide education regarding cognitive behavioral therapy principles from a smartphone. Objective: The key objective of this study was to perform a nonsponsored third-party academic assessment of an industry-generated data set; this data set focused on the safety, feasibility, and accessibility of a commercial automated digital mobile mental health app that was developed to reduce feelings associated with depression. Methods: The Feeling Good App development team created a waitlist cohort crossover design and measured symptoms of depression and anxiety using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and an app-specific measure of negative feelings called the 7 Dimension Emotion Slider (7-DES). The waitlist cohort crossover design divided the participants into 2 groups, where 48.6% (141/290) of the participants were given immediate access to the apps, while 51.4% (149/290) were placed on a 2-week waitlist before being given access to the app. Data collected by the Feeling Good App development team were deidentified and provided to the authors of this paper for analysis through a nonsponsored university data use agreement. All quantitative data were analyzed using SPSS Statistics (version 28.0; IBM Corp). Descriptive statistics were calculated for demographic variables. Feasibility and acceptability were descriptively assessed. All participants included in the quantitative data were given access to the Feeling Good App; this study did not include a control group. Results: In terms of safety, there was no statistically significant change in suicidality from preintervention to postintervention time points (t288=0.0; P>.99), and there was a statistically significant decrease in hopelessness from preintervention to postintervention time points (F289=30.16; P<.01). In terms of acceptability, 72.2% (166/230) of the users who started the initial 2-day IBT went on to complete it, while 34.8% (80/230) of the users who started IBT completed the entirety of the apps’ 4-week protocol (150/230, 65.22% dropout rate over 4 weeks). Conclusions: This study is the first reported proof-of-concept evaluation of the Feeling Good App in terms of safety, feasibility, and statistical trends within the data set. It demonstrates a feasible and novel approach to industry and academic collaboration in the process of developing a digital mental health technology translated from an existing evidence-informed treatment. The results support the prototype app as safe for a select nonclinical population. The app had acceptable levels of engagement and dropouts throughout the intervention. Those who stay engaged showed reductions in symptom severity of depression warranting further investigation of the app’s efficacy. %M 38728080 %R 10.2196/52369 %U https://mental.jmir.org/2024/1/e52369 %U https://doi.org/10.2196/52369 %U http://www.ncbi.nlm.nih.gov/pubmed/38728080 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53890 %T A Mindfulness-Based App Intervention for Pregnant Women: Protocol for a Pilot Feasibility Study %A Rizzi,Silvia %A Poggianella,Stefania %A Pavesi,Maria Chiara %A Gios,Lorenzo %A Bincoletto,Giorgia %A Scolari,Isabella %A Paoli,Claudia %A Marroni,Debora %A Tassinari,Irene %A Baietti,Barbara %A Gianatti,Anna %A Albertini,Veronica %A Burlon,Barbara %A Chiodega,Vanda %A Endrizzi,Barbara %A Benini,Elena %A Guella,Chiara %A Gadotti,Erik %A Forti,Stefano %A Taddei,Fabrizio %+ Digital Health Research, Centre for Digital Health & Wellbeing, Fondazione Bruno Kessler, Via Sommarive 18, Trento, 38123, Italy, 39 0461312415, srizzi@fbk.eu %K mindfulness %K promoting well-being %K pregnancy %K eHealth %K mobile health %K mHealth %K mobile apps %K development %K usability %K user-centered design %K mindfulness based %K intervention %K pregnant women %K pregnant %K feasibility study %K well-being %K women %K quality of life %K psychological symptoms %K digital solution %K virtual coach %K smartphone %K mobile phone %D 2024 %7 10.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Pregnancy is a complex time characterized by major transformations in a woman, which impact her physical, mental, and social well-being. How a woman adapts to these changes can affect her quality of life and psychological well-being. The literature indicates that pregnant women commonly experience psychological symptoms, with anxiety, stress, and depression being among the most frequent. Hence, promoting a healthy lifestyle focused on women’s psychological well-being is crucial. Recently developed digital solutions have assumed a crucial role in supporting psychological well-being in physiologically pregnant women. Therefore, the need becomes evident for the development and implementation of digital solutions, such as a virtual coach implemented in a smartphone, as a support for the psychological well-being of pregnant women who do not present psychological and psychiatric disorders. Objective: This study aims to assess the feasibility, acceptability, and utility of a mindfulness-based mobile app. The primary objective is to explore the feasibility of using a virtual coach, Maia, developed within the TreC Mamma app to promote women’s psychological well-being during pregnancy through a psychoeducational module based on mindfulness. Finally, through the delivery of this module, the level of psychological well-being will be explored as a secondary objective. Methods: This is a proof-of-concept study in which a small sample (N=50) is sufficient to achieve the intended purposes. Recruitment will occur within the group of pregnant women belonging to the pregnancy care services of the Trento Azienda Provinciale per i Servizi Sanitari di Trento. The convenience sampling method will be used. Maia will interact with the participating women for 8 weeks, starting from weeks 24 and 26 of pregnancy. Specifically, there will be 2 sessions per week, which the woman can choose, to allow more flexibility toward her needs. Results: The psychoeducational pathway is expected to lead to significant results in terms of usability and engagement in women’s interactions with Maia. Furthermore, it is anticipated that there will be improvements in psychological well-being and overall quality of life. The analysis of the data collected in this study will be mainly descriptive, orientated toward assessing the achievement of the study objectives. Conclusions: Literature has shown that women preferred web-based support during the perinatal period, suggesting that implementing digital interventions can overcome barriers to social stigma and asking for help. Maia can be a valuable resource for regular psychoeducational support for women during pregnancy. International Registered Report Identifier (IRRID): RR1-10.2196/53890 %M 38567964 %R 10.2196/53890 %U https://www.researchprotocols.org/2024/1/e53890 %U https://doi.org/10.2196/53890 %U http://www.ncbi.nlm.nih.gov/pubmed/38567964 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55238 %T Evaluating and Enhancing an Educational Intervention to Reduce Smallholder Farmers’ Exposure to Pesticides in Uganda Through a Digital, Systematic Approach to Behavior Change: Protocol for a Cluster-Randomized Controlled Trial %A Ssekkadde,Peter %A Tomberge,Vica Marie Jelena %A Brugger,Curdin %A Atuhaire,Aggrey %A Dalvie,Mohamed Aqiel %A Rother,Hanna-Andrea %A Röösli,Martin %A Inauen,Jennifer %A Fuhrimann,Samuel %+ Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Switzerland, 41 762010833, samuel.fuhrimann@swisstph.ch %K smallholder farmers %K knowledge %K attitude %K practice %K behavior change %K psychosocial determinants of behavior %K health %K education %K pesticide exposure %K SMS text messages %D 2024 %7 8.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smallholder farmers receive educational interventions on safe pesticide handling by governmental agencies, industries, or nongovernmental organizations to reduce exposure risks. However, existing educational interventions have limited effects on changing behaviors. Targeting psychosocial determinants of behavior change in educational interventions through theory- and evidence-based approaches may enhance their effectiveness. Objective: We aim at describing the intervention development and study design of a 3-arm cluster-randomized controlled trial to assess the effects in improving safe pesticide handling and reducing pesticide exposure of (1) an existing educational intervention and (2) a newly developed SMS text messaging intervention based on the Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) behavior change approach. Methods: We enrolled 539 Ugandan smallholder farmers in 12 clusters (subcounties). The clusters, each with 45 farmers, were randomly allocated to one of the three arms: (1) educational intervention, (2) educational intervention+RANAS-based SMS text messages, or (3) control group. The educational intervention comprised a 2-day workshop that targeted multiple aspects of safe pesticide handling, whereas the SMS text messages targeted the use of personal protective equipment (PPE) and were based on the RANAS approach. For intervention development in this study, this approach includes identifying psychosocial determinants of PPE use at baseline and selecting behavior change techniques to target them in SMS text messages. The primary outcomes of the study are (1) pesticide knowledge, attitude, and practice scores indicating performance throughout the educational intervention; and (2) frequency of PPE use. Secondary outcomes are the RANAS-based behavioral determinants of PPE use, the frequency of glove use, algorithm-based pesticide exposure intensity scores, and signs and symptoms of pesticide poisoning. The outcomes were assessed in structured interviews before the intervention (baseline) and at the 12-month follow-up. The effect of the interventions among the arms will be analyzed using the intervention arms and baseline measures as predictors and the follow-up measures as outcomes in linear multivariable mixed models including the clusters as random effects. The mediating psychosocial determinants of the interventions will be assessed in multiple mediation models. Results: The study was conducted from 2020 to 2021—baseline interviews were conducted in October 2020, and the educational intervention was delivered in November 2020. The RANAS-based SMS text messages were developed based on the baseline data for relevant behavioral determinants of PPE use and sent between February 2021 and September 2021. Follow-up interviews were conducted in October 2021. Overall, 539 farmers were enrolled in the study at baseline; 8.3% (45/539) were lost to follow-up by the end of the study. Conclusions: This study will contribute to a better understanding of the effectiveness and behavior change mechanisms of educational interventions by using an experimental, cluster-randomized study design to improve pesticide handling among smallholder farmers. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) 18237656; https://doi.org/10.1186/ISRCTN18237656 International Registered Report Identifier (IRRID): DERR1-10.2196/55238 %M 38718387 %R 10.2196/55238 %U https://www.researchprotocols.org/2024/1/e55238 %U https://doi.org/10.2196/55238 %U http://www.ncbi.nlm.nih.gov/pubmed/38718387 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e52575 %T Knowledge, Skills, and Experience With Technology in Relation to Nutritional Intake and Physical Activity Among Older Adults at Risk of Falls: Semistructured Interview Study %A Kikkenborg,Julie %A Magelund,Emma %A Riise,Maria Silke %A Kayser,Lars %A Terp,Rikke %+ Section of Health Service Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark, 45 28757291, lk@sund.ku.dk %K eHealth %K self-management %K fall prevention %K older adults %K physical activity %K nutritional intake %K Readiness and Enablement Index for Health Technology %K READHY %K social support %K support %K management %K fall %K nutrition %K diet %K qualitative study %K malnutrition %K physical inactivity %K injury %K injuries %K food %K food intake %K nutritional needs %K outpatient clinic %K social network %K mobile phone %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: More than one-third of older adults (aged ≥65 y) experience falls every year. The prevalent modifiable risk factors for falling are malnutrition and physical inactivity, among others. The involvement of older adults in the prevention of falls can decrease injuries, hospitalizations, and dependency on health care professionals. In this regard, eHealth can support older adults’ self-management through more physical activity and adequate food intake. eHealth must be tailored to older adults’ needs and preferences so that they can reap its full benefits. Therefore, it is necessary to gain insight into the knowledge, skills, and mindset of older adults living at home who are at risk of falls regarding eHealth. Objective: This qualitative study aims to explore older adults’ use of everyday digital services and technology and how they acquire knowledge about and manage their nutritional intake and physical activity in relation to their health. Methods: Semistructured interviews were conducted with 15 older adults (n=9, 60% women; n=6, 40% men; age range 71-87 y) who had all experienced falls or were at risk of falling. These individuals were recruited from a geriatric outpatient clinic. The interviews were analyzed using deductive content analysis based on a modification of the Readiness and Enablement Index for Health Technology framework. Results: The qualitative data showed that the informants’ social networks had a positive impact on their self-management, use of technology, and mindset toward nutritional intake and physical activity. Although the informants generally lived active lives, they all lacked knowledge about how their food intake influenced their physical health, including their risk of falling. Another finding was the large diversity in the use of technology among the informants, which was related to their mindset toward technology. Conclusions: Older adults can use technology for everyday purposes, but some need additional introduction and support to be able to use it for managing their health. They also need to learn about the importance of proper nutritional intake and physical activity in preventing falls. Older adults need a more personalized introduction to technology, nutrition, and physical activity in their contact with health professionals. %M 38717810 %R 10.2196/52575 %U https://humanfactors.jmir.org/2024/1/e52575 %U https://doi.org/10.2196/52575 %U http://www.ncbi.nlm.nih.gov/pubmed/38717810 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55374 %T Efficacy of the iJobs Web-Based Psychoeducational Intervention to Improve Job Search Behavior and Promote Mental Health Among Unemployed People: Protocol for a Waitlist Randomized Controlled Trial %A Bodnaru,Alexandra %A Rusu,Andrei %A Vîrgă,Delia %A Van den Broeck,Anja %A Blonk,Roland W B %A Trancă,Loredana Marcela %A Iliescu,Dragoș %+ Department of Psychology, West University of Timișoara, 4, Vasile Pârvan Boulevard, Timișoara, 300223, Romania, 40 727977093, alexandra.bodnaru@e-uvt.ro %K iJobs %K JOBS II program %K employability %K internet intervention %K randomized-controlled trial %D 2024 %7 8.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Unemployment affects millions of people worldwide and, beyond its economic impact, has severe implications for people’s well-being and mental health. Different programs have been developed in response to this phenomenon, but to date, job-search interventions have proved to be most effective, especially the JOBS II program. The JOBS II program proved not only to be effective for re-employment but also has a positive impact on beneficiaries’ mental health (ie, reduces anxiety or depression). However, by now, this evidence-based program has been delivered only on site in the various countries where it was implemented. In the digital era, web-based alternatives to such programs are highly needed because they have the advantages of scalability and cost-effectiveness. Objective: In this context, we aim to investigate the efficacy of iJobs, the web-based adaptation of the JOBS II program, on job-search intensity and effort, the quality of job-search behaviors, and job-search self-efficacy. Further, 1 month after the intervention, we will also assess the employment status and the satisfaction with the job (if applicable). This study will also investigate the effect of iJobs on well-being and mental health (ie, anxiety and depression). Methods: This study is a 2-arm randomized controlled trial. The 2 independent groups (intervention vs waiting list control group) will be crossed with 3 measurement times (ie, baseline, the postintervention time point, and 1-month follow-up). The design will be a 2 (intervention vs control) × 3 (baseline, the postintervention time point, and 1-month follow-up) factorial design. iJobs is a 2-week intervention consisting of 6 modules: an introductive module and 5 modules adapted from the original JOBS II program to the web-based setting and Romanian population. The web-based intervention also has a human component, as beneficiaries receive personalized written feedback after each module on the platform from a team of psychologists involved in the project. Results: The enrollment of study participants started in June 2023 and is expected to end in May 2024. The data collection is expected to be completed by July 2024. The results are expected to be submitted for publication in the summer of 2024. Conclusions: This study is the first large-scale randomized controlled trial aiming to test the efficacy of a web-based adaptation of the JOBS II program. If our results support the efficacy of iJobs, they will offer the premise for it to become an evidence-based, accessible alternative for unemployed people in Romania and might be implemented in other countries. Trial Registration: ClinicalTrials.gov NCT05962554; https://clinicaltrials.gov/study/NCT05962554 International Registered Report Identifier (IRRID): PRR1-10.2196/55374 %M 38717812 %R 10.2196/55374 %U https://www.researchprotocols.org/2024/1/e55374 %U https://doi.org/10.2196/55374 %U http://www.ncbi.nlm.nih.gov/pubmed/38717812 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46036 %T Effectiveness of an Artificial Intelligence-Assisted App for Improving Eating Behaviors: Mixed Methods Evaluation %A Chew,Han Shi Jocelyn %A Chew,Nicholas WS %A Loong,Shaun Seh Ern %A Lim,Su Lin %A Tam,Wai San Wilson %A Chin,Yip Han %A Chao,Ariana M %A Dimitriadis,Georgios K %A Gao,Yujia %A So,Jimmy Bok Yan %A Shabbir,Asim %A Ngiam,Kee Yuan %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 3, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 65168687, jocelyn.chew.hs@nus.edu.sg %K artificial intelligence %K chatbot %K chatbots %K weight %K overweight %K eating %K food %K weight loss %K mHealth %K mobile health %K app %K apps %K applications %K self-regulation %K self-monitoring %K anxiety %K depression %K consideration of future consequences %K mental health %K conversational agent %K conversational agents %K eating behavior %K healthy eating %K food consumption %K obese %K obesity %K diet %K dietary %D 2024 %7 7.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: A plethora of weight management apps are available, but many individuals, especially those living with overweight and obesity, still struggle to achieve adequate weight loss. An emerging area in weight management is the support for one’s self-regulation over momentary eating impulses. Objective: This study aims to examine the feasibility and effectiveness of a novel artificial intelligence–assisted weight management app in improving eating behaviors in a Southeast Asian cohort. Methods: A single-group pretest-posttest study was conducted. Participants completed the 1-week run-in period of a 12-week app-based weight management program called the Eating Trigger-Response Inhibition Program (eTRIP). This self-monitoring system was built upon 3 main components, namely, (1) chatbot-based check-ins on eating lapse triggers, (2) food-based computer vision image recognition (system built based on local food items), and (3) automated time-based nudges and meal stopwatch. At every mealtime, participants were prompted to take a picture of their food items, which were identified by a computer vision image recognition technology, thereby triggering a set of chatbot-initiated questions on eating triggers such as who the users were eating with. Paired 2-sided t tests were used to compare the differences in the psychobehavioral constructs before and after the 7-day program, including overeating habits, snacking habits, consideration of future consequences, self-regulation of eating behaviors, anxiety, depression, and physical activity. Qualitative feedback were analyzed by content analysis according to 4 steps, namely, decontextualization, recontextualization, categorization, and compilation. Results: The mean age, self-reported BMI, and waist circumference of the participants were 31.25 (SD 9.98) years, 28.86 (SD 7.02) kg/m2, and 92.60 (SD 18.24) cm, respectively. There were significant improvements in all the 7 psychobehavioral constructs, except for anxiety. After adjusting for multiple comparisons, statistically significant improvements were found for overeating habits (mean –0.32, SD 1.16; P<.001), snacking habits (mean –0.22, SD 1.12; P<.002), self-regulation of eating behavior (mean 0.08, SD 0.49; P=.007), depression (mean –0.12, SD 0.74; P=.007), and physical activity (mean 1288.60, SD 3055.20 metabolic equivalent task-min/day; P<.001). Forty-one participants reported skipping at least 1 meal (ie, breakfast, lunch, or dinner), summing to 578 (67.1%) of the 862 meals skipped. Of the 230 participants, 80 (34.8%) provided textual feedback that indicated satisfactory user experience with eTRIP. Four themes emerged, namely, (1) becoming more mindful of self-monitoring, (2) personalized reminders with prompts and chatbot, (3) food logging with image recognition, and (4) engaging with a simple, easy, and appealing user interface. The attrition rate was 8.4% (21/251). Conclusions: eTRIP is a feasible and effective weight management program to be tested in a larger population for its effectiveness and sustainability as a personalized weight management program for people with overweight and obesity. Trial Registration: ClinicalTrials.gov NCT04833803; https://classic.clinicaltrials.gov/ct2/show/NCT04833803 %M 38713909 %R 10.2196/46036 %U https://www.jmir.org/2024/1/e46036 %U https://doi.org/10.2196/46036 %U http://www.ncbi.nlm.nih.gov/pubmed/38713909 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e53461 %T Accuracy of a Web-Based Time-Use Diary (MEDAL) in Assessing Children’s Meal Intakes With Food Photography by Parents as Reference: Instrument Validation Study %A Chong,Kar Mun %A Chia,Airu %A Shah Budin,Nur Syahirah %A Poh,Bee Koon %A Jamil,Nor Aini %A Koh,Denise %A Chong,Mary Foong-Fong %A Wong,Jyh Eiin %+ Center for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz,, Kuala Lumpur, 50300, Malaysia, 60 3 9289 7683, wjeiin@ukm.edu.my %K children %K dietary intake %K time-use diary %K food photography %K accuracy %K mobile phone %D 2024 %7 7.5.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: My E-Diary for Activities and Lifestyle (MEDAL) is a web-based time-use diary developed to assess the diet and movement behaviors of Asian school children. Objective: This study aims to determine the accuracy of MEDAL in assessing the dietary intake of Malaysian school children, using photographs of the children’s meals taken by their parents as an objective reference. Methods: A convenience sample of 46 children aged 10 to 11 years recorded their daily meals in MEDAL for 4 days (2 weekdays and 2 weekend days). Their parents took photographs of the meals and snacks of their children before and after consumption during the 4-day period and sent them along with a brief description of food and drinks consumed via an instant SMS text messaging app. The accuracy of the children’s reports of the food they had consumed was determined by comparing their MEDAL reports to the photographs of the food sent by their parents. Results: Overall, the match, omission, and intrusion rates were 62% (IQR 46%-86%), 39% (IQR 16%-55%), and 20% (IQR 6%-44%), respectively. Carbohydrate-based items from the food categories “rice and porridge”; “breads, spreads, and cereals”; and “noodles, pasta, and potatoes” were reported most accurately (total match rates: 68%-76%). “Snack and dessert” items were omitted most often (omission rate: 54%). Furthermore, side dishes from “vegetables and mushrooms,” “eggs and tofu,” “meat and fish,” and “curry” food groups were often omitted (omission rates: 42%-46%). Items from “milk, cheese, and yogurt”; “snacks and desserts”; and “drinks” food groups intruded most often (intrusion rates: 37%-46%). Compared to the items reported by the boys, those reported by the girls had higher match rates (69% vs 53%) and lesser omission rates (31% vs 49%; P=.03, respectively). Conclusions: In conclusion, children aged 10 to 11 years can self-report all their meals in MEDAL, although some items are omitted or intruded. Therefore, MEDAL is a tool that can be used to assess the dietary intake of Malaysian school children. %M 38713499 %R 10.2196/53461 %U https://pediatrics.jmir.org/2024/1/e53461 %U https://doi.org/10.2196/53461 %U http://www.ncbi.nlm.nih.gov/pubmed/38713499 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e46282 %T Motion Tracking of Daily Living and Physical Activities in Health Care: Systematic Review From Designers’ Perspective %A Wei,Lai %A Wang,Stephen Jia %+ School of Design, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, China (Hong Kong), 852 2766 5478, stephen.j.wang@polyu.edu.hk %K motion tracking %K daily living %K physical activity %K health care application %K design %K public health %K systematic review %K mobile phone %D 2024 %7 6.5.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Motion tracking technologies serve as crucial links between physical activities and health care insights, facilitating data acquisition essential for analyzing and intervening in physical activity. Yet, systematic methodologies for evaluating motion tracking data, especially concerning user activity recognition in health care applications, remain underreported. Objective: This study aims to systematically review motion tracking in daily living and physical activities, emphasizing the critical interaction among devices, users, and environments from a design perspective, and to analyze the process involved in health care application research. It intends to delineate the design and application intricacies in health care contexts, focusing on enhancing motion tracking data’s accuracy and applicability for health monitoring and intervention strategies. Methods: Using a systematic review, this research scrutinized motion tracking data and their application in health care and wellness, examining studies from Scopus, Web of Science, EBSCO, and PubMed databases. The review used actor network theory and data-enabled design to understand the complex interplay between humans, devices, and environments within these applications. Results: Out of 1501 initially identified studies, 54 (3.66%) were included for in-depth analysis. These articles predominantly used accelerometer and gyroscope sensors (n=43, 80%) to monitor and analyze motion, demonstrating a strong preference for these technologies in capturing both dynamic and static activities. While incorporating portable devices (n=11, 20%) and multisensor configurations (n=16, 30%), the application of sensors across the body (n=15, 28%) and within physical spaces (n=17, 31%) highlights the diverse applications of motion tracking technologies in health care research. This diversity reflects the application’s alignment with activity types ranging from daily movements to specialized scenarios. The results also reveal a diverse participant pool, including the general public, athletes, and specialized groups, with a focus on healthy individuals (n=31, 57%) and athletes (n=14, 26%). Despite this extensive application range, the focus primarily on laboratory-based studies (n=39, 72%) aimed at professional uses, such as precise activity identification and joint functionality assessment, emphasizes a significant challenge in translating findings from controlled environments to the dynamic conditions of everyday physical activities. Conclusions: This study’s comprehensive investigation of motion tracking technology in health care research reveals a significant gap between the methods used for data collection and their practical application in real-world scenarios. It proposes an innovative approach that includes designers in the research process, emphasizing the importance of incorporating data-enabled design framework. This ensures that motion data collection is aligned with the dynamic and varied nature of daily living and physical activities. Such integration is crucial for developing health applications that are accessible, intuitive, and tailored to meet diverse user needs. By leveraging a multidisciplinary approach that combines design, engineering, and health sciences, the research opens new pathways for enhancing the usability and effectiveness of health technologies. %M 38709547 %R 10.2196/46282 %U https://mhealth.jmir.org/2024/1/e46282 %U https://doi.org/10.2196/46282 %U http://www.ncbi.nlm.nih.gov/pubmed/38709547 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e49519 %T Efficacy of the QuitSure App for Smoking Cessation in Adult Smokers: Cross-Sectional Web Survey %A Goldgof,Gregory M %A Mishra,Shweta %A Bajaj,Kriti %+ QuitSure, Rapidkart Online Private Limited, Bajaj Bhavan, 2nd Floor, 226 Nariman Point, Mumbai, 400021, India, 91 2222023626, kriti@quitsure.app %K smoking %K quit smoking %K smoking cessation %K smoking app %K QuitSure %K smoke free %K quit vaping %K vaping %K smoker %K smoke %K cross-sectional study %K smartphone app %K tobacco consumption %K tobacco %K survey %K nicotine %K nicotine withdrawal %K mobile phone %D 2024 %7 6.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Cigarette smoking remains one of the leading causes of preventable death worldwide. A worldwide study by the World Health Organization concluded that more than 8 million people die every year from smoking, tobacco consumption, and secondhand smoke. The most effective tobacco cessation programs require personalized human intervention combined with costly pharmaceutical supplementation, making them unaffordable or inaccessible to most tobacco users. Thus, digital interventions offer a promising alternative to these traditional methods. However, the leading smartphone apps available in the market today have either not been studied in a clinical setting or are unable to match the smoking cessation success rates of their expensive offline counterparts. We would like to understand whether QuitSure, a novel smoking cessation app built by Rapidkart Online Private Limited, is able to bridge this efficacy gap and deliver affordable and effective smoking cessation at scale. Objective: Our objective was to do an initial exploration into the engagement, efficacy, and safety of QuitSure based on the self-reported experiences of its users. Outcomes measured were program completion, the effect of program completion on smoking behavior, including self-reported cessation outcomes, and negative health events from using the app. Methods: All QuitSure registered users who created their accounts on the QuitSure app between April 1, 2021, and February 28, 2022, were sent an anonymized web-based survey. The survey results were added to their engagement data on the app to evaluate the feasibility and efficacy of the app as a smoking cessation intervention. The data were analyzed using descriptive statistics (frequencies and percentages) and the χ2 test of independence. Results: In total, 1299 users who had completed the QuitSure program submitted the survey and satisfied the inclusion criteria of the study. Of these, 1286 participants had completed the program more than 30 days before filling out the survey, and 1040 (80.1%, 95% CI 79.1%-82.6%) of them had maintained prolonged abstinence for at least 30 days after program completion. A majority of participants (770/891, 86.4%) who were still maintaining abstinence at the time of submitting the survey did not experience any severe nicotine withdrawal symptoms, while 41.9% (373/891) experienced no mild withdrawal symptoms either. Smoking quantity prior to completing the program significantly affected quit rates (P<.001), with heavy smokers (>20 cigarettes per day) having a lower 30-day prolonged abstinence rate (relative risk=0.91; 95% CI 90.0%-96.2%) compared to lighter smokers. No additional adverse events outside of known nicotine withdrawal symptoms were reported. Conclusions: The nature of web-based surveys and cohort selection allows for extensive unknown biases. However, the efficacy rates of survey respondents who completed the program were high and provide a case for further investigation in the form of randomized controlled trials on the QuitSure tobacco cessation program. %M 38709553 %R 10.2196/49519 %U https://humanfactors.jmir.org/2024/1/e49519 %U https://doi.org/10.2196/49519 %U http://www.ncbi.nlm.nih.gov/pubmed/38709553 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53756 %T Self-Selected Versus Assigned Target to Reduce Smartphone Use and Improve Mental Health: Protocol for a Randomized Controlled Trial %A Sharma,Kamal Kant %A Somasundaram,Jeeva %A Sachdeva,Ashish %+ Max Institute of Healthcare Management, Indian School of Business, Knowledge City, Sector 81, Sahibzada Ajit Singh Nagar, Punjab, 140306, India, 91 01724591831, ashish_sachdeva@isb.edu %K screen time %K monetary incentives %K target selection %K mental health %K mobile phone %D 2024 %7 6.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smartphones have become integral to people’s lives, with a noticeable increase in the average screen time, both on a global scale and, notably, in India. Existing research links mobile consumption to sleep problems, poor physical and mental health, and lower subjective well-being. The comparative effectiveness of monetary incentives given for self-selected versus assigned targets on reducing screen time and thereby improving mental health remains unanswered. Objective: This study aims to assess the impact of monetary incentives and target selection on mobile screen time reduction and mental health. Methods: We designed a 3-armed randomized controlled trial conducted with employees and students at an educational institution in India. The study is conducted digitally over 12 weeks, including baseline (2 weeks), randomization (1 week), intervention (5 weeks), and postintervention (4 week) periods. We emailed the employees and students to inquire about their interest in participation. Those who expressed interest received detailed study information and consent forms. After securing consent, participants were asked to complete the initial survey and provide their mobile screen time during the baseline period. At the beginning of the intervention period, the participants were randomly allocated into 1 of 3 study groups in a 2:2:1 ratio (self-selected vs assigned vs control). Participants in the self-selected group were presented with 3 target options: 10%, 20%, and 30%, and they were asked to self-select a target to reduce their mobile screen time from their baseline average mobile screen time. Participants in the assigned group were given a target to reduce their mobile screen time from their baseline average mobile screen time. The assigned target was set as the average of the targets selected by participants in the self-selected group. During the intervention period, participants in the self-selected and assigned group were eligible to receive a monetary incentive of INR (Indian Rupee) 50 (US $0.61) per day for successfully attaining their target. Participants in the control group neither received nor selected a target for reducing their mobile screen time and did not receive any monetary incentives during the intervention period. All participants received information regarding the advantages of reducing mobile screen time. As an incentive, all participants would receive INR 500 (US $6.06) upon completion of the study and a chance to win 1 of 2 lotteries valued at INR 5000 (US $60.55) for consistently sharing their mobile screen time data. Results: Currently, the study intervention is being rolled out. Enrollment occurred between August 21, 2023, and September 2, 2023; data collection concluded in November 2023. We expect that results will be available by early 2024. Conclusions: The monetary incentives and self-selected versus assigned targets might be effective interventions in reducing mobile screen time among working professionals and students. Trial Registration: AsPredicted 142497; https://aspredicted.org/hr3nn.pdf International Registered Report Identifier (IRRID): DERR1-10.2196/53756 %M 38709546 %R 10.2196/53756 %U https://www.researchprotocols.org/2024/1/e53756 %U https://doi.org/10.2196/53756 %U http://www.ncbi.nlm.nih.gov/pubmed/38709546 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52853 %T An mHealth Intervention for Gay and Bisexual Men’s Mental, Behavioral, and Sexual Health in a High-Stigma, Low-Resource Context (Project Comunică): Protocol for a Randomized Controlled Trial %A Leluțiu-Weinberger,Corina %A Filimon,Mircea L %A Hoover,Donald %A Lixandru,Mihai %A Hanu,Lucian %A Dogaru,Bogdan %A Kovacs,Tudor %A Fierbințeanu,Cristina %A Ionescu,Florentina %A Manu,Monica %A Mariș,Alexandra %A Pană,Elena %A Dorobănțescu,Cristian %A Streinu-Cercel,Adrian %A Pachankis,John E %+ School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, United States, 1 646 217 9205, cl4265@cumc.columbia.edu %K gay and bisexual men %K HIV prevention %K heavy alcohol use %K stigma %K mental health %K behavioral intervention %K mobile phone %D 2024 %7 6.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The World Health Organization reported that 80% of new HIV diagnoses in Europe in 2014 occurred in Central and Eastern Europe. Romania has a particularly high HIV incidence, AIDS prevalence, and number of related deaths. HIV incidence in Romania is largely attributed to sexual contact among gay and bisexual men. However, homophobic stigma in Romania serves as a risk factor for HIV infection for gay and bisexual men. The Comunică intervention aims to provide a much-needed HIV risk reduction strategy, and it entails the delivery of motivational interviewing and cognitive behavioral therapy skills across 8 live text-based counseling sessions on a mobile platform to gay and bisexual men at risk of HIV. The intervention is based on the information-motivation-behavior and minority stress models. There is preliminary evidence suggesting that Comunică holds promise for reducing gay and bisexual men’s co-occurring sexual (eg, HIV transmission risk behavior), behavioral (eg, heavy alcohol use), and mental (eg, depression) health risks in Romania. Objective: This paper describes the protocol for a randomized controlled trial designed to test the efficacy of Comunică in a national trial. Methods: To test Comunică’s efficacy, 305 gay and bisexual men were randomized to receive Comunică or a content-matched education attention control condition. The control condition consisted of 8 time-matched educational modules that present information regarding gay and bisexual men’s identity development, information about HIV transmission and prevention, the importance of HIV and sexually transmitted infection testing and treatment, heavy alcohol use and its associations with HIV transmission risk behavior, sexual health communication, finding social support, and creating sexual health goals. Participants undergo rapid HIV and syphilis testing and 3-site chlamydia and gonorrhea testing at baseline and the 12-month follow-up. Outcomes are measured before the intervention (baseline) and at the 4-, 8-, and 12-month follow-ups. Results: The study was funded in September 2018, and data collection began in May 2019. The last participant follow-up was in January 2024. Currently, the data analyst is cleaning data sets in preparation for data analyses, which are scheduled to begin in April 2024. Data analysis meetings are scheduled regularly to establish timelines and examine the results as analyses are gradually being conducted. Upon completion, a list of manuscripts will be reviewed and prioritized, and the team will begin preparing them for publication. Conclusions: This study is the first to test the efficacy of an intervention with the potential to simultaneously support the sexual, behavioral, and mental health of gay and bisexual men in Central and Eastern Europe using motivational interviewing support and sensitivity to the high-stigma context of the region. If efficacious, Comunică presents a scalable platform to provide support to gay and bisexual men living in Romania and similar high-stigma, low-resource countries. Trial Registration: ClinicalTrials.gov NCT03912753; https://clinicaltrials.gov/study/NCT03912753 International Registered Report Identifier (IRRID): DERR1-10.2196/52853 %M 38709550 %R 10.2196/52853 %U https://www.researchprotocols.org/2024/1/e52853 %U https://doi.org/10.2196/52853 %U http://www.ncbi.nlm.nih.gov/pubmed/38709550 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53550 %T Integrating Virtual Mindfulness-Based Stress Reduction Into Inflammatory Bowel Disease Care: Mixed Methods Feasibility Trial %A Chappell,Kaitlyn Delaney %A Meakins,Diana %A Marsh-Joyal,Melanie %A Bihari,Allison %A Goodman,Karen J %A Le Melledo,Jean-Michel %A Lim,Allen %A Peerani,Farhad %A Kroeker,Karen Ivy %+ Division of Gastroenterology, Department of Medicine, University of Alberta, 130 University Campus NW, Edmonton, AB, T6G 2X8, Canada, 1 780 492 4873, karen.kroeker@ualberta.ca %K inflammatory bowel disease %K psychosocial care %K multidisciplinary care %K quality of care %K quality of life %K mental health %K adult %K adults %K anxiety %K depression %K IBD %K virtual mindfulness %K feasibility trial %K clinic %K health facility %K Canada %K semistructured interview %K psychiatrist %K psychiatrists %K videoconferencing %K effectiveness %K v-MBSR %K coping %K coping strategy %D 2024 %7 6.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with inflammatory bowel disease (IBD) experience cycles of aggressive physical symptoms including abdominal pain, diarrhea, and fatigue. These acute symptoms regress and return, and chronic symptoms and complications often linger. The nature of the disease can also cause individuals to experience psychological distress including symptoms of anxiety and depression; however, unlike the physical symptoms of IBD, these psychological symptoms often remain untreated. Objective: This study aims to evaluate the feasibility, acceptability, and effectiveness of virtual mindfulness-based stress reduction (v-MBSR) for adults with IBD. Methods: IBD patients with self-reported anxiety or depression were recruited from clinics in Alberta, Canada to participate in an 8-week v-MSBR intervention. Eligible patients participated in v-MBSR delivered by psychiatrists using a videoconferencing platform. Primary feasibility outcomes included trial uptake, adherence, attendance, and attrition rates. Secondary effectiveness outcomes included measures of anxiety, depression, quality of life (QoL), and mindfulness. Effectiveness data were collected at 3 time points: baseline, at intervention completion, and 6 months after completion. To further assess feasibility and acceptability, participants were invited to participate in a semistructured interview after completing v-MBSR. Results: A total of 16 of the 64 (25%) referred patients agreed to participate in v-MBSR with the most common reason for decline being a lack of time while 7 of the 16 (43.8%) participants completed the program and experienced encouraging effects including decreased anxiety and depression symptoms and increased health-related QoL with both improvements persisting at 6-month follow-up. Participants described improved coping strategies and disease management techniques as benefits of v-MBSR. Conclusions: Patients with IBD were interested in a psychiatrist-led virtual anxiety management intervention, but results demonstrate v-MBSR may be too time intensive for some patients with IBD patients. v-MBSR was acceptable to those who completed the intervention, and improvements to anxiety, depression, and QoL were promising and sustainable. Future studies should attempt to characterize the patients with IBD who may benefit most from interventions like v-MBSR. %M 38709548 %R 10.2196/53550 %U https://formative.jmir.org/2024/1/e53550 %U https://doi.org/10.2196/53550 %U http://www.ncbi.nlm.nih.gov/pubmed/38709548 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52145 %T A Factorial Randomized Controlled Trial to Optimize User Engagement With a Chatbot-Led Parenting Intervention: Protocol for the ParentText Optimisation Trial %A Ambrosio,Maria Da Graca %A Lachman,Jamie M %A Zinzer,Paula %A Gwebu,Hlengiwe %A Vyas,Seema %A Vallance,Inge %A Calderon,Francisco %A Gardner,Frances %A Markle,Laurie %A Stern,David %A Facciola,Chiara %A Schley,Anne %A Danisa,Nompumelelo %A Brukwe,Kanyisile %A Melendez-Torres,GJ %+ University of Oxford, Barnett House, 32-37 Wellington Square, Oxford, OX1 2ER, United Kingdom, 44 (0)1865270325, maria.ambrosio@wolfson.ox.ac.uk %K parenting intervention %K chatbot-led public health intervention %K engagement %K implementation science %K mobile phone %D 2024 %7 3.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Violence against children (VAC) is a serious public health concern with long-lasting adverse effects. Evidence-based parenting programs are one effective means to prevent VAC; however, these interventions are not scalable in their typical in-person group format, especially in low- and middle-income countries where the need is greatest. While digital delivery, including via chatbots, offers a scalable and cost-effective means to scale up parenting programs within these settings, it is crucial to understand the key pillars of user engagement to ensure their effective implementation. Objective: This study aims to investigate the most effective and cost-effective combination of external components to optimize user engagement with ParentText, an open-source chatbot-led parenting intervention to prevent VAC in Mpumalanga, South Africa. Methods: This study will use a mixed methods design incorporating a 2 × 2 factorial cluster-randomized controlled trial and qualitative interviews. Parents of adolescent girls (32 clusters, 120 participants [60 parents and 60 girls aged 10 to 17 years] per cluster; N=3840 total participants) will be recruited from the Ehlanzeni and Nkangala districts of Mpumalanga. Clusters will be randomly assigned to receive 1 of the 4 engagement packages that include ParentText alone or combined with in-person sessions and a facilitated WhatsApp support group. Quantitative data collected will include pretest-posttest parent- and adolescent-reported surveys, facilitator-reported implementation data, and digitally tracked engagement data. Qualitative data will be collected from parents and facilitators through in-person or over-the-phone individual semistructured interviews and used to expand the interpretation and understanding of the quantitative findings. Results: Recruitment and data collection started in August 2023 and were finalized in November 2023. The total number of participants enrolled in the study is 1009, with 744 caregivers having completed onboarding to the chatbot-led intervention. Female participants represent 92.96% (938/1009) of the sample population, whereas male participants represent 7.03% (71/1009). The average participant age is 43 (SD 9) years. Conclusions: The ParentText Optimisation Trial is the first study to rigorously test engagement with a chatbot-led parenting intervention in a low- or middle-income country. The results of this study will inform the final selection of external delivery components to support engagement with ParentText in preparation for further evaluation in a randomized controlled trial in 2024. Trial Registration: Open Science Framework (OSF); https://doi.org/10.17605/OSF.IO/WFXNE International Registered Report Identifier (IRRID): DERR1-10.2196/52145 %M 38700935 %R 10.2196/52145 %U https://www.researchprotocols.org/2024/1/e52145 %U https://doi.org/10.2196/52145 %U http://www.ncbi.nlm.nih.gov/pubmed/38700935 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55156 %T KIJANI App to Promote Physical Activity in Children and Adolescents: Protocol for a Mixed Method Evaluation %A Willinger,Laura %A Böhm,Birgit %A Schweizer,Florian %A Reimer,Lara Marie %A Jonas,Stephan %A Scheller,Daniel A %A Oberhoffer-Fritz,Renate %A Müller,Jan %+ Chair of Preventive Pediatrics, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992 München, Munich, Germany, 49 28924900, laura.willinger@tum.de %K physical activity %K health promotion %K digital health %K gamification %K childhood %K adolescence %K adolescents %K adolescent %K children %K augmented reality %K KIJANI intervention %K KIJANI %K intervention %K user experience %D 2024 %7 3.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The prevalence of physical inactivity among children and adolescents is alarmingly high despite the well-documented and comprehensive benefits of regular physical activity (PA). Therefore, PA promotion should start early in childhood and adolescence. Although reducing recreational screen time in children and adolescents is an urgent concern, digital approaches have the potential to make activity promotion attractive and age appropriate for the target group. KIJANI is a mobile app approach to promote PA in children and adolescents via gamification and augmented reality. Objective: This study protocol aims to describe the KIJANI intervention in detail, as well as the evaluation approach. Methods: KIJANI is based on the concept that virtual coins can be earned through PA, for example, in the form of a collected step count. With these coins, in turn, blocks can be bought, which can be used to create virtual buildings and integrate them into the player’s real-world environment via augmented reality. PA of users is detected via accelerometers integrated into the smartphones. KIJANI can be played at predefined play locations that were comprehensively identified as safe, child-friendly, and attractive for PA by the target group in a partner project. The evaluation process will be divided into 2 different stages. The phase-I evaluation will be a mixed methods approach with one-on-one semistructured interviews and questionnaires to evaluate the user experience and receive feedback from the target group. After the implementation of results and feedback from the target group, the phase-II evaluation will proceed in the form of a 2-arm randomized controlled trial, in which the effectiveness of KIJANI will be assessed via objectively measured PA as well as questionnaires. Results: The study received ethical approval from the ethical board of the Technical University of Munich. Participants for the phase-I evaluation are currently being recruited. Conclusions: The study will help to determine the efficacy, applicability, and user experience of a gamified activity promotion application in children and adolescents. Overall, digital health approaches provide easy and wide reachability at low cost and are age appropriate and attractive for the target group of adolescents. Strategies have to be developed to apply digital health approaches in the best possible way for activity promotion. International Registered Report Identifier (IRRID): DERR1-10.2196/55156 %M 38700911 %R 10.2196/55156 %U https://www.researchprotocols.org/2024/1/e55156 %U https://doi.org/10.2196/55156 %U http://www.ncbi.nlm.nih.gov/pubmed/38700911 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e54124 %T Efficacy of the Flo App in Improving Health Literacy, Menstrual and General Health, and Well-Being in Women: Pilot Randomized Controlled Trial %A Cunningham,Adam C %A Prentice,Carley %A Peven,Kimberly %A Wickham,Aidan %A Bamford,Ryan %A Radovic,Tara %A Klepchukova,Anna %A Fomina,Maria %A Cunningham,Katja %A Hill,Sarah %A Hantsoo,Liisa %A Payne,Jennifer %A Zhaunova,Liudmila %A Ponzo,Sonia %+ Flo Health UK Limited, 27 Old Gloucester Street, London, WC1N 3AX, United Kingdom, 44 7770032146, l_zhaunova@flo.health %K digital health %K health literacy %K menstrual cycle %K period tracking app %K women’s health %K PMS %K PMDD %K tracking %K app %K application %K tracking app %K tracking application %K menstrual %K women %K efficacy %K general health %K wellbeing %K randomized controlled trial %K awareness %K symptoms %K manage %K management %K premenstrual %K premenstrual syndrome %K premenstrual dysphoric disorder %K reproductive %K reproductive health %K health management %K communication %K pregnancy %K quality of life %K productivity %K education %K functionality %D 2024 %7 2.5.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Reproductive health literacy and menstrual health awareness play a crucial role in ensuring the health and well-being of women and people who menstruate. Further, awareness of one’s own menstrual cycle patterns and associated symptoms can help individuals identify and manage conditions of the menstrual cycle such as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Digital health products, and specifically menstrual health apps, have the potential to effect positive change due to their scalability and ease of access. Objective: The primary aim of this study was to measure the efficacy of a menstrual and reproductive health app, Flo, in improving health literacy and health and well-being outcomes in menstruating individuals with and without PMS and PMDD. Further, we explored the possibility that the use of the Flo app could positively influence feelings around reproductive health management and communication about health, menstrual cycle stigma, unplanned pregnancies, quality of life, work productivity, absenteeism, and body image. Methods: We conducted 2 pilot, 3-month, unblinded, 2-armed, remote randomized controlled trials on the effects of using the Flo app in a sample of US-based (1) individuals who track their cycles (n=321) or (2) individuals who track their cycles and are affected by PMS or PMDD (n=117). Results: The findings revealed significant improvements at the end of the study period compared to baseline for our primary outcomes of health literacy (cycle tracking: D̄=1.11; t311=5.73, P<.001; PMS or PMDD: D̄=1.20; t115=3.76, P<.001) and menstrual health awareness (D̄=3.97; t311=7.71, P<.001), health and well-being (D̄=3.44; t311=5.94, P<.001), and PMS or PMDD symptoms burden (D̄=–7.08; t115=–5.44, P<.001). Improvements were also observed for our secondary outcomes of feelings of control and management over health (D̄=1.01; t311=5.08, P<.001), communication about health (D̄=0.93; t311=2.41, P=.002), menstrual cycle stigma (D̄=–0.61; t311=–2.73, P=.007), and fear of unplanned pregnancies (D̄=–0.22; t311=–2.11, P=.04) for those who track their cycles, as well as absenteeism from work and education due to PMS or PMDD (D̄=–1.67; t144=–2.49, P=.01). Conclusions: These pilot randomized controlled trials demonstrate that the use of the Flo app improves menstrual health literacy and awareness, general health and well-being, and PMS or PMDD symptom burden. Considering the widespread use and affordability of the Flo app, these findings show promise for filling important gaps in current health care provisioning such as improving menstrual knowledge and health. Trial Registration: OSF Registries osf.io/pcgw7; https://osf.io/pcgw7 ; OSF Registries osf.io/ry8vq; https://osf.io/ry8vq %M 38696773 %R 10.2196/54124 %U https://mhealth.jmir.org/2024/1/e54124 %U https://doi.org/10.2196/54124 %U http://www.ncbi.nlm.nih.gov/pubmed/38696773 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e54622 %T Harnessing Consumer Wearable Digital Biomarkers for Individualized Recognition of Postpartum Depression Using the All of Us Research Program Data Set: Cross-Sectional Study %A Hurwitz,Eric %A Butzin-Dozier,Zachary %A Master,Hiral %A O'Neil,Shawn T %A Walden,Anita %A Holko,Michelle %A Patel,Rena C %A Haendel,Melissa A %+ Department of Genetics, University of North Carolina at Chapel Hill, 120 Mason Farm Road, Chapel Hill, NC, 27599, United States, 1 9198436475, eric_hurwitz@med.unc.edu %K wearable device %K All of Us %K postpartum depression %K machine learning %K Fitbit %K mobile phone %D 2024 %7 2.5.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Postpartum depression (PPD) poses a significant maternal health challenge. The current approach to detecting PPD relies on in-person postpartum visits, which contributes to underdiagnosis. Furthermore, recognizing PPD symptoms can be challenging. Therefore, we explored the potential of using digital biomarkers from consumer wearables for PPD recognition. Objective: The main goal of this study was to showcase the viability of using machine learning (ML) and digital biomarkers related to heart rate, physical activity, and energy expenditure derived from consumer-grade wearables for the recognition of PPD. Methods: Using the All of Us Research Program Registered Tier v6 data set, we performed computational phenotyping of women with and without PPD following childbirth. Intraindividual ML models were developed using digital biomarkers from Fitbit to discern between prepregnancy, pregnancy, postpartum without depression, and postpartum with depression (ie, PPD diagnosis) periods. Models were built using generalized linear models, random forest, support vector machine, and k-nearest neighbor algorithms and evaluated using the κ statistic and multiclass area under the receiver operating characteristic curve (mAUC) to determine the algorithm with the best performance. The specificity of our individualized ML approach was confirmed in a cohort of women who gave birth and did not experience PPD. Moreover, we assessed the impact of a previous history of depression on model performance. We determined the variable importance for predicting the PPD period using Shapley additive explanations and confirmed the results using a permutation approach. Finally, we compared our individualized ML methodology against a traditional cohort-based ML model for PPD recognition and compared model performance using sensitivity, specificity, precision, recall, and F1-score. Results: Patient cohorts of women with valid Fitbit data who gave birth included <20 with PPD and 39 without PPD. Our results demonstrated that intraindividual models using digital biomarkers discerned among prepregnancy, pregnancy, postpartum without depression, and postpartum with depression (ie, PPD diagnosis) periods, with random forest (mAUC=0.85; κ=0.80) models outperforming generalized linear models (mAUC=0.82; κ=0.74), support vector machine (mAUC=0.75; κ=0.72), and k-nearest neighbor (mAUC=0.74; κ=0.62). Model performance decreased in women without PPD, illustrating the method’s specificity. Previous depression history did not impact the efficacy of the model for PPD recognition. Moreover, we found that the most predictive biomarker of PPD was calories burned during the basal metabolic rate. Finally, individualized models surpassed the performance of a conventional cohort-based model for PPD detection. Conclusions: This research establishes consumer wearables as a promising tool for PPD identification and highlights personalized ML approaches, which could transform early disease detection strategies. %M 38696234 %R 10.2196/54622 %U https://mhealth.jmir.org/2024/1/e54622 %U https://doi.org/10.2196/54622 %U http://www.ncbi.nlm.nih.gov/pubmed/38696234 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50922 %T Digital Intervention (Keep-On-Keep-Up Nutrition) to Improve Nutrition in Older Adults: Protocol for a Feasibility Randomized Controlled Trial %A French,Chloe %A Burden,Sorrel %A Stanmore,Emma %+ School of Health Sciences, University of Manchester, 176 Oxford Road, Manchester, M13 9PL, United Kingdom, 44 01613067856, emma.stanmore@manchester.ac.uk %K feasibility %K usability %K digital health %K diet %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K elder %K elderly %K older person %K older people %K ageing %K aging %K dietary %K nutrition %K hydration %K community dwelling %K RCT %K randomized %K controlled trial %K controlled trials %D 2024 %7 30.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital health tools can support behavior change and allow interventions to be scalable at a minimal cost. Keep-on-Keep-up Nutrition (KOKU-Nut) is a free, tablet-based app that focuses on increasing physical activity and improving the dietary intake of older adults based on UK guidelines. The intervention targets an important research area identified as a research priority reported by the James Lind Alliance priority setting partnership for malnutrition. Objective: This study aims to assess the feasibility of using the digital health tool KOKU-Nut among community-dwelling older adults to inform a future randomized controlled trial. The secondary aims are to determine the acceptability, usability, preliminary effect sizes, and safety of the study and the intervention (KOKU-Nut). Methods: This is a feasibility randomized controlled trial. We plan to recruit a total of 36 community-dwelling older adults using purposive sampling. Participants will be randomized 1:1 to either the intervention or the control group. The intervention group will be asked to engage with KOKU-Nut 3 times a week for 12 weeks. Participants in the control group will receive a leaflet promoting a healthy lifestyle. All study participants will complete questionnaires at baseline and the end of the 12 weeks. A sample of participants will be asked to participate in an optional interview. The study will collect a range of data including anthropometry (height and weight), dietary intake (3-day food diary), physical function (grip strength and 5-times sit-to-stand), perceived quality of life (EQ-5D), usability (System Usability Scale), and safety (adverse events). Results: Data collection commenced in March 2024, and the results will be ready for publication by January 2025. Feasibility will be determined on the basis of participants’ self-reported engagement with the intervention, and recruitment and retention rates and will be summarized descriptively. We will also consider the amount of missing data and assess how outcomes are related to group assignment. Acceptability will be measured using the modified treatment evaluation inventory and one-to-one semistructured interviews. Transcripts from the interviews will be analyzed using NVivo (version 12; QSR International) software using framework analysis to understand any barriers to the recruitment process, the suitability of the assessment measures, and the acceptability of the intervention and study design. Conclusions: The study aligns with guidelines developed by the Medical Research Council for developing a complex intervention by using qualitative and quantitative research to examine the barriers of the intervention and identify potential challenges around recruitment and retention. We anticipate that these results will inform the development of a future powered randomized controlled design trial to test the true effectiveness of KOKU-Nut. Trial Registration: ClinicalTrials.gov NCT05943366; https://classic.clinicaltrials.gov/ct2/show/NCT05943366 International Registered Report Identifier (IRRID): PRR1-10.2196/50922 %M 38687981 %R 10.2196/50922 %U https://www.researchprotocols.org/2024/1/e50922 %U https://doi.org/10.2196/50922 %U http://www.ncbi.nlm.nih.gov/pubmed/38687981 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52957 %T Digital Remote Monitoring Using an mHealth Solution for Survivors of Cancer: Protocol for a Pilot Observational Study %A Innominato,Pasquale F %A Macdonald,Jamie H %A Saxton,Wendy %A Longshaw,Laura %A Granger,Rachel %A Naja,Iman %A Allocca,Carlo %A Edwards,Ruth %A Rasheed,Solah %A Folkvord,Frans %A de Batlle,Jordi %A Ail,Rohit %A Motta,Enrico %A Bale,Catherine %A Fuller,Claire %A Mullard,Anna P %A Subbe,Christian P %A Griffiths,Dawn %A Wreglesworth,Nicholas I %A Pecchia,Leandro %A Fico,Giuseppe %A Antonini,Alessio %+ Knowledge Media Institute, The Open University, Level 4, Room 4, Berrill Building, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom, 44 1908 654356, alessio.antonini@open.ac.uk %K cancer %K survivorship %K artificial intelligence %K remote monitoring %K mobile health %K mHealth %K digital health %K circadian %K actigraphy %K mobile phone %D 2024 %7 30.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Healthy lifestyle interventions have a positive impact on multiple disease trajectories, including cancer-related outcomes. Specifically, appropriate habitual physical activity, adequate sleep, and a regular wholesome diet are of paramount importance for the wellness and supportive care of survivors of cancer. Mobile health (mHealth) apps have the potential to support novel tailored lifestyle interventions. Objective: This observational pilot study aims to assess the feasibility of mHealth multidimensional longitudinal monitoring in survivors of cancer. The primary objective is to test the compliance (user engagement) with the monitoring solution. Secondary objectives include recording clinically relevant subjective and objective measures collected through the digital solution. Methods: This is a monocentric pilot study taking place in Bangor, Wales, United Kingdom. We plan to enroll up to 100 adult survivors of cancer not receiving toxic anticancer treatment, who will provide self-reported behavioral data recorded via a dedicated app and validated questionnaires and objective data automatically collected by a paired smartwatch over 16 weeks. The participants will continue with their normal routine surveillance care for their cancer. The primary end point is feasibility (eg, mHealth monitoring acceptability). Composite secondary end points include clinically relevant patient-reported outcome measures (eg, the Edmonton Symptom Assessment System score) and objective physiological measures (eg, step counts). This trial received a favorable ethical review in May 2023 (Integrated Research Application System 301068). Results: This study is part of an array of pilots within a European Union funded project, entitled “GATEKEEPER,” conducted at different sites across Europe and covering various chronic diseases. Study accrual is anticipated to commence in January 2024 and continue until June 2024. It is hypothesized that mHealth monitoring will be feasible in survivors of cancer; specifically, at least 50% (50/100) of the participants will engage with the app at least once a week in 8 of the 16 study weeks. Conclusions: In a population with potentially complex clinical needs, this pilot study will test the feasibility of multidimensional remote monitoring of patient-reported outcomes and physiological parameters. Satisfactory compliance with the use of the app and smartwatch, whether confirmed or infirmed through this study, will be propaedeutic to the development of innovative mHealth interventions in survivors of cancer. International Registered Report Identifier (IRRID): PRR1-10.2196/52957 %M 38687985 %R 10.2196/52957 %U https://www.researchprotocols.org/2024/1/e52957 %U https://doi.org/10.2196/52957 %U http://www.ncbi.nlm.nih.gov/pubmed/38687985 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51478 %T Effectiveness of mHealth App–Based Interventions for Increasing Physical Activity and Improving Physical Fitness in Children and Adolescents: Systematic Review and Meta-Analysis %A Wang,Jun-Wei %A Zhu,Zhicheng %A Shuling,Zhang %A Fan,Jia %A Jin,Yu %A Gao,Zhan-Le %A Chen,Wan-Di %A Li,Xue %+ School of Sport Medicine and Health, Chengdu Sport University, No.2, Tiyuan Road, Wuhou District, Chengdu, 610041, China, 86 13550146822, lixue2078@126.com %K mobile health %K mHealth apps %K children and adolescents %K physical activity %K physical fitness %K systematic review %K meta-analysis %K mobile phone %D 2024 %7 30.4.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic has significantly reduced physical activity (PA) levels and increased sedentary behavior (SB), which can lead to worsening physical fitness (PF). Children and adolescents may benefit from mobile health (mHealth) apps to increase PA and improve PF. However, the effectiveness of mHealth app–based interventions and potential moderators in this population are not yet fully understood. Objective: This study aims to review and analyze the effectiveness of mHealth app–based interventions in promoting PA and improving PF and identify potential moderators of the efficacy of mHealth app–based interventions in children and adolescents. Methods: We searched for randomized controlled trials (RCTs) published in the PubMed, Web of Science, EBSCO, and Cochrane Library databases until December 25, 2023, to conduct this meta-analysis. We included articles with intervention groups that investigated the effects of mHealth-based apps on PA and PF among children and adolescents. Due to high heterogeneity, a meta-analysis was conducted using a random effects model. The Cochrane Risk of Bias Assessment Tool was used to evaluate the risk of bias. Subgroup analysis and meta-regression analyses were performed to identify potential influences impacting effect sizes. Results: We included 28 RCTs with a total of 5643 participants. In general, the risk of bias of included studies was low. Our findings showed that mHealth app–based interventions significantly increased total PA (TPA; standardized mean difference [SMD] 0.29, 95% CI 0.13-0.45; P<.001), reduced SB (SMD –0.97, 95% CI –1.67 to –0.28; P=.006) and BMI (weighted mean difference –0.31 kg/m2, 95% CI –0.60 to –0.01 kg/m2; P=.12), and improved muscle strength (SMD 1.97, 95% CI 0.09-3.86; P=.04) and agility (SMD –0.35, 95% CI –0.61 to –0.10; P=.006). However, mHealth app–based interventions insignificantly affected moderate to vigorous PA (MVPA; SMD 0.11, 95% CI –0.04 to 0.25; P<.001), waist circumference (weighted mean difference 0.38 cm, 95% CI –1.28 to 2.04 cm; P=.65), muscular power (SMD 0.01, 95% CI –0.08 to 0.10; P=.81), cardiorespiratory fitness (SMD –0.20, 95% CI –0.45 to 0.05; P=.11), muscular endurance (SMD 0.47, 95% CI –0.08 to 1.02; P=.10), and flexibility (SMD 0.09, 95% CI –0.23 to 0.41; P=.58). Subgroup analyses and meta-regression showed that intervention duration was associated with TPA and MVPA, and age and types of intervention was associated with BMI. Conclusions: Our meta-analysis suggests that mHealth app–based interventions may yield small-to-large beneficial effects on TPA, SB, BMI, agility, and muscle strength in children and adolescents. Furthermore, age and intervention duration may correlate with the higher effectiveness of mHealth app–based interventions. However, due to the limited number and quality of included studies, the aforementioned conclusions require validation through additional high-quality research. Trial Registration: PROSPERO CRD42023426532; https://tinyurl.com/25jm4kmf %M 38687568 %R 10.2196/51478 %U https://mhealth.jmir.org/2024/1/e51478 %U https://doi.org/10.2196/51478 %U http://www.ncbi.nlm.nih.gov/pubmed/38687568 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48185 %T Effectiveness of a Smartphone App (Heia Meg) in Improving Decisions About Nutrition and Physical Activity: Prospective Longitudinal Study %A Olsen,Christine %A Lungu,Daniel Adrian %+ Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Kjell Arholms gate 41, Stavanger, 4021, Norway, 47 51 83 10 00, daniel.a.lungu@uis.no %K app %K BMI %K diet %K exercise %K health %K Heia Meg %K lifestyle change %K longitudinal %K mHealth %K mobile health %K motivation %K nutrition %K obese %K obesity %K overweight %K physical activity %K smartphone apps %K weight %D 2024 %7 30.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Obesity is a prevalent and serious chronic condition associated with abnormal or excessive fat buildup that poses significant health risks. The rates of overweight and obesity in adults and children continue to rise, with global rates of children with overweight or obesity aged 5-19 years growing from 4% to 18% between 1975 and 2016. Furthermore, in 2017, nearly 4 million people died due to complications arising from being overweight or obese. Objective: This study aims to investigate the potential impact of the mobile app Heia Meg on promoting healthier lifestyle choices regarding nutrition and physical activity. Methods: A prospective longitudinal study was conducted in collaboration with the Norwegian Directorate of Health. Participants were recruited through the Heia Meg app and were asked to complete a questionnaire before and after using the app. A total of 199 responses were included in the first (preintervention) questionnaire, while 99 valid responses were obtained in the second (postintervention) questionnaire. Results: The majority (159/199, 79.9%) of participants were female, and their age ranged from 18 years to 70 years and older. The results show a reduction in BMI after the digital intervention. However, some variables influence the BMI reduction effect: sex, age, education, and smoking. The group that obtained the most benefit from the intervention consisted of those who were male, aged 30-39 years, highly educated, and nonsmokers. Although positive, some of the findings are slightly above the statistical significance threshold and therefore should be interpreted carefully. Conclusions: Our study found weak evidence to support the effectiveness of the Heia Meg app in promoting healthier lifestyle choices. However, limitations and confounding factors suggest that further research in different populations with larger sample sizes is needed to confirm or disprove our findings. %M 38687565 %R 10.2196/48185 %U https://formative.jmir.org/2024/1/e48185 %U https://doi.org/10.2196/48185 %U http://www.ncbi.nlm.nih.gov/pubmed/38687565 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52075 %T Effectiveness of a Smartphone App–Based Intervention With Bluetooth-Connected Monitoring Devices and a Feedback System in Heart Failure (SMART-HF Trial): Randomized Controlled Trial %A Yoon,Minjae %A Lee,Seonhwa %A Choi,Jah Yeon %A Jung,Mi-Hyang %A Youn,Jong-Chan %A Shim,Chi Young %A Choi,Jin-Oh %A Kim,Eung Ju %A Kim,Hyungseop %A Yoo,Byung-Su %A Son,Yeon Joo %A Choi,Dong-Ju %+ Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seognam, 13620, Republic of Korea, 82 317877007, djchoi@snubh.org %K heart failure %K mobile applications %K mobile health %K self-care %K vital sign monitoring %K mobile phone %D 2024 %7 29.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Current heart failure (HF) guidelines recommend a multidisciplinary approach, discharge education, and self-management for HF. However, the recommendations are challenging to implement in real-world clinical settings. Objective: We developed a mobile health (mHealth) platform for HF self-care to evaluate whether a smartphone app–based intervention with Bluetooth-connected monitoring devices and a feedback system can help improve HF symptoms. Methods: In this prospective, randomized, multicenter study, we enrolled patients 20 years of age and older, hospitalized for acute HF, and who could use a smartphone from 7 tertiary hospitals in South Korea. In the intervention group (n=39), the apps were automatically paired with Bluetooth-connected monitoring devices. The patients could enter information on vital signs, HF symptoms, diet, medications, and exercise regimen into the app daily and receive feedback or alerts on their input. In the control group (n=38), patients could only enter their blood pressure, heart rate, and weight using conventional, non-Bluetooth devices and could not receive any feedback or alerts from the app. The primary end point was the change in dyspnea symptom scores from baseline to 4 weeks, assessed using a questionnaire. Results: At 4 weeks, the change in dyspnea symptom score from baseline was significantly greater in the intervention group than in the control group (mean –1.3, SD 2.1 vs mean –0.3, SD 2.3; P=.048). A significant reduction was found in body water composition from baseline to the final measurement in the intervention group (baseline level mean 7.4, SD 2.5 vs final level mean 6.6, SD 2.5; P=.003). App adherence, which was assessed based on log-in or the percentage of days when symptoms were first observed, was higher in the intervention group than in the control group. Composite end points, including death, rehospitalization, and urgent HF visits, were not significantly different between the 2 groups. Conclusions: The mobile-based health platform with Bluetooth-connected monitoring devices and a feedback system demonstrated improvement in dyspnea symptoms in patients with HF. This study provides evidence and rationale for implementing mobile app–based self-care strategies and feedback for patients with HF. Trial Registration: ClinicalTrials.gov NCT05668000; https://clinicaltrials.gov/study/NCT05668000 %M 38683665 %R 10.2196/52075 %U https://www.jmir.org/2024/1/e52075 %U https://doi.org/10.2196/52075 %U http://www.ncbi.nlm.nih.gov/pubmed/38683665 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54581 %T Usability Comparison Among Healthy Participants of an Anthropomorphic Digital Human and a Text-Based Chatbot as a Responder to Questions on Mental Health: Randomized Controlled Trial %A Thunström,Almira Osmanovic %A Carlsen,Hanne Krage %A Ali,Lilas %A Larson,Tomas %A Hellström,Andreas %A Steingrimsson,Steinn %+ Region Västra Götaland, Psychiatric Department, Sahlgrenska University Hospital, Journalvägen 5, Gothenburg, 41650, Sweden, 46 313421000, steinn.steingrimsson@gu.se %K chatbot %K chatbots %K chat-bot %K chat-bots %K text-only chatbot, voice-only chatbot %K mental health %K mental illness %K mental disease %K mental diseases %K mental illnesses %K mental health service %K mental health services %K interface %K system usability %K usability %K digital health %K machine learning %K ML %K artificial intelligence %K AI %K algorithm %K algorithms %K NLP %K natural language processing %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The use of chatbots in mental health support has increased exponentially in recent years, with studies showing that they may be effective in treating mental health problems. More recently, the use of visual avatars called digital humans has been introduced. Digital humans have the capability to use facial expressions as another dimension in human-computer interactions. It is important to study the difference in emotional response and usability preferences between text-based chatbots and digital humans for interacting with mental health services. Objective: This study aims to explore to what extent a digital human interface and a text-only chatbot interface differed in usability when tested by healthy participants, using BETSY (Behavior, Emotion, Therapy System, and You) which uses 2 distinct interfaces: a digital human with anthropomorphic features and a text-only user interface. We also set out to explore how chatbot-generated conversations on mental health (specific to each interface) affected self-reported feelings and biometrics. Methods: We explored to what extent a digital human with anthropomorphic features differed from a traditional text-only chatbot regarding perception of usability through the System Usability Scale, emotional reactions through electroencephalography, and feelings of closeness. Healthy participants (n=45) were randomized to 2 groups that used a digital human with anthropomorphic features (n=25) or a text-only chatbot with no such features (n=20). The groups were compared by linear regression analysis and t tests. Results: No differences were observed between the text-only and digital human groups regarding demographic features. The mean System Usability Scale score was 75.34 (SD 10.01; range 57-90) for the text-only chatbot versus 64.80 (SD 14.14; range 40-90) for the digital human interface. Both groups scored their respective chatbot interfaces as average or above average in usability. Women were more likely to report feeling annoyed by BETSY. Conclusions: The text-only chatbot was perceived as significantly more user-friendly than the digital human, although there were no significant differences in electroencephalography measurements. Male participants exhibited lower levels of annoyance with both interfaces, contrary to previously reported findings. %M 38683664 %R 10.2196/54581 %U https://humanfactors.jmir.org/2024/1/e54581 %U https://doi.org/10.2196/54581 %U http://www.ncbi.nlm.nih.gov/pubmed/38683664 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e55364 %T Digital Interventions for Combating Internet Addiction in Young Children: Qualitative Study of Parent and Therapist Perspectives %A Theopilus,Yansen %A Al Mahmud,Abdullah %A Davis,Hilary %A Octavia,Johanna Renny %+ Centre for Design Innovation, Swinburne University of Technology, John St, Hawthorn, Melbourne, 3122, Australia, 61 39214383, aalmahmud@swin.edu.au %K addiction therapist %K children %K digital intervention %K internet addiction %K digital devices %K parents %K parental control %K mobile phone %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Internet addiction is an emerging mental health issue in this digital age. Nowadays, children start using the internet in early childhood, thus making them vulnerable to addictive use. Previous studies have reported that the risk of internet addiction tends to be higher in lower-income regions with lower quality of life, such as Indonesia. Indonesia has high risks and prevalence of internet addiction, including in children. Digital interventions have been developed as an option to combat internet addiction in children. However, little is known about what parents and therapists in Indonesia perceive about these types of interventions. Objective: This study aims to investigate the experiences, perceptions, and considerations of parents and therapists regarding digital interventions for combating internet addiction in young Indonesian children. Methods: This study used a qualitative exploratory approach through semistructured interviews. We involved 22 parents of children aged 7 to 11 years and 6 experienced internet addiction therapists for children. The interview data were transcribed and analyzed using thematic analysis. Results: Participants in this study recognized 3 existing digital interventions to combat internet addiction: Google Family Link, YouTube Kids, and Apple parental control. They perceived that digital interventions could be beneficial in continuously promoting healthy digital behavior in children and supporting parents in supervision. However, the existing interventions were not highly used due to limitations such as the apps’ functionality and usability, parental capability, parent-child relationships, cultural incompatibility, and data privacy. Conclusions: The findings suggest that digital interventions should focus not only on restricting and monitoring screen time but also on suggesting substitutive activities for children, developing children’s competencies to combat addictive behavior, improving digital literacy in children and parents, and supporting parental decision-making to promote healthy digital behavior in their children. Suggestions for future digital interventions are provided, such as making the existing features more usable and relatable, investigating gamification features to enhance parental motivation and capability in managing their children’s internet use, providing tailored or personalized content to suit users’ characteristics, and considering the provision of training and information about the use of interventions and privacy agreements. %M 38669672 %R 10.2196/55364 %U https://pediatrics.jmir.org/2024/1/e55364 %U https://doi.org/10.2196/55364 %U http://www.ncbi.nlm.nih.gov/pubmed/38669672 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51201 %T An mHealth Intervention Promoting Physical Activity and Healthy Eating in a Family Setting (SMARTFAMILY): Randomized Controlled Trial %A Wunsch,Kathrin %A Fiedler,Janis %A Hubenschmid,Sebastian %A Reiterer,Harald %A Renner,Britta %A Woll,Alexander %+ Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, Karlsruhe, 76131, Germany, 49 721608 ext 45431, kathrin.wunsch@kit.edu %K mobile app %K telemedicine %K behavior change %K health behavior %K family %K primary prevention %K exercise %K diet %K food and nutrition %K randomized controlled trial %K accelerometer %K wearable electronic devices %K social-cognitive determinants %K just-in-time adaptive intervention %K digital intervention %K mobile phone %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Numerous smartphone apps are targeting physical activity (PA) and healthy eating (HE), but empirical evidence on their effectiveness for the initialization and maintenance of behavior change, especially in children and adolescents, is still limited. Social settings influence individual behavior; therefore, core settings such as the family need to be considered when designing mobile health (mHealth) apps. Objective: The purpose of this study was to evaluate the effectiveness of a theory- and evidence-based mHealth intervention (called SMARTFAMILY [SF]) targeting PA and HE in a collective family–based setting. Methods: A smartphone app based on behavior change theories and techniques was developed, implemented, and evaluated with a cluster randomized controlled trial in a collective family setting. Baseline (t0) and postintervention (t1) measurements included PA (self-reported and accelerometry) and HE measurements (self-reported fruit and vegetable intake) as primary outcomes. Secondary outcomes (self-reported) were intrinsic motivation, behavior-specific self-efficacy, and the family health climate. Between t0 and t1, families of the intervention group (IG) used the SF app individually and collaboratively for 3 consecutive weeks, whereas families in the control group (CG) received no treatment. Four weeks following t1, a follow-up assessment (t2) was completed by participants, consisting of all questionnaire items to assess the stability of the intervention effects. Multilevel analyses were implemented in R (R Foundation for Statistical Computing) to acknowledge the hierarchical structure of persons (level 1) clustered in families (level 2). Results: Overall, 48 families (CG: n=22, 46%, with 68 participants and IG: n=26, 54%, with 88 participants) were recruited for the study. Two families (CG: n=1, 2%, with 4 participants and IG: n=1, 2%, with 4 participants) chose to drop out of the study owing to personal reasons before t0. Overall, no evidence for meaningful and statistically significant increases in PA and HE levels of the intervention were observed in our physically active study participants (all P>.30). Conclusions: Despite incorporating behavior change techniques rooted in family life and psychological theories, the SF intervention did not yield significant increases in PA and HE levels among the participants. The results of the study were mainly limited by the physically active participants and the large age range of children and adolescents. Enhancing intervention effectiveness may involve incorporating health literacy, just-in-time adaptive interventions, and more advanced features in future app development. Further research is needed to better understand intervention engagement and tailor mHealth interventions to individuals for enhanced effectiveness in primary prevention efforts. Trial Registration: German Clinical Trials Register DRKS00010415; https://drks.de/search/en/trial/DRKS00010415 International Registered Report Identifier (IRRID): RR2-10.2196/20534 %M 38669071 %R 10.2196/51201 %U https://mhealth.jmir.org/2024/1/e51201 %U https://doi.org/10.2196/51201 %U http://www.ncbi.nlm.nih.gov/pubmed/38669071 %0 Journal Article %@ 2291-5222 %I %V 12 %N %P e44463 %T Effects of a Planned Web-Based Educational Intervention Based on the Health Belief Model for Patients With Ischemic Stroke in Promoting Secondary Prevention During the COVID-19 Lockdown in China: Quasi-Experimental Study %A Liu,Zhuo %A Sun,Xin %A Guo,Zhen-Ni %A Sun,Ye %A Yang,Yi %A Yan,Xiuli %K health belief model %K health education %K secondary prevention %K stroke %K medication adherence %K patient education %K web-based education %K digital intervention %K promotion %K stroke patients %K ischemic %K prevention %K quasi-experimental study %K education %K control group %K health management %K management %K systolic blood pressure %K blood pressure %K effectiveness %K medication adherence %D 2024 %7 24.4.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Some common modified vascular risk factors remain poorly controlled among stroke survivors, and educational programs may help improve these conditions. Objective: This study aimed to evaluate the effect of a planned web-based educational intervention based on the health belief model (HBM) in promoting secondary prevention among patients with ischemic stroke. Methods: An evaluation-blinded quasi-experimental trial with a historical control group was conducted. Patients admitted from March to June 2020 were assigned to the historical control group, and patients admitted from July to October 2020 were assigned to the intervention group. The control group received routine health management. The intervention group received 6 additional sessions based on the HBM via Tencent Meeting, an audio and video conferencing application, within 3 months after discharge. Sessions were held every 2 weeks, with each session lasting approximately 40 minutes. These sessions were conducted in small groups, with about 8 to 10 people in each group. The primary outcomes were changes in blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), hemoglobin A1c (HbA1c), and the proportion of patients achieving the treatment target. The secondary outcomes were medication adherence, assessed with the Morisky Medicine Adherence Scale (MMAS), and disability, assessed with the modified Rankin scale. Results: In total, 315 patients experiencing their first-ever stroke were analyzed. More patients in the intervention group had controlled BP (41.9% vs 28.4%; adjusted odds ratio [aOR] 1.93; P=.01), LDL-C (83.1% vs 67.7%; aOR 2.66; P=.001), and HbA1c (91.9% vs 83.9%; aOR: 3.37; P=.04) levels as well as a significant postintervention decrease in the systolic BP (adjusted β −3.94; P=.02), LDL-C (adjusted β −0.21; P=.008), and HbA1c (adjusted β −0.27; P<.001), compared with control groups. Significant between-group differences were observed in medication adherence (79.4% vs 63.2%; aOR 2.31; P=.002) but not in favorable functional outcomes. Conclusions: A web-based education program based on the HBM may be more effective than current methods used to educate patients having strokes on optimal vascular risk factors and medication adherence. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000040804; https://www.chictr.org.cn/showproj.html?proj=62431 %R 10.2196/44463 %U https://mhealth.jmir.org/2024/1/e44463 %U https://doi.org/10.2196/44463 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52090 %T An Integrated mHealth App for Smoking Cessation in Black Smokers With HIV: Protocol for a Randomized Controlled Trial %A Bizier,Andre %A Jones,Arielle %A Businelle,Michael %A Kezbers,Krista %A Hoeppner,Bettina B %A Giordano,Thomas P %A Thai,Jessica M %A Charles,Jacqueline %A Montgomery,Audrey %A Gallagher,Matthew W %A Cheney,Marshall K %A Zvolensky,Michael %A Garey,Lorra %+ University of Houston, 3695 Cullen Blvd, Fred J. Heyne Building, Suite 126, Houston, TX, United States, 1 7137438056, llgarey@uh.edu %K smoking cessation %K Black %K HIV %K anxiety sensitivity %K mobile health %K mHealth %K just-in-time adaptive intervention %K mobile phone %D 2024 %7 24.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Black adults who smoke and have HIV experience immense stressors (eg, racial discrimination and HIV stigma) that impede smoking cessation success and perpetuate smoking-related health disparities. These stressors also place Black adults who smoke and have HIV at an increased risk of elevated interoceptive stress (eg, anxiety and uncomfortable bodily sensations) and smoking to manage symptoms. In turn, this population is more likely to smoke to manage interoceptive stress, which contributes to worse HIV-related outcomes in this group. However, no specialized treatment exists to address smoking cessation, interoceptive stress, and HIV management for Black smokers with HIV. Objective: This study aims to test a culturally adapted and novel mobile intervention that targets combustible cigarette smoking, HIV treatment engagement and adherence, and anxiety sensitivity (a proxy for difficulty and responsivity to interoceptive stress) among Black smokers with HIV (ie, Mobile Anxiety Sensitivity Program for Smoking and HIV [MASP+]). Various culturally tailored components of the app are being evaluated for their ability to help users quit smoking, manage physiological stress, and improve health care management. Methods: This study is a pilot randomized controlled trial in which Black combustible cigarette smokers with HIV (N=72) are being recruited and randomly assigned to use either (1) the National Cancer Institute’s QuitGuide app or (2) MASP+. Study procedures include a web-based prescreener; active intervention period for 6 weeks; smartphone-based assessments, including daily app-based ecological momentary assessments for 6 weeks (4 ecological momentary assessments each day); a video-based qualitative interview using Zoom Video Communications software at week 6 for participants in all study conditions; and smartphone-based follow-up assessments at 0, 1, 2 (quit date), 3, 4, 5, 6, and 28 weeks postbaseline (26 weeks postquitting date). Results: Primary outcomes include biochemically verified 7-day point prevalence of abstinence, HIV-related quality of life, use of antiretroviral therapy, and HIV care appointment adherence at 26 weeks postquitting date. Qualitative data are also being collected and assessed to obtain feedback that will guide further tailoring of app content and evaluation of efficacy. Conclusions: The results of this study will determine whether the MASP+ app serves as a successful aid for combustible cigarette smoking cessation, HIV treatment engagement, and physiological stress outcomes among Black people with HIV infection. If successful, this study will provide evidence for the efficacy of a new means of addressing major mental and physical health difficulties for this high-risk population. If the results are promising, the data from this study will be used to update and tailor the MASP+ app for testing in a fully powered randomized controlled trial that will evaluate its efficacy in real-world behavioral health and social service settings. Trial Registration: ClinicalTrials.gov NCT05709002; https://clinicaltrials.gov/study/NCT05709002 International Registered Report Identifier (IRRID): PRR1-10.2196/52090 %M 38657227 %R 10.2196/52090 %U https://www.researchprotocols.org/2024/1/e52090 %U https://doi.org/10.2196/52090 %U http://www.ncbi.nlm.nih.gov/pubmed/38657227 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48725 %T Behavior Change Approaches in Digital Technology–Based Physical Rehabilitation Interventions Following Stroke: Scoping Review %A Gooch,Helen J %A Jarvis,Kathryn A %A Stockley,Rachel C %+ Stroke Research Team, School of Nursing and Midwifery, University of Central Lancashire, BB247 Brook Building, Victoria Street, Preston, PR1 2HE, United Kingdom, 44 1772894956, HJGooch@uclan.ac.uk %K behavior change %K behavior therapy %K digital health technology %K digital health %K digital technology %K health behavior %K physical and rehabilitation medicine %K scoping review %K stroke rehabilitation %D 2024 %7 24.4.2024 %9 Review %J J Med Internet Res %G English %X Background: Digital health technologies (DHTs) are increasingly used in physical stroke rehabilitation to support individuals in successfully engaging with the frequent, intensive, and lengthy activities required to optimize recovery. Despite this, little is known about behavior change within these interventions. Objective: This scoping review aimed to identify if and how behavior change approaches (ie, theories, models, frameworks, and techniques to influence behavior) are incorporated within physical stroke rehabilitation interventions that include a DHT. Methods: Databases (Embase, MEDLINE, PsycINFO, CINAHL, Cochrane Library, and AMED) were searched using keywords relating to behavior change, DHT, physical rehabilitation, and stroke. The results were independently screened by 2 reviewers. Sources were included if they reported a completed primary research study in which a behavior change approach could be identified within a physical stroke rehabilitation intervention that included a DHT. Data, including the study design, DHT used, and behavior change approaches, were charted. Specific behavior change techniques were coded to the behavior change technique taxonomy version 1 (BCTTv1). Results: From a total of 1973 identified sources, 103 (5%) studies were included for data charting. The most common reason for exclusion at full-text screening was the absence of an explicit approach to behavior change (165/245, 67%). Almost half (45/103, 44%) of the included studies were described as pilot or feasibility studies. Virtual reality was the most frequently identified DHT type (58/103, 56%), and almost two-thirds (65/103, 63%) of studies focused on upper limb rehabilitation. Only a limited number of studies (18/103, 17%) included a theory, model, or framework for behavior change. The most frequently used BCTTv1 clusters were feedback and monitoring (88/103, 85%), reward and threat (56/103, 54%), goals and planning (33/103, 32%), and shaping knowledge (33/103, 32%). Relationships between feedback and monitoring and reward and threat were identified using a relationship map, with prominent use of both of these clusters in interventions that included virtual reality. Conclusions: Despite an assumption that DHTs can promote engagement in rehabilitation, this scoping review demonstrates that very few studies of physical stroke rehabilitation that include a DHT overtly used any form of behavior change approach. From those studies that did consider behavior change, most did not report a robust underpinning theory. Future development and research need to explicitly articulate how including DHTs within an intervention may support the behavior change required for optimal engagement in physical rehabilitation following stroke, as well as establish their effectiveness. This understanding is likely to support the realization of the transformative potential of DHTs in stroke rehabilitation. %R 10.2196/48725 %U https://www.jmir.org/2024/1/e48725 %U https://doi.org/10.2196/48725 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54478 %T The Impact of Video-Based Microinterventions on Attitudes Toward Mental Health and Help Seeking in Youth: Web-Based Randomized Controlled Trial %A Lemmer,Diana %A Moessner,Markus %A Arnaud,Nicolas %A Baumeister,Harald %A Mutter,Agnes %A Klemm,Sarah-Lena %A König,Elisa %A Plener,Paul %A Rummel-Kluge,Christine %A Thomasius,Rainer %A Kaess,Michael %A Bauer,Stephanie %+ Center for Psychotherapy Research, Center for Psychosocial Medicine, University Hospital Heidelberg, Bergheimer Str. 54, Heidelberg, 69115, Germany, 49 6221 56 7345, stephanie.bauer@med.uni-heidelberg.de %K help seeking %K mental health %K stigma %K mental health literacy %K psychoeducation %K web-based experiment %K web-based randomized controlled trial %K microinterventions %K video-based interventions %D 2024 %7 24.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health (MH) problems in youth are prevalent, burdening, and frequently persistent. Despite the existence of effective treatment, the uptake of professional help is low, particularly due to attitudinal barriers. Objective: This study evaluated the effectiveness and acceptability of 2 video-based microinterventions aimed at reducing barriers to MH treatment and increasing the likelihood of seeking professional help in young people. Methods: This study was entirely web based and open access. The interventions addressed 5 MH problems: generalized anxiety disorder, depression, bulimia, nonsuicidal self-injury, and problematic alcohol use. Intervention 1 aimed to destigmatize and improve MH literacy, whereas intervention 2 aimed to induce positive outcome expectancies regarding professional help seeking. Of the 2435 participants who commenced the study, a final sample of 1394 (57.25%) participants aged 14 to 29 years with complete data and sufficient durations of stay on the video pages were randomized in a fully automated manner to 1 of the 5 MH problems and 1 of 3 conditions (control, intervention 1, and intervention 2) in a permuted block design. After the presentation of a video vignette, no further videos were shown to the control group, whereas a second, short intervention video was presented to the intervention 1 and 2 groups. Intervention effects on self-reported potential professional help seeking (primary outcome), stigma, and attitudes toward help seeking were examined using analyses of covariance across and within the 5 MH problems. Furthermore, we assessed video acceptability. Results: No significant group effects on potential professional help seeking were found in the total sample (F2,1385=0.99; P=.37). However, the groups differed significantly with regard to stigma outcomes and the likelihood of seeking informal help (F2,1385=3.75; P=.02). Furthermore, separate analyses indicated substantial differences in intervention effects among the 5 MH problems. Conclusions: Interventions to promote help seeking for MH problems may require disorder-specific approaches. The study results can inform future research and public health campaigns addressing adolescents and young adults. Trial Registration: German Clinical Trials Register DRKS00023110; https://drks.de/search/de/trial/DRKS00023110 %M 38656779 %R 10.2196/54478 %U https://www.jmir.org/2024/1/e54478 %U https://doi.org/10.2196/54478 %U http://www.ncbi.nlm.nih.gov/pubmed/38656779 %0 Journal Article %@ 2368-7959 %I %V 11 %N %P e51791 %T A Web-Based and Mobile Intervention Program Using a Spaced Education Approach for Workplace Mental Health Literacy: Cluster Randomized Controlled Trial %A Lam,Lawrence T %A Lam,Mary K P %K mHealth %K web-based intervention %K mental health literacy %K psychoeducation %K randomized controlled trial %K workplace %K performance %K worker %K intervention %K digital health %K mental wellness %K promote %K well-being %K mobile health %K technology %D 2024 %7 23.4.2024 %9 %J JMIR Ment Health %G English %X Background: Workplace mental health is an important global health concern. Objectives: This unblinded, phase-III, wait-listed cluster randomized controlled trial aimed to examine the effectiveness of a mobile health (mHealth) psychoeducation program using a spaced education approach on mental health literacy (MHL) in the workplace. The main interest of this paper was the immediate and 3-month medium-term effect of the program on the MHL of workers. The purposely built mHealth platform was also evaluated as a health-related app. Methods: The mHealth platform was designed using the principle of spaced education as a psychoeducation intervention program, with various modules of web-based and mobile materials presented to the participant in a progressive manner. Short quizzes at the end of each module ensured adequate learning, and successful completion qualified the learner to progress to the next level. The trial recruited 456 employees of specific industries with high levels of work-related stress. Participants who were nested in different offices or units were allocated into the intervention and wait-listed control groups using a block randomization process, with the office or unit as the cluster. A separate sample of 70 individual raters were used for the evaluation of the mHealth platform. The Australian National MHL and Stigma Survey and the Mobile Apps Rating Scale were completed through a web-based self-reported survey to assess MHL and evaluate the app. The trial and follow-up data were analyzed by a generalized linear latent and mixed model with adjustments for the clustering effect of work sites and repeated measures. Results: Of the 456 participants in the trial, 236 (51.8%) responded to the follow-up survey. Most MHL outcomes obtained significant results immediately after the intervention and across time. After adjusting for the clustering effect, the postintervention weighted mean scores were significantly higher in the intervention group than the control group for correct recognition of a mental health problem, help seeking, and stigmatization by 0.2 (SE 0.1; P=.003), 0.9 (SE 0.2; P<.001), and 1.8 (SE 0.4; P<.001), respectively. After adjusting for the clustering effect, significant differences across time were found in help-seeking intention (P=.01), stigmatization (P<.001), and social distancing (P<.001). The evaluation of the mHealth program resulted in average scores of the 4 major domains ranging from 3.8 to 4.2, with engagement having the lowest score. Conclusions: The mHealth psychoeducation intervention program using this platform had immediate and 3-month medium-term effects of retaining and improving MHL. The platform was evaluated to have satisfactory performance in terms of functionality, aesthetics, information content, and utility in enhancing MHL. It is anticipated that ongoing development in digital health will provide great benefits in improving the mental health of the global population. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619000464167; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377176 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3748-y %R 10.2196/51791 %U https://mental.jmir.org/2024/1/e51791 %U https://doi.org/10.2196/51791 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54254 %T Testing the Effectiveness of an Intervention to Improve Romanian Teachers’ LGBT+-Related Attitudes, Cognitions, Behaviors, and Affect: Protocol for a Randomized Controlled Trial %A Latu,Ioana %A Sălăgean,Nastasia %A Larsen,Torill M B %A Isbasoiu,Andreea Bogdana %A Sava,Florin Alin %+ Department of Psychology, Faculty of Sociology and Psychology, West University of Timisoara, Bulevardul Vasile Pârvan 4, Timisoara, 300223, Romania, 40 7901037222, i.latu@qub.ac.uk %K discrimination %K intervention %K school %K lesbian, gay, bisexual, and transgender %K attitude %K behavior %K cognition %K stigma %K stigmatization %K negative impact %K physical health %K mental health %K minority stress model %K European %K Europe %K Romania %K stress %K young %K student %K students %K undergraduate %K bias %K data analysis %K online intervention %K lesbian, gay, bisexual, and transgender stigma %K sentiment %D 2024 %7 23.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Repeated stigmatization due to group membership constitutes a recurrent stressor with negative impact on physical and mental health (minority stress model). Among European countries, Romania ranks low on LGBT+ (lesbian, gay, bisexual, and transgender people. The “+” represents individuals whose identities do not fit typical binary notions of male and female [nonbinary]) inclusion, with 45% of Romanian LGBT+ respondents reporting discrimination in at least 1 area of life in the year preceding the survey. Importantly, while all LGBT+ people might experience minority stress, younger sexual minority individuals are more prone to the detrimental impacts of stigma on their mental and physical health. As such, interventions are necessary to improve the inclusion climate within schools, where young people spend most of their time. Until now, most interventions addressing this topic have been conducted on undergraduate students in Western countries, with no studies conducted in countries that have widespread anti-LGBT+ attitudes. Objective: This paper describes the research protocol for a randomized controlled trial investigating whether LGBT+ stigma and bias among Romanian school teachers can be reduced using an internet-based intervention focusing on education and contact as primary training elements. Methods: A sample of 175 school teachers will be randomly assigned to either the control or experimental group. The experimental group participants will receive the intervention first and then complete the outcome measures, whereas the control group will complete the outcome measures first and then receive the intervention. The 1-hour multimedia intervention is developed for internet-based delivery under controlled conditions. It includes 2 interactive exercises, 2 recorded presentations, animations, and testimonies from LGBT+ individuals. Data for attitudinal, behavioral, cognitive, and affective measures will be collected during the same session (before or after the intervention, depending on the condition). We also plan to conduct a brief mixed methods follow-up study at 6 to 8 months post participation to investigate potential long-term effects of training. However, due to attrition and lack of experimental control (all participants will have completed the intervention, regardless of the condition), these data will be analyzed and reported separately using a mixed methods approach. Results: This paper details the protocol for the teacher intervention study. Data collection began in December 2022 and was completed by February 2023. Data analysis will be performed upon protocol acceptance. Follow-up measures will be completed in 2024. Results are expected to be submitted for publication following analysis in the spring of 2024. Conclusions: The findings of this study will establish the effectiveness of an internet-based intervention intended to lessen anti-LGBT stigma and sentiment in a nation where these views have long been prevalent. If successful, the intervention could end up serving as a resource for Romanian teachers and guidance counselors in high schools. Trial Registration: ISRCTN 84290049; https://doi.org/10.1186/ISRCTN84290049 International Registered Report Identifier (IRRID): DERR1-10.2196/54254 %M 38652533 %R 10.2196/54254 %U https://www.researchprotocols.org/2024/1/e54254 %U https://doi.org/10.2196/54254 %U http://www.ncbi.nlm.nih.gov/pubmed/38652533 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48756 %T Effectiveness of an Interactive mHealth App (EVITE) in Improving Lifestyle After a Coronary Event: Randomized Controlled Trial %A Bernal-Jiménez,María Ángeles %A Calle,German %A Gutiérrez Barrios,Alejandro %A Gheorghe,Livia Luciana %A Cruz-Cobo,Celia %A Trujillo-Garrido,Nuria %A Rodríguez-Martín,Amelia %A Tur,Josep A %A Vázquez-García,Rafael %A Santi-Cano,María José %+ Faculty of Nursing and Physiotherapy, University of Cádiz, Avda. Ana de Viya, 52, Cádiz, 11009, Spain, 34 956019042, mariajose.santi@uca.es %K coronary artery disease %K healthy lifestyle %K mHealth %K mobile health %K percutaneous coronary intervention %K randomized controlled trial %K secondary prevention %K therapeutic adherence %D 2024 %7 22.4.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Coronary heart disease is one of the leading causes of mortality worldwide. Secondary prevention is essential, as it reduces the risk of further coronary events. Mobile health (mHealth) technology could become a useful tool to improve lifestyles. Objective: This study aimed to evaluate the effect of an mHealth intervention on people with coronary heart disease who received percutaneous coronary intervention. Improvements in lifestyle regarding diet, physical activity, and smoking; level of knowledge of a healthy lifestyle and the control of cardiovascular risk factors (CVRFs); and therapeutic adherence and quality of life were analyzed. Methods: This was a randomized controlled trial with a parallel group design assigned 1:1 to either an intervention involving a smartphone app (mHealth group) or to standard health care (control group). The app was used for setting aims, the self-monitoring of lifestyle and CVRFs using measurements and records, educating people with access to information on their screens about healthy lifestyles and adhering to treatment, and giving motivation through feedback about achievements and aspects to improve. Both groups were assessed after 9 months. The primary outcome variables were adherence to the Mediterranean diet, frequency of food consumed, patient-reported physical activity, smoking, knowledge of healthy lifestyles and the control of CVRFs, adherence to treatment, quality of life, well-being, and satisfaction. Results: The study analyzed 128 patients, 67 in the mHealth group and 61 in the control group; most were male (92/128, 71.9%), with a mean age of 59.49 (SD 8.97) years. Significant improvements were observed in the mHealth group compared with the control group regarding adherence to the Mediterranean diet (mean 11.83, SD 1.74 points vs mean 10.14, SD 2.02 points; P<.001), frequency of food consumption, patient-reported physical activity (mean 619.14, SD 318.21 min/week vs mean 471.70, SD 261.43 min/week; P=.007), giving up smoking (25/67, 75% vs 11/61, 42%; P=.01), level of knowledge of healthy lifestyles and the control of CVRFs (mean 118.70, SD 2.65 points vs mean 111.25, SD 9.05 points; P<.001), and the physical component of the quality of life 12-item Short Form survey (SF-12; mean 45.80, SD 10.79 points vs mean 41.40, SD 10.78 points; P=.02). Overall satisfaction was higher in the mHealth group (mean 48.22, SD 3.89 vs mean 46.00, SD 4.82 points; P=.002) and app satisfaction and usability were high (mean 44.38, SD 6.18 out of 50 points and mean 95.22, SD 7.37 out of 100). Conclusions: The EVITE app was effective in improving the lifestyle of patients in terms of adherence to the Mediterranean diet, frequency of healthy food consumption, physical activity, giving up smoking, knowledge of healthy lifestyles and controlling CVRFs, quality of life, and overall satisfaction. The app satisfaction and usability were excellent. Trial Registration: Clinicaltrials.gov NCT04118504; https://clinicaltrials.gov/study/NCT04118504 %M 38648103 %R 10.2196/48756 %U https://mhealth.jmir.org/2024/1/e48756 %U https://doi.org/10.2196/48756 %U http://www.ncbi.nlm.nih.gov/pubmed/38648103 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53614 %T Stimulating Preconception Care Uptake by Women With a Vulnerable Health Status Through a Mobile Health App (Pregnant Faster): Pilot Feasibility Study %A Smith,Sharissa M %A Bais,Babette %A Ismaili M'hamdi,Hafez %A Schermer,Maartje HN %A Steegers-Theunissen,Régine PM %+ Department of Obstetrics and Gynecology, Erasmus University Medical Center, Doctor Molewaterplein 40, Rotterdam, 3015 CD, Netherlands, 31 10704 ext 0704, r.steegers@erasmusmc.nl %K preconception care %K mHealth %K mobile health %K pregnancy preparation %K nudge %K health inequality %K socioeconomic status %K lifestyle %K women %K pregnancy %K pregnant women %K pregnant %K socioeconomic %K pilot feasibility study %K mHealth app %K mHealth application %K app %K application %K risk factor %K nutrition %K stress %K chronic stress %K health literacy %K usability %K user satisfaction %K user %K users %D 2024 %7 22.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: A low socioeconomic status is associated with a vulnerable health status (VHS) through the accumulation of health-related risk factors, such as poor lifestyle behaviors (eg, inadequate nutrition, chronic stress, and impaired health literacy). For pregnant women, a VHS translates into a high incidence of adverse pregnancy outcomes and therefore pregnancy-related inequity. We hypothesize that stimulating adequate pregnancy preparation, targeting lifestyle behaviors and preconception care (PCC) uptake, can reduce these inequities and improve the pregnancy outcomes of women with a VHS. A nudge is a behavioral intervention aimed at making healthy choices easier and more attractive and may therefore be a feasible way to stimulate engagement in pregnancy preparation and PCC uptake, especially in women with a VHS. To support adequate pregnancy preparation, we designed a mobile health (mHealth) app, Pregnant Faster, that fits the preferences of women with a VHS and uses nudging to encourage PCC consultation visits and engagement in education on healthy lifestyle behaviors. Objective: This study aimed to test the feasibility of Pregnant Faster by determining usability and user satisfaction, the number of visited PCC consultations, and the course of practical study conduction. Methods: Women aged 18-45 years, with low-to-intermediate educational attainment, who were trying to become pregnant within 12 months were included in this open cohort. Recruitment took place through social media, health care professionals, and distribution of flyers and posters from September 2021 until June 2022. Participants used Pregnant Faster daily for 4 weeks, earning coins by reading blogs on pregnancy preparation, filling out a daily questionnaire on healthy lifestyle choices, and registering for a PCC consultation with a midwife. Earned coins could be spent on rewards, such as fruit, mascara, and baby products. Evaluation took place through the mHealth App Usability Questionnaire (MAUQ), an additional interview or questionnaire, and assessment of overall study conduction. Results: Due to limited inclusions, the inclusion criterion “living in a deprived neighborhood” was dropped. This resulted in the inclusion of 47 women, of whom 39 (83%) completed the intervention. In total, 16 (41%) of 39 participants visited a PCC consultation, with their main motivation being obtaining personalized information. The majority of participants agreed with 16 (88.9%) of 18 statements of the MAUQ, indicating high user satisfaction. The mean rating was 7.7 (SD 1.0) out of 10. Points of improvement included recruitment of the target group, simplification of the log-in system, and automation of manual tasks. Conclusions: Nudging women through Pregnant Faster to stimulate pregnancy preparation and PCC uptake has proven feasible, but the inclusion criteria must be revised. A substantial number of PCC consultations were conducted, and this study will therefore be continued with an open cohort of 400 women, aiming to establish the (cost-)effectiveness of an updated version, named Pregnant Faster 2. International Registered Report Identifier (IRRID): RR2-10.2196/45293 %M 38648092 %R 10.2196/53614 %U https://humanfactors.jmir.org/2024/1/e53614 %U https://doi.org/10.2196/53614 %U http://www.ncbi.nlm.nih.gov/pubmed/38648092 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51858 %T AI-Led Mental Health Support (Wysa) for Health Care Workers During COVID-19: Service Evaluation %A Chang,Christel Lynne %A Sinha,Chaitali %A Roy,Madhavi %A Wong,John Chee Meng %+ Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 9, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore, 65 6772 3481, pcmwcmj@nus.edu.sg %K AI %K app %K application %K artificial intelligence %K COVID-19 %K digital %K health care workers %K mental health %K pandemic %K Wysa %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The impact that the COVID-19 pandemic has had on health care workers’ mental health, in particular, cannot be ignored. Not only did the pandemic exacerbate mental health challenges through elevated stress, anxiety, risk of infection, and social isolation, but regulations to minimize infection additionally hindered the conduct of traditional in-person mental health care. Objective: This study explores the feasibility of using Wysa, an artificial intelligence–led mental health app, among health care workers. Methods: A national tertiary health care cluster in Singapore piloted the use of Wysa among its own health care workers to support the management of their mental well-being during the pandemic (July 2020-June 2022). The adoption of this digital mental health intervention circumvented the limitations of in-person contact and enabled large-scale access to evidence-based care. Rates and patterns of user engagement were evaluated. Results: Overall, the opportunity to use Wysa was well-received. Out of the 527 staff who were onboarded in the app, 80.1% (422/527) completed a minimum of 2 sessions. On average, users completed 10.9 sessions over 3.80 weeks. The interventions most used were for sleep and anxiety, with a strong repeat-use rate. In this sample, 46.2% (73/158) of health care workers reported symptoms of anxiety (Generalized Anxiety Disorder Assessment-7 [GAD-7]), and 15.2% (24/158) were likely to have symptoms of depression (Patient Health Questionnaire-2 [PHQ-2]). Conclusions: Based on the present findings, Wysa appears to strongly engage those with none to moderate symptoms of anxiety. This evaluation demonstrates the viability of implementing Wysa as a standard practice among this sample of health care workers, which may support the use of similar digital interventions across other communities. %M 38640476 %R 10.2196/51858 %U https://formative.jmir.org/2024/1/e51858 %U https://doi.org/10.2196/51858 %U http://www.ncbi.nlm.nih.gov/pubmed/38640476 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e53712 %T Testing the Efficacy of a Brief, Self-Guided Mindfulness Ecological Momentary Intervention on Emotion Regulation and Self-Compassion in Social Anxiety Disorder: Randomized Controlled Trial %A Zainal,Nur Hani %A Tan,Hui Han %A Hong,Ryan Yee Shiun %A Newman,Michelle Gayle %+ Department of Psychology, National University of Singapore, 9 Arts Link, Singapore, 117572, Singapore, 65 917 767 7088, hanizainal@nus.edu.sg %K social anxiety disorder %K mindfulness %K ecological momentary intervention %K randomized controlled trial %K emotion regulation %K self-compassion %K mechanisms of change %K mobile phone %K momentary interventions %K self-monitoring app %K regulations %K participant %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Theories propose that brief, mobile, self-guided mindfulness ecological momentary interventions (MEMIs) could enhance emotion regulation (ER) and self-compassion. Such changes are posited to be mechanisms of change. However, rigorous tests of these theories have not been conducted. Objective: In this assessor-blinded, parallel-group randomized controlled trial, we aimed to test these theories in social anxiety disorder (SAD). Methods: Participants with SAD (defined as having a prerandomization cut-off score ≥20 on the Social Phobia Inventory self-report) were randomized to a 14-day fully self-guided MEMI (96/191, 50.3%) or self-monitoring app (95/191, 49.7%) arm. They completed web-based self-reports of 6 clinical outcome measures at prerandomization, 15-day postintervention (administered the day after the intervention ended), and 1-month follow-up time points. ER and self-compassion were assessed at preintervention and 7-day midintervention time points. Multilevel modeling determined the efficacy of MEMI on ER and self-compassion domains from pretrial to midintervention time points. Bootstrapped parallel multilevel mediation analysis examined the mediating role of pretrial to midintervention ER and self-compassion domains on the efficacy of MEMI on 6 clinical outcomes. Results: Participants demonstrated strong compliance, with 78% (149/191) engaging in at least 80% of the MEMI and self-monitoring prompts. MEMI was more efficacious than the self-monitoring app in decreasing ER goal–directed behavior difficulties (between-group Cohen d=−0.24) and lack of emotional clarity (Cohen d=0.16) and increasing self-compassion social connectedness (Cohen d=0.19), nonidentification with emotions (Cohen d=0.16), and self-kindness (Cohen d=0.19) from pretrial to midintervention time points. The within-group effect sizes from pretrial to midintervention were larger in the MEMI arm than in the self-monitoring app arm (ER goal–directed behavior difficulties: Cohen d=−0.73 vs −0.29, lack of emotional clarity: Cohen d=−0.39 vs −0.21, self-compassion domains of social connectedness: Cohen d=0.45 vs 0.19, nonidentification with emotions: Cohen d=0.63 vs 0.48, and self-kindness: Cohen d=0.36 vs 0.10). Self-monitoring, but not MEMI, alleviated ER emotional awareness issues (between-group Cohen d=0.11 and within-group: Cohen d=−0.29 vs −0.13) and reduced self-compassion acknowledging shared human struggles (between-group Cohen d=0.26 and within-group: Cohen d=−0.23 vs 0.13). No ER and self-compassion domains were mediators of the effect of MEMI on SAD symptoms (P=.07-<.99), generalized anxiety symptoms (P=.16-.98), depression severity (P=.20-.94), repetitive negative thinking (P=.12-.96), and trait mindfulness (P=.18-.99) from pretrial to postintervention time points. Similar nonsignificant mediation effects emerged for all of these clinical outcomes from pretrial to 1-month follow-up time points (P=.11-.98). Conclusions: Brief, fully self-guided, mobile MEMIs efficaciously increased specific self-compassion domains and decreased ER difficulties associated with goal pursuit and clarity of emotions from pretrial to midintervention time points. Higher-intensity MEMIs may be required to pinpoint the specific change mechanisms in ER and self-compassion domains of SAD. Trial Registration: Open Science Framework (OSF) Registries; osf.io/m3kxz https://osf.io/m3kxz %M 38640015 %R 10.2196/53712 %U https://mental.jmir.org/2024/1/e53712 %U https://doi.org/10.2196/53712 %U http://www.ncbi.nlm.nih.gov/pubmed/38640015 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e42402 %T Effects of a Web-based Weight Management Education Program on Various Factors for Overweight and Obese Women: Randomized Controlled Trial %A Han,Yunmin %A Sung,Hoyong %A Kim,Geonhui %A Ryu,Yeun %A Yoon,Jiyeon %A Kim,Yeon Soo %+ Department of Physical Education, Seoul National University, Seoul, Gawnak Gu, Gawankro 1, 71-1, 408, Seoul, 08826, Republic of Korea, 82 2 880 7894, kys0101@snu.ac.kr %K weight loss %K obesity %K health education %K self-management %K health promotion %K tailored feedback %K web-based intervention %K behavior change %D 2024 %7 18.4.2024 %9 Original Paper %J JMIR Cardio %G English %X Background: Mediated diet and exercise methods yield effective short-term weight loss but are costly and hard to manage. However, web-based programs can serve many participants, offering ease of access and cost-efficiency. Objective: This study aimed to compare the effectiveness of a web-based weight management program through web-based education alone (MINE) or combined with tailored video feedback (MINE Plus) with a control (CO) group. Methods: This intervention included 60 Korean women with overweight and obesity (BMI≥23 kg/m2) aged 19 years to 39 years old. We randomly allocated 60 participants to each of 3 groups: (1) MINE group (web-based education video and self-monitoring app), (2) MINE Plus group (web-based education video, self-monitoring app, and 1:1 tailored video feedback), and (3) CO group (only self-monitoring app). Web-based education included nutrition, physical activity, psychological factors, medical knowledge for weight loss, goal setting, and cognitive and behavioral strategies. Tailored feedback aimed to motivate and provide solutions via weekly 10-minute real-time video sessions. The intervention lasted 6 weeks, followed by a 6-week observation period to assess the education's lasting effects, with evaluations at baseline, 6 weeks, and 12 weeks. A generalized linear mixed model was used to evaluate time and group interactions. Results: In the intention-to-treat analysis including all 60 participants, there were significant differences in weight change at 6 weeks in the MINE and MINE Plus groups, with mean weight changes of –0.74 (SD 1.96) kg (P=.03) and –1.87 (SD 1.8) kg (P<.001), respectively, while no significant change was observed in the CO group, who had a mean weight increase of 0.03 (SD 1.68) kg (P=.91). After 12 weeks, changes in body weight were –1.65 (SD 2.64) kg in the MINE group, –1.59 (SD 2.79) kg in the MINE Plus group, and 0.43 (SD 1.42) kg in the CO group. There was a significant difference between the MINE and MINE Plus groups (P<.001). Significant group × time effects were found for body weight in the MINE and CO groups (P<.001) and in the MINE Plus and CO groups (P<.001), comparing baseline and 12 weeks. Regarding physical activity and psychological factors, only body shape satisfaction and health self-efficacy were associated with improvements in the MINE and MINE Plus groups (P<.001). Conclusions: This study found that the group receiving education and tailored feedback showed significant weight loss and improvements in several psychological factors, though there were differences in the sustainability of the effects. Trial Registration: Korea Disease Control and Prevention Agency (KDCA) KCT0007780: https://cris.nih.go.kr/cris/search/detailSearch.do/22861 %M 38635975 %R 10.2196/42402 %U https://cardio.jmir.org/2024/1/e42402 %U https://doi.org/10.2196/42402 %U http://www.ncbi.nlm.nih.gov/pubmed/38635975 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55031 %T Digital Interventions for Recreational Cannabis Use Among Young Adults: Systematic Review, Meta-Analysis, and Behavior Change Technique Analysis of Randomized Controlled Studies %A Côté,José %A Chicoine,Gabrielle %A Vinette,Billy %A Auger,Patricia %A Rouleau,Geneviève %A Fontaine,Guillaume %A Jutras-Aswad,Didier %+ Research Centre of the Centre Hospitalier de l’Université de Montréal, 850 Saint-Denis, Montreal, QC, H2X 0A9, Canada, 1 514 890 8000, jose.cote@umontreal.ca %K cannabis %K young adults %K digital intervention %K systematic review %K meta-analysis %K behavior change technique analysis %K mobile phone %D 2024 %7 17.4.2024 %9 Review %J J Med Internet Res %G English %X Background: The high prevalence of cannabis use among young adults poses substantial global health concerns due to the associated acute and long-term health and psychosocial risks. Digital modalities, including websites, digital platforms, and mobile apps, have emerged as promising tools to enhance the accessibility and availability of evidence-based interventions for young adults for cannabis use. However, existing reviews do not consider young adults specifically, combine cannabis-related outcomes with those of many other substances in their meta-analytical results, and do not solely target interventions for cannabis use. Objective: We aimed to evaluate the effectiveness and active ingredients of digital interventions designed specifically for cannabis use among young adults living in the community. Methods: We conducted a systematic search of 7 databases for empirical studies published between database inception and February 13, 2023, assessing the following outcomes: cannabis use (frequency, quantity, or both) and cannabis-related negative consequences. The reference lists of included studies were consulted, and forward citation searching was also conducted. We included randomized studies assessing web- or mobile-based interventions that included a comparator or control group. Studies were excluded if they targeted other substance use (eg, alcohol), did not report cannabis use separately as an outcome, did not include young adults (aged 16-35 y), had unpublished data, were delivered via teleconference through mobile phones and computers or in a hospital-based setting, or involved people with mental health disorders or substance use disorders or dependence. Data were independently extracted by 2 reviewers using a pilot-tested extraction form. Authors were contacted to clarify study details and obtain additional data. The characteristics of the included studies, study participants, digital interventions, and their comparators were summarized. Meta-analysis results were combined using a random-effects model and pooled as standardized mean differences. Results: Of 6606 unique records, 19 (0.29%) were included (n=6710 participants). Half (9/19, 47%) of these articles reported an intervention effect on cannabis use frequency. The digital interventions included in the review were mostly web-based. A total of 184 behavior change techniques were identified across the interventions (range 5-19), and feedback on behavior was the most frequently used (17/19, 89%). Digital interventions for young adults reduced cannabis use frequency at the 3-month follow-up compared to control conditions (including passive and active controls) by −6.79 days of use in the previous month (95% CI −9.59 to −4.00; P<.001). Conclusions: Our results indicate the potential of digital interventions to reduce cannabis use in young adults but raise important questions about what optimal exposure dose could be more effective, both in terms of intervention duration and frequency. Further high-quality research is still needed to investigate the effects of digital interventions on cannabis use among young adults. Trial Registration: PROSPERO CRD42020196959; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=196959 %M 38630515 %R 10.2196/55031 %U https://www.jmir.org/2024/1/e55031 %U https://doi.org/10.2196/55031 %U http://www.ncbi.nlm.nih.gov/pubmed/38630515 %0 Journal Article %@ 2291-5222 %I %V 12 %N %P e52074 %T Tailored Prompting to Improve Adherence to Image-Based Dietary Assessment: Mixed Methods Study %A Lee,Lachlan %A Hall,Rosemary %A Stanley,James %A Krebs,Jeremy %K dietary assessment %K diet %K dietary %K nutrition %K mobile phone apps %K image-based dietary assessment %K nutritional epidemiology %K mHealth %K mobile health %K app %K apps %K applications %K applications %K image %K RCT %K randomized %K controlled trial %K controlled trials %K cross-over %K images %K photo %K photographs %K photos %K photograph %K assessment %K prompt %K prompts %K nudge %K nudges %K food %K meal %K meals %K consumption %K behaviour change %K behavior change %D 2024 %7 15.4.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Accurately assessing an individual’s diet is vital in the management of personal nutrition and in the study of the effect of diet on health. Despite its importance, the tools available for dietary assessment remain either too imprecise, expensive, or burdensome for clinical or research use. Image-based methods offer a potential new tool to improve the reliability and accessibility of dietary assessment. Though promising, image-based methods are sensitive to adherence, as images cannot be captured from meals that have already been consumed. Adherence to image-based methods may be improved with appropriately timed prompting via text message. Objective: This study aimed to quantitatively examine the effect of prompt timing on adherence to an image-based dietary record and qualitatively explore the participant experience of dietary assessment in order to inform the design of a novel image-based dietary assessment tool. Methods: This study used a randomized crossover design to examine the intraindividual effect of 3 prompt settings on the number of images captured in an image-based dietary record. The prompt settings were control, where no prompts were sent; standard, where prompts were sent at 7:15 AM, 11:15 AM, and 5:15 PM for every participant; and tailored, where prompt timing was tailored to habitual meal times for each participant. Participants completed a text-based dietary record at baseline to determine the timing of tailored prompts. Participants were randomized to 1 of 6 study sequences, each with a unique order of the 3 prompt settings, with each 3-day image-based dietary record separated by a washout period of at least 7 days. The qualitative component comprised semistructured interviews and questionnaires exploring the experience of dietary assessment. Results: A total of 37 people were recruited, and 30 participants (11 male, 19 female; mean age 30, SD 10.8 years), completed all image-based dietary records. The image rate increased by 0.83 images per day in the standard setting compared to control (P=.23) and increased by 1.78 images per day in the tailored setting compared to control (P≤.001). We found that 13/21 (62%) of participants preferred to use the image-based dietary record versus the text-based dietary record but reported method-specific challenges with each method, particularly the inability to record via an image after a meal had been consumed. Conclusions: Tailored prompting improves adherence to image-based dietary assessment. Future image-based dietary assessment tools should use tailored prompting and offer both image-based and written input options to improve record completeness. %R 10.2196/52074 %U https://mhealth.jmir.org/2024/1/e52074 %U https://doi.org/10.2196/52074 %0 Journal Article %@ 2291-5222 %I %V 12 %N %P e49509 %T mHealth-Based Gamification Interventions Among Men Who Have Sex With Men in the HIV Prevention and Care Continuum: Systematic Review and Meta-Analysis %A Luo,Qianqian %A Zhang,Yue %A Wang,Wei %A Cui,Tianyu %A Li,Tianying %K mHealth %K gamification %K HIV %K men who have sex with men %K meta-analysis %K PRISMA %K mobile health %K Preferred Reporting Items for Systematic Reviews and Meta-Analyses %D 2024 %7 15.4.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: In the past few years, a burgeoning interest has emerged in applying gamification to promote desired health behaviors. However, little is known about the effectiveness of such applications in the HIV prevention and care continuum among men who have sex with men (MSM). Objective: This study aims to summarize and evaluate research on the effectiveness of gamification on the HIV prevention and care continuum, including HIV-testing promotion; condomless anal sex (CAS) reduction; and uptake of and adherence to pre-exposure prophylaxis (PrEP), postexposure prophylaxis (PEP), and antiretroviral therapy (ART). Methods: We comprehensively searched PubMed, Embase, the Cochrane Library, Web of Science, Scopus, and the Journal of Medical Internet Research and its sister journals for studies published in English and Chinese from inception to January 2024. Eligible studies were included when they used gamified interventions with an active or inactive control group and assessed at least one of the following outcomes: HIV testing; CAS; and uptake of and adherence to PrEP, PEP, and ART. During the meta-analysis, a random-effects model was applied. Two reviewers independently assessed the quality and risk of bias of each included study. Results: The systematic review identified 26 studies, including 10 randomized controlled trials (RCTs). The results indicated that gamified digital interventions had been applied to various HIV outcomes, such as HIV testing, CAS, PrEP uptake and adherence, PEP uptake, and ART adherence. Most of the studies were conducted in the United States (n=19, 73%). The most frequently used game component was gaining points, followed by challenges. The meta-analysis showed gamification interventions could reduce the number of CAS acts at the 3-month follow-up (n=2 RCTs; incidence rate ratio 0.62, 95% CI 0.44-0.88). The meta-analysis also suggested an effective but nonstatistically significant effect of PrEP adherence at the 3-month follow-up (n=3 RCTs; risk ratio 1.16, 95% CI 0.96-1.38) and 6-month follow-up (n=4 RCTs; risk ratio 1.28, 95% CI 0.89-1.84). Only 1 pilot RCT was designed to evaluate the effectiveness of a gamified app in promoting HIV testing and PrEP uptake. No RCT was conducted to evaluate the effect of the gamified digital intervention on PEP uptake and adherence, and ART initiation among MSM. Conclusions: Our findings suggest the short-term effect of gamified digital interventions on lowering the number of CAS acts in MSM. Further well-powered studies are still needed to evaluate the effect of the gamified digital intervention on HIV testing, PrEP uptake, PEP initiation and adherence, and ART initiation in MSM. Trial Registration: PROSPERO CRD42023392193; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=392193 %R 10.2196/49509 %U https://mhealth.jmir.org/2024/1/e49509 %U https://doi.org/10.2196/49509 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54214 %T Developing a Multiprofessional Mobile App to Enhance Health Habits in Older Adults: User-Centered Approach %A Sobrinho,Andressa Crystine da Silva %A Gomes,Grace Angelica de Oliveira %A Bueno Júnior,Carlos Roberto %+ Faculty of Medicine of the University of São Paulo, Bandeirantes Avenue 9000, Ribeirão Preto, 14055-230, Brazil, 55 16988155152, andressa.sobrinho@usp.br %K information and communications technologies %K ICTs %K health care %K digital inclusion %K focus groups %K health promotion %K user %K usability %K health literacy %K digital competencies %K digital skills %K mobile phone %D 2024 %7 15.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Although comprehensive lifestyle habits are crucial for healthy aging, their adherence tends to decline as individuals grow older. Sustaining a healthy life over time poses a motivational challenge. Some digital tools, such as smartphone apps aimed at promoting healthy habits, have been used to counteract this decline. However, a more profound investigation is necessary into the diverse experiences of users, particularly when it concerns older adults or those who are unfamiliar with information and communications technologies. Objective: We aimed to develop a mobile app focused on promoting the health of older adults based on the principles of software engineering and a user-centered design. The project respected all ethical guidelines and involved the participation of older adults at various stages of the development of the app. Methods: This study used a mixed methods approach, combining both quantitative and qualitative methodologies for data collection. The study was conducted in Ribeirão Prêto, São Paulo, Brazil, and involved 20 older adults of both genders who were aged ≥60 years and enrolled in the Physical Education Program for the Elderly at the University of São Paulo. The research unfolded in multiple phases, encompassing the development and refinement of the app with active engagement from the participants. Results: A total of 20 participants used a mobile health app with an average age of 64.8 (SD 2.7) years. Most participants had a high school education, middle-class status, and varying health literacy (mean score 73.55, SD 26.70). Overall, 90% (18/20) of the participants owned smartphones. However, 20% (4/20) of the participants faced installation challenges and 30% (6/20) struggled with web-based searches. The focus groups assessed app usability and satisfaction. Adjustments increased satisfaction scores significantly (Suitability Assessment of Materials: 34.89% to 70.65%; System Usability Scale: 71.23 to 87.14). Participant feedback emphasized font size, navigation, visual feedback, and personalization, and suggestions included health device integration, social interaction, and in-app communication support. Conclusions: This study contributes to the development of health care technologies tailored to the older adult population, considering their specific needs. It is anticipated that the resulting app will serve as a valuable tool for promoting healthy habits and enhancing the quality of life for older adults. %M 38619865 %R 10.2196/54214 %U https://formative.jmir.org/2024/1/e54214 %U https://doi.org/10.2196/54214 %U http://www.ncbi.nlm.nih.gov/pubmed/38619865 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51428 %T The Effectiveness of a Digital App for Reduction of Clinical Symptoms in Individuals With Panic Disorder: Randomized Controlled Trial %A Kim,KunJung %A Hwang,Hyunchan %A Bae,Sujin %A Kim,Sun Mi %A Han,Doug Hyun %+ Chung Ang University Hospital, 102 Heucsock ro, Seoul, 06973, Republic of Korea, 82 2 6299 3132, hduk70@gmail.com %K digital app %K mHealth %K mobile health %K app %K apps %K application %K applications %K functional near-infrared spectroscopy %K hemodynamic %K hemodynamics %K panic disorder %K anxiety %K panic %K mental %K fear %K spectroscopy %K digital therapy %K fNIRS %K brain %K imaging %K neurology %K neuroscience %K cortex %K cortices %D 2024 %7 12.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Panic disorder is a common and important disease in clinical practice that decreases individual productivity and increases health care use. Treatments comprise medication and cognitive behavioral therapy. However, adverse medication effects and poor treatment compliance mean new therapeutic models are needed. Objective: We hypothesized that digital therapy for panic disorder may improve panic disorder symptoms and that treatment response would be associated with brain activity changes assessed with functional near-infrared spectroscopy (fNIRS). Methods: Individuals (n=50) with a history of panic attacks were recruited. Symptoms were assessed before and after the use of an app for panic disorder, which in this study was a smartphone-based app for treating the clinical symptoms of panic disorder, panic symptoms, depressive symptoms, and anxiety. The hemodynamics in the frontal cortex during the resting state were measured via fNIRS. The app had 4 parts: diary, education, quest, and serious games. The study trial was approved by the institutional review board of Chung-Ang University Hospital (1041078-202112-HR-349-01) and written informed consent was obtained from all participants. Results: The number of participants with improved panic symptoms in the app use group (20/25, 80%) was greater than that in the control group (6/21, 29%; χ21=12.3; P=.005). During treatment, the improvement in the Panic Disorder Severity Scale (PDSS) score in the app use group was greater than that in the control group (F1,44=7.03; P=.01). In the app use group, the total PDSS score declined by 42.5% (mean score 14.3, SD 6.5 at baseline and mean score 7.2, SD 3.6 after the intervention), whereas the PDSS score declined by 14.6% in the control group (mean score 12.4, SD 5.2 at baseline and mean score 9.8, SD 7.9 after the intervention). There were no significant differences in accumulated oxygenated hemoglobin (accHbO2) at baseline between the app use and control groups. During treatment, the reduction in accHbO2 in the right ventrolateral prefrontal cortex (VLPFC; F1,44=8.22; P=.006) and the right orbitofrontal cortex (OFC; F1,44=8.88; P=.005) was greater in the app use than the control group. Conclusions: Apps for panic disorder should effectively reduce symptoms and VLPFC and OFC brain activity in patients with panic disorder. The improvement of panic disorder symptoms was positively correlated with decreased VLPFC and OFC brain activity in the resting state. Trial Registration: Clinical Research Information Service KCT0007280; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=21448 %M 38608270 %R 10.2196/51428 %U https://www.jmir.org/2024/1/e51428 %U https://doi.org/10.2196/51428 %U http://www.ncbi.nlm.nih.gov/pubmed/38608270 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45959 %T Mental Distress, Label Avoidance, and Use of a Mental Health Chatbot: Results From a US Survey %A Kosyluk,Kristin %A Baeder,Tanner %A Greene,Karah Yeona %A Tran,Jennifer T %A Bolton,Cassidy %A Loecher,Nele %A DiEva,Daniel %A Galea,Jerome T %+ Department of Mental Health Law & Policy, University of South Florida, 13301 Bruce B Downs Boulevard, MHC 2735, Tampa, FL, 33612, United States, 1 8139746019, kkosyluk@usf.edu %K chatbots %K conversational agents %K mental health %K resources %K screening %K resource referral %K stigma %K label avoidance %K survey %K training %K behavioral %K COVID-19 %K pilot test %K design %K users %K psychological distress %K symptoms %D 2024 %7 12.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: For almost two decades, researchers and clinicians have argued that certain aspects of mental health treatment can be removed from clinicians’ responsibilities and allocated to technology, preserving valuable clinician time and alleviating the burden on the behavioral health care system. The service delivery tasks that could arguably be allocated to technology without negatively impacting patient outcomes include screening, triage, and referral. Objective: We pilot-tested a chatbot for mental health screening and referral to understand the relationship between potential users’ demographics and chatbot use; the completion rate of mental health screening when delivered by a chatbot; and the acceptability of a prototype chatbot designed for mental health screening and referral. This chatbot not only screened participants for psychological distress but also referred them to appropriate resources that matched their level of distress and preferences. The goal of this study was to determine whether a mental health screening and referral chatbot would be feasible and acceptable to users. Methods: We conducted an internet-based survey among a sample of US-based adults. Our survey collected demographic data along with a battery of measures assessing behavioral health and symptoms, stigma (label avoidance and perceived stigma), attitudes toward treatment-seeking, readiness for change, and technology readiness and acceptance. Participants were then offered to engage with our chatbot. Those who engaged with the chatbot completed a mental health screening, received a distress score based on this screening, were referred to resources appropriate for their current level of distress, and were asked to rate the acceptability of the chatbot. Results: We found that mental health screening using a chatbot was feasible, with 168 (75.7%) of our 222 participants completing mental health screening within the chatbot sessions. Various demographic characteristics were associated with a willingness to use the chatbot. The participants who used the chatbot found it to be acceptable. Logistic regression produced a significant model with perceived usefulness and symptoms as significant positive predictors of chatbot use for the overall sample, and label avoidance as the only significant predictor of chatbot use for those currently experiencing distress. Conclusions: Label avoidance, the desire to avoid mental health services to avoid the stigmatized label of mental illness, is a significant negative predictor of care seeking. Therefore, our finding regarding label avoidance and chatbot use has significant public health implications in terms of facilitating access to mental health resources. Those who are high on label avoidance are not likely to seek care in a community mental health clinic, yet they are likely willing to engage with a mental health chatbot, participate in mental health screening, and receive mental health resources within the chatbot session. Chatbot technology may prove to be a way to engage those in care who have previously avoided treatment due to stigma. %M 38607665 %R 10.2196/45959 %U https://formative.jmir.org/2024/1/e45959 %U https://doi.org/10.2196/45959 %U http://www.ncbi.nlm.nih.gov/pubmed/38607665 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49780 %T Race and Socioeconomic Status as Predictors of Willingness to Use Digital Mental Health Interventions or One-On-One Psychotherapy: National Survey Study %A Lorenzo-Luaces,Lorenzo %A Wasil,Akash %A Kacmarek,Corinne N %A DeRubeis,Robert %+ Indiana University-Bloomington, 1101 E 10th St, Bloomington, IN, 47405, United States, 1 8128560866, lolorenz@indiana.edu %K digital mental health %K ethnicity %K health disparities %K internet-based CBT %K cognitive behavioral therapy %K intervention %K mental health %K mental health care %K race %K therapy %D 2024 %7 11.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is an ongoing debate about whether digital mental health interventions (DMHIs) can reduce racial and socioeconomic inequities in access to mental health care. A key factor in this debate involves the extent to which racial and ethnic minoritized individuals and socioeconomically disadvantaged individuals are willing to use, and pay for, DMHIs. Objective: This study examined racial and ethnic as well as socioeconomic differences in participants’ willingness to pay for DMHIs versus one-on-one therapy (1:1 therapy). Methods: We conducted a national survey of people in the United States (N=423; women: n=204; mean age 45.15, SD 16.19 years; non-Hispanic White: n=293) through Prolific. After reading descriptions of DMHIs and 1:1 therapy, participants rated their willingness to use each treatment (1) for free, (2) for a small fee, (3) as a maximum dollar amount, and (4) as a percentage of their total monthly income. At the end of the study, there was a decision task to potentially receive more information about DMHIs and 1:1 therapy. Results: Race and ethnicity was associated with willingness to pay more of one’s income, as a percent or in dollar amounts, and was also associated with information-seeking for DMHIs in the behavioral task. For most outcomes, race and ethnicity was not associated with willingness to try 1:1 therapy. Greater educational attainment was associated to willingness to try DMHIs for free, the decision to learn more about DMHIs, and willingness to pay for 1:1 therapy. Income was inconsistently associated to willingness to try DMHIs or 1:1 therapy. Conclusions: If they are available for free or at very low costs, DMHIs may reduce inequities by expanding access to mental health care for racial and ethnic minoritized individuals and economically disadvantaged groups. %M 38602769 %R 10.2196/49780 %U https://formative.jmir.org/2024/1/e49780 %U https://doi.org/10.2196/49780 %U http://www.ncbi.nlm.nih.gov/pubmed/38602769 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57226 %T Smartphone App–Delivered Mindfulness-Based Intervention for Mild Traumatic Brain Injury in Adolescents: Protocol for a Feasibility Randomized Controlled Trial %A Ledoux,Andrée-Anne %A Zemek,Roger %A Cairncross,Molly %A Silverberg,Noah %A Sicard,Veronik %A Barrowman,Nicholas %A Goldfield,Gary %A Gray,Clare %A Harris,Ashley D %A Jaworska,Natalia %A Reed,Nick %A Saab,Bechara J %A Smith,Andra %A Walker,Lisa %+ Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada, 1 6137377600 ext 4104, aledoux@cheo.on.ca %K pediatric %K concussion %K persisting symptoms after concussion %K mindfulness %K randomized controlled trial %K feasibility RCT %K psychological intervention %K youth %K digital therapeutics %K eHealth %K mobile health %K mHealth %K mobile phone %D 2024 %7 11.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Concussion in children and adolescents is a significant public health concern, with 30% to 35% of patients at risk for prolonged emotional, cognitive, sleep, or physical symptoms. These symptoms negatively impact a child’s quality of life while interfering with their participation in important neurodevelopmental activities such as schoolwork, socializing, and sports. Early psychological intervention following a concussion may improve the ability to regulate emotions and adapt to postinjury symptoms, resulting in the greater acceptance of change; reduced stress; and recovery of somatic, emotional, and cognitive symptoms. Objective: The primary objective of this study is to assess the feasibility of conducting a parallel-group (1:1) randomized controlled trial (RCT) to evaluate a digital therapeutics (DTx) mindfulness-based intervention (MBI) in adolescents aged 12 to <18 years. The attention-matched comparator intervention (a math game also used in previous RCTs) will be delivered on the same DTx platform. Both groups will be provided with the standard of care guidelines. The secondary objective is to examine intervention trends for quality of life; resilience; self-efficacy; cognition such as attention, working memory, and executive functioning; symptom burden; and anxiety and depression scores at 4 weeks after concussion, which will inform a more definitive RCT. A subsample will be used to examine whether those randomized to the experimental intervention group have different brain-based imaging patterns compared with those randomized to the control group. Methods: This study is a double-blind Health Canada–regulated trial. A total of 70 participants will be enrolled within 7 days of concussion and randomly assigned to receive the 4-week DTx MBI (experimental group) or comparator intervention. Feasibility will be assessed based on the recruitment rate, treatment adherence to both interventions, and retention. All outcome measures will be evaluated before the intervention (within 7 days after injury) and at 1, 2, and 4 weeks after the injury. A subset of 60 participants will undergo magnetic resonance imaging within 72 hours and at 4 weeks after recruitment to identify the neurophysiological mechanisms underlying the potential benefits from MBI training in adolescents following a concussion. Results: The recruitment began in October 2022, and the data collection is expected to be completed by September 2024. Data collection and management is still in progress; therefore, data analysis is yet to be conducted. Conclusions: This trial will confirm the feasibility and resolve uncertainties to inform a future definitive multicenter efficacy RCT. If proven effective, a smartphone-based MBI has the potential to be an accessible and low-risk preventive treatment for youth at risk of experiencing prolonged postconcussion symptoms and complications. Trial Registration: ClinicalTrials.gov NCT05105802; https://classic.clinicaltrials.gov/ct2/show/NCT05105802 International Registered Report Identifier (IRRID): DERR1-10.2196/57226 %M 38602770 %R 10.2196/57226 %U https://www.researchprotocols.org/2024/1/e57226 %U https://doi.org/10.2196/57226 %U http://www.ncbi.nlm.nih.gov/pubmed/38602770 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 9 %N %P e55165 %T Moderating Effect of Depression on Glycemic Control in an eHealth Intervention Among Black Youth With Type 1 Diabetes: Findings From a Multicenter Randomized Controlled Trial %A Ellis,Deborah %A Carcone,April Idalski %A Templin,Thomas %A Evans,Meredyth %A Weissberg-Benchell,Jill %A Buggs-Saxton,Colleen %A Boucher-Berry,Claudia %A Miller,Jennifer L %A Drossos,Tina %A Dekelbab,M Bassem %+ Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, IBio Behavioral Health, 6135 Woodward Avenue, Detroit, MI, 48202, United States, 1 3135771055, dellis@med.wayne.edu %K adolescents %K black %K depression %K eHealth %K family intervention %K randomized clinical trial %K randomized controlled trial %K T1D %K type 1 diabetes %D 2024 %7 9.4.2024 %9 Original Paper %J JMIR Diabetes %G English %X Background: Black adolescents with type 1 diabetes (T1D) are at increased risk for suboptimal diabetes health outcomes; however, evidence-based interventions for this population are lacking. Depression affects a high percentage of youth with T1D and increases the likelihood of health problems associated with diabetes. Objective: Our aim was to test whether baseline levels of depression moderate the effects of a brief eHealth parenting intervention delivered to caregivers of young Black adolescents with T1D on youths’ glycemic control. Methods: We conducted a multicenter randomized controlled trial at 7 pediatric diabetes clinics located in 2 large US cities. Participants (N=149) were allocated to either the intervention group or a standard medical care control group. Up to 3 intervention sessions were delivered on a tablet computer during diabetes clinic visits over a 12-month period. Results: In a linear mixed effects regression model, planned contrasts did not show significant reductions in hemoglobin A1c (HbA1c) for intervention adolescents compared to controls. However, adolescents with higher baseline levels of depressive symptoms who received the intervention had significantly greater improvements in HbA1c levels at 6-month follow-up (0.94%; P=.01) and 18-month follow-up (1.42%; P=.002) than those with lower levels of depression. Within the intervention group, adolescents had a statistically significant reduction in HbA1c levels from baseline at 6-month and 18-month follow-up. Conclusions: A brief, culturally tailored eHealth parenting intervention improved health outcomes among Black adolescents with T1D and depressive symptoms. Trial Registration: ClinicalTrials.gov NCT03168867; https://clinicaltrials.gov/study/NCT03168867 %M 38593428 %R 10.2196/55165 %U https://diabetes.jmir.org/2024/1/e55165 %U https://doi.org/10.2196/55165 %U http://www.ncbi.nlm.nih.gov/pubmed/38593428 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55509 %T Effectiveness and Implementation of a Text Messaging mHealth Intervention to Prevent Childhood Obesity in Mexico in the COVID-19 Context: Mixed Methods Study %A Lozada-Tequeanes,Ana Lilia %A Théodore,Florence L %A Kim-Herrera,Edith %A García-Guerra,Armando %A Quezada-Sánchez,Amado D %A Alvarado-Casas,Rocio %A Bonvecchio,Anabelle %+ National Institute of Public Health, Instituto Nacional de Salud Pública de México, Avenida Universidad 655, Cuernavaca, 62100, Mexico, 52 +527773293000, ftheodore@insp.mx %K effectiveness %K feasibility %K mHealth %K SMS text message %K mixed methods %K infant obesity %K physical activity %K healthy feeding %K children %K COVID-19 %K Mexico %D 2024 %7 9.4.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Promoting physical activity (PA) and healthy feeding (HF) is crucial to address the alarming increase in obesity rates in developing countries. Leveraging mobile phones for behavior change communication to encourage infant PA and promote HF is particularly significant within the Mexican context. Objective: This study aims to explore the effectiveness and feasibility of mHealth interventions aimed at promoting PA and HF among primary caregivers (PCs) of Mexican children under the age of 5 years. Additionally, the study aims to disseminate insights gained from intervention implementation amidst the COVID-19 pandemic and assess the potential of behavior change mHealth interventions on a broader population scale. Methods: NUTRES, an mHealth intervention, underwent an effectiveness-implementation hybrid trial. Over 36 weeks, participants in the intervention group (IG), totaling 230 individuals, received approximately 108 SMS text messages tailored to their children’s age. These messages covered topics such as PA and HF and emphasized the significance of proper child nutrition amidst the COVID-19 pandemic. NUTRES participants were recruited from both urban and rural health units across 2 states in Mexico. Given the COVID-19 context, both baseline and follow-up surveys were conducted via mobile or fixed telephone. The evaluation of effectiveness and implementation used a mixed methods approach. Qualitative analysis delved into participants’ experiences with NUTRES and various implementation indicators, including acceptance, relevance, and coverage. Grounded theory was used for coding and analysis. Furthermore, difference-in-differences regression models were used to discern disparities between groups (comparison group [CG] versus IG) concerning knowledge and practices pertaining to infant PA and HF. Results: Of the total 494 PCs enrolled in NUTRES, 334 persisted until the end of the study, accounting for 67.6% (334/494) participation across both groups. A majority of PCs (43/141, 30.5%, always; and 97/141, 68.8%, sometimes) used the SMS text message information. Satisfaction and acceptability toward NUTRES were notably high, reaching 98% (96/98), with respondents expressing that NUTRES was “good,” “useful,” and “helpful” for enhancing child nutrition. Significant differences after the intervention were observed in PA knowledge, with social interaction favored (CG: 8/135, 5.9% vs IG: 20/137, 14.6%; P=.048), as well as in HF practice knowledge. Notably, sweetened beverage consumption, associated with the development of chronic diseases, showed divergence (CG: 92/157, 58.6% vs IG: 110/145, 75.9%; P=.003). In the difference-in-differences model, a notable increase of 0.03 in knowledge regarding the benefits of PA was observed (CG: mean 0.13, SD 0.10 vs IG: mean 0.16, SD 0.11; P=.02). PCs expressed feeling accompanied and supported, particularly amidst the disruption of routine health care services during the COVID-19 pandemic. Conclusions: While NUTRES exhibited a restricted impact on targeted knowledge and behaviors, the SMS text messages functioned effectively as both a reminder and a source of new knowledge for PCs of Mexican children under 5 years of age. The key lessons learned were as follows: mHealth intervention strategies can effectively maintain communication with individuals during emergencies, such as the COVID-19 pandemic; methodological and implementation barriers can constrain the effectiveness of mHealth interventions; and using mixed methods approaches ensures the complementary nature of results. The findings contribute valuable evidence regarding the opportunities and constraints associated with using mobile phones to enhance knowledge and practices concerning PA and HF among PCs of children under 5 years old. Trial Registration: ClinicalTrials.gov NCT04250896; https://clinicaltrials.gov/ct2/show/NCT04250896 %M 38592753 %R 10.2196/55509 %U https://mhealth.jmir.org/2024/1/e55509 %U https://doi.org/10.2196/55509 %U http://www.ncbi.nlm.nih.gov/pubmed/38592753 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e53998 %T Feasibility, Acceptability, and Preliminary Efficacy of a Smartphone App–Led Cognitive Behavioral Therapy for Depression Under Therapist Supervision: Open Trial %A Wilhelm,Sabine %A Bernstein,Emily E %A Bentley,Kate H %A Snorrason,Ivar %A Hoeppner,Susanne S %A Klare,Dalton %A Greenberg,Jennifer L %A Weingarden,Hilary %A McCoy,Thomas H %A Harrison,Oliver %+ Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, United States, 1 617 724 6146, swilhelm@mgh.harvard.edu %K depressive disorder %K depressive %K depression %K open trial %K open trials %K single arm %K smartphone %K cognitive behavioral therapy %K cognitive behavioural therapy %K CBT %K psychotherapy %K psychoeducation %K digital health %K mobile applications %K mHealth %K mobile health %K app %K apps %K application %K applications %K psychiatry %K psychiatric %K feasibility %K acceptability %K usability %K satisfaction %K user experience %K mental %D 2024 %7 9.4.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Major depressive disorder affects approximately 1 in 5 adults during their lifetime and is the leading cause of disability worldwide. Yet, a minority receive adequate treatment due to person-level (eg, geographical distance to providers) and systems-level (eg, shortage of trained providers) barriers. Digital tools could improve this treatment gap by reducing the time and frequency of therapy sessions needed for effective treatment through the provision of flexible, automated support. Objective: This study aimed to examine the feasibility, acceptability, and preliminary clinical effect of Mindset for Depression, a deployment-ready 8-week smartphone-based cognitive behavioral therapy (CBT) supported by brief teletherapy appointments with a therapist. Methods: This 8-week, single-arm open trial tested the Mindset for Depression app when combined with 8 brief (16-25 minutes) video conferencing visits with a licensed doctoral-level CBT therapist (n=28 participants). The app offers flexible, accessible psychoeducation, CBT skills practice, and support to patients as well as clinician guidance to promote sustained engagement, monitor safety, and tailor treatment to individual patient needs. To increase accessibility and thus generalizability, all study procedures were conducted remotely. Feasibility and acceptability were assessed via attrition, patient expectations and feedback, and treatment utilization. The primary clinical outcome measure was the clinician-rated Hamilton Depression Rating Scale, administered at pretreatment, midpoint, and posttreatment. Secondary measures of functional impairment and quality of life as well as maintenance of gains (3-month follow-up) were also collected. Results: Treatment credibility (week 4), expectancy (week 4), and satisfaction (week 8) were moderate to high, and attrition was low (n=2, 7%). Participants self-reported using the app or practicing (either on or off the app) the CBT skills taught in the app for a median of 50 (IQR 30-60; week 4) or 60 (IQR 30-90; week 8) minutes per week; participants accessed the app on an average 36.8 (SD 10.0) days and completed a median of 7 of 8 (IQR 6-8) steps by the week 8 assessment. The app was rated positively across domains of engagement, functionality, aesthetics, and information. Participants’ depression severity scores decreased from an average Hamilton Depression Rating Scale score indicating moderate depression (mean 19.1, SD 5.0) at baseline to a week 8 mean score indicating mild depression (mean 10.8, SD 6.1; d=1.47; P<.001). Improvement was also observed for functional impairment and quality of life. Gains were maintained at 3-month follow-up. Conclusions: The results show that Mindset for Depression is a feasible and acceptable treatment option for individuals with major depressive disorder. This smartphone-led treatment holds promise to be an efficacious, scalable, and cost-effective treatment option. The next steps include testing Mindset for Depression in a fully powered randomized controlled trial and real-world clinical settings. Trial Registration: ClinicalTrials.gov NCT05386329; https://clinicaltrials.gov/study/NCT05386329?term=NCT05386329 %M 38592771 %R 10.2196/53998 %U https://mental.jmir.org/2024/1/e53998 %U https://doi.org/10.2196/53998 %U http://www.ncbi.nlm.nih.gov/pubmed/38592771 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51558 %T Assessing the Clinical Efficacy of a Virtual Reality Tool for the Treatment of Obesity: Randomized Controlled Trial %A Anastasiadou,Dimitra %A Herrero,Pol %A Garcia-Royo,Paula %A Vázquez-De Sebastián,Julia %A Slater,Mel %A Spanlang,Bernhard %A Álvarez de la Campa,Elena %A Ciudin,Andreea %A Comas,Marta %A Ramos-Quiroga,Josep Antoni %A Lusilla-Palacios,Pilar %+ Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Bellaterra, Barcelona, 08193, Spain, 34 935813854, dimitra.anastasiadou@uab.cat %K obesity %K virtual reality %K psychological treatment %K embodiment %K motivational interviewing %K self-conversation %D 2024 %7 5.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Virtual reality (VR) interventions, based on cognitive behavioral therapy principles, have been proven effective as complementary tools in managing obesity and have been associated with promoting healthy behaviors and addressing body image concerns. However, they have not fully addressed certain underlying causes of obesity, such as a lack of motivation to change, low self-efficacy, and the impact of weight stigma interiorization, which often impede treatment adherence and long-term lifestyle habit changes. To tackle these concerns, this study introduces the VR self-counseling paradigm, which incorporates embodiment and body-swapping techniques, along with motivational strategies, to help people living with obesity effectively address some of the root causes of their condition. Objective: This study aims to assess the clinical efficacy of ConVRself (Virtual Reality self-talk), a VR platform that allows participants to engage in motivational self-conversations. Methods: A randomized controlled trial was conducted with 68 participants from the bariatric surgery waiting list from the obesity unit of the Vall d’Hebron University Hospital in Barcelona, Spain. Participants were assigned to 1 of 3 groups: a control group (CG), which only received treatment as usual from the obesity unit; experimental group 1 (EG1), which, after intensive motivational interviewing training, engaged in 4 sessions of VR-based self-conversations with ConVRself, and underwent embodiment and body-swapping techniques; and experimental group 2 (EG2), which engaged in 4 VR-based sessions led by a virtual counselor with a prerecorded discourse, and only underwent the embodiment technique. In the case of both EG1 and EG2, the VR interventions were assisted by a clinical researcher. Readiness to change habits, eating habits, and psychological variables, as well as adherence and satisfaction with ConVRself were measured at baseline, after the intervention, 1 week after the intervention, and 4 weeks after the intervention. Results: Regarding the primary outcomes, EG1 (24/68, 35%) and EG2 (22/68, 32%) showed significant improvements in confidence to lose weight compared to the CG (22/68, 32%) at all assessment points (β=−.16; P=.02). Similarly, EG1 demonstrated a significant increase after the intervention in readiness to exercise more compared to the CG (β=−.17; P=.03). Regarding the secondary outcomes, EG1 participants showed a significant reduction in uncontrolled eating (β=.71; P=.01) and emotional eating (β=.29; P=.03) compared to the CG participants, as well as in their anxiety levels compared to EG2 and CG participants (β=.65; P=.01). In addition, participants from the experimental groups reported high adherence and satisfaction with the VR platform (EG1: mean 59.82, SD 4.00; EG2: mean 58.43, SD 5.22; d=0.30, 95% CI −0.30 to 0.89). Conclusions: This study revealed that using VR self-conversations, based on motivational interviewing principles, may have benefits in helping people with obesity to enhance their readiness to change habits and self-efficacy, as well as reduce dysfunctional eating behaviors and anxiety. Trial Registration: ClinicalTrials.gov NCT05094557; https://www.clinicaltrials.gov/study/NCT05094557 %M 38578667 %R 10.2196/51558 %U https://www.jmir.org/2024/1/e51558 %U https://doi.org/10.2196/51558 %U http://www.ncbi.nlm.nih.gov/pubmed/38578667 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53841 %T Acceptability of a Self-Guided Lifestyle Intervention Among Young Men: Mixed Methods Analysis of Pilot Findings %A Reading,Jean Miki %A Crane,Melissa M %A Guan,Justin %A Jackman,Ronston %A Thomson,Maria D %A LaRose,Jessica Gokee %+ Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Dr, Chicago, IL, 60611, United States, 1 3125034870, jean.reading@northwestern.edu %K digital health %K gender %K weight loss %K health behaviors %K low touch %K obesity %K obese %K mixed methods analysis %K lifestyle intervention %K young men %K men %K effectiveness %K digital tools %K food intake %K diet %D 2024 %7 5.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Young men are vastly underrepresented in lifestyle interventions, suggesting a need to develop appealing yet effective interventions for this population. Objective: This study aimed to determine the acceptability of a self-guided lifestyle intervention designed specifically for young men (age: 18-35 years old). Methods: Semistructured interviews and surveys were completed by 14 men following completion of a remotely delivered, 12-week lifestyle intervention. The intervention included 1 virtual group session, digital tools, access to self-paced web- and mobile-based content, and 12 weekly health risk text messages. We quantitatively and qualitatively examined young men’s experiences with the intervention components of a remotely delivered, self-guided lifestyle intervention targeting weight loss. Data were integrated using convergent mixed methods analysis. Results: Men were a mean age of 29.9 (SD 4.9) years with a mean BMI of 31.0 (SD 4.5) kg/m2. The self-guided aspect was not acceptable, and a majority preferred more check-ins. Participants expressed a desire for a social aspect in future lifestyle interventions. All men found the focus on health risks appealing. A majority of men found the study-issued, Bluetooth-enabled scale acceptable. Conclusions: Acceptability of the self-guided lifestyle intervention was perceived as suboptimal by young men. The findings highlight the need to add intervention components that sustain motivation and provide additional social support for young men. Trial Registration: ClinicalTrials.gov NCT04267263; https://www.clinicaltrials.gov/study/NCT04267263 %M 38578686 %R 10.2196/53841 %U https://formative.jmir.org/2024/1/e53841 %U https://doi.org/10.2196/53841 %U http://www.ncbi.nlm.nih.gov/pubmed/38578686 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55166 %T Combined Motivational Interviewing and Ecological Momentary Intervention to Reduce Hazardous Alcohol Use Among Sexual Minority Cisgender Men and Transgender Individuals: Protocol for a Randomized Controlled Trial %A Lauckner,Carolyn %A Takenaka,Bryce Puesta %A Sesenu,Fidelis %A Brown,Jaime S %A Kirklewski,Sally J %A Nicholson,Erin %A Haney,Kimberly %A Adatorwovor,Reuben %A Boyd,Donte T %A Fallin-Bennett,Keisa %A Restar,Arjee Javellana %A Kershaw,Trace %+ Center for Health Equity Transformation, University of Kentucky, 465 Healthy Kentucky Bldg, 760 Press Ave, Lexington, KY, 40536, United States, 1 859 562 3335, carolyn.lauckner@uky.edu %K alcohol use %K sexual minority %K transgender %K young adults %K mobile health %K mHealth %K HIV risk behaviors %K sexual risk behaviors %K motivational interviewing %K ecological momentary interventions %K mobile phone %D 2024 %7 5.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sexual minority cisgender men and transgender (SMMT) individuals, particularly emerging adults (aged 18-34 years), often report hazardous drinking. Given that alcohol use increases the likelihood of HIV risk behaviors, and HIV disproportionately affects SMMT individuals, there is a need to test interventions that reduce hazardous alcohol use and subsequent HIV risk behaviors among this population. Ecological momentary interventions (EMIs), which use mobile phones to deliver risk reduction messages based on current location and behaviors, can help to address triggers that lead to drinking in real time. Objective: This study will test an EMI that uses motivational interviewing (MI), smartphone surveys, mobile breathalyzers, and location tracking to provide real-time messaging that addresses triggers for drinking when SMMT individuals visit locations associated with hazardous alcohol use. In addition, the intervention will deliver harm reduction messaging if individuals report engaging in alcohol use. Methods: We will conduct a 3-arm randomized controlled trial (N=405 HIV-negative SMMT individuals; n=135, 33% per arm) comparing the following conditions: (1) Tracking and Reducing Alcohol Consumption (a smartphone-delivered 4-session MI intervention), (2) Tracking and Reducing Alcohol Consumption and Environmental Risk (an EMI combining MI with real-time messaging based on geographic locations that are triggers to drinking), and (3) a smartphone-based alcohol monitoring–only control group. Breathalyzer results and daily self-reports will be used to assess the primary and secondary outcomes of drinking days, drinks per drinking day, binge drinking episodes, and HIV risk behaviors. Additional assessments at baseline, 3 months, 6 months, and 9 months will evaluate exploratory long-term outcomes. Results: The study is part of a 5-year research project funded in August 2022 by the National Institute on Alcohol Abuse and Alcoholism. The first 1.5 years of the study will be dedicated to planning and development activities, including formative research, app design and testing, and message design and testing. The subsequent 3.5 years will see the study complete participant recruitment, data collection, analyses, report writing, and dissemination. We expect to complete all study data collection in or before January 2027. Conclusions: This study will provide novel evidence about the relative efficacy of using a smartphone-delivered MI intervention and real-time messaging to address triggers for hazardous alcohol use and sexual risk behaviors. The EMI approach, which incorporates location-based preventive messaging and behavior surveys, may help to better understand the complexity of daily stressors among SMMT individuals and their impact on hazardous alcohol use and HIV risk behaviors. The tailoring of this intervention toward SMMT individuals helps to address their underrepresentation in existing alcohol use research and will be promising for informing where structural alcohol use prevention and treatment interventions are needed to support SMMT individuals. Trial Registration: ClinicalTrials.gov NCT05576350; https://www.clinicaltrials.gov/study/NCT05576350 International Registered Report Identifier (IRRID): PRR1-10.2196/55166 %M 38578673 %R 10.2196/55166 %U https://www.researchprotocols.org/2024/1/e55166 %U https://doi.org/10.2196/55166 %U http://www.ncbi.nlm.nih.gov/pubmed/38578673 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50241 %T A Bluetooth-Based Smartphone App for Detecting Peer Proximity: Protocol for Evaluating Functionality and Validity %A Barnett,Nancy P %A Sokolovsky,Alexander W %A Meisel,Matthew K %A Forkus,Shannon R %A Jackson,Kristina M %+ Department of Behavioral and Social Sciences, Brown University, Box G-S121, Providence, RI, 02912, United States, 1 40189636649, Nancy_Barnett@brown.edu %K Bluetooth technology %K passive sensing %K proximity detection %K ecological momentary assessment %K social influence %K alcohol use %K mobile phone %D 2024 %7 5.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: While ecological momentary assessment (EMA) is commonly used to study social contexts and social influence in the real world, EMA almost exclusively relies on participant self-report of present circumstances, including the proximity to influential peers. There is the potential for developing a proximity sensing approach that uses small Bluetooth beacons and smartphone-based detection and data collection to collect information about interactions between individuals passively in real time. Objective: This paper aims to describe the methods for evaluating the functionality and validity of a Bluetooth-based beacon and a smartphone app to identify when ≥2 individuals are physically proximal. Methods: We will recruit 20 participants aged 18 to 29 years with Android smartphones to complete a 3-week study during which beacon detection and self-report data will be collected using a smartphone app (MEI Research). Using an interviewer-administered social network interview, participants will identify up to 3 peers of the same age who are influential on health behavior (alcohol use in this study). These peers will be asked to carry a Bluetooth beacon (Kontakt asset tag) for the duration of the study; each beacon has a unique ID that, when detected, will be recorded by the app on the participant’s phone. Participants will be prompted to respond to EMA surveys (signal-contingent reports) when a peer beacon encounter meets our criteria and randomly 3 times daily (random reports) and every morning (morning reports) to collect information about the presence of peers. In all reports, the individualized list of peers will be presented to participants, followed by questions about peer and participant behavior, including alcohol use. Data from multiple app data sets, including beacon encounter specifications, notification, and app logs, participant EMA self-reports and postparticipation interviews, and peer surveys, will be used to evaluate project goals. We will examine the functionality of the technology, including the stability of the app (eg, app crashes and issues opening the app), beacon-to-app detection (ie, does the app detect proximal beacons?), and beacon encounter notification when encounter criteria are met. The validity of the technology will be defined as the concordance between passive detection of peers via beacon-to-app communication and the participant’s EMA report of peer presence. Disagreement between the beacon and self-report data (ie, false negatives and false positives) will be investigated in multiple ways (ie, to determine if the reason was technology-related or participant compliance-related) using encounter data and information collected from participants and peers. Results: Participant recruitment began in February 2023, and enrollment was completed in December 2023. Results will be reported in 2025. Conclusions: This Bluetooth-based technology has important applications and clinical implications for various health behaviors, including the potential for just-in-time adaptive interventions that target high-risk behavior in real time. International Registered Report Identifier (IRRID): DERR1-10.2196/50241 %M 38578672 %R 10.2196/50241 %U https://www.researchprotocols.org/2024/1/e50241 %U https://doi.org/10.2196/50241 %U http://www.ncbi.nlm.nih.gov/pubmed/38578672 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54386 %T The Asthma App as a New Way to Promote Responsible Short-Acting Beta2-Agonist Use in People With Asthma: Results of a Mixed Methods Pilot Study %A van den Berg,Liselot N %A Hallensleben,Cynthia %A Vlug,Lisa AE %A Chavannes,Niels H %A Versluis,Anke %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2300 RC, Netherlands, 31 71 526 57 61, L.N.van_den_Berg@lumc.nl %K asthma %K short-acting beta2-agonist %K SABA overuse %K app %K eHealth %K feasibility %K usability %K mobile phone %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Approximately 262 million people worldwide are affected by asthma, and the overuse of reliever medication—specifically, short-acting beta2-agonist (SABA) overuse—is common. This can lead to adverse health effects. A smartphone app, the Asthma app, was developed via a participatory design to help patients gain more insight into their SABA use through monitoring and psychoeducation. Objective: This pilot study aims to evaluate the feasibility and usability of the app. The preliminary effects of using the app after 3 months on decreasing asthma symptoms and improving quality of life were examined. Methods: A mixed methods study design was used. Quantitative data were collected using the app. Asthma symptoms (measured using the Control of Allergic Rhinitis and Asthma Test) and the triggers of these symptoms were collected weekly. Quality of life (36-Item Short-Form Health Survey) was assessed at baseline and after 3, 6, and 12 months. User experience (System Usability Scale) was measured at all time points, except for baseline. Furthermore, objective user data were collected, and qualitative interviews, focusing on feasibility and usability, were organized. The interview protocol was based on the Unified Theory of Acceptance and Use of Technology framework. Qualitative data were analyzed using the Framework Method. Results: The baseline questionnaire was completed by 373 participants. The majority were female (309/373, 82.8%), with a mean age of 46 (SD 15) years, and used, on average, 10 SABA inhalations per week. App usability was rated as good: 82.3 (SD 13.2; N=44) at 3 months. The Control of Allergic Rhinitis and Asthma Test score significantly improved at 3 months (18.5) compared with baseline (14.8; β=.189; SE 0.048; P<.001); however, the obtained score still indicated uncontrolled asthma. At 3 months, there was no significant difference in the quality of life. Owing to the high dropout rate, insufficient data were collected at 6 and 12 months and were, therefore, not further examined. User data showed that 335 users opened the app (250/335, 74.6%, were returning visitors), with an average session time of 1 minute, and SABA registration was most often used (7506/13,081, 57.38%). Qualitative data (from a total of 4 participants; n=2, 50% female) showed that the participants found the app acceptable and clear. Three participants stated that gaining insight into asthma and its triggers was helpful. Two participants no longer used the app because they perceived their asthma as controlled and, therefore, did not use SABA often or only used it regularly based on the advice of the pulmonologist. Conclusions: The initial findings regarding the app’s feasibility and usability are encouraging. However, the notable dropout rate underscores the need for a cautious interpretation of the results. Subsequent studies, particularly those focusing on implementation, should explore the potential integration of the app into standard treatment practices. %M 38574348 %R 10.2196/54386 %U https://humanfactors.jmir.org/2024/1/e54386 %U https://doi.org/10.2196/54386 %U http://www.ncbi.nlm.nih.gov/pubmed/38574348 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e35132 %T Gamification and Oral Health in Children and Adolescents: Scoping Review %A Moreira,Rui %A Silveira,Augusta %A Sequeira,Teresa %A Durão,Nuno %A Lourenço,Jessica %A Cascais,Inês %A Cabral,Rita Maria %A Taveira Gomes,Tiago %+ School of Medicine and Biomedical Sciences, Instituto de Ciencias Biomédicas Abel Salazar, University of Porto, Rua de Jorge Viterbo Ferreira, 228, Porto, 4050-313, Portugal, 351 914180479, ruidcmoreira@gmail.com %K gamification %K mechanisms of gamification %K gamification components %K intrinsic and extrinsic motivators %K oral health care %K health behavior %K oral health care applications %D 2024 %7 4.4.2024 %9 Review %J Interact J Med Res %G English %X Background: Oral health is a determinant of overall well-being and quality of life. Individual behaviors, such as oral hygiene and dietary habits, play a central role in oral health. Motivation is a crucial factor in promoting behavior change, and gamification offers a means to boost health-related knowledge and encourage positive health behaviors. Objective: This study aims to evaluate the impact of gamification and its mechanisms on oral health care of children and adolescents. Methods: A systematic search covered multiple databases: PubMed/MEDLINE, PsycINFO, the Cochrane Library, ScienceDirect, and LILACS. Gray literature, conference proceedings, and WHOQOL internet resources were considered. Studies from January 2013 to December 2022 were included, except for PubMed/MEDLINE, which was searched until January 2023. A total of 15 studies were selected following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The eligibility criteria were peer-reviewed, full-text, and empirical research related to gamification in oral health care, reports of impact, and oral health care outcomes. The exclusion criteria encompassed duplicate articles; unavailable full texts; nonoriginal articles; and non–digital game–related, non–oral health–related, and protocol studies. Selected studies were scrutinized for gamification mechanisms and outcomes. Two main questions were raised: “Does gamification in oral health care impact oral health?” and “Does oral health care gamification enhance health promotion and literacy?” The PICO (Patient, Intervention, Comparison, Outcome) framework guided the scoping review. Results: Initially, 617 records were obtained from 5 databases and gray literature sources. After applying exclusion criteria, 15 records were selected. Sample size in the selected studies ranged from 34 to 190 children and adolescents. A substantial portion (11/15, 73%) of the studies discussed oral self-care apps supported by evidence-based oral health. The most clearly defined data in the apps were “brushing time” (11/11, 100%) and “daily amount brushing” (10/11, 91%). Most studies (11/15, 73%) mentioned oral health care behavior change techniques and included “prompt intention formation” (11/26, 42%), “providing instructions” (11/26, 42%), “providing information on the behavior-health link” (10/26, 38%), “providing information on consequences” (9/26, 35%), “modeling or demonstrating behavior” (9/26, 35%), “providing feedback on performance” (8/26, 31%), and “providing contingent rewards” (8/26, 31%). Furthermore, 80% (12/15) of the studies identified game design elements incorporating gamification features in oral hygiene applications. The most prevalent gamification features were “ideological incentives” (10/12, 83%) and “goals” (9/16, 56%), which were found in user-specific and challenge categories, respectively. Conclusions: Gamification in oral health care shows potential as an innovative approach to promote positive health behaviors. Most studies reported evidence-based oral health and incorporated oral health care behavior change techniques. %M 38573750 %R 10.2196/35132 %U https://www.i-jmr.org/2024/1/e35132 %U https://doi.org/10.2196/35132 %U http://www.ncbi.nlm.nih.gov/pubmed/38573750 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55270 %T Using Smartphones to Enhance Vision Screening in Rural Areas: Pilot Study %A Wang,Zheng %A Kempen,John %A Luo,Gang %+ Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, United States, 1 6179122529, gang_luo@meei.harvard.edu %K vision screening %K refractive error %K strabismus %K smartphone %K visual acuity %K vision %K visual %K eye %K eyes %K screening %K mHealth %K mobile health %K app %K apps %K application %K applications %K feasibility %K optometry %K ophthalmology %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: While it is treatable, uncorrected refractive error is the number one cause of visual impairment worldwide. This eye condition alone, or together with ocular misalignment, can also cause amblyopia, which is also treatable if detected early but still occurs in about 4% of the population. Mass vision screening is the first and most critical step to address these issues, but due to limited resources, vision screening in many rural areas remains a major challenge. Objective: We aimed to pilot-test the feasibility of using smartphone apps to enhance vision screening in areas where access to eye care is limited. Methods: A vision screening program was piggybacked on a charity summer camp program in a rural county in Sichuan, China. A total of 73 fourth and fifth graders were tested for visual acuity using a standard eye chart and were then tested for refractive error and heterophoria using 2 smartphone apps (a refraction app and a strabismus app, respectively) by nonprofessional personnel. Results: A total of 5 of 73 (6.8%, 95% CI 2.3%-15.3%) students were found to have visual acuity worse than 20/20 (logarithm of minimal angle of resolution [logMAR] 0) in at least one eye. Among the 5 students, 3 primarily had refractive error according to the refraction app. The other 2 students had manifest strabismus (one with 72–prism diopter [PD] esotropia and one with 33-PD exotropia) according to the strabismus app. Students without manifest strabismus were also measured for phoria using the strabismus app in cover/uncover mode. The median phoria was 0.0-PD (IQR 2.9-PD esophoria to 2.2-PD exophoria). Conclusions: The results from this vision screening study are consistent with findings from other population-based vision screening studies in which conventional tools were used by ophthalmic professionals. The smartphone apps are promising and have the potential to be used in mass vision screenings for identifying risk factors for amblyopia and for myopia control. The smartphone apps may have significant implications for the future of low-cost vision care, particularly in resource-constrained and geographically remote areas. %M 38573757 %R 10.2196/55270 %U https://formative.jmir.org/2024/1/e55270 %U https://doi.org/10.2196/55270 %U http://www.ncbi.nlm.nih.gov/pubmed/38573757 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56206 %T Evaluating the User Experience of a Smartphone-Delivered Sexual Health Promotion Program for Older Adults in the Netherlands: Single-Arm Pilot Study %A Correia de Barros,Ana %A Bergmans,Mariëtte %A Hasanaj,Kreshnik %A Krasniqi,Drianë %A Nóbrega,Catarina %A Carvalho Carneiro,Bruna %A Vasconcelos,Priscila A %A Quinta-Gomes,Ana Luísa %A Nobre,Pedro J %A Couto da Silva,Joana %A Mendes-Santos,Cristina %+ Fraunhofer Portugal AICOS, Rua Alfredo Allen, 455, Porto, 4200-135, Portugal, 351 220430306, ana.barros@fraunhofer.pt %K internet interventions %K mobile health %K mHealth %K older adults %K sexual health %K smartphone %K user experience %K pilot study %K mobile phone %D 2024 %7 3.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Sexual health is an important component of quality of life in older adults. However, older adults often face barriers to attaining a fulfilling sexual life because of issues such as stigma, lack of information, or difficult access to adequate support. Objective: We aimed to evaluate the user experience of a self-guided, smartphone-delivered program to promote sexual health among older adults. Methods: The mobile app was made available to community-dwelling older adults in the Netherlands, who freely used the app for 8 weeks. User experience and its respective components were assessed using self-developed questionnaires, the System Usability Scale, and semistructured interviews. Quantitative and qualitative data were descriptively and thematically analyzed, respectively. Results: In total, 15 participants (mean age 71.7, SD 9.5 years) completed the trial. Participants showed a neutral to positive stance regarding the mobile app’s usefulness and ease of use. Usability was assessed as “Ok/Fair.” The participants felt confident about using the mobile app. To increase user experience, participants offered suggestions to improve content and interaction, including access to specialized sexual health services. Conclusions: The sexual health promotion program delivered through a smartphone in a self-guided mode was usable. Participants’ perception is that improvements to user experience, namely in content and interaction, as well as connection to external services, will likely improve usefulness and acceptance. %M 38568726 %R 10.2196/56206 %U https://humanfactors.jmir.org/2024/1/e56206 %U https://doi.org/10.2196/56206 %U http://www.ncbi.nlm.nih.gov/pubmed/38568726 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50850 %T Web-Based Emotion Regulation Training for Sexual Health: Randomized Controlled Trial %A Jobim Fischer,Vinicius %A Rossato Holz,Maila %A Billieux,Joël %A Andersson,Gerhard %A Vögele,Claus %+ Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, 11, Porte des Sciences, Esch-sur-Alzette, L-4366, Luxembourg, 352 46 66 44 9740, viniciusjfischer@gmail.com %K emotion regulation %K internet %K sexual health %K FSFI %K randomized controlled trial %K intervention %K psychosexual intervention %K sexual disorder %K sexual dysfunction %K internet-based %D 2024 %7 3.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Effective emotional regulation (ER) skills are important for sexual function, as they impact emotional awareness and expression during sexual activity, and therefore, satisfaction and distress. Emotion regulation interventions may offer a promising approach to improve sexual health. Web-based emotion regulation may be a therapeutic strategy for men and women with sexual health concerns. Nevertheless, there is a scarcity of intervention trials investigating its effects in this context, much less using the internet. Objective: This study aims to investigate the effects of a web-based emotion regulation training program for sexual function in both men and women. Methods: The participants were recruited based on their self-reported sexual problems, which for men was defined by a score of <25 on the International Index Erectile Function (IIEF) and for women by a score of <26.55 on the Female Sexual Function Index (FSFI). The final sample included 60 participants who were randomized to either a web-based emotion regulation training for sexual function or to a waitlist control group. The treatment consisted of an 8-week web-based emotion regulation training for sexual function. The participants were assessed at baseline, post intervention, and the 3-month follow-up. Results: Of the 60 participants included, only 6 completed all 3 assessment points (n=5, 20% in the treatment group and n=1, 5% in the waitlist control group) after receiving the intervention. At follow-up, there were no significant differences between groups in any measure. Among the intervention completers, large-to-moderate within-group effect sizes were observed between the assessment points on measures of emotion regulation, depression, lubrication, orgasm, thoughts of sexual failure, and abuse during sexual activity. The adherence rate was very low, limiting the generalizability of the findings. Conclusions: Participants who completed the intervention showed improvements in both sexual function domains and emotion regulation. Nonetheless, due to a high dropout rate, this trial failed to collect sufficient data to allow for any conclusions to be drawn on treatment effects. Trial Registration: ClinicalTrials.gov NCT04792177; https://clinicaltrials.gov/study/NCT04792177 %M 38568720 %R 10.2196/50850 %U https://formative.jmir.org/2024/1/e50850 %U https://doi.org/10.2196/50850 %U http://www.ncbi.nlm.nih.gov/pubmed/38568720 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e56083 %T The Association of Macronutrient Consumption and BMI to Exhaled Carbon Dioxide in Lumen Users: Retrospective Real-World Study %A Yeshurun,Shlomo %A Cramer,Tomer %A Souroujon,Daniel %A Mor,Merav %+ Metaflow Ltd, HaArba’a St 30, Tel-Aviv, 6473926, Israel, 972 37684062, shlomoyesh@gmail.com %K app %K applications %K association %K BMI %K body mass index %K carbohydrate %K carbon dioxide %K consumption %K correlate %K correlation %K diet %K dietary %K exhalation %K exhale %K food %K Lumen %K macronutrient %K meal %K metabolic flexibility %K metabolic %K metabolism %K mHealth %K mobile health %K nutrient %K nutrition %K nutritional %K obese %K obesity %K postprandial %K prandial %K retrospective %K weight %D 2024 %7 1.4.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Metabolic flexibility is the ability of the body to rapidly switch between fuel sources based on their accessibility and metabolic requirements. High metabolic flexibility is associated with improved health outcomes and a reduced risk of several metabolic disorders. Metabolic flexibility can be improved through lifestyle changes, such as increasing physical activity and eating a balanced macronutrient diet. Lumen is a small handheld device that measures metabolic fuel usage through exhaled carbon dioxide (CO2), which allows individuals to monitor their metabolic flexibility and make lifestyle changes to enhance it. Objective: This retrospective study aims to examine the postprandial CO2 response to meals logged by Lumen users and its relationship with macronutrient intake and BMI. Methods: We analyzed deidentified data from 2607 Lumen users who logged their meals and measured their exhaled CO2 before and after those meals between May 1, 2023, and October 18, 2023. A linear mixed model was fitted to test the association between macronutrient consumption, BMI, age, and gender to the postprandial CO2 response, followed by a 2-way ANOVA. Results: The model demonstrated significant associations (P<.001) between CO2 response after meals and both BMI and carbohydrate intake (BMI: β=–0.112, 95% CI –0.156 to –0.069; carbohydrates: β=0.046, 95% CI 0.034-0.058). In addition, a 2-way ANOVA revealed that higher carbohydrate intake resulted in a higher CO2 response compared to low carbohydrate intake (F2,2569=24.23; P<.001), and users with high BMI showed modest responses to meals compared with low BMI (F2,2569=5.88; P=.003). Conclusions: In this study, we show that Lumen’s CO2 response is influenced both by macronutrient consumption and BMI. The results of this study highlight a distinct pattern of reduced metabolic flexibility in users with obesity, indicating the value of Lumen for assessing postprandial metabolic flexibility. %M 38439744 %R 10.2196/56083 %U https://mhealth.jmir.org/2024/1/e56083 %U https://doi.org/10.2196/56083 %U http://www.ncbi.nlm.nih.gov/pubmed/38439744 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49921 %T The Influence of Joe Wicks on Physical Activity During the COVID-19 Pandemic: Thematic, Location, and Social Network Analysis of X Data %A Ahmed,Wasim %A Aiyenitaju,Opeoluwa %A Chadwick,Simon %A Hardey,Mariann %A Fenton,Alex %+ Management School, University of Stirling, Airthrey Road, Stirling, FK9 4LA, United Kingdom, 44 1482 346311, w.ahmed@hull.ac.uk %K social media %K social network analysis %K COVID-19 %K influencers %K public health %K social network %K physical activity %K promotion %K fitness %K exercise %K workout %K Twitter %K content creation %K communication %D 2024 %7 29.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background:  Social media (SM) was essential in promoting physical activity during the COVID-19 pandemic, especially among people confined to their homes. Joe Wicks, a fitness coach, became particularly popular on SM during this time, posting daily workouts that millions of people worldwide followed. Objective:  This study aims to investigate the influence of Joe Wicks on SM and the impact of his content on physical activity levels among the public. Methods:  We used NodeXL Pro (Social Media Research Foundation) to collect data from X (formerly Twitter) over 54 days (March 23, 2020, to May 15, 2020), corresponding to the strictest lockdowns in the United Kingdom. We collected 290,649 posts, which we analyzed using social network analysis, thematic analysis, time-series analysis, and location analysis. Results:  We found that there was significant engagement with content generated by Wicks, including reposts, likes, and comments. The most common types of posts were those that contained images, videos, and text of young people (school-aged children) undertaking physical activity by watching content created by Joe Wicks and posts from schools encouraging pupils to engage with the content. Other shared posts included those that encouraged others to join the fitness classes run by Wicks and those that contained general commentary. We also found that Wicks’ network of influence was extensive and complex. It contained numerous subcommunities and resembled a broadcast network shape. Other influencers added to engagement with Wicks via their networks. Our results show that influencers can create networks of influence that are exhibited in distinctive ways. Conclusions: Our study found that Joe Wicks was a highly influential figure on SM during the COVID-19 pandemic and that his content positively impacted physical activity levels among the public. Our findings suggest that influencers can play an important role in promoting public health and that government officials should consider working with influencers to communicate health messages and promote healthy behaviors. Our study has broader implications beyond the status of fitness influencers. Recognizing the critical role of individuals such as Joe Wicks in terms of health capital should be a critical area of inquiry for governments, public health authorities, and policy makers and mirrors the growing interest in health capital as part of embodied and digital experiences in everyday life. %M 38551627 %R 10.2196/49921 %U https://www.jmir.org/2024/1/e49921 %U https://doi.org/10.2196/49921 %U http://www.ncbi.nlm.nih.gov/pubmed/38551627 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48027 %T The Effectiveness of a Cell Phone eHealth App in Changing Knowledge, Stigmatizing Attitudes, and Intention to Seek Help Associated With Obsessive-Compulsive Disorder: Pilot Questionnaire Study %A Chaves,Antonio %A Arnáez,Sandra %A García-Soriano,Gemma %+ Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de València, Avda Blasco Ibáñez, 21, Valencia, 46010, Spain, 34 963983389, gemma.garcia@uv.es %K obsessive-compulsive disorder %K OCD %K mental health literacy %K stigma %K app %K help-seeking intention %K seek help %K mobile phone %D 2024 %7 29.3.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obsessive-compulsive disorder (OCD) is a disabling disorder associated with high interference in people’s lives. However, patients with OCD either do not seek help or delay seeking help. Research suggests that this could be explained by poor mental health literacy about the disorder and the associated stigma. Objective: This study aims to evaluate the feasibility, acceptability, and preliminary effectiveness of a mental health mobile app, esTOCma, developed to improve knowledge about OCD and its treatment, increase help-seeking intention, and reduce stigmatizing attitudes and social distance associated with OCD. Methods: We used preintervention, postintervention, and 3-month follow-up assessments in this single-arm pilot intervention. Overall, 90 participants were recruited from the community using the snowball sampling method. We used esTOCma to defeat the “stigma monster” over the course of 10 missions. The participants completed the sociodemographic information and Obsessive-Compulsive Inventory–Revised at preassessment and an acceptability questionnaire at postassessment. All other measures were completed at the preassessment, postassessment, and 3-month follow-up (ie, the Spanish Mental Illness Stigma Attribution Questionnaire–27, the General Help-Seeking Questionnaire, the Social Distance Scale, and the Mental Health Literacy Questionnaire). Results: Of the 90 participants from the community that were assessed for eligibility, 86% (n=78) were allocated to intervention. Of these 78 participants, 79% (n=62) completed the game and answered the postintervention assessment (completer group). Overall, 69% (43/62) of the participants also completed the 3-month follow-up assessment. The participants completing the study were older (P=.003) and had a higher baseline knowledge of OCD (P=.05). The participants took an average of 13.64 (SD 10.50) days to complete the intervention, including the pre- and postassessments. The participants spent an average of 4.56 (SD 3.33) days completing the 10 missions included in the app. Each mission took a mean of between 2 (SD 3.01) and 9.35 (SD 3.06) minutes. The app was rated as useful or very useful by the vast majority of participants 90% (56/62). Moreover, 90% (56/62) of the participants reported that they had learned or learned a lot, and 98% (61/62) of the participants reported that they would recommend the app to a friend. Repeated measures ANOVA (43/62, 69%) showed that after the intervention participants showed an increased knowledge of mental health and intention to seek help as well as fewer stigmatizing attitudes and less social distance. Conclusions: Preliminary data show that esTOCma is a feasible and acceptable app, and after completing its 10 missions, there is an increase in the understanding of OCD and help-seeking intention along with a decrease in the social stigma and social distance associated with OCD that lasts for at least 3 months. The results support the potential of technology-based interventions to increase the intention to seek help and reduce the stigma associated with OCD. A larger, community-controlled study is also recommended. %M 38551629 %R 10.2196/48027 %U https://mhealth.jmir.org/2024/1/e48027 %U https://doi.org/10.2196/48027 %U http://www.ncbi.nlm.nih.gov/pubmed/38551629 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56002 %T Preferences for mHealth Intervention to Address Mental Health Challenges Among Men Who Have Sex With Men in Nepal: Qualitative Study %A Gautam,Kamal %A Aguilar,Camille %A Paudel,Kiran %A Dhakal,Manisha %A Wickersham,Jeffrey A %A Acharya,Bibhav %A Sapkota,Sabitri %A Deuba,Keshab %A Shrestha,Roman %+ Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Storrs, CT, 06269, United States, 1 860 486 2834, roman.shrestha@uconn.edu %K mental health %K MSM %K mHealth %K smartphone apps %K digital health %K Nepal %K gay %K homosexual %K homosexuality %K men who have sex with men %K focus group %K focus groups %K qualitative %K barrier %K barriers %K thematic %K mHealth %K mobile health %K app %K apps %K applications %K applications %D 2024 %7 29.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Men who have sex with men (MSM) are disproportionately burdened by poor mental health. Despite the increasing burden, evidence-based interventions for MSM are largely nonexistent in Nepal. Objective: This study explored mental health concerns, contributing factors, barriers to mental health care and support, and preferred interventions to improve access to and use of mental health support services among MSM in Nepal. Methods: We conducted focus groups with MSM in Kathmandu, Nepal, in January 2023. In total, 28 participants took part in 5 focus group sessions. Participants discussed several topics related to the mental health issues they experienced, factors contributing to these issues, and their suggestions for potential interventions to address existing barriers. The discussions were recorded, transcribed, and analyzed using Dedoose (version 9.0.54; SocioCultural Research Consultants, LLC) software for thematic analysis. Results: Participants reported substantial mental health problems, including anxiety, depression, suicidal ideation, and behaviors. Contributing factors included family rejection, isolation, bullying, stigma, discrimination, and fear of HIV and other sexually transmitted infections. Barriers to accessing services included cost, lack of lesbian, gay, bisexual, transgender, intersex, queer, and asexual (LGBTIQA+)–friendly providers, and the stigma associated with mental health and sexuality. Participants suggested a smartphone app with features such as a mental health screening tool, digital consultation, helpline number, directory of LGBTIQA+-friendly providers, mental health resources, and a discussion forum for peer support as potential solutions. Participants emphasized the importance of privacy and confidentiality to ensure mobile apps are safe and accessible. Conclusions: The findings of this study have potential transferability to other low-resource settings facing similar challenges. Intervention developers can use these findings to design tailored mobile apps to facilitate mental health care delivery and support for MSM and other marginalized groups. %M 38551632 %R 10.2196/56002 %U https://humanfactors.jmir.org/2024/1/e56002 %U https://doi.org/10.2196/56002 %U http://www.ncbi.nlm.nih.gov/pubmed/38551632 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50330 %T Weight Gain Prevention Outcomes From a Pragmatic Digital Health Intervention With Community Health Center Patients: Randomized Controlled Trial %A Miller,Hailey N %A Gallis,John A %A Berger,Miriam B %A Askew,Sandy %A Egger,Joseph R %A Kay,Melissa C %A Finkelstein,Eric Andrew %A de Leon,Mia %A DeVries,Abigail %A Brewer,Ashley %A Holder,Marni Gwyther %A Bennett,Gary G %+ Duke Digital Health Science Center, Duke University, 417 Chapel Drive, Room 048, Campus Box 90086, Durham, NC, 27708, United States, 1 919 613 8398, miriam.berger@duke.edu %K weight gain prevention %K digital health %K pragmatic clinical trial %K primary care %K health disparities %K obesity %K obese %K prevalence %K weight management %K overweight %K intervention %D 2024 %7 28.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The prevalence of obesity and its associated comorbidities continue to rise in the United States. Populations who are uninsured and from racial and ethnic minority groups continue to be disproportionately affected. These populations also experience fewer clinically meaningful outcomes in most weight loss trials. Weight gain prevention presents a useful strategy for individuals who experience barriers to weight loss. Given the often-limited weight management resources available to patients in primary care settings serving vulnerable patients, evaluating interventions with pragmatic designs may help inform the design of comprehensive obesity care delivered in primary care. Objective: This study aims to evaluate the effectiveness of Balance, a 2-arm, 12-month pragmatic randomized controlled trial of a digital weight gain prevention intervention, delivered to patients receiving primary care within federally qualified community health centers. Methods: Balance was a 2-arm, 12-month pragmatic randomized controlled trial of a digital weight gain prevention intervention delivered to individuals who had a BMI of 25-40 kg/m2, spoke English or Spanish, and were receiving primary care within a network of federally qualified community health centers in North Carolina. The Balance intervention was designed to encourage behavioral changes that result in a slight energy deficit. Intervention participants received tailored goal setting and tracking, skills training, self-monitoring, and responsive health coaching from registered dietitians. Weight was measured at regular primary care visits and documented in the electronic health record. We compared the percentage of ≤3% weight gain in each arm at 24 months after randomization—our primary outcome—using individual empirical best linear unbiased predictors from the linear mixed-effects model. We used individual empirical best linear unbiased predictors from participants with at least 1 electronic health record weight documented within a 6-month window centered on the 24-month time point. Results: We randomized 443 participants, of which 223 (50.3%) participants were allocated to the intervention arm. At baseline, participants had a mean BMI of 32.6 kg/m2. Most participants were Latino or Hispanic (n=200, 45.1%) or non–Latino or Hispanic White (n=115, 26%). In total, 53% (n=235) of participants had at least 1 visit with weight measured in the primary time window. The intervention group had a higher proportion with ≤3% weight gain at 6 months (risk ratio=1.12, 95% CI 0.94-1.28; risk difference=9.5, 95% CI –4.5 to 16.4 percentage points). This difference attenuated to the null by 24 months (risk ratio=1.00, 95% CI 0.82-1.20; risk difference=0.2, 95% CI –12.1 to 11.0 percentage points). Conclusions: In adults with overweight or obesity receiving primary care at a community health center, we did not find long-term evidence to support the dissemination of a digital health intervention for weight gain prevention. Trial Registration: ClinicalTrials.gov NCT03003403; https://clinicaltrials.gov/study/NCT03003403 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-6926-7 %M 38416574 %R 10.2196/50330 %U https://www.jmir.org/2024/1/e50330 %U https://doi.org/10.2196/50330 %U http://www.ncbi.nlm.nih.gov/pubmed/38416574 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e52763 %T Translating Suicide Safety Planning Components Into the Design of mHealth App Features: Systematic Review %A Gryglewicz,Kim %A Orr,Victoria L %A McNeil,Marissa J %A Taliaferro,Lindsay A %A Hines,Serenea %A Duffy,Taylor L %A Wisniewski,Pamela J %+ School of Social Work, University of Central Florida, 12805 Pegasus Drive HS I, Orlando, FL, 32816, United States, 1 14078232954, kgryglew@ucf.edu %K suicide prevention %K suicide safety planning %K mobile health %K mHealth apps %K eHealth %K digital health %K systematic review %K Preferred Reporting Items for Systematic Reviews and Meta-Analyses %K PRISMA %D 2024 %7 28.3.2024 %9 Review %J JMIR Ment Health %G English %X Background: Suicide safety planning is an evidence-based approach used to help individuals identify strategies to keep themselves safe during a mental health crisis. This study systematically reviewed the literature focused on mobile health (mHealth) suicide safety planning apps. Objective: This study aims to evaluate the extent to which apps integrated components of the safety planning intervention (SPI), and if so, how these safety planning components were integrated into the design-based features of the apps. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we systematically analyzed 14 peer-reviewed studies specific to mHealth apps for suicide safety planning. We conducted an analysis of the literature to evaluate how the apps incorporated SPI components and examined similarities and differences among the apps by conducting a comparative analysis of app features. An independent review of SPI components and app features was conducted by downloading the available apps. Results: Most of the mHealth apps (5/7, 71%) integrated SPI components and provided customizable features that expanded upon traditional paper-based safety planning processes. App design features were categorized into 5 themes, including interactive features, individualized user experiences, interface design, guidance and training, and privacy and sharing. All apps included access to community supports and revisable safety plans. Fewer mHealth apps (3/7, 43%) included interactive features, such as associating coping strategies with specific stressors. Most studies (10/14, 71%) examined the usability, feasibility, and acceptability of the safety planning mHealth apps. Usability findings were generally positive, as users often found these apps easy to use and visually appealing. In terms of feasibility, users preferred using mHealth apps during times of crisis, but the continuous use of the apps outside of crisis situations received less support. Few studies (4/14, 29%) examined the effectiveness of mHealth apps for suicide-related outcomes. Positive shifts in attitudes and desire to live, improved coping strategies, enhanced emotional stability, and a decrease in suicidal thoughts or self-harm behaviors were examined in these studies. Conclusions: Our study highlights the need for researchers, clinicians, and app designers to continue to work together to align evidence-based research on mHealth suicide safety planning apps with lessons learned for how to best deliver these technologies to end users. Our review brings to light mHealth suicide safety planning strategies needing further development and testing, such as lethal means guidance, collaborative safety planning, and the opportunity to embed more interactive features that leverage the advanced capabilities of technology to improve client outcomes as well as foster sustained user engagement beyond a crisis. Although preliminary evidence shows that these apps may help to mitigate suicide risk, clinical trials with larger sample sizes and more robust research designs are needed to validate their efficacy before the widespread adoption and use. %M 38546711 %R 10.2196/52763 %U https://mental.jmir.org/2024/1/e52763 %U https://doi.org/10.2196/52763 %U http://www.ncbi.nlm.nih.gov/pubmed/38546711 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e47699 %T The Journey of Engaging With Web-Based Self-Harm and Suicide Content: Longitudinal Qualitative Study %A Haime,Zoë %A Kennedy,Laura %A Grace,Lydia %A Cohen,Rachel %A Derges,Jane %A Biddle,Lucy %+ Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom, 44 01179289000, zoe.haime@bristol.ac.uk %K suicide %K self-harm %K online %K longitudinal %K qualitative %D 2024 %7 28.3.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Self-harm and suicide are major public health concerns worldwide, with attention focused on the web environment as a helpful or harmful influence. Longitudinal research on self-harm and suicide–related internet use is limited, highlighting a paucity of evidence on long-term patterns and effects of engaging with such content. Objective: This study explores the experiences of people engaging with self-harm or suicide content over a 6-month period. Methods: This study used qualitative and digital ethnographic methods longitudinally, including one-to-one interviews at 3 time points to explore individual narratives. A trajectory analysis approach involving 4 steps was used to interpret the data. Results: The findings from 14 participants established the web-based journey of people who engage with self-harm or suicide content. In total, 5 themes were identified: initial interactions with self-harm or suicide content, changes in what self-harm or suicide content people engage with and where, changes in experiences of self-harm or suicide behaviors associated with web-based self-harm or suicide content engagement, the disengagement-reengagement cycle, and future perspectives on web-based self-harm or suicide content engagement. Initial engagements were driven by participants seeking help, often when offline support had been unavailable. Some participants’ exposure to self-harm and suicide content led to their own self-harm and suicide behaviors, with varying patterns of change over time. Notably, disengagement from web-based self-harm and suicide spaces served as a protective measure for all participants, but the pull of familiar content resulted in only brief periods of disconnection. Participants also expressed future intentions to continue returning to these self-harm and suicide web-based spaces, acknowledging the nonlinear nature of their own recovery journey and aiming to support others in the community. Within the themes identified in this study, narratives revealed that participants’ behavior was shaped by cognitive flexibility and rigidity, metacognitive abilities, and digital expertise. Opportunities for behavior change arose during periods of cognitive flexibility prompted by life events, stressors, and shifts in mental health. Participants sought diverse and potentially harmful content during challenging times but moved toward recovery-oriented engagements in positive circumstances. Metacognitive and digital efficacy skills also played a pivotal role in participants’ control of web-based interactions, enabling more effective management of content or platforms or sites that posed potential harms. Conclusions: This study demonstrated the complexity of web-based interactions, with beneficial and harmful content intertwined. Participants who demonstrated metacognition and digital efficacy had better control over web-based engagements. Some attributed these skills to study processes, including taking part in reflective diaries, showing the potential of upskilling users. This study also highlighted how participants remained vulnerable by engaging with familiar web-based spaces, emphasizing the responsibility of web-based industry leaders to develop tools that empower users to enhance their web-based safety. %M 38546718 %R 10.2196/47699 %U https://infodemiology.jmir.org/2024/1/e47699 %U https://doi.org/10.2196/47699 %U http://www.ncbi.nlm.nih.gov/pubmed/38546718 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54287 %T Effectiveness of the Minder Mobile Mental Health and Substance Use Intervention for University Students: Randomized Controlled Trial %A Vereschagin,Melissa %A Wang,Angel Y %A Richardson,Chris G %A Xie,Hui %A Munthali,Richard J %A Hudec,Kristen L %A Leung,Calista %A Wojcik,Katharine D %A Munro,Lonna %A Halli,Priyanka %A Kessler,Ronald C %A Vigo,Daniel V %+ Department of Psychiatry, Faculty of Medicine, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T2A1, Canada, 1 6048228048, daniel.vigo@ubc.ca %K mental health %K substance use %K college students %K mobile interventions %K digital interventions %K randomized controlled trial %K mobile phone %D 2024 %7 27.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: University attendance represents a transition period for students that often coincides with the emergence of mental health and substance use challenges. Digital interventions have been identified as a promising means of supporting students due to their scalability, adaptability, and acceptability. Minder is a mental health and substance use mobile app that was codeveloped with university students. Objective: This study aims to examine the effectiveness of the Minder mobile app in improving mental health and substance use outcomes in a general population of university students. Methods: A 2-arm, parallel-assignment, single-blinded, 30-day randomized controlled trial was used to evaluate Minder using intention-to-treat analysis. In total, 1489 participants were recruited and randomly assigned to the intervention (n=743, 49.9%) or waitlist control (n=746, 50.1%) condition. The Minder app delivers evidence-based content through an automated chatbot and connects participants with services and university social groups. Participants are also assigned a trained peer coach to support them. The primary outcomes were measured through in-app self-assessments and included changes in general anxiety symptomology, depressive symptomology, and alcohol consumption risk measured using the 7-item General Anxiety Disorder scale, 9-item Patient Health Questionnaire, and US Alcohol Use Disorders Identification Test–Consumption Scale, respectively, from baseline to 30-day follow-up. Secondary outcomes included measures related to changes in the frequency of substance use (cannabis, alcohol, opioids, and nonmedical stimulants) and mental well-being. Generalized linear mixed-effects models were used to examine each outcome. Results: In total, 79.3% (589/743) of participants in the intervention group and 83% (619/746) of participants in the control group completed the follow-up survey. The intervention group had significantly greater average reductions in anxiety symptoms measured using the 7-item General Anxiety Disorder scale (adjusted group mean difference=−0.85, 95% CI −1.27 to −0.42; P<.001; Cohen d=−0.17) and depressive symptoms measured using the 9-item Patient Health Questionnaire (adjusted group mean difference=−0.63, 95% CI −1.08 to −0.17; P=.007; Cohen d=−0.11). A reduction in the US Alcohol Use Disorders Identification Test–Consumption Scale score among intervention participants was also observed, but it was not significant (P=.23). Statistically significant differences in favor of the intervention group were found for mental well-being and reductions in the frequency of cannabis use and typical number of drinks consumed. A total of 77.1% (573/743) of participants in the intervention group accessed at least 1 app component during the study period. Conclusions: In a general population sample of university students, the Minder app was effective in reducing symptoms of anxiety and depression, with provisional support for increasing mental well-being and reducing the frequency of cannabis and alcohol use. These findings highlight the potential ability of e-tools focused on prevention and early intervention to be integrated into existing university systems to support students’ needs. Trial Registration: ClinicalTrials.gov NCT05606601; https://clinicaltrials.gov/ct2/show/NCT05606601 International Registered Report Identifier (IRRID): RR2-10.2196/49364 %M 38536225 %R 10.2196/54287 %U https://www.jmir.org/2024/1/e54287 %U https://doi.org/10.2196/54287 %U http://www.ncbi.nlm.nih.gov/pubmed/38536225 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56324 %T Effects of Electronic Nicotine Delivery Systems Substitution on Body Weight Status: Protocol for a Systematic Review and Meta-Analysis %A La Rosa,Giusy Rita Maria %A Qureshi,Maria Ahmed %A Frittitta,Lucia %A Anastasi,Erika %A Polosa,Riccardo %+ Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia, 89, Catania, 95123, Italy, 39 095 4781124, g_larosa92@live.it %K Electronic Nicotine Delivery Systems %K body weight %K smoking cessation %K tobacco harm reduction %K systematic review %K meta-analysis %D 2024 %7 26.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Weight gain following smoking cessation is a well-documented concern, often attributed to the absence of nicotine’s metabolic influence. The adoption of Electronic Nicotine Delivery Systems (ENDS) has been used to achieve smoking cessation, with claims of aiding weight control. However, existing reviews present conflicting conclusions on ENDS’ impact on weight status, necessitating a rigorous evaluation. Objective: We aim to conduct a systematic review with meta-analysis to assess the actual impact of ENDS on weight status in individuals who have ceased or reduced conventional smoking. The primary goal is to provide clinicians with evidence-based insights into the potential effects of ENDS use as a smoking substitute on weight control. Methods: Adhering to PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines, our systematic review will analyze randomized and nonrandomized controlled trials, clinical trials (quasi-experimental), and prospective or retrospective cohort studies on the weight status effects of ENDS among individuals who have either quit or reduced smoking. Searches will include PubMed, Scopus, and Cochrane Library, covering the period from 2010 to January 2024. A gray literature search and supplementary searches will be performed. Data will be extracted independently by 2 reviewers and quality assessments will be conducted concurrently. Quality assessments will use Joanna Briggs Institute tools, 2020 version, along with bias assessments for internal validity and reporting bias based on the Catalogue of Bias. The included studies will be examined for any internal data reporting discrepancies by using Puljak’s checklist. Meta-analysis and subgroup analyses (ie, general ENDS usage, ENDS use coupled with a reduction in smoking exceeding 50%, and exclusive ENDS use for achieving smoking cessation) are planned. Certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Results: The protocol has been registered in PROSPERO (CRD42023494974) and the entire systematic review is expected to be completed by April 2024. The main goal of this review is to retrieve all current human research studies investigating the influence of ENDS on weight management among individuals who have quit or reduced smoking. Furthermore, the review will assess the quality of these studies and examine potential biases to identify the most dependable evidence available. Dissemination strategies will include traditional journal publications, social media announcements, and a white paper. The latter, available for download and distributed at conferences, aims to reach a broad audience, including clinicians and ENDS users. Conclusions: The review will address the importance of informing health care professionals and patients about the current and robust evidence regarding the effects of transitioning to ENDS for smoking cessation on weight status. Trial Registration: PROSPERO CRD42023494974; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=494974 International Registered Report Identifier (IRRID): PRR1-10.2196/56324 %M 38530329 %R 10.2196/56324 %U https://www.researchprotocols.org/2024/1/e56324 %U https://doi.org/10.2196/56324 %U http://www.ncbi.nlm.nih.gov/pubmed/38530329 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55517 %T Community Members’ Perceptions of a Resource-Rich Well-Being Website in California During the COVID-19 Pandemic: Qualitative Thematic Analysis %A Heilemann,MarySue V %A Lai,Jianchao %A Cadiz,Madonna P %A Meza,Jocelyn I %A Flores Romero,Daniela %A Wells,Kenneth B %+ School of Nursing, University of California, Los Angeles, 700 Tiverton Avenue, Box 956919, Los Angeles, CA, 90095-6919, United States, 1 310 206 4735, mheilema@sonnet.ucla.edu %K adaptation %K humans %K pandemics %K mental health %K COVID-19 %K health resources %K California %K psychological %K stigma %K digital %K prevention %K public health %K emotions %K website %K qualitative research %D 2024 %7 25.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To address needs for emotional well-being resources for Californians during the COVID-19 pandemic, the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website was developed in collaboration with multiple community partners across California, funded by the California Department of Health Care Services Behavioral Health Division federal emergency response. Objective: This qualitative study was designed to explore and describe the perspectives of participants affiliated with California organizations on the T4W/Juntos website, understand their needs for web-based emotional health resources, and inform iterative website development. Methods: After providing informed consent and reviewing the website, telephone interviews were conducted with 29 participants (n=21, 72% in English and n=8, 28% in Spanish) recruited by partnering community agencies (October 2021-February 2022). A 6-phase thematic analysis was conducted, enhanced using grounded theory techniques. The investigators wrote reflexive memos and performed line-by-line coding of 12 transcripts. Comparative analyses led to the identification of 15 overarching codes. The ATLAS.ti Web software (ATLAS.ti Scientific Software Development GmbH) was used to mark all 29 transcripts using these codes. After examining the data grouped by codes, comparative analyses led to the identification of main themes, each with a central organizing concept. Results: Four main themes were identified: (1) having to change my coping due to the pandemic, (2) confronting a context of shifting perceptions of mental health stigma among diverse groups, (3) “Feels like home”—experiencing a sense of inclusivity and belonging in T4W/Juntos, and (4) “It’s a one-stop-shop”—judging T4W/Juntos to be a desirable and useful website. Overall, the T4W/Juntos website communicated support and community to this sample during the pandemic. Participants shared suggestions for website improvement, including adding a back button and a drop-down menu to improve functionality as well as resources tailored to the needs of groups such as older adults; adolescents; the lesbian, gay, bisexual, transgender, and queer community; police officers; and veterans. Conclusions: The qualitative findings from telephone interviews with this sample of community members and service providers in California suggest that, during the COVID-19 pandemic, the T4W/Juntos website was well received as a useful, accessible tool, with some concerns noted such as language sometimes being too “professional” or “clinical.” The look, feel, and content of the website were described as welcoming due to pictures, animations, and videos that showcased resources in a personal, colorful, and inviting way. Furthermore, the content was perceived as lacking the stigma typically attached to mental health, reflecting the commitment of the T4W/Juntos team. Unique features and diverse resources, including multiple languages, made the T4W/Juntos website a valuable resource, potentially informing dissemination. Future efforts to develop mental health websites should consider engaging a diverse sample of potential users to understand how to tailor messages to specific communities and help reduce stigma. %M 38526558 %R 10.2196/55517 %U https://formative.jmir.org/2024/1/e55517 %U https://doi.org/10.2196/55517 %U http://www.ncbi.nlm.nih.gov/pubmed/38526558 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53294 %T Understanding Heterogeneity in Individual Responses to Digital Lifestyle Intervention Through Self-Monitoring Adherence Trajectories in Adults With Overweight or Obesity: Secondary Analysis of a 6-Month Randomized Controlled Trial %A Li,Shiyu %A Du,Yan %A Miao,Hongyu %A Sharma,Kumar %A Li,Chengdong %A Yin,Zenong %A Brimhall,Bradley %A Wang,Jing %+ College of Nursing, Florida State University, Vivian M Duxbury Hall, 98 Varsity Way, Tallahassee, FL, 31306, United States, 1 850 644 3299, jingwang@nursing.fsu.edu %K self-monitoring %K adherence %K weight loss %K digital technology %K behavior change %K group-based trajectory modeling %K precision health %K mobile phone %D 2024 %7 20.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Achieving clinically significant weight loss through lifestyle interventions for obesity management is challenging for most individuals. Improving intervention effectiveness involves early identification of intervention nonresponders and providing them with timely, tailored interventions. Early and frequent self-monitoring (SM) adherence predicts later weight loss success, making it a potential indicator for identifying nonresponders in the initial phase. Objective: This study aims to identify clinically meaningful participant subgroups based on longitudinal adherence to SM of diet, activity, and weight over 6 months as well as psychological predictors of participant subgroups from a self-determination theory (SDT) perspective. Methods: This was a secondary data analysis of a 6-month digital lifestyle intervention for adults with overweight or obesity. The participants were instructed to perform daily SM on 3 targets: diet, activity, and weight. Data from 50 participants (mean age: 53.0, SD 12.6 y) were analyzed. Group-based multitrajectory modeling was performed to identify subgroups with distinct trajectories of SM adherence across the 3 SM targets. Differences between subgroups were examined for changes in clinical outcomes (ie, body weight, hemoglobin A1c) and SDT constructs (ie, eating-related autonomous motivation and perceived competence for diet) over 6 months using linear mixed models. Results: Two distinct SM trajectory subgroups emerged: the Lower SM group (21/50, 42%), characterized by all-around low and rapidly declining SM, and the Higher SM group (29/50, 58%), characterized by moderate and declining diet and weight SM with high activity SM. Since week 2, participants in the Lower SM group exhibited significantly lower levels of diet (P=.003), activity (P=.002), and weight SM (P=.02) compared with the Higher SM group. In terms of clinical outcomes, the Higher SM group achieved a significant reduction in body weight (estimate: −6.06, SD 0.87 kg; P<.001) and hemoglobin A1c (estimate: −0.38, SD 0.11%; P=.02), whereas the Lower SM group exhibited no improvements. For SDT constructs, both groups maintained high levels of autonomous motivation for over 6 months. However, the Lower SM group experienced a significant decline in perceived competence (P=.005) compared with the Higher SM group, which maintained a high level of perceived competence throughout the intervention (P=.09). Conclusions: The presence of the Lower SM group highlights the value of using longitudinal SM adherence trajectories as an intervention response indicator. Future adaptive trials should identify nonresponders within the initial 2 weeks based on their SM adherence and integrate intervention strategies to enhance perceived competence in diet to benefit nonresponders. Trial Registration: ClinicalTrials.gov NCT05071287; https://clinicaltrials.gov/study/NCT05071287 International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2022.106845 %M 38506903 %R 10.2196/53294 %U https://www.jmir.org/2024/1/e53294 %U https://doi.org/10.2196/53294 %U http://www.ncbi.nlm.nih.gov/pubmed/38506903 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49857 %T An Ecological Mobile Momentary Intervention to Support Dynamic Goal Pursuit: Feasibility and Acceptability Study %A O'Driscoll,Ciarán %A Singh,Aneesha %A Chichua,Iya %A Clodic,Joachim %A Desai,Anjali %A Nikolova,Dara %A Yap,Alex Jie %A Zhou,Irene %A Pilling,Stephen %+ CORE Data Lab, Centre for Outcomes Research and Effectiveness, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 207679 1897, c.odriscoll@ucl.ac.uk %K goal pursuit %K ecological momentary intervention %K ecological momentary assessment %K mood %K dynamics %K network analysis %K MCII %K COM-B %K support %K pilot study %K training %K feasibility %K acceptability %K self-monitoring %K implementation %K psychological %K effectiveness %D 2024 %7 20.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals can experience difficulties pursuing their goals amid multiple competing priorities in their environment. Effective goal dynamics require flexible and generalizable pursuit skills. Supporting successful goal pursuit requires a perpetually adapting intervention responsive to internal states. Objective: The purpose of this study was to (1) develop a flexible intervention that can adapt to an individual’s changing short to medium-term goals and be applied to their daily life and (2) examine the feasibility and acceptability of the just-in-time adaptive intervention for goal pursuit. Methods: This study involved 3 iterations to test and systematically enhance all aspects of the intervention. During the pilot phase, 73 participants engaged in an ecological momentary assessment (EMA) over 1 month. After week 1, they attended an intervention training session and received just-in-time intervention prompts during the following 3 weeks. The training employed the Capability, Opportunity, Motivation, and Behavior (COM-B) framework for goal setting, along with mental contrasting with implementation intentions (MCII). Subsequent prompts, triggered by variability in goal pursuit, guided the participants to engage in MCII in relation to their current goal. We evaluated feasibility and acceptability, efficacy, and individual change processes by combining intensive (single-case experimental design) and extensive methods. Results: The results suggest that the digital intervention was feasible and acceptable to participants. Compliance with the intervention was high (n=63, 86%). The participants endorsed high acceptability ratings relating to both the study procedures and the intervention. All participants (N=73, 100%) demonstrated significant improvements in goal pursuit with an average difference of 0.495 units in the outcome (P<.001). The results of the dynamic network modeling suggest that self-monitoring behavior (EMA) and implementing the MCII strategy may aid in goal reprioritization, where goal pursuit itself is a driver of further goal pursuit. Conclusions: This pilot study demonstrated the feasibility and acceptability of a just-in-time adaptive intervention among a nonclinical adult sample. This intervention used self-monitoring of behavior, the COM-B framework, and MCII strategies to improve dynamic goal pursuit. It was delivered via an Ecological Momentary Intervention (EMI) procedure. Future research should consider the utility of this approach as an additional intervention element within psychological interventions to improve goal pursuit. Sustaining goal pursuit throughout interventions is central to their effectiveness and warrants further evaluation. %M 38506904 %R 10.2196/49857 %U https://formative.jmir.org/2024/1/e49857 %U https://doi.org/10.2196/49857 %U http://www.ncbi.nlm.nih.gov/pubmed/38506904 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53651 %T The Use of Mobile Technologies to Promote Physical Activity and Reduce Sedentary Behaviors in the Middle East and North Africa Region: Systematic Review and Meta-Analysis %A Tong,Huong Ly %A Alnasser,Aroub %A Alshahrani,Najim Z %A Bawaked,Rowaedh A %A AlAhmed,Reem %A Alsukait,Reem F %A Rakic,Severin %A Cetinkaya,Volkan %A Al-Hazzaa,Hazzaa M %A Alqahtani,Saleh A %+ Cultural and Indigenous Research Centre Australia, 16 Eveleight St, Redfern, 2016, Australia, 61 28585 ext 1311, lytong.2208@gmail.com %K mobile apps %K fitness trackers %K SMS %K SMS text messaging %K physical activity %K exercise %K sedentary behavior %K Middle East %K Africa, Northern %K movement %K physical inactivity %K smartphone %K mobile phone %K mobile health %K mHealth %K digital health %K behavior change %K intervention %D 2024 %7 19.3.2024 %9 Review %J J Med Internet Res %G English %X Background: The Middle East and North Africa (MENA) region faces unique challenges in promoting physical activity and reducing sedentary behaviors, as the prevalence of insufficient physical activity is higher than the global average. Mobile technologies present a promising approach to delivering behavioral interventions; however, little is known about the effectiveness and user perspectives on these technologies in the MENA region. Objective: This study aims to evaluate the effectiveness of mobile interventions targeting physical activity and sedentary behaviors in the MENA region and explore users’ perspectives on these interventions as well as any other outcomes that might influence users’ adoption and use of mobile technologies (eg, appropriateness and cultural fit). Methods: A systematic search of 5 databases (MEDLINE, Embase, CINAHL, Scopus, and Global Index Medicus) was performed. Any primary studies (participants of all ages regardless of medical condition) conducted in the MENA region that investigated the use of mobile technologies and reported any measures of physical activity, sedentary behaviors, or user perceptions were included. We conducted a narrative synthesis of all studies and a meta-analysis of randomized controlled trials (RCTs). The Cochrane risk-of-bias tool was used to assess the quality of the included RCTs; quality assessment of the rest of the included studies was completed using the relevant Joanna Briggs Institute critical appraisal tools. Results: In total, 27 articles describing 22 interventions (n=10, 37% RCTs) and 4 (15%) nonexperimental studies were included (n=6141, 46% women). Half (11/22, 50%) of the interventions included mobile apps, whereas the other half examined SMS. The main app functions were goal setting and self-monitoring of activity, whereas SMS interventions were primarily used to deliver educational content. Users in experimental studies described several benefits of the interventions (eg, gaining knowledge and receiving reminders to be active). Engagement with the interventions was poorly reported; few studies (8/27, 30%) examined users’ perspectives on the appropriateness or cultural fit of the interventions. Nonexperimental studies examined users’ perspectives on mobile apps and fitness trackers, reporting several barriers to their use, such as perceived lack of usefulness, loss of interest, and technical issues. The meta-analysis of RCTs showed a positive effect of mobile interventions on physical activity outcomes (standardized mean difference=0.45, 95% CI 0.17-0.73); several sensitivity analyses showed similar results. The trim-and-fill method showed possible publication bias. Only 20% (2/10) of the RCTs measured sedentary behaviors; both reported positive changes. Conclusions: The use of mobile interventions for physical activity and sedentary behaviors in the MENA region is in its early stages, with preliminary evidence of effectiveness. Policy makers and researchers should invest in high-quality studies to evaluate long-term effectiveness, intervention engagement, and implementation outcomes, which can inform the design of culturally and socially appropriate interventions for countries in the MENA region. Trial Registration: PROSPERO CRD42023392699; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=392699 %M 38502160 %R 10.2196/53651 %U https://www.jmir.org/2024/1/e53651 %U https://doi.org/10.2196/53651 %U http://www.ncbi.nlm.nih.gov/pubmed/38502160 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50506 %T Association of Digital Engagement With Relaxation Tools and Stress Level Reduction: Retrospective Cohort Study %A Breuer-Asher,Inbar %A Ritholz,Marilyn D %A Horwitz,David L %A Manejwala,Omar %A Behar,Ephraim %A Fundoiano-Hershcovitz,Yifat %+ DarioHealth, Ofek 8, 5 Tarshish Street, Caesarea, 3079821, Israel, 972 525296979, yifat@dariohealth.com %K mental health %K perceived stress %K stress reduction %K digital health %K video sessions %K behavioral health %K relaxation %K breathing exercises %K CBT %K anxiety %K cognitive behavioral therapy %D 2024 %7 19.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Stress is an emotional response caused by external triggers and is a high-prevalence global problem affecting mental and physical health. Several different digital therapeutic solutions are effective for stress management. However, there is limited understanding of the association between relaxation components and stress levels when using a digital app. Objective: This study investigated the contribution of relaxation tools to stress levels over time. We hypothesized that participation in breathing exercises and cognitive behavioral therapy–based video sessions would be associated with a reduction in stress levels. We also hypothesized a significant reduction specifically in participants’ perceived sense of burden and lack of productivity when engaged with breathing exercises and video sessions. Methods: Stress levels were evaluated in a real-world data cohort using a behavioral health app for digital intervention and monitoring change. This retrospective real-world analysis of users on a mobile platform–based treatment followed users (N=490) who started with moderate and above levels of stress and completed at least 2 stress assessments. The levels of stress were tracked throughout the first 10 weeks. A piecewise mixed effects model was applied to model the trajectories of weekly stress mean scores in 2 time segments (1-6 weeks and 6-10 weeks). Next, a simple slope analysis was used for interpreting interactions probing the moderators: breathing exercises and video sessions. Piecewise mixed-effects models were also used to model the trajectories of specific perceived stress item rates in the stress questionnaire in the 2 segments (1-6 weeks and 6-10 weeks) and whether they are moderated by the relaxation engagements. Simple slope analysis was also used here for the interpretation of the interactions. Results: Analysis revealed a significant decrease in stress symptoms (β=–.25; 95% CI –0.32 to –0.17; P<.001) during the period of 1-6 weeks of app use that was maintained during the period of 6-10 weeks. Breathing exercises significantly moderated the reduction in stress symptoms during the period of 1-6 weeks (β=–.07; 95% CI –0.13 to –0.01; P=.03), while engagement in digital video sessions did not moderate stress scores. Engagement in digital video sessions, as well as breathing exercises, significantly moderated the reduction in perceived sense of burden and lack of productivity during weeks 1-6 and remained stable during weeks 6-10 on both items. Conclusions: This study sheds light on the association between stress level reduction and specific components of engagement in a digital health app, breathing exercises, and cognitive behavioral therapy–based video sessions. Our findings provide a basis for further investigation of current and moderating factors that contribute to the personalization of digital intervention. In addition, results may aid in developing a more comprehensive understanding of how digital intervention tools work for mental health and for whom they are most effective. %M 38502164 %R 10.2196/50506 %U https://formative.jmir.org/2024/1/e50506 %U https://doi.org/10.2196/50506 %U http://www.ncbi.nlm.nih.gov/pubmed/38502164 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55193 %T Examining Parent Mood, Feeding Context, and Feeding Goals as Predictors of Feeding Practices Used by Parents of Preschool Children With Avid Eating Behavior: Protocol for an Ecological Momentary Assessment Study %A Edwards,Katie %A Croker,Helen %A Farrow,Claire %A Haycraft,Emma %A Herle,Moritz %A Llewellyn,Clare %A Pickard,Abigail %A Blissett,Jacqueline %+ School of Psychology and Institute of Health and Neurodevelopment, Aston University, Aston Triangle, Birmingham, B4 7ET, United Kingdom, 44 121 204 3784, k.edwards4@aston.ac.uk %K ecological momentary assessment %K avid eating %K children’s eating behavior %K parental feeding practices %K feeding behaviour %K parent %K children %K eating behaviour %K obesity %K environmental factors %K observational study %K feeding %K United Kingdom %D 2024 %7 19.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: An avid eating behavior profile is characterized by a greater interest in food and a tendency to overeat in response to negative emotions. Parents use specific strategies to manage feeding interactions with children with avid eating behavior. While momentary and contextual factors, such as parental mood, have been found to influence parental feeding practices, there is a lack of research examining parents’ daily experiences of feeding children with avid eating behavior. Examining this is important because parental feeding practices are key levers in tailored interventions to support children’s healthy eating behavior. Objective: We aim to describe the ecological momentary assessment methods and procedures used in the APPETItE (Appetite in Preschoolers: Producing Evidence for Tailoring Interventions Effectively) project, which aims to examine how variation in parental mood, feeding goals, and the context of eating occasions affect the parental feeding practices used to manage feeding interactions with children with an avid eating behavior profile. Methods: Participants are primary caregivers from the APPETItE cohort who have a preschool-age child (aged 3-5 years) with an avid eating behavior profile. Caregivers complete a 10-day ecological momentary assessment period using signal- and event-contingent surveys to examine (1) mood and stress, (2) parental feeding goals, and (3) contextual factors as predictors of parental feeding practices. Results: Recruitment and data collection began in October 2023 and is expected to be completed by spring 2024. The data have a 3-level structure: repeated measurements (level 1) nested within days (level 2) nested within an individual (level 3). Thus, lag-dependent models will be conducted to test the main hypotheses. Conclusions: The findings from this study will provide an understanding of caregivers’ daily experiences of feeding preschool children with avid eating behavior, who are at greater risk for the development of obesity. Understanding the predictors of feeding practices at the moment they occur, and across various contexts, will inform the development of tailored resources to support caregivers in managing children’s avid eating behavior. International Registered Report Identifier (IRRID): DERR1-10.2196/55193 %M 38502178 %R 10.2196/55193 %U https://www.researchprotocols.org/2024/1/e55193 %U https://doi.org/10.2196/55193 %U http://www.ncbi.nlm.nih.gov/pubmed/38502178 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48050 %T Preliminary Efficacy of a Cognitive Behavioral Therapy–Based Smartphone App for Smoking Cessation in China: Randomized Controlled Pilot Trial %A Chen,Shanshan %A Tang,Jinsong %A Wu,Congyang %A Zhang,Ge %A Zhang,Jing %A Liao,Yanhui %+ Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, China, 86 18814898844, liaoyanhui@zju.edu.cn %K China %K cognitive behavioral therapy %K program acceptability %K randomized controlled trial %K smartphone app %K smoking cessation %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The overall prevalence of cigarette smokers in China is very high, and China’s total cigarette consumption makes up more than 40% of the world’s consumption. In view of the lack of smoking cessation services and social support in China and the effectiveness of mobile phone apps for quitting smoking in other countries, we carried out a smartphone app–based smoking cessation trial in China. Objective: This study aimed to evaluate the efficacy of a cognitive behavioral therapy (CBT)–based smoking cessation smartphone app among smokers seeking treatment in China. Methods: We conducted a randomized controlled, web-based pilot clinical trial in China between February 23 and June 27, 2021. Eligible participants were randomly assigned to the smoking cessation app intervention group or the control group in a ratio of 1:1. The intervention group received the CBT smoking cessation intervention using a smartphone app, and the control group received a “thank you” message. The intervention was 4 weeks long, and the patients were followed up for 4 weeks. The primary outcome was self-reported continuous smoking abstinence at week 4 after the quit date. The secondary outcomes included self-reported 7-day point prevalence of smoking abstinence; reduction of the number of cigarettes smoked per day at weeks 1, 2, 3, and 4; and program acceptability. Results: A total of 973 people were recruited to quit smoking, of whom 262 completed basic information, 56 were excluded, and 206 were randomized and included in the final analysis. There were 189 (91.7%) men and 17 (8.3%) women, with an average age of 34.46 (SD 7.53) years and an average daily smoking rate of 15.93 (SD 7.10) cigarettes/day. We found 30 (29.7%) of the 101 participants in the intervention group and 7 (6.7%) of the 105 participants in the control group reported continuous smoking cessation after the quit date at week 4 (odds ratio 5.92, 95% CI 3.78-9.26; P<.001). The 7-day point prevalence abstinence rate of the intervention group varied from 42.6% (43/101) to 46.5% (47/101) after 1, 2, 3, and 4 weeks, while the control group varied from 18.1% (19/105) to 26.7% (28/105). Compared to the control group, continued smokers consumed 1.5-3.0 fewer cigarettes per day in the intervention group. The overall program got positive user feedback with a high satisfaction rate (66/87, 76%) and an average Mobile Application Rating Scale user version score of 3.46. Conclusions: Our pilot study provided preliminary evidence that the CBT-based smoking cessation smartphone app led to improved smoking quit rates versus control in Chinese smokers. The study demonstrated the CBT-based smartphone app may be an effective and feasible digital treatment model to help smokers quit, which may improve smoking cessation service quality and accessibility in China. Trial Registration: ClinicalTrials.gov NCT04421170; https://clinicaltrials.gov/study/NCT04421170 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-041985 %M 38498030 %R 10.2196/48050 %U https://formative.jmir.org/2024/1/e48050 %U https://doi.org/10.2196/48050 %U http://www.ncbi.nlm.nih.gov/pubmed/38498030 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e45860 %T Lessons and Untapped Potential of Smartphone-Based Physical Activity Interventions for Mental Health: Narrative Review %A Bernstein,Emily E %A Wolfe,Emma C %A Huguenel,Brynn M %A Wilhelm,Sabine %+ Department of Psychology, University of Virginia, Gilmer Hall, 485 McCormick Road, Charlottesville, VA, 22903, United States, 1 3014665679, rpu3zk@virginia.edu %K smartphone %K digital health %K exercise %K physical activity %K mental health %K depression %K anxiety %K mobile phone %D 2024 %7 15.3.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Physical activity has well-known and broad health benefits, including antidepressive and anxiolytic effects. However, only approximately half of Americans meet even the minimum exercise recommendations. Individuals with anxiety, depression, or related conditions are even less likely to do so. With the advent of mobile sensors and phones, experts have quickly noted the utility of technology for the enhanced measurement of and intervention for physical activity. In addition to being more accessible than in-person approaches, technology-driven interventions may uniquely engage key mechanisms of behavior change such as self-awareness. Objective: This study aims to provide a narrative overview and specific recommendations for future research on smartphone-based physical activity interventions for psychological disorders or concerns. Methods: In this paper, we summarized early efforts to adapt and test smartphone-based or smartphone-supported physical activity interventions for mental health. The included articles described or reported smartphone-delivered or smartphone-supported interventions intended to increase physical activity or reduce sedentary behavior and included an emotional disorder, concern, or symptom as an outcome measure. We attempted to extract details regarding the intervention designs, trial designs, study populations, outcome measures, and inclusion of adaptations specifically for mental health. In taking a narrative lens, we drew attention to the type of work that has been done and used these exemplars to discuss key directions to build on. Results: To date, most studies have examined mental health outcomes as secondary or exploratory variables largely in the context of managing medical concerns (eg, cancer and diabetes). Few trials have recruited psychiatric populations or explicitly aimed to target psychiatric concerns. Consequently, although there are encouraging signals that smartphone-based physical activity interventions could be feasible, acceptable, and efficacious for individuals with mental illnesses, this remains an underexplored area. Conclusions: Promising avenues for tailoring validated smartphone-based interventions include adding psychoeducation (eg, the relationship between depression, physical activity, and inactivity), offering psychosocial treatment in parallel (eg, cognitive restructuring), and adding personalized coaching. To conclude, we offer specific recommendations for future research, treatment development, and implementation in this area, which remains open and promising for flexible, highly scalable support. %M 38488834 %R 10.2196/45860 %U https://mhealth.jmir.org/2024/1/e45860 %U https://doi.org/10.2196/45860 %U http://www.ncbi.nlm.nih.gov/pubmed/38488834 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e49808 %T A Mobile Health App to Support Home-Based Aerobic Exercise in Neuromuscular Diseases: Usability Study %A Veneman,Tim %A Koopman,Fieke Sophia %A Oorschot,Sander %A Koomen,Pien G %A Nollet,Frans %A Voorn,Eric L %+ Amsterdam University Medical Center location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 20 56 64421, e.l.voorn@amsterdamumc.nl %K neuromuscular disorders %K endurance training %K home-based exercise %K eHealth %K tele-rehabilitation %K app %K exercise %K aerobic exercise %K mhealth %K mobile app %K neuromuscular disease %K usability %D 2024 %7 15.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Home-based aerobic exercise in people with neuromuscular diseases (NMDs) has benefits compared to exercise in the hospital or a rehabilitation center because traveling is often cumbersome due to mobility limitations, and societal costs are lower. Barriers to home-based aerobic exercise include reduced possibilities for monitoring and lack of motivation. To overcome these and other barriers, we developed a mobile health app: Keep on training with ReVi (hereafter referred to as ReVi). Objective: We aimed to determine the usability of the ReVi app. Methods: Patients followed a 4-month, polarized, home-based aerobic exercise program on a cycle or rowing ergometer, with 2 low-intensity sessions and 1 high-intensity session per week supported by the ReVi app. The app collected training data, including heart rate and ratings of perceived exertion, provided real-time feedback on reaching target intensity zones, and enabled monitoring via an online dashboard. Physiotherapists instructed patients on how to use the ReVi app and supervised them during their training program. Patients and physiotherapists separately evaluated usability with self-developed questionnaires, including 9 questions on a 5-point Likert scale, covering the usability elements efficiency, effectiveness, and satisfaction. Results: Twenty-nine ambulatory adult patients (n=19 women; mean age 50.4, SD 14.2 years) with 11 different slowly progressive NMDs participated. Both patients and physiotherapists (n=10) reported that the app, in terms of its efficiency, was easy to use and had a rapid learning curve. Sixteen patients (55%) experienced 1 or more technical issue(s) during the course of the exercise program. In the context of effectiveness, 23 patients (81%) indicated that the app motivated them to complete the program and that it helped them to exercise within the target intensity zones. Most patients (n=19, 70%) and physiotherapists (n=6, 60%) were satisfied with the use of the app. The median attendance rate was 88% (IQR 63%-98%), with 76% (IQR 69%-82%) of time spent within the target intensity zones. Four adverse events were reported, 3 of which were resolved without discontinuation of the exercise program. Conclusions: The usability of the ReVi app was high, despite the technical issues that occurred. Further development of the app to resolve these issues is warranted before broader implementation into clinical practice. %M 38488838 %R 10.2196/49808 %U https://humanfactors.jmir.org/2024/1/e49808 %U https://doi.org/10.2196/49808 %U http://www.ncbi.nlm.nih.gov/pubmed/38488838 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53555 %T Characteristics of Users of a Digital Hypnotherapy Intervention for Hot Flashes: Retrospective Study %A Snyder,Morgan %A Elkins,Gary R %+ Department of Psychology and Neuroscience, Baylor University, One Bear Place 97334, Waco, TX, 76798, United States, 1 254 710 2961, gary_elkins@baylor.edu %K hypnotherapy %K hot flashes %K smartphone app %K mHealth %K mobile health %K app %K apps %K applications %K hypnosis %K menopause %K menopausal %K gynecology %K usage %K women's health %K user %K users %K demographics %K demographic %K characteristic %K characteristics %K mental health %K alternative %K complementary %K mind body %K hypnotism %D 2024 %7 14.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Hot flashes are associated with a lower quality of life and sleep disturbances. Given the many consequences of hot flashes, it is important to find treatments to reduce them. Hypnotherapy, the use of hypnosis for a medical disorder or concern, has been shown in clinical trials to be effective in reducing hot flashes, but it is not routinely used in clinical practice. One solution to close this implementation gap is to administer hypnotherapy for hot flashes via a smartphone app. Evia is a smartphone app that delivers hypnotherapy for hot flashes. Evia has made hypnotherapy more widely accessible for women who are experiencing hot flashes; however, the app has yet to undergo empirical testing. Additionally, research on user characteristics is lacking. Objective: This study aims to (1) determine the average age, stage of menopause, and length of menopause symptoms for users of the Evia app; (2) determine the characteristics of hot flashes and night sweats for users of the Evia app; (3) determine the self-reported sleep quality of users of the Evia app; (4) determine the self-reported mental health of users of the Evia app; and (5) determine the relationship between hot flash frequency and anxiety and depression for users of the Evia app. Methods: This study analyzed data collected from participants who have downloaded the Evia app. Data were collected at 1 time point from a self-report questionnaire that assessed the demographic and clinical characteristics of users. The questionnaire was given to users when they downloaded the Evia app. Users of the Evia app fill out a questionnaire upon enrolling in the program and prior to beginning the intervention. This included 9764 users. Results: Results showed that the mean age of users was 49.31 years. A total of 41.6% (1942/4665) of users reported experiencing 5 or more hot flashes per day, while 51.2% (1473/2877) of users reported having difficulty falling asleep each night and 47.7% (1253/2626) of users reported their sleep quality to be terrible. In addition, 38.4% (1104/2877) of users reported that they often feel anxious or depressed. There was a small, significant, and negative correlation between hot flash frequency and self-report frequency of anxiety and depression (r=–0.09). Conclusions: This study showed that the average age of app users is in line with the median age of natural menopause. A large percentage of users reported experiencing 5 or more hot flashes per day, reported difficulties with sleep, and reported experiencing depression and anxiety. These findings are in line with previous studies that assessed hot flash frequency and the consequences of hot flashes. This was the first study to report on the characteristics of users of the Evia app. Results will be used to optimize the hypnotherapy program delivered via the Evia app. %M 38483465 %R 10.2196/53555 %U https://formative.jmir.org/2024/1/e53555 %U https://doi.org/10.2196/53555 %U http://www.ncbi.nlm.nih.gov/pubmed/38483465 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e54163 %T Mobile App/Web Platform for Monitoring Food Oral Immunotherapy in Children: Longitudinal Clinical Validation Study %A Sánchez-Fernández,Sergio %A Lasa,Eva María %A Terrados,Soledad %A Sola-Martínez,Francisco Javier %A Martínez-Molina,Sara %A López de Calle,Marta %A Cabrera-Freitag,Paula %A Goikoetxea,María José %+ Allergy and Clinical Immunology Department, Clínica Universidad de Navarra, Pío XII, 36, Pamplona, 31008, Spain, 34 948255400, mjgoiko@unav.es %K adverse reactions %K egg allergy %K food oral immunotherapy %K mHealth %K milk allergy %K monitoring %D 2024 %7 13.3.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Milk and egg allergies significantly impact the quality of life, particularly in children. In this regard, food oral immunotherapy (OIT) has emerged as an effective treatment option; however, the occurrence of frequent adverse reactions poses a challenge, necessitating close monitoring during treatment. Objective: This study aims to evaluate the ability of a new mobile/web app called OITcontrol to monitor milk and egg OIT. Methods: Patients undergoing milk or egg OIT were recruited and divided into 2 groups: the active group used the OITcontrol app in conjunction with standard written monitoring methods, whereas the control group relied solely on written diaries. Investigators documented hospital doses, hospital reactions, and administered treatments on the website. Patients recorded their daily allergen home-dose intake, home reactions, and administered treatments using the app. The following variables were compared between both groups: number and severity of hospital and reported home reactions, patient’s adhesion to the OITcontrol app or written diary or both in terms of daily home-dose intake and home reactions recording, and treatment and dose adjustment compliance at home in case of reaction. Results: Sixteen patients were assigned to be monitored using the OITcontrol app along with additional written methods (active group), while 14 patients relied solely on a written paper diary (control group). A similar distribution was observed in terms of sex, age, basal characteristics, allergen treated in OIT, premedication, and sensitization profile. Active patients reported a comparable number of hospital and home reactions compared with the control group. In terms of recording system usage, 13/16 (81%) active patients used the OITcontrol app, while 10/14 (71%) control patients relied on the written diary. Among active patients, 6/16 (38%) used both methods, and 1 active patient used only written methods. However, control patients recorded home reactions more frequently than active patients (P=.009). Among active patients, the app was the preferred method for recording reactions (59/86, 69%), compared with the written diary (15/86, 17%) or both methods (12/86, 14%; P<.001). Treatment compliance in home-recorded reactions was similar between both groups (P=.15). However, treatment indications after an adverse reaction were more frequently followed (P=.04) in reactions recorded solely in the app (36/59, 61%) than in the written diary (29/71, 41%) or both systems (4/12, 33%). Moreover, compliance with dose adjustments after a moderate-severe reaction in home-recorded reactions was higher in the active group than in the control group (P<.001). Home reactions recorded only in the app (16/19, 84%) were more likely to follow dose adjustments (P<.001) than those recorded in the written diary (3/20, 15%) or using both methods (2/3, 67%). Conclusions: The OITcontrol app appears to be a valuable tool for monitoring OIT treatment in children with food allergies. It proves to be a suitable method for recording daily home dose intakes and reactions, and it seems to enhance adherence to treatment indications following an adverse reaction as well as compliance with dose adjustments in home reactions. However, additional studies are necessary to comprehensively grasp the benefits and limitations of using the OITcontrol app in the management of OIT. %M 38477961 %R 10.2196/54163 %U https://pediatrics.jmir.org/2024/1/e54163 %U https://doi.org/10.2196/54163 %U http://www.ncbi.nlm.nih.gov/pubmed/38477961 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50135 %T Feasibility Study on Menstrual Cycles With Fitbit Device (FEMFIT): Prospective Observational Cohort Study %A Lang,Anna-Lena %A Bruhn,Rosa-Lotta %A Fehling,Maya %A Heidenreich,Anouk %A Reisdorf,Jonathan %A Khanyaree,Ifrah %A Henningsen,Maike %A Remschmidt,Cornelius %+ Data4Life gGmbH, c/o Digital Health Cluster im Hasso-Plattner-Institut, Potsdam, 14482, Germany, 49 15756025551, annalena.lang.26@gmail.com %K women’s health %K menstrual cycle %K premenstrual syndrome %K PMS %K mobile app %K wearable device %K sensor data %K digital health %D 2024 %7 12.3.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite its importance to women’s reproductive health and its impact on women’s daily lives, the menstrual cycle, its regulation, and its impact on health remain poorly understood. As conventional clinical trials rely on infrequent in-person assessments, digital studies with wearable devices enable the collection of longitudinal subjective and objective measures. Objective: The study aims to explore the technical feasibility of collecting combined wearable and digital questionnaire data and its potential for gaining biological insights into the menstrual cycle. Methods: This prospective observational cohort study was conducted online over 12 weeks. A total of 42 cisgender women were recruited by their local gynecologist in Berlin, Germany, and given a Fitbit Inspire 2 device and access to a study app with digital questionnaires. Statistical analysis included descriptive statistics on user behavior and retention, as well as a comparative analysis of symptoms from the digital questionnaires with metrics from the sensor devices at different phases of the menstrual cycle. Results: The average time spent in the study was 63.3 (SD 33.0) days with 9 of the 42 individuals dropping out within 2 weeks of the start of the study. We collected partial data from 114 ovulatory cycles, encompassing 33 participants, and obtained complete data from a total of 50 cycles. Participants reported a total of 2468 symptoms in the daily questionnaires administered during the luteal phase and menses. Despite difficulties with data completeness, the combined questionnaire and sensor data collection was technically feasible and provided interesting biological insights. We observed an increased heart rate in the mid and end luteal phase compared with menses and participants with severe premenstrual syndrome walked substantially fewer steps (average daily steps 10,283, SD 6277) during the luteal phase and menses compared with participants with no or low premenstrual syndrome (mean 11,694, SD 6458). Conclusions: We demonstrate the feasibility of using an app-based approach to collect combined wearable device and questionnaire data on menstrual cycles. Dropouts in the early weeks of the study indicated that engagement efforts would need to be improved for larger studies. Despite the challenges of collecting wearable data on consecutive days, the data collected provided valuable biological insights, suggesting that the use of questionnaires in conjunction with wearable data may provide a more complete understanding of the menstrual cycle and its impact on daily life. The biological findings should motivate further research into understanding the relationship between the menstrual cycle and objective physiological measurements from sensor devices. %M 38470472 %R 10.2196/50135 %U https://mhealth.jmir.org/2024/1/e50135 %U https://doi.org/10.2196/50135 %U http://www.ncbi.nlm.nih.gov/pubmed/38470472 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e40406 %T Mobile-Delivered Mindfulness Intervention on Anxiety Level Among College Athletes: Randomized Controlled Trial %A Gao,Yu %A Shi,Lu %A Fu,Ning %A Yang,Nan %A Weeks-Gariepy,Tracy %A Mao,Yuping %+ Department of Health Science, Pace University, One Pace Plaza, New York, NY, 10038, United States, 1 (866) 722 3338, lshi@pace.edu %K anxiety %K athletes %K body %K calmness %K cognition %K college students %K college %K feasibility %K feedback %K intervention %K meditation %K mHealth %K mindfulness %K mobile %K participant %K positive %K program %K relaxation %K sleep %K students %D 2024 %7 8.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: College athletes are a group often affected by anxiety. Few interventional studies have been conducted to address the anxiety issues in this population. Objective: We conducted a mobile-delivered mindfulness intervention among college athletes to study its feasibility and efficacy in lowering their anxiety level and improving their mindfulness (measured by the Five Facet Mindfulness Questionnaire [FFMQ]). Methods: In April 2019, we recruited 290 college athletes from a public university in Shanghai, China, and 288 of them were randomized into an intervention group and a control group (closed trial), with the former (n=150) receiving a therapist-guided, smartphone-delivered mindfulness-based intervention and the latter receiving mental health promotion messages (n=138). We offered in-person instructions during the orientation session for the intervention group in a classroom, with the therapist interacting with the participants on the smartphone platform later during the intervention. We used generalized linear modeling and the intent-to-treat approach to compare the 2 groups' outcomes in dispositional anxiety, precompetition anxiety, and anxiety during competition, plus the 5 dimensions of mindfulness (measured by the FFMQ). Results: Our intent-to-treat analysis and generalized linear modeling found no significant difference in dispositional anxiety, precompetition anxiety, or anxiety during competition. Only the “observation” facet of mindfulness measures had a notable difference between the changes experienced by the 2 groups, whereby the intervention group had a net gain of .214 yet fell short of reaching statistical significance (P=.09). Participants who specialized in group sports had a higher level of anxiety (β=.19; SE=.08), a lower level of “nonjudgemental inner experience” in FFMQ (β=–.07; SE=.03), and a lower level of “nonreactivity” (β=–.138; SE=.052) than those specializing in individual sports. Conclusions: No significant reduction in anxiety was detected in this study. Based on the participant feedback, the time availability for mindfulness practice and session attendance for these student athletes in an elite college could have compromised the intervention’s effectiveness. Future interventions among this population could explore a more student-friendly time schedule (eg, avoid final exam time) or attempt to improve cognitive and scholastic outcomes. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900024449; https://www.chictr.org.cn/showproj.html?proj=40865 %M 38457201 %R 10.2196/40406 %U https://www.jmir.org/2024/1/e40406 %U https://doi.org/10.2196/40406 %U http://www.ncbi.nlm.nih.gov/pubmed/38457201 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54635 %T An mHealth Intervention to Address Depression and Improve Antiretroviral Therapy Adherence Among Youths Living With HIV in Uganda: Protocol for a Pilot Randomized Controlled Trial %A Nabunya,Proscovia %A Cavazos-Rehg,Patricia %A Mugisha,James %A Kasson,Erin %A Namuyaba,Olive Imelda %A Najjuuko,Claire %A Nsubuga,Edward %A Filiatreau,Lindsey M %A Mwebembezi,Abel %A Ssewamala,Fred M %+ International Center for Child Health and Development, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, United States, 1 3149359087, nabunyap@wustl.edu %K depression %K adherence %K mHealth %K cognitive behavioral therapy %K antiretroviral therapy %K youth living with HIV %K Uganda %D 2024 %7 8.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: People living with HIV often struggle with mental health comorbidities that lower their antiretroviral therapy (ART) adherence. There is growing evidence that depression treatment may improve ART adherence and result in improved HIV outcomes. Given that mental health services are severely underequipped in low-resource settings, including in Uganda, new solutions to increase access to mental health care and close the treatment gap are urgently needed. This protocol paper presents the Suubi-Mhealth study, which proposed to develop a mobile health (mHealth) intervention for use among Ugandan youths (14-17 years) with comorbid HIV and depression, taking into account their unique contextual, cultural, and developmental needs. Objective: The proposed study is guided by the following objectives: (1) to develop and iteratively refine an intervention protocol for Suubi-Mhealth based on formative work to understand the needs of youths living with HIV; (2) to explore the feasibility and acceptability of Suubi-Mhealth on a small scale to inform subsequent refinement; (3) to test the preliminary impact of Suubi-Mhealth versus a waitlist control group on youths’ outcomes, including depression and treatment adherence; and (4) to examine barriers and facilitators for integrating Suubi-Mhealth into health care settings. Methods: Youths will be eligible to participate in the study if they are (1) 14-17 years of age, (2) HIV-positive and aware of their status, (3) receiving care and ART from one of the participating clinics, and (4) living within a family. The study will be conducted in 2 phases. In phase 1, we will conduct focus group discussions with youths and health care providers, for feedback on the proposed intervention content and methods, and explore the feasibility and acceptability of the intervention. In phase II, we will pilot-test the preliminary impact of the intervention on reducing depression and improving ART adherence. Assessments will be conducted at baseline, 1-, 2-, and 6-months post intervention completion. Results: Participant recruitment for phase 1 is completed. Youths and health care providers participated in focus group discussions to share their feedback on the proposed Suubi-Mhealth intervention content, methods, design, and format. Transcription and translation of focus group discussions have been completed. The team is currently developing Suubi-Mhealth content based on participants’ feedback. Conclusions: This study will lay important groundwork for several initiatives at the intersection of digital therapeutics, HIV treatment, and mental health, especially among sub-Saharan African youths, as they transition through adolescence and into adult HIV care settings. Trial Registration: ClinicalTrials.gov NCT05965245; https://clinicaltrials.gov/study/NCT05965245 International Registered Report Identifier (IRRID): DERR1-10.2196/54635 %M 38457202 %R 10.2196/54635 %U https://www.researchprotocols.org/2024/1/e54635 %U https://doi.org/10.2196/54635 %U http://www.ncbi.nlm.nih.gov/pubmed/38457202 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45904 %T Smartphone Apps for Food Purchase Choices: Scoping Review of Designs, Opportunities, and Challenges %A Benthem de Grave,Remco %A Bull,Christopher N %A Monjardino de Souza Monteiro,Diogo %A Margariti,Eleni %A McMurchy,Gareth %A Hutchinson,Joseph William %A Smeddinck,Jan David %+ Open Lab, School of Computing, Newcastle University, Open Lab, Floor 1, Urban Sciences Building, Newcastle Helix, Newcastle upon Tyne, NE4 5TG, United Kingdom, 44 1912084630, r.benthemdegrave2@newcastle.ac.uk %K behavior change %K mobile apps %K food choices %K grocery shopping %K sustainability %K healthy eating %K digital health %K mobile phone %D 2024 %7 6.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphone apps can aid consumers in making healthier and more sustainable food purchases. However, there is still a limited understanding of the different app design approaches and their impact on food purchase choices. An overview of existing food purchase choice apps and an understanding of common challenges can help speed up effective future developments. Objective: We examined the academic literature on food purchase choice apps and provided an overview of the design characteristics, opportunities, and challenges for effective implementation. Thus, we contribute to an understanding of how technologies can effectively improve food purchase choice behavior and provide recommendations for future design efforts. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we considered peer-reviewed literature on food purchase choice apps within IEEE Xplore, PubMed, Scopus, and ScienceDirect. We inductively coded and summarized design characteristics. Opportunities and challenges were addressed from both quantitative and qualitative perspectives. From the quantitative perspective, we coded and summarized outcomes of comparative evaluation trials. From the qualitative perspective, we performed a qualitative content analysis of commonly discussed opportunities and challenges. Results: We retrieved 55 articles, identified 46 unique apps, and grouped them into 5 distinct app types. Each app type supports a specific purchase choice stage and shares a common functional design. Most apps support the product selection stage (selection apps; 27/46, 59%), commonly by scanning the barcode and displaying a nutritional rating. In total, 73% (8/11) of the evaluation trials reported significant findings and indicated the potential of food purchase choice apps to support behavior change. However, relatively few evaluations covered the selection app type, and these studies showed mixed results. We found a common opportunity in apps contributing to learning (knowledge gain), whereas infrequent engagement presents a common challenge. The latter was associated with perceived burden of use, trust, and performance as well as with learning. In addition, there were technical challenges in establishing comprehensive product information databases or achieving performance accuracy with advanced identification methods such as image recognition. Conclusions: Our findings suggest that designs of food purchase choice apps do not encourage repeated use or long-term adoption, compromising the effectiveness of behavior change through nudging. However, we found that smartphone apps can enhance learning, which plays an important role in behavior change. Compared with nudging as a mechanism for behavior change, this mechanism is less dependent on continued use. We argue that designs that optimize for learning within each interaction have a better chance of achieving behavior change. This review concludes with design recommendations, suggesting that food purchase choice app designers anticipate the possibility of early abandonment as part of their design process and design apps that optimize the learning experience. %M 38446500 %R 10.2196/45904 %U https://www.jmir.org/2024/1/e45904 %U https://doi.org/10.2196/45904 %U http://www.ncbi.nlm.nih.gov/pubmed/38446500 %0 Journal Article %@ 2291-5222 %I %V 12 %N %P e52968 %T The Real-World Impact of App-Based Mindfulness on Headspace Members With Moderate and Severe Perceived Stress: Observational Study %A Callahan,Christine %A Kimber,Justin %A Hu,Emily %A Tanner,Leah %A Kunkle,Sarah %K digital mental health %K meditation %K real word evidence %K mental health %K app %K application %K stress %K observational study %K depression %K anxiety %K tool %K tools %K psychological %K psychological symptom %K engagement %K stress reduction %K PSS-10 %D 2024 %7 4.3.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Perceived stress in the United States has drastically increased since the COVID-19 pandemic and is associated with negative mental health outcomes such as depression and anxiety. Digital mental health (DMH) interventions are efficacious tools to address negative mental health outcomes and have helped reduce the severity of psychological symptoms, such as anxiety, depression, and perceived stress, compared to waitlist controls. Although DMH tools have been studied in controlled settings, less is known about the real-world evidence of such interventions. Objective: This study aimed to (1) characterize patterns in baseline perceived stress and changes in perceived stress among Headspace members with moderate and severe baseline perceived stress and (2) examine associations between engagement with Headspace content and changes in perceived stress (ie, evaluate whether there is a dose-response relationship). Methods: We evaluated real-world perceived stress and engagement data at 2 time points among Headspace app members with baseline moderate and severe perceived stress. Perceived stress was measured using the Perceived Stress Scale (PSS-10) and engagement using active days and active minutes engaged with Headspace as well as the number of user sessions. Descriptive statistics were computed for all variables. Correlations between baseline and follow-up scores, percent change in PSS-10 scores, days between PSS-10 use, active days, active days per week, active minutes, active minutes per day, sessions, and sessions per week were evaluated. We used t tests to investigate differences in the abovementioned parameters between (1) participants who did and those who did not see improvements in PSS-10 scores (yes vs no improvement) and (2) participants who saw ≥30% improvement versus those who saw a <30% improvement in PSS-10 scores. Results: Overall, 21,088 Headspace members were included in these analyses. On average, members saw a 23.52% decrease in PSS-10 scores from baseline to follow-up. On average, members had 2.42 (SD 1.76) active days per week and 25.89 (SD 33.40) active minutes per day, and completed 7.11 (SD 8.34) sessions per week. t tests suggest that members who saw improvements in PSS-10 scores from baseline to follow-up had significantly higher baseline PSS-10 scores (Cohen d=0.56), more active days per week (Cohen d=0.33), and more sessions per week (Cohen d=0.27) than those who did not see improvements in PSS-10 scores (all P<.001). Additional t tests suggest that members with ≥30% improvement in PSS-10 scores had significantly higher baseline PSS-10 scores (Cohen d=0.35), more active days per week (Cohen d=0.36), and more sessions per week (Cohen d=0.31) than those with a >30% improvement (all P<.001). Conclusions: Real-world use of Headspace is associated with decreased perceived stress. Furthermore, data suggest that more engagement, specifically weekly active days and sessions, is associated with a greater likelihood of stress reduction. %R 10.2196/52968 %U https://mhealth.jmir.org/2024/1/e52968 %U https://doi.org/10.2196/52968 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55003 %T Evaluation of Patient-Facing Mobile Apps to Support Physiotherapy Care: Systematic Review %A Merolli,Mark %A Francis,Jill J %A Vallance,Patrick %A Bennell,Kim L %A Malliaras,Peter %A Hinman,Rana S %+ Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, 161 Barry Street, Parkville, Melbourne, 3052, Australia, 61 383443689, merollim@unimelb.edu.au %K physiotherapy %K physical therapy %K digital health intervention %K mobile app %K behavior change technique %K behavior change %K exercise %K systematic review %K quality %K rehabilitation %K BCT %K mHealth %K mobile health %K app %K apps %K physical activity %K fitness %K synthesis %K syntheses %K review methods %K review methodology %K search %K searches %K searching %K systematic %K mobile phone %D 2024 %7 4.3.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health interventions delivered through mobile apps are increasingly used in physiotherapy care. This may be because of the potential of apps to facilitate changes in behavior, which is central to the aims of care delivered by physiotherapists. A benefit of using apps is their ability to incorporate behavior change techniques (BCTs) that can optimize the effectiveness of physiotherapeutic interventions. Research continues to suggest that despite their importance, behavior change strategies are often missing in patient management. Evaluating mobile apps that physiotherapists can use to drive behavior change may inform clinical practice and potentially improve patient outcomes. Examining the quality of apps and exploring their key features that can support behavior change and physiotherapy care are important aspects of such an evaluation. Objective: The primary aim of this study was to describe the range of mobile apps in app stores that are intended for use by patients to support physiotherapy care. The secondary aims were to assess app quality, BCTs, and their behavior change potential. Methods: A systematic review of mobile apps in app stores was undertaken. The Apple App Store and Google Play were searched using a 2-step search strategy, using terms relevant to the physiotherapy discipline. Strict inclusion and exclusion criteria were applied: apps had to be intended for use by patients and be self-contained (or stand-alone) without the requirement to be used in conjunction with a partner wearable device or another plugin. Included apps were coded for BCTs using the Behavior Change Technique Taxonomy version 1. App quality was assessed using the Mobile App Rating Scale, and the App Behavior Change Scale was used to assess the app’s potential to change behavior. Results: In total, 1240 apps were screened, and 35 were included. Of these 35 apps, 22 (63%) were available on both the Apple App Store and Google Play platforms. In total, 24 (69%) were general in their focus (eg, not condition-specific), with the remaining 11 (31%) being more specific (eg, knee rehabilitation and pelvic floor training). The mean app quality score (Mobile App Rating Scale) was 3.7 (SD 0.4) of 5 (range 2.8-4.5). The mean number of BCTs identified per app was 8.5 (SD 3.6). BCTs most frequently included in the apps were instruction on how to perform a behavior (n=32), action planning (n=30), and self-monitoring of behavior (n=28). The mean behavior change potential score (App Behavior Change Scale) was 8.5 (SD 3.1) of 21 (range 3-15). Conclusions: Mobile apps available to support patient care received from a physiotherapist are of variable quality. Although they contain some BCTs, the potential for behavior change varied widely across apps. International Registered Report Identifier (IRRID): RR2-10.2196/29047 %M 38437018 %R 10.2196/55003 %U https://mhealth.jmir.org/2024/1/e55003 %U https://doi.org/10.2196/55003 %U http://www.ncbi.nlm.nih.gov/pubmed/38437018 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48883 %T Assessing the Effectiveness of STAPP@Work, a Self-Management Mobile App, in Reducing Work Stress and Preventing Burnout: Single-Case Experimental Design Study %A Demirel,Sevda %A Roke,Yvette %A Hoogendoorn,Adriaan W %A Hoefakker,Jamie %A Hoeberichts,Kirsten %A van Harten,Peter N %+ Expertise Center for Autism Spectrum Disorder, GGz Centraal, Boomgaardweg 12, Almere, 1326 AD, Netherlands, 31 41807329, S.demirel@ggzcentraal.nl %K mental health %K stress %K coping %K burnout %K stress management %K digital intervention %K health promotion %K mobile apps %K mobile health %K mHealth %K mental health professionals %D 2024 %7 29.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Work-related stress and burnout remain common problems among employees, leading to impaired health and higher absenteeism. The use of mobile health apps to promote well-being has grown substantially; however, the impact of such apps on reducing stress and preventing burnout is limited. Objective: This study aims to assess the effectiveness of STAPP@Work, a mobile-based stress management intervention, on perceived stress, coping self-efficacy, and the level of burnout among mental health employees. Methods: The study used a single-case experimental design to examine the use of STAPP@Work among mental health employees without a known diagnosis of burnout (N=63). Participants used the app for 1 week per month repeatedly for a period of 6 months. Using a reversal design, the participants used the app 6 times to assess replicated immediate (1 week after use) and lasting (3 weeks after use) effects. The Perceived Stress Scale, the Coping Self-Efficacy Scale, and the Burnout Assessment Tool were used to measure the outcomes. Linear mixed models were used to analyze the data. Results: After 6 months of app use for 1 week per month, the participants showed a statistically significant decrease in perceived stress (b=–0.38, 95% CI –0.67 to –0.09; P=.01; Cohen d=0.50) and burnout symptoms (b=–0.31, 95% CI –0.51 to –0.12; P=.002; Cohen d=0.63) as well as a statistically significant improvement in problem-focused coping self-efficacy (b=0.42, 95% CI 0-0.85; P=.049; Cohen d=0.42). Long-term use of the app provided consistent reductions in burnout symptoms over time, including in the level of exhaustion and emotional impairment. Conclusions: The use of an app-based stress management intervention has been shown to reduce burnout symptoms and enhance coping self-efficacy among mental health workers. Prevention of burnout and minimization of work-related stress are of utmost importance to protect employee health and reduce absenteeism. %M 38275128 %R 10.2196/48883 %U https://www.jmir.org/2024/1/e48883 %U https://doi.org/10.2196/48883 %U http://www.ncbi.nlm.nih.gov/pubmed/38275128 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55246 %T Physical Therapists’ Acceptance of a Wearable, Fabric-Based Sensor System (Motion Tape) for Use in Clinical Practice: Qualitative Focus Group Study %A Lee,Audrey %A Dionicio,Patricia %A Farcas,Emilia %A Godino,Job %A Patrick,Kevin %A Wyckoff,Elijah %A Loh,Kenneth J %A Gombatto,Sara %+ School of Exercise & Nutritional Sciences, College of Health & Human Services, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-7251, United States, 1 619 594 3288, sgombatto@sdsu.edu %K low back pain %K physical therapy %K physical therapist %K wearable sensor %K technology acceptance model %K motion tape %K kinesiology tape %D 2024 %7 29.2.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Low back pain (LBP) is a costly global health condition that affects individuals of all ages and genders. Physical therapy (PT) is a commonly used and effective intervention for the management of LBP and incorporates movement assessment and therapeutic exercise. A newly developed wearable, fabric-based sensor system, Motion Tape, uses novel sensing and data modeling to measure lumbar spine movements unobtrusively and thus offers potential benefits when used in conjunction with PT. However, physical therapists’ acceptance of Motion Tape remains unexplored. Objective: The primary aim of this research study was to evaluate physical therapists’ acceptance of Motion Tape to be used for the management of LBP. The secondary aim was to explore physical therapists’ recommendations for future device development. Methods: Licensed physical therapists from the American Physical Therapy Association Academy of Leadership Technology Special Interest Group participated in this study. Overall, 2 focus groups (FGs; N=8) were conducted, in which participants were presented with Motion Tape samples and examples of app data output on a poster. Informed by the Technology Acceptance Model, we conducted semistructured FGs and explored the wearability, usefulness, and ease of use of and suggestions for improvements in Motion Tape for PT management of LBP. FG data were transcribed and analyzed using rapid qualitative analysis. Results: Regarding wearability, participants perceived that Motion Tape would be able to adhere for several days, with some variability owing to external factors. Feedback was positive for the low-profile and universal fit, but discomfort owing to wires and potential friction with clothing was of concern. Other concerns included difficulty with self-application and potential skin sensitivity. Regarding usefulness, participants expressed that Motion Tape would enhance the efficiency and specificity of assessments and treatment. Regarding ease of use, participants stated that the app would be easy, but data management and challenges with interpretation were of concern. Physical therapists provided several recommendations for future design improvements including having a wireless system or removable wires, customizable sizes for the tape, and output including range of motion data and summary graphs and adding app features that consider patient input and context. Conclusions: Several themes related to Motion Tape’s wearability, usefulness, and ease of use were identified. Overall, physical therapists expressed acceptance of Motion Tape’s potential for assessing and monitoring low back posture and movement, both within and outside clinical settings. Participants expressed that Motion Tape would be a valuable tool for the personalized treatment of LBP but highlighted several future improvements needed for Motion Tape to be used in practice. %M 38421708 %R 10.2196/55246 %U https://humanfactors.jmir.org/2024/1/e55246 %U https://doi.org/10.2196/55246 %U http://www.ncbi.nlm.nih.gov/pubmed/38421708 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e51426 %T Exploring the Feasibility of Using ChatGPT to Create Just-in-Time Adaptive Physical Activity mHealth Intervention Content: Case Study %A Willms,Amanda %A Liu,Sam %+ School of Exercise Science, Physical and Health Education, University of Victoria, PO Box 3010 STN CSC, Victoria, BC, V8W 2Y2, Canada, 1 250 721 8392, awillms@uvic.ca %K ChatGPT %K digital health %K mobile health %K mHealth %K physical activity %K application %K mobile app %K mobile apps %K content creation %K behavior change %K app design %D 2024 %7 29.2.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: Achieving physical activity (PA) guidelines’ recommendation of 150 minutes of moderate-to-vigorous PA per week has been shown to reduce the risk of many chronic conditions. Despite the overwhelming evidence in this field, PA levels remain low globally. By creating engaging mobile health (mHealth) interventions through strategies such as just-in-time adaptive interventions (JITAIs) that are tailored to an individual’s dynamic state, there is potential to increase PA levels. However, generating personalized content can take a long time due to various versions of content required for the personalization algorithms. ChatGPT presents an incredible opportunity to rapidly produce tailored content; however, there is a lack of studies exploring its feasibility. Objective: This study aimed to (1) explore the feasibility of using ChatGPT to create content for a PA JITAI mobile app and (2) describe lessons learned and future recommendations for using ChatGPT in the development of mHealth JITAI content. Methods: During phase 1, we used Pathverse, a no-code app builder, and ChatGPT to develop a JITAI app to help parents support their child’s PA levels. The intervention was developed based on the Multi-Process Action Control (M-PAC) framework, and the necessary behavior change techniques targeting the M-PAC constructs were implemented in the app design to help parents support their child’s PA. The acceptability of using ChatGPT for this purpose was discussed to determine its feasibility. In phase 2, we summarized the lessons we learned during the JITAI content development process using ChatGPT and generated recommendations to inform future similar use cases. Results: In phase 1, by using specific prompts, we efficiently generated content for 13 lessons relating to increasing parental support for their child’s PA following the M-PAC framework. It was determined that using ChatGPT for this case study to develop PA content for a JITAI was acceptable. In phase 2, we summarized our recommendations into the following six steps when using ChatGPT to create content for mHealth behavior interventions: (1) determine target behavior, (2) ground the intervention in behavior change theory, (3) design the intervention structure, (4) input intervention structure and behavior change constructs into ChatGPT, (5) revise the ChatGPT response, and (6) customize the response to be used in the intervention. Conclusions: ChatGPT offers a remarkable opportunity for rapid content creation in the context of an mHealth JITAI. Although our case study demonstrated that ChatGPT was acceptable, it is essential to approach its use, along with other language models, with caution. Before delivering content to population groups, expert review is crucial to ensure accuracy and relevancy. Future research and application of these guidelines are imperative as we deepen our understanding of ChatGPT and its interactions with human input. %M 38421689 %R 10.2196/51426 %U https://mededu.jmir.org/2024/1/e51426 %U https://doi.org/10.2196/51426 %U http://www.ncbi.nlm.nih.gov/pubmed/38421689 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47040 %T Comparing the Effectiveness of the Blended Delivery Mode With the Face-to-Face Delivery Mode of Smoking Cessation Treatment: Noninferiority Randomized Controlled Trial %A Siemer,Lutz %A Pieterse,Marcel E %A Ben Allouch,Somaya %A Postel,Marloes G %A Brusse-Keizer,Marjolein G J %+ School of Social Work, Saxion University of Applied Sciences, M. H. Tromplaan 28, Enschede, 7513 AB, Netherlands, 31 657459469, l.siemer@saxion.nl %K tobacco %K blended treatment %K smoking cessation %K randomized controlled trial %K effectiveness %K noninferiority %K evaluation %K mobile phone %D 2024 %7 20.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Tobacco consumption is a leading cause of death and disease, killing >8 million people each year. Smoking cessation significantly reduces the risk of developing smoking-related diseases. Although combined treatment for addiction is promising, evidence of its effectiveness is still emerging. Currently, there is no published research comparing the effectiveness of blended smoking cessation treatments (BSCTs) with face-to-face (F2F) treatments, where web-based components replace 50% of the F2F components in blended treatment. Objective: The primary objective of this 2-arm noninferiority randomized controlled trial was to determine whether a BSCT is noninferior to an F2F treatment with identical ingredients in achieving abstinence rates. Methods: This study included 344 individuals who smoke (at least 1 cigarette per day) attending an outpatient smoking cessation clinic in the Netherlands. The participants received either a blended 50% F2F and 50% web-based BSCT or only F2F treatment with similar content and intensity. The primary outcome measure was cotinine-validated abstinence rates from all smoking products at 3 and 15 months after treatment initiation. Additional measures included carbon monoxide–validated point prevalence abstinence; self-reported point prevalence abstinence; and self-reported continuous abstinence rates at 3, 6, 9, and 15 months after treatment initiation. Results: None of the 13 outcomes showed statistically confirmed noninferiority of the BSCT, whereas 4 outcomes showed significantly (P<.001) inferior abstinence rates of the BSCT: cotinine-validated point prevalence abstinence rate at 3 months (difference 12.7, 95% CI 6.2-19.4), self-reported point prevalence abstinence rate at 6 months (difference 19.3, 95% CI 11.5-27.0) and at 15 months (difference 11.7, 95% CI 5.8-17.9), and self-reported continuous abstinence rate at 6 months (difference 13.8, 95% CI 6.8-20.8). The remaining 9 outcomes, including the cotinine-validated point prevalence abstinence rate at 15 months, were inconclusive. Conclusions: In this high-intensity outpatient smoking cessation trial, the blended mode was predominantly less effective than the traditional F2F mode. The results contradict the widely assumed potential benefits of blended treatment and suggest that further research is needed to identify the critical factors in the design of blended interventions. Trial Registration: Netherlands Trial Register 27150; https://onderzoekmetmensen.nl/nl/trial/27150 International Registered Report Identifier (IRRID): RR2-doi.org/10.1186/s12889-016-3851-x %M 38376901 %R 10.2196/47040 %U https://www.jmir.org/2024/1/e47040 %U https://doi.org/10.2196/47040 %U http://www.ncbi.nlm.nih.gov/pubmed/38376901 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e49317 %T HealthySMS Text Messaging System Adjunct to Adolescent Group Cognitive Behavioral Therapy in the Context of COVID-19 (Let’s Text!): Pilot Feasibility and Acceptability Study %A Haack,Lauren M %A Armstrong,Courtney C %A Travis,Kate %A Aguilera,Adrian %A Darrow,Sabrina M %+ Department of Psychiatry and Behavioral Sciences, University of California San Francisco, 675 18th Street, San Francisco, CA, 94107, United States, 1 415 502 8060, lauren.haack@ucsf.edu %K depression %K adolescents %K evidence-based intervention %K texting %K SMS text message %K cognitive behavioral therapy %K CBT %K group CBT %K shelter-in-place %K COVID-19 %K mobile health %K mHealth %K therapy %K cognitive %K behavior %K web-based therapy %K e-therapy %K youth %K young adults %K mobile phone %D 2024 %7 19.2.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: The widespread occurrence and devastating impact of adolescent depression warrant health service research focused on feasible and acceptable digital health tools to supplement evidence-based intervention (EBI) efforts, particularly in the context of shelter-in-place guidelines disrupting youth socialization and service use in the wake of the COVID-19 pandemic. Given the promise of SMS text message interventions to enhance EBI engagement, our team developed the HealthySMS system as an adjunct to one of the most empirically supported interventions for adolescent depression: cognitive behavioral therapy (CBT) group services. The system sends daily SMS text messages requesting responses assessing mood, thoughts, and activities; weekly attendance reminder messages; daily tips about adherence (eg, a prompt for activity completion); and personalized responses based on participants’ texts. Objective: This study aims to evaluate the feasibility and acceptability of HealthySMS in a real-world setting and explore potential mechanisms of change in EBI engagement, before evaluating the system’s impact on adolescents’ group CBT engagement and, ultimately, depression outcomes. Methods: Over the course of 2020, we invited all 20 adolescents receiving CBT group services for depression at an outpatient psychiatry clinic to enroll in our HealthySMS study; ultimately, 17 (85%) adolescents agreed to participate. We tracked participant initiation and engagement with the HealthySMS system as well as the content of SMS text message responses to HealthySMS. We also invited each participant to engage in a semistructured interview to gather additional qualitative inputs on the system. Results: All (n=17, 100%) research participants invited agreed to receive HealthySMS messages, and 94% (16/17) of the participants maintained use during the first month without opting out. We uncovered meaningful qualitative themes regarding the feasibility and acceptability of HealthySMS, as well as its potential impact on EBI engagement. Conclusions: Taken together, the results of this pilot study suggest that HealthySMS adjunct to adolescent CBT group depression services is feasible and acceptable, as evidenced by high rates of HealthySMS initiation and low rates of dropout, as well as meaningful themes uncovered from participants’ qualitative feedback. In addition, the findings provide evidence regarding iterative improvements to the HealthySMS system and research protocol, as well as potential mechanisms of change for enhanced EBI engagement and, ultimately, adolescent depression outcomes, which can be used in future effectiveness research. %M 38373030 %R 10.2196/49317 %U https://mental.jmir.org/2024/1/e49317 %U https://doi.org/10.2196/49317 %U http://www.ncbi.nlm.nih.gov/pubmed/38373030 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49178 %T Effectiveness and Feasibility of Telehealth-Based Dietary Interventions Targeting Cardiovascular Disease Risk Factors: Systematic Review and Meta-Analysis %A Trivedi,Rupal %A Elshafie,Shaimaa %A Tackett,Randall %A Young,Henry %A Sattler,Elisabeth Lilian Pia %+ Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, 250 W Green St, Athens, GA, United States, 1 7065421040, lilian@uga.edu %K telehealth %K dietary interventions %K cardiovascular diseases %K risk factors %K self-management %K systematic review and meta-analysis %D 2024 %7 16.2.2024 %9 Review %J J Med Internet Res %G English %X Background: Telehealth-based dietary interventions were recommended for cardiovascular disease (CVD) management during the COVID-19 pandemic; however, data regarding their effectiveness and feasibility are limited. Objective: We aimed to examine (1) the effectiveness of telehealth-based dietary interventions in improving clinical CVD risk factors and (2) the feasibility of these interventions among individuals with CVD. Methods: To conduct this systematic review and meta-analysis of randomized controlled trials (RCTs), 2 investigators searched PubMed, Cochrane Library, Web of Science, and ClinicalTrials.gov databases based on predetermined search terms and included English-language RCTs published between January 2000 and July 2022. The Cochrane Risk of Bias tool was used to assess RCT quality. To evaluate intervention effectiveness, weight, BMI, systolic and diastolic blood pressure, and levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, or blood glucose were compared postintervention in telehealth and usual care (UC) groups. Feasibility was determined through the number of participants retained in intervention and UC groups. Pooled data for each CVD outcome were analyzed using a random effects model. Mean difference (MD), standardized MD, or risk ratio were calculated using R software. Results: A total of 13 RCTs with 3013 participants were included in the analysis to assess the effectiveness and feasibility of telehealth-based dietary interventions among individuals with CVD. Participants had a mean age of 61.0 (SD 3.7) years, and 18.5% (n=559) were women. Approximately one-third of RCTs were conducted in the United States (n=4, 31%). Included studies used telephone, app, text, audio-visual media, or website-based interventions. Of the 13 included studies, 3 were of high quality, 9 were of moderate quality, and only 1 was of low quality. Pooled estimates showed systolic blood pressure (MD –2.74, 95% CI –4.93 to –0.56) and low-density lipoprotein cholesterol (standardized MD –0.11, 95% CI –0.19 to –0.03) to be significantly improved among individuals with CVD as a result of telehealth-based dietary interventions compared to UC. No significant difference in effectiveness was detected for weight, BMI, and levels of diastolic blood pressure, total cholesterol, high-density lipoprotein, and triglycerides between telehealth-based dietary interventions and UC among those with CVD. There was no significant difference between the feasibility of telehealth-based dietary interventions versus UC. Significant I2 indicated moderate to considerable heterogeneity. Conclusions: Telehealth-based dietary interventions show promise in addressing CVD risk factors. %M 38363635 %R 10.2196/49178 %U https://www.jmir.org/2024/1/e49178 %U https://doi.org/10.2196/49178 %U http://www.ncbi.nlm.nih.gov/pubmed/38363635 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49839 %T Mobile App–Based Lifestyle Coaching Intervention for Patients With Nonalcoholic Fatty Liver Disease: Randomized Controlled Trial %A Kwon,Oh Young %A Lee,Mi Kyung %A Lee,Hye Won %A Kim,Hyerang %A Lee,Jae Seung %A Jang,Yeonsoo %+ College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 3343, ysjang517@yuhs.ac %K lifestyle modification %K mobile health %K nonalcoholic fatty liver disease %K self-management %K randomized controlled trial %D 2024 %7 15.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Lifestyle modification in patients with nonalcoholic fatty liver disease (NAFLD) is key to improving health outcomes. Mobile health technologies may offer potential effective and efficient health care support to facilitate self-management. Objective: This study aims to develop a lifestyle coaching intervention using a mobile app for patients with NAFLD and evaluate physiological and psychological health outcomes for 6 months. Methods: This study was a randomized controlled trial. The personalized lifestyle coaching intervention using a mobile app was developed through established guidelines and literature reviews. This intervention consisted of information on NAFLD management, diet and physical activity self-monitoring, and coaching sessions based on patient records and SMS text messages. A total of 102 individuals were enrolled in the study and randomly assigned to the intervention group (n=48) or the control group (n=54). The outcomes were improvements in physiological (weight, liver fat score, aspartate aminotransferase, alanine transferase, and gamma-glutamyl transferase) and clinical outcomes (self-management, NAFLD self-management knowledge, self-efficacy, fatigue, depression, and quality of life). Data were analyzed using descriptive analysis and a linear mixed model to test the effects of the intervention. Results: All participants completed the study. The mean age of the participants was 48.9 (SD 13.74) years, 38.2% (39/102) were female participants, and 65.7% (67/102) were married. There were no differences in baseline demographic and clinical data between the intervention and control groups. Changes from baseline to 6 months were significant only within the intervention group for weight (P<.001), liver fat score (P=.01), aspartate aminotransferase (P=.03), alanine transferase (P=.002), gamma-glutamyl transferase (P=.04), self-management (P<.001), fatigue (P=.005), depression (P=.003), and quality of life (P<.001). The differences between the 2 groups for the changes over the 6 months were significant in self-management (P=.004), self-management knowledge (P=.04), fatigue (P=.004), depression (P=.04), and quality of life (P=.01). However, the intervention-by-time interaction was significantly effective only for self-management (P=.006) and fatigue (P=.02). Conclusions: Nonpharmacological interventions using a mobile app may be effective in improving the physiological and psychological health outcomes of patients with NAFLD. Trial Registration: Clinical Research Information Service KCT0005549; http://tinyurl.com/y2zb6usy %M 38358794 %R 10.2196/49839 %U https://www.jmir.org/2024/1/e49839 %U https://doi.org/10.2196/49839 %U http://www.ncbi.nlm.nih.gov/pubmed/38358794 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51908 %T Effect of a Mobile Game–Based Intervention to Enhance Child Safety: Randomized Controlled Trial %A Wong,Rosa S %A Tung,Keith T S %A Ho,Frederick K W %A Wong,Wilfred H S %A Chow,Chun Bong %A Chan,Ko Ling %A Fu,King Wa %A Ip,Patrick %+ Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China (Hong Kong), 852 22554090, patricip@hku.hk %K mobile game %K injury prevention %K safety education %K unintentional injuries %K gamification %K game %K games %K gaming %K safety %K injury %K injuries %K gamify %K gamified %K child %K children %K youth %K pediatric %K pediatrics %K danger %K hazard %K hazards %K RCT %K randomized %K controlled trial %K controlled trials %K mobile phone %D 2024 %7 14.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Evidence supports the effectiveness of serious games in health education, but little is known about their effects on the psychosocial well-being of children in the general population. Objective: This study aimed to investigate the potential of a mobile game–based safety education program in improving children’s safety and psychosocial outcomes. Methods: Safe City is a mobile roleplaying game specifically designed to educate children in Hong Kong about safety. This randomized controlled trial included 340 children in grades 4 through 6. Intervention arm participants (n=170) were instructed to play the Safe City mobile game for 4 weeks, whereas control arm participants (n=170) received a safety booklet. All participants completed a survey on safety knowledge and behaviors and psychosocial problems at baseline (T1), 1 month postintervention (T2), and 3 months postintervention (T3). Cumulative game scores and mini-game performance were analyzed as a proxy for the extent of exposure to the game. Outcome data were analyzed using 2-sample 2-tailed t tests to compare mean change from T1 to T2 and to T3 for intervention versus control arm participants. The association of game use with outcome changes postintervention was analyzed using generalized additive models. Results: No significant differences were found in mean changes between the intervention and control arms. However, use analyses showed that higher game scores were associated with improvements in safe behavior (P=.03) and internalizing problems (P=.01) at T3. Matching and Spot the Danger mini-game performance significantly predicted improvements in safety knowledge at T2 and T3. Conclusions: Analysis of use has shown that playing the Safe City mobile game can result in significant improvements in safety knowledge and reductions in unsafe behavior and internalizing problems. These findings provide evidence for the positive impact of serious games on psychological and social well-being, highlighting the potential of technology-driven interventions to assist children in learning about safety and preventing injuries. Trial Registration: ClinicalTrials.org NCT04096196; https://clinicaltrials.gov/show/NCT04096196 International Registered Report Identifier (IRRID): RR2-10.2196/17756 %M 38354042 %R 10.2196/51908 %U https://www.jmir.org/2024/1/e51908 %U https://doi.org/10.2196/51908 %U http://www.ncbi.nlm.nih.gov/pubmed/38354042 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47181 %T Determining the Right Levels of Health Coaching and Heart Rate Variability Biofeedback in a Workplace Behavior Change Intervention: Multiphase Optimization Strategy Preparation Study %A Locke,Sean %A Osborne,Jenna %+ Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St Catharines, ON, L2S 3A1, Canada, 1 905 668 5550 ext 4958, slocke@brocku.ca %K mobile health %K mHealth %K behavior change %K stress management %K intervention %K pilot study %K heart rate variability %K health coaching %K coach %K coaching %K coaches %K work-related stress %K stress %K wellness %K burnout %K behavioral intervention %K work %K worker %K workers %K employee %K employees %K occupational health %K job %K satisfaction %K web-based %K remote %K corporate %K web analytics %K biofeedback %K survey %K surveys %K interview %K interviews %K experience %K experiences %K attitude %K attitudes %K opinion %K opinion %K perception %K perceptions %K perspective %K perspectives %K acceptance %D 2024 %7 14.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Work-related stress is associated with poor job performance and negative health outcomes. Changing health behaviors through corporate wellness programs can improve physical and mental health and help employees manage stress. This project sought to pilot the potential addition of brief coaching and biofeedback to an 8-week web-based self-help program to improve employee stress using the multiphase optimization strategy. Objective: This study aims to determine which candidate components will be tested in a later optimization phase and at what dose they will be tested, examine the feasibility and acceptability of delivering the different components, investigate whether the outcomes can be feasibly measured, and review evidence to build a conceptual model before the optimization phase. Methods: The study was positioned within the preparation phase of the multiphase optimization strategy. It is a 2×2×2×2 design with 4 components: 2 types of health coaching and 2 types of biofeedback. All components were tested by turning them on or off. A total of 16 adult office workers (mean age 40, SD 14.3 years; n=15 women) completed an 8-week self-paced web-based stress management and health behavior change program and were randomly assigned to 1 of the 16 conditions, created from a combination of the 4 candidate components. Assessments included web analytics, surveys, and interviews regarding program recommendations, likes, and dislikes. Results: Findings from the interviews provided suggestions to improve the intervention (eg, separating wellness from stress content) and trial conduct (eg, streamlining the onboarding process). On average, participants logged into the wellness program 83 times (range 36-291), with 75% (12/16) participant retention and 67% (8/12) survey completion. There were no reported problems with coaching or obtaining data from interviews or apps. The interview findings suggested potential mediators to include and assess in a future conceptual model. Conclusions: The results provided areas to improve the intervention content and trial methods. Instead of progressing to the next scheduled large-scale optimization phase, our plan to iterate through a second preparation phase after making changes to the protocol, apps, and corporate coaching partner. %M 38354036 %R 10.2196/47181 %U https://formative.jmir.org/2024/1/e47181 %U https://doi.org/10.2196/47181 %U http://www.ncbi.nlm.nih.gov/pubmed/38354036 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53410 %T Telehealth Behavioral Intervention for Chronic Disease Self-Management in Adults With Physical Disabilities (My Health, My Life, My Way): Protocol for Intervention Fidelity and Dashboard Design for a Randomized Controlled Trial %A Evans,Eric %A Zengul,Ayse %A Subhash Chilke,Tejaswini %A Knight,Amy %A Willig,Amanda %A Cherrington,Andrea %A Mehta,Tapan %A Thirumalai,Mohanraj %+ Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, SHPB 590D, 1716 9th Ave S, Birmingham, AL, 35233, United States, 1 2059347189, mohanraj@uab.edu %K chronic health conditions %K telehealth %K health coaching %K self-management %K intervention fidelity protocol %D 2024 %7 12.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Individuals with physical disabilities experience higher rates of chronic health conditions than individuals without physical disabilities. Self-management programs that use health coaching are effective at eliciting health behavior change in health outcomes such as goal setting, adherence, and health care use. Additionally, web-based resources such as telehealth-based technologies, including SMSS text messaging, web-based applications, and educational multimedia content, can complement health coaching to improve health-related behaviors and the use of health services. The complexity of studies using these resources requires a fidelity protocol to ensure that health behavior studies are administered properly. Objective: The My Health, My Life, My Way fidelity protocol provides methods, strategies, and procedures of a multifaceted telehealth program for individuals with permanent physical disabilities and chronic health conditions. This health behavior study is a randomized controlled trial with four study arms: (1) scheduled coaching calls with gamified rewards, (2) no scheduled coaching calls with gamified rewards, (3) scheduled coaching calls with fixed rewards, and (4) no scheduled coaching calls with fixed rewards. To guide the fidelity protocol developed, we used the National Institutes of Health Behavior Change Consortium framework (NIH BCC). Methods: The fidelity intervention protocol was developed by using the 5 primary domains provided by the NIH BCC: study design, provider training, treatment delivery, treatment receipt, and enactment of treatment skills. Following the NIH BCC guidelines and implementing social cognitive theory, this study is designed to ensure that all study arms receive equal treatment across conditions and groups. Health coaches and providers will be trained to deliver consistent health coaching, and thus participants will receive appropriate attention. Educational content will be developed to account for health literacy and comprehension of the material. Multiple fidelity intervention steps such as coaching call logs, regular content review, and participant progress monitoring will translate to participants using the skills learned in their daily lives. Different monitoring steps will be implemented to minimize differences among the 4 treatment groups. Results: My Health, My Life, My Way has been approved by the institutional review board and will begin enrollment in January 2024 and end in December 2024, with results reported in early 2025. Conclusions: Intervention fidelity protocols are necessary to ensure that health behavior change studies can be implemented in larger real-world settings. The My Health, My Life, My Way fidelity protocol has used the guidelines by the NIH BCC to administer a telehealth intervention combined with health coaching for individuals with physical disabilities and chronic health conditions. This fidelity protocol can be used as a complementary resource for other researchers who conduct similar research using telehealth technologies and health coaching in real-world settings. Trial Registration: ClinicalTrials NCT05481593; https://clinicaltrials.gov/study/NCT05481593 International Registered Report Identifier (IRRID): PRR1-10.2196/53410 %M 38345845 %R 10.2196/53410 %U https://www.researchprotocols.org/2024/1/e53410 %U https://doi.org/10.2196/53410 %U http://www.ncbi.nlm.nih.gov/pubmed/38345845 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51057 %T Reflective Engagement With a Digital Physical Activity Intervention Among People Living With and Beyond Breast Cancer: Mixed Methods Study %A Robertson,Michael C %A Cox-Martin,Emily %A Basen-Engquist,Karen %A Lyons,Elizabeth J %+ Department of Family and Preventive Medicine, TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, 655 Research Pkwy #400, Oklahoma City, OK, 73104, United States, 1 405 271 6872, michael-robertson@ouhsc.edu %K survivors of cancer %K exercise %K acceptance and commitment therapy %K fatigue %K mindfulness %K motivation %K behavioral sciences %D 2024 %7 9.2.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: People living with and beyond breast cancer can face internal barriers to physical activity (eg, fatigue and pain). Digital interventions that promote psychological acceptance and motivation may help this population navigate these barriers. The degree to which individuals (1) adhere to intervention protocols and (2) reflect on and internalize intervention content may predict intervention efficacy. Objective: The objective of this study was to characterize the nature of reflective processes brought about by an 8-week acceptance- and mindfulness-based physical activity intervention for insufficiently active survivors of breast cancer (n=75). Furthermore, we explored the potential utility of a metric of reflective processes for predicting study outcomes. Methods: Of the intervention’s 8 weekly modules, 7 (88%) included an item that asked participants to reflect on what they found to be most useful. Two coders conducted directed content analysis on participants’ written responses. They assessed each comment’s depth of reflection using an existing framework (ranging from 0 to 4, with 0=simple description and 4=fundamental change with consideration of social and ethical issues). The coders identified themes within the various levels of reflection. We fit multiple linear regression models to evaluate whether participants’ (1) intervention adherence (ie, number of modules completed) and (2) the mean level of the depth of reflection predicted study outcomes. Results: Participants were aged on average 57.2 (SD 11.2) years, mostly non-Hispanic White (58/75, 77%), and mostly overweight or obese (54/75, 72%). Of the 407 responses to the item prompting personal reflection, 70 (17.2%) were rated as reflection level 0 (ie, description), 247 (60.7%) were level 1 (ie, reflective description), 74 (18.2%) were level 2 (ie, dialogic reflection), 14 (3.4%) were level 3 (ie, transformative reflection), and 2 (0.5%) were level 4 (ie, critical reflection). Lower levels of reflection were characterized by the acquisition of knowledge or expressing intentions. Higher levels were characterized by personal insight, commentary on behavior change processes, and a change of perspective. Intervention adherence was associated with increases in self-reported weekly bouts of muscle-strengthening exercise (B=0.26, SE 0.12, 95% CI 0.02-0.50) and decreases in sleep disturbance (B=−1.04, SE 0.50, 95% CI −0.06 to −2.02). The mean level of reflection was associated with increases in psychological acceptance (B=3.42, SE 1.70, 95% CI 0.09-6.75) and motivation for physical activity (ie, integrated regulation: B=0.55, SE 0.25, 95% CI 0.06-1.04). Conclusions: We identified a useful method for understanding the reflective processes that can occur during digital behavior change interventions serving people living with and beyond breast cancer. Intervention adherence and the depth of reflection each predicted changes in study outcomes. Deeper reflection on intervention content was associated with beneficial changes in the determinants of sustained behavior change. More research is needed to investigate the relations among digital behavior change intervention use, psychological processes, and intervention efficacy. %M 38335025 %R 10.2196/51057 %U https://mhealth.jmir.org/2024/1/e51057 %U https://doi.org/10.2196/51057 %U http://www.ncbi.nlm.nih.gov/pubmed/38335025 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50196 %T A Smartphone Food Record App Developed for the Dutch National Food Consumption Survey: Relative Validity Study %A Ocké,Marga %A Dinnissen,Ceciel Simone %A van den Bogaard,Coline %A Beukers,Marja %A Drijvers,José %A Sanderman-Nawijn,Eline %A van Rossum,Caroline %A Toxopeus,Ido %+ National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, Netherlands, 31 088 689 8989, ceciel.dinnissen@rivm.nl %K relative validity %K smartphone food record %K 24-hour dietary recall %K mobile app %K national food consumption surveys %K smartphone %K food %K food consumption %K app %K diet %K dietary intake %K nutrients %K survey %K mobile phone %D 2024 %7 9.2.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the Dutch National Food Consumption Survey, dietary intake has been assessed since 2003 through 24-hour dietary recalls using the GloboDiet software. A new self-administered smartphone food record app called DitEetIk! was developed for potential use in future surveys. Objective: This study aims to evaluate the data collected using the DitEetIk! app and its relative validity for food group, energy, and nutrient intake compared with the previous dietary assessment method (GloboDiet 24-hour dietary recalls). Methods: A total of 300 participants aged 18 to 79 years were recruited from a consumer panel. Participants were asked to keep a record of their consumption using the DitEetIk! app on 3 nonconsecutive days. Trained dietitians conducted a 24-hour dietary recall interview by telephone using the GloboDiet software (International Agency for Research on Cancer) regarding 1 of 3 DitEetIk! recording days. Nutrient intake was calculated using the NEVO database (version 2021/7.0). Relative validity was studied by comparing data from GloboDiet 24-hour dietary recalls and the DitEetIk app for the same day. Participants with implausible records, defined as days with energy intake of <0.6 or >3.0 basal metabolic rate, were excluded from the analyses. For 19 food groups and 29 nutrients, differences in median intake were assessed using the Wilcoxon signed rank test, and Spearman correlation coefficients were calculated. Bland-Altman plots with mean differences and 95% limits of agreement were created for energy intake and the contribution to energy intake from fat, carbohydrates, and protein. Results: A total of 227 participants completed a combination of a DitEetIk! app recording day and a 24-hour dietary recall interview for the same day. Of this group, 211 participants (n=104, 49.3% men and n=107, 50.7% women) had plausible recording days. Of all recorded food items, 12.8% (114/894) were entered via food barcode scanning, and 18.9% (169/894) were searched at the brand level. For 31% (5/16) of the food groups, the median intake assessed using the DitEetIk! app was >10% lower than that assessed using 24-hour dietary recalls; this was the case for fruit (P=.005), added fats (P=.001), milk and milk products (P=.02), cereal products (P=.01), and sauces (P<.001). This was also the case for 14% (4/29) of the nutrients (all P<.001). Regarding mean intake, differences were generally smaller. Regarding energy intake, the mean difference and 95% limits of agreement were 14 kcal (−1096 to 1124). Spearman correlation coefficients between intake assessed using the DitEetIk! app and 24-hour dietary recalls ranged from 0.48 to 0.88 (median 0.78) for food groups and from 0.58 to 0.90 (median 0.72) for nutrients. Conclusions: Compared with GloboDiet 24-hour dietary recalls, the DitEetIk! app assessed similar mean energy intake levels but somewhat lower median intake levels for several food groups and nutrients. %M 38335009 %R 10.2196/50196 %U https://mhealth.jmir.org/2024/1/e50196 %U https://doi.org/10.2196/50196 %U http://www.ncbi.nlm.nih.gov/pubmed/38335009 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e45942 %T Mobile App Intervention of a Randomized Controlled Trial for Patients With Obesity and Those Who Are Overweight in General Practice: User Engagement Analysis Quantitative Study %A Buss,Vera Helen %A Barr,Margo %A Parker,Sharon M %A Kabir,Alamgir %A Lau,Annie Y S %A Liaw,Siaw-Teng %A Stocks,Nigel %A Harris,Mark F %+ Centre for Primary Health Care and Equity, University of New South Wales, AGSM Building, High Street, Kensington Campus, Sydney, 2052, Australia, 61 290656041, Margo.barr@unsw.edu.au %K health literacy %K primary health care %K mobile application %K overweight %K vulnerable populations %K health behavior %K mHealth %K obesity %K weight loss %K mysnapp app %K mobile phone %D 2024 %7 9.2.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Health eLiteracy for Prevention in General Practice trial is a primary health care–based behavior change intervention for weight loss in Australians who are overweight and those with obesity from lower socioeconomic areas. Individuals from these areas are known to have low levels of health literacy and are particularly at risk for chronic conditions, including diabetes and cardiovascular disease. The intervention comprised health check visits with a practice nurse, a purpose-built patient-facing mobile app (mysnapp), and a referral to telephone coaching. Objective: This study aimed to assess mysnapp app use, its user profiles, the duration and frequency of use within the Health eLiteracy for Prevention in General Practice trial, its association with other intervention components, and its association with study outcomes (health literacy and diet) to determine whether they have significantly improved at 6 months. Methods: In 2018, a total of 22 general practices from 2 Australian states were recruited and randomized by cluster to the intervention or usual care. Patients who met the main eligibility criteria (ie, BMI>28 in the previous 12 months and aged 40-74 years) were identified through the clinical software. The practice staff then provided the patients with details about this study. The intervention consisted of a health check with a practice nurse and a lifestyle app, a telephone coaching program, or both depending on the participants’ choice. Data were collected directly through the app and combined with data from the 6-week health check with the practice nurses, the telephone coaching, and the participants’ questionnaires at baseline and 6-month follow-up. The analyses comprised descriptive and inferential statistics. Results: Of the 120 participants who received the intervention, 62 (52%) chose to use the app. The app and nonapp user groups did not differ significantly in demographics or prior recent hospital admissions. The median time between first and last app use was 52 (IQR 4-95) days, with a median of 5 (IQR 2-10) active days. App users were significantly more likely to attend the 6-week health check (2-sided Fisher exact test; P<.001) and participate in the telephone coaching (2-sided Fisher exact test; P=.007) than nonapp users. There was no association between app use and study outcomes shown to have significantly improved (health literacy and diet) at 6 months. Conclusions: Recruitment and engagement were difficult for this study in disadvantaged populations with low health literacy. However, app users were more likely to attend the 6-week health check and participate in telephone coaching, suggesting that participants who opted for several intervention components felt more committed to this study. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617001508369; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373505 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-023239 %M 38335014 %R 10.2196/45942 %U https://mhealth.jmir.org/2024/1/e45942 %U https://doi.org/10.2196/45942 %U http://www.ncbi.nlm.nih.gov/pubmed/38335014 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e51704 %T Incorporating a Stepped Care Approach Into Internet-Based Cognitive Behavioral Therapy for Depression: Randomized Controlled Trial %A Jagayat,Jasleen Kaur %A Kumar,Anchan %A Shao,Yijia %A Pannu,Amrita %A Patel,Charmy %A Shirazi,Amirhossein %A Omrani,Mohsen %A Alavi,Nazanin %+ Centre for Neuroscience Studies, Queen's University, 18 Stuart Street, Kingston, ON, K7L 3N6, Canada, 1 613 533 2600, jasleenjagayat@gmail.com %K internet-based cognitive behavioral therapy %K i-CBT %K major depressive disorder %K MDD %K stepped care %K digital mental health care %K mobile phone %D 2024 %7 9.2.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depression is a hidden burden, yet it is a leading cause of disability worldwide. Despite the adverse effects of depression, fewer than one-third of patients receive care. Internet-based cognitive behavioral therapy (i-CBT) is an effective treatment for depression, and combining i-CBT with supervised care could make the therapy scalable and effective. A stepped care model is a framework for beginning treatment with an effective and low-intensity intervention while adapting care based on the patient’s needs. Objective: This study investigated the efficacy of a stepped care i-CBT model for depression based on changes in self-reported depressive symptoms. Methods: In this single-blinded, randomized controlled trial, participants were allocated to either the i-CBT–only group (28/56, 50%) or the i-CBT with stepped care group (28/56, 50%). Both groups received a 13-week i-CBT program tailored for depression. The i-CBT program was provided through a secure, online mental health clinic called the Online Psychotherapy Tool. Participants read through the sessions and completed the assignments related to each session. Participants in the stepped care group received additional interventions from their care provider based on standard questionnaire scores (ie, Patient Health Questionnaire–9 [PHQ-9], Quick Inventory of Depressive Symptomatology [QIDS], and Quality of Life Enjoyment and Satisfaction Questionnaire–Short Form) and their assignment responses. From lowest to highest intensity, the additional interventions included SMS text messages, phone calls, video calls, or a video call with a psychiatrist. Results: For this study, 56 participants were recruited to complete an i-CBT program (n=28, 50%; mean age 37.9; SD 13.08 y; 7/28, 27% were men) or an i-CBT with stepped care program (n=28, 50%; mean age 40.6; SD 14.28 y; 11/28, 42% were men). The results of this study indicate that the i-CBT program was effective in significantly reducing depressive symptoms, as measured by the PHQ-9 (F4,80=9.95; P<.001) and QIDS (F2,28=5.73; P=.008); however, there were no significant differences in the reduction of depressive symptoms between the 2 groups (PHQ-9: F4,80=0.43; P=.78; QIDS: F2,28=3.05; P=.06). The stepped care group was not significantly better in reducing depressive symptoms than the i-CBT group (PHQ-9, P=.79; QIDS, P=.06). Although there were no significant differences observed between the number of participants who completed the program between the groups (χ21=2.6; P=.10), participants in the stepped care group, on average, participated in more sessions than those who prematurely terminated participation in the i-CBT group (t55=−2; P=.03; 95% CI –4.83 to –0.002). Conclusions: Implementing a stepped care approach in i-CBT is an effective treatment for depression, and the stepped care model can assist patients to complete more sessions in their treatment. Trial Registration: Clinicaltrials.gov NCT04747873; https://clinicaltrials.gov/study/NCT04747873 %M 38173167 %R 10.2196/51704 %U https://mental.jmir.org/2024/1/e51704 %U https://doi.org/10.2196/51704 %U http://www.ncbi.nlm.nih.gov/pubmed/38173167 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48467 %T Preliminary Efficacy of a Digital Intervention for Adolescent Depression: Randomized Controlled Trial %A Peake,Emily %A Miller,Ian %A Flannery,Jessica %A Chen,Lang %A Lake,Jessica %A Padmanabhan,Aarthi %+ Limbix Health Inc, 548 Market St, PMB 91609, San Francisco, CA, 94104, United States, 1 888 546 2495, aarthi.padmanabhan@bighealth.com %K adolescent %K depression %K randomized controlled trial %K mobile phone %K digital therapeutics %K mobile app %K cognitive behavioral therapy %K behavioral activation %K mobile health %D 2024 %7 7.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescent depression is a significant public health concern; however, access to effective mental health care is limited. Digital therapeutics (DTx) can improve access to evidence-based interventions; however, their efficacy in adolescents is sparsely documented. Objective: This study aims to examine the efficacy of a mobile app DTx versus an active control as an adjunct treatment for adolescent depression symptoms. Methods: An internet-based open-label randomized control trial was conducted nationwide with a partial crossover design, and 168 adolescents aged 13 to 21 years with symptoms of depression were recruited between November 2020 and September 2021. Participants were randomized (1:1) to the cognitive behavioral therapy–based treatment app (Spark) or to a psychoeducational control app (control), which they would use for a duration of 5 weeks. The primary outcome was a between-group (Spark vs control) difference in the change in depression symptoms from baseline to postintervention, as measured by the Patient Health Questionnaire-8 (PHQ-8) using a linear mixed-effects analysis. The PHQ-8 ranges from 0 to 24, with scores of 5 to 9 indicating mild depression symptoms, scores of 10 to 14 indicating moderate symptoms, scores of 15 to 19 indicating moderately severe symptoms, and scores of 20 to 24 indicating severe symptoms. A minimal clinically important difference (5-point reduction between baseline and postintervention) in the Spark arm and group differences in remission and treatment response rates based on the PHQ-8 at postintervention were also investigated. Results: A total of 160 participants were randomized, 80 in the Spark arm (mean age 16.89, SD 2.5 y) and 80 in the control arm (mean age 16.79, SD 2.59 y). Data from 121 participants (Spark: n=63; control: n=58) with moderate to severe (PHQ-8≥10) symptoms at baseline were included in the primary analyses following a modified intention-to-treat principle. A linear mixed-effect analysis revealed a nonsignificant difference between the study arms in depression symptom change over the intervention period. The Spark arm met a minimal clinically important difference threshold (mean −5.08, 95% CI −6.72 to −3.42). The remission rate in the Spark arm was significantly higher than that in the control arm (11/63, 17% vs 2/58, 3%; χ21=6.2; P=.01; false discovery rate–adjusted P=.03). The treatment response rates were not significantly different between the study arms (P=.07; false discovery rate–adjusted P=.16). Post hoc analyses including participants with mild to severe (PHQ-8 score ≥5) symptoms at baseline revealed promising evidence that Spark is effective in those with mild to severe symptoms. Conclusions: There is initial evidence that a self-guided, cognitive behavioral therapy–based DTx intervention may effectively treat mild to severe depression symptoms in adolescents. DTx may improve access to mental health care for adolescents or serve as an important adjunct to the standard of care. Trial Registration: ClinicalTrials.gov NCT04524598; https://clinicaltrials.gov/study/NCT04524598 %M 38324367 %R 10.2196/48467 %U https://www.jmir.org/2024/1/e48467 %U https://doi.org/10.2196/48467 %U http://www.ncbi.nlm.nih.gov/pubmed/38324367 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e46347 %T Investigating Receptivity and Affect Using Machine Learning: Ecological Momentary Assessment and Wearable Sensing Study %A King,Zachary D %A Yu,Han %A Vaessen,Thomas %A Myin-Germeys,Inez %A Sano,Akane %+ Department of Electrical and Computer Engineering, Rice University, 6100 Main St, Houston, TX, 77005, United States, 1 713 348 0000, zdk2@rice.edu %K mobile health %K mHealth %K affect inference %K study design %K ecological momentary assessment %K EMA %K just-in-time adaptive interventions %K JITAIs %K receptivity %K mobile phone %D 2024 %7 7.2.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As mobile health (mHealth) studies become increasingly productive owing to the advancements in wearable and mobile sensor technology, our ability to monitor and model human behavior will be constrained by participant receptivity. Many health constructs are dependent on subjective responses, and without such responses, researchers are left with little to no ground truth to accompany our ever-growing biobehavioral data. This issue can significantly impact the quality of a study, particularly for populations known to exhibit lower compliance rates. To address this challenge, researchers have proposed innovative approaches that use machine learning (ML) and sensor data to modify the timing and delivery of surveys. However, an overarching concern is the potential introduction of biases or unintended influences on participants’ responses when implementing new survey delivery methods. Objective: This study aims to demonstrate the potential impact of an ML-based ecological momentary assessment (EMA) delivery system (using receptivity as the predictor variable) on the participants’ reported emotional state. We examine the factors that affect participants’ receptivity to EMAs in a 10-day wearable and EMA–based emotional state–sensing mHealth study. We study the physiological relationships indicative of receptivity and affect while also analyzing the interaction between the 2 constructs. Methods: We collected data from 45 healthy participants wearing 2 devices measuring electrodermal activity, accelerometer, electrocardiography, and skin temperature while answering 10 EMAs daily, containing questions about perceived mood. Owing to the nature of our constructs, we can only obtain ground truth measures for both affect and receptivity during responses. Therefore, we used unsupervised and supervised ML methods to infer affect when a participant did not respond. Our unsupervised method used k-means clustering to determine the relationship between physiology and receptivity and then inferred the emotional state during nonresponses. For the supervised learning method, we primarily used random forest and neural networks to predict the affect of unlabeled data points as well as receptivity. Results: Our findings showed that using a receptivity model to trigger EMAs decreased the reported negative affect by >3 points or 0.29 SDs in our self-reported affect measure, scored between 13 and 91. The findings also showed a bimodal distribution of our predicted affect during nonresponses. This indicates that this system initiates EMAs more commonly during states of higher positive emotions. Conclusions: Our results showed a clear relationship between affect and receptivity. This relationship can affect the efficacy of an mHealth study, particularly those that use an ML algorithm to trigger EMAs. Therefore, we propose that future work should focus on a smart trigger that promotes EMA receptivity without influencing affect during sampled time points. %M 38324358 %R 10.2196/46347 %U https://mhealth.jmir.org/2024/1/e46347 %U https://doi.org/10.2196/46347 %U http://www.ncbi.nlm.nih.gov/pubmed/38324358 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55700 %T Physical Activity Intervention for Urban Black Women With Asthma: Protocol for a Randomized Controlled Efficacy Study %A Davis,Ellen %A Townsend,Elizabeth %A Cavalier,Aero %A Chen,Yi-Fan %A Edwards-Hart,Dameka %A Kitsiou,Spyros %A Kowalczyk,Wiktoria %A Mansur,Iliana %A Okpara,Ebere %A Powell,Karen %A Press,Valerie G %A Ramirez,Toni %A Salvo,Deborah %A Sharp,Lisa K %A Wright,Brittani %A Nyenhuis,Sharmilee Maria %+ Section of Allergy and Immunology, Department of Pediatrics, University of Chicago, 5837 S Maryland Ave, Chicago, IL, 60637, United States, 1 7738347121, snyenhuis@bsd.uchicago.edu %K asthma %K physical activity %K lifestyle %K Black women %D 2024 %7 7.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Black women experience a higher prevalence of poor asthma outcomes and physical inactivity than their White counterparts. Black women comprise a particularly vulnerable group of patients with asthma, with some of the highest rates of asthma in adults, high health care use (emergency department visits and hospitalizations), and the highest crude asthma mortality rate of all race or ethnicity groups. Despite recommendations to engage in regular physical activity, fewer than 15% of Black women meet the 2008 National Physical Activity Guidelines, the lowest of all racial subgroups of adults. Given the connection between physical inactivity and poor asthma outcomes, addressing physical activity among Black women with asthma is imperative. Objective: This 2-arm randomized controlled trial aims to (1) determine the efficacy of a lifestyle walking intervention on asthma control compared to an education (control) group over 24 weeks, (2) examine the maintenance effects of the lifestyle walking intervention on asthma control at 48 weeks, (3) explore the behavioral mediators (eg, self-efficacy, social support, self-regulation, and daily physical activity levels) and contextual moderators (eg, baseline asthma severity, neighborhood environment, comorbid conditions, and social determinants of health) that contribute to treatment responsiveness, and (4) assess the reach and implementation potential of the intervention. Methods: The proposed study (ACTION [A Lifestyle Physical Activity Intervention for Minority Women with Asthma]) delivers a 24-week lifestyle walking intervention designed for and by urban Black women with asthma. Participants (n=224) will be recruited through 2 urban health care systems that care for a diverse Black population. Patients will be randomized to one of two groups: (1) ACTION intervention (group sessions, physical activity self-monitoring—Fitbit, and text-based support for step goal setting) or (2) education control (an individual asthma education session and SMS text messages related to asthma education). Outcome assessments will take place at baseline, 12, 24, and 48 weeks. The primary outcome is a change in asthma control from baseline to week 24 as assessed by the asthma control questionnaire-6 (ACQ-6). Secondary outcomes include asthma-related quality of life, health care use, and asthma exacerbations and behavioral outcomes such as self-efficacy, self-regulation, social support, and physical activity. Results: This study was funded by the National Institute of Minority Health Disparities in August 2022. We pilot-tested our recruitment and intervention procedures and began recruitment in April 2023, with the enrollment of our first participant in May 2023. The anticipated completion of the study is April 2027. Conclusions: This study will deliver a new approach to physical activity interventions in Black women with asthma and help to provide guidance for addressing physical activity within this subgroup. This study will also provide a potential framework for future studies in minoritized populations with other disease conditions associated with low levels of physical activity. Trial Registration: ClinicalTrials.gov NCT05726487; https://clinicaltrials.gov/study/NCT05726487 International Registered Report Identifier (IRRID): DERR1-10.2196/55700 %M 38324365 %R 10.2196/55700 %U https://www.researchprotocols.org/2024/1/e55700 %U https://doi.org/10.2196/55700 %U http://www.ncbi.nlm.nih.gov/pubmed/38324365 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48668 %T Attitudes, Barriers, and Motivators Toward Daily Walking and a Mobile App to Increase Walking Among Women: Web-Based Anonymous Survey %A Jones,Catherine %A Chandarana,Shikha %A Vyas,Amita %A Napolitano,Melissa %+ Milken Institute School of Public Health, The George Washington University, 950 New Hampsire Avenue, Washington, DC, 20052, United States, 1 301 283 8703, catherinegjones@gwu.edu %K mHealth %K mobile health %K mobile app %K walking %K physical activity %K step counts %K women’s health %K age %K wearable activity tracker %K chronic disease %K mental health %K mobile phone %K COVID-19 %D 2024 %7 6.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There are disparities in the prevalence of physical activity (PA) with women engaging in less PA than men, a gap which widens during midlife. Walking is a generally accepted form of PA among women and should be encouraged. Motivations, barriers, and attitudes to engaging in walking change with age, but the influencing factors are not well understood nor are the features of mobile apps that facilitate daily walking. Objective: This study explores the relationship between age and women’s self-reported motivations, barriers, attitudes, and beliefs toward daily walking. It further assesses attitudes toward features of a mobile app designed to sync with a wearable step tracker to increase and maintain levels of daily walking among women. Methods: A web-based anonymous survey was completed by 400 women, aged 21-75 years. The 31-item survey captured women’s perceived barriers and motivators toward daily walking and attitudes toward mobile apps to support and maintain daily walking. For analysis, responses to the survey were grouped into 2 categories of women: ages 21-49 years and ages 50-75 years. Bivariate analyses were conducted through SPSS (IBM Corp) for each of the survey questions using chi-square for dichotomous variables and 1-tailed t tests for scales and continuous variables to identify significant differences between the groups. One-tailed t tests were run for scaled variables to identify significant differences between the 10-year age increments. Results: Significant barriers to daily walking were observed in the 21-49–year group for personal and work responsibilities, motivational and psychosocial factors, and physical and environmental factors. Motivators to walk daily in the 21- 49–year group were significantly higher to reduce stress and anxiety, and motivators to walk daily in the 50-75–year group were significantly higher to help manage or lose weight and to reduce the risk of chronic illness. Women’s walking preferences, beliefs around their walking behaviors, and their perceived importance of the features of a future mobile app for walking designed specifically for women showed significant variation according to age. When asked about the importance of features for a mobile app, women aged 21-49 years indicated a significantly higher number of positive responses for the following features: digital community support, rewards or point system, and seeing a daily or weekly or monthly progress chart. Conclusions: Our findings indicate that barriers, motivators, and beliefs around daily walking and the importance of preferred features of a mobile app vary according to women’s ages. Messaging and app features should be tailored to different age groups of women. These study results can be viewed as a foundation for future research and development of mobile health interventions to effectively increase daily walking among women of all ages. %M 38319695 %R 10.2196/48668 %U https://formative.jmir.org/2024/1/e48668 %U https://doi.org/10.2196/48668 %U http://www.ncbi.nlm.nih.gov/pubmed/38319695 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52560 %T Mental Health and Well-Being in Racial or Ethnic Minority Individuals After Using a Faith and Prayer Mobile App (Pray.com): Feasibility and Preliminary Efficacy Trial %A Laird,Breanne %A Zuniga,Sabrina %A Hook,Joshua N %A Van Tongeren,Daryl R %A Joeman,Lynda %A Huberty,Jennifer %+ Pray, Inc, 4607 Lakeview Canyon Rd #456, Westlack Village, CA, 91361, United States, 1 9095574002, breanne.laird@pray.com %K religion %K spirituality %K mobile apps %K mental health %K well-being %K app %K ethnic %K technology %K engagement %K stress %K depression %K anxiety %K quality of life %K spiritual well-being %K racial %K spiritual practices %K spiritual practice %K mobile phone %K mobile health %K mHealth %D 2024 %7 2.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Research is needed on how faith and prayer apps fit within the values of racial and ethnic minority (REM) groups, as well as whether such apps are effective in promoting mental health and well-being. Objective: This study aims to determine the feasibility and preliminary effectiveness of using the mobile app Pray.com on mental health and well-being among REM participants. Methods: This study was a single-group (N=77), 4-week feasibility trial in REM groups (65/77, 84% Black or African American). Participants were asked to use the Pray.com app at no cost for at least 5 times per week for 5 minutes per day. Participants completed questionnaires at the baseline and postintervention time points. Feasibility questionnaires were only completed at the postintervention time point, including qualitative interviews (n=15). The feasibility questions included acceptability (ie, satisfaction, intent to continue use, perceived appropriateness, and fit within culture), demand (ie, self-reported app use, expressed interest, and perceived demand), and practicality (ie, ease or difficulty of use, ability to use the app, and cost-effectiveness). Frequency and descriptive statistics were used to analyze feasibility outcomes. Changes in dependent variables were analyzed using paired-sample 2-tailed t tests. Partial correlations were conducted to explore the association between app use and outcomes, controlling for baseline scores. Results: Participants reported (54/72, 75% responded with “very likely” or “likely” to the feasibility questions) that they perceived the Pray.com app as acceptable. These findings were supported by qualitative interviews (n=15). Most participants (62/72, 86%) did not meet the app use prescription but expressed interest in using the app in the future and perceived demand for it in their communities. In addition, participants reported that the app was easy to use and perceived it to be inexpensive (US $7.99). Participants reported improved mental health (ie, stress and depressive and anxiety symptoms) and well-being (ie, satisfaction with life, spiritual well-being, religious commitment, and racial or ethnic identity development) at postintervention despite relatively low average levels and high variability of app use (average total of 45.83, SD 111.90 min over the course of the study). Greater app use was significantly associated with improvements in mental health and spiritual well-being. However, app use and study methodology limitations suggest that the study results may not accurately capture the full impact of Pray.com use. Conclusions: This is the first study to assess the feasibility of a faith and prayer app for mental health and well-being in a sample of REM individuals. Our findings suggest that the use of a faith and prayer app (ie, Pray.com) could be feasible and significantly impactful for the improvement of mental health symptoms and well-being in REM individuals and their communities, especially Black and African American individuals with a Christian affiliation. Further research is warranted. %M 38306173 %R 10.2196/52560 %U https://formative.jmir.org/2024/1/e52560 %U https://doi.org/10.2196/52560 %U http://www.ncbi.nlm.nih.gov/pubmed/38306173 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51066 %T Acceptability and Utility of a Digital Group Intervention to Prevent Perinatal Depression in Youths via Interactive Maternal Group for Information and Emotional Support (IMAGINE): Pilot Cohort Study %A Ronen,Keshet %A Gewali,Anupa %A Dachelet,Kristin %A White,Erica %A Jean-Baptiste,Marimirca %A Evans,Yolanda N %A Unger,Jennifer A %A Tandon,S Darius %A Bhat,Amritha %+ Department of Global Health, University of Washington, 3980 15th Avenue North East, Seattle, WA, 98195, United States, 1 2066854363, keshet@uw.edu %K perinatal depression %K youth %K mHealth %K digital health %K acceptability %K utility %K depression %K pilot study %K pregnancy %K postpartum %K prevention %K cognitive behavioral therapy %K psychoeducation %K mixed methods %K manage %K mood %K mobile phone %D 2024 %7 2.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Perinatal depression (depression during pregnancy or the first year postpartum) affects 10%-25% of perinatal individuals, with a higher risk among youths aged <25 years. The Mothers and Babies Course (MB) is an evidence-based intervention for the prevention of perinatal depression, grounded in cognitive behavioral therapy, attachment theory, and psychoeducation. Objective: We developed a digital adaptation of MB (Interactive Maternal Group for Information and Emotional Support [IMAGINE]) and evaluated it in a pre-post mixed methods pilot among young perinatal people in the United States. Methods: IMAGINE was a structured digital group of up to 7 participants, with scheduled MB content and open discussion for 12 weeks, facilitated by a social worker. Scheduled content included asynchronous SMS text messages, graphics, prerecorded videos, mood polls, and optional weekly synchronous video calls. Eligible participants were pregnant or ≤80 days postpartum, aged 16 to 24 years, had access to a smartphone, spoke English, and had a Patient Health Questionnaire score <10. Participants were recruited throughout the United States from August 2020 to January 2021 through paid social media ads, in-person outreach at clinics, and respondent-driven sampling. Participants completed quantitative questionnaires at enrollment and 3 months, and qualitative interviews at 3 months. We determined uptake, acceptability (by Acceptability of Intervention Measure score), and utility (by use of cognitive behavioral therapy skills). We compared depression symptoms (by Patient Health Questionnaire score), social support (by abbreviated Social Support Behavior score), and perceived stress (by Perceived Stress Score) between enrollment and follow-up by paired 2-tailed t test. Results: Among 68 individuals who contacted this study, 22 were screened, 13 were eligible, and 10 enrolled, for an uptake of 76.9%. Furthermore, 4 (40%) participants were pregnant at enrollment. Participants had a median age of 17.9 (IQR 17.4-21.7) years, 6 (67%) identified as Black, 5 (56%) Latinx, and 6 (67%) using Medicaid health insurance. Further, 9 (90%) participants completed follow-up. Among these, the mean acceptability score was 4.3 out of 5 (SD 0.6) and all participants said they would recommend IMAGINE to a friend. Participants reported using a median of 7 of 11 skills (IQR 5-7 skills) at least half the days. We found no significant changes in depression symptoms, perceived stress, or social support. Qualitatively, participants reported one-to-one support from the facilitator, connection with other parents, and regular mood reflection were especially helpful aspects of the intervention. Additionally, participants reported that the intervention normalized their mental health challenges, improved their ability to manage their mood, and increased their openness to mental health care. Conclusions: This pilot study provides promising evidence of the acceptability and utility of IMAGINE among perinatal youths. Our study’s small sample size did not detect changes in clinical outcomes; our findings suggest IMAGINE warrants larger-scale evaluation. %M 38306159 %R 10.2196/51066 %U https://formative.jmir.org/2024/1/e51066 %U https://doi.org/10.2196/51066 %U http://www.ncbi.nlm.nih.gov/pubmed/38306159 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e47102 %T Effectiveness of a Nurse-Led Mobile-Based Health Coaching Program for Patients With Prostate Cancer at High Risk of Metabolic Syndrome: Randomized Waitlist Controlled Trial %A Lee,Kyoungjin %A Park,Jeongok %A Oh,Eui Geum %A Lee,JuHee %A Park,Chang %A Choi,Young Deuk %+ Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seodaemun-gu, Seoul, Korea, Seoul, 03722, Republic of Korea, 82 2 2228 3390, JOPARK02@yuhs.ac %K nurses %K prostate neoplasms %K healthy lifestyle %K metabolic syndrome %K exercise %K diet %K mobile phone %D 2024 %7 1.2.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Androgen deprivation therapy (ADT), a standard treatment for prostate cancer (PC), causes many physical side effects. In particular, it causes metabolic changes such as fasting glucose abnormalities or accumulation of body fat, and its continuation can lead to metabolic syndrome (MetS), which is closely related to diabetes and cardiovascular disease. Therefore, it is important to maintain and practice a healthy lifestyle in patients with PC. Objective: This study aims to evaluate the effectiveness of a nurse-led mobile-based program that aims to promote a healthy lifestyle in patients with PC undergoing ADT with MetS risk factors. Methods: This was a single-blind, randomized, waitlist control interventional study. A total of 48 patients were randomly assigned to the experimental and waitlist control groups at the urology cancer clinic of a tertiary general hospital in South Korea. The inclusion criteria were patients who had undergone ADT for >6 months, had at least 1 of the 5 MetS components in the abnormal range, and could access a mobile-based education program. The experimental group attended a 4-week mobile-based program on exercise and diet that included counseling and encouragement to maintain a healthy lifestyle, whereas the control group was placed on a waitlist and received usual care during the follow-up period, followed by the intervention. The primary outcome was a change in the lifestyle score. The secondary outcomes were changes in 5 MetS components, body composition, and health-related quality of life. The outcomes were measured at 6 weeks and 12 weeks after the initiation of the intervention. Each participant was assigned to each group in a sequential order of enrollment in a 4×4 permuted block design randomization table generated in the SAS (SAS Institute) statistical program. A linear mixed model was used for statistical analysis. Results: A total of 24 participants were randomly assigned to each group; however, 2 participants in the experimental group dropped out for personal reasons before starting the intervention. Finally, 46 participants were included in the intention-to-treat analysis. The experimental group showed more positive changes in the healthy lifestyle score (β=29.23; P≤.001), level of each MetS component (fasting blood sugar: β=−12.0; P=.05 and abdominal circumference: β=−2.49; P=.049), body composition (body weight: β=−1.52; P<.001 and BMI: β=−0.55; P<.001), and the urinary irritative and obstructive domain of health-related quality of life (β=14.63; P<.001) over time than the waitlist control group. Conclusions: Lifestyle changes through nurse-led education can improve level of each MetS components, body composition, and ADT side effects. Nurses can induce positive changes in patients’ lifestyles and improve the self-management of patients starting ADT through this program. Trial Registration: Clinical Research Information Service KCT0006560; http://tinyurl.com/yhvj4vwh %M 38300697 %R 10.2196/47102 %U https://mhealth.jmir.org/2024/1/e47102 %U https://doi.org/10.2196/47102 %U http://www.ncbi.nlm.nih.gov/pubmed/38300697 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47850 %T User Requirements in Developing a Novel Dietary Assessment Tool for Children: Mixed Methods Study %A van der Heijden,Zoë %A de Gooijer,Femke %A Camps,Guido %A Lucassen,Desiree %A Feskens,Edith %A Lasschuijt,Marlou %A Brouwer-Brolsma,Elske %+ Division of Human Nutrition and Health, Wageningen University & Research, Stippeneng 4, Wageningen, 6700 AA, Netherlands, 31 7480 100, zoe.vanderheijden@wur.nl %K diet %K children %K dietary assessment %K recall %K technological innovation %K mobile health %K mHealth %K mobile phone %D 2024 %7 1.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of childhood obesity and comorbidities is rising alarmingly, and diet is an important modifiable determinant. Numerous dietary interventions in children have been developed to reduce childhood obesity and overweight rates, but their long-term effects are unsatisfactory. Stakeholders call for more personalized approaches, which require detailed dietary intake data. In the case of primary school children, caregivers are key to providing such dietary information. However, as school-aged children are not under the full supervision of one specific caregiver anymore, data are likely to be biased. Recent technological advancements provide opportunities for the role of children themselves, which would serve the overall quality of the obtained dietary data. Objective: This study aims to conduct a child-centered exploratory sequential mixed methods study to identify user requirements for a dietary assessment tool for children aged 5 to 6 years. Methods: Formative, nonsystematic narrative literature research was undertaken to delineate initial user requirements and inform prototype ideation in an expert panel workshop (n=11). This yielded 3 prototype dietary assessment tools: FoodBear (tangible piggy bank), myBear (smartphone or tablet app), and FoodCam (physical camera). All 3 prototypes were tested for usability by means of a usability task (video analyses) and user experience (This or That method) among 14 Dutch children aged 5 to 6 years (n=8, 57% boys and n=6, 43% girls). Results: Most children were able to complete FoodBear’s (11/14, 79%), myBear’s (10/14, 71%), and FoodCam’s (9/14, 64%) usability tasks, but all children required assistance (14/14, 100%) and most of the children encountered usability problems (13/14, 93%). Usability issues were related to food group categorization and recognition, frustrations owing to unsatisfactory functioning of (parts) of the prototypes, recall of food products, and the distinction between eating moments. No short-term differences in product preference between the 3 prototypes were observed, but autonomy, challenge, gaming elements, being tablet based, appearance, social elements, and time frame were identified as determinants of liking the product. Conclusions: Our results suggest that children can play a complementary role in dietary data collection to enhance the data collected by their parents. Incorporation of a training program, auditory or visual prompts, reminders and feedback, a user-friendly and intuitive interaction design, child-friendly food groups or icons, and room for children’s autonomy were identified as requirements for the future development of a novel and usable dietary assessment tool for children aged 5 to 6 years. Our findings can serve as valuable guidance for ongoing innovations in the field of children’s dietary assessment and the provision of personalized dietary support. %M 38300689 %R 10.2196/47850 %U https://formative.jmir.org/2024/1/e47850 %U https://doi.org/10.2196/47850 %U http://www.ncbi.nlm.nih.gov/pubmed/38300689 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e46973 %T Exploring Maternal and Infant Health App Development and Effectiveness Research: Scoping Review %A Phillips,J Craig %A Alfano,Alliete R %A Barfield,Latisha C %A Cain,Lisa %A Sadjadi,Masoud %A Morales,Eduardo %A Phillips-Beck,Wanda %A Galarza,M Grisel %A Torres,Maritza %A Zindani,Sadaf %A Rayani,Ahmad %A Edwards,Khalee %A Jones,Sande Gracia %A Hannan,Jean %+ School of Nursing, University of Ottawa, 308-29 Main St, Ottawa, ON, K1S 1B1, Canada, 1 613 562 5800 ext 8612, craig.phillips@uottawa.ca %K maternal and child health %K smartphone %K mobile health %K mHealth %K eHealth %K app development %K app evaluation %K app effectiveness %K maternal and infant app %K pregnancy, postpartum %K mothers %K mobile phone %K artificial intelligence %K AI %D 2024 %7 26.1.2024 %9 Review %J JMIR Pediatr Parent %G English %X Background: Globally, high rates of maternal and infant mortality call for interventions during the perinatal period to engage pregnant people as well as their loved ones in care. Mobile health technologies have become ubiquitous in our lives and in health care settings. However, there is a need to further explore their safety and effectiveness to support and improve health outcomes locally and globally. Objective: The aim of this study was to review and synthesize published literature that described the development process or effectiveness evaluations of maternal and infant apps. Methods: We applied a methodological framework for scoping reviews as well as the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines; in addition, the systematic review platform Covidence (Veritas Health Innovation Ltd) was used to facilitate the review of included studies. Search terms were developed collaboratively, and health sciences–associated databases were searched for studies conducted between January 1, 2000, and February 4, 2022. We excluded studies about apps that only gathered or tracked data or targeted care providers. Results: A total of 1027 articles were included for title and abstract screening, of which 87 (8.47%) were chosen for full-text screening. Of these 87 articles, 74 (85%) were excluded with reasons, and 19 (22%) were included. Four articles were added at data extraction from hand searching and 2 others were excluded. Thus, we reviewed and synthesized data from 11 unique studies reported in 21 articles published between 2017 and 2021. The included studies represented 8 different countries. Most of the apps (8/11, 73%) were in English, although apps were also developed in Arabic, Bahasa Indonesia, and Nepali. The articles reviewed revealed the early stage of development of the field of maternal and infant health apps, with modest evidence of app use and achievement of study outcomes. Only 1 (9%) of the 11 apps was endorsed by an independent health care provider society. App development and evaluation processes emerged, and specific app features were identified as vital for well-functioning apps. End-user engagement occurred in some, but not all, parts of app research and development. Conclusions: Apps to improve maternal and infant health are being developed and launched in enormous numbers, with many of them not developed with mothers’ needs in mind. There are concerns about privacy, safety, and the standardization of current apps as well as a need for professional or institution-specific guidelines or best practices. Despite challenges inherent in currently available apps and their design processes, maternal and infant app technology holds promise for achieving health equity goals and improving maternal and child health outcomes. Finally, we propose recommendations for advancing the knowledge base for maternal and infant apps. %M 38055330 %R 10.2196/46973 %U https://pediatrics.jmir.org/2024/1/e46973 %U https://doi.org/10.2196/46973 %U http://www.ncbi.nlm.nih.gov/pubmed/38055330 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50132 %T Development and Evaluation of a Smartphone-Based Chatbot Coach to Facilitate a Balanced Lifestyle in Individuals With Headaches (BalanceUP App): Randomized Controlled Trial %A Ulrich,Sandra %A Gantenbein,Andreas R %A Zuber,Viktor %A Von Wyl,Agnes %A Kowatsch,Tobias %A Künzli,Hansjörg %+ School of Applied Psychology, Zurich University of Applied Sciences, Pfingstweidstrasse 96, 2, Zurich, 8005, Switzerland, 41 58 934 ext 8451, sandra.ulrich@zhaw.ch %K chatbot %K mobile health %K mHealth %K smartphone %K headache management %K psychoeducation %K behavior change %K stress management %K mental well-being %K lifestyle %K mindfulness %K relaxation %K mobile phone %D 2024 %7 24.1.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Primary headaches, including migraine and tension-type headaches, are widespread and have a social, physical, mental, and economic impact. Among the key components of treatment are behavior interventions such as lifestyle modification. Scalable conversational agents (CAs) have the potential to deliver behavior interventions at a low threshold. To our knowledge, there is no evidence of behavioral interventions delivered by CAs for the treatment of headaches. Objective: This study has 2 aims. The first aim was to develop and test a smartphone-based coaching intervention (BalanceUP) for people experiencing frequent headaches, delivered by a CA and designed to improve mental well-being using various behavior change techniques. The second aim was to evaluate the effectiveness of BalanceUP by comparing the intervention and waitlist control groups and assess the engagement and acceptance of participants using BalanceUP. Methods: In an unblinded randomized controlled trial, adults with frequent headaches were recruited on the web and in collaboration with experts and allocated to either a CA intervention (BalanceUP) or a control condition. The effects of the treatment on changes in the primary outcome of the study, that is, mental well-being (as measured by the Patient Health Questionnaire Anxiety and Depression Scale), and secondary outcomes (eg, psychosomatic symptoms, stress, headache-related self-efficacy, intention to change behavior, presenteeism and absenteeism, and pain coping) were analyzed using linear mixed models and Cohen d. Primary and secondary outcomes were self-assessed before and after the intervention, and acceptance was assessed after the intervention. Engagement was measured during the intervention using self-reports and usage data. Results: A total of 198 participants (mean age 38.7, SD 12.14 y; n=172, 86.9% women) participated in the study (intervention group: n=110; waitlist control group: n=88). After the intervention, the intention-to-treat analysis revealed evidence for improved well-being (treatment: β estimate=–3.28, 95% CI –5.07 to –1.48) with moderate between-group effects (Cohen d=–0.66, 95% CI –0.99 to –0.33) in favor of the intervention group. We also found evidence of reduced somatic symptoms, perceived stress, and absenteeism and presenteeism, as well as improved headache management self-efficacy, application of behavior change techniques, and pain coping skills, with effects ranging from medium to large (Cohen d=0.43-1.05). Overall, 64.8% (118/182) of the participants used coaching as intended by engaging throughout the coaching and completing the outro. Conclusions: BalanceUP was well accepted, and the results suggest that coaching delivered by a CA can be effective in reducing the burden of people who experience headaches by improving their well-being. Trial Registration: German Clinical Trials Register DRKS00017422; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00017422 %M 38265863 %R 10.2196/50132 %U https://www.jmir.org/2024/1/e50132 %U https://doi.org/10.2196/50132 %U http://www.ncbi.nlm.nih.gov/pubmed/38265863 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50616 %T Effects of Digital Physical Health Exercises on Musculoskeletal Diseases: Systematic Review With Best-Evidence Synthesis %A Nagel,Johanna %A Wegener,Florian %A Grim,Casper %A Hoppe,Matthias Wilhelm %+ Movement and Training Science, Leipzig University, Jahnallee 59, Leipzig, 04109, Germany, 49 3419731822, jojo_nagel@yahoo.de %K mobile health %K mHealth %K electronic health %K eHealth %K digital health applications %K DiGA %K musculoskeletal %K MSK %K home-based %K PROM %K disorder %K mobile phone %D 2024 %7 23.1.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Musculoskeletal diseases affect 1.71 billion people worldwide, impose a high biopsychosocial burden on patients, and are associated with high economic costs. The use of digital health interventions is a promising cost-saving approach for the treatment of musculoskeletal diseases. As physical exercise is the best clinical practice in the treatment of musculoskeletal diseases, digital health interventions that provide physical exercises could have a highly positive impact on musculoskeletal diseases, but evidence is lacking. Objective: This systematic review aims to evaluate the impact of digital physical health exercises on patients with musculoskeletal diseases concerning the localization of the musculoskeletal disease, patient-reported outcomes, and medical treatment types. Methods: We performed systematic literature research using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was conducted using the PubMed, BISp, Cochrane Library, and Web of Science databases. The Scottish Intercollegiate Guidelines Network checklist was used to assess the quality of the included original studies. To determine the evidence and direction of the impact of digital physical health exercises, a best-evidence synthesis was conducted, whereby only studies with at least acceptable methodological quality were included for validity purposes. Results: A total of 8988 studies were screened, of which 30 (0.33%) randomized controlled trials met the inclusion criteria. Of these, 16 studies (53%) were of acceptable or high quality; they included 1840 patients (1008/1643, 61.35% female; 3 studies including 197 patients did not report gender distribution) with various musculoskeletal diseases. A total of 3 different intervention types (app-based interventions, internet-based exercises, and telerehabilitation) were used to deliver digital physical health exercises. Strong evidence was found for the positive impact of digital physical health exercises on musculoskeletal diseases located in the back. Moderate evidence was found for diseases located in the shoulder and hip, whereas evidence for the entire body was limited. Conflicting evidence was found for diseases located in the knee and hand. For patient-reported outcomes, strong evidence was found for impairment and quality of life. Conflicting evidence was found for pain and function. Regarding the medical treatment type, conflicting evidence was found for operative and conservative therapies. Conclusions: Strong to moderate evidence was found for a positive impact on musculoskeletal diseases located in the back, shoulder, and hip and on the patient-reported outcomes of impairment and quality of life. Thus, digital physical health exercises could have a positive effect on a variety of symptoms of musculoskeletal diseases. %M 38261356 %R 10.2196/50616 %U https://mhealth.jmir.org/2024/1/e50616 %U https://doi.org/10.2196/50616 %U http://www.ncbi.nlm.nih.gov/pubmed/38261356 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e49467 %T Design and Implementation of a Brief Digital Mindfulness and Compassion Training App for Health Care Professionals: Cluster Randomized Controlled Trial %A Jaiswal,Satish %A Purpura,Suzanna R %A Manchanda,James K %A Nan,Jason %A Azeez,Nihal %A Ramanathan,Dhakshin %A Mishra,Jyoti %+ Department of Psychiatry, University of California San Diego, 9452 Medical Center Dr, La Jolla, CA, San Diego, CA, 92037, United States, 1 858 232 2855, s2jaiswal@health.ucsd.edu %K compassion %K digital app %K digital health %K digital intervention %K digital mental health %K digital mindfulness %K EEG %K health workers %K healthcare professionals %K mindfulness %K neuroplasticity %K physicians %K training %D 2024 %7 22.1.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Several studies show that intense work schedules make health care professionals particularly vulnerable to emotional exhaustion and burnout. Objective: In this scenario, promoting self-compassion and mindfulness may be beneficial for well-being. Notably, scalable, digital app–based methods may have the potential to enhance self-compassion and mindfulness in health care professionals. Methods: In this study, we designed and implemented a scalable, digital app–based, brief mindfulness and compassion training program called “WellMind” for health care professionals. A total of 22 adult participants completed up to 60 sessions of WellMind training, 5-10 minutes in duration each, over 3 months. Participants completed behavioral assessments measuring self-compassion and mindfulness at baseline (preintervention), 3 months (postintervention), and 6 months (follow-up). In order to control for practice effects on the repeat assessments and calculate effect sizes, we also studied a no-contact control group of 21 health care professionals who only completed the repeated assessments but were not provided any training. Additionally, we evaluated pre- and postintervention neural activity in core brain networks using electroencephalography source imaging as an objective neurophysiological training outcome. Results: Findings showed a post- versus preintervention increase in self-compassion (Cohen d=0.57; P=.007) and state-mindfulness (d=0.52; P=.02) only in the WellMind training group, with improvements in self-compassion sustained at follow-up (d=0.8; P=.01). Additionally, WellMind training durations correlated with the magnitude of improvement in self-compassion across human participants (ρ=0.52; P=.01). Training-related neurophysiological results revealed plasticity specific to the default mode network (DMN) that is implicated in mind-wandering and rumination, with DMN network suppression selectively observed at the postintervention time point in the WellMind group (d=–0.87; P=.03). We also found that improvement in self-compassion was directly related to the extent of DMN suppression (ρ=–0.368; P=.04). Conclusions: Overall, promising behavioral and neurophysiological findings from this first study demonstrate the benefits of brief digital mindfulness and compassion training for health care professionals and compel the scale-up of the digital intervention. Trial Registration: Trial Registration: International Standard Randomized Controlled Trial Number Registry ISRCTN94766568, https://www.isrctn.com/ISRCTN94766568 %M 38252479 %R 10.2196/49467 %U https://mental.jmir.org/2024/1/e49467 %U https://doi.org/10.2196/49467 %U http://www.ncbi.nlm.nih.gov/pubmed/38252479 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48992 %T Acceptability and Feasibility of a Smartphone-Based Real-Time Assessment of Suicide Among Black Men: Mixed Methods Pilot Study %A Adams,Leslie B %A Watts,Thomasina %A DeVinney,Aubrey %A Haroz,Emily E %A Thrul,Johannes %A Stephens,Jasmin Brooks %A Campbell,Mia N %A Antoine,Denis %A Lê Cook,Benjamin %A Joe,Sean %A Thorpe Jr,Roland J %+ Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, United States, 1 410 955 1906, ladams36@jhu.edu %K Black men %K suicide %K ecological momentary assessment %K feasibility %K acceptability %K mixed methods %K smartphone %K real-time assessment %K suicide prevention %K user experience %K behavior %K implementation %K intervention %K mobile phone %D 2024 %7 22.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Suicide rates in the United States have increased recently among Black men. To address this public health crisis, smartphone-based ecological momentary assessment (EMA) platforms are a promising way to collect dynamic, real-time data that can help improve suicide prevention efforts. Despite the promise of this methodology, little is known about its suitability in detecting experiences related to suicidal thoughts and behavior (STB) among Black men. Objective: This study aims to clarify the acceptability and feasibility of using smartphone-based EMA through a pilot study that assesses the user experience among Black men. Methods: We recruited Black men aged 18 years and older using the MyChart patient portal messaging (the patient-facing side of the Epic electronic medical record system) or outpatient provider referrals. Eligible participants self-identified as Black men with a previous history of STB and ownership of an Android or iOS smartphone. Eligible participants completed a 7-day smartphone-based EMA study. They received a prompt 4 times per day to complete a brief survey detailing their STB, as well as proximal risk factors, such as depression, social isolation, and feeling like a burden to others. At the conclusion of each day, participants also received a daily diary survey detailing their sleep quality and their daily experiences of everyday discrimination. Participants completed a semistructured exit interview of 60-90 minutes at the study’s conclusion. Results: In total, 10 participants completed 166 EMA surveys and 39 daily diary entries. A total of 4 of the 10 participants completed 75% (21/28) or more of the EMA surveys, while 9 (90%) out of 10 completed 25% (7/28) or more. The average completion rate of all surveys was 58% (20.3/35), with a minimum of 17% (6/35) and maximum of 100% (35/35). A total of 4 (40%) out of 10 participants completed daily diary entries for the full pilot study. No safety-related incidents were reported. On average, participants took 2.08 minutes to complete EMA prompts and 2.72 minutes for daily diary surveys. Our qualitative results generally affirm the acceptability and feasibility of the study procedures, but the participants noted difficulties with the technology and the redundancy of the survey questions. Emerging themes also addressed issues such as reduced EMA survey compliance and diminished mood related to deficit-framed questions related to suicide. Conclusions: Findings from this study will be used to clarify the suitability of EMA for Black men. Overall, our EMA pilot study demonstrated mixed feasibility and acceptability when delivered through smartphone-based apps to Black men. Specific recommendations are provided for managing safety within these study designs and for refinements in future intervention and implementation science research. International Registered Report Identifier (IRRID): RR2-10.2196/31241 %M 38252475 %R 10.2196/48992 %U https://formative.jmir.org/2024/1/e48992 %U https://doi.org/10.2196/48992 %U http://www.ncbi.nlm.nih.gov/pubmed/38252475 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52835 %T Development and Usability Testing of an mHealth Tool for Trauma-Informed Prevention of Substance Use, HIV Acquisition, and Risky Sexual Behaviors Among Adolescents: Mixed Methods Study %A Danielson,Carla Kmett %A Moreland,Angela %A Hahn,Austin %A Banks,Devin %A Ruggiero,Kenneth J %+ Department of Psychiatry & Behavioral Science, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, United States, 1 8437922945, danielso@musc.edu %K traumatic stress %K prevention %K substance use %K HIV %K qualitative methods %K adolescents %K mobile phone %D 2024 %7 18.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Youth who experience traumatic events are at a substantially higher risk of engaging in substance use and sexual risk behaviors and problems (eg, HIV acquisition) than their non–trauma-exposed counterparts. Evidence-based substance use and risky sexual behavior prevention may reduce the risk of these outcomes. Trauma-focused mental health treatment provides a window of opportunity for the implementation of such preventive work with these youth. However, overburdened clinicians face challenges in adding prevention content while implementing evidence-based treatments. Mobile health (mHealth) tools can help reduce this burden in delivering prevention curricula. Trauma-Informed Prevention for Substance Use and Risky Sexual Behavior (TIPS) is an mHealth app that was developed to aid trauma-focused cognitive behavioral therapy (TF-CBT) clinicians in the implementation of an evidence-based risk behavior prevention curriculum. Objective: The goal of this paper is to describe the rationale for and development of the TIPS app and present the results of a mixed methods approach for the initial evaluation of its usability. Methods: Participants included clinicians (n=11), adolescents (n=11), and caregivers (n=10) who completed qualitative interviews and an adapted version of the Website Analysis and Measurement Inventory. Results: In total, 4 overarching themes emerged from the participants’ answers to the qualitative interview questions, demonstrating a generally positive response to the app. The themes were (1) strength of app content, (2) suggestions about app content, (3) esthetics and usability, and (4) benefits to the patient and session implementation. Clinicians, adolescents, and caregivers all agreed that the content was very relevant to adolescents and used examples and language that adolescents could relate to. All 3 groups also discussed that the content was comprehensive and addressed issues often faced by adolescents. All 3 groups of users made suggestions about the esthetics, which mostly comprised suggestions to change the font, color, or pictures within the app. Of all the groups, adolescents were most positive about the esthetics and usability of the app. Results from the Website Analysis and Measurement Inventory further illustrated the users’ favorable reaction to the TIPS app, with 100% (11/11) of clinicians, 100% (10/10) of caregivers, and most adolescents (7/11, 64%) selecting strongly agree or somewhat agree to the following statement: “This app has much that is of interest to me.” Adolescents generally found the app easier to use than did caregivers and clinicians. Conclusions: The TIPS app shows promise as an mHealth tool for TF-CBT clinicians to integrate evidence-based substance use, risky sexual behavior, and HIV prevention during treatment. Future research, including a randomized controlled trial comparing TF-CBT implementation with and without the inclusion of the app, is necessary to evaluate the feasibility and efficacy of the app in reducing the risk of substance use and risky sexual behavior among trauma-exposed adolescents. Trial Registration: ClinicalTrials.gov NCT03710720; https://clinicaltrials.gov/study/NCT03710720 %M 38236634 %R 10.2196/52835 %U https://formative.jmir.org/2024/1/e52835 %U https://doi.org/10.2196/52835 %U http://www.ncbi.nlm.nih.gov/pubmed/38236634 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52662 %T Testing an Evidence-Based Self-Help Program for Infertility-Related Distress: Protocol for a Randomized Controlled Trial %A Gordon,Jennifer L %A Poulter,Megan M L %A Balsom,Ashley A %A Campbell,Tavis S %+ Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada, 1 306 585 4389, jennifer.gordon@uregina.ca %K anxiety %K cognitive-behavior therapy %K depression %K infertility %K infertility-related distress %K mHealth %D 2024 %7 18.1.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Infertility—the inability to achieve pregnancy despite ≥12 months of focused attempts to conceive—is experienced by 1 in 6 couples. Women typically carry a disproportionate share of the psychological burden associated with infertility, experiencing poor quality of life, and 30%-40% experiencing depressive mood or anxiety. Unfortunately, currently available psychological interventions targeting infertility-related distress are associated with modest effects. Objective: Our team, in collaboration with patient advisors, has designed a self-help intervention for infertility-related distress involving 7 weekly 10-minute videos addressing the cognitive, behavioral, and interpersonal challenges associated with infertility, delivered through a mobile app. A feasibility study suggests that it is well accepted and highly effective in reducing symptoms of anxiety and depressed mood among distressed individuals dealing with infertility. This study represents the next step in this line of research: a fully powered randomized controlled trial comparing the intervention to a waitlist control group. Methods: We will recruit 170 individuals struggling to become pregnant in Canada or the United States to be randomized to our 7-week self-help program or a treatment-as-usual condition. The primary outcome will be fertility quality of life, while secondary outcomes will include depressive symptoms, anxious symptoms, and relationship quality, assessed before and after the program as well as biweekly for 16 weeks following completion of the program. Self-reported health care use and the presence of diagnosed mood and anxiety disorders, assessed through a structured psychiatric interview, will also be assessed immediately following the intervention and at the 16-week follow-up assessment. Treatment adherence and retention will also be recorded throughout the intervention. Multilevel modeling will compare the intervention arm to the treatment-as-usual condition in terms of all continuous outcomes across the 9 measurement points. Logistic regression will be used to assess the occurrence of mood and anxiety disorders in the 2 treatment arms at the posttreatment assessment as well as at the 16-week follow-up. Sensitivity analyses will examine potential treatment moderators: membership in the LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, and asexual) communities, baseline fertility quality of life, cultural background, disability status, and pursuit of conception through medical intervention. Results: We expect our intervention to be more effective than treatment-as-usual in improving all mental health parameters assessed and decreasing health care use related to both mental and reproductive health. Effects are expected to be larger with decreasing baseline quality of life and equally effective regardless of membership in the LGBTQIA+ communities, cultural background, or disability status. Conclusions: If our intervention is successful, this would suggest that it should be scaled up and made publicly available. The availability of this program would fill an important gap in light of the high rates of psychopathology among those experiencing infertility and considering the current lack of effective psychotherapy approaches for infertility. Trial Registration: Clinicaltrials.gov NCT06006936; https://classic.clinicaltrials.gov/ct2/show/NCT06006936 International Registered Report Identifier (IRRID): PRR1-10.2196/52662 %M 38236638 %R 10.2196/52662 %U https://www.researchprotocols.org/2024/1/e52662 %U https://doi.org/10.2196/52662 %U http://www.ncbi.nlm.nih.gov/pubmed/38236638 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50787 %T Effectiveness of Telecare Interventions on Depression Symptoms Among Older Adults: Systematic Review and Meta-Analysis %A Wu,Man %A Li,Chaoyang %A Hu,Ting %A Zhao,Xueyang %A Qiao,Guiyuan %A Gao,Xiaolian %A Zhu,Xinhong %A Yang,Fen %+ School of Nursing, Hubei University of Chinese Medicine, North District, No 16, Huangjiahu West Road, Hongshan District, Wuhan, 430065, China, 86 18062003261, fenyang@hbtcm.edu.cn %K telecare %K depression %K anxiety %K quality of life %K older adults %K meta-analysis %D 2024 %7 17.1.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Depression is the most common psychiatric disorder among older adults. Despite the effectiveness of pharmacological and psychological therapies, many patients with late-life depression (LLD) are unable to access timely treatment. Telecare has been shown to be effective in addressing patients' psychosocial issues, while its effectiveness in serving patients with LLD remains unclear. Objective: This study aimed to evaluate the effectiveness of telecare in reducing depression and anxiety symptoms and improving quality of life (QoL) in patients with LLD. Methods: Databases including the Cochrane Library, Web of Science, PubMed, Embase, and EBSCO were searched for randomized controlled trials (RCTs) evaluating the effectiveness of telecare for LLD from database establishment to December 28, 2022. Results: A total of 12 RCTs involving 1663 participants were identified in this study. The meta-analysis showed that (1) telecare significantly reduced depressive symptoms in patients with LLD compared to those in usual care (UC; standardized mean difference [SMD]=–0.46, 95% CI –0.53 to –0.38; P<.001), with the best improvement observed within 3 months of intervention (SMD=–0.72, 95% CI –1.16 to –0.28; P<.001); (2) other scales appeared more effective than the Patient Health Questionnaire-9 for LLD in telecare interventions (SMD=–0.65, 95% CI –0.96 to –0.35; P<.001); (3) telecare was more effective than telephone-based interventions for remote monitoring of LLD (SMD=–1.13, 95% CI –1.51 to –0.76; P<.001); (4) the reduction of depressive symptoms was more pronounced in patients with LLD with chronic conditions (SMD=–0.67, 95% CI –0.89 to –0.44; P<.001); (5) telecare was more effective for LLD in Europe and the Americas than in other regions (SMD=–0.73, 95% CI –0.99 to –0.47; P<.001); (6) telecare significantly reduced anxiety symptoms in patients with LLD (SMD=–0.53, 95% CI –0.73 to –0.33; P=.02); and (7) there was no significant improvement in the psychological components of QoL in patients with LLD compared to those receiving UC (SMD=0.30, 95% CI 0.18-0.43; P=.80). Conclusions: Telecare is a promising modality of care for treatment, which can alleviate depression and anxiety symptoms in patients with LLD. Continued in-depth research into the effectiveness of telecare in treating depression could better identify where older patients would benefit from this intervention. %M 38231546 %R 10.2196/50787 %U https://mhealth.jmir.org/2024/1/e50787 %U https://doi.org/10.2196/50787 %U http://www.ncbi.nlm.nih.gov/pubmed/38231546 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e49373 %T Effects of mHealth-Based Lifestyle Interventions on Gestational Diabetes Mellitus in Pregnant Women With Overweight and Obesity: Systematic Review and Meta-Analysis %A He,Yirong %A Huang,Chuanya %A He,Qiuyang %A Liao,Shujuan %A Luo,Biru %+ Department of Nursing, West China Second University Hospital, Sichuan University, #No. 20, Section 3, People’s South Road, Chengdu, Sichuan, 610041, China, 86 88570307, luomr@scu.edu.cn %K mobile health %K mHealth %K lifestyle intervention %K gestational diabetes mellitus %K meta-analysis %K mobile phone %D 2024 %7 17.1.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The increasing incidence of gestational diabetes mellitus (GDM) is a global health problem that is more likely to occur in pregnant women with overweight or obesity. Adhering to a healthy lifestyle is associated with a reduced risk of GDM. With the development of IT, mobile health (mHealth) interventions have become widely available in health care. However, there are no definitive conclusions on the effectiveness of mHealth-based lifestyle interventions in preventing GDM. Objective: This study aims to evaluate the impact of mHealth-based lifestyle interventions on GDM and other pregnancy outcomes in pregnant women with overweight or obesity. Methods: A systematic literature search was conducted in 5 English databases (MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL) and 4 Chinese databases (CBM, CNKI, Vip, and Wanfang) to identify randomized controlled trials (RCTs) on the effectiveness of mHealth-based interventions for GDM from inception to January 10, 2023. In total, 2 authors independently screened the studies and extracted the data. The quality of the included studies was examined using the Cochrane risk-of-bias tool. Data synthesis was conducted using Review Manager (version 5.4; The Cochrane Collaboration). Results: A total of 16 RCTs with 7351 participants were included in this study. The included studies were published between 2014 and 2021 and were conducted in China, the United States, Australia, New Zealand, the United Kingdom, Ireland, and Norway. The sample sizes of the studies ranged from 75 to 2202, and the duration of the mHealth-based lifestyle interventions ranged from 4 to 28 weeks. Compared with usual care, mHealth-based lifestyle interventions significantly reduced the incidence of GDM (odds ratio [OR] 0.74, 95% CI 0.56-0.96; P=.03; I2=65%), preterm birth (OR 0.65, 95% CI 0.48-0.87; P=.004; I2=25%), macrosomia (OR 0.59, 95% CI 0.40-0.87; P=.008; I2=59%), and gestational weight gain (mean difference=−1.12 kg, 95% CI −1.44 to −0.80; P<.001; I2=43%). The subgroup analysis showed that interventions delivered via apps (OR 0.55, 95% CI 0.37-0.83; P=.004; I2=44%), provided by obstetricians (OR 0.69, 95% CI 0.51-0.93; P=.02; I2=60%), and targeted at Asian populations (OR 0.44, 95% CI 0.34-0.58; P<.001; I2=0%) and that used the International Association of Diabetes and Pregnancy Study Groups diagnostic criteria (OR 0.58, 95% CI 0.39-0.86; P=.007; I2=69%) showed a statistically significant reduction in the risk of GDM. Conclusions: mHealth-based lifestyle interventions had a favorable impact on the prevention of GDM in pregnant women with overweight and obesity. Future studies need to further explore the potential of mHealth-based interventions for GDM through better design and more rigorous large-scale RCTs. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021286995; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=286995 %M 38231555 %R 10.2196/49373 %U https://mhealth.jmir.org/2024/1/e49373 %U https://doi.org/10.2196/49373 %U http://www.ncbi.nlm.nih.gov/pubmed/38231555 %0 Journal Article %@ 2561-7605 %I %V 6 %N %P e48646 %T Identifying Preferred Appearance and Functional Requirements of Aged Care Robots Among Older Chinese Immigrants: Cross-Sectional Study %A Chiu,Ching-Ju %A Lo,Yi-Hsuan %A Montayre,Jed %A Abu-Odah,Hammoda %A Chen,Mei-Lan %A Zhao,Ivy Yan %K robotic technology services %K appearance %K function %K aged care %K immigrant %K Chinese %K robot %K robots %K robotic %K robotics %K older adults %K elderly %K preference %K cross sectional %K cross-sectional %K survey %K healthy aging %K aging in place %K social %K isolation %K companion %K companionship %K Asian %K Asian population %K population %K population studies %K aging %D 2023 %7 8.11.2023 %9 %J JMIR Aging %G English %X Background: Older Chinese immigrants constitute the largest older Asian ethnic population in New Zealand. Aging in a foreign land can be complex, presenting increasing challenges for gerontology scholars, practitioners, and policy makers. Older Chinese immigrants are more susceptible to experiencing loneliness and social isolation compared to native older people, primarily due to language, transportation, and cultural barriers. These factors subsequently impact their physical and mental health. With advancements in robotic technology, aged care robots are being applied to support older people with their daily living needs. However, studies on using robots with older immigrants living in the community are sparse. Their preferences for the appearance and function of aged care robots are unclear, which impacts the acceptance and usability of robots, highlighting the need for a user-centered design approach. Objective: This study aims to explore older Chinese immigrants’ needs and preferences toward the appearance and function of aged care robots and to examine their relationships with the demographic characteristics of participants. Methods: A cross-sectional design was used in this study, which was undertaken between March and May 2020. A total of 103 participants completed a web-based survey. Results: The average age of participants was 68.7 (SD 5.5) years. The results suggest that 41.7% (n=43) of the 103 participants preferred a humanlike adult appearance, while 32% (n=33) suggested an animallike appearance. These participants reported higher scores in both rigorousness and friendliness compared to others who preferred different robot appearances. Participants expressed a greater preference for the functions of housework assistance (n=86, 83.5%), language translation (n=79, 76.7%), health monitoring (n=78, 75.7%), facial expressions (n=77, 74.8%), news reading (n=66, 64.1%), and security monitoring (n=65, 63.1%). These preferences were found to be significantly associated with marital status, financial status, and duration of immigration. Conclusions: To support immigrant populations to age well in a foreign country and address the growing shortage of health and social professionals, it is important to develop reliable robotic technology services that are tailored based on the needs and preferences of individuals. We collected and compared the perspectives of immigrant and nonimmigrant participants on using robots to support aging in place. The results on users’ needs and preferences inform robotic technology services, indicating a need to prioritize older Chinese immigrants’ preference toward aged care robots that perform housework assistance, language translation, and health and safety monitoring, and robots with humanlike features. %R 10.2196/48646 %U https://aging.jmir.org/2023/1/e48646 %U https://doi.org/10.2196/48646 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e46397 %T Effectiveness of Metaverse Space–Based Exercise Video Distribution in Young Adults: Randomized Controlled Trial %A Mizuta,Rami %A Maeda,Noriaki %A Tashiro,Tsubasa %A Suzuki,Yuta %A Kuroda,Sayo %A Ishida,Ayano %A Oda,Sakura %A Watanabe,Tomoya %A Tamura,Yuki %A Komiya,Makoto %A Urabe,Yukio %+ Department of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan, 81 082 257 5405, yurabe@hiroshima-u.ac.jp %K exercise video distribution %K exercise %K metaverse %K physical activity %K web-based intervention %D 2024 %7 16.1.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In response to the serious lack of physical activity among young adults, recent attempts have been made to encourage young people to exercise through exercise video distribution. However, merely distributing videos does not lead to improved physical activity levels. Metaverse space, which enables web-based interaction through avatars, allows users to watch exercise videos in the same space as other avatars. Objective: This study explored whether exercise video distribution using metaverse space is effective in improving physical activity levels, along with mental health and locomotive function, among young people. Methods: In this parallel-group randomized controlled trial participants were recruited using printed poster displays. A total of 48 young adults aged between 18 and 30 years were assigned to 3 groups of 16 each: the metaverse, YouTube, and control group. To encourage exercise, the metaverse group was given an exercise video each week with a load of around 4-8 metabolic equivalents of tasks (METs) for 8 videos delivered in the metaverse space. The YouTube group was sent a URL on YouTube every week to view exercise videos with the same content as the metaverse group. The control group was given no special instructions. The intervention period was 8 weeks. Pre- and postintervention physical activity, well-being, locomotive syndrome risk tests, and social capital were measured. Although this study was not blinded to the participants, the measurers did not know to which group the participants belonged. Mixed model repeated-measures analyses and a post hoc Wilcoxon signed rank sum test were performed to detect the effects of the intervention in all groups. Results: The results of the mixed model repeated-measures analyses showed a significant interaction between groups and before and after the intervention for total physical activity (metaverse group: pre 737.1, SD 609.5 METs/week, post 1575.4, SD 1071.8 METs/week; YouTube group: pre 661.7, SD 710.7 METs/week, post 911.9, SD 1103.3 METs/week; and control group: pre 930.6, SD 665.1 METs/week, post 844.7, SD 701.8 METs/week; P=.04) but none for the indicators of well-being (P=.40), locomotive function scale (P=.17), and social capital (P=.23). A post hoc test showed a significant increase in physical activity in the metaverse group before and after the intervention (P=.006). Conclusions: This study is the first to show that delivering exercise videos through metaverse space can increase physical activity in young adults by providing a gathering space for individuals similarly motivated for exercise practice. This way, the sense of isolation during exercise is reduced compared with merely distributing videos on YouTube. The use of metaverse space in health promotion is likely to spread, and this study provides a useful reference for its exploration. Trial Registration: ClinicalTrials.gov NCT06019156; https://ichgcp.net/clinical-trials-registry/NCT06019156 %M 38227355 %R 10.2196/46397 %U https://mhealth.jmir.org/2024/1/e46397 %U https://doi.org/10.2196/46397 %U http://www.ncbi.nlm.nih.gov/pubmed/38227355 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50222 %T Exploring Adolescents’ Attitudes Toward Mental Health Apps: Concurrent Mixed Methods Study %A Høgsdal,Helene %A Kyrrestad,Henriette %A Rye,Marte %A Kaiser,Sabine %+ Regional Centre for Child and Youth Mental Health and Child Welfare - North, Faculty of Health Sciences, UiT The Arctic University of Norway, Campus Tromsø, Tromsø, 9019, Norway, 47 77646619, helene.hogsdal@uit.no %K mental health applications %K mental health %K adolescents %K adolescent %K youth %K mobile health %K app %K apps %K application %K applications %K opinion %K opinions %K cross sectional %K survey %K surveys %K questionnaire %D 2024 %7 15.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescence is a critical time in which many psychological disorders develop. Mental health promotion is important, especially during this period. In recent years, an increasing number of mobile apps geared toward mental health promotion and preventing mental illness have been developed specifically for adolescents, with the goal of strengthening their mental health and well-being. Objective: This study aims to explore adolescents’ attitudes toward mental health apps, as well as the perceived usefulness of mental health apps. Methods: In this mixed methods study, a total of 183 adolescents (mean age 15.62, SD 3.21 years) answered a cross-sectional questionnaire, with 10 questions (eg, “What do you think about mental health apps in general?”). To complement the quantitative findings, individual interviews were conducted with 9 adolescents, during which they could elaborate on their opinions about mental health apps. Results: A total of 30% (56/183) of the adolescents in the quantitative study had used a mental health app. Over half of the respondents (77/126, 61.1%) reported that they would use a mental health app if they had a mental health problem as well as that they thought mental health apps were somewhat or very useful (114/183, 62.3%). Availability was the most frequently reported advantage of mental health apps (107/183, 58.8%). Possible associated costs of mental health apps were the most frequently mentioned barrier to their use (87/183, 47.5%). Findings from the interviews also pointed to the importance of the availability of mental health apps as well as their credibility and potential to provide adolescents with autonomy when seeking mental health advice and help. Conclusions: Overall, the results indicate that adolescents have a positive attitude toward and an interest in mental health apps. However, adolescents are also more or less unaware of such apps, which might be one reason why they are often not used. The findings of this study have important implications for future research on mental health apps and for developers of mental health apps that target young people. The insights gained from this study can inform the development of more effective mental health apps that better meet the needs and preferences of adolescents. %M 38224474 %R 10.2196/50222 %U https://formative.jmir.org/2024/1/e50222 %U https://doi.org/10.2196/50222 %U http://www.ncbi.nlm.nih.gov/pubmed/38224474 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e45854 %T A Behaviorally Informed Mobile App to Improve the Nutritional Quality of Grocery Shopping (SwapSHOP): Feasibility Randomized Controlled Trial %A Piernas,Carmen %A Lee,Charlotte %A Hobson,Alice %A Harmer,Georgina %A Payne Riches,Sarah %A Noreik,Michaela %A Jebb,Susan A %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, 200 Woodstock Rd, Oxford, OX26GG, United Kingdom, 44 07752599266, carmen.piernas-sanchez@phc.ox.ac.uk %K swaps %K mobile app %K supermarket %K food purchases %K diet %K randomized controlled trial %K mobile phone %D 2024 %7 11.1.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Interventions targeting the nutritional quality of grocery shopping have the potential to help improve diet and health outcomes. Objective: This study aims to assess the feasibility and acceptability of receiving advice on healthier food purchases through SwapSHOP, a behaviorally informed smartphone app that allows users to scan barcodes of grocery products from the United Kingdom, providing nutritional information and personalized swap suggestions to encourage healthier purchases. Methods: We randomized adult volunteers in a 6-arm parallel-group controlled feasibility trial. Participants used the SwapSHOP app to record their grocery shopping during a 2-week run-in period and were individually randomized in a 3:1 ratio to either intervention or control arms within 3 strata related to a nutrient of concern of their choice: saturated fat (SFA), sugar, or salt. Participants randomized to the intervention received the SwapSHOP app with a healthier swap function, goal setting, and personalized feedback. Participants in the control group were instructed to use a simpler version of the app to log all their food purchases without receiving any guidance or advice. The primary outcome was the feasibility of progression to a full trial, including app use and follow-up rates at 6 weeks. The secondary outcomes included other feasibility outcomes, process and qualitative measures, and exploratory effectiveness outcomes to assess changes in the nutrient content of the purchased foods. Results: A total of 112 participants were randomized into 3 groups: SFA (n=38 intervention and n=13 control), sugar (n=40 intervention and n=15 control), and salt (n=5 intervention and n=1 control, not analyzed). The 2 progression criteria were met for SFA and sugar: 81% (30/37) and 87% (34/39) of intervention participants in the SFA and sugar groups, respectively, used the app to obtain healthier swaps, and 89% (68/76) of intervention participants and 96% (23/24) of control participants completed follow-up by scanning all purchases over the follow-up period. The process and qualitative outcomes suggested that the intervention was acceptable and has the potential to influence shopping behaviors. There were reductions of −0.56 g per 100 g (95% CI −1.02 to −0.19) in SFA and −1 g per 100 g (95% CI −1.97 to −0.03) in total sugars across all food purchases in the intervention groups. Conclusions: People were willing to use the SwapSHOP app to help reduce sugar and SFA (but not salt) in their grocery shopping. Adherence and follow-up rates suggest that a full trial is feasible. Given the suggestive evidence indicating that the intervention resulted in reductions in sugars and SFA, a definitive trial is necessary to target improvements in health outcomes. Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN13022312; https://doi.org/10.1186/ISRCTN13022312 %M 38206671 %R 10.2196/45854 %U https://mhealth.jmir.org/2024/1/e45854 %U https://doi.org/10.2196/45854 %U http://www.ncbi.nlm.nih.gov/pubmed/38206671 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e47321 %T Use and Engagement With Low-Intensity Cognitive Behavioral Therapy Techniques Used Within an App to Support Worry Management: Content Analysis of Log Data %A Farrand,Paul %A Raue,Patrick J %A Ward,Earlise %A Repper,Dean %A Areán,Patricia %+ Clinical Education, Development and Research, Faculty of Health and Life Sciences, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Reserach, Perry Road, Exeter, EX4 4QG, United Kingdom, 44 01392725793, p.a.farrand@exeter.ac.uk %K cognitive behavioral therapy %K low-intensity %K mCBT %K app %K log data %K worry management %K CBT %K management %K application %K therapy %K implementation %K treatment %K symptoms %K anxiety %K worry %K engagement %D 2024 %7 10.1.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Low-intensity cognitive behavioral therapy (LICBT) has been implemented by the Improving Access to Psychological Therapies services across England to manage excessive worry associated with generalized anxiety disorder and support emotional well-being. However, barriers to access limit scalability. A solution has been to incorporate LICBT techniques derived from an evidence-based protocol within the Iona Mind Well-being app for Worry management (IMWW) with support provided through an algorithmically driven conversational agent. Objective: This study aims to examine engagement with a mobile phone app to support worry management with specific attention directed toward interaction with specific LICBT techniques and examine the potential to reduce symptoms of anxiety. Methods: Log data were examined with respect to a sample of “engaged” users who had completed at least 1 lesson related to the Worry Time and Problem Solving in-app modules that represented the “minimum dose.” Paired sample 2-tailed t tests were undertaken to examine the potential for IMWW to reduce worry and anxiety, with multivariate linear regressions examining the extent to which completion of each of the techniques led to reductions in worry and anxiety. Results: There was good engagement with the range of specific LICBT techniques included within IMWW. The vast majority of engaged users were able to interact with the cognitive behavioral therapy model and successfully record types of worry. When working through Problem Solving, the conversational agent was successfully used to support the user with lower levels of engagement. Several users engaged with Worry Time outside of the app. Forgetting to use the app was the most common reason for lack of engagement, with features of the app such as completion of routine outcome measures and weekly reflections having lower levels of engagement. Despite difficulties in the collection of end point data, there was a significant reduction in severity for both anxiety (t53=5.5; P<.001; 95% CI 2.4-5.2) and low mood (t53=2.3; P=.03; 95% CI 0.2-3.3). A statistically significant linear model was also fitted to the Generalized Anxiety Disorder–7 (F2,51=6.73; P<.001), while the model predicting changes in the Patient Health Questionnaire–8 did not reach significance (F2,51=2.33; P=.11). This indicates that the reduction in these measures was affected by in-app engagement with Worry Time and Problem Solving. Conclusions: Engaged users were able to successfully interact with the LICBT-specific techniques informed by an evidence-based protocol although there were lower completion rates of routine outcome measures and weekly reflections. Successful interaction with the specific techniques potentially contributes to promising data, indicating that IMWW may be effective in the management of excessive worry. A relationship between dose and improvement justifies the use of log data to inform future developments. However, attention needs to be directed toward enhancing interaction with wider features of the app given that larger improvements were associated with greater engagement. %M 38029300 %R 10.2196/47321 %U https://mhealth.jmir.org/2024/1/e47321 %U https://doi.org/10.2196/47321 %U http://www.ncbi.nlm.nih.gov/pubmed/38029300 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e46656 %T The Association of eHealth Literacy Skills and mHealth Application Use Among US Adults With Obesity: Analysis of Health Information National Trends Survey Data %A Shaw Jr,George %A Castro,Bianca A %A Gunn,Laura H %A Norris,Keith %A Thorpe Jr,Roland J %+ Department of Public Health Sciences, School of Data Science, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223-0001, United States, 1 7045620021, gshaw11@charlotte.edu %K accessibility %K eHealth literacy %K mHealth %K multivariable logistic regression %K obesity %K smartphones %D 2024 %7 10.1.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical inactivity and a poor diet are modifiable behaviors that contribute to obesity. Obesity is a well-recognized risk factor for chronic diseases, including diabetes. Mobile health (mHealth) apps can play an important adjuvant role in preventing and treating chronic diseases and promoting positive health behavior change among people with obesity, and eHealth literacy skills have the potential to impact mHealth app use. Objective: The purpose of this study was to explore the associations between the 2 dimensions, access and application, of eHealth literacy skills and mHealth app use among US adults (≥18 years of age) with obesity (BMI ≥30 kg/m2). Methods: Data were obtained from February to June 2020 using the Health Information National Trends Survey 5. A total of 1079 respondents met the inclusion criteria of adults with obesity and owners of smartphones. Individual associations between mHealth app use and sociodemographic variables were explored using weighted chi-square and 2-tailed t tests. A multivariable weighted logistic regression model was fitted, and adjusted odds ratios (ORs) of using mHealth apps with corresponding 95% CIs were reported across multiple sociodemographic variables. An Ising model-weighted network visualization was produced. A receiver operating characteristic curve was calculated, and the area under the curve was reported with the corresponding Delong 95% CI. Results: A majority of respondents were female (550/923, 59.6%) or non-Hispanic White (543/923, 58.8%). Individuals in households earning less than US $50,000 comprised 41.4% (382/923) of the sample. All sociodemographic variables were found to be univariately significant at the 5% level, except employment and region. Results from the multivariable weighted logistic regression model showed that the adjusted odds of using an mHealth app are 3.13 (95% CI 1.69-5.80) and 2.99 (95% CI 1.67-5.37) times higher among those with an access eHealth literacy skill of using an electronic device to look for health or medical information for themselves and an application eHealth literacy skill of using electronic communications with a doctor or doctor’s office, respectively. Several sociodemographic variables were found to be significant, such as education, where adjusted ORs comparing subgroups to the lowest educational attainment were substantial (ORs ≥7.77). The network visualization demonstrated that all eHealth literacy skills and the mHealth app use variable were positively associated to varying degrees. Conclusions: This work provides an initial understanding of mHealth app use and eHealth literacy skills among people with obesity, identifying people with obesity subpopulations who are at risk of a digital health divide. Future studies should identify equitable solutions for people with obesity (as well as other groups) and their use of mHealth apps. %M 38198196 %R 10.2196/46656 %U https://mhealth.jmir.org/2024/1/e46656 %U https://doi.org/10.2196/46656 %U http://www.ncbi.nlm.nih.gov/pubmed/38198196 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e49302 %T Short-Term Effect of a Health Promotion Intervention Based on the Electronic 12-Hour Dietary Recall (e-12HR) Smartphone App on Adherence to the Mediterranean Diet Among Spanish Primary Care Professionals: Randomized Controlled Clinical Trial %A Béjar,Luis María %A Mesa-Rodríguez,Pedro %A García-Perea,María Dolores %+ Department of Preventive Medicine and Public Health, Institute of Anatomy, School of Medicine, University of Seville, 3rd Floor, Sánchez-Pizjuán Avenue, Seville, 41009, Spain, 34 954551771, lmbprado@us.es %K primary care professionals %K Mediterranean diet %K smartphone applications %K smartphone apps %K health promotion %K Mediterranean diet adherence %K food group %D 2024 %7 8.1.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The World Health Organization has called for addressing the growing burden of noncommunicable diseases (NCDs) by promoting healthy lifestyles among the population. Regarding patient health, primary care professionals (PCPs) are the first line of care who can positively influence patients’ behavior and lifestyle habits. However, a significant percentage of PCPs do not lead a healthy lifestyle. Therefore, addressing their health behaviors may be the key to substantially increasing health promotion advice in general practice. The Mediterranean diet has been extensively studied, and there is strong evidence of it being a dietary pattern for the prevention of NCDs, in addition to its significant environmental, sociocultural, and local economics benefits. Objective: This study focused only on the dietary aspect of the PCPs’ lifestyle. The primary objective was to evaluate the effect of using the Electronic 12-Hour Dietary Recall (e-12HR) smartphone app to improve diet, specifically to promote adherence to the Mediterranean diet (AMD), among PCPs. The secondary objectives were to establish the usability of the e-12HR app and to determine AMD among PCPs. Methods: An individual-level randomized, controlled, and single-blind clinical trial was conducted with 2 parallel groups: a control group (CG), using the nonfeedback version of the e-12HR app, and an intervention group (IG), using the feedback version of the e-12HR app. The level of human involvement was fully automated through the use of the app. There was a 28-day follow-up period. Participants were PCPs (medicine or nursing) recruited offline at one of the selected primary care centers (Andalusia, Spain, Southern Europe), of both sexes, over 18 years old, possessing a smartphone, and having smartphone literacy. Results: The study response rate was 73% (71 of 97 PCPs), with 27 (38%) women and 44 (62%) men: 40 (56%) PCPs in the CG and 31 (44%) in the IG. At baseline, AMD was medium (mean Mediterranean Diet Serving Score [MDSS] index 9.45, range 0-24), with 47 (66%) PCPs with a medium/high MDSS index. There were significant statistical improvements (CG vs IG, in favor of the IG) at week 4 (no significant statistical differences at baseline): +25.6% for the MDSS index (P=.002) and +213.1% for the percentage with a medium/high MDSS index (P=.001). In relation to specific food groups, there were significant statistical improvements for fruits (+33.8%, P=.02), vegetables (+352%, P=.001), nuts (+184%, P=.02), and legumes (+75.1%, P=.03). The responses to the usability rating questionnaire were satisfactory. Conclusions: The results support recommending the use of the e-12HR app as a tool to contribute to improving diet and preventing NCDs among PCPs, while positively influencing patient dietary behavior and preventing diet-related NCDs among patients. Trial Registration: ClinicalTrials.gov NCT05532137; https://clinicaltrials.gov/study/NCT05532137 %M 38190226 %R 10.2196/49302 %U https://mhealth.jmir.org/2024/1/e49302 %U https://doi.org/10.2196/49302 %U http://www.ncbi.nlm.nih.gov/pubmed/38190226 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52969 %T Remote Delivery of the Cuidándome Telehealth Intervention for Self-Management of Depression and Anxiety Among Latina Immigrant Women: Randomized Controlled Trial %A Alvarez,Carmen %A Aryal,Subhash %A Vrany,Elizabeth %A Sanchez R,Maria Jose %A Quiles,Rosalphie %A Escobar-Acosta,Lia %A Hill-Briggs,Felicia %+ School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA, 19104, United States, 1 2158980715, alcarmen@nursing.upenn.edu %K Latina immigrant %K mental health %K depression %K anxiety %K problem-solving %K intervention study %K trauma-informed %K depressive %K Latinx %K Latin %K Latino %K Latina %K Hispanic %K Spanish %K immigrant %K immigrants %K survivor %K child %K children %K childhood %K trauma %K traumatic %K adverse %K telehealth %K telemedicine %K eHealth %K digital health %K feasibility %K acceptability %K randomized %K controlled trial %K controlled trials %K mobile phone %D 2024 %7 8.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Growing evidence suggests that Latina immigrant survivors of adverse childhood experiences (ACEs) are at increased risk for developing and remaining with either depression or anxiety or both symptoms. This study examined the feasibility and acceptability of a telehealth intervention—Cuidándome (quee-DAN-doh-meh, “taking care of myself”). Cuidándome is a 10-week, patient-centered, trauma-informed intervention delivered by a trained facilitator that promotes self-management of depression and anxiety symptoms through improved problem-solving skills and strategies. Objective: The aim of this study was to examine the feasibility and acceptability of Cuidándome delivered remotely (via Zoom) with Latina immigrant ACE survivors with either depression or anxiety or both symptoms. We also estimated the effect sizes associated with the intervention on decreasing depression and anxiety symptoms and improving social problem–solving styles. Methods: We evaluated Cuidándome using a randomized controlled trial design. Latina immigrants (N=47) who had experienced at least 1 ACE and had at least mild depression or anxiety symptoms were randomized to Cuidándome or a comparison group delivered by trained facilitators. We assessed for changes in depression and anxiety symptoms as well as social problem–solving styles at baseline, post intervention, and 3- and 6-month follow-up. Results: Analyses indicated significant decreases over time within both Cuidándome and comparison groups for depression and anxiety symptoms and maladaptive problem-solving. The intervention effect was largest for anxiety; at 6-month follow-up, Cuidándome participants had significantly lower anxiety scores than the comparison group. In addition, we observed a greater average point reduction in depression symptoms at 6 months among Cuidándome participants (5.7 points) than in the comparison group (3.7 points). Conclusions: A mental health program delivered via Zoom by a trained facilitator was feasible and acceptable to Latina immigrant women and can be beneficial for reducing anxiety and depression symptoms. More research is needed to assess the effectiveness of Cuidándome among a powered sample size of Latina immigrants. Trial Registration: ISRCTN Registry ISRCTN16668518; https://www.isrctn.com/ISRCTN16668518 %M 38190239 %R 10.2196/52969 %U https://formative.jmir.org/2024/1/e52969 %U https://doi.org/10.2196/52969 %U http://www.ncbi.nlm.nih.gov/pubmed/38190239 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50293 %T Dissemination Strategies for mHealth Apps: Systematic Review %A Moungui,Henri Claude %A Nana-Djeunga,Hugues Clotaire %A Anyiang,Che Frankline %A Cano,Mireia %A Ruiz Postigo,Jose Antonio %A Carrion,Carme %+ Universitat Oberta de Catalunya, Rambla del Poblenou, 156, Barcelona, 08018, Spain, 34 672192283, henrimoungui@yahoo.fr %K mobile health %K mHealth %K mobile health apps %K mHealth apps %K dissemination %K marketing strategies %K digital marketing %K engagement %K onboarding %K systematic review %K systematic %K market %K marketing %K app %K apps %K adoption %K consumer %K mobile phone %D 2024 %7 5.1.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Among the millions of mobile apps in existence, thousands fall under the category of mobile health (mHealth). Although the utility of mHealth apps has been demonstrated for disease diagnosis, treatment data management, and health promotion strategies, to be effective they must reach and be used by their target audience. An appropriate marketing strategy can ensure that apps reach potential users and potentially convert them to actual users. Such a strategy requires definitions of target end users, communication channels, and advertising content, as well as a timeline for effectively reaching and motivating end users to adopt and maintain engagement with the mHealth app. Objective: The aim of this study was to identify strategies and elements that ensure that end users adopt and remain engaged with mHealth apps. Methods: A systematic search of the PubMed, PsycINFO, Scopus, and CINAHL databases was conducted for suitable studies published between January 1, 2018, and September 30, 2022. Two researchers independently screened studies for inclusion, extracted data, and assessed the risk of bias. The main outcome was dissemination strategies for mHealth apps. Results: Of the 648 papers retrieved from the selected databases, only 10 (1.5%) met the inclusion criteria. The marketing strategies used in these studies to inform potential users of the existence of mHealth apps and motivate download included both paid and unpaid strategies and used various channels, including social media, emails, printed posters, and face-to-face communication. Most of the studies reported a combination of marketing concepts used to advertise their mHealth apps. Advertising messages included instructions on where and how to download and install the apps. In most of the studies (6/10, 60%), instructions were oriented toward how to use the apps and maintain engagement with a health intervention. The most frequently used paid marketing platform was Facebook Ads Manager (2/10, 20%). Advertising performance was influenced by many factors, including but not limited to advertising content. In 1 (10%) of the 10 studies, animated graphics generated the greatest number of clicks compared with other image types. The metrics used to assess marketing strategy effectiveness were number of downloads; nonuse rate; dropout rate; adherence rate; duration of app use; and app usability over days, weeks, or months. Additional indicators such as cost per click, cost per install, and clickthrough rate were mainly used to assess the cost-effectiveness of paid marketing campaigns. Conclusions: mHealth apps can be disseminated via paid and unpaid marketing strategies using various communication channels. The effects of these strategies are reflected in download numbers and user engagement with mHealth apps. Further research could provide guidance on a framework for disseminating mHealth apps and encouraging their routine use. %M 38180796 %R 10.2196/50293 %U https://mhealth.jmir.org/2024/1/e50293 %U https://doi.org/10.2196/50293 %U http://www.ncbi.nlm.nih.gov/pubmed/38180796 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51658 %T Effectiveness of the QuitSure Smartphone App for Smoking Cessation: Findings of a Prospective Single Arm Trial %A Pandya,Apurvakumar %A K S,Mythri %A Mishra,Shweta %A Bajaj,Kriti %+ Parul Institute of Public Health, Parul University, At & Post - Limda, Waghodia, Vadodara, 391760, India, 91 9825558237, drapurvakumar@gmail.com %K smoking %K nicotine dependence %K smoking cessation %K QuitSure app %K smartphone application %K mHealth %K mobile health %K app %K apps %K application %K applications %K nicotine %K smoke %K smoker %K quit %K quitting %K cessation %K abstinence %K mobile phone %D 2023 %7 29.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital therapies, especially smartphone apps for active and continuous smoking cessation support, are strongly emerging as an alternative smoking cessation therapy. In the Indian context, there is a growing interest in the use of app-based smoking cessation programs; however, there is limited evidence regarding their effectiveness in achieving long-term continuous abstinence. Objective: This study aimed to evaluate the long-term abstinence effect (up to 30-d abstinence postprogram completion) of a smartphone app, QuitSure, for smoking cessation in active smokers from India. Methods: In this prospective single-arm study, participants who signed up for the QuitSure app were enrolled in this study. The primary end point was the prolonged abstinence (PA) rate from weeks 1 to 4 (day 7 to day 30). Furthermore, data for withdrawal symptoms, relapse reasons, and reasons for not continuing the program were also assessed. Results: The quit rate was calculated considering only the participants who followed up and completed the survey sent to them (per protocol) at day 7 and at day 30, respectively. The PA rate at day 7 was found to be 64.5% (111/172; 95% CI 56% to 72%), and the PA rate at day 30 was found to be 55.8% (72/129; 95% CI 45% to 65%). Within the 7-day abstinence period, 60.4% (67/111) of the participants did not have any withdrawal symptoms. The most common mild withdrawal symptoms were mild sleep disturbance (21/111, 18.9%), mild digestive changes (19/111, 17.1%), and coughing (17/111, 15.3%). Severe withdrawal symptoms were rare, with only 5.4% (6/111) experiencing them. For those achieving 30-day postprogram abstinence, 85% (61/72) had no mild withdrawal symptoms, and 99% (71/72) had no severe withdrawal symptoms. Among successful quitters at day 7, a total of 72.1% (80/111) reported minimal to no cravings, which increased to 88% (63/72) at day 30. Furthermore, 78% (56/72) of those with PA at day 30 reported no change in weight or reduced weight. Among participants experiencing relapse, 48% (28/58) cited intense cravings, 28% (16/58) mentioned facing a tragedy, and 26% (15/58) reported relapsing due to alcohol consumption. The PA rates as a result of the QuitSure program were found to be better than those reported in the results of other smoking-cessation app programs’ studies. Conclusions: The QuitSure app yields high PA rates and ameliorates symptoms associated with smoking cessation. In order to obtain conclusive evidence regarding the effectiveness and efficacy of the QuitSure program, future research should include appropriate control measures. Nevertheless, the QuitSure program can serve as a valuable adjunct to a conventional smoking cessation treatment program to aid sustained abstinence. %M 38157243 %R 10.2196/51658 %U https://formative.jmir.org/2023/1/e51658 %U https://doi.org/10.2196/51658 %U http://www.ncbi.nlm.nih.gov/pubmed/38157243 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e54284 %T Exploring Generation Z and Young Millennials’ Perspectives of a Spiritual Self-Care App and Their Spiritual Identity (Skylight): Qualitative Semistructured Interview Study %A Park,Susanna Y %A Yourell,Jacqlyn %A McAlister,Kelsey L %A Huberty,Jennifer %+ Skylight, Radiant Foundation, 55 N 300 W Suite 800, Salt Lake City, UT, 84101, United States, 1 720 675 7228, syjpark@gmail.com %K Gen Z %K Generation Z %K millennial %K GenZennials %K millennials %K young adult %K young adults %K spirituality %K spiritual %K self-care %K mental health %K sleep %K mobile health %K app %K apps %K digital health %K experience %K experiences %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K acceptance %K interview %K interviews %K thematic analysis %K mobile phone %D 2023 %7 28.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Generation Z and young millennials (ages 18-35 years), collectively referred to as GenZennials, are connected to technology and the internet like no other generation before them. This has mental health implications, such as increased rates of anxiety and stress. Recent research has shown that app-based mental health interventions can be useful to address such mental health concerns. However, spirituality is an untapped resource, especially since GenZennials largely identify as spiritual and already integrate spiritual practices into their self-care. Objective: There were four objectives to this study: (1) comprehensively explore reasons why GenZennials use a spiritual self-care app (ie, Skylight; Radiant Foundation), (2) understand how GenZennials identify spiritually, (3) understand the app’s relevance to GenZennials, and (4) gather feedback and suggestions to improve the app. Methods: Semistructured interviews were conducted with 23 GenZennials (ages 18-35 years; mean 28.7, SD 5.0 years; n=20, 87% female) who used the Skylight app. Interviews were 30 to 60 minutes and conducted on Zoom. Thematic analysis was used to analyze interviews. Results: Five major categories emerged from the analysis, each encompassing one to several themes: (1) reasons for using the Skylight app, (2) content favorites, (3) defining spiritual identity, (4) relevance to GenZennials, and (5) overall improvement recommendations. Participants used the app for various reasons including to relax, escape, or ground themselves; improve mood; and enhance overall health and wellness. Participants also cited the app’s variety of content offerings and its free accessibility as their primary reasons for using it. Most participants identified themselves as solely spiritual (8/23/35%) among the options provided (ie, spiritual or religious or both), and they appreciated the app’s inclusive content. Participants felt that the app was relevant to their generation as it offered modern content (eg, spiritual self-care activities and short content). Participants recommended adding more personalization capabilities, content, and representation to the app. Conclusions: This is the first study to qualitatively explore GenZennials’ perspectives and the use of a spiritual self-care app. Our findings should inform the future creation and improvement of spiritual self-care apps aimed at cultivating GenZennials’ spiritual and mental well-being. Future research is warranted to examine the effects of using a spiritual self-care app on GenZennial mental health. %M 38064199 %R 10.2196/54284 %U https://formative.jmir.org/2023/1/e54284 %U https://doi.org/10.2196/54284 %U http://www.ncbi.nlm.nih.gov/pubmed/38064199 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e53933 %T Evaluating the Impact of an App-Delivered Mindfulness Meditation Program to Reduce Stress and Anxiety During Pregnancy: Pilot Longitudinal Study %A Balsam,Donna %A Bounds,Dawn T %A Rahmani,Amir M %A Nyamathi,Adeline %+ School of Nursing, San Diego State University, 5500 Campanile Mall, San Diego, CA, 92182, United States, 1 6195942540, dbalsam@sdsu.edu %K mindfulness app %K pregnancy %K pregnant %K maternal %K obstetric %K obstetrics %K stress %K anxiety %K heart rate variability %K mindfulness %K mHealth %K mobile health %K app %K apps %K applications %K mental health %K meditation %K mind-body %K complementary %K alternative %K heart rate %K sleep %K mobile phone %D 2023 %7 25.12.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Stress and anxiety during pregnancy are extremely prevalent and are associated with numerous poor outcomes, among the most serious of which are increased rates of preterm birth and low birth weight infants. Research supports that while in-person mindfulness training is effective in reducing pregnancy stress and anxiety, there are barriers limiting accessibility. Objective: The aim of this paper is to determine if mindfulness meditation training with the Headspace app is effective for stress and anxiety reduction during pregnancy. Methods: A longitudinal, single-arm trial was implemented with 20 pregnant women who were instructed to practice meditation via the Headspace app twice per day during the month-long trial. Validated scales were used to measure participant’s levels of stress and anxiety pre- and postintervention. Physiological measures reflective of stress (heart rate variability and sleep) were collected via the Oura Ring. Results: Statistically significant reductions were found in self-reported levels of stress (P=.005), anxiety (P=.01), and pregnancy anxiety (P<.0001). Hierarchical linear modeling revealed a statistically significant reduction in the physiological data reflective of stress in 1 of 6 heart rate variability metrics, the low-frequency power band, which decreased by 13% (P=.006). A total of 65% of study participants (n=13) reported their sleep improved during the trial, and 95% (n=19) stated that learning mindfulness helped with other aspects of their lives. Participant retention was 100%, with 65% of participants (n=13) completing about two-thirds of the intervention, and 50% of participants (n=10) completing ≥95%. Conclusions: This study found evidence to support the Headspace app as an effective intervention to aid in stress and anxiety reduction during pregnancy. %M 38145479 %R 10.2196/53933 %U https://pediatrics.jmir.org/2023/1/e53933 %U https://doi.org/10.2196/53933 %U http://www.ncbi.nlm.nih.gov/pubmed/38145479 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48335 %T Preferences in the Willingness to Download an mHealth App: Discrete Choice Experimental Study in Spain, Germany, and the Netherlands %A Folkvord,Frans %A Bol,Nadine %A Stazi,Giacomo %A Peschke,Lutz %A Lupiáñez-Villanueva,Francisco %+ Tilburg School of Humanities and Digital Sciences, Tilburg University, Warrandelaan, Tilburg, 5037 AB, Netherlands, 31 682240480, fransfolkvord@gmail.com %K mHealth adoption %K discrete choice task %K mobile apps %K self-monitoring %K willingness %K mobile health app %K mobile app %K mobile health %K mHealth %K adoption %K mHealth tools %K health care cost %K effectiveness %K mobile phone %D 2023 %7 25.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the worldwide growth in mobile health (mHealth) tools and the possible benefits for both patients and health care providers, the adoption of mHealth is low, and only a limited number of studies have examined the intention to download mHealth apps. Objective: In this study, we investigated individuals’ preferences in the adoption of a health app. Methods: We conducted a discrete choice experimental study in 3 countries (Spain: n=800, Germany: n=800, and the Netherlands: n=416) with 4 different attributes and levels (ie, price: €1.99 vs €4.99 [a currency exchange rate of €1=US $1.09 is applicable] vs for free, data protection: data protection vs no information, recommendation: patients’ association vs doctors, and manufacturer: medical association vs pharmaceutical company). Participants were randomly assigned. For the analyses, we used the conditional logistic model separately for each country. Results: The results showed that price and data protection were considered important factors that significantly increased the probability to download an mHealth app. In general, the source of the recommendation and the manufacturer affected the probability to download the mHealth app less. However, in Germany and the Netherlands, we found that if the app was manufactured by a pharmaceutical company, the probability to download the mHealth app decreased. Conclusions: mHealth tools are highly promising to reduce health care costs and increase the effectiveness of traditional health interventions and therapies. Improving data protection, reducing costs, and creating sound business models are the major driving forces to increase the adoption of mHealth apps in the future. It is thereby essential to create trustworthy standards for mobile apps, whereby prices, legislation concerning data protection, and health professionals can have a leading role to inform the potential consumers. %M 38145470 %R 10.2196/48335 %U https://formative.jmir.org/2023/1/e48335 %U https://doi.org/10.2196/48335 %U http://www.ncbi.nlm.nih.gov/pubmed/38145470 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48958 %T Developing Mood-Based Computer-Tailored Health Communication for Smoking Cessation: Feasibility Randomized Controlled Trial %A Lee,Donghee N %A Sadasivam,Rajani S %A Stevens,Elise M %+ Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, UMass Chan Medical School, 368 Plantation St, Worcester, MA, 01605, United States, 1 774 455 4871, donghee.lee10@umassmed.edu %K mood %K smoking cessation messages %K computer-tailored health communication %K innovation %K smoking %K cessation %K digital intervention %K effectiveness %K text mining %K adult %K motivation %D 2023 %7 22.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Computer-tailored health communication (CTHC), a widely used strategy to increase the effectiveness of smoking cessation interventions, is focused on selecting the best messages for an individual. More recently, CTHC interventions have been tested using contextual information such as participants’ current stress or location to adapt message selection. However, mood has not yet been used in CTCH interventions and may increase their effectiveness. Objective: This study aims to examine the association of mood and smoking cessation message effectiveness among adults who currently smoke cigarettes. Methods: In January 2022, we recruited a web-based convenience sample of adults who smoke cigarettes (N=615; mean age 41.13 y). Participants were randomized to 1 of 3 mood conditions (positive, negative, or neutral) and viewed pictures selected from the International Affective Picture System to induce an emotional state within the assigned condition. Participants then viewed smoking cessation messages with topics covering five themes: (1) financial costs or rewards, (2) health, (3) quality of life, (4) challenges of quitting, and (5) motivation or reasons to quit. Following each message, participants completed questions on 3 constructs: message receptivity, perceived relevance, and their motivation to quit. The process was repeated 30 times. We used 1-way ANOVA to estimate the association of the mood condition on these constructs, controlling for demographics, cigarettes per day, and motivation to quit measured during the pretest. We also estimated the association between mood and outcomes for each of the 5 smoking message theme categories. Results: There was an overall statistically significant effect of the mood condition on the motivation to quit outcome (P=.02) but not on the message receptivity (P=.16) and perceived relevance (P=.86) outcomes. Participants in the positive mood condition reported significantly greater motivation to quit compared with those in the negative mood condition (P=.005). Participants in the positive mood condition reported higher motivation to quit after viewing smoking cessation messages in the financial (P=.03), health (P=.01), quality of life (P=.04), and challenges of quitting (P=.03) theme categories. We also compared each mood condition and found that participants in the positive mood condition reported significantly greater motivation to quit after seeing messages in the financial (P=.01), health (P=.003), quality of life (P=.01), and challenges of quitting (P=.01) theme categories than those in the negative mood condition. Conclusions: Our findings suggest that considering mood may be important for future CTHC interventions. Because those in the positive mood state at the time of message exposure were more likely to have greater quitting motivations, smoking cessation CTHC interventions may consider strategies to help improve participants’ mood when delivering these messages. For those in neutral and negative mood states, focusing on certain message themes (health and motivation to quit) may be more effective than other message themes. %M 38133916 %R 10.2196/48958 %U https://formative.jmir.org/2023/1/e48958 %U https://doi.org/10.2196/48958 %U http://www.ncbi.nlm.nih.gov/pubmed/38133916 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e46910 %T Mobile Prenatal Education and Its Impact on Reducing Adverse Pregnancy Outcomes: Retrospective Real-World Study %A Hao,Jie %A Yang,Lin %A Wang,Yaxin %A Lan,Yushan %A Xu,Xiaowei %A Wang,Ziyang %A Li,Zanmei %A Ma,Liangkun %A Li,Jiao %A Zhang,Suhan %A Sun,Yin %+ Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, China, 86 10 69151305, goldhill@163.com %K adverse pregnancy outcome %K mobile prenatal education %K pregnancy %K real-world study %K retrospective study %D 2023 %7 20.12.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pregnancy is a pivotal phase in a woman’s life, demanding special attention to ensure maternal and fetal health. Prenatal education plays a vital role in promoting healthy pregnancies and reducing adverse outcomes for pregnant women. Mobile prenatal education programs have gained traction due to their accessibility and timeliness, especially in light of finite health care resources and the constraints imposed by the COVID-19 pandemic. Objective: This study aims to develop and evaluate the effectiveness of a mobile-based prenatal education program in improving pregnancy outcomes. Methods: We developed a mobile-based prenatal education curriculum in collaboration with a multidisciplinary maternal care team from Peking Union Medical College Hospital (PUMCH) in Beijing, China. Data were retrospectively collected from 1941 pregnant women who had registered for the PUMCH mobile prenatal education program and subsequently delivered at PUMCH between May 2021 and August 2022. The study compared pregnancy outcomes between the completing group, which were pregnant women who had completed at least 1 course, and the noncompleting group. We also analyzed differences among course topics within the completing group and assessed course topic popularity among pregnant women. Results: The PUMCH mobile prenatal education curriculum consists of 436 courses across 9 topics. Out of the participants, a total of 1521 did not complete any courses, while 420 completed at least 1 course. Compared with the noncompleting group, pregnant women who completed courses exhibited a significant reduction in the risk of gestational diabetes mellitus, induced abortion, postpartum infection, fetal intrauterine distress, and neonatal malformation. Among those in the completing group, a total of 86% (361/420) started course completion during the first and second trimesters. Furthermore, completing courses related to topics of pregnancy psychology and pregnancy nutrition was associated with reduced risks of premature rupture of membranes and small for gestational age infants, respectively. Pregnancy psychology and postpartum recovery were the preferred topics among pregnant women. Conclusions: The study demonstrates the potential of mobile-based prenatal education programs in improving pregnancy outcomes and supporting health care providers in delivering effective prenatal education. The rise of mobile prenatal education presents an opportunity to improve maternal and child health outcomes. Further research and broader implementation of such programs are warranted to continually improve maternal and child health. %M 38117555 %R 10.2196/46910 %U https://mhealth.jmir.org/2023/1/e46910 %U https://doi.org/10.2196/46910 %U http://www.ncbi.nlm.nih.gov/pubmed/38117555 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47987 %T The Effectiveness of Strategies to Improve User Engagement With Digital Health Interventions Targeting Nutrition, Physical Activity, and Overweight and Obesity: Systematic Review and Meta-Analysis %A Grady,Alice %A Pearson,Nicole %A Lamont,Hannah %A Leigh,Lucy %A Wolfenden,Luke %A Barnes,Courtney %A Wyse,Rebecca %A Finch,Meghan %A Mclaughlin,Matthew %A Delaney,Tessa %A Sutherland,Rachel %A Hodder,Rebecca %A Yoong,Sze Lin %+ School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 (02) 4924 6499, alice.grady@newcastle.edu.au %K engagement %K digital health interventions %K systematic review %K nutrition %K physical activity %K obesity %D 2023 %7 19.12.2023 %9 Review %J J Med Internet Res %G English %X Background: Digital health interventions (DHIs) are effective in improving poor nutrition, physical inactivity, overweight and obesity. There is evidence suggesting that the impact of DHIs may be enhanced by improving user engagement. However, little is known about the overall effectiveness of strategies on engagement with DHIs. Objective: This study aims to assess the overall effectiveness of strategies to improve engagement with DHIs targeting nutrition, physical activity, and overweight or obesity and explore associations between strategies and engagement outcomes. The secondary aim was to explore the impact of these strategies on health risk outcomes. Methods: The MEDLINE, Embase, PsycINFO, CINAHL, CENTRAL, Scopus, and Academic Source Complete databases were searched up to July 24, 2023. Eligible studies were randomized controlled trials that evaluated strategies to improve engagement with DHIs and reported on outcomes related to DHI engagement (use or user experience). Strategies were classified according to behavior change techniques (BCTs) and design features (eg, supplementary emails). Multiple-variable meta-analyses of the primary outcomes (usage and user experience) were undertaken to assess the overall effectiveness of strategies. Meta-regressions were conducted to assess associations between strategies and use and user experience outcomes. Synthesis of secondary outcomes followed the “Synthesis Without Meta-Analysis” guidelines. The methodological quality and evidence was assessed using the Cochrane risk-of-bias tool, and the Grading of Recommendations Assessment, Development, and Evaluation tool respectively. Results: Overall, 54 studies (across 62 publications) were included. Pooled analysis found very low-certainty evidence of a small-to-moderate positive effect of the use of strategies to improve DHI use (standardized mean difference=0.33, 95% CI 0.20-0.46; P<.001) and very low-certainty evidence of a small-to-moderate positive effect on user experience (standardized mean difference=0.29, 95% CI 0.07-0.52; P=.01). A significant positive association was found between the BCTs social support (effect size [ES]=0.40, 95% CI 0.14-0.66; P<.001) and shaping knowledge (ES=0.39, 95% CI 0.03-0.74; P=.03) and DHI use. A significant positive association was found among the BCTs social support (ES=0.70, 95% CI 0.18-1.22; P=.01), repetition and substitution (ES=0.29, 95% CI 0.05-0.53; P=.03), and natural consequences (ES=0.29, 95% CI 0.05-0.53; P=.02); the design features email (ES=0.29, 95% CI 0.05-0.53; P=.02) and SMS text messages (ES=0.34, 95% CI 0.11-0.57; P=.01); and DHI user experience. For secondary outcomes, 47% (7/15) of nutrition-related, 73% (24/33) of physical activity–related, and 41% (14/34) of overweight- and obesity-related outcomes reported an improvement in health outcomes. Conclusions: Although findings suggest that the use of strategies may improve engagement with DHIs targeting such health outcomes, the true effect is unknown because of the low quality of evidence. Future research exploring whether specific forms of social support, repetition and substitution, natural consequences, emails, and SMS text messages have a greater impact on DHI engagement is warranted. Trial Registration: PROSPERO CRD42018077333; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=77333 %M 38113062 %R 10.2196/47987 %U https://www.jmir.org/2023/1/e47987 %U https://doi.org/10.2196/47987 %U http://www.ncbi.nlm.nih.gov/pubmed/38113062 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43809 %T Efficacy of an mHealth App to Support Patients’ Self-Management of Hypertension: Randomized Controlled Trial %A Liu,Fang %A Song,Ting %A Yu,Ping %A Deng,Ning %A Guan,Yingping %A Yang,Yang %A Ma,Yuanji %+ Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai, 200031, China, 86 21 64041990, myj-215@163.com %K mobile app %K mHealth %K mobile health %K smartphone %K high blood pressure %K medication adherence %K reminder %K health education %K motivation %K hypertension control %K hypertension %K blood pressure %K self-management %D 2023 %7 19.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Hypertension is a significant global disease burden. Mobile health (mHealth) offers a promising means to provide patients with hypertension with easy access to health care services. Yet, its efficacy needs to be validated, especially in lower-income areas with a high-salt diet. Objective: This study aims to assess the efficacy of an mHealth app–based intervention in supporting patients’ self-management of hypertension. Methods: A 2-arm randomized controlled trial was conducted among 297 patients with hypertension at the General Hospital of Ningxia Medical University, Ningxia Hui Autonomous Region, China. Participants selected via convenience sampling were randomly allocated into intervention and control groups. Intervention group participants were trained and asked to use an mHealth app named Blood Pressure Assistant for 6 months. They could use the app to record and upload vital signs, access educational materials, and receive self-management reminders and feedback from health care providers based on the analysis of the uploaded data. Control group participants received usual care. Blood pressure (BP) and 2 questionnaire surveys about hypertension knowledge and lifestyle behavior were used to assess all participants at baseline and 6 months. Data analysis was performed with SPSS software using 2-tailed t tests and a chi-square test. Results: There were no significant differences in baseline characteristics and medication use between the 2 groups (all P>.05). After 6 months, although both groups show a significant pre-post improvement (P<.001 each), the BP control rate (ie, the proportion of patients with a systolic BP of <140 mm Hg and diastolic BP of <90 mm Hg) in the intervention group was better than that in the control group (100/111, 90.1% vs 75/115, 65.2%; P<.001). The mean systolic and diastolic BP were significantly reduced by 25.83 (SD 8.99) and 14.28 (SD 3.74) mm Hg in the intervention group (P<.001) and by 21.83 (SD 6.86) and 8.87 (SD 4.22) mm Hg in the control group (P<.001), respectively. The differences in systolic and diastolic BP between the 2 groups were significant (P<.001 and P=.01, respectively). Hypertension knowledge significantly improved only in the intervention group in both pre-post and intergroup comparisons (both P<.001). However, only intragroup improvement was observed for lifestyle behaviors in the intervention group (P<.001), including medication adherence (P<.001), healthy diet (P=.02), low salt intake (P<.001), and physical exercises (P=.02), and no significant difference was observed in the control group or on intergroup comparisons. Conclusions: This research shows that the mHealth app–based intervention has the potential to improve patient health knowledge and support self-management among them toward a healthier lifestyle, including medication adherence, low-salt diets, and physical exercises, thereby achieving optimal BP control. Further research is still needed to verify the specific effects of these interventions. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900026437; https://www.chictr.org.cn/showproj.html?proj=38801 %M 38113071 %R 10.2196/43809 %U https://www.jmir.org/2023/1/e43809 %U https://doi.org/10.2196/43809 %U http://www.ncbi.nlm.nih.gov/pubmed/38113071 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42510 %T Comparing Web-Based and Blended Training for Coping With Challenges of Flexible Work Designs: Randomized Controlled Trial %A Althammer,Sarah Elena %A Wöhrmann,Anne Marit %A Michel,Alexandra %+ Federal Institute for Occupational Safety and Health, Friedrich-Henkel-Weg 1-25, Dortmund, 44149, Germany, 49 23190712071, sarah.althammer@alumni.uni-heidelberg.de %K blended training %K web-based training %K psychological detachment %K well-being %K work-life balance %D 2023 %7 19.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Workers with flexible work designs (FWDs) face specific challenges, such as difficulties in detaching from work, setting boundaries between work and private life, and recovering from work. Objective: This study evaluated the effectiveness of an intervention in improving the recovery, work-life balance, and well-being of workers with FWDs compared with a waitlist control group. It also compares the effectiveness of a web-based training format and blended training format. Methods: In the web-based training format, participants individually completed 6 web-based modules and daily tasks over 6 weeks, learning self-regulation strategies to meet the particular challenges of FWDs. In the blended training format, participants attended 3 group sessions in addition to completing the 6 web-based modules. In a randomized controlled trial, participants were assigned to a web-based intervention group (196/575, 34.1%), blended intervention group (198/575, 34.4%), or waitlist control group (181/575, 31.5%). Study participants self-assessed their levels of primary outcomes (psychological detachment, satisfaction with work-life balance, and well-being) before the intervention, after the intervention, at a 4-week follow-up, and at a 6-month follow-up. The final sample included 373 participants (web-based intervention group: n=107, 28.7%; blended intervention group: n=129, 34.6%; and control group: n=137, 36.7%). Compliance was assessed as a secondary outcome. Results: The results of multilevel analyses were in line with our hypothesis that both training formats would improve psychological detachment, satisfaction with work-life balance, and well-being. We expected blended training to reinforce these effects, but blended training participants did not profit more from the intervention than web-based training participants. However, they reported to have had more social exchange, and blended training participants were more likely to adhere to the training. Conclusions: Both web-based and blended training are effective tools for improving the recovery, work-life balance, and well-being of workers with FWDs. Group sessions can increase the likelihood of participants actively participating in web-based modules and exercises. Trial Registration: German Clinical Trials Register DRKS00032721; https://drks.de/search/en/trial/DRKS00032721 %M 38113084 %R 10.2196/42510 %U https://www.jmir.org/2023/1/e42510 %U https://doi.org/10.2196/42510 %U http://www.ncbi.nlm.nih.gov/pubmed/38113084 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44762 %T Narrowing the Patient–Physician Gap Based on Self-Reporting and Monthly Hepatologist Feedback for Patients With Alcohol-Related Liver Disease: Interventional Pilot Study Using a Journaling Smartphone App %A Yamashiki,Noriyo %A Kawabata,Kyoko %A Murata,Miki %A Ikeda,Shunichiro %A Fujimaki,Takako %A Suwa,Kanehiko %A Seki,Toshihito %A Aramaki,Eiji %A Naganuma,Makoto %+ Department of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Fumizono 10-15, Moriguchi, Osaka, 570-8507, Japan, 81 6 6992 1001, yamashno@takii.kmu.ac.jp %K alcohol-related liver disease %K alcohol use disorder %K alcoholism %K smartphone %K mobile health %D 2023 %7 19.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Screening and intervention for alcohol use disorders (AUDs) are recommended to improve the prognosis of patients with alcohol-related liver disease (ALD). Most patients’ smartphone app diaries record drinking behavior for self-monitoring. A smartphone app can be expected to also be helpful for physicians because it can provide rich patient information to hepatologists, leading to suitable feedback. We conducted this prospective pilot study to assess the use of a smartphone app as a journaling tool and as a self-report–based feedback source for patients with ALD. Objective: The aims of this study were assessment of whether journaling (self-report) and self-report–based feedback can help patients maintain abstinence and improve liver function data. Methods: This pilot study used a newly developed smartphone journaling app for patients, with input data that physicians can review. After patients with ALD were screened for harmful alcohol use, some were invited to use the smartphone journaling app for 8 weeks. Their self-reported alcohol intake, symptoms, and laboratory data were recorded at entry, week 4, and week 8. Biomarkers for alcohol use included gamma glutamyl transferase (GGT), percentage of carbohydrate-deficient transferrin to transferrin (%CDT), and GGT-CDT (GGT-CDT= 0.8 × ln[GGT] + 1.3 × ln[%CDT]). At each visit, their recorded data were reviewed by a hepatologist to evaluate changes in alcohol consumption and laboratory data. The relation between those outcomes and app usage was also investigated. Results: Of 14 patients agreeing to participate, 10 completed an 8-week follow-up, with diary input rates between 44% and 100% of the expected days. Of the 14 patients, 2 withdrew from clinical follow-up, and 2 additional patients never used the smartphone journaling app. Using the physician’s view, a treating hepatologist gave feedback via comments to patients at each visit. Mean self-reported alcohol consumption dropped from baseline (100, SD 70 g) to week 4 (13, SD 25 g; P=.002) and remained lower at week 8 (13, SD 23 g; P=.007). During the study, 5 patients reported complete abstinence. No significant changes were found in mean GGT and mean %CDT alone, but the mean GGT-CDT combination dropped significantly from entry (5.2, SD 1.2) to the week 4 visit (4.8, SD 1.1; P=.02) and at week 8 (4.8, SD 1.0; P=.01). During the study period, decreases in mean total bilirubin (3.0, SD 2.4 mg/dL to 2.4, SD 1.9 mg/dL; P=.01) and increases in mean serum albumin (3.0, SD 0.9 g/dL to 3.3, SD 0.8 g/dL; P=.009) were recorded. Conclusions: These pilot study findings revealed that a short-term intervention with a smartphone journaling app used by both patients and treatment-administering hepatologists was associated with reduced drinking and improved liver function. Trial Registration: UMIN CTR UMIN000045285; http://tinyurl.com/yvvk38tj %R 10.2196/44762 %U https://formative.jmir.org/2023/1/e44762/ %U https://doi.org/10.2196/44762 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e51531 %T Digital Therapeutic Intervention for Women in the UK Armed Forces Who Consume Alcohol at a Hazardous or Harmful Level: Protocol for a Randomized Controlled Trial %A Williamson,Grace %A Carr,Ewan %A Fear,Nicola T %A Dymond,Simon %A King,Kate %A Simms,Amos %A Goodwin,Laura %A Murphy,Dominic %A Leightley,Daniel %+ King's Centre for Military Health Research, King's College London, Strand, London, SE5 9RJ, United Kingdom, 44 (0)20 7123 4843, daniel.leightley@kcl.ac.uk %K mental health %K digital health %K DrinksRation %K women %K woman %K United Kingdom %K Armed Forces %K alcohol %K randomized controlled trial %K RCT %K controlled trials %K study protocol %K alcohol misuse %K smartphone app %K mobile app %K mobile health %K mHealth %K veterans %K women veterans %K mobile phone %K digital therapeutic %D 2023 %7 19.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol misuse is common in the United Kingdom Armed Forces (UKAF), with prevalence significantly higher than in the general population. To date, digital health initiatives to support alcohol misuse have focused on male individuals, who represent approximately 89% of the UKAF. However, female veterans drink disproportionally more than female members of the public. Objective: This 2-arm participant-blinded (single-blinded) confirmatory randomized controlled trial (RCT) aims to assess the efficacy of a brief alcohol intervention (DrinksRation) in reducing weekly self-reported alcohol consumption between baseline and a 3-month follow-up (day 84) among women who have served in the UKAF. Methods: In this 2-arm single-blinded RCT, a smartphone app that includes interactive user-focused features tailored toward the needs of female veterans and designed to enhance participants’ motivations to reduce the amount of alcohol they consume is compared with the UK Chief Medical Officer guidance on alcohol consumption. The trial will be conducted among women who have served at least 1 day of paid service in the UKAF. Recruitment, consent, and data collection will be carried out automatically through the DrinksRation app or the BeAlcoholSmart platform. The primary outcome is change in self-reported weekly alcohol consumption between baseline (day 0) and the 3-month follow-up (day 84) measured using the Timeline Follow Back for alcohol consumption. The secondary outcome is the change in the Alcohol Use Disorders Identification Test score measured at baseline and 3-month follow-up between the control and intervention groups. The process evaluation measures include (1) app use and (2) usability ratings as measured by the mHealth App Usability Questionnaire. Results: RCT recruitment will begin in January 2024 and last for 5 months. We aim to complete all data collection, including interviews, by May 2024. Conclusions: This study will assess whether a smartphone app tailored to the needs of women who have served in the UKAF is efficacious in reducing self-reported alcohol consumption. If successful, the digital therapeutics platform could be used not only to support women who have served in the UKAF but also for other conditions and disorders. Trial Registration: ClinicalTrials.gov NCT05970484; https://www.clinicaltrials.gov/study/NCT05970484 International Registered Report Identifier (IRRID): PRR1-10.2196/51531 %M 38113103 %R 10.2196/51531 %U https://www.researchprotocols.org/2023/1/e51531 %U https://doi.org/10.2196/51531 %U http://www.ncbi.nlm.nih.gov/pubmed/38113103 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49352 %T Mobile Phone Technology for Preventing HIV and Related Youth Health Problems, Sexual Health, Mental Health, and Substance Use Problems in Southwest Uganda (Youth Health SMS): Protocol for a Pilot Randomized Controlled Trial %A Kreniske,Philip %A Namuyaba,Olive Imelda %A Kasumba,Robert %A Namatovu,Phionah %A Ssewamala,Fred %A Wingood,Gina %A Wei,Ying %A Ybarra,Michele L %A Oloya,Charlotte %A Tindyebwa,Costella %A Ntulo,Christina %A Mujune,Vincent %A Chang,Larry W %A Mellins,Claude A %A Santelli,John S %+ Community Health and Social Sciences Department, Graduate School of Public Health and Health Policy, City University of New York, 55 W 125th Street, New York, NY, 10027, United States, 1 (646) 364 9600, philip.kreniske@sph.cuny.edu %K adolescence %K PrEP %K pre-exposure prophylaxis %K HIV %K mental health %K substance use %K sexual health %K mobile phones %K randomized controlled trial %K adaptation %K Uganda %D 2023 %7 19.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: East and Southern Africa have the highest HIV incidence and prevalence in the world, with adolescents and young adults being at the greatest risk. Despite effective combination prevention tools, including the recently available pre-exposure prophylaxis (PrEP), HIV incidence among adolescents and young adults in Uganda remains high, and PrEP use remains low. Mental health and substance use (behavioral health) play a role in sexual behavior and decision-making, contributing to an increase in the risk for acquiring HIV. Interventions that target multiple HIV risk factors, including sexual and mental health and problematic substance use, are crucial to ending the HIV epidemic. Yet few interventions addressing HIV related health disparities and comorbidities among adolescents and young adults in East and Southern Africa currently exist. Objective: This study aims to evaluate the acceptability and feasibility of Kirabo, an SMS text message intervention informed by the information, motivation, and behavior model and to be disseminated through secondary schools. The study will gather preliminary estimates of Kirabo’s effectiveness in increasing HIV testing and linking users to mental health counselors. Methods: We identified Mobile 4 Reproductive Health for adaptation using the assessment, decision, administration, production, topical experts, integration, training, testing (ADAPT-ITT) framework. Mobile 4 Reproductive Health is an evidence-based automated 2-way SMS text messaging and interactive voice response platform that offers sexual and reproductive health information and links users to HIV clinics in East Africa. Through ADAPT-ITT we refined our approach and created Kirabo, an SMS text message–based intervention for linking adolescents and young adults to health services, including HIV testing and mental health counseling. We will conduct a 2-arm randomized controlled trial in Masaka, Uganda. Adolescents (N=200) will be recruited from local schools. Baseline sociodemographic characteristics, HIV test history, and behavioral health symptoms will be assessed. We will evaluate acceptability and feasibility using surveys, interviews, and mobile phone data. The preliminary efficacy of Kirabo in increasing HIV testing and linking users to mental health counselors will be evaluated immediately after the intervention and at the 3-month follow-up. We will also assess the intervention’s impact on self-efficacy in testing for HIV, adopting PrEP, and contacting a mental health counselor. Results: Intervention adaptation began in 2019. A pretest was conducted in 2021. The randomized controlled trial, including usability and feasibility assessments and effectiveness measurements, commenced in August 2023. Conclusions: Kirabo is a tool that assists in the efforts to end the HIV epidemic by targeting the health disparities and comorbidities among adolescents in Uganda. The intervention includes local HIV clinic information, PrEP information, and behavioral health screening, with referrals as needed. Increasing access to prevention strategies and mitigating factors that make adolescents and young adults susceptible to HIV acquisition can contribute to global efforts to end the HIV epidemic. Trial Registration: ClinicalTrials.gov NCT05130151; https://clinicaltrials.gov/study/NCT05130151 International Registered Report Identifier (IRRID): DERR1-10.2196/49352 %M 38113102 %R 10.2196/49352 %U https://www.researchprotocols.org/2023/1/e49352 %U https://doi.org/10.2196/49352 %U http://www.ncbi.nlm.nih.gov/pubmed/38113102 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e53094 %T Evaluation of a Cannabis Harm Reduction Intervention for People With First-Episode Psychosis: Protocol for a Pilot Multicentric Randomized Trial %A Coronado-Montoya,Stephanie %A Abdel-Baki,Amal %A Côté,José %A Crockford,David %A Dubreucq,Simon %A Fischer,Benedikt %A Lachance-Touchette,Pamela %A Lecomte,Tania %A L'Heureux,Sophie %A Ouellet-Plamondon,Clairélaine %A Roy,Marc-André %A Tatar,Ovidiu %A Tibbo,Phillip %A Villeneuve,Marie %A Wittevrongel,Anne %A Jutras-Aswad,Didier %+ Research Centre, Centre Hospitalier de l’Université de Montréal, CHUM Research Centre, 900 St-Denis, Viger Tower, room R05.746, Montréal, QC, H2X 1P1, Canada, 1 514 890 8000 ext 35703, didier.jutras-aswad@umontreal.ca %K cannabis, psychosis, harm reduction, pilot, mobile health %K psychological intervention %K mHealth %K young adult %K schizophrenia %K motivational interviewing %K intervention %K RCT %K randomized %K controlled trial %K controlled trials %K multi-centric %K young people %K clinical trials %K feasibility %K perspectives %K perspective %K evidence-based %D 2023 %7 18.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cannabis use is highly prevalent in young people with first-episode psychosis (FEP). Most report cannabis use and are often diagnosed with a cannabis use disorder upon admission to specialized services for psychosis. Cannabis use in this population is associated with worse clinical and psychosocial outcomes, rendering it an important clinical target. Despite this, few cannabis-specific interventions have been developed for FEP and empirically evaluated through randomized controlled trials. Most evaluated interventions have targeted cannabis abstinence, with limited efficacy, but none have centered on harm reduction outcomes for people with FEP who use cannabis. Early intervention services (EIS), the standard of care for FEP, have not successfully addressed problematic cannabis use in people with FEP either. Clinical trials are needed to explore the potential of harm reduction strategies, although these should be preceded by robust pilot studies to establish optimal design and approaches. Objective: Recognizing the need for harm reduction strategies for individuals with FEP who use cannabis and based on research on patients’ preferences supporting harm reduction interventions, we developed a mobile app–based cannabis harm reduction intervention for this population. This intervention is called Cannabis Harm–reducing Application to Manage Practices Safely (CHAMPS). Here, we describe the protocol for a multicenter, 2-arm, parallel group, randomized pilot trial evaluating the acceptability of CHAMPS for people with FEP who use cannabis and the feasibility of conducting a full-scale trial in this population using CHAMPS. The impact on key clinical outcomes will also be explored. Methods: This pilot trial aims to recruit 100 young people with FEP using cannabis from 6 Canadian EIS clinics. Participants will be randomized in a 1:1 ratio to CHAMPS+EIS or EIS-only. CHAMPS acceptability will be assessed using completion rates for the intervention arm. Trial feasibility will be assessed using a retention rate for randomized participants. Secondary outcomes will explore tendencies of change in the use of protective behavioral strategies and in motivation to change strategies. Exploratory outcomes include cannabis use–related problems, other substance use, the severity of dependence, psychotic symptoms, and health care service use. Results: Recruitment began in December 2021. Data collection and analysis are expected to be completed in early 2024. Study results describing CHAMPS acceptability and trial feasibility will then be submitted for publication in a peer-reviewed journal. Conclusions: CHAMPS uniquely combines evidence-based approaches, patient perspectives, and mobile health technology to support harm reduction in people with FEP who use cannabis. Attaining adequate acceptability and feasibility through this trial may justify further exploration of harm reduction tools, particularly within the context of conducting a larger-scale randomized controlled trial. This pilot trial has the potential to advance knowledge for researchers and clinicians regarding a feasible and user-acceptable research design in the cannabis and early psychosis fields. Trial Registration: ClinicalTrials.gov NCT04968275, https://clinicaltrials.gov/ct2/show/NCT04968275 International Registered Report Identifier (IRRID): DERR1-10.2196/53094 %M 38109196 %R 10.2196/53094 %U https://www.researchprotocols.org/2023/1/e53094 %U https://doi.org/10.2196/53094 %U http://www.ncbi.nlm.nih.gov/pubmed/38109196 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48704 %T Wearable Activity Trackers That Motivate Women to Increase Physical Activity: Mixed Methods Study %A Peterson,Neil E %A Bate,Danielle A %A Macintosh,Janelle LB %A Trujillo Tanner,Corinna %+ College of Nursing, Brigham Young University, 500 Spencer W. Kimball Tower, Provo, UT, 84602, United States, 1 8014224893, neil-peterson@byu.edu %K physical activity %K women %K motivation %K wearable activity trackers %K mobile health %K mHealth %K self-determination %K mobile phone %D 2023 %7 14.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical inactivity is a significant public health concern, particularly among women in the United States. Wearable activity trackers (WATs) have been proposed as a potential solution to increase awareness of and engagement in physical activity (PA). However, to be effective, WATs must include features and designs that encourage daily use. Objective: This study aims to explore the features and designs of WATs that appeal to women and determine whether devices with these attributes are effective motivators for women to be physically active. Methods: A mixed methods study guided by the self-determination theory was conducted among 15 women. Participants trialed 3 WATs with influence in their respective accessory domains: Apple Watch for the wrist; Oura Ring for the finger; and Bellabeat Leaf Urban for multiple sites (it can be worn as a bracelet, necklace, or clip). Participants documented their daily PA levels and rated their satisfaction with each device’s comfort, features, and motivational effect. Focus groups were also conducted to gather additional feedback and experiences within the a priori areas of comfort, features, and motivation. Results: Behavioral Regulation in Exercise Questionnaire–2 scores indicated that most participants (14/15, 93%) were motivated at baseline (amotivation score: mean 0.13, SD 0.45), but on average, participants did not meet the national minimum PA guidelines according to the self-reported Physical Activity Vital Sign questionnaire (moderate to vigorous PA score: mean 144, SD 97.5 min/wk). Mean WAT wear time was 16.9 (SD 4.4) hours, 19.4 (SD 5.3) hours, and 20.4 (SD 4.7) hours for Apple Watch, Bellabeat Leaf Urban, and Oura Ring, respectively. During focus groups, participants reinforced their quantitative ratings and rankings of the WATs based on personal experiences. Participants shared a variety of both activity-related and non–activity-related features that they look for in a motivating device. When considering what the ideal WAT would be for a woman, participants suggested features of (1) comfort, (2) extended battery life, (3) durability, (4) immediate PA feedback, (5) intuitive PA sensing, and (6) programmability. Conclusions: This study is the first to specifically address women’s experiences with and preferences for different types of WATs. Those who work with women should realize how they view WATs and the role they play in motivation to be active. %M 38096000 %R 10.2196/48704 %U https://formative.jmir.org/2023/1/e48704 %U https://doi.org/10.2196/48704 %U http://www.ncbi.nlm.nih.gov/pubmed/38096000 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e50636 %T The Effects of a Digital, Transdiagnostic, Clinically and Peer-Moderated Treatment Platform for Young People With Emerging Mental Health Complaints: Repeated Measures Within-Subjects Study %A van Doorn,Marilon %A Monsanto,Anne %A Wang,Chen Lu %A Verfaillie,Sander C J %A van Amelsvoort,Thérèse A M J %A Popma,Arne %A Jaspers,Monique W M %A Öry,Ferko %A Alvarez-Jimenez,Mario %A Gleeson,John F %A Nieman,Dorien H %+ Amsterdam University Medical Centers (Location AMC), 5 Meibergdreef 9, Amsterdam, 1105AZ, Netherlands, 31 208913747, m.vandoorn@amsterdamumc.nl %K indicative prevention %K youth mental health %K Moderated Online Social Therapy %K MOST+ %K eHealth %K well-being %K early detection and intervention %K Engage Young People Early %K ENYOY %D 2023 %7 13.12.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To address the growing prevalence of youth mental health problems, early intervention is crucial to minimize individual, societal, and economic impacts. Indicative prevention aims to target emerging mental health complaints before the onset of a full-blown disorder. When intervening at this early stage, individuals are more responsive to treatment, resulting in cost-effective outcomes. The Moderated Online Social Therapy platform, which was successfully implemented and proven effective in Australia, is a digital, peer- and clinically moderated treatment platform designed for young people. The Netherlands was the first country outside Australia to implement this platform, under the name Engage Young People Early (ENYOY). It has the potential to reduce the likelihood of young people developing serious mental health disorders. Objective: This study aims to investigate the effects on young people using the ENYOY-platform in relation to psychological distress, psychosocial functioning, and positive health parameters. Methods: Dutch-speaking young people with emerging mental health complaints (N=131) participated in the ENYOY-platform for 6 months in a repeated measures within-subjects study. Psychological distress, psychosocial functioning, and positive health parameters were assessed at baseline and 3, 6, and 12 months. Repeated measures ANOVA was conducted and adjusted for age, sex, therapy, and community activity. The Reliable Change Index and Clinically Significant Index were computed to compare the baseline with the 6- and 12-month measurements. The missing data rate was 22.54% and the dropout rate 62.6% (82/131). Results: The primary analysis (77/131, 58.8%) showed that psychological distress decreased and psychosocial functioning improved over time with large effect sizes (P<.001 in both cases; ηp2=0.239 and 0.318, respectively) independent of age (P=.76 for psychological distress and P=.48 for psychosocial functioning), sex (P=.24 and P=.88, respectively), therapy activity (P=.49 and P=.80, respectively), or community activity (P=.59 and P=.48, respectively). Similarly, secondary analyses (51/131, 38.9%) showed significant effects of time on the quality of life, well-being, and meaningfulness positive health parameters (P<.05; ηp2=0.062, 0.140, and 0.121, respectively). Improvements in all outcome measures were found between baseline and 3 and 6 months (P≤.001-.01; d=0.23-0.62) and sustained at follow-up (P=.18-.97; d=0.01-0.16). The Reliable Change Index indicated psychological distress improvements in 38% (39/102) of cases, no change in 54.9% (56/102) of cases, and worsening in 5.9% (6/102) of cases. Regarding psychosocial functioning, the percentages were 50% (51/102), 43.1% (44/102), and 6.9% (7/102), respectively. The Clinically Significant Index demonstrated clinically significant changes in 75.5% (77/102) of cases for distress and 89.2% (91/102) for functioning. Conclusions: This trial demonstrated that the ENYOY-platform holds promise as a transdiagnostic intervention for addressing emerging mental health complaints among young people in the Netherlands and laid the groundwork for further clinical research. It would be of great relevance to expand the population on and service delivery of the platform. International Registered Report Identifier (IRRID): RR2-10.1186/s12888-021-03315-x %M 38090802 %R 10.2196/50636 %U https://mhealth.jmir.org/2023/1/e50636 %U https://doi.org/10.2196/50636 %U http://www.ncbi.nlm.nih.gov/pubmed/38090802 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e44993 %T Unveiling Consumer Preferences and Intentions for Cocreated Features of a Combined Diet and Physical Activity App: Cross-Sectional Study in 4 European Countries %A Mahmoodi Kahriz,Bahram %A Snuggs,Sarah %A Sah,Anumeha %A Clot,Sophie %A Lamport,Daniel %A Forrest,Joseph %A Helme-Guizon,Agnes %A Wilhelm,Marie-Claire %A Caldara,Cindy %A Anin,Camille Valentine %A Vogt,Julia %+ Henley Business School, University of Reading, Whiteknights, Reading, RG6 6UD, United Kingdom, 44 01491 571454, bahram.mahmoodikahriz@henley.ac.uk %K mobile apps %K healthy eating and physical activity %K attitude %K BMI and self-efficacy %D 2023 %7 11.12.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Numerous mobile health apps are marketed globally, and these have specific features including physical activity tracking, motivational feedback, and recipe provision. It is important to understand which features individuals prefer and whether these preferences differ between consumer groups. Objective: In this study, we aimed to identify consumers’ most preferred features and rewards for a mobile app that targets healthy eating and physical activity and to reduce the number of individual mobile health app features to a smaller number of key categories as perceived by consumers. In addition, we investigated the impact of differences in consumers’ BMI and self-efficacy on their intention to use and willingness to pay for such an app. Finally, we identified the characteristics of different target groups of consumers and their responses toward app features via cluster analysis. Methods: A total of 212 participants from France, Italy, the United Kingdom, and Germany were recruited via the web to answer questions about app features, motivation, self-efficacy, demographics, and geographic factors. It is important to note that our study included an evenly distributed sample of people in the age range of 23 to 50 years (23-35 and 35-50 years). The app features in question were generated from a 14-day cocreation session by a group of consumers from the United Kingdom and the Republic of Ireland. Results: “Home work out suggestions,” “exercise tips,” and “progress charts” were the most preferred app features, whereas “gift vouchers” and “shopping discounts” were the most preferred rewards. “Connections with other communication apps” was the least preferred feature, and “charitable giving” was the least preferred reward. Importantly, consumers’ positive attitude toward the “social support and connectedness and mindfulness” app feature predicted willingness to pay for such an app (β=.229; P=.004). Differences in consumers’ health status, motivational factors, and basic demographics moderated these results and consumers’ intention to use and willingness to pay for such an app. Notably, younger and more motivated consumers with more experience and knowledge about health apps indicated more positive attitudes and intentions to use and willingness to pay for this type of app. Conclusions: This study indicated that consumers tend to prefer app features that are activity based and demonstrate progress. It also suggested a potential role for monetary rewards in promoting healthy lifestyle behaviors. Moreover, the results highlighted the role of consumers’ health status, motivational factors, and socioeconomic status in predicting their app use. These results provide up-to-date, practical, and pragmatic information for the future design and operation of mobile health apps. %M 38079197 %R 10.2196/44993 %U https://humanfactors.jmir.org/2023/1/e44993 %U https://doi.org/10.2196/44993 %U http://www.ncbi.nlm.nih.gov/pubmed/38079197 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e52097 %T Embodied Conversational Agents Providing Motivational Interviewing to Improve Health-Related Behaviors: Scoping Review %A Mercado,José %A Espinosa-Curiel,Ismael Edrein %A Martínez-Miranda,Juan %+ Unidad de Transferencia Tecnológica Tepic, Centro de Investigación Científica y de Educación Superior de Ensenada, Andador 10, entre calles 3 y 4, Ciudad del Conocimiento, Tepic, Nayarit, 63173, Mexico, 52 3111295930 ext 28602, jmiranda@cicese.mx %K embodied conversational agent %K ECA %K motivational interview %K MI %K health-related behaviors %K virtual agents %K mobile phone %D 2023 %7 8.12.2023 %9 Review %J J Med Internet Res %G English %X Background: Embodied conversational agents (ECAs) are advanced human-like interfaces that engage users in natural face-to-face conversations and interactions. These traits position ECAs as innovative tools for delivering interventions for promoting health-related behavior adoption. This includes motivational interviewing (MI), a therapeutic approach that combines brief interventions with motivational techniques to encourage the adoption of healthier behaviors. Objective: This study aims to identify the health issues addressed by ECAs delivering MI interventions, explore the key characteristics of these ECAs (eg, appearance, dialogue mechanism, emotional model), analyze the implementation of MI principles and techniques within ECAs, and examine the evaluation methods and primary outcomes of studies that use ECAs providing MI interventions. Methods: We conducted a scoping review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) methodology. Our systematic search covered the PubMed, Scopus, IEEE Xplore, ACM Digital, and PsycINFO databases for papers published between January 2008 and December 2022. We included papers describing ECAs developed for delivering MI interventions targeting health-related behaviors and excluded articles that did not describe ECAs with human appearances and without the necessary evaluation or MI explanation. In a multistage process, 3 independent reviewers performed screening and data extraction, and the collected data were synthesized using a narrative approach. Results: The initial search identified 404 articles, of which 3.5% (n=14) were included in the review. ECAs primarily focused on reducing alcohol use (n=5, 36%), took on female representations (n=9, 64%), and gave limited consideration to user ethnicity (n=9, 64%). Most of them used rules-driven dialogue mechanisms (n=13, 93%), include emotional behavior to convey empathy (n=8, 57%) but without an automatic recognition of user emotions (n=12, 86%). Regarding MI implementation, of 14 studies, 3 (21%) covered all MI principles, 4 (29%) included all processes, and none covered all techniques. Most studies (8/14, 57%) conducted acceptability, usability, and user experience assessments, whereas a smaller proportion (4/14, 29%) used randomized controlled trials to evaluate behavior changes. Overall, the studies reported positive results regarding acceptability, usability, and user experience and showed promising outcomes in changes in attitudes, beliefs, motivation, and behavior. Conclusions: This study revealed significant advancements in the use of ECAs for delivering MI interventions aimed at promoting healthier behaviors over the past 15 years. However, this review emphasizes the need for a more in-depth exploration of ECA characteristics. In addition, there is a need for the enhanced integration of MI principles, processes, and techniques into ECAs. Although acceptability and usability have received considerable attention, there is a compelling argument for placing a stronger emphasis on assessing changes in attitudes, beliefs, motivation, and behavior. Consequently, inclusion of more randomized controlled trials is essential for comprehensive intervention evaluations. %M 38064707 %R 10.2196/52097 %U https://www.jmir.org/2023/1/e52097 %U https://doi.org/10.2196/52097 %U http://www.ncbi.nlm.nih.gov/pubmed/38064707 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e46419 %T The Role of Daily Steps in the Treatment of Major Depressive Disorder: Secondary Analysis of a Randomized Controlled Trial of a 6-Month Internet-Based, Mindfulness-Based Cognitive Behavioral Therapy Intervention for Youth %A Dang,Kevin %A Ritvo,Paul %A Katz,Joel %A Gratzer,David %A Knyahnytska,Yuliya %A Ortiz,Abigail %A Walters,Clarice %A Attia,Mohamed %A Gonzalez-Torres,Christina %A Lustig,Andrew %A Daskalakis,Zafiris %+ School of Kinesiology and Health Sciences, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada, 1 416 580 8021, pritvo@yorku.ca %K accelerometer %K anxiety %K CBT %K chronic pain %K cognitive behavioral therapy %K controlled trials %K depression %K depressive symptoms %K digital health %K eHealth %K exercise %K fitbit %K intervention study %K longitudinal study %K major depressive disorder %K mHealth %K mindfulness %K mindfulness-based CBT %K objectively measured activity %K online health %K online intervention %K online therapy %K pain %K physical activity %K prospective study %K randomized controlled trial %K RCT %K step %K steps %D 2023 %7 8.12.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Current evidence supports physical activity (PA) as an adjunctive treatment for major depressive disorder (MDD). Few studies, however, have examined the relationship between objectively measured PA and MDD treatment outcomes using prospective data. Objective: This study is a secondary analysis of data from a 24-week internet-based, mindfulness-based cognitive behavioral therapy program for MDD. The purpose of this analysis was twofold: (1) to examine average daily step counts in relation to MDD symptom improvement, and whether pain moderated this relationship; and (2) to examine whether changes in step activity (ie, step trajectories) during treatment were associated with baseline symptoms and symptom improvement. Methods: Patients from the Centre for Addiction and Mental Health were part of a randomized controlled trial evaluating the effects of internet-based, mindfulness-based cognitive behavioral therapy for young adults (aged 18-30 years old) with MDD. Data from 20 participants who had completed the intervention were analyzed. PA, in the form of objectively measured steps, was measured using the Fitbit-HR Charge 2 (Fitbit Inc), and self-reported depression severity was measured with the Beck Depression Inventory-II (BDI-II). Linear regression analysis was used to test PA’s relationship with depression improvement and the moderating effect of pain severity and pain interference. Growth curve and multivariable regression models were used to test longitudinal associations. Results: Participants walked an average of 8269 steps per day, and each additional +1000-step difference between participants was significantly associated with a 2.66-point greater improvement (reduction) in BDI-II, controlling for anxiety, pain interference, and adherence to Fitbit monitoring (P=.02). Pain severity appeared to moderate (reduce) the positive effect of average daily steps on BDI-II improvement (P=.03). Higher baseline depression and anxiety symptoms predicted less positive step trajectories throughout treatment (Ps≤.001), and more positive step trajectories early in the trial predicted greater MDD improvement at the end of the trial (Ps<.04). However, step trajectories across the full duration of the trial did not significantly predict MDD improvement (Ps=.40). Conclusions: This study used objective measurements to demonstrate positive associations between PA and depression improvement in the context of cognitive behavioral treatment. Pain appeared to moderate this relationship, and baseline symptoms of anxiety and depression predicted PA trajectories. The findings inform future interventions for major depression. Future research with larger samples should consider additional moderators of PA-related treatment success and the extent to which outcomes are related to PA change in multimodal interventions. Trial Registration: Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052 International Registered Report Identifier (IRRID): RR2-10.2196/11591 %M 38064262 %R 10.2196/46419 %U https://www.i-jmr.org/2023/1/e46419 %U https://doi.org/10.2196/46419 %U http://www.ncbi.nlm.nih.gov/pubmed/38064262 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e50729 %T Implementation of Remote Activity Sensing to Support a Rehabilitation Aftercare Program: Observational Mixed Methods Study With Patients and Health Care Professionals %A Lu,Ziyuan %A Signer,Tabea %A Sylvester,Ramona %A Gonzenbach,Roman %A von Wyl,Viktor %A Haag,Christina %+ Institute for Implementation Science in Health Care, University of Zurich, Universitätstrasse 84, Zurich, 8006, Switzerland, 41 446346380, viktor.vonwyl@uzh.ch %K physical activity %K activity sensor %K normalization process theory %K rehabilitation %K chronic disease %K chronic %K aftercare %K sensor %K sensors %K exercise %K neurology %K neuroscience %K neurorehabilitation %K adherence %K need %K needs %K experience %K experiences %K questionnaire %K questionnaires %K mobile phone %D 2023 %7 8.12.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity is central to maintaining the quality of life for patients with complex chronic conditions and is thus at the core of neurorehabilitation. However, maintaining activity improvements in daily life is challenging. The novel Stay With It program aims to promote physical activity after neurorehabilitation by cultivating self-monitoring skills and habits. Objective: We examined the implementation of the Stay With It program at the Valens Rehabilitation Centre in Switzerland using the normalization process theory framework, focusing on 3 research aims. We aimed to examine the challenges and facilitators of program implementation from the perspectives of patients and health care professionals. We aimed to evaluate the potential of activity sensors to support program implementation and patient acceptance. Finally, we aimed to evaluate patients’ engagement in physical activity after rehabilitation, patients’ self-reported achievement of home activity goals, and factors influencing physical activity. Methods: Patients were enrolled if they had a disease that was either chronic or at risk for chronicity and participated in the Stay With It program. Patients were assessed at baseline, the end of rehabilitation, and a 3-month follow-up. The health care professionals designated to deliver the program were surveyed before and after program implementation. We used a mixed methods approach combining standardized questionnaires, activity-sensing data (patients only), and free-text questions. Results: This study included 23 patients and 13 health care professionals. The diverse needs of patients and organizational hurdles were major challenges to program implementation. Patients’ intrinsic motivation and health care professionals’ commitment to refining the program emerged as key facilitators. Both groups recognized the value of activity sensors in supporting program implementation and sustainability. Although patients appreciated the sensor’s ability to monitor, motivate, and quantify activity, health care professionals saw the sensor as a motivational tool but expressed concerns about technical difficulties and potential inaccuracies. Physical activity levels after patients returned home varied considerably, both within and between individuals. The self-reported achievement of activity goals at home also varied, in part because of vague definitions. Common barriers to maintaining activity at home were declining health and fatigue often resulting from heat and pain. At the 3-month follow-up, 35% (8/23) of the patients withdrew from the study, with most citing deteriorating physical health as the reason and that monitoring and discussing their low activity would negatively affect their mental health. Conclusions: Integrating aftercare programs like Stay With It into routine care is vital for maintaining physical activity postrehabilitation. Although activity trackers show promise in promoting motivation through monitoring, they may lead to frustration during health declines. Their acceptability may also be influenced by an individual’s health status, habits, and technical skills. Our study highlights the importance of considering health care professionals’ perspectives when integrating new interventions into routine care. %M 38064263 %R 10.2196/50729 %U https://mhealth.jmir.org/2023/1/e50729 %U https://doi.org/10.2196/50729 %U http://www.ncbi.nlm.nih.gov/pubmed/38064263 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51277 %T Secure Messaging Intervention in Patients Starting New Antidepressant to Promote Adherence: Pilot Randomized Controlled Trial %A Turvey,Carolyn %A Fuhrmeister,Lindsey %A Klein,Dawn %A McCoy,Kimberly %A Moeckli,Jane %A Stewart Steffensmeier,Kenda R %A Suiter,Natalie %A Van Tiem,Jen %+ Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA, 52246, United States, 1 3193216799, Carolyn.Turvey@va.gov %K depression %K text messaging %K medication adherence %K medication %K medications %K adherence %K antidepressant %K antidepressants %K depressive %K text message %K text messages %K messaging %K SMS %K veteran %K veterans %K military %K randomized controlled trial %K RCT %K controlled trials %K mental health %K psychiatry %K mobile phone %D 2023 %7 8.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There are a range of effective pharmacological and behavioral treatments for depression. However, approximately one-third of patients discontinue antidepressants within the first month of treatment and 44% discontinue them by the third month of treatment. The major reasons reported for discontinuation were side effect burden, patients experiencing that the medications were not working, and patients wanting to resolve their depression without using medication. Objective: This study tested the acceptability, feasibility, and preliminary effectiveness of an SMS messaging intervention designed to improve antidepressant adherence and depression outcomes in veterans. The intervention specifically targeted the key reasons for antidepressant discontinuation. For example, the secure message included reminders that it can take up to 6 weeks for an antidepressant to work, or prompts to call their provider should the side effect burden become significant. Methods: This pilot was a 3-armed randomized controlled trial of 53 veterans undergoing depression treatment at the Iowa City Veterans Affairs Health Care System. Veterans starting a new antidepressant were randomized to secure messaging only (SM-Only), secure messaging with coaching (SM+Coach), or attention control (AC) groups. The intervention lasted 12 weeks with follow-up assessments of key outcomes at 6 and 12-weeks. This included a measure of antidepressant adherence, depressive symptom severity, and side effect burden. Results: The 2 active interventions (SM-Only and SM+Coach) demonstrated small to moderate effect sizes (ESs) in improving antidepressant adherence and reducing side effect burden. They did not appear to reduce the depressive symptom burden any more than in the AC arm. Veteran participants in the SM arms demonstrated improved medication adherence from baseline to 12 weeks on the Medication Adherence Rating Scale compared with those in the AC arm, who had a decline in adherence (SM-Only: ES=0.09; P=.19; SM+Coach: ES=0.85; P=.002). Depression scores on the 9-Item Patient Health Questionnaire decreased for all 3 treatment arms, although the decline was slightly larger for the SM-Only (ES=0.32) and the SM+Coach (ES=0.24) arms when compared with the AC arm. The 2 intervention arms indicated a decrease in side effects on the Frequency, Intensity, and Burden of Side Effects Ratings, whereas the side effect burden for the AC arm increased. These differences indicated moderate ES (SM-Only vs AC: ES=0.40; P=.07; SM+Coach: ES=0.54; P=.07). Conclusions: A secure messaging program targeting specific reasons for antidepressant discontinuation had small-to-moderate ES in improving medication adherence. Consistent with prior research, the intervention that included brief synchronic meetings with a coach appeared to have a greater benefit than the SMS-alone intervention. Veterans consistently engaged with the SMS messaging in both treatment arms throughout the study period. They additionally provided feedback on which texts were most helpful, tending to prefer messages providing overall encouragement rather than specific wellness recommendations. Trial Registration: ClinicalTrials.gov NCT03930849; https://clinicaltrials.gov/study/NCT03930849 %M 38064267 %R 10.2196/51277 %U https://formative.jmir.org/2023/1/e51277 %U https://doi.org/10.2196/51277 %U http://www.ncbi.nlm.nih.gov/pubmed/38064267 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43096 %T Strengths and Limitations of Web-Based Cessation Support for Individuals Who Smoke, Dual Use, or Vape: Qualitative Interview Study %A Struik,Laura %A Christianson,Kyla %A Khan,Shaheer %A Sharma,Ramona H %+ School of Nursing, University of British Columbia Okanagan, ART 140, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada, 1 2508647879, laura.struik@ubc.ca %K qualitative research %K tobacco use %K smoking %K vaping %K cessation %K eHealth %K individuals who smoke %K users %K tobacco %K e-cigarettes %K cigarettes %K web-based %K support %K behavioral %K smartphone app %K social media %K mobile phone %D 2023 %7 8.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Tobacco use has shifted in recent years, especially with the introduction of e-cigarettes. Despite the current variable and intersecting tobacco product use among tobacco users, most want to quit, which necessitates cessation programs to adapt to these variable trends (vs focusing on combustible cigarettes alone). The use of web-based modalities for cessation support has become quite popular in recent years and has been compounded by the COVID-19 pandemic. Therefore, understanding the current strengths and limitations of existing programs to meet the needs of current various tobacco users is critical for ensuring the saliency of such programs moving forward. Objective: The purpose of this study was to understand the strengths and limitations of web-based cessation support offered through QuitNow to better understand the needs of a variety of end users who smoke, dual use, or vape. Methods: Semistructured interviews were conducted with 36 nicotine product users in British Columbia. Using conventional content analysis methods, we inductively derived descriptive categories and themes related to the strengths and limitations of QuitNow for those who smoke, dual use, or vape. We analyzed the data with the support of NVivo (version 12; QSR International) and Excel (Microsoft Corporation). Results: Participants described several strengths and limitations of QuitNow and provided suggestions for improvement, which fell under 2 broad categories: look and feel and content and features. Shared strengths included the breadth of information and the credible nature of the website. Individuals who smoke were particularly keen about the site having a nonjudgmental feeling. Moreover, compared with individuals who smoke, individuals who dual use and individuals who vape were particularly keen about access to professional quit support (eg, quit coach). Shared limitations included the presence of too much text and the need to create an account. Individuals who dual use and individuals who vape thought that the content was geared toward older adults and indicated that there was a lack of information about vaping and personalized content. Regarding suggestions for improvement, participants stated that the site needed more interaction, intuitive organization, improved interface esthetics, a complementary smartphone app, forum discussion tags, more information for different tobacco user profiles, and user testimonials. Individuals who vape were particularly interested in website user reviews. In addition, individuals who vape were more interested in an intrinsic approach to quitting (eg, mindfulness) compared with extrinsic approaches (eg, material incentives), the latter of which was endorsed by more individuals who dual use and individuals who smoke. Conclusions: The findings of this study provide directions for enhancing the saliency of web-based cessation programs for a variety of tobacco use behaviors that hallmark current tobacco use. %M 38064266 %R 10.2196/43096 %U https://formative.jmir.org/2023/1/e43096 %U https://doi.org/10.2196/43096 %U http://www.ncbi.nlm.nih.gov/pubmed/38064266 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39310 %T The Hombres Saludables Physical Activity Web-Based and Mobile Phone Intervention: Pilot Randomized Controlled Trial With Latino Men %A Dulin,Akilah J %A Dunsiger,Shira %A Benitez,Tanya %A Larsen,Britta %A Marcus,Bess H %A Champion,Gregory %A Gans,Kim M %+ Center for Health Promotion and Health Equity, Brown University, Box G-S121-8, Providence, RI, 02912, United States, 1 4018635392, akilah_dulin@brown.edu %K physical activity %K Latino %K Hispanic %K men %K eHealth %K expert system %K internet %K SMS text messaging %K mobile phone %K social media %K mobile health %K mHealth %K mobile phone %D 2023 %7 7.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Owing to structural-level, interpersonal-level, and individual-level barriers, Latino men have disproportionately high rates of physical inactivity and experience related chronic diseases. Despite these disparities, few physical activity (PA) interventions are culturally targeted for Latino men. Objective: This study reported the feasibility and acceptability of Hombres Saludables PA intervention for Latino men. We also reported the preliminary efficacy of the intervention on PA change and provided the results of the exploratory moderator and mediator analysis. Methods: We completed a 6-month, single-blind, pilot randomized controlled trial of Hombres Saludables with Latino men aged between 18 and 65 years. Men were randomized to either (1) a theory-driven, individually tailored, internet-based and SMS text message–based, Spanish-language PA intervention arm or (2) a nutrition and wellness attention contact control arm that was also delivered via the web and SMS text message. We assessed the primary study outcomes of feasibility using participant retention and acceptability using postintervention survey and open-ended interview questions. We measured the preliminary efficacy via change in minutes of moderate to vigorous PA per week using ActiGraph wGT3X-BT accelerometry (primary measure) and self-reported minutes per week using 7-day Physical Activity Recall. Participants completed the assessments at study enrollment and after 6 months. Results: The 38 participants were predominantly Dominican (n=8, 21%) or Guatemalan (n=5, 13%), and the mean age was 38.6 (SD 12.43) years. Retention rates were 91% (21/23) for the PA intervention arm and 100% (15/15) for the control arm. Overall, 95% (19/20) of the intervention arm participants reported that the Hombres study was somewhat to very helpful in getting them to be more physically active. Accelerometry results indicated that participants in the intervention group increased their PA from a median of 13 minutes per week at study enrollment to 34 minutes per week at 6 months, whereas the control group participants showed no increases. On the basis of self-reports, the intervention group was more likely to meet the US PA guidelines of 150 minutes per week of moderate to vigorous PA at 6-month follow-up, with 42% (8/19) of the intervention participants meeting the PA guidelines versus 27% (4/15) of the control participants (odds ratio 3.22, 95% CI 0.95-13.69). Exploratory analyses suggested conditional effects on PA outcomes based on baseline stage of motivational readiness, employment, and neighborhood safety. Conclusions: The PA intervention demonstrated feasibility and acceptability. Results of this pilot study indicate that the Hombres Saludables intervention is promising for increasing PA in Latino men and suggest that a fully powered trial is warranted. Our technology-based PA intervention provides a potentially scalable approach that can improve health in a population that is disproportionately affected by low PA and related chronic disease. Trial Registration: ClinicalTrials.gov NCT03196570; https://classic.clinicaltrials.gov/ct2/show/NCT03196570 International Registered Report Identifier (IRRID): RR2-10.2196/23690 %M 38060285 %R 10.2196/39310 %U https://www.jmir.org/2023/1/e39310 %U https://doi.org/10.2196/39310 %U http://www.ncbi.nlm.nih.gov/pubmed/38060285 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e48991 %T Self-Guided Mental Health Apps Targeting Racial and Ethnic Minority Groups: Scoping Review %A Saad,Fiby %A Eisenstadt,Mia %A Liverpool,Shaun %A Carlsson,Courtney %A Vainieri,Isabella %+ Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, Faculty of Brain Sciences, Gower Street, London, WC1E 6BT, United Kingdom, 44 2039872684 ext 2684, ucjuiva@ucl.ac.uk %K mental health apps %K racial and ethnic minority groups %K self-guided %K mental health %K culturally appropriate technology %D 2023 %7 6.12.2023 %9 Review %J JMIR Ment Health %G English %X Background: The use of mental health apps (MHAs) is increasing rapidly. However, little is known about the use of MHAs by racial and ethnic minority groups. Objective: In this review, we aimed to examine the acceptability and effectiveness of MHAs among racial and ethnic minority groups, describe the purposes of using MHAs, identify the barriers to MHA use in racial and ethnic minority groups, and identify the gaps in the literature. Methods: A systematic search was conducted on August 25, 2023, using Web of Science, Embase, PsycINFO, PsycArticles, PsycExtra, and MEDLINE. Articles were quality appraised using the Mixed Methods Appraisal Tool, and data were extracted and summarized to form a narrative synthesis. Results: A total of 15 studies met the inclusion criteria. Studies were primarily conducted in the United States, and the MHAs designed for racial and ethnic minority groups included ¡Aptívate!, iBobbly, AIMhi- Y, BRAVE, Build Your Own Theme Song, Mindful You, Sanadak, and 12 more MHAs used in 1 study. The MHAs were predominantly informed by cognitive behavioral therapy and focused on reducing depressive symptoms. MHAs were considered acceptable for racial and ethnic minority groups; however, engagement rates dropped over time. Only 2 studies quantitatively reported the effectiveness of MHAs among racial and ethnic minority groups. Barriers to use included the repetitiveness of the MHAs, stigma, lack of personalization, and technical issues. Conclusions: Considering the growing interest in MHAs, the available evidence for MHAs for racial and ethnic minority groups appears limited. Although the acceptability seems consistent, more research is needed to support the effectiveness of MHAs. Future research should also prioritize studies to explore the specific needs of racial and ethnic minority groups if MHAs are to be successfully adopted. %M 38055315 %R 10.2196/48991 %U https://mental.jmir.org/2023/1/e48991 %U https://doi.org/10.2196/48991 %U http://www.ncbi.nlm.nih.gov/pubmed/38055315 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e46718 %T Assessment of a Digital Symptom Checker Tool's Accuracy in Suggesting Reproductive Health Conditions: Clinical Vignettes Study %A Peven,Kimberly %A Wickham,Aidan P %A Wilks,Octavia %A Kaplan,Yusuf C %A Marhol,Andrei %A Ahmed,Saddif %A Bamford,Ryan %A Cunningham,Adam C %A Prentice,Carley %A Meczner,András %A Fenech,Matthew %A Gilbert,Stephen %A Klepchukova,Anna %A Ponzo,Sonia %A Zhaunova,Liudmila %+ Flo Health UK Limited, 27 Old Gloucester Street, London, WC1N 3AX, United Kingdom, 44 60396823, a_wickham@flo.health %K women's health %K symptom checkers %K symptom checker %K digital health %K chatbot %K accuracy %K eHealth apps %K mobile phone %K mobile health %K mHealth %K mobile health app %K polycystic ovary syndrome %K gynecology %K digital health tool %K endometriosis %K uterus %K uterine %K uterine fibroids %K vignettes %K clinical vignettes %D 2023 %7 5.12.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Reproductive health conditions such as endometriosis, uterine fibroids, and polycystic ovary syndrome (PCOS) affect a large proportion of women and people who menstruate worldwide. Prevalence estimates for these conditions range from 5% to 40% of women of reproductive age. Long diagnostic delays, up to 12 years, are common and contribute to health complications and increased health care costs. Symptom checker apps provide users with information and tools to better understand their symptoms and thus have the potential to reduce the time to diagnosis for reproductive health conditions. Objective: This study aimed to evaluate the agreement between clinicians and 3 symptom checkers (developed by Flo Health UK Limited) in assessing symptoms of endometriosis, uterine fibroids, and PCOS using vignettes. We also aimed to present a robust example of vignette case creation, review, and classification in the context of predeployment testing and validation of digital health symptom checker tools. Methods: Independent general practitioners were recruited to create clinical case vignettes of simulated users for the purpose of testing each condition symptom checker; vignettes created for each condition contained a mixture of condition-positive and condition-negative outcomes. A second panel of general practitioners then reviewed, approved, and modified (if necessary) each vignette. A third group of general practitioners reviewed each vignette case and designated a final classification. Vignettes were then entered into the symptom checkers by a fourth, different group of general practitioners. The outcomes of each symptom checker were then compared with the final classification of each vignette to produce accuracy metrics including percent agreement, sensitivity, specificity, positive predictive value, and negative predictive value. Results: A total of 24 cases were created per condition. Overall, exact matches between the vignette general practitioner classification and the symptom checker outcome were 83% (n=20) for endometriosis, 83% (n=20) for uterine fibroids, and 88% (n=21) for PCOS. For each symptom checker, sensitivity was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, and 100% for PCOS; specificity was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 75% for PCOS; positive predictive value was reported as 81.8% for endometriosis, 84.6% for uterine fibroids, 80% for PCOS; and negative predictive value was reported as 84.6% for endometriosis, 81.8% for uterine fibroids, and 100% for PCOS. Conclusions: The single-condition symptom checkers have high levels of agreement with general practitioner classification for endometriosis, uterine fibroids, and PCOS. Given long delays in diagnosis for many reproductive health conditions, which lead to increased medical costs and potential health complications for individuals and health care providers, innovative health apps and symptom checkers hold the potential to improve care pathways. %M 38051574 %R 10.2196/46718 %U https://mhealth.jmir.org/2023/1/e46718 %U https://doi.org/10.2196/46718 %U http://www.ncbi.nlm.nih.gov/pubmed/38051574 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e45947 %T Exploring Adherence to Pelvic Floor Muscle Training in Women Using Mobile Apps: Scoping Review %A Harper,Rosie C %A Sheppard,Sally %A Stewart,Carly %A Clark,Carol J %+ Faculty of Health and Social Sciences, Bournemouth University, Bournemouth Gateway Building, 12 St Paul’s Lane, Bournemouth, BH8 8GP, United Kingdom, 44 01202 524111, rharper1@bournemouth.ac.uk %K adherence %K behavior change %K mHealth %K mobile apps %K pelvic floor muscle training %K women %D 2023 %7 30.11.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Pelvic floor dysfunction is a public health issue, with 1 in 3 women experiencing symptoms at some point in their lifetime. The gold standard of treatment for pelvic floor dysfunction is supervised pelvic floor muscle training (PFMT); however, adherence to PFMT in women is poor. Mobile apps are increasingly being used in the National Health Service to enable equity in the distribution of health care and increase accessibility to services. However, it is unclear how PFMT mobile apps influence PFMT adherence in women. Objective: We aimed to identify which behavior change techniques (BCTs) have been used in PFMT mobile apps, to distinguish the core “capability, opportunity, and motivation” (COM) behaviors targeted by the BCTs used in PFMT mobile apps, and to compare the levels of PFMT adherence in women between those using PFMT mobile apps and those receiving usual care. Methods: We conducted a scoping review of the literature. Published quantitative literature that compared the use of a PFMT mobile app to a control group was included to address the objectives of the study. The electronic bibliographic databases searched included MEDLINE, CINAHL, Scopus, Web of Science, and PEDro, along with CENTRAL. Studies were also identified from reference searching of systematic reviews. Original articles written in English from 2006 onward were included. Nonexperimental quantitative studies, qualitative studies, studies that use male participants, case studies, web-based interventions, and interventions that use vaginal probes were excluded. Narrative synthesis was conducted on eligible articles based on the aims of the study. Results: Of the 114 records retrieved from the search, a total of 6 articles met the eligibility and inclusion criteria. The total number of participants in the studies was 471. All PFMT mobile apps used the BCT “prompts and cues.” Opportunity was the core COM behavior targeted by the PFMT mobile apps. Higher levels of adherence to PFMT were observed among women using PFMT mobile apps. Conclusions: Digital “prompts and cues” are a BCT commonly used in PFMT mobile apps, and further research is required to practically assess whether a future randomized controlled trial that investigates the effectiveness of digital “prompts and cues” on PFMT adherence in women can be conducted. %M 38032694 %R 10.2196/45947 %U https://mhealth.jmir.org/2023/1/e45947 %U https://doi.org/10.2196/45947 %U http://www.ncbi.nlm.nih.gov/pubmed/38032694 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e46928 %T Facilitating In-House Mobile App Development Within Psychiatric Outpatient Services for Patients Diagnosed With Borderline Personality Disorder: Rapid Application Development Approach %A Shaker,Ali Abbas %A Austin,Stephen F %A Jørgensen,Mie Sedoc %A Sørensen,John Aasted %A Bechmann,Henrik %A Kinnerup,Henriette E %A Petersen,Charlotte Juul %A Olsen,Ragnar Klein %A Simonsen,Erik %+ Psychiatric Research Unit, Psychiatric Department, Region Zealand Psychiatry, Fælledvej 6, Bygning 3, 4. sal, Slagelse, 4200, Denmark, 45 58536070, ashak@regionsjaelland.dk %K software models %K in-house development %K psychiatric services %K borderline personality disorder %K mobile application %K development %K mental health %K user design %K design %K psychiatric %K implementation %K innovation %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile app development within mental health is often time- and resource-consuming, challenging the development of mobile apps for psychiatry. There is a continuum of software development methods ranging from linear (waterfall model) to continuous adaption (Scrum). Rapid application development (RAD) is a model that so far has not been applied to psychiatric settings and may have some advantages over other models. Objective: This study aims to explore the utility of the RAD model in developing a mobile app for patients with borderline personality disorder (BPD) in a psychiatric outpatient setting. Methods: The 4 phases of the RAD model: (1) requirements planning, (2) user design, (3) construction, and (4) cutover, were applied to develop a mobile app within psychiatric outpatient services for patients diagnosed with BPD. Results: For the requirements planning phase, a short time frame was selected to minimize the time between product conceptualization and access within a clinical setting. Evidenced-based interactive content already developed was provided by current staff to enhance usability and trustworthiness. For the user design phase, activity with video themes and a discrete number of functions were used to improve the app functionality and graphical user interface. For the construction phase, close collaboration between clinicians, researchers, and software developers yielded a fully functional, in-house–developed app ready to be tested in clinical practice. For the cutover phase, the mobile app was tested successfully with a small number (n=5) of patients with a BPD. Conclusions: The RAD model could be meaningfully applied in a psychiatric setting to develop an app for BPD within a relatively short time period from conceptualization to implementation in the clinic. Short time frames and identifying a limited number of stakeholders with relevant skills in-house facilitated the use of this model. Despite some limitations, RAD could be a useful model in the development of apps for clinical populations to enable development and access to evidence-based technology. %M 38032709 %R 10.2196/46928 %U https://humanfactors.jmir.org/2023/1/e46928 %U https://doi.org/10.2196/46928 %U http://www.ncbi.nlm.nih.gov/pubmed/38032709 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51423 %T User-Centered Design of a Gamified Mental Health App for Adolescents in Sub-Saharan Africa: Multicycle Usability Testing Study %A Pozuelo,Julia R %A Moffett,Bianca D %A Davis,Meghan %A Stein,Alan %A Cohen,Halley %A Craske,Michelle G %A Maritze,Meriam %A Makhubela,Princess %A Nabulumba,Christine %A Sikoti,Doreen %A Kahn,Kathleen %A Sodi,Tholene %A , %A van Heerden,Alastair %A O’Mahen,Heather A %+ Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, 641 Huntington Avenue, Boston, MA, 02115, United States, 1 617 432 1707, julia_ruizpozuelo@hms.harvard.edu %K depression %K adolescents %K mental health app %K behavioral activation %K user-centered design %K low- and middle-income countries %K mobile phone %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There is an urgent need for scalable psychological treatments to address adolescent depression in low-resource settings. Digital mental health interventions have many potential advantages, but few have been specifically designed for or rigorously evaluated with adolescents in sub-Saharan Africa. Objective: This study had 2 main objectives. The first was to describe the user-centered development of a smartphone app that delivers behavioral activation (BA) to treat depression among adolescents in rural South Africa and Uganda. The second was to summarize the findings from multicycle usability testing. Methods: An iterative user-centered agile design approach was used to co-design the app to ensure that it was engaging, culturally relevant, and usable for the target populations. An array of qualitative methods, including focus group discussions, in-depth individual interviews, participatory workshops, usability testing, and extensive expert consultation, was used to iteratively refine the app throughout each phase of development. Results: A total of 160 adolescents from rural South Africa and Uganda were involved in the development process. The app was built to be consistent with the principles of BA and supported by brief weekly phone calls from peer mentors who would help users overcome barriers to engagement. Drawing on the findings of the formative work, we applied a narrative game format to develop the Kuamsha app. This approach taught the principles of BA using storytelling techniques and game design elements. The stories were developed collaboratively with adolescents from the study sites and included decision points that allowed users to shape the narrative, character personalization, in-app points, and notifications. Each story consists of 6 modules (“episodes”) played in sequential order, and each covers different BA skills. Between modules, users were encouraged to work on weekly activities and report on their progress and mood as they completed these activities. The results of the multicycle usability testing showed that the Kuamsha app was acceptable in terms of usability and engagement. Conclusions: The Kuamsha app uniquely delivered BA for adolescent depression via an interactive narrative game format tailored to the South African and Ugandan contexts. Further studies are currently underway to examine the intervention’s feasibility, acceptability, and efficacy in reducing depressive symptoms. %M 38032691 %R 10.2196/51423 %U https://formative.jmir.org/2023/1/e51423 %U https://doi.org/10.2196/51423 %U http://www.ncbi.nlm.nih.gov/pubmed/38032691 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50324 %T Sadness-Based Approach-Avoidance Modification Training for Subjective Stress in Adults: Pilot Randomized Controlled Trial %A Rupp,Lydia Helene %A Keinert,Marie %A Böhme,Stephanie %A Schindler-Gmelch,Lena %A Eskofier,Bjoern %A Schuller,Björn %A Berking,Matthias %+ Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nägelsbachstr. 25a, Erlangen, 91052, Germany, 49 91318567560, lydia.rupp@fau.de %K stress %K emotion %K eHealth %K approach-avoidance %K mental health %K somatic health %K chronic stress %K intervention %K stress-related illness %K app-based %K stress management %K belief %K training %K mobile phone %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: A key vulnerability factor in mental health problems is chronic stress. There is a need for easy-to-disseminate and effective interventions to advance the prevention of stress-related illnesses. App-based stress management trainings can fulfill this need. As subjectively experienced stress may be influenced by dysfunctional beliefs, modifying their evaluations might reduce subjective stress. Approach-avoidance modification trainings (AAMT) can be used to modify stimulus evaluations and are promising candidates for a mobile stress intervention. As the standard training reactions of the AAMT (swiping and joystick motion) have little valence, emotions could be incorporated as approach and avoidance reactions to enhance the effectiveness of AAMTs. Objective: We aimed to evaluate the feasibility of a mobile emotion-enhanced AAMT that engages users to display sadness to move stress-enhancing beliefs away and display positive emotions to move stress-reducing beliefs toward themselves (emotion-based AAMT using sadness and positive emotions [eAAMT-SP]). We explored the clinical efficacy of this novel intervention. Methods: We allocated 30 adult individuals with elevated stress randomly to 1 of 3 conditions (eAAMT-SP, a swipe control condition, and an inactive control condition). We evaluated the feasibility of the intervention (technical problems, adherence, usability, and acceptability). To explore the clinical efficacy of the intervention, we compared pretest-posttest differences in perceived stress (primary clinical outcome) and 3 secondary clinical outcomes (agreement with and perceived helpfulness of dysfunctional beliefs, emotion regulation, and depressive symptoms) among the conditions. Results: The predetermined benchmarks of 50% for intervention completion and 75% for feasibility of the study design (completion of the study design) were met, whereas the cutoff for technical feasibility of the study design (95% of trials without technical errors) was not met. Effect sizes for usability and acceptability were in favor of the eAAMT-SP condition (compared with the swipe control condition; intelligibility of the instructions: g=−0.86, distancing from dysfunctional beliefs: g=0.22, and approaching functional beliefs: g=0.55). Regarding clinical efficacy, the pretest-posttest effect sizes for changes in perceived stress were g=0.80 for the comparison between the eAAMT-SP and inactive control conditions and g=0.76 for the comparison between the eAAMT-SP and swipe control conditions. Effect sizes for the secondary clinical outcomes indicated greater pretest-posttest changes in the eAAMT-SP condition than in the inactive control condition and comparable changes in the swipe control condition. Conclusions: The findings regarding the feasibility of the intervention were satisfactory except for the technical feasibility of the intervention, which should be improved. The effect sizes for the clinical outcomes provide preliminary evidence for the therapeutic potential of the intervention. The findings suggest that extending the AAMT paradigm through the use of emotions may increase its efficacy. Future research should evaluate the eAAMT-SP in sufficiently powered randomized controlled trials. Trial Registration: German Clinical Trials Registry DRKS00023007; https://drks.de/search/en/trial/DRKS00023007 %M 38032725 %R 10.2196/50324 %U https://formative.jmir.org/2023/1/e50324 %U https://doi.org/10.2196/50324 %U http://www.ncbi.nlm.nih.gov/pubmed/38032725 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49257 %T Effects of an Individualized mHealth-Based Intervention on Health Behavior Change and Cardiovascular Risk Among People With Metabolic Syndrome Based on the Behavior Change Wheel: Quasi-Experimental Study %A Chen,Dandan %A Zhang,Hui %A Wu,Jingjie %A Xue,Erxu %A Guo,Pingping %A Tang,Leiwen %A Shao,Jing %A Cui,Nianqi %A Wang,Xiyi %A Chen,Liying %A Ye,Zhihong %+ Nursing Department, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No.3 East Qingchun Road, Shangcheng district, Hangzhou, 310020, China, 86 13606612119, yezh@zju.edu.cn %K metabolic syndrome %K health behavior %K cardiovascular risk %K mobile health %K behavior change wheel %D 2023 %7 29.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Metabolic syndrome (MetS) is a common public health challenge. Health-promoting behaviors such as diet and physical activity are central to preventing and controlling MetS. However, the adoption of diet and physical activity behaviors has always been challenging. An individualized mobile health (mHealth)–based intervention using the Behavior Change Wheel is promising in promoting health behavior change and reducing atherosclerotic cardiovascular disease (ASCVD) risk. However, the effects of this intervention are not well understood among people with MetS in mainland China. Objective: We aimed to evaluate the effects of the individualized mHealth-based intervention using the Behavior Change Wheel on behavior change and ASCVD risk in people with MetS. Methods: We conducted a quasi-experimental, nonrandomized study. Individuals with MetS were recruited from the health promotion center of a tertiary hospital in Zhejiang province, China. The study involved 138 adults with MetS, comprising a control group of 69 participants and an intervention group of 69 participants. All participants received health education regarding diet and physical activity. The intervention group additionally received a 12-week individualized intervention through a WeChat mini program and a telephone follow-up in the sixth week of the intervention. Primary outcomes included diet, physical activity behaviors, and ASCVD risk. Secondary outcomes included diet self-efficacy, physical activity self-efficacy, knowledge of MetS, quality of life, and the quality and efficiency of health management services. The Mann-Whitney U test and Wilcoxon signed rank test were primarily used for data analysis. Data analysis was conducted based on the intention-to-treat principle using SPSS (version 25.0; IBM Corp). Results: Baseline characteristics did not differ between the 2 groups. Compared with the control group, participants in the intervention group showed statistically significant improvements in diet behavior, physical activity behavior, diet self-efficacy, physical activity self-efficacy, knowledge of MetS, physical health, and mental health after a 12-week intervention (P=.04, P=.001, P=.04, P=.04, P=.001, P=.04, P=.04, and P<.05). The intervention group demonstrated a statistically significant improvement in outcomes from pre- to postintervention evaluations (P<.001, P=.03, P<.001, P=.04, P<.001, P<.001, and P<.001). The intervention also led to enhanced health management services and quality. Conclusions: The individualized mHealth-based intervention using the Behavior Change Wheel was effective in promoting diet and physical activity behaviors in patients with MetS. Nurses and other health care professionals may incorporate the intervention into their health promotion programs. %M 38019579 %R 10.2196/49257 %U https://www.jmir.org/2023/1/e49257 %U https://doi.org/10.2196/49257 %U http://www.ncbi.nlm.nih.gov/pubmed/38019579 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e49135 %T Using Mobile Ecological Momentary Assessment to Understand Consumption and Context Around Online Food Delivery Use: Pilot Feasibility and Acceptability Study %A Jia,Si Si %A Allman-Farinelli,Margaret %A Roy,Rajshri %A Phongsavan,Philayrath %A Hyun,Karice %A Gibson,Alice Anne %A Partridge,Stephanie Ruth %+ School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown NSW 2006, Sydney, 2006, Australia, 61 2 8627 1697, sisi.jia@sydney.edu.au %K ecological momentary assessment %K mobile applications %K mobile apps %K feasibility studies %K online food delivery %K smartphone %K young adult %K adolescent %K food environment %K consumer behavior %K mobile phone %D 2023 %7 29.11.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile ecological momentary assessment (EMA) is a powerful tool for collecting real-time and contextual data from individuals. As our reliance on online technologies to increase convenience accelerates, the way we access food is changing. Online food delivery (OFD) services may further encourage unhealthy food consumption habits, given the high availability of energy-dense, nutrient-poor foods. We used EMA to understand the real-time effects of OFD on individuals’ food choices and consumption behaviors. Objective: The primary aims of this pilot study were to assess the feasibility and acceptability of using EMA in young users of OFD and compare 2 different EMA sampling methods. The secondary aims were to gather data on OFD events and their context and examine any correlations between demographics, lifestyle chronic disease risk factors, and OFD use. Methods: This study used EMA methods via a mobile app (mEMASense, ilumivu Inc). Existing users of OFD services aged 16 to 35 years in Australia who had access to a smartphone were recruited. Participants were randomly assigned to 1 of 2 groups: signal-contingent or event-contingent. The signal-contingent group was monitored over 3 days between 7 AM and 10 PM. They received 5 prompts each day to complete EMA surveys via the smartphone app. In contrast, the event-contingent group was monitored over 7 days and was asked to self-report any instance of OFD. Results: A total of 102 participants were analyzed, with 53 participants in the signal-contingent group and 49 participants in the event-contingent group. Compliance rates, indicating the feasibility of signal-contingent and event-contingent protocols, were similar at 72.5% (574/792) and 73.2% (251/343), respectively. Feedback from the participants suggested that the EMA app was not easy to use, which affected their acceptability of the study. Participants in the event-contingent group were 3.53 (95% CI 1.52-8.17) times more likely to have had an OFD event captured during the study. Pizza (23/124, 18.5%) and fried chicken (18/124, 14.5%) comprised a bulk of the 124 OFD orders captured. Most orders were placed at home (98/124, 79%) for 1 person (68/124, 54.8%). Age (incidence rate ratio 0.95, 95% CI 0.91-0.99; P=.03) and dependents (incidence rate ratio 2.01, 95% CI 1.16-3.49; P=.01) were significantly associated with the number of OFD events in a week after adjusting for gender, socioeconomic status, diet quality score, and perceived stress levels. Conclusions: This pilot study showed that EMA using an event-contingent sampling approach may be a better method to capture OFD events and context than signal-contingent sampling. The compliance rates showed that both sampling methods were feasible and acceptable. Although the findings from this study have gathered some insight on the consumption and context of OFD in young people, further studies are required to develop targeted interventions. %M 38019563 %R 10.2196/49135 %U https://mhealth.jmir.org/2023/1/e49135 %U https://doi.org/10.2196/49135 %U http://www.ncbi.nlm.nih.gov/pubmed/38019563 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e53602 %T Behavior Change Techniques for the Maintenance of Physical Activity in Cancer %A Edbrooke,Lara %A Jones,Tamara L %+ The University of Melbourne, Level 7, 161 Barry St, Melbourne, 3053, Australia, 61 3 9035 4213, larae@unimelb.edu.au %K cancer %K physical activity %K behavior change %D 2023 %7 28.11.2023 %9 Commentary %J JMIR Cancer %G English %X Ester et al report the findings from a 2-arm cluster randomized controlled trial nested within a hybrid effectiveness-implementation study, which involved a 12-week exercise and behavior change program for rural and remote Canadians (Exercise for Cancer to Enhance Living Well [EXCEL]). The addition of 23 weeks of app-based physical activity monitoring to the EXCEL program did not result in significant between-group differences in physical activity at 6 months. While several behavior change techniques were included in the initial 12-week intervention, additional techniques were embedded within the mobile app. However, there is currently a lack of evidence regarding how many and which behavior change techniques are the most effective for people with cancer and if these differ based on individual characteristics. Potentially, the use of the mobile app was not required in addition to the behavior change support delivered to both groups as part of the EXCEL program. Further research should involve participants who may be in most need of behavioral support, for example, those with lower levels of self-efficacy. Suggestions for future research to tailor behavior change support for people with cancer are discussed. %M 38015601 %R 10.2196/53602 %U https://cancer.jmir.org/2023/1/e53602 %U https://doi.org/10.2196/53602 %U http://www.ncbi.nlm.nih.gov/pubmed/38015601 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e48040 %T Development and Promotion of an mHealth App for Adolescents Based on the European Code Against Cancer: Retrospective Cohort Study %A Mallafré-Larrosa,Meritxell %A Papi,Ginevra %A Trilla,Antoni %A Ritchie,David %+ Association of European Cancer Leagues, Chaussée de Louvain 479, Brussels, 1030, Belgium, 32 2 256 2000, mmallafre7@gmail.com %K adolescent health %K cancer prevention %K digital health %K ECAC %K European Code Against Cancer %K health promotion %K mHealth %K mobile app %K mobile health %K NCD %K noncommunicable disease %K primary prevention %D 2023 %7 28.11.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Mobile health technologies, underpinned by scientific evidence and ethical standards, exhibit considerable promise and potential in actively engaging consumers and patients while also assisting health care providers in delivering cancer prevention and care services. The WASABY mobile app was conceived as an innovative, evidence-based mobile health tool aimed at disseminating age-appropriate messages from the European Code Against Cancer (ECAC) to adolescents across Europe. Objective: This study aims to assess the outcomes of the design, development, and promotion of the WASABY app through a 3-pronged evaluation framework that encompasses data on social media promotion, app store traffic, and user engagement. Methods: The WASABY app’s content, cocreated with cancer-focused civil society organizations across 6 European countries, drew upon scientific evidence from the ECAC. The app’s 10 modules were designed using the health belief model and a gamification conceptual framework characterized by spaced repetition learning techniques, refined through 2 rounds of testing. To evaluate the effectiveness of the app, we conducted a retrospective cohort study using the WASABY app’s user database registered from February 4 to June 30, 2021, using a 3-pronged assessment framework: social media promotion, app store traffic, and user engagement. Descriptive statistics and association analyses explored the relationship between sociodemographic variables and user performance analytics. Results: After extensive promotion on various social media platforms and subsequent traffic to the Apple App and Google Play stores, a sample of 748 users aged between 14 and 19 years was included in the study cohort. The selected sample exhibited a mean age of 16.08 (SD 1.28) years and was characterized by a predominant representation of female users (499/748, 66.7%). Most app users identified themselves as nonsmokers (689/748, 92.1%), reported either no or infrequent alcohol consumption (432/748, 57.8% and 250/748, 33.4%, respectively), and indicated being physically active for 1 to 5 hours per week (505/748, 67.5%). In aggregate, the app’s content garnered substantial interest, as evidenced by 40.8% (305/748) of users visiting each of the 10 individual modules. Notably, sex and smoking habits emerged as predictors of app completion rates; specifically, male and smoking users demonstrated a decreased likelihood of successfully completing the app’s content (odds ratio 0.878, 95% CI 0.809-0.954 and odds ratio 0.835, 95% CI 0.735-0.949, respectively). Conclusions: The development and promotion of the WASABY app presents a valuable case study, illustrating the effective dissemination of evidence-based recommendations on cancer prevention within the ECAC through an innovative mobile app aimed at European adolescents. The data derived from this study provide insightful findings for the implementation of Europe’s Beating Cancer Plan, particularly the creation of the EU Mobile App for Cancer Prevention. %M 38015612 %R 10.2196/48040 %U https://cancer.jmir.org/2023/1/e48040 %U https://doi.org/10.2196/48040 %U http://www.ncbi.nlm.nih.gov/pubmed/38015612 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e51792 %T Efficacy of mHealth Interventions for Improving Maternal and Neonatal Outcomes Among Pregnant Women With Hypertensive Disorders: Protocol for a Systematic Review %A Noronha,Judith Angelitta %A Lewis,Mitchelle S %A Phagdol,Tenzin %A Nayak,Baby S %A D,Anupama %A Shetty,Jyothi %A N,Ravishankar %A Nair,Sreekumaran %+ Department of Fundamentals of Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Madhav Nagar, Manipal, 576104, India, 91 7259693480, lewis.mitchelle@manipal.edu %K digital health %K gestational hypertension %K hypertension %K hypertensive %K knowledge synthesis %K maternal health outcomes %K maternal %K mHealth %K mobile health application %K mobile health %K neonatal health outcomes %K neonatal %K neonates %K preeclampsia %K pregnancy %K pregnant %K review methodology %K review methods %K SMS %K systematic %K telemedicine %K text messaging %K sustainable development goal %D 2023 %7 28.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Hypertension is one of the most prevalent medical conditions that arise during pregnancy, resulting in maternal and neonatal complications. Mobile health (mHealth) has emerged as an innovative intervention for delivering maternal and child health care services. The evidence on the effectiveness of mHealth interventions in improving the health outcomes of pregnant women with hypertensive disorders is lacking. Therefore, there is a need for evidence synthesis using systematic review methods to address this evidence gap. Objective: This review aims to determine the efficacy of mHealth interventions in improving maternal and neonatal outcomes among pregnant women with hypertensive disorders. The review will answer the following research questions: (1) What are the types of mHealth interventions used in pregnant women with hypertensive disorders? (2) Are the various mHealth interventions effective in improving maternal and neonatal health outcomes, health behaviors, and their knowledge of the disease? and (3) Are mHealth interventions effective in supporting health care providers to make health care decisions for pregnant women with hypertensive disorders? Methods: This review will include randomized controlled trials, nonrandomized controlled trials, and cohort studies focusing on mHealth interventions for pregnant women with hypertensive disorders. Studies reporting health care providers use of mHealth interventions in caring for pregnant women with hypertensive disorders will be included. The search strategy will be tailored to each database using database-specific search terms. The search will be conducted in PubMed-MEDLINE, ProQuest, CINAHL, Scopus, Web of Science, and CENTRAL. Other literature sources, such as trial registries and bibliographies of relevant studies, will be additionally searched. Studies published in English from January 2000 to January 2023 will be included. A total of 2 review authors will independently perform the data extraction and the quality appraisal. For quality appraisal of randomized controlled trials, the Cochrane Risk of Bias 2 tool will be used. The Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-1) tool will be used for nonrandomized controlled trials, and the Critical Appraisal Skills Programme checklist for cohort studies will be used. Any disagreements between the 2 reviewers will be resolved through discussion and a third reviewer if required. A meta-analysis will be performed based on the availability of the data. Results: As per the protocol, the study methodology was followed, and 2 independent reviewers conducted the search in 6 databases and clinical registries. Currently, the review is in the full-text screening stage. The review will publish the results in the first quarter of 2024. Conclusions: The evidence synthesized from this systematic review will help guide future research, support health care decisions, and inform policy makers on the effectiveness of mHealth interventions in improving the maternal and neonatal outcomes of pregnant women with hypertensive disorders. International Registered Report Identifier (IRRID): PRR1-10.2196/51792 %M 38015596 %R 10.2196/51792 %U https://www.researchprotocols.org/2023/1/e51792 %U https://doi.org/10.2196/51792 %U http://www.ncbi.nlm.nih.gov/pubmed/38015596 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e50226 %T The Most Popular Commercial Weight Management Apps in the Chinese App Store: Analysis of Quality, Features, and Behavior Change Techniques %A Geng,Lan %A Jiang,Genyan %A Yu,Lingling %A Xu,Yueming %A Huang,Wei %A Chen,Zhiqi %A Qi,Xiaoyan %A Zhang,Ting %A Zhao,Mei %+ School of Nursing, Anhui Medical University, No.15 Feicui Road, Hefei, 230601, China, 86 551 63869167, zhaomei@ahmu.edu.cn %K quality %K mobile health %K mobile apps %K weight loss %K weight management %K apps %K MARS %K China %D 2023 %7 24.11.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many smartphone apps designed to assist individuals in managing their weight are accessible, but the assessment of app quality and features has predominantly taken place in Western countries. Nevertheless, there is a scarcity of research evaluating weight management apps in China, which highlights the need for further investigation in this area. Objective: This study aims to conduct a comprehensive search for the most popular commercial Chinese smartphone apps focused on weight management and assess their quality, behavior change techniques (BCTs), and content-related features using appropriate evaluation scales. Additionally, the study sought to investigate the associations between the quality of various domains within weight management apps and the number of incorporated BCTs and app features. Methods: In April 2023, data on weight management apps from the iOS and Android app stores were downloaded from the Qimai Data platform. Subsequently, a total of 35 weight management apps were subjected to screening and analysis by 2 researchers. The features and quality of the apps were independently assessed by 6 professionals specializing in nutrition management and health behavioral change using the Mobile Application Rating Scale (MARS). Two registered dietitians, who had experience in app development and coding BCTs, applied the established 26-item BCT taxonomy to verify the presence of BCTs. Mean (SD) scores and their distributions were calculated for each section and item. Spearman correlations were used to assess the relationship between an app’s quality and its technical features, as well as the number of incorporated BCTs. Results: The data set included a total of 35 apps, with 8 available in the Android Store, 10 in the Apple Store, and 17 in both. The overall quality, with a mean MARS score of 3.44 (SD 0.44), showed that functionality was the highest scoring domain (mean 4.18, SD 0.37), followed by aesthetics (mean 3.43, SD 0.42), engagement (mean 3.26, SD 0.64), and information (mean 2.91, SD 0.52), which had the lowest score. The mean number of BCTs in the analyzed apps was 9.17 (range 2-18 BCTs/app). The most common BCTs were “prompt review of behavioral goals” and “provide instruction,” present in 31 apps (89%). This was followed by “prompt self-monitoring of behavior” in 30 apps (86%), “prompt specific goal setting” in 29 apps (83%), and “provide feedback on performance” in 27 apps (77%). The most prevalent features in the analyzed apps were the need for web access (35/35, 100%), monitoring/tracking (30/35, 86%), goal setting (29/35, 83%), and sending alerts (28/35, 80%). The study also revealed strong positive correlations among the number of BCTs incorporated, app quality, and app features. This suggests that apps with a higher number of BCTs tend to have better overall quality and more features. Conclusions: The study found that the overall quality of weight management apps in China is moderate, with a particular weakness in the quality of information provided. The most prevalent BCTs in these apps were reviewing behavioral goals, providing guidance, self-monitoring of behavior, goal setting, and offering performance feedback. The most common features were the need for web access, monitoring and tracking, goal setting, and sending alerts. Notably, higher-quality weight management apps in China tended to incorporate more BCTs and features. These findings can be valuable for developers looking to improve weight management apps and enhance their potential to drive behavioral change in weight management. %M 37999950 %R 10.2196/50226 %U https://mhealth.jmir.org/2023/1/e50226 %U https://doi.org/10.2196/50226 %U http://www.ncbi.nlm.nih.gov/pubmed/37999950 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e44425 %T Within-Person Associations of Accelerometer-Assessed Physical Activity With Time-Varying Determinants in Older Adults: Time-Based Ecological Momentary Assessment Study %A Maes,Iris %A Mertens,Lieze %A Poppe,Louise %A Vetrovsky,Tomas %A Crombez,Geert %A De Backere,Femke %A Brondeel,Ruben %A Van Dyck,Delfien %+ Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, Ghent, 9000, Belgium, 32 9 264 63 63, iris.maes@ugent.be %K ecological momentary assessment %K EMA %K associations %K emotions %K physical concerns %K intention %K self-efficacy %K older adult %K mobile phone %D 2023 %7 23.11.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Despite the availability of physical activity (PA) interventions, many older adults are still not active enough. This might be partially explained by the often-limited effects of PA interventions. In general, health behavior change interventions often do not focus on contextual and time-varying determinants, which may limit their effectiveness. However, before the dynamic tailoring of interventions can be developed, one should know which time-dependent determinants are associated with PA and how strong these associations are. Objective: The aim of this study was to examine within-person associations between multiple determinants of the capability, opportunity, motivation, and behavior framework assessed using Ecological Momentary Assessment (EMA) and accelerometer-assessed light PA, moderate to vigorous PA, and total PA performed at 15, 30, 60, and 120 minutes after the EMA trigger. Methods: Observational data were collected from 64 healthy older adults (36/64, 56% men; mean age 72.1, SD 5.6 y). Participants were asked to answer a time-based EMA questionnaire 6 times per day that assessed emotions (ie, relaxation, satisfaction, irritation, and feeling down), the physical complaint fatigue, intention, intention, and self-efficacy. An Axivity AX3 was wrist worn to capture the participants’ PA. Multilevel regression analyses in R were performed to examine these within-person associations. Results: Irritation, feeling down, intention, and self-efficacy were positively associated with subsequent light PA or moderate to vigorous PA at 15, 30, 60, or 120 minutes after the trigger, whereas relaxation, satisfaction, and fatigue were negatively associated. Conclusions: Multiple associations were observed in this study. This knowledge in combination with the time dependency of the determinants is valuable information for future interventions so that suggestions to be active can be provided when the older adult is most receptive. %M 37995131 %R 10.2196/44425 %U https://aging.jmir.org/2023/1/e44425 %U https://doi.org/10.2196/44425 %U http://www.ncbi.nlm.nih.gov/pubmed/37995131 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e34232 %T Biofeedback and Digitalized Motivational Interviewing to Increase Daily Physical Activity: Series of Factorial N-of-1 Randomized Controlled Trials Piloting the Precious App %A Nurmi,Johanna %A Knittle,Keegan %A Naughton,Felix %A Sutton,Stephen %A Ginchev,Todor %A Khattak,Fida %A Castellano-Tejedor,Carmina %A Lusilla-Palacios,Pilar %A Ravaja,Niklas %A Haukkala,Ari %+ Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35, L363, Jyväskylä, 40014, Finland, 358 504698252, keegan.p.knittle@jyu.fi %K smartphone %K daily steps %K activity tracker %K activity bracelet %K motivational interviewing %K self-efficacy %K self-regulation %K biofeedback %K N-of-1 %K automated %K digitalized %K behavior change %K intervention %K ecological momentary assessment %K within-person design %K intensive longitudinal multilevel modeling %K mobile phone %D 2023 %7 23.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Insufficient physical activity is a public health concern. New technologies may improve physical activity levels and enable the identification of its predictors with high accuracy. The Precious smartphone app was developed to investigate the effect of specific modular intervention elements on physical activity and examine theory-based predictors within individuals. Objective: This study pilot-tested a fully automated factorial N-of-1 randomized controlled trial (RCT) with the Precious app and examined whether digitalized motivational interviewing (dMI) and heart rate variability–based biofeedback features increased objectively recorded steps. The secondary aim was to assess whether daily self-efficacy and motivation predicted within-person variability in daily steps. Methods: In total, 15 adults recruited from newspaper advertisements participated in a 40-day factorial N-of-1 RCT. They installed 2 study apps on their phones: one to receive intervention elements and one to collect ecological momentary assessment (EMA) data on self-efficacy, motivation, perceived barriers, pain, and illness. Steps were tracked using Xiaomi Mi Band activity bracelets. The factorial design included seven 2-day biofeedback interventions with a Firstbeat Bodyguard 2 (Firstbeat Technologies Ltd) heart rate variability sensor, seven 2-day dMI interventions, a wash-out day after each intervention, and 11 control days. EMA questions were sent twice per day. The effects of self-efficacy, motivation, and the interventions on subsequent steps were analyzed using within-person dynamic regression models and aggregated data using longitudinal multilevel modeling (level 1: daily observations; level 2: participants). The analyses were adjusted for covariates (ie, within- and between-person perceived barriers, pain or illness, time trends, and recurring events). Results: All participants completed the study, and adherence to activity bracelets and EMA measurements was high. The implementation of the factorial design was successful, with the dMI features used, on average, 5.1 (SD 1.0) times of the 7 available interventions. Biofeedback interventions were used, on average, 5.7 (SD 1.4) times out of 7, although 3 participants used this feature a day later than suggested and 1 did not use it at all. Neither within- nor between-person analyses revealed significant intervention effects on step counts. Self-efficacy predicted steps in 27% (4/15) of the participants. Motivation predicted steps in 20% (3/15) of the participants. Aggregated data showed significant group-level effects of day-level self-efficacy (B=0.462; P<.001), motivation (B=0.390; P<.001), and pain or illness (B=−1524; P<.001) on daily steps. Conclusions: The automated factorial N-of-1 trial with the Precious app was mostly feasible and acceptable, especially the automated delivery of the dMI components, whereas self-conducted biofeedback measurements were more difficult to time correctly. The findings suggest that changes in self-efficacy and motivation may have same-day effects on physical activity, but the effects vary across individuals. This study provides recommendations based on the lessons learned on the implementation of factorial N-of-1 RCTs. %M 37995122 %R 10.2196/34232 %U https://formative.jmir.org/2023/1/e34232 %U https://doi.org/10.2196/34232 %U http://www.ncbi.nlm.nih.gov/pubmed/37995122 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e47103 %T Empowerment Enabled by Information and Communications Technology and Intention to Sustain a Healthy Behavior: Survey of General Users %A Alluhaidan,Ala Saleh %A Chatterjee,Samir %A Drew,David E %A Ractham,Peter %A Kaewkitipong,Laddawan %+ Center of Excellence in Operations and Information Management, Thammasat Business School, Thammasat University, 2 Prachan Rd., Pranakorn, Bangkok, 10200, Thailand, 66 26132200, laddawan@tbs.tu.ac.th %K empowerment %K behavior change %K information and communications technology %K ICT %K sustaining health behavior %K long-term health behavior %K mobile phone %D 2023 %7 22.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Most people with chronic conditions fail to adhere to self-management behavioral guidelines. In the last 2 decades, several mobile health apps and IT-based systems have been designed and developed to help patients change and sustain their healthy behaviors. However, these systems often lead to short-term behavior change or adherence while the goal is to engage the population toward long-term behavior change. Objective: This study aims to contribute to the development of long-term health behavior changes or to help people sustain their healthy behavior. For this purpose, we built and tested a theoretical model that includes enablers of empowerment and an intention to sustain a healthy behavior when patients are assisted by information and communications technology. Methods: Structural equation modeling was used to analyze 427 survey returns collected from a diverse population of participants and patients. Notably, the model testing was performed for physical activity as a generally desirable healthy goal. Results: Message aligned with personal goals, familiarity with technology tools, high self-efficacy, social connection, and community support played a significant role (P<.001) in empowering individuals to maintain a healthy behavior. The feeling of being empowered exhibited a strong influence, with a path coefficient of 0.681 on an intention to sustain healthy behavior. Conclusions: The uniqueness of this model is its recognition of needs (ie, social connection, community support, and self-efficacy) to sustain a healthy behavior. Individuals are empowered when they are assisted by family and community, specifically when they possess the knowledge, skills, and self-awareness to ascertain and achieve their goals. This nascent theory explains what might lead to more sustainable behavior change and is meant to help designers build better apps that enable people to conduct self-care routines and sustain their behavior. %M 37991814 %R 10.2196/47103 %U https://humanfactors.jmir.org/2023/1/e47103 %U https://doi.org/10.2196/47103 %U http://www.ncbi.nlm.nih.gov/pubmed/37991814 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47463 %T The Effect of Interactivity, Tailoring, and Use Intensity on the Effectiveness of an Internet-Based Smoking Cessation Intervention Over a 12-Month Period: Randomized Controlled Trial %A Maiwald,Phillip %A Bischoff,Martina %A Lindinger,Peter %A Tinsel,Iris %A Sehlbrede,Matthias %A Fichtner,Urs Alexander %A Metzner,Gloria %A Schlett,Christian %A Farin-Glattacker,Erik %+ Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Straße 49, Freiburg, 79106, Germany, 49 761 270 72461, martina.bischoff@uniklinik-freiburg.de %K eHealth %K internet-based %K smoking cessation %K interactivity %K tailoring %K use intensity %K randomized controlled trial %K mobile phone %D 2023 %7 21.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth approaches show promising results for smoking cessation (SC). They can improve quit rates, but rigorous research is sparse regarding their effectiveness and the effects of their interactivity, tailoring, and use intensity. Objective: We examined the effectiveness of Techniker Krankenkasse Smoking Cessation Coaching (TK-SCC), an internet-based, tailored, and interactive SC intervention. Our hypotheses were as follows: hypothesis 1, in the intervention group (IG; access to TK-SCC), a clinically relevant number of participants will be abstinent at the 12-month follow-up (T3); hypothesis 2, the number of abstinent participants will be significantly greater in the IG than the control group (CG) at T3; and hypothesis 3, in the IG, more intense use of TK-SCC will be positively associated with abstinence. Methods: Individuals who smoke were randomized into the IG (563/1115, 50.49%) or CG (552/1115, 49.51%), which received a noninteractive, nontailored, and information-only web-based intervention. Data were collected before the intervention, at the postintervention time point (T1), at the 4-month follow-up (T2), and at T3. We tested hypothesis 1 through equivalence tests between the IG’s success rate and success rates of comparable effective interventions reported in 2 current meta-analyses. For hypothesis 2, we conducted binary logistic regressions. For hypothesis 3, we assigned the IG participants to 1 of 4 user types and used binary logistic regressions with user types as the independent variable and smoking abstinence as the dependent variable. Results: In the IG, 11.5% (65/563) and 11.9% (67/563) of participants were smoke free at T1 and T3, respectively. These values were statistically equivalent to the effects in the 2 meta-analyses, which reported 9% (z score=0.64, P=.74) and 10.9% (z score=−0.71, P=.24) success rates, respectively. In the CG, 6.2% (34/552) of the participants were smoke free at T1, which increased up to 8.2% (45/552) at T3. The difference between the IG and CG was statistically significant only at T1 (odds ratio [OR] 2.0, 99% CI 1.1 to 3.6; P=.002), whereas the effect was nonsignificant following α error corrections at T3 (OR 1.6, 99% CI 0.9 to 2.7; P=.02). In the IG, constant users of the program became smoke free significantly more often than rare users of the program (T1: OR 15.0, 99% CI 6.1 to 36.9; P<.001; T3: OR 6.5, 99% CI 2.8 to 15.5; P<.001). Conclusions: TK-SCC is effective for SC. However, its superiority compared with a minimal SC intervention could not be confirmed in the long term. Insufficient implementation of the techniques used and cotreatment bias could explain this outcome. Higher use intensity of TK-SCC was positively related to abstinence. Therefore, additional efforts to motivate users to adhere to intervention use as intended could improve the intervention’s effectiveness. Trial Registration: German Clinical Trials Register DRKS00020249, Universal Trial Number U1111-1245-0273; https://drks.de/search/de/trial/DRKS00020249 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-021-05470-8 %M 37988144 %R 10.2196/47463 %U https://www.jmir.org/2023/1/e47463 %U https://doi.org/10.2196/47463 %U http://www.ncbi.nlm.nih.gov/pubmed/37988144 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51334 %T mHealth Intervention to Promote Physical Activity Among Employees Using a Deep Learning Model for Passive Monitoring of Depression and Anxiety: Single-Arm Feasibility Trial %A Watanabe,Kazuhiro %A Okusa,Shoichi %A Sato,Mitsuhiro %A Miura,Hideki %A Morimoto,Masahiro %A Tsutsumi,Akizumi %+ Department of Public Health, Kitasato University School of Medicine, 1-15-1 Kitazato, Minami-ku, Sagamihara, 252-0374, Japan, 81 427789352, kzwatanabe-tky@umin.ac.jp %K eHealth %K behavioral change %K mobile phone %K smartphone %K mHealth %K mobile health %K app %K apps %K applications %K monitor %K monitoring %K physical activity %K exercise %K fitness %K application %K workplace %K distress %K depression %K depressive %K anxiety %K mental health %K worker %K workers %K employee %K employees %K occupational health %K satisfaction %K feasibility %K acceptability %D 2023 %7 17.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical activity effectively prevents depression and anxiety. Although mobile health (mHealth) technologies offer promising results in promoting physical activity and improving mental health, conflicting evidence exists on their effectiveness, and employees face barriers to using mHealth services. To address these problems, we recently developed a smartphone app named ASHARE to prevent depression and anxiety in the working population; it uses a deep learning model for passive monitoring of depression and anxiety from information about physical activity. Objective: This study aimed to preliminarily investigate (1) the effectiveness of the developed app in improving physical activity and reducing depression and anxiety and (2) the app’s implementation outcomes (ie, its acceptability, appropriateness, feasibility, satisfaction, and potential harm). Methods: We conducted a single-arm interventional study. From March to April 2023, employees aged ≥18 years who were not absent were recruited. The participants were asked to install and use the app for 1 month. The ideal usage of the app was for the participants to take about 5 minutes every day to open the app, check the physical activity patterns and results of an estimated score of psychological distress, and increase their physical activity. Self-reported physical activity (using the Global Physical Activity Questionnaire, version 2) and psychological distress (using the 6-item Kessler Psychological Distress Scale) were measured at baseline and after 1 month. The duration of physical activity was also recorded digitally. Paired t tests (two-tailed) and chi-square tests were performed to evaluate changes in these variables. Implementation Outcome Scales for Digital Mental Health were also measured for acceptability, appropriateness, feasibility, satisfaction, and harm. These average scores were assessed by comparing them with those reported in previous studies. Results: This study included 24 employees. On average, the app was used for 12.54 days (44.8% of this study’s period). After using the app, no significant change was observed in physical activity (–12.59 metabolic equivalent hours per week, P=.31) or psychological distress (–0.43 metabolic equivalent hours per week, P=.93). However, the number of participants with severe psychological distress decreased significantly (P=.01). The digitally recorded duration of physical activity increased during the intervention period (+0.60 minutes per day, P=.08). The scores for acceptability, appropriateness, and satisfaction were lower than those in previous mHealth studies, whereas those for feasibility and harm were better. Conclusions: The ASHARE app was insufficient in promoting physical activity or improving psychological distress. At this stage, the app has many issues that are to be addressed in terms of both implementation and effectiveness. The main reason for this low effectiveness might be the poor evaluation of the implementation outcomes by app users. Improving acceptability, appropriateness, and satisfaction are identified as key issues to be addressed in future implementation. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000050430; https://tinyurl.com/mrx5ntcmrecptno=R000057438 %M 37976094 %R 10.2196/51334 %U https://formative.jmir.org/2023/1/e51334 %U https://doi.org/10.2196/51334 %U http://www.ncbi.nlm.nih.gov/pubmed/37976094 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e48950 %T Think Aloud Testing of a Smartphone App for Lifestyle Change Among Persons at Risk of Type 2 Diabetes: Usability Study %A Lunde,Pernille %A Skoglund,Gyri %A Olsen,Cecilie Fromholt %A Hilde,Gunvor %A Bong,Way Kiat %A Nilsson,Birgitta Blakstad %+ Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, P44, PB 4, Street Olavs Plass, Oslo, 0130, Norway, 47 48063537, plunde@oslomet.no %K mHealth %K mobile phone app %K smartphone %K lifestyle %K usability %K diabetes %K diabetic %K mobile health %K smartphone %K app %K apps %K application %K applications %K think-aloud %K think aloud %K user experience %K mobile phone %D 2023 %7 15.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Type 2 diabetes mellitus (DM2) is a leading cause of morbidity and mortality worldwide and is considered a global epidemic. Despite the growing evidence on the effectiveness of mobile health interventions in the management of DM2, the evidence on the effect of mobile health interventions in prevention of DM2 is sparse. Therefore, we have developed an app aiming to promote initiation of behavioral change and adherence to healthy behavior. Before commencing a small-scale randomized controlled trial to assess the feasibility of using an app for initiation and adherence of healthy behavior in people at risk of DM2, testing the usability of the app in the target population is warranted. Objective: The aim of this study was to assess the usability of an app among people at risk of DM2. Methods: A qualitative study with the use of a think aloud (TA) procedure was conducted from April to November 2022. The TA procedure consisted of 10 problem-solving tasks and a semistructured interview which was carried out after the tasks. These interviews served to gain more in-depth knowledge of the users experience of the problem-solving tasks. The TA-sessions and the postactivity interviews were recorded and transcribed verbatim, and the data were coded and analyzed following the principles of thematic analysis. Results: In total, 7 people at risk of DM2 with a median age of 66 (range 41-75) years participated in this study. The analysis resulted in the following themes: (1) user interface design; and (2) suggestions for improvements of the functionality of the app. Conclusions: Overall, the participants were satisfied with the usability of the app. Through the TA-sessions, real time perspective on the appeal, relevance, and utility of the app were gained. Only minor changes to the functionality of the prototype app were reported as necessary to improve the usability of the app. Points of guidance from the participants in this study have been adopted and incorporated into the final design of the app now being assessed for feasibility in a small-scale randomized controlled trial. %M 37966894 %R 10.2196/48950 %U https://humanfactors.jmir.org/2023/1/e48950 %U https://doi.org/10.2196/48950 %U http://www.ncbi.nlm.nih.gov/pubmed/37966894 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47404 %T Testing a Digital Health App for Patients With Alcohol-Associated Liver Disease: Mixed Methods Usability Study %A Park,Linda S %A Kornfield,Rachel %A Yezihalem,Mihret %A Quanbeck,Andrew %A Mellinger,Jessica %A German,Margarita %+ Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, 610 N. Whitney Way #200, Madison, WI, 53705, United States, 1 608 345 6859, linda.park@fammed.wisc.edu %K alcohol-associated liver disease %K ALD %K alcohol use disorder %K AUD %K mobile health %K mHealth %K digital tools %K alcohol cessation %K usability test %K mobile phone %D 2023 %7 15.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol-associated liver disease (ALD) is increasingly common and associated with serious and costly health consequences. Cessation of drinking can improve ALD morbidity and mortality; however, support for cessation is not routinely offered to those diagnosed with ALD, and continued drinking or resumption of drinking after diagnosis is common. Mobile health (mHealth) has the potential to offer convenient and scalable support for alcohol cessation to those diagnosed with ALD, but mHealth interventions for alcohol cessation have not been designed for or evaluated in a population with ALD. Objective: This study aims to understand how individuals with ALD would perceive and use an mHealth tool for alcohol cessation and to gather their perspectives on potential refinements to the tool that would allow it to better meet their needs. Methods: We interviewed 11 individuals who attended clinic visits related to their ALD to elicit their needs related to support for alcohol cessation and views on how mHealth could be applied. After completing initial interviews (pre), participants were provided with access to an mHealth app designed for alcohol cessation, which they used for 1 month. Afterward, they were interviewed again (post) to give feedback on their experiences, including aspects of the app that met their needs and potential refinements. We applied a mixed methods approach, including a qualitative analysis to identify major themes from the interview transcripts and descriptive analyses of use of the app over 1 month. Results: First, we found that a diagnosis of ALD is perceived as a motivator to quit drinking but that patients had difficulty processing the overwhelming amount of information about ALD they received and finding resources for cessation of alcohol use. Second, we found that the app was perceived as usable and useful for supporting drinking recovery, with patients responding favorably to the self-tracking and motivational components of the app. Finally, patients identified areas in which the app could be adapted to meet the needs of patients with ALD, such as providing information on the medical implications of an ALD diagnosis and how to care for their liver as well as connecting individuals with ALD to one another via a peer-to-peer support forum. Rates of app use were high and sustained across the entire study, with participants using the app a little more than half the days during the study on average and with 100% (11/11) of participants logging in each week. Conclusions: Our results highlight the need for convenient access to resources for alcohol cessation after ALD diagnosis and support the potential of an mHealth approach to integrate recovery support into care for ALD. Our findings also highlight the ways the alcohol cessation app should be modified to address ALD-specific concerns. %M 37966869 %R 10.2196/47404 %U https://formative.jmir.org/2023/1/e47404 %U https://doi.org/10.2196/47404 %U http://www.ncbi.nlm.nih.gov/pubmed/37966869 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50870 %T A Mobile Intervention Designed Specifically for Older Adults With Frailty to Support Healthy Eating: Pilot Randomized Controlled Trial %A Su,Yan %A Wu,Kuan-Ching %A Chien,Shao-Yun %A Naik,Aishwarya %A Zaslavsky,Oleg %+ School of Nursing, University of Washington, 1959 NE Pacific Ave, Box 357266, Seattle, WA, 98195-7266, United States, 1 206 849 3301, ozasl@uw.edu %K frailty %K healthy eating %K mobile %K mHealth %K mobile health %K app %K apps %K clinical trial %K Mediterranean diet %K metabolic health %K diet %K dietary %K RCT %K randomized controlled trial %K randomized %K controlled trial %K controlled trials %K frail %K eating %K food %K nutrition %K adherence %D 2023 %7 15.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Frailty, a common geriatric syndrome, predisposes older adults to functional decline. No medications can alter frailty's trajectory, but nutritional interventions may aid in supporting independence. Objective: This paper presents a pilot randomized controlled trial to investigate the feasibility and efficacy of a mobile health intervention, “Olitor,” designed to enhance adherence to the Mediterranean diet among older adults with frailty, requiring no external assistance. Methods: The study sample consisted of 15 participants aged 66-77 (mean 70.5, SD 3.96) years randomized into intervention (n=8; 8 females; mean 72.4, SD 4.8 years) and control groups (n=7; 6 females, 1 male; mean 70.0, SD 3.9 years). The intervention involved a patient-facing mobile app called “Olitor” and a secure web-based administrative dashboard. Participants were instructed to use the app at least weekly for 3 months, which provided feedback on their food choices, personalized recipe recommendations, and an in-app messaging feature. Using Mann-Whitney tests to compare change scores and Hedges g statistics to estimate effect sizes, the primary efficacy outcomes were adherence to the Mediterranean diet score and insulin resistance measures. Secondary outcomes included retention as a measure of feasibility, engagement level and user app quality ratings for acceptability, and additional metrics to evaluate efficacy. Models were adjusted for multiple comparisons. Results: The findings demonstrated a significant improvement in the Mediterranean diet adherence score in the intervention group compared to the control (W=50.5; adjusted P=.04) with median change scores of 2 (IQR 2-4.25) and 0 (IQR –0.50 to 0.50), respectively. There was a small and insignificant reduction in homeostasis model assessment of insulin resistance measure (W=23; adjusted P=.85). Additionally, there were significant increases in legume intake (W=54; adjusted P<.01). The intervention's effect size was large for several outcomes, such as Mediterranean diet adherence (Hedges g=1.58; 95% CI 0.34-2.67) and vegetable intake (Hedges g=1.14; 95% CI 0.08-2.21). The retention rate was 100%. The app's overall quality rating was favorable with an average interaction time of 12 minutes weekly. Conclusions: This pilot study revealed the potential of the mobile intervention “Olitor” in promoting healthier eating habits among older adults with frailty. It demonstrated high retention rates, significant improvement in adherence to the Mediterranean diet, and increased intake of recommended foods. Insulin resistance showed a minor nonsignificant improvement. Several secondary outcomes, such as lower extremity function and Mediterranean diet knowledge, had a large effect size. Although the app's behavior change features were similar to those of previous digital interventions, the distinctive focus on theory-informed mechanistic measures involved in behavioral change, such as self-regulation, self-efficacy, and expected negative outcomes, may have enhanced its potential. Further investigations in a more diverse and representative population, focusing on individuals with impaired insulin sensitivity, are warranted to validate these preliminary findings. Trial Registration: ClinicalTrials.gov NCT05236712; https://clinicaltrials.gov/study/NCT05236712 %M 37966877 %R 10.2196/50870 %U https://formative.jmir.org/2023/1/e50870 %U https://doi.org/10.2196/50870 %U http://www.ncbi.nlm.nih.gov/pubmed/37966877 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47312 %T Personalized Coaching via Texting for Behavior Change to Understand a Healthy Lifestyle Intervention in a Naturalistic Setting: Mixed Methods Study %A Bäccman,Charlotte %A Bergkvist,Linda %A Wästlund,Erik %+ Service Research Center (CTF), Karlstad University, Universitetsgatan 2, Karlstad, 65188, Sweden, 46 547002519, charlotte.baccman@kau.se %K digital health intervention %K behavior change %K personalized SMS coaching %K Capability, Opportunity, Motivation–Behavior %K COM-B %K physical activity %K mixed methods design %K mobile phone %D 2023 %7 15.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health interventions, such as personalized SMS coaching, are considered affordable and scalable methods to support healthy lifestyle changes. SMS, or texting, is a readily available service to most people in Sweden, and personalized SMS coaching has shown great promise in supporting behavior changes. Objective: This study aims to explore the effectiveness of highly personalized SMS coaching for behavior change according to the Capability, Opportunity, Motivation–Behavior (COM-B) model on a sample of physically inactive adults in a nonprofit fitness organization in Sweden. Methods: The study used a mixed methods design in which clients acted as their own controls. The participants were clients (n=28) and fitness consultants (n=12). Three types of data were collected: (1) quantitative data at baseline and after the SMS intervention and the waitlist from the clients, (2) qualitative data from semistructured interviews with the fitness consultants, and (3) pseudonymized texting conversations between the fitness consultants and clients. Results: Overall, the results showed that personalized SMS coaching was effective in supporting the clients’ behavior changes. The quantitative analysis showed how the clients’ capabilities (Cohen d=0.50), opportunities (Cohen d=0.43), and relationship with the fitness consultants (Cohen d=0.51) improved during the SMS intervention in comparison with baseline. Furthermore, the qualitative analysis revealed how personalized texts added value to existing work methods (eg, increasing continuity and flexibility) and how the relationship between the clients and fitness consultants changed during the intervention, which helped motivate the clients. Conclusions: Personalized SMS coaching is an effective method for supporting healthy behavior changes. The human connection that emerged in this study needs to be further explored to fully understand the effectiveness of a digital health intervention. %M 37966893 %R 10.2196/47312 %U https://formative.jmir.org/2023/1/e47312 %U https://doi.org/10.2196/47312 %U http://www.ncbi.nlm.nih.gov/pubmed/37966893 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44919 %T RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Evaluation of the Use of Activity Trackers in the Clinical Care of Adults Diagnosed With a Chronic Disease: Integrative Systematic Review %A Hodgson,William %A Kirk,Alison %A Lennon,Marilyn %A Janssen,Xanne %A Russell,Eilidh %A Wani,Carolina %A Eskandarani,Dina %+ School of Psychological Sciences and Health, Department of Physical Activity for Health, University of Strathclyde, Graham Hills Building, 40, George Street, Glasgow, G1 1QE, United Kingdom, 44 1857616479, william.hodgson@strath.ac.uk %K activity trackers %K clinical care %K physical activity %K sedentary behavior %K adults %K chronic diseases %K Reach, Effectiveness, Adoption, Implementation, and Maintenance %K RE-AIM %K mortality %K sedentary lifestyle %K intervention %K mobile phone %D 2023 %7 13.11.2023 %9 Review %J J Med Internet Res %G English %X Background: Chronic diseases are a leading cause of adult mortality, accounting for 41 million deaths globally each year. Low levels of physical activity and sedentary behavior are major risk factors for adults to develop a chronic disease. Physical activity interventions can help support patients in clinical care to be more active. Commercial activity trackers that can measure daily steps, physical activity intensity, sedentary behavior, and distance moved are being more frequently used within health-related interventions. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is a planning and evaluation approach to explore the reach, effectiveness, adoption, implementation, and maintenance of interventions. Objective: The objective of this study is to conduct an integrative systematic review and report the 5 main RE-AIM dimensions in interventions that used activity trackers in clinical care to improve physical activity or reduce sedentary behavior in adults diagnosed with chronic diseases. Methods: A search strategy and study protocol were developed and registered on the PROSPERO platform. Inclusion criteria included adults (18 years and older) diagnosed with a chronic disease and have used an activity tracker within their clinical care. Searches of 10 databases and gray literature were conducted, and qualitative, quantitative, and mixed methods studies were included. Screening was undertaken by more than 1 researcher to reduce the risk of bias. After screening, the final studies were analyzed using a RE-AIM framework data extraction evaluation tool. This tool assisted in identifying the 28 RE-AIM indicators within the studies and linked them to the 5 main RE-AIM dimensions. Results: The initial search identified 4585 potential studies. After a title and abstract review followed by full-text screening, 15 studies were identified for data extraction. The analysis of the extracted data found that the RE-AIM dimensions of adoption (n=1, 7% of studies) and maintenance (n=2, 13% of studies) were underreported. The use of qualitative thematic analysis to understand the individual RE-AIM dimensions was also underreported and only used in 3 of the studies. Two studies used qualitative analysis to explore the effectiveness of the project, while 1 study used thematic analysis to understand the implementation of an intervention. Conclusions: Further research is required in the use of activity trackers to support patients to lead a more active lifestyle. Such studies should consider using the RE-AIM framework at the planning stage with a greater focus on the dimensions of adoption and maintenance and using qualitative methods to understand the main RE-AIM dimensions within their design. These results should form the basis for establishing long-term interventions in clinical care. Trial Registration: PROSPERO CRD42022319635; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=319635 %M 37955960 %R 10.2196/44919 %U https://www.jmir.org/2023/1/e44919 %U https://doi.org/10.2196/44919 %U http://www.ncbi.nlm.nih.gov/pubmed/37955960 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48853 %T App-Supported Lifestyle Interventions in Pregnancy to Manage Gestational Weight Gain and Prevent Gestational Diabetes: Scoping Review %A Raab,Roxana %A Geyer,Kristina %A Zagar,Sophia %A Hauner,Hans %+ Institute of Nutritional Medicine, Else Kröner Fresenius Centre for Nutritional Medicine, TUM School of Medicine and Health, Technical University of Munich, Georg-Brauchle-Ring 62, Munich, 80992, Germany, 49 892 892 4921, hans.hauner@tum.de %K mobile health %K mHealth %K eHealth %K mobile app %K lifestyle intervention %K pregnancy %K gestational weight gain %K gestational diabetes %K prevention %K overweight %K obesity %K mobile phone %D 2023 %7 10.11.2023 %9 Review %J J Med Internet Res %G English %X Background: Excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM) are common pregnancy complications that have been shown to be preventable through the use of lifestyle interventions. However, a significant gap exists between research on pregnancy lifestyle interventions and translation into clinical practice. App-supported interventions might aid in overcoming previous implementation barriers. The current status in this emerging research area is unknown. Objective: This scoping review aims to provide a comprehensive overview of planned, ongoing, and completed studies on eHealth and mobile health (mHealth) app–supported lifestyle interventions in pregnancy to manage GWG and prevent GDM. The review assesses the scope of the literature in the field; describes the population, intervention, control, outcomes, and study design (PICOS) characteristics of included studies as well as the findings on GWG and GDM outcomes; and examines app functionalities. Methods: The scoping review was conducted according to a preregistered protocol and followed established frameworks. Four electronic databases and 2 clinical trial registers were systematically searched. All randomized and quasi-randomized controlled trials (RCTs) of app-supported lifestyle interventions in pregnancy and related qualitative and quantitative research across the different study phases were considered for inclusion. Eligible studies and reports of studies were included until June 2022. Extracted data were compiled in descriptive analyses and reported in narrative, tabular, and graphical formats. Results: This review included 97 reports from 43 lifestyle intervention studies. The number of published reports has steadily increased in recent years; of the 97 included reports, 38 (39%) were trial register entries. Of the 39 identified RCTs, 10 efficacy or effectiveness trials and 8 pilot trials had published results on GWG (18/39, 46%); of these 18 trials, 7 (39%) trials observed significant intervention effects on GWG outcomes. Of all 39 RCTs, 5 (13%) efficacy or effectiveness trials reported GDM results, but none observed significant intervention effects on GDM. The RCTs included in the review were heterogeneous in terms of their PICOS characteristics. Most of the RCTs were conducted in high-income countries, included women with overweight or obesity and from all BMI categories, delivered multicomponent interventions, delivered interventions during pregnancy only, and focused on diet and physical activity. The apps used in the studies were mostly mHealth apps that included features for self-monitoring, feedback, goal setting, prompts, and educational content. Self-monitoring was often supported by wearable activity monitors and Bluetooth-connected weight scales. Conclusions: Research in this field is nascent, and the effectiveness and implementability of app-supported interventions have yet to be determined. The complexity and heterogeneity of intervention approaches pose challenges in identifying the most beneficial app features and intervention components and call for consistent and comprehensive intervention and outcome reporting. %M 37948111 %R 10.2196/48853 %U https://www.jmir.org/2023/1/e48853 %U https://doi.org/10.2196/48853 %U http://www.ncbi.nlm.nih.gov/pubmed/37948111 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45725 %T A Guided, Internet-Based Stress Management Intervention for University Students With High Levels of Stress: Feasibility and Acceptability Study %A Amanvermez,Yagmur %A Karyotaki,Eirini %A Cuijpers,Pim %A Ciharova,Marketa %A Donker,Marianne %A Hurks,Petra %A Salemink,Elske %A Spinhoven,Philip %A Struijs,Sascha %A de Wit,Leonore M %+ Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, TIAS Building, Room 508, Tilburg, 5037 AB, Netherlands, 31 134663665, y.amanvermez@tilburguniversity.edu %K internet-based interventions %K stress management %K university students %K e–mental health %K feasibility study %K stress %K digital interventions %D 2023 %7 10.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Transitioning to adulthood and challenges in university life can result in increased stress levels among university students. Chronic and severe stress is associated with deleterious psychological and physiological effects. Digital interventions could succeed in approaching and helping university students who might be at risk; however, the experiences of students with internet-based stress management interventions are insufficiently understood. Objective: This study aims to explore the feasibility; acceptability; and changes in perceived stress, depressive symptoms, and quality of life from baseline to posttest assessment of a 5-session, internet-based stress management intervention guided by an e-coach, developed for university students experiencing high levels of stress. Methods: A single-arm study was conducted. Students were recruited from different channels, mainly from a web survey. Students were eligible if they (1) scored ≥20 on the Perceived Stress Scale–10, (2) were aged ≥18 years, and (3) were studying at one of the participating universities. Feasibility and acceptability of the intervention were investigated using several indications, including satisfaction (Client Satisfaction Questionnaire–8) and usability (System Usability Scale–10). We also investigated the indicators of intervention adherence using use metrics (eg, the number of completed sessions). Our secondary goal was to explore the changes in perceived stress (Perceived Stress Scale–10), depressive symptoms (Patient Health Questionnaire–9), and quality of life (EQ-5D-5L scale) from baseline to posttest assessment. In addition, we conducted semistructured interviews with intervention completers and noncompleters to understand user experiences in depth. For all primary outcomes, descriptive statistics were calculated. Changes from baseline to posttest assessment were examined using 2-tailed paired sample t tests or the Wilcoxon signed rank test. Qualitative data were analyzed using thematic analysis. Results: Of 436 eligible students, 307 (70.4%) students started using the intervention. Overall, 25.7% (79/307) completed the core sessions (ie, sessions 1-3) and posttest assessment. A substantial proportion of the students (228/307, 74.3%) did not complete the core sessions or the posttest assessment. Students who completed the core sessions reported high satisfaction (mean 25.78, SD 3.30) and high usability of the intervention (mean 86.01, SD 10.25). Moreover, this group showed large reductions in perceived stress (Cohen d=0.80) and moderate improvements in depression score (Cohen d=0.47) and quality of life (Cohen d=−0.35) from baseline to posttest assessment. Qualitative findings highlight that several personal and intervention-related factors play a role in user experience. Conclusions: The internet-based stress management intervention seems to be feasible, acceptable, and possibly effective for some university students with elevated stress levels. However, given the high dropout rate and qualitative findings, several adjustments in the content and features of the intervention are needed to maximize the user experience and the impact of the intervention. Trial Registration: Netherlands Trial Register 8686; https://onderzoekmetmensen.nl/nl/trial/20889 International Registered Report Identifier (IRRID): RR2-10.1016/j.invent.2021.100369 %M 37948106 %R 10.2196/45725 %U https://formative.jmir.org/2023/1/e45725 %U https://doi.org/10.2196/45725 %U http://www.ncbi.nlm.nih.gov/pubmed/37948106 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e50038 %T Designing a Mobile e-Coaching App for Immigrant Informal Caregivers: Qualitative Study Using the Persuasive System Design Model %A Premanandan,Shweta %A Ahmad,Awais %A Cajander,Åsa %A Ågerfalk,Pär %A Dolezel,Michal %A van Gemert-Pijnen,Lisette %+ Department of Informatics and Media, Uppsala University, Ekonomikum (Plan 3), Kyrkogårdsgatan 10, Uppsala, 751 20, Sweden, 46 707689331, shweta.premanandan@im.uu.se %K e-coaching %K mobile health %K mHealth %K immigrant informal caregivers %K designing app %K persuasive system design %K user needs %K caregiver %K app %K design %K users %K aging %K development %K diversity %K language barrier %K inclusion %K training %K mental health %K mobile phone %D 2023 %7 9.11.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Informal caregivers are vital in caring for their family and friends at home who may have illnesses or disabilities. In particular, the demands for caregiving can be even more challenging for those with limited resources, support systems, and language barriers, such as immigrant informal caregivers. They face complex challenges in providing care for their relatives. These challenges can be related to sociocultural diversity, language barriers, and health care system navigation. Acknowledging the global context of the increasing number of immigrants is essential in designing inclusive mobile health apps. Objective: This study aims to investigate the needs of immigrant informal caregivers in Sweden and discuss the application of the Persuasive System Design Model (PSDM) to develop an e-coaching prototype. By addressing the unique challenges faced by immigrant informal caregivers, this study will contribute to the development of more effective and inclusive mobile health apps. Methods: The participants were considered immigrants and included in the study if they and their parents were born outside of Sweden. Through various channels, such as the National Association of Relatives, rehabilitation departments at municipalities, and immigrant groups, we recruited 13 immigrant informal caregivers. These immigrant informal caregivers were primarily women aged 18 to 40 years. Most participants belonged to the Middle Eastern region whereas some were from North Africa. However, all of them spoke Arabic. We used semistructured interviews to gather data from the participants in Arabic, which were translated into English. Data were analyzed using thematic analysis and discussed in relation to the extended PSDM. The needs of the caregivers were compared with the description of persuasive design principles, and a design principle was chosen based on the match. The PSDM was extended if the need description did not match any principles. Several brainstorming and prototyping sessions were conducted to design the mobile e-coaching app. Results: Immigrant informal caregivers have various needs in their caregiving role. They reported a need for training on the illness and future caregiving needs, assistance with understanding the Swedish language and culture, and help with accessing internet-based information and services. They also required recognition and appreciation for their efforts, additional informal support, and easy access to health care services, which can be important for their mental health. The PSDM was adapted to the informal caregiving context by adding “facilitating conditions” and “verbal encouragement” as additional persuasive design principles. This study also presents the subsequent mobile e-coaching app for immigrant informal caregivers in Sweden. Conclusions: This study revealed important immigrant informal caregivers’ needs based on which design suggestions for a mobile e-coaching app were presented. We also proposed an adapted PSDM, for the informal caregiving context. The adapted PSDM can be further used to design digital interventions for caregiving. %M 37943598 %R 10.2196/50038 %U https://mhealth.jmir.org/2023/1/e50038 %U https://doi.org/10.2196/50038 %U http://www.ncbi.nlm.nih.gov/pubmed/37943598 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e48896 %T Use of e-Cigarettes in Cigarette Smoking Cessation: Secondary Analysis of a Randomized Controlled Trial %A Santiago-Torres,Margarita %A Mull,Kristin E %A Sullivan,Brianna M %A Bricker,Jonathan B %+ Fred Hutchinson Cancer Center, 1100 Fairview Avenue North, Seattle, WA, 98109, United States, 1 2066674780, msantiag@fredhutch.org %K acceptance and commitment therapy %K cigarette smoking %K digital behavioral interventions %K e-cigarettes %K smoking cessation %K smartphone apps %K vaping %K mobile phone %D 2023 %7 9.11.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many adults use e-cigarettes to help them quit cigarette smoking. However, the impact of self-selected use of e-cigarettes on cigarette smoking cessation, particularly when concurrently receiving app-based behavioral interventions, remains unexplored. Objective: This study used data from a randomized trial of 2 smartphone apps to compare 12-month cigarette smoking cessation rates between participants who used e-cigarettes on their own (ie, adopters: n=465) versus those who did not (ie, nonadopters: n=1097). Methods: The study population included all participants who did not use e-cigarettes at baseline. “Adopters” were those who self-reported the use of e-cigarettes at either 3- or 6-month follow-ups. “Nonadopters” were those who self-reported no use of e-cigarettes at either follow-up time point. The primary cessation outcome was self-reported, complete-case, 30-day point prevalence abstinence from cigarette smoking at 12 months. Secondary outcomes were missing-as-smoking and multiple imputation analyses of the primary outcome, prolonged abstinence, and cessation of all nicotine and tobacco products at 12 months. In logistic regression models, we first examined the potential interaction between e-cigarette use and treatment arm (iCanQuit vs QuitGuide) on the primary cessation outcome. Subsequently, we compared 12-month cigarette smoking cessation rates between adopters and nonadopters separately for each app. Results: There was suggestive evidence for an interaction between e-cigarette use and treatment arm on cessation (P=.05). In the iCanQuit arm, 12-month cigarette smoking cessation rates were significantly lower among e-cigarette adopters compared with nonadopters (41/193, 21.2% vs 184/527, 34.9%; P=.003; odds ratio 0.55, 95% CI 0.37-0.81). In contrast, in the QuitGuide arm, 12-month cigarette smoking cessation rates did not differ between adopters and nonadopters (46/246, 18.7% vs 104/522, 19.9%; P=.64; odds ratio 0.91, 95% CI 0.62-1.35). Conclusions: The use of e-cigarettes while concurrently receiving an app-based smoking cessation intervention was associated with either a lower or an unimproved likelihood of quitting cigarette smoking compared to no use. Future behavioral treatments for cigarette smoking cessation should consider including information on the potential consequences of e-cigarette use. Trial Registration: ClinicalTrials.gov NCT02724462; https://clinicaltrials.gov/study/NCT02724462 %M 37943594 %R 10.2196/48896 %U https://mhealth.jmir.org/2023/1/e48896 %U https://doi.org/10.2196/48896 %U http://www.ncbi.nlm.nih.gov/pubmed/37943594 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50643 %T Designing Implementation Strategies for a Digital Suicide Safety Planning Intervention in a Psychiatric Emergency Department: Protocol for a Multimethod Research Project %A Shin,Hwayeon Danielle %A Zaheer,Juveria %A Torous,John %A Strudwick,Gillian %+ Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada, 1 9022922836, hdanielle.shin@mail.utoronto.ca %K implementation science %K suicide prevention %K eHealth %K mental health %K health informatics %K integrated knowledge translation %K co-design %K research protocol %K mobile phone %D 2023 %7 9.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Suicide prevention is currently a national health priority in Canada. Emergency departments (EDs) are critical settings for suicide prevention, and in our local psychiatric ED at the Centre for Addiction and Mental Health, we plan to embed an app-based tool called the Hope app to support suicide safety planning intervention. The app is free and available on app stores, and usability tests have been completed. As a next step to embed this new tool into the routine clinical workflow, research is needed to assess determinants of and design strategies for implementation with the end goal of routinization. Objective: The purpose of this 2-phased research is to implement the app in the routine clinical workflow in our local psychiatric ED. The specific objectives are as follows: (1) understanding ED clinicians’ perceptions and experience of implementing the app in routine practice and identifying barriers to and facilitators of implementation (phase 1) and (2) using findings and outputs from phase 1 and collaborating with service users, families, and ED clinicians to co-design implementation strategies for the app (phase 2). Methods: We will use an integrated knowledge translation approach throughout this project. In phase 1, we will conduct interviews with ED clinicians to identify implementation determinants using a behavior change framework. In phase 2, a co-design team comprising clinicians, ED service users, and families will design implementation strategies that align with the determinants identified in phase 1. Results: This protocol presents detailed information about the entire structure of the 2-phased research project. Ethics approval for conducting the qualitative descriptive study (phase 1) has been obtained, and the recruitment and data collection processes will be completed no later than December 2023. Ethics approval for phase 2 is underway. Conclusions: Involving multiple knowledge user groups early in the research and decision-making process is crucial for successful implementation. Although co-designing is commonly practiced during innovation development, there is often a misconception that the responsibility for implementing what has been designed falls on others. This research aims to fill this methodological gap in the health informatics literature. By the end of this project, we will have developed theory-informed implementation strategies to support Centre for Addiction and Mental Health ED clinicians in adopting the Hope app to complete safety planning intervention. These strategies, guided by a behavior change framework, will target clinicians’ behavior change and seamlessly integrate the app into the routine clinical workflow. In addition, this research project will provide recommendations on how to involve multiple knowledge user groups and offer insights into how the methodology used can be adapted to other areas within the health informatics literature. International Registered Report Identifier (IRRID): PRR1-10.2196/50643 %M 37943582 %R 10.2196/50643 %U https://www.researchprotocols.org/2023/1/e50643 %U https://doi.org/10.2196/50643 %U http://www.ncbi.nlm.nih.gov/pubmed/37943582 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e41371 %T An Internet- and Kinect-Based Multiple Sclerosis Fitness Intervention Training With Pilates Exercises: Development and Usability Study %A Tacchino,Andrea %A Ponzio,Michela %A Confalonieri,Paolo %A Leocani,Letizia %A Inglese,Matilde %A Centonze,Diego %A Cocco,Eleonora %A Gallo,Paolo %A Paolicelli,Damiano %A Rovaris,Marco %A Sabattini,Loredana %A Tedeschi,Gioacchino %A Prosperini,Luca %A Patti,Francesco %A Bramanti,Placido %A Pedrazzoli,Elisabetta %A Battaglia,Mario Alberto %A Brichetto,Giampaolo %+ Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, Genoa, 16149, Italy, 39 0102713812, andrea.tacchino@aism.it %K exergame %K Multiple Sclerosis Fitness Intervention Training %K MS-FIT %K Pilates %K Kinect %K multiple sclerosis %K exercise %K serious games %K balance %K mobile phone %D 2023 %7 8.11.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: Balance impairments are common in people with multiple sclerosis (MS), with reduced ability to maintain position and delayed responses to postural adjustments. Pilates is a popular alternative method for balance training that may reduce the rapid worsening of symptoms and the increased risk of secondary conditions (eg, depression) that are frequently associated with physical inactivity. Objective: In this paper, we aimed to describe the design, development, and usability testing of MS Fitness Intervention Training (MS-FIT), a Kinect-based tool implementing Pilates exercises customized for MS. Methods: MS-FIT has been developed using a user-centered design approach (design, prototype, user feedback, and analysis) to gain the target user’s perspective. A team composed of 1 physical therapist, 2 game programmers, and 1 game designer developed the first version of MS-FIT that integrated the knowledge and experience of the team with MS literature findings related to Pilates exercises and balance interventions based on exergames. MS-FIT, developed by using the Unity 3D (Unity Technologies) game engine software with Kinect Sensor V2 for Windows, implements exercises for breathing, posture, and balance. Feedback from an Italian panel of experts in MS rehabilitation (neurologists, physiatrists, physical therapists, 1 statistician, and 1 bioengineer) and people with MS was collected to customize the tool for use in MS. The context of MS-FIT is traveling around the world to visit some of the most important cities to learn the aspects of their culture through pictures and stories. At each stay of the travel, the avatar of a Pilates teacher shows the user the exercises to be performed. Overall, 9 people with MS (n=4, 44% women; mean age 42.89, SD 11.97 years; mean disease duration 10.19, SD 9.18 years; Expanded Disability Status Scale score 3.17, SD 0.75) were involved in 3 outpatient user test sessions of 30 minutes; MS-FIT’s usability was assessed through an ad hoc questionnaire (maximum value=5; higher the score, higher the usability) evaluating easiness to use, playability, enjoyment, satisfaction, and acceptance. Results: A user-centered design approach was used to develop an accessible and challenging tool for balance training. All people with MS (9/9, 100%) completed the user test sessions and answered the ad hoc questionnaire. The average score on each item ranged from 3.78 (SD 0.67) to 4.33 (SD 1.00), which indicated a high usability level. The feedback and suggestions provided by 64% (9/14) of people with MS and 36% (5/14) of therapists involved in the user test were implemented to refine the first prototype to release MS-FIT 2.0. Conclusions: The participants reported that MS-FIT was a usable tool. It is a promising system for enhancing the motivation and engagement of people with MS in performing exercise with the aim of improving their physical status. %M 37938895 %R 10.2196/41371 %U https://games.jmir.org/2023/1/e41371 %U https://doi.org/10.2196/41371 %U http://www.ncbi.nlm.nih.gov/pubmed/37938895 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48435 %T The Efficacy of an mHealth App in Facilitating Weight Loss Among Japanese Fitness Center Members: Regression Analysis Study %A Eguchi,Akifumi %A Kawamura,Yumi %A Kawashima,Takayuki %A Ghaznavi,Cyrus %A Ishimura,Keiko %A Kohsaka,Shun %A Matsuo,Satoru %A Mizuno,Shinichiro %A Sasaki,Yuki %A Takahashi,Arata %A Tanoue,Yuta %A Yoneoka,Daisuke %A Miyata,Hiroaki %A Nomura,Shuhei %+ Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan, 81 3 5363 3774, s-nomura@keio.jp %K digital health %K gym attendance %K Japan %K real-world data %K smartphone application %K weight loss %D 2023 %7 8.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-tracking smartphone apps have emerged as promising tools to encourage healthy behaviors. In this longitudinal study, we used gym use data from members of a major fitness club that operates gyms throughout Japan from January 2014 to December 2019. Objective: Our objective was to assess the extent to which a health and fitness self-tracking mobile app introduced to gym members on January 1, 2018, contributed to their weight loss. The app allows users to input information regarding diet, sleep, weight, and gym exercise so that they can receive personalized feedback from an artificial intelligence chatbot to improve their health behaviors. Methods: We used linear regression to quantify the association between app use and weight loss. The primary outcome of the study was the weight loss achieved by each gym user, which was calculated as the difference between their initial and final weights in kilograms, as recorded in the app. Individuals who did not attend the gym or failed to use the mobile app at least twice during the study period were excluded from the analysis. The model accounted for age, gender, distance between the gym and the member’s residence, average weekly number of times a member used the gym, user’s gym membership length in weeks, average weekly number of times a member input information into the app, and the number of weeks that the app was used at least once. Results: Data from 26,589 participants were analyzed. Statistically significant associations were detected between weight loss and 2 metrics related to app use: the average weekly frequency of use and the total number of weeks in which the app was used at least once. One input per week was found to be associated with a loss of 62.1 (95% CI 53.8-70.5) g, and 1 week of app use was associated with 21.7 (95% CI 20.5-22.9) g of weight loss from the day of the first input to that of the final input to the app. Furthermore, the average number of times that a member used the gym weekly was also shown to be statistically significantly associated with weight loss: 1 use per week was associated with 255.5 (95% CI 228.5-282.6) g of weight loss. Conclusions: This empirical study demonstrated a significant association between weight loss among gym members and not only the frequency of weekly gym use but also the use of a health and fitness self-tracking app. However, further work is needed to examine the mechanisms through which mobile apps affect health behaviors and to identify the specific app features that are most effective in promoting weight loss. %M 37938885 %R 10.2196/48435 %U https://formative.jmir.org/2023/1/e48435 %U https://doi.org/10.2196/48435 %U http://www.ncbi.nlm.nih.gov/pubmed/37938885 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e45068 %T Effects of a Self-Guided Transdiagnostic Smartphone App on Patient Empowerment and Mental Health: Randomized Controlled Trial %A Kerber,André %A Beintner,Ina %A Burchert,Sebastian %A Knaevelsrud,Christine %+ Department of Clinical-Psychological Intervention, Freie Universität Berlin, Habelschwerdter Allee 45, Berlin, 14195, Germany, 49 30 838 63093, andre.kerber@fu-berlin.de %K patient empowerment %K mental health–related self-management skills %K help-seeking attitude %K mental health literacy %K internet-based interventions %K unguided %K self-guided %K transdiagnostic mental health app %D 2023 %7 6.11.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental disorders impact both individuals and health systems. Symptoms and syndromes often remain undetected and untreated, resulting in chronification. Besides limited health care resources, within-person barriers such as the lack of trust in professionals, the fear of stigmatization, or the desire to cope with problems without professional help contribute to the treatment gap. Self-guided mental health apps may support treatment seeking by reducing within-person barriers and facilitating mental health literacy. Digital mental health interventions may also improve mental health related self-management skills and contribute to symptom reduction and the improvement of quality of life. Objective: This study aims to investigate the effects of a self-guided transdiagnostic app for mental health on help seeking, reduced stigma, mental health literacy, self-management skills, mental health symptoms, and quality of life using a randomized controlled design. Methods: Overall, 1045 participants (recruited via open, blinded, and web-based recruitment) with mild to moderate depression or anxiety-, sleep-, eating-, or somatization-related psychopathology were randomized to receive either access to a self-guided transdiagnostic mental health app (MindDoc) in addition to care as usual or care as usual only. The core features of the app were regular self-monitoring, automated feedback, and psychological courses and exercises. The coprimary outcomes were mental health literacy, mental health–related patient empowerment and self-management skills (MHPSS), attitudes toward help seeking, and actual mental health service use. The secondary outcomes were psychopathological symptom burden and quality of life. Data were collected at baseline and 8 weeks and 6 months after randomization. Treatment effects were investigated using analyses of covariance, including baseline variables as predictors and applying multiple imputation. Results: We found small but robust between-group effects for MHPSS (Cohen d=0.29), symptoms burden (Cohen d=0.28), and quality of life (Cohen d=0.19) 8 weeks after randomization. The effects on MHPSS were maintained at follow-up. Follow-up assessments also showed robust effects on mental health literacy and preliminary evidence for the improvement of help seeking. Predictors of attrition were lower age and higher personality dysfunction. Among the non-attritors, predictors for deterioration were less outpatient treatment and higher initial symptom severity. Conclusions: A self-guided transdiagnostic mental health app can contribute to lasting improvements in patient empowerment. Symptoms of common mental disorders and quality of life improved faster in the intervention group than in the control group. Therefore, such interventions may support individuals with symptoms of 1 or more internalizing disorders, develop health-centered coping skills, prevent chronification, and accelerate symptom improvement. Although the effects for individual users are small and predictors of attrition and deterioration need to be investigated further, the potential public health impact of a self-guided intervention can be large, given its high scalability. Trial Registration: German Clinical Trials Register DRKS00022531; https://drks.de/search/de/trial/DRKS00022531 %M 37930749 %R 10.2196/45068 %U https://mental.jmir.org/2023/1/e45068 %U https://doi.org/10.2196/45068 %U http://www.ncbi.nlm.nih.gov/pubmed/37930749 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50872 %T Automated Messaging Delivered Alongside Behavioral Treatment for Weight Loss: Qualitative Study %A Berry,Michael %A Taylor,Lauren %A Huang,Zhuoran %A Chwyl,Christina %A Kerrigan,Stephanie %A Forman,Evan %+ Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut St., Philadelphia, PA, 19103, United States, 1 (267) 961 2578, mpb334@drexel.edu %K mobile health technology %K weight loss %K tailored messaging %K lifestyle modification %K mobile health %K mHealth %K messaging %K weight loss %K intervention %K overweight %K obesity %K qualitative %K thematic analysis %D 2023 %7 6.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health interventions for weight loss frequently use automated messaging. However, this intervention modality appears to have limited weight loss efficacy. Furthermore, data on users’ subjective experiences while receiving automated messaging–based interventions for weight loss are scarce, especially for more advanced messaging systems providing users with individually tailored, data-informed feedback. Objective: The purpose of this study was to characterize the experiences of individuals with overweight or obesity who received automated messages for 6-12 months as part of a behavioral weight loss trial. Methods: Participants (n=40) provided Likert-scale ratings of messaging acceptability and completed a structured qualitative interview (n=39) focused on their experiences with the messaging system and generating suggestions for improvement. Interview data were analyzed using thematic analysis. Results: Participants found the messages most useful for summarizing goal progress and least useful for suggesting new behavioral strategies. Overall message acceptability was moderate (2.67 out of 5). From the interviews, 2 meta-themes emerged. Participants indicated that although the messages provided useful reminders of intervention goals and skills, they did not adequately capture their lived experiences while losing weight. Conclusions: Many participants found the automated messages insufficiently tailored to their personal weight loss experiences. Future studies should explore alternative methods for message tailoring (eg, allowing for a higher degree of participant input and interactivity) that may boost treatment engagement and efficacy. Trial Registration: ClinicalTrials.gov NCT05231824; https://clinicaltrials.gov/study/NCT05231824 %M 37930786 %R 10.2196/50872 %U https://formative.jmir.org/2023/1/e50872 %U https://doi.org/10.2196/50872 %U http://www.ncbi.nlm.nih.gov/pubmed/37930786 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e48404 %T Freely Available Training Videos for Suicide Prevention: Scoping Review %A Wislocki,Katherine %A Jager-Hyman,Shari %A Brady,Megan %A Weiss,Michal %A Schaechter,Temma %A Khazanov,Gabriela %A Young,Sophia %A Becker-Haimes,Emily %+ Department of Psychological Science, University of California, Irvine, 214 Pereira Drive, Irvine, CA, 92617, United States, 1 9498246803, kwislock@uci.edu %K freely available videos %K asynchronous training %K suicide prevention %K evidence-based practice %K dissemination %K implementation %D 2023 %7 3.11.2023 %9 Review %J JMIR Ment Health %G English %X Background: Freely available and asynchronous implementation supports can reduce the resource burden of evidence-based practice training to facilitate uptake. Freely available web-based training videos have proliferated, yet there have been no efforts to quantify their breadth, depth, and content for suicide prevention. Objective: This study presents results from a scoping review of freely available training videos for suicide prevention and describes a methodological framework for reviewing such videos. Methods: A scoping review of freely available training videos (≥2 minutes) for suicide prevention practices was conducted using 4 large video-sharing platforms: YouTube, Vimeo, Bing Video, and Google Video. Identified suicide prevention training videos (N=506) were reviewed and coded. Results: Most content was targeted toward gatekeepers or other lay providers (n=370) versus clinical providers (n=136). Videos most commonly provided content related to suicidal thoughts or behaviors (n=420). Many videos (n=274, 54.2%) included content designed for certain communities or organizations. Less than half (n=232, 45.8%) of training videos included formal clinical content pertaining to assessment or intervention for suicide prevention. Conclusions: Results suggested an abundance of videos providing broad informational content (eg, “signs and symptoms of someone at risk for suicide”) and a limited portion of videos with instructional content aimed at clinical providers delivering formal evidence-based assessments or interventions for suicide prevention. Development of resources to address identified gaps may be needed. Future work may leverage machine learning techniques to expedite the review process. %M 37921847 %R 10.2196/48404 %U https://mental.jmir.org/2023/1/e48404 %U https://doi.org/10.2196/48404 %U http://www.ncbi.nlm.nih.gov/pubmed/37921847 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e46912 %T A Video Game Intervention to Prevent Opioid Misuse Among Older Adolescents: Development and Preimplementation Study %A Aneni,Kammarauche %A Fernandes,Claudia-Santi F %A Hoerner,Lily A %A Szapary,Claire %A Pendergrass Boomer,Tyra M %A Fiellin,Lynn E %+ Department of Internal Medicine, Yale University School of Medicine, 2 Church Street South, Suite 515, New Haven, CT, 06519, United States, 1 203 785 2885, lynn.sullivan@yale.edu %K videogames %K serious games %K opioid misuse %K mental health %K adolescents %D 2023 %7 3.11.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: Opioid misuse and mental disorders are highly comorbid conditions. The ongoing substance misuse and mental health crises among adolescents in the United States underscores the importance of widely scalable substance misuse preventive interventions that also address mental health risks. Serious video games offer an engaging, widely scalable method for delivering and implementing preventive interventions. However, there are no video game interventions that focus on preventing opioid misuse among older adolescents, and there are limited existing video game interventions that address mental health. Objective: This study aims to develop and conduct a formative evaluation of a video game intervention to prevent opioid misuse and promote mental health among adolescents aged 16-19 years (PlaySmart). We conducted formative work in preparation for a subsequent randomized controlled trial. Methods: We conducted development and formative evaluation of PlaySmart in 3 phases (development, playtesting, and preimplementation) through individual interviews and focus groups with multiple stakeholders (adolescents: n=103; school-based health care providers: n=51; and addiction treatment providers: n=6). PlaySmart content development was informed by the health belief model, the theory of planned behavior, and social cognitive theory. User-centered design principles informed the approach to development and play testing. The Exploration, Preparation, Implementation, and Sustainability framework informed preimplementation activities. Thematic analysis was used to identify themes from interviews and focus groups that informed PlaySmart game content and approaches to future implementation of PlaySmart. Results: We developed a novel video game PlaySmart for older adolescents that addresses the risk and protective factors for opioid misuse and mental health. Nine themes emerged from the focus groups that provided information regarding game content. Playtesting revealed areas of the game that required improvement, which were modified for the final game. Preimplementation focus groups identified potential barriers and facilitators for implementing PlaySmart in school settings. Conclusions: PlaySmart offers a promising digital intervention to address the current opioid and mental health crises among adolescents in a scalable manner. %M 37921851 %R 10.2196/46912 %U https://games.jmir.org/2023/1/e46912 %U https://doi.org/10.2196/46912 %U http://www.ncbi.nlm.nih.gov/pubmed/37921851 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44469 %T Cultural Adaptation of the Actionable Health App Evaluation in Japan: Protocol for a Web-Based Modified Delphi Expert Consensus Study %A Yokomitsu,Kengo %A Takashina,Hikari N %A Takebayashi,Yoshitake %A Muranaka,Seiji %+ School of Psychological Sciences, University of Human Environments, 9-12, Dogo-himata, Matsuyama, Ehime, 790-0825, Japan, 81 89 926 7007, yokomitsuken5@gmail.com %K mobile %K eHealth %K mHealth apps %K mobile health %K modified Delphi study %K Japan %D 2023 %7 3.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: With an increase in both the number of mental health disorders people are experiencing and the difficulty in accessing mental health care, the demand for accessible mental health care services has increased. The use of mobile devices has allowed people to receive care in their daily lives without restrictions on time or location. However, the majority of publicly available mobile health apps are not evidence-based, and the top-rated apps are not always safe or user-friendly and may not offer clinically beneficial results. Objective: This study aims to create a cultural adaptation of the American Psychiatric Association’s comprehensive app evaluation framework in Japan using a web-based modified Delphi expert consensus. Methods: A web-based modified Delphi study includes developing the Japanese version of the comprehensive app evaluation framework and 3 Delphi rounds. In the first round, our working group sends a questionnaire to the panelists, who then complete it. In the second and third rounds, the working group sends a questionnaire and a summary of the panelists’ answers based on each of the previous rounds. The panelists answer the questionnaires based on this summary. The summarization procedure is automated to help reduce the biases that can be generated when panelists’ answers are summarized and when the panelists receive them. The working group sends only the result of the summarization with the next round’s questionnaire. All interactions between the working group and the panelists will be conducted on Qualtrics (Qualtrics Japan LLC), a questionnaire platform. To culturally validate the comprehensive mental health app evaluation framework, participants from the following three categories will be recruited in Japan: (1) researchers, (2) practitioners, and (3) app developers. Results: This study received funding from a crowdfunding campaign in Japan (April 2023). The Delphi study began in January 2023 and will be completed in December 2023. We had already completed the translation of the 105 original app evaluation item questions by December 2022. Conclusions: While the need for treatment using mental health apps is increasing, no framework that can be used to develop a centralized database for health apps is available or accessible, and no consensus has been reached among stakeholders in Japan about an appropriate framework. The results of the web-based modified Delphi method presented in this paper may provide direction for the development and use of mental health apps in the future among the relevant stakeholders. Furthermore, this study will enhance recognition of the framework among researchers, clinicians, mental health app developers, and users, in addition to devising new instruments to help users or practitioners efficiently choose the right app for their situations. International Registered Report Identifier (IRRID): PRR1-10.2196/44469 %M 37921839 %R 10.2196/44469 %U https://www.researchprotocols.org/2023/1/e44469 %U https://doi.org/10.2196/44469 %U http://www.ncbi.nlm.nih.gov/pubmed/37921839 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e41539 %T Experiences of Patients With Chronic Obstructive Pulmonary Disease Using the Apple Watch Series 6 Versus the Traditional Finger Pulse Oximeter for Home SpO2 Self-Monitoring: Qualitative Study Part 2 %A Liu,Yuxin %A Arnaert,Antonia %A da Costa,Daniel %A Sumbly,Pia %A Debe,Zoumanan %A Charbonneau,Sylvain %+ Ingram School of Nursing, McGill University, 680 Sherbrooke West, Montreal, QC, H3A 2M7, Canada, 1 514 726 0235, antonia.arnaert@mcgill.ca %K Apple Watch %K chronic obstructive pulmonary disease %K pulse oximeter %K qualitative descriptive %K self-monitoring %K smartwatch %D 2023 %7 2.11.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Amid the rise in mobile health, the Apple Watch now has the capability to measure peripheral blood oxygen saturation (SpO2). Although the company indicated that the Watch is not a medical device, evidence suggests that SpO2 measurements among patients with chronic obstructive pulmonary disease (COPD) are accurate in controlled settings. Yet, to our knowledge, the SpO2 function has not been validated for patients with COPD in naturalistic settings. Objective: This qualitative study explored the experiences of patients with COPD using the Apple Watch Series 6 versus a traditional finger pulse oximeter for home SpO2 self-monitoring. Methods: We conducted individual semistructured interviews with 8 female and 2 male participants with moderate to severe COPD, and transcripts were qualitatively analyzed. All received a watch to monitor their SpO2 for 5 months. Results: Due to respiratory distress, the watch was unable to collect reliable SpO2 measurements, as it requires the patient to remain in a stable position. However, despite the physical limitations and lack of reliable SpO2 values, participants expressed a preference toward the watch. Moreover, participants’ health needs and their unique accessibility experiences influenced which device was more appropriate for self-monitoring purposes. Overall, all shared the perceived importance of prioritizing their physical COPD symptoms over device selection to manage their disease. Conclusions: Differing results between participant preferences and smartwatch limitations warrant further investigation into the reliability and accuracy of the SpO2 function of the watch and the balance among self-management, medical judgment, and dependence on self-monitoring technology. %M 37917147 %R 10.2196/41539 %U https://aging.jmir.org/2023/1/e41539 %U https://doi.org/10.2196/41539 %U http://www.ncbi.nlm.nih.gov/pubmed/37917147 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49809 %T Behavioral Activation–Based Digital Smoking Cessation Intervention for Individuals With Depressive Symptoms: Randomized Clinical Trial %A Dahne,Jennifer %A Wahlquist,Amy E %A Kustanowitz,Jacob %A Natale,Noelle %A Fahey,Margaret %A Graboyes,Evan M %A Diaz,Vanessa A %A Carpenter,Matthew J %+ Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 86 Jonathan Lucas Street, MSC 955, Charleston, SC, 29425, United States, 1 8438762280, dahne@musc.edu %K smoking cessation %K depression %K digital health %K decentralized trial %K mental health %K depressive %K RCT %K randomized %K controlled trial %K smoking %K smoke %K smoker %K quit %K quitting %K cessation %K digital health %K eHealth %K e-health %K NRT %K nicotine %K mobile health %K mHealth %K app %K apps %K application %K applications %D 2023 %7 1.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression is common among adults who smoke cigarettes. Existing depression-specific cessation interventions have limited reach and are unlikely to improve smoking prevalence rates among this large subgroup of smokers. Objective: This study aimed to determine whether a mobile app–based intervention tailored for depression paired with a mailed sample of nicotine replacement therapy (NRT) is efficacious for treating depression and promoting smoking cessation. Methods: A 2-arm nationwide remote randomized clinical trial was conducted in the United States. Adults (N=150) with elevated depressive symptoms (Patient Health Questionnaire-8≥10) who smoked were enrolled. The mobile app (“Goal2Quit”) provided behavioral strategies for treating depression and quitting smoking based on Behavioral Activation Treatment for Depression. Goal2Quit participants also received a 2-week sample of combination NRT. Treatment as usual participants received a self-help booklet for quitting smoking that was not tailored for depression. Primary end points included Goal2Quit usability, change in depression (Beck Depression Inventory-II) across 12 weeks, and smoking cessation including reduction in cigarettes per day, incidence of 24-hour quit attempts, floating abstinence, and 7-day point prevalence abstinence (PPA). Results: In total, 150 participants were enrolled between June 25, 2020, and February 23, 2022, of which 80 were female (53.3%) and the mean age was 38.4 (SD 10.3) years. At baseline, participants on average reported moderate depressive symptoms and smoked a mean of 14.7 (SD 7.5) cigarettes per day. Goal2Quit usability was strong with a mean usability rating on the System Usability Scale of 78.5 (SD 16.9), with 70% scoring above the ≥68 cutoff for above-average usability. Retention data for app use were generally strong immediately following trial enrollment and declined in subsequent weeks. Those who received Goal2Quit and the NRT sample reported lower mean depressive symptoms over the trial duration as compared to treatment as usual (difference of mean 3.72, SE 1.37 points less; P=.01). Across time points, all cessation outcomes favored Goal2Quit. Regarding abstinence, Goal2Quit participants reported significantly higher rates of 7-day PPA at weeks 4 (11% vs 0%; P=.02), 8 (7-day PPA: 12% vs 0%; P=.02), and 12 (16% vs 2%; P=.02). Conclusions: A mobile app intervention tailored for depression paired with a sample of NRT was effective for depression treatment and smoking cessation. Findings support the utility of this intervention approach for addressing the currently unmet public health treatment need for tailored, scalable depression-specific cessation treatments. Trial Registration: ClinicalTrials.gov NCT03837379; https://clinicaltrials.gov/ct2/show/NCT03837379 %M 37910157 %R 10.2196/49809 %U https://www.jmir.org/2023/1/e49809 %U https://doi.org/10.2196/49809 %U http://www.ncbi.nlm.nih.gov/pubmed/37910157 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49137 %T Gay App Use, Sexuality Traits, and High-Risk Sexual Behaviors Among Men Who Have Sex With Men in China: Mediation Analysis %A Luo,Rui %A Xie,Zhi %A Silenzio,Vincent M B %A Kuang,Yun %A Luo,Dan %+ Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, 172 Tongzipo Road, Changsha, 410078, China, 86 0731 84805454, luodan_csu_2011@126.com %K geosocial networking apps %K men who have sex with men %K respondent-driven sampling %K high-risk sexual behaviors %K sexuality traits %K mobile phone %D 2023 %7 1.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Gay geosocial networking apps, also known as “gay apps,” have gained increasing popularity in the men who have sex with men (MSM) community. Certain sexuality traits and gay app use are both associated with high-risk sexual behaviors among MSM. However, little is known about the underlying mechanism of such relationships. Objective: Based on the uses and gratifications theory, this study aimed to test the mediation effect of gay app use on the relationship between sexuality traits (sexual compulsivity and sexual sensation seeking) and high-risk sexual behaviors (multiple sexual partners and unprotected anal intercourse) among MSM. Methods: A cross-sectional, multicenter study was conducted in Wuhan and Changsha, China, from August to October 2020. A representative sample of 402 MSM was recruited through respondent-driven sampling. A self-administered web-based structured questionnaire was used to collect data on sociodemographic information, high-risk sexual behaviors, gay app use, sexual compulsivity, and sexual sensation seeking. Path analysis was conducted to assess the mediation effect. Results: Our study revealed that 67.42% (n=271) of MSM used gay apps for seeking potential sexual partners, with 37.06% (n=149) of them engaging in unprotected anal intercourse, and 45.42% (n=218) of them having multiple sexual partners. Of the participants, 17.16% (n=69) reported significant sexual compulsivity, while 29.10% (n=117) reported significant sexual sensation seeking. Notably, gay app usage partially mediated the relationship between sexual compulsivity and multiple sexual partners but fully mediated the relationship between sexual compulsivity and unprotected anal intercourse. Furthermore, gay app usage partially mediated the relationship between sexual sensation seeking and multiple sexual partners but fully mediated the relationship between sexual sensation seeking and unprotected anal intercourse. Conclusions: High-risk sexual behaviors are common among MSM. Most MSM rely on gay apps to find sexual partners, which, when combined with higher levels of sexual compulsivity and sexual sensation seeking, can increase the likelihood of engaging in high-risk sexual behaviors. Therefore, interventions aimed at reducing these behaviors among MSM should focus on addressing the use of gay apps, while also considering the influence of their sexuality traits on gay app use. %M 37910154 %R 10.2196/49137 %U https://www.jmir.org/2023/1/e49137 %U https://doi.org/10.2196/49137 %U http://www.ncbi.nlm.nih.gov/pubmed/37910154 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48857 %T Varenicline Combined With Oral Nicotine Replacement Therapy and Smartphone-Based Medication Reminders for Smoking Cessation: Feasibility Randomized Controlled Trial %A Sifat,Munjireen %A Hébert,Emily T %A Ahluwalia,Jasjit S %A Businelle,Michael S %A Waring,Joseph J C %A Frank-Pearce,Summer G %A Bryer,Chase %A Benson,Lizbeth %A Madison,Stefani %A Planas,Lourdes G %A Baranskaya,Irina %A Kendzor,Darla E %+ Tobacco Settlement Endowment Trust Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 215 955 8874, mys519@jefferson.edu %K mHealth %K smartphone-based medication reminders %K varenicline combined with oral nicotine replacement therapy %K smoking cessation %K medication adherence %K smoking %K smoker %K smoke %K cessation %K quit %K quitting %K nicotine %K nicotine replacement therapy %K NRT %K randomized %K controlled trial %K mobile phone %D 2023 %7 27.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Varenicline and oral nicotine replacement therapy (NRT) have each been shown to increase the likelihood of smoking cessation, but their combination has not been studied. In addition, smoking cessation medication adherence is often poor, thus, challenging the ability to evaluate medication efficacy. Objective: This study examined the effects of combined varenicline and oral NRT and smartphone medication reminders on pharmacotherapy adherence and smoking abstinence among adults enrolled in smoking cessation treatment. Methods: A 2×2 factorial design was used. Participants (N=34) were randomized to (1) varenicline + oral NRT (VAR+NRT) or varenicline alone (VAR) and (2) smartphone medication reminder messages (REM) or no reminder messages (NREM) over 13 weeks. Participants assigned to VAR+REM received varenicline reminder prompts, and those assigned to VAR+NRT+REM also received reminders to use oral NRT. The other 2 groups (VAR+NREM and VAR+NRT+NREM) did not receive medication reminders. Participants were not blinded to intervention groups. All participants received tobacco cessation counseling. Smartphone assessments of smoking as well as varenicline and NRT use (if applicable) were prompted daily through the first 12 weeks after a scheduled quit date. Descriptive statistics were generated to characterize the relations between medication and reminder group assignments with daily smoking, daily varenicline adherence, and daily quantity of oral NRT used. Participants completed follow-up assessments for 26 weeks after the quit date. Results: Participants were predominantly White (71%), and half were female (50%). On average, participants were 54.2 (SD 9.4) years of age, they smoked an average of 19.0 (SD 9.0) cigarettes per day and had smoked for 34.6 (SD 12.7) years. Descriptively, participants assigned to VAR+NRT reported more days of smoking abstinence compared to VAR (29.3 vs 26.3 days). Participants assigned to REM reported more days of smoking abstinence than those assigned to NREM (40.5 vs 21.8 days). Participants assigned to REM were adherent to varenicline on more days compared to those assigned to NREM (58.6 vs 40.5 days), and participants assigned to VAR were adherent to varenicline on more days than those assigned to VAR + NRT (50.7 vs 43.3 days). In the subsample of participants assigned to VAR+NRT, participants assigned to REM reported more days where ≥5 pieces of NRT were used than NREM (14.0 vs 7.4 days). Average overall medication adherence (assessed via the Medication Adherence Questionnaire) showed the same pattern as the daily smartphone-based adherence assessments. Conclusions: Preliminary findings indicated that smoking cessation interventions may benefit from incorporating medication reminders and combining varenicline with oral NRT, though combining medications may be associated with poorer adherence. Further study is warranted. Trial Registration: ClinicalTrials.gov NCT03722966; https://classic.clinicaltrials.gov/ct2/show/NCT03722966 %M 37889541 %R 10.2196/48857 %U https://formative.jmir.org/2023/1/e48857 %U https://doi.org/10.2196/48857 %U http://www.ncbi.nlm.nih.gov/pubmed/37889541 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50145 %T Digital Self-Monitoring Tools for the Management of Gestational Weight Gain: Protocol for a Systematic Review %A Mooney,Jan %A Dahl,Alicia A %+ Department of Public Health Sciences, College of Health and Human Services, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, United States, 1 7046875612, adahl3@charlotte.edu %K protocol %K systematic review %K gestational weight gain %K self-monitoring %K digital health %K review methods %K review methodology %K pregnant %K pregnancy %K gestational %K weight %K maternal %K mobile phone %D 2023 %7 26.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Gestational weight gain (GWG) exceeding the recommendations of the Institute of Medicine (in the United States) is associated with numerous adverse maternal and infant health outcomes. While many behavioral interventions targeting nutrition and physical activity have been developed to promote GWG within the Institute of Medicine guidelines, engagement and results are variable. Technology-mediated interventions can potentially increase the feasibility, acceptability, and reach of interventions, particularly for pregnant women, for whom integration of interventions into daily life may be critical to retention and adherence. Previous reviews highlight GWG self-monitoring as a common intervention component, and emerging work has begun to integrate digital self-monitoring into technology-mediated interventions. With rapid advances in technology-mediated interventions, a focused synthesis of literature examining the role of digital self-monitoring tools in managing GWG is warranted to guide clinical practice and inform future studies. Objective: The proposed review aims to synthesize the emerging research base evaluating digital GWG self-monitoring interventions, primarily focusing on whether the intervention is effective in managing GWG. Depending on the characteristics of the included research, secondary focus areas will comprise intervention recruitment and retention, feasibility, acceptability, and differences between stand-alone and multicomponent interventions. Methods: This protocol was developed following the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines for systematic review protocols. The proposed review would use a planned and systematic approach to identify, evaluate, and synthesize relevant and recent empirical quantitative studies (reported in English) examining the use of digital weight self-monitoring tools in the context of technology-mediated interventions to manage GWG in pregnant US adults, with at least 2 instances of data collection. Literature eligible for inclusion will have a publication date between January 2010 and July 2020. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies will be used to assess the methodological quality of included studies across various domains, and results will be synthesized and summarized per the synthesis without meta-analysis guidelines. Results: The initial queries of 1150 records have been executed and papers have been screened for inclusion. Data extractions are expected to be finished by December 2023. Results are expected in 2024. The systematic review that will be generated from this protocol will offer evidence for the use of digital self-monitoring tools in the management of GWG. Conclusions: The planned, focused synthesis of relevant literature has the potential to inform the use of digital weight self-monitoring tools in the context of future technology-mediated interventions to manage GWG. In addition, the planned review has the potential to contribute as part of a broader movement in research toward empirically supporting the inclusion of specific components within more extensive, multicomponent interventions to balance parsimony and effectiveness. Trial Registration: PROSPERO CRD42020204820; https://tinyurl.com/ybzt6bvr International Registered Report Identifier (IRRID): PRR1-10.2196/50145 %M 37883145 %R 10.2196/50145 %U https://www.researchprotocols.org/2023/1/e50145 %U https://doi.org/10.2196/50145 %U http://www.ncbi.nlm.nih.gov/pubmed/37883145 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47050 %T A Web-Based Total Worker Health Intervention for Those Fighting Wildland Fires: Mixed Methods Development and Effectiveness Trial %A Kuehl,Kerry %A Elliot,Diane %A DeFrancesco,Carol %A McGinnis,Wendy %A Ek,Susanna %A Garg,Bharti %+ Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, United States, 1 503 575 6556, kuehlk@ohsu.edu %K wildland %K firefighter %K Total Worker Health %K web-based %K occupational safety %K health promotion %K wildland firefighter %K web-based safety %K mixed methods %K occupational health %K health and safety %K health care worker %K mobile phone %D 2023 %7 25.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Fire seasons are longer, with more and larger wildfires, placing increased demands and risks on those fighting wildland fires. There are multiple agencies involved with fighting wildland fires and unique worksite conditions make meeting these workers’ needs a challenge. Objective: The aim of the study is to develop and establish the effectiveness of a web-based safety and health program for those fighting wildland fires. Methods: This mixed methods project had 3 phases. The initial qualitative phase assessed the needs of 150 diverse firefighters through interviews and focus groups across 11 US sites to establish and prioritize program content. Interview transcripts were read for thematic content with iterative readings used to identify, code, and rank health and safety issues. The second phase used that information to build a comprehensive Total Worker Health program for those fighting wildfires. The program content was based on the qualitative interview data and consisted of 6 core and 8 elective 30-minute, web-based modules primarily done individually on a smartphone or computer. The final, third phase evaluated the program with a quantitative prospective proof-of-concept, usability, and effectiveness trial among wildland firefighter participants. Effectiveness was assessed with paired 2-tailed t tests for pre- and post-Likert agreement scale survey items, adjusted for multiple comparisons. In addition to assessing mean and SD at baseline and postsurvey, observed effect sizes were calculated (Cohen d). Usability and reaction to the program among firefighters who responded to postsurvey were also assessed. Results: The qualitative themes and subthemes were used to inform the program’s content. For the effectiveness trial, 131 firefighters completed the presurvey, and 50 (38.2%) completed the postsurvey. The majority of the participants were White (n=123, 93.9%), male (n=117, 89.3%), with an average age of 41 (SD 12.9) years. Significant increases in knowledge and desired health and safety behaviors were found for both cancer (P<.001) and cardiovascular risk (P=.01), nutrition behaviors (P=.01), hydration or overheating (P=.001), binge drinking (P=.002), and getting medical checkups (P=.001). More than 80% (n=40) of postsurvey respondents agreed or strongly agreed that the program was easy to use and would recommend it to others. Conclusions: An innovative web-based safety and health promotion program for those fighting wildland fires was feasible, scalable, and usable. It improved the health and safety of those fighting wildland fires. Trial Registration: ClinicalTrials.gov NCT05753358; https://classic.clinicaltrials.gov/ct2/show/NCT05753358 %M 37878362 %R 10.2196/47050 %U https://www.jmir.org/2023/1/e47050 %U https://doi.org/10.2196/47050 %U http://www.ncbi.nlm.nih.gov/pubmed/37878362 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e48934 %T Understanding the Tensions of “Good Motherhood” Through Women’s Digital Technology Use: Descriptive Qualitative Study %A Facca,Danica %A Hall,Jodi %A Hiebert,Bradley %A Donelle,Lorie %+ College of Nursing, University of South Carolina, 1601 Greene Street, Colombia, SC, 29208, United States, 1 803 777 6528, ldonelle@mailbox.sc.edu %K motherhood %K parenting %K digital health %K apps %K social media %K mother %K parent %K technology use %K use %K computer use %K interview %K interviews %K perspective %K perspectives %K mothers %K mobile phone %D 2023 %7 25.10.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Research suggests that expectant and new mothers consult and value information gathered from digital technologies, such as pregnancy-specific mobile apps and social media platforms, to support their transition to parenting. Notably, this transitional context can be rich with profound physiological, psychological, and emotional fluctuation for women as they cope with the demands of new parenting and navigate the cultural expectations of “good motherhood.” Given the ways in which digital technologies can both support and hinder women’s perceptions of their parenting abilities, understanding expectant and new mothers’ experiences using digital technologies and the tensions that may arise from such use during the transition to parenting period warrants nuanced exploration. Objective: This study aims to understand mothers’ use of digital technologies during the transition to parenting period. Methods: A descriptive qualitative study was conducted in a predominantly urban region of Southwestern Ontario, Canada. Purposive and snowball sampling strategies were implemented to recruit participants who had become a parent within the previous 24 months. Researchers conducted focus groups using a semistructured interview guide with 26 women. The interviews were audio recorded, transcribed, and thematically analyzed. Results: Participants’ experiences of using digital technologies in the transition to parenting period were captured within the overarching theme “balancing the tensions of digital technology use in the transition to parenting” and 4 subthemes: self-comparison on social media, second-guessing parenting practices, communities of support, and trusting intuition over technology. Although digital technologies purportedly offered “in-the-moment” access to community support and health information, this came at a cost to mothers, as they described feelings of guilt, shame, and self-doubt that provoked them to question and hold in contention whether they were a good mother and using technology in a morally upright manner. Conclusions: These findings raise critical questions concerning the promotion and commercialization of digital technologies and the ways in which they can further push the boundaries of hegemonic parenting practices, provoke feelings of inadequacy, and compromise well-being among expectant and new mothers. %M 37878372 %R 10.2196/48934 %U https://pediatrics.jmir.org/2023/1/e48934 %U https://doi.org/10.2196/48934 %U http://www.ncbi.nlm.nih.gov/pubmed/37878372 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46008 %T Web-Based Cognitive Bias Modification Program for Young People With Social Anxiety and Hazardous Alcohol Use: Feasibility, Acceptability, and Preliminary Efficacy Study %A Prior,Katrina %A Salemink,Elske %A Piggott,Monique %A Manning,Victoria %A Wiers,Reinout W %A Teachman,Bethany A %A Teesson,Maree %A Baillie,Andrew J %A Mahoney,Alison %A McLellan,Lauren %A Newton,Nicola C %A Stapinski,Lexine A %+ Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell building (G02), Sydney, 2006, Australia, 61 286279032, katrina.prior@sydney.edu.au %K alcohol %K anxiety %K cognitive bias modification %K interpretation bias %K approach bias %K young adult %K mobile phone %D 2023 %7 25.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Interpretation bias modification (IBM) and approach bias modification (ApBM) cognitive retraining interventions can be efficacious adjunctive treatments for improving social anxiety and alcohol use problems. However, previous trials have not examined the combination of these interventions in a young, comorbid sample. Objective: This study aims to describe the feasibility, acceptability, and preliminary efficacy of a web-based IBM+ApBM program for young adults with social anxiety and hazardous alcohol use (“Re-Train Your Brain”) when delivered in conjunction with treatment as usual (TAU). Methods: The study involved a 3-arm randomized controlled pilot trial in which treatment-seeking young adults (aged 18-30 y) with co-occurring social anxiety and hazardous alcohol use were randomized to receive (1) the “integrated” Re-Train Your Brain program, where each session included both IBM and ApBM (50:50 ratio), plus TAU (35/100, 35%); (2) the “alternating” Re-Train Your Brain program, where each session focused on IBM or ApBM in an alternating pattern, plus TAU (32/100, 32%); or (3) TAU only (33/100, 33%). Primary outcomes included feasibility and acceptability, and secondary efficacy outcomes included changes in cognitive biases, social anxiety symptoms, and alcohol use. Assessments were conducted at baseline, after the intervention period (6 weeks after baseline), and 12 weeks after baseline. Results: Both Re-Train Your Brain program formats were feasible and acceptable for young adults. When coupled with TAU, both integrated and alternating programs resulted in greater self-reported improvements than TAU only in anxiety interpretation biases (at the 6-week follow-up; Cohen d=0.80 and Cohen d=0.89) and comorbid interpretation biases (at the 12-week follow-up; Cohen d=1.53 and Cohen d=1.67). In addition, the alternating group reported larger improvements over the control group in generalized social anxiety symptoms (at the 12-week follow-up; Cohen d=0.83) and alcohol cravings (at the 6-week follow-up; Cohen d=0.81). There were null effects on all other variables and no differences between the intervention groups in efficacy outcomes. Conclusions: Should these findings be replicated in a larger randomized controlled trial, Re-Train Your Brain has the potential to be a scalable, low-cost, and non–labor-intensive adjunct intervention for targeting interpretation and comorbidity biases as well as generalized anxiety and alcohol-related outcomes in the real world. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001273976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364131 International Registered Report Identifier (IRRID): RR2-10.2196/28667 %M 37878363 %R 10.2196/46008 %U https://formative.jmir.org/2023/1/e46008 %U https://doi.org/10.2196/46008 %U http://www.ncbi.nlm.nih.gov/pubmed/37878363 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e49783 %T Comparing the Acceptability and Quality of Intervention Modalities for Suicidality in the Emergency Department: Randomized Feasibility Trial %A Larkin,Celine %A Tulu,Bengisu %A Djamasbi,Soussan %A Garner,Roscoe %A Varzgani,Fatima %A Siddique,Mariam %A Pietro,John %A Boudreaux,Edwin D %+ Department of Emergency Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 5084211436, celine.larkin@umassmed.edu %K suicide %K self-harm %K emergency department %K mobile app %K intervention %K mobile technology %K safety planning %K safety %K suicidal %K emergency %K mHealth %K mobile health %K mental health %K mobile phone %D 2023 %7 24.10.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Emergency departments (EDs) manage many patients with suicide risk, but effective interventions for suicidality are challenging to implement in this setting. ReachCare is a technology-facilitated version of an evidence-based intervention for suicidal ED patients. Here, we present findings on the acceptability and quality of ReachCare in the ED, as well as a comparison of these measures across 3 potential delivery modalities Objective: Our aim was to test the feasibility of the ReachCare intervention in its entirety through conducting a pilot study with patients presenting with suicidality to the ED. We tested three different ways of receiving the ED-based components of ReachCare: (1) self-administered on the tablet app using a chatbot interface, (2) administered by an in-person clinician, or (3) administered by a telehealth clinician. Methods: In total, 47 ED patients who screened positive for suicide risk were randomly allocated to receive one of three delivery modalities of ReachCare in the ED: (1) self-administered on the patient-facing tablet app with a chatbot interface, (2) delivered by an in-person clinician, or (3) delivered by a telehealth clinician, with the latter two using a clinician-facing web app. We measured demographic and clinical characteristics, acceptability and appropriateness of the intervention, and quality and completeness of the resulting safety plans. Results: Patients assigned high ratings for the acceptability (median 4.00/5, IQR 4.00-4.50) and appropriateness (median 4.00/5, IQR 4.00-4.25) of ReachCare’s ED components, and there were no substantial differences across the 3 delivery modalities [H(acceptability)=3.90, P=.14; H(appropriateness)=1.05, P=.59]. The self-administered modality took significantly less time than the 2 clinician modalities (H=27.91, P<.001), and the usability of the self-administered version was in the “very high” range (median 93.75/100, IQR 80.00-97.50). The safety plans created across all 3 modalities were high-quality (H=0.60, P=.74). Conclusions: Patients rated ReachCare in the ED as highly acceptable and appropriate regardless of modality. Self-administration may be a feasible way to ensure patients with suicide risk receive an intervention in resource constrained EDs. Limitations include small sample size and demographic differences between those enrolled versus not enrolled. Further research will examine the clinical outcomes of patients receiving both the in-ED and post-ED components of ReachCare. Trial Registration: ClinicalTrials.gov NCT04720911; https://clinicaltrials.gov/ct2/show/NCT04720911 %M 37874619 %R 10.2196/49783 %U https://mental.jmir.org/2023/1/e49783 %U https://doi.org/10.2196/49783 %U http://www.ncbi.nlm.nih.gov/pubmed/37874619 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48968 %T Effectiveness of a Theory-Based Digital Animated Video Intervention to Reduce Intention and Willingness to Sext Among Diploma Students: Cluster Randomized Controlled Trial %A Mansor,Norain %A Ahmad,Norliza %A Md Said,Salmiah %A Tan,Kit-Aun %A Sutan,Rosnah %+ Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Serdang, 43400, Malaysia, 60 192710577, lizaahmad@upm.edu.my %K sexting %K randomized controlled trial %K YouTube %K intention %K willingness %K young adult %K Malaysia, diploma students %K digital content %K digital health intervention %K attrition rate %K primary outcome %K sexual risk %K sexual health %K WhatsApp %D 2023 %7 20.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexting refers to the exchange of sexually explicit digital content in the form of texts, photos, or videos. In recent years, sexting has become a public health concern. Surveys in Malaysia show a high prevalence of young adults engaged in sexting. Given that sexting is associated with sexual risk behavior, cyberbullying, and mental health issues, this behavior needs intervention to alleviate the resulting public health burden. However, there is a scarcity of theory-based intervention programs on the prevention of intention and willingness to sext among young adults. Objective: This study aimed to develop and implement a sexting intervention module guided by the prototype willingness model (PWM), delivered using web-based animated video, and evaluate its effectiveness among diploma students from a public higher educational institution. The primary outcomes were intention and willingness to sext, while the secondary outcomes were knowledge, attitude, perceived norms, and prototype perceptions of sexting. Methods: This 2-armed, parallel, single-blinded cluster randomized controlled trial was conducted in a public higher educational institution in the state of Melaka, Malaysia. Diploma students from 12 programs were randomly allocated into intervention and control groups. Both groups answered a self-administered web-based questionnaire assessing the outcomes at the baseline. The intervention group received a newly developed intervention module based on the PWM in the form of 5 animated videos posted on a private YouTube platform, while the control group was put on the waitlist. The intervention group was encouraged to discuss any issues raised with the researchers via WhatsApp private chat after viewing the videos. All participants were observed immediately and 3 months postintervention. Data analysis was performed with SPSS (version 26; IBM Corp). A generalized linear mixed model was used to determine the effectiveness of the intervention. Results: There were a total of 300 participants with an attrition rate of 8.3% (n=25). After adjusting for age, sex, relationship status, and the amount of time spent on the web, there were significant differences in the intention to sext (β=–.12; P=.002; Cohen d=0.23), willingness to sext (β=–.16; P<.001; Cohen d=0.40), knowledge (β=.12; P<.001; Cohen d=0.39), attitude (β=–.11; P=.001; Cohen d=0.31), perceived norms (β=–.06; P=.04; Cohen d=0.18), and prototype perceptions (β=–.11; P<.001; Cohen d=0.35) between the intervention and control groups over 3 months. Conclusions: In this study, the sexting intervention module using the PWM that was delivered via web-based animated videos was effective in reducing intention and willingness to sext as well as in improving knowledge of sexting, attitudes, perceived norms, and prototype perceptions. Therefore, relevant agencies involved in the promotion of sexual and reproductive health among young adults in Malaysia can consider the implementation of this module. Trial Registration: Thai Clinical Trial Registry TCTR20201010002; https://www.thaiclinicaltrials.org/show/TCTR20201002001 %M 37862090 %R 10.2196/48968 %U https://www.jmir.org/2023/1/e48968 %U https://doi.org/10.2196/48968 %U http://www.ncbi.nlm.nih.gov/pubmed/37862090 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45678 %T Mobile Behavioral Health Coaching as a Preventive Intervention for Occupational Public Health: Retrospective Longitudinal Study %A Toh,Sean Han Yang %A Lee,Sze Chi %A Sündermann,Oliver %+ Intellect Private Limited Company, 171 Tras St, #02-179 Union Building, Singapore, 079025, Singapore, 65 93571995, oliver@intellect.co %K mobile health apps %K mHealth apps %K behavioral health coaching %K behavioral coaching %K app-based coaching %K self-help %K employees %K well-being %K mood %K stress %K public health %K preventive interventions %K positive psychology %D 2023 %7 20.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Researchers have recently proposed that behavioral health coaching (BHC) is effective in promoting proactive care among employees. However, to qualify as a preventive workplace intervention, more research is needed to evaluate whether BHC can further elevate well-being among moderately mentally healthy employees. Objective: Using real-world data, this study evaluates the preliminary effectiveness of app-based BHC against a nonrandomized control group with open access to self-help tools in improving well-being (ie, mood levels and perceived stress). The study also explores the active ingredients of BHC and dose-response associations between the number of BHC sessions and well-being improvements. Methods: Employees residing across Asia-Pacific countries (N=1025; mean age 30.85, SD 6.97 y) who reported moderately positive mood and medium levels of perceived stress in their first week of using the mental health app Intellect were included in this study. Users who were given access by their organizations to Intellect’s BHC services were assigned to the “Coaching” condition (512/1025, 49.95%; mean age 31.09, SD 6.87 y), whereas other employees remained as “Control” participants (513/1025, 50.05%; mean age 30.61, SD 7.06 y). To evaluate effectiveness, monthly scores from the validated mood and stress sliders were aggregated into a composite well-being score and further examined using repeated-measure conditional growth models. Postcoaching items on “Perceived Usefulness of the BHC session” and “Working Alliance with my Coach” were examined as active ingredients of BHC using 1-1-1 multilevel mediation models. Finally, 2-way repeated-measure mixed ANOVA models were conducted to examine dose-response effects on well-being improvements between groups (coaching and control) across time. Results: Growth curve analyses revealed significant time by group interaction effects for composite well-being, where “Coaching” users reported significantly greater improvements in well-being than “Control” participants across time (composite well-being: F1,391=6.12; ηp2=0.02; P=.01). Among “Coaching” participants, dependent-sample 2-tailed t tests revealed significant improvements in composite well-being from baseline to 11 months (t512=1.98; Cohen d=0.17; P=.049). Improvements in “Usefulness of the BHC session” (β=.078, 95% Cl .043-.118; P<.001) and “Working Alliance” (β=.070, 95% Cl .037-.107; P<.001) fully mediated within-level well-being enhancements over time. Comparing against baseline or first month scores, significant time by group interactions were observed between the second and sixth months, with the largest effect size observed at the fifth month mark (first month vs fifth month: F1,282=15.0; P<.001; ηp2=0.051). Conclusions: We found preliminary evidence that BHC is an effective preventive workplace intervention. Mobile-based coaching may be a convenient, cost-effective, and scalable means for organizations and governments to boost public mental health. %M 37862086 %R 10.2196/45678 %U https://formative.jmir.org/2023/1/e45678 %U https://doi.org/10.2196/45678 %U http://www.ncbi.nlm.nih.gov/pubmed/37862086 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39995 %T Detecting Prolonged Stress in Real Life Using Wearable Biosensors and Ecological Momentary Assessments: Naturalistic Experimental Study %A Tutunji,Rayyan %A Kogias,Nikos %A Kapteijns,Bob %A Krentz,Martin %A Krause,Florian %A Vassena,Eliana %A Hermans,Erno J %+ Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Kapittelweg, Nijmegen, 6525EN, Netherlands, 31 36168494, rayyan.tutunji@donders.ru.nl %K biosensor %K devices %K ecological momentary assessments %K experience sampling %K machine learning %K mental disorder %K mental health %K monitoring %K physiological %K prevention %K psychological %K smartwatches %K stress %K wearables %D 2023 %7 19.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Increasing efforts toward the prevention of stress-related mental disorders have created a need for unobtrusive real-life monitoring of stress-related symptoms. Wearable devices have emerged as a possible solution to aid in this process, but their use in real-life stress detection has not been systematically investigated. Objective: We aimed to determine the utility of ecological momentary assessments (EMA) and physiological arousal measured through wearable devices in detecting ecologically relevant stress states. Methods: Using EMA combined with wearable biosensors for ecological physiological assessments (EPA), we investigated the impact of an ecological stressor (ie, a high-stakes examination week) on physiological arousal and affect compared to a control week without examinations in first-year medical and biomedical science students (51/83, 61.4% female). We first used generalized linear mixed-effects models with maximal fitting approaches to investigate the impact of examination periods on subjective stress exposure, mood, and physiological arousal. We then used machine learning models to investigate whether we could use EMA, wearable biosensors, or the combination of both to classify momentary data (ie, beeps) as belonging to examination or control weeks. We tested both individualized models using a leave-one-beep-out approach and group-based models using a leave-one-subject-out approach. Results: During stressful high-stakes examination (versus control) weeks, participants reported increased negative affect and decreased positive affect. Intriguingly, physiological arousal decreased on average during the examination week. Time-resolved analyses revealed peaks in physiological arousal associated with both momentary self-reported stress exposure and self-reported positive affect. Mediation models revealed that the decreased physiological arousal in the examination week was mediated by lower positive affect during the same period. We then used machine learning to show that while individualized EMA outperformed EPA in its ability to classify beeps as originating from examinations or from control weeks (1603/4793, 33.45% and 1648/4565, 36.11% error rates, respectively), a combination of EMA and EPA yields optimal classification (1363/4565, 29.87% error rate). Finally, when comparing individualized models to group-based models, we found that the individualized models significantly outperformed the group-based models across all 3 inputs (EMA, EPA, and the combination). Conclusions: This study underscores the potential of wearable biosensors for stress-related mental health monitoring. However, it emphasizes the necessity of psychological context in interpreting physiological arousal captured by these devices, as arousal can be related to both positive and negative contexts. Moreover, our findings support a personalized approach in which momentary stress is optimally detected when referenced against an individual’s own data. %M 37856180 %R 10.2196/39995 %U https://www.jmir.org/2023/1/e39995 %U https://doi.org/10.2196/39995 %U http://www.ncbi.nlm.nih.gov/pubmed/37856180 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44658 %T The Effectiveness of Fully Automated Digital Interventions in Promoting Mental Well-Being in the General Population: Systematic Review and Meta-Analysis %A Groot,Julia %A MacLellan,Alexander %A Butler,Madelaine %A Todor,Elisa %A Zulfiqar,Mahnoor %A Thackrah,Timothy %A Clarke,Christopher %A Brosnan,Mark %A Ainsworth,Ben %+ Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 01225 383800, jmdg20@bath.ac.uk %K mental well-being %K promotion %K intervention %K digital %K web-based %K apps %K mobile phone %D 2023 %7 19.10.2023 %9 Review %J JMIR Ment Health %G English %X Background: Recent years have highlighted an increasing need to promote mental well-being in the general population. This has led to a rapidly growing market for fully automated digital mental well-being tools. Although many individuals have started using these tools in their daily lives, evidence on the overall effectiveness of digital mental well-being tools is currently lacking. Objective: This study aims to review the evidence on the effectiveness of fully automated digital interventions in promoting mental well-being in the general population. Methods: Following the preregistration of the systematic review protocol on PROSPERO, searches were carried out in MEDLINE, Web of Science, Cochrane, PsycINFO, PsycEXTRA, Scopus, and ACM Digital (initial searches in February 2022; updated in October 2022). Studies were included if they contained a general population sample and a fully automated digital intervention that exclusively used psychological mental well-being promotion activities. Two reviewers, blinded to each other’s decisions, conducted data selection, extraction, and quality assessment of the included studies. Narrative synthesis and a random-effects model of per-protocol data were adopted. Results: We included 19 studies that involved 7243 participants. These studies included 24 fully automated digital mental well-being interventions, of which 15 (63%) were included in the meta-analysis. Compared with no intervention, there was a significant small effect of fully automated digital mental well-being interventions on mental well-being in the general population (standardized mean difference 0.19, 95% CI 0.04-0.33; P=.02). Specifically, mindfulness-, acceptance-, commitment-, and compassion-based interventions significantly promoted mental well-being in the general population (P=.006); insufficient evidence was available for positive psychology and cognitive behavioral therapy–based interventions; and contraindications were found for integrative approaches. Overall, there was substantial heterogeneity, which could be partially explained by the intervention duration, comparator, and study outcomes. The risk of bias was high, and confidence in the quality of the evidence was very low (Grading of Recommendations, Assessment, Development, and Evaluations), primarily because of the high rates of study dropout (average 37%; range 0%-85%) and suboptimal intervention adherence (average 40%). Conclusions: This study provides a novel contribution to knowledge regarding the effectiveness, strengths, and weaknesses of fully automated digital mental well-being interventions in the general population. Future research and practice should consider these findings when developing fully automated digital mental well-being tools. In addition, research should aim to investigate positive psychology and cognitive behavioral therapy–based tools as well as develop further strategies to improve adherence and reduce dropout in fully automated digital mental well-being interventions. Finally, it should aim to understand when and for whom these interventions are particularly beneficial. Trial Registration: PROSPERO CRD42022310702; https://tinyurl.com/yc7tcwy7 %M 37856172 %R 10.2196/44658 %U https://mental.jmir.org/2023/1/e44658 %U https://doi.org/10.2196/44658 %U http://www.ncbi.nlm.nih.gov/pubmed/37856172 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49558 %T Pilot Testing of an mHealth App for Tobacco Cessation in People Living With HIV: Protocol for a Pilot Randomized Controlled Trial %A Brin,Maeve %A Trujillo,Paul %A Jia,Haomiao %A Cioe,Patricia %A Huang,Ming-Chun %A Chen,Huan %A Qian,Xiaoye %A Xu,Wenyao %A Schnall,Rebecca %+ Columbia University School of Nursing, 560 W 168th St, New York City, NY, 10032, United States, 1 212 342 6886, rb897@cumc.columbia.edu %K addict %K addiction %K app %K application %K applications %K apps %K cessation %K cigar %K cigarette %K cigarettes %K HIV %K mHealth %K mobile health %K quit %K quitting %K randomized controlled trial %K RCT %K smartwatch %K smoker %K smoking cessation %K smoking %K tobacco %D 2023 %7 19.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: An estimated 40% of people living with HIV smoke cigarettes. Although smoking rates in the United States have been declining in recent years, people living with HIV continue to smoke cigarettes at twice the rate of the general population. Mobile health (mHealth) technology is an effective tool for people living with a chronic illness, such as HIV, as currently 84% of households in the United States report that they have a smartphone. Although many studies have used mHealth interventions for smoking cessation, few studies have recruited people living with HIV who smoke. Objective: The objective of the pilot randomized controlled trial (RCT) is to examine the feasibility, acceptability, and preliminary efficacy of the Sense2Quit App as a tool for people living with HIV who are motivated to quit smoking. Methods: The Sense2Quit study is a 2-arm RCT for people living with HIV who smoke cigarettes (n=60). Participants are randomized to either the active intervention condition, which consists of an 8-week supply of nicotine replacement therapy, standard smoking cessation counseling, and access to the Sense2Quit mobile app and smartwatch, or the control condition, which consists of standard smoking cessation counseling and a referral to the New York State Smokers’ Quitline. The Sense2Quit app is a mobile app connected through Bluetooth to a smartwatch that tracks smoking gestures and distinguishes them from other everyday hand movements. In the Sense2Quit app, participants can view their smoking trends, which are recorded through their use of the smartwatch, including how often or how much they smoke and the amount of money that they are spending on cigarettes, watch videos with quitting tips, information, and distractions, play games, set reminders, and communicate with a study team member. Results: Enrollment of study participants began in March 2023 and is expected to end in October 2023. All data collection is expected to be completed by the end of January 2024. This RCT will test the difference in outcomes between the control and intervention arms. The primary outcome will be the percentage of participants with biochemically verified 7-day point prevalence smoking or tobacco abstinence at their 12-week follow-up. Results from this pilot study will be disseminated to the research community following the completion of all data collection. Conclusions: The Sense2Quit study leverages mHealth so that it can help smokers improve their efforts at smoking cessation. Our research has the potential to not only increase quitting rates among people living with HIV who may need a prolonged, tailored intervention but also inform further development of mHealth for people living with HIV. This mHealth study will contribute significant findings to the greater mHealth research community, providing evidence as to how mHealth should be developed and tested among the target population. Trial Registration: ClinicalTrials.gov NCT05609032; https://clinicaltrials.gov/study/NCT05609032 International Registered Report Identifier (IRRID): DERR1-10.2196/49558 %M 37856173 %R 10.2196/49558 %U https://www.researchprotocols.org/2023/1/e49558 %U https://doi.org/10.2196/49558 %U http://www.ncbi.nlm.nih.gov/pubmed/37856173 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e49132 %T A Motivational Interviewing Chatbot With Generative Reflections for Increasing Readiness to Quit Smoking: Iterative Development Study %A Brown,Andrew %A Kumar,Ash Tanuj %A Melamed,Osnat %A Ahmed,Imtihan %A Wang,Yu Hao %A Deza,Arnaud %A Morcos,Marc %A Zhu,Leon %A Maslej,Marta %A Minian,Nadia %A Sujaya,Vidya %A Wolff,Jodi %A Doggett,Olivia %A Iantorno,Mathew %A Ratto,Matt %A Selby,Peter %A Rose,Jonathan %+ The Edward S Rogers Sr Department of Electrical & Computer Engineering, University of Toronto, 10 King's College Rd, Toronto, ON, M5S 3G4, Canada, 1 416 978 6992, jonathan.rose@ece.utoronto.ca %K conversational agents %K chatbots %K behavior change %K smoking cessation %K motivational interviewing %K deep learning %K natural language processing %K transformers %K generative artificial intelligence %K artificial intelligence %K AI %D 2023 %7 17.10.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: The motivational interviewing (MI) approach has been shown to help move ambivalent smokers toward the decision to quit smoking. There have been several attempts to broaden access to MI through text-based chatbots. These typically use scripted responses to client statements, but such nonspecific responses have been shown to reduce effectiveness. Recent advances in natural language processing provide a new way to create responses that are specific to a client’s statements, using a generative language model. Objective: This study aimed to design, evolve, and measure the effectiveness of a chatbot system that can guide ambivalent people who smoke toward the decision to quit smoking with MI-style generative reflections. Methods: Over time, 4 different MI chatbot versions were evolved, and each version was tested with a separate group of ambivalent smokers. A total of 349 smokers were recruited through a web-based recruitment platform. The first chatbot version only asked questions without reflections on the answers. The second version asked the questions and provided reflections with an initial version of the reflection generator. The third version used an improved reflection generator, and the fourth version added extended interaction on some of the questions. Participants’ readiness to quit was measured before the conversation and 1 week later using an 11-point scale that measured 3 attributes related to smoking cessation: readiness, confidence, and importance. The number of quit attempts made in the week before the conversation and the week after was surveyed; in addition, participants rated the perceived empathy of the chatbot. The main body of the conversation consists of 5 scripted questions, responses from participants, and (for 3 of the 4 versions) generated reflections. A pretrained transformer-based neural network was fine-tuned on examples of high-quality reflections to generate MI reflections. Results: The increase in average confidence using the nongenerative version was 1.0 (SD 2.0; P=.001), whereas for the 3 generative versions, the increases ranged from 1.2 to 1.3 (SD 2.0-2.3; P<.001). The extended conversation with improved generative reflections was the only version associated with a significant increase in average importance (0.7, SD 2.0; P<.001) and readiness (0.4, SD 1.7; P=.01). The enhanced reflection and extended conversations exhibited significantly better perceived empathy than the nongenerative conversation (P=.02 and P=.004, respectively). The number of quit attempts did not significantly change between the week before the conversation and the week after across all 4 conversations. Conclusions: The results suggest that generative reflections increase the impact of a conversation on readiness to quit smoking 1 week later, although a significant portion of the impact seen so far can be achieved by only asking questions without the reflections. These results support further evolution of the chatbot conversation and can serve as a basis for comparison against more advanced versions. %M 37847539 %R 10.2196/49132 %U https://mental.jmir.org/2023/1/e49132 %U https://doi.org/10.2196/49132 %U http://www.ncbi.nlm.nih.gov/pubmed/37847539 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45977 %T Optimizing an mHealth Program to Promote Type 2 Diabetes Prevention in High-Risk Individuals: Cross-Sectional Questionnaire Study %A Ross,Edgar %A Al Ozairi,Ebaa %A Al qabandi,Naeema %A Jamison,Robert %+ Atrius Healthcare, Harvard Medical School, 20 Wall Street, Burlington, MA, 01803-4758, United States, 1 617 657 6410, edgarross245@gmail.com %K SMS %K short text message interventions: mHealth %K smartphone %K type 2 diabetes prevention %K social media %K friends and family %K percolation theory %K diabetes %K prevention %K risk %K development %K pilot study %K social network %K theory modeling %K disease control %K initiative %D 2023 %7 16.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: We evaluated the outcomes of a pilot SMS text messaging–based public health campaign that identified social networking nodes and variations of response rates to develop a list of variables that could be used to analyze and develop an outreach strategy that would maximize the impact of future public health campaigns planned for Kuwait. Computational analysis of connections has been used to analyze the spread of infectious diseases, dissemination of new thoughts and ideas, efficiency of logistics networks, and even public health care campaigns. Percolation theory network analysis provides a mathematical alternative to more established heuristic approaches that have been used to optimize network development. We report on a pilot study designed to identify and treat subjects at high risk of developing type 2 diabetes mellitus in Kuwait. Objective: The aim of this study was to identify ways to optimize efficient deployment of resources and improve response rates in a public health campaign by using variables identified in this secondary analysis of our previously published data (Alqabandi et al, 2020). This analysis identified key variables that could be used in a computational analysis to plan for future public health campaigns. Methods: SMS text message screening posts were sent inviting recipients to answer 6 questions to determine their risk of developing type 2 diabetes mellitus. If subjects agreed to participate, a link to the Centers for Disease Control and Prevention prediabetes screening test was automatically transmitted to their mobile devices. The phone numbers used in this campaign were recorded and compared to the responses received through SMS text messaging and social media forwarding. Results: A total of 180,000 SMS text messages through 5 different campaigns were sent to 6% of the adult population in Kuwait. A total of 260 individuals agreed to participate, of which 153 (58.8%) completed the screening. Remarkably, 367 additional surveys were received from individuals who were not invited by the original circulated SMS text messages. These individuals were invited through forwarded surveys from the original recipients after authentication with the study center. The original SMS text messages were found to successfully identify influencers in existing social networks to improve the efficacy of the public health campaign. Conclusions: SMS text messaging–based health care screening campaigns were found to have limited effectiveness alone; however, the increased reach through shared second-party forwarding suggests the potential of exponentially expanding the reach of the study and identifying a higher percentage of eligible candidates through the use of percolation theory. Future research should be directed toward designing SMS text messaging campaigns that support a combination of SMS text message invitations and social networks along with identification of influential nodes and key variables, which are likely unique to the environment and cultural background of the population, using percolation theory modeling and chatbots. %M 37843911 %R 10.2196/45977 %U https://formative.jmir.org/2023/1/e45977 %U https://doi.org/10.2196/45977 %U http://www.ncbi.nlm.nih.gov/pubmed/37843911 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e47371 %T App-Based Mindfulness for Attenuation of Subjective and Physiological Stress Reactivity in a Population With Elevated Stress: Randomized Controlled Trial %A Kirk,Ulrich %A Staiano,Walter %A Hu,Emily %A Ngnoumen,Christelle %A Kunkle,Sarah %A Shih,Emily %A Clausel,Alicia %A Purvis,Clare %A Lee,Lauren %+ Department of Psychology, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark, 45 65502695, ukirk@health.sdu.dk %K Mindfulness %K mental health %K stress %K smartphone %K technology %K Headspace %K mobile phone %D 2023 %7 13.10.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Stress-related mental health disorders have steadily increased and contributed to a worldwide disease burden with up to 50% experiencing a stress-related mental health disorder worldwide. Data suggest that only approximately 20%-65% of individuals receive treatment. This gap in receiving treatment may be attributed to barriers such as limited treatment access, negative stigma surrounding mental health treatment, approachability (ie, not having a usual treatment plan or provider), affordability (ie, lack of insurance coverage and high treatment cost), and availability (ie, long waits for appointments) leaving those who need treatment without necessary care. To mitigate the limited access mental health treatment, there has been a rise in the application and study of digital mental health interventions. As such, there is an urgent need and opportunity for effective digital mental health interventions to alleviate stress symptoms, potentially reducing adverse outcomes of stress-related disorders. Objective: This study examined if app-based guided mindfulness could improve subjective levels of stress and influence physiological markers of stress reactivity in a population with elevated symptoms of stress. Methods: The study included 163 participants who had moderate to high perceived stress as assessed by the Perceived Stress Scale (PSS-10). Participants were randomly allocated to 1 of 5 groups: a digital guided program designed to alleviate stress (Managing Stress), a digital mindfulness fundamentals course (Basics), digitally delivered breathing exercises, an active control intervention (Audiobook), and a Waitlist Control group. The 3 formats of mindfulness interventions (Managing Stress, Basics, and Breathing) all had a total duration of 300 minutes spanning 20-30 days. Primary outcome measures were perceived stress using the PSS-10, self-reported sleep quality using the Pittsburgh Sleep Quality Index, and trait mindfulness using the Mindful Attention Awareness Scale. To probe the effects of physiological stress, an acute stress manipulation task was included, specifically the cold pressor task (CPT). Heart rate variability was collected before, during, and after exposure to the CPT and used as a measure of physiological stress. Results: The results showed that PSS-10 and Pittsburgh Sleep Quality Index scores for the Managing Stress (all P<.001) and Basics (all P≤.002) groups were significantly reduced between preintervention and postintervention periods, while no significant differences were reported for the other groups. No significant differences among groups were reported for Mindful Attention Awareness Scale (P=.13). The physiological results revealed that the Managing Stress (P<.001) and Basics (P=.01) groups displayed reduced physiological stress reactivity between the preintervention and postintervention periods on the CPT. There were no significant differences reported for the other groups. Conclusions: These results demonstrate efficacy of app-based mindfulness in a population with moderate to high stress on improving self-reported stress, sleep quality, and physiological measures of stress during an acute stress manipulation task. Trial Registration: ClinicalTrials.gov NCT05832632; https://www.clinicaltrials.gov/ct2/show/NCT05832632 %M 37831493 %R 10.2196/47371 %U https://mhealth.jmir.org/2023/1/e47371 %U https://doi.org/10.2196/47371 %U http://www.ncbi.nlm.nih.gov/pubmed/37831493 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e41779 %T Commercially Available Mobile Apps With Family Behavioral Goal Setting and Tracking for Parents: Review and Quality Evaluation %A Weber,Summer Joy %A Mulvaney,Shelagh A %A Faiola,Anthony %A Brown,Madeline %A Koyama,Tatsuki %A Sun,Lili %A Goggans,Susanna Lynn %A Hull,Pamela Carmen %+ Markey Cancer Center, University of Kentucky, 760 Press Avenue, Suite 460, Lexington, KY, 40536, United States, 1 859 562 3233, pam.hull@uky.edu %K goal setting %K goal tracking %K nutrition %K health behavior %K nutrition %K parents %K children %K mobile apps %D 2023 %7 13.10.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Goal setting and tracking are well established behavior change techniques. Little is known about the extent to which commercially available mobile apps are designed to guide parents in using these strategies, their evidence base, and their quality. Objective: This study aims to review commercially available apps that target parents in relation to setting and tracking behavioral goals for their children. The objectives were to classify the apps’ general characteristics, features, evidence base, and target behaviors and assess app quality overall and separately for apps that target health-related behaviors (HRBs) and apps without a health-related behavior (WHRB). Methods: Apps were identified using keyword searches in the Apple App Store and Google Play in the United States. Apps were included if their primary purpose was to assist with setting goals, tracking goals, tracking behaviors, or giving feedback pertaining to goals for children by parents. App characteristics and common features were documented and summarized. Two reviewers assessed app quality using the Mobile App Rating Scale (MARS). Descriptive statistics summarized the MARS total score, 4 quality subscales, and 6 app-specific items that reflect the perceived impact of the app on goal setting and tracking, overall and with subgroup analysis for HRB and WHRB apps. Results: Of the 21 apps identified, 16 (76%) met the review criteria. Overall, 9 apps defined and targeted the following HRBs: nutrition and mealtime (6/16, 38%), physical activity and screen time (5/16, 31%), sleep (7/16, 44%), and personal hygiene (6/16, 38%). Three apps targeted specific age groups (2 apps were for children aged 6-13 years and 1 app was for children aged ≥4 years). None of the apps provided tailored assessments or guidance for goal setting. None of the apps indicated that they were intended for the involvement of a health professional or had been tested for efficacy. The MARS total score indicated moderate app quality overall (mean 3.42, SD 0.49) and ranged from 2.5 to 4.2 out of 5 points. The Habitz app ranked highest on the MARS total score among HRB apps (score=4.2), whereas Thumsters ranked highest (score=3.9) among the WHRB apps. Subgroup analysis revealed a pattern of higher quality ratings in the HRB group than the WHRB group, including the mean MARS total score (mean 3.67, SD 0.34 vs mean 3.09, SD 0.46; P=.02); the engagement and information subscales; and the app-specific items about perceived impact on knowledge, attitudes, and behavior change. Conclusions: Several high-quality commercially available apps target parents to facilitate goal setting and tracking for child behavior change related to both health and nonhealth behaviors. However, the apps lack evidence of efficacy. Future research should address this gap, particularly targeting parents of young children, and consider individually tailored guided goal setting and involvement of health professionals. %M 37831486 %R 10.2196/41779 %U https://pediatrics.jmir.org/2023/1/e41779 %U https://doi.org/10.2196/41779 %U http://www.ncbi.nlm.nih.gov/pubmed/37831486 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47903 %T Enhancing Mental Health and Medication Adherence Among Men Who Have Sex With Men Recently Diagnosed With HIV With a Dialectical Behavior Therapy–Informed Intervention Incorporating mHealth, Online Skills Training, and Phone Coaching: Development Study Using Human-Centered Design Approach %A Wang,Liying %A Yuwen,Weichao %A Hua,Wenzhe %A Chen,Lingxiao %A Forsythe Cox,Vibh %A Zheng,Huang %A Ning,Zhen %A Zhao,Zhuojun %A Liu,Zhaoyu %A Jiang,Yunzhang %A Li,Xinran %A Guo,Yawen %A Simoni,Jane M %+ Department of Psychology, University of Washington, 3921 W Stevens Way NE, Seattle, WA, 98195, United States, 1 (206) 543 2640, liyingw@uw.edu %K intervention mapping %K participatory approach %K cultural adaptation %K dialectical behavior therapy %K DBT %K men who have sex with men %K MSM %K coping skill training %D 2023 %7 13.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health problems are common among men who have sex with men (MSM) living with HIV and may negatively affect medication adherence. Psychosocial interventions designed to address these urgent needs are scarce in China. Incorporating behavioral health theories into intervention development strengthens the effectiveness of these interventions. The absence of a robust theoretical basis for interventions may also present challenges to identify active intervention ingredients. Objective: This study aims to systematically describe the development of a mobile health–based intervention for MSM recently diagnosed with HIV in China, including the theoretical basis for the content and the considerations for its technological delivery. Methods: We used intervention mapping (IM) to guide overall intervention development, a behavioral intervention technology model for technological delivery design, and a human-centered design and cultural adaptation model for intervention tailoring throughout all steps of IM. Results: The dialectical behavior therapy (DBT)–informed intervention, Turning to Sunshine, comprised 3 components: app-based individual skills learning, group-based skills training, and on-demand phone coaching. The theoretical basis for the intervention content is based on the DBT model of emotions, which fits our conceptualization of the intervention user’s mental health needs. The intervention aims to help MSM recently diagnosed with HIV (1) survive moments of high emotional intensity and strong action urges, (2) change emotional expression to regulate emotions, and (3) reduce emotional vulnerability, as well as (4) augment community resources for mental health services. Technological delivery considerations included rationale of the medium, complexity, and esthetics of information delivery; data logs; data visualization; notifications; and passive data collection. Conclusions: This study laid out the steps for the development of a DBT-informed mobile health intervention that integrated app-based individual learning, group-based skills training, and phone coaching. This intervention, Turning to Sunshine, aims to improve mental health outcomes for MSM newly diagnosed with HIV in China. The IM framework informed by human-centered design principles and cultural adaptation considerations offered a systematic approach to develop the current intervention and tailor it to the target intervention users. The behavioral intervention technology model facilitated the translation of behavioral intervention strategies into technological delivery components. The systematic development and reporting of the current intervention can serve as a guide for similar intervention studies. The content of the current intervention could be adapted for a broader population with similar emotional struggles to improve their mental health outcomes. %M 37831497 %R 10.2196/47903 %U https://formative.jmir.org/2023/1/e47903 %U https://doi.org/10.2196/47903 %U http://www.ncbi.nlm.nih.gov/pubmed/37831497 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49918 %T The DrinksRation Smartphone App for Modifying Alcohol Use Behaviors in UK Military Service Personnel at Risk of Alcohol-Related Harm: Protocol for a Randomized Controlled Trial %A King,Kate %A Leightley,Daniel %A Greenberg,Neil %A Fear,Nicola %+ Academic Department of Military General Practice, Research & Clinical Innovation, Defence Medical Services, ICT Centre, Birmingham Research Park, Vincent Drive, Birmingham, B152SQ, United Kingdom, 44 7901221593, kboddy@doctors.org.uk %K alcohol drinking %K alcohol brief intervention %K digital intervention %K military %D 2023 %7 13.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Consumption of alcohol is synonymous with military populations, and studies have shown that serving personnel drink more than age- and sex-matched civilian populations. While ingrained in the military culture, excessive alcohol use is associated with increased rates of disciplinary issues, sickness absence, and loss of productivity, as well as contributing to a burden of acute and chronic health problems. Alcohol brief interventions can reduce alcohol use in civilian populations, but there is a paucity of evidence relating to the effectiveness of similar interventions in military populations. The DrinksRation smartphone app was designed to have a basis in behavior change technique theory and focuses on providing interactive behavioral prompts tailored to a military population. It has previously been shown to be effective in a help-seeking veteran population. Objective: The primary aim of the Military DrinksRation randomized controlled trial study is to determine whether it is similarly effective in a serving military population. Methods: We compare the effectiveness of the DrinksRation smartphone app with treatment as usual for personnel identified at risk of alcohol-related harm using the Military DrinksRation study that is a 2-arm, single-blind, 1:1 randomized controlled trial of the UK Armed Forces population. It is hypothesized that the DrinksRation app will be more efficacious at reducing alcohol consumption compared to treatment as usual. Recruitment will be predominantly from routine, periodic dental inspections all service personnel regularly undertake, supplemented by recruitment from military-targeted media messaging. The primary outcome is the change in alcohol units consumed per week between baseline and day 84, measured using the timeline follow-back method. Secondary outcome measures are a change in the Alcohol Use Disorders Identification Test score, a change in the quality of life assessment, and a change in drinking motivations and app usability (intervention arm only) between baseline and day 84. A final data collection at 168 days will assess the persistence of any changes over a longer duration. Results: The study is expected to open in August 2023 and aims to enroll 728 participants to allow for a study sample size requirement of 218 per arm and a 40% attrition rate. It is expected to take up to 12 months to complete. The results will be published in 2024. Conclusions: The Military DrinksRation study will assess the efficacy of the smartphone app on changing alcohol use behaviors in service personnel. If a positive effect is shown, the UK Defence Medical Services would have an effective, evidence-based tool to use as part of an alcohol management clinical pathway, thereby providing better support for military personnel at risk of harm from alcohol drinking. Trial Registration: ISRCTN Registry 42646;. https://doi.org/10.1186/ISRCTN14977034 International Registered Report Identifier (IRRID): PRR1-10.2196/49918 %M 37831507 %R 10.2196/49918 %U https://www.researchprotocols.org/2023/1/e49918 %U https://doi.org/10.2196/49918 %U http://www.ncbi.nlm.nih.gov/pubmed/37831507 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 8 %N %P e46654 %T An Evidence-Based Framework for Creating Inclusive and Personalized mHealth Solutions—Designing a Solution for Medicaid-Eligible Pregnant Individuals With Uncontrolled Type 2 Diabetes %A Fareed,Naleef %A Swoboda,Christine %A Wang,Yiting %A Strouse,Robert %A Hoseus,Jenelle %A Baker,Carrie %A Joseph,Joshua J %A Venkatesh,Kartik %+ Department of Biomedical Informatics, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH, 43210, United States, 1 6143660283, naleef.fareed@osumc.edu %K personalization %K mobile health %K mHealth %K pregnancy %K pregnant %K maternal %K personalized %K diabetic %K algorithm %K diabetes %K rule-based algorithms %K social determinants of health %K inclusive %K inclusivity %K design %D 2023 %7 12.10.2023 %9 Viewpoint %J JMIR Diabetes %G English %X Mobile health (mHealth) apps can be an evidence-based approach to improve health behavior and outcomes. Prior literature has highlighted the need for more research on mHealth personalization, including in diabetes and pregnancy. Critical gaps exist on the impact of personalization of mHealth apps on patient engagement, and in turn, health behaviors and outcomes. Evidence regarding how personalization, engagement, and health outcomes could be aligned when designing mHealth for underserved populations is much needed, given the historical oversights with mHealth design in these populations. This viewpoint is motivated by our experience from designing a personalized mHealth solution focused on Medicaid-enrolled pregnant individuals with uncontrolled type 2 diabetes, many of whom also experience a high burden of social needs. We describe fundamental components of designing mHealth solutions that are both inclusive and personalized, forming the basis of an evidence-based framework for future mHealth design in other disease states with similar contexts. %M 37824196 %R 10.2196/46654 %U https://diabetes.jmir.org/2023/1/e46654 %U https://doi.org/10.2196/46654 %U http://www.ncbi.nlm.nih.gov/pubmed/37824196 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e49471 %T Supporting Pain Self-Management in Patients With Cancer: App Development Based on a Theoretical and Evidence-Driven Approach %A Abahussin,Asma A %A West,Robert M %A Wong,David C %A Ziegler,Lucy E %A Allsop,Matthew J %+ Department of Biomedical Technology, College of Applied Medical Sciences, King Saud University, Building 11, PO Box 10219, Riyadh, 11433, Saudi Arabia, 966 11 8052824, asmabahussin@ksu.edu.sa %K pain %K cancer %K behavior change %K capability, opportunity, motivation, and behavior model %K COM-B model %K Behavior Change Wheel %K BCW %K mobile health %K mHealth %K app %K pain self-management %K evidence-based %K intervention design %K theory %D 2023 %7 9.10.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: To inform the development of an intervention, it is essential to have a well-developed theoretical understanding of how an intervention causes change, as stated in the UK Medical Research Council guidelines for developing complex interventions. Theoretical foundations are often ignored in the development of mobile health apps intended to support pain self-management for patients with cancer. Objective: This study aims to systematically set a theory- and evidence-driven design for a pain self-management app and specify the app’s active features. Methods: The Behavior Change Wheel (BCW) framework, a step-by-step theoretical approach to the development of interventions, was adopted to achieve the aim of this study. This started by understanding and identifying sources of behavior that could be targeted to support better pain management. Ultimately, the application of the BCW framework guided the identification of the active contents of the app, which were characterized using the Behavior Change Technique Taxonomy version 1. Results: The theoretical analysis revealed that patients may have deficits in their capability, opportunity, and motivation that prevent them from performing pain self-management. The app needs to use education, persuasion, training, and enablement intervention functions because, based on the analysis, they were found the most likely to address the specified factors. Eighteen behavior change techniques were selected to describe precisely how the intervention functions can be presented to induce the desired change regarding the intervention context. In other words, they were selected to form the active contents of the app, potentially reducing barriers and serving to support patients in the self-management of pain while using the app. Conclusions: This study fully reports the design and development of a pain self-management app underpinned by theory and evidence and intended for patients with cancer. It provides a model example of the BCW framework application for health app development. The work presented in this study is the first systematic theory- and evidence-driven design for a pain app for patients with cancer. This systematic approach can support clarity in evaluating the intervention’s underlying mechanisms and support future replication. %M 37812491 %R 10.2196/49471 %U https://cancer.jmir.org/2023/1/e49471 %U https://doi.org/10.2196/49471 %U http://www.ncbi.nlm.nih.gov/pubmed/37812491 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e48229 %T Testing the Effect of a Smartphone App on Hospital Admissions and Sedentary Behavior in Cardiac Rehabilitation Participants: ToDo-CR Randomized Controlled Trial %A Patterson,Kacie %A Davey,Rachel %A Keegan,Richard %A Niyonsenga,Theo %A Mohanty,Itismita %A Bowen,Sarah %A Regan,Elizabeth %A Lander,Michelle %A van Berlo,Sander %A Freene,Nicole %+ Health Research Institute, Faculty of Health, University of Canberra, University Drive, Bruce, ACT, 2617, Australia, 61 2 6201 5550, Kacie.Patterson@canberra.edu.au %K mobile health %K secondary prevention %K cardiovascular disease %K sedentary behavior %K hospital admissions %K cost-effectiveness %K mobile phone %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: People with coronary heart disease are at an increased risk of morbidity and mortality even if they attend cardiac rehabilitation. High sedentary behavior levels potentially contribute to this morbidity. Smartphone apps may be feasible to facilitate sedentary behavior reductions and lead to reduced health care use. Objective: We aimed to test the effect of a sedentary behavior change smartphone app (Vire app and ToDo-CR program) as an adjunct to cardiac rehabilitation on hospital admissions and emergency department (ED) presentations over 12 months. Methods: A multicenter, randomized controlled trial was conducted with 120 participants recruited from 3 cardiac rehabilitation programs. Participants were randomized 1:1 to cardiac rehabilitation plus the fully automated 6-month Vire app and ToDo-CR program (intervention) or usual care (control). The primary outcome was nonelective hospital admissions and ED presentations over 12 months. Secondary outcomes including accelerometer-measured sedentary behavior, BMI, waist circumference, and quality of life were recorded at baseline and 6 and 12 months. Logistic regression models were used to analyze the primary outcome, and linear mixed-effects models were used to analyze secondary outcomes. Data on intervention and hospital admission costs were collected, and the incremental cost-effectiveness ratios (ICERs) were calculated. Results: Participants were, on average, aged 62 (SD 10) years, and the majority were male (93/120, 77.5%). The intervention group were more likely to experience all-cause (odds ratio [OR] 1.54, 95% CI 0.58-4.10; P=.39) and cardiac-related (OR 3.26, 95% CI 0.84-12.55; P=.09) hospital admissions and ED presentations (OR 2.07, 95% CI 0.89-4.77; P=.09) than the control group. Despite this, cardiac-related hospital admission costs were lower in the intervention group over 12 months (Aus $252.40 vs Aus $859.38; P=.24; a currency exchange rate of Aus $1=US $0.69 is applicable). There were no significant between-group differences in sedentary behavior minutes per day over 12 months, although the intervention group completed 22 minutes less than the control group (95% CI −22.80 to 66.69; P=.33; Cohen d=0.21). The intervention group had a lower BMI (β=1.62; P=.05), waist circumference (β=5.81; P=.01), waist-to-hip ratio (β=.03, P=.03), and quality of life (β=3.30; P=.05) than the control group. The intervention was more effective but more costly in reducing sedentary behavior (ICER Aus $351.77) and anxiety (ICER Aus $10,987.71) at 12 months. The intervention was also more effective yet costly in increasing quality of life (ICER Aus $93,395.50) at 12 months. Conclusions: The Vire app and ToDo-CR program was not an outcome-effective or cost-effective solution to reduce all-cause hospital admissions or ED presentations in cardiac rehabilitation compared with usual care. Smartphone apps that target sedentary behavior alone may not be an effective solution for cardiac rehabilitation participants to reduce hospital admissions and sedentary behavior. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001223123; https://australianclinicaltrials.gov.au/anzctr/trial/ACTRN12619001223123 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-040479 %M 37788043 %R 10.2196/48229 %U https://mhealth.jmir.org/2023/1/e48229 %U https://doi.org/10.2196/48229 %U http://www.ncbi.nlm.nih.gov/pubmed/37788043 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e42851 %T The Effectiveness of a Neurofeedback-Assisted Mindfulness Training Program Using a Mobile App on Stress Reduction in Employees: Randomized Controlled Trial %A Min,Beomjun %A Park,Heyeon %A Kim,Johanna Inhyang %A Lee,Sungmin %A Back,Soyoung %A Lee,Eunhwa %A Oh,Sohee %A Yun,Je-Yeon %A Kim,Bung-Nyun %A Kim,Yonghoon %A Hwang,JungHyun %A Lee,Sanghyop %A Kim,Jeong-Hyun %+ Department of Public Health Medical Services, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, 13620, Republic of Korea, 82 31 787 2025, retrial3@hanmail.net %K mindfulness %K neurofeedback %K stress %K resilience %K mobile app %K employee %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mindfulness-based training programs have consistently shown efficacy in stress reduction. However, questions regarding the optimal duration and most effective delivery methods remain. Objective: This research explores a 4-week neurofeedback-assisted mindfulness training for employees via a mobile app. The study’s core query is whether incorporating neurofeedback can amplify the benefits on stress reduction and related metrics compared with conventional mindfulness training. Methods: A total of 92 full-time employees were randomized into 3 groups: group 1 received mobile mindfulness training with neurofeedback assistance (n=29, mean age 39.72 years); group 2 received mobile mindfulness training without neurofeedback (n=32, mean age 37.66 years); and group 3 were given self-learning paper materials on stress management during their first visit (n=31, mean age 38.65 years). The primary outcomes were perceived stress and resilience scales. The secondary outcomes were mindfulness awareness, emotional labor, occupational stress, insomnia, and depression. Heart rate variability and electroencephalography were measured for physiological outcomes. These measurements were collected at 3 different times, namely, at baseline, immediately after training, and at a 4-week follow-up. The generalized estimating equation model was used for data analysis. Results: The 4-week program showed significant stress reduction (Wald χ22=107.167, P<.001) and improvements in psychological indices including resilience, emotional labor, insomnia, and depression. A significant interaction was observed in resilience (time × group, Wald χ42=10.846, P=.02). The post hoc analysis showed a statistically significant difference between groups 1 (least squares mean [LSM] 21.62, SE 0.55) and 3 (LSM 19.90, SE 0.61) at the posttraining assessment (P=.008). Group 1 showed a significant improvement (P<.001) at the posttraining assessment, with continued improvements through the 1-month follow-up assessment period (LSM 21.55, SE 0.61). Physiological indices were analyzed only for data of 67 participants (22 in group 1, 22 in group 2, and 23 in group 3) due to the data quality. The relaxation index (ratio of alpha to high beta power) from the right electroencephalography channel showed a significant interaction (time × group, Wald χ22=6.947, P=.03), with group 1 revealing the highest improvement (LSM 0.43, SE 0.15) compared with groups 2 (LSM –0.11, SE 0.10) and 3 (LSM 0.12, SE 0.10) at the 1-month follow-up assessment. Conclusions: The study demonstrated that the neurofeedback-assisted group achieved superior outcomes in resilience and relaxation during the 4-week mobile mindfulness program. Further research with larger samples and long-term follow-up is warranted. Trial Registration: ClinicalTrials.gov NCT03787407; https://clinicaltrials.gov/ct2/show/NCT03787407 %M 37788060 %R 10.2196/42851 %U https://mhealth.jmir.org/2023/1/e42851 %U https://doi.org/10.2196/42851 %U http://www.ncbi.nlm.nih.gov/pubmed/37788060 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48301 %T Acceptability and Usability of a Theory-Driven Intervention via Email to Promote Physical Activity in Women Who Are Overweight or Obese: Substudy Within a Randomized Controlled Trial %A Brunet,Jennifer %A Sharma,Sitara %A Price,Jenson %A Black,Melissa %+ School of Human Kinetics, University of Ottawa, 125 University Private, Montpetit Hall # 339, Ottawa, ON, K1N 6N5, Canada, 1 613 562 5800 ext 3068, jennifer.brunet@uottawa.ca %K behavior change %K motivation %K overweight %K obese %K physical activity %K women %K digital %K randomized trial %K mobile phone %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Insufficient physical activity (PA) and excess weight increase illness risk for women. Face-to-face interventions can increase PA levels; however, they are often inaccessible. With growing interest in digital interventions, a Self-Determination Theory (SDT)–driven intervention was developed and delivered via email to promote PA in women who were insufficiently active and overweight or obese. Objective: This substudy explores users’ perspectives about the acceptability and usability of the intervention, which was coupled with a wearable activity monitor and PA recommendations. Methods: A 3-arm, parallel group, randomized controlled trial (unblinded) was conducted in Ontario, Canada. Recruitment occurred from September 2018 to March 2019 via advertising through social media, web-based boards, and posters in publicly accessible areas. In total, 47 women with a BMI of ≥25 kg/m2 who were not meeting the Canadian PA guidelines were randomly assigned to 1 of 3 arms (arm 1: n=15, 32%; arm 2: n=16, 34%; arm 3: n=16, 34%). This substudy focused on the 15 participants allocated to the main intervention arm. Participants received an automated intervention consisting of (1) 6 weekly emails, (2) a Polar Electro Inc A300 activity monitor (with access to the Polar Flow website and companion smartphone app), and (3) a copy of the Canadian PA guidelines for adults. Emails were developed using SDT and designed to enhance autonomous motivation by fostering the psychological needs of competence, autonomy, and relatedness. Well-established motivational and behavior change techniques were embedded in the emails to promote needs satisfaction. After the intervention (ie, 7 weeks after randomization), participants were invited to complete a web-based acceptability and usability survey containing open-ended and closed-ended questions; responses were analyzed using descriptive and content analyses, respectively. Results: The analyses included data from 93% (14/15) of the women (age: mean 33.4, SD 7.5; range 24-44 years; BMI: mean 31.3, SD 5.8 kg/m2; range 25-40.5 kg/m2) who received the main intervention and completed the postintervention survey. Open-ended responses indicated that participants were generally satisfied with the intervention and appreciated that emails prompted self-reflection, kept them on track and accountable, provided informational support, and were nonpressuring. Furthermore, they suggested that the monitor was “enjoyable” and “helpful”; quantitative data corroborated this, as 71% (10/14) said that the monitor was “very valuable/absolutely valuable,” 71% (10/14) would “very probably/definitely” still use one, and 86% (12/14) wore it for ≥5 days per week for ≥8 hours per day and checked it “occasionally/frequently/very frequently.” Potential threats to acceptability included “long” and “text-heavy” emails; lack of personal contact; and cumbersome, unaesthetic monitors. Conclusions: Results suggest that this SDT-driven, email-delivered intervention may be an acceptable low-contact approach to promote PA in women who are overweight or obese and insufficiently active; however, improvements are warranted and studies ascertaining its effectiveness are needed. Trial Registration: ClinicalTrials.gov NCT03601663; http://clinicaltrials.gov/ct2/show/NCT03601663 International Registered Report Identifier (IRRID): RR2-10.1177/20552076221093134 %M 37788048 %R 10.2196/48301 %U https://formative.jmir.org/2023/1/e48301 %U https://doi.org/10.2196/48301 %U http://www.ncbi.nlm.nih.gov/pubmed/37788048 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e36596 %T The Effect of a Digital Mental Health Program on Anxiety and Depression Symptoms: Retrospective Analysis of Clinical Severity %A Dzubur,Eldin %A Yu,Jessica %A Hoffman,Julia %A Painter,Stefanie %A James,Roberta %A Shah,Bimal %+ Teladoc Health, 2 Manhattanville Rd, Purchase, NY, 10577, United States, 1 3123307236, spainter@teladoc.com %K digital health %K mental health %K anxiety %K depression %K digital mental health %K program usage %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Evidence-based digital health programs have shown efficacy in being primary tools to improve emotional and mental health, as well as offering supplementary support to individuals undergoing psychotherapy for anxiety, depression, and other mental health disorders. However, information is lacking about the dose response to digital mental health interventions. Objective: The objective of the study was to examine the effect of time in program and program usage on symptom change among individuals enrolled in a real-world comprehensive digital mental health program (myStrength) who are experiencing severe anxiety or depression. Methods: Eligible participants (N=18,626) were adults aged 18 years and older who were enrolled in myStrength for at least four weeks as part of their employee wellness benefit program, who completed baseline, the 2-week, 2-month, and 6-month surveys querying symptoms of anxiety (Generalized Anxiety Disorder–7 [GAD-7]) and depression (Patient Health Questionnaire–9 [PHQ-9]). Linear growth curve models were used to analyze the effect of average weekly program usage on subsequent GAD-7 and PHQ-9 scores for participants with scores indicating severe anxiety (GAD-7≥15) or depression (PHQ-9≥15). All models were adjusted for baseline score and demographics. Results: Participants in the study (N=1519) were 77.4% female (1176/1519), had a mean age of 45 years (SD 14 years), and had an average enrollment time of 3 months. At baseline, participants reported an average of 9.39 (SD 6.04) on the GAD-7 and 11.0 (SD 6.6) on the PHQ-9. Those who reported 6-month results had an average of 8.18 (SD 6.15) on the GAD-7 and 9.18 (SD 6.79) on the PHQ-9. Participants with severe scores (n=506) experienced a significant improvement of 2.97 (SE 0.35) and 3.97 (SE 0.46) at each time point for anxiety and depression, respectively (t=–8.53 and t=–8.69, respectively; Ps<.001). Those with severe baseline scores also saw a reduction of 0.27 (SE 0.08) and 0.25 (SE 0.09) points in anxiety and depression, respectively, for each additional program activity per week (t=–3.47 and t=–2.66, respectively; Ps<.05). Conclusions: For participants with severe baseline scores, the study found a clinically significant reduction of approximately 9 points for anxiety and 12 points for depression after 6 months of enrollment, suggesting that interventions targeting mental health must maintain active, ongoing engagement when symptoms are present and be available as a continuous resource to maximize clinical impact, specifically in those experiencing severe anxiety or depression. Moreover, a dosing effect was shown, indicating improvement in outcomes among participants who engaged with the program every other day for both anxiety and depression. This suggests that digital mental health programs that provide both interesting and evidence-based activities could be more successful in further improving mental health outcomes. %M 37788069 %R 10.2196/36596 %U https://formative.jmir.org/2023/1/e36596 %U https://doi.org/10.2196/36596 %U http://www.ncbi.nlm.nih.gov/pubmed/37788069 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e51899 %T Optimizing a Technology-Based Body and Mind Intervention to Prevent Falls and Reduce Health Disparities in Low-Income Populations: Protocol for a Clustered Randomized Controlled Trial %A Thiamwong,Ladda %A Xie,Rui %A Park,Joon-Hyuk %A Lighthall,Nichole %A Loerzel,Victoria %A Stout,Jeffrey %+ Nursing Systems Department, College of Nursing, University of Central Florida, 12201 Research Parkway, Suite 300, Orlando, FL, 32826, United States, 1 4078232744, ladda.thiamwong@ucf.edu %K fall prevention %K fear of falling %K low income %K older adults %K exercise %K technology %D 2023 %7 3.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The lack of health care coverage, low education, low motivation, and inconvenience remain barriers to participating in fall prevention programs, especially among low-income older adults. Low-income status also contributes to negative aging self-perceptions and is associated with a high perceived barrier to care. Existing fall prevention intervention technologies do not enable participants and practitioners to interact and collaborate, even with technologies that bring viable strategies to maintain independence, prevent disability, and increase access to quality care. Research is also limited on the use of technology to enhance motivation and help individuals align their perception with physiological fall risk. We developed a novel, 8-week Physio-Feedback Exercise Program (PEER), which includes (1) technology-based physio-feedback using a real-time portable innovative technology—the BTrackS Balance Tracking System, which is reliable and affordable, allows for home testing, and provides feedback and tracks balance progression; (2) cognitive reframing using the fall risk appraisal matrix; and (3) peer-led exercises focusing on balance, strength training, and incorporating exercises into daily activities. Objective: This study consists of 3 aims. Aim 1 is to examine the effects of the technology-based PEER intervention on fall risk, dynamic balance, and accelerometer-based physical activity (PA). Aim 2 is to examine the effects of the PEER intervention on fall risk appraisal shifting and negative self-perceptions of aging. Aim 3 is to explore participants’ experiences with the PEER intervention and potential barriers to accessing and adopting the technology-based PEER intervention to inform future research. Methods: This is an intention-to-treat, single-blinded, parallel, 2-arm clustered randomized controlled trial study. We will collect data from 340 low-income older adults at baseline (T1) and measure outcomes after program completion (T2) and follow-up at 3 months (T3) and 6 months (T4). Participants will be enrolled if they meet all the following inclusion criteria: aged ≥60 years, cognitively intact, and able to stand without assistance. Exclusion criteria were as follows: a medical condition precluding exercise or PA, currently receiving treatment from a rehabilitation facility, plan to move within 1 year, hospitalized >3 times in the past 12 months, and does not speak English or Spanish. Results: As of August 2023, the enrollment of participants is ongoing. Conclusions: This study addresses the public health problem by optimizing a customized, technology-driven approach that can operate in low-resource environments with unlimited users to prevent falls and reduce health disparities in low-income older adults. The PEER is a novel intervention that combines concepts of physio-feedback, cognitive reframing, and peer-led exercise by motivating a shift in self-estimation of fall risk to align with physiological fall risk to improve balance, PA, and negative aging self-perception. Trial Registration: ClinicalTrials.gov NCT05778604; https://www.clinicaltrials.gov/ct2/show/study/NCT05778604 International Registered Report Identifier (IRRID): DERR1-10.2196/51899 %M 37788049 %R 10.2196/51899 %U https://www.researchprotocols.org/2023/1/e51899 %U https://doi.org/10.2196/51899 %U http://www.ncbi.nlm.nih.gov/pubmed/37788049 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 7 %N %P e47818 %T Feasibility and Acceptability of a Combined Digital Platform and Community Health Worker Intervention for Patients With Heart Failure: Single-Arm Pilot Study %A Carter,Jocelyn %A Swack,Natalia %A Isselbacher,Eric %A Donelan,Karen %A Thorndike,Anne N %+ Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Blake 15, Boston, MA, 02114, United States, 1 6177262000, jcarter0@mgh.harvard.edu %K heart failure %K digital platform %K remote monitoring %K home-based care %K community health worker %K social needs care %K community health work %K care %K monitoring %K pilot study %K heart %K feasibility %K acceptability %K community %K heart rate %K oxygenation %K willingness %K mobile phone %D 2023 %7 2.10.2023 %9 Original Paper %J JMIR Cardio %G English %X Background: Heart failure (HF) is one of the leading causes of hospital admissions. Clinical (eg, complex comorbidities and low ejection fraction) and social needs factors (eg, access to transportation, food security, and housing security) have both contributed to hospitalizations, emphasizing the importance of increased clinical and social needs support at home. Digital platforms designed for remote monitoring of HF can improve clinical outcomes, but their effectiveness has been limited by patient barriers such as lack of familiarity with technology and unmet social care needs. To address these barriers, this study explored combining a digital platform with community health worker (CHW) social needs care for patients with HF. Objective: We aim to determine the feasibility and acceptability of an intervention combining digital platform use and CHW social needs care for patients with HF. Methods: Adults (aged ≥18 years) with HF receiving care at a single health care institution and with a history of hospital admission in the previous 12 months were enrolled in a single-arm pilot study from July to November 2021 (N=14). The 30-day intervention used a digital platform within a mobile app that included symptom questionnaire and educational videos connected to a biometric sensor (tracking heart rate, oxygenation, and steps taken), a digital weight scale, and a digital blood pressure monitor. All patients were paired with a CHW who had access to the digital platform data. A CHW provided routine phone calls to patients throughout the study period to discuss their biometric data and to address barriers to any social needs. Feasibility outcomes were patient use of the platform and engagement with the CHW. The acceptability outcome was patient willingness to use the intervention again. Results: Participants (N=14) were 67.7 (SD 11.7) years old; 8 (57.1%) were women, and 7 (50%) were insured by Medicare. Participants wore the sensor for 82.2% (n=24.66) of study days with an average of 13.5 (SD 2.1) hours per day. Participants used the digital blood pressure monitor and digital weight scale for an average of 1.2 (SD 0.17) times per day and 1.1 (SD 0.12) times per day, respectively. All participants completed the symptom questionnaire on at least 71% (n=21.3) of study days; 11 (78.6%) participants had ≥3 CHW interactions, and 11 (78.6%) indicated that if given the opportunity, they would use the platform again in the future. Exit interviews found that despite some platform “glitches,” participants generally found the remote monitoring platform to be “helpful” and “motivating.” Conclusions: A novel intervention combining a digital platform with CHW social needs care for patients with HF was feasible and acceptable. The majority of participants were engaged throughout the study and indicated their willingness to use the intervention again. A future clinical trial is needed to determine the effectiveness of this intervention. %M 37698975 %R 10.2196/47818 %U https://cardio.jmir.org/2023/1/e47818 %U https://doi.org/10.2196/47818 %U http://www.ncbi.nlm.nih.gov/pubmed/37698975 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46082 %T Testing the Effects of App-Based Motivational Messages on Physical Activity and Resting Heart Rate Through Smartphone App Compliance in Patients With Vulnerable Coronary Artery Plaques: Protocol for a Microrandomized Trial %A Mitra,Sayan %A Kroeger,Cynthia M %A Xu,Jing %A Avery,Leah %A Masedunskas,Andrius %A Cassidy,Sophie %A Wang,Tian %A Hunyor,Imre %A Wilcox,Ian %A Huang,Robin %A Chakraborty,Bibhas %A Fontana,Luigi %+ Charles Perkins Centre, The University of Sydney, John Hopkins Drive, Camperdown, NSW 2006, Australia, 61 02 86275819, sayan.mitra@sydney.edu.au %K adherence %K coronary artery disease %K coronary heart disease %K digital health %K health behavior %K heart rate %K messages %K mhealth %K microrandomized trial %K mobile app %K physical activity %K smartphone %K telehealth %K user motivation %D 2023 %7 2.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Achieving the weekly physical activity recommendations of at least 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic exercise is important for reducing cardiometabolic risk, but evidence shows that most people struggle to meet these goals, particularly in the mid to long term. Objective: The Messages Improving Resting Heart Health (MIRTH) study aims to determine if (1) sending daily motivational messages through a research app is effective in improving motivation and in promoting adherence to physical activity recommendations in men and women with coronary heart disease randomized to a 12-month intensive lifestyle intervention, and (2) the time of the day when the message is delivered impacts compliance with exercise training. Methods: We will conduct a single-center, microrandomized trial. Participants will be randomized daily to either receive or not receive motivational messages over two 90-day periods at the beginning (phase 1: months 4-6) and at the end (phase 2: months 10-12) of the Lifestyle Vulnerable Plaque Study. Wrist-worn devices (Fitbit Inspire 2) and Bluetooth pairing with smartphones will be used to passively collect data for proximal (ie, physical activity duration, steps walked, and heart rate within 180 minutes of receiving messages) and distal (ie, change values for resting heart rate and total steps walked within and across both phases 1 and 2 of the trial) outcomes. Participants will be recruited from a large academic cardiology office practice (Central Sydney Cardiology) and the Royal Prince Alfred Hospital Departments of Cardiology and Radiology. All clinical investigations will be undertaken at the Charles Perkins Centre Royal Prince Alfred clinic. Individuals aged 18-80 years (n=58) with stable coronary heart disease who have low attenuation plaques based on a coronary computed tomography angiography within the past 3 months and have been randomized to an intensive lifestyle intervention program will be included in MIRTH. Results: The Lifestyle Vulnerable Plaque Study was funded in 2020 and started enrolling participants in February 2022. Recruitment for MIRTH commenced in November 2022. As of September 2023, 2 participants were enrolled in the MIRTH study and provided baseline data. Conclusions: This MIRTH microrandomized trial will represent the single most detailed and integrated analysis of the effects of a comprehensive lifestyle intervention delivered through a customized mobile health app on smart devices on time-based motivational messaging for patients with coronary heart disease. This study will also help inform future studies optimizing for just-in-time adaptive interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12622000731796; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382861 International Registered Report Identifier (IRRID): DERR1-10.2196/46082 %M 37782531 %R 10.2196/46082 %U https://www.researchprotocols.org/2023/1/e46082 %U https://doi.org/10.2196/46082 %U http://www.ncbi.nlm.nih.gov/pubmed/37782531 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46989 %T Effectiveness of a Mobile App Intervention for Preparing Preschool Children and Parents for Day Surgery: Randomized Controlled Trial %A Kerimaa,Heli %A Hakala,Mervi %A Haapea,Marianne %A Vähänikkilä,Hannu %A Serlo,Willy %A He,Hong-Gu %A Pölkki,Tarja %+ Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5A, Oulu, 90220, Finland, 358 294485602, heli.kerimaa@oulu.fi %K anxiety %K day surgery %K fear %K mobile app %K pain %K parents %K preparation %K preschool child %K randomized controlled trial %K stress %K mobile phone %D 2023 %7 29.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Day surgery allows families to return home quickly. Only a few approaches to preparing for day surgery have demonstrated how digital solutions can support families and children. Objective: This study aims to evaluate the effectiveness of a mobile app intervention on preschool children’s fear and pain and parents’ anxiety and stress in preparing children for day surgery. Methods: This study was conducted at the Pediatric Day Surgical Department of a university hospital in Finland between 2018 and 2020. Parents of children (aged 2-6 y) who were in a queue for elective day surgery were randomized into the intervention group (IG; n=36) and control group (CG; n=34). The CG received routine preparations, whereas the IG was prepared using a mobile app. Parents’ and children’s outcomes were measured using validated scales at 4 different points: at home (T1 and T4) and at the hospital (T2 and T3) before and after surgery. Group differences were analyzed using statistical methods suitable for the material. Results: Before surgery, parents in both groups experienced mild anxiety, which decreased after surgery. Parental anxiety did not differ between groups preoperatively (P=.78) or postoperatively (P=.63). Both groups had less anxiety at home after surgery compared with before. The IG showed a significant decrease (P=.003); the CG also improved (P=.002). Preoperatively at home, most parents in both groups experienced no stress or mild stress (P=.61). Preoperatively at the hospital, parents in both groups experienced mild stress; however, parents in the IG experienced more stress during this phase (P=.02). Parents in the IG experienced significantly less stress postoperatively than those in the CG (P=.05). Both groups showed decreased stress levels from before to after surgery (IG: P=.003; CG: P=.004) within each group. There were no significant differences in children’s pain levels between the groups and measurement points. This was observed before surgery at home (P=.25), before surgery at the hospital (P=.98), and after surgery at the hospital (P=.72). Children’s fear decreased more in the IG (P=.006) than in the CG (P=.44) comparing the phases before and after surgery at home. Fear did not differ between the IG and CG preoperatively at home (P=.20) or at the hospital (P=.59) or postoperatively at the hospital (P=.62) or at home (P=.81). Conclusions: The mobile app intervention did not reduce anxiety or pain. However, it was observed that parents in the IG experienced substantially heightened stress levels before surgery at the hospital, which decreased significantly after surgery at home. In addition, fear levels in children in the IG decreased over time, whereas no significant change was observed in the CG. These results are important for developing health care service chains and providing families with innovative and customer-oriented preparation methods. Trial Registration: ClinicalTrials.gov NCT03774303; https://classic.clinicaltrials.gov/ct2/show/NCT03774303 %M 37773624 %R 10.2196/46989 %U https://www.jmir.org/2023/1/e46989 %U https://doi.org/10.2196/46989 %U http://www.ncbi.nlm.nih.gov/pubmed/37773624 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e46878 %T Acceptability of the eHealth Intervention Sustainable Worker Digital Support for Persons With Chronic Pain and Their Employers (SWEPPE): Questionnaire and Interview Study %A Svanholm,Frida %A Turesson,Christina %A Löfgren,Monika %A Björk,Mathilda %+ Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Brigadgatan 22, Linköping, s-58185, Sweden, 46 730 447785, frida.svanholm@liu.se %K chronic pain %K digital support %K eHealth %K return to work %K rehabilitation %K support %K quality of life %K implementation %K acceptability %K interview %K questionnaire %K qualitative %K barrier %K users %K mobile phone %D 2023 %7 28.9.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Sick leave and decreased ability to work are the consequences of chronic pain. Interdisciplinary pain rehabilitation programs (IPRPs) aim to improve health-related quality of life and participation in work activities, although implementing rehabilitation strategies at work after IPRPs can be difficult. Employers’ knowledge about pain and the role of rehabilitation needs to be strengthened. The self-management of chronic pain can be improved through eHealth interventions. However, these interventions do not involve communicating with employers to improve work participation. To address this deficiency, a new eHealth intervention, Sustainable Worker Digital Support for Persons with Chronic Pain and Their Employers (SWEPPE), was developed. Objective: This study aimed to describe the acceptability of SWEPPE after IPRPs from the perspective of patients with chronic pain and their employers. Methods: This study included 11 patients and 4 employers who were recruited to test SWEPPE in daily life for 3 months after IPRPs. Data were collected using individual interviews at the end of the 3-month test period and questionnaires, which were completed when SWEPPE was introduced (questionnaire 1) and at a 3-month follow-up (questionnaire 2). Data were also collected on how often SWEPPE was used. Qualitative data were analyzed through a qualitative content analysis using an abductive approach. The framework used for the deductive approach was the theoretical framework of acceptability. Quantitative data were analyzed through descriptive statistics and the differences between the responses to questionnaires 1 and questionnaire 2 using the Wilcoxon signed rank test. Results: Both patients and employers reported that SWEPPE increased their knowledge and understanding of how to improve work participation and helped them identify goals, barriers, and strategies for return to work. In addition, participants noted that SWEPPE improved employer-employee communication and collaboration. However, experiences and ratings varied among participants and the different SWEPPE modules. The acceptability of SWEPPE was lower in patients who experienced significant pain and fatigue. A high degree of flexibility and choice of ratings in SWEPPE were generally described as helpful. Conclusions: This study shows promising results on the user acceptability of SWEPPE from both patient and employer perspectives. However, the variations among patients and modules indicate a need for further testing and research to refine the content and identify the group of patients who will best benefit from SWEPPE. %M 37768708 %R 10.2196/46878 %U https://humanfactors.jmir.org/2023/1/e46878 %U https://doi.org/10.2196/46878 %U http://www.ncbi.nlm.nih.gov/pubmed/37768708 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46877 %T Efficacy, Safety, and Evaluation Criteria of mHealth Interventions for Depression: Systematic Review %A Duarte-Díaz,Andrea %A Perestelo-Pérez,Lilisbeth %A Gelabert,Estel %A Robles,Noemí %A Pérez-Navarro,Antoni %A Vidal-Alaball,Josep %A Solà-Morales,Oriol %A Sales Masnou,Ariadna %A Carrion,Carme %+ Canary Islands Health Research Institute Foundation (FIISC), Camino Candelaria, 44, El Rosario, 38109, Spain, 34 922478320, andrea.duartediaz@sescs.es %K mobile health %K mHealth %K apps %K depression %K systematic review %K meta-analysis %D 2023 %7 27.9.2023 %9 Review %J JMIR Ment Health %G English %X Background: Depression is a significant public health issue that can lead to considerable disability and reduced quality of life. With the rise of technology, mobile health (mHealth) interventions, particularly smartphone apps, are emerging as a promising approach for addressing depression. However, the lack of standardized evaluation tools and evidence-based principles for these interventions remains a concern. Objective: In this systematic review and meta-analysis, we aimed to evaluate the efficacy and safety of mHealth interventions for depression and identify the criteria and evaluation tools used for their assessment. Methods: A systematic review and meta-analysis of the literature was carried out following the recommendations of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Studies that recruited adult patients exhibiting elevated depressive symptoms or those diagnosed with depressive disorders and aimed to assess the effectiveness or safety of mHealth interventions were eligible for consideration. The primary outcome of interest was the reduction of depressive symptoms, and only randomized controlled trials (RCTs) were included in the analysis. The risk of bias in the original RCTs was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials. Results: A total of 29 RCTs were included in the analysis after a comprehensive search of electronic databases and manual searches. The efficacy of mHealth interventions in reducing depressive symptoms was assessed using a random effects meta-analysis. In total, 20 RCTs had an unclear risk of bias and 9 were assessed as having a high risk of bias. The most common element in mHealth interventions was psychoeducation, followed by goal setting and gamification strategies. The meta-analysis revealed a significant effect for mHealth interventions in reducing depressive symptoms compared with nonactive control (Hedges g=−0.62, 95% CI −0.87 to −0.37, I2=87%). Hybrid interventions that combined mHealth with face-to-face sessions were found to be the most effective. Three studies compared mHealth interventions with active controls and reported overall positive results. Safety analyses showed that most studies did not report any study-related adverse events. Conclusions: This review suggests that mHealth interventions can be effective in reducing depressive symptoms, with hybrid interventions achieving the best results. However, the high level of heterogeneity in the characteristics and components of mHealth interventions indicates the need for personalized approaches that consider individual differences, preferences, and needs. It is also important to prioritize evidence-based principles and standardized evaluation tools for mHealth interventions to ensure their efficacy and safety in the treatment of depression. Overall, the findings of this study support the use of mHealth interventions as a viable method for delivering mental health care. Trial Registration: PROSPERO CRD42022304684; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=304684 %M 37756042 %R 10.2196/46877 %U https://mental.jmir.org/2023/1/e46877 %U https://doi.org/10.2196/46877 %U http://www.ncbi.nlm.nih.gov/pubmed/37756042 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50239 %T A Spiritual Self-Care Mobile App (Skylight) for Mental Health, Sleep, and Spiritual Well-Being Among Generation Z and Young Millennials: Cross-Sectional Survey %A Park,Susanna Y %A Huberty,Jennifer %A Yourell,Jacqlyn %A McAlister,Kelsey L %A Beatty,Clare C %+ Skylight, Radiant Foundation, 55 N 300 W Suite 800, Salt Lake City, UT, 84180, United States, 1 7202515121, syjpark@gmail.com %K Gen Z %K millennial %K spirituality %K spiritual self-care %K mental health %K sleep %K mobile health %K mHealth %K digital health %K spiritual %K self-care %K app %K apps %K mental wellness %K mental well-being %K young adult %K young adults %K engagement %K perception %K perceptions %D 2023 %7 27.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Generation Z (Gen Z) and young millennials (GenZennials) (ages 18-35 years) are unique in that they either have no memory of or were born shortly after the internet “explosion.” They are constantly on the internet, face significant challenges with their mental health and sleep, and are frequent users of digital wellness apps. GenZennials also uniquely identify with and practice spirituality, which has been linked to better mental health and sleep in adult populations. Research has not examined digital approaches to spiritual self-care and its relationship to mental health and sleep in GenZennials. Objective: The purpose of this study was to describe a sample of adult GenZennials who use a spiritual self-care app (ie, Skylight), describe how users engage with and perceive the app, and assess the relationship between frequency of using the app with mental health, sleep, and spiritual well-being. Methods: Participants were 475 adult Gen Z (ages 18-28 years) and young millennial (ages 29-35 years) Skylight app users who responded to an anonymous survey on the web. The survey asked about demographics, spiritual self-care and practice, and user engagement and perceptions of the app. Outcome measures included 4 validated surveys for mental health (ie, depression, anxiety, and stress) and sleep disturbance, and one validated survey on spiritual well-being. Mean scores were calculated for all measures, and linear regressions were conducted to examine the relationship between the frequency of app use and mental health, sleep, and spiritual well-being outcomes. Results: Participants were predominantly White (324/475, 68.2%) and female (255/475, 53.7%), and approximately half Gen Z (260/475, 54.5%) and half young millennials (215/475, 45.3%). Most users engaged in spiritual self-care (399/475, 84%) and said it was important or very important to them (437/475, 92%). Users downloaded the app for spiritual well-being (130/475, 30%) and overall health (125/475, 26.3%). Users had normal, average depressive symptoms (6.9/21), borderline abnormal anxiety levels (7.7/21), slightly elevated stress (6.7/16), and nonclinically significant sleep disturbance (5.3/28). Frequency of app use was significantly associated with lower anxiety (Moderate use: β=–2.01; P=.02; high use: β=–2.58; P<.001). There were no significant relationships between the frequency of app use and mental health, sleep, and spiritual well-being outcomes except for the personal domain of spiritual well-being. Conclusions: This is the first study to describe a sample of adult GenZennials who use a spiritual self-care app and examine how the frequency of app use is related to their mental health, sleep, and spiritual well-being. Spiritual self-care apps like Skylight may be useful in addressing anxiety among GenZennials and be a resource to spiritually connect to their personal spiritual well-being. Future research is needed to determine how a spiritual self-care app may benefit mental health, sleep, and spiritual well-being in adult GenZennials. %M 37597179 %R 10.2196/50239 %U https://formative.jmir.org/2023/1/e50239 %U https://doi.org/10.2196/50239 %U http://www.ncbi.nlm.nih.gov/pubmed/37597179 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49668 %T Mobile Phone Text Messages to Support People to Stop Smoking by Switching to Vaping: Codevelopment, Coproduction, and Initial Testing Study %A Sideropoulos,Vassilis %A Vangeli,Eleni %A Naughton,Felix %A Cox,Sharon %A Frings,Daniel %A Notley,Caitlin %A Brown,Jamie %A Kimber,Catherine %A Dawkins,Lynne %+ Department of Psychology & Human Development, IOE, UCL’s Faculty of Education and Society, University College London, 20 Bedford Way, London, WC1H 0AL, United Kingdom, 44 02035495417, v.sideropoulos@ucl.ac.uk %K coproduction %K SMS text messages %K e-cigarette %K smoking %K eHealth %K vaping %K mobile phone %K codevelopment %K text message %D 2023 %7 27.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: SMS text messages are affordable, scalable, and effective smoking cessation interventions. However, there is little research on SMS text message interventions specifically designed to support people who smoke to quit by switching to vaping. Objective: Over 3 phases, with vapers and smokers, we codeveloped and coproduced a mobile phone SMS text message program. The coproduction paradigm allowed us to collaborate with researchers and the community to develop a more relevant, acceptable, and equitable SMS text message program. Methods: In phase 1, we engaged people who vape via Twitter and received 167 responses to our request to write SMS text messages for people who wish to quit smoking by switching to vaping. We screened, adjusted, refined, and themed the messages, resulting in a set of 95 that were mapped against the Capability, Opportunity, and Motivation–Behavior constructs. In phase 2, we evaluated the 95 messages from phase 1 via a web survey where participants (66/202, 32.7% woman) rated up to 20 messages on 7-point Likert scales on 9 constructs: being understandable, clear, believable, helpful, interesting, inoffensive, positive, and enthusiastic and how happy they would be to receive the messages. In phase 3, we implemented the final set of SMS text messages as part of a larger randomized optimization trial, in which 603 participants (mean age 38.33, SD 12.88 years; n=369, 61.2% woman) received SMS text message support and then rated their usefulness and frequency and provided free-text comments at the 12-week follow-up. Results: For phase 2, means and SDs were calculated for each message across the 9 constructs. Those with means below the neutral anchor of 4 or with unfavorable comments were discussed with vapers and further refined or removed. This resulted in a final set of 78 that were mapped against early, mid-, or late stages of quitting to create an order for the messages. For phase 3, a total of 38.5% (232/603) of the participants provided ratings at the 12-week follow-up. In total, 69.8% (162/232) reported that the SMS text messages had been useful, and a significant association between quit rates and usefulness ratings was found (χ21=9.6; P=.002). A content analysis of free-text comments revealed that the 2 most common positive themes were helpful (13/47, 28%) and encouraging (6/47, 13%) and the 2 most common negative themes were too frequent (9/47, 19%) and annoying (4/47, 9%). Conclusions: In this paper, we describe the initial coproduction and codevelopment of a set of SMS text messages to help smokers stop smoking by transitioning to vaping. We encourage researchers to use, further develop, and evaluate the set of SMS text messages and adapt it to target populations and relevant contexts. %M 37756034 %R 10.2196/49668 %U https://formative.jmir.org/2023/1/e49668 %U https://doi.org/10.2196/49668 %U http://www.ncbi.nlm.nih.gov/pubmed/37756034 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46310 %T Mindfulness-Based Mobile Health to Address Unhealthy Eating Among Middle-Aged Sexual Minority Women With Early Life Adversity: Mixed Methods Feasibility Trial %A Sun,Shufang %A Nardi,William %A Murphy,Matthew %A Scott,Ty %A Saadeh,Frances %A Roy,Alexandra %A Brewer,Judson %+ Department of Behavioral and Social Sciences, Brown University, 121 South Main Street, Providence, RI, 02903, United States, 1 401 863 5735, shufang_sun@brown.edu %K mobile health %K mindfulness %K obesity %K sexual minority women %K early life adversity %K cell phone %K mobile phone %D 2023 %7 26.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexual minority women (lesbian, gay, bisexual, pansexual, queer, and other nonheterosexual women) remain considerably underrepresented in health research despite being at a higher risk for diabetes and obesity as well as stigma and psychological distress than their heterosexual peers. In addition, early life adversity (ELA) is prevalent among sexual minority women, which further increases risks for obesity, psychological distress, and poor cardiovascular health. App-based mindfulness interventions are potentially promising for this group in mitigating the adverse health effects of ELA, reducing food craving and unhealthy eating, addressing the risks associated with obesity. Objective: This mixed methods feasibility trial aimed to test a mindfulness-based mobile health approach for middle-aged sexual minority women (aged 30-55 years) with ELA and overweight or obesity (BMI ≥25 kg/m2) to improve health outcomes. Methods: The single-arm trial was advertised on social media and various lesbian, gay, bisexual, transgender, and queer web-based groups. At baseline, after the intervention (2 months), and at the 4-month follow-up, participants completed assessments of primary outcomes (food craving, emotional eating, and weight via a mailed scale) and secondary outcomes (depression, anxiety, mindfulness, and emotion dysregulation). A standardized weight measure was mailed to participants for weight reporting. Feasibility and acceptability were assessed after the intervention via surveys and semistructured exit interviews. Results: We screened 442 individuals, among which 30 eligible sexual minority women (mean age 40.20, SD 7.15 years) from various US regions were enrolled in the study. At baseline, 86% (26/30) and 80% (24/30) of participants had elevated depressive and anxiety symptoms, respectively. Among the 30 enrolled participants, 20 (66%) completed all intervention modules, 25 (83%) were retained at the 2-month follow-up, and 20 (66%) were retained at the 4-month follow-up. None reported adverse effects. From baseline to the 4-month follow-up, large effects were found in food craving (Cohen d=1.64) and reward-based eating (Cohen d=1.56), whereas small effects were found with weight (Cohen d=0.20; 4.21 kg on average). Significant improvements were also found in the secondary outcomes (depression, Cohen d=0.98; anxiety, Cohen d=0.50; mindfulness, Cohen d=0.49; and emotion dysregulation, Cohen d=0.44; all P<.05). Participants with higher levels of parental verbal and emotional abuse were particularly responsive to the intervention. Participants reported that the program aligned with their goals and expectations, was easy to use, and facilitated changes in eating behavior and mental health. Barriers to engagement included the need for diverse teachers, individualized support, and body positive language. Conclusions: This early phase feasibility trial provides proof-of-concept support for a mindfulness mobile health approach to improve obesity-related outcomes among sexual minority women and warrants a larger randomized controlled trial in the future. The findings also suggest the need to address trauma and psychological health when addressing weight-related outcomes among sexual minority women. %M 37751273 %R 10.2196/46310 %U https://www.jmir.org/2023/1/e46310 %U https://doi.org/10.2196/46310 %U http://www.ncbi.nlm.nih.gov/pubmed/37751273 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46458 %T Efficacy of a Text-Based Mental Health Coaching App in Improving the Symptoms of Stress, Anxiety, and Depression: Randomized Controlled Trial %A Lim,Yee Siew %A Quek,Jia Hui %A Ching,Xiu Wei %A Lim,Dominic Tao Ran %A Lim,Kean Ghee %A Thuraisingham,Chandramani %A George,Parikial Philip %+ International Medical University (IMU), Jalan Rasah, Bukit Rasah, Seremban, 70300, Malaysia, 60 67677798, lim.yeesiew@outlook.com %K digital mental health %K mobile health %K randomized control trial %K mobile phone %K mental health %K Depression, Anxiety, and Stress Scale–21 items %K DASS-21 %K Asia %K Malaysia %D 2023 %7 22.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Stress, anxiety, and depression are major mental health concerns worldwide. A wide variety of digital mental health interventions have demonstrated efficacy in improving one’s mental health status, and digital interventions that involve some form of human involvement have been shown to demonstrate greater efficacy than self-guided digital interventions. Studies demonstrating the efficacy of digital mental health interventions within the Asian region are scarce. Objective: This study aimed to investigate the potential efficacy of the digital mental health intervention, ThoughtFullChat, which consists of one-on-one, asynchronous, text-based coaching with certified mental health professionals and self-guided tools, in improving self-reported symptoms of depression, anxiety, and stress. The study also aims to examine the potential differences in efficacy among occupational subgroups and between sexes. Methods: A randomized controlled study was conducted among housemen (trainee physicians), students, faculty members, and corporate staff at International Medical University, Malaysia. A total of 392 participants were enrolled and randomized to the intervention (n=197, 50.3%) and control (n=195, 49.7%) groups. Depression, anxiety, and stress symptoms were measured using the Depression, Anxiety, and Stress Scale–21 items at baseline and after the 3-month intervention period. The Satisfaction with Life Scale and Brief Resilience Scale were also included, along with a questionnaire about demographics. Results: Significant decrease was observed in depression (P=.02) and anxiety (P=.002) scores in the intervention group. A subgroup (corporate staff) also demonstrated significant decrease in stress (P=.005) alongside depression (P=.006) and anxiety (P=.002). Females showed significant improvements in depression (P=.02) and anxiety (P<.001) when compared with males. Conclusions: This study provides evidence that the ThoughtFullChat app is effective in improving the symptoms of depression, anxiety, and stress in individuals, particularly among corporate staff from the educational field. It also supports the notion that mobile mental health apps that connect users to mental health professionals in a discreet and cost-efficient manner can make important contributions to the improvement of mental health outcomes. The differential improvements among occupational subgroups and between sexes in this study indicate the need for future digital mental health app designs to consider an element of personalization focused on systemic components relating to occupation. Trial Registration: Clinicaltrials.gov NCT04944277; https://classic.clinicaltrials.gov/ct2/show/NCT04944277 %M 37738081 %R 10.2196/46458 %U https://formative.jmir.org/2023/1/e46458 %U https://doi.org/10.2196/46458 %U http://www.ncbi.nlm.nih.gov/pubmed/37738081 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e51852 %T Authors’ Reply: Concerns on Generalizability %A Chung,Hsueh-Wen %A Tai,Chen-Jei %A Chang,Polun %A Su,Wen-Lin %A Chien,Li-Yin %+ Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, No. 155, Section 2, Li-Nong Street, Beitou District, Taipei City, 112304, Taiwan, 1 886 2 2826 71, lychien@nycu.edu.tw %K mHealth app %K mobile health %K mHealth %K app %K prediabetes %K traditional Chinese medicine %K TCM %K health-related quality of life %K body constitution %K meridian energy %D 2023 %7 21.9.2023 %9 Letter to the Editor %J JMIR Mhealth Uhealth %G English %X %M 37733412 %R 10.2196/51852 %U https://mhealth.jmir.org/2023/1/e51852 %U https://doi.org/10.2196/51852 %U http://www.ncbi.nlm.nih.gov/pubmed/37733412 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e50280 %T Concerns on Generalizability %A Lin,Yongjian %+ Department of Gastrointestinal and Gland Surgery, First Affiliated Hospital of Guangxi Medical University, No 6 Shuangyong Road, Qingxiu District, Nanning, 530021, China, 86 1 387 887 0525, linyongjian163@163.com %K mHealth app %K mobile health %K mHealth %K app %K prediabetes %K traditional Chinese medicine %K TCM %K health-related quality of life %K body constitution %K meridian energy %D 2023 %7 21.9.2023 %9 Letter to the Editor %J JMIR Mhealth Uhealth %G English %X %M 37733387 %R 10.2196/50280 %U https://mhealth.jmir.org/2023/1/e50280 %U https://doi.org/10.2196/50280 %U http://www.ncbi.nlm.nih.gov/pubmed/37733387 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43358 %T The Effects of Dose, Practice Habits, and Objects of Focus on Digital Meditation Effectiveness and Adherence: Longitudinal Study of 280,000 Digital Meditation Sessions Across 103 Countries %A Cearns,Micah %A Clark,Scott R %+ Insight Timer Research, Insight Timer, 64 York Street, Sydney, 2000, Australia, 61 8313 8163, micah@insight.co %K mindfulness %K meditation %K digital meditation %K mindfulness dose-response %K meditation dose-response %K dose-response %K meditation adherence %K mindfulness adherence %K longitudinal meditation research %K outcome %K ecological memory assessment %K mental well-being %K healthy lifestyle %K digital health intervention %D 2023 %7 19.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The efficacy of digital meditation is well established. However, the extent to which the benefits remain after 12 weeks in real-world settings remains unknown. Additionally, findings related to dosage and practice habits have been mixed, and the studies were conducted on small and homogeneous samples and used a limited range of analytical procedures and meditation techniques. Findings related to the predictors of adherence are also lacking and may help inform future meditators and meditation programs on how to best structure healthy sustainable practices. Objective: This study aimed to measure outcome change across a large and globally diverse population of meditators and meditations in their naturalistic practice environments, assess the dose-response relationships between practice habits and outcome change, and identify predictors of adherence. Methods: We used ecological momentary assessment to assess participants’ well-being over a 14-month period. We engineered outcomes related to the variability of change over time (equanimity) and recovery following a drop in mood (resilience) and established the convergent and divergent validity of these outcomes using a validated scale. Using linear mixed-effects and generalized additive mixed-effects models, we modeled outcome changes and patterns of dose-response across outcomes. We then used logistic regression to study the practice habits of participants in their first 30 sessions to derive odds ratios of long-term adherence. Results: Significant improvements were observed in all outcomes (P<.001). Generalized additive mixed models revealed rapid improvements over the first 50-100 sessions, with further improvements observed until the end of the study period. Outcome change corresponded to 1 extra day of improved mood for every 5 days meditated and half-a-day-faster mood recovery compared with baseline. Overall, consistency of practice was associated with the largest outcome change (4-7 d/wk). No significant differences were observed across session lengths in linear models (mood: P=.19; equanimity: P=.10; resilience: P=.29); however, generalized additive models revealed significant differences over time (P<.001). Longer sessions (21-30 min) were associated with the largest magnitude of change in mood from the 20th session onward and fewer sessions to recovery (increased resilience); midlength sessions (11-20 min) were associated with the largest decreases in recovery; and mood stability was similar across session lengths (equanimity). Completing a greater variety of practice types was associated with significantly greater improvements across all outcomes. Adhering to a long-term practice was best predicted by practice consistency (4-7 d/wk), a morning routine, and maintaining an equal balance between interoceptive and exteroceptive meditations. Conclusions: Long-term real-world digital meditation practice is effective and associated with improvements in mood, equanimity, and resilience. Practice consistency and variety rather than length best predict improvement. Long-term sustainable practices are best predicted by consistency, a morning routine, and a practice balanced across objects of focus that are internal and external to the body. %M 37725801 %R 10.2196/43358 %U https://www.jmir.org/2023/1/e43358 %U https://doi.org/10.2196/43358 %U http://www.ncbi.nlm.nih.gov/pubmed/37725801 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45540 %T The Use of Mobile Assessments for Monitoring Mental Health in Youth: Umbrella Review %A Marciano,Laura %A Vocaj,Emanuela %A Bekalu,Mesfin A %A La Tona,Antonino %A Rocchi,Giulia %A Viswanath,Kasisomayajula %+ Lee Kum Sheung Center for Health and Happiness, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, United States, 1 6175828025, lmarciano@hsph.harvard.edu %K mobile assessment %K ecological momentary assessments %K EMAs %K digital phenotyping %K umbrella review %K youth %K mental health %K mobile phone %D 2023 %7 19.9.2023 %9 Review %J J Med Internet Res %G English %X Background: Improving mental health in youth is a major concern. Future approaches to monitor and intervene in youth mental health problems should rely on mobile tools that allow for the daily monitoring of mental health both actively (eg, using ecological momentary assessments [EMAs]) and passively (eg, digital phenotyping) by capturing individuals’ data. Objective: This umbrella review aims to (1) report the main characteristics of existing reviews on mental health and young people, including mobile approaches to mental health; (2) describe EMAs and trace data and the mental health conditions investigated; (3) report the main results; and (4) outline promises, limitations, and directions for future research. Methods: A systematic literature search was carried out in 9 scientific databases (Communication & Mass Media Complete, Psychology and Behavioral Sciences Collection, PsycINFO, CINAHL, ERIC, MEDLINE, the ProQuest Sociology Database, Web of Science, and PubMed) on January 30, 2022, coupled with a hand search and updated in July 2022. We included (systematic) reviews of EMAs and trace data in the context of mental health, with a specific focus on young populations, including children, adolescents, and young adults. The quality of the included reviews was evaluated using the AMSTAR (Assessment of Multiple Systematic Reviews) checklist. Results: After the screening process, 30 reviews (published between 2016 and 2022) were included in this umbrella review, of which 21 (70%) were systematic reviews and 9 (30%) were narrative reviews. The included systematic reviews focused on symptoms of depression (5/21, 24%); bipolar disorders, schizophrenia, or psychosis (6/21, 29%); general ill-being (5/21, 24%); cognitive abilities (2/21, 9.5%); well-being (1/21, 5%); personality (1/21, 5%); and suicidal thoughts (1/21, 5%). Of the 21 systematic reviews, 15 (71%) summarized studies that used mobile apps for tracing, 2 (10%) summarized studies that used them for intervention, and 4 (19%) summarized studies that used them for both intervention and tracing. Mobile tools used in the systematic reviews were smartphones only (8/21, 38%), smartphones and wearable devices (6/21, 29%), and smartphones with other tools (7/21, 33%). In total, 29% (6/21) of the systematic reviews focused on EMAs, including ecological momentary interventions; 33% (7/21) focused on trace data; and 38% (8/21) focused on both. Narrative reviews mainly focused on the discussion of issues related to digital phenotyping, existing theoretical frameworks used, new opportunities, and practical examples. Conclusions: EMAs and trace data in the context of mental health assessments and interventions are promising tools. Opportunities (eg, using mobile approaches in low- and middle-income countries, integration of multimodal data, and improving self-efficacy and self-awareness on mental health) and limitations (eg, absence of theoretical frameworks, difficulty in assessing the reliability and effectiveness of such approaches, and need to appropriately assess the quality of the studies) were further discussed. Trial Registration: PROSPERO CRD42022347717; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=347717 %M 37725422 %R 10.2196/45540 %U https://www.jmir.org/2023/1/e45540 %U https://doi.org/10.2196/45540 %U http://www.ncbi.nlm.nih.gov/pubmed/37725422 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49828 %T Guided Internet-Based Cognitive Behavioral Therapy for Women With Bulimia Nervosa: Protocol for a Multicenter Randomized Controlled Trial %A Hamatani,Sayo %A Matsumoto,Kazuki %A Andersson,Gerhard %A Tomioka,Yukiko %A Numata,Shusuke %A Kamashita,Rio %A Sekiguchi,Atsushi %A Sato,Yasuhiro %A Fukudo,Shin %A Sasaki,Natsuki %A Nakamura,Masayuki %A Otani,Ryoko %A Sakuta,Ryoichi %A Hirano,Yoshiyuki %A Kosaka,Hirotaka %A Mizuno,Yoshifumi %+ Research Center for Child Mental Development, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan, 81 776 61 3111, sayoh@u-fukui.ac.jp %K bulimia nervosa %K internet-based cognitive behavioral therapy %K ICBT %K randomized controlled trial %K RCT %K protocol %K randomized %K controlled trial %K bulimia %K eating %K cognitive behavioral therapy %K CBT %K binge eating %K purging %K mobile phone %D 2023 %7 19.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Individual face-to-face cognitive behavioral therapy is known to be effective for bulimia nervosa (BN). Since foods vary considerably between regions and cultures in which patients live, cultural adaptation of the treatment program is particularly important in cognitive behavioral therapy for BN. Recently, an internet-based cognitive behavioral therapy (ICBT) program was developed for Japanese women with BN, adapted to the Japanese food culture. However, no previous randomized controlled trial has examined the effectiveness of ICBT. Objective: This paper presents a research protocol for strategies to examine the effects of guided ICBT. Methods: This study is designed as a multicenter, prospective, assessor-blinded randomized controlled trial. The treatment groups will be divided into treatment as usual (TAU) alone as the control group and ICBT combined with TAU as the intervention group. The primary outcome is the total of binge eating and purging behaviors assessed before and after treatment by an independent assessor. Secondary outcomes will include measures of eating disorder severity, depression, anxiety, quality of life, treatment satisfaction, and working alliances. Treatment satisfaction and working alliances will be measured post assessment only. Other measures will be assessed at baseline, post intervention, and follow-up, and the outcomes will be analyzed on an intention-to-treat basis. Results: This study will be conducted at 7 different medical institutions in Japan from August 2022 to October 2026. Recruitment of participants began on August 19, 2022, and recruitment is scheduled to continue until July 2024. The first participants were registered on September 8, 2022. Conclusions: This is the first multicenter randomized controlled trial in Japan comparing the effectiveness of ICBT and TAU in patients with BN. Trial Registration: University Hospital Medical Information Network UMIN000048732; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055522 International Registered Report Identifier (IRRID): DERR1-10.2196/49828 %M 37725414 %R 10.2196/49828 %U https://www.researchprotocols.org/2023/1/e49828 %U https://doi.org/10.2196/49828 %U http://www.ncbi.nlm.nih.gov/pubmed/37725414 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e48157 %T Long-Term Outcomes of a Comprehensive Mobile Smoking Cessation Program With Nicotine Replacement Therapy in Adult Smokers: Pilot Randomized Controlled Trial %A Marler,Jennifer D %A Fujii,Craig A %A Utley,MacKenzie T %A Balbierz,Daniel J %A Galanko,Joseph A %A Utley,David S %+ Pivot Health Technologies, Inc, 1010 Commercial St., Suite C, San Carlos, CA, 94070, United States, 1 4082145545, marler@pivot.co %K smoking cessation %K digital health %K smartphone %K digital sensor %K carbon monoxide %K breath sensor %K biofeedback %K mobile apps %K health promotion %K app %K mobile phone %D 2023 %7 18.9.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Increased smartphone ownership has led to the development of mobile smoking cessation programs. Although the related body of evidence, gathered through the conduct of randomized controlled trials (RCTs), has grown in quality and rigor, there is a need for longer-term data to assess associated smoking cessation durability. Objective: The primary aim was to compare smoking cessation outcomes at 52 weeks in adult smokers randomized to a mobile smoking cessation program, Pivot (intervention), versus QuitGuide (control). The secondary aims included comparison of other smoking-related behaviors, outcomes and participant feedback, and exploratory analyses of baseline factors associated with smoking cessation. Methods: In this remote pilot RCT, cigarette smokers in the United States were recruited on the web. Participants were offered 12 weeks of free nicotine replacement therapy (NRT). Data were self-reported via a web-based questionnaire with videoconference biovalidation in participants who reported 7-day point-prevalence abstinence (PPA). Outcomes focused on cessation rates with additional assessment of quit attempts, cigarettes per day (CPD), self-efficacy via the Smoking Abstinence Self-Efficacy Questionnaire, NRT use, and participant feedback. Cessation outcomes included self-reported 7- and 30-day PPA, abstinence from all tobacco products, and continuous abstinence. PPA and continuous abstinence were biovalidated using witnessed breath carbon monoxide samples. Exploratory post hoc regression analyses were performed to identify baseline variables associated with smoking cessation. Results: Participants comprised 188 smokers (n=94, 50% in the Pivot group and n=94, 50% in the QuitGuide group; mean age 46.4, SD 9.2 years; n=104, 55.3% women; n=128, 68.1% White individuals; mean CPD 17.6, SD 9.0). Several cessation rates were higher in the Pivot group (intention to treat): self-reported continuous abstinence was 20% (19/94) versus 9% (8/94; P=.03) for QuitGuide, biochemically confirmed abstinence was 31% (29/94) versus 18% (17/94; P=.04) for QuitGuide, and biochemically confirmed continuous abstinence was 19% (18/94) versus 9% (8/94; P=.046) for QuitGuide. More Pivot participants (93/94, 99% vs 80/94, 85% in the QuitGuide group; P<.001) placed NRT orders (mean 3.3, SD 2.0 vs 1.8, SD 1.6 for QuitGuide; P<.001). Pivot participants had increased self-efficacy via the Smoking Abstinence Self-Efficacy Questionnaire (mean point increase 3.2, SD 7.8, P<.001 vs 1.0, SD 8.5, P=.26 for QuitGuide). QuitGuide participants made more mean quit attempts (7.0, SD 6.3 for Pivot vs 9.5, SD 7.5 for QuitGuide; P=.01). Among those who did not achieve abstinence, QuitGuide participants reported greater CPD reduction (mean −34.6%, SD 35.5% for Pivot vs −46.1%, SD 32.3% for QuitGuide; P=.04). Among those who reported abstinence, 90% (35/39) of Pivot participants and 90% (26/29) of QuitGuide participants indicated that their cessation program helped them quit. Conclusions: This pilot RCT supports the long-term effectiveness of the Pivot mobile smoking cessation program, with abstinence rates durable to 52 weeks. Trial Registration: ClinicalTrials.gov NCT04955639; https://clinicaltrials.gov/ct2/show/NCT04955639 %M 37585282 %R 10.2196/48157 %U https://mhealth.jmir.org/2023/1/e48157 %U https://doi.org/10.2196/48157 %U http://www.ncbi.nlm.nih.gov/pubmed/37585282 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45510 %T A Series of Personalized Virtual Light Therapy Interventions for Fatigue: Feasibility Randomized Crossover Trial for N-of-1 Treatment %A Butler,Mark %A D’Angelo,Stefani %A Ahn,Heejoon %A Chandereng,Thevaa %A Miller,Danielle %A Perrin,Alexandra %A Romain,Anne-Marie N %A Scatoni,Ava %A Friel,Ciaran P %A Cheung,Ying-Kuen %A Davidson,Karina W %+ Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, 130 East 59th Street, Suite 14C, New York, NY, 10022, United States, 1 9084140238, markbutler@northwell.edu %K virtual light therapy interventions %K fatigue %K light therapy %K primary care %K feasibility %K acceptability %K effectiveness %K usability %K seasonal affective disorder %K phototherapy %K photoradiation %K photochemotherapy %K color therapy %K heliotherapy %K photothermal therapy %K UV therapy %K chromotherapy %K color light therapy %K mobile phone %D 2023 %7 18.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Fatigue is one of the most common symptoms treated in primary care and can lead to deficits in mental health and functioning. Light therapy can be an effective treatment for symptoms of fatigue; however, the feasibility, scalability, and individual-level heterogeneity of light therapy for fatigue are unknown. Objective: This study aimed to evaluate the feasibility, acceptability, and effectiveness of a series of personalized (N-of-1) interventions for the virtual delivery of bright light (BL) therapy and dim light (DL) therapy versus usual care (UC) treatment for fatigue in 60 participants. Methods: Participants completed satisfaction surveys comprising the System Usability Scale (SUS) and items assessing satisfaction with the components of the personalized trial. Symptoms of fatigue were measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) daily, PROMIS weekly, and ecological momentary assessment (EMA) questionnaires delivered 3 times daily. Comparisons of fatigue between the BL, DL, and UC treatment periods were conducted using generalized linear mixed model analyses between participants and generalized least squares analyses within individual participants. Results: Participants rated the usability of the personalized trial as acceptable (average SUS score=78.9, SD 15.6), and 92% (49/53) of those who completed satisfaction surveys stated that they would recommend the trial to others. The levels of fatigue symptoms measured using the PROMIS daily fatigue measure were lower or improved in the BL (B=−1.63, 95% CI −2.63 to −0.63) and DL (B=−1.44, 95% CI −2.50 to −0.38) periods relative to UC. The treatment effects of BL and DL on the PROMIS daily measure varied among participants. Similar findings were demonstrated for the PROMIS weekly and EMA measures of fatigue symptoms. Conclusions: The participant scores on the SUS and satisfaction surveys suggest that personalized N-of-1 trials of light therapy for fatigue symptoms are both feasible and acceptable. Both interventions produced significant (P<.05) reductions in participant-reported PROMIS and EMA fatigue symptoms relative to UC. However, the heterogeneity of these treatment effects across participants indicated that the effect of light therapy was not uniform. This heterogeneity along with high ratings of usability and satisfaction support the use of personalized N-of-1 research designs in evaluating the effect of light therapy on fatigue for each patient. Furthermore, the results of this trial provide additional support for the use of a series of personalized N-of-1 research trials. Trial Registration: ClinicalTrials.gov NCT04707846; https://clinicaltrials.gov/ct2/show/NCT04707846 %M 37721795 %R 10.2196/45510 %U https://formative.jmir.org/2023/1/e45510 %U https://doi.org/10.2196/45510 %U http://www.ncbi.nlm.nih.gov/pubmed/37721795 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e51431 %T A Complex mHealth Coaching Intervention to Prevent Overweight, Obesity, and Diabetes in High-Risk Women in Antenatal Care: Protocol for a Hybrid Type 2 Effectiveness-Implementation Study %A O'Reilly,Sharleen L %A Laws,Rachel %A Maindal,Helle Terkildsen %A Teede,Helena %A Harrison,Cheryce %A McAuliffe,Fionnuala M %A Geraghty,Aisling %A Campoy,Cristina %A Bermúdez,Mercedes G %A Pirhonen,Laura %A Burden,Christy %A Davies,Anna %A Laursen,Ditte Hjorth %A Skinner,Timothy %A , %+ School of Agriculture and Food Science, University College Dublin, School of Agriculture and Food Science, University College Dublin, Belfield, Dublin, D4, Ireland, 353 17162157, sharleen.oreilly@ucd.ie %K hybrid type 2 effectiveness-implementation %K gestational diabetes %K obesity %K mHealth %K mobile health %K health behavior change %K pregnancy %K postpartum %K weight management %K health coaching %K maternal health %D 2023 %7 18.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Women with overweight and obesity are at higher risk of developing complications in pregnancy such as gestational diabetes and longer-term chronic conditions. Research concerning health behavior change interventions during pregnancy and postpartum shows promising effects, but implementation into routine services is sparsely investigated. Most interventions focus on the antenatal or postpartum life stages, failing to meet the needs of women. IMPACT DIABETES Bump2Baby is a multicenter project across 4 high-income countries developed to test the implementation of an antenatal and postpartum evidence-based mobile health (mHealth) coaching intervention called Bump2Baby and Me (B2B&Me) designed to sit alongside usual care in the perinatal period. Objective: We aim to explore the feasibility and implementation of the B2B&Me intervention and investigate the effectiveness of this intervention in women at risk of gestational diabetes. Methods: IMPACT DIABETES Bump2Baby is a hybrid type 2 effectiveness-implementation study, which integrates an evidence-based mHealth coaching app that includes personalized health behavior change coaching provided by health care professionals alongside antenatal care from the first antenatal visit to 12 months postpartum. The mHealth app offers the possibility of synchronous calls, asynchronous contact (including coach-participant text and video messaging exchanges tailored to the participant’s needs), and ongoing access to an extensive library of bespoke intervention materials. Participants will interact asynchronously with their health coach throughout the intervention via the app. This randomized controlled trial across 4 clinical sites within Ireland, the United Kingdom, Spain, and Australia will recruit 800 women in early pregnancy to evaluate the effectiveness on postpartum weight. The Exploration, Preparation, Implementation, and Sustainment implementation framework is the theoretical underpinning of the study. The implementation evaluation will be assessed at the individual, hospital staff, and broader community levels using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Data sources for the RE-AIM evaluation will include app and platform analytics, screening and training records, participant medical records, key informant interviews, participant and partner exit interviews, cost data, study questionnaires, staff surveys, and blood sample analyses. Results: The study was approved and registered with the Australian New Zealand Clinical Trials Registry on November 19, 2020. Recruitment commenced on February 9, 2021, and data collection is ongoing. Publication of the results is expected in 2024. Conclusions: This is the first hybrid effectiveness-implementation study of an 18-month mHealth coaching intervention in at-risk women that we are aware of. As research aims to move toward real-world implementable solutions, it is critical that hybrid studies are conducted. The data from this large multicenter study will be useful in planning the potential implementation and scale-up of evidence-based perinatal health behavior change interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001240932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380020&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/51431 %M 37721798 %R 10.2196/51431 %U https://www.researchprotocols.org/2023/1/e51431 %U https://doi.org/10.2196/51431 %U http://www.ncbi.nlm.nih.gov/pubmed/37721798 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e33810 %T A Culturally Adapted Diet and Physical Activity Text Message Intervention to Prevent Type 2 Diabetes Mellitus for Women of Pakistani Origin Living in Scotland: Formative Study %A Krasuska,Marta %A Davidson,Emma M %A Beune,Erik %A Jenum,Anne Karen %A Gill,Jason MR %A Stronks,Karien %A van Valkengoed,Irene GM %A Diaz,Esperanza %A Sheikh,Aziz %+ Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, United Kingdom, 44 131 650 8102, emma.davidson@ed.ac.uk %K diabetes %K diet %K ethnic minority populations %K Pakistani %K physical activity %K prevention %K South Asian %K text messages %K women %K women’s health %K health intervention %K digital health %K mobile health %K minority %K exercise %K text message %K text messaging %K SMS %K development %K formative %K diabetes mellitus %D 2023 %7 15.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals of South Asian origin are at an increased risk of developing type 2 diabetes mellitus (T2DM) compared with other ethnic minority groups. Therefore, there is a need to develop interventions to address, and reduce, this heightened risk. Objective: We undertook formative work to develop a culturally adapted diet and physical activity text message intervention to prevent T2DM for women of Pakistani origin living in Scotland. Methods: We used a stepwise approach that was informed by the Six Steps in Quality Intervention Development framework, which consisted of gathering evidence through literature review and focus groups (step 1), developing a program theory for the intervention (step 2), and finally developing the content of the text messages and an accompanying delivery plan (step 3). Results: In step 1, we reviewed 12 articles and identified 3 key themes describing factors impacting on diet and physical activity in the context of T2DM prevention: knowledge on ways to prevent T2DM through diet and physical activity; cultural, social, and gender norms; and perceived level of control and sense of inevitability over developing T2DM. The key themes that emerged from the 3 focus groups with a total of 25 women were the need for interventions to provide “friendly encouragement,” “companionship,” and a “focus on the individual” and also for the text messages to “set achievable goals” and include “information on cooking healthy meals.” We combined the findings of the focus groups and literature review to create 13 guiding principles for culturally adapting the text messages. In step 2, we developed a program theory, which specified the main determinants of change that our text messages should aim to enhance: knowledge and skills, sense of control, goal setting and planning behavior, peer support, and norms and beliefs guiding behavior. In step 3, we used both the intervention program theory and guiding principles to develop a set of 73 text messages aimed at supporting a healthy diet and 65 text messages supporting increasing physical activity. Conclusions: We present a theory-based approach to develop a culturally adapted diet and physical activity text message intervention to prevent T2DM for women of Pakistani origin living in Scotland. This study outlines an approach that may also be applicable to the development of interventions for other ethnic minority populations in diverse settings. There is now a need to build on this formative work and undertake a feasibility trial of a text message–based diet and physical activity intervention to prevent T2DM for women of Pakistani origin living in Scotland. %M 37713245 %R 10.2196/33810 %U https://formative.jmir.org/2023/1/e33810 %U https://doi.org/10.2196/33810 %U http://www.ncbi.nlm.nih.gov/pubmed/37713245 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42712 %T Digital Health App to Address Disparate HIV Outcomes Among Black Women Living in Metro-Atlanta: Protocol for a Multiphase, Mixed Methods Pilot Feasibility Study %A Chandler,Rasheeta %A Farinu,Oluyemi T O %A Guillaume,Dominique %A Francis,Sherilyn %A Parker,Andrea G %A Shah,Kewal %A Hernandez,Natalie D %A , %+ Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd NE, Atlanta, GA, 30322, United States, 1 404 727 8164, r.d.chandler@emory.edu %K Black women %K CBPR %K community-based participatory research %K HIV %K human centered design %K mhealth %K pilot usability study %D 2023 %7 15.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cisgender Black women in the southern United States are at heightened risk for HIV and adverse sexual and reproductive health outcomes. Mobile health interventions that target HIV risk while being adapted to the needs and lived experiences of Black women are remarkably limited. Objective: The study aims to refine SavvyHER, a mobile app for HIV prevention, with Black women residing in high HIV incidence areas of Georgia and evaluate the feasibility, acceptability, and usability of SavvyHER. This paper describes the procedures implemented to conduct this research. Methods: Community-based participatory research tenets guide this multiphase study to finalize the development of what we hypothesize will be an effective, sustainable, and culturally relevant HIV prevention and optimal sexual health and reproductive wellness app for Black women. This multiphased, mixed methods study consists of 3 phases. The first phase entails focus groups with Black women to understand their preferences for the functionality and design of a beta prototype version of SavvyHER. In the second phase, an app usability pretest (N=10) will be used to refine and optimize the SavvyHER app. The final phase will entail a pilot randomized controlled trial (N=60) to evaluate the app’s feasibility and usability in preparation for a larger trial. Results: Findings from preliminary focus groups revealed educational content, app aesthetics, privacy considerations, and marketing preferred by Black women, thus informing the first functional SavvyHER prototype. As we adapt and test the feasibility of SavvyHER, we hypothesize that the app will be an effective, sustainable, and culturally relevant HIV prevention, sexual health, and reproductive wellness tool for Black women. Conclusions: The findings from this research substantiate the importance of developing health interventions curated for and by Black women to address critical HIV disparities. The knowledge gained from this research can reduce HIV disparities among Black women through a targeted intervention that centers on their health needs and priorities. International Registered Report Identifier (IRRID): DERR1-10.2196/42712 %M 37713259 %R 10.2196/42712 %U https://www.researchprotocols.org/2023/1/e42712 %U https://doi.org/10.2196/42712 %U http://www.ncbi.nlm.nih.gov/pubmed/37713259 %0 Journal Article %@ 2291-5222 %I %V 11 %N %P e45091 %T Short-Form Video Exposure and Its Two-Sided Effect on the Physical Activity of Older Community Women in China: Secondary Data Analysis %A Wu,Chen %A Chen,Si %A Wang,Shan %A Peng,Sijing %A Cao,Jiepin %K short-form video %K media exposure %K physical activity %K step counts %K older adults %K apps %D 2023 %7 13.9.2023 %9 %J JMIR Mhealth Uhealth %G English %X Background: There is a tendency for older adults to become more physically inactive, especially older women. Physical inactivity has been exacerbated since the COVID-19 pandemic. Lockdowns and information-based preventive measures for COVID-19 increased the number of short-form video app users and short-form video exposure, including content exposure and the duration of exposure, which has demonstrated important effects on youths’ health and health-related behaviors. Despite more older adults viewing short-form videos, less is known about the status of their short-form video exposure or the impacts of the exposure on their physical activity. Objective: This study aims to describe physical activity–related content exposure among older adults and to quantify its impacts along with the duration of short-form video exposure on step counts, low-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Methods: We analyzed a subsample (N=476) of older women who used smartphones and installed short-form video apps, using the baseline data collected from an ongoing cohort study named the Physical Activity and Health in Older Women Study (PAHIOWS) launched from March to June 2021 in Yantai, Shandong Province, China. The information on short-form video exposure was collected by unstructured questions; physical activity–related content exposure was finalized by professionals using the Q-methodology, and the duration of exposure was transformed into hours per day. Step counts, LPA, and MVPA were assessed with ActiGraph wGT3X-BT accelerometers. Multiple subjective and objective covariates were assessed. Linear regression models were used to test the effects of short-form video exposure on step counts, LPA, and MVPA. MVPA was dichotomized into less than 150 minutes per week and 150 minutes or more per week, and the binary logistic regression model was run to test the effects of short-form video exposure on the achievement of spending 150 minutes or more on MVPA. Results: Of 476 older women (mean age 64.63, SD 2.90 years), 23.7% (113/476) were exposed to physical activity–related short-form videos, and their daily exposure to short-form videos was 1.5 hours. Physical activity–related content exposure increased the minutes spent on MVPA by older women (B=4.14, 95% CI 0.13-8.15); the longer duration of short-form video exposure was associated with a reduced step count (B=−322.58, 95% CI −500.24 to −144.92) and minutes engaged in LPA (B=−6.95, 95% CI −12.19 to −1.71) and MVPA (B=−1.56, 95% CI −2.82 to −0.29). Neither content exposure nor the duration of exposure significantly increased or decreased the odds of older women engaging in MVPA for 150 minutes or more per week. Conclusions: Short-form video exposure has both positive and negative impacts on the physical activity of older adults. Efforts are needed to develop strategies to leverage the benefits while avoiding the harms of short-form videos. %R 10.2196/45091 %U https://mhealth.jmir.org/2023/1/e45091 %U https://doi.org/10.2196/45091 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43654 %T A Tailored mHealth Intervention for Improving Antenatal Care Seeking and Health Behavioral Determinants During Pregnancy Among Adolescent Girls and Young Women in South Africa: Development and Protocol for a Pilot Randomized Controlled Trial %A Sewpaul,Ronel %A Resnicow,Ken %A Crutzen,Rik %A Dukhi,Natisha %A Ellahebokus,Afzal %A Reddy,Priscilla %+ Public Health, Societies and Belonging, Human Sciences Research Council, 134 Pretorius Street, Pretoria, 0002, South Africa, 27 214667912, rsewpaul@hsrc.ac.za %K antenatal care %K adolescent girls and young women %K AGYW %K adolescent pregnancy %K mobile health %K mHealth %K tailoring %K motivational interviewing %K South Africa %K mobile phone %D 2023 %7 13.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: South Africa, a middle-income country, has an adolescent fertility rate far higher than that of high-income countries. Adolescent girls and young women have an increased risk of pregnancy-related complications and lower antenatal appointment attendance rates than older adult pregnant women. Mobile health (mHealth) interventions to improve health behaviors among pregnant adolescent girls and young women in low- and middle-income countries are scarce. Objective: This paper describes the development and components of an mHealth intervention to improve antenatal appointment attendance and health behavioral determinants among pregnant adolescent girls and young women in South Africa and details the protocol for a pilot randomized controlled trial that evaluated the intervention’s efficacy and user acceptability. Methods: The intervention, Teen MomConnect, sent tailored motivational behavior change and behavioral reinforcement SMS text messages to participants about antenatal appointment keeping and pregnancy behaviors. The delivery methodology of the intervention was adapted from MomConnect, an mHealth education program for pregnant women in South Africa that has nationwide coverage. In addition, participants received a face-to-face motivational interviewing session delivered by a trained research assistant. Pregnant adolescent girls and young women aged 13 to 20 years were recruited from health facilities and community networks. Participants were randomized into the control group that received the standard MomConnect health SMS text messages or the experimental group that received the Teen MomConnect intervention. Participants completed a baseline questionnaire upon enrollment in the study and a follow-up questionnaire after the end of their pregnancy. The questionnaires assessed demographic characteristics, pregnancy behaviors, and the psychosocial determinants of antenatal appointment attendance (knowledge, attitudes, social support, risk perceptions, self-efficacy, intention, and action planning). Feasibility was assessed using descriptive analyses of acceptability, study implementation processes, and perceived satisfaction with the intervention. The number of appointments attended was obtained from the participants’ clinic records. Appointment attendance was compared between the control and experimental groups, as were awareness of HIV status and the psychosocial determinants of antenatal appointment attendance. Results: Participant recruitment was conducted from May 2018 to December 2018, and the questionnaire-based data collection was completed by December 2019. Overall, 412 participants were enrolled. Conclusions: This paper describes the Teen MomConnect intervention to improve antenatal appointment attendance and pregnancy health behaviors among adolescent girls and young women. The results on the intervention’s preliminary efficacy and user acceptability will inform policy makers and health program officers on how tailored, age-appropriate, and motivational health behavior messages can be delivered via mobile phone to pregnant adolescent girls and young women. Trial Registration: Pan African Clinical Trial Registry (PACTR) PACTR201912734889796; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9565 International Registered Report Identifier (IRRID): DERR1-10.2196/43654 %M 37703092 %R 10.2196/43654 %U https://www.researchprotocols.org/2023/1/e43654 %U https://doi.org/10.2196/43654 %U http://www.ncbi.nlm.nih.gov/pubmed/37703092 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49020 %T Wellness in Nursing Education to Promote Resilience and Reduce Burnout: Protocol for a Holistic Multidimensional Wellness Intervention and Longitudinal Research Study Design in Nursing Education %A Strout,Kelley %A Schwartz-Mette,Rebecca %A McNamara,Jade %A Parsons,Kayla %A Walsh,Dyan %A Bonnet,Jen %A O'Brien,Liam M %A Robinson,Kathryn %A Sibley,Sean %A Smith,Annie %A Sapp,Maile %A Sprague,Lydia %A Sabegh,Nima Sajedi %A Robinson,Kaitlin %A Henderson,Amanda %+ School of Nursing, University of Maine, Dunn Hall, Orono, ME, 04469, United States, 1 2075812601, kelley.strout@maine.edu %K nursing workforce %K academic performance %K burnout %K resilience %K wellness %K nursing %K education %K nursing education %K protocol %K nursing students %K students %K holistic %K implementation %K workforce %D 2023 %7 8.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The United States faces a nursing shortage driven by a burnout epidemic among nurses and nursing students. Nursing students are an integral population to fuel the nursing workforce at high risk of burnout and increased rates of perceived stress. Objective: The aim of this paper is to describe WellNurse, a holistic, interdisciplinary, multidimensional longitudinal research study that examines evidence-based interventions intended to reduce burnout and increase resilience among graduate and undergraduate nursing students. Methods: Graduate and undergraduate nursing students matriculated at a large public university in the northeastern United States are eligible to enroll in this ongoing, longitudinal cohort study beginning in March 2021. Participants complete a battery of health measurements twice each semester during the fourth week and the week before final examinations. The measures include the Perceived Stress Scale, the Satisfaction with Life Scale, the Oldenburg Burnout Inventory, the Brief Resilience Scale, and the Pittsburgh Sleep Quality Index. Participants are eligible to enroll in a variety of interventions, including mindfulness-based stress reduction, mindful eating, fitness training, and massage therapy. Those who enroll in specific, targeted interventions complete additional measures designed to target the aim of the intervention. All participants receive a free Fitbit device. Additional environmental changes are being implemented to further promote a culture that supports academic well-being, including recruiting a diverse student population through evidence-based holistic admissions, inclusive teaching design, targeted resilience and stress reduction workshops, and cultural shifts within classrooms and curricula. The study design protocol is registered at Open Science Framework DOI 10.17605/OSF.IO/NCBPE. Results: The project was funded on January 1, 2022. Data collection started in March 2022. A total of 267 participants have been recruited. Results will be published after each semester starting in December 2023. WellNurse evaluation follows the Rapid Cycle Quality Improvement framework to continuously monitor ongoing project processes, activity outcomes, and progress toward reducing burnout and increasing resilience. Rapid Cycle Quality Improvement promotes the ability to alter WellNurse interventions, examine multiple interventions, and test their effectiveness among the nursing education population to identify the most effective interventions. Conclusions: Academic nursing organizations must address student burnout risk and increase resilience to produce a future workforce that provides high-quality patient care to a diverse population. Findings from WellNurse will support evidence-based implementations for public baccalaureate and master’s nursing programs in the United States. International Registered Report Identifier (IRRID): DERR1-10.2196/49020 %R 10.2196/49020 %U https://www.researchprotocols.org/2023/1/e49020/ %U https://doi.org/10.2196/49020 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e47187 %T Effectiveness of a Self-Monitoring App in Supporting Physical Activity Maintenance Among Rural Canadians With Cancer After an Exercise Oncology Program: Cluster Randomized Controlled Trial %A Ester,Manuel %A Wagoner,Chad W %A Dreger,Julianna %A Chen,Guanmin %A McDonough,Meghan H %A McNeely,Margaret L %A Culos-Reed,S Nicole %+ Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N 1N4, Canada, 1 4032108482, manuel.ester@ucalgary.ca %K eHealth %K mHealth %K mobile health %K mobile apps %K self-monitoring %K cancer %K oncology %K physical activity %K exercise %K randomized controlled trial %K intervention %K mobile phone %D 2023 %7 7.9.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Despite the benefits of physical activity (PA) for individuals with cancer, most remain insufficiently active. Exercise oncology interventions can improve PA levels. Individuals struggle to maintain PA levels after interventions because of persistent psychological and environmental PA barriers. Health technology (eHealth) may address some PA barriers and deliver effective, scalable PA interventions in oncology, yet its effectiveness for changing PA levels remains mixed. Using eHealth to support PA maintenance among rural populations with cancer, who may need greater PA support given lower PA levels and worse health outcomes, remains under-studied. Objective: This study examined the effectiveness of an app-based self-monitoring intervention in supporting PA maintenance among rural populations with cancer after a supervised web-based exercise oncology program. Methods: This 2-arm, cluster randomized controlled trial was embedded within the Exercise for Cancer to Enhance Living Well (EXCEL) effectiveness-implementation study. Upon consent, participants were randomized 1:1 by EXCEL class clusters to the intervention (24 weeks of app-based PA self-monitoring) or waitlist control (app access after 24 weeks). Both groups completed a 12-week supervised web-based exercise oncology program followed by a 12-week self-directed PA maintenance period. Baseline demographics, eHealth literacy, and patient-reported outcomes were compared using chi-square and 2-tailed t tests. App use was measured throughout the intervention. The primary outcome—self-reported moderate-to-vigorous PA (MVPA) minutes—and secondary outcomes—objective MVPA minutes and steps and app usability ratings—were collected at baseline, 12 weeks, and 24 weeks. Intervention effects on self-report MVPA maintenance were assessed via linear mixed modeling, with secondary outcomes explored descriptively. Results: Of the 359 eligible EXCEL participants, 205 (57.1%) consented, 199 (55.4%; intervention: 106/199, 53.3%; control: 93/199, 46.7%) started the study, and 183 (51%; intervention: 100/183, 54.6%; control: 83/183, 45.4%) and 141 (39.3%; intervention: 69/141, 48.9%; control: 72/141, 51.1%) completed 12- and 24-week measures, respectively. Mean age was 57.3 (SD 11.5) years. Most participants were female (174/199, 87.4%), White (163/199, 81.9%), and diagnosed with breast cancer (108/199, 54.3%). Median baseline self-report weekly MVPA minutes were 60.0 (IQR 0-180) and 40.0 (IQR 0-135) for the intervention and waitlist control groups, respectively (P=.74). Median app use duration was 10.3 (IQR 1.3-23.9) weeks, with 9.6 (IQR 4.4-17.8) self-monitoring entries/week. Both groups increased their weekly MVPA minutes significantly at 12 weeks (P<.001) and maintained the increases at 24 weeks (P<.001), relative to baseline, with no between-group differences (P=.87). The intervention group had significantly higher step counts for 7 of the 12 weeks during the PA maintenance period (P=.048 to <.001). Conclusions: The app-based self-monitoring intervention did not improve MVPA maintenance but may have contributed to increased step counts during the PA maintenance period. More work is needed to realize the full potential of eHealth in exercise oncology. Trial Registration: ClinicalTrials.gov NCT04790578; https://clinicaltrials.gov/study/NCT04790578 International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2021.106474 %M 37676714 %R 10.2196/47187 %U https://cancer.jmir.org/2023/1/e47187 %U https://doi.org/10.2196/47187 %U http://www.ncbi.nlm.nih.gov/pubmed/37676714 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43825 %T Leveraging the Black Girls Run Web-Based Community as a Supportive Community for Physical Activity Engagement: Mixed Methods Study %A Kalinowski,Jolaade %A Idiong,Christie %A Blackman-Carr,Loneke %A Cooksey Stowers,Kristen %A Davis,Shardé %A Pan,Cindy %A Chhabra,Alisha %A Eaton,Lisa %A Gans,Kim M %A Alexander,Jay Ell %A Pagoto,Sherry %+ Department of Human Development and Family Sciences, The University of Connecticut, 348 Mansfield Rd, Storrs, CT, 06269, United States, 1 2032518421, jolaade.kalinowski@uconn.edu %K physical activity %K social media %K women’s health %K African American women %K mHealth %K mobile health %K Facebook %K African American %K exercise %K web-based community %K web-based communities %K content analysis %D 2023 %7 7.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: About 59%-73% of Black women do not meet the recommended targets for physical activity (PA). PA is a key modifiable lifestyle factor that can help mitigate risk for chronic diseases such as obesity, diabetes, and hypertension that disproportionately affect Black women. Web-based communities focused on PA have been emerging in recent years as web-based gathering spaces to provide support for PA in specific populations. One example is Black Girls Run (BGR), which is devoted to promoting PA in Black women. Objective: The purpose of this study was to describe the content shared on the BGR public Facebook page to provide insight into how web-based communities engage Black women in PA and inform the development of web-based PA interventions for Black women. Methods: Using Facebook Crowdtangle, we collected posts (n=397) and associated engagement data from the BGR public Facebook page for the 6-month period between June 1, 2021, and December 31, 2021. We pooled data in Dedoose to analyze the qualitative data and conducted a content analysis of qualitative data. We quantified types of posts, post engagement, and compared post types on engagement: “like,” “love,” “haha,” “wow,” “care,” “sad,” “angry,” “comments,” and “shares.” Results: The content analysis revealed 8 categories of posts: shout-outs to members for achievements (n=122, 31%), goals or motivational (n=65, 16%), announcements (n=63, 16%), sponsored or ads (n=54, 14%), health related (n=47, 11%), the lived Black experience (n=23, 6%), self-care (n=15, 4%), and holidays or greetings (n=8, 2%). The 397 posts attracted a total of 55,354 engagements (reactions, comments, and shares). Associations between the number of engagement and post categories were analyzed using generalized linear models. Shout-out posts (n=22,268) elicited the highest average of total user engagement of 181.7 (SD 116.7), followed by goals or motivational posts (n=11,490) with an average total engagement of 160.1 (SD 125.2) and announcements (n=7962) having an average total engagement of 129.9 (SD 170.7). Significant statistical differences were found among the total engagement of posts (χ72=80.99, P<.001), “like” (χ72=119.37, P<.001), “love” (χ72=63.995, P<.001), “wow” (χ72=23.73, P<.001), “care” (χ72=35.06, P<.001), “comments” (χ72=80.55, P<.001), and “shares” (χ72=71.28, P<.001). Conclusions: The majority of content on the BGR Facebook page (n=250, 63%) was focused on celebrating member achievements, motivating members to get active, and announcing and promoting active events. These types of posts attracted 75% of total post engagement. BGR appears to be a rich web-based community that offers social support for PA as well as culturally relevant health and social justice content. Web-based communities may be uniquely positioned to engage minoritized populations in health behavior. Further research should explore how and if web-based communities such as BGR can be interwoven into health interventions and health promotion. %M 37676722 %R 10.2196/43825 %U https://formative.jmir.org/2023/1/e43825 %U https://doi.org/10.2196/43825 %U http://www.ncbi.nlm.nih.gov/pubmed/37676722 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e46143 %T The Use of Patient-Oriented Mobile Phone Apps in Oral Health: Scoping Review %A Väyrynen,Elina %A Hakola,Sanna %A Keski-Salmi,Anniina %A Jämsä,Hannaleena %A Vainionpää,Raija %A Karki,Saujanya %+ Research Unit of Population Health, Faculty of Medicine, University of Oulu, Aapistie 3, Oulu, 90220, Finland, 358 294485643, saujanya.karki@oulu.fi %K oral health %K dentistry %K mobile apps %K mobile health %K mHealth %K mobile phone %D 2023 %7 6.9.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Oral health is a significant part of general health. Poor oral health can influence an individual’s appearance, self-esteem, eating, and speaking. The use of mobile phone apps has been growing in the field of medicine, including dentistry. However, to date, there is no evidence related to the availability of mobile apps focusing on various branches of dentistry. Objective: The aim of this study was to review the scientific literature on the use of patient-oriented mobile phone apps in oral health and summarize the key findings. Methods: A scoping review of published scientific literature on the use of patient-oriented mobile phone apps in oral health was conducted in accordance with the Joanna Briggs Institute. A search was performed in PubMed and Scopus for studies published between January 2000 and June 2021 that were written in English. All study types except for those reporting developmental protocols were included in this review. In total, 2 reviewers independently screened the studies using the eligibility criteria. The study protocol was registered in the Open Science Framework registries in June 2021. Results: The initial search yielded a total of 977 studies, 45 (4.6%) of which met the inclusion criteria. All the studies (45/45, 100%) were published after 2009. Most studies (31/45, 69%) concerned oral health promotion using mobile phone apps, followed by behavior management (5/45, 11%). More than half (23/45, 51%) of the included studies were conducted in Asian countries. Overall, 31% (14/45) of the studies focused on adolescents. A total of 51% (23/45) of the studies were randomized controlled trials (RCTs). Approximately 39% (9/23) of the included RCT studies reported a substantial reduction in dental plaque, and 26% (6/23) of the studies reported significant improvement in gingival health. Regarding dental anxiety management, 13% (3/23) of the RCT studies reported a significant decrease in mean heart rate and lower Facial Image Scale scores. Conclusions: According to the literature, the use of mobile apps in oral health is increasing among patients, mainly children and adolescents. Many studies that have used mobile apps have focused on promoting oral health. However, other areas such as diagnostic and remote consultations (teledentistry) have until recently been neglected despite their great potential. %M 37672331 %R 10.2196/46143 %U https://mhealth.jmir.org/2023/1/e46143 %U https://doi.org/10.2196/46143 %U http://www.ncbi.nlm.nih.gov/pubmed/37672331 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43719 %T One-Week Suicide Risk Prediction Using Real-Time Smartphone Monitoring: Prospective Cohort Study %A Barrigon,Maria Luisa %A Romero-Medrano,Lorena %A Moreno-Muñoz,Pablo %A Porras-Segovia,Alejandro %A Lopez-Castroman,Jorge %A Courtet,Philippe %A Artés-Rodríguez,Antonio %A Baca-Garcia,Enrique %+ Department of Psychiatry, Jimenez Diaz Foundation University Hospital, Av Reyes Católicos, 2, Madrid, 28040, Spain, 34 91 541 72 67, ebacgar2@yahoo.es %K e-health %K m-health %K Ecological Mometary Asssessment %K risk prediction %K sensor monitoring %K suicidal %K suicide attempt %K suicide %D 2023 %7 1.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Suicide is a major global public health issue that is becoming increasingly common despite preventive efforts. Though current methods for predicting suicide risk are not sufficiently accurate, technological advances provide invaluable tools with which we may evolve toward a personalized, predictive approach. Objective: We aim to predict the short-term (1-week) risk of suicide by identifying changes in behavioral patterns characterized through real-time smartphone monitoring in a cohort of patients with suicidal ideation. Methods: We recruited 225 patients between February 2018 and March 2020 with a history of suicidal thoughts and behavior as part of the multicenter SmartCrisis study. Throughout 6 months of follow-up, we collected information on the risk of suicide or mental health crises. All participants underwent voluntary passive monitoring using data generated by their own smartphones, including distance walked and steps taken, time spent at home, and app usage. The algorithm constructs daily activity profiles for each patient according to these data and detects changes in the distribution of these profiles over time. Such changes are considered critical periods, and their relationship with suicide-risk events was tested. Results: During follow-up, 18 (8%) participants attempted suicide, and 14 (6.2%) presented to the emergency department for psychiatric care. The behavioral changes identified by the algorithm predicted suicide risk in a time frame of 1 week with an area under the curve of 0.78, indicating good accuracy. Conclusions: We describe an innovative method to identify mental health crises based on passively collected information from patients’ smartphones. This technology could be applied to homogeneous groups of patients to identify different types of crises. %M 37656498 %R 10.2196/43719 %U https://www.jmir.org/2023/1/e43719 %U https://doi.org/10.2196/43719 %U http://www.ncbi.nlm.nih.gov/pubmed/37656498 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46560 %T A Text Messaging Intervention for Priming the Affective Rewards of Exercise in Adults: Protocol for a Microrandomized Trial %A Mishra,Sonali R %A Dempsey,Walter %A Klasnja,Predrag %+ Department of Internal Medicine, University of Michigan, NCRC B100, Ann Arbor, MI, 48109, United States, 1 215 266 0952, srmishra@umich.edu %K mobile health %K mHealth interventions %K physical activity %K affective attitudes %K mobile phone %D 2023 %7 1.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical activity is a critical target for health interventions, but effective interventions remain elusive. A growing body of work suggests that interventions targeting affective attitudes toward physical activity may be more effective for sustaining activity long term than those that rely on cognitive constructs alone, such as goal setting and self-monitoring. Anticipated affective response in particular is a promising target for intervention. Objective: We will evaluate the efficacy of an SMS text messaging intervention that manipulates anticipated affective response to exercise to promote physical activity. We hypothesize that reminding users of a positive postexercise affective state before their planned exercise sessions will increase their calories burned during this exercise session. We will deploy 2 forms of affective SMS text messages to explore the design space: low-reflection messages written by participants for themselves and high-reflection prompts that require users to reflect and respond. We will also explore the effect of the intervention on affective attitudes toward exercise. Methods: A total of 120 individuals will be enrolled in a 9-week microrandomized trial testing affective messages that remind users about feeling good after exercise (40% probability), control reminders (30% probability), or no message (30% probability). Two types of affective SMS text messages will be deployed: one requiring a response and the other in a read-only format. Participants will write the read-only messages themselves to ensure that the messages accurately reflect the participants’ anticipated postexercise affective state. Affective attitudes toward exercise and intrinsic motivation for exercise will be measured at the beginning and end of the study. The weighted and centered least squares method will be used to analyze the effect of delivering the intervention versus not on calories burned over 4 hours around the time of the planned activity, measured by the Apple Watch. Secondary analyses will include the effect of the intervention on step count and active minutes, as well as an investigation of the effects of the intervention on affective attitudes toward exercise and intrinsic motivation for exercise. Participants will be interviewed to gain qualitative insights into intervention impact and acceptability. Results: Enrollment began in May 2023, with 57 participants enrolled at the end of July 2023. We anticipate enrolling 120 participants. Conclusions: This study will provide early evidence about the effect of a repeated manipulation of anticipated affective response to exercise. The use of 2 different types of messages will yield insight into optimal design strategies for improving affective attitudes toward exercise. Trial Registration: ClinicalTrials.gov NCT05582369; https://classic.clinicaltrials.gov/ct2/show/NCT05582369 International Registered Report Identifier (IRRID): PRR1-10.2196/46560 %M 37656493 %R 10.2196/46560 %U https://www.researchprotocols.org/2023/1/e46560 %U https://doi.org/10.2196/46560 %U http://www.ncbi.nlm.nih.gov/pubmed/37656493 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44955 %T An Evaluation of a Personalized Multicomponent Commercial Digital Weight Management Program: Single-Arm Behavioral Trial %A Pagoto,Sherry %A Xu,Ran %A Bullard,Tiffany %A Foster,Gary D %A Bannor,Richard %A Arcangel,Kaylei %A DiVito,Joseph %A Schroeder,Matthew %A Cardel,Michelle I %+ Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Rd, Unit 1101, Storrs, CT, 06269-1101, United States, 1 617 877 0923, sherry.pagoto@uconn.edu %K weight loss %K digital behavioral weight management program %K single-arm behavioral trial %K personalized weight loss program %K ZeroPoint foods %K weight management %K digital intervention %K diet management %K exercise %D 2023 %7 29.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital behavioral weight loss programs are scalable and effective, and they provide an opportunity to personalize intervention components. However, more research is needed to test the acceptability and efficacy of personalized digital behavioral weight loss interventions. Objective: In a 6-month single-arm trial, we examined weight loss, acceptability, and secondary outcomes of a digital commercial weight loss program (WeightWatchers). This digital program included a personalized weight loss program based on sex, age, height, weight, and personal food preferences, as well as synchronous (eg, virtual workshops and individual weekly check-ins) and asynchronous (eg, mobile app and virtual group) elements. In addition to a personalized daily and weekly PersonalPoints target, the program provided users with personalized lists of ≥300 ZeroPoint foods, which are foods that do not need to be weighed, measured, or tracked. Methods: We conducted a pre-post evaluation of this 6-month, digitally delivered, and personalized WeightWatchers weight management program on weight loss at 3 and 6 months in adults with overweight and obesity. The secondary outcomes included participation, satisfaction, fruit and vegetable intake, physical activity, sleep quality, hunger, food cravings, quality of life, self-compassion, well-being, and behavioral automaticity. Results: Of the 153 participants, 107 (69.9%) were female, and 65 (42.5%) identified as being from a minoritized racial or ethnic group. Participants’ mean age was 41.09 (SD 13.78) years, and their mean BMI was 31.8 (SD 5.0) kg/m2. Participants had an average weight change of −4.25% (SD 3.93%) from baseline to 3 months and −5.05% (SD 5.59%) from baseline to 6 months. At 6 months, the percentages of participants who experienced ≥3%, ≥5%, and ≥10% weight loss were 63.4% (97/153), 51% (78/153), and 14.4% (22/153), respectively. The mean percentage of weeks in which participants engaged in ≥1 aspects of the program was 87.53% (SD 23.40%) at 3 months and 77.67% (SD 28.69%) at 6 months. Retention was high (132/153, 86.3%), and more than two-thirds (94/140, 67.1%) of the participants reported that the program helped them lose weight. Significant improvements were observed in fruit and vegetable intake, physical activity, sleep quality, hunger, food cravings, quality of life, and well-being (all P values <.01). Conclusions: This personalized, digital, and scalable behavioral weight management program resulted in clinically significant weight loss in half (78/153, 51%) of the participants as well as improvements in behavioral and psychosocial outcomes. Future research should compare personalized digital weight loss programs with generic programs on weight loss, participation, and acceptability. %M 37642986 %R 10.2196/44955 %U https://www.jmir.org/2023/1/e44955 %U https://doi.org/10.2196/44955 %U http://www.ncbi.nlm.nih.gov/pubmed/37642986 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42541 %T Evaluating the Effectiveness of Apps Designed to Reduce Mobile Phone Use and Prevent Maladaptive Mobile Phone Use: Multimethod Study %A Rahmillah,Fety Ilma %A Tariq,Amina %A King,Mark %A Oviedo-Trespalacios,Oscar %+ Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, Delft, 2628 BX, Netherlands, 31 15 2783887, O.OviedoTrespalacios@tudelft.nl %K mobile phone %K maladaptive mobile phone use %K apps %K features %K problematic phone use %D 2023 %7 29.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile apps are a popular strategy for reducing mobile phone use and preventing maladaptive mobile phone use (MMPU). Previous research efforts have been made to understand the features of apps that have the potential to reduce mobile phone use and MMPU. However, there has been a lack of a comprehensive examination of the effectiveness of such apps and their features. Objective: This paper investigated existing apps designed to reduce mobile phone use and prevent MMPU and examined the evidence of their effectiveness. The research aimed to provide a comprehensive analysis of app features that can reduce mobile phone use and MMPU, while also assessing their effectiveness. In addition, we explored users’ perceptions of these apps and the various features the apps offer to understand potential adoption issues and identify opportunities. Methods: This study used 3 methods: a review of scientific evidence, content analysis, and sentiment analysis. Results: Our study comprehensively examine the common features of 13 apps designed to reduce mobile phone use. We extracted and classified the features into 7 types: self-tracking, social tracking, goal setting, blocking, gamification, simplification, and assessment. The effectiveness of these apps in reducing mobile phone use and MMPU varied from weak to strong. On the basis of content analysis, self-tracking and goal setting were the most frequently used features, whereas gamification and assessment were used the least frequently. The intervention strategies that effectively reduce mobile phone use and MMPU included using grayscale mode, app limit features, and mixed interventions. Overall, users tended to accept these apps, as indicated by sentiment scores ranging from 61 to 86 out of 100. Conclusions: This study demonstrates that app-based management has the potential to reduce mobile phone use and MMPU. However, further research is required to evaluate the effectiveness of app-based interventions. Collaborations among researchers, app developers, mobile phone manufacturers, and policy makers could enhance the process of delivering, evaluating, and optimizing apps aimed at reducing mobile phone use and MMPU. %M 37643002 %R 10.2196/42541 %U https://www.jmir.org/2023/1/e42541 %U https://doi.org/10.2196/42541 %U http://www.ncbi.nlm.nih.gov/pubmed/37643002 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e42415 %T Stress Management Apps: Systematic Search and Multidimensional Assessment of Quality and Characteristics %A Paganini,Sarah %A Meier,Evelyn %A Terhorst,Yannik %A Wurst,Ramona %A Hohberg,Vivien %A Schultchen,Dana %A Strahler,Jana %A Wursthorn,Max %A Baumeister,Harald %A Messner,Eva-Maria %+ Department of Sport Psychology, Institute of Sports and Sport Science, University of Freiburg, Sandfangweg 4, Freiburg, 79102, Germany, 49 76120345, sarah.paganini@sport.uni-freiburg.de %K stress management %K mobile app %K mHealth %K mobile health %K quality assessment %K review %K evidence base %K availability %D 2023 %7 29.8.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Chronic stress poses risks for physical and mental well-being. Stress management interventions have been shown to be effective, and stress management apps (SMAs) might help to transfer strategies into everyday life. Objective: This review aims to provide a comprehensive overview of the quality and characteristics of SMAs to give potential users or health professionals a guideline when searching for SMAs in common app stores. Methods: SMAs were identified with a systematic search in the European Google Play Store and Apple App Store. SMAs were screened and checked according to the inclusion criteria. General characteristics and quality were assessed by 2 independent raters using the German Mobile Application Rating Scale (MARS-G). The MARS-G assesses quality (range 1 to 5) on the following four dimensions: (1) engagement, (2) functionality, (3) esthetics, and (4) information. In addition, the theory-based stress management strategies, evidence base, long-term availability, and common characteristics of the 5 top-rated SMAs were assessed and derived. Results: Of 2044 identified apps, 121 SMAs were included. Frequently implemented strategies (also in the 5 top-rated SMAs) were psychoeducation, breathing, and mindfulness, as well as the use of monitoring and reminder functions. Of the 121 SMAs, 111 (91.7%) provided a privacy policy, but only 44 (36.4%) required an active confirmation of informed consent. Data sharing with third parties was disclosed in only 14.0% (17/121) of the SMAs. The average quality of the included apps was above the cutoff score of 3.5 (mean 3.59, SD 0.50). The MARS-G dimensions yielded values above this cutoff score (functionality: mean 4.14, SD 0.47; esthetics: mean 3.76, SD 0.73) and below this score (information: mean 3.42, SD 0.46; engagement: mean 3.05, SD 0.78). Most theory-based stress management strategies were regenerative stress management strategies. The evidence base for 9.1% (11/121) of the SMAs could be identified, indicating significant group differences in several variables (eg, stress or depressive symptoms) in favor of SMAs. Moreover, 38.0% (46/121) of the SMAs were no longer available after a 2-year period. Conclusions: The moderate information quality, scarce evidence base, constraints in data privacy and security features, and high volatility of SMAs pose challenges for users, health professionals, and researchers. However, owing to the scalability of SMAs and the few but promising results regarding their effectiveness, they have a high potential to reach and help a broad audience. For a holistic stress management approach, SMAs could benefit from a broader repertoire of strategies, such as more instrumental and mental stress management strategies. The common characteristics of SMAs with top-rated quality can be used as guidance for potential users and health professionals, but owing to the high volatility of SMAs, enhanced evaluation frameworks are needed. %M 37642999 %R 10.2196/42415 %U https://mhealth.jmir.org/2023/1/e42415 %U https://doi.org/10.2196/42415 %U http://www.ncbi.nlm.nih.gov/pubmed/37642999 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e47183 %T Acceptability and Utility of a Smartphone App to Support Adolescent Mental Health (BeMe): Program Evaluation Study %A Prochaska,Judith J %A Wang,Yixin %A Bowdring,Molly A %A Chieng,Amy %A Chaudhary,Neha P %A Ramo,Danielle E %+ Stanford Prevention Research Center, Department of Medicine, Stanford University, 3180 Porter Drive Room A105, Palo Alto, CA, 94304-1212, United States, 1 650 724 3608, jpro@stanford.edu %K adolescents %K mobile app %K depression %K anxiety %K resilience %K digital intervention %K digital mental health %K mobile phone %D 2023 %7 28.8.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adolescents face unprecedented mental health challenges, and technology has the opportunity to facilitate access and support digitally connected generations. The combination of digital tools and live human connection may hold particular promise for resonating with and flexibly supporting young people’s mental health. Objective: This study aimed to describe the BeMe app-based platform to support adolescents’ mental health and well-being and to examine app engagement, usability, and satisfaction. Methods: Adolescents in the United States, aged 13 to 20 years, were recruited via the web and enrolled between September 1 and October 31, 2022. App engagement, feature use, clinical functioning, and satisfaction with BeMe were examined for 30 days. BeMe provides content based on cognitive behavioral therapy, dialectical behavior therapy, motivational interviewing, and positive psychology; interactive activities; live text-based coaching; links to clinical services; and crisis support tools (digital and live). Results: The average age of the sample (N=13,421) was 15.04 (SD 1.7) years, and 56.72% (7612/13,421) identified with she/her pronouns. For the subsample that completed the in-app assessments, the mean scores indicated concern for depression (8-item Patient Health Questionnaire mean 15.68/20, SD 5.9; n=239), anxiety (7-item Generalized Anxiety Disorder Questionnaire mean 13.37/17, SD 5.0; n=791), and poor well-being (World Health Organization–Five Well-being Index mean 30.15/100, SD 16.1; n=1923). Overall, the adolescents engaged with BeMe for an average of 2.38 (SD 2.7) days in 7.94 (SD 24.1) sessions and completed 11.26 (SD 19.8) activities. Most adolescents engaged with BeMe’s content (12,270/13,421, 91.42%), mood ratings (13,094/13,421, 97.56%), and interactive skills (10,098/13,421, 75.24%), and almost one-fifth of the adolescents engaged with coaching (2539/13,421, 18.92%), clinical resources (2411/13,421, 17.96%), and crisis support resources (2499/13,421, 18.62%). Overall app engagement (total activities) was highest among female and gender-neutral adolescents compared with male adolescents (all P<.001) and was highest among younger adolescents (aged 13-14 years) compared with all other ages (all P<.001). Satisfaction ratings were generally high for content (eg, 158/176, 89.8% rated as helpful and 1044/1139, 91.66% improved coping self-efficacy), activities (5362/8468, 63.32% helpful and 4408/6072, 72.6% useful in coping with big feelings), and coaching (747/894, 83.6% helpful and 747/894, 83.6% improved coping self-efficacy). Engagement (total activities completed) predicted the likelihood of app satisfaction (P<.001). Conclusions: Many adolescents downloaded the BeMe app and completed multiple sessions and activities. Engagement with BeMe was higher among female and younger adolescents. Ratings of BeMe’s content, activities, and coaching were very positive for cognitive precursors aimed at reducing depression and anxiety and improving well-being. The findings will inform future app development to promote more sustained engagement, and future evaluations will assess the effects of BeMe on changes in mental health outcomes. %M 37639293 %R 10.2196/47183 %U https://mhealth.jmir.org/2023/1/e47183 %U https://doi.org/10.2196/47183 %U http://www.ncbi.nlm.nih.gov/pubmed/37639293 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40640 %T Prototyping Apps for the Management of Sleep, Fatigue, and Behavioral Health in Austere Far-Forward Environments: Development Study %A Germain,Anne %A Wolfson,Megan %A Pulantara,I Wayan %A Wallace,Meredith L %A Nugent,Katie %A Mesias,George %A Clarke-Walper,Kristina %A Quartana,Phillip J %A Wilk,Joshua %+ Noctem, LLC, 218 Oakland Avenue, Pittsburgh, PA, 15213, United States, 1 412 897 3183, anne@noctemhealth.com %K military digital health technology %K operational environment %K self-monitoring %K self-management %K connectivity protocol %K evidence-based practice %K deployment health %K military %K army %K smartphone app %K mHealth %K mobile health %K health app %K feasibility %K prototype %K digital health %K health technology %K eHealth %K decision support %K medic %K soldier %K sleep %K fatigue %K behavioral health %K operational setting %K mental health %K mental well-being %D 2023 %7 28.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Military service inherently includes frequent periods of high-stress training, operational tempo, and sustained deployments to austere far-forward environments. These occupational requirements can contribute to acute and chronic sleep disruption, fatigue, and behavioral health challenges related to acute and chronic stress and disruption of team dynamics. To date, there is no centralized mobile health platform that supports self- and supervised detection, monitoring, and management of sleep and behavioral health issues in garrison and during and after deployments. Objective: The objective of this study was to adapt a clinical decision support platform for use outside clinical settings, in garrison, and during field exercises by medics and soldiers to monitor and manage sleep and behavioral health in operational settings. Methods: To adapt an existing clinical decision support digital health platform, we first gathered system, content, and context-related requirements for a sleep and behavioral health management system from experts. Sleep and behavioral health assessments were then adapted for prospective digital data capture. Evidence-based and operationally relevant educational and interventional modules were formatted for digital delivery. These modules addressed the management and mitigation of sleep, circadian challenges, fatigue, stress responses, and team communication. Connectivity protocols were adapted to accommodate the absence of cellular or Wi-Fi access in deployed settings. The resulting apps were then tested in garrison and during 2 separate field exercises. Results: Based on identified requirements, 2 Android smartphone apps were adapted for self-monitoring and management for soldiers (Soldier app) and team supervision and intervention by medics (Medic app). A total of 246 soldiers, including 28 medics, received training on how to use the apps. Both apps function as expected under conditions of limited connectivity during field exercises. Areas for future technology enhancement were also identified. Conclusions: We demonstrated the feasibility of adapting a clinical decision support platform into Android smartphone–based apps to collect, save, and synthesize sleep and behavioral health data, as well as share data using adaptive data transfer protocols when Wi-Fi or cellular data are unavailable. The AIRE (Autonomous Connectivity Independent System for Remote Environments) prototype offers a novel self-management and supervised tool to augment capabilities for prospective monitoring, detection, and intervention for emerging sleep, fatigue, and behavioral health issues that are common in military and nonmilitary high-tempo occupations (eg, submarines, long-haul flights, space stations, and oil rigs) where medical expertise is limited. %M 37639304 %R 10.2196/40640 %U https://www.jmir.org/2023/1/e40640 %U https://doi.org/10.2196/40640 %U http://www.ncbi.nlm.nih.gov/pubmed/37639304 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41833 %T Acceptability of Personal Sensing Among People With Alcohol Use Disorder: Observational Study %A Wyant,Kendra %A Moshontz,Hannah %A Ward,Stephanie B %A Fronk,Gaylen E %A Curtin,John J %+ Department of Psychology, University of Wisconsin-Madison, 1202 W Johnson St, Madison, WI, 53706, United States, 1 (608) 262 1040, jjcurtin@wisc.edu %K personal sensing %K digital therapeutics %K mobile health %K smartphone %K alcohol use disorder %K self-report %K alcohol use %K symptom monitoring %K mental health %K acceptability %K alcohol intake %K mobile phone %D 2023 %7 28.8.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Personal sensing may improve digital therapeutics for mental health care by facilitating early screening, symptom monitoring, risk prediction, and personalized adaptive interventions. However, further development and the use of personal sensing requires a better understanding of its acceptability to people targeted for these applications. Objective: We aimed to assess the acceptability of active and passive personal sensing methods in a sample of people with moderate to severe alcohol use disorder using both behavioral and self-report measures. This sample was recruited as part of a larger grant-funded project to develop a machine learning algorithm to predict lapses. Methods: Participants (N=154; n=77, 50% female; mean age 41, SD 11.9 years; n=134, 87% White and n=150, 97% non-Hispanic) in early recovery (1-8 weeks of abstinence) were recruited to participate in a 3-month longitudinal study. Participants were modestly compensated for engaging with active (eg, ecological momentary assessment [EMA], audio check-in, and sleep quality) and passive (eg, geolocation, cellular communication logs, and SMS text message content) sensing methods that were selected to tap into constructs from the Relapse Prevention model by Marlatt. We assessed 3 behavioral indicators of acceptability: participants’ choices about their participation in the study at various stages in the procedure, their choice to opt in to provide data for each sensing method, and their adherence to a subset of the active methods (EMA and audio check-in). We also assessed 3 self-report measures of acceptability (interference, dislike, and willingness to use for 1 year) for each method. Results: Of the 192 eligible individuals screened, 191 consented to personal sensing. Most of these individuals (169/191, 88.5%) also returned 1 week later to formally enroll, and 154 participated through the first month follow-up visit. All participants in our analysis sample opted in to provide data for EMA, sleep quality, geolocation, and cellular communication logs. Out of 154 participants, 1 (0.6%) did not provide SMS text message content and 3 (1.9%) did not provide any audio check-ins. The average adherence rate for the 4 times daily EMA was .80. The adherence rate for the daily audio check-in was .54. Aggregate participant ratings indicated that all personal sensing methods were significantly more acceptable (all P<.001) compared with neutral across subjective measures of interference, dislike, and willingness to use for 1 year. Participants did not significantly differ in their dislike of active methods compared with passive methods (P=.23). However, participants reported a higher willingness to use passive (vs active) methods for 1 year (P=.04). Conclusions: These results suggest that active and passive sensing methods are acceptable for people with alcohol use disorder over a longer period than has previously been assessed. Important individual differences were observed across people and methods, indicating opportunities for future improvement. %M 37639300 %R 10.2196/41833 %U https://mhealth.jmir.org/2023/1/e41833 %U https://doi.org/10.2196/41833 %U http://www.ncbi.nlm.nih.gov/pubmed/37639300 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46508 %T Evaluating a Smartphone App (MeT4VeT) to Support the Mental Health of UK Armed Forces Veterans: Feasibility Randomized Controlled Trial %A Parkes,Steven %A Croak,Bethany %A Brooks,Samantha K %A Stevelink,Sharon A M %A Leightley,Daniel %A Fear,Nicola T %A Rafferty,Laura %A Greenberg,Neil %+ King’s Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, 10 Cutcombe Road, London, SE5 9RJ, United Kingdom, 44 0207848 ext 5335, steven.j.parkes@kcl.ac.uk %K military %K veteran %K mental health %K military to civilian transition %K digital health %K mobile apps %K smartphone %K mobile phone %K mobile health %K mHealth %K digital intervention %K support %K app %K feasibility %K acceptability %K engagement %K usability %D 2023 %7 28.8.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Previous research demonstrates that less than 50% of military veterans experiencing mental health difficulties seek formal support. Veterans often struggle to identify problems as mental health difficulties. In addition, they may fail to recognize the need for support before reaching a crisis point and face difficulties navigating care pathways to access support. Objective: A feasibility trial was conducted to assess a novel digital smartphone app (Mental Health Toolkit for Veterans Project [MeT4VeT]) for UK Armed Forces (UKAF) veterans experiencing mental health difficulties. The trial aimed to explore the feasibility and acceptability of trial procedures for a later randomized controlled trial (RCT) and to assess the acceptability of the MeT4VeT app. Methods: Participants were recruited at UK military medical centers, by advertising on social media, and through veteran third-sector organizations between February and November 2021, and assessed for eligibility (male, owned a smartphone, served at least 2 years in the UKAF, left the UKAF within the last 2 years, not undertaking formal mental health treatment). Eligible participants were assigned, on a 1:1 ratio, to either the intervention group (full app) or a control group (noninteractive app with signposting information). Three key objectives were determined a priori to assess the practicality of running an RCT including an assessment of recruitment and retention, evaluation of the technical app delivery and measurement processes, and acceptability and usability of the intervention. Results: In total, 791 individuals completed the participant information sheet, of which 261 (33%) were ineligible, 377 (48%) declined or were unable to be contacted for consent, and 103 (13%) did not download the app or complete the baseline measures. Of this, 50 participants completed baseline measures and were randomly assigned to the intervention group (n=24) or the control group (n=26). The trial was effective at enabling both the technical delivery of the intervention and collection of outcome measures, with improvements in mental health demonstrated for the intervention group from baseline to the 3-month follow-up. Recruitment and retention challenges were highlighted with only 50 out of the 530 eligible participants enrolled in the trial. The acceptability and usability of the MeT4VeT app were generally supported, and it was reported to be a useful, accessible way for veterans to monitor and manage their mental health. Conclusions: The results highlighted that further work is needed to refine recruitment processes and maintain engagement with the app. Following this, an RCT can be considered to robustly assess the ability of the app to positively affect mental health outcomes indicated within this trial. Trial Registration: ClinicalTrials.gov NCT05993676; https://clinicaltrials.gov/ct2/show/NCT05993676 %M 37639295 %R 10.2196/46508 %U https://mental.jmir.org/2023/1/e46508 %U https://doi.org/10.2196/46508 %U http://www.ncbi.nlm.nih.gov/pubmed/37639295 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e38515 %T Smartphone-Based Psychotherapeutic Interventions in Blended Care of Cancer Survivors: Nested Randomized Clinical Trial %A Meinlschmidt,Gunther %A Grossert,Astrid %A Meffert,Cornelia %A Roemmel,Noa %A Hess,Viviane %A Rochlitz,Christoph %A Pless,Miklos %A Hunziker,Sabina %A Wössmer,Brigitta %A Geuter,Ulfried %A Schaefert,Rainer %+ Department of Psychosomatic Medicine, University Hospital Basel, Hebelstrasse 2, Basel, 4031, Switzerland, 41 61 328 63 10, gunther.meinlschmidt@unibas.ch %K digital therapeutics %K ecological momentary assessment (EMA) %K ecological momentary intervention (EMI) %K internet- and mobile-based intervention %K microintervention %K neoplasm %K smartphone-based intervention %K postcancer treatment %K body psychotherapy %K mobile phone %D 2023 %7 28.8.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Cancer is related to not only physical but also mental suffering. Notably, body image disturbances are highly relevant to cancer-related changes often persisting beyond recovery from cancer. Scalable and low-barrier interventions that can be blended with face-to-face psychotherapy for cancer survivors are highly warranted. Objective: The aim of the study is to investigate whether smartphone-based bodily interventions are more effective to improve the mood of patients with cancer than smartphone-based fairy tale interventions (control intervention). Methods: We recruited patients with cancer in 2 Swiss hospitals and conducted daily, fully automated smartphone-based interventions 6 times a week for 5 consecutive weeks, blended with weekly face-to-face group body psychotherapy. We applied 2 types of smartphone-based interventions using a within-subject design, randomly assigning patients daily to either bodily interventions or fairy tales. Each intervention type was presented 3 times a week. For this secondary analysis, 3-level mixed models were estimated with mood assessed by the 3 Multidimensional Mood Questionnaire subscales for good-bad mood, wakefulness, and calmness as key indicators. In addition, the effects on experience of presence, vitality, and burden assessed with visual analog scales were investigated. Results: Based on the data from s=732 interventions performed by 36 participants, good-bad mood improved (β=.27; 95% CI 0.062-0.483), and participants became calmer (β=.98; 95% CI 0.740-1.211) following smartphone-based interventions. Wakefulness did not significantly change from pre- to postsmartphone–based intervention (β=.17; 95% CI –0.081 to 0.412). This was true for both intervention types. There was no interaction effect of intervention type with change in good-bad mood (β=–.01; 95% CI –0.439 to 0.417), calmness (β=.22; 95% CI –0.228 to 0.728), or wakefulness (β=.14; 95% CI –0.354 to 0.644). Experience of presence (β=.34; 95% CI 0.271-0.417) and vitality (β=.35; 95% CI 0.268-0.426) increased from pre- to postsmartphone–based intervention, while experience of burden decreased (β=–0.40; 95% CI –0.481 to 0.311). Again, these effects were present for both intervention types. There were no significant interaction effects of intervention type with pre- to postintervention changes in experience of presence (β=.14; 95% CI –0.104 to 0.384), experience of vitality (β=.06; 95% CI –0.152 to 0.265), and experience of burden (β=–.16; 95% CI –0.358 to 0.017). Conclusions: Our results suggest that both smartphone-based audio-guided bodily interventions and fairy tales have the potential to improve the mood of cancer survivors. Trial Registration: ClinicalTrials.gov NCT03707548; https://clinicaltrials.gov/study/NCT03707548 International Registered Report Identifier (IRRID): RR2-10.1186/s40359-019-0357-1 %M 37639296 %R 10.2196/38515 %U https://cancer.jmir.org/2023/1/e38515 %U https://doi.org/10.2196/38515 %U http://www.ncbi.nlm.nih.gov/pubmed/37639296 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44742 %T Efficacy of a Brief Blended Cognitive Behavioral Therapy Program for the Treatment of Depression and Anxiety in University Students: Uncontrolled Intervention Study %A Atik,Ece %A Stricker,Johannes %A Schückes,Magnus %A Pittig,Andre %+ Clinical Psychology Research Group, Department of Experimental Psychology, Heinrich Heine University Düsseldorf, Universitätsstr. 1, Düsseldorf, 40225, Germany, 49 211 81 10850, johannes.stricker@hhu.de %K blended cognitive behavioral therapy %K bCBT %K digital mental health %K e–mental health %K depression %K anxiety disorder %K video psychotherapy %K mobile phone %D 2023 %7 25.8.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Blended cognitive behavioral therapy (bCBT)—the combination of cognitive behavioral therapy and digital mental health applications—has been increasingly used to treat depression and anxiety disorders. As a resource-efficient treatment approach, bCBT appears promising for addressing the growing need for mental health care services, for example, as an early intervention before the chronification of symptoms. However, further research on the efficacy and feasibility of integrated bCBT interventions is needed. Objective: This study aimed to evaluate the efficacy of a novel bCBT program comprising short (25 min), weekly face-to-face therapy sessions combined with a smartphone-based digital health app for treating mild to moderate symptoms of depression or anxiety. Methods: This prospective uncontrolled trial comprised 2 measurement points (before and after treatment) and 2 intervention groups. We recruited university students with mild to moderate symptoms of depression or anxiety. On the basis of the primary symptoms, participants were assigned to either a depression intervention group (n=67 completers) or an anxiety intervention group (n=33 completers). Participants in each group received 6 weekly individual psychotherapy sessions via videoconference and completed modules tailored to their respective symptoms in the smartphone-based digital health app. Results: The depression group displayed medium to large improvements in the symptoms of depression (Cohen d=−0.70 to −0.90; P<.001). The anxiety group experienced significant improvements in the symptoms of generalized anxiety assessed with the Generalized Anxiety Disorder-7 scale with a large effect size (Cohen d=−0.80; P<.001) but not in symptoms of anxiety assessed with the Beck Anxiety Inventory (Cohen d=−0.35; P=.06). In addition, both groups experienced significant improvements in their perceived self-efficacy (Cohen d=0.50; P<.001 in the depression group and Cohen d=0.71; P<.001 in the anxiety group) and quality of life related to psychological health (Cohen d=0.87; P<.001 in the depression group and Cohen d=0.40; P=.03 in the anxiety group). Work and social adjustment of patients improved significantly in the depression group (Cohen d=−0.49; P<.001) but not in the anxiety group (Cohen d=−0.06; P=.72). Patients’ mental health literacy improved in the anxiety group (Cohen d=0.45; P=.02) but not in the depression group (Cohen d=0.21; P=.10). Patient satisfaction with the bCBT program and ratings of the usability of the digital app were high in both treatment groups. Conclusions: This study provides preliminary evidence for the feasibility and efficacy of a novel brief bCBT intervention. The intervention effects were generalized across a broad spectrum of patient-reported outcomes. Hence, the newly developed bCBT intervention appears promising for treating mild to moderate depression and anxiety in young adults. %M 37624631 %R 10.2196/44742 %U https://mental.jmir.org/2023/1/e44742 %U https://doi.org/10.2196/44742 %U http://www.ncbi.nlm.nih.gov/pubmed/37624631 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43676 %T Acceptability of the LetSync App Wireframes for an mHealth Intervention to Improve HIV Care Engagement and Treatment Among Black Partnered Sexual Minority Men: Findings from In-Depth Qualitative Interviews %A Becker,Nozipho %A Kim,Hyunjin C %A Bright,Darius J %A Williams III,Robert %A Anguera,Joaquin A %A Arnold,Emily A %A Saberi,Parya %A Neilands,Torsten B %A Pollack,Lance M %A Tan,Judy Y %+ Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, United States, 1 415 502 1000 ext 17163, judy.tan@ucsf.edu %K digital health %K mobile health %K mHealth %K mobile app %K app %K Black sexual minority men %K couples %K HIV care engagement %K HIV treatment %K United States %K mobile phone %D 2023 %7 25.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV disparities continue to be a significant challenge affecting Black sexual minority men in the United States. Inadequate engagement and retention of patients in HIV care has been associated with poor health outcomes. Interventions to improve sustained commitment to HIV care are needed. Mobile health interventions can help facilitate access to and use of HIV health services, particularly among individuals at risk for disengaging with care. Objective: We designed the LetSync app wireframes for a mobile health intervention using a couple-centered design approach to improve HIV engagement and treatment among Black sexual minority men and their partners. The objective of this study was to gauge future app user interest and elicit feedback to improve the design, development, and usability of the LetSync app. Methods: We conducted in-depth interviews with 24 Black sexual minority men to assess the acceptability of the LetSync app wireframes between May 2020 and January 2021. Participants reviewed the LetSync app wireframes and provided feedback regarding perceived usefulness and interest in future app use and suggestions for improvement. Results: Participants indicated interest in the future LetSync app and noted that the wireframes’ features were acceptable and usable. In our study, the future LetSync app was frequently referred to as a potential resource that could help facilitate users’ engagement in HIV care through the following mechanisms: enable scheduling of appointments and timely reminders for clinic visits; help improve HIV medication adherence; encourage and motivate participants to ask questions to their health care provider and stay engaged in conversations during clinic visits; facilitate effective communication by assisting couples with planning, coordination, and management of daily routines; help participants understand their partner’s health needs, including access to and use of health care services; and facilitate participants’ ability to improve their relationship skills, partner support, and self-efficacy in managing conflict. In addition to near-universal interest in potential daily app use, study participants indicted that they would recommend the LetSync app to other family members, friends, and people in their social networks who are living with HIV. Conclusions: Our findings revealed considerable interest in future app use for HIV care management, which could possibly increase the chance of the LetSync app being successfully adopted by Black sexual minority men in couples. Owing to its interactive and couple-centered approach, the LetSync app could help improve communication between Black sexual minority men and their partners and health providers. In addition, the LetSync app could provide an acceptable modality for these men to receive support in accessing HIV care services. %M 37624634 %R 10.2196/43676 %U https://formative.jmir.org/2023/1/e43676 %U https://doi.org/10.2196/43676 %U http://www.ncbi.nlm.nih.gov/pubmed/37624634 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45963 %T Selective Prevention of Depression in Workers Using a Smartphone App: Randomized Controlled Trial %A Deady,Mark %A Collins,Daniel A J %A Lavender,Isobel %A Mackinnon,Andrew %A Glozier,Nicholas %A Bryant,Richard %A Christensen,Helen %A Harvey,Samuel B %+ Black Dog Institute, Faculty of Medicine and Health, University of New South Wales, Hospital Rd, Randwick, 2031, Australia, 61 02 9065 9144, m.deady@unsw.edu.au %K depression %K smartphone app %K workplace mental health %K randomized controlled trial %K prevention %K stress %K mobile phone %D 2023 %7 24.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: There is increasing evidence that depression can be prevented; however, universal approaches have had limited success. Appropriate targeting of interventions to at-risk populations has been shown to have potential, but how to selectively determine at-risk individuals remains unclear. Workplace stress is a risk factor for depression and a target for intervention, but few interventions exist to prevent depression among workers at risk due to heightened stress. Objective: This trial aimed to evaluate the efficacy of a smartphone-based intervention in reducing the onset of depression and improving related outcomes in workers experiencing at least moderate levels of stress. Methods: A randomized controlled trial was conducted with participants who were currently employed and reported no clinically significant depression and at least moderate stress. The intervention group (n=1053) were assigned Anchored, a 30-day self-directed smartphone app-based cognitive behavioral- and mindfulness-based intervention. The attention-control group (n=1031) were assigned a psychoeducation website. Assessment was performed via web-based self-report questionnaires at baseline and at 1-, 3-, and 6-month postbaseline time points. The primary outcome was new depression caseness aggregated over the follow-up period. The secondary outcomes included depressive and anxiety symptoms, stress, well-being, resilience, work performance, work-related burnout, and quality of life. Analyses were conducted within an intention-to-treat framework using mixed modeling. Results: There was no significant between-group difference in new depression caseness (z score=0.69; P=.49); however, those in the Anchored arm had significantly greater depressive symptom reduction at 1 month (Cohen d=0.02; P=.049) and 6 months (Cohen d=0.08; P=.03). Anchored participants also showed significantly greater reduction in anxiety symptoms at 1 month (Cohen d=0.07; P=.04) and increased work performance at 1 month (Cohen d=0.07; P=.008) and 6 months (Cohen d=0.13; P=.01), compared with controls. Notably, for Anchored participants completing at least two-thirds of the intervention, there was a significantly lower rate of depression onset (1.1%, 95% CI 0.0%-3.7%) compared with controls (9.0%, 95% CI 6.8%-12.3%) at 1 month (z score=4.50; P<.001). Significant small to medium effect sizes for most secondary outcomes were seen in the highly engaged Anchored users compared with controls, with effects maintained at the 6-month follow-up for depressive symptoms, well-being, stress, and quality of life. Conclusions: Anchored was associated with a small comparative reduction in depressive symptoms compared with controls, although selective prevention of case-level depression was not observed in the intention-to-treat analysis. When users adequately engaged with the app, significant findings pertaining to depression prevention, overall symptom reduction, and functional improvement were found, compared with controls. There is a need for a greater focus on engagement techniques in future research. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000178943; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378592 %M 37616040 %R 10.2196/45963 %U https://www.jmir.org/2023/1/e45963 %U https://doi.org/10.2196/45963 %U http://www.ncbi.nlm.nih.gov/pubmed/37616040 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e47473 %T The Impact of a Digital Weight Loss Intervention on Health Care Resource Utilization and Costs Compared Between Users and Nonusers With Overweight and Obesity: Retrospective Analysis Study %A Mitchell,Ellen Siobhan %A Fabry,Alexander %A Ho,Annabell Suh %A May,Christine N %A Baldwin,Matthew %A Blanco,Paige %A Smith,Kyle %A Michaelides,Andreas %A Shokoohi,Mostafa %A West,Michael %A Gotera,Kim %A El Massad,Omnya %A Zhou,Anna %+ Academic Research, Noom, Inc, 450 W 33rd St, New York City, NY, 10001, United States, 1 8882665071, christinem@noom.com %K mobile health %K mHealth %K obesity %K overweight %K Noom Weight %K digital weight loss intervention %K health care resource utilization %K costs %K electronic health record %K EHR %K insurance claims %K inverse probability of treatment weighting %K IPTW %K mobile phone %D 2023 %7 24.8.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Noom Weight program is a smartphone-based weight management program that uses cognitive behavioral therapy techniques to motivate users to achieve weight loss through a comprehensive lifestyle intervention. Objective: This retrospective database analysis aimed to evaluate the impact of Noom Weight use on health care resource utilization (HRU) and health care costs among individuals with overweight and obesity. Methods: Electronic health record data, insurance claims data, and Noom Weight program data were used to conduct the analysis. The study included 43,047 Noom Weight users and 14,555 non–Noom Weight users aged between 18 and 80 years with a BMI of ≥25 kg/m² and residing in the United States. The index date was defined as the first day of a 3-month treatment window during which Noom Weight was used at least once per week on average. Inverse probability treatment weighting was used to balance sociodemographic covariates between the 2 cohorts. HRU and costs for inpatient visits, outpatient visits, telehealth visits, surgeries, and prescriptions were analyzed. Results: Within 12 months after the index date, Noom Weight users had less inpatient costs (mean difference [MD] −US $20.10, 95% CI −US $30.08 to −US $10.12), less outpatient costs (MD −US $124.33, 95% CI −US $159.76 to −US $88.89), less overall prescription costs (MD −US $313.82, 95% CI −US $565.42 to −US $62.21), and less overall health care costs (MD −US $450.39, 95% CI −US $706.28 to −US $194.50) per user than non–Noom Weight users. In terms of HRU, Noom Weight users had fewer inpatient visits (MD −0.03, 95% CI −0.04 to −0.03), fewer outpatient visits (MD −0.78, 95% CI −0.93 to −0.62), fewer surgeries (MD −0.01, 95% CI −0.01 to 0.00), and fewer prescriptions (MD −1.39, 95% CI −1.76 to −1.03) per user than non–Noom Weight users. Among a subset of individuals with 24-month follow-up data, Noom Weight users incurred lower overall prescription costs (MD −US $1139.52, 95% CI −US $1972.21 to −US $306.83) and lower overall health care costs (MD −US $1219.06, 95% CI −US $2061.56 to −US $376.55) per user than non–Noom Weight users. The key differences were associated with reduced prescription use. Conclusions: Noom Weight use is associated with lower HRU and costs than non–Noom Weight use, with potential cost savings of up to US $1219.06 per user at 24 months after the index date. These findings suggest that Noom Weight could be a cost-effective weight management program for individuals with overweight and obesity. This study provides valuable evidence for health care providers and payers in evaluating the potential benefits of digital weight loss interventions such as Noom Weight. %M 37616049 %R 10.2196/47473 %U https://mhealth.jmir.org/2023/1/e47473 %U https://doi.org/10.2196/47473 %U http://www.ncbi.nlm.nih.gov/pubmed/37616049 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48113 %T An mHealth-Delivered Sexual Harm Reduction Tool (PartyPack) for Men Who Have Sex With Men in Malaysia: Usability Study %A Gautam,Kamal %A Paudel,Kiran %A Jacobs,Jerome %A Wickersham,Jeffrey A %A Ikhtiaruddin,Wan Mohd %A Azwa,Iskandar %A Saifi,Rumana %A Lim,Sin How %A Shrestha,Roman %+ Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Rd, Storrs, CT, 06269, United States, 1 860 486 2834, roman.shrestha@uconn.edu %K chemsex %K party and play %K sexualized drug use %K PartyPack %K harm reduction tool %K men who have sex with men %K Malaysia %K health promotion %K sexual health %K mHealth intervention %K HIV prevention %D 2023 %7 24.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Chemsex—the use of psychoactive drugs to enhance the sexual experience—is an increasing phenomenon globally. Despite the increasing burden and associated harms of chemsex, evidence-based interventions (ie, behavioral and pharmacological) for chemsex users are nonexistent. Objective: In this study, we assessed the usability and acceptability of a mobile health (mHealth)–delivered safer chemsex package (“PartyPack”) as a sexual harm reduction strategy among men who have sex with men in Malaysia—a setting where chemsex is becoming increasingly prevalent. Methods: This study is part of a larger smartphone app-based intervention (ie, JomPrEP; University of Connecticut) designed to improve access to HIV prevention services among Malaysian men who have sex with men. A total of 50 participants were recruited from the Greater Kuala Lumpur region of Malaysia to use the JomPrEP app, which included a feature allowing participants to order PartyPack, for 30 days (March-April 2022). The usability and acceptability of the PartyPack were assessed using self-report, app analytics, and exit interviews (n=20). Results: Overall, 8% (4/50) of participants reported having engaged in chemsex in the past 6 months; however, engagement in condomless sex (34/50, 68%) and group sex (9/50, 18%) was much higher. A total of 43 (86%) participants ordered PartyPack, of which 27 (63%) made multiple orders during the 30 days. Most participants (41/43, 95%) reported being satisfied with the PartyPack order feature in the app, with 91% (39/43) indicating the order and tracking process was easy. Thematic data exploration further revealed important information for understanding (eg, items included in the package, use of mHealth platform to order package, and discreetness of the PartyPack box and order and delivery) and refining the logistical preferences (eg, using branded items and allowing customization during order). Conclusions: Our findings provide strong evidence of the usability and acceptability of a mHealth-delivered safer chemsex package as a potential sexual harm reduction tool among this underserved population. Replication in a study with a larger sample size to test the efficacy of the PartyPack is warranted. %M 37616034 %R 10.2196/48113 %U https://formative.jmir.org/2023/1/e48113 %U https://doi.org/10.2196/48113 %U http://www.ncbi.nlm.nih.gov/pubmed/37616034 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46949 %T Mobile Technologies for Supporting Mental Health in Youths: Scoping Review of Effectiveness, Limitations, and Inclusivity %A Litke,Shannon Grace %A Resnikoff,Annie %A Anil,Ashley %A Montgomery,Meredith %A Matta,Rishabh %A Huh-Yoo,Jina %A Daly,Brian P %+ Department of Psychological and Brain Sciences, Drexel University, Stratton Hall Suite 118/119, 3201 Chestnut Street, Philadelphia, PA, 19104, United States, 1 7329938165, sgl46@drexel.edu %K mHealth %K mobile app %K children %K adolescents %K mental health %K effectiveness %K efficacy %K scoping review %K mobile phone %D 2023 %7 23.8.2023 %9 Review %J JMIR Ment Health %G English %X Background: Over the past decade, there has been growing support for the use of mobile health (mHealth) technologies to improve the availability of mental health interventions. While mHealth is a promising tool for improving access to interventions, research on the effectiveness and efficacy of mHealth apps for youths is limited, particularly for underrepresented populations, including youths of color and economically marginalized youths. Objective: This scoping review study sought to evaluate the following research questions: (1) What is the extent of the current literature on mHealth apps that provide intervention for mental health problems in children and adolescents? (2) What is known from the existing literature about the effectiveness or efficacy of delivering mental health services via mHealth apps? (3) What are the gaps in the knowledge base in the fields of technology and mental health? (4) Do the reviewed mHealth apps address issues of cultural sensitivity or have they been tested with underrepresented groups (ie, youths of color or economically marginalized groups)? Methods: An electronic database search was conducted using relevant search terms. Seven independent reviewers screened identified studies, including title and abstract review to determine if studies met the following inclusion criteria: (1) targeted samples with mental health symptomology or disorders, (2) studied youth participants aged 6-17 years, and (3) examined the use of a mobile app–based platform for intervention. Relevant studies were subjected to full-text review to extract and chart relevant data based on a priori research questions. Results: The initial database search yielded 304 papers published from 2010 to 2021. After screening and selection, the final review included 10 papers on the effectiveness and efficacy of mental health intervention apps for youths aged 8 to 17 years. Identified apps targeted a broad range of mental health challenges in youths (ie, depression, self-harm, autism spectrum disorder, anxiety, and obsessive-compulsive disorder). Results identified only a small number of studies suggesting that current effectiveness and efficacy research in this area are limited. While some studies provided general support for the effectiveness of mHealth apps in improving mental health outcomes in youths, several notable limitations were present across the literature, reducing the generalizability of findings. Additionally, considerations around racial, ethnic, and socioeconomic diversity were scarce across studies. Conclusions: Although some studies cited in this scoping review provide support for the effectiveness and efficacy of mHealth apps targeting mental health concerns in youths, the overall body of literature remains quite limited. Moreover, mHealth apps expressly developed to be culturally responsive are almost nonexistent. Further efforts are needed to recruit youths who are typically underrepresented in research and invite stakeholder participation and collaborative input in the early stages of the mHealth app development process. %M 37610818 %R 10.2196/46949 %U https://mental.jmir.org/2023/1/e46949 %U https://doi.org/10.2196/46949 %U http://www.ncbi.nlm.nih.gov/pubmed/37610818 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45133 %T Effects of Increased Standing and Light-Intensity Physical Activity to Improve Postprandial Glucose in Sedentary Office Workers: Protocol for a Randomized Crossover Trial %A Wilson,Shannon L %A Crosley-Lyons,Rachel %A Junk,Jordan %A Hasanaj,Kristina %A Larouche,Miranda L %A Hollingshead,Kevin %A Gu,Haiwei %A Whisner,Corrie %A Sears,Dorothy D %A Buman,Matthew P %+ College of Health Solutions, Arizona State University, 500 North 3rd Street, Phoenix, AZ, 85004, United States, 1 602 496 8617, mbuman@asu.edu %K sitting bouts %K digital health intervention %K standing desk %K endothelial function %K glycemic control %K sleep %K blood pressure %K insulin %K mHealth %D 2023 %7 23.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Prolonged bouts of sedentary time, independent from the time spent in engaging in physical activity, significantly increases cardiometabolic risk. Nonetheless, the modern workforce spends large, uninterrupted portions of the day seated at a desk. Previous research suggests—via improved cardiometabolic biomarkers—that this risk might be attenuated by simply disrupting sedentary time with brief breaks of standing or moving. However, this evidence is derived from acute, highly controlled laboratory experiments and thus has low external validity. Objective: This study aims to investigate if similar or prolonged cardiometabolic changes are observed after a prolonged (2-week) practice of increased brief standing and moving behaviors in real-world office settings. Methods: This randomized crossover trial, called the WorkWell Study, will compare the efficacy of two 2-week pilot intervention conditions designed to interrupt sitting time in sedentary office workers (N=15) to a control condition. The intervention conditions use a novel smartphone app to deliver real-time prompts to increase standing (STAND) or moving (MOVE) by an additional 6 minutes each hour during work. Our primary aim is to assess intervention-associated improvements to daily postprandial glucose using continuous glucose monitors. Our secondary aim is to determine whether the interventions successfully evoke substantive positional changes and light-intensity physical activity (LPA). Other outcomes include the feasibility and acceptability of the intervention conditions, fasting blood glucose concentration, femoral artery flow-mediated dilation (f-FMD), and systolic and diastolic blood pressure. Results: The trial is ongoing at the time of submission. Conclusions: This study is a novel, randomized crossover trial designed to extend a laboratory-based controlled study design into the free-living environment. By using digital health technologies to monitor and prompt participants in real time, we will be able to rigorously test the effects of breaking up sedentary behavior over a longer period of time than is seen in traditional laboratory-based studies. Our innovative approach will leverage the strengths of highly controlled laboratory and free-living experiments to achieve maximal internal and external validity. The research team’s multidisciplinary expertise allows for a broad range of biological measures to be sampled, providing robust results that will extend knowledge of both the acute and chronic real-life effects of increased standing and LPA in sedentary office workers. The WorkWell Study uses a rigorous transdisciplinary protocol that will contribute to a more comprehensive picture of the beneficial effects of breaking up sitting behavior. Trial Registration: ClinicalTrials.gov NCT04269070; https://clinicaltrials.gov/study/NCT04269070 International Registered Report Identifier (IRRID): DERR1-10.2196/45133 %M 37610800 %R 10.2196/45133 %U https://www.researchprotocols.org/2023/1/e45133 %U https://doi.org/10.2196/45133 %U http://www.ncbi.nlm.nih.gov/pubmed/37610800 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45834 %T Effect of an Internet–Delivered Cognitive Behavioral Therapy–Based Sleep Improvement App for Shift Workers at High Risk of Sleep Disorder: Single-Arm, Nonrandomized Trial %A Ito-Masui,Asami %A Sakamoto,Ryota %A Matsuo,Eri %A Kawamoto,Eiji %A Motomura,Eishi %A Tanii,Hisashi %A Yu,Han %A Sano,Akane %A Imai,Hiroshi %A Shimaoka,Motomu %+ Department of Molecular Pathology & Cell Adhesion Biology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan, 81 59 231 5031, motomushimaoka@gmail.com %K shift worker sleep disorder %K internet-based cognitive behavioral therapy %K mobile apps %K fitness tracker %K subjective well-being %K machine learning %K mobile phone %D 2023 %7 22.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Shift workers are at high risk of developing sleep disorders such as shift worker sleep disorder or chronic insomnia. Cognitive behavioral therapy (CBT) is the first-line treatment for insomnia, and emerging evidence shows that internet-based CBT is highly effective with additional features such as continuous tracking and personalization. However, there are limited studies on internet-based CBT for shift workers with sleep disorders. Objective: This study aimed to evaluate the impact of a 4-week, physician-assisted, internet-delivered CBT program incorporating machine learning–based well-being prediction on the sleep duration of shift workers at high risk of sleep disorders. We evaluated these outcomes using an internet-delivered CBT app and fitness trackers in the intensive care unit. Methods: A convenience sample of 61 shift workers (mean age 32.9, SD 8.3 years) from the intensive care unit or emergency department participated in the study. Eligible participants were on a 3-shift schedule and had a Pittsburgh Sleep Quality Index score ≥5. The study comprised a 1-week baseline period, followed by a 4-week intervention period. Before the study, the participants completed questionnaires regarding the subjective evaluation of sleep, burnout syndrome, and mental health. Participants were asked to wear a commercial fitness tracker to track their daily activities, heart rate, and sleep for 5 weeks. The internet-delivered CBT program included well-being prediction, activity and sleep chart, and sleep advice. A job-based multitask and multilabel convolutional neural network–based model was used for well-being prediction. Participant-specific sleep advice was provided by sleep physicians based on daily surveys and fitness tracker data. The primary end point of this study was sleep duration. For continuous measurements (sleep duration, steps, etc), the mean baseline and week-4 intervention data were compared. The 2-tailed paired t test or Wilcoxon signed rank test was performed depending on the distribution of the data. Results: In the fourth week of intervention, the mean daily sleep duration for 7 days (6.06, SD 1.30 hours) showed a statistically significant increase compared with the baseline (5.54, SD 1.36 hours; P=.02). Subjective sleep quality, as measured by the Pittsburgh Sleep Quality Index, also showed statistically significant improvement from baseline (9.10) to after the intervention (7.84; P=.001). However, no significant improvement was found in the subjective well-being scores (all P>.05). Feature importance analysis for all 45 variables in the prediction model showed that sleep duration had the highest importance. Conclusions: The physician-assisted internet-delivered CBT program targeting shift workers with a high risk of sleep disorders showed a statistically significant increase in sleep duration as measured by wearable sensors along with subjective sleep quality. This study shows that sleep improvement programs using an app and wearable sensors are feasible and may play an important role in preventing shift work–related sleep disorders. International Registered Report Identifier (IRRID): RR2-10.2196/24799. %M 37606971 %R 10.2196/45834 %U https://www.jmir.org/2023/1/e45834 %U https://doi.org/10.2196/45834 %U http://www.ncbi.nlm.nih.gov/pubmed/37606971 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45223 %T Use of the Smoking Cessation App Ex-Smokers iCoach and Associations With Smoking-Related Outcomes Over Time in a Large Sample of European Smokers: Retrospective Observational Study %A Mansour,Marthe BL %A Busschers,Wim B %A Crone,Mathilde R %A van Asselt,Kristel M %A van Weert,Henk C %A Chavannes,Niels H %A Meijer,Eline %+ Department of General Practice, Academic Medical Centre Amsterdam, Amsterdam University Medical Centres, Meibergdreef 15, Amsterdam, 1105 AZ, Netherlands, 31 654273668, m.b.mansour@amsterdamumc.nl %K smoking cessation app %K digital smoking cessation intervention %K user groups %K trajectories of use patterns %K engagement %K smoking-related outcomes %K smoker characteristics %K European smokers %K mobile phone %D 2023 %7 22.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital interventions are increasingly used to support smoking cessation. Ex-smokers iCoach was a widely available app for smoking cessation used by 404,551 European smokers between June 15, 2011, and June 21, 2013. This provides a unique opportunity to investigate the uptake of a freely available digital smoking cessation intervention and its effects on smoking-related outcomes. Objective: We aimed to investigate whether there were distinct trajectories of iCoach use, examine which baseline characteristics were associated with user groups (based on the intensity of use), and assess if and how these groups were associated with smoking-related outcomes. Methods: Analyses were performed using data from iCoach users registered between June 15, 2011, and June 21, 2013. Smoking-related data were collected at baseline and every 3 months thereafter, with a maximum of 8 follow-ups. First, group-based modeling was applied to detect distinct trajectories of app use. This was performed in a subset of steady users who had completed at least 1 follow-up measurement. Second, ordinal logistic regression was used to assess the baseline characteristics that were associated with user group membership. Finally, generalized estimating equations were used to examine the association between the user groups and smoking status, quitting stage, and self-efficacy over time. Results: Of the 311,567 iCoach users, a subset of 26,785 (8.6%) steady iCoach users were identified and categorized into 4 distinct user groups: low (n=17,422, 65.04%), mild (n=4088, 15.26%), moderate (n=4415, 16.48%), and intensive (n=860, 3.21%) users. Older users and users who found it important to quit smoking had higher odds of more intensive app use, whereas men, employed users, heavy smokers, and users with higher self-efficacy scores had lower odds of more intensive app use. User groups were significantly associated with subsequent smoking status, quitting stage, and self-efficacy over time. For all groups, over time, the probability of being a smoker decreased, whereas the probability of being in an improved quitting stage increased, as did the self-efficacy to quit smoking. For all outcomes, the greatest change was observed between baseline and the first follow-up at 3 months. In the intensive user group, the greatest change was seen between baseline and the 9-month follow-up, with the observed change declining gradually in moderate, mild, and low users. Conclusions: In the subset of steady iCoach users, more intensive app use was associated with higher smoking cessation rates, increased quitting stage, and higher self-efficacy to quit smoking over time. These users seemed to benefit most from the app in the first 3 months of use. Women and older users were more likely to use the app more intensively. Additionally, users who found quitting difficult used the iCoach app more intensively and grew more confident in their ability to quit over time. %M 37606969 %R 10.2196/45223 %U https://www.jmir.org/2023/1/e45223 %U https://doi.org/10.2196/45223 %U http://www.ncbi.nlm.nih.gov/pubmed/37606969 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46925 %T Long-Term Efficacy of Internet-Based Cognitive Behavioral Therapy Self-Help Programs for Adults With Depression: Systematic Review and Meta-Analysis of Randomized Controlled Trials %A Mamukashvili-Delau,Megi %A Koburger,Nicole %A Dietrich,Sandra %A Rummel-Kluge,Christine %+ Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Klinik und Poliklinik für Psychiatrie und Psychotherapie Semmelweisstraße 10, Haus 13, Leipzig, 04103, Germany, 49 0341 97 24464, Christine.Rummel-Kluge@medizin.uni-leipzig.de %K depression %K internet-based cognitive behavioral therapy %K iCBT %K self-help %K minimal guidance %K long-term %K follow-up %K mental health %K psychotherapy %K cognitive behavioral therapy %K CBT %K systematic review %K meta-analysis %K meta-analyses %K review method %D 2023 %7 22.8.2023 %9 Review %J JMIR Ment Health %G English %X Background: Depression is a worldwide mental disorder and a leading cause of disability. Many people with depression do not want to take medication or have the motivation to seek psychotherapy treatment for many reasons. Guided internet-based self-help programs may be a promising solution for addressing these issues. This kind of intervention has proven to be effective in reducing depression symptoms on a short-term scale. However, as treatment often is a long-term rehabilitation process, it is important to examine not only the short-term effects of internet-based cognitive behavioral therapy (iCBT) self-help treatment but also the follow-up or long-term efficacy of this kind of intervention. Objective: This systematic review and meta-analysis aimed to identify studies that examined follow-up data ≥8 weeks after posttreatment measurements and thereby examined the long-term efficacy of iCBT self-help programs with minimal weekly guidance for people with depression. It aimed to analyze the long-term efficacy of iCBT treatments compared to control conditions as well as long-term efficacy within the iCBT treatment conditions. Additionally, it aimed to conduct subgroup analyses according to the follow-up time points for each outcome. Finally, it examined long-term improvements in quality of life. Methods: The Cochrane Collaboration Depression, Anxiety, and Neurosis Controlled Trials Register (CCDANCTR), grey literature, reference lists, and correspondence were used to search for published and unpublished randomized controlled trials (RCTs) that reported the long-term or follow-up efficacy of computer-based or iCBT self-help treatments for depression with minimal guidance of up to 10 min/wk. The search took place between 2015 and 2022 (October). Results: The search resulted in a total of 2809 study abstracts, of which 15 studies (with 17 samples) met all inclusion criteria and were included in the long-term analysis. The results showed that the depression outcomes of all follow-up time points together in the treatment conditions were favored over the control conditions with a medium effect size of 0.43 (n=1689 participants; 9 RCTs; standardized mean difference [SMD] –0.43, 95% CI –0.67 to –0.20; P<.001). The analysis of long-term efficacy within the iCBT treatment conditions showed that the follow-up outcomes of the treatment groups were favored over the posttreatment outcomes with a small effect size of 0.20 (n=2196 participants; 17 RCTs; SMD 0.20, 95% CI 0.07-0.49; P=.003). Findings for improving quality of life also showed that the iCBT conditions were favored over the control conditions with a small effect size of 0.19 (n=1345 participants; 3 RCTs; SMD 0.19, 95% CI 0.08-0.30; P<.001). Conclusions: This systematic review and meta-analysis found that iCBT self-help interventions had a superior long-term efficacy for individuals with depressive symptoms compared to control groups. The within-group analysis of iCBT treatment conditions also showed statistically significant improvements in reducing depressive symptoms at follow-up compared to posttreatment measurements. %M 37606990 %R 10.2196/46925 %U https://mental.jmir.org/2023/1/e46925 %U https://doi.org/10.2196/46925 %U http://www.ncbi.nlm.nih.gov/pubmed/37606990 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43837 %T Novel At-Home Mother’s Milk Conductivity Sensing Technology as an Identification System of Delay in Milk Secretory Activation Progress and Early Breastfeeding Problems: Feasibility Assessment %A Haramati,Sharon %A Firsow,Anastasia %A Navarro,Daniela Abigail %A Shechter,Ravid %+ MyMilk Laboratories Ltd, Glil Yam, Kibbutz, Glil Yam, 4690500, Israel, 972 526166705, shechter.ravid@gmail.com %K breastfeeding %K feasibility %K human milk %K biomarker %K remote sensing technology %K mobile health %K retrospective %K secretory activation %K lactogenesis %K milk supply %K milk %K sensing technology %K monitoring tool %K lactation %K exclusive breastfeeding %K breastfeed %K maternal health %K maternal and infant health %K infant health %K maternal and child health %K prolactin %K lactation consultant %K lactation support provider %K mother %K milk maturation %D 2023 %7 22.8.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Prolonged exclusive breastfeeding is a public health priority and a personal desire by mothers; however, rates are low with milk supply challenges as a predominant cause. Early breastfeeding management at home is key. Milk electrolytes, mainly sodium ions, are accepted as biomarkers of secretory activation processes throughout the first weeks after birth and predictors for prolonged breastfeeding success, although they are not incorporated into routine care practice. Objective: The aim of this study was to test the feasibility of a novel handheld smartphone-operated milk conductivity sensing system that was designed to compute a novel parameter, milk maturation percent (MM%), calculated from milk sample conductivity for tracking individual secretory activation progress in a real-world home setting. Methods: System performance was initially evaluated in data collected from laboratory-based milk analysis, followed by a retrospective analysis of observational real-world data gathered with the system, on the spot in an at-home setting, implemented by lactation support providers or directly by mothers (N=592). Data collected included milk sample sensing data, baby age, and self-reported breastfeeding status and breastfeeding-related conditions. The data were retroactively classified in a day after birth–dependent manner. Results were compared between groups classified according to breastfeeding exclusivity and breastfeeding problems associated with ineffective breastfeeding and low milk supply. Results: Laboratory analysis in a set of breast milk samples demonstrated a strong correlation between the system’s results and sodium ion levels. In the real-world data set, a total of 1511 milk sensing records were obtained on the spot with over 592 real-world mothers. Data gathered with the system revealed a typical time-dependent increase in the milk maturation parameter (MM%), characterized by an initial steep increase, followed by a moderate increase, and reaching a plateau during the first weeks postpartum. Additionally, MM% levels captured by the system were found to be sensitive to breastfeeding status classifications of exclusive breastfeeding and breastfeeding problems, manifested by differences in group means in the several-day range after birth, predominantly during the first weeks postpartum. Differences could also be demonstrated for the per-case time after birth–dependent progress in individual mothers. Conclusions: This feasibility study demonstrates that the use of smart milk conductivity sensing technology can provide a robust, objective measure of individual breastfeeding efficiency, facilitating remote data collection within a home setting. This system holds considerable potential to augment both self-monitoring and remote breastfeeding management capabilities, as well as to refine clinical classifications. To further validate the clinical relevance and potential of this home milk monitoring tool, future controlled clinical studies are necessary, which will provide insights into its impact on user and care provider satisfaction and its potential to meet breastfeeding success goals. %M 37464893 %R 10.2196/43837 %U https://pediatrics.jmir.org/2023/1/e43837 %U https://doi.org/10.2196/43837 %U http://www.ncbi.nlm.nih.gov/pubmed/37464893 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44924 %T Understanding Attrition in Text-Based Health Promotion for Fathers: Survival Analysis %A Fletcher,Richard %A Regan,Casey %A Dizon,Jason %A Leigh,Lucy %+ School of Health Sciences, College of Health, Medicine, and Wellbeing, The University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 429 152 405, richard.fletcher@newcastle.edu.au %K attrition %K dropout %K text-based program %K parenting %K fathers %D 2023 %7 18.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based interventions targeting parents with health and parenting support frequently report high rates of attrition. The SMS4dads text messaging program, developed in Australia, has delivered texts to over 10,000 fathers. The brief text messages, which are sent 3 times per week from 16 weeks of gestation to 48 weeks after birth, include regular reminders that participants can leave the program by texting back “STOP” to any message. Although acceptance of the program is high, almost 1 in 5 ask it to be removed. Analyzing the factors influencing attrition from digital parenting programs such as SMS4dads may assist in developing more effective interventions. Objective: This study aimed to examine factors associated with attrition in a text-based intervention targeting fathers. Methods: Demographic characteristics, requests to complete a psychological scale, individual message content, participant feedback, and automatically collected data registering clicks on links embedded in the texts were examined to identify attrition factors among 3261 participants enrolled in SMS4dads from 4 local health districts in New South Wales, Australia, between September 2020 and December 2021. Results: Participants who were smokers, recorded risky alcohol consumption, had a lower education level, or signed up prenatally had 30% to 47% higher hazard of dropout from the program, whereas participant age, Aboriginal or Torres Strait Islander status, rurality, and psychological distress score (as Kessler Psychological Distress Scale [K10] category) were not associated with dropout. Primary reasons for dropping out reported by 202 of 605 respondents included “other reasons” (83/202, 41.1%), followed by “not helpful” (47/202, 23.3%) and “too busy” (44/202, 21.8%). Program features such as repeated requests to complete a psychological scale (K10) and the content of individual messages were not linked to increased dropout rates. Analysis of a sample (216/2612) of inactive participants who had not engaged (clicked on any embedded links) for at least 10 weeks but who had not opted out identified a further 1.5% of participants who would opt to leave the program if asked. Conclusions: Identifying which features of the participant population and of the program are linked to dropout rates can provide guidance for improving program adherence. However, with limited information from feedback surveys of those exiting early, knowing which features to target does not, by itself, suggest ways to increase engagement. Planning ahead to include robust measures of attrition, including more detailed feedback from participants, could provide more effective guidance. A novel element in this study was seeking feedback from inactive participants to estimate dropout from this group and thereby provide an overall dropout rate of 20%. The retention rate of 80%, relatively high compared with other web-based parenting programs for fathers, suggests that tailoring the content to specifically address fathers’ role may be an important consideration in reducing fathers’ disengagement. %M 37594788 %R 10.2196/44924 %U https://formative.jmir.org/2023/1/e44924 %U https://doi.org/10.2196/44924 %U http://www.ncbi.nlm.nih.gov/pubmed/37594788 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45407 %T Exploring the Effect of the Dynamics of Behavioral Phenotypes on Health Outcomes in an mHealth Intervention for Childhood Obesity: Longitudinal Observational Study %A Woo,Sarah %A Jung,Sunho %A Lim,Hyunjung %A Kim,YoonMyung %A Park,Kyung Hee %+ Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea, 82 31 380 3805, beloved920@gmail.com %K behavioral dynamics %K behavioral phenotype %K functional data analysis %K FDA %K machine learning analysis %K mobile health %K mHealth %K obesity intervention %K pediatric obesity %K mobile phone %D 2023 %7 17.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Advancements in mobile health technologies and machine learning approaches have expanded the framework of behavioral phenotypes in obesity treatment to explore the dynamics of temporal changes. Objective: This study aimed to investigate the dynamics of behavioral changes during obesity intervention and identify behavioral phenotypes associated with weight change using a hybrid machine learning approach. Methods: In total, 88 children and adolescents (ages 8-16 years; 62/88, 71% male) with age- and sex-specific BMI ≥85th percentile participated in the study. Behavioral phenotypes were identified using a hybrid 2-stage procedure based on the temporal dynamics of adherence to the 5 behavioral goals during the intervention. Functional principal component analysis was used to determine behavioral phenotypes by extracting principal component factors from the functional data of each participant. Elastic net regression was used to investigate the association between behavioral phenotypes and weight change. Results: Functional principal component analysis identified 2 distinctive behavioral phenotypes, which were named the high or low adherence level and late or early behavior change. The first phenotype explained 47% to 69% of each factor, whereas the second phenotype explained 11% to 17% of the total behavioral dynamics. High or low adherence level was associated with weight change for adherence to screen time (β=−.0766, 95% CI −.1245 to −.0312), fruit and vegetable intake (β=.1770, 95% CI .0642-.2561), exercise (β=−.0711, 95% CI −.0892 to −.0363), drinking water (β=−.0203, 95% CI −.0218 to −.0123), and sleep duration. Late or early behavioral changes were significantly associated with weight loss for changes in screen time (β=.0440, 95% CI .0186-.0550), fruit and vegetable intake (β=−.1177, 95% CI −.1441 to −.0680), and sleep duration (β=−.0991, 95% CI −.1254 to −.0597). Conclusions: Overall level of adherence, or the high or low adherence level, and a gradual improvement or deterioration in health-related behaviors, or the late or early behavior change, were differently associated with weight loss for distinctive obesity-related lifestyle behaviors. A large proportion of health-related behaviors remained stable throughout the intervention, which indicates that health care professionals should closely monitor changes made during the early stages of the intervention. Trial Registration: Clinical Research Information Science KCT0004137; https://tinyurl.com/ytxr83ay %M 37590040 %R 10.2196/45407 %U https://www.jmir.org/2023/1/e45407 %U https://doi.org/10.2196/45407 %U http://www.ncbi.nlm.nih.gov/pubmed/37590040 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46550 %T Microtemporal Dynamics of Dietary Intake, Physical Activity, and Impulsivity in Adult Attention-Deficit/Hyperactivity Disorder: Ecological Momentary Assessment Study Within Nutritional Psychiatry %A Ruf,Alea %A Neubauer,Andreas B %A Koch,Elena D %A Ebner-Priemer,Ulrich %A Reif,Andreas %A Matura,Silke %+ Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Heinrich-Hoffmann-Straße 10, Frankfurt, 60528, Germany, 49 69 6301 83348, alea.ruf@kgu.de %K impulsivity %K nutrition %K macronutrient intake %K physical activity %K ecological momentary assessment %K EMA %K attention-deficit/hyperactivity disorder %K ADHD %K diet %K neurodevelopmental %K hyperactivity %K macronutrient %K psychiatry %K symptoms %K mobile %K impulsivity %K mobile phone %D 2023 %7 17.8.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Increasing attention is being paid to lifestyle factors, such as nutrition and physical activity (PA), as potential complementary treatment options in attention-deficit/hyperactivity disorder (ADHD). Previous research indicates that sugar and saturated fat intake may be linked to increased impulsivity, a core symptom of ADHD, whereas protein intake and PA may be related to reduced impulsivity. However, most studies rely on cross-sectional data that lack microtemporal resolution and ecological validity, wherefore questions of microtemporal dynamics (eg, is the consumption of foods high in sugar associated with increased impulsivity within minutes or hours?) remain largely unanswered. Ecological momentary assessment (EMA) has the potential to bridge this gap. Objective: This study is the first to apply EMA to assess microtemporal associations among macronutrient intake, PA, and state impulsivity in the daily life of adults with and without ADHD. Methods: Over a 3-day period, participants reported state impulsivity 8 times per day (signal-contingent), recorded food and drink intake (event-contingent), and wore an accelerometer. Multilevel 2-part models were used to study the association among macronutrient intake, PA, and the probability to be impulsive as well as the intensity of impulsivity (ADHD: n=36; control: n=137). Results: No association between macronutrient intake and state impulsivity was found. PA was not related to the intensity of impulsivity but to a higher probability to be impulsive (ADHD: β=−.09, 95% CI −0.14 to −0.04; control: β=−.03, 95% CI −0.05 to −0.01). No evidence was found that the combined intake of saturated fat and sugar amplified the increase in state impulsivity and that PA alleviated the positive association between sugar or fat intake and state impulsivity. Conclusions: Important methodological considerations are discussed that can contribute to the optimization of future EMA protocols. EMA research in the emerging field of nutritional psychiatry is still in its infancy; however, EMA is a highly promising and innovative approach as it offers insights into the microtemporal dynamics of psychiatric symptomology, dietary intake, and PA in daily life. %M 37590053 %R 10.2196/46550 %U https://mental.jmir.org/2023/1/e46550 %U https://doi.org/10.2196/46550 %U http://www.ncbi.nlm.nih.gov/pubmed/37590053 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43526 %T Effects of Community-Based Caring Contact in Reducing Thwarted Belongingness Among Postdischarge Young Adults With Self-Harm: Randomized Controlled Trial %A Law,Yik Wa %A Lok,Rita Hui Ting %A Chiang,Byron %A Lai,Carmen Chui Shan %A Tsui,Sik Hon Matthew %A Chung,Pui Yin Joseph %A Leung,Siu Chung %+ Department of Social Work and Social Administration, University of Hong Kong, RM534, The Jockey Club Tower,, The Centennial Campus, HKU, Pokfulam, Hong Kong, Hong Kong, 852 93029863, flawhk@hku.hk %K self-harm %K suicidal ideation %K volunteers %K mobile app %K thwarted belongingness %K suicide %K youth %K community %K support %K treatment %K effectiveness %K risk %K patient %K intervention %K model %K care %K hospital %D 2023 %7 16.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: For patients with self-harm behaviors, the urge to hurt themselves persists after hospital discharge, leading to costly readmissions and even death. Hence, postdischarge intervention programs that reduce self-harm behavior among patients should be part of a cogent community mental health care policy. Objective: We aimed to determine whether a combination of a self-help mobile app and volunteer support could complement treatment as usual (TAU) to reduce the risk of suicide among these patients. Methods: We conducted a pragmatic randomized controlled trial on discharged patients aged between 18 and 45 years with self-harm episodes/suicide attempts, all of whom were recruited from 4 hospital emergency departments in Hong Kong. Participants were randomly assigned to one of three groups: (1) mobile app + TAU (“apps”), (2) mobile app + volunteer support + TAU (“volunteers”), or (3) TAU only as the control group (“TAU”). They were asked to submit a mobile app–based questionnaire during 4 measurement time points at monthly intervals. Results: A total of 40 participants were recruited. Blending volunteer care with a preprogrammed mobile app was found to be effective in improving service compliance. Drawing upon the interpersonal-psychological theory of suicide, our findings suggested that a reduction in perceived burdensomeness and thwarted belongingness through community-based caring contact are linked to improvement in hopelessness, albeit a transient one, and suicide risk. Conclusions: A combination of volunteer care with a self-help mobile app as a strategy for strengthening the continuity of care can be cautiously implemented for discharged patients at risk of self-harm during the transition from the hospital to a community setting. Trial Registration: ClinicalTrials.gov NCT03081078; https://clinicaltrials.gov/study/NCT03081078 %M 37585260 %R 10.2196/43526 %U https://formative.jmir.org/2023/1/e43526 %U https://doi.org/10.2196/43526 %U http://www.ncbi.nlm.nih.gov/pubmed/37585260 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47968 %T An App to Support Fathers’ Mental Health and Well-Being: User-Centered Development Study %A Liverpool,Shaun %A Eisenstadt,Mia %A Mulligan Smith,Aoife %A Kozhevnikova,Sofia %+ Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, University College London, 4-8 Rodney Street London, London, N1 9JH, United Kingdom, 44 7960674724, mia.eisenstadt@annafreud.org %K fathers %K parenting %K apps %K mental health %K well-being %D 2023 %7 14.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Numerous studies describe the popularity and usefulness of parenting programs. In particular, parenting programs are generally viewed as effective for supporting parents’ mental well-being during key transition periods. However, the evidence base for fathers is limited owing to their lack of involvement in parenting programs and scarcity of tailored support. Objective: This paper aimed to describe the co-design process for a universal digital intervention for fathers (fatherli) and the outline of a logic model with its expected outcomes. Methods: Following established guidelines for co-designing and developing complex interventions, we conducted a nonsystematic review of the available literature to gather key information, developed market surveys to assess fathers’ needs and interests, consulted with key stakeholders to obtain expert opinions, and engaged in a rapid iterative prototyping process with app developers. Each step was summarized, and the information was collated and integrated to inform a logic model and the features of the resulting intervention. Results: The steps in the co-design process confirmed a need for and interest in a digital intervention for fathers. In response to this finding, fatherli was developed, consisting of 5 key features: a discussion forum for anyone to post information about various topics (the forum), a socializing platform for fathers to create and engage with others in small groups about topics or points of shared interest (dad hub), a tool for fathers to find other fathers with shared interests or within the same geographic location (dad finder), a resource for fathers to access up-to-date information about topics that interest them (dad wiki), and a portal to book sessions with coaches who specialize in different topics (dad coaching space). The evidence-based logic model proposes that if fatherli is successfully implemented, important outcomes such as increased parental efficacy and mental health help-seeking behaviors may be observed. Conclusions: We documented the co-design and development process of fatherli, which confirmed that it is possible to use input from end users and experts, integrated with theory and research evidence, to create suitable digital well-being interventions for fathers. In general, the key findings suggest that an app that facilitates connection, communication, and psychoeducation may appeal to fathers. Further studies will now focus on acceptability, feasibility, and effectiveness. Feedback gathered during pilot-testing will inform any further developments in the app to increase its applicability to fathers and its usability. %M 37578834 %R 10.2196/47968 %U https://formative.jmir.org/2023/1/e47968 %U https://doi.org/10.2196/47968 %U http://www.ncbi.nlm.nih.gov/pubmed/37578834 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e46602 %T Developing a Game (Inner Dragon) Within a Leading Smartphone App for Smoking Cessation: Design and Feasibility Evaluation Study %A White,Justin S %A Salem,Marie K %A Toussaert,Séverine %A Westmaas,J Lee %A Raiff,Bethany R %A Crane,David %A Warrender,Edward %A Lyles,Courtney %A Abroms,Lorien %A Thrul,Johannes %+ Philip R Lee Institute for Health Policy Studies, University of California, 490 Illinois Street, Box 0936, San Francisco, CA, 94158, United States, 1 415 476 8045, Justin.White@ucsf.edu %K smoking cessation %K mobile app %K games for health %K gamification %K software design %K feasibility %K mobile phone %D 2023 %7 11.8.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: Several stand-alone smartphone apps have used serious games to provide an engaging approach to quitting smoking. So far, the uptake of these games has been modest, and the evidence base for their efficacy in promoting smoking cessation is still evolving. The feasibility of integrating a game into a popular smoking cessation app is unclear. Objective: The aim of this paper was to describe the design and iterative development of the Inner Dragon game within Smoke Free, a smartphone app with proven efficacy, and the results of a single-arm feasibility trial as part of a broad program that seeks to assess the effectiveness of the gamified app for smoking cessation. Methods: In phase 1, the study team undertook a multistep process to design and develop the game, including web-based focus group discussions with end users (n=15). In phase 2, a single-arm study of Smoke Free users who were trying to quit (n=30) was conducted to assess the feasibility and acceptability of the integrated game and to establish the feasibility of the planned procedures for a randomized pilot trial. Results: Phase 1 led to the final design of Inner Dragon, informed by principles from psychology and behavioral economics and incorporating several game mechanics designed to increase user engagement and retention. Inner Dragon users maintain an evolving pet dragon that serves as a virtual avatar for the users’ progress in quitting. The phase-2 study established the feasibility of the study methods. The mean number of app sessions completed per user was 13.8 (SD 13.1; median 8; range 1-46), with a mean duration per session of 5.8 (median 1.1; range 0-81.1) minutes. Overall, three-fourths (18/24, 75%) of the participants entered the Inner Dragon game at least once and had a mean of 2.4 (SD 2.4) sessions of game use. The use of Inner Dragon was positively associated with the total number of app sessions (correlation 0.57). The mean satisfaction score of participants who provided ratings (11/24, 46%) was 4.2 (SD 0.6) on a 5-point scale; however, satisfaction ratings for Inner Dragon were only completed by 13% (3/24) of the participants. Conclusions: Findings supported further development and evaluation of Inner Dragon as a beneficial feature of Smoke Free. The next step of this study is to conduct a randomized pilot trial to determine whether the gamified version of the app increases user engagement over a standard version of the app. %M 37566442 %R 10.2196/46602 %U https://games.jmir.org/2023/1/e46602 %U https://doi.org/10.2196/46602 %U http://www.ncbi.nlm.nih.gov/pubmed/37566442 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e44348 %T Eating Behavior and Satiety With Virtual Reality Meals Compared With Real Meals: Randomized Crossover Study %A Glympi,Alkyoni %A Odegi,Dorothy %A Zandian,Modjtaba %A Södersten,Per %A Bergh,Cecilia %A Langlet,Billy %+ Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels allé 23, Huddinge, Stockholm, 141 52, Sweden, 46 086905826, billy.langlet@ki.se %K exposure therapy %K eating behavior %K anorexia nervosa %K bulimia nervosa %K binge eating disorder %K overweight %K obesity %K immersive virtual reality %K VR %K virtual reality %D 2023 %7 10.8.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: Eating disorders and obesity are serious health problems with poor treatment outcomes and high relapse rates despite well-established treatments. Several studies have suggested that virtual reality technology could enhance the current treatment outcomes and could be used as an adjunctive tool in their treatment. Objective: This study aims to investigate the differences between eating virtual and real-life meals and test the hypothesis that eating a virtual meal can reduce hunger among healthy women. Methods: The study included 20 healthy women and used a randomized crossover design. The participants were asked to eat 1 introduction meal, 2 real meals, and 2 virtual meals, all containing real or virtual meatballs and potatoes. The real meals were eaten on a plate that had been placed on a scale that communicated with analytical software on a computer. The virtual meals were eaten in a room where participants were seated on a real chair in front of a real table and fitted with the virtual reality equipment. The eating behavior for both the real and virtual meals was filmed. Hunger was measured before and after the meals using questionnaires. Results: There was a significant difference in hunger from baseline to after the real meal (mean difference=61.8, P<.001) but no significant change in hunger from before to after the virtual meal (mean difference=6.9, P=.10). There was no significant difference in food intake between the virtual and real meals (mean difference=36.8, P=.07). Meal duration was significantly shorter in the virtual meal (mean difference=–5.4, P<.001), which led to a higher eating rate (mean difference=82.9, P<.001). Some participants took bites and chewed during the virtual meal, but the number of bites and chews was lower than in the real meal. The meal duration was reduced from the first virtual meal to the second virtual meal, but no significant difference was observed between the 2 real meals. Conclusions: Eating a virtual meal does not appear to significantly reduce hunger in healthy individuals. Also, this methodology does not significantly result in eating behaviors identical to real-life conditions but does evoke chewing and bite behavior in certain individuals. Trial Registration: ClinicalTrials.gov NCT05734209, https://clinicaltrials.gov/ct2/show/NCT05734209 %M 37561558 %R 10.2196/44348 %U https://games.jmir.org/2023/1/e44348 %U https://doi.org/10.2196/44348 %U http://www.ncbi.nlm.nih.gov/pubmed/37561558 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47950 %T Maternal Social Loneliness Detection Using Passive Sensing Through Continuous Monitoring in Everyday Settings: Longitudinal Study %A Sarhaddi,Fatemeh %A Azimi,Iman %A Niela-Vilen,Hannakaisa %A Axelin,Anna %A Liljeberg,Pasi %A Rahmani,Amir M %+ Department of Computer Science, University of California, Donald Bren Hall, 6210, Irvine, CA, 92697, United States, 1 949 824 5011, azimii@uci.edu %K health monitoring %K internet of things %K maternal loneliness %K passive sensing %K wearable device %D 2023 %7 9.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Maternal loneliness is associated with adverse physical and mental health outcomes for both the mother and her child. Detecting maternal loneliness noninvasively through wearable devices and passive sensing provides opportunities to prevent or reduce the impact of loneliness on the health and well-being of the mother and her child. Objective: The aim of this study is to use objective health data collected passively by a wearable device to predict maternal (social) loneliness during pregnancy and the postpartum period and identify the important objective physiological parameters in loneliness detection. Methods: We conducted a longitudinal study using smartwatches to continuously collect physiological data from 31 women during pregnancy and the postpartum period. The participants completed the University of California, Los Angeles (UCLA) loneliness questionnaire in gestational week 36 and again at 12 weeks post partum. Responses to this questionnaire and background information of the participants were collected through our customized cross-platform mobile app. We leveraged participants’ smartwatch data from the 7 days before and the day of their completion of the UCLA questionnaire for loneliness prediction. We categorized the loneliness scores from the UCLA questionnaire as loneliness (scores≥12) and nonloneliness (scores<12). We developed decision tree and gradient-boosting models to predict loneliness. We evaluated the models by using leave-one-participant-out cross-validation. Moreover, we discussed the importance of extracted health parameters in our models for loneliness prediction. Results: The gradient boosting and decision tree models predicted maternal social loneliness with weighted F1-scores of 0.897 and 0.872, respectively. Our results also show that loneliness is highly associated with activity intensity and activity distribution during the day. In addition, resting heart rate (HR) and resting HR variability (HRV) were correlated with loneliness. Conclusions: Our results show the potential benefit and feasibility of using passive sensing with a smartwatch to predict maternal loneliness. Our developed machine learning models achieved a high F1-score for loneliness prediction. We also show that intensity of activity, activity pattern, and resting HR and HRV are good predictors of loneliness. These results indicate the intervention opportunities made available by wearable devices and predictive models to improve maternal well-being through early detection of loneliness. %M 37556183 %R 10.2196/47950 %U https://formative.jmir.org/2023/1/e47950 %U https://doi.org/10.2196/47950 %U http://www.ncbi.nlm.nih.gov/pubmed/37556183 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45293 %T Stimulating the Uptake of Preconception Care by Women With a Vulnerable Health Status Through mHealth App–Based Nudging (Pregnant Faster): Cocreation Design and Protocol for a Cohort Study %A Smith,Sharissa M %A Bais,Babette %A Ismaili M'hamdi,Hafez %A Schermer,Maartje H N %A Steegers-Theunissen,Regine P M %+ Department of Obstetrics and Gynecology, Erasmus University Medical Center, Doctor Molewaterplein 40, Rotterdam, 3015GD, Netherlands, 31 0107040704, r.steegers@erasmusmc.nl %K preconception care %K periconception %K health inequality %K socioeconomic status %K lifestyle %K ethics %K mobile health %K mHealth %K mental stressor %K pregnancy %K mobile phone %D 2023 %7 9.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Women with a low socioeconomic status often have a vulnerable health status due to an accumulation of health-deteriorating factors such as poor lifestyle behaviors, including inadequate nutrition, mental stressors, and impaired health literacy and agency, which puts them at an unnecessary high risk of adverse pregnancy outcomes. Adequately preparing for pregnancy through preconception care (PCC) uptake and lifestyle improvement can improve these outcomes. We hypothesize that nudging is a successful way of encouraging engagement in PCC. A nudge is a behavioral intervention that changes choice behavior through influencing incentives. The mobile health (mHealth) app–based loyalty program Pregnant Faster aims to reward women in an ethically justified way and nudges to engage in pregnancy preparation by visiting a PCC consultation. Objective: Here, we first describe the process of the cocreation of the mHealth app Pregnant Faster that aims to increase engagement in pregnancy preparation by women with a vulnerable health status. Second, we describe the cohort study design to assess the feasibility of Pregnant Faster. Methods: The content of the app is based on the eHealth lifestyle coaching program Smarter Pregnancy, which has proven to be effective in ameliorating preconceptional lifestyle behaviors (folic acid, vegetables, fruits, smoking, and alcohol) and an interview study pertaining to the preferences of the target group with regard to an mHealth app stimulating PCC uptake. For moral guidance on the design, an ethical framework was developed based on the bioethical principles of Beauchamp and Childress. The app was further developed through iterative cocreation with the target group and health care providers. For 4 weeks, participants will engage with Pregnant Faster, during which opportunities will arise to earn coins such as reading informative blogs and registering for a PCC consultation. Coins can be spent on small fun rewards, such as folic acid, fruits, and mascara. Pregnant Faster’s feasibility will be tested in a study including 40 women aged 18 to 45 years, who are preconceptional or <8 weeks pregnant, with a low educational level, and living in a deprived neighborhood. The latter 2 factors will serve as a proxy of a low socioeconomic status. Recruitment will take place through flyers, social media, and health care practices. After finalization, participants will evaluate the app through the “mHealth App Usability Questionnaire” and additional interviews or questionnaires. Results: Results are expected to be published by December 2023. Conclusions: Pregnant Faster has been designed through iterative cocreation with the target group and health care professionals. With the designed study, we will test Pregnant Faster’s feasibility. If overall user satisfaction and PCC uptake is achieved, the app will be further developed and the cohort will be continued with an additional 400 inclusions to establish effectiveness. International Registered Report Identifier (IRRID): DERR1-10.2196/45293 %M 37556197 %R 10.2196/45293 %U https://www.researchprotocols.org/2023/1/e45293 %U https://doi.org/10.2196/45293 %U http://www.ncbi.nlm.nih.gov/pubmed/37556197 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47158 %T The Impact of a Mobile Support Group on Distress and Physical Activity in Breast Cancer Survivors: Randomized, Parallel-Group, Open-Label, Controlled Trial %A Jung,Miyeon %A Lee,Sae Byul %A Lee,Jong Won %A Park,Yu Rang %A Chung,Haekwon %A Min,Yul Ha %A Park,Hye Jin %A Lee,Minsun %A Chung,Seockhoon %A Son,Byung Ho %A Ahn,Sei-Hyun %A Chung,Il Yong %+ Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Olympicro 88 43gil, Seoul, 05505, Republic of Korea, 82 2 3010 3998, doorkeeper1@gmail.com %K breast neoplasms %K mental distress %K mobile apps %K mobile health intervention %K mobile phone %K physical activity %K randomized controlled trial %K RCT %K support group %K survivorship %K telemedicine %D 2023 %7 7.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: While mobile health apps have demonstrated their potential in revolutionizing health behavior changes, the impact of a mobile community built on these apps on the level of physical activity and mental well-being in cancer survivors remains unexplored. Objective: In this randomized controlled trial, we examine the effects of participation in a mobile health community specifically designed for breast cancer survivors on their physical activity levels and mental distress. Methods: We performed a single-center, randomized, parallel-group, open-label, controlled trial. This trial enrolled women between 20 and 60 years of age with stage 0 to III breast cancer, an Eastern Cooperative Oncology Group performance status of 0, and the capability of using their own smartphone apps. From January 7, 2019, to April 17, 2020, a total of 2,616 patients were consecutively screened for eligibility after breast cancer surgery. Overall, 202 patients were enrolled in this trial, and 186 patients were randomly assigned (1:1) to either the intervention group (engagement in a mobile peer support community using an app for tracking steps; n=93) or the control group (using the app for step tracking only; n=93) with a block size of 10 without stratification. The mobile app provides a visual interface of daily step counts, while the community function also provides rankings among its members and regular notifications encouraging physical activity. The primary end point was the rate of moderate to severe distress for the 24-week study period, measured through an app-based survey using the Distress Thermometer. The secondary end point was the total weekly steps during the 24-week period. Results: After excluding dropouts, 85 patients in the intervention group and 90 patients in the control group were included in the analysis. Multivariate analyses showed that patients in the intervention group had a significantly lower degree of moderate to severe distress (B=–0.558; odds ratio 0.572; P<.001) and a higher number of total weekly step counts (B=0.125; rate ratio 1.132; P<.001) during the 24-week period. Conclusions: Engagement in a mobile app–based patient community was effective in reducing mental distress and increasing physical activity in breast cancer survivors. Trial Registration: ClinicalTrials.gov NCT03783481; https://classic.clinicaltrials.gov/ct2/show/NCT03783481 %M 37549004 %R 10.2196/47158 %U https://www.jmir.org/2023/1/e47158 %U https://doi.org/10.2196/47158 %U http://www.ncbi.nlm.nih.gov/pubmed/37549004 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e44388 %T Assessing Mood With the Identifying Depression Early in Adolescence Chatbot (IDEABot): Development and Implementation Study %A Viduani,Anna %A Cosenza,Victor %A Fisher,Helen L %A Buchweitz,Claudia %A Piccin,Jader %A Pereira,Rivka %A Kohrt,Brandon A %A Mondelli,Valeria %A van Heerden,Alastair %A Araújo,Ricardo Matsumura %A Kieling,Christian %+ Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, 90035003, Brazil, 55 5133085624, ckieling@ufrgs.com %K depression %K adolescent %K ambulatory assessment %K chatbot %K smartphone %K digital mental health %K mobile phone %D 2023 %7 7.8.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mental health status assessment is mostly limited to clinical or research settings, but recent technological advances provide new opportunities for measurement using more ecological approaches. Leveraging apps already in use by individuals on their smartphones, such as chatbots, could be a useful approach to capture subjective reports of mood in the moment. Objective: This study aimed to describe the development and implementation of the Identifying Depression Early in Adolescence Chatbot (IDEABot), a WhatsApp-based tool designed for collecting intensive longitudinal data on adolescents’ mood. Methods: The IDEABot was developed to collect data from Brazilian adolescents via WhatsApp as part of the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo) study. It supports the administration and collection of self-reported structured items or questionnaires and audio responses. The development explored WhatsApp’s default features, such as emojis and recorded audio messages, and focused on scripting relevant and acceptable conversations. The IDEABot supports 5 types of interactions: textual and audio questions, administration of a version of the Short Mood and Feelings Questionnaire, unprompted interactions, and a snooze function. Six adolescents (n=4, 67% male participants and n=2, 33% female participants) aged 16 to 18 years tested the initial version of the IDEABot and were engaged to codevelop the final version of the app. The IDEABot was subsequently used for data collection in the second- and third-year follow-ups of the IDEA-RiSCo study. Results: The adolescents assessed the initial version of the IDEABot as enjoyable and made suggestions for improvements that were subsequently implemented. The IDEABot’s final version follows a structured script with the choice of answer based on exact text matches throughout 15 days. The implementation of the IDEABot in 2 waves of the IDEA-RiSCo sample (140 and 132 eligible adolescents in the second- and third-year follow-ups, respectively) evidenced adequate engagement indicators, with good acceptance for using the tool (113/140, 80.7% and 122/132, 92.4% for second- and third-year follow-up use, respectively), low attrition (only 1/113, 0.9% and 1/122, 0.8%, respectively, failed to engage in the protocol after initial interaction), and high compliance in terms of the proportion of responses in relation to the total number of elicited prompts (12.8, SD 3.5; 91% out of 14 possible interactions and 10.57, SD 3.4; 76% out of 14 possible interactions, respectively). Conclusions: The IDEABot is a frugal app that leverages an existing app already in daily use by our target population. It follows a simple rule-based approach that can be easily tested and implemented in diverse settings and possibly diminishes the burden of intensive data collection for participants by repurposing WhatsApp. In this context, the IDEABot appears as an acceptable and potentially scalable tool for gathering momentary information that can enhance our understanding of mood fluctuations and development. %M 37548996 %R 10.2196/44388 %U https://humanfactors.jmir.org/2023/1/e44388 %U https://doi.org/10.2196/44388 %U http://www.ncbi.nlm.nih.gov/pubmed/37548996 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46839 %T A Novel Mobile App for Personalized Dietary Advice Leveraging Persuasive Technology, Computer Vision, and Cloud Computing: Development and Usability Study %A Guan,Vivienne %A Zhou,Chenghuai %A Wan,Hengyi %A Zhou,Rengui %A Zhang,Dongfa %A Zhang,Sihan %A Yang,Wangli %A Voutharoja,Bhanu Prakash %A Wang,Lei %A Win,Khin Than %A Wang,Peng %+ School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Bldg 41 Northfields Ave, Wollongong, New South Wales, 2522, Australia, 61 2 4221 3555, vguan@uow.edu.au %K food %K diet %K mobile health %K mHealth %K persuasive technology %K gamification %K computer vision %K cloud computing %K design science research %K mobile phone %D 2023 %7 7.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The Australian Dietary Guidelines (ADG) translate the best available evidence in nutrition into food choice recommendations. However, adherence to the ADG is poor in Australia. Given that following a healthy diet can be a potentially cost-effective strategy for lowering the risk of chronic diseases, there is an urgent need to develop novel technologies for individuals to improve their adherence to the ADG. Objective: This study describes the development process and design of a prototype mobile app for personalized dietary advice based on the ADG for adults in Australia, with the aim of exploring the usability of the prototype. The goal of the prototype was to provide personalized, evidence-based support for self-managing food choices in real time. Methods: The guidelines of the design science paradigm were applied to guide the design, development, and evaluation of a progressive web app using Amazon Web Services Elastic Compute Cloud services via iterations. The food layer of the Nutrition Care Process, the strategies of cognitive behavioral theory, and the ADG were translated into prototype features guided by the Persuasive Systems Design model. A gain-framed approach was adopted to promote positive behavior changes. A cross-modal image-to-recipe retrieval model under an Apache 2.0 license was deployed for dietary assessment. A survey using the Mobile Application Rating Scale and semistructured in-depth interviews were conducted to explore the usability of the prototype through convenience sampling (N=15). Results: The prominent features of the prototype included the use of image-based dietary assessment, food choice tracking with immediate feedback leveraging gamification principles, personal goal setting for food choices, and the provision of recipe ideas and information on the ADG. The overall prototype quality score was “acceptable,” with a median of 3.46 (IQR 2.78-3.81) out of 5 points. The median score of the perceived impact of the prototype on healthy eating based on the ADG was 3.83 (IQR 2.75-4.08) out of 5 points. In-depth interviews identified the use of gamification for tracking food choices and innovation in the image-based dietary assessment as the main drivers of the positive user experience of using the prototype. Conclusions: A novel evidence-based prototype mobile app was successfully developed by leveraging a cross-disciplinary collaboration. A detailed description of the development process and design of the prototype enhances its transparency and provides detailed insights into its creation. This study provides a valuable example of the development of a novel, evidence-based app for personalized dietary advice on food choices using recent advancements in computer vision. A revised version of this prototype is currently under development. %M 37549000 %R 10.2196/46839 %U https://formative.jmir.org/2023/1/e46839 %U https://doi.org/10.2196/46839 %U http://www.ncbi.nlm.nih.gov/pubmed/37549000 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44638 %T Mindfulness-Based Mobile Apps and Their Impact on Well-Being in Nonclinical Populations: Systematic Review of Randomized Controlled Trials %A Schwartz,Katrin %A Ganster,Fabienne Marie %A Tran,Ulrich S %+ Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Liebiggasse 5, Vienna, 1010, Austria, 43 4277471 ext 19, ulrich.tran@univie.ac.at %K mindfulness %K well-being %K mobile app %K systematic review %K randomized controlled trial %K RCT %K mobile phone %D 2023 %7 4.8.2023 %9 Review %J J Med Internet Res %G English %X Background: Mindfulness-based mobile apps have become popular tools for enhancing well-being in today’s fast-paced world. Their ability to reduce geographical, financial, and social barriers makes them a promising alternative to traditional interventions. Objective: As most available apps lack a theoretical framework, this review aimed to evaluate their effectiveness and assess their quality. We expected to find small sample sizes, high dropout rates, and small effect sizes in the included studies. Methods: A systematic literature search was conducted using PsycInfo, PsycNet, PubMed, an institutional search engine (u:search), and Google Scholar. Randomized controlled trials assessing the impact of mobile mindfulness apps on well-being in nonclinical samples were included. Study selection, risk of bias (using the version 2 of the Cochrane risk-of-bias tool for randomized trials), and reporting quality (using selected CONSORT [Consolidated Standards of Reporting Trials] statement criteria) assessments were performed by 2 authors independently and discussed until a consensus was reached. Results: The 28 included randomized controlled trials differed in well-being measures, apps, and intervention duration (7 to 56 days; median duration 28 days). A wide range of sample sizes (12 to 2282; median 161) and attrition rates (0% to 84.7%; median rate 23.4%) were observed. Most studies (19/28, 68%) reported positive effects on at least one aspect of well-being. The effects were presented using different metrics but were primarily small or small to medium in size. Overall risk of bias was mostly high. Conclusions: The wide range of sample sizes, attrition rates, and intervention periods and the variation in well-being measures and mobile apps contributed to the limited comparability of the studies. Although most studies (16/28, 57%) reported small or small to medium effects for at least one well-being outcome, this review demonstrates that the generalizability of the results is limited. Further research is needed to obtain more consistent conclusions regarding the impact of mindfulness-based mobile apps on well-being in nonclinical populations. %M 37540550 %R 10.2196/44638 %U https://www.jmir.org/2023/1/e44638 %U https://doi.org/10.2196/44638 %U http://www.ncbi.nlm.nih.gov/pubmed/37540550 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e45079 %T The Use of a Decision Support System (MyFood) to Assess Dietary Intake Among Free-Living Older Adults in Norway: Evaluation Study %A Severinsen,Frida %A Andersen,Lene Frost %A Paulsen,Mari Mohn %+ Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Postboks 1046, Blindern, Oslo, 0317, Norway, 47 95772048, m.m.paulsen@medisin.uio.no %K dietary assessment %K malnutrition %K eHealth %K validation study %K older adults %K mobile phone %D 2023 %7 3.8.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The proportion of older adults in the world is constantly increasing, and malnutrition is a common challenge among the older adults aged ≥65 years. This poses a need for better tools to prevent, assess, and treat malnutrition among older adults. MyFood is a decision support system developed with the intention to prevent and treat malnutrition. Objective: This study aimed to evaluate the ability of the MyFood app to estimate the intake of energy, protein, fluids, and food and beverage items among free-living older adults aged ≥65 years, primarily at an individual level and secondarily at a group level. In addition, the aim was to measure the experiences of free-living older adults using the app. Methods: Participants were instructed to record their dietary intake in the MyFood app for 4 consecutive days. In addition, each participant completed two 24-hour recalls, which were used as a reference method to evaluate the dietary assessment function in the MyFood app. Differences in the estimations of energy, protein, fluid, and food groups were analyzed at both the individual and group levels, by comparing the recorded intake in MyFood with the 2 corresponding recalls and by comparing the mean of all 4 recording days with the mean of the 2 recalls, respectively. A short, study-specific questionnaire was used to measure the participants’ experiences with the app. Results: This study included 35 free-living older adults residing in Norway. Approximately half of the participants had ≥80% agreement between MyFood and the 24-hour recalls for energy intake on both days. For protein and fluids, approximately 60% of the participants had ≥80% agreement on the first day of comparison. Dinner was the meal with the lowest agreement between the methods, at both the individual and group levels. MyFood tended to underestimate the intake of energy, protein, fluid, and food items at both the individual and group levels. The food groups that achieved the greatest agreement between the 2 methods were eggs, yogurt, self-composed dinner, and hot beverages. All participants found the app easy to use, and 74% (26/35) of the participants reported that the app was easy to navigate. Conclusions: The results showed that the MyFood app tended to underestimate the participants’ dietary intake compared with the 24-hour recalls at both the individual and group levels. The app’s ability to estimate intake within food groups was greater for eggs, yogurt, and self-composed dinner than for spreads, mixed meals, vegetables, and snacks. The app was well accepted among the study participants and may be a useful tool among free-living older adults, given that the users are provided follow-up and support in how to record their dietary intake. %M 37535420 %R 10.2196/45079 %U https://mhealth.jmir.org/2023/1/e45079 %U https://doi.org/10.2196/45079 %U http://www.ncbi.nlm.nih.gov/pubmed/37535420 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e48270 %T Accuracy and Reliability of a Suite of Digital Measures of Walking Generated Using a Wrist-Worn Sensor in Healthy Individuals: Performance Characterization Study %A Kowahl,Nathan %A Shin,Sooyoon %A Barman,Poulami %A Rainaldi,Erin %A Popham,Sara %A Kapur,Ritu %+ Verily Life Sciences, 269 E Grand Ave, South San Francisco, CA, 94080, United States, 1 415 504 2681, natekowahl@verily.com %K digital measurements %K wearable technology %K mobility measurements %K walking patterns %K wearable %K wearables %K sensor %K sensors %K mobility %K measurement %K measurements %K walk %K walking %K gait %K step %K wrist-worn %K reliability %K accuracy %D 2023 %7 3.8.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobility is a meaningful aspect of an individual’s health whose quantification can provide clinical insights. Wearable sensor technology can quantify walking behaviors (a key aspect of mobility) through continuous passive monitoring. Objective: Our objective was to characterize the analytical performance (accuracy and reliability) of a suite of digital measures of walking behaviors as critical aspects in the practical implementation of digital measures into clinical studies. Methods: We collected data from a wrist-worn device (the Verily Study Watch) worn for multiple days by a cohort of volunteer participants without a history of gait or walking impairment in a real-world setting. On the basis of step measurements computed in 10-second epochs from sensor data, we generated individual daily aggregates (participant-days) to derive a suite of measures of walking: step count, walking bout duration, number of total walking bouts, number of long walking bouts, number of short walking bouts, peak 30-minute walking cadence, and peak 30-minute walking pace. To characterize the accuracy of the measures, we examined agreement with truth labels generated by a concurrent, ankle-worn, reference device (Modus StepWatch 4) with known low error, calculating the following metrics: intraclass correlation coefficient (ICC), Pearson r coefficient, mean error, and mean absolute error. To characterize the reliability, we developed a novel approach to identify the time to reach a reliable readout (time to reliability) for each measure. This was accomplished by computing mean values over aggregation scopes ranging from 1 to 30 days and analyzing test-retest reliability based on ICCs between adjacent (nonoverlapping) time windows for each measure. Results: In the accuracy characterization, we collected data for a total of 162 participant-days from a testing cohort (n=35 participants; median observation time 5 days). Agreement with the reference device–based readouts in the testing subcohort (n=35) for the 8 measurements under evaluation, as reflected by ICCs, ranged between 0.7 and 0.9; Pearson r values were all greater than 0.75, and all reached statistical significance (P<.001). For the time-to-reliability characterization, we collected data for a total of 15,120 participant-days (overall cohort N=234; median observation time 119 days). All digital measures achieved an ICC between adjacent readouts of >0.75 by 16 days of wear time. Conclusions: We characterized the accuracy and reliability of a suite of digital measures that provides comprehensive information about walking behaviors in real-world settings. These results, which report the level of agreement with high-accuracy reference labels and the time duration required to establish reliable measure readouts, can guide the practical implementation of these measures into clinical studies. Well-characterized tools to quantify walking behaviors in research contexts can provide valuable clinical information about general population cohorts and patients with specific conditions. %M 37535417 %R 10.2196/48270 %U https://humanfactors.jmir.org/2023/1/e48270 %U https://doi.org/10.2196/48270 %U http://www.ncbi.nlm.nih.gov/pubmed/37535417 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44323 %T The Influence of Greenspace Exposure on Affect in People With and Those Without Schizophrenia: Exploratory Study %A Kangarloo,Tairmae %A Mote,Jasmine %A Abplanalp,Samuel %A Gold,Alisa %A James,Peter %A Gard,David %A Fulford,Daniel %+ Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, United States, 1 6035681431, tairmaek@bu.edu %K greenspace %K mental health %K mobile technology %K affect %K smartphone %K sensing %K schizophrenia %K natural vegetation %K mental health %K exposure %K assessment %K mechanism %D 2023 %7 3.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Exposure to natural vegetation (ie, “greenspace”) is related to beneficial outcomes, including higher positive and lower negative affect, in individuals with and those without mental health concerns. Researchers have yet to examine dynamic associations between greenspace exposure and affect within individuals over time. Smartphone-based ecological momentary assessment (EMA) and passive sensors (eg, GPS, microphone) allow for frequent sampling of data that may reveal potential moment-to-moment mechanisms through which greenspace exposure impacts mental health. Objective: In this study, we examined associations between greenspace exposure and affect (both self-reported and inferred through speech) in people with and those without schizophrenia spectrum disorder (SSD) at the daily level using smartphones. Methods: Twenty people with SSD and 14 healthy controls reported on their current affect 3 times per day over 7 days using smartphone-based EMA. Affect expressed through speech was labeled from ambient audio data collected via the phone’s microphone using Linguistic Inquiry and Word Count (LIWC). Greenspace exposure, defined as the normalized difference vegetation index (NDVI), was quantified based on continuous geo-location data collected from the phone’s GPS. Results: Overall, people with SSD used significantly more positive affect words (P=.04) and fewer anger words (P=.04) than controls. Groups did not significantly differ in mean EMA-reported positive or negative affect, LIWC total word count, or NDVI exposure. Greater greenspace exposure showed small to moderate associations with lower EMA-reported negative affect across groups. In controls, greenspace exposure on a given day was associated with significantly lower EMA-reported anxiety on that day (b=–0.40, P=.03, 95% CI –0.76 to –0.04) but significantly higher use of negative affect words (b=0.66, P<.001, 95% CI 0.29-1.04). There were no significant associations between greenspace exposure and affect at the daily level among participants with SSD. Conclusions: Our findings speak to the utility of passive and active smartphone assessments for identifying potential mechanisms through which greenspace exposure influences mental health. We identified preliminary evidence that greenspace exposure could be associated with improved mental health by reducing experiences of negative affect. Future directions will focus on furthering our understanding of the relationship between greenspace exposure and affect on individuals with and those without SSD. %M 37535418 %R 10.2196/44323 %U https://formative.jmir.org/2023/1/e44323 %U https://doi.org/10.2196/44323 %U http://www.ncbi.nlm.nih.gov/pubmed/37535418 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43493 %T Using a Geosocial Networking App to Investigate New HIV Infections and Related Risk Factors Among Student and Nonstudent Men Who Have Sex With Men in Chengdu, China: Open Cohort Study %A Dai,Zhen %A Mi,Guodong %A Yu,Fei %A Chen,Guodong %A Wang,Xiaodong %A He,Qinying %+ Department of Sexually Transmitted Disease, AIDS Prevention and Control, Chengdu Center for Disease Control and Prevention, Longxiang Road 4, Wuhou District, Chengdu, 610041, China, 86 028 87033114, 78004693@qq.com %K geosocial networking app %K GSN app %K young men who have sex with men %K MSM %K HIV %K incidence %K risk factors %K cohort study %K smartphone %K mobile phone %D 2023 %7 28.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In China, condomless sex among men who have sex with men (MSM) is the primary route of HIV infection in young people. Chengdu is a hotspot for reported HIV cases among young people nationwide. Extensive use of geosocial networking (GSN) smartphone apps has dramatically changed the pattern of sexual behavior among young MSM (YMSM). However, data on HIV incidence and the risk behavior of YMSM using the GSN app are still obscure. Objective: This study aims to analyze and understand the HIV incidence and its risk factors among YMSM using GSN apps in Chengdu, China. Methods: An open cohort study was conducted among YMSM aged 18-24 years through a gay GSN smartphone app in Chengdu, China, from July 2018 to December 2020. Every participant completed a web-based questionnaire on sociodemographic characteristics, sexual behaviors, and other related statuses; made a reservation for a web-based HIV testing; and then voluntarily got tested at the designated testing site. At least one additional HIV test was taken via the app during the study period, and participants were evaluated at the end of the study or at the time of HIV seroconversion. By dividing the sum of the observed HIV seroconversions by the observed person-years, HIV incidence was calculated and compared between the student and nonstudent MSM. Univariate and multivariate (Cox proportional hazards regression) analyses were used to discuss the risk factors for new HIV infections. Results: In the study cohort, 24 seroconversions occurred among 625 YMSM who took at least two HIV tests through the app during the study period, contributing to 505 observed person-years. The HIV incidence rate per 100 person-years was 4.75 (95% CI 2.89-6.61) among all MSM, 3.60 (95% CI 1.27-5.93) among student MSM, and 5.88 (95% CI 2.97-8.79) among nonstudent MSM. In addition, the HIV incidence per 100 person-years was 11.11 (95% CI 4.49-17.73) among those who had resided in the area for 6 months or less and 7.14 (95% CI 1.52-12.77) among those with senior high school or less education. Two or more sexual partners (adjusted hazards ratio [HR] 3.63, 95% CI 1.08-12.23) in the preceding 6 months was a risk factor for new HIV infections. Consistent condom use for anal sex (adjusted HR 0.38, 95% CI 0.16-0.88) and insertive anal sex only (adjusted HR 0.10, 95% CI 0.01-0.75) in the preceding 6 months were protective factors for new HIV infections. Conclusions: The rate of new HIV infections among YMSM who actively used GSN smartphone apps was high, especially among migrant nonstudent MSM. Targeted interventions on GSN smartphone apps should be implemented to provide demand-adapted prevention and services to reduce the threat of HIV. %M 37505891 %R 10.2196/43493 %U https://www.jmir.org/2023/1/e43493 %U https://doi.org/10.2196/43493 %U http://www.ncbi.nlm.nih.gov/pubmed/37505891 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47320 %T Studying Movement-Related Behavioral Maintenance and Adoption in Real Time: Protocol for an Intensive Ecological Momentary Assessment Study Among Older Adults %A Maher,Jaclyn P %A Hevel,Derek J %A Bittel,Kelsey M %A Hudgins,Brynn L %A Labban,Jeffery D %A Kennedy-Malone,Laurie %+ Department of Kinesiology, University of North Carolina Greensboro, 1408 Walker Avenue, Coleman Bldg, Rm 250, Greensboro, NC, 27401, United States, 1 3362561379, jpmaher@uncg.edu %K physical activity %K sedentary behavior %K aging %K multiburst design %K ambulatory assessment %K experience sampling method %K accelerometers %K stage of change %K dual process %K motivation %K mobile phone %D 2023 %7 28.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older adults struggle to maintain newly initiated levels of physical activity (PA) or sedentary behavior (SB) and often regress to baseline levels over time. This is partly because health behavior theories that inform interventions rarely address how the changing contexts of daily life influence the processes regulating PA and SB or how those processes differ across the behavior change continuum. Few studies have focused on motivational processes that regulate the dynamic nature of PA and SB adoption and maintenance on microtimescales (ie, across minutes, hours, or days). Objective: The overarching goal of Project Studying Maintenance and Adoption in Real Time (SMART) is to determine the motivational processes that regulate behavioral adoption versus maintenance over microtimescales, using a dual process framework combined with ecological momentary assessment and sensor-based monitoring of behavior. This paper describes the recruitment, enrollment, data collection, and analytics protocols for Project SMART. Methods: In Project SMART, older adults engaging in at least 30 minutes of moderate-to-vigorous intensity PA per week complete 3 data collection periods over 1 year, with each data collection period lasting 14 days. Across each data collection period, participants wear an ActiGraph GT3X accelerometer (ActiGraph, LLC) on their nondominant waist and an ActivPAL micro4 accelerometer (PAL Technologies, Ltd) on their anterior thigh to measure PA and SB, respectively. Ecological momentary assessment questionnaires are randomly delivered via smartphone 10 times per day on 4 selected days in each data collection period and assess reflective processes (eg, evaluating one’s efficacy and exerting self-control) and reactive processes (eg, contextual cues) within the dual process framework. At the beginning and end of each data collection period, participants complete a computer-based questionnaire to learn more about their typical motivation for PA and SB, physical and mental health, and life events over the course of the study. Results: Recruitment and enrollment began in January 2021; enrollment in the first data collection period was completed by February 2022; and all participants completed their second and third data collection by July 2022 and December 2022, respectively. Data were collected from 202 older adults during the first data collection period, with approximate retention rates of 90.1% (n=182) during the second data collection period and 88.1% (n=178) during the third data collection period. Multilevel models and mixed-effects location scale modeling will be used to evaluate the study aims. Conclusions: Project SMART seeks to predict and model the adoption and maintenance of optimal levels of PA and SB among older adults. In turn, this will inform the future delivery of personalized intervention content under conditions where the content will be most effective to promote sustained behavior change among older adults. International Registered Report Identifier (IRRID): DERR1-10.2196/47320 %M 37505805 %R 10.2196/47320 %U https://www.researchprotocols.org/2023/1/e47320 %U https://doi.org/10.2196/47320 %U http://www.ncbi.nlm.nih.gov/pubmed/37505805 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44079 %T The Effectiveness and Cost-Effectiveness of a Universal Digital Parenting Intervention Designed and Implemented During the COVID-19 Pandemic: Evidence From a Rapid-Implementation Randomized Controlled Trial Within a Cohort %A Palmer,Melanie %A Beckley-Hoelscher,Nicholas %A Shearer,James %A Kostyrka-Allchorne,Katarzyna %A Robertson,Olly %A Koch,Marta %A Pearson,Oliver %A Slovak,Petr %A Day,Crispin %A Byford,Sarah %A Goldsmith,Kimberley %A Waite,Polly %A Creswell,Cathy %A Sonuga-Barke,Edmund J S %+ Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 0207 848 0269, edmund.sonuga-barke@kcl.ac.uk %K parenting %K intervention %K digital application %K randomized controlled trial %K COVID-19 pandemic %K mobile phone %D 2023 %7 27.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Children’s conduct and emotional problems increased during the COVID-19 pandemic. Objective: We tested whether a smartphone parenting support app, Parent Positive, developed specifically for this purpose, reversed these effects in a cost-effective way. Parent Positive includes 3 zones. Parenting Boosters (zone 1) provided content adapted from standard face-to-face parent training programs to tackle 8 specific challenges identified by parents and parenting experts as particularly relevant for parents during the pandemic. The Parenting Exchange (zone 2) was a parent-to-parent and parent-to-expert communication forum. Parenting Resources (zone 3) provided access to existing high-quality web-based resources on a range of additional topics of value to parents (eg, neurodevelopmental problems, diet, and sleep). Methods: Supporting Parents And Kids Through Lockdown Experiences (SPARKLE), a randomized controlled trial, was embedded in the UK-wide COVID-19: Supporting Parents, Adolescents and Children during Epidemics (Co-SPACE) longitudinal study on families’ mental health during the pandemic. Parents of children aged 4 to 10 years were randomized 1:1 to Parent Positive or follow-up as usual (FAU) between May 19, 2021, and July 26, 2021. Parent Positive provided advice on common parenting challenges and evidence-based web-based resources and facilitated parent-to-parent and expert-to-parent support. Child conduct and emotional problems and family well-being were measured before randomization (T1) and at 1 (T2) and 2 (T3) months after randomization. Service use, costs, and adverse events were measured, along with app use and satisfaction. The primary outcome was T2 parent-reported child conduct problems, which were analyzed using linear mixed regression models. Results: A total of 320 participants were randomized to Parent Positive, and 326 were randomized to FAU. The primary outcome analysis included 79.3% (512/646) of the participants (dropout: 84/320, 26% on Parent Positive and 50/326, 15% on FAU). There were no statistically significant intervention effects on conduct problems at either T2 (standardized effect=−0.01) or T3 (secondary outcome; standardized effect=−0.09) and no moderation by baseline conduct problems. Significant intervention-related reductions in emotional problems were observed at T2 and T3 (secondary outcomes; standardized effect=−0.13 in both cases). Parent Positive, relative to FAU, was associated with more parental worries at T3 (standardized effect=0.14). Few intervention-attributable adverse events were reported. Parent Positive was cost-effective once 4 outliers with extremely high health care costs were excluded. Conclusions: Parent Positive reduced child emotional problems and was cost-effective compared with FAU once outliers were removed. Although small when considered against targeted therapeutic interventions, the size of these effects was in line with trials of nontargeted universal mental health interventions. This highlights the public health potential of Parent Positive if implemented at the community level. Nevertheless, caution is required before making such an interpretation, and the findings need to be replicated in large-scale, whole-community studies. Trial Registration: ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080 %M 37498669 %R 10.2196/44079 %U https://www.jmir.org/2023/1/e44079 %U https://doi.org/10.2196/44079 %U http://www.ncbi.nlm.nih.gov/pubmed/37498669 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45027 %T Boosting Empathy and Compassion Through Mindfulness-Based and Socioemotional Dyadic Practice: Randomized Controlled Trial With App-Delivered Trainings %A Silveira,Sarita %A Godara,Malvika %A Singer,Tania %+ Social Neuroscience Lab, Max Planck Society, Bertha-Benz-Str 3, Berlin, 10557, Germany, 49 030 23608 1512, sarita.silveira@social.mpg.de %K mental training %K compassion %K empathy %K mindfulness %K dyadic practice %K acceptance %K digital mental health %K self-compassion %K app-delivered training %K Affect Dyad %K mobile phone %D 2023 %7 26.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Contemplative trainings have been found to effectively improve social skills such as empathy and compassion. However, there is a lack of research on the efficacy of app-delivered mindfulness-based and dyadic practices in boosting socioaffective capacity. Objective: The first aim of this study was to compare a novel app-delivered, partner-based socioemotional intervention (Affect Dyad) with mindfulness-based training to foster empathy and compassion for the self or others. The second aim of this study was to investigate the underlying mechanisms of these effects. Methods: This randomized controlled trial included socioemotional and mindfulness-based interventions and a waitlist control group, which received socioemotional training after the postintervention assessment. We used linear mixed-effects models to test intervention effects on self-report measures and an ecologically valid computer task of empathy, compassion for the self and others, and theory of mind. Moderated mediation models were used to investigate whether changes in acceptance, empathic distress, empathic listening, interoceptive awareness, and mindfulness served as underlying psychological processes of intervention effects. Results: In 218 participants (mean age 44.12, SD 11.71 years; 160/218, 73.4% female), we found all interventions to have positive effects on composite scores for compassion toward the self (βsocioemotional=.44, P<.001; βwaitlist socioemotional=.30, P=.002; βmindfulness-based=.35, P<.001) and others (βsocioemotional=.24, P=.003; βwaitlist socioemotional=.35, P<.001; βmindfulness-based=.29, P<.001). Compassion measured with the computer task did not change significantly but showed a trend toward increase only in socioemotional dyadic practice (βsocioemotional=.08, P=.08; βwaitlist socioemotional=.11, P=.06). Similarly, on the empathic concern subscale of the Interpersonal Reactivity Index, a nonsignificant trend toward increase was found in the socioemotional intervention group (βsocioemotional=.17; P=.08). Empathy significantly increased in both socioemotional groups (βsocioemotional=.16, P=.03; βwaitlist socioemotional=.35, P<.001) and the mindfulness-based group (βmindfulness-based=.15; P=.04). The measures of theory of mind did not change over time. In the mindfulness-based group, the increase in self-compassion was mediated by a decrease in empathic distress (indirect effect abmindfulness-based=0.07, 95% CI 0.02-0.14). In the socioemotional group, an increase in self-compassion could be predicted by an increase in acceptance (βsocioemotional=6.63, 95% CI 0.52-12.38). Conclusions: Using a multimethod approach, this study shows that app-delivered socioemotional and mindfulness-based trainings are effective in fostering compassion for the self and others in self-report. Both low-dose trainings could boost behavioral empathy markers; however, the effects on behavioral and dispositional markers of compassion only trended after dyadic practice, yet these effects did not reach statistical significance. Training-related increases in self-compassion rely on differential psychological processes, that is, on improved empathic distress regulation through mindfulness-based training and the activation of a human care– and acceptance-based system through socioemotional dyadic training. Trial Registration: ClinicalTrials.gov NCT04889508; https://clinicaltrials.gov/ct2/show/NCT04889508 %M 37494106 %R 10.2196/45027 %U https://www.jmir.org/2023/1/e45027 %U https://doi.org/10.2196/45027 %U http://www.ncbi.nlm.nih.gov/pubmed/37494106 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45098 %T Factors Influencing Nutritional Intake and Interests in Educational Content of Athletes and Sport Professionals Toward the Development of a Clinician-Supported Mobile App to Combat Relative Energy Deficiency in Sport: Formative Research and a Description of App Functions %A Mey,Jacob T %A Karpinski,Christine A %A Yang,Shengping %A Madere,Joseph D %A Piattoly,Tavis %A Harper,Ronnie %A Kirwan,John P %+ Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, United States, 1 2257632644, jacob.mey@pbrc.edu %K dietitian %K malnutrition %K mHealth %K mobile health %K performance %K RED-S %K relative energy deficiency in sport %K sports nutrition %K technology %D 2023 %7 26.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Relative energy deficiency in sport (RED-S) as a consequence of athlete malnutrition remains a prominent issue. However, it remains underrecognized, in part due to the perceived outward health of athletes. The Eat2Win app was designed to combat RED-S and athlete malnutrition by providing education, behavior modification, and direct communication with expert sports dietitians to athletes and sport professionals (professionals who work with athletes, eg, sport coaches and athletic trainers). Objective: The purpose of this formative research was to gain critical insight on motivators and barriers to optimal nutritional intake from both the athletes’ and sport professionals’ perspectives. Additionally, since these 2 groups represent the primary end users of an app aimed at improving athlete nutrition and reducing the risk of RED-S, a secondary objective was to gain insight on the preferences and perceptions of app-based educational content and functionality. Methods: An electronic survey was developed by an interdisciplinary team of experts. Survey questions were established based upon prevailing literature, professional dietetic field experience, and app design considerations to obtain respondent knowledge on key sports nutrition topics along with motivations and barriers to meal choices. Additionally, the survey included questions about the development of an integrative, clinician-support app aimed at addressing RED-S. These questions included preferences for educational content, modes of in-app information, and communication delivery for the target population (app end users: athletes and sport professionals). The survey was distributed through Research Electronic Data Capture (REDCap) to athletes and sport professionals using targeted email, social media, and community engagement campaigns. The electronic survey was available from May 4 to August 2, 2022. Results: Survey respondents (n=1352) included athletes and professionals who work with athletes from a variety of settings, like high school, collegiate, professional, and club sports. Respondents reported high interest in 8 core sports nutrition topics. The preferred modes of information and communication delivery were visual formats (eg, videos and infographics) and in-app alerts (eg, direct messaging and meal reminders). Only athlete respondents were asked about motivators and barriers that influence meal choices. “Health” and “sports performance” were the highest scoring motivators, while the highest scoring barriers were “cost of food,” “easy access to unhealthy food,” and “time to cook or prepare food.” Notably, survey respondents provided positive feedback and interest using a novel function of the app: real-time meal feedback through food photography. Conclusions: The Eat2Win app is designed to combat RED-S and athlete malnutrition. Results from this study provide critical information on end-user opinions and preferences and will be used to further develop the Eat2Win app. Future research will aim to determine whether the Eat2Win app can prevent RED-S and the risk of athlete malnutrition to improve both health and performance. %M 37494083 %R 10.2196/45098 %U https://formative.jmir.org/2023/1/e45098 %U https://doi.org/10.2196/45098 %U http://www.ncbi.nlm.nih.gov/pubmed/37494083 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42803 %T Intentional Self-Harm Among US Veterans With Traumatic Brain Injury or Posttraumatic Stress Disorder: Retrospective Cohort Study From 2008 to 2017 %A Rawat,Bhanu Pratap Singh %A Reisman,Joel %A Pogoda,Terri K %A Liu,Weisong %A Rongali,Subendhu %A Aseltine Jr,Robert H %A Chen,Kun %A Tsai,Jack %A Berlowitz,Dan %A Yu,Hong %A Carlson,Kathleen F %+ Manning College of Information and Computer Sciences, University of Massachusetts Amherst, 140 Governors Dr, Amherst, MA, 01002, United States, 1 4135452744, brawat@umass.edu %K self-harm %K suicide %K suicide attempt %K suicidal ideation %K veteran %K suicidal %K brain injury %K trauma %K posttraumatic stress disorder %K PTSD %K big data %K prevalence %K correlation %K risk factor %K traumatic brain injury %K TBI %D 2023 %7 24.7.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Veterans with a history of traumatic brain injury (TBI) and/or posttraumatic stress disorder (PTSD) may be at increased risk of suicide attempts and other forms of intentional self-harm as compared to veterans without TBI or PTSD. Objective: Using administrative data from the US Veterans Health Administration (VHA), we studied associations between TBI and PTSD diagnoses, and subsequent diagnoses of intentional self-harm among US veterans who used VHA health care between 2008 and 2017. Methods: All veterans with encounters or hospitalizations for intentional self-harm were assigned “index dates” corresponding to the date of the first related visit; among those without intentional self-harm, we randomly selected a date from among the veteran’s health care encounters to match the distribution of case index dates over the 10-year period. We then examined the prevalence of TBI and PTSD diagnoses within the 5-year period prior to veterans’ index dates. TBI, PTSD, and intentional self-harm were identified using International Classification of Diseases diagnosis and external cause of injury codes from inpatient and outpatient VHA encounters. We stratified analyses by veterans’ average yearly VHA utilization in the 5-year period before their index date (low, medium, or high). Variations in prevalence and odds of intentional self-harm diagnoses were compared by veterans’ prior TBI and PTSD diagnosis status (TBI only, PTSD only, and comorbid TBI/PTSD) for each VHA utilization stratum. Multivariable models adjusted for age, sex, race, ethnicity, marital status, Department of Veterans Affairs service-connection status, and Charlson Comorbidity Index scores. Results: About 6.7 million veterans with at least two VHA visits in the 5-year period before their index dates were included in the analyses; 86,644 had at least one intentional self-harm diagnosis during the study period. During the periods prior to veterans’ index dates, 93,866 were diagnosed with TBI only; 892,420 with PTSD only; and 102,549 with comorbid TBI/PTSD. Across all three VHA utilization strata, the prevalence of intentional self-harm diagnoses was higher among veterans diagnosed with TBI, PTSD, or TBI/PTSD than among veterans with neither diagnosis. The observed difference was most pronounced among veterans in the high VHA utilization stratum. The prevalence of intentional self-harm was six times higher among those with comorbid TBI/PTSD (6778/58,295, 11.63%) than among veterans with neither TBI nor PTSD (21,979/1,144,991, 1.92%). Adjusted odds ratios suggested that, after accounting for potential confounders, veterans with TBI, PTSD, or comorbid TBI/PTSD had higher odds of self-harm compared to veterans without these diagnoses. Among veterans with high VHA utilization, those with comorbid TBI/PTSD were 4.26 (95% CI 4.15-4.38) times more likely to receive diagnoses for intentional self-harm than veterans with neither diagnosis. This pattern was similar for veterans with low and medium VHA utilization. Conclusions: Veterans with TBI and/or PTSD diagnoses, compared to those with neither diagnosis, were substantially more likely to be subsequently diagnosed with intentional self-harm between 2008 and 2017. These associations were most pronounced among veterans who used VHA health care most frequently. These findings suggest a need for suicide prevention efforts targeted at veterans with these diagnoses. %M 37486751 %R 10.2196/42803 %U https://publichealth.jmir.org/2023/1/e42803 %U https://doi.org/10.2196/42803 %U http://www.ncbi.nlm.nih.gov/pubmed/37486751 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e46313 %T Digitally Based Blood Pressure Self-Monitoring Program That Promotes Hypertension Self-Management and Health Education Among Patients With Low-Income: Usability Study %A Poblete,Jacqueline Yareli %A Vawter,Natalie Lauren %A Lewis,Sydney Virginia %A Felisme,Earl Marc %A Mohn,Paloma Adriana %A Shea,Jennifer %A Northrup,Adam William %A Liu,Jie %A Al-Rousan,Tala %A Godino,Job Gideon %+ Laura Rodriguez Research Institute, Family Health Centers of San Diego, LRRI, 3rd Fl, 1750 Fifth Ave, San Diego, CA, 92101, United States, 1 619 515 2344, jobg@fhcsd.org %K hypertension %K blood pressure %K digital health %K health education %K self-measured blood pressure monitoring %K remote patient monitoring %D 2023 %7 24.7.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: According to evidence-based clinical guidelines, adults with hypertension are advised to self-monitor their blood pressure (BP) twice daily. Self-measured BP monitoring is a recommended strategy for improving hypertension management. Objective: We aimed to determine the feasibility and acceptability of a digitally based BP self-monitoring program that promotes hypertension self-management and health education among low-income patients. We hypothesized that the program would be highly feasible and acceptable and that at least 50% of the patients would use the monitor at the rate required for the reimbursement of the device’s cost (16 days of measurements in any 30-day period). Methods: Withings BPM Connect was deployed to patients at Family Health Centers of San Diego. Program elements included training, SMS text message reminders, and physician communication. Compliance, use, mean BP, and BP control status were calculated. A Kaplan-Meier time-to-event analysis was conducted to compare time to compliance between a strict definition (≥16 days in any rolling 30-day window) and a lenient definition (≥1 day per week for 4 consecutive weeks). A log-rank test was performed to determine whether the difference in time to compliance between the definitions was statistically significant. Mean systolic BP (SBP) and diastolic BP (DBP) before the intervention and after the intervention and mean change in SBP and DBP across patients were calculated. Paired sample t tests (2-tailed) were performed to assess the changes in SBP and DBP from before to after the intervention. Results: A total of 179 patients received the monitors. The mean changes in SBP and DBP from before to after the intervention were +2.62 (SE 1.26) mm Hg and +3.31 (SE 0.71) mm Hg, respectively. There was a statistically significant increase in both SBP and DBP after the intervention compared with before the intervention (P=.04 and P<.001). At the first and last measurements, 37.5% (63/168) and 48.8% (82/168) of the patients had controlled BP, respectively. During the observation period, 83.3% (140/168) of the patients had at least 1 controlled BP measurement. Use decreased over time, with 53.6% (90/168) of the patients using their monitor at week 2 and only 25% (42/168) at week 11. Although only 25.6% (43/168) achieved the strict definition of compliance, 42.3% (71/168) achieved the lenient definition of compliance. The median time to compliance was 130 days for the strict definition and 95 days for the lenient definition. The log-rank test showed a statistically significant difference in time to compliance between the compliance definitions (P<.001). Only 26.8% (45/168) complied with the measurement rate that would result in device cost reimbursement. Conclusions: Few patients used the monitors at a rate that would result in reimbursement, raising financial feasibility concerns. Plans for sustaining costs among low-income patients need to be further evaluated. %M 37486745 %R 10.2196/46313 %U https://humanfactors.jmir.org/2023/1/e46313 %U https://doi.org/10.2196/46313 %U http://www.ncbi.nlm.nih.gov/pubmed/37486745 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e45099 %T Using Intervention Mapping and Behavior Change Techniques to Develop a Digital Intervention for Self-Management in Stroke: Development Study %A Wong,Alex W K %A Fong,Mandy W M %A Munsell,Elizabeth G S %A Metts,Christopher L %A Lee,Sunghoon I %A Nicol,Ginger E %A DePaul,Olivia %A Tomazin,Stephanie E %A Kaufman,Katherine J %A Mohr,David C %+ Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, 355 E Erie St, Chicago, IL, 60611, United States, 1 312 238 1742, wwong@sralab.org %K mobile health %K digital intervention %K technology %K SMS text messaging %K intervention mapping %K behavior change %K self-management %K stroke %K rehabilitation %K mobile phone %D 2023 %7 24.7.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital therapeutics, such as interventions provided via smartphones or the internet, have been proposed as promising solutions to support self-management in persons with chronic conditions. However, the evidence supporting self-management interventions through technology in stroke is scarce, and the intervention development processes are often not well described, creating challenges in explaining why and how the intervention would work. Objective: This study describes a specific use case of using intervention mapping (IM) and the taxonomy of behavior change techniques (BCTs) in designing a digital intervention to manage chronic symptoms and support daily life participation in people after stroke. IM is an implementation science framework used to bridge the gap between theories and practice to ensure that the intervention can be implemented in real-world settings. The taxonomy of BCTs consists of a set of active ingredients designed to change self-management behaviors. Methods: We used the first 4 steps of the IM process to develop a technology-supported self-management intervention, interactive Self-Management Augmented by Rehabilitation Technologies (iSMART), adapted from a face-to-face stroke-focused psychoeducation program. Planning group members were involved in adapting the intervention. They also completed 3 implementation measures to assess the acceptability, appropriateness, and feasibility of iSMART. Results: In step 1, we completed a needs assessment consisting of assembling a planning group to codevelop the intervention, conducting telephone surveys of people after stroke (n=125) to identify service needs, and performing a systematic review of randomized controlled trials to examine evidence of the effectiveness of digital self-management interventions to improve patient outcomes. We identified activity scheduling, symptom management, stroke prevention, access to care resources, and cognitive enhancement training as key service needs after a stroke. The review suggested that digital self-management interventions, especially those using cognitive behavioral theory, effectively reduce depression, anxiety, and fatigue and enhance self-efficacy in neurological disorders. Step 2 identified key determinants, objectives, and strategies for self-management in iSMART, including knowledge, behavioral regulation, skills, self-efficacy, motivation, negative and positive affect, and social and environmental support. In step 3, we generated the intervention components underpinned by appropriate BCTs. In step 4, we developed iSMART with the planning group members. Especially, iSMART simplified the original psychoeducation program and added 2 new components: SMS text messaging and behavioral coaching, intending to increase the uptake by people after stroke. iSMART was found to be acceptable (mean score 4.63, SD 0.38 out of 5), appropriate (mean score 4.63, SD 0.38 out of 5), and feasible (mean score 4.58, SD 0.34 out of 5). Conclusions: We describe a detailed example of using IM and the taxonomy of BCTs for designing and developing a digital intervention to support people after stroke in managing chronic symptoms and maintaining active participation in daily life. %M 37486748 %R 10.2196/45099 %U https://humanfactors.jmir.org/2023/1/e45099 %U https://doi.org/10.2196/45099 %U http://www.ncbi.nlm.nih.gov/pubmed/37486748 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e44701 %T Comparing the Effectiveness of a Web-Based Application With a Digital Live Seminar to Improve Safe Communication for Pregnant Women: 3-Group Partially Randomized Controlled Trial %A Kötting,Lukas %A Derksen,Christina %A Keller,Franziska Maria %A Lippke,Sonia %+ Psychology & Methods, Constructor University, Campus Ring 1, Bremen, 28759, Germany, 49 421 200 4721, l.koetting@jacobs-university.de %K Health Action Process Approach %K HAPA %K intention %K safe communication behavior %K patient safety %K obstetric patients %K digital intervention %K web-based app %D 2023 %7 24.7.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Medical internet interventions such as asynchronous apps and synchronous digital live seminars can be effective behavior change interventions. The research question of this study was whether digital interventions based on the Health Action Process Approach can improve pregnant women’s safe communication and patient safety in obstetric care. Objective: This study aims to compare a digital live seminar with a web-based application intervention and a passive control group and to identify which social cognitive variables determine safe communication behavior and patient safety. Methods: In total, 657 pregnant women were recruited, and hereof, 367 expectant mothers from 2 German university hospitals participated in the pre-post study (live seminar: n=142; web-based app: n=81; passive control group: n=144). All interventions targeted intention, planning, self-efficacy, and communication of personal preferences. The 2.5-hour midwife-assisted live seminar included exercises on empathy and clear communication. The fully automated web-based application consisted of 9 consecutive training lessons with the same content as that of the live seminar. Results: Controlled for sociodemographic characteristics, repeated measures analyses of covariance revealed that pregnant women significantly improved their self-reported communication behavior in all groups. The improvement was more pronounced after the digital live seminar than after the web-based application (P<.001; ηp2=0.043). Perceived patient safety improved more for pregnant women participating in the live seminar than for those participating in the web-based application group (P=.03 ηp2=0.015). A regression analysis revealed that social cognitive variables predicted safe communication behavior. Conclusions: Overall, the web-based application intervention appeared to be less effective than the digital live training in terms of communication behavior. Application interventions addressing communication behaviors might require more face-to-face elements. Improving intention, coping planning, and coping self-efficacy appeared to be key drivers in developing safe communication behavior in pregnant women. Future research should include social learning aspects and focus on the practical application of medical internet interventions when aiming to improve pregnant women’s communication and patient safety in obstetrics. Trial Registration: ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735 %M 37486755 %R 10.2196/44701 %U https://pediatrics.jmir.org/2023/1/e44701 %U https://doi.org/10.2196/44701 %U http://www.ncbi.nlm.nih.gov/pubmed/37486755 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44753 %T Parents’ Perceptions of Children’s and Adolescents’ Use of Electronic Devices to Promote Physical Activity: Systematic Review of Qualitative Evidence %A Visier-Alfonso,María Eugenia %A Sánchez-López,Mairena %A Rodríguez-Martín,Beatriz %A Ruiz-Hermosa,Abel %A Bartolomé-Gutiérrez,Raquel %A Sequí-Domínguez,Irene %A Martínez-Vizcaíno,Vicente %+ Faculty of Nursing, University of Castilla-La Mancha, Camino de Nohales 4, Cuenca, 16071, Spain, 34 630872012, mariaeugenia.visier@uclm.es %K physical activity %K electronic devices %K eHealth %K parents’ perceptions %K children %K adolescents %K systematic review %K qualitative %D 2023 %7 20.7.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The use of physical activity (PA) electronic devices offers a unique opportunity to engage children and adolescents in PA. For this age group (2-17 years), parents play a key role in promoting healthy lifestyles and regulating the use of electronic devices. Therefore, parents’ perceptions of the use of electronic devices for PA in children and adolescents are critical for efficient intervention. Objective: The aim of this qualitative systematic review was to improve the understanding of parents’ perceptions of the use of electronic devices for PA in children and adolescents. Methods: A systematic search of electronic databases (Medline/PubMed, SPORTDiscus, Web of Science, Scopus, OpenGrey, and Deep Blue) was conducted. Studies from inception (2010) to May 2022 were identified. Qualitative studies on the perceptions of healthy children’s and adolescents’ (aged 2-17 years) parents regarding PA interventions performed on electronic devices were included according to the Cochrane Qualitative and Implementation Methods Group Guidance Series and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. The Joanna Briggs Institute Qualitative Assessment and Review Instrument was used for methodological validity. Results: In total, 18 studies with 410 parents, mostly mothers, were included. Parents’ perceptions were grouped into 4 categories: usefulness, advantages, general perceptions (electronic devices for health promotion, preferences for real-life PA, and concerns), and acceptability (barriers and facilitators) of electronic devices for PA. Parents perceived electronic devices as useful for increasing PA, learning new skills, and increasing motivation for PA and valued those devices that promoted socialization and family and peer bonding. In terms of general perceptions, parents had positive attitudes toward PA electronic devices; however, they preferred outdoor and real-life PA, especially for preschoolers and children. Concerns, such as physical and psychological harm, addiction, conflicts, and compliance difficulties, were found. Facilitators were identified as ease of use, appropriate feedback, promotion of socialization, and motivational strategies, such as rewards, challenges, and attractiveness. Barriers, such as discomfort, price, and difficulties in using or understanding electronic devices, were also identified. For older children and adolescents, parents were more concerned about high levels of screen time and setting limits on electronic devices and therefore preferred PA electronic devices rather than traditional ones. Conclusions: Overall, the participants had positive attitudes toward electronic devices for PA and perceived them as an effective way to promote PA in children and adolescents. They also perceived several benefits of using electronic devices, such as health promotion, increased awareness and motivation, and socialization, as well as barriers, facilitators, and age differences. The results of this study could provide researchers with insights into designing more effective, age-appropriate PA electronic devices for children and adolescents and improving adherence to their use. Trial Registration: PROSPERO CRD42021292340; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=292340 %M 37471127 %R 10.2196/44753 %U https://mhealth.jmir.org/2023/1/e44753 %U https://doi.org/10.2196/44753 %U http://www.ncbi.nlm.nih.gov/pubmed/37471127 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e39929 %T Planting Seeds for the Future: Scoping Review of Child Health Promotion Apps for Parents %A Blakeslee,Sarah B %A Vieler,Kristin %A Horak,Ingo %A Stritter,Wiebke %A Seifert,Georg %+ Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany, 49 30 450 566058, sarah.blakeslee@charite.de %K scoping review %K child health promotion %K parents %K mobile apps %K health apps %K digital prevention %K behavior change %K mHealth %D 2023 %7 20.7.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Increasingly, parents use child health promotion apps to find health information. An overview of child health promotion apps for parents currently does not exist. The scope of child health topics addressed by parent apps is thus needed, including how they are evaluated. Objective: This scoping review aims to describe existing reported mobile health (mHealth) parent apps of middle- to high-income countries that promote child health. The focus centers on apps developed in the last 5 years, showing how the reported apps are evaluated, and listing reported outcomes found. Methods: A scoping review was conducted according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews) guidelines to identify parent apps or web-based programs on child health promotion published between January 2016 and June 2021 in 5 databases: PubMed, ERIC, IEEE Xplore, Web of Science, and Google Scholar. Separate sources were sought through an expert network. Included studies were summarized and analyzed through a systematic and descriptive content analysis, including keywords, year of publication, country of origin, aims/purpose, study population/sample size, intervention type, methodology/method(s), broad topic(s), evaluation, and study outcomes. Results: In total, 39 studies met the inclusion criteria from 1040 database and 60 expert-identified studies. Keywords reflected the health topics and app foci. About 64% (25/39) of included studies were published after 2019 and most stemmed from the United States, Australian, and European-based research. Studies aimed to review or evaluate apps or conducted app-based study interventions. The number of participants ranged from 7 to 1200. Quantitative and qualitative methods were used. Interventions included 28 primary studies, 6 app feasibility studies, and 5 app or literature reviews. Eight separate topics were found: parental feeding and nutrition, physical activity, maternal-child health, parent-child health, healthy environment, dental health, mental health, and sleep. Study intervention evaluations cited behavior change theories in 26 studies and evaluations were carried out with a variety of topic-specific, adapted, self-developed, or validated questionnaires and evaluation tools. To evaluate apps, user input and qualitative evaluations were often combined with surveys and frequently rated with the Mobile App Rating Scale. Outcomes reported some positive effects, while several intervention studies saw no effect at all. Effectively evaluating changes in behavior through apps, recruiting target groups, and retaining app engagement were challenges cited. Conclusions: New parents are a key target group for child health apps, but evaluating child health promotion apps remains a challenge. Whether tailored to parent needs or adapted to the specific topic, apps should be rooted in a transparent theoretical groundwork. Applicable lessons for parent apps from existing research are to tailor app content, include intuitive and adaptive features, and embed well-founded parameters for long-term effect evaluation on child health promotion. %M 37471125 %R 10.2196/39929 %U https://mhealth.jmir.org/2023/1/e39929 %U https://doi.org/10.2196/39929 %U http://www.ncbi.nlm.nih.gov/pubmed/37471125 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45975 %T Effect of a Wearable Device–Based Physical Activity Intervention in North Korean Refugees: Pilot Randomized Controlled Trial %A Kim,Ji Yoon %A Kim,Kyoung Jin %A Kim,Kyeong Jin %A Choi,Jimi %A Seo,Jinhee %A Lee,Jung-Been %A Bae,Jae Hyun %A Kim,Nam Hoon %A Kim,Hee Young %A Lee,Soo-Kyung %A Kim,Sin Gon %+ Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea, 82 2 920 5890, k50367@korea.ac.kr %K digital health intervention %K wearable activity tracker %K physical activity intervention %K Fitbit %K North Korean refugees %K metabolic risk management %K step counts %D 2023 %7 19.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective health interventions for North Korean refugees vulnerable to metabolic disorders are currently unelucidated. Objective: This study aimed to evaluate the effects of digital health interventions in North Korean refugees using a wearable activity tracker (Fitbit device). Methods: We conducted a prospective, randomized, open-label study on North Korean refugees aged 19-59 years between June 2020 and October 2021 with a 12-week follow-up period. The participants were randomly assigned to either an intervention group or a control group in a 1:1 ratio. The intervention group received individualized health counseling based on Fitbit data every 4 weeks, whereas the control group wore the Fitbit device but did not receive individualized counseling. The primary and secondary outcomes were the change in the mean daily step count and changes in the metabolic parameters, respectively. Results: The trial was completed by 52 North Korean refugees, of whom 27 and 25 were in the intervention and control groups, respectively. The mean age was 43 (SD 10) years, and 41 (78.8%) participants were women. Most participants (44/52, 95.7%) had a low socioeconomic status. After the intervention, the daily step count in the intervention group increased, whereas that in the control group decreased. However, there were no significant differences between the 2 groups (+83 and –521 steps in the intervention and control groups, respectively; P=.500). The effects of the intervention were more prominent in the participants with a lower-than-average daily step count at baseline (<11,667 steps/day). After the 12-week study period, 85.7% (12/14) and 46.7% (7/15) of the participants in the intervention and control groups, respectively, had an increased daily step count (P=.05). The intervention prevented the worsening of the metabolic parameters, including BMI, waist circumference, fasting blood glucose level, and glycated hemoglobin level, during the study period. Conclusions: The wearable device–based physical activity intervention did not significantly increase the average daily step count in the North Korean refugees in this study. However, the intervention was effective among the North Korean refugees with a lower-than-average daily step count; therefore, a large-scale, long-term study of this intervention type in an underserved population is warranted. Trial Registration: Clinical Research Information Service KCT0007999; https://cris.nih.go.kr/cris/search/detailSearch.do/23622 %M 37467013 %R 10.2196/45975 %U https://www.jmir.org/2023/1/e45975 %U https://doi.org/10.2196/45975 %U http://www.ncbi.nlm.nih.gov/pubmed/37467013 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45984 %T Scope, Characteristics, Behavior Change Techniques, and Quality of Conversational Agents for Mental Health and Well-Being: Systematic Assessment of Apps %A Lin,Xiaowen %A Martinengo,Laura %A Jabir,Ahmad Ishqi %A Ho,Andy Hau Yan %A Car,Josip %A Atun,Rifat %A Tudor Car,Lorainne %+ Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Rd, Singapore, Singapore, 308232, Singapore, 65 69041258, lorainne.tudor.car@ntu.edu.sg %K conversational agent %K chatbot %K mental health %K mobile health %K mHealth %K behavior change %K apps %K Mobile Application Rating Scale %K MARS %K mobile phone %D 2023 %7 18.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental disorders cause substantial health-related burden worldwide. Mobile health interventions are increasingly being used to promote mental health and well-being, as they could improve access to treatment and reduce associated costs. Behavior change is an important feature of interventions aimed at improving mental health and well-being. There is a need to discern the active components that can promote behavior change in such interventions and ultimately improve users’ mental health. Objective: This study systematically identified mental health conversational agents (CAs) currently available in app stores and assessed the behavior change techniques (BCTs) used. We further described their main features, technical aspects, and quality in terms of engagement, functionality, esthetics, and information using the Mobile Application Rating Scale. Methods: The search, selection, and assessment of apps were adapted from a systematic review methodology and included a search, 2 rounds of selection, and an evaluation following predefined criteria. We conducted a systematic app search of Apple’s App Store and Google Play using 42matters. Apps with CAs in English that uploaded or updated from January 2020 and provided interventions aimed at improving mental health and well-being and the assessment or management of mental disorders were tested by at least 2 reviewers. The BCT taxonomy v1, a comprehensive list of 93 BCTs, was used to identify the specific behavior change components in CAs. Results: We found 18 app-based mental health CAs. Most CAs had <1000 user ratings on both app stores (12/18, 67%) and targeted several conditions such as stress, anxiety, and depression (13/18, 72%). All CAs addressed >1 mental disorder. Most CAs (14/18, 78%) used cognitive behavioral therapy (CBT). Half (9/18, 50%) of the CAs identified were rule based (ie, only offered predetermined answers) and the other half (9/18, 50%) were artificial intelligence enhanced (ie, included open-ended questions). CAs used 48 different BCTs and included on average 15 (SD 8.77; range 4-30) BCTs. The most common BCTs were 3.3 “Social support (emotional),” 4.1 “Instructions for how to perform a behavior,” 11.2 “Reduce negative emotions,” and 6.1 “Demonstration of the behavior.” One-third (5/14, 36%) of the CAs claiming to be CBT based did not include core CBT concepts. Conclusions: Mental health CAs mostly targeted various mental health issues such as stress, anxiety, and depression, reflecting a broad intervention focus. The most common BCTs identified serve to promote the self-management of mental disorders with few therapeutic elements. CA developers should consider the quality of information, user confidentiality, access, and emergency management when designing mental health CAs. Future research should assess the role of artificial intelligence in promoting behavior change within CAs and determine the choice of BCTs in evidence-based psychotherapies to enable systematic, consistent, and transparent development and evaluation of effective digital mental health interventions. %M 37463036 %R 10.2196/45984 %U https://www.jmir.org/2023/1/e45984 %U https://doi.org/10.2196/45984 %U http://www.ncbi.nlm.nih.gov/pubmed/37463036 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e45057 %T Patterns and Predictors of Engagement With Digital Self-Monitoring During the Maintenance Phase of a Behavioral Weight Loss Program: Quantitative Study %A Crane,Nicole %A Hagerman,Charlotte %A Horgan,Olivia %A Butryn,Meghan %+ Center for Weight, Eating, and Lifestyle Science, Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut Street, Stratton Hall, Philadelphia, PA, 19104, United States, 1 724 740 8648, nvt24@drexel.edu %K weight loss %K digital technology %K diet %K exercise %K behavior change %K mobile phone %D 2023 %7 18.7.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Long-term self-monitoring (SM) of weight, diet, and exercise is commonly recommended by behavioral weight loss (BWL) treatments. However, sustained SM engagement is notoriously challenging; therefore, more must be learned about patterns of engagement with digital SM tools during weight loss maintenance (WLM). In addition, insight into characteristics that may influence SM engagement could inform tailored approaches for participants at risk for poor adherence. Objective: This study explored patterns of digital SM of weight, diet, and exercise during WLM (aim 1) and examined timing, patterns, and rates of disengagement and reengagement (aim 2). This study also assessed relationships between individual-level factors (weight-related information avoidance and weight bias internalization) and SM engagement (aim 3). Methods: Participants were 72 adults enrolled in a BWL program consisting of a 3-month period of weekly treatment designed to induce weight loss (phase I), followed by a 9-month period of less frequent contact to promote WLM (phase II). Participants were prescribed daily digital SM of weight, diet, and exercise. At baseline, self-report measures assessed weight-related information avoidance and weight bias internalization. SM adherence was objectively measured with the days per month that participants tracked weight, diet, and exercise. Repeated-measures ANOVA examined differences in adherence across SM targets. Multilevel modeling examined changes in adherence across phase II. Relationships between individual-level variables and SM adherence were assessed with Pearson correlations, 2-tailed independent samples t tests, and multilevel modeling. Results: During WLM, consistently high rates of SM (≥50% of the days in each month) were observed for 61% (44/72) of the participants for exercise, 40% (29/72) of the participants for weight, and 21% (15/72) of the participants for diet. Adherence for SM of exercise was higher than that for weight or diet (P<.001). Adherence decreased over time for all SM targets throughout phase II (P<.001), but SM of exercise dropped off later in WLM (mean 10.07, SD 2.83 months) than SM of weight (mean 7.92, SD 3.23 months) or diet (mean 7.58, SD 2.92 months; P<.001). Among participants with a period of low SM adherence (ie, <50% of the days in a month), only 33% (17/51 for weight, 19/57 for diet) to 46% (13/28 for exercise) subsequently had ≥1 months with high adherence. High weight-related information avoidance predicted a faster rate of decrease in dietary SM (P<.001). Participants with high weight bias internalization had the highest rates of weight SM (P=.03). Conclusions: Participants in BWL programs have low adherence to the recommendation to sustain daily SM during WLM, particularly for SM of diet and weight. Weight-related information avoidance and weight bias internalization may be relevant indicators for SM engagement. Interventions may benefit from innovative strategies that target participants at key moments of risk for disengagement. %M 37463017 %R 10.2196/45057 %U https://mhealth.jmir.org/2023/1/e45057 %U https://doi.org/10.2196/45057 %U http://www.ncbi.nlm.nih.gov/pubmed/37463017 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e42377 %T Examining Predictors of Depression and Anxiety Symptom Change in Cognitive Behavioral Immersion: Observational Study %A Ezawa,Iony D %A Hollon,Steven D %A Robinson,Noah %+ Department of Psychology, University of Southern California, 3620 McClintock Ave, Los Angeles, CA, 90089, United States, 1 213 740 2203, ezawa@usc.edu %K Cognitive Behavioral Immersion %K virtual reality %K metaverse %K alliance %K social support %K cognitive behavioral %K depression %K anxiety %K mood %K mental health %K mobile phone %D 2023 %7 14.7.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depressive and anxiety disorders are the most common mental disorders, and there is a critical need for effective, affordable, and accessible interventions. Cognitive Behavioral Immersion (CBI) is a novel group-based cognitive behavioral skills training program delivered by lay coaches in the metaverse that can be accessed through various modalities including virtual reality (VR) head-mounted displays or flat-screen devices. Combining its ability to offer empirically supported therapy skills in a digital setting that can still facilitate interpersonal variables (eg, working alliance and sense of social support) with the aid of lay coaches, CBI has the potential to help fill this critical need. Objective: This study had 2 primary aims. First, we aimed to examine changes in depression and anxiety symptoms in a sample of individuals who participated in CBI. Second, we aimed to examine 2 interpersonal process variables (working alliance and web-based social support) as predictors of symptom changes. We predicted CBI participants would experience depression and anxiety symptom improvements and that such improvements would be associated with an increase in both interpersonal process variables. Methods: The study sample consists of 127 participants who endorsed clinical levels of depression or anxiety symptoms during their first CBI session and attended at least 2 sessions. Participants were asked to complete self-report measures of depression symptoms, anxiety symptoms, alliance, and web-based social support throughout their participation in CBI. Results: Repeated measures ANOVAs determined that depression and anxiety symptom scores differed significantly across sessions (Ps<.01). We also found participants’ web-based social support predicted improvement in depression symptoms (P=.01), but neither the alliance nor web-based social support predicted change in anxiety symptoms (Ps>.05). We also observed a significant difference in anxiety symptoms between participants who used a VR head-mounted display to access CBI and those who did not, such that participants who used VR head-mounted displays endorsed lower anxiety symptoms than those who did not at nearly every session (P=.04). Conclusions: Participation in CBI is associated with both depression and anxiety symptom improvement. Web-based social support may play an important role in fostering changes in depression symptoms. Future studies are encouraged to continue examining the process of change in CBI with special attention paid to methods that can elucidate causal mechanisms of change. %M 37450322 %R 10.2196/42377 %U https://mental.jmir.org/2023/1/e42377 %U https://doi.org/10.2196/42377 %U http://www.ncbi.nlm.nih.gov/pubmed/37450322 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44529 %T Association of Depressive Symptom Trajectory With Physical Activity Collected by mHealth Devices in the Electronic Framingham Heart Study: Cohort Study %A Wang,Xuzhi %A Pathiravasan,Chathurangi H %A Zhang,Yuankai %A Trinquart,Ludovic %A Borrelli,Belinda %A Spartano,Nicole L %A Lin,Honghuang %A Nowak,Christopher %A Kheterpal,Vik %A Benjamin,Emelia J %A McManus,David D %A Murabito,Joanne M %A Liu,Chunyu %+ Department of Biostatistics, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, United States, 1 6176385104, liuc@bu.edu %K depression %K mobile health %K risk factors %K physical activity %K eCohort %K Framingham Heart Study %D 2023 %7 14.7.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Few studies have examined the association between depressive symptom trajectories and physical activity collected by mobile health (mHealth) devices. Objective: We aimed to investigate if antecedent depressive symptom trajectories predict subsequent physical activity among participants in the electronic Framingham Heart Study (eFHS). Methods: We performed group-based multi-trajectory modeling to construct depressive symptom trajectory groups using both depressive symptoms (Center for Epidemiological Studies-Depression [CES-D] scores) and antidepressant medication use in eFHS participants who attended 3 Framingham Heart Study research exams over 14 years. At the third exam, eFHS participants were instructed to use a smartphone app for submitting physical activity index (PAI) surveys. In addition, they were provided with a study smartwatch to track their daily step counts. We performed linear mixed models to examine the association between depressive symptom trajectories and physical activity including app-based PAI and smartwatch-collected step counts over a 1-year follow-up adjusting for age, sex, wear hour, BMI, smoking status, and other health variables. Results: We identified 3 depressive symptom trajectory groups from 722 eFHS participants (mean age 53, SD 8.5 years; n=432, 60% women). The low symptom group (n=570; mean follow-up 287, SD 109 days) consisted of participants with consistently low CES-D scores, and a small proportion reported antidepressant use. The moderate symptom group (n=71; mean follow-up 280, SD 118 days) included participants with intermediate CES-D scores, who showed the highest and increasing likelihood of reporting antidepressant use across 3 exams. The high symptom group (n=81; mean follow-up 252, SD 116 days) comprised participants with the highest CES-D scores, and the proportion of antidepressant use fell between the other 2 groups. Compared to the low symptom group, the high symptom group had decreased PAI (mean difference –1.09, 95% CI –2.16 to –0.01) and the moderate symptom group walked fewer daily steps (823 fewer, 95% CI –1421 to –226) during the 1-year follow-up. Conclusions: Antecedent depressive symptoms or antidepressant medication use was associated with lower subsequent physical activity collected by mHealth devices in eFHS. Future investigation of interventions to improve mood including via mHealth technologies to help promote people’s daily physical activity is needed. %M 37450333 %R 10.2196/44529 %U https://mental.jmir.org/2023/1/e44529 %U https://doi.org/10.2196/44529 %U http://www.ncbi.nlm.nih.gov/pubmed/37450333 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45207 %T The Effectiveness of Digital Apps Providing Personalized Exercise Videos: Systematic Review With Meta-Analysis %A Davergne,Thomas %A Meidinger,Philippe %A Dechartres,Agnès %A Gossec,Laure %+ Physical Medicine and Rehabilitation Department, Assistance Publique – Hôpitaux de Paris Lariboisière-Fernand-Widal, Université Paris Cité, Institut national de la santé et de la recherche médicale, Biologie de l'os et du cartilage, 2 Rue Ambroise Paré, Paris, 75010, France, 33 675976781, thomas.davergne@gmail.com %K app %K exercise program %K telerehabilitation %K rehabilitation %K disability %K disabilities %K digital care %K web-based %K exercise %K physical activity %K fitness %K health app %K HRQoL %K QoL %K quality of life %K physical therapy %K physiotherapy %K systematic review %K review method %K adherence %K meta-analysis %K meta-analyses %D 2023 %7 13.7.2023 %9 Review %J J Med Internet Res %G English %X Background: Among available digital apps, those providing personalized video exercises may be helpful for individuals undergoing functional rehabilitation. Objective: We aimed to assess the effectiveness of apps providing personalized video exercises to support rehabilitation for people with short- and long-term disabling conditions, on functional capacity, confidence in exercise performance, health care consumption, health-related quality of life, adherence, and adverse events. Methods: In this systematic review, we searched MEDLINE, CENTRAL, and Embase databases up to March 2022. All randomized controlled trials evaluating the effect of apps providing personalized video exercises to support rehabilitation for any condition requiring physical rehabilitation were included. Selection, extraction, and risk of bias assessment were performed by 2 independent reviewers. The primary outcome was functional capacity at the end of the intervention. The secondary outcomes included confidence in exercise performance, care consumption, health-related quality of life, adherence, and adverse events. A meta-analysis was performed where possible; the magnitude of the effect was assessed with the standardized mean difference (SMD). Results: From 1641 identified references, 10 papers (n=1050 participants, 93% adults) were included: 7 papers (n=906 participants) concerned musculoskeletal disorders and 3 (n=144 participants) concerned neurological disorders. Two (n=332 participants) were employee based. The apps were mostly commercial (7/10); the videos were mostly elaborated on by a physiotherapist (8/10). The duration of app use was 3-48 weeks. All included studies had a high overall risk of bias. Low-quality evidence suggested that the use of apps providing personalized video exercises led to a significant small to moderate improvement in physical function (SMD 0.35, 95% CI 0.19-0.51; Phet=.86; I2=0%) and confidence in exercise performance (SMD 0.67; 95% CI 0.37-0.96; Phet=.22; I2=33%). Because of the very low quality of the evidence, the effects on quality of life and exercise adherence were uncertain. Apps did not influence the rate of adverse events. Conclusions: Apps providing personalized video exercises to support exercise performance significantly improved physical function and confidence in exercise performance. However, the level of evidence was low; more robust studies are needed to confirm these results. Trial Registration: PROSPERO CRD42022323670; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=323670 %M 37440300 %R 10.2196/45207 %U https://www.jmir.org/2023/1/e45207 %U https://doi.org/10.2196/45207 %U http://www.ncbi.nlm.nih.gov/pubmed/37440300 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45183 %T Smartphone Apps for Smoking Cessation: Systematic Framework for App Review and Analysis %A Bold,Krysten W %A Garrison,Kathleen A %A DeLucia,Angela %A Horvath,Mark %A Nguyen,Milton %A Camacho,Erica %A Torous,John %+ Department of Psychiatry, Yale School of Medicine, 34 Park Street CMHC, New Haven, CT, 06519, United States, 1 203 974 7603, krysten.bold@yale.edu %K addict %K app review %K application %K apps %K cessation %K cigarette %K digital health %K mhealth %K mobile app %K mobile health %K quit %K review of app %K smartphone app %K smoker %K smoking cessation %K smoking %K tobacco %D 2023 %7 13.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Cigarette smoking is a leading cause of preventable death, and identifying novel treatment approaches to promote smoking cessation is critical for improving public health. With the rise of digital health and mobile apps, these tools offer potential opportunities to address smoking cessation, yet the functionality of these apps and whether they offer scientifically based support for smoking cessation are unknown. Objective: The goal of this research was to use the American Psychiatric Association app evaluation model to evaluate the top-returned apps from Android and Apple app store platforms related to smoking cessation and investigate the common app features available for end users. Methods: We conducted a search of both Android and iOS app stores in July 2021 for apps related to the keywords “smoking,” “tobacco,” “smoke,” and “cigarette” to evaluate apps for smoking cessation. Apps were screened for relevance, and trained raters identified and analyzed features, including accessibility (ie, cost), privacy, clinical foundation, and features of the apps, using a systematic framework of 105 objective questions from the American Psychiatric Association app evaluation model. All app rating data were deposited in mindapps, a publicly accessible database that is continuously updated every 6 months given the dynamic nature of apps available in the marketplace. We characterized apps available in July 2021 and November 2022. Results: We initially identified 389 apps, excluded 161 due to irrelevance and nonfunctioning, and rated 228, including 152 available for Android platforms and 120 available for iOS platforms. Some of the top-returned apps (71/228, 31%) in 2021 were no longer functioning in 2022. Our analysis of rated apps revealed limitations in accessibility and features. While most apps (179/228, 78%) were free to download, over half had costs associated with in-app purchases or full use. Less than 65% (149/228) had a privacy policy addressing the data collected in the app. In terms of intervention features, more than 56% (128/228) of apps allowed the user to set and check in on goals, and more than 46% (106/228) of them provided psychoeducation, although few apps provided evidence-based support for smoking cessation, such as peer support or skill training, including mindfulness and deep breathing, and even fewer provided evidence-based interventions, such as acceptance and commitment therapy or cognitive behavioral therapy. Only 12 apps in 2021 and 11 in 2022 had published studies supporting the feasibility or efficacy for smoking cessation. Conclusions: Numerous smoking cessation apps were identified, but analysis revealed limitations, including high rates of irrelevant and nonfunctioning apps, high rates of turnover, and few apps providing evidence-based support for smoking cessation. Thus, it may be challenging for consumers to identify relevant, evidence-based apps to support smoking cessation in the app store, and a comprehensive evaluation system of mental health apps is critically important. %M 37440305 %R 10.2196/45183 %U https://www.jmir.org/2023/1/e45183 %U https://doi.org/10.2196/45183 %U http://www.ncbi.nlm.nih.gov/pubmed/37440305 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41815 %T Trajectories of Symptoms in Digital Interventions for Depression and Anxiety Using Routine Outcome Monitoring Data: Secondary Analysis Study %A Cumpanasoiu,Diana Catalina %A Enrique,Angel %A Palacios,Jorge E %A Duffy,Daniel %A McNamara,Scott %A Richards,Derek %+ SilverCloud Science, SilverCloud Health, One Stephen Street Upper, Dublin, D08 DR9P, Ireland, 353 6467031051, catalina.cumpanasoiu@amwell.com %K internet-delivered cognitive behavioral therapy %K iCBT %K depression %K anxiety %K trajectory of symptom change %K routine outcome monitoring data %D 2023 %7 12.7.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Research suggests there is heterogeneity in treatment response for internet-delivered cognitive behavioral therapy (iCBT) users, but few studies have investigated the trajectory of individual symptom change across iCBT treatment. Large patient data sets using routine outcome measures allows the investigation of treatment effects over time as well as the relationship between outcomes and platform use. Understanding trajectories of symptom change, as well as associated characteristics, may prove important for tailoring interventions or identifying patients who may not benefit from the intervention. Objective: We aimed to identify latent trajectories of symptom change during the iCBT treatment course for depression and anxiety and to investigate the patients’ characteristics and platform use for each of these classes. Methods: This is a secondary analysis of data from a randomized controlled trial designed to examine the effectiveness of guided iCBT for anxiety and depression in the UK Improving Access to Psychological Therapies (IAPT) program. This study included patients from the intervention group (N=256) and followed a longitudinal retrospective design. As part of the IAPT’s routine outcome monitoring system, patients were prompted to complete the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) after each supporter review during the treatment period. Latent class growth analysis was used to identify the underlying trajectories of symptom change across the treatment period for both depression and anxiety. Differences in patient characteristics were then evaluated between these trajectory classes, and the presence of a time-varying relationship between platform use and trajectory classes was investigated. Results: Five-class models were identified as optimal for both PHQ-9 and GAD-7. Around two-thirds (PHQ-9: 155/221, 70.1%; GAD-7: 156/221, 70.6%) of the sample formed various trajectories of improvement classes that differed in baseline score, the pace of symptom change, and final clinical outcome score. The remaining patients were in 2 smaller groups: one that saw minimal to no gains and another with consistently high scores across the treatment journey. Baseline severity, medication status, and program assigned were significantly associated (P<.001) with different trajectories. Although we did not find a time-varying relationship between use and trajectory classes, we found an overall effect of time on platform use, suggesting that all participants used the intervention significantly more in the first 4 weeks (P<.001). Conclusions: Most patients benefit from treatment, and the various patterns of improvement have implications for how the iCBT intervention is delivered. Identifying predictors of nonresponse or early response might inform the level of support and monitoring required for different types of patients. Further work is necessary to explore the differences between these trajectories to understand what works best for whom and to identify early on those patients who are less likely to benefit from treatment. %M 37436812 %R 10.2196/41815 %U https://mhealth.jmir.org/2023/1/e41815 %U https://doi.org/10.2196/41815 %U http://www.ncbi.nlm.nih.gov/pubmed/37436812 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e45186 %T Testing Mechanisms of Change for Text Message–Delivered Cognitive Behavioral Therapy: Randomized Clinical Trial for Young Adult Depression %A Mason,Michael J %A Coatsworth,J Douglas %A Zaharakis,Nikola %A Russell,Michael %A Brown,Aaron %A McKinstry,Sydney %+ Center for Behavioral Health Research, College of Social Work, University of Tennessee, Center for Behavioral Health Research, 202 Henson Hall, Knoxville, TN, 37996, United States, 1 18659749148, mmason29@utk.edu %K young adults %K depression %K SMS text message–delivered treatment %K cognitive behavioral therapy %K randomized clinical trial %K mobile health treatment %K mHealth treatment %K mobile phone %D 2023 %7 11.7.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Current psychiatric epidemiological evidence estimates that 17% of young adults (aged 18-25 years) experienced a major depressive episode in 2020, relative to 8.4% of all adults aged ≥26 years. Young adults with a major depressive episode in the past year are the least likely to receive treatment for depression compared with other age groups. Objective: We conducted a randomized clinical trial following our initial 4-week SMS text message–delivered cognitive behavioral therapy (CBT-txt) for depression in young adults. We sought to test mechanisms of change for CBT-txt. Methods: Based on participant feedback, outcome data, and the empirical literature, we increased the treatment dosage from 4-8 weeks and tested 3 mechanisms of change with 103 young adults in the United States. Participants were from 34 states, recruited from Facebook and Instagram and presenting with at least moderate depressive symptomatology. Web-based assessments occurred at baseline prior to randomization and at 1, 2, and 3 months after enrollment. The primary outcome, the severity of depressive symptoms, was assessed using the Beck Depression Inventory II. Behavioral activation, perseverative thinking, and cognitive distortions were measured as mechanisms of change. Participants were randomized to CBT-txt or a waitlist control condition. Those assigned to the CBT-txt intervention condition received 474 fully automated SMS text messages, delivered every other day over a 64-day period and averaging 14.8 (SD 2.4) SMS text messages per treatment day. Intervention texts are delivered via TextIt, a web-based automated SMS text messaging platform. Results: Across all 3 months of the study, participants in the CBT-txt group showed significantly larger decreases in depressive symptoms than those in the control group (P<.001 at each follow-up), producing a medium-to-large effect size (Cohen d=0.76). Over half (25/47, 53%) of the treatment group moved into the “high-end functioning” category, representing no or minimal clinically significant depressive symptoms, compared with 15% (8/53) of the control condition. Mediation analysis showed that CBT-txt appeared to lead to greater increases in behavioral activation and greater decreases in cognitive distortions and perseverative thinking across the 3-month follow-up period, which were then associated with larger baseline to 3-month decreases in depression. The size of the indirect effects was substantial: 57%, 41%, and 50% of the CBT-txt effect on changes in depression were mediated by changes in behavioral activation, cognitive distortions, and perseverative thinking, respectively. Models including all 3 mediators simultaneously showed that 63% of the CBT-txt effect was mediated by the combined indirect effects. Conclusions: Results provide evidence for the efficacy of CBT-txt to reduce young adult depressive symptoms through hypothesized mechanisms. To the best of our knowledge, CBT-txt is unique in its SMS text message–delivered modality, the strong clinical evidence supporting efficacy and mechanisms of change. Trial Registration: ClinicalTrials.gov NCT05551702; https://clinicaltrials.gov/study/NCT05551702 %M 37432723 %R 10.2196/45186 %U https://mhealth.jmir.org/2023/1/e45186 %U https://doi.org/10.2196/45186 %U http://www.ncbi.nlm.nih.gov/pubmed/37432723 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46781 %T Effects of an Artificial Intelligence Platform for Behavioral Interventions on Depression and Anxiety Symptoms: Randomized Clinical Trial %A Sadeh-Sharvit,Shiri %A Camp,T Del %A Horton,Sarah E %A Hefner,Jacob D %A Berry,Jennifer M %A Grossman,Eyal %A Hollon,Steven D %+ Eleos Health, 260 Charles St, Waltham, MA, 02453, United States, 1 5109848132, ssharvit@paloaltou.edu %K augmentation %K anxiety %K artificial intelligence %K cognitive-behavioral therapy %K community-based center %K depression %K evidence-based practices %K health force burnout %K depressive %D 2023 %7 10.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The need for scalable delivery of mental health care services that are efficient and effective is now a major public health priority. Artificial intelligence (AI) tools have the potential to improve behavioral health care services by helping clinicians collect objective data on patients’ progress, streamline their workflow, and automate administrative tasks. Objective: The aim of this study was to determine the feasibility, acceptability, and preliminary efficacy of an AI platform for behavioral health in facilitating better clinical outcomes for patients receiving outpatient therapy. Methods: The study was conducted at a community-based clinic in the United States. Participants were 47 adults referred for outpatient, individual cognitive behavioral therapy for a main diagnosis of a depressive or anxiety disorder. The platform provided by Eleos Health was compared to a treatment-as-usual (TAU) approach during the first 2 months of therapy. This AI platform summarizes and transcribes the therapy session, provides feedback to therapists on the use of evidence-based practices, and integrates these data with routine standardized questionnaires completed by patients. The information is also used to draft the session’s progress note. Patients were randomized to receive either therapy provided with the support of an AI platform developed by Eleos Health or TAU at the same clinic. Data analysis was carried out based on an intention-to-treat approach from December 2022 to January 2023. The primary outcomes included the feasibility and acceptability of the AI platform. Secondary outcomes included changes in depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) scores as well as treatment attendance, satisfaction, and perceived helpfulness. Results: A total of 72 patients were approached, of whom 47 (67%) agreed to participate. Participants were adults (34/47, 72% women and 13/47, 28% men; mean age 30.64, SD 11.02 years), with 23 randomized to the AI platform group, and 24 to TAU. Participants in the AI group attended, on average, 67% (mean 5.24, SD 2.31) more sessions compared to those in TAU (mean 3.14, SD 1.99). Depression and anxiety symptoms were reduced by 34% and 29% in the AI platform group versus 20% and 8% for TAU, respectively, with large effect sizes for the therapy delivered with the support of the AI platform. No group difference was found in 2-month treatment satisfaction and perceived helpfulness. Further, therapists using the AI platform submitted their progress notes, on average, 55 hours earlier than therapists in the TAU group (t=–0.73; P<.001). Conclusions: In this randomized controlled trial, therapy provided with the support of Eleos Health demonstrated superior depression and anxiety outcomes as well as patient retention, compared with TAU. These findings suggest that complementing the mental health services provided in community-based clinics with an AI platform specializing in behavioral treatment was more effective in reducing key symptoms than standard therapy. Trial Registration: ClinicalTrials.gov NCT05745103; https://classic.clinicaltrials.gov/ct2/show/NCT05745103 %M 37428547 %R 10.2196/46781 %U https://www.jmir.org/2023/1/e46781 %U https://doi.org/10.2196/46781 %U http://www.ncbi.nlm.nih.gov/pubmed/37428547 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e43052 %T A Mental Health and Well-Being Chatbot: User Event Log Analysis %A Booth,Frederick %A Potts,Courtney %A Bond,Raymond %A Mulvenna,Maurice %A Kostenius,Catrine %A Dhanapala,Indika %A Vakaloudis,Alex %A Cahill,Brian %A Kuosmanen,Lauri %A Ennis,Edel %+ School of Psychology, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom, 44 28953675, c.potts@ulster.ac.uk %K mental well-being %K positive psychology %K data analysis %K health care %K event log analysis %K ecological momentary assessment %K conversational user interface %K user behavior %K conversational agent %K user interface %K user data %K digital health application %K mental well-being %K mobile health app %K digital intervention %D 2023 %7 6.7.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Conversational user interfaces, or chatbots, are becoming more popular in the realm of digital health and well-being. While many studies focus on measuring the cause or effect of a digital intervention on people’s health and well-being (outcomes), there is a need to understand how users really engage and use a digital intervention in the real world. Objective: In this study, we examine the user logs of a mental well-being chatbot called ChatPal, which is based on the concept of positive psychology. The aim of this research is to analyze the log data from the chatbot to provide insight into usage patterns, the different types of users using clustering, and associations between the usage of the app’s features. Methods: Log data from ChatPal was analyzed to explore usage. A number of user characteristics including user tenure, unique days, mood logs recorded, conversations accessed, and total number of interactions were used with k-means clustering to identify user archetypes. Association rule mining was used to explore links between conversations. Results: ChatPal log data revealed 579 individuals older than 18 years used the app with most users being female (n=387, 67%). User interactions peaked around breakfast, lunchtime, and early evening. Clustering revealed 3 groups including “abandoning users” (n=473), “sporadic users” (n=93), and “frequent transient users” (n=13). Each cluster had distinct usage characteristics, and the features were significantly different (P<.001) across each group. While all conversations within the chatbot were accessed at least once by users, the “treat yourself like a friend” conversation was the most popular, which was accessed by 29% (n=168) of users. However, only 11.7% (n=68) of users repeated this exercise more than once. Analysis of transitions between conversations revealed strong links between “treat yourself like a friend,” “soothing touch,” and “thoughts diary” among others. Association rule mining confirmed these 3 conversations as having the strongest linkages and suggested other associations between the co-use of chatbot features. Conclusions: This study has provided insight into the types of people using the ChatPal chatbot, patterns of use, and associations between the usage of the app’s features, which can be used to further develop the app by considering the features most accessed by users. %M 37410539 %R 10.2196/43052 %U https://mhealth.jmir.org/2023/1/e43052 %U https://doi.org/10.2196/43052 %U http://www.ncbi.nlm.nih.gov/pubmed/37410539 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47098 %T Using Wearable Passive Sensing to Predict Binge Eating in Response to Negative Affect Among Individuals With Transdiagnostic Binge Eating: Protocol for an Observational Study %A Presseller,Emily K %A Lampe,Elizabeth W %A Zhang,Fengqing %A Gable,Philip A %A Guetterman,Timothy C %A Forman,Evan M %A Juarascio,Adrienne S %+ Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut St., Stratton Hall 2nd. Floor, Philadelphia, PA, 19104, United States, 1 2155537100, emily.k.presseller@drexel.edu %K affect %K binge eating %K heart rate %K heart rate variability %K electrodermal activity %K ecological momentary assessment %K wearable sensors %K ecological momentary intervention %D 2023 %7 6.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Binge eating (BE), characterized by eating a large amount of food accompanied by a sense of loss of control over eating, is a public health crisis. Negative affect is a well-established antecedent for BE. The affect regulation model of BE posits that elevated negative affect increases momentary risk for BE, as engaging in BE alleviates negative affect and reinforces the behavior. The eating disorder field’s capacity to identify moments of elevated negative affect, and thus BE risk, has exclusively relied on ecological momentary assessment (EMA). EMA involves the completion of surveys in real time on one’s smartphone to report behavioral, cognitive, and emotional symptoms throughout the day. Although EMA provides ecologically valid information, EMA surveys are often delivered only 5-6 times per day, involve self-report of affect intensity only, and are unable to assess affect-related physiological arousal. Wearable, psychophysiological sensors that measure markers of affect arousal including heart rate, heart rate variability, and electrodermal activity may augment EMA surveys to improve accurate real-time prediction of BE. These sensors can objectively and continuously measure biomarkers of nervous system arousal that coincide with affect, thus allowing them to measure affective trajectories on a continuous timescale, detect changes in negative affect before the individual is consciously aware of them, and reduce user burden to improve data completeness. However, it is unknown whether sensor features can distinguish between positive and negative affect states, given that physiological arousal may occur during both negative and positive affect states. Objective: The aims of this study are (1) to test the hypothesis that sensor features will distinguish positive and negative affect states in individuals with BE with >60% accuracy and (2) test the hypothesis that a machine learning algorithm using sensor data and EMA-reported negative affect to predict the occurrence of BE will predict BE with greater accuracy than an algorithm using EMA-reported negative affect alone. Methods: This study will recruit 30 individuals with BE who will wear Fitbit Sense 2 wristbands to passively measure heart rate and electrodermal activity and report affect and BE on EMA surveys for 4 weeks. Machine learning algorithms will be developed using sensor data to distinguish instances of high positive and high negative affect (aim 1) and to predict engagement in BE (aim 2). Results: This project will be funded from November 2022 to October 2024. Recruitment efforts will be conducted from January 2023 through March 2024. Data collection is anticipated to be completed in May 2024. Conclusions: This study is anticipated to provide new insight into the relationship between negative affect and BE by integrating wearable sensor data to measure affective arousal. The findings from this study may set the stage for future development of more effective digital ecological momentary interventions for BE. International Registered Report Identifier (IRRID): DERR1-10.2196/47098 %M 37410522 %R 10.2196/47098 %U https://www.researchprotocols.org/2023/1/e47098 %U https://doi.org/10.2196/47098 %U http://www.ncbi.nlm.nih.gov/pubmed/37410522 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45983 %T Indigenous Women and Their Nutrition During Pregnancy (the Mums and Bubs Deadly Diets Project): Protocol for a Co-designed mHealth Resource Development Study %A Gilbert,Stephanie %A Irvine,Rachel %A D'or,Melissa %A Adam,Marc T P %A Collins,Clare E %A Marriott,Rhonda %A Rollo,Megan %A Walker,Roz %A Rae,Kym %+ Mater Research Institute, Aubigny Place, 1 Raymond Terrace, Brisbane, 4101, Australia, 61 0431379872, kym.rae@uq.edu.au %K co-design %K community-based participatory research %K mHealth %K Aboriginal and Torres Strait Islander %K maternal health %K pregnancy %K nutrition %K Indigenous women %K diet %K health literacy %K Indigenous %K Indigenous people %K mobile phone %D 2023 %7 6.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Nutrition in pregnancy is pivotal to optimizing infant growth and maternal well-being. The factors affecting Indigenous people’s food and nutrition intake are complex with a history of colonization impacting the disproportionate effect of social determinants to this day. Literature regarding the dietary intake or dietary priorities of Indigenous women in Australia is scarce, with supportive, culturally appropriate resources developed for and with this group rare. Research suggests mobile health (mHealth) tools are effective in supporting health knowledge of Indigenous people and positive health behavior changes when designed and developed with the expertise of Indigenous communities. Objective: This study seeks to build the body of knowledge related to nutrition needs and priorities for Indigenous women in Australia during pregnancy. Further, this project team and its participants will co-design an mHealth digital tool to support these nutrition needs. Methods: The Mums and Bubs Deadly Diets study recruits Indigenous women and health care professionals who support Indigenous women during pregnancy into 2 phases. Phase 1 (predesign) uses a mixed methods convergent design using a biographical questionnaire and social or focus groups to inform phase 2 (generative). Phase 2 will use a participatory action research process during co-design workshops to iteratively develop the digital tool; the exact actions within a workshop will evolve according to the participant group decisions. Results: To date, this project has undertaken phase 1 focus groups at all Queensland sites, with New South Wales and Western Australia to begin in early to mid-2023. We have recruited 12 participants from Galangoor Duwalami, 18 participants from Carbal in Toowoomba, and 18 participants from Carbal in Warwick. We are expecting similar numbers of recruits in Western Australia and New South Wales. Participants have been both community members and health care professionals. Conclusions: This study is an iterative and adaptive research program that endeavors to develop real-world, impactful resources to support the nutrition needs and priorities of pregnant Indigenous women in Australia. This comprehensive project requires a combination of methods and methodologies to ensure Indigenous voices are heard at each stage and in all aspects of research output. The development of an mHealth resource for this cohort will provide a necessary bridge where there is often a gap in access to nutrition resources for women in pregnancy in Indigenous communities. International Registered Report Identifier (IRRID): DERR1-10.2196/45983 %M 37147188 %R 10.2196/45983 %U https://www.researchprotocols.org/2023/1/e45983 %U https://doi.org/10.2196/45983 %U http://www.ncbi.nlm.nih.gov/pubmed/37147188 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43869 %T The Association Between Goal Setting and Weight Loss: Prospective Analysis of a Community Weight Loss Program %A Wren,Gina M %A Koutoukidis,Dimitrios A %A Scragg,Jadine %A Whitman,Michael %A Jebb,Susan %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 01865 ext 617855, gina.wren@phc.ox.ac.uk %K obesity %K overweight %K weight loss %K goals %K motivation %K mobile app %K mobile health %K mHealth %K behavior change %K mobile phone %D 2023 %7 5.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Goal setting aids health-related behavior changes; however, the influence of different types of goals on weight loss remains unclear. Objective: We aimed to investigate the association of 3 aspects of goal setting with weight and program dropout over a 24-week period. Methods: This study was a prospective longitudinal analysis of participants in a 12-week digital behavioral weight loss program. Weight and engagement data for eligible participants (N=36,794) were extracted from the database. Eligible participants were adults in the United Kingdom who had enrolled in the program, had a BMI ≥25 kg/m2, and a weight reading recorded at baseline. Three aspects of goal setting were self-reported at enrollment: weight loss motivation (appearance, health, fitness, or self-efficacy), overall goal preference (low, medium, or high), and percentage weight loss goal (<5%, 5%-10%, or >10%). Weight was measured at 4, 12, and 24 weeks. Mixed models for repeated measures were used to explore the association between goals and weight across the 24-week period. To measure sustained weight change, the primary outcome was weight at 24 weeks. We explored dropout rates over the 24-week period by goal and whether engagement mediated the association between goals and weight loss. Results: Of the 36,794 participants (mean 46.7, SD 11.1 years; 33,902/36,794, 92.14% female) included in the cohort, 13.09% (n=4818) reported weight at 24 weeks. Most participants set goals of 5%-10% weight loss (23,629/36,794, 64.22%), but setting goals for >10% was associated with greater weight loss (mean difference 5.21 kg, 95% CI 5.01-5.41; P<.001). There was no difference between goals of 5%-10% and <5% (mean difference 0.59 kg, 95% CI 0.00-1.18; P=.05). Appearance was the most prevalent motivational factor (14,736/36,794, 40.05%), but health and fitness were associated with greater weight losses (mean difference health vs appearance 1.40 kg, 95% CI 1.15-1.65; P<.001 and mean difference fitness vs appearance 0.38 kg, 95% CI 0.05-0.70; P=.03). Goal preference had no association with weight. Engagement was an independent predictor of weight loss but not a mediator of the effect of goal setting. At 24 weeks, those who set goals of >10% were less likely to drop out compared with 5%-10% goals (odds ratio [OR] 0.40, 95% CI 0.38-0.42; P<.001); those who liked to set overall high goals were more likely to drop out compared with medium goals (OR 1.20, 95% CI 1.11-1.29; P<.001); and those motivated by fitness or health were less likely to drop out compared with appearance (OR 0.92, 95% CI 0.85-0.995; P=.04 and OR 0.84, 95% CI 0.78-0.89; P<.001, respectively). Conclusions: Setting higher weight loss goals and being motivated by health or fitness were associated with greater weight loss and lower likelihood of dropout. Randomized trials for setting these types of goals are required to confirm causality. %M 37405833 %R 10.2196/43869 %U https://www.jmir.org/2023/1/e43869 %U https://doi.org/10.2196/43869 %U http://www.ncbi.nlm.nih.gov/pubmed/37405833 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44400 %T mHealth Early Intervention to Reduce Posttraumatic Stress and Alcohol Use After Sexual Assault (THRIVE): Feasibility and Acceptability Results From a Pilot Trial %A Dworkin,Emily R %A Schallert,Macey %A Lee,Christine M %A Kaysen,Debra %+ Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St., Box 356560, Seattle, WA, 98195, United States, 1 206 221 6932, edworkin@uw.edu %K mobile health %K mHealth %K mobile apps %K prevention %K alcohol use %K trauma %K sexual violence %K rape %K mobile phone %D 2023 %7 4.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual assault is associated with increased risk for both posttraumatic stress (PTS) and alcohol misuse. Mobile health interventions have shown promise in addressing PTS and substance use in trauma survivors and might be a promising strategy in extending the reach of early interventions to individuals who have recently experienced trauma. Objective: This study assesses the feasibility and acceptability of THRIVE, a mobile health early intervention for recent survivors of sexual assault involving a cognitive behavioral app used daily over 21 days with weekly telephone coaching. Methods: Twenty adult female survivors of past–10-week sexual assault with elevated PTS and alcohol use were randomized to receive the THRIVE intervention as part of a pilot randomized controlled trial. We sought to understand feasibility by examining rates of completion of intervention activities and testing changes in participants’ self-reported knowledge of key intervention concepts from baseline to after the intervention. We assessed acceptability by collecting self-report ratings of satisfaction with the intervention and app usability in a follow-up survey. The coach took notes during coaching calls to track call content and record participant feedback; these notes were qualitatively analyzed to elaborate on the aforementioned domains. Results: Feasibility was demonstrated by moderate rates of activity completion: all participants at least opened the app, 19 (95%) of the 20 participants completed at least 1 cognitive behavioral exercise, and 16 (80%) of the 20 participants attended all 4 coaching calls. Participants completed cognitive behavioral exercises on an average of 10.40 (SD 6.52) out of 21 days. The coaching call notes documented participant comments that app-generated reminders increased completion rates. Feasibility was also demonstrated by the finding that knowledge changes occurred from baseline to after the intervention; this indicated that THRIVE was successful in conveying key concepts. Acceptability was demonstrated by high participant ratings of THRIVE’s usability; the ratings corresponded to a B+ usability grade. The coaching call notes documented that usability was increased by the coaching calls, the app exercises’ clarity, and the app exercises’ inclusion of suggestions; however, the coaching call notes also documented that some of the participants found aspects of the app exercises to be difficult or confusing. Acceptability was also demonstrated by participant ratings of satisfaction: most of the participants (15/16, 94%) rated the app as either moderately helpful or very helpful. The coaching call notes documented that the cognitive behavioral activity modules were seen as appealing and that the positive impact of the intervention contributed to participants’ satisfaction. Conclusions: These findings suggest that THRIVE is feasible and acceptable to survivors of recent sexual assault and that further testing of THRIVE is warranted. Trial Registration: ClinicalTrials.gov NCT03703258; https://clinicaltrials.gov/ct2/show/NCT03703258 %M 37402144 %R 10.2196/44400 %U https://formative.jmir.org/2023/1/e44400 %U https://doi.org/10.2196/44400 %U http://www.ncbi.nlm.nih.gov/pubmed/37402144 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48913 %T Designing High-Fidelity Mobile Health for Depression in Indonesian Adolescents Using Design Science Research: Mixed Method Approaches %A Shania,Mila %A Handayani,Putu Wuri %A Asih,Sali %+ Faculty of Psychology, University of Indonesia, Jl Kampus UI, Depok, 16424, Indonesia, 62 217863419, Putu.wuri@cs.ui.ac.id %K mobile health %K mental health %K user interface %K design science research %K Indonesia %K digital app %K mHealth %K depression %K pandemic %K adolescents %D 2023 %7 3.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 mitigation protocols, enacted to control the pandemic, have also been shown to have a negative impact on mental health, including the mental health of adolescents. The threat of being infected by SARS-CoV-2 and substantial changes in lifestyle, including limited social interaction due to stay-at-home orders, led to loneliness as well as depressive symptoms. However, offline psychological assistance is restricted, as psychologists are bounded by mitigation protocols. Further, not all adolescents’ guardians are open to their children attending or have the means to pay for psychological service; thus, adolescents remain untreated. Having a mobile health (mHealth) app for mental health that uses monitoring, provides social networks, and delivers psychoeducation may provide a solution, especially in countries that have limited health facilities and mental health workers. Objective: This study aimed to design an mHealth app to help prevent and monitor depression in adolescents. The design of this mHealth app was carried out as a high-fidelity prototype. Methods: We used a design science research (DSR) methodology with 3 iterations and 8 golden rule guidelines. The first iteration used interviews, and the second and third iterations used mixed method approaches. The DSR stages include the following: (1) identify the problem; (2) define the solution; (3) define the solution objective; (4) develop, demonstrate, and evaluate the solution; and (5) communicate the solution. This study involved students and medical experts. Results: The first iteration resulted in a wireframe and prototype for the next iteration. The second iteration resulted in a System Usability Scale score of 67.27, indicating a good fit. In the third iteration, the system usefulness, information quality, interface quality, and overall values were 2.416, 2.341, 2.597, and 2.261, respectively, indicating a good design. Key features of this mHealth app include a mood tracker, community, activity target, and meditation, and supporting features that complement the design include education articles and early detection features. Conclusions: Our findings provide guidance for health facilities and to design and implement future mHealth apps to help treat adolescent depression. %M 37399059 %R 10.2196/48913 %U https://formative.jmir.org/2023/1/e48913 %U https://doi.org/10.2196/48913 %U http://www.ncbi.nlm.nih.gov/pubmed/37399059 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45298 %T Workout Logging Through an mHealth App for Weight Reduction Among Different Generations: Secondary Analysis of the MED PSU×ThaiSook Healthier Challenge %A Sae-lee,Kittiya %A Surangsrirat,Decho %A Parlawong,Chanatip %A Anawilkul,T-touch %A Assawachamrun,Narinuch %A Boonbandan,Pawanya %A Ladapongpuwat,Paweerata %A Chupetch,Bhawat %A Thongchai,Supatcha %A Pruphetkaew,Nannapat %A Thongseiratch,Therdpong %A Vichitkunakorn,Polathep %A Ngamchaliew,Pitchayanont %+ Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, 15 Karnchanawanich Road, Hat Yai, Songkhla, 90110, Thailand, 66 74451330, pitchayanont@hotmail.com %K generations %K logging frequency %K mobile health app %K weight status %K weight reduction %D 2023 %7 30.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Being overweight or obese presents a major risk factor for noncommunicable diseases (NCDs) such as cardiovascular disease, diabetes, and musculoskeletal disorders. These problems are preventable and solvable via weight reduction and increased physical activity and exercise. The number of adults who are overweight or affected by obesity has tripled in the last 4 decades. Using mobile health (mHealth) apps can help users with health issues, including reducing their weight by restricting their daily calorie intake, which can be recorded along with other parameters, such as physical activity and exercise. These features could further enhance health and prevent NCDs. ThaiSook, a Thai mHealth app developed by the National Science and Technology Development Agency, aims to promote healthy lifestyles and reduce the risk behaviors of NCDs. Objective: This study aimed to determine whether ThaiSook users were successful in 1-month weight reduction and identify which demographic factors or logging functions were associated with significant weight reduction. Methods: A secondary data analysis was performed using data collected from the “MED PSU×ThaiSook Healthier Challenge,” a month-long challenge to encourage a healthy lifestyle. We enrolled 376 participants to evaluate the study outcomes. The variables, comprising demographic characteristics (ie, sex, generation, group size, and BMI), were classified into 4 groups: normal (18.5-22.9 kg/m2), overweight (23-24.9 kg/m2), obese I (25-29.9 kg/m2), and obese II (BMI ≥30 kg/m2). Logging functions (ie, water, fruit and vegetables, sleep, workout, step, and run) were classified into 2 groups: consistent (≥80%) and inconsistent (<80%) users. Weight reduction was categorized into 3 groups: no weight reduction, slight weight reduction (0%-3%), and significant weight reduction (>3%). Results: Of 376 participants, most were female (n=346, 92%), had normal BMI (n=178, 47.3%), belonged to Generation Y (n=147, 46.7%), and had a medium group size (6-10 members; n=250, 66.5%). The results showed that 56 (14.9%) participants had 1-month significant weight loss, and the median weight reduction of the group was −3.85% (IQR −3.40% to −4.50%). Most participants (264/376, 70.2%) experienced weight loss, with an overall median weight loss of −1.08% (IQR −2.40% to 0.00%). The factors associated with significant weight reduction were consistently logging workouts (adjusted odds ratio [AOR] 1.69, 95% CI 1.07-2.68), being Generation Z (AOR 3.06, 95% CI 1.01-9.33), and being overweight or being obese compared to those with normal BMI (AOR 2.66, 95% CI 1.41-5.07; AOR 1.76, 95% CI 1.08-2.87, respectively). Conclusions: More than half of the “MED PSU×ThaiSook Healthier Challenge” participants achieved a slight weight reduction, and 14.9% (56/376) of users lost significant weight. Factors including workout logging, being Generation Z, being overweight, and being obese were associated with significant weight reduction. %M 37389918 %R 10.2196/45298 %U https://formative.jmir.org/2023/1/e45298 %U https://doi.org/10.2196/45298 %U http://www.ncbi.nlm.nih.gov/pubmed/37389918 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e46155 %T Feasibility, Acceptability, and Potential Impact of a Novel mHealth App for Smokers Ambivalent About Quitting: Randomized Pilot Study %A McClure,Jennifer B %A Heffner,Jaimee L %A Krakauer,Chloe %A Mun,Sophia %A Klasnja,Predrag %A Catz,Sheryl L %+ Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, United States, 1 206 287 2737, Jennifer.B.McClure@kp.org %K ambivalence %K app %K digital health intervention %K mHealth intervention %K mHealth %K motivation %K nicotine %K smoking %K smoking cessation %K tobacco %D 2023 %7 28.6.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Most smokers are ambivalent about quitting—they want to quit someday, but not now. Interventions are needed that can engage ambivalent smokers, build their motivation for quitting, and support future quit attempts. Mobile health (mHealth) apps offer a cost-effective platform for such interventions, but research is needed to inform their optimal design and assess their acceptability, feasibility, and potential effectiveness. Objective: This study aims to assess the feasibility, acceptability, and potential impact of a novel mHealth app for smokers who want to quit smoking someday but are ambivalent about quitting in the near term. Methods: We enrolled adults across the United States who smoked more than 10 cigarettes a day and were ambivalent about quitting (n=60). Participants were randomly assigned to 1 of 2 versions of the GEMS app: standard care (SC) versus enhanced care (EC). Both had a similar design and identical evidence-based, best-practice smoking cessation advice and resources, including the ability to earn free nicotine patches. EC also included a series of exercises called experiments designed to help ambivalent smokers clarify their goals, strengthen their motivation, and learn important behavioral skills for changing smoking behavior without making a commitment to quit. Outcomes were analyzed using automated app data and self-reported surveys at 1 and 3 months post enrollment. Results: Participants who installed the app (57/60, 95%) were largely female, White, socioeconomically disadvantaged, and highly nicotine dependent. As expected, key outcomes trended in favor of the EC group. Compared to SC users, EC participants had greater engagement (mean sessions 19.9 for EC vs 7.3 for SC). An intentional quit attempt was reported by 39.3% (11/28) of EC users and 37.9% (11/29) of SC users. Seven-day point prevalence smoking abstinence at the 3-month follow-up was reported by 14.7% (4/28) of EC users and 6.9% (2/29) of SC users. Among participants who earned a free trial of nicotine replacement therapy based on their app usage, 36.4% (8/22) of EC participants and 11.1% (2/18) of SC participants requested the treatment. A total of 17.9% (5/28) of EC and 3.4% (1/29) of SC participants used an in-app feature to access a free tobacco quitline. Other metrics were also promising. EC participants completed an average of 6.9 (SD 3.1) out of 9 experiments. Median helpfulness ratings for completed experiments ranged from 3 to 4 on a 5-point scale. Finally, satisfaction with both app versions was very good (mean 4.1 on a 5-point Likert scale) and 95.3% (41/43) of all respondents would recommend their app version to others. Conclusions: Ambivalent smokers were receptive to the app-based intervention, but the EC version, which combined best-practice cessation advice with self-paced, experiential exercises, was associated with greater use and evidence of behavior change. Further development and evaluation of the EC program is warranted. Trial Registration: ClinicalTrials.gov NCT04560868; https://clinicaltrials.gov/ct2/show/NCT04560868 %M 37379059 %R 10.2196/46155 %U https://mhealth.jmir.org/2023/1/e46155 %U https://doi.org/10.2196/46155 %U http://www.ncbi.nlm.nih.gov/pubmed/37379059 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43528 %T Effect of a Mobile App–Based Urinary Incontinence Self-Management Intervention Among Pregnant Women in China: Pragmatic Randomized Controlled Trial %A Chen,Ling %A Zhang,Danli %A Li,Tiantian %A Liu,Sha %A Hua,Jie %A Cai,Wenzhi %+ Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 1333, Xinhu Road, Baoán District Shenzhen, Guangdong, Shenzhen, 518101, China, 86 13078484316, caiwzh@smu.edu.cn %K mobile health %K mHealth %K mobile apps %K urinary incontinence %K pregnancy %K pragmatic randomized controlled trial %K mobile phone %D 2023 %7 27.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Urinary incontinence (UI) is a highly prevalent health concern commonly observed during and after pregnancy that can substantially impact women’s physical and psychological well-being and quality of life. Owing to its numerous advantages, mobile health may be a promising solution; however, it is unclear whether the app-based intervention can effectively improve UI symptoms during and after pregnancy. Objective: This study aimed to evaluate the effectiveness of the Urinary Incontinence for Women (UIW) app–based intervention for UI symptom improvement among pregnant women in China. Methods: Singleton pregnant women without incontinence before pregnancy who were aged ≥18 years and between 24 and 28 weeks of gestation were recruited from a tertiary public hospital in China and were randomly allocated (1:1) to either an experimental group (n=63) or a control group (n=63). The experimental group received the UIW app intervention and oral pelvic floor muscle training (PFMT) instructions, whereas the control group received oral PFMT instructions alone. Neither the participants nor the researchers were blinded to the intervention. The primary outcome was UI severity. The secondary outcomes included quality of life, self-efficacy with PFMT, and knowledge of UI. All data were collected at baseline, 2 months after randomization, and 6 weeks post partum through electronic questionnaires or by checking the electronic medical record system. Data analysis followed the intention-to-treat principle. A linear mixed model was used to examine the intervention effect on primary and secondary outcomes. Results: Participants in the experimental and control groups were comparable at baseline. Of the 126 overall participants, 117 (92.9%) and 103 (81.7%) women completed follow-up visits at 2 months after randomization and 6 weeks after delivery, respectively. A statistically significant difference in UI symptom severity was observed between the experimental group and control group (2 months after randomization: mean difference −2.86, 95% CI −4.09 to −1.64, P<.001; 6 weeks post partum: mean difference −2.68, 95% CI −3.87 to −1.49, P<.001). For the secondary outcomes, a statistically significant intervention effect on the quality of life, self-efficacy, and UI knowledge was found at the 2-month follow-up (all P<.05) and 6 weeks post partum (all P<.001). Conclusions: The app-based UI self-management intervention (UIW) effectively improved UI symptom severity, quality of life, self-efficacy with PFMT, and knowledge of UI during the late pregnancy and early postnatal periods. Larger multicenter studies with a longer postpartum follow-up are required to further extend these findings. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800016171; http://www.chictr.org.cn/showproj.aspx?proj=27455 International Registered Report Identifier (IRRID): RR2-10.2196/22771 %M 37368465 %R 10.2196/43528 %U https://www.jmir.org/2023/1/e43528 %U https://doi.org/10.2196/43528 %U http://www.ncbi.nlm.nih.gov/pubmed/37368465 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e46286 %T The Effectiveness of a Mobile Phone–Based Physical Activity Program for Treating Depression, Stress, Psychological Well-Being, and Quality of Life Among Adults: Quantitative Study %A Kim,Hyungsook %A Lee,Kikwang %A Lee,Ye Hoon %A Park,Yoonjung %A Park,Yonghyun %A Yu,Yeonwoo %A Park,Jaeyoung %A Noh,Sihyeon %+ Division of Global Sport Industry, Hankuk University of Foreign Studies, 81, Oedae-ro, Mohyeon-eup, Cheoin-gu, Gyeonggi-do, 17035, Republic of Korea, 82 31 330 4986, leeye22@o365.hufs.ac.kr %K depressive symptoms %K mobile intervention %K exercise %K internet-based fitness %K mental health %D 2023 %7 26.6.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Depression is a substantial global health problem, affecting >300 million people and resulting in 12.7% of all deaths. Depression causes various physical and cognitive problems, leading to a 5-year to 10-year decrease in life expectancy compared with the general population. Physical activity is known to be an effective, evidence-based treatment for depression. However, people generally have difficulties with participating in physical activity owing to limitations in time and accessibility. Objective: To address this issue, this study aimed to contribute to the development of alternative and innovative intervention methods for depression and stress management in adults. More specifically, we attempted to investigate the effectiveness of a mobile phone–based physical activity program on depression, perceived stress, psychological well-being, and quality of life among adults in South Korea. Methods: Participants were recruited and randomly assigned to the mobile phone intervention or waitlist group. Self-report questionnaires were used to assess variables before and after treatment. The treatment group used the program around 3 times per week at home for 4 weeks, with each session lasting about 30 minutes. To evaluate the program’s impact, a 2 (condition) × 2 (time) repeated-measures ANOVA was conducted, considering pretreatment and posttreatment measures along with group as independent variables. For a more detailed analysis, paired-samples 2-tailed t tests were used to compare pretreatment and posttreatment measurements within each group. Independent-samples 2-tailed t tests were conducted to assess intergroup differences in pretreatment measurements. Results: The study included a total of 68 adults aged between 18 and 65 years, who were recruited both through web-based and offline methods. Of these 68 individuals, 41 (60%) were randomly assigned to the treatment group and 27 (40%) to the waitlist group. The attrition rate was 10.2% after 4 weeks. The findings indicated that there is a significant main effect of time (F1,60=15.63; P=.003; ηp2=0.21) in participants’ depression scores, indicating that there were changes in depression level across time. No significant changes were observed in perceived stress (P=.25), psychological well-being (P=.35), or quality of life (P=.07). Furthermore, depression scores significantly decreased in the treatment group (from 7.08 to 4.64; P=.03; Cohen d=0.50) but not in the waitlist group (from 6.72 to 5.08; P=.20; Cohen d=0.36). Perceived stress score of the treatment group also significantly decreased (from 2.95 to 2.72; P=.04; Cohen d=0.46) but not in the waitlist group (from 2.82 to 2.74; P=.55; Cohen d=0.15). Conclusions: This study provided experimental evidence that mobile phone–based physical activity program affects depression significantly. By exploring the potential of mobile phone–based physical activity programs as a treatment option, this study sought to improve accessibility and encourage participation in physical activity, ultimately promoting better mental health outcomes for individuals with depression and stress. %M 37358905 %R 10.2196/46286 %U https://mhealth.jmir.org/2023/1/e46286 %U https://doi.org/10.2196/46286 %U http://www.ncbi.nlm.nih.gov/pubmed/37358905 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e45414 %T Usage and Daily Attrition of a Smartphone-Based Health Behavior Intervention: Randomized Controlled Trial %A Egilsson,Erlendur %A Bjarnason,Ragnar %A Njardvik,Urdur %+ Department of Psychology, University of Iceland, Saemundargata 12, Reykjavik, 102, Iceland, 354 5254240, erlendu@hi.is %K mHealth intervention %K mobile health %K adolescent %K attrition %K mental health %K physical activity %D 2023 %7 26.6.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although most adolescents have access to smartphones, few of them use mobile health (mHealth) apps for health improvement, highlighting the apparent lack of interest in mHealth apps among adolescents. Adolescent mHealth interventions have been burdened with high attrition rates. Research on these interventions among adolescents has frequently lacked detailed time-related attrition data alongside analysis of attrition reasons through usage. Objective: The objective was to obtain daily attrition rates among adolescents in an mHealth intervention to gain a deeper understanding of attrition patterns, including the role of motivational support, such as altruistic rewards, through analysis of app usage data. Methods: A randomized controlled trial was conducted with 304 adolescent participants (152 boys and 152 girls) aged 13-15 years. Based on 3 participating schools, participants were randomly assigned to control, treatment as usual (TAU), and intervention groups. Measures were obtained at baseline, continuously throughout the 42-day trial period (research groups), and at the trial end. The mHealth app is called SidekickHealth and is a social health game with the following 3 main categories: nutrition, mental health, and physical health. Primary measures were attrition based on time from launch, and the type, frequency, and time of health behavior exercise usage. Outcome differences were obtained through comparison tests, while regression models and survival analyses were used for attrition measures. Results: Attrition differed significantly between the intervention and TAU groups (44.4% vs 94.3%; χ21=61.220; P<.001). The mean usage duration was 6.286 days in the TAU group and 24.975 days in the intervention group. In the intervention group, male participants were active significantly longer than female participants (29.155 vs 20.433 days; χ21=6.574; P<.001). Participants in the intervention group completed a larger number of health exercises in all trial weeks, and a significant decrease in usage was observed from the first to second week in the TAU group (t105=9.208; P<.001) but not in the intervention group. There was a significant increase in health exercises in the intervention group from the fifth to sixth week (t105=3.446; P<.001). Such a significant increase in usage was not evident in the TAU group. The research group was significantly related to attrition time (hazard ratio 0.308, 95% CI 0.222-0.420), as well as the numbers of mental health exercises (P<.001) and nutrition exercises (P<.001). Conclusions: Differences in attrition rates and usage between groups of adolescents were identified. Motivational support is a significant factor for lowering attrition in adolescent mHealth interventions. The results point to sensitivity periods in the completion of diverse health tasks, and emphasis on time-specific attrition, along with the type, frequency, and time of health behavior exercise usage, is likely a fruitful avenue for further research on mHealth interventions for adolescent populations, in which attrition rates remain excessive. Trial Registration: ClinicalTrials.gov NCT05912439; https://clinicaltrials.gov/study/NCT05912439 %M 37358888 %R 10.2196/45414 %U https://mhealth.jmir.org/2023/1/e45414 %U https://doi.org/10.2196/45414 %U http://www.ncbi.nlm.nih.gov/pubmed/37358888 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e40579 %T Factors Reducing the Use of a Persuasive mHealth App and How to Mitigate Them: Thematic Analysis %A Kekkonen,Markku %A Korkiakangas,Eveliina %A Laitinen,Jaana %A Oinas-Kukkonen,Harri %+ Oulu Advanced Research on Service and Information Systems, Faculty of Information Technology and Electrical Engineering, University of Oulu, Pentti Kaiteran katu 1, Oulu, 90014, Finland, 358 029 4480000, markku.kekkonen@oulu.fi %K mobile phone %K mobile health %K mHealth %K Persuasive Systems Design %K behavior change %K thematic analysis %K microentrepreneurs %K randomized controlled trial %D 2023 %7 26.6.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Studies on which persuasive features may work for different users in health contexts are rare. The participants in this study were microentrepreneurs. We built a persuasive mobile app to help them to recover from work. Representatives of this target group tend to be very busy due to work, which was reflected in their use of the app during the randomized controlled trial intervention. Microentrepreneurs also often have dual roles; they are professionals in their line of work as well as entrepreneurs managing their own business, which may add to their workload. Objective: This study aimed to present users’ views on the factors that hinder their use of the mobile health app that we developed and how these factors could be mitigated. Methods: We interviewed 59 users and conducted both data-driven and theory-driven analyses on the interviews. Results: Factors reducing app use could be divided into 3 categories: use context (problem domain–related issues, eg, the lack of time due to work), user context (user-related issues, eg, concurrent use of other apps), and technology context (technology-related issues, eg, bugs and usability). Due to the nature of the participants’ entrepreneurship, which often interferes with personal life, it became clear that designs targeting similar target groups should avoid steep learning curves and should be easy (quick) to use. Conclusions: Personalized tunneling—guiding the user through a system via personalized solutions—could help similar target groups with similar issues better engage with and keep using health apps because of the easy learning curve. When developing health apps for interventions, background theories should not be interpreted too strictly. Applying theory in practice may require rethinking approaches for adaptation as technology has evolved rapidly and continues to evolve. Trial Registration: ClinicalTrials.gov NCT03648593; https://clinicaltrials.gov/ct2/show/NCT03648593 %M 37358883 %R 10.2196/40579 %U https://humanfactors.jmir.org/2023/1/e40579 %U https://doi.org/10.2196/40579 %U http://www.ncbi.nlm.nih.gov/pubmed/37358883 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44877 %T Mindcraft, a Mobile Mental Health Monitoring Platform for Children and Young People: Development and Acceptability Pilot Study %A Kadirvelu,Balasundaram %A Bellido Bel,Teresa %A Wu,Xiaofei %A Burmester,Victoria %A Ananth,Shayma %A Cabral C C Branco,Bianca %A Girela-Serrano,Braulio %A Gledhill,Julia %A Di Simplicio,Martina %A Nicholls,Dasha %A Faisal,A Aldo %+ Brain & Behaviour Lab, Department of Computing and Department of Bioengineering, Imperial College London, Royal School of Mines, London, SW7 2AZ, United Kingdom, 44 20 7594 6373, a.faisal@imperial.ac.uk %K mobile mental health %K passive sensing %K smartphone apps for mental health %K children and young people %K adolescents %K digital tools %K mobile apps %D 2023 %7 26.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Children and young people's mental health is a growing public health concern, which is further exacerbated by the COVID-19 pandemic. Mobile health apps, particularly those using passive smartphone sensor data, present an opportunity to address this issue and support mental well-being. Objective: This study aimed to develop and evaluate a mobile mental health platform for children and young people, Mindcraft, which integrates passive sensor data monitoring with active self-reported updates through an engaging user interface to monitor their well-being. Methods: A user-centered design approach was used to develop Mindcraft, incorporating feedback from potential users. User acceptance testing was conducted with a group of 8 young people aged 15-17 years, followed by a pilot test with 39 secondary school students aged 14-18 years, which was conducted for a 2-week period. Results: Mindcraft showed encouraging user engagement and retention. Users reported that they found the app to be a friendly tool helping them to increase their emotional awareness and gain a better understanding of themselves. Over 90% of users (36/39, 92.5%) answered all active data questions on the days they used the app. Passive data collection facilitated the gathering of a broader range of well-being metrics over time, with minimal user intervention. Conclusions: The Mindcraft app has shown promising results in monitoring mental health symptoms and promoting user engagement among children and young people during its development and initial testing. The app's user-centered design, the focus on privacy and transparency, and a combination of active and passive data collection strategies have all contributed to its efficacy and receptiveness among the target demographic. By continuing to refine and expand the app, the Mindcraft platform has the potential to contribute meaningfully to the field of mental health care for young people. %M 37358901 %R 10.2196/44877 %U https://formative.jmir.org/2023/1/e44877 %U https://doi.org/10.2196/44877 %U http://www.ncbi.nlm.nih.gov/pubmed/37358901 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e45162 %T Influencing Factors to mHealth Uptake With Indigenous Populations: Qualitative Systematic Review %A Goodman,Andrew %A Mahoney,Ray %A Spurling,Geoffrey %A Lawler,Sheleigh %+ School of Public Health, The University of Queensland, 266 Herston Road, Turrbal, Jagera Country, Herston, 4006, Australia, 61 733655393, Andrew.Goodman@csiro.au %K mHealth %K Indigenous %K Canada %K Australia %K New Zealand %K United States %K Papua New Guinea %K Samoa %K qualitative %K systematic review %K feasibility %K acceptability %K users %K design %K workflow %D 2023 %7 23.6.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The advancements and abundance of mobile phones and portable health devices have created an opportunity to use mobile health (mHealth) for population health systems. There is increasing evidence for the feasibility and acceptance of mHealth with Indigenous populations. Providing a synthesis of qualitative findings of mHealth with Indigenous populations will gain insights into the strengths and challenges to mHealth use in Indigenous populations. Objective: This review aimed to identify and synthesize qualitative data pertaining to the experiences and perceptions of mHealth from the perspectives of end users (patients and service providers) living in the colonial settler democracies of Canada, Australia, New Zealand, the United States, the Pacific Islands, and the Sápmi region of northern Europe. Methods: In May 2021, systematic searches of peer-reviewed, scientific papers were conducted across the 5 databases of PubMed, CINAHL, Embase, PsycINFO, and Web of Science. Qualitative or mixed method studies were included where a mHealth intervention was the primary focus for responding to health challenges with Indigenous populations. Two authors independently screened papers for eligibility and assessed the risk of bias using a modified version of the Critical Appraisal Skills Programme. A meta-aggregative approach was used to analyze the findings of included studies. Results: Seventeen papers met the eligibility criteria, 8 studies with patients, 7 studies with service providers, and 2 studies that included both patients and service providers. Studies were conducted in Australia (n=10), Canada (n=2), New Zealand (n=2), Papua New Guinea (n=1), the United States (n=1), and Samoa (n=1). Our interpretation of these qualitative findings shows commonalities between Indigenous patients’ and service providers’ perceptions of mHealth. We summarize our findings in six themes: (1) mHealth literacy, (2) mHealth as a facilitator for connection and support, (3) mHealth content needed to be culturally relevant, (4) mHealth security and confidentiality, (5) mHealth supporting rather than replacing service providers, and (6) workplace and organizational capacity. Conclusions: This research suggests that mHealth can meet the needs of both patients and service providers when the mHealth intervention is culturally relevant, accounts for digital and health literacy, incorporates interactive components, is supported by workplaces, fits into health provider workflows, and meets security and confidentiality standards. Future mHealth research with Indigenous populations should partner with key representatives (eg, patients, service providers, and executive leaders) in the mHealth design appropriate to the purpose, people, setting, and delivery. %M 37351947 %R 10.2196/45162 %U https://mhealth.jmir.org/2023/1/e45162 %U https://doi.org/10.2196/45162 %U http://www.ncbi.nlm.nih.gov/pubmed/37351947 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45254 %T Mobile Assessments of Mood, Cognition, Smartphone-Based Sensor Activity, and Variability in Craving and Substance Use in Patients With Substance Use Disorders in Norway: Prospective Observational Feasibility Study %A Lauvsnes,Anders Dahlen Forsmo %A Hansen,Tor Ivar %A Ankill,Sebastian Øiungen %A Bae,Sang Won %A Gråwe,Rolf W %A Braund,Taylor A %A Larsen,Mark %A Langaas,Mette %+ Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, PO Box 8905, Trondheim, 7491, Norway, 47 99592222, anders.d.f.lauvsnes@ntnu.no %K executive functioning %K substance use disorder %K ecological momentary assessment %K clinical inference %K substance use %K pilot study %K mood %K mental health %K neurocognitive functioning %K smartphone use %K mobile sensor %K sensor %K decision support %K mobile phone %D 2023 %7 23.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with substance use disorders (SUDs) are at increased risk for symptom deterioration following treatment, with up to 60% resuming substance use within the first year posttreatment. Substance use craving together with cognitive and mental health variables play important roles in the understanding of the trajectories from abstinence to substance use. Objective: This prospective observational feasibility study aims to improve our understanding of specific profiles of variables explaining SUD symptom deterioration, in particular, how individual variability in mental health, cognitive functioning, and smartphone use is associated with craving and substance use in a young adult clinical population. Methods: In this pilot study, 26 patients with SUDs were included at about 2 weeks prior to discharge from inpatient SUD treatment from 3 different treatment facilities in Norway. Patients underwent baseline neuropsychological and mental health assessments; they were equipped with smartwatches and they downloaded an app for mobile sensor data collection in their smartphones. Every 2 days for up to 8 weeks, the patients were administered mobile ecological momentary assessments (EMAs) to evaluate substance use, craving, mental health, cognition, and a mobile Go/NoGo performance task. Repeated EMAs as well as the smartphone’s battery use data were averaged across all days per individual and used as candidate input variables together with the baseline measures in models of craving intensity and the occurrence of any substance use episodes. Results: A total of 455 momentary assessments were completed out of a potential maximum of 728 assessments. Using EMA and baseline data as candidate input variables and craving and substance use as responses, model selection identified mean craving intensity as the most important predictor of having one or more substance use episodes and with variabilities in self-reported impulsivity, mental health, and battery use as significant explanatory variables of craving intensity. Conclusions: This prospective observational feasibility study adds novelty by collecting high-intensity data for a considerable period of time, including mental health data, mobile cognitive assessments, and mobile sensor data. Our study also contributes to our knowledge about a clinical population with the most severe SUD presentations in a vulnerable period during and after discharge from inpatient treatment. We confirmed the importance of variability in cognitive function and mood in explaining variability in craving and that smartphone usage may possibly add to this understanding. Further, we found that craving intensity is an important explanatory variable in understanding substance use episodes. %M 37351934 %R 10.2196/45254 %U https://formative.jmir.org/2023/1/e45254 %U https://doi.org/10.2196/45254 %U http://www.ncbi.nlm.nih.gov/pubmed/37351934 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46842 %T Trauma-Informed Care in Digital Health Technologies: Protocol for a Scoping Review %A Abdulai,Abdul-Fatawu %A Naghdali,Hasti %A Tekie Ghirmay,Eden %A Adam,Fuseini %A Bawafaa,Eunice %+ School of Nursing, Faculty of Applied Sciences, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada, 1 6048227214, fatawu.abdulai@ubc.ca %K clinical intervention %K digital health technologies %K digital health %K psychological trauma %K stress %K trauma %K trauma-informed care %D 2023 %7 23.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The use of digital health technologies is becoming increasingly common across the globe as they offer immense potential to enhance health care delivery by promoting accessibility, flexibility, and personalized care, connecting patients to health care professionals, and offering more efficient services and treatments to remote residents. At the same time, there is an increasing recognition of how digital health can inadvertently foment psychological trauma. This phenomenon has led to the adoption of trauma-informed care in designing and deploying digital health technologies. However, how trauma-informed care is defined and characterized, and the various trauma-informed care strategies used in designing and deploying digital health technologies remain unexplored. Objective: This scoping review aims to explore and synthesize the literature on how trauma-informed care is defined and characterized in digital health and the various trauma-informed care principles, strategies, or recommendations used in designing and deploying digital health. Methods: This review will draw on the Joanna Briggs Institute’s updated methodological guidance for scoping reviews. A search will be conducted on CINAHL, PubMed, Embase, Compendex Engineering Village, Web of Science, Scopus, and PsycINFO. This review will consider published research studies and unpublished work (gray literature). Studies will be included if they applied trauma-informed care in designing or deploying digital health for patients across all geographical locations or provide trauma-informed recommendations on how web developers should develop digital health. Studies will be limited to publications within the past 10 years and studies in all languages will be considered. Two independent reviewers will screen the titles and abstracts, and then perform a full-text review. Data will be extracted into a data extraction tool developed for this study. Results: The scoping review was undergoing a full search as of April 2023. The main results will synthesize the peer-reviewed and gray literature on adopting trauma-informed care practices in digital health research and development. The study is expected to be completed by December 2023 and the results are expected to be published in a peer-reviewed journal. Conclusions: This review is expected to provide the knowledge base on the adoption of trauma-informed care in designing and deploying digital health. This knowledge can lead to more engaging, and likely, more effective digital health interventions that have less potential for harm. A synthesis of the various trauma-informed care strategies in digital health will also provide a trauma-informed language by enabling researchers and digital health developers to consider trauma as a critical factor in each stage of the design process. International Registered Report Identifier (IRRID): DERR1-10.2196/46842 %M 37351935 %R 10.2196/46842 %U https://www.researchprotocols.org/2023/1/e46842 %U https://doi.org/10.2196/46842 %U http://www.ncbi.nlm.nih.gov/pubmed/37351935 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48898 %T Testing the Efficacy of a Scalable Telephone-Delivered Guided Imagery Tobacco Cessation Treatment: Protocol for a Randomized Clinical Trial %A Gordon,Judith S %A Armin,Julie S %A Giacobbi Jr,Peter %A Hsu,Chiu-Hsieh %A Marano,Kari %A Sheffer,Christine E %+ College of Nursing, University of Arizona, 1305 N Martin Avenue, Tucson, AZ, 85718, United States, 1 520 6264970, judithg@email.arizona.edu %K tobacco %K smoking %K treatment %K integrative health %K guided imagery %K behavior change %K telephone %K mobile phone %D 2023 %7 23.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tobacco use continues to be a leading preventable cause of death and disease in the United States, accounting for >480,000 deaths each year. Although treatments for tobacco use are effective for many, there is substantial variability in outcomes, and these approaches are not effective for all individuals seeking to quit smoking cigarettes. New, effective therapeutic approaches are needed to meet the preferences of people who want to stop smoking. Guided imagery (GI) is a mind-body technique that involves the guided visualization of specific mental images, which is enhanced with other sensory modalities and emotions. Preliminary evidence provides initial support for the use of GI as a treatment for cigarette smoking. Meta-analyses have shown that standard treatment for cigarette smoking delivered over the telephone via quitlines is effective. A telephone-based intervention that uses GI might provide another effective treatment option and increase the reach and effectiveness of quitlines. Objective: This study aims to test the efficacy of Be Smoke Free, a telephone-delivered GI treatment for smoking cessation. Methods: This multisite randomized clinical trial (RCT) will compare a novel telephone-delivered GI tobacco cessation treatment with a standard evidence-based behavioral treatment. The study will be conducted over 5 years. In phase 1, we refined protocols and procedures for the New York State and West Virginia sites for use in the RCT. During phase 2, we will conduct an RCT with 1200 participants: 600 (50%) recruited via quitlines and 600 (50%) recruited via population-based methods. Participants will be randomly assigned to either the GI condition or the behavioral condition; both treatments will be delivered by trained study coaches located at the University of Arizona. Assessments will be conducted at baseline and 3 and 6 months after enrollment by University of Arizona research staff. The primary outcome will be self-reported 30-day point prevalence abstinence 6 months after enrollment. Secondary outcomes include biochemically verified 7-day point prevalence abstinence 6 months after enrollment. Results: Recruitment in West Virginia and New York began in October 2022. As of March 31, 2023, a total of 242 participants had been enrolled. Follow-up assessments began in November 2022. As of March 31, 2023, of the 118 eligible participants, 97 (82.2%) had completed the 3-month assessment, and 93% (26/28) of eligible participants had completed the 6-month assessment. Biochemical verification and qualitative interviews began in April 2023. Recruitment will continue through 2025 and follow-up assessments through 2026. Primary results are expected to be published in 2027. Conclusions: The Be Smoke Free study is a first-of-its-kind RCT that incorporates GI into telephone-based tobacco cessation treatment. If successful, Be Smoke Free will have substantial benefits for the long-term health of people who use tobacco across the United States. Trial Registration: ClinicalTrials.gov NCT05277831; https://clinicaltrials.gov/ct2/show/NCT05277831 International Registered Report Identifier (IRRID): PRR1-10.2196/48898 %M 37351932 %R 10.2196/48898 %U https://www.researchprotocols.org/2023/1/e48898 %U https://doi.org/10.2196/48898 %U http://www.ncbi.nlm.nih.gov/pubmed/37351932 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45188 %T Novel Location-Based Survey Using Cognitive Interviews to Assess Geographic Networks and Hotspots of Sex and Drug Use: Implementation and Validation Study %A Reid,Sean C %A Wang,Vania %A Assaf,Ryan D %A Kaloper,Sofia %A Murray,Alan T %A Shoptaw,Steven %A Gorbach,Pamina %A Cassels,Susan %+ Department of Geography, University of California, Santa Barbara, 1832 Ellison Hall, UC Santa Barbara, Santa Barbara, CA, 93106, United States, 1 801 927 7714, seanreid@ucsb.edu %K networks %K sexual network geography %K activity space %K HIV %K survey design %K risk hotspots %K cognitive interviews %K health interventions %K mobile phone %D 2023 %7 22.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The Ending the HIV Epidemic initiative in the United States relies on HIV hotspots to identify where to geographically target new resources, expertise, and technology. However, interventions targeted at places with high HIV transmission and infection risk, not just places with high HIV incidence, may be more effective at reducing HIV incidence and achieving health equity. Objective: We described the implementation and validation of a web-based activity space survey on HIV risk behaviors. The survey was intended to collect geographic information that will be used to map risk behavior hotspots as well as the geography of sexual networks in Los Angeles County. Methods: The survey design team developed a series of geospatial questions that follow a 3-level structure that becomes more geographically precise as participants move through the levels. The survey was validated through 9 cognitive interviews and iteratively updated based on participant feedback until the saturation of topics and technical issues was reached. Results: In total, 4 themes were identified through the cognitive interviews: functionality of geospatial questions, representation and accessibility, privacy, and length and understanding of the survey. The ease of use for the geospatial questions was critical as many participants were not familiar with mapping software. The inclusion of well-known places, landmarks, and road networks was critical for ease of use. The addition of a Google Maps interface, which was familiar to many participants, aided in collecting accurate and precise location information. The geospatial questions increased the length of the survey and warranted the inclusion of features to simplify it and speed it up. Using nicknames to refer to previously entered geographic locations limited the number of geospatial questions that appeared in the survey and reduced the time taken to complete it. The long-standing relationship between participants and the research team improved comfort to disclose sensitive geographic information related to drug use and sex. Participants in the cognitive interviews highlighted how trust and inclusive and validating language in the survey alleviated concerns related to privacy and representation. Conclusions: This study provides promising results regarding the feasibility of using a web-based mapping survey to collect sensitive location information relevant to ending the HIV epidemic. Data collection at several geographic levels will allow for insights into spatial recall of behaviors as well as future sensitivity analysis of the spatial scale of hotspots and network characteristics. This design also promotes the privacy and comfort of participants who provide location information for sensitive topics. Key considerations for implementing this type of survey include trust from participants, community partners, or research teams to overcome concerns related to privacy and comfort. The implementation of similar surveys should consider local characteristics and knowledge when crafting the geospatial components. %M 37347520 %R 10.2196/45188 %U https://formative.jmir.org/2023/1/e45188 %U https://doi.org/10.2196/45188 %U http://www.ncbi.nlm.nih.gov/pubmed/37347520 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43855 %T Smartphone Ownership and Usage Among Pregnant Women Living With HIV in South Africa: Secondary Analysis of CareConekta Trial Data %A Noholoza,Sandisiwe %A Phillips,Tamsin K %A Madwayi,Sindiswa %A Mrubata,Megan %A Camlin,Carol S %A Myer,Landon %A Clouse,Kate %+ Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, 9 Anzio Road, Observatory, Cape Town, 7925, South Africa, 27 732901598, sandisiwe.noholoza@uct.ac.za %K HIV %K mHealth %K mobile phone %K ownership %K smartphone %K South Africa %D 2023 %7 22.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) initiatives are increasingly common in low-resource settings, but the appropriateness of smartphone interventions in health care settings is uncertain. More research is needed to establish the appropriateness and feasibility of integrating new mHealth modalities (novel apps and social media apps) in the South African context. Objective: In this study, to inform future mHealth interventions, we describe smartphone ownership, preferences, and usage patterns among pregnant women living with HIV in Gugulethu, South Africa. Methods: We screened pregnant women living with HIV from December 2019 to February 2021 for the CareConekta trial. To be enrolled in the trial, respondents were required to be 18 years of age or older, living with HIV, ≥28 weeks pregnant, and own a smartphone that met the technical requirements of the CareConekta app. In this secondary analysis, we describe mobile phone ownership and sociodemographic characteristics of all women screened for eligibility (n=639), and smartphone use patterns among those enrolled in the trial (n=193). Results: Overall, median age was 31 (IQR 27-35) years. Of the 582 women who owned smartphones, 580 responded to the question about whether or not it was a smartphone, 2 did not. Among those with smartphones, 92% (421/458) of them used the Android operating system of version 5.0 or above, 98% (497/506) of phones had a GPS, and 96% (485/506) of individuals charged their phones less than twice a day. Among women who were enrolled in the trial, nearly all (99%, 190/193) owned the smartphone themselves; however, 14% (26/193) shared their smartphone with someone. In this case, 96% (25/26) reported possessing the phone most of the day. Median duration of ownership of the smartphone was 12 (IQR 5-24) months, median duration with current phone number use was 25 (IQR 12-60) months, and median number of cell phone numbers owned 2 years prior to enrollment in the trial was 2 (IQR 1-2). Receiving (192/193, 99.5%) and making (190/193, 99%) phone calls were among the most common smartphone uses. The least used features were GPS (106/193, 55%) and email (91/193, 47%). WhatsApp was most frequently reported as a favorite app (181/193, 94%). Conclusions: Smartphone ownership is very common among pregnant women living with HIV in this low-resource, periurban setting. Phone sharing was uncommon, nearly all used the Android system, and phones retained sufficient battery life. These results are encouraging to the development of mHealth interventions. Existing messaging platforms—particularly WhatsApp—are exceedingly popular and could be leveraged for interventions. Findings of moderate smartphone ownership turnover and phone number turnover are considerations for mHealth interventions in similar settings. Trial Registration: ClinicalTrials.gov NCT03836625; https://clinicaltrials.gov/ct2/show/NCT03836625?term=NCT03836625 %M 37347521 %R 10.2196/43855 %U https://formative.jmir.org/2023/1/e43855 %U https://doi.org/10.2196/43855 %U http://www.ncbi.nlm.nih.gov/pubmed/37347521 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41099 %T The Effectiveness of a Traditional Chinese Medicine–Based Mobile Health App for Individuals With Prediabetes: Randomized Controlled Trial %A Chung,Hsueh-Wen %A Tai,Chen-Jei %A Chang,Polun %A Su,Wen-Lin %A Chien,Li-Yin %+ Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, No. 155, Sec. 2 Linong Street, Beitou District, Taipei City, 11221, Taiwan, 886 2 2826 7000 ext 7142, lychien@nycu.edu.tw %K mHealth app %K prediabetes %K traditional Chinese medicine %K health-related quality of life %K body constitution %K meridian energy %D 2023 %7 20.6.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Traditional Chinese medicine (TCM) theories assert that body constitution and meridian energy lay the foundation for disease prevention. TCM-based health concepts have not yet been incorporated into mobile health (mHealth) apps for individuals with prediabetes. Objective: The aim of this study was to examine the effectiveness of a TCM mHealth app for individuals with prediabetes. Methods: This randomized controlled trial recruited 121 individuals with prediabetes at a teaching hospital in New Taipei City between February 2020 and May 2021. The participants were randomly assigned to the TCM mHealth app group (n=42), ordinary mHealth app group (n=41), or control group (n=38). All participants received the usual care that included 15-20 minutes of health education about the disease, along with healthy diet and exercise encouragement. The ordinary mHealth app included physical activity (PA), diet, and disease education, along with individual records. The TCM mHealth app additionally included qi and body constitution information, along with constitution-based PA and diet advice. The control group received the usual care alone and did not have access to any app. Data were collected at baseline, at the end of the 12-week intervention, and 1 month after the intervention. Body constitution, including yang-deficiency, yin-deficiency, and phlegm-stasis, was measured according to the Body Constitution Questionnaire, with higher scores indicating a greater deficiency. Body energy was examined using the Meridian Energy Analysis Device. The Short-Form 36 questionnaire was used to evaluate health-related quality of life (HRQOL), which yielded physical component scores and mental component scores, with higher scores indicating better physical and mental aspects of HRQOL, respectively. Results: Compared to the control group, the TCM mHealth app group showed greater improvement in hemoglobin A1c (HbA1c), yang-deficiency and phlegm-stasis body constitution, and BMI; however, no significant differences were found in these outcomes between the TCM mHealth app and ordinary mHealth app groups. The TCM mHealth app group showed better improvement in body energy and mental component scores than the ordinary mHealth app group. There were no significant differences in fasting plasma glucose, yin-deficiency body constitution, Dietary Approaches to Stop Hypertension dietary behavior, and total PA among the three groups after the intervention. Conclusions: Use of either the ordinary or TCM mHealth app improved HRQOL among individuals with prediabetes. Compared to the outcomes of controls not using any app, use of the TCM mHealth app was effective at improving HbA1c, BMI, yang-deficiency and phlegm-stasis body constitution, and HRQOL. Moreover, using the TCM mHealth app seemed to improve the body energy and HRQOL more than when using the ordinary mHealth app. Further studies with a larger sample size and longer follow-up period may be necessary to determine whether the differences favoring the TCM app are clinically meaningful. Trial Registration: ClinicalTrials.gov NCT04096989; https://clinicaltrials.gov/ct2/show/NCT04096989 %M 37338977 %R 10.2196/41099 %U https://mhealth.jmir.org/2023/1/e41099 %U https://doi.org/10.2196/41099 %U http://www.ncbi.nlm.nih.gov/pubmed/37338977 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e39515 %T Incorporating Consumers’ Needs in Nutrition Apps to Promote and Maintain Use: Mixed Methods Study %A van der Haar,Sandra %A Raaijmakers,Ireen %A Verain,Muriel C D %A Meijboom,Saskia %+ Wageningen Food & Biobased Research, Wageningen University & Research, Bornse Weilanden 9, Wageningen, 6708 WG, Netherlands, 31 317480171, sandra.vanderhaar@wur.nl %K mobile health %K mHealth %K mHealth apps %K nutrition apps %K diet apps %K consumer needs %K app %K use %K nutrition %K tool %K consumer %K eating %K habit %K users %K dietary behavior %K reliable %K food %K database %K time %K developers %K mobile phone %D 2023 %7 20.6.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nutrition apps seem to be promising tools for supporting consumers toward healthier eating habits. There is a wide variety of nutrition apps available; however, users often discontinue app use at an early stage before a permanent change in dietary behavior can be achieved. Objective: The main objective of this study was to identify, from both a user and nonuser perspective, which functionalities should be included in nutrition apps to increase intentions to start and maintain use of these apps. A secondary objective was to gain insight into reasons to quit using nutrition apps at an early stage. Methods: This study used a mixed methods approach and included a qualitative and a quantitative study. The qualitative study (n=40) consisted of a home-use test with 6 commercially available nutrition apps, followed by 6 focus group discussions (FGDs) to investigate user experiences. The quantitative study was a large-scale survey (n=1420), which was performed in a representative sample of the Dutch population to quantify the FGDs’ results. In the survey, several app functionalities were rated on 7-point Likert scales ranging from 1 (very unimportant) to 7 (very important). Results: A total of 3 different phases of app use, subdivided into 10 user-centric app aspects and 46 associated app functionalities, were identified as relevant nutrition app elements in the FGDs. Relevance was confirmed in the survey, as all user-centric aspects and almost all app functionalities were rated as important to include in a nutrition app. In the starting phase, a clear introduction (mean 5.45, SD 1.32), purpose (mean 5.40, SD 1.40), and flexible food tracking options (mean 5.33, SD 1.45) were the most important functionalities. In the use phase, a complete and reliable food product database (mean 5.58, SD 1.41), easy navigation (mean 5.56, SD 1.36), and limited advertisements (mean 5.53, SD 1.51) were the most important functionalities. In the end phase, the possibility of setting realistic goals (mean 5.23, SD 1.44), new personal goals (mean 5.13, SD 1.45), and continuously offering new information (mean 4.88, SD 1.44) were the most important functionalities. No large differences between users, former users, and nonusers were found. The main reason for quitting a nutrition app in the survey was the high time investment (14/38, 37%). This was also identified as a barrier in the FGDs. Conclusions: Nutrition apps should be supportive in all 3 phases of use (start, use, and end) to increase consumers’ intentions to start and maintain the use of these apps and achieve a change in dietary behavior. Each phase includes several key app functionalities that require specific attention from app developers. High time investment is an important reason to quit nutrition app use at an early stage. %M 37338978 %R 10.2196/39515 %U https://mhealth.jmir.org/2023/1/e39515 %U https://doi.org/10.2196/39515 %U http://www.ncbi.nlm.nih.gov/pubmed/37338978 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e39934 %T Using Chatbot Technology to Improve Brazilian Adolescents’ Body Image and Mental Health at Scale: Randomized Controlled Trial %A Matheson,Emily L %A Smith,Harriet G %A Amaral,Ana C S %A Meireles,Juliana F F %A Almeida,Mireille C %A Linardon,Jake %A Fuller-Tyszkiewicz,Matthew %A Diedrichs,Phillippa C %+ Centre for Appearance Research, University of the West of England, Coldharbour Ln, Bristol, BS16 1QY, United Kingdom, 44 1173284398, emily.matheson@uwe.ac.uk %K adolescent %K Brazil %K body image %K chatbot %K microintervention %K randomized controlled trial %K mobile phone %D 2023 %7 19.6.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Accessible, cost-effective, and scalable mental health interventions are limited, particularly in low- and middle-income countries, where disparities between mental health needs and services are greatest. Microinterventions (ie, brief, stand-alone, or digital approaches) aim to provide immediate reprieve and enhancements in mental health states and offer a novel and scalable framework for embedding evidence-based mental health promotion techniques into digital environments. Body image is a global public health issue that increases young peoples’ risk of developing more severe mental and physical health issues. Embedding body image microinterventions into digital environments is one avenue for providing young people with immediate and short-term reprieve and protection from the negative exposure effects associated with social media. Objective: This 2-armed, fully remote, and preregistered randomized controlled trial assessed the impact of a body image chatbot containing microinterventions on Brazilian adolescents’ state and trait body image and associated well-being outcomes. Methods: Geographically diverse Brazilian adolescents aged 13-18 years (901/1715, 52.54% girls) were randomized into the chatbot or an assessment-only control condition and completed web-based self-assessments at baseline, immediately after the intervention time frame, and at 1-week and 1-month follow-ups. The primary outcomes were mean change in state (at chatbot entry and at the completion of a microintervention technique) and trait body image (before and after the intervention), with the secondary outcomes being mean change in affect (state and trait) and body image self-efficacy between the assessment time points. Results: Most participants who entered the chatbot (258/327, 78.9%) completed ≥1 microintervention technique, with participants completing an average of 5 techniques over the 72-hour intervention period. Chatbot users experienced small significant improvements in primary (state: P<.001, Cohen d=0.30, 95% CI 0.25-0.34; and trait body image: P=.02, Cohen d range=0.10, 95% CI 0.01-0.18, to 0.26, 95% CI 0.13-0.32) and secondary outcomes across various time points (state: P<.001, Cohen d=0.28, 95% CI 0.22-0.33; trait positive affect: P=.02, Cohen d range=0.15, 95% CI 0.03-0.27, to 0.23, 95% CI 0.08-0.37; negative affect: P=.03, Cohen d range=−0.16, 95% CI −0.30 to −0.02, to −0.18, 95% CI −0.33 to −0.03; and self-efficacy: P=.02, Cohen d range=0.14, 95% CI 0.03-0.25, to 0.19, 95% CI 0.08-0.32) relative to the control condition. Intervention benefits were moderated by baseline levels of concerns but not by gender. Conclusions: This is the first large-scale randomized controlled trial assessing a body image chatbot among Brazilian adolescents. Intervention attrition was high (531/858, 61.9%) and reflected the broader digital intervention literature; barriers to engagement were discussed. Meanwhile, the findings support the emerging literature that indicates microinterventions and chatbot technology are acceptable and effective web-based service provisions. This study also offers a blueprint for accessible, cost-effective, and scalable digital approaches that address disparities between health care needs and provisions in low- and middle-income countries. Trial Registration: Clinicaltrials.gov NCT04825184; http://clinicaltrials.gov/ct2/show/NCT04825184 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-021-12129-1 %M 37335604 %R 10.2196/39934 %U https://mhealth.jmir.org/2023/1/e39934 %U https://doi.org/10.2196/39934 %U http://www.ncbi.nlm.nih.gov/pubmed/37335604 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42573 %T Computerized Cognitive Behavioral Therapy for Anxiety and Depression in Farming Communities: Mixed Methods Feasibility Study of Participant Use and Acceptability %A Bowyer,Harriet L %A Pegler,Ruth %A Williams,Christopher %+ Department of Psychology, Glasgow Caledonian University, Cowcaddens Rd, Glasgow, G4 0BA, United Kingdom, 44 1413318630, harriet.bowyer@gcu.ac.uk %K computerized cognitive behavioral therapy %K cCBT %K cognitive behavioral therapy %K CBT %K farmer %K depression %D 2023 %7 19.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Farmers have higher rates of depression than nonfarmers and higher rates of suicide than the general population. Several barriers to help seeking have been identified in farmers, which may be overcome by offering web-based mental health support. Computerized cognitive behavioral therapy (cCBT) is an effective intervention used to prevent and treat mild to moderate depression but has not been evaluated in the farming community. Objective: This study explored the feasibility of delivering a cCBT course tailored to farmers using a mixed methods approach. Methods: Farmers (aged ≥18 years) with no, minimal, or moderately severe depressive symptoms (Patient Health Questionnaire–9 [PHQ-9] score <20) were recruited using web-based and offline advertisements and given access to a cCBT course consisting of 5 core modules and automated and personalized email support. Depression (PHQ-9), anxiety (General Anxiety Disorder–7), and social functioning (Work and Social Adjustment Scale) were measured at baseline and the 8-week follow-up. Wilcoxon signed rank tests assessed changes in scores for all outcome measures over time. Telephone interviews focusing on participant use and satisfaction with the course were analyzed using thematic analysis. Results: Overall, 56 participants were recruited; 27 (48%) through social media. Overall, 62% (35/56) of participants logged into the course. At baseline, almost half of the participants reported experiencing minimal depressive symptoms (25/56, 45%) and mild anxiety (25/56, 45%), and just over half (30/56, 54%) reported mild to moderate functional impairment. Posttreatment data were available for 27% (15/56) of participants (41/56, 73% attrition rate). On average, participants experienced fewer depressive symptoms (P=.38) and less functional impairment (P=.26) at the 8-week follow-up; these results were not statistically significant. Participants experienced significantly fewer symptoms of anxiety at the 8-week follow-up (P=.02). Most participants (13/14, 93%) found the course helpful and easy to access (10/13, 77%) and the email support helpful (12/14, 86%). Qualitative interviews identified heavy workloads and mental health stigma within the farming community as barriers to help seeking. Participants thought that web-based support would be helpful, being convenient and anonymous. There were concerns that older farmers and those with limited internet connections may have difficulty accessing the course. Improvements regarding the layout and content of the course were suggested. Dedicated support from someone with farming knowledge was recommended to improve retention. Conclusions: cCBT may be a convenient way of supporting mental health within farming communities. However, challenges in recruiting and retaining farmers may indicate that cCBT supported only by email may not be an acceptable mode of mental health care delivery for many; however, it was valued by respondents. Involving farming organizations in planning, recruitment, and support may address these issues. Mental health awareness campaigns targeting farming communities may also help reduce stigma and improve recruitment and retention. %M 37335597 %R 10.2196/42573 %U https://formative.jmir.org/2023/1/e42573 %U https://doi.org/10.2196/42573 %U http://www.ncbi.nlm.nih.gov/pubmed/37335597 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44951 %T Understanding Mobile Health and Youth Mental Health: Scoping Review %A Ding,Xiaoxu %A Wuerth,Kelli %A Sakakibara,Brodie %A Schmidt,Julia %A Parde,Natalie %A Holsti,Liisa %A Barbic,Skye %+ Faculty of Medicine, Department of Occupational Science and Occupational Therapy, University of British Columbia, T325 - 2211 Wesbrook Mall | Musqueam Territory, Vancouver, BC, V6T 2A1, Canada, 1 236 992 8222, xxd51@student.ubc.ca %K adolescent %K COVID-19 %K engagement %K health outcome %K illness %K implementation %K mental disorder %K mental health %K mHealth intervention %K mHealth tools %K mHealth %K policy %K scoping review %K young adult %K youth %D 2023 %7 16.6.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A total of 75% of people with mental health disorders have an onset of illness between the ages of 12 and 24 years. Many in this age group report substantial obstacles to receiving quality youth-centered mental health care services. With the rapid development of technology and the recent COVID-19 pandemic, mobile health (mHealth) has presented new opportunities for youth mental health research, practice, and policy. Objective: The research objectives were to (1) synthesize the current evidence supporting mHealth interventions for youths who experience mental health challenges and (2) identify current gaps in the mHealth field related to youth’s access to mental health services and health outcomes. Methods: Guided by the methods of Arksey and O’Malley, we conducted a scoping review of peer-reviewed studies that used mHealth tools to improve youth mental health (January 2016-February 2022). We searched MEDLINE, PubMed, PsycINFO, and Embase databases using the following key terms: (1) mHealth; (2) youth and young adults; and (3) mental health. The current gaps were analyzed using content analysis. Results: The search produced 4270 records, of which 151 met inclusion criteria. Included articles highlight the comprehensive aspects of youth mHealth intervention resource allocation for targeted conditions, mHealth delivery methods, measurement tools, evaluation of mHealth intervention, and youth engagement. The median age for participants in all studies is 17 (IQR 14-21) years. Only 3 (2%) studies involved participants who reported their sex or gender outside of the binary option. Many studies (68/151, 45%) were published after the onset of the COVID-19 outbreak. Study types and designs varied, with 60 (40%) identified as randomized controlled trials. Notably, 143 out of 151 (95%) studies came from developed countries, suggesting an evidence shortfall on the feasibility of implementing mHealth services in lower-resourced settings. Additionally, the results highlight concerns related to inadequate resources devoted to self-harm and substance uses, weak study design, expert engagement, and the variety of outcome measures selected to capture impact or changes over time. There is also a lack of standardized regulations and guidelines for researching mHealth technologies for youths and the use of non–youth-centered approaches to implementing results. Conclusions: This study may be used to inform future work as well as the development of youth-centered mHealth tools that can be implemented and sustained over time for diverse types of youths. Implementation science research that prioritizes youths’ engagement is needed to advance the current understanding of mHealth implementation. Moreover, core outcome sets may support a youth-centered measurement strategy to capture outcomes in a systematic way that prioritizes equity, diversity, inclusion, and robust measurement science. Finally, this study suggests that future practice and policy research are needed to ensure the risk of mHealth is minimized and that this innovative health care service is meeting the emerging needs of youths over time. %M 37220197 %R 10.2196/44951 %U https://mhealth.jmir.org/2023/1/e44951 %U https://doi.org/10.2196/44951 %U http://www.ncbi.nlm.nih.gov/pubmed/37220197 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e43990 %T Using Smartphone Survey and GPS Data to Inform Smoking Cessation Intervention Delivery: Case Study %A Luken,Amanda %A Desjardins,Michael R %A Moran,Meghan B %A Mendelson,Tamar %A Zipunnikov,Vadim %A Kirchner,Thomas R %A Naughton,Felix %A Latkin,Carl %A Thrul,Johannes %+ Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, United States, 1 732 690 2886, aluken95@gmail.com %K adult %K application %K case study %K cessation %K delivery %K GIS %K GPS %K health interventions %K mHealth %K mobile phone %K smartphone application %K smartphone %K smoker %K smoking cessation %K smoking %D 2023 %7 16.6.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Interest in quitting smoking is common among young adults who smoke, but it can prove challenging. Although evidence-based smoking cessation interventions exist and are effective, a lack of access to these interventions specifically designed for young adults remains a major barrier for this population to successfully quit smoking. Therefore, researchers have begun to develop modern, smartphone-based interventions to deliver smoking cessation messages at the appropriate place and time for an individual. A promising approach is the delivery of interventions using geofences—spatial buffers around high-risk locations for smoking that trigger intervention messages when an individual’s phone enters the perimeter. Despite growth in personalized and ubiquitous smoking cessation interventions, few studies have incorporated spatial methods to optimize intervention delivery using place and time information. Objective: This study demonstrates an exploratory method of generating person-specific geofences around high-risk areas for smoking by presenting 4 case studies using a combination of self-reported smartphone-based surveys and passively tracked location data. The study also examines which geofence construction method could inform a subsequent study design that will automate the process of deploying coping messages when young adults enter geofence boundaries. Methods: Data came from an ecological momentary assessment study with young adult smokers conducted from 2016 to 2017 in the San Francisco Bay area. Participants reported smoking and nonsmoking events through a smartphone app for 30 days, and GPS data was recorded by the app. We sampled 4 cases along ecological momentary assessment compliance quartiles and constructed person-specific geofences around locations with self-reported smoking events for each 3-hour time interval using zones with normalized mean kernel density estimates exceeding 0.7. We assessed the percentage of smoking events captured within geofences constructed for 3 types of zones (census blocks, 500 ft2 fishnet grids, and 1000 ft2 fishnet grids). Descriptive comparisons were made across the 4 cases to better understand the strengths and limitations of each geofence construction method. Results: The number of reported past 30-day smoking events ranged from 12 to 177 for the 4 cases. Each 3-hour geofence for 3 of the 4 cases captured over 50% of smoking events. The 1000 ft2 fishnet grid captured the highest percentage of smoking events compared to census blocks across the 4 cases. Across 3-hour periods except for 3:00 AM-5:59 AM for 1 case, geofences contained an average of 36.4%-100% of smoking events. Findings showed that fishnet grid geofences may capture more smoking events compared to census blocks. Conclusions: Our findings suggest that this geofence construction method can identify high-risk smoking situations by time and place and has potential for generating individually tailored geofences for smoking cessation intervention delivery. In a subsequent smartphone-based smoking cessation intervention study, we plan to use fishnet grid geofences to inform the delivery of intervention messages. %M 37327031 %R 10.2196/43990 %U https://mhealth.jmir.org/2023/1/e43990 %U https://doi.org/10.2196/43990 %U http://www.ncbi.nlm.nih.gov/pubmed/37327031 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e36578 %T A Smartphone-Based Implicit Theories Intervention for Health Behavior Change: Randomized Trial %A Schreiber,Mike %A Dohle,Simone %+ Faculty of Psychology, University of Vienna, Universitätsstr 7, Vienna, 1010, Austria, 43 1427747353, mike.schreiber@univie.ac.at %K daily diary %K ecological momentary assessment %K health behavior %K implicit theories %K lay theories %K mindsets %K multiple health behavior change %K randomized trial %K smartphone-based intervention %D 2023 %7 15.6.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Implicit theories of health describe individuals’ beliefs about the malleability of health. Individuals with an incremental theory of health believe that health, in general, is malleable, whereas individuals with an entity theory of health endorse the idea that health is largely fixed and predetermined. Previous research has shown that an incremental theory of health is associated with beneficial health outcomes and behaviors. A mobile health implicit theories intervention could be an effective way to increase health-promoting behaviors in the general population. Objective: The aim of this study was to estimate the effect of a smartphone-based intervention designed to promote an incremental theory of health on the frequency of health-promoting behaviors in everyday life. The study used ecological momentary assessment to measure health behavior change. Methods: This 2-arm, single-blind, delayed intervention design included 149 German participants (mean age 30.58, SD 9.71 years; n=79 female). Participants were asked to report their engagement in 10 health-promoting behaviors throughout the day for 3 weeks. Participants were randomly assigned to either an early intervention group (n=72) or a delayed intervention group (n=77). The intervention materials, designed to promote an incremental theory of health, were provided to participants after 1 week (early intervention group) or 2 weeks (delayed intervention group) of baseline behavior measurement. Data for this study were collected between September 2019 and October 2019. Results: A paired-samples 2-tailed t test revealed that participants reported a stronger incremental theory after responding to the intervention materials (mean 5.58, SE 0.07) compared with incremental theory measured in an entry questionnaire (mean 5.29, SE 0.08; t148=4.07, SE 0.07; P<.001; 95% CI 0.15-0.43; d=0.33). Multilevel analyses showed that participants reported engaging in health-promoting behaviors more often after being presented with the intervention materials compared with baseline across conditions (b=0.14; t146.65=2.06, SE 0.07; P=.04; 95% CI 0.01-0.28). However, when the analysis was conducted separately for the early and delayed intervention groups, the intervention effect was only significant for the delayed intervention group (b=0.27; t1492.37=3.50, SE 0.08; P<.001; 95% CI 0.12-0.42). There was no significant increase in health-promoting behaviors for the early intervention group (b=0.02; t69.23=0.14, SE 0.11;P=.89; 95% CI −0.2 to 0.23). Conclusions: This study suggests that a smartphone-based intervention designed to promote an incremental theory of health is a cost- and time-effective approach to increase the frequency of engaging in health-promoting behaviors. However, research is needed to understand the reasons for the difference in intervention effects between the early and delayed intervention groups. The results of this study can guide the development of future digital health interventions that focus on implicit theories to promote health behavior change. Trial Registration: DRKS – German Clinical Trials Register DRKS00017379; https://drks.de/search/de/trial/DRKS00017379 %M 37318864 %R 10.2196/36578 %U https://mhealth.jmir.org/2023/1/e36578 %U https://doi.org/10.2196/36578 %U http://www.ncbi.nlm.nih.gov/pubmed/37318864 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48228 %T Rationale, Design, and Methods for the Sedentary Behavior Reduction in Pregnancy Intervention (SPRING): Protocol for a Pilot and Feasibility Randomized Controlled Trial %A Barone Gibbs,Bethany %A Kozai,Andrea C %A McAdoo,Shannon N %A Bastyr,Meghan C %A Davis,Kelliann D %A Hauspurg,Alisse %A Catov,Janet M %+ Department of Epidemiology and Biostatistics, West Virginia University School of Public Health, 64 Medical Center Drive, PO Box 9190, Morgantown, WV, 26506, United States, 1 4123105988, bethany.gibbs@hsc.wvu.edu %K pregnancy %K behavioral intervention %K pilot and feasibility trial %K sedentary behavior %K physical activity %K mobile phone %D 2023 %7 14.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adverse pregnancy outcomes (APOs) identify cardiovascular disease risk, but few effective interventions are available. High sedentary behavior (SED) has recently been associated with APOs, but very few randomized controlled trials (RCTs) have tested SED reduction in pregnancy. Objective: The Sedentary Behavior Reduction in Pregnancy Intervention (SPRING) pilot and feasibility RCT addresses this gap by testing the feasibility, acceptability, and preliminary pregnancy health effects of an intervention to reduce SED in pregnant women. The objective of this manuscript is to describe the rationale and design of SPRING. Methods: Pregnant participants (n=53) in their first trimester, who are at risk for high SED and APO and without contraindications, are randomized in a 2:1 ratio to an intervention or control group. SED (primary outcome) and standing durations, and steps per day, are measured objectively in each trimester for 1 week with a thigh-mounted activPAL3 accelerometer. SPRING also seeks to demonstrate feasibility and acceptability while estimating preliminary effects on maternal-fetal health outcomes assessed during study visits and abstracted from medical records. The pregnancy-customized intervention promotes daily behavioral targets of less than 9 hours of SED and at least 7500 steps, achieved via increased standing and incorporating light-intensity movement breaks each hour. The multicomponent intervention provides a height-adjustable workstation, a wearable activity monitor, behavioral counseling every 2 weeks (through videoconference), and membership in a private social media group. Herein, we review the rationale, describe recruitment and screening processes, and detail the intervention, assessment protocols, and planned statistical analyses. Results: This study was funded by the American Heart Association (20TPA3549099), with a funding period of January 1, 2021, and until December 31, 2023. Institutional review board approval was obtained on February 24, 2021. Participants were randomized between October 2021 and September 2022, with final data collection planned for May 2023. Analyses and submission of results are expected for winter of 2023. Conclusions: The SPRING RCT will provide initial evidence on the feasibility and acceptability of an SED-reduction intervention to decrease SED in pregnant women. These data will inform the design of a large clinical trial testing SED reduction as a strategy to reduce APO risk. Trial Registration: ClincialTrials.gov NCT05093842; https://clinicaltrials.gov/ct2/show/NCT05093842 International Registered Report Identifier (IRRID): DERR1-10.2196/48228 %M 37314845 %R 10.2196/48228 %U https://www.researchprotocols.org/2023/1/e48228 %U https://doi.org/10.2196/48228 %U http://www.ncbi.nlm.nih.gov/pubmed/37314845 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43418 %T Testing Behavior Change Techniques to Increase Physical Activity in Middle-Aged and Older Adults: Protocol for a Randomized Personalized Trial Series %A Friel,Ciaran P %A Robles,Patrick L %A Butler,Mark %A Pahlevan-Ibrekic,Challace %A Duer-Hefele,Joan %A Vicari,Frank %A Chandereng,Thevaa %A Cheung,Ken %A Suls,Jerry %A Davidson,Karina W %+ Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, 140 East 59th Street, New York, NY, 10022, United States, 1 9172027729, cfriel@northwell.edu %K behavior change techniques %K N-of-1 %K personalized trials %K physical activity %K behavior change %K aging %K quality of life %K feasibility %K acceptability %K effectiveness %K web-based %K intervention %K text %K email %K survey %D 2023 %7 14.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Being physically active is critical to successful aging, but most middle-aged and older adults do not move enough. Research has shown that even small increases in activity can have a significant impact on risk reduction and improve quality of life. Some behavior change techniques (BCTs) can increase activity, but prior studies on their effectiveness have primarily tested them in between-subjects trials and in aggregate. These design approaches, while robust, fail to identify those BCTs most influential for a given individual. In contrast, a personalized, or N-of-1, trial design can assess a person’s response to each specific intervention. Objective: This study is designed to test the feasibility, acceptability, and preliminary effectiveness of a remotely delivered personalized behavioral intervention to increase low-intensity physical activity (ie, walking) in adults aged 45 to 75 years. Methods: The intervention will be administered over 10 weeks, starting with a 2-week baseline period followed by 4 BCTs (goal-setting, self-monitoring, feedback, and action planning) delivered one at a time, each for 2 weeks. In total, 60 participants will be randomized post baseline to 1 of 24 intervention sequences. Physical activity will be continuously measured by a wearable activity tracker, and intervention components and outcome measures will be delivered and collected by email, SMS text messages, and surveys. The effect of the overall intervention on step counts relative to baseline will be examined using generalized linear mixed models with an autoregressive model that accounts for possible autocorrelation and linear trends for daily steps across time. Participant satisfaction with the study components and attitudes and opinions toward personalized trials will be measured at the intervention's conclusion. Results: Pooled change in daily step count will be reported between baseline and individual BCTs and baseline versus overall intervention. Self-efficacy scores will be compared between baseline and individual BCTs and between baseline and the overall intervention. Mean and SD will be reported for survey measures (participant satisfaction with study components and attitudes and opinions toward personalized trials). Conclusions: Assessing the feasibility and acceptability of delivering a personalized, remote physical activity intervention for middle-aged and older adults will inform what steps will be needed to scale up to a fully powered and within-subjects experimental design remotely. Examining the effect of each BCT in isolation will allow for their unique impact to be assessed and support design of future behavioral interventions. In using a personalized trial design, the heterogeneity of individual responses for each BCT can be quantified and inform later National Institutes of Health stages of intervention development trials. Trial Registration: clinicaltrials.gov NCT04967313; https://clinicaltrials.gov/ct2/show/NCT04967313 International Registered Report Identifier (IRRID): RR1-10.2196/43418 %M 37314839 %R 10.2196/43418 %U https://www.researchprotocols.org/2023/1/e43418 %U https://doi.org/10.2196/43418 %U http://www.ncbi.nlm.nih.gov/pubmed/37314839 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e38342 %T How Notifications Affect Engagement With a Behavior Change App: Results From a Micro-Randomized Trial %A Bell,Lauren %A Garnett,Claire %A Bao,Yihan %A Cheng,Zhaoxi %A Qian,Tianchen %A Perski,Olga %A Potts,Henry W W %A Williamson,Elizabeth %+ Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, United Kingdom, 44 02035495303, h.potts@ucl.ac.uk %K mobile health %K mHealth %K digital health %K behavior change %K behavior change %K digital behavior change %K engagement %K micro-randomized trial %K randomized trial %K randomization %K just-in-time adaptive intervention %K adaptive intervention %K push notification %K notification %K excessive alcohol consumption %K smartphone app %K alcohol %K drinking %K drinker %K mobile phone %D 2023 %7 9.6.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Drink Less is a behavior change app to help higher-risk drinkers in the United Kingdom reduce their alcohol consumption. The app includes a daily notification asking users to “Please complete your drinks and mood diary,” yet we did not understand the causal effect of the notification on engagement nor how to improve this component of Drink Less. We developed a new bank of 30 new messages to increase users’ reflective motivation to engage with Drink Less. This study aimed to determine how standard and new notifications affect engagement. Objective: Our objective was to estimate the causal effect of the notification on near-term engagement, to explore whether this effect changed over time, and to create an evidence base to further inform the optimization of the notification policy. Methods: We conducted a micro-randomized trial (MRT) with 2 additional parallel arms. Inclusion criteria were Drink Less users who consented to participate in the trial, self-reported a baseline Alcohol Use Disorders Identification Test score of ≥8, resided in the United Kingdom, were aged ≥18 years, and reported interest in drinking less alcohol. Our MRT randomized 350 new users to test whether receiving a notification, compared with receiving no notification, increased the probability of opening the app in the subsequent hour, over the first 30 days since downloading Drink Less. Each day at 8 PM, users were randomized with a 30% probability of receiving the standard message, a 30% probability of receiving a new message, or a 40% probability of receiving no message. We additionally explored time to disengagement, with the allocation of 60% of eligible users randomized to the MRT (n=350) and 40% of eligible users randomized in equal number to the 2 parallel arms, either receiving the no notification policy (n=98) or the standard notification policy (n=121). Ancillary analyses explored effect moderation by recent states of habituation and engagement. Results: Receiving a notification, compared with not receiving a notification, increased the probability of opening the app in the next hour by 3.5-fold (95% CI 2.91-4.25). Both types of messages were similarly effective. The effect of the notification did not change significantly over time. A user being in a state of already engaged lowered the new notification effect by 0.80 (95% CI 0.55-1.16), although not significantly. Across the 3 arms, time to disengagement was not significantly different. Conclusions: We found a strong near-term effect of engagement on the notification, but no overall difference in time to disengagement between users receiving the standard fixed notification, no notification at all, or the random sequence of notifications within the MRT. The strong near-term effect of the notification presents an opportunity to target notifications to increase “in-the-moment” engagement. Further optimization is required to improve the long-term engagement. International Registered Report Identifier (IRRID): RR2-10.2196/18690 %M 37294612 %R 10.2196/38342 %U https://mhealth.jmir.org/2023/1/e38342 %U https://doi.org/10.2196/38342 %U http://www.ncbi.nlm.nih.gov/pubmed/37294612 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42114 %T Adaptation of a Mobile Interactive Obesity Treatment Approach for Early Severe Mental Illness: Protocol for a Mixed Methods Implementation and Pilot Randomized Controlled Trial %A Nicol,Ginger E %A Jansen,Madeline O %A Ricchio,Amanda R %A Schweiger,Julia A %A Keenoy,Katie E %A Miller,J Philip %A Morrato,Elaine H %A Guo,Zhaohua %A Evanoff,Bradley A %A Parks,Joseph J %A Newcomer,John W %+ Department of Psychiatry, Washington University School of Medicine, Washington University in St. Louis, 600 S Taylor Ave, Suite 121, Saint Louis, MO, 63110, United States, 1 3143625154, nicolg@wustl.edu %K community mental health services %K implementation science %K mental disorders %K obesity %K primary prevention %D 2023 %7 9.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Obesity is common in individuals with severe mental illness (SMI), contributing to a significantly shortened lifespan when compared to the general population. Available weight loss treatments have attenuated efficacy in this population, underscoring the importance of prevention and early intervention. Objective: Here, we describe a type 1 hybrid study design for adapting and pilot-testing an existing mobile health intervention for obesity prevention in individuals with early SMI and Class I or early-stage obesity, defined as a BMI of 30-35. Methods: An existing, evidence-based interactive obesity treatment approach using low-cost, semiautomated SMS text messaging was selected for adaptation. Community mental health clinics and Clubhouse settings in Eastern Missouri and South Florida were identified to participate. This study has the following 3 aims. First, using the Enhanced Framework for Reporting Adaptations and Modifications to Evidence-based interventions, contextual aspects of the clinical and digital treatment environments are identified for adaptation, considering 5 main stakeholder groups (clinical administrators, prescribing clinicians, case managers, nurses, and patients). Following a 2-week trial of unadapted SMS text messaging, Innovation Corps methods are used to discover needed intervention adaptations by stakeholder group and clinical setting. Second, adaptations to digital functionality and intervention content will be made based on themes identified in aim 1, followed by rapid usability testing with key stakeholders. A process for iterative treatment adaptation will be developed for making unplanned modifications during the aim 3 implementation pilot study. Individuals working in partner community mental health clinics and Clubhouse settings will be trained in intervention delivery. Third, in a randomized pilot and feasibility trial, adults with 5 years or less of treatment for an SMI diagnosis will be randomized 2:1 to 6 months of an adapted interactive obesity treatment approach or to an attentional control condition, followed by a 3-month extension phase of SMS text messages only. Changes in weight, BMI, and behavioral outcomes, as well as implementation challenges, will be evaluated at 6 and 9 months. Results: Institutional review board approval for aims 1 and 2 was granted on August 12, 2018, with 72 focus group participants enrolled; institutional review board approval for aim 3 was granted on May 6, 2020. To date, 52 participants have been enrolled in the study protocol. Conclusions: In this type 1 hybrid study design, we apply an evidence-based treatment adaptation framework to plan, adapt, and feasibility test a mobile health intervention in real-world treatment settings. Resting at the intersection of community mental health treatment and physical health promotion, this study aims to advance the use of simple technology for obesity prevention in individuals with early-stage mental illness. Trial Registration: ClinicalTrials.gov NCT03980743; https://clinicaltrials.gov/ct2/show/NCT03980743 International Registered Report Identifier (IRRID): DERR1-10.2196/42114 %M 37294604 %R 10.2196/42114 %U https://www.researchprotocols.org/2023/1/e42114 %U https://doi.org/10.2196/42114 %U http://www.ncbi.nlm.nih.gov/pubmed/37294604 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e40111 %T Feasibility and Acceptability of the Aboriginal and Islander Mental Health Initiative for Youth App: Nonrandomized Pilot With First Nations Young People %A Dingwall,Kylie M %A Povey,Josie %A Sweet,Michelle %A Friel,Jaylene %A Shand,Fiona %A Titov,Nickolai %A Wormer,Julia %A Mirza,Tamoor %A Nagel,Tricia %+ Menzies School of Health Research, Charles Darwin University, PO Box 795, Alice Springs, 0871, Australia, 61 889595380, kylie.dingwall@menzies.edu.au %K digital mental health %K First Nations %K Indigenous %K young people %K feasibility study %K digital health %K mental health %K depression %K mHealth %K mobile app %K aboriginal %K acceptibility %K youth %D 2023 %7 7.6.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Despite young First Nations Australians being typically healthy, happy, and connected to family and culture, high rates of emotional distress, suicide, and self-harm are also observed. Differing worldviews of service providers and First Nations young people regarding illness and treatment practices, language differences, culturally inappropriate service models, geographical remoteness, and stigma can all inhibit access to appropriate mental health support. Mental health treatments delivered digitally (digital mental health; dMH) offer flexible access to evidence-based, nonstigmatizing, low-cost treatment and early intervention on a broad scale. There is a rapidly growing use and acceptance of these technologies among young First Nations people. Objective: The objective was to assess the feasibility, acceptability, and use of the newly developed Aboriginal and Islander Mental Health Initiative for Youth (AIMhi-Y) app and determine the feasibility of study procedures in preparation for future assessments of effectiveness. Methods: This was a nonrandomized pre-post study using mixed methods. First Nations young people aged 12-25 years who provided consent (with parental consent where appropriate) and possessed the ability to navigate a simple app with basic English literacy were included. Researchers conducted one face-to-face 20-minute session with participants to introduce and orient them to the AIMhi-Y app. The app integrates culturally adapted low-intensity cognitive behavioral therapy (CBT), psychoeducation, and mindfulness-based activities. Participants received supportive text messages weekly throughout the 4-week intervention period and completed assessments of psychological distress, depression, anxiety, substance misuse, help-seeking, service use, and parent-rated strengths and difficulties at baseline and 4 weeks. Qualitative interviews and rating scales were completed at 4 weeks to gain feedback on subjective experience, look and style, content, overall rating, check-ins, and involvement in the study. App use data were collected. Results: Thirty young people (17 males and 13 females) aged between 12 and 18 (mean 14.0, SD 1.55) years were assessed at baseline and 4 weeks. Repeated measures 2-tailed t tests showed improvements in well-being measures that were statistically and clinically significant for psychological distress (Kessler Psychological Distress Scale, 10-item) and depressive symptoms (Patient Health Questionnaire, 2-item). Participants spent on average 37 minutes in the app. The app was rated positively, with mean ratings of 4 out of 5 points (on scales of 1-5). Participants reported that they found the app easy to use, culturally relevant, and useful. The feasibility of the study was demonstrated with a 62% recruitment rate, a 90% retention rate, and high study acceptability ratings. Conclusions: This study supports earlier research suggesting that dMH apps that are appropriately designed with and for the target populations are a feasible and acceptable means of lowering symptoms for mental health disorders among First Nations youth. %M 37285184 %R 10.2196/40111 %U https://humanfactors.jmir.org/2023/1/e40111 %U https://doi.org/10.2196/40111 %U http://www.ncbi.nlm.nih.gov/pubmed/37285184 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44500 %T Acceptability of an mHealth App for Monitoring Perinatal and Postpartum Mental Health: Qualitative Study With Women and Providers %A Varma,Deepthi S %A Mualem,Maya %A Goodin,Amie %A Gurka,Kelly K %A Wen,Tony Soo-Tung %A Gurka,Matthew J %A Roussos-Ross,Kay %+ Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610, United States, 1 352 294 5941, dvarma@ufl.edu %K perinatal mental health %K mobile health %K mHealth %K mobile apps %K ecological momentary assessment %K EMA %K mobile phone %D 2023 %7 7.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Up to 15% of pregnant and postpartum women commonly experience undiagnosed and untreated mental health conditions, such as depression and anxiety, which may result in serious health complications. Mobile health (mHealth) apps related to mental health have been previously used for early diagnosis and intervention but not among pregnant and postpartum women. Objective: This study aims to assess the acceptability of using mHealth to monitor and assess perinatal and postpartum depression and anxiety. Methods: Focus group discussions with pregnant and postpartum women (n=20) and individual interviews with health care providers (n=8) were conducted to inform the acceptability of mHealth and determine its utility for assessing perinatal and postpartum mood symptoms. Participants were recruited via purposive sampling from obstetric clinics and the surrounding community. A semistructured interview guide was developed by an epidemiologist with qualitative research training in consultation with an obstetrician. The first author conducted all focus group discussions and provider interviews either in person or via Zoom (Zoom Video Communications, Inc) depending on the COVID-19 protocol that was in place during the study period. All interviews were audio recorded with consent; transcribed; and uploaded for coding to ATLAS.ti 8 (ATLAS.ti Scientific Software Development Gmb H), a qualitative data analysis and retrieval software. Data were analyzed using the deductive content analysis method using a set of a priori codes developed based on the interview guide. Methodological rigor and quality were ensured by adopting a systematic approach during the implementation, data collection, data analysis, and reporting of the data. Results: Almost all women and providers had downloaded and used at least 1 health app. The respondents suggested offering short questions in layperson language that could be understood by women of all educational levels and offering no more than 2 to 3 assessments per day at preferred timings decided by the women themselves. They also suggested that the women themselves receive the alerts first, with other options being family members, spouses, or friends if the women themselves did not respond within 24 to 72 hours. Customization and snooze features were strongly endorsed by women and providers to improve acceptability and utility. Women mentioned competing demands on their time during the postpartum period, fatigue, privacy, and the security of mental health data as concerns. Health care professionals highlighted the long-term sustainability of app-based mood assessment and monitoring as an important challenge. Conclusions: The findings from this study show that mHealth would be acceptable to pregnant and postpartum women for monitoring mood symptoms. This could inform the development of clinically meaningful and inexpensive tools for facilitating the continuous monitoring of, the early diagnosis of, and an early intervention for mood disorders in this vulnerable population. %M 37285185 %R 10.2196/44500 %U https://formative.jmir.org/2023/1/e44500 %U https://doi.org/10.2196/44500 %U http://www.ncbi.nlm.nih.gov/pubmed/37285185 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45234 %T Promoting Engagement With Smartphone Apps for Suicidal Ideation in Young People: Development of an Adjunctive Strategy Using a Lived Experience Participatory Design Approach %A Gan,Daniel Z Q %A McGillivray,Lauren %A Larsen,Mark Erik %A Bloomfield,Taylor %A Torok,Michelle %+ Black Dog Institute, University of New South Wales, Hospital Road, Sydney, NSW 2031, Australia, 61 423828945, danielzqgan@gmail.com %K eHealth %K digital mental health %K smartphone app %K engagement %K youth suicide prevention %K qualitative methods %K suicide %K development %K youth %K mental health %K support %K user-centered %K design %K survey %K interview %K prototype %K prevention %K participatory design %K mobile phone %D 2023 %7 6.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Suicide among young people is a worrying public health concern. Despite this, there is a lack of suitable interventions aligned with the needs of this priority population. Emerging evidence supports the effectiveness of digital interventions in alleviating the severity of suicidal thoughts. However, their efficacy may be undermined by poor engagement. Technology-supported strategies (eg, electronic prompts and reminders) have been deployed alongside digital interventions to increase engagement with the latter. However, evidence of their efficacy is inconclusive. User-centered design approaches may be key to developing feasible and effective engagement strategies. Currently, no study has been published on how such an approach might be expressly applied toward developing strategies for promoting engagement with digital interventions. Objective: This study aimed to detail the processes and activities involved in developing an adjunctive strategy for promoting engagement with LifeBuoy—a smartphone app that helps young people manage suicidal thoughts. Methods: Development of the engagement strategy took place in 2 phases. The discovery phase aimed to create an initial prototype by synthesizing earlier findings—from 2 systematic reviews and a cross-sectional survey of the broader mental health app user population—with qualitative insights from LifeBuoy users. A total of 16 web-based interviews were conducted with young people who participated in the LifeBuoy trial. Following the discovery phase, 3 interviewees were invited by the research team to take part in the workshops in the design phase, which sought to create a final prototype by making iterative improvements to the initial prototype. These improvements were conducted over 2 workshops. Thematic analysis was used to analyze the qualitative data obtained from the interviews and workshops. Results: Main themes from the interviews centered around the characteristics of the strategy, timing of notifications, and suitability of social media platforms. Subsequently, themes that emerged from the design workshops emphasized having a wider variety of content, greater visual consistency with LifeBuoy, and a component with more detailed information to cater to users with greater informational needs. Thus, refinements to the prototype were focused on (1) improving the succinctness, variety, and practical value of Instagram content, (2) creating a blog containing articles contributed by mental health professionals and young people with lived experience of suicide, and (3) standardizing the use of marine-themed color palettes across the Instagram and blog components. Conclusions: This is the first study to describe the development of a technology-supported adjunctive strategy for promoting engagement with a digital intervention. It was developed by integrating perspectives from end users with lived experience of suicide with evidence from the existing literature. The development process documented in this study may be useful for guiding similar projects aimed at supporting the use of digital interventions for suicide prevention or mental health. %M 37279058 %R 10.2196/45234 %U https://formative.jmir.org/2023/1/e45234 %U https://doi.org/10.2196/45234 %U http://www.ncbi.nlm.nih.gov/pubmed/37279058 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e45531 %T Improving Kidney Outcomes in Patients With Nondiabetic Chronic Kidney Disease Through an Artificial Intelligence–Based Health Coaching Mobile App: Retrospective Cohort Study %A Liu,Wei %A Yu,Xiaojuan %A Wang,Jiangyuan %A Zhou,Tianmeng %A Yu,Ting %A Chen,Xuyong %A Xie,Shasha %A Han,Fuman %A Wang,Zi %+ Renal Division, Department of Medicine, Peking University First Hospital, No. 8. Xishiku Street, Xicheng District, Beijing, 100034, China, 86 01083575685, tonypedia@126.com %K chronic kidney disease %K self-management %K mobile apps %K end-stage kidney disease %K eHealth intervention %K kidney %K efficacy %K eHealth care %K dialysis %K deep-learning %K artificial intelligence %K patient care %D 2023 %7 1.6.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic kidney disease (CKD) is a global health burden. However, the efficacy of different modes of eHealth care in facilitating self-management for patients with CKD is unclear. Objective: The aim of this study was to evaluate the effectiveness of a mobile app–based intelligent care system in improving the kidney outcomes of patients with CKD. Methods: Our study was a retrospective analysis based on the KidneyOnline intelligent system developed in China. Patients with CKD but not dependent on dialysis who registered on the KidneyOnline app between January 2017 and January 2021 were screened. Patients in the the KidneyOnline intelligent system group and those in the conventional care group were 1:1 matched according to their baseline characteristics. The intervention group received center-based follow-up combined with the KidneyOnline intelligent patient care system, which was a nurse-led, patient-oriented collaborative management system. Health-related data uploaded by the patients were integrated using deep learning optical character recognition (OCR). Artificial intelligence (AI)–generated personalized recipes, lifestyle intervention suggestions, early warnings, real-time questions and answers, and personalized follow-up plans were also provided. Patients in the conventional group could get professional suggestions from the nephrologists through regular clinical visits, but they did not have access to the service provided by AI and the health coach team. Patients were followed for at least 3 months after recruitment or until death or start of renal replacement therapy. Results: A total of 2060 eligible patients who registered on the KidneyOnline app from 2017 to 2021 were enrolled for the analysis. Of those, 902 (43.8%) patients were assessed for survival analysis after propensity score matching, with 451(50%) patients in the KidneyOnline intelligent patient care system group and 451(50%) patients in the conventional care group. After a mean follow-up period of 15.8 (SD 9.5) months, the primary composite kidney outcome occurred in 28 (6%) participants in the KidneyOnline intelligent patient care system group and 32 (7%) in the conventional care group, with a hazard ratio of 0.391 (95% CI 0.231-0.660; P<.001). Subgroup survival analysis demonstrated that the KidneyOnline care system significantly reduced the risk of composite kidney outcome, irrespective of age, sex, baseline estimated glomerular filtration rate (eGFR), and proteinuria. In addition, the mean arterial pressure (MAP) significantly decreased from 88.9 (SD 10.5) mmHg at baseline to 85.6 (SD 7.9) mmHg at 6 months (P<.001) in the KidneyOnline intelligent patient care system group and from 89.3 (SD 11.1) mmHg to 87.5 (SD 8.2) mmHg (P=.002) in the conventional CKD care group. Conclusions: The utilization of the KidneyOnline intelligent care system was associated with reduced risk of unfavorable kidney outcomes in nondiabetic patients with CKD. %M 37261895 %R 10.2196/45531 %U https://mhealth.jmir.org/2023/1/e45531 %U https://doi.org/10.2196/45531 %U http://www.ncbi.nlm.nih.gov/pubmed/37261895 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e44132 %T Effectiveness of Digital Health Interventions Containing Game Components for the Self-management of Type 2 Diabetes: Systematic Review %A Ossenbrink,Linda %A Haase,Tina %A Timpel,Patrick %A Schoffer,Olaf %A Scheibe,Madlen %A Schmitt,Jochen %A Deckert,Stefanie %A Harst,Lorenz %+ Center for Evidence-based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, Dresden, 01307, Germany, 49 37133335325, lorenz.harst@tu-dresden.de %K diabetes %K gamification %K digital health %K diabetes self-management %K mobile phone %D 2023 %7 1.6.2023 %9 Review %J JMIR Serious Games %G English %X Background: Games and game components have become a major trend in the realm of digital health research and practice as they are assumed to foster behavior change and thereby improve patient-reported and clinical outcomes for patients with type 2 diabetes. Objective: The aim of this systematic review was to summarize and evaluate the current evidence on the effectiveness of digital health interventions containing game components on behavioral, patient-reported, and clinical outcomes for patients with type 2 diabetes. Methods: An electronic search was conducted in MEDLINE and PsycINFO in April 2020; updated in April 2022; and supplemented by additional searches via Google Scholar, Web of Science (which was used for forward citation tracking), and within the references of the included records. Articles were identified using predefined inclusion and exclusion criteria. In total, 2 reviewers independently conducted title, abstract, and full-text screening and then individually performed a critical appraisal of all the included studies using the Cochrane risk-of-bias tool version 2. A consensus was reached through discussion. Results: Of 2325 potentially relevant titles (duplicates excluded), 10 (0.43%) randomized controlled trials were included in this review. Quality assessment revealed a high risk of bias for all randomized controlled trials except for 10% (1/10), with performance bias due to the lack of blinding being the major source of bias. There is evidence suggesting that digital health interventions containing game components can substantially improve motivation for physical activity (1/1, 100% of the studies dealing with PA motivation), exercise intensity (3/5, 60%), dietary behavior (4/4, 100%), health literacy (1/3, 33%), mental quality of life (2/2, 100%), glycated hemoglobin level (2/6, 33%), BMI (1/3, 33%), fasting plasma glucose level (1/2, 50%), waist circumference (1/1, 100%), and aerobic capacity (1/1, 100%). Conclusions: Published studies indicated that digital health interventions containing game components might improve health behavior patterns, quality of life, and clinical outcomes in patients with type 2 diabetes. However, the intervention types and outcomes studied were heterogeneous, and study quality was mostly low, which translates to ambiguous results. Future research should focus on sound methodology and reporting as well as on identifying game components that contribute to significant positive effects. Trial Registration: PROSPERO CRD42020209706; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209706 %M 37261900 %R 10.2196/44132 %U https://games.jmir.org/2023/1/e44132 %U https://doi.org/10.2196/44132 %U http://www.ncbi.nlm.nih.gov/pubmed/37261900 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e41256 %T Implementation of a Digital Health Tool for Patients Awaiting Input From a Specialist Weight Management Team: Observational Study %A Hanson,Petra %A Summers,Charlotte %A Panesar,Arjun %A Liarakos,Alexandros Leonidas %A Oduro-Donkor,Dominic %A Whyte Oshodi,Danniella %A Hailston,Luke %A Randeva,Harpal %A Menon,Vinod %A de la Fosse,Michaela %A Kaura,Amit %A Shuttlewood,Emma %A Loveder,Mark %A Poole,Donna %A Barber,Thomas M %+ National Heart & Lung Institute, Imperial College London, 9th Floor, Building E - Sir Michael Uren, White City Campus, London, W12 7ED, United Kingdom, 44 (0)20 7594 5735, a.kaura@imperial.ac.uk %K weight management %K precision health %K digital health, hospital %K secondary care %K tier 3 weight management %K National Health Service %K weight %K obese %K obesity %K focus group %K perspective %K opinion %K attitude %K behavior change %K behavior change %K mHealth %K mobile health %K health app %D 2023 %7 31.5.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital tools are increasingly used on a population level as a weight loss strategy for people living with overweight and obesity. Evidence supports the feasibility of digital tools for the management of obesity in a community setting, but there is only emerging evidence for the feasibility of such tools in specialist weight management services. No study has assessed the uptake of digital tools among patients awaiting their first appointment with a specialist weight management service. Objective: The objective of this study was to understand interest, acceptance, and engagement with a digital behavioral change platform to support specialist weight management. Methods: This was an observational study registered as a service innovation. All patients on the waiting list for a first appointment in the tier 3 weight management service at University Hospitals Coventry and Warwickshire National Health Service (NHS) Trust were eligible to access the NHS-approved digital tool. Data on interest and engagement with the digital tool were collected. Routine clinical data were used to describe patient demographics. Focus groups were held to explore patients’ views on the use of digital tools as part of a specialist weight management service. Results: A total of 199 patients on the waiting list were informed about the available digital tool. Just over a half (n=102, 51.3%) of patients were interested in using the app, with over one-third (n=68, 34%) of all patients engaging with the app. Overall, a third of patients on the waiting list (n=63, 32%) did not respond to the invite and 34 (17%) of patients expressed no interest in the app. Emotional eating and higher BMI was associated with interest in the Gro Health app. Male gender was associated with reduced engagement with the app. There were no differences in interest in the Gro Health app according to age, ethnicity, metabolic measures of glycemia, and lipid profile. Conclusions: It is feasible to offer digital tools such as Gro Health to patients awaiting their first appointment with specialist weight management services. Future research should explore barriers and facilitators of engagement with digital tools. Additionally, there is a need to further evaluate the effectiveness of such tools in specialist weight management services. %M 37256653 %R 10.2196/41256 %U https://humanfactors.jmir.org/2023/1/e41256 %U https://doi.org/10.2196/41256 %U http://www.ncbi.nlm.nih.gov/pubmed/37256653 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42983 %T Increasing Participation in a TelePrEP Program for Sexual and Gender Minority Adolescents and Young Adults in Louisiana: Protocol for an SMS Text Messaging–Based Chatbot %A Braddock,William Richard Traylor %A Ocasio,Manuel A %A Comulada,W Scott %A Mandani,Jan %A Fernandez,M Isabel %+ Department of Pediatrics, School of Medicine, Tulane University, Suite 965, 1440 Canal St, New Orleans, LA, 70112, United States, 1 504 988 3864, manuel.ocasio@gmail.com %K chatbot %K conversational agent %K develop %K iterative %K messaging %K text message %K HIV %K PrEP %K pre-exposure prophylaxis %K user testing %K rule-based %K prevention %K eHealth %K telehealth %K mobile phone %K sexual minority youth %K gender minority youth %K young adult %K youth %K adolescent %K sexual minority %K gender minority %K gender diverse %K gender diversity %K SMS %K artificial intelligence %K patient education %K health information %K web-based information %K user experience %D 2023 %7 31.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sexual and gender minority (SGM) adolescents and young adults (AYAs) are at increased risk of HIV infection, particularly in the Southern United States. Despite the availability of effective biomedical prevention strategies, such as pre-exposure prophylaxis (PrEP), access and uptake remain low among SGM AYAs. In response, the Louisiana Department of Health initiated the LA TelePrEP Program, which leverages the power of telemedicine to connect Louisiana residents to PrEP. A virtual TelePrEP Navigator guides users through the enrollment process, answers questions, schedules appointments, and facilitates lab testing and medication delivery. To increase the participation of SGM AYAs in the program, the TelePrEP program partnered with researchers to develop a chatbot that would facilitate access to the program and support navigator functions. Chatbots are capable of carrying out many functions that reduce employee workload, and despite their successful use in health care and public health, they are relatively new to HIV prevention. Objective: In this paper, we describe the iterative and community-engaged process that we used to develop an SMS text messaging–based chatbot tailored to SGM AYAs that would support navigator functions and disseminate PrEP-related information. Methods: Our process was comprised of 2 phases: conceptualization and development. In the conceptualization phase, aspects of navigator responsibilities, program logistics, and user interactions to prioritize in chatbot programming (eg, scheduling appointments and answering questions) were identified. We also selected a commercially available chatbot platform that could execute these functions and could be programmed with minimal coding experience. In the development phase, we engaged Department of Health staff and SGM AYAs within our professional and personal networks. Five different rounds of testing were conducted with various groups to evaluate each iteration of the chatbot. After each iteration of the testing process, the research team met to discuss feedback, guide the programmer on incorporating modifications, and re-evaluate the chatbot’s functionality. Results: Through our highly collaborative and community-engaged process, a rule-based chatbot with artificial intelligence components was successfully created. We gained important knowledge that could advance future chatbot development efforts for HIV prevention. Key to the PrEPBot’s success was resolving issues that hampered the user experience, like asking unnecessary questions, responding too quickly, and misunderstanding user input. Conclusions: HIV prevention researchers can feasibly and efficiently program a rule-based chatbot with the assistance of commercially available tools. Our iterative process of engaging researchers, program personnel, and different subgroups of SGM AYAs to obtain input was key to successful chatbot development. If the results of this pilot trial show that the chatbot is feasible and acceptable to SGM AYAs, future HIV researchers and practitioners could consider incorporating chatbots as part of their programs. International Registered Report Identifier (IRRID): PRR1-10.2196/42983 %M 37256669 %R 10.2196/42983 %U https://www.researchprotocols.org/2023/1/e42983 %U https://doi.org/10.2196/42983 %U http://www.ncbi.nlm.nih.gov/pubmed/37256669 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43603 %T Black Smokers’ Preferences for Features of a Smoking Cessation App: Qualitative Study %A Enyioha,Chineme %A Loufman,Larissa M %A Grewe,Mary E %A Cené,Crystal W %A Khairat,Saif %A Goldstein,Adam O %A Kistler,Christine E %+ Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC, 27599, United States, 1 9842155048, chineme_enyioha@med.unc.edu %K mobile health apps %K smoking cessation %K Black smokers %K smoking %K mobile health %K intervention %K application %K development %K online research %K interview %K functionality %K social network %D 2023 %7 30.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) interventions for smoking cessation have grown extensively over the last few years. Although these interventions improve cessation rates, studies of these interventions consistently lack sufficient Black smokers; hence knowledge of features that make mHealth interventions attractive to Black smokers is limited. Identifying features of mHealth interventions for smoking cessation preferred by Black smokers is critical to developing an intervention that they are likely to use. This may in turn address smoking cessation challenges and barriers to care, which may reduce smoking-related disparities that currently exist. Objective: This study aims to identify features of mHealth interventions that appeal to Black smokers using an evidence-based app developed by the National Cancer Institute, QuitGuide, as a reference. Methods: We recruited Black adult smokers from national web-based research panels with a focus on the Southeastern United States. Participants were asked to download and use QuitGuide for at least a week before participation in remote individual interviews. Participants gave their opinions about features of the QuitGuide app and other mHealth apps they may have used in the past and suggestions for future apps. Results: Of the 18 participants, 78% (n=14) were women, with age ranging from 32 to 65 years. Themes within five major areas relevant for developing a future mHealth smoking cessation app emerged from the individual interviews: (1) content needs including health and financial benefits of quitting, testimonials from individuals who were successful in quitting, and strategies for quitting; (2) format needs such as images, ability to interact with and respond to elements within the app, and links to other helpful resources; (3) functionality including tracking of smoking behavior and symptoms, provision of tailored feedback and reminders to users, and an app that allows for personalization of functions; (4) social network, such as connecting with friends and family through the app, connecting with other users on social media, and connecting with a smoking cessation coach or therapist; and (5) the need for inclusivity for Black individuals, which may be accomplished through the inclusion of smoking-related information and health statistics specific for Black individuals, the inclusion of testimonials from Black celebrities who successfully quit, and the inclusion of cultural relevance in messages contained in the app. Conclusions: Certain features of mHealth interventions for smoking cessation were highly preferred by Black smokers based on their use of a preexisting mHealth app, QuitGuide. Some of these preferences are similar to those already identified by the general population, whereas preferences for increasing the inclusivity of the app are more specific to Black smokers. These findings can serve as the groundwork for a large-scale experiment to evaluate preferences with a larger sample size and can be applied in developing mHealth apps that Black smokers may be more likely to use. %M 37252777 %R 10.2196/43603 %U https://formative.jmir.org/2023/1/e43603 %U https://doi.org/10.2196/43603 %U http://www.ncbi.nlm.nih.gov/pubmed/37252777 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44082 %T Using the Person-Based Approach to Develop a Digital Intervention Targeting Diet and Physical Activity in Pregnancy: Development Study %A Rhodes,Alexandra %A Pimprikar,Arya %A Baum,Alison %A Smith,Andrea D %A Llewellyn,Clare H %+ Research Department of Behavioural Science and Health, Institute of Epidemiology and Healthcare, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 2076791720, alexandra.rhodes.15@ucl.ac.uk %K digital %K app %K dietary %K physical activity %K lifestyle %K pregnancy %K prenatal %K person-based approach %K behavior change habit formation %K intervention %D 2023 %7 26.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In pregnancy, eating well, keeping active, and avoiding excessive weight gain are associated with better maternal and fetal health outcomes. Dietary and physical activity (PA) interventions can be effective in changing behaviors and managing weight gain. The comparatively lower cost and greater accessibility of digital interventions make them an attractive alternative to in-person interventions. Baby Buddy is a free pregnancy and parenting app from the charity Best Beginnings. Designed to support parents, improve health outcomes, and reduce inequalities, the app is actively used within the UK National Health Service. It offers an ideal platform for delivering and evaluating a new prenatal dietary and PA intervention. Objective: The aim of this study was to create a theory-based intervention within Baby Buddy to empower, encourage, and support expectant parents to develop healthier dietary and PA habits for pregnancy and parenthood. Methods: The intervention’s development process was guided by the Behavior Change Wheel, with the person-based approach used to create and test its design. Three stages of qualitative research with pregnant and recently pregnant parents guided the intervention design. Study 1 (n=30), comprising 4 web-based focus groups and 12 telephone interviews, gauged response to the rudimentary concept and generated ideas for its development. Results were analyzed thematically. At this stage, the guiding principles for the intervention development were established, and regular team meetings ensured that the intervention design remained aligned with Best Beginnings’ objectives, evidence-based approach, and feasibility criteria. Study 2 (n=29), comprising web-based individual and couple interviews, explored design ideas using wireframes and scripts and generated iterative feedback on the intervention content, branding, and tone. A table of changes analysis tracked design amendments. Study 3 (n=19) tested an app prototype using think-aloud interviews with current Baby Buddy users. A patient and public involvement and engagement activity (n=18) and other expert contributors (n=14) provided ad hoc input into the research process and design development. Results: Study 1 confirmed the appeal and relevance of the intervention concept and its novel approach of including partners. The identified themes underpinned the development of the intervention design. Iterative feedback from study 2, in conjunction with patient and public involvement and engagement and expert contributor input, helped refine the intervention design and ensure its relevance and appeal to a diverse target user group. Study 3 highlighted functionality, content, and design issues with the app prototype and identified ways of improving the user experience. Conclusions: This study illustrates the value of combining a theoretical method for intervention development with the person-based approach to create a theory-based intervention that is also user-friendly, appealing, and engaging for its target audience. Further research is needed to evaluate the effectiveness of the intervention in improving diet, PA, and weight management in pregnancy. %M 37234026 %R 10.2196/44082 %U https://formative.jmir.org/2023/1/e44082 %U https://doi.org/10.2196/44082 %U http://www.ncbi.nlm.nih.gov/pubmed/37234026 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e39649 %T Conversational Agents and Avatars for Cardiometabolic Risk Factors and Lifestyle-Related Behaviors: Scoping Review %A Lyzwinski,Lynnette Nathalie %A Elgendi,Mohamed %A Menon,Carlo %+ Menrva Research Group, Schools of Mechatronic Systems Engineering and Engineering Science, Simon Fraser University, 250-13450 102 Avenue, Metro Vancouver, BC, V3T 0A3, Canada, 1 778 302 1151, lnl2@sfu.ca %K chatbots %K avatars %K conversational coach %K diet %K physical activity %K cardiovascular disease %K hypertension %K cardiometabolic %K behavior change %K hypertension diabetes %K metabolic syndrome %K mobile phone %D 2023 %7 25.5.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: In recent years, there has been a rise in the use of conversational agents for lifestyle medicine, in particular for weight-related behaviors and cardiometabolic risk factors. Little is known about the effectiveness and acceptability of and engagement with conversational and virtual agents as well as the applicability of these agents for metabolic syndrome risk factors such as an unhealthy dietary intake, physical inactivity, diabetes, and hypertension. Objective: This review aimed to get a greater understanding of the virtual agents that have been developed for cardiometabolic risk factors and to review their effectiveness. Methods: A systematic review of PubMed and MEDLINE was conducted to review conversational agents for cardiometabolic risk factors, including chatbots and embodied avatars. Results: A total of 50 studies were identified. Overall, chatbots and avatars appear to have the potential to improve weight-related behaviors such as dietary intake and physical activity. There were limited studies on hypertension and diabetes. Patients seemed interested in using chatbots and avatars for modifying cardiometabolic risk factors, and adherence was acceptable across the studies, except for studies of virtual agents for diabetes. However, there is a need for randomized controlled trials to confirm this finding. As there were only a few clinical trials, more research is needed to confirm whether conversational coaches may assist with cardiovascular disease and diabetes, and physical activity. Conclusions: Conversational coaches may regulate cardiometabolic risk factors; however, quality trials are needed to expand the evidence base. A future chatbot could be tailored to metabolic syndrome specifically, targeting all the areas covered in the literature, which would be novel. %M 37227765 %R 10.2196/39649 %U https://mhealth.jmir.org/2023/1/e39649 %U https://doi.org/10.2196/39649 %U http://www.ncbi.nlm.nih.gov/pubmed/37227765 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44838 %T An Overview of Chatbot-Based Mobile Mental Health Apps: Insights From App Description and User Reviews %A Haque,M D Romael %A Rubya,Sabirat %+ Department of Computer Science, Marquette University, 1313 W Wisconsin Ave, Milwaukee, WI, 53233, United States, 1 4144397646, mdromael.haque@marquette.edu %K chatbot %K mobile mental health apps %K consumer reviews %K health care app %K mental health app %K app development %K user experience %K mHealth intervention %K mobile health %D 2023 %7 22.5.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chatbots are an emerging technology that show potential for mental health care apps to enable effective and practical evidence-based therapies. As this technology is still relatively new, little is known about recently developed apps and their characteristics and effectiveness. Objective: In this study, we aimed to provide an overview of the commercially available popular mental health chatbots and how they are perceived by users. Methods: We conducted an exploratory observation of 10 apps that offer support and treatment for a variety of mental health concerns with a built-in chatbot feature and qualitatively analyzed 3621 consumer reviews from the Google Play Store and 2624 consumer reviews from the Apple App Store. Results: We found that although chatbots’ personalized, humanlike interactions were positively received by users, improper responses and assumptions about the personalities of users led to a loss of interest. As chatbots are always accessible and convenient, users can become overly attached to them and prefer them over interacting with friends and family. Furthermore, a chatbot may offer crisis care whenever the user needs it because of its 24/7 availability, but even recently developed chatbots lack the understanding of properly identifying a crisis. Chatbots considered in this study fostered a judgment-free environment and helped users feel more comfortable sharing sensitive information. Conclusions: Our findings suggest that chatbots have great potential to offer social and psychological support in situations where real-world human interaction, such as connecting to friends or family members or seeking professional support, is not preferred or possible to achieve. However, there are several restrictions and limitations that these chatbots must establish according to the level of service they offer. Too much reliance on technology can pose risks, such as isolation and insufficient assistance during times of crisis. Recommendations for customization and balanced persuasion to inform the design of effective chatbots for mental health support have been outlined based on the insights of our findings. %M 37213181 %R 10.2196/44838 %U https://mhealth.jmir.org/2023/1/e44838 %U https://doi.org/10.2196/44838 %U http://www.ncbi.nlm.nih.gov/pubmed/37213181 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41114 %T Development of a Mobile Health Snacktivity App to Promote Physical Activity in Inactive Adults (SnackApp): Intervention Mapping and User Testing Study %A Sanders,James P %A Gokal,Kajal %A Thomas,Jonah J C %A Rawstorn,Jonathan C %A Sherar,Lauren B %A Maddison,Ralph %A Greaves,Colin J %A Esliger,Dale %A Daley,Amanda J %A , %+ Centre for Lifestyle Medicine and Behaviour, Loughborough University, Sir John Beckwith Building, Epinal way, Loughborough, LE11 3TU, United Kingdom, 44 01509 ext 225454, J.Sanders2@lboro.ac.uk %K intervention development %K physical activity %K mobile health %K mHealth %K health app %K user testing %K intervention %K behavior %K smartphone %K app %K social %K user %K engagement %K development %K testing %K mobile phone %D 2023 %7 22.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the unequivocal evidence demonstrating the benefits of being physically active, many people do not meet the recommended guidelines of at least 150 minutes of moderate- to vigorous-intensity physical activity per week. This can be changed with the development and implementation of innovative interventions. The use of mobile health (mHealth) technologies has been suggested as a mechanism to offer people innovative health behavior change interventions. Objective: This study aims to outline the systematic, theory-driven processes and user testing applied to the development of a smartphone-based physical activity app (SnackApp) to promote participation in a novel physical activity intervention called Snacktivity. The acceptability of the app was explored and reported. Methods: Intervention mapping involves a 6-step process, the first 4 of which were presented in this study. These steps were used to develop the SnackApp for use within the Snacktivity intervention. The first step involved a needs assessment, which included composing an expert planning group, patient and public involvement group, and gathering the views of the public on Snacktivity and the public perception of the use of wearable technology to support Snacktivity. This first step aimed to determine the overall purpose of the Snacktivity intervention. Steps 2 to 4 involved determining the intervention objectives, the behavior change theory and techniques on which the intervention is based, and the development of the intervention resources (ie, SnackApp). After the completion of steps 1 to 3 of the intervention mapping process, the SnackApp was developed and linked to a commercial physical activity tracker (Fitbit Versa Lite) for the automated capture of physical activity. SnackApp includes provisions for goal setting, activity planning, and social support. Stage 4 involved users (inactive adults, N=15) testing the SnackApp for 28 days. App engagement (mobile app use analytics) was analyzed to determine app use and to inform the further development of SnackApp. Results: Over the study period (step 4), participants engaged with SnackApp an average of 77 (SD 80) times. On average, participants used the SnackApp for 12.6 (SD 47) minutes per week, with most of the time spent on the SnackApp dashboard and engaging, on average, 14 (SD 12.1) times, lasting 7 to 8 minutes per week. Overall, male participants used the SnackApp more than female participants did. The app rating score was 3.5 (SD 0.6) out of 5, suggesting that SnackApp was rated as fair to good. Conclusions: This study outlines and reports data regarding the development of an innovative mHealth app using a systematic, theory-driven framework. This approach can guide the development of future mHealth programs. User testing of the SnackApp suggested that physically inactive adults will engage with the SnackApp, indicating its applicability of use in the Snacktivity physical activity intervention. %M 37213198 %R 10.2196/41114 %U https://formative.jmir.org/2023/1/e41114 %U https://doi.org/10.2196/41114 %U http://www.ncbi.nlm.nih.gov/pubmed/37213198 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44945 %T The Implementation of a GPS-Based Location-Tracking Smartphone App in South Africa to Improve Engagement in HIV Care: Randomized Controlled Trial %A Clouse,Kate %A Noholoza,Sandisiwe %A Madwayi,Sindiswa %A Mrubata,Megan %A Camlin,Carol S %A Myer,Landon %A Phillips,Tamsin K %+ Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN, 37240, United States, 1 615 343 5351, kate.clouse@vanderbilt.edu %K mobile health %K mHealth %K smartphone %K mobile phone %K HIV/AIDS %K South Africa %K pregnancy %D 2023 %7 19.5.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health interventions are common in public health settings in Africa, and our preliminary work showed that smartphones are increasing in South Africa. We developed a novel smartphone app—CareConekta—that used GPS location data to characterize personal mobility to improve engagement in HIV care among pregnant and postpartum women living with HIV in South Africa. The app also used the user’s location to map nearby clinics. Objective: We aimed to describe the feasibility, acceptability, and initial efficacy of using the app in a real-world setting. Methods: We conducted a prospective randomized controlled trial at a public sector clinic near Cape Town, South Africa. We enrolled 200 pregnant (third trimester) women living with HIV who owned a smartphone that met the required specifications. All participants installed the app, designed to collect 2 GPS heartbeats per day to geolocate the participant within a random 1-km fuzzy radius (for privacy). We randomized (1:1) participants to a control arm to receive the app with no additional support or an intervention arm to receive supportive phone calls, WhatsApp (Meta Platforms, Inc) messages, or both from the study team when traveling >50 km from the study area for >7 days. In addition to mobility data collected daily through the phone, participants completed questionnaires at enrollment and follow-up (approximately 6 months post partum). Results: A total of 7 participants were withdrawn at enrollment or shortly after because of app installation failure (6/200, 3%) or changing to an unsuitable phone (1/200, 0.50%). During the study period, no participant’s smartphone recorded at least 1 heartbeat per day, which was our primary feasibility measure. Of the 171 participants who completed follow-up, only half (91/171, 53.2%) reported using the same phone as that used at enrollment, with the CareConekta app still installed on the phone and GPS usually enabled. The top reasons reported for the lack of heartbeat data were not having mobile data, uninstalling the app, and no longer having a smartphone. Acceptability measures were positive, but participants at follow-up demonstrated a lack of understanding of the app’s purpose and function. The clinic finder was a popular feature. Owing to the lack of consistent GPS heartbeats throughout the study, we were unable to assess the efficacy of the intervention. Conclusions: Several key challenges impeded our study feasibility. Although the app was designed to reverse bill participants for any data use, the lack of mobile data was a substantial barrier to our study success. Participants reported purchasing WhatsApp data, which could not support the app. Problems with the web-based dashboard meant that we could not consistently monitor mobility. Our study provides important lessons about implementing an ambitious GPS-based study under real-world conditions in a limited-resource setting. Trial Registration: ClinicalTrials.gov NCT03836625; https://clinicaltrials.gov/ct2/show/NCT03836625 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-4190-x %M 37204838 %R 10.2196/44945 %U https://mhealth.jmir.org/2023/1/e44945 %U https://doi.org/10.2196/44945 %U http://www.ncbi.nlm.nih.gov/pubmed/37204838 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e44792 %T Using Human-Centered Design and Cocreation to Create the Live 5-2-1-0 Mobile App to Promote Healthy Behaviors in Children: App Design and Development %A Yau,Kiana W %A Tang,Tricia S %A Görges,Matthias %A Pinkney,Susan %A Amed,Shazhan %+ Research Institute, BC Children's Hospital, A4-196, 950 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada, 1 6048753113, SAmed@cw.bc.ca %K childhood obesity %K mobile health %K health behaviors %K prevention %K mobile health app %K mHealth app %K human-centered design %K cocreation %K participatory approach %K mobile phone %D 2023 %7 17.5.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The prevalence of obesity among Canadian children is rising, partly because of increasingly obesogenic environments that limit opportunities for physical activity and healthy nutrition. Live 5-2-1-0 is a community-based multisectoral childhood obesity prevention initiative that engages stakeholders to promote and support the message of consuming ≥5 servings of vegetables and fruits, having <2 hours of recreational screen time, participating in ≥1 hour of active play, and consuming 0 sugary drinks every day. A Live 5-2-1-0 Toolkit for health care providers (HCPs) was previously developed and piloted in 2 pediatric clinics at British Columbia Children’s Hospital. Objective: This study aimed to co-create, in partnership with children, parents, and HCPs, a Live 5-2-1-0 mobile app that supports healthy behavior change and could be used as part of the Live 5-2-1-0 Toolkit for HCPs. Methods: Three focus groups (FGs) were conducted using human-centered design and participatory approaches. In FG 1, children (separately) and parents and HCPs (together) participated in sessions on app conceptualization and design. Researchers and app developers analyzed and interpreted qualitative data from FG 1 in an ideation session, and key themes were subsequently presented separately to parents, children, and HCPs in FG-2 (co-creation) sessions to identify desired app features. Parents and children tested a prototype in FG 3, provided feedback on usability and content, and completed questionnaires. Thematic analysis and descriptive statistics were used for the qualitative and quantitative data, respectively. Results: In total, 14 children (mean age 10.2, SD 1.3 years; 5/14, 36% male; 5/14, 36% White), 12 parents (9/12, 75% aged 40-49 years; 2/12, 17% male; 7/12, 58% White), and 18 HCPs participated; most parents and children (20/26, 77%) participated in ≥2 FGs. Parents wanted an app that empowered children to adopt healthy behaviors using internal motivation and accountability, whereas children described challenge-oriented goals and family-based activities as motivating. Parents and children identified gamification, goal setting, daily steps, family-based rewards, and daily notifications as desired features; HCPs wanted baseline behavior assessments and to track users’ behavior change progress. Following prototype testing, parents and children reported ease in completing tasks, with a median score of 7 (IQR 6-7) on a 7-point Likert scale (1=very difficult; 7=very easy). Children liked most suggested rewards (28/37, 76%) and found 79% (76/96) of suggested daily challenges (healthy behavior activities that users complete to achieve their goal) realistic to achieve. Participant suggestions included strategies to maintain users’ interest and content that further motivates healthy behavior change. Conclusions: Co-creating a mobile health app with children, parents, and HCPs was feasible. Stakeholders desired an app that facilitated shared decision-making with children as active agents in behavior change. Future research will involve clinical implementation and assessment of the usability and effectiveness of the Live 5-2-1-0 app. %M 37195754 %R 10.2196/44792 %U https://pediatrics.jmir.org/2023/1/e44792 %U https://doi.org/10.2196/44792 %U http://www.ncbi.nlm.nih.gov/pubmed/37195754 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e44564 %T Older Adults and New Technology: Mapping Review of the Factors Associated With Older Adults’ Intention to Adopt Digital Technologies %A Schroeder,Tanja %A Dodds,Laura %A Georgiou,Andrew %A Gewald,Heiko %A Siette,Joyce %+ The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead Innovation Quarter, 160 Hawkesbury Road, Westmead, 2145, Australia, 61 2 9772 6648, joyce.siette@westernsydney.edu.au %K technology adoption %K digital technology %K older adults %K seniors %K intention to use digital technologies %D 2023 %7 16.5.2023 %9 Review %J JMIR Aging %G English %X Background: Ongoing advancements in digital solutions support older adults’ healthy aging and well-being. However, a unified synthesis of sociodemographic, cognitive, attitudinal, emotional, and environmental factors that influence older adults’ intention to use these new digital technologies is still lacking. Understanding the salient factors that influence older adults’ intention to use digital technologies will help to ensure that technology is developed appropriately and contextually. This understanding is also likely to contribute to developing technology acceptance models specifically for the aging generation, by reorganizing principles and constructing objectivity criteria for future research studies. Objective: This review aims to identify the key factors associated with older adults’ intention to use digital technologies and to provide a comprehensive conceptual framework to describe the relationships between these key factors and older adults’ intention to use digital technologies. Methods: A mapping review was conducted using 9 databases from inception to November 2022. Articles were selected for review if they had an evaluative component of older adults’ intention to use digital technologies. Three researchers independently reviewed the articles and extracted the data. Data synthesis was performed via narrative review and quality appraisal was measured using 3 different tools based on each article’s study design. Results: We identified a total of 59 articles investigating older adults’ intention to use digital technologies. The majority (40/59, 68%) of articles did not use an existing framework or model for technology acceptance. Studies mostly adopted a quantitative research design (27/59, 46%). We found 119 unique factors reported to influence older adults’ intention to use digital technologies. These were categorized into 6 distinct themes: Demographics and Health Status, Emotional Awareness and Needs, Knowledge and Perception, Motivation, Social Influencers, and Technology Functional Features. Conclusions: Given the importance of global demographic change toward an aging society, there is surprisingly limited research on the factors that influence older adults’ intention to use digital technologies. Our identification of the key factors across different types of digital technology and models supports the future integration of a comprehensive perspective encompassing environmental, psychological, and social determinants for older adults’ intention to use digital technologies. %M 37191976 %R 10.2196/44564 %U https://aging.jmir.org/2023/1/e44564 %U https://doi.org/10.2196/44564 %U http://www.ncbi.nlm.nih.gov/pubmed/37191976 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46659 %T Automated Diet Capture Using Voice Alerts and Speech Recognition on Smartphones: Pilot Usability and Acceptability Study %A Chikwetu,Lucy %A Daily,Shaundra %A Mortazavi,Bobak J %A Dunn,Jessilyn %+ Department of Biomedical Engineering, Duke University, 1427 FCIEMAS, Durham, NC, 27708, United States, 1 9196605131, jessilyn.dunn@duke.edu %K automatic dietary monitoring %K ADM %K food logging %K diet logging %K voice technologies %K voice alert %K speech recognition %K natural language processing %K NLP %D 2023 %7 16.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Effective monitoring of dietary habits is critical for promoting healthy lifestyles and preventing or delaying the onset and progression of diet-related diseases, such as type 2 diabetes. Recent advances in speech recognition technologies and natural language processing present new possibilities for automated diet capture; however, further exploration is necessary to assess the usability and acceptability of such technologies for diet logging. Objective: This study explores the usability and acceptability of speech recognition technologies and natural language processing for automated diet logging. Methods: We designed and developed base2Diet—an iOS smartphone application that prompts users to log their food intake using voice or text. To compare the effectiveness of the 2 diet logging modes, we conducted a 28-day pilot study with 2 arms and 2 phases. A total of 18 participants were included in the study, with 9 participants in each arm (text: n=9, voice: n=9). During phase I of the study, all 18 participants received reminders for breakfast, lunch, and dinner at preselected times. At the beginning of phase II, all participants were given the option to choose 3 times during the day to receive 3 times daily reminders to log their food intake for the remainder of the phase, with the ability to modify the selected times at any point before the end of the study. Results: The total number of distinct diet logging events per participant was 1.7 times higher in the voice arm than in the text arm (P=.03, unpaired t test). Similarly, the total number of active days per participant was 1.5 times higher in the voice arm than in the text arm (P=.04, unpaired t test). Furthermore, the text arm had a higher attrition rate than the voice arm, with only 1 participant dropping out of the study in the voice arm, while 5 participants dropped out in the text arm. Conclusions: The results of this pilot study demonstrate the potential of voice technologies in automated diet capturing using smartphones. Our findings suggest that voice-based diet logging is more effective and better received by users compared to traditional text-based methods, underscoring the need for further research in this area. These insights carry significant implications for the development of more effective and accessible tools for monitoring dietary habits and promoting healthy lifestyle choices. %M 37191989 %R 10.2196/46659 %U https://formative.jmir.org/2023/1/e46659 %U https://doi.org/10.2196/46659 %U http://www.ncbi.nlm.nih.gov/pubmed/37191989 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43065 %T Mobile Acceptance and Commitment Therapy With Distressed First-Generation College Students: Microrandomized Trial %A Thomas,Emily Brenny Kroska %A Sagorac Gruichich,Tijana %A Maronge,Jacob M %A Hoel,Sydney %A Victory,Amanda %A Stowe,Zachary N %A Cochran,Amy %+ Department of Psychological and Brain Sciences, University of Iowa, 340 Iowa Avenue, G60 PBSB, Iowa City, IA, 52242, United States, 1 319 467 1691, emily-kroska@uiowa.edu %K acceptance and commitment therapy %K randomized controlled trials %K mobile health %K mHealth %K first-generation college students %K psychological flexibility %K distress %K depression %D 2023 %7 15.5.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Extant gaps in mental health services are intensified among first-generation college students. Improving access to empirically based interventions is critical, and mobile health (mHealth) interventions are growing in support. Acceptance and commitment therapy (ACT) is an empirically supported intervention that has been applied to college students, via mobile app, and in brief intervals. Objective: This study evaluated the safety, feasibility, and effectiveness of an ACT-based mHealth intervention using a microrandomized trial (MRT) design. Methods: Participants (N=34) were 18- to 19-year-old first-generation college students reporting distress, who participated in a 6-week intervention period of twice-daily assessments and randomization to intervention. Participants logged symptoms, moods, and behaviors on the mobile app Lorevimo. After the assessment, participants were randomized to an ACT-based intervention or no intervention. Analyses examined proximal change after randomization using a weighted and centered least squares approach. Outcomes included values-based and avoidance behavior, as well as depressive symptoms and perceived stress. Results: The findings indicated the intervention was safe and feasible. The intervention increased values-based behavior but did not decrease avoidance behavior. The intervention reduced depressive symptoms but not perceived stress. Conclusions: An MRT of an mHealth ACT-based intervention among distressed first-generation college students suggests that a larger MRT is warranted. Future investigations may tailor interventions to contexts where intervention is most impactful. Trial Registration: ClinicalTrials.gov NCT04081662; https://clinicaltrials.gov/show/NCT04081662 International Registered Report Identifier (IRRID): RR2-10.2196/17086 %M 37184896 %R 10.2196/43065 %U https://mental.jmir.org/2023/1/e43065 %U https://doi.org/10.2196/43065 %U http://www.ncbi.nlm.nih.gov/pubmed/37184896 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e43033 %T The Effect of Periodic Email Prompts on Participant Engagement With a Behavior Change mHealth App: Longitudinal Study %A Agachi,Elena %A Bijmolt,Tammo H A %A van Ittersum,Koert %A Mierau,Jochen O %+ Department of Marketing, Faculty of Economics and Business, University of Groningen, Nettelbosje 2, Groningen, 9747 AE, Netherlands, 31 50 363 3686, e.agachi@rug.nl %K mobile health %K behavior change %K mobile app %K digital health %K engagement %K retention %K email %K hidden Markov model %D 2023 %7 11.5.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Following the need for the prevention of noncommunicable diseases, mobile health (mHealth) apps are increasingly used for promoting lifestyle behavior changes. Although mHealth apps have the potential to reach all population segments, providing accessible and personalized services, their effectiveness is often limited by low participant engagement and high attrition rates. Objective: This study concerns a large-scale, open-access mHealth app, based in the Netherlands, focused on improving the lifestyle behaviors of its participants. The study examines whether periodic email prompts increased participant engagement with the mHealth app and how this effect evolved over time. Points gained from the activities in the app were used as an objective measure of participant engagement with the program. The activities considered were physical workouts tracked through the mHealth app and interactions with the web-based coach. Methods: The data analyzed covered 22,797 unique participants over a period of 78 weeks. A hidden Markov model (HMM) was used for disentangling the overtime effects of periodic email prompts on participant engagement with the mHealth app. The HMM accounted for transitions between latent activity states, which generated the observed measure of points received in a week. Results: The HMM indicated that, on average, 70% (15,958/22,797) of the participants were in the inactivity state, gaining 0 points in total per week; 18% (4103/22,797) of the participants were in the average activity state, gaining 27 points per week; and 12% (2736/22,797) of the participants were in the high activity state, gaining 182 points per week. Receiving and opening a generic email was associated with a 3 percentage point increase in the likelihood of becoming active in that week, compared with the weeks when no email was received. Examining detailed email categories revealed that the participants were more likely to increase their activity level following emails that were in line with the program’s goal, such as emails regarding health campaigns, while being resistant to emails that deviated from the program’s goal, such as emails regarding special deals. Conclusions: Participant engagement with a behavior change mHealth app can be positively influenced by email prompts, albeit to a limited extent. Given the relatively low costs associated with emails and the high population reach that mHealth apps can achieve, such instruments can be a cost-effective means of increasing participant engagement in the stride toward improving program effectiveness. %M 37166974 %R 10.2196/43033 %U https://mhealth.jmir.org/2023/1/e43033 %U https://doi.org/10.2196/43033 %U http://www.ncbi.nlm.nih.gov/pubmed/37166974 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41345 %T Mental Health in Urban Environments: Uncovering the Black Box of Person-Place Interactions Requires Interdisciplinary Approaches %A Kanning,Martina %A Yi,Li %A Yang,Chih-Hsiang %A Niermann,Christina %A Fina,Stefan %+ Department of Sport Science, University of Konstanz, Univeristätsstraße 10, Konstanz, 78464, Germany, 49 7531 88 3154, martina.kanning@uni-konstanz.de %K physical activity %K urban health %K ambulatory assessment %K environment %K mental health %K real-time data %K within-subject association %D 2023 %7 11.5.2023 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Living in urban environments affects individuals’ mental health through different pathways. For instance, physical activity and social participation are seen as mediators. However, aiming to understand underlying mechanisms, it is necessary to consider that the individual is interacting with its environment. In this regard, this viewpoint discusses how urban health research benefits from integration of socioecological and interdisciplinary perspectives, combined with innovative ambulatory data assessments that enable researchers to integrate different data sources. It is stated that neither focusing on the objective and accurate assessment of the environment (from the perspective of spatial sciences) nor focusing on subjectively measured individual variables (from the public health as well as a psychosocial perspective) alone is suitable to further develop the field. Addressing person-place interactions requires an interdisciplinary view on the level of theory (eg, which variables should be focused on?), assessment methods (eg, combination of time-varying objective and subjective measures), as well as data analysis and interpretation. Firstly, this viewpoint gives an overview on previous findings addressing the relationship of environmental characteristics to physical activity and mental health outcomes. We emphasize the need for approaches that allow us to appropriately assess the real-time interaction between a person and a specific environment and examine within-subject associations. This requires the assessment of environmental features, the spatial-temporal behavior of the individual, and the subjective experiences of the situation together with other individual factors, such as momentary affective states. Therefore, we finally focused on triggered study designs as an innovative ambulatory data assessment approach that allows us to capture real-time data in predefined situations (eg, while walking through a specific urban area). %M 37166963 %R 10.2196/41345 %U https://mhealth.jmir.org/2023/1/e41345 %U https://doi.org/10.2196/41345 %U http://www.ncbi.nlm.nih.gov/pubmed/37166963 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e36815 %T An Evidence-Based Digital Prevention Program to Improve Oral Health Literacy of People With a Migration Background: Intervention Mapping Approach %A Weil,Marie-Theres %A Spinler,Kristin %A Lieske,Berit %A Dingoyan,Demet %A Walther,Carolin %A Heydecke,Guido %A Kofahl,Christopher %A Aarabi,Ghazal %+ Department of Periodontics, Preventive and Restorative Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Bldg O58, Martinistrasse 52, Hamburg, 20246, Germany, 49 40 7410 55332, g.aarabi@uke.de %K oral health %K health behavior %K oral health knowledge %K migration %K mobile health %K mHealth %K preventive dentistry %K intervention mapping %K mobile phone %D 2023 %7 11.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Studies in Germany have shown that susceptible groups, such as people with a migration background, have poorer oral health than the majority of the population. Limited oral health literacy (OHL) appears to be an important factor that affects the oral health of these groups. To increase OHL and to promote prevention-oriented oral health behavior, we developed an evidence-based prevention program in the form of an app for smartphones or tablets, the Förderung der Mundgesundheitskompetenz und Mundgesundheit von Menschen mit Migrationshintergrund (MuMi) app. Objective: This study aims to describe the development process of the MuMi app. Methods: For the description and analysis of the systematic development process of the MuMi app, we used the intervention mapping approach. The approach was implemented in 6 steps: needs assessment, formulation of intervention goals, selection of evidence-based methods and practical strategies for behavior change, planning and designing the intervention, planning the implementation and delivery of the intervention, and planning the evaluation. Results: On the basis of our literature search, expert interviews, and a focus group with the target population, we identified limited knowledge of behavioral risk factors or proper oral hygiene procedures, limited proficiency of the German language, and differing health care socialization as the main barriers to good oral health. Afterward, we selected modifiable determinants of oral health behavior that were in line with behavior change theories. On this basis, performance objectives and change objectives for the relevant population at risk were formalized. Appropriate behavior change techniques to achieve the program objectives, such as the provision of health information, encouragement of self-control and self-monitoring, and sending reminders, were identified. Subsequently, these were translated into practical strategies, such as multiple-choice quizzes or videos. The resulting program, the MuMi app, is available in the Apple app store and Android app store. The effectiveness of the app was evaluated in the MuMi intervention study. The analyses showed that users of the MuMi app had a substantial increase in their OHL and improved oral hygiene (as measured by clinical parameters) after 6 months compared with the control group. Conclusions: The intervention mapping approach provided a transparent, structured, and evidence-based process for the development of our prevention program. It allowed us to identify the most appropriate and effective techniques to initiate behavior change in the target population. The MuMi app takes into account the cultural and specific determinants of people with a migration background in Germany. To our knowledge, it is the first evidence-based app that addresses OHL among people with a migration background. %M 37166956 %R 10.2196/36815 %U https://formative.jmir.org/2023/1/e36815 %U https://doi.org/10.2196/36815 %U http://www.ncbi.nlm.nih.gov/pubmed/37166956 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44513 %T WeChat-Based HIV e-Report, a New Approach for HIV Serostatus Requests and Disclosures Among Men Who Have Sex With Men: Prospective Subgroup Analysis of a Randomized Controlled Trial %A Sun,Hai-Tong %A Fan,Xiao-Ru %A Gu,Yu-Zhou %A Lu,Yong-Heng %A Qiu,Jia-Ling %A Yang,Qing-Ling %A Li,Jing-Hua %A Gu,Jing %A Hao,Chun %+ Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Rd Yuexiu District, Guangzhou, 510080, China, 86 87332517, haochun@mail.sysu.edu.cn %K behavioral intervention %K HIV serostatus disclosure %K HIV testing %K men who have sex with men %K mHealth %D 2023 %7 8.5.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Requesting and disclosing HIV serostatus is associated with a reduction in HIV transmission among men who have sex with men (MSM). However, the reliability of common methods for HIV serostatus request and disclosure is inadequate. Validated approaches for requesting and disclosing HIV serostatus are necessary. Objective: The objective of this study was to investigate the use of the HIV e-report as authentic evidence of HIV serostatus among the MSM community in Guangzhou, China. Additionally, the study aimed to explore its correlation with HIV serostatus requesting and disclosure receiving behavior. Methods: This study is a subgroup analysis of a cluster randomized controlled trial (RCT) that enrolled 357 participants during the first year. Participants in this RCT were recruited from the WeChat-based HIV testing service miniprogram developed by Guangzhou Center for Disease Control and Prevention, China. Participants completed web-based questionnaires at baseline and at the month 3 follow-up, which covered sociodemographic characteristics, HIV-related, HIV serostatus requests, receiving HIV serostatus disclosures, and HIV e-report usage. Results: The WeChat-based HIV e-report was available in Guangzhou when the RCT project started. At the month 3 follow-up, 32.2% (115/357) of participants had their own HIV e-reports, and 37.8% (135/357) of them had received others’ HIV e-reports. In all, 13.1% (27/205) and 10.5% (16/153) of participants started to use HIV e-reports to request the HIV serostatus from regular and casual male sex partners, respectively. Moreover, 27.3% (42/154) and 16.5% (18/109) of the regular and casual male sex partners, respectively, chose HIV e-reports to disclose their HIV serostatus. Compared to MSM who did not have HIV e-reports, those who had HIV e-reports and stated, “I had had my own HIV e-report(s) but hadn’t sent to others” (multivariate odds ratio 2.71, 95% CI 1.19-6.86; P=.02) and “I had had my own HIV e-reports and had sent to others” (multivariate odds ratio 2.67, 95% CI 1.07-7.73; P=.048) were more likely to request HIV serostatus from their partners. However, no factor was associated with receiving an HIV serostatus disclosure from partners. Conclusions: The HIV e-report has been accepted by the MSM community in Guangzhou and could be applied as a new optional approach for HIV serostatus requests and disclosures. This innovative intervention could be effective in promoting infectious disease serostatus disclosure among the related high-risk population. Trial Registration: ClinicalTrials.gov NCT03984136; https://clinicaltrials.gov/show/NCT03984136 International Registered Report Identifier (IRRID): RR2-10.1186/s12879-021-06484-y %M 37155223 %R 10.2196/44513 %U https://mhealth.jmir.org/2023/1/e44513 %U https://doi.org/10.2196/44513 %U http://www.ncbi.nlm.nih.gov/pubmed/37155223 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e39700 %T Comparing the Use of a Mobile App and a Web-Based Notification Platform for Surveillance of Adverse Events Following Influenza Immunization: Randomized Controlled Trial %A Bota,A Brianne %A Bettinger,Julie A %A Sarfo-Mensah,Shirley %A Lopez,Jimmy %A Smith,David P %A Atkinson,Katherine M %A Bell,Cameron %A Marty,Kim %A Serhan,Mohamed %A Zhu,David T %A McCarthy,Anne E %A Wilson,Kumanan %+ Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Administrative Service Building, Box 684, Ottawa, ON, K1Y 4E9, Canada, 1 6137985555 ext 17921, kwilson@toh.ca %K active participant–centered reporting %K health technology %K adverse event reporting %K mobile apps %K immunization %K vaccine %K safety %K influenza %K campaign %K apps %K mobile %K surveillance %K pharmacovigilance %D 2023 %7 8.5.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Vaccine safety surveillance is a core component of vaccine pharmacovigilance. In Canada, active, participant-centered vaccine surveillance is available for influenza vaccines and has been used for COVID-19 vaccines. Objective: The objective of this study is to evaluate the effectiveness and feasibility of using a mobile app for reporting participant-centered seasonal influenza adverse events following immunization (AEFIs) compared to a web-based notification system. Methods: Participants were randomized to influenza vaccine safety reporting via a mobile app or a web-based notification platform. All participants were invited to complete a user experience survey. Results: Among the 2408 randomized participants, 1319 (54%) completed their safety survey 1 week after vaccination, with a higher completion rate among the web-based notification platform users (767/1196, 64%) than among mobile app users (552/1212, 45%; P<.001). Ease-of-use ratings were high for the web-based notification platform users (99% strongly agree or agree) and 88.8% of them strongly agreed or agreed that the system made reporting AEFIs easier. Web-based notification platform users supported the statement that a web-based notification-only approach would make it easier for public health professionals to detect vaccine safety signals (91.4%, agreed or strongly agreed). Conclusions: Participants in this study were significantly more likely to respond to a web-based safety survey rather than within a mobile app. These results suggest that mobile apps present an additional barrier for use compared to the web-based notification–only approach. Trial Registration: ClinicalTrials.gov NCT05794113; https://clinicaltrials.gov/show/NCT05794113 %M 37155240 %R 10.2196/39700 %U https://publichealth.jmir.org/2023/1/e39700 %U https://doi.org/10.2196/39700 %U http://www.ncbi.nlm.nih.gov/pubmed/37155240 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42952 %T Behavioral Predictors of Intention to Use a Text Messaging Reminder System Among People Living With HIV in Rural Uganda: Survey Study %A Campbell,Jeffrey I %A Aturinda,Isaac %A Mwesigwa,Evans %A Habinka,Annabella %A Kanyesigye,Michael %A Holden,Richard J %A Siedner,Mark J %A Kraemer,John D %+ Boston Medical Center, 6th floor, 670, Albany Street, Boston, MA, 02118, United States, 1 617 414 4290, jeffrey.campbell@bmc.org %K mobile health %K mHealth %K HIV %K intention %K SMS %K cellular phone %K cell phone %K Africa %K reminder %K alert %K notification %K prompt %D 2023 %7 5.5.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The expansion of cellular phones in sub-Saharan Africa spurred the development of SMS text message–based mobile health (mHealth) technology. Numerous SMS text message–based interventions have attempted to increase retention in care for people living with HIV in sub-Saharan Africa. Many of these interventions have failed to scale. Understanding theory-grounded factors leading to mHealth acceptability is needed to create scalable, contextually appropriate, and user-focused interventions to improve longitudinal HIV care for people living with HIV in sub-Saharan Africa. Objective: In this study, we aimed to understand the relationship between constructs from the Unified Theory of Acceptance and Use of Technology (UTAUT), constructs identified in previous qualitative research, and behavioral intention to use a novel SMS text message–based mHealth intervention designed to improve care retention among people living with HIV initiating treatment in rural Uganda. Methods: We conducted a survey of people living with HIV who were newly initiating HIV care in Mbarara, Uganda, and had agreed to use a novel SMS text message–based system that notified them of abnormal laboratory results and reminded them to return to the clinic. Survey items assessed behavioral intention to use the SMS text messaging system; constructs from UTAUT; and demographics, literacy, SMS text messaging experience, HIV status disclosure, and social support. We used factor analysis and logistic regression to estimate the relationships between UTAUT constructs and the behavioral intention to use the SMS text messaging system. Results: A total of 249 participants completed the surveys, of whom 115 (46.2%) expressed high behavioral intention to use the SMS text messaging intervention. In a multivariable analysis, we found that performance expectancy (adjusted odds ratio [aOR] of the scaled factor score 5.69, 95% CI 2.64-12.25; P<.001), effort expectancy (aOR of the scaled factor score 4.87, 95% CI 1.75-13.51; P=.002), and social influence (measured as a 1-unit Likert score increase in the perception that clinical staff have been helpful in the use of the SMS text messaging program; aOR 3.03, 95% CI 1.21-7.54; P=.02) were significantly associated with high behavioral intention to use the SMS text messaging program. SMS text messaging experience (aOR/1-unit increase 1.48, 95% CI 1.11-1.96; P=.008) and age (aOR/1-year increase 1.07, 95% CI 1.03-1.13; P=.003) were also significantly associated with increased odds of high intention to use the system. Conclusions: Performance expectancy, effort expectancy, and social influence, as well as age and SMS experience, were drivers of high behavioral intention to use an SMS text messaging reminder system among people living with HIV initiating treatment in rural Uganda. These findings highlight salient factors associated with SMS intervention acceptability in this population and indicate attributes that are likely to be key to the successful development and scaling of novel mHealth interventions. %M 37145834 %R 10.2196/42952 %U https://humanfactors.jmir.org/2023/1/e42952 %U https://doi.org/10.2196/42952 %U http://www.ncbi.nlm.nih.gov/pubmed/37145834 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e37727 %T A Mobile Self-control Training App to Improve Self-control and Physical Activity in People With Severe Mental Illness: Protocol for 2 Single-Case Experimental Designs %A Dekkers,Tessa %A Heirbaut,Tahnee %A Schouten,Stephanie E %A Kelders,Saskia M %A Beerlage-de Jong,Nienke %A Ludden,Geke D S %A Deenik,Jeroen %A Bouman,Yvonne H A %A Kip,Hanneke %+ Centre for eHealth and Wellbeing Research, Department of Technology, Human and Institutional Behaviour, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 534896536, t.dekkers@utwente.nl %K mobile health %K mHealth %K mobile apps %K self-control %K physical activity %K accelerometry %K single-case experimental design %K mobile phone %D 2023 %7 5.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Lack of physical activity is a common issue with detrimental consequences for the health of people with severe mental illness (SMI). Existing physical activity interventions show suboptimal effects as they require substantial cognitive skills, including goal setting and writing, whereas cognitive deficits are common in this population. To bolster the effectiveness of physical activity interventions, self-control training (SCT), in which users practice the ability to override unwanted thoughts and behaviors, can be used in addition. Recent research has demonstrated the initial effectiveness of a mobile SCT app, but this has not been studied in psychiatric clinical practice. Objective: This study aims to evaluate to what extent adding a mobile SCT app designed for and with people with SMI to a mobile lifestyle intervention aimed at increasing physical activity increases physical activity and self-control levels. Methods: A mixed methods approach incorporating 2 single-case experimental designs (SCEDs) and qualitative interviews was used to evaluate and optimize SCT. Overall, 12 participants with SMI will be recruited from 2 organizations offering outpatient and inpatient care to people with SMI. Each experiment will include 6 patients. SCED I is a concurrent multiple-baseline design across participants that explores initial effectiveness and optimal intervention duration. Using accelerometry and experience sampling questionnaires, participants’ physical activity and self-control will be monitored for ≥5 days from baseline, followed by the sequential introduction of Google Fit, the physical activity intervention, for 7 days and the addition of SCIPP: Self-Control Intervention App for 28 days. SCED II is an introduction/withdrawal design in which optimized SCT will be introduced and withdrawn to validate the findings from SCED I. In both experiments, the daily average of total activity counts per hour and the state level of self-control will serve as the primary and secondary outcome measures. Data will be analyzed using visual analysis and piecewise linear regression models. Results: The study was designated as not subject to the Dutch Medical Research Involving Human Subjects Act by the Medical Research Ethical Committee Oost-Nederland and approved by the Ethics Committee/domain Humanities and Social Sciences of the Faculty of Behavioural, Management, and Social Sciences at the University of Twente. Participant recruitment started in January 2022, and we expect to publish the results in early 2023. Conclusions: The mobile SCT app is expected to be feasible and effective. It is self-paced and scalable and can increase patient motivation, making it a suitable intervention for people with SMI. SCED is a relatively novel yet promising method for gaining insights into whether and how mobile apps work that can handle heterogeneous samples and makes it possible to involve a diverse population with SMI without having to include a large number of participants. International Registered Report Identifier (IRRID): PRR1-10.2196/37727 %M 37145845 %R 10.2196/37727 %U https://www.researchprotocols.org/2023/1/e37727 %U https://doi.org/10.2196/37727 %U http://www.ncbi.nlm.nih.gov/pubmed/37145845 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44030 %T Quality, Usability, and Effectiveness of mHealth Apps and the Role of Artificial Intelligence: Current Scenario and Challenges %A Deniz-Garcia,Alejandro %A Fabelo,Himar %A Rodriguez-Almeida,Antonio J %A Zamora-Zamorano,Garlene %A Castro-Fernandez,Maria %A Alberiche Ruano,Maria del Pino %A Solvoll,Terje %A Granja,Conceição %A Schopf,Thomas Roger %A Callico,Gustavo M %A Soguero-Ruiz,Cristina %A Wägner,Ana M %A , %+ Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe, Las Palmas de Gran Canaria, 35011, Spain, 34 928453431, ana.wagner@ulpgc.es %K artificial intelligence %K chronic disease prevention and management %K big data %K mobile health %K mHealth %K noncommunicable diseases %K mobile phone %D 2023 %7 4.5.2023 %9 Viewpoint %J J Med Internet Res %G English %X The use of artificial intelligence (AI) and big data in medicine has increased in recent years. Indeed, the use of AI in mobile health (mHealth) apps could considerably assist both individuals and health care professionals in the prevention and management of chronic diseases, in a person-centered manner. Nonetheless, there are several challenges that must be overcome to provide high-quality, usable, and effective mHealth apps. Here, we review the rationale and guidelines for the implementation of mHealth apps and the challenges regarding quality, usability, and user engagement and behavior change, with a special focus on the prevention and management of noncommunicable diseases. We suggest that a cocreation-based framework is the best method to address these challenges. Finally, we describe the current and future roles of AI in improving personalized medicine and provide recommendations for developing AI-based mHealth apps. We conclude that the implementation of AI and mHealth apps for routine clinical practice and remote health care will not be feasible until we overcome the main challenges regarding data privacy and security, quality assessment, and the reproducibility and uncertainty of AI results. Moreover, there is a lack of both standardized methods to measure the clinical outcomes of mHealth apps and techniques to encourage user engagement and behavior changes in the long term. We expect that in the near future, these obstacles will be overcome and that the ongoing European project, Watching the risk factors (WARIFA), will provide considerable advances in the implementation of AI-based mHealth apps for disease prevention and health promotion. %M 37140973 %R 10.2196/44030 %U https://www.jmir.org/2023/1/e44030 %U https://doi.org/10.2196/44030 %U http://www.ncbi.nlm.nih.gov/pubmed/37140973 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e43162 %T Assessing the Pragmatic Nature of Mobile Health Interventions Promoting Physical Activity: Systematic Review and Meta-analysis %A Stecher,Chad %A Pfisterer,Bjorn %A Harden,Samantha M %A Epstein,Dana %A Hirschmann,Jakob M %A Wunsch,Kathrin %A Buman,Matthew P %+ College of Health Solutions, Arizona State University, 500 N 3rd Street, Room 438, Phoenix, AZ, 85004, United States, 1 6024960957, chad.stecher@asu.edu %K physical activity %K mobile health %K mHealth %K Reach, Effectiveness, Adoption, Implementation, Maintenance %K RE-AIM %K Pragmatic-Explanatory Continuum Indicator Summary-2 %K PRECIS-2 %K systematic review %K meta-analysis %K digital health %K mobile phone %D 2023 %7 4.5.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps can promote physical activity; however, the pragmatic nature (ie, how well research translates into real-world settings) of these studies is unknown. The impact of study design choices, for example, intervention duration, on intervention effect sizes is also understudied. Objective: This review and meta-analysis aims to describe the pragmatic nature of recent mHealth interventions for promoting physical activity and examine the associations between study effect size and pragmatic study design choices. Methods: The PubMed, Scopus, Web of Science, and PsycINFO databases were searched until April 2020. Studies were eligible if they incorporated apps as the primary intervention, were conducted in health promotion or preventive care settings, included a device-based physical activity outcome, and used randomized study designs. Studies were assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) and Pragmatic-Explanatory Continuum Indicator Summary-2 (PRECIS-2) frameworks. Study effect sizes were summarized using random effect models, and meta-regression was used to examine treatment effect heterogeneity by study characteristics. Results: Overall, 3555 participants were included across 22 interventions, with sample sizes ranging from 27 to 833 (mean 161.6, SD 193.9, median 93) participants. The study populations’ mean age ranged from 10.6 to 61.5 (mean 39.6, SD 6.5) years, and the proportion of males included across all studies was 42.8% (1521/3555). Additionally, intervention lengths varied from 2 weeks to 6 months (mean 60.9, SD 34.9 days). The primary app- or device-based physical activity outcome differed among interventions: most interventions (17/22, 77%) used activity monitors or fitness trackers, whereas the rest (5/22, 23%) used app-based accelerometry measures. Data reporting across the RE-AIM framework was low (5.64/31, 18%) and varied within specific dimensions (Reach=44%; Effectiveness=52%; Adoption=3%; Implementation=10%; Maintenance=12.4%). PRECIS-2 results indicated that most study designs (14/22, 63%) were equally explanatory and pragmatic, with an overall PRECIS-2 score across all interventions of 2.93/5 (SD 0.54). The most pragmatic dimension was flexibility (adherence), with an average score of 3.73 (SD 0.92), whereas follow-up, organization, and flexibility (delivery) appeared more explanatory with means of 2.18 (SD 0.75), 2.36 (SD 1.07), and 2.41 (SD 0.72), respectively. An overall positive treatment effect was observed (Cohen d=0.29, 95% CI 0.13-0.46). Meta-regression analyses revealed that more pragmatic studies (−0.81, 95% CI −1.36 to −0.25) were associated with smaller increases in physical activity. Treatment effect sizes were homogenous across study duration, participants’ age and gender, and RE-AIM scores. Conclusions: App-based mHealth physical activity studies continue to underreport several key study characteristics and have limited pragmatic use and generalizability. In addition, more pragmatic interventions observe smaller treatment effects, whereas study duration appears to be unrelated to the effect size. Future app-based studies should more comprehensively report real-world applicability, and more pragmatic approaches are needed for maximal population health impacts. Trial Registration: PROSPERO CRD42020169102; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=169102 %M 37140972 %R 10.2196/43162 %U https://mhealth.jmir.org/2023/1/e43162 %U https://doi.org/10.2196/43162 %U http://www.ncbi.nlm.nih.gov/pubmed/37140972 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42186 %T Removing Dust From the German Health Care System by Introducing Health Apps Into Standard Care: Semistructured Interview Study %A Heidel,Alexandra %A Hagist,Christian %A Spinler,Stefan %A Schoeneberger,Michael %+ WHU - Otto Beisheim School of Management, Burgplatz 2, Vallendar, 56179, Germany, 49 261 6509 25, alexandra.heidel@whu.edu %K health apps %K DVG %K Digitale Versorgung Gesetz %K Digital Healthcare Act %K mobile health %K mHealth %K German statutory health care system %K interview study %D 2023 %7 4.5.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In 2019, Germany launched the Digital Healthcare Act. The reform enables physicians to prescribe health apps as treatments to their statutory-insured patients. Objective: We aimed to determine the extent to which the integration of health apps into standard care could be considered beneficial and which aspects of the regulation could still be improved. Methods: We conducted a semistructured interview study with 23 stakeholders in Germany and analyzed them thematically. We used descriptive coding for the first-order codes and pattern coding for the second-order codes. Results: We created 79 first-order codes and 9 second-order codes following the interview study. Most stakeholders argued that the option of prescribing health apps could improve treatment quality. Conclusions: The inclusion of health apps into German standard care could improve the quality of treatment by expanding treatment portfolios. The educational elements of the apps might additionally lead to more patient emancipation through a better understanding of personal conditions. Location and time flexibility are the biggest advantages of the new technologies, but they also raise the most significant concerns for stakeholders because app use requires personal initiative and self-motivation. Overall, stakeholders agree that the Digital Healthcare Act has the potential to remove dust from the German health care system. %M 37140980 %R 10.2196/42186 %U https://humanfactors.jmir.org/2023/1/e42186 %U https://doi.org/10.2196/42186 %U http://www.ncbi.nlm.nih.gov/pubmed/37140980 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39862 %T Leveraging Mobile Phone Sensors, Machine Learning, and Explainable Artificial Intelligence to Predict Imminent Same-Day Binge-drinking Events to Support Just-in-time Adaptive Interventions: Algorithm Development and Validation Study %A Bae,Sang Won %A Suffoletto,Brian %A Zhang,Tongze %A Chung,Tammy %A Ozolcer,Melik %A Islam,Mohammad Rahul %A Dey,Anind K %+ Human-Computer Interaction and Human-Centered AI Systems Lab, AI for Healthcare Lab, School of Systems and Enterprises, Stevens Institute of Technology, 1 Castle Point Terrace, Hoboken, NJ, 07030, United States, 1 4122658616, sbae4@stevens.edu %K alcohol consumption %K binge-drinking event %K BDE %K behavioral prediction model %K machine learning %K smartphone sensors %K passive sensing %K explainable artificial intelligence %K XAI %K just-in-time adaptive interventions %K JITAIs %K mobile phone %D 2023 %7 4.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital just-in-time adaptive interventions can reduce binge-drinking events (BDEs; consuming ≥4 drinks for women and ≥5 drinks for men per occasion) in young adults but need to be optimized for timing and content. Delivering just-in-time support messages in the hours prior to BDEs could improve intervention impact. Objective: We aimed to determine the feasibility of developing a machine learning (ML) model to accurately predict future, that is, same-day BDEs 1 to 6 hours prior BDEs, using smartphone sensor data and to identify the most informative phone sensor features associated with BDEs on weekends and weekdays to determine the key features that explain prediction model performance. Methods: We collected phone sensor data from 75 young adults (aged 21 to 25 years; mean 22.4, SD 1.9 years) with risky drinking behavior who reported their drinking behavior over 14 weeks. The participants in this secondary analysis were enrolled in a clinical trial. We developed ML models testing different algorithms (eg, extreme gradient boosting [XGBoost] and decision tree) to predict same-day BDEs (vs low-risk drinking events and non-drinking periods) using smartphone sensor data (eg, accelerometer and GPS). We tested various “prediction distance” time windows (more proximal: 1 hour; distant: 6 hours) from drinking onset. We also tested various analysis time windows (ie, the amount of data to be analyzed), ranging from 1 to 12 hours prior to drinking onset, because this determines the amount of data that needs to be stored on the phone to compute the model. Explainable artificial intelligence was used to explore interactions among the most informative phone sensor features contributing to the prediction of BDEs. Results: The XGBoost model performed the best in predicting imminent same-day BDEs, with 95% accuracy on weekends and 94.3% accuracy on weekdays (F1-score=0.95 and 0.94, respectively). This XGBoost model needed 12 and 9 hours of phone sensor data at 3- and 6-hour prediction distance from the onset of drinking on weekends and weekdays, respectively, prior to predicting same-day BDEs. The most informative phone sensor features for BDE prediction were time (eg, time of day) and GPS-derived features, such as the radius of gyration (an indicator of travel). Interactions among key features (eg, time of day and GPS-derived features) contributed to the prediction of same-day BDEs. Conclusions: We demonstrated the feasibility and potential use of smartphone sensor data and ML for accurately predicting imminent (same-day) BDEs in young adults. The prediction model provides “windows of opportunity,” and with the adoption of explainable artificial intelligence, we identified “key contributing features” to trigger just-in-time adaptive intervention prior to the onset of BDEs, which has the potential to reduce the likelihood of BDEs in young adults. Trial Registration: ClinicalTrials.gov NCT02918565; https://clinicaltrials.gov/ct2/show/NCT02918565 %M 36809294 %R 10.2196/39862 %U https://formative.jmir.org/2023/1/e39862 %U https://doi.org/10.2196/39862 %U http://www.ncbi.nlm.nih.gov/pubmed/36809294 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44855 %T Effectiveness of a Mindfulness Meditation App Based on an Electroencephalography-Based Brain-Computer Interface in Radiofrequency Catheter Ablation for Patients With Atrial Fibrillation: Pilot Randomized Controlled Trial %A He,Ying %A Tang,Zhijie %A Sun,Guozhen %A Cai,Cheng %A Wang,Yao %A Yang,Gang %A Bao,ZhiPeng %+ Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China, 86 15895903958, baozhipeng1219@163.com %K atrial fibrillation %K radiofrequency catheter ablation %K mindfulness meditation %K brain computer interface %K mHealth %K smartphone app %K randomized controlled trial %D 2023 %7 3.5.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Radiofrequency catheter ablation (RFCA) for patients with atrial fibrillation (AF) can generate considerable physical and psychological discomfort under conscious sedation. App-based mindfulness meditation combined with an electroencephalography (EEG)-based brain-computer interface (BCI) shows promise as effective and accessible adjuncts in medical practice. Objective: This study aimed to investigate the effectiveness of a BCI-based mindfulness meditation app in improving the experience of patients with AF during RFCA. Methods: This single-center pilot randomized controlled trial involved 84 eligible patients with AF scheduled for RFCA, who were randomized 1:1 to the intervention and control groups. Both groups received a standardized RFCA procedure and a conscious sedative regimen. Patients in the control group were administered conventional care, while those in the intervention group received BCI-based app–delivered mindfulness meditation from a research nurse. The primary outcomes were the changes in the numeric rating scale, State Anxiety Inventory, and Brief Fatigue Inventory scores. Secondary outcomes were the differences in hemodynamic parameters (heart rate, blood pressure, and peripheral oxygen saturation), adverse events, patient-reported pain, and the doses of sedative drugs used in ablation. Results: BCI-based app–delivered mindfulness meditation, compared to conventional care, resulted in a significantly lower mean numeric rating scale (mean 4.6, SD 1.7 [app-based mindfulness meditation] vs mean 5.7, SD 2.1 [conventional care]; P=.008), State Anxiety Inventory (mean 36.7, SD 5.5 vs mean 42.3, SD 7.2; P<.001), and Brief Fatigue Inventory (mean 3.4, SD 2.3 vs mean 4.7, SD 2.2; P=.01) scores. No significant differences were observed in hemodynamic parameters or the amounts of parecoxib and dexmedetomidine used in RFCA between the 2 groups. The intervention group exhibited a significant decrease in fentanyl use compared to the control group, with a mean dose of 3.96 (SD 1.37) mcg/kg versus 4.85 (SD 1.25) mcg/kg in the control group (P=.003).The incidence of adverse events was lower in the intervention group (5/40) than in the control group (10/40), though this difference was not significant (P=.15). Conclusions: BCI-based app–delivered mindfulness meditation effectively relieved physical and psychological discomfort and may reduce the doses of sedative medication used in RFCA for patients with AF. Trial Registration: ClinicalTrials.gov NCT05306015; https://clinicaltrials.gov/ct2/show/NCT05306015 %M 37133926 %R 10.2196/44855 %U https://mhealth.jmir.org/2023/1/e44855 %U https://doi.org/10.2196/44855 %U http://www.ncbi.nlm.nih.gov/pubmed/37133926 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44840 %T Utilization and Effectiveness of a Message-Based Tobacco Cessation Program (mCessation) in the Chinese General Population: Longitudinal, Real-world Study %A Su,Zheng %A Wei,Xiaowen %A Cheng,Anqi %A Zhou,Xinmei %A Li,Jinxuan %A Qin,Rui %A Liu,Yi %A Xia,Xin %A Song,Qingqing %A Liu,Zhao %A Zhao,Liang %A Xiao,Dan %A Wang,Chen %+ Department of Tobacco Control and Prevention of Respiratory Diseases, China-Japan Friendship Hospital, Center of Respiratory Medicine, District Chaoyang, Beijing, 100021, China, 86 868 420 5425, danxiao@263.net %K smoking cessation %K real-world evidence %K text message %K general population %D 2023 %7 2.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Randomized controlled trials on text message interventions for smoking cessation have shown they are effective and recommended for tobacco control. However, the effectiveness in real-world settings is largely unknown, especially in low- and middle-income countries. Objective: This study aimed to provide real-world evidence about the utilization and effectiveness of a message-based tobacco cessation program (mCessation) in China. Methods: From May 2021 to September 2022, 16,746 people from the general population participated in the mCessation program provided by the World Health Organization. All participants received text messages on smoking cessation via instant messaging for 6 months, and they were also required to report smoking status. We randomly selected 2500 participants and interviewed them by telephone to determine the 7-day point prevalence abstinence rate at 6 months. Descriptive statistics were used to analyze population characteristics and abstinence rate. Logistic regression analysis was performed to explore risk factors for the abstinence rate. Results: Among the 2500 participants, the mean age was 35 years, and most (2407/2500, 96.20%) were male. The prevalence of tobacco dependence and light degree of tobacco dependence were 85.70% (2142/2500) and 89.10% (2228/2500), respectively. For respondents (953/2500, 38.10%), the 7-day point prevalence abstinence rate at 6 months was 21.90% (209/953). Participants older than 40 years or with tobacco dependence had significantly higher abstinence rates than those who were younger than 30 years old (odds ratio [OR] 1.77, 95% CI 1.06-3.29) or without dependence (OR 1.64, 95% CI 1.08-2.51), respectively. However, married people or heavily dependent smokers tended to find it more difficult to successfully quit smoking compared with unmarried people (OR 0.57, 95% CI 0.34-0.93) or lightly dependent smokers (OR 0.16, 95% CI 0.02-0.98), respectively. Conclusions: In a real-world setting, mCessation China was generally acceptable to men and lightly dependent smokers, and it could help 1 in 5 smokers aged 18 years to 67 years quit smoking. However, strategies to increase awareness of young and married adults may improve implementation and abstinence rates. %M 37129934 %R 10.2196/44840 %U https://www.jmir.org/2023/1/e44840 %U https://doi.org/10.2196/44840 %U http://www.ncbi.nlm.nih.gov/pubmed/37129934 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43842 %T A Technology-Enhanced Intervention for Violence and Substance Use Prevention Among Young Black Men: Protocol for Adaptation and Pilot Testing %A Emezue,Chuka %A Karnik,Niranjan S %A Reeder,Blaine %A Schoeny,Michael %A Layfield,Rickey %A Zarling,Amie %A Julion,Wrenetha %+ Department of Women, Children and Family Nursing, Rush University College of Nursing, 600 South Paulina St. Suite 1080, Chicago, IL, 60612, United States, 1 5739992594, chuka_n_emezue@rush.edu %K youth %K violence %K adolescent health %K mindfulness %K digital health %K usability %K Black %K African American %K men %K mobile app %D 2023 %7 1.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Black boys and men from disinvested communities are disproportionately survivors and perpetrators of youth violence. Those presenting to emergency departments with firearm-related injuries also report recent substance use. However, young Black men face several critical individual and systemic barriers to accessing trauma-focused prevention programs. These barriers contribute to service avoidance, the exacerbation of violence recidivism, substance use relapse, and a revolving-door approach to prevention. In addition, young Black men are known to be digital natives. Therefore, technology-enhanced interventions offer a pragmatic and promising opportunity to mitigate these barriers, provide vital life skills for self-led behavior change, and boost service engagement with vital community resources. Objective: The study aims to systematically adapt and pilot-test Boosting Violence-Related Outcomes Using Technology for Empowerment, Risk Reduction, and Life Skills Preparation in Youth Based on Acceptance and Commitment Therapy (BrotherlyACT), a culturally congruent, trauma-focused digital psychoeducational and service-engagement tool tailored to young Black men aged 15-24 years. BrotherlyACT will incorporate microlearning modules, interactive safety planning tools for risk assessment, goal-setting, mindfulness practice, and a service-engagement conversational agent or chatbot to connect young Black men to relevant services. Methods: The development of BrotherlyACT will occur in 3 phases. In phase 1, we will qualitatively investigate barriers and facilitators influencing young Black men’s willingness to use violence and substance use prevention services with 15-30 young Black men (aged 15-24 years) who report perpetrating violence and substance use in the past year and 10 service providers (aged >18 years; any gender; including health care providers, street outreach workers, social workers, violence interrupters, community advocates, and school staff). Both groups will be recruited from community and pediatric emergency settings. In phase 2, a steering group of topic experts (n=3-5) and a youth and community advisory board comprising young Black men (n=8-12) and service providers (n=5-10) will be involved in participatory design, alpha testing, and beta testing sessions to develop, refine, and adapt BrotherlyACT based on an existing skills-based program (Achieving Change Through Values-Based Behavior). We will use user-centered design principles and the Assessment, Decision, Administration, Production, Topical, Experts, Integration, Training, and Testing framework to guide this adaptation process (phase 2). In phase 3, a total of 60 young Black men will pilot-test the adapted BrotherlyACT over 10 weeks in a single-group, pretest-posttest design to determine its feasibility and implementation outcomes. Results: Phase 1 data collection began in September 2021. Phases 2 and 3 are scheduled to start in June 2023 and end in September 2024. Conclusions: The development and testing of BrotherlyACT is a crucial first step in expanding an evidence-based psychoeducational and service-mediating intervention for young Black men involved in violence. This colocation of services shifts the current prevention strategy from telling them why to change to teaching them how. International Registered Report Identifier (IRRID): PRR1-10.2196/43842 %M 37126388 %R 10.2196/43842 %U https://www.researchprotocols.org/2023/1/e43842 %U https://doi.org/10.2196/43842 %U http://www.ncbi.nlm.nih.gov/pubmed/37126388 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41926 %T Effects of Smartphone-Based Remote Interventions on Dietary Intake, Physical Activity, Weight Control, and Related Health Benefits Among the Older Population With Overweight and Obesity in China: Randomized Controlled Trial %A Zhang,Na %A Zhou,Mingzhu %A Li,Muxia %A Ma,Guansheng %+ Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Hai Dian District, Beijing, 100191, China, 86 010 82805266, mags@bjmu.edu.cn %K overweight and obesity %K remote interventions %K older population %K dietary intake %K physical activity %K weight management %K health %K mobile phone %D 2023 %7 28.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Traditional health management requires many human and material resources and cannot meet the growing needs. Remote medical technology provides an opportunity for health management; however, the research on it is insufficient. Objective: The objective of this study was to assess the effects of remote interventions on weight management. Methods: In this randomized controlled study, 750 participants were randomly assigned to a remote dietary and physical activity intervention group (group DPI), remote physical activity intervention group (group PI), or control group (group C). At baseline (time 1), day 45 (time 2), and day 90 (time 3), data were collected, including data on dietary intake, physical activity, indexes related to weight control, and health benefits. Results: A total of 85.6% (642/750) of participants completed the follow-up. Compared with group C, group DPI showed a significant decrease in energy intake (−581 vs −82 kcal; P<.05), protein intake (−17 vs −3 g; P<.05), fat intake (−8 vs 3 g; P<.05), and carbohydrate intake (−106.5 vs −4.7 g; P<.05) at time 3. Compared with time 1, groups DPI and PI showed a significant decrease in cereal and potato intake (P<.05). Compared with time 1, the physical activity levels related to transportation (group PI: 693 vs 597 metabolic equivalent [MET]–min/week, group C: 693 vs 594 MET-min/week; P<.05) and housework and gardening (group PI: 11 vs 0 MET-min/week, group C: 11 vs 4 MET-min/week; P<.05) in groups PI and C were improved at time 3. Compared with groups PI and C, group DPI showed a significant decrease in weight (−1.56 vs −0.86 kg and −1.56 vs −0.66 kg, respectively; P<.05) and BMI (−0.61 vs −0.33 kg/m2 and −0.61 vs −0.27 kg/m2, respectively; P<.05) at time 2. Compared with groups PI and C, group DPI showed a significant decrease in body weight (−4.11 vs −1.01 kg and −4.11 vs −0.83 kg, respectively; P<.05) and BMI (−1.61 vs −0.40 kg/m2 and −1.61 vs −0.33 kg/m2, respectively; P<.05) at time 3. Compared with group C, group DPI showed a significant decrease in triglyceride (−0.06 vs 0.32 mmol/L; P<.05) at time 2. Compared with groups PI and C, group DPI showed a significant decrease in systolic blood pressure (−8.15 vs −3.04 mmHg and −8.15 vs −3.80 mmHg, respectively; P<.05), triglyceride (−0.48 vs 0.11 mmol/L and −0.48 vs 0.18 mmol/L, respectively; P<.05), and fasting blood glucose (−0.77 vs 0.43 mmol/L and −0.77 vs 0.14 mmol/L, respectively; P<.05). There were significant differences in high-density lipoprotein cholesterol (−0.00 vs −0.07 mmol/L; P<.05) and hemoglobin A1c (−0.19% vs −0.07%; P<.05) between groups DPI and C. Conclusions: Remote dietary and physical activity interventions can improve dietary intake among participants with overweight and obesity, are beneficial for weight control, and have potential health benefits. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900023355; https://www.chictr.org.cn/showproj.html?proj=38976 %M 37115608 %R 10.2196/41926 %U https://www.jmir.org/2023/1/e41926 %U https://doi.org/10.2196/41926 %U http://www.ncbi.nlm.nih.gov/pubmed/37115608 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43565 %T Situating Meditation Apps Within the Ecosystem of Meditation Practice: Population-Based Survey Study %A Lam,Sin U %A Xie,Qiang %A Goldberg,Simon B %+ Department of Counseling Psychology, University of Wisconsin-Madison, 335 Education Building, 1000 Bascom Mall, Madison, WI, 53706, United States, 1 6082624807, sbgoldberg@wisc.edu %K mindfulness %K meditation %K consumer behavior %K user engagement %K mobile health %K digital health %K mobile phone %D 2023 %7 28.4.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Meditation apps have the potential to increase access to evidence-based strategies to promote mental health. However, it is currently unclear how meditation apps are situated within the broader landscape of meditation practice and what factors may influence engagement with them. Objective: This study aimed to clarify the prevalence and correlates of meditation app use in a population-based sample of individuals with lifetime exposure to meditation in the United States. In addition, we sought to identify the concerns and desired features of meditation apps among those with lifetime exposure to meditation. Methods: A total of 953 participants completed an initial screening survey. Of these 953 participants, 434 (45.5%) reported lifetime exposure to meditation and completed a follow-up survey (434/470, 92.3% response rate) assessing their meditation app use, anxiety, depression, loneliness, initial motivation for meditation, and concerns about and desired features of meditation apps. Results: Almost half (434/953, 45.5%) of the participants who completed the screening survey reported lifetime exposure to meditation. Among those with lifetime exposure to meditation (ie, meditators), more than half (255/434, 58.8%) had used meditation apps at least once in their lives, and 21.7% (94/434) used meditation apps weekly or daily (ie, active users). Younger age, higher anxiety, and a mental health motivation for practicing meditation were associated with lifetime exposure to meditation apps. Among meditators, those with lifetime exposure to meditation apps were more likely to report concerns about apps, including concerns regarding the cost and effectiveness of apps, time required for use, technical issues with apps, and app user-friendliness. Meditators who used meditation apps weekly or daily (ie, active users) were younger, less likely to be men and non-Latinx White individuals and have lower income, and more likely to have an initial spiritual motivation for meditation. Active users reported more concerns regarding usability and technical problems and were less likely to report disinterest in apps. Headspace and Calm were the most frequently used apps. Tips and reminders for practice, encouragement of “mini” practices, and mental health content were the most desired features. Participants were less interested in social features (eg, the ability to communicate with other users or teachers). Conclusions: Meditation apps are commonly used by meditators in the United States, with a higher use among certain demographic groups. Future studies may increase user engagement in meditation apps by addressing concerns (eg, cost and effectiveness) and incorporating desired features (eg, tips and reminders for practice). %M 37115618 %R 10.2196/43565 %U https://mental.jmir.org/2023/1/e43565 %U https://doi.org/10.2196/43565 %U http://www.ncbi.nlm.nih.gov/pubmed/37115618 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e39930 %T Combining Behavioral Economics–Based Incentives With the Anchoring Strategy: Protocol for a Randomized Controlled Trial %A Stecher,Chad %A Cloonan,Sara %A Linnemayr,Sebastian %A Huberty,Jennifer %+ Arizona State University, 500 N 3rd Street, Phoenix, AZ, 85004, United States, 1 602 496 0957, chad.stecher@asu.edu %K habits %K mindfulness meditation %K mobile apps %K mobile health %K mHealth %K adherence %K meditation %K mindfulness %K intervention %K apps %K smartphone apps %K stress %K management %K mobile phone %D 2023 %7 28.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic (ie, long-term) elevated stress is associated with a number of mental and physical health conditions. Mindfulness meditation mobile apps are a promising tool for stress self-management that can overcome several barriers associated with in-person interventions; however, to date, poor app-based intervention adherence has limited the efficacy of these mobile health tools. Anchoring, or pairing, a new behavior with an existing routine has been shown to effectively establish habits that are maintained over time, but this strategy typically only works for those with high initial motivation and has yet to be tested for maintaining meditation with a mobile app. Objective: This study will test novel combinations of behavioral economics–based incentives with the anchoring strategy for establishing and maintaining adherence to an effective dose of meditation with a mobile app. Methods: This 16-week study will use a 5-arm, parallel, partially blinded (participants only), randomized controlled design. We will implement a fractional factorial study design that varies the use of self-monitoring messages and financial incentives to support participants’ use of their personalized anchoring strategy for maintaining adherence to a ≥10 minute-per-day meditation prescription during an 8-week intervention period, followed by an 8-week postintervention observation period. Specifically, we will vary the use of self-monitoring messages of either the target behavior (ie, meditation tracking) or the outcome associated with the target behavior (ie, mood symptom tracking). We will also vary the use of financial incentives conditional on either meditation at any time of day or meditation performed at approximately the same time of day as participants’ personalized anchors. Results: Continuous meditation app use data will be used to measure weekly meditation adherence over the 16-week study period as a binary variable equal to 1 if participants complete ≥10 minutes of meditation for ≥4 days per week and 0 otherwise. We will measure weekly anchoring plan adherence as a binary variable equal to 1 if participants complete ≥10 minutes of meditation within +1 or −1 hour of the timing of their chosen anchor on ≥4 days per week and 0 otherwise. In addition to these primary measures of meditation and anchoring plan adherence, we will also assess the secondary measures of stress, anxiety, posttraumatic stress disorder, sleep disturbance, and meditation app habit strength at baseline, week 8, and week 16. Conclusions: This study will fill an important gap in the mobile health literature by testing novel intervention approaches for establishing and maintaining adherence to app-based mindfulness meditation. If successful, this study will identify an accessible and scalable stress self-management intervention that can help combat stress in the United States. Trial Registration: ClinicalTrials.gov NCT05217602; https://clinicaltrials.gov/ct2/show/NCT05217602 International Registered Report Identifier (IRRID): DERR1-10.2196/39930 %M 37115610 %R 10.2196/39930 %U https://www.researchprotocols.org/2023/1/e39930 %U https://doi.org/10.2196/39930 %U http://www.ncbi.nlm.nih.gov/pubmed/37115610 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44108 %T Efficacy of an mHealth Behavior Change Intervention for Promoting Physical Activity in the Workplace: Randomized Controlled Trial %A Alshagrawi,Salah %A Abidi,Syed Taha %+ Saudi Electronic University, 6730 Prince Mohammed Ibn Salman Ibn Abdulaziz Rd, Riyadh, 13316, Saudi Arabia, 966 580462066, s.alshagrawi@seu.edu.sa %K text messaging %K mobile phones %K physical activity %K eHealth %K pedometer %K smartphone %K activity tracker %K accelerometer %K behavioral %K workplace %K risk factor %K noncommunicable disease %K BMI %K wellness %D 2023 %7 27.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Insufficient physical activity (PA) is a well-established risk factor for several noncommunicable diseases such as cardiovascular diseases, cancer, diabetes, depression, and dementia. The World Health Organization (WHO) advises that individuals engage in 150 minutes of moderate PA per week or 75 minutes of intense PA per week. According to the WHO’s latest report, 23% of adults fail to meet the minimum recommended level of PA. The percentage was even higher in a recent global study that showed 27% of adults were insufficiently active and reported a 5% increase in the prevalence trend of insufficient PA between 2001 and 2016. The study also showed the rate of insufficient PA among countries varied significantly. For instance, it was estimated that 40% were insufficiently active in the United States, and the percentage was even higher in Saudi Arabia (more than 50%). Governments are actively developing policies and methods to successfully establish a PA-inducing environment that encourages a healthy lifestyle in order to address the global steady decline in PA. Objective: The purpose of this study was to determine the effectiveness of mobile health (mHealth) interventions, particularly SMS text messaging interventions, to improve PA and decrease BMI in healthy adults in the workplace. Methods: In this parallel, 2-arm randomized controlled trial, healthy adults (N=327) were randomized to receive an mHealth intervention (tailored text messages combined with self-monitoring (intervention; n=166) or no intervention (control; n=161). Adults who were fully employed in an academic institution and had limited PA during working hours were recruited for the study. Outcomes, such as PA and BMI, were assessed at baseline and 3 months later. Results: Results showed significant improvement in PA levels (weekly step counts) in the intervention group (β=1097, 95% CI 922-1272, P<.001). There was also a significant reduction in BMI (β=0.60, 95% CI 0.50-0.69, P<.001). Conclusions: Combining tailored text messages and self-monitoring interventions to improve PA and lower BMI was significantly effective and has the potential to leverage current methods to improve wellness among the public. %M 37103981 %R 10.2196/44108 %U https://www.jmir.org/2023/1/e44108 %U https://doi.org/10.2196/44108 %U http://www.ncbi.nlm.nih.gov/pubmed/37103981 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41545 %T Delivering a Postpartum Weight Loss Intervention via Facebook or In-Person Groups: Results From a Randomized Pilot Feasibility Trial %A Waring,Molly E %A Pagoto,Sherry L %A Moore Simas,Tiffany A %A Blackman Carr,Loneke T %A Eamiello,Madison L %A Libby,Brooke A %A Rudin,Lauren R %A Heersping,Grace E %+ Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Rd, Unit 1101, Storrs, CT, 06269, United States, 1 8604861446, molly.waring@uconn.edu %K postpartum weight loss %K Facebook %K social media %K pilot study %K feasibility %K mobile phone %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Postpartum weight retention contributes to weight gain and obesity. Remotely delivered lifestyle interventions may be able to overcome barriers to attending in-person programs during this life phase. Objective: This study aimed to conduct a randomized feasibility pilot trial of a 6-month postpartum weight loss intervention delivered via Facebook or in-person groups. Feasibility outcomes were recruitment, sustained participation, contamination, retention, and feasibility of study procedures. Percent weight loss at 6 and 12 months were exploratory outcomes. Methods: Women with overweight or obesity who were 8 weeks to 12 months post partum were randomized to receive a 6-month behavioral weight loss intervention based on the Diabetes Prevention Program lifestyle intervention via Facebook or in-person groups. Participants completed assessments at baseline, 6 months, and 12 months. Sustained participation was defined by intervention meeting attendance or visible engagement in the Facebook group. We calculated percent weight change for participants who provided weight at each follow-up. Results: Among individuals not interested in the study, 68.6% (72/105) were not interested in or could not attend in-person meetings and 2.9% (3/105) were not interested in the Facebook condition. Among individuals excluded at screening, 18.5% (36/195) were ineligible owing to reasons related to the in-person condition, 12.3% (24/195) related to the Facebook condition, and 2.6% (5/195) were unwilling to be randomized. Randomized participants (n=62) were a median of 6.1 (IQR 3.1-8.3) months post partum, with a median BMI of 31.7 (IQR 28.2-37.4) kg/m2. Retention was 92% (57/62) at 6 months and 94% (58/62) at 12 months. The majority (21/30, 70%) of Facebook and 31% (10/32) of in-person participants participated in the last intervention module. Half (13/26, 50%) of Facebook and 58% (15/26) of in-person participants would be likely or very likely to participate again if they had another baby, and 54% (14/26) and 70% (19/27), respectively, would be likely or very likely to recommend the program to a friend. In total, 96% (25/26) of Facebook participants reported that it was convenient or very convenient to log into the Facebook group daily compared with 7% (2/27) of in-person participants who said it was convenient or very convenient to attend group meetings each week. Average weight loss was 3.0% (SD 7.2%) in the Facebook condition and 5.4% (SD 6.8%) in the in-person condition at 6 months, and 2.8% (SD 7.4%) in the Facebook condition and 4.8% (SD 7.6%) in the in-person condition at 12 months. Conclusions: Barriers to attending in-person meetings hampered recruitment efforts and intervention participation. Although women found the Facebook group convenient and stayed engaged in the group, weight loss appeared lower. Research is needed to further develop care models for postpartum weight loss that balance accessibility with efficacy. Trial Registration: ClinicalTrials.gov, NCT03700736; https://clinicaltrials.gov/ct2/show/NCT03700736 %M 37103991 %R 10.2196/41545 %U https://mhealth.jmir.org/2023/1/e41545 %U https://doi.org/10.2196/41545 %U http://www.ncbi.nlm.nih.gov/pubmed/37103991 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37839 %T Exploring the Acceptability, Feasibility, and Effectiveness of a Digital Parenting Program to Improve Parental Well-being After the Christchurch Earthquakes: Cluster-Randomized Trial %A Donkin,Liesje %A Merry,Sally %A Moor,Stephanie %A Mowat,Anna %A Hetrick,Sarah %A Hopkins,Sarah %A Seers,Kara %A Frampton,Chris %A D'Aeth,Lucy %+ Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, Waipapa Taumata Rau, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand, 64 21847886, liesje.donkin@aut.ac.nz %K psychology %K eHealth %K app %K parenting %K digital health %K children %K parent %K well-being %K earthquake %K cluster-randomized trial %K distress %K child %K mental health %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Up to 6 years after the 2011 Christchurch earthquakes, approximately one-third of parents in the Christchurch region reported difficulties managing the continuously high levels of distress their children were experiencing. In response, an app named Kākano was co-designed with parents to help them better support their children’s mental health. Objective: The objective of this study was to evaluate the acceptability, feasibility, and effectiveness of Kākano, a mobile parenting app to increase parental confidence in supporting children struggling with their mental health. Methods: A cluster-randomized delayed access controlled trial was carried out in the Christchurch region between July 2019 and January 2020. Parents were recruited through schools and block randomized to receive immediate or delayed access to Kākano. Participants were given access to the Kākano app for 4 weeks and encouraged to use it weekly. Web-based pre- and postintervention measurements were undertaken. Results: A total of 231 participants enrolled in the Kākano trial, with 205 (88.7%) participants completing baseline measures and being randomized (101 in the intervention group and 104 in the delayed access control group). Of these, 41 (20%) provided full outcome data, of which 19 (18.2%) were for delayed access and 21 (20.8%) were for the immediate Kākano intervention. Among those retained in the trial, there was a significant difference in the mean change between groups favoring Kākano in the brief parenting assessment (F1,39=7, P=.012) but not in the Short Warwick-Edinburgh Mental Well-being Scale (F1,39=2.9, P=.099), parenting self-efficacy (F1,39=0.1, P=.805), family cohesion (F1,39=0.4, P=.538), or parenting sense of confidence (F1,40=0.6, P=.457). Waitlisted participants who completed the app after the waitlist period showed similar trends for the outcome measures with significant changes in the brief assessment of parenting and the Short Warwick-Edinburgh Mental Well-being Scale. No relationship between the level of app usage and outcome was found. Although the app was designed with parents, the low rate of completion of the trial was disappointing. Conclusions: Kākano is an app co-designed with parents to help manage their children’s mental health. There was a high rate of attrition, as is often seen in digital health interventions. However, for those who did complete the intervention, there was some indication of improved parental well-being and self-assessed parenting. Preliminary indications from this trial show that Kākano has promising acceptability, feasibility, and effectiveness, but further investigation is warranted. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12619001040156; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377824&isReview=true %M 37103986 %R 10.2196/37839 %U https://formative.jmir.org/2023/1/e37839 %U https://doi.org/10.2196/37839 %U http://www.ncbi.nlm.nih.gov/pubmed/37103986 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41911 %T A Personalized Mobile Cessation Intervention to Promote Smokers From the Preparation Stage to the Action Stage: Double-blind Randomized Controlled Trial %A Lin,Haoxiang %A Wang,Ying %A Xing,Yanling %A Han,Yinglian %A Zhang,Chengqian %A Luo,Ting %A Chang,Chun %+ School of Public Health, Peking University, 38 Xueyuanlu, Beijing, 100191, China, 86 13641338346, changchun@bjmu.edu.cn %K smoking cessation %K mobile health %K health education %K smoking %K behavior intervention %K behavior change %K support %K text message %K personalized %K smoking abstinence %K health behavior %K health promotion %D 2023 %7 26.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Most mobile cessation studies have found that such interventions have a higher quitting rate than interventions providing minimal smoking cessation support. However, why such interventions are effective has been almost unstudied by researchers. Objective: This paper describes the principles of the personalized mobile cessation intervention-based WeChat app and used generalized estimated equations to assess why a personalized mobile cessation intervention was more likely to promote smokers from the preparation stage to the action stage than a nonpersonalized intervention. Methods: This is a 2-arm, double-blind, randomized controlled trial in five cities in China. The intervention group received a personalized mobile cessation intervention. The control group received a nonpersonalized SMS text message smoking cessation intervention. All information was sent by the WeChat app. The outcomes were the change in protection motivation theory construct scores and the change in transtheoretical model stages. Results: A total of 722 participants were randomly assigned to the intervention or control group. Compared with those who received the nonpersonalized SMS text message intervention, smokers who received the personalized intervention presented lower intrinsic rewards, extrinsic rewards, and response costs. Intrinsic rewards were determinants of stage change, thus explaining why the intervention group was more likely to promote smokers from the preparation stage to the action stage (odds ratio 2.65, 95% CI 1.41-4.98). Conclusions: This study identified the psychological determinants at different stages to facilitate smokers moving forward to the next stage of quitting behavior and provides a framework to explore why a smoking cessation intervention is effective. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100041942; https://tinyurl.com/2hhx4m7f %M 37099360 %R 10.2196/41911 %U https://www.jmir.org/2023/1/e41911 %U https://doi.org/10.2196/41911 %U http://www.ncbi.nlm.nih.gov/pubmed/37099360 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e40427 %T Characterization of Self-reported Improvements in Knowledge and Health Among Users of Flo Period Tracking App: Cross-sectional Survey %A Zhaunova,Liudmila %A Bamford,Ryan %A Radovic,Tara %A Wickham,Aidan %A Peven,Kimberly %A Croft,Jazz %A Klepchukova,Anna %A Ponzo,Sonia %+ Flo Health LTU, Saltoniškių g. 2, Vilnius, LT-01109, Lithuania, 370 60396823, l_zhaunova@flo.health %K health knowledge %K menstrual cycle %K pregnancy %K period-tracking app %K digital health %K women’s health %D 2023 %7 26.4.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Research shows that poor knowledge and awareness of menstrual and pregnancy health among women are associated with adverse reproductive health and pregnancy outcomes. Menstrual cycle– and pregnancy-tracking mobile apps are promising tools for improving women’s awareness of and attitudes toward their reproductive health; however, there is little information about subscribers’ perceptions of app functionality and its impact on their knowledge and health. Objective: This study aimed to explore knowledge and health improvements related to menstrual cycle and pregnancy, as well as improvements in general health among Flo app users. We also investigated what components of the Flo app were associated with the abovementioned improvements and evaluated whether those improvements differed based on education level, country of residence (low- and middle-income vs high-income countries), free or premium subscription to the app, short- or long-term use of the app, and frequency of use. Methods: Flo subscribers who had been using the app for no less than 30 days, completed a web-based survey. A total of 2212 complete survey responses were collected. The survey included demographic questions and questions about motivations guiding the use of the Flo app and which components of the app improved their knowledge and health, as well as to what extent. Results: Most study participants reported improvements in menstrual cycle (1292/1452, 88.98%) and pregnancy (698/824, 84.7%) knowledge from Flo app use. Participants with higher levels of education and those from high-income countries reported using the app predominantly for getting pregnant (χ21=4.2, P=.04; χ21=52.3, P<.001, respectively) and pregnancy tracking (χ21=19.3, P<.001; χ21=20.9, P=.001, respectively). Participants with less education reported using the app to avoid pregnancy (χ21=4.2; P=.04) and to learn more about their body (χ21=10.8; P=.001) and sexual health (χ21=6.3; P=.01), while participants from low- and middle-income countries intended to mainly learn more about their sexual health (χ21=18.2; P<.001). Importantly, the intended use of the app across education levels and country income levels matched areas in which they had gained knowledge and achieved their health goals upon use of the Flo app. Period, fertile days, and ovulation predictions as well as symptom tracking were consistently the top 3 components in the app that helped users with their cycle knowledge and general health. Reading articles or watching videos helped with users' education regarding their pregnancy. Finally, the strongest improvements in knowledge and health were observed in premium, frequent, and long-term users. Conclusions: This study suggests that menstrual health apps, such as Flo, could present revolutionary tools to promote consumer health education and empowerment on a global scale. %M 37099370 %R 10.2196/40427 %U https://mhealth.jmir.org/2023/1/e40427 %U https://doi.org/10.2196/40427 %U http://www.ncbi.nlm.nih.gov/pubmed/37099370 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e36837 %T An App-Based Intervention for Pediatric Weight Management: Pre-Post Acceptability and Feasibility Trial %A Cox,Jennifer S %A Hinton,Elanor C %A Hamilton Shield,Julian %A Lawrence,Natalia S %+ NIHR Bristol Biomedical Research Centre Nutrition Theme, 3rd Floor, Education & Research Centre, Upper Maudlin Street, Bristol, BS2 8AE, United Kingdom, 44 07718905807, jennifer.cox@bristol.ac.uk %K obesity %K pediatric %K intervention %K eHealth %K weight management %D 2023 %7 24.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: A multidisciplinary approach to weight management is offered at tier 3 pediatric weight management services in the United Kingdom. Encouraging dietary change is a major aim, with patients meeting with dieticians, endocrinologists, psychologists, nurse specialists, and social workers on average every other month. Objective: This research sought to trial an inhibitory control training smartphone app—FoodT—with the clinic population of a pediatric weight management service. FoodT has shown positive impacts on food choice in adult users, with resulting weight loss. It was hoped that when delivered as an adjunctive treatment alongside the extensive social, medical, psychological, and dietetic interventions already offered at the clinic, the introduction of inhibitory control training may offer patients another tool that supports eating choice. In this feasibility trial, recruitment, retention, and app use were the primary outcomes. An extensive battery of measures was included to test the feasibility and acceptability of these measures for future powered trials. Methods: FoodT was offered to pediatric patients and their parents during a routine clinic appointment, and patients were asked to use the app at home every day for the first week and once per week for the rest of the month. Feasibility and acceptability were measured in terms of recruitment, engagement with the app, and retention to the trial. A battery of psychometric tests was given before and after app use to assess the acceptability of collecting data on changes to food choices and experiences that would inform future trial work. Results: A total of 12 children and 10 parents consented (22/62, 35% of those approached). Further, 1 child and no parents achieved the recommended training schedule. No participants completed the posttrial measures. The reasons for not wanting to be recruited to the trial included participants not considering their weight to be connected to eating choices and not feeling that the app suited their needs. No reasons are known for noncompletion. Conclusions: It is unclear whether the intervention itself or the research processes, including the battery of measures, prevented completion. It is therefore difficult to make any decisions as to the value that the app has within this setting. Important lessons have been learned from this research that have potential broad relevance, including the importance of co-designing interventions with service users and avoiding deterring people from early-stage participation in extensive data collection. %M 37093633 %R 10.2196/36837 %U https://formative.jmir.org/2023/1/e36837 %U https://doi.org/10.2196/36837 %U http://www.ncbi.nlm.nih.gov/pubmed/37093633 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44720 %T Adapting and Scaling a Digital Health Intervention to Improve Maternal and Child Health Among Ethnic Minority Women in Vietnam Amid the COVID-19 Context: Protocol for the dMOM Project %A McBride,Bronwyn %A O'Neil,John %A Nguyen,Phuong Chi %A Linh,Dang Thuy %A Trinh,Hue Thi %A Vu,Nguyen C %A Nguyen,Liem T %+ Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, BC, V5A 1S6, Canada, 1 6044417162, bronwyn_mcbride@sfu.ca %K mobile health %K digital health %K Vietnam %K maternal health %K maternal, newborn, and child health %K MNCH, health equity, ethnic minority %K maternal and child health %K child health %K ethnography %K coronavirus %K COVID-19 %K perinatal %K antenatal %K woman %K mother %K pregnancy %K newborn %K infant %K baby %K ethnic %K ethnicity %K visible minority %K culture %D 2023 %7 24.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Due to interconnected structural determinants including low maternal health knowledge, economic marginalization, and remoteness from low-capacity health centers, ethnic minority women in remote areas of Vietnam face severe maternal, newborn, and child health (MNCH) inequities. As ethnic minorities represent 15% of the Vietnamese population, these disparities are significant. mMOM—a pilot mobile health (mHealth) intervention using SMS text messaging to improve MNCH outcomes among ethnic minority women in northern Vietnam—was implemented from 2013-2016 with promising results. Despite mMOM’s findings, exacerbated MNCH inequities, and digital health becoming more salient amid COVID-19, mHealth has not yet been scaled to address MNCH among ethnic minority women in Vietnam. Objective: We describe the protocol for adapting, expanding, and exponentially scaling the mMOM intervention qualitatively through adding COVID-19–related MNCH guidance and novel technological components (mobile app and artificial intelligence chatbots) and quantitatively through broadening the geographical area to reach exponentially more participants, within the evolving COVID-19 context. Methods: dMOM will be conducted in 4 phases. (1) Drawing on a review of international literature and government guidelines on MNCH amid COVID-19, mMOM project components will be updated to respond to COVID-19 and expanded to include a mobile app and artificial intelligence chatbots to more deeply engage participants. (2) Using an intersectionality lens and participatory action research approach, a scoping study and rapid ethnographic fieldwork will explore ethnic minority women’s unmet MNCH needs; acceptability and accessibility of digital health; technical capacity of commune health centers; gendered power dynamics and cultural, geographical, and social determinants impacting health outcomes; and multilevel impacts of COVID-19. Findings will be applied to further refine the intervention. (3) dMOM will be implemented and incrementally scaled across 71 project communes. (4) dMOM will be evaluated to assess whether SMS text messaging or mobile app delivery engenders better MNCH outcomes among ethnic minority women. The documentation of lessons learned and dMOM models will be shared with Vietnam’s Ministry of Health for adoption and further scaling up. Results: The dMOM study was funded by the International Development Research Centre (IDRC) in November 2021, cofacilitated by the Ministry of Health, and is being coimplemented by provincial health departments in 2 mountainous provinces. Phase 1 was initiated in May 2022, and phase 2 is planned to begin in December 2022. The study is expected to be complete in June 2025. Conclusions: dMOM research outcomes will generate important empirical evidence on the effectiveness of leveraging digital health to address intractable MNCH inequities among ethnic minority women in low-resource settings in Vietnam and provide critical information on the processes of adapting mHealth interventions to respond to COVID-19 and future pandemics. Finally, dMOM activities, models, and findings will inform a national intervention led by the Ministry of Health. International Registered Report Identifier (IRRID): PRR1-10.2196/44720 %M 37058576 %R 10.2196/44720 %U https://www.researchprotocols.org/2023/1/e44720 %U https://doi.org/10.2196/44720 %U http://www.ncbi.nlm.nih.gov/pubmed/37058576 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41414 %T Motivational Message Framing Effects on Physical Activity Dynamics in a Digital Messaging Intervention: Secondary Analysis %A Lee,Alexandra M %A Hojjatinia,Sahar %A Courtney,Jimikaye B %A Brunke-Reese,Deborah %A Hojjatinia,Sarah %A Lagoa,Constantino M %A Conroy,David E %+ The Pennsylvania State University, 266 Rec Hall, University Park, PA, 16802, United States, 1 814 863 3451, conroy@psu.edu %K physical activity %K exercise %K fitness %K Fitbit %K tracking %K patient-specific modeling %K dynamical model %K patient specific %K fitness tracker %K psychological theory %K messaging %K motivation %K behavior change %D 2023 %7 21.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital smartphone messaging can be used to promote physical activity to large populations with limited cost. It is not clear which psychological constructs should be targeted by digital messages to promote physical activity. This gap presents a challenge for developing optimal content for digital messaging interventions. Objective: The aim of this study is to compare affectively framed and social cognitively framed messages on subsequent changes in physical activity using dynamical modeling techniques. Methods: We conducted a secondary analysis of data collected from a digital messaging intervention in insufficiently active young adults (18-29 years) recruited between April 2019 and July 2020 who wore a Fitbit smartwatch for 6 months. Participants received 0 to 6 messages at random per day across the intervention period. Messages were drawn from 3 content libraries: affectively framed, social cognitively framed, or inspirational quotes. Person-specific dynamical models were identified, and model features of impulse response and cumulative step response were extracted for comparison. Two-way repeated-measures ANOVAs evaluated the main effects and interaction of message type and day type on model features. This early-phase work with novel dynamic features may have been underpowered to detect differences between message types so results were interpreted descriptively. Results: Messages (n=20,689) were paired with valid physical activity monitoring data from 45 participants for analysis. Received messages were distributed as 40% affective (8299/20,689 messages), 39% social-cognitive (8187/20,689 messages), and 20% inspirational quotes (4219/20,689 messages). There were no statistically significant main effects for message type when evaluating the steady state of step responses. Participants demonstrated heterogeneity in intervention response: some had their strongest responses to affectively framed messages, some had their strongest responses to social cognitively framed messages, and some had their strongest responses to the inspirational quote messages. Conclusions: No single type of digital message content universally promotes physical activity. Future work should evaluate the effects of multiple message types so that content can be continuously tuned based on person-specific responses to each message type. %M 37083710 %R 10.2196/41414 %U https://formative.jmir.org/2023/1/e41414 %U https://doi.org/10.2196/41414 %U http://www.ncbi.nlm.nih.gov/pubmed/37083710 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43242 %T The Effectiveness of Smartphone App–Based Interventions for Assisting Smoking Cessation: Systematic Review and Meta-analysis %A Guo,Yi-Qiang %A Chen,Yuling %A Dabbs,Annette DeVito %A Wu,Ying %+ School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Feng-tai District, Beijing, 100069, China, 86 10 8391 1766, helenywu@vip.163.com %K smartphone app %K smoking cessation %K meta-analysis %K eHealth %K mHealth %K smoking %K application %K intervention %K effectiveness %K electronic %K adult %K pharmacotherapy %D 2023 %7 20.4.2023 %9 Review %J J Med Internet Res %G English %X Background: Smoking is a leading cause of premature death globally. Quitting smoking reduces the risk of all-cause mortality by 11%-34%. Smartphone app–based smoking cessation (SASC) interventions have been developed and are widely used. However, the evidence for the effectiveness of smartphone-based interventions for smoking cessation is currently equivocal. Objective: The purpose of this study was to synthesize the evidence for the effectiveness of smartphone app–based interventions for smoking cessation. Methods: We conducted a systematic review and meta-analysis of the effectiveness of smartphone interventions for smoking cessation based on the Cochrane methodology. An electronic literature search was performed using the Cochrane Library, Web of Science, PubMed, Embase, PsycINFO, China National Knowledge Infrastructure, and Wanfang databases to identify published papers in English or Chinese (there was no time limit regarding the publication date). The outcome was the smoking abstinence rate, which was either a 7-day point prevalence abstinence rate or a continuous abstinence rate. Results: A total of 9 randomized controlled trials involving 12,967 adults were selected for the final analysis. The selected studies from 6 countries (the United States, Spain, France, Switzerland, Canada, and Japan) were included in the meta-analysis between 2018 and 2022. Pooled effect sizes (across all follow-up time points) revealed no difference between the smartphone app group and the comparators (standard care, SMS text messaging intervention, web-based intervention, smoking cessation counseling, or apps as placebos without real function; odds ratio [OR] 1.25, 95% CI 0.99-1.56, P=.06, I2=73.6%). Based on the subanalyses, 6 trials comparing smartphone app interventions to comparator interventions reported no significant differences in effectiveness (OR 1.03, 95% CI 0.85-1.26, P=.74, I2=57.1%). However, the 3 trials that evaluated the combination of smartphone interventions combined with pharmacotherapy compared to pharmacotherapy alone found higher smoking abstinence rates in the combined intervention (OR 1.79, 95% CI 1.38-2.33, P=.74, I2=7.4%). All SASC interventions with higher levels of adherence were significantly more effective (OR 1.48, 95% CI 1.20-1.84, P<.001, I2=24.5%). Conclusions: This systematic review and meta-analysis did not support the effectiveness of delivering smartphone-based interventions alone to achieve higher smoking abstinence rates. However, the efficacy of smartphone-based interventions increased when combined with pharmacotherapy-based smoking cessation approaches. Trial Registration: PROSPERO CRD42021267615; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=267615 %M 37079352 %R 10.2196/43242 %U https://www.jmir.org/2023/1/e43242 %U https://doi.org/10.2196/43242 %U http://www.ncbi.nlm.nih.gov/pubmed/37079352 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e38307 %T Effectiveness of eHealth Interventions Targeting Employee Health Behaviors: Systematic Review %A Sevic,Aleksandra %A Hashemi,Neda S %A Thørrisen,Mikkel Magnus %A Strømstad,Kine %A Skarpaas,Lisebet Skeie %A Storm,Marianne %A Brønnick,Kolbjørn Kallesten %+ Department of Public Health, Faculty of Health Sciences, University of Stavanger, Hagbard Lines hus, Telegrafdirektør Heftyes vei 35, Stavanger, 4021, Norway, 47 45781149, aleksandra.sevic@uis.no %K eHealth %K employees %K workplace %K health behaviors %K sickness absence %K behavior change techniques %K systematic review %K mobile phone %D 2023 %7 20.4.2023 %9 Review %J J Med Internet Res %G English %X Background: The number of people with noncommunicable diseases is increasing. Noncommunicable diseases are the major cause of disability and premature mortality worldwide, associated with negative workplace outcomes such as sickness absence and reduced work productivity. There is a need to identify scalable interventions and their active components to relieve disease and treatment burden and facilitate work participation. eHealth interventions have shown potential in clinical and general populations to increase well-being and physical activity and could be well suited for workplace settings. Objective: We aimed to provide an overview of the effectiveness of eHealth interventions at the workplace targeting employee health behaviors and map behavior change techniques (BCTs) used in these interventions. Methods: A systematic literature search was performed in PubMed, Embase, PsycINFO, Cochrane CENTRAL, and CINAHL in September 2020 and updated in September 2021. Extracted data included participant characteristics, setting, eHealth intervention type, mode of delivery, reported outcomes, effect sizes, and attrition rates. Quality and risk of bias of the included studies were assessed using the Cochrane Collaboration risk-of-bias 2 tool. BCTs were mapped in accordance with the BCT Taxonomy v1. The review was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. Results: In total, 17 randomized controlled trials met the inclusion criteria. The measured outcomes, treatment and follow-up periods, content of eHealth interventions, and workplace contexts had high heterogeneity. Of the 17 studies, 4 (24%) reported unequivocally significant findings for all primary outcomes, with effect sizes ranging from small to large. Furthermore, 53% (9/17) of the studies reported mixed results, and 24% (4/17) reported nonsignificant results. The most frequently targeted behavior was physical activity (15/17, 88% of the studies); the least frequently targeted behavior was smoking (2/17, 12% of the studies). Attrition varied greatly across the studies (0%-37%). Risk of bias was high in 65% (11/17) of the studies, with some concerns in the remaining 35% (6/17). Interventions used various BCTs, and the most frequently used were feedback and monitoring (14/17, 82%), goals and planning (10/17, 59%), antecedents (10/17, 59%), and social support (7/17, 41%). Conclusions: This review suggests that, although eHealth interventions may have potential, there are still unanswered questions regarding their effectiveness and what drives the mechanism behind these effects. Low methodological quality, high heterogeneity and complexity, the characteristics of the included samples, and often high attrition rates challenge the investigation of the effectiveness and the making of sound inferences about the effect sizes and significance of the results. To address this, new studies and methods are needed. A megastudy design in which different interventions are evaluated in the same population over the same period on the same outcomes may solve some of the challenges. Trial Registration: PROSPERO CRD42020202777; https://www-crd-york-ac-uk/prospero/display_record.php?RecordID=202777 %M 37079369 %R 10.2196/38307 %U https://www.jmir.org/2023/1/e38307 %U https://doi.org/10.2196/38307 %U http://www.ncbi.nlm.nih.gov/pubmed/37079369 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43164 %T Mobile Acceptance and Commitment Therapy in Bipolar Disorder: Microrandomized Trial %A Cochran,Amy %A Maronge,Jacob M %A Victory,Amanda %A Hoel,Sydney %A McInnis,Melvin G %A Thomas,Emily BK %+ Department of Population Health Sciences, University of Wisconsin Madison, 610 Walnut Street, Madison, WI, 53726, United States, 1 608 262 0772, cochran4@wisc.edu %K acceptance and commitment therapy %K bipolar disorder %K mobile applications %K randomized controlled trials %K micro-randomized trial %K precision medicine %K mindfulness %D 2023 %7 20.4.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mobile interventions promise to fill in gaps in care with their broad reach and flexible delivery. Objective: Our goal was to investigate delivery of a mobile version of acceptance and commitment therapy (ACT) for individuals with bipolar disorder (BP). Methods: Individuals with BP (n=30) participated in a 6-week microrandomized trial. Twice daily, participants logged symptoms in the app and were repeatedly randomized (or not) to receive an ACT intervention. Self-reported behavior and mood were measured as the energy devoted to moving toward valued domains or away from difficult emotions and with depressive d and manic m scores from the digital survey of mood in BP survey (digiBP). Results: Participants completed an average of 66% of in-app assessments. Interventions did not significantly impact the average toward energy or away energy but did significantly increase the average manic score m (P=.008) and depressive score d (P=.02). This was driven by increased fidgeting and irritability and interventions focused on increasing awareness of internal experiences. Conclusions: The findings of the study do not support a larger study on the mobile ACT in BP but have significant implications for future studies seeking mobile therapy for individuals with BP. Trial Registration: ClinicalTrials.gov NCT04098497; https://clinicaltrials.gov/ct2/show/NCT04098497 %M 37079363 %R 10.2196/43164 %U https://mental.jmir.org/2023/1/e43164 %U https://doi.org/10.2196/43164 %U http://www.ncbi.nlm.nih.gov/pubmed/37079363 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41838 %T End Users' Perspectives on the Quality and Design of mHealth Technologies During the COVID-19 Pandemic in the Philippines: Qualitative Study %A Gonzales,Aldren %A Custodio,Razel %A Lapitan,Marie Carmela %A Ladia,Mary Ann %+ Medical Informatics Unit, College of Medicine, University of the Philippines Manila, 547 Pedro Gil Street, Ermita, Manila, 1000, Philippines, 63 2027511303, abgonzales2@up.edu.ph %K mHealth %K COVID-19 %K pandemic %K digital health %K mobile health %K end-user engagement %K focus group %K technology implementation %K Philippines %K technology use %K privacy %K user engagement %D 2023 %7 20.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has expanded the use of mobile health (mHealth) technologies in contact tracing, communicating COVID-19–related information, and monitoring the health conditions of the general population in the Philippines. However, the limited end-user engagement in the features and feedback along the development cycle of mHealth technologies results in risks in adoption. The World Health Organization (WHO) recommends user-centric design and development of mHealth technologies to ensure responsiveness to the needs of the end users. Objective: The goal of the study is to understand, using end users’ perspectives, the design and quality of mHealth technology implementations in the Philippines during the COVID-19 pandemic, with a focus on the areas identified by stakeholders: (1) utility, (2) technology readiness level, (3) design, (4) information, (5) usability, (6) features, and (7) security and privacy. Methods: Using a descriptive qualitative design, we conducted 5 interviews and 3 focus group discussions (FGDs) with a total of 16 participants (6, 37.5%, males and 10, 62.5%, females). Questions were based on the Mobile App Rating Scale (MARS). Using the cyclical coding approach, transcripts were analyzed with NVivo 12. Themes were identified. Results: The qualitative analysis identified 18 themes that were organized under the 7 focus areas: (1) utility: use of mHealth technologies and motivations in using mHealth; (2) technology readiness: mobile technology literacy and user segmentation; (3) design: user interface design, language and content accessibility, and technology design; (4) information: accuracy of information and use of information; (5) usability: design factors, dependency on human processes, and technical issues; (6) features: interoperability and data integration, other feature and design recommendations, and technology features and upgrades; and (7) privacy and security: trust that mHealth can secure data, lack of information, and policies. To highlight, accessibility, privacy and security, a simple interface, and integration are some of the design and quality areas that end users find important and consider in using mHealth tools. Conclusions: Engaging end users in the development and design of mHealth technologies ensures adoption and accessibility, making it a valuable tool in curbing the pandemic. The 6 principles for developers, researchers, and implementers to consider when scaling up or developing a new mHealth solution in a low-resource setting are that it should (1) be driven by value in its implementation, (2) be inclusive, (3) address users’ physical and cognitive restrictions, (4) ensure privacy and security, (5) be designed in accordance with digital health systems’ standards, and (6) be trusted by end users. %M 36943932 %R 10.2196/41838 %U https://formative.jmir.org/2023/1/e41838 %U https://doi.org/10.2196/41838 %U http://www.ncbi.nlm.nih.gov/pubmed/36943932 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41900 %T Addressing Preconception Behavior Change Through Mobile Phone Apps: Systematic Review and Meta-analysis %A Musgrave,Loretta %A Cheney,Kate %A Dorney,Edwina %A Homer,Caroline S E %A Gordon,Adrienne %+ Centre for Midwifery, Child and Family Health, University of Technology Sydney, 235 Jones St, NSW, Sydney, 2007, Australia, 61 9514 5069, loretta.musgrave@uts.edu.au %K apps %K mobile %K preconception %K prenatal care %K perinatal %K reproductive health %K reproductive age %K maternal %K interconception %K behavior change %K mobile phone %D 2023 %7 19.4.2023 %9 Review %J J Med Internet Res %G English %X Background: Positive health behavior changes before pregnancy can optimize perinatal outcomes for mothers, babies, and future generations. Women are often motivated to positively change their behavior in preparation for pregnancy to enhance their health and well-being. Mobile phone apps may provide an opportunity to deliver public health interventions during the preconception period. Objective: This review aimed to synthesize the evidence of the effectiveness of mobile phone apps in promoting positive behavior changes in women of reproductive age before they are pregnant (preconception and interconception periods), which may improve future outcomes for mothers and babies. Methods: Five databases were searched in February 2022 for studies exploring mobile phone apps as a prepregnancy intervention to promote positive behavior change. The identified studies were retrieved and exported to EndNote (Thomson Reuters). Using Covidence (Veritas Health Innovation), a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) study flow diagram was generated to map the number of records identified, included, and excluded. Three independent reviewers assessed the risk of bias and conducted data extraction using the Review Manager software (version 5.4, The Cochrane Collaboration), and the data were then pooled using a random-effects model. The Grades of Recommendation, Assessment, Development, and Evaluation system was used to assess the certainty of the evidence. Results: Of the 2973 publications identified, 7 (0.24%) were included. The total number of participants across the 7 trials was 3161. Of the 7 studies, 4 (57%) included participants in the interconception period, and 3 (43%) included women in the preconception period. Of the 7 studies, 5 (71%) studies focused on weight reduction, assessing the outcomes of reductions in adiposity and weight. Of the 7 studies, nutrition and dietary outcomes were evaluated in 2 (29%) studies, blood pressure outcomes were compared in 4 (57%) studies, and biochemical and marker outcomes associated with managing disease symptoms were included in 4 (57%) studies. Analysis showed that there were no statistically significant differences in energy intake; weight loss; body fat; and biomarkers such as glycated hemoglobin, total cholesterol, fasting lipid profiles, or blood pressure when compared with standard care. Conclusions: Owing to the limited number of studies and low certainty of the evidence, no firm conclusions can be drawn on the effects of mobile phone app interventions on promoting positive behavior changes in women of reproductive age before they are pregnant (preconception and interconception periods). Trial Registration: PROSPERO CRD42017065903; https://tinyurl.com/2p9dwk4a International Registered Report Identifier (IRRID): RR2-10.1186/s13643-019-0996-6 %M 37074767 %R 10.2196/41900 %U https://www.jmir.org/2023/1/e41900 %U https://doi.org/10.2196/41900 %U http://www.ncbi.nlm.nih.gov/pubmed/37074767 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42432 %T Effectiveness of Combined Health Coaching and Self-Monitoring Apps on Weight-Related Outcomes in People With Overweight and Obesity: Systematic Review and Meta-analysis %A Chew,Han Shi Jocelyn %A Rajasegaran,Nagadarshini Nicole %A Chin,Yip Han %A Chew,W S Nicholas %A Kim,Kyung Mi %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 3, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 65168687, jocelyn.chew.hs@nus.edu.sg %K apps %K BMI %K cardiometabolic %K database %K diet behaviour %K health coaching %K monitoring %K obesity %K physical activity %K waist circumference %K weight loss %K weight %D 2023 %7 18.4.2023 %9 Review %J J Med Internet Res %G English %X Background: Self-monitoring smartphone apps and health coaching have both individually been shown to improve weight-related outcomes, but their combined effects remain unclear. Objective: This study aims to examine the effectiveness of combining self-monitoring apps with health coaching on anthropometric, cardiometabolic, and lifestyle outcomes in people with overweight and obesity. Methods: Relevant articles published from inception till June 9, 2022, were searched through 8 databases (Embase, CINAHL, PubMed, PsycINFO, Scopus, The Cochrane Library, and Web of Science). Effect sizes were pooled using random-effects models. Behavioral strategies used were coded using the behavior change techniques taxonomy V1. Results: A total of 14 articles were included, representing 2478 participants with a mean age of 39.1 years and a BMI of 31.8 kg/m2. Using combined intervention significantly improved weight loss by 2.15 kg (95% CI −3.17 kg to −1.12 kg; P<.001; I2=60.3%), waist circumference by 2.48 cm (95% CI −3.51 cm to −1.44 cm; P<.001; I2=29%), triglyceride by 0.22 mg/dL (95% CI −0.33 mg/dL to 0.11 mg/dL; P=.008; I2=0%), glycated hemoglobin by 0.12% (95% CI −0.21 to −0.02; P=.03; I2=0%), and total calorie consumption per day by 128.30 kcal (95% CI −182.67 kcal to −73.94 kcal; P=.003; I2=0%) kcal, but not BMI, blood pressure, body fat percentage, cholesterol, and physical activity. Combined interventional effectiveness was superior to receiving usual care and apps for waist circumference but only superior to usual care for weight loss. Conclusions: Combined intervention could improve weight-related outcomes, but more research is needed to examine its added benefits to using an app. Trial Registration: PROSPERO CRD42022345133; https://tinyurl.com/2zxfdpay %M 37071452 %R 10.2196/42432 %U https://www.jmir.org/2023/1/e42432 %U https://doi.org/10.2196/42432 %U http://www.ncbi.nlm.nih.gov/pubmed/37071452 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40851 %T SNapp, a Tailored Smartphone App Intervention to Promote Walking in Adults of Low Socioeconomic Position: Development and Qualitative Pilot Study %A Vos,Anne L %A de Bruijn,Gert-Jan %A Klein,Michel C A %A Lakerveld,Jeroen %A Boerman,Sophie C %A Smit,Edith G %+ Amsterdam School of Communication Research, University of Amsterdam, Nieuwe Achtergracht 166, Amsterdam, 1018 WV, Netherlands, 31 0205253, a.l.vos@uva.nl %K cardiovascular disease %K physical activity %K walking %K smartphone %K mobile health %K mHealth %K mobile app %K behavior change techniques %K tailoring %K intervention development %K socioeconomic position %K mobile phone %D 2023 %7 17.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Adults of low socioeconomic position (SEP) are generally less physically active than those who are more socioeconomically advantaged, which increases their cardiovascular disease incidence risk. Moreover, individuals of low SEP are often less easily reached with physical activity (PA) interventions than individuals of higher SEP. Smartphone apps have been presented as a promising platform for delivering PA interventions to difficult-to-reach individuals of low SEP. Although PA apps are widely available, they are rarely based on health behavior theories and most predominantly offer generic PA advice. Consequently, it is unlikely that available apps are the most effective PA intervention tools. Objective: To respond to these areas for improvement, we developed SNapp, an app-based intervention encouraging adults of low SEP to increase PA by providing tailored coaching messages targeting walking behavior. This study aimed to describe SNapp’s stepwise development and pilot evaluation process. Methods: We applied a stepwise approach: analyzing the health problem, developing a program framework, developing tailoring assessments, writing tailored messages, automating the tailoring process, and implementing and evaluating the program in a qualitative pilot study (11 participants). Results: SNapp consisted of several elements. First, an app was developed to collect step count and geolocation data using smartphone sensor functionalities. In addition, a survey measure was created to assess users’ behavior change technique (BCT) preferences. These 3 data types were used to tailor SNapp’s coaching messages to stimulate walking. This allows SNapp to offer feedback on performance levels, contextually tailored prompts when users are near green spaces, and coaching content that aligns with individual BCT preferences. Finally, a server-based Python program that interacts with databases containing user data and tailored messages was built using Microsoft Azure to select and automatically send messages to users through Telegram messenger. Pilot study findings indicated that SNapp was rated positively, with participants reporting that its design, technical functioning, and message content were acceptable. Participants suggested additional functionalities that are worth considering for future updates. Conclusions: SNapp is an app-based intervention that aims to promote walking in adults of low SEP by offering tailored coaching messages. Its development is theory based, and it is among the first to incorporate contextualized feedback and content tailored to individual BCT preferences. The effectiveness of SNapp will be evaluated in a 12-month real-life parallel cluster-randomized controlled trial. %M 37067890 %R 10.2196/40851 %U https://formative.jmir.org/2023/1/e40851 %U https://doi.org/10.2196/40851 %U http://www.ncbi.nlm.nih.gov/pubmed/37067890 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41807 %T Characterizing Consumer Smartphone Apps for Virtual Reality–Based Exposure Therapy: Content Analysis %A Sunkara,Charvi %A Thakkar,Rajvi %A Ong,Triton %A Bunnell,Brian E %+ Doxy.me Research, Doxy.me Inc, 3445 Winton Place, Suite #114, Rochester, NY, 14623, United States, 1 8444369963, triton.ong@doxy.me %K virtual reality %K exposure therapy %K phobia %K apps %K smartphones %K VR %K smartphone apps %K mobile phone apps %K content analysis %K treatment %K clinical evaluation %K phobia %K consumer apps %K mHealth apps %D 2023 %7 14.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In vivo exposure therapy is the most effective treatment for phobias but is often impractical. Virtual reality exposure therapy (VRET) can help overcome critical barriers to in vivo exposure therapy. However, accessible mobile software related to VRET is not well understood. Objective: The purpose of our study is to describe the landscape of accessible smartphone apps with potential utility for clinical VRET. Methods: We conducted a content analysis of publicly available smartphone apps related to virtual reality on the Google Play Store and the Apple App Store as of March 2020. Results: The initial search yielded 525 apps, with 84 apps (52 on the Google Play Store and 32 on the Apple App Store) included for analysis. The most common phobic stimulus depicted was bodies of water or weather events (25/84, 29.8%), followed by heights (24/84, 28.6%), and animals (23/84, 27.4%). More than half of the apps were visually abstract (39/84, 53.5%). Most apps were free to use (48/84, 57.1%), while the rest were free to try (22/84, 26.2%) or required payment for use (14/84, 16.7%), with the highest cost for use being US $6. The average overall app rating was 2.9 stars out of 5, but the number of ratings ranged from 0 to 49,233. None of the 84 apps advertised compliance with the Health Insurance Portability and Accountability Act, offered the ability to monitor data, provided clinician control over variables in the app experiences, or explicitly stated use by or development with clinicians. Conclusions: None of the smartphone apps reviewed were explicitly developed for phobia therapy. However, 16 of the 84 included apps were considered ideal candidates to investigate further as part of treatment due to their accessibility, depiction of phobia-relevant stimuli, low or no cost, and high user scores. Most of these apps were visually abstract and free to use, making them accessible and potentially flexible as part of clinical exposure hierarchies. However, none of the apps were designed for clinical use, nor did they provide tools for clinician workflows. Formal evaluation of these accessible smartphone apps is needed to understand the clinical potential of accessible VRET solutions. %M 37058343 %R 10.2196/41807 %U https://www.jmir.org/2023/1/e41807 %U https://doi.org/10.2196/41807 %U http://www.ncbi.nlm.nih.gov/pubmed/37058343 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44131 %T Investigating Employees’ Concerns and Wishes Regarding Digital Stress Management Interventions With Value Sensitive Design: Mixed Methods Study %A Kerr,Jasmine I %A Naegelin,Mara %A Benk,Michaela %A v Wangenheim,Florian %A Meins,Erika %A Viganò,Eleonora %A Ferrario,Andrea %+ Mobiliar Lab for Analytics at ETH Zurich, Department of Management, Technology, and Economics, ETH Zurich, Weinbergstrasse 56/58, Zürich, 8092, Switzerland, 41 44 632 65 83, jkerr@ethz.ch %K value sensitive design %K digital health intervention %K stress %K employee well-being %K monitoring %K machine learning %K ethics %K mobile phone %D 2023 %7 13.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Work stress places a heavy economic and disease burden on society. Recent technological advances include digital health interventions for helping employees prevent and manage their stress at work effectively. Although such digital solutions come with an array of ethical risks, especially if they involve biomedical big data, the incorporation of employees’ values in their design and deployment has been widely overlooked. Objective: To bridge this gap, we used the value sensitive design (VSD) framework to identify relevant values concerning a digital stress management intervention (dSMI) at the workplace, assess how users comprehend these values, and derive specific requirements for an ethics-informed design of dSMIs. VSD is a theoretically grounded framework that front-loads ethics by accounting for values throughout the design process of a technology. Methods: We conducted a literature search to identify relevant values of dSMIs at the workplace. To understand how potential users comprehend these values and derive design requirements, we conducted a web-based study that contained closed and open questions with employees of a Swiss company, allowing both quantitative and qualitative analyses. Results: The values health and well-being, privacy, autonomy, accountability, and identity were identified through our literature search. Statistical analysis of 170 responses from the web-based study revealed that the intention to use and perceived usefulness of a dSMI were moderate to high. Employees’ moderate to high health and well-being concerns included worries that a dSMI would not be effective or would even amplify their stress levels. Privacy concerns were also rated on the higher end of the score range, whereas concerns regarding autonomy, accountability, and identity were rated lower. Moreover, a personalized dSMI with a monitoring system involving a machine learning-based analysis of data led to significantly higher privacy (P=.009) and accountability concerns (P=.04) than a dSMI without a monitoring system. In addition, integrability, user-friendliness, and digital independence emerged as novel values from the qualitative analysis of 85 text responses. Conclusions: Although most surveyed employees were willing to use a dSMI at the workplace, there were considerable health and well-being concerns with regard to effectiveness and problem perpetuation. For a minority of employees who value digital independence, a nondigital offer might be more suitable. In terms of the type of dSMI, privacy and accountability concerns must be particularly well addressed if a machine learning-based monitoring component is included. To help mitigate these concerns, we propose specific requirements to support the VSD of a dSMI at the workplace. The results of this work and our research protocol will inform future research on VSD-based interventions and further advance the integration of ethics in digital health. %M 37052996 %R 10.2196/44131 %U https://www.jmir.org/2023/1/e44131 %U https://doi.org/10.2196/44131 %U http://www.ncbi.nlm.nih.gov/pubmed/37052996 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e37347 %T Health Monitoring Using Smart Home Technologies: Scoping Review %A Morita,Plinio P %A Sahu,Kirti Sundar %A Oetomo,Arlene %+ School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 31372, plinio.morita@uwaterloo.ca %K monitor %K smart home %K ambient assisted living %K active assisted living %K AAL %K assisted living %K review %K internet of things %K aging %K gerontology %K elder %K older adult %K older people %K geriatric %K digital health %K eHealth %K smart technology %K older population %K independent living %K big data %K machine learning %K algorithm %K deep learning %D 2023 %7 13.4.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The Internet of Things (IoT) has become integrated into everyday life, with devices becoming permanent fixtures in many homes. As countries face increasing pressure on their health care systems, smart home technologies have the potential to support population health through continuous behavioral monitoring. Objective: This scoping review aims to provide insight into this evolving field of research by surveying the current technologies and applications for in-home health monitoring. Methods: Peer-reviewed papers from 2008 to 2021 related to smart home technologies for health care were extracted from 4 databases (PubMed, Scopus, ScienceDirect, and CINAHL); 49 papers met the inclusion criteria and were analyzed. Results: Most of the studies were from Europe and North America. The largest proportion of the studies were proof of concept or pilot studies. Approximately 78% (38/49) of the studies used real human participants, most of whom were older females. Demographic data were often missing. Nearly 60% (29/49) of the studies reported on the health status of the participants. Results were primarily reported in engineering and technology journals. Almost 62% (30/49) of the studies used passive infrared sensors to report on motion detection where data were primarily binary. There were numerous data analysis, management, and machine learning techniques employed. The primary challenges reported by authors were differentiating between multiple participants in a single space, technology interoperability, and data security and privacy. Conclusions: This scoping review synthesizes the current state of research on smart home technologies for health care. We were able to identify multiple trends and knowledge gaps—in particular, the lack of collaboration across disciplines. Technological development dominates over the human-centric part of the equation. During the preparation of this scoping review, we noted that the health care research papers lacked a concrete definition of a smart home, and based on the available evidence and the identified gaps, we propose a new definition for a smart home for health care. Smart home technology is growing rapidly, and interdisciplinary approaches will be needed to ensure integration into the health sector. %M 37052984 %R 10.2196/37347 %U https://mhealth.jmir.org/2023/1/e37347 %U https://doi.org/10.2196/37347 %U http://www.ncbi.nlm.nih.gov/pubmed/37052984 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40671 %T Sensa Mobile App for Managing Stress, Anxiety, and Depression Symptoms: Pilot Cohort Study %A Valinskas,Sarunas %A Nakrys,Marius %A Aleknavicius,Kasparas %A Jonusas,Justinas %+ KiloHealth, Antakalnio st. 17, Vilnius, LT 10312, Lithuania, 370 61456067, justinas.jonusas@kilo.health %K depression %K anxiety %K stress %K depressive %K DASS-21 %K mobile application %K CBT %K cognitive behavioral therapy %K psychotherapy %K mHealth %K mobile health %K Sensa %K app %K application %K health care %K intervention %K effectiveness %K assessment %K symptoms %K treatment %K mental health %D 2023 %7 13.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: An increase in depression, anxiety, and stress symptoms worldwide, attributed to the COVID-19 pandemic, has been reported. If not treated, it may negatively affect a person's everyday life by altering physical and social well-being and productivity and increasing expenditure on health care. Cognitive behavioral therapy (CBT)–based interventions are gaining popularity as a means to reduce stress and alleviate anxiety and depression symptoms. Moreover, CBT delivered through a mobile app has the same elements as traditional CBT training (eg, guided discovery). However, unlike conventional training, users of mobile apps are allowed to tailor their own experience at their own speed and schedule. Objective: This study aims to analyze Sensa users’ retrospective data and explore the dose-duration effect to find the optimal usage time when the user showed results. Methods: The study cohort comprised 381 consecutive community-based nonclinical users who started using Sensa between October 2021 and March 2022. All users included in the study took the Depression Anxiety Stress Scale-21 (DASS-21) assessment at least 2 times. Other parameters from the database containing all self-reported data were gender, number of active days, total time of use, and age. The primary outcome of the study was a change in the DASS-21 score. Statistical analyses were performed using GraphPad Prism (version 9, GraphPad Software). In addition, a logistic regression model was created to predict how the obtained independent parameters influenced the DASS-21 score. Results: The main finding of our study was that the majority of participants who started using Sensa were experiencing depression, anxiety, and stress symptoms (92.13%, 80.05%, and 87.93%, respectively). There was a statistically significant decrease of the DASS-21 subdomain scores after the use of the application (anxiety: mean 7.25, SD 4.03 vs mean 6.12, SD 4.00; P=.001; depression: mean 11.05, SD 4.26 vs mean 9.01, SD 4.77; P=.001; stress: mean 11.42, SD 3.44 vs mean 9.96, SD 3.65; P<.001). Finally, the logistic regression model showed that users who were using the app for more than 24 days and had at least 12 active days during that time had 3.463 (95% CI 1.142-11.93) and 2.644 (95% CI 1.024-7.127) times higher chances to reduce their DASS-21 subdomain scores of depression and anxiety, respectively. Conclusions: Using the Sensa mobile app was related to decreased depression, anxiety, and stress symptoms. %M 37052990 %R 10.2196/40671 %U https://formative.jmir.org/2023/1/e40671 %U https://doi.org/10.2196/40671 %U http://www.ncbi.nlm.nih.gov/pubmed/37052990 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44939 %T Efficacy of Mobile-Based Cognitive Behavioral Therapy on Lowering Low-density Lipoprotein Cholesterol Levels in Patients With Atherosclerotic Cardiovascular Disease: Multicenter, Prospective Randomized Controlled Trial %A Li,DuanBin %A Xu,Tian %A Xie,DaQi %A Wang,MiaoYun %A Sun,ShuPing %A Wang,Min %A Zhang,SiSi %A Yang,XinRui %A Zhang,ZhongNan %A Wang,Shen %A Kuang,Ming %A Tang,Jia %A Liu,HongYing %A Hong,XuLin %A Fu,GuoSheng %A Zhang,WenBin %+ Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 Qingchun East Road, Shangcheng District, Zhejiang Province, Hangzhou, 310020, China, 86 0571 86006491, 3313011@zju.edu.cn %K mobile-based cognitive behavioral therapy %K low-density lipoprotein cholesterol %K atherosclerotic cardiovascular disease %K self-efficacy %K quality of life %D 2023 %7 12.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Elevated low-density lipoprotein cholesterol (LDL-C) is an established risk factor for atherosclerotic cardiovascular disease (ASCVD). However, low adherence to medication and lifestyle management has limited the benefits of lowering lipid levels. Cognitive behavioral therapy (CBT) has been proposed as a promising solution. Objective: This trial aimed to evaluate the efficacy of mobile-based CBT interventions in lowering LDL-C levels in patients with ASCVD. Methods: This multicenter, prospective, randomized controlled trial enrolled 300 patients with ASCVD, who were randomly assigned to the mobile-based CBT intervention group and the control group in a ratio of 1:1. The intervention group received CBT for ASCVD lifestyle interventions delivered by WeChat MiniApp: “CBT ASCVD.” The control group only received routine health education during each follow-up. The linear regression and logistic regression analyses were used to determine the effects of a mobile-based CBT intervention on LDL-C, triglyceride, C-reactive protein, the score of General Self-Efficacy Scale (GSE), quality of life index (QL-index), and LDL-C up-to-standard rate (<1.8 mmol/L) at the first, third, and sixth months. Results: Finally, 296 participants completed the 6-month follow-up (CBT group: n=148; control group: n=148). At baseline, the mean LDL-C level was 2.48 (SD 0.90) mmol/L, and the LDL-C up-to-standard rate (<1.8 mmol/L) was 21.3%. Mobile-based CBT intervention significantly increased the reduction of LDL-C change (%) at the 6-month follow-up (β=–10.026, 95% CI –18.111 to –1.940). In addition, this benefit remained when baseline LDL-C <1.8 mmol/L (β=–24.103, 95% CI –43.110 to –5.095). Logistic regression analysis showed that mobile-based CBT intervention moderately increased the LDL-C up-to-standard rates (<1.8 mmol/L) in the sixth month (odds ratio 1.579, 95% CI 0.994-2.508). For GSE and QL-index, mobile-based CBT intervention significantly increased the change of scores (%) at the 1-, 3-, and 6-month follow-up (all P values <.05). Conclusions: In patients with ASCVD, mobile-based CBT is effective in reducing LDL-C levels (even for those who already had a standard LDL-C) and can improve self-efficacy and quality of life. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100046775; https://www.chictr.org.cn/showproj.aspx?proj=127140 %M 37043273 %R 10.2196/44939 %U https://www.jmir.org/2023/1/e44939 %U https://doi.org/10.2196/44939 %U http://www.ncbi.nlm.nih.gov/pubmed/37043273 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42581 %T Engagement With Tailored Physical Activity Content: Secondary Findings From the Families Improving Together for Weight Loss Randomized Controlled Trial %A Sweeney,Allison M %A Wilson,Dawn K %A Resnicow,Kenneth %A Van Horn,M Lee %A Kitzman,Heather %+ Department of Biobehavioral Health & Nursing Science, College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29201, United States, 1 8035767891, sweeneam@mailbox.sc.edu %K tailoring %K eHealth %K African Americans %K physical activity %K weight loss %D 2023 %7 12.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based tailored interventions offer rich opportunities for improved access to and personalization of behavioral interventions. However, despite the promise of this approach, the engagement and underrepresentation of minority groups remain major issues. Objective: This study evaluated whether engagement (log-in status and log-in duration) with different types of tailored behavioral content from the Families Improving Together for weight loss web-based intervention was associated with changes in moderate to vigorous physical activity (MVPA) among African American families with overweight or obesity. Methods: Parent-adolescent dyads were randomized to a web-based tailored intervention or web-based health education comparison program. The web-based intervention (N=119) was completed by parents and targeted 6 weight-related behaviors to support their adolescent children’s weight loss goals (session contents included energy balance, fast food, fruits and vegetables, physical activity [PA], sedentary behavior, and sweetened beverages). MVPA was measured using accelerometers at baseline and after the intervention. Results: Using a hierarchical approach, the log-in status and duration for each web-based session were used to evaluate the additive effects of engagement with different types of tailored behavioral content on MVPA after the web-based intervention. Among parents, logging in to the PA session was not associated with greater MVPA (B=−12.561, 95% CI −18.759 to −6.367), but MVPA increased with greater log-in duration for the PA (B=0.008, 95% CI 0.004-0.012) and sedentary behavior (B= 0.008, 95% CI 0.004-0.012) sessions. These results suggest that parents who logged in to the PA session had lower MVPA, but MVPA increased with greater log-in duration for the PA and sedentary behavior sessions. These associations remained even after accounting for engagement with other content sessions. However, these engagement effects did not translate to the adolescents. Conclusions: The results of this study highlight the need to disentangle the impact of engagement with different tailored content to improve the efficacy of tailored web-based interventions, especially for promoting PA in African American families. Trial Registration: ClinicalTrials.gov NCT01796067; https://clinicaltrials.gov/ct2/show/NCT01796067 %M 37043271 %R 10.2196/42581 %U https://www.jmir.org/2023/1/e42581 %U https://doi.org/10.2196/42581 %U http://www.ncbi.nlm.nih.gov/pubmed/37043271 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42455 %T The Added Value of Remote Technology in Cardiac Rehabilitation on Physical Function, Anthropometrics, and Quality of Life: Cluster Randomized Controlled Trial %A Lahtio,Heli %A Heinonen,Ari %A Paajanen,Teemu %A Sjögren,Tuulikki %+ Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35, Jyväskylä, 40014, Finland, 358 14260 1211, heli.lahtio@gmail.com %K weight loss %K cardiac rehabilitation %K remote technology %K physical function %K 6-minute walk test %K overweight %K obesity %K body mass %K BMI %K waist circumference %K quality of life %K QoL %K mobile phone %D 2023 %7 12.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Cardiovascular diseases (CVDs) cause most deaths globally and can reduce quality of life (QoL) of rehabilitees with cardiac disease. The risk factors of CVDs are physical inactivity and increased BMI. With physical activity, it is possible to prevent CVDs, improve QoL, and help maintain a healthy body mass. Current literature shows the possibilities of digitalization and advanced technology in supporting independent self-rehabilitation. However, the interpretation of the results is complicated owing to the studies’ high heterogeneity. In addition, the added value of this technology has not been studied well, especially in cardiac rehabilitation. Objective: We aimed to examine the effectiveness of added remote technology in cardiac rehabilitation on physical function, anthropometrics, and QoL in rehabilitees with CVD compared with conventional rehabilitation. Methods: Rehabilitees were cluster randomized into 3 remote technology intervention groups (n=29) and 3 reference groups (n=30). The reference group received conventional cardiac rehabilitation, and the remote technology intervention group received conventional cardiac rehabilitation with added remote technology, namely, the Movendos mCoach app and Fitbit charge accelerometer. The 12 months of rehabilitation consisted of three 5-day in-rehabilitation periods in the rehabilitation center. Between these periods were two 6-month self-rehabilitation periods. Outcome measurements included the 6-minute walk test, body mass, BMI, waist circumference, and World Health Organization QoL-BREF questionnaire at baseline and at 6 and 12 months. Between-group differences were assessed using 2-tailed t tests and Mann-Whitney U test. Within-group differences were analyzed using a paired samples t test or Wilcoxon signed-rank test. Results: Overall, 59 rehabilitees aged 41 to 66 years (mean age 60, SD 6 years; n=48, 81% men) were included in the study. Decrement in waist circumference (6 months: 1.6 cm; P=.04; 12 months: 3 cm; P<.001) and increment in self-assessed QoL were greater (environmental factors: 0.5; P=.02) in the remote technology intervention group than the reference group. Both groups achieved statistically significant improvements in the 6-minute walk test in both time frames (P=.01-.03). Additionally, the remote technology intervention group achieved statistically significant changes in the environmental domain at 0-6 months (P=.03) and waist circumference at both time frames (P=.01), and reference group achieve statistically significant changes in waist circumference at 0-6 months (P=.02). Conclusions: Remote cardiac rehabilitation added value to conventional cardiac rehabilitation in terms of waist circumference and QoL. The results were clinically small, but the findings suggest that adding remote technology to cardiac rehabilitation may increase beneficial health outcomes. There was some level of systematic error during rehabilitation intervention, and the sample size was relatively small. Therefore, care must be taken when generalizing the study results beyond the target population. To confirm assumptions of the added value of remote technology in rehabilitation interventions, more studies involving different rehabilitees with cardiac disease are required. Trial Registration: ISRCTN Registry ISRCTN61225589; https://www.isrctn.com/ISRCTN61225589 %M 37043264 %R 10.2196/42455 %U https://www.jmir.org/2023/1/e42455 %U https://doi.org/10.2196/42455 %U http://www.ncbi.nlm.nih.gov/pubmed/37043264 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39029 %T Time-Dependent Changes in Depressive Symptoms Among Control Participants in Digital-Based Psychological Intervention Studies: Meta-analysis of Randomized Controlled Trials %A Tong,Alan CY %A Ho,Florence SY %A Chu,Owen HH %A Mak,Winnie WS %+ Department of Psychology, The Chinese University of Hong Kong, Rm 354, Sino Building, New Territories, Hong Kong, 852 39436577, wwsmak@cuhk.edu.hk %K digital-based psychological intervention %K control groups %K meta-analysis %K depression %K depressive symptoms %K mobile phone %D 2023 %7 12.4.2023 %9 Review %J J Med Internet Res %G English %X Background: Digital-based psychological interventions (DPIs) have been shown to be efficacious in many randomized controlled trials (RCTs) in dealing with depression in adults. However, the effects of control comparators in these DPI studies have been largely overlooked, and they may vary in their effects on depression management. Objective: This meta-analytical study aimed to provide a quantitative estimate of the within-subject effects of control groups across different time intervals and explore the moderating effects of control types and symptom severity at baseline. Methods: A systematic literature search was conducted in late September 2021 on selected electronic databases: PubMed; ProQuest; Web of Science; and the Ovid system with MEDLINE, PsycINFO, and Embase. The control conditions in 107 RCTs with a total of 11,803 adults with depressive symptoms were included in the meta-analysis, and effect sizes (Hedges g) were calculated using the standardized mean difference approach. Study quality was assessed using the Cochrane risk-of-bias tool for randomized trials version 2. Results: The control conditions collectively yielded small to moderate effects in reducing depressive symptoms within 8 weeks since the baseline assessment (g=−0.358, 95% CI −0.434 to −0.281). The effects grew to moderate within 9 to 24 weeks (g=−0.549, 95% CI −0.638 to −0.460) and peaked at g=−0.810 (95% CI −0.950 to −0.670) between 25 and 48 weeks. The effects were maintained at moderate to large ranges (g=−0.769, 95% CI −1.041 to −0.498) beyond 48 weeks. The magnitude of the reduction differed across the types of control and severity of symptoms. Care as usual was the most powerful condition of all and produced a large effect (g=−0.950, 95% CI −1.161 to −0.739) in the medium term. The findings showed that waitlist controls also produced a significant symptomatic reduction in the short term (g=−0.291, 95% CI −0.478 to −0.104), refuting the previous suspicion of a nocebo effect. In addition, a large effect on depressive symptom reduction in the long term (g=−1.091, 95% CI −1.210 to −0.972) was noted among participants with severe levels of depressive symptoms at baseline. Conclusions: This study provided evidence that depressive symptoms generally reduced over time among control conditions in research trials of DPIs. Given that different control conditions produce variable and significant levels of symptomatic reduction, future intervention trials must adopt an RCT design and should consider the contents of control treatments when investigating the efficacy of DPIs. The results of waitlist controls confirmed previous findings of spontaneous recovery among people with mild to moderate depressive symptoms in face-to-face studies. Researchers may adopt watchful waiting as participants wait for the availability of digital-based psychological services. %M 37043276 %R 10.2196/39029 %U https://www.jmir.org/2023/1/e39029 %U https://doi.org/10.2196/39029 %U http://www.ncbi.nlm.nih.gov/pubmed/37043276 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41018 %T Use of a Mobile Biofeedback App to Provide Health Coaching for Stress Self-management: Pilot Quasi-Experiment %A Son,Changwon %A Hegde,Sudeep %A Markert,Carl %A Zahed,Karim %A Sasangohar,Farzan %+ Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, TX, 77843, United States, 1 9794582337, sasangohar@tamu.edu %K mental health %K health coaching %K stress %K biofeedback %K mHealth %K mobile apps %K breathing exercises %K students %K veterans %K COVID-19 %K vulnerable population %K college student %K self-management %K mobile health app %K psychological well-being %K digital health intervention %D 2023 %7 12.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health is an increasing concern among vulnerable populations, including college students and veterans. Objective: The purpose of this study was to determine if mobile health technology combined with health coaching can better enable a user to self-manage their mental health. Methods: This study evaluated the mobile app “Biofeedback” that provided health coaching on stress self-management for college student veterans’ mental health concerns. Twenty-four college student veterans were recruited from a large public university in Texas during the spring 2020 semester, impacted by COVID-19. Ten participants were assigned to the intervention group where they used the mobile Biofeedback app on their smartphones and smartwatches, and 14 were assigned to the control group without the app; assignment was based on mobile phone compatibility. Both groups participated in one initial lab session where they learned a deep-breathing exercise technique. The intervention group was then asked to use the mobile Biofeedback app during their daily lives and a smartwatch, and the control group was asked to perform the breathing exercises on their own. Both groups filled out Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) self-assessments at 2-week intervals. At the end of the semester, both groups were given an exit interview to provide user experience and perceived benefits of health coaching via the mobile biofeedback app. Results: The deep-breathing exercise in the initial lab session reduced stress in both groups. Over the course of the study, the app recorded 565 coached breathing exercises with a significant decrease (approximately 3 beats per minute) in participants’ heart rate during the 6-minute time period immediately after conducting the breathing exercises (Spearman rank correlation coefficient –0.61, P<.001; S=9,816,176). There was no significant difference between the two groups for PHQ-9 and GAD-7 scores over the course of the semester. Exit interview responses indicated that participants perceived that the mobile Biofeedback app improved their health and helped them address stress challenges. All participants reported that the intervention helped them manage their stress better and expressed that health coaching via a mobile device would improve their overall health. Conclusions: Participants reported a positive perception of the app for their mental health self-management during a stressful semester. Future work should examine long-term effects of the app with a larger sample size balanced between male and female participants, randomized participant allocation, real-time detection of mental health symptoms, and additional features of the app. %M 36952560 %R 10.2196/41018 %U https://formative.jmir.org/2023/1/e41018 %U https://doi.org/10.2196/41018 %U http://www.ncbi.nlm.nih.gov/pubmed/36952560 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45970 %T Barriers to and Facilitators of a Blended Cognitive Behavioral Therapy Program for Depression and Anxiety Based on Experiences of University Students: Qualitative Interview Study %A Braun,Pia %A Atik,Ece %A Guthardt,Lisa %A Apolinário-Hagen,Jennifer %A Schückes,Magnus %+ Institute of Occupational, Social and Environmental Medicine, Faculty of Medicine, Centre for Health and Society, Heinrich Heine University Düsseldorf, Moorenstr. 5, Düsseldorf, 40225, Germany, 49 211 8106477, jennifer.apolinario.hagen@hhu.de %K digital therapeutics %K blended cognitive behavioral therapy %K bCBT %K depression %K anxiety %K acceptance %K user experiences %K university students %K mobile phone %D 2023 %7 12.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Blended cognitive behavioral therapy (bCBT) programs have been proposed to increase the acceptance and adoption of digital therapeutics (DTx) such as digital health apps. These programs allow for more personalized care by combining regular face-to-face therapy sessions with DTx. However, facilitators of and barriers to the use of DTx in bCBT programs have rarely been examined among students, who are particularly at risk for developing symptoms of depression and anxiety disorders. Objective: This study aimed to evaluate the facilitators of and barriers to the use of a bCBT program with the elona therapy app among university students with mild to moderate depression or anxiety symptoms. Methods: Semistructured interviews were conducted via videoconference between January 2022 and April 2022 with 102 students (mean age 23.93, SD 3.63 years; 89/102, 87.2% female) from universities in North Rhine-Westphalia, Germany, after they had completed weekly individual cognitive behavioral therapy sessions (25 minutes each) via videoconference for 6 weeks and regularly used the depression (n=67, 65.7%) or anxiety (n=35, 34.3%) module of the app. The interviews were coded based on grounded theory. Results: Many participants highlighted the intuitive handling of the app and indicated that they perceived it as a supportive tool between face-to-face sessions. Participants listed other benefits, such as increased self-reflection and disorder-specific knowledge as well as the transfer of the content of therapy sessions into their daily lives. Some stated that they would have benefited from more personalized and interactive tasks. In general, participants mentioned the time requirement, increased use of the smartphone, and the feeling of being left alone with potentially arising emotions while working on tasks for the next therapy session as possible barriers to the use of the app. Data security was not considered a major concern. Conclusions: Students mostly had positive attitudes toward elona therapy as part of the bCBT program. Our study shows that DTx complementing face-to-face therapy sessions can be perceived as a helpful tool for university students with mild to moderate anxiety or depression symptoms in their daily lives. Future research could elaborate on whether bCBT programs might also be suitable for students with more severe symptoms of mental disorders. In addition, the methods by which such bCBT programs could be incorporated into the university context to reach students in need of psychological support should be explored. %M 37043272 %R 10.2196/45970 %U https://formative.jmir.org/2023/1/e45970 %U https://doi.org/10.2196/45970 %U http://www.ncbi.nlm.nih.gov/pubmed/37043272 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44275 %T Wearable Sensor and Mobile App–Based mHealth Approach for Investigating Substance Use and Related Factors in Daily Life: Protocol for an Ecological Momentary Assessment Study %A Takano,Ayumi %A Ono,Koki %A Nozawa,Kyosuke %A Sato,Makito %A Onuki,Masaki %A Sese,Jun %A Yumoto,Yosuke %A Matsushita,Sachio %A Matsumoto,Toshihiko %+ Department of Mental Health and Psychiatric Nursing, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan, 81 3 5803 5348, ayumi-takano@umin.ac.jp %K alcohol and drug use %K alcoholism %K digital health %K drug use %K ecological momentary assessment %K ecological momentary intervention %K electronic health record %K Fitbit %K machine learning %K mHealth %K mobile app %K self-monitoring %K wearables devices %D 2023 %7 11.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital health technologies using mobile apps and wearable devices are a promising approach to the investigation of substance use in the real world and for the analysis of predictive factors or harms from substance use. Moreover, consecutive repeated data collection enables the development of predictive algorithms for substance use by machine learning methods. Objective: We developed a new self-monitoring mobile app to record daily substance use, triggers, and cravings. Additionally, a wearable activity tracker (Fitbit) was used to collect objective biological and behavioral data before, during, and after substance use. This study aims to describe a model using machine learning methods to determine substance use. Methods: This study is an ongoing observational study using a Fitbit and a self-monitoring app. Participants of this study were people with health risks due to alcohol or methamphetamine use. They were required to record their daily substance use and related factors on the self-monitoring app and to always wear a Fitbit for 8 weeks, which collected the following data: (1) heart rate per minute, (2) sleep duration per day, (3) sleep stages per day, (4) the number of steps per day, and (5) the amount of physical activity per day. Fitbit data will first be visualized for data analysis to confirm typical Fitbit data patterns for individual users. Next, machine learning and statistical analysis methods will be performed to create a detection model for substance use based on the combined Fitbit and self-monitoring data. The model will be tested based on 5-fold cross-validation, and further preprocessing and machine learning methods will be conducted based on the preliminary results. The usability and feasibility of this approach will also be evaluated. Results: Enrollment for the trial began in September 2020, and the data collection finished in April 2021. In total, 13 people with methamphetamine use disorder and 36 with alcohol problems participated in this study. The severity of methamphetamine or alcohol use disorder assessed by the Drug Abuse Screening Test-10 or the Alcohol Use Disorders Identification Test-10 was moderate to severe. The anticipated results of this study include understanding the physiological and behavioral data before, during, and after alcohol or methamphetamine use and identifying individual patterns of behavior. Conclusions: Real-time data on daily life among people with substance use problems were collected in this study. This new approach to data collection might be helpful because of its high confidentiality and convenience. The findings of this study will provide data to support the development of interventions to reduce alcohol and methamphetamine use and associated negative consequences. International Registered Report Identifier (IRRID): DERR1-10.2196/44275 %M 37040162 %R 10.2196/44275 %U https://www.researchprotocols.org/2023/1/e44275 %U https://doi.org/10.2196/44275 %U http://www.ncbi.nlm.nih.gov/pubmed/37040162 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42482 %T Time of Day Preferences and Daily Temporal Consistency for Predicting the Sustained Use of a Commercial Meditation App: Longitudinal Observational Study %A Berardi,Vincent %A Fowers,Rylan %A Rubin,Gavriella %A Stecher,Chad %+ Department of Psychology, Chapman University, 1 University Drive, Orange, CA, 92866, United States, 1 7145165883, berardi@chapman.edu %K behavioral habits %K habit formation %K mindfulness meditation %K mobile health %K health app %K app usage %K meditation app %K temporal analysis %K circadian rhythm %K healthy life style %K physical activity %K mental well being %K habit %K mindfulness %K meditation %K wellbeing %K mental health %K longitudinal %K observational %K advice %K morning %D 2023 %7 10.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The intensive data typically collected by mobile health (mHealth) apps allows factors associated with persistent use to be investigated, which is an important objective given users’ well-known struggles with sustaining healthy behavior. Objective: Data from a commercial meditation app (n=14,879; 899,071 total app uses) were analyzed to assess the validity of commonly given habit formation advice to meditate at the same time every day, preferably in the morning. Methods: First, the change in probability of meditating in 4 nonoverlapping time windows (morning, midday, evening, and late night) on a given day over the first 180 days after creating a meditation app account was calculated via generalized additive mixed models. Second, users’ time of day preferences were calculated as the percentage of all meditation sessions that occurred within each of the 4 time windows. Additionally, the temporal consistency of daily meditation behavior was calculated as the entropy of the timing of app usage sessions. Linear regression was used to examine the effect of time of day preference and temporal consistency on two outcomes: (1) short-term engagement, defined as the number of meditation sessions completed within the sixth and seventh month of a user’s account, and (2) long-term use, defined as the days until a user’s last observed meditation session. Results: Large reductions in the probability of meditation at any time of day were seen over the first 180 days after creating an account, but this effect was smallest for morning meditation sessions (63.4% reduction vs reductions ranging from 67.8% to 74.5% for other times). A greater proportion of meditation in the morning was also significantly associated with better short-term engagement (regression coefficient B=2.76, P<.001) and long-term use (B=50.6, P<.001). The opposite was true for late-night meditation sessions (short-term: B=–2.06, P<.001; long-term: B=–51.7, P=.001). Significant relationships were not found for midday sessions (any outcome) or for evening sessions when examining long-term use. Additionally, temporal consistency in the performance of morning meditation sessions was associated with better short-term engagement (B=–1.64, P<.001) but worse long-term use (B=55.8, P<.001). Similar-sized temporal consistency effects were found for all other time windows. Conclusions: Meditating in the morning was associated with higher rates of maintaining a meditation practice with the app. This is consistent with findings from other studies that have hypothesized that the strength of existing morning routines and circadian rhythms may make the morning an ideal time to build new habits. In the long term, less temporal consistency in meditation sessions was associated with more persistent app use, suggesting there are benefits from maintaining flexibility in behavior performance. These findings improve our understanding of how to promote enduring healthy lifestyles and can inform the design of mHealth strategies for maintaining behavior changes. %M 37036755 %R 10.2196/42482 %U https://www.jmir.org/2023/1/e42482 %U https://doi.org/10.2196/42482 %U http://www.ncbi.nlm.nih.gov/pubmed/37036755 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44104 %T Associations Between Social Cognitive Determinants and Movement-Related Behaviors in Studies Using Ecological Momentary Assessment Methods: Systematic Review %A Bittel,Kelsey M %A O'Briant,Kate Y %A Ragaglia,Rena M %A Buseth,Lake %A Murtha,Courtney %A Yu,Jessica %A Stanely,Jennifer M %A Hudgins,Brynn L %A Hevel,Derek J %A Maher,Jaclyn P %+ Department of Kinesiology, University Of North Carolina Greensboro, 1408 Walker Avenue, Greensboro, NC, 27412, United States, 1 8147690663, bittekelsey@gmail.com %K motivation %K psychosocial %K physical activity %K sedentary behavior %K ambulatory assessment %K mobile phone %D 2023 %7 7.4.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The social cognitive framework is a long-standing framework within physical activity promotion literature to explain and predict movement-related behaviors. However, applications of the social cognitive framework to explain and predict movement-related behaviors have typically examined the relationships between determinants and behavior across macrotimescales (eg, weeks and months). There is more recent evidence suggesting that movement-related behaviors and their social cognitive determinants (eg, self-efficacy and intentions) change across microtimescales (eg, hours and days). Therefore, efforts have been devoted to examining the relationship between social cognitive determinants and movement-related behaviors across microtimescales. Ecological momentary assessment (EMA) is a growing methodology that can capture movement-related behaviors and social cognitive determinants as they change across microtimescales. Objective: The objective of this systematic review was to summarize evidence from EMA studies examining associations between social cognitive determinants and movement-related behaviors (ie, physical activity and sedentary behavior). Methods: Studies were included if they quantitatively tested such an association at the momentary or day level and excluded if they were an active intervention. Using keyword searches, articles were identified across the PubMed, SPORTDiscus, and PsycINFO databases. Articles were first assessed through abstract and title screening followed by full-text review. Each article was screened independently by 2 reviewers. For eligible articles, data regarding study design, associations between social cognitive determinants and movement-related behaviors, and study quality (ie, Methodological Quality Questionnaire and Checklist for Reporting Ecological Momentary Assessment Studies) were extracted. At least 4 articles were required to draw a conclusion regarding the overall associations between a social cognitive determinant and movement-related behavior. For the social cognitive determinants in which a conclusion regarding an overall association could be drawn, 60% of the articles needed to document a similar association (ie, positive, negative, or null) to conclude that the association existed in a particular direction. Results: A total of 24 articles including 1891 participants were eligible for the review. At the day level, intentions and self-efficacy were positively associated with physical activity. No other associations could be determined because of conflicting findings or the small number of studies investigating associations. Conclusions: Future research would benefit from validating EMA assessments of social cognitive determinants and systematically investigating associations across different operationalizations of key constructs. Despite the only recent emergence of EMA to understand social cognitive determinants of movement-related behaviors, the findings indicate that daily intentions and self-efficacy play an important role in regulating physical activity in everyday life. Trial Registration: PROSPERO CRD42022328500; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=328500 %M 37027185 %R 10.2196/44104 %U https://mhealth.jmir.org/2023/1/e44104 %U https://doi.org/10.2196/44104 %U http://www.ncbi.nlm.nih.gov/pubmed/37027185 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 7 %N %P e38900 %T Engagement in Self-measured Blood Pressure Monitoring Among Medically Underresourced Participants (the Reach Out Trial): Digital Framework Qualitative Study %A Hellem,Abby Katherine %A Whitfield,Candace %A Casetti,Amanda %A Robles,Maria Cielito %A Dinh,Mackenzie %A Meurer,William %A Skolarus,Lesli %+ Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave Suite 11500, Chicago, IL, 60611, United States, 1 312 503 0399, lesli.skolarus@northwestern.edu %K mobile health %K mHealth %K cardiovascular disease %K hypertension %K blood pressure %K semistructured interviews %K intervention engagement %K social determinants of health %K DBCI framework %D 2023 %7 7.4.2023 %9 Original Paper %J JMIR Cardio %G English %X Background: Mobile health (mHealth) interventions serve as a scalable opportunity to engage people with hypertension in self-measured blood pressure (SMBP) monitoring, an evidence-based approach to lowering blood pressure (BP) and improving BP control. Reach Out is an SMS text messaging–based SMBP mHealth trial that aims to reduce BP among hypertensive patients recruited from the emergency department of a safety net hospital in a low-income, predominately Black city. Objective: As the benefits of Reach Out are predicated on participants’ engagement with the intervention, we sought to understand participants’ determinants of engagement via prompted SMBP with personalized feedback (SMBP+feedback). Methods: We conducted semistructured telephone interviews based on the digital behavior change interventions framework. Participants were purposively sampled from 3 engagement categories: high engagers (≥80% response to SMBP prompts), low engagers (≤20% response to BP prompts), and early enders (participants who withdrew from the trial). Results: We conducted interviews with 13 participants, of whom 7 (54%) were Black, with a mean age of 53.6 (SD 13.25) years. Early enders were less likely to be diagnosed with hypertension prior to Reach Out, less likely to have a primary care provider, and less likely to be taking antihypertensive medications than their counterparts. Overall, participants liked the SMS text messaging design of the intervention, including the SMBP+feedback. Several participants across all levels of engagement expressed interest in and identified the benefit of enrolling in the intervention with a partner of their choice. High engagers expressed the greatest understanding of the intervention, the least number of health-related social needs, and the greatest social support to engage in SMBP. Low engagers and early enders shared a mixed understanding of the intervention and less social support compared to high engagers. Participation decreased as social needs increased, with early enders sharing the greatest amount of resource insecurity apart from a notable exception of a high engager with high health-related social needs. Conclusions: Prompted SMBP+feedback was perceived favorably by all participants. To enhance SMBP engagement, future studies could consider greater support in the initiation of SMBP, evaluating and addressing participants’ unmet health-related social needs, as well as strategies to cultivate social norms. %M 37027200 %R 10.2196/38900 %U https://cardio.jmir.org/2023/1/e38900 %U https://doi.org/10.2196/38900 %U http://www.ncbi.nlm.nih.gov/pubmed/37027200 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44216 %T Tailoring a Digital Mental Health Program for Patients With Sickle Cell Disease: Qualitative Study %A Nikolajski,Cara %A O'Brien,Julia %A Nardo,Emily %A Szigethy,Eva %A Jonassaint,Charles %+ Center for Research on Health Care, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, United States, 1 412 586 9850, cjonassaint@pitt.edu %K mental health %K sickle cell disease %K digital health %K cognitive behavioral therapy %K digital cognitive behavioral therapy %D 2023 %7 6.4.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depression and other mental health disorders are prevalent among people living with chronic health conditions. Although digital cognitive behavioral therapy (CBT) is considered an effective treatment, African American individuals are less likely to engage in and adhere to digital therapies for mental health disorders compared with White individuals. Objective: The aim of this study was to understand digital CBT mental health treatment perceptions and preferences of African American individuals with sickle cell disease (SCD). Methods: African American individuals with SCD from various US locations were invited to participate in a series of focus groups. Participants were introduced to a health coach–supported mental health app and then asked a series of questions about the usability and appeal of the program as well as, more generally, what would make a digital mental health program effective for them. The authors reviewed the focus group transcripts and conducted a qualitative analysis of the results. Results: A total of 25 people participated in 5 focus groups. Overall, 5 primary themes emerged regarding how app content and related coaching could be modified to enhance digital CBT engagement. These themes included connection with others living with SCD, the personalization of app content and coaching, characteristics of coaches, journaling and pain tracking, and considerations for optimal engagement. Conclusions: Enhancing the user experience by making digital CBT tools relevant to patient populations is critical for optimizing program engagement and its uptake. Our findings highlight potential strategies to modify and design digital CBT tools for users with SCD and may also be applicable to patients with other chronic conditions. Trial Registration: ClinicalTrials.gov NCT04587661; https://clinicaltrials.gov/ct2/show/NCT04587661 %M 37023443 %R 10.2196/44216 %U https://mental.jmir.org/2023/1/e44216 %U https://doi.org/10.2196/44216 %U http://www.ncbi.nlm.nih.gov/pubmed/37023443 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42087 %T Predicting Habitual Use of Wearable Health Devices Among Middle-aged Individuals With Metabolic Syndrome Risk Factors in South Korea: Cross-sectional Study %A Ha,Jaeyoung %A Park,Jungmi %A Lee,Sangyi %A Lee,Jeong %A Choi,Jin-Young %A Kim,Junhyoung %A Cho,Sung-il %A Jeon,Gyeong-Suk %+ Department of Nursing, Mokpo National University, 1666 Yeongsan-ro, Dorim-ri, Cheonggye-myeon, Muan, 58554, Republic of Korea, 82 61 450 2675, gsj64@naver.com %K wearable health devices %K HBM %K UTAUT2 %K habitual use %K metabolic syndrome %K wearables %K digital intervention %K health promotion %K predictors of use %K acceptability %D 2023 %7 6.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Prevention of the risk factors for metabolic syndrome (MetS) in middle-aged individuals is an important public health issue. Technology-mediated interventions, such as wearable health devices, can aid in lifestyle modification, but they require habitual use to sustain healthy behavior. However, the underlying mechanisms and predictors of habitual use of wearable health devices among middle-aged individuals remain unclear. Objective: We investigated the predictors of habitual use of wearable health devices among middle-aged individuals with risk factors for MetS. Methods: We proposed a combined theoretical model based on the health belief model, the Unified Technology of Acceptance and Use of Technology 2, and perceived risk. We conducted a web-based survey of 300 middle-aged individuals with MetS between September 3 and 7, 2021. We validated the model using structural equation modeling. Results: The model explained 86.6% of the variance in the habitual use of wearable health devices. The goodness-of-fit indices revealed that the proposed model has a desirable fit with the data. Performance expectancy was the core variable explaining the habitual use of wearable devices. The direct effect of the performance expectancy on habitual use of wearable devices was greater (β=.537, P<.001) than that of intention to continue use (β=.439, P<.001), and the total effect estimate of the performance expectancy was 0.909 (P<.001), including the indirect effect (β=.372, P=.03) on habitual use of wearable devices via intention to continue use. Furthermore, performance expectancy was influenced by health motivation (β=.497, P<.001), effort expectancy (β=.558, P<.001), and risk perception (β=.137, P=.02). Perceived vulnerability (β=.562, P<.001) and perceived severity (β=.243, P=.008) contributed to health motivation. Conclusions: The results suggest the importance of the users’ performance expectations for wearable health devices for the intention of continued use for self-health management and habituation. Based on our results, developers and health care practitioners should find better ways to meet the performance expectations of middle-aged individuals with MetS risk factors. They also should generate device use easier and find a way to encourage users’ health motivation, thereby reducing users’ effort expectancy and resulting in a reasonable performance expectancy of the wearable health device, to induce users’ habitual use behaviors. %M 37023419 %R 10.2196/42087 %U https://formative.jmir.org/2023/1/e42087 %U https://doi.org/10.2196/42087 %U http://www.ncbi.nlm.nih.gov/pubmed/37023419 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43224 %T Lessons for Vietnam on the Use of Digital Technologies to Support Patient-Centered Care in Low- and Middle-Income Countries in the Asia-Pacific Region: Scoping Review %A Kosowicz,Leona %A Tran,Kham %A Khanh,Toan Tran %A Dang,Thu Ha %A Pham,Van An %A Ta Thi Kim,Hue %A Thi Bach Duong,Hoang %A Nguyen,Tran Dong %A Phuong,Anh Tuyet %A Le,Trong Hieu %A Ta,Van Anh %A Wickramasinghe,Nilmini %A Schofield,Penelope %A Zelcer,John %A Pham Le,Tuan %A Nguyen,Tuan Anh %+ Social Gerontology Division, National Ageing Research Institute, Gate 4, Building 8, 34-54 Poplar Road, Parkville, 3052, Australia, 61 3 8387 2305, t.nguyen@nari.edu.au %K digital health technologies %K digital health %K eHealth %K mobile health %K mHealth %K patient-centered care %K Vietnam %K Asia-Pacific region %K digital %K disease %K technology %K database %K self-management %K clinical %K users %D 2023 %7 5.4.2023 %9 Review %J J Med Internet Res %G English %X Background: A rapidly aging population, a shifting disease burden and the ongoing threat of infectious disease outbreaks pose major concerns for Vietnam’s health care system. Health disparities are evident in many parts of the country, especially in rural areas, and the population faces inequitable access to patient-centered health care. Vietnam must therefore explore and implement advanced solutions to the provision of patient-centered care, with a view to reducing pressures on the health care system simultaneously. The use of digital health technologies (DHTs) may be one of these solutions. Objective: This study aimed to identify the application of DHTs to support the provision of patient-centered care in low- and middle-income countries in the Asia-Pacific region (APR) and to draw lessons for Vietnam. Methods: A scoping review was undertaken. Systematic searches of 7 databases were conducted in January 2022 to identify publications on DHTs and patient-centered care in the APR. Thematic analysis was conducted, and DHTs were classified using the National Institute for Health and Care Excellence evidence standards framework for DHTs (tiers A, B, and C). Reporting was in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: Of the 264 publications identified, 45 (17%) met the inclusion criteria. The majority of the DHTs were classified as tier C (15/33, 45%), followed by tier B (14/33, 42%) and tier A (4/33, 12%). At an individual level, DHTs increased accessibility of health care and health-related information, supported individuals in self-management, and led to improvements in clinical and quality-of-life outcomes. At a systems level, DHTs supported patient-centered outcomes by increasing efficiency, reducing strain on health care resources, and supporting patient-centered clinical practice. The most frequently reported enablers for the use of DHTs for patient-centered care included alignment of DHTs with users’ individual needs, ease of use, availability of direct support from health care professionals, provision of technical support as well as user education and training, appropriate governance of privacy and security, and cross-sectorial collaboration. Common barriers included low user literacy and digital literacy, limited user access to DHT infrastructure, and a lack of policies and protocols to guide the implementation and use of DHTs. Conclusions: The use of DHTs is a viable option to increase equitable access to quality, patient-centered care across Vietnam and simultaneously reduce pressures on the health care system. Vietnam can take advantage of the lessons learned by other low- and middle-income countries in the APR when developing a national road map to digital health transformation. Recommendations that Vietnamese policy makers may consider include emphasizing stakeholder engagement, strengthening digital literacy, supporting the improvement of DHT infrastructure, increasing cross-sectorial collaboration, strengthening governance of cybersecurity, and leading the way in DHT uptake. %M 37018013 %R 10.2196/43224 %U https://www.jmir.org/2023/1/e43224 %U https://doi.org/10.2196/43224 %U http://www.ncbi.nlm.nih.gov/pubmed/37018013 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45920 %T Acceptability and Initial Adoption of the Heart Observation App for Infants With Congenital Heart Disease: Qualitative Study %A Hjorth-Johansen,Elin %A Børøsund,Elin %A Martinsen Østen,Ingeborg %A Holmstrøm,Henrik %A Moen,Anne %+ Neonatal Intensive Care Unit, Division of Children and Adolescent Medicine, Oslo University Hospital, E2 4th Floor, Sognsvannsveien 20, Oslo, 0372, Norway, 47 98676884, ehjorth@ous-hf.no %K congenital heart disease %K readiness for discharge %K mobile app %K follow-up, health services %K mHealth %D 2023 %7 5.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 1% of all infants are born with a congenital heart disease (CHD). Internationally CHD remains a major cause of infant death, some of which occur unexpectedly after a gradual deterioration at home. Many parents find it difficult to recognize worsening of symptoms. Objective: This study aims to report the acceptability and initial adoption of a mobile app, the Heart Observation app (HOBS), aiming to support parents’ understanding and management of their child’s condition and to increase quality in follow-up from health care professionals in complex health care services in Norway. Methods: A total of 9 families were interviewed on discharge from the neonatal intensive care unit and after 1 month at home. The infant’s primary nurse, community nurse, and cardiologist were also interviewed regarding their experiences about collaboration with the family. The interviews were analyzed inductively with thematic content analysis. Results: The analysis generated 4 main themes related to acceptability and adoption: (1) Individualize Initial Support, (2) Developing Confidence and Coping, (3) Normalize When Appropriate, and (4) Implementation in a Complex Service Pathway. The receptivity of parents to learn and attend in the intervention differs according to their present situation. Health care professionals emphasized the importance of adapting the introduction and guidance to parents’ receptivity to ensure comprehension, self-efficacy, and thereby acceptance before discharge (Individualize Initial Support). Parents perceived that HOBS served them well and nurtured confidence by teaching them what to be aware of. Health care professionals reported most parents as confident and informed. This potential effect increased the possibility of adoption (Developing Confidence and Coping). Parents expressed that HOBS was not an “everyday app” and wanted to normalize everyday life when appropriate. Health care professionals suggested differentiating use according to severity and reducing assessments after recovery to adapt the burden of assessments when appropriate (Normalize When Appropriate). Health care professionals’ attitude to implement HOBS in their services was positive. They perceived HOBS as useful to systemize guidance, to enhance communication regarding an infant’s condition, and to increase understanding of heart defects in health care professionals with sparse experience (Implementation in a Complex Service Pathway). Conclusions: This feasibility study shows that both parents and health care professionals found HOBS as a positive addition to the health care system and follow-up. HOBS was accepted and potentially useful, but health care professionals should guide parents initially to ensure comprehension and adapt timing to parents’ receptivity. By doing so, parents may be confident to know what to look for regarding their child’s health and cope at home. Differentiating between various diagnoses and severity is important to support normalization when appropriate. Further controlled studies are needed to assess adoption, usefulness, and benefits in the health care system. %M 37018028 %R 10.2196/45920 %U https://formative.jmir.org/2023/1/e45920 %U https://doi.org/10.2196/45920 %U http://www.ncbi.nlm.nih.gov/pubmed/37018028 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43823 %T The Development of a Hypertension Prevention and Financial-Incentive mHealth Program Using a “No-Code” Mobile App Builder: Development and Usability Study %A Willms,Amanda %A Rhodes,Ryan E %A Liu,Sam %+ School of Exercise Science, Physical and Health Education, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada, 1 250 721 8392, awillms@uvic.ca %K mobile health %K mHealth %K usability study %K financial incentive %K physical activity %K mobile phone %K smartphone %D 2023 %7 5.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Regular physical activity (PA) is a key lifestyle component for hypertension prevention. Previous studies have shown that mobile health (mHealth) apps can be an effective tool for improving PA behaviors. However, adherence to and poor engagement with these apps is a challenge. A potential solution to overcome this challenge may be to combine financial incentives with innovative behavior theory, such as the Multiprocess Action Control (M-PAC) framework. Currently, there is a lack of PA financial incentive–driven M-PAC mHealth programs aimed at hypertension prevention. Objective: We aimed to describe the process of developing an 8-week mHealth PA and financial-incentive hypertension education program (Healthy Hearts) and to evaluate usability of the Healthy Hearts program. Methods: The first 2 stages of the Integrate, Design, Assess, and Share framework were used to guide the development of the Healthy Hearts program. The development process consisted of 2 phases. In phase 1, the research team met to discuss implementing the M-PAC framework to adopt an existing web-based hypertension prevention program to a mobile app. The app was developed using a no-code app development platform, Pathverse (Pathverse Inc), to help decrease overall development time. In phase 2, we created a prototype and conducted usability testing to evaluate lesson 1 of the Healthy Hearts program to further enhance the user experience. We used semistructured interviews and the mHealth App Usability Questionnaire to evaluate program acceptability and usability. Results: Intervention development among the research team successfully created an 8-week financial-incentive hypertension education program for adults aged 40-65 years who did not currently meet the Canadian Physical Activity Guidelines (<150 minutes of moderate to vigorous PA per week). This program lasted 8 weeks and comprised 25 lessons guided by the M-PAC framework. The program used various behavior change techniques to further support PA adherence. Usability testing of the first lesson was successful, with 6 participants recruited for 2 rounds of testing. Feedback was gathered to enhance the content, layout, and design of the Healthy Hearts program to prepare the mHealth program for feasibility testing. Results of round 1 of usability testing suggested that the content delivered in the lessons was long. Therefore, the content was divided into multiple lessons before round 2 of usability testing, where feedback was only on design preferences. A minimum viable product was created with these results. Conclusions: The iterative development process and the usability assessments suggested by the Integrate, Design, Assess, and Share framework enabled participants to provide valuable feedback on the content, design, and layout of the program before advancing to feasibility testing. Furthermore, the use of the “no-code” app development tool enabled our team to rapidly make changes to the app based on user feedback during the iterative design process. %M 37018038 %R 10.2196/43823 %U https://formative.jmir.org/2023/1/e43823 %U https://doi.org/10.2196/43823 %U http://www.ncbi.nlm.nih.gov/pubmed/37018038 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45178 %T Effectiveness of the Internet of Things for Improving Working-Aged Women’s Health in High-Income Countries: Protocol for a Systematic Review and Network Meta-analysis %A Yamaji,Noyuri %A Nitamizu,Aya %A Nishimura,Etsuko %A Suzuki,Daichi %A Sasayama,Kiriko %A Rahman,Md. Obaidur %A Saito,Eiko %A Yoneoka,Daisuke %A Ota,Erika %+ Global Health Nursing, Graduate School of Nursing, St. Luke’s International University, Akashi-cho 10-1, Chuo-ku, Tokyo, 104-0044, Japan, 81 3 3543 6391, 18dn017@slcn.ac.jp %K Internet of Things %K IoT %K women’s health %K network meta-analysis %K apps %K meta analysis %K meta analyses %K review method %K systematic review %K high income %K mHealth %K mobile health %K health app %K application %K digital health %D 2023 %7 4.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Women often experience many unique health issues and conditions throughout their working lives. The Internet of Things (IoT) is a system of interrelated digital devices that can enable data exchanges over a network without human-to-human or human-to-computer interaction. The usage of applications and IoT in improving women’s health has recently increased worldwide. However, there has been no consensus on the effectiveness of IoT in improving women’s health outcomes. Objective: This systematic review and network meta-analysis (NMA) aims to assess and synthesize the role of apps and the IoT in improving women’s health and to identify the ranking of interventions for ensuring better results for each stated outcome. Methods: Our systematic review and NMA will be conducted in accordance with the guidelines of the Cochrane Handbook. We will comprehensively search the following electronic databases: PubMed (including MEDLINE), Cochrane Central Register of Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature (ie, CINAHL), PsycINFO, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry, along with other resources to identify relevant randomized controlled trials that have assessed the effects of various apps and the IoT with regard to improving working-aged women’s health in high-income countries. We will segment and analyze the results of the included studies based on age categories (women undergoing a preconception period, those undergoing gestational and postpartum periods, and menopausal and pre- and postmenopausal women) and the medical history (women who have a specific medical condition—eg, cancer or diabetes—and women who do not have them) separately. Two independent reviewers will perform the study selection, data extraction, and quality assessment. Our primary outcomes include health status, well-being, and quality of life. We will perform pairwise meta-analysis and NMA to estimate the direct, indirect, and relative effects of apps and the IoT on women’s health outcomes. We will also assess the hierarchy of interventions, statistical inconsistencies, and certainties of evidence for each outcome. Results: We plan to conduct the search in January 2023 and are currently discussing search strategies with the literature search specialists. The final report is planned for submission to a peer-reviewed journal in September 2023. Conclusions: To the best of our knowledge, this review will be the first to identify the ranking of IoT intervention for ensuring working-aged women’s health outcomes. These findings may be of great use to researchers, policy makers, and others with an interest in the field. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42022384620; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=384620 International Registered Report Identifier (IRRID): PRR1-10.2196/45178 %M 37014674 %R 10.2196/45178 %U https://www.researchprotocols.org/2023/1/e45178 %U https://doi.org/10.2196/45178 %U http://www.ncbi.nlm.nih.gov/pubmed/37014674 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42499 %T Evaluating the Efficacy of a Social Media–Based Intervention (Warna-Warni Waktu) to Improve Body Image Among Young Indonesian Women: Parallel Randomized Controlled Trial %A Garbett,Kirsty M %A Haywood,Sharon %A Craddock,Nadia %A Gentili,Caterina %A Nasution,Kholisah %A Saraswati,L Ayu %A Medise,Bernie Endyarni %A White,Paul %A Diedrichs,Phillippa C %A Williamson,Heidi %+ Centre for Appearance Research, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom, 44 11732 82911, kirsty.garbett@uwe.ac.uk %K body image %K body dissatisfaction %K Indonesia %K adolescent mental health %K randomized controlled trial %K eHealth intervention %K Southeast Asia %K social media %K lower- and middle-income countries %K LMICs %D 2023 %7 3.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Body dissatisfaction is a global issue, particularly among adolescent girls and young women. Effective body image interventions exist but face barriers to scaling up, particularly in lower- and middle-income countries, such as Indonesia, where a need exists. Objective: We aimed to evaluate the acceptability and efficacy of Warna-Warni Waktu, a social media–based, fictional 6-episode video series with self-guided web-based activities for improving body image among young Indonesian adolescent girls and young women. We hypothesized that Warna-Warni Waktu would increase trait body satisfaction and mood and decrease internalization of appearance ideals and skin shade dissatisfaction relative to the waitlist control condition. We also anticipated improvements in state body satisfaction and mood immediately following each video. Methods: We conducted a web-based, 2-arm randomized controlled trial among 2000 adolescent girls and young women, aged 15 to 19 years, recruited via telephone by an Indonesian research agency. Block randomization (1:1 allocation) was performed. Participants and researchers were not concealed from the randomized arm. Participants completed self-report assessments of trait body satisfaction (primary outcome) and the internalization of appearance ideals, mood, and skin shade dissatisfaction at baseline (before randomization), time 2 (1 day after the intervention [T2]), and time 3 (1 month after the intervention [T3]). Participants also completed state body satisfaction and mood measures immediately before and after each video. Data were evaluated using linear mixed models with an intent-to-treat analysis. Intervention adherence was tracked. Acceptability data were collected. Results: There were 1847 participants. Relative to the control condition (n=923), the intervention group (n=924) showed reduced internalization of appearance ideals at T2 (F1,1758=40.56, P<.001, partial η2=0.022) and T3 (F1,1782=54.03, P<.001, partial η2=0.03) and reduced skin shade dissatisfaction at T2 (F1,1744=8.05, P=.005, partial η2=0.005). Trait body satisfaction improvements occurred in the intervention group at T3 (F1, 1781=9.02, P=.005, partial η2=0.005), which was completely mediated by the internalization change scores between baseline and T2 (indirect effect: β=.03, 95% CI 0.017-0.041; direct effect: β=.03, P=.13), consistent with the Tripartite Influence Model of body dissatisfaction. Trait mood showed no significant effects. Dependent sample t tests (2-tailed) found each video improved state body satisfaction and mood. Cumulative analyses found significant and progressive improvements in pre- and poststate body satisfaction and mood. Intervention adherence was good; participants watched an average of 5.2 (SD 1.66) videos. Acceptability scores were high for understandability, enjoyment, age appropriateness, usefulness, and likelihood to recommend. Conclusions: Warna-Warni Waktu is an effective eHealth intervention to reduce body dissatisfaction among Indonesian adolescent girls and young women. Although the effects were small, Warna-Warni Waktu is a scalable, cost-effective alternative to more intense interventions. Initially, dissemination through paid social media advertising will reach thousands of young Indonesian women. Trial Registration: ClinicalTrials.gov NCT05383807, https://clinicaltrials.gov/ct2/show/NCT05383807 ; ISRCTN Registry ISRCTN35483207, https://www.isrctn.com/ISRCTN35483207 International Registered Report Identifier (IRRID): RR2-10.2196/33596 %M 37010911 %R 10.2196/42499 %U https://www.jmir.org/2023/1/e42499 %U https://doi.org/10.2196/42499 %U http://www.ncbi.nlm.nih.gov/pubmed/37010911 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44925 %T Effectiveness and Feasibility of a Self-guided Mobile App Targeting Emotional Well-being in Healthy Adults: 4-Week Randomized Controlled Trial %A Brindal,Emily %A Kakoschke,Naomi %A Golley,Sinead %A Rebuli,Megan %A Baird,Danielle %+ Commonwealth Scientific and Industrial Research Organisation, Gate 13 Kintore Avenue, Adelaide, South Australia, 5000, Australia, 61 08 8305 0633, emily.brindal@csiro.au %K emotional well-being %K self-guided %K smartphone app %K mobile health %K mHealth %K affect %K mobile phone %D 2023 %7 3.4.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Commercial smartphone apps designed to promote emotional well-being are becoming increasingly popular, but few apps have been empirically validated. Objective: This study examined the feasibility and effectiveness of a self-guided app designed to reduce daily stress via positive messaging and tailored short inspirational talks (ie, peps). Methods: A total of 166 participants (n=112, 67.5% female; mean age 38.48, SD 6.73 years) were recruited through social media advertising and randomized into an intervention (Hey Lemonade app plus twice daily mood monitoring using the Multidimensional Mood Questionnaire [MDMQ]) or active control (twice daily mood monitoring [MDMQ]) group. Primary (coping self-efficacy [CSE]; 3 subscales) and secondary outcomes (vitality, satisfaction with life, perceived stress, positive and negative affect, and hassles and uplifts) were measured at the baseline (week 1) and end point (week 4). The app evaluation questions were assessed at week 2. All interactions and measurements were collected on the internet and through the apps. Results: In total, of 166 participants, 125 (75.3%) completed the trial. There were no differences in dropout rates between the groups (62/81, 76% intervention; 63/85, 74% control). There were significant group-by-time interactions for vitality and hassles but no significant effect for CSE total (P=.05). For the intervention group, the change from baseline to week 4 was significant for vitality (P=.002) and hassles (P=.004), CSE total (P=.008), and CSE Emotional subscale (P=.02). For the control group, any changes over 4 weeks were not significant for any outcome. There was a significant group-by-time interaction for MDMQ calmness (P=.04). By week 4, calmness was significantly higher in the intervention group (P=.046). Of those in the intervention group at week 2 (n=68), 39 (57%) participants recommended the app and 41 (60%) participants wanted to continue using it. Pep talks and customizable voice options were the most popular features. Conclusions: Participants who had access to the smartphone app on an as-needed basis over the 4-week trial showed significant improvements in emotional well-being indicators. More broadly, this suggests that simple accessible solutions may generate meaningful well-being outcomes. Whether these changes are sustained and can be generalized to other population groups is yet to be determined. Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR) 12622001005741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384304&isReview=true %M 37010898 %R 10.2196/44925 %U https://mental.jmir.org/2023/1/e44925 %U https://doi.org/10.2196/44925 %U http://www.ncbi.nlm.nih.gov/pubmed/37010898 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42967 %T Development of a Mobile App to Monitor the Effectiveness of a Hydrolyzed Cartilage Matrix Supplement on Joint Discomfort: Real-World Study %A Newman,Christie %A Adriaens,Els %A Virgilio,Nicolina %A Vleminckx,Sara %A de Pelsmaeker,Sara %A Prawitt,Janne %A F Silva,Catarina I %+ Rousselot BV, Meulestedekaai 81, Gent, 9000, Belgium, 31 61 271 0263, catarina.silva@rousselot.com %K digital tool %K hydrolyzed cartilage matrix %K hydrolyzed collagen %K chondroitin sulfate %K joint discomfort %K real-world study %K dietary supplement %K mobile application %D 2023 %7 3.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Joint discomfort is a widespread and growing problem in active adults. The rising interest in preventative nutrition has increased the demand for supplements reducing joint discomfort. Protocols assessing the effect of a nutritional intervention on health commonly involve a series of face-to-face meetings between participants and study staff that can weigh on resources, participant availabilities, and even increase dropout rates. Digital tools are increasingly added to protocols to facilitate study conduct, but fully digitally run studies are still scarce. With the increasing interest in real-world studies, the development of health apps for mobile devices to monitor study outcomes is of great importance. Objective: The purpose of this real-world study was to develop a specific mobile app, Ingredients for Life, to conduct a 100% digital study testing the effectiveness of a hydrolyzed cartilage matrix (HCM) supplement on joint discomfort in a heterogeneous group of healthy, active consumers. Methods: The Ingredients for Life mobile app using a visual analog scale was specifically developed to monitor the variation in joint pain after exercise by the study participants. A total of 201 healthy and physically active women and men (18-72 years old) with joint pain completed the study over a period of 16 weeks. Participants were randomly allocated to the study groups and did not receive any dietary or lifestyle advice. Each participant indicated one area of joint pain and logged the type and duration of their weekly activities. They received blinded study supplements and took a daily regimen of 1 g of HCM (HCM group) or 1 g of maltodextrin (placebo group) for 12 weeks while weekly logging joint pain scores in the app. This was followed by a 4-week washout period during which participants continued reporting their joint pain scores (until the end of week 16). Results: Joint pain was reduced within 3 weeks of taking a low dosage of HCM (1 g/day), regardless of gender, age group, and activity intensity when compared with the placebo group. After stopping supplementation, joint pain scores gradually increased but still remained significantly lower than those of the placebo group after 4 weeks of washout. The low dropout rate (<6% of participants, mainly in the placebo group) demonstrates that the digital study was well received by the study population. Conclusions: The digital tool allowed us to measure a heterogeneous group of active adults in a real-world setting (without any lifestyle intervention), thus promoting inclusivity and diversity. With low dropout rates, it demonstrates that mobile apps can generate qualitative, quantifiable, real-world data showcasing supplement effectiveness. The study confirmed that the oral intake of a low dose (1 g/day) of HCM led to a significant reduction of joint pain from 3 weeks after starting supplementation. %M 36848035 %R 10.2196/42967 %U https://formative.jmir.org/2023/1/e42967 %U https://doi.org/10.2196/42967 %U http://www.ncbi.nlm.nih.gov/pubmed/36848035 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44393 %T Evaluation of the Effectiveness of Therapy for Anxiety in Williams Beuren Syndrome Using a Smartphone App: Protocol for a Single-Case Experiment %A Lehman,Natacha %A Trouillet,Raphaël %A Genevieve,David %+ EA4556 Laboratoire Epsylon, Université Paul Valery Montpellier 3, Rte de Mende, Montpellier, 34090, France, 33 617437801, natacha.lehman@gmail.com %K single case experimental design %K cognitive behavioral therapy %K intellectual disability %K rare disease %K Williams syndrome %K smartphone application %K ecological momentary assessment %D 2023 %7 3.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Williams syndrome (WS-OMIM 194050, orphaned number: Orpha 904) is a rare condition mostly associated with intellectual disability. People with Williams syndrome are 8 times more likely to have anxiety disorders than the general population. Therapeutic solutions to treat the anxiety remain limited, particularly nonpharmacological therapy. However, cognitive behavioral therapy (CBT) has been found efficacious in managing anxiety disorders and can be used for people with intellectual disability. Objective: This paper describes a protocol to assess the efficiency of a CBT program based on digital support for people with Williams syndrome and anxiety based on a research methodology designed for rare diseases. Methods: We will recruit 5 individuals with Williams syndrome and anxiety. They will participate in 9 CBT sessions. Participants will perform daily self-assessments of anxiety using a digital app, which will allow for ecological and repeated evaluation of their anxiety. This digital app will provide support for each therapy session. Anxiety and quality of life will be externally assessed before and after the program and at a 3-month follow-up. This is a single-case intervention research design with multiple baselines implying repeated measures of judgment criteria. The present protocol ensures high internal validity and will help identify encouraging contributions for later clinical trials. Results: Participant recruitment and data collection began in September 2019, and we project that the study findings will be available for dissemination by spring 2023. Conclusions: This study will allow the assessment of the efficiency of a CBT program based on digital support to treat anxiety in people with Williams syndrome. Finally, the program could be used as an example of nonpharmacological therapy for rare diseases. Trial Registration: ClinicalTrials.gov ID: NCT03827525; https://clinicaltrials.gov/ct2/show/NCT03827525 International Registered Report Identifier (IRRID): DERR1-10.2196/44393 %M 37010888 %R 10.2196/44393 %U https://www.researchprotocols.org/2023/1/e44393 %U https://doi.org/10.2196/44393 %U http://www.ncbi.nlm.nih.gov/pubmed/37010888 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41117 %T Collecting Food and Drink Intake Data With Voice Input: Development, Usability, and Acceptability Study %A Millard,Louise A C %A Johnson,Laura %A Neaves,Samuel R %A Flach,Peter A %A Tilling,Kate %A Lawlor,Deborah A %+ Medical Research Council (MRC) Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, United Kingdom, 44 0117 455 7676, louise.millard@bristol.ac.uk %K digital health %K data collection %K voice-based approaches %K Amazon Alexa %K self-reported data %K food and drink %D 2023 %7 31.3.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Voice-based systems such as Amazon Alexa may be useful for collecting self-reported information in real time from participants of epidemiology studies using verbal input. In epidemiological research studies, self-reported data tend to be collected using short, infrequent questionnaires, in which the items require participants to select from predefined options, which may lead to errors in the information collected and lack of coverage. Voice-based systems give the potential to collect self-reported information “continuously” over several days or weeks. At present, to the best of our knowledge, voice-based systems have not been used or evaluated for collecting epidemiological data. Objective: We aimed to demonstrate the technical feasibility of using Alexa to collect information from participants, investigate participant acceptability, and provide an initial evaluation of the validity of the collected data. We used food and drink information as an exemplar. Methods: We recruited 45 staff members and students at the University of Bristol (United Kingdom). Participants were asked to tell Alexa what they ate or drank for 7 days and to also submit this information using a web-based form. Questionnaires asked for basic demographic information, about their experience during the study, and the acceptability of using Alexa. Results: Of the 37 participants with valid data, most (n=30, 81%) were aged 20 to 39 years and 23 (62%) were female. Across 29 participants with Alexa and web entries corresponding to the same intake event, 60.1% (357/588) of Alexa entries contained the same food and drink information as the corresponding web entry. Most participants reported that Alexa interjected, and this was worse when entering the food and drink information (17/35, 49% of participants said this happened often; 1/35, 3% said this happened always) than when entering the event date and time (6/35, 17% of participants said this happened often; 1/35, 3% said this happened always). Most (28/35, 80%) said they would be happy to use a voice-controlled system for future research. Conclusions: Although there were some issues interacting with the Alexa skill, largely because of its conversational nature and because Alexa interjected if there was a pause in speech, participants were mostly willing to participate in future research studies using Alexa. More studies are needed, especially to trial less conversational interfaces. %M 37000476 %R 10.2196/41117 %U https://mhealth.jmir.org/2023/1/e41117 %U https://doi.org/10.2196/41117 %U http://www.ncbi.nlm.nih.gov/pubmed/37000476 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44765 %T Smartphone and Mobile App Use Among Physicians in Clinical Practice: Scoping Review %A Lee,Mauricette %A Bin Mahmood,Abu Bakar Shakran %A Lee,Eng Sing %A Smith,Helen Elizabeth %A Tudor Car,Lorainne %+ Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore, 65 69041258, lorainne.tudor.car@ntu.edu.sg %K evidence-based medicine %K specialist %K general practitioners %K GP %K primary care physicians %K mobile apps %K consultants %K surgeons %K pediatricians %K clinical care %K mobile phone %D 2023 %7 31.3.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Health care professionals are increasingly using smartphones in clinical care. Smartphone use can affect patient quality of care and clinical outcomes. Objective: This scoping review aimed to describe how physicians use smartphones and mobile apps in clinical settings. Methods: We conducted a scoping review using the Joanna Briggs Institute methodology and reported the results according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. We used the following databases in our literature search: MEDLINE, Embase, Cochrane Library, Web of Science, Google Scholar, and gray literature for studies published since 2010. An additional search was also performed by scanning the reference lists of included studies. A narrative synthesis approach was used. Results: A total of 10 studies, published between 2016 and 2021, were included in this review. Of these studies, 8 used surveys and 2 used surveys with focus group study designs to explore smartphone use, its adoption, experience of using it, and views on the use of smartphones among physicians. There were studies with only general practitioners (n=3), studies with only specialists (n=3), and studies with both general practitioners and specialists (n=4). Physicians use smartphones and mobile apps for communication (n=9), clinical decision-making (n=7), drug compendium (n=7), medical education and training (n=7), maintaining health records (n=4), managing time (n=4), and monitoring patients (n=2) in clinical practice. The Medscape medical app was frequently used for information gathering. WhatsApp, a nonmedical app, was commonly used for physician-patient communication. The commonly reported barriers were lack of regulatory oversight, privacy concerns, and limited Wi-Fi or internet access. The commonly reported facilitator was convenience and having access to evidence-based medicine, clinical decision-making support, and a wide array of apps. Conclusions: Smartphones and mobile apps were used for communication, medical education and training, clinical decision-making, and drug compendia in most studies. Although the benefits of smartphones and mobile apps for physicians at work were promising, there were concerns about patient privacy and confidentiality. Legislation is urgently needed to protect the liability of health care professionals using smartphones. %M 37000498 %R 10.2196/44765 %U https://mhealth.jmir.org/2023/1/e44765 %U https://doi.org/10.2196/44765 %U http://www.ncbi.nlm.nih.gov/pubmed/37000498 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44041 %T Development of a Conversational Agent for Individuals Ambivalent About Quitting Smoking: Protocol for a Proof-of-Concept Study %A Nair,Uma S %A Greene,Karah %A Marhefka,Stephanie %A Kosyluk,Kristin %A Galea,Jerome T %+ College of Nursing, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, United States, 1 813 974 2578, nairu@usf.edu %K cigarettes %K conversational agent %K mhealth %K smoking cessation %D 2023 %7 31.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cigarette smoking is the leading preventable cause of disease and death in the United States. Despite the availability of a plethora of evidence-based smoking cessation resources, less than one-third of individuals who smoke seek cessation services, and individuals using these services are often those who are actively contemplating quitting smoking. There is a distinct dearth of low-cost, scalable interventions to support smokers not ready to quit (ambivalent smokers). Such interventions can assist in gradually promoting smoking behavior changes in this target population until motivation to quit arises, at which time they can be navigated to existing evidence-based smoking cessation interventions. Conversational agents or chatbots could provide cessation education and support to ambivalent smokers to build motivation and navigate them to evidence-based resources when ready to quit. Objective: The goal of our study is to test the proof-of-concept of the development and preliminary feasibility and acceptability of a smoking cessation support chatbot. Methods: We will accomplish our study aims in 2 phases. In phase 1, we will survey 300 ambivalent smokers to determine their preferences and priorities for a smoking cessation support chatbot. A “forced-choice experiment” will be administered to understand participants’ preferred characteristics (attributes) of the proposed chatbot prototype. The data gathered will be used to program the prototype. In phase 2, we will invite 25 individuals who smoke to use the developed prototype. For this phase, participants will receive an overview of the chatbot and be encouraged to use the chatbot and engage and interact with the programmed attributes and components for a 2-week period. Results: At the end of phase 1, we anticipate identifying key attributes that ambivalent smokers prefer in a smoking cessation support chatbot. At the end of phase 2, chatbot acceptability and feasibility will be assessed. The study was funded in June 2022, and data collection for both phases of the study is currently ongoing. We expect study results to be published by December 2023. Conclusions: Study results will yield a smoking behavior change chatbot prototype developed for ambivalent smokers that will be ready for efficacy testing in a larger study. International Registered Report Identifier (IRRID): DERR1-10.2196/44041 %M 37000505 %R 10.2196/44041 %U https://www.researchprotocols.org/2023/1/e44041 %U https://doi.org/10.2196/44041 %U http://www.ncbi.nlm.nih.gov/pubmed/37000505 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43619 %T Evaluation of the Effectiveness of a Whole-System Intervention to Increase the Physical Activity of Children Aged 5 to 11 Years (Join Us: Move Play, JU:MP): Protocol for a Quasiexperimental Trial %A Bingham,Daniel D %A Daly-Smith,Andy %A Seims,Amanda %A Hall,Jennifer %A Eddy,Lucy %A Helme,Zoe %A Barber,Sally E %+ Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, BD7 1DP, United Kingdom, 44 1274 232323, d.bingham@bradford.ac.uk %K physical activity %K accelerometry %K complex intervention %K whole system %K children %K quasiexperimental %D 2023 %7 31.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Daily physical activity is vital for the health and development of children. However, many children are inactive. Previous attempts to achieve sustained increases in daily physical activity in children have been ineffective. Join Us: Move Play (JU:MP) is a whole-system, complex, community-based intervention aiming to increase the physical activity levels of children aged 7 to 11 years who live in areas of Bradford, England, which are multicultural and have high levels of deprivation. Objective: The purpose of this quasiexperimental controlled trial is to assess whether the JU:MP program increases primary school children’s physical activity. Methods: The study has a 2-arm, quasiexperimental, nonblinded, nonequivalent group design and will be conducted with primary school children aged 5 to 11 years at 3 timepoints, including baseline (before intervention), 24 months (during intervention), and 36 months (after intervention). Children attending primary schools within the intervention area will be invited to participate. Children attending similar schools within similar neighborhoods based on school and community census demographics (deprivation, free school meals, and ethnicity) outside of the JU:MP geographical area will be invited to participate in the control condition. At each timepoint, consenting participants will wear an accelerometer for 7 consecutive days (24 hours a day) to measure the primary outcome (average daily moderate-to-vigorous physical activity). Multivariable mixed effects linear regression will be applied to estimate differences in the primary outcome between the 2 arms at 24 months and 36 months on an intention-to-treat basis. The secondary outcome analysis will explore changes in socioemotional well-being (teacher reported), quality of life (parental/carer reported), and other contextual factors (parents/carer reported), as well as segments of the day activity, sleep, sedentary screen time, frequency of places to be active, parent practices (nondirective support and autonomy support), social cohesion, and neighborhood walking/exercise environment. Results: Recruitment occurred from July 2021 to March 2022, and baseline data were collected from September 2021 to March 2022. As of March 2022 (end of baseline data collection), a total of 1454 children from 37 schools (17 intervention schools and 20 control schools) have been recruited. The first follow-up data collection will occur from September 2023 to March 2024, and the second and final follow-up data collection will occur from September 2024 to March 2025. Data analysis has not begun, and the final results will be published in December 2025. Conclusions: This article describes the protocol for a quasiexperimental controlled trial examining a novel whole-system intervention. Trial Registration: ISRCTN ISRCTN14332797; https://www.isrctn.com/ISRCTN14332797 International Registered Report Identifier (IRRID): DERR1-10.2196/43619 %M 37000512 %R 10.2196/43619 %U https://www.researchprotocols.org/2023/1/e43619 %U https://doi.org/10.2196/43619 %U http://www.ncbi.nlm.nih.gov/pubmed/37000512 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44862 %T The Effectiveness of a Smartphone Intervention Targeting Suicidal Ideation in Young Adults: Randomized Controlled Trial Examining the Influence of Loneliness %A McGillivray,Lauren %A Keng-Meng Hui,Nicholas %A Wong,Quincy J J %A Han,Jin %A Qian,Jiahui %A Torok,Michelle %+ Black Dog Institute, University of New South Wales, Hospital Rd, Sydney, 2031, Australia, 61 2 9065 9133, m.torok@unsw.edu.au %K loneliness %K suicidal ideation %K suicide prevention %K digital therapeutics %K smartphone intervention %K apps %D 2023 %7 30.3.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Loneliness is commonly reported by young people and has been shown to contribute to the rapid onset and escalation of depression and suicidal ideation during adolescence. Lonely people may also be particularly susceptible to disengaging from treatment early given the likelihood of their more complex clinical profiles leading to cognitive fatigue. While a smartphone intervention (LifeBuoy) has been shown to effectively reduce suicidal ideation in young adults, poor engagement is a well-documented issue for this therapeutic modality and has been shown to result in poorer treatment outcomes. Objective: This study aims to determine whether loneliness affects how young people experiencing suicidal ideation engage with and benefit from a therapeutic smartphone intervention (LifeBuoy). Methods: A total of 455 community-based Australian young adults (aged 18-25 years) experiencing recent suicidal ideation were randomized to use a dialectical behavioral therapy–based smartphone intervention (LifeBuoy) or an attention-matched control app (LifeBuoy-C) for 6 weeks. Participants completed measures of suicidal ideation, depression, anxiety, and loneliness at baseline (T0), post intervention (T1), and 3 months post intervention (T2). Piecewise linear mixed models were used to examine whether loneliness levels moderated the effect of LifeBuoy and LifeBuoy-C on suicidal ideation and depression across time (T0 to T1; T1 to T2). This statistical method was then used to examine whether app engagement (number of modules completed) influenced the relationship between baseline loneliness and suicidal ideation and depression across time. Results: Loneliness was positively associated with higher levels of overall suicidal ideation (B=0.75, 95% CI 0.08-1.42; P=.03) and depression (B=0.88, 95% CI 0.45-1.32; P<.001), regardless of time point or allocated condition. However, loneliness did not affect suicidal ideation scores across time (time 1: B=1.10, 95% CI –0.25 to 2.46; P=.11; time 2: B=0.43, 95% CI –1.25 to 2.12; P=.61) and depression scores across time (time 1: B=0.00, 95% CI –0.67 to 0.66; P=.99; time 2: B=0.41, 95% CI –0.37 to 1.18; P=.30) in either condition. Similarly, engagement with the LifeBuoy app was not found to moderate the impact of loneliness on suicidal ideation (B=0.00, 95% CI –0.17 to 0.18; P=.98) or depression (B=–0.08, 95% CI –0.19 to 0.03; P=.14). Conclusions: Loneliness was not found to affect young adults’ engagement with a smartphone intervention (LifeBuoy) nor any clinical benefits derived from the intervention. LifeBuoy, in its current form, can effectively engage and treat individuals regardless of how lonely they may be. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001671156; https://tinyurl.com/yvpvn5n8 International Registered Report Identifier (IRRID): RR2-10.2196/23655 %M 36995752 %R 10.2196/44862 %U https://mental.jmir.org/2023/1/e44862 %U https://doi.org/10.2196/44862 %U http://www.ncbi.nlm.nih.gov/pubmed/36995752 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e42092 %T Evaluating Barriers and Facilitators to the Uptake of mHealth Apps in Cancer Care Using the Consolidated Framework for Implementation Research: Scoping Literature Review %A Ardito,Vittoria %A Golubev,Georgi %A Ciani,Oriana %A Tarricone,Rosanna %+ Centre for Research on Health and Social Care Management (CERGAS), Government, Health and Not for Profit Division, SDA Bocconi School of Management, Via Sarfatti, 10, Milan, 20136, Italy, 39 3400631572, vittoria.ardito@sdabocconi.it %K mobile health %K mHealth %K smartphones %K mobile %K oncology %K cancer %K implementation science %K consolidated framework for implementation research %K CFIR %K mobile phones %D 2023 %7 30.3.2023 %9 Review %J JMIR Cancer %G English %X Background: Mobile health (mHealth) solutions have proven to be effective in a wide range of patient outcomes and have proliferated over time. However, a persistent challenge of digital health technologies, including mHealth, is that they are characterized by early dropouts in clinical practice and struggle to be used outside experimental settings or on larger scales. Objective: This study aimed to explore barriers and enablers to the uptake of mHealth solutions used by patients with cancer undergoing treatment, using a theory-guided implementation science model, that is, the Consolidated Framework for Implementation Research (CFIR). Methods: A scoping literature review was conducted using PubMed (MEDLINE), Web of Science, and ScienceDirect databases in March 2022. We selected studies that analyzed the development, evaluation, and implementation of mHealth solutions for patients with cancer that were used in addition to the standard of care. Only empirical designs (eg, randomized controlled trials, observational studies, and qualitative studies) were considered. First, information on the study characteristics, patient population, app functionalities, and study outcomes was extracted. Then, the CFIR model was used as a practical tool to guide data collection and interpretation of evidence on mHealth uptake. Results: Overall, 91 papers were included in the data synthesis. The selected records were mostly randomized controlled trials (26/91, 29%) and single-arm, noncomparative studies (52/91, 57%). Most of the apps (42/73, 58%) were designed for both patients and clinicians and could be used to support any type of cancer (29/73, 40%) and a range of oncological treatments. Following the CFIR scheme (intervention, outer setting, inner setting, individuals, process), multistakeholder co-design, codevelopment, and testing of mHealth interventions were identified as key enablers for later uptake. A variety of external drivers emerged, although the most relevant outer incentive fostering mHealth use was addressing patient needs. Among organizational factors likely to influence technology uptake, interoperability was the most prominent, whereas other providers’ dimensions such as managerial attitudes or organizational culture were not systematically discussed. Technology-related impediments that could hamper the use of mHealth at the individual level were considered least often. Conclusions: The hype surrounding mHealth in cancer care is hindered by several factors that can affect its use in real world and nonexperimental settings. Compared with the growing evidence on mHealth efficacy, knowledge to inform the uptake of mHealth solutions in clinical cancer care is still scarce. Although some of our findings are supported by previous implementation research, our analysis elaborates on the distinguishing features of mHealth apps and provides an integrated perspective on the factors that should be accounted for implementation efforts. Future syntheses should liaise these dimensions with strategies observed in successful implementation initiatives. %M 36995750 %R 10.2196/42092 %U https://cancer.jmir.org/2023/1/e42092 %U https://doi.org/10.2196/42092 %U http://www.ncbi.nlm.nih.gov/pubmed/36995750 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e42461 %T Physical Activity Surveillance in Children and Adolescents Using Smartphone Technology: Systematic Review %A Nasruddin,Nur Izzatun Nasriah %A Murphy,Joey %A Armstrong,Miranda Elaine Glynis %+ Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, United Kingdom, 44 117 455 2103, izzah.nasruddin@bristol.ac.uk %K physical activity %K surveillance %K children %K adolescents %K smartphone technology %K smartphone apps %K smartphone %K technology %K application %K database %K mobile phone %D 2023 %7 29.3.2023 %9 Review %J JMIR Pediatr Parent %G English %X Background: Self-reported physical activity (PA) questionnaires have traditionally been used for PA surveillance in children and adolescents, especially in free-living conditions. Objective measures are more accurate at measuring PA, but high cost often creates a barrier for their use in low- and middle-income settings. The advent of smartphone technology has greatly influenced mobile health and has offered new opportunities in health research, including PA surveillance. Objective: This review aimed to systematically explore the use of smartphone technology for PA surveillance in children and adolescents, specifically focusing on the use of smartphone apps. Methods: A literature search was conducted using 5 databases (PubMed, Scopus, CINAHL, MEDLINE, and Web of Science) and Google Scholar to identify articles relevant to the topic that were published from 2008 to 2023. Articles were included if they included children and adolescents within the age range of 5 to 18 years; used smartphone technology as PA surveillance; had PA behavioral outcomes such as energy expenditure, step count, and PA levels; were written in English; and were published between 2008 and 2023. Results: We identified and analyzed 8 studies (5 cross-sectional studies and 3 cohort studies). All participants were aged 12-18 years, and all studies were conducted in high-income countries only. Participants were recruited from schools, primary care facilities, and voluntarily. Five studies used mobile apps specifically and purposely developed for the study, whereas 3 studies used mobile apps downloadable from the Apple App Store and Android Play Store. PA surveillance using these apps was conducted from 24 hours to 4 weeks. Conclusions: Evidence of PA surveillance using smartphone technology in children and adolescents was insufficient, which demonstrated the knowledge gap. Additional research is needed to further study the feasibility and validity of smartphone apps for PA surveillance among children and adolescents, especially in low- and middle-income countries. %M 36989033 %R 10.2196/42461 %U https://pediatrics.jmir.org/2023/1/e42461 %U https://doi.org/10.2196/42461 %U http://www.ncbi.nlm.nih.gov/pubmed/36989033 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 10 %N %P e43507 %T The Effect of a Mobile Health App on Treatment Adherence and Revenue at Physical Health Clinics: Retrospective Record Review %A Topp,Robert %A Greenstein,Jay %A Etnoyer-Slaski,Jena %+ College of Nursing, The University of Toledo, 3000 Arlington Ave, Toledo, OH, 43614, United States, 1 419 530 4847, robert.topp@utoledo.edu %K physical health %K completion of therapy %K phone app %K clinic charges and payments %K payment %K cost %K physiotherapy %K physical therapy %K adherence %K attrition %K mobile phone %K reminder %K mobile health %K mHealth %K health app %K mobile app %D 2023 %7 28.3.2023 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: A significant number of patients do not adhere to their prescribed course of physical therapy or discharge themselves from care. Adhering to prescribed physical therapy, including attending physical therapy clinic appointments, contributes to patients achieving the goals of therapy including reducing pain and increasing functionality. Web-based platforms have been demonstrated to be effective means for managing clinical patients with musculoskeletal pain, similar to managing them in person. Behavior change techniques introduced through digital or web-based platforms can reduce nonadherence with prescribed physical therapy and improve patient outcomes. Literature also indicates that a phone-based app provided to patients, which includes a reward-incentive gamification to complement their care, contributed to a greater number of kept appointments in a physical therapy clinic. Objective: This study aims to compare the rate of provider discharge with self-discharge and the number of clinic visits among patients attending a physical health clinic who did and did not choose to adopt a phone-based app to complement their care. A secondary purpose was to compare the revenue generated by patients attending a physical health clinic who did and did not choose to adopt a phone-based app to complement their care. Methods: A retrospective analysis of all new outpatient medical records (N=5328) from a multisite physical health practice was conducted between January 2018 and December 2019. Patients in the sample self-selected the 2018 Usual Care, the 2019 Usual Care, or the 2019 Kanvas App groups. Kanvas is a customized private practice app, designed for patient engagement with their specific health care provider. This app included a gamification system that provided rewards to the patient for attending their scheduled clinic appointments. According to their medical record, each patient was classified as completing their prescribed therapy (provider discharged) or not completing their prescribed therapy (self-discharged). Additionally, the total number of clinic visits each patient attended, the total charges for services, and the total payments received by the clinic per patient were extracted from each patient’s medical record. Results: Patients in the 2019 Kanvas App Group exhibited a higher rate of provider discharge compared to patients who did not adopt the app. This greater rate of provider discharges among the patients who adopted the Kanvas app likely contributed to this group attending more clinic visits (13.21, SD 12.09) than the other study groups who did not download the app (10.72, SD 9.80 to 11.35, SD 11.10). This greater number of clinic visits in turn contributed to the patients who adopted the app generating more clinic charges and payments. Conclusions: Future investigators need to employ more rigorous methods to confirm these findings, and clinicians need to weigh the anticipated benefits against the cost and staff involvement in managing the Kanvas app. %M 36889337 %R 10.2196/43507 %U https://rehab.jmir.org/2023/1/e43507 %U https://doi.org/10.2196/43507 %U http://www.ncbi.nlm.nih.gov/pubmed/36889337 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45833 %T An Evidence-Based Serious Game App for Public Education on Antibiotic Use and Antimicrobial Resistance: Protocol of a Randomized Controlled Trial %A Huang,Zhilian %A Tang,Wern Ee %A Guo,Huiling %A Natarajan,Karthiga %A Lee,Tau Hong %A Yeo,Tsin Wen %A Chow,Angela %+ Infectious Diseases Research and Training Office, National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore, 308433, Singapore, 65 65115076, zhilian_huang@ttsh.com.sg %K antibiotic resistance %K antibiotic use %K app development %K development %K educational intervention %K health education %K public education %K randomized controlled trial %K serious games %K user engagement %K user satisfaction %D 2023 %7 28.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The misuse and overuse of antibiotics contribute to the acceleration of antimicrobial resistance (AMR), but public knowledge on appropriate antibiotic use and AMR remained low despite ongoing health promotion efforts. App gamification has gained traction in recent years for health promotion and to affect change in health behaviors. Hence, we developed an evidence-based serious game app “SteWARdS Antibiotic Defence” to educate the public on appropriate antibiotic use and AMR and address knowledge gaps. Objective: We aim to evaluate the effectiveness of the “SteWARdS Antibiotic Defence” app in improving the knowledge of, attitude toward, and perception (KAP) of appropriate antibiotic use and AMR among the public. The primary objective is to assess the changes in KAP of antibiotic use and AMR in our participants, while the secondary objectives are to assess the extent of user engagement with the app and the level of user satisfaction in using the app. Methods: Our study is a parallel 2-armed randomized controlled trial with a 1:1 allocation. We plan to recruit 400 participants (patients or their caregivers) aged 18-65 years from government-funded primary care clinics in Singapore. Participants are randomized in blocks of 4 and into the intervention or control group. Participants in the intervention group are required to download the “SteWARdS Antibiotic Defence” app on their smartphones and complete a game quest within 2 weeks. Users will learn about appropriate antibiotic use and effective methods to recover from uncomplicated upper respiratory tract infections by interacting with the nonplayer characters and playing 3 minigames in the app. The control group will not receive any intervention. Results: The primary study outcome is the change in participants’ KAP toward antibiotic use and AMR 6-10 weeks post intervention or 6-10 weeks from baseline for the control group (web-based survey). We will also assess the knowledge level of participants immediately after the participant completes the game quest (in the app). The secondary study outcomes are the user engagement level (tracked by the app) and satisfaction level of playing the game (via the immediate postgame survey). The satisfaction survey will also collect participants’ feedback on the game app. Conclusions: Our proposed study provides a unique opportunity to assess the effectiveness of a serious game app in public health education. We anticipate possible ceiling effects and selection bias in our study and have planned to perform subgroup analyses to adjust for confounding factors. The app intervention will benefit a larger population if it is proven to be effective and acceptable to users. Trial Registration: ClinicalTrials.gov NCT05445414; https://clinicaltrials.gov/ct2/show/NCT05445414 International Registered Report Identifier (IRRID): DERR1-10.2196/45833 %M 36976619 %R 10.2196/45833 %U https://www.researchprotocols.org/2023/1/e45833 %U https://doi.org/10.2196/45833 %U http://www.ncbi.nlm.nih.gov/pubmed/36976619 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 7 %N %P e43781 %T Implementation and User Evaluation of an eHealth Technology Platform Supporting Patients With Cardiovascular Disease in Managing Their Health After a Cardiac Event: Mixed Methods Study %A Bente,Britt E %A Wentzel,Jobke %A Schepers,Celina %A Breeman,Linda D %A Janssen,Veronica R %A Pieterse,Marcel E %A Evers,Andrea W M %A van Gemert-Pijnen,Lisette %+ Department of Psychology, Health, and Technology, Faculty of Behavioral, Management and Social Sciences, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 53 489 9660, b.e.bente@utwente.nl %K patient needs %K health behavior %K lifestyle support %K user-centered design %K implementation %K evaluation %K cardiovascular disease %K app %K web-based platform %K intervention %D 2023 %7 24.3.2023 %9 Original Paper %J JMIR Cardio %G English %X Background: eHealth technology can help patients with cardiovascular disease adopt and maintain a healthy lifestyle by supporting self-management and offering guidance, coaching, and tailored information. However, to support patients over time, eHealth needs to blend in with their needs, treatment, and daily lives. Just as needs can differ between patients, needs can change within patients over time. To better adapt technology features to patients’ needs, it is necessary to account for these changes in needs and contexts of use. Objective: This study aimed to identify and monitor patients’ needs for support from a web-based health management platform and how these needs change over time. It aimed to answer the following research questions: “How do novice and more advanced users experience an online health management platform?” “What user expectations support or hinder the adoption of an online health management platform, from a user perspective?” and “How does actual usage relate to user experiences and adoption?” Methods: A mixed methods design was adopted. The first method involved 2 rounds of usability testing, followed by interviews, with 10 patients at 0 months (round 1) and 12 patients at 6 months (round 2). In the second method, log data were collected to describe the actual platform use. Results: After starting cardiac rehabilitation, the platform was used frequently. The patients mentioned that they need to have an incentive, set goals, self-monitor their health data, and feel empowered by the platform. However, soon after the rehabilitation program stopped, use of the platform declined or patients even quit because of the lack of continued tailored or personalized advice. The reward system motivated them to log data, but most participants indicated that being healthy should be the main focus, not receiving gifts. A web-based platform is flexible, accessible, and does not have any obligations; however, it should be implemented as an addition to regular care. Conclusions: Although use of the platform declined in the longer term, patients quitting the technology did not directly indicate that the technology was not functioning well or that patients no longer focused on achieving their values. The key to success should not be user adherence to a platform but adherence to healthy lifestyle habits. Therefore, the implementation of eHealth should include the transition to a stage where patients might no longer need support from a technology platform to be independently and sustainably adherent to their healthy lifestyle habits. This emphasizes the importance of conducting multi-iterative evaluations to continuously monitor whether and how patients’ needs and contexts of use change over time. Future research should focus on how this transition can be identified and monitored and how these insights can inform the design and implementation of the technology. %M 36961491 %R 10.2196/43781 %U https://cardio.jmir.org/2023/1/e43781 %U https://doi.org/10.2196/43781 %U http://www.ncbi.nlm.nih.gov/pubmed/36961491 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e36562 %T Effects of Mobile-Based Financial Incentive Interventions for Adults at Risk of Developing Hypertension: Feasibility Randomized Controlled Trial %A Willms,Amanda %A Rhodes,Ryan E %A Liu,Sam %+ School of Exercise Science, Physical and Health Education, University of Victoria, PO Box 3010 STN CSC, Victoria, BC, V8W 2Y2, Canada, 1 250 721 8392, awillms@uvic.ca %K mHealth %K physical activity %K financial incentive %K hypertension %K mobile health %K exercise %K lifestyle health %K cardiovascular disease %K mortality %K heart disease %K incentive %K motivation %D 2023 %7 24.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Hypertension is the leading modifiable risk factor for cardiovascular disease and mortality. Adopting lifestyle modifications, like increasing physical activity (PA), can be an effective strategy in blood pressure (BP) control, but many adults do not meet the PA guidelines. Financial incentive interventions have the power to increase PA levels but are often limited due to cost. Further, mobile health technologies can make these programs more scalable. There is a gap in the literature about the most feasible and effective financial incentive PA framework; thus, pay-per-minute (PPM) and self-funded investment incentive (SFII) frameworks were explored. Objective: The aims were to (1) determine the feasibility (recruitment, engagement, and acceptability) of an 8-week mobile-based PPM and SFII hypertension prevention PA program and (2) explore the effects of PPM and SFII interventions relative to a control on the PA levels, BP, and PA motivation. Methods: In total, 55 adults aged 40-65 years not meeting the Canadian PA guidelines were recruited from Facebook and randomized into the following groups: financial incentive groups, PPM or SFII, receiving up to CAD $20 each (at the time of writing: CAD $1=US $0.74), or a control group without financial incentive. PPM participants received CAD $0.02 for each minute of moderate-to-vigorous PA (MVPA) per week up to the PA guidelines and the SFII received CAD $2.50 for each week they met the PA guidelines. Feasibility outcome measures (recruitment, engagement, and acceptability) were assessed. Secondary outcomes included changes in PA outcomes (MVPA and daily steps) relative to baseline were compared among PPM, SFII, and control groups at 4 and 8 weeks using linear regressions. Changes in BP and relative autonomy index relative to baseline were compared among the groups at follow-up. Results: Participants were randomized to the PPM (n=19), SFII (n=18), or control (n=18) groups. The recruitment, retention rate, and engagement were 77%, 75%, and 65%, respectively. The intervention received overall positive feedback, with 90% of comments praising the intervention structure, financial incentive, and educational materials. Relative to the control at 4 weeks, the PPM and SFII arms increased their MVPA with medium effect (PPM vs control: η2p=0.06, mean 117.8, SD 514 minutes; SFII vs control: η2p=0.08, mean 145.3, SD 616 minutes). At 8 weeks, PPM maintained a small effect in MVPA relative to the control (η2p=0.01, mean 22.8, SD 249 minutes) and SFII displayed a medium effect size (η2p=0.07, mean 113.8, SD 256 minutes). Small effects were observed for PPM and SFII relative to the control for systolic blood pressure (SBP) and diastolic blood pressure (DBP) (PPM: η2p=0.12, Δmean SBP 7.1, SD 23.61 mm Hg; η2p=0.04, Δmean DBP 3.5, SD 6.2 mm Hg; SFII: η2p=0.01, Δmean SBP −0.4, SD 1.4 mm Hg; η2p=0.02, Δmean DBP −2.3, SD 7.7 mm Hg) and relative autonomy index (PPM: η2p=0.01; SFII: η2p=0.03). Conclusions: The feasibility metrics and preliminary findings suggest that a future full-scale randomized controlled trial examining the efficacy of PPM and SFII relative to a control is feasible, and studies with longer duration are warranted. %M 36961486 %R 10.2196/36562 %U https://formative.jmir.org/2023/1/e36562 %U https://doi.org/10.2196/36562 %U http://www.ncbi.nlm.nih.gov/pubmed/36961486 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e37469 %T Smartphone-Tracked Digital Markers of Momentary Subjective Stress in College Students: Idiographic Machine Learning Analysis %A Aalbers,George %A Hendrickson,Andrew T %A Vanden Abeele,Mariek MP %A Keijsers,Loes %+ Department of Cognitive Science & Artificial Intelligence, Tilburg University, Warandelaan 2, Tilburg, 5037 AB, Netherlands, 31 13 466 9111, h.j.g.aalbers@tilburguniversity.edu %K mobile health %K mobile phone %K digital phenotype %K digital biomarker %K machine learning %K personalized models %D 2023 %7 23.3.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Stress is an important predictor of mental health problems such as burnout and depression. Acute stress is considered adaptive, whereas chronic stress is viewed as detrimental to well-being. To aid in the early detection of chronic stress, machine learning models are increasingly trained to learn the quantitative relation from digital footprints to self-reported stress. Prior studies have investigated general principles in population-wide studies, but the extent to which the findings apply to individuals is understudied. Objective: We aimed to explore to what extent machine learning models can leverage features of smartphone app use log data to recognize momentary subjective stress in individuals, which of these features are most important for predicting stress and represent potential digital markers of stress, the nature of the relations between these digital markers and stress, and the degree to which these relations differ across people. Methods: Student participants (N=224) self-reported momentary subjective stress 5 times per day up to 60 days in total (44,381 observations); in parallel, dedicated smartphone software continuously logged their smartphone app use. We extracted features from the log data (eg, time spent on app categories such as messenger apps and proxies for sleep duration and onset) and trained machine learning models to predict momentary subjective stress from these features using 2 approaches: modeling general relations at the group level (nomothetic approach) and modeling relations for each person separately (idiographic approach). To identify potential digital markers of momentary subjective stress, we applied explainable artificial intelligence methodology (ie, Shapley additive explanations). We evaluated model accuracy on a person-to-person basis in out-of-sample observations. Results: We identified prolonged use of messenger and social network site apps and proxies for sleep duration and onset as the most important features across modeling approaches (nomothetic vs idiographic). The relations of these digital markers with momentary subjective stress differed from person to person, as did model accuracy. Sleep proxies, messenger, and social network use were heterogeneously related to stress (ie, negative in some and positive or zero in others). Model predictions correlated positively and statistically significantly with self-reported stress in most individuals (median person-specific correlation=0.15-0.19 for nomothetic models and median person-specific correlation=0.00-0.09 for idiographic models). Conclusions: Our findings indicate that smartphone log data can be used for identifying digital markers of stress and also show that the relation between specific digital markers and stress differs from person to person. These findings warrant follow-up studies in other populations (eg, professionals and clinical populations) and pave the way for similar research using physiological measures of stress. %M 36951924 %R 10.2196/37469 %U https://mhealth.jmir.org/2023/1/e37469 %U https://doi.org/10.2196/37469 %U http://www.ncbi.nlm.nih.gov/pubmed/36951924 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38042 %T Examining a Resilience Mental Health App in Adolescents: Acceptability and Feasibility Study %A Elledge,Daniel K %A Lee,Simon Craddock %A Stewart,Sunita M %A Pop,Radu %A Trivedi,Madhukar H %A Hughes,Jennifer L %+ Center for Depression Research and Clinical Care, Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9119, United States, 1 214 648 0188, madhukar.trivedi@utsouthwestern.edu %K youth %K prevention %K resilience %K mental health app %K mobile phone %D 2023 %7 22.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Resilience is defined as the ability to rely on internal characteristics and external strengths to adapt to adverse events. Although universal resilience-enhancing programs are effective for adolescents, there is a need for interventions that are more easily accessible and can be customized for individual teens. Phone apps are easy to use, can be tailored to individuals, and have demonstrated positive effects for mental health outcomes. Objective: This study aimed to examine the feasibility and acceptability of a resilience app for adolescents. This app aimed to enhance resilience through modules focused on depression prevention, stress management, and healthy lifestyle approaches containing videos, measures, and practice suggestions. Furthermore, the study aimed to evaluate the effect of short-term app use on changes in resilience. Methods: In study 1, individual interviews and focus groups were conducted with adolescents, parents, teachers, and clinicians to discuss possible incentives for using a mental health app, the benefits of app use, and concerns associated with app use. Feedback from study 1 led to ideas for the prototype. In study 2, individual interviews and focus groups were conducted with adolescents, parents, teachers, and clinicians to gather feedback about the resilience app prototype. Feedback from study 2 led to changes in the prototype, although not all suggestions could be implemented. In study 3, 40 adolescents used the app for 30 days to determine feasibility and acceptability. Additionally, resilience and secondary mental health outcomes were measured before and after app use. Dependent samples 2-tailed t tests were conducted to determine whether there were changes in resilience and secondary mental health outcomes among the adolescents before and after app use. Results: Multiple themes were identified through study 1 individual interviews and focus groups, including app content, features, engagement, benefits, concerns, and improvement. Specifically, the adolescents provided helpful suggestions for making the prototype more appealing and functional for teen users. Study 2 adolescents and adults reported that the prototype was feasible and acceptable through the Computer System Usability Questionnaire (mean 6.30, SD 1.03) and Mobile App Rating Scale (mean 4.08, SD 0.61). In study 2, there were no significant differences in resilience and mental health outcomes after using the app for 30 days. There was variation between the participants in the extent to which they used the app, which may have led to variation in the results. The users appeared to prefer the depression module and survey sections, which provided mental health feedback. Conclusions: Qualitative and quantitative data provide evidence that youth are interested in a resilience mental health app and that the current prototype is feasible. Although there were no significant mental health changes in study 3 users, practical implications and future directions are discussed for mental health app research. %M 36947113 %R 10.2196/38042 %U https://formative.jmir.org/2023/1/e38042 %U https://doi.org/10.2196/38042 %U http://www.ncbi.nlm.nih.gov/pubmed/36947113 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e39052 %T Effectiveness of an App-Based Short Intervention to Improve Sleep: Randomized Controlled Trial %A Vollert,Bianka %A Müller,Luise %A Jacobi,Corinna %A Trockel,Mickey %A Beintner,Ina %+ Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Chemnitzer Strasse 46, Dresden, 01187, Germany, 49 351 463 38576, bianka.vollert@tu-dresden.de %K sleep %K insomnia %K cognitive behavioral treatment for insomnia %K eHealth %K mobile app %D 2023 %7 21.3.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: A growing body of evidence for digital interventions to improve sleep shows promising effects. The interventions investigated so far have been primarily web-based; however, app-based interventions may reach a wider audience and be more suitable for daily use. Objective: This study aims to evaluate the intervention effects, adherence, and acceptance of an unguided app-based intervention for individuals who wish to improve their sleep. Methods: In a randomized controlled trial, we evaluated the effects of an app-based short intervention (Refresh) to improve sleep compared with a waitlist condition. Refresh is an 8-week unguided intervention covering the principles of cognitive behavioral therapy for insomnia (CBT-I) and including a sleep diary. The primary outcome was sleep quality (insomnia symptoms) as self-assessed by the Regensburg Insomnia Scale (RIS). The secondary outcomes were depression (9-item Patient Health Questionnaire [PHQ-9] score) and perceived insomnia-related impairment. Results: We included 371 participants, of which 245 reported poor sleep at baseline. About 1 in 3 participants who were allocated to the intervention group never accessed the intervention. Active participants completed on average 4 out of 8 chapters. Retention rates were 67.4% (n=250) at postassessment and 57.7% (n=214) at the 6-month follow-up. At postintervention, insomnia symptoms in the intervention group had improved more than those in the waitlist group, with a small effect (d=0.26) in the whole sample and a medium effect (d=0.45) in the subgroup with poor sleep. Effects in the intervention group were maintained at follow-up. Perceived insomnia-related impairment also improved from pre- to postassessment. No significant intervention effect on depression was detected. Working alliance and acceptance were moderate to good. Conclusions: An app-based, unguided intervention is a feasible and effective option to scale-up CBT-I-based treatment, but intervention uptake and adherence need to be carefully addressed. Trial Registration: ISRCTN Registry ISRCTN53553517; https://www.isrctn.com/ISRCTN53553517 %M 36943337 %R 10.2196/39052 %U https://mental.jmir.org/2023/1/e39052 %U https://doi.org/10.2196/39052 %U http://www.ncbi.nlm.nih.gov/pubmed/36943337 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39917 %T Training and Profiling a Pediatric Facial Expression Classifier for Children on Mobile Devices: Machine Learning Study %A Banerjee,Agnik %A Mutlu,Onur Cezmi %A Kline,Aaron %A Surabhi,Saimourya %A Washington,Peter %A Wall,Dennis Paul %+ Department of Pediatrics (Systems Medicine), Stanford University, 3145 Porter Drive, Stanford, CA, 94304, United States, 1 650 666 7676, dpwall@stanford.edu %K edge computing %K affective computing %K autism spectrum disorder %K autism %K ASD %K classifier %K classification %K model %K algorithm %K mobile health %K computer vision %K deep learning %K machine learning for health %K pediatrics %K emotion recognition %K mHealth %K diagnostic tool %K digital therapy %K child %K developmental disorder %K smartphone %K image analysis %K machine learning %K Image classification %K neural network %D 2023 %7 21.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Implementing automated facial expression recognition on mobile devices could provide an accessible diagnostic and therapeutic tool for those who struggle to recognize facial expressions, including children with developmental behavioral conditions such as autism. Despite recent advances in facial expression classifiers for children, existing models are too computationally expensive for smartphone use. Objective: We explored several state-of-the-art facial expression classifiers designed for mobile devices, used posttraining optimization techniques for both classification performance and efficiency on a Motorola Moto G6 phone, evaluated the importance of training our classifiers on children versus adults, and evaluated the models’ performance against different ethnic groups. Methods: We collected images from 12 public data sets and used video frames crowdsourced from the GuessWhat app to train our classifiers. All images were annotated for 7 expressions: neutral, fear, happiness, sadness, surprise, anger, and disgust. We tested 3 copies for each of 5 different convolutional neural network architectures: MobileNetV3-Small 1.0x, MobileNetV2 1.0x, EfficientNetB0, MobileNetV3-Large 1.0x, and NASNetMobile. We trained the first copy on images of children, second copy on images of adults, and third copy on all data sets. We evaluated each model against the entire Child Affective Facial Expression (CAFE) set and by ethnicity. We performed weight pruning, weight clustering, and quantize-aware training when possible and profiled each model’s performance on the Moto G6. Results: Our best model, a MobileNetV3-Large network pretrained on ImageNet, achieved 65.78% accuracy and 65.31% F1-score on the CAFE and a 90-millisecond inference latency on a Moto G6 phone when trained on all data. This accuracy is only 1.12% lower than the current state of the art for CAFE, a model with 13.91x more parameters that was unable to run on the Moto G6 due to its size, even when fully optimized. When trained solely on children, this model achieved 60.57% accuracy and 60.29% F1-score. When trained only on adults, the model received 53.36% accuracy and 53.10% F1-score. Although the MobileNetV3-Large trained on all data sets achieved nearly a 60% F1-score across all ethnicities, the data sets for South Asian and African American children achieved lower accuracy (as much as 11.56%) and F1-score (as much as 11.25%) than other groups. Conclusions: With specialized design and optimization techniques, facial expression classifiers can become lightweight enough to run on mobile devices and achieve state-of-the-art performance. There is potentially a “data shift” phenomenon between facial expressions of children compared with adults; our classifiers performed much better when trained on children. Certain underrepresented ethnic groups (e.g., South Asian and African American) also perform significantly worse than groups such as European Caucasian despite similar data quality. Our models can be integrated into mobile health therapies to help diagnose autism spectrum disorder and provide targeted therapeutic treatment to children. %M 35962462 %R 10.2196/39917 %U https://formative.jmir.org/2023/1/e39917 %U https://doi.org/10.2196/39917 %U http://www.ncbi.nlm.nih.gov/pubmed/35962462 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e40539 %T A Digital Intervention to Improve Mental Health and Interpersonal Resilience in Young People Who Have Experienced Technology-Assisted Sexual Abuse: Protocol for a Nonrandomized Feasibility Clinical Trial and Nested Qualitative Study %A Bucci,Sandra %A Varese,Filippo %A Quayle,Ethel %A Cartwright,Kim %A Machin,Matthew %A Whelan,Pauline %A Chitsabesan,Prathiba %A Richards,Cathy %A Green,Victoria %A Norrie,John %A Schwannauer,Matthias %+ Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science, The University of Manchester, 2nd Floor, Sochonis Building, Brunswick Street, Manchester, M13 9PL, United Kingdom, 1 01613060422, sandra.bucci@manchester.ac.uk %K technology-assisted sexual abuse %K digital %K young people %K abuse %K eHealth %K mobile health %K mHealth %K mobile phone %D 2023 %7 21.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: No evidence-based support has been offered to young people (YP) who have experienced technology-assisted sexual abuse (TASA). Interventions aimed at improving mentalization (the ability to understand the mental states of oneself and others) are increasingly being applied to treat YP with various clinical issues. Digital technology use among YP is now common. A digital intervention aimed at improving mentalization in YP who have experienced TASA may reduce the risk of revictimization and future harm and make YP more resilient and able to manage distress that might result from TASA experiences. Objective: In this paper, we describe a protocol for determining the feasibility of the i-Minds trial and the acceptability, safety, and usability of the digital intervention (the i-Minds app) and explore how to best integrate i-Minds into existing routine care pathways. Methods: This is a mixed methods nonrandomized study aimed to determine the feasibility, acceptability, safety, and usability of the intervention. Participants aged between 12 and 18 years who report distress associated with TASA exposure will be recruited from the United Kingdom from the National Health Service (NHS) Trust Child and Adolescent Mental Health Services, sexual assault referral centers, and a web-based e-therapy provider. All participants will receive the i-Minds app for 6 weeks. Coproduced with YP and a range of stakeholders, the i-Minds app focuses on 4 main topics: mentalization, TASA and its impact, emotional and mental health, and trauma. A daily prompt will encourage YP to use the app, which is designed to be used in a stand-alone manner alongside routine care. We will follow participants up after the intervention and conduct interviews with stakeholders to explore the acceptability of the app and trial procedures and identify areas for improvement. Informed by the normalization process theory, we will examine barriers and enablers relevant to the future integration of the intervention into existing care pathways, including traditional clinic-based NHS and NHS e-therapy providers. Results: This study was approved by the Research Ethics Board of Scotland. We expect data to be collected from up to 60 YP. We expect to conduct approximately 20 qualitative interviews with participants and 20 health care professionals who referred YP to the study. The results of this study have been submitted for publication. Conclusions: This study will provide preliminary evidence on the feasibility of recruiting YP to a trial of this nature and on the acceptability, safety, and usability of the i-Minds app, including how to best integrate it into existing routine care. The findings will inform the decision to proceed with a powered efficacy trial. Trial Registration: International Standard Randomised Controlled Trial Number Registry (ISRCTN) ISRCTN43130832; https://www.isrctn.com/ISRCTN43130832 International Registered Report Identifier (IRRID): DERR1-10.2196/40539 %M 36943343 %R 10.2196/40539 %U https://www.researchprotocols.org/2023/1/e40539 %U https://doi.org/10.2196/40539 %U http://www.ncbi.nlm.nih.gov/pubmed/36943343 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44542 %T Exploring the Perceptions of mHealth Interventions for the Prevention of Common Mental Disorders in University Students in Singapore: Qualitative Study %A Salamanca-Sanabria,Alicia %A Jabir,Ahmad Ishqi %A Lin,Xiaowen %A Alattas,Aishah %A Kocaballi,A Baki %A Lee,Jimmy %A Kowatsch,Tobias %A Tudor Car,Lorainne %+ Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Level 18, Singapore, 308232, Singapore, 65 69041258, lorainne.tudor.car@ntu.edu.sg %K interventions %K students %K mobile health %K mHealth %K mental health %K mental disorders %K university %K common mental disorders %K anxiety %K depression %D 2023 %7 20.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health interventions delivered through mobile health (mHealth) technologies can increase the access to mental health services, especially among university students. The development of mHealth intervention is complex and needs to be context sensitive. There is currently limited evidence on the perceptions, needs, and barriers related to these interventions in the Southeast Asian context. Objective: This qualitative study aimed to explore the perception of university students and mental health supporters in Singapore about mental health services, campaigns, and mHealth interventions with a focus on conversational agent interventions for the prevention of common mental disorders such as anxiety and depression. Methods: We conducted 6 web-based focus group discussions with 30 university students and one-to-one web-based interviews with 11 mental health supporters consisting of faculty members tasked with student pastoral care, a mental health first aider, counselors, psychologists, a clinical psychologist, and a psychiatrist. The qualitative analysis followed a reflexive thematic analysis framework. Results: The following 6 main themes were identified: a healthy lifestyle as students, access to mental health services, the role of mental health promotion campaigns, preferred mHealth engagement features, factors that influence the adoption of mHealth interventions, and cultural relevance of mHealth interventions. The interpretation of our findings shows that students were reluctant to use mental health services because of the fear of stigma and a possible lack of confidentiality. Conclusions: Study participants viewed mHealth interventions for mental health as part of a blended intervention. They also felt that future mental health mHealth interventions should be more personalized and capable of managing adverse events such as suicidal ideation. %M 36939808 %R 10.2196/44542 %U https://www.jmir.org/2023/1/e44542 %U https://doi.org/10.2196/44542 %U http://www.ncbi.nlm.nih.gov/pubmed/36939808 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42776 %T The Usefulness of a Smartphone App–Based Smoking Cessation Program for Conventional Cigarette Users, Heated Tobacco Product Users, and Dual Users: Retrospective Study %A Noda,Yuko %A So,Ryuhei %A Sonoda,Misaki %A Tabuchi,Takahiro %A Nomura,Akihiro %+ Department of Biomedical Informatics, CureApp Institute, 4136-1 Azayakozawa, Nagakura, Karuizawa, 389-0111, Japan, 81 9087019830, akihiro.nomura@cureapp.institute %K smoking cessation %K nicotine dependence %K digital therapeutics %K telemedicine %K telecare %K mobile phone %K smoking cessation program %K online counseling %K online therapy %K heated tobacco product %K HTP %D 2023 %7 17.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Heated tobacco products (HTPs) are widespread in Japan, and smoking cessation of such products has become an important issue owing to the spread of harmful effects from HTPs. The efficacy of online digital therapy has been reported in smoking cessation treatment; however, we have limited evidence of online smoking cessation programs for HTP users. Objective: In this study, we evaluate the usefulness of the Ascure program for HTP users (defined as exclusive HTP use or dual use of HTP and cigarettes) compared with exclusive cigarette users. Methods: This was a retrospective study. We recruited adult smokers participating in the Ascure online smoking cessation program in Japan from June 2019 to February 2021. The Ascure smartphone app provided four elements: (1) educational video tutorials to enhance the understanding of nicotine dependence, (2) a personalized to-do list for behavior change, (3) a digital diary for record keeping, and (4) interactive chat sessions for relief from cravings or withdrawal symptoms. The primary outcome was the continuous abstinence rate (CAR) at weeks 21 to 24, biochemically validated using salivary cotinine testing. We considered those who dropped out of the program as smoking cessation failures. We analyzed the primary outcome using inverse probability weighting against tobacco product type estimated by multinomial propensity scores. We also assessed CAR at weeks 9 to 12 and program adherence. Results: We analyzed data from 2952 participants, including 52% (1524/3478) in the cigarette group, 35% (1038/3478) in the HTP group, and 13% (390/3478) in the dual-use group, who had a mean age of 43.4 (SD 10.8) years and included 17% (513/2952) women. CAR at weeks 21 to 24 showed that exclusive HTP users were more likely to stop tobacco use than exclusive cigarette smokers (CAR 52.6% for cigarette users vs CAR 64.8% for HTP users; odds ratio [OR] 1.17, 95% CI 1.12-1.22; P<.001). There was no significant difference between the exclusive cigarette users and the dual users (CAR 52.6% for cigarette users vs CAR 48.7% for dual users; OR 0.99, 95% CI 0.93-1.05; P=.77). CAR at weeks 9 to 12 was 56.7% (95% CI 54.2%-59.2%) for the exclusive cigarette users, 68.3% (95% CI 65.5%-71.1%) for the exclusive HTP users, and 58.2% (95% CI 53.3%-63.1%) for the dual users. The program adherence rate at week 24 was 70.7% overall (68.4% for cigarette users, 75% for HTP users, and 67.9% for dual users). Conclusions: Exclusive HTP users had higher CARs and adherence compared with exclusive cigarette users, indicating a higher affinity for the Ascure online smoking cessation program. This program might be a useful smoking cessation option for HTP users, as well as for cigarette smokers. %M 36930197 %R 10.2196/42776 %U https://www.jmir.org/2023/1/e42776 %U https://doi.org/10.2196/42776 %U http://www.ncbi.nlm.nih.gov/pubmed/36930197 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e39253 %T The Efficacy of Be a Mom, a Web-Based Intervention to Prevent Postpartum Depression: Examining Mechanisms of Change in a Randomized Controlled Trial %A Carona,Carlos %A Pereira,Marco %A Araújo-Pedrosa,Anabela %A Canavarro,Maria Cristina %A Fonseca,Ana %+ Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, University of Coimbra, Colégio Novo St., Coimbra, 3000-115, Portugal, 351 239851450, ccarona@fpce.uc.pt %K Be a Mom %K randomized controlled trial %K postpartum depression %K web-based interventions %K cognitive behavioral therapy %K prevention %K mobile phone %D 2023 %7 17.3.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Postpartum depression (PPD) is treatable and preventable, but most women do not seek professional help for their perinatal depressive symptoms. One increasingly popular approach of improving access to care is the use of web-based intervention programs. Objective: The objective of this study was 2-fold: first, to assess the efficacy of Be a Mom, a brief web-based selective or indicated preventive intervention, in reducing depressive and anxiety symptoms of women at high risk for PPD; and second, to examine mechanisms of change linking modifiable self-regulatory skills (ie, emotion regulation, self-compassion, and psychological flexibility) to improved perinatal mental health outcomes. Methods: This 2-arm, open-label randomized controlled trial involved a sample of 1053 perinatal women presenting high risk for PPD who were allocated to the Be a Mom intervention group or a waitlist control group and completed self-report measures at baseline and postintervention assessments. Univariate latent change score models were computed to determine changes over time in adjustment processes and outcomes, with a multigroup-model approach to detect differences between the intervention and control groups and a 2-wave latent change score model to examine whether changes in processes were related to changes in outcomes. Results: Be a Mom was found to be effective in reducing depressive (intervention group: µΔ=–3.35; P<.001 vs control group: µΔ=–1.48; P<.001) and anxiety symptoms (intervention group: µΔ=–2.24; P<.001 vs control group: µΔ=–0.43; P=.04) in comparison with the control group, where such changes were inexistent or much smaller. All 3 psychological processes under study improved statistically significantly in posttreatment assessments: emotion regulation ability (Δχ23=12.3; P=.007) and psychological flexibility (Δχ23=34.9; P<.001) improved only in the intervention group, and although self-compassion increased in both groups (Δχ23=65.6; P<.001), these improvements were considerably greater in the intervention group. Conclusions: These results suggest that Be a Mom, a low-intensity cognitive behavioral therapy program, is a promising first-line intervention for helping perinatal women, particularly those with early-onset PPD symptoms. Trial Registration: ClinicalTrials.gov NCT03024645; https://clinicaltrials.gov/ct2/show/NCT03024645 %M 36930182 %R 10.2196/39253 %U https://mental.jmir.org/2023/1/e39253 %U https://doi.org/10.2196/39253 %U http://www.ncbi.nlm.nih.gov/pubmed/36930182 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41275 %T The Relationship Between How Participants Articulate Their Goals and Accomplishments and Weight Loss Outcomes: Secondary Analysis of a Pilot of a Web-Based Weight Loss Intervention %A Jake-Schoffman,Danielle E %A Waring,Molly E %A DiVito,Joseph %A Goetz,Jared M %A Pan,Cindy %A Pagoto,Sherry L %+ Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, PO Box 118210, Gainesville, FL, 32611, United States, 1 352 294 1046, djakeschoffman@ufl.edu %K weight loss %K social media %K goal setting %K web-based program %K behavior change %K habit formation %K diabetes %K Facebook %K lifestyle %D 2023 %7 16.3.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In behavioral weight loss interventions, participants are asked to set weekly goals to support long-term habits that lead to weight loss. Although participants are asked to set and accomplish weekly goals, we do not know how often they do this and whether doing so is associated with weight loss. Web-based weight loss interventions allow for the analysis of participant engagement data, including how participants articulate their goals and accomplishments. Objective: Using engagement data from a web-based weight loss intervention, we examined whether participants articulating their goals and accomplishments in measurable and repeating terms were associated with greater weight loss. Methods: Adults with overweight or obesity received a 12-week Facebook-delivered weight loss intervention based on the Diabetes Prevention Program Lifestyle Intervention. Participants replied to conversation threads that queried about their goals and accomplishments. Two independent coders classified participants’ posts that articulated goals or accomplishments as measurable or repeating. Crude and age-adjusted linear regression models were used to examine the relationship between the frequency of post type and percent weight loss. Results: Participants (N=53; n=48, 91% female; n=48, 91% non-Hispanic White) were on average 46.2 (SD 10.5) years old with a mean BMI of 32.4 (SD 4.8) kg/m2. Over 12 weeks, participants shared a median of 4 (IQR 1-8) posts that reported goals and 10 (IQR 4-24) posts that reported accomplishments. Most participants shared ≥1 post with a goal (n=43, 81%) and ≥1 post with an accomplishment (n=47, 89%). Each post reporting a goal was associated with 0.2% greater weight loss (95% CI −0.3% to 0.0%). Sharing ≥1 post with a repeating goal was associated with an average of 2.2% greater weight loss (95% CI −3.9% to −0.4%). Each post with a repeating goal was associated with an average of 0.5% greater weight loss (95% CI −1.0% to 0.0%). Sharing ≥1 post with measurable and repeating goals was associated with an average of 1.9% greater weight loss (95% CI −3.7% to −0.2%). Sharing each post with an accomplishment was associated with an average of 0.1% greater weight loss (95% CI −0.1% to 0.0%). Every post with an accomplishment that was repeating was associated with an average of 0.2% greater weight loss (95% CI −0.3% to 0.0%). Sharing other types of goals and accomplishments was not associated with weight loss. Conclusions: In a web-based weight loss intervention, stating goals in repeating or both measurable and repeating terms was associated with greater weight loss, but simply stating them in measurable terms was not. For accomplishments, only those articulated in repeating terms were associated with greater weight loss. Posts about one-time goals and accomplishments represent an opportunity to encourage planning for future behaviors. Future research should examine if stating goals and accomplishments in repeating terms signals habit formation. %M 36927569 %R 10.2196/41275 %U https://mhealth.jmir.org/2023/1/e41275 %U https://doi.org/10.2196/41275 %U http://www.ncbi.nlm.nih.gov/pubmed/36927569 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 8 %N %P e42389 %T The Clinical Impact of Flash Glucose Monitoring—a Digital Health App and Smartwatch Technology in Patients With Type 2 Diabetes: Scoping Review %A Diez Alvarez,Sergio %A Fellas,Antoni %A Santos,Derek %A Sculley,Dean %A Wynne,Katie %A Acharya,Shamasunder %A Navathe,Pooshan %A Girones,Xavier %A Coda,Andrea %+ School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive Callaghan, Newcastle, 2258, Australia, 61 409916949, sergio.diezalvarez@uon.edu.au %K type 2 diabetes %K flash glucose monitoring %K digital health %K smartwatch %K scoping review %K app %K smartphone %K mobile phone %K mHealth %K digital %K application %K technology %K effective %K management %K glucose %K monitoring %K database %K wearable %K diabetes %K diabetic %K glucose monitoring %D 2023 %7 15.3.2023 %9 Review %J JMIR Diabetes %G English %X Background: Type 2 diabetes has a growing prevalence and confers significant cost burden to the health care system, raising the urgent need for cost-effective and easily accessible solutions. The management of type 2 diabetes requires significant commitment from the patient, caregivers, and the treating team to optimize clinical outcomes and prevent complications. Technology and its implications for the management of type 2 diabetes is a nascent area of research. The impact of some of the more recent technological innovations in this space, such as continuous glucose monitoring, flash glucose monitoring, web-based applications, as well as smartphone- and smart watch–based interactive apps has received limited attention in the research literature. Objective: This scoping review aims to explore the literature available on type 2 diabetes, flash glucose monitoring, and digital health technology to improve diabetic clinical outcomes and inform future research in this area. Methods: A scoping review was undertaken by searching Ovid MEDLINE and CINAHL databases. A second search using all identified keywords and index terms was performed on Ovid MEDLINE (January 1966 to July 2021), EMBASE (January 1980 to July 2021), Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library, latest issue), CINAHL (from 1982), IEEE Xplore, ACM Digital Libraries, and Web of Science databases. Results: There were very few studies that have explored the use of mobile health and flash glucose monitoring in type 2 diabetes. These studies have explored somewhat disparate and limited areas of research, and there is a distinct lack of methodological rigor in this area of research. The 3 studies that met the inclusion criteria have addressed aspects of the proposed research question. Conclusions: This scoping review has highlighted the lack of research in this area, raising the opportunity for further research in this area, focusing on the clinical impact and feasibility of the use of multiple technologies, including flash glucose monitoring in the management of patients with type 2 diabetes. %M 36920464 %R 10.2196/42389 %U https://diabetes.jmir.org/2023/1/e42389 %U https://doi.org/10.2196/42389 %U http://www.ncbi.nlm.nih.gov/pubmed/36920464 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e41182 %T The Impact of Digital Health on Smoking Cessation %A Cobos-Campos,Raquel %A Cordero-Guevara,Jose Aurelio %A Apiñaniz,Antxon %A de Lafuente,Arantza Sáez %A Bermúdez Ampudia,Cristina %A Argaluza Escudero,Julene %A Pérez Llanos,Iraida %A Parraza Diez,Naiara %+ Epidemiology and Public Health Group, Bioaraba Health Research Institute, José Atxotegi s/n, Vitoria-Gasteiz, 01009, Spain, 34 680953032, raquelcobos1976@gmail.com %K smoking cessation %K smoking %K cessation %K smoker %K quit %K care delivery %K service delivery %K health technology %K mHealth %K mobile applications %K mobile health %K digital health %K mobile app %K health app %K smartphone %K health service %K eHealth %K trend %D 2023 %7 15.3.2023 %9 Viewpoint %J Interact J Med Res %G English %X Background: Smartphones have become useful tools for medicine, with the use of specific apps making it possible to bring health care closer to inaccessible areas, continuously monitor a patient's pathology at any time and place, promote healthy habits, and ultimately improve patients’ quality of life and the efficiency of the health care system. Since 2020, the use of smartphones has reached unprecedented levels. There are more than 350,000 health apps, according to a 2021 IQVIA Institute report, that address, among other things, the management of patient appointments; communication among different services or professionals; the promotion of lifestyle changes related to adopting healthy habits; and the monitoring of different pathologies and chronic conditions, including smoking cessation. The number of mobile apps for quitting smoking is high. As early as 2017, a total of 177 unique smoking cessation–relevant apps were identified in the iPhone App Store, 139 were identified in Google Play, 70 were identified in the BlackBerry app store, and 55 were identified in the Windows Phone Store, but very few have adequate scientific support. It seems clear that efforts are needed to assess the quality of these apps, as well as their effectiveness in different population groups, to have tools that offer added value to standard practices. Objective: This viewpoint aims to highlight the benefits of mobile health (mHealth) and its potential as an adjuvant tool in health care. Methods: A review of literature and other data sources was performed in order to show the current status of mobile apps that can offer support for smoking cessation. For this purpose, the PubMed, Embase, and Cochrane databases were explored between May and November 2022. Results: In terms of smoking cessation, mHealth has become a powerful coadjuvant tool that allows health workers to perform exhaustive follow-ups for the process of quitting tobacco and provide support anytime and anywhere. mHealth tools are effective for different groups of smokers (eg, pregnant women, patients with chronic obstructive pulmonary disease, patients with mental illness, and the general population) and are cost-effective, generating savings for the health system. However, there are some patient characteristics that can predict the success of using mobile apps in the smoking cessation process, such as the lower age of patients, dependence on tobacco, the number of quit attempts, and the previous use of mobile apps, among others. Therefore, it is preferable to offer these tools to patients with a higher probability of quitting tobacco. Conclusions: mHealth is a promising tool for helping smokers in the smoking cessation process. There is a need for well-designed clinical studies and economic evaluations to jointly assess the effectiveness of new interventions in different population groups, as well as their impact on health care resources. %M 36920468 %R 10.2196/41182 %U https://www.i-jmr.org/2023/1/e41182 %U https://doi.org/10.2196/41182 %U http://www.ncbi.nlm.nih.gov/pubmed/36920468 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41685 %T Wrist Accelerometer Estimates of Physical Activity Intensity During Walking in Older Adults and People Living With Complex Health Conditions: Retrospective Observational Data Analysis Study %A Weber,Kyle S %A Godkin,F Elizabeth %A Cornish,Benjamin F %A McIlroy,William E %A Van Ooteghem,Karen %+ Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada, 1 (519) 888 4567, kvanooteghem@uwaterloo.ca %K neurodegenerative disease %K aging %K older adults %K wearable sensors %K physical activity %K activity intensity %K activity monitoring %K exercise prescription %K accelerometry %K health technology %D 2023 %7 15.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Accurate measurement of daily physical activity (PA) is important as PA is linked to health outcomes in older adults and people living with complex health conditions. Wrist-worn accelerometers are widely used to estimate PA intensity, including walking, which composes much of daily PA. However, there is concern that wrist-derived PA data in these cohorts is unreliable due to slow gait speed, mobility aid use, disease-related symptoms that impact arm movement, and transient activities of daily living. Despite the potential for error in wrist-derived PA intensity estimates, their use has become ubiquitous in research and clinical application. Objective: The goals of this work were to (1) determine the accuracy of wrist-based estimates of PA intensity during known walking periods in older adults and people living with cerebrovascular disease (CVD) or neurodegenerative disease (NDD) and (2) explore factors that influence wrist-derived intensity estimates. Methods: A total of 35 older adults (n=23 with CVD or NDD) wore an accelerometer on the dominant wrist and ankle for 7 to 10 days of continuous monitoring. Stepping was detected using the ankle accelerometer. Analyses were restricted to gait bouts ≥60 seconds long with a cadence ≥80 steps per minute (LONG walks) to identify periods of purposeful, continuous walking likely to reflect moderate-intensity activity. Wrist accelerometer data were analyzed within LONG walks using 15-second epochs, and published intensity thresholds were applied to classify epochs as sedentary, light, or moderate-to-vigorous physical activity (MVPA). Participants were stratified into quartiles based on the percent of walking epochs classified as sedentary, and the data were examined for differences in behavioral or demographic traits between the top and bottom quartiles. A case series was performed to illustrate factors and behaviors that can affect wrist-derived intensity estimates during walking. Results: Participants averaged 107.7 (SD 55.8) LONG walks with a median cadence of 107.3 (SD 10.8) steps per minute. Across participants, wrist-derived intensity classification was 22.9% (SD 15.8) sedentary, 27.7% (SD 14.6) light, and 49.3% (SD 25.5) MVPA during LONG walks. All participants measured a statistically lower proportion of wrist-derived activity during LONG walks than expected (all P<.001), and 80% (n=28) of participants had at least 20 minutes of LONG walking time misclassified as sedentary based on wrist-derived intensity estimates. Participants in the highest quartile of wrist-derived sedentary classification during LONG walks were significantly older (t16=4.24, P<.001) and had more variable wrist movement (t16=2.13, P=.049) compared to those in the lowest quartile. Conclusions: The current best practice wrist accelerometer method is prone to misclassifying activity intensity during walking in older adults and people living with complex health conditions. A multidevice approach may be warranted to advance methods for accurately assessing PA in these groups. %M 36920452 %R 10.2196/41685 %U https://formative.jmir.org/2023/1/e41685 %U https://doi.org/10.2196/41685 %U http://www.ncbi.nlm.nih.gov/pubmed/36920452 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40259 %T The Effectiveness of Wearable Devices Using Artificial Intelligence for Blood Glucose Level Forecasting or Prediction: Systematic Review %A Ahmed,Arfan %A Aziz,Sarah %A Abd-alrazaq,Alaa %A Farooq,Faisal %A Househ,Mowafa %A Sheikh,Javaid %+ AI Center for Precision Health, Weill Cornell Medicine-Qatar, Education City, PO Box 24144, Doha, Qatar, 974 44928826, ara4013@qatar-med.cornell.edu %K diabetes %K artificial intelligence %K wearable devices %K machine learning %K blood glucose %K forecasting %K prediction %D 2023 %7 14.3.2023 %9 Review %J J Med Internet Res %G English %X Background: In 2021 alone, diabetes mellitus, a metabolic disorder primarily characterized by abnormally high blood glucose (BG) levels, affected 537 million people globally, and over 6 million deaths were reported. The use of noninvasive technologies, such as wearable devices (WDs), to regulate and monitor BG in people with diabetes is a relatively new concept and yet in its infancy. Noninvasive WDs coupled with machine learning (ML) techniques have the potential to understand and conclude meaningful information from the gathered data and provide clinically meaningful advanced analytics for the purpose of forecasting or prediction. Objective: The purpose of this study is to provide a systematic review complete with a quality assessment looking at diabetes effectiveness of using artificial intelligence (AI) in WDs for forecasting or predicting BG levels. Methods: We searched 7 of the most popular bibliographic databases. Two reviewers performed study selection and data extraction independently before cross-checking the extracted data. A narrative approach was used to synthesize the data. Quality assessment was performed using an adapted version of the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Results: From the initial 3872 studies, the features from 12 studies were reported after filtering according to our predefined inclusion criteria. The reference standard in all studies overall (n=11, 92%) was classified as low, as all ground truths were easily replicable. Since the data input to AI technology was highly standardized and there was no effect of flow or time frame on the final output, both factors were categorized in a low-risk group (n=11, 92%). It was observed that classical ML approaches were deployed by half of the studies, the most popular being ensemble-boosted trees (random forest). The most common evaluation metric used was Clarke grid error (n=7, 58%), followed by root mean square error (n=5, 42%). The wide usage of photoplethysmogram and near-infrared sensors was observed on wrist-worn devices. Conclusions: This review has provided the most extensive work to date summarizing WDs that use ML for diabetic-related BG level forecasting or prediction. Although current studies are few, this study suggests that the general quality of the studies was considered high, as revealed by the QUADAS-2 assessment tool. Further validation is needed for commercially available devices, but we envisage that WDs in general have the potential to remove the need for invasive devices completely for glucose monitoring in the not-too-distant future. Trial Registration: PROSPERO CRD42022303175; https://tinyurl.com/3n9jaayc %M 36917147 %R 10.2196/40259 %U https://www.jmir.org/2023/1/e40259 %U https://doi.org/10.2196/40259 %U http://www.ncbi.nlm.nih.gov/pubmed/36917147 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40285 %T A Digital Platform and Smartphone App to Increase Physical Activity in Patients With Type 2 Diabetes: Overview Of a Technical Solution %A Bonn,Stephanie E %A Alexandrou,Christina %A Trolle Lagerros,Ylva %+ Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Maria Aspmans gata 16, Stockholm, 171 76, Sweden, 46 8 517 791 83, stephanie.bonn@ki.se %K methods %K mHealth %K mobile app %K self-management %K smartphone %K digital %K platform %K physical activity %K diabetes %K technical %K engagement %K self-care %K development %K app %K walking %K effective %D 2023 %7 14.3.2023 %9 Viewpoint %J JMIR Form Res %G English %X Mobile Health (mHealth) solutions can be used to increase patients’ engagement in self-care. Descriptions of the technical solutions behind mHealth smartphone apps may guide the development of future apps. Here, we aim to describe the technical background and visual display of the DiaCert system, which was developed to support daily walking among patients with type 2 diabetes. The DiaCert system publishes one application program interface developed for patient devices (ie, smartphone apps running on iOS or Android) and another for web-based health care provider components (ie, administrative components). An individual care plan is created for each patient on the caregiver platform, and data on physical activity (ie, steps), blood samples, and questionnaires are shared between patient and caregiver in the DiaCert system. Technical solutions such as this enable us to reach more individuals at a lower cost compared to traditional health care. An advantage to the DiaCert technical solution is that it is built on a simple architecture and therefore is easily scalable. However, as it is a separate solution, it means adding yet another process for health care personnel to integrate into their work, which must be acknowledged. We hope that the technical description and visual display of the DiaCert system herein can guide researchers in the design and building of new and effective mHealth solutions.International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5026-4 %M 36917156 %R 10.2196/40285 %U https://formative.jmir.org/2023/1/e40285 %U https://doi.org/10.2196/40285 %U http://www.ncbi.nlm.nih.gov/pubmed/36917156 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41040 %T Attitudes of Physicians and Individuals Toward Digital Mental Health Tools: Protocol for a Web-Based Survey Research Project %A Nogueira-Leite,Diogo %A Cruz-Correia,Ricardo %+ Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, Porto, 4200-450, Portugal, 351 913667140, diogo.fdnl@gmail.com %K mental health %K mobile apps %K digital technology %K government regulation %D 2023 %7 14.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital transformation is impacting health care delivery. Great market dynamism is bringing opportunities and concerns alike into public discussion. Digital health apps are a vibrant segment where regulation is emerging, with Germany paving the way with its DiGA (Digitale Gesundheitsanwendungen, in German, meaning digital health apps) program. Simultaneously, mental ill-health constitutes a global health concern, and prevalence is expected to worsen due to the COVID-19 pandemic and its containment measures. Portugal and its National Health System may be a useful testbed for digital health interventions. Objective: The paper outlines the protocol for a research project on the attitudes of physicians and potential users toward digital mental health apps to improve access to care, patient outcomes, and reduce the burden of disease of mental ill-health. Methods: Web surveys will be conducted to acquire data from the main stakeholders (physicians and the academic community). Data analysis will replicate the statistical analysis performed in the studies from Dahlhausen and Borghouts to derive conclusions regarding the relative acceptance and likelihood of successful implementation of digital mental health apps in Portugal. Results: The findings of the proposed studies will elicit important information on how physicians and individuals perceive digital mental health app interventions to improve access to care, patient outcomes, and reduce the burden of disease of mental ill-health. Data collection ran between September 26 and November 6, 2022, for the first study and September 20 and October 20, 2022, for the second study. We obtained 160 responses to the first study’s survey and 539 answers to the second study’s survey. Data analysis is concluded, and both studies’ results are expected to be published in 2023. Conclusions: The results of the studies projected in this research protocol will have implications for researchers and academia, industry, and policy makers concerning the adoption and implementation of digital health mental apps and associated interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/41040 %M 36917172 %R 10.2196/41040 %U https://www.researchprotocols.org/2023/1/e41040 %U https://doi.org/10.2196/41040 %U http://www.ncbi.nlm.nih.gov/pubmed/36917172 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e39977 %T Development of a ParticipACTION App–Based Intervention for Improving Postsecondary Students’ 24-Hour Movement Guideline Behaviors: Protocol for the Application of Intervention Mapping %A Flood,Stephanie M %A Thompson,Brooke %A Faulkner,Guy %A Vanderloo,Leigh M %A Blackett,Beth %A Dolf,Matt %A Latimer-Cheung,Amy E %A Duggan,Mary %A Di Sebastiano,Katie M %A Lane,Kirstin N %A Brouwers,Melissa C %A McKenna,Julia %A Chulak-Bozzer,Tala %A Fuller,Daniel %A Ruissen,Geralyn R %A Sturrock,Shelby L %A Tomasone,Jennifer R %+ School of Kinesiology and Health Studies, Queen's University, Room 301F, 28 Division Street, Kingston, ON, K7L 3N6, Canada, 1 6135336000 ext 79193, tomasone@queensu.ca %K 24-Hour Movement Guidelines %K multiple behavior change %K mobile health %K mHealth %K postsecondary students %K physical activity %K sedentary behavior %K sleep %K app %K mobile phone %D 2023 %7 14.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The Canadian 24-Hour Movement Guidelines for adults provide specific recommendations for levels of physical activity, sedentary behavior, and sleep (ie, the movement behaviors) required for optimal health. Performance of the movement behaviors is associated with improved mental well-being. However, most postsecondary students do not meet the movement behavior recommendations within the Canadian 24-Hour Movement Guidelines and experience increased stress and declining well-being, suggesting the need for an intervention targeting students’ movement behaviors. Objective: We aimed to develop and implement a theory-informed intervention intended to improve the movement behaviors and mental well-being of first-year postsecondary students. Methods: The Intervention Mapping protocol was applied in the development and implementation of the intervention. Intervention Mapping entailed performing a needs assessment, determining the intervention outcomes, selecting theory- and evidence-based change methods and applications, preparing and producing intervention plans and materials, developing the implementation plan, and finally developing an evaluation plan. The Theoretical Domains Framework and the Behavior Change Wheel were also used in conjunction with the Intervention Mapping protocol to ensure a solid theoretical basis for the intervention. This protocol led to the development and implementation of a 6-week, theory-informed ParticipACTION app–based intervention aimed at helping first-year postsecondary students improve their movement behaviors and mental well-being. The developed app content provided students with information on each of the movement behaviors and behavioral strategies (ie, goal setting, action planning, monitoring, and coping planning). The use of Intervention Mapping allowed for the continuous involvement of various multidisciplinary partners and end users, ensuring that the intervention design and implementation was appropriate for the target audience. The feasibility, acceptability, and potential impact of the intervention will be examined in a subsequent proof-of-concept study at 2 Canadian university campuses. Results: Participant recruitment occurred during September 2021, and the intervention was conducted from October to December 2021. The deadline for completion of the postintervention questionnaire by participants was mid-December 2021. The analysis of data examining the feasibility, acceptability, and potential impact of the intervention began in January 2022, with the publication of the proof-of-concept evaluation expected in 2023. Conclusions: Intervention Mapping with the Theoretical Domains Framework and Behavior Change Wheel was a useful approach to combine evidence and theoretical concepts to guide the design and implementation of a ParticipACTION app–based intervention targeting postsecondary students’ movement behaviors and mental well-being. This process may serve as an example for other researchers developing multiple behavior change app–based interventions. Should the forthcoming evaluation demonstrate the intervention’s acceptability, feasibility, and potential impact, the intervention may provide a scalable method of improving postsecondary students’ movement behaviors and mental well-being. International Registered Report Identifier (IRRID): RR1-10.2196/39977 %M 36917173 %R 10.2196/39977 %U https://www.researchprotocols.org/2023/1/e39977 %U https://doi.org/10.2196/39977 %U http://www.ncbi.nlm.nih.gov/pubmed/36917173 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41273 %T Acceptability and Feasibility of “Village,” a Digital Communication App for Young People Experiencing Low Mood, Thoughts of Self-harm, and Suicidal Ideation to Obtain Support From Family and Friends: Mixed Methods Pilot Open Trial %A Thabrew,Hiran %A Kumar,Harshali %A Steadman,Evandah %+ Department of Psychological Medicine, The University go Auckland, 20-22 Park Road, Grafton, Auckland, 1142, New Zealand, 64 021402055, h.thabrew@auckland.ac.nz %K youth %K suicide %K self-harm %K depression %K support %K application %K mobile phone %D 2023 %7 13.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Young people experiencing low mood, thoughts related to self-harm, and suicidal ideation often struggle to communicate their emotions and receive timely support from family and friends. Technologically delivered support interventions may be useful in addressing this need. Objective: This paper aimed to evaluate the acceptability and feasibility of “Village,” a communication app co-designed with young people and their family and friends from New Zealand. Methods: A mixed methods pilot open trial design was adopted. Participants were primarily recruited via social media advertisements and clinicians in specialist mental health services over an 8-month period. The primary outcomes were acceptability of the app (via thematically analyzed qualitative feedback and retention rates) and feasibility of conducting a larger randomized controlled trial gauged via effectiveness of recruitment methods, completion of chosen outcome measures, and occurrence of unanticipated operational issues. Secondary outcomes were app usability, safety, and changes in symptoms of depression (via the Patient Health Questionnaire–9 modified for adolescents), suicidal ideation (on the Suicidal Ideation Questionnaire), and functioning (using the World Health Organization Disability Assessment Schedule 2.0 or Child and Youth version). Results: A total of 26 young people (“users”) were enrolled in the trial, of which 21 recruited friends and family members (“buddies”) and completed quantitative outcome measures at baseline, 4 weeks, and 3 months. Furthermore, 13 users and 12 buddies also provided qualitative feedback about the app, identifying the key themes of appeal of app features and layout, usefulness of its content, and technological challenges (primarily with onboarding and notifications). Users gave Village a mean rating of 3.8 (range 2.7-4.6) out of 5 on a 5-point scale for app quality and an overall star rating of 3.4 out of 5 for subjective quality. Within this limited sample, users reported a clinically significant reduction in depressive symptoms (P=.007), but nonsignificant changes in suicidal ideation and functioning. The embedded risk detection software was activated on 3 occasions, and no additional support was required for users. Conclusions: During this open trial, Village was found to be acceptable, usable, and safe. The feasibility of a larger randomized controlled trial was also confirmed after some modifications to the recruitment strategy and app. Trial Registration: Australian New Zealand Clinical Trials Network Registry ACTRN12620000241932p; https://tinyurl.com/ya6t4fx2 %M 36912882 %R 10.2196/41273 %U https://formative.jmir.org/2023/1/e41273 %U https://doi.org/10.2196/41273 %U http://www.ncbi.nlm.nih.gov/pubmed/36912882 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41804 %T Effects of a Mobile-Based Intervention for Parents of Children With Crying, Sleeping, and Feeding Problems: Randomized Controlled Trial %A Augustin,Michaela %A Licata-Dandel,Maria %A Breeman,Linda D %A Harrer,Mathias %A Bilgin,Ayten %A Wolke,Dieter %A Mall,Volker %A Ziegler,Margret %A Ebert,David Daniel %A Friedmann,Anna %+ Social Pediatrics, TUM School of Medicine, Technical University of Munich, Heiglhofstr.65, Munich, 81377, Germany, 49 8971009149, michaela.augustin@tum.de %K children %K crying problems %K sleeping problems %K feeding problems %K feeding %K regulatory problems %K intervention study %K Mobile Health Care %K health app %K mobile app %K patient education %K psychoeducation %K eHealth %K mobile health %K mHealth %K parenting %K baby %K babies %K sleep %K crying %K newborn %K mobile phone %D 2023 %7 10.3.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Excessive crying, sleeping, and feeding problems in early childhood are major stressors that can result in parents feeling socially isolated and having low self-efficacy. Affected children are a risk group for being maltreated and developing emotional and behavioral problems. Thus, the development of an innovative and interactive psychoeducational app for parents of children with crying, sleeping, and feeding problems may provide low-threshold access to scientifically based information and reduce negative outcomes in parents and children. Objective: We aimed to investigate whether following the use of a newly developed psychoeducational app, the parents of children with crying, sleeping, or feeding problems experienced less parenting stress; gained more knowledge about crying, sleeping, and feeding problems; and perceived themselves as more self-effective and as better socially supported and whether their children’s symptoms decreased more than those of the parents who did not use the app. Methods: Our clinical sample consisted of 136 parents of children (aged 0-24 months) who contacted a cry baby outpatient clinic in Bavaria (Southern Germany) for an initial consultation. Using a randomized controlled design, families were randomly allocated to either an intervention group (IG; 73/136, 53.7%) or a waitlist control group (WCG; 63/136, 46.3%) during the usual waiting time until consultation. The IG was given a psychoeducational app that included evidence-based information via text and videos, a child behavior diary function, a parent chat forum and experience report, tips on relaxation, an emergency plan, and a regional directory of specialized counseling centers. Outcome variables were assessed using validated questionnaires at baseline test and posttest. Both groups were compared at posttest regarding changes in parenting stress (primary outcome) and secondary outcomes, namely knowledge about crying, sleeping, and feeding problems; perceived self-efficacy; perceived social support; and child symptoms. Results: The mean individual study duration was 23.41 (SD 10.42) days. The IG reported significantly lower levels of parenting stress (mean 83.18, SD 19.94) after app use compared with the WCG (mean 87.46, SD 16.67; P=.03; Cohen d=0.23). Furthermore, parents in the IG reported a higher level of knowledge about crying, sleeping, and feeding (mean 62.91, SD 4.30) than those in the WCG (mean 61.15, SD 4.46; P<.001; Cohen d=0.38). No differences at posttest were found between groups in terms of parental efficacy (P=.34; Cohen d=0.05), perceived social support (P=.66; Cohen d=0.04), and child symptoms (P=.35; Cohen d=0.10). Conclusions: This study provides initial evidence of the efficacy of a psychoeducational app for parents with child crying, sleeping, and feeding problems. By reducing parental stress and increasing knowledge of children’s symptoms, the app has the potential to serve as an effective secondary preventive measure. Additional large-scale studies are needed to investigate long-term benefits. Trial Registration: German Clinical Trials Register DRKS00019001; https://drks.de/search/en/trial/DRKS00019001 %M 36897641 %R 10.2196/41804 %U https://mhealth.jmir.org/2023/1/e41804 %U https://doi.org/10.2196/41804 %U http://www.ncbi.nlm.nih.gov/pubmed/36897641 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e37351 %T Text Messages Exchanged Between Individuals With Opioid Use Disorder and Their mHealth e-Coaches: Content Analysis Study %A Ranjit,Yerina S %A Davis,Warren M %A Fentem,Andrea %A Riordan,Raven %A Roscoe,Rikki %A Cavazos-Rehg,Patricia %+ Department of Communication, University of Missouri, 207 Switzler Hall, Columbia, MO, 65211, United States, 1 573 882 4431, ranjity@missouri.edu %K opioid use disorder %K opioid %K opium %K overdose %K drug %K substance use %K content analysis %K text message intervention %K text message %K text messaging %K mobile health %K mHealth %K social support %K e-coach %K counseling %K mental health %K depression %K recovery support %K eHealth %K digital health %D 2023 %7 10.3.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Opioid use disorder (OUD) has affected 2.2 million people in the United States. About 7.2 million people reported using illicit drugs in 2019, which contributed to over 70,000 overdose deaths. SMS text messaging interventions have been shown to be effective in OUD recovery. However, the interpersonal communication between individuals in OUD treatment and a support team on digital platforms has not been well examined. Objective: This study aims to understand the communication between participants undergoing OUD recovery and their e-coaches by examining the SMS text messages exchanged from the lens of social support and the issues related to OUD treatment. Methods: A content analysis of messages exchanged between individuals recovering from OUD and members of a support team was conducted. Participants were enrolled in a mobile health intervention titled “uMAT-R,” a primary feature of which is the ability for patients to instantly connect with a recovery support staff or an “e-coach” via in-app messaging. Our team analyzed dyadic text-based messages of over 12 months. In total, 70 participants’ messages and 1196 unique messages were analyzed using a social support framework and OUD recovery topics. Results: Out of 70 participants, 44 (63%) were between the ages of 31 and 50 years, 47 (67%) were female, 41 (59%) were Caucasian, and 42 (60%) reported living in unstable housing conditions. An average of 17 (SD 16.05) messages were exchanged between each participant and their e-coach. Out of 1196 messages, 64% (n=766) messages were sent by e-coaches and 36% (n=430) by participants. Messages of emotional support occurred the most, with 196 occurrences (n=9, 0.8%) and e-coaches (n=187, 15.6%). Messages of material support had 110 occurrences (participants: n=8, 0.7%; e-coaches: n=102, 8.5%). With OUD recovery topics, opioid use risk factors appeared in most (n=72) occurrences (patient: n=66, 5.5%; e-coach: n=6, 0.5%), followed by a message of avoidance of drug use 3.9% (n=47), which occurred mainly from participants. Depression was correlated with messages of social support (r=0.27; P=.02). Conclusions: Individuals with OUD who had mobile health needs tended to engage in instant messaging with the recovery support staff. Participants who are engaged in messaging often engage in conversations around risk factors and avoidance of drug use. Instant messaging services can be instrumental in providing the social and educational support needs of individuals recovering from OUD. %M 36897632 %R 10.2196/37351 %U https://humanfactors.jmir.org/2023/1/e37351 %U https://doi.org/10.2196/37351 %U http://www.ncbi.nlm.nih.gov/pubmed/36897632 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44254 %T Implementing an Activity Tracker to Increase Motivation for Physical Activity in Patients With Diabetes in Primary Care: Strengths, Weaknesses, Opportunities and Threats (SWOT) Analysis %A Pelletier,Cynthia %A Chabot,Christian %A Gagnon,Marie-Pierre %A Rhéaume,Caroline %+ Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Local 4617, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Québec, QC, G1V 0A6, Canada, 1 418 656 8711 ext 5172, caroline.rheaume@fmed.ulaval.ca %K activity tracker %K type 2 diabetes %K family medicine research %K SWOT analysis %K physical activity %K physical activity motivation %K diabetes %K implementation %K chronic disease %K intervention %K questionnaire %K tool %D 2023 %7 10.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Many projects related to technology implementation in the context of chronic diseases have been developed over the years to better manage lifestyle medicine interventions and improve patient care. However, technology implementation in primary care settings remains challenging. Objective: The aim is to carry out a strengths, weaknesses, opportunities, and threats (SWOT) analysis (1) to assess satisfaction among patients with type 2 diabetes using an activity tracker to increase motivation for physical activity (PA) and (2) to explore the research and health care team’s perceptions of this technology’s implementation in a primary care setting. Methods: A 3-month hybrid type 1 study, which included 2 stages, was conducted in an academic primary health center in Quebec City, Quebec, Canada. In stage 1, a total of 30 patients with type 2 diabetes were randomized to the intervention (activity tracker) group or the control group. In stage 2, a SWOT analysis was performed on both patients and health care professionals to determine the components of successful technology implementation. Two questionnaires were used to gather feedback: a satisfaction and acceptability questionnaire concerning an activity tracker (15 patients in the intervention group) and a questionnaire based on the SWOT elements (15 patients in the intervention group and 7 health care professionals). Both questionnaires contained quantitative and qualitative questions. Qualitative variables from open questions were synthesized in a matrix and ranked according to apparition frequency and global importance. A thematic analysis was performed by the first author and validated by 2 coauthors separately. The information gathered was triangulated to propose recommendations that were then approved by the team. Both quantitative (randomized controlled trial participants) and qualitative (randomized controlled trial participants and team) results were combined for recommendations. Results: In total, 86% (12/14) of the participants were satisfied with their activity tracker use and 75% (9/12) felt that it incited them to stick to their PA program. The main strengths of the team members’ perspectives were the project initiation and involvement of a patient partner, the study design, the team, and the device. The weaknesses were the budgetary constraints, the turnover, and the technical issues. The opportunities were the primary care setting, the loan of equipment, and common technology. The threats were recruitment issues, administrative challenges, technological difficulties, and a single research site. Conclusions: Patients with type 2 diabetes were satisfied with their activity tracker used to improve motivation for PA. Health care team members agreed that implementation can be done in primary care, but some challenges remain in using this technological tool in clinical practice regularly. Trial Registration: ClinicalTrials.gov NCT03709966; https://clinicaltrials.gov/ct2/show/NCT03709966 %M 36897642 %R 10.2196/44254 %U https://formative.jmir.org/2023/1/e44254 %U https://doi.org/10.2196/44254 %U http://www.ncbi.nlm.nih.gov/pubmed/36897642 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41768 %T Factors That Influence the Use of eHealth in Home Care: Scoping Review and Cross-sectional Survey %A Mathijssen,Elke %A de Lange,Wendela %A Bleijenberg,Nienke %A van Houwelingen,Thijs %A Jaarsma,Tiny %A Trappenburg,Jaap %A Westland,Heleen %+ The Healthcare Innovation Center, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, Netherlands, 31 627247920, E.G.E.Mathijssen-2@umcutrecht.nl %K eHealth %K digital health %K mHealth %K mobile applications %K telehealth %K telemedicine %K telecare %K implementation %K influencing factors %K home care %D 2023 %7 9.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In home care, eHealth implementation requires health care professionals and home care clients to change their behavior because they have to incorporate the use of eHealth into their daily routines. Knowledge of factors that influence the use of eHealth in home care is needed to optimize implementation strategies. However, a comprehensive overview of such factors is lacking. Objective: The aims of this study were to (1) provide insight into the types of eHealth that are used and preferred in home care and (2) identify factors that influence the use of eHealth in home care according to health care professionals and home care clients. Methods: A scoping review and online, cross-sectional survey were conducted sequentially. The survey was conducted among Dutch health care professionals with a nursing background who were working for a home care organization at the time. The capability, opportunity, motivation, behavior (COM-B) model, which posits that for any behavior (B) to occur, a person must have the capability (C), opportunity (O), and motivation (M) to perform the behavior, was used to identify influencing factors. The use of a theoretical model may contribute to a better understanding of how to achieve and sustain behavior change in clinical practice. Results: We included 30 studies in the scoping review. The most frequently studied type of eHealth was a telecommunication/telemonitoring system. The survey was completed by 102 participants. The most frequently used types of eHealth were electronic health records, social alarms, and online client portals. A health app was the most frequently preferred type of eHealth. We identified 22 factors that influence the use of eHealth in home care according to health care professionals and home care clients. Influencing factors were organized into the components of the COM-B model, namely capability (n=6), opportunity (n=10), and motivation (n=6). We found that there is no single influencing factor that is key to the complexity of eHealth implementation. Conclusions: Different types of eHealth are used, and many types of eHealth are preferred by health care professionals. The identified factors that influence the use of eHealth in home care relate to all components of the COM-B model. These factors need to be addressed and embedded in implementation strategies of eHealth to optimize the use of eHealth in home care. %M 36892935 %R 10.2196/41768 %U https://www.jmir.org/2023/1/e41768 %U https://doi.org/10.2196/41768 %U http://www.ncbi.nlm.nih.gov/pubmed/36892935 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e37873 %T Effectiveness of a Mobile App to Increase Risk Perception of Tobacco, Alcohol, and Marijuana Use in Mexican High School Students: Quantitative Study %A Fuentes A,Patricia María del Carmen %A Jiménez Tapia,Alberto %A Ruiz-Cortés,Eunice M %A Bolaños-Ceballos,Fernando %A Flores Castro,Julio César %A Gutiérrez,Rafael %A González-Forteza,Catalina %+ Direction of Epidemiological and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Calzada Mexico Xochimilco, 101, Mexico City, 14370, Mexico, 52 5541605154, alberjt1969@gmail.com %K adolescents %K students %K risk perception %K tobacco %K alcohol %K marijuana %K mobile apps %K apps %K substance use %K prevention %D 2023 %7 9.3.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Young people have the highest rate of drug use worldwide. Recent data from Mexico in this population show that the prevalence of illicit drug use doubled between 2011 and 2016 (2.9%-6.2%), with marijuana being the one with the highest increase (2.4%-5.3%), but also point out that alcohol and tobacco use have remained steady or decreased. Mexican adolescents are at high risk for drug use owing to a low perception of risk and the availability of drugs. Adolescence is an ideal period to reduce or prevent risky behaviors using evidence-based strategies. Objective: In this study, we aimed to test the short-term effectiveness of a mobile intervention app (“What Happens if you Go Too Far?” [“¿Qué pasa si te pasas?”]) that seeks to increase risk perception of tobacco, alcohol, and marijuana use in a sample of Mexican high school students. Methods: A nonexperimental evaluation based on pretest-posttest design was used to measure the effectiveness of a preventive intervention using a mobile app, “What Happens If You Go Too Far?” The dimensions analyzed were knowledge of drugs and their effects, life skills, self-esteem, and risk perception. The intervention was conducted on a high school campus with 356 first-year students. Results: The sample included 359 first-year high school students (mean 15, SD 0.588 years; women: 224/359, 62.4% men: 135/359, 37.6%). The intervention increased the overall risk perception of tobacco (χ24=21.6; P<.001) and alcohol use (χ24=15.3; P<.001). There was no significant difference in the perception that it is dangerous to smoke 5 cigarettes, and there was a marginal difference in the perception that it is very dangerous to smoke 1 cigarette or to use alcohol or marijuana. We used a generalized estimating equation method to determine the impact of the variables on risk perception. The results showed that knowledge about smoking increased the risk perception of smoking 1 cigarette (odds ratio [OR] 1.1065, 95% CI 1.013-1.120; P=.01), and that knowledge about marijuana use (OR 1.109, 95% CI 1.138-1.185; P=.002) and self-esteem (OR 1.102, 95% CI 1.007-1.206; P=.04) produced significant increases in the risk perception of consuming 5 cigarettes. Resistance to peer pressure and assertiveness also increased the perceived risk of using tobacco and alcohol. Conclusions: The intervention has the potential to increase the perception of risk toward drug use in high school students by providing knowledge about the effects and psychosocial risks of drug use and by strengthening life skills that are associated with increased risk perception. The use of mobile technologies in intervention processes may broaden the scope of preventive work for adolescents. %M 36892918 %R 10.2196/37873 %U https://mhealth.jmir.org/2023/1/e37873 %U https://doi.org/10.2196/37873 %U http://www.ncbi.nlm.nih.gov/pubmed/36892918 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e39645 %T Using Text Messages and Fotonovelas to Increase Return of Home-Mailed Colorectal Cancer Screening Tests: Mixed Methods Evaluation %A Levitz,Carly E %A Kuo,Elena %A Guo,Monica %A Ruiz,Esmeralda %A Torres-Ozadali,Evelyn %A Brar Prayaga,Rena %A Escaron,Anne %+ Center for Community Health and Evaluation, Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, United States, 1 2062872488, carly.e.levitz@kp.org %K colorectal cancer screening %K texting campaign %K patient navigation %K fotonovela %K fecal immunochemical test kit %K FIT kit %K screening %K cancer %K colorectal cancer %K CRC %K bidirectional texting %K health text messaging %K health promotion %K participation %K fotonovela %K comics %D 2023 %7 7.3.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Colorectal cancer (CRC) is currently the second leading cause of cancer-related deaths in the United States; however, it is mostly preventable with appropriate screening and is often treatable when detected at early stages. Many patients enrolled in an urban Federally Qualified Health Center (FQHC) clinic were found to be past due for CRC screening. Objective: This study described a quality improvement (QI) project to improve CRC screening rates. This project used bidirectional texting with fotonovela comics and natural language understanding (NLU) to encourage patients to mail fecal immunochemical test (FIT) kits back to the FQHC. Methods: The FQHC mailed FIT kits to 11,000 unscreened patients in July 2021. Consistent with the usual care, all patients received 2 text messages and a patient navigator call within the first month of mailing. As part of a QI project, 5241 patients who did not return their FIT kit within 3 months, aged 50-75 years, and spoke either English or Spanish were randomized to either usual care (no further intervention) or intervention (4-week texting campaign with a fotonovela comic and remailing kits if requested) groups. The fotonovela was developed to address known barriers to CRC screening. The texting campaign used NLU to respond to patients’ texts. A mixed methods evaluation used data from SMS text messages and electronic medical records to understand the impact of the QI project on CRC screening rates. Open-ended text messages were analyzed for themes, and interviews were completed with a convenience sample of patients to understand barriers to screening and impact of the fotonovela. Results: Of the 2597 participants, 1026 (39.5%) in the intervention group engaged with bidirectional texting. Participating in bidirectional texting was related to language preference (χ22=11.0; P=.004) and age group (χ22=19.0; P<.001). Of the 1026 participants who engaged bidirectionally, 318 (31%) clicked on the fotonovela. Furthermore, 54% (32/59) of the patients clicked on the fotonovela and responded that they loved it, and 36% (21/59) of patients responded that they liked it. The intervention group was more likely to get screened (487/2597, 18.75%) than those in usual care (308/2644, 11.65%; P<.001), and this pattern held, regardless of demographic subgroup (sex, age, screening history, preferred language, and payer type). Interview data (n=16) indicated that the text messages, navigator calls, and fotonovelas were well received and not unduly invasive. Interviewees noted several important barriers to CRC screening and offered suggestions for reducing barriers and increasing screening. Conclusions: Texting using NLU and fotonovela is valuable in increasing CRC screening as observed by the FIT return rate for patients in the intervention group. There were patterns in which patients did not engage bidirectionally; future work should investigate how to ensure that populations are not left out of screening campaigns. %M 36881466 %R 10.2196/39645 %U https://cancer.jmir.org/2023/1/e39645 %U https://doi.org/10.2196/39645 %U http://www.ncbi.nlm.nih.gov/pubmed/36881466 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e41088 %T Development of a Secondary Prevention Smartphone App for Students With Unhealthy Alcohol Use: Results From a Qualitative Assessment %A Bertholet,Nicolas %A Schmutz,Elodie %A Cunningham,John A %A McNeely,Jennifer %A Gmel,Gerhard %A Daeppen,Jean-Bernard %A Grazioli,Véronique S %+ Addiction Medicine Unit, Department of Psychiatry, Lausanne University Hospital, Bugnon 23 A, Lausanne, 1011, Switzerland, 41 0213148400, Nicolas.Bertholet@chuv.ch %K app %K alcohol-related secondary prevention %K university students %K tertiary students %K qualitative %K alcohol %K mHealth %K mobile app %K smartphone %K mobile phone %D 2023 %7 7.3.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Despite considerable efforts devoted to the development of prevention interventions aiming at reducing unhealthy alcohol use in tertiary students, their delivery remains often challenging. Interventions including information technology are promising given their potential to reach large parts of the population. Objective: This study aims to develop a secondary prevention smartphone app with an iterative qualitative design involving the target population. Methods: The app development process included testing a first prototype and a second prototype, developed based on the results of 2 consecutive qualitative assessments. Participants (aged ≥18 years, screened positive for unhealthy alcohol use) were students from 4 tertiary education institutions in the French-speaking part of Switzerland. Participants tested prototype 1 or prototype 2 or both and provided feedback in 1-to-1 semistructured interviews after 2-3 weeks of testing. Results: The mean age of the participants was 23.3 years. A total of 9 students (4/9 female) tested prototype 1 and participated in qualitative interviews. A total of 11 students (6/11 female) tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. Content analysis identified 6 main themes: “General Acceptance of the App,” “Importance of the Targeted and Relevant App Content,” “Importance of Credibility,” “Importance of the App Usability,” “Importance of a Simple and Attractive Design,” “Importance of Notifications to Ensure App Use over Time.” Besides a general acceptance of the app, these themes reflected participants’ recommendations toward increased usability; to improve the design; to include useful and rewarding contents; to make the app look serious and credible; and to add notifications to ensure its use over time. A total of 11 students tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. The 6 same themes emerged from the analysis. Participants from phase 1 generally found the design and content of the app improved. Conclusions: Students recommend prevention smartphone apps to be easy to use, useful, rewarding, serious, and credible. These findings may be important to consider when developing prevention smartphone apps to increase the likelihood of app use over time. Trial Registration: ISRCTN registry 10007691; https://www.isrctn.com/ISRCTN10007691 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-4145-2 %M 36881448 %R 10.2196/41088 %U https://humanfactors.jmir.org/2023/1/e41088 %U https://doi.org/10.2196/41088 %U http://www.ncbi.nlm.nih.gov/pubmed/36881448 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e35045 %T Comparison of a Daily Smartphone App and Retrospective Questionnaire Measures of Adherence to Nicotine Replacement Therapy Among Pregnant Women: Observational Study %A Emery,Joanne %A Huang,Yue %A Naughton,Felix %A Cooper,Sue %A McDaid,Lisa %A Dickinson,Anne %A Clark,Miranda %A Kinahan-Goodwin,Darren %A Thomson,Ross %A Phillips,Lucy %A Lewis,Sarah %A Coleman,Tim %+ School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom, 44 1603 456161, joanne.emery@uea.ac.uk %K smoking cessation %K pregnancy %K nicotine replacement therapy %K treatment adherence measurement %K smartphone app %K questionnaires %K ecological momentary assessment %K mHealth %K mobile health %K smoking %K nicotine %D 2023 %7 7.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Few studies have investigated how to best measure adherence to smoking cessation medications, but continuous usage measures are recommended. Objective: In this first study of its kind, we compared methods for measuring adherence to nicotine replacement therapy (NRT) among pregnant women, investigating the completeness and validity of data collected from daily assessments using a smartphone app versus data collected from retrospective questionnaires. Methods: Women aged ≥16 years who were daily smokers and <25 weeks pregnant were offered smoking-cessation counseling and encouraged to use NRT. For 28 days after setting a quit date (QD), women were asked to report NRT use daily to a smartphone app and to questionnaires administered in person or remotely at 7 and 28 days. For both data collection methods, we provided up to £25 (~US $30) as compensation for the time taken providing research data. Data completeness and NRT use reported to the app and in questionnaires were compared. For each method, we also correlated mean daily nicotine doses reported within 7 days of the QD with Day 7 saliva cotinine concentrations. Results: Of the 438 women assessed for eligibility, 40 participated and 35 accepted NRT. More participants (31/35) submitted NRT usage data to the app by Day 28 (median 25, IQR 11 days) than completed the Day 28 questionnaire (24/35) or either of the two questionnaires (27/35). Data submitted to the app showed a lower reported duration of NRT use compared to that indicated in the questionnaire (median for app 24 days, IQR 10.25; median for questionnaire 28 days, IQR 4.75; P=.007), and there appeared to be specific cases of overreporting to the questionnaire. Mean daily nicotine doses between the QD and Day 7 were lower when calculated using app data (median for app 40 mg, IQR 52.1; median for questionnaire 40 mg, IQR 63.1; P=.001), and some large outliers were evident for the questionnaire. Mean daily nicotine doses, adjusted for cigarettes smoked, were not associated with cotinine concentrations for either method (app rs=0.184, P=.55; questionnaire rs=0.031, P=.92), but the small sample size meant that the analysis was likely underpowered. Conclusions: Daily assessment of NRT use via a smartphone app facilitated more complete data (a higher response rate) than questionnaires, and reporting rates over 28 days were encouraging among pregnant women. App data had better face validity; retrospective questionnaires appeared to overestimate NRT use for some participants. %M 36881452 %R 10.2196/35045 %U https://formative.jmir.org/2023/1/e35045 %U https://doi.org/10.2196/35045 %U http://www.ncbi.nlm.nih.gov/pubmed/36881452 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e40898 %T Design Features Associated With Engagement in Mobile Health Physical Activity Interventions Among Youth: Systematic Review of Qualitative and Quantitative Studies %A Schwarz,Ayla %A Winkens,Laura H H %A de Vet,Emely %A Ossendrijver,Dian %A Bouwsema,Kirsten %A Simons,Monique %+ Department of Social Sciences, Chair Group Consumption & Healthy Lifestyles, Wageningen University & Research, Hollandseweg 1, Wageningen, 6706KN, Netherlands, 31 0639187108, ayla.schwarz@wur.nl %K systematic review %K youth %K physical activity %K design features %K engagement %K mHealth %K mobile health %K mobile phone %D 2023 %7 6.3.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Globally, 81% of youth do not meet the physical activity (PA) guidelines. Youth of families with a low socioeconomic position are less likely to meet the recommended PA guidelines. Mobile health (mHealth) interventions are preferred by youth over traditional in-person approaches and are in line with their media preferences. Despite the promise of mHealth interventions in promoting PA, a common challenge is to engage users in the long term or effectively. Earlier reviews highlighted the association of different design features (eg, notifications and rewards) with engagement among adults. However, little is known about which design features are important for increasing engagement among youth. Objective: To inform the design process of future mHealth tools, it is important to investigate the design features that can yield effective user engagement. This systematic review aimed to identify which design features are associated with engagement in mHealth PA interventions among youth who were aged between 4 and 18 years. Methods: A systematic search was conducted in EBSCOhost (MEDLINE, APA PsycINFO, and Psychology & Behavioral Sciences Collection) and Scopus. Qualitative and quantitative studies were included if they documented design features associated with engagement. Design features and related behavior change techniques and engagement measures were extracted. Study quality was assessed according to the Mixed Method Assessment Tool, and one-third of all screening and data extraction were double coded by a second reviewer. Results: Studies (n=21) showed that various features were associated with engagement, such as a clear interface, rewards, multiplayer game mode, social interaction, variety of challenges with personalized difficulty level, self-monitoring, and variety of customization options among others, including self-set goals, personalized feedback, progress, and a narrative. In contrast, various features need to be carefully considered while designing mHealth PA interventions, such as sounds, competition, instructions, notifications, virtual maps, or self-monitoring, facilitated by manual input. In addition, technical functionality can be considered as a prerequisite for engagement. Research addressing youth from low socioeconomic position families is very limited with regard to engagement in mHealth apps. Conclusions: Mismatches between different design features in terms of target group, study design, and content translation from behavior change techniques to design features are highlighted and set up in a design guideline and future research agenda. Trial Registration: PROSPERO CRD42021254989; https://tinyurl.com/5n6ppz24 %M 36877551 %R 10.2196/40898 %U https://mhealth.jmir.org/2023/1/e40898 %U https://doi.org/10.2196/40898 %U http://www.ncbi.nlm.nih.gov/pubmed/36877551 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44370 %T Improving Mental Health Literacy and Reducing Psychological Problems Among Teachers in Zambia: Protocol for Implementation and Evaluation of a Wellness4Teachers Email Messaging Program %A Agyapong,Belinda %A Chishimba,Charles %A Wei,Yifeng %A da Luz Dias,Raquel %A Eboreime,Ejemai %A Msidi,Eleanor %A Abidi,Syed Sibte Raza %A Mutaka-Loongo,Maryn %A Mwansa,James %A Orji,Rita %A Zulu,John Mathias %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor Abbie J. Lane Memorial Building QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 7802157771, agyapong@ualberta.ca %K burnout %K stress %K Zambia %K Africa %K teacher %K educator %K school %K anxiety %K wellness %K depression %K e-mental health %K intervention %K health literacy %K mental health %K depressive %K psychological issue %K psychological problem %K text message %K messaging %K decision-making %D 2023 %7 6.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Primary, basic, secondary, and high school teachers are constantly faced with increased work stressors that can result in psychological health challenges such as burnout, anxiety, and depression, and in some cases, physical health problems. It is presently unknown what the mental health literacy levels are or the prevalence and correlates of psychological issues among teachers in Zambia. It is also unknown if an email mental messaging program (Wellness4Teachers) would effectively reduce burnout and associated psychological problems and improve mental health literacy among teachers. Objective: The primary objectives of this study are to determine if daily supportive email messages plus weekly mental health literacy information delivered via email can help improve mental health literacy and reduce the prevalence of moderate to high stress symptoms, burnout, moderate to high anxiety symptoms, moderate to high depression symptoms, and low resilience among school teachers in Zambia. The secondary objectives of this study are to evaluate the baseline prevalence and correlates of moderate to high stress, burnout, moderate to high anxiety, moderate to high depression, and low resilience among school teachers in Zambia. Methods: This is a quantitative longitudinal and cross-sessional study. Data will be collected at the baseline (the onset of the program), 6 weeks, 3 months, 6 months (the program midpoint), and 12 months (the end point) using web-based surveys. Individual teachers will subscribe by accepting an invitation to do so from the Lusaka Apex Medical University organizational account on the ResilienceNHope web-based application. Data will be analyzed using SPSS version 25 with descriptive and inferential statistics. Outcome measures will be evaluated using standardized rating scales. Results: The Wellness4Teachers email program is expected to improve the participating teachers’ mental health literacy and well-being. It is anticipated that the prevalence of stress, burnout, anxiety, depression, and low resilience among teachers in Zambia will be similar to those reported in other jurisdictions. In addition, it is expected that demographic, socioeconomic, and organizational factors, class size, and grade teaching will be associated with burnout and other psychological disorders among teachers, as indicated in the literature. Results are expected 2 years after the program’s launch. Conclusions: The Wellness4Teachers email program will provide essential insight into the prevalence and correlates of psychological problems among teachers in Zambia and the program’s impact on subscribers’ mental health literacy and well-being. The outcome of this study will help inform policy and decision-making regarding psychological interventions for teachers in Zambia. International Registered Report Identifier (IRRID): PRR1-10.2196/44370 %M 36877571 %R 10.2196/44370 %U https://www.researchprotocols.org/2023/1/e44370 %U https://doi.org/10.2196/44370 %U http://www.ncbi.nlm.nih.gov/pubmed/36877571 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41443 %T A Smartphone Intervention to Promote a Sustainable Healthy Diet: Protocol for a Pilot Study %A Fresán,Ujué %A Bernard,Paquito %A Fabregues,Sergi %A Boronat,Anna %A Araújo-Soares,Vera %A König,Laura M %A Chevance,Guillaume %+ ISGlobal, Carrer Doctor Aiguader, 88, Barcelona, 08024, Spain, 34 93 214 7300, ujue.fresan@isglobal.org %K eating behavior change protocol %K sustainable diet %K dietary sustainability %K eating behavior change %K n-of-1 %K nutritional education %K eHealth %K mobile health %K mHealth %K mobile phone %D 2023 %7 2.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Changing current dietary patterns into sustainable healthy diets (ie, healthy diets with low environmental impact and socioeconomic fairness) is urgent. So far, few eating behavior change interventions have addressed all the dimensions of sustainable healthy diets at once and used cutting-edge methods from the field of digital health behavior change. Objective: The primary objectives of this pilot study were to assess the feasibility and effectiveness of an individual behavior change intervention toward the adoption of a more environmentally sustainable healthy diet as a whole and changes in specific relevant food groups, food waste, and obtaining food from fair sources. The secondary objectives included the identification of mechanisms of action that potentially mediate the effect of the intervention on behaviors, identification of potential spillover effects and covariations among different food outcomes, and identification of the role of socioeconomic status in behavior changes. Methods: We will run a series of ABA n-of-1 trials over a year, with the first A phase corresponding to a 2-week baseline evaluation, the B phase to a 22-week intervention, and the second A phase to a 24-week postintervention follow-up. We plan to enroll 21 participants from low, middle, and high socioeconomic statuses, with 7 from each socioeconomic group. The intervention will involve sending text messages and providing brief individualized web-based feedback sessions based on regular app-based assessments of eating behavior. The text messages will contain brief educational messages on human health and the environmental and socioeconomic effects of dietary choices; motivational messages to encourage the adoption of sustainable healthy diets by participants, providing tips to achieve their own behavioral goals; or links to recipes. Both quantitative and qualitative data will be collected. Quantitative data (eg, on eating behaviors and motivation) will be collected through self-reported questionnaires on several weekly bursts spread through the study. Qualitative data will be collected through 3 individual semistructured interviews before the intervention period, at the end of the intervention period, and at the end of the study. Analyses will be performed at both the individual and group levels depending on the outcome and objective. Results: The first participants were recruited in October 2022. The final results are expected by October 2023. Conclusions: The results of this pilot study will be useful for designing future larger interventions on individual behavior change for sustainable healthy diets. International Registered Report Identifier (IRRID): PRR1-10.2196/41443 %M 36862497 %R 10.2196/41443 %U https://www.researchprotocols.org/2023/1/e41443 %U https://doi.org/10.2196/41443 %U http://www.ncbi.nlm.nih.gov/pubmed/36862497 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40937 %T Digital Behavioral Activation Interventions During the Perinatal Period: Scoping Review %A Mancinelli,Elisa %A Dell'Arciprete,Gaia %A Pattarozzi,Davide %A Gabrielli,Silvia %A Salcuni,Silvia %+ Department of Developmental and Socialization Psychology, University of Padova, Via Venezia 8, Padova, 35121, Italy, 39 3342799698, elisa.mancinelli@phd.unipd.it %K behavioral activation %K eHealth %K perinatal care %K depression symptoms %K scoping review %K mobile phone %D 2023 %7 28.2.2023 %9 Review %J JMIR Pediatr Parent %G English %X Background: Pregnancy is a complex period that implies many biopsychosocial changes, and the way women adapt to these changes impacts their well-being and the chances of developing mental health problems. During the perinatal period, women have expressed a preference for support delivered on the web. In this regard, interventions such as behavioral activation (BA), which are brief and structured psychosocial interventions, seem particularly suited to be delivered through digital solutions. Objective: This study aimed to map the literature investigating digital BA interventions deployed during the perinatal period. We paid particular attention to the methodological underpinnings of the studies, the potential impact of BA interventions on symptoms other than depression, and the existence of differences occurring when these interventions were administered during pregnancy versus the postpartum period. Methods: A systematic search compliant with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines was conducted considering 5 bibliographic databases; reference lists and key journals were also screened by 2 independent authors following a double-blind approach. Results: A total of 7 studies published between 2013 and 2022 were included. In total, 2 studies were protocols for randomized controlled trials, 5 were empirical studies, and 1 was a qualitative study. All studies focused on the postpartum period, except for 1 that focused on the broader perinatal period. Promising effects on depression symptoms were reported but not on other psychosocial symptoms. Low intervention adherence has emerged, whereas the usability associated with the digital means used to deploy interventions was scarcely addressed; moreover, information on the digital platforms used was poorly reported overall. Conclusions: Our findings highlight the scarcity and preliminary nature of digital BA interventions deployed during the perinatal period, where the focus seems more on treatment rather than prevention. Moreover, future studies should also consider and address usability and user engagement, given their relevance to intervention efficacy. %M 36853756 %R 10.2196/40937 %U https://pediatrics.jmir.org/2023/1/e40937 %U https://doi.org/10.2196/40937 %U http://www.ncbi.nlm.nih.gov/pubmed/36853756 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e41239 %T Selection of and Response to Physical Activity–Based Social Comparisons in a Digital Environment: Series of Daily Assessment Studies %A Arigo,Danielle %A Gray,Robert C %A Dallal,Diane H %A Villareale,Jennifer %A Zhu,Jichen %+ Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, United States, 1 856 256 4500 ext 53775, arigo@rowan.edu %K social comparison %K physical activity %K motivation %K web platform %K selection %K exercise %K fitness %K mobile phone %D 2023 %7 27.2.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Innovative approaches are needed to understand barriers to and facilitators of physical activity among insufficiently active adults. Although social comparison processes (ie, self-evaluations relative to others) are often used to motivate physical activity in digital environments, user preferences and responses to comparison information are poorly understood. Objective: We used an iterative approach to better understand users’ selection of comparison targets, how they interacted with their selected targets, and how they responded to these targets. Methods: Across 3 studies, different samples of insufficiently active college students used the Fitbit system (Fitbit LLC) to track their steps per day as well as a separate, adaptive web platform each day for 7 to 9 days (N=112). The adaptive platform was designed with different layouts for each study; each allowed participants to select their preferred comparison target from various sets of options, view the desired amount of information about their selected target, and rate their physical activity motivation before and after viewing information about their selected target. Targets were presented as achieving physical activity at various levels below and above their own, which were accessed via the Fitbit system each day. We examined the types of comparison target selections, time spent viewing and number of elements viewed for each type of target, and day-level associations between comparison selections and physical activity outcomes (motivation and behavior). Results: Study 1 (n=5) demonstrated that the new web platform could be used as intended and that participants’ interactions with the platform (ie, the type of target selected, the time spent viewing the selected target’s profile, and the number of profile elements viewed) varied across the days. Studies 2 (n=53) and 3 (n=54) replicated these findings; in both studies, age was positively associated with time spent viewing the selected target’s profile and the number of profile elements viewed. Across all studies, upward targets (who had more steps per day than the participant) were selected more often than downward targets (who had fewer steps per day than the participant), although only a subset of either type of target selection was associated with benefits for physical activity motivation or behavior. Conclusions: Capturing physical activity–based social comparison preferences is feasible in an adaptive digital environment, and day-to-day differences in preferences for social comparison targets are associated with day-to-day changes in physical activity motivation and behavior. Findings show that participants only sometimes focus on the comparison opportunities that support their physical activity motivation or behavior, which helps explain previous, equivocal findings regarding the benefits of physical activity–based comparisons. Additional investigation of day-level determinants of comparison selections and responses is needed to fully understand how best to harness comparison processes in digital tools to promote physical activity. %M 36848204 %R 10.2196/41239 %U https://humanfactors.jmir.org/2023/1/e41239 %U https://doi.org/10.2196/41239 %U http://www.ncbi.nlm.nih.gov/pubmed/36848204 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43019 %T Development of an mHealth App to Support the Prevention of Sexually Transmitted Infections Among Black Men Who Have Sex With Men Engaged in Pre-exposure Prophylaxis Care in New Orleans, Louisiana: Qualitative User-Centered Design Study %A Clement,Meredith Edwards %A Lovett,Aish %A Caldwell,Sylvia %A Beckford,Jeremy %A Hilgart,Michelle %A Corneli,Amy %A Flickinger,Tabor %A Dillingham,Rebecca %A Ingersoll,Karen %+ Division of Infectious Diseases, Louisiana State University Health Sciences Center- New Orleans, 1542 Tulane Ave, Suite 331C, New Orleans, LA, 701120000, United States, 1 5045685204, mclem5@lsuhsc.edu %K pre-exposure prophylaxis %K HIV %K mobile apps %K mobile phone %D 2023 %7 27.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual health disparities exist for Black men who have sex with men (BMSM) in New Orleans, Louisiana. Rates of sexually transmitted infections (STIs) are high for both BMSM and those taking HIV pre-exposure prophylaxis (PrEP). Objective: In this study, we introduced an existing PrEP adherence app to new potential users—BMSM engaged in PrEP care in New Orleans—to guide app adaptation with STI prevention features and tailoring for the local context. Methods: Using a user-centered design, we conducted 4 focus group discussions (FGDs), with interim app adaptations from December 2020 to March 2021. During the FGDs, a video of the app, app website, and mock-ups were shown to participants. We asked about facilitators of and barriers to STI prevention in general, current app use, impressions of the existing app, new app features to potentially facilitate STI prevention, and how the app should be tailored for BMSM. We used applied qualitative thematic analysis to identify themes and needs of the population. Results: Overall, 4 FGDs were conducted with 24 BMSM taking PrEP. We grouped themes into 4 categories: STI prevention, current app use and preferences, preexisting features and impressions of the prep’d app, and new features and modifications for BMSM. Participants noted concern about STIs and shared that anxiety about some STIs was higher than that for others; some participants shared that since the emergence of PrEP, little thought is given to STIs. However, participants desired STI prevention strategies and suggested prevention methods to implement through the app, including access to resources, educational content, and sex diaries to follow their sexual activity. When discussing app preferences, they emphasized the need for an app to offer relevant features and be easy to use and expressed that some notifications were important to keep users engaged but that they should be limited to avoid notification fatigue. Participants thought that the current app was useful and generally liked the existing features, including the ability to communicate with providers, staff, and each other through the community forum. They had suggestions for modifications for STI prevention, such as the ability to comment on sexual encounters, and for tailoring to the local context, such as depictions of iconic sights from the area. Mental health emerged as an important need to be addressed through the app during discussion of almost all features. Participants also stressed the importance of ensuring privacy and reducing stigma through the app. Conclusions: A PrEP adherence app was iteratively adapted with feedback from BMSM, resulting in a new app modified for the New Orleans context and with STI prevention features. Participants gave the app a new name, PCheck, to be more discreet. Next steps will assess PCheck use and STI prevention outcomes. %M 36848209 %R 10.2196/43019 %U https://formative.jmir.org/2023/1/e43019 %U https://doi.org/10.2196/43019 %U http://www.ncbi.nlm.nih.gov/pubmed/36848209 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40207 %T Perceptions of Using Instant Messaging Apps for Alcohol Reduction Intervention Among University Student Drinkers: Semistructured Interview Study With Chinese University Students in Hong Kong %A Chau,Siu Long %A Wong,Yiu Cheong %A Zeng,Ying Pei %A Lee,Jung Jae %A Wang,Man Ping %+ School of Nursing, The University of Hong Kong, 5/F, Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong, Hong Kong, 852 3917 6636, mpwang@hku.hk %K instant messaging apps %K mobile phone %K WhatsApp %K alcohol reduction intervention %K alcohol use %K university students %K young adults %K instant messaging %K alcohol reduction %K adverse lifestyle %K intervention %K health promotion %K text messages %K health behaviours %K health behaviors %K apps %D 2023 %7 27.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile instant messaging (IM) apps (eg, WhatsApp and WeChat) have been widely used by the general population and are more interactive than text-based programs (SMS text messaging) to modify unhealthy lifestyles. Little is known about IM app use for health promotion, including alcohol reduction for university students. Objective: This study aims to explore university student drinkers' perceptions of using IM apps for alcohol reduction as they had high alcohol exposure (eg, drinking invitations from peers and alcohol promotion on campus) and the proportion of IM app use in Hong Kong. Methods: A qualitative study was conducted with 20 Hong Kong Chinese university students (current drinkers) with Alcohol Use Disorder Identification test scores of ≥8 recruited using purposive sampling. Semistructured individual interviews were conducted from September to October 2019. Interview questions focused on drinking behaviors, quitting history, opinions toward IM app use as an intervention tool, perceived usefulness of IM apps for alcohol reduction, and opinions on the content and design of IM apps for alcohol reduction. Each interview lasted approximately 1 hour. All interviews were audio-taped and transcribed verbatim. Two researchers independently analyzed the transcripts using thematic analysis with an additional investigator to verify the consistency of the coding. Results: Participants considered IM apps a feasible and acceptable platform for alcohol reduction intervention. They preferred to receive IMs based on personalized problem-solving and drinking consequences with credible sources. Other perceived important components of instant messages included providing psychosocial support in time and setting goals with participants to reduce drinking. They further provided suggestions on the designs of IM interventions, in which they preferred simple and concise messages, chat styles based on participants' preferences (eg, adding personalized emojis and stickers in the chat), and peers as counselors. Conclusions: Qualitative interviews with Chinese university student drinkers showed high acceptability, engagement, and perceived utility of IM apps for alcohol reduction intervention. IM intervention can be an alternative for alcohol reduction intervention apart from traditional text-based programs. The study has implications for developing the IM intervention for other unhealthy behaviors and highlights important topics that warrant future research, including substance use and physical inactivity. Trial Registration: ClinicalTrials.gov NCT04025151; https://clinicaltrials.gov/ct2/show/NCT04025151?term=NCT04025151 %M 36848207 %R 10.2196/40207 %U https://formative.jmir.org/2023/1/e40207 %U https://doi.org/10.2196/40207 %U http://www.ncbi.nlm.nih.gov/pubmed/36848207 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40789 %T Artificial Intelligence–Based Chatbots for Promoting Health Behavioral Changes: Systematic Review %A Aggarwal,Abhishek %A Tam,Cheuk Chi %A Wu,Dezhi %A Li,Xiaoming %A Qiao,Shan %+ Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene St, Columbia, SC, 29201, United States, 1 803 777 6844, SHANQIAO@mailbox.sc.edu %K chatbot %K artificial intelligence %K AI %K health behavior change %K engagement %K efficacy %K intervention %K feasibility %K usability %K acceptability %K mobile phone %D 2023 %7 24.2.2023 %9 Review %J J Med Internet Res %G English %X Background: Artificial intelligence (AI)–based chatbots can offer personalized, engaging, and on-demand health promotion interventions. Objective: The aim of this systematic review was to evaluate the feasibility, efficacy, and intervention characteristics of AI chatbots for promoting health behavior change. Methods: A comprehensive search was conducted in 7 bibliographic databases (PubMed, IEEE Xplore, ACM Digital Library, PsycINFO, Web of Science, Embase, and JMIR publications) for empirical articles published from 1980 to 2022 that evaluated the feasibility or efficacy of AI chatbots for behavior change. The screening, extraction, and analysis of the identified articles were performed by following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Of the 15 included studies, several demonstrated the high efficacy of AI chatbots in promoting healthy lifestyles (n=6, 40%), smoking cessation (n=4, 27%), treatment or medication adherence (n=2, 13%), and reduction in substance misuse (n=1, 7%). However, there were mixed results regarding feasibility, acceptability, and usability. Selected behavior change theories and expert consultation were used to develop the behavior change strategies of AI chatbots, including goal setting, monitoring, real-time reinforcement or feedback, and on-demand support. Real-time user-chatbot interaction data, such as user preferences and behavioral performance, were collected on the chatbot platform to identify ways of providing personalized services. The AI chatbots demonstrated potential for scalability by deployment through accessible devices and platforms (eg, smartphones and Facebook Messenger). The participants also reported that AI chatbots offered a nonjudgmental space for communicating sensitive information. However, the reported results need to be interpreted with caution because of the moderate to high risk of internal validity, insufficient description of AI techniques, and limitation for generalizability. Conclusions: AI chatbots have demonstrated the efficacy of health behavior change interventions among large and diverse populations; however, future studies need to adopt robust randomized control trials to establish definitive conclusions. %M 36826990 %R 10.2196/40789 %U https://www.jmir.org/2023/1/e40789 %U https://doi.org/10.2196/40789 %U http://www.ncbi.nlm.nih.gov/pubmed/36826990 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37987 %T Mobile Phone Apps for HIV Prevention Among College-Aged Black Women in Atlanta: Mixed Methods Study and User-Centered Prototype %A Tesema,Naomi %A Guillaume,Dominique %A Francis,Sherilyn %A Paul,Sudeshna %A Chandler,Rasheeta %+ Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, 30322, United States, 1 404 727 7980, dguilla@emory.edu %K Black women %K HIV prevention %K mobile health %K mHealth app %K mobile technology %K reproductive health %K women’s health %D 2023 %7 23.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Black women in college are disproportionately affected by HIV diagnoses. Mobile apps can facilitate the innovative delivery of accurate HIV and sexual and reproductive health information. However, mobile health interventions are severely underused in this population. Objective: We aimed to quantitatively and qualitatively explore the perspectives of college-aged Black women on using a mobile health app for HIV prevention and sexual and reproductive health. The data obtained from Black women were used to design preliminary mobile app wireframes and features. Methods: This explanatory, sequential mixed methods study took place from 2019 to 2020 and targeted Black women who were enrolled in college or who had recently graduated from college. Convenience sampling was used during the quantitative phase, followed by purposive sampling in the qualitative phase. A cross-sectional web-based survey evaluating the willingness to use a mobile app for HIV prevention was conducted in the quantitative phase. Descriptive statistics were used for all variables. A separate focus group discussion was conducted with Black women in college to expand on the quantitative results. Focus group discussions explored their perceptions on HIV and health content delivered through a mobile app along with potential features that participants desired within the app. Using the data obtained, we selected the primary features for the app prototype. Results: In total, we enrolled 34 participants in the survey, with 6 participating in focus group discussions. Over half of the respondents reported a willingness to use an app that contained pre-exposure prophylaxis content. Women who claimed recent sexual activity reported being more likely to use an app feature that would allow them to order an at-home HIV testing kit than their non–sexually active counterparts. The emerging themes from the focus group session were Black women’s health concerns, HIV risk, sources of health information, and preferred app features. The content in our prototype included speaking with a specialist, HIV and pre-exposure prophylaxis information, holistic wellness, and features promoting engagement and retention. Conclusions: The results of our study guided the design of wireframes for an app prototype targeting HIV prevention in college-aged Black women. The rapid growth of mobile devices in Black communities, coupled with high rates of smartphone ownership among Black youth, makes mobile health interventions a promising strategy for addressing sexual and reproductive health disparities. Participants in our sample were willing to use a culturally appropriate and gender-considerate app for their sexual health needs. Our findings indicate that Black women in college may be excellent candidates for mobile app–based interventions. %M 36821362 %R 10.2196/37987 %U https://formative.jmir.org/2023/1/e37987 %U https://doi.org/10.2196/37987 %U http://www.ncbi.nlm.nih.gov/pubmed/36821362 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e43885 %T Evaluating the Effects of the Supportive Parenting App on Infant Developmental Outcomes: Longitudinal Study %A Shorey,Shefaly %A Chong,Yap Seng %A Shi,Luming %A Chua,Jing Shi %A , %A Mathews,Jancy %A Lim,Siew Hoon %A Du,Ruochen %A Chan,Yiong Huak %A Tan,Thiam Chye %A Chee,Cornelia %A Law,Evelyn %+ Alice Lee Centre for Nursing Studies, National University of Singapore, Clinical Research Centre, Level 2, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 66011294, nurssh@nus.edu.sg %K infant development %K parenting %K mobile health technology %K social support %K psychoeducation %K peer support %K mobile phone %D 2023 %7 22.2.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Previous studies have investigated the various effects of parenting on infant developmental outcomes. In particular, parental stress and social support have been found to significantly affect the growth of the newborn. Although many parents today use mobile apps to obtain more support in parenting and perinatal care, few studies have examined how these apps could affect infant development. Objective: This study aimed to examine the effectiveness of the Supportive Parenting App (SPA) in improving infant developmental outcomes during the perinatal period. Methods: This study adopted a 2-group parallel prospective longitudinal design and recruited 200 infants and their parents (N=400 mothers and fathers). The parents were recruited at 24 weeks of gestation for a randomized controlled trial conducted from February 2020 to July 2022. They were randomly allocated to either the intervention or control group. The infant outcome measures included cognition, language, motor skills, and social-emotional development. Data were collected from the infants when they were aged 2, 4, 6, 9, and 12 months. Linear and modified Poisson regressions were used to analyze the data to examine between- and within-group changes. Results: At 9 and 12 months post partum, the infants in the intervention group were found to have better communication and language skills than those in the control group. An analysis of motor development revealed that a larger proportion of the infants in the control group fell under the at-risk category, where they scored approximately 2 SDs below the normative scores. The control group infants scored higher on the problem solving domain at 6 months post partum. However, at 12 months postpartum, the infants in the intervention group performed better on cognitive tasks than those in the control group. Despite not being statistically significant, the intervention group infants were found to have consistently scored better on the social components of the questionnaires than the control group infants. Conclusions: Overall, the infants whose parents had received the SPA intervention tended to fare better in most developmental outcome measures than those whose parents had received standard care only. The findings of this study suggest that the SPA intervention exerted positive effects on the communication, cognition, motor, and socioemotional development of the infants. Further research is needed to improve the content and support provided by the intervention to maximize the benefits gained by infants and their parents. Trial Registration: ClinicalTrials.gov NCT04706442; https://clinicaltrials.gov/ct2/show/NCT04706442 %M 36811952 %R 10.2196/43885 %U https://mhealth.jmir.org/2023/1/e43885 %U https://doi.org/10.2196/43885 %U http://www.ncbi.nlm.nih.gov/pubmed/36811952 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42935 %T Association Between the Severity of Depressive Symptoms and Human-Smartphone Interactions: Longitudinal Study %A Yang,Xiao %A Knights,Jonathan %A Bangieva,Victoria %A Kambhampati,Vinayak %+ Mindstrong Health, 101 Jefferson Dr. Suite 228, Menlo Park, CA, 94025, United States, 1 8889952230, vwendy@gmail.com %K depression %K human-smartphone interaction %K longitudinal data analysis %K within-person effect %K between-person effect %K nonergodicity %D 2023 %7 22.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Various behavioral sensing research studies have found that depressive symptoms are associated with human-smartphone interaction behaviors, including lack of diversity in unique physical locations, entropy of time spent in each location, sleep disruption, session duration, and typing speed. These behavioral measures are often tested against the total score of depressive symptoms, and the recommended practice to disaggregate within- and between-person effects in longitudinal data is often neglected. Objective: We aimed to understand depression as a multidimensional process and explore the association between specific dimensions and behavioral measures computed from passively sensed human-smartphone interactions. We also aimed to highlight the nonergodicity in psychological processes and the importance of disaggregating within- and between-person effects in the analysis. Methods: Data used in this study were collected by Mindstrong Health, a telehealth provider that focuses on individuals with serious mental illness. Depressive symptoms were measured by the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult Survey every 60 days for a year. Participants’ interactions with their smartphones were passively recorded, and 5 behavioral measures were developed and were expected to be associated with depressive symptoms according to either theoretical proposition or previous empirical evidence. Multilevel modeling was used to explore the longitudinal relations between the severity of depressive symptoms and these behavioral measures. Furthermore, within- and between-person effects were disaggregated to accommodate the nonergodicity commonly found in psychological processes. Results: This study included 982 records of DSM Level 1 depressive symptom measurements and corresponding human-smartphone interaction data from 142 participants (age range 29-77 years; mean age 55.1 years, SD 10.8 years; 96 female participants). Loss of interest in pleasurable activities was associated with app count (γ10=−0.14; P=.01; within-person effect). Depressed mood was associated with typing time interval (γ05=0.88; P=.047; within-person effect) and session duration (γ05=−0.37; P=.03; between-person effect). Conclusions: This study contributes new evidence for associations between human-smartphone interaction behaviors and the severity of depressive symptoms from a dimensional perspective, and it highlights the importance of considering the nonergodicity of psychological processes and analyzing the within- and between-person effects separately. %M 36811951 %R 10.2196/42935 %U https://formative.jmir.org/2023/1/e42935 %U https://doi.org/10.2196/42935 %U http://www.ncbi.nlm.nih.gov/pubmed/36811951 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44205 %T Using a Safety Planning Mobile App to Address Suicidality in Young People Attending Community Mental Health Services in Ireland: Protocol for a Pilot Randomized Controlled Trial %A Melia,Ruth %A Francis,Kady %A Duggan,Jim %A Bogue,John %A O'Sullivan,Mary %A Young,Karen %A Chambers,Derek %A McInerney,Shane J %A O'Dea,Edmond %A Bernert,Rebecca %+ Department of Psychology, University of Limerick, Castletroy, Limerick, V94 T9PX, Ireland, 353 61 202 700, ruth.melia@ul.ie %K suicide prevention %K mobile health %K mHealth %K safety planning %K SafePlan %K mobile phone %D 2023 %7 21.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Over 700,000 people die by suicide annually, making it the fourth leading cause of death among those aged 15-29 years globally. Safety planning is recommended best practice when individuals at risk of suicide present to health services. A safety plan, developed in collaboration with a health care practitioner, details the steps to be taken in an emotional crisis. SafePlan, a safety planning mobile app, was designed to support young people experiencing suicidal thoughts and behaviors and to record their plan in a way that is accessible immediately and in situ. Objective: The aim of this study is to assess the feasibility and acceptability of the SafePlan mobile app for patients experiencing suicidal thoughts and behaviors and their clinicians within Irish community mental health services, examine the feasibility of study procedures for both patients and clinicians, and determine if the SafePlan condition yields superior outcomes when compared with the control condition. Methods: A total of 80 participants aged 16-35 years accessing Irish mental health services will be randomized (1:1) to receive the SafePlan app plus treatment as usual or treatment as usual plus a paper-based safety plan. The feasibility and acceptability of the SafePlan app and study procedures will be evaluated using both qualitative and quantitative methodologies. The primary outcomes are feasibility outcomes and include the acceptability of the app to participants and clinicians, the feasibility of delivery in this setting, recruitment, retention, and app use. The feasibility and acceptability of the following measures in a full randomized controlled trial will also be assessed: the Beck Scale for Suicide Ideation, Columbia Suicide Severity Rating Scale, Coping Self-Efficacy Scale, Interpersonal Needs Questionnaire, and Client Service Receipt Inventory. A repeated measures design with outcome data collected at baseline, post intervention (8 weeks), and at 6-month follow-up will be used to compare changes in suicidal ideation for the intervention condition relative to the waitlist control condition. A cost-outcome description will also be undertaken. Thematic analyses will be used to analyze the qualitative data gathered through semistructured interviews with patients and clinicians. Results: As of January 2023, funding and ethics approval have been acquired, and clinician champions across mental health service sites have been established. Data collection is expected to commence by April 2023. The submission of completed manuscript is expected by April 2025. Conclusions: The framework for Decision-making after Pilot and feasibility Trials will inform the decision to progress to a full trial. The results will inform patients, researchers, clinicians, and health services of the feasibility and acceptability of the SafePlan app in community mental health services. The findings will have implications for further research and policy regarding the broader integration of safety planning apps. Trial Registration: OSF Registries osf.io/3y54m; https://osf.io/3y54m International Registered Report Identifier (IRRID): PRR1-10.2196/44205 %M 36809171 %R 10.2196/44205 %U https://www.researchprotocols.org/2023/1/e44205 %U https://doi.org/10.2196/44205 %U http://www.ncbi.nlm.nih.gov/pubmed/36809171 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e40736 %T Associations Between Product Type and Intensity of Tobacco and Cannabis Co-use on the Same Day Among Young Adult Smokers: Smartphone-Based Daily-Diary Study %A Nguyen,Nhung %A Thrul,Johannes %A Neilands,Torsten B %A Ling,Pamela M %+ Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Ave, San Francisco, CA, 94143, United States, 1 415 476 2265, Nhung.Nguyen@ucsf.edu %K tobacco %K cannabis %K substance co-use %K young adults %K intensive longitudinal data %K EMA %K mHealth %K smartphone-based data collection %K data collection %K smartphone data %K substance use %D 2023 %7 20.2.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Co-use of tobacco and cannabis is highly prevalent among young US adults. Same-day co-use of tobacco and cannabis (ie, use of both substances on the same day) may increase the extent of use and negative health consequences among young adults. However, much remains unknown about same-day co-use of tobacco and cannabis, in part due to challenges in measuring this complex behavior. Nuanced understanding of tobacco and cannabis co-use in terms of specific products and intensity (ie, quantity of tobacco and cannabis use within a day) is critical to inform prevention and intervention efforts. Objective: We used a daily-diary data collection method via smartphone to capture occurrence of tobacco and cannabis co-use within a day. We examined (1) whether the same route of administration would facilitate co-use of 2 substances on the same day and (2) whether participants would use more tobacco on a day when they use more cannabis. Methods: This smartphone-based study collected 2891 daily assessments from 147 cigarette smokers (aged 18-26 years, n=76, 51.7% female) during 30 consecutive days. Daily assessments measured type (ie, cigarette, cigarillo, or e-cigarette) and intensity (ie, number of cigarettes or cigarillos smoked or number of times vaping e-cigarettes per day) of tobacco use and type (ie, combustible, vaporized, or edible) and intensity (ie, number of times used per day) of cannabis use. We estimated multilevel models to examine day-level associations between types of cannabis use and each type of tobacco use, as well as day-level associations between intensities of using cannabis and tobacco. All models controlled for demographic covariates, day-level alcohol use, and time effects (ie, study day and weekend vs weekday). Results: Same-day co-use was reported in 989 of the total 2891 daily assessments (34.2%). Co-use of cigarettes and combustible cannabis (885 of the 2891 daily assessments; 30.6%) was most commonly reported. Participants had higher odds of using cigarettes (adjusted odds ratio [AOR] 1.92, 95% CI 1.31-2.81) and cigarillos (AOR 244.29, 95% CI 35.51-1680.62) on days when they used combustible cannabis. Notably, participants had higher odds of using e-cigarettes on days when they used vaporized cannabis (AOR 23.21, 95% CI 8.66-62.24). Participants reported a greater intensity of using cigarettes (AOR 1.35, 95% CI 1.23-1.48), cigarillos (AOR 2.04, 95% CI 1.70-2.46), and e-cigarettes (AOR 1.48, 95% CI 1.16-1.88) on days when they used more cannabis. Conclusions: Types and intensities of tobacco and cannabis use within a day among young adult smokers were positively correlated, including co-use of vaporized products. Prevention and intervention efforts should address co-use and pay attention to all forms of use and timeframes of co-use (eg, within a day or at the same time), including co-use of e-cigarettes and vaporized cannabis, to reduce negative health outcomes. %M 36806440 %R 10.2196/40736 %U https://mhealth.jmir.org/2023/1/e40736 %U https://doi.org/10.2196/40736 %U http://www.ncbi.nlm.nih.gov/pubmed/36806440 %0 Journal Article %I %V %N %P %T %D %7 .. %9 %J %G English %X %U %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44123 %T The Feasibility of Using Smartphone Sensors to Track Insomnia, Depression, and Anxiety in Adults and Young Adults: Narrative Review %A Alamoudi,Doaa %A Breeze,Emma %A Crawley,Esther %A Nabney,Ian %+ Department of Computer Science, University of Bristol, Merchant Venturers’ Building, Woodland Road, Bristol, BS8 1UB, United Kingdom, 44 117 928 3000, d.alamoudi@bristol.ac.uk %K mHealth %K digital %K health %K mental health %K insomnia %K technology %K sleep %K risk %K cardiovascular disease %K diabetes %K men %K mortality %K sleep disorder %K anxiety %K depression %K heart disease %K obesity %K dementia %K sensor %K intervention %K young adult %D 2023 %7 17.2.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Since the era of smartphones started in early 2007, they have steadily turned into an accepted part of our lives. Poor sleep is a health problem that needs to be closely monitored before it causes severe mental health problems, such as anxiety or depression. Sleep disorders (eg, acute insomnia) can also develop to chronic insomnia if not treated early. More specifically, mental health problems have been recognized to have casual links to anxiety, depression, heart disease, obesity, dementia, diabetes, and cancer. Several researchers have used mobile sensors to monitor sleep and to study changes in individual mood that may cause depression and anxiety. Objective: Extreme sleepiness and insomnia not only influence physical health, they also have a significant impact on mental health, such as by causing depression, which has a prevalence of 18% to 21% among young adults aged 16 to 24 in the United Kingdom. The main body of this narrative review explores how passive data collection through smartphone sensors can be used in predicting anxiety and depression. Methods: A narrative review of the English language literature was performed. We investigated the use of smartphone sensors as a method of collecting data from individuals, regardless of whether the data source was active or passive. Articles were found from a search of Google Scholar records (from 2013 to 2020) with keywords including “mobile phone,” “mobile applications,” “health apps,” “insomnia,” “mental health,” “sleep monitoring,” “depression,” “anxiety,” “sleep disorder,” “lack of sleep,” “digital phenotyping,” “mobile sensing,” “smartphone sensors,” and “sleep detector.” Results: The 12 articles presented in this paper explain the current practices of using smartphone sensors for tracking sleep patterns and detecting changes in mental health, especially depression and anxiety over a period of time. Several researchers have been exploring technological methods to detect sleep using smartphone sensors. Researchers have also investigated changes in smartphone sensors and linked them with mental health and well-being. Conclusions: The conducted review provides an overview of the possibilities of using smartphone sensors unobtrusively to collect data related to sleeping pattern, depression, and anxiety. This provides a unique research opportunity to use smartphone sensors to detect insomnia and provide early detection or intervention for mental health problems such as depression and anxiety if insomnia is detected. %M 36800211 %R 10.2196/44123 %U https://mhealth.jmir.org/2023/1/e44123 %U https://doi.org/10.2196/44123 %U http://www.ncbi.nlm.nih.gov/pubmed/36800211 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40269 %T Evaluation of a Mobile-Based Immunization Decision Support System for Scheduling Age-Appropriate Vaccine Schedules for Children Younger Than 2 Years in Pakistan and Bangladesh: Lessons From a Multisite, Mixed Methods Study %A Siddiqi,Danya Arif %A Ali,Rozina Feroz %A Shah,Mubarak Taighoon %A Dharma,Vijay Kumar %A Khan,Anokhi Ali %A Roy,Tapash %A Chandir,Subhash %+ IRD Global, The Great Room, Level 10, One George Street, Singapore, 049145, Singapore, 1 4109295557, subhash.chandir@ird.global %K missed opportunities for vaccination %K mobile-based immunization decision support system %K catch-up immunizations %D 2023 %7 17.2.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Missed opportunities for vaccination (MOVs), that is, when children interact with the health system but fail to receive age-eligible vaccines, pose a crucial challenge for equitable and universal immunization coverage. Inaccurate interpretations of complex catch-up schedules by health workers contribute to MOVs. Objective: We assessed the feasibility of a mobile-based immunization decision support system (iDSS) to automatically construct age-appropriate vaccination schedules for children and to prevent MOVs. Methods: A sequential exploratory mixed methods study was conducted at 6 immunization centers in Pakistan and Bangladesh. An android-based iDSS that is packaged in the form of an application programming interface constructed age-appropriate immunization schedules for eligible children. The diagnostic accuracy of the iDSS was measured by comparing the schedules constructed by the iDSS with the gold standard of evaluation (World Health Organization–recommended Expanded Programme on Immunization schedule constructed by a vaccines expert). Preliminary estimates were collected on the number of MOVs among visiting children (caused by inaccurate vaccination scheduling by vaccinators) that could be reduced through iDSS by comparing the manual schedules constructed by vaccinators with the gold standard. Finally, the vaccinators’ understanding, perceived usability, and acceptability of the iDSS were determined through interviews with key informants. Results: From July 5, 2019, to April 11, 2020, a total of 6241 immunization visits were recorded from 4613 eligible children. Data were collected for 17,961 immunization doses for all antigens. The iDSS correctly scheduled 99.8% (17,932/17,961) of all age-appropriate immunization doses compared with the gold standard. In comparison, vaccinators correctly scheduled 96.8% (17,378/17,961) of all immunization doses. A total of 3.2% (583/17,961) of all due doses (across antigens) were missed in age-eligible children by the vaccinators across both countries. Vaccinators reported positively on the usefulness of iDSS, as well as the understanding and benefits of the technology. Conclusions: This study demonstrated the feasibility of a mobile-based iDSS to accurately construct age-appropriate vaccination schedules for children aged 0 to 23 months across multicountry and low- and middle-income country settings, and underscores its potential to increase immunization coverage and timeliness by eliminating MOVs. %M 36800221 %R 10.2196/40269 %U https://pediatrics.jmir.org/2023/1/e40269 %U https://doi.org/10.2196/40269 %U http://www.ncbi.nlm.nih.gov/pubmed/36800221 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40536 %T Feasibility and Acceptability of Wearable Cameras to Assess Self-care in People With Heart Failure: Pilot Study %A Askman,Sanna %A Löf,Marie %A Maddison,Ralph %A Nourse,Rebecca %+ Department of Health, Medicine and Caring Sciences, Linköping University, Norra Skolgatan 18, Malmö, 21152, Sweden, 46 0730773773, sanna.askman@hotmail.se %K heart failure %K HF %K life logging %K self-management %K cardiovascular disease %K wearable devices %K self management %K self-care %D 2023 %7 17.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Heart failure (HF) is a common chronic condition that affects over 26 million people worldwide. It is a progressive and debilitating disease with a broad symptom profile, intermittently marked by periods of acute decompensation. People with HF generally do not self-manage their condition well (eg, monitoring symptoms, taking medications regularly, physical activity, etc). A better understanding of self-care activities and what factors may indicate deterioration is warranted. Objective: The aim of this study was to determine the feasibility and acceptability of using wearable cameras to assess self-care activities in people with HF. The study objectives were to (1) explore whether changes in self-care activities could be identified prior to hospitalization and (2) determine the acceptability of wearable cameras to people with HF. Methods: A total of 30 people recently diagnosed with HF wore a camera for a maximum of 30 days; the camera took a photo every 30 seconds in the forward-facing direction. At the end of the study, all 30 participants were presented with 8 statements of acceptability, scored on a 5-point Likert scale. To determine whether camera images could identify changes in self-care activities and lifestyle risk factors before hospitalization, we analyzed images from participants (n=8) who were hospitalized during the 30-day study period. Images from the period immediately prior to hospitalization and a comparison were selected for each participant. Images were manually coded according to 9 different event categories relating to self-care and lifestyle risk factors, and events were compared between the 2 periods. Results: The participants reported high acceptability for wearing the cameras, as most strongly agreed or agreed that they were comfortable to wear (28/30, 93%) and easy to use (30/30, 100%). The results of the camera image analysis showed that participants undertook fewer activities of daily living (P=.008) and were more sedentary (P=.02) prior to being hospitalized, compared to a period nonadjacent to hospitalization. Conclusions: Adults with HF were accepting of using a wearable camera for periods within a 30-day time frame. Wearable cameras were a feasible approach for providing data on selected self-care activities and lifestyle risk factors for HF and offer the potential to be a valuable tool for improving our understanding of self-care. %M 36800215 %R 10.2196/40536 %U https://formative.jmir.org/2023/1/e40536 %U https://doi.org/10.2196/40536 %U http://www.ncbi.nlm.nih.gov/pubmed/36800215 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44468 %T Clinic-Integrated Smartphone App (JomPrEP) to Improve Uptake of HIV Testing and Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Malaysia: Mixed Methods Evaluation of Usability and Acceptability %A Shrestha,Roman %A Altice,Frederick L %A Khati,Antoine %A Azwa,Iskandar %A Gautam,Kamal %A Gupta,Sana %A Sullivan,Patrick Sean %A Ni,Zhao %A Kamarulzaman,Adeeba %A Phiphatkunarnon,Panyaphon %A Wickersham,Jeffrey A %+ Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road Unit 1101, Storrs, CT, 06269, United States, 1 8604862834, roman.shrestha@uconn.edu %K men who have sex with men %K mHealth %K HIV prevention %K pre-exposure prophylaxis %K mobile phone %K Malaysia %K MSM %K mobile health %K HIV %K prevention %K usability %K acceptability %K sexual minority %K gay %K homosexual %D 2023 %7 16.2.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: HIV disproportionately affects men who have sex with men (MSM). In Malaysia, where stigma and discrimination toward MSM are high, including in health care settings, mobile health (mHealth) platforms have the potential to open new frontiers in HIV prevention. Objective: We developed an innovative, clinic-integrated smartphone app called JomPrEP, which provides a virtual platform for Malaysian MSM to engage in HIV prevention services. In collaboration with the local clinics in Malaysia, JomPrEP offers a range of HIV prevention (ie, HIV testing and pre-exposure prophylaxis [PrEP]) and other support services (eg, referral to mental health support) without having to interface face to face with clinicians. This study evaluated the usability and acceptability of JomPrEP to deliver HIV prevention services for MSM in Malaysia. Methods: In total, 50 PrEP-naive MSM without HIV in Greater Kuala Lumpur, Malaysia, were recruited between March and April 2022. Participants used JomPrEP for a month and completed a postuse survey. The usability of the app and its features were assessed using self-report and objective measures (eg, app analytics, clinic dashboard). Acceptability was evaluated using the System Usability Scale (SUS). Results: The participants’ mean age was 27.9 (SD 5.3) years. Participants used JomPrEP for an average of 8 (SD 5.0) times during 30 days of testing, with each session lasting an average of 28 (SD 38.9) minutes. Of the 50 participants, 42 (84%) ordered an HIV self-testing (HIVST) kit using the app, of whom 18 (42%) ordered an HIVST more than once. Almost all participants (46/50, 92%) initiated PrEP using the app (same-day PrEP initiation: 30/46, 65%); of these, 16/46 (35%) participants chose PrEP e-consultation via the app (vs in-person consultation). Regarding PrEP dispensing, 18/46 (39%) participants chose to receive their PrEP via mail delivery (vs pharmacy pickup). The app was rated as having high acceptability with a mean score of 73.8 (SD 10.1) on the SUS. Conclusions: JomPrEP was found to be a highly feasible and acceptable tool for MSM in Malaysia to access HIV prevention services quickly and conveniently. A broader, randomized controlled trial is warranted to evaluate its efficacy on HIV prevention outcomes among MSM in Malaysia. Trial Registration: ClinicalTrials.gov NCT05052411; https://clinicaltrials.gov/ct2/show/NCT05052411 International Registered Report Identifier (IRRID): RR2-10.2196/43318 %M 36795465 %R 10.2196/44468 %U https://mhealth.jmir.org/2023/1/e44468 %U https://doi.org/10.2196/44468 %U http://www.ncbi.nlm.nih.gov/pubmed/36795465 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e42396 %T Cost-effectiveness of Digital Tools for Behavior Change Interventions Among People With Chronic Diseases: Systematic Review %A Kyaw,Tun Lin %A Ng,Nawi %A Theocharaki,Margarita %A Wennberg,Patrik %A Sahlen,Klas-Göran %+ Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Universitetstorget 4, Umeå, SE-901 87, Sweden, 46 764229739, tunlinnkyawrcs@gmail.com %K digital tools %K chronic diseases %K cost-effectiveness %K lifestyle %K behavior %K systematic review %K mobile phone %D 2023 %7 16.2.2023 %9 Review %J Interact J Med Res %G English %X Background: Chronic diseases, including cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, and cerebrovascular diseases, contribute to the most significant disease burden worldwide, negatively impacting patients and their family members. People with chronic diseases have common modifiable behavioral risk factors, including smoking, alcohol overconsumption, and unhealthy diets. Digital-based interventions for promoting and sustaining behavioral changes have flourished in recent years, although evidence of the cost-effectiveness of such interventions remains inconclusive. Objective: In this study, we aimed to investigate the cost-effectiveness of digital health interventions for behavioral changes among people with chronic diseases. Methods: This systematic review evaluated published studies focused on the economic evaluation of digital tools for behavioral change among adults with chronic diseases. We followed the Population, Intervention, Comparator, and Outcomes framework to retrieve relevant publications from 4 databases: PubMed, CINAHL, Scopus, and Web of Science. We used the Joanna Briggs Institute’s criteria for economic evaluation and randomized controlled trials to assess the risk of bias in the studies. Two researchers independently screened, assessed the quality, and extracted data from the studies selected for the review. Results: In total, 20 studies published between 2003 and 2021 fulfilled our inclusion criteria. All the studies were conducted in high-income countries. These studies used telephones, SMS text messaging, mobile health apps, and websites as digital tools for behavior change communication. Most digital tools for interventions focused on diet and nutrition (17/20, 85%) and physical activity (16/20, 80%), and a few focused on smoking and tobacco control (8/20, 40%), alcohol reduction (6/20, 30%), and reduction of salt intake (3/20, 15%). Most studies (17/20, 85%) used the health care payer perspective for economic analysis, and only 15% (3/20) used the societal perspective. Only 45% (9/20) of studies conducted a full economic evaluation. Most studies (7/20, 35%) based on full economic evaluation and 30% (6/20) of studies based on partial economic evaluation found digital health interventions to be cost-effective and cost-saving. Most studies had short follow-ups and failed to include proper indicators for economic evaluation, such as quality-adjusted life-years, disability-adjusted life-years, lack of discounting, and sensitivity analysis. Conclusions: Digital health interventions for behavioral change among people with chronic diseases are cost-effective in high-income settings and can therefore be scaled up. Similar evidence from low- and middle-income countries based on properly designed studies for cost-effectiveness evaluation is urgently required. A full economic evaluation is needed to provide robust evidence for the cost-effectiveness of digital health interventions and their potential for scaling up in a wider population. Future studies should follow the National Institute for Health and Clinical Excellence recommendations to take a societal perspective, apply discounting, address parameter uncertainty, and apply a lifelong time horizon. %M 36795470 %R 10.2196/42396 %U https://www.i-jmr.org/2023/1/e42396 %U https://doi.org/10.2196/42396 %U http://www.ncbi.nlm.nih.gov/pubmed/36795470 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44456 %T An mHealth Intervention to Reduce Gestational Obesity (mami-educ): Protocol for a Randomized Controlled Trial %A Chiarello,Delia Indira %A Pardo,Fabian %A Moya,Jessica %A Pino,Maricela %A Rodríguez,Andrea %A Araneda,María Eugenia %A Bertini,Ayleen %A Gutiérrez,Jaime %+ Cellular Signaling and Differentiation Laboratory, School of Medical Technology, Faculty of Medicine and Science, Universidad San Sebastián, Lota 2465, Santiago, 7510157, Chile, 56 (2) 22606855, delia.chiarello@uss.cl %K gestational obesity %K mHealth %K primary care %K randomized controlled trial %D 2023 %7 15.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The World Federation of Obesity warns that the main health problem of the next decade will be childhood obesity. It is known that factors such as gestational obesity produce profound effects on fetal programming and are strong predictors of overweight and obesity in children. Therefore, establishing healthy eating behaviors during pregnancy is the key to the primary prevention of the intergenerational transmission of obesity. Mobile health (mHealth) programs are potentially more effective than face-to-face interventions, especially during a public health emergency such as the COVID-19 outbreak. Objective: This study aims to evaluate the effectiveness of an mHealth intervention to reduce excessive weight gain in pregnant women who attend family health care centers. Methods: The design of the intervention corresponds to a classic randomized clinical trial. The participants are pregnant women in the first trimester of pregnancy who live in urban and semiurban areas. Before starting the intervention, a survey will be applied to identify the barriers and facilitators perceived by pregnant women to adopt healthy eating behaviors. The dietary intake will be estimated in the same way. The intervention will last for 12 weeks and consists of sending messages through a multimedia messaging service with food education, addressing the 3 domains of learning (cognitive, affective, and psychomotor). Descriptive statistics will be used to analyze the demographic, socioeconomic, and obstetric characteristics of the respondents. The analysis strategy follows the intention-to-treat principle. Logistic regression analysis will be used to compare the intervention with routine care on maternal pregnancy outcome and perinatal outcome. Results: The recruitment of study participants began in May 2022 and will end in May 2023. Results include the effectiveness of the intervention in reducing the incidence of excessive gestational weight gain. We also will examine the maternal-fetal outcome as well as the barriers and facilitators that influence the weight gain of pregnant women. Conclusions: Data from this effectiveness trial will determine whether mami-educ successfully reduces rates of excessive weight gain during pregnancy. If successful, the findings of this study will generate knowledge to design and implement personalized prevention strategies for gestational obesity that can be included in routine primary care. Trial Registration: ClinicalTrials.gov NCT05114174; https://clinicaltrials.gov/ct2/show/NCT05114174 International Registered Report Identifier (IRRID): DERR1-10.2196/44456 %M 36790846 %R 10.2196/44456 %U https://www.researchprotocols.org/2023/1/e44456 %U https://doi.org/10.2196/44456 %U http://www.ncbi.nlm.nih.gov/pubmed/36790846 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42980 %T The Independent Walking for Brain Health Intervention for Older Adults: Protocol for a Pilot Randomized Controlled Trial %A Hays Weeks,Chelsea C %A Moore,Alison A %A Allison,Matthew %A Patrick,Kevin %A Bondi,Mark W %A Nebeker,Camille %A Liu,Thomas T %A Wing,David %A Higgins,Michael %A Hartman,Sheri J %A Rissman,Robert A %A Zlatar,Zvinka Z %+ Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, United States, 1 858 822 7737, zzlatar@health.ucsd.edu %K older adults %K seniors %K real world %K real time %K digital health %K feasibility %K brain perfusion %K cognition %K adaptive intervention %K exercise %K clinical trial %K mechanisms %D 2023 %7 13.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Extensive research suggests that physical activity (PA) is important for brain and cognitive health and may help to delay or prevent Alzheimer's disease and related dementias. Most PA interventions designed to improve brain health in older adults have been conducted in laboratory, gym, or group settings that require extensive resources and travel to the study site or group sessions. Research is needed to develop novel interventions that leverage mobile health (mHealth) technologies to help older adults increase their engagement in PA in free-living environments, reducing participant burden and increasing generalizability of research findings. Moreover, promoting engagement in moderate-to-vigorous PA (MVPA) may be most beneficial to brain health; thus, using mHealth to help older adults increase time spent in MVPA in free-living environments may help to offset the burden of Alzheimer's disease and related dementias and improve quality of life in older age. Objective: We developed a novel PA intervention that leverages mHealth to help older adults achieve more minutes of MVPA independently. This pilot study was a 12-week randomized controlled trial to investigate the feasibility of providing just-in-time (JIT) feedback about PA intensity during free-living exercise sessions to help older adults meet current PA recommendations (150 minutes per week of MVPA). Methods: Participants were eligible if they were cognitively healthy English speakers aged between 65 and 80 years without major cardiovascular, neurologic, or mental health conditions; could ambulate independently; and undergo magnetic resonance imaging. Enrollment occurred from October 2017 to March 2020. Participants randomized to the PA condition received an individualized exercise prescription and an mHealth device that provided heart rate–based JIT feedback on PA intensity, allowing them to adjust their behavior in real time to maintain MVPA during exercise sessions. Participants assigned to the healthy aging education condition received a reading prescription consisting of healthy aging topics and completed weekly quizzes based on the materials. Results: In total, 44 participants were randomized to the intervention. A follow-up manuscript will describe the results of the intervention as well as discuss screening, recruitment, adverse events, and participants’ opinions regarding their participation in the intervention. Conclusions: The long-term goal of this intervention is to better understand how MVPA affects brain and cognitive health in the real world and extend laboratory findings to everyday life. This pilot randomized controlled trial was conducted to determine the feasibility of using JIT heart rate zone feedback to help older adults independently increase time spent in MVPA while collecting data on the plausible mechanisms of change (frontal and medial temporal cerebral blood flow and cardiorespiratory fitness) that may affect cognition (memory and executive function) to help refine a planned stage 2 behavioral trial. Trial Registration: ClinicalTrials.gov NCT03058146; https://clinicaltrials.gov/ct2/show/NCT03058146 International Registered Report Identifier (IRRID): DERR1-10.2196/42980 %M 36535765 %R 10.2196/42980 %U https://www.researchprotocols.org/2023/1/e42980 %U https://doi.org/10.2196/42980 %U http://www.ncbi.nlm.nih.gov/pubmed/36535765 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41240 %T Tough Talks COVID-19 Digital Health Intervention for Vaccine Hesitancy Among Black Young Adults: Protocol for a Hybrid Type 1 Effectiveness Implementation Randomized Controlled Trial %A Budhwani,Henna %A Maragh-Bass,Allysha C %A Tolley,Elizabeth E %A Comello,Maria Leonora G %A Stoner,Marie C D %A Adams Larsen,Margo %A Brambilla,Donald %A Muessig,Kathryn E %A Pettifor,Audrey %A Bond,Christyenne L %A Toval,Christina %A Hightow-Weidman,Lisa B %+ Intervention Research and Implementation Science Lab, College of Nursing, Florida State University, 98 Varsity Way, Tallahassee, FL, 32306, United States, 1 8506443296, hbudhwani@fsu.edu %K COVID-19 %K COVID %K vaccine hesitancy framework %K African American %K young adults %K implementation science %K digital health %K mHealth %K behavioral intervention %K vaccination %K intervention %K mortality %K USA %D 2023 %7 13.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Interventions for increasing the uptake of COVID-19 vaccination among Black young adults are central to ending the pandemic. Black young adults experience harms from structural forces, such as racism and stigma, that reduce receptivity to traditional public health messaging due to skepticism and distrust. As such, Black young adults continue to represent a priority population on which to focus efforts for promoting COVID-19 vaccine uptake. Objective: In aims 1 and 2, the Tough Talks digital health intervention for HIV disclosure will be adapted to address COVID-19 vaccine hesitancy and tailored to the experiences of Black young adults in the southern United States (Tough Talks for COVID-19). In aim 3, the newly adapted Tough Talks for COVID-19 digital health intervention will be tested across the following three southern states: Alabama, Georgia, and North Carolina. Methods: Our innovative digital health intervention study will include qualitative and quantitative assessments. A unique combination of methodological techniques, including web-based surveys, choose-your-own-adventures, digital storytelling, user acceptability testing, and community-based participatory approaches, will culminate in a 2-arm hybrid type 1 effectiveness implementation randomized controlled trial, wherein participants will be randomized to the Tough Talks for COVID-19 intervention arm or a standard-of-care control condition (N=360). Logistic regression will be used to determine the effect of the treatment arm on the probability of vaccination uptake (primary COVID-19 vaccine series or recommended boosters). Concurrently, the inner and outer contexts of implementation will be ascertained and catalogued to inform future scale-up. Florida State University’s institutional review board approved the study (STUDY00003617). Results: Our study was funded at the end of April 2021. Aim 1 data collection concluded in early 2022. The entire study is expected to conclude in January 2025. Conclusions: If effective, our digital health intervention will be poised for broad, rapid dissemination to reduce COVID-19 mortality among unvaccinated Black young adults in the southern United States. Our findings will have the potential to inform efforts that seek to address medical mistrust through participatory approaches. The lessons learned from the conduct of our study could be instrumental in improving health care engagement among Black young adults for several critical areas that disproportionately harm this community, such as tobacco control and diabetes prevention. Trial Registration: ClinicalTrials.gov NCT05490329; https://clinicaltrials.gov/ct2/show/NCT05490329 International Registered Report Identifier (IRRID): DERR1-10.2196/41240 %M 36689557 %R 10.2196/41240 %U https://www.researchprotocols.org/2023/1/e41240 %U https://doi.org/10.2196/41240 %U http://www.ncbi.nlm.nih.gov/pubmed/36689557 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41298 %T Effectiveness of Digital Guided Self-help Mindfulness Training During Pregnancy on Maternal Psychological Distress and Infant Neuropsychological Development: Randomized Controlled Trial %A Zhang,Xuan %A Li,Yang %A Wang,Juan %A Mao,Fangxiang %A Wu,Liuliu %A Huang,Yongqi %A Sun,Jiwei %A Cao,Fenglin %+ School of Nursing and Rehabilitation, Shandong University, No.44 Wenhua Xi Road, Jinan, 250012, China, 86 53188382291, caofenglin2008@126.com %K digital %K mobile health %K mHealth %K guided self-help %K psychological distress %K pregnancy %K psychosocial intervention %K mindfulness %K infant %K neuropsychological performance %D 2023 %7 10.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Maternal psychological distress during pregnancy is associated with unfavorable outcomes in infants. Mindfulness-based interventions (MBIs) can effectively alleviate psychological distress, but there are often barriers to the access of face-to-face interventions. Objective: This study aimed to investigate the effectiveness of a digital guided self-help (GSH) MBI (GSH-MBI) in reducing maternal psychological distress and improving infant neuropsychological performance. Methods: This was a randomized controlled trial. We recruited 160 women who were 12 to 20 weeks pregnant and exhibited psychological distress. We randomized them into a digital GSH-MBI group and a control group (usual perinatal care). The digital GSH-MBI consisted of a 6-week intervention through a WeChat mini program, with a daily reminder sent to the participants by a research assistant via WeChat. The primary outcomes consisted of maternal psychological distress, including depression, anxiety, and pregnancy-related anxiety symptoms, which were assessed at 6 time points from baseline to 6 months post partum (only pregnancy-related anxiety symptoms were assessed 3 times during pregnancy). The secondary outcomes were infant neuropsychological outcomes, including temperament and developmental behaviors, which were assessed at 6 weeks and 6 months post partum. Results: Compared with the control group, the digital GSH-MBI group showed a significant reduction in depression, anxiety, and pregnancy-related anxiety symptoms. In addition, the scores of the digital GSH-MBI group were lower than those of the control group for the 3 types of infant temperament at 6 weeks post partum, including quality of mood, distractibility, and adaptability. Conclusions: Digital GSH-MBIs are effective in alleviating psychological distress among pregnant women and protecting infant outcomes. Trial Registration: Chinese Clinical Trial Register ChiCTR2000040717; https://www.chictr.org.cn/showproj.aspx?proj=65376 %M 36763452 %R 10.2196/41298 %U https://www.jmir.org/2023/1/e41298 %U https://doi.org/10.2196/41298 %U http://www.ncbi.nlm.nih.gov/pubmed/36763452 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39258 %T Digital Phenotyping Data to Predict Symptom Improvement and Mental Health App Personalization in College Students: Prospective Validation of a Predictive Model %A Currey,Danielle %A Torous,John %+ Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02446, United States, 1 6176676700, jtorous@gmail.com %K mHealth %K mental health %K smartphones %K phenotype %K symptom %K college %K students %K young adults %K responsive %K personalized %K app %K application %K intervention %K effectiveness %K protocol %K model %K digital %K engagement %K algorithm %K usage %D 2023 %7 9.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health apps offer a transformative means to increase access to scalable evidence-based care for college students. Yet low rates of engagement currently preclude the effectiveness of these apps. One promising solution is to make these apps more responsive and personalized through digital phenotyping methods able to predict symptoms and offer tailored interventions. Objective: Following our protocol and using the exact model shared in that paper, our primary aim in this study is to assess the prospective validity of mental health symptom prediction using the mindLAMP app through a replication study. We also explored secondary aims around app intervention personalization and correlations of engagement with the Technology Acceptance Model (TAM) and Digital Working Alliance Inventory scale in the context of automating the study. Methods: The study was 28 days in duration and followed the published protocol, with participants collecting digital phenotyping data and being offered optional scheduled and algorithm-recommended app interventions. Study compensation was tied to the completion of weekly surveys and was not otherwise tied to engagement or use of the app. Results: The data from 67 participants were used in this analysis. The area under the curve values for the symptom prediction model ranged from 0.58 for the UCLA Loneliness Scale to 0.71 for the Patient Health Questionnaire-9. Engagement with the scheduled app interventions was high, with a study mean of 73%, but few participants engaged with the optional recommended interventions. The perceived utility of the app in the TAM was higher (P=.01) among those completing at least one recommended intervention. Conclusions: Our results suggest how digital phenotyping methods can be used to create generalizable models that may help create more personalized and engaging mental health apps. Automating studies is feasible, and our results suggest targets to increase engagement in future studies. International Registered Report Identifier (IRRID): RR2-10.2196/37954 %M 36757759 %R 10.2196/39258 %U https://www.jmir.org/2023/1/e39258 %U https://doi.org/10.2196/39258 %U http://www.ncbi.nlm.nih.gov/pubmed/36757759 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43160 %T Effects of a Smartphone App on Fruit and Vegetable Consumption Among Saudi Adolescents: Randomized Controlled Trial %A Shatwan,Israa M %A Alhefani,Rabab S %A Bukhari,Mawadah F %A Hanbazazah,Danah A %A Srour,Jumanah K %A Surendran,Shelini %A Aljefree,Najlaa M %A Almoraie,Noha M %+ Food and Nutrition Department, Human Sciences and Design Faculty, King Abdulaziz University, Abdulalah Suliman Street, 3270, Jeddah, 6269, Saudi Arabia, 966 535619144, eshatwan@kau.edu.sa %K smartphone app %K fruit and vegetable consumption %K Saudi Arabia %K adolescents %K nutrition %K health outcome %K digital health intervention %K digital health app %K pediatrics %K youth %D 2023 %7 9.2.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Dietary patterns and nutritional status during adolescence have a direct effect on future health outcomes. Objective: This study aimed to promote fruit and vegetable intake among adolescents using a smartphone app called MyPlate. Methods: This randomized intervention study was conducted in an urban area of Jeddah, Saudi Arabia. We included 104 adolescents aged 13 to 18 years, who were randomized into intervention (n=55) or control (n=49) arms. We examined the effects of MyPlate on fruit and vegetable intake over 6 weeks in the intervention group. Pre- and postintervention questionnaires were used in the intervention and control groups. Results: The control group showed a significant increase in fruit consumption scores between baseline (1.15, SD 0.68) and postintervention (1.64, SD 0.98; P=.01), but no significant difference in vegetable consumption scores was observed before (1.44, SD 0.97) and after intervention (1.55, SD 0.90; P=.54). However, there was no significant difference between scores at baseline and after 6 weeks of using the smartphone app for fruit (1.48, SD 0.99 and 1.70, SD 1.11, respectively; P=.31) or vegetables (1.50, SD 0.97 and 1.43, SD 1.03, respectively; P=.30) in the intervention group. Our findings showed no significant impact of using a smartphone app on fruit and vegetable consumption. Conclusions: These findings suggest that a smartphone app did not significantly improve fruit and vegetable intake among adolescents. Trial Registration: ClinicalTrials.gov NCT05692765; https://clinicaltrials.gov/ct2/show/NCT05692765 %M 36757770 %R 10.2196/43160 %U https://pediatrics.jmir.org/2023/1/e43160 %U https://doi.org/10.2196/43160 %U http://www.ncbi.nlm.nih.gov/pubmed/36757770 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38894 %T The Cultural Adaption of a Sobriety Support App for Alaska Native and American Indian People: Qualitative Feasibility and Acceptability Study %A Trinidad,Susan Brown %A Shane,Aliassa L %A Guinn,Tiffany R %A Apok,Charlene R %A Collier,Ann F %A Avey,Jaedon P %A Donovan,Dennis M %+ Department of Bioethics and Humanities, School of Medicine, University of Washington, Box 357120, Seattle, WA, 98195-7120, United States, 1 206 543 2508, sbtrini@uw.edu %K alcohol misuse %K sobriety support %K peer support %K smartphone app %K community reinforcement approach %K mobile phone %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite high rates of alcohol abstinence, Alaska Native and American Indian (ANAI) people experience a disproportionate burden of alcohol-related morbidity and mortality. Multiple barriers to treatment exist for this population, including a lack of culturally relevant resources; limited access to or delays in receiving treatment; and privacy concerns. Many ANAI people in the state of Alaska, United States, live in sparsely populated rural areas, where treatment access and privacy concerns regarding peer-support programs may be particularly challenging. In addition, prior research demonstrates that many ANAI people prefer a self-management approach to sobriety, rather than formal treatment. Taken together, these factors suggest a potential role for a culturally adapted smartphone app to support ANAI people interested in changing their behavior regarding alcohol use. Objective: This study was the first phase of a feasibility and acceptability study of a culturally tailored version of an off-the-shelf smartphone app to aid ANAI people in managing or reducing their use of alcohol. The aim of this qualitative needs assessment was to gather insights and preferences from ANAI people and health care providers serving ANAI people to guide feature development, content selection, and cultural adaptation before a pilot test of the smartphone app with ANAI people. Methods: From October 2018 to September 2019, we conducted semistructured interviews with 24 ANAI patients aged ≥21 years and 8 providers in a tribal health care organization in south-central Alaska. Results: Participants generally endorsed the usefulness of a smartphone app for alcohol self-management. They cited anonymity, 24/7 access, peer support, and patient choice as key attributes of an app. The desired cultural adaptations included ANAI- and land-themed design elements, cultural content (eg, stories from elders), and spiritual resources. Participants considered an app especially useful for rural-dwelling ANAI people, as well as those who lack timely access to treatment services or prefer to work toward managing their alcohol use outside the clinical setting. Conclusions: This needs assessment identified key features, content, and cultural adaptations that are being implemented in the next phase of the study. In future work, we will determine the extent to which these changes can be accommodated in a commercially available app, the feasibility of implementation, and the acceptability of the culturally adapted version of the app among ANAI users. %M 36473107 %R 10.2196/38894 %U https://formative.jmir.org/2023/1/e38894 %U https://doi.org/10.2196/38894 %U http://www.ncbi.nlm.nih.gov/pubmed/36473107 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e42566 %T Evaluation of an App-Delivered Psychological Flexibility Skill Training Intervention for Medical Student Burnout and Well-being: Randomized Controlled Trial %A Ditton,Elizabeth %A Knott,Brendon %A Hodyl,Nicolette %A Horton,Graeme %A Oldmeadow,Christopher %A Walker,Frederick Rohan %A Nilsson,Michael %+ Centre for Rehab Innovations, University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 2 404 ext 20738, elizabeth.ditton@uon.edu.au %K burnout %K psychological %K burnout interventions %K well-being %K medicine %K medical student %K digital intervention %K app-delivered intervention %K individualized intervention %K randomized controlled trial %K RCT %K randomized %K Acceptance and Commitment Training %K stress %K mobile health %K mHealth %K mobile phone %D 2023 %7 6.2.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Physician burnout is a common problem, with onset frequently occurring during undergraduate education. Early intervention strategies that train medical students in psychological flexibility skills could support well-being and mitigate burnout risks associated with unmodifiable career stressors. There is a need for randomized controlled trials to assess effectiveness. As psychological flexibility varies contextually and among individuals, tailoring interventions may improve outcomes. Smartphone apps can facilitate individualization and accessibility, and the evaluation of this approach is an identified research priority. Objective: This study aimed to evaluate the effectiveness of a stand-alone app–delivered Acceptance and Commitment Training intervention for improving medical students’ self-reported burnout, well-being, psychological flexibility, and psychological distress outcomes. We aimed to explore whether an individualized app would demonstrate benefits over a nonindividualized version. Methods: This parallel randomized controlled trial was conducted with a sample of medical students from 2 Australian universities (N=143). Participants were randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waitlist) using a 1:1:1 allocation ratio. Individualized and nonindividualized participants were blinded to group allocation. The 5-week intervention included an introductory module (stage 1) and on-demand access to short skill training activities (stage 2), which students accessed at their own pace. Stage 2 was either nonindividualized or individualized to meet students’ identified psychological flexibility training needs. Results: The mean differences in change from baseline between the intervention groups and the waitlist group were not statistically significant for burnout outcomes: exhaustion (primary; individualized: −0.52, 95% CI −3.70 to 2.65, P=.75; nonindividualized: 1.60, 95% CI −1.84 to 5.03, P=.37), cynicism (individualized: −1.26, 95% CI −4.46 to 1.94, P=.44; nonindividualized: 1.00, 95% CI −2.45 to 4.46, P=.57), and academic efficacy (individualized: 0.94, 95% CI −0.90 to 2.79, P=.32; nonindividualized: 2.02, 95% CI 0.02-4.03, P=.05). Following the intervention, the individualized group demonstrated improved psychological flexibility (0.50, 95% CI 0.12-0.89; P=.01), reduced inflexibility (0.48, 95% CI −0.92 to −0.04; P=.04), and reduced stress (−6.89, 95% CI −12.01 to 5.99; P=.01), and the nonindividualized group demonstrated improved well-being (6.46, 95% CI 0.49-12.42; P=.04) and stress (−6.36, 95% CI −11.90 to −0.83; P=.03) compared with waitlist participants. Between-group differences for the individualized and nonindividualized arms were not statistically significant. High attrition (75/143, 52.4%) was observed. Conclusions: This trial provides early support for the potential benefits of Acceptance and Commitment Training for medical student well-being and psychological outcomes and demonstrates that psychological flexibility and inflexibility can be trained using a smartphone app. Although postintervention burnout outcomes were not statistically significant, improvements in secondary outcomes could indicate early risk mitigation. Replication studies with larger samples and longer-term follow-up are required, and future research should focus on improving implementation frameworks to increase engagement and optimize individualization methods. Trial Registration: Australian New Zealand Clinical Trials Registry 12621000911897; https://tinyurl.com/2p92cwrw International Registered Report Identifier (IRRID): RR2-10.2196/32992 %M 36745486 %R 10.2196/42566 %U https://mental.jmir.org/2023/1/e42566 %U https://doi.org/10.2196/42566 %U http://www.ncbi.nlm.nih.gov/pubmed/36745486 %0 Journal Article %@ 2817-092X %I JMIR Publications %V 2 %N %P e37944 %T Remote Testing Apps for Multiple Sclerosis Patients: Scoping Review of Published Articles and Systematic Search and Review of Public Smartphone Apps %A Michaud,Jacob B %A Penny,Cameron %A Cull,Olivia %A Hervet,Eric %A Chamard-Witkowski,Ludivine %+ Department of Neurology, Dr.-Georges-L.-Dumont University Hospital Center, 330 Université Ave, Moncton, NB, E1C 2Z3, Canada, 1 506 869 721, Ludivine.Witkowski@vitalitenb.ca %K multiple sclerosis %K mobile application %K mobile phone %K app %K mHealth %K eHealth %K digital health %K telehealth %D 2023 %7 6.2.2023 %9 Review %J JMIR Neurotech %G English %X Background: Many apps have been designed to remotely assess clinical status and monitor symptom evolution in persons with multiple sclerosis (MS). These may one day serve as an adjunct for in-person assessment of persons with MS, providing valuable insight into the disease course that is not well captured by cross-sectional snapshots obtained from clinic visits. Objective: This study sought to review the current literature surrounding apps used for remote monitoring of persons with MS. Methods: A scoping review of published articles was conducted to identify and evaluate the literature published regarding the use of apps for monitoring of persons with MS. PubMed/Medline, EMBASE, CINAHL, and Cochrane databases were searched from inception to January 2022. Cohort studies, feasibility studies, and randomized controlled trials were included in this review. All pediatric studies, single case studies, poster presentations, opinion pieces, and commentaries were excluded. Studies were assessed for risk of bias using the Scottish Intercollegiate Guidelines Network, when applicable. Key findings were grouped in categories (convergence to neurological exam, feasibility of implementation, impact of weather, and practice effect), and trends are presented. In a parallel systematic search, the Canadian Apple App Store and Google Play Store were searched to identify relevant apps that are available but have yet to be formally studied and published in peer-reviewed publications. Results: We included 18 articles and 18 apps. Although many MS-related apps exist, only 10 apps had published literature supporting their use. Convergence between app-based testing and the neurological exam was examined in 12 articles. Most app-based tests focused on physical disability and cognition, although other domains such as ambulation, balance, visual acuity, and fatigue were also evaluated. Overall, correlations between the app versions of standardized tests and their traditional counterparts were moderate to strong. Some novel app-based tests had a stronger correlation with clinician-derived outcomes than traditional testing. App-based testing correlated well with the Multiple Sclerosis Functional Composite but less so with the Expanded Disability Status Scale; the latter correlated to a greater extent with patient quality of life questionnaire scores. Conclusions: Although limited by a small number of included studies and study heterogeneity, the findings of this study suggest that app-based testing demonstrates adequate convergence to traditional in-person assessment and may be used as an adjunct to and perhaps in lieu of specific neurological exam metrics documented at clinic visits, particularly if the latter is not readily accessible for persons with MS. %R 10.2196/37944 %U https://neuro.jmir.org/2023/1/e37944 %U https://doi.org/10.2196/37944 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40934 %T Engagement With and Acceptability of Digital Media Platforms for Use in Improving Health Behaviors Among Vulnerable Families: Systematic Review %A Eppes,Elisabet V %A Augustyn,Marycatherine %A Gross,Susan M %A Vernon,Paris %A Caulfield,Laura E %A Paige,David M %+ Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 484 467 3121, elisabet.eppes@gmail.com %K text messaging %K social media %K mobile app %K low-income %K engagement %K health promotion %K community %K nutrition and physical activity %K pregnancy %K breastfeeding %K maternal and child health %K mobile phone %D 2023 %7 3.2.2023 %9 Review %J J Med Internet Res %G English %X Background: The use of digital communication platforms to improve health behaviors has increased dramatically over the last decade. Public health practitioners have adopted digital communication technologies such as text messages, mobile apps, and social media to reach diverse populations. However, the effectiveness of digital communication platforms used by community-serving agencies remains unclear, and patterns of engagement and acceptability of different platforms have not been studied. Objective: This review aimed to identify the types of digital communication strategies used by community-serving organizations to promote healthy behaviors, assess the strength of evidence for health behavioral change, and describe the degree of consumer engagement with and acceptability of these strategies. The study population included low-income pregnant women, parents of young children, and adolescents. Methods: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, Scopus, Web of Science, CINAHL, and APA PsycInfo, covering research conducted from 2009 to 2022. Studies were included if they examined the use of digital communication (ie, texting, mobile apps, or social media) to promote healthy behaviors in the target population. Risk of bias and strength of evidence were assessed using the Effective Public Health Practice Project Risk of Bias tool and criteria from Agency for Healthcare Research and Quality, respectively. Results: Twenty-three peer-reviewed research studies published between 2012 and 2022, conducted in the United States, the United Kingdom, and Australia, were included in the review. The sample comprised studies exploring the use of texting (n=12), apps (n=6), social media (n=3), and multiple platforms (n=2; eg, texting and mobile apps). Targeted health behaviors included healthy diet, physical activity, obesity prevention, healthy pregnancy, breastfeeding, vaccine use, smoking cessation, and nutrition benefit redemption. The sample included 8 randomized controlled trials, 6 pretest-posttest design, 3 mixed methods studies, 2 pilot studies, 1 feasibility study, 1 prospective cohort study, 1 descriptive study, and 1 cross-sectional study. The median sample size was 77.5. There was no strong evidence to suggest the effectiveness of digital media campaigns in improving health behaviors; however, there were moderate to high levels of engagement and high levels of acceptability across digital platforms. Conclusions: Low-income pregnant women, parents of young children, and adolescents demonstrated moderate levels of engagement with and high levels of acceptability of digital media health campaigns conducted by community-serving agencies. The effectiveness of these strategies in improving health behaviors was inconclusive. Additional rigorous studies with larger sample sizes are required. In addition, more research is required to consistently measure and report participants’ engagement with each platform. Digital communication platforms are critical tools for public health practitioners, and future investigations of the effectiveness of these platforms in engaging clients and improving health behaviors will maximize client services. %M 36735286 %R 10.2196/40934 %U https://www.jmir.org/2023/1/e40934 %U https://doi.org/10.2196/40934 %U http://www.ncbi.nlm.nih.gov/pubmed/36735286 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e43241 %T Promoting Hand Hygiene During the COVID-19 Pandemic: Parallel Randomized Trial for the Optimization of the Soapp App %A Baretta,Dario %A Amrein,Melanie Alexandra %A Bäder,Carole %A Ruschetti,Gian Giacomo %A Rüttimann,Carole %A Del Rio Carral,Maria %A Fabian,Carlo %A Inauen,Jennifer %+ Institute of Psychology, University of Bern, Fabrikstrasse 8, Bern, 3012, Switzerland, 41 31 684 58 96, dario.baretta@unibe.ch %K COVID-19 %K hand hygiene %K behavior change intervention %K Multiphase Optimization Strategy %K MOST %K smartphone apps %K motivation %K habit %K social norm %K mobile phone %D 2023 %7 3.2.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hand hygiene is an effective behavior for preventing the spread of the respiratory disease COVID-19 and was included in public health guidelines worldwide. Behavior change interventions addressing hand hygiene have the potential to support the adherence to public health recommendations and, thereby, prevent the spread of COVID-19. However, randomized trials are largely absent during a pandemic; therefore, there is little knowledge about the most effective strategies to promote hand hygiene during an ongoing pandemic. This study addresses this gap by presenting the results of the optimization phase of a Multiphase Optimization Strategy of Soapp, a smartphone app for promoting hand hygiene in the context of the COVID-19 pandemic. Objective: This study aimed to identify the most effective combination and sequence of 3 theory- and evidence-based intervention modules (habit, motivation, and social norms) for promoting hand hygiene. To this end, 9 versions of Soapp were developed (conditions), and 2 optimization criteria were defined: the condition with the largest increase in hand hygiene at follow-up and condition with the highest engagement, usability, and satisfaction based on quantitative and qualitative analyses. Methods: This study was a parallel randomized trial with 9 intervention conditions defined by the combination of 2 intervention modules and their sequence. The trial was conducted from March to August 2021 with interested participants from the Swiss general population (N=232; randomized). Randomization was performed using Qualtrics (Qualtrics International Inc), and blinding was ensured. The duration of the intervention was 34 days. The primary outcome was self-reported hand hygiene at follow-up, which was assessed using an electronic diary. The secondary outcomes were user engagement, usability, and satisfaction assessed at follow-up. Nine participants were further invited to participate in semistructured exit interviews. A set of ANOVAs was performed to test the main hypotheses, whereas a thematic analysis was performed to analyze the qualitative data. Results: The results showed a significant increase in hand hygiene over time across all conditions. There was no interaction effect between time and intervention condition. Similarly, no between-group differences in engagement, usability, and satisfaction emerged. Seven themes (eg, “variety and timeliness of the task load” and “social interaction”) were found in the thematic analysis. Conclusions: The effectiveness of Soapp in promoting hand hygiene laid the foundation for the next evaluation phase of the app. More generally, the study supported the value of digital interventions in pandemic contexts. The findings showed no differential effect of intervention conditions involving different combinations and sequences of the habit, motivation, and social norms modules on hand hygiene, engagement, usability, and satisfaction. In the absence of quantitative differences, we relied on the results from the thematic analysis to select the best version of Soapp for the evaluation phase. Trial Registration: ClinicalTrials.gov NCT04830761; https://clinicaltrials.gov/ct2/show/NCT04830761 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-055971 %M 36599056 %R 10.2196/43241 %U https://mhealth.jmir.org/2023/1/e43241 %U https://doi.org/10.2196/43241 %U http://www.ncbi.nlm.nih.gov/pubmed/36599056 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e40865 %T The Effects of Providing a Connected Scale in an App-Based Digital Health Program: Cross-sectional Examination %A Auster-Gussman,Lisa A %A Rikhy,Mohit %A Lockwood,Kimberly G %A Branch,OraLee H %A Graham,Sarah A %+ Lark Health, 2570 El Camino Real, Mountain View, CA, 94040, United States, 1 650 300 1755, sarah.graham@lark.com %K engagement %K retention %K scales %K self-monitoring %K mobile app %K digital health %K AI %K smartphone %K platform %K app %K application %K health program %K program %D 2023 %7 3.2.2023 %9 Research Letter %J JMIR Mhealth Uhealth %G English %X %M 36735288 %R 10.2196/40865 %U https://mhealth.jmir.org/2023/1/e40865 %U https://doi.org/10.2196/40865 %U http://www.ncbi.nlm.nih.gov/pubmed/36735288 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e38713 %T Identifying Desired Features That Would Be Acceptable and Helpful in a Wrist-Worn Biosensor–Based Alcohol Intervention: Interview Study Among Adults Who Drink Heavily %A Richards,Veronica L %A Rajendran,Saahas %A Cook,Robert L %A Leeman,Robert F %A Wang,Yan %A Prins,Cindy %A Cook,Christa %+ Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, 320 Biobehavioral Health Building, University Park, PA, 16802, United States, 1 814 867 2119, vlr5157@psu.edu %K transdermal %K biosensor %K alcohol %K intervention %K qualitative interview %K patient preferences %K mobile phone %D 2023 %7 2.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Alcohol misuse is highly prevalent in the United States and results in a huge financial and public health burden. Current alcohol reduction treatments are underused, and there is a critical need for innovation in the field. Transdermal alcohol biosensors measure alcohol use passively and continuously and may be helpful tools in alcohol interventions. To date, however, alcohol biosensors have not been widely used to directly intervene on alcohol use. There is a new wrist-worn biosensor that could be used to help people reduce their drinking, although it is unclear how best to incorporate such a device into an alcohol intervention. Objective: We aimed to identify desired features that would be acceptable and helpful in a wrist-worn biosensor–based alcohol intervention for adults who drink heavily. Methods: Participants were recruited through an alcohol contingency management study, a contact registry, and participant referral. To qualify, participants had to be aged at least 40 years, report drinking at least twice per week, and indicate interest in reducing their drinking. We conducted a semistructured interview with each participant via Zoom (Zoom Video Communications, Inc). The interview guide addressed general thoughts on the wrist-worn biosensor, how participants thought a wrist-worn biosensor could be used to help people quit or reduce drinking, types of information that participants would want to receive from the biosensor, how they would want to receive this information, and how they thought this information could be used to change their behavior. Interviews were transcribed verbatim and analyzed using thematic analysis. Results: The sample comprised 20 adults (mean age 55.1, SD 6.1 years; 11/20, 55%, women; and 17/20, 85%, Black). Of the 20 participants, 9 (45%) had previous experience with the Secure Continuous Remote Alcohol Monitor continuous alcohol monitoring ankle biosensor from participating in an alcohol contingency management study. The desirable features could be grouped into 5 main themes: features that would influence willingness to use the biosensor (it should look attractive and be both comfortable to wear and accessible), personalized messaging (personalized biosensor-based prompts and feedback could be helpful), preference for time wearing the biosensor (for some, just wearing the biosensor could have an intervention effect), sharing data with others (this was appealing to many but not to all), and mental health support (many felt that mental health support could be incorporated into the biosensor). Conclusions: Five main themes that would maximize interest in using a wrist-worn biosensor for alcohol intervention were identified. Taken together, the identified themes could inform the development of a just-in-time adaptive intervention that uses a wrist-worn biosensor to help adults who drink heavily reduce their alcohol use. %M 36729576 %R 10.2196/38713 %U https://www.jmir.org/2023/1/e38713 %U https://doi.org/10.2196/38713 %U http://www.ncbi.nlm.nih.gov/pubmed/36729576 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e42611 %T The Use of Sensors to Detect Anxiety for In-the-Moment Intervention: Scoping Review %A Dobson,Rosie %A Li,Linwei Lily %A Garner,Katie %A Tane,Taria %A McCool,Judith %A Whittaker,Robyn %+ National Institute for Health Innovation, University of Auckland, Building 507, Grafton Campus, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 9 373 7599, r.dobson@auckland.ac.nz %K anxiety %K wearables %K sensors %K mental health %K digital mental health %K digital health intervention %K wearable device %D 2023 %7 2.2.2023 %9 Review %J JMIR Ment Health %G English %X Background: With anxiety a growing issue and barriers to accessing support services, there is a need for innovative solutions to provide early intervention. In-the-moment interventions support individuals to recognize early signs of distress and use coping mechanisms to prevent or manage this distress. There is potential for wearable sensors linked to an individual’s mobile phone to provide in-the-moment support tailored to individual needs and physiological responses. Objective: The aim of this scoping review is to examine the role of sensors in detecting the physiological signs of anxiety to initiate and direct interventions for its management. Methods: Relevant studies were identified through searches conducted in Embase, MEDLINE, APA PsycINFO, ProQuest, and Scopus. Studies were identified if they were conducted with people with stress or anxiety or at risk of anxiety and included a wearable sensor providing real-time data for in-the-moment management of anxiety. Results: Of the 1087 studies identified, 11 studies were included in the review, including 5 randomized controlled trials and 6 pilot or pretesting studies. The results showed that most studies successfully demonstrated improvements in their target variables. This included overall anxiety and stress levels, and the implementation of in-the-moment stress and anxiety management techniques such as diaphragmatic breathing. There was wide variation in the types of sensors used, physiological measures, and sensor-linked interventions. Conclusions: This review indicates that sensors are potentially a useful tool in detecting anxiety and facilitating the implementation of a known control mechanism to reduce anxiety and improve mood, but further work is needed to understand the acceptability and effectiveness of this type of intervention. %M 36729590 %R 10.2196/42611 %U https://mental.jmir.org/2023/1/e42611 %U https://doi.org/10.2196/42611 %U http://www.ncbi.nlm.nih.gov/pubmed/36729590 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e39975 %T Engagement With Gamification Elements in a Smoking Cessation App and Short-term Smoking Abstinence: Quantitative Assessment %A Rajani,Nikita B %A Bustamante,Luz %A Weth,Dominik %A Romo,Lucia %A Mastellos,Nikolaos %A Filippidis,Filippos T %+ Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London, W6 8RP, United Kingdom, 44 7427615928, nikita.rajani14@imperial.ac.uk %K gamification %K smoking cessation %K smoking abstinence %K mHealth %K mobile apps %K mobile phone %K smartphone %K digital health %K user engagement %K cognitive outcome %K self-support %K in-app metrics %D 2023 %7 1.2.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: Gamification in smoking cessation apps has been found to improve cognitive outcomes associated with higher odds of quitting. Although some research has shown that gamification can also positively impact behavioral outcomes such as smoking cessation, studies have largely focused on physical activity and mental health. Only a few studies have explored the effects of gamification on smoking cessation outcomes, of which the majority have adopted qualitative methodologies and/or assessed engagement with apps using self-report. Objective: This study aimed to explore levels of user engagement with gamification features in a smoking cessation app via in-app metrics. Specifically, the objective of this paper was to investigate whether higher engagement with gamification features is associated with the likelihood of quitting in the short term. Methods: Data from a larger online study that recruited smokers seeking to quit were analyzed to address the objectives presented in this paper. The study took place between June 2019 and July 2020, and participants were primarily recruited via social media posts. Participants who met the eligibility criteria used 1 of 2 mobile apps for smoking cessation. In-app metrics shared by the developer of one of the smoking cessation apps, called Kwit, were used to assess engagement with gamification features. Out of 58 participants who used the Kwit app, 14 were excluded due to missing data or low engagement with the app (ie, not opening the app once a week). For the remaining 44 participants, mean (SD) values were calculated for engagement with the app using in-app metrics. A logistic regression model was used to investigate the association between engagement with gamification and 7-day smoking abstinence. Results: In total, data from 44 participants who used the Kwit app were analyzed. The majority of participants were male, married, and employed. Almost 30% (n=13) of participants self-reported successful 7-day abstinence at the end of the study. On average, the Kwit app was opened almost 31 (SD 39) times during the 4-week study period, with the diary feature used the most often (mean 22.8, SD 49.3). Moreover, it was found that each additional level unlocked was associated with approximately 22% higher odds of achieving 7-day abstinence after controlling for other factors such as age and gender (odds ratio 1.22, 95% CI 1.01-1.47). Conclusions: This study highlights the likely positive effects of certain gamification elements such as levels and achievements on short-term smoking abstinence. Although more robust research with a larger sample size is needed, this research highlights the important role that gamification features integrated into mobile apps can play in facilitating and supporting health behavior change. %M 36724003 %R 10.2196/39975 %U https://games.jmir.org/2023/1/e39975 %U https://doi.org/10.2196/39975 %U http://www.ncbi.nlm.nih.gov/pubmed/36724003 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40237 %T Forensic Psychiatric Outpatients’ and Therapists’ Perspectives on a Wearable Biocueing App (Sense-IT) as an Addition to Aggression Regulation Therapy: Qualitative Focus Group and Interview Study %A ter Harmsel,Janna F %A Smulders,Lisanne M %A Noordzij,Matthijs L %A Swinkels,Lise T A %A Goudriaan,Anna E %A Popma,Arne %A van der Pol,Thimo M %+ Inforsa Forensic Mental Healthcare, Vlaardingenlaan 5, Amsterdam, 1059 GL, Netherlands, 31 205904578, annemieke.ter.harmsel@inforsa.nl %K biocueing %K biofeedback %K aggression %K behavior change %K forensic psychiatry %K wearable technology %K mobile health %K mHealth %K implementation %K mobile phone %D 2023 %7 1.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Given the increased use of smart devices and the advantages of individual behavioral monitoring and assessment over time, wearable sensor–based mobile health apps are expected to become an important part of future (forensic) mental health care. For successful implementation in clinical practice, consideration of barriers and facilitators is of utmost importance. Objective: The aim of this study was to provide insight into the perspectives of both psychiatric outpatients and therapists in a forensic setting on the use and implementation of the Sense-IT biocueing app in aggression regulation therapy. Methods: A combination of qualitative methods was used. First, we assessed the perspectives of forensic outpatients on the use of the Sense-IT biocueing app using semistructured interviews. Next, 2 focus groups with forensic therapists were conducted to gain a more in-depth understanding of their perspectives on facilitators of and barriers to implementation. Results: Forensic outpatients (n=21) and therapists (n=15) showed a primarily positive attitude toward the addition of the biocueing intervention to therapy, with increased interoceptive and emotional awareness as the most frequently mentioned advantage in both groups. In the semistructured interviews, patients mainly reported barriers related to technical or innovation problems (ie, connection and notification issues, perceived inaccuracy of the feedback, and limitations in the ability to personalize settings). In the focus groups with therapists, 92 facilitator and barrier codes were identified and categorized into technical or innovation level (n=13, 14%), individual therapist level (n=28, 30%), individual patient level (n=33, 36%), and environmental and organizational level (n=18, 20%). The predominant barriers were limitations in usability of the app, patients’ motivation, and both therapists’ and patients’ knowledge and skills. Integration into treatment, expertise within the therapists’ team, and provision of time and materials were identified as facilitators. Conclusions: The chances of successful implementation and continued use of sensor-based mobile health interventions such as the Sense-IT biocueing app can be increased by considering the barriers and facilitators from patients’ and therapists’ perspectives. Technical or innovation-related barriers such as usability issues should be addressed first. At the therapist level, increasing integration into daily routines and enhancing affinity with the intervention are highly recommended for successful implementation. Future research is expected to be focused on further development and personalization of biocueing interventions considering what works for whom at what time in line with the trend toward personalizing treatment interventions in mental health care. %M 36724008 %R 10.2196/40237 %U https://formative.jmir.org/2023/1/e40237 %U https://doi.org/10.2196/40237 %U http://www.ncbi.nlm.nih.gov/pubmed/36724008 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e40373 %T Virtual Digital Psychotherapist App–Based Treatment in Patients With Methamphetamine Use Disorder (Echo-APP): Single-Arm Pilot Feasibility and Efficacy Study %A Chen,Tianzhen %A Chen,Liyu %A Li,Shuo %A Du,Jiang %A Su,Hang %A Jiang,Haifeng %A Wu,Qianying %A Zhang,Lei %A Bao,Jiayi %A Zhao,Min %+ Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wan Ping Road, Shanghai, Shanghai, 200030, China, 86 2134773146, drminzhao@smhc.org.cn %K tablet %K Android program %K substance use disorder %K methamphetamine use disorder %K digital agent %K virtual digital human %D 2023 %7 31.1.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Substance use disorder is one of the severe public health problems worldwide. Inequitable resources, discrimination, and physical distances limit patients’ access to medical help. Automated conversational agents have the potential to provide in-home and remote therapy. However, automatic dialogue agents mostly use text and other methods to interact, which affects the interaction experience, treatment immersion, and clinical efficacy. Objective: The aim of this paper is to describe the design and development of Echo-APP, a tablet-based app with the function of a virtual digital psychotherapist, and to conduct a pilot study to explore the feasibility and preliminary efficacy results of Echo-APP for patients with methamphetamine use disorder. Methods: Echo-APP is an assessment and rehabilitation program developed for substance use disorder (SUD) by a team of clinicians, psychotherapists, and computer experts. The program is available for Android tablets. In terms of assessment, the focus is on the core characteristics of SUD, such as mood, impulsivity, treatment motivation, and craving level. In terms of treatment, Echo-APP provides 10 treatment units, involving awareness of addiction, motivation enhancement, emotion regulation, meditation, etc. A total of 47 patients with methamphetamine dependence were eventually enrolled in the pilot study to receive a single session of the Echo-APP–based motivational enhancement treatment. The outcomes were assessed before and after the patients’ treatment, including treatment motivation, craving levels, self-perception on the importance of drug abstinence, and their confidence in stopping the drug use. Results: In the pilot study, scores on the Stages of Change Readiness and Treatment Eagerness Scale and the questionnaire on motivation for abstaining from drugs significantly increased after the Echo-APP–based treatment (P<.001, Cohen d=–0.60), while craving was reduced (P=.01, Cohen d=0.38). Patients’ baseline Generalized Anxiety Disorder-7 assessment score (β=3.57; P<.001; 95% CI 0.80, 2.89) and Barratt Impulsiveness Scale (BIS)–motor impulsiveness score (β=–2.10; P=.04; 95% CI –0.94, –0.02) were predictive of changes in the patients’ treatment motivation during treatment. Moreover, patients’ baseline Generalized Anxiety Disorder-7 assessment score (β=–1.607; P=.03; 95% CI –3.08, –0.14), BIS—attentional impulsivity score (β=–2.43; P=.004; 95% CI –4.03, –0.83), and BIS—nonplanning impulsivity score (β=2.54; P=.002; 95% CI 0.98, 4.10) were predictive of changes in craving scores during treatment. Conclusions: Echo-APP is a practical, accepted, and promising virtual digital psychotherapist program for patients with methamphetamine dependence. The preliminary findings lay a good foundation for further optimization of the program and the promotion of large-scale randomized controlled clinical studies for SUD. %M 36719727 %R 10.2196/40373 %U https://mhealth.jmir.org/2023/1/e40373 %U https://doi.org/10.2196/40373 %U http://www.ncbi.nlm.nih.gov/pubmed/36719727 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38378 %T The Effectiveness of a Web-Based Application for a Balanced Diet and Healthy Weight Among Indonesian Pregnant Women: Randomized Controlled Trial %A Koeryaman,Mira Trisyani %A Pallikadavath,Saseendran %A Ryder,Isobel Helen %A Kandala,Ngianga %+ Maternity Nursing Department, Universitas Padjadjaran, Jl Raya Bandung Sumedang KM 21, Fakultas Keperawatan, Jatinangor, 45363, Indonesia, 62 22 7795596, mira.koeryaman@port.ac.uk %K web-based application %K nutrition %K pregnant women %K pregnancy %K mobile app %K diet %K dietary intake %K application %K Indonesia %K randomized controlled trial %K tool %K consumption %K maternal %K weight %K weight gain %K intervention %K control group %K treatment %K vitamins %K minerals %K healthy diet %K calorie %K food %D 2023 %7 30.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Pregnant women have self-declared that they have difficulties in estimating nutrient intakes. The Nutrition Information System for Indonesian Pregnant Women (SISFORNUTRIMIL) application was created as a dietary assessment and calorie-counting tool to guide pregnant women to eat the right portion sizes for each meal. Objective: The study aimed to examine the effectiveness of the SISFORNUTRIMIL application in helping users achieve a balanced diet and healthy maternal weight gain in comparison to nonusers in Indonesia. Methods:  First-pregnancy women in the second trimester aged 19-30 years (N=112) participated in the randomized controlled trial. Recruited women who were eligible and consented to participate in the study were allocated into the intervention group, or application user (n=56), and the control group, or application nonuser (n=56). The intervention recommended that pregnant women consume at least 5 food groups and calculate a recommended average portion size for 12 weeks. Both groups were self-monitored and recorded their intake in food records for 3 days every week. The dietary diversity consumed, macro- and micronutrient intake, and maternal weight gain were assessed pre- and postintervention. Data were collected three times during the intervention. Diversity food consumption was measured by the Minimum Dietary Diversity for Women of reproductive age. Furthermore, the Indonesian recommended dietary allowances were used to refer to and validate appropriate energy and nutrient amounts. Independent sample t test was used to compare differences between the intervention and control groups. Results: The mean dietary diversity score for the application user group (7.79, SD 1.20) was significantly greater than for the application nonuser group (7.02, SD 1.39; adjusted mean difference 0.77, 95% CI 0.28-1.25; d=0.28; P=.005). Macro- and micronutrient intake was significantly more in accordance with the dietary recommendations for the user group compared to the control group, including an energy daily intake of 156.88 kcal (95% CI 114.52-199.23; d=–1.39; P=.002), 102.43 g of carbohydrates (95% CI –125.2 to –79.60; d=–1.68; P=.02), 14.33 g of protein (95% CI 11.40-17.25; d=1.86; P<.001), and 10.96 g of fat (95% CI –13.71 to –8.20; d=–1.49; P<.001). Furthermore, there was a significantly higher intake of daily vitamins and minerals in the intervention group than in the control group. Other results showed that maternal weight gain in the intervention group was in accordance with the parameters of healthy weight gain. Conclusions:  Recording food intake using the application was significantly effective in improving the dietary diversity consumed, improving adequate energy and nutrient intake, and producing healthy maternal weight during pregnancy. Trial Registration: ISRCTN Registry ISRCTN42690828; https://www.isrctn.com/ISRCTN42690828 %M 36716078 %R 10.2196/38378 %U https://formative.jmir.org/2023/1/e38378 %U https://doi.org/10.2196/38378 %U http://www.ncbi.nlm.nih.gov/pubmed/36716078 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44296 %T Development and Validation of Multivariable Prediction Algorithms to Estimate Future Walking Behavior in Adults: Retrospective Cohort Study %A Park,Junghwan %A Norman,Gregory J %A Klasnja,Predrag %A Rivera,Daniel E %A Hekler,Eric %+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, United States, 1 858 429 9370, jup014@ucsd.edu %K mobile health %K mHealth %K physical activity %K walk %K prediction %K classification %K multilayered perceptron %K microrandomized trial %K MRT %K just-in-time adaptive intervention %K JITAI %K prevention %K female %K development %K validation %K application %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical inactivity is associated with numerous health risks, including cancer, cardiovascular disease, type 2 diabetes, increased health care expenditure, and preventable, premature deaths. The majority of Americans fall short of clinical guideline goals (ie, 8000-10,000 steps per day). Behavior prediction algorithms could enable efficacious interventions to promote physical activity by facilitating delivery of nudges at appropriate times. Objective: The aim of this paper is to develop and validate algorithms that predict walking (ie, >5 min) within the next 3 hours, predicted from the participants’ previous 5 weeks’ steps-per-minute data. Methods: We conducted a retrospective, closed cohort, secondary analysis of a 6-week microrandomized trial of the HeartSteps mobile health physical-activity intervention conducted in 2015. The prediction performance of 6 algorithms was evaluated, as follows: logistic regression, radial-basis function support vector machine, eXtreme Gradient Boosting (XGBoost), multilayered perceptron (MLP), decision tree, and random forest. For the MLP, 90 random layer architectures were tested for optimization. Prior 5-week hourly walking data, including missingness, were used for predictors. Whether the participant walked during the next 3 hours was used as the outcome. K-fold cross-validation (K=10) was used for the internal validation. The primary outcome measures are classification accuracy, the Mathew correlation coefficient, sensitivity, and specificity. Results: The total sample size included 6 weeks of data among 44 participants. Of the 44 participants, 31 (71%) were female, 26 (59%) were White, 36 (82%) had a college degree or more, and 15 (34%) were married. The mean age was 35.9 (SD 14.7) years. Participants (n=3, 7%) who did not have enough data (number of days <10) were excluded, resulting in 41 (93%) participants. MLP with optimized layer architecture showed the best performance in accuracy (82.0%, SD 1.1), whereas XGBoost (76.3%, SD 1.5), random forest (69.5%, SD 1.0), support vector machine (69.3%, SD 1.0), and decision tree (63.6%, SD 1.5) algorithms showed lower performance than logistic regression (77.2%, SD 1.2). MLP also showed superior overall performance to all other tried algorithms in Mathew correlation coefficient (0.643, SD 0.021), sensitivity (86.1%, SD 3.0), and specificity (77.8%, SD 3.3). Conclusions: Walking behavior prediction models were developed and validated. MLP showed the highest overall performance of all attempted algorithms. A random search for optimal layer structure is a promising approach for prediction engine development. Future studies can test the real-world application of this algorithm in a “smart” intervention for promoting physical activity. %M 36705954 %R 10.2196/44296 %U https://mhealth.jmir.org/2023/1/e44296 %U https://doi.org/10.2196/44296 %U http://www.ncbi.nlm.nih.gov/pubmed/36705954 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41660 %T Loss-Framed Adaptive Microcontingency Management for Preventing Prolonged Sedentariness: Development and Feasibility Study %A Choi,Woohyeok %A Lee,Uichin %+ School of Computing, Korea Advanced Institute of Science & Technology, 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea, 82 42 350 3544, uclee@kaist.edu %K contingency management %K incentive %K sedentary behavior %K sedentariness %K behavior change %K health promotion %K financial incentives %K health intervention %K user compliance %K incentive-based intervention %K mobile phone %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A growing body of evidence shows that financial incentives can effectively reinforce individuals’ positive behavior change and improve compliance with health intervention programs. A critical factor in the design of incentive-based interventions is to set a proper incentive magnitude. However, it is highly challenging to determine such magnitudes as the effects of incentive magnitude depend on personal attitudes and contexts. Objective: This study aimed to illustrate loss-framed adaptive microcontingency management (L-AMCM) and the lessons learned from a feasibility study. L-AMCM discourages an individual’s adverse health behaviors by deducting particular expenses from a regularly assigned budget, where expenses are adaptively estimated based on the individual’s previous responses to varying expenses and contexts. Methods: We developed a mobile health intervention app for preventing prolonged sedentary lifestyles. This app delivered a behavioral mission (ie, suggesting taking an active break for a while) with an incentive bid when 50 minutes of uninterrupted sedentary behavior happened. Participants were assigned to either the fixed (ie, deducting the monotonous expense for each mission failure) or adaptive (ie, deducting varying expenses estimated by the L-AMCM for each mission failure) incentive group. The intervention lasted 3 weeks. Results: We recruited 41 participants (n=15, 37% women; fixed incentive group: n=20, 49% of participants; adaptive incentive group: n=21, 51% of participants) whose mean age was 24.0 (SD 3.8; range 19-34) years. Mission success rates did not show statistically significant differences by group (P=.54; fixed incentive group mean 0.66, SD 0.24; adaptive incentive group mean 0.61, SD 0.22). The follow-up analysis of the adaptive incentive group revealed that the influence of incentive magnitudes on mission success was not statistically significant (P=.18; odds ratio 0.98, 95% CI 0.95-1.01). On the basis of the qualitative interviews, such results were possibly because the participants had sufficient intrinsic motivation and less sensitivity to incentive magnitudes. Conclusions: Although our L-AMCM did not significantly affect users’ mission success rate, this study configures a pioneering work toward adaptively estimating incentives by considering user behaviors and contexts through leveraging mobile sensing and machine learning. We hope that this study inspires researchers to develop incentive-based interventions. %M 36705949 %R 10.2196/41660 %U https://mhealth.jmir.org/2023/1/e41660 %U https://doi.org/10.2196/41660 %U http://www.ncbi.nlm.nih.gov/pubmed/36705949 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41422 %T ReachCare Mobile Apps for Patients Experiencing Suicidality in the Emergency Department: Development and Usability Testing Using Mixed Methods %A Larkin,Celine %A Djamasbi,Soussan %A Boudreaux,Edwin D %A Varzgani,Fatima %A Garner,Roscoe %A Siddique,Mariam %A Pietro,John %A Tulu,Bengisu %+ Department of Emergency Medicine, University of Massachusetts Chan Medical School, 55 Lake Ave, Worcester, MA, 01655, United States, 1 7743291688, celine.larkin@umassmed.edu %K suicide %K emergency department %K mobile app %K usability %K engagement %K mobile phone %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Many individuals with suicide risk present to acute care settings such as emergency departments (EDs). However, staffing and time constraints mean that many EDs are not well equipped to deliver evidence-based interventions for patients experiencing suicidality. An existing intervention initiated in the ED for patients with suicide risk (Emergency Department Safety Assessment and Follow-up Evaluation [ED-SAFE]) has been found to be effective but faces trenchant barriers for widespread adoption. Objective: On the basis of the ED-SAFE intervention, we aimed to develop 2 apps for patients with suicide risk: a web app guiding patients through safety planning in the ED (ED app) and a smartphone app providing patients components of the ED-SAFE program on their phones after discharge (patient app). We then tested the usability of these apps with patients presenting to the ED with suicide risk. Methods: Using a user-centered design framework, we first developed user personas to explore the needs and characteristics of patients who are at risk for suicide using inputs from clinicians (n=3) and suicidologists (n=4). Next, we validated these personas during interviews with individuals with lived experience of suicidality (n=6) and used them to inform our application designs. We field-tested the apps with ED patients presenting with suicide risk (n=14) in 2 iterative cycles to assess their usability and engagement using a mixed methods approach. We also rated the quality and fidelity of the safety plans created. Results: We developed 2 interoperable and complementary apps. The first is a web app designed for use on a tablet device during ED admission that guides the patient by creating a safety plan using a chatbot-style interface. The second is a smartphone app for use after discharge and allows the patient to view, edit, and share their completed safety plan; access self-care education, helplines, and behavioral health referrals; and track follow-up appointments with the study clinician. The initial prototype usability testing (n=9) demonstrated satisfactory scores (ED app System Usability Scale [SUS], mean 78.6/100, SD 24.1; User Engagement Scale, mean 3.74/5, SD 0.72; patient app SUS, mean 81.7/100, SD 20.1). After refining the apps based on participant feedback, the second cycle testing (n=5) showed improvement (ED app SUS, mean 90.5/100, SD 9.9; User Engagement Scale, mean 4.07/5, SD 0.36; patient app SUS, mean 97.0/100, SD 1.9). The quality ratings for completed safety plans were satisfactory (Safety Planning Intervention Scoring Algorithm-Brief, mean 27.4, SD 3.4). Conclusions: By adopting a user-centered approach and creating personas to guide development, we were able to create apps for ED patients with suicide risk and obtain satisfactory usability, engagement, and quality scores. Developing digital health tools based on user-centered design principles that deliver evidence-based intervention components may help overcome trenchant implementation barriers in challenging health care settings. %M 36705961 %R 10.2196/41422 %U https://formative.jmir.org/2023/1/e41422 %U https://doi.org/10.2196/41422 %U http://www.ncbi.nlm.nih.gov/pubmed/36705961 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e42866 %T The Feasibility of Implementing Remote Measurement Technologies in Psychological Treatment for Depression: Mixed Methods Study on Engagement %A de Angel,Valeria %A Adeleye,Fadekemi %A Zhang,Yuezhou %A Cummins,Nicholas %A Munir,Sara %A Lewis,Serena %A Laporta Puyal,Estela %A Matcham,Faith %A Sun,Shaoxiong %A Folarin,Amos A %A Ranjan,Yatharth %A Conde,Pauline %A Rashid,Zulqarnain %A Dobson,Richard %A Hotopf,Matthew %+ Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, E3.08, 3rd Floor East Wing, de Crespigny park, London, SE5 8AF, United Kingdom, 44 20 7848 0002, valeria.de_angel@kcl.ac.uk %K depression %K anxiety %K digital health %K wearable devices %K smartphone %K passive sensing %K mobile health %K mHealth %K digital phenotyping %K mobile phone %D 2023 %7 24.1.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Remote measurement technologies (RMTs) such as smartphones and wearables can help improve treatment for depression by providing objective, continuous, and ecologically valid insights into mood and behavior. Engagement with RMTs is varied and highly context dependent; however, few studies have investigated their feasibility in the context of treatment. Objective: A mixed methods design was used to evaluate engagement with active and passive data collection via RMT in people with depression undergoing psychotherapy. We evaluated the effects of treatment on 2 different types of engagement: study attrition (engagement with study protocol) and patterns of missing data (engagement with digital devices), which we termed data availability. Qualitative interviews were conducted to help interpret the differences in engagement. Methods: A total of 66 people undergoing psychological therapy for depression were followed up for 7 months. Active data were gathered from weekly questionnaires and speech and cognitive tasks, and passive data were gathered from smartphone sensors and a Fitbit (Fitbit Inc) wearable device. Results: The overall retention rate was 60%. Higher-intensity treatment (χ21=4.6; P=.03) and higher baseline anxiety (t56.28=−2.80, 2-tailed; P=.007) were associated with attrition, but depression severity was not (t50.4=−0.18; P=.86). A trend toward significance was found for the association between longer treatments and increased attrition (U=339.5; P=.05). Data availability was higher for active data than for passive data initially but declined at a sharper rate (90%-30% drop in 7 months). As for passive data, wearable data availability fell from a maximum of 80% to 45% at 7 months but showed higher overall data availability than smartphone-based data, which remained stable at the range of 20%-40% throughout. Missing data were more prevalent among GPS location data, followed by among Bluetooth data, then among accelerometry data. As for active data, speech and cognitive tasks had lower completion rates than clinical questionnaires. The participants in treatment provided less Fitbit data but more active data than those on the waiting list. Conclusions: Different data streams showed varied patterns of missing data, despite being gathered from the same device. Longer and more complex treatments and clinical characteristics such as higher baseline anxiety may reduce long-term engagement with RMTs, and different devices may show opposite patterns of missingness during treatment. This has implications for the scalability and uptake of RMTs in health care settings, the generalizability and accuracy of the data collected by these methods, feature construction, and the appropriateness of RMT use in the long term. %M 36692937 %R 10.2196/42866 %U https://mental.jmir.org/2023/1/e42866 %U https://doi.org/10.2196/42866 %U http://www.ncbi.nlm.nih.gov/pubmed/36692937 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43639 %T Use of and Satisfaction With Mobile Health Education During the COVID-19 Pandemic in Thailand: Cross-sectional Study %A Kittipimpanon,Kamonrat %A Noyudom,Angun %A Panjatharakul,Pawanrat %A Visudtibhan,Poolsuk Janepanish %+ Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand, 66 814376763, angun.ket@mahidol.ac.th %K mHealth %K COVID-19 %K chatbot %K use %K satisfaction %D 2023 %7 24.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: RamaCovid is a mobile health (mHealth) education system that provides the Thai population with information about COVID-19 and self-risk assessment. RamaCovid has a chatbot system that provides automatic conversations (available 24 hours per day) and a live chat function that allows users to directly communicate with health professionals (available 4 hours per day in the evening). The system consists of (1) COVID-19 vaccine information, (2) self-care after vaccination, (3) frequently asked questions, (4) self-risk assessment, (5) hospital finding, (6) contact number finding, and (7) live chat with a health professional. Objective: This study investigates the use of and satisfaction with the RamaCovid system. Methods: Overall, 400 people were recruited via RamaCovid by broadcasting an infographic about the study. Questionnaires collected demographic data, users’ experiences of RamaCovid, and the use of and satisfaction with the system. The questions were answered using a 5-point Likert scale. Descriptive statistics were used to describe the participant characteristics and their use of and satisfaction with the RamaCovid system. The Mann-Whitney U test was performed to examine the difference in use and satisfaction between the adult and older adult groups. Results: The participants showed high use of and satisfaction with the RamaCovid system. They used the information to take care of themselves and their family, and they gained information about their COVID-19 risk. The users were satisfied with the system because the information was easy to understand, trustworthy, and up to date. However, the older adult group had lower use of and satisfaction with the system compared to the adult group. Conclusions: RamaCovid is an example of the successful implementation of mHealth education. It was an alternative way to work with the call center during the COVID-19 pandemic and increased access to health information and health care services. Providing ongoing updated information, improving the attractiveness of the media information, and the age group difference are important issues for further system development. %M 36596210 %R 10.2196/43639 %U https://formative.jmir.org/2023/1/e43639 %U https://doi.org/10.2196/43639 %U http://www.ncbi.nlm.nih.gov/pubmed/36596210 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42266 %T User Engagement and Weight Loss Facilitated by a Mobile App: Retrospective Review of Medical Records %A Valinskas,Sarunas %A Nakrys,Marius %A Aleknavičius,Kasparas %A Jonusas,Justinas %A Lileikienė,Angelė %+ Lithuania Business University of Applied Sciences, Turgaus st 21, Klaipėda, 91249, Lithuania, 370 26311099, justinas.jonusas@kilo.health %K intermittent fasting %K fasting %K weight %K weight loss %K mobile application %K body composition %K mHealth %K mobile health %K diet %K dietary intervention %K weight loss outcome %K adherence %K engagement %K mobile app %K motivation %K intervention outcome %K fasting apps %K dietary interventions %K obesity %K regression analysis %D 2023 %7 24.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Intermittent fasting (IF) has gained popularity in recent years for its effect on weight loss and supposed additional health benefits, such as a positive effect on body composition and metabolic markers. Mobile apps can act as platforms that help deliver dietary interventions by improving adherence and motivation. Although the effect of IF on weight loss has been demonstrated in earlier trials, there is not much research about the engagement and weight loss results with IF apps. Objective: Our main objective was to compare how a nudging platform (including smart scales) influences engagement (the extent to which users interact with the app measured by the number of active days) with the app among users who had obesity at the beginning of use. The secondary objectives were to evaluate the body weight changes among active and nonactive users and, finally, to evaluate the body composition changes of users possessing smart scales during app usage. Through this study, we hope to provide (1) more insight into how nudging (using smart scales as a nudging platform) is associated with engagement with the mobile app, (2) how engagement with the mobile app is associated with weight loss, and (3) how IF is associated with body composition. Methods: We performed a retrospective analysis of data from 665 users with obesity (BMI≥30) who started using the IF app DoFasting. Of them, 244 used body composition scales that estimated body fat and body muscle values. Users were stratified into engagement groups in accordance with their activity ratio (number of active days divided by the total time of use). Baseline and final users' weight (in kg), body fat (in %), and body muscle (in %) were compared. Results: Our findings suggest an association between the nudging platform (smart scales) and better engagement with the app. Smart scale users had a significantly higher activity ratio than regular users. Additionally, active DoFasting users lost significantly more weight. Further, body composition analysis showed that app usage might be related to body fat loss and an increase in muscle mass. Conclusions: We found a possible association between the nudging and gamified elements and higher app engagement. Additionally, increased app engagement is associated with increased weight loss. Thus, nudging and gamified elements of mobile health apps, such as interactive tools, goals, challenges, and progress tracking, are suggested to affect engagement positively and should be investigated further in future research. Finally, the IF regime delivered through the DoFasting app might be related to the body muscle mass gain and reduced fat mass. %M 36692936 %R 10.2196/42266 %U https://formative.jmir.org/2023/1/e42266 %U https://doi.org/10.2196/42266 %U http://www.ncbi.nlm.nih.gov/pubmed/36692936 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e39640 %T Facebook Intervention for Young-Onset Melanoma Survivors and Families: Protocol for a Randomized Controlled Trial %A Manne,Sharon %A Pagoto,Sherry %A Peterson,Susan %A Heckman,Carolyn %A Kashy,Deborah %A Berger,Adam %A Studts,Christina %A Negrón,Rosalyn %A Buller,David %A Paddock,Lisa %A Gallo,Joseph %A Kulik,Alexandria %A Frederick,Sara %A Pesanelli,Morgan %A Domider,Mara %A Grosso,Marissa %+ Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, 120 Albany Street, Tower II, New Brunswick, NJ, 08901, United States, 1 7323577978, mannesl@cinj.rutgers.edu %K cancer survivors %K melanoma survivors %K skin self-examination %K clinical skin examination %K sun protection %K behavioral intervention %K social media %D 2023 %7 24.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Individuals diagnosed with melanoma before the age of 40 years (young-onset melanoma survivors) and their first-degree relatives (FDRs) are a growing population at risk for developing recurrent melanoma or new melanomas. Regular surveillance using clinical skin examination (CSE) and skin self-examination (SSE) and engagement in preventive behaviors including sun protection are recommended. Given the growing population of survivors and their families who are at increased risk, it is surprising that no behavioral interventions have been developed and evaluated to improve risk-reduction behaviors. Objective: We describe the rationale and methodology for a randomized controlled trial evaluating the efficacy of a Facebook intervention providing information, goal setting, and peer support to increase CSE, SSE, and sun protection for young-onset melanoma survivors and their FDRs. Methods: Overall, 577 survivors and 577 FDRs will be randomly assigned to either the Young Melanoma Family Facebook Group or the Melanoma Family Healthy Lifestyle Facebook Group condition. Participants will complete measures of CSE, SSE, and sun protection, and mediator measures of attitudes and beliefs before and after the intervention. The primary aim is to evaluate the impact of the Young Melanoma Family Facebook intervention versus the Melanoma Family Healthy Lifestyle Facebook intervention on CSE, SSE frequency and comprehensiveness, and sun protection among FDRs. The secondary aims examine the efficacy of the Young Melanoma Family Facebook intervention on survivors’ SSE frequency and comprehensiveness and sun protection behaviors and mechanisms of intervention efficacy for intervention impact on FDR and survivor outcomes. The exploratory aim is to evaluate the efficacy of the 2 interventions on perceived stress, physical activity, and healthy eating. Results: This project was funded by the National Institutes of Health (R01CA221854). The project began in May 2018, and recruitment started in January 2019. We anticipate completing enrollment by November 2023. Power calculations recommended a sample size of 577 survivors and 577 FDRs. Multilevel modeling treating family as the upper-level sampling unit and individual as the lower-level sampling unit will be the primary data analytic approach. Fixed effect predictors in these models will include condition, role, sex, all 2- and 3-way interactions, and covariates. Conclusions: The Young Melanoma Family Facebook intervention aims to improve primary and secondary skin cancer prevention for young-onset melanoma survivors and their family members. The intervention’s delivery via a popular, freely available social media platform increases its impact because of the potential for dissemination in many contexts. If efficacious, this program could be disseminated by dermatologist practices, public health or nonprofit organizations focused on melanoma, and existing melanoma and skin cancer Facebook groups, thereby expanding its reach. This project will produce a content library of posts and a moderation guide for others. Trial Registration: ClinicalTrials.gov NCT03677739; https://clinicaltrials.gov/ct2/show/NCT03677739 International Registered Report Identifier (IRRID): DERR1-10.2196/39640 %M 36692933 %R 10.2196/39640 %U https://www.researchprotocols.org/2023/1/e39640 %U https://doi.org/10.2196/39640 %U http://www.ncbi.nlm.nih.gov/pubmed/36692933 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e42799 %T Effectiveness of mHealth on Adherence to Antiretroviral Therapy in Patients Living With HIV: Meta-analysis of Randomized Controlled Trials %A Sun,Liang %A Qu,Mengbing %A Chen,Bing %A Li,Chuancang %A Fan,Haohao %A Zhao,Yang %+ College of Public Health, Zhengzhou University, New campus of Zhengzhou University, 100 Science Avenue, Zhengzhou, 450001, China, 86 13803845359, zhaomiemie@126.com %K HIV %K mHealth %K antiretroviral therapy %K meta-analysis %D 2023 %7 23.1.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The World Health Organization recommends that all adults with HIV adhere to antiretroviral therapy (ART). Good adherence to ART is beneficial to patients and the public. Furthermore, mHealth has shown promise in improving HIV medication adherence globally. Objective: The aim of this meta-analysis is to analyze the effectiveness of mHealth on adherence to antiretroviral therapy in patients living with HIV. Methods: Randomized controlled trials (RCTs) of the association between mHealth and adherence to ART published until December 2021 were searched in electronic databases. Odds ratios (ORs), weighted mean differences, and 95% CIs were calculated. This meta-analysis was performed using the Mantel-Haenszel method or the inverse variance test. We evaluated heterogeneity with the I2 statistic. If I2 was ≤50%, heterogeneity was absent, and a fixed effect model was used. If I2 was >50%, heterogeneity was present, and a random effects model was used. Results: A total of 2163 participants in 8 studies were included in this meta-analysis. All included studies were RCTs. The random effects model was used for a meta-analysis of the effects of various intervention measures compared to routine nursing; the outcome was not statistically significant (OR 1.54, 95% CI 0.99-2.38; P=.05). In the subgroups, only short messaging service (SMS)-based interventions significantly increased adherence to ART (OR 1.76, 95% CI 1.07-2.89; P=.03). Further analysis showed that only interactive or bidirectional SMS could significantly increase ART adherence (OR 1.69, 95% CI 1.22-2.34; P=.001). After combining the difference in CD4 cell count before and after the interventions, we concluded that there was no statistical heterogeneity among the studies (I2=0%; tau2=0.37; P=.95). Conclusions: Interactive or bidirectional SMS can enhance intervention effects. However, whether mHealth can improve adherence to ART in patients with HIV needs further study. Owing to a lack of the required significant staff time, training, and ongoing supervision, there is still much more to do to apply mHealth to the clinical use of ART for patients living with HIV. Trial Registration: PROSPERO CRD42022358774; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=358774 %M 36689267 %R 10.2196/42799 %U https://mhealth.jmir.org/2023/1/e42799 %U https://doi.org/10.2196/42799 %U http://www.ncbi.nlm.nih.gov/pubmed/36689267 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42178 %T The Acceptability of Technology-Based Physical Activity Interventions in Postbariatric Surgery Women: Insights From Qualitative Analysis Using the Unified Theory of Acceptance and Use of Technology 2 Model %A Thérouanne,Pierre %A Hayotte,Meggy %A Halgand,Florent %A d'Arripe-Longueville,Fabienne %+ Université Côte d'Azur, LAPCOS, Laboratoire d'Anthropologie et de Psychologie Cliniques, Cognitives et Sociales Campus Saint Jean d'Angely / SJA3 / MSHS Sud-Est, 25 avenue François Mitterrand, Nice, 06300, France, 33 4 89 15 23 49, pierre.therouanne@univ-cotedazur.fr %K acceptability %K health technology %K physical activity %K obesity %K UTAUT2 %D 2023 %7 23.1.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Bariatric surgery offers an opportunity for physical activity (PA) promotion due to patients’ increased ability to engage in PA. Technology-based PA interventions are promising tools for promoting PA to support patients in this key period. The Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model is a recognized theoretical model for examining technology acceptability. Although a previous study reported that 92% of women with obesity have high acceptability of at least one technology-based PA intervention, little is known about the factors that lead to different levels of acceptability between technologies and therefore the reasons for choosing a preferred intervention. Objective: The purpose of this study was to (1) characterize the acceptability of 3 technology-based PA interventions (ie, telehealth, active video game, mobile app) in the context of bariatric surgery, and (2) explore patients’ preference motives. This study, using a qualitative design, examined the suitability of the UTAUT2 model in this specific context. Methods: Participants (n=26) read written French descriptions of the technology-based PA interventions with illustrations and chose their preferred intervention. Semidirective interviews were conducted to explore the reasons for their choice of the preferred intervention, notably using the UTAUT2 framework. Data were analyzed based on inductive and deductive approaches. Results: All participants who preferred a technology-based PA intervention (ie, active video game, n=10; mobile app, n=10; telehealth, n=6) expressed a behavioral intention to use it. In addition, some of them expressed a high behavioral intention to use another technology (ie, active video game, n=4; mobile app, n=1; telehealth, n=7). All the constructs of the UTAUT2 emerged during the qualitative interviews and were specified through subcategories. Additional constructs also emerged, especially other motivational factors. Conclusions: This study showed that, in the context of technology-based PA interventions for postbariatric patients, the UTAUT2 is suitable, although additional motivational factors (which were not considered by the UTAUT2 model) should be considered. %M 36689255 %R 10.2196/42178 %U https://humanfactors.jmir.org/2023/1/e42178 %U https://doi.org/10.2196/42178 %U http://www.ncbi.nlm.nih.gov/pubmed/36689255 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43629 %T Can a Single Variable Predict Early Dropout From Digital Health Interventions? Comparison of Predictive Models From Two Large Randomized Trials %A Bricker,Jonathan %A Miao,Zhen %A Mull,Kristin %A Santiago-Torres,Margarita %A Vock,David M %+ Division of Public Health Sciences, Fred Hutch Cancer Center, 1100 Fairview Avenue North, M3-B232, Seattle, WA, 98109, United States, 1 2066675000, jbricker@fredhutch.org %K acceptance and commitment therapy %K ACT %K attrition %K digital interventions %K dropout %K eHealth %K engagement %K iCanQuit %K mobile health %K mHealth %K QuitGuide %K smartphone apps %K smoking %K tobacco %K trajectories %K mobile phone %D 2023 %7 20.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: A single generalizable metric that accurately predicts early dropout from digital health interventions has the potential to readily inform intervention targets and treatment augmentations that could boost retention and intervention outcomes. We recently identified a type of early dropout from digital health interventions for smoking cessation, specifically, users who logged in during the first week of the intervention and had little to no activity thereafter. These users also had a substantially lower smoking cessation rate with our iCanQuit smoking cessation app compared with users who used the app for longer periods. Objective: This study aimed to explore whether log-in count data, using standard statistical methods, can precisely predict whether an individual will become an iCanQuit early dropout while validating the approach using other statistical methods and randomized trial data from 3 other digital interventions for smoking cessation (combined randomized N=4529). Methods: Standard logistic regression models were used to predict early dropouts for individuals receiving the iCanQuit smoking cessation intervention app, the National Cancer Institute QuitGuide smoking cessation intervention app, the WebQuit.org smoking cessation intervention website, and the Smokefree.gov smoking cessation intervention website. The main predictors were the number of times a participant logged in per day during the first 7 days following randomization. The area under the curve (AUC) assessed the performance of the logistic regression models, which were compared with decision trees, support vector machine, and neural network models. We also examined whether 13 baseline variables that included a variety of demographics (eg, race and ethnicity, gender, and age) and smoking characteristics (eg, use of e-cigarettes and confidence in being smoke free) might improve this prediction. Results: The AUC for each logistic regression model using only the first 7 days of log-in count variables was 0.94 (95% CI 0.90-0.97) for iCanQuit, 0.88 (95% CI 0.83-0.93) for QuitGuide, 0.85 (95% CI 0.80-0.88) for WebQuit.org, and 0.60 (95% CI 0.54-0.66) for Smokefree.gov. Replacing logistic regression models with more complex decision trees, support vector machines, or neural network models did not significantly increase the AUC, nor did including additional baseline variables as predictors. The sensitivity and specificity were generally good, and they were excellent for iCanQuit (ie, 0.91 and 0.85, respectively, at the 0.5 classification threshold). Conclusions: Logistic regression models using only the first 7 days of log-in count data were generally good at predicting early dropouts. These models performed well when using simple, automated, and readily available log-in count data, whereas including self-reported baseline variables did not improve the prediction. The results will inform the early identification of people at risk of early dropout from digital health interventions with the goal of intervening further by providing them with augmented treatments to increase their retention and, ultimately, their intervention outcomes. %M 36662550 %R 10.2196/43629 %U https://www.jmir.org/2023/1/e43629 %U https://doi.org/10.2196/43629 %U http://www.ncbi.nlm.nih.gov/pubmed/36662550 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40784 %T Increasing Engagement in the Electronic Framingham Heart Study: Factorial Randomized Controlled Trial %A Trinquart,Ludovic %A Liu,Chunyu %A McManus,David D %A Nowak,Christopher %A Lin,Honghuang %A Spartano,Nicole L %A Borrelli,Belinda %A Benjamin,Emelia J %A Murabito,Joanne M %+ Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, 73 Mount Wayte Ave, Framingham, MA, 01702, United States, 1 5089353400, murabito@bu.edu %K smartphone notifications %K digital device use %K randomized trial %K smartphone %K apps %K mobile health %K mHealth %K devices %K cardiovascular %K data %K intervention %K blood pressure %K heart rate %K digital %K tool %K notification %K messaging %K prompt %K nudge %K behavior change %K self-monitoring %K self care %K cardiology %D 2023 %7 20.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphone apps and mobile health devices offer innovative ways to collect longitudinal cardiovascular data. Randomized evidence regarding effective strategies to maintain longitudinal engagement is limited. Objective: This study aimed to evaluate smartphone messaging interventions on remote transmission of blood pressure (BP) and heart rate (HR) data. Methods: We conducted a 2 × 2 × 2 factorial blinded randomized trial with randomization implemented centrally to ensure allocation concealment. We invited participants from the Electronic Framingham Heart Study (eFHS), an e-cohort embedded in the FHS, and asked participants to measure their BP (Withings digital cuff) weekly and wear their smartwatch daily. We assessed 3 weekly notification strategies to promote adherence: personalized versus standard; weekend versus weekday; and morning versus evening. Personalized notifications included the participant’s name and were tailored to whether or not data from the prior week were transmitted to the research team. Intervention notification messages were delivered weekly automatically via the eFHS app. We assessed if participants transmitted at least one BP or HR measurement within 7 days of each notification after randomization. Outcomes were adherence to BP and HR transmission at 3 months (primary) and 6 months (secondary). Results: Of the 791 FHS participants, 655 (82.8%) were eligible and randomized (mean age 53, SD 9 years; 392/655, 59.8% women; 596/655, 91% White). For the personalized versus standard notifications, 38.9% (126/324) versus 28.8% (94/327) participants sent BP data at 3 months (difference=10.1%, 95% CI 2.9%-17.4%; P=.006), but no significant differences were observed for HR data transmission (212/324, 65.4% vs 209/327, 63.9%; P=.69). Personalized notifications were associated with increased BP and HR data transmission versus standard at 6 months (BP: 107/291, 36.8% vs 66/295, 22.4%; difference=14.4%, 95% CI 7.1- 21.7%; P<.001; HR: 186/281, 66.2% vs 158/281, 56.2%; difference=10%, 95% CI 2%-18%; P=.02). For BP and HR primary or secondary outcomes, there was no evidence of differences in data transmission for notifications sent on weekend versus weekday or morning versus evening. Conclusions: Personalized notifications increased longitudinal adherence to BP and HR transmission from mobile and digital devices among eFHS participants. Our results suggest that personalized messaging is a powerful tool to promote adherence to mobile health systems in cardiovascular research. Trial Registration: ClinicalTrials.gov NCT03516019; https://clinicaltrials.gov/ct2/show/NCT03516019 %M 36662544 %R 10.2196/40784 %U https://www.jmir.org/2023/1/e40784 %U https://doi.org/10.2196/40784 %U http://www.ncbi.nlm.nih.gov/pubmed/36662544 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e37537 %T Prototyping of a Digital Life Course Care Platform for Preconception and Pregnancy Care: Pilot Feasibility and Acceptability Study %A van der Windt,Melissa %A van Zundert,Sofie Karolina Maria %A Schoenmakers,Sam %A van Rossem,Lenie %A Steegers-Theunissen,Régine Patricia Maria %+ Department of Obstetrics and Gynecology, Erasmus University Medical Center, P O Box 2040, Rotterdam, 3000 CA, Netherlands, 31 6 14 79 23 10, r.steegers@erasmusmc.nl %K eHealth %K app %K lifestyle %K lifestyle care %K life course care %K preconception %K periconception %K pregnancy %K health care %K pilot %D 2023 %7 20.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: A healthy lifestyle plays a key role in the prevention of lifestyle-related diseases, including subfertility and pregnancy complications. Although the benefits of a healthy lifestyle are well-known, long-term adherence is limited. Moreover, memory for lifestyle-related information as well as medical information provided by the medical professional is often poor and insufficient. In order to innovate and improve health care for both the patients and health care professionals, we developed a prototype of a digital life course care platform (Smarter Health app), providing personalized lifestyle care trajectories integrated in medical care journeys. Objective: This pilot study aimed to evaluate the feasibility, defined as the actual app use, and the acceptability, which included patient satisfaction and appreciation, of the Smarter Health app. Methods: Between March 17, 2021, and September 30, 2021, pregnant women familiar with the Dutch language seeking tertiary preconception and pregnancy care were offered the app as part of standard medical care at the outpatient clinic Healthy Pregnancy of the Department of Obstetrics and Gynecology of the Erasmus University Medical Center. Three months after activation of the app, patients received a digital questionnaire consisting of aspects of feasibility and acceptability. Results: During this pilot study, 440 patients visited the outpatient clinic Healthy Pregnancy. Of the 440 patients, 293 (66.6%) activated the app. Of the 293 patients who activated the app, 125 (42.7%) filled out the questionnaire. Of these 125 patients, 48 (38.4%) used the app. Most app users used it occasionally and logged in 8 times during their medical care trajectory. Overall, app users were satisfied with the app (median 5-point Likert scale=2.4, IQR 2.0-3.3). Conclusions: Our findings showed that the Smarter Health app, which integrates lifestyle care in medical care, is a feasible health care innovation, and that patients were satisfied with the app. Follow-up and evaluation of pregnancy outcomes should be performed to further substantiate wider clinical implementation. %M 36662557 %R 10.2196/37537 %U https://www.jmir.org/2023/1/e37537 %U https://doi.org/10.2196/37537 %U http://www.ncbi.nlm.nih.gov/pubmed/36662557 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e37716 %T mHealth Apps Targeting Obesity and Overweight in Young People: App Review and Analysis %A Vlahu-Gjorgievska,Elena %A Burazor,Andrea %A Win,Khin Than %A Trajkovik,Vladimir %+ School of Computing and Information Technology, University of Wollongong, Northfields Ave, Wollongong, 2522, Australia, 61 42214606, elenavg@uow.edu.au %K behavior change techniques %K user interface design patterns %K mHealth apps %K obesity %K lifestyle %K mobile app %K mobile health %K mobile phone %D 2023 %7 19.1.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Overweight and obesity have been linked to several serious health problems and medical conditions. With more than a quarter of the young population having weight problems, the impacts of overweight and obesity on this age group are particularly critical. Mobile health (mHealth) apps that support and encourage positive health behaviors have the potential to achieve better health outcomes. These apps represent a unique opportunity for young people (age range 10-24 years), for whom mobile phones are an indispensable part of their everyday living. However, despite the potential of mHealth apps for improved engagement in health interventions, user adherence to these health interventions in the long term is low. Objective: The aims of this research were to (1) review and analyze mHealth apps targeting obesity and overweight and (2) propose guidelines for the inclusion of user interface design patterns (UIDPs) in the development of mHealth apps for obese young people that maximizes the impact and retention of behavior change techniques (BCTs). Methods: A search for apps was conducted in Google Play Store using the following search string: [“best weight loss app for obese teens 2020”] OR [“obesity applications for teens”] OR [“popular weight loss applications”]. The most popular apps available in both Google Play and Apple App Store that fulfilled the requirements within the inclusion criteria were selected for further analysis. The designs of 17 mHealth apps were analyzed for the inclusion of BCTs supported by various UIDPs. Based on the results of the analysis, BCT-UI design guidelines were developed. The usability of the guidelines was presented using a prototype app. Results: The results of our analysis showed that only half of the BCTs are implemented in the reviewed apps, with a subset of those BCTs being supported by UIDPs. Based on these findings, we propose design guidelines that associate the BCTs with UIDPs. The focus of our guidelines is the implementation of BCTs using design patterns that are impactful for the young people demographics. The UIDPs are classified into 6 categories, with each BCT having one or more design patterns appropriate for its implementation. The applicability of the proposed guidelines is presented by mock-ups of the mHealth app “Morphe,” intended for young people (age range 10-24 years). The presented use cases showcase the 5 main functionalities of Morphe: learn, challenge, statistics, social interaction, and settings. Conclusions: The app analysis results showed that the implementation of BCTs using UIDPs is underutilized. The purposed guidelines will help developers in designing mHealth apps for young people that are easy to use and support behavior change. Future steps involve the development and deployment of the Morphe app and the validation of its usability and effectiveness. %M 36656624 %R 10.2196/37716 %U https://mhealth.jmir.org/2023/1/e37716 %U https://doi.org/10.2196/37716 %U http://www.ncbi.nlm.nih.gov/pubmed/36656624 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41939 %T The Use of Technology to Provide Mental Health Services to Youth Experiencing Homelessness: Scoping Review %A Lal,Shalini %A Elias,Sarah %A Sieu,Vida %A Peredo,Rossana %+ School of Rehabilitation, Faculty of Medicine, University of Montréal, C.P. 6128, succursale Centre-ville, Montréal, QC, H3C 3J7, Canada, 1 5148908000 ext 31581, shalini.lal@umontreal.ca %K digital equity %K homelessness %K telemedicine %K telehealth %K cellular phone %K internet %K e-mental health %K digital health %K mobile health %K mHealth %K literature review %K mobile phone %D 2023 %7 16.1.2023 %9 Review %J J Med Internet Res %G English %X Background: There is growing interest in using information and communication technologies (ICTs) to improve access to mental health services for youth experiencing homelessness (YEH); however, limited efforts have been made to synthesize this literature. Objective: This study aimed to review the research on the use of ICTs to provide mental health services and interventions for YEH. Methods: We used a scoping review methodology following the Arksey and O’Malley framework and guidelines from the Joanna Briggs Institute Manual for Evidence Synthesis. The results are reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A systematic search was conducted from 2005 to 2021 in MEDLINE, Embase, CINAHL, PsycInfo, Cochrane, Web of Science, and Maestro and in ProQuest Thesis and Dissertations, Papyrus, Homeless Hub, and Google Scholar for gray literature. Studies were included if participants’ mean age was between 13 and 29 years, youth with mental health issues were experiencing homelessness or living in a shelter, ICTs were used as a means of intervention, and the study provided a description of the technology. The exclusion criteria were technology that did not allow for interaction (eg, television) and languages other than French or English. The data were analyzed using descriptive statistics and qualitative approaches. Two reviewers were involved in the screening and data extraction process in consultation with a third reviewer. The data were summarized in tables and by narrative synthesis. Results: From the 2153 abstracts and titles screened, 12 were included in the analysis. The most common types of ICTs used were communication technologies (eg, phone, video, and SMS text messages) and mobile apps. The intervention goals varied widely across studies; the most common goal was reducing risky behaviors, followed by addressing cognitive functioning, providing emotional support, providing vital resources, and reducing anxiety. Most studies (9/11, 82%) focused on the feasibility of interventions. Almost all studies reported high levels of acceptability (8/9, 89%) and moderate to high frequency of use (5/6, 83%). The principal challenges were related to technical problems such as the need to replace phones, issues with data services, and phone charging. Conclusions: Our results indicate the emerging role of ICTs in the delivery of mental health services to YEH and that there is a high level of acceptability based on early feasibility studies. However, our results should be interpreted cautiously, considering the limited number of studies included in the analysis and the elevated levels of dropout. There is a need to advance efficacy and effectiveness research in this area with larger and longer studies. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-061313 %M 36645703 %R 10.2196/41939 %U https://www.jmir.org/2023/1/e41939 %U https://doi.org/10.2196/41939 %U http://www.ncbi.nlm.nih.gov/pubmed/36645703 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e39898 %T Feasibility, Safety, Enjoyment, and System Usability of Web-Based Aerobic Dance Exercise Program in Older Adults: Single-Arm Pilot Study %A Hyodo,Kazuki %A Kidokoro,Tetsuhiro %A Yamaguchi,Daisuke %A Iida,Michitaka %A Watanabe,Yuya %A Ueno,Aiko %A Noda,Takayuki %A Kawahara,Kenji %A Nishida,Sumiyo %A Kai,Yuko %A Arao,Takashi %+ Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare, Tobuki 150, Hachioji, Tokyo, 192-0001, Japan, 81 42 691 1163, k-hyodo@my-zaidan.or.jp %K low-intensity exercise %K home exercise %K online exercise %K supervised exercise %K elderly %K COVID-19 %K smartphone %K tablet %K videoconferencing platform %D 2023 %7 16.1.2023 %9 Original Paper %J JMIR Aging %G English %X Background: During the COVID-19 epidemic, opportunities for social interaction and physical activity among older people are decreasing, which may have a negative impact on their health. As a solution, a web-based group exercise program provided through a videoconferencing platform would be useful. As a web-based exercise program that older adults can easily, safely, and enjoyably perform at home, we developed a short-duration, light-intensity aerobic dance exercise program. Before studying the effectiveness of this exercise program, its characteristics, such as feasibility, safety, enjoyment, and system usability, should be examined among older adults. Objective: This pilot study aimed to examine the feasibility, safety, and enjoyment of a web-based aerobic dance exercise program and the usability of a web-based exercise delivery system using a videoconferencing platform for older adults. Methods: This study was designed as a prospective single-arm pilot study. A total of 16 older adults participated in an 8-week web-based aerobic dance program held every morning (8:30 AM to 8:50 AM) on weekdays at home. Retention and adherence rates were measured for the program’s feasibility. Safety was assessed by the heart rate reserve, an index of exercise intensity calculated from heart rate, and the number of adverse events during exercise sessions. Enjoyment of this exercise program was assessed by an 11-point Likert scale ranging from 0 (not enjoyable at all) to 10 (extremely enjoyable) obtained through telephone interviews after the first-, third-, sixth-, and eighth-week intervention. For usability, the ease of the videoconferencing platform system was assessed through telephone interviews after the intervention. Results: A female participant with hypertension dropped out in the second week because of the continuously reported high blood pressure (≥180 mmHg) before attending the exercise session in the first week. Therefore, the retention rate was 93.8% (15/16). Among the remaining participants, the median (IQR) overall adherence rate was 97.4% (94.7-100). Regarding safety, the mean (SD) heart rate reserve during the aerobic dance exercise was 29.8% (6.8%), showing that the exercise was relatively safe with very light to light intensity. There were no adverse events during the exercise session. The enjoyment score (0-10 points) significantly increased from the first (6.7 [1.7]) to sixth (8.2 [1.3]) and eighth week (8.5 [1.3]). Regarding usability, 11 participants reported difficulties at the beginning, such as basic touch panel operations and the use of unfamiliar applications; however, all got accustomed to it and subsequently reported no difficulty. Conclusions: This study showed high feasibility, enjoyment, and safety of the web-based aerobic dance exercise program in older adults, and the web-based exercise delivery system may have areas for improvement, albeit without serious problems. Our web-based aerobic dance exercise program may contribute to an increase in physical and social activities among older adults. %M 36645705 %R 10.2196/39898 %U https://aging.jmir.org/2023/1/e39898 %U https://doi.org/10.2196/39898 %U http://www.ncbi.nlm.nih.gov/pubmed/36645705 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41235 %T Behavior Change Effectiveness Using Nutrition Apps in People With Chronic Diseases: Scoping Review %A Salas-Groves,Emily %A Galyean,Shannon %A Alcorn,Michelle %A Childress,Allison %+ Department of Nutritional Sciences, Texas Tech University, 1301 Akron Avenue, Lubbock, TX, 79409, United States, 1 8068342286, shannon.galyean@ttu.edu %K mobile apps %K apps %K mobile health %K mHealth %K eHealth %K nutrition education %K cancer %K obesity %K diabetes %K cardiovascular disease %K mobile phone %D 2023 %7 13.1.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Cardiovascular disease, cancer, diabetes mellitus, and obesity are common chronic diseases, and their prevalence is reaching an epidemic level worldwide. As the impact of chronic diseases continues to increase, finding strategies to improve care, access to care, and patient empowerment becomes increasingly essential. Health care providers use mobile health (mHealth) to access clinical information, collaborate with care teams, communicate over long distances with patients, and facilitate real-time monitoring and interventions. However, these apps focus on improving general health care concerns, with limited apps focusing on specific chronic diseases and the nutrition involved in the disease state. Hence, available evidence on the effectiveness of mHealth apps toward behavior change to improve chronic disease outcomes is limited. Objective: The objective of this scoping review was to provide an overview of behavior change effectiveness using mHealth nutrition interventions in people with chronic diseases (ie, cardiovascular disease, diabetes mellitus, cancer, and obesity). We further evaluated the behavior change techniques and theories or models used for behavior change, if any. Methods: A scoping review was conducted through a systematic literature search in the MEDLINE, EBSCO, PubMed, ScienceDirect, and Scopus databases. Studies were excluded from the review if they did not involve an app or nutrition intervention, were written in a language other than English, were duplicates from other database searches, or were literature reviews. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, the systematic review process included 4 steps: identification of records through the database search, screening of duplicate and excluded records, eligibility assessment of full-text records, and final analysis of included records. Results: In total, 46 studies comprising 256,430 patients were included. There was diversity in the chronic disease state, study design, number of participants, in-app features, behavior change techniques, and behavior models used in the studies. In addition, our review found that less than half (19/46, 41%) of the studies based their nutrition apps on a behavioral theory or its constructs. Of the 46 studies, 11 (24%) measured maintenance of health behavior change, of which 7 (64%) sustained behavior change for approximately 6 to 12 months and 4 (36%) showed a decline in behavior change or discontinued app use. Conclusions: The results suggest that mHealth apps involving nutrition can significantly improve health outcomes in people with chronic diseases. Tailoring nutrition apps to specific populations is recommended for effective behavior change and improvement of health outcomes. In addition, some studies (7/46, 15%) showed sustained health behavior change, and some (4/46, 9%) showed a decline in the use of nutrition apps. These results indicate a need for further investigation on the sustainability of the health behavior change effectiveness of disease-specific nutrition apps. %M 36637888 %R 10.2196/41235 %U https://mhealth.jmir.org/2023/1/e41235 %U https://doi.org/10.2196/41235 %U http://www.ncbi.nlm.nih.gov/pubmed/36637888 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40231 %T The Acceptability of Using Augmented Reality as a Mechanism to Engage Children in Asthma Inhaler Technique Training: Qualitative Interview Study With Deductive Thematic Analysis %A O'Connor,Antonia %A Tai,Andrew %A Brinn,Malcolm %A Hoang,Amy Nguyen Thuc Hien %A Cataldi,Daniele %A Carson-Chahhoud,Kristin %+ Respiratory and Sleep Department, Women's and Children's Hospital, South Australia, 72 King William Road, North Adelaide, Adelaide, 5006, Australia, 61 08 8161 7234, antonia.chan@sa.gov.au %K asthma %K asthma education %K pediatric asthma %K augmented reality %K mobile phone %D 2023 %7 13.1.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Inhaled medications or inhalers provide first-line pharmacotherapeutic treatment for patients with asthma for both acute symptomatic relief and long-term management to keep symptoms under control. A good technique requires only basic instruction and training; however, a recent study identified that 92% of children do not follow all correct steps when using inhalers. There is a growing interest in technology-enhanced asthma education, with evidence demonstrating improvements in knowledge and treatment adherence. Subsequently, there are calls to explore the role of technology-based solutions in improving asthma management and disease outcomes from public health experts, health professionals, and patients with asthma. Augmented reality (AR) technology is an information delivery mechanism with proven efficacy in educational settings. AR displays digital content in a real-world environment using the camera on a smartphone or tablet device to create an immersive learning experience. Objective: The study aimed to evaluate the acceptability of AR as a mechanism for delivering asthma inhaler technique education from the perspective of children with asthma and their parents and health professionals, examined through the theoretical framework of acceptability (TFA). Methods: An asthma education resource enhanced with AR technology was created to provide inhaler technique education to children. An iterative co-design process was undertaken with target end users for a qualitative evaluation. The participants were 8 to 12 years old with asthma, their caregivers, and health professionals who had experience in managing asthma. Qualitative data were obtained through semistructured one-on-one interviews. Deductive thematic analysis using TFA was undertaken using NVivo software 2020 to assess the acceptability of AR as a delivery modality for asthma inhaler technique education. Results: Overall, 6 health care professionals, 5 asthmatic children, and 5 caregivers of children with asthma totaled a sample of 16. The use of AR in the asthma inhaler resource was found to be acceptable when responses were examined in accordance with TFA. Each of the 7 component constructs of TFA was coded throughout the 16 interviews, with perceived effectiveness (157 times) and affective attitude (63 times) coded most frequently. Positive responses included the intervention being accessible, easy to use, interesting, and fitting within the users’ value systems. Negative responses included the need to maintain an interest in children and concerns about the loss of face-to-face interaction with health professionals. Conclusions: AR appears to be an acceptable modality for delivering asthma education to children when explored using TFA constructs. Although some challenges were identified with the use of AR, the results were predominantly positive. Future designs of asthma education interventions involving AR should consider the results of this study, and further research should focus on the feasibility, usability, and barriers and facilitators of behavior change to ensure the successful implementation and uptake of AR into clinical settings. International Registered Report Identifier (IRRID): RR2-10.1177/16094069211042229 %M 36637889 %R 10.2196/40231 %U https://pediatrics.jmir.org/2023/1/e40231 %U https://doi.org/10.2196/40231 %U http://www.ncbi.nlm.nih.gov/pubmed/36637889 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40602 %T Engagement With mHealth COVID-19 Digital Biomarker Measurements in a Longitudinal Cohort Study: Mixed Methods Evaluation %A Rennie,Kirsten L %A Lawlor,Emma R %A Yassaee,Arrash %A Booth,Adam %A Westgate,Kate %A Sharp,Stephen J %A Tyrrell,Carina S B %A Aral,Mert %A Wareham,Nicholas J %+ Medical Research Council Epidemiology Unit, University of Cambridge, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, United Kingdom, 44 1223 330315, kirsten.rennie@mrc-epid.cam.ac.uk %K smartphone %K apps %K engagement %K COVID-19 %K pandemic %K cohort studies %K epidemiology %K mobile health %K digital health %K biomarker %K mobile phone %D 2023 %7 13.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic accelerated the interest in implementing mobile health (mHealth) in population-based health studies, but evidence is lacking on engagement and adherence in studies. We conducted a fully remote study for ≥6 months tracking COVID-19 digital biomarkers and symptoms using a smartphone app nested within an existing cohort of adults. Objective: We aimed to investigate participant characteristics associated with initial and sustained engagement in digital biomarker collection from a bespoke smartphone app and if engagement changed over time or because of COVID-19 factors and explore participants’ reasons for consenting to the smartphone substudy and experiences related to initial and continued engagement. Methods: Participants in the Fenland COVID-19 study were invited to the app substudy from August 2020 to October 2020 until study closure (April 30, 2021). Participants were asked to complete digital biomarker modules (oxygen saturation, body temperature, and resting heart rate [RHR]) and possible COVID-19 symptoms in the app 3 times per week. Participants manually entered the measurements, except RHR that was measured using the smartphone camera. Engagement was categorized by median weekly frequency of completing the 3 digital biomarker modules (categories: 0, 1-2, and ≥3 times per week). Sociodemographic and health characteristics of those who did or did not consent to the substudy and by engagement category were explored. Semistructured interviews were conducted with 35 participants who were purposively sampled by sex, age, educational attainment, and engagement category, and data were analyzed thematically; 63% (22/35) of the participants consented to the app substudy, and 37% (13/35) of the participants did not consent. Results: A total of 62.61% (2524/4031) of Fenland COVID-19 study participants consented to the app substudy. Of those, 90.21% (2277/2524) completed the app onboarding process. Median time in the app substudy was 34.5 weeks (IQR 34-37) with no change in engagement from 0 to 3 months or 3 to 6 months. Completion rates (≥1 per week) across the study between digital biomarkers were similar (RHR: 56,517/77,664, 72.77%; temperature: 56,742/77,664, 73.06%; oxygen saturation: 57,088/77,664, 73.51%). Older age groups and lower managerial and intermediate occupations were associated with higher engagement, whereas working, being a current smoker, being overweight or obese, and high perceived stress were associated with lower engagement. Continued engagement was facilitated through routine and personal motivation, and poor engagement was caused by user error and app or equipment malfunctions preventing data input. From these results, we developed key recommendations to improve engagement in population-based mHealth studies. Conclusions: This mixed methods study demonstrated both high initial and sustained engagement in a large mHealth COVID-19 study over a ≥6-month period. Being nested in a known cohort study enabled the identification of participant characteristics and factors associated with engagement to inform future applications in population-based health research. %M 36194866 %R 10.2196/40602 %U https://www.jmir.org/2023/1/e40602 %U https://doi.org/10.2196/40602 %U http://www.ncbi.nlm.nih.gov/pubmed/36194866 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41845 %T Repeatability, Reproducibility, and Concurrent Validity of a Stethoscope and Health App System for the Quantification of Breath Rate in Healthy Adults: Repeatability and Validity Study %A Becerro de Bengoa Vallejo,Ricardo %A Losa Iglesias,Marta Elena %A Robles Sanchez,Oscar David %+ Departamento de Enfermería y Estomatología, Facultad de CC de la Salud, Universidad Rey Juan Carlos, Av de Atenas S/N, Alcorcón, 28922, Spain, 34 616962413, marta.losa@urjc.es %K breath rate %K stethoscope %K smartphone app %K breathing rate %K vital sign %K respiration %K mobile phone app %K health app %K mobile app %K mHealth %K mobile health %K measurement %K breathing %K assessment %K monitoring %K reliability %K validity %K medical device %K medical instrument %D 2023 %7 12.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Apps for smartphones that can measure the breathing rate easily can be downloaded. Objective: The aim of this study was to demonstrate agreement in measuring breath rates between the stethoscope and Breath Counter health app. Methods: We performed a repeatability study with 56 healthy volunteers. The patient’s demographic data and breathing rates per minute were collected. Breathing rates were measured via two methods: (1) using a stethoscope placed in the upper area of the right lung and (2) a Breath Counter app developed by Vadion on a Samsung Fold smartphone. Results: This study demonstrated high repeatability and validity with respect to the breathing rate parameter of healthy adults using the aforementioned 2 systems. Intrasession repeatability measure using the intraclass correlation coefficient was >0.962, indicating excellent repeatability. Moreover, the intraclass correlation coefficient between methods was 0.793, indicating good repeatability, and coefficients of variation of method errors values were 1.83% with very low values in terms of other repeatability parameters. We found significant correlation coefficients and no systematic differences between the app and stethoscope methods. Conclusions: The app method may be attractive to individuals who require repeatability in a recreational setting. %M 36633892 %R 10.2196/41845 %U https://www.jmir.org/2023/1/e41845 %U https://doi.org/10.2196/41845 %U http://www.ncbi.nlm.nih.gov/pubmed/36633892 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e40017 %T A Digital Lifestyle Coach (E-Supporter 1.0) to Support People With Type 2 Diabetes: Participatory Development Study %A Hietbrink,Eclaire A G %A Middelweerd,Anouk %A van Empelen,Pepijn %A Preuhs,Katharina %A Konijnendijk,Annemieke A J %A Oude Nijeweme-d’Hollosy,Wendy %A Schrijver,Laura K %A Laverman,Gozewijn D %A Vollenbroek-Hutten,Miriam M R %+ Department of Biomedical Signals and Systems, University of Twente, Drienerlolaan 5, Enschede, 7500 AE Enschede, Netherlands, 31 53 4892760, e.a.g.hietbrink@utwente.nl %K eHealth %K mHealth %K diet %K nutrition %K physical activity %K lifestyle change %K coaching %K dynamic tailoring %K behavior change %K blended care %K type 2 diabetes %K design %K treatment %K chronic disease %K behavioral %K theory %K intervention %K acceptability %K usability %K cost %D 2023 %7 12.1.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: A healthy lifestyle, including regular physical activity and a healthy diet, is becoming increasingly important in the treatment of chronic diseases. eHealth interventions that incorporate behavior change techniques (BCTs) and dynamic tailoring strategies could effectively support a healthy lifestyle. E-Supporter 1.0 is an eCoach designed to support physical activity and a healthy diet in people with type 2 diabetes (T2D). Objective: This paper aimed to describe the systematic development of E-Supporter 1.0. Methods: Our systematic design process consisted of 3 phases. The definition phase included the selection of the target group and formulation of intervention objectives, and the identification of behavioral determinants based on which BCTs were selected to apply in the intervention. In the development phase, intervention content was developed by specifying tailoring variables, intervention options, and decision rules. In the last phase, E-Supporter 1.0 integrated in the Diameter app was evaluated using a usability test in 9 people with T2D to assess intervention usage and acceptability. Results: The main intervention objectives were to stimulate light to moderate-vigorous physical activities or adherence to the Dutch dietary guidelines in people with T2D. The selection of behavioral determinants was informed by the health action process approach and theories explaining behavior maintenance. BCTs were included to address relevant behavioral determinants (eg, action control, self-efficacy, and coping planning). Development of the intervention resulted in 3 types of intervention options, consisting of motivational messages, behavioral feedback, and tailor-made supportive exercises. On the basis of IF-THEN rules, intervention options could be tailored to, among others, type of behavioral goal and (barriers to) goal achievement. Data on these variables could be collected using app data, activity tracker data, and daily ecological momentary assessments. Usability testing revealed that user experiences were predominantly positive, despite some problems in the fixed delivery of content. Conclusions: The systematic development approach resulted in a theory-based and dynamically tailored eCoach. Future work should focus on expanding intervention content to other chronic diseases and lifestyle behaviors, enhancing the degree of tailoring and evaluating intervention effects on acceptability, use, and cost-effectiveness. %M 36633898 %R 10.2196/40017 %U https://humanfactors.jmir.org/2023/1/e40017 %U https://doi.org/10.2196/40017 %U http://www.ncbi.nlm.nih.gov/pubmed/36633898 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42119 %T A Universal Mental Health–Promoting Mobile App for Adolescents: Protocol for a Cluster Randomized Controlled Trial %A Kaiser,Sabine %A Rye,Marte %A Jakobsen,Reidar %A Martinussen,Monica %A Høgsdal,Helene %A Kyrrestad,Henriette %+ Regional Centre for Child and Youth Mental Health and Child Welfare - North, Faculty of Health Sciences, UiT The Arctic University of Norway, Campus Tromsø, Breivika, MH 2, plan 9 og 10, Tromsø, 9019, Norway, 47 77 64 58 50, sabine.kaiser@uit.no %K mental health promotion %K mobile app %K mobile phone %K adolescents %K Opp %K teens %K application %K effectiveness %K intervention %K effect %K health %K health promotion %D 2023 %7 11.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: In times of increasing mental health problems among young people, strengthening efforts to improve mental health through mental health promotion and prevention becomes increasingly important. Effective measures that support young people in coping with negative thoughts, feelings, and stress are essential, not just for the individual but also for society. Objective: The aim of this paper is to provide a description of a cluster randomized controlled trial that will be conducted to examine the effectiveness of Opp, a universal mental health–promoting mobile app for adolescents aged 13 to 19 years that provides information and exercises to better cope with stress, negative thoughts, and negative feelings. The protocol was developed in accordance with the SPIRIT checklist. Methods: An effectiveness study will be conducted with 3 measurement points: preintervention (T1), 2 weeks after the intervention (T2), and about 1 month after the intervention (T3). Adolescents will be recruited from middle and high schools in Norway and randomly assigned to the intervention or control groups. Randomization will be conducted on the school level. Opp can be downloaded from the Google Play or App Store but is password protected with a 4-digit code, which will be removed after study completion. Participants in the intervention group will receive a text message with the code to unlock the app. The participants in the intervention group can use Opp without limits on length or time of use. Objective data on how long or how often the participants use the app will not be collected. However, the second and third questionnaires for the intervention group contain app-specific questions on, for example, the use of the app. Results: Recruitment and data collection started in August and September 2022. So far, 381 adolescents have answered the first questionnaire. Data collection was expected to end in December 2022 but has had to be prolonged to approximately June 2023. The results of the study will be available in 2023 at the earliest. Conclusions: This project will contribute unique knowledge to the field, as there are few studies that have examined the effects of universal health-promoting mobile apps for adolescents. However, several limitations have to be taken into account when interpreting the results, such as randomization on the school level, the short time frame in which the study was conducted, and the lack of objective data to monitor the use of the app. Trial Registration: ClinicalTrials.gov NCT05211713; https://www.clinicaltrials.gov/ct2/show/NCT05211713 International Registered Report Identifier (IRRID): PRR1-10.2196/42119 %M 36630167 %R 10.2196/42119 %U https://www.researchprotocols.org/2023/1/e42119 %U https://doi.org/10.2196/42119 %U http://www.ncbi.nlm.nih.gov/pubmed/36630167 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42416 %T Remote Cognitive Screening Of Healthy Older Adults for Primary Care With the MyCog Mobile App: Iterative Design and Usability Evaluation %A Young,Stephanie Ruth %A Lattie,Emily Gardiner %A Berry,Andrew B L %A Bui,Lynn %A Byrne,Greg Joseph %A Yoshino Benavente,Julia Noelani %A Bass,Michael %A Gershon,Richard C %A Wolf,Michael S %A Nowinski,Cindy J %+ Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 633 N St Clair St, Chicago, IL, 60611, United States, 1 (312) 503 1725, stephanieruth.young@northwestern.edu %K human-centered design %K mobile health %K mHealth %K usability %K cognitive screening %K older adults %K mobile phone %D 2023 %7 10.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Annual cognitive screening in adults aged >65 years can improve early detection of cognitive impairment, yet less than half of all cases are identified in primary care. Time constraints in primary care settings present a major barrier to routine screening. A remote cognitive screener completed on a patient’s own smartphone before a visit has the potential to save primary care clinics time, encourage broader screening practices, and increase early detection of cognitive decline. Objective: We described the iterative design and proposed the implementation of a remote cognitive screening app, MyCog Mobile, to be completed on a patient’s smartphone before an annual wellness visit. The research questions were as follows: What would motivate primary care clinicians and clinic administrators to implement a remote cognitive screening process? How might we design a remote cognitive screener to fit well with existing primary care workflows? What would motivate an older adult patient to complete a cognitive screener on a smartphone before a primary care visit? How might we optimize the user experience of completing a remote cognitive screener on a smartphone for older adults? Methods: To address research questions 1 and 2, we conducted individual interviews with clinicians (n=5) and clinic administrators (n=3). We also collaborated with clinic administrators to create user journey maps of their existing and proposed MyCog Mobile workflows. To address research questions 3 and 4, we conducted individual semistructured interviews with cognitively healthy older adults (n=5) and solicited feedback from a community stakeholder panel (n=11). We also tested and refined high-fidelity prototypes of the MyCog Mobile app with the older adult interview participants, who rated the usability on the Simplified System Usability Scale and After-Scenario Questionnaire. Results: Clinicians and clinic administrators were motivated to adopt a remote cognitive screening process if it saved time in their workflows. Findings from interviews and user journey mapping informed the proposed implementation and core functionality of MyCog Mobile. Older adult participants were motivated to complete cognitive screeners to ensure that they were cognitively healthy and saw additional benefits to remote screening, such as saving time during their visit and privacy. Older adults also identified potential challenges to remote smartphone screening, which informed the user experience design of the MyCog Mobile app. The average rating across prototype versions was 91 (SD 5.18) on the Simplified System Usability Scale and 6.13 (SD 8.40) on the After-Scenario Questionnaire, indicating above-average usability. Conclusions: Through an iterative, human-centered design process, we developed a viable remote cognitive screening app and proposed an implementation strategy for primary care settings that was optimized for multiple stakeholders. The next steps include validating the cognitive screener in clinical and healthy populations and piloting the finalized app in a community primary care clinic. %M 36626223 %R 10.2196/42416 %U https://formative.jmir.org/2023/1/e42416 %U https://doi.org/10.2196/42416 %U http://www.ncbi.nlm.nih.gov/pubmed/36626223 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e40421 %T Differences in Brain Activity and Body Movements Between Virtual Reality and Offline Exercise: Randomized Crossover Trial %A Kim,Hee Jin %A Lee,Jea Woog %A Choi,Gangta %A Huh,Junghoon %A Han,Doug Hyun %+ Department of Psychiatry, College of Medicine, Chung-Ang University, Heuk Seok Ro 84, Seoul, 06974, Republic of Korea, 82 2 6299 3132, hduk70@gmail.com %K virtual reality exercise %K near-infrared spectroscopy %K spectroscopy %K hemodynamic %K blood flow %K hemoglobin %K brain %K prefrontal cortex %K orbitofrontal cortex %K immersion %K virtual reality %K VR %K exercise %K range of motion %K physical activity %K fitness %K motion %K movement %K randomized %K calorie %D 2023 %7 5.1.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: Virtual reality (VR) has been suggested to be effective at enhancing physical exercises because of its immersive characteristics. However, few studies have quantitatively assessed the range of motion and brain activity during VR exercises. Objective: We hypothesized that 3D immersive VR could stimulate body movement and brain activity more effectively than standard exercises and that the increased range of motions during 3D immersive VR exercises would be associated with orbitofrontal activation. Methods: A randomized crossover trial was conducted to compare exercises with and without VR. A total of 24 healthy males performed the same motions when exercising with and without 3D immersive VR, and the recorded videos were used for motion analysis. Hemodynamic changes in the prefrontal cortex were assessed using functional near-infrared spectroscopy. Results: There were significant differences in the total angle (z=−2.31; P=.02), length (z=−2.78; P=.005), calorie consumption (z=−3.04; P=.002), and change in accumulated oxygenated hemoglobin within the right orbitofrontal cortex (F1,94=9.36; P=.003) between the VR and offline trials. Hemodynamic changes in the right orbitofrontal cortex were positively correlated with the total angle (r=0.45; P=.001) and length (r=0.38; P=.007) in the VR exercise; however, there was no significant correlation in the offline trial. Conclusions: The results of this study suggest that 3D immersive VR exercise effectively increases the range of motion in healthy individuals in relation to orbitofrontal activation. Trial Registration: Clinical Research Information Service KCT0008021; https://cris.nih.go.kr/cris/search/detailSearch.do/23671 %M 36602842 %R 10.2196/40421 %U https://games.jmir.org/2023/1/e40421 %U https://doi.org/10.2196/40421 %U http://www.ncbi.nlm.nih.gov/pubmed/36602842 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e38603 %T Personalization of Mobile Apps for Health Behavior Change: Protocol for a Cross-sectional Study %A Gosetto,Laetitia %A Pittavino,Marta %A Falquet,Gilles %A Ehrler,Frederic %+ Centre Universitaire d'Informatique, Geneva School of Economics and Management, University of Geneva, Route de Drize 7, Carouge, 1227, Switzerland, 41 0223790166, laetitia.gosetto@unige.ch %K mobile health %K mHealth %K personalization %K mobile app %K behavior change theory %K gamification %K functionalities %D 2023 %7 5.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mobile health apps have the potential to motivate people to adopt healthier behavior, but many fail to maintain this behavior over time. However, it has been suggested that long-term adherence can be improved by personalizing the proposed interventions. Based on the literature, we created a conceptual framework for selecting appropriate functionalities according to the user's profile. Objective: This cross-sectional study aims to investigate if the relationships linking functionalities and profiles proposed in our conceptual framework are confirmed by user preferences. Methods: A web-based questionnaire comprising several sections was developed to determine the mobile app functionalities most likely to promote healthier behavior. First, participants completed questionnaires to define the user profile (Big Five Inventory-10, Hexad Scale, and perception of the social norm using dimensions of the Theory of Planned Behavior). Second, participants were asked to select the 5 functionalities they considered to be the most relevant to motivate healthier behavior and to evaluate them on a score ranging from 0 to 100. We will perform logistic regressions with the selected functionalities as dependent variables and with the 3 profile scales as predictors to allow us to understand the effect of the participants’ scores on each of the 3 profile scales on the 5 selected functionalities. In addition, we will perform logistic ordinal regressions with the motivation score of the functionalities chosen as dependent variables and with scores of the 3 profile scales as predictors to determine whether the scores on the different profile scales predict the functionality score. Results: Data collection was conducted between July and December 2021. Analysis of responses began in January 2022, with the publication of results expected by the end of 2022. Conclusions: This study will allow us to validate our conceptual model by defining the preferred functionalities according to user profiles. International Registered Report Identifier (IRRID): RR1-10.2196/38603 %M 36602850 %R 10.2196/38603 %U https://www.researchprotocols.org/2023/1/e38603 %U https://doi.org/10.2196/38603 %U http://www.ncbi.nlm.nih.gov/pubmed/36602850 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37429 %T Participants’ and Health Care Providers’ Insights Regarding a Web-Based and Mobile-Delivered Healthy Eating Program for Disadvantaged People With Type 2 Diabetes: Descriptive Qualitative Study %A Karimi,Nazgol %A Opie,Rachelle %A Crawford,David %A O’Connell,Stella %A Hamblin,Peter Shane %A Steele,Cheryl %A Ball,Kylie %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Building J, SENS, 221 Burwood Highway, Burwood, Melbourne, VIC 3125, Australia, 61 392517310, karimin@deakin.edu.au %K type 2 diabetes %K healthy eating %K diet %K dietary intervention %K low socioeconomic position %K digitally delivered %K mobile health %K mHealth %K website %K mobile phone %K SMS text message %K qualitative descriptive %D 2023 %7 4.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Healthy eating is a key element of type 2 diabetes (T2D) self-management. Digital interventions offer new avenues to reach broad audiences to promote healthy eating behaviors. However, acceptance of these interventions by socioeconomically disadvantaged people (eg, those with lower levels of education and income or from ethnic minority groups) has not yet been fully evaluated. Objective: This study aimed to investigate the acceptability and usability of EatSmart, a 12-week web-based and mobile-delivered healthy eating behavior change support program, from the perspective of intervention participants living with T2D and health care providers (HCPs) involved in diabetes care. Methods: This study used a qualitative descriptive design. Overall, 60 disadvantaged adults with T2D, as determined by receipt of either a HealthCare Card or a pension or benefit as the main source of income, were recruited. Data from participants regarding their experiences with and perceptions of the program and longer-term maintenance of any behavior or attitudinal changes were collected through a web-based self-report survey with open-ended questions administered 12 weeks after baseline (54/60, 90%) and semistructured telephone interviews administered 36 weeks after baseline (16/60, 27%). Supplementary semistructured interviews with 6 HCPs involved in diabetes care (endocrinologists, accredited practicing dietitians, and diabetes nurse educators) were also conducted 36 weeks after baseline. These interviews aimed to understand HCPs’ views on successful and unsuccessful elements of EatSmart as a technology-delivered intervention; any concerns or barriers regarding the use of these types of interventions; and feedback from their interactions with patients on the intervention’s content, impact, or observed benefits. All data from the surveys and interviews were pooled and thematically analyzed. Results: In total, 5 key themes emerged from the data: program impact on food-related behaviors and routines, satisfaction with the program, reasons for low engagement and suggestions for future programs, benefits and challenges of digital interventions, and cultural considerations. Results showed that EatSmart was acceptable to participants and contributed positively to improving food-related behaviors. Most participants (27/43, 63%) mentioned that they enjoyed their experience with EatSmart and expressed high satisfaction with its content and delivery. The educational and motivational content was considered the most useful part of the program. Benefits discussed by intervention participants included gaining health knowledge and skills, positive changes in their food purchasing and cooking, and eating greater quantities and varieties of fruits and vegetables. HCPs also described the intervention as beneficial and persuasive for the target audience and had specific suggestions for future tailoring of such programs. Conclusions: The findings suggested that this digitally delivered intervention with supportive educational modules and SMS text messages was generally appealing for both participants and HCPs. This intervention medium shows promise and could feasibly be rolled out on a broader scale to augment usual diabetes care. International Registered Report Identifier (IRRID): RR2-10.2196/19488 %M 36598815 %R 10.2196/37429 %U https://formative.jmir.org/2023/1/e37429 %U https://doi.org/10.2196/37429 %U http://www.ncbi.nlm.nih.gov/pubmed/36598815 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39128 %T Effects of Mobile Mindfulness Meditation on the Mental Health of University Students: Systematic Review and Meta-analysis %A Chen,Bin %A Yang,Ting %A Xiao,Lei %A Xu,Changxia %A Zhu,Chunqin %+ Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine, Number 155, Hanzhong Road, Nanjing, 210001, China, 86 13951086486, zhu504123@163.com %K digital health %K mobile mindfulness meditation %K mental health %K university students %K meta-analysis %D 2023 %7 3.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile mindfulness meditation (MMM) is a mindfulness meditation intervention implemented using mobile devices such as smartphones and apps. MMM has been used to help manage the mental health of university students. Objective: This study aims to evaluate the effectiveness of MMM on the mental health of university students in the areas of stress, anxiety, depression, mindfulness, well-being, and resilience. Methods: We conducted a systematic review and meta-analysis of the effectiveness of MMM on the mental health of university students. This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic literature search was performed on PubMed, Web of Science, EBSCO, Cochrane Library, and Embase databases, from inception to July 16, 2021. This study was conducted to identify studies that reported the effects of MMM on the primary outcomes including stress, anxiety, and depression, and on the secondary outcomes including mindfulness, well-being, and resilience. Two reviewers retrieved articles, evaluated quality, and extracted data independently. The methodological quality of the selected studies was determined using the Cochrane criteria for risk-of-bias assessment. Standardized mean differences (SMDs) for continuous outcomes and risk ratios for dichotomous outcomes were calculated. Sensitivity analyses and subgroup analyses were performed for results with high heterogeneity. The RevMan version 5.3 was used to perform meta-analysis. Results: A total of 10 studies, including 958 university students, were selected for this meta-analysis. Results of the primary outcome showed that the MMM groups were more effective than the control groups in decreasing stress (SMD –0.41, 95% CI –0.59 to –0.23; P<.001) and alleviating anxiety (SMD –0.29, 95% CI –0.50 to –0.09; P=.004). However, there was no difference between the MMM groups and the control groups in depression (SMD –0.14, 95% CI –0.30 to 0.03; P=.11). The use of either waitlist control or traditional face-to-face intervention in the control group was identified as the source of heterogeneity. Specifically, the waitlist control subgroup (SMD –0.33, 95% CI –0.53 to –0.13; P=.002) was superior when compared with the face-to-face subgroup (SMD 0.29, 95% CI –0.01 to 0.59; P=.06). Results of the secondary outcome showed that the MMM groups were more effective than the control groups in enhancing well-being (SMD 0.30, 95% CI 0.11-0.50; P=.003) and improving mindfulness (SMD 2.66, 95% CI 0.77-4.55; P=.006). Whether commercial sponsorship was obtained was considered as the source of heterogeneity. The “without company support” group (SMD 17.60, 95% CI 11.32-23.87; P<.001) was superior to the “with company support” group (SMD 1.17, 95% CI –0.82 to 3.15; P=.25) in raising the level of mindfulness. However, there was no difference between the MMM and control groups in resilience (SMD –0.06, 95% CI –0.26 to 0.15; P=.59). The evidence level of the results from the 10 studies was determined to be moderate to low. Conclusions: MMM was an effective method to reduce stress and anxiety, and to increase the well-being and mindfulness of university students. However, further studies are needed to confirm our findings. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022303585; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=303585 %M 36596239 %R 10.2196/39128 %U https://www.jmir.org/2023/1/e39128 %U https://doi.org/10.2196/39128 %U http://www.ncbi.nlm.nih.gov/pubmed/36596239 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 12 %P e41767 %T Factors Associated With Self-reported Use of Web and Mobile Health Apps Among US Military Veterans: Cross-sectional Survey %A Hogan,Timothy P %A Etingen,Bella %A Lipschitz,Jessica M %A Shimada,Stephanie L %A McMahon,Nicholas %A Bolivar,Derek %A Bixler,Felicia R %A Irvin,Dawn %A Wacks,Rachel %A Cutrona,Sarah %A Frisbee,Kathleen L %A Smith,Bridget M %+ Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, 200 Springs Road (152), Building 70, Bedford, MA, 01730, United States, 1 781 687 3181, timothy.hogan@va.gov %K mobile health apps %K patient engagement %K consumer health informatics %K provider encouragement %K veterans %D 2022 %7 30.12.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite their prevalence and reported patient interest in their use, uptake of health-related apps is limited. The Veterans Health Administration (VHA) has developed a variety of apps to support veterans; however, uptake remains low nationally. Objective: We examined the prevalence of VHA health-related app use and how veterans learned about these apps in order to identify factors associated with their use. Methods: As part of a VHA quality improvement initiative, we recruited a national cohort of veterans to obtain feedback on their use of technology for health and collected data from them via a cross-sectional survey. The survey data were supplemented with VHA administrative data. We used descriptive statistics to examine demographic and health characteristics, health-related technology use, and how veterans learned about apps. We assessed factors associated with app use using bivariate analyses and multiple logistic regression models. Results: We had complete data on 1259 veterans. A majority of the sample was male (1069/1259, 84.9%), aged older than 65 years (740/1259, 58.8%), White (1086/1259, 86.3%), and non-Hispanic (1218/1259, 96.7%). Most respondents (1125/1259, 89.4%) reported being very comfortable and confident using computers, over half (675/1259, 53.6%) reported being an early adopter of technology, and almost half (595/1259, 47.3%) reported having used a VHA health-related app. Just over one-third (435/1259, 34.6%) reported that their VHA care team members encouraged them to use health-related apps. Respondents reported learning about available VHA health-related apps by reading about them on the VHA’s patient portal (468/1259, 37.2%), being told about them by their VHA health care team (316/1259, 25.1%), and reading about them on the VHA’s website (139/1259, 11%). Veterans who self-reported having used VHA health-related apps were more likely to receive care at the VHA (OR [odds ratio] 1.3, 95% CI 1.0-1.7), be in worse health (as assessed by Hierarchical Condition Community score; OR 1.1, 95% CI 1.0-1.2), report owning a desktop or laptop computer (OR 1.8, 95% CI 1.1-3.1), have posttraumatic stress disorder (OR 1.4, 95% CI 1.1-1.9), and report having VHA health care team members encourage them to use the apps (OR 2.7, 95% CI 2.1-3.4). Conclusions: We found strong associations between self-reported use by veterans of VHA health-related apps and multiple variables in our survey. The strongest association was observed between a veteran self-reporting app use and having received encouragement from their VHA health care team to use the apps. Veterans who reported receiving encouragement from their VHA care team members had nearly 3 times higher odds of using VHA apps than veterans who did not report receiving such encouragement. Our results add to growing evidence suggesting that endorsement of apps by a health care system or health care team can positively impact patient uptake and use. %M 36583935 %R 10.2196/41767 %U https://mhealth.jmir.org/2022/12/e41767 %U https://doi.org/10.2196/41767 %U http://www.ncbi.nlm.nih.gov/pubmed/36583935 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 12 %P e36806 %T Patient and Therapist Expectations for a Blended Cognitive Behavioral Therapy Program for Depression: Qualitative Exploratory Study %A Atik,Ece %A Schückes,Magnus %A Apolinário-Hagen,Jennifer %+ Institute for SME Research and Entrepreneurship, University of Mannheim, L 9, 1–2, Mannheim, 68161, Germany, 49 621 181 2273, schueckes@bwl.uni-mannheim.de %K blended cognitive behavioral therapy %K bCBT %K cognitive behavioral therapy %K digital health %K mental health %K internet %K mobile app %K blended psychotherapy %K depression %K user perspectives %K mobile phone %D 2022 %7 30.12.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Blended cognitive behavioral therapy (bCBT)—the combination of digital elements and face-to-face psychotherapy—has been proposed to alleviate challenges that patients and therapists face in conventional cognitive behavioral therapy. There is growing evidence that adding digital elements to face-to-face psychotherapy can contribute to better treatment outcomes. However, bCBT programs still show considerable shortcomings, and knowledge on how to improve digital apps using a bCBT protocol is limited. Objective: This study aimed to inductively identify functions and qualities that are expected from a bCBT treatment for depression in the eyes of patients and psychotherapists who were not currently receiving or practicing bCBT treatment. Methods: We used a qualitative exploratory study design and conducted 3 focus group interviews (n=6 in each) and 5 semistructured in-depth interviews with therapists as well as 11 individual interviews with patients with a primary diagnosis of depression and currently undergoing cognitive behavioral therapy treatment in Germany. Themes and categories were established inductively from transcribed interview records based on a rigorous coding method. Results: Both therapists and patients expected a digital app to provide patients with the opportunity to track their mood, work on therapeutic homework activities, easily access an intervention set for harder moments, and efficiently facilitate administrative tasks. The desire to be able to customize bCBT protocols to individual patient circumstances was evident in both patient and therapist interviews. Patients differed with respect to what content and the amount of material the app should focus on as well as the method of recording experiences. Therapists viewed digital apps as potentially aiding in their documentation work outside of sessions. Different attitudes surfaced on the topic of data security, with patients not as concerned as therapists. Conclusions: Both patients and therapists had substantially positive attitudes toward the option of an integrated bCBT treatment. Our study presents novel findings on the expectations and attitudes of patients and therapists. %M 36583934 %R 10.2196/36806 %U https://mental.jmir.org/2022/12/e36806 %U https://doi.org/10.2196/36806 %U http://www.ncbi.nlm.nih.gov/pubmed/36583934 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 12 %P e42301 %T Leveraging Mobile Health to Manage Mental Health/Behavioral Health Disorders: Systematic Literature Review %A Kruse,Clemens Scott %A Betancourt,Jose A %A Gonzales,Matthew %A Dickerson,Kennedy %A Neer,Miah %+ School of Health Administration, Texas State University, 601 University Drive, Encino, 250, San Marcos, TX, 78666, United States, 1 512 245 4462, scottkruse@txstate.edu %K mHealth %K telemedicine %K mental health %K behavioral health %K anxiety %K mobile device %K smartphone %K SMS text messaging %K RCT %D 2022 %7 27.12.2022 %9 Review %J JMIR Ment Health %G English %X Background: Mental health is a complex condition, highly related to emotion. The COVID-19 pandemic caused a significant spike in depression (from isolation) and anxiety (event related). Mobile Health (mHealth) and telemedicine offer solutions to augment patient care, provide education, improve symptoms of depression, and assuage fears and anxiety. Objective: This review aims to assess the effectiveness of mHealth to provide mental health care by analyzing articles published in the last year in peer-reviewed, academic journals using strong methodology (randomized controlled trial). Methods: We queried 4 databases (PubMed, CINAHL [Cumulative Index to Nursing and Allied Health Literature], Web of Science, and ScienceDirect) using a standard Boolean search string. We conducted this systematic literature review in accordance with the Kruse protocol and reported it in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 checklist (n=33). Results: A total of 4 interventions (mostly mHealth) from 14 countries identified improvements in primary outcomes of depression and anxiety as well as in several secondary outcomes, namely, quality of life, mental well-being, cognitive flexibility, distress, sleep, self-efficacy, anger, decision conflict, decision regret, digestive disturbance, pain, and medication adherence. Conclusions: mHealth interventions can provide education, treatment augmentation, and serve as the primary modality in mental health care. The mHealth modality should be carefully considered when evaluating modes of care. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022343489; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=343489 %M 36194896 %R 10.2196/42301 %U https://mental.jmir.org/2022/12/e42301 %U https://doi.org/10.2196/42301 %U http://www.ncbi.nlm.nih.gov/pubmed/36194896 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e40210 %T Acceptability and Feasibility of Wearable Transdermal Alcohol Sensors: Systematic Review %A Brobbin,Eileen %A Deluca,Paolo %A Hemrage,Sofia %A Drummond,Colin %+ Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Addiction Science Building, 4 Windsor Walk, London, SE5 8BB, United Kingdom, 44 0207 836 545, eileen.brobbin@kcl.ac.uk %K alcohol consumption %K alcohol monitoring %K digital technology %K transdermal alcohol sensors %K wearables %K acceptability %K feasibility %K monitoring %K sensors %K real-time feedback %K health promotion %K alcohol intake %D 2022 %7 23.12.2022 %9 Review %J JMIR Hum Factors %G English %X Background: Transdermal alcohol sensors (TASs) have the potential to be used to monitor alcohol consumption objectively and continuously. These devices can provide real-time feedback to the user, researcher, or health professional and measure alcohol consumption and peaks of use, thereby addressing some of the limitations of the current methods, including breathalyzers and self-reports. Objective: This systematic review aims to evaluate the acceptability and feasibility of the currently available TAS devices. Methods: A systematic search was conducted in CINAHL, EMBASE, Google Scholar, MEDLINE, PsycINFO, PubMed, and Scopus bibliographic databases in February 2021. Two members of our study team independently screened studies for inclusion, extracted data, and assessed the risk of bias. The study’s methodological quality was appraised using the Mixed Methods Appraisal Tool. The primary outcome was TAS acceptability. The secondary outcome was feasibility. The data are presented as a narrative synthesis. Results: We identified and analyzed 22 studies. Study designs included laboratory- and ambulatory-based studies, mixed designs, randomized controlled trials, and focus groups, and the length the device was worn ranged from days to weeks. Although views on TASs were generally positive with high compliance, some factors were indicated as potential barriers and there are suggestions to overcome these. Conclusions: There is a lack of research investigating the acceptability and feasibility of TAS devices as a tool to monitor alcohol consumption in clinical and nonclinical populations. Although preliminary evidence suggests their potential in short-term laboratory-based studies with volunteers, more research is needed to establish long-term daily use with other populations, specifically, in the clinical and the criminal justice system. Trial Registration: PROSPERO CRD42021231027; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=231027 %M 36563030 %R 10.2196/40210 %U https://humanfactors.jmir.org/2022/4/e40210 %U https://doi.org/10.2196/40210 %U http://www.ncbi.nlm.nih.gov/pubmed/36563030 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40379 %T Feasibility, Usability and Acceptability of a mHealth Intervention to Reduce Cardiovascular Risk in Rural Hispanic Adults: Descriptive Study %A Rowland,Sheri %A Ramos,Athena K %A Trinidad,Natalia %A Quintero,Sophia %A Johnson Beller,Rebecca %A Struwe,Leeza %A Pozehl,Bunny %+ College of Nursing, University of Nebraska Medical Center, 550 N. 19th Street, Lincoln, NE, 68508-0620, United States, 1 402 472 5959, sheri.rowland@unmc.edu %K mHealth %K health behavior %K self-management %K Hispanic/Latino %K rural %K apps %K feasibility %K acceptability %K participation %K engagement %K wearable device %K tracking %K smartphone %D 2022 %7 23.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) technology using apps or devices to self-manage health behaviors is an effective strategy to improve lifestyle-related health problems such as hypertension, obesity, and diabetes. However, few studies have tested an mHealth intervention with Hispanic/Latino adults, and no studies were found testing mHealth with rural Hispanic/Latino adults, the fastest-growing population in rural areas. Objective: The purpose of this study was to evaluate the feasibility, usability, and acceptability of an mHealth cardiovascular risk self-management intervention with rural Hispanic/Latino adults. Methods: A descriptive study using quantitative and qualitative methods was used to evaluate the feasibility, usability, and acceptability of delivering a 12-week mHealth self-management intervention to reduce cardiovascular risk with rural Hispanic/Latino adults who were randomized to 1 of 2 groups. Both groups were asked to use MyFitnessPal to self-monitor daily steps, weight, and calories. The intervention group received support to download, initiate, and troubleshoot technology challenges with MyFitnessPal (Under Armour) and a smart scale, while the enhanced usual care group received only a general recommendation to use MyFitnessPal to support healthy behaviors. The usability of MyFitnessPal and the smart scale was measured using an adapted Health Information Technology Usability EvaluationScale (Health-ITUES). Adherence data in the intervention group (daily steps, weight, and calories) were downloaded from MyFitnessPal. Acceptability was evaluated using semistructured interviews in a subsample (n=5) of intervention group participants. Results: A sample of 70 eligible participants (enhanced usual care group n=34; intervention group n=36) were enrolled between May and December 2019. The overall attrition was 28% at 12 weeks and 54% at 24 weeks. mHealth usability in the intervention group increased at each time point (6, 12, and 24 weeks). Adherence to self-monitoring using mHealth in the intervention group after week 1 was 55% for steps, 39% for calories, and 35% for weights; at the end of the 12-week intervention, the adherence to self-monitoring was 31% for steps, 11% for weight, and 8% for calories. Spikes in adherence coincided with scheduled in-person study visits. Structured interviews identified common technology challenges including scale and steps not syncing with the app and the need for additional technology support for those with limited mHealth experience. Conclusions: Recruitment of rural Hispanic/Latino adults into the mHealth study was feasible using provider and participant referrals. The use of MyFitnessPal, the smart scale, and SMS text messages to self-monitor daily steps, weights, and calories was acceptable and feasible if technology support was provided. Future research should evaluate and support participants’ baseline technology skill level, provide training if needed, and use a phone call or SMS text message follow-ups as a strategy to minimize attrition. A wearable device, separate from the smartphone app, is recommended for activity tracking. %M 36563025 %R 10.2196/40379 %U https://formative.jmir.org/2022/12/e40379 %U https://doi.org/10.2196/40379 %U http://www.ncbi.nlm.nih.gov/pubmed/36563025 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e40933 %T Preferences for a Mental Health Support Technology Among Chinese Employees: Mixed Methods Approach %A Sun,Sijin %A Zhang,Zheyuan %A Tian,Mu %A Mougenot,Celine %A Glozier,Nick %A Calvo,Rafael A %+ Dyson School of Design Engineering, Imperial College London, Imperial College Rd, South Kensington, London, SW7 9EG, United Kingdom, 44 779967397, s.sun20@imperial.ac.uk %K mental health %K digital health %K workplace %K China %D 2022 %7 22.12.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Workplace mental health is under-studied in China, making it difficult to design effective interventions. To encourage the engagement with interventions, it is crucial to understand employees’ motivation toward seeking help through technologies. Objective: This study aimed to understanding how Chinese employees view digital mental health support technology and how mental health support technology could be designed to boost the motivation of Chinese employees to use it. Methods: A mixed methods approach was used. In total, 458 Chinese employees (248/458, 54% female) in 5 industries (manufacturing, software, medical, government, and education) responded to a survey, and 14 employees and 5 managers were interviewed. Results: Government data and employee responses showed that mental health support in China is limited. In the workplace, Chinese employees experience a lower sense of autonomy satisfaction compared with competence and relatedness. Although managers and employees try to empathize with those who have mental health issues, discrimination and the stigma of mental illness are rife in Chinese workplaces. Digital technologies are perceived as a potential medium for mental health interventions; however, privacy is a major concern. Conclusions: The results of this study demonstrated the potential of self-help digital mental health support for Chinese employees. Interdisciplinary cooperation between design engineers and mental health researchers can contribute toward understanding the issues that engage or disengage users with digital mental health interventions. %M 36548027 %R 10.2196/40933 %U https://humanfactors.jmir.org/2022/4/e40933 %U https://doi.org/10.2196/40933 %U http://www.ncbi.nlm.nih.gov/pubmed/36548027 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e38471 %T Evaluating User Preferences, Comprehension, and Trust in Apps for Environmental Health Hazards: Qualitative Case Study %A Workman,Annabelle %A Johnston,Fay H %A Campbell,Sharon L %A Williamson,Grant J %A Lucani,Chris %A Bowman,David M J S %A Cooling,Nick %A Jones,Penelope J %+ Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, 7000, Australia, 61 362267726, penelope.jones@utas.edu.au %K health app %K evaluation %K air pollution %K pollen %K temperature %K mobile phone %D 2022 %7 22.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Climate change is projected to increase environmental health hazard risks through fire-related air pollution and increased airborne pollen levels. To protect vulnerable populations, it is imperative that evidence-based and accessible interventions are available. The environmental health app, AirRater, was developed in 2015 in Australia to provide information on multiple atmospheric health hazards in near real time. The app allows users to view local environmental conditions, and input and track their personal symptoms to enable behaviors that protect health in response to environmental hazards. Objective: This study aimed to develop insights into users’ perceptions of engagement, comprehension, and trust in AirRater to inform the future development of environmental health apps. Specifically, this study explored which AirRater features users engaged with, what additional features or functionality needs users felt they required, users’ self-perception of understanding app information, and their level of trust in the information provided. Methods: A total of 42 adult AirRater users were recruited from 3 locations in Australia to participate in semistructured interviews to capture location- or context-specific experiences. Participants were notified of the recruitment opportunity through multiple avenues including newsletter articles and social media. Informed consent was obtained before participation, and the participants were remunerated for their time and perspectives. A preinterview questionnaire collected data including age range, any preexisting conditions, and location (postcode). All participant data were deidentified. Interviews were recorded, transcribed, and analyzed using thematic analysis in NVivo 12 (QSR International). Results: Participants discussed app features and functionality, as well as their understanding of, and trust in, the information provided by the app. Most (26/42, 62%) participants used and valued visual environmental hazard features, especially maps, location settings, and hazard alerts. Most (33/42, 78%) found information in the app easy to understand and support their needs, irrespective of their self-reported literacy levels. Many (21/42, 50%) users reported that they did not question the accuracy of the data presented in the app. Suggested enhancements include the provision of meteorological information (eg, wind speed or direction, air pressure, UV rating, and humidity), functionality enhancements (eg, forecasting, additional alerts, and the inclusion of health advice), and clarification of existing information (eg, symptom triggers), including the capacity to download personal summary data for a specified period. Conclusions: Participants’ perspectives can inform the future development of environmental health apps. Specifically, participants’ insights support the identification of key elements for the optimal development of environmental health app design, including streamlining, capacity for users to customize, use of real time data, visual cues, credibility, and accuracy of data. The results also suggest that, in the future, iterative collaboration between developers, environmental agencies, and users will likely promote better functional design, user trust in the data, and ultimately better population health outcomes. %M 36548030 %R 10.2196/38471 %U https://formative.jmir.org/2022/12/e38471 %U https://doi.org/10.2196/38471 %U http://www.ncbi.nlm.nih.gov/pubmed/36548030 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 12 %P e42504 %T Comparison of Sun Protection Factor (SPF) 30 Persistence Between Inorganic and Organic Sunscreen in Swimmers: Protocol for a Multicenter, Randomized, Noninferiority, Split-Body, Double-Blind Clinical Trial %A Rachmani,Karin %A Yusharyahya,Shannaz Nadia %A Sampurna,Adhimukti %A Ranakusuma,Respati W %A Widaty,Sandra %+ Department of Dermatology and Venereology, Faculty of Medicine, Cipto Mangunkusumo General Hospital, Universitas Indonesia, Gedung G5, Jl. Diponegoro No. 71, Jakarta Pusat, DKI Jakarta, 10430, Indonesia, 62 878 7870 7048, sandra.widaty@gmail.com %K inorganic sunscreen %K organic sunscreen %K persistence %K sun protection factor %K sunscreen %K swimmer %K swimming %D 2022 %7 21.12.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Outdoor swimming athletes are often exposed to undesirable environmental conditions such as long-term sun exposure. The risk of sunburn can still occur in this population due to the loss of sunscreen and an increase in the sensitivity of the skin to ultraviolet rays, particularly ultraviolet B, in wet conditions. Some previous trials showed that organic sunscreens had a longer shelf-life than inorganic sunscreens after exercise due to their characteristics to bind better with the skin layer. Meanwhile, inorganic sunscreens tend to form layers on the skin’s surface so that they can be more easily removed. To our knowledge, no studies evaluate sunscreens' resistance, either inorganic or organic, after exercising in Indonesia. Objective: This study aims to evaluate the persistence of inorganic versus organic sunscreens used by swimmers. The primary objective is to assess whether the inorganic sunscreen is as good as the organic sunscreen in the field of the persistence of sunscreens after swimming for 1.5 hours. Methods: This study is a randomized, split-body, double-blind, noninferiority, and multicenter clinical trial in Cikini, Jakarta, Indonesia. An estimated 22 athletes in each group, who aged 18-40 years and practice in the morning or afternoon, will be randomized using a computer-generated randomization method. We calculated the sample size using the difference in the average decrease in sun protection factor (SPF) levels that is considered significant based on the clinical judgment set by the researchers, which was 5. Neither the research subjects nor the researchers are aware of the type of sunscreen that will be applied. The hypothesis will be tested using paired-sample t test or Wilcoxon to assess the difference of SPF levels in each group between organic and inorganic sunscreens with SPSS (version 20.0; IBM Corp). Results: This study has been approved by the Ethical Committee Faculty of Medicine Universitas Indonesia and is funded by the International Publication Grant from Universitas Indonesia. The enrollment process was completed in December 2020. Conclusions: This study will test all procedures in preparation for conducting the main study, including several potential obstacles and challenges from the perspective of participating physicians and eligible swimmers. The study results will be disseminated through publications in a peer-reviewed journal with Open Access format. This study will provide information about SPF 30 persistence in sunscreens and the best type of sunscreen to be used while swimming, particularly for athletes. Trial Registration: ClinicalTrials.gov NCT04618536; https://clinicaltrials.gov/ct2/show/NCT04618536?term=NCT04618536 International Registered Report Identifier (IRRID): RR1-10.2196/42504 %M 36542453 %R 10.2196/42504 %U https://www.researchprotocols.org/2022/12/e42504 %U https://doi.org/10.2196/42504 %U http://www.ncbi.nlm.nih.gov/pubmed/36542453 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 12 %P e39678 %T Using Intervention Mapping to Develop an mHealth Intervention to Support Men Who Have Sex With Men Engaging in Chemsex (Budd): Development and Usability Study %A Herrijgers,Corinne %A Platteau,Tom %A Vandebosch,Heidi %A Poels,Karolien %A Florence,Eric %+ Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerpen, 2000, Belgium, 32 033455656, cherrijgers@itg.be %K mobile health %K chemsex %K intervention mapping %K harm reduction %K men who have sex with men %K intervention %K mobile phone %D 2022 %7 21.12.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chemsex refers to the intentional use of drugs before or during sex among men who have sex with men (MSM). Engaging in chemsex has been linked to significant negative impacts on physical, psychological, and social well-being. However, no evidence-based support tools have addressed either these harms or the care needs of MSM who engage in chemsex. Objective: The purpose of this paper was to describe the development of a mobile health intervention (named Budd) using the intervention mapping protocol (IMP). Budd aims to support and inform MSM who participate in chemsex, reduce the negative impacts associated with chemsex, and encourage more reasoned participation. Methods: The IMP consists of 6 steps to develop, implement, and evaluate evidence-based health interventions. A needs assessment was carried out between September 2, 2019, and March 31, 2020, by conducting a literature study and in-depth interviews. Change objectives were selected based on these findings, after which theory-based intervention methods were selected. The first version of the intervention was developed in December 2020 and pilot-tested between February 1, 2021, and April 30, 2021. Adjustments were made based on the findings from this study. A separate article will be dedicated to the effectiveness study, conducted between October 15, 2021, and February 24, 2022, and implementation of the intervention. The Budd app went live in April 2022. Results: Budd aims to address individual factors and support chemsex participants in applying harm reduction measures when taking drugs (drug information, drug combination tool, and notebook), preparing for participation in a chemsex session (articles on chemsex, preparation tool, and event-specific checklist), planning sufficient time after a chemsex session to recover (planning tool), seeking support for their chemsex participation (overview of existing local health care and peer support services, reflection, personal statistics, and user testimonials), taking HIV medication or pre-exposure prophylaxis in a timely manner during a chemsex session (preparation tool), and contacting emergency services in case of an emergency and giving first aid to others (emergency information and personal buddy). Conclusions: The IMP proved to be a valuable tool in the planning and development of the Budd app. This study provides researchers and practitioners with valuable information that may help them to set up their own health interventions. International Registered Report Identifier (IRRID): RR1-10.2196/39678 %M 36542451 %R 10.2196/39678 %U https://www.researchprotocols.org/2022/12/e39678 %U https://doi.org/10.2196/39678 %U http://www.ncbi.nlm.nih.gov/pubmed/36542451 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40058 %T Analysis of Patient Cues in Asynchronous Health Interactions: Pilot Study Combining Empathy Appraisal and Systemic Functional Linguistics %A Rey Velasco,Elena %A Pedersen,Hanne Sæderup %A Skinner,Timothy %A , %+ Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, Copenhagen, 1353, Denmark, 45 35324800, erv@psy.ku.dk %K telehealth %K telecoaching %K asynchronous communication %K empathy %K systemic functional linguistics %K communication %K health promotion %K coding %K linguistic analysis %K user experience %K coach-user interaction %K tool development %K lifestyle-related disease %D 2022 %7 20.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Lifestyle-related diseases are among the leading causes of death and disability. Their rapid increase worldwide has called for low-cost, scalable solutions to promote health behavior changes. Digital health coaching has proved to be effective in delivering affordable, scalable programs to support lifestyle change. This approach increasingly relies on asynchronous text-based interventions to motivate and support behavior change. Although we know that empathy is a core element for a successful coach-user relationship and positive patient outcomes, we lack research on how this is realized in text-based interactions. Systemic functional linguistics (SFL) is a linguistic theory that may support the identification of empathy opportunities (EOs) in text-based interactions, as well as the reasoning behind patients' linguistic choices in their formulation. Objective: This study aims to determine whether empathy and SFL approaches correspond and complement each other satisfactorily to study text-based communication in a health coaching context. We sought to explore whether combining empathic assessment with SFL categories can provide a means to understand client-coach interactions in asynchronous text-based coaching interactions. Methods: We retrieved 148 text messages sent by 29 women who participated in a randomized trial of telecoaching for the prevention of gestational diabetes mellitus (GDM) and postnatal weight loss. We conducted a pilot study to identify users' explicit and implicit EOs and further investigated these statements using the SFL approach, focusing on the analysis of transitivity and thematic analysis. Results: We identified 164 EOs present in 42.37% (3478/8209) of the word count in the corpus. These were mainly negative (n=90, 54.88%) and implicit (n=55, 60.00%). We distinguished opening, content and closing messages structures. Most of the wording was found in the content (n=7077, 86.21%) with a declarative structure (n=7084, 86.30%). Processes represented 22.4% (n=1839) of the corpus, with half being material (n=876, 10.67%) and mostly related to food and diet (n=196, 54.92%), physical activity (n=96, 26.89%), and lifestyle goals (n=40, 11.20%). Conclusions: Our findings show that empathy and SFL approaches are compatible. The results from our transitivity analysis reveal novel insights into the meanings of the users’ EOs, such as their seek for help or praise, often missed by health care professionals (HCPs), and on the coach-user relationship. The absence of explicit EOs and direct questions could be attributed to low trust on or information about the coach’s abilities. In the future, we will conduct further research to explore additional linguistic features and code coach messages. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620001240932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380020 %M 36538352 %R 10.2196/40058 %U https://formative.jmir.org/2022/12/e40058 %U https://doi.org/10.2196/40058 %U http://www.ncbi.nlm.nih.gov/pubmed/36538352 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 12 %P e40340 %T Individual and Parental Factors of Adolescents’ mHealth App Use: Nationally Representative Cross-sectional Study %A Gulec,Hayriye %A Smahel,David %+ Interdisciplinary Research Team on Internet and Society, Faculty of Social Studies, Masaryk University, Joštova 10, Brno, 602 00, Czech Republic, 420 549 49 4180, hayriyegulec@uludag.edu.tr %K mobile health %K mHealth %K eHealth literacy %K parental mediation %K health anxiety %K sleep %K body mass index %K digital skills %K phone attitudes %K mobile phone %D 2022 %7 16.12.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Knowledge of the characteristics of adolescents who use mobile health (mHealth) apps to monitor health and how these characteristics differ from those of app nonusers is limited. Objective: We aimed to determine mHealth app use based on adolescent and parental factors, including sociodemographics, digital skills, and health indicators, in a nationally representative sample of Czech adolescents (N=2500). Methods: Adolescents aged 11 to 16 years and one of their parents participated in an online survey in 2021. A professional research agency recruited the participants. Quotas were used to ensure the sample’s representativeness. The sociodemographic factors were the adolescents’ age, gender, and parental perceived financial security. The adolescents also provided information about their screen time, eHealth literacy, BMI, health anxiety, physical activity, and sleep quality. Parents reported their digital skills, mobile phone attitudes, and the mediation of their children’s online health information–seeking behaviors. We evaluated the differences between the users and nonusers of mHealth apps and identified the significant predictors of mHealth app use. Next, we separately examined how these factors were associated with the use of mHealth apps that track calorie intake or expenditure, number of steps, weight, or sports activity (eg, exercise, running, and working out), as well as other mHealth apps (eg, those that track sleep and heart rate). Results: More than half of the adolescents (1429/2455, 58.21%) reported using mHealth apps. App users were relatively older and, more often, girls. Apps that counted the number of steps were used most frequently, and adolescents whose parents reported higher perceived financial security used them more regularly. Overall, being older and physically active and having higher eHealth literacy skills were associated with using mHealth apps. Adolescents with higher BMI, health anxiety, and lower sleep quality more frequently used mHealth apps to track calorie intake or expenditure, weight, and health indicators. mHealth apps to track physical activity were used more regularly by girls. There was a positive association between parental mediation of online health information–seeking behaviors and adolescents’ mHealth app use. Conclusions: These findings demonstrated that older age, physical activity, and eHealth literacy skills were the common underlying factors of adolescents’ mHealth app use. We initially showed parents as significant role models for their children’s adoption of, and engagement with, mHealth apps when they actively mediate their online health information–seeking behaviors. Improving the eHealth literacy skills of adolescents through parental guidance might enhance health technology use in this population. Tracking eating behaviors, weight, and health were more prevalent for adolescents who reported higher BMI, health anxiety, and lower sleep quality. Future research studies should examine the determinants and health outcomes of adolescents’ mHealth app use longitudinally. %M 36525286 %R 10.2196/40340 %U https://mhealth.jmir.org/2022/12/e40340 %U https://doi.org/10.2196/40340 %U http://www.ncbi.nlm.nih.gov/pubmed/36525286 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 4 %P e38133 %T Applying Gamification Principles and Therapeutic Movement Sequences to Design an Interactive Physical Activity Game: Development Study %A Kim,Hyungsook %A O'Sullivan,David Michael %A Chung,Seong Hee %+ Division of Sport Science, Pusan National University, 2, Busandaehak-ro 63beon-gil, Geumjeong-gu, Pusan, 46241, Republic of Korea, 82 1076845811, davidosullivan@pusan.ac.kr %K home workout %K mobile assistant %K movement %K physical activity %K depression %D 2022 %7 16.12.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Depression is a severe illness that has accelerated with the spread of COVID-19 and associated lockdowns. As a result, reported physical activity has substantially decreased, further increasing depressive symptoms. Objective: This study aims to explain the use of gamification principles to develop content for an interactive physical activity game for depression based on clinically proven depression diagnostic criteria. Methods: We discuss related work in this field, the game design framework, the users’ depression severity, how we customize the contents accordingly, the gradual progression of the game to match exercise principles, and user flow optimization. Results: We provide a brief description of each of the games developed, including instructions on how to play and design aspects for flow, audio, and visual feedback methods. Exergames (interactive physical activity–based games) stimulate certain physical fitness factors such as improving reaction time, endurance, cardiovascular fitness, and flexibility. In addition, the game difficulty progresses based on various factors, such as the user’s performance for successful completion, reaction time, movement speed, and stimulated larger joint range of motions. Cognitive aspects are included, as the user has to memorize particular movement sequences. Conclusions: Mental health issues are linked to behavior and movement; therefore, future physical activity–based interactive games may provide excellent stimulation for inducing user flow, while physical activity can help train various physical fitness factors linked to depression. %M 36525298 %R 10.2196/38133 %U https://games.jmir.org/2022/4/e38133 %U https://doi.org/10.2196/38133 %U http://www.ncbi.nlm.nih.gov/pubmed/36525298 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40139 %T End User Participation in the Development of an Ecological Momentary Intervention to Improve Coping With Cannabis Cravings: Formative Study %A Anderson,Molly A %A Budney,Alan J %A Jacobson,Nicholas C %A Nahum-Shani,Inbal %A Stanger,Catherine %+ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 46 Centerra Parkway, EverGreen Center, Suite 315, Lebanon, NH, 03766, United States, 1 603 646 7023, catherine.stanger@dartmouth.edu %K cannabis %K formative %K distraction %K mindfulness %K coping %K youth %K public health %K mental health %K health intervention %K ecological momentary intervention %D 2022 %7 15.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Cannabis misuse in young adults is a major public health concern. An important predictor of continued use is cannabis craving. Due to the time-varying nature of cravings, brief momentary interventions delivered while cravings are elevated may improve the use of strategies to cope with cravings and reduce cannabis use. Objective: The goal of this manuscript is to describe a formative study to develop coping strategy messages for use in a subsequent intervention. Methods: Young adults (aged 19-25 years; n=20) who reported using cannabis >10 of the past 30 days recruited via social media participated in this formative study. Participants rated an initial set of 15 mindfulness and 15 distraction coping strategies on a scale from 1 to 4 (very low degree to very high degree) for clarity, usefulness, and tone. They also provided comments about the content. Results: Participants found the initial distraction messages slightly clearer than mindfulness (mean 3.5, SD 0.4 and mean 3.4, SD 0.4, respectively), both were comparable in tone (mean 3.2, SD 0.5 and mean 3.2, SD 0.4, respectively), and mindfulness messages were more useful than distraction (mean 3.0, SD 0.5 and mean 2.8, SD 0.6, respectively). Of the 30 messages, 29 received a rating of very low or low (<2) on any domain by >3 participants or received a comment suggesting a change. We revised all these messages based on this feedback, and the participants rated the revised messages approximately 2 weeks later. Participants earned US $10 for completing the first and US $20 for the second survey. The ratings improved on usefulness (especially the distraction items) with very little change in clarity and tone. The top 10 messages of each coping type (mindfulness and distraction) were identified by overall average rating (collapsed across all 3 dimensions: all rated >3.0). The final items were comparable in clarity (distraction mean 3.6, SD 0.4; mindfulness mean 3.6, SD 0.4), tone (distraction mean 3.4, SD 0.4; mindfulness mean 3.4, SD 0.4), and usefulness (distraction mean 3.1, SD 0.5; mindfulness mean 3.2, SD 0.5). Conclusions: The inclusion of end users in the formative process of developing these messages was valuable and resulted in improvements to the content of the messages. The majority of the messages were changed in some way including the removal of potentially triggering language. These messages were subsequently used in an ecological momentary intervention. %M 36520509 %R 10.2196/40139 %U https://formative.jmir.org/2022/12/e40139 %U https://doi.org/10.2196/40139 %U http://www.ncbi.nlm.nih.gov/pubmed/36520509 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e40892 %T Challenges in Recruiting University Students for Web-Based Indicated Prevention of Depression and Anxiety: Results From a Randomized Controlled Trial (ICare Prevent) %A Bolinski,Felix %A Kleiboer,Annet %A Neijenhuijs,Koen %A Karyotaki,Eirini %A Wiers,Reinout %A de Koning,Lisa %A Jacobi,Corinna %A Zarski,Anna-Carlotta %A Weisel,Kiona K %A Cuijpers,Pim %A Riper,Heleen %+ Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1105, Amsterdam, 1081HV, Netherlands, 31 0205985204, f.bolinski@vu.nl %K digital mental health %K students %K indicated prevention %K recruitment %K randomized trial %K mobile phone %D 2022 %7 14.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression and anxiety are common mental health conditions in college and university student populations. Offering transdiagnostic, web-based prevention programs such as ICare Prevent to those with subclinical complaints has the potential to reduce some barriers to receiving help (eg, availability of services, privacy considerations, and students’ desire for autonomy). However, uptake of these interventions is often low, and accounts of recruitment challenges are needed to complement available effectiveness research in student populations. Objective: The aims of this study were to describe recruitment challenges together with effective recruitment strategies for ICare Prevent and provide basic information on the intervention’s effectiveness. Methods: A 3-arm randomized controlled trial was conducted in a student sample with subclinical symptoms of depression and anxiety on the effectiveness of an individually guided (human support and feedback on exercises provided after each session, tailored to each participant) and automatically guided (computer-generated messages provided after each session, geared toward motivation) version of ICare Prevent, a web-based intervention with transdiagnostic components for the indicated prevention of depression and anxiety. The intervention was compared with care as usual. Descriptive statistics were used to outline recruitment challenges and effective web-based and offline strategies as well as students’ use of the intervention. A basic analysis of intervention effects was conducted using a Bayesian linear mixed model, with Bayes factors reported as the effect size. Results: Direct recruitment through students’ email addresses via the central student administration was the most effective strategy. Data from 35 participants were analyzed (individually guided: n=14, 40%; automatically guided: n=8, 23%; care as usual: n=13, 37%). Use of the intervention was low, with an average of 3 out of 7 sessions (SD 2.9) completed. The analyses did not suggest any intervention effects other than anecdotal evidence (all Bayes factors10≤2.7). Conclusions: This report adds to the existing literature on recruitment challenges specific to the student population. Testing the feasibility of recruitment measures and the greater involvement of the target population in their design, as well as shifting from direct to indirect prevention, can potentially help future studies in the field. In addition, this report demonstrates an alternative basic analytical strategy for underpowered randomized controlled trials. Trial Registration: International Clinical Trials Registry Platform NTR6562; https://tinyurl.com/4rbexzrk International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2477-y %M 36515986 %R 10.2196/40892 %U https://www.jmir.org/2022/12/e40892 %U https://doi.org/10.2196/40892 %U http://www.ncbi.nlm.nih.gov/pubmed/36515986 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e41606 %T The Relationship Between Physical Activity and Mobile Phone Addiction Among Adolescents and Young Adults: Systematic Review and Meta-analysis of Observational Studies %A Xiao,Wen %A Wu,Jinlong %A Yip,Joanne %A Shi,Qiuqiong %A Peng,Li %A Lei,Qiwen Emma %A Ren,Zhanbing %+ College of Physical Education, Shenzhen University, No 3588 Nanhai Road, Nanshan District, Shenzhen, 518060, China, 86 0755 265347, rzb@szu.edu.cn %K mobile phone addiction %K physical activity %K adolescents %K young adults %K systematic review %K phone addiction %K association %K correlation %K phone use %D 2022 %7 14.12.2022 %9 Review %J JMIR Public Health Surveill %G English %X Background: Previous studies have reported a potential negative correlation between physical activity (PA) and mobile phone addiction (MPA) among adolescents and young adults. To date, the strength of this correlation has not been well characterized. Objective: This review and meta-analysis aimed to synthesize available empirical studies to examine the correlations between PA and MPA among adolescents and young adults. We also explored several potential moderators, including time of data collection, country or region, and type of population, associated with the relationship between PA and MPA. Methods: Four electronic databases (PubMed, Scopus, PsycINFO, and Web of Science) were searched from database inception to March 2022 to identify relevant studies. The pooled Pearson correlation coefficients and their corresponding 95% CIs for the relationship between PA and MPA were calculated using the inverse variance method. The methodological quality of the included cross-sectional studies was determined based on the Joanna Briggs Institute appraisal checklist. The study conformed to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analyses) guidelines. Results: In total, 892 relevant articles were identified, of which 22 were selected based on the inclusion and exclusion criteria. The final meta-analysis included 17 of the 22 studies. Results of random effects modeling revealed a moderate correlation between PA and MPA among adolescents and young adults (summary r=–0.243, P<.001). Sensitivity and publication bias analyses further demonstrated the robustness of our results. All the included studies were scored as high quality with a low risk of bias. Subgroup analysis further indicated that none of the hypothesized moderators (time of data collection, country or region, and type of population) significantly affected the relationship between PA and MPA, as confirmed by the mixed effects analysis. In addition, in the data collection subgroups, medium effect sizes were obtained for data collected before COVID-19 (r=–0.333, P<.001) and data collected during COVID-19 (r=–0.207, P<.001). In subgroup analyses for country or region, the correlation coefficient for China and other developing regions showed a similarly moderate effect size (r=–0.201, P<.001 and r= –0.217, P<.001, respectively). However, the effect sizes for developed regions were not significant (r=–0.446, P=.39). In a subgroup analysis based on the type of population, we found that the effect size for young adults was moderate (r=–0.250, P<.001). However, that of adolescents was not significant (r=–0.129, P=.24). Conclusions: Our results demonstrate a moderately negative relationship between PA and MPA among young adults. The strength of this relationship was not influenced by the time of data collection, country or region, or type of population. %M 36515994 %R 10.2196/41606 %U https://publichealth.jmir.org/2022/12/e41606 %U https://doi.org/10.2196/41606 %U http://www.ncbi.nlm.nih.gov/pubmed/36515994 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40723 %T Efficacy of the Mental Health App Intellect to Reduce Stress: Randomized Controlled Trial With a 1-Month Follow-up %A Toh,Sean Han Yang %A Tan,Jessalin Hui Yan %A Kosasih,Feodora Roxanne %A Sündermann,Oliver %+ Intellect Pte Ltd, 171 Tras St, #02-179 Union Building, Singapore, S079025, Singapore, 65 93571995, oliver@intellect.co %K mobile health %K mHealth %K randomized controlled trial %K RCT %K self-guided interventions %K cognitive behavioral therapy %K CBT %K stress coping %K stress management %K university students %K psychological mindedness %K coping self-efficacy %K mobile phone %D 2022 %7 14.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Excessive stress is a major global health concern, particularly in young adults. Short skills-focused self-guided interventions (SGIs) on smartphones are a scalable way to improve stress-coping skills at the population level. Objective: In this randomized controlled trial, we aimed to examine the possible efficacy of a recently developed stress-coping SGI (Intellect) in improving psychological distress, relative to an active control group and 2 potential moderators of this predicted relationship (ie, psychological mindedness [PM] and coping self-efficacy [CSE]). Methods: University students (N=321) were randomly assigned to either an 8-day SGI on stress-coping or an active control group. Self-reported measures were obtained at baseline, after the intervention, and at the 1-month follow-up. The primary outcome was psychological stress (Psychological Stress Measure-9). Secondary outcomes were anxiety (Generalized Anxiety Disorder-7) and depressive symptoms (Patient Health Questionnaire-9). PM and CSE were assessed as potential moderators at baseline. Results: The final sample (n=264) included 188 (71.2%) female, 66 (25%) male, 7 (2.7%) nonbinary, and 3 (1.1%) others participants with a mean age of 22.5 (SD 5.41) years. The intervention group reported significantly lower perceived stress (partial eta–squared [ηp2]=0.018; P=.03) and anxiety (ηp2=0.019; P=.03) levels after intervention relative to the active control group. The effects on perceived stress levels remained statistically significant at the 1-month follow-up (ηp2=0.015; P=.05). Students with the lowest CSE and highest PM experienced the fastest decline in perceived stress levels (β=6.37, 95% Cl 2.98-9.75). Improvements in anxiety levels were not observed at 1-month follow-up. Similarly, no intervention effects were found for depression levels at postintervention and follow-up periods. Conclusions: This study provides evidence that the Intellect stress-coping SGI is effective in reducing perceived stress and anxiety levels among university students. Mobile health apps are brief, scalable, and can make important contributions to public mental health. Trial Registration: ClinicalTrials.gov NCT04978896; https://www.clinicaltrials.gov/ct2/show/NCT04978896 %M 36515984 %R 10.2196/40723 %U https://formative.jmir.org/2022/12/e40723 %U https://doi.org/10.2196/40723 %U http://www.ncbi.nlm.nih.gov/pubmed/36515984 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e38479 %T Using Continuous Glucose Monitoring to Detect and Intervene on Dietary Restriction in Individuals With Binge Eating: The SenseSupport Withdrawal Design Study %A Juarascio,Adrienne S %A Srivastava,Paakhi %A Presseller,Emily K %A Lin,Mandy %A Patarinski,Anna G G %A Manasse,Stephanie M %A Forman,Evan M %+ Center for Weight, Eating, and Lifestyle Science, Drexel University, 3201 Chestnut St., Philadelphia, PA, 19104, United States, 1 215 553 7154, asj32@drexel.edu %K binge eating %K loss-of-control eating %K continuous glucose monitoring %K mobile phone %D 2022 %7 14.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Dietary restraint is a key factor for maintaining engagement in binge eating among individuals with binge eating disorder (BED) and bulimia nervosa (BN). Reducing dietary restraint is a mechanism of change in cognitive behavioral therapy (CBT) for individuals with BN and BED. However, many individuals who undergo CBT fail to adequately reduce dietary restraint during treatment, perhaps owing to difficulty in using treatment skills (eg, regular eating) to reduce dietary restraint during their daily lives. The SenseSupport system, a novel just-in-time, adaptive intervention (JITAI) system that uses continuous glucose monitoring to detect periods of dietary restraint, may improve CBT to reduce dietary restraint during treatment by providing real-time interventions. Objective: This study aimed to describe the feasibility, acceptability, and initial evaluation of SenseSupport. We presented feasibility, acceptability, target engagement, and initial treatment outcome data from a small trial using an ABAB (A=continuous glucose monitoring data sharing and JITAIs-Off, B=continuous glucose monitoring data sharing and JITAIs-On) design (in which JITAIs were turned on for 2 weeks and then turned off for 2 weeks throughout the treatment). Methods: Participants (N=30) were individuals with BED or BN engaging in ≥3 episodes of ≥5 hours without eating per week at baseline. Participants received 12 sessions of CBT and wore continuous glucose monitors to detect eating behaviors and inform the delivery of JITAIs. Participants completed 4 assessments and reported eating disorder behaviors, dietary restraint, and barriers to app use weekly throughout treatment. Results: Retention was high (25/30, 83% after treatment). However, the rates of continuous glucose monitoring data collection were low (67.4% of expected glucose data were collected), and therapists and participants reported frequent app-related issues. Participants reported that the SenseSupport system was comfortable, minimally disruptive, and easy to use. The only form of dietary restraint that decreased significantly more rapidly during JITAIs-On periods relative to JITAIs-Off periods was the desire for an empty stomach (t43=1.69; P=.049; Cohen d=0.25). There was also a trend toward greater decrease in overall restraint during JITAs-On periods compared with JITAIs-Off periods, but these results were not statistically significant (t43=1.60; P=.06; Cohen d=0.24). There was no significant difference in change in the frequency of binge eating during JITAIs-On periods compared with JITAIs-Off periods (P=.23). Participants demonstrated clinically significant, large decreases in binge eating (t24=10.36; P<.001; Cohen d=2.07), compensatory behaviors (t24=3.40; P=.001; Cohen d=0.68), and global eating pathology (t24=6.25; P<.001; Cohen d=1.25) from pre- to posttreatment. Conclusions: This study describes the successful development and implementation of the first intervention system combining passive continuous glucose monitors and JITAIs to augment CBT for binge-spectrum eating disorders. Despite the lower-than-anticipated collection of glucose data, the high acceptability and promising treatment outcomes suggest that the SenseSupport system warrants additional investigation via future, fully powered clinical trials. Trial Registration: ClinicalTrials.gov NCT04126694; https://clinicaltrials.gov/ct2/show/NCT04126694 %M 36515992 %R 10.2196/38479 %U https://formative.jmir.org/2022/12/e38479 %U https://doi.org/10.2196/38479 %U http://www.ncbi.nlm.nih.gov/pubmed/36515992 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 12 %P e38785 %T The Use of Passive Smartphone Data to Monitor Anxiety and Depression Among College Students in Real-World Settings: Protocol for a Systematic Review %A Girousse,Eva %A Vuillerme,Nicolas %+ AGEIS, Université Grenoble Alpes, La Tronche, Grenoble, 38706, France, 33 4 7663 7104, nicolas.vuillerme@univ-grenoble-alpes.fr %K smartphones %K anxiety %K depression %K college students %K smartphone %K data %K monitor %K students %K systematic review %K public health %K mental conditions %K disorder %K strength %K limitation %D 2022 %7 14.12.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: College students are particularly at risk of depression and anxiety. These disorders have a serious impact on public health and affect patients’ daily lives. The potential for using smartphones to monitor these mental conditions, providing passively collected physiological and behavioral data, has been reported among the general population. However, research on the use of passive smartphone data to monitor anxiety and depression among specific populations of college students has never been reviewed. Objective: This review’s objectives are (1) to provide an overview of the use of passive smartphone data to monitor depression and anxiety among college students, given their specific type of smartphone use and living setting, and (2) to evaluate the different methods used to assess those smartphone data, including their strengths and limitations. Methods: This review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Two independent investigators will review English-language, full-text, peer-reviewed papers extracted from PubMed and Web of Science that measure passive smartphone data and levels of depression or anxiety among college students. A preliminary search was conducted in February 2022 as a proof of concept. Results: Our preliminary search identified 115 original articles, 8 of which met our eligibility criteria. Our planned full study will include an article selection flowchart, tables, and figures representing the main information extracted on the use of passive smartphone data to monitor anxiety and depression among college students. Conclusions: The planned review will summarize the published research on using passive smartphone data to monitor anxiety and depression among college students. The review aims to better understand whether and how passive smartphone data are associated with indicators of depression and anxiety among college students. This could be valuable in order to provide a digital solution for monitoring mental health issues in this specific population by enabling easier identification and follow-up of the patients. Trial Registration: PROSPERO CRD42022316263; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=316263 International Registered Report Identifier (IRRID): DERR1-10.2196/38785 %M 36515983 %R 10.2196/38785 %U https://www.researchprotocols.org/2022/12/e38785 %U https://doi.org/10.2196/38785 %U http://www.ncbi.nlm.nih.gov/pubmed/36515983 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e42191 %T Detailed Versus Simplified Dietary Self-monitoring in a Digital Weight Loss Intervention Among Racial and Ethnic Minority Adults: Fully Remote, Randomized Pilot Study %A Patel,Michele L %A Cleare,Angel E %A Smith,Carly M %A Rosas,Lisa Goldman %A King,Abby C %+ Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA, 94304, United States, 1 650 549 7047, michele.patel@stanford.edu %K weight loss %K obesity %K behavioral intervention %K self-monitoring %K race %K ethnicity %K digital health %K diet tracking %K engagement %K randomized controlled trial %K RCT %K mobile phone %D 2022 %7 13.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Detailed self-monitoring (or tracking) of dietary intake is a popular and effective weight loss approach that can be delivered via digital tools, although engagement declines over time. Simplifying the experience of self-monitoring diet may counteract this decline in engagement. Testing these strategies among racial and ethnic minority groups is important as these groups are often disproportionately affected by obesity yet underrepresented in behavioral obesity treatment. Objective: In this 2-arm pilot study, we aimed to evaluate the feasibility and acceptability of a digital weight loss intervention with either detailed or simplified dietary self-monitoring. Methods: We recruited racial and ethnic minority adults aged ≥21 years with a BMI of 25 kg/m2 to 45 kg/m2 and living in the United States. The Pacific time zone was selected for a fully remote study. Participants received a 3-month stand-alone digital weight loss intervention and were randomized 1:1 to either the detailed arm that was instructed to self-monitor all foods and drinks consumed each day using the Fitbit mobile app or to the simplified arm that was instructed to self-monitor only red zone foods (foods that are highly caloric and of limited nutritional value) each day via a web-based checklist. All participants were instructed to self-monitor both steps and body weight daily. Each week, participants were emailed behavioral lessons, action plans, and personalized feedback. In total, 12 a priori benchmarks were set to establish feasibility, including outcomes related to reach, retention, and self-monitoring engagement (assessed objectively via digital tools). Acceptability was assessed using a questionnaire. Weight change was assessed using scales shipped to the participants’ homes and reported descriptively. Results: The eligibility screen was completed by 248 individuals, of whom 38 (15.3%) were randomized, 18 to detailed and 20 to simplified. At baseline, participants had a mean age of 47.4 (SD 14.0) years and BMI of 31.2 (SD 4.8) kg/m2. More than half (22/38, 58%) were identified as Hispanic of any race. The study retention rate was 92% (35/38) at 3 months. The detailed arm met 9 of 12 feasibility benchmarks, while the simplified arm met all 12. Self-monitoring engagement was moderate to high (self-monitoring diet: median of 49% of days for detailed, 97% for simplified; self-monitoring steps: 99% for detailed, 100% for simplified; self-monitoring weight: 67% for detailed, 80% for simplified). Participants in both arms reported high satisfaction, with 89% indicating that they would recommend the intervention. Weight change was −3.4 (95% CI −4.6 to −2.2) kg for detailed and −3.3 (95% CI −4.4 to −2.2) kg for simplified. Conclusions: A digital weight loss intervention that incorporated either detailed or simplified dietary self-monitoring was feasible, with high retention and engagement, and acceptable to racial and ethnic minority adults. Trial Registration: ASPREDICTED #66674; https://aspredicted.org/ka478.pdf %M 36512404 %R 10.2196/42191 %U https://formative.jmir.org/2022/12/e42191 %U https://doi.org/10.2196/42191 %U http://www.ncbi.nlm.nih.gov/pubmed/36512404 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40045 %T Development of an mHealth App–Based Intervention for Depressive Rumination (RuminAid): Mixed Methods Focus Group Evaluation %A Rosenfeld,Eve A %A Lyman,Cassondra %A Roberts,John E %+ Dissemination and Training Division, National Center for PTSD, VA Palo Alto Healthcare System, NCPTSD – 334, 795 Willow Road, Menlo Park, CA, 94025, United States, 1 908 907 4135, earosenf@stanford.edu %K depression %K rumination %K mobile health %K mHealth %K evidence-based treatment %K focus group %K mental health %K mobile app %K mobile phone %D 2022 %7 13.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression is a common mental health condition that poses a significant public health burden. Effective treatments for depression exist; however, access to evidence-based care remains limited. Mobile health (mHealth) apps offer an avenue for improving access. However, few mHealth apps are informed by evidence-based treatments and even fewer are empirically evaluated before dissemination. To address this gap, we developed RuminAid, an mHealth app that uses evidence-based treatment components to reduce depression by targeting a single key depressogenic process—rumination. Objective: The primary objective of this study was to collect qualitative and quantitative feedback that could be used to improve the design of RuminAid before the software development phase. Methods: We reviewed empirically supported interventions for depression and rumination and used the key aspects of each to create a storyboard version of RuminAid. We distributed an audio-guided presentation of the RuminAid storyboard to 22 individuals for viewing and solicited user feedback on app content, design, and perceived functionality across 7 focus group sessions. Results: The consumer-rated quality of the storyboard version of RuminAid was in the acceptable to good range. Indeed, most participants reported that they thought RuminAid would be an engaging, functional, and informational app. Likewise, they endorsed overwhelming positive beliefs about the perceived impact of RuminAid; specifically, 96% (21/22) believed that RuminAid will help depressed ruminators with depression and rumination. Nevertheless, the results highlighted the need for improved app aesthetics (eg, a more appealing color scheme and modern design). Conclusions: Focus group members reported that the quality of information was quite good and had the potential to help adults who struggle with depression and rumination but expressed concern that poor aesthetics would interfere with users’ desire to continue using the app. To address these comments, we hired a graphic designer and redesigned each screen to improve visual appeal. We also removed time gating from the app based on participant feedback and findings from related research. These changes helped elevate RuminAid and informed its initial software build for a pilot trial that focused on evaluating its feasibility and acceptability. %M 36512400 %R 10.2196/40045 %U https://formative.jmir.org/2022/12/e40045 %U https://doi.org/10.2196/40045 %U http://www.ncbi.nlm.nih.gov/pubmed/36512400 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e38496 %T Use of an Interactive Obesity Treatment Approach in Individuals With Severe Mental Illness: Feasibility, Acceptability, and Proposed Engagement Criteria %A Nicol,Ginger %A Jansen,Madeline %A Haddad,Rita %A Ricchio,Amanda %A Yingling,Michael D %A Schweiger,Julia A %A Keenoy,Katie %A Evanoff,Bradley A %A Newcomer,John W %+ Department of Psychiatry, Washington University School of Medicine, 600 S. Taylor Ave., Suite 121, St. Louis, MO, 63110, United States, 1 13143625939, nicolg@wustl.edu %K obesity %K mentally ill people/persons %K health services %K mobile health %D 2022 %7 13.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital and mobile health interventions are increasingly being used to support healthy lifestyle change, including in certain high-risk populations such as those with severe mental illnesses (SMIs). Life expectancy in this population lags 15 years behind counterparts in the general population, primarily due to obesity-related health conditions. Objective: We tested the feasibility and usability of a 12-week interactive obesity treatment approach (iOTA) to adults with chronic SMIs (depression, bipolar disorder and schizophrenia spectrum disorder) receiving treatment in community settings. The iOTA incorporates short message service (SMS) text messages to supplement monthly in-person health coaching. Methods: Factors hypothesized to be associated with weight change were illness severity and treatment engagement. Severe psychiatric symptoms were defined as baseline Clinical Global Impression severity score of >5. Criterion engagement was defined as a text messaging response rate >80% during the first 4 weeks of treatment. Disordered eating, assessed with the Loss of Control Over Eating Scores, was also evaluated. Participants provided qualitative data, further informing assessment of intervention feasibility, usability, and acceptability. Results: A total of 26 participants were enrolled. The mean age was 48.5 (SD 15.67) years; 40% (10/26) were Black and 60% (15/26) female. Participants with lower symptom severity and adequate engagement demonstrated significantly decreased weight (F1,16=22.54, P<.001). Conversely, high symptom severity and lower text message response rates were associated with trend-level increases in weight (F1,7=4.33, P=.08). Loss-of-control eating was not observed to impact treatment outcome. Participants voiced preference for combination of live health coaching and text messaging, expressing desire for personalized message content. Conclusions: These results demonstrate the feasibility of delivering an adapted iOTA to SMI patients receiving care in community settings and suggest testable criteria for defining sufficient treatment engagement and psychiatric symptom severity, two factors known to impact weight loss outcomes. These important findings suggest specific adaptations may be needed for optimal treatment outcomes in individuals with SMI. %M 36512399 %R 10.2196/38496 %U https://formative.jmir.org/2022/12/e38496 %U https://doi.org/10.2196/38496 %U http://www.ncbi.nlm.nih.gov/pubmed/36512399 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 12 %P e38049 %T The Effectiveness of Internet-Guided Self-help Interventions to Promote Physical Activity Among Individuals With Depression: Systematic Review %A Tang,Yiling %A Gierc,Madelaine %A Lam,Raymond W %A Liu,Sam %A Faulkner,Guy %+ School of Kinesiology, University of British Columbia, 6081 University Blvd, Vancouver, BC, V6T 1Z1, Canada, 1 6048222211, yilingtt@student.ubc.ca %K physical activity %K eHealth %K mobile health %K mHealth %K depression %K systematic review %K internet %K mobile phone %D 2022 %7 12.12.2022 %9 Review %J JMIR Ment Health %G English %X Background: Depression is a prevalent and debilitating mental disorder and a leading cause of disability worldwide. Physical activity (PA) interventions have been shown to alleviate depressive symptoms. However, not all patients have access to PA programing tailored for depression. Internet-guided self-help (IGSH) interventions may be an effective option for increasing PA among people with depression who cannot or prefer not to access supervised exercise treatment. Objective: We aimed to evaluate the effectiveness of IGSH interventions in increasing PA and alleviating depressive symptoms in people with depression. Methods: A systematic literature search was conducted for randomized controlled trials and quasiexperimental studies using 9 electronic databases. The review was registered in PROSPERO (2020 CRD42020221713). Results: A total of 4 randomized controlled trials (430 participants) met the inclusion criteria. Of these, 3 were web-based and 1 was app-based. Three studies found IGSH interventions to have medium to large effects on decreasing depressive symptoms but not on increasing PA compared with waitlist or usual care. One study showed increased self-reported PA but no significant difference in depressive symptoms in the intervention group compared with the control group. Goal setting was the most common behavior change technique used in the interventions. Dropout rates within the intervention groups were relatively low (0%-19%). Conclusions: Our findings suggested that IGSH PA interventions are feasible and have the potential to reduce depressive symptoms in people with depression. More well-designed and tailored interventions with different combinations of behavior change techniques, particularly those targeting the emotion domain, are needed to assess the overall effectiveness and feasibility of using IGSH interventions to increase PA among people with depression. Trial Registration: PROSPERO CRD42020221713; https://tinyurl.com/ysaua5bu %M 36508243 %R 10.2196/38049 %U https://mental.jmir.org/2022/12/e38049 %U https://doi.org/10.2196/38049 %U http://www.ncbi.nlm.nih.gov/pubmed/36508243 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 4 %P e42923 %T Self-Monitoring Physical Activity, Diet, and Weight Among Adults Who Are Legally Blind: Exploratory Investigation %A Miller,Kamilla %A Jerome,Gerald J %+ Department of Kinesiology, Towson University, 8000 York Road, Towson, MD, 21252, United States, 1 4107045283, gjerome@towson.edu %K blindness %K visually impaired %K obesity %K weight loss %K weight management %K physical activity %K digital health intervention %K telehealth %K health support %K mobile phone %D 2022 %7 12.12.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Obesity is a global pandemic. Lifestyle approaches have been shown effective for weight loss and weight loss maintenance. Central to these evidence-based approaches are increased physical activity, decreased caloric intake, regular self-weighing, and the tracking of these behaviors. Objective: This exploratory descriptive study surveyed adults who are legally blind to identify strategies related to tracking physical activity, diet, and weight. These health behaviors are essential components to evidence-based weight loss programs. We also identified areas where we can better support adults who are legally blind in their independent efforts to change these behaviors and improve their health. Methods: Participants (≥18 years of age) who self-identified as being legally blind were recruited using email announcements in low vision advocacy groups. They completed an interviewer-administered survey on the telephone and an in-person visit for standardized assessment of height and weight. Results: The participants (N=18) had an average age of 31.2 (SD 13.4) years; 50% (9/18) had normal weight (BMI 18.5 to <25); 44% (8/18) were female; 44% (8/18) were Black; and 39% (7/18) were Non-Hispanic White. Most participants (16/18, 89%) used their smartphone to access the internet daily, and 67% (12/18) had at least 150 mins of exercise per week. Although 78% (14/18) of the participants indicated tracking their weight, only 61% (11/18) could indicate how they tracked their weight, and 22% (4/18) indicated they tracked it mentally. Providing individuals with a talking scale was the most consistent recommendation (12/18, 67%) to facilitate independence in managing weight through lifestyle changes. Even though 50% (9/18) of the participants indicated using an app or electronic notes to track some portion of their diet, participants reported challenges with determining portion size and corresponding calorie counts. Most participants (17/18, 94%) reported using apps, electronic notes, smartphones, or wearable devices to track their physical activity. Although strategies such as using wearables and smartphones could provide measurements (eg, step counts) as well as recording data, they also pose financial and technology literacy barriers. Conclusions: Technology-based solutions were identified for tracking weight, diet, and physical activity for weight management. These strategies have financial and technology literacy barriers. A range of strategies for adopting and tracking health behaviors will be needed to assist individuals with varying skills and life experiences. %M 36508250 %R 10.2196/42923 %U https://rehab.jmir.org/2022/4/e42923 %U https://doi.org/10.2196/42923 %U http://www.ncbi.nlm.nih.gov/pubmed/36508250 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 12 %P e40271 %T Assessing the Acceptability and Effectiveness of Mobile-Based Physical Activity Interventions for Midlife Women During Menopause: Systematic Review of the Literature %A AlSwayied,Ghada %A Guo,Haoyue %A Rookes,Tasmin %A Frost,Rachael %A Hamilton,Fiona L %+ UCL Research Department of Primary Care and Population Health, University College London, Upper 3rd Floor, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, United Kingdom, 44 02077940500 ext 31498, zczlgbi@ucl.ac.uk %K mobile app %K mobile health %K mHealth %K smartphone %K smartphone apps %K physical activity %K exercise %K midlife women %K menopause %K menopausal symptoms %K behavior change %K women’s health %K wearable %K activity tracker %K effectiveness %K acceptability %K review %K meta-analysis %K mobile phone %D 2022 %7 9.12.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Midlife women with menopausal symptoms are less likely to meet the recommended level of physical activity (PA). Promoting PA among women in midlife could reduce their risk of cardiovascular diseases and perhaps improve menopausal symptoms. Mobile PA interventions in the form of smartphone apps and wearable activity trackers can potentially encourage users to increase PA levels and address time and resource barriers to PA. However, evidence on the acceptability and effectiveness of these interventions among midlife women is unclear. Objective: This systematic review evaluated the effectiveness, acceptability, and active behavior change techniques (BCTs) of mobile PA technologies among midlife menopausal women. Methods: A mixed methods systematic review of qualitative and quantitative studies was conducted. MEDLINE (Ovid), Embase, Scopus, CINAHL, Web of Science, SPORTDiscus, CENTRAL, PsycINFO, and the ProQuest Sports Medicine and Education Index were systematically searched. Studies were selected and screened according to predetermined eligibility criteria. In total, 2 reviewers independently assessed the risk of bias using the Mixed Methods Appraisal Tool and completed BCT mapping of the included interventions using the BCT Taxonomy v1. Results: A total of 12 studies were included in this review. Overall risk of bias was “Moderate to high” in 58% (7/12) of the included studies and “low” in 42% (5/12) of the studies. Of the 12 studies, 7 (58%) assessed changes in PA levels. The pooled effect size of 2 randomized controlled trials resulted in a small to moderate increase in moderate to vigorous PA of approximately 61.36 weekly minutes among midlife women, at least in the short term (95% CI 17.70-105.01; P=.006). Although a meta-analysis was not feasible because of heterogeneity, positive improvements were also found in a range of menopause-related outcomes such as weight reduction, anxiety management, sleep quality, and menopause-related quality of life. Midlife women perceived mobile PA interventions to be acceptable and potentially helpful in increasing PA and daily steps. The average number of BCTs per mobile PA intervention was 8.8 (range 4-13) according to the BCT Taxonomy v1. “Self-monitoring of behaviour,” “Biofeedback,” and “Goal setting (behaviour)” were the most frequently described BCTs across the included interventions. Conclusions: This review demonstrated that mobile PA interventions in the form of smartphone apps and wearable trackers are potentially effective for small to moderate increases in moderate to vigorous PA among midlife women with menopausal symptoms. Although menopause is a natural condition affecting half the population worldwide, there is a substantial lack of evidence to support the acceptability and effectiveness of mobile PA interventions on menopause-related outcomes, which needs further investigation. Trial Registration: PROSPERO CRD42021273062; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=273062 %M 36485026 %R 10.2196/40271 %U https://mhealth.jmir.org/2022/12/e40271 %U https://doi.org/10.2196/40271 %U http://www.ncbi.nlm.nih.gov/pubmed/36485026 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 12 %P e39393 %T Assessing the Quality of the World Health Organization’s Skin NTDs App as a Training Tool in Ghana and Kenya: Protocol for a Cross-sectional Study %A Frej,Asmae %A Cano,Mireia %A Ruiz-Postigo,José A %A Macharia,Paul %A Phillips,Richard Odame %A Amoako,Yaw Ampem %A Carrion,Carme %+ eHealth Lab Research Group, eHealth Center & School of Health Sciences, Universitat Oberta de Catalunya, Avenue Tibidabo 39, Barcelona, 08035, Spain, 34 630983328, mcarrionr@uoc.edu %K Skin NTDs App %K mHealth %K mobile health %K neglected tropical diseases %K skin neglected tropical diseases %K low- and middle-income countries %D 2022 %7 8.12.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Neglected tropical diseases (NTDs) affect over 1.5 billion people worldwide, the majority of them belonging to impoverished populations in low- and middle-income countries (LMICs). Skin NTDs are a subgroup of NTDs that manifest primarily as skin lesions. The diagnosis and treatment of skin NTDs entail considerable resources, including trained personnel and financial backing. Many interventions are being launched and evaluated, particularly mobile health (mHealth) interventions, such as Skin NTDs App, a training and decision support tool offered by the World Health Organization (WHO) for frontline health workers (FHWs). As most digital health guidelines prioritize the thorough evaluation of mHealth interventions, it is essential to conduct a rigorous and validated assessment of Skin NTDs App. Objective: We aim to assess the quality of version 3 of Skin NTDs App, developed for the WHO by Universal Doctor and Netherlands Leprosy Relief as a training and decision support tool for FHWs. Methods: A cross-sectional study will be conducted in 2 LMICs: Ghana and Kenya. We will use snowball sampling recruitment to select 48 participants from the target population of all FHWs dealing with skin NTDs. The sample group of FHWs will be asked to download and use Skin NTDs App for at least 5 days before answering a web-based survey containing demographic variables and the user Mobile App Rating Scale (uMARS) questionnaire. A semistructured interview will then be conducted. Quantitative and qualitative data will be analyzed using SPSS (version 25; SPSS Inc), with statistical significance for all tests set at a 95% CI and P≤.05 considered significant. Data derived from the semistructured interviews will be clustered in themes and coded to enable analysis of various dimensions using ATLAS.ti. Results: The estimated completion date of the study is in the third quarter of 2022. The results are expected to show that Skin NTDs App version 3 has a good reported user experience, as assessed using the uMARS scale. No differences are expected to be found, except for those related to experience in dermatology and the use of mobile technology that could influence the final score. Semistructured interviews are expected to complete the results obtained on the uMARS scale. Moreover, they will be the previous step before assessing other aspects of the app, such as its efficiency and how it should be disseminated or implemented. Conclusions: This study is the first step in a qualitative and quantitative assessment of Skin NTDs App as a training and support tool for FHWs diagnosing and managing skin NTDs. Our results will serve to improve future versions of the App. International Registered Report Identifier (IRRID): PRR1-10.2196/39393 %M 36480252 %R 10.2196/39393 %U https://www.researchprotocols.org/2022/12/e39393 %U https://doi.org/10.2196/39393 %U http://www.ncbi.nlm.nih.gov/pubmed/36480252 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e39483 %T Changes in a Digital Type 2 Diabetes Self-management Intervention During National Rollout: Mixed Methods Study of Fidelity %A Benton,Jack S %A Cotterill,Sarah %A Hawkes,Rhiannon E %A Miles,Lisa M %A French,David P %+ Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Coupland 1 Building, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 7853986479, jack.benton@manchester.ac.uk %K type 2 diabetes %K Healthy Living %K digital interventions %K behavior change %K self-management %K fidelity %K implementation %K mixed methods %K mobile phone %D 2022 %7 7.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: “Healthy Living for People with type 2 Diabetes (HeLP-Diabetes)” was a theory-based digital self-management intervention for people with type 2 diabetes mellitus that encouraged behavior change using behavior change techniques (BCTs) and promoted self-management. HeLP-Diabetes was effective in reducing HbA1c levels in a randomized controlled trial (RCT). National Health Service (NHS) England commissioned a national rollout of HeLP-Diabetes in routine care (now called “Healthy Living”). Healthy Living presents a unique opportunity to examine the fidelity of the national rollout of an intervention originally tested in an RCT. Objective: This research aimed to describe the Healthy Living BCT and self-management content and features of intervention delivery, compare the fidelity of Healthy Living with the original HeLP-Diabetes intervention, and explain the reasons for any fidelity drift during national rollout through qualitative interviews. Methods: Content analysis of Healthy Living was conducted using 3 coding frameworks (objective 1): the BCT Taxonomy v1, a new coding framework for assessing self-management tasks, and the Template for Intervention Description and Replication. The extent to which BCTs and self-management tasks were included in Healthy Living was compared with published descriptions of HeLP-Diabetes (objective 2). Semistructured interviews were conducted with 9 stakeholders involved in the development of HeLP-Diabetes or Healthy Living to understand the reasons for any changes during national rollout (objective 3). Qualitative data were thematically analyzed using a modified framework approach. Results: The content analysis identified 43 BCTs in Healthy Living. Healthy Living included all but one of the self-regulatory BCTs (“commitment”) in the original HeLP-Diabetes intervention. Healthy Living was found to address all areas of self-management (medical, emotional, and role) in line with the original HeLP-Diabetes intervention. However, 2 important changes were identified. First, facilitated access by a health care professional was not implemented; interviews revealed this was because general practices had fewer resources in comparison with the RCT. Second, Healthy Living included an additional structured web-based learning curriculum that was developed by the HeLP-Diabetes team but was not included in the original RCT; interviews revealed that this was because of changes in NHS policy that encouraged referral to structured education. Interviewees described how the service provider had to reformat the content of the original HeLP-Diabetes website to make it more usable and accessible to meet the multiple digital standards required for implementation in the NHS. Conclusions: The national rollout of Healthy Living had good fidelity to the BCT and self-management content of HeLP-Diabetes. Important changes were attributable to the challenges of scaling up a digital intervention from an RCT to a nationally implemented intervention, mainly because of fewer resources available in practice and the length of time since the RCT. This study highlights the importance of considering implementation throughout all phases of intervention development. %M 36476723 %R 10.2196/39483 %U https://www.jmir.org/2022/12/e39483 %U https://doi.org/10.2196/39483 %U http://www.ncbi.nlm.nih.gov/pubmed/36476723 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40278 %T Changes in Glycemic Control Following Use of a Spanish-Language, Culturally Adapted Diabetes Program: Retrospective Study %A Edwards,Caitlyn %A Orellana,Elisa %A Rawlings,Kelly %A Rodriguez-Pla,Mirta %A Venkatesan,Aarathi %+ Vida Health, 100 Montgomery St, Ste 750, San Francisco, CA, 94104, United States, 1 415 989 1017, caitlyn.edwards@vida.com %K type 2 diabetes %K digital health %K diabetes intervention %K diabetes %K mobile health %K mhealth %K app-based %K health coaching %K HbA1c %K glycemic improvements %K localization %K Spanish %K health application %K health education %K patient education %K nutrition %K digital health intervention %K health management %D 2022 %7 7.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Several barriers to diabetes treatment and care exist, particularly in underserved medical communities. Objective: This study aimed to evaluate a novel, culturally adapted, Spanish-language mHealth diabetes program for glycemic control. Methods: Professional Spanish translators, linguists, and providers localized the entirety of the Vida Health Diabetes Management Program into a culturally relevant Spanish-language version. The Spanish-language Vida Health Diabetes Management Program was used by 182 (n=119 women) Spanish-speaking adults with diabetes. This app-based program provided access to culturally adapted educational content on diabetes self-management, one-on-one remote counseling and coaching sessions, and on-demand in-app messaging with bilingual (Spanish and English) certified health coaches, registered dietitian nutritionists, and certified diabetes care and education specialists. Hemoglobin A1c (HbA1c) was the primary outcome measure, and a 2-tailed, paired t test was used to evaluate changes in HbA1c before and after program use. To determine the relationship between program engagement and changes in glycemic control, a cluster-robust multiple regression analysis was employed. Results: We observed a significant decrease in HbA1c of –1.23 points between baseline (mean 9.65%, SD 1.56%) and follow-up (mean 8.42%, SD 1.44%; P<.001). Additionally, we observed a greater decrease in HbA1c among participants with high program engagement (high engagement: –1.59%, SD 1.97%; low engagement: –0.84%, SD 1.64%; P<.001). Conclusions: This work highlights improvements in glycemic control that were clinically as well as statistically significant among Spanish-preferring adults enrolled in the Vida Health Spanish Diabetes Management Program. Greater improvements in glycemic control were observed among participants with higher program engagement. These results provide needed support for the use of digital health interventions to promote meaningful improvements in glycemic control in a medically underserved community. %M 36476397 %R 10.2196/40278 %U https://formative.jmir.org/2022/12/e40278 %U https://doi.org/10.2196/40278 %U http://www.ncbi.nlm.nih.gov/pubmed/36476397 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 12 %P e43208 %T Development and Exploration of the Effectiveness and Feasibility of a Digital Intervention for Type 2 Diabetes Mellitus (DEsireD): Protocol for a Clinical Nonrandomized Pilot Trial in Brunei Darussalam %A Chan,Hiu Nam %A Lim,Hong Shen %A Chong,Pui Lin %A Yung,Chee Kwang %A Abd Mulok,Musjarena %A Wei,Yuan %A Yong,Alice Moi Ling %+ EVYD Research Pte Ltd, 55 Tras Street, #03-01, Singapore, 078994, Singapore, 65 92300660, candy.chan@evydtech.com %K DEsireD %K type 2 diabetes mellitus %K digital intervention %K mHealth %K health coaching %K chronic disease management %K EMR %K value-based care %D 2022 %7 7.12.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide. Digital interventions that incorporate the use of mobile phones and wearables have been getting popular. A combination of a digital intervention with support from professional management can enhance users’ self-efficacy better than a digital intervention alone and provide better accessibility to a lifestyle intervention. However, there are limited studies exploring the feasibility and efficacy of applying a digital intervention in Muslim-majority countries, and none have been conducted in Brunei Darussalam. Objective: The study aims to determine the effectiveness and feasibility of a proposed 16-week digital intervention program for T2DM self-management and to guide the rollout of a mobile app as part of a population health solution for adults with T2DM in Brunei. The primary outcome of this study is to measure the proportion of participants with a hemoglobin A1c (HbA1c) reduction of at least 0.6% from baseline, and the secondary outcomes include a change in HbA1c, BMI, lipid profile, and EQ-5D-5L score. Methods: This single-arm nonrandomized pilot study will recruit participants using web-based (with the national health care app [BruHealth] and official social media platforms being used for outreach) and offline (in-person recruitment at health centers) approaches. A target of 180 individuals with T2DM aged between 20 and 70 years that meet the inclusion criteria will be enrolled in a 16-week digital intervention program. Baseline and postintervention markers will be evaluated. Results: The study received approval from the Medical and Health Research & Ethics Committee of the Brunei Darussalam Ministry of Health (MHREC/MOH/2022/4(1)). The recruitment process is ongoing, and we anticipate that the study will conclude by April 2023. This will be followed by data analysis and the reporting of outcomes with the intention to publish. The results of this study will be disseminated through scientific publications and conferences. This study will serve as a guide to launch T2DM digital therapeutic programs and extend to other noncommunicable diseases (NCDs) if proven as an effective and feasible approach in Brunei. Conclusions: The Development and Exploration of the Effectiveness and Feasibility of a Digital Intervention for Type 2 Diabetes Mellitus (DEsireD) study will be the first study to investigate the clinical effectiveness and feasibility of the proposed 16-week T2DM digital intervention program tailored for Brunei, a Muslim-majority country. The findings of this study can potentially scale up the proposed model of care to other NCDs as a national approach for health management solutions. Trial Registration: ClinicalTrials.gov NCT05364476; https://clinicaltrials.gov/ct2/show/NCT05364476 International Registered Report Identifier (IRRID): DERR1-10.2196/43208 %M 36477014 %R 10.2196/43208 %U https://www.researchprotocols.org/2022/12/e43208 %U https://doi.org/10.2196/43208 %U http://www.ncbi.nlm.nih.gov/pubmed/36477014 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e39647 %T Social Determinants of Digital Health Adoption: Pilot Cross-sectional Survey %A Patel,Sharvil Piyush %A Sun,Elizabeth %A Reinhardt,Alec %A Geevarghese,Sanjaly %A He,Simon %A Gazmararian,Julie A %+ Omnimed Inc, 5363 Veterans Parkway, Suite C, Columbus, GA, 31904, United States, 1 706 905 2971, spatel@omnimedinc.org %K digital health %K health accessibility %K utilization %K mobile health %K mHealth %K telemedicine %D 2022 %7 6.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Interest in and funding for digital health interventions have rapidly grown in recent years. Despite the increasing familiarity with mobile health from regulatory bodies, providers, and patients, overarching research on digital health adoption has been primarily limited to morbidity-specific and non-US samples. Consequently, there is a limited understanding of what personal factors hold statistically significant relationships with digital health uptake. Moreover, this limits digital health communities’ knowledge of equity along digital health use patterns. Objective: This study aims to identify the social determinants of digital health tool adoption in Georgia. Methods: Web-based survey respondents in Georgia 18 years or older were recruited from mTurk to answer primarily closed-ended questions within the following domains: participant demographics and health consumption background, telehealth, digital health education, prescription management tools, digital mental health services, and doctor finder tools. Participants spent around 15 to 20 minutes on a survey to provide demographic and personal health care consumption data. This data was analyzed with multivariate linear and logistic regressions to identify which of these determinants, if any, held statistically significant relationships with the total number of digital health tool categories adopted and which of these determinants had absolute relationships with specific categories. Results: A total of 362 respondents completed the survey. Private insurance, residence in an urban area, having a primary care provider, fewer urgent emergency room (ER) visits, more ER visits leading to inpatient stays, and chronic condition presence were significantly associated with the number of digital health tool categories adopted. The separate logistic regressions exhibited substantial variability, with 3.5 statistically significant predictors per model, on average. Age, federal poverty level, number of primary care provider visits in the past 12 months, number of nonurgent ER visits in the past 12 months, number of urgent ER visits in the past 12 months, number of ER visits leading to inpatient stays in the past 12 months, race, gender, ethnicity, insurance, education, residential area, access to the internet, difficulty accessing health care, usual source of care, status of primary care provider, and status of chronic condition all had at least one statistically significant relationship with the use of a specific digital health category. Conclusions: The results demonstrate that persons who are socioeconomically disadvantaged may not adopt digital health tools at disproportionately higher rates. Instead, digital health tools may be adopted along social determinants of health, providing strong evidence for the digital health divide. The variability of digital health adoption necessitates investing in and building a common framework to increase mobile health access. With a common framework and a paradigm shift in the design, evaluation, and implementation strategies around digital health, disparities can be further mitigated and addressed. This likely will begin with a coordinated effort to determine barriers to adopting digital health solutions. %M 36472905 %R 10.2196/39647 %U https://formative.jmir.org/2022/12/e39647 %U https://doi.org/10.2196/39647 %U http://www.ncbi.nlm.nih.gov/pubmed/36472905 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 12 %P e39881 %T Mobile Health Apps for Patient-Centered Care: Review of United States Rheumatoid Arthritis Apps for Engagement and Activation %A Cozad,Melanie J %A Crum,Marissa %A Tyson,Hannah %A Fleming,Perry R %A Stratton,Jeanine %A Kennedy,Ann Blair %A Lindley,Lisa C %A Horner,Ronnie D %+ Health Services Research and Administration Department, College of Public Health, University of Nebraska Medical Center, 9843650 Nebraska Medical Center, Omaha, NE, 68198-4350, United States, 1 757 613 1569, mcozad@unmc.edu %K rheumatoid arthritis %K rheumatism %K arthritis %K mobile app %K mobile applications %K mHealth %K patient engagement %K patient activation %K patient-centered care %K patient centred %K person centered %K Mobile Application Rating Scale %K social cognitive theory %K mobile health %K review %K systematic search %K app feature %K content analysis %K functionality %K user rating %K patient rating %D 2022 %7 5.12.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Rheumatoid arthritis (RA) is a highly dynamic and individualized disease in terms of its patterns of symptomatic flare-ups and periods of remission. Patient-centered care (PCC) aligns patients’ lifestyle goals with their preferences for managing symptoms and side effects through the selection of therapies appropriate for disease management. Mobile health (mHealth) apps have the potential to engage and activate patients in PCC. mHealth apps can provide features that increase disease knowledge, collect patient-generated health indicators and behavioral metrics, and highlight goals for disease management. However, little evidence-based guidance exists as to which apps contain functionality essential for supporting the delivery of PCC. Objective: The objective of this study was to evaluate the patient-centeredness of United States–based rheumatoid arthritis mobile apps in terms of patient engagement and activation. Methods: A search of mobile apps on 2 major United States app stores (Apple App Store and Google Play) was conducted from June 2020 to July 2021 to identify apps designed for use by patients with RA by adapting the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines for mobile health app screening based on the literature. Reviewers conducted a content analysis of mobile app features to evaluate their functionality for patient engagement and activation. Engagement and activation were assessed using the Mobile Application Rating Scale (MARS) and social cognitive theory, respectively. Apps were ranked by their ability to facilitate PCC care along 2 dimensions: engagement and activation. Results: A total of 202 mobile apps were initially identified, and 20 remained after screening. Two apps emerged with the greatest ability to facilitate PCC. Both apps were scored as having acceptable or good patient engagement according to the MARS. These 2 apps also had high patient activation according to social cognitive theory, with many features within those apps representing theoretical constructs such as knowledge, perceived self-efficacy, and expectations about outcomes that support behavioral management of RA. Conclusions: We found very few mobile apps available within the United States that have functionality that both engages and activates the patient to facilitate PCC. As the prevalence of mobile apps expands, the design of mobile apps needs to integrate patients to ensure that their functionality promotes engagement and activation. More research is needed to understand how mobile app use impacts patient engagement and activation, and ultimately, treatment decisions and disease trajectory. %M 36469397 %R 10.2196/39881 %U https://mhealth.jmir.org/2022/12/e39881 %U https://doi.org/10.2196/39881 %U http://www.ncbi.nlm.nih.gov/pubmed/36469397 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 12 %P e40713 %T A Smartphone-Based Intervention for Anxiety and Depression in Racially and Ethnically Diverse Adults (EASE): Protocol for a Randomized Controlled Trial %A Garey,Lorra %A Zvolensky,Michael J %A Gallagher,Matthew W %A Vujanovic,Anka %A Kendzor,Darla E %A Stephens,Lancer %A Cheney,Marshall K %A Cole,Ashley B %A Kezbers,Krista %A Matoska,Cameron T %A Robison,Jillian %A Montgomery,Audrey %A Zappi,Christopher V %A Businelle,Michael S %+ Department of Psychology, University of Houston, Fred J. Heyne Building, Suite 104, 3695 Cullen Blvd, Houston, TX, 77204, United States, 1 713 743 8056, llgarey@uh.edu %K COVID-19 %K just-in-time adaptive intervention %K anxiety %K depression %K mHealth %K minority populations %K death %K behavioral %K care %K mobile application %K app %K public health %K symptoms %K risk %D 2022 %7 5.12.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Clear health disparities have emerged in the rates of COVID-19 exposure, hospitalization, and death among Black, Hispanic, and American Indian (BHAI) individuals, relative to non-Hispanic White (NHW) individuals. BHAI populations have been disproportionately affected by lower behavioral health access and heightened negative mental health outcomes during the pandemic. Objective: This project directly addresses health disparities in access to behavioral health care during the COVID-19 pandemic among BHAI populations via an adaptation of the established, initially validated, low-cost, mobile app Easing Anxiety Sensitivity for Everyone (EASE) among individuals with symptoms of elevated anxiety or depression or both. Methods: The EASE trial is a 2-arm, prospective, randomized, blinded-assessor study with intention-to-treat analysis. Participants (N=800; n=200, 25%, Black; n=200, 25%, Hispanic; n=200, 25%, American Indian; and n=200, 25%, NHW) are randomized to receive either EASE or an active comparison condition for anxiety and depression. Participants compete an online prescreener, an enrollment call to provide informed consent, a baseline survey, a 6-month intervention period, and 3- and 6-month postbaseline assessments. Select participants also complete a 3- and 6-month postbaseline qualitative interview via phone or an online platform (eg, Zoom). Participants complete 2 scheduled daily ecological momentary assessments (EMAs) during the 6-month study period. These twice-daily EMAs guide a just-in-time approach to immediate, personalized behavioral health care. Results: Outcomes include reductions in anxiety and depressive symptoms and functional impairment at 3 and 6 months postrandomization. We also will examine putative mechanisms (eg, anxiety sensitivity [AS] and COVID-19–specific stress and fear) of the intervention effects. Further, as treatment effects may differ across sociocultural factors, perceived discrimination, social support, and socioeconomic status (SES) will be evaluated as potential moderators of treatment effects on the primary outcomes. Process evaluation using data collected during the study, as well as individual interviews with participants, will complement quantitative data. Conclusions: Data from this efficacy trial will determine whether EASE successfully improves symptoms of anxiety and depression and whether these improvements outperform an active comparison control app. If successful, findings from this study have the potential to decrease anxiety and depression symptoms among vulnerable populations determined to be most at risk of exacerbated, long-lasting negative health sequelae. Data from this study may be used to support an implementation and dissemination trial of EASE within real-world behavioral health and social service settings. Trial Registration: ClinicalTrials.gov NCT05074693; https://clinicaltrials.gov/ct2/show/NCT05074693 International Registered Report Identifier (IRRID): DERR1-10.2196/40713 %M 36409958 %R 10.2196/40713 %U https://www.researchprotocols.org/2022/12/e40713 %U https://doi.org/10.2196/40713 %U http://www.ncbi.nlm.nih.gov/pubmed/36409958 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 12 %P e39238 %T Collective Action for Wellness in the Malaysian Workplace: Protocol for a Feasibility Study %A Thai,Janus Y %A McCaffrey,Tracy %A Ramadas,Amutha %A Chandrasekara,Dharshani %A Koh,Sharon G M %A Choi,Tammie Suet Ting %A Malini,Hema %A Xie,Jue %A Olivier,Patrick %A Md Zain,Anuar Zaini %A Watterson,Jessica %+ Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor, Subang Jaya, 47500, Malaysia, 60 355146000, jessica.watterson@monash.edu %K workplace wellness %K healthy behaviours %K chronic diseases %K digital health %K Malaysia %K wellness %K workplace %K disease %K digital wellness %K digital %K promote %K health knowledge %K diet %K employee %K mobile device %K intervention %K social %K social group %D 2022 %7 5.12.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic diseases and the associated risk factors are preventable with lifestyle changes such as eating a healthier diet and being more physically active. In Malaysia, the prevalence of chronic diseases, including diabetes, hypertension, and heart diseases, has risen. In the present study, we explore the potential of co-designing and implementing a digital wellness intervention to promote socially-driven health knowledge and practices in the workplace in Malaysia, drawing on social cognitive theory, social impact theory, and social influence theory. Objective: This study aims to co-design and assess the feasibility of a socially-driven digital health intervention to promote healthy behavior and prevent chronic diseases in a workplace in Malaysia. Methods: This study involves two phases: (i) identifying the barriers and facilitators to healthy behaviors at work and co-designing the intervention activities with the employees, (ii) implementing and evaluating the intervention’s feasibility. Phase 1 will involve qualitative data collection and analysis through semi-structured, in-depth interviews and co-design workshops with the employees, while Phase 2 will consist of a feasibility study employing quantitative measurements of health behaviors through accelerometers and questionnaires. Results: This study was funded in June 2021 and ethics approval for Phase 1 was obtained from the Monash University Human Research Ethics Committee in January 2022. As of August 2022, qualitative interviews with 12 employees have been completed and the data has been transcribed and analyzed. These results will be published in a future paper with results from all Phase 1 activities. Conclusions: The study will help us to better understand the mechanisms through which digital technologies can promote socially-driven health knowledge and behaviors. This research will also result in a scalable wellness intervention that could be further tailored and expanded to other employers and social groups across the region. International Registered Report Identifier (IRRID): PRR1-10.2196/39238 %M 36469407 %R 10.2196/39238 %U https://www.researchprotocols.org/2022/12/e39238/ %U https://doi.org/10.2196/39238 %U http://www.ncbi.nlm.nih.gov/pubmed/36469407 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 12 %P e39593 %T Effectiveness of mHealth Interventions in the Control of Lifestyle and Cardiovascular Risk Factors in Patients After a Coronary Event: Systematic Review and Meta-analysis %A Cruz-Cobo,Celia %A Bernal-Jiménez,María Ángeles %A Vázquez-García,Rafael %A Santi-Cano,María José %+ Faculty of Nursing and Physiotherapy, University of Cádiz, Av. Ana de Viya, 52, Cádiz, 11009, Spain, 34 956 019042 ext 9042, mariajose.santi@uca.es %K coronary disease %K acute coronary syndrome %K mobile health %K smartphone %K mobile apps %K mobile phone %D 2022 %7 2.12.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Coronary artery disease is the main cause of death and loss of disability-adjusted life years worldwide. Information and communication technology has become an important part of health care systems, including the innovative cardiac rehabilitation services through mobile phone and mobile health (mHealth) interventions. Objective: In this study, we aimed to determine the effectiveness of different kinds of mHealth programs in changing lifestyle behavior, promoting adherence to treatment, and controlling modifiable cardiovascular risk factors and psychosocial outcomes in patients who have experienced a coronary event. Methods: A systematic review of the literature was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A thorough search of the following biomedical databases was conducted: PubMed, Embase, Web of Science, SciELO, CINAHL, Scopus, The Clinical Trial, and Cochrane. Articles that were randomized clinical trials that involved an intervention consisting of an mHealth program using a mobile app in patients after a coronary event were included. The articles analyzed some of the following variables as outcome variables: changes in lifestyle behavior, cardiovascular risk factors, and anthropometric and psychosocial variables. A meta-analysis of the variables studied was performed with the Cochrane tool. The risk of bias was assessed using the Cochrane Collaboration tool; the quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation tool; and heterogeneity was measured using the I2 test. Results: A total of 23 articles were included in the review, and 20 (87%) were included in the meta-analysis, with a total sample size of 4535 patients. Exercise capacity measured using the 6-minute walk test (mean difference=21.64, 95% CI 12.72-30.55; P<.001), physical activity (standardized mean difference [SMD]=0.42, 95% CI 0.04-0.81; P=.03), and adherence to treatment (risk difference=0.19, 95% CI 0.11-0.28; P<.001) were significantly superior in the mHealth group. Furthermore, both the physical and mental dimensions of quality of life were better in the mHealth group (SMD=0.26, 95% CI 0.09-0.44; P=.004 and SMD=0.27, 95% CI 0.06-0.47; P=.01, respectively). In addition, hospital readmissions for all causes and cardiovascular causes were statistically higher in the control group than in the mHealth group (SMD=–0.03, 95% CI –0.05 to –0.00; P=.04 vs SMD=–0.04, 95% CI –0.07 to –0.00; P=.05). Conclusions: mHealth technology has a positive effect on patients who have experienced a coronary event in terms of their exercise capacity, physical activity, adherence to medication, and physical and mental quality of life, as well as readmissions for all causes and cardiovascular causes. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42022299931; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=299931 %M 36459396 %R 10.2196/39593 %U https://mhealth.jmir.org/2022/12/e39593 %U https://doi.org/10.2196/39593 %U http://www.ncbi.nlm.nih.gov/pubmed/36459396 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 12 %P e38649 %T Preliminary Use and Outcome Data of a Digital Home Exercise Program for Back, Hip, and Knee Pain: Retrospective Observational Study With a Time Series and Matched Analysis %A Teepe,Gisbert Wilhelm %A Kowatsch,Tobias %A Hans,Felix Patricius %A Benning,Leo %+ University Emergency Center, Medical Center - University of Freiburg, Sir-Hans-A-Krebs-Strasse, Freiburg, 79106, Germany, 49 76127033266, leo.benning@uniklinik-freiburg.de %K digital health %K home exercise %K musculoskeletal conditions %K digital intervention %K exercise %K physical activity %K smartphone %K pain %K management %K back pain %K hip pain %K knee pain %K mobility %K intervention %D 2022 %7 2.12.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Musculoskeletal conditions are among the main contributors to the global burden of disease. International guidelines consider patient education and movement exercises as the preferred therapeutic option for unspecific and degenerative musculoskeletal conditions. Innovative and decentralized therapeutic means are required to provide access to and availability of such care to meet the increasing therapeutic demand for this spectrum of conditions. Objective: This retrospective observational study of preliminary use and outcome data explores the clinical outcomes of Vivira (hereafter referred to as “program”), a smartphone-based program for unspecific and degenerative pain in the back, hip, and knee before it received regulatory approval for use in the German statutory health insurance system. Methods: An incomplete matched block design was employed to assess pain score changes over the intended 12-week duration of the program. Post hoc analyses were performed. In addition, a matched comparison of self-reported functional scores and adherence rates is presented. Results: A total of 2517 participants met the inclusion criteria and provided sufficient data to be included in the analyses. Overall, initial self-reported pain scores decreased significantly from an average of 5.19 out of 10 (SD 1.96) to an average of 3.35 out of 10 (SD 2.38) after 12 weeks. Post hoc analyses indicate a particularly emphasized pain score reduction over the early use phases. Additionally, participants with back pain showed significant improvements in strength and mobility scores, whereas participants with hip or knee pain demonstrated significant improvements in their coordination scores. Across all pain areas and pain durations, a high yet expected attrition rate could be observed. Conclusions: This observational study provides the first insights into the clinical outcomes of an exercise program for unspecific and degenerative back, hip, and knee pain. Furthermore, it demonstrates a potential secondary benefit of improved functionality (ie, strength, mobility, coordination). However, as this study lacks confirmatory power, further research is required to substantiate the clinical outcomes of the program assessed. Trial Registration: German Clinical Trials Register DRKS00021785; https://drks.de/search/en/trial/DRKS00021785 %M 36459399 %R 10.2196/38649 %U https://mhealth.jmir.org/2022/12/e38649 %U https://doi.org/10.2196/38649 %U http://www.ncbi.nlm.nih.gov/pubmed/36459399 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e40123 %T Low– and Medium–Socioeconomic-Status Group Members’ Perceived Challenges and Solutions for Healthy Nutrition: Qualitative Focus Group Study %A Hermsen,Sander %A van Kraaij,Alex %A Camps,Guido %+ OnePlanet Research Center, Bronland 10, Wageningen, 6708 WH, Netherlands, 31 317 791 009, sander.hermsen@imec.nl %K nutrition %K citizen science %K socioeconomic status %K digital technology %D 2022 %7 2.12.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Although digital tools for healthy nutrition have shown great potential, their actual impact remains variable as digital solutions often do not fit users’ needs and barriers. This is especially poignant for priority communities in society. Involving these groups in citizen science may have great benefits even beyond the increase in knowledge of the lives and experiences of these groups. However, this requires specialized skills. Participants from priority groups could benefit from an approach that offers sensitization and discussion to help them voice their needs regarding healthy nutrition and technology to support healthy eating. Objective: This study aimed to gather insights into people’s thoughts on everyday eating practices, self-regulation in healthy eating, and skill acquisition and on applying technological innovations to these domains. Methods: Participants answered 3 daily questionnaires to garner their current practices regarding habits, self-regulation, skills, and technology use surrounding healthy eating and make it easier for them to collect their thoughts and experiences (sensitization). Within a week of filling out the 3 questionnaires, participants took part in a web-based focus group discussion session. All sessions were transcribed and analyzed using a thematic qualitative approach. Results: A total of 42 people took part in 7 focus group interviews of 6 people each. The analysis showed that participants would like to receive support from technology for a broad range of aspects of nutrition, such as measuring the effect their personal nutrition has on their individual health, providing them with reliable product information, giving them practical guidance for healthy eating and snacking, and reducing the burden of registering food intake. Technology should be easy to use, reduce burdens, and be tailored to personal situations. Privacy and cost were major concerns for the participants. Conclusions: This study shows that people from low– and medium–socioeconomic-status groups have a need for specific support in tailoring their knowledge of healthy nutrition to their own situation and see technology as a means to achieve this. %M 36459403 %R 10.2196/40123 %U https://humanfactors.jmir.org/2022/4/e40123 %U https://doi.org/10.2196/40123 %U http://www.ncbi.nlm.nih.gov/pubmed/36459403 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e39501 %T The Relationship Between the Big Five Personality Traits and the Theory of Planned Behavior in Using Mindfulness Mobile Apps: Cross-sectional Survey %A Kim,Sunghak %A Park,Jin Young %A Chung,Kyungmi %+ Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Yonsei University Health System, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 10 4234 3442, chungkyungmi@yuhs.ac %K personality traits %K Theory of Planned Behavior %K mindfulness %K mobile apps %K mental health %D 2022 %7 30.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Mindfulness has emerged as a promising approach toward improving mental health. Interest in mindfulness mobile app services has also increased in recent years. Understanding the determinants of mindfulness behavior is essential to predict people’s utilization of mindfulness mobile apps and beneficial for developing and implementing relevant intervention strategies. Nevertheless, little has been done to determine the predictors of mindfulness behavior. Objective: This study investigates the association between the Big Five personality traits and the Theory of Planned Behavior (TPB) variables in the context of using mindfulness mobile apps to explore the potential indirect effects of conscientiousness and neuroticism on people’s behavioral intention for mindfulness, mediated by their attitude toward mindfulness, subjective norm about mindfulness, and perceived behavior control over mindfulness. Methods: The authors conducted an online, cross-sectional survey in December 2021. Structural equation modeling was conducted to evaluate the overall model fit and test possible linkages among conscientiousness, neuroticism, attitude toward mindfulness, subjective norm about mindfulness, perceived behavior control over mindfulness, and behavioral intention for mindfulness. Bootstrapping mediation analyses were also conducted to test the potential mediating effect in the model. Results: A total of 297 Korean participants’ responses (153 males and 144 females) were analyzed. The proposed model had a good fit. Conscientiousness was correlated with attitude toward mindfulness (β=.384, P<.001), subjective norm about mindfulness (β=.249, P<.001), and perceived behavior control over mindfulness (β=.443, P<.001). Neuroticism was not correlated with attitude toward mindfulness (β=−.072, P=.28), but was correlated with subjective norm about mindfulness (β=.217, P=.003) and perceived behavior control over mindfulness (β=−.235, P<.001). Attitude toward mindfulness (β=.508, P<.001), subjective norm about mindfulness (β=.132, P=.01), and perceived behavior control over mindfulness (β=.540, P<.001) were separately correlated with behavioral intention for mindfulness. Conscientiousness was not directly correlated with behavioral intention for mindfulness (β=−.082, P=.27), whereas neuroticism was directly correlated with behavioral intention for mindfulness (β=.194, P=.001). Conscientiousness was indirectly linked with behavioral intention for mindfulness through attitude toward mindfulness (B=0.171, 95% CI 0.103-0.251) and perceived behavior control over mindfulness (B=0.198, 95% CI 0.132-0.273) but not through subjective norm about mindfulness (B=0.023, 95% CI −0.002 to 0.060). Neuroticism was indirectly linked with behavioral intention for mindfulness via perceived behavior control over mindfulness (B=−0.138, 95% CI −0.197 to −0.088) but not via subjective norm about mindfulness (B=0.021, 95% CI −0.002 to 0.059). Conclusions: The results show that the integration of the Big Five personality traits and TPB constructs is useful in predicting the use of mindfulness mobile apps. Focusing on conscientiousness and neuroticism in developing information dissemination and implementation strategies for enhancing mindfulness behavior using mobile apps may lead to the successful promotion of mindfulness mobile apps and adherence to mindfulness techniques. %M 36449344 %R 10.2196/39501 %U https://www.jmir.org/2022/11/e39501 %U https://doi.org/10.2196/39501 %U http://www.ncbi.nlm.nih.gov/pubmed/36449344 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e37684 %T Examining Use Behavior of a Goal-Supporting mHealth App in Primary Care Among Patients With Multiple Chronic Conditions: Qualitative Descriptive Study %A Tahsin,Farah %A Austin,Tujuanna %A McKinstry,Brian %A Mercer,Stewart W %A Loganathan,Mayura %A Thavorn,Kednapa %A Upshur,Ross %A Steele Gray,Carolyn %+ Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada, 1 647 825 4684, farah.tahsin@mail.utoronto.ca %K mobile health %K mHealth %K multimorbidity %K chronic disease management %K goal-oriented care %K multimorbid %K app %K primary care %K telemedicine %K use %K usability %K human factors %K behavior %K sociobehavioral %K health technology %K mobile phone %D 2022 %7 30.11.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Although mobile health (mHealth) apps are increasingly being used to support patients with multiple chronic conditions (multimorbidity), most mHealth apps experience low interaction and eventual abandonment. To tackle this engagement issue, when developing an mHealth program, it is important to understand the social-behavioral factors that affect patients’ use behavior. Objective: The aim of this study was to explore the social and behavioral factors contributing to patients’ use behavior of an mHealth app called the electronic Patient-Reported Outcome (ePRO). The ePRO app supports goal-oriented care delivery in interdisciplinary primary care models. Methods: A descriptive qualitative study was used to analyze interview data collected for a larger mixed methods pragmatic trial. The original 15-month trial was conducted in 6 primary care teams across Ontario, Canada, between 2018 and 2019. The eligibility criteria for patients were being aged ≥60 years with ≥10 visits within the previous 12 months of study enrollment. For this analysis, patients were classified as long-term or short-term users based on their length of use of the ePRO app during the trial. The Social Cognitive Theory by Bandura was used to categorize social-behavioral factors that contributed to patients’ decision to continue or discontinue using the app. Results: The patient-provider relationship emerged as a key factor that shaped patients’ experiences with the app and subsequent decision to continue using the app. Other factors that contributed to patients’ decision to continue using the app were personal and social circumstances, perceived usefulness, patients’ previous experience with goal-related behaviors, and confidence in one’s capability. There was an overlap of experience between long- and short-term app users but, in general, long-term users perceived the app to be more useful and their goals to be more meaningful than short-term app users. This observation was complicated by the fact that patient health-related goals were dynamic and changed over time. Conclusions: Complex patients’ use behavior of a goal-supporting mHealth app is shaped by an array of sociobehavioral factors that can evolve. To tackle this dynamism, there should be an emphasis on creating adaptable health technologies that are easily customizable by patients and able to respond to their changing contexts and needs. Trial Registration: ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954 %M 36449335 %R 10.2196/37684 %U https://humanfactors.jmir.org/2022/4/e37684 %U https://doi.org/10.2196/37684 %U http://www.ncbi.nlm.nih.gov/pubmed/36449335 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e33952 %T Fitbits for Monitoring Depressive Symptoms in Older Aged Persons: Qualitative Feasibility Study %A Mughal,Fiza %A Raffe,William %A Stubbs,Peter %A Kneebone,Ian %A Garcia,Jaime %+ Faculty of Engineering and IT, University of Technology Sydney, 15 Broadway, Ultimo, Sydney, 2007, Australia, 61 4 5262 7824, fiza.mughal@uts.edu.au %K digital mental health %K Fitbit %K smartwatch %K smart wearable %K geriatric %K aging %K health informatics %K feasibility %K usability %K older aged %D 2022 %7 29.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In 2022, an estimated 1.105 billion people used smart wearables and 31 million used Fitbit devices worldwide. Although there is growing evidence for the use of smart wearables to benefit physical health, more research is required on the feasibility of using these devices for mental health and well-being. In studies focusing on emotion recognition, emotions are often inferred and dependent on external cues, which may not be representative of true emotional states. Objective: The aim of this study was to evaluate the feasibility and acceptability of using consumer-grade activity trackers for apps in the remote mental health monitoring of older aged people. Methods: Older adults were recruited using criterion sampling. Participants were provided an activity tracker (Fitbit Alta HR) and completed weekly online questionnaires, including the Geriatric Depression Scale, for 4 weeks. Before and after the study period, semistructured qualitative interviews were conducted to provide insight into the acceptance and feasibility of performing the protocol over a 4-week period. Interview transcripts were analyzed using a hybrid inductive-deductive thematic analysis. Results: In total, 12 participants enrolled in the study, and 9 returned for interviews after the study period. Participants had positive attitudes toward being remotely monitored, with 78% (7/9) of participants experiencing no inconvenience throughout the study period. Moreover, 67% (6/9) were interested in trialing our prototype when it is implemented. Participants stated they would feel more comfortable if mental well-being was being monitored by carers remotely. Conclusions: Fitbit-like devices were an unobtrusive and convenient tool to collect physiological user data. Future research should integrate physiological user inputs to differentiate and predict depressive tendencies in users. %M 36268552 %R 10.2196/33952 %U https://formative.jmir.org/2022/11/e33952 %U https://doi.org/10.2196/33952 %U http://www.ncbi.nlm.nih.gov/pubmed/36268552 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e37954 %T Digital Phenotyping Data to Predict Symptom Improvement and App Personalization: Protocol for a Prospective Study %A Currey,Danielle %A Torous,John %+ School of Medicine, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106, United States, 1 617 667 6700, jtorous@gmail.com %K digital phenotyping %K digital phenotype %K mental health %K depression %K anxiety %K smartphone %K app %K college student %K university student %K young adult %K engagement %K digital health %K mobile health %K mHealth %K health app %K Technology Acceptance Model %K adoption %D 2022 %7 29.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smartphone apps that capture surveys and sensors are increasingly being leveraged to collect data on clinical conditions. In mental health, this data could be used to personalize psychiatric support offered by apps so that they are more effective and engaging. Yet today, few mental health apps offer this type of support, often because of challenges associated with accurately predicting users’ actual future mental health. Objective: In this protocol, we present a study design to explore engagement with mental health apps in college students, using the Technology Acceptance Model as a theoretical framework, and assess the accuracy of predicting mental health changes using digital phenotyping data. Methods: There are two main goals of this study. First, we present a logistic regression model fit on data from a prior study on college students and prospectively test this model on a new student cohort to assess its accuracy. Second, we will provide users with data-driven activity suggestions every 4 days to determine whether this type of personalization will increase engagement or attitudes toward the app compared to those receiving no personalized recommendations. Results: The study was completed in the spring of 2022, and the manuscript is currently in review at JMIR Publications. Conclusions: This is one of the first digital phenotyping algorithms to be prospectively validated. Overall, our results will inform the potential of digital phenotyping data to serve as tailoring data in adaptive interventions and to increase rates of engagement. International Registered Report Identifier (IRRID): PRR1-10.2196/37954 %M 36445745 %R 10.2196/37954 %U https://www.researchprotocols.org/2022/11/e37954 %U https://doi.org/10.2196/37954 %U http://www.ncbi.nlm.nih.gov/pubmed/36445745 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 4 %P e40366 %T The Use of Information and Communication Technology–Based Self-management System DialBeticsLite in Treating Abdominal Obesity in Japanese Office Workers: Prospective Single-Arm Pilot Intervention Study %A Kawai,Yuki %A Waki,Kayo %A Yamaguchi,Satoko %A Shibuta,Tomomi %A Miyake,Kana %A Kimura,Shigeko %A Toyooka,Tsuguyoshi %A Nakajima,Ryo %A Uneda,Kazushi %A Wakui,Hiromichi %A Tamura,Kouichi %A Nangaku,Masaomi %A Ohe,Kazuhiko %+ Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan, 81 70857985897, kwaki-tky@m.u-tokyo.ac.jp %K abdominal obesity %K self-management %K telemedicine %K mobile phone %D 2022 %7 28.11.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: Making lifestyle changes is an essential element of abdominal obesity (AO) reduction. To support lifestyle modification and self-management, we developed an information and communication technology–based self-management system—DialBeticsLite—with a fully automated dietary evaluation function for the treatment of AO. Objective: The objective of this study was to evaluate the preliminary efficacy and feasibility of DialBeticsLite among Japanese office workers with AO. Methods: A 2- to 3-month prospective single-arm pilot intervention study was designed to assess the effects of the intervention using DialBeticsLite. The information and communication technology system was composed of 4 modules: data transmission (body weight, blood pressure, blood glucose, and pedometer count); data evaluation; exercise input; and food recording and dietary evaluation. Eligible participants were workers who were aged ≥20 years and with AO (waist circumference ≥85 cm for men and ≥90 cm for women). Physical parameters, blood tests, nutritional intake, and self-care behavior were compared at baseline and after the intervention. Results: A total of 48 participants provided completed data for analysis, which yielded a study retention rate of 100%. The average age was 46.8 (SD 6.8) years, and 92% (44/48) of participants were male. The overall average measurement rate of DialBeticsLite, calculated by dividing the number of days with at least one measurement by the number of days of the intervention, was 98.6% (SD 3.4%). In total, 85% (41/48) of the participants reported that their participation in the study helped them to improve their lifestyle. BMI, waist circumference, and visceral fat area decreased significantly after the intervention (P<.001). In addition, the daily calorie intake reduced significantly (P=.02). There was a significant improvement in self-care behavior in terms of exercise and diet (P=.001). Conclusions: Using DialBeticsLite was shown to be a feasible and potentially effective method for reducing AO by providing users with a motivational framework to evaluate their lifestyle behaviors. %M 36441577 %R 10.2196/40366 %U https://diabetes.jmir.org/2022/4/e40366 %U https://doi.org/10.2196/40366 %U http://www.ncbi.nlm.nih.gov/pubmed/36441577 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e37552 %T Assessing the Content and Quality of Digital Tools for Managing Gestational Weight Gain: Systematic Search and Evaluation %A Brammall,Bonnie R %A Garad,Rhonda M %A Boyle,Jacqueline A %A Hayman,Melanie J %A de Jersey,Susan J %A Teede,Helena J %A Hong,Quoc V %A Carrandi,Alayna %A Harrison,Cheryce L %+ Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Kanooka Grove, Clayton, 3168, Australia, 61 3 8572 2662, cheryce.harrison@monash.edu %K digital %K gestational %K weight %K tracking %K pregnancy %D 2022 %7 25.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health resources have the potential to assist women in optimizing gestational weight gain (GWG) during pregnancy to improve maternal health outcomes. Objective: In this study, we aimed to evaluate the quality and behavior change potential of publicly available digital tools (websites and apps) that facilitate GWG tracking. Methods: Digital tools were identified using key search terms across website search engines and app stores and evaluated using the Mobile App Rating Scale, the App Behavior Change Scale, as well as criteria to evaluate the rigor and safety of GWG information. Results: Overall, 1085 tools were screened for inclusion (162 websites and 923 apps), and 19 were deemed eligible. The mean Mobile App Rating Scale quality score was 3.31 (SD 0.53) out of 5, ranging from 2.26 to 4.39, and the mean App Behavior Change Scale score was 6 (SD 3.4) out of 21, ranging from 19 to 0. Of the 19 items used to evaluate rigor of GWG advice, most tools (n=11, 57.9%) contained ≤3 items. Conclusions: This review emphasizes the substantial limitations in current digital resources promoting the monitoring and optimization of GWG. Most tools were of low quality, had minimal behavior change potential, and were potentially unsafe, with minimal linkage to evidence-based information or partnership with health care. %M 36427237 %R 10.2196/37552 %U https://www.jmir.org/2022/11/e37552 %U https://doi.org/10.2196/37552 %U http://www.ncbi.nlm.nih.gov/pubmed/36427237 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e41489 %T How to Use the Six-Step Digital Ethnography Framework to Develop Buyer Personas: The Case of Fan Fit %A Fenton,Alex %A Heinze,Aleksej %A Osborne,McVal %A Ahmed,Wasim %+ Management School, University of Stirling, Stirling, FK9 4LA, United Kingdom, 44 1786 467, Wasim.Ahmed@Stirling.ac.uk %K health tracking %K digital %K ethnography %K apps %K mobile app %K customer %K physical activity %D 2022 %7 25.11.2022 %9 Viewpoint %J JMIR Form Res %G English %X Background: One of the key features of digital marketing is customer centricity, which can be applied to the domain of health. This is expressed through the ability to target specific customer segments with relevant content using appropriate channels and having data to track and understand each interaction. In order to do this, marketers create buyer personas based on a wide spectrum of quantitative and qualitative data. Digital ethnography is another established method for studying web-based communities. However, for practitioners, the complexity, rigor, and time associated with ethnographical work are sometimes out of reach. Objective: This paper responds to the gaps in the practically focused method of using social media for digital ethnography to develop buyer personas. This paper aims to demonstrate how digital ethnography can be used as a way to create and refine buyer personas. Methods: Using a case study of the Fan Fit smartphone app, which aimed to increase physical activity, a digital ethnography was applied to create a better understanding of customers and to create and refine buyer personas. Results: We propose two buyer personas, and we develop a 6-step digital ethnography framework designed for the development of buyer personas. Conclusions: The key contribution of this work is the proposal of a 6-step digital ethnography framework designed for the development of buyer personas. We highlight that the 6-step digital ethnography could be a robust tool for practitioners and academicians to analyze digital communications for the process of creating and updating data-driven buyer personas to create deeper insights into digital and health marketing efforts. %M 36427232 %R 10.2196/41489 %U https://formative.jmir.org/2022/11/e41489 %U https://doi.org/10.2196/41489 %U http://www.ncbi.nlm.nih.gov/pubmed/36427232 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e39322 %T Analyzing Person-Place Interactions During Walking Episodes: Innovative Ambulatory Assessment Approach of Walking-Triggered e-Diaries %A Kanning,Martina %A Bollenbach,Lukas %A Schmitz,Julian %A Niermann,Christina %A Fina,Stefan %+ Department of Sport Science, University of Konstanz, Universitätsstraße 10, Konstanz, 78464, Germany, 49 7531 883651, martina.kanning@uni-konstanz.de %K ecological momentary assessment %K active transport %K socio-ecological model %K subjective well-being %K mental health %K urban health %K GEMA %K geographically explicit ecological momentary assessment %K behaviour change %K walking %K experience %K environment %K monitoring %K activity %K tracking %K e-diary %K assessment %D 2022 %7 25.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Walking behavior is positively associated with physiological and mental health as much evidence has already shown. Walking is also becoming a critical issue for health promotion in urban environments as it is the most often used form of active mobility and helps to replace carbon dioxide emissions from motorized forms of transport. It therefore contributes to mitigate the negative effects of climate change and heat islands within cities. However, to promote walking among urban dwellers and to utilize its health-enhancing potential, we need to know more about the way in which physical and social environments shape individual experiences during walking episodes. Such person-place interactions could not adequately be analyzed in former studies owing to methodological constraints. Objective: This study introduces walking-triggered e-diaries as an innovative ambulatory assessment approach for time-varying associations, and investigates its accuracy with 2 different validation strategies. Methods: The walking trigger consists of a combination of movement acceleration via an accelerometer and mobile positioning of the cellphone via GPS and transmission towers to track walking activities. The trigger starts an e-diary whenever a movement acceleration exceeds a predetermined threshold and participants' locations are identified as nonstationary outside a predefined place of residence. Every 420 (±300) seconds, repeated e-diaries were prompted as long as the trigger conditions were met. Data were assessed on 10 consecutive days. First, to investigate accuracy, we reconstructed walking routes and calculated a percentage score for all triggered prompts in relation to all walking routes where a prompt could have been triggered. Then, to provide data about its specificity, we used momentary self-reports and objectively assessed movement behavior to describe activity levels before the trigger prompted an e-diary. Results: Data of 67 participants could be analyzed and the walking trigger led to 3283 e-diary prompts, from which 2258 (68.8%) were answered. Regarding accuracy, the walking trigger prompted an e-diary on 732 of 842 (86.9%) reconstructed walking routes. Further, in 838 of 1206 (69.5%) triggered e-diaries, participants self-reported that they were currently walking outdoors. Steps and acceleration movement was higher during these self-reported walking episodes than when participants denied walking outdoors (steps: 106 vs 32; acceleration>0.2 g in 58.4% vs 19% of these situations). Conclusions: Accuracy analysis revealed that walking-triggered e-diaries are suitable to collect different data of individuals' current experiences in situations in which a person walks outdoors. Combined with environmental data, such an approach increases knowledge about person-place interactions and provides the possibility to gain knowledge about user preferences for health-enhancing urban environments. From a methodological viewpoint, however, specificity analysis showed how changes in trigger conditions (eg, increasing the threshold for movement acceleration) lead to changes in accuracy. %M 36427231 %R 10.2196/39322 %U https://formative.jmir.org/2022/11/e39322 %U https://doi.org/10.2196/39322 %U http://www.ncbi.nlm.nih.gov/pubmed/36427231 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e30285 %T Identifying Personality Characteristics and Indicators of Psychological Well-Being Associated With Attrition in the Motivation Makes the Move! Physical Activity Intervention: Randomized Technology-Supported Trial %A Kaseva,Kaisa %A Tervaniemi,Mari %A Heikura,Enni %A Kostilainen,Kaisamari %A Pöyhönen-Alho,Maritta %A Shoemaker,J Kevin %A Petrella,Robert J %A Peltonen,Juha E %+ Department of Sport and Exercise Medicine, Clinicum, Faculty of Medicine, University of Helsinki, Alppikatu 2, Helsinki, 00530, Finland, 358 443077737, kaisa.kaseva@helsinki.fi %K randomized trial %K physical activity %K lifestyles %K personality %K psychological well-being %K study attrition %K mental health %K lifestyle interventions %D 2022 %7 25.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Data attrition has been a common problem in longitudinal lifestyle interventions. The contributors to attrition in technology-supported physical activity interventions have not been thoroughly studied. Objective: The present study examined the roles of personality characteristics and indicators of psychological well-being in data attrition within a technology-supported, longitudinal intervention study with overweight adults. Methods: Participants (N=89) were adults from the Motivation Makes the Move! intervention study. Data attrition was studied after a 3-month follow-up. Participants’ personality characteristics were studied using the Short Five self-report questionnaire. Psychological well-being indicators were assessed with the RAND 36-item health survey, Positive and Negative Affect Schedule, and Beck Depression Inventory. Logistic regression analyses were conducted to assess the risk of discontinuing the study. The analyses were adjusted for sex, age, study group, and educational status. Results: At the 3-month follow-up, 65 of 89 participants (73% of the initial sample) had continued in the study. Participants’ personality characteristics and indicators of psychological well-being were not associated with the risk of dropping out of the study (all P values >.05). The results remained the same after covariate controls. Conclusions: Participant attrition was not attributable to personality characteristics or psychological well-being in the Motivation Makes the Move! study conducted with overweight adults. As attrition remains a challenge within longitudinal, technology-supported lifestyle interventions, attention should be paid to the potentially dynamic natures of personality and psychological well-being, as well as other elements beyond these. Trial Registration: ClinicalTrials.gov NCT02686502; https://clinicaltrials.gov/ct2/show/NCT02686502 %M 36427239 %R 10.2196/30285 %U https://formative.jmir.org/2022/11/e30285 %U https://doi.org/10.2196/30285 %U http://www.ncbi.nlm.nih.gov/pubmed/36427239 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e41658 %T Outcomes of a Comprehensive Mobile Smoking Cessation Program With Nicotine Replacement Therapy in Adult Smokers: Pilot Randomized Controlled Trial %A Marler,Jennifer D %A Fujii,Craig A %A Utley,MacKenzie T %A Balbierz,Daniel J %A Galanko,Joseph A %A Utley,David S %+ Pivot Health Technologies Inc., 1010 Commercial St., Suite C, San Carlos, CA, 94070, United States, 1 4157577696, marler@pivot.co %K smoking cessation %K digital health %K smartphone %K digital sensor %K carbon monoxide %K breath sensor %K biofeedback %K mobile apps %K health promotion %K app %K mobile phone %D 2022 %7 24.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cigarette smoking remains the leading cause of preventable illness and death, underscoring ongoing need for evidence-based solutions. Pivot, a US Clinical Practice Guideline–based mobile smoking cessation program, comprises a personal carbon monoxide breath sensor; a smartphone app; in-app, text-based human-provided coaching; nicotine replacement therapy; and a moderated web-based community. Promising Pivot cohort studies have established the foundation for comparative assessment. Objective: This study aimed to compare engagement, retention, attitudes toward quitting smoking, smoking behavior, and participant feedback between Pivot and QuitGuide, a US Clinical Practice Guideline–based smoking cessation smartphone app from the National Cancer Institute. Methods: In this remote pilot randomized controlled trial, cigarette smokers in the United States were recruited on the web and randomized to Pivot or QuitGuide. Participants were offered 12 weeks of free nicotine replacement therapy. Data were self-reported via weekly web-based questionnaires for 12 weeks and at 26 weeks. Outcomes included engagement and retention, attitudes toward quitting smoking, smoking behavior, and participant feedback. The primary outcome was self-reported app openings at 12 weeks. Cessation outcomes included self-reported 7- and 30-day point prevalence abstinence (PPA), abstinence from all tobacco products, and continuous abstinence at 12 and 26 weeks. PPA and continuous abstinence were biovalidated via breath carbon monoxide samples. Results: Participants comprised 188 smokers (94 Pivot and 94 QuitGuide): mean age 46.4 (SD 9.2) years, 104 (55.3%) women, 128 (68.1%) White individuals, and mean cigarettes per day 17.6 (SD 9.0). Engagement via mean “total app openings through 12 weeks” (primary outcome) was Pivot, 157.9 (SD 210.6) versus QuitGuide, 86.5 (SD 66.3; P<.001). Self-reported 7-day PPA at 12 and 26 weeks was Pivot, 35% (33/94) versus QuitGuide, 28% (26/94; intention to treat [ITT]: P=.28) and Pivot, 36% (34/94) versus QuitGuide, 27% (25/94; ITT: P=.12), respectively. Self-reported 30-day PPA at 12 and 26 weeks was Pivot, 29% (27/94) versus QuitGuide, 22% (21/94; ITT: P=.32) and Pivot, 32% (30/94) versus QuitGuide, 22% (21/94; ITT: P=.12), respectively. The biovalidated abstinence rate at 12 weeks was Pivot, 29% (27/94) versus QuitGuide, 13% (12/94; ITT: P=.008). Biovalidated continuous abstinence at 26 weeks was Pivot, 21% (20/94) versus QuitGuide, 10% (9/94; ITT: P=.03). Participant feedback, including ease of setup, impact on smoking, and likelihood of program recommendation were favorable for Pivot. Conclusions: In this randomized controlled trial comparing the app-based smoking cessation programs Pivot and QuitGuide, Pivot participants had higher engagement and biovalidated cessation rates and more favorable user feedback at 12 and 26 weeks. These findings support Pivot as an effective, durable mobile smoking cessation program. Trial Registration: ClinicalTrials.gov NCT04955639; https://clinicaltrials.gov/ct2/show/NCT04955639 %M 36257323 %R 10.2196/41658 %U https://mhealth.jmir.org/2022/11/e41658 %U https://doi.org/10.2196/41658 %U http://www.ncbi.nlm.nih.gov/pubmed/36257323 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e40391 %T Wearable Activity Tracker Use and Physical Activity Among Informal Caregivers in the United States: Quantitative Study %A Mahmood,Asos %A Kim,Hyunmin %A Kedia,Satish %A Dillon,Patrick %+ School of Health Professions, The University of Southern Mississippi, 118 College Drive #5122, Hattiesburg, MS, 39406, United States, 1 6015969087, hyunmin.kim@usm.edu %K informal caregivers %K caregiving %K health and activity trackers %K wearables %K physical activity %K health-promoting behavior %K mobile phone %D 2022 %7 24.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With an increase in aging population and chronic medical conditions in the United States, the role of informal caregivers has become paramount as they engage in the care of their loved ones. Mounting evidence suggests that such responsibilities place substantial burden on informal caregivers and can negatively impact their health. New wearable health and activity trackers (wearables) are increasingly being used to facilitate and monitor healthy behaviors and to improve health outcomes. Although prior studies have examined the efficacy of wearables in improving health and well-being in the general population, little is known about their benefits among informal caregivers. Objective: This study aimed to examine the association between use of wearables and levels of physical activity (PA) among informal caregivers in the United States. Methods: We used data from the National Cancer Institute’s Health Information National Trends Survey 5 (cycle 3, 2019 and cycle 4, 2020) for a nationally representative sample of 1273 community-dwelling informal caregivers—aged ≥18 years, 60% (757/1273) female, 75.7% (990/1273) had some college or more in education, and 67.3% (885/1273) had ≥1 chronic medical condition—in the United States. Using jackknife replicate weights, a multivariable logistic regression was fit to assess an independent association between the use of wearables and a binary outcome: meeting or not meeting the current World Health Organization’s recommendation of PA for adults (≥150 minutes of at least moderate-intensity PA per week). Results: More than one-third (466/1273, 37.8%) of the informal caregivers met the recommendations for adult PA. However, those who reported using wearables (390/1273, 31.7%) had slightly higher odds of meeting PA recommendations (adjusted odds ratios 1.1, 95% CI 1.04-1.77; P=.04) compared with those who did not use wearables. Conclusions: The results demonstrated a positive association between the use of wearables and levels of PA among informal caregivers in the United States. Therefore, efforts to incorporate wearable technology into the development of health-promoting programs or interventions for informal caregivers could potentially improve their health and well-being. However, any such effort should address the disparities in access to innovative digital technologies, including wearables, to promote health equity. Future longitudinal studies are required to further support the current findings of this study. %M 36422886 %R 10.2196/40391 %U https://mhealth.jmir.org/2022/11/e40391 %U https://doi.org/10.2196/40391 %U http://www.ncbi.nlm.nih.gov/pubmed/36422886 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e40133 %T Health Tracking via Mobile Apps for Depression Self-management: Qualitative Content Analysis of User Reviews %A Polhemus,Ashley %A Simblett,Sara %A Dawe-Lane,Erin %A Gilpin,Gina %A Elliott,Benjamin %A Jilka,Sagar %A Novak,Jan %A Nica,Raluca Ileana %A Temesi,Gergely %A Wykes,Til %+ Merck Research Labs Information Technology, Merck, Sharpe, & Dohme, The Circle 66, Zurich, 8058, Switzerland, 41 762519453, polhemusam@gmail.com %K depression %K mental health %K health tracking %K self-management %K data visualization %K mobile phone %D 2022 %7 23.11.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Tracking and visualizing health data using mobile apps can be an effective self-management strategy for mental health conditions. However, little evidence is available to guide the design of mental health–tracking mechanisms. Objective: The aim of this study was to analyze the content of user reviews of depression self-management apps to guide the design of data tracking and visualization mechanisms for future apps. Methods: We systematically reviewed depression self-management apps on Google Play and iOS App stores. English-language reviews of eligible apps published between January 1, 2018, and December 31, 2021, were extracted from the app stores. Reviews that referenced health tracking and data visualization were included in sentiment and qualitative framework analyses. Results: The search identified 130 unique apps, 26 (20%) of which were eligible for inclusion. We included 783 reviews in the framework analysis, revealing 3 themes. Impact of app-based mental health tracking described how apps increased reviewers’ self-awareness and ultimately enabled condition self-management. The theme designing impactful mental health–tracking apps described reviewers’ feedback and requests for app features during data reporting, review, and visualization. It also described the desire for customization and contexts that moderated reviewer preference. Finally, implementing impactful mental health–tracking apps described considerations for integrating apps into a larger health ecosystem, as well as the influence of paywalls and technical issues on mental health tracking. Conclusions: App-based mental health tracking supports depression self-management when features align with users’ individual needs and goals. Heterogeneous needs and preferences raise the need for flexibility in app design, posing challenges for app developers. Further research should prioritize the features based on their importance and impact on users. %M 36416875 %R 10.2196/40133 %U https://humanfactors.jmir.org/2022/4/e40133 %U https://doi.org/10.2196/40133 %U http://www.ncbi.nlm.nih.gov/pubmed/36416875 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e41800 %T Efficacy of the Mental Health App “Intellect” to Improve Body Image and Self-compassion in Young Adults: A Randomized Controlled Trial With a 4-Week Follow-up %A Ong,Wen Yi %A Sündermann,Oliver %+ Department of Psychology, National University of Singapore, 9 Arts Link, Block AS4, Singapore, 117572, Singapore, 65 93571995, oliver@intellect.co %K body image %K body image program %K mobile health app %K mHealth app %K mobile-based interventions %K dissonance-based interventions %K self-compassion %D 2022 %7 21.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Body image concerns are prevalent among young adults, who may be vulnerable to developing body image concerns because of particular risk factors associated with this life period. With technological advancements, digital mobile health (mHealth) apps are cost-effective and scalable interventions. Thus, mHealth apps can be explored as a form of prevention effort to alleviate body image concerns in young adults. Objective: In this randomized controlled trial, we examined the effectiveness of a self-guided mHealth app in improving body image and self-compassion in a sample of university students. Methods: Participants (N=310) were randomized to a 9-day self-guided body image and self-compassion mHealth app (n=149) and to an active waitlist control group (n=161), where they completed a similarly structured 9-day program on cooperation. Both programs consisted of content learning and activities such as quizzes, with the number and length of activities matched for both programs. Measures were obtained at baseline, upon completion of the programs (after the intervention), and at 4-week follow-up. Results: The intervention group for female participants reported significant reduction in body dissatisfaction (P<.001) and improvements in body appreciation (P<.001) and self-compassion (P=.001) compared with the active waitlist control group after the intervention. Similarly, for male participants after the intervention, a significant reduction was found in the intervention group in body dissatisfaction (P<.001) after the intervention as well as improvements in body appreciation (P=.02) and self-compassion (P=.047). The effects were maintained at 4-week follow-up for female participants on body dissatisfaction (P<.001), body appreciation (P<.001), and self-compassion (P=.02) but not for male participants. On body image risk factors, significant reductions were found for female participants after the intervention for thin-ideal internalization (P<.001), peer pressure (P=.002), and media pressure (P<.001) after the intervention, while the effects were only maintained for thin-ideal internalization (P=.008) and media pressure (P=.01) at 4-week follow-up, compared with the active waitlist control group. As for male participants, no intervention effects were found both after the intervention and at follow-up for all body image risk factors of muscularity internalization, peer pressure, and media pressure. Both apps were acceptable and participants engaged equally across the intervention and active waitlist control groups, as indicated on a measure of app engagement (P=.76). Conclusions: This study provides preliminary evidence for a self-guided mHealth app in improving body image concerns and self-compassion in young adult university students. Future studies should include longer follow-ups, and examine its effects with the wider populations of young adults. Trial Registration: ClinicalTrials.gov NCT04977973; https://clinicaltrials.gov/ct2/show/NCT04977973 %M 36409542 %R 10.2196/41800 %U https://mhealth.jmir.org/2022/11/e41800 %U https://doi.org/10.2196/41800 %U http://www.ncbi.nlm.nih.gov/pubmed/36409542 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e32757 %T First-time Mothers’ Understanding and Use of a Pregnancy and Parenting Mobile App (The Baby Buddy App): Qualitative Study Using Appreciative Inquiry %A Bailey,Elizabeth %A Nightingale,Samantha %A Thomas,Nicky %A Coleby,Dawn %A Deave,Toity %A Goodenough,Trudy %A Ginja,Samuel %A Lingam,Raghu %A Kendall,Sally %A Day,Crispin %A Coad,Jane %+ School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Queens Medical Centre, Derby Rd, Lenton, Nottingham, NG7 2UH, United Kingdom, 44 07717416441, jane.coad@nottingham.ac.uk %K pregnancy %K antenatal support %K antenatal education %K communication %K digital %K pregnancy apps %K mobile phone %D 2022 %7 21.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Internationally, there is increasing emphasis on early support for pregnant women to optimize the health and development of mothers and newborns. To increase intervention reach, digital and app-based interventions have been advocated. There are growing numbers of pregnancy health care apps with great variation in style, function, and objectives, but evidence about impact on pregnancy well-being and behavior change following app interaction is lacking. This paper reports on the qualitative arm of the independent multicomponent study exploring the use and outcomes of first-time mothers using the Baby Buddy app, a pregnancy and parenting support app, available in the National Health Service App Library and developed by a UK child health and well-being charity, Best Beginnings. Objective: This study aims to understand when, why, and how first-time mothers use the Baby Buddy app and the perceived benefits and challenges. Methods: This paper reports on the qualitative arm of an independent, longitudinal, mixed methods study. An Appreciative Inquiry qualitative approach was used with semistructured interviews (17/60, 28%) conducted with new mothers, either by telephone or in a focus group setting. First-time mothers were recruited from 3 study sites from across the United Kingdom. Consistent with the Appreciative Inquiry approach, mothers were prompted to discuss what worked well and what could have been better regarding their interactions with the app during pregnancy. Thematic analysis was used, and findings are presented as themes with perceived benefits and challenges. Results: The main benefit, or what worked well, for first-time mothers when using the app was being able to access new information, which they felt was reliable and easy to find. This led to a feeling of increased confidence in the information they accessed, thus supporting family and professional communication. The main challenge was the preference for face-to-face information with a health care professional, particularly around specific issues that they wished to discuss in depth. What could have been improved included that there were some topics that some mothers would have preferred in more detail, but in other areas, they felt well-informed and thus did not feel a need to seek additional information via an app. Conclusions: Although this study included a small sample, it elicited rich data and insights into first-time mothers’ app interactions. The findings suggest that easily accessible pregnancy information, which is perceived as reliable, can support first-time mothers in communicating with health care professionals. Face-to-face contact with professionals was preferred, particularly to discuss specific and personalized needs. Further studies on maternal and professional digital support preferences after the COVID-19 global pandemic and how they facilitate antenatal education and informed decision-making are recommended, particularly because digital solutions remain as a key element in pregnancy and early parenting care. International Registered Report Identifier (IRRID): RR2-10.1017/S1463423618000294 %M 36409530 %R 10.2196/32757 %U https://mhealth.jmir.org/2022/11/e32757 %U https://doi.org/10.2196/32757 %U http://www.ncbi.nlm.nih.gov/pubmed/36409530 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 4 %P e38910 %T Smartphone Apps for Surveillance of Gestational Diabetes: Scoping Review %A Smyth,Suzanne %A Curtin,Eimear %A Tully,Elizabeth %A Molphy,Zara %A Breathnach,Fionnuala %+ Rotunda Hospital, Parnell Square, Dublin, D01P5W9, Ireland, 353 1 402 2540 ext 2540, suzannejksmyth@gmail.com %K gestational diabetes %K digital health %K mHealth %K telemedicine %K diabetes %K apps %K smartphone %K remote feedback %D 2022 %7 21.11.2022 %9 Review %J JMIR Diabetes %G English %X Background: Developments and evolutions in the information and communication technology sector have provided a solid foundation for the emergence of mobile health (mHealth) in recent years. The cornerstone to management of gestational diabetes mellitus (GDM) is the self-management of glycemic indices, dietary intake, and lifestyle adaptations. Given this, it is readily adaptable to incorporation of remote monitoring strategies involving mHealth solutions. Objective: We sought to examine and assess the available smartphone apps which enable self-monitoring and remote surveillance of GDM with a particular emphasis on the generation of individualized patient feedback. Methods: Five databases were searched systematically for any studies evaluating mHealth-supported smartphone solutions for GDM management from study inception until January 2022. The studies were screened and assessed for eligibility of inclusion by 2 independent reviewers. Ultimately, 17 studies were included involving 1871 patients across 11 different countries. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) conceptual framework was adhered to for data extraction and categorization purposes. Results: All studies analyzed as part of this review facilitated direct uploading of data from the handheld glucometer to the downloaded patient-facing smartphone app. Glycemic data were captured by all studies and were reassuringly found to be either improved or noninferior to extant models of hospital-based care. Feedback was delivered in either an automated fashion through in-app communication from the health care team or facilitated through bidirectional communication with the app and hospital portal. Although resource utilization and cost-effective analyses were reported in some studies, the results were disparate and require more robust analysis. Where patient and staff satisfaction levels were evaluated, the response was overwhelmingly positive for mHealth smartphone–delivered care strategies. Emergency cesarean section rates were reduced; however, elective cesarean sections were comparatively increased among studies where the mode of delivery was assessed. Most reviewed studies did not identify any differences in maternal, perinatal, or neonatal health when app-based care was compared with usual in-person review. Conclusions: This comprehensive scoping review highlights the feasibility, reliability, and acceptability of app-assisted health care for the management of GDM. Although further exploration of the economic benefit is required prior to implementation in a real-world clinical setting, the prospect of smartphone-assisted health care for GDM is hugely promising %M 36409549 %R 10.2196/38910 %U https://diabetes.jmir.org/2022/4/e38910 %U https://doi.org/10.2196/38910 %U http://www.ncbi.nlm.nih.gov/pubmed/36409549 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e39357 %T A Digital Platform to Support HIV Case Management for Youth and Young Adults: Mixed Methods Feasibility Study %A Fee,Connie %A Fuller,Julia %A Guss,Carly E %A Woods,Elizabeth R %A Cooper,Ellen R %A Bhaumik,Urmi %A Graham,Dionne %A Burchett,Sandra K %A Dumont,Olivia %A Martey,Emily B %A Narvaez,Maria %A Haberer,Jessica E %A Swendeman,Dallas %A Mulvaney,Shelagh A %A Kumar,Vikram S %A Jackson,Jonathan L %A Ho,Y Xian %+ Dimagi, Inc, 585 Massachusetts Ave., Suite 3, Cambridge, MA, 02139-4075, United States, 1 617 649 2214 ext 63, yho@dimagi.com %K HIV %K case management %K youth %K young adult %K mobile health %K mHealth %K digital health %K mobile phone %D 2022 %7 21.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Advances in medical treatments in recent years have contributed to an overall decline in HIV-related opportunistic infections and deaths in youth; however, mortality and morbidity rates in perinatally and nonperinatally infected adolescents and young adults (AYA) living with HIV remain relatively high today. Objective: The goal of this project was to assess the use, utility, and cost-effectiveness of PlusCare, a digital app for HIV case management in AYA living with HIV. The app supports routine case management tasks, such as scheduling follow-up visits, sharing documents for review and signature, laboratory test results, and between-visit communications (eg, encouraging messages). Methods: We conducted a single-group mixed methods pre-post study with HIV case management programs in 2 large urban hospitals in the Boston metro area. Case management staff (case managers [CMs], N=20) and AYA living with HIV participants (N=45) took part in the study with access to PlusCare for up to 15 and 12 months, respectively. Results: The CMs and AYA living with HIV reported mean System Usability Scale scores of 51 (SD 7.9) and 63 (SD 10.6), respectively. Although marginally significant, total charges billed at 1 of the 2 sites compared with the 12 months before app use (including emergency, inpatient, and outpatient charges) decreased by 41% (P=.046). We also observed slight increases in AYA living with HIV self-reported self-efficacy in chronic disease management and quality of life (Health-Related Quality of Life-4) from baseline to the 12-month follow-up (P=.02 and P=.03, respectively) and increased self-efficacy from the 6- to 12-month follow-up (P=.02). There was no significant change in HIV viral suppression, appointment adherence, or medication adherence in this small-sample pilot study. Conclusions: Although perceived usability was low, qualitative feedback from CMs and use patterns suggested that direct messaging and timely, remote, and secure sharing of laboratory results and documents (including electronic signatures) between CMs and AYA living with HIV can be particularly useful and have potential value in supporting care coordination and promoting patient self-efficacy and quality of life. Trial Registration: ClinicalTrials.gov NCT03758066; https://clinicaltrials.gov/ct2/show/NCT03758066 %M 36409541 %R 10.2196/39357 %U https://formative.jmir.org/2022/11/e39357 %U https://doi.org/10.2196/39357 %U http://www.ncbi.nlm.nih.gov/pubmed/36409541 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e40261 %T A Conversational, Virtual, Avatar-Led Cognitive Behavioral Therapy App Intervention for Improving the Quality of Life and Mental Health of People With Epilepsy: Protocol for a Randomized Controlled Trial %A Burbach,Frank %A Lecce,Francesca %A Allen,Victoria M E %A Porter,Catherine M %+ Healios Ltd, 4a Tileyard Studios Tileyard Road Kings Cross, London, N7 9AH, United Kingdom, 44 330 124 4222, frank.burbach@healios.org.uk %K epilepsy %K mental health %K anxiety %K depression %K quality of life %K cognitive behavioral therapy %K digital therapy %K smartphone %K mobile phone %K app %D 2022 %7 21.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Epilepsy is a common neurological disorder affecting about 1 in 100 people in the United Kingdom. Many individuals experience a lower quality of life as a result of their epilepsy diagnosis and are more likely to develop mental health problems, such as anxiety and depression. Medical interventions for this client group tend to focus on the treatment of seizures, whereas mental health disorders often remain undiagnosed and untreated. Early identification and treatment of mental health difficulties in people with epilepsy are vital to ensure better outcomes and improvements in quality of life. Objective: The aim of this exploratory randomized controlled trial is to evaluate whether an 8-week cognitive behavioral therapy–based intervention delivered through a mobile app—ThinkNinja for Epilepsy—is a clinically effective tool to improve quality of life, mental health, and emotional well-being in a large sample of people with epilepsy and anxiety or comorbid anxiety and depression. Methods: The study aims to recruit 184 individuals, 18 to 65 years of age, with a self-reported diagnosis of epilepsy and anxiety or comorbid anxiety and depression. Participants will be randomly assigned to the ThinkNinja for Epilepsy app condition (arm A) or the waiting-list control group (arm B). Participants in arm A will receive access to the ThinkNinja for Epilepsy app first. After 8 weeks, participants in arm B will receive the same full access to the ThinkNinja for Epilepsy app as the participants in arm A. This design will allow an initial between-subjects analysis between the two conditions as well as a within-subject analysis including all participants. The primary outcome is participants’ quality of life, measured by the 10-item patient-weighted Quality of Life in Epilepsy questionnaire. The secondary outcomes include measures of anxiety, using the 7-item Generalized Anxiety Disorder assessment; depression, using the 9-item Patient Health Questionnaire; medication adherence, using the Medication Adherence Questionnaire; and impression of change, using the Patient Global Impression of Change questionnaire. Results: Recruitment for this study began in March 2022 and was completed in October 2022. We expect data collection to be finalized by May 2023 and study results to be available within 12 months of the final data collection date. Results of the study will be written up as soon as possible thereafter, with the intention of publishing the outcomes in high-quality peer-reviewed journals. Conclusions: This study aims to determine the clinical efficacy and safety of the ThinkNinja for Epilepsy intervention at improving the quality of life, mental health, and emotional well-being of people with epilepsy. The findings from our study will hopefully contribute to addressing the critical gap in universal provision and accessibility of mental health and emotional well-being support for people with epilepsy. Trial Registration: ISRCTN Registry 16270209 (04/03/2022); https://www.isrctn.com/ISRCTN16270209 International Registered Report Identifier (IRRID): DERR1-10.2196/40261 %M 36409536 %R 10.2196/40261 %U https://www.researchprotocols.org/2022/11/e40261 %U https://doi.org/10.2196/40261 %U http://www.ncbi.nlm.nih.gov/pubmed/36409536 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e37590 %T Enhancing Food Intake Tracking in Long-term Care With Automated Food Imaging and Nutrient Intake Tracking (AFINI-T) Technology: Validation and Feasibility Assessment %A Pfisterer,Kaylen %A Amelard,Robert %A Boger,Jennifer %A Keller,Heather %A Chung,Audrey %A Wong,Alexander %+ Department of Systems Design Engineering, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567, kaylen.pfisterer@uhn.ca %K long-term care %K automated nutrient intake %K convolutional neural network %K food segmentation %K food classification %K depth imaging %K deep learning %K collaborative design %K aging %K food intake %D 2022 %7 17.11.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Half of long-term care (LTC) residents are malnourished, leading to increased hospitalization, mortality, and morbidity, with low quality of life. Current tracking methods are subjective and time-consuming. Objective: This paper presented the automated food imaging and nutrient intake tracking technology designed for LTC. Methods: A needs assessment was conducted with 21 participating staff across 12 LTC and retirement homes. We created 2 simulated LTC intake data sets comprising modified (664/1039, 63.91% plates) and regular (375/1039, 36.09% plates) texture foods. Overhead red-green-blue-depth images of plated foods were acquired, and foods were segmented using a pretrained food segmentation network. We trained a novel convolutional autoencoder food feature extractor network using an augmented UNIMIB2016 food data set. A meal-specific food classifier was appended to the feature extractor and tested on our simulated LTC food intake data sets. Food intake (percentage) was estimated as the differential volume between classified full portion and leftover plates. Results: The needs assessment yielded 13 nutrients of interest, requirement for objectivity and repeatability, and account for real-world environmental constraints. For 12 meal scenarios with up to 15 classes each, the top-1 classification accuracy was 88.9%, with mean intake error of −0.4 (SD 36.7) mL. Nutrient intake estimation by volume was strongly linearly correlated with nutrient estimates from mass (r2=0.92-0.99), with good agreement between methods (σ=−2.7 to −0.01; 0 within each of the limits of agreement). Conclusions: The automated food imaging and nutrient intake tracking approach is a deep learning–powered computational nutrient sensing system that appears to be feasible (validated accuracy against gold-standard weighed food method, positive end user engagement) and may provide a novel means for more accurate and objective tracking of LTC residents’ food intake to support and prevent malnutrition tracking strategies. %M 36394940 %R 10.2196/37590 %U https://aging.jmir.org/2022/4/e37590 %U https://doi.org/10.2196/37590 %U http://www.ncbi.nlm.nih.gov/pubmed/36394940 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e41455 %T Examining the Use of Mobile Technology to Deliver Tailored Sexual Assault Prevention in a Classroom Environment in the Military: Development and Usability Study %A Eckhoff,Randall %A Boyce,Matthew %A Watkins,Rebecca Lee %A Kan,Marni %A Scaglione,Nichole %A Pound,Leah %A Root,Meghan %+ RTI International, 3040 East Cornwallis Rd., P.O. Box 12194, Research Triangle Park, NC, 27709, United States, 1 919 961 0990, reckhoff@rti.org %K research techniques %K mobile technology %K tablet %K iPad %K restricted %K resource limited %K Wi-Fi %K tailored learning %K military %K data security %D 2022 %7 16.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Advances in mobile technology over the last 10 years have expanded its use in scientific research. However, there are challenges in creating a reliable system for intervention content delivery and data collection in an environment with limited internet connectivity and limited staffing capacity. The Sexual Communication and Consent (SCC) study used tablets to provide individualized Sexual Assault Prevention and Response training in a classroom environment that was both technologically and support staff limited. Objective: We developed the SCC Basic Military Training app and a separate Sexual Assault Response Coordinator app to support individualized training within the new SCC program. This paper presents the functionality, protocols, challenges, and feasibility of deploying mobile technology in an educational environment in the military with limited resources. Methods: We developed both mobile apps targeting the Apple iOS ecosystem. The Basic Military Training app provided a screening instrument that routed the trainee into 1 of 5 specific intervention programs. Over 2 days of basic military training set 2 weeks apart, trainees received a combined 6 hours of program-specific tablet training, combined with universal, interactive classroom training, led by qualified instructors. The Sexual Assault Response Coordinator app, used to deliver supplemental content to a subgroup of trainees, was made available for voluntary and private use at the Sexual Assault Response Coordinator’s office on base. All anonymous data were manually transferred onto laptops, where the data were aggregated into files and securely transferred to the project staff for analysis. The study was conducted at the Lackland Air Force Base, Joint Base San Antonio, with 9196 trainees providing the data. Results: A total of 7742 trainees completed both the sessions of the SCC program and a series of evaluative assessments. Some trainees did not receive day 2 training, and only received day 1 training because the COVID-19 pandemic shortened the study period. Of the 190 SCC classes taught, only one class was unable to complete tablet training because of Apple licensing–related technology failure. The 360 study tablets were distributed across 3 classrooms (120 per classroom) and were handled at least 16,938 times with no reports of breakage or requiring replacement. Wi-Fi access limitations exacerbated the complexity of Apple licensing revalidation and the secure transfer of data from the classroom to project personnel. The instructor staff’s limited technical knowledge to perform certain technical tasks was challenging. Conclusions: The results demonstrated the feasibility of deploying a mobile app for tablet-based training in a military educational environment. Although successful, the study was not without technical challenges. This paper gives examples of technical lessons learned and recommendations for conducting the study differently, with the aim that the knowledge gained may be helpful to other researchers encountering similar requirements. %M 36383404 %R 10.2196/41455 %U https://mhealth.jmir.org/2022/11/e41455 %U https://doi.org/10.2196/41455 %U http://www.ncbi.nlm.nih.gov/pubmed/36383404 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e36174 %T Developing an mHealth Intervention to Reduce COVID-19–Associated Psychological Distress Among Health Care Workers in Nigeria: Protocol for a Design and Feasibility Study %A Akinsulore,Adesanmi %A Aloba,Olutayo %A Oginni,Olakunle %A Oloniniyi,Ibidunni %A Ibigbami,Olanrewaju %A Seun-Fadipe,Champion Tobi %A Opakunle,Tolulope %A Owojuyigbe,Afolabi Muyiwa %A Olibamoyo,Olushola %A Mapayi,Boladale %A Okorie,Victor Ogbonnaya %A Adewuya,Abiodun Olugbenga %+ Department of Mental Health, Faculty of Clinical Sciences, Obafemi Awolowo University, College of Health Sciences Building, Road 1, Ile-Ife, 220005, Nigeria, 234 8033968554, sanmilore@oauife.edu.ng %K COVID-19 %K psychological distress %K Nigeria %K health care workers %K mental health %K well-being %K pandemic %K mHealth %K mobile health %K digital health intervention %K health intervention %K health care %K smartphone %K mobile phone %D 2022 %7 16.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, COVID-19–related psychological distress is seriously eroding health care workers’ mental health and well-being, especially in low-income countries like Nigeria. The use of mobile health (mHealth) interventions is now increasingly recognized as an innovative approach that may improve mental health and well-being. This project aims to develop an mHealth psychological intervention (mPsyI) to reduce COVID-19–related psychological distress among health care workers in Nigeria. Objective: Our objective is to present a study protocol to determine the level of COVID-19–related psychological distress among health care workers in Nigeria; explore health care workers’ experience of COVID-19–related psychological distress; develop and pilot test mPsyI to reduce this distress; and assess the feasibility of this intervention (such as usability, engagement, and satisfaction). Methods: A mixed (quantitative and qualitative) methods approach is used in which health care workers will be recruited from 2 tertiary health care facilities in southwest Nigeria. The study is divided into 4 phases based on the study objectives. Phase 1 involves a quantitative survey to assess the type and levels of psychosocial distress. Phase 2 collects qualitative data on psychosocial distress among health care workers. Phase 3 involves development of the mHealth-based psychological intervention, and phase 4 is a mixed methods study to assess the feasibility and acceptability of the intervention. Results: This study was funded in November 2020 by the Global Effort on COVID-19 Health Research, and collection of preliminary baseline data started in July 2021. Conclusions: This is the first study to report the development of an mHealth-based intervention to reduce COVID-19–related psychological distress among health care workers in Nigeria. Using a mixed methods design in this study can potentially facilitate the adaptation of an evidence-based treatment method that is culturally sensitive and cost-effective for the management of COVID-19–related psychological distress among health care workers in Nigeria. International Registered Report Identifier (IRRID): DERR1-10.2196/36174 %M 36318638 %R 10.2196/36174 %U https://www.researchprotocols.org/2022/11/e36174 %U https://doi.org/10.2196/36174 %U http://www.ncbi.nlm.nih.gov/pubmed/36318638 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e40797 %T Trends in Smart Helmets With Multimodal Sensing for Health and Safety: Scoping Review %A Lee,Peter %A Kim,Heepyung %A Zitouni,M Sami %A Khandoker,Ahsan %A Jelinek,Herbert F %A Hadjileontiadis,Leontios %A Lee,Uichin %A Jeong,Yong %+ Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro Yuseong gu, Daejeon, 34141, Republic of Korea, 82 423504324, yong@kaist.ac.kr %K Internet of Things %K IoT %K sensor technology %K smart helmet %K smart sensor %K wearable device %K mobile phone %D 2022 %7 15.11.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: As a form of the Internet of Things (IoT)–gateways, a smart helmet is one of the core devices that offers distinct functionalities. The development of smart helmets connected to IoT infrastructure helps promote connected health and safety in various fields. In this regard, we present a comprehensive analysis of smart helmet technology and its main characteristics and applications for health and safety. Objective: This paper reviews the trends in smart helmet technology and provides an overview of the current and future potential deployments of such technology, the development of smart helmets for continuous monitoring of the health status of users, and the surrounding environmental conditions. The research questions were as follows: What are the main purposes and domains of smart helmets for health and safety? How have researchers realized key features and with what types of sensors? Methods: We selected studies cited in electronic databases such as Google Scholar, Web of Science, ScienceDirect, and EBSCO on smart helmets through a keyword search from January 2010 to December 2021. In total, 1268 papers were identified (Web of Science: 87/1268, 6.86%; EBSCO: 149/1268, 11.75%; ScienceDirect: 248/1268, 19.55%; and Google Scholar: 784/1268, 61.82%), and the number of final studies included after PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) study selection was 57. We also performed a self-assessment of the reviewed articles to determine the quality of the paper. The scoring was based on five criteria: test environment, prototype quality, feasibility test, sensor calibration, and versatility. Results: Smart helmet research has been considered in industry, sports, first responder, and health tracking scenarios for health and safety purposes. Among 57 studies, most studies with prototype development were industrial applications (18/57, 32%), and the 2 most frequent studies including simulation were industry (23/57, 40%) and sports (23/57, 40%) applications. From our assessment-scoring result, studies tended to focus on sensor calibration results (2.3 out of 3), while the lowest part was a feasibility test (1.6 out of 3). Further classification of the purpose of smart helmets yielded 4 major categories, including activity, physiological and environmental (hazard) risk sensing, as well as risk event alerting. Conclusions: A summary of existing smart helmet systems is presented with a review of the sensor features used in the prototyping demonstrations. Overall, we aimed to explore new possibilities by examining the latest research, sensor technologies, and application platform perspectives for smart helmets as promising wearable devices. The barriers to users, challenges in the development of smart helmets, and future opportunities for health and safety applications are also discussed. In conclusion, this paper presents the current status of smart helmet technology, main issues, and prospects for future smart helmet with the objective of making the smart helmet concept a reality. %M 36378505 %R 10.2196/40797 %U https://mhealth.jmir.org/2022/11/e40797 %U https://doi.org/10.2196/40797 %U http://www.ncbi.nlm.nih.gov/pubmed/36378505 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e36696 %T Health-Related Indicators Measured Using Earable Devices: Systematic Review %A Choi,Jin-Young %A Jeon,Seonghee %A Kim,Hana %A Ha,Jaeyoung %A Jeon,Gyeong-suk %A Lee,Jeong %A Cho,Sung-il %+ Department of Public Health Science, Graduate School of Public Health, Seoul National University, Bldg 220, Rm 703., 1 Gwanak-ro, Gwanak-gu., Seoul, 08826, Republic of Korea, 82 2 880 2717, persontime@hotmail.com %K digital public health %K earable %K wearable %K biomarker %K health status %K disease monitoring %K prevention strategy %K Internet of Things %K systematic review %K mobile phone %D 2022 %7 15.11.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Earable devices are novel, wearable Internet of Things devices that are user-friendly and have potential applications in mobile health care. The position of the ear is advantageous for assessing vital status and detecting diseases through reliable and comfortable sensing devices. Objective: Our study aimed to review the utility of health-related indicators derived from earable devices and propose an improved definition of disease prevention. We also proposed future directions for research on the health care applications of earable devices. Methods: A systematic review was conducted of the PubMed, Embase, and Web of Science databases. Keywords were used to identify studies on earable devices published between 2015 and 2020. The earable devices were described in terms of target health outcomes, biomarkers, sensor types and positions, and their utility for disease prevention. Results: A total of 51 articles met the inclusion criteria and were reviewed, and the frequency of 5 health-related characteristics of earable devices was described. The most frequent target health outcomes were diet-related outcomes (9/51, 18%), brain status (7/51, 14%), and cardiovascular disease (CVD) and central nervous system disease (5/51, 10% each). The most frequent biomarkers were electroencephalography (11/51, 22%), body movements (6/51, 12%), and body temperature (5/51, 10%). As for sensor types and sensor positions, electrical sensors (19/51, 37%) and the ear canal (26/51, 51%) were the most common, respectively. Moreover, the most frequent prevention stages were secondary prevention (35/51, 69%), primary prevention (12/51, 24%), and tertiary prevention (4/51, 8%). Combinations of ≥2 target health outcomes were the most frequent in secondary prevention (8/35, 23%) followed by brain status and CVD (5/35, 14% each) and by central nervous system disease and head injury (4/35, 11% each). Conclusions: Earable devices can provide biomarkers for various health outcomes. Brain status, healthy diet status, and CVDs were the most frequently targeted outcomes among the studies. Earable devices were mostly used for secondary prevention via monitoring of health or disease status. The potential utility of earable devices for primary and tertiary prevention needs to be investigated further. Earable devices connected to smartphones or tablets through cloud servers will guarantee user access to personal health information and facilitate comfortable wearing. %M 36239201 %R 10.2196/36696 %U https://mhealth.jmir.org/2022/11/e36696 %U https://doi.org/10.2196/36696 %U http://www.ncbi.nlm.nih.gov/pubmed/36239201 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 4 %P e38994 %T The Effects of an Individualized Smartphone-Based Exercise Program on Self-defined Motor Tasks in Parkinson Disease: Pilot Interventional Study %A Gaßner,Heiko %A Friedrich,Jana %A Masuch,Alisa %A Jukic,Jelena %A Stallforth,Sabine %A Regensburger,Martin %A Marxreiter,Franz %A Winkler,Jürgen %A Klucken,Jochen %+ Department of Molecular Neurology, University Hospital Erlangen, Schwabachanlage 6, Erlangen, 91054, Germany, 49 913185 ext 39324, Heiko.Gassner@uk-erlangen.de %K Parkinson disease %K exercise %K telemedicine %K wearable sensors %K patient-defined outcome measure %K mobile phone %D 2022 %7 15.11.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Bradykinesia and rigidity are prototypical motor impairments of Parkinson disease (PD) highly influencing everyday life. Exercise training is an effective treatment alternative for motor symptoms, complementing dopaminergic medication. High frequency training is necessary to yield clinically relevant improvements. Exercise programs need to be tailored to individual symptoms and integrated in patients’ everyday life. Due to the COVID-19 pandemic, exercise groups in outpatient setting were largely reduced. Developing remotely supervised solutions is therefore of significant importance. Objective: This pilot study aimed to evaluate the feasibility of a digital, home-based, high-frequency exercise program for patients with PD. Methods: In this pilot interventional study, patients diagnosed with PD received 4 weeks of personalized exercise at home using a smartphone app, remotely supervised by specialized therapists. Exercises were chosen based on the patient-defined motor impairment and depending on the patients’ individual capacity (therapists defined 3-5 short training sequences for each participant). In a first education session, the tailored exercise program was explained and demonstrated to each participant and they were thoroughly introduced to the smartphone app. Intervention effects were evaluated using the Unified Parkinson Disease Rating Scale, part III; standardized sensor-based gait analysis; Timed Up and Go Test; 2-minute walk test; quality of life assessed by the Parkinson Disease Questionnaire; and patient-defined motor tasks of daily living. Usability of the smartphone app was assessed by the System Usability Scale. All participants gave written informed consent before initiation of the study. Results: In total, 15 individuals with PD completed the intervention phase without any withdrawals or dropouts. The System Usability Scale reached an average score of 72.2 (SD 6.5) indicating good usability of the smartphone app. Patient-defined motor tasks of daily living significantly improved by 40% on average in 87% (13/15) of the patients. There was no significant impact on the quality of life as assessed by the Parkinson Disease Questionnaire (but the subsections regarding mobility and social support improved by 14% from 25 to 21 and 19% from 15 to 13, respectively). Motor symptoms rated by Unified Parkinson Disease Rating Scale, part III, did not improve significantly but a descriptive improvement of 14% from 18 to 16 could be observed. Clinically relevant changes in Timed Up and Go test, 2-minute walk test, and sensor-based gait parameters or functional gait tests were not observed. Conclusions: This pilot interventional study presented that a tailored, digital, home-based, and high-frequency exercise program over 4 weeks was feasible and improved patient-defined motor activities of daily life based on a self-developed patient-defined impairment score indicating that digital exercise concepts may have the potential to beneficially impact motor symptoms of daily living. Future studies should investigate sustainability effects in controlled study designs conducted over a longer period. %M 36378510 %R 10.2196/38994 %U https://rehab.jmir.org/2022/4/e38994 %U https://doi.org/10.2196/38994 %U http://www.ncbi.nlm.nih.gov/pubmed/36378510 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 4 %P e41140 %T Analyzing User Engagement Within a Patient-Reported Outcomes Texting Tool for Diabetes Management: Engagement Phenotype Study %A Mandal,Soumik %A Belli,Hayley M %A Cruz,Jocelyn %A Mann,Devin %A Schoenthaler,Antoinette %+ Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, United States, 1 7326891369, soumik.mandal@nyulangone.org %K user engagement %K patient-reported outcomes %K mobile health %K mHealth %K digital health %K SMS %K type 2 diabetes %K health behavior %K digital phenotyping %D 2022 %7 14.11.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: Patient-reported outcomes (PROs) capture patients’ views on their health conditions and its management, and are increasingly used in clinical trials, including those targeting type 2 diabetes (T2D). Mobile health (mHealth) tools offer novel solutions for collecting PRO data in real time. Although patients are at the center of any PRO-based intervention, few studies have examined user engagement with PRO mHealth tools. Objective: This study aimed to evaluate user engagement with a PRO mHealth tool for T2D management, identify patterns of user engagement and similarities and differences between the patients, and identify the characteristics of patients who are likely to drop out or be less engaged with a PRO mHealth tool. Methods: We extracted user engagement data from an ongoing clinical trial that tested the efficacy of a PRO mHealth tool designed to improve hemoglobin A1c levels in patients with uncontrolled T2D. To date, 61 patients have been randomized to the intervention, where they are sent 6 PRO text messages a day that are relevant to T2D self-management (healthy eating and medication adherence) over the 12-month study. To analyze user engagement, we first compared the response rate (RR) and response time between patients who completed the 12-month intervention and those who dropped out early (noncompleters). Next, we leveraged latent class trajectory modeling to classify patients from the completer group into 3 subgroups based on similarity in the longitudinal engagement data. Finally, we investigated the differences between the subgroups of completers from various cross-sections (time of the day and day of the week) and PRO types. We also explored the patient demographics and their distribution among the subgroups. Results: Overall, 19 noncompleters had a lower RR to PRO questions and took longer to respond to PRO questions than 42 completers. Among completers, the longitudinal RRs demonstrated differences in engagement patterns over time. The completers with the lowest engagement showed peak engagement during month 5, almost at the midstage of the program. The remaining subgroups showed peak engagement at the beginning of the intervention, followed by either a steady decline or sustained high engagement. Comparisons of the demographic characteristics showed significant differences between the high engaged and low engaged subgroups. The high engaged completers were predominantly older, of Hispanic descent, bilingual, and had a graduate degree. In comparison, the low engaged subgroup was composed mostly of African American patients who reported the lowest annual income, with one of every 3 patients earning less than US $20,000 annually. Conclusions: There are discernible engagement phenotypes based on individual PRO responses, and their patterns vary in the timing of peak engagement and demographics. Future studies could use these findings to predict engagement categories and tailor interventions to promote longitudinal engagement. Trial Registration: Clinicaltrials.gov NCT03652389; https://clinicaltrials.gov/ct2/show/NCT03652389 International Registered Report Identifier (IRRID): RR2-10.2196/18554 %M 36374531 %R 10.2196/41140 %U https://diabetes.jmir.org/2022/4/e41140 %U https://doi.org/10.2196/41140 %U http://www.ncbi.nlm.nih.gov/pubmed/36374531 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e40765 %T Recruitment and Retention in Remote Research: Learnings From a Large, Decentralized Real-world Study %A Li,Sophia Xueying %A Halabi,Ramzi %A Selvarajan,Rahavi %A Woerner,Molly %A Fillipo,Isabell Griffith %A Banerjee,Sreya %A Mosser,Brittany %A Jain,Felipe %A Areán,Patricia %A Pratap,Abhishek %+ Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, 250 College Street, 12th floor, Toronto, ON, M5T 1R8, Canada, 1 416 535 8501, Abhishek.Pratap@camh.ca %K participant recruitment %K participant retention %K decentralized studies %K active and passive data collection %K retention %K adherence %K compliance %K engagement %K smartphone %K mobile health %K mHealth %K sensor data %K clinical research %K data sharing %K recruitment %K mobile phone %D 2022 %7 14.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphones are increasingly used in health research. They provide a continuous connection between participants and researchers to monitor long-term health trajectories of large populations at a fraction of the cost of traditional research studies. However, despite the potential of using smartphones in remote research, there is an urgent need to develop effective strategies to reach, recruit, and retain the target populations in a representative and equitable manner. Objective: We aimed to investigate the impact of combining different recruitment and incentive distribution approaches used in remote research on cohort characteristics and long-term retention. The real-world factors significantly impacting active and passive data collection were also evaluated. Methods: We conducted a secondary data analysis of participant recruitment and retention using data from a large remote observation study aimed at understanding real-world factors linked to cold, influenza, and the impact of traumatic brain injury on daily functioning. We conducted recruitment in 2 phases between March 15, 2020, and January 4, 2022. Over 10,000 smartphone owners in the United States were recruited to provide 12 weeks of daily surveys and smartphone-based passive-sensing data. Using multivariate statistics, we investigated the potential impact of different recruitment and incentive distribution approaches on cohort characteristics. Survival analysis was used to assess the effects of sociodemographic characteristics on participant retention across the 2 recruitment phases. Associations between passive data-sharing patterns and demographic characteristics of the cohort were evaluated using logistic regression. Results: We analyzed over 330,000 days of engagement data collected from 10,000 participants. Our key findings are as follows: first, the overall characteristics of participants recruited using digital advertisements on social media and news media differed significantly from those of participants recruited using crowdsourcing platforms (Prolific and Amazon Mechanical Turk; P<.001). Second, participant retention in the study varied significantly across study phases, recruitment sources, and socioeconomic and demographic factors (P<.001). Third, notable differences in passive data collection were associated with device type (Android vs iOS) and participants’ sociodemographic characteristics. Black or African American participants were significantly less likely to share passive sensor data streams than non-Hispanic White participants (odds ratio 0.44-0.49, 95% CI 0.35-0.61; P<.001). Fourth, participants were more likely to adhere to baseline surveys if the surveys were administered immediately after enrollment. Fifth, technical glitches could significantly impact real-world data collection in remote settings, which can severely impact generation of reliable evidence. Conclusions: Our findings highlight several factors, such as recruitment platforms, incentive distribution frequency, the timing of baseline surveys, device heterogeneity, and technical glitches in data collection infrastructure, that could impact remote long-term data collection. Combined together, these empirical findings could help inform best practices for monitoring anomalies during real-world data collection and for recruiting and retaining target populations in a representative and equitable manner. %M 36374539 %R 10.2196/40765 %U https://formative.jmir.org/2022/11/e40765 %U https://doi.org/10.2196/40765 %U http://www.ncbi.nlm.nih.gov/pubmed/36374539 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e40321 %T Mobile Digital Health Intervention to Promote Nutrition and Physical Activity Behaviors Among Long-term Unemployed in Rural Areas: Protocol for a Randomized Controlled Trial %A Weishaupt,Iris %A Mages-Torluoglu,Jennifer %A Kunze,Christophe %A Weidmann,Christian %A Steinhausen,Kirsten %A Bailer,Anja Christina %+ Care & Technology Lab (IMTT), Faculty of Health, Safety, Society, Furtwangen University, Robert-Gerwig-Platz 1, Furtwangen, 78120, Germany, 49 7723 920 2833, Anja.Bailer@hs-furtwangen.de %K digital health intervention %K behavior changes %K nutrition %K physical activity %K long-term unemployment %K rural areas %K Germany %K mobile phone %D 2022 %7 14.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Long-term unemployed have poor nutritional and physical activity statuses, and, therefore, special health promotion needs. Particularly in rural areas, however, they often do not have access to health promotion service. Thus, new promising strategies to improve the health of long-term unemployed are needed. Hence, a digital health intervention to promote nutritional and physical health behaviors was conceived, and the effectiveness of the intervention in combination with face-to-face sessions will be evaluated in a randomized controlled trial. Objective: The aim of this study is to elucidate the effectiveness of a mobile digital health intervention to promote the nutritional and physical activity behaviors of long-term unemployed in the rural areas of Germany. Methods: The 9-week intervention aims to promote nutritional or physical activity behavior by improving drinking habits, increasing the consumption of fruits, vegetables, and whole grains, increasing daily step count, strengthening muscles, and improving endurance. The intervention design is based on the transtheoretical model and is implemented in a mobile app using the MobileCoach open-source platform. The effectiveness of the intervention will be elucidated by a 9-week, 2-armed, parallel-designed trial. Therefore, long-term unemployed will be recruited by employees of the German social sector institutions and randomized either to receive information brochures; the digital intervention in the form of a mobile app; and 3 face-to-face sessions regarding technical support, healthy eating, and physical activity (n=100) or to receive a control treatment consisting of solely the hand over of information brochures (n=100). The effectiveness of the intervention will be assessed using questionnaires at baseline, after 9 weeks in face-to-face appointments, and after a 3-month follow-up period by postal contact. The use of the mobile app will be monitored, and qualitative interviews or focus groups with the participants will be conducted. Incentives of €50 (US $49.7) will be paid to the participants and are tied to the completion of the questionnaires and not to the use of the mobile app or progress in the intervention. Results: The effectiveness of the intervention in promoting the nutritional and physical activity behaviors of long-term unemployed participants will be elucidated. The adherence of the participants to and the acceptance and usability of the mobile device app will be evaluated. Recruitment started in March 2022, and the final publication of the results is expected in the first half of 2023. Conclusions: Positive health-related changes made by the intervention would display the potency of digital health interventions to promote nutritional and physical activity behaviors among long-term unemployed in the rural areas of Germany, which would also contribute to an improved health status of the German population in general. Trial Registration: German Clinical Trials Register DRKS00024805; https://www.drks.de/DRKS00024805 International Registered Report Identifier (IRRID): PRR1-10.2196/40321 %M 36374540 %R 10.2196/40321 %U https://www.researchprotocols.org/2022/11/e40321 %U https://doi.org/10.2196/40321 %U http://www.ncbi.nlm.nih.gov/pubmed/36374540 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e39997 %T Understanding the Technological Landscape of Home Health Aides: Scoping Literature Review and a Landscape Analysis of Existing mHealth Apps %A Kuo,Elizabeth Fong-Chy %A Cho,Jacklyn %A Olaye,Iredia %A Delgado,Diana %A Dell,Nicola %A Sterling,Madeline R %+ Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, Room LH-357, New York, NY, 10021, United States, 1 646 962 5029, mrs9012@med.cornell.edu %K home health aides %K home care services %K mobile health %K mHealth %K mobile apps %K mobile phone apps %K smartphones %K educational technology %K technology %K mobile phone %D 2022 %7 11.11.2022 %9 Review %J J Med Internet Res %G English %X Background: Home health aides (HHAs) provide necessary hands-on care to older adults and those with chronic conditions in their homes. Despite their integral role, HHAs experience numerous challenges in their work, including their ability to communicate with other health care professionals about patient care while caring for patients and access to educational resources. Although technological interventions have the potential to address these challenges, little is known about the technological landscape and existing technology-based interventions designed for and used by this workforce. Objective: We conducted a scoping review of the scientific literature to identify existing studies that have described, designed, deployed, or tested technology-based tools and apps intended for use by HHAs to care for patients at home. To complement our literature review, we conducted a landscape analysis of existing mobile apps intended for HHAs providing in-home care. Methods: We searched the following databases from their inception to October 2020: Ovid MEDLINE, Ovid Embase, Cochrane Library, and CINAHL (EBSCO). A total of 3 researchers screened the yield using prespecified inclusion and exclusion criteria. In addition, 4 researchers independently reviewed these articles, and a fifth researcher arbitrated when needed. Among studies that met the inclusion criteria, data were extracted and summarized narratively. An analysis of mobile health apps designed for HHAs was performed using a predefined set of terms to search Google Play and Apple App stores. Overall, 2 researchers independently screened the resulting apps, and those that met the inclusion criteria were categorized according to their intended purpose and functionality. Results: Of the 8643 studies retrieved, 182 (2.11%) underwent full-text review, and 4.9% (9/182) met our inclusion criteria. Approximately half (4/9, 44%) of the studies were descriptive in nature, proposing technology-based systems (eg, web portals and dashboards) or prototypes without a technical or user-based evaluation of the technology. In most (7/9, 78%) papers, HHAs were just one of several users and not the sole or primary intended users of the technology. Our review of mobile apps yielded 166 Android and iOS apps, of which 48 (29%) met the inclusion criteria. These apps provided HHAs with one or more of the following functions: electronic visit verification (29/48, 60%), clocking in and out (23/48, 48%), documentation (22/48, 46%), task checklist (19/48, 40%), communication between HHA and agency (14/48, 29%), patient information (6/48, 13%), resources (5/48, 10%), and communication between HHA and patients (4/48, 8%). Of the 48 apps, 25 (52%) performed monitoring functions, 4 (8%) performed supporting functions, and 19 (40%) performed both. Conclusions: A limited number of studies and mobile apps have been designed to support HHAs in their work. Further research and rigorous evaluation of technology-based tools are needed to assess their impact on the work HHAs provide in patient’s homes. %M 36176033 %R 10.2196/39997 %U https://www.jmir.org/2022/11/e39997 %U https://doi.org/10.2196/39997 %U http://www.ncbi.nlm.nih.gov/pubmed/36176033 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e42320 %T The Effect of the First UK COVID-19 Lockdown on Users of the Drink Less App: Interrupted Time Series Analysis of Sociodemographic Characteristics, Engagement, and Alcohol Reduction %A Oldham,Melissa %A Perski,Olga %A Loebenberg,Gemma %A Brown,Jamie %A Garnett,Claire %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Pl, London, WC1E 7HB, United Kingdom, 44 7507712530, m.oldham@ucl.ac.uk %K alcohol reduction %K COVID-19 %K digital intervention %K smartphone app %K United Kingdom %K alcohol %K app %K Drink Less %K engagement %K users %K lockdown %K female %D 2022 %7 10.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The first UK COVID-19 lockdown had a polarizing impact on drinking behavior and may have impacted engagement with digital interventions to reduce alcohol consumption. Objective: We examined the effect of lockdown on engagement, alcohol reduction, and the sociodemographic characteristics of users of the popular and widely available alcohol reduction app Drink Less. Methods: This was a natural experiment. The study period spanned 468 days between March 24, 2019, and July 3, 2020, with the introduction of UK lockdown measures beginning on March 24, 2020. Users were 18 years or older, based in the United Kingdom, and interested in drinking less. Interrupted time series analyses using generalized additive mixed models (GAMMs) were conducted for each outcome variable (ie, sociodemographic characteristics, app downloads and engagement levels, alcohol consumption, and extent of alcohol reduction) for existing (downloaded the app prelockdown) and new (downloaded the app during the lockdown) users of the app. Results: Among existing users of the Drink Less app, there were increases in the time spent on the app per day (B=0.01, P=.01), mean units of alcohol recorded per day (B>0.00 P=.02), and mean heavy drinking (>6 units) days (B>0.00, P=.02) during the lockdown. Previous declines in new app downloads plateaued during the lockdown (incidence rate ratio [IRR]=1.00, P=.18). Among new app users, there was an increase in the proportion of female users (B>0.00, P=.04) and those at risk of alcohol dependence (B>0.00, P=.01) and a decrease in the proportion of nonmanual workers (B>–0.00, P=.04). Among new app users, there were step increases in the mean number of alcohol units per day (B=20.12, P=.03), heavy-drinking days (B=1.38, P=.01), and the number of days the app was used (B=2.05, P=.02), alongside a step decrease in the percentage of available screens viewed (B=–0.03, P=.04), indicating users were using less of the intervention components within the app. Conclusions: Following the first UK lockdown, there was evidence of increases in engagement and alcohol consumption among new and existing users of the Drink Less app. %M 36240461 %R 10.2196/42320 %U https://www.jmir.org/2022/11/e42320 %U https://doi.org/10.2196/42320 %U http://www.ncbi.nlm.nih.gov/pubmed/36240461 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e40507 %T A Digital Video and Text Messaging Intervention to Support People With Chronic Pain During Opioid Tapering: Content Development Using Co-design %A Magee,Michael R %A Gholamrezaei,Ali %A McNeilage,Amy G %A Sim,Alison %A Dwyer,Leah %A Ferreira,Manuela L %A Darnall,Beth D %A Glare,Paul %A Ashton-James,Claire E %+ Pain Management Research Institute, Faculty of Medicine and Health, The University of Sydney, Douglas Building, Royal North Shore Hospital, Reserve Rd, Sydney, St Leonards 2065, Australia, 61 2 9463 1526, mmag9080@uni.sydney.edu.au %K chronic pain %K deprescribing %K tapering %K dose reduction %K opioids %K mHealth %K mobile health %K SMS %K text messaging %K digital health %K behavior change %K self-efficacy %K consumer engagement %K co-design %K coproduction %D 2022 %7 10.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: People living with chronic pain report that tapering prescribed opioids is challenging and more support is needed. In our formative research, consumers indicated that mobile health (mHealth) technology could be an acceptable form of support for opioid tapering and may improve tapering self-efficacy. Objective: We aimed to evaluate and improve the content of an mHealth intervention before pilot-testing, based on consumer and clinician feedback. Methods: Participants were 12 consumers and 12 clinicians who evaluated an initial draft of a video script and 90 SMS text messages. Consumers and clinicians rated the appropriateness and likely usefulness (consumers) or likely effectiveness (clinicians) of a video script and a random selection of 15 SMS text messages using a 5-point Likert-type scale (1=totally disagree; 5=totally agree). Each draft SMS text message was reviewed by 2 consumers and 2 clinicians. Texts were deemed acceptable for inclusion in the pilot intervention only if the summed participant ratings of text appropriateness and usefulness or effectiveness were ≥8. Participants were also invited to provide open-text feedback on the draft script and SMS text messages. Results: Consumers generally agreed that the draft video script and text content were likely to be appropriate (video: mean 4.4, SD 0.52; text: mean 4.3, SD 0.79) and useful (video: mean 4.3, SD 0.65; text: mean 4.2, SD 0.84). Similarly, clinicians generally agreed that the draft video script and text content were likely to be appropriate (video: mean 4.5, SD 0.67; text: mean 4.4, SD 0.81) and effective (video: mean 4.0, SD 0.43; text: mean 4.3, SD 0.76). Overall, 77% (69/90) of the draft texts met the threshold rating for acceptability for inclusion in the pilot test of mHealth intervention by consumers, and 82% (74/90) met the threshold for acceptability by clinicians. Consumers' and clinicians’ ratings were used to rank order the texts. The top 56 draft texts (all meeting the threshold levels of acceptability) were selected for inclusion in the pilot intervention. When consumer or clinician feedback was provided, the texts meeting the criteria for inclusion in the pilot were further revised and improved. Feedback on the video script was also used to further improve the acceptability of the video script before pilot-testing the intervention. Conclusions: This study describes the process by which a 28-day mHealth intervention to support patients with chronic pain to taper opioid medications was evaluated and improved before pilot-testing. The mHealth intervention consisted of a 10-minute psychoeducational video about pain and opioid tapering and 56 unique SMS text messages providing information and reassurance (texts delivered twice per day for 28 days). Having established that the content of the mHealth intervention is acceptable to both consumer and clinician groups, the mHealth intervention will be piloted in future research. %M 36355415 %R 10.2196/40507 %U https://formative.jmir.org/2022/11/e40507 %U https://doi.org/10.2196/40507 %U http://www.ncbi.nlm.nih.gov/pubmed/36355415 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e37234 %T Behavior Change Techniques in Digital Health Interventions for Midlife Women: Systematic Review %A Sediva,Hana %A Cartwright,Tina %A Robertson,Claire %A Deb,Sanjoy K %+ Centre for Nutraceuticals, School of Life Sciences, University of Westminster, 115 New Cavendish Street, London, W1B 2HW, United Kingdom, 44 020 7911 5000, hana.sediva@my.westminster.ac.uk %K menopause %K midlife %K women’s health %K lifestyle %K behavior change technique %K BCT %K behavioral intervention %K digital health %K mobile health %K mHealth %K menopausal symptom %K behavior change %K review %K mobile phone %D 2022 %7 9.11.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Digital health interventions are efficacious in health-promoting behaviors (eg, healthy eating and regular physical activity) that mitigate health risks and menopausal symptoms in midlife. However, integrated evidence-based knowledge about the mechanisms of change in these interventions is unclear. Objective: This systematic review aimed to evaluate studies on behavior change techniques (BCTs) and mechanisms of change in digital health interventions aimed at promoting health-enhancing behaviors in midlife women (aged 40-65 years). Methods: A systematic literature search of the electronic databases PubMed, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials in the Cochrane Library was conducted. In total, 2 independent reviewers selected the studies for inclusion, extracted data, and completed BCT mapping of eligible studies. The mechanism of action and intervention functions of eligible studies were evaluated using the behavior change wheel framework. Reporting of psychological theory use within these interventions was explored using the Theory Coding Scheme. Mode of delivery, psychological theory, and BCTs were presented as descriptive statistics. Results: In total, 13 interventions (including 1315 women) reviewed used 13 (SD 4.30, range 6-21) BCTs per intervention on average. The “Shaping knowledge” and “Repetition and substitution” behavior change categories were used most frequently, with 92% (12/13) of the interventions implementing at least one of the BCTs from these 2 categories. Only 13.98% (169/1209) of the 93 available BCTs were used, with “Instructions on behaviour” most frequently used (12/13, 92%). The behavior change wheel mapping suggests that half of the intervention content aimed to increase “Capability” (49/98, 50% of the intervention strategies), “Motivation” (41/98, 42%), and “Opportunity” (8/98, 8%). “Behavioural Regulation” was the most frequently used mechanism of action (15/98, 15%), followed by increasing “Knowledge” (13/98, 13%) and “Cognitive and Interpersonal skills” (10/98, 10%). A total of 78% (7/9) of the intervention functions were used in the studies to change behavior, primarily through “Enablement” (60/169, 35.5%), whereas no study used “Restriction” or “Modelling” functions. Although 69% (9/13) of the interventions mentioned a psychological theory or model, most (10/13, 77%) stated or suggested rather than demonstrated the use of a theoretical base, and none reported explicit links between all BCTs within the intervention and the targeted theoretical constructs. Technological components were primarily based on web-based (9/13, 69%) modes of delivery, followed by phone or SMS text message (8/13, 62%) and wearables (7/13, 54%). Conclusions: The findings of this review indicate an overall weak use of theory, low levels of treatment fidelity, insignificant outcomes, and insufficient description of several interventions to support the assessment of how specific BCTs were activated. Thus, the identified limitations in the current literature provide an opportunity to improve the design of lifestyle health-enhancing interventions for women in midlife. Trial Registration: PROSPERO CRD42021259246; https://tinyurl.com/4ph74a9u %M 36350694 %R 10.2196/37234 %U https://mhealth.jmir.org/2022/11/e37234 %U https://doi.org/10.2196/37234 %U http://www.ncbi.nlm.nih.gov/pubmed/36350694 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e37579 %T Text Message Reminders to Improve Immunization Appointment Attendance in Alberta, Canada: The Childhood Immunization Reminder Project Pilot Study %A MacDonald,Shannon E %A Marfo,Emmanuel %A Sell,Hannah %A Assi,Ali %A Frank-Wilson,Andrew %A Atkinson,Katherine %A Kellner,James D %A McNeil,Deborah %A Klein,Kristin %A Svenson,Lawrence W %+ Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405 - 87 Ave NW, Edmonton, AB, T6G 1C9, Canada, 1 780 248 1463, smacdon@ualberta.ca %K text message %K SMS %K immunization reminder %K reminder-recall %K routine immunization %K childhood %K immunization %K reminder %K children %K language barrier %K Canada %K vaccine %K vaccination %K coverage %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Vaccine coverage for 18-month-old children in Canada is often below the recommended level, which may be partially because of parental forgetfulness. SMS text message reminders have been shown to potentially improve childhood immunization uptake but have not been widely used in Alberta, Canada. In addition, it has been noted that language barriers may impede immunization service delivery but continue to remain unaddressed in many existing reminder and recall systems. Objective: This study aimed to assess the effectiveness and acceptability of using SMS text messages containing a link to web-based immunization information in different languages to remind parents of their child’s 18-month immunization appointment. Methods: The Childhood Immunization Reminder Project was a pilot intervention at 2 public health centers, one each in Lethbridge and Edmonton, Alberta, Canada. Two SMS text message reminders were sent to parents: a booking reminder 3 months before their child turned 18 months old and an appointment reminder 3 days before their scheduled appointment. Booking reminders included a link to the study website hosting immunization information in 9 languages. To evaluate intervention effectiveness, we compared the absolute attendance no-show rates before the intervention and after the intervention. The acceptability of the intervention was evaluated through web-based surveys completed by parents and public health center staff. Google Analytics was used to determine how often web-based immunization information was accessed, from where, and in which languages. Results: Following the intervention, the health center in Edmonton had a reduction of 6.4% (95% CI 3%-9.8%) in appointment no-shows, with no change at the Lethbridge Health Center (0.8%, 95% CI −1.4% to 3%). The acceptability surveys were completed by 222 parents (response rate: 23.9%) and 22 staff members. Almost all (>95%) respondents indicated that the reminders were helpful and provided useful suggestions for improvement. All surveyed parents (222/222, 100%) found it helpful to read web-based immunization information in their language of choice. Google Analytics data showed that immunization information was most often read in English (118/207, 57%), Punjabi (52/207, 25.1%), Arabic (13/207, 6.3%), Spanish (12/207, 5.8%), Italian (4/207, 1.9%), Chinese (4/207, 1.9%), French (2/207, 0.9%), Tagalog (1/207, 0.5%), and Vietnamese (1/207, 0.5%). Conclusions: The study’s findings support the use of SMS text message reminders as a convenient and acceptable method to minimize parental forgetfulness and potentially reduce appointment no-shows. The diverse languages accessed in web-based immunization information suggest the need to provide appropriate translated immunization information. Further research is needed to evaluate the impact of SMS text message reminders on childhood immunization coverage in different settings. %M 36346666 %R 10.2196/37579 %U https://mhealth.jmir.org/2022/11/e37579 %U https://doi.org/10.2196/37579 %U http://www.ncbi.nlm.nih.gov/pubmed/36346666 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e38793 %T Quality of Mobile Apps for Child Development Support: Search in App Stores and Content Analysis %A DeWitt,Akeiylah %A Kientz,Julie %A Liljenquist,Kendra %+ Department of Human-Centered Design and Engineering, 423 Sieg Building, Seattle, WA, 98195, United States, 1 206 543 2567, adewitt@uw.edu %K mobile health technologies %K early childhood health promotion %K child development %K parent support technologies %K pediatrics %K parenting %K mobile app %K mobile health %K mHealth %K mobile phone %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Following increases in smartphone access, more parents seek parenting advice through internet sources, including blogs, web-based forums, or mobile apps. However, identifying quality apps (ones that respond to the diverse experiences of families) for guidance on child development can be challenging. Objective: This review of mobile health apps aimed to document the landscape, design, and content of apps in the United States available to parents as they promote their child’s developmental health. Methods: To understand the availability and quality of apps for early childhood health promotion, we completed a content analysis of apps in 2 major app stores (Google Play and Apple App stores). Results: We found that most apps do not provide tailored experiences to parents, including cultural considerations, and instead promote generic guidance that may be useful to parents in some contexts. We discuss the need for an evaluative framework to assess apps aimed to support parents on child development topics. Conclusions: Future work is needed on how to support designers in this area, specifically related to avoiding potential burdens on users and providing culturally informed and equity-driven experiences. %M 36346656 %R 10.2196/38793 %U https://pediatrics.jmir.org/2022/4/e38793 %U https://doi.org/10.2196/38793 %U http://www.ncbi.nlm.nih.gov/pubmed/36346656 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e41689 %T Effectiveness of Mental Health Apps for Distress During COVID-19 in US Unemployed and Essential Workers: Remote Pragmatic Randomized Clinical Trial %A Comtois,Katherine Anne %A Mata-Greve,Felicia %A Johnson,Morgan %A Pullmann,Michael D %A Mosser,Brittany %A Arean,Patricia %+ Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 Pacific Stree NE, Seattle, WA, 98195, United States, 1 14152727222, parean@uw.edu %K COVID-19 %K COVID %K coronavirus %K pandemic %K SARS-CoV-2 %K essential worker %K suicide %K suicidal %K commercial app %K mental health apps %K health app %K mental health %K mHealth %K mobile health %K occupational health %K employee %K employment %K unemployed %K worker %K job %K depression %K anxiety %K stress %K distress %K mobile app %K RCT %K pragmatic trial %K randomized %K health care worker %K health care provider %K frontline staff %D 2022 %7 7.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: During the COVID-19 pandemic, the general public was concerned about the mental health impacts of unemployment due to COVID-19 and the stress essential workers experienced during this time. Several reports indicated that people in distress were turning to digital technology, but there was little evidence about the impact of these tools on mitigating distress. Objective: This study seeks to determine the acceptability, feasibility, usability, and effectiveness of mobile mental health apps for decreasing mental health symptoms in essential workers and unemployed individuals with suicide risk. Methods: We recruited participants who indicated that they were unemployed because of COVID-19 or were COVID-19–designated essential workers. Participants were randomized to 1 of 4 free commercial mobile apps for managing distress that were (1) highly rated by PsyberGuide and (2) met the criteria for intervention features these participants indicated were desirable in a previous survey. Participants used the apps for 4 weeks and completed baseline and 4-week self-assessments of depression, anxiety emotional regulation, and suicide risk. Results: We found no differences between the apps in any outcome but did find significant changes in depression and anxiety over time (Patient Health Questionnaire [PHQ]-9: estimate=–1.5, SE 0.2, 95% CI –1.1 to –1.8, P<.001; Generalized Anxiety Disorder Scale [GAD]-7: estimate=–1.3, SE 0.2, 95% CI –1.0 to –1.6, P<.001). We found no significant changes in suicidal behavior (Suicide Behaviors Questionnaire-Revised [SBQ-R]) or emotional regulation (Difficulties in Emotion Regulation Scale – Short Form [DERS-SF]) for the 4 weeks. We did find a significant dose-response pattern for changes in depression and anxiety. Using the app at least once a week resulted in greater improvements in treatment conditions over time on depression (estimate=–0.6, SE 0.2, 95% CI 1.0-0.2, P=.003) and anxiety (estimate=0.1, SE 0.2, 95% CI 0.4-0.6, P=.78). There was no association between app frequency and changes in suicidal behavior (SBQ-R) or emotional regulation (DERS-SF). We further found a significant difference between the conditions with regard to app usability, with the control app being the most usable (meanBeautiful Mood 72.9, SD 16.7; meanCOVID Coach 71.2, SD 15.4; meanCalm 66.8, SD 17.3; mean7 Cups 65.2, SD 17.7). We found no significant differences for app acceptability or appropriateness. Conclusions: Few studies have evaluated prospectively the utility and usability of commercial apps for mood. This study found that free, self-guided commercial mobile mental health apps are seen as usable, but no one app is superior to the other. Although we found that regular use is indicated for effects on depression and anxiety to occur in those who are more symptomatic, regression to the mean cannot be ruled out. Trial Registration: ClinicalTrials.gov NCT04536935; https://tinyurl.com/mr36zx3s %M 36191176 %R 10.2196/41689 %U https://mhealth.jmir.org/2022/11/e41689 %U https://doi.org/10.2196/41689 %U http://www.ncbi.nlm.nih.gov/pubmed/36191176 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e42376 %T Remotely Assessing Mechanisms of Behavioral Change in Community Substance Use Disorder Treatment to Facilitate Measurement-Informed Care: Pilot Longitudinal Questionnaire Study %A Hallgren,Kevin A %+ Department of Psychiatry and Behavioral Sciences, University of Washington, University of Washington Medical Center, Box 356560, 1959 NE Pacific Street, Seattle, WA, 98195, United States, 1 206 616 2906, khallgre@uw.edu %K addiction %K clinical pilot %K measurement-based care %K mechanisms of change %K mobile health %K mHealth %K mobile phone %D 2022 %7 7.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Research shows that improvements in coping strategies, abstinence self-efficacy, craving, and depression are potential mechanisms of behavioral change (MOBC) in treatments for substance use disorders (SUDs). However, little is known about how these insights regarding MOBC can be applied to SUD treatment settings. One way to facilitate MOBC-informed care in frontline settings could be to measure and monitor changes in MOBC throughout treatment using brief, frequent questionnaires that patients complete by using mobile technologies (eg, smartphones). The results derived from these questionnaires could potentially be used for clinical monitoring (ie, measurement-based care) to better understand whether individual patients are experiencing treatment-related improvements on key clinical targets. Objective: This study evaluated whether brief, weekly MOBC questionnaires completed by patients remotely can potentially provide clinically meaningful information about changes in MOBC in the context of real-world, community-based SUD treatment. Methods: A total of 30 patients (14/30, 47% female; 13/30, 43% racial or ethnic minority) in a community SUD treatment clinic participated in a pilot study where they were invited to complete brief, weekly questionnaires that assessed various MOBC, including coping strategies, abstinence self-efficacy, craving, depression, and therapeutic alliance. Questionnaires were typically completed remotely via smartphone for up to 6 months; 618 questionnaires were completed in total. Participants also completed longer, psychometrically validated measures of the same MOBC at baseline and 6-month research appointments. Statistical analyses tested whether brief, weekly, remotely completed MOBC questionnaires exhibited characteristics that would be desirable for real-world longitudinal clinical monitoring, including a tendency to detect within-person changes in MOBC over time; cross-sectional and longitudinal associations with longer, psychometrically validated measures completed at research appointments; and similar patterns of associations with 6-month percentage of days abstinent as longer, psychometrically validated MOBC measures completed at research appointments. Results: The results of this study indicated that the brief, weekly, remotely completed MOBC measures exhibited characteristics that are desirable for clinical monitoring, including a tendency to vary longitudinally (within patients over time) more often than measures of alcohol and drug consumption, generally having medium to large cross-sectional and longitudinal correlations with longer psychometrically validated measures of MOBC completed at research appointments, and generally having similar patterns of association with 6-month percentage of days abstinent from alcohol and drugs as longer psychometrically validated MOBC measures completed at research appointments. Conclusions: The results of this pilot study provide initial evidence that incorporating brief, weekly, and remotely completed MOBC questionnaires into community SUD treatment may be a viable approach for facilitating MOBC-informed care. Such questionnaires can potentially support measurement-based care by providing meaningful information about within-patient changes in clinical domains that are often directly targeted in SUD treatments and predict long-term substance use outcomes. %M 36342773 %R 10.2196/42376 %U https://formative.jmir.org/2022/11/e42376 %U https://doi.org/10.2196/42376 %U http://www.ncbi.nlm.nih.gov/pubmed/36342773 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e40907 %T Use of a Rapid Qualitative Method to Inform the Development of a Text Messaging Intervention for People With Serious Mental Illness Who Smoke: Formative Research Study %A Nagawa,Catherine S %A Lane,Ian A %A McKay,Colleen E %A Kamberi,Ariana %A Shenette,Lisa L %A Kelly,Megan M %A Davis,Maryann %A Sadasivam,Rajani S %+ Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 508 856 8999, cnagawa@mgh.harvard.edu %K serious mental illness %K mental disorder %K psychiatric disorder %K tobacco use %K smoking cessation %K text messaging %K intervention %K smoking %K mental health %K virtual %K COVID-19 %K pandemic %K symptom %D 2022 %7 7.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: People with serious mental illness are disproportionately affected by smoking and face barriers to accessing smoking cessation treatments in mental health treatment settings. Text-based interventions are cost-effective and represent a widely accessible approach to providing smoking cessation support. Objective: We aimed to identify key factors for adapting text-based cessation interventions for people with serious mental illness who smoke. Methods: We recruited 24 adults from mental health programs who had a serious mental illness and currently smoked cigarettes or had quit smoking within the past 5 years. We then conducted virtual qualitative interviews between November 2020 and August 2021. Data were analyzed using the rapid thematic analytic approach. Results: We identified the following 3 major themes: (1) interplay between smoking and having a serious mental illness, (2) social contextual factors of smoking in adults with serious mental illness, and (3) smoking and quitting behaviors similar to the general population. Participants reported barriers and facilitators to quitting across the 3 themes. Within the “interplay between smoking and having a serious mental illness” theme, barriers included smoking to manage stress and mental health symptoms, and facilitators to quitting included the awareness of the harm of smoking on mental health and patient-provider discussions on smoking and mental health. In the “social contextual factors of smoking in adults with serious mental illness” theme, barriers included high social acceptability of smoking among peers. Positive support and the combined social stigma of smoking and having a mental health condition outside of peer groups motivated individuals to quit. Some participants indicated that low exposure to other smokers during the COVID-19 pandemic helped them to engage in cessation efforts. In the “smoking and quitting behaviors similar to the general population” theme, barriers included smoking after eating, having coffee, drinking alcohol, and experiencing negative social support, and facilitators included health concerns, improvement in the general quality of life, and use of evidence-based tobacco treatments when available. Conclusions: People with serious mental illness often smoke to cope with intense emotional states, manage mental health symptoms, or maintain social bonds. Text message content emphasizing equally effective and less harmful ways for stress reduction and mental health symptom management may improve quit rates in individuals with serious mental illness. %M 36342765 %R 10.2196/40907 %U https://formative.jmir.org/2022/11/e40907 %U https://doi.org/10.2196/40907 %U http://www.ncbi.nlm.nih.gov/pubmed/36342765 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e38951 %T The Effects of an Exposure-Based Mobile App on Symptoms of Posttraumatic Stress Disorder in Veterans: Pilot Randomized Controlled Trial %A McLean,Carmen %A Davis,C Adrian %A Miller,Madeleine %A Ruzek,Josef %A Neri,Eric %+ National Center for Posttraumatic Stress Disorder, Dissemination and Training Division, Department of Veterans Affairs, 795 Willow Road, Menlo Park, CA, 94025, United States, 1 6504935000, carmen.mclean4@va.gov %K posttraumatic stress disorder %K veteran’s health %K exposure therapy %K cognitive behavioral therapy %K mHealth %K mobile apps %K self-management %D 2022 %7 4.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Barriers to accessing in-person care can prevent veterans with posttraumatic stress disorder (PTSD) from receiving trauma-focused treatments such as exposure therapy. Mobile apps may help to address unmet need for services by offering tools for users to self-manage PTSD symptoms. Renew is a mobile mental health app that focuses on exposure therapy and incorporates a social support function designed to promote user engagement. Objective: We examined the preliminary efficacy of Renew with and without support from a research staff member compared with waitlist among 93 veterans with clinically significant PTSD symptoms. We also examined the impact of study staff support on participant engagement with the app. Methods: In a pilot randomized controlled trial, we compared Renew with and without support from a research staff member (active use condition) with waitlist (delayed use condition) over 6 weeks. Participants were recruited through online advertisements. The Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) was used to measure PTSD symptoms at pre, post, and 6-week follow-up. Usage data were collected to assess engagement with Renew. Results: Results indicated a small effect size (d=–0.39) favoring those in the active use conditions relative to the delayed use condition, but the between-group difference was not significant (P=.29). There were no differences on indices of app engagement between the 2 active use conditions. Exploratory analyses found that the number of support persons users added to the app, but not the number of support messages received, was positively correlated with app engagement. Conclusions: Findings suggest Renew may hold promise as a self-management tool to reduce PTSD symptoms in veterans. Involving friends and family in mobile mental health apps may help bolster engagement with no additional cost to public health systems. Trial Registration: ClinicalTrials.gov NCT04155736; https://clinicaltrials.gov/ct2/show/NCT04155736 %M 36331540 %R 10.2196/38951 %U https://mhealth.jmir.org/2022/11/e38951 %U https://doi.org/10.2196/38951 %U http://www.ncbi.nlm.nih.gov/pubmed/36331540 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 11 %P e41482 %T Development of the First Episode Digital Monitoring mHealth Intervention for People With Early Psychosis: Qualitative Interview Study With Clinicians %A Stefancic,Ana %A Rogers,R Tyler %A Styke,Sarah %A Xu,Xiaoyan %A Buchsbaum,Richard %A Nossel,Ilana %A Cabassa,Leopoldo J %A Stroup,T Scott %A Kimhy,David %+ Department of Psychiatry, Icahn School of Medicine, One Gustave L Levy Place, Box 1230, New York, NY, 10029, United States, 1 212 659 8752, david.kimhy@mssm.edu %K first-episode psychosis %K early psychosis %K coordinated specialty care %K mental health treatment %K shared decision-making %K mobile health %K smartphone apps %K qualitative %K digital psychiatry %K mobile phone %D 2022 %7 4.11.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mobile health (mHealth) technologies have been used extensively in psychosis research. In contrast, their integration into real-world clinical care has been limited despite the broad availability of smartphone-based apps targeting mental health care. Most apps developed for treatment of individuals with psychosis have focused primarily on encouraging self-management skills of patients via practicing cognitive behavioral techniques learned during face-to-face clinical sessions (eg, challenging dysfunctional thoughts and relaxation exercises), reminders to engage in health-promoting activities (eg, exercising, sleeping, and socializing), or symptom monitoring. In contrast, few apps have sought to enhance the clinical encounter itself to improve shared decision-making (SDM) and therapeutic relationships with clinicians, which have been linked to positive clinical outcomes. Objective: This qualitative study sought clinicians’ input to develop First Episode Digital Monitoring (FREEDoM), an app-based mHealth intervention. FREEDoM was designed to improve the quality, quantity, and timeliness of clinical and functional data available to clinicians treating patients experiencing first-episode psychosis (FEP) to enhance their therapeutic relationship and increase SDM. Methods: Following the app’s initial development, semistructured qualitative interviews were conducted with 11 FEP treatment providers at 3 coordinated specialty care clinics to elicit input on the app’s design, the data report for clinicians, and planned usage procedures. We then generated a summary template and conducted matrix analysis to systematically categorize suggested adaptations to the evidence-based intervention using dimensions of the Framework for Reporting Adaptations and Modifications‐Enhanced (FRAME) and documented the rationale for adopting or rejecting suggestions. Results: The clinicians provided 31 suggestions (18 adopted and 13 rejected). Suggestions to add or refine the content were most common (eg, adding questions in the app). Adaptations to context were most often related to plans for implementing the intervention, how the reported data were displayed to clinicians, and with whom the reports were shared. Reasons for suggestions primarily included factors related to health narratives and priorities of the patients (eg, focus on the functional impact of symptoms vs their severity), providers’ clinical judgment (eg, need for clinically relevant information), and organizations’ mission and culture. Reasons for rejecting suggestions included requests for data and procedures beyond the intervention’s scope, concerns regarding dilution of the intervention’s core components, and concerns about increasing patient burden while using the app. Conclusions: FREEDoM focuses on a novel target for the deployment of mHealth technologies in the treatment of FEP patients—the enhancement of SDM and improvement of therapeutic relationships. This study illustrates the use of the FRAME, along with methods and tools for rapid qualitative analysis, to systematically track adaptations to the app as part of its development process. Such adaptations may contribute to enhanced acceptance of the intervention by clinicians and a higher likelihood of integration into clinical care. Trial Registration: ClinicalTrials.gov NCT04248517; https://tinyurl.com/tjuyxvv6 %M 36331539 %R 10.2196/41482 %U https://mental.jmir.org/2022/11/e41482 %U https://doi.org/10.2196/41482 %U http://www.ncbi.nlm.nih.gov/pubmed/36331539 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 2 %P e35876 %T The Use of Dietary Approaches to Stop Hypertension (DASH) Mobile Apps for Supporting a Healthy Diet and Controlling Hypertension in Adults: Systematic Review %A Alnooh,Ghadah %A Alessa,Tourkiah %A Hawley,Mark %A de Witte,Luc %+ Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, 1st Floor, The Innovation Centre, 217 Portobello, Sheffield, S1 4DP, United Kingdom, 44 114 222 0682, mark.hawley@sheffield.ac.uk %K DASH diet %K Dietary Approaches to Stop Hypertension %K smartphone app %K mobile app %K blood pressure %D 2022 %7 2.11.2022 %9 Review %J JMIR Cardio %G English %X Background: Uncontrolled hypertension is a public health issue, with increasing prevalence worldwide. The Dietary Approaches to Stop Hypertension (DASH) diet is one of the most effective dietary approaches for lowering blood pressure (BP). Dietary mobile apps have gained popularity and are being used to support DASH diet self-management, aiming to improve DASH diet adherence and thus lower BP. Objective: This systematic review aimed to assess the effectiveness of smartphone apps that support self-management to improve DASH diet adherence and consequently reduce BP. A secondary aim was to assess engagement, satisfaction, acceptance, and usability related to DASH mobile app use. Methods: The Embase (OVID), Cochrane Library, CINAHL, Web of Science, Scopus, and Google Scholar electronic databases were used to conduct systematic searches for studies conducted between 2008 and 2021 that used DASH smartphone apps to support self-management. The reference lists of the included articles were also checked. Studies were eligible if they (1) were randomized controlled trials (RCTs) or pre-post studies of app-based interventions for adults (aged 18 years or above) with prehypertension or hypertension, without consideration of gender or sociodemographic characteristics; (2) used mobile phone apps alone or combined with another component, such as communication with others; (3) used or did not use any comparator; and (4) had the primary outcome measures of BP level and adherence to the DASH diet. For eligible studies, data were extracted and outcomes were organized into logical categories, including clinical outcomes (eg, systolic BP, diastolic BP, and weight loss), DASH diet adherence, app usability and acceptability, and user engagement and satisfaction. The quality of the studies was evaluated using the Cochrane Collaboration’s Risk of Bias tool for RCTs, and nonrandomized quantitative studies were evaluated using a tool provided by the US National Institutes of Health. Results: A total of 5 studies (3 RCTs and 2 pre-post studies) including 334 participants examined DASH mobile apps. All studies found a positive trend related to the use of DASH smartphone apps, but the 3 RCTs had a high risk of bias. One pre-post study had a high risk of bias, while the other had a low risk. As a consequence, no firm conclusions could be drawn regarding the effectiveness of DASH smartphone apps for increasing DASH diet adherence and lowering BP. All the apps appeared to be acceptable and easy to use. Conclusions: There is weak emerging evidence of a positive effect of using DASH smartphone apps for supporting self-management to improve DASH diet adherence and consequently lower BP. Further research is needed to provide high-quality evidence that can determine the effectiveness of DASH smartphone apps. %M 36322108 %R 10.2196/35876 %U https://cardio.jmir.org/2022/2/e35876 %U https://doi.org/10.2196/35876 %U http://www.ncbi.nlm.nih.gov/pubmed/36322108 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e25879 %T Digital Coaching Using Smart Inhaler Technology to Improve Asthma Management in Patients With Asthma in Italy: Community-Based Study %A Rumi,Gabriele %A Canonica,G Walter %A Foster,Juliet M %A Chavannes,Niels H %A Valenti,Giuseppe %A Contiguglia,Rosario %A Rapsomaniki,Eleni %A Kocks,Janwillem W H %A De Brasi,Dario %A Braido,Fulvio %+ Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore – Medicina Interna, Presidio Columbus – COVID Team, Via Giuseppe Moscati 31, Rome, 00168, Italy, 39 06 30155896, gabriele.rumi@policlinicogemelli.it %K asthma control %K asthma management %K connected devices %K digital health %K eHealth %K inhalers %K maintenance and reliever therapy %K mobile phone %D 2022 %7 2.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Reliance on short-acting β-2 agonists and nonadherence to maintenance medication are associated with poor clinical outcomes in asthma. Digital health solutions could support optimal medication use and therefore disease control in patients with asthma; however, their use in community settings has not been determined. Objective: The primary objective of this study is to investigate community implementation of the Turbu+ program designed to support asthma self-management, including adherence to budesonide and formoterol (Symbicort) Turbuhaler, a combination inhaler for both maintenance therapy or maintenance and reliever therapy. The secondary objective is to provide health care professionals with insights into how patients were using their medication in real life. Methods: Patients with physician-diagnosed asthma were prescribed budesonide and formoterol as maintenance therapy, at a dose of either 1 inhalation twice daily (1-BID) or 2 inhalations twice daily (2-BID), or as maintenance and reliever therapy (1-BID and reliever or 2-BID and reliever in a single inhaler), and they received training on Turbu+ in secondary care centers across Italy. An electronic device attached to the patients’ inhaler for ≥90 days (data cutoff) securely uploaded medication use data to a smartphone app and provided reminders, visualized medication use, and motivational nudge messages. Average medication adherence was defined as the proportion of daily maintenance inhalations taken as prescribed (number of recorded maintenance actuations per day or maintenance inhalations prescribed per day) averaged over the monitoring period. The proportion of adherent days was defined as the proportion of days when all prescribed maintenance inhalations were taken on a given day. The Wilcoxon test was used to compare the proportion of adherent days between patients in the maintenance regimen and patients in the maintenance and reliever regimen of a given dose. Results: In 661 patients, the mean (SD) number of days monitored was 217.2 (SD 109.0) days. The average medication adherence (maintenance doses taken/doses prescribed) was 70.2% (108,040/153,820) overall and was similar across the groups (1-BID: 6332/9520, 66.5%; 1‑BID and reliever: 43,578/61,360, 71.0%; 2-BID: 10,088/14,960, 67.4%; 2-BID and reliever: 48,042/67,980, 70.7%). The proportion of adherent days (prescribed maintenance doses/doses taken in a given day) was 56.6% (31,812/56,175) overall and was higher with maintenance and reliever therapy (1-BID and reliever vs 1-BID: 18,413/30,680, 60.0% vs 2510/4760, 52.7%; P<.001; 2-BID and reliever vs 2-BID: 8995/16,995, 52.9% vs 1894/3740, 50.6%; P=.02). Rates of discontinuation from the Turbu+ program were significantly lower with maintenance and reliever therapy compared with maintenance therapy alone (P=.01). Conclusions: Overall, the high medication adherence observed during the study might be attributed to the electronic monitoring and feedback mechanism provided by the Turbu+ program. %M 36322120 %R 10.2196/25879 %U https://mhealth.jmir.org/2022/11/e25879 %U https://doi.org/10.2196/25879 %U http://www.ncbi.nlm.nih.gov/pubmed/36322120 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e38460 %T Brief App-Based Cognitive Behavioral Therapy for Anxiety Symptoms in Psychiatric Inpatients: Feasibility Randomized Controlled Trial %A Sharma,Gaurav %A Schlosser,Lisa %A Jones,Brett D M %A Blumberger,Daniel M %A Gratzer,David %A Husain,M Omair %A Mulsant,Benoit H %A Rappaport,Lance %A Stergiopoulos,Vicky %A Husain,Muhammad Ishrat %+ Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada, 1 416 979 6948, mr.sharma@mail.utoronto.ca %K inpatient %K mental health %K mental disorder %K psychiatry %K psychiatric %K smartphone app %K cognitive behavioral therapy %K CBT %K anxiety %K mobile app %K mobile health %K mHealth %K health app %K digital health %K eHealth %K feasibility study %K randomized controlled trial %K RCT %K feasibility %K acceptability %D 2022 %7 2.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychiatric inpatients often have limited access to psychotherapeutic education or skills for managing anxiety, a common transdiagnostic concern in severe and acute mental illness. COVID-19–related restrictions further limited access to therapy groups on inpatient psychiatric units. App-based interventions may improve access, but evidence supporting the feasibility of their use, acceptability, and effectiveness in psychiatric inpatient settings is limited. MindShift CBT is a free app based on cognitive behavioral therapy principles with evidence for alleviating anxiety symptoms in the outpatient setting. Objective: We aimed to recruit 24 participants from an acute general psychiatric inpatient ward to a 1-month randomized control study assessing the feasibility and acceptability of providing patients with severe and acute mental illness access to the MindShift CBT app for help with managing anxiety symptoms. Methods: Recruitment, data collection, analysis, and interpretation were completed collaboratively by clinician and peer researchers. Inpatients were randomized to two conditions: treatment as usual (TAU) versus TAU plus use of the MindShift CBT app over 6 days. We collected demographic and quantitative data on acceptability and usability of the intervention. Symptoms of depression, anxiety, and psychological distress were measured in pre- and poststudy surveys for preliminary signals of efficacy. We conducted individual semistructured interviews with participants in the MindShift CBT app group at the end of their trial period, which were interpreted using a standardized protocol for thematic analysis. Results: Over 4 weeks, 33 inpatients were referred to the study, 24 consented to participate, 20 were randomized, and 11 completed the study. Of the 9 randomized participants who did not complete the study, 7 were withdrawn because they were discharged or transferred prior to study completion, with a similar distribution among both conditions. Among the enrolled patients, 65% (13/20) were admitted for a psychotic disorder and no patient was admitted primarily for an anxiety disorder. The average length of stay was 20 days (SD 4.4; range 3-21) and 35% (7/20) of patients were involuntarily admitted to hospital. Small sample sizes limited accurate interpretation of the efficacy data. Themes emerging from qualitative interviews included acceptability and usability of the app, and patient agency associated with voluntary participation in research while admitted to hospital. Conclusions: Our study benefitted from collaboration between peer and clinician researchers. Due to rapid patient turnover in the acute inpatient setting, additional flexibility in recruitment and enrollment is needed to determine the efficacy of using app-based psychotherapy on an acute psychiatric ward. Despite the limited sample size, our study suggests that similar interventions may be feasible and acceptable for acutely unwell inpatients. Further study is needed to compare the efficacy of psychotherapeutic apps with existing standards of care in this setting. Trial Registration: ClinicalTrials.gov NCT04841603; https://clinicaltrials.gov/ct2/show/NCT04841603 %M 36322113 %R 10.2196/38460 %U https://formative.jmir.org/2022/11/e38460 %U https://doi.org/10.2196/38460 %U http://www.ncbi.nlm.nih.gov/pubmed/36322113 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 10 %P e37980 %T The Definitions of Health Apps and Medical Apps From the Perspective of Public Health and Law: Qualitative Analysis of an Interdisciplinary Literature Overview %A Maaß,Laura %A Freye,Merle %A Pan,Chen-Chia %A Dassow,Hans-Henrik %A Niess,Jasmin %A Jahnel,Tina %+ Department of Health, Long-Term Care and Pensions, Research Center on Inequality and Social Policy, University of Bremen, Unicom-Building, Room 3.4200, Mary-Somerville-Straße 3, Bremen, 28359, Germany, 49 421 218 58610, laura.maass@uni-bremen.de %K mobile health %K health app %K medical app %K digital health %K regulation %K mobile medical device %K digital health applications %K DiGA %K digital care applications %K DiPA %K snowball search %K mobile phone %D 2022 %7 31.10.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The terms health app and medical app are often used interchangeably but do not necessarily mean the same thing. To better understand these terms and better regulate such technologies, we need distinct definitions of health and medical apps. Objective: This study aimed to provide an overview of the definitions of health and medical apps from an interdisciplinary perspective. We summarized the core elements of the identified definitions for their holistic understanding in the context of digital public health. Methods: The legal frameworks for medical device regulation in the United States, the European Union, and Germany formed the basis of this study. We then searched 6 databases for articles defining health or medical apps from an interdisciplinary perspective. The narrative literature review was supported by a forward and backward snowball search for more original definitions of health and medical apps. A qualitative analysis was conducted on the identified relevant aspects and core elements of each definition. On the basis of these findings, we developed a holistic definition of health and medical apps and created a decision flowchart to highlight the differences between the 2 types. Results: The legal framework showed that medical apps could be regulated as mobile medical devices, whereas there is no legal term for health apps. Our narrative literature review identified 204 peer-reviewed publications that offered a definition of health and medical apps. After screening for original definitions and applying the snowball method, 11.8% (24/204) of the publications were included in the qualitative analysis. Of these 24 publications, 22 (88%) provided an original definition of health apps and 11 (44%) described medical apps. The literature suggests that medical apps are a part of health apps. To describe health or medical apps, most definitions used the user group, a description of health, the device, the legal regulation, collected data, or technological functions. However, the regulation should not be a distinction criterion as it requires legal knowledge, which is neither suitable nor practical. An app’s intended medical or health use enables a clear differentiation between health and medical apps. Ultimately, the health aim of an app and its main target group are the only distinction criteria. Conclusions: Health apps are software programs on mobile devices that process health-related data on or for their users. They can be used by every health-conscious person to maintain, improve, or manage the health of an individual or the community. As an umbrella term, health apps include medical apps. Medical apps share the same technological functions and devices. Health professionals, patients, and family caregivers are the main user groups. Medical apps are intended for clinical and medical purposes and can be legally regulated as mobile medical devices. %M 36315221 %R 10.2196/37980 %U https://mhealth.jmir.org/2022/10/e37980 %U https://doi.org/10.2196/37980 %U http://www.ncbi.nlm.nih.gov/pubmed/36315221 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 10 %P e28082 %T Validity of Chatbot Use for Mental Health Assessment: Experimental Study %A Schick,Anita %A Feine,Jasper %A Morana,Stefan %A Maedche,Alexander %A Reininghaus,Ulrich %+ Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, Mannheim, 68219, Germany, 49 62117031941, anita.schick@zi-mannheim.de %K chatbot %K distress %K monitoring %K mobile health %K social desirability %K social presence %D 2022 %7 31.10.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental disorders in adolescence and young adulthood are major public health concerns. Digital tools such as text-based conversational agents (ie, chatbots) are a promising technology for facilitating mental health assessment. However, the human-like interaction style of chatbots may induce potential biases, such as socially desirable responding (SDR), and may require further effort to complete assessments. Objective: This study aimed to investigate the convergent and discriminant validity of chatbots for mental health assessments, the effect of assessment mode on SDR, and the effort required by participants for assessments using chatbots compared with established modes. Methods: In a counterbalanced within-subject design, we assessed 2 different constructs—psychological distress (Kessler Psychological Distress Scale and Brief Symptom Inventory-18) and problematic alcohol use (Alcohol Use Disorders Identification Test-3)—in 3 modes (chatbot, paper-and-pencil, and web-based), and examined convergent and discriminant validity. In addition, we investigated the effect of mode on SDR, controlling for perceived sensitivity of items and individuals’ tendency to respond in a socially desirable way, and we also assessed the perceived social presence of modes. Including a between-subject condition, we further investigated whether SDR is increased in chatbot assessments when applied in a self-report setting versus when human interaction may be expected. Finally, the effort (ie, complexity, difficulty, burden, and time) required to complete the assessments was investigated. Results: A total of 146 young adults (mean age 24, SD 6.42 years; n=67, 45.9% female) were recruited from a research panel for laboratory experiments. The results revealed high positive correlations (all P<.001) of measures of the same construct across different modes, indicating the convergent validity of chatbot assessments. Furthermore, there were no correlations between the distinct constructs, indicating discriminant validity. Moreover, there were no differences in SDR between modes and whether human interaction was expected, although the perceived social presence of the chatbot mode was higher than that of the established modes (P<.001). Finally, greater effort (all P<.05) and more time were needed to complete chatbot assessments than for completing the established modes (P<.001). Conclusions: Our findings suggest that chatbots may yield valid results. Furthermore, an understanding of chatbot design trade-offs in terms of potential strengths (ie, increased social presence) and limitations (ie, increased effort) when assessing mental health were established. %M 36315228 %R 10.2196/28082 %U https://mhealth.jmir.org/2022/10/e28082 %U https://doi.org/10.2196/28082 %U http://www.ncbi.nlm.nih.gov/pubmed/36315228 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 4 %P e41401 %T Clinical Utility of a Digital Therapeutic Intervention in Indian Patients With Type 2 Diabetes Mellitus: 12-Week Prospective Single-Arm Intervention Study %A Chawla,Rajeev %A Jaggi,Shalini %A Gupta,Amit %A Bantwal,Ganapathi %A Patil,Suhas %+ Terrals Technologies Private Ltd, Phable Care, 2734 27th Main Road, Sector-1, HSR Layout, Bangaluru, 560102, India, 91 9145653175, suhas.patil@phablecare.com %K HbA1c %K type 2 diabetes %K digital therapeutics %K fasting blood glucose %K postprandial blood glucose %K mHealth %K digital health intervention %K glycemic control %K mobile health %D 2022 %7 31.10.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: Patients with type 2 diabetes mellitus (T2DM) having elevated levels of blood glucose and glycated hemoglobin (HbA1c) are at higher risk of macro- and microvascular complications. Nonetheless, the goal of achieving glycemic control cannot be met with the use of pharmacotherapy alone. The recent emergence of digital therapeutic tools has shown the possibility of improving the modifiable risk factors and self-management of diabetes. Objective: The aim of this study was to examine the clinical utility of a digital therapeutic intervention as an add-on therapy to achieve glycemic control in patients with T2DM. Methods: This was a 12-week prospective, single-arm digital intervention study in patients with T2DM receiving regular antidiabetic treatment. The eligibility criteria included male and female patients with HbA1c≥6.5%, functional English literacy, and a mobile phone capable of running the intervention app. Outcome measures of the study were mean changes in HbA1c, fasting blood glucose (FBG), postprandial blood glucose (PPBG), BMI, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index at the end of 12 weeks. Results: A total of 128 participants completed the study period of 12 weeks. There were 54.7% (70/128) men and 45.3% (58/128) women with a mean age of 48.48 years (SD 10.27). At the end of 12 weeks, the mean change in HbA1c, FBG, PPBG, and BMI for the overall study population was –0.84% (P<.001), –8.39 mg/dl (P=.02), –14.97 mg/dl (P<.001), and –0.24 kg/m2 (P=.06), respectively. Among the participants showing improvement in the HbA1c value at the end of 12 weeks (responders), the mean change in HbA1c, FBG, PPBG, and BMI was –1.24% (P<.001), –12.42 mg/dl (P=.003), –21.45 mg/dl (P<.001), and –0.34 kg/m2 (P=.007), respectively. There was an increase in HOMA-IR values for the overall study population (0.54, P=.29). HbA1c response showed a significant association with a baseline HbA1c level ≥7.5%, no prior history of smoking, and no prior COVID-19 infection, as well as with higher levels of program engagement. Conclusions: A digital therapeutic intervention when used alongside standard medications significantly reduces HbA1c, FBG, and PPBG levels in patients with T2DM. %M 36226840 %R 10.2196/41401 %U https://diabetes.jmir.org/2022/4/e41401 %U https://doi.org/10.2196/41401 %U http://www.ncbi.nlm.nih.gov/pubmed/36226840 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e38387 %T Informing mHealth and Web-Based Eating Disorder Interventions: Combining Lived Experience Perspectives With Design Thinking Approaches %A Jarman,Hannah K %A McLean,Siân A %A Rodgers,Rachel %A Fuller-Tyszkiewicz,Matthew %A Paxton,Susan %A O'Gorman,Beth %A Harris,Emily %A Shatte,Adrian %A Bishop,Katie %A Baumann,Tahlia %A Mahoney,Danielle %A Daugelat,Melissa-Claire %A Yager,Zali %+ School of Psychology, Deakin University, 1 Gheringhap St, Geelong, 3220, Australia, 61 3 9251 7777, h.jarman@deakin.edu.au %K eating disorders %K app-based intervention %K lived experience %K design thinking %K interviews %K young women %K co-design %K mobile health %K mHealth %D 2022 %7 31.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: App-based interventions designed to prevent and treat eating disorders have considerable potential to overcome known barriers to treatment seeking. Existing apps have shown efficacy in terms of symptom reduction; however, uptake and retention issues are common. To ensure that apps meet the needs and preferences of those for whom they were designed, it is critical to understand the lived experience of potential users and involve them in the process of design, development, and delivery. However, few app-based interventions are pretested on and co-designed with end users before randomized controlled trials. Objective: To address the issue, this study used a highly novel design thinking approach to provide the context and a lived experience perspective of the end user, thus allowing for a deeper level of understanding. Methods: In total, 7 young women (mean age 25.83, SD 5.34, range 21-33 years) who self-identified as having a history of body image issues or eating disorders were recruited. Participants were interviewed about their lived experience of body image and eating disorders and reported their needs and preferences for app-based eating disorder interventions. Traditional (thematic analysis) and novel (empathy mapping; visually depicting and empathizing with the user’s personal experience) analyses were performed, providing a lived experience perspective of eating disorders and identifying the needs and preferences of this population in relation to app-based interventions for eating disorders. Key challenges and opportunities for app-based eating disorder interventions were also identified. Results: Findings highlighted the importance of understanding and identifying problematic eating disorder symptoms for the user, helpful practices for recovery that identify personal values and goals, the role of social support in facilitating hope, and aspects of usability to promote continued engagement and recovery. Conclusions: Practical guidance and recommendations are described for those developing app-based eating disorder interventions. These findings have the potential to inform practices to enhance participant uptake and retention in the context of app-based interventions for this population. %M 36315225 %R 10.2196/38387 %U https://formative.jmir.org/2022/10/e38387 %U https://doi.org/10.2196/38387 %U http://www.ncbi.nlm.nih.gov/pubmed/36315225 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e42216 %T Incentives and Reminders to Improve Long-term Medication Adherence (INMIND): Protocol for a Pilot Randomized Controlled Trial %A Stecher,Chad %A Ghai,Ishita %A Lunkuse,Lillian %A Wabukala,Peter %A Odiit,Mary %A Nakanwagi,Agnes %A Linnemayr,Sebastian %+ College of Health Solutions, Arizona State University, 500 N 3rd Street, Phoenix, AZ, 85004, United States, 1 6024960957, chad.stecher@asu.edu %K medication adherence %K HIV %K antiretroviral therapy %K habit formation %K routines %K behavioral economics %D 2022 %7 31.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Nonadherence to antiretroviral therapy (ART) among people living with HIV is a crucial barrier to attaining viral suppression globally. Existing behavioral interventions have successfully increased ART adherence, but typically show only short-term impact that dissipates after the interventions are withdrawn. Objective: This study aims to test the feasibility, acceptability, and preliminary efficacy of a novel intervention that uses SMS text messages and conditional incentives to support ART initiators in establishing pill-taking habits. Methods: A sample of 150 participants aged ≥18 years who have initiated ART in the preceding 3 months will be recruited from Mildmay Uganda in Kampala, Uganda. All (150/150, 100%) participants will be educated on the anchoring strategy and will choose an existing routine to pair with their daily ART adherence from a set of 3 suggested routines: getting dressed in the morning, eating breakfast, or eating dinner. Then, participants will be randomized to receive either usual care (control group: 50/150, 33.3%) or 1 of the 2 interventions delivered over 3 months: daily SMS text message reminders to follow their chosen anchoring plan (messages group; treatment group 1: 50/150, 33.3%) or daily SMS text messages and incentives conditional on taking their ART medication around the time of their chosen anchor (incentives group; treatment group 2: 50/150, 33.3%). Long-term ART adherence will be evaluated for 6 months after the intervention, and survey assessments will be conducted at baseline, 3 months, and 9 months. Outcomes include feasibility and acceptability measures and intervention efficacy outcomes defined by electronically measured mean medication adherence during the intervention and during the 6 months after the intervention, along with a measure of routine ART adherence based on taking medications around the time of participants’ anchor during the intervention and during the 6 months after intervention. Results: As of February 18, 2022, recruitment was completed. A total of 150 participants were recruited, and data collection is expected to end in December of 2022. Final results are expected to be submitted for publication by April 2023. Conclusions: This study is the first to use behavioral economics–based interventions in combination with the anchoring strategy to improve long-term ART adherence among treatment initiators. We hypothesize that the combination of SMS text message reminders and incentives will increase participants’ use of their anchoring strategy, and thus medication adherence will be better maintained after the intervention ends in our intervention groups relative to the control group that uses only the anchoring strategy. Results of this pilot study will help to refine this combined intervention approach for testing at scale and broaden our understanding of the habit formation process. Trial Registration: ClinicalTrials.gov NCT05131165; https://clinicaltrials.gov/ct2/show/NCT05131165 International Registered Report Identifier (IRRID): DERR1-10.2196/42216 %M 36315224 %R 10.2196/42216 %U https://www.researchprotocols.org/2022/10/e42216 %U https://doi.org/10.2196/42216 %U http://www.ncbi.nlm.nih.gov/pubmed/36315224 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e39225 %T Developing a Parenting App to Support Young Children’s Socioemotional and Cognitive Development in Culturally Diverse Low- and Middle-Income Countries: Protocol for a Co-design Study %A LaMonica,Haley M %A Crouse,Jacob J %A Song,Yun J C %A Alam,Mafruha %A Ekambareshwar,Mahalakshmi %A Loblay,Victoria %A Yoon,Adam %A Cha,Grace %A Wilson,Chloe %A Sweeney-Nash,Madelaine %A Foo,Nathanael %A Teo,Melissa %A Perhirin,Mikael %A Troy,Jakelin %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Sydney, 2050, Australia, 61 426955658, haley.lamonica@sydney.edu.au %K child development %K digital technology %K global health %K co-design %K participatory research %K stakeholder participation %K mobile app %D 2022 %7 31.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital technologies are widely recognized for their equalizing effect, improving access to affordable health care regardless of gender, ethnicity, socioeconomic status, or geographic region. The Thrive by Five app is designed to promote positive interactions between children and their parents, extended family, and trusted members of the community to support socioemotional and cognitive development in the first 5 years of life and to strengthen connections to culture and community. Objective: This paper aims to describe the iterative co-design process that underpins the development and refinement of Thrive by Five’s features, functions, and content. Minderoo Foundation commissioned this work as a quality improvement activity to support an engaging user experience and inform the development of culturally appropriate and relevant content for parents and caregivers in each country where the app is implemented. Methods: The app content, referred to as Collective Actions, comprises “The Why,” that presents scientific principles that underpin socioemotional and cognitive development in early childhood. The scientific information is coupled with childrearing activities for parents, extended family, and members of the community to engage in with the children to support their healthy development and to promote positive connections between parents, families, and communities and these young children. Importantly, the initial content is designed and iteratively refined in collaboration with a subject matter expert group from each country (ie, alpha testing). This content is then configured into the app (either a beta version or localized version) for testing (ie, beta testing) by local parents and caregivers as well as experts who are invited to provide their feedback and suggestions for improvements in app content, features, and functions via a brief web-based survey and a series of co-design workshops. The quantitative survey data will be analyzed using descriptive statistics, whereas the analysis of qualitative data from the workshops will follow established thematic techniques. Results: To date, the co-design protocol has been completed with subject matter experts, parents, and caregivers from 9 countries, with the first results expected to be published by early 2023. The protocol will be implemented serially in the remaining 21 countries. Conclusions: Mobile technologies are the primary means of internet connection in many countries worldwide, which underscores the potential for mobile health programs to improve access to valuable, evidence-based, and previously unavailable parenting information. However, for maximum impact, it is critically important to ensure that mobile health programs are designed in collaboration with the target audience to support the alignment of content with parents’ cultural values and traditions and its relevance to their needs and circumstances. International Registered Report Identifier (IRRID): DERR1-10.2196/39225 %M 36315237 %R 10.2196/39225 %U https://www.researchprotocols.org/2022/10/e39225 %U https://doi.org/10.2196/39225 %U http://www.ncbi.nlm.nih.gov/pubmed/36315237 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e36049 %T Telehealth Movement-to-Music to Increase Physical Activity Participation Among Adolescents With Cerebral Palsy: Pilot Randomized Controlled Trial %A Lai,Byron %A Vogtle,Laura %A Young,Raven %A Craig,Mary %A Kim,Yumi %A Gowey,Marissa %A Swanson-Kimani,Erin %A Davis,Drew %A Rimmer,James H %+ Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Avenue South, 5 Dearth, McWane 5601, Birmingham, AL, 35209, United States, 1 205 638 9790 ext 8, blai@uabmc.edu %K exercise %K developmental disability %K cerebral palsy %K telemedicine %K telerehabilitation %K therapy %K mobile phone %D 2022 %7 28.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents with cerebral palsy (CP) who have mobility limitations have almost no access to inexpensive and enjoyable home-based programs that can be disseminated on a large scale to help them independently manage their health through participation in leisure-time physical activity (LTPA). Objective: The primary aim of this study was to determine the preliminary efficacy of the early adoption phase of an adult Movement-to-Music (M2M) program with behavioral telecoaching for increasing LTPA and activity participation compared with a waitlist control group in adolescents with CP. The secondary aim was to explore the effects of the program on perceived levels of pain and fatigue. The tertiary aim was to qualitatively evaluate the factors that influenced adherence and develop a theory that would inform the development of a more targeted M2M telehealth program for this group. Methods: This randomized controlled trial piloted a 4-week M2M program with weekly behavioral telecoaching among 58 adolescents with CP who walked or used wheelchairs. The participants were randomized into one of 2 groups: M2M or control, which maintained their daily activities. M2M included videos that participants were asked to complete 3 times each week at home (asynchronous training). Adherence to video minutes was objectively measured using cloud-based analytics. Changes in activity and LTPA participation were measured before and after the intervention using the Children’s Assessment of Participation and Enjoyment total domain scores and active physical recreation domain scores, respectively. Perceived pain and fatigue were measured using the National Institutes of Health Neuro-QoL short forms. The changes in scores were compared between the groups using analysis of covariance. A grounded theory approach was used to analyze one-on-one interviews, coaching notes, and feedback surveys. Results: A total of 58 people were enrolled, of which 49 (84%) completed the primary outcome follow-up assessment. The mean adherence to the prescribed exercise video minutes across all 4 weeks was 68%, starting from 90% in week 1 and gradually declining to 43% in week 4. Mean adherence to coaching calls was 91%. Analysis of covariance revealed a statistically significant difference between the pre- to postchange scores for Children’s Assessment of Participation and Enjoyment Active Physical Recreation–Intensity domain scores in favor of the intervention group (F1,47=8.76; P=.005; effect size=0.17, also known as volume of LTPA). The qualitative findings highlighted 5 critical factors that influenced participants’ adherence to the program: caregiver support, video elements, suitable exercises, music, and behavioral coaching. Conclusions: This project determined that adolescents with CP responded well to an M2M telehealth program that could enhance their LTPA levels. This paper describes a theory in which adherence to a telehealth LTPA program can be optimized through functional and age-specific modifications for adolescents with CP. Trial Registration: ClinicalTrials.gov NCT04264390; https://clinicaltrials.gov/ct2/show/NCT04264390 %M 36306154 %R 10.2196/36049 %U https://formative.jmir.org/2022/10/e36049 %U https://doi.org/10.2196/36049 %U http://www.ncbi.nlm.nih.gov/pubmed/36306154 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e42554 %T Leveraging Social Media to Increase Access to an Evidence-Based Diabetes Intervention Among Low-Income Chinese Immigrants: Protocol for a Pilot Randomized Controlled Trial %A Hu,Lu %A Islam,Nadia %A Zhang,Yiyang %A Shi,Yun %A Li,Huilin %A Wang,Chan %A Sevick,Mary Ann %+ Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Ave, New York, NY, 10016, United States, 1 646 501 3438, lu.hu@nyulangone.org %K diabetes %K health equity %K immigrant health %K mobile health %K social media %K messaging app %K health education %K education video %K diabetes education %K self-management %D 2022 %7 28.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Type 2 diabetes (T2D) in Chinese Americans is a rising public health concern for the US health care system. The majority of Chinese Americans with T2D are foreign-born older immigrants and report limited English proficiency and health literacy. Multiple social determinants of health limit access to evidence-based diabetes interventions for underserved Chinese immigrants. A social media–based diabetes intervention may be feasible to reach this community. Objective: The purpose of the Chinese American Research and Education (CARE) study was to examine the potential efficacy of a social media–based intervention on glycemic control in Chinese Americans with T2D. Additionally, the study aimed to explore the potential effects of the intervention on psychosocial and behavioral factors involved in successful T2D management. In this report, we describe the design and protocol of the CARE trial. Methods: CARE was a pilot randomized controlled trial (RCT; n=60) of a 3-month intervention. Participants were randomized to one of two arms (n=30 each): wait-list control or CARE intervention. Each week, CARE intervention participants received two culturally and linguistically tailored diabetes self-management videos for a total of 12 weeks. Video links were delivered to participants via WeChat, a free and popular social media app among Chinese immigrants. In addition, CARE intervention participants received biweekly phone calls from the study’s community health workers to set goals related to T2D self-management and work on addressing goal-achievement barriers. Hemoglobin A1c (HbA1c), self-efficacy, diabetes self-management behaviors, dietary intake, and physical activity were measured at baseline, 3 months, and 6 months. Piecewise linear mixed-effects modeling will be performed to examine intergroup differences in HbA1c and psychosocial and behavioral outcomes. Results: This pilot RCT study was approved by the Institutional Review Board at NYU Grossman School of Medicine in March 2021. The first participant was enrolled in March 2021, and the recruitment goal (n=60) was met in March 2022. All data collection is expected to conclude by November 2022, with data analysis and study results ready for reporting by December 2023. Findings from this pilot RCT will further guide the team in planning a future large-scale study. Conclusions: This study will serve as an important first step in exploring scalable interventions to increase access to evidence-based diabetes interventions among underserved, low-income, immigrant populations. This has significant implications for chronic care in other high-risk immigrant groups, such as low-income Hispanic immigrants, who also bear a high T2D burden, face similar barriers to accessing diabetes programs, and report frequent social media use (eg, WhatsApp). Trial Registration: ClinicalTrials.gov NCT03557697; https://clinicaltrials.gov/ct2/show/NCT03557697 International Registered Report Identifier (IRRID): DERR1-10.2196/42554 %M 36306161 %R 10.2196/42554 %U https://www.researchprotocols.org/2022/10/e42554 %U https://doi.org/10.2196/42554 %U http://www.ncbi.nlm.nih.gov/pubmed/36306161 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e38215 %T Relationships Between Blood Pressure Reduction, Weight Loss, and Engagement in a Digital App–Based Hypertension Care Program: Observational Study %A Branch,OraLee H %A Rikhy,Mohit %A Auster-Gussman,Lisa A %A Lockwood,Kimberly G %A Graham,Sarah A %+ Lark Technologies, Inc, 2570 El Camino Real, Mountain View, CA, 94040, United States, 1 650 300 1755, sarah.graham@lark.com %K high blood pressure %K obesity %K weight loss %K conversational artificial intelligence %K lifestyle coaching %D 2022 %7 27.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Home blood pressure (BP) monitoring is recommended for people with hypertension; however, meta-analyses have demonstrated that BP improvements are related to additional coaching support in combination with self-monitoring, with little or no effect of self-monitoring alone. High-contact coaching requires substantial resources and may be difficult to deliver via human coaching models. Objective: This observational study assessed changes in BP and body weight following participation in a fully digital program called Lark Hypertension Care with coaching powered by artificial intelligence (AI). Methods: Participants (N=864) had a baseline systolic BP (SBP) ≥120 mm Hg, provided their baseline body weight, and had reached at least their third month in the program. The primary outcome was the change in SBP at 3 and 6 months, with secondary outcomes of change in body weight and associations of changes in SBP and body weight with participant demographics, characteristics, and program engagement. Results: By month 3, there was a significant drop of –5.4 mm Hg (95% CI –6.5 to –4.3; P<.001) in mean SBP from baseline. BP did not change significantly (ie, the SBP drop maintained) from 3 to 6 months for participants who provided readings at both time points (P=.49). Half of the participants achieved a clinically meaningful drop of ≥5 mm Hg by month 3 (178/349, 51.0%) and month 6 (98/199, 49.2%). The magnitude of the drop depended on starting SBP. Participants classified as hypertension stage 2 had the largest mean drop in SBP of –12.4 mm Hg (SE 1.2 mm Hg) by month 3 and –13.0 mm Hg (SE 1.6 mm Hg) by month 6; participants classified as hypertension stage 1 lowered by –5.2 mm Hg (SE 0.8) mm Hg by month 3 and –7.3 mm Hg (SE 1.3 mm Hg) by month 6; participants classified as elevated lowered by –1.1 mm Hg (SE 0.7 mm Hg) by month 3 but did not drop by month 6. Starting SBP (β=.11; P<.001), percent weight change (β=–.36; P=.02), and initial BMI (β=–.56; P<.001) were significantly associated with the likelihood of lowering SBP ≥5 mm Hg by month 3. Percent weight change acted as a mediator of the relationship between program engagement and drop in SBP. The bootstrapped unstandardized indirect effect was –0.0024 (95% CI –0.0052 to 0; P=.002). Conclusions: A hypertension care program with coaching powered by AI was associated with a clinically meaningful reduction in SBP following 3 and 6 months of program participation. Percent weight change was significantly associated with the likelihood of achieving a ≥5 mm Hg drop in SBP. An AI-powered solution may offer a scalable approach to helping individuals with hypertension achieve clinically meaningful reductions in their BP and associated risk of cardiovascular disease and other serious adverse outcomes via healthy lifestyle changes such as weight loss. %M 36301618 %R 10.2196/38215 %U https://formative.jmir.org/2022/10/e38215 %U https://doi.org/10.2196/38215 %U http://www.ncbi.nlm.nih.gov/pubmed/36301618 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e39233 %T Mindfulness Training for Depressed Older Adults Using Smartphone Technology: Protocol for a Fully Remote Precision Clinical Trial %A Schweiger,Abigail %A Rodebaugh,Thomas L %A Lenze,Eric J %A Keenoy,Katie %A Hassenstab,Jason %A Kloeckner,Jeanne %A Gettinger,Torie R %A Nicol,Ginger E %+ Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, Campus Box 8134, 660 South Euclid, Saint Louis, MO, 63110, United States, 1 314 747 1862, nicolg@wustl.edu %K mHealth %K mindfulness %K depression %K aging %K precision medicine %K fully remote trial %K technology %K older %K adult %K smartphone %K clinical trial %K intervention %K death %K needs %K preferences %K online %K remote %K treatment %K depressed %K training %K mind %K session %K medicine %D 2022 %7 27.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Precision medicine, optimized interventions, and access to care are catchphrases for the future of behavioral treatments. Progress has been slow due to the dearth of clinical trials that optimize interventions’ benefits, individually tailor interventions to meet individual needs and preferences, and lead to rapid implementation after effectiveness is demonstrated. Two innovations have emerged to meet these challenges: fully remote trials and precision clinical trials. Objective: This paper provides a detailed description of Mindful MyWay, a study designed to test online mindfulness training in older adults with depression. Consistent with the concept of fully remote trials using a smartphone app, the study requires no in-person contact and can be conducted with participants anywhere in the United States. Based upon the precision medicine framework, the study assesses participants using high-frequency assessments of symptoms, cognitive performance, and patient preferences to both understand the individualized nature of treatment response and help individually tailor the intervention. Methods: Mindful MyWay is an open-label early-phase clinical trial for individuals 65 years and older with current depression. A smartphone app was developed to help coordinate the study, deliver the intervention, and evaluate the acceptability of the intervention, as well as predictors and outcomes of it. The curriculum for the fully remote intervention parallels the mindfulness-based stress reduction curriculum, a protocolized group-based mindfulness training that is typically provided in person. After consent and screening, participants download The Healthy Mind Lab mobile health smartphone app from the Apple App Store, allowing them to complete brief smartphone-based assessments of depressive symptoms and cognitive performance 4 times each day for 4 weeks prior to and after completing the intervention. The intervention consists of an introduction video and 10 weekly mindfulness training sessions, with the expectation to practice mindfulness at home daily. The app collects participant preference data throughout the 10-week intervention period; these high-frequency assessments identify participants’ individually dynamic preferences toward the goal of optimizing the intervention in future iterations. Results: Participant recruitment and data collection began in March 2019. Final end point assessments will be collected in May 2022. The paper describes lessons learned regarding the critical role of early-phase testing prior to moving to a randomized trial. Conclusions: The Mindful MyWay study is an exemplar of innovative clinical trial designs that use smartphone technology in behavioral and neuropsychiatric conditions. These include fully remote studies that can recruit throughout the United States, including hard-to-access areas, and collect high-frequency data, which is ideal for idiographic assessment and individualized intervention optimization. Our findings will be used to modify our methods and inform future randomized controlled trials within a precision medicine framework. Trial Registration: ClinicalTrials.gov NCT03922217; https://clinicaltrials.gov/ct2/show/NCT03922217 International Registered Report Identifier (IRRID): DERR1-10.2196/39233 %M 36301604 %R 10.2196/39233 %U https://www.researchprotocols.org/2022/10/e39233 %U https://doi.org/10.2196/39233 %U http://www.ncbi.nlm.nih.gov/pubmed/36301604 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e40292 %T A Smartphone App to Promote Patient Activation and Support Shared Decision-making in People With a Diagnosis of Schizophrenia in Outpatient Treatment Settings (Momentum Trial): Randomized Controlled Assessor-Blinded Trial %A Vitger,Tobias %A Hjorthøj,Carsten %A Austin,Stephen F %A Petersen,Lone %A Tønder,Esben Sandvik %A Nordentoft,Merete %A Korsbek,Lisa %+ Competence Center for Rehabilitation and Recovery, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Maglevænget 19, Ballerup, 2750, Denmark, 45 51408519, tobias246@hotmail.com %K mobile health %K mHealth %K digital intervention %K shared decision-making %K patient activation %K schizophrenia %K schizotypal %K early intervention %K randomized clinical trial %K mobile phone %D 2022 %7 26.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Shared decision-making (SDM) is a process aimed at facilitating patient-centered care by ensuring that the patient and provider are actively involved in treatment decisions. In mental health care, SDM has been advocated as a means for the patient to gain or regain control and responsibility over their life and recovery process. To support the process of patient-centered care and SDM, digital tools may have advantages in terms of accessibility, structure, and reminders. Objective: In this randomized controlled trial, we aimed to investigate the effect of a digital tool to support patient activation and SDM. Methods: The trial was designed as a randomized, assessor-blinded, 2-armed, parallel-group multicenter trial investigating the use of a digital SDM intervention for 6 months compared with treatment as usual. Participants with a diagnosis of schizophrenia, schizotypal or delusional disorder were recruited from 9 outpatient treatment sites in the Capital Region of Denmark. The primary outcome was the self-reported level of activation at the postintervention time point. The secondary outcomes included self-efficacy, hope, working alliance, satisfaction, preparedness for treatment consultation, symptom severity, and level of functioning. Explorative outcomes on the effect of the intervention at the midintervention time point along with objective data on the use of the digital tool were collected. Results: In total, 194 participants were included. The intention-to-treat analysis revealed a statistically significant effect favoring the intervention group on patient activation (mean difference 4.39, 95% CI 0.99-7.79; Cohen d=0.33; P=.01), confidence in communicating with one’s provider (mean difference 1.85, 95% CI 0.01-3.69; Cohen d=0.24; P=.05), and feeling prepared for decision-making (mean difference 5.12, 95% CI 0.16-10.08; Cohen d=0.27; P=.04). We found no effect of the digital SDM tool on treatment satisfaction, hope, self-efficacy, working alliance, severity of symptoms, level of functioning, use of antipsychotic medicine, and number or length of psychiatric hospital admissions. Conclusions: This trial showed a significant effect of a digital SDM tool on the subjective level of patient activation, confidence in communicating with one’s provider, and feeling prepared for decision-making at the postintervention time point. The effect size was smaller than the 0.42 effect size that we had anticipated and sampled for. The trial contributes to the evidence on how digital tools may support patient-centered care and SDM in mental health care. Trial Registration: ClinicalTrials.gov NCT03554655; https://clinicaltrials.gov/ct2/show/NCT03554655 International Registered Report Identifier (IRRID): RR2-10.1186/s12888-019-2143-2 %M 36287604 %R 10.2196/40292 %U https://www.jmir.org/2022/10/e40292 %U https://doi.org/10.2196/40292 %U http://www.ncbi.nlm.nih.gov/pubmed/36287604 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e37581 %T Evaluation of Breastfeeding App Features: Content Analysis Study %A Dinour,Lauren M %A Pole,Antoinette %+ Department of Nutrition and Food Studies, College of Education and Human Services, Montclair State University, 1 Normal Avenue, Montclair, NJ, 07043, United States, 1 973 655 5395, dinourl@montclair.edu %K breastfeeding %K breastmilk expression %K bottle feeding %K infant food %K infant health %K infant care %K consumer health informatics %K mobile apps %K smartphone %K cross-sectional study %D 2022 %7 26.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: While a variety of health apps abound, less than half of adults in the United States report using a health app, despite the ubiquity of smartphones among users aged 18 to 49 years. Several studies have examined the use of breastfeeding apps; however, less is known about the types of features found on these apps and what factors might influence app ratings. Objective: This paper seeks to characterize breastfeeding apps, assess whether apps with higher user ratings differ from apps with lower user ratings in their tracking and nontracking features, and analyze whether the type and number of features predict user star ratings and whether an app is higher- or lower-rated. Methods: Using a cross-sectional design, a convenience sample of breastfeeding apps was culled from the Apple App Store (iOS) and Google Play Store (Android). Content analysis of the apps (N=82) was conducted using a schema of 87 items, which was then compiled into 9 topical indices for breastfeeding, bottle feeding, solid foods, infant health, infant care, technical characteristics, informatics, informational characteristics, and interactivity. Analysis consisted of descriptive statistics, the Mann-Whitney U test, and Spearman rank correlations. Linear regression and binary logistic regression analyses were conducted to determine which features predicted user star ratings. Results: On average, users rated breastfeeding apps 4.4 of 5 stars. Two-thirds of apps (n=54) were higher rated (≥4.5 stars), and one-third (n=28) were lower rated (<4.5 stars). Higher-rated apps offered more tracking features for breastfeeding, bottle feeding, solid foods, infant health, and infant care than lower-rated apps. The breastfeeding, solid-food, and technical indices explained 17% of user star ratings. For each additional breastfeeding and solid-food feature, we can expect to see a 27% and 35% increase, respectively, in user star ratings. Additionally, as the number of solid-food features increased, the odds that the app is higher rated increased 1.58 times. Conclusions: Our findings suggest user ratings are driven in part by tracking features, specifically those related to breastfeeding and solid foods. The proliferation of mobile health apps offers opportunities for parents and caregivers to track behaviors associated with infant feeding and other health metrics in a dynamic, detailed, and comprehensive manner. Hence, breastfeeding apps have the potential to promote and support breastfeeding among users. %M 36287596 %R 10.2196/37581 %U https://pediatrics.jmir.org/2022/4/e37581 %U https://doi.org/10.2196/37581 %U http://www.ncbi.nlm.nih.gov/pubmed/36287596 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 2 %P e35796 %T Cardiorespiratory Fitness Estimation Based on Heart Rate and Body Acceleration in Adults With Cardiovascular Risk Factors: Validation Study %A Rissanen,Antti-Pekka E %A Rottensteiner,Mirva %A Kujala,Urho M %A Kurkela,Jari L O %A Wikgren,Jan %A Laukkanen,Jari A %+ Department of Sports and Exercise Medicine, Clinicum, University of Helsinki, Urhea-halli, Mäkelänkatu 47, Helsinki, 00550, Finland, 358 9 434 2100, antti-pekka.rissanen@helsinki.fi %K cardiopulmonary exercise test %K cardiorespiratory fitness %K heart rate variability %K hypertension %K type 2 diabetes %K wearable technology %D 2022 %7 25.10.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Cardiorespiratory fitness (CRF) is an independent risk factor for cardiovascular morbidity and mortality. Adding CRF to conventional risk factors (eg, smoking, hypertension, impaired glucose metabolism, and dyslipidemia) improves the prediction of an individual’s risk for adverse health outcomes such as those related to cardiovascular disease. Consequently, it is recommended to determine CRF as part of individualized risk prediction. However, CRF is not determined routinely in everyday clinical practice. Wearable technologies provide a potential strategy to estimate CRF on a daily basis, and such technologies, which provide CRF estimates based on heart rate and body acceleration, have been developed. However, the validity of such technologies in estimating individual CRF in clinically relevant populations is poorly known. Objective: The objective of this study is to evaluate the validity of a wearable technology, which provides estimated CRF based on heart rate and body acceleration, in working-aged adults with cardiovascular risk factors. Methods: In total, 74 adults (age range 35-64 years; n=56, 76% were women; mean BMI 28.7, SD 4.6 kg/m2) with frequent cardiovascular risk factors (eg, n=64, 86% hypertension; n=18, 24% prediabetes; n=14, 19% type 2 diabetes; and n=51, 69% metabolic syndrome) performed a 30-minute self-paced walk on an indoor track and a cardiopulmonary exercise test on a treadmill. CRF, quantified as peak O2 uptake, was both estimated (self-paced walk: a wearable single-lead electrocardiogram device worn to record continuous beat-to-beat R-R intervals and triaxial body acceleration) and measured (cardiopulmonary exercise test: ventilatory gas analysis). The accuracy of the estimated CRF was evaluated against that of the measured CRF. Results: Measured CRF averaged 30.6 (SD 6.3; range 20.1-49.6) mL/kg/min. In all participants (74/74, 100%), mean difference between estimated and measured CRF was −0.1 mL/kg/min (P=.90), mean absolute error was 3.1 mL/kg/min (95% CI 2.6-3.7), mean absolute percentage error was 10.4% (95% CI 8.5-12.5), and intraclass correlation coefficient was 0.88 (95% CI 0.80-0.92). Similar accuracy was observed in various subgroups (sexes, age, BMI categories, hypertension, prediabetes, and metabolic syndrome). However, mean absolute error was 4.2 mL/kg/min (95% CI 2.6-6.1) and mean absolute percentage error was 16.5% (95% CI 8.6-24.4) in the subgroup of patients with type 2 diabetes (14/74, 19%). Conclusions: The error of the CRF estimate, provided by the wearable technology, was likely below or at least very close to the clinically significant level of 3.5 mL/kg/min in working-aged adults with cardiovascular risk factors, but not in the relatively small subgroup of patients with type 2 diabetes. From a large-scale clinical perspective, the findings suggest that wearable technologies have the potential to estimate individual CRF with acceptable accuracy in clinically relevant populations. %M 36282560 %R 10.2196/35796 %U https://cardio.jmir.org/2022/2/e35796 %U https://doi.org/10.2196/35796 %U http://www.ncbi.nlm.nih.gov/pubmed/36282560 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 10 %P e35722 %T Digital Biomarker–Based Studies: Scoping Review of Systematic Reviews %A Motahari-Nezhad,Hossein %A Fgaier,Meriem %A Mahdi Abid,Mohamed %A Péntek,Márta %A Gulácsi,László %A Zrubka,Zsombor %+ Doctoral School of Business and Management, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary, 36 702097967, h.motahari.lib@gmail.com %K scoping review %K digital biomarkers %K health %K behavioral data %K physiological data %K digital health %K remote monitoring %K wearable %K implantable %K digestible %K portable %K sensor %K digital health %K mobile phone %D 2022 %7 24.10.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Sensors and digital devices have revolutionized the measurement, collection, and storage of behavioral and physiological data, leading to the new term digital biomarkers. Objective: This study aimed to investigate the scope of clinical evidence covered by systematic reviews (SRs) of randomized controlled trials involving digital biomarkers. Methods: This scoping review was organized using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. With the search limited to English publications, full-text SRs of digital biomarkers included randomized controlled trials that involved a human population and reported changes in participants’ health status. PubMed and the Cochrane Library were searched with time frames limited to 2019 and 2020. The World Health Organization’s classification systems for diseases (International Classification of Diseases, Eleventh Revision), health interventions (International Classification of Health Interventions), and bodily functions (International Classification of Functioning, Disability, and Health [ICF]) were used to classify populations, interventions, and outcomes, respectively. Results: A total of 31 SRs met the inclusion criteria. The majority of SRs studied patients with circulatory system diseases (19/31, 61%) and respiratory system diseases (9/31, 29%). Most of the prevalent interventions focused on physical activity behavior (16/31, 52%) and conversion of cardiac rhythm (4/31, 13%). Looking after one’s health (physical activity; 15/31, 48%), walking (12/31, 39%), heart rhythm functions (8/31, 26%), and mortality (7/31, 23%) were the most commonly reported outcomes. In total, 16 physiological and behavioral data groups were identified using the ICF tool, such as looking after one’s health (physical activity; 14/31, 45%), walking (11/31, 36%), heart rhythm (7/31, 23%), and weight maintenance functions (7/31, 23%). Various digital devices were also studied to collect these data in the included reviews, such as smart glasses, smartwatches, smart bracelets, smart shoes, and smart socks for measuring heart functions, gait pattern functions, and temperature. A substantial number (24/31, 77%) of digital biomarkers were used as interventions. Moreover, wearables (22/31, 71%) were the most common types of digital devices. Position sensors (21/31, 68%) and heart rate sensors and pulse rate sensors (12/31, 39%) were the most prevalent types of sensors used to acquire behavioral and physiological data in the SRs. Conclusions: In recent years, the clinical evidence concerning digital biomarkers has been systematically reviewed in a wide range of study populations, interventions, digital devices, and sensor technologies, with the dominance of physical activity and cardiac monitors. We used the World Health Organization’s ICF tool for classifying behavioral and physiological data, which seemed to be an applicable tool to categorize the broad scope of digital biomarkers identified in this review. To understand the clinical value of digital biomarkers, the strength and quality of the evidence on their health consequences need to be systematically evaluated. %M 36279171 %R 10.2196/35722 %U https://mhealth.jmir.org/2022/10/e35722 %U https://doi.org/10.2196/35722 %U http://www.ncbi.nlm.nih.gov/pubmed/36279171 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 10 %P e35628 %T Long-term Effects of the Use of a Step Count–Specific Smartphone App on Physical Activity and Weight Loss: Randomized Controlled Clinical Trial %A Yoshimura,Eiichi %A Tajiri,Eri %A Michiwaki,Ryota %A Matsumoto,Naoyuki %A Hatamoto,Yoichi %A Tanaka,Shigeho %+ Department of Nutrition and Metabolism, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, Tokyo, 162-8636, Japan, 81 0332035725, eyoshi@nibiohn.go.jp %K step counts %K weight loss %K smartphone app %K step count–specific mobile app %K physical activity %K moderate-to-vigorous intensity physical activity %K lifestyle intervention %K mHealth %K mobile app: mobile phone %D 2022 %7 24.10.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Some studies on weight loss promotion using smartphone apps have shown a weight loss effect but not an increase in physical activity. However, the long-term effects of smartphone apps on weight loss and increasing physical activity have not been rigorously examined to date. Objective: The aim of this study was to assess whether the use of a smartphone app will increase physical activity and reduce body weight. Methods: In this parallel randomized clinical trial, participants recruited between April 2018 and June 2019 were randomized in equal proportions to a smartphone app group (n=55) or a control group (n=54). The intention-to-treat approach was used to analyze the data from December 2019 through November 2021. Before the intervention, an hour-long lecture on weight loss instruction and increasing physical activity was conducted once for both groups. Participants in both groups were instructed to weigh themselves immediately after waking up at least once daily from the start of the intervention. Monthly emails were sent advising the participants in both groups on how to lose weight and increase physical activity in order to maintain or increase motivation. Participants in the smartphone app group were instructed to open the app at least once a day to check their step count and rank. The primary outcome was daily accelerometer-measured physical activity (step count) and the secondary outcome was body weight. Since there was a significant difference in the wear time of the accelerometer depending on the intervention period (P<.001), the number of steps and moderate-to-vigorous physical activity were also evaluated per wear time. Results: The mean age of the 109 participants in this study was 47 (SD 8) years. At baseline, the mean daily total steps were 7259 (SD 3256) steps per day for the smartphone app group and 8243 (SD 2815) steps per day for the control group. The difference in the step count per wear time between preintervention and postintervention was significantly different between the app group and the control group (average difference [95% CI], 65 [30 to 101] steps per hour vs –9 [–56 to 39] steps per hour; P=.042). The weight loss was –2.2 kg (SD –3.1%) in the smartphone app group and –2.2 kg (SD –3.1%) in the control group, with no significant difference between the groups. In addition, when divided into weekdays (Monday through Friday) and weekends (Saturday and Sunday), there was a significant interaction between step counts (P=.004) and MVPA (P=.003) during the intervention, with the app group showing higher interaction on weekends than the control group. Conclusions: In this trial, the group with the smartphone app intervention showed increased physical activity, especially on weekends. However, this increased physical activity did not lead to increased weight loss. Trial Registration: University Hospital Medical Information Network UMIN000033397; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000037956 %M 36279159 %R 10.2196/35628 %U https://mhealth.jmir.org/2022/10/e35628 %U https://doi.org/10.2196/35628 %U http://www.ncbi.nlm.nih.gov/pubmed/36279159 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 10 %P e39085 %T Measurement Properties of Smartphone Approaches to Assess Physical Activity in Healthy Young People: Systematic Review %A Parmenter,Belinda %A Burley,Claire %A Stewart,Courtney %A Whife,Jesse %A Champion,Katrina %A Osman,Bridie %A Newton,Nicola %A Green,Olivia %A Wescott,Annie B %A Gardner,Lauren A %A Visontay,Rachel %A Birrell,Louise %A Bryant,Zachary %A Chapman,Cath %A Lubans,David R %A Sunderland,Matthew %A Slade,Tim %A Thornton,Louise %+ School of Health Sciences, University of New South Wales, Room 234, Level 2 Wallace Wurth Building, Corner of High Street and Botany Street, Kensington, NSW 2052, Australia, 61 0290653510, c.burley@unsw.edu.au %K smartphone %K mobile phone %K mHealth %K prevention %K risk %K physical activity %K sedentary behavior %K young people %D 2022 %7 21.10.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Physical inactivity is a preventable risk factor for several chronic diseases and one of the driving forces behind the growing global burden of disease. Recent evidence has shown that interventions using mobile smartphone apps can promote a significant increase in physical activity (PA) levels. However, the accuracy and reliability of using apps is unknown. Objective: The aim of our review was to determine the accuracy and reliability of using mobile apps to measure PA levels in young people. We conducted a systematic review guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Methods: Studies published from 2007 to 2020 were sourced from 8 databases—Ovid MEDLINE, Embase (Elsevier), Cochrane Library (Wiley), PsychINFO (EBSCOhost), CINAHL (EBSCOhost), Web of Science (Clarivate), SPORTDiscus (EBSCOhost), and IEEE Xplore Digital Library database. Studies were conducted in young people aged 10-24 years and without chronic illnesses, who evaluated a mobile app’s ability to measure PA. Primary outcomes included validity, reliability, and responsiveness of the measurement approach. Duplicate screening was conducted for eligibility, data extraction, and assessing the risk of bias. Results were reported as a systematic review. The main physical activity measures evaluated for each study were the following: total PA time (min/day or min/week), total moderate to vigorous PA per week, daily step count, intensity measure (heart rate), and frequency measure (days per week). Results: Of the 149 identified studies, 5 met the inclusion criteria (322 participants, 176 female; mean age 14, SD 3 years). A total of 3 studies measured criterion validity and compared PA measured via apps against PA measured via an Actigraph accelerometer. The 2 studies that reported on construct validity identified a significant difference between self-reported PA and the objective measure. Only 1 of the 5 apps examined was available to the public, and although this app was highly accepted by young people, the app recorded PA to be significantly different to participants’ self-reported PA. Conclusions: Overall, few studies assess the reliability, validity, and responsiveness of mobile apps to measure PA in healthy young people, with studies typically only reporting on one measurement property. Of the 3 studies that measured validity, all concluded that mobile phones were acceptable and valid tools. More research is needed into the validity and reliability of smartphone apps to measure PA levels in this population as well as in populations with other characteristics, including other age groups and those with chronic diseases. Trial Registration: PROSPERO CRD42019122242; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=122242 %M 36269659 %R 10.2196/39085 %U https://mhealth.jmir.org/2022/10/e39085 %U https://doi.org/10.2196/39085 %U http://www.ncbi.nlm.nih.gov/pubmed/36269659 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e35926 %T A Smartphone Physical Activity App for Patients in Alcohol Treatment: Single-Arm Feasibility Trial %A Abrantes,Ana M %A Meshesha,Lidia Z %A E Blevins,Claire %A Battle,Cynthia L %A Lindsay,Clifford %A Marsh,Eliza %A Feltus,Sage %A Buman,Matthew %A Agu,Emmanuel %A Stein,Michael %+ Butler Hospital, 345 Blackstone Blvd, Providence, RI, 02906, United States, 1 4014556440, Ana_Abrantes@Brown.edu %K alcohol use disorder %K AUD %K physical activity %K smartphone app %K Fitbit %K feasibility study %K mobile phone %D 2022 %7 19.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use disorder (AUD) is a significant public health concern worldwide. Alcohol consumption is a leading cause of death in the United States and has a significant negative impact on individuals and society. Relapse following treatment is common, and adjunct intervention approaches to improve alcohol outcomes during early recovery continue to be critical. Interventions focused on increasing physical activity (PA) may improve AUD treatment outcomes. Given the ubiquity of smartphones and activity trackers, integrating this technology into a mobile app may be a feasible, acceptable, and scalable approach for increasing PA in individuals with AUD. Objective: This study aims to test the Fit&Sober app developed for patients with AUD. The goals of the app were to facilitate self-monitoring of PA engagement and daily mood and alcohol cravings, increase awareness of immediate benefits of PA on mood and cravings, encourage setting and adjusting PA goals, provide resources and increase knowledge for increasing PA, and serve as a resource for alcohol relapse prevention strategies. Methods: To preliminarily test the Fit&Sober app, we conducted an open pilot trial of patients with AUD in early recovery (N=22; 13/22, 59% women; mean age 43.6, SD 11.6 years). At the time of hospital admission, participants drank 72% of the days in the last 3 months, averaging 9 drinks per drinking day. The extent to which the Fit&Sober app was feasible and acceptable among patients with AUD during early recovery was examined. Changes in alcohol consumption, PA, anxiety, depression, alcohol craving, and quality of life were also examined after 12 weeks of app use. Results: Participants reported high levels of satisfaction with the Fit&Sober app. App metadata suggested that participants were still using the app approximately 2.5 days per week by the end of the intervention. Pre-post analyses revealed small-to-moderate effects on increase in PA, from a mean of 5784 (SD 2511) steps per day at baseline to 7236 (SD 3130) steps per day at 12 weeks (Cohen d=0.35). Moderate-to-large effects were observed for increases in percentage of abstinent days (Cohen d=2.17) and quality of life (Cohen d=0.58) as well as decreases in anxiety (Cohen d=−0.71) and depression symptoms (Cohen d=−0.58). Conclusions: The Fit&Sober app is an acceptable and feasible approach for increasing PA in patients with AUD during early recovery. A future randomized controlled trial is necessary to determine the efficacy of the Fit&Sober app for long-term maintenance of PA, ancillary mental health, and alcohol outcomes. If the efficacy of the Fit&Sober app could be established, patients with AUD would have a valuable adjunct to traditional alcohol treatment that can be delivered in any setting and at any time, thereby improving the overall health and well-being of this population. Trial Registration: ClinicalTrials.gov NCT02958280; https://www.clinicaltrials.gov/ct2/show/NCT02958280 %M 36260381 %R 10.2196/35926 %U https://formative.jmir.org/2022/10/e35926 %U https://doi.org/10.2196/35926 %U http://www.ncbi.nlm.nih.gov/pubmed/36260381 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e34089 %T Developing the "Choosing Health" Digital Weight Loss and Maintenance Intervention: Intervention Mapping Study %A Palacz-Poborczyk,Iga %A Idziak,Paulina %A Januszewicz,Anna %A Luszczynska,Aleksandra %A Quested,Eleanor %A Naughton,Felix %A Hagger,Martin S %A Pagoto,Sherry %A Verboon,Peter %A Robinson,Suzanne %A Kwasnicka,Dominika %+ Faculty of Psychology, SWPS University of Social Sciences and Humanities, Aleksandra Ostrowskiego 30b, Wroclaw, 53-238, Poland, 48 501205532, dkwasnicka@gmail.com %K behavior change %K behavior maintenance %K behavioral theory %K weight loss %K overweight %K obesity %K randomized controlled trial %K digital health %K within-person design %K Intervention Mapping %D 2022 %7 18.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health promotion programs tailored to the individual are a potential cost-effective and scalable solution to enable self-management and provide support to people with excess body weight. However, solutions that are widely accessible, personalized, and theory- and evidence-based are still limited. Objective: This study aimed to develop a digital behavior change program, Choosing Health, that could identify modifiable predictors of weight loss and maintenance for each individual and use these to provide tailored support. Methods: We applied an Intervention Mapping protocol to design the program. This systematic approach to develop theory- and evidence-based health promotion programs consisted of 6 steps: development of a logic model of the problem, a model of change, intervention design and intervention production, the implementation plan, and the evaluation plan. The decisions made during the Intervention Mapping process were guided by theory, existing evidence, and our own research—including 4 focus groups (n=40), expert consultations (n=12), and interviews (n=11). The stakeholders included researchers, public representatives (including individuals with overweight and obesity), and experts from a variety of relevant backgrounds (including nutrition, physical activity, and the health care sector). Results: Following a structured process, we developed a tailored intervention that has the potential to reduce excess body weight and support behavior changes in people with overweight and obesity. The Choosing Health intervention consists of tailored, personalized text messages and email support that correspond with theoretical domains potentially predictive of weight outcomes for each participant. The intervention content includes behavior change techniques to support motivation maintenance, self-regulation, habit formation, environmental restructuring, social support, and addressing physical and psychological resources. Conclusions: The use of an Intervention Mapping protocol enabled the systematic development of the Choosing Health intervention and guided the implementation and evaluation of the program. Through the involvement of different stakeholders, including representatives of the general public, we were able to map out program facilitators and barriers while increasing the ecological validity of the program to ensure that we build an intervention that is useful, user-friendly, and informative. We also summarized the lessons learned for the Choosing Health intervention development and for other health promotion programs. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-040183 %M 36256827 %R 10.2196/34089 %U https://www.jmir.org/2022/10/e34089 %U https://doi.org/10.2196/34089 %U http://www.ncbi.nlm.nih.gov/pubmed/36256827 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e40726 %T Understanding Mental Health Apps for Youth: Focus Group Study With Latinx Youth %A Agapie,Elena %A Chang,Katherine %A Patrachari,Sneha %A Neary,Martha %A Schueller,Stephen M %+ Department of Psychological Science, University of California, Irvine, 4201 Social and Behavioral Sciences Gateway, Irvine, CA, 92697, United States, 1 949 824 3850, s.schueller@uci.edu %K mental health %K mental health apps %K youth %K child %K teenager %K focus group %K human-centered design %K mobile health %K mHealth %K health app %K cognitive behavioral therapy %K CBT %K perspective %K qualitative %K mindfulness %K health app %K digital health tool %K Latino %K Latinx %K mobile phone %D 2022 %7 18.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: An increasing number of mental health apps (MHapps) are being developed for youth. In addition, youth are high users of both technologies and MHapps. However, little is known about their perspectives on MHapps. MHapps might be particularly well suited to reach the youth underserved by traditional mental health resources, and incorporating their perspectives is especially critical to ensure such tools are useful to them. Objective: The goal of this study was to develop and pilot a process for eliciting youth perspectives on MHapps in a structured and collaborative way. We also sought to generate learnings on the perspectives of Latinx youth on MHapps and their use in ways that might facilitate discovery, activation, or engagement in MHapps, especially in Latinx populations. Methods: We created a series of focus groups consisting of 5 sessions. The groups introduced different categories of MHapps (cognitive behavioral therapy apps, mindfulness apps, and miscellaneous apps). Within each category, we selected 4 MHapps that participants chose to use for a week and provided feedback through both between-session and in-session activities. We recruited 5 youths ranging in age from 15 to 21 (mean 18, SD 2.2) years. All the participants identified as Hispanic or Latinx. After completing all 5 focus groups, the participants completed a brief questionnaire to gather their impressions of the apps they had used. Results: Our focus group methodology collected detailed and diverse information about youth perspectives on MHapps. However, we did identify some aspects of our methods that were less successful at engaging the youth, such as our between-session activities. The Latinx youth in our study wanted apps that were accessible, relatable, youth centric, and simple and could be integrated with their offline lives. We also found that the mindfulness apps were viewed most favorably but that the miscellaneous and cognitive behavioral therapy apps were viewed as more impactful. Conclusions: Eliciting youth feedback on MHapps is critical if these apps are going to serve a role in supporting their mental health and well-being. We refined a process for collecting feedback from the youth and identified factors that were important to a set of Latinx youth. Future work could be broader, that is, recruit larger samples of more diverse youth, or deeper, that is, collect more information from each youth around interests, needs, barriers, or facilitators or better understand the various impacts of MHapps by using qualitative and quantitative measures. Nevertheless, this study advances the formative understanding of how the youth, particularly Latinx youth, might be viewing these tools. %M 36256835 %R 10.2196/40726 %U https://formative.jmir.org/2022/10/e40726 %U https://doi.org/10.2196/40726 %U http://www.ncbi.nlm.nih.gov/pubmed/36256835 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e41415 %T Impact of the COVID-19 Pandemic on the Implementation of Mobile Health to Improve the Uptake of Hydroxyurea in Patients With Sickle Cell Disease: Mixed Methods Study %A Badawy,Sherif M %A DiMartino,Lisa %A Brambilla,Donald %A Klesges,Lisa %A Baumann,Ana %A Burns,Ebony %A DeMartino,Terri %A Jacobs,Sara %A Khan,Hamda %A Nwosu,Chinonyelum %A Shah,Nirmish %A Hankins,Jane S %A , %+ Department of Hematology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 800, Memphis, TN, 38105, United States, 1 901 5954153, jane.hankins@stjude.org %K sickle cell anemia %K implementation science %K adherence %K hydroxycarbamide %K self-efficacy %D 2022 %7 14.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Hydroxyurea therapy is effective for reducing complications related to sickle cell disease (SCD) and is recommended by National Health Lung and Blood Institute care guidelines. However, hydroxyurea is underutilized, and adherence is suboptimal. We wanted to test a multilevel mobile health (mHealth) intervention to increase hydroxyurea adherence among patients and improve prescribing among providers in a multicenter clinical trial. In the first 2 study sites, participants were exposed to the early phases of the COVID-19 pandemic, which included disruption to their regular SCD care. Objective: We aimed to describe the impact of the COVID-19 pandemic on the implementation of an mHealth behavioral intervention for improving hydroxyurea adherence among patients with SCD. Methods: The first 2 sites initiated enrollment 3 months prior to the start of the pandemic (November 2019 to March 2020). During implementation, site A clinics shut down for 2 months and site B clinics shut down for 9 months. We used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to evaluate the implementation and effectiveness of the intervention. mHealth implementation was assessed based on patients’ daily app use. Adherence to hydroxyurea was calculated as the proportion of days covered (PDC) from prescription records over the first 12 and 24 weeks after implementation. A linear model examined the relationship between app usage and PDC change, adjusting for baseline PDC, lockdown duration, and site. We conducted semistructured interviews with patients, health care providers, administrators, and research staff to identify factors associated with mHealth implementation and effectiveness. We used a mixed methods approach to investigate the convergence of qualitative and quantitative findings. Results: The percentage of patients accessing the app decreased after March 15, 2020 from 86% (n=55) to 70% (n=45). The overall mean PDC increase from baseline to week 12 was 4.5% (P=.32) and to week 24 was 1.5% (P=.70). The mean PDC change was greater at site A (12 weeks: 20.9%; P=.003; 24 weeks: 16.7%; P=.01) than site B (12 weeks: −8.2%; P=.14; 24 weeks: −10.3%; P=.02). After adjustment, PDC change was 13.8% greater in those with increased app use after March 15, 2020. Interview findings indicated that site B’s closure during COVID-19 had a greater impact, but almost all patients reported that the InCharge Health app helped support more consistent medication use. Conclusions: We found significant impacts of the early clinic lockdowns, which reduced implementation of the mHealth intervention and led to reduced patient adherence to hydroxyurea. However, disruptions were lower among participants who experienced shorter clinic lockdowns and were associated with higher hydroxyurea adherence. Investigation of added strategies to mitigate the effects of care interruptions during major emergencies (eg, patient coaching and health navigation) may “insulate” the implementation of interventions to increase medication adherence. Trial Registration: ClinicalTrials.gov NCT04080167; https://clinicaltrials.gov/ct2/show/NCT04080167 International Registered Report Identifier (IRRID): RR2-10.2196/16319 %M 36240004 %R 10.2196/41415 %U https://formative.jmir.org/2022/10/e41415 %U https://doi.org/10.2196/41415 %U http://www.ncbi.nlm.nih.gov/pubmed/36240004 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e39869 %T mHealth Technologies for Managing Problematic Pornography Use: Content Analysis %A Henry,Nathan %A Donkin,Liesje %A Williams,Matt %A Pedersen,Mangor %+ Auckland University of Technology, 55 Wellesley Street East, Auckland CBD, Auckland, 1010, New Zealand, 64 9 921 9666 ext 7304, nathan.henry@aut.ac.nz %K pornography %K compulsive sexual behavior disorder %K CSBD %K mobile health %K mHealth %K problematic pornography use %K PPU %K mobile intervention %K just-in-time adaptive intervention %K smartphone-based therapy %K addiction %K internet addiction %K behavioral addiction %K mobile phone %D 2022 %7 13.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Several mobile apps are currently available that purportedly help with managing pornography addiction. However, the utility of these apps is unclear, given the lack of literature on the effectiveness of mobile health solutions for problematic pornography use. Little is also known about the content, structure, and features of these apps. Objective: This study aims to characterize the purpose, content, and popularity of mobile apps that claim to manage pornography addiction. Methods: The phrase “pornography addiction” was entered as a search term in the app stores of the two major mobile phone platforms (Android and iOS). App features were categorized according to a coding scheme that contained 16 categories. Apps were included in the analysis if they were described as helpful for reducing pornography use, and data were extracted from the store descriptions of the apps. Metrics such as number of user ratings, mean rating score, and number of installations were analyzed on a per-feature basis. Results: In total, 170 apps from both app stores met the inclusion criteria. The five most common and popular features, both in terms of number of apps with each feature and minimum possible number of installations, were the ability to track the time since last relapse (apps with feature=72/170, 42.4%; minimum possible number of installations=6,388,000), tutorials and coaching (apps with feature=63/170, 37.1%; minimum possible number of installations=9,286,505), access to accountability partners or communities (apps with feature=51/170, 30%; minimum possible number of installations=5,544,500), content blocking or content monitoring (apps with feature=46/170, 27.1%; minimum possible number of installations=17,883,000), and a reward system for progress (apps with feature=34/170, 20%; minimum possible number of installations=4,425,300). Of these features, content-blocking apps had the highest minimum possible number of installations. Content blocking was also the most detected feature combination in a combinatorial analysis (with 28 apps having only this feature), but it also had the lowest mean consumer satisfaction rating (4.04) and second-lowest median rating (4.00) out of 5 stars. None of the apps reviewed contained references to literature that provided direct evidence for the app’s efficacy or safety. Conclusions: There are several apps with the potential to provide low- or zero-cost real-time interventions for people struggling to manage problematic pornography use. Popular app features include blockers of pornographic content, behavior monitoring, and tutorials that instruct users how to eliminate pornography use. However, there is currently no empirical evidence to support the effectiveness and safety of these apps. Further research is required to be able to provide recommendations about which apps (and app features) are safe for public consumption. %M 36227634 %R 10.2196/39869 %U https://formative.jmir.org/2022/10/e39869 %U https://doi.org/10.2196/39869 %U http://www.ncbi.nlm.nih.gov/pubmed/36227634 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 10 %P e41282 %T Mental Health Mobile Apps in the French App Store: Assessment Study of Functionality and Quality %A Carrouel,Florence %A du Sartz de Vigneulles,Benjamin %A Bourgeois,Denis %A Kabuth,Bernard %A Baltenneck,Nicolas %A Nusbaum,Fanny %A Burge,Valérie %A Roy,Sylvain %A Buchheit,Sophie %A Carrion-Martinaud,Marie-Line %A Massoubre,Catherine %A Fraticelli,Laurie %A Dussart,Claude %+ Health Systemic Process, Research Unit UR4129, University Claude Bernard Lyon 1, University of Lyon, 7 rue Guillaume Paradin, Lyon, 69372, France, 33 0478785745, florence.carrouel@univ-lyon1.fr %K mobile apps %K behavior change %K mental %K prevention %K mobile health %K mHealth %K lifestyle %K French %K well-being %D 2022 %7 12.10.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Approximately 800 million people, representing 11% of the world’s population, are affected by mental health problems. The COVID-19 pandemic exacerbated problems and triggered a decline in well-being, with drastic increase in the incidence of conditions such as anxiety, depression, and stress. Approximately 20,000 mental health apps are listed in mobile app stores. However, no significant evaluation of mental health apps in French, spoken by approximately 300 million people, has been identified in the literature yet. Objective: This study aims to review the mental health mobile apps currently available on the French Apple App Store and Google Play Store and to evaluate their quality using Mobile App Rating Scale–French (MARS-F). Methods: Screening of mental health apps was conducted from June 10, 2022, to June 17, 2022, on the French Apple App Store and Google Play Store. A shortlist of 12 apps was identified using the criteria of selection and assessed using MARS-F by 9 mental health professionals. Intraclass correlation was used to evaluate interrater agreement. Mean (SD) scores and their distributions for each section and item were calculated. Results: The highest scores for MARS-F quality were obtained by Soutien psy avec Mon Sherpa (mean 3.85, SD 0.48), Evoluno (mean 3.54, SD 0.72), and Teale (mean 3.53, SD 0.87). Mean engagement scores (section A) ranged from 2.33 (SD 0.69) for Reflexe reussite to 3.80 (SD 0.61) for Soutien psy avec Mon Sherpa. Mean aesthetics scores (section C) ranged from 2.52 (SD 0.62) for Mental Booster to 3.89 (SD 0.69) for Soutien psy avec Mon Sherpa. Mean information scores (section D) ranged from 2.00 (SD 0.75) for Mental Booster to 3.46 (SD 0.77) for Soutien psy avec Mon Sherpa. Mean Mobile App Rating Scale subjective quality (section E) score varied from 1.22 (SD 0.26) for VOS – journal de l’humeur to 2.69 (SD 0.84) for Soutien psy avec Mon Sherpa. Mean app specificity (section F) score varied from 1.56 (SD 0.97) for Mental Booster to 3.31 (SD 1.22) for Evoluno. For all the mental health apps studied, except Soutien psy avec Mon Sherpa (11/12, 92%), the subjective quality score was always lower than the app specificity score, which was always lower than the MARS-F quality score, and that was lower than the rating score from the iPhone Operating System or Android app stores. Conclusions: Mental health professionals assessed that, despite the lack of scientific evidence, the mental health mobile apps available on the French Apple App Store and Google Play Store were of good quality. However, they are reluctant to use them in their professional practice. Additional investigations are needed to assess their compliance with recommendations and their long-term impact on users. %M 36223178 %R 10.2196/41282 %U https://mhealth.jmir.org/2022/10/e41282 %U https://doi.org/10.2196/41282 %U http://www.ncbi.nlm.nih.gov/pubmed/36223178 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e36987 %T Behavior Change App for Self-management of Gestational Diabetes: Design and Evaluation of Desirable Features %A Kytö,Mikko %A Koivusalo,Saila %A Ruonala,Antti %A Strömberg,Lisbeth %A Tuomonen,Heli %A Heinonen,Seppo %A Jacucci,Giulio %+ Helsinki University Hospital IT Management, Helsinki University Hospital, Paciuksenkatu 25, Helsinki, 00270, Finland, 358 94711, mikko.kyto@hus.fi %K gestational diabetes %K mobile app %K features %K behavior change %K digital health %K eHealth %K telehealth %K self-tracking %K self-management %K personalized health care %D 2022 %7 12.10.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Gestational diabetes (GDM) has considerable and increasing health effects as it raises both the mother’s and the offspring’s risk for short- and long-term health problems. GDM can usually be treated with a healthier lifestyle, such as appropriate dietary modifications and sufficient physical activity. Although telemedicine interventions providing weekly or more frequent feedback from health care professionals have shown the potential to improve glycemic control among women with GDM, apps without extensive input from health care professionals are limited and have not been shown to be effective. Different features in personalization and support have been proposed to increase the efficacy of GDM apps, but the knowledge of how these features should be designed is lacking. Objective: The aim of this study is to investigate how GDM apps should be designed, considering the desirable features based on the previous literature. Methods: We designed an interactive GDM prototype app that provided example implementations of desirable features, such as providing automatic and personalized suggestions and social support through the app. Women with GDM explored the prototype and provided feedback in semistructured interviews. Results: We identified that (1) self-tracking data in GDM apps should be extended with written feedback, (2) habits and goals should be highly customizable to be useful, (3) the app should have different functions to provide social support, and (4) health care professionals should be notified through the app if something unusual occurs. In addition, we found 2 additional themes. First, basic functionalities that are fast to learn by women with GDM who have recently received the diagnosis should be provided, but there should also be deeper features to maintain interest for women with GDM at a later stage of pregnancy. Second, as women with GDM may have feelings of guilt, the app should have a tolerance for and a supporting approach to unfavorable behavior. Conclusions: The feedback on the GDM prototype app supported the need for desirable features and provided new insights into how these features should be incorporated into GDM apps. We expect that following the proposed designs and feedback will increase the efficacy of GDM self-management apps. Trial Registration: ClinicalTrials.gov NCT03941652; https://clinicaltrials.gov/ct2/show/NCT03941652 %M 36222806 %R 10.2196/36987 %U https://humanfactors.jmir.org/2022/4/e36987 %U https://doi.org/10.2196/36987 %U http://www.ncbi.nlm.nih.gov/pubmed/36222806 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e37866 %T Information Resources Among Flemish Pregnant Women: Cross-sectional Study %A Lanssens,Dorien %A Thijs,Inge M %A Dreesen,Pauline %A Van Hecke,Ann %A Coorevits,Pascal %A Gaethofs,Gitte %A Derycke,Joyce %A Tency,Inge %+ Faculty of Medicine and Life Sciences, Limburg Clinical Research Center, University of Hasselt, Martelarenlaan 42, Hasselt, 3500, Belgium, 32 494919476, dorien.lanssens@uhasselt.be %K pregnancy app %K mobile app %K questionnaire %K pregnancy %K pregnant %K mHealth %K mobile health %K cross-sectional %K user need %K user expectation %K survey %K maternal %K maternity %K user experience %D 2022 %7 11.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There has been an exponential growth in the availability of apps, resulting in increased use of pregnancy apps. However, information on resources and use of apps among pregnant women is relatively limited. Objective: The aim of this study is to map the current information resources and the use of pregnancy apps among pregnant women in Flanders. Methods: A cross-sectional study was conducted, using a semistructured survey (April-June 2019) consisting of four different domains: (1) demographics; (2) use of devices; (3) sources of information; and (4) use of pregnancy apps. Women were recruited by social media, flyers, and paper questionnaires at prenatal consultations. Statistical analysis was mainly focused on descriptive statistics. Differences in continuous and categorical variables were tested using independent Student t tests and chi-square tests. Correlations were investigated between maternal characteristics and the women’s responses. Results: In total, 311 women completed the entire questionnaire. Obstetricians were the primary source of information (268/311, 86.2%) for pregnant women, followed by websites/internet (267/311, 85.9%) and apps (233/311, 74.9%). The information that was most searched for was information about the development of the baby (275/311, 88.5%), discomfort/complaints (251/311, 80.7%) and health during pregnancy (248/311, 79.7%), administrative/practical issues (233/311, 74.9%), and breastfeeding (176/311, 56.6%). About half of the women (172/311, 55.3%) downloaded a pregnancy app, and primarily searched app stores (133/311, 43.0%). Pregnant women who are single asked their mothers (22/30, 73.3%) or other family members (13/30, 43.3%) for significantly more information than did married women (mother [in law]: 82/160, 51.3%, P=.02; family members: 35/160, 21.9%, P=.01). Pregnant women with lower education were significantly more likely to have a PC or laptop than those with higher education (72/73, 98.6% vs 203/237, 85.5%; P=.008), and to consult other family members for pregnancy information (30/73, 41.1% vs 55/237, 23.1%; P<.001), but were less likely to consult a gynecologist (70/73, 95.9% vs 198/237, 83.5%; P=.001). They also followed more prenatal sessions (59/73, 80.8% vs 77/237, 32.5%; P=.04) and were more likely to search for information regarding discomfort/complaints during pregnancy (65/73, 89% vs 188/237, 79.5%; P=.02). Compared to multigravida, primigravida were more likely to solicit advice about their pregnancy from other women in their social networks (family members: primigravida 44/109, 40.4% vs multigravida 40/199, 20.1%; P<.001; other pregnant women: primigravida 58/109, 53.2% vs multigravida 80/199, 40.2%; P<.03). Conclusions: Health care professionals need to be aware that apps are important and are a growing source of information for pregnant women. Concerns rise about the quality and safety of those apps, as only a limited number of apps are subjected to an external quality check. Therefore, it is important that health care providers refer to high-quality digital resources and take the opportunity to discuss digital information with pregnant women. %M 36222794 %R 10.2196/37866 %U https://formative.jmir.org/2022/10/e37866 %U https://doi.org/10.2196/37866 %U http://www.ncbi.nlm.nih.gov/pubmed/36222794 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 10 %P e37968 %T A Digital Mental Health Intervention (Inuka) for Common Mental Health Disorders in Zimbabwean Adults in Response to the COVID-19 Pandemic: Feasibility and Acceptability Pilot Study %A Dambi,Jermaine %A Norman,Clara %A Doukani,Asmae %A Potgieter,Stephan %A Turner,Jean %A Musesengwa,Rosemary %A Verhey,Ruth %A Chibanda,Dixon %+ Rehabilitation Sciences Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Mt Pleasant, Harare, Zimbabwe, 263 773444911, jermainedambi@gmail.com %K acceptability %K COVID-19 %K feasibility %K Friendship Bench %K Inuka %K pilot %K task-shifting %K Zimbabwe %D 2022 %7 7.10.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Common mental health disorders (CMDs) are leading causes of disability globally. The ongoing COVID-19 pandemic has further exacerbated the burden of CMDs. COVID-19 containment measures, including lockdowns, have disrupted access to in-person mental health care. It is therefore imperative to explore the utility of digital mental health interventions to bridge the treatment gap. Mobile health technologies are effective tools for increasing access to treatment at a lower cost. This study explores the utility of Inuka, a chat-based app hinged on the Friendship Bench problem-solving therapy intervention. The Inuka app offers double anonymity, and clients can book or cancel a session at their convenience. Inuka services can be accessed either through a mobile app or the web. Objective: We aimed to explore the feasibility of conducting a future clinical trial. Additionally, we evaluated the feasibility, acceptability, appropriateness, scalability, and preliminary effectiveness of Inuka. Methods: Data were collected using concurrent mixed methods. We used a pragmatic quasiexperimental design to compare the feasibility, acceptability, and preliminary clinical effectiveness of Inuka (experimental group) and WhatsApp chat-based counseling (control). Participants received 6 problem-solving therapy sessions delivered by lay counselors. A reduction in CMDs was the primary clinical outcome. The secondary outcomes were health-related quality of life (HRQoL), disability and functioning, and social support. Quantitative outcomes were analyzed using descriptive and bivariate statistics. Finally, we used administrative data and semistructured interviews to gather data on acceptability and feasibility; this was analyzed using thematic analysis. Results: Altogether, 258 participants were screened over 6 months, with 202 assessed for eligibility, and 176 participants were included in the study (recruitment ratio of 29 participants/month). The participants’ mean age was 24.4 (SD 5.3) years, and most participants were female and had tertiary education. The mean daily smartphone usage was 8 (SD 3.5) hours. Eighty-three users signed up and completed at least one session. The average completion rate was 3 out of 4 sessions. Inuka was deemed feasible and acceptable in the local context, with connectivity challenges, app instability, expensive mobile data, and power outages cited as potential barriers to scale up. Generally, there was a decline in CMDs (F2,73=2.63; P=.08), depression (F2,73=7.67; P<.001), and anxiety (F2,73=2.95; P=.06) and a corresponding increase in HRQoL (F2,73=7.287; P<.001) in both groups. Conclusions: Study outcomes showed that it is feasible to run a future large-scale randomized clinical trial (RCT) and lend support to the feasibility and acceptability of Inuka, including evidence of preliminary effectiveness. The app’s double anonymity and structured support were the most salient features. There is a great need for iterative app updates before scaling up. Finally, a large-scale hybrid RCT with a longer follow-up to evaluate the clinical implementation and cost-effectiveness of the app is needed. %M 35960595 %R 10.2196/37968 %U https://mental.jmir.org/2022/10/e37968 %U https://doi.org/10.2196/37968 %U http://www.ncbi.nlm.nih.gov/pubmed/35960595 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e38339 %T Investigating Rewards and Deposit Contract Financial Incentives for Physical Activity Behavior Change Using a Smartphone App: Randomized Controlled Trial %A de Buisonjé,David R %A Reijnders,Thomas %A Cohen Rodrigues,Talia R %A Prabhakaran,Santhanam %A Kowatsch,Tobias %A Lipman,Stefan A %A Bijmolt,Tammo H A %A Breeman,Linda D %A Janssen,Veronica R %A Kraaijenhagen,Roderik A %A Kemps,Hareld M C %A Evers,Andrea W M %+ Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, Room 2A22, Leiden, 2333 AK, Netherlands, 31 630665252, d.r.de.buisonje@fsw.leidenuniv.nl %K eHealth %K behavior change %K rewards %K reward learning %K financial incentives %K deposit contracts %K commitment contracts %K physical activity %K mobile phone %D 2022 %7 6.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Financial incentive interventions for improving physical activity have proven to be effective but costly. Deposit contracts (in which participants pledge their own money) could be an affordable alternative. In addition, deposit contracts may have superior effects by exploiting the power of loss aversion. Previous research has often operationalized deposit contracts through loss framing a financial reward (without requiring a deposit) to mimic the feelings of loss involved in a deposit contract. Objective: This study aimed to disentangle the effects of incurring actual losses (through self-funding a deposit contract) and loss framing. We investigated whether incentive conditions are more effective than a no-incentive control condition, whether deposit contracts have a lower uptake than financial rewards, whether deposit contracts are more effective than financial rewards, and whether loss frames are more effective than gain frames. Methods: Healthy participants (N=126) with an average age of 22.7 (SD 2.84) years participated in a 20-day physical activity intervention. They downloaded a smartphone app that provided them with a personalized physical activity goal and either required a €10 (at the time of writing: €1=US $0.98) deposit up front (which could be lost) or provided €10 as a reward, contingent on performance. Daily feedback on incentive earnings was provided and framed as either a loss or gain. We used a 2 (incentive type: deposit or reward) × 2 (feedback frame: gain or loss) between-subjects factorial design with a no-incentive control condition. Our primary outcome was the number of days participants achieved their goals. The uptake of the intervention was a secondary outcome. Results: Overall, financial incentive conditions (mean 13.10, SD 6.33 days goal achieved) had higher effectiveness than the control condition (mean 8.00, SD 5.65 days goal achieved; P=.002; ηp2=0.147). Deposit contracts had lower uptake (29/47, 62%) than rewards (50/50, 100%; P<.001; Cramer V=0.492). Furthermore, 2-way analysis of covariance showed that deposit contracts (mean 14.88, SD 6.40 days goal achieved) were not significantly more effective than rewards (mean 12.13, SD 6.17 days goal achieved; P=.17). Unexpectedly, loss frames (mean 10.50, SD 6.22 days goal achieved) were significantly less effective than gain frames (mean 14.67, SD 5.95 days goal achieved; P=.007; ηp2=0.155). Conclusions: Financial incentives help increase physical activity, but deposit contracts were not more effective than rewards. Although self-funded deposit contracts can be offered at low cost, low uptake is an important obstacle to large-scale implementation. Unexpectedly, loss framing was less effective than gain framing. Therefore, we urge further research on their boundary conditions before using loss-framed incentives in practice. Because of limited statistical power regarding some research questions, the results of this study should be interpreted with caution, and future work should be done to confirm these findings. Trial Registration: Open Science Framework Registries osf.io/34ygt; https://osf.io/34ygt %M 36201384 %R 10.2196/38339 %U https://www.jmir.org/2022/10/e38339 %U https://doi.org/10.2196/38339 %U http://www.ncbi.nlm.nih.gov/pubmed/36201384 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 10 %P e39150 %T The Effects of Objective Push-Type Sleep Feedback on Habitual Sleep Behavior and Momentary Symptoms in Daily Life: mHealth Intervention Trial Using a Health Care Internet of Things System %A Takeuchi,Hiroki %A Suwa,Kaori %A Kishi,Akifumi %A Nakamura,Toru %A Yoshiuchi,Kazuhiro %A Yamamoto,Yoshiharu %+ Graduate School of Education, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan, 81 03 5841 3968, takeuchi@p.u-tokyo.ac.jp %K wearable activity monitor %K smartphone app %K sleep feedback %K ecological momentary assessment %K stabilized sleep timing %K mood and physical symptoms %D 2022 %7 6.10.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Sleep is beneficial for physical and mental health. Several mobile and wearable sleep-tracking devices have been developed, and personalized sleep feedback is the most common functionality among these devices. To date, no study has implemented an objective push-type feedback message and investigated the characteristics of habitual sleep behavior and diurnal symptoms when receiving sleep feedback. Objective: We conducted a mobile health intervention trial to examine whether sending objective push-type sleep feedback changes the self-reported mood, physical symptoms, and sleep behavior of Japanese office workers. Methods: In total, 31 office workers (mean age 42.3, SD 7.9 years; male-to-female ratio 21:10) participated in a 2-arm intervention trial from November 30 to December 19, 2020. The participants were instructed to indicate their momentary mood and physical symptoms (depressive mood, anxiety, stress, sleepiness, fatigue, and neck and shoulder stiffness) 5 times a day using a smartphone app. In addition, daily work performance was rated once a day after work. They were randomly assigned to either a feedback or control group, wherein they did or did not receive messages about their sleep status on the app every morning, respectively. All participants wore activity monitors on their nondominant wrists, through which objective sleep data were registered on the web on a server. On the basis of the estimated sleep data on the server, personalized sleep feedback messages were generated and sent to the participants in the feedback group using the app. These processes were fully automated. Results: Using hierarchical statistical models, we examined the differences in the statistical properties of sleep variables (sleep duration and midpoint of sleep) and daily work performance over the trial period. Group differences in the diurnal slopes for mood and physical symptoms were examined using a linear mixed effect model. We found a significant group difference among within-individual residuals at the midpoint of sleep (expected a posteriori for the difference: −15, 95% credible interval −26 to −4 min), suggesting more stable sleep timing in the feedback group. However, there were no significant group differences in daily work performance. We also found significant group differences in the diurnal slopes for sleepiness (P<.001), fatigue (P=.002), and neck and shoulder stiffness (P<.001), which was largely due to better scores in the feedback group at wake-up time relative to those in the control group. Conclusions: This is the first mobile health study to demonstrate that objective push-type sleep feedback improves sleep timing of and physical symptoms in healthy office workers. Future research should incorporate specific behavioral instructions intended to improve sleep habits and examine the effectiveness of these instructions. %M 36201383 %R 10.2196/39150 %U https://mhealth.jmir.org/2022/10/e39150 %U https://doi.org/10.2196/39150 %U http://www.ncbi.nlm.nih.gov/pubmed/36201383 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e38940 %T The Current State of Mobile Apps Owned by Large Pediatric Hospitals in the United States: Systematic Search and Analysis on Google Play and Apple App Stores %A Lieser,Tyler %A Huang,Yungui %A Sezgin,Emre %+ The Abigail Wexner Research Institute, Nationwide Children's Hospital, 575 Children's Xrd, Columbus, OH, 43215, United States, 1 6147222210, tyler.lieser@nationwidechildrens.org %K pediatric %K child %K hospital %K mobile app %K mobile health %K mHealth %K health app %K digital health %K eHealth %K hospital-owned app %K telehealth %K review %K app feature %K accessibility %K patient experience %K functionality %D 2022 %7 6.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Pediatric hospitals in the United States are increasingly leveraging patient-facing mobile apps as their digital front doors for patients, families, and caretakers. These mobile health apps are sanctioned by pediatric hospitals to inform the public or populations about pediatric care to provide individualized information, to enhance communication, and to improve patient experience. Yet the functionalities and user feedback of these hospital mobile apps have not been systematically investigated. Objective: Our aim was to understand the current state of hospital-owned mobile apps provided by large pediatric hospitals, comparatively analyze and report the services provided, and identify potential gaps to inform developers and providers. The American Hospital Association defines large hospitals as those having a bed count of more than 400. Methods: We conducted a systematic search on Google Play and Apple App Store to identify all hospital-owned mobile apps from the large pediatric hospitals included in our review. Our inclusion criteria were (1) apps provided by large pediatric hospitals; (2) hospital-owned apps available in Apple App Store and Google Play; and (3) apps that are provided for general populations. Specialty apps that serve specific user groups or populations focusing on education, telehealth, specific conditions or procedures, or apps intended for research or clinician use were excluded. The features and functionality of the included apps were examined. Results: Of the 16 pediatric hospitals included in our review, 4 (25%) had no general patient-facing apps, 4 (25%) had one app, and 8 (50%) had more than one app available on Google Play or Apple App Store. The 12 hospitals with at least one mobile app had a combined total of 72 apps. Of these 72 apps, 61 (85%) were considered specialty and were excluded from our review, leaving a total of 11 (15%) apps to analyze. Among the 11 apps analyzed, the most common feature was appointment scheduling or reminder (n=9, 82%). Doctor search (n=8, 73%) and patient resources (n=8, 73%) were the second most common, followed by payment, billing, or claims (n=7, 64%), patient portal integration (n=6, 55%), personal health management (n=6, 55%), hospital way finding (n=5, 45%), message a provider (n=4, 36%), urgent care wait times (n=4, 36%), video chat (n=4, 36%), and health information access (n=4, 36%). Parking information (n=3, 27%) was the least common. Conclusions: Out of the 16 pediatric hospitals identified for our review, 75% (n=12) offer mobile apps. Based on the most common features, these apps were intended to help improve accessibility for patients and families in terms of finding providers, scheduling appointments, and accessing patient resources. We believe the findings will inform pediatric hospital administrators, developers, and other stakeholders to improve app feature offerings and increase their impact on service accessibility and patient experience. %M 36201385 %R 10.2196/38940 %U https://pediatrics.jmir.org/2022/4/e38940 %U https://doi.org/10.2196/38940 %U http://www.ncbi.nlm.nih.gov/pubmed/36201385 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 10 %P e38709 %T Electronic Health Diary Campaigns to Complement Longitudinal Assessments in Persons With Multiple Sclerosis: Nested Observational Study %A Sieber,Chloé %A Chiavi,Deborah %A Haag,Christina %A Kaufmann,Marco %A Horn,Andrea B %A Dressel,Holger %A Zecca,Chiara %A Calabrese,Pasquale %A Pot,Caroline %A Kamm,Christian Philipp %A von Wyl,Viktor %A , %+ Swiss Multiple Sclerosis Registry, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, 8001, Switzerland, 41 44 634 63 80, viktor.vonwyl@uzh.ch %K registry %K multiple sclerosis %K digital health %K electronic health diary %K diary %K participation %K adherence %K patient-reported outcome %K natural language processing %K unstructured text %D 2022 %7 5.10.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Electronic health diaries hold promise in complementing standardized surveys in prospective health studies but are fraught with numerous methodological challenges. Objective: The study aimed to investigate participant characteristics and other factors associated with response to an electronic health diary campaign in persons with multiple sclerosis, identify recurrent topics in free-text diary entries, and assess the added value of structured diary entries with regard to current symptoms and medication intake when compared with survey-collected information. Methods: Data were collected by the Swiss Multiple Sclerosis Registry during a nested electronic health diary campaign and during a regular semiannual Swiss Multiple Sclerosis Registry follow-up survey serving as comparator. The characteristics of campaign participants were descriptively compared with those of nonparticipants. Diary content was analyzed using the Linguistic Inquiry and Word Count 2015 software (Pennebaker Conglomerates, Inc) and descriptive keyword analyses. The similarities between structured diary data and follow-up survey data on health-related quality of life, symptoms, and medication intake were examined using the Jaccard index. Results: Campaign participants (n=134; diary entries: n=815) were more often women, were not working full time, did not have a higher education degree, had a more advanced gait impairment, and were on average 5 years older (median age 52.5, IQR 43.25-59.75 years) than eligible nonparticipants (median age 47, IQR 38-55 years; n=524). Diary free-text entries (n=632; participants: n=100) most often contained references to the following standard Linguistic Inquiry and Word Count word categories: negative emotion (193/632, 30.5%), body parts or body functioning (191/632, 30.2%), health (94/632, 14.9%), or work (67/632, 10.6%). Analogously, the most frequently mentioned keywords (diary entries: n=526; participants: n=93) were “good,” “day,” and “work.” Similarities between diary data and follow-up survey data, collected 14 months apart (median), were high for health-related quality of life and stable for slow-changing symptoms such as fatigue or gait disorder. Similarities were also comparatively high for drugs requiring a regular application, including interferon beta-1a (Avonex) and glatiramer acetate (Copaxone), and for modern oral therapies such as fingolimod (Gilenya) and teriflunomide (Aubagio). Conclusions: Diary campaign participation seemed dependent on time availability and symptom burden and was enhanced by reminder emails. Electronic health diaries are a meaningful complement to regular structured surveys and can provide more detailed information regarding medication use and symptoms. However, they should ideally be embedded into promotional activities or tied to concrete research study tasks to enhance regular and long-term participation. %M 36197713 %R 10.2196/38709 %U https://mhealth.jmir.org/2022/10/e38709 %U https://doi.org/10.2196/38709 %U http://www.ncbi.nlm.nih.gov/pubmed/36197713 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 10 %P e35896 %T Retention, Fasting Patterns, and Weight Loss With an Intermittent Fasting App: Large-Scale, 52-Week Observational Study %A Torres,Luisa %A Lee,Joy L %A Park,Seho %A Di Lorenzo,R Christian %A Branam,Jonathan P %A Fraser,Shelagh A %A Salisbury,Benjamin A %+ LifeOmic, 351 W. 10th St, Indianapolis, IN, 46202, United States, 1 9377512962, ben.salisbury@lifeomic.com %K intermittent fasting %K time-restricted eating %K weight loss %K obesity %K mobile apps %K diet trackers %K retention %D 2022 %7 4.10.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Intermittent fasting (IF) is an increasingly popular approach to dietary control that focuses on the timing of eating rather than the quantity and content of caloric intake. IF practitioners typically seek to improve their weight and other health factors. Millions of practitioners have turned to purpose-built mobile apps to help them track and adhere to their fasts and monitor changes in their weight and other biometrics. Objective: This study aimed to quantify user retention, fasting patterns, and weight loss by users of 2 IF mobile apps. We also sought to describe and model starting BMI, amount of fasting, frequency of weight tracking, and other demographics as correlates of retention and weight change. Methods: We assembled height, weight, fasting, and demographic data of adult users (ages 18-100 years) of the LIFE Fasting Tracker and LIFE Extend apps from 2018 to 2020. Retention for up to 52 weeks was quantified based on recorded fasts and correlated with user demographics. Users who provided height and at least 2 readings of weight and whose first fast and weight records were contemporaneous were included in the weight loss analysis. Fasting was quantified as extended fasting hours (EFH; hours beyond 12 in a fast) averaged per day (EFH per day). Retention was modeled using a Cox proportional hazards regression. Weight loss was analyzed using linear regression. Results: A total of 792,692 users were followed for retention based on 26 million recorded fasts. Of these, 132,775 (16.7%) users were retained at 13 weeks, 54,881 (6.9%) at 26 weeks, and 16,478 (2.1%) at 52 weeks, allowing 4 consecutive weeks of inactivity. The survival analysis using Cox regression indicated that retention was positively associated with age and exercise and negatively associated with stress and smoking. Weight loss in the qualifying cohort (n=161,346) was strongly correlated with starting BMI and EFH per day, which displayed a positive interaction. Users with a BMI ≥40 kg/m2 lost 13.9% of their starting weight by 52 weeks versus a slight weight gain on average for users with starting BMI <23 kg/m2. EFH per day was an approximately linear predictor of weight loss. By week 26, users lost over 1% of their starting weight per EFH per day on average. The regression analysis using all variables was highly predictive of weight change at 26 weeks (R2=0.334) with starting BMI and EFH per day as the most significant predictors. Conclusions: IF with LIFE mobile apps appears to be a sustainable approach to weight reduction in the overweight and obese population. Healthy weight and underweight individuals do not lose much weight on average, even with extensive fasting. Users who are obese lose substantial weight over time, with more weight loss in those who fast more. %M 36194463 %R 10.2196/35896 %U https://mhealth.jmir.org/2022/10/e35896 %U https://doi.org/10.2196/35896 %U http://www.ncbi.nlm.nih.gov/pubmed/36194463 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 10 %P e40667 %T Associations Between Depression Symptom Severity and Daily-Life Gait Characteristics Derived From Long-Term Acceleration Signals in Real-World Settings: Retrospective Analysis %A Zhang,Yuezhou %A Folarin,Amos A %A Sun,Shaoxiong %A Cummins,Nicholas %A Vairavan,Srinivasan %A Qian,Linglong %A Ranjan,Yatharth %A Rashid,Zulqarnain %A Conde,Pauline %A Stewart,Callum %A Laiou,Petroula %A Sankesara,Heet %A Matcham,Faith %A White,Katie M %A Oetzmann,Carolin %A Ivan,Alina %A Lamers,Femke %A Siddi,Sara %A Simblett,Sara %A Rintala,Aki %A Mohr,David C %A Myin-Germeys,Inez %A Wykes,Til %A Haro,Josep Maria %A Penninx,Brenda W J H %A Narayan,Vaibhav A %A Annas,Peter %A Hotopf,Matthew %A Dobson,Richard J B %A , %+ Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, SGDP Centre, IoPPN, PO Box 80, De Crespigny Park, Denmark Hill, London, SE5 8AF, United Kingdom, 44 75 7985 6617, yuezhou.zhang@kcl.ac.uk %K depression %K gait %K mobile health %K mHealth %K acceleration signals %K monitoring %K wearable devices %K mobile phones %K mental health %D 2022 %7 4.10.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Gait is an essential manifestation of depression. However, the gait characteristics of daily walking and their relationships with depression have yet to be fully explored. Objective: The aim of this study was to explore associations between depression symptom severity and daily-life gait characteristics derived from acceleration signals in real-world settings. Methods: We used two ambulatory data sets (N=71 and N=215) with acceleration signals collected by wearable devices and mobile phones, respectively. We extracted 12 daily-life gait features to describe the distribution and variance of gait cadence and force over a long-term period. Spearman coefficients and linear mixed-effects models were used to explore the associations between daily-life gait features and depression symptom severity measured by the 15-item Geriatric Depression Scale (GDS-15) and 8-item Patient Health Questionnaire (PHQ-8) self-reported questionnaires. The likelihood-ratio (LR) test was used to test whether daily-life gait features could provide additional information relative to the laboratory gait features. Results: Higher depression symptom severity was significantly associated with lower gait cadence of high-performance walking (segments with faster walking speed) over a long-term period in both data sets. The linear regression model with long-term daily-life gait features (R2=0.30) fitted depression scores significantly better (LR test P=.001) than the model with only laboratory gait features (R2=0.06). Conclusions: This study indicated that the significant links between daily-life walking characteristics and depression symptom severity could be captured by both wearable devices and mobile phones. The daily-life gait patterns could provide additional information for predicting depression symptom severity relative to laboratory walking. These findings may contribute to developing clinical tools to remotely monitor mental health in real-world settings. %M 36194451 %R 10.2196/40667 %U https://mhealth.jmir.org/2022/10/e40667 %U https://doi.org/10.2196/40667 %U http://www.ncbi.nlm.nih.gov/pubmed/36194451 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e33826 %T Promoting Adolescent Sexual and Reproductive Health in North America Using Free Mobile Apps: Environmental Scan %A Benoit,James Russell Andrew %A Louie-Poon,Samantha %A Kauser,Samar %A Meherali,Salima %+ Faculty of Nursing, University of Alberta, 5-147 Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, AB, T6E1S1, Canada, 1 780 777 1864, jrbenoit@ualberta.ca %K mHealth %K mobile health %K adolescent %K sexual and reproductive health %K environmental scan %K mobile app %K sexual health %K reproductive health %K health %K sexual %K reproductive %K MARS %K Mobile App Rating Scale %K digital health %K adolescents %D 2022 %7 4.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Neglecting adolescents’ sexual and reproductive health (SRH) can affect multiple domains of development. Promoting healthy adolescent SRH is increasingly done using mobile phone apps. Providing SRH information via mobile phones can positively influence SRH outcomes including improving knowledge, reducing sexual risk behavior, and increasing the use of health services. A systematic approach to establishing and evaluating the quality of adolescent SRH mobile apps is urgently needed to rigorously evaluate whether they are a viable and effective strategy for reaching adolescents and improving adolescent SRH knowledge and behaviors in particular. Objective: This study aimed to conduct an environmental scan to produce an inventory of adolescent SRH–specific mobile apps with descriptions of their purpose, structure, operations, and quality of evidence. Methods: We used a literature review to develop 15 search terms for adolescent SRH–related apps in the Canadian and US Apple and Google app stores. After generating the search results, inclusion and exclusion criteria were applied. Using the remaining apps, we built an evidence table of app information, and app reviewers assessed each included app using the Mobile App Rating Scale. App assessments were then used to highlight trends between apps and identify gaps in app quality. Results: In total, 2761 apps were identified by our searches, of which 1515 were duplicates. Of the 1246 remaining apps, 15 met the criteria for further assessment. Across all subdomains, on a scale of 1-5, the mean app score was 3.4/5. The Functionality subdomain had the highest mean score of 4.1/5, whereas the Engagement subdomain had the lowest score of 2.9/5. The top 4 apps were Tia: Female Health Advisor (4.7/5), Under the Stethoscope (4.2/5), Condom Credit Card (4.1/5), and Shnet (3.7/5). Conclusions: This environmental scan aimed to provide a comprehensive overview of the mobile apps developed to promote adolescent SRH knowledge and outcomes. Of the 15 mobile apps available to provide information related to adolescent SRH, few provided comprehensive, reliable, and evidence-based SRH information. Areas of strength included the apps’ gestural design, performance, ease of use, and navigation. Areas of weakness included app goals, evidence base, and app customization options. These results can be used to conduct future studies evaluating the use and efficacy of mobile apps on health knowledge and behaviors and promote adolescent SRH. %M 36194450 %R 10.2196/33826 %U https://pediatrics.jmir.org/2022/4/e33826 %U https://doi.org/10.2196/33826 %U http://www.ncbi.nlm.nih.gov/pubmed/36194450 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e39243 %T Conversational Agents in Health Care: Scoping Review of Their Behavior Change Techniques and Underpinning Theory %A Martinengo,Laura %A Jabir,Ahmad Ishqi %A Goh,Westin Wei Tin %A Lo,Nicholas Yong Wai %A Ho,Moon-Ho Ringo %A Kowatsch,Tobias %A Atun,Rifat %A Michie,Susan %A Tudor Car,Lorainne %+ Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Clinical Sciences Building Level 18, Singapore, 308232, Singapore, 65 69047142, lorainne.tudor.car@ntu.edu.sg %K behavior change %K behavior change techniques %K conversational agent %K chatbot %K mHealth %D 2022 %7 3.10.2022 %9 Review %J J Med Internet Res %G English %X Background: Conversational agents (CAs) are increasingly used in health care to deliver behavior change interventions. Their evaluation often includes categorizing the behavior change techniques (BCTs) using a classification system of which the BCT Taxonomy v1 (BCTTv1) is one of the most common. Previous studies have presented descriptive summaries of behavior change interventions delivered by CAs, but no in-depth study reporting the use of BCTs in these interventions has been published to date. Objective: This review aims to describe behavior change interventions delivered by CAs and to identify the BCTs and theories guiding their design. Methods: We searched PubMed, Embase, Cochrane’s Central Register of Controlled Trials, and the first 10 pages of Google and Google Scholar in April 2021. We included primary, experimental studies evaluating a behavior change intervention delivered by a CA. BCTs coding followed the BCTTv1. Two independent reviewers selected the studies and extracted the data. Descriptive analysis and frequent itemset mining to identify BCT clusters were performed. Results: We included 47 studies reporting on mental health (n=19, 40%), chronic disorders (n=14, 30%), and lifestyle change (n=14, 30%) interventions. There were 20/47 embodied CAs (43%) and 27/47 CAs (57%) represented a female character. Most CAs were rule based (34/47, 72%). Experimental interventions included 63 BCTs, (mean 9 BCTs; range 2-21 BCTs), while comparisons included 32 BCTs (mean 2 BCTs; range 2-17 BCTs). Most interventions included BCTs 4.1 “Instruction on how to perform a behavior” (34/47, 72%), 3.3 “Social support” (emotional; 27/47, 57%), and 1.2 “Problem solving” (24/47, 51%). A total of 12/47 studies (26%) were informed by a behavior change theory, mainly the Transtheoretical Model and the Social Cognitive Theory. Studies using the same behavior change theory included different BCTs. Conclusions: There is a need for the more explicit use of behavior change theories and improved reporting of BCTs in CA interventions to enhance the analysis of intervention effectiveness and improve the reproducibility of research. %M 36190749 %R 10.2196/39243 %U https://www.jmir.org/2022/10/e39243 %U https://doi.org/10.2196/39243 %U http://www.ncbi.nlm.nih.gov/pubmed/36190749 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 4 %P e38192 %T Are Conventional Combined Training Interventions and Exergames Two Facets of the Same Coin to Improve Brain and Cognition in Healthy Older Adults? Data-Based Viewpoint %A Temprado,Jean-Jacques %A Torre,Marta Maria %+ Aix Marseille Université, Institut des Sciences du Mouvement, 163 Avenue de Luminy, BP 910, Marseille, 13288, France, 33 611837288, jean-jacques.temprado@univ-amu.fr %K aging %K older %K gerontology %K exergame %K physical activity %K cognition %K training %K intervention %K cognitive %K brain %K older adult %K motor skills %K exercise %K physical %K motor %K combined training %D 2022 %7 3.10.2022 %9 Viewpoint %J JMIR Serious Games %G English %X Combining physical, motor, and cognitive exercises is expected to be effective to attenuate age-related declines of brain and cognition in older adults. This can be achieved either by conventional interventions or by exergames. This paper aimed to determine whether conventional combined training and exergame interventions are two comparable ways for delivering combined training. In total, 24 studies on conventional training and 23 studies on exergames were selected and compared. A common framework was used to analyze both types of combined training interventions. Our analysis showed that conventional combined training interventions were more effective than separated physical and motor training to improve brain and cognition, while their superiority over cognitive training alone remains to be confirmed. Exergames scarcely led to cognitive benefits superior to those observed after physical, motor, or cognitive training alone. Thus, although both conventional training interventions and exergames allowed delivering combined training programs, they are not two facets of the same coin. Further studies that are more theoretically grounded are necessary to determine whether interventions delivered via exergames may lead to superior benefits compared to conventional separated and combined training interventions. %M 36190757 %R 10.2196/38192 %U https://games.jmir.org/2022/4/e38192 %U https://doi.org/10.2196/38192 %U http://www.ncbi.nlm.nih.gov/pubmed/36190757 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e40572 %T Feasibility of Measuring Screen Time, Activity, and Context Among Families With Preschoolers: Intensive Longitudinal Pilot Study %A Parker,Hannah %A Burkart,Sarah %A Reesor-Oyer,Layton %A Smith,Michal T %A Dugger,Roddrick %A von Klinggraeff,Lauren %A Weaver,R Glenn %A Beets,Michael W %A Armstrong,Bridget %+ Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly St, Columbia, SC, 29208-3904, United States, 1 803 576 8418, ba12@mailbox.sc.edu %K ecological momentary assessment %K accelerometry %K objective digital media use %K screen time %K sleep %K activity %K preschool %K dyads %K mobile phone %D 2022 %7 29.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital media has made screen time more available across multiple contexts, but our understanding of the ways children and families use digital media has lagged behind the rapid adoption of this technology. Objective: This study evaluated the feasibility of an intensive longitudinal data collection protocol to objectively measure digital media use, physical activity, sleep, sedentary behavior, and socioemotional context among caregiver-child dyads. This paper also describes preliminary convergent validity of ecological momentary assessment (EMA) measures and preliminary agreement between caregiver self-reported phone use and phone use collected from passive mobile sensing. Methods: Caregivers and their preschool-aged child (3-5 years) were recruited to complete a 30-day assessment protocol. Within 30-days, caregivers completed 7 days of EMA to measure child behavior problems and caregiver stress. Caregivers and children wore an Axivity AX3 (Newcastle Upon Tyne) accelerometer to assess physical activity, sedentary behavior, and sleep. Phone use was assessed via passive mobile sensing; we used Chronicle for Android users and screenshots of iOS screen time metrics for iOS users. Participants were invited to complete a second 14-day protocol approximately 3-12 months after their first assessment. We used Pearson correlations to examine preliminary convergent validity between validated questionnaire measures of caregiver psychological functioning, child behavior, and EMA items. Root mean square errors were computed to examine the preliminary agreement between caregiver self-reported phone use and objective phone use. Results: Of 110 consenting participants, 105 completed all protocols (105/110, 95.5% retention rate). Compliance was defined a priori as completing ≥70%-75% of each protocol task. There were high compliance rates for passive mobile sensing for both Android (38/40, 95%) and iOS (64/65, 98%). EMA compliance was high (105/105, 100%), but fewer caregivers and children were compliant with accelerometry (62/99, 63% and 40/100, 40%, respectively). Average daily phone use was 383.4 (SD 157.0) minutes for Android users and 354.7 (SD 137.6) minutes for iOS users. There was poor agreement between objective and caregiver self-reported phone use; root mean square errors were 157.1 and 81.4 for Android and iOS users, respectively. Among families who completed the first assessment, 91 re-enrolled to complete the protocol a second time, approximately 7 months later (91/105, 86.7% retention rate). Conclusions: It is feasible to collect intensive longitudinal data on objective digital media use simultaneously with accelerometry and EMA from an economically and racially diverse sample of families with preschool-aged children. The high compliance and retention of the study sample are encouraging signs that these methods of intensive longitudinal data collection can be completed in a longitudinal cohort study. The lack of agreement between self-reported and objectively measured mobile phone use highlights the need for additional research using objective methods to measure digital media use. International Registered Report Identifier (IRRID): RR2-36240 %M 36173677 %R 10.2196/40572 %U https://formative.jmir.org/2022/9/e40572 %U https://doi.org/10.2196/40572 %U http://www.ncbi.nlm.nih.gov/pubmed/36173677 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 9 %P e40500 %T The Indirect Effects of a Mindfulness Mobile App on Productivity Through Changes in Sleep Among Retail Employees: Secondary Analysis %A Espel-Huynh,Hallie %A Baldwin,Matthew %A Puzia,Megan %A Huberty,Jennifer %+ Calm.com, Inc, 77 Geary St #3, San Francisco, CA, 94108, United States, 1 415 984 5864, hallie.espel.huynh@calm.com %K mindfulness %K mobile apps %K workforce %K workplace %K sleep %K presenteeism %K mobile phone %D 2022 %7 28.9.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic sleep disturbance is prevalent among United States employees and associated with costly productivity impairment. Mindfulness interventions improve sleep (ie, insomnia and daytime sleepiness) and productivity outcomes, and mobile apps provide scalable means of intervention delivery. However, few studies have examined the effects of mindfulness mobile apps on employees, and no research to date has tested the role of sleep improvement as a potential mechanism of action for productivity outcomes. Objective: This study examined the effects of Calm, a consumer-based mindfulness app, and sleep coaching, on productivity impairment among retail employees through the indirect effects of changes in insomnia and daytime sleepiness. Methods: This study was a secondary analysis of data from a randomized controlled trial (N=1029) comparing the use of Calm (n=585, 56.9%) to a waitlist control (n=444, 43.2%) for 8 weeks among employees of a large retail employer in the United States. A subset of individuals with elevated insomnia symptoms also had access to brief sleep coaching with Calm (n=101, 9.8%). Insomnia symptom severity, daytime sleepiness, and productivity impairment (ie, absenteeism, presenteeism, overall productivity impairment, and non–work activity impairment) were assessed at baseline and weeks 2, 4, 6, and 8. Indirect effects were evaluated with latent growth curve modeling to test whether the Calm intervention (Calm group vs waitlist control) was effective in reducing work productivity impairment through changes in sleep disturbance. Results: No significant main effects of Calm intervention on productivity impairment were detected for any outcome at α level of .05, with the exception of non–work activity impairment models, in which Calm intervention reduced non–work activity impairment over time (P=.01 and P=.02 for insomnia and sleepiness models, respectively). Significant indirect effects of insomnia were detected for presenteeism (P=.002), overall work productivity (P=.01), and non–work activity impairment (P=.002); Calm intervention produced significantly greater reductions in insomnia symptoms (relative to waitlist control), and decreases in insomnia were associated with decreases in work productivity impairment. There was no significant indirect effect of change in insomnia on changes in absenteeism (P=.20). Furthermore, we detected no significant indirect effects of daytime sleepiness on productivity impairment. Conclusions: We found that Calm (plus sleep coaching for a small subset of individuals) had beneficial effects on employee sleep, and these benefits on sleep were related to indirect effects on productivity impairment (ie, presenteeism, overall work productivity impairment, and non–work activity impairment). There were no overall main effects of Calm intervention on productivity impairment; however, insomnia appears to be a mechanism associated with benefits for employee productivity. This is one of the first studies to suggest that sleep benefits of a mindfulness mobile app may also indirectly relate to benefits for workplace productivity. Trial Registration: ClinicalTrials.gov NCT05120310; https://clinicaltrials.gov/ct2/show/NCT05120310 %M 36169994 %R 10.2196/40500 %U https://mhealth.jmir.org/2022/9/e40500 %U https://doi.org/10.2196/40500 %U http://www.ncbi.nlm.nih.gov/pubmed/36169994 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 9 %P e38903 %T Testing the Pragmatic Effectiveness of a Consumer-Based Mindfulness Mobile App in the Workplace: Randomized Controlled Trial %A Huberty,Jennifer L %A Espel-Huynh,Hallie M %A Neher,Taylor L %A Puzia,Megan E %+ Calm.com, Inc., 77 Geary St. Fl. 3, San Francisco, CA, 94108, United States, 1 402 301 1304, jenhubertyphd@gmail.com %K mindfulness %K mobile apps %K workforce %K workplace %K presenteeism %K mental health %D 2022 %7 28.9.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental health and sleep problems are prevalent in the workforce, corresponding to costly impairment in productivity and increased health care use. Digital mindfulness interventions are efficacious in improving sleep and mental health in the workplace; however, evidence supporting their pragmatic utility, potential for improving productivity, and ability to reduce employer costs is limited. Objective: This pragmatic, cluster randomized controlled trial aimed to evaluate the experimental effects of implementing a commercially available mindfulness app—Calm—in employees of a large, multisite employer in the United States. Outcomes included mental health (depression, anxiety, and stress), sleep (insomnia and daytime sleepiness), resilience, productivity impairment (absenteeism, presenteeism, overall work impairment, and non–work activity impairment), and health care use (medical visit frequency). Methods: Employees were randomized at the work site to receive either the Calm app intervention or waitlist control. Participants in the Calm intervention group were instructed to use the Calm app for 10 minutes per day for 8 weeks; individuals with elevated baseline insomnia symptoms could opt-in to 6 weeks of sleep coaching. All outcomes were assessed every 2 weeks, with the exception of medical visits (weeks 4 and 8 only). Effects of the Calm intervention on outcomes were evaluated via mixed effects modeling, controlling for relevant baseline characteristics, with fixed effects of the intervention on outcomes assessed at weeks 2, 4, 6, and 8. Models were analyzed via complete-case and intent-to-treat analyses. Results: A total of 1029 employees enrolled (n=585 in the Calm intervention group, including 101 who opted-in to sleep coaching, and n=444 in waitlist control). Of them, 192 (n=88 for the Calm intervention group and n=104 for waitlist) completed all 5 assessments. In the complete-case analysis at week 8, employees at sites randomized to the Calm intervention group experienced significant improvements in depression (P=.02), anxiety (P=.01), stress (P<.001), insomnia (P<.001), sleepiness (P<.001), resilience (P=.02), presenteeism (P=.01), overall work impairment (P=.004), and nonwork impairment (P<.001), and reduced medical care visit frequency (P<.001) and productivity impairment costs (P=.01), relative to the waitlist control. In the intent-to-treat analysis at week 8, significant benefits of the intervention were observed for depression (P=.046), anxiety (P=.01), insomnia (P<.001), sleepiness (P<.001), nonwork impairment (P=.04), and medical visit frequency (P<.001). Conclusions: The results suggest that the Calm app is an effective workplace intervention for improving mental health, sleep, resilience, and productivity and for reducing medical visits and costs owing to work impairment. Future studies should identify optimal implementation strategies that maximize employee uptake and large-scale implementation success across diverse, geographically dispersed employers. Trial Registration: ClinicalTrials.gov NCT05120310; https://clinicaltrials.gov/ct2/show/NCT05120310 %M 36169991 %R 10.2196/38903 %U https://mhealth.jmir.org/2022/9/e38903 %U https://doi.org/10.2196/38903 %U http://www.ncbi.nlm.nih.gov/pubmed/36169991 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 9 %P e30602 %T The Effects of a Lifestyle Intervention Supported by the InterWalk Smartphone App on Increasing Physical Activity Among Persons With Type 2 Diabetes: Parallel-Group, Randomized Trial %A Thorsen,Ida Kær %A Yang,Yanxiang %A Valentiner,Laura Staun %A Glümer,Charlotte %A Karstoft,Kristian %A Brønd,Jan Christian %A Nielsen,Rasmus Oestergaard %A Brøns,Charlotte %A Christensen,Robin %A Nielsen,Jens Steen %A Vaag,Allan Arthur %A Pedersen,Bente Klarlund %A Langberg,Henning %A Ried-Larsen,Mathias %+ Center of Inflammation and Metabolism and Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark, 45 28700785, ida.kaer.thorsen@regionh.dk %K type 2 diabetes mellitus %K exercise %K telemedicine %K primary health care %K accelerometry %K quality of life %K waist circumference %K mHealth %K mobile app %D 2022 %7 28.9.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Effective and sustainable implementation of physical activity (PA) in type 2 diabetes (T2D) health care has in general not been successful. Efficacious and contemporary approaches to support PA adherence and adoption are required. Objective: The primary objective of this study was to investigate the effectiveness of including an app-based (InterWalk) approach in municipality-based rehabilitation to increase moderate-and-vigorous PA (MVPA) across 52 weeks compared with standard care among individuals with T2D. Methods: The study was designed as a parallel-group, randomized trial with 52 weeks’ intervention and subsequent follow-up for effectiveness (52 weeks from baseline). Participants were recruited between January 2015 and December 2016 and randomly allocated (2:1) into 12 weeks of (1) standard care + InterWalk app–based interval walking training (IWT; IWT group; n=140), or (2) standard care + the standard exercise program (StC group; n=74). Following 12 weeks, the IWT group was encouraged to maintain InterWalk app–based IWT (3 times per week for 30-60 minutes) and the StC group was encouraged to maintain exercise without structured support. Moreover, half of the IWT group (IWTsupport group, n=54) received additional motivational support following the 12-week program until 52-week follow-up. The primary outcome was change in objectively measured MVPA time (minutes/day) from baseline to 52-week follow-up. Key secondary outcomes included changes in self-rated physical and mental health–related quality of life (HRQoL), physical fitness, weight, and waist circumference. Results: Participants had a mean age of 59.6 (SD 10.6) years and 128/214 (59.8%) were men. No changes in MVPA time were observed from baseline to 52-week follow-up in the StC and IWT groups (least squares means [95% CI] 0.6 [–4.6 to 5.8] and –0.2 [–3.8 to 3.3], respectively) and no differences were observed between the groups (mean difference [95% CI] –0.8 [–8.1 to 6.4] minutes/day; P=.82). Physical HRQoL increased by a mean of 4.3 (95% CI 1.8 to 6.9) 12-item Short-Form Health Survey (SF-12) points more in the IWT group compared with the StC group (Benjamini-Hochberg adjusted P=.007) and waist circumference apparently decreased a mean of –2.3 (95% CI –4.1 to –0.4) cm more in the IWT group compared with the StC group but with a Benjamini-Hochberg adjusted P=.06. No between-group differences were observed among the remaining key secondary outcomes. Conclusions: Among individuals with T2D referred to municipality-based lifestyle programs, randomization to InterWalk app–based IWT did not increase objectively measured MVPA time over 52 weeks compared with standard health care, although apparent benefits were observed for physical HRQoL. Trial Registration: ClinicalTrials.gov NCT02341690; https://clinicaltrials.gov/ct2/show/NCT02341690 %M 36170002 %R 10.2196/30602 %U https://mhealth.jmir.org/2022/9/e30602 %U https://doi.org/10.2196/30602 %U http://www.ncbi.nlm.nih.gov/pubmed/36170002 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 9 %P e36247 %T Usability and Effectiveness of an Individualized, Tablet-Based, Multidomain Exercise Program for People With Dementia Delivered by Nursing Assistants: Protocol for an Evaluation of the InCoPE-App %A Barisch-Fritz,Bettina %A Bezold,Jelena %A Scharpf,Andrea %A Trautwein,Sandra %A Krell-Roesch,Janina %A Woll,Alexander %+ Institue of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, Karlsruhe, 76131, Germany, 49 017623523840, bettina.barisch-fritz@kit.edu %K institutionalization %K institutionalized %K sport %K physical activity %K fitness %K exercise %K dementia %K digital application %K cognitive performance %K physical performance %K cognitive function %K physical function %K cognitive decline %K nursing home %K long-term care %K usability %K effectiveness %K mHealth %K mobile health %K health app %D 2022 %7 26.9.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has had drastic consequences on everyday life in nursing homes. Limited personnel resources and modified hygiene and safety measures (eg, no external exercise instructors, no group settings) have often led to interrupted physical exercise treatments. As a consequence, people with dementia benefiting from individualized exercise programs are affected by the pandemic’s impact. Objective: Our goal is to develop an easily applicable mobile application (Individualized Cognitive and Physical Exercise [InCoPE] app) allowing nursing assistants to test cognitive function and physical performance and subsequently train people with dementia through a multidomain, individualized exercise program. Methods: We will evaluate the usability and effectiveness of the InCoPE-App by applying a mixed method design. Nursing assistants will use the InCoPE-App for 18 weeks to assess the cognitive function and physical performance of 44 people with dementia every 3 weeks and apply the individualized exercise program. We will record overall usability using questionnaires (eg, Post-Study System Usability and ISONORM 9241/10), log events, and interviews. Perceived hedonic and pragmatic quality will be assessed using the AttrakDiff questionnaire. Effectiveness will be evaluated by considering changes in quality of life as well as cognitive function and physical performance between before and after the program. Results: Enrollment into the study will be completed in the first half of 2022. We expect an improvement in the quality of life of people with dementia accompanied by improvements in cognitive function and physical performance. The usability of the InCoPE-App is expected to be rated well by nursing assistants. Conclusions: To date, there is no scientifically evaluated app available that enables nursing assistants without expertise in sports science to deliver an individualized exercise program among people with dementia. A highly usable and effective InCoPE-App allows nursing assistants to test cognitive function and physical performance of people with dementia and, based thereon, select and deliver an appropriate individualized exercise program based on the cognitive and physical status of an individual, even in times of a pandemic. Trial Registration: German Register of Clinical Trials DRKS00024069; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024069 International Registered Report Identifier (IRRID): DERR1-10.2196/36247 %M 36156463 %R 10.2196/36247 %U https://www.researchprotocols.org/2022/9/e36247 %U https://doi.org/10.2196/36247 %U http://www.ncbi.nlm.nih.gov/pubmed/36156463 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e39741 %T Long-term Weight Loss in a Primary Care–Anchored eHealth Lifestyle Coaching Program: Randomized Controlled Trial %A Hesseldal,Laura %A Christensen,Jeanette Reffstrup %A Olesen,Thomas Bastholm %A Olsen,Michael Hecht %A Jakobsen,Pernille Ravn %A Laursen,Ditte Hjorth %A Lauridsen,Jørgen Trankjær %A Nielsen,Jesper Bo %A Søndergaard,Jens %A Brandt,Carl Joakim %+ Research Unit for General Practice, Department of Public Health, University of Southern Denmark, WP 9, J. B. Winsløws Vej 9A, 5000 Odense, Odense, 5000, Denmark, 45 314919945, lhesseldal@health.sdu.dk %K obesity %K digital behavioral coaching %K health behavior change %K interactive advice %K lifestyle change %K mobile intervention %K patient engagement %K telemedicine %K eHealth %K digital health %K digital coach %K weight loss %K coaching %K training %K engagement %K behavior changes %K diabetes %K type 2 diabetes %K T2D %D 2022 %7 23.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Long-term weight loss in people living with obesity can reduce the risk and progression of noncommunicable diseases. Observational studies suggest that digital coaching can lead to long-term weight loss. Objective: We investigated whether an eHealth lifestyle coaching program for people living with obesity with or without type 2 diabetes led to significant, long-term (12-month) weight loss compared to usual care. Methods: In a randomized controlled trial that took place in 50 municipalities in Denmark, 340 people living with obesity with or without type 2 diabetes were enrolled from April 16, 2018, to April 1, 2019, and randomized via an automated computer algorithm to an intervention (n=200) or a control (n=140) group. Patients were recruited via their general practitioners, the Danish diabetes organization, and social media. The digital coaching intervention consisted of an initial 1-hour face-to-face motivational interview followed by digital coaching using behavioral change techniques enabled by individual live monitoring. The primary outcome was change in body weight from baseline to 12 months. Results: Data were assessed for 200 participants, including 127 from the intervention group and 73 from the control group, who completed 12 months of follow-up. After 12 months, mean body weight and BMI were significantly reduced in both groups but significantly more so in the intervention group than the control group (–4.5 kg, 95% CI –5.6 to –3.4 vs –1.5 kg, 95% CI –2.7 to –0.2, respectively; P<.001; and –1.5 kg/m2, 95% CI –1.9 to –1.2 vs –0.5 kg/m2, 95% CI –0.9 to –0.1, respectively; P<.001). Hemoglobin A1c was significantly reduced in both the intervention (–6.0 mmol/mol, 95% CI –7.7 to –4.3) and control (–4.9 mmol/mol, 95% CI –7.4 to –2.4) groups, without a significant group difference (all P>.46). Conclusions: Compared to usual care, digital lifestyle coaching can induce significant weight loss for people living with obesity, both with and without type 2 diabetes, after 12 months. Trial Registration: ClinicalTrials.gov NCT03788915; https://clinicaltrials.gov/ct2/show/NCT03788915 %M 36149735 %R 10.2196/39741 %U https://www.jmir.org/2022/9/e39741 %U https://doi.org/10.2196/39741 %U http://www.ncbi.nlm.nih.gov/pubmed/36149735 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e39813 %T Comparing Professional and Consumer Ratings of Mental Health Apps: Mixed Methods Study %A Hudson,Georgie %A Negbenose,Esther %A Neary,Martha %A Jansli,Sonja M %A Schueller,Stephen M %A Wykes,Til %A Jilka,Sagar %+ Warwick Medical School, University of Warwick, Medical School Building, Coventry, CV4 7AL, United Kingdom, 44 7708715627, sagar.jilka@warwick.ac.uk %K well-being %K apps %K patient and public involvement %K coproduction %K mental health %K service user %K technology %K mobile health %K mHealth %K digital %K mobile phone %D 2022 %7 23.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: As the number of mental health apps has grown, increasing efforts have been focused on establishing quality tailored reviews. These reviews prioritize clinician and academic views rather than the views of those who use them, particularly those with lived experiences of mental health problems. Given that the COVID-19 pandemic has increased reliance on web-based and mobile mental health support, understanding the views of those with mental health conditions is of increasing importance. Objective: This study aimed to understand the opinions of people with mental health problems on mental health apps and how they differ from established ratings by professionals. Methods: A mixed methods study was conducted using a web-based survey administered between December 2020 and April 2021, assessing 11 mental health apps. We recruited individuals who had experienced mental health problems to download and use 3 apps for 3 days and complete a survey. The survey consisted of the One Mind PsyberGuide Consumer Review Questionnaire and 2 items from the Mobile App Rating Scale (star and recommendation ratings from 1 to 5). The consumer review questionnaire contained a series of open-ended questions, which were thematically analyzed and using a predefined protocol, converted into binary (positive or negative) ratings, and compared with app ratings by professionals and star ratings from app stores. Results: We found low agreement between the participants’ and professionals’ ratings. More than half of the app ratings showed disagreement between participants and professionals (198/372, 53.2%). Compared with participants, professionals gave the apps higher star ratings (3.58 vs 4.56) and were more likely to recommend the apps to others (3.44 vs 4.39). Participants’ star ratings were weakly positively correlated with app store ratings (r=0.32, P=.01). Thematic analysis found 11 themes, including issues of user experience, ease of use and interactivity, privacy concerns, customization, and integration with daily life. Participants particularly valued certain aspects of mental health apps, which appear to be overlooked by professional reviewers. These included functions such as the ability to track and measure mental health and providing general mental health education. The cost of apps was among the most important factors for participants. Although this is already considered by professionals, this information is not always easily accessible. Conclusions: As reviews on app stores and by professionals differ from those by people with lived experiences of mental health problems, these alone are not sufficient to provide people with mental health problems with the information they desire when choosing a mental health app. App rating measures must include the perspectives of mental health service users to ensure ratings represent their priorities. Additional work should be done to incorporate the features most important to mental health service users into mental health apps. %M 36149733 %R 10.2196/39813 %U https://formative.jmir.org/2022/9/e39813 %U https://doi.org/10.2196/39813 %U http://www.ncbi.nlm.nih.gov/pubmed/36149733 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e40141 %T Sustainability of Weight Loss Through Smartphone Apps: Systematic Review and Meta-analysis on Anthropometric, Metabolic, and Dietary Outcomes %A Chew,Han Shi Jocelyn %A Koh,Wee Ling %A Ng,Janelle Shaina Hui Yi %A Tan,Ker Kan %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 3, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 65168687, jocelyn.chew.hs@nus.edu.sg %K smartphone app %K mobile app %K mobile health %K mHealth %K eHealth %K weight management %K weight loss %K obesity %K app %K diet %K eating %K mobile phone %D 2022 %7 21.9.2022 %9 Review %J J Med Internet Res %G English %X Background: Evidence on the long-term effects of weight management smartphone apps on various weight-related outcomes remains scarce. Objective: In this review, we aimed to examine the effects of smartphone apps on anthropometric, metabolic, and dietary outcomes at various time points. Methods: Articles published from database inception to March 10, 2022 were searched, from 7 databases (Embase, CINAHL, PubMed, PsycINFO, Cochrane Library, Scopus, and Web of Science) using forward and backward citation tracking. All randomized controlled trials that reported weight change as an outcome in adults with overweight and obesity were included. We performed separate meta-analyses using random effects models for weight, waist circumference, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, blood glucose level, blood pressure, and total energy intake per day. Methodological quality was assessed using the Cochrane Risk of Bias tool. Results: Based on our meta-analyses, weight loss was sustained between 3 and 12 months, with a peak of 2.18 kg at 3 months that tapered down to 1.63 kg at 12 months. We did not find significant benefits of weight loss on the secondary outcomes examined, except for a slight improvement in systolic blood pressure at 3 months. Most of the included studies covered app-based interventions that comprised of components beyond food logging, such as real-time diet and exercise self-monitoring, personalized and remote progress tracking, timely feedback provision, smart devices that synchronized activity and weight data to smartphones, and libraries of diet and physical activity ideas. Conclusions: Smartphone weight loss apps are effective in initiating and sustaining weight loss between 3 and 12 months, but their effects are minimal in their current states. Future studies could consider the various aspects of the socioecological model. Conversational and dialectic components that simulate health coaches could be useful to enhance user engagement and outcome effectiveness. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42022329197; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=329197 %M 36129739 %R 10.2196/40141 %U https://www.jmir.org/2022/9/e40141 %U https://doi.org/10.2196/40141 %U http://www.ncbi.nlm.nih.gov/pubmed/36129739 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e38497 %T Preliminary Investigation of Shift, a Novel Smartphone App to Support Junior Doctors’ Mental Health and Well-being: Examination of Symptom Progression, Usability, and Acceptability After 1 Month of Use %A Sanatkar,Samineh %A Counson,Isabelle %A Mackinnon,Andrew %A Bartholomew,Alexandra %A Glozier,Nick %A Harvey,Samuel %+ Black Dog Institute, Hospital Road, Randwick, 2031, Australia, 61 02 9065 9179, s.sanatkar@unsw.edu.au %K digital mental health %K mobile health apps %K mHealth apps %K help seeking %K junior doctors %K depression %K mobile phone %D 2022 %7 21.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Shift is a novel smartphone app for providing a digital-first mental health resource to junior doctors. It contains psychoeducational material, cognitive behavioral modules, guided mediations, information on common work stressors, and a section on help-seeking options for psychological problems through workplace and private avenues. Objective: This study aimed to conduct a preliminary investigation of the use and potential effectiveness of Shift on depressive and anxiety symptoms (primary outcomes) and work and social functioning, COVID-19 safety concerns, and help seeking (secondary outcomes). This study also sought feedback on whether Shift was seen as an acceptable tool. Methods: Junior doctors in New South Wales, Australia, were approached through promotional activities from the Ministry of Health, specialist medical colleges, and social media advertisements between June and August 2020. Consenting participants provided web-based baseline data, used the Shift app for 30 days, and were asked to complete a poststudy web-based questionnaire. Outcomes were analyzed under the intention-to-treat principle. Results: A total of 222 (n=156 female, 70.3%; mean age 29.2, SD 4.61 years) junior doctors provided full baseline data. Of these, 89.2% (198/222) downloaded the app, logged into the app approximately 6 times (mean 5.68, SD 7.51), completed 4 in-app activities (mean 3.77, SD 4.36), and spent a total of 1 hour on in-app activities (mean 52:23, SD 6:00:18) over 30 days. Postintervention and app use data were provided by 24.3% (54/222) of participants. Depressive and anxiety symptoms significantly decreased between the pre- and postassessment points as expected; however, physicians’ COVID-19 safety concerns significantly increased. Work and social functioning, COVID-19 concerns for family and friends, and help seeking did not change significantly. There was no significant relationship between symptom changes and app use (number of log-ins, days between first and last log-in, and total activity time). Most poststudy completers (31/54, 57%) rated Shift highly or very highly. Conclusions: Despite high levels of nonresponse to the poststudy assessment and increases in COVID-19 safety concerns, junior doctors who used the app reported some improvements in depression and anxiety, which warrant further exploration in a robust manner. %M 36129745 %R 10.2196/38497 %U https://www.jmir.org/2022/9/e38497 %U https://doi.org/10.2196/38497 %U http://www.ncbi.nlm.nih.gov/pubmed/36129745 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 9 %P e38368 %T Mobile for Mothers mHealth Intervention to Augment Maternal Health Awareness and Behavior of Pregnant Women in Tribal Societies: Randomized Quasi-Controlled Study %A Choudhury,Avishek %A Choudhury,Murari %+ Industrial and Management Systems Engineering, Benjamin M Statler College of Engineering and Mineral Resources, West Virginia University, 1306 Evansdale Drive, PO Box 6107, Morgantown, WV, 26506-6107, United States, 1 3042939431, avishek.choudhury@mail.wvu.edu %K maternal health %K mHealth %K digital divide %K disparity %K socioeconomic %K India %K health %K awareness %K mobile %K intervention %K adherence %K health behaviors %K tribal %K community %K education %D 2022 %7 21.9.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite several initiatives taken by government bodies, disparities in maternal health have been noticeable across India’s socioeconomic gradient due to poor health awareness. Objective: The aim of this study was to implement an easy-to-use mobile health (mHealth) app—Mobile for Mothers (MfM)—as a supporting tool to improve (1) maternal health awareness and (2) maternal health–related behavioral changes among tribal and rural communities in India. Methods: Pregnant women, aged 18 to 45 years, were selected from two rural villages of Jharkhand, India: (1) the intervention group received government-mandated maternal care through an mHealth app and (2) the control group received the same government-mandated care via traditional means (ie, verbally). A total of 800 accredited social health activists (ASHAs) were involved, of which 400 were allocated to the intervention group. ASHAs used the MfM app to engage with pregnant women during each home visit in the intervention group. The mHealth intervention commenced soon after the baseline survey was completed in February 2014. The end-line data were collected between November 2015 and January 2016. We calculated descriptive statistics related to demographics and the percentage changes for each variable between baseline and end line per group. The baseline preintervention groups were compared to the end-line postintervention groups using Pearson chi-square analyses. Mantel-Haenszel tests for conditional independence were conducted to determine if the pre- to postintervention differences in the intervention group were significantly different from those in the control group. Results: Awareness regarding the five cleans (5Cs) in the intervention group increased (P<.001) from 143 (baseline) to 555 (end line) out of 740 participants. Awareness about tetanus vaccine injections and the fact that pregnant women should receive two shots of tetanus vaccine in the intervention group significantly increased (P<.001) from 73 out of 740 participants (baseline) to 372 out of 555 participants (end line). In the intervention group, awareness regarding the fact that problems like painful or burning urination and itchy genitals during pregnancy are indicative of a reproductive tract infection increased (P<.001) from 15 (baseline) to 608 (end line) out of 740 participants. Similarly, knowledge about HIV testing increased (P<.001) from 39 (baseline) to 572 (end line) out of 740 participants. We also noted that the number of pregnant women in the intervention group who consumed the prescribed dosage of iron tablets increased (P<.001) from 193 (baseline) out of 288 participants to 612 (end line) out of 663 participants. Conclusions: mHealth interventions can augment awareness of, and persistence in, recommended maternal health behaviors among tribal communities in Jharkhand, India. In addition, mHealth could act as an educational tool to help tribal societies break away from their traditional beliefs about maternal health and take up modern health care recommendations. Trial Registration: OSF Registries 9U8D5; https://doi.org/10.17605/OSF.IO/9U8D5 %M 36129749 %R 10.2196/38368 %U https://mhealth.jmir.org/2022/9/e38368 %U https://doi.org/10.2196/38368 %U http://www.ncbi.nlm.nih.gov/pubmed/36129749 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e39497 %T Using Wake-Up Tasks for Morning Behavior Change: Development and Usability Study %A Oh,Kyue Taek %A Ko,Jisu %A Shin,Jaemyung %A Ko,Minsam %+ Department of Human-Computer Interaction, Hanyang University, Ansan, Republic of Korea, 82 314001071, minsam@hanyang.ac.kr %K health app design %K morning behavior change %K wake-up task %K mobile alarm %K productivity %D 2022 %7 21.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Early morning behaviors between waking up and beginning daily work can develop into productive habits. However, sleep inertia limits the level of human ability immediately after waking, lowering a person’s motivation and available time for productive morning behavior. Objective: This study explores a design for morning behavior change using a wake-up task, a simple assignment the user needs to finish before alarm dismissal. Specifically, we set two research objectives: (1) exploring key factors that relate to morning behavior performance, including the use of wake-up tasks in an alarm app and (2) understanding the general practice of affecting morning behavior change by implementing wake-up tasks. Methods: We designed and implemented an apparatus that provides wake-up task alarms and facilities for squat exercises. We recruited 36 participants to perform squat exercises in the early morning using the wake-up tasks for 2 weeks. First, we conducted a generalized estimating equation (GEE) analysis for the first research objective. Next, we conducted a thematic analysis of the postsurvey answers to identify key themes about morning behavior change with the wake-up tasks for the second objective. Results: The use of wake-up tasks was significantly associated with both the completion of the target behavior (math task: P=.005; picture task: P<.001) and the elapsed time (picture task: P=.08); the time to alarm dismissal was significantly related to the elapsed time to completion (P<.001). Moreover, the theory of planned behavior (TPB) variables, common factors for behavior change, were significant, but their magnitudes and directions differed slightly from the other domains. Furthermore, the survey results reveal how the participants used the wake-up tasks and why they were effective for morning behavior performance. Conclusions: The results reveal the effectiveness of wake-up tasks in accomplishing the target morning behavior and address key factors for morning behavior change, such as (1) waking up on time, (2) escaping from sleep inertia, and (3) quickly starting the desired target behavior. %M 36129742 %R 10.2196/39497 %U https://formative.jmir.org/2022/9/e39497 %U https://doi.org/10.2196/39497 %U http://www.ncbi.nlm.nih.gov/pubmed/36129742 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e37637 %T mHealth-Supported Gender- and Culturally Sensitive Weight Loss Intervention for Hispanic Men With Overweight and Obesity: Single-Arm Pilot Study %A Garcia,David O %A Valdez,Luis A %A Aceves,Benjamin %A Bell,Melanie L %A Rabe,Brooke A %A Villavicencio,Edgar A %A Marrero,David G %A Melton,Forest %A Hooker,Steven P %+ Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 3950 S. Country Club, Suite 330, Tucson, AZ, 85714, United States, 1 520 626 4641, davidogarcia@arizona.edu %K Hispanic %K mobile health %K mHealth %K overweight %K obesity %K weight loss %D 2022 %7 21.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Hispanic men have disproportionate rates of overweight and obesity compared with other racial and ethnic subpopulations. However, few weight loss interventions have been developed specifically for this high-risk group. Furthermore, the use of mobile health (mHealth) technologies to support lifestyle behavior changes in weight loss interventions for Hispanic men is largely untested. Objective: This single-arm pilot study examined the feasibility and acceptability of integrating mHealth technology into a 12-week gender- and culturally sensitive weight loss intervention (GCSWLI) for Hispanic men with overweight and obesity. Methods: A total of 18 Hispanic men (mean age 38, SD 10.9 years; mean BMI 34.3, SD 5.5 kg/m²; 10/18, 56% Spanish monolingual) received a GCSWLI, including weekly in-person individual sessions, a daily calorie goal, and prescription of ≥225 minutes of moderate-intensity physical activity per week. mHealth technology support included tailored SMS text messaging, behavior self-monitoring support using Fitbit Charge 2, and weight tracking using a Fitbit Aria Wi-Fi Smart Scale. Changes in weight from baseline to 12 weeks were estimated using a paired 2-tailed t test. Descriptive analyses characterized the use of Fitbit and smart scales. Semistructured interviews were conducted immediately after intervention to assess the participants’ weight loss experiences and perspectives on mHealth technologies. Results: Of 18 participants, 16 (89%) completed the 12-week assessments; the overall attrition rate was 11.1%. The mean weight loss at week 12 was −4.7 kg (95% CI 7.1 to −2.4 kg; P<.001). Participants wore the Fitbit 71.58% (962/1344) of the intervention days and logged their body weight using the smart scale (410/1344, 30.51% of the intervention days). Participants identified barriers to the use of the technology, such as lack of technological literacy and unreliable internet access for the smart scale. Conclusions: Although clinically significant weight loss was achieved by integrating mHealth technology into the GCSWLI, adherence to the prescribed use of technology was modest. Addressing barriers to the use of such technologies identified in our work may help to refine an mHealth intervention approach for Hispanic men. Trial Registration: ClinicalTrials.gov NCT02783521; https://clinicaltrials.gov/ct2/show/NCT02783521 %M 36129735 %R 10.2196/37637 %U https://formative.jmir.org/2022/9/e37637 %U https://doi.org/10.2196/37637 %U http://www.ncbi.nlm.nih.gov/pubmed/36129735 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 9 %P e39867 %T The Early Detection and Case Management of Skin Diseases With an mHealth App (eSkinHealth): Protocol for a Mixed Methods Pilot Study in Côte d’Ivoire %A Yotsu,Rie R %A Itoh,Sakiko %A Yao,Koffi Aubin %A Kouadio,Kouamé %A Ugai,Kazuko %A Koffi,Yao Didier %A Almamy,Diabate %A Vagamon,Bamba %A Blanton,Ronald E %+ Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, United States, 1 504 988 5388, ryotsu@tulane.edu %K skin diseases %K neglected diseases %K skin NTDs %K teledermatology %K telemedicine %K remote consultation %D 2022 %7 21.9.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a high prevalence of skin diseases sub-Saharan Africa, including skin neglected tropical diseases (NTDs) that could lead to lifelong disabilities and deformities if not diagnosed and treated early. To achieve early detection and early treatment of these skin diseases, we developed a mobile health app, eSkinHealth. Objective: This paper outlines a protocol for evaluating the effect of our eSkinHealth app in the early detection and effective management of skin diseases in Côte d’Ivoire. Methods: A mixed methods pilot trial will be conducted in Côte d’Ivoire and will consist of 3 phases: (1) the development and improvement of the eSkinHealth app, (2) a pilot trial to evaluate the usability of the eSkinHealth app for local medical staff in Côte d’Ivoire, and (3) a pilot trial to evaluate the effectiveness of early detection and case management of targeted skin NTDs (Buruli ulcer, leprosy, yaws, and lymphatic filariasis) with the eSkinHealth app in Côte d’Ivoire. The pilot study will be implemented as a 2-arm trial with local health care providers and patients with skin NTDs over a 3-month follow-up period. The local health care providers will be assigned to an intervention group receiving the eSkinHealth app to be used in their daily practices or a control group. Training will be provided on the use and implementation of the app and the diagnostic pipeline to the intervention group only, while both groups will receive training on skin diseases. Our primary outcome is to evaluate the early detection and effective management of skin diseases using the eSkinHealth app in Côte d’Ivoire by the number of cases diagnosed and managed. Additionally, we will evaluate the eSkinHealth app with validated questionnaires and in-depth interviews. Procedures of our methods have been reviewed and approved by the Institutional Review Board of the Ministry of Health, Côte d’Ivoire and by Tulane University in 2021. Results: This study was funded in 2021. We started the enrollment of patients in February 2022, and data collection is currently underway. We expect the first results to be submitted for publication in 2023. Conclusions: Our eSkinHealth app is a field-adapted platform that could provide both direct diagnostic and management assistance to health workers in remote settings. The study will provide evidence for the usability and the effectiveness of the eSkinHealth app to improve the early detection and case management of skin NTDs in Côte d’Ivoire and, furthermore, is expected to contribute to knowledge on mobile health approaches in the control of skin NTDs. Trial Registration: ClinicalTrials.gov NCT05300399; https://clinicaltrials.gov/ct2/show/study/NCT05300399 International Registered Report Identifier (IRRID): DERR1-10.2196/39867 %M 35922062 %R 10.2196/39867 %U https://www.researchprotocols.org/2022/9/e39867 %U https://doi.org/10.2196/39867 %U http://www.ncbi.nlm.nih.gov/pubmed/35922062 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e39476 %T A Web-Based Positive Psychology App for Patients With Bipolar Disorder: Development Study %A Geerling,Bart %A Kelders,Saskia M %A Stevens,Anja W M M %A Kupka,Ralph W %A Bohlmeijer,Ernst T %+ Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 0622274351, b.geerling@dimence.nl %K bipolar disorder %K positive psychology %K cocreation %K mobile health %K mHealth %K web-based %K psychology %K bipolar %K intervention %K quality of life %K mental illness %K pilot %K self-esteem %K acceptance %K social isolation %K manic episode %K manic %K self-help %K positive %K mobile phone %D 2022 %7 19.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with bipolar disorder (BD) report lower quality of life and lower levels of well-being than the general population. Despite the growing availability of psychotherapeutic and self-management interventions, important unmet needs remain. These unmet needs are closely linked to positive psychology domains. Although a growing number of studies have evaluated the impact of positive psychology interventions (PPIs) on patients with severe mental illness in general, only few have addressed the application of positive psychology for BD. Objective: This study aimed to gain insight into the opinions of patients with BD and health care professionals about (web-based) PPIs for BD and to develop and pilot-test an app containing PPIs specifically designed for patients with BD. Methods: The study was conducted in accordance with the Center for eHealth and Disease Management road map principles and incorporated cocreation and designing for implementation. Data were collected using focus group discussions, questionnaires, rapid prototyping, and web-based feedback on a prototype from the participants. In total, 3 focus groups were conducted with 62% (8/13) of patients with BD and 38% (5/13) of professionals. The collected data were used to develop a smartphone app containing short PPIs. The content was based on PPIs for which a solid base of evidence is available. Finally, a pilot test was conducted to test the app. Results: Focus groups revealed that PPIs as part of the current BD treatment can potentially meet the following needs: offering hope, increasing self-esteem, expressing feelings, acceptance, and preventing social isolation. Some patients expressed concern that PPIs may provoke a manic or hypomanic episode by increasing positive affect. The pilot of the app showed that the PPIs are moderately to highly valued by the participants. There were no adverse effects such as increase in manic or hypomanic symptoms. Conclusions: With the systematic use of user involvement (patients and professionals) in all steps of the development process, we were able to create an app that can potentially fulfill some of the current unmet needs in the treatment of BD. We reached consensus among consumers and professionals about the potential benefits of PPIs to address the unmet needs of patients with BD. The use of PPI for BD is intriguing and can be usefully explored in further studies. We emphasize that more evaluation studies (quantitative and qualitative) that are focused on the effect of PPIs in the treatment of BD should be conducted. In addition, to establish the working mechanisms in BD, explorative, qualitative, designed studies are required to reveal whether PPIs can address unmet needs in BD. %M 35946327 %R 10.2196/39476 %U https://formative.jmir.org/2022/9/e39476 %U https://doi.org/10.2196/39476 %U http://www.ncbi.nlm.nih.gov/pubmed/35946327 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e36805 %T Influence of 2 Digital Exercise Modules of a Multimodular System on Balance and Leg Strength Under Consideration of Use Adherence: Prospective Cohort Study %A Venek,Verena %A Kranzinger,Christina %A Jungreitmayr,Sonja %A Ring-Dimitriou,Susanne %A Schwameder,Hermann %A Stöggl,Thomas %+ Salzburg Research Forschungsgesellschaft mbH, Jakob Haringer Straße 5/3, Salzburg, 5020, Austria, 43 6622288 ext 415, v.venek@fh-kaernten.at %K active and assisted living %K functional fitness training %K information and communication technology %K use adherence %D 2022 %7 19.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: To empower healthy aging, digital solutions embed multiple modules for physical activity, cognitive health promotion, and social engagement. Integrating new empowering technologies such as digital exercise monitoring requires assessment measures and analysis procedures, considering variable compliance of users with different modules. Objective: This study aims to assess the influence of a tablet-based and a feedback system–based exercise module on balance and leg strength by considering use adherence instead of the use of the entire multimodular system. Methods: In the prospective cohort study within the fit4AAL project, 83 users (n=67, 81% women; n=16, 19% men; mean age 66.2, SD 2.3 years) used the 2 digital exercise modules of a multimodular physical activity promotion system for >18 weeks. A data-driven clustering method based on the average use frequency of the exercise modules determined the number of user types that met the World Health Organization–recommended training frequency of at least twice per week. On the basis of this use adherence, statistical analysis was performed with features of functional performance tests (unipedal stance, 30-second chair rise, Y-balance, and hurdle step tests). The tests were conducted 6 months before the intervention, immediately before the intervention, and after the intervention, comparing the baseline phase with the 3 feedback use groups of the study (using only the tablet, the tablet and the feedback system, or only the feedback system). Results: Of the 83 users, 43 (52%) met the World Health Organization–recommended frequency of muscle-strengthening activities. Overall, the feedback use groups achieved, on average, more chair rises in 30 seconds than the baseline group (P=.01; moderate effect size of 0.07). Of the 43 users, 26 (60%) additionally used the feedback system–based exercise module. They improved in balance compared with the users using either the tablet or the feedback system (P=.02). In addition, they improved their leg strength within the group (P=.04) and compared with the baseline (P=.01). Conclusions: The additional use of a feedback system showed a tendency to positively maintain and influence the already exceptionally high functional performance of older adults. Considering use adherence in future multimodular system studies is crucial to assess the influence of single and combined use of exercise modules on functional performance. %M 36121691 %R 10.2196/36805 %U https://formative.jmir.org/2022/9/e36805 %U https://doi.org/10.2196/36805 %U http://www.ncbi.nlm.nih.gov/pubmed/36121691 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e35486 %T Participants’ and Nurses’ Experiences With a Digital Intervention for Patients With Depressive Symptoms and Comorbid Hypertension or Diabetes in Peru: Qualitative Post–Randomized Controlled Trial Study %A Toyama,Mauricio %A Cavero,Victoria %A Araya,Ricardo %A Menezes,Paulo Rossi %A Mohr,David C %A Miranda,J Jaime %A Diez-Canseco,Francisco %+ CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 445, Miraflores, Lima, 15074, Peru, 51 958549065, m.toyama.g@gmail.com %K mobile intervention %K depression %K diabetes %K hypertension %K comorbidity %K qualitative research %K mobile phone %D 2022 %7 15.9.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Depression is one of the most prevalent mental disorders and a leading cause of disability, disproportionately affecting specific groups, such as patients with noncommunicable diseases. Over the past decade, digital interventions have been developed to provide treatment for these patients. CONEMO (Emotional Control in Spanish) is an 18-session psychoeducational digital intervention delivered through a smartphone app and minimally supported by a nurse. CONEMO demonstrated effectiveness in reducing depressive symptoms through a randomized controlled trial (RCT) among patients with diabetes, hypertension, or both, in Lima, Peru. However, in addition to clinical outcomes, it is important to explore users’ experiences, satisfaction, and perceptions of usability and acceptability, which can affect their engagement with the intervention. Objective: This study aimed to explore the RCT participants’ experiences with CONEMO in Peru, complemented with information provided by the nurses who monitored them. Methods: In 2018, semistructured interviews were conducted with a sample of 29 (13.4%) patients from the 217 patients who participated in the CONEMO intervention in Peru and the 3 hired nurses who supported its delivery. Interviewees were selected at random based on their adherence to the digital intervention (0-5, 10-14, and 15-18 sessions completed), to include different points of view. Content analysis was conducted to analyze the interviews. Results: Participants’ mean age was 64.4 (SD 8.5) years, and 79% (23/29) of them were women. Most of the interviewed participants (21/29, 72%) stated that CONEMO fulfilled their expectations and identified positive changes in their physical and mental health after using it. Some of these improvements were related to their thoughts and feelings (eg, think differently, be more optimistic, and feel calmer), whereas others were related to their routines (eg, go out more and improve health-related habits). Most participants (19/29, 66%) reported not having previous experience with using smartphones, and despite experiencing some initial difficulties, they managed to use CONEMO. The most valued features of the app were the videos and activities proposed for the participant to perform. Most participants (27/29, 93%) had a good opinion about the study nurses and reported feeling supported by them. A few participants provided suggestions to improve the intervention, which included adding more videos, making the sessions’ text simple, extending the length of the intervention, and improving the training session with long explanations. Conclusions: The findings of this qualitative study provide further support and contextualize the positive results found in the CONEMO RCT, including insights into the key features that made the intervention effective and engaging. The participants’ experience with the smartphone and CONEMO app reveal that it is feasible to be used by people with little knowledge of technology. In addition, the study identified suggestions to improve the CONEMO intervention for its future scale-up. Trial Registration: ClinicalTrials.gov NCT03026426; https://clinicaltrials.gov/ct2/show/NCT03026426 %M 36107482 %R 10.2196/35486 %U https://humanfactors.jmir.org/2022/3/e35486 %U https://doi.org/10.2196/35486 %U http://www.ncbi.nlm.nih.gov/pubmed/36107482 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 9 %P e37849 %T mHealth Support to Stimulate Physical Activity in Individuals With Intellectual Disability: Protocol for a Mixed Methods Pilot Study %A Michalsen,Henriette %A Wangberg,Silje C %A Hartvigsen,Gunnar %A Henriksen,André %A Pettersen,Gunn %A Jaccheri,Letizia %A Jahnsen,Reidun Birgitta %A Thrane,Gyrd %A Arntzen,Cathrine %A Anke,Audny %+ Department of Rehabilitation, University Hospital of North Norway, Hansine Hansens vei 67, Tromsø, 9038, Norway, 47 41500304, henriette.michalsen@uit.no %K intellectual disability %K physical activity %K technology %K mHealth %K mobile health %K exercise %K protocol %K technology %K pilot study %K trial %K caregivers %D 2022 %7 15.9.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Several studies have shown that individuals with intellectual disabilities (IDs) have low levels of physical activity (PA), and intervention studies on PA suggest inconsistent evidence. The use of technology as a means of motivation for PA has yet to be extensively explored and needs to be further investigated. Objective: We aim to assess the feasibility and acceptability of procedures for an intervention arm in a future trial on mobile health (mHealth) to support PA for individuals with IDs. In addition, we aim to examine how the use of technology can influence motivation for PA among participants, their caregivers, and staff members. Methods: A mixed methods pilot study of an intervention arm will be carried out in a planned randomized controlled trial (RCT). Ten participants with ID and their caregivers or a staff member will be included. Information will always be provided by a caregiver or a staff member, or participants with ID if possible. Assessments will be carried out at baseline, follow-up after 4 weeks, and 12 weeks, and include questionnaires on PA, social support, self-efficacy, and challenging behavior. PA will be measured with 2 different activity trackers (Fitbit and Axivity) for 1 week at all assessments. Feasibility will be assessed as recruitment and adherence rate, missing data, usability of the motivational mHealth tool, and estimates of effectiveness. Acceptability of study procedures, activity measures, and motivation for participation in PA will be additionally assessed with qualitative methods at the end of the intervention. Results: Enrollment commenced in May 2021. Data collection was completed in March 2022. Conclusions: This pilot study will evaluate the feasibility and acceptability of study procedures of the intervention arm of a planned RCT to address feasibility issues, improve study procedures, and estimate effectiveness of the study measures. How the use of technology can influence motivation for PA will also be examined, which can help guide and improve future PA interventions involving the use of technology. Trial Registration: ClinicalTrials.gov NCT04929106; https://clinicaltrials.gov/ct2/show/NCT04929106 International Registered Report Identifier (IRRID): DERR1-10.2196/37849 %M 36107473 %R 10.2196/37849 %U https://www.researchprotocols.org/2022/9/e37849 %U https://doi.org/10.2196/37849 %U http://www.ncbi.nlm.nih.gov/pubmed/36107473 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 9 %P e31996 %T Effect of Face-to-Face and WhatsApp Communication of a Theory-Based Health Education Intervention on Breastfeeding Self-Efficacy (SeBF Intervention): Cluster Randomized Controlled Field Trial %A Mohamad Pilus,Farahana %A Ahmad,Norliza %A Mohd Zulkefli,Nor Afiah %A Mohd Shukri,Nurul Husna %+ Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Jalan Hospital Serdang, Serdang, 43400, Malaysia, 60 97692424, lizaahmad@upm.edu.my %K self-efficacy %K breastfeeding %K intervention %K social cognitive theory %D 2022 %7 14.9.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The exclusive breastfeeding rate in Malaysia is still not satisfactory. Previous studies have shown that breastfeeding self-efficacy is one of the determinants of exclusive breastfeeding, and it can be improved using social cognitive theory. WhatsApp, which is widely used among Malaysians, could be leveraged as a platform to deliver health education interventions. Objective: This study aimed to develop, implement, and evaluate the effect of using a face-to-face and WhatsApp-based health education intervention based on social cognitive theory, namely the Self-Efficacy in Breastfeeding (SeBF) module, on mothers' self-efficacy, knowledge, and attitudes in a district in Selangor state. Methods: This study was a 2-arm, parallel, single-blind, cluster randomized controlled field trial with an intervention and a control group involving primigravida or multigravida mothers who reside in a district in Selangor state and did not exclusively breastfeed during their previous pregnancy. All 12 maternity and pediatric clinics in this district were randomly divided into 6 intervention and 6 control groups. A total of 172 pregnant mothers were randomly assigned to the intervention group (n=86) or the control group (n=86). The control group received usual routine care. The primary outcome was breastfeeding self-efficacy, while secondary outcomes were knowledge and attitude toward breastfeeding. Each subject was assessed at 4 time points: at baseline, immediately after the intervention, 4 weeks post partum, and 8 weeks post partum. Generalized mixed model analysis was applied to measure the effect of health education on breastfeeding self-efficacy, knowledge, and attitude after the intervention. Results: The response rate was 81% (139/172), with the dropout rate being 7% (6/86) in the intervention group and 31% (27/86) in the control group. In the intent-to-treat analysis, the intervention group showed a significant increase in the mean total breastfeeding self-efficacy score 8 weeks after delivery compared with the control group (F21,601=111.73, P<.001). In addition, the mean total score for breastfeeding knowledge increased significantly in the intervention group after the intervention compared to the control group (F21,601=8.33, P<.001). However, no significant difference was found in the mean total score for breastfeeding attitude after the intervention (F21,602=5.50, P=.47). Conclusions: Face-to-face and WhatsApp-based participation in the SeBF program, designed on the basis of social cognitive theory, contributed to improved self-efficacy and knowledge about breastfeeding. Further studies need to be conducted with a longer duration (until 6 months post partum) to evaluate its effectiveness in increasing exclusive breastfeeding. Furthermore, new strategies in health education need to be developed to improve breastfeeding attitudes. Trial Registration: Thaiclinicaltrials.org TCTR20200213004; https://www.thaiclinicaltrials.org/show/TCTR20200213004 %M 36103244 %R 10.2196/31996 %U https://mhealth.jmir.org/2022/9/e31996 %U https://doi.org/10.2196/31996 %U http://www.ncbi.nlm.nih.gov/pubmed/36103244 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e40739 %T Agreement Between Clinically Measured Weight and Self-reported Weight Among Patients With Type 2 Diabetes Through an mHealth Lifestyle Coaching Program in Denmark: Secondary Analysis of a Randomized Controlled Trial %A Imeraj,Albi %A Olesen,Thomas Bastholm %A Laursen,Ditte Hjorth %A Søndergaard,Jens %A Brandt,Carl Joakim %+ Research Unit for General Practice, Department of Public Health, University of Southern Denmark, J B Winsløws Vej 9A, Odense, 5000, Denmark, 45 31390187, aimeraj@health.sdu.dk %K telemedicine %K digital behavioral coaching %K lifestyle change %K mobile intervention %K obesity %K diabetes %K patient engagement %K validation %K self-report %K body weight %D 2022 %7 14.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health interventions are increasingly used to handle and promote positive health behaviors. Clinical measures are often used, and a certain precision is essential for digital health interventions to have an effect. Only few studies have compared clinically measured weights with self-reported weights. No study has examined the validity of self-reported weight from a mobile app used in a tailored weight loss intervention. Objective: The aim of this study was to analyze the agreement between clinically measured weight and self-reported weight collected from a mobile health lifestyle coaching program during a 12-month weight loss intervention for obese patients with and without type 2 diabetes. The secondary aim was to investigate the determinants for possible discrepancies between clinically measured and self-reported weights of these patients with different demographic and lifestyle characteristics and achievements of weight loss goals. Methods: Weight registrations were collected from participants (N=104) in a Danish randomized controlled trial examining the effect of a digital lifestyle intervention on weight loss among obese patients with and without type 2 diabetes. Data were collected at baseline and after 6 and 12 months. Self-reported weight was measured at home and registered in the app. Results: Self-reported body weight was lower than the weight measured in the clinic after 6 months by 1.03 kg (95% CI 1.01-1.05; P<.001) and after 12 months also by 1.03 kg (95% CI 0.99-1.04; P<.001). After 6 months, baseline weight and BMI were associated with a discrepancy of 0.03 kg (95% CI 0.01-0.04; P=.01) and 0.09 kg (95% CI 0.02-0.17; P=.02) per increment of 1 kg and 1 kg/m2, respectively, between clinically measured weight and self-reported weight. Weight change during the first 6 months was also associated with a difference of 0.1 kg (95% CI 0.04-0.01; P<.001) per kilogram of difference in weight between clinically measured weight and self-reported weight. Participants who did not achieve the 5% weight loss goal underestimated their weight by 0.79 kg (95% CI 0.34-1.23) at 6 months. After 12 months, only baseline weight was associated with a discrepancy of 0.03 kg (95% CI 0.01-0.05; P=.02) per increment of kilogram between clinically measured weight and self-reported weight. None of the other factors showed any significant discrepancy after 12 months. Conclusions: Self-reported weight obtained from mobile health is a valid method for collecting anthropometric measurements. Trial Registration: ClinicalTrials.gov NCT03788915; https://clinicaltrials.gov/ct2/show/NCT03788915 %M 36047606 %R 10.2196/40739 %U https://formative.jmir.org/2022/9/e40739 %U https://doi.org/10.2196/40739 %U http://www.ncbi.nlm.nih.gov/pubmed/36047606 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e38579 %T A Versatile and Scalable Platform That Streamlines Data Collection for Patient-Centered Studies: Usability and Feasibility Study %A Huang,Haley %A Aschettino,Sofia %A Lari,Nasim %A Lee,Ting-Hsuan %A Rosenberg,Sarah Stothers %A Ng,Xinyi %A Muthuri,Stella %A Bakshi,Anirudh %A Bishop,Korrin %A Ezzeldin,Hussein %+ Center for Biologics Evaluation and Research, United States Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, United States, 1 240 402 8629, hussein.ezzeldin@fda.hhs.gov %K mobile app %K patient experience data %K data-collection app %K mobile phone %K usability %K mHealth app %K feasibility %K user centered %K eHealth %K patient-generated data %D 2022 %7 14.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Food and Drug Administration Center for Biologics Evaluation and Research (CBER) established the Biologics Effectiveness and Safety (BEST) Initiative with several objectives, including the expansion and enhancement of CBER’s access to fit-for-purpose data sources, analytics, tools, and infrastructures to improve the understanding of patient experiences with conditions related to CBER-regulated products. Owing to existing challenges in data collection, especially for rare disease research, CBER recognized the need for a comprehensive platform where study coordinators can engage with study participants and design and deploy studies while patients or caregivers could enroll, consent, and securely participate as well. Objective: This study aimed to increase awareness and describe the design, development, and novelty of the Survey of Health and Patient Experience (SHAPE) platform, its functionality and application, quality improvement efforts, open-source availability, and plans for enhancement. Methods: SHAPE is hosted in a Google Cloud environment and comprises 3 parts: the administrator application, participant app, and application programming interface. The administrator can build a study comprising a set of questionnaires and self-report entries through the app. Once the study is deployed, the participant can access the app, consent to the study, and complete its components. To build SHAPE to be scalable and flexible, we leveraged the open-source software development kit, Ionic Framework. This enabled the building and deploying of apps across platforms, including iOS, Android, and progressive web applications, from a single codebase by using standardized web technologies. SHAPE has been integrated with a leading Health Level 7 (HL7®) Fast Healthcare Interoperability Resources (FHIR®) application programming interface platform, 1upHealth, which allows participants to consent to 1-time data pull of their electronic health records. We used an agile-based process that engaged multiple stakeholders in SHAPE’s design and development. Results: SHAPE allows study coordinators to plan, develop, and deploy questionnaires to obtain important end points directly from patients or caregivers. Electronic health record integration enables access to patient health records, which can validate and enhance the accuracy of data-capture methods. The administrator can then download the study data into HL7® FHIR®–formatted JSON files. In this paper, we illustrate how study coordinators can use SHAPE to design patient-centered studies. We demonstrate its broad applicability through a hypothetical type 1 diabetes cohort study and an ongoing pilot study on metachromatic leukodystrophy to implement best practices for designing a regulatory-grade natural history study for rare diseases. Conclusions: SHAPE is an intuitive and comprehensive data-collection tool for a variety of clinical studies. Further customization of this versatile and scalable platform allows for multiple use cases. SHAPE can capture patient perspectives and clinical data, thereby providing regulators, clinicians, researchers, and patient advocacy organizations with data to inform drug development and improve patient outcomes. %M 36103218 %R 10.2196/38579 %U https://formative.jmir.org/2022/9/e38579 %U https://doi.org/10.2196/38579 %U http://www.ncbi.nlm.nih.gov/pubmed/36103218 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e35316 %T Patient Perspectives on Using a Smartphone App to Support Home-Based Exercise During Physical Therapy Treatment: Qualitative Study %A Arensman,Remco %A Kloek,Corelien %A Pisters,Martijn %A Koppenaal,Tjarco %A Ostelo,Raymond %A Veenhof,Cindy %+ Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Rijnzathe 16, De Meern, 3454PV, Netherlands, 31 306866103, r.m.arensman-2@umcutrecht.nl %K patient perspectives %K mobile health %K mHealth %K home-based exercise %K adherence %K low back pain %K physical therapy %D 2022 %7 13.9.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Home-based exercise is an important part of physical therapy treatment for patients with low back pain. However, treatment effectiveness depends heavily on patient adherence to home-based exercise recommendations. Smartphone apps designed to support home-based exercise have the potential to support adherence to exercise recommendations and possibly improve treatment effects. A better understanding of patient perspectives regarding the use of smartphone apps to support home-based exercise during physical therapy treatment can assist physical therapists with optimal use and implementation of these apps in clinical practice. Objective: The aim of this study was to investigate patient perspectives on the acceptability, satisfaction, and performance of a smartphone app to support home-based exercise following recommendations from a physical therapist. Methods: Using an interpretivist phenomenology approach, 9 patients (4 males and 5 females; aged 20-71 years) with nonspecific low back pain recruited from 2 primary care physical therapy practices were interviewed within 2 weeks after treatment ended. An interview guide was used for the interviews to ensure that different aspects of the patients’ perspectives were discussed. The Physitrack smartphone app was used to support home-based exercise as part of treatment for all patients. Data were analyzed using the “Framework Method” to assist with interpretation of the data. Results: Data analysis revealed 11 categories distributed among the 3 themes “acceptability,” “satisfaction,” and “performance.” Patients were willing to accept the app as part of treatment when it was easy to use, when it benefited the patient, and when the physical therapist instructed the patient in its use. Satisfaction with the app was determined by users’ perceived support from the app when exercising at home and the perceived increase in adherence. The video and text instructions, reminder functions, and self-monitor functions were considered the most important aspects for performance during treatment. The patients did not view the Physitrack app as a replacement for the physical therapist and relied on their therapist for instructions and support when needed. Conclusions: Patients who use an app to support home-based exercise as part of treatment are accepting of the app when it is easy to use, when it benefits the patient, and when the therapist instructs the patient in its use. Physical therapists using an app to support home-based exercise can use the findings from this study to effectively support their patients when exercising at home during treatment. %M 36098993 %R 10.2196/35316 %U https://humanfactors.jmir.org/2022/3/e35316 %U https://doi.org/10.2196/35316 %U http://www.ncbi.nlm.nih.gov/pubmed/36098993 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e40046 %T Examining the Delivery of a Tailored Chinese Mind-Body Exercise to Low-Income Community-Dwelling Older Latino Individuals for Healthy Aging: Feasibility and Acceptability Study %A Du,Yan %A Patel,Neela %A Hernandez,Arthur %A Zamudio-Samano,Maria %A Li,Shiyu %A Zhang,Tianou %A Fernandez,Roman %A Choi,Byeong Yeob %A Land,William M %A Ullevig,Sarah %A Estrada Coats,Vanessa %A Moussavou,Jessh Mondesir Mavoungou %A Parra-Medina,Deborah %A Yin,Zenong %+ Center on Smart and Connected Health Technology, School of Nursing, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, United States, 1 5044931202, duy@uthscsa.edu %K qigong %K mind-body exercise %K Five Animal Frolics %K health technology %K older adults %K Hispanics %K Latinos %K low-income %K healthy aging %K aging in place %K independent living %D 2022 %7 13.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Older Latino individuals are disproportionally affected by various chronic conditions including impairments in physical and cognitive functions, which are essential for healthy aging and independent living. Objective: This study aimed to evaluate the feasibility and acceptability of FITxOlder, a 12-week mind-body exercise program, in community-dwelling low-income, predominantly older Latino individuals, and assess its preliminary effects on health parameters relevant to healthy aging and independent living. Methods: This 12-week, single-arm, stage 1B feasibility study had a pre- and poststudy design. A total of 13 older adults (mean age 76.4, SD 7.9 years; 11/13, 85% Latino) of a congregate meal program in a senior center were enrolled. FITxOlder was a tailored Chinese mind-body exercise program using Five Animal Frolics led by a bilingual community health worker (CHW) participating twice a week at the senior center and facilitated by mobile health technology for practice at home, with incrementally increasing goals moving from once a week to at least 3 times a week. The feasibility and acceptability of the study were examined using both quantitative and qualitative data. Healthy aging–related outcomes (eg, physical and cognitive function) were assessed using paired 2-tailed t tests. Qualitative interview data were analyzed using thematic analysis. Results: The attendance rate for the 24 exercise sessions was high (22.7/24, 95%), ranging from 93% (1.8/2) to 97% (1.9/2) over the 12 weeks. Participants were compliant with the incremental weekly exercise goals, with 69.2% (9/13) and 75.0% (9/12) meeting the home and program goals in the last 4 weeks, respectively. Approximately 83% (10/12) to 92% (11/12) of the participants provided favorable feedback on survey questions regarding the study and program implementation, such as program content and support, delivery by the CHW, enjoyment and appeal of the Five Animal Frolics, study burden and incentives, and safety concerns. The qualitative interview data revealed that FITxOlder was well accepted; participants reported enjoyment and health benefits and the desire to continue to practice and share it with others. The 5-time sit-to-stand test (mean change at posttest assessment=−1.62; P<.001; Cohen d=0.97) and 12-Item Short Form Health Survey physical component scores (mean change at post intervention=5.71; P=.01; Cohen d=0.88) exhibited changes with large effect sizes from baseline to 12 weeks; the other parameters showed small or medium effect sizes. Conclusions: The research findings indicated that the CHW-led and mobile health–facilitated Chinese qigong exercise program is feasible and acceptable among low-income Latino older adults. The trending health benefits of the 12-week FITxOlder program suggest it is promising to promote physical activity engagement in underserved older populations to improve health outcomes for healthy aging and independent living. Future research with larger samples and longer interventions is warranted to assess the health benefits and suitability of FITxOlder. %M 35997685 %R 10.2196/40046 %U https://formative.jmir.org/2022/9/e40046 %U https://doi.org/10.2196/40046 %U http://www.ncbi.nlm.nih.gov/pubmed/35997685 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 9 %P e39532 %T Wearables for Measuring Health Effects of Climate Change–Induced Weather Extremes: Scoping Review %A Koch,Mara %A Matzke,Ina %A Huhn,Sophie %A Gunga,Hanns-Christian %A Maggioni,Martina Anna %A Munga,Stephen %A Obor,David %A Sié,Ali %A Boudo,Valentin %A Bunker,Aditi %A Dambach,Peter %A Bärnighausen,Till %A Barteit,Sandra %+ Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 6221 5634030, mara.koch@uni-heidelberg.de %K wearable %K consumer-grade wearables %K fitness trackers %K climate change %K heat %K global health %K public health %K review %K mobile phone %D 2022 %7 9.9.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Although climate change is one of the biggest global health threats, individual-level and short-term data on direct exposure and health impacts are still scarce. Wearable electronic devices (wearables) present a potential solution to this research gap. Wearables have become widely accepted in various areas of health research for ecological momentary assessment, and some studies have used wearables in the field of climate change and health. However, these studies vary in study design, demographics, and outcome variables, and existing research has not been mapped. Objective: In this review, we aimed to map existing research on wearables used to detect direct health impacts and individual exposure during climate change–induced weather extremes, such as heat waves or wildfires. Methods: We conducted a scoping review according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework and systematically searched 6 databases (PubMed [MEDLINE], IEEE Xplore, CINAHL [EBSCOhost], WoS, Scopus, Ovid [MEDLINE], and Google Scholar). The search yielded 1871 results. Abstracts and full texts were screened by 2 reviewers (MK and IM) independently using the inclusion and exclusion criteria. The inclusion criteria comprised studies published since 2010 that used off-the-shelf wearables that were neither invasive nor obtrusive to the user in the setting of climate change–related weather extremes. Data were charted using a structured form, and the study outcomes were narratively synthesized. Results: The review included 55,284 study participants using wearables in 53 studies. Most studies were conducted in upper–middle-income and high-income countries (50/53, 94%) in urban environments (25/53, 47%) or in a climatic chamber (19/53, 36%) and assessed the health effects of heat exposure (52/53, 98%). The majority reported adverse health effects of heat exposure on sleep, physical activity, and heart rate. The remaining studies assessed occupational heat stress or compared individual- and area-level heat exposure. In total, 26% (14/53) of studies determined that all examined wearables were valid and reliable for measuring health parameters during heat exposure when compared with standard methods. Conclusions: Wearables have been used successfully in large-scale research to measure the health implications of climate change–related weather extremes. More research is needed in low-income countries and vulnerable populations with pre-existing conditions. In addition, further research could focus on the health impacts of other climate change–related conditions and the effectiveness of adaptation measures at the individual level to such weather extremes. %M 36083624 %R 10.2196/39532 %U https://mhealth.jmir.org/2022/9/e39532 %U https://doi.org/10.2196/39532 %U http://www.ncbi.nlm.nih.gov/pubmed/36083624 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 9 %P e33247 %T mHealth Apps Using Behavior Change Techniques to Self-report Data: Systematic Review %A Aguiar,Maria %A Trujillo,Maria %A Chaves,Deisy %A Álvarez,Roberto %A Epelde,Gorka %+ Vicomtech Foundation, Basque Research and Technology Alliance, Paseo Mikeletegi 57, Donostia-San Sebastián, 20009, Spain, 34 943 30 92 30, maria.aguiar@correounivalle.edu.co %K mobile health %K mHealth %K behavior change techniques %K adherence %K app %K mobile health interventions %K behavior %D 2022 %7 9.9.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The popularization of mobile health (mHealth) apps for public health or medical care purposes has transformed human life substantially, improving lifestyle behaviors and chronic condition management. Objective: This review aimed to identify behavior change techniques (BCTs) commonly used in mHealth, assess their effectiveness based on the evidence reported in interventions and reviews to highlight the most appropriate techniques to design an optimal strategy to improve adherence to data reporting, and provide recommendations for future interventions and research. Methods: We performed a systematic review of studies published between 2010 and 2021 in relevant scientific databases to identify and analyze mHealth interventions using BCTs that evaluated their effectiveness in terms of user adherence. Search terms included a mix of general (eg, data, information, and adherence), computer science (eg, mHealth and BCTs), and medicine (eg, personalized medicine) terms. Results: This systematic review included 24 studies and revealed that the most frequently used BCTs in the studies were feedback and monitoring (n=20), goals and planning (n=14), associations (n=14), shaping knowledge (n=12), and personalization (n=7). However, we found mixed effectiveness of the techniques in mHealth outcomes, having more effective than ineffective outcomes in the evaluation of apps implementing techniques from the feedback and monitoring, goals and planning, associations, and personalization categories, but we could not infer causality with the results and suggest that there is still a need to improve the use of these and many common BCTs for better outcomes. Conclusions: Personalization, associations, and goals and planning techniques were the most used BCTs in effective trials regarding adherence to mHealth apps. However, they are not necessarily the most effective since there are studies that use these techniques and do not report significant results in the proposed objectives; there is a notable overlap of BCTs within implemented app components, suggesting a need to better understand best practices for applying (a combination of) such techniques and to obtain details on the specific BCTs used in mHealth interventions. Future research should focus on studies with longer follow-up periods to determine the effectiveness of mHealth interventions on behavior change to overcome the limited evidence in the current literature, which has mostly small-sized and single-arm experiments with a short follow-up period. %M 36083606 %R 10.2196/33247 %U https://mhealth.jmir.org/2022/9/e33247 %U https://doi.org/10.2196/33247 %U http://www.ncbi.nlm.nih.gov/pubmed/36083606 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e34471 %T An Intervention Offering Self-management Support Through mHealth and Health Coaching to Patients With Prostate Cancer: Interpretive Description of Patients’ Experiences and Perspectives %A Obro,Louise Faurholt %A Osther,Palle Jörn Sloth %A Ammentorp,Jette %A Pihl,Gitte Thybo %A Heiselberg,Kasper Kvols %A Krogh,Peter Gall %A Handberg,Charlotte %+ Urological Research Center, Vejle Hospital (Lillebaelt Hospital), University Hospital of Southern Denmark, Beriderbakken 4, Vejle, 7100, Denmark, 45 24994502, louise.faurholt.obro@rsyd.dk %K mobile phone %K mobile health %K mHealth %K prostate cancer %K self-management %K health coaching %K coaching %D 2022 %7 8.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Observational management strategies such as active surveillance and watchful waiting are considered to be acceptable approaches in patients with low-risk localized prostate cancer and a safe alternative to aggressive treatment. During observational management, treatment is postponed until the disease progresses, which often never occurs. However, approximately 90% of patients with a low-risk disease choose aggressive treatment owing to anxiety. Strategies to address anxiety are needed for optimal management of this population and to improve the quality of life of patients with low-risk localized prostate cancer. A review highlighted that mobile health (mHealth) in tandem with health coaching can support patients’ self-management of health behaviors and improve well-being. Objective: This study aims to explore patients’ experiences with and perspectives on an intervention offering self-management support through the use of mHealth devices and health coaching to identify supportive features that enable patients to perform sustainable changes that improve well-being. Methods: We used an interpretive description approach, combining semistructured interviews with 13 purposively selected patients with prostate cancer and participant observations of patient-coach interactions in coaching sessions. The interviews were transcribed and analyzed. The self-determination theory was used as a theoretical lens. Field notes and coaching notes from each session were used to orient data generation and confirm or challenge the analysis. Results: Our analysis suggested that patients’ self-awareness and psychological identity influenced their experiences with and perspectives on the self-management support offered by mHealth and health coaching in clinical practice. The patients’ individual experiences and perspectives indicated that they placed themselves in a dynamic continuum of sustaining or repressing their identity, self-awareness, and individual qualities. Our analysis revealed 4 interacting themes, all related to the psychological identity of the patients. Conclusions: For the group of patients with prostate cancer to experience well-being, we found it important for them to sustain their self-image when offered a self-management intervention. Motivation and autonomy were important aspects for the individual patients to sustain their self-image throughout the intervention. In contrast, demotivation and a sense of paternalism could result in fostering an experience of having to repress self-awareness. %M 35925751 %R 10.2196/34471 %U https://formative.jmir.org/2022/9/e34471 %U https://doi.org/10.2196/34471 %U http://www.ncbi.nlm.nih.gov/pubmed/35925751 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e32795 %T Design, Development, and Testing of BEST4Baby, an mHealth Technology to Support Exclusive Breastfeeding in India: Pilot Study %A Ma,Tony %A Chang,Katie %A Alyusuf,Amal %A Bajracharya,Elina %A Washio,Yukiko %A Kelly,Patricia J %A Bellad,Roopa M %A Mahantashetti,Niranjana S %A Charantimath,Umesh %A Short,Vanessa L %A Lalakia,Parth %A Jaeger,Frances %A Goudar,Shivaprasad %A Derman,Richard %+ Benten Technologies, Inc, 9408 Grant Avenue, Suite 206, Manassas, VA, 20110-1816, United States, 1 703 662 5858 ext 143, tonyma@bententech.com %K mobile health %K mHealth %K peer counselors %K breastfeeding %K rural %K usability %K low- and middle-income countries %K agile %K task shifting %K user-centered design %K mobile phone %D 2022 %7 8.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Exclusive breastfeeding (EBF) at 6 months of age in most low- and middle-income countries, including India, is surprisingly low. There is a relative lack of mobile health apps that specifically focus on leveraging the use of peer counselors (PCs) to support mothers as a means of increasing EBF practices in low- and middle-income countries. Objective: This study aimed to design, develop, and test the usability of Breastfeeding Education Support Tool for Baby (BEST4Baby), a mobile health app specifically designed to support PCs in providing in-home breastfeeding counseling support to mothers in rural India on optimal breastfeeding practices. Methods: A user-centered design process with an agile development methodology was used. The approach involved stakeholders and mothers who were trained to serve as PCs to guide BEST4Baby’s design and development, including the app’s content and features. PCs were engaged through focus groups with interactive wireframes. During the 24-month pilot study period, we conducted a feasibility test of the BEST4Baby app with 22 PCs who supported home visits with mothers residing in rural India. The intervention protocol required PCs to provide education and follow mothers using the BEST4Baby app, with 9 scheduled home visits from the late prenatal stage to 6 months post partum. BEST4Baby’s usability from the PCs’ perspective was assessed using the translated System Usability Scale (SUS). Results: The findings of this study align with best practices in user-centered design (ie, understanding user experience, including context with iterative design with stakeholders) to address EBF barriers. This led to the cultural tailoring and contextual alignment of an evidence-based World Health Organization breastfeeding program with an iterative design and agile development of the BEST4Baby app. A total of 22 PCs tested and rated the BEST4Baby app as highly usable, with a mean SUS score of 85.3 (SD 9.1), placing it over the 95th percentile for SUS scores. The approach translated into a highly usable BEST4Baby app for use by PCs in breastfeeding counseling, which also statistically increased EBF practices. Conclusions: The findings suggest that BEST4Baby was highly usable and accepted by mothers serving as PCs to support other mothers in their EBF practices and led to positive outcomes in the intervention group’s EBF rates. The pilot study demonstrated that using the specially designed BEST4Baby app was an important support tool for mothers to serve as PCs during the 9 home visits. Trial Registration: Clinicaltrials.gov NCT03533725; https://clinicaltrials.gov/ct2/show/NCT03533725 %M 36074546 %R 10.2196/32795 %U https://formative.jmir.org/2022/9/e32795 %U https://doi.org/10.2196/32795 %U http://www.ncbi.nlm.nih.gov/pubmed/36074546 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 9 %P e37288 %T A Mobile Phone App for the Prevention of Type 2 Diabetes in Malaysian Women With Gestational Diabetes Mellitus: Protocol for a Feasibility Randomized Controlled Trial %A Benton,Madeleine %A Iman,Iklil %A Goldsmith,Kimberley %A Forbes,Angus %A Ching,Siew Mooi %A Papachristou Nadal,Iliatha %A Guess,Nicola %A Murphy,Helen R %A Mohd Yusof,Barakatun-Nisak %A Baharom,Anisah %A Mahamad Sobri,Nur Hafizah %A Basri,Nurul Iftida %A Salim,Mazatulfazura Sf %A Ismail,Irmi Zarina %A Hassan,Faezah %A Ismail,Khalida %A Chew,Boon How %+ Department of Psychological Medicine, King's College London, Weston Education Centre, 10 Cutcombe Rd, Brixton, London, SE5 9RJ, United Kingdom, 44 07832158429, madeleine.benton@kcl.ac.uk %K gestational diabetes mellitus %K diabetes prevention %K randomized controlled trial %K mobile app %D 2022 %7 8.9.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Over 50% of women with a history of gestational diabetes mellitus (GDM) will develop type 2 diabetes (T2D) in later life. Asian women experience a disproportionate risk of both GDM and T2D compared to women from other ethnic backgrounds. Lifestyle interventions and behavior change can delay or even prevent the onset of T2D. We have developed a digitalized diabetes prevention intervention for the prevention of T2D in Malaysian women with GDM. Objective: The protocol describes a randomized controlled trial (RCT) to test the feasibility of undertaking a definitive trial of a diabetes prevention intervention, including a smartphone app and group support. Secondary aims are to summarize anthropometric, biomedical, psychological, and lifestyle outcomes overall and by allocation group, and to undertake a process evaluation. Methods: This is a two-arm parallel feasibility RCT. A total of 60 Malaysian women with GDM will be randomized in the antenatal period to receive the intervention or standard care until 12 months post partum. The intervention is a diabetes prevention intervention delivered via a smartphone app developed based on the Information-Motivation-Behavioral Skills model of behavior change and group support using motivational interviewing. The intervention provides women with tailored information and support to encourage weight loss through adapted dietary intake and physical activity. Women in the control arm will receive standard care. The Malaysian Ministry of Health’s Medical Research and Ethics Committee has approved the trial (NMRR-21-1667-60212). Results: Recruitment and enrollment began in February 2022. Future outcomes will be published in peer-reviewed health-related research journals and presented at national, regional, or state professional meetings and conferences. This publication is based on protocol version 2, January 19, 2022. Conclusions: To our knowledge, this will be the first study in Malaysia that aims to determine the feasibility of a digital intervention in T2D prevention among women with GDM. Findings from this feasibility study will inform the design of a full-scale RCT in the future. Trial Registration: ClinicalTrials.gov NCT05204706; https://clinicaltrials.gov/ct2/show/NCT05204706 International Registered Report Identifier (IRRID): PRR1-10.2196/37288 %M 36074545 %R 10.2196/37288 %U https://www.researchprotocols.org/2022/9/e37288 %U https://doi.org/10.2196/37288 %U http://www.ncbi.nlm.nih.gov/pubmed/36074545 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 9 %P e39454 %T Effectiveness and Minimum Effective Dose of App-Based Mobile Health Interventions for Anxiety and Depression Symptom Reduction: Systematic Review and Meta-Analysis %A Lu,Sheng-Chieh %A Xu,Mindy %A Wang,Mei %A Hardi,Angela %A Cheng,Abby L %A Chang,Su-Hsin %A Yen,Po-Yin %+ Department of Symptom Research, University of Texas MD Anderson Cancer Center, 6565 MD Anderson Blvd, Houston, TX, 77030, United States, 1 7137944453, Slu4@mdanderson.org %K mental health %K mobile health %K smartphone apps %K intervention dose effectiveness %K systematic review and meta-analysis %D 2022 %7 7.9.2022 %9 Review %J JMIR Ment Health %G English %X Background: Mobile health (mHealth) apps offer new opportunities to deliver psychological treatments for mental illness in an accessible, private format. The results of several previous systematic reviews support the use of app-based mHealth interventions for anxiety and depression symptom management. However, it remains unclear how much or how long the minimum treatment “dose” is for an mHealth intervention to be effective. Just-in-time adaptive intervention (JITAI) has been introduced in the mHealth domain to facilitate behavior changes and is positioned to guide the design of mHealth interventions with enhanced adherence and effectiveness. Objective: Inspired by the JITAI framework, we conducted a systematic review and meta-analysis to evaluate the dose effectiveness of app-based mHealth interventions for anxiety and depression symptom reduction. Methods: We conducted a literature search on 7 databases (ie, Ovid MEDLINE, Embase, PsycInfo, Scopus, Cochrane Library (eg, CENTRAL), ScienceDirect, and ClinicalTrials, for publications from January 2012 to April 2020. We included randomized controlled trials (RCTs) evaluating app-based mHealth interventions for anxiety and depression. The study selection and data extraction process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We estimated the pooled effect size using Hedge g and appraised study quality using the revised Cochrane risk-of-bias tool for RCTs. Results: We included 15 studies involving 2627 participants for 18 app-based mHealth interventions. Participants in the intervention groups showed a significant effect on anxiety (Hedge g=–.10, 95% CI –0.14 to –0.06, I2=0%) but not on depression (Hedge g=–.08, 95% CI –0.23 to 0.07, I2=4%). Interventions of at least 7 weeks’ duration had larger effect sizes on anxiety symptom reduction. Conclusions: There is inconclusive evidence for clinical use of app-based mHealth interventions for anxiety and depression at the current stage due to the small to nonsignificant effects of the interventions and study quality concerns. The recommended dose of mHealth interventions and the sustainability of intervention effectiveness remain unclear and require further investigation. %M 36069841 %R 10.2196/39454 %U https://mental.jmir.org/2022/9/e39454 %U https://doi.org/10.2196/39454 %U http://www.ncbi.nlm.nih.gov/pubmed/36069841 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 9 %P e37354 %T The Apple Watch for Monitoring Mental Health–Related Physiological Symptoms: Literature Review %A Lui,Gough Yumu %A Loughnane,Dervla %A Polley,Caitlin %A Jayarathna,Titus %A Breen,Paul P %+ The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia, 61 298525222, G.Lui@westernsydney.edu.au %K Apple Watch %K data %K validation %K mental health %K psychology %K precision medicine %K heart rate variability %K energy expenditure %K sleep tracking %K digital health %K mobile phone %D 2022 %7 7.9.2022 %9 Review %J JMIR Ment Health %G English %X Background: An anticipated surge in mental health service demand related to COVID-19 has motivated the use of novel methods of care to meet demand, given workforce limitations. Digital health technologies in the form of self-tracking technology have been identified as a potential avenue, provided sufficient evidence exists to support their effectiveness in mental health contexts. Objective: This literature review aims to identify current and potential physiological or physiologically related monitoring capabilities of the Apple Watch relevant to mental health monitoring and examine the accuracy and validation status of these measures and their implications for mental health treatment. Methods: A literature review was conducted from June 2021 to July 2021 of both published and gray literature pertaining to the Apple Watch, mental health, and physiology. The literature review identified studies validating the sensor capabilities of the Apple Watch. Results: A total of 5583 paper titles were identified, with 115 (2.06%) reviewed in full. Of these 115 papers, 19 (16.5%) were related to Apple Watch validation or comparison studies. Most studies showed that the Apple Watch could measure heart rate acceptably with increased errors in case of movement. Accurate energy expenditure measurements are difficult for most wearables, with the Apple Watch generally providing the best results compared with peers, despite overestimation. Heart rate variability measurements were found to have gaps in data but were able to detect mild mental stress. Activity monitoring with step counting showed good agreement, although wheelchair use was found to be prone to overestimation and poor performance on overground tasks. Atrial fibrillation detection showed mixed results, in part because of a high inconclusive result rate, but may be useful for ongoing monitoring. No studies recorded validation of the Sleep app feature; however, accelerometer-based sleep monitoring showed high accuracy and sensitivity in detecting sleep. Conclusions: The results are encouraging regarding the application of the Apple Watch in mental health, particularly as heart rate variability is a key indicator of changes in both physical and emotional states. Particular benefits may be derived through avoidance of recall bias and collection of supporting ecological context data. However, a lack of methodologically robust and replicated evidence of user benefit, a supportive health economic analysis, and concerns about personal health information remain key factors that must be addressed to enable broader uptake. %M 36069848 %R 10.2196/37354 %U https://mental.jmir.org/2022/9/e37354 %U https://doi.org/10.2196/37354 %U http://www.ncbi.nlm.nih.gov/pubmed/36069848 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 9 %P e35727 %T Wearable Devices in Diving: Scoping Review %A Bube,Benjamin %A Zanón,Bruno Baruque %A Lara Palma,Ana María %A Klocke,Heinrich %+ Faculty of Computer Science and Engineering Science, University of Applied Sciences Cologne, Steinmüllerallee 1, Gummersbach, 51643, Germany, 49 1601688162, benjaminbube@googlemail.com %K wearable device %K underwater communication %K head-up display %K safety device %K scuba diving %K free diving %D 2022 %7 6.9.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Wearables and their benefits for the safety and well-being of users have been widely studied and have had an enormous impact on the general development of these kinds of devices. Yet, the extent of research into the use and impact of wearable devices in the underwater environment is comparatively low. In the past 15 years, there has been an increased interest in research into wearables that are used underwater, as the use of such wearables has steadily grown over time. However, there has so far been no clear indication in the literature about the direction in which efforts for the design and construction of underwater wearable devices are developing. Therefore, the analysis presented in this scoping review establishes a good and powerful basis for the further development and orientation of current underwater wearables within the field. Objective: In this scoping review, we targeted wearable devices for underwater use to make a comprehensive map of their capabilities and features and discuss the general direction of the development of underwater wearables and the orientation of research into novel prototypes of these kinds of devices. Methods: In September 2021, we conducted an extensive search for existing literature on 4 databases and for grey literature to identify developed prototypes and early-stage products that were described and tested in water, could be worn and interacted with (eg, displays, buttons, etc), and were fully functional without external equipment. The studies were written in English, came from peer-reviewed academic sources, and were published between 2005 and 2021. We reviewed each title and abstract. The data extraction process was carried out by one author and verified by another author. Results: In total, 36 relevant studies were included. Among these, 4 different categories were identified; 18 studies dealt primarily with safety devices, 9 dealt with underwater communication devices, 7 dealt with head-up displays, and 2 dealt with underwater human-computer interaction approaches. Although the safety devices seemed to have gained the most interest at the time of this study, a clear trend toward underwater communication wearables was identified. Conclusions: This review sought to provide a first insight into the possibilities and challenges of the technologies that have been used in and for wearable devices that are meant for use in the underwater environment. Among these, underwater communication technologies have had the most significant influence on future developments. Moreover, a topic that has not received enough attention but should be further addressed is human-computer interaction. By developing underwater wearables that cover 2 or more of the technology categories that we identified, the extent of the benefits of such devices can be significantly increased in the future. %M 36066926 %R 10.2196/35727 %U https://mhealth.jmir.org/2022/9/e35727 %U https://doi.org/10.2196/35727 %U http://www.ncbi.nlm.nih.gov/pubmed/36066926 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e34433 %T The Physical Activity Assessment of Adults With Type 2 Diabetes Using Accelerometer-Based Cut Points: Scoping Review %A Moldovan,Ioana A %A Bragg,Alexa %A Nidhiry,Anna S %A De La Cruz,Barbara A %A Mitchell,Suzanne E %+ Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, 55 Lake Avenue, Worcester, MA, 01655, United States, 1 9789856033, Suzanne.Mitchell2@umassmed.edu %K accelerometer %K cut points %K type 2 diabetes %K physical activity %D 2022 %7 6.9.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Incorporating physical activity into lifestyle routines is recommended for individuals with type 2 diabetes. Accelerometers offer a promising method for objectively measuring physical activity and for assessing interventions. However, the existing literature for accelerometer-measured physical activity among middle-aged and older adults with type 2 diabetes is lacking. Objective: This study aims to identify research studies in which accelerometer-based cut points were used to classify the physical activity intensity of middle-aged to older adults with type 2 diabetes as sedentary, light, moderate, vigorous, and very vigorous, and to determine if validated accelerometer cut points specifically for this population exist. Methods: We followed the Joanna Briggs Institute methodology for scoping reviews. Between June 23 and July 12, 2020, two reviewers independently screened records from four databases (PubMed, Web of Science, Embase, Engineering Village) and the ActiGraph Corp web site for eligible studies that included patients with type 2 diabetes with a sample mean age ≥50 years, used research-grade accelerometers, applied cut points to categorize objectively measured physical activity, and were available in English. We excluded studies reporting exclusively steps or step counts measured by accelerometers or pedometers and conference abstracts or other sources that did not have a full text available. Data extraction was completed using Microsoft Excel. Data for the following variables were tabulated based on frequency distributions: study design, accelerometer type, device placement, epoch length, total wear time, and cut points used. Study aims and participant demographic data were summarized. Results: A total of 748 records were screened at the abstract level, and 88 full-text articles were assessed for eligibility. Ultimately, 46 articles were retained and analyzed. Participants’ mean ages ranged from 50 to 79.9 years. The ActiGraph accelerometer and the Freedson et al and Troiano et al counts-per-minute cut points were the most frequently used across the literature. Freedson et al and Troiano et al counts-per-minute cut points for light, moderate, and vigorous activity correspond to <1952, 1952-5724, and ≥5725, and 100-2019, 2020-5998, and ≥5999, respectively. The Lopes et al cut points were developed by calibrating the ActiGraph in middle-aged and older adults with overweight/obesity and type 2 diabetes. These counts-per-minute thresholds are ≥200 (light), ≥1240 (moderate), and ≥2400 (vigorous), and were applied in 1 interventional study. Conclusions: An assortment of accelerometer cut points have been used by researchers to categorize physical activity intensity for middle-aged and older adults with diabetes. Only one set of cut points was validated and calibrated in our population of interest. Additional research is warranted to address the need for diabetes-specific cut points to inform public health recommendations. This includes confirmation that the Lopes et al cut points reflect clinically meaningful changes in physical activity for adults with diabetes who have comorbidities other than overweight/obesity and the development of relative intensity cut points that may be more suitable for those with suboptimal physical functioning. %M 36066937 %R 10.2196/34433 %U https://www.i-jmr.org/2022/2/e34433 %U https://doi.org/10.2196/34433 %U http://www.ncbi.nlm.nih.gov/pubmed/36066937 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e38262 %T A Method to Deliver Automated and Tailored Intervention Content: 24-month Clinical Trial %A Miller,Hailey N %A Voils,Corrine I %A Cronin,Kate A %A Jeanes,Elizabeth %A Hawley,Jeffrey %A Porter,Laura S %A Adler,Rachel R %A Sharp,Whitney %A Pabich,Samantha %A Gavin,Kara L %A Lewis,Megan A %A Johnson,Heather M %A Yancy Jr,William S %A Gray,Kristen E %A Shaw,Ryan J %+ School of Nursing, Duke University, 307 Trent Drive, North Carolina, NC, 27710, United States, 1 919 684 9434, ryan.shaw@duke.edu %K text message %K weight management %K automation %K clinical trial %K engagement %K digital technology %K electronic data capture %K REDCap %K automated text message %K digital health intervention %K health intervention %K health database %K digital health %D 2022 %7 6.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of digital technologies and software allows for new opportunities to communicate and engage with research participants over time. When software is coupled with automation, we can engage with research participants in a reliable and affordable manner. Research Electronic Data Capture (REDCap), a browser-based software, has the capability to send automated text messages. This feature can be used to automate delivery of tailored intervention content to research participants in interventions, offering the potential to reduce costs and improve accessibility and scalability. Objective: This study aimed to describe the development and use of 2 REDCap databases to deliver automated intervention content and communication to index participants and their partners (dyads) in a 2-arm, 24-month weight management trial, Partner2Lose. Methods: Partner2Lose randomized individuals with overweight or obesity and cohabitating with a partner to a weight management intervention alone or with their partner. Two databases were developed to correspond to 2 study phases: one for weight loss initiation and one for weight loss maintenance and reminders. The weight loss initiation database was programmed to send participants (in both arms) and their partners (partner-assisted arm) tailored text messages during months 1-6 of the intervention to reinforce class content and support goal achievement. The weight maintenance and reminder database was programmed to send maintenance-related text messages to each participant (both arms) and their partners (partner-assisted arm) during months 7-18. It was also programmed to send text messages to all participants and partners over the course of the 24-month trial to remind them of group classes, dietary recall and physical activity tracking for assessments, and measurement visits. All text messages were delivered via Twilio and were unidirectional. Results: Five cohorts, comprising 231 couples, were consented and randomized in the Partner2Lose trial. The databases will send 53,518 automated, tailored text messages during the trial, significantly reducing the need for staff to send and manage intervention content over 24 months. The cost of text messaging will be approximately US $450. Thus far, there is a 0.004% known error rate in text message delivery. Conclusions: Our trial automated the delivery of tailored intervention content and communication using REDCap. The approach described provides a framework that can be used in future behavioral health interventions to create an accessible, reliable, and affordable method for intervention delivery and engagement that requires minimal trial-specific resources and personnel time. Trial Registration: ClinicalTrials.gov NCT03801174; https://clinicaltrials.gov/ct2/show/NCT03801174?term=NCT03801174 %M 36066936 %R 10.2196/38262 %U https://formative.jmir.org/2022/9/e38262 %U https://doi.org/10.2196/38262 %U http://www.ncbi.nlm.nih.gov/pubmed/36066936 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e38520 %T The Impact of Smartphone Apps Designed to Reduce Food Waste on Improving Healthy Eating, Financial Expenses and Personal Food Waste: Crossover Pilot Intervention Trial Studying Students’ User Experiences %A Mathisen,Therese Fostervold %A Johansen,Frode Ramstad %+ Faculty of Health, Welfare and Organisation, Østfold University College, Høgskolen i Østfold, PO Box 700, Halden, No-1757, Norway, 47 69 60 80 00, therese.f.mathisen@hiof.no %K smartphone app %K food waste %K healthy eating %K diet %K automatic %K registration %K global sustainability %K financial expenses %D 2022 %7 2.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Global sustainability and individual health need coordinated attention. While individuals are recommended a healthy diet to reduce the burden of noncommunicable diseases, global attention to natural resource conservation is also needed. The latter specifically means effective measures to reduce food waste. Objective: This pilot study evaluates the experiences of students and effect from using smartphone apps designed to reduce food waste on personal healthy eating, financial expenses, and food waste. Methods: A total of 6 students from different study programs (mean age 24.7, SD 2.9) were recruited to evaluate 2 different apps designed to reduce food waste and to register food consumption, food waste, and financial food expenses before and after the app trials. The apps evaluated were the commercially available TotalCtrl Home and Too-Good-To-Go. Results were analyzed by mixed methods, comprising statistical analyses for quantifiable data and thematic analyses for qualitative data. The apps were used separately in random order, each for 1 month. Primary outcome was user expectations to and experiences from the use of the apps, which were obtained by semistructured interviews. Secondary outcomes were changes in food waste volume, financial food expenses, and healthy eating. While information on food waste and food expenses was obtained by weighing food waste and registering food costs for 2 weeks before and after app trials, scores for consuming healthy diets were calculated from registered food records by scoring criteria matched to national recommendations for healthy eating. Results: Awareness on food waste increased after app trials, but experiences with apps pointed toward several potential for technical and content improvements. The students reported that there were too many manual operations in the apps to induce permanent use (TotalCtrl Home), that services seemed more concerned about the producers’ interests than the individual’s needs (Too-Good-To-Go), and that they missed a composite app that included functions to promote healthy eating and overview of budget and expenses as well as of food waste (both apps). Use of apps designed to reduce food waste and personal costs and to improve healthy eating did not result in any measurable effects, that is, no change in food waste (mean change 0.81, SD 1.5 kg; P=.13), healthy eating (mean change –0.24, SD 0.43; P=.24), or personal food expenses (mean change 47.5 NOK or US $4.8, SD 416.9 NOK or US $42.5; P=.39). Conclusions: Apps may aid in increased awareness of food waste at the producer and consumer levels. Large-scale studies with longer duration are needed to see if apps may induce measurable changes in food waste, healthy eating, and financial expenses. %M 36053667 %R 10.2196/38520 %U https://formative.jmir.org/2022/9/e38520 %U https://doi.org/10.2196/38520 %U http://www.ncbi.nlm.nih.gov/pubmed/36053667 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e39851 %T The Effects of a Digital Well-being Intervention on Older Adults: Retrospective Analysis of Real-world User Data %A Boucher,Eliane %A Honomichl,Ryan %A Ward,Haley %A Powell,Tyler %A Stoeckl,Sarah Elizabeth %A Parks,Acacia %+ Twill, 114 Fifth Avenue, 10th floor, New York, NY, 10011, United States, 1 432 258 5233, eliane@twill.health %K mobile apps %K mental health %K older adults %K technology adoption %K digital health %K mobile phone %D 2022 %7 2.9.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Digital interventions have been shown to be effective for a variety of mental health disorders and problems. However, few studies have examined the effects of digital interventions in older adults; therefore, little is known about how older adults engage with or benefit from these interventions. Given that adoption rates for technology among people aged ≥65 years remain substantially lower than in the general population and that approximately 20% of older adults are affected by mental health disorders, research exploring whether older adults will use and benefit from digital interventions is needed. Objective: This study aimed to examine the extent to which older adults engaged with a digital well-being intervention (Happify) and whether engaging with this program led to improvements in both subjective well-being and anxiety symptoms. Methods: In this retrospective analysis, we analyzed data from 375 real-world Happify users aged ≥65 years who signed up for the platform between January 1, 2019, and December 23, 2021. Changes in well-being and anxiety symptoms across 42 to 182 days were assessed using responses to the in-app assessment, which users were prompted to take every 2 weeks, and were compared among users who engaged with the program at the recommended level (ie, 2 or more activities per week) or below the recommended level. Results: In all, 30% (113/375) of the sample engaged with the platform at the recommended level (ie, completed an average of 2 or more activities per week), and overall, users completed an average of 43.35 (SD 87.80) activities, ranging from 1 to 786, between their first and last assessment. Users were also active on the platform for an average of 19.36 (SD 27.16) days, ranging from 1 to 152 days. Moreover, older adults who engaged at the recommended level experienced significantly greater improvements in subjective well-being (P=.002) and anxiety symptoms (P<.001) relative to those who completed fewer activities. Conclusions: These data provide preliminary evidence that older adults engage with and benefit from digital well-being interventions. We believe that these findings highlight the importance of considering older adult populations in digital health research. More research is needed to understand potential barriers to using digital interventions among older adults and whether digital interventions should be modified to account for this population’s particular needs (eg, ensuring that the intervention is accessible using a variety of devices). However, these results are an important step in demonstrating the feasibility of such interventions in a population that is assumed to be less inclined toward digital approaches. %M 36053569 %R 10.2196/39851 %U https://aging.jmir.org/2022/3/e39851 %U https://doi.org/10.2196/39851 %U http://www.ncbi.nlm.nih.gov/pubmed/36053569 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e36919 %T Integrating Social Determinants of Health With Tobacco Treatment for Individuals With Opioid Use Disorder: Feasibility and Acceptability Study of Delivery Through Text Messaging %A Kathuria,Hasmeena %A Shankar,Divya %A Cobb,Vinson %A Newman,Julia %A Bulekova,Katia %A Werntz,Scott %A Borrelli,Belinda %+ The Pulmonary Center, Boston University School of Medicine, 72 E Concord St, R304, Boston, MA, 02118, United States, 1 6176384860, hasmeena@bu.edu %K text message %K smoking cessation %K opioid use disorder %K tobacco dependence %K tobacco treatment interventions %K mobile phone %D 2022 %7 1.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with opioid use disorder (OUD) have a high prevalence of smoking and frequently experience unmet social determinants of health (SDOH), which may be barriers to smoking cessation. Hospitalization is an opportunity to encourage smoking cessation. Unfortunately, many clinicians do not provide tobacco treatment to support the maintenance of cessation achieved during hospitalization. Interventions are required to support these high-risk individuals after hospital discharge. Objective: This study aimed to test the feasibility and acceptability of a 28-day SMS text messaging program tailored to individuals with OUD, which provides smoking cessation support and addresses unmet SDOH needs. Methods: From July to December 2019, we enrolled 25 individuals who were hospitalized with tobacco dependence and OUD at our large safety net hospital. The SMS text messaging program was initiated during hospitalization and continued for 28 days. Participants were enrolled in either the ready to quit within 30 days or the not ready to quit within 30 days program based on their readiness to quit. Automated SMS text messages were sent twice daily for 4 weeks. The topics included health and cost benefits of quitting, both general and opioid specific (16 messages); managing mood and stress (8 messages); motivation, coping strategies, and encouragement (18 messages); addressing medication misconceptions (5 messages); links to resources to address substance use (2 messages providing links to the Massachusetts Substance Use Helpline and Boston Medical Center resources), tobacco dependence (1 message providing a link to the Massachusetts Quitline), and unmet SDOH needs (6 messages assessing SDOH needs with links to resources if unmet SDOH needs were identified). Questionnaires and interviews were conducted at baseline and at 2 and 4 weeks after enrollment. Results: The participants were 56% (14/25) female, 36% (9/25) African American, 92% (23/25) unemployed, and 96% (24/25) Medicaid insured. Approximately 84% (21/25) activated the program, and none of the participants unsubscribed. Approximately 57% (12/21) completed either the 2- or 4-week questionnaires. Program satisfaction was high (overall mean 6.7, SD 0.8, range 1-7). Many perceived that the SMS text messaging program provided social support, companionship, and motivation to stop smoking. Messages about the health benefits of quitting were well received, whereas messages on how quitting cigarettes may prevent relapse from other substances had mixed views, highlighting the importance of tailoring interventions to patient preferences. Conclusions: SMS text messaging to promote smoking cessation and address SDOH needs may be an effective tool for improving quit rates and health outcomes in individuals with tobacco dependence and OUD. Our study adds to the growing body of evidence that SMS text messaging approaches are feasible and acceptable for providing tobacco treatment to all individuals who smoke, even among low-income populations who have OUD and are not ready to quit. %M 36048509 %R 10.2196/36919 %U https://formative.jmir.org/2022/9/e36919 %U https://doi.org/10.2196/36919 %U http://www.ncbi.nlm.nih.gov/pubmed/36048509 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 8 %P e33772 %T Role of Social and App-Related Factors in Behavioral Engagement With mHealth for Improved Well-being Among Chronically Ill Patients: Scenario-Based Survey Study %A Van Baelen,Freek %A De Regge,Melissa %A Larivière,Bart %A Verleye,Katrien %A Schelfout,Sam %A Eeckloo,Kristof %+ Strategic Policy Cell, Ghent University Hospital, 10, Corneel Heymanslaan, Ghent, 9000, Belgium, 32 92643493, melissa.deregge@uzgent.be %K mHealth app %K engagement %K social influence %K app integration %K well-being %K Belgium %K mHealth %K behavioral %K behavioral engagement %K mobile health %K mobile health apps %K mobile phone %D 2022 %7 26.8.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The last decade has seen a considerable increase in the number of mobile health (mHealth) apps in everyday life. These mHealth apps have the potential to significantly improve the well-being of chronically ill patients. However, behavioral engagement with mHealth apps remains low. Objective: The aim of this study was to describe the behavioral engagement of chronically ill patients with mHealth apps by investigating (1) how it is affected by social factors (ie, physician recommendation) and app-related factors (ie, app integration) and (2) how it affects patient well-being. This study also considers the moderating effect of attachment to traditional health care and the mobile app experience among patients. Methods: We carried out a scenario-based survey study of chronically ill patients (N=521). A Bayesian structural equation modeling with mediation and moderation analysis was conducted in MPlus. Results: Both physician recommendations for mHealth app use and app integration have positive effects on the behavioral engagement of chronically ill patients with mHealth apps. Higher behavioral engagement positively affects the hedonic well-being (extent of pleasure) and the eudaemonic well-being (extent of self-efficacy) of chronically ill patients. Mobile app experience, however, positively moderates the relationship between app integration and behavioral engagement, whereas patient attachment to traditional care does not moderate the relationship between physician recommendation and behavioral engagement. Taken together, the proportion of variance explained (R²) equals 21% for behavioral engagement and 52.8% and 62.2% for hedonic and eudaemonic well-being, respectively, thereby providing support for the strong influence of app integration and physician recommendation via the mediation of the patients’ behavioral engagement on both patients’ hedonic and eudaemonic well-being. Conclusions: Physician recommendation and app integration enable behavioral engagement and promote well-being among chronically ill patients. It is thus important to take social and app-related factors into consideration during and after the development of mHealth apps. %M 36018618 %R 10.2196/33772 %U https://mhealth.jmir.org/2022/8/e33772 %U https://doi.org/10.2196/33772 %U http://www.ncbi.nlm.nih.gov/pubmed/36018618 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e37994 %T Heart Rate Variability Biofeedback to Treat Anxiety in Young People With Autism Spectrum Disorder: Findings From a Home-Based Pilot Study %A Coulter,Helen %A Donnelly,Mark %A Mallett,John %A Kernohan,W George %+ Ulster University, Shore Road, Newtownabbey, BT370QB, United Kingdom, 44 2895365135, mp.donnelly@ulster.ac.uk %K autism %K anxiety %K biofeedback %K remote intervention %K mobile phone %D 2022 %7 26.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: People with autism spectrum disorder (ASD) frequently experience high levels of anxiety. Despite this, many clinical settings do not provide specialist ASD mental health services, and demand for professional support frequently outstrips supply. Across many sectors of health, investigators have explored digital health solutions to mitigate demand and extend the reach of professional practice beyond traditional clinical settings. Objective: This critical appraisal and pilot feasibility study examines heart rate variability (HRV) biofeedback as an approach to help young people with ASD to manage anxiety symptoms outside of formal settings. The aim is to explore the use of portable biofeedback devices to manage anxiety, while also highlighting the risks and benefits of this approach with this population. Methods: We assessed the feasibility of using home-based HRV biofeedback for self-management of anxiety in young people with ASD. We adopted coproduction, involving people with ASD, to facilitate development of the study design. Next, a separate pilot with 20 participants with ASD (n=16, 80% male participants and n=4, 20% female participants, aged 13-24 years; IQ>70) assessed adoption and acceptability of HRV biofeedback devices for home use over a 12-week period. Data were collected from both carers and participants through questionnaires and interviews; participants also provided single-lead electrocardiogram recordings as well as daily reports through smartphone on adoption and use of their device. Results: Pre-post participant questionnaires indicated a significant reduction in anxiety in children (t6=2.55; P=.04; Cohen d=0.99) as well as adults (t7=3.95; P=.006; Cohen d=0.54). Participant age was significantly negatively correlated with all HRV variables at baseline, namely high-frequency heart rate variability (HF-HRV: P=.02), the root mean square of successive differences in normal heartbeat contractions (RMSSD: P=.02) and the variability of normal-to-normal interbeat intervals (SDNN: P=.04). At follow-up, only SDNN was significantly negatively correlated with age (P=.05). Levels of ASD symptoms were positively correlated with heart rate both before (P=.04) and after the intervention (P=.01). The majority (311/474, 65.6%) of reports from participants indicated that the devices helped when used. Difficulties with the use of some devices and problems with home testing of HRV were noted. These initial findings are discussed within the context of the strengths and challenges of remotely delivering a biofeedback intervention for people with ASD. Conclusions: HRV biofeedback devices have shown promise in this pilot study. There is now a need for larger evaluation of biofeedback to determine which delivery methods achieve the greatest effect for people with ASD. Trial Registration: ClinicalTrials.gov NCT04955093; https://clinicaltrials.gov/ct2/show/NCT04955093 %M 36018712 %R 10.2196/37994 %U https://formative.jmir.org/2022/8/e37994 %U https://doi.org/10.2196/37994 %U http://www.ncbi.nlm.nih.gov/pubmed/36018712 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e36000 %T Effects of a WeChat-Based Life Review Program for Patients With Digestive System Cancer: 3-Arm Parallel Randomized Controlled Trial %A Zheng,Meihua %A Zhang,Xiaoling %A Xiao,Huimin %+ School of Nursing, Fujian Medical University, No 1 Xuefu North Road, University Town, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, 350122, China, 86 13860692061, huimin_xiao@126.com %K digestive system cancer %K life review %K digital technology %K anxiety %K depression %K hope %K self-transcendence %K cancer %K randomized controlled trial %K distress %K psychological %K digestive system %D 2022 %7 25.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients with digestive system cancer often experience psychospiritual distress. Life review is an evidence-based psychological intervention for patients with cancer, but the effects of digital life review programs are unclear, especially for patients with digestive system cancer. Objective: We examined the effects of a WeChat-based life review program on the psychospiritual well-being of patients with digestive system cancer. Methods: This study was a 3-arm parallel randomized controlled trial. Eligible patients with digestive system cancer were recruited from a university hospital in Fujian, China. They were randomized to a life review group and 2 control groups. All participants received routine care, and the life review group also received the 4-week WeChat-based life review program. Control group 1 also received a 4-week program of friendly visiting. Anxiety, depression, hope, and self-transcendence were measured at baseline and 2 days, 1 month, and 6 months after the intervention. Results: A total of 150 participants were randomly allocated to the WeChat-based life review group (n=50), control group 1 (n=50), or control group 2 (n=50). The overall dropout rate was 10% (15/150), and 92% (46/50) of participants in the the life review group completed the intervention. Significant interaction effects for time and group membership were found for anxiety (P<.001), depression (P<.001), hope (P<.001), and self-transcendence (P<.001) at all follow-up time points. For anxiety and depression, the scores did not differ significantly between the life review group and control group 1 on day 2 (P=.80 for anxiety, P=.51 for depression), but the scores were significantly lower in the life review group at month 1 and month 6 (P=.02 for anxiety at both months 1 and 6; P=.003 and P<.001 for depression at months 1 and 6, respectively). Significant increases in hope and self-transcendence were revealed in the life review group compared to control group participants at all follow-up sessions. Conclusions: The WeChat-based life review program was effective in reducing anxiety and depressive symptoms and in improving the level of hope and self-transcendence among patients with digestive system cancer. Though friendly visiting can also help to relieve anxiety, its effects are short-term. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IOR-17011998; https://tinyurl.com/5acycpd4 %M 36006665 %R 10.2196/36000 %U https://www.jmir.org/2022/8/e36000 %U https://doi.org/10.2196/36000 %U http://www.ncbi.nlm.nih.gov/pubmed/36006665 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 8 %P e31744 %T Health Care Workers’ Need for Headspace: Findings From a Multisite Definitive Randomized Controlled Trial of an Unguided Digital Mindfulness-Based Self-help App to Reduce Healthcare Worker Stress %A Taylor,Heather %A Cavanagh,Kate %A Field,Andy P %A Strauss,Clara %+ School of Psychology, University of Sussex, Falmer, Brighton, BN1 9QH, United Kingdom, 44 01273 876638, c.y.strauss@sussex.ac.uk %K self-help %K mindfulness %K randomized control trial %K health care worker %K National Health Service %K NHS %K doctors %K nurses %K stress %K mental health %K burnout %K mobile phone %D 2022 %7 25.8.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health care workers experience high stress. Accessible, affordable, and effective approaches to reducing stress are lacking. In-person mindfulness-based interventions can reduce health care worker stress but are not widely available or accessible to busy health care workers. Unguided, digital, mindfulness-based self-help (MBSH) interventions show promise and can be flexibly engaged with. However, their effectiveness in reducing health care worker stress has not yet been explored in a definitive trial. Objective: This study aimed to investigate the effectiveness of an unguided digital MBSH app (Headspace) in reducing health care worker stress. Methods: This was a definitive superiority randomized controlled trial with 2182 National Health Service staff in England recruited on the web and allocated in a 1:1 ratio to fully automated Headspace (n=1095, 50.18%) or active control (Moodzone; n=1087, 49.82%) for 4.5 months. Outcomes were subscales of the Depression, Anxiety, and Stress (primary outcome) Scale short form; Short Warwick Edinburgh Mental Well-being Scale; Maslach Burnout Inventory; 15-item Five-Facet Mindfulness Questionnaire minus Observe items; Self-Compassion Scale–Short Form; Compassionate Love Scale; Penn State Worry Questionnaire; Brooding subscale of the Ruminative Response Scale; and sickness absence. Results: Intention-to-treat analyses found that Headspace led to greater reductions in stress over time than Moodzone (b=–0.31, 95% CI –0.47 to –0.14; P<.001), with small effects. Small effects of Headspace versus Moodzone were found for depression (b=–0.24, 95% CI –0.40 to –0.08; P=.003), anxiety (b=–0.19, 95% CI –0.32 to –0.06; P=.004), well-being (b=0.14, 95% CI 0.05-0.23; P=.002), mindfulness (b=0.22, 95% CI 0.09-0.34; P=.001), self-compassion (b=0.48, 95% CI 0.33-0.64; P<.001), compassion for others (b=0.02, 95% CI 0.00-0.04; P=.04), and worry (b=–0.30, 95% CI –0.51 to –0.09; P=.005) but not for burnout (b=–0.19, –0.04, and 0.13, all 95% CIs >0; P=.65, .67, and .35), ruminative brooding (b=–0.06, 95% CI –0.12 to 0.00; P=.06), or sickness absence (γ=0.09, 95% CI –0.18 to 0.34). Per-protocol effects of Headspace (454/1095, 41.46%) versus Moodzone (283/1087, 26.03%) over time were found for stress, self-compassion, and compassion for others but not for the other outcomes. Engagement (practice days per week) and improvements in self-compassion during the initial 1.5-month intervention period mediated pre- to postintervention improvements in stress. Improvements in mindfulness, rumination, and worry did not mediate pre- to postintervention improvements in stress. No serious adverse events were reported. Conclusions: An unguided digital MBSH intervention (Headspace) can reduce health care workers’ stress. Effect sizes were small but could have population-level benefits. Unguided digital MBSH interventions can be part of the solution to reducing health care worker stress alongside potentially costlier but potentially more effective in-person mindfulness-based interventions, nonmindfulness courses, and organizational-level interventions. Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN15424185; https://tinyurl.com/rv9en5kc %M 36006668 %R 10.2196/31744 %U https://mhealth.jmir.org/2022/8/e31744 %U https://doi.org/10.2196/31744 %U http://www.ncbi.nlm.nih.gov/pubmed/36006668 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e39086 %T Serious Games Supporting the Prevention and Treatment of Alcohol and Drug Consumption in Youth: Scoping Review %A Martínez-Miranda,Juan %A Espinosa-Curiel,Ismael Edrein %+ Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica Tepic, Andador 10, Ciudad del Conocimiento, Tepic, 63173, Mexico, 52 3111295930 ext 28602, jmiranda@cicese.mx %K serious games %K substance use %K alcohol and drugs %K young population %K mobile phone %D 2022 %7 25.8.2022 %9 Review %J JMIR Serious Games %G English %X Background: The consumption of alcohol and drugs, particularly in adolescents and young adults, has increased worldwide in the last several years, representing a significant public health challenge. Serious games have the potential to support preventive and treatment interventions for substance use, facilitating the acquisition of relevant knowledge and the motivation for changes in attitudes and behaviors regarding substance consumption. Objective: This scoping review aims to analyze a set of 7 relevant characteristics of current serious games designed to support the prevention and treatment of alcohol and drug consumption in adolescents and young adults—the substance addressed, the type of intervention, the theoretical basis, the computational techniques used, the mechanism for data security and privacy, the evaluation procedure followed, and the main results obtained. Methods: The review was performed by following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Data were retrieved from January 2010 to May 2022, using PubMed, Scopus (Elsevier), IEEE Xplore, and ACM Digital as data sources. The eligibility criteria included studies that described serious games designed to support the prevention or treatment of alcohol and drug consumption, targeted a population aged between 12 and 30 years, and included an evaluation procedure. Authors (JMM and IEEC) individually screened the titles and abstracts, and then full articles were reviewed for a final inclusion decision. Results: A total of 629 records were obtained, and 29 (4.6%) fulfilled the inclusion criteria. Most of the serious games (14/29, 48%) were focused on the prevention or treatment of alcohol use. The type of intervention that was the most supported was prevention (18/29, 62%), and most studies mentioned the theory, theoretical construct, or therapeutic technique used as a foundation (22/29, 76%). Most of the studies only provided information about the platform for execution (23/29, 79%), and few described the use of computational techniques, such as virtual reality or motion-based interaction (5/29, 17%). A small set of studies (10/29, 34%) explicitly mentioned how data security and privacy were addressed. Most of the reported evaluation protocols were pilot studies (11/29, 38%), followed by randomized controlled trials (10/29, 34%), and the reported results were positive in terms of acceptability, usability, and efficacy. However, more research is needed to assess long-term effects. Conclusions: Given the increasing interest in the use of serious games as digital interventions to support the prevention or treatment of substance use, knowing their main features is highly important. This review highlights whether and how current serious games incorporate 7 key features that are useful to consider for the further development of the area. %M 36006694 %R 10.2196/39086 %U https://games.jmir.org/2022/3/e39086 %U https://doi.org/10.2196/39086 %U http://www.ncbi.nlm.nih.gov/pubmed/36006694 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 8 %P e38495 %T Predicting Multiple Sclerosis Outcomes During the COVID-19 Stay-at-home Period: Observational Study Using Passively Sensed Behaviors and Digital Phenotyping %A Chikersal,Prerna %A Venkatesh,Shruthi %A Masown,Karman %A Walker,Elizabeth %A Quraishi,Danyal %A Dey,Anind %A Goel,Mayank %A Xia,Zongqi %+ Department of Neurology, University of Pittsburgh, 3501 Fifth Avenue,, BST3, Suite 7014, Pittsburgh, PA, 15260, United States, 1 412 383 5377, zxia1@pitt.edu %K mobile sensing %K sensor %K sensing %K mobile health %K mHealth %K algorithm %K multiple sclerosis %K disability %K mental health %K depression %K sleep %K fatigue %K tiredness %K predict %K machine learning %K feature selection %K neurological disorder %K COVID-19 %K isolation %K behavior change %K health outcome %K fitness %K movement %K physical activity %K exercise %K tracker %K digital phenotyping %D 2022 %7 24.8.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has broad negative impact on the physical and mental health of people with chronic neurological disorders such as multiple sclerosis (MS). Objective: We presented a machine learning approach leveraging passive sensor data from smartphones and fitness trackers of people with MS to predict their health outcomes in a natural experiment during a state-mandated stay-at-home period due to a global pandemic. Methods: First, we extracted features that capture behavior changes due to the stay-at-home order. Then, we adapted and applied an existing algorithm to these behavior-change features to predict the presence of depression, high global MS symptom burden, severe fatigue, and poor sleep quality during the stay-at-home period. Results: Using data collected between November 2019 and May 2020, the algorithm detected depression with an accuracy of 82.5% (65% improvement over baseline; F1-score: 0.84), high global MS symptom burden with an accuracy of 90% (39% improvement over baseline; F1-score: 0.93), severe fatigue with an accuracy of 75.5% (22% improvement over baseline; F1-score: 0.80), and poor sleep quality with an accuracy of 84% (28% improvement over baseline; F1-score: 0.84). Conclusions: Our approach could help clinicians better triage patients with MS and potentially other chronic neurological disorders for interventions and aid patient self-monitoring in their own environment, particularly during extraordinarily stressful circumstances such as pandemics, which would cause drastic behavior changes. %M 35849686 %R 10.2196/38495 %U https://mental.jmir.org/2022/8/e38495 %U https://doi.org/10.2196/38495 %U http://www.ncbi.nlm.nih.gov/pubmed/35849686 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e38958 %T A Gambling Just-In-Time Adaptive Intervention (GamblingLess: In-The-Moment): Protocol for a Microrandomized Trial %A Dowling,Nicki A %A Merkouris,Stephanie S %A Youssef,George J %A Lubman,Dan I %A Bagot,Kathleen L %A Hawker,Chloe O %A Portogallo,Hannah J %A Thomas,Anna C %A Rodda,Simone N %+ School of Psychology, Deakin University, 1 Gheringhap St, Geelong, 3220, Australia, 61 3 9244 5610, nicki.dowling@deakin.edu.au %K mobile health %K mHealth %K just-in-time adaptive intervention %K ecological momentary intervention %K microrandomized trial %K gambling %K addiction %K treatment %K intervention %K protocol %K relapse %K mobile phone %D 2022 %7 23.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The presence of discrete but fluctuating precipitants, in combination with the dynamic nature of gambling episodes, calls for the development of tailored interventions delivered in real time, such as just-in-time adaptive interventions (JITAIs). JITAIs leverage mobile and wireless technologies to address dynamically changing individual needs by providing the type and amount of support required at the right time and only when needed. They have the added benefit of reaching underserved populations by providing accessible, convenient, and low-burden support. Despite these benefits, few JITAIs targeting gambling behavior are available. Objective: This study aims to redress this gap in service provision by developing and evaluating a theoretically informed and evidence-based JITAI for people who want to reduce their gambling. Delivered via a smartphone app, GamblingLess: In-The-Moment provides tailored cognitive-behavioral and third-wave interventions targeting cognitive processes explicated by the relapse prevention model (cravings, self-efficacy, and positive outcome expectancies). It aims to reduce gambling symptom severity (distal outcome) through short-term reductions in the likelihood of gambling episodes (primary proximal outcome) by improving craving intensity, self-efficacy, or expectancies (secondary proximal outcomes). The primary aim is to explore the degree to which the delivery of a tailored intervention at a time of cognitive vulnerability reduces the probability of a subsequent gambling episode. Methods: GamblingLess: In-The-Moment interventions are delivered to gamblers who are in a state of receptivity (available for treatment) and report a state of cognitive vulnerability via ecological momentary assessments 3 times a day. The JITAI will tailor the type, timing, and amount of support for individual needs. Using a microrandomized trial, a form of sequential factorial design, each eligible participant will be randomized to a tailored intervention condition or no intervention control condition at each ecological momentary assessment across a 28-day period. The microrandomized trial will be supplemented by a 6-month within-group follow-up evaluation to explore long-term effects on primary (gambling symptom severity) and secondary (gambling behavior, craving severity, self-efficacy, and expectancies) outcomes and an acceptability evaluation via postintervention surveys, app use and engagement indices, and semistructured interviews. In all, 200 participants will be recruited from Australia and New Zealand. Results: The project was funded in June 2019, with approval from the Deakin University Human Research Ethics Committee (2020-304). Stakeholder user testing revealed high acceptability scores. The trial began on March 29, 2022, and 84 participants have been recruited (as of June 24, 2022). Results are expected to be published mid-2024. Conclusions: GamblingLess: In-The-Moment forms part of a suite of theoretically informed and evidence-based web-based and mobile gambling interventions. This trial will provide important empirical data that can be used to facilitate the JITAI’s optimization to make it a more effective, efficient, and scalable tailored intervention. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622000490774; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380757&isClinicalTrial=False International Registered Report Identifier (IRRID): PRR1-10.2196/38958 %M 35998018 %R 10.2196/38958 %U https://www.researchprotocols.org/2022/8/e38958 %U https://doi.org/10.2196/38958 %U http://www.ncbi.nlm.nih.gov/pubmed/35998018 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e30581 %T The Impact of a Place-Tailored Digital Health App Promoting Exercise Classes on African American Women’s Physical Activity and Obesity: Simulation Study %A Powell-Wiley,Tiffany M %A Martinez,Marie F %A Tamura,Kosuke %A Neally,Sam J %A O'Shea,Kelly J %A Curlin,Kaveri %A Albarracin,Yardley %A Vijayakumar,Nithya P %A Morgan,Matthew %A Ortiz-Chaparro,Erika %A Bartsch,Sarah M %A Osei Baah,Foster %A Wedlock,Patrick T %A Ortiz-Whittingham,Lola R %A Scannell,Sheryl %A Potharaju,Kameswari A %A Randall,Samuel %A Solano Gonzales,Mario %A Domino,Molly %A Ranganath,Kushi %A Hertenstein,Daniel %A Syed,Rafay %A Weatherwax,Colleen %A Lee,Bruce Y %+ Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, United States, 1 (301) 547 5275, tiffany.powell-wiley@nih.gov %K computational modeling %K digital health %K physical activity %K BMI %K obesity %K built environment %K impact %K app %K exercise %K simulation %K intervention %K women %K African American %K agent %D 2022 %7 22.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The increasing prevalence of smartphone apps to help people find different services raises the question of whether apps to help people find physical activity (PA) locations would help better prevent and control having overweight or obesity. Objective: The aim of this paper is to determine and quantify the potential impact of a digital health intervention for African American women prior to allocating financial resources toward implementation. Methods: We developed our Virtual Population Obesity Prevention, agent-based model of Washington, DC, to simulate the impact of a place-tailored digital health app that provides information about free recreation center classes on PA, BMI, and overweight and obesity prevalence among African American women. Results: When the app is introduced at the beginning of the simulation, with app engagement at 25% (eg, 25% [41,839/167,356] of women aware of the app; 25% [10,460/41,839] of those aware downloading the app; and 25% [2615/10,460] of those who download it receiving regular push notifications), and a 25% (25/100) baseline probability to exercise (eg, without the app), there are no statistically significant increases in PA levels or decreases in BMI or obesity prevalence over 5 years across the population. When 50% (83,678/167,356) of women are aware of the app; 58.23% (48,725/83,678) of those who are aware download it; and 55% (26,799/48,725) of those who download it receive regular push notifications, in line with existing studies on app usage, introducing the app on average increases PA and decreases weight or obesity prevalence, though the changes are not statistically significant. When app engagement increased to 75% (125,517/167,356) of women who were aware, 75% (94,138/125,517) of those who were aware downloading it, and 75% (70,603/94,138) of those who downloaded it opting into the app’s push notifications, there were statistically significant changes in PA participation, minutes of PA and obesity prevalence. Conclusions: Our study shows that a digital health app that helps identify recreation center classes does not result in substantive population-wide health effects at lower levels of app engagement. For the app to result in statistically significant increases in PA and reductions in obesity prevalence over 5 years, there needs to be at least 75% (125,517/167,356) of women aware of the app, 75% (94,138/125,517) of those aware of the app download it, and 75% (70,603/94,138) of those who download it opt into push notifications. Nevertheless, the app cannot fully overcome lack of access to recreation centers; therefore, public health administrators as well as parks and recreation agencies might consider incorporating this type of technology into multilevel interventions that also target the built environment and other social determinants of health. %M 35994313 %R 10.2196/30581 %U https://www.jmir.org/2022/8/e30581 %U https://doi.org/10.2196/30581 %U http://www.ncbi.nlm.nih.gov/pubmed/35994313 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 8 %P e34734 %T Wearables for Measuring the Physical Activity and Sedentary Behavior of Patients With Axial Spondyloarthritis: Systematic Review %A Soulard,Julie %A Carlin,Thomas %A Knitza,Johannes %A Vuillerme,Nicolas %+ Université Grenoble Alpes, AGEIS, Batiment Jean Roget, Faculté de médecine, La Tronche, 38700, France, 33 476637104, juliesoulard.physio@gmail.com %K axial spondyloarthritis %K rheumatology %K physical activity %K sedentary behavior %K objective measures %K wearable %K mobile health %K mHealth %K eHealth %K systematic review %K mobile phone %D 2022 %7 22.8.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Axial spondyloarthritis (axSpA) is an inflammatory rheumatic disease associated with chronic back pain and restricted mobility and physical function. Increasing physical activity is a viable strategy for improving the health and quality of life of patients with axSpA. Thus, quantifying physical activity and sedentary behavior in this population is relevant to clinical outcomes and disease management. However, to the best of our knowledge, no systematic review to date has identified and synthesized the available evidence on the use of wearable devices to objectively measure the physical activity or sedentary behavior of patients with axSpA. Objective: This study aimed to review the literature on the use of wearable activity trackers as outcome measures for physical activity and sedentary behavior in patients with axSpA. Methods: PubMed, PEDro, and Cochrane electronic databases were searched in July 2021 for relevant original articles, with no limits on publication dates. Studies were included if they were original articles, targeted adults with a diagnosis of axSpA, and reported wearable device–measured physical activity or sedentary behavior among patients with axSpA. Data regarding the study’s characteristics, the sample description, the methods used for measuring physical activity and sedentary behavior (eg, wearable devices, assessment methods, and outcomes), and the main results of the physical activity and sedentary behavior assessments were extracted. Results: A total of 31 studies were initially identified; 13 (13/31, 42%) met the inclusion criteria, including 819 patients with axSpA. All the studies used accelerometer-based wearable devices to assess physical activity. Of the 13 studies, 4 (4/31, 31%) studies also reported outcomes related to sedentary behavior. Wearable devices were secured on the wrists (3/13 studies, 23%), lower back (3/13, 23%), right hip (3/13, 23%), waist (2/13, 15%), anterior thigh (1/13, 8%), or right arm (1/13, 8%). The methods for reporting physical activity and sedentary behavior were heterogeneous. Approximately 77% (10/13) of studies had a monitoring period of 1 week, including weekend days. Conclusions: To date, few studies have used wearable devices to quantify the physical activity and sedentary behavior of patients with axSpA. The methodologies and results were heterogeneous, and none of these studies assessed the psychometric properties of these wearables in this specific population. Further investigation in this direction is needed before using wearable device–measured physical activity and sedentary behavior as outcome measures in intervention studies in patients with axSpA. Trial Registration: PROSPERO CRD42020182398; https://tinyurl.com/ec22jzkt International Registered Report Identifier (IRRID): RR2-10.2196/23359 %M 35994315 %R 10.2196/34734 %U https://mhealth.jmir.org/2022/8/e34734 %U https://doi.org/10.2196/34734 %U http://www.ncbi.nlm.nih.gov/pubmed/35994315 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e36912 %T Modification and Validation of an mHealth App Quality Assessment Methodology for International Use: Cross-sectional and eDelphi Studies %A Woulfe,Fionn %A Fadahunsi,Kayode Philip %A O'Grady,Michael %A Chirambo,Griphin Baxter %A Mawkin,Mala %A Majeed,Azeem %A Smith,Simon %A Henn,Patrick %A O'Donoghue,John %+ Department of Primary Care and Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London, W6 8RP, United Kingdom, 44 20 7589 5111, k.fadahunsi14@imperial.ac.uk %K evaluation tool %K mobile health %K mHealth %K smartphone app %K app %K international mHealth %D 2022 %7 19.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Over 325,000 mobile health (mHealth) apps are available to download across various app stores. However, quality assurance in this field of medicine remains relatively undefined. Globally, around 84% of the population have access to mobile broadband networks. Given the potential for mHealth app use in health promotion and disease prevention, their role in patient care worldwide is ever apparent. Quality assurance regulations both nationally and internationally will take time to develop. Frameworks such as the Mobile App Rating Scale and Enlight Suite have demonstrated potential for use in the interim. However, these frameworks require adaptation to be suitable for international use. Objective: This study aims to modify the Enlight Suite, a comprehensive app quality assessment methodology, to improve its applicability internationally and to assess the preliminary validity and reliability of this modified tool in practice. Methods: A two-round Delphi study involving 7 international mHealth experts with varied backgrounds in health, technology, and clinical psychology was conducted to modify the Enlight Suite for international use and to improve its content validity. The Modified Enlight Suite (MES) was then used by 800 health care professionals and health care students in Ireland to assess a COVID-19 tracker app in an online survey. The reliability of the MES was assessed using Cronbach alpha, while the construct validity was evaluated using confirmatory factor analysis. Results: The final version of the MES has 7 sections with 32 evaluating items. Of these items, 5 were novel and based on consensus for inclusion by Delphi panel members. The MES has satisfactory reliability with a Cronbach alpha score of .925. The subscales also demonstrated acceptable internal consistency. Similarly, the confirmatory factor analysis demonstrated a positive and significant factor loading for all 32 items in the MES with a modestly acceptable model fit, thus indicating the construct validity of the MES. Conclusions: The Enlight Suite was modified to improve its international relevance to app quality assessment by introducing new items relating to cultural appropriateness, accessibility, and readability of mHealth app content. This study indicates both the reliability and validity of the MES for assessing the quality of mHealth apps in a high-income country, with further studies being planned to extrapolate these findings to low- and middle-income countries. %M 35984688 %R 10.2196/36912 %U https://formative.jmir.org/2022/8/e36912 %U https://doi.org/10.2196/36912 %U http://www.ncbi.nlm.nih.gov/pubmed/35984688 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e34303 %T mHealth Physical Activity Intervention for Individuals With Spinal Cord Injury: Planning and Development Processes %A Lawrason,Sarah Victoria Clewes %A Brown-Ganzert,Lynda %A Campeau,Lysa %A MacInnes,Megan %A Wilkins,C J %A Martin Ginis,Kathleen Anne %+ School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, 1147 Research Rd, Kelowna, BC, V1V 1V7, Canada, 1 250 807 9187, svcl11@mail.ubc.ca %K exercise %K stakeholder participation %K spinal cord injuries %K telemedicine %K mobile apps %K mobile phone %D 2022 %7 19.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Interventions to support physical activity participation among individuals with spinal cord injury (SCI) are required given this population’s low levels of physical activity and extensive barriers to quality physical activity experiences. Objective: This study aimed to develop a mobile health intervention, called SCI Step Together, to improve the quantity and quality of physical activity among individuals with SCI who walk. Methods: Our overarching methodological framework was the Person-Based approach. This included the following 4 steps: conduct primary and secondary research (step 1); design intervention objectives and features (step 2a); conduct behavioral analysis and theory (step 2b); create a logic model (step 3); and complete the SCI Step Together program content and integrated knowledge translation (IKT; step 4), which occurred throughout development. The partnership approach was informed by the SCI IKT Guiding Principles. Three end users pilot-tested the app and participated in the interviews. Results: Step 1 identified issues to be addressed when designing intervention objectives and features (step 2a) and features were mapped onto the Behavior Change Wheel (step 2b) to determine the behavior change techniques (eg, action planning) to be included in the app. The logic model linked the mechanisms of action to self-determination theory (steps 2/3). Interviews with end users generated recommendations for the technology (eg, comparing physical activity levels with guidelines), trial (eg, emailing participants’ worksheets), and intervention content (eg, removing graded tasks; step 4). Conclusions: Using the SCI IKT Guiding Principles to guide partner engagement and involvement ensured that design partners had shared decision-making power in intervention development. Equal decision-making power maximizes the meaningfulness of the app for end users. Future research will include testing the acceptability, feasibility, and engagement of the program. Partners will be involved throughout the research process. Trial Registration: ClinicalTrials.gov: NCT05063617; https://clinicaltrials.gov/ct2/show/NCT05063617 %M 35984695 %R 10.2196/34303 %U https://formative.jmir.org/2022/8/e34303 %U https://doi.org/10.2196/34303 %U http://www.ncbi.nlm.nih.gov/pubmed/35984695 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e39208 %T Smoking Cessation Smartphone App Use Over Time: Predicting 12-Month Cessation Outcomes in a 2-Arm Randomized Trial %A Bricker,Jonathan B %A Mull,Kristin E %A Santiago-Torres,Margarita %A Miao,Zhen %A Perski,Olga %A Di,Chongzhi %+ Division of Public Health Sciences, Fred Hutch Cancer Center, 1100 Fairview Avenue North, M3-B232, Seattle, WA, 98109, United States, 1 2066675074, jbricker@fredhutch.org %K acceptance and commitment therapy %K ACT %K digital interventions %K eHealth %K engagement %K iCanQuit %K QuitGuide %K mobile health %K mHealth %K smartphone apps %K trajectories %K tobacco %K smoking %K mobile phone %D 2022 %7 18.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Little is known about how individuals engage over time with smartphone app interventions and whether this engagement predicts health outcomes. Objective: In the context of a randomized trial comparing 2 smartphone apps for smoking cessation, this study aimed to determine distinct groups of smartphone app log-in trajectories over a 6-month period, their association with smoking cessation outcomes at 12 months, and baseline user characteristics that predict data-driven trajectory group membership. Methods: Functional clustering of 182 consecutive days of smoothed log-in data from both arms of a large (N=2415) randomized trial of 2 smartphone apps for smoking cessation (iCanQuit and QuitGuide) was used to identify distinct trajectory groups. Logistic regression was used to determine the association of group membership with the primary outcome of 30-day point prevalence of smoking abstinence at 12 months. Finally, the baseline characteristics associated with group membership were examined using logistic and multinomial logistic regression. The analyses were conducted separately for each app. Results: For iCanQuit, participants were clustered into 3 groups: “1-week users” (610/1069, 57.06%), “4-week users” (303/1069, 28.34%), and “26-week users” (156/1069, 14.59%). For smoking cessation rates at the 12-month follow-up, compared with 1-week users, 4-week users had 50% higher odds of cessation (30% vs 23%; odds ratio [OR] 1.50, 95% CI 1.05-2.14; P=.03), whereas 26-week users had 397% higher odds (56% vs 23%; OR 4.97, 95% CI 3.31-7.52; P<.001). For QuitGuide, participants were clustered into 2 groups: “1-week users” (695/1064, 65.32%) and “3-week users” (369/1064, 34.68%). The difference in the odds of being abstinent at 12 months for 3-week users versus 1-week users was minimal (23% vs 21%; OR 1.16, 95% CI 0.84-1.62; P=.37). Different baseline characteristics predicted the trajectory group membership for each app. Conclusions: Patterns of 1-, 3-, and 4-week smartphone app use for smoking cessation may be common in how people engage in digital health interventions. There were significantly higher odds of quitting smoking among 4-week users and especially among 26-week users of the iCanQuit app. To improve study outcomes, strategies for detecting users who disengage early from these interventions (1-week users) and proactively offering them a more intensive intervention could be fruitful. %M 35831180 %R 10.2196/39208 %U https://www.jmir.org/2022/8/e39208 %U https://doi.org/10.2196/39208 %U http://www.ncbi.nlm.nih.gov/pubmed/35831180 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 3 %P e35203 %T A Gender Lens on User Quality Ratings From Young Teenagers Assessing the Sun Safe App: Comparing Responses From Co-researchers and Participants of Pilot Intervention Studies %A Clare,Isabelle M %A Francis,Jacinta %A Gamage,Nisali %A Nguyen,Rebecca %A Gorman,Shelley %+ Telethon Kids Institute, University of Western Australia, Level 7, Perth Children's Hospital, 15 Hospital Drive, Nedlands, Perth, 6052, Australia, 61 8 6319 1747, Shelley.Gorman@telethonkids.org.au %K app development %K co-design %K sun exposure %K sun protection %K teenager %K uMARS %K UV index %K vitamin D %K young adolescents %K sunburn %K adolescent %K smartphone %K gender %K sun %K protection %K app %K engagement %K sunburn %K risk %K melanoma %K decision-making %D 2022 %7 18.8.2022 %9 Research Letter %J JMIR Dermatol %G English %X %M 39475809 %R 10.2196/35203 %U https://derma.jmir.org/2022/3/e35203 %U https://doi.org/10.2196/35203 %U http://www.ncbi.nlm.nih.gov/pubmed/39475809 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e35661 %T Apprentices’ Attitudes Toward Using a Mental Health Mobile App to Support Healthy Coping: Mixed Methods Study %A Choi,Isabella %A Petrie,Katherine %A Einboden,Rochelle %A Collins,Daniel %A Ryan,Rose %A Johnston,David %A Harvey,Samuel B %A Glozier,Nicholas %A Wray,Alexis %A Deady,Mark %+ Central Clinical School, Faculty of Medicine and Health, University of Sydney, Level 5 Professor Marie Bashir Centre, Missenden Road, Camperdown, Sydney, 2050, Australia, 61 0286277240, isabella.choi@sydney.edu.au %K apprentice %K coping strategies %K mental health %K app %K wellbeing %K focus group %K coping behaviour %D 2022 %7 18.8.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Apprenticeships are a common pathway for young people transitioning into the workforce. Apprentices often face many employment-related challenges and have high levels of psychological distress, drug and alcohol use, and suicidal ideation. Little is known about the attitudes of apprentices toward using smartphone apps to support their mental health and the content that would engage them. Objective: This study explored (1) apprentices’ interest in using an app to support their mental health and (2) the healthy coping strategies used to manage their mental well-being in the face of workplace challenges, in order to inform future app content. Methods: A mixed methods study was conducted with 54 apprentices (50/54 male, 93%) with a mean age of 22.7 (SD 5.7) years. Participants completed a survey on preferred ways of using an app to support mental health. Across 8 focus groups, participants were asked to describe healthy strategies they used to cope with occupational stressors. Results: Only 11% (6/54) of participants currently used a well-being app, but there was high interest in using an app to support their friends (47/54 participants, 87%) and develop self-help strategies to manage or prevent mental health issues (42/54 participants, 78%). Four major types of coping behaviors were identified: (1) social connection for disclosure, advice, and socializing; (2) pleasurable activities, such as engaging in hobbies, time-outs, and developing work-life separation; (3) cognitive approaches, including defusing from thoughts and cognitive reframing; and (4) self-care approaches, including exercise, a healthy diet, and getting adequate sleep. Conclusions: There is interest among apprentices to use an app with a positive well-being focus that helps them to develop self-management skills and support their friends. Apprentices utilized a range of healthy behaviors to cope with workplace stressors that can be incorporated into mental health apps to improve uptake and engagement. However, many of the preferred coping strategies identified are not those focused on by currently available apps, indicating the need for more targeted digital interventions for this group. %M 35980733 %R 10.2196/35661 %U https://humanfactors.jmir.org/2022/3/e35661 %U https://doi.org/10.2196/35661 %U http://www.ncbi.nlm.nih.gov/pubmed/35980733 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e37309 %T Evaluation of a Text Messaging Intervention to Promote Preconception Micronutrient Supplement Use: Feasibility Study Nested in the Healthy Life Trajectories Initiative Study in South Africa %A Soepnel,Larske M %A McKinley,Michelle C %A Klingberg,Sonja %A Draper,Catherine E %A Prioreschi,Alessandra %A Norris,Shane A %A Ware,Lisa J %+ SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Private Bag X3, Wits, Johannesburg, 2050, South Africa, 27 010 447 3721, larske.soepnel@gmail.com %K preconception health %K micronutrient supplements %K adherence %K behavioral %K SMS text messaging intervention %K mobile health %K mHealth %K radio serial %K mobile phone %D 2022 %7 18.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Social messaging strategies such as SMS text messaging and radio are promising avenues for health promotion and behavior change in low- to middle-income settings. However, evidence of their acceptability, feasibility, and impact in the context of young women’s health and micronutrient deficiencies is lacking. Objective: This study aimed to evaluate the feasibility of an automated 2-way text messaging intervention nested in an ongoing preconception health trial, the Healthy Life Trajectories Initiative (HeLTI; HeLTI Bukhali) in Soweto, South Africa. Second, we aimed to evaluate the acceptability of a health promotion radio serial, which aired concurrently in the region. Methods: In this feasibility study, 120 participants enrolled in HeLTI Bukhali between November 2020 and February 2021 received the 6-month 2-way text messaging intervention. Quantitative and qualitative data on intervention acceptability, usability, interaction, perceived benefit, and fidelity were collected during 5 focus group discussions (FGDs) and from study data logs. During the FGDs, data were collected on the acceptability of the radio serial. Following the text messaging intervention, capillary hemoglobin levels were assessed, and a participant questionnaire provided information on adherence and attitudes toward supplements. The text messaging control group comprised the first 120 women recruited from November 2019 to February 2020, who received the Bukhali intervention but not the text messages. Statistical significance testing and a linear mixed model were used for indicative effect comparisons between the text message–receiving and control groups. Results: The text messaging intervention was found to be acceptable and to have perceived benefits, including being reminded to take supplements, gaining knowledge, and feeling supported by the study team. The use of the 2-way text messaging reply function was limited, with only a 10.8% (13/120) response rate by week 24. Barriers to replying included a lack of interest or phone credit and technical issues. Regarding the indicative effect, participants receiving the text messages had higher self-reported adherence at follow-up than the text messaging control group (42/63, 67% vs 33/85, 39% taking supplements every time; P=.02), and altitude-adjusted hemoglobin increased more between baseline and follow-up in the SMS text message–receiving group than in the text messaging control group (1.03, 95% CI 0.49-1.57; P<.001). The radio serial content was acceptable, although few participants reported exposure before the FGD. Conclusions: Women reported that the text messaging intervention was useful and described the benefits of receiving the messages. Examination of hemoglobin status indicated a promising beneficial effect of text messaging support on adherence to micronutrient supplementation, requiring further exploration through randomized controlled studies. Health promotion through radio and text messages were both found to be acceptable, although more research into the radio serial reach among young women is needed. Trial Registration: Pan African Clinical Trials Registry (PACTR) PACTR201903750173871; https://tinyurl.com/4x6n32ff %M 35980731 %R 10.2196/37309 %U https://formative.jmir.org/2022/8/e37309 %U https://doi.org/10.2196/37309 %U http://www.ncbi.nlm.nih.gov/pubmed/35980731 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 3 %P e38367 %T A Digital Educational Intervention With Wearable Activity Trackers to Support Health Behaviors Among Childhood Cancer Survivors: Pilot Feasibility and Acceptability Study %A Ha,Lauren %A Wakefield,Claire E %A Mizrahi,David %A Diaz,Claudio %A Cohn,Richard J %A Signorelli,Christina %A Yacef,Kalina %A Simar,David %+ School of Health Sciences, UNSW Medicine and Health, UNSW Sydney, High St, Sydney, 2052, Australia, 61 9385 1000, lauren.ha@unsw.edu.au %K childhood cancer %K survivorship %K physical activity %K exercise %K activity tracker %K eHealth %K education %K behavior change %D 2022 %7 17.8.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Childhood cancer survivors are at increased risk of cardiometabolic complications that are exacerbated by poor health behaviors. Critically, many survivors do not meet physical activity guidelines. Objective: The primary aim was to evaluate the feasibility and acceptability of iBounce, a digital health intervention for educating and engaging survivors in physical activity. Our secondary aims were to assess the change in survivors’ physical activity levels and behaviors, aerobic fitness, and health-related quality of life (HRQoL) after participating in the iBounce program. Methods: We recruited survivors aged 8 to 13 years who were ≥12 months post cancer treatment completion. The app-based program involved 10 educational modules, goal setting, and home-based physical activities monitored using an activity tracker. We assessed objective physical activity levels and behaviors using cluster analysis, aerobic fitness, and HRQoL at baseline and after the intervention (week 12). Parents were trained to reassess aerobic fitness at home at follow-up (week 24). Results: In total, 30 participants opted in, of whom 27 (90%) completed baseline assessments, and 23 (77%) commenced iBounce. Our opt-in rate was 59% (30/51), and most (19/23, 83%) of the survivors completed the intervention. More than half (13/23, 57%) of the survivors completed all 10 modules (median 10, IQR 4-10). We achieved a high retention rate (19/27, 70%) and activity tracker compliance (15/19, 79%), and there were no intervention-related adverse events. Survivors reported high satisfaction with iBounce (median enjoyment score 75%; ease-of-use score 86%), but lower satisfaction with the activity tracker (median enjoyment score 60%). Parents reported the program activities to be acceptable (median score 70%), and their overall satisfaction was 60%, potentially because of technological difficulties that resulted in the program becoming disjointed. We did not observe any significant changes in physical activity levels or HRQoL at week 12. Our subgroup analysis for changes in physical activity behaviors in participants (n=11) revealed five cluster groups: most active, active, moderately active, occasionally active, and least active. Of these 11 survivors, 3 (27%) moved to a more active cluster group, highlighting their engagement in more frequent and sustained bouts of moderate-to-vigorous physical activity; 6 (56%) stayed in the same cluster; and 2 (18%) moved to a less active cluster. The survivors’ mean aerobic fitness percentiles increased after completing iBounce (change +17, 95% CI 1.7-32.1; P=.03) but not at follow-up (P=.39). Conclusions: We demonstrated iBounce to be feasible for delivery and acceptable among survivors, despite some technical difficulties. The distance-delivered format provides an opportunity to engage survivors in physical activity at home and may address barriers to care, particularly for regional or remote families. We will use these pilot findings to evaluate an updated version of iBounce. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000259842; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=ACTRN12621000259842 %M 35976683 %R 10.2196/38367 %U https://cancer.jmir.org/2022/3/e38367 %U https://doi.org/10.2196/38367 %U http://www.ncbi.nlm.nih.gov/pubmed/35976683 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 8 %P e33545 %T Operationalizing Engagement With an Interpretation Bias Smartphone App Intervention: Case Series %A Ramadurai,Ramya %A Beckham,Erin %A McHugh,R Kathryn %A Björgvinsson,Thröstur %A Beard,Courtney %+ Department of Psychology, American University, 4400 Massachusetts Avenue NW, Washington, DC, 20016, United States, 1 202 885 8000, rr4748a@student.american.edu %K engagement %K mental health apps %K cognitive bias modification %K human support %K mobile health %K mHealth %K mobile phone %D 2022 %7 17.8.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Engagement with mental health smartphone apps is an understudied but critical construct to understand in the pursuit of improved efficacy. Objective: This study aimed to examine engagement as a multidimensional construct for a novel app called HabitWorks. HabitWorks delivers a personalized interpretation bias intervention and includes various strategies to enhance engagement such as human support, personalization, and self-monitoring. Methods: We examined app use in a pilot study (n=31) and identified 5 patterns of behavioral engagement: consistently low, drop-off, adherent, high diary, and superuser. Results: We present a series of cases (5/31, 16%) from this trial to illustrate the patterns of behavioral engagement and cognitive and affective engagement for each case. With rich participant-level data, we emphasize the diverse engagement patterns and the necessity of studying engagement as a heterogeneous and multifaceted construct. Conclusions: Our thorough idiographic exploration of engagement with HabitWorks provides an example of how to operationalize engagement for other mental health apps. %M 35976196 %R 10.2196/33545 %U https://mental.jmir.org/2022/8/e33545 %U https://doi.org/10.2196/33545 %U http://www.ncbi.nlm.nih.gov/pubmed/35976196 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 8 %P e35261 %T Mediators of Effects on Physical Activity and Sedentary Time in an Activity Tracker and Behavior Change Intervention for Adolescents: Secondary Analysis of a Cluster Randomized Controlled Trial %A Verswijveren,Simone Johanna Josefa Maria %A Abbott,Gavin %A Lai,Samuel K %A Salmon,Jo %A Timperio,Anna %A Brown,Helen %A Macfarlane,Susie %A Ridgers,Nicola D %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, 3125, Australia, 61 03 9244 6100, s.verswijveren@deakin.edu.au %K movement behavior %K youth %K accelerometry %K Fitbit %K correlates %K correlate %K physical activity %K exercise %K randomized controlled trial %K RCT %K control trial %K Australia %K adolescent %K adolescence %K teenager %K sedentary %K cognitive theory %K behavioral theory %K wearable %K tracker %K tracking device %K clinical trial %D 2022 %7 16.8.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adolescence is a critical age where steep declines in physical activity and increases in sedentary time occur. Promoting physical activity should therefore be a priority for short- and long-term health benefits. Wearable activity trackers in combination with supportive resources have the potential to influence adolescents’ physical activity levels and sedentary behavior. Examining the pathways through which such interventions work can inform which mediators to target in future studies. Objective: The aim of this paper is to examine the impact of the Raising Awareness of Physical Activity (RAW-PA) intervention on potential mediators of behavior change after intervention, and whether these mediated the intervention effects on physical activity and sedentary time at 6-month follow-up. Methods: RAW-PA was a 12-week intervention, grounded in social cognitive theory and behavioral choice theory, aimed at increasing physical activity among inactive adolescents through combining a wearable activity tracker with digital resources delivered via a private Facebook group (n=159 complete cases). The targeted potential mediators were identified from previous studies conducted in adolescents and included self-efficacy, peer support, family support, teacher support, self-regulation strategies, barriers, and enjoyment. Outcomes included sedentary time as well as light- and moderate-to-vigorous–intensity physical activity. A series of mixed linear models were used to estimate intervention effects on physical activity and sedentary behavior at follow-up and on potential mediators after intervention and to test whether there were indirect effects of the intervention on physical activity and sedentary behavior via mediators. Results: Adolescents in the intervention group (n=75) engaged in higher sedentary time and lower light intensity at 6-month follow-up compared to the wait-list controls (n=84). There were no intervention effects for moderate-to-vigorous–intensity physical activity. The intervention group perceived more barriers to physical activity than the wait-list control group at 6-month follow-up (mean adjusted difference=1.77; 95% CI 0.19-3.34; P=.03). However, indirect effects for each outcome were not statistically significant, indicating that perceived barriers to physical activity did not mediate intervention effects for physical activity or sedentary time. Conclusions: RAW-PA did not beneficially impact hypothesized mediators in these inactive adolescents, despite strategies being designed to target them. This suggests that the lack of overall intervention effects on physical activity and sedentary time observed in the RAW-PA study could be due to the limited impact of the intervention on the targeted mediators. Future studies should consider different strategies to target theoretically informed potential mediators and identify intervention strategies that effectively target key mediators to improve physical activity among inactive adolescents. Finally, intervention effects according to level of wearable tracker use or level of engagement with the intervention should be explored. This may provide important insights for designing successful wearable activity tracker interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000899448; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370716&isReview=true International Registered Report Identifier (IRRID): RR2-10.1186/s12889-016-3945-5 %M 35972777 %R 10.2196/35261 %U https://mhealth.jmir.org/2022/8/e35261 %U https://doi.org/10.2196/35261 %U http://www.ncbi.nlm.nih.gov/pubmed/35972777 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e39186 %T Breathing as an Input Modality in a Gameful Breathing Training App (Breeze 2): Development and Evaluation Study %A Lukic,Yanick Xavier %A Teepe,Gisbert Wilhelm %A Fleisch,Elgar %A Kowatsch,Tobias %+ Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Weinbergstrasse 56/58, Zurich, , Switzerland, 41 446328638, ylukic@ethz.ch %K breathing training %K serious game %K biofeedback %K digital health %K mobile health %K mHealth %K mobile phone %K machine learning %K deep learning %K transfer learning %K neural networks %D 2022 %7 16.8.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Slow-paced breathing training can have positive effects on physiological and psychological well-being. Unfortunately, use statistics indicate that adherence to breathing training apps is low. Recent work suggests that gameful breathing training may help overcome this challenge. Objective: This study aimed to introduce and evaluate the gameful breathing training app Breeze 2 and its novel real-time breathing detection algorithm that enables the interactive components of the app. Methods: We developed the breathing detection algorithm by using deep transfer learning to detect inhalation, exhalation, and nonbreathing sounds (including silence). An additional heuristic prolongs detected exhalations to stabilize the algorithm’s predictions. We evaluated Breeze 2 with 30 participants (women: n=14, 47%; age: mean 29.77, SD 7.33 years). Participants performed breathing training with Breeze 2 in 2 sessions with and without headphones. They answered questions regarding user engagement (User Engagement Scale Short Form [UES-SF]), perceived effectiveness (PE), perceived relaxation effectiveness, and perceived breathing detection accuracy. We used Wilcoxon signed-rank tests to compare the UES-SF, PE, and perceived relaxation effectiveness scores with neutral scores. Furthermore, we correlated perceived breathing detection accuracy with actual multi-class balanced accuracy to determine whether participants could perceive the actual breathing detection performance. We also conducted a repeated-measure ANOVA to investigate breathing detection differences in balanced accuracy with and without the heuristic and when classifying data captured from headphones and smartphone microphones. The analysis controlled for potential between-subject effects of the participants’ sex. Results: Our results show scores that were significantly higher than neutral scores for the UES-SF (W=459; P<.001), PE (W=465; P<.001), and perceived relaxation effectiveness (W=358; P<.001). Perceived breathing detection accuracy correlated significantly with the actual multi-class balanced accuracy (r=0.51; P<.001). Furthermore, we found that the heuristic significantly improved the breathing detection balanced accuracy (F1,25=6.23; P=.02) and that detection performed better on data captured from smartphone microphones than than on data from headphones (F1,25=17.61; P<.001). We did not observe any significant between-subject effects of sex. Breathing detection without the heuristic reached a multi-class balanced accuracy of 74% on the collected audio recordings. Conclusions: Most participants (28/30, 93%) perceived Breeze 2 as engaging and effective. Furthermore, breathing detection worked well for most participants, as indicated by the perceived detection accuracy and actual detection accuracy. In future work, we aim to use the collected breathing sounds to improve breathing detection with regard to its stability and performance. We also plan to use Breeze 2 as an intervention tool in various studies targeting the prevention and management of noncommunicable diseases. %M 35972793 %R 10.2196/39186 %U https://games.jmir.org/2022/3/e39186 %U https://doi.org/10.2196/39186 %U http://www.ncbi.nlm.nih.gov/pubmed/35972793 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e36872 %T App-Based Evaluation of Older People’s Fall Risk Using the mHealth App Lindera Mobility Analysis: Exploratory Study %A Strutz,Nicole %A Brodowski,Hanna %A Kiselev,Joern %A Heimann-Steinert,Anika %A Müller-Werdan,Ursula %+ Geriatrics Research Group, Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin), Reinickendorfer Straße 61, Berlin, 13407, Germany, 49 030 450 553369, nicole.strutz@charite.de %K mobility %K fall risk %K smartphone %K app %K analysis %K older people %K accuracy %K mobility restriction %D 2022 %7 16.8.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Falls and the risk of falling in older people pose a high risk for losing independence. As the risk of falling progresses over time, it is often not adequately diagnosed due to the long intervals between contacts with health care professionals. This leads to the risk of falling being not properly detected until the first fall. App-based software able to screen fall risks of older adults and to monitor the progress and presence of fall risk factors could detect a developing fall risk at an early stage prior to the first fall. As smartphones become more common in the elderly population, this approach is easily available and feasible. Objective: The aim of the study is to evaluate the app Lindera Mobility Analysis (LIN). The reference standards determined the risk of falling and validated functional assessments of mobility. Methods: The LIN app was utilized in home- and community-dwelling older adults aged 65 years or more. The Berg Balance Scale (BBS), the Tinetti Test (TIN), and the Timed Up & Go Test (TUG) were used as reference standards. In addition to descriptive statistics, data correlation and the comparison of the mean difference of analog measures (reference standards) and digital measures were tested. Spearman rank correlation analysis was performed and Bland-Altman (B-A) plots drawn. Results: Data of 42 participants could be obtained (n=25, 59.5%, women). There was a significant correlation between the LIN app and the BBS (r=–0.587, P<.001), TUG (r=0.474, P=.002), and TIN (r=–0.464, P=.002). B-A plots showed only few data points outside the predefined limits of agreement (LOA) when combining functional tests and results of LIN. Conclusions: The digital app LIN has the potential to detect the risk of falling in older people. Further steps in establishing the validity of the LIN app should include its clinical applicability. Trial Registration: German Clinical Trials Register DRKS00025352; https://tinyurl.com/65awrd6a %M 35972785 %R 10.2196/36872 %U https://aging.jmir.org/2022/3/e36872 %U https://doi.org/10.2196/36872 %U http://www.ncbi.nlm.nih.gov/pubmed/35972785 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 8 %P e38934 %T Clinical Targets and Attitudes Toward Implementing Digital Health Tools for Remote Measurement in Treatment for Depression: Focus Groups With Patients and Clinicians %A de Angel,Valeria %A Lewis,Serena %A White,Katie M %A Matcham,Faith %A Hotopf,Matthew %+ Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, E3.08, 3rd floor East Wing, 16 De Crespigny Park, London, SE5 8AF , United Kingdom, 44 7415838882, valeria.de_angel@kcl.ac.uk %K depression %K digital health tools %K implementation %K qualitative %K wearable devices %K smartphone %K passive sensing %K sensor data %K mobile health %K mHealth %K mood disorders %K digital phenotyping %K mobile phone %D 2022 %7 15.8.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Remote measurement technologies, such as smartphones and wearable devices, can improve treatment outcomes for depression through enhanced illness characterization and monitoring. However, little is known about digital outcomes that are clinically meaningful to patients and clinicians. Moreover, if these technologies are to be successfully implemented within treatment, stakeholders’ views on the barriers to and facilitators of their implementation in treatment must be considered. Objective: This study aims to identify clinically meaningful targets for digital health research in depression and explore attitudes toward their implementation in psychological services. Methods: A grounded theory approach was used on qualitative data from 3 focus groups of patients with a current diagnosis of depression and clinicians with >6 months of experience with delivering psychotherapy (N=22). Results: Emerging themes on clinical targets fell into the following two main categories: promoters and markers of change. The former are behaviors that participants engage in to promote mental health, and the latter signal a change in mood. These themes were further subdivided into external changes (changes in behavior) or internal changes (changes in thoughts or feelings) and mapped with potential digital sensors. The following six implementation acceptability themes emerged: technology-related factors, information and data management, emotional support, cognitive support, increased self-awareness, and clinical utility. Conclusions: The promoters versus markers of change differentiation have implications for a causal model of digital phenotyping in depression, which this paper presents. Internal versus external subdivisions are helpful in determining which factors are more susceptible to being measured by using active versus passive methods. The implications for implementation within psychotherapy are discussed with regard to treatment effectiveness, service provision, and patient and clinician experience. %M 35969448 %R 10.2196/38934 %U https://mental.jmir.org/2022/8/e38934 %U https://doi.org/10.2196/38934 %U http://www.ncbi.nlm.nih.gov/pubmed/35969448 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e32768 %T Exploring Factors Associated With Mobile Phone Behaviors and Attitudes Toward Technology Among Adults With Alcohol Use Disorder and Implications for mHealth Interventions: Exploratory Study %A Sillice,Marie Aline %A Stein,Michael %A Battle,Cynthia L %A Meshesha,Lidia Z %A Lindsay,Clifford %A Agu,Emmanuel %A Abrantes,Ana M %+ City University of New York School of Public Health & Health Policies, Center for Systems and Community Design, 55 W 125th St, New York, NY, 10027, United States, 1 646 364 0281, marie.sillice@sph.cuny.edu %K mobile phone use patterns %K substance use %K alcohol %K technological attitude %K alcohol use disorder %K demographic differences %K anxiety %K depression %K mobile phone %K patient attitude %D 2022 %7 15.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use disorder (AUD) is associated with severe chronic medical conditions and premature mortality. Expanding the reach or access to effective evidence-based treatments to help persons with AUD is a public health objective. Mobile phone or smartphone technology has the potential to increase the dissemination of clinical and behavioral interventions (mobile health interventions) that increase the initiation and maintenance of sobriety among individuals with AUD. Studies about how this group uses their mobile phone and their attitudes toward technology may have meaningful implications for participant engagement with these interventions. Objective: This exploratory study examined the potential relationships among demographic characteristics (race, gender, age, marital status, and income), substance use characteristics (frequency of alcohol and cannabis use), and clinical variables (anxiety and depression symptoms) with indicators of mobile phone use behaviors and attitudes toward technology. Methods: A sample of 71 adults with AUD (mean age 42.9, SD 10.9 years) engaged in an alcohol partial hospitalization program completed 4 subscales from the Media Technology Usage and Attitudes assessment: Smartphone Usage measures various mobile phone behaviors and activities, Positive Attitudes and Negative Attitudes measure attitudes toward technology, and the Technological Anxiety/Dependence measure assesses level of anxiety when individuals are separated from their phone and dependence on this device. Participants also provided demographic information and completed the Epidemiologic Studies Depression Scale (CES-D) and the Generalized Anxiety Disorder (GAD-7) scale. Lastly, participants reported their frequency of alcohol use over the past 3 months using the Drug Use Frequency Scale. Results: Results for the demographic factors showed a significant main effect for age, Smartphone Usage (P=.003; ηp2=0.14), and Positive Attitudes (P=.01; ηp2=0.07). Marital status (P=.03; ηp2=0.13) and income (P=.03; ηp2=0.14) were associated only with the Technological Anxiety and Dependence subscale. Moreover, a significant trend was found for alcohol use and the Technological Anxiety/Dependence subscale (P=.06; R2=0.02). Lastly, CES-D scores (P=.03; R2=0.08) and GAD symptoms (P=.004; R2=0.13) were significant predictors only of the Technological Anxiety/Dependence subscale. Conclusions: Findings indicate differences in mobile phone use patterns and attitudes toward technology across demographic, substance use, and clinical measures among patients with AUD. These results may help inform the development of future mHealth interventions among this population. %M 35969449 %R 10.2196/32768 %U https://formative.jmir.org/2022/8/e32768 %U https://doi.org/10.2196/32768 %U http://www.ncbi.nlm.nih.gov/pubmed/35969449 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e37163 %T Delivering an mHealth Adherence Support Intervention for Patients With HIV: Mixed Methods Process Evaluation of the Philippines Connect for Life Study %A O'Connor,Cara %A Leyritana,Katerina %A Doyle,Aoife M %A Birdthistle,Isolde %A Lewis,James J %A Gill,Randeep %A Salvaña,Edsel Maurice %+ Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 791336248, caraoc@gmail.com %K mobile health %K mHealth %K adherence %K HIV %K antiretroviral therapy %K process evaluation %K Philippines %K men who have sex with men %K MSM %K mobile phone %D 2022 %7 12.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Philippines HIV epidemic is one of the fastest growing epidemics globally, and infections among men who have sex with men are increasing at an alarming rate. Connect for Life Philippines is a mobile health (mHealth) intervention that supports antiretroviral therapy (ART) adherence in this key population through individualized voice calls and SMS text messages. Objective: The objective of this process evaluation is to assess the intervention reach, dose delivered and received, fidelity, and acceptability and to describe contextual factors affecting the implementation of an mHealth adherence support intervention for patients on ART in a clinic in Metro Manila, Philippines. Methods: A mixed methods process evaluation approach was used in an observational cohort study. Quantitative data sources for the process evaluation were call and SMS text message logs obtained from the mHealth platform and questionnaires collected at 12-, 24-, and 48-week study visits. Qualitative data were collected from process reports and through a series of focus group discussions conducted with a subset of participants during the intervention development phase, after an initial 8-week pilot phase, and at the end of the study. Results: The 462 study participants received 31,095 interactive voice calls and 8234 SMS text messages during the study. Owing to technical issues, intervention fidelity was low, with only 22.1% (102/462) of the participants receiving reminders via voice calls and others (360/462, 77.9%) receiving only SMS text messages during the intervention. After 48 weeks in the study, 63.5% (293/462) of the participants reported that they would be quite likely or very likely to recommend the program to a friend, and 53.8% (249/462) of the participants reported that they benefited quite a bit or very much from the intervention. Participants who were on ART for <6 months at the beginning of the study and those who received the daily or weekly pill reminders were more likely to report that they benefited from the intervention (P=.02 and P=.01, respectively). Conclusions: The Connect for Life intervention had high participant satisfaction and acceptability, especially among those who received high dose of the intervention. However, poor reliability of local telecommunication networks had a large impact on the intervention’s usability, fidelity, and dose received. %M 35969425 %R 10.2196/37163 %U https://formative.jmir.org/2022/8/e37163 %U https://doi.org/10.2196/37163 %U http://www.ncbi.nlm.nih.gov/pubmed/35969425 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e37541 %T A 2.5-Year Weight Management Program Using Noom Health: Protocol for a Randomized Controlled Trial %A Sysko,Robyn %A Bibeau,Jessica %A Boyar,Allison %A Costello,Kayla %A Michaelides,Andreas %A Mitchell,Ellen Siobhan %A Susanin,Annabel %A Hildebrandt,Tom %+ Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, Box 1230, New York, NY, 10029, United States, 1 212 659 8724, robyn.sysko@mssm.edu %K weight loss %K weight loss maintenance %K digital health %K Noom %K Diabetes Prevention Program %K DPP %K mobile phone %D 2022 %7 12.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Overweight and obesity are serious public health concerns. As the prevalence of excess weight among individuals continues to increase, there is a parallel need for inexpensive, highly accessible, and evidence-based weight loss programs. Objective: This weight loss trial will aim to examine the efficacy of the Noom weight loss program in comparison to a digital control after a 6-month intervention phase and a 24-month maintenance phase, with assessments continuing for 2 years beyond the intervention (to 30 months—after the baseline). The secondary outcomes include quality of life, psychosocial functioning, sleep quality, physical activity, diet, and health status. This trial will also examine the severity of obesity-related functional impairment, weight loss history, and demographic moderators, along with adherence and self-efficacy as mediators of the outcome. Methods: A total of 600 participants were randomized in a parallel-group, controlled trial to either Noom Healthy Weight Program (intervention) or Noom Healthy Weight Control (control) for a 6-month intervention. Both intervention and control groups include diet and exercise recommendations, educational content, daily logging capabilities, and daily weigh-in entries. The Noom Healthy Weight Program also includes a coach support for weight loss. Remote follow-up assessments of eating, physical activity, psychosocial factors, app use data, and weight will be conducted at 1, 4, 6, 12, 18, 24, and 30 months after baseline. Weight is measured at each follow-up point during a Zoom call using the participants’ scales. Results: Enrollment began in March 2021 and the 6-month intervention phase ended in March 2022. Data collection for the final assessment will be completed in March 2024. Conclusions: This study tests commercially available digital lifestyle interventions for individuals with overweight and obesity seeking weight loss support. Data obtained from the study will evaluate whether the Noom Healthy Weight Control Program can help individuals overcome weight loss, achieve long-term maintenance, adhere to lifestyle changes, and feature use barriers that are present in other traditional weight loss treatments. Trial Registration: ClinicalTrials.gov NCT04797169; https://clinicaltrials.gov/ct2/show/NCT04797169 International Registered Report Identifier (IRRID): DERR1-10.2196/37541 %M 35969439 %R 10.2196/37541 %U https://www.researchprotocols.org/2022/8/e37541 %U https://doi.org/10.2196/37541 %U http://www.ncbi.nlm.nih.gov/pubmed/35969439 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e35283 %T Technology-Delivered Adaptations of Motivational Interviewing for the Prevention and Management of Chronic Diseases: Scoping Review %A Pedamallu,Havisha %A Ehrhardt,Matthew J %A Maki,Julia %A Carcone,April Idalski %A Hudson,Melissa M %A Waters,Erika A %+ Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, School of Medicine, 600 S Euclid Ave, Campus Box 8100, St Louis, MO, 63110, United States, 1 314 747 5705, waterse@wustl.edu %K motivational interviewing %K technology %K telehealth %K health behavior %K chronic disease %K socioeconomic factors %K health promotion %K disease management %K primary prevention %K secondary prevention %K minority health %D 2022 %7 9.8.2022 %9 Review %J J Med Internet Res %G English %X Background: Motivational interviewing (MI) can increase health-promoting behaviors and decrease health-damaging behaviors. However, MI is often resource intensive, precluding its use with people with limited financial or time resources. Mobile health–based versions of MI interventions or technology-delivered adaptations of MI (TAMIs) might increase reach. Objective: We aimed to understand the characteristics of existing TAMIs. We were particularly interested in the inclusion of people from marginalized sociodemographic groups, whether the TAMI addressed sociocontextual factors, and how behavioral and health outcomes were reported. Methods: We employed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews to conduct our scoping review. We searched PubMed, CINAHL, and PsycInfo from January 1, 1996, to April 6, 2022, to identify studies that described interventions incorporating MI into a mobile or electronic health platform. For inclusion, the study was required to (1) describe methods/outcomes of an MI intervention, (2) feature an intervention delivered automatically via a mobile or electronic health platform, and (3) report a behavioral or health outcome. The exclusion criteria were (1) publication in a language other than English and (2) description of only in-person intervention delivery (ie, no TAMI). We charted results using Excel (Microsoft Corp). Results: Thirty-four studies reported the use of TAMIs. Sample sizes ranged from 10 to 2069 participants aged 13 to 70 years. Most studies (n=27) directed interventions toward individuals engaging in behaviors that increased chronic disease risk. Most studies (n=22) oversampled individuals from marginalized sociodemographic groups, but few (n=3) were designed specifically with marginalized groups in mind. TAMIs used text messaging (n=8), web-based intervention (n=22), app + text messaging (n=1), and web-based intervention + text messaging (n=3) as delivery platforms. Of the 34 studies, 30 (88%) were randomized controlled trials reporting behavioral and health-related outcomes, 23 of which reported statistically significant improvements in targeted behaviors with TAMI use. TAMIs improved targeted health behaviors in the remaining 4 studies. Moreover, 11 (32%) studies assessed TAMI feasibility, acceptability, or satisfaction, and all rated TAMIs highly in this regard. Among 20 studies with a disproportionately high number of people from marginalized racial or ethnic groups compared with the general US population, 16 (80%) reported increased engagement in health behaviors or better health outcomes. However, no TAMIs included elements that addressed sociocontextual influences on behavior or health outcomes. Conclusions: Our findings suggest that TAMIs may improve some health promotion and disease management behaviors. However, few TAMIs were designed specifically for people from marginalized sociodemographic groups, and none included elements to help address sociocontextual challenges. Research is needed to determine how TAMIs affect individual health outcomes and how to incorporate elements that address sociocontextual factors, and to identify the best practices for implementing TAMIs into clinical practice. %M 35943775 %R 10.2196/35283 %U https://www.jmir.org/2022/8/e35283 %U https://doi.org/10.2196/35283 %U http://www.ncbi.nlm.nih.gov/pubmed/35943775 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 8 %P e39516 %T The Effect of Mental Health App Customization on Depressive Symptoms in College Students: Randomized Controlled Trial %A Six,Stephanie G %A Byrne,Kaileigh A %A Aly,Heba %A Harris,Maggie W %+ Department of Psychology, Clemson University, 418 Brackett Hall, Clemson University, Clemson, SC, 29634-0001, United States, 1 864 656 3935, kaileib@clemson.edu %K depression %K mental health apps %K customization %K personalization %K cognitive behavioral therapy %K avatars %K mobile phone %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health apps have shown promise in improving mental health symptoms, including depressive symptoms. However, limited research has been aimed at understanding how specific app features and designs can optimize the therapeutic benefits and adherence to such mental health apps. Objective: The primary purpose of this study is to investigate the effect of avatar customization on depressive symptoms and adherence to use a novel cognitive behavioral therapy (CBT)–based mental health app. The secondary aim is to examine whether specific app features, including journaling, mood tracking, and reminders, affect the usability of the mental health app. Methods: College students were recruited from a university study recruitment pool website and via flyer advertisements throughout campus. A total of 94 participants completed a randomized controlled trial in which they were randomized to either customization or no customization version of the app. Customization involved personalizing a virtual avatar and a travel vehicle to one’s own preferences and use of one’s name throughout the app. Participants completed a 14-day trial using a novel CBT-based mental health app called AirHeart. Self-report scores for depressive symptoms, anxiety, and stress were measured at baseline and after the intervention. Postintervention survey measures also included usability and avatar identification questionnaires. Results: Of the 94 enrolled participants, 83 (88%) completed the intervention and postintervention assessments. AirHeart app use significantly reduced symptoms of depression (P=.006) from baseline to the end of the 2-week intervention period for all participants, regardless of the customization condition. However, no differences in depressive symptoms (P=.17) or adherence (P=.80) were observed between the customization (39/83, 47%) and no customization (44/83, 53%) conditions. The frequency of journaling, usefulness of mood tracking, and helpfulness of reminders were not associated with changes in depressive symptoms or adherence (P>.05). Exploratory analyses showed that there were 3 moderate positive correlations between avatar identification and depressive symptoms (identification: r=−0.312, P=.02; connection: r=−0.305, P=.02; and lack of relatability: r=0.338, P=.01). Conclusions: These results indicate that CBT mental health apps, such as AirHeart, have the potential to reduce depressive symptoms over a short intervention period. The randomized controlled trial results demonstrated that customization of app features, such as avatars, does not further reduce depressive symptoms over and above the CBT modules and standard app features, including journal, reminders, and mood tracking. However, further research elucidating the relationship between virtual avatar identification and mental health systems is needed as society becomes increasingly more digitized. These findings have potential implications for improving the optimization of mental health app designs. Trial Registration: Open Science Framework t28gm; https://osf.io/t28gm %M 35943788 %R 10.2196/39516 %U https://mental.jmir.org/2022/8/e39516 %U https://doi.org/10.2196/39516 %U http://www.ncbi.nlm.nih.gov/pubmed/35943788 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 8 %P e37547 %T Accuracy and Precision of Consumer-Grade Wearable Activity Monitors for Assessing Time Spent in Sedentary Behavior in Children and Adolescents: Systematic Review %A Martinko,Antonio %A Karuc,Josip %A Jurić,Petra %A Podnar,Hrvoje %A Sorić,Maroje %+ Faculty of Kinesiology, University of Zagreb, Horvaćanski zavoj 15, Zagreb, 10000, Croatia, 385 981302484, antonio.martinko@kif.hr %K accuracy %K precision %K sedentary behavior %K children %K adolescents %K wearable activity monitor %K eHealth %K digital health %K mobile health %K mHealth %K mobile phone %D 2022 %7 9.8.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: A large number of wearable activity monitor models are released and used each year by consumers and researchers. As more studies are being carried out on children and adolescents in terms of sedentary behavior (SB) assessment, knowledge about accurate and precise monitoring devices becomes increasingly important. Objective: The main aim of this systematic review was to investigate and communicate findings on the accuracy and precision of consumer-grade physical activity monitors in assessing the time spent in SB in children and adolescents. Methods: Searches of PubMed (MEDLINE), Scopus, SPORTDiscus (full text), ProQuest, Open Access Theses and Dissertations, DART Europe E-theses Portal, and Networked Digital Library of Theses and Dissertations electronic databases were performed. All relevant studies that compared different types of consumer-grade monitors using a comparison method in the assessment of SB, published in European languages from 2015 onward were considered for inclusion. The risk of bias was estimated using Consensus-Based Standards for the Selection of Health Status Measurement Instruments. For enabling comparisons of accuracy measures within the studied outcome domain, measurement accuracy interpretation was based on group mean or percentage error values and 90% CI. Acceptable limits were predefined as –10% to +10% error in controlled and free-living settings. For determining the number of studies with group error percentages that fall within or outside one of the sides from previously defined acceptable limits, two 1-sided tests of equivalence were carried out, and the direction of measurement error was examined. Results: A total of 8 studies complied with the predefined inclusion criteria, and 3 studies provided acceptable data for quantitative analyses. In terms of the presented accuracy comparisons, 14 were subsequently identified, with 6 of these comparisons being acceptable in terms of quantitative analysis. The results of the Cochran Q test indicated that the included studies did not share a common effect size (Q5=82.86; P<.001). I2, which represents the percentage of total variation across studies due to heterogeneity, amounted to 94%. The summary effect size based on the random effects model was not statistically significant (effect size=14.36, SE 12.04, 90% CI −5.45 to 34.17; P=.23). According to the equivalence test results, consumer-grade physical activity monitors did not generate equivalent estimates of SB in relation to the comparison methods. Majority of the studies (3/7, 43%) that reported the mean absolute percentage errors have reported values of <30%. Conclusions: This is the first study that has attempted to synthesize available evidence on the accuracy and precision of consumer-grade physical activity monitors in measuring SB in children and adolescents. We found very few studies on the accuracy and almost no evidence on the precision of wearable activity monitors. The presented results highlight the large heterogeneity in this area of research. Trial Registration: PROSPERO CRD42021251922; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=251922 %M 35943763 %R 10.2196/37547 %U https://mhealth.jmir.org/2022/8/e37547 %U https://doi.org/10.2196/37547 %U http://www.ncbi.nlm.nih.gov/pubmed/35943763 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e36515 %T Mitigating Feelings of Loneliness and Depression by Means of Web-Based or Print-Based Physical Activity Interventions: Pooled Analysis of 2 Community-Based Intervention Trials %A Lippke,Sonia %A Ratz,Tiara %A Keller,Franziska Maria %A Juljugin,Dennis %A Peters,Manuela %A Pischke,Claudia %A Voelcker-Rehage,Claudia %+ Psychology & Methods, Jacobs University Bremen, Campus Ring 1, Bremen, 28759, Germany, 49 421200 ext 4730, s.lippke@jacobs-university.de %K physical activity %K older adults %K intervention %K loneliness %K depression %K eHealth %K mobile health %K mHealth %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Physical activity (PA) is associated with benefits, such as fewer depressive symptoms and loneliness. Web- and print-based PA interventions can help older individuals accordingly. Objective: We aimed to test the following research questions: Do PA interventions delivered in a web- or print-based mode improve self-reported PA stage of change, social-cognitive determinants of PA, loneliness, and symptoms of depression? Is subjective age a mediator and stage of change a moderator of this effect? Methods: Overall, 831 adults aged ≥60 years were recruited and either allocated to a print-based or web-based intervention group or assigned to a wait-list control group (WLCG) in 2 community-based PA intervention trials over 10 weeks. Missing value imputation using an expectation-maximization algorithm was applied. Frequency analyses, multivariate analyses of variance, and moderated mediation analyses were conducted. Results: The web-based intervention outperformed (47/59, 80% of initially inactive individuals being adopters, and 396/411, 96.4% of initially active individuals being maintainers of the recommended PA behavior) the print-based intervention (20/25, 80% of adopters, and 63/69, 91% of maintainers) and the WLCG (5/7, 71% of adopters; 141/150, 94% of maintainers). The pattern regarding adopters was statistically significant (web vs print Z=–1.94; P=.02; WLCG vs web Z=3.8367; P=.01). The pattern was replicated with stages (χ24=79.1; P<.001; contingency coefficient 0.314; P<.001); in the WLCG, 40.1% (63/157) of the study participants moved to or remained in action stage. This number was higher in the groups receiving web-based (357/470, 76%) or print-based interventions (64/94, 68.1%). A significant difference was observed favoring the 2 intervention groups over and above the WLCG (F19, 701=4.778; P<.001; η2=0.098) and a significant interaction of time and group (F19, 701=2.778; P<.001; η2=0.070) for predictors of behavior. The effects of the interventions on subjective age, loneliness, and depression revealed that both between-group effects (F3, 717=8.668; P<.001; η2=0.018) and the interaction between group and time were significant (F3, 717=6.101; P<.001; η2=0.025). In a moderated mediation model, both interventions had a significant direct effect on depression in comparison with the WLCG (web-based: c′ path −0.86, 95% CI −1.58 to −0.13, SE 0.38; print-based: c′ path −1.96, 95% CI −2.99 to −0.92, SE 0.53). Furthermore, subjective age was positively related to depression (b path 0.14, 95% CI 0.05-0.23; SE 0.05). An indirect effect of the intervention on depression via subjective age was only present for participants who were in actor stage and received the web-based intervention (ab path −0.14, 95% CI −0.34 to −0.01; SE 0.09). Conclusions: Web-based interventions appear to be as effective as print-based interventions. Both modes might help older individuals remain or become active and experience fewer depression symptoms, especially if they feel younger. Trial Registration: German Registry of Clinical Trials DRKS00010052 (PROMOTE 1); https://tinyurl.com/nnzarpsu and DRKS00016073 (PROMOTE 2); https://tinyurl.com/4fhcvkwy International Registered Report Identifier (IRRID): RR2-10.2196/15168 %M 35943790 %R 10.2196/36515 %U https://aging.jmir.org/2022/3/e36515 %U https://doi.org/10.2196/36515 %U http://www.ncbi.nlm.nih.gov/pubmed/35943790 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e34588 %T Intervention Mapping of a Gamified Therapy Prescription App for Children With Disabilities: User-Centered Design Approach %A Johnson,Rowan W %A White,Becky K %A Gucciardi,Daniel F %A Gibson,Noula %A Williams,Sian A %+ Therapy Services, Ability WA, 106 Bradford Street, Coolbinia, Perth, 6069, Australia, 61 1300106106, rowan.johnson@abilitywa.com.au %K neurodevelopmental disability %K mobile health %K self-determination theory %K gamification %K physiotherapy %K occupational therapy %K speech pathology %K behavior change %K mobile phone %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Mobile health (mHealth) apps for children are increasing in availability and scope. Therapy (physiotherapy, speech pathology, and occupational therapy) prescription apps to improve home or school program adherence work best when developed to be highly engaging for children and when they incorporate behavior change techniques (BCTs) within their design. Objective: The aim of this study was to describe the development of a user-centered therapy prescription app for children (aged 6-12 years) with neurodevelopmental disabilities (eg, cerebral palsy, autism spectrum disorder, and intellectual disability) incorporating intervention mapping (IM) and gamified design. Methods: We used an iterative, user-centered app development model incorporating the first 3 steps of IM. We conducted a needs analysis with user feedback from our previous mHealth app study, a literature review, and a market audit. Change objectives were then specified in alignment with the psychological needs of autonomy, competence, and relatedness identified in self-determination theory. From these objectives, we then selected BCTs, stipulating parameters for effectiveness and how each BCT would be operationalized. A gamification design was planned and implemented focusing on maximizing engagement in children. In total, 2 rounds of consultations with parents, teachers, and therapists and 1 round of prototype app testing with children were conducted to inform app development, with a final iteration developed for further testing. Results: The IM process resulted in the specification of app elements, self-determination theory–informed BCTs, that were embedded into the app design. The gamification design yielded the selection of a digital pet avatar with a fantasy anime visual theme and multiple layers of incentives earned by completing prescribed therapy activities. Consultation groups with professionals working with children with disabilities (4 therapists and 3 teachers) and parents of children with disabilities (n=3) provided insights into the motivation of children and the pragmatics of implementing app-delivered therapy programs that informed the app development. User testing with children with disabilities (n=4) highlighted their enthusiasm for the app and the need for support in the initial phase of learning the app. App quality testing (Mobile Application Rating Scale-user version) with the children yielded means (out of 5) of 4.5 (SD 0.8) for engagement, 3.3 (SD 1.6) for function, 3.3 (SD 1.7) for aesthetics, and 4.3 (SD 1.1) for subjective quality. Conclusions: mHealth apps designed for children can be greatly enhanced with a systematic yet flexible development process considering the specific contextual needs of the children with user-centered design, addressing the need for behavior change using the IM process, and maximizing engagement with gamification and strong visual design. %M 35943782 %R 10.2196/34588 %U https://pediatrics.jmir.org/2022/3/e34588 %U https://doi.org/10.2196/34588 %U http://www.ncbi.nlm.nih.gov/pubmed/35943782 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e23261 %T Effects of Feedback From Self-Monitoring Devices on Lifestyle Changes in Workers with Diabetes: 3-Month Randomized Controlled Pilot Trial %A Nagata,Tomohisa %A Aoyagi,Sona-Sanae %A Takahashi,Minekazu %A Nagata,Masako %A Mori,Koji %+ Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, yahatanishi-ku, Kitakyushu, 807-8555, Japan, 81 93 603 1611, tomohisa@med.uoeh-u.ac.jp %K mobile health %K digital health %K diabetes %K workers %K self-monitoring %K BMI %K daily activity %K randomized controlled trial %K smartphone %K mobile phone %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Although lifestyle interventions are useful in the prevention and management of diabetes, they can be expensive and time-consuming. There is some evidence on the effectiveness of automated mobile technology for health self-monitoring; however, few studies have used such devices in the occupational health field. Objective: We aimed to examine the effectiveness of a digital self-monitoring device on glucose levels and activity of workers with diabetes in Japan. The primary outcomes were changes in blood glucose levels, and the secondary outcomes were changes in weight and BMI. Methods: A 2-arm randomized controlled pilot trial was conducted with workers from 23 organizations. The intervention group (n=50) wore an armband activity monitor, a body composition monitor, and a blood pressure monitor for 3 months and received semiautomated weekly email messages tailored to their device data. The control group (n=53) engaged in no self-monitoring. Messages were developed by a physician and a dietician. Postintervention changes in blood glucose levels, weight, and BMI were compared between the intervention and control groups, using blood tests and questionnaires. Results: At the end of 3 months, the intervention group showed significantly lower blood glucose levels (HbA1c: intervention group mean 6.4% (SD 0.3%) vs control group mean 6.6% (SD 0.3%); Cohen d=0.7, 95% CI 0.2-1.1; P=.009). There were no significant between-group differences in weight and BMI. Conclusions: Mobile digital self-monitoring was effective in improving blood glucose levels in workers with diabetes. The use of digital health devices is a cost-effective way of implementing health self-monitoring for large numbers of individuals in the workplace. However, due to the large volume of missing values in this study, we need to be careful in interpreting the results, and well-designed intervention studies need to be conducted. Trial Registration: University Hospital Medical Information Network UMIN000023651; https://upload.umin.ac.jp/cgi-open-bin/icdr/ctr_view_cb.cgi?recptno=R000027244&flwp_key=1008PYbOcXKmk7CAg4Th1FWS %M 35943766 %R 10.2196/23261 %U https://formative.jmir.org/2022/8/e23261 %U https://doi.org/10.2196/23261 %U http://www.ncbi.nlm.nih.gov/pubmed/35943766 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e39280 %T Understanding Preconception Women’s Needs and Preferences for Digital Health Resources: Qualitative Study %A Walker,Ruth Elizabeth %A Quong,Sara %A Olivier,Patrick %A Wu,Ling %A Xie,Jue %A Boyle,Jacqueline %+ Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, 3168, Australia, 61 437789800, ruth.walker@monash.edu %K digital health %K preconception %K health promotion %K behavior change %K women's health %K maternal health %K digital health resource %K healthy life style %K qualitative analysis %K online health information %D 2022 %7 5.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Improving preconception health can benefit all women, their children, and their families regardless of their individual pregnancy intentions. Rapidly increasing access to information technology and online engagement have created opportunities to use digital health resources to engage with preconception women regarding lifestyle behaviors. Objective: This study explores how preconception women engage with digital health resources and online platforms to inform the design and development of a digital health resource to support women to make positive behavior change for their preconception health. Methods: This codesign research followed the Double Diamond process, which focuses on contextualization and explorative processes in phase 1 and ideation and development processes in phase 2. Phase 1 is reported on in this study and was undertaken via a series of 1-on-1 in-depth interviews with female participants (N=12) aged 18-45 years over 3 months. Interviews were designed to explore participants’ lived experiences in relation to their health and desired supports for healthy lifestyle behaviors. The first interview focused on participants’ perceptions of health and health behaviors, the second interview focused on social connections for health, and the third interview focused on digital health information and supports. Conversations from the first interview informed the development of the second interview, and conversations from the second interview informed the development of the third interview. Community advisors (N=8) met to provide feedback and advice to the researchers throughout the interview process. Qualitative analyses of transcripts from interviews were undertaken by 2 researchers before a deductive process identified themes mapped to the capability, opportunity, motivation, and behavior (COM-B) framework. Results: In total, 9 themes and 8 subthemes were identified from 124 codes. In relation to digital health resources, specifically, participants were already engaging with a range of digital health resources and had high expectations of these. Digital health resources needed to be easy to access, make women’s busy lives easier, be evidence based, and be reputable. Social connectedness was also highly important to our participants, with information and advice from peers with similar experiences being preferred over yet more online health information. Online communities facilitated these social interactions. Participants were open to the idea of chatbots and virtual assistants but acknowledged that they would not replace authentic social interactions. Conclusions: Codesigned digital health resources should be evidence based, reputable, and easy to access. Social connections were considered highly important to women, and designers of digital health resources should consider how they can increase opportunities for women to connect and learn from each other to promote health behaviors. %M 35930344 %R 10.2196/39280 %U https://formative.jmir.org/2022/8/e39280 %U https://doi.org/10.2196/39280 %U http://www.ncbi.nlm.nih.gov/pubmed/35930344 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e33964 %T Sleep Patterns and Affect Dynamics Among College Students During the COVID-19 Pandemic: Intensive Longitudinal Study %A Mousavi,Zahra Avah %A Lai,Jocelyn %A Simon,Katharine %A Rivera,Alexander P %A Yunusova,Asal %A Hu,Sirui %A Labbaf,Sina %A Jafarlou,Salar %A Dutt,Nikil D %A Jain,Ramesh C %A Rahmani,Amir M %A Borelli,Jessica L %+ Department of Psychological Science, University of California, Irvine, Social & Behavioral Sciences Gateway, Irvine, CA, 92697, United States, 1 949 824 6803, mousaviz@uci.edu %K sleep %K objective sleep outcomes %K COVID-19 %K affect variability %K affect dynamics %D 2022 %7 5.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Sleep disturbance is a transdiagnostic risk factor that is so prevalent among young adults that it is considered a public health epidemic, which has been exacerbated by the COVID-19 pandemic. Sleep may contribute to mental health via affect dynamics. Prior literature on the contribution of sleep to affect is largely based on correlational studies or experiments that do not generalize to the daily lives of young adults. Furthermore, the literature examining the associations between sleep variability and affect dynamics remains scant. Objective: In an ecologically valid context, using an intensive longitudinal design, we aimed to assess the daily and long-term associations between sleep patterns and affect dynamics among young adults during the COVID-19 pandemic. Methods: College student participants (N=20; female: 13/20, 65%) wore an Oura ring (Ōura Health Ltd) continuously for 3 months to measure sleep patterns, such as average and variability in total sleep time (TST), wake after sleep onset (WASO), sleep efficiency, and sleep onset latency (SOL), resulting in 1173 unique observations. We administered a daily ecological momentary assessment by using a mobile health app to evaluate positive affect (PA), negative affect (NA), and COVID-19 worry once per day. Results: Participants with a higher sleep onset latency (b=−1.09, SE 0.36; P=.006) and TST (b=−0.15, SE 0.05; P=.008) on the prior day had lower PA on the next day. Further, higher average TST across the 3-month period predicted lower average PA (b=−0.36, SE 0.12; P=.009). TST variability predicted higher affect variability across all affect domains. Specifically, higher variability in TST was associated higher PA variability (b=0.09, SE 0.03; P=.007), higher negative affect variability (b=0.12, SE 0.05; P=.03), and higher COVID-19 worry variability (b=0.16, SE 0.07; P=.04). Conclusions: Fluctuating sleep patterns are associated with affect dynamics at the daily and long-term scales. Low PA and affect variability may be potential pathways through which sleep has implications for mental health. %M 35816447 %R 10.2196/33964 %U https://formative.jmir.org/2022/8/e33964 %U https://doi.org/10.2196/33964 %U http://www.ncbi.nlm.nih.gov/pubmed/35816447 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e39010 %T Passive Mobile Self-tracking of Mental Health by Veterans With Serious Mental Illness: Protocol for a User-Centered Design and Prospective Cohort Study %A Young,Alexander S %A Choi,Abigail %A Cannedy,Shay %A Hoffmann,Lauren %A Levine,Lionel %A Liang,Li-Jung %A Medich,Melissa %A Oberman,Rebecca %A Olmos-Ochoa,Tanya T %+ Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 300 UCLA Medical Plaza, Los Angeles, CA, 90095, United States, 1 310 794 7219, ayoung@ucla.edu %K serious mental illness %K mobile health %K mental health %K passive sensing %K health informatics %K behavior %K sensor %K self-tracking %K predict %K assessment %D 2022 %7 5.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Serious mental illnesses (SMI) are common, disabling, and challenging to treat, requiring years of monitoring and treatment adjustments. Stress or reduced medication adherence can lead to rapid worsening of symptoms and behaviors. Illness exacerbations and relapses generally occur with little or no clinician awareness in real time, leaving limited opportunity to modify treatments. Previous research suggests that passive mobile sensing may be beneficial for individuals with SMI by helping them monitor mental health status and behaviors, and quickly detect worsening mental health for prompt assessment and intervention. However, there is too little research on its feasibility and acceptability and the extent to which passive data can predict changes in behaviors or symptoms. Objective: The aim of this research is to study the feasibility, acceptability, and safety of passive mobile sensing for tracking behaviors and symptoms of patients in treatment for SMI, as well as developing analytics that use passive data to predict changes in behaviors and symptoms. Methods: A mobile app monitors and transmits passive mobile sensor and phone utilization data, which is used to track activity, sociability, and sleep in patients with SMI. The study consists of a user-centered design phase and a mobile sensing phase. In the design phase, focus groups, interviews, and usability testing inform further app development. In the mobile sensing phase, passive mobile sensing occurs with participants engaging in weekly assessments for 9 months. Three- and nine-month interviews study the perceptions of passive mobile sensing and ease of app use. Clinician interviews before and after the mobile sensing phase study the usefulness and feasibility of app utilization in clinical care. Predictive analytic models are built, trained, and selected, and make use of machine learning methods. Models use sensor and phone utilization data to predict behavioral changes and symptoms. Results: The study started in October 2020. It has received institutional review board approval. The user-centered design phase, consisting of focus groups, usability testing, and preintervention clinician interviews, was completed in June 2021. Recruitment and enrollment for the mobile sensing phase began in October 2021. Conclusions: Findings may inform the development of passive sensing apps and self-tracking in patients with SMI, and integration into care to improve assessment, treatment, and patient outcomes. Trial Registration: ClinicalTrials.gov NCT05023252; https://clinicaltrials.gov/ct2/show/NCT05023252 International Registered Report Identifier (IRRID): DERR1-10.2196/39010 %M 35930336 %R 10.2196/39010 %U https://www.researchprotocols.org/2022/8/e39010 %U https://doi.org/10.2196/39010 %U http://www.ncbi.nlm.nih.gov/pubmed/35930336 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e33754 %T Alignment Between Heart Rate Variability From Fitness Trackers and Perceived Stress: Perspectives From a Large-Scale In Situ Longitudinal Study of Information Workers %A Martinez,Gonzalo J %A Grover,Ted %A Mattingly,Stephen M %A Mark,Gloria %A D’Mello,Sidney %A Aledavood,Talayeh %A Akbar,Fatema %A Robles-Granda,Pablo %A Striegel,Aaron %+ Computer Science and Engineering, University of Notre Dame, 400 Main Building, Notre Dame, IN, 46556, United States, 1 (574) 631 8320, gonzalo.martinez@ieee.org %K stress measurement %K heart rate variability %K HRV %K perceived stress %K ecological momentary assessment %K EMA %K wearables %K fitness tracker %D 2022 %7 4.8.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Stress can have adverse effects on health and well-being. Informed by laboratory findings that heart rate variability (HRV) decreases in response to an induced stress response, recent efforts to monitor perceived stress in the wild have focused on HRV measured using wearable devices. However, it is not clear that the well-established association between perceived stress and HRV replicates in naturalistic settings without explicit stress inductions and research-grade sensors. Objective: This study aims to quantify the strength of the associations between HRV and perceived daily stress using wearable devices in real-world settings. Methods: In the main study, 657 participants wore a fitness tracker and completed 14,695 ecological momentary assessments (EMAs) assessing perceived stress, anxiety, positive affect, and negative affect across 8 weeks. In the follow-up study, approximately a year later, 49.8% (327/657) of the same participants wore the same fitness tracker and completed 1373 EMAs assessing perceived stress at the most stressful time of the day over a 1-week period. We used mixed-effects generalized linear models to predict EMA responses from HRV features calculated over varying time windows from 5 minutes to 24 hours. Results: Across all time windows, the models explained an average of 1% (SD 0.5%; marginal R2) of the variance. Models using HRV features computed from an 8 AM to 6 PM time window (namely work hours) outperformed other time windows using HRV features calculated closer to the survey response time but still explained a small amount (2.2%) of the variance. HRV features that were associated with perceived stress were the low frequency to high frequency ratio, very low frequency power, triangular index, and SD of the averages of normal-to-normal intervals. In addition, we found that although HRV was also predictive of other related measures, namely, anxiety, negative affect, and positive affect, it was a significant predictor of stress after controlling for these other constructs. In the follow-up study, calculating HRV when participants reported their most stressful time of the day was less predictive and provided a worse fit (R2=0.022) than the work hours time window (R2=0.032). Conclusions: A significant but small relationship between perceived stress and HRV was found. Thus, although HRV is associated with perceived stress in laboratory settings, the strength of that association diminishes in real-life settings. HRV might be more reflective of perceived stress in the presence of specific and isolated stressors and research-grade sensing. Relying on wearable-derived HRV alone might not be sufficient to detect stress in naturalistic settings and should not be considered a proxy for perceived stress but rather a component of a complex phenomenon. %M 35925662 %R 10.2196/33754 %U https://humanfactors.jmir.org/2022/3/e33754 %U https://doi.org/10.2196/33754 %U http://www.ncbi.nlm.nih.gov/pubmed/35925662 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 2 %P e38570 %T Prediction of VO2max From Submaximal Exercise Using the Smartphone Application Myworkout GO: Validation Study of a Digital Health Method %A Helgerud,Jan %A Haglo,Håvard %A Hoff,Jan %+ Medical Rehabilitation Clinic, Myworkout, Ingvald Ystgaards veg 23, Trondheim, 7047, Norway, 47 92621619, havard@treningsklinikken.no %K high-intensity interval training %K cardiovascular health %K physical inactivity %K endurance training %K measurement accuracy %D 2022 %7 4.8.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Physical inactivity remains the largest risk factor for the development of cardiovascular disease worldwide. Wearable devices have become a popular method of measuring activity-based outcomes and facilitating behavior change to increase cardiorespiratory fitness (CRF) or maximal oxygen consumption (VO2max) and reduce weight. However, it is critical to determine their accuracy in measuring these variables. Objective: This study aimed to determine the accuracy of using a smartphone and the application Myworkout GO for submaximal prediction of VO2max. Methods: Participants included 162 healthy volunteers: 58 women and 104 men (17-73 years old). The study consisted of 3 experimental tests randomized to 3 separate days. One-day VO2max was assessed with Metamax II, with the participant walking or running on the treadmill. On the 2 other days, the application Myworkout GO used standardized high aerobic intensity interval training (HIIT) on the treadmill to predict VO2max. Results: There were no significant differences between directly measured VO2max (mean 49, SD 14 mL/kg/min) compared with the VO2max predicted by Myworkout GO (mean 50, SD 14 mL/kg/min). The direct and predicted VO2max values were highly correlated, with an R2 of 0.97 (P<.001) and standard error of the estimate (SEE) of 2.2 mL/kg/min, with no sex differences. Conclusions: Myworkout GO accurately calculated VO2max, with an SEE of 4.5% in the total group. The submaximal HIIT session (4 x 4 minutes) incorporated in the application was tolerated well by the participants. We present health care providers and their patients with a more accurate and practical version of health risk estimation. This might increase physical activity and improve exercise habits in the general population. %M 35925653 %R 10.2196/38570 %U https://cardio.jmir.org/2022/2/e38570 %U https://doi.org/10.2196/38570 %U http://www.ncbi.nlm.nih.gov/pubmed/35925653 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 8 %P e33850 %T Predicting the Next-Day Perceived and Physiological Stress of Pregnant Women by Using Machine Learning and Explainability: Algorithm Development and Validation %A Ng,Ada %A Wei,Boyang %A Jain,Jayalakshmi %A Ward,Erin A %A Tandon,S Darius %A Moskowitz,Judith T %A Krogh-Jespersen,Sheila %A Wakschlag,Lauren S %A Alshurafa,Nabil %+ McCormick School of Engineering, Northwestern University, 633 Clark St, Evanston, IL, 60208, United States, 1 8474913741, adang@u.northwestern.edu %K explainability %K just-in-time interventions %K machine learning %K prenatal stress %K stress prediction %K wearable %K mobile phone %D 2022 %7 2.8.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cognitive behavioral therapy–based interventions are effective in reducing prenatal stress, which can have severe adverse health effects on mothers and newborns if unaddressed. Predicting next-day physiological or perceived stress can help to inform and enable pre-emptive interventions for a likely physiologically and perceptibly stressful day. Machine learning models are useful tools that can be developed to predict next-day physiological and perceived stress by using data collected from the previous day. Such models can improve our understanding of the specific factors that predict physiological and perceived stress and allow researchers to develop systems that collect selected features for assessment in clinical trials to minimize the burden of data collection. Objective: The aim of this study was to build and evaluate a machine-learned model that predicts next-day physiological and perceived stress by using sensor-based, ecological momentary assessment (EMA)–based, and intervention-based features and to explain the prediction results. Methods: We enrolled pregnant women into a prospective proof-of-concept study and collected electrocardiography, EMA, and cognitive behavioral therapy intervention data over 12 weeks. We used the data to train and evaluate 6 machine learning models to predict next-day physiological and perceived stress. After selecting the best performing model, Shapley Additive Explanations were used to identify the feature importance and explainability of each feature. Results: A total of 16 pregnant women enrolled in the study. Overall, 4157.18 hours of data were collected, and participants answered 2838 EMAs. After applying feature selection, 8 and 10 features were found to positively predict next-day physiological and perceived stress, respectively. A random forest classifier performed the best in predicting next-day physiological stress (F1 score of 0.84) and next-day perceived stress (F1 score of 0.74) by using all features. Although any subset of sensor-based, EMA-based, or intervention-based features could reliably predict next-day physiological stress, EMA-based features were necessary to predict next-day perceived stress. The analysis of explainability metrics showed that the prolonged duration of physiological stress was highly predictive of next-day physiological stress and that physiological stress and perceived stress were temporally divergent. Conclusions: In this study, we were able to build interpretable machine learning models to predict next-day physiological and perceived stress, and we identified unique features that were highly predictive of next-day stress that can help to reduce the burden of data collection. %M 35917157 %R 10.2196/33850 %U https://mhealth.jmir.org/2022/8/e33850 %U https://doi.org/10.2196/33850 %U http://www.ncbi.nlm.nih.gov/pubmed/35917157 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e36936 %T A Biofeedback-Based Mobile App With Serious Games for Young Adults With Anxiety in the United Arab Emirates: Development and Usability Study %A Almeqbaali,Mariam %A Ouhbi,Sofia %A Serhani,Mohamed Adel %A Amiri,Leena %A Jan,Reem K %A Zaki,Nazar %A Sharaf,Ayman %A Al Helali,Abdulla %A Almheiri,Eisa %+ Department of Information Systems and Security, College of Information Technology, United Arab Emirates University, Sheik Khalifa Bin Zayed St, Al Ain, Abu Dhabi, United Arab Emirates, 971 3 7135572, serhanim@uaeu.ac.ae %K connected mental health %K mental health %K anxiety %K digital game %K biofeedback %K app %K serious game %K gaming %K gamification %K young adult %K user-centered design %K stress %K stress relief %K user-centred design %K youth %K user feedback %K user experience %K usability %K user need %K development %K mHealth %K mobile health %D 2022 %7 2.8.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Following the outbreak of COVID-19, several studies have reported that young adults encountered a rise in anxiety symptoms, which could negatively affect their quality of life. Promising evidence suggests that mobile apps with biofeedback, serious games, breathing exercises, and positive messaging, among other features, are useful for anxiety self-management and treatment. Objective: This study aimed to develop and evaluate the usability of a biofeedback-based app with serious games for young adults with anxiety in the United Arab Emirates (UAE). Methods: This study consists of two phases: Phase I describes the design and development of the app, while Phase II presents the results of a usability evaluation by experts. To elicit the app’s requirements during Phase I, we conducted (1) a survey to investigate preferences of young adults in the UAE for mobile games for stress relief; (2) an analysis of serious games for anxiety; and (3) interviews with mental health professionals and young adults in the UAE. In Phase II, five experts tested the usability of the developed app using a set of Nielsen’s usability heuristics. Results: A fully functional biofeedback-based app with serious games was co-designed with mental health professionals. The app included 4 games (ie, a biofeedback game, card game, arcade game, and memory game), 2 relaxation techniques (ie, a breathing exercise and yoga videos), and 2 additional features (ie, positive messaging and a mood tracking calendar). The results of Phase II showed that the developed app is efficient, simple, and easy to use. Overall, the app design scored an average of 4 out of 5. Conclusions: The elicitation techniques used in Phase I resulted in the development of an easy-to-use app for the self-management of anxiety. Further research is required to determine the app’s usability and effectiveness in the target population. %M 35916692 %R 10.2196/36936 %U https://games.jmir.org/2022/3/e36936 %U https://doi.org/10.2196/36936 %U http://www.ncbi.nlm.nih.gov/pubmed/35916692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e35268 %T Just-in-Time Prompts for Running, Walking, and Performing Strength Exercises in the Built Environment: 4-Week Randomized Feasibility Study %A Sporrel,Karlijn %A Wang,Shihan %A Ettema,Dick D F %A Nibbeling,Nicky %A Krose,Ben J A %A Deutekom,Marije %A de Boer,Rémi D D %A Simons,Monique %+ Human Geography and Spatial Planning, Utrecht University, Princetonlaan 8a, Utrecht, 3584 CB, Netherlands, 31 642514287, k.sporrel@uu.nl %K just-in-time interventions %K context-based %K prompts %K reminders %K physical activity %K mobile health %K mHealth %K exercise application %K Fogg Behavior Model %K user experience %K engagement %K feasibility study %K mobile phone %D 2022 %7 1.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: App-based mobile health exercise interventions can motivate individuals to engage in more physical activity (PA). According to the Fogg Behavior Model, it is important that the individual receive prompts at the right time to be successfully persuaded into PA. These are referred to as just-in-time (JIT) interventions. The Playful Active Urban Living (PAUL) app is among the first to include 2 types of JIT prompts: JIT adaptive reminder messages to initiate a run or walk and JIT strength exercise prompts during a walk or run (containing location-based instruction videos). This paper reports on the feasibility of the PAUL app and its JIT prompts. Objective: The main objective of this study was to examine user experience, app engagement, and users’ perceptions and opinions regarding the PAUL app and its JIT prompts and to explore changes in the PA behavior, intrinsic motivation, and the perceived capability of the PA behavior of the participants. Methods: In total, 2 versions of the closed-beta version of the PAUL app were evaluated: a basic version (Basic PAUL) and a JIT adaptive version (Smart PAUL). Both apps send JIT exercise prompts, but the versions differ in that the Smart PAUL app sends JIT adaptive reminder messages to initiate running or walking behavior, whereas the Basic PAUL app sends reminder messages at randomized times. A total of 23 participants were randomized into 1 of the 2 intervention arms. PA behavior (accelerometer-measured), intrinsic motivation, and the perceived capability of PA behavior were measured before and after the intervention. After the intervention, participants were also asked to complete a questionnaire on user experience, and they were invited for an exit interview to assess user perceptions and opinions of the app in depth. Results: No differences in PA behavior were observed (Z=−1.433; P=.08), but intrinsic motivation for running and walking and for performing strength exercises significantly increased (Z=−3.342; P<.001 and Z=−1.821; P=.04, respectively). Furthermore, participants increased their perceived capability to perform strength exercises (Z=2.231; P=.01) but not to walk or run (Z=−1.221; P=.12). The interviews indicated that the participants were enthusiastic about the strength exercise prompts. These were perceived as personal, fun, and relevant to their health. The reminders were perceived as important initiators for PA, but participants from both app groups explained that the reminder messages were often not sent at times they could exercise. Although the participants were enthusiastic about the functionalities of the app, technical issues resulted in a low user experience. Conclusions: The preliminary findings suggest that the PAUL apps are promising and innovative interventions for promoting PA. Users perceived the strength exercise prompts as a valuable addition to exercise apps. However, to be a feasible intervention, the app must be more stable. %M 35916693 %R 10.2196/35268 %U https://formative.jmir.org/2022/8/e35268 %U https://doi.org/10.2196/35268 %U http://www.ncbi.nlm.nih.gov/pubmed/35916693 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e30149 %T Data-Driven User-Type Clustering of a Physical Activity Promotion App: Usage Data Analysis Study %A Kranzinger,Christina %A Venek,Verena %A Rieser,Harald %A Jungreitmayr,Sonja %A Ring-Dimitriou,Susanne %+ Salzburg Research Forschungsgesellschaft mbH, Jakob-⁠Haringer-⁠Straße 5/⁠3, Salzburg, 5020, Austria, 43 6622288 ext 252, christina.kranzinger@salzburgresearch.at %K active and assisted living %K app usage %K cluster analysis %K Jenks natural breaks algorithm %K Partitioning Around Medoids algorithm %K physical activity promotion %K usage groups %D 2022 %7 1.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical inactivity remains a leading risk factor for mortality worldwide. Owing to increasing sedentary behavior (activities in a reclining, seated, or lying position with low-energy expenditures), vehicle-based transport, and insufficient physical workload, the prevalence of physical activity decreases significantly with age. To promote sufficient levels of participation in physical activities, the research prototype Fit-mit-ILSE was developed with the goal of making adults aged ≥55 years physically fit and fit for the use of assistive technologies. The system combines active and assisted living technologies and smart services in the ILSE app. Objective: The clustering of health and fitness app user types, especially in the context of active and assisted living projects, has been mainly defined by experts through 1D cluster thresholds based on app usage frequency. We aimed to investigate and present data-driven methods for clustering app user types and to identify usage patterns based on the ILSE app function Fit at home. Methods: During the 2 phases of the field trials, ILSE app log data were collected from 165 participants. Using this data set, 2 data-driven approaches were applied for clustering to group app users who were similar to each other. First, the common approach of user-type clustering based on expert-defined thresholds was replaced by a data-driven derivation of the cluster thresholds using the Jenks natural breaks algorithm. Second, a multidimensional clustering approach using the Partitioning Around Medoids algorithm was explored to consider the detailed app usage pattern data. Results: Applying the Jenks clustering algorithm to the mean usage per day and clustering the users into 4 groups showed that most of the users (63/165, 38.2%) used the Fit at home function between once a week and every second day. More men were in the low usage group than women. In addition, the younger users were more often identified as moderate or high users than the older users, who were mainly classified as low users; moreover, the regional differences between Vienna and Salzburg were identified. In addition, the multidimensional approach identified 4 different user groups that differed mainly in terms of time of use, gender, and region. Overall, the younger women living in Salzburg were the users with highest average app usage. Conclusions: The application of different clustering approaches showed that data-driven calculations of user groups can complement expert-based definitions, provide objective thresholds for the analysis of app usage data, and identify groups that can be targeted individually based on their specific group characteristics. %M 35916687 %R 10.2196/30149 %U https://formative.jmir.org/2022/8/e30149 %U https://doi.org/10.2196/30149 %U http://www.ncbi.nlm.nih.gov/pubmed/35916687 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e35206 %T Transdiagnostic Psychopathology in a Help-Seeking Population of an Early Recognition Center for Mental Disorders: Protocol for an Experience Sampling Study %A Rosen,Marlene %A Betz,Linda T %A Montag,Christian %A Kannen,Christopher %A Kambeitz,Joseph %+ Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Straße 62, Cologne, 50937, Germany, 49 221 478 87166, marlene.rosen@uk-koeln.de %K help-seeking population %K phenotyping %K ecological momentary assessment %K symptom networks %K transdiagnositc psychiatry %K prevention %K early intervention %K psychiatry %K mental health %D 2022 %7 1.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Prevention in psychiatry provides a promising way to address the burden of mental illness. However, established approaches focus on specific diagnoses and do not address the heterogeneity and manifold potential outcomes of help-seeking populations that present at early recognition services. Conceptualizing the psychopathology manifested in help-seeking populations from a network perspective of interacting symptoms allows transdiagnostic investigations beyond binary disease categories. Furthermore, modern technologies such as smartphones facilitate the application of the Experience Sampling Method (ESM). Objective: This study is a combination of ESM with network analyses to provide valid insights beyond the established assessment instruments in a help-seeking population. Methods: We will examine 75 individuals (aged 18-40 years) of the help-seeking population of the Cologne early recognition center. For a maximally naturalistic sample, only minimal exclusion criteria will be applied. We will collect data for 14 days using a mobile app to assess 10 transdiagnostic symptoms (ie, depressive, anxious, and psychotic symptoms) as well as distress level 5 times a day. With these data, we will generate average group-level symptom networks and personalized symptom networks using a 2-step multilevel vector autoregressive model. Additionally, we will explore associations between symptom networks and sociodemographic, risk, and resilience factors, as well as psychosocial functioning. Results: The protocol was designed in February 2020 and approved by the Ethics Committee of the University Hospital Cologne in October 2020. The protocol was reviewed and funded by the Köln Fortune program in September 2020. Data collection began in November 2020 and was completed in November 2021. Of the 258 participants who were screened, 93 (36%) fulfilled the inclusion criteria and were willing to participate in the study. Of these 93 participants, 86 (92%) completed the study. The first results are expected to be published in 2022. Conclusions: This study will provide insights about the feasibility and utility of the ESM in a help-seeking population of an early recognition center. Providing the first explorative phenotyping of transdiagnostic psychopathology in this population, our study will contribute to the innovation of early recognition in psychiatry. The results will help pave the way for prevention and targeted early intervention in a broader patient group, and thus, enable greater intended effects in alleviating the burden of psychiatric disorders. International Registered Report Identifier (IRRID): DERR1-10.2196/35206 %M 35916702 %R 10.2196/35206 %U https://www.researchprotocols.org/2022/8/e35206 %U https://doi.org/10.2196/35206 %U http://www.ncbi.nlm.nih.gov/pubmed/35916702 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 7 %P e34254 %T The Impact of Mobile Technology-Delivered Interventions on Youth Well-being: Systematic Review and 3-Level Meta-analysis %A Conley,Colleen S %A Raposa,Elizabeth B %A Bartolotta,Kate %A Broner,Sarah E %A Hareli,Maya %A Forbes,Nicola %A Christensen,Kirsten M %A Assink,Mark %+ Department of Psychology, Loyola University Chicago, 1032 W. Sheridan Road, Chicago, IL, 60660, United States, 1 7735083603, cconley@luc.edu %K meta-analysis %K mental health %K well-being %K intervention %K treatment %K youth %K technology %K smartphone %K mobile phone %K app %K mobile health %D 2022 %7 29.7.2022 %9 Review %J JMIR Ment Health %G English %X Background: Rates of mental health problems among youth are high and rising, whereas treatment seeking in this population remains low. Technology-delivered interventions (TDIs) appear to be promising avenues for broadening the reach of evidence-based interventions for youth well-being. However, to date, meta-analytic reviews on youth samples have primarily been limited to computer and internet interventions, whereas meta-analytic evidence on mobile TDIs (mTDIs), largely comprising mobile apps for smartphones and tablets, have primarily focused on adult samples. Objective: This study aimed to evaluate the effectiveness of mTDIs for a broad range of well-being outcomes in unselected, at-risk, and clinical samples of youth. Methods: The systematic review used 5 major search strategies to identify 80 studies evaluating 83 wellness- and mental health-focused mTDIs for 19,748 youth (mean age 2.93-26.25 years). We conducted a 3-level meta-analysis on the full sample and a subsample of the 38 highest-quality studies. Results: Analyses demonstrated significant benefits of mTDIs for youth both at posttest (g=0.27) and follow-up (range 1.21-43.14 weeks; g=0.26) for a variety of psychosocial outcomes, including general well-being and distress, symptoms of diverse psychological disorders, psychosocial strategies and skills, and health-related symptoms and behaviors. Effects were significantly moderated by the type of comparison group (strongest for no intervention, followed by inert placebo or information-only, and only marginal for clinical comparison) but only among the higher-quality studies. With respect to youth characteristics, neither gender nor pre-existing mental health risk level (not selected for risk, at-risk, or clinical) moderated effect sizes; however, effects increased with the age of youth in the higher-quality studies. In terms of intervention features, mTDIs in these research studies were effective regardless of whether they included various technological features (eg, tailoring, social elements, or gamification) or support features (eg, orientation, reminders, or coaching), although the use of mTDIs in a research context likely differs in important ways from their use when taken up through self-motivation, parent direction, peer suggestion, or clinician referral. Only mTDIs with a clear prescription for frequent use (ie, at least once per week) showed significant effects, although this effect was evident only in the higher-quality subsample. Moderation analyses did not detect statistically significant differences in effect sizes based on the prescribed duration of mTDI use (weeks or sessions), and reporting issues in primary studies limited the analysis of completed duration, thereby calling for improved methodology, assessment, and reporting to clarify true effects. Conclusions: Overall, this study’s findings demonstrate that youth can experience broad and durable benefits of mTDIs, delivered in a variety of ways, and suggest directions for future research and development of mTDIs for youth, particularly in more naturalistic and ecologically valid settings. %M 35904845 %R 10.2196/34254 %U https://mental.jmir.org/2022/7/e34254 %U https://doi.org/10.2196/34254 %U http://www.ncbi.nlm.nih.gov/pubmed/35904845 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e38234 %T Feature-Level Analysis of a Smoking Cessation Smartphone App Based on a Positive Psychology Approach: Prospective Observational Study %A Hoepper,Bettina B %A Siegel,Kaitlyn R %A Carlon,Hannah A %A Kahler,Christopher W %A Park,Elyse R %A Taylor,Steven Trevor %A Simpson,Hazel V %A Hoeppner,Susanne S %+ Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, 6th Floor, 151 Merrimac St, Boston, MA, 02114, United States, 1 617 643 1988, bhoeppner@mgh.harvard.edu %K mHealth %K smartphone %K smartphone app %K smoking %K smoking cessation %K nondaily smoking %K positive psychology %K happiness %K positive affect %K clinical trial %K feasibility %K acceptability %K app usage %K mobile health %D 2022 %7 28.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking cessation smartphone apps have emerged as highly accessible tools to support smoking cessation efforts. It is unknown how specific app features contribute to user engagement over time and relate to smoking outcomes. Objective: To provide a feature-level analysis of the Smiling Instead of Smoking app (version 2) and to link feature use to subsequent smoking cessation. Methods: Nondaily smokers (N=100) used the app for a period of 49 days (1 week before quitting and 6 weeks after quitting). Participants self-reported 30-day point-prevalence abstinence at the end of this period and at a 6-month follow up (the survey response rate was 94% and 89% at these points, respectively). Self-reported 30-day point prevalence abstinence rates were 40% at the end of treatment and 56% at the 6-month follow up. The app engaged users in both positive psychology content and traditional behavioral smoking cessation content. The app sent push notifications to prompt participants to complete prescribed content (ie, a “happiness exercise” every day and a “behavioral challenge” to use the app’s smoking cessation tools on 15 out of 49 days). Actions that participants took within the app were timestamped and recorded. Results: Participants used the app on 24.7 (SD 13.8) days out of the 49 prescribed days, interacting with the happiness content on more days than the smoking content (23.8, SD 13.8 days vs 17.8, SD 10.3 days; t99=9.28 [2-tailed]; P<.001). The prescribed content was frequently completed (45% of happiness exercises; 57% of behavioral challenges) and ad libitum tools were used on ≤7 days. Most participants used each ad libitum smoking cessation tool at least once, with higher use of personalized content (≥92% used “strategies,” “cigarette log,” “smoke alarms,” and “personal reasons”) than purely didactic content (79% viewed “benefits of quitting smoking”). The number of days participants used the app significantly predicted 30-day point-prevalence abstinence at the end of treatment (odds ratio [OR] 1.05, 95% CI 1.02-1.09; P=.002) and at the 6-month follow up (OR 1.04, 95% CI 1.008-1.07; P=.01). The number of days participants engaged with the happiness content significantly predicted smoking abstinence at the end of treatment (OR 1.05, 95% CI 1.02-1.08; P=.002) and at the 6-month follow up (OR 1.04, 95% CI 1.007-1.07; P=.02). This effect was not significant for the number of days participants engaged with the smoking cessation content of the app, either at the end of treatment (OR 1.04, 95% CI 0.996-1.08, P=.08) or at the 6-month follow up (OR 1.02, 95% CI 0.98-1.06; P=.29). Conclusions: Greater app usage predicted greater odds of self-reported 30-day point-prevalence abstinence at both the end of treatment and over the long term, suggesting that the app had a therapeutic benefit. Positive psychology content and prescriptive clarity may promote sustained app engagement over time. Trial Registration: ClinicalTrials.gov NCT03951766; https://clinicaltrials.gov/ct2/show/NCT03951766 %M 35900835 %R 10.2196/38234 %U https://formative.jmir.org/2022/7/e38234 %U https://doi.org/10.2196/38234 %U http://www.ncbi.nlm.nih.gov/pubmed/35900835 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e35701 %T Effects of a Gamified, Behavior Change Technique–Based Mobile App on Increasing Physical Activity and Reducing Anxiety in Adults With Autism Spectrum Disorder: Feasibility Randomized Controlled Trial %A Lee,Daehyoung %A Frey,Georgia C %A Cothran,Donetta J %A Harezlak,Jaroslaw %A Shih,Patrick C %+ Department of Applied Human Sciences, University of Minnesota Duluth, 123 Sports and Health Center, 1216 Ordean Court, Duluth, MN, 55812, United States, 1 2187267816, lee03284@d.umn.edu %K gamification %K behavior change techniques %K physical activity %K sedentary behavior %K anxiety %K autism %K mobile app %K mental health %K mHealth %K mobile phone %D 2022 %7 28.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical activity (PA) has an impact on physical and mental health in neurotypical populations, and addressing these variables may improve the prevalent burden of anxiety in adults with autism spectrum disorder (ASD). Gamified mobile apps using behavior change techniques present a promising way of increasing PA and reducing sedentary time, thus reducing anxiety in adults with ASD. Objective: This study aimed to compare the effectiveness of a gamified and behavior change technique–based mobile app, PuzzleWalk, versus a commercially available app, Google Fit, on increasing PA and reducing sedentary time as an adjunct anxiety treatment for this population. Methods: A total of 24 adults with ASD were assigned to either the PuzzleWalk or Google Fit group for 5 weeks using a covariate-adaptive randomization design. PA and anxiety were assessed over 7 days at 3 different data collection periods (ie, baseline, intervention start, and intervention end) using triaxial accelerometers and the Beck Anxiety Inventory. Group differences in outcome variables were assessed using repeated-measures analysis of covariance, adjusting for age, sex, and BMI. Results: The findings indicated that the PuzzleWalk group spent a significantly longer amount of time on app use compared with the Google Fit group (F2,38=5.07; P=.01; partial η2=0.21), whereas anxiety was unfavorably associated with increases in light PA and decreases in sedentary time after intervention (all P<.05). Conclusions: Further research is needed to clarify the determinants of physical and mental health and their interrelationship in adults with ASD to identify the factors that facilitate the use and adoption of mobile health technologies in these individuals. Despite these mixed results, the small changes in PA or anxiety may be clinically significant for adults with ASD. Trial Registration: ClinicalTrials.gov NCT05466617; https://clinicaltrials.gov/show/NCT05466617 %M 35900808 %R 10.2196/35701 %U https://formative.jmir.org/2022/7/e35701 %U https://doi.org/10.2196/35701 %U http://www.ncbi.nlm.nih.gov/pubmed/35900808 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e35749 %T Understanding Design Approaches and Evaluation Methods in mHealth Apps Targeting Substance Use: Protocol for a Systematic Review %A Kunchay,Sahiti %A Linden-Carmichael,Ashley N %A Lanza,Stephanie T %A Abdullah,Saeed %+ College of Information Sciences and Technology, The Pennsylvania State University, E397 Westgate Building, University Park, PA, 16802, United States, 1 814 865 8947, sahiti@psu.edu %K substance use %K mHealth %K human-centered design %K use disorder %K substance %K design rationale %K theoretical framing %K protocol %K systematic review %K mobile health %K smartphone %K mobile phone %K digital health %D 2022 %7 28.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Substance use and use disorders in the United States have had significant and devastating impacts on individuals and communities. This escalating substance use crisis calls for urgent and innovative solutions to effectively detect and provide interventions for individuals in times of need. Recent mobile health (mHealth)–based approaches offer promising new opportunities to address these issues through ubiquitous devices. However, the design rationales, theoretical frameworks, and mechanisms through which users’ perspectives and experiences guide the design and deployment of such systems have not been analyzed in any prior systematic reviews. Objective: In this paper, we systematically review these approaches and apps for their feasibility, efficacy, and usability. Further, we evaluate whether human-centered research principles and techniques guide the design and development of these systems and examine how the current state-of-the-art systems apply to real-world contexts. In an effort to gauge the applicability of these systems, we also investigate whether these approaches consider the effects of stigma and privacy concerns related to collecting data on substance use. Lastly, we examine persistent challenges in the design and large-scale adoption of substance use intervention apps and draw inspiration from other domains of mHealth to suggest actionable reforms for the design and deployment of these apps. Methods: Four databases (PubMed, IEEE Xplore, JMIR, and ACM Digital Library) were searched over a 5-year period (2016-2021) for articles evaluating mHealth approaches for substance use (alcohol use, marijuana use, opioid use, tobacco use, and substance co-use). Articles that will be included describe an mHealth detection or intervention targeting substance use, provide outcomes data, and include a discussion of design techniques and user perspectives. Independent evaluation will be conducted by one author, followed by secondary reviewer(s) who will check and validate themes and data. Results: This is a protocol for a systematic review; therefore, results are not yet available. We are currently in the process of selecting the studies for inclusion in the final analysis. Conclusions: To the best of our knowledge, this is the first systematic review to assess real-world applicability, scalability, and use of human-centered design and evaluation techniques in mHealth approaches targeting substance use. This study is expected to identify gaps and opportunities in current approaches used to develop and assess mHealth technologies for substance use detection and intervention. Further, this review also aims to highlight various design processes and components that result in engaging, usable, and effective systems for substance use, informing and motivating the future development of such systems. International Registered Report Identifier (IRRID): DERR1-10.2196/35749 %M 35900813 %R 10.2196/35749 %U https://www.researchprotocols.org/2022/7/e35749 %U https://doi.org/10.2196/35749 %U http://www.ncbi.nlm.nih.gov/pubmed/35900813 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e32330 %T The Role of mHealth Interventions in Changing Gender Relations: Systematic Review of Qualitative Findings %A Kirkwood,Elizabeth K %A Clymer,Caitlin %A Imbulana,Kheminda %A Mozumder,Sumaya %A Dibley,Michael J %A Alam,Neeloy Ashraful %+ Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, 328 Edward Ford, Camperdown, 2006, Australia, 61 0410517874, elizabeth.kirkwood@sydney.edu.au %K mobile health %K mHealth %K gender relations %K systematic review %K low- and middle-income countries %K mobile phone %D 2022 %7 21.7.2022 %9 Review %J JMIR Hum Factors %G English %X Background: The rapid and widespread growth of mobile technologies in low- and middle-income countries can offer groundbreaking ways of disseminating public health interventions. However, gender-based inequalities present a challenge for women in accessing mobile technology. Research has shown that mobile health (mHealth) interventions can affect gender relations in both positive and negative ways; however, few mHealth programs use a gender-sensitive lens when designing, implementing, or analyzing programs. Objective: This systematic review aims to identify and summarize the findings of qualitative research studies that explore the impact of mHealth interventions on gender relations as a result of participating in such initiatives in low- and middle-income countries. Methods: We performed a systematic literature review to examine empirical evidence of changes in gender relations attributed to participation in an mHealth intervention in low- and middle-income countries. Peer-reviewed articles were included based on whether they evaluated an mHealth intervention and were published between 2013 and 2020. Articles using mHealth that solely targeted health workers, did not assess a specific intervention, used mobile technology for data collection only, or were formative or exploratory in nature were excluded. The search terms were entered into 4 key electronic databases—MEDLINE, EMBASE, PsycINFO, and Scopus—generating a comprehensive list of potentially relevant peer-reviewed articles. Thematic analysis was used to identify, analyze, and report the themes that emerged from our data. Results: Of the 578 full-text articles retrieved, 14 (2.4%) were eligible for inclusion in the study. None of the articles appraised gender from the outset. The articles uncovered findings on gender relations through the course of the intervention or postprogram evaluation. Most studies took place in sub-Saharan Africa, with the remainder in South and Southeast Asia. The articles focused on maternal and child health, HIV diagnosis and treatment, and reproductive health. This review found that mHealth programs could enhance spousal communication, foster emotional support between couples, improve women’s self-efficacy and autonomy in seeking health information and services, and increase their involvement in health-related decision-making. Despite the positive impacts, some mHealth interventions had an adverse effect, reinforcing the digital divide, upholding men as gatekeepers of information and sole decision-makers, and exacerbating relationship problems. Conclusions: These results suggest that given the rapid and persistent upscale of mHealth interventions in low- and middle-income settings, it is imperative to design interventions that consider their impact on power dynamics and gender relations. Future research is needed to fill the evidence gaps on gender and mHealth, acknowledging that women are not passive beneficiaries and that they need to actively participate and be empowered by mHealth interventions. %M 35862143 %R 10.2196/32330 %U https://humanfactors.jmir.org/2022/3/e32330 %U https://doi.org/10.2196/32330 %U http://www.ncbi.nlm.nih.gov/pubmed/35862143 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e35197 %T Exploring an Artificial Intelligence–Based, Gamified Phone App Prototype to Track and Improve Food Choices of Adolescent Girls in Vietnam: Acceptability, Usability, and Likeability Study %A C Braga,Bianca %A Nguyen,Phuong H %A Aberman,Noora-Lisa %A Doyle,Frank %A Folson,Gloria %A Hoang,Nga %A Huynh,Phuong %A Koch,Bastien %A McCloskey,Peter %A Tran,Lan %A Hughes,David %A Gelli,Aulo %+ Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, United States, 1 6176363777, curi.bianca@tufts.edu %K adolescent %K dietary quality %K food choice %K gamification %K low- and middle-income country %K smartphone app %K mobile phone %D 2022 %7 21.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents’ consumption of healthy foods is suboptimal in low- and middle-income countries. Adolescents’ fondness for games and social media and the increasing access to smartphones make apps suitable for collecting dietary data and influencing their food choices. Little is known about how adolescents use phones to track and shape their food choices. Objective: This study aimed to examine the acceptability, usability, and likability of a mobile phone app prototype developed to collect dietary data using artificial intelligence–based image recognition of foods, provide feedback, and motivate users to make healthier food choices. The findings were used to improve the design of the app. Methods: A total of 4 focus group discussions (n=32 girls, aged 15-17 years) were conducted in Vietnam. Qualitative data were collected and analyzed by grouping ideas into common themes based on content analysis and ground theory. Results: Adolescents accepted most of the individual- and team-based dietary goals presented in the app prototype to help them make healthier food choices. They deemed the overall app wireframes, interface, and graphic design as acceptable, likable, and usable but suggested the following modifications: tailored feedback based on users’ medical history, anthropometric characteristics, and fitness goals; new language on dietary goals; provision of information about each of the food group dietary goals; wider camera frame to fit the whole family food tray, as meals are shared in Vietnam; possibility of digitally separating food consumption on shared meals; and more appealing graphic design, including unique badge designs for each food group. Participants also liked the app’s feedback on food choices in the form of badges, notifications, and statistics. A new version of the app was designed incorporating adolescent’s feedback to improve its acceptability, usability, and likability. Conclusions: A phone app prototype designed to track food choice and help adolescent girls from low- and middle-income countries make healthier food choices was found to be acceptable, likable, and usable. Further research is needed to examine the feasibility of using this technology at scale. %M 35862147 %R 10.2196/35197 %U https://formative.jmir.org/2022/7/e35197 %U https://doi.org/10.2196/35197 %U http://www.ncbi.nlm.nih.gov/pubmed/35862147 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e36974 %T Quality Assessment of Digital Health Applications: Protocol for a Scoping Review %A Giebel,Godwin Denk %A Schrader,Nils Frederik %A Speckemeier,Christian %A Abels,Carina %A Börchers,Kirstin %A Wasem,Jürgen %A Blase,Nikola %A Neusser,Silke %+ Institute for Healthcare Management and Research, University of Duisburg-Essen, Weststadt-Carree, Thea-Leymann-Straße 9, Essen, 45127, Germany, 49 2011833180, godwin.giebel@medman.uni-due.de %K digital health application %K mHealth %K mHealth app %K quality assurance %K quality assessment %K mobile health %K application %K protocol %K app %K digital health %K telehealth %K eHealth %D 2022 %7 20.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: All over the world, development and usage of mobile health (mHealth) apps is increasing. While apps offer numerous opportunities to improve health care, there are associated problems that differ significantly from those of traditional health care services. Further investigations on the quality of mHealth apps are needed to address these problems. Objective: This study aims to identify and map research on quality assessment and quality assurance of mHealth apps and their transferability to continuous quality assurance of mHealth apps. Methods: The scoping review will follow published methodological frameworks for scoping studies as well as Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews criteria. Electronic databases (Medline, EMBASE, and PsycINFO), reference lists of relevant articles, and websites of relevant institutions will be searched. Two reviewers will independently assess eligibility of articles. Therefore, a 2-stage (title and abstract, followed by full text) screening process was conducted. Quality management systems and quality assessment tools will be analyzed and included in our review. Particular focus is placed on quality dimensions. Results: This scoping review provides an overview of the available evidence and identifies research gaps regarding continuous quality assessment of mHealth apps. Thereby, relevant quality dimensions and criteria can be identified and their eligibility and relevance for the development of a continuous quality assurance system of mHealth apps can be determined. Our results are planned to be submitted to an indexed, peer-reviewed journal in the second half of 2022. Conclusions: This is the first review in the context of continuous quality assurance of mHealth apps. Our results will be used within the research “Continuous quality assurance of Digital Health Applications” (“QuaSiApps”) project funded by the German Federal Joint Committee. International Registered Report Identifier (IRRID): DERR1-10.2196/36974 %M 35857359 %R 10.2196/36974 %U https://www.researchprotocols.org/2022/7/e36974 %U https://doi.org/10.2196/36974 %U http://www.ncbi.nlm.nih.gov/pubmed/35857359 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e32280 %T Inducing and Recording Acute Stress Responses on a Large Scale With the Digital Stress Test (DST): Development and Evaluation Study %A Norden,Matthias %A Hofmann,Amin Gerard %A Meier,Martin %A Balzer,Felix %A Wolf,Oliver T %A Böttinger,Erwin %A Drimalla,Hanna %+ Faculty of Technology, Bielefeld University, Postfach 10 01 31, Bielefeld, 33619, Germany, 49 521 106 12043, drimalla@techfak.uni-bielefeld.de %K stress induction %K smartphone %K stress reactivity %K Trier Social Stress Test %K TSST %K remote %K video recording %K acute stress %K digital health %K mobile health %K mHealth %K mobile phone %D 2022 %7 15.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Valuable insights into the pathophysiology and consequences of acute psychosocial stress have been gained using standardized stress induction experiments. However, most protocols are limited to laboratory settings, are labor-intensive, and cannot be scaled to larger cohorts or transferred to daily life scenarios. Objective: We aimed to provide a scalable digital tool that enables the standardized induction and recording of acute stress responses in outside-the-laboratory settings without any experimenter contact. Methods: On the basis of well-described stress protocols, we developed the Digital Stress Test (DST) and evaluated its feasibility and stress induction potential in a large web-based study. A total of 284 participants completed either the DST (n=103; 52/103, 50.5% women; mean age 31.34, SD 9.48 years) or an adapted control version (n=181; 96/181, 53% women; mean age 31.51, SD 11.18 years) with their smartphones via a web application. We compared their affective responses using the international Positive and Negative Affect Schedule Short Form before and after stress induction. In addition, we assessed the participants’ stress-related feelings indicated in visual analogue scales before, during, and after the procedure, and further analyzed the implemented stress-inducing elements. Finally, we compared the DST participants’ stress reactivity with the results obtained in a classic stress test paradigm using data previously collected in 4 independent Trier Social Stress Test studies including 122 participants overall. Results: Participants in the DST manifested significantly higher perceived stress indexes than the Control-DST participants at all measurements after the baseline (P<.001). Furthermore, the effect size of the increase in DST participants’ negative affect (d=0.427) lay within the range of effect sizes for the increase in negative affect in the previously conducted Trier Social Stress Test experiments (0.281-1.015). Conclusions: We present evidence that a digital stress paradigm administered by smartphone can be used for standardized stress induction and multimodal data collection on a large scale. Further development of the DST prototype and a subsequent validation study including physiological markers are outlined. %M 35838765 %R 10.2196/32280 %U https://www.jmir.org/2022/7/e32280 %U https://doi.org/10.2196/32280 %U http://www.ncbi.nlm.nih.gov/pubmed/35838765 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e36811 %T The Outcomes of App-Based Health Coaching to Improve Dietary Behavior Among Nurses in a Tertiary Hospital: Pilot Intervention Study %A Lim,Wei Xiang %A Fook-Chong,Stephanie %A Lim,John Wah %A Gan,Wee Hoe %+ Department of Occupational and Environmental Medicine, Singapore General Hospital, Academia, Level 4, 20 College Road, Singapore, 169856, Singapore, 65 65767438, gan.wee.hoe@singhealth.com.sg %K smartphone app %K weight loss %K dietary behavior %K nurse %K app %K mobile health %K mHealth %K app-based health %K health coaching %K diet %K dietary choice %D 2022 %7 15.7.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: At the workplace, health care workers face multiple challenges in maintaining healthy dietary behaviors, which is the major factor behind obesity. A hospital-wide mass health screening exercise showed an increasing trend in the prevalence of obesity and median BMI from 2004 to 2019, as well as a higher crude obesity rate among shift workers. Objective: We aimed to evaluate the effectiveness of mobile app–based health coaching and incentives for achieving weight loss from better dietary choices among hospital nurses. Methods: We conducted a pilot study from June 2019 to March 2020, involving the use of a health-coaching app by 145 hospital nurses over 6 months. Weight and BMI were self-reported, and food scores were calculated. Data among overweight nurses, shift work nurses, and incentive groups were analyzed. Results: A total of 61 nurses were included in the final analysis. Of these 61 nurses, 38 (62%) lost weight. The median percentage weight loss was 1.2% (IQR 0%-2.9%; P<.001), and the median decrease in BMI was 0.35 (IQR −0.15 to 0.82; P<.001), but they were not clinically significant. The median improvement in the food score was 0.4 (IQR 0-0.8). There was no difference between the incentive and nonincentive groups. A total of 49 (34%) participants engaged for ≥8 weeks. Conclusions: The study demonstrated an association between the use of app-based health coaching and the attainment of some weight loss in nurses, without a significant improvement in the food score. Incentives may nudge on-boarding, but do not sustain engagement. %M 35838811 %R 10.2196/36811 %U https://nursing.jmir.org/2022/1/e36811 %U https://doi.org/10.2196/36811 %U http://www.ncbi.nlm.nih.gov/pubmed/35838811 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e34277 %T Effects of an mHealth Intervention for Pulmonary Tuberculosis Self-management Based on the Integrated Theory of Health Behavior Change: Randomized Controlled Trial %A Bao,Yuhan %A Wang,Chunxiang %A Xu,Haiping %A Lai,Yongjie %A Yan,Yupei %A Ma,Yuanyuan %A Yu,Ting %A Wu,Yibo %+ School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China, 86 18810169630, bjmuwuyibo@outlook.com %K ITHBC %K mHealth %K RCT %K pulmonary tuberculosis %D 2022 %7 14.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Improving the health self-management level of patients with tuberculosis (TB) is significant for reducing drug resistance, improving the cure rate, and controlling the prevalence of TB. Mobile health (mHealth) interventions based on behavioral science theories may be promising to achieve this goal. Objective: This study aims to explore and conduct an mHealth intervention based on the Integrated Theory of Health Behavior Change (ITHBC) in patients with pulmonary TB to increase their ability of self-care management. Methods: A prospective randomized controlled study was conducted from May to November 2020. A total of 114 patients who were admitted consecutively to the TB clinic of Harbin Chest Hospital, China from May 2020 to August 2020 were recruited by convenience sampling. Patients were divided into the control group and intervention group, and all received a 3-month intervention. Patients in the intervention group and the control group received routine medical and nursing care in the TB clinic, including the supervision of their medications. In addition, pharmacist-assisted mHealth (WeChat) intervention based on the ITHBC theory about TB management was provided to the intervention group. The primary outcome was self-management behavior, while the secondary outcomes were TB awareness, self-efficacy, social support, and degree of satisfaction with health education. The outcomes were measured using web-based self-designed and standard questionnaires administered at baseline and at the end point of the study. Intergroup data were assessed using the Mann-Whitney U test, whereas intragroup data were assessed with the Wilcoxon test (for paired samples). Results: A total of 112 patients (59 in intervention group and 53 in control group) completed the study. After the intervention, a statistically significant increase was noted in the scores of each item of self-care management behaviors compared with the scores at the baseline (P<.001) in the intervention group. The scores of all self-care management behaviors of the control group were lower than those of all self-care management behaviors in the intervention group (all P<.05), except for the item “cover your mouth and nose when coughing or sneezing” (P=.23) and item “wash hands properly” (P=.60), which had no statistically significant difference from those in the intervention group. Compared with those at baseline, TB knowledge awareness, self-efficacy, social support, and degree of satisfaction with health education in the intervention group increased significantly (P<.001), and the intervention group had significantly higher scores than the control group (P<.001). Conclusions: mHealth intervention for TB self-management based on ITHBC could deepen the understanding of patients with TB about their disease and improve their objective initiative and self-care management behaviors, which were beneficial for promoting compliance behavior and quality of prevention and control for pulmonary TB. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200055557; https://tinyurl.com/4ray3xnw %M 35834302 %R 10.2196/34277 %U https://publichealth.jmir.org/2022/7/e34277 %U https://doi.org/10.2196/34277 %U http://www.ncbi.nlm.nih.gov/pubmed/35834302 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e37934 %T Burnout and Associated Psychological Problems Among Teachers and the Impact of the Wellness4Teachers Supportive Text Messaging Program: Protocol for a Cross-sectional and Program Evaluation Study %A Agyapong,Belinda %A Wei,Yifeng %A da Luz Dias,Raquel %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor Abbie J Lane Memorial Building QEII Health Sciences Centre, Halifax, NS, B3H 4R2, Canada, 1 7807144315, vincent.agyapong@nshealth.ca %K burnout %K stress %K Wellness4Teachers %K anxiety %K depression %K e-mental health %K teachers %K support %K text message %K mental health %K SMS %K high school %K elementary school %K prevalence %K psychological intervention %K school %D 2022 %7 14.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Stress, burnout, anxiety, and depression continue to be a problem among teachers worldwide. It is not presently known what the prevalence and correlates for these psychological problems are among teachers in Alberta and Nova Scotia. It is also not known if a supportive text message program (Wellness4Teachers) would be effective in reducing stress, burnout, anxiety, or depression symptoms among teachers. Objective: The goal of this study is to evaluate the prevalence and correlates of stress, burnout, symptoms of anxiety, depression, and low resilience among elementary and high school teachers in Alberta and Nova Scotia, Canada. It also aims to determine if daily supportive text messages can help reduce the prevalence of these psychological problems in teachers. Methods: This is a cross-sessional mixed methods study with data to be collected from subscribers of Wellness4Teachers using a web-based survey at baseline (onset of text messaging), 6 weeks, the program’s midpoint (3 months), and end point (6 months). Teachers can subscribe to the Wellness4Teachers program by texting the keyword “TeachWell” to the program phone number. Outcome measures will be assessed using standardized rating scales and key informant interviews. Data will be analyzed with descriptive and inferential statistics using SPSS and thematic analysis using NVivo. Results: The results of this study are expected 24 months after program launch. It is expected that the prevalence of stress, burnout, anxiety, depression, and low resilience among teachers in Alberta and Nova Scotia would be comparable to those reported in other jurisdictions. It is also expected that factors such as gender, number of years teaching, grade of teaching, and school type (elementary vs high school) will have an association with burnout and other psychological disorders among teachers. Furthermore, it is expected that Wellness4Teachers will reduce the prevalence and severity of psychological problems in teachers, and subscriber satisfaction will be high. Conclusions: The Wellness4Teachers project will provide key information regarding prevalence and correlates of common mental health conditions in teachers in Alberta and Nova Scotia, as well as the impact of daily supportive text messages on these mental health parameters. Information from this study will be useful for informing policy and decision-making concerning psychological interventions for schoolteachers. %M 35834305 %R 10.2196/37934 %U https://www.researchprotocols.org/2022/7/e37934 %U https://doi.org/10.2196/37934 %U http://www.ncbi.nlm.nih.gov/pubmed/35834305 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e36666 %T Investigating Microtemporal Processes Underlying Health Behavior Adoption and Maintenance: Protocol for an Intensive Longitudinal Observational Study %A Wang,Shirlene %A Intille,Stephen %A Ponnada,Aditya %A Do,Bridgette %A Rothman,Alexander %A Dunton,Genevieve %+ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1875 N Soto St, 3rd Floor, Los Angeles, CA, 90032, United States, 1 3125327663, shirlenw@usc.edu %K emerging adulthood %K behavior change %K longitudinal data collection %K ecological momentary assessment %K sensing %K theory %K young adult %K weight gain %K EMA %K chronic disease %K physical activity %D 2022 %7 14.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young adulthood (ages 18-29 years) is marked by substantial weight gain, leading to increased lifetime risks of chronic diseases. Engaging in sufficient levels of physical activity and sleep, and limiting sedentary time are important contributors to the prevention of weight gain. Dual-process models of decision-making and behavior that delineate reflective (ie, deliberative, slow) and reactive (ie, automatic, fast) processes shed light on different mechanisms underlying the adoption versus maintenance of these energy-balance behaviors. However, reflective and reactive processes may unfold at different time scales and vary across people. Objective: This paper describes the study design, recruitment, and data collection procedures for the Temporal Influences on Movement and Exercise (TIME) study, a 12-month intensive longitudinal data collection study to examine real-time microtemporal influences underlying the adoption and maintenance of physical activity, sedentary behavior, and sleep. Methods: Intermittent ecological momentary assessment (eg, intentions, self-control) and continuous, sensor-based passive monitoring (eg, location, phone/app use, activity levels) occur using smartwatches and smartphones. Data analyses will combine idiographic (person-specific, data-driven) and nomothetic (generalizable, theory-driven) approaches to build models that may predict within-subject variation in the likelihood of behavior “episodes” (eg, ≥10 minutes of physical activity, ≥120 minutes of sedentary time, ≥7 hours sleep) and “lapses” (ie, not attaining recommended levels for ≥7 days) as a function of reflective and reactive factors. Results: The study recruited young adults across the United States (N=246). Rolling recruitment began in March 2020 and ended August 2021. Data collection will continue until August 2022. Conclusions: Results from the TIME study will be used to build more predictive health behavior theories, and inform personalized behavior interventions to reduce obesity and improve public health. International Registered Report Identifier (IRRID): DERR1-10.2196/36666 %M 35834296 %R 10.2196/36666 %U https://www.researchprotocols.org/2022/7/e36666 %U https://doi.org/10.2196/36666 %U http://www.ncbi.nlm.nih.gov/pubmed/35834296 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 7 %P e35684 %T Wearing the Future—Wearables to Empower Users to Take Greater Responsibility for Their Health and Care: Scoping Review %A Kang,Harjeevan Singh %A Exworthy,Mark %+ College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom, 44 121 414 3344, harjeevankangmedicine@gmail.com %K wearable %K device %K tracker %K activity tracker %K fitness tracker %K technology %K MedTech %K HealthTech %K sensor %K monitor %K gadget %K smartwatch %K empowerment %K self-care %K management %K behavior %K responsibility %K attitude %K personalization %K mobile phone %K self-management %K smartphone %K wearable electronic devices %K health promotion %K health behavior %K mHealth %K digital health %K health care wearables %K scoping review %D 2022 %7 13.7.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Wearables refer to devices that are worn by individuals. In the health care field, wearables may assist with individual monitoring and diagnosis. In fact, the potential for wearable technology to assist with health care has received recognition from health systems around the world, including a place in the strategic Long Term Plan shared by the National Health Service in England. However, wearables are not limited to specialist medical devices used by patients. Leading technology companies, including Apple, have been exploring the capabilities of wearable health technology for health-conscious consumers. Despite advancements in wearable health technology, research is yet to be conducted on wearables and empowerment. Objective: This study aimed to identify, summarize, and synthesize knowledge on how wearable health technology can empower individuals to take greater responsibility for their health and care. Methods: This study was a scoping review with thematic analysis and narrative synthesis. Relevant guidance, such as the Arksey and O’Malley framework, was followed. In addition to searching gray literature, we searched MEDLINE, EMBASE, PsycINFO, HMIC, and Cochrane Library. Studies were included based on the following selection criteria: publication in English, publication in Europe or the United States, focus on wearables, relevance to the research, and the availability of the full text. Results: After identifying 1585 unique records and excluding papers based on the selection criteria, 20 studies were included in the review. On analysis of these 20 studies, 3 main themes emerged: the potential barriers to using wearables, the role of providers and the benefits to providers from promoting the use of wearables, and how wearables can drive behavior change. Conclusions: Considerable literature findings suggest that wearables can empower individuals by assisting with diagnosis, behavior change, and self-monitoring. However, greater adoption of wearables and engagement with wearable devices depend on various factors, including promotion and support from providers to encourage uptake; increased short-term investment to upskill staff, especially in the area of data analysis; and overcoming the barriers to use, particularly by improving device accuracy. Acting on these suggestions will require investment and constructive input from key stakeholders, namely users, health care professionals, and designers of the technology. As advancements in technology to make wearables viable health care devices have only come about recently, further studies will be important for measuring the effectiveness of wearables in empowering individuals. The investigation of user outcomes through large-scale studies would also be beneficial. Nevertheless, a significant challenge will be in the publication of research to keep pace with rapid developments related to wearable health technology. %M 35830222 %R 10.2196/35684 %U https://mhealth.jmir.org/2022/7/e35684 %U https://doi.org/10.2196/35684 %U http://www.ncbi.nlm.nih.gov/pubmed/35830222 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e35898 %T Relationship Between Protein Intake in Each Traditional Meal and Physical Activity: Cross-sectional Study %A Shinto,Takae %A Makino,Saneyuki %A Tahara,Yu %A Nitta,Lyie %A Kuwahara,Mai %A Tada,Ayako %A Abe,Nanako %A Michie,Mikiko %A Shibata,Shigenobu %+ Department of Bioscience and Engineering, Waseda University, Wakamatsu-cho 2-2, Shinjuku-ku, Tokyo, 162-0056, Japan, 81 +81353697318, shibatas@waseda.jp %K protein %K dietary pattern %K physical activity %K chrononutrition %D 2022 %7 12.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Protein intake plays an important role in the synthesis and maintenance of skeletal muscles for the prevention of health risks. It is also widely known that physical activity influences muscle function. However, no large-scale studies have examined the relationship between daily dietary habits, especially the timing of protein intake, and daily physical activity. Objective: The purpose of this cross-sectional study was to investigate how protein intake and composition (involving the 3 major nutrients protein, fat, and carbohydrate) in the 3 traditional meals (breakfast, lunch, and dinner) are associated with physical activity. Methods: Using daily dietary data accumulated in the smartphone food log app “Asken” and a web-based cross-sectional survey involving Asken users (N=8458), we analyzed nutrient intake and composition, as well as daily activity levels. As very few individuals skipped breakfast (1102/19,319 responses, 5.7%), we analyzed data for 3 meals per day. Results: Spearman rank correlation analysis revealed that breakfast and lunch protein intakes had higher positive correlations with daily physical activity among the 3 major macronutrients (P<.001). These findings were confirmed by multivariate logistic regression analysis with confounding factors. Moreover, participants with higher protein intake and composition at breakfast or lunch tended to exhibit significantly greater physical activity than those with higher protein intake at dinner (P<.001). Conclusions: Among the 3 macronutrients, protein intake during breakfast and lunch was closely associated with daily physical activity. %M 35819831 %R 10.2196/35898 %U https://publichealth.jmir.org/2022/7/e35898 %U https://doi.org/10.2196/35898 %U http://www.ncbi.nlm.nih.gov/pubmed/35819831 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 7 %P e34767 %T The Association Between Smartphone App–Based Self-monitoring of Hypertension-Related Behaviors and Reductions in High Blood Pressure: Systematic Review and Meta-analysis %A Kassavou,Aikaterini %A Wang,Michael %A Mirzaei,Venus %A Shpendi,Sonia %A Hasan,Rana %+ The Primary Care Unit, Department of Public Health and Primary Care, The University of Cambridge, East Forvie Building, Cambridge, CB2 0SR, United Kingdom, 44 1223330456, aikaterini.kassavou@wbs.ac.uk %K self-monitoring %K smartphone apps %K behavior change %K hypertension %K blood pressure %K mobile health %K mHealth %K mobile app %K self-management %K lifestyle %D 2022 %7 12.7.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Self-monitoring of behavior can support lifestyle modifications; however, we do not know whether such interventions are effective in supporting positive changes in hypertension-related health behaviors and thus in reducing blood pressure in patients treated for hypertension. Objective: This systematic literature review evaluates the extent to which smartphone app–based self-monitoring of health behavior supports reductions in blood pressure and changes in hypertension-related behaviors. It also explores the behavioral components that might explain intervention effectiveness. Methods: A systematic search of 7 databases was conducted in August 2021. Article screening, study and intervention coding, and data extraction were completed independently by reviewers. The search strategy was developed using keywords from previous reviews and relevant literature. Trials involving adults, published after the year 2000, and in the English language were considered for inclusion. The random-effects meta-analysis method was used to account for the distribution of the effect across the studies. Results: We identified 4638 articles, of which 227 were included for full-text screening. A total of 15 randomized controlled trials were included in the review. In total, 7415 patients with hypertension were included in the meta-analysis. The results indicate that app-based behavioral self-monitoring interventions had a small but significant effect in reducing systolic blood pressure (SBP), on average, by 1.64 mmHg (95% CI 2.73-0.55, n=7301; odds ratio [OR] 1.60, 95% CI 0.74-3.42, n=114) and in improving changes in medication adherence behavior (standardized mean difference [SMD] 0.78, 95% CI 0.22-1.34) compared to usual care or minimal intervention. The review found the intervention had a small effect on supporting improvements in healthy diet by changing habits related to high sodium food (SMD –0.44, 95% CI –0.79 to –0.08) and a trend, although insignificant, toward supporting smoking cessation, low alcohol consumption, and better physical activity behaviors. A subgroup analysis found that behavioral self-monitoring interventions combined with tailored advice resulted in higher and significant changes in both SBP and diastolic blood pressure (DBP) in comparison to those not providing tailored advice (SBP: –2.92 mmHg, 95% CI –3.94 to –1.90, n=3102 vs –0.72 mmHg, 95% CI –1.67 to 0.23, n=4199, χ2=9.65, P=.002; DBP: –2.05 mmHg, 95% CI –3.10 to –1.01, n=968 vs 1.54 mmHg, 95% CI –0.53 to 3.61, n=400, χ2=9.19, P=.002). Conclusions: Self-monitoring of hypertension-related behaviors via smartphone apps combined with tailored advice has a modest but potentially clinically significant effect on blood pressure reduction. Future studies could use rigorous methods to explore its effects on supporting changes in both blood pressure and hypertension-related health behaviors to inform recommendations for policy making and service provision. Trial Registration: PROSPERO CRD42019136158; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=136158 %M 35819830 %R 10.2196/34767 %U https://mhealth.jmir.org/2022/7/e34767 %U https://doi.org/10.2196/34767 %U http://www.ncbi.nlm.nih.gov/pubmed/35819830 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e36018 %T Improving Well-being With a Mobile Artificial Intelligence–Powered Acceptance Commitment Therapy Tool: Pragmatic Retrospective Study %A Naor,Navot %A Frenkel,Alex %A Winsberg,Mirène %+ Kai.ai, Yigal Alon St 114, Tel Aviv, 6744320, Israel, 972 502183965, navot@kai.ai %K Acceptance Commitment Therapy %K well-being %K WHO-5 %K World Health Organization-Five Well-Being Index %K mHealth %K mobile health %K smartphone %K health application %K mental health %K quality of life %K artificial intelligence %D 2022 %7 12.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Research and dissemination of smartphone apps to deliver coaching and psychological driven intervention had seen a great surge in recent years. Notably, Acceptance Commitment Therapy (ACT) protocols were shown to be uniquely effective in treating symptoms for both depression and anxiety when delivered through smartphone apps. The aim of this study is to expand on that work and test the suitability of artificial intelligence–driven interventions delivered directly through popular texting apps. Objective: This study evaluated our hypothesis that using Kai.ai will result in improved well-being. Methods: We performed a pragmatic retrospective analysis of 2909 users who used Kai.ai on one of the top messaging apps (iMessage, WhatsApp, Discord, Telegram, etc). Users’ well-being levels were tracked using the World Health Organization-Five Well-Being Index throughout the engagement with service. A 1-tailed paired samples t test was used to assess well-being levels before and after usage, and hierarchical linear modeling was used to examine the change in symptoms over time. Results: The median well-being score at the last measurement was higher (median 52) than that at the start of the intervention (median 40), indicating a significant improvement (W=2682927; P<.001). Furthermore, HLM results showed that the improvement in well-being was linearly related to the number of daily messages a user sent (β=.029; t81.36=4; P<.001), as well as the interaction between the number of messages and unique number of days (β=–.0003; t81.36=–2.2; P=.03). Conclusions: Mobile-based ACT interventions are effective means to improve individuals’ well-being. Our findings further demonstrate Kai.ai’s great promise in helping individuals improve and maintain high levels of well-being and thus improve their daily lives. %M 35598216 %R 10.2196/36018 %U https://formative.jmir.org/2022/7/e36018 %U https://doi.org/10.2196/36018 %U http://www.ncbi.nlm.nih.gov/pubmed/35598216 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e25982 %T Developing a Consensus for Adolescent and Young Adult mHealth HIV Prevention Interventions in the United States: A Delphi Method Study %A Knowles,Kayla %A Dowshen,Nadia %A Lee,Susan %A Tanner,Amanda %+ PolicyLab, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 10th Floor, #10-2222, Philadelphia, PA, 19146, United States, 1 267 425 1449, knowlesk1@chop.edu %K HIV prevention and care %K adolescents %K mHealth %K mobile apps %K Delphi method %K health application %K HIV care %K HIV prevention %K health intervention %K public health %K health care %K health accessibility %K health technology %K digital health %K HIV %D 2022 %7 12.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Engaging adolescents and young adults (AYAs) who are at elevated risk for HIV acquisition or who are living with HIV in health care has posed a major challenge in HIV prevention and care efforts. Mobile health (mHealth) interventions are a popular and accessible strategy to support AYA engagement despite barriers to care present along the HIV care continuum. Even with progress in the field of mHealth research, expert recommendations for the process of designing, evaluating, and implementing HIV-related mHealth interventions are underdeveloped. Objective: The aim of this study was to compile expert recommendations on the development, evaluation, and implementation of AYA-focused HIV prevention and care mHealth interventions. Methods: Experts from adolescent mHealth HIV research networks and investigators of recently funded HIV mHealth projects and programs were identified and invited to complete a series of electronic surveys related to the design, implementation, and evaluation of HIV-related mHealth interventions. A modified Delphi method was used to ask experts to score 35 survey items on a 4-point Likert scale from not important to very important and encouraged experts to leave additional comments in textboxes. Responses were reviewed by the researchers, a team of 4 HIV mHealth intervention experts. The average importance ratings from survey responses were calculated and then categorized as retained (high importance), flagged (mid-level importance), or dropped (no/low importance). Additionally, thematic analysis of expert comments helped modify survey items for the next survey round. An evaluation of the level of agreement among experts on the most important items followed each round until consensus was reached. Results: Of the 35 invited experts, 23 completed the first survey representing a variety of roles within a research team. Following two rounds of Delphi surveys, experts scored 24 of the 28 (86%) survey items included in round two as important to very important. The final consensus items included 24 recommendations related to the mHealth intervention design process (n=15), evaluation (n=2), and implementation (n=7). The 3 survey items with the highest average scores focused on the design process, specifically, (1) the creation of a diverse team including researchers, app software developers, and youth representation; (2) the importance of AYA-focused content; and (3) the value of an iterative process. Additionally, experts highlighted the importance of establishing the best ways to collect data and the types of data for collection during the evaluation process as well as constructing a plan for participant technology disruption when implementing an mHealth intervention. Conclusions: The modified Delphi method was a useful tool to convene experts to determine recommendations for AYA-focused HIV prevention and care mHealth interventions. These recommendations can inform future mHealth interventions. To ensure the acceptability, feasibility, and efficacy of these AYA HIV prevention interventions, the focus must be on the specific needs of AYAs by including representation of AYAs in the process, including consistent and relevant content, ensuring appropriate data is collected, and considering technology and health accessibility barriers. %M 35819824 %R 10.2196/25982 %U https://formative.jmir.org/2022/7/e25982 %U https://doi.org/10.2196/25982 %U http://www.ncbi.nlm.nih.gov/pubmed/35819824 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e33085 %T mHealth Interventions to Support Caregivers of Older Adults: Equity-Focused Systematic Review %A Garnett,Anna %A Northwood,Melissa %A Ting,Justine %A Sangrar,Ruheena %+ Arthur Labatt Family School of Nursing, Western University, FIMS & Nursing Building, Rm 2306, London, ON, N6A 5B9, Canada, 1 519 661 2111, agarnet6@uwo.ca %K caregivers %K older adults %K mobile health %K social determinants of health %K intervention %K mobile phone %D 2022 %7 8.7.2022 %9 Review %J JMIR Aging %G English %X Background: Informal caregivers, hereafter referred to as caregivers, provide support to older adults so that they can age safely at home. The decision to become a caregiver can be influenced by individual factors, such as personal choice, or societal factors such as social determinants of health, including household income, employment status, and culture-specific gender roles. Over time, caregivers’ health can be negatively affected by their caregiving roles. Although programs exist to support caregivers, the availability and appropriateness of services do not match caregivers’ expressed needs. Research suggests that supportive interventions offered through mobile health (mHealth) technologies have the potential to increase caregivers’ access to supportive services. However, a knowledge gap remains regarding the extent to which social determinants of health are considered in the design, implementation, and evaluation of mHealth interventions intended to support the caregivers of older adults. Objective: This study aimed to conduct a systematic review to determine how health equity is considered in the design, implementation, and evaluation of mHealth interventions for caregivers of older adults using Cochrane Equity’s PROGRESS-Plus (place of residence, race, ethnicity, culture, language, occupation, gender, religion, education, social capital, socioeconomic status–plus age, disability, and sexual orientation) framework and synthesize evidence of the impacts of the identified caregiver-focused mHealth interventions. Methods: A systematic review was conducted using 5 databases. Articles published between January 2010 and June 2021 were included if they evaluated or explored the impact of mHealth interventions on the health and well-being of informal caregivers of older adults. mHealth interventions were defined as supportive services, for example, education, that caregivers of older adults accessed via mobile or wireless devices. Results: In total, 28 articles met the inclusion criteria and were included in the review. The interventions evaluated sought to connect caregivers with services, facilitate caregiving, and promote caregivers’ health and well-being. The PROGRESS-Plus framework factors were mainly considered in the results, discussion, and limitations sections of the included studies. Some PROGRESS-Plus factors such as sexual orientation, religion, and occupation, received little to no consideration across any phase of the intervention design, implementation, or evaluation. Overall, the findings of this review suggest that mHealth interventions were positively received by study participants. Such interventions have the potential to reduce caregiver burden and positively affect caregivers’ physical and mental health while supporting them as caregivers. The study findings highlight the importance of making support available to help facilitate caregivers’ use of mHealth interventions, as well as in the use of appropriate language and text. Conclusions: The successful uptake and spread of mHealth interventions to support caregivers of older adults will depend on creating opportunities for the inclusive involvement of a broad range of stakeholders at all stages of design, implementation, and evaluation. %M 35616514 %R 10.2196/33085 %U https://aging.jmir.org/2022/3/e33085 %U https://doi.org/10.2196/33085 %U http://www.ncbi.nlm.nih.gov/pubmed/35616514 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e37600 %T Pilot Implementation of a User-Driven, Web-Based Application Designed to Improve Sexual Health Knowledge and Communication Among Young Zambians: Mixed Methods Study %A Sharma,Anjali %A Mwamba,Chanda %A Ng'andu,Mwila %A Kamanga,Vikwato %A Zoonadi Mendamenda,Mayamiko %A Azgad,Yael %A Jabbie,Zainab %A Chipungu,Jenala %A Pry,Jake M %+ Department of Public Health Sciences, University of California, Medical Sciences 1-C, One Shield's Ave, Davis, CA, 95616, United States, 1 9366616885, Jmpry@ucdavis.edu %K sexual and reproductive health %K web application %K digital health intervention %K pilot study %K quasi-experiment %K adolescent %K young people %K Zambia %K sub-Saharan Africa %K mobile phone %D 2022 %7 7.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health interventions show promise in improving the uptake of HIV services among adolescents and young people aged 15 to 24 years in sub-Saharan Africa. Objective: This study aimed to pilot-test a theory-based, empirically grounded web-based application designed to increase condom-related knowledge, sexual and reproductive health (SRH) communication, and healthier choices among young Zambians. Methods: We conducted a pre-post quasi-experimental evaluation of the user-driven Be in the Know Zambia (BITKZ) web application using web-based surveys and in-depth interviews (IDIs) on the phone. We enrolled participants using social media advertisements. Our final analysis set comprised 46.04% (749/1627) of participants in the intervention group (which received the BITKZ link) and 53.96% (878/1627) of participants in the comparison group (no intervention). We collected survey data at study enrollment (baseline) and 5 weeks after the first enrollment in each group. Approximately 85% (637/749) of BITKZ users completed a user survey, of whom 9.3% (59/637) participated in IDIs. We calculated the time interfacing with BITKZ using the application log files. We conducted descriptive analyses to describe baseline characteristics and the user experience. At the endline, we assessed association using a t test and adjusted logistic regression for binary outcomes and ordinal regression for ordered outcomes, conditioning on age, sex, marital status, and employment status. We used adjusted average treatment effects (aATE) to assess the effects of BITKZ intervention. We conducted rapid matrix analyses of IDI transcripts in Microsoft Excel, sorting the data by theme, gender, and experience rating. Results: Users rated BITKZ highly (excellent: 352/609, 57.8%; good: 218/609, 35.8%). At the endline, the intervention group had a higher level of knowledge related to condoms (adjusted odds ratio [aOR]: 1.35, 95% CI 1.06-1.69) and on wearing condoms correctly (aOR: 1.23, 95% CI 1.02-1.49). Those who had full-time employment had increased odds of knowing how to wear condoms correctly (aOR: 1.67, 95% CI 1.06-2.63) compared with those who reported being unemployed, as did men when compared with women (aOR: 1.92, 95% CI 1.59-2.31). Those in the intervention group were more likely to score higher for intention to test for sexually transmitted infections (STIs; aATE 0.21; P=.01) and HIV (aATE 0.32; P=.05), as well as for resisting peer pressure (aATE 2.64; P=.02). IDIs corroborated increased knowledge on correct condom use among men and female condoms among women, awareness of STIs and testing, and resistance to peer pressure. Interviewees provided examples of more open SRH communication with partners and peers and of considering, adopting, and influencing others to adopt healthier behaviors. Conclusions: Despite the high baseline awareness of SRH among Zambian adolescents and young people with internet access, BITKZ provided modest gains in condom-related knowledge, resistance to peer pressure, and intention to test for STIs and HIV. %M 35797099 %R 10.2196/37600 %U https://www.jmir.org/2022/7/e37600 %U https://doi.org/10.2196/37600 %U http://www.ncbi.nlm.nih.gov/pubmed/35797099 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e32487 %T The Effect of a Future-Self Avatar Mobile Health Intervention (FutureMe) on Physical Activity and Food Purchases: Randomized Controlled Trial %A Mönninghoff,Annette %A Fuchs,Klaus %A Wu,Jing %A Albert,Jan %A Mayer,Simon %+ Institute for Mobility, University of St. Gallen, Bahnhofstrasse 8, St Gallen, 9000, Switzerland, 41 712242132, Annette.Moenninghoff@unisg.ch %K mHealth %K mobile health %K preventative medicine %K avatar %K present bias %K nutrition tracking %K physical activity %K randomized controlled trial %D 2022 %7 7.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Insufficient physical activity and unhealthy diets are contributing to the rise in noncommunicable diseases. Preventative mobile health (mHealth) interventions may help reverse this trend, but present bias might reduce their effectiveness. Future-self avatar interventions have resulted in behavior change in related fields, yet evidence of whether such interventions can change health behavior is lacking. Objective: We aimed to investigate the impact of a future-self avatar mHealth intervention on physical activity and food purchasing behavior and examine the feasibility of a novel automated nutrition tracking system. We also aimed to understand how this intervention impacts related attitudinal and motivational constructs. Methods: We conducted a 12-week parallel randomized controlled trial (RCT), followed by semistructured interviews. German-speaking smartphone users aged ≥18 years living in Switzerland and using at least one of the two leading Swiss grocery loyalty cards, were recruited for the trial. Data were collected from November 2020 to April 2021. The intervention group received the FutureMe intervention, a physical activity and food purchase tracking mobile phone app that uses a future-self avatar as the primary interface and provides participants with personalized food basket analysis and shopping tips. The control group received a conventional text- and graphic-based primary interface intervention. We pioneered a novel system to track nutrition by leveraging digital receipts from loyalty card data and analyzing food purchases in a fully automated way. Data were consolidated in 4-week intervals, and nonparametric tests were conducted to test for within- and between-group differences. Results: We recruited 167 participants, and 95 eligible participants were randomized into either the intervention (n=42) or control group (n=53). The median age was 44 years (IQR 19), and the gender ratio was balanced (female 52/95, 55%). Attrition was unexpectedly high with only 30 participants completing the intervention, negatively impacting the statistical power. The FutureMe intervention led to small statistically insignificant increases in physical activity (median +242 steps/day) and small insignificant improvements in the nutritional quality of food purchases (median −1.28 British Food Standards Agency Nutrient Profiling System Dietary Index points) at the end of the intervention. Intrinsic motivation significantly increased (P=.03) in the FutureMe group, but decreased in the control group. Outcome expectancy directionally increased in the FutureMe group, but decreased in the control group. Leveraging loyalty card data to track the nutritional quality of food purchases was found to be a feasible and accepted fully automated nutrition tracking system. Conclusions: Preventative future-self avatar mHealth interventions promise to encourage improvements in physical activity and food purchasing behavior in healthy population groups. A full-powered RCT is needed to confirm this preliminary evidence and to investigate how future-self avatars might be modified to reduce attrition, overcome present bias, and promote sustainable behavior change. Trial Registration: ClinicalTrials.gov NCT04505124; https://clinicaltrials.gov/ct2/show/NCT04505124 %M 35797104 %R 10.2196/32487 %U https://www.jmir.org/2022/7/e32487 %U https://doi.org/10.2196/32487 %U http://www.ncbi.nlm.nih.gov/pubmed/35797104 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 7 %P e34102 %T Awareness, Acceptability, and Perceived Effectiveness of Text-Based Therapy Among Graduate Students: Cross-sectional Study %A Blair,Samari A %A Brockmann,Andrea N %A Arroyo,Kelsey M %A Carpenter,Chelsea A %A Ross,Kathryn M %+ Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, PO Box 100165, Gainesville, FL, 32610, United States, 1 352 294 8433, kmross@phhp.ufl.edu %K mental health %K text-based therapy %K graduate students %D 2022 %7 7.7.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Research has suggested that there is a mental health crisis occurring among graduate students in the United States. Moreover, many students go without effective treatment owing to the limited availability of mental and behavioral health resources on college campuses. Text-based therapy may represent a viable method for increasing access to mental health support for graduate students, but little is known regarding its acceptability in this population. Objective: The purpose of this study was to assess how graduate students perceive text-based therapy and their likelihood of seeking out this form of therapy. Methods: In total, 265 graduate students completed a cross-sectional web-based survey that included multiple-choice and open-ended questions assessing their perceptions of text-based therapy and the likelihood of seeking out this form of therapy. Chi-square tests, ANOVAs, and nonparametric Wilcoxon signed-rank tests were used to examine differences in multiple-choice questions. The constant comparative method was used for qualitative analyses of the open-ended question responses. Results: Participants (n=265) were predominately non-Hispanic White (166/265, 62.6%) and female (167/265, 63%) with a mean age of 28.3 (SD 5.1) years. Over half of the participants (139/265, 52.5%) were not aware that text-based therapy existed; however, 65.3% (173/265) reported that they would consider using text-based services, if available. In comparison to face-to-face therapy, participants reported being less likely to seek out text-based therapy and perceived it as less effective (P<.001). Qualitative results indicated that participants were concerned about the ability to effectively communicate and build rapport through text-based therapy and thought that this modality may be more effective for some mental and behavioral health concerns than others. Moreover, participants noted that text-based therapy would be best implemented as a way to supplement, rather than replace, face-to-face services. Conclusions: Altogether, the results of this study suggest that text-based therapy holds the potential to increase access to and use of mental and behavioral health services; however, graduate students remain concerned about its effectiveness and the optimal methods of implementation. Future research should investigate how therapeutic processes (eg, effective communication and rapport-building) can be facilitated in digital environments and how text-based therapy could be best implemented to supplement and extend, rather than replace, face-to-face services. %M 35797098 %R 10.2196/34102 %U https://mhealth.jmir.org/2022/7/e34102 %U https://doi.org/10.2196/34102 %U http://www.ncbi.nlm.nih.gov/pubmed/35797098 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e36370 %T Acceptability of an In-home Multimodal Sensor Platform for Parkinson Disease: Nonrandomized Qualitative Study %A Morgan,Catherine %A Tonkin,Emma L %A Craddock,Ian %A Whone,Alan L %+ Movement Disorders Group, Bristol Brain Centre, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, United Kingdom, 44 01174559985, catherine.morgan@bristol.ac.uk %K sensor %K Parkinson disease %K wearables %K cameras %K acceptability %K smart home %K behavior change %K multimodal home-based %K qualitative %D 2022 %7 7.7.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Parkinson disease (PD) symptoms are complex, gradually progressive, and fluctuate hour by hour. Home-based technological sensors are being investigated to measure symptoms and track disease progression. A smart home sensor platform, with cameras and wearable devices, could be a useful tool to use to get a fuller picture of what someone’s symptoms are like. High-resolution video can capture the ground truth of symptoms and activities. There is a paucity of information about the acceptability of such sensors in PD. Objective: The primary objective of our study was to explore the acceptability of living with a multimodal sensor platform in a naturalistic setting in PD. Two subobjectives are to identify any suggested limitations and to explore the sensors’ impact on participant behaviors. Methods: A qualitative study was conducted with an inductive approach using semistructured interviews with a cohort of PD and control participants who lived freely for several days in a home-like environment while continuously being sensed. Results: This study of 24 participants (12 with PD) found that it is broadly acceptable to use multimodal sensors including wrist-worn wearables, cameras, and other ambient sensors passively in free-living in PD. The sensor that was found to be the least acceptable was the wearable device. Suggested limitations on the platform for home deployment included camera-free time and space. Behavior changes were noted by the study participants, which may have related to being passively sensed. Recording high-resolution video in the home setting for limited periods of time was felt to be acceptable to all participants. Conclusions: The results broaden the knowledge of what types of sensors are acceptable for use in research in PD and what potential limitations on these sensors should be considered in future work. The participants’ reported behavior change in this study should inform future similar research design to take this factor into account. Collaborative research study design, involving people living with PD at every stage, is important to ensure that the technology is acceptable and that the data outcomes produced are ecologically valid and accurate. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-041303 %M 35797101 %R 10.2196/36370 %U https://humanfactors.jmir.org/2022/3/e36370 %U https://doi.org/10.2196/36370 %U http://www.ncbi.nlm.nih.gov/pubmed/35797101 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e38243 %T The Effect of Tailored, Daily, Smartphone Feedback to Lifestyle Self-Monitoring on Weight Loss at 12 Months: the SMARTER Randomized Clinical Trial %A Burke,Lora E %A Sereika,Susan M %A Bizhanova,Zhadyra %A Parmanto,Bambang %A Kariuki,Jacob %A Cheng,Jessica %A Beatrice,Britney %A Cedillo,Maribel %A Pulantara,I Wayan %A Wang,Yuhan %A Loar,India %A Conroy,Molly B %+ School of Nursing, University of Pittsburgh, 3500 Victoria St, Pittsburgh, PA, 15261, United States, 1 412 779 0555, lbu100@pitt.edu %K self-monitoring %K behavioral intervention/weight loss %K feedback messages %K engagement %K mHealth %K adherence %K obesity %K randomized clinical trial %K smart scales %K physical activity trackers %K digital health %D 2022 %7 5.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Self-monitoring (SM) is the centerpiece of behavioral weight loss treatment, but the efficacy of smartphone-delivered SM feedback (FB) has not been tested in large, long-term, randomized trials. Objective: The aim of this study was to establish the efficacy of providing remote FB to diet, physical activity (PA), and weight SM on improving weight loss outcomes when comparing the SM plus FB (SM+FB) condition to the SM-only condition in a 12-month randomized controlled trial. The study was a single-site, population-based trial that took place in southwestern Pennsylvania, USA, conducted between 2018 and 2021. Participants were smartphone users age ≥18 years, able to engage in moderate PA, with a mean BMI between 27 and 43 kg/m2. Methods: All participants received a 90-minute, one-to-one, in-person behavioral weight loss counseling session addressing behavioral strategies, establishing participants’ dietary and PA goals, and instructing on use of the PA tracker (Fitbit Charge 2), smart scale, and diet SM app. Only SM+FB participants had access to an investigator-developed smartphone app that read SM data, in which an algorithm selected tailored messages sent to the smartphone up to 3 times daily. The SM-only participants did not receive any tailored FB based on SM data. The primary outcome was percent weight change from baseline to 12 months. Secondary outcomes included engagement with digital tools (eg, monthly percentage of FB messages opened and monthly percentage of days adherent to the calorie goal). Results: Participants (N=502) were on average 45.0 (SD 14.4) years old with a mean BMI of 33.7 (SD 4.0) kg/m2. The sample was 79.5% female (n=399/502) and 82.5% White (n=414/502). At 12 months, retention was 78.5% (n=394/502) and similar by group (SM+FB: 202/251, 80.5%; SM: 192/251, 76.5%; P=.28). There was significant percent weight loss from baseline in both groups (SM+FB: –2.12%, 95% CI –3.04% to –1.21%, P<.001; SM: –2.39%, 95% CI –3.32% to –1.47%; P<.001), but no difference between the groups (–0.27%; 95% CI –1.57% to 1.03%; t =–0.41; P=.68). Similarly, 26.3% (66/251) of the SM+FB group and 29.1% (73/251) of the SM group achieved ≥5% weight loss (chi-square value=0.49; P=.49). A 1% increase in FB messages opened was associated with a 0.10 greater percent weight loss at 12 months (b=–0.10; 95% CI –0.13 to –0.07; t =–5.90; P<.001). A 1% increase in FB messages opened was associated with 0.12 greater percentage of days adherent to the calorie goal per month (b=0.12; 95% CI 0.07-0.17; F=22.19; P<.001). Conclusions: There were no significant between-group differences in weight loss; however, the findings suggested that the use of commercially available digital SM tools with or without FB resulted in a clinically significant weight loss in over 25% of participants. Future studies need to test additional strategies that will promote greater engagement with digital tools. Trial Registration: Clinicaltrials.gov NCT03367936; https://clinicaltrials.gov/ct2/show/NCT03367936 %M 35787516 %R 10.2196/38243 %U https://www.jmir.org/2022/7/e38243 %U https://doi.org/10.2196/38243 %U http://www.ncbi.nlm.nih.gov/pubmed/35787516 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 7 %P e36226 %T Impact of a Mobile Application for Tracking Nausea and Vomiting During Pregnancy (NVP) on NVP Symptoms, Quality of Life, and Decisional Conflict Regarding NVP Treatments: MinSafeStart Randomized Controlled Trial %A Ngo,Elin %A Truong,Maria Bich-Thuy %A Wright,David %A Nordeng,Hedvig %+ PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Postbox 1068 Blindern, Oslo, 0316, Norway, 47 93849866, e.t.p.ngo@farmasi.uio.no %K eHealth %K mHealth %K decision support tool %K nausea and vomiting %K pregnancy %K RCT %D 2022 %7 5.7.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pregnant women are active users of mobile apps for health purposes. These apps may improve self-management of health-related conditions. Up to 70% of pregnant women experience nausea and vomiting (NVP). Even mild NVP can significantly reduce quality of life (QoL), and it can become an economic burden for both the woman and society. NVP often occurs before the first maternal care visit; therefore, apps can potentially play an important role in empowering pregnant women to recognize, manage, and seek appropriate treatment for NVP, when required. Objective: This study investigated whether the MinSafeStart (MSS) mobile app could impact NVP-related symptoms, QoL, and decisional conflict regarding NVP treatment. Methods: This randomized controlled trial enrolled 268 pregnant women with NVP in Norway from 2019 to 2020. The intervention group had access to the MSS app, which could be used to track NVP symptoms and access tailored advice. NVP severity was rated with the Pregnancy Unique Quantification of Emesis (PUQE) score. The control group followed standard maternal care. We collected data on maternal baseline characteristics, NVP severity, QoL, and decisional conflict using 2 sets of online questionnaires. One set of questionnaires was completed at enrollment, and the other was completed after 2 weeks. We performed linear regression analyses to explore whether the use of the MSS app was associated with NVP severity, QoL, or decisional conflict. Results: Among the 268 women enrolled in the study, 192 (86.5%) completed the baseline questionnaires and were randomized to either the intervention (n=89) or control group (n=103). In the intervention group, 88 women downloaded the app, and 468 logs were recorded. In both groups, women were enrolled at a median of 8 gestational weeks. At baseline, the average PUQE scores were 4.9 and 4.7; the average QoL scores were 146 and 149; and the average DCS scores were 40 and 43 in the intervention and control groups, respectively. The app had no impact on NVP severity (aβ 0.6, 95% Cl −0.1 to 1.2), QoL (aβ −5.3, 95% Cl −12.5 to 1.9), or decisional conflict regarding NVP treatment (aβ −1.1, 95% Cl −6.2 to 4.2), compared with standard care. Conclusions: Tracking NVP symptoms with the MSS app was not associated with improvements in NVP symptoms, QoL, or decisional conflict after 2 weeks, compared with standard care. Future studies should include a process evaluation to improve our understanding of how pregnant women use the app and how to optimize its utility within maternity care. Specifically, studies should focus on how digital tools might facilitate counseling and communication between pregnant women and health care providers regarding NVP management during pregnancy. Trial Registration: ClinicalTrails.gov (NCT04719286): https://www.clinicaltrials.gov/ct2/show/NCT04719286 %M 35787487 %R 10.2196/36226 %U https://mhealth.jmir.org/2022/7/e36226 %U https://doi.org/10.2196/36226 %U http://www.ncbi.nlm.nih.gov/pubmed/35787487 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 7 %P e30976 %T The Efficacy of “Foundations,” a Digital Mental Health App to Improve Mental Well-being During COVID-19: Proof-of-Principle Randomized Controlled Trial %A Catuara-Solarz,Silvina %A Skorulski,Bartlomiej %A Estella-Aguerri,Iñaki %A Avella-Garcia,Claudia Bibiana %A Shepherd,Sarah %A Stott,Emily %A Hemmings,Nicola R %A Ruiz de Villa,Aleix %A Schulze,Laura %A Dix,Sophie %+ Koa Health, Carrer de la Ciutat de Granada 121, Barcelona, 08018, Spain, 44 7702 500882, sophie.dix@koahealth.com %K mental well-being %K digital health %K cognitive behavioral therapy %K positive psychology %K insomnia %K COVID-19 %K mental health %K mobile app %K anxiety %K health app %D 2022 %7 1.7.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Against a long-term trend of increasing demand, the COVID-19 pandemic has led to a global rise in common mental disorders. Now more than ever, there is an urgent need for scalable, evidence-based interventions to support mental well-being. Objective: The aim of this proof-of-principle study was to evaluate the efficacy of a mobile-based app in adults with self-reported symptoms of anxiety and stress in a randomized control trial that took place during the first wave of the COVID-19 pandemic in the United Kingdom. Methods: Adults with mild to severe anxiety and moderate to high levels of perceived stress were randomized to either the intervention or control arm. Participants in the intervention arm were given access to the Foundations app for the duration of the 4-week study. All participants were required to self-report a range of validated measures of mental well-being (10-item Connor-Davidson Resilience scale [CD-RISC-10], 7-item Generalized Anxiety Disorder scale [GAD-7], Office of National Statistics Four Subjective Well-being Questions [ONS-4], World Health Organization-5 Well-Being Index [WHO-5]) and sleep (Minimal Insomnia Scale [MISS]) at baseline and at weeks 2 and 4. The self-reported measures of perceived stress (10-item Perceived Stress Score [PSS-10]) were obtained weekly. Results: A total of 136 participants completed the study and were included in the final analysis. The intervention group (n=62) showed significant improvements compared to the control group (n=74) on measures of anxiety, with a mean GAD-7 score change from baseline of –1.35 (SD 4.43) and –0.23 (SD 3.24), respectively (t134=1.71, P=.04); resilience, with a mean change in CD-RISC score of 1.79 (SD 4.08) and –0.31 (SD 3.16), respectively (t134=–3.37, P<.001); sleep, with a mean MISS score change of –1.16 (SD 2.67) and –0.26 (SD 2.29), respectively (t134=2.13, P=.01); and mental well-being, with a mean WHO-5 score change of 1.53 (SD 5.30) and –0.23 (SD 4.20), respectively (t134=–2.16, P=.02), within 2 weeks of using Foundations, with further improvements emerging at week 4. Perceived stress was also reduced within the intervention group, although the difference did not reach statistical significance relative to the control group, with a PSS score change from baseline to week 2 of –2.94 (SD 6.84) and –2.05 (SD 5.34), respectively (t134= 0.84, P=.20). Conclusions: This study provides a proof of principle that the digital mental health app Foundations can improve measures of mental well-being, anxiety, resilience, and sleep within 2 weeks of use, with greater effects after 4 weeks. Foundations therefore offers potential as a scalable, cost-effective, and accessible solution to enhance mental well-being, even during times of crisis such as the COVID-19 pandemic. Trial Registration: OSF Registries osf.io/f6djb; https://osf.io/vm3xq %M 34978535 %R 10.2196/30976 %U https://mhealth.jmir.org/2022/7/e30976 %U https://doi.org/10.2196/30976 %U http://www.ncbi.nlm.nih.gov/pubmed/34978535 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e38469 %T Remotely Conducted App-Based Intervention for Cardiovascular Disease and Diabetes Risk Awareness and Prevention: Single-Group Feasibility Trial %A Buss,Vera Helen %A Varnfield,Marlien %A Harris,Mark %A Barr,Margo %+ Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 7, Surgical Treatment and Rehabilitation Service, 296 Herston Road, Herston, 4029, Australia, 61 732533603, vera.buss@csiro.au %K mobile health %K feasibility studies %K primary prevention %K cardiovascular disease %K diabetes mellitus, type 2 %K mHealth %K cardiology %K heart disease %K diabetes %K smartphone %K participate engagement %K app-based intervention %D 2022 %7 1.7.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Cardiovascular disease and type 2 diabetes mellitus are two of the most prevalent chronic conditions worldwide. An unhealthy lifestyle greatly contributes to someone’s risk of developing these conditions. Mobile health is an emerging technology that can help deliver health promotion interventions to the population, for example, in the form of health apps. Objective: The aim of this study was to test the feasibility of an app-based intervention for cardiovascular and diabetes risk awareness and prevention by measuring nonusage, dropout, adherence to app use, and usability of the app over 3 months. Methods: Participants were eligible if they were aged 45 years or older, resided in Australia, were free of cardiovascular disease and diabetes, were fluent in English, and owned a smartphone. In the beginning, participants received an email with instructions on how to install the app and a user guide. After 3 months, they received an email with an invitation to an end-of-study survey. The survey included questions about general smartphone use and the user version of the Mobile Application Rating Scale. We analyzed app-generated and survey data by using descriptive and inferential statistics as well as thematic analysis for open-text comments. Results: Recruitment took place between September and October 2021. Of the 46 participants who consented to the study, 20 (44%) never used the app and 15 (33%) dropped out. The median age of the app users at baseline was 62 (IQR 56-67) years. Adherence to app use, that is, using the app at least once a week over 3 months, was 17% (8/46) of the total sample and 31% (8/26) of all app users. The mean app quality rating on the user version of the Mobile Application Rating Scale was 3.5 (SD 0.6) of 5 points. The app scored the highest for the information section and the lowest for the engagement section of the scale. Conclusions: Nonusage and dropouts were too high, and the adherence was too low to consider the intervention in its current form feasible. Potential barriers that we identified include the research team not actively engaging with participants early in the study to verify that all participants could install the app, the intervention did not involve direct contact with health care professionals, and the app did not have enough interactive features. %M 35776504 %R 10.2196/38469 %U https://humanfactors.jmir.org/2022/3/e38469 %U https://doi.org/10.2196/38469 %U http://www.ncbi.nlm.nih.gov/pubmed/35776504 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e29725 %T Bridging the Digital Divide in Psychological Therapies: Observational Study of Engagement With the SlowMo Mobile App for Paranoia in Psychosis %A Hardy,Amy %A Ward,Thomas %A Emsley,Richard %A Greenwood,Kathryn %A Freeman,Daniel %A Fowler,David %A Kuipers,Elizabeth %A Bebbington,Paul %A Garety,Philippa %+ Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Henry Wellcome Building, London, SE5 8AF, United Kingdom, 44 2078485178, amy.hardy@kcl.ac.uk %K paranoia %K psychosis %K digital health %K apps %K human-centered design %K user experience %K adherence %K engagement %K therapy %D 2022 %7 1.7.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Marginalized groups are more likely to experience problems with technology-related access, motivation, and skills. This is known as the “digital divide.” Technology-related exclusion is a potential barrier to the equitable implementation of digital health. SlowMo therapy was developed with an inclusive, human-centered design to optimize accessibility and bridge the “digital divide.” SlowMo is an effective, blended digital psychological therapy for paranoia in psychosis. Objective: This study explores the “digital divide” and mobile app engagement in the SlowMo randomized controlled trial. Methods: Digital literacy was assessed at baseline, and a multidimensional assessment of engagement (ie, adherence [via system analytics and self-report] and self-reported user experience) was conducted at 12 weeks after therapy. Engagement was investigated in relation to demographics (ie, gender, age, ethnicity, and paranoia severity). Results: Digital literacy data demonstrated that technology use and confidence were lower in Black people and older people (n=168). The engagement findings indicated that 80.7% (96/119) of therapy completers met the a priori analytics adherence criteria. However, analytics adherence did not differ by demographics. High rates of user experience were reported overall (overall score: mean 75%, SD 17.1%; n=82). No differences in user experience were found for ethnicity, age, or paranoia severity, although self-reported app use, enjoyment, and usefulness were higher in women than in men. Conclusions: This study identified technology-related inequalities related to age and ethnicity, which did not influence engagement with SlowMo, suggesting that the therapy design bridged the “digital divide.” Intervention design may moderate the influence of individual differences on engagement. We recommend the adoption of inclusive, human-centered design to reduce the impact of the “digital divide” on therapy outcomes. Trial Registration: ISRCTN Registry ISRCTN32448671; https://www.isrctn.com/ISRCTN32448671 %M 35776506 %R 10.2196/29725 %U https://humanfactors.jmir.org/2022/3/e29725 %U https://doi.org/10.2196/29725 %U http://www.ncbi.nlm.nih.gov/pubmed/35776506 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e37086 %T Fitbit Use and Activity Levels From Intervention to 2 Years After: Secondary Analysis of a Randomized Controlled Trial %A Hartman,Sheri J %A Chen,Ruohui %A Tam,Rowena M %A Narayan,Hari K %A Natarajan,Loki %A Liu,Lin %+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 3855 Health Sciences Drive, #0901, La Jolla, CA, 92037, United States, 1 8585349235, sjhartman@ucsd.edu %K physical activity %K fitness %K exercise %K Fitbit %K wearable %K health technology %K mHealth %K digital health %K activity tracker %K maintenance %K adherence %K tracker %K use pattern %K activity level %K behavior change %K cancer %K breast %K survivor %K long-term use %K sustained use %D 2022 %7 30.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There has been a rapid increase in the use of commercially available activity trackers, such as Fitbit, in physical activity intervention research. However, little is known about the long-term sustained use of trackers and behavior change after short-term interventions. Objective: This study aims to use minute-level data collected from a Fitbit tracker for up to 2 years after the end of a randomized controlled trial to examine patterns of Fitbit use and activity over time. Methods: Participants in this secondary data analysis were 75 female breast cancer survivors who had been enrolled in a 12-week physical activity randomized controlled trial. Participants randomized to the exercise intervention (full intervention arm) received a Fitbit One, which was worn daily throughout the 12-week intervention, and then were followed for 2 years after the intervention. Participants randomized to the waitlist arm, after completing the randomized controlled trial, received a Fitbit One and a minimal version of the exercise intervention (light intervention arm), and then were followed for 2 years after the intervention. Average and daily adherence and MVPA were compared between the 2 groups in the interventional and postinterventional periods using both linear and generalized additive mixed effects models. Results: Adherence to wearing the Fitbit during the 12-week intervention period was significantly higher in the full intervention arm than in the light intervention arm (85% vs 60%; P<.001). Average adherence was significantly lower for both study arms during the follow-up period than in the intervention period; however, there were statistically different patterns of adherence during the follow-up period, with the light intervention arm having steeper declines than the full intervention arm over time (P<.001). Similar to the adherence results, mean minutes of Fitbit-measured MVPA was higher for the full intervention arm than for the light intervention arm during the 12-week intervention period (mean MVPA 27.89 minutes/day, SD 16.38 minutes/day vs 18.35 minutes/day, SD 12.64 minutes/day; P<.001). During the follow-up period, average MVPA was significantly lower than the 12-week intervention period for both the full intervention arm (21.74 minutes/day, SD 24.65 minutes/day; P=.002) and the light intervention arm (15.03 minutes/day, SD 13.27 minutes/day; P=.004). Although the mean MVPA in each arm was similar across the follow-up period (P=.33), the pattern of daily MVPA was significantly different between the 2 groups (P<.001). Conclusions: While adherence to wearing activity trackers and maintaining physical activities declined after completion of a 12-week exercise intervention, a more active interventional strategy resulted in greater wear time and activity levels during the intervention and more stable patterns of adherence and activity in the long term. An improved understanding of long-term maintenance patterns may inform improved exercise interventions that result in sustained increases in physical activity. Trial Registration: ClinicalTrials.gov NCT02332876; https://clinicaltrials.gov/ct2/show/NCT02332876 %M 35771607 %R 10.2196/37086 %U https://mhealth.jmir.org/2022/6/e37086 %U https://doi.org/10.2196/37086 %U http://www.ncbi.nlm.nih.gov/pubmed/35771607 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e36091 %T Development of a WeChat-based Mobile Messaging Smoking Cessation Intervention for Chinese Immigrant Smokers: Qualitative Interview Study %A Jiang,Nan %A Rogers,Erin S %A Cupertino,Paula %A Zhao,Xiaoquan %A Cartujano-Barrera,Francisco %A Lyu,Joanne Chen %A Hu,Lu %A Sherman,Scott E %+ Department of Population Health, Grossman School of Medicine, New York University, 180 Madison Ave, Rm #17-54, New York, NY, 10016, United States, 1 646 501 3553, Nan.Jiang@nyulangone.org %K smoking cessation %K text messaging %K mobile health %K Chinese American %D 2022 %7 30.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking remains a major public health issue among Chinese immigrants. Smoking cessation programs that focus on this population are scarce and have a limited population-level impact due to their low reach. Mobile messaging interventions have the potential to reach large audiences and expand smokers’ access to smoking cessation treatment. Objective: This study describes the development of a culturally and linguistically appropriate mobile messaging smoking cessation intervention for Chinese immigrant smokers delivered via WeChat, the most frequently used social media platform among Chinese people globally. Methods: This study had 2 phases. In phase 1, we developed a mobile message library based on social cognitive theory and the US Clinical Practice Guidelines for Treating Tobacco Use and Dependence. We culturally adapted messages from 2 social cognitive theory-based text messaging smoking cessation programs (SmokefreeTXT and Decídetexto). We also developed new messages targeting smokers who were not ready to quit smoking and novel content addressing Chinese immigrant smokers’ barriers to quitting and common misconceptions related to willpower and nicotine replacement therapy. In phase 2, we conducted in-depth interviews with 20 Chinese immigrant smokers (including 7 women) in New York City between July and August 2021. The interviews explored the participants’ smoking and quitting experiences followed by assessment of the text messages. Participants reviewed 17 text messages (6 educational messages, 3 self-efficacy messages, and 8 skill messages) via WeChat and rated to what extent the messages enhanced their motivation to quit, promoted confidence in quitting, and increased awareness about quitting strategies. The interviews sought feedback on poorly rated messages, explored participant preferences for content, length, and format, discussed their concerns with WeChat cessation intervention, and solicited recommendations for frequency and timing of messages. Results: Overall, participants reported that the messages enhanced their motivation to quit, offered encouragement, and made them more informed about how to quit. Participants particularly liked the messages about the harms of smoking and strategies for quitting. They reported barriers to applying some of the quitting strategies, including coping with stress and staying abstinent at work. Participants expressed strong interest in the WeChat mobile messaging cessation intervention and commented on its potential to expand their access to smoking cessation treatment. Conclusions: Mobile messages are well accepted by Chinese immigrant smokers. Research is needed to assess the feasibility, acceptability, and efficacy of WeChat mobile messaging smoking cessation interventions for promoting abstinence among Chinese immigrant smokers. %M 35771603 %R 10.2196/36091 %U https://formative.jmir.org/2022/6/e36091 %U https://doi.org/10.2196/36091 %U http://www.ncbi.nlm.nih.gov/pubmed/35771603 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 6 %P e33750 %T The Effectiveness of a Brief Telehealth and Smartphone Intervention for College Students Receiving Traditional Therapy: Longitudinal Study Using Ecological Momentary Assessment Data %A Taylor,Madison E %A Lozy,Olivia %A Conti,Kaileigh %A Wacha-Montes,Annmarie %A Bentley,Kate H %A Kleiman,Evan M %+ Department of Psychology, Rutgers, The State University of New Jersey, Tillet Hall, 53 Avenue E, Piscataway, NJ, 08854, United States, 1 717 394 1180, metaylor1116@gmail.com %K college students %K digital mental health %K brief interventions %D 2022 %7 29.6.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Brief interventions such as mental health apps and single-session interventions are increasingly popular, efficacious, and accessible delivery formats that may be beneficial for college students whose mental health needs may not be adequately met by college counseling centers. However, no studies so far have examined the effectiveness of these modes of treatment for college students who are already receiving traditional therapy, despite it being common among this population. Objective: The aim of this study was to compare the differences in self-reported momentary negative affect between college students in therapy and not in therapy who received a brief single-session intervention delivered by counseling center staff and a supplemental mobile app. Methods: Data for this study were drawn from E-Manage, a brief mobile health intervention geared toward college students. Participants in the study were 173 college students who indicated whether they had received therapy. We conducted a multilevel model to determine whether there were differences between those in therapy versus not in therapy in negative affect reported throughout the study. Following this, we conducted multilevel models with therapy status as the predictor and negative affect as the outcome. Results: Results of the multilevel model testing showed that the cross-level interaction between the time point (ie, pre- vs postexercise) and therapy status was significant (P=.008), with the reduction in negative affect from pre- to postexercise greater for those in therapy (b=–0.65, 95% CI –0.91 to –0.40; P<.001) than it was for those not in therapy (b=–0.31, 95% CI –0.43 to –0.19; P<.001). Therapy status was unassociated with both the pre-exercise (b=–1.69, 95% CI –3.51 to 0.13; P=.07) and postexercise (b=–1.37, 95% CI –3.17 to 0.43; P=.14) ratings of negative affect. Conclusions: These findings suggest that app-based and single-session interventions are also appropriate to use among college students who are receiving traditional therapy. A randomized controlled trial comparing students receiving therapy to students receiving therapy and E-Manage will be necessary to determine to what extent E-Manage contributed to the reductions in negative affect that therapy-attending college students experienced. %M 35767338 %R 10.2196/33750 %U https://mental.jmir.org/2022/6/e33750 %U https://doi.org/10.2196/33750 %U http://www.ncbi.nlm.nih.gov/pubmed/35767338 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e29035 %T Movement as Medicine for Cardiovascular Disease Prevention: Pilot Feasibility Study of a Physical Activity Promotion Intervention for At-Risk Patients in Primary Care %A Knittle,Keegan %A Charman,Sarah J %A O'Connell,Sophie %A Avery,Leah %A Catt,Michael %A Sniehotta,Falko F %A Trenell,Michael I %+ Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE1 7RU, United Kingdom, 44 191 208 2258, michael.trenell@ncl.ac.uk %K primary care %K physical activity %K cardiovascular disease %K prevention %K internet-based intervention %K motivational interviewing %K self-regulation %D 2022 %7 29.6.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Physical activity (PA) can reduce cardiovascular disease (CVD) risk factors, and although primary care settings offer a large reach to promote PA and reduce CVD risk, primary health care professionals may lack self-efficacy and tools to effectively promote PA in practice. Movement as Medicine for CVD Prevention is a suite of 2 theory-based, web-based behavioral interventions—one for health care professionals and one for patients—which may offer a pathway for promoting PA and reducing CVD risk in primary care. Objective: This study aims to examine the feasibility and possible effects of Movement as Medicine for CVD Prevention. Methods: This nonrandomized pilot study recruited participants from primary care organizations in the Northeast of England. Enrolled health care professionals followed a theory-based, web-based course on PA counseling and motivational interviewing techniques. After the course, health care professionals delivered behavior change consultations based on motivational interviewing to inactive individuals with >20% risk of developing CVD within 10 years. Patients were then given access to a website based on self-determination and self-regulation theories, which targeted increased levels of PA. Outcomes were assessed at baseline and after 3 months, and patient data were analyzed on an intention-to-treat basis in a multiple imputation data set. Results: Recruitment rates of primary care organizations fell below expectations. A total of 11 health care professionals from 3 enrolled primary care organizations completed the web-based course and reported increases in important theoretical determinants of PA promotion in practice (eg, self-efficacy, Cohen d=1.24, 95% CI 0.67-1.80; and planning, Cohen d=0.85, 95% CI −0.01 to 1.69). A total of 83 patients were enrolled in the study, and 58 (70%) completed both the baseline and 3-month assessments. Compared with baseline, patients had higher levels of objective (Cohen d=0.77, 95% CI 0.13-1.41) but not subjective (Cohen d=0.40, 95% CI −0.03 to 0.83) moderate to vigorous PA at 3 months. Patients also reported higher levels of the PA determinants of intention, self-efficacy, intrinsic motivation, and action planning and action control at 3 months (effect sizes ranged from Cohen d=0.39 to 0.60). Conclusions: The Movement as Medicine for CVD Prevention intervention seems to have the potential to improve patient PA behaviors and important determinants of health care professionals’ PA promotion practices. However, the recruitment rates of primary care organizations in this study were low and would need to be increased to examine the efficacy of the program. This study offers several insights into improving the feasibility of this primary care PA promotion pathway. Trial Registration: ISRCTN Registry ISRCTN14582348; http://www.isrctn.com/ISRCTN14582348 %M 35767316 %R 10.2196/29035 %U https://cardio.jmir.org/2022/1/e29035 %U https://doi.org/10.2196/29035 %U http://www.ncbi.nlm.nih.gov/pubmed/35767316 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e36870 %T Monitoring and Managing Lifestyle Behaviors Using Wearable Activity Trackers: Mixed Methods Study of Views From the Huntington Disease Community %A Morgan-Jones,Philippa %A Jones,Annabel %A Busse,Monica %A Mills,Laura %A Pallmann,Philip %A Drew,Cheney %A Arnesen,Astri %A Wood,Fiona %A , %+ Division of Population Medicine, Cardiff University, 8th floor, Neuadd Meirionnydd, University Hospital of Wales, Cardiff, CF14 4YS, United Kingdom, 44 2920687185, wood@cardiff.ac.uk %K Huntington disease %K activity tracker %K perceptions %K digital technologies %K physical activity %K qualitative research %K survey %D 2022 %7 29.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There are early indications that lifestyle behaviors, specifically physical activity and sleep, may be associated with the onset and progression of Huntington disease (HD). Wearable activity trackers offer an exciting opportunity to collect long-term activity data to further investigate the role of lifestyle, physical activity, and sleep in disease modification. Given how wearable devices rely on user acceptance and long-term adoption, it is important to understand users’ perspectives on how acceptable any device might be and how users might engage over the longer term. Objective: This study aimed to explore the perceptions, motivators, and potential barriers relating to the adoption of wearable activity trackers by people with HD for monitoring and managing their lifestyle and sleep. This information intended to guide the selection of wearable activity trackers for use in a longitudinal observational clinical study. Methods: We conducted a mixed methods study; this allowed us to draw on the potential strengths of both quantitative and qualitative methods. Opportunistic participant recruitment occurred at 4 Huntington’s Disease Association meetings, including 1 international meeting and 3 United Kingdom–based regional meetings. Individuals with HD, their family members, and carers were invited to complete a user acceptance questionnaire and participate in a focus group discussion. The questionnaire consisted of 35 items across 8 domains using a 0 to 4 Likert scale, along with some additional demographic questions. Average questionnaire responses were recorded as positive (score>2.5), negative (score<1.5), or neutral (score between 1.5 and 2.5) opinions for each domain. Differences owing to demographics were explored using the Kruskal-Wallis and Wilcoxon rank sum tests. Focus group discussions (conducted in English) were driven by a topic guide, a vignette scenario, and an item ranking exercise. The discussions were audio recorded and then analyzed using thematic analysis. Results: A total of 105 completed questionnaires were analyzed (47 people with HD and 58 family members or carers). All sections of the questionnaire produced median scores >2.5, indicating a tendency toward positive opinions on wearable activity trackers, such as the devices being advantageous, easy and enjoyable to use, and compatible with lifestyle and users being able to understand the information from trackers and willing to wear them. People with HD reported a more positive attitude toward wearable activity trackers than their family members or caregivers (P=.02). A total of 15 participants participated in 3 focus groups. Device compatibility and accuracy, data security, impact on relationships, and the ability to monitor and self-manage lifestyle behaviors have emerged as important considerations in device use and user preferences. Conclusions: Although wearable activity trackers were broadly recognized as acceptable for both monitoring and management, various aspects of device design and functionality must be considered to promote acceptance in this clinical cohort. %M 35767346 %R 10.2196/36870 %U https://formative.jmir.org/2022/6/e36870 %U https://doi.org/10.2196/36870 %U http://www.ncbi.nlm.nih.gov/pubmed/35767346 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e37853 %T A Mobile Phone App Intervention to Promote Healthy Salt Intake Among Adults: Protocol for a Randomized Controlled Study %A Perin,Milena Sia %A São-João,Thais %A Gallani,Maria Cecília Bueno Jayme %A Agbadje,Titilayo Tatiana %A Rodrigues,Roberta Cunha Matheus %A Cornélio,Marilia Estevam %+ Faculty of Nursing, University of Campinas, Rua Tessália Vieira de Camargo, 126 Cidade Universitária, Campinas, 13083-887, Brazil, 55 193521 9127, misperin@gmail.com %K mHealth %K intervention %K sodium chloride %K dietary %K behavior change %K mobile health %D 2022 %7 29.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is sound evidence associating high salt intake and a greater risk of cardiovascular and noncardiovascular diseases. High salt intake has been observed in several populations worldwide. Therefore, promoting healthier salt consumption has been encouraged as a low-cost strategy to reduce this risk factor. However, these strategies need to be sound, built on theoretical and methodological bases, and consider the target population’s context. Objective: This protocol aims to describe a mobile phone app intervention to promote healthy salt intake among adults. Methods: This is an experimental and longitudinal study protocol conducted in three modules. Module 1 refers to the planning of the intervention based on the Behaviour Change Wheel framework. Module 2 is the development of the mobile phone app intervention based on the date of module 1. In module 3, the intervention will be evaluated using a randomized controlled study, with three steps of data collection in a 2-month follow-up in a sample of 86 adults (43 participants for each group: the control group and intervention group) recruited from the primary health care centers of a Brazilian town. The discretionary salt intake questionnaire will assess salt consumption, the app usability will be assessed using the System Usability Scale, and psychosocial variables (habit, intention, and self-efficacy) will also be measured. Results: Recruitment began in October 2021, and the follow-up will end in August 2022. The results of this study are expected to be published in 2023. Conclusions: Results from this study will help people to control salt intake when cooking at home, will stimulate self-care, will work as an alternative or supportive method in the relationship between health care professionals and patients, and will contribute to implementing the app intervention to promote healthy salt intake on a large scale. Trial Registration: The Brazilian Clinical Trials Registry RBR-4s8qyyq; https://ensaiosclinicos.gov.br/rg/RBR-4s8qyyq International Registered Report Identifier (IRRID): DERR1-10.2196/37853 %M 35767347 %R 10.2196/37853 %U https://www.researchprotocols.org/2022/6/e37853 %U https://doi.org/10.2196/37853 %U http://www.ncbi.nlm.nih.gov/pubmed/35767347 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e34278 %T User Perceptions of eHealth and mHealth Services Promoting Physical Activity and Healthy Diets: Systematic Review %A Bergevi,Julia %A Andermo,Susanne %A Woldamanuel,Yohannes %A Johansson,Unn-Britt %A Hagströmer,Maria %A Rossen,Jenny %+ Department of Health Promoting Science, Sophiahemmet University, Lindstedsvägen 8, Stockholm, 11486, Sweden, 46 701718634, jenny.rossen@shh.se %K acceptability %K behavior change %K engagement %K health technology %K noncommunicable diseases %K usability %K user feedback %K qualitative studies %K physical activity %K healthy diet %D 2022 %7 28.6.2022 %9 Review %J JMIR Hum Factors %G English %X Background: Physical activity and a diet that follows general recommendations can help to prevent noncommunicable diseases. However, most adults do not meet current recommended guidelines, and support for behavior change needs to be strengthened. There is growing evidence that shows the benefits of eHealth and mobile health (mHealth) services in promoting healthy habits; however, their long-term effectiveness is uncertain because of nonadherence. Objective: We aimed to explore users’ perceptions of acceptability, engagement, and usability of eHealth and mHealth services that promote physical activity, healthy diets, or both in the primary or secondary prevention of noncommunicable diseases. Methods: We conducted a systematic review with a narrative synthesis. We performed the literature search in PubMed, PsycINFO, and CINAHL electronic databases in February 2021 and July 2021. The search was limited to papers published in English between 2016 and 2021. Papers on qualitative and mixed method studies that encompassed eHealth and mHealth services for adults with a focus on physical activity, healthy diet, or both in the primary or secondary prevention of noncommunicable diseases were included. Three authors screened the studies independently, and 2 of the authors separately performed thematic analysis of qualitative data. Results: With an initial finding of 6308 articles and the removal of 427 duplicates, 23 articles were deemed eligible for inclusion in the review. Based on users’ preferences, an overarching theme—eHealth and mHealth services provide value but need to be tailored to individual needs—and 5 subthemes—interactive and integrated; varying and multifunctional; easy, pedagogic, and attractive; individualized and customizable; and reliable—emerged. Conclusions: New evidence on the optimization of digital services that promote physical activity and healthy diets has been synthesized. The findings represent users’ perceptions of acceptability, engagement, and usability of eHealth and mHealth services and show that services should be personalized, dynamic, easily manageable, and reliable. These findings can help improve adherence to digital health-promoting services. %M 35763339 %R 10.2196/34278 %U https://humanfactors.jmir.org/2022/2/e34278 %U https://doi.org/10.2196/34278 %U http://www.ncbi.nlm.nih.gov/pubmed/35763339 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e35997 %T Innovative App (ExoDont) and Other Conventional Methods to Improve Patient Compliance After Minor Oral Surgical Procedures: Pilot, Nonrandomized, and Prospective Comparative Study %A Sybil,Deborah %A Krishna,Meenakshi %A Shrivastava,Priyanshu Kumar %A Singh,Shradha %A Khan,Imran %+ Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Jamia Millia Islamia, Maulana Mohammad Ali Jauhar Marg, Jamia Nagar, Delhi, 110025, India, 91 9958756661, ikhan3@jmi.ac.in %K ExoDont %K mHealth %K mobile health %K Android app %K dental extraction %K postoperative %K oral surgery %K dentistry %K teledentistry %K mobile app %D 2022 %7 28.6.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Postoperative care is influenced by various factors such as compliance, comprehension, retention of instructions, and other unaccounted elements. It is imperative that patients adhere to the instructions and prescribed regimen for smooth and placid healing. ExoDont, an Android-based mobile health app, was designed to ensure a smooth postoperative period for patients after a dental extraction. Besides providing postoperative instructions at defined intervals, the app also sends drug reminders as an added advantage over other available, conventional methods. Objective: The aim of this study was to compare the compliance rate of individuals with respect to the prescribed regimen and postoperative instructions. Additionally, we aimed to assess any changes in the postoperative complication rate of patients assigned to 3 categories: the verbal, verbal plus written, and ExoDont app-based delivery groups. Methods: We conducted a pilot, nonrandomized, and prospective comparative study in which patients after tooth extraction were assigned to 3 groups—verbal (Group A), verbal plus written (Group B), and ExoDont app-based delivery (Group C)—based on the eligibility criteria, and a 1-week follow-up was planned to obtain the responses regarding compliance and postoperative complications from the participants. Results: In total, 90 patients were recruited and equally divided into 3 groups. Compliance to prescribed drug was found to be the highest in Group C, where of the 30 participants, 25 (83%) and 28 (93%) followed the entire course of antibiotics and analgesics, respectively. For postoperative instructions, higher compliance was observed in Group C in relation to compliance to diet restrictions (P=.001), not rinsing for 24 hours (P<.001), and warm saline rinses after 24 hours (P=.001). However, the difference was not significant for smoking restrictions (P=.07) and avoiding alcohol (P=.16). Moreover, the difference in postoperative complication rate was not statistically significant among the 3 groups (P=.31). Conclusions: As evident from the results, it is anticipated that the ExoDont app will be helpful in circumventing the unaccounted possibilities of missing the prescribed dosage and postoperative instructions and ensuring the smooth recovery of patients after dental extraction. However, future studies are required to establish this app-based method of delivery of postoperative instructions as a viable option in routine clinical practice. %M 35763332 %R 10.2196/35997 %U https://periop.jmir.org/2022/1/e35997 %U https://doi.org/10.2196/35997 %U http://www.ncbi.nlm.nih.gov/pubmed/35763332 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e34863 %T Effectiveness of Recruitment Strategies of Latino Smokers: Secondary Analysis of a Mobile Health Smoking Cessation Randomized Clinical Trial %A Arana-Chicas,Evelyn %A Cartujano-Barrera,Francisco %A Rieth,Katherine K %A Richter,Kimber K %A Ellerbeck,Edward F %A Cox,Lisa Sanderson %A Graves,Kristi D %A Diaz,Francisco J %A Catley,Delwyn %A Cupertino,Ana Paula %+ Department of Surgery, University of Rochester School of Medicine & Dentistry, 265 Crittenden Blvd, Rochester, NY, 14642, United States, 1 585 287 4217, Evelyn_Arana@urmc.rochester.edu %K smoking cessation %K Latino health, Latino recruitment %K health disparities %K participant recruitment %D 2022 %7 27.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Latinos remain disproportionately underrepresented in clinical trials, comprising only 2%-3% of research participants. In order to address health disparities, it is critically important to increase enrollment of Latino smokers in smoking cessation trials. There is limited research examining effective recruitment strategies for this population. Objective: The purpose of this study was to compare the effectiveness of direct versus mass and high- versus low-effort recruitment strategies on recruitment and retention of Latino smokers to a randomized smoking cessation trial. We also examine how the type of recruitment might have influenced the characteristics of enrolled participants. Methods: Latino smokers were enrolled into Decídetexto from 4 states—New Jersey, Kansas, Missouri, and New York. Participants were recruited from August 2018 until March 2021. Mass recruitment strategies included English and Spanish advertisements to the Latino community via flyers, Facebook ads, newspapers, television, radio, church bulletins, and our Decídetexto website. Direct, high-effort strategies included referrals from clinics or community-based organizations with whom we partnered, in-person community outreach, and patient registry calls. Direct, low-effort strategies included texting or emailing pre-existing lists of patients who smoked. A team of trained bilingual (English and Spanish) recruiters from 9 different Spanish-speaking countries of origin conducted recruitment, assessed eligibility, and enrolled participants into the trial. Results: Of 1112 individuals who were screened, 895 (80.5%) met eligibility criteria, and 457 (457/895, 51.1%) enrolled in the trial. Within the pool of screened individuals, those recruited by low-effort recruitment strategies (both mass and direct) were significantly more likely to be eligible (odds ratio [OR] 1.67, 95% CI 1.01-2.76 and OR 1.70, 95% CI 0.98-2.96, respectively) and enrolled in the trial (OR 2.60, 95% CI 1.81-3.73 and OR 3.02, 95% CI 2.03-4.51, respectively) compared with those enrolled by direct, high-effort strategies. Among participants enrolled, the retention rates at 3 months and 6 months among participants recruited via low-effort strategies (both mass and direct) were similar to participants recruited via direct, high-effort methods. Compared with enrolled participants recruited via direct (high- and low-effort) strategies, participants recruited via mass strategies were less likely to have health insurance (44.0% vs 71.2% and 71.7%, respectively; P<.001), lived fewer years in the United States (22.4 years vs 32.4 years and 30.3 years, respectively; P<.001), more likely to be 1st generation (92.7% vs 76.5% and 77.5%, respectively; P=.007), more likely to primarily speak Spanish (89.3% vs 65.8% and 66.3%, respectively), and more likely to be at high risk for alcohol abuse (5.8 mean score vs 3.8 mean score and 3.9 mean score, respectively; P<.001). Conclusions: Although most participants were recruited via direct, high-effort strategies, direct low-effort recruitment strategies yielded a screening pool more likely to be eligible for the trial. Mass recruitment strategies were associated with fewer acculturated enrollees with lower access to health services—groups who might benefit a great deal from the intervention. Trial Registration: ClinicalTrials.gov identifier: NCT03586596; https://clinicaltrials.gov/ct2/show/NCT03586596 International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2020.106188 %M 35759320 %R 10.2196/34863 %U https://www.jmir.org/2022/6/e34863 %U https://doi.org/10.2196/34863 %U http://www.ncbi.nlm.nih.gov/pubmed/35759320 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e33867 %T Correlates of Engagement Within an Online HIV Prevention Intervention for Single Young Men Who Have Sex With Men: Randomized Controlled Trial %A Choi,Seul Ki %A Golinkoff,Jesse %A Michna,Mark %A Connochie,Daniel %A Bauermeister,José %+ Department of Family and Community Health, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, United States, 1 2155734734, skchoi@nursing.upenn.edu %K paradata %K mobile health %K mHealth %K digital health intervention %K risk reduction %K HIV prevention %K public health %K digital health %K sexual health %K sexual risks %D 2022 %7 27.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Digital HIV interventions (DHI) have been efficacious in reducing sexual risk behaviors among sexual minority populations, yet challenges in promoting and sustaining users’ engagement in DHI persist. Understanding the correlates of DHI engagement and their impact on HIV-related outcomes remains a priority. This study used data from a DHI (myDEx) designed to promote HIV prevention behaviors among single young men who have sex with men (YMSM; ages 18-24 years) seeking partners online. Objective: The goal of this study is to conduct a secondary analysis of the myDex project data to examine whether YMSM’s online behaviors (eg, online partner-seeking behaviors and motivations) are linked to participants’ engagement (ie, the number of log-ins and the number of sessions viewed). Methods: We recruited 180 YMSM who were randomized into either myDEx arm or attention-control arm using a stratified 2:1 block randomization. In the myDEx arm, we had 120 YMSM who had access to the 6-session intervention content over a 3-month period. We used Poisson regressions to assess the association between YMSM’s baseline characteristics on their DHI engagement. We then examined the association between the participants’ engagement and their self-reported changes in HIV-related outcomes at the 3-month follow-up. Results: The mean number of log-ins was 5.44 (range 2-14), and the number of sessions viewed was 6.93 (range 0-22) across the 3-month trial period. In multivariable models, the number of log-ins was positively associated with high education attainment (estimated Poisson regression coefficient [β]=.22; P=.045). The number of sessions viewed was associated with several baseline characteristics, including the greater number of sessions viewed among non-Hispanic YMSM (β=.27; P=.002), higher education attainment (β=.22; P=.003), higher perceived usefulness of online dating for hookups (β=.13; P=.002) and perceived loneliness (β=.06; P=.004), as well as lower experienced online discrimination (β=–.01; P=.007) and limerence (β=–.02; P=.004). The number of sessions viewed was negatively associated with changes in internalized homophobia (β=–.06; P<.001) and with changes in perceived usefulness of online dating for hookups (β=–.20; P<.001). There were no significant associations between the number of log-ins and changes in the participants’ behaviors at the 90-day follow-up. Conclusions: DHI engagement is linked to participants’ sociodemographic and online behaviors. Given the importance of intervention engagement in the intervention’s effectiveness, DHIs with personalized intervention components that consider the individuals’ differences could increase the overall engagement and efficacy of DHIs. Trial Registration: ClinicalTrials.gov NCT02842060; https://clinicaltrials.gov/ct2/show/NCT02842060. %M 35759333 %R 10.2196/33867 %U https://publichealth.jmir.org/2022/6/e33867 %U https://doi.org/10.2196/33867 %U http://www.ncbi.nlm.nih.gov/pubmed/35759333 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e34273 %T Effectiveness of a Conversational Chatbot (Dejal@bot) for the Adult Population to Quit Smoking: Pragmatic, Multicenter, Controlled, Randomized Clinical Trial in Primary Care %A Olano-Espinosa,Eduardo %A Avila-Tomas,Jose Francisco %A Minue-Lorenzo,Cesar %A Matilla-Pardo,Blanca %A Serrano Serrano,María Encarnación %A Martinez-Suberviola,F Javier %A Gil-Conesa,Mario %A Del Cura-González,Isabel %A , %+ Healthcare Center Los Castillos, Madrid Health Service, Calle Carballino 25, Alcorcón, 28924, Spain, 34 679325778, e.oeoeoeoe@gmail.com %K smoking %K tobacco cessation %K primary care %K smartphone use %K chatbot %K dialog systems %K artificial intelligence %K tobacco %K mHealth %K primary care %D 2022 %7 27.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Tobacco addiction is the leading cause of preventable morbidity and mortality worldwide, but only 1 in 20 cessation attempts is supervised by a health professional. The potential advantages of mobile health (mHealth) can circumvent this problem and facilitate tobacco cessation interventions for public health systems. Given its easy scalability to large populations and great potential, chatbots are a potentially useful complement to usual treatment. Objective: This study aims to assess the effectiveness of an evidence-based intervention to quit smoking via a chatbot in smartphones compared with usual clinical practice in primary care. Methods: This is a pragmatic, multicenter, controlled, and randomized clinical trial involving 34 primary health care centers within the Madrid Health Service (Spain). Smokers over the age of 18 years who attended on-site consultation and accepted help to quit tobacco were recruited by their doctor or nurse and randomly allocated to receive usual care (control group [CG]) or an evidence-based chatbot intervention (intervention group [IG]). The interventions in both arms were based on the 5A’s (ie, Ask, Advise, Assess, Assist, and Arrange) in the US Clinical Practice Guideline, which combines behavioral and pharmacological treatments and is structured in several follow-up appointments. The primary outcome was continuous abstinence from smoking that was biochemically validated after 6 months by the collaborators. The outcome analysis was blinded to allocation of patients, although participants were unblinded to group assignment. An intention-to-treat analysis, using the baseline-observation-carried-forward approach for missing data, and logistic regression models with robust estimators were employed for assessing the primary outcomes. Results: The trial was conducted between October 1, 2018, and March 31, 2019. The sample included 513 patients (242 in the IG and 271 in the CG), with an average age of 49.8 (SD 10.82) years and gender ratio of 59.3% (304/513) women and 40.7% (209/513) men. Of them, 232 patients (45.2%) completed the follow-up, 104/242 (42.9%) in the IG and 128/271 (47.2%) in the CG. In the intention-to-treat analysis, the biochemically validated abstinence rate at 6 months was higher in the IG (63/242, 26%) compared with that in the CG (51/271, 18.8%; odds ratio 1.52, 95% CI 1.00-2.31; P=.05). After adjusting for basal CO-oximetry and bupropion intake, no substantial changes were observed (odds ratio 1.52, 95% CI 0.99-2.33; P=.05; pseudo-R2=0.045). In the IG, 61.2% (148/242) of users accessed the chatbot, average chatbot-patient interaction time was 121 (95% CI 121.1-140.0) minutes, and average number of contacts was 45.56 (SD 36.32). Conclusions: A treatment including a chatbot for helping with tobacco cessation was more effective than usual clinical practice in primary care. However, this outcome was at the limit of statistical significance, and therefore these promising results must be interpreted with caution. Trial Registration: Clinicaltrials.gov NCT 03445507; https://tinyurl.com/mrnfcmtd International Registered Report Identifier (IRRID): RR2-10.1186/s12911-019-0972-z %M 35759328 %R 10.2196/34273 %U https://mhealth.jmir.org/2022/6/e34273 %U https://doi.org/10.2196/34273 %U http://www.ncbi.nlm.nih.gov/pubmed/35759328 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e32089 %T The Effects of Theory-Based Educational Intervention and WhatsApp Follow-up on Papanicolaou Smear Uptake Among Postnatal Women in Malaysia: Randomized Controlled Trial %A Mohammad,Zaahirah %A Ahmad,Norliza %A Baharom,Anisah %+ Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Jalan Universiti 1, Seri Kembangan, Serdang, 43400, Malaysia, 60 192710577, lizaahmad@upm.edu.my %K uterine cervical neoplasms %K Papanicolaou test %K psychological theory %K self-efficacy %K social media %K health knowledge %K attitude %K practice %K Malaysia %D 2022 %7 27.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the availability and accessibility of free Papanicolaou (Pap) smear as a screening tool for cervical cancer, the uptake of Pap smear in Malaysia has not changed in the last 15 years. Previous studies have shown that the high uptake of Pap smear reduces the mortality rate of patients with cervical cancer. The low uptake of Pap smear is multifactorial, and the problem could be minimized through the use of mobile technologies. Nevertheless, most intervention studies focused on individual factors, while other important aspects such as mobile technologies, especially WhatsApp, have not been investigated yet. Objective: This study aims to determine the effects of a theory-based educational intervention and WhatsApp follow-up (Pap smear uptake [PSU] intervention) in improving PSU among postnatal women in Seremban, Negeri Sembilan, Malaysia. Methods: A 2-arm, parallel single-blind cluster randomized controlled trial was conducted among postpartum women from the Seremban district. Twelve health clinics were randomly assigned to the intervention and control groups. At baseline, both groups received a self-administered questionnaire. The intervention group received standard care and PSU intervention delivered by a researcher. This 2-stage intervention module was developed based on Social Cognitive Theory, where the first stage was conducted face-to-face and the second stage included a WhatsApp follow-up. The control group received standard care. Participants were observed immediately and at 4, 8, and 12 weeks after the intervention. The primary endpoint was PSU, whereas the secondary endpoints were knowledge, attitude, and self-efficacy scores for Pap smear screening self-assessed using a Google Forms questionnaire. A generalized mixed model was used to determine the effectiveness of the intervention. All data were analyzed using IBM SPSS (version 25), and P value of .05 was considered statistically significant. Results: We analyzed 401 women, of whom 76 (response rate: 325/401, 81%) had withdrawn because of the COVID-19 pandemic, with a total of 162 respondents in the intervention group and 163 respondents in the control group. The proportion of Pap smears at the 12-week follow-up was 67.9% (110/162) in the intervention group versus 39.8% (65/163) in the control group (P<.001). Significant differences between the intervention and control groups were found for Pap smear use (F4,1178; P<.001), knowledge scores (F4,1172=14.946; P<.001), attitude scores (F4,1172=24.417; P<.001), and self-efficacy scores (F1,1172=10.432; P<.001). Conclusions: This study demonstrated that the PSU intervention is effective in increasing the uptake of Pap smear among postnatal women in Seremban district, Malaysia. This intervention module can be tested in other populations of women. Trial Registration: Thai Clinical Trials Registry TCTR20200205001; https://www.thaiclinicaltrials.org/show/TCTR20200205001 %M 35759319 %R 10.2196/32089 %U https://mhealth.jmir.org/2022/6/e32089 %U https://doi.org/10.2196/32089 %U http://www.ncbi.nlm.nih.gov/pubmed/35759319 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e33312 %T A Web-Based, Time-Use App To Assess Children’s Movement Behaviors: Validation Study of My E-Diary for Activities and Lifestyle (MEDAL) %A Tan,Sarah Yi Xuan %A Chia,Airu %A Tai,Bee Choo %A Natarajan,Padmapriya %A Goh,Claire Marie Jie Lin %A Shek,Lynette P %A Saw,Seang Mei %A Chong,Mary Foong-Fong %A Müller-Riemenschneider,Falk %+ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #09-01Q, Singapore, 117549, Singapore, 65 6516 4969, mary_chong@nus.edu.sg %K children %K accelerometer %K MEDAL %K web-based app %K self-report %K validity %K physical activity %K movement behavior %K pediatrics %K sleep %K digital health %K behavior %D 2022 %7 24.6.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Existing modes of collecting self-reported 24-hour movement information from children, including digital assessments, have not been demonstrated to be of acceptable validity when compared to objective measurements. My E-Diary for Activities and Lifestyle (MEDAL) is an interactive web-based diary developed to collect time-use information from children aged 10 years and older. Objective: This study evaluated the validity of MEDAL for assessing children’s movement behaviors by comparing self-reported and accelerometer-measured time spent in movement behavior among children in Singapore aged 10-11 years. Methods: Funding for this study was obtained in October 2017, and data were collected between April and August 2020. Participants recorded their daily activities using MEDAL over 2 specified weekdays and 2 weekend days and wore an Actigraph accelerometer on their nondominant wrist throughout the study to objectively assess movement behaviors. Spearman correlation coefficient and intraclass correlation coefficient (ICC) were used to compare the accelerometer measurements and self-reports for each movement behavior. Bland-Altman plots were generated to investigate trends of bias in the self-reports. Results: Among the participants aged 10-11 years (29/49, 59% boys), we observed that children reported lower light physical activity (LPA) and higher moderate-to-vigorous physical activity (MVPA), inactivity, and night sleep than that measured by the accelerometer. There was a moderate-to-strong correlation between self-reported and accelerometer-measured MVPA (r=0.37; 95% CI 0.20-0.54), inactivity (r=0.36; 95% CI 0.18-0.54), and night sleep (r=0.58; 95% CI 0.43-0.74); the correlation for LPA was poor (r=0.19; 95% CI 0.02-0.36). Agreement was poor for all behaviors (MVPA: ICC=0.24, 95% CI 0.07-0.40; LPA: ICC=0.19, 95% CI 0.01-0.36; inactivity: ICC=0.29, 95% CI 0.11-0.44; night sleep: ICC=0.45, 95% CI 0.29-0.58). There was stronger correlation and agreement on weekdays for inactivity and night sleep; conversely, there was stronger correlation and agreement for MVPA and LPA on weekend days. Finally, based on Bland-Altman plots, we observed that with increasing MVPA, children tended to report higher MVPA than that measured by the accelerometer. There were no clear trends for the other behaviors. Conclusions: MEDAL may be used to assess the movement behaviors of children. Based on self-reports, the children are able to estimate their time spent in MVPA, inactivity, and night sleep although actual time spent in these behaviors may differ from accelerometer-derived estimates; self-reported LPA warrant cautious interpretation. Observable differences in reporting accuracy exist between weekdays and weekend days. %M 35749208 %R 10.2196/33312 %U https://pediatrics.jmir.org/2022/2/e33312 %U https://doi.org/10.2196/33312 %U http://www.ncbi.nlm.nih.gov/pubmed/35749208 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 2 %P e35694 %T Self-monitoring of Physical Activity After Hospital Discharge in Patients Who Have Undergone Gastrointestinal or Lung Cancer Surgery: Mixed Methods Feasibility Study %A de Leeuwerk,Marijke Elizabeth %A Botjes,Martine %A van Vliet,Vincent %A Geleijn,Edwin %A de Groot,Vincent %A van Wegen,Erwin %A van der Schaaf,Marike %A Tuynman,Jurriaan %A Dickhoff,Chris %A van der Leeden,Marike %+ Rehabilitation Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, Netherlands, 31 612640672, m.e.deleeuwerk@amsterdamumc.nl %K mobile phone %K physical activity %K self-monitoring %K fitness trackers %K telemedicine %K cancer %K physical therapy %D 2022 %7 24.6.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Self-monitoring of physical activity (PA) using an accelerometer is a promising intervention to stimulate PA after hospital discharge. Objective: This study aimed to evaluate the feasibility of PA self-monitoring after discharge in patients who have undergone gastrointestinal or lung cancer surgery. Methods: A mixed methods study was conducted in which 41 patients with cancer scheduled for lobectomy, esophageal resection, or hyperthermic intraperitoneal chemotherapy were included. Preoperatively, patients received an ankle-worn accelerometer and the corresponding mobile health app to familiarize themselves with its use. The use was continued for up to 6 weeks after surgery. Feasibility criteria related to the study procedures, the System Usability Scale, and user experiences were established. In addition, 6 patients were selected to participate in semistructured interviews. Results: The percentage of patients willing to participate in the study (68/90, 76%) and the final participation rate (57/90, 63%) were considered good. The retention rate was acceptable (41/57, 72%), whereas the rate of missing accelerometer data was relatively high (31%). The mean System Usability Scale score was good (77.3). Interviewed patients mentioned that the accelerometer and app were easy to use, motivated them to be more physically active, and provided postdischarge support. The technical shortcomings and comfort of the ankle straps should be improved. Conclusions: Self-monitoring of PA after discharge appears to be feasible based on good system usability and predominantly positive user experiences in patients with cancer after lobectomy, esophageal resection, or hyperthermic intraperitoneal chemotherapy. Solving technical problems and improving the comfort of the ankle strap may reduce the number of dropouts and missing data in clinical use and follow-up studies. %M 35749165 %R 10.2196/35694 %U https://cancer.jmir.org/2022/2/e35694 %U https://doi.org/10.2196/35694 %U http://www.ncbi.nlm.nih.gov/pubmed/35749165 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e39669 %T Optimizing an mHealth Intervention to Change Food Purchasing Behaviors for Cancer Prevention: Protocol for a Pilot Randomized Controlled Trial %A Horgan,Olivia Z %A Crane,Nicole T %A Forman,Evan M %A Milliron,Brandy-Joe %A Simone,Nicole L %A Zhang,Fengqing %A Butryn,Meghan L %+ Center for Weight, Eating, and Lifestyle Science, Department of Psychological and Brain Sciences, Drexel University, Stratton Hall, 3001 Chestnut St., Philadelphia, PA, 19104, United States, 1 215 553 7108, mlb34@drexel.edu %K mHealth %K cancer prevention %K grocery shopping %K diet %K eating %K mobile phone %D 2022 %7 24.6.2022 %9 Proposal %J JMIR Res Protoc %G English %X Background: Dietary intake is a powerful modifiable factor that influences cancer risk; however, most US adults do not adhere to dietary guidelines for cancer prevention. One promising pathway for improving dietary adherence is targeting grocery shopping habits. Interventions might facilitate healthy grocery choices, with a combination of mHealth and traditional methods, by promoting the salience of dietary goals while shopping, enhancing motivation to make dietary changes, and increasing household support for healthy food purchasing. Objective: This pilot study will assess feasibility and acceptability of intervention components designed to improve adherence to dietary guidelines for cancer prevention (preliminary aim). The primary aim of the study is to quantify the effect of each intervention component, individually and in combination, on dietary intake (primary aim) and grocery store food purchases (exploratory aim). Mediation analyses will be conducted to understand the mechanisms of action (goal salience, motivation, and household support—secondary aims). The overarching goal is to optimize an mHealth intervention to be tested in a future fully powered clinical trial. Methods: The study enrolled adults (N=62) with low adherence to dietary recommendations for cancer prevention. In a 20-week program, all participants attend a nutrition education workshop and receive weekly educational messages through an app. A factorial design is used to test 4 intervention components: (1) location-triggered messages: educational messages are delivered when arriving at grocery stores; (2) reflections on the benefits of change: content is added to messages to encourage reflection on anticipated benefits of healthy eating, and participants attend an additional workshop session and 3 coach calls on this topic; (3) coach monitoring: food purchases are monitored digitally by a coach who sends personalized weekly app messages and conducts 3 coaching calls that focus on feedback about purchases; and (4) household support: another adult in the household receives messages designed to elicit support for healthy food purchasing, and support is addressed in 3 coach calls and an extra workshop session attended by the index participant and household member. Assessments are completed at weeks 0, 10, and 20 using self-report measures, as well as objective capture of grocery data from the point of purchase using store loyalty accounts. Results: The National Cancer Institute funded this study (R21CA252933) on July 7, 2020. Participant recruitment began in the spring of 2021 and concluded with the successful enrollment of 62 participants. Data collection is expected to be completed in the summer of 2022, and results are expected to be disseminated in the summer of 2023. Conclusions: The results of this study will inform the development of scalable interventions to lower cancer risk via changes in dietary intake. Trial Registration: ClinicalTrials.gov NCT04947150; https://clinicaltrials.gov/ct2/show/NCT04947150 International Registered Report Identifier (IRRID): DERR1-10.2196/39669 %M 35749216 %R 10.2196/39669 %U https://www.researchprotocols.org/2022/6/e39669 %U https://doi.org/10.2196/39669 %U http://www.ncbi.nlm.nih.gov/pubmed/35749216 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e37414 %T Remotely Delivered Behavioral Weight Loss Intervention Using an Ad Libitum Plant-Based Diet: Pilot Acceptability, Feasibility, and Preliminary Results %A Chwyl,Christina %A Wright,Nicholas %A M Turner-McGrievy,Gabrielle %A L Butryn,Meghan %A M Forman,Evan %+ Center for Weight, Eating, and Lifestyle Sciences, Drexel University, 3141 Chestnut Street, Philadelphia, PA, 19104, United States, 1 267 606 0414, cmc646@drexel.edu %K vegetarian diet %K vegan diet %K overweight %K eHealth %K behavioral intervention %D 2022 %7 23.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Many traditional lifestyle interventions use calorie prescriptions, but most individuals have difficulty sustaining calorie tracking and thus weight loss. In contrast, whole food plant-based diets (WFPBDs) have previously shown significant weight loss without this issue. However, most WFPBD interventions are face-to-face and time-intensive, and do not leverage gold standard behavioral strategies for health behavior change. Objective: This open pilot trial was the first to evaluate the feasibility of a fully featured, remotely delivered behavioral weight loss intervention using an ad libitum WFPBD. Methods: Over 12 weeks, participants (N=15) with overweight or obesity received a newly designed program that integrated behavioral weight loss and a WFPBD prescription via weekly web-based modules and brief phone coaching calls. Assessments were performed at baseline, midtreatment (6 weeks), and after treatment (12 weeks). Results: The intervention was rated as highly acceptable (mean 4.40 out of 5, SE 0.18), and attrition was low (6.7%). In all, intention-to-treat analyses revealed that 69% (10.4/15) of the participants lost 5% of their weight (mean –5.89, SE 0.68 kg). Predefined benchmarks for quality of life were met. Conclusions: A pilot digital behavioral weight loss intervention with a non–energy-restricted WFPBD was feasible, and the mean acceptability was high. Minimal contact time (80-150 minutes of study interventionist time per participant over 12 weeks) led to clinically relevant weight loss and dietary adherence for most participants (10.4/15, 69% and 11.8/15, 79%, respectively), and quality of life improvements (reliable change indices >1.53). We hope that this work will serve as a springboard for future larger scale randomized controlled studies evaluating the efficacy of such programs for weight loss, dietary change, and quality of life. Trial Registration: ClinicalTrials.gov NCT04892030; https://clinicaltrials.gov/ct2/show/NCT04892030 %M 35737443 %R 10.2196/37414 %U https://formative.jmir.org/2022/6/e37414 %U https://doi.org/10.2196/37414 %U http://www.ncbi.nlm.nih.gov/pubmed/35737443 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e31011 %T Assessing the Risk Factors For Diagnosed Symptomatic Dry Eye Using a Smartphone App: Cross-sectional Study %A Kasetsuwan,Ngamjit %A Suwan-Apichon,Olan %A Lekhanont,Kaevalin %A Chuckpaiwong,Varintorn %A Reinprayoon,Usanee %A Chantra,Somporn %A Puangsricharern,Vilavun %A Pariyakanok,Lalida %A Prabhasawat,Pinnita %A Tesavibul,Nattaporn %A Chaidaroon,Winai %A Tananuvat,Napaporn %A Hirunpat,Chakree %A Prakairungthong,Nauljira %A Sansanayudh,Wiwan %A Chirapapaisan,Chareenun %A Phrueksaudomchai,Pakornkit %+ Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Rama 4 Rd Pathum Wan, Pathumwan District, Bangkok, 10330, Thailand, 66 22564000 ext 81875, ngamjitk@gmail.com %K blink rate %K dry eye %K smartphone application %K maximum blink interval %K prevalence %K mHealth %K epidemiology %K screening %K risk factors %K symptoms %K ophthalmology %K vision %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dry eye (DE) is a chronic inflammatory disease of the ocular surface of the eye that affects millions of people throughout the world. Smartphone use as an effective health care tool has grown exponentially. The “Dry eye or not?” app was created to evaluate the prevalence of symptomatic DE, screen for its occurrence, and provide feedback to users with symptomatic DE throughout Thailand. Objective: The purpose of this study was to compare the prevalence of symptomatic dry eye (DE), blink rate, maximum blink interval (MBI), and best spectacle-corrected visual acuity (BSCVA) between people with and without symptomatic DE and to identify risk factors for symptomatic DE in Thailand. Methods: This cross-sectional study sourced data from the “Dry eye or not?” smartphone app between November 2019 and July 2020. This app collected demographic data, Ocular Surface Disease Index (OSDI) score, blink rate, MBI, BSCVA, and visual display terminal (VDT) use data. The criterion for symptomatic DE was OSDI score ≥13. Results: The prevalence of symptomatic DE among individuals using this smartphone app in Thailand was 85.8% (8131/9482), with the Northeastern region of Thailand having the highest prevalence, followed by the Northern region. Worse BSCVA (median 0.20, IQR 0.40; P=.02), increased blink rate (median 18, IQR 16; P<.001), reduced MBI (median 8.90, IQR 10.80; P<.001), female sex (adjusted OR 1.83; 95% CI 1.59-2.09; P<.001), more than 6 hours of VDT use (adjusted OR 1.59; 95% CI 1.15-2.19; P=.004), and lower than bachelor’s degree (adjusted OR 1.30; 95% CI 1.03-1.64; P=.02) were significantly associated with symptomatic DE. An age over 50 years (adjusted OR 0.77; 95% CI 0.60-0.99) was significantly less associated with symptomatic DE (P=.04). Conclusions: This smartphone DE app showed that the prevalence of symptomatic DE in Thailand was 85.8%. Signs and risk factors could be also evaluated with this smartphone DE app. Screening for DE by this app may allow for the development of strategic plans for health care systems in Thailand. %M 35731569 %R 10.2196/31011 %U https://mhealth.jmir.org/2022/6/e31011 %U https://doi.org/10.2196/31011 %U http://www.ncbi.nlm.nih.gov/pubmed/35731569 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e35869 %T User Experience and Usability of Neumorphism and Gamification User Interface Designs in an HIV Self-Test Referral Program for Men Who Have Sex With Men: Prospective Open-Label Parallel-Group Randomized Controlled Trial %A Kwan,Tsz Ho %A Chan,Denise Pui Chung %A Lee,Shui Shan %+ Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Room 207, Postgraduate Education Centre, Prince of Wales Hospital, Hong Kong, China (Hong Kong), 852 22528812, sslee@cuhk.edu.hk %K HIV %K self-test %K men who have sex with men %K gamification %K neumorphism %K digital intervention %K HIV prevention %K user interface %K games %K digital health %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Digital interventions have been applied for promoting HIV prevention and care among men who have sex with men (MSM). As user interface (UI) design plays a role in determining usability and user experience (UX), the intervention outcome could be affected. Objective: In this study, we hypothesized that 2 UI design styles, namely gamification and neumorphism, could impact usability and be differentially preferred by distinct groups of MSM. Methods: A prospective parallel-group open-label randomized controlled trial was conducted in Hong Kong. Eligible participants were adult MSM recruited by the research team or referred by enrolled participants, who followed instructions for performing an HIV self-test and promoted its use within their social network. Participants were randomized in a 1:1 ratio into either a gamification or neumorphism arm, with primarily visual differences in the UI only. The primary outcome was usability measured by the System Usability Scale (SUS) between the 2 arms. Distinct characteristics of promoters in the 2 arms who gave an SUS score of 80 or above were identified. Results: Of 463 MSM registered in the study, 232 and 231 were randomized to the gamification and neumorphism arms, respectively. Excluding those who did not request a self-test kit, data from 218 and 216 participants in the gamification and neumorphism arms, respectively, were analyzed (totally 434 participants). With a median SUS score of 80 overall, participants in the neumorphism arm gave a higher score (P<.001), with a higher proportion giving a promoter-level SUS score (P=.002). Promoters used social media for sex networking (P=.02), used pre-exposure prophylaxis in the preceding year (P=.006), had higher satisfaction in UI design (P<.001), and had made a self-test referral (P=.04). In general, higher usability was recorded among participants who were confident in performing the HIV self-test (P<.001), and this was associated with a promoter-level SUS score in both arms. While no other personal characteristics were associated with promoters in the neumorphism arm, those in the gamification arm had higher HIV-related knowledge (P=.01), preferred a specific partner body image type (P=.03), and progressed toward peer referral by completing online training (P=.04). Conclusions: Both gamified and neumorphic UI designs were well-accepted by MSM. UX and satisfaction of UI were both crucial in influencing the willingness of MSM to promote the application by referring their peers in the community to participate. The simplistic visual design of neumorphism conferred a more general acceptance in the community, whereas gamification was preferred in certain MSM subcommunities. Appropriate UI/UX design should be considered when developing digital interventions targeting the MSM community. Trial Registration: ClinicalTrials.gov NCT04379206; https://clinicaltrials.gov/ct2/show/NCT04379206 %M 35731564 %R 10.2196/35869 %U https://games.jmir.org/2022/2/e35869 %U https://doi.org/10.2196/35869 %U http://www.ncbi.nlm.nih.gov/pubmed/35731564 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33929 %T A Web-Based mHealth Intervention With Telephone Support to Increase Physical Activity Among Pregnant Patients With Overweight or Obesity: Feasibility Randomized Controlled Trial %A Thomas,Tainayah %A Xu,Fei %A Sridhar,Sneha %A Sedgwick,Tali %A Nkemere,Linda %A Badon,Sylvia E %A Quesenberry,Charles %A Ferrara,Assiamira %A Mandel,Sarah %A Brown,Susan D %A Hedderson,Monique %+ Department of Epidemiology and Population Health, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, United States, 1 3107211208, tainayah@stanford.edu %K mobile health %K gestational weight gain %K obesity %K physical activity %K mobile phone %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Pregnant patients with overweight or obesity are at high risk for perinatal complications. Excess gestational weight gain (GWG) further exacerbates this risk. Mobile health (mHealth) lifestyle interventions that leverage technology to facilitate self-monitoring and provide just-in-time feedback may motivate behavior change to reduce excess GWG, reduce intervention costs, and increase scalability by improving access. Objective: This study aimed to test the acceptability and feasibility of a pilot mHealth lifestyle intervention for pregnant patients with overweight or obesity to promote moderate intensity physical activity (PA), encourage guideline-concordant GWG, and inform the design of a larger pragmatic cluster randomized controlled trial. Methods: We conducted a mixed methods acceptability and feasibility randomized controlled trial among pregnant patients with a prepregnancy BMI of 25 to 40 kg/m2. Patients with singletons at 8 to 15 weeks of gestation who were aged ≥21 years and had Wi-Fi access were recruited via email from 2 clinics within Kaiser Permanente Northern California and randomized to receive usual prenatal care or an mHealth lifestyle intervention. Participants in the intervention arm received wireless scales, access to an intervention website, activity trackers to receive automated feedback on weight gain and activity goals, and monthly calls from a lifestyle coach. Surveys and focus groups with intervention participants assessed intervention satisfaction and ways to improve the intervention. PA outcomes were self-assessed using the Pregnancy Physical Activity Questionnaire, and GWG was assessed using electronic health record data for both arms. Results: Overall, 33 patients were randomly assigned to the intervention arm, and 35 patients were randomly assigned to the usual care arm. All participants in the intervention arm weighed themselves at least once a week, compared with 20% (7/35) of the participants in the usual care arm. Participants in the intervention arm wore the activity tracker 6.4 days per week and weighed themselves 5.3 times per week, and 88% (29/33) of them rated the program “good to excellent.” Focus groups found that participants desired more nutrition-related support to help them manage GWG and would have preferred an app instead of a website. Participants in the intervention arm had a 23.46 metabolic equivalent of task hours greater change in total PA per week and a 247.2-minute greater change in moderate intensity PA per week in unadjusted models, but these effects were attenuated in adjusted models (change in total PA: 15.55 metabolic equivalent of task hours per week; change in moderate intensity PA: 199.6 minutes per week). We found no difference in total GWG (mean difference 1.14 kg) compared with usual care. Conclusions: The pilot mHealth lifestyle intervention was feasible, highly acceptable, and promoted self-monitoring. Refined interventions are needed to effectively affect PA and GWG among pregnant patients with overweight or obesity. Trial Registration: ClinicalTrials.gov NCT03936283; https://clinicaltrials.gov/ct2/show/NCT03936283 %M 35731565 %R 10.2196/33929 %U https://formative.jmir.org/2022/6/e33929 %U https://doi.org/10.2196/33929 %U http://www.ncbi.nlm.nih.gov/pubmed/35731565 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e32354 %T Breast Cancer Physical Activity Mobile Intervention: Early Findings From a User Experience and Acceptability Mixed Methods Study %A Signorelli,Gabriel Ruiz %A Monteiro-Guerra,Francisco %A Rivera-Romero,Octavio %A Núñez-Benjumea,Francisco J %A Fernández-Luque,Luis %+ Adhera Health, Inc, Circuito II Bldg, Av de los Descubrimientos, s/n, Mairena del Aljarafe - Seville, Palo Alto, CA, United States, 1 656930901, luis@adherahealth.com %K breast cancer %K BC %K mobile app %K physical activity %K mHealth %K acceptability %K user experience %K mobile phone %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical activity (PA) is the most well-established lifestyle factor associated with breast cancer (BC) survival. Even women with advanced BC may benefit from moderate PA. However, most BC symptoms and treatment side effects are barriers to PA. Mobile health coaching systems can implement functionalities and features based on behavioral change theories to promote healthier behaviors. However, to increase its acceptability among women with BC, it is essential that these digital persuasive systems are designed considering their contextual characteristics, needs, and preferences. Objective: This study aimed to examine the potential acceptability and feasibility of a mobile-based intervention to promote PA in patients with BC; assess usability and other aspects of the user experience; and identify key considerations and aspects for future improvements, which may help increase and sustain acceptability and engagement. Methods: A mixed methods case series evaluation of usability and acceptability was conducted in this study. The study comprised 3 sessions: initial, home, and final sessions. Two standardized scales were used: the Satisfaction with Life Scale and the International Physical Activity Questionnaire–Short Form. Participants were asked to use the app at home for approximately 2 weeks. App use and PA data were collected from the app and stored on a secure server during this period. In the final session, the participants filled in 2 app evaluation scales and took part in a short individual interview. They also completed the System Usability Scale and the user version of the Mobile App Rating Scale. Participants were provided with a waist pocket, wired in-ear headphones, and a smartphone. They also received printed instructions. A content analysis of the qualitative data collected in the interviews was conducted iteratively, ensuring that no critical information was overlooked. Results: The International Physical Activity Questionnaire–Short Form found that all participants (n=4) were moderately active; however, half of them did not reach the recommended levels in the guidelines. System Usability Scale scores were all >70 out of 100 (72.5, 77.5, 95, and 80), whereas the overall user version of the Mobile App Rating Scale scores were 4, 4.3, 4.4, and 3.6 out of 5. The app was perceived to be nice, user-friendly, straightforward, and easy to understand. Recognition of achievements, the possibility of checking activity history, and the rescheduling option were positively highlighted. Technical difficulties with system data collection, particularly with the miscount of steps, could make users feel frustrated. The participants suggested improvements and indicated that the app has the potential to work well for survivors of BC. Conclusions: Early results presented in this study point to the potential of this tool concept to provide a friendly and satisfying coaching experience to users, which may help improve PA adherence in survivors of BC. %M 35731554 %R 10.2196/32354 %U https://formative.jmir.org/2022/6/e32354 %U https://doi.org/10.2196/32354 %U http://www.ncbi.nlm.nih.gov/pubmed/35731554 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e38614 %T Beyond Pathogen Filtration: Possibility of Smart Masks as Wearable Devices for Personal and Group Health and Safety Management %A Lee,Peter %A Kim,Heepyung %A Kim,Yongshin %A Choi,Woohyeok %A Zitouni,M Sami %A Khandoker,Ahsan %A Jelinek,Herbert F %A Hadjileontiadis,Leontios %A Lee,Uichin %A Jeong,Yong %+ Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro Yuseong gu, Daejeon, 34141, Republic of Korea, 82 423507165, yong@kaist.ac.kr %K smart mask %K pathogen filtration %K COVID-19 %K protective equipment %K digital health %K wearable %K smart device %K wearable device %K sensor %K health monitoring %D 2022 %7 21.6.2022 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Face masks are an important way to combat the COVID-19 pandemic. However, the prolonged pandemic has revealed confounding problems with the current face masks, including not only the spread of the disease but also concurrent psychological, social, and economic complications. As face masks have been worn for a long time, people have been interested in expanding the purpose of masks from protection to comfort and health, leading to the release of various “smart” mask products around the world. To envision how the smart masks will be extended, this paper reviewed 25 smart masks (12 from commercial products and 13 from academic prototypes) that emerged after the pandemic. While most smart masks presented in the market focus on resolving problems with user breathing discomfort, which arise from prolonged use, academic prototypes were designed for not only sensing COVID-19 but also general health monitoring aspects. Further, we investigated several specific sensors that can be incorporated into the mask for expanding biophysical features. On a larger scale, we discussed the architecture and possible applications with the help of connected smart masks. Namely, beyond a personal sensing application, a group or community sensing application may share an aggregate version of information with the broader population. In addition, this kind of collaborative sensing will also address the challenges of individual sensing, such as reliability and coverage. Lastly, we identified possible service application fields and further considerations for actual use. Along with daily-life health monitoring, smart masks may function as a general respiratory health tool for sports training, in an emergency room or ambulatory setting, as protection for industry workers and firefighters, and for soldier safety and survivability. For further considerations, we investigated design aspects in terms of sensor reliability and reproducibility, ergonomic design for user acceptance, and privacy-aware data-handling. Overall, we aim to explore new possibilities by examining the latest research, sensor technologies, and application platform perspectives for smart masks as one of the promising wearable devices. By integrating biomarkers of respiration symptoms, a smart mask can be a truly cutting-edge device that expands further knowledge on health monitoring to reach the next level of wearables. %M 35679029 %R 10.2196/38614 %U https://mhealth.jmir.org/2022/6/e38614 %U https://doi.org/10.2196/38614 %U http://www.ncbi.nlm.nih.gov/pubmed/35679029 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e38991 %T Evaluating the Efficacy of the Drinks:Ration Mobile App to Reduce Alcohol Consumption in a Help-Seeking Military Veteran Population: Randomized Controlled Trial %A Leightley,Daniel %A Williamson,Charlotte %A Rona,Roberto J %A Carr,Ewan %A Shearer,James %A Davis,Jordan P %A Simms,Amos %A Fear,Nicola T %A Goodwin,Laura %A Murphy,Dominic %+ Institute of Psychiatry, Psychology & Neuroscience, King’s Centre for Military Health Research, King's College London, 10 Cutcombe Road, London, SE5 9RJ, United Kingdom, 44 78485351, daniel.leightley@kcl.ac.uk %K military %K veteran %K digital health %K alcohol misuse %K smartphone %K mobile health %K mHealth %K alcohol intervention %K digital intervention %K mental health %K smartphone application %K health intervention %K alcohol consumption %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Alcohol misuse is higher in the UK armed forces (AF) than in the general population. Research demonstrates that alcohol misuse persists after an individual leaves service, and this is notably the case for those who are seeking help for a mental health difficulty. Despite this, there is no work on testing a mobile alcohol reduction intervention that is personalized to support the UK AF. Objective: To address this gap, we investigated the efficacy of a 28-day brief alcohol intervention delivered via a mobile app in reducing weekly self-reported alcohol consumption among UK veterans seeking help for mental health difficulties. Methods: We performed a 2-arm participant-blinded randomized controlled trial (RCT). We compared a mobile app that included interactive features designed to enhance participants’ motivation and personalized messaging (intervention arm) with a version that provided government guidance on alcohol consumption only (control arm). Adults were eligible if they had served in the UK AF, were currently receiving or had received clinical support for mental health symptoms, and consumed 14 units (approximately 112 g of ethanol) or more of alcohol per week. Participants received the intervention or the control mobile app (1:1 ratio). The primary outcome was a change in self-reported weekly alcohol consumption between baseline and day 84 assessed using the validated Timeline Follow Back for Alcohol Consumption (TLFB) (prior 7 days), with a secondary outcome exploring self-reported change in the Alcohol Use Disorder Identification Test (AUDIT) score. Results: Between October 2020 and April 2021, 2708 individuals were invited to take part, of which 2531 (93.5%) did not respond, 54 (2%) were ineligible, and 123 (4.5%) responded and were randomly allocated (62, 50.4%, intervention; 61, 49.6%, control). At day 84, 41 (66.1%) participants in the intervention arm and 37 (60.7%) in the control arm completed the primary outcome assessment. Between baseline and day 84, weekly alcohol consumption reduced by –10.5 (95% CI –19.5 to –1.5) units in the control arm and –28.2 (95% CI –36.9 to –19.5) units in the intervention arm (P=.003, Cohen d=0.35). We also found a significant reduction in the AUDIT score of –3.9 (95% CI –6.2 to –1.6) in the intervention arm (Cohen d=0.48). Our primary and secondary effects did not persist over the longer term (day 168). Two adverse events were detected during the trial. Conclusions: This study examined the efficacy of a fully automated 28-day brief alcohol intervention delivered via a mobile app in a help-seeking sample of UK veterans with hazardous alcohol consumption. We found that participants receiving Drinks:Ration reduced their alcohol consumption more than participants receiving guidance only (at day 84). In the short term, we found Drinks:Ration is efficacious in reducing alcohol consumption in help-seeking veterans. Trial Registration: ClinicalTrials.gov NCT04494594; https://tinyurl.com/34em6n9f International Registered Report Identifier (IRRID): RR2-10.2196/19720 %M 35724966 %R 10.2196/38991 %U https://mhealth.jmir.org/2022/6/e38991 %U https://doi.org/10.2196/38991 %U http://www.ncbi.nlm.nih.gov/pubmed/35724966 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e29640 %T Possible Impact of a 12-Month Web- and Smartphone-Based Program to Improve Long-term Physical Activity in Patients Attending Spa Therapy: Randomized Controlled Trial %A Fillol,Florie %A Paris,Ludivine %A Pascal,Sébastien %A Mulliez,Aurélien %A Roques,Christian-François %A Rousset,Sylvie %A Duclos,Martine %+ Biomouv SAS Inc, 259 Rue Saint Honoré, Paris, 75001, France, 33 0664421389, florie.fillol@gmail.com %K physical activity %K spa %K mobile phone %K older adults %K internet %K exercise %K aged %K sedentary behavior %K quality of life %K follow-up studies %D 2022 %7 16.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Lack of physical activity (PA) and sedentary behaviors are leading risk factors for noncommunicable diseases (NCDs). Web- and smartphone-based interventions are effective in increasing PA in older adults and in patients with NCD. In many countries, spa therapy, commonly prescribed to patients with NCD, represents an ideal context to initiating lifestyle changes. Objective: This study aimed to evaluate, in patients attending spa therapy, the effectiveness of an intervention combining a face-to-face coaching and, when returning home, a web- and smartphone-based PA program on the achievement of PA guidelines (PAG) 12 months after the end of spa therapy. Methods: This was a 12-month, prospective, parallel-group randomized controlled trial. Patients were enrolled during spa therapy and randomized 1:1 to intervention or control group who received PA usual advice. From the end of spa therapy, PA, weight, waist circumference, and quality of life of the participants were assessed by phone every 2 months. Primary outcome was meeting PAG (PA ≥600 metabolic equivalent of task) at 12 months. Secondary outcomes were meeting current PAG at 6 months; sedentary time, weight, waist circumference, PA, and quality of life at 6 and 12 months. Objective use data of the web- and smartphone-based PA program were collected. Analytic methods included intention to treat and constrained longitudinal data analyses. Results: The study sample included 228 participants (n=176, 77.2% females) with a mean age of 62.4 (SD 6.7) years and a mean BMI of 28.2 (SD 4.2) kg/m2. Approximately 53.9% (123/228) of the participants were retired. No group differences were found for any baseline variable. At 12 months, the proportion of patients achieving PAG was significantly higher in intervention group than in the control group (81% vs 67% respectively, odds ratio 2.34, 95% CI 1.02-5.38; P=.045). No difference between intervention and control group was found neither in achieving PAG at 6 months nor for sedentary time, weight, and waist circumference at 6 and 12 months. Regarding quality of life, the physical component subscale score was significantly higher at 12 months in the intervention group than in the control group (mean difference: 4.1, 95% CI 1.9-6.3; P<.001). The mean duration use of the program was 7.1 (SD 4.5) months. Attrition rate during the first 2 months was 20.4% (23/113) whereas 39.8% (45/113) of the participants used the program for at least 10 months. Conclusions: PA increased in both the intervention group and the control group. However, at 12 months, more participants met PAG in the intervention group compared with the controls. This indicates that the web- and smartphone-based program could have maintained PA in the intervention group. In addition, a spa therapy seems to be an ideal time and framework to implement PA education. Trial Registration: ClinicalTrials.gov NCT02694796; https://clinicaltrials.gov/ct2/show/NCT02694796 %M 35708743 %R 10.2196/29640 %U https://www.jmir.org/2022/6/e29640 %U https://doi.org/10.2196/29640 %U http://www.ncbi.nlm.nih.gov/pubmed/35708743 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e38283 %T Assessing the Initial Validity of the PortionSize App to Estimate Dietary Intake Among Adults: Pilot and Feasibility App Validation Study %A Saha,Sanjoy %A Lozano,Chloe Panizza %A Broyles,Stephanie %A Martin,Corby K %A Apolzan,John W %+ Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Road, Baton Rouge, LA, 70808, United States, 1 2257632827, john.apolzan@pbrc.edu %K dietary assessment %K eating %K food intake %K energy intake %K portion size %K mHealth %K digital health %K eHealth %K nutrition %K food groups %D 2022 %7 15.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Accurately assessing dietary intake can promote improved nutrition. The PortionSize app (Pennington Biomedical Research Center) was designed to quantify and provide real-time feedback on the intake of energy, food groups, saturated fat, and added sugar. Objective: This study aimed to assess the preliminary feasibility and validity of estimating food intake via the PortionSize app among adults. Methods: A total of 15 adults (aged 18-65 years) were recruited and trained to quantify the food intake from a simulated meal by using PortionSize. Trained personnel prepared 15 simulated meals and covertly weighed (weigh back) the amount of food provided to participants as well as food waste. Equivalence tests (±25% bounds) were performed to compare PortionSize to the weigh back method. Results: Participants were aged a mean of 28 (SD 12) years, and 11 were female. The mean energy intake estimated with PortionSize was 742.9 (SD 328.2) kcal, and that estimated via weigh back was 659.3 (SD 190.7) kcal (energy intake difference: mean 83.5, SD 287.5 kcal). The methods were not equivalent in estimating energy intake (P=.18), and PortionSize overestimated energy intake by 83.5 kcal (12.7%) at the meal level. Estimates of portion sizes (gram weight; P=.01), total sugar (P=.049), fruit servings (P=.01), and dairy servings (P=.047) from PortionSize were equivalent to those estimated via weigh back. PortionSize was not equivalent to weigh back with regard to estimates for carbohydrate (P=.10), fat (P=.32), vegetable (P=.37), grain (P=.31), and protein servings (P=.87). Conclusions: Due to power limitations, the equivalence tests had large equivalence bounds. Though preliminary, the results of this small pilot study warrant the further adaptation, development, and validation of PortionSize as a means to estimate energy intake and provide users with real-time and actionable dietary feedback. %M 35704355 %R 10.2196/38283 %U https://formative.jmir.org/2022/6/e38283 %U https://doi.org/10.2196/38283 %U http://www.ncbi.nlm.nih.gov/pubmed/35704355 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e38223 %T Advancing Posttraumatic Stress Disorder Diagnosis and the Treatment of Trauma in Humanitarian Emergencies via Mobile Health: Protocol for a Proof-of-Concept Nonrandomized Controlled Trial %A Pinto,Janaina V %A Hunt,Caroline %A O'Toole,Brian %+ Faculty of Medicine and Health, The University of Sydney, 94 Mallett St, Sydney, 2050, Australia, 61 481244463, jpin6516@uni.sydney.edu.au %K posttraumatic stress disorder %K PTSD %K trauma %K humanitarian %K emergencies %K mobile health %K mHealth %K technology %K neuroscience %K electrophysiology %K electroencephalogram %K EEG %K cognition %K health system %K biometric %K health application %K mental health %K cognition %K trauma %K health intervention %K mobile phone %D 2022 %7 15.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Decentralized health systems in low- and middle-income countries (LMICs) affected by humanitarian crises lack resources and a qualified workforce to attend to the overwhelming demand for mental health care in emergencies. Innovative approaches that are safe, cost-effective, and scalable are needed to address the burden of traumatic stress caused by emergencies. High mobile phone ownership rates combined with the precision of neural, cognitive, and biometric measures of trauma and their feasible integration with artificial intelligence makes digital app interventions a promising pathway to promote precision diagnosis and high-impact care. Objective: This study aimed to advance methods for the objective diagnosis and treatment of trauma in emergencies across LMICs by examining neural, cognitive, and biometric markers and the efficacy of the eResilience app, a neuroscience-informed mobile health mental health app intervention, via changes in clinical symptomatology, cognitive performance, and brain activity. Methods: Trauma-exposed African refugees residing in Australia were selected for this study. A research software version of the eResilience app with advanced monitoring capabilities was designed for this trial. Participants completed the eResilience app at home during a 7-day period. Clinical, cognitive, and electrophysiological data were collected at baseline, along with posttest measurements to examine biomarkers of trauma and the efficacy of the proposed digital intervention for the treatment of trauma and its potential outcomes, including depression, anxiety, physical symptoms, self-harm, substance misuse, and cognitive impairment. In addition, biofeedback, well-being, and subjective stress data points were collected via the app during the treatment week, followed by clinical interviews at 1, 3, 6, and 12 months after the intervention. Results: Data collection was conducted between 2018 and 2020. A total of 100 participants exposed to war were screened; 75 (75%) were enrolled and assigned to a trauma-exposed control (38/75, 51%) or posttraumatic stress disorder condition (37/75, 49%); and 70 (70%) completed all baseline, treatment, and posttest assessments. A total of 89% (62/70) of those who completed the intervention opted to enroll in the 3-, 6-, and 12-month follow-ups. Data collection is complete. As of May 2022, the results of all proposed analyses are being prepared for publication. If proven efficacious, this proof-of-concept clinical trial will inform fully powered randomized clinical trials in LMICs to further develop artificial intelligence–powered, app-based diagnostic and prognostic features and determine the app’s cross-cultural efficacy for the treatment of trauma in emergency settings. Conclusions: This protocol provides researchers with a comprehensive background of the study rationale, a detailed guideline for replication studies interested in examining the feasibility and efficacy of the eResilience app across varied demographics, and a robust framework for investigating low-cost objective diagnostic markers in mental health interventions. Methodological limitations and suggestions are also provided. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616001205426; https://tinyurl.com/yckwc4d7 International Registered Report Identifier (IRRID): RR1-10.2196/38223 %M 35596546 %R 10.2196/38223 %U https://www.researchprotocols.org/2022/6/e38223 %U https://doi.org/10.2196/38223 %U http://www.ncbi.nlm.nih.gov/pubmed/35596546 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e32218 %T The Role of Agency and Threat Immediacy in Interactive Digital Narrative Fear Appeals for the Prevention of Excessive Alcohol Use: Randomized Controlled Trial %A Engelbrecht,Hendrik %A van der Laan,Laura Nynke %A van Enschot,Renske %A Krahmer,Emiel %+ Tilburg School of Humanities and Digital Sciences, Tilburg University, Warandelaan 2, Tilburg, 5037AB, Netherlands, 31 134663383, h.engelbrecht@tilburguniversity.edu %K young adults %K college students %K alcohol abuse %K drinking %K EPPM %K fear appeals %K agency %K serious games %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Serious games for the training of prevention behaviors have been widely recognized as potentially valuable tools for adolescents and young adults across a variety of risk behaviors. However, the role of agency as a distinguishing factor from traditional health interventions has seldom been isolated and grounded in the persuasive health communication theory. Fear appeals have different effects on intentions to perform prevention behaviors depending on the immediacy of the consequences. Looking into how to increase self-efficacy beliefs for health behavior with distant consequences is the first step toward improving game-based interventions for adverse health outcomes. Objective: This study aimed to investigate the effect of agency on self-efficacy and the intention to drink less alcohol in an interactive digital narrative fear appeal. Furthermore, the communicated immediacy of threat outcomes was evaluated as a potential moderator of the effect of agency on self-efficacy. Methods: A web-based experimental study was conducted with university students (N=178). The participants were presented with a fear appeal outlining the consequences of excessive alcohol use in a fully automated web-based interactive narrative. Participants either had perceived control over the outcome of the narrative scenario (high agency) or no control over the outcome (low agency). The threat was either framed as a short-term (high immediacy) or long-term (low immediacy) negative health outcome resulting from the execution of the risk behavior (drinking too much alcohol). Results: A total of 123 valid cases were analyzed. Self-efficacy and intention to limit alcohol intake were not influenced by the agency manipulation. Self-efficacy was shown to be a significant predictor of behavioral intention. The immediacy of the threat did not moderate the relationship between agency and self-efficacy. Conclusions: Although agency manipulation was successful, we could not find evidence of an effect of agency or threat immediacy on self-efficacy. The implications for different operationalizations of different agency concepts, as well as the malleability of self-efficacy beliefs for long-term threats, are discussed. The use of repeated versus single interventions and different threat types (eg, health and social threats) should be tested empirically to establish a way forward for diversifying intervention approaches. Trial Registration: ClinicalTrials.gov NCT05321238; https://www.clinicaltrials.gov/ct2/show/NCT05321238 %M 35699976 %R 10.2196/32218 %U https://games.jmir.org/2022/2/e32218 %U https://doi.org/10.2196/32218 %U http://www.ncbi.nlm.nih.gov/pubmed/35699976 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e38075 %T Interest in HIV Prevention Mobile Phone Apps: Focus Group Study With Sexual and Gender Minority Persons Living in the Rural Southern United States %A Jones,Jeb %A Edwards,O Winslow %A Merrill,Leland %A Sullivan,Patrick S %A Stephenson,Rob %+ Department of Epidemiology, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 4047122275, jeb.jones@emory.edu %K men who have sex with men %K transgender persons %K nonbinary persons %K mHealth %K mobile app %K HIV %K pre-exposure prophylaxis %K PrEP %K sexually transmitted infection testing %K STI testing %K HIV testing %K mobile phone %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) interventions, including smartphone apps, have been found to be an effective means of increasing the uptake of HIV prevention tools, including HIV and sexually transmitted infection (STI) tests and pre-exposure prophylaxis. However, most HIV prevention mHealth apps tested in the United States have been tested among populations living in areas surrounding urban centers. Owing to reduced access to broadband internet and reliable cellular data services, it remains unclear how accessible and effective these interventions will be in rural areas. In addition, gay and bisexual men who have sex with men and gender minority populations in rural areas experience enhanced stigma when compared with their more urban counterparts, and these experiences might affect their willingness and interest in mHealth apps. Objective: This study aimed to conduct online focus groups with men who have sex with men and transgender and gender diverse populations in the rural southern United States to assess their interest in mHealth HIV prevention apps and the features that they would be the most interested in using. Methods: Focus group participants were recruited from a larger pool of sexual and gender minority respondents to a web-based research survey. The participants indicated that they would be willing to participate in an online focus group discussion. Focus groups were conducted via secure Zoom (Zoom Video Communications Inc) videoconferencing. During the focus group discussions, participants were asked to discuss their experiences with HIV and STI prevention and how these experiences were affected by living in a rural area. They were then shown screenshots of a new app to promote HIV and STI prevention among rural populations and asked to provide their opinions on the app’s features. The transcripts of the discussions were reviewed and coded using a constant comparative approach. Results: A total of 6 focus groups were conducted with 26 participants. Most participants were cisgender gay and bisexual men who have sex with men (19/26, 73%); the remaining participants were transgender men (2/26, 8%), were nonbinary people (2/26, 8%), or had multiple gender identities (3/26, 12%). Participants reported numerous barriers to accessing HIV and STI prevention services and accurate information about HIV and STI prevention options. Overall, the participants reported a high degree of interest in mHealth interventions for HIV and STI prevention and suggested several recommendations for the features of an app-based intervention that would be the most useful for rural residents. Conclusions: These focus group discussions indicate that rural residence is not a major barrier to mHealth HIV and STI prevention intervention implementation and that there is a high degree of interest in these approaches to HIV and STI prevention. %M 35699980 %R 10.2196/38075 %U https://formative.jmir.org/2022/6/e38075 %U https://doi.org/10.2196/38075 %U http://www.ncbi.nlm.nih.gov/pubmed/35699980 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e34191 %T Electronic Health Record–Based Recruitment and Retention and Mobile Health App Usage: Multisite Cohort Study %A Coughlin,Janelle W %A Martin,Lindsay M %A Zhao,Di %A Goheer,Attia %A Woolf,Thomas B %A Holzhauer,Katherine %A Lehmann,Harold P %A Lent,Michelle R %A McTigue,Kathleen M %A Clark,Jeanne M %A Bennett,Wendy L %+ Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive Suite 100, Baltimore, MD, 21224, United States, 1 410 550 7988, jwilder3@jhmi.edu %K mHealth %K mobile apps %K recruitment %K engagement %K retention %K timing of eating %K timing of sleep %K obesity %K EHR %D 2022 %7 10.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: To address the obesity epidemic, there is a need for novel paradigms, including those that address the timing of eating and sleep in relation to circadian rhythms. Electronic health records (EHRs) are an efficient way to identify potentially eligible participants for health research studies. Mobile health (mHealth) apps offer available and convenient data collection of health behaviors, such as timing of eating and sleep. Objective: The aim of this descriptive analysis was to report on recruitment, retention, and app use from a 6-month cohort study using a mobile app called Daily24. Methods: Using an EHR query, adult patients from three health care systems in the PaTH clinical research network were identified as potentially eligible, invited electronically to participate, and instructed to download and use the Daily24 mobile app, which focuses on eating and sleep timing. Online surveys were completed at baseline and 4 months. We described app use and identified predictors of app use, defined as 1 or more days of use, versus nonuse and usage categories (ie, immediate, consistent, and sustained) using multivariate regression analyses. Results: Of 70,661 patients who were sent research invitations, 1021 (1.44%) completed electronic consent forms and online baseline surveys; 4 withdrew, leaving a total of 1017 participants in the analytic sample. A total of 53.79% (n=547) of the participants were app users and, of those, 75.3% (n=412), 50.1% (n=274), and 25.4% (n=139) were immediate, consistent, and sustained users, respectively. Median app use was 28 (IQR 7-75) days over 6 months. Younger age, White race, higher educational level, higher income, having no children younger than 18 years, and having used 1 to 5 health apps significantly predicted app use (vs nonuse) in adjusted models. Older age and lower BMI predicted early, consistent, and sustained use. About half (532/1017, 52.31%) of the participants completed the 4-month online surveys. A total of 33.5% (183/547), 29.3% (157/536), and 27.1% (143/527) of app users were still using the app for at least 2 days per month during months 4, 5, and 6 of the study, respectively. Conclusions: EHR recruitment offers an efficient (ie, high reach, low touch, and minimal participant burden) approach to recruiting participants from health care settings into mHealth research. Efforts to recruit and retain less engaged subgroups are needed to collect more generalizable data. Additionally, future app iterations should include more evidence-based features to increase participant use. %M 35687400 %R 10.2196/34191 %U https://www.jmir.org/2022/6/e34191 %U https://doi.org/10.2196/34191 %U http://www.ncbi.nlm.nih.gov/pubmed/35687400 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e31685 %T Feedback on Trunk Movements From an Electronic Game to Improve Postural Balance in People With Nonspecific Low Back Pain: Pilot Randomized Controlled Trial %A Meinke,Anita %A Peters,Rick %A Knols,Ruud H %A Swanenburg,Jaap %A Karlen,Walter %+ Mobile Health Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Balgrist Campus, BAA, Lengghalde 5, Zurich, 8008, Switzerland, 41 446337754, meinke_a@outlook.de %K low back pain %K postural balance %K exergame %K postural feedback %K motor control %K kinesiophobia %K inertial measurement unit %K randomized controlled trial %D 2022 %7 10.6.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Postural balance is compromised in people with low back pain, possibly by changes in motor control of the trunk. Augmenting exercising interventions with sensor-based feedback on trunk posture and movements might improve postural balance in people with low back pain. Objective: We hypothesized that exercising with feedback on trunk movements reduces sway in anterior-posterior direction during quiet standing in people with low back pain. Secondary outcomes were lumbar spine and hip movement assessed during box lift and waiter bow tasks, as well as participant-reported outcomes. Adherence to the exercising intervention was also examined. Methods: A randomized controlled trial was conducted with the intervention group receiving unsupervised home exercises with visual feedback using the Valedo Home, an exergame based on 2 inertial measurement units. The control group received no intervention. Outcomes were recorded by blinded staff during 4 visits (T1-T4) at University Hospital Zurich. The intervention group performed 9 sessions of 20 minutes in the 3 weeks between T2 and T3 and were instructed to exercise at their own convenience between T3 and T4. Postural balance was assessed on a force platform. Lumbar spine and hip angles were obtained from 3 inertial measurement units. The assessments included pain intensity, disability, quality of life, and fear of movement questionnaires. Results: A total of 32 participants with nonspecific low back pain completed the first assessment T1, and 27 (84%) participants were randomized at T2 (n=14, 52% control and n=13, 48% intervention). Intention-to-treat analysis revealed no significant difference in change in anterior-posterior sway direction during the intervention period with a specified schedule (T2-T3) between the groups (W=99; P=.36; r=0.07). None of the outcomes showed significant change in accordance with our hypotheses. The intervention group completed a median of 61% (55/90; range 2%-99%) of the exercises in the predefined training program. Adherence was higher in the first intervention period with a specified schedule. Conclusions: The intervention had no significant effect on postural balance or other outcomes, but the wide range of adherence and a limited sample size challenged the robustness of these conclusions. Future work should increase focus on improving adherence to digital interventions. Trial Registration: ClinicalTrials.gov NCT04364243; https://clinicaltrials.gov/ct2/show/NCT04364243 International Registered Report Identifier (IRRID): RR2-10.2196/26982 %M 35687390 %R 10.2196/31685 %U https://games.jmir.org/2022/2/e31685 %U https://doi.org/10.2196/31685 %U http://www.ncbi.nlm.nih.gov/pubmed/35687390 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e34651 %T Improving Postoperative Care Through Mindfulness-Based and Isometric Exercise Training Interventions: Systematic Review %A Reynolds,Allie %A Hamidian Jahromi,Alireza %+ Department of Plastic and Reconstructive Surgery, Temple University Medical Center, 3500 N Broad Street, Philadelphia, PA, 19140, United States, 1 3185184600, alirezahamidian@yahoo.com %K postoperative care %K mindfulness %K isometric exercise %K mindfulness-based interventions %K meditation %K cognitive therapy %K improving care %K postoperative %K systematic review %D 2022 %7 10.6.2022 %9 Review %J JMIR Perioper Med %G English %X Background: Mindfulness-based cognitive therapy and isometric exercise training (IET) interventions are relatively new approaches to maintain physical functioning, alleviate pain, prevent joint stiffness and muscular atrophy, and positively influence other postoperative care outcomes. Objective: The aim of this review was to identify the impacts of mindfulness-based interventions (MBIs) and IET and, more specifically, their combination, which have not previously been assessed to our knowledge. Methods: Studies were identified by searching the PubMed and Cochrane databases within the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) algorithm format and using relevant keyword combinations, which resulted in 39 studies meeting the inclusion criteria. Results: In general, MBI was shown to positively impact both pain relief and physical functioning, while IET positively impacted physical functioning. Numerous other benefits, including improved quality of life and decreased postoperative opioid use, were also described from both interventions; however, further research is needed to confirm these findings as well as to determine other possible benefits. No studies were found that combined MBI and IET. Conclusions: Despite many positive results from each individual intervention, there is a lack of information about how the combination of MBI and IET might impact postoperative care. The combination of these two interventions might prove to be more effective than each individual intervention alone, and the findings from this review show that they could even be complementary. Going forward, research should be expanded to study the possible benefits of the combination of MBI and IET in postoperative care routines as well as other possible combinations. %M 35687415 %R 10.2196/34651 %U https://periop.jmir.org/2022/1/e34651 %U https://doi.org/10.2196/34651 %U http://www.ncbi.nlm.nih.gov/pubmed/35687415 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35118 %T A Theory-Informed, Personalized mHealth Intervention for Adolescents (Mobile App for Physical Activity): Development and Pilot Study %A Domin,Alex %A Uslu,Arif %A Schulz,André %A Ouzzahra,Yacine %A Vögele,Claus %+ Research Group: Self-Regulation and Health, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Maison des Sciences Humaines, 11, Porte des Sciences, Esch-sur-Alzette, 4366, Luxembourg, 352 46 66 44 93, alex.domin@uni.lu %K mobile health %K physical activity %K app %K adolescents %K within-subject %K mHealth %K sedentary behavior %K behavior change techniques %K BCTs %K Fitbit %K mobile phone %D 2022 %7 10.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Evidence suggests that physical activity (PA) during childhood and adolescence is crucial as it usually results in adequate PA levels in adulthood. Given the ubiquitous use of smartphones by adolescents, these devices may offer feasible means to reach young populations and deliver interventions aiming to increase PA participation and decrease sedentary time. To date, very few studies have reported smartphone-based interventions promoting PA for adolescents. In addition, most available fitness apps do not include the latest evidence-based content. Objective: This paper described the systematic development of a behavior change, theory-informed Mobile App for Physical Activity intervention with personalized prompts for adolescents aged 16 to 18 years. The within-subject trial results provided the first evidence of the general effectiveness of the intervention based on the outcomes step count, sedentary time, and moderate to vigorous PA (MVPA) minutes. The effectiveness of the intervention component personalized PA prompt was also assessed. Methods: A 4-week within-subject trial with 18 healthy adolescents aged 16 to 18 years was conducted (mean age 16.33, SD 0.57 years). After the baseline week, the participants used the Mobile App for Physical Activity intervention (Fitbit fitness tracker+app), which included a daily personalized PA prompt delivered via a pop-up notification. A paired 1-tailed t test was performed to assess the effectiveness of the intervention. Change-point analysis was performed to assess the effectiveness of a personalized PA prompt 30 and 60 minutes after prompt delivery. Results: The results showed that the intervention significantly reduced sedentary time in adolescents during the first week of the trial (t17=−1.79; P=.04; bootstrapped P=.02). This trend, although remaining positive, diminished over time. Our findings indicate that the intervention had no effect on metabolic equivalent of task–based MVPA minutes, although the descriptive increase may give reason for further investigation. Although the results suggested no overall change in heart rate–based MVPA minutes, the results from the change-point analyses suggest that the personalized PA prompts significantly increased heart rate per minute during the second week of the study (t16=1.84; P=.04; bootstrapped P=.04). There were no significant increases in participants’ overall step count; however, the personalized PA prompts resulted in a marginally significant increase in step counts per minute in the second week of the study (t17=1.35; P=.09; bootstrapped P=.05). Conclusions: The results of the trial provide preliminary evidence of the benefit of the Mobile App for Physical Activity intervention for modest yet significant reductions in participants’ sedentary time and the beneficial role of personalized PA prompts. These results also provide further evidence of the benefits and relative efficacy of personalized activity suggestions for inclusion in smartphone-based PA interventions. This study provides an example of how to guide the development of smartphone-based mobile health PA interventions for adolescents. %M 35687409 %R 10.2196/35118 %U https://formative.jmir.org/2022/6/e35118 %U https://doi.org/10.2196/35118 %U http://www.ncbi.nlm.nih.gov/pubmed/35687409 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e36377 %T Quality Evaluation of Free-living Validation Studies for the Assessment of 24-Hour Physical Behavior in Adults via Wearables: Systematic Review %A Giurgiu,Marco %A Timm,Irina %A Becker,Marlissa %A Schmidt,Steffen %A Wunsch,Kathrin %A Nissen,Rebecca %A Davidovski,Denis %A Bussmann,Johannes B J %A Nigg,Claudio R %A Reichert,Markus %A Ebner-Priemer,Ulrich W %A Woll,Alexander %A von Haaren-Mack,Birte %+ Department of Sports and Sports Science, Karlsruhe Institute of Technology, Hertzstr. 16, Karlsruhe, 76187, Germany, 49 017620763557, marco.giurgiu@kit.edu %K wearables %K validation %K sedentary behavior %K physical activity %K sleep %D 2022 %7 9.6.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Wearable technology is a leading fitness trend in the growing commercial industry and an established method for collecting 24-hour physical behavior data in research studies. High-quality free-living validation studies are required to enable both researchers and consumers to make guided decisions on which study to rely on and which device to use. However, reviews focusing on the quality of free-living validation studies in adults are lacking. Objective: This study aimed to raise researchers’ and consumers’ attention to the quality of published validation protocols while aiming to identify and compare specific consistencies or inconsistencies between protocols. We aimed to provide a comprehensive and historical overview of which wearable devices have been validated for which purpose and whether they show promise for use in further studies. Methods: Peer-reviewed validation studies from electronic databases, as well as backward and forward citation searches (1970 to July 2021), with the following, required indicators were included: protocol must include real-life conditions, outcome must belong to one dimension of the 24-hour physical behavior construct (intensity, posture or activity type, and biological state), the protocol must include a criterion measure, and study results must be published in English-language journals. The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool with 9 questions separated into 4 domains (patient selection or study design, index measure, criterion measure, and flow and time). Results: Of the 13,285 unique search results, 222 (1.67%) articles were included. Most studies (153/237, 64.6%) validated an intensity measure outcome such as energy expenditure. However, only 19.8% (47/237) validated biological state and 15.6% (37/237) validated posture or activity-type outcomes. Across all studies, 163 different wearables were identified. Of these, 58.9% (96/163) were validated only once. ActiGraph GT3X/GT3X+ (36/163, 22.1%), Fitbit Flex (20/163, 12.3%), and ActivPAL (12/163, 7.4%) were used most often in the included studies. The percentage of participants meeting the quality criteria ranged from 38.8% (92/237) to 92.4% (219/237). On the basis of our classification tree to evaluate the overall study quality, 4.6% (11/237) of studies were classified as low risk. Furthermore, 16% (38/237) of studies were classified as having some concerns, and 72.9% (173/237) of studies were classified as high risk. Conclusions: Overall, free-living validation studies of wearables are characterized by low methodological quality, large variability in design, and focus on intensity. Future research should strongly aim at biological state and posture or activity outcomes and strive for standardized protocols embedded in a validation framework. Standardized protocols for free-living validation embedded in a framework are urgently needed to inform and guide stakeholders (eg, manufacturers, scientists, and consumers) in selecting wearables for self-tracking purposes, applying wearables in health studies, and fostering innovation to achieve improved validity. %M 35679106 %R 10.2196/36377 %U https://mhealth.jmir.org/2022/6/e36377 %U https://doi.org/10.2196/36377 %U http://www.ncbi.nlm.nih.gov/pubmed/35679106 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e35053 %T Emerging Artificial Intelligence–Empowered mHealth: Scoping Review %A Bhatt,Paras %A Liu,Jia %A Gong,Yanmin %A Wang,Jing %A Guo,Yuanxiong %+ Department of Electrical & Computer Engineering, The University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX, 78249, United States, 1 210 458 8028, yuanxiong.guo@utsa.edu %K mobile health units %K telemedicine %K machine learning %K artificial intelligence %K review literature as topic %D 2022 %7 9.6.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Artificial intelligence (AI) has revolutionized health care delivery in recent years. There is an increase in research for advanced AI techniques, such as deep learning, to build predictive models for the early detection of diseases. Such predictive models leverage mobile health (mHealth) data from wearable sensors and smartphones to discover novel ways for detecting and managing chronic diseases and mental health conditions. Objective: Currently, little is known about the use of AI-powered mHealth (AIM) settings. Therefore, this scoping review aims to map current research on the emerging use of AIM for managing diseases and promoting health. Our objective is to synthesize research in AIM models that have increasingly been used for health care delivery in the last 2 years. Methods: Using Arksey and O’Malley’s 5-point framework for conducting scoping reviews, we reviewed AIM literature from the past 2 years in the fields of biomedical technology, AI, and information systems. We searched 3 databases, PubsOnline at INFORMS, e-journal archive at MIS Quarterly, and Association for Computing Machinery (ACM) Digital Library using keywords such as “mobile healthcare,” “wearable medical sensors,” “smartphones”, and “AI.” We included AIM articles and excluded technical articles focused only on AI models. We also used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) technique for identifying articles that represent a comprehensive view of current research in the AIM domain. Results: We screened 108 articles focusing on developing AIM models for ensuring better health care delivery, detecting diseases early, and diagnosing chronic health conditions, and 37 articles were eligible for inclusion, with 31 of the 37 articles being published last year (76%). Of the included articles, 9 studied AI models to detect serious mental health issues, such as depression and suicidal tendencies, and chronic health conditions, such as sleep apnea and diabetes. Several articles discussed the application of AIM models for remote patient monitoring and disease management. The considered primary health concerns belonged to 3 categories: mental health, physical health, and health promotion and wellness. Moreover, 14 of the 37 articles used AIM applications to research physical health, representing 38% of the total studies. Finally, 28 out of the 37 (76%) studies used proprietary data sets rather than public data sets. We found a lack of research in addressing chronic mental health issues and a lack of publicly available data sets for AIM research. Conclusions: The application of AIM models for disease detection and management is a growing research domain. These models provide accurate predictions for enabling preventive care on a broader scale in the health care domain. Given the ever-increasing need for remote disease management during the pandemic, recent AI techniques, such as federated learning and explainable AI, can act as a catalyst for increasing the adoption of AIM and enabling secure data sharing across the health care industry. %M 35679107 %R 10.2196/35053 %U https://mhealth.jmir.org/2022/6/e35053 %U https://doi.org/10.2196/35053 %U http://www.ncbi.nlm.nih.gov/pubmed/35679107 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e33972 %T Features and Components Preferred by Adolescents in Smartphone Apps for the Promotion of Physical Activity: Focus Group Study %A Domin,Alex %A Ouzzahra,Yacine %A Vögele,Claus %+ Research Group for Self-Regulation and Health, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Maison des Sciences Humaines, 11, Porte des Sciences, Esch-sur-Alzette, L-4366, Luxembourg, 352 46 66 44 9389, alex.domin@uni.lu %K mHealth %K physical activity %K mobile phone %K health %K qualitative research %K focus groups %K smartphone apps %K behavior change %K mobile health %K adolescents %D 2022 %7 9.6.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: There is solid evidence that lack of physical activity (PA) is a risk factor for chronic diseases. Sufficient levels of PA in childhood and adolescence are particularly important, as they can set the standards for PA levels in adulthood. The latest reports show that only a small percentage of adolescents reach the recommended levels of PA in European Union countries at the age of 15 years. In view of the scale of the problem, it is crucial to develop interventions that promote and support PA in adolescents. Considering their low implementation costs and ubiquitous presence, smartphone apps could be advantageous as a part of PA interventions. Objective: This study aimed at investigating the attitudes and preferences of adolescents aged 16-18 years toward various PA app features and components that could (1) make the app more attractive for them and consequently (2) increase their interest and engagement with the app. Methods: Two separate focus group discussions were conducted in 2 groups of adolescents (n=4 each) aged 16-18 years. Focus groups were carried out online via video conference. The discussions were conducted using a semistructured interview. Participants (n=8; 4 males and 4 females) had a mean age of 17.25 years (SD 0.82 years). Transcripts were analyzed following the approach by Krueger and Casey, that is, categorizing participants’ answers and comments according to the questions and themes from the focus group schedule. Results: Features, such as “goal setting and planning,” “coaching and training programs,” “activity tracking,” “feedback,” and “location tracking” were appraised as attractive, motivating, and interesting. An “automatic activity recognition” feature was perceived as useful only under the condition that its precision was high. The “reminders” component was also deemed as useful only if a range of conditions was fulfilled (timeliness, opportunity for customization, etc). The features “mood and sleep tracking,” “sharing workout results via social networks,” “digital avatar and coach,” and “rewards” were generally perceived negatively and considered as useless and not motivating. In general, participants preferred features with an easy-to-navigate interface and a clear, simplistic, and straightforward layout with a modern design. Customization and personalization qualities were highly appreciated throughout an app, together with data precision. Conclusions: This study contributes to the understanding of the features and components preferred by adolescents in apps promoting PA. Such apps should provide users with precise data, and have a simplistic modern design and a straightforward easy-to-use interface. Apps should be personalized and customizable. Desired features to be included in an app are goal setting and planning, feedback, coaching and training programs, and activity tracking. The features should involve high levels of data precision and timely delivery while taking into consideration the real-life context. %M 35679113 %R 10.2196/33972 %U https://humanfactors.jmir.org/2022/2/e33972 %U https://doi.org/10.2196/33972 %U http://www.ncbi.nlm.nih.gov/pubmed/35679113 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e35747 %T mHealth Research for Weight Loss, Physical Activity, and Sedentary Behavior: Bibliometric Analysis %A Wu,Chieh-Chen %A Huang,Chih-Wei %A Wang,Yao-Chin %A Islam,Md.Mohaimenul %A Kung,Woon-Man %A Weng,Yung-Ching %A Su,Chun-Hsien %+ Graduate Institute of Sport Coaching Science, College of Kinesiology and Health, Chinese Culture University, No. 55, Hwa-Kang Road, Yang-Ming-Shan, Taipei, 11114, Taiwan, 886 2 2861 0511, chsu@ulive.pccu.edu.tw %K mobile health %K weight loss %K physical activity %K sedentary behavior %K bibliometric analysis %K mHealth %K weight %K behavior %K research %K literature %K bibliometric %K journal %K trend %K app %D 2022 %7 8.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Research into mobile health (mHealth) technologies on weight loss, physical activity, and sedentary behavior has increased substantially over the last decade; however, no research has been published showing the research trend in this field. Objective: The purpose of this study was to provide a dynamic and longitudinal bibliometric analysis of recent trends of mHealth research for weight loss, physical activity, and sedentary behavior. Methods: A comprehensive search was conducted through Web of Science to retrieve all existing relevant documents published in English between January 1, 2010, and November 1, 2021. We developed appropriate research questions; based on the proven bibliometric approaches, a search strategy was formulated to screen the title for eligibility. Finally, we conducted bibliometric analyses to explore the growth rate of publications; publication patterns; and the most productive authors, institutions, and countries, and visualized the trends in the field using a keyword co-occurrence network. Results: The initial search identified 8739 articles, of which 1035 were included in the analyses. Our findings show an exponential growth trend in the number of annual publications of mHealth technology research in these fields. JMIR mHealth and uHealth (n=214, 20.67%), Journal of Medical Internet Research (n=71, 6.86%), and BMC Public Health (n=36, 3.47%) were the top 3 journals, publishing higher numbers of articles. The United States remained the leading contributor in these areas (n=405, 39.13%), followed by Australia (n=154, 14.87%) and England (n=125, 12.07%). Among the universities, the University of Sydney (n=36, 3.47%) contributed the most mHealth technology research in these areas; however, Deakin University (n=25, 2.41%) and the National University of Singapore (n=23, 2.22%) were in the second and third positions, respectively. Conclusions: Although the number of papers published on mobile technologies for weight loss, physical activity, and sedentary behavior was initially low, there has been an overall increase in these areas in recent years. The findings of the study indicate that mobile apps and technologies have substantial potential to reduce weight, increase physical activity, and change sedentary behavior. Indeed, this study provides a useful overview of the publication trends and valuable guidance on future research directions and perspectives in this rapidly developing field. %M 35675126 %R 10.2196/35747 %U https://www.jmir.org/2022/6/e35747 %U https://doi.org/10.2196/35747 %U http://www.ncbi.nlm.nih.gov/pubmed/35675126 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e30817 %T Measurement of Adherence to mHealth Physical Activity Interventions and Exploration of the Factors That Affect the Adherence: Scoping Review and Proposed Framework %A Yang,Yang %A Boulton,Elisabeth %A Todd,Chris %+ School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Jean McFarlane Building, Manchester, M13 9PL, United Kingdom, 44 07422943521, yang.yang-3@manchester.ac.uk %K mobile health %K mHealth %K physical activity %K adherence %K framework %K scoping review %K mobile phone %D 2022 %7 8.6.2022 %9 Review %J J Med Internet Res %G English %X Background: Mobile health (mHealth) is widely used as an innovative approach to delivering physical activity (PA) programs. Users’ adherence to mHealth programs is important to ensure the effectiveness of mHealth-based programs. Objective: Our primary aim was to review the literature on the methods used to assess adherence, factors that could affect users’ adherence, and the investigation of the association between adherence and health outcomes. Our secondary aim was to develop a framework to understand the role of adherence in influencing the effectiveness of mHealth PA programs. Methods: MEDLINE, PsycINFO, EMBASE, and CINAHL databases were searched to identify studies that evaluated the use of mHealth to promote PA in adults aged ≥18 years. We used critical interpretive synthesis methods to summarize the data collected. Results: In total, 54 papers were included in this review. We identified 31 specific adherence measurement methods, which were summarized into 8 indicators; these indicators were mapped to 4 dimensions: length, breadth, depth, and interaction. Users’ characteristics (5 factors), technology-related factors (12 factors), and contextual factors (1 factor) were reported to have impacts on adherence. The included studies reveal that adherence is significantly associated with intervention outcomes, including health behaviors, psychological indicators, and clinical indicators. A framework was developed based on these review findings. Conclusions: This study developed an adherence framework linking together the adherence predictors, comprehensive adherence assessment, and clinical effectiveness. This framework could provide evidence for measuring adherence comprehensively and guide further studies on adherence to mHealth-based PA interventions. Future research should validate the utility of this proposed framework. %M 35675111 %R 10.2196/30817 %U https://www.jmir.org/2022/6/e30817 %U https://doi.org/10.2196/30817 %U http://www.ncbi.nlm.nih.gov/pubmed/35675111 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e34951 %T Feasibility, Acceptability, and Preliminary Efficacy of an App-Based Meditation Intervention to Decrease Firefighter Psychological Distress and Burnout: A One-Group Pilot Study %A Pace,Thaddeus W W %A Zeiders,Katharine H %A Cook,Stephanie H %A Sarsar,Evelyn D %A Hoyt,Lindsay T %A Mirin,Nicholas L %A Wood,Erica P %A Tatar,Raquel %A Davidson,Richard J %+ Division of Biobehavioral Health Science, College of Nursing, University of Arizona, 1305 N Martin Ave, Tucson, AZ, 85721, United States, 1 520 626 3520, twwpace@arizona.edu %K firefighter %K meditation %K smartphone app %K anxiety %K cortisol %K digital health %K mobile health %K mHealth %K mental health %K burnout %K stress management %D 2022 %7 8.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Firefighters are often exposed to occupational stressors that can result in psychological distress (ie, anxiety and depression) and burnout. These occupational stressors have only intensified with the onset of the COVID-19 pandemic and will likely persist in the postpandemic world. Objective: To address occupational stressors confronting firefighters, we pilot tested a novel, cost-effective, smartphone app–based meditation intervention created by Healthy Minds Innovations that focused on mindfulness (awareness) training along with practices designed to cultivate positive relationships (connection), insight into the nature of the self (insight), and a sense of purpose in the context of challenge (purpose) with a sample of professional firefighters from a large metropolitan area in southwestern United States. Methods: A total of 35 participants were recruited from a closed online group listserv and completed the self-guided 10-unit meditation app over the course of 10 days, at 1 unit per day. We assessed anxiety symptoms, depression symptoms, burnout, and negative affect as well as saliva diurnal cortisol rhythm, an objective indicator of stress-related biology, before and after use of the meditation app. Results: This study demonstrated the meditation app was both feasible and acceptable for use by the majority of firefighters. We also found significant reductions in firefighters’ anxiety (P=.01), burnout (P=.05), and negative affect (P=.04), as well as changes in cortisol diurnal rhythm, such as waking cortisol (P=.02), from before to after use of the meditation app. Conclusions: Our study findings call for future research to demonstrate the efficacy of this meditation app to reduce psychological distress and burnout in firefighters. %M 35675115 %R 10.2196/34951 %U https://formative.jmir.org/2022/6/e34951 %U https://doi.org/10.2196/34951 %U http://www.ncbi.nlm.nih.gov/pubmed/35675115 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e30630 %T Evaluation of Dietary Management Using Artificial Intelligence and Human Interventions: Nonrandomized Controlled Trial %A Okaniwa,Fusae %A Yoshida,Hiroshi %+ Department of Theoretical Social Security Research, National Institute of Population and Social Security Research, 2-2-3 Uchisaiwaicho, Chiyoda-ku, Tokyo, 100-0011, Japan, 81 3 3595 2984, okaniwa-fusae@ipss.go.jp %K health promotion %K dietary management %K intervention %K artificial intelligence %K body fat percentage %K body mass index %K behavioral economics %K nonprofessional %K Japan %D 2022 %7 8.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There has been an increase in personal health records with the increased use of wearable devices and smartphone apps to improve health. Traditional health promotion programs by human professionals have limitations in terms of cost and reach. Due to labor shortages and to save costs, there has been a growing emphasis in the medical field on building health guidance systems using artificial intelligence (AI). AI will replace advanced human tasks to some extent in the future. However, it is difficult to sustain behavioral change through technology alone at present. Objective: This study investigates whether AI alone can effectively encourage healthy behaviors or whether human interventions are needed to achieve and sustain health-related behavioral change. We examined the effectiveness of AI and human interventions to encourage dietary management behaviors. In addition, we elucidated the conditions for maximizing the effect of AI on health improvement. We hypothesized that the combination of AI and human interventions will maximize their effectiveness. Methods: We conducted a 3-month experiment by recruiting participants who were users of a smartphone diet management app. We recruited 102 participants and divided them into 3 groups. Treatment group I received text messages using the standard features of the app (AI-based text message intervention). Treatment group II received video messages from a companion, in addition to the text messages (combined text message and human video message intervention by AI). The control group used the app to keep a dietary record, but no feedback was provided (no intervention). We examine the participants’ continuity and the effects on physical indicators. Results: Combined AI and video messaging (treatment group II) led to a lower dropout rate from the program compared to the control group, and the Cox proportional-hazards model estimate showed a hazard ratio (HR) of 0.078, which was statistically significant at the 5% level. Further, human intervention with AI and video messaging significantly reduced the body fat percentage (BFP) of participants after 3 months compared to the control group, and the rate of reduction was greater in the group with more individualized intervention. The AI-based text messages affected the BMI but had no significant effect on the BFP. Conclusions: This experiment shows that it is challenging to sustain participants' healthy behavior with AI intervention alone. The results also suggest that even if the health information conveyed is the same, the information conveyed by humans and AI is more effective in improving health than the information sent by AI alone. The support received from the companion in the form of video messages may have promoted voluntary health behaviors. It is noteworthy that companions were competent, even though they were nonexperts. This means that person-to-person communication is crucial for health interventions. %M 35675107 %R 10.2196/30630 %U https://formative.jmir.org/2022/6/e30630 %U https://doi.org/10.2196/30630 %U http://www.ncbi.nlm.nih.gov/pubmed/35675107 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e28238 %T Apps for Promoting Children’s Oral Health: Systematic Search in App Stores and Quality Evaluation %A Ho,Teresa C Y %A McGrath,Colman %A Yiu,Cynthia K Y %A Lee,Gillian H M %+ Paediatric Dentistry & Orthodontics, Faculty of Dentistry, University of Hong Kong, Room 2A20A, 2/F, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong, China (Hong Kong), 852 28590255, lee.gillian@gmail.com %K apps %K oral health %K evidence-based %K oral hygiene %K children %D 2022 %7 6.6.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Increasingly, mobile apps are being used to promote oral care. Many of them are aimed at children. Objective: This study aimed to systematically search and evaluate apps that promote oral care and hygiene for children. Methods: A broad search strategy (13 keywords) was developed to identify apps from Apple’s App Store and the Google Play Store in April 2019. After reviewing the apps’ titles and summaries, potentially relevant apps were downloaded for viewing. The quality of the apps that met the inclusion criteria was assessed by the Health on the Net Foundation Code of Conduct (HONcode) criteria for medical and health websites and the Scientific Basis of Oral Self-care (SBOSC). Results: More than 3000 Apps were identified and 54 relevant apps informed the review. The quality of the apps according to the HONcode criteria was generally low. The mean HONcode score was 1.8/8.0. One-quarter of the apps had a HONcode score of 0 (14/54, 26%). The SBOSC score of the apps was evaluated based on a 6-point scale. The mean SBOSC score was 1.5/6.0; 19% (10/54) of the apps had a score of 0. There was a significant and positive correlation between HONcode and SBOSC scores (r=0.37; P<.01). More recently uploaded apps had significantly higher HONcode scores (P<.05). Conclusions: There are many apps aiming to promote oral self-care among children. The quality and scientific basis of these apps are low. Newer apps are of higher quality in terms of scientific basis. There is a need to ensure high-quality and evidence-based apps are available. The effectiveness of apps in terms of oral care and clinical outcomes among children needs to be evaluated. %M 35666565 %R 10.2196/28238 %U https://pediatrics.jmir.org/2022/2/e28238 %U https://doi.org/10.2196/28238 %U http://www.ncbi.nlm.nih.gov/pubmed/35666565 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e35697 %T The Surveillance of Physical Activity, Sedentary Behavior, and Sleep: Protocol for the Development and Feasibility Evaluation of a Novel Measurement System %A Crowley,Patrick %A Ikeda,Erika %A Islam,Sheikh Mohammed Shariful %A Kildedal,Rasmus %A Schade Jacobsen,Sandra %A Roslyng Larsen,Jon %A Johansson,Peter J %A Hettiarachchi,Pasan %A Aadahl,Mette %A Mork,Paul Jarle %A Straker,Leon %A Stamatakis,Emmanuel %A Holtermann,Andreas %A Gupta,Nidhi %+ The National Research Centre for the Working Environment, Lersø Parkallé 105, Copenhagen, 2100, Denmark, 45 20469173, pjc@nfa.dk %K accelerometer %K thigh-worn %K sensor-based %K system acceptability %K surveillance %K physical activity %K physical health %K physical %K sedentary %K sedentary behavior %K sleep %K surPASS %K public health %D 2022 %7 6.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is increasing recognition of the need for more comprehensive surveillance data, including information on physical activity of all intensities, sedentary behavior, and sleep. However, meeting this need poses significant challenges for current surveillance systems, which are mainly reliant on self-report. Objective: The primary objective of this project is to develop and evaluate the feasibility of a sensor-based system for use in the surveillance of physical activity, sedentary behavior, and sleep (SurPASS) at a national level in Denmark. Methods: The SurPASS project involves an international, multidisciplinary team of researchers collaborating with an industrial partner. The SurPASS system consists of (1) a thigh-worn accelerometer with Bluetooth connectivity, (2) a smartphone app, (3) an integrated back end, facilitating the automated upload, analysis, storage, and provision of individualized feedback in a manner compliant with European Union regulations on data privacy, and (4) an administrator web interface (web application) to monitor progress. The system development and evaluation will be performed in 3 phases. These phases will include gathering user input and specifications (phase 1), the iterative development, evaluation, and refinement of the system (phase 2), and the feasibility evaluation (phase 3). Results: The project started in September 2020 and completed phase 2 in February 2022. Phase 3 began in March 2022 and results will be made available in 2023. Conclusions: If feasible, the SurPASS system could be a catalyst toward large-scale, sensor-based surveillance of physical activity, sedentary behavior, and sleep. It could also be adapted for cohort and interventional research, thus contributing to the generation of evidence for both interventions and public health policies and recommendations. International Registered Report Identifier (IRRID): DERR1-10.2196/35697 %M 35666571 %R 10.2196/35697 %U https://www.researchprotocols.org/2022/6/e35697 %U https://doi.org/10.2196/35697 %U http://www.ncbi.nlm.nih.gov/pubmed/35666571 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e33458 %T Trends in Heart Rate and Heart Rate Variability During Pregnancy and the 3-Month Postpartum Period: Continuous Monitoring in a Free-living Context %A Sarhaddi,Fatemeh %A Azimi,Iman %A Axelin,Anna %A Niela-Vilen,Hannakaisa %A Liljeberg,Pasi %A Rahmani,Amir M %+ Department of Computer Science, University of California, Irvine, Donald Bren Hall, 6210, Irvine, CA, 92697, United States, 1 949 824 3590, a.rahmani@uci.edu %K heart rate %K heart rate variability %K pregnancy %K postpartum %K continuous monitoring %K PPG %K mobile phone %D 2022 %7 3.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Heart rate variability (HRV) is a noninvasive method that reflects the regulation of the autonomic nervous system. Altered HRV is associated with adverse mental or physical health complications. The autonomic nervous system also has a central role in physiological adaption during pregnancy, causing normal changes in HRV. Objective: The aim of this study was to assess trends in heart rate (HR) and HRV parameters as a noninvasive method for remote maternal health monitoring during pregnancy and 3-month postpartum period. Methods: A total of 58 pregnant women were monitored using an Internet of Things–based remote monitoring system during pregnancy and 3-month postpartum period. Pregnant women were asked to continuously wear Gear Sport smartwatch to monitor their HR and HRV extracted from photoplethysmogram (PPG) signals. In addition, a cross-platform mobile app was used to collect background and delivery-related information. We analyzed PPG signals collected during the night and discarded unreliable signals by applying a PPG quality assessment method to the collected signals. HR, HRV, and normalized HRV parameters were extracted from reliable signals. The normalization removed the effect of HR changes on HRV trends. Finally, we used hierarchical linear mixed models to analyze the trends of HR, HRV, and normalized HRV parameters. Results: HR increased significantly during the second trimester (P<.001) and decreased significantly during the third trimester (P=.006). Time-domain HRV parameters, average normal interbeat intervals (IBIs; average normal IBIs [AVNN]), SD of normal IBIs (SDNN), root mean square of the successive difference of normal IBIs (RMSSD), normalized SDNN, and normalized RMSSD decreased significantly during the second trimester (P<.001). Then, AVNN, SDNN, RMSSD, and normalized SDNN increased significantly during the third trimester (with P=.002, P<.001, P<.001, and P<.001, respectively). Some of the frequency-domain parameters, low-frequency power (LF), high-frequency power (HF), and normalized HF, decreased significantly during the second trimester (with P<.001, P<.001, and P=.003, respectively), and HF increased significantly during the third trimester (P=.007). In the postpartum period, normalized RMSSD decreased (P=.01), and the LF to HF ratio (LF/HF) increased significantly (P=.004). Conclusions: Our study indicates the physiological changes during pregnancy and the postpartum period. We showed that HR increased and HRV parameters decreased as pregnancy proceeded, and the values returned to normal after delivery. Moreover, our results show that HR started to decrease, whereas time-domain HRV parameters and HF started to increase during the third trimester. The results also indicated that age was significantly associated with HRV parameters during pregnancy and postpartum period, whereas education level was associated with HRV parameters during the third trimester. In addition, our results demonstrate the possibility of continuous HRV monitoring in everyday life settings. %M 35657667 %R 10.2196/33458 %U https://mhealth.jmir.org/2022/6/e33458 %U https://doi.org/10.2196/33458 %U http://www.ncbi.nlm.nih.gov/pubmed/35657667 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e34566 %T A Yoga Exercise App Designed for Patients With Axial Spondylarthritis: Development and User Experience Study %A Truong,Minh Tam %A Nwosu,Obioma Bertrand %A Gaytan Torres,Maria Elena %A Segura Vargas,Maria Paula %A Seifer,Ann-Kristin %A Nitschke,Marlies %A Ibrahim,Alzhraa A %A Knitza,Johannes %A Krusche,Martin %A Eskofier,Bjoern M %A Schett,Georg %A Morf,Harriet %+ Department of Internal Medicine 3, Rheumatology and Immunology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany, 49 9131 8543023, harriet.morf@uk-erlangen.de %K spondylarthritis %K digital health application %K yoga %K usability %K patient empowerment %K mobile health %K mHealth %K health applications %K smartphone %K physical exercise %K wellness %K mobile phone %D 2022 %7 3.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Besides anti-inflammatory medication, physical exercise represents a cornerstone of modern treatment for patients with axial spondyloarthritis (AS). Digital health apps (DHAs) such as the yoga app YogiTherapy could remotely empower patients to autonomously and correctly perform exercises. Objective: This study aimed to design and develop a smartphone-based app, YogiTherapy, for patients with AS. To gain additional insights into the usability of the graphical user interface (GUI) for further development of the app, this study focused exclusively on evaluating users’ interaction with the GUI. Methods: The development of the app and the user experience study took place between October 2020 and March 2021. The DHA was designed by engineering students, rheumatologists, and patients with AS. After the initial development process, a pilot version of the app was evaluated by 5 patients and 5 rheumatologists. The participants had to interact with the app’s GUI and complete 5 navigation tasks within the app. Subsequently, the completion rate and experience questionnaire (attractiveness, perspicuity, efficiency, dependability, stimulation, and novelty) were completed by the patients. Results: The results of the posttest questionnaires showed that most patients were already familiar with digital apps (4/5, 80%). The task completion rates of the usability test were 100% (5/5) for the tasks T1 and T2, which included selecting and starting a yoga lesson and navigating to an information page. Rheumatologists indicated that they were even more experienced with digital devices (2/5, 40% experts; 3/5, 60% intermediates). In this case, they scored task completion rates of 100% (5/5) for all 5 usability tasks T1 to T5. The mean results from the User Experience Questionnaire range from −3 (most negative) to +3 (most positive). According to rheumatologists’ evaluations, attractiveness (mean 2.267, SD 0.401) and stimulation (mean 2.250, SD 0.354) achieved the best mean results compared with dependability (mean 2.000, SD 0.395). Patients rated attractiveness at a mean of 2.167 (SD 0.565) and stimulation at a mean of 1.950 (SD 0.873). The lowest mean score was reported for perspicuity (mean 1.250, SD 1.425). Conclusions: The newly developed and tested DHA YogiTherapy demonstrated moderate usability among rheumatologists and patients with rheumatic diseases. The app can be used by patients with AS as a complementary treatment. The initial evaluation of the GUI identified significant usability problems that need to be addressed before the start of a clinical evaluation. Prospective trials are also needed in the second step to prove the clinical benefits of the app. %M 35657655 %R 10.2196/34566 %U https://formative.jmir.org/2022/6/e34566 %U https://doi.org/10.2196/34566 %U http://www.ncbi.nlm.nih.gov/pubmed/35657655 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 2 %P e33521 %T Inertial Measurement Units and Application for Remote Health Care in Hip and Knee Osteoarthritis: Narrative Review %A Rose,Michael J. %A Costello,Kerry E %A Eigenbrot,Samantha %A Torabian,Kaveh %A Kumar,Deepak %+ Department of Physical Therapy & Athletic Training, Boston University College of Health & Rehabilitation Sciences: Sargent College, 635 Commonwealth Avenue, Boston, MA, 02215, United States, 1 617 358 3125, kumard@bu.edu %K wearable technology %K accelerometer %K gyroscope %K magnetometer %K remote monitoring %K biofeedback %D 2022 %7 2.6.2022 %9 Review %J JMIR Rehabil Assist Technol %G English %X Background: Measuring and modifying movement-related joint loading is integral to the management of lower extremity osteoarthritis (OA). Although traditional approaches rely on measurements made within the laboratory or clinical environments, inertial sensors provide an opportunity to quantify these outcomes in patients’ natural environments, providing greater ecological validity and opportunities to develop large data sets of movement data for the development of OA interventions. Objective: This narrative review aimed to discuss and summarize recent developments in the use of inertial sensors for assessing movement during daily activities in individuals with hip and knee OA and to identify how this may translate to improved remote health care for this population. Methods: A literature search was performed in November 2018 and repeated in July 2019 and March 2021 using the PubMed and Embase databases for publications on inertial sensors in hip and knee OA published in English within the previous 5 years. The search terms encompassed both OA and wearable sensors. Duplicate studies, systematic reviews, conference abstracts, and study protocols were also excluded. One reviewer screened the search result titles by removing irrelevant studies, and 2 reviewers screened study abstracts to identify studies using inertial sensors as the main sensing technology and a primary outcome related to movement quality. In addition, after the March 2021 search, 2 reviewers rescreened all previously included studies to confirm their relevance to this review. Results: From the search process, 43 studies were determined to be relevant and subsequently included in this review. Inertial sensors have been successfully implemented for assessing the presence and severity of OA (n=11), assessing disease progression risk and providing feedback for gait retraining (n=7), and remotely monitoring intervention outcomes and identifying potential responders and nonresponders to interventions (n=14). In addition, studies have validated the use of inertial sensors for these applications (n=8) and analyzed the optimal sensor placement combinations and data input analysis for measuring different metrics of interest (n=3). These studies show promise for remote health care monitoring and intervention delivery in hip and knee OA, but many studies have focused on walking rather than a range of activities of daily living and have been performed in small samples (<100 participants) and in a laboratory rather than in a real-world environment. Conclusions: Inertial sensors show promise for remote monitoring, risk assessment, and intervention delivery in individuals with hip and knee OA. Future opportunities remain to validate these sensors in real-world settings across a range of activities of daily living and to optimize sensor placement and data analysis approaches. %M 35653180 %R 10.2196/33521 %U https://rehab.jmir.org/2022/2/e33521 %U https://doi.org/10.2196/33521 %U http://www.ncbi.nlm.nih.gov/pubmed/35653180 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e36339 %T Effect of a Daily Collagen Peptide Supplement on Digestive Symptoms in Healthy Women: 2-Phase Mixed Methods Study %A Abrahams,Mariette %A O’Grady,Rochez %A Prawitt,Janne %+ Rousselot BV, Meulestedekaai 81, Gent, 9000, Belgium, 32 92551818, janne.prawitt@rousselot.com %K collagen peptides %K collagen hydrolysates %K digital study %K gut %K digestive symptoms %K technology %K bloating %K Peptan %K microbiome %K health care professionals %K mobile phone %D 2022 %7 31.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The effect of dietary collagen on managing digestive symptoms is currently lacking in the literature. Objective: To gain a better understanding of this issue, we conducted a 2-phase mixed methods study. Methods: Phase 1 was a mixed methods design to explore current attitude and practice among consumers and health care practitioners. The findings were used to design an 8-week phase 2 digital study called Gutme! conducted in the United States in healthy female volunteers (BMI>25 kg/m2). Our aim was, first, to determine the feasibility of conducting a fully digital mixed methods study; second, the study explored the effect of an 8-week daily supplementation of 20 g dietary collagen peptide (Peptan) on digestive symptoms. Phase 2 was a prospective, open-label, longitudinal, single-arm study. Participation involved 2 weeks of baseline tracking (digestive symptoms, mood, stool, and lifestyle) using an app, followed by 8 weeks of tracking and taking 20 g collagen peptide supplement split into 2 dosages per day. Participants were required to complete a web-based symptom questionnaire at baseline, week 2, and week 8, as well as participate in 2 scheduled video interviews. Results: Phase 1 revealed that consumer awareness of collagen for digestive health is low (64/204, 31.4%). Among the dietitians prescribing collagen for their patients, the most common dosage was 20 g a day with notable effects after 6 weeks of intake. Within the phase 2 study, of the 40 recruited participants, 14 (35%) completed the full course of supplementation. The findings indicate that 93% (13/14) of those who completed the study experienced a reduction in digestive symptoms, which included bloating. Conclusions: A mixed methods digital study design is feasible and acceptable for collecting relevant data in a real-life setting. The use of a 20 g daily collagen peptide supplement may reduce bloating and improve mild digestive symptoms in otherwise healthy female adults in the absence of any other dietary or lifestyle interventions. Trial Registration: ClinicalTrials.gov NCT04245254; https://clinicaltrials.gov/ct2/show/NCT04245254 %M 35639457 %R 10.2196/36339 %U https://formative.jmir.org/2022/5/e36339 %U https://doi.org/10.2196/36339 %U http://www.ncbi.nlm.nih.gov/pubmed/35639457 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e38905 %T An Integrated mHealth App for Smoking Cessation in Black Smokers With Anxiety: Protocol for a Randomized Controlled Trial %A Businelle,Michael S %A Garey,Lorra %A Gallagher,Matthew W %A Hébert,Emily T %A Vujanovic,Anka %A Alexander,Adam %A Kezbers,Krista %A Matoska,Cameron %A Robison,Jillian %A Montgomery,Audrey %A Zvolensky,Michael J %+ TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, United States, 1 405 271 8001 ext 50460, michael-businelle@ouhsc.edu %K smoking cessation %K treatment %K Black %K African American %K anxiety sensitivity %K mHealth %K just-in-time adaptive intervention %K mobile phone %D 2022 %7 30.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Black smokers have greater difficulty in quitting and higher rates of smoking-related diseases and disabilities than the general population. The smoking disparities experienced by this group are, in part, a consequence of multiple chronic life stressors (eg, racial discrimination) that engender increased exposure to interoceptive stress symptoms (eg, anxiety), which can ultimately lead to smoking as a means of immediate emotion regulation. Objective: This study aimed to culturally adapt and initially test a novel mobile intervention (ie, Mobile Anxiety Sensitivity Program for Smoking [MASP]) that targets anxiety sensitivity (AS; a proxy for difficulty and responsivity to interoceptive stress) among Black smokers. The MASP intervention is culturally informed to address interoceptive stress management difficulties among Black smokers and is thus hypothesized to facilitate smoking cessation. Methods: In phase 1, a total of 25 Black smokers with elevated AS will be administered MASP for 6 weeks. Following the completion of phase 1, we will further refine the MASP based on qualitative and quantitative data from participants to produce the final MASP iteration. In phase 2, a total of 200 Black smokers with elevated AS will be enrolled and randomly assigned to receive nicotine replacement therapy and either the smartphone-based National Cancer Institute QuitGuide app for standard mobile smoking cessation treatment or the MASP intervention. All participants in phases 1 and 2 will be enrolled remotely and will complete a web-based study screener; smartphone-based baseline assessment; daily smartphone-based ecological momentary assessments for 6 weeks; phone-based end-of-treatment qualitative interviews; and smartphone-based follow-up assessments at postbaseline weeks 1, 2 (quit date), 3, 4, 5, 6, 28, and 54 (weeks 28 and 54 follow-ups will be completed by phase 2 participants only). The MASP intervention is intended to offset barriers to treatment and encourage treatment engagement via smartphones. Results: This project was funded in September 2020. Phase 1 data collection began in January 2022. Phase 2 data collection is scheduled to begin in July 2022. Conclusions: If successful, data from this study will support culturally informed treatment approaches for Black smokers and, pending findings of efficacy, provide an evidence-based mobile intervention for smoking cessation that is ready for dissemination and implementation. Trial Registration: ClinicalTrials.gov NCT04838236; https://clinicaltrials.gov/ct2/show/NCT04838236 International Registered Report Identifier (IRRID): DERR1-10.2196/38905 %M 35635746 %R 10.2196/38905 %U https://www.researchprotocols.org/2022/5/e38905 %U https://doi.org/10.2196/38905 %U http://www.ncbi.nlm.nih.gov/pubmed/35635746 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e37372 %T Combining Persuasive System Design Principles and Behavior Change Techniques in Digital Interventions Supporting Long-term Weight Loss Maintenance: Design and Development of eCHANGE %A Asbjørnsen,Rikke Aune %A Hjelmesæth,Jøran %A Smedsrød,Mirjam Lien %A Wentzel,Jobke %A Ollivier,Marianne %A Clark,Matthew M %A van Gemert-Pijnen,Julia E W C %A Solberg Nes,Lise %+ Center for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, De Zul 10, Enschede, 7522 NJ, Netherlands, 31 534899111, r.a.asbjornsen@utwente.nl %K eHealth %K weight loss maintenance %K behavior change %K persuasive technology %K digital health interventions %K design thinking %K co-design %K Agile development %K human-centered design %K mobile phone %D 2022 %7 27.5.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Long-term weight maintenance after weight loss is challenging, and innovative solutions are required. Digital technologies can support behavior change and, therefore, have the potential to be an effective tool for weight loss maintenance. However, to create meaningful and effective digital behavior change interventions that support end user values and needs, a combination of persuasive system design (PSD) principles and behavior change techniques (BCTs) might be needed. Objective: This study aimed to investigate how an evidence-informed digital behavior change intervention can be designed and developed by combining PSD principles and BCTs into design features to support end user values and needs for long-term weight loss maintenance. Methods: This study presents a concept for how PSD principles and BCTs can be translated into design features by combining design thinking and Agile methods to develop and deliver an evidence-informed digital behavior change intervention aimed at supporting weight maintenance. Overall, 45 stakeholders participated in the systematic and iterative development process comprising co-design workshops, prototyping, Agile development, and usability testing. This included prospective end users (n=17, 38%; ie, people with obesity who had lost ≥8% of their weight), health care providers (n=9, 20%), healthy volunteers (n=4, 9%), a service designer (n=1, 2%), and stakeholders from the multidisciplinary research and development team (n=14, 31%; ie, software developers; digital designers; and eHealth, behavior change, and obesity experts). Stakeholder input on how to operationalize the design features and optimize the technology was examined through formative evaluation and qualitative analyses using rapid and in-depth analysis approaches. Results: A total of 17 design features combining PSD principles and BCTs were identified as important to support end user values and needs based on stakeholder input during the design and development of eCHANGE, a digital intervention to support long-term weight loss maintenance. The design features were combined into 4 main intervention components: Week Plan, My Overview, Knowledge and Skills, and Virtual Coach and Smart Feedback System. To support a healthy lifestyle and continued behavior change to maintain weight, PSD principles such as tailoring, personalization, self-monitoring, reminders, rewards, rehearsal, praise, and suggestions were combined and implemented into the design features together with BCTs from the clusters of goals and planning, feedback and monitoring, social support, repetition and substitution, shaping knowledge, natural consequences, associations, antecedents, identity, and self-belief. Conclusions: Combining and implementing PSD principles and BCTs in digital interventions aimed at supporting sustainable behavior change may contribute to the design of engaging and motivating interventions in line with end user values and needs. As such, the design and development of the eCHANGE intervention can provide valuable input for future design and tailoring of evidence-informed digital interventions, even beyond digital interventions in support of health behavior change and long-term weight loss maintenance. Trial Registration: ClinicalTrials.gov NCT04537988; https://clinicaltrials.gov/ct2/show/NCT04537988 %M 35622394 %R 10.2196/37372 %U https://humanfactors.jmir.org/2022/2/e37372 %U https://doi.org/10.2196/37372 %U http://www.ncbi.nlm.nih.gov/pubmed/35622394 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e36068 %T Development of a Peer Support Mobile App and Web-Based Lesson for Adolescent Mental Health (Mind Your Mate): User-Centered Design Approach %A Birrell,Louise %A Furneaux-Bate,Ainsley %A Debenham,Jennifer %A Spallek,Sophia %A Newton,Nicola %A Chapman,Catherine %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building (G02), Sydney, 2006, Australia, 61 286279003, louise.birrell@sydney.edu.au %K mobile health %K depression %K anxiety %K psychosocial support system %K alcohol drinking %K adolescent %K digital technology %K mobile intervention %K intervention %K social %K economic %K development %K mind your mate %K app %K application %K mHealth %K mobile phone %D 2022 %7 27.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital technologies and mobile interventions are possible tools for prevention initiatives to target the substantial social and economic impacts that anxiety, mood, and substance use disorders have on young people. Objective: This paper described the design and development of the Mind your Mate program, a smartphone app and introductory classroom lesson enhancing peer support around the topics of anxiety, depression, and substance use for adolescents. Methods: The development of Mind your Mate was an iterative process conducted in collaboration with adolescents (n=23), experts, school staff, and software developers. The development process consisted of 3 stages: scoping; end-user consultations, including a web-based survey and 2 focus groups with 23 adolescents (mean age 15.9, SD 0.6 years); and app development and beta-testing. Results: This process resulted in a smartphone peer support app and introductory classroom lesson aimed at empowering adolescents to access evidence-based information and tools to better support peers regarding mental health and substance use–related issues. The program contains links to external support services and encourages adolescents to reach out for help if they are concerned about themselves or a friend. Conclusions: The Mind your Mate program was developed in collaboration with a number of key stakeholders in youth mental health, including adolescents. The resulting program has the potential to be taken to scale to aid prevention efforts for youth mental health and substance use. The next step is to conduct a randomized controlled trial testing the feasibility, acceptability, and efficacy of the program. %M 35622401 %R 10.2196/36068 %U https://formative.jmir.org/2022/5/e36068 %U https://doi.org/10.2196/36068 %U http://www.ncbi.nlm.nih.gov/pubmed/35622401 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34339 %T Rating the Quality of Smartphone Apps Related to Shoulder Pain: Systematic Search and Evaluation Using the Mobile App Rating Scale %A Agnew,Jonathon M R %A Nugent,Chris %A Hanratty,Catherine E %A Martin,Elizabeth %A Kerr,Daniel P %A McVeigh,Joseph G %+ Discipline in Physiotherapy, School of Life and Health Sciences, University of Ulster, Shore Road, Newtownabbey, BT37 0QB, United Kingdom, 44 07576629548, agnew-j10@ulster.ac.uk %K mobile app %K shoulder pain %K mHealth %K Mobile App Rating Scale %K mobile phone %D 2022 %7 26.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The successful rehabilitation of musculoskeletal pain requires more than medical input alone. Conservative treatment, including physiotherapy and exercise therapy, can be an effective way of decreasing pain associated with musculoskeletal pain. However, face-to-face appointments are currently not feasible. New mobile technologies, such as mobile health technologies in the form of an app for smartphones, can be a solution to this problem. In many cases, these apps are not backed by scientific literature. Therefore, it is important that they are reviewed and quality assessed. Objective: The aim is to evaluate and measure the quality of apps related to shoulder pain by using the Mobile App Rating Scale. Methods: This study included 25 free and paid apps—8 from the Apple Store and 17 from the Google Play Store. A total of 5 reviewers were involved in the evaluation process. A descriptive analysis of the Mobile App Rating Scale results provided a general overview of the quality of the apps. Results: Overall, app quality was generally low, with an average star rating of 1.97 out of 5. The best scores were in the “Functionality” and “Aesthetics” sections, and apps were scored poorer in the “Engagement” and “Information” sections. The apps were also rated poorly in the “Subjective Quality” section. Conclusions: In general, the apps were well built technically and were aesthetically pleasing. However, the apps failed to provide quality information to users, which resulted in a lack of engagement. Most of the apps were not backed by scientific literature (24/25, 96%), and those that contained scientific references were vastly out-of-date. Future apps would need to address these concerns while taking simple measures to ensure quality control. %M 35617008 %R 10.2196/34339 %U https://formative.jmir.org/2022/5/e34339 %U https://doi.org/10.2196/34339 %U http://www.ncbi.nlm.nih.gov/pubmed/35617008 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e29767 %T Functional and Technical Aspects of Self-management mHealth Apps: Systematic App Search and Literature Review %A Alwakeel,Lyan %A Lano,Kevin %+ Department of Informatics, King’s College London, Strand, London, WC2R 2LS, United Kingdom, 44 02078365454, lyan.alwakeel@kcl.ac.uk %K mHealth %K mobile health apps %K mobile apps %K apps %K systematic literature review %K SLR %K apps %K Mobile App Rating Scale %K MARS %K smartphone %K iOS %K Android %K mobile phone %D 2022 %7 25.5.2022 %9 Review %J JMIR Hum Factors %G English %X Background: Although the past decade has witnessed the development of many self-management mobile health (mHealth) apps that enable users to monitor their health and activities independently, there is a general lack of empirical evidence on the functional and technical aspects of self-management mHealth apps from a software engineering perspective. Objective: This study aims to systematically identify the characteristics and challenges of self-management mHealth apps, focusing on functionalities, design, development, and evaluation methods, as well as to specify the differences and similarities between published research papers and commercial and open-source apps. Methods: This research was divided into 3 main phases to achieve the expected goal. The first phase involved reviewing peer-reviewed academic research papers from 7 digital libraries, and the second phase involved reviewing and evaluating apps available on Android and iOS app stores using the Mobile Application Rating Scale. Finally, the third phase involved analyzing and evaluating open-source apps from GitHub. Results: In total, 52 research papers, 42 app store apps, and 24 open-source apps were analyzed, synthesized, and reported. We found that the development of self-management mHealth apps requires significant time, effort, and cost because of their complexity and specific requirements, such as the use of machine learning algorithms, external services, and built-in technologies. In general, self-management mHealth apps are similar in their focus, user interface components, navigation and structure, services and technologies, authentication features, and architecture and patterns. However, they differ in terms of the use of machine learning, processing techniques, key functionalities, inference of machine learning knowledge, logging mechanisms, evaluation techniques, and challenges. Conclusions: Self-management mHealth apps may offer an essential means of managing users’ health, expecting to assist users in continuously monitoring their health and encourage them to adopt healthy habits. However, developing an efficient and intelligent self-management mHealth app with the ability to reduce resource consumption and processing time, as well as increase performance, is still under research and development. In addition, there is a need to find an automated process for evaluating and selecting suitable machine learning algorithms for the self-management of mHealth apps. We believe that these issues can be avoided or significantly reduced by using a model-driven engineering approach with a decision support system to accelerate and ameliorate the development process and quality of self-management mHealth apps. %M 35612887 %R 10.2196/29767 %U https://humanfactors.jmir.org/2022/2/e29767 %U https://doi.org/10.2196/29767 %U http://www.ncbi.nlm.nih.gov/pubmed/35612887 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e30294 %T A Mobile App for Stress Management in Middle-Aged Men and Women (Calm): Feasibility Randomized Controlled Trial %A Laird,Breanne %A Puzia,Megan %A Larkey,Linda %A Ehlers,Diane %A Huberty,Jennifer %+ Arizona State University, 425 N 5th St, Phoenix, AZ, 85004, United States, 1 7046043782, bmlaird@asu.edu %K stress %K meditation %K mHealth %K COVID-19 %K mobile app %K mental health %K mindfulness %K digital intervention %K psychological outcomes %D 2022 %7 24.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Middle-aged adults (40-65 years) report higher stress levels than most other age groups. There is a need to determine the feasibility of using a meditation app to reduce stress and improve stress-related outcomes in middle-aged adults with a focus on men, as previous meditation app–based studies have reported a low proportion of or even no male participants. Objective: This study aims to (1) determine the feasibility (ie, acceptability and demand with a focus on men) of a consumer-based meditation app (Calm), to reduce stress among middle-aged adults reporting elevated stress levels, and (2) explore the preliminary effects of Calm on perceived stress, psychological outcomes (anxiety, depressive symptoms, mindfulness, and general coping), health behaviors (physical activity and eating habits), and COVID-19 perceptions. Methods: This feasibility randomized controlled trial evaluated an app-based meditation intervention in middle-aged adults (N=83) with elevated stress levels (ie, Perceived Stress Scale score ≥15) and limited or no previous experience with meditation. Participants were randomized to the intervention group (Calm app) or a control (educational podcasts; POD) group. Participants completed self-report assessments at baseline and postintervention (week 4). Feasibility was measured as acceptability and demand using Bowen framework. Feasibility and COVID-19 perceptions data were examined using descriptive statistics, and preliminary effects were evaluated using repeated measures analysis of variance. Results: Participants were satisfied with Calm (27/28, 96%) and found it appropriate or useful (26/28, 93%). Most reported they would likely continue using the Calm app (18/28, 64%). More Calm users reported satisfaction, appropriateness or usefulness, and intent to continue app use than POD users. Calm users (n=33) completed a mean of 20 (SD 31.1) minutes of meditation on the days they meditated and 103 (SD 109.1) minutes of meditation per week. The average adherence rate to the prescribed meditation was 71% among Calm app users, compared to 62% among POD users. Recruitment rate of men was 35% (29/83). Of those randomized to Calm, 55% (15/29) were men, and retention among them was higher (14/15, 93%) than that among women (12/20, 60%). No significant within or between group differences were observed. Conclusions: A 4-week, app-based mindfulness meditation intervention (Calm) may be feasible for middle-aged adults and a useful stress-management tool. Calm users expressed satisfaction with the app and felt it was appropriate and useful. Significant improvements in perceived stress and psychological outcomes or stress-related health behaviors were not observed. Even though men spent less time in meditation than women did and completed fewer weekly sessions, they were more likely to adhere to the prescription. Further research is needed for improving stress and stress-related outcomes among middle-aged adults with emphasis on the effects of mindfulness meditation apps for men. Trial Registration: ClinicalTrials.gov NCT04272138; https://clinicaltrials.gov/ct2/show/NCT04272138 %M 34989677 %R 10.2196/30294 %U https://formative.jmir.org/2022/5/e30294 %U https://doi.org/10.2196/30294 %U http://www.ncbi.nlm.nih.gov/pubmed/34989677 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e37820 %T Evaluation of Digital Interventions for Physical Activity Promotion: Scoping Review %A De Santis,Karina Karolina %A Jahnel,Tina %A Matthias,Katja %A Mergenthal,Lea %A Al Khayyal,Hatem %A Zeeb,Hajo %+ Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Achterstr. 30, Bremen, 28359, Germany, 49 421 218 56908, desantis@leibniz-bips.de %K evaluation %K digital interventions %K physical activity %K scoping review %K review %K health promotion %K behavior change theory %K digital health %K public health %K digital technology %D 2022 %7 23.5.2022 %9 Review %J JMIR Public Health Surveill %G English %X Background: Digital interventions are interventions supported by digital tools or technologies, such as mobile apps, wearables, or web-based software. Digital interventions in the context of public health are specifically designed to promote and improve health. Recent reviews have shown that many digital interventions target physical activity promotion; however, it is unclear how such digital interventions are evaluated. Objective: We aimed to investigate evaluation strategies in the context of digital interventions for physical activity promotion using a scoping review of published reviews. We focused on the target (ie, user outcomes or tool performance), methods (ie, tool data or self-reported data), and theoretical frameworks of the evaluation strategies. Methods: A protocol for this study was preregistered and published. From among 300 reviews published up to March 19, 2021 in Medline, PsycINFO, and CINAHL databases, 40 reviews (1 rapid, 9 scoping, and 30 systematic) were included in this scoping review. Two authors independently performed study selection and data coding. Consensus was reached by discussion. If applicable, data were coded quantitatively into predefined categories or qualitatively using definitions or author statements from the included reviews. Data were analyzed using either descriptive statistics, for quantitative data (relative frequencies out of all studies), or narrative synthesis focusing on common themes, for qualitative data. Results: Most reviews that were included in our scoping review were published in the period from 2019 to 2021 and originated from Europe or Australia. Most primary studies cited in the reviews included adult populations in clinical or nonclinical settings, and focused on mobile apps or wearables for physical activity promotion. The evaluation target was a user outcome (efficacy, acceptability, usability, feasibility, or engagement) in 38 of the 40 reviews or tool performance in 24 of the 40 reviews. Evaluation methods relied upon objective tool data (in 35/40 reviews) or other data from self-reports or assessments (in 28/40 reviews). Evaluation frameworks based on behavior change theory, including goal setting, self-monitoring, feedback on behavior, and educational or motivational content, were mentioned in 22 out of 40 reviews. Behavior change theory was included in the development phases of digital interventions according to the findings of 20 out of 22 reviews. Conclusions: The evaluation of digital interventions is a high priority according to the reviews included in this scoping review. Evaluations of digital interventions, including mobile apps or wearables for physical activity promotion, typically target user outcomes and rely upon objective tool data. Behavior change theory may provide useful guidance not only for development of digital interventions but also for the evaluation of user outcomes in the context of physical activity promotion. Future research should investigate factors that could improve the efficacy of digital interventions and the standardization of terminology and reporting in this field. International Registered Report Identifier (IRRID): RR2-10.2196/35332 %M 35604757 %R 10.2196/37820 %U https://publichealth.jmir.org/2022/5/e37820 %U https://doi.org/10.2196/37820 %U http://www.ncbi.nlm.nih.gov/pubmed/35604757 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 5 %P e34154 %T Adolescent Health Promotion Interventions Using Well-Care Visits and a Smartphone Cognitive Behavioral Therapy App: Randomized Controlled Trial %A Nagamitsu,Shinichiro %A Kanie,Ayako %A Sakashita,Kazumi %A Sakuta,Ryoichi %A Okada,Ayumi %A Matsuura,Kencho %A Ito,Masaya %A Katayanagi,Akiko %A Katayama,Takashi %A Otani,Ryoko %A Kitajima,Tasuku %A Matsubara,Naoki %A Inoue,Takeshi %A Tanaka,Chie %A Fujii,Chikako %A Shigeyasu,Yoshie %A Ishii,Ryuta %A Sakai,Sayaka %A Matsuoka,Michiko %A Kakuma,Tatsuyuki %A Yamashita,Yushiro %A Horikoshi,Masaru %+ Department of Pediatrics, Fukuoka University Faculty of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Japan, 81 92 801 1011, snagamit@fukuoka-u.ac.jp %K health promotion %K well-care visit %K cognitive behavioral therapy %K app %K randomized controlled trial %K RCT %K mobile phone %D 2022 %7 23.5.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adolescent health promotion is important in preventing risk behaviors and improving mental health. Health promotion during adolescence has been shown to contribute to the prevention of late onset of the mental health disease. However, scalable interventions have not been established yet. Objective: This study was designed to test the efficacy of two adolescent health promotion interventions: a well-care visit (WCV) with a risk assessment interview and counseling and self-monitoring with a smartphone cognitive behavioral therapy (CBT) app. Our hypothesis was that participants who had received both WCV and the CBT app would have better outcomes than those who had received only WCV or those who had not received any intervention. We conducted a prospective multi-institutional randomized controlled trial. Methods: Participants were 217 adolescents aged 13-18 years. They were randomly divided into two intervention groups (WCV group and WCV with CBT app group) and a nonintervention group. WCV comprised a standardized physical examination along with a structured interview and counseling for youth risk assessment, which was designed with reference to the Guideline for Health Supervision of Adolescents of Bright Futures. A smartphone-based CBT program was developed based on the CBT approach. The CBT app comprised a 1-week psychoeducation component and a 1-week self-monitoring component. During the CBT program, participants created several self-monitoring sheets based on the CBT model with five window panels: event, thoughts, feelings, body response, and actions. The primary outcome was the change in scores for depressive symptoms. Secondary outcomes included changes in scores for self-esteem, quality of life, self-monitoring, and an adolescent health promotion scale. These outcomes were evaluated at baseline and at 1, 2, and 4 months after baseline. The exploratory outcome was the presence of suicidal ideation during the observation period. Intervention effects were estimated using mixed effect models. Results: In total, 94% (204/217) of the participants completed the 4-month evaluation. Both intervention groups showed a significant effect in the form of reduced scores for depressive symptoms at 1 month in high school students; however, these effects were not observed at 2 and 4 months. The intervention effect was significantly more predominant in those scoring above cutoff for depressive symptoms. There was significantly less suicidal ideation in the intervention groups. As for secondary outcomes, there was significant increase in health promotion scale scores at the 4-month follow-up among junior high school students in the WCV group. Moreover, the CBT app was significantly effective in terms of obtaining self-monitoring skills and reducing depressive symptoms. Conclusions: Although adolescent health promotion interventions may have short-term benefits, the frequency of WCV and further revision of the CBT app should be considered to evaluate long-term effectiveness. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN 000036343; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000041246 %M 35604760 %R 10.2196/34154 %U https://mhealth.jmir.org/2022/5/e34154 %U https://doi.org/10.2196/34154 %U http://www.ncbi.nlm.nih.gov/pubmed/35604760 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 5 %P e23887 %T Physical Activity Behavior of Patients at a Skilled Nursing Facility: Longitudinal Cohort Study %A Ramezani,Ramin %A Zhang,Wenhao %A Roberts,Pamela %A Shen,John %A Elashoff,David %A Xie,Zhuoer %A Stanton,Annette %A Eslami,Michelle %A Wenger,Neil S %A Trent,Jacqueline %A Petruse,Antonia %A Weldon,Amelia %A Ascencio,Andy %A Sarrafzadeh,Majid %A Naeim,Arash %+ Center for Smart Health, University of California, Los Angeles, 404 Westwood Plaza, Los Angeles, CA, 90095, United States, 1 4242997051, raminr@ucla.edu %K physical medicine and rehabilitation %K geriatrics %K remote sensing technology %K physical activity %K frailty %K health care delivery models %K wearable sensors %K indoor localization %K Bluetooth low energy beacons %K smartwatches %D 2022 %7 23.5.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: On-body wearable sensors have been used to predict adverse outcomes such as hospitalizations or fall, thereby enabling clinicians to develop better intervention guidelines and personalized models of care to prevent harmful outcomes. In our previous work, we introduced a generic remote patient monitoring framework (Sensing At-Risk Population) that draws on the classification of human movements using a 3-axial accelerometer and the extraction of indoor localization using Bluetooth low energy beacons, in concert. Using the same framework, this paper addresses the longitudinal analyses of a group of patients in a skilled nursing facility. We try to investigate if the metrics derived from a remote patient monitoring system comprised of physical activity and indoor localization sensors, as well as their association with therapist assessments, provide additional insight into the recovery process of patients receiving rehabilitation. Objective: The aim of this paper is twofold: (1) to observe longitudinal changes of sensor-based physical activity and indoor localization features of patients receiving rehabilitation at a skilled nursing facility and (2) to investigate if the sensor-based longitudinal changes can complement patients’ changes captured by therapist assessments over the course of rehabilitation in the skilled nursing facility. Methods: From June 2016 to November 2017, patients were recruited after admission to a subacute rehabilitation center in Los Angeles, CA. Longitudinal cohort study of patients at a skilled nursing facility was followed over the course of 21 days. At the time of discharge from the skilled nursing facility, the patients were either readmitted to the hospital for continued care or discharged to a community setting. A longitudinal study of the physical therapy, occupational therapy, and sensor-based data assessments was performed. A generalized linear mixed model was used to find associations between functional measures with sensor-based features. Occupational therapy and physical therapy assessments were performed at the time of admission and once a week during the skilled nursing facility admission. Results: Of the 110 individuals in the analytic sample with mean age of 79.4 (SD 5.9) years, 79 (72%) were female and 31 (28%) were male participants. The energy intensity of an individual while in the therapy area was positively associated with transfer activities (β=.22; SE 0.08; P=.02). Sitting energy intensity showed positive association with transfer activities (β=.16; SE 0.07; P=.02). Lying down energy intensity was negatively associated with hygiene activities (β=–.27; SE 0.14; P=.04). The interaction of sitting energy intensity with time (β=–.13; SE 0.06; P=.04) was associated with toileting activities. Conclusions: This study demonstrates that a combination of indoor localization and physical activity tracking produces a series of features, a subset of which can provide crucial information to the story line of daily and longitudinal activity patterns of patients receiving rehabilitation at a skilled nursing facility. The findings suggest that detecting physical activity changes within locations may offer some insight into better characterizing patients’ progress or decline. %M 35604762 %R 10.2196/23887 %U https://mhealth.jmir.org/2022/5/e23887 %U https://doi.org/10.2196/23887 %U http://www.ncbi.nlm.nih.gov/pubmed/35604762 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e33856 %T Assessment of Social Behavior Using a Passive Monitoring App in Cognitively Normal and Cognitively Impaired Older Adults: Observational Study %A Muurling,Marijn %A Reus,Lianne M %A de Boer,Casper %A Wessels,Sterre C %A Jagesar,Raj R %A Vorstman,Jacob A S %A Kas,Martien J H %A Visser,Pieter Jelle %+ Alzheimer Center, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center, De Boelelaan 1118, Amsterdam, 1081 HZ, Netherlands, 31 (0)204448527, m.muurling@amsterdamumc.nl %K passive monitoring %K smartphone app %K cognitive impairment %K social behavior %K dementia %K mHealth %K mobile app %K cognitive %K mental health %K social withdrawal %K well-being %D 2022 %7 20.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: In people with cognitive impairment, loss of social interactions has a major impact on well-being. Therefore, patients would benefit from early detection of symptoms of social withdrawal. Current measurement techniques such as questionnaires are subjective and rely on recall, in contradiction to smartphone apps, which measure social behavior passively and objectively. Objective: This study uses the remote monitoring smartphone app Behapp to assess social behavior, and aims to investigate (1) the association between social behavior, demographic characteristics, and neuropsychiatric symptoms in cognitively normal (CN) older adults, and (2) if social behavior is altered in cognitively impaired (CI) participants. In addition, we explored in a subset of individuals the association between Behapp outcomes and neuropsychiatric symptoms. Methods: CN, subjective cognitive decline (SCD), and CI older adults installed the Behapp app on their own Android smartphone for 7 to 42 days. CI participants had a clinical diagnosis of mild cognitive impairment (MCI) or Alzheimer-type dementia. The app continuously measured communication events, app use and location. Neuropsychiatric Inventory (NPI) total scores were available for 20 SCD and 22 CI participants. Linear models were used to assess group differences on Behapp outcomes and to assess the association of Behapp outcomes with the NPI. Results: We included CN (n=209), SCD (n=55) and CI (n=22) participants. Older cognitively normal participants called less frequently and made less use of apps (P<.05). No sex effects were found. Compared to the CN and SCD groups, CI individuals called less unique contacts (β=–0.7 [SE 0.29], P=.049) and contacted the same contacts relatively more often (β=0.8 [SE 0.25], P=.004). They also made less use of apps (β=–0.83 [SE 0.25], P=.004). Higher total NPI scores were associated with further traveling (β=0.042 [SE 0.015], P=.03). Conclusions: CI individuals show reduced social activity, especially those activities that are related to repeated and unique behavior, as measured by the smartphone app Behapp. Neuropsychiatric symptoms seemed only marginally associated with social behavior as measured with Behapp. This research shows that the Behapp app is able to objectively and passively measure altered social behavior in a cognitively impaired population. %M 35594063 %R 10.2196/33856 %U https://aging.jmir.org/2022/2/e33856 %U https://doi.org/10.2196/33856 %U http://www.ncbi.nlm.nih.gov/pubmed/35594063 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 5 %P e35867 %T Evaluation of the Effect of Patient Education and Strengthening Exercise Therapy Using a Mobile Messaging App on Work Productivity in Japanese Patients With Chronic Low Back Pain: Open-Label, Randomized, Parallel-Group Trial %A Itoh,Naohiro %A Mishima,Hirokazu %A Yoshida,Yuki %A Yoshida,Manami %A Oka,Hiroyuki %A Matsudaira,Ko %+ Medical Affairs Department, Shionogi & Co, Ltd, 1-8, Doshomachi 3-chome, Chuo-ku, Osaka, 541-0045, Japan, 81 6 6209 7412, naohiro.itoh@shionogi.co.jp %K mobile app %K patient education %K chronic low back pain %K exercise regimen %K mobile phone %D 2022 %7 16.5.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Artificial intelligence–assisted interactive health promotion systems are useful tools for the management of musculoskeletal conditions. Objective: This study aimed to explore the effects of web-based video patient education and strengthening exercise therapy, using a mobile messaging app, on work productivity and pain in patients with chronic low back pain (CLBP) receiving pharmacological treatment. Methods: Patients with CLBP were randomly allocated to either the exercise group, who received education and exercise therapy using a mobile messaging app, or the conventional group. For patient education, a web-based video program was used to provide evidence-based thinking regarding the importance of a cognitive behavioral approach for CLBP. The exercise therapy was developed in accordance with the recommendations for alignment, core muscles, and endogenous activation, including improvement of posture and mobility for proper alignment, stimulation and/or strengthening of deep muscles for spinal stability, and operation of intrinsic pain for the activation of endogenous substances by aerobic exercise. Both groups continued to receive the usual medical care with pharmacological treatment. The end points were changes in work productivity, pain intensity, quality of life, fear of movement, and depression. The observation period for this study was 12 weeks. An analysis adjusted for baseline values, age at the time of consent acquisition, sex, and willingness to strengthen the exercise therapy was performed. Results: The exercise and conventional groups included 48 and 51 patients, with a mean age of 47.9 years (SD 10.2 years; n=27, 56.3% male patients) and 46.9 years (SD 12.3 years; n=28, 54.9% male patients) in the full analysis set, respectively. No significant impact of these interventions on work productivity was observed in the exercise group compared with the conventional group (primary end point: Quantity and Quality method; 0.062 vs 0.114; difference between groups −0.053, 95% CI −0.184 to 0.079; P=.43). However, the exercise group showed consistently better trends for the other end points than did the conventional group. Compared with the conventional group, the exercise group showed a significant improvement in the symptoms of low back pain (3.2 vs 3.8; difference between groups −0.5, 95% CI −1.1 to 0.0; P=.04), quality of life (EuroQoL 5 Dimensions 5 Level: 0.068 vs 0.006; difference between groups 0.061, 95% CI 0.008 to 0.114; P=.03), and fear of movement at week 12 (−2.3 vs 0.5; difference between groups −2.8, 95% CI −5.5 to −0.1; P=.04). Conclusions: This study suggests that patient education and strengthening exercise therapy using a mobile messaging app may be useful for treating CLBP. This study does not reveal the effect of therapeutic interventions on CLBP on work productivity. Thus, further research is required to assess work productivity with therapeutic interventions. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000041037; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046866 %M 35576560 %R 10.2196/35867 %U https://mhealth.jmir.org/2022/5/e35867 %U https://doi.org/10.2196/35867 %U http://www.ncbi.nlm.nih.gov/pubmed/35576560 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e38063 %T Understanding Whole-Person Health and Resilience During the COVID-19 Pandemic and Beyond: A Cross-sectional and Descriptive Correlation Study %A Rajamani,Sripriya %A Austin,Robin %A Geiger-Simpson,Elena %A Jantraporn,Ratchada %A Park,Suhyun %A Monsen,Karen A %+ University of Minnesota, 5-140 Weaver-Densford Hall; 308 Harvard St SE, Minneapolis, MN, 55455, United States, 1 6512787426, sripriya@umn.edu %K Omaha System %K whole-person health %K strengths %K resilience %K assessment %K app %K health information technology %K health informatics %K nursing %K health care %K mobile health %K health application %K mHealth %K health data %K health community %K digital health %D 2022 %7 16.5.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: The COVID-19 pandemic has prompted an interest in whole-person health and emotional well-being. Informatics solutions through user-friendly tools such as mobile health apps offer immense value. Prior research developed a consumer-facing app MyStrengths + MyHealth using Simplified Omaha System Terms (SOST) to assess whole-person health. The MyStrengths + MyHealth app assesses strengths, challenges, and needs (SCN) for 42 concepts across four domains (My Living, My Mind and Networks, My Body, My Self-care; eg, Income, Emotions, Pain, and Nutrition, respectively). Given that emotional well-being was a predominant concern during the COVID-19 pandemic, we sought to understand whole-person health for participants with/without Emotions challenges. Objective: This study aims to use visualization techniques and data from attendees at a Midwest state fair to examine SCN overall and by groups with/without Emotions challenges, and to explore the resilience of participants. Methods: This cross-sectional and descriptive correlational study surveyed adult attendees at a 2021 Midwest state fair. Data were visualized using Excel and analyzed using descriptive and inferential statistics using SPSS. Results: The study participants (N=182) were primarily female (n=123, 67.6%), aged ≥45 years (n=112, 61.5%), White (n=154, 84.6%), and non-Hispanic (n=177, 97.3%). Compared to those without Emotions challenges, those with Emotions challenges were aged 18-44 (P<.001) years, more often female (P=.02), and not married (P=.01). Overall, participants had more strengths (mean 28.6, SD 10.5) than challenges (mean 12, SD 7.5) and needs (mean 4.2, SD 7.5). The most frequent needs were in Emotions, Nutrition, Income, Sleeping, and Exercising. Compared to those without Emotions challenges, those with Emotions challenges had fewer strengths (P<.001), more challenges (P<.001), and more needs (P<.001), along with fewer strengths for Emotions (P<.001) and for the cluster of health-related behaviors domain concepts, Sleeping (P=.002), Nutrition (P<.001), and Exercising (P<.001). Resilience was operationalized as correlations among strengths for SOST concepts and visualized for participants with/without an Emotions challenge. Those without Emotions challenges had more positive strengths correlations across multiple concepts/domains. Conclusions: This survey study explored a large community-generated data set to understand whole-person health and showed between-group differences in SCN and resilience for participants with/without Emotions challenges. It contributes to the literature regarding an app-aided and data-driven approach to whole-person health and resilience. This research demonstrates the power of health informatics and provides researchers with a data-driven methodology for additional studies to build evidence on whole-person health and resilience. %M 35576563 %R 10.2196/38063 %U https://nursing.jmir.org/2022/1/e38063 %U https://doi.org/10.2196/38063 %U http://www.ncbi.nlm.nih.gov/pubmed/35576563 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e33037 %T Contrasting a Mobile App With a Conversational Chatbot for Reducing Alcohol Consumption: Randomized Controlled Pilot Trial %A Dulin,Patrick %A Mertz,Robyn %A Edwards,Alexandra %A King,Diane %+ Department of Psychology, University of Alaska Anchorage, 3211 Providence Drive, Anchorage, AK, 99508, United States, 1 907 786 1653, aehauser@alaska.edu %K alcohol %K hazardous drinking %K smartphone app %K chatbot %K brief intervention %K effectiveness %K utilization %K mobile phone %D 2022 %7 16.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile apps have shown considerable promise for reducing alcohol consumption among problem drinkers, but like many mobile health apps, they frequently report low utilization, which is an important limitation, as research suggests that effectiveness is related to higher utilization. Interactive chatbots have the ability to provide a conversational interface with users and may be more engaging and result in higher utilization and effectiveness, but there is limited research into this possibility. Objective: This study aimed to develop a chatbot alcohol intervention based on an empirically supported app (Step Away) for reducing drinking and to conduct a pilot trial of the 2 interventions. Included participants met the criteria for hazardous drinking and were interested in reducing alcohol consumption. The study assessed utilization patterns and alcohol outcomes across the 2 technology conditions, and a waitlist control group. Methods: Participants were recruited using Facebook advertisements. Those who met the criteria for hazardous consumption and expressed an interest in changing their drinking habits were randomly assigned to three conditions: the Step Away app, Step Away chatbot, and waitlist control condition. Participants were assessed on the web using the Alcohol Use Disorders Identification Test, Adapted for Use in the United States, Readiness to Change Questionnaire, Short Inventory of Problems-Revised, and Timeline Followback at baseline and at 12 weeks follow-up. Results: A total of 150 participants who completed the baseline and follow-up assessments were included in the final analysis. ANOVA results indicated that participants in the 3 conditions changed their drinking from baseline to follow-up, with large effect sizes noted (ie, η2=0.34 for change in drinks per day across conditions). However, the differences between groups were not significant across the alcohol outcome variables. The only significant difference between conditions was in the readiness to change variable, with the bot group showing the greatest improvement in readiness (F2,147=5.6; P=.004; η2=0.07). The results suggested that the app group used the app for a longer duration (mean 50.71, SD 49.02 days) than the bot group (mean 27.16, SD 30.54 days; P=.02). Use of the interventions was shown to predict reduced drinking in a multiple regression analysis (β=.25, 95% CI 0.00-0.01; P=.04). Conclusions: Results indicated that all groups in this study reduced their drinking considerably from baseline to the 12-week follow-up, but no differences were found in the alcohol outcome variables between the groups, possibly because of a combination of small sample size and methodological issues. The app group reported greater use and slightly higher usability scores than the bot group, but the bot group demonstrated improved readiness to change scores over the app group. The strengths and limitations of the app and bot interventions as well as directions for future research are discussed. Trial Registration: ClinicalTrials.gov NCT04447794; https://clinicaltrials.gov/ct2/show/NCT04447794 %M 35576569 %R 10.2196/33037 %U https://formative.jmir.org/2022/5/e33037 %U https://doi.org/10.2196/33037 %U http://www.ncbi.nlm.nih.gov/pubmed/35576569 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e29227 %T Our Whole Lives for Hypertension and Cardiac Risk Factors—Combining a Teaching Kitchen Group Visit With a Web-Based Platform: Feasibility Trial %A Gardiner,Paula %A McGonigal,Lisa %A Villa,Ariel %A Kovell,Lara C %A Rohela,Pallavi %A Cauley,Andrew %A Rinker,Diana %A Olendzki,Barbara %+ Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Benedict Building, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 781 929 6460, paula.gardiner@umassmed.edu %K hypertension %K health disparities %K teaching kitchen %K technology %K mindfulness %K low income %K medical group visits %K mobile phone %D 2022 %7 16.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Hypertension (HTN) affects millions of Americans. Our Whole Lives: an eHealth toolkit for Hypertension and Cardiac Risk Factors (OWL-H) is an eHealth platform that teaches evidence-based lifestyle strategies, such mindfulness and cooking skills, to improve self-management of HTN. Objective: The primary goal of this pilot study was to evaluate the feasibility of OWL-H combined with teaching kitchen medical group visits (TKMGVs) in a low-income population of participants with HTN. Methods: We conducted a pre-post 8-week study to assess the feasibility of a hybrid program (a web-based 9-module self-management program, which includes mindfulness and Mediterranean and Dietary Approaches to Stop Hypertension diet) accompanied by 3 in-person TKMGVs among patients with HTN. Data including demographics, platform use, and satisfaction after using OWL-H were examined. Outcome data collected at baseline and 8 weeks included the Mediterranean Diet Questionnaire, Hypertension Self-Care Profile Self-Efficacy Instrument, Blood Pressure Knowledge Questionnaire, and the number of self-reported blood pressure readings. For the statistical analysis, we used descriptive statistics, paired sample t tests (1-tailed), and qualitative methods. Results: Of the 25 enrolled participants, 22 (88%) participants completed the study. Participants’ average age was 57 (SD 12.1) years, and 46% (11/24) of them reported a household income 5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence. Conclusions: Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions. %M 35551058 %R 10.2196/35159 %U https://mental.jmir.org/2022/5/e35159 %U https://doi.org/10.2196/35159 %U http://www.ncbi.nlm.nih.gov/pubmed/35551058 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 5 %P e15719 %T The Quality of Indian Obesity-Related mHealth Apps: PRECEDE-PROCEED Model–Based Content Analysis %A Selvaraj,Shanmuga Nathan %A Sriram,Arulchelvan %+ Department of Media Sciences, College of Engineering, Anna University, No 12 Sardar Patel Rd, Guindy, Chennai, 600025, India, 91 99946 63036, shunmu.nathu@gmail.com %K obesity %K mHealth apps %K PRECEDE-PROCEED Model %K Mobile App Rating Scale %K health communication %K health behavior change techniques %K health information %D 2022 %7 11.5.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The prevalence of obesity in India is increasing at an alarming rate. Obesity-related mHealth apps have proffered an exciting opportunity to remotely deliver obesity-related information. This opportunity raises the question of whether such apps are truly effective. Objective: The aim of this study was to identify existing obesity-related mHealth apps in India and evaluate the potential of the apps’ contents to promote health behavior change. This study also aimed to discover the general quality of obesity-related mHealth apps. Methods: A systematic search for obesity-related mHealth apps was conducted in both the Google Play Store and the Apple App Store. The features and quality of the sample apps were assessed using the Mobile Application Rating Scale (MARS) and the potential of the sample apps’ contents to promote health behavior change was assessed using the PRECEDE-PROCEED Model (PPM). Results: A total of 13 apps (11 from the Google Play Store and 2 from the Apple App Store) were considered eligible for the study. The general quality of the 13 apps assessed using MARS resulted in mean scores ranging from 1.8 to 3.7. The bivariate Pearson correlation between the MARS rating and app user rating failed to establish statistically significant results. The multivariate regression analysis result indicated that the PPM factors are significant determinants of health behavior change (F3,9=63.186; P<.001) and 95.5% of the variance (R2=0.955; P<.001) in the dependent variable (health behavior change) can be explained by the independent variables (PPM factors). Conclusions: In general, mHealth apps are found to be more effective when they are based on theory. The presence of PPM factors in an mHealth app can greatly influence the likelihood of health behavior change among users. So, we suggest mHealth app developers consider this to develop efficient apps. Also, mHealth app developers should consider providing health information from credible sources and indicating the sources of the information, which will increase the perceived credibility of the apps among the users. We strongly recommend health professionals and health organizations be involved in the development of mHealth apps. Future research should include mHealth app users to understand better the apps’ effectiveness in bringing about health behavior change. %M 35544318 %R 10.2196/15719 %U https://mhealth.jmir.org/2022/5/e15719 %U https://doi.org/10.2196/15719 %U http://www.ncbi.nlm.nih.gov/pubmed/35544318 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 5 %P e35920 %T mHealth Interventions to Reduce Physical Inactivity and Sedentary Behavior in Children and Adolescents: Systematic Review and Meta-analysis of Randomized Controlled Trials %A Baumann,Hannes %A Fiedler,Janis %A Wunsch,Kathrin %A Woll,Alexander %A Wollesen,Bettina %+ Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, Karlsruhe, 76131, Germany, 49 721 608 454, kathrin.wunsch@kit.edu %K health behavior change %K individualization %K sedentary behavior %K physical activity %K tailored interventions %K personalized medicine %K health app %K mobile phone %D 2022 %7 11.5.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Children and adolescents increasingly do not meet physical activity (PA) recommendations. Hence, insufficient PA (IPA) and sedentary behavior (SB) among children and adolescents are relevant behavior change domains for using individualized mobile health (mHealth) interventions. Objective: This review and meta-analysis investigated the effectiveness of mHealth interventions on IPA and SB, with a special focus on the age and level of individualization. Methods: PubMed, Scopus, Web of Science, SPORTDiscus, and Cochrane Library were searched for randomized controlled trials published between January 2000 and March 2021. mHealth interventions for primary prevention in children and adolescents addressing behavior change related to IPA and SB were included. Included studies were compared for content characteristics and methodological quality and summarized narratively. In addition, a meta-analysis with a subsequent exploratory meta-regression examining the moderating effects of age and individualization on overall effectiveness was performed. Results: On the basis of the inclusion criteria, 1.3% (11/828) of the preliminary identified studies were included in the qualitative synthesis, and 1.2% (10/828) were included in the meta-analysis. Trials included a total of 1515 participants (mean age (11.69, SD 0.788 years; 65% male and 35% female) self-reported (3/11, 27%) or device-measured (8/11, 73%) health data on the duration of SB and IPA for an average of 9.3 (SD 5.6) weeks. Studies with high levels of individualization significantly decreased insufficient PA levels (Cohen d=0.33; 95% CI 0.08-0.58; Z=2.55; P=.01), whereas those with low levels of individualization (Cohen d=−0.06; 95% CI −0.32 to 0.20; Z=0.48; P=.63) or targeting SB (Cohen d=−0.11; 95% CI −0.01 to 0.23; Z=1.73; P=.08) indicated no overall significant effect. The heterogeneity of the studies was moderate to low, and significant subgroup differences were found between trials with high and low levels of individualization (χ21=4.0; P=.04; I2=75.2%). Age as a moderator variable showed a small effect; however, the results were not significant, which might have been because of being underpowered. Conclusions: Evidence suggests that mHealth interventions for children and adolescents can foster moderate reductions in IPA but not SB. Moreover, individualized mHealth interventions to reduce IPA seem to be more effective for adolescents than for children. Although, to date, only a few mHealth studies have addressed inactive and sedentary young people, and their quality of evidence is moderate, these findings indicate the relevance of individualization on the one hand and the difficulties in reducing SB using mHealth interventions on the other. Trial Registration: PROSPERO CRD42020209417; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209417 %M 35544294 %R 10.2196/35920 %U https://mhealth.jmir.org/2022/5/e35920 %U https://doi.org/10.2196/35920 %U http://www.ncbi.nlm.nih.gov/pubmed/35544294 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 5 %P e36404 %T Nonusage Attrition of Adolescents in an mHealth Promotion Intervention and the Role of Socioeconomic Status: Secondary Analysis of a 2-Arm Cluster-Controlled Trial %A Maenhout,Laura %A Peuters,Carmen %A Cardon,Greet %A Crombez,Geert %A DeSmet,Ann %A Compernolle,Sofie %+ Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, Ghent, 9000, Belgium, 32 92646363, laura.maenhout@ugent.be %K mHealth %K nonusage attrition %K adolescents %K socioeconomic status %K mobile phone %D 2022 %7 10.5.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) interventions may help adolescents adopt healthy lifestyles. However, attrition in these interventions is high. Overall, there is a lack of research on nonusage attrition in adolescents, particularly regarding the role of socioeconomic status (SES). Objective: The aim of this study was to focus on the role of SES in the following three research questions (RQs): When do adolescents stop using an mHealth intervention (RQ1)? Why do they report nonusage attrition (RQ2)? Which intervention components (ie, self-regulation component, narrative, and chatbot) prevent nonusage attrition among adolescents (RQ3)? Methods: A total of 186 Flemish adolescents (aged 12-15 years) participated in a 12-week mHealth program. Log data were monitored to measure nonusage attrition and usage duration for the 3 intervention components. A web-based questionnaire was administered to assess reasons for attrition. A survival analysis was conducted to estimate the time to attrition and determine whether this differed according to SES (RQ1). Descriptive statistics were performed to map the attrition reasons, and Fisher exact tests were used to determine if these reasons differed depending on the educational track (RQ2). Mixed effects Cox proportional hazard regression models were used to estimate the associations between the use duration of the 3 components during the first week and attrition. An interaction term was added to the regression models to determine whether associations differed by the educational track (RQ3). Results: After 12 weeks, 95.7% (178/186) of the participants stopped using the app. 30.1% (56/186) of the adolescents only opened the app on the installation day, and 44.1% (82/186) stopped using the app in the first week. Attrition at any given time during the intervention period was higher for adolescents from the nonacademic educational track compared with those from the academic track. The other SES indicators (family affluence and perceived financial situation) did not explain attrition. The most common reasons for nonusage attrition among participants were perceiving that the app did not lead to behavior change, not liking the app, thinking that they already had a sufficiently healthy lifestyle, using other apps, and not being motivated by the environment. Attrition reasons did not differ depending on the educational track. More time spent in the self-regulation and narrative components during the first week was associated with lower attrition, whereas chatbot use duration was not associated with attrition rates. No moderating effects of SES were observed in the latter association. Conclusions: Nonusage attrition was high, especially among adolescents in the nonacademic educational track. The reported reasons for attrition were diverse, with no statistical differences according to the educational level. The duration of the use of the self-regulation and narrative components during the first week may prevent attrition for both educational tracks. Trial Registration: ClinicalTrials.gov NCT04719858; http://clinicaltrials.gov/ct2/show/NCT04719858 %M 35536640 %R 10.2196/36404 %U https://mhealth.jmir.org/2022/5/e36404 %U https://doi.org/10.2196/36404 %U http://www.ncbi.nlm.nih.gov/pubmed/35536640 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e35273 %T Momentary Self-regulation: Scale Development and Preliminary Validation %A Scherer,Emily A %A Kim,Sunny Jung %A Metcalf,Stephen A %A Sweeney,Mary Ann %A Wu,Jialing %A Xie,Haiyi %A Mazza,Gina L %A Valente,Matthew J %A MacKinnon,David P %A Marsch,Lisa A %+ Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Suite 315, 46 Centerra Pkwy, Lebanon, NH, 03766, United States, 1 603 646 7000, blood.emily@gmail.com %K self-regulation %K momentary self-regulation %K ecological momentary assessment %K psychometric %K health behavior change %K health risk behaviors %K mobile phone %D 2022 %7 10.5.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Self-regulation refers to a person’s ability to manage their cognitive, emotional, and behavioral processes to achieve long-term goals. Most prior research has examined self-regulation at the individual level; however, individual-level assessments do not allow the examination of dynamic patterns of intraindividual variability in self-regulation and thus cannot aid in understanding potential malleable processes of self-regulation that may occur in response to the daily environment. Objective: This study aims to develop a brief, psychometrically sound momentary self-regulation scale that can be practically administered through participants’ mobile devices at a momentary level. Methods: This study was conducted in 2 phases. In the first phase, in a sample of 522 adults collected as part of a larger self-regulation project, we examined 23 previously validated assessments of self-regulation containing 594 items in total to evaluate the underlying structure of self-regulation via exploratory and confirmatory factor analyses. We then selected 20 trait-level items to be carried forward to the second phase. In the second phase, we converted each item into a momentary question and piloted the momentary items in a sample of 53 adults over 14 days. Using the results from the momentary pilot study, we explored the psychometric properties of the items and assessed their underlying structure. We then proposed a set of subscale and total score calculations. Results: In the first phase, the selected individual-level items appeared to measure 4 factors of self-regulation. The factors identified were perseverance, sensation seeking, emotion regulation, and mindfulness. In the second phase of the ecological momentary assessment pilot, the selected items demonstrated strong construct validity as well as predictive validity for health risk behaviors. Conclusions: Our findings provide preliminary evidence for a 12-item momentary self-regulation scale comprising 4 subscales designed to capture self-regulatory dynamics at the momentary level. %M 35536605 %R 10.2196/35273 %U https://mental.jmir.org/2022/5/e35273 %U https://doi.org/10.2196/35273 %U http://www.ncbi.nlm.nih.gov/pubmed/35536605 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35065 %T A Mobile App for Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus: Development and Usability Study %A Buss,Vera Helen %A Varnfield,Marlien %A Harris,Mark %A Barr,Margo %+ Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Level 7, Surgical, Treatment and Rehabilitation Service, 296 Herston Road, Herston, 4029, Australia, 61 732533603, vera.buss@csiro.au %K mobile health %K behavior change intervention %K primary prevention %K health promotion %K cardiovascular disease %K diabetes mellitus, type 2 %K mobile phone %D 2022 %7 10.5.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are posing a huge burden on health care systems worldwide. Mobile apps can deliver behavior change interventions for chronic disease prevention on a large scale, but current evidence for their effectiveness is limited. Objective: This paper reported on the development and user testing of a mobile app that aims at increasing risk awareness and engaging users in behavior change. It would form part of an intervention for primary prevention of CVD and T2DM. Methods: The theoretical framework of the app design was based on the Behaviour Change Wheel, combined with the capability, opportunity, and motivation for behavior change system and the behavior change techniques from the Behavior Change Technique Taxonomy (version 1). In addition, evidence from scientific literature has guided the development process. The prototype was tested for user-friendliness via an iterative approach. We conducted semistructured interviews with individuals in the target populations, which included the System Usability Scale. We transcribed and analyzed the interviews using descriptive statistics for the System Usability Scale and thematic analysis to identify app features that improved utility and usability. Results: The target population was Australians aged ≥45 years. The app included 4 core modules (risk score, goal setting, health measures, and education). In these modules, users learned about their risk for CVD and T2DM; set goals for smoking, alcohol consumption, diet, and physical activity; and tracked them. In total, we included 12 behavior change techniques. We conducted 2 rounds of usability testing, each involving 5 participants. The average age of the participants was 58 (SD 8) years. Totally, 60% (6/10) of the participants owned iPhone Operating System phones, and 40% (4/10) of them owned Android phones. In the first round, we identified a technical issue that prevented 30% (3/10) of the participants from completing the registration process. Among the 70% (7/10) of participants who were able to complete the registration process, 71% (5/7) rated the app above average, based on the System Usability Scale. During the interviews, we identified some issues related to functionality, content, and language and clarity. We used the participants’ feedback to improve these aspects. Conclusions: We developed the app using behavior change theory and scientific evidence. The user testing allowed us to identify and remove technical errors and integrate additional functions into the app, which the participants had requested. Next, we will evaluate the feasibility of the revised version of the app developed through this design process and usability testing. %M 35536603 %R 10.2196/35065 %U https://humanfactors.jmir.org/2022/2/e35065 %U https://doi.org/10.2196/35065 %U http://www.ncbi.nlm.nih.gov/pubmed/35536603 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e36768 %T Modification in the Motor Skills of Seniors in Care Homes Using Serious Games and the Impact of COVID-19: Field Study %A Kleschnitzki,Jana Marina %A Grossmann,Inga %A Beyer,Reinhard %A Beyer,Luzi %+ Institute of Psychology, Faculty of Human Sciences, Humboldt-University of Berlin, Rudower Chaussee 18, Berlin, 12489, Germany, 49 15231964606, janakleschnitzki@posteo.de %K serious games %K motor skills %K motor %K long-term care %K exercise %K movement %K coronavirus effects %K eHealth %K seniors %K older adult %K elder %K senior population %K aged %K care home %K intervention effects analysis %K COVID-19 %K pandemic %K digital game %K digital health %K physical activity %D 2022 %7 10.5.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: The pandemic has highlighted the importance of low-threshold opportunities for exercise and physical activity. At the beginning of 2020, the COVID-19 pandemic led to many restrictions, which affected seniors in care facilities in the form of severe isolation. The isolation led, among other things, to a lack of exercise, which has led to a multitude of negative effects for this target group. Serious games can potentially help by being used anywhere at any time to strengthen skills with few resources. Objective: The aim of this study is to evaluate the effectiveness of a serious game to strengthen motor skills (study 1) and the influence of pandemic restrictions (study 2) on seniors in care facilities. Methods: The data on motor skills (measured by the Tinetti test) originated from an intervention study with repeated measurements that was interrupted by the pandemic conditions. Data were collected 4 times every 3 months with an intervention group (IG, training 3 times for 1 hour per week) and a control group (CG, no intervention). There were 2 substudies. The first considered the first 6 months until the pandemic restrictions, while the second considered the influence of the restrictions on motor skills. Results: The sample size was 70. The IG comprised 31 (44%) participants, with 22 (71%) female and 9 (29%) male seniors with an average age of 85 years. The CG comprised 39 (56%) participants, with 31 (79%) female and 8 (21%) male seniors with an average age of 87 years. In study 1, mixed-design ANOVA showed no significant interaction between measurement times and group membership for the first measurements (F2.136=1.414, P<.25, partial η2=.044), but there was a significant difference between the CG (mean 16.23, SD 1.1) and the IG (mean 19.81, SD 1.2) at the third time of measurement (P=.02). In study 2 the mixed-design ANOVA (used to investigate motor skills before and after the pandemic conditions between the 2 groups) couldn’t reveal any significant interaction between measurement times and group membership: F1.67=2.997, P<.09, partial η2=.043. However, there was a significant main effect of the time of measurement: F1.67=5.44, P<.02, partial η²=.075. Conclusions: During the first 6 months, the IG showed increased motor skills, whereas the motor skills of the CG slightly deteriorated and showed a statistically significant difference after 6 months. The pandemic restrictions leveled the difference and showed a significant negative effect on motor skills over 3 months. As our results show, digital games have the potential to break down access barriers and promote necessary maintenance for important skills. The pandemic has highlighted the importance of low-threshold opportunities for exercise and physical activity. This potentially great benefit for the challenges of tomorrow shows the relevance of the topic and demonstrates the urgent need for action and research. Trial Registration: Deutsches Register klinischer Studien DRKS00016633; https://tinyurl.com/yckmj4px %M 35536610 %R 10.2196/36768 %U https://games.jmir.org/2022/2/e36768 %U https://doi.org/10.2196/36768 %U http://www.ncbi.nlm.nih.gov/pubmed/35536610 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e37946 %T Asthma and Technology in Emerging African American Adults (The ATHENA Project): Protocol for a Trial Using the Multiphase Optimization Strategy Framework %A Baptist,Alan %A Gibson-Scipio,Wanda %A Carcone,April Idalski %A Ghosh,Samiran %A Jacques-Tiura,Angela J %A Hall,Amy %A MacDonell,Karen Kolmodin %+ Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, iBio 6135 Woodward Ave, Detroit, MI, 48202, United States, 1 3135776996, karen.macdonell@wayne.edu %K African American emerging adults %K asthma management %K mHealth %K mobile health %K motivational interviewing %K asthma control %K physical activity %D 2022 %7 10.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Asthma causes substantial morbidity and mortality in the United States, particularly among African American emerging adults (AAEAs; aged 18-30 years), but very few asthma programs have targeted this population. Interventions that provide education and address underlying motivation for managing asthma may be the most effective. However, intensive face-to-face interventions are often difficult to implement in this population. Objective: The purpose of this study is to develop an effective mobile asthma management intervention to improve control among AAEAs. Methods: We will assess the ability of multiple technologic components to assist and improve traditional asthma education. The first component is the Motivational Enhancement System for asthma management. It is a mobile 4-session intervention using supported self-regulation and motivational interviewing. Personalized content is based on each participant’s activity level, daily experiences, and goals. The second component is supportive accountability. It is administered by asthma nurses using targeted mobile support (Skype/voice calls) to provide education, promote self-efficacy, and overcome barriers through a motivational interviewing–based framework. The third component is SMS text messaging. It provides reminders for asthma education, medication adherence, and physical activity. The fourth component is physical activity tracking. It uses wearable technology to help meet user-defined physical activity goals. Using a multiphase optimization strategy (MOST) framework, we will test intervention components and combinations of components to identify the most effective mobile intervention. The MOST framework is an innovative, and cost- and time-effective framework that uses engineering principles to produce effective behavioral interventions. We will conduct a component selection experiment using a factorial research design to build an intervention that has been optimized for maximum efficacy, using a clinically significant improvement in asthma. Participants (N=180) will be randomized to 1 of 6 intervention arms. Participants will be recruited from multiple sites of the American Lung Association-Airway Clinical Research Centers network and ambulatory care clinics at the Detroit Medical Center. Data collections will occur at baseline, and 3, 6, and 12 months. Results: At study completion, we will have an empirically supported optimized mobile asthma management intervention to improve asthma control for AAEAs. We hypothesize that postintervention (3, 6, and 12 months), participants with uncontrolled asthma will show a clinically significant improvement in asthma control. We also hypothesize that improvements in asthma management behaviors (including physical activity), quality of life, symptoms, adherence, and exacerbation (secondary outcomes) will be observed. Conclusions: AAEAs are disproportionately impacted by asthma, but have been underrepresented in research. Mobile asthma management interventions may help improve asthma control and allow people to live healthier lives. During this project, we will use an innovative strategy to develop an optimized mobile asthma management intervention using the most effective combination of nurse-delivered asthma education, a smartphone app, and text messaging. International Registered Report Identifier (IRRID): PRR1-10.2196/37946 %M 35536642 %R 10.2196/37946 %U https://www.researchprotocols.org/2022/5/e37946 %U https://doi.org/10.2196/37946 %U http://www.ncbi.nlm.nih.gov/pubmed/35536642 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e32006 %T Factors Predicting Engagement of Older Adults With a Coach-Supported eHealth Intervention Promoting Lifestyle Change and Associations Between Engagement and Changes in Cardiovascular and Dementia Risk: Secondary Analysis of an 18-Month Multinational Randomized Controlled Trial %A Coley,Nicola %A Andre,Laurine %A Hoevenaar-Blom,Marieke P %A Ngandu,Tiia %A Beishuizen,Cathrien %A Barbera,Mariagnese %A van Wanrooij,Lennard %A Kivipelto,Miia %A Soininen,Hilkka %A van Gool,Willem %A Brayne,Carol %A Moll van Charante,Eric %A Richard,Edo %A Andrieu,Sandrine %A , %A , %+ Center for Epidemiology and Research in Population health (CERPOP), University of Toulouse III Paul Sabatier (UPS), National Institute of Health and Medical Research (INSERM) mixed research unit (UMR) 1295, 37 allées Jules Guesde, Toulouse, 31000, France, 33 561145680, nicola.coley@inserm.fr %K aging %K eHealth %K disparities %K engagement %K prevention %K cardiovascular %K lifestyle %K risk factors %D 2022 %7 9.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health interventions could help to prevent age-related diseases, but little is known about how older adults engage with such interventions, especially in the long term, or whether engagement is associated with changes in clinical, behavioral, or biological outcomes in this population. Disparities in engagement levels with digital health interventions may exist among older people and be associated with health inequalities. Objective: This study aimed to describe older adults’ engagement with an eHealth intervention, identify factors associated with engagement, and examine associations between engagement and changes in cardiovascular and dementia risk factors (blood pressure, cholesterol, BMI, physical activity, diet, and cardiovascular and dementia risk scores). Methods: This was a secondary analysis of the 18-month randomized controlled Healthy Ageing Through Internet Counselling in the Elderly trial of a tailored internet-based intervention encouraging behavior changes, with remote support from a lifestyle coach, to reduce cardiovascular and cognitive decline risk in 2724 individuals aged ≥65 years, recruited offline in the Netherlands, Finland, and France. Engagement was assessed via log-in frequency, number of lifestyle goals set, measurements entered and messages sent to coaches, and percentage of education materials read. Clinical and biological data were collected during in-person visits at baseline and 18 months. Lifestyle data were self-reported on a web-based platform. Results: Of the 1389 intervention group participants, 1194 (85.96%) sent at least one message. They logged in a median of 29 times, and set a median of 1 goal. Higher engagement was associated with significantly greater improvement in biological and behavioral risk factors, with evidence of a dose-response effect. Compared with the control group, the adjusted mean difference (95% CI) in 18-month change in the primary outcome, a composite z-score comprising blood pressure, BMI, and cholesterol, was −0.08 (−0.12 to −0.03), −0.04 (−0.08 to 0.00), and 0.00 (−0.08 to 0.08) in the high, moderate, and low engagement groups, respectively. Low engagers showed no improvement in any outcome measures compared with the control group. Participants not using a computer regularly before the study engaged much less with the intervention than those using a computer up to 7 (adjusted odds ratio 5.39, 95% CI 2.66-10.95) or ≥7 hours per week (adjusted odds ratio 6.58, 95% CI 3.21-13.49). Those already working on or with short-term plans for lifestyle improvement at baseline, and with better cognition, engaged more. Conclusions: Greater engagement with an eHealth lifestyle intervention was associated with greater improvement in risk factors in older adults. However, those with limited computer experience, who tended to have a lower level of education, or who had poorer cognition engaged less. Additional support or forms of intervention delivery for such individuals could help minimize potential health inequalities associated with the use of digital health interventions in older people. %M 35385395 %R 10.2196/32006 %U https://www.jmir.org/2022/5/e32006 %U https://doi.org/10.2196/32006 %U http://www.ncbi.nlm.nih.gov/pubmed/35385395 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e33498 %T Using Smart Speaker Technology for Health and Well-being in an Older Adult Population: Pre-Post Feasibility Study %A McCloud,Rachel %A Perez,Carly %A Bekalu,Mesfin Awoke %A Viswanath,K %+ Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, United States, 1 706 224 8893, rachel_faulkenberry@dfci.harvard.edu %K technology %K older adults %K communication inequalities %K digital health %K elderly population %K smart technology %K smart speaker %K well-being %K health technology %K mobile phone %D 2022 %7 9.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Although smart speaker technology is poised to help improve the health and well-being of older adults by offering services such as music, medication reminders, and connection to others, more research is needed to determine how older adults from lower socioeconomic position (SEP) accept and use this technology. Objective: This study aimed to investigate the feasibility of using smart speakers to improve the health and well-being of low-SEP older adults. Methods: A total of 39 adults aged between 65 and 85 years who lived in a subsidized housing community were recruited to participate in a 3-month study. The participants had a smart speaker at their home and were given a brief orientation on its use. Over the course of the study, participants were given weekly check-in calls to help assist with any problems and newsletters with tips on how to use the speaker. Participants received a pretest and posttest to gauge comfort with technology, well-being, and perceptions and use of the speaker. The study staff also maintained detailed process notes of interactions with the participants over the course of the study, including a log of all issues reported. Results: At the end of the study period, 38% (15/39) of the participants indicated using the speaker daily, and 38% (15/39) of the participants reported using it several times per week. In addition, 72% (28/39) of the participants indicated that they wanted to continue using the speaker after the end of the study. Most participants (24/39, 62%) indicated that the speaker was useful, and approximately half of the participants felt that the speaker gave them another voice to talk to (19/39, 49%) and connected them with the outside world (18/39, 46%). Although common uses were using the speaker for weather, music, and news, fewer participants reported using it for health-related questions. Despite the initial challenges participants experienced with framing questions to the speaker, additional explanations by the study staff addressed these issues in the early weeks of the study. Conclusions: The results of this study indicate that there is promise for smart speaker technology for low-SEP older adults, particularly to connect them to music, news, and reminders. Future studies will need to provide more upfront training on query formation as well as develop and promote more specific options for older adults, particularly in the area of health and well-being. %M 35532979 %R 10.2196/33498 %U https://aging.jmir.org/2022/2/e33498 %U https://doi.org/10.2196/33498 %U http://www.ncbi.nlm.nih.gov/pubmed/35532979 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 5 %P e34531 %T The Effectiveness of a Mobile Health Care App and Human Coaching Program in Primary Care Clinics: Pilot Multicenter Real-World Study %A Ju,HyoRim %A Kang,EunKyo %A Kim,YoungIn %A Ko,HyunYoung %A Cho,Belong %+ Department of Family Medicine, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 03080, Republic of Korea, 82 2 2072 2195, belong@snu.ac.kr %K healthcare %K health care %K mobile application %K app %K self-management %K primary care %K chronic conditions %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As the global burden of chronic conditions increases, their effective management is a concern. Although the need for chronic disease management using mobile self-management health care apps is increasing, there are still many barriers to their practical application in the primary care field. Objective: This study evaluated the effectiveness of primary care services combining a mobile self-management health care app with human coaching for patients with chronic diseases in the current primary care system. Methods: A total of 110 patients (mean age 53.2, SD 9.2 years; 64 of 110, 58.2% female) with hypertension, diabetes, dyslipidemia, or metabolic syndrome who visited one of 17 participating primary care clinics from September to November 2020 were included in this study. All participants recorded data regarding changes in body weight, sleep conditions, quality of life, depression, anxiety, stress, BMI, waist circumference, blood sugar levels, blood pressure, and blood lipids levels. The app user group (n=65) used a mobile self-management health care app with human coaching for 12 weeks, and the control group (n=45) underwent conventional self-managed health care. Results: Patients in the app user group reported significantly more weight loss than those in the control group—the body weight of the app user group decreased by 1.43 kg (95% CI –2.07 to –0.79) and that of the control group decreased by 0.13 kg (95% CI –0.67 to 0.41; P=.002). The weight loss was markedly greater after using the app for 9 weeks than that when used for 4 weeks or 5-8 weeks (P=.002). Patients in the app user group reported better sleep quality (P=.04) and duration (P=.004) than those in the control group. Conclusions: The combination of primary care clinics and a mobile self-management health care app with human coaching results in better management of chronic conditions. This study shows that the primary care services combining a mobile self-management health care app with human coaching are effective in the current primary care system. An implication of this study is the possibility that a mobile self-management health care app with human coaching is a treatment option in the current primary care system. %M 35522461 %R 10.2196/34531 %U https://mhealth.jmir.org/2022/5/e34531 %U https://doi.org/10.2196/34531 %U http://www.ncbi.nlm.nih.gov/pubmed/35522461 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 5 %P e33735 %T Privacy, Data Sharing, and Data Security Policies of Women’s mHealth Apps: Scoping Review and Content Analysis %A Alfawzan,Najd %A Christen,Markus %A Spitale,Giovanni %A Biller-Andorno,Nikola %+ Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, Zurich, 8006, Switzerland, 41 446348370, najd.alfawzan@uzh.ch %K mHealth %K women’s health %K ethics %K privacy policy %K data sharing %K privacy %K data security %K data transparency %K femtech %K mobile apps %K mobile health %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Women’s mobile health (mHealth) is a growing phenomenon in the mobile app global market. An increasing number of women worldwide use apps geared to female audiences (female technology). Given the often private and sensitive nature of the data collected by such apps, an ethical assessment from the perspective of data privacy, sharing, and security policies is warranted. Objective: The purpose of this scoping review and content analysis was to assess the privacy policies, data sharing, and security policies of women’s mHealth apps on the current international market (the App Store on the Apple operating system [iOS] and Google Play on the Android system). Methods: We reviewed the 23 most popular women’s mHealth apps on the market by focusing on publicly available apps on the App Store and Google Play. The 23 downloaded apps were assessed manually by 2 independent reviewers against a variety of user data privacy, data sharing, and security assessment criteria. Results: All 23 apps collected personal health-related data. All apps allowed behavioral tracking, and 61% (14/23) of the apps allowed location tracking. Of the 23 apps, only 16 (70%) displayed a privacy policy, 12 (52%) requested consent from users, and 1 (4%) had a pseudoconsent. In addition, 13% (3/23) of the apps collected data before obtaining consent. Most apps (20/23, 87%) shared user data with third parties, and data sharing information could not be obtained for the 13% (3/23) remaining apps. Of the 23 apps, only 13 (57%) provided users with information on data security. Conclusions: Many of the most popular women’s mHealth apps on the market have poor data privacy, sharing, and security standards. Although regulations exist, such as the European Union General Data Protection Regulation, current practices do not follow them. The failure of the assessed women’s mHealth apps to meet basic data privacy, sharing, and security standards is not ethically or legally acceptable. %M 35522465 %R 10.2196/33735 %U https://mhealth.jmir.org/2022/5/e33735 %U https://doi.org/10.2196/33735 %U http://www.ncbi.nlm.nih.gov/pubmed/35522465 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e33663 %T A Facebook-Delivered Weight Loss Intervention Using Open Enrollment: Randomized Pilot Feasibility Trial %A Pagoto,Sherry L %A Schroeder,Matthew W %A Xu,Ran %A Waring,Molly E %A Groshon,Laurie %A Goetz,Jared M %A Idiong,Christie %A Troy,Haley %A DiVito,Joseph %A Bannor,Richard %+ Department of Allied Health Sciences, Institute for Collaboration in Health, Interventions, and Policy, University of Connecticut, 2006 Hillside Road, Unit 1248, Room 22, Storrs, CT, 06268, United States, 1 860 486 7130, Sherry.Pagoto@uconn.edu %K weight loss %K obesity %K social media %K Facebook %K social networking %K mobile phone %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Behavioral weight loss programs typically enroll 12-40 people into groups that then suffer from declining engagement over time. Web-based patient communities, on the other hand, typically offer no limits on capacity and membership is fluid. This model may be useful for boosting engagement in behavioral weight loss interventions, which could lead to better outcomes. Objective: In this study, we aimed to examine the feasibility and acceptability of continuously enrolling participants into a Facebook-delivered weight loss intervention for the first 8 of 16 weeks relative to the same intervention where no new participants were enrolled after randomization. Methods: We conducted a randomized pilot trial to compare a Facebook weight loss group that used open enrollment with a group that used closed enrollment on feasibility and acceptability in adults with BMI 27-45 kg/m2. The feasibility outcomes included retention, engagement, and diet tracking adherence. We described the percentage loss of ≥5% weight in both groups as an exploratory outcome. We also explored the relationship between total volume of activity in the group and weight loss. The participants provided feedback via web-based surveys and focus groups. Results: Randomized participants (68/80, 85% women) were on average, aged 40.2 (SD 11.2) years with a mean BMI of 34.4 (SD 4.98) kg/m2. We enrolled an additional 54 participants (50/54, 93% female) in the open enrollment condition between weeks 1 and 8, resulting in a total group size of 94. Retention was 88% and 98% under the open and closed conditions, respectively. Randomized participants across conditions did not differ in engagement (P=.72), or diet tracking adherence (P=.42). Participant feedback in both conditions revealed that sense of community was what they liked most about the program and not enough individualized feedback was what they liked the least. Weight loss of ≥5% was achieved by 30% (12/40) of the participants randomized to the open enrollment condition and 18% (7/40) of the participants in the closed enrollment condition. Exploratory analyses revealed that the open condition (median 385, IQR 228-536.5) had a greater volume of engagement than the closed condition (median 215, IQR 145.5-292; P=.007). Furthermore, an increase of 100 in the total volume of engagement in the Facebook group each week was associated with an additional 0.1% weekly weight loss among the randomized participants (P=.02), which was independent of time, individual participant engagement, and sociodemographic characteristics. Conclusions: Open enrollment was as feasible and acceptable as closed enrollment. A greater volume of engagement in the Facebook group was associated with weight loss, suggesting that larger groups that produce more engagement overall may be beneficial. Future research should examine the efficacy of the open enrollment approach for weight loss in a fully powered randomized trial. Trial Registration: ClinicalTrials.gov NCT02656680; https://clinicaltrials.gov/ct2/show/NCT02656680 %M 35522466 %R 10.2196/33663 %U https://formative.jmir.org/2022/5/e33663 %U https://doi.org/10.2196/33663 %U http://www.ncbi.nlm.nih.gov/pubmed/35522466 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 5 %P e36284 %T Sociotechnical Factors Affecting Patients’ Adoption of Mobile Health Tools: Systematic Literature Review and Narrative Synthesis %A Jacob,Christine %A Sezgin,Emre %A Sanchez-Vazquez,Antonio %A Ivory,Chris %+ University of Applied Sciences Northwestern Switzerland, Riggenbachstrasse 16, 13b, Olten, 4600, Switzerland, 41 798769376, christine.k.jacob@gmail.com %K telemedicine %K smartphone %K mobile phone %K electronic health record %K public health practice %K technology %K perception %K health education %K mHealth %K mobile health %K telehealth %K eHealth %K patients %D 2022 %7 5.5.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) tools have emerged as a promising health care technology that may contribute to cost savings, better access to care, and enhanced clinical outcomes; however, it is important to ensure their acceptance and adoption to harness this potential. Patient adoption has been recognized as a key challenge that requires further exploration. Objective: The aim of this review was to systematically investigate the literature to understand the factors affecting patients’ adoption of mHealth tools by considering sociotechnical factors (from technical, social, and health perspectives). Methods: A structured search was completed following the participants, intervention, comparators, and outcomes framework. We searched the MEDLINE, PubMed, Cochrane Library, and SAGE databases for studies published between January 2011 and July 2021 in the English language, yielding 5873 results, of which 147 studies met the inclusion criteria. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the Cochrane Handbook were followed to ensure a systematic process. Extracted data were analyzed using NVivo (QSR International), with thematic analysis and narrative synthesis of emergent themes. Results: The technical factors affecting patients’ adoption of mHealth tools were categorized into six key themes, which in turn were divided into 20 subthemes: usefulness, ease of use, data-related, monetary factors, technical issues, and user experience. Health-related factors were categorized into six key themes: the disease or health condition, the care team’s role, health consciousness and literacy, health behavior, relation to other therapies, integration into patient journey, and the patients’ insurance status. Social and personal factors were divided into three key clusters: demographic factors, personal characteristics, and social and cultural aspects; these were divided into 19 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them. Conclusions: This review builds on the growing body of research that investigates patients’ adoption of mHealth services and highlights the complexity of the factors affecting adoption, including personal, social, technical, organizational, and health care aspects. We recommend a more patient-centered approach by ensuring the tools’ fit into the overall patient journey and treatment plan, emphasizing inclusive design, and warranting comprehensive patient education and support. Moreover, empowering and mobilizing clinicians and care teams, addressing ethical data management issues, and focusing on health care policies may facilitate adoption. %M 35318189 %R 10.2196/36284 %U https://mhealth.jmir.org/2022/5/e36284 %U https://doi.org/10.2196/36284 %U http://www.ncbi.nlm.nih.gov/pubmed/35318189 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e37292 %T A Group-Facilitated, Internet-Based Intervention to Promote Mental Health and Well-Being in a Vulnerable Population of University Students: Randomized Controlled Trial of the Be Well Plan Program %A Fassnacht,Daniel B %A Ali,Kathina %A van Agteren,Joep %A Iasiello,Matthew %A Mavrangelos,Teri %A Furber,Gareth %A Kyrios,Michael %+ College of Education, Psychology and Social Work, Flinders University, Sturt Road, Bedford Park, Adelaide, 5042, Australia, 61 8 8201 2621, dan.fassnacht@flinders.edu.au %K COVID-19 %K mental health %K well-being %K depression %K anxiety %K online %K digital %K intervention %K Be Well Plan %K health outcome %K online health %K digital health %K health intervention %K primary outcome %K cognition %K randomized control trial %K resilience %K participant satisfaction %K student %D 2022 %7 5.5.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: A growing literature supports the use of internet-based interventions to improve mental health outcomes. However, most programs target specific symptoms or participant groups and are not tailored to facilitate improvements in mental health and well-being or do not allow for needs and preferences of individual participants. The Be Well Plan, a 5-week group-facilitated, internet-based mental health and well-being group intervention addresses these gaps, allowing participants to select a range of activities that they can tailor to their specific characteristics, needs, and preferences. Objective: This study aims to test whether the Be Well Plan program was effective in improving primary outcomes of mental well-being, resilience, anxiety, and depression compared to a waitlist control group during the COVID-19 pandemic; secondary outcomes included self-efficacy, a sense of control, and cognitive flexibility. The study further seeks to examine participants’ engagement and satisfaction with the program. Methods: A randomized controlled trial (RCT) was conducted with 2 parallel arms, an intervention and a waitlist control group. The intervention involved 5 weekly 2-hour sessions, which were facilitated in group format using Zoom videoconferencing software. University students were recruited via social media posts, lectures, emails, flyers, and posters. Results: Using an intentional randomization 2:1 allocation strategy, we recruited 215 participants to the trial (n=126, 58.6%, intervention group; n=89, 41.4%, waitlist control group). Of the 126 participants assigned to the intervention group, 75 (59.5%) commenced the program and were included in modified intention-to-treat (mITT) analyses. mITT intervention participants attended, on average, 3.41 sessions (SD 1.56, median 4); 55 (73.3%) attended at least 4 sessions, and 25 (33.3%) attended all 5 sessions. Of the 49 intervention group participants who completed the postintervention assessment, 47 (95.9%) were either very satisfied (n=31, 66%) or satisfied (n=16, 34%). The mITT analysis for well-being (F1,162=9.65, P=.002, Cohen d=0.48) and resilience (F1,162=7.85, P=.006, Cohen d=0.44) showed significant time × group interaction effects, suggesting that both groups improved over time, but the Be Well Plan (intervention) group showed significantly greater improvement compared to the waitlist control group. A similar pattern of results was observed for depression and anxiety (Cohen d=0.32 and 0.37, respectively), as well as the secondary outcomes (self-efficacy, Cohen d=0.50; sense of control, Cohen d=0.42; cognitive flexibility, Cohen d=0.65). Larger effect sizes were observed in the completer analyses. Reliable change analysis showed that the majority of mITT participants (58/75, 77.3%) demonstrated a significant reliable improvement in at least 1 of the primary outcomes. Conclusions: The Be Well Plan program was effective in improving mental health and well-being, including mental well-being, resilience, depression, and anxiety. Participant satisfaction scores and attendance indicated a high degree of engagement and satisfaction with the program. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12621000180819; https://tinyurl.com/2p8da5sk %M 35471196 %R 10.2196/37292 %U https://mental.jmir.org/2022/5/e37292 %U https://doi.org/10.2196/37292 %U http://www.ncbi.nlm.nih.gov/pubmed/35471196 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e33714 %T Perceptions of In-home Monitoring Technology for Activities of Daily Living: Semistructured Interview Study With Community-Dwelling Older Adults %A Camp,Nicola %A Johnston,Julie %A Lewis,Martin G C %A Zecca,Massimiliano %A Di Nuovo,Alessandro %A Hunter,Kirsty %A Magistro,Daniele %+ School of Science and Technology, Nottingham Trent University, College Drive, Clifton, Nottingham, NG3 5FP, United Kingdom, 44 01159418418, nicola.camp@ntu.ac.uk %K aging %K wearable sensors %K environmental sensors %K social robots %K activities of daily living %K aging %K older adults %K elderly %K robots %K wearables %D 2022 %7 5.5.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Many older adults prefer to remain in their own homes for as long as possible. However, there are still questions surrounding how best to ensure that an individual can cope with autonomous living. Technological monitoring systems are an attractive solution; however, there is disagreement regarding activities of daily living (ADL) and the optimal technologies that should be used to monitor them. Objective: This study aimed to understand older adults’ perceptions of important ADL and the types of technologies they would be willing to use within their own homes. Methods: Semistructured interviews were conducted on the web with 32 UK adults, divided equally into a younger group (aged 55-69 years) and an older group (≥70 years). Results: Both groups agreed that ADL related to personal hygiene and feeding were the most important and highlighted the value of socializing. The older group considered several activities to be more important than their younger counterparts, including stair use and foot care. The older group had less existing knowledge of monitoring technology but was more willing to accept wearable sensors than the younger group. The younger group preferred sensors placed within the home but highlighted that they would not have them until they felt that daily life was becoming a struggle. Conclusions: Overall, technological monitoring systems were perceived as an acceptable method for monitoring ADL. However, developers and carers must be aware that individuals may express differences in their willingness to engage with certain types of technology depending on their age and circumstances. %M 35511248 %R 10.2196/33714 %U https://aging.jmir.org/2022/2/e33714 %U https://doi.org/10.2196/33714 %U http://www.ncbi.nlm.nih.gov/pubmed/35511248 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e30073 %T Delivering Mindfulness-Based Interventions for Insomnia, Pain, and Dysfunctional Eating Through a Text Messaging App: Three Randomized Controlled Trials Investigating the Effectiveness and Mediating Mechanisms %A Li,Amanda CM %A Wong,Keith KL %A Chio,Floria HN %A Mak,Winnie WS %A Poon,Loretta WH %+ Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, Hong Kong, 852 39436577, wwsmak@psy.cuhk.edu.hk %K text messaging %K mindfulness %K insomnia %K pain %K dysregulated eating %K mHealth %K mental health %K SMS %K distress %K intervention %K outcome %K mobile interventions %D 2022 %7 3.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Although text messaging has the potential to be the core intervention modality, it is often used as an adjunct only. To improve health and alleviate the distress related to insomnia, pain, and dysregulated eating of people living in urban areas, text messaging–based mindfulness-based interventions were designed and evaluated in 3 randomized controlled trials. Objective: This study investigated the effectiveness and mediating mechanisms of text messaging–based mindfulness-based interventions for people with distress related to insomnia, pain, or dysregulated eating. Methods: In these trials, 333, 235, and 351 participants were recruited online and randomized to intervention and wait-list control conditions for insomnia, pain, and dysregulated eating, respectively. Participants experienced 21 days of intervention through WhatsApp Messenger. Participants completed pre-, post-, 1-month follow-up, and 3-month follow-up self-report questionnaires online. The retention rates at postmeasurements were 83.2% (139/167), 77.1% (91/118), and 72.9% (129/177) for intervention groups of insomnia, pain, and dysregulated eating, respectively. Participants’ queries were answered by a study technician. Primary outcomes included insomnia severity, presleep arousal, pain intensity, pain acceptance, and eating behaviors. Secondary outcomes included mindfulness, depression, anxiety, mental well-being, and functional impairments. Mindfulness, dysfunctional beliefs and attitudes about sleep, pain catastrophizing, and reactivity to food cues were hypothesized to mediate the relationship between the intervention and outcomes. Results: For all 3 studies, the intervention groups showed significant improvement on most outcomes at 1-month follow-up compared to their respective wait-list control groups; some primary outcomes (eg, insomnia, pain, dysregulated eating indicators) and secondary outcomes (eg, depression, anxiety symptoms) were sustained at 3-month follow-up. Medium-to-large effect sizes were found at postassessments in most outcomes in all studies. In the intervention for insomnia, mediation analyses showed that dysfunctional beliefs and attitudes about sleep mediated the effect of the intervention on all primary outcomes and most secondary outcomes at both 1-month and 3-month follow-ups, whereas mindfulness mediated the intervention effect on presleep arousal at 1-month and 3-month follow-ups. In the intervention for pain, pain catastrophizing mediated the effect of intervention on pain intensity and functioning at both 1-month and 3-month follow-ups, whereas mindfulness only mediated the effect of intervention on anxiety and depressive symptoms. In the intervention for dysregulated eating, power of food mediated the effect of intervention on both uncontrolled and emotional eating at both 1-month and 3-month follow-ups and mindfulness was found to mediate the effect on depressive symptoms at both 1-month and 3-month follow-ups. Conclusions: These 3 studies converged and provided empirical evidence that mindfulness-based interventions delivered through text messaging are effective in improving distress related to sleep, pain, and dysregulated eating. Text messaging has the potential to be a core intervention modality to improve various common health outcomes for people living a fast-paced lifestyle. Trial Registration: Clinical Research and Biostatistics Clinical Trials Registry CUHK_CCRB00559; https://tinyurl.com/24rkwarz %M 35503653 %R 10.2196/30073 %U https://www.jmir.org/2022/5/e30073 %U https://doi.org/10.2196/30073 %U http://www.ncbi.nlm.nih.gov/pubmed/35503653 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e37348 %T Effectiveness of an 8-Week Physical Activity Intervention Involving Wearable Activity Trackers and an eHealth App: Mixed Methods Study %A McCormack,Gavin R %A Petersen,Jennie %A Ghoneim,Dalia %A Blackstaffe,Anita %A Naish,Calli %A Doyle-Baker,Patricia K %+ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive, Calgary, AB, T2N 4Z6, Canada, 1 403 220 8193, gmccorma@ucalgary.ca %K activity tracker %K technology %K eHealth %K physical activity %K intervention %K exercise %K mHealth %K fitness %K wearable %K sensor %K digital health %K COVID-19 %K health promotion %K mixed methods study %K wearable technology %D 2022 %7 3.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Health-promotion interventions incorporating wearable technology or eHealth apps can encourage participants to self-monitor and modify their physical activity and sedentary behavior. In 2020, a Calgary (Alberta, Canada) recreational facility developed and implemented a health-promotion intervention (Vivo Play Scientist program) that provided a commercially available wearable activity tracker and a customized eHealth dashboard to participants free of cost. Objective: The aim of this study was to independently evaluate the effectiveness of the Vivo Play Scientist program for modifying physical activity and sedentary behavior during the initial 8 weeks of the piloted intervention. Methods: Our concurrent mixed methods study included a single-arm repeated-measures quasiexperiment and semistructured interviews. Among the 318 eligible participants (≥18 years of age) registered for the program, 87 completed three self-administered online surveys (baseline, T0; 4 weeks, T1; and 8 weeks, T2). The survey captured physical activity, sedentary behavior, use of wearable technology and eHealth apps, and sociodemographic characteristics. Twenty-three participants were recruited using maximal-variation sampling and completed telephone-administered semistructured interviews regarding their program experiences. Self-reported physical activity and sedentary behavior outcomes were statistically compared among the three time points using Friedman tests. Thematic analysis was used to analyze the interview data. Results: The mean age of participants was 39.8 (SD 7.4) years and 75% (65/87) were women. Approximately half of all participants had previously used wearable technology (40/87, 46%) or an eHealth app (43/87, 49%) prior to the intervention. On average, participants reported wearing the activity tracker (Garmin Vivofit4) for 6.4 (SD 1.7) days in the past week at T1 and for 6.0 (SD 2.2) days in the past week at T2. On average, participants reported using the dashboard for 1.6 (SD 2.1) days in the past week at T1 and for 1.0 (SD 1.8) day in the past week at T2. The mean time spent walking at 8 weeks was significantly higher compared with that at baseline (T0 180.34 vs T2 253.79 minutes/week, P=.005), with no significant differences for other physical activity outcomes. Compared to that at baseline, the mean time spent sitting was significantly lower at 4 weeks (T0 334.26 vs T1 260.46 minutes/day, P<.001) and 8 weeks (T0 334.26 vs T2 267.13 minutes/day, P<.001). Significant differences in physical activity and sitting between time points were found among subgroups based on the household composition, history of wearable technology use, and history of eHealth app use. Participants described how wearing the Vivofit4 device was beneficial in helping them to modify physical activity and sedentary behavior. The social support, as a result of multiple members of the same household participating in the program, motivated changes in physical activity. Participants experienced improvements in their mental, physical, and social health. Conclusions: Providing individuals with free-of-cost commercially available wearable technology and an eHealth app has the potential to support increases in physical activity and reduce sedentary behavior in the short term, even under COVID-19 public health restrictions. %M 35404832 %R 10.2196/37348 %U https://formative.jmir.org/2022/5/e37348 %U https://doi.org/10.2196/37348 %U http://www.ncbi.nlm.nih.gov/pubmed/35404832 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e35699 %T Characterizing User Experiences With an SMS Text Messaging–Based mHealth Intervention: Mixed Methods Study %A King,Sayde Leya %A Lebert,Jana %A Karpisek,Lacey Anne %A Phillips,Amelia %A Neal,Tempestt %A Kosyluk,Kristin %+ Department of Computer Science and Engineering, College of Engineering, University of South Florida, 4202 East Fowler Avenue, Tampa, FL, 33620, United States, 1 813 396 9353, saydeking@usf.edu %K text messaging %K SMS %K mobile health %K mHealth %K stigma %K user perceptions %K ubiquitous sensing %K low-intensity intervention %K coping %K mental health %K cognitive restructuring %K mobile phone %D 2022 %7 3.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Limited access to mental health care services due to provider shortages, geographic limitations, and cost has driven the area of mobile health (mHealth) care to address these access gaps. Reports from the Cohen Veterans Network and National Council for Behavioral Health show that in states where mental health care is more accessible, 38% of people still do not receive the care they need. mHealth strategies help to provide care to individuals experiencing these barriers at lower cost and greater convenience, making mHealth a great resource to bridge the gaps. Objective: We present a mixed methods study to evaluate user experiences with the mental mHealth service, Cope Notes. Specifically, we aimed to investigate the following research questions: How do users perceive the service in relation to stigma, impact of the intervention, and perceived usefulness? How do users rate the Cope Notes service and SMS text messaging along various dimensions of acceptability? What is the relationship between Cope Notes SMS text message ratings, user personality, and coping strategies? What are user perspectives of leveraging ubiquitous sensing technologies to improve delivery and provide tailored content? Methods: We performed qualitative interviews with Cope Notes users (N=14) who have used the service for at least 30 days to evaluate their experiences and usefulness of the service. These interviews were coded by 2 raters (SLK and JL), and the interrater reliability was calculated with SPSS (IBM Corp) at 61.8%. In addition, participants completed quantitative measures, including a user experiences survey, personality inventory (Big Five Inventory-10), and coping assessment (Brief Coping Orientation to Problems Experienced). Results: We derived 7 themes from our qualitative interviews: Likes or Perceived Benefits, Dislikes or Limitations, Suggested Changes, Stigma or Help Seeking, Perceptions of Ubiquitous Sensing, Cultural Sensitivity, and Alternative mHealth Resources. Exploratory analyses between acceptability ratings of Cope Notes and personality factors showed statistically significant positive relationships between seeing oneself as someone who is generally trusting and acceptability items, the most significant being item 7 (I fully understood the sentiment behind Cope Notes Messages) with (rs(10)=0.82, P=.001). We also found statistically significant relationships between acceptability and Brief Coping Orientation to Problems Experienced items, with the strongest positive correlation between participants strongly endorsing coping by accepting the reality that an event has happened and acceptability item 7 (rs(8)=0.86, P=.001). Conclusions: Our study found that Cope Notes subscribers appreciate the service for reframing their mental wellness with statistically significant correlations between personality and acceptability of the service. We found that some users prefer a more personalized experience with neutral to positive reactions to a potential companion app that continuously monitors user behavior via smartphone sensors to provide just-in-time interventions when users need it most. %M 35503524 %R 10.2196/35699 %U https://formative.jmir.org/2022/5/e35699 %U https://doi.org/10.2196/35699 %U http://www.ncbi.nlm.nih.gov/pubmed/35503524 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 5 %P e30517 %T Lifelog Retrieval From Daily Digital Data: Narrative Review %A Ribeiro,Ricardo %A Trifan,Alina %A Neves,António J R %+ Institute of Electronics and Informatics Engineering of Aveiro, University of Aveiro, Campus Universitário de Santiago, Aveiro, 3810-193, Portugal, 351 234370500, rfribeiro@ua.pt %K lifelog %K lifelogging %K information retrieval %K image retrieval %K computer vision %K signal processing %K event segmentation %K mobile phone %D 2022 %7 2.5.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Over the past decade, the wide availability and small size of different types of sensors, together with the decrease in pricing, have allowed the acquisition of a substantial amount of data about a person’s life in real time. These sensors can be incorporated into personal electronic devices available at a reasonable cost, such as smartphones and small wearable devices. They allow the acquisition of images, audio, location, physical activity, and physiological signals among other data. With these data, usually denoted as lifelog data, we can then analyze and understand personal experiences and behaviors. This process is called lifelogging. Objective: The objective of this paper was to present a narrative review of the existing literature about lifelogging over the past decade. To achieve this goal, we analyzed lifelogging applications used to retrieve relevant information from daily digital data, some of them with the purpose of monitoring and assisting people with memory issues and others designed for memory augmentation. We aimed for this review to be used by researchers to obtain a broad idea of the type of data used, methodologies, and applications available in this research field. Methods: We followed a narrative review methodology to conduct a comprehensive search for relevant publications in Google Scholar and Scopus databases using lifelog topic–related keywords. A total of 411 publications were retrieved and screened. Of these 411 publications, 114 (27.7%) publications were fully reviewed. In addition, 30 publications were manually included based on our bibliographical knowledge of this research field. Results: From the 144 reviewed publications, a total of 113 (78.5%) were selected and included in this narrative review based on content analysis. The findings of this narrative review suggest that lifelogs are prone to become powerful tools to retrieve memories or increase knowledge about an individual’s experiences or behaviors. Several computational tools are already available for a considerable range of applications. These tools use multimodal data of different natures, with visual lifelogs being one of the most used and rich sources of information. Different approaches and algorithms to process these data are currently in use, as this review will unravel. Moreover, we identified several open questions and possible lines of investigation in lifelogging. Conclusions: The use of personal lifelogs can be beneficial to improve the quality of our life, as they can serve as tools for memory augmentation or for providing support to people with memory issues. Through the acquisition and analysis of lifelog data, lifelogging systems can create digital memories that can be potentially used as surrogate memory. Through this narrative review, we understand that contextual information can be extracted from lifelogs, which provides an understanding of the daily life of a person based on events, experiences, and behaviors. %M 35499858 %R 10.2196/30517 %U https://mhealth.jmir.org/2022/5/e30517 %U https://doi.org/10.2196/30517 %U http://www.ncbi.nlm.nih.gov/pubmed/35499858 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e36541 %T Development of a Mobile Assessment Tool for Understanding Social Comparison Processes Among Individuals With Schizophrenia: Two-Phase Survey Study %A Arigo,Danielle %A Torous,John %+ Department of Psychology, Rowan University, 201 Mullica Hill Road, Robinson 116G, Glassboro, NJ, 08028, United States, 1 8562564500 ext 53775, arigo@rowan.edu %K schizophrenia %K social comparison %K mobile assessment %K smartphone app %K variability %D 2022 %7 2.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital tools may help to address social deficits in schizophrenia, particularly those that engage social comparison processes (ie, evaluating oneself relative to others). Yet, little is known about social comparison processes in schizophrenia or how best to capture between- versus within-person variability, which is critical to engaging comparisons in digital interventions. Objective: The goals of this pilot study were to (1) better understand affective responses to social comparisons among individuals with schizophrenia, relative to healthy controls, using a validated global self-report measure; and (2) test a new brief, mobile assessment of affective responses to social comparison among individuals with schizophrenia, relative to the full measure. This study was conducted in 2 phases. Methods: We first compared self-reported affective responses to social comparisons between individuals with schizophrenia (n=39) and healthy controls (n=38) using a traditional self-report measure, at 2 time points. We examined the temporal stability in responses and differences between groups. We then evaluated the performance of brief, mobile assessment of comparison responses among individuals with schizophrenia, completed over 12 weeks (n=31). Results: Individuals with schizophrenia showed greater variability in affective responses to social comparison than controls on traditional measures and completed an average of 7.46 mobile assessments over 12 weeks. Mobile assessments captured within-person variability in affective responses in the natural environment (intraclass correlation coefficients of 0.40-0.60). Average scores for mobile assessments were positively correlated with responses to traditional measures. Conclusions: Affective responses to social comparison vary both between and within individuals with schizophrenia and capturing this variability via smartphone surveys shows some evidence of feasibility. As affective variability is a potential indicator of poor outcomes among individuals with mental health conditions, in the future, a brief, mobile assessment of affective responses to social comparisons may be useful for screening among individuals with schizophrenia. Further research on this process is needed to identify when specific comparison messaging may be most effective in digital interventions and could suggest new therapeutic targets for illnesses such as schizophrenia. %M 35499856 %R 10.2196/36541 %U https://formative.jmir.org/2022/5/e36541 %U https://doi.org/10.2196/36541 %U http://www.ncbi.nlm.nih.gov/pubmed/35499856 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e33656 %T Agreement Between Self-reports and Photos to Assess e-Cigarette Device and Liquid Characteristics in Wave 1 of the Vaping and Patterns of e-Cigarette Use Research Study: Web-Based Longitudinal Cohort Study %A Crespi,Elizabeth %A Hardesty,Jeffrey J %A Nian,Qinghua %A Sinamo,Joshua %A Welding,Kevin %A Kennedy,Ryan David %A Cohen,Joanna E %+ Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, Baltimore, MD, 21205, United States, 1 410 614 5378, ecrespi2@jhu.edu %K tobacco %K e-cigarette %K methodology %K internet %K photo %K survey %K self-report %D 2022 %7 27.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: e-Cigarette device and liquid characteristics are highly customizable; these characteristics impact nicotine delivery and exposure to toxic constituents. It is critical to understand optimal methods for measuring these characteristics to accurately assess their impacts on user behavior and health. Objective: To inform future survey development, we assessed the agreement between responses from survey participants (self-reports) and photos uploaded by participants and the quantity of usable data derived from each approach. Methods: Adult regular e-cigarette users (≥5 days per week) aged ≥21 years (N=1209) were asked questions about and submitted photos of their most used e-cigarette device (1209/1209, 100%) and liquid (1132/1209, 93.63%). Device variables assessed included brand, model, reusability, refillability, display, and adjustable power. Liquid variables included brand, flavor, nicotine concentration, nicotine formulation, and bottle size. For each variable, percentage agreement was calculated where self-report and photo data were available. Krippendorff α and intraclass correlation coefficient (ICC) were calculated for categorical and continuous variables, respectively. Results were stratified by device (disposable, reusable with disposable pods or cartridges, and reusable with refillable pods, cartridges, or tanks) and liquid (customized and noncustomized) type. The sample size for each calculation ranged from 3.89% (47/1209; model of disposable devices) to 95.12% (1150/1209; device reusability). Results: Percentage agreement between photos and self-reports was substantial to very high across device and liquid types for all variables except nicotine concentration. These results are consistent with Krippendorff α calculations, except where prevalence bias was suspected. ICC results for nicotine concentration and bottle size were lower than percentage agreement, likely because ICC accounts for the level of disagreement between values. Agreement varied by device and liquid type. For example, percentage agreement for device brand was higher among users of reusable devices (94%) than among users of disposable devices (75%). Low percentage agreement may result from poor participant knowledge of characteristics, user modifications of devices inconsistent with manufacturer-intended use, inaccurate or incomplete information on websites, or photo submissions that are not a participant’s most used device or liquid. The number of excluded values (eg, self-report was “don’t know” or no photo submitted) differed between self-reports and photos; for questions asked to participants, self-reports had more usable data than photos for all variables except device model and nicotine formulation. Conclusions: Photos and self-reports yield data of similar accuracy for most variables assessed in this study: device brand, device model, reusability, adjustable power, display, refillability, liquid brand, flavor, and bottle size. Self-reports provided more data for all variables except device model and nicotine formulation. Using these approaches simultaneously may optimize data quantity and quality. Future research should examine how to assess nicotine concentration and variables not included in this study (eg, wattage and resistance) and the resource requirements of these approaches. %M 35475727 %R 10.2196/33656 %U https://www.jmir.org/2022/4/e33656 %U https://doi.org/10.2196/33656 %U http://www.ncbi.nlm.nih.gov/pubmed/35475727 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 4 %P e30089 %T Exploring Wearables to Focus on the “Sweet Spot” of Physical Activity and Sleep After Hospitalization: Secondary Analysis %A Greysen,S Ryan %A Waddell,Kimberly J %A Patel,Mitesh S %+ Section of Hospital Medicine, University of Pennsylvania, 3400 Spruce Street, Maloney Suite 5040, Philadelphia, PA, 19104, United States, 1 202 664 6084, ryan.greysen@pennmedicine.upenn.edu %K sleep %K physical activity %K hospitalization %K wearables %K health care %K digital health %K patient reported outcomes %K hospital %D 2022 %7 27.4.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Inadequate sleep and physical activity are common during and after hospitalization, but their impact on patient-reported functional outcomes after discharge is poorly understood. Wearable devices that measure sleep and activity can provide patient-generated data to explore ideal levels of sleep and activity to promote recovery after hospital discharge. Objective: This study aimed to examine the relationship between daily sleep and physical activity with 6 patient-reported functional outcomes (symptom burden, sleep quality, physical health, life space mobility, activities of daily living, and instrumental activities of daily living) at 13 weeks after hospital discharge. Methods: This secondary analysis sought to examine the relationship between daily sleep, physical activity, and patient-reported outcomes at 13 weeks after hospital discharge. We utilized wearable sleep and activity trackers (Withings Activité wristwatch) to collect data on sleep and activity. We performed descriptive analysis of device-recorded sleep (minutes/night) with patient-reported sleep and device-recorded activity (steps/day) for the entire sample with full data to explore trends. Based on these trends, we performed additional analyses for a subgroup of patients who slept 7-9 hours/night on average. Differences in patient-reported functional outcomes at 13 weeks following hospital discharge were examined using a multivariate linear regression model for this subgroup. Results: For the full sample of 120 participants, we observed a “T-shaped” distribution between device-reported physical activity (steps/day) and sleep (patient-reported quality or device-recorded minutes/night) with lowest physical activity among those who slept <7 or >9 hours/night. We also performed a subgroup analysis (n=60) of participants that averaged the recommended 7-9 hours of sleep/night over the 13-week study period. Our key finding was that participants who had both adequate sleep (7-9 hours/night) and activity (>5000 steps/day) had better functional outcomes at 13 weeks after hospital discharge. Participants with adequate sleep but less activity (<5000 steps/day) had significantly worse symptom burden (z-score 0.93, 95% CI 0.3 to 1.5; P=.02), community mobility (z-score –0.77, 95% CI –1.3 to –0.15; P=.02), and perceived physical health (z-score –0.73, 95% CI –1.3 to –0.13; P=.003), compared with those who were more physically active (≥5000 steps/day). Conclusions: Participants within the “sweet spot” that balances recommended sleep (7-9 hours/night) and physical activity (>5000 steps/day) reported better functional outcomes after 13 weeks compared with participants outside the “sweet spot.” Wearable sleep and activity trackers may provide opportunities to hone postdischarge monitoring and target a “sweet spot” of recommended levels for both sleep and activity needed for optimal recovery. Trial Registration: ClinicalTrials.gov NCT03321279; https://clinicaltrials.gov/ct2/show/NCT03321279 %M 35476034 %R 10.2196/30089 %U https://mhealth.jmir.org/2022/4/e30089 %U https://doi.org/10.2196/30089 %U http://www.ncbi.nlm.nih.gov/pubmed/35476034 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35671 %T Understanding People With Chronic Pain Who Use a Cognitive Behavioral Therapy–Based Artificial Intelligence Mental Health App (Wysa): Mixed Methods Retrospective Observational Study %A Meheli,Saha %A Sinha,Chaitali %A Kadaba,Madhura %+ Wysa Inc, 131 Dartmouth St, Boston, MA, United States, 1 916 753 7824, chaitali@wysa.io %K chronic pain %K digital mental health %K mobile health %K mHealth %K pain management %K artificial intelligence %K cognitive behavioral therapy %K conversational agent %K software agent %K pain conditions %K depression %K anxiety %D 2022 %7 27.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital health interventions can bridge barriers in access to treatment among individuals with chronic pain. Objective: This study aimed to evaluate the perceived needs, engagement, and effectiveness of the mental health app Wysa with regard to mental health outcomes among real-world users who reported chronic pain and engaged with the app for support. Methods: Real-world data from users (N=2194) who reported chronic pain and associated health conditions in their conversations with the mental health app were examined using a mixed methods retrospective observational study. An inductive thematic analysis was used to analyze the conversational data of users with chronic pain to assess perceived needs, along with comparative macro-analyses of conversational flows to capture engagement within the app. Additionally, the scores from a subset of users who completed a set of pre-post assessment questionnaires, namely Patient Health Questionnaire-9 (PHQ-9) (n=69) and Generalized Anxiety Disorder Assessment-7 (GAD-7) (n=57), were examined to evaluate the effectiveness of Wysa in providing support for mental health concerns among those managing chronic pain. Results: The themes emerging from the conversations of users with chronic pain included health concerns, socioeconomic concerns, and pain management concerns. Findings from the quantitative analysis indicated that users with chronic pain showed significantly greater app engagement (P<.001) than users without chronic pain, with a large effect size (Vargha and Delaney A=0.76-0.80). Furthermore, users with pre-post assessments during the study period were found to have significant improvements in group means for both PHQ-9 and GAD-7 symptom scores, with a medium effect size (Cohen d=0.60-0.61). Conclusions: The findings indicate that users look for tools that can help them address their concerns related to mental health, pain management, and sleep issues. The study findings also indicate the breadth of the needs of users with chronic pain and the lack of support structures, and suggest that Wysa can provide effective support to bridge the gap. %M 35314422 %R 10.2196/35671 %U https://humanfactors.jmir.org/2022/2/e35671 %U https://doi.org/10.2196/35671 %U http://www.ncbi.nlm.nih.gov/pubmed/35314422 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e32348 %T Relations Between BMI Trajectories and Habitual Physical Activity Measured by a Smartwatch in the Electronic Cohort of the Framingham Heart Study: Cohort Study %A Hammond,Michael M %A Zhang,Yuankai %A Pathiravasan,Chathurangi H. %A Lin,Honghuang %A Sardana,Mayank %A Trinquart,Ludovic %A Benjamin,Emelia J %A Borrelli,Belinda %A Manders,Emily S %A Fusco,Kelsey %A Kornej,Jelena %A Spartano,Nicole L %A Kheterpal,Vik %A Nowak,Christopher %A McManus,David D %A Liu,Chunyu %A Murabito,Joanne M %+ Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 715 Albany St., Boston, MA, 02118, United States, 1 508 935 3461, murabito@bu.edu %K mobile health %K BMI %K smartwatch %K physical activity %K cardiovascular diseases %K cardiology %K digital health %K mHealth %K mobile health apps %D 2022 %7 27.4.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: The prevalence of obesity is rising. Most previous studies that examined the relations between BMI and physical activity (PA) measured BMI at a single timepoint. The association between BMI trajectories and habitual PA remains unclear. Objective: This study assesses the relations between BMI trajectories and habitual step-based PA among participants enrolled in the electronic cohort of the Framingham Heart Study (eFHS). Methods: We used a semiparametric group-based modeling to identify BMI trajectories from eFHS participants who attended research examinations at the Framingham Research Center over 14 years. Daily steps were recorded from the smartwatch provided at examination 3. We excluded participants with <30 days or <5 hours of smartwatch wear data. We used generalized linear models to examine the association between BMI trajectories and daily step counts. Results: We identified 3 trajectory groups for the 837 eFHS participants (mean age 53 years; 57.8% [484/837] female). Group 1 included 292 participants whose BMI was stable (slope 0.005; P=.75), group 2 included 468 participants whose BMI increased slightly (slope 0.123; P<.001), and group 3 included 77 participants whose BMI increased greatly (slope 0.318; P<.001). The median follow-up period for step count was 516 days. Adjusting for age, sex, wear time, and cohort, participants in groups 2 and 3 took 422 (95% CI –823 to –21) and 1437 (95% CI –2084 to –790) fewer average daily steps, compared with participants in group 1. After adjusting for metabolic and social risk factors, group 2 took 382 (95% CI –773 to 10) and group 3 took 1120 (95% CI –1766 to –475) fewer steps, compared with group 1. Conclusions: In this community-based eFHS, participants whose BMI trajectory increased greatly over time took significantly fewer steps, compared with participants with stable BMI trajectories. Our findings suggest that greater weight gain may correlate with lower levels of step-based physical activity. %M 35476038 %R 10.2196/32348 %U https://cardio.jmir.org/2022/1/e32348 %U https://doi.org/10.2196/32348 %U http://www.ncbi.nlm.nih.gov/pubmed/35476038 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e34654 %T Live Video Mind-Body Program for Patients With Knee Osteoarthritis, Comorbid Depression, and Obesity: Development and Feasibility Pilot Study %A Mace,Ryan A %A Greenberg,Jonathan %A Lemaster,Nicole %A Duarte,Brooke %A Penn,Terence %A Kanaya,Millan %A Doorley,James D %A Burris,Jessica L %A Jacobs,Cale A %A Vranceanu,Ana-Maria %+ Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, 740 S Limestone, Suite K401, Lexington, KY, 40536-0284, United States, 1 (859) 797 8197, cale.jacobs@uky.edu %K knee osteoarthritis %K depression %K obesity %K mind-body %K physical activity %K mixed-methods %K mobile phone %D 2022 %7 27.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Knee osteoarthritis (KOA) is the most common joint disorder in the United States and a leading cause of disability. Depression and obesity are highly comorbid with KOA and accelerate knee degeneration and disability through biopsychosocial mechanisms. Mind-body physical activity programs can engage biological, mechanical, and psychological mechanisms to improve outcomes in KOA, but such programs are not currently available. Objective: This mixed methods study aims to adapt a mind-body activity program for the unique needs of patients with KOA, depression, and obesity (GetActive-OA) delivered via live video. Methods: Participants were adults (aged ≥45 years) from rural Kentucky with obesity (BMI≥30 kg/m2), idiopathic KOA with mild to moderate radiographic changes, and elevated depressive symptoms (9-item Patient Health Questionnaire ≥10) recruited from 2 orthopedic centers. In phase 1, we developed GetActive-OA and the study protocol using qualitative focus group feedback from the study population (N=9; 2 focus groups, 90 minutes) and multidisciplinary expertise from clinical psychologists and orthopedic researchers. In phase 2, we explored the initial feasibility, credibility, and acceptability of GetActive-OA, live video delivery, and study procedures via an open pilot with exit interviews (N=5; 1 group). This research was guided by National Institutes of Health (NIH) model stage IA. Results: Phase 1 qualitative analyses revealed nuanced information about challenges with coping and increasing activity, high interest in a mind-body activity program, program participation facilitators (flexibility with technology) and barriers (amotivation and forgetfulness), and perceived challenges with data collection procedures (blood and urine samples and homework). Phase 2 quantitative analyses showed that GetActive-OA met most a priori feasibility markers: acceptability (80%), expectancy (100%), credibility (100%), clinician adherence (90%), homework adherence (80%), questionnaire data collection (100%), program satisfaction (100%), and safety (100%). Adherence to ActiGraph wear (80% baseline, 20% posttest) and collection of blood samples (60%) were low. Participation in GetActive-OA was associated with signals of improvements in general coping (Cohen d=2.41), pain catastrophizing (Cohen d=1.24), depression (Cohen d=0.88), anxiety (Cohen d=0.78), self-efficacy (Cohen d=0.73), pain (Cohen d=0.39), and KOA symptoms (Cohen d=0.36). Qualitative exit interviews confirmed quantitative findings and provided valuable information to optimize the program and protocol. Conclusions: Patients with KOA, depression, and obesity from rural Kentucky were interested in a live video mind-body activity program. GetActive-OA shows promise; however, the program and protocol require further NIH stage I refinement before formal efficacy testing (NIH model stage II). International Registered Report Identifier (IRRID): RR2-10.1016/j.conctc.2021.100720 %M 35475787 %R 10.2196/34654 %U https://formative.jmir.org/2022/4/e34654 %U https://doi.org/10.2196/34654 %U http://www.ncbi.nlm.nih.gov/pubmed/35475787 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e32146 %T Detecting Mental Health Behaviors Using Mobile Interactions: Exploratory Study Focusing on Binge Eating %A Vega,Julio %A Bell,Beth T %A Taylor,Caitlin %A Xie,Jue %A Ng,Heidi %A Honary,Mahsa %A McNaney,Roisin %+ Department of Human Centred Computing, Monash University, Wellington Rd, Clayton, VIC 3800, Australia, 61 3 9902 6000, roisin.mcnaney@monash.edu %K eating disorder %K binge eating %K mental health %K mobile sensing %K context-aware computing %K NAP %K EMA %K mobile phone %D 2022 %7 25.4.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Binge eating is a subjective loss of control while eating, which leads to the consumption of large amounts of food. It can cause significant emotional distress and is often accompanied by purging behaviors (eg, meal skipping, overexercising, or vomiting). Objective: The aim of this study was to explore the potential of mobile sensing to detect indicators of binge-eating episodes, with a view toward informing the design of future context-aware mobile interventions. Methods: This study was conducted in 2 stages. The first involved the development of the DeMMI (Detecting Mental health behaviors using Mobile Interactions) app. As part of this, we conducted a consultation session to explore whether the types of sensor data we were proposing to capture were useful and appropriate, as well as to gather feedback on some specific app features relating to self-reporting. The second stage involved conducting a 6-week period of data collection with 10 participants experiencing binge eating (logging both their mood and episodes of binge eating) and 10 comparison participants (logging only mood). An optional interview was conducted after the study, which discussed their experience using the app, and 8 participants (n=3, 38% binge eating and n=5, 63% comparisons) consented. Results: The findings showed unique differences in the types of sensor data that were triangulated with the individuals’ episodes (with nearby Bluetooth devices, screen and app use features, mobility features, and mood scores showing relevance). Participants had a largely positive opinion about the app, its unobtrusive role, and its ease of use. Interacting with the app increased participants’ awareness of and reflection on their mood and phone usage patterns. Moreover, they expressed no privacy concerns as these were alleviated by the study information sheet. Conclusions: This study contributes a series of recommendations for future studies wishing to scale our approach and for the design of bespoke mobile interventions to support this population. %M 35086064 %R 10.2196/32146 %U https://mental.jmir.org/2022/4/e32146 %U https://doi.org/10.2196/32146 %U http://www.ncbi.nlm.nih.gov/pubmed/35086064 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e30680 %T An E–Mental Health Solution to Prevent and Manage Posttraumatic Stress Injuries Among First Responders in Alberta: Protocol for the Implementation and Evaluation of Text Messaging Services (Text4PTSI and Text4Wellbeing) %A Obuobi-Donkor,Gloria %A Eboreime,Ejemai %A Bond,Jennifer %A Phung,Natalie %A Eyben,Scarlett %A Hayward,Jake %A Zhang,Yanbo %A MacMaster,Frank %A Clelland,Steven %A Greiner,Russell %A Jones,Chelsea %A Cao,Bo %A Brémault-Phillips,Suzette %A Wells,Kristopher %A Li,Xin-Min %A Hilario,Carla %A Greenshaw,Andrew J %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor Abbie J Lane Memorial Building QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 7802157771, vn602367@dal.ca %K posttraumatic stress injury %K first responders %K messaging %K mobile phone %K text-based intervention %K Text4PTSI %K Text4Wellbeing %D 2022 %7 25.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: First responders are confronted with traumatic events in their work that has a substantial toll on their psychological health and may contribute to or result in posttraumatic stress injuries (PTSIs) for many responders. Persons with a PTSI usually seek management therapies. Evidence indicates that digital delivery of these therapies is an innovative, efficient, and effective way to improve PTSI symptoms as an adjunct to in-person delivery. Objective: This project aims to implement and provide accessible, convenient, and economical SMS text messaging services, known as Text4PTSI and Text4Wellbeing, to first responders in Alberta, Canada; to prevent and improve the symptoms of PTSI among first responders; and to improve their overall quality of life. We will evaluate posttraumatic symptoms and the impact of Text4PTSI and Text4Wellbeing on stress, anxiety, and depression in relation to the correspondents’ demographic backgrounds. Methods: First responders who subscribe to Text4PTSI or Text4Wellbeing receive daily supportive and psychoeducational SMS text messages for 6 months. The SMS text messages are preprogrammed into an online software program that delivers messages to subscribers. Baseline and follow-up data are collected through online questionnaires using validated scales at enrollment, 6 weeks, 12 weeks, and 24 weeks (end point). In-depth interviews will be conducted to assess satisfaction with the text-based intervention. Results: We hypothesize that participants who enroll in this program will have improved PTSI symptoms; increased or improved quality of life; and significant reduction in associated stress, depression, and anxiety symptoms, among other psychological concerns. Improvement will be determined in comparison to established baseline parameters. Conclusions: This research will be beneficial for practitioners and will inform policy-making and decision-making regarding psychological interventions for PTSI. Lessons from this study will inform the scale-up of the intervention, a cost-effective, zero contact therapeutic option to manage PTSI. International Registered Report Identifier (IRRID): PRR1-10.2196/30680 %M 35468094 %R 10.2196/30680 %U https://www.researchprotocols.org/2022/4/e30680 %U https://doi.org/10.2196/30680 %U http://www.ncbi.nlm.nih.gov/pubmed/35468094 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e36702 %T Acceptance of an Internet-Based Team Development Tool Aimed at Improving Work-Related Well-being in Nurses: Cross-sectional Study %A Broetje,Sylvia %A Bauer,Georg F %A Jenny,Gregor J %+ Center of Salutogenesis, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, 8001, Switzerland, 41 446344854, sylvia.libro@gmail.com %K digital intervention %K eHealth %K nurses %K online intervention %K organizational health %K technology acceptance %K UTAUT %K workplace health promotion %K mHealth %D 2022 %7 22.4.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: Workplace health interventions can produce beneficial health- and business-related outcomes. However, such interventions have traditionally focused on lifestyle behaviors of individuals, mostly not considering the role of working conditions. The wecoach intervention is an internet-based tool that combines both a digital and a participatory team development approach aimed at addressing critical job demands and resources as key aspects of health-promoting working conditions. Nursing staff are particularly affected by challenging working conditions and could potentially benefit greatly. Understanding the acceptance of novel workplace health promotion approaches is a critical precursor to their successful implementation and use. Objective: This study aims to examine the factors influencing the acceptance of a digitally supported team development tool among nurse managers. Methods: A sample of 32 nurse managers from 3 German-speaking countries tested wecoach and completed our online questionnaire. Hypotheses were based on the unified theory of acceptance and use of technology (UTAUT) and the organizational health development (OHD) model and were tested using multiple regression analyses. Results: Our analyses found that merely capacities on the team level (CapTeam) significantly contributed to the acceptance of wecoach, although only after the other variables were excluded in the stepwise multiple regression analysis. The UTAUT predictors were unable to add significant variance explanation beyond that, and their inclusion masked the contribution of CapTeam. Conclusions: For the acceptance of a digitally supported participatory tool, the fit with the team, its culture, and its motivation are of critical importance, while aspects proposed by traditional acceptance models, such as the UTAUT, may not be applicable. %M 35452403 %R 10.2196/36702 %U https://nursing.jmir.org/2022/1/e36702 %U https://doi.org/10.2196/36702 %U http://www.ncbi.nlm.nih.gov/pubmed/35452403 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 4 %P e25561 %T A Mobile Phone App to Support Adherence to Daily HIV Pre-exposure Prophylaxis Engagement Among Young Men Who Have Sex With Men and Transgender Women Aged 15 to 19 Years in Thailand: Pilot Randomized Controlled Trial %A Kawichai,Surinda %A Songtaweesin,Wipaporn Natalie %A Wongharn,Prissana %A Phanuphak,Nittaya %A Cressey,Tim R %A Moonwong,Juthamanee %A Vasinonta,Anuchit %A Saisaengjan,Chutima %A Chinbunchorn,Tanat %A Puthanakit,Thanyawee %+ Center of Excellence in Transgender Health, Chulalongkorn University, King Chulalongkorn Memorial Hospital, 1873 Rama 4 Rd, Patumwan, Bangkok, 10330, Thailand, 66 22564930, wipaporn.n@chula.ac.th %K mHealth %K PrEP adherence %K adolescents %K men who have sex with men %K transgender women %K mobile phone %D 2022 %7 21.4.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Widespread smartphone use provides opportunities for mobile health HIV prevention strategies among at-risk populations. Objective: This study aims to investigate engagement in a theory-based (information–motivation–behavioral skills model) mobile phone app developed to support HIV pre-exposure prophylaxis (PrEP) adherence among Thai young men who have sex with men (YMSM) and young transgender women (YTGW) in Bangkok, Thailand. Methods: A randomized controlled trial was conducted among HIV-negative YMSM and YTGW aged 15-19 years initiating daily oral PrEP. Participants were randomized to receive either youth-friendly PrEP services (YFS) for 6 months, including monthly contact with site staff (clinic visits or telephone follow-up) and staff consultation access, or YFS plus use of a PrEP adherence support app (YFS+APP). The target population focus group discussion findings and the information–motivation–behavioral skills model informed app development. App features were based on the 3Rs—risk assessment of self-HIV acquisition risk, reminders to take PrEP, and rewards as redeemable points. Dried blood spots quantifying of tenofovir diphosphate were collected at months 3 and 6 to assess PrEP adherence. Tenofovir diphosphate ≥350-699 fmol/punch was classified as fair adherence and ≥700 fmol/punch as good adherence. Data analysis on app use paradata and exit interviews were conducted on the YFS+APP arm after 6 months of follow-up. Results: Between March 2018 and June 2019, 200 participants with a median age of 18 (IQR 17-19) years were enrolled. Overall, 74% (148/200) were YMSM; 87% (87/100) of participants who received YFS+APP logged in to the app and performed weekly HIV acquisition risk assessments (log-in and risk assessment [LRA]). The median duration between the first and last log-in was 3.5 (IQR 1.6-5.6) months, with a median frequency of 6 LRAs (IQR 2-10). Moreover, 22% (22/100) of the participants in the YFS+APP arm were frequent users (LRA≥10) during the 6-month follow-up period. YMSM were 9.3 (95% CI 1.2-74.3) times more likely to be frequent app users than YTGW (P=.04). Frequent app users had higher proportions (12%-16%) of PrEP adherence at both months 3 and 6 compared with infrequent users (LRA<10) and the YFS arm, although this did not reach statistical significance. Of the 100 participants in the YFS+APP arm, 23 (23%) were interviewed. The risk assessment function is perceived as the most useful app feature. Further aesthetic adaptations and a more comprehensive rewards system were suggested by the interviewees. Conclusions: Higher rates of PrEP adherence among frequent app users were observed; however, this was not statistically significant. A short app use duration of 3 months suggests that they may be useful in establishing habits in taking daily PrEP, but not long-term adherence. Further studies on the specific mechanisms of mobile phone apps that influence health behaviors are needed. Trial Registration: ClinicalTrials.gov NCT03778892; https://clinicaltrials.gov/ct2/show/NCT03778892 %M 35451976 %R 10.2196/25561 %U https://mhealth.jmir.org/2022/4/e25561 %U https://doi.org/10.2196/25561 %U http://www.ncbi.nlm.nih.gov/pubmed/35451976 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 4 %P e32557 %T Digital Health Technologies for Long-term Self-management of Osteoporosis: Systematic Review and Meta-analysis %A Alhussein,Ghada %A Hadjileontiadis,Leontios %+ Department of Biomedical Engineering, Khalifa University of Science and Technology, AlSaada Street, Abu Dhabi, United Arab Emirates, 971 508292048, ghada.alhussein@ku.ac.ae %K mHealth %K digital health %K osteoporosis %K self-management %K systematic review %K meta-analysis %K chronic disease %K bone health %K self-management %K nutrition %K physical activity %K risk assessment %K mobile phone %D 2022 %7 21.4.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Osteoporosis is the fourth most common chronic disease worldwide. The adoption of preventative measures and effective self-management interventions can help improve bone health. Mobile health (mHealth) technologies can play a key role in the care and self-management of patients with osteoporosis. Objective: This study presents a systematic review and meta-analysis of the currently available mHealth apps targeting osteoporosis self-management, aiming to determine the current status, gaps, and challenges that future research could address, as well as propose appropriate recommendations. Methods: A systematic review of all English articles was conducted, in addition to a survey of all apps available in iOS and Android app stores as of May 2021. A comprehensive literature search (2010 to May 2021) of PubMed, Scopus, EBSCO, Web of Science, and IEEE Xplore was conducted. Articles were included if they described apps dedicated to or useful for osteoporosis (targeting self-management, nutrition, physical activity, and risk assessment) delivered on smartphone devices for adults aged ≥18 years. Of the 32 articles, a random effects meta-analysis was performed on 13 (41%) studies of randomized controlled trials, whereas the 19 (59%) remaining studies were only included in the narrative synthesis as they did not provide enough data. Results: In total, 3906 unique articles were identified. Of these 3906 articles, 32 (0.81%) articles met the inclusion criteria and were reviewed in depth. The 32 studies comprised 14,235 participants, of whom, on average, 69.5% (n=9893) were female, with a mean age of 49.8 (SD 17.8) years. The app search identified 23 relevant apps for osteoporosis self-management. The meta-analysis revealed that mHealth-supported interventions resulted in a significant reduction in pain (Hedges g −1.09, 95% CI −1.68 to −0.45) and disability (Hedges g −0.77, 95% CI −1.59 to 0.05). The posttreatment effect of the digital intervention was significant for physical function (Hedges g 2.54, 95% CI −4.08 to 4.08) but nonsignificant for well-being (Hedges g 0.17, 95% CI −1.84 to 2.17), physical activity (Hedges g 0.09, 95% CI −0.59 to 0.50), anxiety (Hedges g −0.29, 95% CI −6.11 to 5.53), fatigue (Hedges g −0.34, 95% CI −5.84 to 5.16), calcium (Hedges g −0.05, 95% CI −0.59 to 0.50), vitamin D intake (Hedges g 0.10, 95% CI −4.05 to 4.26), and trabecular score (Hedges g 0.06, 95% CI −1.00 to 1.12). Conclusions: Osteoporosis apps have the potential to support and improve the management of the disease and its symptoms; they also appear to be valuable tools for patients and health professionals. However, most of the apps that are currently available lack clinically validated evidence of their efficacy and focus on a limited number of symptoms. A more holistic and personalized approach within a cocreation design ecosystem is needed. Trial Registration: PROSPERO 2021 CRD42021269399; https://tinyurl.com/2sw454a9 %M 35451968 %R 10.2196/32557 %U https://mhealth.jmir.org/2022/4/e32557 %U https://doi.org/10.2196/32557 %U http://www.ncbi.nlm.nih.gov/pubmed/35451968 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e34704 %T A Web-Based Health Application to Translate Nutrition Therapy for Cardiovascular Risk Reduction in Primary Care (PortfolioDiet.app): Quality Improvement and Usability Testing Study %A Kavanagh,Meaghan E %A Chiavaroli,Laura %A Glenn,Andrea J %A Heijmans,Genevieve %A Grant,Shannan M %A Chow,Chi-Ming %A Josse,Robert G %A Malik,Vasanti S %A Watson,William %A Lofters,Aisha %A Holmes,Candice %A Rackal,Julia %A Srichaikul,Kristie %A Sherifali,Diana %A Snelgrove-Clarke,Erna %A Udell,Jacob A %A Juni,Peter %A Booth,Gillian L %A Farkouh,Michael E %A Leiter,Lawrence A %A Kendall,Cyril W C %A Jenkins,David J A %A Sievenpiper,John L %+ Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, 5th floor, room 5334, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada, 1 416 867 3732, john.sievenpiper@utoronto.ca %K portfolio diet %K dietary portfolio %K nutrition therapy %K dietary application %K eHealth %K usability testing %K quality improvement %K mobile phone %D 2022 %7 21.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The Portfolio Diet, or Dietary Portfolio, is a therapeutic dietary pattern that combines cholesterol-lowering foods to manage dyslipidemia for the prevention of cardiovascular disease. To translate the Portfolio Diet for primary care, we developed the PortfolioDiet.app as a patient and physician educational and engagement tool for PCs and smartphones. The PortfolioDiet.app is currently being used as an add-on therapy to the standard of care (usual care) for the prevention of cardiovascular disease in primary care. To enhance the adoption of this tool, it is important to ensure that the PortfolioDiet.app meets the needs of its target end users. Objective: The main objective of this project is to undertake user testing to inform modifications to the PortfolioDiet.app as part of ongoing engagement in quality improvement (QI). Methods: We undertook a 2-phase QI project from February 2021 to September 2021. We recruited users by convenience sampling. Users included patients, family physicians, and dietitians, as well as nutrition and medical students. For both phases, users were asked to use the PortfolioDiet.app daily for 7 days. In phase 1, a mixed-form questionnaire was administered to evaluate the users’ perceived acceptability, knowledge acquisition, and engagement with the PortfolioDiet.app. The questionnaire collected both quantitative and qualitative data, including 2 open-ended questions. The responses were used to inform modifications to the PortfolioDiet.app. In phase 2, the System Usability Scale was used to assess the usability of the updated PortfolioDiet.app, with a score higher than 70 being considered acceptable. Results: A total of 30 and 19 users were recruited for phase 1 and phase 2, respectively. In phase 1, the PortfolioDiet.app increased users’ perceived knowledge of the Portfolio Diet and influenced their perceived food choices. Limitations identified by users included challenges navigating to resources and profile settings, limited information on plant sterols, inaccuracies in points, timed-logout frustration, request for step-by-step pop-up windows, and request for a mobile app version; when looking at positive feedback, the recipe section was the most commonly praised feature. Between the project phases, 6 modifications were made to the PortfolioDiet.app to incorporate and address user feedback. At phase 2, the average System Usability Scale score was 85.39 (SD 11.47), with 100 being the best possible. Conclusions: By undertaking user testing of the PortfolioDiet.app, its limitations and strengths were able to be identified, informing modifications to the application, which resulted in a clinical tool that better meets users’ needs. The PortfolioDiet.app educates users on the Portfolio Diet and is considered acceptable by users. Although further refinements to the PortfolioDiet.app will continue to be made before its evaluation in a clinical trial, the result of this QI project is an improved clinical tool. %M 35451981 %R 10.2196/34704 %U https://humanfactors.jmir.org/2022/2/e34704 %U https://doi.org/10.2196/34704 %U http://www.ncbi.nlm.nih.gov/pubmed/35451981 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e32702 %T Problems and Barriers Related to the Use of Digital Health Applications: Protocol for a Scoping Review %A Giebel,Godwin Denk %A Speckemeier,Christian %A Abels,Carina %A Börchers,Kirstin %A Wasem,Jürgen %A Blase,Nikola %A Neusser,Silke %+ Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, Essen, 45127, Germany, 49 02011833180, godwin.giebel@medman.uni-due.de %K digital health application %K DHA %K mHealth, problems, barriers, scoping review %K mobile health %K health insurance %K electronic database %K health database %K mHealth app %D 2022 %7 21.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The use of mobile health (mHealth) apps is increasing rapidly worldwide. More and more institutions and organizations develop regulations and guidelines to enable an evidence-based and safe use. In Germany, mHealth apps fulfilling predefined criteria (Digitale Gesundheitsanwendungen [DiGA]) can be prescribed and are reimbursable by the German statutory health insurance scheme. Due to the increasing distribution of DiGA, problems and barriers should receive special attention. Objective: This study aims to identify the relevant problems and barriers related to the use of mHealth apps fulfilling the criteria of DiGA. Methods: This scoping review will follow published methodological frameworks and the PRISMA-Scr (Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews) criteria. Electronic databases (MEDLINE, EMBASE, PsycINFO, and JMIR), reference lists of relevant articles, and grey literature sources will be searched. Two reviewers will assess the eligibility of the articles by a two-stage (title and abstract as well as full text) screening process. Only problems and barriers related to mHealth apps fulfilling the criteria of DiGA are included for this research. The identified studies will be categorized and analyzed with MAXQDA. Results: This scoping review gives an overview of the available evidence and identifies research gaps regarding problems and barriers related to DiGA. The results are planned to be submitted to an indexed, peer-reviewed journal in the first quarter of 2022. Conclusions: This is the first review to identify the problems and barriers related to the use of mHealth apps fulfilling the German definition of DiGA. Nevertheless, the findings can be applied to other contexts and health care systems as well. International Registered Report Identifier (IRRID): DERR1-10.2196/32702 %M 35451979 %R 10.2196/32702 %U https://www.researchprotocols.org/2022/4/e32702 %U https://doi.org/10.2196/32702 %U http://www.ncbi.nlm.nih.gov/pubmed/35451979 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 4 %P e33628 %T Residual Effect of Texting to Promote Medication Adherence for Villagers with Schizophrenia in China: 18-Month Follow-up Survey After the Randomized Controlled Trial Discontinuation %A Cai,Yiyuan %A Gong,Wenjie %A He,Wenjun %A He,Hua %A Hughes,James P %A Simoni,Jane %A Xiao,Shuiyuan %A Gloyd,Stephen %A Lin,Meijuan %A Deng,Xinlei %A Liang,Zichao %A Dai,Bofeng %A Liao,Jing %A Hao,Yuantao %A Xu,Dong Roman %+ Center for World Health Organization (WHO) Studies and Department of Health Management, School of Health Management of Southern Medical University, 1023 South Shatai Road, Guangzhou, 510515, China, 86 02061647194, romanxu@i.smu.edu.cn %K medication adherence %K mobile texting %K lay health worker %K resource-poor community %K primary health care %K quality of care %K mHealth %K schizophrenia %K maintenance %K residual effect %K mental health %K patient outcomes %D 2022 %7 19.4.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Reducing the treatment gap for mental health in low- and middle-income countries is a high priority. Even with treatment, adherence to antipsychotics is rather low. Our integrated intervention package significantly improved medication adherence within 6 months for villagers with schizophrenia in resource-poor communities in rural China. However, considering the resource constraint, we need to test whether the effect of those behavior-shaping interventions may be maintained even after the suspension of the intervention. Objective: The aim of this study is to explore the primary outcome of adherence and other outcomes at an 18-month follow-up after the intervention had been suspended. Methods: In a 6-month randomized trial, 277 villagers with schizophrenia were randomized to receive either a government community mental health program (686 Program) or the 686 Program plus Lay health supporters, e-platform, award, and integration (LEAN), which included health supporters for medication or care supervision, e-platform access for sending mobile SMS text messaging reminders and education message, a token gift for positive behavior changes (eg, continuing taking medicine), and integrating the e-platform with the existing 686 Program. After the 6-month intervention, both groups received only the 686 Program for 18 months (phase 2). Outcomes at both phases included antipsychotic medication adherence, functioning, symptoms, number of rehospitalization, suicide, and violent behaviors. The adherence and functioning were assessed at the home visit by trained assessors. We calculated the adherence in the past 30 days by counting the percentage of dosages taken from November to December 2018 by unannounced home-based pill counts. The functioning was assessed using the World Health Organization Disability Assessment Schedule 2.0. The symptoms were evaluated using the Clinical Global Impression–Schizophrenia during their visits to the 686 Program psychiatrists. Other outcomes were routinely collected in the 686 Program system. We used intention-to-treat analysis, and missing data were dealt with using multiple imputation. The generalized estimating equation model was used to assess program effects on adherence, functioning, and symptoms. Results: In phase 1, antipsychotic adherence and rehospitalization incidence improved significantly. However, in phase 2, the difference of the mean of antipsychotic adherence (adjusted mean difference 0.05, 95% CI −0.06 to 0.16; P=.41; Cohen d effect size=0.11) and rehospitalization incidence (relative risk 0.65, 95% CI 0.32-1.33; P=.24; number needed to treat 21.83, 95% CI 8.30-34.69) was no longer statistically significant, and there was no improvement in other outcomes in either phase (P≥.05). Conclusions: The simple community-based LEAN intervention could not continually improve adherence and reduce the rehospitalization of people with schizophrenia. Our study inclined to suggest that prompts for medication may be necessary to maintain medication adherence for people with schizophrenia, although we cannot definitively exclude other alternative interpretations. %M 35438649 %R 10.2196/33628 %U https://mhealth.jmir.org/2022/4/e33628 %U https://doi.org/10.2196/33628 %U http://www.ncbi.nlm.nih.gov/pubmed/35438649 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e31730 %T Toward Research-Informed Design Implications for Interventions Limiting Smartphone Use: Functionalities Review of Digital Well-being Apps %A Almoallim,Sultan %A Sas,Corina %+ School of Computing and Communications, Lancaster University, InfoLab21, Bailrigg, Lancaster, LA1 4YW, United Kingdom, 44 07453728107, s.almoallim@lancaster.ac.uk %K digital well-being %K smartphone apps %K tracking use %K monitoring against set use limits %K interventions for limiting use %K barriers %K design for friction %K screen time %K attention %K self-regulation %K mobile phone %D 2022 %7 19.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Much research in human-computer interaction has focused on well-being and how it can be better supported through a range of technologies, from affective interfaces to mindfulness systems. At the same time, we have seen a growing number of commercial digital well-being apps. However, there has been limited scholarly work reviewing these apps. Objective: This paper aims to report on an autoethnographic study and functionality review of the 39 most popular commercial digital well-being apps on Google Play Store and 17 apps described in academic papers. Methods: From 1250 apps on Google Play Store, we selected 39 (3.12%) digital well-being apps, and from Google Scholar, we identified 17 papers describing academic apps. Both sets of digital well-being apps were analyzed through a review of their functionalities based on their descriptions. The commercial apps were also analyzed through autoethnography, wherein the first author interacted with them to understand how these functionalities work and how they may be experienced by users in their daily lives. Results: Our findings indicate that these apps focus mostly on limiting screen time, and we advanced a richer conversation about such apps, articulating the distinctions among monitoring use, tracking use against set limits, and 4 specific interventions supporting limited use. Conclusions: We conclude with 6 implications for designing digital well-being apps, namely calling to move beyond screen time and support the broader focus of digital well-being; supporting meaningful use rather than limiting meaningless use; leveraging (digital) navigation in design for friction; supporting collaborative interaction to limit phone overuse; supporting explicit, time-based visualizations for monitoring functionality; and supporting the ethical design of digital well-being apps. %M 35188897 %R 10.2196/31730 %U https://formative.jmir.org/2022/4/e31730 %U https://doi.org/10.2196/31730 %U http://www.ncbi.nlm.nih.gov/pubmed/35188897 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e29291 %T The Cost-effectiveness of a Mass Media Campaign to Promote Smartphone Apps for Weight Loss: Updated Modeling Study %A Jones,Amanda C %A Grout,Leah %A Wilson,Nick %A Nghiem,Nhung %A Cleghorn,Christine %+ Department of Public Health, University of Otago, PO Box 7343, Newtown, Wellington, 6242, New Zealand, 64 4 918 6182, cristina.cleghorn@otago.ac.nz %K mass media %K smartphone apps %K weight loss %K cost-effectiveness %K simulation modeling %K health equity %K mobile phone %D 2022 %7 19.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Evidence suggests that smartphone apps can be effective in the self-management of weight. Given the low cost, broad reach, and apparent effectiveness of weight loss apps, governments may seek to encourage their uptake as a tool to reduce excess weight in the population. Mass media campaigns are 1 mechanism for promoting app use. However, the cost and potential cost-effectiveness are important considerations. Objective: The aim of our study was to use modeling to assess the health impacts, health system costs, cost-effectiveness, and health equity of a mass media campaign to promote high-quality smartphone apps for weight loss in New Zealand. Methods: We used an established proportional multistate life table model that simulates the 2011 New Zealand adult population over the lifetime, subgrouped by age, sex, and ethnicity (Māori [Indigenous] or non-Māori). The risk factor was BMI. The model compared business as usual to a one-off mass media campaign intervention, which included the pooled effect size from a recent meta-analysis of smartphone weight loss apps. The resulting impact on BMI and BMI-related diseases was captured through changes in health gain (quality-adjusted life years) and in health system costs. The difference in total health system costs was the net sum of intervention costs and downstream cost offsets because of altered disease rates. An annual discount rate of 3% was applied to health gains and health system costs. Multiple scenarios and sensitivity analyses were conducted, including an equity adjustment. Results: Across the remaining lifetime of the modeled 2011 New Zealand population, the mass media campaign to promote weight loss app use had an estimated overall health gain of 181 (95% uncertainty interval 113-270) quality-adjusted life years and health care costs of –NZ $606,000 (–US $408,000; 95% uncertainty interval –NZ $2,540,000 [–US $1,709,000] to NZ $907,000 [US $610,000]). The mean health care costs were negative, representing overall savings to the health system. Across the outcomes examined in this study, the modeled mass media campaign to promote weight loss apps among the general population would be expected to provide higher per capita health gain for Māori and hence reduce health inequities arising from high BMI, assuming that the intervention would be as effective for Māori as it is for non-Māori. Conclusions: A modeled mass media campaign to encourage the adoption of smartphone apps to promote weight loss among the New Zealand adult population is expected to yield an overall gain in health and to be cost-saving to the health system. Although other interventions in the nutrition and physical activity space are even more beneficial to health and produce larger cost savings (eg, fiscal policies and food reformulation), governments may choose to include strategies to promote health app use as complementary measures. %M 35438643 %R 10.2196/29291 %U https://formative.jmir.org/2022/4/e29291 %U https://doi.org/10.2196/29291 %U http://www.ncbi.nlm.nih.gov/pubmed/35438643 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e29380 %T Weight Loss Trajectories and Related Factors in a 16-Week Mobile Obesity Intervention Program: Retrospective Observational Study %A Kim,Ho Heon %A Kim,Youngin %A Michaelides,Andreas %A Park,Yu Rang %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 010 5240 3434, yurangpark@yuhs.ac %K clustering %K mobile health %K weight loss %K weight management %K behavior management %K time series analysis %K mHealth %K obesity %K outcomes %K machine learning %K mobile app %K adherence %K prediction %K mobile phone %D 2022 %7 15.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: In obesity management, whether patients lose ≥5% of their initial weight is a critical factor in clinical outcomes. However, evaluations that take only this approach are unable to identify and distinguish between individuals whose weight changes vary and those who steadily lose weight. Evaluation of weight loss considering the volatility of weight changes through a mobile-based intervention for obesity can facilitate understanding of an individual’s behavior and weight changes from a longitudinal perspective. Objective: The aim of this study is to use a machine learning approach to examine weight loss trajectories and explore factors related to behavioral and app use characteristics that induce weight loss. Methods: We used the lifelog data of 13,140 individuals enrolled in a 16-week obesity management program on the health care app Noom in the United States from August 8, 2013, to August 8, 2019. We performed k-means clustering with dynamic time warping to cluster the weight loss time series and inspected the quality of clusters with the total sum of distance within the clusters. To identify use factors determining clustering assignment, we longitudinally compared weekly use statistics with effect size on a weekly basis. Results: The initial average BMI value for the participants was 33.6 (SD 5.9) kg/m2, and it ultimately reached 31.6 (SD 5.7) kg/m2. Using the weight log data, we identified five clusters: cluster 1 (sharp decrease) showed the highest proportion of participants who reduced their weight by >5% (7296/11,295, 64.59%), followed by cluster 2 (moderate decrease). In each comparison between clusters 1 and 3 (yo-yo) and clusters 2 and 3, although the effect size of the difference in average meal record adherence and average weight record adherence was not significant in the first week, it peaked within the initial 8 weeks (Cohen d>0.35) and decreased after that. Conclusions: Using a machine learning approach and clustering shape-based time series similarities, we identified 5 weight loss trajectories in a mobile weight management app. Overall adherence and early adherence related to self-monitoring emerged as potential predictors of these trajectories. %M 35436211 %R 10.2196/29380 %U https://www.jmir.org/2022/4/e29380 %U https://doi.org/10.2196/29380 %U http://www.ncbi.nlm.nih.gov/pubmed/35436211 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 4 %P e32643 %T A Novel Method for Evaluating Mobile Apps (App Rating Inventory): Development Study %A Mackey,Rachel %A Gleason,Ann %A Ciulla,Robert %+ Connected Health Branch, Defense Health Agency, JBLM Box 339500 MS 34, 9933 West Hayes Street, Tacoma, WA, 98433-9500, United States, 1 253 278 1535, ann.m.gleason3.ctr@mail.mil %K mobile health apps %K app rating %K app analysis methodology %K app market research %K mobile phone %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Selecting and integrating health-related apps into patient care is impeded by the absence of objective guidelines for identifying high-quality apps from the many thousands now available. Objective: This study aimed to evaluate the App Rating Inventory, which was developed by the Defense Health Agency’s Connected Health branch, to support clinical decisions regarding app selection and evaluate medical and behavioral apps. Methods: To enhance the tool’s performance, eliminate item redundancy, reduce scoring system subjectivity, and ensure a broad application of App Rating Inventory–derived results, inventory development included 3 rounds of validation testing and 2 trial periods conducted over a 6-month interval. The development focused on content validity testing, dimensionality (ie, whether the tool’s criteria performed as operationalized), factor and commonality analysis, and interrater reliability (reliability scores improved from 0.62 to 0.95 over the course of development). Results: The development phase culminated in a review of 248 apps for a total of 6944 data points and a final 28-item, 3-category app rating system. The App Rating Inventory produces scores for the following three categories: evidence (6 items), content (11 items), and customizability (11 items). The final (fourth) metric is the total score, which constitutes the sum of the 3 categories. All 28 items are weighted equally; no item is considered more (or less) important than any other item. As the scoring system is binary (either the app contains the feature or it does not), the ratings’ results are not dependent on a rater’s nuanced assessments. Conclusions: Using predetermined search criteria, app ratings begin with an environmental scan of the App Store and Google Play. This first step in market research funnels hundreds of apps in a given disease category down to a manageable top 10 apps that are, thereafter, rated using the App Rating Inventory. The category and final scores derived from the rating system inform the clinician about whether an app is evidence informed and easy to use. Although a rating allows a clinician to make focused decisions about app selection in a context where thousands of apps are available, clinicians must weigh the following factors before integrating apps into a treatment plan: clinical presentation, patient engagement and preferences, available resources, and technology expertise. %M 35436227 %R 10.2196/32643 %U https://mhealth.jmir.org/2022/4/e32643 %U https://doi.org/10.2196/32643 %U http://www.ncbi.nlm.nih.gov/pubmed/35436227 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 4 %P e31233 %T An Unstructured Supplementary Service Data–Based mHealth App Providing On-Demand Sexual Reproductive Health Information for Adolescents in Kibra, Kenya: Randomized Controlled Trial %A Macharia,Paul %A Pérez-Navarro,Antoni %A Sambai,Betsy %A Inwani,Irene %A Kinuthia,John %A Nduati,Ruth %A Carrion,Carme %+ Universitat Oberta de Catalunya, Rambla del Poblenou, 156, Barcelona, 08018, Spain, 34 619963691, paulmachariah@gmail.com %K adolescents %K sexual reproductive health %K mobile phones %K randomized controlled trial %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adolescents transitioning from childhood to adulthood need to be equipped with sexual reproductive health (SRH) knowledge, skills, attitudes, and values that empower them. Accessible, reliable, appropriate, and friendly information can be provided through mobile phone–based health interventions. Objective: This study aims to investigate the effectiveness and impact of an Unstructured Supplementary Service Data (USSD)–based app in increasing adolescents’ knowledge about contraceptives, gender-based stereotypes, sexually transmitted infections (STIs), abstinence, and perceived vulnerability, and helping adolescents make informed decisions about their SRH. Methods: A randomized controlled trial (RCT) methodology was applied to investigate the potential of a USSD-based app for providing on-demand SRH information. To be eligible, adolescents aged 15 to 19 years residing in Kibra, Kenya, had to have access to a phone and be available for the 3-month follow-up visit. Participants were randomly assigned to the intervention (n=146) and control (n=154) groups using sequentially numbered, opaque, sealed envelopes. The primary outcome was improved SRH knowledge. The secondary outcome was improved decision-making on SRH. The outcomes were measured using validated tools on adolescent SRH and user perceptions during the follow-up visit. A paired sample t test was used to compare the changes in knowledge scores in both groups. The control group did not receive any SRH information. Results: During the RCT, 54.9% (62/109) of adolescents used the USSD-based app at least once. The mean age by randomization group was 17.3 (SD 1.23) years for the control group and 17.3 (SD 1.12) years for the intervention group. There was a statistically significant difference in the total knowledge scores in the intervention group (mean 10.770, SD 2.012) compared with the control group (mean 10.170, SD 2.412) conditions (t179=2.197; P=.03). There was a significant difference in abstinence (P=.01) and contraceptive use (P=.06). Of the individuals who used the app, all participants felt the information received could improve decision-making regarding SRH. Information on STIs was of particular interest, with 27% (20/62) of the adolescents seeking information in this area, of whom 55% (11/20) were female. In relation to improved decision-making, 21.6% (29/134) of responses showed the adolescents were able to identify STIs and were likely to seek treatment; 51.7% (15/29) of these were female. Ease of use was the most important feature of the app for 28.3% (54/191) of the responses. Conclusions: Adolescents require accurate and up-to-date SRH information to guide their decision-making and improve health outcomes. As adolescents already use mobile phones in their day-to-day lives, apps provide an ideal platform for this information. A USSD-based app could be an appropriate tool for increasing SRH knowledge among adolescents in low-resource settings. Adolescents in the study valued the information provided because it helped them identify SRH topics on which they needed more information. Trial Registration: Pan African Clinical Trial Registry PACTR202204774993198; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=22623 %M 35436230 %R 10.2196/31233 %U https://mhealth.jmir.org/2022/4/e31233 %U https://doi.org/10.2196/31233 %U http://www.ncbi.nlm.nih.gov/pubmed/35436230 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e36794 %T Feasibility, Acceptability, and Preliminary Outcomes of a Cognitive Behavioral Therapy–Based Mobile Mental Well-being Program (Noom Mood): Single-Arm Prospective Cohort Study %A McCallum,Meaghan %A Ho,Annabell Suh %A Mitchell,Ellen Siobhan %A May,Christine N %A Behr,Heather %A Ritschel,Lorie %A Mochrie,Kirk %A Michaelides,Andreas %+ Academic Research, Noom Inc, 229 W 28th St, Fl 9, New York, NY, 10001, United States, 1 631 938 1248, siobhan@noom.com %K mHealth %K mobile mental health %K mental health %K stress %K anxiety %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of anxiety, depression, and general distress has risen in recent years. Mobile mental health programs have been found to provide support to nonclinical populations and may overcome some of the barriers associated with traditional in-person treatment; however, researchers have voiced concerns that many publicly available mobile mental health programs lack evidence-based theoretical foundations, peer-reviewed research, and sufficient engagement from the public. Objective: This study aimed to evaluate the feasibility, acceptability, and preliminary outcomes of Noom Mood, a commercial mobile cognitive behavioral therapy– and mindfulness-based program. Methods: In this single-arm prospective cohort study, individuals who joined Noom Mood between August and October 2021 completed surveys at baseline and 4-week follow-up. Per-protocol analyses included those who completed both surveys (n=113), and intention-to-treat analyses included all participants (N=185). Results: A majority of the sample reported that the program is easy to use, they felt confident recommending the program to a friend, and they perceived the program to be effective at improving stress and anxiety. There were significant improvements in anxiety symptoms, perceived stress, depressive feelings, emotion regulation, and optimism in both the per-protocol and intention-to-treat analyses (all P<.001). Participants reported benefiting most from learning skills (eg, breathing and cognitive reframing techniques), interacting with the program features, and gaining awareness of their emotions and thought patterns. Participants also made a number of suggestions to improve product functionality and usability. Conclusions: Results suggest that Noom Mood is feasible and acceptable to participants, with promising preliminary outcomes. Future studies should build on these results to evaluate the effects of Noom Mood using more rigorous designs. %M 35436218 %R 10.2196/36794 %U https://formative.jmir.org/2022/4/e36794 %U https://doi.org/10.2196/36794 %U http://www.ncbi.nlm.nih.gov/pubmed/35436218 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e35614 %T Evaluation of the Immediate Effects of Web-Based Intervention Modules for Goals, Planning, and Coping Planning on Physical Activity: Secondary Analysis of a Randomized Controlled Trial on Weight Loss Maintenance %A Mattila,Elina %A Horgan,Graham %A Palmeira,António L %A O'Driscoll,Ruairi %A Stubbs,R James %A Heitmann,Berit L %A Marques,Marta M %+ VTT Technical Research Centre of Finland Ltd, Visiokatu 4, Tampere, 33720, Finland, 358 407162230, elina.m.mattila@vtt.fi %K digital intervention %K Fitbit %K weight %K weight loss maintenance %K physical activity %K fitness %K exercise %K goal setting %K action planning %K coping planning %K control trial %K secondary analysis %K RCT %K randomized controlled trial %K long-term effect %K short-term effect %K immediate effect %K sustained effect %D 2022 %7 14.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of digital interventions can be accurately monitored via log files. However, monitoring engagement with intervention goals or enactment of the actual behaviors targeted by the intervention is more difficult and is usually evaluated based on pre-post measurements in a controlled trial. Objective: The objective of this paper is to evaluate if engaging with 2 digital intervention modules focusing on (1) physical activity goals and action plans and (2) coping with barriers has immediate effects on the actual physical activity behavior. Methods: The NoHoW Toolkit (TK), a digital intervention developed to support long-term weight loss maintenance, was evaluated in a 2 x 2 factorial randomized controlled trial. The TK contained various modules based on behavioral self-regulation and motivation theories, as well as contextual emotion regulation approaches, and involved continuous tracking of weight and physical activity through connected commercial devices (Fitbit Aria and Charge 2). Of the 4 trial arms, 2 had access to 2 modules directly targeting physical activity: a module for goal setting and action planning (Goal) and a module for identifying barriers and coping planning (Barriers). Module visits and completion were determined based on TK log files and time spent in the module web page. Seven physical activity metrics (steps; activity; energy expenditure; fairly active, very active and total active minutes; and distance) were compared before and after visiting and completing the modules to examine whether the modules had immediate or sustained effects on physical activity. Immediate effect was determined based on 7-day windows before and after the visit, and sustained effects were evaluated for 1 to 8 weeks after module completion. Results: Out of the 811 participants, 498 (61.4%) visited the Goal module and 406 (50.1%) visited the Barriers module. The Barriers module had an immediate effect on very active and total active minutes (very active minutes: before median 24.2, IQR 10.4-43.0 vs after median 24.9, IQR 10.0-46.3; P=.047; total active minutes: before median 45.1, IQR 22.9-74.9 vs after median 46.9, IQR 22.4-78.4; P=.03). The differences were larger when only completed Barriers modules were considered. The Barriers module completion was also associated with sustained effects in fairly active and total active minutes for most of the 8 weeks following module completion and for 3 weeks in very active minutes. Conclusions: The Barriers module had small, significant, immediate, and sustained effects on active minutes measured by a wrist-worn activity tracker. Future interventions should pay attention to assessing barriers and planning coping mechanisms to overcome them. Trial Registration: ISRCTN Registry ISRCTN88405328; https://www.isrctn.com/ISRCTN88405328 %M 35436232 %R 10.2196/35614 %U https://www.jmir.org/2022/4/e35614 %U https://doi.org/10.2196/35614 %U http://www.ncbi.nlm.nih.gov/pubmed/35436232 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 4 %P e33938 %T Low- and High-Intensity Physical Activity Among People with HIV: Multilevel Modeling Analysis Using Sensor- and Survey-Based Predictors %A Cook,Paul %A Jankowski,Catherine %A Erlandson,Kristine M %A Reeder,Blaine %A Starr,Whitney %A Flynn Makic,Mary Beth %+ College of Nursing, University of Colorado, 13120 E 19th Ave, Campus Box C288-04, Aurora, CO, 80045, United States, 1 3037248537, paul.cook@cuanschutz.edu %K ecological momentary assessment %K fatigue %K HIV %K physical activity %K stress %K mobile phone %D 2022 %7 14.4.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: High-intensity physical activity improves the health of people with HIV. Even when people have good intentions to engage in physical activity, they often find it difficult to maintain physical activity behavior in the long term. Two Minds Theory is a neurocognitive model that explains gaps between people’s intentions and behaviors based on the operations of 2 independent mental systems. This model predicts that everyday experiences will affect physical activity and that factors outside people’s awareness, such as sleep and stress, can have particularly strong effects on physical activity behaviors. Objective: We designed this study to test the effects of daily experiences on physical activity among people with HIV, including measures of people’s conscious experiences using daily electronic surveys and measures of nonconscious influences using sensor devices. Methods: In this study, 55 people with HIV wore a Fitbit Alta for 30 days to monitor their physical activity, sleep, and heart rate variability (HRV) as a physiological indicator of stress. Participants also used their smartphones to complete daily electronic surveys for the same 30 days about fatigue, self-efficacy, mood, stress, coping, motivation, and barriers to self-care. Time-lagged, within-person, multilevel models were used to identify the best prospective predictors of physical activity, considering the daily survey responses of people with HIV and sensor data as predictors of their physical activity the following day. We also tested baseline surveys as predictors of physical activity for comparison with daily variables. Results: Different people had different average levels of physical activity; however, physical activity also varied substantially from day to day, and daily measures were more predictive than baseline surveys. This suggests a chance to intervene based on day-to-day variations in physical activity. High-intensity physical activity was more likely when people with HIV reported less subjective fatigue on the prior day (r=−0.48) but was unrelated to actual sleep based on objective sensor data. High-intensity physical activity was also predicted by higher HRV (r=0.56), indicating less stress, lower HIV-related stigma (r=−0.21), fewer barriers to self-care (r=−0.34), and less approach coping (r=−0.34). Similar variables predicted lower-level physical activity measured based on the number of steps per day of people with HIV. Conclusions: Some predictors of physical activity, such as HRV, were only apparent based on sensor data, whereas others, such as fatigue, could be measured via self-report. Findings about coping were unexpected; however, other findings were in line with the literature. This study extends our prior knowledge on physical activity by demonstrating a prospective effect of everyday experiences on physical activity behavior, which is in line with the predictions of Two Minds Theory. Clinicians can support the physical activity of people with HIV by helping their patients reduce their daily stress, fatigue, and barriers to self-care. %M 35436236 %R 10.2196/33938 %U https://mhealth.jmir.org/2022/4/e33938 %U https://doi.org/10.2196/33938 %U http://www.ncbi.nlm.nih.gov/pubmed/35436236 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e35511 %T A Photography-based, Social Media Walking Intervention Targeting Autonomous Motivations for Physical Activity: Semistructured Interviews With Older Women %A Robertson,Michael C %A Swartz,Maria Chang %A Christopherson,Ursela %A Bentley,Jason R %A Basen-Engquist,Karen M %A Thompson,Debbe %A Volpi,Elena %A Lyons,Elizabeth J %+ Department of Nutrition, Metabolism & Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch at Galveston, 301 University Blvd, Galveston, TX, 77555, United States, 1 409 772 2575, ellyons@utmb.edu %K physical activity %K walking %K exercise %K fitness %K social media %K health %K intervention %K behavior %K behavior mechanism %K psychological theory %K serious games %K gamification %K older women %K older adults %K behavior change %K behavioral interventions %K mobile phone %K photography %K patient perspective %K patient attitude %D 2022 %7 14.4.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Older adult women are at risk for negative health outcomes that engaging in sustained physical activity can help prevent. However, promoting long-term maintenance of physical activity in this population has proven to be a challenge. Increasing autonomous motivations (ie, intrinsic, integrated, and identified regulations) for physical activity may facilitate enduring behavior change. Digitally delivered games for health that take a celebratory technology approach, that is, using technology to create new ways to experience valued behaviors and express valued beliefs, may be a useful way to target autonomous motivations for physical activity. Formative research with the target population is needed to design compelling intervention content. Objective: The objective of this study is to investigate older adult women’s reactions to and thoughts about a photography-based, social media walking game targeting autonomous motivations for physical activity. Methods: During an individual semistructured interview, a moderator solicited feedback from 20 older adult women (age range 65-74 years) as part of formative research to develop a social media game featuring weekly walking challenges. The challenges were designed to target autonomous motivations for physical activity. Interviews were audio-recorded and transcribed verbatim. Two reviewers conducted thematic content analysis on interview transcripts. Results: We identified 3 overarching themes in qualitative data analysis. These reflected the playful experiences, value, and acceptability associated with the intervention challenges. Generally, participants understood what the challenges were asking them to do, proffered appropriate example responses, and indicated that the challenges would be enjoyable. Participants reported that the intervention content afforded many and varied playful experiences (eg, competition, discovery, exploration, expression, fellowship, humor, nurture, sensation). Further, participants indicated that the intervention increased their motivation for physical activity, occasioned meaningful shifts in perspective, increased their knowledge of various topics of interest, provided an opportunity to create valued connection with others, and provided health-related benefits. Participants suggested the intervention emphasize local history, nature, and cultural events. Conclusions: The photography-based, social media walking game with relatively simple game mechanics was well received and judged to be apt to bring about a wide variety of emotive experiences. A clear, geographically specific identity emerged as a key driver of interest for intervention content. Taking a celebratory technology approach holds promise for targeting autonomous motivations for physical activity in older adult women. %M 35436205 %R 10.2196/35511 %U https://games.jmir.org/2022/2/e35511 %U https://doi.org/10.2196/35511 %U http://www.ncbi.nlm.nih.gov/pubmed/35436205 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e35196 %T App-Based Mindfulness Meditation for People of Color Who Experience Race-Related Stress: Protocol for a Randomized Controlled Trial %A Ramos,Giovanni %A Aguilera,Adrian %A Montoya,Amanda %A Lau,Anna %A Wen,Chu Yin %A Cruz Torres,Victor %A Chavira,Denise %+ Department of Psychology, University of California, Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, United States, 1 786 564 2448, gioramos@ucla.edu %K race-related stress %K discrimination %K mindfulness %K meditation %K mental health %K app %K digital mental health intervention %K racial and ethnic minority %K people of color %K BIPOC %D 2022 %7 14.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: People of color (POC) who experience race-related stress are at risk of developing mental health problems, including high levels of stress, anxiety, and depression. Mindfulness meditation may be especially well suited to help POC cope, given its emphasis on gaining awareness and acceptance of emotions associated with discriminatory treatment. However, mindfulness meditation rarely reaches POC, and digital approaches could reduce this treatment gap by addressing traditional barriers to care. Objective: This study will test the effectiveness of a self-directed app-based mindfulness meditation program among POC who experience elevated levels of race-related stress. Implementation outcomes such as treatment acceptability, adherence, and satisfaction will be examined. Methods: Participants (n=80) will be recruited online by posting recruitment materials on social media and sending emails to relevant groups. In-person recruitment will consist of posting flyers in communities with significant POC representation. Eligible participants will be block randomized to either the intervention group (n=40) that will complete a self-directed 4-week mindfulness meditation program or a wait-list control condition (n=40) that will receive access to the app after study completion. All participants will complete measures at baseline, midtreatment, and posttreatment. Primary outcomes include changes in stress, anxiety, and depression, and secondary outcomes constitute changes in mindfulness, self-compassion, rumination, emotion suppression, and experiential avoidance. Exploratory analyses will examine whether changes in the secondary outcomes mediate changes in primary outcomes. Finally, treatment acceptability, adherence, and satisfaction will be examined descriptively. Results: Recruitment began in October 2021. Data will be analyzed using multilevel modeling, a statistical methodology that accounts for the dependence among repeated observations. Considering attrition issues in self-directed digital interventions and their potential effects on statistical significance and treatment effect sizes, we will examine data using both intention-to-treat and per-protocol analyses. Conclusions: To our knowledge, this will be the first study to provide data on the effectiveness of a self-directed app-based mindfulness meditation program for POC recruited based on elevated race-related stress, a high-risk population. Similarly, meaningful clinical targets for POC affected by stressors related to race will be examined. Findings will provide important information regarding whether this type of intervention is an acceptable treatment among these marginalized groups. Trial Registration: ClinicalTrials.gov NCT05027113; https://clinicaltrials.gov/ct2/show/NCT05027113 International Registered Report Identifier (IRRID): DERR1-10.2196/35196 %M 35436228 %R 10.2196/35196 %U https://www.researchprotocols.org/2022/4/e35196 %U https://doi.org/10.2196/35196 %U http://www.ncbi.nlm.nih.gov/pubmed/35436228 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e33165 %T The Acceptability of Digital Technology and Tele-Exercise in the Age of COVID-19: Cross-sectional Study %A Ho,Vanda %A Merchant,Reshma A %+ Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Rd, Tower Block Level 10, Division of Geriatric Medicine, Singapore, 119228, Singapore, 65 6779 5555, reshmaa@nuhs.edu.sg %K senior %K telehealth %K digital exercise %K acceptability %K telemedicine %K elderly %K older adults %K outcome %K isolation %K decline %K function %K adoption %K perception %K exercise %K physical activity %K questionnaire %K COVID-19 %D 2022 %7 13.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: With the COVID-19 pandemic, telehealth has been increasingly used to offset the negative outcomes of social isolation and functional decline in older adults. Crucial to the success of telehealth is end user adoption. Objective: This study aims to investigate perception and acceptability of digital technology among Asian older adults. Methods: The Healthy Ageing Promotion Program for You (HAPPY) dual-task exercise was conducted virtually to participants aged ≥60 years. Questionnaires were administered digitally and collected data on demographics, perceptions of digital technology and evaluation of HAPPY, the 6-item Lubben Social Network Scale, intrinsic capacity using the Integrated Care for Older People tool, and a functional screening with the FRAIL scale and five chair rises. Descriptive analysis was used. Results: A total of 42 participants were digitally interviewed. The mean age was 69.1 (4.7) years. Hearing, vision, and 3-item recall difficulty were present in 14% (n=6), 12% (n=5), and 24% (n=10) of participants, respectively. Of the participants, 29% (n=12) had possible sarcopenia and 14% (n=6) were prefrail. Around 24% (n=10) were at risk of social isolation. Most of the participants (n=38, 91%) agreed that technology is good, and 79% (n=33) agreed that technology would allow them to be independent for longer. Over three-quarters of participants (n=33, 79%) agreed that they have the necessary knowledge, and 91% (n=38) had technological assistance available. However, 57% (n=24) were still apprehensive about using technology. Despite 71% (n=30) of older adults owning their devices, 36% (n=15) felt finances were limiting. Through digital HAPPY, 45% (n=19) of participants reported feeling stronger, 48% (n=20) had improved spirits, and 40% (n=17) and 38% (n=16) had improved mood and memory, respectively. Conclusions: The majority of older adults in this study believed in digital technology and had the necessary knowledge and help, but almost half still felt apprehensive and had financial barriers to adopting technology. A digitally administered exercise program especially in a group setting is a feasible option to enhance intrinsic capacity in older adults. However, more work is needed in elucidating sources of apprehension and financial barriers to adopting technology. %M 35294921 %R 10.2196/33165 %U https://aging.jmir.org/2022/2/e33165 %U https://doi.org/10.2196/33165 %U http://www.ncbi.nlm.nih.gov/pubmed/35294921 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 4 %P e34638 %T Loneliness and Social Isolation Detection Using Passive Sensing Techniques: Scoping Review %A Qirtas,Malik Muhammad %A Zafeiridi,Evi %A Pesch,Dirk %A White,Eleanor Bantry %+ School of Computer Science & Information Technology, University College Cork, Room 2.09, Western Gateway Building, Western Road, Cork, T23 W623, Ireland, 353 0851873544, qirtas333@gmail.com %K passive sensing %K loneliness %K social isolation %K smartphone %K sensors %K wearables %K monitoring %K scoping review %K eHealth %K mHealth %K mobile phone %D 2022 %7 12.4.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Loneliness and social isolation are associated with multiple health problems, including depression, functional impairment, and death. Mobile sensing using smartphones and wearable devices, such as fitness trackers or smartwatches, as well as ambient sensors, can be used to acquire data remotely on individuals and their daily routines and behaviors in real time. This has opened new possibilities for the early detection of health and social problems, including loneliness and social isolation. Objective: This scoping review aimed to identify and synthesize recent scientific studies that used passive sensing techniques, such as the use of in-home ambient sensors, smartphones, and wearable device sensors, to collect data on device users’ daily routines and behaviors to detect loneliness or social isolation. This review also aimed to examine various aspects of these studies, especially target populations, privacy, and validation issues. Methods: A scoping review was undertaken, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Studies on the topic under investigation were identified through 6 databases (IEEE Xplore, Scopus, ACM, PubMed, Web of Science, and Embase). The identified studies were screened for the type of passive sensing detection methods for loneliness and social isolation, targeted population, reliability of the detection systems, challenges, and limitations of these detection systems. Results: After conducting the initial search, a total of 40,071 papers were identified. After screening for inclusion and exclusion criteria, 29 (0.07%) studies were included in this scoping review. Most studies (20/29, 69%) used smartphone and wearable technology to detect loneliness or social isolation, and 72% (21/29) of the studies used a validated reference standard to assess the accuracy of passively collected data for detecting loneliness or social isolation. Conclusions: Despite the growing use of passive sensing technologies for detecting loneliness and social isolation, some substantial gaps still remain in this domain. A population heterogeneity issue exists among several studies, indicating that different demographic characteristics, such as age and differences in participants’ behaviors, can affect loneliness and social isolation. In addition, despite extensive personal data collection, relatively few studies have addressed privacy and ethical issues. This review provides uncertain evidence regarding the use of passive sensing to detect loneliness and social isolation. Future research is needed using robust study designs, measures, and examinations of privacy and ethical concerns. %M 35412465 %R 10.2196/34638 %U https://mhealth.jmir.org/2022/4/e34638 %U https://doi.org/10.2196/34638 %U http://www.ncbi.nlm.nih.gov/pubmed/35412465 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35668 %T Evaluating User Feedback for an Artificial Intelligence–Enabled, Cognitive Behavioral Therapy–Based Mental Health App (Wysa): Qualitative Thematic Analysis %A Malik,Tanya %A Ambrose,Adrian Jacques %A Sinha,Chaitali %+ Wysa Inc, 131 Dartmouth St, Boston, MA, United States, 1 9874803442, tanya@wysa.io %K digital mental health %K artificial intelligence %K user reviews %K cognitive behavioral therapy %K CBT %D 2022 %7 12.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital mental health apps are rapidly becoming a common source of accessible support across the world, but their effectiveness is often influenced by limited helpfulness and engagement. Objective: This study’s primary objective was to analyze feedback content to understand users’ experiences with engaging with a digital mental health app. As a secondary objective, an exploratory analysis captured the types of mental health app users. Methods: This study utilized a user-led approach to understanding factors for engagement and helpfulness in digital mental health by analyzing feedback (n=7929) reported on Google Play Store about Wysa, a mental health app (1-year period). The analysis of keywords in the user feedback categorized and evaluated the reported user experience into the core domains of acceptability, usability, usefulness, and integration. The study also captured key deficits and strengths of the app and explored salient characteristics of the types of users who benefit from accessible digital mental health support. Results: The analysis of user feedback found the app to be overwhelmingly positively reviewed (6700/7929, 84.50% 5-star rating). The themes of engaging exercises, interactive interface, and artificial intelligence (AI) conversational ability indicated the acceptability of the app, while the nonjudgmentality and ease of conversation highlighted its usability. The app’s usefulness was portrayed by themes such as improvement in mental health, convenient access, and cognitive restructuring exercises. Themes of privacy and confidentiality underscored users’ preference for the integrated aspects of the app. Further analysis revealed 4 predominant types of individuals who shared app feedback on the store. Conclusions: Users reported therapeutic elements of a comfortable, safe, and supportive environment through using the digital mental health app. Digital mental health apps may expand mental health access to those unable to access traditional forms of mental health support and treatments. %M 35249886 %R 10.2196/35668 %U https://humanfactors.jmir.org/2022/2/e35668 %U https://doi.org/10.2196/35668 %U http://www.ncbi.nlm.nih.gov/pubmed/35249886 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e35554 %T Effectiveness of Digital Interventions for Preventing Alcohol Consumption in Pregnancy: Systematic Review and Meta-analysis %A Oh,Sarah Soyeon %A Moon,Jong Youn %A Chon,Doukyoung %A Mita,Carol %A Lawrence,Jourdyn A %A Park,Eun-Cheol %A Kawachi,Ichiro %+ Department of Preventive Medicine, Gachon University College of Medicine, 191 Hambangmoe-ro, Yeonsu-gu, Incheon, 21936, Republic of Korea, 82 8572647167, moonjy@gachon.ac.kr %K fetal alcohol spectrum disorders %K fetal alcohol syndrome %K digital health %K pregnancy %K alcohol consumption %K text message %K text messaging %K alcohol %K digital intervention %K mother %K systematic review %K meta-analysis %K mobile health %K mHealth %K computer-based intervention %K internet-based intervention %D 2022 %7 11.4.2022 %9 Review %J J Med Internet Res %G English %X Background: Alcohol consumption in pregnancy has been associated with serious fetal health risks and maternal complications. While previous systematic reviews of digital interventions during pregnancy have targeted smoking cessation and flu vaccine uptake, few studies have sought to evaluate their effectiveness in preventing alcohol consumption during pregnancy. Objective: This systematic review aims to assess (1) whether digital interventions are effective in preventing alcohol consumption during the pregnancy/pregnancy-planning period, and (2) the differential effectiveness of alternative digital intervention platforms (ie, computers, mobiles, and text messaging services). Methods: PubMed, Embase, CINAHL, and Web of Science were searched for studies with digital interventions aiming to prevent alcohol consumption among pregnant women or women planning to become pregnant. A random effects primary meta-analysis was conducted to estimate the combined effect size and extent to which different digital platforms were successful in preventing alcohol consumption in pregnancy. Results: Six studies were identified and included in the final review. The primary meta-analysis produced a sample-weighted odds ratio (OR) of 0.62 (95% CI 0.42-0.91; P=.02) in favor of digital interventions decreasing the risk of alcohol consumption during pregnancy when compared to controls. Computer/internet-based interventions (OR 0.59, 95% CI 0.38-0.93) were an effective platform for preventing alcohol consumption. Too few studies of text messaging (OR 0.29, 95% CI 0.29-2.52) were available to draw a conclusion. Conclusions: Overall, our review highlights the potential for digital interventions to prevent alcohol consumption among pregnant women and women planning to become pregnant. Considering the advantages of digital interventions in promoting healthy behavioral changes, future research is necessary to understand how certain platforms may increase user engagement and intervention effectiveness to prevent women from consuming alcohol during their pregnancies. %M 35404257 %R 10.2196/35554 %U https://www.jmir.org/2022/4/e35554 %U https://doi.org/10.2196/35554 %U http://www.ncbi.nlm.nih.gov/pubmed/35404257 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e28260 %T Detecting Anomalies in Daily Activity Routines of Older Persons in Single Resident Smart Homes: Proof-of-Concept Study %A Shahid,Zahraa Khais %A Saguna,Saguna %A Åhlund,Christer %+ Division of Computer Science, Department of Computer Science, Electrical and Space Engineering, Luleå University of Technology, Forskargatan 1, Skellefteå, 931 77, Sweden, 46 704741624, zahraa.shahid@ltu.se %K Activities of daily living %K smart homes %K elderly care %K anomaly detection %K IoT devices %K smart device %K elderly %K sensors %K digital sensors %K Internet of things %D 2022 %7 11.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: One of the main challenges of health monitoring systems is the support of older persons in living independently in their homes and with relatives. Smart homes equipped with internet of things devices can allow older persons to live longer in their homes. Previous surveys used to identify sensor-based data sets in human activity recognition systems have been limited by the use of public data set characteristics, data collected in a controlled environment, and a limited number of older participants. Objective: The objective of our study is to build a model that can learn the daily routines of older persons, detect deviations in daily living behavior, and notify these anomalies in near real-time to relatives. Methods: We extracted features from large-scale sensor data by calculating the time duration and frequency of visits. Anomalies were detected using a parametric statistical approach, unusually short or long durations being detected by estimating the mean (μ) and standard deviation (σ) over hourly time windows (80 to 355 days) for different apartments. The confidence level is at least 75% of the tested values within two (σ) from the mean. An anomaly was triggered where the actual duration was outside the limits of 2 standard deviations (μ−2σ, μ+2σ), activity nonoccurrence, or absence of activity. Results: The patterns detected from sensor data matched the routines self-reported by users. Our system observed approximately 1000 meals and bathroom activities and notifications sent to 9 apartments between July and August 2020. A service evaluation of received notifications showed a positive user experience, an average score of 4 being received on a 1 to 5 Likert-like scale. One was poor, two fair, three good, four very good, and five excellent. Our approach considered more than 75% of the observed meal activities were normal. This figure, in reality, was 93%, normal observed meal activities of all participants falling within 2 standard deviations of the mean. Conclusions: In this research, we developed, implemented, and evaluated a real-time monitoring system of older participants in an uncontrolled environment, with off-the-shelf sensors and internet of things devices being used in the homes of older persons. We also developed an SMS-based notification service and conducted user evaluations. This service acts as an extension of the health/social care services operated by the municipality of Skellefteå provided to older persons and relatives. %M 35404260 %R 10.2196/28260 %U https://aging.jmir.org/2022/2/e28260 %U https://doi.org/10.2196/28260 %U http://www.ncbi.nlm.nih.gov/pubmed/35404260 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e33974 %T Use and Effect of Embodied Conversational Agents for Improving Eating Behavior and Decreasing Loneliness Among Community-Dwelling Older Adults: Randomized Controlled Trial %A Kramer,Lean L %A van Velsen,Lex %A Clark,Jenna L %A Mulder,Bob C %A de Vet,Emely %+ Consumption and Healthy Lifestyles, Wageningen University & Research, Hollandseweg 1, Wageningen, 6706 KN, Netherlands, 31 623412092, lean.kramer@wur.nl %K eHealth %K online intervention %K embodied conversational agent %K lifestyle change %K older adult %K user experience %K eating habits %K eating behavior %D 2022 %7 11.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Embodied conversational agents (ECAs) have been proposed as a promising interaction modality for the delivery of programs focused on promoting lifestyle changes. However, it is not understood what factors influence the health effects of ECAs or their use. Objective: We aimed to (1) identify whether ECAs could persuade community-dwelling older adults to change their dietary behavior and whether ECA use could decrease loneliness, (2) test the pathways to these effects, and (3) understand factors influencing the use of ECAs. Methods: A randomized controlled trial was conducted. The intervention group received access to the PACO service for 8 weeks. The waitlist group started PACO use after waiting for 4 weeks. Two primary outcomes (eating behavior and loneliness) were assessed via online questionnaires at intake, upon joining the waitlist, after 4 weeks, and after 8 weeks. The third primary outcome (use) was assessed via data logs. Secondary outcomes were measured at the same time points, via questionnaires or an optional interview. Results: In total, 32 participants completed the intervention. We found a significant correlation between use in minutes on the one hand, and perceived usefulness (r=0.39, P=.03) and enjoyment on the other (r=0.38, P=.03). However, these did not predict use in the full regression model (F2,29=1.98, P=.16, R2=0.12). Additionally, PACO use did not lead to improvement in eating behavior (χ22=0.34, P=.85) or a decrease in loneliness (χ22=0.02, P=.99). Conclusions: Our study did not provide any concluding evidence about factors that are linked to the use or health effects of ECAs. Future service design could benefit from either creating a functional design catering to the predominant stage in the precaution adoption process model of the targeted population, or by personalizing the service based on an intake in which the end user’s stage is determined. Trial Registration: ClinicalTrials.gov NCT04510883; https://clinicaltrials.gov/ct2/show/NCT04510883 International Registered Report Identifier (IRRID): RR2-10.2196/22186 %M 35404255 %R 10.2196/33974 %U https://formative.jmir.org/2022/4/e33974 %U https://doi.org/10.2196/33974 %U http://www.ncbi.nlm.nih.gov/pubmed/35404255 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 4 %P e32435 %T The Effectiveness of Wearable Devices as Physical Activity Interventions for Preventing and Treating Obesity in Children and Adolescents: Systematic Review and Meta-analysis %A Wang,Wentao %A Cheng,Jing %A Song,Weijun %A Shen,Yi %+ Department of Basic Education, Zhejiang Tongji Vocational College of Science and Technology, Number 418, Gengwen Road, Xiaoshan District, Hangzhou, 311231, China, 86 15068156990, 371457623@qq.com %K wearable devices %K obesity %K children %K adolescents %K meta-analysis %D 2022 %7 8.4.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The prevalence of obesity in children and adolescents remains a global public health issue. Wearable devices may offer new opportunities for prevention and intervention in obesity. Previous systematic reviews have only examined the effect of the wearable device interventions on preventing and treating obesity in adults. However, no systematic review has provided an evaluation of wearable devices as physical activity interventions for preventing and treating obesity in children and adolescents. Objective: The purpose of this review and meta-analysis was to evaluate the effectiveness of wearable devices as physical activity interventions on obesity-related anthropometric outcomes in children and adolescents. Methods: Research articles retrieved from PubMed, EMBASE, Cochrane Library, Scopus, and EBSCO from inception to February 1, 2021, were reviewed. The search was designed to identify studies utilizing wearable devices for preventing and treating obesity in children and adolescents. The included studies were evaluated for risk of bias following the Cochrane recommendation. Meta-analyses were conducted to evaluate the effectiveness of wearable devices as physical activity interventions on body weight, body fat, BMI z-score (BMI-Z), BMI, and waist circumference. Subgroup analyses were performed to determine whether the characteristics of the interventions had an impact on the effect size. Results: A total of 12 randomized controlled trials (3227 participants) were selected for meta-analysis. Compared with the control group, wearable device interventions had statistically significant beneficial effects on BMI (mean difference [MD] –0.23; 95% CI –0.43 to –0.03; P=.03; I2=2%), BMI-Z (MD –0.07; 95% CI –0.13 to –0.01; P=.01; I2=81%), body weight (MD –1.08; 95% CI –2.16 to –0.00; P=.05; I2=58%), and body fat (MD –0.72; 95% CI –1.19 to –0.25; P=.003; I2=5%). However, no statistically significant effect was found on waist circumference (MD 0.55; 95% CI –0.21 to 1.32; P=.16; I2=0%). The subgroup analysis showed that for participants with overweight or obesity (MD –0.75; 95% CI –1.18 to –0.31; P<.01; I2=0%), in the short-term (MD –0.62; 95% CI –1.03 to –0.21; P<.01; I2=0%), wearable-based interventions (MD –0.56; 95% CI –0.95 to –0.18; P<.01; I2=0%) generally resulted in greater intervention effect size on BMI. Conclusions: Evidence from this meta-analysis shows that wearable devices as physical activity interventions may be useful for preventing and treating obesity in children and adolescents. Future research is needed to identify the most effective physical activity indicators of wearable devices to prevent and treat obesity in children and adolescents. %M 35394447 %R 10.2196/32435 %U https://mhealth.jmir.org/2022/4/e32435 %U https://doi.org/10.2196/32435 %U http://www.ncbi.nlm.nih.gov/pubmed/35394447 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 4 %P e35479 %T The Effectiveness of Combining Nonmobile Interventions With the Use of Smartphone Apps With Various Features for Weight Loss: Systematic Review and Meta-analysis %A Antoun,Jumana %A Itani,Hala %A Alarab,Natally %A Elsehmawy,Amir %+ American University of Beirut, Riad El-Solh, Beirut, 110236, Lebanon, 961 3486509, ja46@aub.edu.lb %K obesity %K weight loss %K mobile app %K self-monitoring %K behavioral %K tracker %K behavioral coaching %K coach %K dietitian %K mobile phone %D 2022 %7 8.4.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The effectiveness of smartphone apps for weight loss is limited by the diversity of interventions that accompany such apps. This research extends the scope of previous systematic reviews by including 2 subgroup analyses based on nonmobile interventions that accompanied smartphone use and human-based versus passive behavioral interventions. Objective: The primary objective of this study is to systematically review and perform a meta-analysis of studies that evaluated the effectiveness of smartphone apps on weight loss in the context of other interventions combined with app use. The secondary objective is to measure the impact of different mobile app features on weight loss and mobile app adherence. Methods: We conducted a systematic review and meta-analysis of relevant studies after an extensive search of the PubMed, MEDLINE, and EBSCO databases from inception to January 31, 2022. Gray literature, such as abstracts and conference proceedings, was included. Working independently, 2 investigators extracted the data from the articles, resolving disagreements by consensus. All randomized controlled trials that used smartphone apps in at least 1 arm for weight loss were included. The weight loss outcome was the change in weight from baseline to the 3- and 6-month periods for each arm. Net change estimates were pooled across the studies using random-effects models to compare the intervention group with the control group. The risk of bias was assessed independently by 2 authors using the Cochrane Collaboration tool for assessing the risk of bias in randomized trials. Results: Overall, 34 studies were included that evaluated the use of a smartphone app in at least 1 arm. Compared with controls, the use of a smartphone app–based intervention showed a significant weight loss of –1.99 kg (95% CI –2.19 to –1.79 kg; I2=81%) at 3 months and –2.80 kg (95% CI –3.03 to –2.56 kg; I2=91%) at 6 months. In the subgroup analysis, based on the various intervention components that were added to the mobile app, the combination of the mobile app, tracker, and behavioral interventions showed a statistically significant weight loss of –2.09 kg (95% CI –2.32 to –1.86 kg; I2=91%) and –3.77 kg (95% CI –4.05 to –3.49 kg; I2=90%) at 3 and 6 months, respectively. When a behavioral intervention was present, only the combination of the mobile app with intensive behavior coaching or feedback by a human coach showed a statistically significant weight loss of –2.03 kg (95% CI –2.80 to –1.26 kg; I2=83%) and –2.63 kg (95% CI –2.97 to –2.29 kg; I2=91%) at 3 and 6 months, respectively. Neither the type nor the number of mobile app features was associated with weight loss. Conclusions: Smartphone apps have a role in weight loss management. Nevertheless, the human-based behavioral component remained key to higher weight loss results. %M 35394443 %R 10.2196/35479 %U https://mhealth.jmir.org/2022/4/e35479 %U https://doi.org/10.2196/35479 %U http://www.ncbi.nlm.nih.gov/pubmed/35394443 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e33307 %T Human Support in App-Based Cognitive Behavioral Therapies for Emotional Disorders: Scoping Review %A Bernstein,Emily E %A Weingarden,Hilary %A Wolfe,Emma C %A Hall,Margaret D %A Snorrason,Ivar %A Wilhelm,Sabine %+ Massachusetts General Hospital, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, United States, 1 6177246032, eebernstein@mgh.harvard.edu %K digital health %K mental health %K cognitive behavioral therapy %K coaching %K guided %K mobile app %K emotional disorder %K mobile phone %D 2022 %7 8.4.2022 %9 Review %J J Med Internet Res %G English %X Background: Smartphone app–based therapies offer clear promise for reducing the gap in available mental health care for people at risk for or people with mental illness. To this end, as smartphone ownership has become widespread, app-based therapies have become increasingly common. However, the research on app-based therapies is lagging behind. In particular, although experts suggest that human support may be critical for increasing engagement and effectiveness, we have little systematic knowledge about the role that human support plays in app-based therapy. It is critical to address these open questions to optimally design and scale these interventions. Objective: The purpose of this study is to provide a scoping review of the use of human support or coaching in app-based cognitive behavioral therapy for emotional disorders, identify critical knowledge gaps, and offer recommendations for future research. Cognitive behavioral therapy is the most well-researched treatment for a wide range of concerns and is understood to be particularly well suited to digital implementations, given its structured, skill-based approach. Methods: We conducted systematic searches of 3 databases (PubMed, PsycINFO, and Embase). Broadly, eligible articles described a cognitive behavioral intervention delivered via smartphone app whose primary target was an emotional disorder or problem and included some level of human involvement or support (coaching). All records were reviewed by 2 authors. Information regarding the qualifications and training of coaches, stated purpose and content of the coaching, method and frequency of communication with users, and relationship between coaching and outcomes was recorded. Results: Of the 2940 titles returned by the searches, 64 (2.18%) were eligible for inclusion. This review found significant heterogeneity across all of the dimensions of coaching considered as well as considerable missing information in the published articles. Moreover, few studies had qualitatively or quantitatively evaluated how the level of coaching impacts treatment engagement or outcomes. Although users tend to self-report that coaching improves their engagement and outcomes, there is limited and mixed supporting quantitative evidence at present. Conclusions: Digital mental health is a young but rapidly expanding field with great potential to improve the reach of evidence-based care. Researchers across the reviewed articles offered numerous approaches to encouraging and guiding users. However, with the relative infancy of these treatment approaches, this review found that the field has yet to develop standards or consensus for implementing coaching protocols, let alone those for measuring and reporting on the impact. We conclude that coaching remains a significant hole in the growing digital mental health literature and lay out recommendations for future data collection, reporting, experimentation, and analysis. %M 35394434 %R 10.2196/33307 %U https://www.jmir.org/2022/4/e33307 %U https://doi.org/10.2196/33307 %U http://www.ncbi.nlm.nih.gov/pubmed/35394434 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 4 %P e29510 %T Demographic Imbalances Resulting From the Bring-Your-Own-Device Study Design %A Cho,Peter Jaeho %A Yi,Jaehan %A Ho,Ethan %A Shandhi,Md Mobashir Hasan %A Dinh,Yen %A Patil,Aneesh %A Martin,Leatrice %A Singh,Geetika %A Bent,Brinnae %A Ginsburg,Geoffrey %A Smuck,Matthew %A Woods,Christopher %A Shaw,Ryan %A Dunn,Jessilyn %+ Department of Biomedical Engineering, Duke University, Room 1427, Fitzpatrick Center (FCIEMAS), 101 Science Drive, Durham, NC, 27708-0281, United States, 1 919 660 5131, jessilyn.dunn@duke.edu %K bring your own device %K wearable device %K mHealth %D 2022 %7 8.4.2022 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Digital health technologies, such as smartphones and wearable devices, promise to revolutionize disease prevention, detection, and treatment. Recently, there has been a surge of digital health studies where data are collected through a bring-your-own-device (BYOD) approach, in which participants who already own a specific technology may voluntarily sign up for the study and provide their digital health data. BYOD study design accelerates the collection of data from a larger number of participants than cohort design; this is possible because researchers are not limited in the study population size based on the number of devices afforded by their budget or the number of people familiar with the technology. However, the BYOD study design may not support the collection of data from a representative random sample of the target population where digital health technologies are intended to be deployed. This may result in biased study results and biased downstream technology development, as has occurred in other fields. In this viewpoint paper, we describe demographic imbalances discovered in existing BYOD studies, including our own, and we propose the Demographic Improvement Guideline to address these imbalances. %M 34913871 %R 10.2196/29510 %U https://mhealth.jmir.org/2022/4/e29510 %U https://doi.org/10.2196/29510 %U http://www.ncbi.nlm.nih.gov/pubmed/34913871 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e32157 %T Using the Stay Strong App for the Well-being of Indigenous Australian Prisoners: Feasibility Study %A Perdacher,Elke %A Kavanagh,David %A Sheffield,Jeanie %A Healy,Karyn %A Dale,Penny %A Heffernan,Edward %+ Queensland Forensic Mental Health Service, GPO Box 8161, Brisbane, 4001, Australia, 61 7 3837 5820, elke.perdacher@health.qld.gov.au %K First Nation %K Indigenous %K digital mental health %K e-mental health %K mental health %K social and emotional well-being %K SEWB %K prisoner %K prison %K mobile phone %D 2022 %7 8.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The gap between mental health needs and resources for Aboriginal and Torres Strait Islander people, the Indigenous people of Australia, is most marked in the prison population. Indigenous people are overrepresented in Australian prisons. In prison, this group experiences mental disorders to a greater degree than non-Indigenous prisoners. This group has also been found to experience mental disorder at a higher rate than Indigenous people in the community. In addition to pre-existing determinants of poor mental health, these high prevalence rates may reflect poor engagement in mainstream interventions or the efficacy of available interventions. In community populations, the use of digital mental health resources may help to increase access to well-being support. However, culturally appropriate digital tools have not been available to Indigenous people in prisons. The absence of feasibility and efficacy studies of these tools needs to be addressed. Objective: The aim of this study is to determine the feasibility of the Stay Strong app as a digital well-being and mental health tool for use by Indigenous people in prison. Methods: Dual government agency (health and corrective services) precondition requirements of implementation were identified and resolved. This was essential given that the Stay Strong app was to be delivered by an external health agency to Indigenous prisoners. Then, acceptability at a practice level was tested using postuse qualitative interviews with clients and practitioners of the Indigenous Mental Health Intervention Program. All Indigenous Mental Health Intervention Program practitioners (10/37, 27%) and client participants who had completed their second follow-up (review of the Stay Strong app; 27/37, 73%) during the study period were invited to participate. Results: Owing to the innovative nature of this project, identifying and resolving the precondition requirements of implementation was challenging but provided support for the implementation of the app in practice. Acceptability of the app by clients and practitioners at a practice level was demonstrated, with nine themes emerging across the interviews: satisfaction with the current Stay Strong app, supported client goal setting, increased client self-insight, improved client empowerment, cultural appropriateness, enhanced engagement, ease of use, problems with using an Android emulator, and recommendations to improve personalization. Conclusions: The Stay Strong Custody Project is a pioneering example of digital mental health tools being implemented within Australian prisons. Using the app within high-security prison settings was found to be feasible at both strategic and practice levels. Feedback from both clients and practitioners supported the use of the app as a culturally safe digital mental health and well-being tool for Aboriginal and Torres Strait Islander people in prison. %M 35394444 %R 10.2196/32157 %U https://formative.jmir.org/2022/4/e32157 %U https://doi.org/10.2196/32157 %U http://www.ncbi.nlm.nih.gov/pubmed/35394444 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e27387 %T Impact of SMS Text Messaging Reminders on Helmet Use Among Motorcycle Drivers in Dar es Salaam, Tanzania: Randomized Controlled Trial %A Campbell,Benjamin %A Heitner,Jesse %A Amos Mwelelo,Peter %A Fogel,Alexis %A Mujumdar,Vaidehi %A Adams,Lisa V %A Boniface,Respicious %A Su,Yanfang %+ International Clinical Research Center, Department of Global Health, University of Washington, 908 Jefferson St, Seattle, WA, 98104, United States, 1 510 220 4266, jah495@mail.harvard.edu %K road traffic injury %K behavior change %K SMS reminders %K mobile health %K vehicle safety %K mHealth %K SMS %K traffic injuries %K transportation %K public transportation %K safety %K automotive %K automotive safety %D 2022 %7 7.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Road traffic injury is a pressing public health issue in Tanzania. Increasing helmet use among motorcycle drivers can help reduce the burden due to road traffic injuries in the country. Helmet adherence can be supported through mobile health interventions. Objective: The aim of this study is to evaluate the comparative impact of two different types of SMS text messaging reminders on motorcycle helmet use. Methods: Participants were 391 commercial motorcycle taxi drivers in Dar es Salaam, Tanzania. Participants were randomized into three groups, each receiving a different set of messages: (1) social norming messages aimed at emphasizing society’s positive stance on helmet wearing, (2) fear appeal messages that emphasized the dangers of riding without a helmet, and (3) control group messages, which included basic road safety messages unrelated to helmet use. Every participant received the control messages. Adherence to helmet use was evaluated by self-report through surveys conducted at baseline, 3 weeks, and 6 weeks. Results: At 6 weeks, the odds of self-reporting consistent helmet use were estimated to be 1.58 times higher in the social norming group than in the control group (P=.04), though this difference was not significant after accounting for multiple testing. There was little difference between fear appeal and control group recipients (odds ratio 1.03, P=.47). Subgroup analysis suggests that both fear appeal and social norming message types might have been associated with increased helmet use among participants who did not consistently wear helmets at baseline (odds ratio 1.66 and odds ratio 1.84, respectively), but this was not significant (P=.11 and P=.07, respectively). Among those who were consistent wearers at baseline, the social norming messages performed better than the fear appeal messages, and this difference reached traditional significance (P=.03), but was not significant after accounting for multiple testing. Conclusions: The use of SMS text messaging reminders may improve helmet use among motorcycle drivers when framed as social norming messages. Given that nearly half of the drivers in our sample did not consistently wear their helmets on every trip, strategies to increase consistent usage could greatly benefit public safety. Trial Registration: ClinicalTrials.gov NCT02120742; https://clinicaltrials.gov/ct2/show/NCT02120742 %M 35389364 %R 10.2196/27387 %U https://www.jmir.org/2022/4/e27387 %U https://doi.org/10.2196/27387 %U http://www.ncbi.nlm.nih.gov/pubmed/35389364 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e34662 %T A Personalized Smartphone-Delivered Just-in-time Adaptive Intervention (JitaBug) to Increase Physical Activity in Older Adults: Mixed Methods Feasibility Study %A Mair,Jacqueline Louise %A Hayes,Lawrence D %A Campbell,Amy K %A Buchan,Duncan S %A Easton,Chris %A Sculthorpe,Nicholas %+ Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, 1 Create Way, Singapore, 138602, Singapore, 65 6601 6076, jacqueline.mair@sec.ethz.ch %K mobile health %K mHealth %K sedentary lifestyle %K digital health intervention %K intervention design %K feasibility study %K aging %K mobile phone %D 2022 %7 7.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Just-in-time adaptive interventions (JITAIs) provide real time in-the-moment behavior change support to people when they need it most. JITAIs could be a viable way to provide personalized physical activity (PA) support to older adults in the community. However, it is unclear how feasible it is to remotely deliver a PA intervention through a smartphone to older adults or how acceptable they would find a JITAI targeting PA in everyday life. Objective: The aims of this study are to describe the development of JitaBug, a personalized smartphone-delivered JITAI designed to support older adults to increase or maintain their PA level, assess the feasibility of conducting an effectiveness trial of the JitaBug intervention, and explore the acceptability of JitaBug among older adults in a free-living setting. Methods: The intervention was developed using the Behavior Change Wheel and consisted of a wearable activity tracker (Fitbit) and a companion smartphone app (JitaBug) that delivered goal-setting, planning, reminders, and JITAI messages to encourage achievement of personalized PA goals. Message delivery was tailored based on time of day, real time PA tracker data, and weather conditions. We tested the feasibility of remotely delivering the intervention with older adults in a 6-week trial. Data collection involved assessment of PA through accelerometery and activity tracker, self-reported mood and mental well-being through ecological momentary assessment, and contextual information on PA through voice memos. Feasibility outcomes included recruitment capability and adherence to the intervention, intervention delivery in the wild, appropriateness of data collection methodology, adverse events, and participant satisfaction. Results: Of the 46 recruited older adults (aged 56-72 years), 31 (67%) completed the intervention. The intervention was successfully delivered as intended; 87% (27/31) of the participants completed the intervention independently; 94% (2247/2390) of the PA messages were successfully delivered; 99% (2239/2261) of the Fitbit and 100% (2261/2261) of the weather data calls were successful. Valid and usable wrist-worn accelerometer data were obtained from 90% (28/31) of the participants at baseline and follow-up. On average, the participants recorded 50% (7.9/16, SD 7.3) of the voice memos, 38% (3.3/8, SD 4.2) of the mood assessments, and 50% (2.1/4, SD 1.6) of the well-being assessments through the app. Overall acceptability of the intervention was very good (23/30, 77% expressed satisfaction). Participant feedback suggested that more diverse and tailored PA messages, app use reminders, technical refinements, and an improved user interface could improve the intervention and make it more appealing. Conclusions: This study suggests that a smartphone-delivered JITAI is an acceptable way to support PA in older adults in the community. Overall, the intervention is feasible; however, based on user feedback, the JitaBug app requires further technical refinements that may enhance use, engagement, and user satisfaction before moving to effectiveness trials. %M 35389348 %R 10.2196/34662 %U https://formative.jmir.org/2022/4/e34662 %U https://doi.org/10.2196/34662 %U http://www.ncbi.nlm.nih.gov/pubmed/35389348 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 4 %P e27061 %T eHealth Interventions to Address HIV and Other Sexually Transmitted Infections, Sexual Risk Behavior, Substance Use, and Mental Ill-health in Men Who Have Sex With Men: Systematic Review and Meta-analysis %A Melendez-Torres,GJ %A Meiksin,Rebecca %A Witzel,T Charles %A Weatherburn,Peter %A Falconer,Jane %A Bonell,Chris %+ University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, United Kingdom, 44 07847360259, g.j.melendez-torres@exeter.ac.uk %K men who have sex with men %K HIV and sexually transmitted infections %K mental health %K substance use %K mobile apps %K HIV %K eHealth %K electronic media %K mobile phone apps %K sexual risk %D 2022 %7 6.4.2022 %9 Review %J JMIR Public Health Surveill %G English %X Background: Men who have sex with men experience disproportionately high levels of HIV and other sexually transmitted infections (STIs), sexual risk behavior, substance use, and mental ill-health. These experiences are interrelated, and these interrelations are potentiated by structural conditions of discrimination, stigma, and unequal access to appropriate health services, and they magnify each other and have intersecting causal pathways, worsening both risk for each condition and risk for the negative sequelae of each condition. eHealth interventions could address these issues simultaneously and thus have wide-ranging and greater effects than would be for any 1 outcome alone. Objective: We systematically reviewed the evidence for the effectiveness of eHealth interventions in addressing these outcomes separately or together. Methods: We searched 19 databases for randomized trials of interactive or noninteractive eHealth interventions delivered via mobile phone apps, internet, or other electronic media to populations consisting entirely or principally of men who have sex with men to prevent HIV, STIs, sexual risk behavior, alcohol and drug use, or common mental illnesses. We extracted data and appraised each study, estimated meta-analyses where possible by using random effects and robust variance estimation, and assessed the certainty of our findings (closeness of the estimated effect to the true effect) by using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). Results: We included 14 trials, of which 13 included active versus control comparisons; none reported mental health outcomes, and all drew from 12 months or less of follow-up postintervention. Findings for STIs drew on low numbers of studies and did not suggest consistent short-term (<3 months postintervention; d=0.17, 95% CI –0.18 to 0.52; I2=0%; 2 studies) or midterm (3-12 months postintervention, no meta-analysis, 1 study) evidence of effectiveness. Eight studies considering sexual risk behavior outcomes suggested a short-term, nonsignificant reduction (d=–0.14, 95% CI –0.30 to 0.03) with very low certainty, but 6 studies reporting midterm follow-ups suggested a significant impact on reducing sexual risk behavior (d=–0.12, 95% CI –0.19 to –0.05) with low certainty. Meta-analyses could not be undertaken for alcohol and drug use (2 heterogeneous studies) or for HIV infections (1 study for each of short-term or midterm follow-up), and alcohol outcomes alone were not captured in the included studies. Certainty was graded as low to very low for most outcomes, including all meta-analyses. Conclusions: To create a comprehensive eHealth intervention that targets multiple outcomes, intervention evaluations should seek to generalize both mechanisms and components that are successfully used to achieve change in 1 outcome over multiple outcomes. However, additional evaluations of interventions seeking to address outcomes other than sexual risk behavior are needed before development and evaluation of a joined-up intervention. %M 35384845 %R 10.2196/27061 %U https://publichealth.jmir.org/2022/4/e27061 %U https://doi.org/10.2196/27061 %U http://www.ncbi.nlm.nih.gov/pubmed/35384845 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e34425 %T Use of a Paid Digital Marketing Campaign to Promote a Mobile Health App to Encourage Parent-Engaged Developmental Monitoring: Implementation Study %A Arshanapally,Suraj %A Green,Katie %A Slaughter,Karnesha %A Muller,Robert %A Wheaton,Demeika %+ National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, Mail Stop S106-4, Atlanta, GA, United States, 1 404 498 1007, otv1@cdc.gov %K health communication %K health promotion %K internet %K social media %K child development %K mobile health %K pediatrics %K parenting %K early child development %K developmental disability %K mobile phone %D 2022 %7 5.4.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The internet has become an increasingly popular medium for parents to obtain health information. More studies investigating the impact of paid digital marketing campaigns for parents on promoting children’s healthy development are needed. Objective: This study aims to explore the outcomes of a paid digital marketing campaign, which occurred from 2018 to 2020, to promote messages about parent-engaged developmental monitoring and ultimately direct parents to the Centers for Disease Control and Prevention’s (CDC’s) Milestone Tracker app, a mobile health (mHealth) app developed by the CDC. Methods: The paid digital marketing campaign occurred in 3 phases from 2018 to 2020. In each phase, 24 to 36 marketing messages, in English and Spanish, were created and disseminated using Google’s Universal App Campaigns and Facebook Ads Manager. Outcomes were measured using impressions, clicks, and install data. Return on investment was measured using click-through rate (CTR), cost per click, and cost per install metrics. Results: The Google-driven marketing messages garnered a total of 4,879,722 impressions (n=1,991,250, 40.81% for English and n=2,888,472, 59.19% for Spanish). The messages resulted in a total of 73,956 clicks (n=44,328, 59.94% for English and n=29,628, 40.06% for Spanish), with a total average CTR of 1.52% (2.22% for English and 1.03% for Spanish). From these clicks, there were 13,707 installs (n=9765, 71.24% for English and n=3942, 28.76% for Spanish) of the CDC’s Milestone Tracker app on Google Play Store. The total average cost per install was US $0.93 across all phases. The phase 3 headline “Track your child’s development” generated the highest CTR of 3.23% for both English and Spanish audiences. The Facebook-driven marketing messages garnered 2,434,320 impressions (n=1,612,934, 66.26% for English and n=821,386, 33.74% for Spanish). The messages resulted in 44,698 clicks (n=33,353, 74.62% for English and n=11,345, 25.38% for Spanish), with an average CTR of 1.84% (2.07% for English and 1.38% for Spanish). In all 3 phases, animated graphics generated the greatest number of clicks among both English and Spanish audiences on Facebook when compared with other types of images. Conclusions: These paid digital marketing campaigns can increase targeted message exposure about parent-engaged developmental monitoring and direct a parent audience to an mHealth app. Digital marketing platforms provide helpful metrics that can be used to assess the reach, engagement, and cost-effectiveness of this effort. The results from this study suggest that paid digital marketing can be an effective strategy and can inform future digital marketing activities to promote mHealth apps targeting parents of young children. %M 35380545 %R 10.2196/34425 %U https://pediatrics.jmir.org/2022/2/e34425 %U https://doi.org/10.2196/34425 %U http://www.ncbi.nlm.nih.gov/pubmed/35380545 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 4 %P e33527 %T The Implementation of Behavior Change Techniques in mHealth Apps for Sleep: Systematic Review %A Arroyo,Amber Carmen %A Zawadzki,Matthew J %+ Department of Psychological Sciences, University of California, 5200 N Lake Road, Merced, CA, 95343, United States, 1 209 228 4787, aarroyo22@ucmerced.edu %K behavior change techniques %K sleep %K mHealth %K apps %K digital health %K mobile phone %D 2022 %7 4.4.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps targeting health behaviors using behavior change techniques (BCTs) have been successful in promoting healthy behaviors; however, their efficacy with sleep is unclear. Some work has shown success in promoting sleep through mHealth, whereas there have been reports that sleep apps can be adverse and lead to unhealthy obsessions with achieving perfect sleep. Objective: This study aims to report and describe the use of BCTs in mHealth apps for sleep with the following research questions: How many BCTs are used on average in sleep apps, and does this relate to their effectiveness on sleep outcomes? Are there specific BCTs used more or less often in sleep apps, and does this relate to their effectiveness on sleep outcomes? Does the effect of mHealth app interventions on sleep change when distinguishing between dimension and measurement of sleep? Methods: We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to review articles on mHealth app interventions for sleep published between 2010 and 2020. Results: A total of 12 studies met the eligibility criteria. Most studies reported positive sleep outcomes, and there were no negative effects reported. Sleep quality was the most common dimension of sleep targeted. Subjective measures of sleep were used across all apps, whereas objective measures were often assessed but rarely reported as part of results. The average number of BCTs used was 7.67 (SD 2.32; range 3-11) of 16. Of the 12 studies, the most commonly used BCTs were feedback and monitoring (n=11, 92%), shaping knowledge (n=11, 92%), goals and planning (n=10, 83%), and antecedents (n=10, 83%), whereas the least common were scheduled consequences (n=0, 0%), self-belief (n=0, 0%), and covert learning (n=0, 0%). Most apps used a similar set of BCTs that unfortunately did not allow us to distinguish which BCTs were present when studies reported more positive outcomes. Conclusions: Our study describes the peer-reviewed literature on sleep apps and provides a foundation for further examination and optimization of BCTs used in mHealth apps for sleep. We found strong evidence that mHealth apps are effective in improving sleep, and the potential reasons for the lack of adverse sleep outcome reporting are discussed. We found evidence that the type of BCTs used in mHealth apps for sleep differed from other health outcomes, although more research is needed to understand how BCTs can be implemented effectively to improve sleep using mHealth and the mechanisms of action through which they are effective (eg, self-efficacy, social norms, and attitudes). %M 35377327 %R 10.2196/33527 %U https://mhealth.jmir.org/2022/4/e33527 %U https://doi.org/10.2196/33527 %U http://www.ncbi.nlm.nih.gov/pubmed/35377327 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e36849 %T Adaptive Text Messaging for Postpartum Risky Drinking: Conceptual Model and Protocol for an Ecological Momentary Assessment Study %A Dauber,Sarah %A Beacham,Alexa %A Hammond,Cori %A West,Allison %A Thrul,Johannes %+ Partnership to End Addiction, 711 Third Avenue, New York, NY, 10017, United States, 1 212 841 5270, sdauber@toendaddiction.org %K postpartum %K alcohol use %K risky drinking %K mobile health %K ecologic momentary assessment %K mobile phone %D 2022 %7 4.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Risky drinking is prevalent among women of childbearing age. Although many women reduce their drinking during pregnancy, more than half return to prepregnancy levels during the early postpartum period. Risky drinking in new mothers may be associated with negative child and maternal health outcomes; however, new mothers are unlikely to seek treatment for risky drinking because of stigma and fear of child protective service involvement. SMS text messaging is a promising approach for reaching non–treatment-seeking new mothers at risk because of risky drinking. SMS text messaging interventions (TMIs) are empirically supported for alcohol use, but a tailored intervention for new mothers does not exist. This study aims to fill this gap by developing a just-in-time adaptive TMI for postpartum risky drinking. Objective: The objectives of this paper are to present a preliminary conceptual model of postpartum risky drinking and describe the protocol for conducting an ecological momentary assessment (EMA) study with new mothers to inform the refinement of the conceptual model and development of the TMI. Methods: This paper presents a preliminary conceptual model of postpartum risky drinking based on the motivational model of alcohol use, social cognitive theory, and temporal self-regulation theory. The model proposes three primary intervention targets: motivation, self-efficacy, and self-regulation. Theoretical and empirical literature in support of the conceptual model is described. The paper also describes procedures for a study that will collect EMA data from 30 participants recruited via social media and the perinatal Central Intake system of New Jersey. Following the baseline assessment, EMA surveys will be sent 5 times per day for 14 days. The assessment instruments and data analysis procedures are described. Results: Recruitment is scheduled to begin in January 2022 and is anticipated to conclude in March 2022. Study results are estimated to be published in July 2022. Conclusions: The study findings will enhance our understanding of daily and momentary fluctuations in risk and protective factors for risky drinking during the early postpartum period. The findings will be used to refine the conceptual model and inform the development of the TMI. The next steps for this work include the development of intervention components via an iterative participatory design process and testing of the resulting intervention in a pilot microrandomized trial. International Registered Report Identifier (IRRID): PRR1-10.2196/36849 %M 35373778 %R 10.2196/36849 %U https://www.researchprotocols.org/2022/4/e36849 %U https://doi.org/10.2196/36849 %U http://www.ncbi.nlm.nih.gov/pubmed/35373778 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 4 %P e28811 %T Usability of Smart Home Thermostat to Evaluate the Impact of Weekdays and Seasons on Sleep Patterns and Indoor Stay: Observational Study %A Jalali,Niloofar %A Sahu,Kirti Sundar %A Oetomo,Arlene %A Morita,Plinio Pelegrini %+ School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567 ext 31372, plinio.morita@uwaterloo.ca %K public health %K Internet of Things (IoT) %K big data %K sleep monitoring %K health monitoring %K mobile phone %D 2022 %7 1.4.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Sleep behavior and time spent at home are important determinants of human health. Research on sleep patterns has traditionally relied on self-reported data. Not only does this methodology suffer from bias but the population-level data collection is also time-consuming. Advances in smart home technology and the Internet of Things have the potential to overcome these challenges in behavioral monitoring. Objective: The objective of this study is to demonstrate the use of smart home thermostat data to evaluate household sleep patterns and the time spent at home and how these behaviors are influenced by different weekdays and seasonal variations. Methods: From the 2018 ecobee Donate your Data data set, 481 North American households were selected based on having at least 300 days of data available, equipped with ≥6 sensors, and having a maximum of 4 occupants. Daily sleep cycles were identified based on sensor activation and used to quantify sleep time, wake-up time, sleep duration, and time spent at home. Each household’s record was divided into different subsets based on seasonal, weekday, and seasonal weekday scales. Results: Our results demonstrate that sleep parameters (sleep time, wake-up time, and sleep duration) were significantly influenced by the weekdays. The sleep time on Fridays and Saturdays is greater than that on Mondays, Wednesdays, and Thursdays (n=450; P<.001; odds ratio [OR] 1.8, 95% CI 1.5-3). There is significant sleep duration difference between Fridays and Saturdays and the rest of the week (n=450; P<.001; OR 1.8, 95% CI 1.4-2). Consequently, the wake-up time is significantly changing between weekends and weekdays (n=450; P<.001; OR 5.6, 95% CI 4.3-6.3). The results also indicate that households spent more time at home on Sundays than on the other weekdays (n=445; P<.001; OR 2.06, 95% CI 1.64-2.5). Although no significant association is found between sleep parameters and seasonal variation, the time spent at home in the winter is significantly greater than that in summer (n=455; P<.001; OR 1.6, 95% CI 1.3-2.3). These results are in accordance with existing literature. Conclusions: This is the first study to use smart home thermostat data to monitor sleep parameters and time spent at home and their dependence on weekday, seasonal, and seasonal weekday variations at the population level. These results provide evidence of the potential of using Internet of Things data to help public health officials understand variations in sleep indicators caused by global events (eg, pandemics and climate change). %M 35363147 %R 10.2196/28811 %U https://mhealth.jmir.org/2022/4/e28811 %U https://doi.org/10.2196/28811 %U http://www.ncbi.nlm.nih.gov/pubmed/35363147 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e33493 %T Smartphone Alcohol Use Disorder Recovery Apps: Cross-sectional Survey of Behavioral Intention to Use %A Menon,Rijuta %A Meyer,Julien %A Nippak,Pria %A Begum,Housne %+ School of Health Services Management, Ted Rogers School of Management, Ryerson University, 350 Victoria Street, Office: TRS 3-081, Toronto, ON, M5B 2K3, Canada, 1 4169951338, julien.meyer@ryerson.ca %K mobile health %K alcohol use disorder %K disease management %K mobile apps %K Unified Theory of Acceptance and Use of Technology %D 2022 %7 1.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Alcohol use disorder (AUD) carries a huge health and economic cost to society. Effective interventions exist but numerous challenges limit their adoption, especially in a pandemic context. AUD recovery apps (AUDRA) have emerged as a potential complement to in-person interventions. They are easy to access and show promising results in terms of efficacy. However, they rely on individual adoption decisions and remain underused. Objective: The aim of this survey study is to explore the beliefs that determine the intention to use AUDRA. Methods: We conducted a cross-sectional survey study of people with AUD. We used the Unified Theory of Acceptance and Use of Technology, which predicts use and behavioral intention to use based on performance expectancy, effort expectancy, social influence, and facilitating conditions. Participants were recruited directly from 2 sources; first, respondents at addiction treatment facilities in Ontario, Canada, were contacted in person, and they filled a paper form; second, members from AUD recovery support groups on social media were contacted and invited to fill an internet-based survey. The survey was conducted between October 2019 and June 2020. Results: The final sample comprised 159 participants (124 involved in the web-based survey and 35 in the paper-based survey) self-identifying somewhat or very much with AUD. Most participants (n=136, 85.5%) were aware of AUDRA and those participants scored higher on performance expectancy, effort expectancy, and social influence. Overall, the model explains 35.4% of the variance in the behavioral intention to use AUDRA and 11.1% of the variance in use. Social influence (P=.31), especially for women (P=.23), and effort expectancy (P=.25) were key antecedents of behavioral intention. Facilitating conditions were not significant overall but were moderated by age (P=.23), suggesting that it matters for older participants. Performance expectancy did not predict behavioral intention, which is unlike many other technologies but confirms other findings associated with mobile health (mHealth). Open-ended questions suggest that privacy concerns may significantly influence the use of AUDRA. Conclusions: This study suggests that unlike many other technologies, the adoption of AUDRA is not mainly determined by utilitarian factors such as performance expectancy. Rather, effort expectancy and social influence play a key role in determining the intention to use AUDRA. %M 35363145 %R 10.2196/33493 %U https://humanfactors.jmir.org/2022/2/e33493 %U https://doi.org/10.2196/33493 %U http://www.ncbi.nlm.nih.gov/pubmed/35363145 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e33783 %T Efficacy of a Digital Acceptance and Commitment Therapy Intervention for the Improvement of Self-management Behaviors and Psychological Flexibility in Adults With Cardiac Disease: Protocol for a Single Case Experimental Design %A Moran,Orla %A Doyle,Julie %A Giggins,Oonagh %A McHugh,Louise %A Gould,Evelyn %A Smith,Suzanne %A Gavin,Shane %A Sojan,Nisanth %A Boyle,Gordon %+ NetwellCASALA, Dundalk Institute of Technology, PJ Carroll Building, Dublin Road, Dundalk, A91 K584, Ireland, 353 429370400 ext 2074, orla.moran@dkit.ie %K cardiac disease %K acceptance and commitment therapy %K distress management %K self-management %K single case experimental design %K digital health %D 2022 %7 1.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Research indicates that the management of distress levels in those with cardiac disease is not only important for improving quality of life and functioning but also critical for condition management; adherence to treatment; and, ultimately, disease prognosis and progression. Acceptance and commitment therapy (ACT) has consistently demonstrated positive long-term outcomes across a wide array of conditions, including chronic illness. However, most empirical investigations conducted to date have also involved in-person therapy, which can be difficult to access, particularly for those dealing with the demands of chronic disease. Objective: The objective of our research is to evaluate a digital ACT intervention for improving self-management behaviors and distress levels in those with cardiac conditions. Methods: The digital ACT intervention will be delivered via a digital health self-management platform over 6 sessions. This will involve a randomized, multiple baseline, single case experimental design with approximately 3 to 15 adults with cardiac disease. The independent variable for each participant will be the pre-post intervention phase. The dependent variables will be a daily self-report measure of psychological flexibility as well as objective measures of condition self-management (eg, blood pressure readings) and engagement with the app (eg, completing guided mindfulness). One-to-one qualitative interviews will also be conducted to further examine participants’ experiences with using the intervention and what factors contribute to or impede successful outcomes. Results: Participant recruitment and data collection began in October 2021, and it is projected that the study findings will be available for dissemination by spring 2022. Conclusions: The findings will be discussed in terms of how a digital ACT intervention can best meet the needs of cardiac patients. International Registered Report Identifier (IRRID): PRR1-10.2196/33783 %M 35363156 %R 10.2196/33783 %U https://www.researchprotocols.org/2022/4/e33783 %U https://doi.org/10.2196/33783 %U http://www.ncbi.nlm.nih.gov/pubmed/35363156 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e28801 %T Evaluating the Impact of Adaptive Personalized Goal Setting on Engagement Levels of Government Staff With a Gamified mHealth Tool: Results From a 2-Month Randomized Controlled Trial %A Nuijten,Raoul %A Van Gorp,Pieter %A Khanshan,Alireza %A Le Blanc,Pascale %A van den Berg,Pauline %A Kemperman,Astrid %A Simons,Monique %+ Department of Industrial Engineering, Eindhoven University of Technology, Groene Loper 3, Eindhoven, 5612 AE, Netherlands, 31 040 247 2290, r.c.y.nuijten@tue.nl %K mHealth %K health promotion %K physical activity %K personalization %K adaptive goal setting %K gamification %K office workers %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although the health benefits of physical activity are well established, it remains challenging for people to adopt a more active lifestyle. Mobile health (mHealth) interventions can be effective tools to promote physical activity and reduce sedentary behavior. Promising results have been obtained by using gamification techniques as behavior change strategies, especially when they were tailored toward an individual’s preferences and goals; yet, it remains unclear how goals could be personalized to effectively promote health behaviors. Objective: In this study, we aim to evaluate the impact of personalized goal setting in the context of gamified mHealth interventions. We hypothesize that interventions suggesting health goals that are tailored based on end users’ (self-reported) current and desired capabilities will be more engaging than interventions with generic goals. Methods: The study was designed as a 2-arm randomized intervention trial. Participants were recruited among staff members of 7 governmental organizations. They participated in an 8-week digital health promotion campaign that was especially designed to promote walks, bike rides, and sports sessions. Using an mHealth app, participants could track their performance on two social leaderboards: a leaderboard displaying the individual scores of participants and a leaderboard displaying the average scores per organizational department. The mHealth app also provided a news feed that showed when other participants had scored points. Points could be collected by performing any of the 6 assigned tasks (eg, walk for at least 2000 m). The level of complexity of 3 of these 6 tasks was updated every 2 weeks by changing either the suggested task intensity or the suggested frequency of the task. The 2 intervention arms—with participants randomly assigned—consisted of a personalized treatment that tailored the complexity parameters based on participants’ self-reported capabilities and goals and a control treatment where the complexity parameters were set generically based on national guidelines. Measures were collected from the mHealth app as well as from intake and posttest surveys and analyzed using hierarchical linear models. Results: The results indicated that engagement with the program inevitably dropped over time. However, engagement was higher for participants who had set themselves a goal in the intake survey. The impact of personalization was especially observed for frequency parameters because the personalization of sports session frequency did foster higher engagement levels, especially when participants set a goal to improve their capabilities. In addition, the personalization of suggested ride duration had a positive effect on self-perceived biking performance. Conclusions: Personalization seems particularly promising for promoting the frequency of physical activity (eg, promoting the number of suggested sports sessions per week), as opposed to the intensity of the physical activity (eg, distance or duration). Replications and variations of our study setup are critical for consolidating and explaining (or refuting) these effects. Trial Registration: ClinicalTrials.gov NCT05264155; https://clinicaltrials.gov/ct2/show/NCT05264155 %M 35357323 %R 10.2196/28801 %U https://mhealth.jmir.org/2022/3/e28801 %U https://doi.org/10.2196/28801 %U http://www.ncbi.nlm.nih.gov/pubmed/35357323 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34300 %T The Perceived Benefits of Digital Interventions for Behavioral Health: Qualitative Interview Study %A Marcu,Gabriela %A Ondersma,Steven J %A Spiller,Allison N %A Broderick,Brianna M %A Kadri,Reema %A Buis,Lorraine R %+ Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104-1213, United States, 1 734 998 7120, buisl@umich.edu %K computers %K mobile apps %K screening %K brief interventions %K diagnosis %K computer-assisted/methods %K surveys and questionnaires %K motivational interviewing %K therapy %K computer-assisted/methods %K implementation %K qualitative %K mobile phone %D 2022 %7 30.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital interventions have gained momentum in terms of behavioral health. However, owing to lacking standard approaches or tools for creating digital behavioral interventions, clinical researchers follow widely varying conceptions of how best to go about digital intervention development. Researchers also face significant cost-, time-, and expertise-related challenges in digital intervention development. Improving the availability of tools and guidance for researchers will require a thorough understanding of the motivations and needs of researchers seeking to create digital interventions. Objective: This study aims to understand the perceptions of behavioral researchers toward digital interventions, and inform the use of these interventions, by documenting the reasons why researchers are increasingly focusing their efforts on digital interventions and their perspectives on the perceived benefits that digital approaches can provide for researchers and intervention recipients. Methods: We conducted semistructured qualitative interviews with 18 researchers who had experience designing digital behavioral interventions or running studies with them. A convenience sample of interviewees was recruited from among users of the Computerized Intervention Authoring System platform, a web-based tool that facilitates the process of creating and deploying digital interventions in behavioral research. Interviews were conducted over teleconference between February and April 2020. Recordings from the interviews were transcribed and thematically analyzed by multiple coders. Results: Interviews were completed with 18 individuals and lasted between 24 and 65 (mean 46.9, SD 11.3) minutes. Interviewees were predominantly female (17/18, 94%) and represented different job roles, ranging from researcher to project or study staff. Four major themes came out of the interviews concerning the benefits of digital interventions for behavioral health: convenience and flexibility for interventionists and recipients, support for implementing evidence-based interventions with fidelity, scaling and improving access to interventions, and getting a foot in the door despite stigma and disenfranchisement. Conclusions: Interviewees described a number of important potential benefits of digital interventions, particularly with respect to scientific rigor, scalability, and overcoming barriers to reaching more people. There are complex considerations with regard to translating behavior change strategies into digital forms of delivery, and interventionists make individual, sometimes unexpected, choices with minimal evidence of their relative effectiveness. Future research should investigate how behavioral researchers can be supported in making these choices toward usability, ease of access, and approachability of digital interventions. Our study underscores the need for authoring platforms that can facilitate the process of creating and deploying digital interventions to reach their full potential for interventionists and recipients alike. %M 35353045 %R 10.2196/34300 %U https://www.jmir.org/2022/3/e34300 %U https://doi.org/10.2196/34300 %U http://www.ncbi.nlm.nih.gov/pubmed/35353045 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e33863 %T Quality of Mobile Apps for Care Partners of People With Alzheimer Disease and Related Dementias: Mobile App Rating Scale Evaluation %A Werner,Nicole E %A Brown,Janetta C %A Loganathar,Priya %A Holden,Richard J %+ Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, WI, 53706, United States, 1 608 890 2578, nwerner3@wisc.edu %K Alzheimer disease and related dementias %K mobile app %K mHealth %K caregivers %K dementia caregiving %K eHealth %K telehealth %K mobile phone %D 2022 %7 29.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Over 11 million care partners in the United States who provide care to people living with Alzheimer disease and related dementias (ADRD) cite persistent and pervasive unmet needs related to their caregiving role. The proliferation of mobile apps for care partners has the potential to meet care partners’ needs, but the quality of apps is unknown. Objective: This study aims to evaluate the quality of publicly available apps for care partners of people living with ADRD and identify design features of low- and high-quality apps to guide future research and user-centered app development. Methods: We searched the US Apple App and Google Play stores with the criteria that included apps needed to be available in the US Google Play or Apple App stores, accessible to users out of the box, and primarily intended for use by an informal (family or friend) care partner of a person living with ADRD. We classified and tabulated app functionalities. The included apps were then evaluated using the Mobile App Rating Scale (MARS) using 23 items across 5 dimensions: engagement, functionality, aesthetics, information, and subjective quality. We computed descriptive statistics for each rating. To identify recommendations for future research and app development, we categorized rater comments on score-driving factors for each MARS rating item and what the app could have done to improve the item score. Results: We evaluated 17 apps. We found that, on average, apps are of minimally acceptable quality. Functionalities supported by apps included education (12/17, 71%), interactive training (3/17, 18%), documentation (3/17, 18%), tracking symptoms (2/17, 12%), care partner community (3/17, 18%), interaction with clinical experts (1/17, 6%), care coordination (2/17, 12%), and activities for the person living with ADRD (2/17, 12%). Of the 17 apps, 8 (47%) had only 1 feature, 6 (35%) had 2 features, and 3 (18%) had 3 features. The MARS quality mean score across apps was 3.08 (SD 0.83) on the 5-point rating scale (1=inadequate to 5=excellent), with apps scoring highest on average on functionality (mean 3.37, SD 0.99) and aesthetics (mean 3.24, SD 0.92) and lowest on average on information (mean 2.95, SD 0.95) and engagement (mean 2.76, SD 0.89). The MARS subjective quality mean score across apps was 2.26 (SD 1.02). Conclusions: We identified apps whose mean scores were more than 1 point below minimally acceptable quality, whereas some were more than 1 point above. Many apps had broken features and were rated as below acceptable for engagement and information. Minimally acceptable quality is likely to be insufficient to meet care partner needs. Future research should establish minimum quality standards across dimensions for care partner mobile apps. Design features of high-quality apps identified in this study can provide the foundation for benchmarking these standards. %M 35348467 %R 10.2196/33863 %U https://mhealth.jmir.org/2022/3/e33863 %U https://doi.org/10.2196/33863 %U http://www.ncbi.nlm.nih.gov/pubmed/35348467 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e34744 %T PTSD Coach Version 3.1: A Closer Look at the Reach, Use, and Potential Impact of This Updated Mobile Health App in the General Public %A Hallenbeck,Haijing Wu %A Jaworski,Beth K %A Wielgosz,Joseph %A Kuhn,Eric %A Ramsey,Kelly M %A Taylor,Katherine %A Juhasz,Katherine %A McGee-Vincent,Pearl %A Mackintosh,Margaret-Anne %A Owen,Jason E %+ Dissemination and Training Division, National Center for Posttraumatic Stress Disorder, Veterans Affairs Palo Alto Health Care System, 795 Willow Rd, Menlo Park, CA, 94025, United States, 1 650 493 5000, haijing.hallenbeck@stanford.edu %K posttraumatic stress disorder %K trauma %K mental health %K mHealth %K mobile app %K public health %K self-management %K mobile phone %D 2022 %7 29.3.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: With widespread smartphone ownership, mobile health apps (mHealth) can expand access to evidence-based interventions for mental health conditions, including posttraumatic stress disorder (PTSD). Research to evaluate new features and capabilities in these apps is critical but lags behind app development. The initial release of PTSD Coach, a free self-management app developed by the US Departments of Veterans Affairs and Defense, was found to have a positive public health impact. However, major stakeholder-driven updates to the app have yet to be evaluated. Objective: We aimed to characterize the reach, use, and potential impact of PTSD Coach Version 3.1 in the general public. As part of characterizing use, we investigated the use of specific app features, which extended previous work on PTSD Coach. Methods: We examined the naturalistic use of PTSD Coach during a 1-year observation period between April 20, 2020, and April 19, 2021, using anonymous in-app event data to generate summary metrics for users. Results: During the observation period, PTSD Coach was broadly disseminated to the public, reaching approximately 150,000 total users and 20,000 users per month. On average, users used the app 3 times across 3 separate days for 18 minutes in total, with steep drop-offs in use over time; a subset of users, however, demonstrated high or sustained engagement. More than half of users (79,099/128,691, 61.46%) accessed one or more main content areas of the app (ie, Manage Symptoms, Track Progress, Learn, or Get Support). Among content areas, features under Manage Symptoms (including coping tools) were accessed most frequently, by over 40% of users (53,314/128,691, 41.43% to 56,971/128,691, 44.27%, depending on the feature). Users who provided initial distress ratings (56,971/128,691, 44.27%) reported relatively high momentary distress (mean 6.03, SD 2.52, on a scale of 0-10), and the use of a coping tool modestly improved momentary distress (mean −1.38, SD 1.70). Among users who completed at least one PTSD Checklist for DSM-5 (PCL-5) assessment (17,589/128,691, 13.67%), PTSD symptoms were largely above the clinical threshold (mean 49.80, SD 16.36). Among users who completed at least two PCL-5 assessments (4989/128,691, 3.88%), PTSD symptoms decreased from the first to last assessment (mean −4.35, SD 15.29), with approximately one-third (1585/4989, 31.77%) of these users experiencing clinically significant improvements. Conclusions: PTSD Coach continues to fulfill its mission as a public health resource. Version 3.1 compares favorably with version 1 on most metrics related to reach, use, and potential impact. Although benefits appear modest on an individual basis, the app provides these benefits to a large population. For mHealth apps to reach their full potential in supporting trauma recovery, future research should aim to understand the utility of individual app features and identify strategies to maximize overall effectiveness and engagement. %M 35348458 %R 10.2196/34744 %U https://mental.jmir.org/2022/3/e34744 %U https://doi.org/10.2196/34744 %U http://www.ncbi.nlm.nih.gov/pubmed/35348458 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e35172 %T Associations Between Behavior Change Techniques and Engagement With Mobile Health Apps: Protocol for a Systematic Review %A Milne-Ives,Madison %A Homer,Sophie %A Andrade,Jackie %A Meinert,Edward %+ Centre for Health Technology, University of Plymouth, 6 Kirkby Place, Room 2, Plymouth, PL4 6DN, United Kingdom, 44 1752600600, madison.milne-ives@plymouth.ac.uk %K engagement %K behavior change techniques %K telemedicine %K mobile apps %D 2022 %7 29.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digitally enabled care along with an emphasis on self-management of health is steadily growing. Mobile health apps provide a promising means of supporting health behavior change; however, engagement with them is often poor and evidence of their impact on health outcomes is lacking. As engagement is a key prerequisite to health behavior change, it is essential to understand how engagement with mobile health apps and their target health behaviors can be better supported. Although the importance of engagement is emphasized strongly in the literature, the understanding of how different components of engagement are associated with specific techniques that aim to change behaviors is lacking. Objective: The purpose of this systematic review protocol is to provide a synthesis of the associations between various behavior change techniques (BCTs) and the different components and measures of engagement with mobile health apps. Methods: The review protocol was structured using the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) and the PICOS (Population, Intervention, Comparator, Outcome, and Study type) frameworks. The following seven databases will be systematically searched: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, APA PsycInfo, ScienceDirect, Cochrane Library, and Web of Science. Title and abstract screening, full-text review, and data extraction will be conducted by 2 independent reviewers. Data will be extracted into a predetermined form, any disagreements in screening or data extraction will be discussed, and a third reviewer will be consulted if consensus cannot be reached. Risk of bias will be assessed using the Cochrane Collaboration Risk of Bias 2 and the Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) tools; descriptive and thematic analyses will be conducted to summarize the relationships between BCTs and the different components of engagement. Results: The systematic review has not yet started. It is expected to be completed and submitted for publication by May 2022. Conclusions: This systematic review will summarize the associations between different BCTs and various components and measures of engagement with mobile health apps. This will help identify areas where further research is needed to examine BCTs that could potentially support effective engagement and help inform the design and evaluation of future mobile health apps. Trial Registration: PROSPERO CRD42022312596; https://tinyurl.com/nhzp8223 International Registered Report Identifier (IRRID): PRR1-10.2196/35172 %M 35348460 %R 10.2196/35172 %U https://www.researchprotocols.org/2022/3/e35172 %U https://doi.org/10.2196/35172 %U http://www.ncbi.nlm.nih.gov/pubmed/35348460 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e32340 %T Safety of Triage Self-assessment Using a Symptom Assessment App for Walk-in Patients in the Emergency Care Setting: Observational Prospective Cross-sectional Study %A Cotte,Fabienne %A Mueller,Tobias %A Gilbert,Stephen %A Blümke,Bibiana %A Multmeier,Jan %A Hirsch,Martin Christian %A Wicks,Paul %A Wolanski,Joseph %A Tutschkow,Darja %A Schade Brittinger,Carmen %A Timmermann,Lars %A Jerrentrup,Andreas %+ Charité Universitäsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30 450 50, faco@gmx.de %K symptom checker %K emergency medicine %K app %K triage %K safety %K innovative %K eHealth %K artificial intelligence %D 2022 %7 28.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Increasing use of emergency departments (EDs) by patients with low urgency, combined with limited availability of medical staff, results in extended waiting times and delayed care. Technological approaches could possibly increase efficiency by providing urgency advice and symptom assessments. Objective: The purpose of this study is to evaluate the safety of urgency advice provided by a symptom assessment app, Ada, in an ED. Methods: The study was conducted at the interdisciplinary ED of Marburg University Hospital, with data collection performed between August 2019 and March 2020. This study had a single-center cross-sectional prospective observational design and included 378 patients. The app’s urgency recommendation was compared with an established triage concept (Manchester Triage System [MTS]), including patients from the lower 3 MTS categories only. For all patients who were undertriaged, an expert physician panel assessed the case to detect potential avoidable hazardous situations (AHSs). Results: Of 378 participants, 344 (91%) were triaged the same or more conservatively and 34 (8.9%) were undertriaged by the app. Of the 378 patients, 14 (3.7%) had received safe advice determined by the expert panel and 20 (5.3%) were considered to be potential AHS. Therefore, the assessment could be considered safe in 94.7% (358/378) of the patients when compared with the MTS assessment. From the 3 lowest MTS categories, 43.4% (164/378) of patients were not considered as emergency cases by the app, but could have been safely treated by a general practitioner or would not have required a physician consultation at all. Conclusions: The app provided urgency advice after patient self-triage that has a high rate of safety, a rate of undertriage, and a rate of triage with potential to be an AHS, equivalent to telephone triage by health care professionals while still being more conservative than direct ED triage. A large proportion of patients in the ED were not considered as emergency cases, which could possibly relieve ED burden if used at home. Further research should be conducted in the at-home setting to evaluate this hypothesis. Trial Registration: German Clinical Trial Registration DRKS00024909; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00024909 %M 35343909 %R 10.2196/32340 %U https://mhealth.jmir.org/2022/3/e32340 %U https://doi.org/10.2196/32340 %U http://www.ncbi.nlm.nih.gov/pubmed/35343909 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e31309 %T Smartphone Apps for Vaping Cessation: Quality Assessment and Content Analysis %A Sanchez,Sherald %A Kundu,Anasua %A Limanto,Elizabeth %A Selby,Peter %A Baskerville,Neill Bruce %A Chaiton,Michael %+ Institute of Medical Science, Termerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada, 1 416 535 8501 ext 32005, Sherald.Sanchez@utoronto.ca %K e-cigarettes %K vaping %K cessation %K mHealth interventions %D 2022 %7 28.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As the prevalence of electronic cigarette (e-cigarette) use, or vaping, continues to grow, particularly among young people, so does the need for research and interventions to address vaping. Objective: This study examines the quality of free vaping cessation apps, their contents and features, popularity among users, and adherence to evidence-based principles. Methods: A systematic search of existing apps for vaping cessation was conducted in December 2020. Eligible apps were free, in English, and included features specifically targeting vaping cessation. Each app included in the analysis was used daily for at least seven consecutive days, assessed using the Mobile App Rating Scale, and rated by at least two authors (AK, EL, or SS) based on adherence to evidence-based practices. Intraclass correlation coefficient (ICC) estimates were computed to assess interrater reliability (excellent agreement; ICC 0.92; 95% CI 0.78-0.98). Results: A total of 8 apps were included in the quality assessment and content analysis: 3 were developed specifically for vaping cessation and 5 focused on smoking cessation while also claiming to address vaping cessation. The mean of app quality total scores was 3.66 out of 5. Existing vaping cessation apps employ similar approaches to smoking cessation apps. However, they are very low in number and have limited features developed specifically for vaping cessation. Conclusions: Given the lack of vaping cessation interventions at a time when they are urgently needed, smartphone apps are potentially valuable tools. Therefore, it is recommended that these apps apply evidence-based practices and undergo rigorous evaluations that can assess their quality, contents and features, and popularity among users. Through this process, we can improve our understanding of how apps can be effective in helping users quit vaping. %M 35343904 %R 10.2196/31309 %U https://mhealth.jmir.org/2022/3/e31309 %U https://doi.org/10.2196/31309 %U http://www.ncbi.nlm.nih.gov/pubmed/35343904 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e34967 %T Effectiveness of Mobile Apps in Promoting Healthy Behavior Changes and Preventing Obesity in Children: Systematic Review %A Yau,Kiana W %A Tang,Tricia S %A Görges,Matthias %A Pinkney,Susan %A Kim,Annie D %A Kalia,Angela %A Amed,Shazhan %+ Research Institute, BC Children's Hospital, A4-196, 950 West 28 Avenue, Vancouver, BC, V5Z 4H4, Canada, 1 604 875 3113, SAmed@cw.bc.ca %K childhood obesity %K mobile health %K health behaviors %K prevention %K study design %K systematic review %K mobile phone %D 2022 %7 28.3.2022 %9 Review %J JMIR Pediatr Parent %G English %X Background: Mobile apps have been increasingly incorporated into healthy behavior promotion interventions targeting childhood obesity. However, their effectiveness remains unclear. Objective: This paper aims to conduct a systematic review examining the effectiveness of mobile apps aimed at preventing childhood obesity by promoting health behavior changes in diet, physical activity, or sedentary behavior in children aged 8 to 12 years. Methods: MEDLINE, Embase, PsycINFO, CINAHL, and ERIC were systematically searched for peer-reviewed primary studies from January 2008 to July 2021, which included children aged 8 to 12 years; involved mobile app use; and targeted at least one obesity-related factor, including diet, physical activity, or sedentary behavior. Data extraction and risk of bias assessments were conducted by 2 authors. Results: Of the 13 studies identified, most used a quasi-experimental design (n=8, 62%). Significant improvements in physical activity (4/8, 50% studies), dietary outcomes (5/6, 83% studies), and BMI (2/6, 33% studies) were reported. All 6 multicomponent interventions and 57% (4/7) of standalone interventions reported significant outcomes in ≥1 behavioral change outcome measured (anthropometric, physical activity, dietary, and screen time outcomes). Gamification, behavioral monitoring, and goal setting were common features of the mobile apps used in these studies. Conclusions: Apps for health behavior promotion interventions have the potential to increase the adoption of healthy behaviors among children; however, their effectiveness in improving anthropometric measures remains unclear. Further investigation of studies that use more rigorous study designs, as well as mobile apps as a standalone intervention, is needed. %M 35343908 %R 10.2196/34967 %U https://pediatrics.jmir.org/2022/1/e34967 %U https://doi.org/10.2196/34967 %U http://www.ncbi.nlm.nih.gov/pubmed/35343908 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e32420 %T A Digital Health Program Targeting Physical Activity Among Adolescents With Overweight or Obesity: Open Trial %A Cummings,Caroline %A Crochiere,Rebecca %A Lansing,Amy Hughes %A Patel,Riya %A Stanger,Catherine %+ Department of Psychological Sciences, Texas Tech University, PO Box 42051, Lubbock, TX, 79409, United States, 1 8068340931, carolicu@ttu.edu %K mHealth program %K physical activity %K adolescent overweight %K adolescent obesity %K incentives %K mobile phone %D 2022 %7 28.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Prior studies suggest that mobile health physical activity programs that provide only weekly or daily text-based health coaching evidence limit the efficacy in improving physical activity in adolescents with overweight or obesity. It is possible that incentives, combined with health coaching and daily feedback on goal success, may increase program efficacy; however, such programs have not yet been tested with adolescents with overweight and obesity. Objective: This study aims to examine the feasibility and acceptability of a 12-week, incentive-based, mobile health physical activity program with text-based health coaching, goal setting, and self-monitoring for adolescents with overweight or obesity. Program adherence and changes in tracked physical activity (ie, steps and active minutes while wearing a Fitbit [Google LLC]), body mass, and body fat are assessed. Methods: A total of 28 adolescents aged 13 to 18 years with a BMI ≥90th percentile participated in the program. Of the 28 participants, 2 (7%) were lost to follow-up; thus, data from 26 (93%) participants were used in analyses. Results: Participant-reported acceptability was high, with all mean ratings of text-based coaching, Fitbit use, and the overall program being >5 on a 7-point scale. In addition, 85% (23/26) of participants reported that they would like to continue to wear the Fitbit. Program adherence was also high, as participants wore the Fitbit on 91.1% (SD 12.6%) of days on average and met their weekly goals for an average of 7 (SD 3.5) of 11 possible weeks. There were no demographic (ie, sex, age, and baseline body mass) differences in the percentage of days participants wore their Fitbit. Across the 12-week study, there were significant improvements in tracked daily active minutes (P=.006) and steps (P<.001) and significant pre- to posttest improvements in body fat percentage (P=.04). Conclusions: The pilot program improved adolescent physical activity and physical health. A larger factorial design trial with adaptive daily goals may clarify the role of each program component in driving physical activity. %M 35343903 %R 10.2196/32420 %U https://pediatrics.jmir.org/2022/1/e32420 %U https://doi.org/10.2196/32420 %U http://www.ncbi.nlm.nih.gov/pubmed/35343903 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e34148 %T Predicting Changes in Depression Severity Using the PSYCHE-D (Prediction of Severity Change-Depression) Model Involving Person-Generated Health Data: Longitudinal Case-Control Observational Study %A Makhmutova,Mariko %A Kainkaryam,Raghu %A Ferreira,Marta %A Min,Jae %A Jaggi,Martin %A Clay,Ieuan %+ Digital Medicine Society, 90 Canal Street, 4th Floor, Boston, MA, 02114, United States, 1 1733095953, ieuan@dimesociety.org %K depression %K machine learning %K person-generated health data %D 2022 %7 25.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In 2017, an estimated 17.3 million adults in the United States experienced at least one major depressive episode, with 35% of them not receiving any treatment. Underdiagnosis of depression has been attributed to many reasons, including stigma surrounding mental health, limited access to medical care, and barriers due to cost. Objective: This study aimed to determine if low-burden personal health solutions, leveraging person-generated health data (PGHD), could represent a possible way to increase engagement and improve outcomes. Methods: Here, we present the development of PSYCHE-D (Prediction of Severity Change-Depression), a predictive model developed using PGHD from more than 4000 individuals, which forecasts the long-term increase in depression severity. PSYCHE-D uses a 2-phase approach. The first phase supplements self-reports with intermediate generated labels, and the second phase predicts changing status over a 3-month period, up to 2 months in advance. The 2 phases are implemented as a single pipeline in order to eliminate data leakage and ensure results are generalizable. Results: PSYCHE-D is composed of 2 Light Gradient Boosting Machine (LightGBM) algorithm–based classifiers that use a range of PGHD input features, including objective activity and sleep, self-reported changes in lifestyle and medication, and generated intermediate observations of depression status. The approach generalizes to previously unseen participants to detect an increase in depression severity over a 3-month interval, with a sensitivity of 55.4% and a specificity of 65.3%, nearly tripling sensitivity while maintaining specificity when compared with a random model. Conclusions: These results demonstrate that low-burden PGHD can be the basis of accurate and timely warnings that an individual’s mental health may be deteriorating. We hope this work will serve as a basis for improved engagement and treatment of individuals experiencing depression. %M 35333186 %R 10.2196/34148 %U https://mhealth.jmir.org/2022/3/e34148 %U https://doi.org/10.2196/34148 %U http://www.ncbi.nlm.nih.gov/pubmed/35333186 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32940 %T Adapting an Evidence-Based e-Learning Cognitive Behavioral Therapy Program Into a Mobile App for People Experiencing Gambling-Related Problems: Formative Study %A Humphrey,Gayl %A Chu,Joanna Ting %A Ruwhiu-Collins,Rebecca %A Erick-Peleti,Stephanie %A Dowling,Nicki %A Merkouris,Stephanie %A Newcombe,David %A Rodda,Simone %A Ho,Elsie %A Nosa,Vili %A Parag,Varsha %A Bullen,Christopher %+ National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland, 1145, New Zealand, 64 21 1100901, g.humphrey@auckland.ac.nz %K gambling %K CBT %K mHealth %K co-design %K smartphone %K self-directed %K behavior change %K engagement %K mobile phone %D 2022 %7 25.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Many people who experience harm and problems from gambling do not seek treatment from gambling treatment services because of personal and resource barriers. Mobile health (mHealth) interventions are widely used across diverse health care areas and populations. However, there are few in the gambling harm field, despite their potential as an additional modality for delivering treatment and support. Objective: This study aims to understand the needs, preferences, and priorities of people experiencing gambling harms and who are potential end users of a cognitive behavioral therapy mHealth intervention to inform design, features, and functions. Methods: Drawing on a mixed methods approach, we used creators and domain experts to review the GAMBLINGLESS web-based program and convert it into an mHealth prototype. Each module was reviewed against the original evidence base to maintain its intended fidelity and conceptual integrity. Early wireframes, design ideas (look, feel, and function), and content examples were developed to initiate discussions with end users. Using a cocreation process with a young adult, a Māori, and a Pasifika peoples group, all with experiences of problem or harmful gambling, we undertook 6 focus groups: 2 cycles per group. In each focus group, participants identified preferences, features, and functions for inclusion in the final design and content of the mHealth intervention. Results: Over 3 months, the GAMBLINGLESS web-based intervention was reviewed and remapped from 4 modules to 6. This revised program is based on the principles underpinning the transtheoretical model, in which it is recognized that some end users will be more ready to change than others. Change is a process that unfolds over time, and a nonlinear progression is common. Different intervention pathways were identified to reflect the end users’ stage of change. In all, 2 cycles of focus groups were then conducted, with 30 unique participants (13 Māori, 9 Pasifika, and 8 young adults) in the first session and 18 participants (7 Māori, 6 Pasifika, and 5 young adults) in the second session. Prototype examples demonstrably reflected the focus group discussions and ideas, and the features, functions, and designs of the Manaaki app were finalized. Attributes such as personalization, cultural relevance, and positive framing were identified as the key. Congruence of the final app attributes with the conceptual frameworks of the original program was also confirmed. Conclusions: Those who experience gambling harms may not seek help. Developing and demonstrating the effectiveness of new modalities to provide treatment and support are required. mHealth has the potential to deliver interventions directly to the end user. Weaving the underpinning theory and existing evidence of effective treatment with end-user input into the design and development of mHealth interventions does not guarantee success. However, it provides a foundation for framing the intervention’s mechanism, context, and content, and arguably provides a greater chance of demonstrating effectiveness. %M 35108213 %R 10.2196/32940 %U https://formative.jmir.org/2022/3/e32940 %U https://doi.org/10.2196/32940 %U http://www.ncbi.nlm.nih.gov/pubmed/35108213 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e30789 %T Impact of Masticatory Behaviors Measured With Wearable Device on Metabolic Syndrome: Cross-sectional Study %A Uehara,Fumiko %A Hori,Kazuhiro %A Hasegawa,Yoko %A Yoshimura,Shogo %A Hori,Shoko %A Kitamura,Mari %A Akazawa,Kohei %A Ono,Takahiro %+ Division of Comprehensive Prosthodontics, Faculty of Dentistry and Graduate School of Medical and Dental Sciences, Niigata University, 2-5274 Gakkocho-dori, Niigata, 9518514, Japan, 81 25 227 2891, hori@dent.niigata-u.ac.jp %K metabolic syndrome %K mastication behaviors %K wearable device %K daily meal %K energy intake %K chew %K internet of things %D 2022 %7 24.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: It has been widely recognized that mastication behaviors are related to the health of the whole body and to lifestyle-related diseases. However, many studies were based on subjective questionnaires or were limited to small-scale research in the laboratory due to the lack of a device for measuring mastication behaviors during the daily meal objectively. Recently, a small wearable masticatory counter device, called bitescan (Sharp Co), for measuring masticatory behavior was developed. This wearable device is designed to assess objective masticatory behavior by being worn on the ear in daily life. Objective: This study aimed to investigate the relation between mastication behaviors in the laboratory and in daily meals and to clarify the difference in mastication behaviors between those with metabolic syndrome (MetS) and those without (non-MetS) measured using a wearable device. Methods: A total of 99 healthy volunteers (50 men and 49 women, mean age 36.4 [SD 11.7] years) participated in this study. The mastication behaviors (ie, number of chews and bites, number of chews per bite, and chewing rate) were measured using a wearable ear-hung device. Mastication behaviors while eating a rice ball (100 g) in the laboratory and during usual meals for an entire day were monitored, and the daily energy intake was calculated. Participants’ abdominal circumference, fasting glucose concentration, blood pressure, and serum lipids were also measured. Mastication behaviors in the laboratory and during meals for 1 entire day were compared. The participants were divided into 2 groups using the Japanese criteria for MetS (positive/negative for MetS or each MetS component), and mastication behaviors were compared. Results: Mastication behaviors in the laboratory and during daily meals were significantly correlated (number of chews r=0.36; P<.001; number of bites r=0.49; P<.001; number of chews per bite r=0.33; P=.001; and chewing rate r=0.51; P<.001). Although a positive correlation was observed between the number of chews during the 1-day meals and energy intake (r=0.26, P=.009), the number of chews per calorie ingested was negatively correlated with energy intake (r=–0.32, P=.002). Of the 99 participants, 8 fit the criteria for MetS and 14 for pre-MetS. The number of chews and bites for a rice ball in the pre-MetS(+) group was significantly lower than the pre-MetS(–) group (P=.02 and P=.04, respectively). Additionally, scores for the positive abdominal circumference and hypertension subgroups were also less than the counterpart groups (P=.004 and P=.01 for chews, P=.006 and P=.02 for bites, respectively). The number of chews and bites for an entire day in the hypertension subgroup were significantly lower than in the other groups (P=.02 and P=.006). Furthermore, the positive abdominal circumference and hypertension subgroups showed lower numbers of chews per calorie ingested for 1-day meals (P=.03 and P=.02, respectively). Conclusions: These results suggest a relationship between masticatory behaviors in the laboratory and those during daily meals and that masticatory behaviors are associated with MetS and MetS components. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry R000034453; https://tinyurl.com/mwzrhrua %M 35184033 %R 10.2196/30789 %U https://mhealth.jmir.org/2022/3/e30789 %U https://doi.org/10.2196/30789 %U http://www.ncbi.nlm.nih.gov/pubmed/35184033 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e25906 %T The Effectiveness of Physical Activity-Promoting Web- and Mobile-Based Distance Weight Loss Interventions on Body Composition in Rehabilitation Settings: Systematic Review, Meta-analysis, and Meta-Regression Analysis %A Lahtio,Heli %A Rintala,Aki %A Immonen,Jaakko %A Sjögren,Tuulikki %+ Faculty of Sport and Health Sciences, The University of Jyväskylä, Keskussairaalantie 4, Jyväskylä, 40014, Finland, 358 14 260 1211, heli.lahtio@gmail.com %K technology %K weight loss %K rehabilitation %K overweight %K obesity %K body mass index %K waist circumference %K body fat percentage %K mobile phone %D 2022 %7 24.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Overweight and obesity are major problems worldwide, and they lead to an increased risk for several diseases. The use of technology in the treatment of obesity is promising, but in the existing literature, there is considerable uncertainty regarding its efficacy. In this review, we included web- and mobile-based weight loss interventions that were implemented remotely in rehabilitation settings. Objective: The aim of this systematic review is to study the effectiveness of physical activity-promoting web- and mobile-based distance weight loss interventions in rehabilitation settings on body composition in comparison with control groups that did not use technology. Methods: Studies were searched from 9 databases. The inclusion criteria were as follows: population: age 18-65 years; intervention: physical activity-promoting web- and mobile-based distance weight loss interventions; comparison: control groups without the use of technology; outcome: changes in BMI, waist circumference, or body fat percentage; study design: randomized controlled trial. The quality of the studies was assessed by 2 researchers. Meta-analysis was performed, and we also conducted a meta-regression analysis to evaluate the factors associated with the changes in body composition outcomes if statistical heterogeneity was observed. Results: The meta-analysis included 30 studies. The mean quality of the studies was 7 of 13 (SD 1.9; range 3-10). A statistically significant difference was observed in BMI (mean difference [MD] 0.83, 95% CI 0.51-1.15 kg/m2; P<.001), waist circumference (MD 2.45, 95% CI 1.83-3.07 cm; P<.001), and body fat percentage (MD 1.07%, 95% CI 0.74%-1.41%; P<.001) in favor of the weight loss groups using web- or mobile-based interventions. Meta-regression analyses found an association between personal feedback and BMI (P=.04), but other factors did not play a role in explaining statistical heterogeneity. Conclusions: Web- and mobile-based distance weight loss interventions significantly reduced BMI, waist circumference, and body fat percentage. Future studies should focus on the comparability of the intervention content. Future studies are needed to better understand weight loss and identify which components are essential in achieving it. Trial Registration: PROSPERO CRD42016035831; https://tinyurl.com/7c93tvd4 %M 35323126 %R 10.2196/25906 %U https://www.jmir.org/2022/3/e25906 %U https://doi.org/10.2196/25906 %U http://www.ncbi.nlm.nih.gov/pubmed/35323126 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33852 %T Effect of Information and Communication Technology–Based Self-management System DialBeticsLite on Treating Abdominal Obesity in the Specific Health Guidance in Japan: Randomized Controlled Trial %A Kondo,Masahiro %A Okitsu,Teru %A Waki,Kayo %A Yamauchi,Toshimasa %A Nangaku,Masaomi %A Ohe,Kazuhiko %+ Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan, 81 3 5800 9129, kwaki-tky@m.u-tokyo.ac.jp %K mHealth %K smartphone app %K abdominal obesity %K self-management %K telemedicine %K digital health %K app %K obesity %K overweight %K weight %K randomized controlled trial %K intervention %K lifestyle %K behavior %K mobile phone %D 2022 %7 24.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) interventions, a more cost-effective approach compared with traditional methods of delivering lifestyle coaching in person, have been shown to improve physical parameters and lifestyle behavior among overweight populations. In Japan, the Specific Health Checkups and Specific Health Guidance (SHG) started in 2008 to treat obesity and abdominal obesity. However, the effectiveness of SHG is limited owing to its in-person counseling. The effect of mHealth on SHG has yet to be demonstrated. Objective: This study aims to determine whether a mobile self-management app (DialBeticsLite) could make the SHG more beneficial among patients with abdominal obesity to achieve a reduction in visceral fat area (VFA). Methods: This study was an open-label, 2-arm, parallel-design randomized controlled trial. We recruited 122 people in September 2017 and randomly assigned them into either the intervention or control group. All participants attended an educational group session that delivered information regarding diet and exercise. In addition, participants in the intervention group were asked to use DialBeticsLite for 3 months. DialBeticsLite facilitated the daily recording of several physical parameters and lifestyle behavior and provided feedback to encourage an improvement in behavior. The primary outcome was the change in VFA from baseline to the 3-month follow-up. Secondary outcomes included changes in both physical and metabolic parameters from baseline to the 3-month follow-up. The Welch 2-tailed t test was conducted to analyze the effects of DialBeticsLite on both the primary and secondary outcomes. Results: Of the 122 participants recruited, 75 (61.5%) were analyzed because 47 (38.5%) were excluded: 37 (30.3%) because of ineligibility and 10 (8.2%) because of withdrawal of consent. The mean age was 49.3 (SD 6.1) years in the intervention group (41/75, 55%) and 48.5 (SD 5.3) years in the control group (34/75, 45%), and all participants were men, although unintentionally. The baseline characteristics did not differ significantly between the intervention and control groups, except for VFA. The average change of VFA was −23.5 (SD 20.6) cm2 in the intervention group and +1.9 (SD 16.2) cm2 in the control group (P<.001). Statistically significant differences were also found for the change of body weight, BMI, and waist circumference. These findings did not change after adjusting for VFA at the baseline. The intervention had no significant effect on any of the metabolic parameters. An exploratory analysis showed significant associations between the change in VFA and steps per day and between the change in VFA and calorie intake per day within the intervention group. Conclusions: Our findings indicate that an mHealth intervention facilitating the daily monitoring of several physical parameters and lifestyle behavior can be highly effective in inducing visceral fat loss and weight loss among adults eligible for SHG. Trial Registration: UMIN Clinical Trials Registry UMIN000042045; https://tinyurl.com/4vat3v53 %M 35323122 %R 10.2196/33852 %U https://formative.jmir.org/2022/3/e33852 %U https://doi.org/10.2196/33852 %U http://www.ncbi.nlm.nih.gov/pubmed/35323122 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e32212 %T Web-Based Versus Print-Based Physical Activity Intervention for Community-Dwelling Older Adults: Crossover Randomized Trial %A Pischke,Claudia R %A Voelcker-Rehage,Claudia %A Ratz,Tiara %A Peters,Manuela %A Buck,Christoph %A Meyer,Jochen %A von Holdt,Kai %A Lippke,Sonia %+ Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstrasse 5, Duesseldorf, 40225, Germany, 49 211 81 ext 08599, ClaudiaRuth.Pischke@med.uni-duesseldorf.de %K physical activity %K older adults %K eHealth %K print-based intervention %K web-based intervention %K physical activity promotion %K healthy aging %K preferences %K randomized trial %K mobile phone %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Fewer than half of older German adults engage in the recommended levels of endurance training. Objective: The study aim is to compare the acceptance and effectiveness of two interventions for physical activity (PA) promotion among initially inactive community-dwelling older adults ≥60 years in a 9-month, crossover randomized trial. Methods: Participants were recruited in person and randomized to one of the following interventions for self-monitoring PA: a print-based intervention (PRINT: 113/242, 46.7%) or a web-based intervention (WEB: 129/242, 53.3%). Furthermore, 29.5% (38/129) of those in the web-based intervention group received a PA tracker in addition to WEB (WEB+). After randomization, the participants and researchers were not blinded. The participants’ baseline intervention preferences were retrospectively assessed. All the intervention groups were offered 10 weekly face-to-face group sessions. Afterward, participants could choose to stay in their group or cross over to one of the other groups, and group sessions were continued monthly for another 6 months. 3D accelerometers to assess PA and sedentary behavior (SB) at baseline (T0), 3-month follow-up (T1), and 9-month follow-up (T2) were used. Adherence to PA recommendations, attendance of group sessions, and intervention acceptance were assessed using self-administered paper-based questionnaires. Linear mixed models were used to calculate differences in moderate to vigorous PA (MVPA) and SB between time points and intervention groups. Results: Of the 242 initially recruited participants, 91 (37.6%) were randomized to the WEB group; 38 (15.7%) to the WEB+ group; and 113 (46.7%) to the PRINT group. Overall, 80.6% (195/242) of the participants completed T1. Only 0.4% (1/242) of the participants changed from the WEB group to the PRINT group and 6.2% (15/242) moved from the PRINT group to the WEB group (WEB-WEB: 103/249, (41.4%); PRINT-PRINT: 76/249, 30.5%) when offered to cross over at T1. Furthermore, 66.1% (160/242) of participants completed T2. MVPA in minutes per day increased between baseline and T1, but these within-group changes disappeared after adjusting for covariates. MVPA decreased by 9 minutes per day between baseline and T2 (βtime=−9.37, 95% CI −18.58 to −0.16), regardless of the intervention group (WEB vs PRINT: βgroup*time=−3.76, 95% CI −13.33 to 5.82, WEB+ vs PRINT: βgroup*time=1.40, 95% CI −11.04 to 13.83). Of the participants, 18.6% (38/204) met the PA recommendations at T0, 16.4% (26/159) at T1, and 20.3% (28/138) at T2. For SB, there were no significant group differences or group-by-time interactions at T1 or T2. Intervention acceptance was generally high. The use of intervention material was high to moderate at T1 and decreased by T2. Conclusions: There was little movement between intervention groups at T1 when given the choice, and participation was not associated with increases in PA or decreases in SB over time. Trial Registration: German Clinical Trials Register DRKS00016073; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016073 %M 35319484 %R 10.2196/32212 %U https://mhealth.jmir.org/2022/3/e32212 %U https://doi.org/10.2196/32212 %U http://www.ncbi.nlm.nih.gov/pubmed/35319484 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e34946 %T Changes in Blood Lipid Levels After a Digitally Enabled Cardiometabolic Preventive Health Program: Pre-Post Study in an Adult Dutch General Population Cohort %A Castela Forte,José %A Gannamani,Rahul %A Folkertsma,Pytrik %A Kumaraswamy,Sridhar %A Mount,Sarah %A van Dam,Sipko %A Hoogsteen,Jan %+ Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, Hanzeplein 1, Groningen, 9713GZ, Netherlands, 31 628218360, jose@ancora.health %K cholesterol %K lifestyle intervention %K prevention %K hypercholesterolemia %K digital health %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Despite widespread education, many individuals fail to follow basic health behaviors such as consuming a healthy diet and exercising. Positive changes in lifestyle habits are associated with improvements in multiple cardiometabolic health risk factors, including lipid levels. Digital lifestyle interventions have been suggested as a viable complement or potential alternative to conventional health behavior change strategies. However, the benefit of digital preventive interventions for lipid levels in a preventive health context remains unclear. Objective: This observational study aimed to determine how the levels of lipids, namely total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, non-HDL cholesterol, and triglycerides, changed over time in a Dutch general population cohort undergoing a digital preventive health program. Moreover, we looked to establish associations between lifestyle factors at baseline and lipid levels. Methods: We included 348 adults from the Dutch general population who underwent a digitally enabled preventive health program at Ancora Health between January 2020 and October 2021. Upon enrollment, participants underwent a baseline assessment involving a comprehensive lifestyle questionnaire, a blood biochemistry panel, physical measurements, and cardiopulmonary fitness measurements. Thereafter, users underwent a lifestyle coaching program and could access the digital application to register and track health behaviors, weight, and anthropometric data at any time. Lipid levels were categorized as normal, elevated, high, and clinical dyslipidemia according to accepted international standards. If at least one lipid marker was high or HDL was low, participants received specific coaching and advice for cardiometabolic health. We retrospectively analyzed the mean and percentage changes in lipid markers in users who were remeasured after a cardiometabolic health–focused intervention, and studied the association between baseline user lifestyle characteristics and having normal lipid levels. Results: In our cohort, 199 (57.2%) participants had dyslipidemia at baseline, of which 104 participants were advised to follow a cardiometabolic health–focused intervention. Eating more amounts of favorable food groups and being more active were associated with normal lipid profiles. Among the participants who underwent remeasurement 9 months after intervention completion, 57% (17/30), 61% (19/31), 56% (15/27), 82% (9/11), and 100% (8/8) showed improvements at remeasurement for total, LDL, HDL, and non-HDL cholesterol, and triglycerides, respectively. Moreover, between 35.3% and 77.8% showed a return to normal levels. In those with high lipid levels at baseline, total cholesterol decreased by 0.5 mmol/L (7.5%), LDL cholesterol decreased by 0.39 mmol/L (10.0%), non-HDL cholesterol decreased by 0.44 mmol/L (8.3%), triglycerides decreased by 0.97 mmol/L (32.0%), and HDL increased by 0.17 mmol/L (15.6%), after the intervention. Conclusions: A cardiometabolic screening program in a general population cohort identified a significant portion of individuals with subclinical and clinical lipid levels. Individuals who, after screening, actively engaged in a cardiometabolic health–focused lifestyle program improved their lipid levels. %M 35319473 %R 10.2196/34946 %U https://cardio.jmir.org/2022/1/e34946 %U https://doi.org/10.2196/34946 %U http://www.ncbi.nlm.nih.gov/pubmed/35319473 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e34294 %T Patients’ Experiences of Using a Smartphone App After Cardiac Rehabilitation: Qualitative Study %A Lunde,Pernille %A Bye,Asta %A Bruusgaard,Kari Anette %A Hellem,Elisabet %A Nilsson,Birgitta Blakstad %+ Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, PB 4, St. Olavs Plass, Oslo, 0130, Norway, 47 48063537, plunde@oslomet.no %K mHealth %K mobile health %K cardiac rehabilitation %K mobile phone app %K smartphone %K lifestyle %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Exercise-based cardiac rehabilitation (CR) is a crucial part of the treatment of patients with cardiac diseases, and adherence to healthy behavior is a prerequisite to improve long-term prognosis. Unfortunately, adherence to healthy behavior adapted in CR is challenging for many cardiac patients in the long term. Recently, we demonstrated that follow-up conducted via an app for 1 year significantly improved adherence to healthy behavior after CR. To increase the knowledge and understanding of mobile Health (mHealth) interventions that can promote acceptance and adherence, qualitative research investigating patients’ experiences with these interventions is warranted. Objective: The aim was to investigate patient experiences with individualized long-term follow-up conducted via an app for 1 year and their thoughts about what features promoted adherence to healthy behavior after CR. The purpose was to increase the understanding of significant findings previously reported and to guide future development of similar interventions in the field of adherence. Methods: A qualitative study with individual interviews was conducted from November 2018 to May 2019. A thematic interview guide was used when conducting the semistructured in-depth interviews. The interviews were audio recorded and transcribed successively during the period in which the interviews were conducted. Texts were managed and systematized by NVivo. Interviews were analyzed by qualitative content analysis. Codes and themes were inductively developed. Results: Ten patients who had participated in a randomized controlled trial evaluating the effect of follow-up conducted via an app on adherence to healthy behavior after CR were included. The median patient age was 65 years (range 46-72 years), and both genders were represented. The analysis resulted in the following 4 themes describing the patients’ experiences: (1) The person behind the app is crucial for motivation and adherence; (2) The app as a commitment; (3) The app as a path to independence; and (4) Suggestions for improvements. Features experienced as beneficial to promote adherence were individualized feedback and the use of goal setting. The significance of the person behind the app (the supervisor) who provided individualized feedback was a consistent finding. This person seemed to promote motivation in general and to enable other known behavioral change techniques. Conclusions: The person behind the app (the supervisor) seems to be one of the most significant success factors in promoting adherence to healthy behavior after CR. This indicates that a health care provider must actively participate in a patient’s process of adherence to healthy behavior, even when using interventions, including an app. Future development of interventions in the field of adherence should strive to create tools that enable an ongoing collaborative relationship between the patient and the health care provider. The follow-up should be based on the patient’s own goals, and individualized feedback should be provided. %M 35319476 %R 10.2196/34294 %U https://humanfactors.jmir.org/2022/1/e34294 %U https://doi.org/10.2196/34294 %U http://www.ncbi.nlm.nih.gov/pubmed/35319476 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e25715 %T Improving Access to Behavioral Strategies to Improve Mental Well-being With an Entertaining Breakfast Show App: Feasibility Evaluation Study %A Öeren,Mariliis %A Jordan,Iain %A Coughlin,Deborah %A Turnbull,Sophie %+ Method X Studios Ltd, The Old Workshop, 1 Ecclesall Road South, Sheffield, S11 9PA, United Kingdom, 44 7722487501, mt679@cantab.ac.uk %K mental well-being %K mental health %K smartphone %K mobile app %K education %K entertainment %K psychotherapy %K feasibility %K mobile phone %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Although mental ill-health is more prevalent among people from lower socioeconomic groups, digital mental well-being innovations are often developed for people from higher socioeconomic groups, who already have resources to maintain good mental and physical health. To decrease health inequalities and ensure that available solutions are appealing and accessible to people with fewer resources, new approaches should be explored. We developed the app Wakey!, which focused on creating engaging mental health content that is accessible, particularly among lower socioeconomic groups in the United Kingdom. Objective: The aim of this study is to assess engagement with the app, investigate initial effectiveness data for 6 well-being outcomes, and explore participants’ subjective experiences of using Wakey! Methods: The app Wakey! was publicly launched on January 20, 2020, and was free to download from Apple Store and Google Play. The app provided its users with entertaining and educational content related to mental well-being. Concurrently, a single-arm mixed methods feasibility trial was carried out from January to April 2020 among people who had downloaded the app and created an account. The primary outcome was engagement, which was collected passively from data logs. Secondary outcome measures were 6 well-being outcomes collected from self-report questionnaires. Individual interviews with 19 app users were carried out in April 2020. Results: In total, 5413 people fit the inclusion criteria and were included in the final sample—65.62% (3520/5364) women, 61.07% (3286/5381) aged between 25 and 44 years, 61.61% (2902/4710) in employment, 8.92% (420/4710) belonging to the lower socioeconomic group, and 8.09% (438/5413) were engaged users. There was no evidence of a difference in engagement regarding sociodemographic and socioeconomic characteristics. There was evidence that users with a higher average daily sleep score, who joined the study more recently, who had higher baseline self-report of sleep quality, and who found episodes more entertaining were more likely to be engaged users. Among 230 users who provided follow-up data, there was evidence of improvements on four of the six well-being outcomes: life satisfaction (P<.001), feeling that life is worthwhile (P=.01), ease of getting up in the morning (P<.001), and self-efficacy (P=.04). The app and its content were well received by those who were interviewed, and several people perceived a positive change in their mental well-being. Conclusions: This study shows that the app Wakey! could potentially be engaging across different socioeconomic groups, and there is an indication that it could positively impact the mental well-being of those engaged with the app. However, this study was a pragmatic trial with a limited sample, and the selection bias was present in the qualitative and quantitative study. Further work is needed to make any generalizable conclusions. Trial Registration: ClinicalTrials.gov NCT04287296; https://clinicaltrials.gov/ct2/show/NCT04287296 %M 35319468 %R 10.2196/25715 %U https://formative.jmir.org/2022/3/e25715 %U https://doi.org/10.2196/25715 %U http://www.ncbi.nlm.nih.gov/pubmed/35319468 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e28751 %T Persuasive Technology in an mHealth App Designed for Pelvic Floor Muscle Training Among Women: Systematic Review %A Jaffar,Aida %A Tan,Chai-Eng %A Mohd-Sidik,Sherina %A Admodisastro,Novia %A Goodyear-Smith,Felicity %+ Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia, 60 03 9769 2541, sherina@upm.edu.my %K urinary incontinence %K pelvic floor muscle training %K mHealth app %K persuasive technology %K capability, opportunity, and motivation–behavior model %K mobile phone %D 2022 %7 22.3.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Pelvic floor muscle training (PFMT) is one of the first-line treatments for stress urinary incontinence among pregnant women. Mobile health (mHealth) technology is potentially effective for delivering PFMT to pregnant women. Persuasive technology in the development of such mobile apps may facilitate behavior change by improving adherence to the exercises. The Capability, Opportunity, and Motivation–Behavior (COM-B) model is potentially useful in selecting the appropriate interventions to be incorporated into the apps. Objective: This review of mHealth apps for PFMT aims to describe the principles of persuasion used for each app and to propose mHealth app design features based on the COM-B model. Methods: A systematic literature search was conducted to answer three main research questions: what are the available mHealth apps for PFMT in the published literature, what persuasive strategies were used in their studies how were they mapped to the COM-B model, and how effective were the selected persuasive strategies for PFMT adherence? We searched PubMed, CINAHL, Web of Science, Scopus, and local Malaysian databases such as MyCite and MyMedR for articles reporting mHealth apps used for the delivery of PFMT. We included original articles reporting experimental and cross-sectional studies, including pilot or feasibility trials. Systematic and narrative reviews were excluded. Narrative and thematic syntheses were conducted on the eligible articles based on the research questions. The Cochrane risk of bias tool and the Risk of Bias Assessment Tool for Non-randomized Studies were used to assess study bias. Results: Of the 169 records from the initial search, 10 (5.9%) articles meeting the selection criteria were included in this review. There were 8 mHealth apps designed for the delivery of PFMT. The Tät, which used 3 categories of persuasive system design, improved PFMT adherence and was cost-effective. Only 1 app, the iBall app, used all categories of persuasive system design, by including social support such as "competition" in its design. The Diário Saúde app was the only app developed using operant conditioning. All apps incorporated Tailoring and Expertise as part of their PSD strategies. Only 3 apps, the Diário Saúde, Tät, and Pen Yi Kang demonstrated improved PFMT adherence. Conclusions: Persuasive technology used in mobile apps may target desired behavior change more effectively. The persuasive system design can be mapped to the COM-B model to explain its effectiveness on behaviour change outcomes. %M 35315777 %R 10.2196/28751 %U https://mhealth.jmir.org/2022/3/e28751 %U https://doi.org/10.2196/28751 %U http://www.ncbi.nlm.nih.gov/pubmed/35315777 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e24725 %T Clinical Outcomes Among Working Adults Using the Health Integrator Smartphone App: Analyses of Prespecified Secondary Outcomes in a Randomized Controlled Trial %A Bonn,Stephanie %A Licitra,Gabriella %A Bellocco,Rino %A Trolle Lagerros,Ylva %+ Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, T2, Karolinska University Hospital, Stockholm, 171 76, Sweden, 46 08 51779173, stephanie.bonn@ki.se %K adults %K body composition %K exercise %K HbA1c %K healthy lifestyle %K metabolic health %K mobile app %K randomized controlled trial %K smartphone %D 2022 %7 21.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a need to find new methods that can enhance the individuals’ engagement in self-care and increase compliance to a healthy lifestyle for the prevention of noncommunicable diseases and improved quality of life. Mobile health (mHealth) apps could provide large-scale, cost-efficient digital solutions to implement lifestyle change, which as a corollary may enhance quality of life. Objective: Here we evaluate if the use of a smartphone-based self-management system, the Health Integrator app, with or without telephone counseling by a health coach, had an effect on clinical variables (secondary outcomes) of importance for noncommunicable diseases. Methods: The study was a 3-armed parallel randomized controlled trial. Participants were randomized to a control group or to 1 of 2 intervention groups using the Health Integrator app with or without additional telephone counseling for 3 months. Clinical variables were assessed before the start of the intervention (baseline) and after 3 months. Due to the nature of the intervention, targeting lifestyle changes, participants were not blinded to their allocation. Robust linear regression with complete case analysis was performed to study the intervention effect among the intervention groups, both in the entire sample and stratifying by type of work (office worker vs bus driver) and sex. Results: Complete data at baseline and follow-up were obtained from 205 and 191 participants, respectively. The mean age of participants was 48.3 (SD 10) years; 61.5% (126/205) were men and 52.2% (107/205) were bus drivers. Improvements were observed at follow-up among participants in the intervention arms. There was a small statistically significant effect on waist circumference (β=–0.97, 95% CI –1.84 to –0.10) in the group receiving the app and additional coach support compared to the control group, but no other statistically significant differences were seen. However, participants receiving only the app had statistically significantly lower BMI (β=–0.35, 95% CI –0.61 to –0.09), body weight (β=–1.08, 95% CI –1.92 to –0.26), waist circumference (β=–1.35, 95% CI –2.24 to –0.45), and body fat percentage (β=–0.83, 95% CI –1.65 to –0.02) at follow-up compared to the controls. There was a statistically significant difference in systolic blood pressure between the two intervention groups at follow-up (β=–3.74, 95% CI –7.32 to –0.16); no other statistically significant differences in outcome variables were seen. Conclusions: Participants randomized to use the Health Integrator smartphone app showed small but statistically significant differences in body weight, BMI, waist circumference, and body fat percentage compared to controls after a 3-month intervention. The effect of additional coaching together with use of the app is unclear. Trial Registration: ClinicalTrials.gov NCT03579342; https://clinicaltrials.gov/ct2/show/NCT03579342 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-6595-6 %M 35311677 %R 10.2196/24725 %U https://www.jmir.org/2022/3/e24725 %U https://doi.org/10.2196/24725 %U http://www.ncbi.nlm.nih.gov/pubmed/35311677 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e28208 %T Using Wearable Cameras to Categorize the Type and Context of Screen-Based Behaviors Among Adolescents: Observational Study %A Thomas,George %A Bennie,Jason A %A De Cocker,Katrien %A Dwi Andriyani,Fitria %A Booker,Bridget %A Biddle,Stuart J H %+ School of Allied Health, Curtin University, 208 Kent Street, Bentley, 6102, Australia, 61 473195605, george.thomas@curtin.edu.au %K adolescent %K screen time %K smartphone %K television %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Automated wearable cameras present a new opportunity to accurately assess human behavior. However, this technology is seldom used in the study of adolescent’s screen exposure, and the field is reliant on poor-quality self-report data. Objective: This study aimed to examine adolescents’ screen exposure by categorizing the type and context of behaviors using automated wearable cameras. Methods: Adolescents (mean age 15.4 years, SD 1.6 years; n=10) wore a camera for 3 school evenings and 1 weekend day. The camera captured an image every 10 seconds. Fieldwork was completed between February and March 2020, and data were analyzed in August 2020. Images were date and time stamped, and coded for screen type, content, and context. Results: Data representing 71,396 images were analyzed. Overall, 74.0% (52,842/71,396) of images contained screens and 16.8% (11,976/71,396) of images contained multiple screens. Most screen exposures involved television sets (25,950/71,396, 36.3%), smartphones (20,851/71,396, 29.2%), and laptop computers (15,309/71,396, 21.4%). The context of screen use differed by device type, although most screen exposures occurred at home (62,455/64,856, 96.3%) and with solitary engagement (54,430/64,856, 83.9%). The immediate after-school period saw high laptop computer use (4785/15,950, 30.0%), while smartphone use (2059/5320, 38.7%) peaked during prebedtime hours. Weekend screen exposure was high, with smartphone use (1070/1927, 55.5%) peaking in the early morning period and fluctuating throughout the day. Conclusions: There was evidence for high screen use during the after-school and weekend period, mostly through solitary engagement, and within the home environment. The findings may inform the basis of larger studies aimed at examining screen exposure in free-living conditions. %M 35311672 %R 10.2196/28208 %U https://pediatrics.jmir.org/2022/1/e28208 %U https://doi.org/10.2196/28208 %U http://www.ncbi.nlm.nih.gov/pubmed/35311672 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e30606 %T Digital Prompts to Increase Engagement With the Headspace App and for Stress Regulation Among Parents: Feasibility Study %A Militello,Lisa %A Sobolev,Michael %A Okeke,Fabian %A Adler,Daniel A %A Nahum-Shani,Inbal %+ College of Nursing, The Ohio State University, 1585 Neil Ave, Columbus, OH, 43210, United States, 1 614 688 4248, militello.14@osu.edu %K Headspace %K engagement %K mHealth %K mindfulness %K mental health %K mobile phone %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Given the interrelated health of children and parents, strategies to promote stress regulation are critically important in the family context. However, the uptake of preventive mental health is limited among parents owing to competing family demands. Objective: In this study, we aim to determine whether it is feasible and acceptable to randomize digital prompts designed to engage parents in real-time brief mindfulness activities guided by a commercially available app. Methods: We conducted a 30-day pilot microrandomized trial among a sample of parents who used Android smartphones. Each day during a parent-specified time frame, participants had a 50% probability of receiving a prompt with a message encouraging them to engage in a mindfulness activity using a commercial app, Headspace. In the 24 hours following randomization, ecological momentary assessments and passively collected smartphone data were used to assess proximal engagement (yes or no) with the app and any mindfulness activity (with or without the app). These data were combined with baseline and exit surveys to determine feasibility and acceptability. Results: Over 4 months, 83 interested parents were screened, 48 were eligible, 16 were enrolled, and 10 were successfully onboarded. Reasons for nonparticipation included technology barriers, privacy concerns, time constraints, or change of mind. In total, 80% (8/10) of parents who onboarded successfully completed all aspects of the intervention. While it is feasible to randomize prompt delivery, only 60% (6/10) of parents reported that the timing of prompts was helpful despite having control over the delivery window. Across the study period, we observed higher self-reported engagement with Headspace on days with prompts (31/62, 50% of days), as opposed to days without prompts (33/103, 32% of days). This pattern was consistent for most participants in this study (7/8, 87%). The time spent using the app on days with prompts (mean 566, SD 378 seconds) was descriptively higher than on days without prompts (mean 225, SD 276 seconds). App usage was highest during the first week and declined over each of the remaining 3 weeks. However, self-reported engagement in mindfulness activities without the app increased over time. Self-reported engagement with any mindfulness activity was similar on days with (40/62, 65% of days) and without (65/103, 63% of days) prompts. Participants found the Headspace app helpful (10/10, 100%) and would recommend the program to others (9/10, 90%). Conclusions: Preliminary findings suggest that parents are receptive to using mindfulness apps to support stress management, and prompts are likely to increase engagement with the app. However, we identified several implementation challenges in the current trial, specifically a need to optimize prompt timing and frequency as a strategy to engage users in preventive digital mental health. %M 35311675 %R 10.2196/30606 %U https://formative.jmir.org/2022/3/e30606 %U https://doi.org/10.2196/30606 %U http://www.ncbi.nlm.nih.gov/pubmed/35311675 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e31040 %T Comparing Reminders Sent via SMS Text Messaging and Email for Improving Adherence to an Electronic Health Program: Randomized Controlled Trial %A Kulhánek,Adam %A Lukavska,Katerina %A Gabrhelík,Roman %A Novák,Daniel %A Burda,Václav %A Prokop,Jindřich %A Holter,Marianne T S %A Brendryen,Håvar %+ Department of Addictology, General University Hospital in Prague, Apolinářská 4, Prague, 12000, Czech Republic, 420 224 968 273, katerina.lukavska@lf1.cuni.cz %K eHealth %K randomized controlled trial %K adherence %K reminders %K SMS text messaging %K email %K smoking cessation %K text message %D 2022 %7 18.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: eHealth interventions can help people change behavior (eg, quit smoking). Reminders sent via SMS text messaging or email may improve the adherence to web-based programs and increase the probability of successful behavior change; however, it is unclear whether their efficiency is affected by the modality of the communication channel. Objective: A 2-armed randomized control trial was conducted to compare the effect of providing reminders via SMS text messaging versus email on the adherence to an eHealth program for smoking cessation and on the probability to initiate a quit attempt. Methods: Smokers were recruited via an internet-based advertisement. A total of 591 participants who diverted from intended use of the program (ie, failed to log on to a session) were automatically randomized to the experimental (SMS text messaging reminder, n=304) or the active comparator (email reminder, n=287) group. Results: Unexpectedly, we found that the mode of reminder delivery did not significantly affect either the adherence, namely the number of completed program sessions, with the SMS text messaging reminder group showing a mean of 4.30 (SD 3.24) and the email reminder group showing a mean of 4.36 (SD 3.27) (t586=0.197, P=.84, and Cohen d=0.016), or the outcome, namely the quit smoking attempt rate (34.2% in the SMS text messaging group vs 31.7% in the email group; χ21=0.4, P=.52). Secondary analyses showed that age, gender, and education had significant effects on program adherence and education on the outcome. Moreover, we found a significant interaction effect between the mode of reminder delivery and gender on program adherence, suggesting that the effectiveness of SMS text message reminders might be different for females and males. However, this particular finding should be treated with care as it was based on post hoc subgroup analysis. Conclusions: This study indicates that the modality of user reminders to log on increased neither the program adherence nor the probability of quitting smoking. This suggests that program developers may save costs using emails instead of SMS text messaging reminders. Trial Registration: ClinicalTrials.gov NCT03276767; https://clinicaltrials.gov/ct2/show/ NCT03276767 %M 35302945 %R 10.2196/31040 %U https://mhealth.jmir.org/2022/3/e31040 %U https://doi.org/10.2196/31040 %U http://www.ncbi.nlm.nih.gov/pubmed/35302945 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e32123 %T The Effectiveness of a Nonguided Mindfulness App on Perceived Stress in a Nonclinical Dutch Population: Randomized Controlled Trial %A Kranenburg,Leonieke W %A Gillis,Jamie %A Mayer,Birgit %A Hoogendijk,Witte J G %+ Section of Medical Psychology, Department of Psychiatry, Erasmus University Medical Center, PO Box 2040, Rotterdam, 3000 CA, Netherlands, 31 10 7040139, l.kranenburg@erasmusmc.nl %K mHealth %K mindfulness %K stress %K burnout %K non-clinical population %K nonclinical %D 2022 %7 18.3.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mindfulness has become increasingly popular, and positive outcomes have been reported for mindfulness-based interventions (MBIs) in reducing stress. These findings make room for innovative perspectives on how MBIs could be applied, for instance through mobile health (mHealth). Objective: The aim of this study is to investigate whether a nonguided mindfulness mobile app can decrease perceived stress in a nonclinical Dutch population over the course of 8 weeks, with follow-up at 6 months. Methods: A randomized controlled trial was performed to compare an experimental group that made use of a structured 8-week mHealth mindfulness program and a control group after 8 weeks, with follow-up after 6 months. Participants were recruited via a national television program. The primary outcome measure was perceived stress as measured by the Perceived Stress Scale, secondary outcomes were symptoms of burnout (measured using the visual analog scale [VAS]) and psychological symptoms (measured using the Four-Dimensional Symptom Questionnaire [4DSQ] at follow-up). Outcomes were analyzed using a multilevel regression model. Results: At baseline, 587 respondents were included. Results showed no postintervention differences between groups for the level of perceived stress. With regard to the secondary outcome measures, the VAS for emotional exhaustion and physical exhaustion showed significantly lower scores for the experimental group after 8 weeks (P=.04 and P=.01, respectively), but not at follow-up. There were no differences between groups for psychological symptoms measured using the 4DSQ. Conclusions: These findings do not support our hypothesis that using the mindfulness app would reduce stress levels. However, our findings related to diminished exhaustion at 8 weeks are encouraging and require further investigation. Trial Registration: ClinicalTrials.gov NCT05246800; https://clinicaltrials.gov/show/NCT05246800 %M 35302504 %R 10.2196/32123 %U https://mental.jmir.org/2022/3/e32123 %U https://doi.org/10.2196/32123 %U http://www.ncbi.nlm.nih.gov/pubmed/35302504 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32342 %T User Experiences With an SMS Text Messaging Program for Smoking Cessation: Qualitative Study %A Budenz,Alexandra %A Coa,Kisha %A Grenen,Emily %A Keefe,Brian %A Sanders,Amy %A Wiseman,Kara P %A Roditis,Maria %+ ICF, 9300 Lee Hwy, Fairfax, VA, 22031, United States, 1 301 572 0369, Emily.Grenen@icfnext.com %K smoking cessation %K text messaging interventions %K qualitative research %K mobile phone %D 2022 %7 18.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health strategies for smoking cessation (eg, SMS text messaging–based interventions) have been shown to be effective in helping smokers quit. However, further research is needed to better understand user experiences with these platforms. Objective: This qualitative study aims to explore the experiences of real-world users of a publicly available smoking cessation program (SmokefreeTXT). Methods: Semistructured phone interviews were conducted with 36 SmokefreeTXT users between March and July 2014. Of these 36 participants, 50% (18/36) of participants completed the SmokefreeTXT program (ie, did not opt out of the program before the 6- to 8-week completion period), and 50% (18/36) did not complete the program (ie, requested to opt out of the program before the completion period). Interview questions focused on smoking behaviors, quitting history, opinions on the program’s content and structure, answering assessment questions, using keywords, reasons for opting out, and perceived usefulness of the program for quitting smoking. A thematic content analysis was conducted, with a focus on themes to increase program engagement and optimization. Results: The findings highlighted features of the program that participants found beneficial, as well as some elements that showed opportunities for improvement to boost program retention and successful cessation. Specifically, most participants found the SmokefreeTXT program to be convenient and supportive of cessation; however, some found the messages to be repetitive and reported a desire for more flexibility based on their readiness to quit and cessation progress. We also found that program completion did not necessarily indicate successful smoking cessation and that program opt out, which might be interpreted as a less positive outcome, may occur because of successful cessation. Finally, several participants reported using SmokefreeTXT together with other evidence-based cessation methods or non–evidence-based strategies. Conclusions: Qualitative interviews with real-world SmokefreeTXT users showed high program acceptability, engagement with program features, and perceived utility for smoking cessation. Our findings directly informed several program updates, such as adding an adaptive quit date feature and offering supplemental information on live support services for users who prefer human interaction during the cessation process. The study has implications for other digital tobacco cessation interventions and highlights important topics that warrant future research, such as the relationship between program engagement (eg, opt out and retention) and successful cessation. %M 35302505 %R 10.2196/32342 %U https://formative.jmir.org/2022/3/e32342 %U https://doi.org/10.2196/32342 %U http://www.ncbi.nlm.nih.gov/pubmed/35302505 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e34758 %T An Integrated, Multimodal, Digital Health Solution for Chronic Obstructive Pulmonary Disease: Prospective Observational Pilot Study %A Gelbman,Brian D %A Reed,Carol R %+ Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical Center, 635 Madison Avenue, Suite 1101, New York, NY, 10022, United States, 1 212 628 6611, Brg9001@med.cornell.edu %K COPD %K patient engagement %K mHealth %K digital health %K mobile phone %K telemedicine %K mobile apps %K remote monitoring %K spirometry %K pulse oximetry %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic obstructive pulmonary disease (COPD) affects millions of Americans and has a high economic impact partially due to frequent emergency room visits and hospitalizations. Advances in digital health have made it possible to collect data remotely from multiple devices to assist in managing chronic diseases such as COPD. Objective: In this pilot study, we evaluated the ability of patients with COPD to use the Wellinks mHealth platform to collect information from multiple modalities important to the management of COPD. We also assessed patient satisfaction and engagement with the platform. Methods: A single-site, observational, prospective pilot study (N=19) was conducted using the Wellinks platform in adults with COPD. All patients were aged over 30 years at screening, owned an iPhone, and were currently undergoing a treatment regimen that included nebulized therapy. Enrolled patients received a study kit consisting of the Flyp nebulizer, Smart One spirometer, the Nonin pulse oximeter, plus the Wellinks mHealth app, and training for all devices. For 8 weeks, participants were to enter daily symptoms and medication use manually; spirometry, nebulizer, and pulse oximeter data were automatically recorded. Data were sent to the attending physician in a monthly report. Patient satisfaction was measured via a 5-point scale and the Net Promoter Score (NPS) captured in interviews at the end of the observation period. Results: Average age of the patients was 79.6 (range 65-95) years. Participants (10 female; 9 male) had an average FEV1% (forced expiratory volume in 1 second as % of predicted for the patient) of 56.2% of predicted (range 23%-113%) and FEV1/forced vital capacity of 65%. COPD severity, as assessed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, was mild in 2 patients, moderate in 6, and severe/very severe in 11; 9 patients were on home oxygen. During this 8-week study, average use of the spirometer was 2.5 times/week, and the pulse oximeter 4.2 times/week. Medication use was manually documented 9.0 times/week, nebulizer use 1.9 times/week, and symptoms recorded 1.2 times/week on average. The correlation coefficients of home to office measurements for peak flow and FEV1 were high (r=0.94 and 0.96, respectively). Patients found the app valuable (13/16, 81%) and easy to use (15/16, 94%). The NPS was 59. Conclusions: This study demonstrates that our cohort of patients with COPD engaged with the Wellinks mHealth platform avidly and consistently over the 8-week period, and that patient satisfaction was high, as indicated by the satisfaction survey and the NPS of 59. In this small, selected sample, patients were both willing to use the technology and capable of doing so successfully regardless of disease severity, age, or gender. The Wellinks mHealth platform was considered useful and valuable by patients, and can assist clinicians in improved, timely decision making for better COPD management. %M 35142291 %R 10.2196/34758 %U https://formative.jmir.org/2022/3/e34758 %U https://doi.org/10.2196/34758 %U http://www.ncbi.nlm.nih.gov/pubmed/35142291 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e27588 %T Effectiveness, Cost-effectiveness, and Cost-Utility of a Digital Smoking Cessation Intervention for Cancer Survivors: Health Economic Evaluation and Outcomes of a Pragmatic Randomized Controlled Trial %A Mujcic,Ajla %A Blankers,Matthijs %A Boon,Brigitte %A Verdonck-de Leeuw,Irma M %A Smit,Filip %A van Laar,Margriet %A Engels,Rutger %+ Erasmus School of Social and Behavioural Sciences, Erasmus University, Burgemeester Oudlaan 50, Rotterdam, 3062PA, Netherlands, 31 30 29 59 256, amujcic@trimbos.nl %K smoking cessation %K cancer survivors %K effectiveness %K cost-effectiveness %K eHealth %D 2022 %7 17.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Smoking cessation (SC) interventions may contribute to better treatment outcomes and the general well-being of cancer survivors. Objective: This study aims to evaluate the effectiveness, cost-effectiveness, and cost-utility of a digital interactive SC intervention compared with a noninteractive web-based information brochure for cancer survivors. Methods: A health economic evaluation alongside a pragmatic 2-arm parallel-group randomized controlled trial was conducted with follow-ups at 3, 6, and 12 months. The study was conducted in the Netherlands over the internet from November 2016 to September 2019. The participants were Dutch adult smoking cancer survivors with the intention to quit smoking. In total, 165 participants were included and analyzed: 83 (50.3%) in the MyCourse group and 82 (49.7%) in the control group. In the intervention group, participants had access to a newly developed, digital, minimally guided SC intervention (MyCourse-Quit Smoking). Control group participants received a noninteractive web-based information brochure on SC. Both groups received unrestricted access to usual care. The primary outcome was self-reported 7-day smoking abstinence at the 6-month follow-up. Secondary outcomes were quality-adjusted life years gained, number of cigarettes smoked, nicotine dependence, and treatment satisfaction. For the health economic evaluation, intervention costs, health care costs, and costs stemming from productivity losses were assessed over a 12-month horizon. Results: At the 6-month follow-up, the quit rates were 28% (23/83) and 26% (21/82) in the MyCourse and control groups, respectively (odds ratio 0.47, 95% CI 0.03-7.86; P=.60). In both groups, nicotine dependence scores were reduced at 12 months, and the number of smoked cigarettes was reduced by approximately half. The number of cigarettes decreased more over time, and the MyCourse group demonstrated a significantly greater reduction at the 12-month follow-up (incidence rate ratio 0.87; 95% CI 0.76-1.00; P=.04). Intervention costs were estimated at US $193 per participant for the MyCourse group and US $74 for the control group. The mean per-participant societal costs were US $25,329 (SD US $29,137) and US $21,836 (SD US $25,792), respectively. In the cost-utility analysis, MyCourse was not preferred over the control group from a societal perspective. With smoking behavior as the outcome, the MyCourse group led to marginally better results per reduced pack-year against higher societal costs, with a mean incremental cost-effectiveness ratio of US $52,067 (95% CI US $32,515-US $81,346). Conclusions: At 6 months, there was no evidence of a differential effect on cessation rates; in both groups, approximately a quarter of the cancer survivors quit smoking and their number of cigarettes smoked was reduced by half. At 12 months, the MyCourse intervention led to a greater reduction in the number of smoked cigarettes, albeit at higher costs than for the control group. No evidence was found for a differential effect on quality-adjusted life years. Trial Registration: The Netherlands Trial Register NTR6011; https://www.trialregister.nl/trial/5434 International Registered Report Identifier (IRRID): RR2-10.1186/s12885-018-4206-z %M 35297777 %R 10.2196/27588 %U https://www.jmir.org/2022/3/e27588 %U https://doi.org/10.2196/27588 %U http://www.ncbi.nlm.nih.gov/pubmed/35297777 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 1 %P e35137 %T The Effects of Using the Sun Safe App on Sun Health Knowledge and Behaviors of Young Teenagers: Results of Pilot Intervention Studies %A Clare,Isabelle M %A Gamage,Nisali %A Alvares,Gail A %A Black,Lucinda J %A Francis,Jacinta %A Jaimangal,Mohinder %A Lucas,Robyn M %A Strickland,Mark %A White,James %A Nguyen,Rebecca %A Gorman,Shelley %+ Telethon Kids Institute, University of Western Australia, PO Box 855, Perth, 6872, Australia, 61 8 6319 1747, Shelley.Gorman@telethonkids.org.au %K app development %K co-design %K knowledge gain %K sun exposure %K sun protection %K sun behaviors %K teenagers %K UV Index %K vitamin D %K young adolescents %K mobile phone %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Dermatol %G English %X Background: A balanced approach toward sun exposure and protection is needed by young people. Excessive sun exposure increases their risk for skin cancers such as melanoma, whereas some exposure is necessary for vitamin D and healthy bones. We have developed a new iOS smartphone app—Sun Safe—through a co-design process, which aims to support healthy and balanced decision-making by young teenagers (aged 12-13 years). Objective: The aim of this study was to test the capacity of Sun Safe to improve sun health knowledge and behaviors of young teenagers in 3 pilot intervention studies completed in 2020. Methods: Young teenagers (aged 12-13 years; N=57) were recruited through the web or through a local school via an open-access website and given access to Sun Safe (29/57, 51%) or a placebo (SunDial) app (28/57, 49%). Participants completed sun health questionnaires and knowledge quizzes before and after the 6-week intervention (either on the web or in class) and rated the quality of the app they used via a survey. Results: Of the 57 participants, 51 (89%) participants (26, 51% for placebo arm and 25, 49% for the Sun Safe arm) completed these studies, with most (>50%) reporting that they used a smartphone to access their designated app either “once a fortnight” or “once/twice in total.” Improved sun health knowledge—particularly about the UV Index—was observed in participants who were given access to Sun Safe compared with those who used the placebo (−6.2 [percentage correct] difference in predicted means, 95% CI –12.4 to –0.03; P=.049; 2-way ANOVA). Unexpectedly, there were significantly more sunburn events in the Sun Safe group (relative risk 1.7, 95% CI 1.1-1.8; P=.02; Fisher exact test), although no differences in time spent outdoors or sun-protective behaviors were reported. COVID-19 pandemic–related community-wide shutdowns during April 2020 (when schools were closed) reduced the time spent outdoors by >100 minutes per day (–105 minutes per day difference in predicted means, 95% CI –150 to –59 minutes per day; P=.002; paired 2-tailed Student t test). Sun Safe was well-rated by participants, particularly for information (mean 4.2, SD 0.6 out of 5). Conclusions: Access to the Sun Safe app increased sun health knowledge among young teenagers in these pilot intervention studies. Further investigations with larger sample sizes are required to confirm these observations and further test the effects of Sun Safe on sun-protective behaviors. %M 37632872 %R 10.2196/35137 %U https://derma.jmir.org/2022/1/e35137 %U https://doi.org/10.2196/35137 %U http://www.ncbi.nlm.nih.gov/pubmed/37632872 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e29171 %T An Educational and Exercise Mobile Phone–Based Intervention to Elicit Electrophysiological Changes and to Improve Psychological Functioning in Adults With Nonspecific Chronic Low Back Pain (BackFit App): Nonrandomized Clinical Trial %A Sitges,Carolina %A Terrasa,Juan L %A García-Dopico,Nuria %A Segur-Ferrer,Joan %A Velasco-Roldán,Olga %A Crespí-Palmer,Jaume %A González-Roldán,Ana María %A Montoya,Pedro %+ Research Institute of Health Sciences (IUNICS) and Balearic Islands Health Research Institute (IdISBa), Department of Psychology, University of the Balearic Islands (UIB), Cra. de Valldemossa km 7.5, Palma, 07122, Spain, 34 971259885, carol.sitges@uib.es %K low back pain %K chronic pain %K mobile apps %K education %K exercise %K brain %K cognition %K depression %K pain threshold %K mHealth %K mobile phone %D 2022 %7 15.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Concomitant psychological and cognitive impairments modulate nociceptive processing and contribute to chronic low back pain (CLBP) maintenance, poorly correlated with radiological findings. Clinical practice guidelines recommend self-management and multidisciplinary educational and exercise-based interventions. However, these recommendations are based on self-reported measurements, which lack evidence of related electrophysiological changes. Furthermore, current mobile health (mHealth) tools for self-management are of low quality and scarce evidence. Thus, it is necessary to increase knowledge on mHealth and electrophysiological changes elicited by current evidence-based interventions. Objective: The aim of this study is to investigate changes elicited by a self-managed educational and exercise-based 4-week mHealth intervention (BackFit app) in electroencephalographic and electrocardiographic activity, pressure pain thresholds (PPTs), pain, disability, and psychological and cognitive functioning in CLBP versus the same intervention in a face-to-face modality. Methods: A 2-arm parallel nonrandomized clinical trial was conducted at the University of the Balearic Islands (Palma, Spain). A total of 50 patients with nonspecific CLBP were assigned to a self-managed group (23/50, 46%; mean age 45.00, SD 9.13 years; 10/23, 43% men) or a face-to-face group (27/50, 54%; mean age 48.63, SD 7.54 years; 7/27, 26% men). The primary outcomes were electroencephalographic activity (at rest and during a modified version of the Eriksen flanker task) and heart rate variability (at rest), PPTs, and pressure pain intensity ratings. The secondary outcomes were pain, disability, psychological functioning (mood, anxiety, kinesiophobia, pain catastrophizing, and fear-avoidance beliefs), and cognitive performance (percentage of hits and reaction times). Results: After the intervention, frequency analysis of electroencephalographic resting-state data showed increased beta-2 (16-23 Hz; 0.0020 vs 0.0024; P=.02) and beta-3 (23-30 Hz; 0.0013 vs 0.0018; P=.03) activity. In addition, source analyses revealed higher power density of beta (16-30 Hz) at the anterior cingulate cortex and alpha (8-12 Hz) at the postcentral gyrus and lower power density of delta (2-4 Hz) at the cuneus and precuneus. Both groups also improved depression (7.74 vs 5.15; P=.01), kinesiophobia (22.91 vs 20.87; P=.002), activity avoidance (14.49 vs 12.86; P<.001), helplessness (6.38 vs 4.74; P=.02), fear-avoidance beliefs (35 vs 29.11; P=.03), and avoidance of physical activity (12.07 vs 9.28; P=.01) scores, but there was an increase in the disability score (6.08 vs 7.5; P=.01). No significant differences between the groups or sessions were found in heart rate variability resting-state data, electroencephalographic data from the Eriksen flanker task, PPTs, subjective ratings, or cognitive performance. Conclusions: Both intervention modalities increased mainly beta activity at rest and improved psychological functioning. Given the limitations of our study, conclusions must be drawn carefully and further research will be needed. Nevertheless, to the best of our knowledge, this is the first study reporting electroencephalographic changes in patients with CLBP after an mHealth intervention. Trial Registration: ClinicalTrials.gov NCT04576611; https://clinicaltrials.gov/ct2/show/NCT04576611 %M 35289758 %R 10.2196/29171 %U https://mhealth.jmir.org/2022/3/e29171 %U https://doi.org/10.2196/29171 %U http://www.ncbi.nlm.nih.gov/pubmed/35289758 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e31501 %T The Effect of Wearable Tracking Devices on Cardiorespiratory Fitness Among Inactive Adults: Crossover Study %A Larsen,Lisbeth Hoejkjaer %A Lauritzen,Maja Hedegaard %A Sinkjaer,Mikkel %A Kjaer,Troels W %+ Department of Neurology, Zealand University Hospital, Sygehusvej 10, Roskilde, 4000, Denmark, 45 41558592, lisbla@regionsjaelland.dk %K activity tracking %K cardiorespiratory fitness %K mHealth %K mobile health %K motivation %K physical activity %K self-monitoring %K wearable %K cardio %K fitness %K cardiorespiratory %K behavior change %D 2022 %7 15.3.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Modern lifestyle is associated with a high prevalence of physical inactivity. Objective: This study aims to investigate the effect of a wearable tracking device on cardiorespiratory fitness among inactive adults and to explore if personal characteristics and health outcomes can predict adoption of the device. Methods: In total, 62 inactive adults were recruited for this study. A control period (4 weeks) was followed by an intervention period (8 weeks) where participants were instructed to register and follow their physical activity (PA) behavior on a wrist-worn tracking device. Data collected included estimated cardiorespiratory fitness, body composition, blood pressure, perceived stress levels, and self-reported adoption of using the tracking device. Results: In total, 50 participants completed the study (mean age 48, SD 13 years, 84% women). Relative to the control period, participants increased cardiorespiratory fitness by 1.52 mL/kg/minute (95% CI 0.82-2.22; P<.001), self-reported PA by 140 minutes per week (95% CI 93.3-187.1; P<.001), daily step count by 982 (95% CI 492-1471; P<.001), and participants’ fat percentage decreased by 0.48% (95% CI –0.84 to –0.13; P=.009). No difference was observed in blood pressure (systolic: 95% CI –2.16 to 3.57, P=.63; diastolic: 95% CI –0.70 to 2.55; P=.27) or perceived stress (95% CI –0.86 to 1.78; P=.49). No associations were found between adoption of the wearable tracking device and age, gender, personality, or education. However, participants with a low perceived stress at baseline were more likely to rate the use of a wearable tracking device highly motivating. Conclusions: Tracking health behavior using a wearable tracking device increases PA resulting in an improved cardiorespiratory fitness among inactive adults. %M 35289763 %R 10.2196/31501 %U https://cardio.jmir.org/2022/1/e31501 %U https://doi.org/10.2196/31501 %U http://www.ncbi.nlm.nih.gov/pubmed/35289763 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e33940 %T Use of an mHealth Ketogenic Diet App Intervention and User Behaviors Associated With Weight Loss in Adults With Overweight or Obesity: Secondary Analysis of a Randomized Clinical Trial %A Falkenhain,Kaja %A Locke,Sean R %A Lowe,Dylan A %A Lee,Terry %A Singer,Joel %A Weiss,Ethan J %A Little,Jonathan P %+ School of Health and Exercise Sciences, The University of British Columbia Okanagan, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada, 1 250 807 9876, jonathan.little@ubc.ca %K acetone %K biofeedback %K psychology %K diet %K ketogenic %K mobile apps %K overweight %K technology %K telemedicine %K weight loss %K mobile phone %D 2022 %7 14.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Low-carbohydrate ketogenic diets are a viable method to lose weight that have regained popularity in recent years. Technology in the form of mobile health (mHealth) apps allows for scalable and remote delivery of such dietary interventions and are increasingly being used by the general population without direct medical supervision. However, it is currently unknown which factors related to app use and user behavior are associated with successful weight loss. Objective: First, to describe and characterize user behavior, we aim to examine characteristics and user behaviors over time of participants who were enrolled in a remotely delivered clinical weight loss trial that tested an mHealth ketogenic diet app paired with a breath acetone biofeedback device. Second, to identify variables of importance to weight loss at 12 weeks that may offer insight for future development of dietary mHealth interventions, we aim to explore which app- and adherence-related user behaviors characterized successful weight loss. Methods: We analyzed app use and self-reported questionnaire data from 75 adults with overweight or obesity who participated in the intervention arm of a previous weight loss study. We examined data patterns over time through linear mixed models and performed correlation, linear regression, and causal mediation analyses to characterize diet-, weight-, and app-related user behavior associated with weight loss. Results: In the context of a low-carbohydrate ketogenic diet intervention delivered remotely through an mHealth app paired with a breath acetone biofeedback device, self-reported dietary adherence seemed to be the most important factor to predict weight loss (β=–.31; t54=–2.366; P=.02). Furthermore, self-reported adherence mediated the relationship between greater app engagement (from c=–0.008, 95% CI –0.014 to –0.0019 to c’=–0.0035, 95% CI –0.0094 to 0.0024) or higher breath acetone levels (from c=–1.34, 95% CI –2.28 to –0.40 to c’=–0.40, 95% CI –1.42 to 0.62) and greater weight loss, explaining a total of 27.8% and 28.8% of the variance in weight loss, respectively. User behavior (compliance with weight measurements and app engagement) and adherence-related aspects (breath acetone values and self-reported dietary adherence) over time differed between individuals who achieved a clinically significant weight loss of >5% and those who did not. Conclusions: Our in-depth examination of app- and adherence-related user behaviors offers insight into factors associated with successful weight loss in the context of mHealth interventions. In particular, our finding that self-reported dietary adherence was the most important metric predicting weight loss may aid in the development of future mHealth dietary interventions. Trial Registration: ClinicalTrials.gov NCT04165707; https://clinicaltrials.gov/ct2/show/NCT04165707 International Registered Report Identifier (IRRID): RR2-10.2196/19053 %M 35285809 %R 10.2196/33940 %U https://mhealth.jmir.org/2022/3/e33940 %U https://doi.org/10.2196/33940 %U http://www.ncbi.nlm.nih.gov/pubmed/35285809 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e35879 %T Nutrition-Related Mobile Apps in the French App Stores: Assessment of Functionality and Quality %A Martinon,Prescilla %A Saliasi,Ina %A Bourgeois,Denis %A Smentek,Colette %A Dussart,Claude %A Fraticelli,Laurie %A Carrouel,Florence %+ Health, Systemic, Process UR 4129 Research Unit, University Claude Bernard, University of Lyon, 11 Rue Guillaume Paradin, Lyon, 69008, France, 33 478785745, florence.carrouel@univ-lyon1.fr %K mobile apps %K behavior change %K diet %K healthy food %K nutrition %K prevention %K mHealth %K mobile health %K lifestyle %K French %D 2022 %7 14.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The global burden of disease attributes 20% of deaths to poor nutrition. Although hundreds of nutrition-related mobile apps have been created, and these have been downloaded by millions of users, the effectiveness of these technologies on the adoption of healthy eating has had mixed Objective: The aim of this study was to review which nutrition-related mobile apps are currently available on the French market and assess their quality. Methods: We screened apps on the Google Play Store and the French Apple App Store, from March 10 to 17, 2021, to identify those related to nutritional health. A shortlist of 15 apps was identified, and each was assessed using the French version of the Mobile App Rating Scale: 8 dietitians and nutritionists assessed 7 apps, and the remaining apps were randomly allocated to ensure 4 assessments per app. Intraclass correlation was used to evaluate interrater agreement. Means and standard deviations of scores for each section and each item were calculated. Results: The top scores for overall quality were obtained by Yazio - Régime et Calories (mean 3.84, SD 0.32), FeelEat (mean 3.71, SD 0.47), and Bonne App (mean 3.65, SD 0.09). Engagement scores ranged from a mean of 1.95 (SD 0.5) for iEatBetter: Journal alimentaire to a mean of 3.85 (SD 0.44) for FeelEat. Functionality scores ranged from a mean of 2.25 (SD 0.54) for Naor to a mean of 4.25 (SD 0.46) for Yazio. Aesthetics scores ranged from a mean of 2.17 (SD 0.34) for Naor to a mean of 3.88 (SD 0.47) for Yazio. Information scores ranged from a mean of 2.38 (SD 0.60) for iEatBetter to a mean of 3.73 (SD 0.29) for Yazio. Subjective quality scores ranged from a mean of 1.13 (SD 0.25) for iEatBetter to a mean of 2.28 (SD 0.88) for Compteur de calories FatSecret. Specificity scores ranged from a mean of 1.38 (SD 0.64) for iEatBetter to a mean of 3.50 (SD 0.91) for FeelEat. The app-specific score was always lower than the subjective quality score, which was always lower than the quality score, which was lower than the rating from the iOS or Android app stores. Conclusions: Although prevention and information messages in apps regarding nutritional habits are not scientifically verified before marketing, we found that app quality was good. Subjective quality and specificity were associated with lower ratings. Further investigations are needed to assess whether information from these apps is consistent with recommendations and to determine the long-term impacts of these apps on users. %M 35285817 %R 10.2196/35879 %U https://mhealth.jmir.org/2022/3/e35879 %U https://doi.org/10.2196/35879 %U http://www.ncbi.nlm.nih.gov/pubmed/35285817 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e31638 %T A Reusable Multiplayer Game for Promoting Active School Transport: Development Study %A Laine,Teemu H %A Duong,Nhi %A Lindvall,Helena %A Oyelere,Solomon Sunday %A Rutberg,Stina %A Lindqvist,Anna-Karin %+ Department of Digital Media, Ajou University, Sanhak Hall 618, 206 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea, 82 312191851, teemu@ubilife.net %K gamification %K active school transport %K physical activity %K formative evaluation %K architecture %K mobile phone %K web browser %D 2022 %7 14.3.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Most children and adolescents in Sweden do not meet the recommended daily physical activity levels of the World Health Organization. Active school transport (AST) and gamification are potential methods for increasing children’s daily physical activity. We previously developed a game named Tic-Tac-Training for promoting active transport at workplaces; however, the game has not been applied to AST. Objective: The objectives of this study are to investigate how Tic-Tac-Training functions to promote AST among schoolchildren in northern Sweden, improve the game to be more suitable for schoolchildren, and construct a road map for future development based on children’s ideas. Methods: First, we developed Tic-Tac-Training using the Scrum agile software development method. Second, we conducted a questionnaire-based formative evaluation of the game with schoolchildren (n=16; 9/16, 56% male; 6/16, 38% female; and 1/16, 6% other aged 11-12 years) in Luleå, Sweden. Third, we conducted focus group interviews with 33 children (13/33, 39% male and 20/33, 61% female aged 12-13 years) to gather ideas for gamifying AST. We mapped the interview results to the Octalysis gamification framework and established a road map for future development. Results: The formative evaluation revealed several issues, including a lack of interesting game features, lack of support for continuous engagement, disliked competitive features, and lack of incentives for discourse and participation. New features such as rewards, collectibles, and levels were implemented based on the results. The focus group interviews revealed additional ideas for gamifying AST, such as using avatars, in-game currency and trading, and context-sensitive tasks. Conclusions: The results have several potential impacts on how reusable, gamified AST interventions can be developed and what kind of gamification elements schoolchildren in northern Sweden wish to see. These results can interest game researchers and teachers who wish to apply gamification in school contexts. Finally, we aim to continue developing the game based on the road map. %M 35285815 %R 10.2196/31638 %U https://games.jmir.org/2022/1/e31638 %U https://doi.org/10.2196/31638 %U http://www.ncbi.nlm.nih.gov/pubmed/35285815 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e35402 %T Developing a Smartphone-Based Adjunct Intervention to Reduce Cannabis Use Among Juvenile Justice-Involved Adolescents: Protocol for a Multiphase Study %A Helseth,Sarah A %A Guigayoma,John %A Price,Dayna %A Spirito,Anthony %A Clark,Melissa A %A Barnett,Nancy P %A Becker,Sara J %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 5th Floor, Providence, RI, , United States, 1 401 863 6881, sarah_helseth@brown.edu %K mobile intervention %K juvenile justice %K justice %K court %K adolescent %K teenager %K substance use %K cannabis %K youth %K adolescence %K protocol %K mHealth %K mobile health %K substance use %K user design %K behavioral app %K health app %K development %K pilot %K prototype %K feasibility %K acceptability %K smartphone app %K marijuana %K mobile phone %D 2022 %7 11.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescents involved in the juvenile justice system who use cannabis are at an increased risk of future substance use disorders and rearrest. Many court-involved, nonincarcerated (CINI) youth are referred for services in the community and often encounter multiple barriers to care, highlighting the need for minimally burdensome services that can be delivered in justice settings. Digital health interventions are accessible, easy to implement, and can provide ongoing support but have not been developed to address the unique needs of CINI youth who use cannabis. Objective: This multiphase study will aim to develop, implement, and pilot test a novel smartphone app, Teen Empowerment through Computerized Health (TECH), to reduce cannabis and other substance use among CINI youth. TECH is conceptualized as a digital adjunct to a brief computerized intervention delivered by our family court partner. Methods: Following the principles of user-centered design, phase I interviews with CINI youth aged 14-18 years (n=14-18), their caregivers (n=6-8), and behavioral health app developers (n=6-8) will guide the TECH design decisions. Next, in phase II, CINI youth (n=10) will beta test the TECH app prototype for 1 month; their feedback regarding feasibility and acceptability will directly inform the app refinement process. Finally, in phase III, CINI youth (n=60) will participate in a pilot randomized controlled trial for 6 months, comparing the preliminary effectiveness of the adjunctive TECH app on cannabis use outcomes. Results: Phase I data collection began in September 2020 and was completed in December 2021; 14 CINI youth, 8 caregivers, and 11 behavioral health app developers participated in the study. Phases II and III will occur in 2022 and 2023 and 2023 and 2025, respectively. Conclusions: This body of work will provide insight into the feasibility and acceptability of a smartphone-based adjunctive intervention designed for CINI youth. Phase III results will offer a preliminary indication of the effectiveness of the TECH app in reducing cannabis use among CINI youth. International Registered Report Identifier (IRRID): DERR1-10.2196/35402 %M 35275086 %R 10.2196/35402 %U https://www.researchprotocols.org/2022/3/e35402 %U https://doi.org/10.2196/35402 %U http://www.ncbi.nlm.nih.gov/pubmed/35275086 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e27791 %T Implementation of Cognitive Behavioral Therapy in e–Mental Health Apps: Literature Review %A Denecke,Kerstin %A Schmid,Nicole %A Nüssli,Stephan %+ Institute for Medical Informatics, Bern University of Applied Sciences, Quellgasse 21, Biel, 2501, Switzerland, 41 32 321 67 94, kerstin.denecke@bfh.ch %K cognitive behavioral therapy %K mHealth %K e–mental health %K chatbot %K mobile phone %D 2022 %7 10.3.2022 %9 Review %J J Med Internet Res %G English %X Background: To address the matter of limited resources for treating individuals with mental disorders, e–mental health has gained interest in recent years. More specifically, mobile health (mHealth) apps have been suggested as electronic mental health interventions accompanied by cognitive behavioral therapy (CBT). Objective: This study aims to identify the therapeutic aspects of CBT that have been implemented in existing mHealth apps and the technologies used. From these, we aim to derive research gaps that should be addressed in the future. Methods: Three databases were screened for studies on mHealth apps in the context of mental disorders that implement techniques of CBT: PubMed, IEEE Xplore, and ACM Digital Library. The studies were independently selected by 2 reviewers, who then extracted data from the included studies. Data on CBT techniques and their technical implementation in mHealth apps were synthesized narratively. Results: Of the 530 retrieved citations, 34 (6.4%) studies were included in this review. mHealth apps for CBT exploit two groups of technologies: technologies that implement CBT techniques for cognitive restructuring, behavioral activation, and problem solving (exposure is not yet realized in mHealth apps) and technologies that aim to increase user experience, adherence, and engagement. The synergy of these technologies enables patients to self-manage and self-monitor their mental state and access relevant information on their mental illness, which helps them cope with mental health problems and allows self-treatment. Conclusions: There are CBT techniques that can be implemented in mHealth apps. Additional research is needed on the efficacy of the mHealth interventions and their side effects, including inequalities because of the digital divide, addictive internet behavior, lack of trust in mHealth, anonymity issues, risks and biases for user groups and social contexts, and ethical implications. Further research is also required to integrate and test psychological theories to improve the impact of mHealth and adherence to the e–mental health interventions. %M 35266875 %R 10.2196/27791 %U https://www.jmir.org/2022/3/e27791 %U https://doi.org/10.2196/27791 %U http://www.ncbi.nlm.nih.gov/pubmed/35266875 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e32499 %T Analysis of Demographic Characteristics of Users of a Free Tobacco Cessation Smartphone App: Observational Study %A Fradkin,Nick %A Zbikowski,Susan M %A Christensen,Trevor %+ Office of Healthy and Safe Communities, Division of Prevention and Community Health, Washington State Department of Health, PO Box 47848, Olympia, WA, 98504-7848, United States, 1 602 326 3439, nfradkin@gmail.com %K mobile applications %K mHealth %K eHealth %K smartphone app %K tobacco %K smoking cessation %K public health %K smoking %K application %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Tobacco use continues to be the leading preventable cause of death, disease, and disability in the United States. Since 2000, Washington state has offered free tobacco “quitline” services to help its residents stop using tobacco. In 2015, the state began offering free access to a tobacco cessation smartphone app to absorb excess quitline demand. Since most publicly funded tobacco cessation programs are designed to provide access to populations disproportionately impacted by tobacco use, it is important to consider who these public health interventions reach. Objective: The aim of this study is to understand who used a free cessation app and the extent to which users represented populations disproportionately impacted by tobacco use. Methods: This is an observational study of 1280 adult Washington state residents who registered for and activated the cessation app. Demographic data were collected as part of the sign-up process, examined using standard descriptive measures, and assessed against state-level surveillance data for representativeness. Results: Participants were primarily non-Hispanic White (978/1218, 80.3%), identified as female (780/1236, 63.1%), were between ages 25-54 years (903/1186, 76.1%), had at least some college education (836/1222, 68.4%), and reported a household income under US $50,000 (742/1055, 70.3%). Fewer respondents were from rural counties (359/1220, 29.4%); identified as lesbian, gay, bisexual, pansexual, queer, questioning, or asexual (LGBQA; 153/1222, 12.5%); were uninsured (147/1206, 12.2%); or were currently pregnant, planning pregnancy, or breastfeeding (42/624, 6.7%). However, relative to available state data for tobacco users, there was high representation of women, 35- to 54-year-olds, college graduates, and LGBQA individuals, as well as individuals with low household income, poor mental health, Medicaid insurance, and those residing in rural counties. Conclusions: A diverse population of tobacco users will use a free cessation app, including some demographic groups disproportionately impacted by tobacco use. With high reach and high efficacy, it is possible to address health disparities associated with tobacco use and dependence treatment among certain underserved and at-risk groups. %M 35262491 %R 10.2196/32499 %U https://publichealth.jmir.org/2022/3/e32499 %U https://doi.org/10.2196/32499 %U http://www.ncbi.nlm.nih.gov/pubmed/35262491 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e30468 %T Data Collection Mechanisms in Health and Wellness Apps: Review and Analysis %A Philip,Ben Joseph %A Abdelrazek,Mohamed %A Bonti,Alessio %A Barnett,Scott %A Grundy,John %+ Deakin University, 221 Burwood Highway, Melbourne, 3125, Australia, 61 426824528, benjo@deakin.edu.au %K data collection %K mHealth apps %K app review %K app analysis %K mHealth %K mobile apps %K development %K data sharing %K user experience %K usability %K automation %K data reliability %K mobile phone %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There has been a steady rise in the availability of health wearables and built-in smartphone sensors that can be used to collect health data reliably and conveniently from end users. Given the feature overlaps and user tendency to use several apps, these are important factors impacting user experience. However, there is limited work on analyzing the data collection aspect of mobile health (mHealth) apps. Objective: This study aims to analyze what data mHealth apps across different categories usually collect from end users and how these data are collected. This information is important to guide the development of a common data model from current widely adopted apps. This will also inform what built-in sensors and wearables, a comprehensive mHealth platform should support. Methods: In our empirical investigation of mHealth apps, we identified app categories listed in a curated mHealth app library, which was then used to explore the Google Play Store for health and medical apps that were then filtered using our selection criteria. We downloaded these apps from a mirror site hosting Android apps and analyzed them using a script that we developed around the popular AndroGuard tool. We analyzed the use of Bluetooth peripherals and built-in sensors to understand how a given app collects health data. Results: We retrieved 3251 apps meeting our criteria, and our analysis showed that 10.74% (349/3251) of these apps requested Bluetooth access. We found that 50.9% (259/509) of the Bluetooth service universally unique identifiers to be known in these apps, with the remainder being vendor specific. The most common health-related Bluetooth Low Energy services using known universally unique identifiers were Heart Rate, Glucose, and Body Composition. App permissions showed the most used device module or sensor to be the camera (669/3251, 20.57%), closely followed by location (598/3251, 18.39%), with the highest occurrence in the staying healthy app category. Conclusions: We found that not many health apps used built-in sensors or peripherals for collecting health data. The small number of the apps using Bluetooth, with an even smaller number of apps using standard Bluetooth Low Energy services, indicates a wider use of proprietary algorithms and custom services, which restrict the device use. The use of standard profiles could open this ecosystem further and could provide end users more options for apps. The relatively small proportion of apps using built-in sensors along with a high reliance on manual data entry suggests the need for more research into using sensors for data collection in health and fitness apps, which may be more desirable and improve end user experience. %M 35262499 %R 10.2196/30468 %U https://mhealth.jmir.org/2022/3/e30468 %U https://doi.org/10.2196/30468 %U http://www.ncbi.nlm.nih.gov/pubmed/35262499 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e34918 %T Suitability of the Unified Theory of Acceptance and Use of Technology 2 Model for Predicting mHealth Acceptance Using Diabetes as an Example: Qualitative Methods Triangulation Study %A Schretzlmaier,Patrik %A Hecker,Achim %A Ammenwerth,Elske %+ Institute of Medical Informatics, UMIT – Private University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, Hall in Tirol, 6060, Austria, 49 17657875980, patrik.schretzlmaier@edu.umit-tirol.at %K mHealth %K mobile health %K mobile apps %K diabetes mellitus %K technology acceptance %K UTAUT2 %K mobile phone %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In recent years, the use of mobile health (mHealth) apps to manage chronic diseases has increased significantly. Although mHealth apps have many benefits, their acceptance is still low in certain areas and groups. Most mHealth acceptance studies are based on technology acceptance models. In particular, the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model was developed to predict technology acceptance in a consumer context. However, to date, only a few studies have used the UTAUT2 model to predict mHealth acceptance and confirm its suitability for the health sector. Thus, it is unclear whether the UTAUT2 model is suitable for predicting mHealth acceptance and whether essential variables for a health-related context are missing. Objective: This study aims to validate the suitability of UTAUT2 for predicting mHealth acceptance. Methods: In this study, diabetes was used as an example as mHealth apps are a significant element of diabetes self-management. In addition, diabetes is one of the most common chronic diseases affecting young and older people worldwide. An explorative literature review and guided interviews with 11 mHealth or technology acceptance experts and 8 mHealth users in Austria and Germany were triangulated to identify all relevant constructs for predicting mHealth acceptance. The interview participants were recruited by purposive sampling until theoretical saturation was reached. Data were analyzed using structured content analysis based on inductive and deductive approaches. Results: This study was able to confirm the relevance of all exogenous UTAUT2 constructs. However, it revealed two additional constructs that may also need to be considered to better predict mHealth acceptance: trust and perceived disease threat. Conclusions: This study showed that the UTAUT2 model is suitable for predicting mHealth acceptance. However, the model should be extended to include 2 additional constructs for use in the mHealth context. %M 35262493 %R 10.2196/34918 %U https://humanfactors.jmir.org/2022/1/e34918 %U https://doi.org/10.2196/34918 %U http://www.ncbi.nlm.nih.gov/pubmed/35262493 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e29663 %T The Effectiveness of Mobile Phone Messaging–Based Interventions to Promote Physical Activity in Type 2 Diabetes Mellitus: Systematic Review and Meta-analysis %A Alsahli,Mohammed %A Abd-Alrazaq,Alaa %A Househ,Mowafa %A Konstantinidis,Stathis %A Blake,Holly %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, PO Box 34110, Doha Al Luqta St, Ar-Rayyan, Doha, 11023/2093, Qatar, 974 55708549, mhouseh@hbku.edu.qa %K type 2 diabetes mellitus %K physical activity %K mobile phone messaging %K systematic review %K meta-analysis %D 2022 %7 8.3.2022 %9 Review %J J Med Internet Res %G English %X Background: The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide. Physical activity (PA) is an important aspect of self-care and first line management for T2DM. SMS text messaging can be used to support self-management in people with T2DM, but the effectiveness of mobile text message–based interventions in increasing PA is still unclear. Objective: This study aims to assess the effectiveness of mobile phone messaging on PA in people with T2DM by summarizing and pooling the findings of previous literature. Methods: A systematic review was conducted to accomplish this objective. Search sources included 5 bibliographic databases (MEDLINE, Cochrane Library, CINAHL, Web of Science, and Embase), the search engine Google Scholar (Google Inc), and backward and forward reference list checking of the included studies and relevant reviews. A total of 2 reviewers (MA and AA) independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence evaluation. The results of the included studies were synthesized narratively and statistically, as appropriate. Results: We included 3.8% (6/151) of the retrieved studies. The results of individual studies were contradictory regarding the effectiveness of mobile text messaging on PA. However, a meta-analysis of the results of 5 studies showed no statistically significant effect (P=.16) of text messages on PA in comparison with no intervention. A meta-analysis of the findings of 2 studies showed a nonsignificant effect (P=.14) of text messages on glycemic control. Of the 541 studies, 2 (0.4%) found a nonsignificant effect of text messages on anthropometric measures (weight and BMI). Conclusions: We could not draw a definitive conclusion regarding the effectiveness of text messaging on PA, glycemic control, weight, or BMI among patients with T2MD, given the limited number of included studies and their high risk of bias. Therefore, there is a need for more high-quality primary studies. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020156465; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=156465 %M 35258463 %R 10.2196/29663 %U https://www.jmir.org/2022/3/e29663 %U https://doi.org/10.2196/29663 %U http://www.ncbi.nlm.nih.gov/pubmed/35258463 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e35984 %T Researching the Links Between Smartphone Behavior and Adolescent Well-being With the FUTURE-WP4 (Modeling the Future: Understanding the Impact of Technology on Adolescent’s Well-being Work Package 4) Project: Protocol for an Ecological Momentary Assessment Study %A Elavsky,Steriani %A Blahošová,Jana %A Lebedíková,Michaela %A Tkaczyk,Michał %A Tancos,Martin %A Plhák,Jaromír %A Sotolář,Ondřej %A Smahel,David %+ Faculty of Informatics, Masaryk University, Botanická 68A, Brno, 60200, Czech Republic, 420 549491814, elavsky@fi.muni.cz %K well-being %K adolescents %K smartphones %K intensive data %K ecological momentary assessment %D 2022 %7 8.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smartphone ownership has increased among teens within the last decade, with up to 89% of adolescents owning a smartphone and engaging daily with the online world through it. Although the results of recent meta-analyses suggest that engaging digital technology plays only a small role in adolescent well-being, parents, professionals, and policymakers remain concerned about the impact that the instant connectivity of smartphones has on adolescent well-being. Objective: Herein, we introduce the protocol of a research study investigating the associations between adolescent smartphone use and different facets of well-being (social, physical, and psychological), with the aim to apply innovative methods to address the limitations of existing empirical studies. Methods: This 12-month prospective study of adolescents uses a repeated measurement-burst design with the ecological momentary assessment methodology. Adolescents (N=203; age range 13-17 years) complete baseline assessments through online questionnaires, four 14-day intensive data collection bursts, and an online questionnaire at the end of the study. As part of the 4 measurement bursts, adolescent smartphone behavior is assessed objectively by passive data collection of smartphone data logs and through self-reports in short questionnaires administered via a custom-built Android app. Results: The protocol describes the study objectives, research tools (including the development of the Android app and specialized software), and process (including pilot studies, the main study, and targets for machine learning approaches). Two of the 203 enrolled participants provided no data during the first data collection burst of the main study. Preliminary analyses of the data from the first data collection burst indicated an acceptable level of compliance (72.25%) with the daily questionnaires. The design of the study will allow for the assessment of both within- and between-person variabilities in smartphone behavior, as well as short-term variation and long-term change in smartphone behavior and how it impacts the indicators of social, physical, and psychological well-being. Conclusions: The innovative methods applied in this study (objective smartphone logs, ecological momentary assessment, and machine learning) will allow for a more nuanced assessment of the links between smartphone use and well-being, informing strategies to help adolescents navigate the online world more constructively in terms of the development of their physical, social, and psychological well-being. International Registered Report Identifier (IRRID): DERR1-10.2196/35984 %M 35258467 %R 10.2196/35984 %U https://www.researchprotocols.org/2022/3/e35984 %U https://doi.org/10.2196/35984 %U http://www.ncbi.nlm.nih.gov/pubmed/35258467 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32669 %T A Tailored App for the Self-management of Musculoskeletal Conditions: Evidencing a Logic Model of Behavior Change %A Berry,Alice %A McClellan,Carey %A Wanless,Ben %A Walsh,Nicola %+ University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, United Kingdom, 44 117 32 87802, alice.berry@uwe.ac.uk %K musculoskeletal %K supported self-management %K behavior change %K digital health intervention %K behavior change wheel %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Musculoskeletal conditions such as joint pain are a growing problem, affecting 18.8 million people in the United Kingdom. Digital health interventions (DHIs) are a potentially effective way of delivering information and supporting self-management. It is vital that the development of such interventions is transparent and can illustrate how individual components work, how they link back to the theoretical constructs they are attempting to change, and how this might influence outcomes. getUBetter is a DHI developed to address the lack of personalized, supported self-management tools available to patients with musculoskeletal conditions by providing knowledge, skills, and confidence to navigate through a self-management journey. Objective: The aim of this study was to map a logic model of behavior change for getUBetter to illustrate how the content and functionality of the DHI are aligned with recognized behavioral theory, effective behavior change techniques, and clinical guidelines. Methods: A range of behavior change models and frameworks were used, including the behavior change wheel and persuasive systems design framework, to map the logic model of behavior change underpinning getUBetter. The three main stages included understanding the behavior the intervention is attempting to change, identifying which elements of the intervention might bring about the desired change in behavior, and describing intervention content and how this can be optimally implemented. Results: The content was mapped to 25 behavior change techniques, including information about health consequences, instruction on how to perform a behavior, reducing negative emotions, and verbal persuasion about capability. Mapping to the persuasive system design framework illustrated the use of a number of persuasive design principles, including tailoring, personalization, simulation, and reminders. Conclusions: This process enabled the proposed mechanisms of action and theoretical foundations of getUBetter to be comprehensively described, highlighting the key techniques used to support patients to self-manage their condition. These findings provide guidance for the ongoing evaluation of the effectiveness (including quality of engagement) of the intervention and highlight areas that might be strengthened in future iterations. %M 35258462 %R 10.2196/32669 %U https://formative.jmir.org/2022/3/e32669 %U https://doi.org/10.2196/32669 %U http://www.ncbi.nlm.nih.gov/pubmed/35258462 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e28332 %T mHealth Intervention to Improve Treatment Outcomes Among People With HIV Who Use Cocaine: Protocol for a Pilot Randomized Controlled Trial %A Ranjit,Yerina S %A Krishnan,Archana %A Ghosh,Debarchana %A Cravero,Claire %A Zhou,Xin %A Altice,Frederick L %+ Department of Communication, University of Missouri, 108 Switzler Hall, Columbia, MO, 65211, United States, 1 573 822 0881, ranjity@missouri.edu %K smart pillbox %K smartphone %K mHealth intervention %K people with HIV %K cocaine use %K antiretroviral therapy %K description of feasibility and acceptability %K mobile phone %D 2022 %7 7.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Antiretroviral therapy is effective in reducing HIV-related morbidity, mortality, and transmission among people with HIV. However, adherence and persistence to antiretroviral therapy are crucial for successful HIV treatment outcomes. People with HIV who use cocaine have poor access to HIV services and lower retention in care. Objective: The primary goal of this paper is to provide a detailed description of a mobile health intervention. This study is designed to improve medication adherence among people with HIV who use cocaine. A secondary goal is to list the important challenges and adaptations incorporated in the study design. Methods: This study, titled Project SMART, used a wireless technology–based intervention, including cellular-enabled electronic pillboxes called TowerView Health and smartphones, to provide reminders and feedback on adherence behavior. The intervention design was based on the theoretical frameworks provided by the self-determination theory and the Motivation Technology Model. The 12-week pilot randomized controlled trial with four arms provided three types of feedback: automated feedback, automated+clinician feedback, and automated feedback+social network feedback. Results: The study was funded by the National Institute of Drug Abuse (R21DA039842) on August 1, 2016. The institutional review board for the study was approved by Yale University on March 21, 2017. Data collection lasted from June 2017 to January 2020. The final enrollment was 71 participants, of whom 57 (80%) completed the study. The data are currently undergoing analysis, and the manuscript is being developed for publication in early 2022. Conclusions: Implementing complex mobile health interventions for high-risk and marginalized populations with multicomponent interventions poses certain challenges, such as finding companies with adequate technology for clients and financial stability and minimizing the research-related burden for the study population. Conducting feasibility studies is important to recognize these challenges and the opportunity to address these challenges with solutions while keeping the design of a randomized controlled trial as true as possible. Trial Registration: Clinicaltrials.gov NCT04418076; https://clinicaltrials.gov/ct2/show/NCT04418076 International Registered Report Identifier (IRRID): DERR1-10.2196/28332 %M 35254270 %R 10.2196/28332 %U https://www.researchprotocols.org/2022/3/e28332 %U https://doi.org/10.2196/28332 %U http://www.ncbi.nlm.nih.gov/pubmed/35254270 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e32129 %T Evidence-Based Behavioral Strategies in Smartphone Apps for Children’s Sleep: Content Analysis %A Simon,Stacey L %A Kaar,Jill L %A Talker,Ishaah %A Reich,Jennifer %+ Department of Pediatrics, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Box B395, Aurora, CO, 80045, United States, 1 720 777 5681, stacey.simon@childrenscolorado.org %K pediatrics %K technology %K smartphones %K health behavior %K sleep applications %K children %K mobile health %K mHealth %K smartphone applications %K health applications %K sleep disorders %K sleep problems %K developer descriptions %K apps %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Empirically supported treatments for pediatric sleep problems exist, but many families turn to other sources for help with their children’s sleep, such as smartphone apps. Sleep apps are easy for families to access, but little evidence exists regarding the validity of the services and information provided in the developer descriptions of the apps. Objective: The goal of this study was to examine the features and claims of developer descriptions of sleep apps for children. Methods: A search of the Apple iTunes store and Google Play was conducted using the terms “kids sleep,” “child sleep,” and “baby sleep.” Data on the type of app, price, user rating, and number of users were collected. Apps were analyzed in comparison with evidence-based behavioral strategies and were thematically coded on the basis of claims provided in developer descriptions. Results: A total of 83 app descriptions were examined, of which only 2 (2.4%) offered sleep improvement strategies. The majority were sound and light apps (78%) and 19% were bedtime games or stories. Only 18 of 83 (21.6%) apps were identified as containing empirically supported behavioral sleep strategies. Despite this, many apps asserted claims that they will help children “fall asleep instantly,” “cry less and sleep better,” or improve child development. Conclusions: A large variety of sleep apps exist for use among children, but few include evidence-based behavioral strategies according to the developer descriptions of the apps. Addressing sleep difficulties in children is important to promote physical, cognitive, and emotional development. Collaboration between sleep researchers and technology developers may be beneficial for creating evidence-supported apps to help with children’s sleep in the future. %M 35238787 %R 10.2196/32129 %U https://pediatrics.jmir.org/2022/1/e32129 %U https://doi.org/10.2196/32129 %U http://www.ncbi.nlm.nih.gov/pubmed/35238787 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e34032 %T Feasibility and Preliminary Efficacy of Web-Based and Mobile Interventions for Common Mental Health Problems in Working Adults: Multi-Arm Randomized Pilot Trial %A Economides,Marcos %A Bolton,Heather %A Male,Rhian %A Cavanagh,Kate %+ Unmind Ltd, 180 Borough High St, London, SE1 1LB, United Kingdom, 44 2078664050, marcos.economides@unmind.com %K mHealth %K workplace %K CBT %K ACT %K feasibility %K stress %K anxiety %K depression %K resilience %K mobile phone %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There is growing interest in digital platforms as a means of implementing scalable, accessible, and cost-effective mental health interventions in the workplace. However, little is known about the efficacy of such interventions when delivered to employee groups. Objective: This study aims to evaluate the feasibility and preliminary efficacy of a digital mental health platform for the workplace, which incorporates evidence-based practices such as cognitive behavioral therapy and acceptance and commitment therapy. A total of 3 brief, unguided interventions designed to address stress, anxiety, and resilience, respectively, are evaluated. The primary aim is to determine the feasibility of the study methods and interventions in preparation for a definitive randomized controlled trial. Methods: The study used a fully remote, parallel, multi-arm, external pilot randomized controlled trial, with 3 intervention arms and a no-intervention control group. Participants were working adults representative of the general UK population with respect to age, sex, and ethnicity who were recruited from a web-based participant platform. Primary outcomes included objective and self-report measures of feasibility, acceptability, engagement, transferability, relevance, and negative effects. Secondary outcomes included 4 self-report measures of mental health and well-being, completed at baseline (time point 0 [t0]), postintervention (time point 1 [t1]), and the 1-month follow-up (time point 2 [t2]). Secondary outcomes were analyzed via linear mixed-effects models using intention-to-treat principles. Preregistered criteria for progression to a definitive trial were evaluated. Results: Data were collected between January and March of 2021. A total of 383 working adult participants meeting trial eligibility were randomized, of whom 356 (93%) were retained at t2. Objective engagement data showed that 67.8% (196/289) of participants randomized to an intervention arm completed their intervention. Overall, 87.1% (203/233) of participants reported being satisfied or very satisfied with their intervention and rated the quality of their intervention as good or excellent. All intervention groups reported significantly greater improvements than the control group on at least one secondary outcome at t1, with between-group Hedges g effect sizes for the pooled interventions ranging from 0.25 (95% CI 0.05-0.46) to 0.43 (95% CI 0.23-0.64). All the improvements were maintained at t2. Conclusions: The study methods were feasible, and all preregistered criteria for progression to a definitive trial were met. Several minor protocol amendments were noted. Preliminary efficacy findings suggest that the study interventions may result in improved mental health outcomes when offered to working adults. Trial Registration: ISRCTN Registry 80309011; http://www.isrctn.com/ISRCTN80309011 %M 35238794 %R 10.2196/34032 %U https://formative.jmir.org/2022/3/e34032 %U https://doi.org/10.2196/34032 %U http://www.ncbi.nlm.nih.gov/pubmed/35238794 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e29832 %T A Smartphone Serious Game for Adolescents (Grow It! App): Development, Feasibility, and Acceptance Study %A Dietvorst,Evelien %A Aukes,Michelle A %A Legerstee,Jeroen S %A Vreeker,Annabel %A Hrehovcsik,Micah M %A Keijsers,Loes %A Hillegers,Manon H J %+ Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children’s Hospital, Erasmus University Medical Center, Wytemaweg 8, Rotterdam, 3015 CN, Netherlands, 31 (0)107040209, m.hillegers@erasmusmc.nl %K ecological momentary assessment %K EMA %K serious game %K CBT %K depression %K internalizing problems %K adolescents %K high risk %K digital health %K mobile health %K mHealth %K game design %K app development %K mobile phone %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Anxiety and mood problems in adolescents often go unnoticed and may therefore remain untreated. Identifying and preventing the development of emotional problems requires monitoring and effective tools to strengthen adolescents' resilience, for example, by enhancing coping skills. Objective: This study describes the developmental process, feasibility, and acceptance of Grow It!, a multiplayer serious game app for adolescents aged 12-25 years. The app consists of the experience sampling method (ESM) to monitor thoughts, behaviors, and emotions in daily life to enhance self-insight and daily cognitive behavioral therapy–based challenges to promote adaptive coping. Methods: Our approach entails an iterative game design process combined with an agile method to develop the smartphone app. The incorporated game features (ie, challenges, chat functionality, and visual representation) in the Grow It! app were co-designed with adolescent end users to increase participant engagement and adherence. Results: The Grow It! app was delivered for Android and iOS in May 2020. Grow It! was offered to adolescents during the COVID-19 crisis between May and December 2020. Participants of the Grow It! COVID-19 study (sample 1: N=685; mean age 16.19, SD 3.11 years; 193/685, 28.2% boys; sample 2: N=1035; mean age 18.78, SD 3.51 years; 193/1035, 18.64% boys) completed 31.5% (13.2/42) to 49.5% (10.4/21) of challenges. Compliance of ESM was suboptimal (35.1/210, 16.7% to 32.5/105, 30.9%). Follow-up questionnaires indicated an overall score of the app of 7.1 out of 10. Moreover, 72.6% (278/383) to 75.6% (487/644) would recommend the app to friends. Conclusions: To our knowledge, Grow It! is the first gamified ESM app that both measures individual differences in emotional dynamics and offers an integrated cognitive behavioral therapy–based intervention. Our findings support the feasibility and acceptance, and therefore applicability, of the Grow It! app in adolescents. Further iterations of this serious game app will focus on the increase of compliance and on providing participants feedback through their personal mood profiles. %M 35238795 %R 10.2196/29832 %U https://formative.jmir.org/2022/3/e29832 %U https://doi.org/10.2196/29832 %U http://www.ncbi.nlm.nih.gov/pubmed/35238795 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e35117 %T The Efficacy of a Smartphone Game to Prevent HIV Among Young Africans: Protocol for a Randomized Controlled Trial in the Context of COVID-19 %A Mudhune,Victor %A Sabben,Gaëlle %A Ondenge,Ken %A Mbeda,Calvin %A Morales,Marissa %A Lyles,Robert H %A Arego,Judith %A Ndivo,Richard %A Bednarczyk,Robert A %A Komro,Kelli %A Winskell,Kate %+ Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 404 7275286, swinske@emory.edu %K HIV %K young Africans %K adolescent %K Kenya %K serious game %K game for health %K randomized controlled trial %K mHealth %K prevention %K smartphone %K teenager %K young adult %K Africa %K gaming %K COVID-19 %K efficacy %D 2022 %7 3.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescents contribute slightly less than one-third of all new HIV infections in sub-Saharan Africa. There is a need for more effective intervention approaches to help young adolescents safely navigate through adolescence and into adulthood. We are assessing the efficacy of Tumaini, a smartphone game designed to prevent HIV among young Africans. Against the background of COVID-19, meaningful alteration of the research protocol was necessary to ensure successful implementation and retention of the study participants in ongoing research. Objective: The objective of our protocol is to determine (1) if Tumaini delays sexual debut and increases condom use at first sex and (2) whether it influences behavioral mediators of early and unprotected sex. Methods: Participants were recruited from Kisumu County in Western Kenya. This study is a 2-arm, individual-randomized controlled trial that enrolled 1004 adolescents aged between 12 years and 15 years. The intervention arm participants are playing Tumaini, while the control arm is provided with Brainilis, a commercially available control game. The study period will last 45 months. At baseline, participants in both arms completed a baseline survey and biological testing for HIV and herpes simplex virus, type 2 (HSV-2); participants will have annual game play periods in years 1-3. They will also complete a total of 12 follow-up surveys. At endline, repeat biological testing will be conducted. Protocol adaptations were necessitated by the COVID-19 pandemic and implemented in accordance with local public health guidelines. Results: Participants were enrolled between October 2020 and November 2020. We plan to complete study procedures in September 2024. The enrolled participant sample was 50.1% (499/996) female and had a mean age of 14.0 (SD 0.6) years. Conclusions: This ongoing research demonstrates that, with appropriate revisions to planned protocol activities guided by the need to maintain study integrity, protect both study participants and staff, and adhere to institutional review board and local health authority guidelines, human subject research is possible in the context of a global pandemic. If the trial demonstrates efficacy, Tumaini would provide an alternative, remote means of delivering age-appropriate education to adolescents on safer sex, HIV prevention, and effective life skills on a highly scalable, low-cost, and culturally adaptable platform. Trial Registration: ClinicalTrials.gov NCT04437667; https://clinicaltrials.gov/ct2/show/NCT04437667 International Registered Report Identifier (IRRID): DERR1-10.2196/35117 %M 35030090 %R 10.2196/35117 %U https://www.researchprotocols.org/2022/3/e35117 %U https://doi.org/10.2196/35117 %U http://www.ncbi.nlm.nih.gov/pubmed/35030090 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e29415 %T mHealth Interventions for Self-management of Hypertension: Framework and Systematic Review on Engagement, Interactivity, and Tailoring %A Cao,Weidan %A Milks,M Wesley %A Liu,Xiaofu %A Gregory,Megan E %A Addison,Daniel %A Zhang,Ping %A Li,Lang %+ Department of Biomedical Informatics, The Ohio State University, 250 Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, United States, 1 614 292 4778, lang.li@osumc.edu %K mHealth %K mobile app %K digital behavior change %K interventions %K systematic review %K hypertension %K engagement %K interactivity %K tailoring %K mobile phone %D 2022 %7 2.3.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Engagement is essential for the effectiveness of digital behavior change interventions. Existing systematic reviews examining hypertension self-management interventions via mobile apps have primarily focused on intervention efficacy and app usability. Engagement in the prevention or management of hypertension is largely unknown. Objective: This systematic review explores the definition and role of engagement in hypertension-focused mobile health (mHealth) interventions, as well as how determinants of engagement (ie, tailoring and interactivity) have been implemented. Methods: A systematic review of mobile app interventions for hypertension self-management targeting adults, published from 2013 to 2020, was conducted. A total of 21 studies were included in this systematic review. Results: The engagement was defined or operationalized as a microlevel concept, operationalized as interaction with the interventions (ie, frequency of engagement, time or duration of engagement with the program, and intensity of engagement). For all 3 studies that tested the relationship, increased engagement was associated with better biomedical outcomes (eg, blood pressure change). Interactivity was limited in digital behavior change interventions, as only 7 studies provided 2-way communication between users and a health care professional, and 9 studies provided 1-way communication in possible critical conditions; that is, when abnormal blood pressure values were recorded, users or health care professionals were notified. The tailoring of interventions varied at different aspects, from the tailoring of intervention content (including goals, patient education, advice and feedback from health professionals, reminders, and motivational messages) to the tailoring of intervention dose and communication mode. Tailoring was carried out in a number of ways, considering patient characteristics such as goals, preferences, disease characteristics (eg, hypertension stage and medication list), disease self-management experience levels, medication adherence rate, and values and beliefs. Conclusions: Available studies support the importance of engagement in intervention effectiveness as well as the essential roles of patient factors in tailoring, interactivity, and engagement. A patient-centered engagement framework for hypertension self-management using mHealth technology is proposed here, with the intent of facilitating intervention design and disease self-management using mHealth technology. %M 35234655 %R 10.2196/29415 %U https://mhealth.jmir.org/2022/3/e29415 %U https://doi.org/10.2196/29415 %U http://www.ncbi.nlm.nih.gov/pubmed/35234655 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e28697 %T Supporting Management of Noncommunicable Diseases With Mobile Health (mHealth) Apps: Experimental Study %A Kela,Neta %A Eytam,Eleanor %A Katz,Adi %+ Shamoon College of Engineering, 84 Jabotinsky St, Ashdod, 77245, Israel, 972 088519309, neta.kela@gmail.com %K mHealth %K digital health %K instrumentality %K aesthetics %K symbolic value %K preference %D 2022 %7 2.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Noncommunicable diseases (NCDs) are the leading global health problem in this century and are the principal causes of death and health care spending worldwide. Mobile health (mHealth) apps can help manage and prevent NCDs if people are willing to use them as supportive tools. Still, many people are reluctant to adopt these technologies. Implementing new apps could result in earlier intervention for many health conditions, preventing more serious complications. Objective: This research project aimed to test the factors that facilitate the adoption of mHealth apps by users with NCDs. We focused on determining, first, what user interface (UI) qualities and complexity levels appeal to users in evaluating mHealth apps. We also wanted to determine whether people prefer that the data collected by an mHealth app be analyzed using a physician or an artificial intelligence (AI) algorithm. The contribution of this work is both theoretical and practical. We examined users’ considerations when adopting mHealth apps that promote healthy lifestyles and helped them manage their NCDs. Our results can also help direct mHealth app UI designers to focus on the most appealing aspects of our findings. Methods: A total of 347 respondents volunteered to rate 3 models of mHealth apps based on 16 items that measured instrumentality, aesthetics, and symbolism. Respondents rated each model after reading 1 of 2 different scenarios. In one scenario, a physician analyzed the data, whereas, in the other, the data were analyzed by an AI algorithm. These scenarios tested the degree of trust people placed in AI algorithms versus the “human touch” of a human physician regarding analyzing data collected by an mHealth app. Results: As shown by the responses, the involvement of a human physician in the application had a significant effect (P<.001) on the perceived instrumentality of the simple model. The complex model with more controls was rated significantly more aesthetic when associated with a physician performing data analysis rather than an AI algorithm (P=.03). Conclusions: Generally, when participants found a human touch in the mHealth app (connection to a human physician who they assumed would analyze their data), they judged the app more favorably. Simple models were evaluated more positively than complex ones, and aesthetics and symbolism were salient predictors of preference. These trends suggest that designers and developers of mHealth apps should keep the designs simple and pay special attention to aesthetics and symbolic value. %M 35234653 %R 10.2196/28697 %U https://humanfactors.jmir.org/2022/1/e28697 %U https://doi.org/10.2196/28697 %U http://www.ncbi.nlm.nih.gov/pubmed/35234653 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e26525 %T Supporting Behavior Change in Sedentary Adults via Real-time Multidimensional Physical Activity Feedback: Mixed Methods Randomized Controlled Trial %A Western,Max James %A Standage,Martyn %A Peacock,Oliver James %A Nightingale,Tom %A Thompson,Dylan %+ Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 1225 383732, M.J.Western@bath.ac.uk %K physical activity %K feedback %K wearables %K behavior change %K sedentary time %D 2022 %7 2.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Increasing physical activity (PA) behavior remains a public health priority, and wearable technology is increasingly being used to support behavior change efforts. Using wearables to capture and provide comprehensive, visually persuasive, multidimensional feedback with real-time support may be a promising way of increasing PA in inactive individuals. Objective: This study aims to explore whether a 6-week self-monitoring intervention using composite web-based multidimensional PA feedback with real-time daily feedback supports increased PA in adults. Methods: A 6-week, mixed methods, 2-armed exploratory randomized controlled trial with 6-week follow-up was used, whereby low to moderately active (PA level [PAL] <2.0) adults (mean age 51.3 years, SD 8.4 years; women 28/51, 55%) were randomly assigned to receive the self-monitoring intervention (36/51, 71%) or waiting list control (15/51, 29%). Assessment of PA across multiple health-harnessing PA dimensions (eg, PAL, weekly moderate to vigorous intensity PA, sedentary time, and steps), psychosocial cognitions (eg, behavioral regulation, barrier self-efficacy, and habit strength), and health were made at the prerandomization baseline at 6 and 12 weeks. An exploratory analysis of the mean difference and CIs was conducted using the analysis of covariance model. After the 12-week assessment, intervention participants were interviewed to explore their views on the program. Results: There were no notable differences in any PA outcome immediately after the intervention; however, at 12 weeks, moderate-to-large effects were observed with a mean difference in PAL of 0.09 (95% CI 0.02-0.15; effect size [Hedges g] 0.8), daily moderate-intensity PA of 24 (95% CI 0-45; Hedges g=0.6) minutes, weekly moderate-to-vigorous intensity PA of 195 (95% CI 58-331; Hedges g=0.8) minutes, and steps of 1545 (95% CI 581-2553; Hedges g=0.7). Descriptive analyses suggested that the differences in PA at 12 weeks were more pronounced in women and participants with lower baseline PA levels. Immediately after the intervention, there were favorable differences in autonomous motivation, controlled motivation, perceived competence for PA, and barrier self-efficacy, with the latter sustained at follow-up. Qualitative data implied that the intervention was highly informative for participants and that the real-time feedback element was particularly useful in providing tangible, day-to-day behavioral support. Conclusions: Using wearable trackers to capture and present sophisticated multidimensional PA feedback combined with discrete real-time support may be a useful way of facilitating changes in behavior. Further investigation into the ways of optimizing the use of wearables in inactive participants and testing the efficacy of this approach via a robust study design is warranted. Trial Registration: ClinicalTrials.gov NCT02432924; https://clinicaltrials.gov/ct2/show/NCT02432924 %M 35234658 %R 10.2196/26525 %U https://formative.jmir.org/2022/3/e26525 %U https://doi.org/10.2196/26525 %U http://www.ncbi.nlm.nih.gov/pubmed/35234658 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e32130 %T Increasing the Effectiveness of a Physical Activity Smartphone Intervention With Positive Suggestions: Randomized Controlled Trial %A Skvortsova,Aleksandrina %A Cohen Rodrigues,Talia %A de Buisonjé,David %A Kowatsch,Tobias %A Santhanam,Prabhakaran %A Veldhuijzen,Dieuwke S %A van Middendorp,Henriët %A Evers,Andrea %+ Department of Psychology, McGill University, 1205 avenue du Docteur-Penfield, Montreal, QC, H3A 1B1, Canada, 1 4386303664, a.skvortsova@fsw.leidenuniv.nl %K eHealth %K mobile health %K physical activity %K walking %K positive suggestions %K outcome expectations %K mobile phone %D 2022 %7 1.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth interventions have the potential to increase the physical activity of users. However, their effectiveness varies, and they often have only short-term effects. A possible way of enhancing their effectiveness is to increase the positive outcome expectations of users by giving them positive suggestions regarding the effectiveness of the intervention. It has been shown that when individuals have positive expectations regarding various types of interventions, they tend to benefit from these interventions more. Objective: The main objective of this web-based study is to investigate whether positive suggestions can change the expectations of participants regarding the effectiveness of a smartphone physical activity intervention and subsequently enhance the number of steps the participants take during the intervention. In addition, we study whether suggestions affect perceived app effectiveness, engagement with the app, self-reported vitality, and fatigue of the participants. Methods: This study involved a 21-day fully automated physical activity intervention aimed at helping participants to walk more steps. The intervention was delivered via a smartphone-based app that delivered specific tasks to participants (eg, setting activity goals or looking for social support) and recorded their daily step count. Participants were randomized to either a positive suggestions group (69/133, 51.9%) or a control group (64/133, 48.1%). Positive suggestions emphasizing the effectiveness of the intervention were implemented in a web-based flyer sent to the participants before the intervention. Suggestions were repeated on days 8 and 15 of the intervention via the app. Results: Participants significantly increased their daily step count from baseline compared with 21 days of the intervention (t107=−8.62; P<.001) regardless of the suggestions. Participants in the positive suggestions group had more positive expectations regarding the app (B=−1.61, SE 0.47; P<.001) and higher expected engagement with the app (B=3.80, SE 0.63; P<.001) than the participants in the control group. No effects of suggestions on the step count (B=−22.05, SE 334.90; P=.95), perceived effectiveness of the app (B=0.78, SE 0.69; P=.26), engagement with the app (B=0.78, SE 0.75; P=.29), and vitality (B=0.01, SE 0.11; P=.95) were found. Positive suggestions decreased the fatigue of the participants during the 3 weeks of the intervention (B=0.11, SE 0.02; P<.001). Conclusions: Although the suggestions did not affect the number of daily steps, they increased the positive expectations of the participants and decreased their fatigue. These results indicate that adding positive suggestions to eHealth physical activity interventions might be a promising way of influencing subjective but not objective outcomes of interventions. Future research should focus on finding ways of strengthening the suggestions, as they have the potential to boost the effectiveness of eHealth interventions. Trial Registration: Open Science Framework 10.17605/OSF.IO/CWJES; https://osf.io/cwjes %M 35230245 %R 10.2196/32130 %U https://www.jmir.org/2022/3/e32130 %U https://doi.org/10.2196/32130 %U http://www.ncbi.nlm.nih.gov/pubmed/35230245 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e31327 %T Personalization of Intervention Timing for Physical Activity: Scoping Review %A Chaudhari,Saurabh %A Ghanvatkar,Suparna %A Kankanhalli,Atreyi %+ Department of Information Systems and Analytics, School of Computing, National University of Singapore, Computing 1, 13 Computing Drive, Singapore, 117417, Singapore, 65 86153503, sach16795@gmail.com %K review %K physical activity %K personalized intervention %K intervention timing %K mobile apps %K fitness tracker %K mobile phone %D 2022 %7 28.2.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The use of sensors in smartphones, smartwatches, and wearable devices has facilitated the personalization of interventions to increase users’ physical activity (PA). Recent research has focused on evaluating the effects of personalized interventions in improving PA among users. However, it is critical to deliver the intervention at an appropriate time to each user to increase the likelihood of adoption of the intervention. Earlier review studies have not focused on the personalization of intervention timing for increasing PA. Objective: This review aims to examine studies of information technology–based PA interventions with personalized intervention timing (PIT); identify inputs (eg, user location) used by the system for generating the PIT, the techniques and methods used for generating the PIT, the content of the PA intervention, and delivery mode of the intervention; and identify gaps in existing literature and suggest future research directions. Methods: A scoping review was undertaken using PsycINFO, PubMed, Scopus, and Web of Science databases based on a structured search query. The main inclusion criteria were as follows: the study aimed to promote PA, included some form of PIT, and used some form of information technology for delivery of the intervention to the user. If deemed relevant, articles were included in this review after removing duplicates and examining the title, abstract, and full text of the shortlisted articles. Results: The literature search resulted in 18 eligible studies. In this review, 72% (13/18) of the studies focused on increasing PA as the primary objective, whereas it was the secondary focus in the remaining studies. The inputs used to generate the PIT were categorized as user preference, activity level, schedule, location, and predicted patterns. On the basis of the intervention technique, studies were classified as manual, semiautomated, or automated. Of these, the automated interventions were either knowledge based (based on rules or guidelines) or data driven. Of the 18 studies, only 6 (33%) evaluated the effectiveness of the intervention and reported positive outcomes. Conclusions: This work reviewed studies on PIT for PA interventions and identified several aspects of the interventions, that is, inputs, techniques, contents, and delivery mode. The reviewed studies evaluated PIT in conjunction with other personalization approaches such as activity recommendation, with no study evaluating the effectiveness of PIT alone. On the basis of the findings, several important directions for future research are also highlighted in this review. %M 35225811 %R 10.2196/31327 %U https://mhealth.jmir.org/2022/2/e31327 %U https://doi.org/10.2196/31327 %U http://www.ncbi.nlm.nih.gov/pubmed/35225811 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e26479 %T A Web-Based Cognitive Behavioral Therapy, Mindfulness Meditation, and Yoga Intervention for Posttraumatic Stress Disorder: Single-Arm Experimental Clinical Trial %A Kirk,Megan A %A Taha,Bilal %A Dang,Kevin %A McCague,Hugh %A Hatzinakos,Dimitrios %A Katz,Joel %A Ritvo,Paul %+ Yale Center for Emotional Intelligence, Yale School of Medicine, Yale University, 350 George Street, 3rd Floor, New Haven, CT, 06511, United States, 1 203 432 4326 ext 24326, megan.kirkchang@yale.edu %K posttraumatic stress disorder %K cognitive therapy %K internet delivery %K pupillometry %K psychophysiology %K PTSD %K therapy %K cognitive behavioral therapy %K mindfulness %K intervention %D 2022 %7 28.2.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Posttraumatic stress disorder (PTSD) is a debilitating, undertreated condition. The web-based delivery of cognitive behavioral therapy supplemented with mindfulness meditation and yoga is a viable treatment that emphasizes self-directed daily practice. Objective: This study aims to examine the effectiveness of a web-based cognitive behavioral therapy, mindfulness, and yoga (CBT-MY) program designed for daily use. Methods: We conducted an 8-week, single-arm, experimental, registered clinical trial on adults reporting PTSD symptoms (n=22; aged 18-35 years). Each participant received web-based CBT-MY content and an hour of web-based counseling each week. Pre-post outcomes included self-reported PTSD symptom severity, depression, anxiety, chronic pain, and mindfulness. Pre-post psychophysiological outcomes included peak pupil dilation (PPD) and heart rate variability (HRV). HRV and PPD were also compared with cross-sectional data from a non-PTSD comparison group without a history of clinical mental health diagnoses and CBT-MY exposure (n=46). Results: Pre-post intention-to-treat analyses revealed substantial improvements in PTSD severity (d=1.60), depression (d=0.83), anxiety (d=0.99), and mindfulness (d=0.88). Linear multilevel mixed models demonstrated a significant pre-post reduction in PPD (B=−0.06; SE=0.01; P<.001; d=0.90) but no significant pre-post change in HRV (P=.87). Overall, participants spent an average of 11.53 (SD 22.76) min/day on self-directed mindfulness practice. Conclusions: Web-based CBT-MY was associated with clinically significant symptom reductions and significant PPD changes, suggesting healthier autonomic functioning. Future randomized controlled trials are needed to further examine the gains apparent in this single-arm study. Trial Registration: ClinicalTrials.gov NCT03684473; https://clinicaltrials.gov/ct2/show/NCT03684473 %M 34499613 %R 10.2196/26479 %U https://mental.jmir.org/2022/2/e26479 %U https://doi.org/10.2196/26479 %U http://www.ncbi.nlm.nih.gov/pubmed/34499613 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e35934 %T Parent SMART (Substance Misuse in Adolescents in Residential Treatment): Protocol of a Randomized Effectiveness Trial of a Technology-Assisted Parenting Intervention %A Becker,Sara J %A Helseth,Sarah A %A Kelly,Lourah M %A Janssen,Tim %A Wolff,Jennifer C %A Spirito,Anthony %A Wright,Thomas %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903-2905, United States, 1 4018636604, sara_becker@brown.edu %K adolescent %K residential %K technology-assisted %K substance use %K parent %K randomized controlled trial %K RCT %K intervention %K eHealth %K problem behaviour %K problem behavior %D 2022 %7 28.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescents in residential substance use treatment are at extremely high risk for relapse following discharge to the community. Parenting practices, including parental monitoring and parent-adolescent communication, have been established as key predictors of adolescent substance use outcomes and relapse. However, traditional office-based therapy may not be feasible for parents who face structural and systemic barriers. There is a clear need for effective, accessible, and scalable interventions for parents of adolescents receiving residential substance use treatment. In a prior pilot randomized controlled trial, we tested Parent SMART (Substance Misuse among Adolescents in Residential Treatment)—a technology-assisted parenting intervention informed by extensive formative research—as an adjunct to residential treatment as usual (TAU). Parent SMART demonstrated high feasibility and acceptability, as well as evidence of effectiveness in improving parental monitoring and communication. Objective: This protocol paper describes a fully-powered randomized controlled pragmatic effectiveness trial of Parent SMART as an adjunct to residential TAU. We hypothesize that families who receive Parent SMART will demonstrate greater improvements in parenting skills, reductions in adolescent substance use, and reductions in adolescent problem behaviors relative to families that receive residential TAU. We will test the exploratory hypothesis that reductions in adolescent substance use will be partially mediated by improvements in parenting skills. Methods: Adolescent-parent dyads (n = 220 dyads; 440 total) will be randomized to either residential TAU only or Parent SMART+TAU. Parents randomized to Parent SMART will receive access to a networking forum, an off-the-shelf computer program called Parenting Wisely, and up to four telehealth coaching calls. Multimethod follow-up assessments consisting of self-reported parent and adolescent measures, a parent-adolescent in vivo interaction task, and 8-panel urine screens will be conducted 6, 12, and 24 weeks postdischarge from residential care. Measures will assess parenting skills, adolescent substance use, and adolescent problem behaviors. Analyses will be conducted using latent change score structural equation modeling. Results: The trial was funded in August 2021; ethics approval was obtained in August 2020, prior to funding. Due to concerns with the administrative interface in the pilot trial, the Parent SMART networking forum is currently being rebuilt by a different vendor. The programming is scheduled to be completed by December 2021, with recruitment beginning in February 2022. Conclusions: The proposed research has the potential to advance the field by serving a high-need, underserved population during a vital treatment juncture; targeting parenting practices (putative mediators) that have been shown to predict adolescent substance use outcomes; addressing barriers to accessing continuing care; and testing a highly scalable intervention model. Trial Registration: ClinicalTrials.gov NCT05169385; https://clinicaltrials.gov/ct2/show/NCT05169385 International Registered Report Identifier (IRRID): PRR1-10.2196/35934 %M 35225821 %R 10.2196/35934 %U https://www.researchprotocols.org/2022/2/e35934 %U https://doi.org/10.2196/35934 %U http://www.ncbi.nlm.nih.gov/pubmed/35225821 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32138 %T Text Messaging Intervention for Mental Wellness in American Indian and Alaska Native Teens and Young Adults (BRAVE Study): Analysis of User Engagement Patterns %A Wrobel,Julia %A Silvasstar,Joshva %A Peterson,Roger %A Sumbundu,Kanku %A Kelley,Allyson %A Stephens,David %A Craig Rushing,Stephanie %A Bull,Sheana %+ Colorado School of Public Health, University of Colorado, 13001 East 17th Place, Mail Stop B119, Aurora, CO, 80045, United States, 1 307 724 4585, JULIA.WROBEL@cuanschutz.edu %K American Indian %K Alaska Native %K adolescent %K mental health %K help-seeking skills, text messaging %K mHealth, behavioral intervention %K user engagement %K feasibility %K engagement %K low-touch %K intervention %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Many American Indian and Alaska Native (AI/AN or Native) communities express concern about high rates of suicide and poor mental health. Technology-based health interventions that nurture resilience, coping skills, connectedness, and help-seeking skills may be an effective strategy for promoting health and wellbeing among AI/AN youth. The Northwest Portland Area Indian Health Board designed the BRAVE intervention for AI/AN youth. BRAVE is delivered via SMS text messaging and includes role model videos, mental wellness strategies, links to culturally relevant resources, and social support from family and friends. Objective: The aim of this study is to explore system data from the BRAVE intervention to determine patterns of user engagement and differences in psychosocial outcomes based on the number of clicks on BRAVE content. Methods: The BRAVE study included 1030 AI/AN teens and young adults nationwide (15 to 24 years old). The message series in the BRAVE and STEM study arms included 3 to 5 SMS text messages per week, featuring 1 role model video and 1 image per week. Messages were sent out via Mobile Commons (Upland Software Inc), a mobile messaging provider that supports text, picture, and video SMS. Results: Of the 509 participants in the original BRAVE analysis, 270 had sufficient data to analyze user engagement, with at least 1 trackable click on a study SMS text message. Of the 270, 184 (68.1%) were female, 50 (18.5%) were male, and 36 (13.3%) selected another gender category. The average participant was 20.6 years old, with a minimum and maximum age of 15 and 26 years. Most participants had relatively low engagement measured by the number of clicks (median 2; mean 3.4), although others clicked message content as many as 49 times. Users engaged most frequently with the YouTube-based content (viewing 1 of 7 role model videos), with 64.8% (175/270) of total clicks coming from the role model videos, and earlier episodes receiving the highest number of clicks. Most baseline psychosocial measures were not significantly associated with the number of links clicked. However, help-seeking behavior was highly significant (P<.001), with a rate ratio of 0.82 (0.73, 0.92), indicating that each 1-unit increase in help-seeking score at baseline was associated with an 18% decrease in the expected number of study content clicks. Conclusions: This is the first study to set initial standards for assessing user engagement in an mHealth intervention. Our work underscores the feasibility of exploring the impact of engagement on intended outcomes, allowing for more precise exploration of the dose-response relationship that may be realized through these low-touch interventions that offer promising potential for reaching high numbers of program participants. Trial Registration: ClinicalTrials.gov NCT04979481; https://clinicaltrials.gov/ct2/show/NCT04979481 %M 35212633 %R 10.2196/32138 %U https://formative.jmir.org/2022/2/e32138 %U https://doi.org/10.2196/32138 %U http://www.ncbi.nlm.nih.gov/pubmed/35212633 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e32274 %T Changes in Use of a Leisure Activity Mobile App for Children With Disabilities During the COVID-19 Pandemic: Retrospective Study %A Yoo,Paul Yejong %A Movahed,Mehrnoosh %A Rue,Ishana %A Santos,Carlos Denner Dos %A Majnemer,Annette %A Shikako,Keiko %+ Faculty of Medicine and Health Sciences, McGill University, 3654 prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada, 1 514 398 4400 ext 0802, keiko.thomas@mcgill.ca %K COVID-19 %K participation %K childhood disability %K online leisure %K app engagement %K mHealth %K children %K parents %K mobile apps %K mobile health %K digital health %K pandemic %K online leisure activities %K user engagement %K app usability %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Participation in leisure activities is essential for child development and a human right as per the United Nations Convention on the Rights of the Child. Children with disabilities face several restrictions when participating in leisure activities as compared to same age peers without disabilities. Access to information about accessible, inclusive leisure activities is one of the barriers limiting participation, and one potential health promotion strategy is to provide access to information to increase participation. The Jooay App is a mobile app listing such activities in Canada and Australia. With the COVID-19 global pandemic and subsequent public health measures, most community-based facilities providing the activities listed on Jooay were closed. The app therefore started listing online activities offered with the expectation of continuing to provide information for families and understanding the extent to which users relied on the mobile app as a tool to identify new safe leisure opportunities. Objective: This study aims to describe the engagement of the Jooay app before and during COVID-19, and to estimate the extent to which the listing of online activities was related to the engagement of the Jooay app. Methods: We conducted a retrospective study comparing Jooay app use between March 2020 and February 2021 to the engagement between March 2019 and February 2020 by Jooay users. Spearman rank correlations were carried out to identify associations between the activities listed and the users’ engagement from May 2020 to February 2021. Results: Active engagement with the Jooay app from March 2020 to February 2021 dropped by an average of 135 engagements (64.2%) compared to engagements in 2019-2020. The largest monthly drop in engagement was observed in May 2020 by 239 engagements (88.8%). There was a strong positive correlation between the number of active users and the number of online activities listed on the app (rs=0.900). Conclusions: The engagement with the Jooay App presented an expected decrease during the first wave of the COVID-19 pandemic. The addition of online adapted leisure activities to the app’s listings during the pandemic increased app use. Access to information about inclusive activities is a barrier for children with disabilities to engage in leisure. Mobile health solutions can be responsive to contextual factors and consider the social determinants of health such as socioeconomic and public health emergency issues that can impact the participation of vulnerable populations such as children with disabilities and help eliminate barriers to participation. The provision of online leisure opportunities during the pandemic could facilitate participation in these activities during the pandemic and beyond, which is essential and beneficial for the physical and mental well-being of children with disabilities and their families. %M 35100129 %R 10.2196/32274 %U https://pediatrics.jmir.org/2022/1/e32274 %U https://doi.org/10.2196/32274 %U http://www.ncbi.nlm.nih.gov/pubmed/35100129 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e34477 %T Participatory Design of a Mobile App to Safeguard Mental Resilience in the Context of Drug Use in Young Adults: Multi-Method Study %A Ben-Yehuda,Ofri %A Dreazen,Efrat %A Koren,Danny %A Peleg,Mor %+ Department of Information Systems, University of Haifa, Abba Khoushy Ave 199, Haifa, 3498838, Israel, 972 048288509, morpeleg@is.haifa.ac.il %K mobile health %K mHealth %K eHealth %K telehealth %K mental health %K mental resilience %K participatory design %K mobile phone %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Existing mental health apps are largely not aimed at generally healthy young people who may be experimenting with addictive substances and mind-altering experiences. Objective: The aim of this study is to examine the interest and expectations of young people regarding a proposed smartphone app designed to help protect and promote mental health and resilience in the face of risks associated with substance use. Methods: The study was based on agile system development and had 3 empirical substudies. Our feasibility study (study 1) included an anonymous questionnaire that examined the potential interest of young people in this type of app. It was answered by 339 Israelis aged 18-30 years. The second part of the feasibility study was a pilot study with 1.2% (4/339) of the people who answered the questionnaire and expressed interest in participating in a focus group. They tested and refined the elements planned for the focus groups. Study 2 was a participatory design study involving 7 focus groups of 5 to 7 participants each (young people aged 18-35 years, n=38). Persona development, open discussion, and a Technology Acceptance Model questionnaire were used to elicit user expectations and requirements for the app and to understand the perceived usefulness and usability of the proposed features. Study 3 comprised in-depth interviews with experts in the field of youth mental health and drug use to enlist their professional opinion regarding the value of such an app and recommendations about the features it should include. Results: The mock-up for the proposed app had five key features: personalized assessment of risk for a drug-associated mental crisis, support for self-monitoring, useful information (eg, warning signs and first-aid guidelines), resilience-building exercises, and a support center. Participants rated highly the usefulness of all 5 main features and 96% (24/25) of the specific features we proposed within those main categories. The participants also suggested additional features as well as a new user persona we had not considered: the parents or family members of the young person. The focus groups rated highly the perceived usability of the app. Most of the experts saw value in all the main features and suggested specific knowledge sources for the app’s content. Finally, participants of both the feasibility study and the participatory design study expressed moderate to high interest in using the app for self-help and high interest in using the app to help friends. Conclusions: The findings provide preliminary encouraging support for the 5 main features suggested by the research team and reinforce recommendations for mobile health apps found in the literature. The findings emphasize the insight that this kind of app should be designed primarily for use by individuals seeking to help others. %M 35212631 %R 10.2196/34477 %U https://formative.jmir.org/2022/2/e34477 %U https://doi.org/10.2196/34477 %U http://www.ncbi.nlm.nih.gov/pubmed/35212631 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e34059 %T The Effect of a Mobile and Wearable Device Intervention on Increased Physical Activity to Prevent Metabolic Syndrome: Observational Study %A Kim,Hee Jin %A Lee,Kang Hyun %A Lee,Jung Hun %A Youk,Hyun %A Lee,Hee Young %+ Department of Emergency Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, 26426, Republic of Korea, 82 33 741 1612, ed119@yonsei.ac.kr %K mHealth %K physical activity %K wearable device %K metabolic syndrome %K health care %K exercise %K intervention %K Asia %K Korea %K rural %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Research on whether wearable devices and app-based interventions can effectively prevent metabolic syndrome (MetS) by increasing physical activity (PA) among middle-aged people living in the rural areas of South Korea remains insufficient. Objective: The aim of this study was to determine whether mobile and wearable device interventions can improve health indicators, including PA, in MetS risk groups in rural South Korea. Methods: In this clinical trial, performed from December 2019 to June 2020, participants were asked to use a wearable device (GalaxyWatch Active1) alone (standard intervention) or the wearable device and mobile app (Yonsei Health Korea) (enhanced intervention). Clinical measures and International Physical Activity Questionnaire (IPAQ) scores were evaluated initially and after 6 months. The number of steps was monitored through the website. The primary outcome was the difference in PA and clinical measures between the enhanced intervention and standard intervention groups. The secondary outcome was the decrease in MetS factors related to the change in PA. Results: A total of 267 participants were randomly selected, 221 of whom completed the 6-month study. Among the 221 participants, 113 were allocated to the enhanced intervention group and 108 were allocated to the standard intervention group. After 6 months, the body weight and BMI for the enhanced intervention group decreased by 0.6 (SD 1.87) and 0.21 (SD 0.76), respectively (P<.001). In both groups, systolic blood pressure, diastolic blood pressure, waist circumference, and glycated hemoglobin A1c (HbA1c) decreased (P<.001). The total PA was approximately 2.8 times lower in the standard intervention group (mean 44.47, SD 224.85) than in the enhanced intervention group (mean 124.36, SD 570.0). Moreover, the enhanced intervention group achieved the recommended level of moderate to vigorous physical activity (MVPA), whereas the standard intervention group did not (188 minutes/week vs 118 minutes/week). Additionally, the number of participants in the enhanced intervention group (n=113) that reached 10,000 daily steps or more after the intervention increased from 9 (8.0%) to 26 (23.1%) (P=.002), whereas this number did not increase significantly in the standard intervention group (n=108), from 8 (7.4%) to 16 (14.8%) (P=.72). The number of participants without any MetS factors increased by 12 (11%) and 8 (7%) in the enhanced and standard intervention group, respectively. Conclusions: PA monitoring and an intervention using wearable devices were effective in preventing MetS in a rural population in Korea. Blood pressure, waist circumference, and HbA1c were improved in both intervention groups, which were effective in reducing MetS factors. However, only the participants in the enhanced intervention group continuously increased their MVPA and step counts above the recommended level to prevent MetS. Body weight and BMI were further improved, and a higher number of participants with zero MetS factors was attained from the enhanced intervention. Trial Registration: Clinical Research Information Service KCT0005783; https://cris.nih.go.kr/cris/search/detailSearch.do/16123 %M 35200145 %R 10.2196/34059 %U https://mhealth.jmir.org/2022/2/e34059 %U https://doi.org/10.2196/34059 %U http://www.ncbi.nlm.nih.gov/pubmed/35200145 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e31530 %T Digitally Supported Lifestyle Intervention to Prevent Type 2 Diabetes Through Healthy Habits: Secondary Analysis of Long-Term User Engagement Trajectories in a Randomized Controlled Trial %A Lavikainen,Piia %A Mattila,Elina %A Absetz,Pilvikki %A Harjumaa,Marja %A Lindström,Jaana %A Järvelä-Reijonen,Elina %A Aittola,Kirsikka %A Männikkö,Reija %A Tilles-Tirkkonen,Tanja %A Lintu,Niina %A Lakka,Timo %A van Gils,Mark %A Pihlajamäki,Jussi %A Martikainen,Janne %+ School of Pharmacy, University of Eastern Finland, P.O. Box 1627, Kuopio, 70211, Finland, 358 407024682, piia.lavikainen@uef.fi %K type 2 diabetes %K user engagement %K digital behavior change intervention %K trajectories %K habit formation %K mobile health %D 2022 %7 24.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health interventions may offer a scalable way to prevent type 2 diabetes (T2D) with minimal burden on health care systems by providing early support for healthy behaviors among adults at increased risk for T2D. However, ensuring continued engagement with digital solutions is a challenge impacting the expected effectiveness. Objective: We aimed to investigate the longitudinal usage patterns of a digital healthy habit formation intervention, BitHabit, and the associations with changes in T2D risk factors. Methods: This is a secondary analysis of the StopDia (Stop Diabetes) study, an unblinded parallel 1-year randomized controlled trial evaluating the effectiveness of the BitHabit app alone or together with face-to-face group coaching in comparison with routine care in Finland in 2017-2019 among community-dwelling adults (aged 18 to 74 years) at an increased risk of T2D. We used longitudinal data on usage from 1926 participants randomized to the digital intervention arms. Latent class growth models were applied to identify user engagement trajectories with the app during the study. Predictors for trajectory membership were examined with multinomial logistic regression models. Analysis of covariance was used to investigate the association between trajectories and 12-month changes in T2D risk factors. Results: More than half (1022/1926, 53.1%) of the participants continued to use the app throughout the 12-month intervention. The following 4 user engagement trajectories were identified: terminated usage (904/1926, 46.9%), weekly usage (731/1926, 38.0%), twice weekly usage (208/1926, 10.8%), and daily usage (83/1926, 4.3%). Active app use during the first month, higher net promoter score after the first 1 to 2 months of use, older age, and better quality of diet at baseline increased the odds of belonging to the continued usage trajectories. Compared with other trajectories, daily usage was associated with a higher increase in diet quality and a more pronounced decrease in BMI and waist circumference at 12 months. Conclusions: Distinct long-term usage trajectories of the BitHabit app were identified, and individual predictors for belonging to different trajectory groups were found. These findings highlight the need for being able to identify individuals likely to disengage from interventions early on, and could be used to inform the development of future adaptive interventions. Trial Registration: ClinicalTrials.gov NCT03156478; https://clinicaltrials.gov/ct2/show/NCT03156478 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-6574-y %M 35200147 %R 10.2196/31530 %U https://www.jmir.org/2022/2/e31530 %U https://doi.org/10.2196/31530 %U http://www.ncbi.nlm.nih.gov/pubmed/35200147 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 2 %P e19877 %T Use of a Smartphone Self-assessment App for a Tobacco-Induced Disease (COPD, Cardiovascular Diseases, Cancer) Screening Strategy and to Encourage Smoking Cessation: Observational Study %A Stavaux,Edouard %A Goupil,François %A Barreau,Guillaume %A Septans,Anne Lise %A Dautzenberg,Bertrand %A Foulet-Rogé,Armelle %A Padilla,Norbert %A Urban,Thierry %A Denis,Fabrice %+ Institut Inter-Regional de Cancérologie Jean Bernard, 9 rue Beauverger, Le Mans, 72000, France, 33 684190480, f.denis@ilcgroupe.fr %K smoking cessation %K mobile health %K self-assessment, lung cancer %K early detection %K tobacco-induced pathologies %D 2022 %7 23.2.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Patient self-assessment via a mobile app detects actionable symptoms and has been shown to detect lung cancer relapses early, thereby lengthening survival. Objective: The purpose of this study was to assess the incidence of chief symptoms associated with the main tobacco-induced pathologies in both current and ex-smokers through a self-assessment smartphone app and to evaluate the app’s capacity to encourage users to quit smoking or reduce consumption, as well as its impact on early lung cancer stages at the time of diagnosis. Methods: Current and ex-smokers were recruited through an advertising campaign in Sarthe county (France) proposing the free download of a smartphone app. App users were asked to answer 13 questions related to symptoms associated with tobacco-induced diseases (chronic obstructive pulmonary disease [COPD], cardiovascular diseases, cancer). In the event of any positive answer, a message was displayed recommending the user to consult a physician. In addition, they were asked about smoking cessation intention before and after answering these 13 questions. Finally, incidence of stage 1 or 2 lung cancers diagnosed during the launch period of our application was evaluated by comparing data from various sources to those from the same period during the previous year. Results: Of the 5671 users who were eligible for evaluation, an alert was sent to the majority (4118/5671, 72.6%), with a higher incidence for current smokers (2833/3679, 77.0% vs 1298/1992, 65.2%; P<.001). The most frequent symptoms triggering the notifications were fatigue (2023/5671, 35.7%), cough (1658/5671, 29.2%), dyspnea (1502/5671, 26.5%), and persistent chest pain (1286/5671, 22.7%). Of the current smokers, 14.0% (515/3679) showed symptoms suggesting COPD, 15.5% (571/3679) showed symptoms suggesting stable angina, 12.4% (455/3679) probably had lower extremity artery disease, and 6.8% (249/3679) had possible cancer. Of the users, 36.5% (1343/3679) claimed that they thought about quitting smoking, and 48.7% (1795/3679) had thought about reducing their consumption. Surgery-eligible stage 1 and 2 lung cancer incidence was 24% (14/58) during the study period versus 9% (5/54) during the previous year in Sarthe county (P=.04), whereas it remained unchanged in the neighboring county of Maine-et-Loire. Conclusions: A majority of current and ex-smokers showed worrying symptoms, and the use of a self-assessment smartphone app may drive a majority of smokers toward the intention of smoking cessation or decreasing consumption. A randomized study should be performed to confirm this intention and to support the potential increase of symptomatic lung cancer detection at early, surgery-accessible stages. Trial Registration: ClinicalTrials.gov NCT04048954; https://www.clinicaltrials.gov/ct2/show/NCT04048954 %M 35195530 %R 10.2196/19877 %U https://publichealth.jmir.org/2022/2/e19877 %U https://doi.org/10.2196/19877 %U http://www.ncbi.nlm.nih.gov/pubmed/35195530 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 1 %P e34465 %T An Innovative, Paradigm-Shifting Lifestyle Intervention to Reduce Glucose Excursions With the Use of Continuous Glucose Monitoring to Educate, Motivate, and Activate Adults With Newly Diagnosed Type 2 Diabetes: Pilot Feasibility Study %A Oser,Tamara K %A Cucuzzella,Mark %A Stasinopoulos,Marilyn %A Moncrief,Matthew %A McCall,Anthony %A Cox,Daniel J %+ Department of Family Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue F496, Academic Office One, Aurora, CO, 80045, United States, 1 303 724 2060, tamara.oser@cuanschutz.edu %K type 2 diabetes %K continuous glucose monitoring %K glycemic excursion minimization %K initial treatment %K diabetes distress %K diabetes %K monitoring %K treatment %K distress %K pilot study %K lifestyle %K intervention %K motivation. %D 2022 %7 23.2.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: Type 2 diabetes (T2D) is a growing epidemic in the United States, and metabolic control has not been improved over the last 10 years. Glycemic excursion minimization (GEM) is an alternative lifestyle treatment option focused on reducing postnutrient glucose excursions rather than reducing weight. GEM has been proven to be superior to routine care when delivered face to face, and equivalent or superior to conventional weight loss therapy, but it has not been evaluated among patients newly diagnosed with T2D or in a self-administered format. Objective: This pilot study evaluated the feasibility of a self-administered version of GEM, augmented with continuous glucose monitoring (CGM), to improve metabolic control (hemoglobin A1c [HbA1c]) while diminishing or delaying the need for diabetes medications in adults recently diagnosed with T2D. These primary objectives were hypothesized to be achieved by reducing carbohydrate intake and increasing physical activity to diminish CGM glucose excursions, leading to the secondary benefits of an increase in diabetes empowerment and reduced diabetes distress, depressive symptoms, and BMI. Methods: GEM was self-administered by 17 adults recently diagnosed with T2D (mean age 52 years, SD 11.6 years; mean T2D duration 3.9 months, SD 2.5 months; mean HbA1c levels 8.0%, SD 1.6%; 40% female; 33.3% non-White), with the aid of a 4-chapter pocket guide and diary, automated motivational text messaging, and feedback from an activity monitor, along with CGM and supplies for the 6-week intervention and the 3-month follow-up. Treatment was initiated with one telephone call reviewing the use of the technology and 3 days later with a second call reviewing the use of the GEM pocket guide and intervention. Results: At 3-month follow-up, 67% of the participants’ diabetes was in remission (HbA1c levels <6.5%), and only one participant started taking diabetes medication. Participants demonstrated a significant reduction in HbA1c levels (–1.8%; P<.001). Participants also experienced significant reductions in high-glycemic-load carbohydrates routinely consumed, CGM readings that were >140 mg/dL, diabetes distress, depressive symptoms, and BMI. Participants felt that use of the CGM was the most significant single element of the intervention. Conclusions: GEM augmented with CGM feedback may be an effective initial intervention for adults newly diagnosed with T2D. A self-administered version of GEM may provide primary care physicians and patients with a new tool to help people recently diagnosed with T2D achieve remission independent of medication and without weight loss as the primary focus. Future research is needed with a larger and more diverse sample. %M 35050857 %R 10.2196/34465 %U https://diabetes.jmir.org/2022/1/e34465 %U https://doi.org/10.2196/34465 %U http://www.ncbi.nlm.nih.gov/pubmed/35050857 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e32815 %T Development and Usability of a Text Messaging Program for Women With Gestational Diabetes: Mixed Methods Study %A Blair,Rachel A %A Horn,Christine E %A Dias,Jennifer M %A McDonnell,Marie E %A Seely,Ellen W %+ Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, United States, 1 6177329479, rblair4@bwh.harvard.edu %K gestational diabetes mellitus %K SMS text messaging %K mobile phone %K mobile health %K pregnancy %K blood glucose self-monitoring %D 2022 %7 22.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Gestational diabetes mellitus (GDM) affects 5%-10% of pregnancies and can lead to serious fetal and maternal complications. SMS text messaging is an effective way to improve diabetes management outside of pregnancy, but has not been well studied in GDM. Objective: This study aimed to perform user experience testing and assess usability and acceptability of an SMS text messaging program (Text 4 Success) for women with GDM. Methods: An automated 2-way texting program was developed. It included (1) reminders to check blood glucose levels, (2) positive feedback to user-reported glucose levels, (3) weekly educational messages, and (4) weekly motivational messages. For the user experience testing, women received simulated messages. For the usability study, women were enrolled in the program and received messages for 2 weeks. All women participated in semistructured interviews. For women in the usability study, data from glucose measuring devices were downloaded to assess adherence to self-monitoring of blood glucose (SMBG), measured as the percentage of recommended SMBG checks performed (a secondary outcome). Results: Ten women participated in user experience testing. Suggestions for optimization included further customization of message timing and minimization of jargon, which were incorporated. Ten women participated in the usability study. All 10 would recommend the program to other women with GDM. Participants liked the immediate feedback to glucose values. Suggestions included further flexibility of messages related to mealtimes and the ability to aggregate blood glucose data into a table or graph. Overall, adherence to SMBG testing was high at baseline (222/238 recommended checks, 93%). In comparing the week prior to the trial with the 2 weeks during the trial, there was a small but statistically insignificant difference (P=.48) in the percentage of recommended SMBG performed (median 93% [25th-75th IQR 89%-100%] vs median 97% [25th-75th IQR 92%-100%]). Conclusions: Overall, women with GDM would recommend the Text 4 Success in GDM program and think it is helpful for GDM self-management. The program was usable and acceptable. The program may be better suited to those who have low levels of adherence to SMBG at baseline or to women at time of their diagnosis of GDM. Adaptations to the program will be made based on user suggestions. Further study of SMS text messaging to improve SMBG in GDM is needed. %M 35191851 %R 10.2196/32815 %U https://humanfactors.jmir.org/2022/1/e32815 %U https://doi.org/10.2196/32815 %U http://www.ncbi.nlm.nih.gov/pubmed/35191851 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e31363 %T Effectiveness of Digital Forced-Choice Nudges for Voluntary Data Donation by Health Self-trackers in Germany: Web-Based Experiment %A Pilgrim,Katharina %A Bohnet-Joschko,Sabine %+ Department of Management and Entrepreneurship, Faculty of Management, Economics and Society, Witten Herdecke University, Alfred-Herrhausen-Str 50, Witten, 58455, Germany, 49 2302926475, katharina.pilgrim@uni-wh.de %K quantified self %K health self-tracking %K digital nudge %K data donation %K health data %K mobile phone %D 2022 %7 21.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Health self-tracking is an evidence-based approach to optimize health and well-being for personal self-improvement through lifestyle changes. At the same time, user-generated health-related data can be of particular value for (health care) research. As longitudinal data, these data can provide evidence for developing better and new medications, diagnosing rare diseases faster, or treating chronic diseases. Objective: This quantitative study aims to investigate the impact of digital forced-choice nudges on the willingness of German health self-trackers to donate self-tracked health-related data for research. This study contributes to the body of knowledge on the effectiveness of nonmonetary incentives. Our study enables a gender-specific statement on influencing factors on the voluntary donation of personal health data and, at the same time, on the effectiveness of digital forced-choice nudges within tracking apps. Methods: We implemented a digital experiment using a web-based questionnaire by graphical manipulation of the Runtastic tracking app interface. We asked 5 groups independently to indicate their willingness to donate tracked data for research. We used a digital forced-choice nudge via a pop-up window, which framed the data donation request with 4 different counter values. We generated the counter values according to the specific target group needs identified from the research literature. Results: A sample of 919 was generated, of which, 625 (68%) were women and 294 (32%) were men. By dividing the sample into male and female participants, we take into account research on gender differences in privacy tendencies on the web and offline, showing that female participants display higher privacy concerns than male participants. A statistical group comparison shows that with a small effect size (r=0.21), men are significantly more likely (P=.04) to donate their self-tracked data for research if the need to take on social responsibility is addressed (the prosocial counter value in this case—contributing to society) compared with the control group without counter value. Selfish or pseudoprosocial counter values had no significant effect on willingness to donate health data among male or female health self-trackers in Germany when presented as a forced-choice nudge within a tracking app. Conclusions: Although surveys regularly reveal an 80% to 95% willingness to donate data on average in the population, our results show that only 41% (377/919) of the health self-trackers would donate their self-collected health data to research. Although selfish motives do not significantly influence willingness to donate, linking data donation to added societal value could significantly increase the likelihood of donating among male self-trackers by 15.5%. Thus, addressing the need to contribute to society promotes the willingness to donate data among male health self-trackers. The implementation of forced-choice framing nudges within tracking apps presented in a pop-up window can add to the accessibility of user-generated health-related data for research. %M 35188472 %R 10.2196/31363 %U https://www.jmir.org/2022/2/e31363 %U https://doi.org/10.2196/31363 %U http://www.ncbi.nlm.nih.gov/pubmed/35188472 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e30671 %T The Use of Gamification and Incentives in Mobile Health Apps to Improve Medication Adherence: Scoping Review %A Tran,Steven %A Smith,Lorraine %A El-Den,Sarira %A Carter,Stephen %+ School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, 2006, Australia, 61 93512222, steventran@hotmail.com.au %K gamification %K incentives %K mobile application %K mHealth %K medication adherence %K mobile phone %D 2022 %7 21.2.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Emerging health care strategies addressing medication adherence include the use of direct-to-patient incentives or elements adapted from computer games. However, there is currently no published evidence synthesis on the use of gamification or financial incentives in mobile apps to improve medication adherence. Objective: The aim of this scoping review is to synthesize and appraise the literature pertaining to the use of mobile apps containing gamification or financial incentives for medication adherence. There were two objectives: to explore the reported effectiveness of these features and to describe and appraise the design and development process, including patient involvement. Methods: The following databases were searched for relevant articles published in English from database inception to September 24, 2020: Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science. The framework by Arksey and O’Malley and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist guided this scoping review. Using a systematic screening process, studies were included if incentives or game features were used within mobile apps to specifically address medication adherence. An appraisal using risk of bias tools was also applied to their respective study design. Results: A total of 11 studies from the initial 691 retrieved articles were included in this review. Across the studies, gamification alone (9/11, 82%) was used more than financial incentives (1/11, 9%) alone or a combination of the two (1/11, 9%). The studies generally reported improved or sustained optimal medication adherence outcomes; however, there was significant heterogeneity in the patient population, methodology such as outcome measures, and reporting of these studies. There was considerable variability in the development process and evaluation of the apps, with authors opting for either the waterfall or agile methodology. App development was often guided by a theory, but across the reviewed studies, there were no common theories used. Patient involvement was not commonly evident in predevelopment phases but were generally reserved for evaluations of feasibility, acceptance, and effectiveness. Patient perspectives on gamified app features indicated a potential to motivate positive health behaviors such as medication adherence along with critical themes of repetitiveness and irrelevance of certain features. The appraisal indicated a low risk of bias in most studies, although concerns were identified in potential confounding. Conclusions: To effectively address medication adherence via gamified and incentivized mobile apps, an evidence-based co-design approach and agile methodology should be used. This review indicates some adoption of an agile approach in app development; however, patient involvement is lacking in earlier stages. Further research in a generalized cohort of patients living with chronic conditions would facilitate the identification of barriers, potential opportunities, and the justification for the use of gamification and financial incentives in mobile apps for medication adherence. %M 35188475 %R 10.2196/30671 %U https://mhealth.jmir.org/2022/2/e30671 %U https://doi.org/10.2196/30671 %U http://www.ncbi.nlm.nih.gov/pubmed/35188475 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e28686 %T Smart Speakers: The Next Frontier in mHealth %A Sunshine,Jacob %+ Department of Anesthesiology & Pain Medicine, University of Washington, 1959 NE Pacific Street, Box 356540, Seattle, WA, 98195, United States, 1 206 543 6814, jesun@uw.edu %K digital health %K mobile health %K machine learning %K smart speaker %K smartphone %D 2022 %7 21.2.2022 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X The rapid dissemination and adoption of smart speakers has enabled substantial opportunities to improve human health. Just as the introduction of the mobile phone led to considerable health innovation, smart speaker computing systems carry several unique advantages that have the potential to catalyze new fields of health research, particularly in out-of-hospital environments. The recent rise and ubiquity of these smart computing systems holds significant potential for enhancing chronic disease management, enabling passive identification of unwitnessed medical emergencies, detecting subtle changes in human behavior and cognition, limiting isolation, and potentially allowing widespread, passive, remote monitoring of respiratory diseases that impact public health. There are 3 broad mechanisms for how a smart speaker can interact with a person to improve health. These include (1) as an intelligent conversational agent, (2) as a passive identifier of medically relevant diagnostic sounds, and (3) by active sensing using the device's internal hardware to measure physiologic parameters, such as with active sonar, radar, or computer vision. Each of these different modalities has specific clinical use cases, all of which need to be balanced against potential privacy concerns, equity concerns related to system access, and regulatory frameworks which have not yet been developed for this unique type of passive data collection. %M 35188467 %R 10.2196/28686 %U https://mhealth.jmir.org/2022/2/e28686 %U https://doi.org/10.2196/28686 %U http://www.ncbi.nlm.nih.gov/pubmed/35188467 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e31116 %T eHealth Interventions for Treatment and Prevention of Depression, Anxiety, and Insomnia During Pregnancy: Systematic Review and Meta-analysis %A Silang,Katherine A %A Sohal,Pooja R %A Bright,Katherine S %A Leason,Jennifer %A Roos,Leslie %A Lebel,Catherine %A Giesbrecht,Gerald F %A Tomfohr-Madsen,Lianne M %+ Department of Psychology, University of Calgary, 2500 University Drive, NW, Calgary, AB, T2N 1N4, Canada, 1 403 220 2243, ltomfohr@ucalgary.ca %K eHealth %K pregnancy %K depression %K anxiety %K insomnia %K mobile phone %D 2022 %7 21.2.2022 %9 Review %J JMIR Ment Health %G English %X Background: Pregnancy is associated with an increased risk for depression, anxiety, and insomnia. eHealth interventions provide a promising and accessible treatment alternative to face-to-face interventions. Objective: The objective of this systematic review and meta-analysis is to determine the effectiveness of eHealth interventions in preventing and treating depression, anxiety, and insomnia during pregnancy. Secondary aims are to identify demographic and intervention moderators of effectiveness. Methods: A total of 5 databases (PsycINFO, Medline, CINAHL, Embase, and Cochrane) were searched from inception to May 2021. Terms related to eHealth, pregnancy, randomized controlled trials (RCTs), depression, anxiety, and insomnia were included. RCTs and pilot RCTs were included if they reported an eHealth intervention for the prevention or treatment of depression, anxiety, or insomnia in pregnant women. Study screening, data extractions, and quality assessment were conducted independently by 2 reviewers from an 8-member research team (KAS, PRS, Hangsel Sanguino, Roshni Sohail, Jasleen Kaur, Songyang (Mark) Jin, Makayla Freeman, and Beatrice Valmana). Random-effects meta-analyses of pooled effect sizes were conducted to determine the effect of eHealth interventions on prenatal mental health. Meta-regression analyses were conducted to identify potential moderators. Results: In total, 17 studies were included in this review that assessed changes in depression (11/17, 65%), anxiety (10/17, 59%), and insomnia (3/17, 18%). Several studies included both depression and anxiety symptoms as outcomes (7/17, 41%). The results indicated that during pregnancy, eHealth interventions showed small effect sizes for preventing and treating symptoms of anxiety and depression and a moderate effect size for treating symptoms of insomnia. With the exception of intervention type for the outcome of depressive symptoms, where mindfulness interventions outperformed other intervention types, no significant moderators were detected. Conclusions: eHealth interventions are an accessible and promising resource for treating symptoms of anxiety, depression, and insomnia during pregnancy. However, more research is necessary to identify ways to increase the efficacy of eHealth interventions for this population. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42020205954; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=205954 %M 35188471 %R 10.2196/31116 %U https://mental.jmir.org/2022/2/e31116 %U https://doi.org/10.2196/31116 %U http://www.ncbi.nlm.nih.gov/pubmed/35188471 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e30340 %T Parents’ Experience With a Mobile Health Intervention to Influence Human Papillomavirus Vaccination Decision Making: Mixed Methods Study %A Becker,Elisabeth RB %A Shegog,Ross %A Savas,Lara S %A Frost,Erica L %A Coan,Sharon P %A Healy,C Mary %A Spinner,Stanley W %A Vernon,Sally W %+ University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX, 77030, United States, 1 (713) 500 9677, elisabethrbecker@gmail.com %K human papillomavirus %K vaccination %K user experience %K parent %K mHealth %K HPV %K vaccine %K HPV vaccine %K parenting %K pediatrics %K sexual health %K cervical cancer %K adolescents %K mHealth %K app %K application %D 2022 %7 21.2.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Human papillomavirus (HPV)-attributed cancers are preventable, yet HPV vaccination rates severely lag behind other adolescent vaccinations. HPVcancerFree (HPVCF) is a mobile health (mHealth) intervention developed to influence parental HPV vaccination decision making by raising awareness of HPV, reducing HPV vaccination barriers, and enabling HPV vaccination scheduling and reminders through a smartphone app. Evaluating the user experience of mHealth interventions is a vital component in assessing their quality and success but tends to be underreported in mHealth intervention evaluation. Objective: We aimed to evaluate the user experience of HPVCF, an HPV cancer prevention app designed for a pediatric clinic network, using mixed methods data collected from log files, survey measures, and qualitative feedback. Methods: Study data were evaluated from parents in a large US pediatric clinic network using HPVCF in the treatment study condition of a group randomized controlled trial. Log data captured HPVCF retention and use. Postintervention rating scales and items assessed HPVCF utility, usefulness, understandability, appeal, credibility, and perceived impact. Overall quality was evaluated using the user version of the Mobile Application Rating Scale (uMars). Open-ended responses assessed parent recommendations for HPVCF enhancement. Results: The 98 parents were mainly female (n=94, 96%), 41 (5.67) years of age, college educated (n=55, 56%), and White and non-Hispanic (n=55, 56%) and had private health insurance for their children (n=75, 77%). Parents used HPVCF 197 times, with the average visit duration approximating 3.5 minutes. The uMARS app quality score was positively skewed (4.2/5.0). Mean ratings were highest for information (4.46 [SD 0.53]) and lowest for engagement (3.74 [SD 0.69]). In addition, of 95 parents, 45 (47%) rated HPVCF as helpful in HPV vaccination decision making and 16 (17%) attributed HPV vaccine initiation to HPVCF. Parents reported that HPVCF increased their awareness (84/95, 88%), knowledge (84/95, 88%), and HPV vaccination intentions (64/95, 67%). Most of the 98 parents rated the 4 HPVCF components as useful (72-92 [73%-94%]). Parents also agreed that HPVCF is clear (86/95, 91%), accurate (86/95, 91%), and more helpful than other HPV vaccine information they had received (89/95, 94%) and that they would recommend it to others (81/95, 85%). In addition, parents suggested ways to increase awareness and engagement with the app, along with opportunities to enhance the content and functionality. Conclusions: HPVCF was well received by parents and performed well on indicators of quality, usefulness, utility, credibility, and perceived impact. This study contributes a multimethod and multimeasure evaluation to the growing body of literature focused on assessing the user experience of patient-focused technology-mediated applications for HPV education. %M 35188469 %R 10.2196/30340 %U https://pediatrics.jmir.org/2022/1/e30340 %U https://doi.org/10.2196/30340 %U http://www.ncbi.nlm.nih.gov/pubmed/35188469 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e34889 %T A Digital Mental Health Intervention in an Orthopedic Setting for Patients With Symptoms of Depression and/or Anxiety: Feasibility Prospective Cohort Study %A Leo,Ashwin J %A Schuelke,Matthew J %A Hunt,Devyani M %A Metzler,John P %A Miller,J Philip %A Areán,Patricia A %A Armbrecht,Melissa A %A Cheng,Abby L %+ Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, Washington University in St Louis School of Medicine, 660 South Euclid Avenue, St Louis, MO, 63110, United States, 1 3147472823, chengal@wustl.edu %K digital health %K mental health %K depression %K anxiety %K chronic pain %K musculoskeletal %K orthopedic %K pain management %K health intervention %K mobile phone %D 2022 %7 21.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Symptoms of depression and anxiety commonly coexist with chronic musculoskeletal pain, and when this occurs, standard orthopedic treatment is less effective. However, mental health intervention is not yet a routine part of standard orthopedic treatment, in part because of access-related barriers. Digital mental health intervention is a potential scalable resource that could be feasibly incorporated into orthopedic care. Objective: This study’s primary purpose was to assess the feasibility of introducing a digital mental health intervention (Wysa) in an outpatient orthopedic setting to patients with coexisting symptoms of depression and/or anxiety. The secondary purpose was to perform a preliminary effectiveness analysis of the intervention. Methods: In this single-arm, prospective cohort study, participants included adult patients (18 years and older) who presented to a nonsurgical orthopedic specialist at a single tertiary care academic center for evaluation of a musculoskeletal condition and who self-reported symptoms of depression and/or anxiety (Patient-Reported Outcomes Measurement Information System [PROMIS] Depression and/or Anxiety score ≥55). Face-to-face enrollment was performed by a research coordinator immediately after the participant’s encounter with an orthopedic clinician. Participants were provided 2 months of access to a mobile app called Wysa, which is an established, multicomponent digital mental health intervention that uses chatbot technology and text-based access to human counselors to deliver cognitive behavioral therapy, mindfulness training, and sleep tools, among other features. For this study, Wysa access also included novel, behavioral activation–based features specifically developed for users with chronic pain. Primary feasibility outcomes included the study recruitment rate, retention rate, and engagement rate with Wysa (defined as engagement with a therapeutic Wysa tool at least once during the study period). Secondary effectiveness outcomes were between-group differences in mean longitudinal PROMIS mental and physical health score changes at 2-month follow-up between high and low Wysa users, defined by a median split. Results: The recruitment rate was 29.3% (61/208), retention rate was 84% (51/61), and engagement rate was 72% (44/61). Compared to low users, high users reported greater improvement in PROMIS Anxiety scores (between-group difference −4.2 points, 95% CI −8.1 to −0.2; P=.04) at the 2-month follow-up. Between-group differences in PROMIS Depression (−3.2 points, 95% CI −7.5 to 1.2; P=.15) and Pain Interference scores (−2.3 points, 95% CI −6.3 to 1.7; P=.26) favored high users but did not meet statistical significance. Improvements in PROMIS Physical Function scores were comparable between groups. Conclusions: Delivery of a digital mental health intervention within the context of orthopedic care is feasible and has the potential to improve mental health and pain-related impairment to a clinically meaningful degree. Participants’ engagement rates exceeded industry standards, and additional opportunities to improve recruitment and retention were identified. Further pilot study followed by a definitive, randomized controlled trial is warranted. Trial Registration: ClinicalTrials.gov NCT04640090; https://clinicaltrials.gov/ct2/show/NCT04640090 %M 35039278 %R 10.2196/34889 %U https://formative.jmir.org/2022/2/e34889 %U https://doi.org/10.2196/34889 %U http://www.ncbi.nlm.nih.gov/pubmed/35039278 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e30211 %T Validity and Feasibility of the Monitoring and Modeling Family Eating Dynamics System to Automatically Detect In-field Family Eating Behavior: Observational Study %A Bell,Brooke Marie %A Alam,Ridwan %A Mondol,Abu Sayeed %A Ma,Meiyi %A Emi,Ifat Afrin %A Preum,Sarah Masud %A de la Haye,Kayla %A Stankovic,John A %A Lach,John %A Spruijt-Metz,Donna %+ Department of Chronic Disease Epidemiology, School of Public Health, Yale University, 60 College St, 8th Floor, New Haven, CT, 06520, United States, 1 475 235 0643, brooke.bell@yale.edu %K ecological momentary assessment %K wearable sensors %K automatic dietary assessment %K eating behavior %K eating context %K smartwatch %K mobile phone %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The field of dietary assessment has a long history, marked by both controversies and advances. Emerging technologies may be a potential solution to address the limitations of self-report dietary assessment methods. The Monitoring and Modeling Family Eating Dynamics (M2FED) study uses wrist-worn smartwatches to automatically detect real-time eating activity in the field. The ecological momentary assessment (EMA) methodology was also used to confirm whether eating occurred (ie, ground truth) and to measure other contextual information, including positive and negative affect, hunger, satiety, mindful eating, and social context. Objective: This study aims to report on participant compliance (feasibility) to the 2 distinct EMA protocols of the M2FED study (hourly time-triggered and eating event–triggered assessments) and on the performance (validity) of the smartwatch algorithm in automatically detecting eating events in a family-based study. Methods: In all, 20 families (58 participants) participated in the 2-week, observational, M2FED study. All participants wore a smartwatch on their dominant hand and responded to time-triggered and eating event–triggered mobile questionnaires via EMA while at home. Compliance to EMA was calculated overall, for hourly time-triggered mobile questionnaires, and for eating event–triggered mobile questionnaires. The predictors of compliance were determined using a logistic regression model. The number of true and false positive eating events was calculated, as well as the precision of the smartwatch algorithm. The Mann-Whitney U test, Kruskal-Wallis test, and Spearman rank correlation were used to determine whether there were differences in the detection of eating events by participant age, gender, family role, and height. Results: The overall compliance rate across the 20 deployments was 89.26% (3723/4171) for all EMAs, 89.7% (3328/3710) for time-triggered EMAs, and 85.7% (395/461) for eating event–triggered EMAs. Time of day (afternoon odds ratio [OR] 0.60, 95% CI 0.42-0.85; evening OR 0.53, 95% CI 0.38-0.74) and whether other family members had also answered an EMA (OR 2.07, 95% CI 1.66-2.58) were significant predictors of compliance to time-triggered EMAs. Weekend status (OR 2.40, 95% CI 1.25-4.91) and deployment day (OR 0.92, 95% CI 0.86-0.97) were significant predictors of compliance to eating event–triggered EMAs. Participants confirmed that 76.5% (302/395) of the detected events were true eating events (ie, true positives), and the precision was 0.77. The proportion of correctly detected eating events did not significantly differ by participant age, gender, family role, or height (P>.05). Conclusions: This study demonstrates that EMA is a feasible tool to collect ground-truth eating activity and thus evaluate the performance of wearable sensors in the field. The combination of a wrist-worn smartwatch to automatically detect eating and a mobile device to capture ground-truth eating activity offers key advantages for the user and makes mobile health technologies more accessible to nonengineering behavioral researchers. %M 35179508 %R 10.2196/30211 %U https://mhealth.jmir.org/2022/2/e30211 %U https://doi.org/10.2196/30211 %U http://www.ncbi.nlm.nih.gov/pubmed/35179508 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e28159 %T Characterizing and Modeling Smoking Behavior Using Automatic Smoking Event Detection and Mobile Surveys in Naturalistic Environments: Observational Study %A Zhai,DongHui %A van Stiphout,Ruud %A Schiavone,Giuseppina %A De Raedt,Walter %A Van Hoof,Chris %+ imec at OnePlanet Research Center, Bronland 10, Wageningen, 6708WH, Netherlands, 31 317 745 801, ruud.vanstiphout@imec.nl %K smoking behavior modeling %K ambulatory study %K wearable sensors %K temporal patterns of smoking %K Poisson mixed-effects model %K mobile phone %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There are 1.1 billion smokers worldwide, and each year, more than 8 million die prematurely because of cigarette smoking. More than half of current smokers make a serious quit every year. Nonetheless, 90% of unaided quitters relapse within the first 4 weeks of quitting due to the lack of limited access to cost-effective and efficient smoking cessation tools in their daily lives. Objective: This study aims to enable quantified monitoring of ambulatory smoking behavior 24/7 in real life by using continuous and automatic measurement techniques and identifying and characterizing smoking patterns using longitudinal contextual signals. This work also intends to provide guidance and insights into the design and deployment of technology-enabled smoking cessation applications in naturalistic environments. Methods: A 4-week observational study consisting of 46 smokers was conducted in both working and personal life environments. An electric lighter and a smartphone with an experimental app were used to track smoking events and acquire concurrent contextual signals. In addition, the app was used to prompt smoking-contingent ecological momentary assessment (EMA) surveys. The smoking rate was assessed based on the timestamps of smoking and linked statistically to demographics, time, and EMA surveys. A Poisson mixed-effects model to predict smoking rate in 1-hour windows was developed to assess the contribution of each predictor. Results: In total, 8639 cigarettes and 1839 EMA surveys were tracked over 902 participant days. Most smokers were found to have an inaccurate and often biased estimate of their daily smoking rate compared with the measured smoking rate. Specifically, 74% (34/46) of the smokers made more than one (mean 4.7, SD 4.2 cigarettes per day) wrong estimate, and 70% (32/46) of the smokers overestimated it. On the basis of the timestamp of the tracked smoking events, smoking rates were visualized at different hours and were found to gradually increase and peak at 6 PM in the day. In addition, a 1- to 2-hour shift in smoking patterns was observed between weekdays and weekends. When moderate and heavy smokers were compared with light smokers, their ages (P<.05), Fagerström Test of Nicotine Dependence (P=.01), craving level (P<.001), enjoyment of cigarettes (P<.001), difficulty resisting smoking (P<.001), emotional valence (P<.001), and arousal (P<.001) were all found to be significantly different. In the Poisson mixed-effects model, the number of cigarettes smoked in a 1-hour time window was highly dependent on the smoking status of an individual (P<.001) and was explained by hour (P=.02) and age (P=.005). Conclusions: This study reported the high potential and challenges of using an electronic lighter for smoking annotation and smoking-triggered EMAs in an ambulant environment. These results also validate the techniques for smoking behavior monitoring and pave the way for the design and deployment of technology-enabled smoking cessation applications. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-028284 %M 35179512 %R 10.2196/28159 %U https://mhealth.jmir.org/2022/2/e28159 %U https://doi.org/10.2196/28159 %U http://www.ncbi.nlm.nih.gov/pubmed/35179512 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e33603 %T Consistency With and Disengagement From Self-monitoring of Weight, Dietary Intake, and Physical Activity in a Technology-Based Weight Loss Program: Exploratory Study %A Carpenter,Chelsea A %A Eastman,Abraham %A Ross,Kathryn M %+ Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, PO Box 100165, Gainesville, FL, 32610, United States, 1 (352) 294 8433, kmross@phhp.ufl.edu %K self-monitoring %K adherence %K weight loss %K digital tools %K mobile phone %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital self-monitoring tools offer promise to improve adherence to self-monitoring of weight and weight-related behaviors; however, less is known regarding the patterns of participant consistency and disengagement with these tools. Objective: This study characterizes the consistency of use and time to disengagement with digital self-monitoring tools during a 6-month weight loss intervention and investigates whether the provision of phone-based intervention improved self-monitoring adherence. Methods: Participants were 54 adults with overweight or obesity (mean age 49.6 years, SD 12.4 years; mean BMI 32.6 kg/m2, SD 3.2 kg/m2) enrolled in a pilot trial assessing the impact of self-monitoring technology (Fitbit Zip, Aria scale, and smartphone app), with and without additional interventionist contact, on weight loss. All participants received weight loss education and were asked to self-monitor weight, dietary intake, and physical activity daily throughout the 6-month program. Consistency was defined as the number of weeks that participants adhered to self-monitoring recommendations (7 out of 7 days). Disengagement was defined as the first of 2 consecutive weeks that the 7-day self-monitoring adherence goal was not met. Wilcoxon signed-rank tests were used to examine differences in consistency and disengagement by behavioral targets. t tests (2-tailed) and Cox proportional hazards models were used to examine whether providing additional interventionist contact would lead to significant improvements in consistency and time to disengagement from self-monitoring tools, respectively. Linear regressions were used to examine associations between consistency, time to disengagement, and weight loss. Results: Participants consistently self-monitored physical activity for more weeks (mean 17.4 weeks, SD 8.5 weeks) than weight (mean 11.1 weeks, SD 8.5 weeks) or dietary intake (mean 10.8 weeks, SD 8.7 weeks; P<.05). Similarly, participants had a significantly longer time to disengagement from self-monitoring of physical activity (median 19.5 weeks) than weight (4 weeks) or dietary intake (10 weeks; P<.001). Participants randomized to receive additional interventionist contact had significantly greater consistency and longer time to disengagement for self-monitoring of dietary intake compared with participants who did not (P=.006); however, there were no statistically significant differences between groups for self-monitoring of weight or physical activity (P=.24 and P=.25, respectively). Greater consistency and longer time to disengagement were associated with greater weight loss for self-monitoring of weight and dietary intake (P<.001 and P=.004, respectively) but not for physical activity (P=.57). Conclusions: Results demonstrated that self-monitoring adherence differed by behavioral target, with greater consistency and longer time to disengagement associated with lower-burden tools (ie, self-monitoring of physical activity). Consistent with supportive accountability theory, additional interventionist contact improved consistency and lengthened time to disengagement from self-monitoring of dietary intake. Given the observed associations between consistency, disengagement, and weight loss outcomes, it is important to identify additional methods of increasing consistency and engagement with digital self-monitoring tools. %M 35179513 %R 10.2196/33603 %U https://formative.jmir.org/2022/2/e33603 %U https://doi.org/10.2196/33603 %U http://www.ncbi.nlm.nih.gov/pubmed/35179513 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e31109 %T Testing an mHealth System for Individuals With Mild to Moderate Alcohol Use Disorders: Protocol for a Type 1 Hybrid Effectiveness-Implementation Trial %A Park,Linda S %A Chih,Ming-Yuan %A Stephenson,Christine %A Schumacher,Nicholas %A Brown,Randall %A Gustafson,David %A Barrett,Bruce %A Quanbeck,Andrew %+ Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin–Madison, Ste 210, 800 University Bay Dr, Madison, WI, 53705, United States, 1 608 345 6859, linda.park@wisc.edu %K mHealth %K mobile health %K alcohol use disorder %K alcohol reduction %K wellness %K risky drinking %K quality of life %K protocol %D 2022 %7 18.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The extent of human interaction needed to achieve effective and cost-effective use of mobile health (mHealth) apps for individuals with mild to moderate alcohol use disorder (AUD) remains largely unexamined. This study seeks to understand how varying levels of human interaction affect the ways in which an mHealth intervention for the prevention and treatment of AUDs works or does not work, for whom, and under what circumstances. Objective: The primary aim is to detect the effectiveness of an mHealth intervention by assessing differences in self-reported risky drinking patterns and quality of life between participants in three study groups (self-monitored, peer-supported, and clinically integrated). The cost-effectiveness of each approach will also be assessed. Methods: This hybrid type 1 study is an unblinded patient-level randomized clinical trial testing the effects of using an evidence-based mHealth system on participants’ drinking patterns and quality of life. There are two groups of participants for this study: individuals receiving the intervention and health care professionals practicing in the broader health care environment. The intervention is a smartphone app that encourages users to reduce their alcohol consumption within the context of integrative medicine using techniques to build healthy habits. The primary outcomes for quantitative analysis will be participant data on their risky drinking days and quality of life as well as app use from weekly and quarterly surveys. Cost measures include intervention and implementation costs. The cost per participant will be determined for each study arm, with intervention and implementation costs separated within each group. There will also be a qualitative assessment of health care professionals’ engagement with the app as well as their thoughts on participant experience with the app. Results: This protocol was approved by the Health Sciences Minimal Risk Institutional Review Board on November 18, 2019, with subsequent annual reviews. Recruitment began on March 6, 2020, but was suspended on March 13, 2020, due to the COVID-19 pandemic restrictions. Limited recruitment resumed on July 6, 2020. Trial status as of November 17, 2021, is as follows: 357 participants were enrolled in the study for a planned enrollment of 546 participants. Conclusions: The new knowledge gained from this study could have wide and lasting benefits related to the integration of mHealth systems for individuals with mild to moderate AUDs. The results of this study will guide policy makers and providers toward cost-effective ways to incorporate technology in health care and community settings. Trial Registration: ClinicalTrials.gov NCT04011644; https://clinicaltrials.gov/ct2/show/NCT04011644 International Registered Report Identifier (IRRID): DERR1-10.2196/31109 %M 35179502 %R 10.2196/31109 %U https://www.researchprotocols.org/2022/2/e31109 %U https://doi.org/10.2196/31109 %U http://www.ncbi.nlm.nih.gov/pubmed/35179502 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e28913 %T The Relation of Attitude Toward Technology and Mastery Experience After an App-Guided Physical Exercise Intervention: Randomized Crossover Trial %A Sassenberg,Kai %A Roesel,Inka %A Sudeck,Gorden %A Bernecker,Katharina %A Durst,Jennifer %A Krauss,Inga %+ Social Processes Lab, Leibniz-Institut für Wissensmedien, Schleichstrasse 6, Tübingen, 72076, Germany, 49 7071 979 220, k.sassenberg@iwm-tuebingen.de %K mobile app %K exercise %K mastery experience %K self-efficacy %K attitudes toward technology %K osteoarthritis %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical exercise has been found to assert a positive impact on many muscular conditions. Exercise under face-to-face supervision is the gold standard, but access to it is limited, for instance, for economic reasons. App-guided therapy is an intervention that is more affordable and easily accessible. However, attitude toward technology is a key predictor for media adoption and is therefore expected to shape user experience during app-guided therapy. This might be of particular importance for mastery experience, which is crucial for promoting exercise-related self-efficacy and perceived usefulness of the interaction. Both should empower patients to continuously exercise. Objective: This study sought to test whether attitudes toward technology predict mastery experience and perceived usefulness of the interaction after an app- versus a physiotherapist-guided treatment. We expect that attitudes toward technology positively predict both outcomes in case of the app-guided but not in case of the physiotherapist-guided treatment. Methods: Patients (n=54) with clinically diagnosed hip osteoarthritis participated in 2 training sessions with the same exercise intervention, once guided by an app on a tablet computer and once guided by a physiotherapist in a German university hospital. The order of the sessions was randomized. Attitude toward technology was assessed as predictor before the first session, while mastery experience and the global perceived usefulness of interaction as self-reported outcomes after each session. Results: In line with our hypotheses, attitude toward technology predicted mastery experience (b=0.16, standard error=0.07, P=.02) and usefulness of interaction (b=0.17, standard error=0.06, P=.01) after the app-based training but not after the training delivered by a physiotherapist (P>.3 in all cases). Mastery experience was lower for the app-based training but reached a very similar level as the physiotherapist-guided training for those holding a very positive attitude toward technology. Conclusions: The attitude toward technology predicts the extent of mastery experience after app-guided exercise therapy. As mastery experience is highly important for self-efficacy and future exercise behavior, attitudes toward technology should be considered when delivering app-guided exercise treatments. Trial Registration: German Clinical Trials Register DRKS00015759; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015759 %M 35179500 %R 10.2196/28913 %U https://formative.jmir.org/2022/2/e28913 %U https://doi.org/10.2196/28913 %U http://www.ncbi.nlm.nih.gov/pubmed/35179500 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e17268 %T Classification of Smoking Cessation Apps: Quality Review and Content Analysis %A Seo,Suin %A Cho,Sung-Il %A Yoon,Wonjeong %A Lee,Cheol Min %+ Department of Epidemiology, Graduate School of Public Health, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 2 880 2717, persontime@hotmail.com %K smoking cessation %K app %K type %K content and functions %K MARS %K quality %K score %K mobile phone %D 2022 %7 17.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many people use apps for smoking cessation, and the effectiveness of these apps has been proven in several studies. However, no study has classified these apps and only few studies have analyzed the characteristics of these apps that influence their quality. Objective: The purpose of this study was to analyze the content and the quality of smoking cessation apps by type and identify the characteristics that affect their overall quality. Methods: Two app marketplaces (App Store and Google Play) were searched in January 2018, and the search was completed by May 2020. The search terms used were “stop smoking,” “quit smoking,” and “smoking cessation.” The apps were categorized into 3 types (combined, multifunctional, and informational). The tailored guideline of Clinical Practice Guideline for Treating Tobacco Use and Dependence was utilized for evaluating app content (or functions), and the Mobile App Rating Scale (MARS) was used to evaluate the quality. Chi-square test was performed for the general characteristics, and one-way analysis of variance was performed for MARS analysis. To identify the general features of the apps that could be associated with the MARS and content scores, multiple regression analysis was done. All analyses were performed using SAS software (ver. 9.3). Results: Among 1543 apps, 104 apps met the selection criteria of this study. These 104 apps were categorized as combined type (n=44), functional type (n=31), or informational type (n=29). A large amount of content specified in the guideline was included in the apps, most notably in the combined type, followed by the multifunctional and informational type; the MARS scores followed the same order (3.64, 3.26, and 3.0, respectively). Regression analysis showed that the sector in which the developer was situated and the feedback channel with the developer had a significant impact on both the content and MARS scores. In addition, problematic apps such as those made by unknown developers or copied and single-function apps were shown to have a large market share. Conclusions: This study is the first to evaluate the content and quality of smoking cessation apps by classification. The combined type had higher-quality content and functionality than other app types. The app developer type and feedback channel with the app developer had a significant impact on the overall quality of the apps. In addition, problematic apps and single-function apps were shown to have a large market share. Our results will contribute to the use and development of better smoking cessation apps after considering the problems identified in this study. %M 35175213 %R 10.2196/17268 %U https://mhealth.jmir.org/2022/2/e17268 %U https://doi.org/10.2196/17268 %U http://www.ncbi.nlm.nih.gov/pubmed/35175213 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e27337 %T Measurement Properties of Smartphone Approaches to Assess Diet, Alcohol Use, and Tobacco Use: Systematic Review %A Thornton,Louise %A Osman,Bridie %A Champion,Katrina %A Green,Olivia %A Wescott,Annie B %A Gardner,Lauren A %A Stewart,Courtney %A Visontay,Rachel %A Whife,Jesse %A Parmenter,Belinda %A Birrell,Louise %A Bryant,Zachary %A Chapman,Cath %A Lubans,David %A Slade,Tim %A Torous,John %A Teesson,Maree %A Van de Ven,Pepijn %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russel Building, Camperdown, Sydney, 2006, Australia, 61 0403744089, louise.thornton@sydney.edu.au %K smartphone %K app %K alcohol %K smoking %K diet %K measurement %K mobile phone %D 2022 %7 17.2.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Poor diet, alcohol use, and tobacco smoking have been identified as strong determinants of chronic diseases, such as cardiovascular disease, diabetes, and cancer. Smartphones have the potential to provide a real-time, pervasive, unobtrusive, and cost-effective way to measure these health behaviors and deliver instant feedback to users. Despite this, the validity of using smartphones to measure these behaviors is largely unknown. Objective: The aim of our review is to identify existing smartphone-based approaches to measure these health behaviors and critically appraise the quality of their measurement properties. Methods: We conducted a systematic search of the Ovid MEDLINE, Embase (Elsevier), Cochrane Library (Wiley), PsycINFO (EBSCOhost), CINAHL (EBSCOHost), Web of Science (Clarivate), SPORTDiscus (EBSCOhost), and IEEE Xplore Digital Library databases in March 2020. Articles that were written in English; reported measuring diet, alcohol use, or tobacco use via a smartphone; and reported on at least one measurement property (eg, validity, reliability, and responsiveness) were eligible. The methodological quality of the included studies was assessed using the Consensus-Based Standards for the Selection of Health Measurement Instruments Risk of Bias checklist. Outcomes were summarized in a narrative synthesis. This systematic review was registered with PROSPERO, identifier CRD42019122242. Results: Of 12,261 records, 72 studies describing the measurement properties of smartphone-based approaches to measure diet (48/72, 67%), alcohol use (16/72, 22%), and tobacco use (8/72, 11%) were identified and included in this review. Across the health behaviors, 18 different measurement techniques were used in smartphones. The measurement properties most commonly examined were construct validity, measurement error, and criterion validity. The results varied by behavior and measurement approach, and the methodological quality of the studies varied widely. Most studies investigating the measurement of diet and alcohol received very good or adequate methodological quality ratings, that is, 73% (35/48) and 69% (11/16), respectively, whereas only 13% (1/8) investigating the measurement of tobacco use received a very good or adequate rating. Conclusions: This review is the first to provide evidence regarding the different types of smartphone-based approaches currently used to measure key behavioral risk factors for chronic diseases (diet, alcohol use, and tobacco use) and the quality of their measurement properties. A total of 19 measurement techniques were identified, most of which assessed dietary behaviors (48/72, 67%). Some evidence exists to support the reliability and validity of using smartphones to assess these behaviors; however, the results varied by behavior and measurement approach. The methodological quality of the included studies also varied. Overall, more high-quality studies validating smartphone-based approaches against criterion measures are needed. Further research investigating the use of smartphones to assess alcohol and tobacco use and objective measurement approaches is also needed. International Registered Report Identifier (IRRID): RR2-10.1186/s13643-020-01375-w %M 35175212 %R 10.2196/27337 %U https://mhealth.jmir.org/2022/2/e27337 %U https://doi.org/10.2196/27337 %U http://www.ncbi.nlm.nih.gov/pubmed/35175212 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e25948 %T Positive Coping as a Mediator of Mobile Health Intervention Effects on Quality of Life Among People Living With HIV: Secondary Analysis of the Randomized Controlled Trial Run4Love %A Zeng,Yu %A Guo,Yan %A Ho,Rainbow Tin Hung %A Zhu,Mengting %A Zeng,Chengbo %A Monroe-Wise,Aliza %A Li,Yiran %A Qiao,Jiaying %A Zhang,Hanxi %A Cai,Weiping %A Li,Linghua %A Liu,Cong %+ Department of Medical Statistic, School of Public Health, Sun Yat-sen University, Guangzhou, China, 86 020 87334202, Yan.Guo1@umassmed.edu %K mediation effect %K mobile health %K quality of life %K positive coping %K HIV %K randomized controlled trial %D 2022 %7 17.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The effectiveness of psychosocial interventions on quality of life (QOL) among people living with HIV has been validated, including mobile health (mHealth) interventions. However, it is unclear which components of such interventions account for these effects. Objective: This study aims to examine positive coping as a potential mediator of the effects of an mHealth intervention on QOL among people living with HIV. Methods: For this secondary analysis, we used data from an mHealth-based randomized controlled trial, Run4Love, which was conducted to improve QOL and mental health outcomes of people living with HIV. A total of 300 participants were randomly assigned to the intervention group to receive the adapted cognitive-behavioral stress management courses and regular physical activity promotion or the waitlist control group in a 1:1 ratio. Our analysis focused on positive coping and QOL, which were repeatedly measured at baseline and at 3-, 6-, and 9-month follow-ups. Latent growth curve models were constructed to explore the mediating role of positive coping in the effects of the mHealth intervention on QOL. Results: Positive coping served as a mediator in the effect of the mHealth intervention on QOL for up to 9 months. The mHealth intervention had a significant and positive indirect effect on the slope of QOL via the slope of positive coping (b=2.592×1.620=4.198, 95% CI 1.189-7.207, P=.006). The direct effect of the intervention was not significant (b=0.552, 95% CI −2.154 to 3.258, P=.69) when controlling for the mediator. Conclusions: The longitudinal findings suggest that positive coping could be a crucial mediator of the mHealth intervention in enhancing QOL among people living with HIV. These findings underscore the importance of improving positive coping skills in mHealth interventions to improve QOL among people living with HIV. %M 35175209 %R 10.2196/25948 %U https://www.jmir.org/2022/2/e25948 %U https://doi.org/10.2196/25948 %U http://www.ncbi.nlm.nih.gov/pubmed/35175209 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e31537 %T The Content, Quality, and Behavior Change Techniques in Nutrition-Themed Mobile Apps for Children in Canada: App Review and Evaluation Study %A Brown,Jacqueline Marie %A Franco-Arellano,Beatriz %A Froome,Hannah %A Siddiqi,Amina %A Mahmood,Amina %A Arcand,JoAnne %+ Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON, L1H 7K4, Canada, 1 905 721 8668, joanne.arcand@ontariotechu.ca %K mHealth %K children %K app quality %K behavior change techniques %K child nutrition %K mobile apps %K Canada %K mobile phone %D 2022 %7 16.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Children increasingly use mobile apps. Strategies to increase child engagement with apps include the use of gamification and images that incite fun and interaction, such as food. However, the foods and beverages that children are exposed to while using apps are unknown and may vary by app type. Objective: The aim of this study is to identify the app content (ie, types of foods and beverages) included in nutrition-themed apps intended for children, to assess the use of game-like features, and to examine app characteristics such as overall quality and behavior change techniques (BCTs). Methods: This analysis used a cross-sectional database of nutrition-themed apps intended for children (≤12 years), collected between May 2018 and June 2019 from the Apple App Store and Google Play Store (n=259). Apps were classified into four types: food games or nongames that included didactic nutrition guides, habit trackers, and other. Food and beverages were identified in apps and classified into 16 food categories, as recommended (8/16, 50%) and as not recommended (8/16, 50%) by dietary guidelines, and quantified by app type. Binomial logistic regression assessed whether game apps were associated with foods and beverages not recommended by guidelines. App quality, overall and by subscales, was determined using the Mobile App Rating Scale. The BCT Taxonomy was used to classify the different behavioral techniques that were identified in a subsample of apps (124/259, 47.9%). Results: A total of 259 apps displayed a median of 6 (IQR 3) foods and beverages. Moreover, 62.5% (162/259) of apps were classified as food games, 27.4% (71/259) as didactic nutrition guides, 6.6% (17/259) as habit trackers, and 3.5% (9/259) as other. Most apps (198/259, 76.4%) displayed at least one food or beverage that was not recommended by the dietary guidelines. Food game apps were almost 3 times more likely to display food and beverages not recommended by the guidelines compared with nongame apps (β=2.8; P<.001). The overall app quality was moderate, with a median Mobile App Rating Scale score of 3.6 (IQR 0.7). Functionality was the subscale with the highest score (median 4, IQR 0.3). Nutrition guides were more likely to be educational and contain informative content on healthy eating (score 3.7), compared with the other app types, although they also scored significantly lower in engagement (score 2.3). Most apps (105/124, 84.7%) displayed at least one BCT, with the most common BCT being information about health consequences. Conclusions: Findings suggest nutrition-themed apps intended for children displayed food and beverage content not recommended by dietary guidelines, with gaming apps more likely to display not recommended foods than their nongame counterparts. Many apps have a moderate app quality, and the use of consequences (instead of rewards) was the most common BCT. %M 35171100 %R 10.2196/31537 %U https://mhealth.jmir.org/2022/2/e31537 %U https://doi.org/10.2196/31537 %U http://www.ncbi.nlm.nih.gov/pubmed/35171100 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30091 %T Usability of Wearable Multiparameter Technology to Continuously Monitor Free-Living Vital Signs in People Living With Chronic Obstructive Pulmonary Disease: Prospective Observational Study %A Hawthorne,Grace %A Greening,Neil %A Esliger,Dale %A Briggs-Price,Samuel %A Richardson,Matthew %A Chaplin,Emma %A Clinch,Lisa %A Steiner,Michael C %A Singh,Sally J %A Orme,Mark W %+ Centre for Exercise and Rehabilitation Science, National Institute for Health Research Leicester Biomedical Research Centre – Respiratory, University Hospitals of Leicester National Health Service Trust, Groby Road, Leicester, LE3 9QP, United Kingdom, 44 116258 ext 3035, grace.france1@nhs.net %K chronic obstructive pulmonary disease %K digital health %K physical activity %K respiratory rate %K wearable technology %K wearable device %K vital signs monitor %D 2022 %7 16.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Vital signs monitoring (VSM) is routine for inpatients, but monitoring during free-living conditions is largely untested in chronic obstructive pulmonary disease (COPD). Objective: This study investigated the usability and acceptability of continuous VSM for people with COPD using wearable multiparameter technology. Methods: In total, 50 people following hospitalization for an acute exacerbation of COPD (AECOPD) and 50 people with stable COPD symptoms were asked to wear an Equivital LifeMonitor during waking hours for 6 weeks (42 days). The device recorded heart rate (HR), respiratory rate (RR), skin temperature, and physical activity. Adherence was defined by the number of days the vest was worn and daily wear time. Signal quality was examined, with thresholds of ≥85% for HR and ≥80% for RR, based on the device’s proprietary confidence algorithm. Data quality was calculated as the percentage of wear time with acceptable signal quality. Participant feedback was assessed during follow-up phone calls. Results: In total, 84% of participants provided data, with average daily wear time of 11.8 (SD 2.2) hours for 32 (SD 11) days (average of study duration 76%, SD 26%). There was greater adherence in the stable group than in the post-AECOPD group (≥5 weeks wear: 71.4% vs 45.7%; P=.02). For all 84 participants, the median HR signal quality was 90% (IQR 80%-94%) and the median RR signal quality was 93% (IQR 92%-95%). The median HR data quality was 81% (IQR 58%-91%), and the median RR data quality was 85% (IQR 77%-91%). Stable group BMI was associated with HR signal quality (rs=0.45, P=.008) and HR data quality (rs=0.44, P=.008). For the AECOPD group, RR data quality was associated with waist circumference and BMI (rs=–0.49, P=.009; rs=–0.44, P=.02). In total, 36 (74%) participants in the Stable group and 21 (60%) participants in the AECOPD group accepted the technology, but 10 participants (12%) expressed concerns with wearing a device around their chest. Conclusions: This wearable multiparametric technology showed good user acceptance and was able to measure vital signs in a COPD population. Data quality was generally high but was influenced by body composition. Overall, it was feasible to continuously measure vital signs during free-living conditions in people with COPD symptoms but with additional challenges in the post-AECOPD context. %M 35171101 %R 10.2196/30091 %U https://humanfactors.jmir.org/2022/1/e30091 %U https://doi.org/10.2196/30091 %U http://www.ncbi.nlm.nih.gov/pubmed/35171101 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32312 %T Digital Companion Choice to Support Teachers’ Stress Self-management: Systematic Approach Through Taxonomy Creation %A Manning,Julia B %A Blandford,Ann %A Edbrooke-Childs,Julian %+ Interaction Centre, Department of Computer Science, University College London, 2nd Floor, 66-72 Gower Street, London, WC1E 6EA, United Kingdom, 44 07973312358, j.manning.17@ucl.ac.uk %K digital technology %K digital health %K psychological treatment %K stress %K self-management %K mobile phone %D 2022 %7 16.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There are thousands of digital companions designed for emotional well-being and stress, including websites, wearables, and smartphone apps. Although public evaluation frameworks and ratings exist, they do not facilitate digital companion choice based on contextual or individual information, such as occupation or personal management strategies. Objective: The aim of this study is to establish a process for creating a taxonomy to support systematic choice of digital companions for teachers’ stress self-management. Methods: We used a 4-step study design. In step 1, we identified the dimension of stress self-management and strategic classifications. In step 2, we identified the dimension of the digital techniques and conceptual descriptions. In step 3, we created 6 criteria for the inclusion of digital companions. In step 4, we used the taxonomy framework created by steps 1 and 2 and populated it with digital companions for stress self-management, as identified in step 3. Results: First, in the dimension of stress self-management, we identified four classes of strategies: educational, physiological, cognitive, and social. Second, in the digital techniques dimension, we derived four conceptual descriptions for the digital companions’ mechanisms of action: fostering reflection, suggesting treatment, peer-to-peer support, and entertainment. Third, we created six criteria for digital companion inclusion in the taxonomy: suitability, availability, evaluation, security, validity, and cost. Using the taxonomy framework and criteria, we populated it with digital companions for stress management ahead of presentation to teachers in a stress study workshop. Conclusions: The elements of our approach can be generalized as principles for the creation of taxonomies for other occupations or conditions. Taxonomies such as this could be a valuable resource for individuals to understand which digital companion could be of help in their personal context. %M 35171106 %R 10.2196/32312 %U https://formative.jmir.org/2022/2/e32312 %U https://doi.org/10.2196/32312 %U http://www.ncbi.nlm.nih.gov/pubmed/35171106 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e28886 %T Effectiveness of a Step Counter Smartband and Midwife Counseling Intervention on Gestational Weight Gain and Physical Activity in Pregnant Women With Obesity (Pas and Pes Study): Randomized Controlled Trial %A Gonzalez-Plaza,Elena %A Bellart,Jordi %A Arranz,Ángela %A Luján-Barroso,Leila %A Crespo Mirasol,Esther %A Seguranyes,Gloria %+ Maternal-Fetal Medicine Department at BCNatal, Clinic Hospital of Barcelona, Sabino de Arana, 1, Barcelona, 08028, Spain, 34 932275400 ext 7294, eplaza@clinic.cat %K obesity %K maternal %K pregnancy %K mHealth %K mobile apps %K telemedicine %K telenursing %K physical activity %K gestational weight gain %K lifestyle %K mobile phone %D 2022 %7 15.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Women who are pregnant and have obesity and excessive gestational weight gain (GWG) present a higher risk of maternal and perinatal complications. The use of mobile apps and a wristband during pregnancy may contribute to promoting healthy lifestyles and, thus, improving maternal and neonatal health. Objective: This study aims to evaluate the effectiveness of a complex digital health intervention, using a smartband and app with midwife counseling, on GWG and physical activity (PA) in women who are pregnant and have obesity and analyze its impact on maternal and perinatal outcomes. In addition, we aim to study the frequency of use, usability, and satisfaction with the mobile apps used by the women in the intervention group. Methods: A parallel, 2-arm, randomized controlled trial was conducted. A total of 150 women who were pregnant and had obesity were included. The intervention group received a complex combined digital intervention. The intervention was delivered with a smartband (Mi Band 2) linked to the app Mi Fit to measure PA and the Hangouts app with the midwife to provide personal health information. The control group received usual care. The validated Spanish versions of the International Physical Activity Questionnaire–Short Form and the System Usability Scale were used. Satisfaction was measured on a 1- to 5-point Likert scale. Results: We analyzed 120 women, of whom 30 (25%) were withdrawn because of the COVID-19 pandemic. The median GWG in the intervention group was 7.0 (IQR 4-11) kg versus 9.3 (IQR 5.9-13.3) kg in the control group (P=.04). The adjusted mean GWG per week was 0.5 (95% CI 0.4-0.6) kg per week in the control group and 0.3 (95% CI 0.3-0.4) kg per week in the intervention group (df=0.1, 95% CI −0.2 to 0.03; P=.008). During the 35 and 37 gestational weeks, women in the intervention group had higher mean PA than women in the control group (1980 metabolic equivalents of tasks–minutes per week vs 1386 metabolic equivalents of tasks–minutes per week, respectively; P=.01). No differences were observed between the study groups in the incidence of maternal and perinatal outcomes. In the intervention group, 61% (36/59) of the women who were pregnant used the smartband daily, and 75% (44/59) evaluated the usability of the Mi Fit app as excellent. All women in the intervention group used the Hangouts app at least once a week. The mean of the satisfaction scale with the health counseling app and midwife support was 4.8/5 (SD 0.6) points. Conclusions: The use of a complex mobile health intervention was associated with adequate GWG, which was lower in the intervention group than in the control group. In addition, we observed that the intervention group had increases in PA. No differences were observed in maternal perinatal complications. Trial Registration: ClinicalTrials.gov NCT03706872; https://www.clinicaltrials.gov/ct2/show/NCT03706872 %M 35166684 %R 10.2196/28886 %U https://mhealth.jmir.org/2022/2/e28886 %U https://doi.org/10.2196/28886 %U http://www.ncbi.nlm.nih.gov/pubmed/35166684 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e28703 %T The Efficacy of a Smartphone-Based App on Stress Reduction: Randomized Controlled Trial %A Hwang,Hyunchan %A Kim,Sun Mi %A Netterstrøm,Bo %A Han,Doug Hyun %+ Department of Psychiatry, College of Medicine, Chung-Ang University, 102 Heukseok-ro, Dongjak-gu, Seoul, 156-756, Republic of Korea, 82 2 6299 1508, hduk70@gmail.com %K stress reduction %K third-wave cognitive behavioral therapy %K individual tailored treatment %K randomized controlled trial %K digital therapeutics %D 2022 %7 15.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Stress management in the workplace is essential for a healthy mental and physical state. Due to technological advancements, individually tailored therapy and online cognitive behavioral therapy (CBT) are on the rise. Objective: This study analyzed the efficacy of a smartphone app based on third-wave CBT tailored to an individual. Methods: A randomized controlled trial was conducted with 126 participants who were divided into 2 groups. The intervention group used the smartphone app BetterLife for 10 weeks, while the control group was placed on a waiting list for the same duration. The Perceived Stress Scale–10 (PSS), Korean Utrecht Work Engagement Scale–9 (UWES), World Health Organization Quality of Life Assessment (WHOQOL), Beck Depression Inventory–II (BDI), and Beck Anxiety Inventory (BAI) were administered at baseline and after 10 weeks to both groups. Results: Of the 126 participants, 11 dropped out during the trial. A 2-way repeated measure analysis of covariance was conducted, controlling for baseline BDI. There were greater improvements in PSS (F=24.33, P<.001, η2=0.17) and UWESK scores (F=8.32, P=.0046, η2=0.06) in the intervention group than in the control group. WHOQOL scores exhibited statistically significant improvement in the intervention group in the overall quality of life (F=8.19, P=.0049, η2=0.06), physical health (F=8.87, P=.003, η2=0.07), psychological health (F=13.32, P<.001, η2=0.10), social relationships (F=19.43, P<.001, η2=0.14), and environmental domains (F=10.14, P=.002, η2=0.08) but not overall health (F=1.68, P=.20). BDI (F=7.17, P=.008, η2=0.06) and BAI (F=6.00, P=.02, η2=0.05) showed a statistically significant improvement in the intervention group, but this significance did not survive the Bonferroni correction (P<.005). Conclusions: These results provide evidence that smartphone-based CBT is a viable option for reducing stress in the workplace. Trial Registration: Clinical Research Information Service KCT0003231; https://cris.nih.go.kr/cris/search/detailSearch.do/15137 %M 35166687 %R 10.2196/28703 %U https://www.jmir.org/2022/2/e28703 %U https://doi.org/10.2196/28703 %U http://www.ncbi.nlm.nih.gov/pubmed/35166687 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e32251 %T Effects on Adherence to a Mobile App–Based Self-management Digital Therapeutics Among Patients With Coronary Heart Disease: Pilot Randomized Controlled Trial %A Li,Yuxi %A Gong,Yanjun %A Zheng,Bo %A Fan,Fangfang %A Yi,Tieci %A Zheng,Yimei %A He,Pengkang %A Fang,Jin %A Jia,Jia %A Zhu,Qin %A Jiang,Jie %A Huo,Yong %+ Department of Cardiology, Peking University First Hospital, Xishiku No. 8, Xicheng District, Beijing, 100034, China, 86 83572283, huoyong@263.net.cn %K coronary heart disease %K secondary prevention %K self-management %K mobile app %K adherence %K digital therapeutics %K mobile phone %D 2022 %7 15.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The adherence to secondary prevention treatment in patients with coronary heart disease (CHD) is low. Digital therapeutics (DTx) refers to an emerging branch of medicine that delivers medical interventions directly to patients using evidence-based, clinically evaluated, technology-based software algorithms or apps to facilitate disease management, which may be an efficient tool to optimize adherence. Objective: This paper aims to investigate the effect of mobile app–based self-management DTx on long-term use of secondary prevention medications in patients with CHD in China. Methods: This pilot study was a parallel-designed, open-labeled, single-center, randomized controlled trial. Hospitalized patients with CHD admitted to Peking University First Hospital between April 2016 and June 2017 were randomized before discharge on a 1:1 ratio. The intervention group received regular follow-up combined with DTx, which is a self-management mobile app already installed on an Android 5 (Mi Pad 1, Xiaomi Corporation) tablet. Structured data from the hospital informatics system were integrated automatically, and medication, lifestyle intervention plan, follow-up protocol, and patient education materials were also provided according to the diagnosis. Participants could use DTx for self-management at home. The control group was under conventional hospital–based follow-up care. Patients were followed up for 1 year, and the primary end point was the percentage of all guideline-recommended medications at 12 months. The secondary end points included the percentage adhered to standard secondary prevention medications at 6 months, the control rate of lipid profile, and blood pressure at 6 months and 1 year. Results: Among 300 randomized patients with CHD, 290 (96.7%) were included in the final analysis, including 49.3% (143/290) and 50.7% (147/290) of patients from the intervention and control groups, respectively. Baseline characteristics were similar between the 2 groups. There was a statistically significant improvement in the percentage of all guideline-recommended medications at 12 months in the intervention group compared with the control group (relative risk [RR] 1.34, 95% CI 1.12-1.61; P=.001), and there was no interaction with baseline characteristics. The intervention group had a significantly higher proportion of patients achieving blood pressure under control (systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg) and low-density lipoprotein cholesterol <1.8 mmol/L (RR 1.45, 95% CI 1.22-1.72; P<.001 and RR 1.40, 95% CI 1.11-1.75; P=.004, respectively) at 12 months. Furthermore, on logistic regression, the intervention group had a lower risk of withdrawing from guideline-recommended medications (odds ratio 0.46, 95% CI 0.27-0.78; P=.004). Conclusions: Among patients with CHD, using a mobile app–based self-management DTx in addition to traditional care resulted in a significant improvement in guideline-recommended medication adherence at 12 months. The results of the trial will be applicable to primary care centers, especially in rural areas with less medical resources. Trial Registration: ClinicalTrials.gov NCT03565978; https://clinicaltrials.gov/ct2/show/NCT03565978 %M 34906924 %R 10.2196/32251 %U https://mhealth.jmir.org/2022/2/e32251 %U https://doi.org/10.2196/32251 %U http://www.ncbi.nlm.nih.gov/pubmed/34906924 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e30675 %T Digital Health Interventions for Weight Management in Children and Adolescents: Systematic Review and Meta-analysis %A Kouvari,Matina %A Karipidou,Melina %A Tsiampalis,Thomas %A Mamalaki,Eirini %A Poulimeneas,Dimitrios %A Bathrellou,Eirini %A Panagiotakos,Demosthenes %A Yannakoulia,Mary %+ Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Eleftheriou Venizelou 70, Athens, 17671, Greece, 30 6944362633, myianna@hua.gr %K childhood obesity %K eHealth %K mHealth %K digital health %K youth %K mobile phone %D 2022 %7 14.2.2022 %9 Review %J J Med Internet Res %G English %X Background: Recent meta-analyses suggest the use of technology-based interventions as a treatment option for obesity in adulthood. Similar meta-analytic approaches for children are scarce. Objective: The aim of this meta-analysis is to examine the effect of technology-based interventions on overweight and obesity treatment in children and adolescents. Methods: A systematic literature search was performed using MEDLINE (PubMed), Scopus, and Cochrane Library for randomized clinical trials to identify interventional studies published between January 2000 and February 2021. Results: In total, 9 manuscripts from 8 clinical trials of 582 children or adolescents were considered eligible. BMI, BMI z-score, and other BMI-related baseline metrics during and after intervention were considered as primary outcomes. In 7 of 8 studies, a technology-based intervention was applied in addition to conventional care. Of the 8 studies, 6 studies were conducted in the United States, 1 in Australia, and 1 in northwestern Europe. In total, 5 studies included adolescents, whereas the rest addressed children aged 9 to 12 years. Intervention duration ranged from 3 to 24 months. Significant differences between groups in BMI metric changes were reported by 5 of the 8 studies. Pooled analysis revealed an overall significant decrease in BMI metrics in the intervention group (standardized mean difference –0.61, 95% CI –1.10 to –0.13; P=.01). Subgroup analysis revealed that significance was lost in case of no parental involvement (standardized mean difference –0.36, 95% CI –0.83 to 0.11; P=.14). The small number of clinical trials found, the varying study quality, and the study heterogeneity are some limitations of this review. Conclusions: The studies reported herein describe functional and acceptable technology-based approaches, in addition to conventional treatments, to enhance weight loss in young populations. %M 35156934 %R 10.2196/30675 %U https://www.jmir.org/2022/2/e30675 %U https://doi.org/10.2196/30675 %U http://www.ncbi.nlm.nih.gov/pubmed/35156934 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e26275 %T Use of Mobile Apps for Visual Acuity Assessment: Systematic Review and Meta-analysis %A Suo,Lingge %A Ke,Xianghan %A Zhang,Di %A Qin,Xuejiao %A Chen,Xuhao %A Hong,Ying %A Dai,Wanwei %A Wu,Defu %A Zhang,Chun %A Zhang,Dongsong %+ Department of Business Information Systems and Operations Management, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223-0001, United States, 1 704 687 1893, dzhang15@uncc.edu %K smartphone %K iPad %K eye screening %K visual acuity %K app %K meta-analysis %D 2022 %7 14.2.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Vision impairments (VIs) and blindness are major global public health issues. A visual acuity (VA) test is one of the most crucial standard psychophysical tests of visual function and has been widely used in a broad range of health care domains, especially in many clinical settings. In recent years, there has been increasing research on mobile app–based VA assessment designed to allow people to test their VA at any time and any location. Objective: The goal of the review was to assess the accuracy and reliability of using mobile VA measurement apps. Methods: We searched PubMed, Embase, Cochrane Library, and Google Scholar for relevant articles on mobile apps for VA assessment published between January 1, 2008, and July 1, 2020. Two researchers independently inspected and selected relevant studies. Eventually, we included 22 studies that assessed tablet or smartphone apps for VA measurement. We then analyzed sensitivity, specificity, and accuracy in the 6 papers we found through a meta-analysis. Results: Most of the 22 selected studies can be considered of high quality based on the Quality Assessment of Diagnostic Accuracy Studies–2. In a meta-analysis of 6 studies involving 24,284 participants, we categorized the studies based on the age groups of the study participants (ie, aged 3-5 years, aged 6-22 years, and aged 55 years and older), examiner (ie, professional and nonprofessional examiners), and the type of mobile devices (ie, smartphone, iPad). In the group aged 3 to 5 years, the pooled sensitivity for VA app tests versus clinical VA tests was 0.87 (95% CI 0.79-0.93; P=.39), and the pooled specificity was 0.78 (95% CI 0.70-0.85; P=.37). In the group aged 6 to 22 years, the pooled sensitivity for VA app tests versus clinical VA tests was 0.86 (95% CI 0.84-0.87; P<.001), and the pooled specificity for VA app tests versus clinical VA tests was 0.91 (95% CI 0.90-0.91; P=.27). In the group aged 55 years and older, the pooled sensitivity for VA app tests versus clinical VA tests was 0.85 (95% CI 0.55-0.98), and the pooled specificity for VA app tests versus clinical VA tests was 0.98 (95% CI 0.95-0.99). We found that the nonprofessional examiner group (AUC 0.93) had higher accuracy than the professional examiner group (AUC 0.87). In the iPad-based group, the pooled sensitivity for VA app tests versus clinical VA tests was 0.86, and the pooled specificity was 0.79. In the smartphone-based group, the pooled sensitivity for VA app tests versus clinical VA tests was 0.86 (P<.001), and the pooled specificity for VA app tests versus clinical VA tests was 0.91 (P<.001). Conclusions: In this study, we conducted a comprehensive review of the research on existing mobile apps for VA tests to investigate their diagnostic value and limitations. Evidence gained from this study suggests that mobile app–based VA tests can be useful for on-demand VI detection. %M 35156935 %R 10.2196/26275 %U https://mhealth.jmir.org/2022/2/e26275 %U https://doi.org/10.2196/26275 %U http://www.ncbi.nlm.nih.gov/pubmed/35156935 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e31724 %T In Search of State and Trait Emotion Markers in Mobile-Sensed Language: Field Study %A Carlier,Chiara %A Niemeijer,Koen %A Mestdagh,Merijn %A Bauwens,Michael %A Vanbrabant,Peter %A Geurts,Luc %A van Waterschoot,Toon %A Kuppens,Peter %+ Department of Psychology and Educational Sciences, Katholieke Universiteit Leuven, Tiensestraat 102, Leuven, 3000, Belgium, 32 16 37 44 85, chiara.carlier@student.kuleuven.be %K depression %K emotions %K mobile sensing %K language %K LIWC %K openSMILE %K speech %K writing %K mobile phone %D 2022 %7 11.2.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Emotions and mood are important for overall well-being. Therefore, the search for continuous, effortless emotion prediction methods is an important field of study. Mobile sensing provides a promising tool and can capture one of the most telling signs of emotion: language. Objective: The aim of this study is to examine the separate and combined predictive value of mobile-sensed language data sources for detecting both momentary emotional experience as well as global individual differences in emotional traits and depression. Methods: In a 2-week experience sampling method study, we collected self-reported emotion ratings and voice recordings 10 times a day, continuous keyboard activity, and trait depression severity. We correlated state and trait emotions and depression and language, distinguishing between speech content (spoken words), speech form (voice acoustics), writing content (written words), and writing form (typing dynamics). We also investigated how well these features predicted state and trait emotions using cross-validation to select features and a hold-out set for validation. Results: Overall, the reported emotions and mobile-sensed language demonstrated weak correlations. The most significant correlations were found between speech content and state emotions and between speech form and state emotions, ranging up to 0.25. Speech content provided the best predictions for state emotions. None of the trait emotion–language correlations remained significant after correction. Among the emotions studied, valence and happiness displayed the most significant correlations and the highest predictive performance. Conclusions: Although using mobile-sensed language as an emotion marker shows some promise, correlations and predictive R2 values are low. %M 35147507 %R 10.2196/31724 %U https://mental.jmir.org/2022/2/e31724 %U https://doi.org/10.2196/31724 %U http://www.ncbi.nlm.nih.gov/pubmed/35147507 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e28372 %T Willingness of French General Practitioners to Prescribe mHealth Apps and Devices: Quantitative Study %A Della Vecchia,Claire %A Leroy,Tanguy %A Bauquier,Charlotte %A Pannard,Myriam %A Sarradon-Eck,Aline %A Darmon,David %A Dufour,Jean-Charles %A Preau,Marie %+ Institut de Psychologie, Université Lyon 2, 5 Avenue Pierre Mendes France, Bron, 69676, France, 33 0672303682, dellavecchia.claire@gmail.com %K mHealth %K health applications %K connected health and wellness devices %K general practitioners %K patients %K prescription %K quantitative study %K mobile phone %D 2022 %7 11.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The field of mobile health (mHealth) is constantly expanding. Integrating mHealth apps and devices in clinical practice is a major and complex challenge. General practitioners (GPs) are an essential link in a patient’s care pathway. As they are patients’ preferred health care intermediaries, GPs play an important role in supporting patients’ transition to mHealth. Objective: This study aims to identify the factors associated with the willingness of French GPs to prescribe mHealth apps and devices to their patients. Methods: This study was part of the ApiAppS project whose overall objective was to help remove barriers GPs face when prescribing mHealth apps and devices by developing a custom-built platform to aid them. The study included GPs recruited from the general practice department of several medical faculties in France (Lyon, Nice, and Rouen) and mailing lists of academic GPs, health care professional associations, and social and professional networks. Participants were asked to complete a web-based questionnaire that collected data on various sociodemographic variables, indicators of their involvement in continued education programs and the amount of time they dedicated to promoting healthy behaviors during patient consultations, and indicators characterizing their patient population. Data on their perceptions of mHealth apps and devices were also collected. Finally, the questionnaire included items to measure GPs’ acceptability of prescribing mHealth apps and devices for several health-related dimensions. Results: Of the 174 GPs, 129 (74.1%) declared their willingness to prescribe mHealth apps and devices to their patients. In multivariate analysis, involvement in continued education programs (odds ratio [OR] 6.17, 95% CI 1.52-28.72), a better patient base command of the French language (OR 1.45, 95% CI 1.13-1.88), GP-perceived benefits of mHealth apps and devices for both patients and their medical practice and GP-perceived drivers for mHealth apps and device implementation in their medical practice (OR 1.04, 95% CI 1.01-1.07), and validation of mHealth apps and devices through randomized clinical trials (OR 1.02, 95% CI 1.00-1.04) were all associated with GPs’ willingness to prescribe mHealth apps and devices. In contrast, older GPs (OR 0.95, 95% CI 0.91-0.98), female GPs (OR 0.26, 95% CI 0.09-0.69), and those who perceived risks for the patient or their medical practice (OR 0.96, 95% CI 0.94-0.99) were less inclined to prescribe mHealth apps and devices. Conclusions: mHealth apps and devices were generally seen by GPs as useful in general medicine and were, for the most part, favorable to prescribing them. Their full integration in general medicine will be conditioned by the need for conclusive certification, transparency (reliable and precise data concerning mHealth app and device methods of construction and clinical validation), software aids to assist GPs prescribe them, and dedicated training programs. %M 35147508 %R 10.2196/28372 %U https://mhealth.jmir.org/2022/2/e28372 %U https://doi.org/10.2196/28372 %U http://www.ncbi.nlm.nih.gov/pubmed/35147508 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e35165 %T Navigating the Online World of Lifestyle Health Information: Qualitative Study With Adolescents %A Raeside,Rebecca %A Jia,Si Si %A Redfern,Julie %A Partridge,Stephanie R %+ Engagement and Co-Design Research Hub, Faculty of Medicine and Health, University of Sydney, Level 6, Block K, Westmead Hospital, Westmead, 2145, Australia, 61 412961432, rebecca.raeside@sydney.edu.au %K adolescents %K chronic disease prevention %K websites %K social media %K smartphone applications %D 2022 %7 11.2.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Adolescence is a critical life stage characterized by an interplay of biological, social, and environmental factors. Such factors influence lifestyle health-related trajectories, including dietary behaviors, physical activity levels, body weight, and sleep. Generation Z (born 1995-2015) is the most internet-dependent and technologically savvy generation in history with increasing rates of smartphone ownership across high- and low-income countries. Gaps exist in understanding what online platforms adolescents are using and barriers and facilitators of these platforms to seek lifestyle health information. Objective: We evaluated adolescents’ perceptions on the use of contemporary digital platforms (websites, social media platforms, smartphone apps) to seek lifestyle heath information or advice. Methods: Virtual focus groups were held via Zoom teleconference between July 2021 and August 2021. Eligible participants were 13 years to 18 years old, were living in Australia, and had searched for online lifestyle health information in the previous 3 months. For this study, lifestyle health information referred to key behaviors and risk factors for chronic disease, namely, diet, physical activity, weight management, and sleep. Participants were recruited through an existing database of research participants and networks of the research team. Focus groups were analyzed using the framework approach, in which data are systematically searched to recognize patterns in the data and manage, analyze, and identify themes. Focus group audio files were transcribed verbatim and independently coded by 2 researchers (RR, SSJ). Through an iterative, reflexive process, a final coding matrix was agreed on by all researchers and used to thematically analyze the data. Results: We held 5 focus groups (n=32; mean age: 16.3 [SD 1.4] years; 18/32, 56% female; 13/32, 41% spoke language other than English at home). Thematic analysis revealed participants searched for information both actively (eg, on Google or YouTube) and passively (eg, scrolling social media and using existing apps preloaded to their smartphone such as Apple Health, Samsung Health, or Google Fit apps). Participants identified that the most helpful information was well-presented in terms of aesthetic appeal and layout and came from a credible and reliable source (eg, any sponsorships disclosed), and they expressed the need for the information to be relatable. Mixed views were reported for the application of lifestyle health information found online. Some participants reported behavior change, while others noted that certain advice was hard to maintain and incorporate into their lifestyle. Conclusions: This study highlights the abundance and complexity of lifestyle health information online for adolescents. Adolescents in the digital age seek access to information that is appealing, credible, relevant, and actionable for lifestyle health behaviors. To appeal to needs of adolescents, future interventions for adolescents relating to lifestyle health must consider co-design methodological approaches. Furthermore, the regulation of lifestyle health information available online warrants further investigation. %M 35147506 %R 10.2196/35165 %U https://pediatrics.jmir.org/2022/1/e35165 %U https://doi.org/10.2196/35165 %U http://www.ncbi.nlm.nih.gov/pubmed/35147506 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e30272 %T Effects of a Mindfulness App on Employee Stress in an Australian Public Sector Workforce: Randomized Controlled Trial %A Bartlett,Larissa %A Martin,Angela J %A Kilpatrick,Michelle %A Otahal,Petr %A Sanderson,Kristy %A Neil,Amanda L %+ Wicking Dementia Research and Education Centre, University of Tasmania, 19 Liverpool Street, Hobart, 7000, Australia, 61 409791606, larissa.bartlett@utas.edu.au %K mindfulness %K stress %K apps %K smartphone app %K employee %K workplace %K performance %K mobile phone %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Workplace-based mindfulness programs have good evidence for improving employee stress and mental health outcomes, but less is known about their effects on productivity and citizenship behaviors. Most of the available evidence is derived from studies of mindfulness programs that use class-based approaches. Mindfulness apps can increase access to training, but whether self-directed app use is sufficient to realize benefits equivalent to class-based mindfulness programs is unknown. Objective: We assessed the effectiveness of a mindfulness app, both with and without supporting classes, for reducing employees’ perceived stress. Changes in mindfulness, mental health, quality of life, perceptions of job demand, control and support, productivity indicators, organizational citizenship, and mindful behaviors at work were also investigated. Methods: Tasmanian State Service employees were invited by the Tasmanian Training Consortium to a 3-arm randomized controlled trial investigating the effects of a mindfulness app on stress. The app used in the Smiling Mind Workplace Program formed the basis of the intervention. The app includes lessons, activities, and guided meditations, and is supported by 4 instructional emails delivered over 8 weeks. Engagement with the app for 10-20 minutes, 5 days a week, was recommended. Reported data were collected at baseline (time point 0), 3 months from baseline (time point 1 [T1]), and at 6-month follow-up (time point 2). At time point 0, participants could nominate a work-based observer to answer surveys about participants’ behaviors. Eligible participants (n=211) were randomly assigned to self-guided app use plus four 1-hour classes (app+classes: 70/211, 33.2%), self-guided app use (app-only: 71/211, 33.6%), or waitlist control (WLC; 70/211, 33.2%). Linear mixed effects models were used to assess changes in the active groups compared with the WLC at T1 and for a head-to-head comparison of the app+classes and app-only groups at follow-up. Results: App use time was considerably lower than recommended (app+classes: 120/343 minutes; app-only: 45/343 minutes). Compared with the WLC at T1, no significant change in perceived stress was observed in either active group. However, the app+classes group reported lower psychological distress (β=−1.77, SE 0.75; P=.02; Cohen d=–0.21) and higher mindfulness (β=.31, SE 0.12; P=.01; Cohen d=0.19). These effects were retained in the app+classes group at 6 months. No significant changes were observed for the app-only group or for other outcomes. There were no significant changes in observer measures at T1, but by time point 2, the app+classes participants were more noticeably mindful and altruistic at work than app-only participants. Conclusions: Including classes in the training protocol appears to have motivated engagement and led to benefits, whereas self-guided app use did not realize any significant results. Effect sizes were smaller and less consistent than meta-estimates for class-based mindfulness training. Trial Registration: Australian New Zealand Clinical Trials Register ACTRN12617001386325; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372942&isReview %M 35142630 %R 10.2196/30272 %U https://mhealth.jmir.org/2022/2/e30272 %U https://doi.org/10.2196/30272 %U http://www.ncbi.nlm.nih.gov/pubmed/35142630 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e34645 %T Risk Factors for COVID-19 in College Students Identified by Physical, Mental, and Social Health Reported During the Fall 2020 Semester: Observational Study Using the Roadmap App and Fitbit Wearable Sensors %A Gilley,Kristen N %A Baroudi,Loubna %A Yu,Miao %A Gainsburg,Izzy %A Reddy,Niyanth %A Bradley,Christina %A Cislo,Christine %A Rozwadowski,Michelle Lois %A Clingan,Caroline Ashley %A DeMoss,Matthew Stephen %A Churay,Tracey %A Birditt,Kira %A Colabianchi,Natalie %A Chowdhury,Mosharaf %A Forger,Daniel %A Gagnier,Joel %A Zernicke,Ronald F %A Cunningham,Julia Lee %A Cain,Stephen M %A Tewari,Muneesh %A Choi,Sung Won %+ Department of Pediatrics, University of Michigan Medical School, 1200 E Hospital Dr, Medical Professional Building D4118, Ann Arbor, MI, 48109, United States, 1 734 615 2263, sungchoi@med.umich.edu %K mHealth %K mobile health %K college student %K mental health %K wearable devices %K wearable %K student %K risk factor %K risk %K COVID-19 %K physical health %K observational %K crisis %K self-report %K outcome %K physical activity %K wellbeing %K well-being %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic triggered a seismic shift in education to web-based learning. With nearly 20 million students enrolled in colleges across the United States, the long-simmering mental health crisis in college students was likely further exacerbated by the pandemic. Objective: This study leveraged mobile health (mHealth) technology and sought to (1) characterize self-reported outcomes of physical, mental, and social health by COVID-19 status; (2) assess physical activity through consumer-grade wearable sensors (Fitbit); and (3) identify risk factors associated with COVID-19 positivity in a population of college students prior to release of the vaccine. Methods: After completing a baseline assessment (ie, at Time 0 [T0]) of demographics, mental, and social health constructs through the Roadmap 2.0 app, participants were instructed to use the app freely, wear the Fitbit, and complete subsequent assessments at T1, T2, and T3, followed by a COVID-19 assessment of history and timing of COVID-19 testing and diagnosis (T4: ~14 days after T3). Continuous measures were described using mean (SD) values, while categorical measures were summarized as n (%) values. Formal comparisons were made on the basis of COVID-19 status. The multivariate model was determined by entering all statistically significant variables (P<.05) in univariable associations at once and then removing one variable at a time through backward selection until the optimal model was obtained. Results: During the fall 2020 semester, 1997 participants consented, enrolled, and met criteria for data analyses. There was a high prevalence of anxiety, as assessed by the State Trait Anxiety Index, with moderate and severe levels in 465 (24%) and 970 (49%) students, respectively. Approximately one-third of students reported having a mental health disorder (n=656, 33%). The average daily steps recorded in this student population was approximately 6500 (mean 6474, SD 3371). Neither reported mental health nor step count were significant based on COVID-19 status (P=.52). Our analyses revealed significant associations of COVID-19 positivity with the use of marijuana and alcohol (P=.02 and P=.046, respectively) and with lower belief in public health measures (P=.003). In addition, graduate students were less likely and those with ≥20 roommates were more likely to report a COVID-19 diagnosis (P=.009). Conclusions: Mental health problems were common in this student population. Several factors, including substance use, were associated with the risk of COVID-19. These data highlight important areas for further attention, such as prioritizing innovative strategies that address health and well-being, considering the potential long-term effects of COVID-19 on college students. Trial Registration: ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788 International Registered Report Identifier (IRRID): RR2-10.2196/29561 %M 34992051 %R 10.2196/34645 %U https://mental.jmir.org/2022/2/e34645 %U https://doi.org/10.2196/34645 %U http://www.ncbi.nlm.nih.gov/pubmed/34992051 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32772 %T Intensive Longitudinal Data Collection Using Microinteraction Ecological Momentary Assessment: Pilot and Preliminary Results %A Ponnada,Aditya %A Wang,Shirlene %A Chu,Daniel %A Do,Bridgette %A Dunton,Genevieve %A Intille,Stephen %+ Khoury College of Computer Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02130, United States, 1 6173061610, ponnada.a@northeastern.edu %K intensive longitudinal data %K ecological momentary assessment %K experience sampling %K microinteractions %K smartwatch %K health behavior research %K mobile phone %D 2022 %7 9.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Ecological momentary assessment (EMA) uses mobile technology to enable in situ self-report data collection on behaviors and states. In a typical EMA study, participants are prompted several times a day to answer sets of multiple-choice questions. Although the repeated nature of EMA reduces recall bias, it may induce participation burden. There is a need to explore complementary approaches to collecting in situ self-report data that are less burdensome yet provide comprehensive information on an individual’s behaviors and states. A new approach, microinteraction EMA (μEMA), restricts EMA items to single, cognitively simple questions answered on a smartwatch with single-tap assessments using a quick, glanceable microinteraction. However, the viability of using μEMA to capture behaviors and states in a large-scale longitudinal study has not yet been demonstrated. Objective: This paper describes the μEMA protocol currently used in the Temporal Influences on Movement & Exercise (TIME) Study conducted with young adults, the interface of the μEMA app used to gather self-report responses on a smartwatch, qualitative feedback from participants after a pilot study of the μEMA app, changes made to the main TIME Study μEMA protocol and app based on the pilot feedback, and preliminary μEMA results from a subset of active participants in the TIME Study. Methods: The TIME Study involves data collection on behaviors and states from 246 individuals; measurements include passive sensing from a smartwatch and smartphone and intensive smartphone-based hourly EMA, with 4-day EMA bursts every 2 weeks. Every day, participants also answer a nightly EMA survey. On non–EMA burst days, participants answer μEMA questions on the smartwatch, assessing momentary states such as physical activity, sedentary behavior, and affect. At the end of the study, participants describe their experience with EMA and μEMA in a semistructured interview. A pilot study was used to test and refine the μEMA protocol before the main study. Results: Changes made to the μEMA study protocol based on pilot feedback included adjusting the single-question selection method and smartwatch vibrotactile prompting. We also added sensor-triggered questions for physical activity and sedentary behavior. As of June 2021, a total of 81 participants had completed at least 6 months of data collection in the main study. For 662,397 μEMA questions delivered, the compliance rate was 67.6% (SD 24.4%) and the completion rate was 79% (SD 22.2%). Conclusions: The TIME Study provides opportunities to explore a novel approach for collecting temporally dense intensive longitudinal self-report data in a sustainable manner. Data suggest that μEMA may be valuable for understanding behaviors and states at the individual level, thus possibly supporting future longitudinal interventions that require within-day, temporally dense self-report data as people go about their lives. %M 35138253 %R 10.2196/32772 %U https://formative.jmir.org/2022/2/e32772 %U https://doi.org/10.2196/32772 %U http://www.ncbi.nlm.nih.gov/pubmed/35138253 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e28959 %T Mobile Phone Apps for Intimate Partner and Sexual Violence Prevention and Response: Systematic Search on App Stores %A Draughon Moret,Jessica %A Todd,Angela %A Rose,Lauren %A Pollitt,Erin %A Anderson,Jocelyn %+ Betty Irene Moore School of Nursing, University of California, Davis, 2570 48th Street, Suite 2600, Sacramento, CA, 95817, United States, 1 916 734 0511, jdmoret@ucdavis.edu %K rape %K intimate partner violence %K gender-based violence %K smartphone %K mobile phone app %D 2022 %7 8.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Since the 2008 advent of the smartphone, more than 180 billion copies of apps have been downloaded from Apple App Store, with more than 2.6 million apps available for Android and 2.2 million apps available for iOS. Many violence prevention and response apps have been developed as part of this app proliferation. Objective: This study aims to evaluate the prevalence and quality of freely available mobile phone apps targeting intimate partner violence (IPV) and sexual violence (SV) prevention and response. Methods: We conducted a systematic search of violence prevention and response mobile phone apps freely available in Apple App Store (iOS; March 2016) and Google Play Store (Android; July 2016). Search terms included violence prevention, sexual assault, domestic violence, intimate partner violence, sexual violence, forensic nursing, wife abuse, and rape. Apps were included for review if they were freely available, were available in English, and had a primary purpose of prevention of or response to SV or IPV regardless of app target end users. Results: Using the Mobile Application Rating Scale (MARS), we evaluated a total of 132 unique apps. The majority of included apps had a primary purpose of sharing information or resources. Included apps were of low-to-moderate quality, with the overall subjective quality mean for the reviewed apps being 2.65 (95% CI 2.58-2.72). Quality scores for each of the 5 MARS categories ranged from 2.80 (engagement) to 4.75 (functionality). An incidental but important finding of our review was the difficulty in searching for apps and the plethora of nonrelated apps that appear when searching for keywords such as “rape” and “domestic violence” that may be harmful to people seeking help. Conclusions: Although there are a variety of mobile apps available designed to provide information or other services related to SV and IPV, they range greatly in quality. They are also challenging to find, given the current infrastructure of app store searches, keyword prioritization, and highlighting based on user rating. It is important for providers to be aware of these resources and be knowledgeable about how to review and recommend mobile phone apps to patients, when appropriate. %M 35133285 %R 10.2196/28959 %U https://formative.jmir.org/2022/2/e28959 %U https://doi.org/10.2196/28959 %U http://www.ncbi.nlm.nih.gov/pubmed/35133285 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e33413 %T Persuasive Design Solutions for a Sustainable Workforce: Review of Persuasive Apps for Real-Time Capability Support for Rural Health Care Professionals %A Pit,Sabrina Winona %A Tan,Aaron J H %A Ramsden,Robyn %A Payne,Kristy %A Freihaut,Winona %A Hayes,Oliver %A Eames,Benjamin %A Edwards,Mike %A Colbran,Richard %+ New South Wales Rural Doctors Network, 1/53 Cleary St, Hamilton, 2303, Australia, 61 429455720, spit@nswrdn.com.au %K health %K wellness %K mobile apps %K persuasive strategies %K behavior change %K review %K health workforce %K capability %K career %K employment %K rural %K workforce planning %D 2022 %7 7.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a need to further investigate how persuasive design principles can change rural health professionals’ behaviors to look after their own health workforce capability. Several theories are used when developing apps to persuade people to change behavior, including the Persuasive System Design Model, consisting of primary task, dialogue, system credibility, and social support categories, and Cialdini’s principles of persuasion. These have not been analyzed yet in the field of health workforce capability. Objective: This study aims to determine the persuasive design techniques used in capability building–related apps and to provide recommendations for designing a health workforce app to increase their persuasiveness. Methods: A Python script was used to extract a total of 3060 apps from Google Play. Keywords centered around health workforce capability elements. App inclusion criteria were as follows: been updated since 2019, rated by users on average 4 and above, and more than 100,000 downloads. Next, 2 experts reviewed whether 32 persuasive strategies were used in the selected apps, and these were further analyzed by capability categories: competencies and skills, health and personal qualities, values and attitudes, and work organization. Results: In all, 53 mobile apps were systematically reviewed to identify the persuasive design techniques. The most common were surface credibility (n=48, 90.6%) and liking (n=48), followed by trustworthiness (n=43, 81.1%), reminders (n=38, 71.7%), and suggestion (n=30, 56.6%). The techniques in the social support domain were the least used across the different apps analyzed for health workforce capability, whereas those in the primary task support domain were used most frequently. The recommendations reflect learnings from our analysis. These findings provided insight into mobile app design principles relevant to apps used in improving health workforce capability. Conclusions: Our review showed that there are many persuasive design techniques that can assist in building health workforce capability. Additionally, several apps are available in the market that can assist in improving health workforce capability. There is, however, a specific lack of digital, real-time support to improve health workforce capability. Social support strategies through using social support persuasive design techniques will need to be integrated more prominently into a health workforce capability app. An app to measure and monitor health workforce capability scores can be used in conjunction with direct real-world person and real-time support to discuss and identify solutions to improve health workforce capability for rural and remote health professionals who are at high risk of burnout or leaving the rural health workforce. %M 35129447 %R 10.2196/33413 %U https://mhealth.jmir.org/2022/2/e33413 %U https://doi.org/10.2196/33413 %U http://www.ncbi.nlm.nih.gov/pubmed/35129447 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e33168 %T The Quality of Health Apps and Their Potential to Promote Behavior Change in Patients With a Chronic Condition or Multimorbidity: Systematic Search in App Store and Google Play %A Bricca,Alessio %A Pellegrini,Alessandro %A Zangger,Graziella %A Ahler,Jonas %A Jäger,Madalina %A Skou,Søren T %+ Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense, 5260, Denmark, 45 65509510, abricca@health.sdu.dk %K app %K self-management %K behavior change %K multimorbidity %K chronic conditions %K health apps %K mHealth %K mobile health %K mobile phone %D 2022 %7 4.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps offer an opportunity to improve the lifestyle of patients with chronic conditions or multimorbidity. However, for apps to be recommended in clinical practice, their quality and potential for promoting behavior change must be considered. Objective: We aimed to investigate the quality of health apps for patients with a chronic condition or multimorbidity (defined as 2 or more chronic conditions) and their potential for promoting behavior change. Methods: We followed the Cochrane Handbook guidelines to conduct and report this study. A systematic search of apps available in English or Danish on App Store (Apple Inc) and Google Play (Google LLC) for patients with 1 or more of the following common and disabling conditions was conducted: osteoarthritis, heart conditions (heart failure and ischemic heart disease), hypertension, type 2 diabetes mellitus, depression, and chronic obstructive pulmonary disease. For the search strategy, keywords related to these conditions were combined. One author screened the titles and content of the identified apps. Subsequently, 3 authors independently downloaded the apps onto a smartphone and assessed the quality of the apps and their potential for promoting behavior change by using the Mobile App Rating Scale (MARS; number of items: 23; score: range 0-5 [higher is better]) and the App Behavior Change Scale (ABACUS; number of items: 21; score: range 0-21 [higher is better]), respectively. We included the five highest-rated apps and the five most downloaded apps but only assessed free content for their quality and potential for promoting behavior change. Results: We screened 453 apps and ultimately included 60. Of the 60 apps, 35 (58%) were available in both App Store and Google Play. The overall average quality score of the apps was 3.48 (SD 0.28) on the MARS, and their overall average score for their potential to promote behavior change was 8.07 (SD 2.30) on the ABACUS. Apps for depression and apps for patients with multimorbidity tended to have higher overall MARS and ABACUS scores, respectively. The most common app features for supporting behavior change were the self-monitoring of physiological parameters (eg, blood pressure monitoring; apps: 38/60, 63%), weight and diet (apps: 25/60, 42%), or physical activity (apps: 22/60, 37%) and stress management (apps: 22/60, 37%). Only 8 out of the 60 apps (13%) were completely free. Conclusions: Apps for patients with a chronic condition or multimorbidity appear to be of acceptable quality but have low to moderate potential for promoting behavior change. Our results provide a useful overview for patients and clinicians who would like to use apps for managing chronic conditions and indicate the need to improve health apps in terms of their quality and potential for promoting behavior change. %M 35119367 %R 10.2196/33168 %U https://mhealth.jmir.org/2022/2/e33168 %U https://doi.org/10.2196/33168 %U http://www.ncbi.nlm.nih.gov/pubmed/35119367 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e31877 %T Using Smartphones to Reduce Research Burden in a Neurodegenerative Population and Assessing Participant Adherence: A Randomized Clinical Trial and Two Observational Studies %A Beukenhorst,Anna L %A Burke,Katherine M %A Scheier,Zoe %A Miller,Timothy M %A Paganoni,Sabrina %A Keegan,Mackenzie %A Collins,Ella %A Connaghan,Kathryn P %A Tay,Anna %A Chan,James %A Berry,James D %A Onnela,Jukka-Pekka %+ Department of Biostatistics, Harvard T.H. Chan School of Public Health, 4th Floor, 677 Huntington Avenue, Boston, MA, MA 02115, United States, 1 (617) 4951000, beuk@hsph.harvard.edu %K digital phenotyping %K mobile health %K trial %K smartphones %K attrition %K mobile phone %D 2022 %7 4.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone studies provide an opportunity to collect frequent data at a low burden on participants. Therefore, smartphones may enable data collection from people with progressive neurodegenerative diseases such as amyotrophic lateral sclerosis at high frequencies for a long duration. However, the progressive decline in patients’ cognitive and functional abilities could also hamper the feasibility of collecting patient-reported outcomes, audio recordings, and location data in the long term. Objective: The aim of this study is to investigate the completeness of survey data, audio recordings, and passively collected location data from 3 smartphone-based studies of people with amyotrophic lateral sclerosis. Methods: We analyzed data completeness in three studies: 2 observational cohort studies (study 1: N=22; duration=12 weeks and study 2: N=49; duration=52 weeks) and 1 clinical trial (study 3: N=49; duration=20 weeks). In these studies, participants were asked to complete weekly surveys; weekly audio recordings; and in the background, the app collected sensor data, including location data. For each of the three studies and each of the three data streams, we estimated time-to-discontinuation using the Kaplan–Meier method. We identified predictors of app discontinuation using Cox proportional hazards regression analysis. We quantified data completeness for both early dropouts and participants who remained engaged for longer. Results: Time-to-discontinuation was shortest in the year-long observational study and longest in the clinical trial. After 3 months in the study, most participants still completed surveys and audio recordings: 77% (17/22) in study 1, 59% (29/49) in study 2, and 96% (22/23) in study 3. After 3 months, passively collected location data were collected for 95% (21/22), 86% (42/49), and 100% (23/23) of the participants. The Cox regression did not provide evidence that demographic characteristics or disease severity at baseline were associated with attrition, although it was somewhat underpowered. The mean data completeness was the highest for passively collected location data. For most participants, data completeness declined over time; mean data completeness was typically lower in the month before participants dropped out. Moreover, data completeness was lower for people who dropped out in the first study month (very few data points) compared with participants who adhered long term (data completeness fluctuating around 75%). Conclusions: These three studies successfully collected smartphone data longitudinally from a neurodegenerative population. Despite patients’ progressive physical and cognitive decline, time-to-discontinuation was higher than in typical smartphone studies. Our study provides an important benchmark for participant engagement in a neurodegenerative population. To increase data completeness, collecting passive data (such as location data) and identifying participants who are likely to adhere during the initial phase of a study can be useful. Trial Registration: ClinicalTrials.gov NCT03168711; https://clinicaltrials.gov/ct2/show/NCT03168711 %M 35119373 %R 10.2196/31877 %U https://mhealth.jmir.org/2022/2/e31877 %U https://doi.org/10.2196/31877 %U http://www.ncbi.nlm.nih.gov/pubmed/35119373 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 2 %P e25890 %T Effectiveness of Mobile Phone and Web-Based Interventions for Diabetes and Obesity Among African American and Hispanic Adults in the United States: Systematic Review %A Enyioha,Chineme %A Hall,Matthew %A Voisin,Christiane %A Jonas,Daniel %+ Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC, 27514, United States, 1 9849744888, chineme_enyioha@med.unc.edu %K mHealth %K mobile health %K technology %K diabetes %K obesity %K African American %K Hispanic %D 2022 %7 4.2.2022 %9 Review %J JMIR Public Health Surveill %G English %X Background: Mobile health (mHealth) and web-based technological advances allow for new approaches to deliver behavioral interventions for chronic diseases such as obesity and diabetes. African American and Hispanic adults experience a disproportionate burden of major chronic diseases. Objective: This paper reviews the evidence for mHealth and web-based interventions for diabetes and obesity in African American and Hispanic adults. Methods: Literature searches of PubMed/Medline, The Cochrane Library, EMBASE, CINAHL Plus, Global Health, Scopus, and Library & Information Science Source were conducted for relevant English-language articles. Articles identified through searches were reviewed by 2 investigators and, if they met the inclusion criteria, were extracted and assessed for risk of bias. Findings were summarized in tabular and narrative format. The overall strength of the evidence was assessed as high, moderate, low, or insufficient on the basis of risk of bias, consistency of findings, directness, precision, and other limitations. Results: Searches yielded 2358 electronic publications, 196 reports were found to be eligible for inclusion, and 7 studies met the eligibility criteria. All 7 included studies were randomized control trials. Five studies evaluated the effectiveness of an mHealth intervention for weight loss, including one that evaluated the effectiveness for diabetes and two studies focused on diabetes. Of all the studies that focused on weight loss, 3 reported significant differences in weight loss in participants in the intervention group compared with those in the usual care group. Although all studies on diabetes control showed greater improvement in glycemic control for the intervention group compared to that in the control group, only one study showed a significant difference between the 2 groups. Conclusions: This analysis indicates that there are few published studies that assessed mHealth interventions among minority populations and focused on weight or diabetes. Although the overall strength of evidence was low for diabetes control, it was moderate for weight loss, and our findings suggest that mHealth and web-based interventions may provide a promising approach for interventions among African American and Hispanic adults who have obesity or diabetes. %M 35119368 %R 10.2196/25890 %U https://publichealth.jmir.org/2022/2/e25890 %U https://doi.org/10.2196/25890 %U http://www.ncbi.nlm.nih.gov/pubmed/35119368 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e32992 %T Assessing the Efficacy of an Individualized Psychological Flexibility Skills Training Intervention App for Medical Student Burnout and Well-being: Protocol for a Randomized Controlled Trial %A Ditton,Elizabeth %A Knott,Brendon %A Hodyl,Nicolette %A Horton,Graeme %A Walker,Frederick Rohan %A Nilsson,Michael %+ Centre for Rehab Innovations, University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 2 404 ext 20738, elizabeth.ditton@newcastle.edu.au %K burnout %K psychological %K burnout interventions %K psychological flexibility %K digital intervention %K individualized intervention %K acceptance and commitment therapy %K medical students %K well-being %K mobile phone %D 2022 %7 4.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Medical student burnout is a prevalent problem with adverse long-term outcomes. Incorporating psychological resource-building interventions into comprehensive burnout prevention approaches during medical training is an identified priority among educators. These interventions could reduce burnout risk by buffering students against nonmodifiable career stressors. However, there is a need for rigorous investigation into optimal intervention targets and methods. Psychological flexibility (PF) is an adaptive behavioral skill set that has demonstrated relationships with medical student burnout and well-being. More broadly, there is evidence that PF mediates burnout and well-being outcomes and may be a protective factor. Efficacy studies assessing the benefits of interventions targeting PF among medical students are needed. Research also supports the need to establish optimal methods for increasing intervention efficacy in the context of individual differences in burnout and PF by using individualized approaches. Objective: This study aims to assess whether an app-delivered PF intervention (Acceptance and Commitment Training) reduces burnout and improves well-being among medical students. We will examine whether changes in burnout and well-being are mediated by changes in PF. The potential benefits of an individualized version of the app versus those of a nonindividualized version will also be evaluated. Methods: In this 3-arm, parallel, randomized controlled study, a sample of medical students will be randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waiting list) by using a 1:1:1 allocation ratio. Participants in the individualized and nonindividualized intervention arms will have 5 weeks to access the app, which includes a PF concepts training session (stage 1) and access to short PF skill activities on demand (stage 2). Stage 2 will be either individualized to meet participants’ identified PF training needs at each log-in or nonindividualized. Results: Burnout, well-being, and PF will be assessed at baseline and after the intervention. Quantitative analyses will include descriptive and inferential statistics. We hypothesize that the Acceptance and Commitment Training intervention app will be effective in improving burnout and well-being and that changes in these outcomes will be mediated by changes in PF. We further hypothesize that participants in the individualized intervention group will demonstrate greater improvements in burnout and well-being outcomes than those in the nonindividualized group. Conclusions: The findings of this study could guide the development of burnout prevention and well-being initiatives for medical students. Identifying PF as a mediating process would provide support for the delivery of preventive intervention programs that train individuals to strengthen this psychological resource before burnout symptoms emerge. This would be an important step in addressing and potentially offsetting the significant costs of burnout among medical students and physicians. Demonstrating the superiority of an individualized version of the app over a nonindividualized version would have implications for enhancing intervention precision and efficacy by using scalable interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ANZCTR 12621000911897; https://www.anzctr.org.au/ACTRN12621000911897.aspx International Registered Report Identifier (IRRID): PRR1-10.2196/32992 %M 35119378 %R 10.2196/32992 %U https://www.researchprotocols.org/2022/2/e32992 %U https://doi.org/10.2196/32992 %U http://www.ncbi.nlm.nih.gov/pubmed/35119378 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e30295 %T Use of a Smartphone App Versus Motivational Interviewing to Increase Walking Distance and Weight Loss in Overweight/Obese Adults With Peripheral Artery Disease: Pilot Randomized Trial %A Collins,Tracie %A Geana,Mugur %A Overton,Kathryn %A Benton,Mary %A Lu,Liuqiang %A Khan,Faarina %A Rohleder,Mason %A Ahluwalia,Jasjit %A Resnicow,Ken %A Zhu,Yiliang %+ College of Population Health, University of New Mexico, MSC09 5070, 1 University of New Mexico, Albuquerque, NM, 87131-0001, United States, 1 505 272 4979, tccollins@salud.unm.edu %K mobile health %K smartphone app %K peripheral artery disease %K motivational interviewing %D 2022 %7 3.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Walking therapy improves functional outcomes in patients with peripheral artery disease (PAD). Less is known about the additive benefit of a dietary intervention. Objective: Our objectives were to develop a smartphone app and, as a pilot, explore its potential efficacy as compared to motivational interviewing (MI) to increase walking distance and promote weight loss in overweight/obese adults with PAD. Methods: We conducted a 3-month, 2-arm randomized pilot study at the University of Kansas. Inclusion criteria were BMI >27 kg/m2 and symptomatic PAD, defined by an ankle-brachial index <0.9. Patients were randomized into 2 groups: MI, delivered through in-person and telephone counseling, and app, a mobile smartphone app. Both interventions encouraged walking for exercise and healthy dietary habits (increasing fruits and vegetables and whole grains while reducing fat and sugary drinks). We assessed medical history at baseline. At baseline and 3 months, participants completed an assessment of 6-minute walking distance, weight, quality of life, exercise behaviors, and dietary habits. The primary outcome was 3-month change in walking distance. Secondary outcomes were changes in weight, quality of life, exercise behaviors, and dietary habits. We used a Wilcoxon rank-sum test to analyze the primary and secondary outcomes at 3 months within the MI and app groups and to compare the changes between the groups with adjustment for baseline. Results: We randomized 29 participants with a mean age of 66.03 (SD 8.12) years; 25 participants completed the trial. At baseline, mean walking distance among completers was 260.40 (SD 94.32) meters and 326.15 (SD 69.28) meters for MI and app participants, respectively. At 3 months, the mean walking distance was 298.67 (SD 101.20) meters and 331.19 (SD 58.63) meters for MI and app participants, respectively (group difference P=.03, adjusting for baseline). Increase in walking distance at 3 months was 40.5 meters (95% CI 6.77 to 61.34; P=.02) in MI group. At baseline, mean body weight was 253.10 (SD 59.45) lbs and 225.13 (SD 58.93) lbs for MI and app participants, respectively. At 3 months, mean body weight was 242.14 (SD 58.54) lbs and 223.44 (SD 59.54) lbs for MI and app, respectively (group difference P=.006, adjusting for baseline). Pre-post study decrease in weight was 10.1 lbs (95% CI –17.9 to –3.0) and 2.3 lbs (95% CI –3.4 to –0.7) in MI and app group, respectively. Comparing baseline to 3 months, there were no statistically significant differences in quality of life, exercise behaviors, or dietary habits. Conclusions: Our study demonstrates that MI can promote walking and weight loss in overweight/obese adults with PAD. The smartphone app showed a small weight loss but no statistically significant increase in walking distance. As this was a pilot study, future large-scale studies are needed to replicate the efficacy of MI to promote weight loss in overweight or obese adults with PAD. Trial Registration: ClinicalTrials.gov NCT03694652; https://clinicaltrials.gov/ct2/show/NCT03694652 %M 35113020 %R 10.2196/30295 %U https://formative.jmir.org/2022/2/e30295 %U https://doi.org/10.2196/30295 %U http://www.ncbi.nlm.nih.gov/pubmed/35113020 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e33189 %T Exploring and Characterizing Patient Multibehavior Engagement Trails and Patient Behavior Preference Patterns in Pathway-Based mHealth Hypertension Self-Management: Analysis of Use Data %A Wu,Dan %A Huyan,Xiaoyuan %A She,Yutong %A Hu,Junbin %A Duan,Huilong %A Deng,Ning %+ College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, 38 Zheda Rd, Zhouyiqing Bldg 512, Yuquan Campus, Hangzhou, 310000, China, 86 571 2295 2693, zju.dengning@gmail.com %K hypertension %K mobile health %K patient behavior %K engagement %K data analysis %D 2022 %7 3.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hypertension is a long-term medical condition. Mobile health (mHealth) services can help out-of-hospital patients to self-manage. However, not all management is effective, possibly because the behavior mechanism and behavior preferences of patients with various characteristics in hypertension management were unclear. Objective: The purpose of this study was to (1) explore patient multibehavior engagement trails in the pathway-based hypertension self-management, (2) discover patient behavior preference patterns, and (3) identify the characteristics of patients with different behavior preferences. Methods: This study included 863 hypertensive patients who generated 295,855 use records in the mHealth app from December 28, 2016, to July 2, 2020. Markov chain was used to infer the patient multibehavior engagement trails, which contained the type, quantity, time spent, sequence, and transition probability value (TP value) of patient behavior. K-means algorithm was used to group patients by the normalized behavior preference features: the number of behavioral states that a patient performed in each trail. The pages in the app represented the behavior states. Chi-square tests, Z-test, analyses of variance, and Bonferroni multiple comparisons were conducted to characterize the patient behavior preference patterns. Results: Markov chain analysis revealed 3 types of behavior transition (1-way transition, cycle transition, and self-transition) and 4 trails of patient multibehavior engagement. In perform task trail (PT-T), patients preferred to start self-management from the states of task blood pressure (BP), task drug, and task weight (TP value 0.29, 0.18, and 0.20, respectively), and spent more time on the task food state (35.87 s). Some patients entered the states of task BP and task drug (TP value 0.20, 0.25) from the reminder item state. In the result-oriented trail (RO-T), patients spent more energy on the ranking state (19.66 s) compared to the health report state (13.25 s). In the knowledge learning trail (KL-T), there was a high probability of cycle transition (TP value 0.47, 0.31) between the states of knowledge list and knowledge content. In the support acquisition trail (SA-T), there was a high probability of self-transition in the questionnaire (TP value 0.29) state. Cluster analysis discovered 3 patient behavior preference patterns: PT-T cluster, PT-T and KL-T cluster, and PT-T and SA-T cluster. There were statistically significant associations between the behavior preference pattern and gender, education level, and BP. Conclusions: This study identified the dynamic, longitudinal, and multidimensional characteristics of patient behavior. Patients preferred to focus on BP, medications, and weight conditions and paid attention to BP and medications using reminders. The diet management and questionnaires were complicated and difficult to implement and record. Competitive methods such as ranking were more likely to attract patients to pay attention to their own self-management states. Female patients with lower education level and poorly controlled BP were more likely to be highly involved in hypertension health education. %M 35113032 %R 10.2196/33189 %U https://mhealth.jmir.org/2022/2/e33189 %U https://doi.org/10.2196/33189 %U http://www.ncbi.nlm.nih.gov/pubmed/35113032 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e27794 %T The Effects of mHealth-Based Gamification Interventions on Participation in Physical Activity: Systematic Review %A Xu,Linqi %A Shi,Hongyu %A Shen,Meidi %A Ni,Yuanyuan %A Zhang,Xin %A Pang,Yue %A Yu,Tianzhuo %A Lian,Xiaoqian %A Yu,Tianyue %A Yang,Xige %A Li,Feng %+ School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130012, China, 86 1 779 008 9009, fli@jlu.edu.cn %K mobile health %K gamification %K physical activity %K systematic review %K mobile phone %D 2022 %7 3.2.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: It is well known that regular physical exercise has associated benefits; yet, participation remains suboptimal. Mobile health (mHealth) has become an indispensable medium to deliver behavior change interventions, and there is a growing interest in the gamification apps in mHealth to promote physical activity (PA) participation. Gamification could use game design elements (such as points, leaderboards, and progress bars), and it has the potential to increase motivation for PA and engagement. However, mHealth-based gamification interventions are still emerging, and little is known about the application status and efficacy of such interventions. Objective: This systematic review aims to investigate gamification apps in mHealth for improving PA levels and simultaneously summarize the impact of gamification interventions on PA participation. Methods: We searched PubMed, Scopus, Web of Science, Embase, CINAHL (EBSCO host), and IEEE Xplore from inception to December 20, 2020. Original empirical research exploring the effects of gamification interventions on PA participation was included. The papers described at least one outcome regarding exercise or PA participation, which could be subjective self-report or objective indicator measurement. Of note, we excluded studies about serious games or full-fledged games. Results: Of 2944 studies identified from the database search, 50 (1.69%) were included, and the information was synthesized. The review revealed that gamification of PA had been applied to various population groups and broadly distributed among young people but less distributed among older adults and patients with a disease. Most of the studies (30/50, 60%) combined gamification with wearable devices to improve PA behavior change, and 50% (25/50) of the studies used theories or principles for designing gamified PA interventions. The most frequently used game elements were goal-setting, followed by progress bars, rewards, points, and feedback. This review demonstrated that gamification interventions could increase PA participation; however, the results were mixed, and modest changes were attained, which could be attributed to the heterogeneity across studies. Conclusions: Overall, this study provides an overview of the existing empirical research in PA gamification interventions and provides evidence for the efficacy of gamification in enhancing PA participation. High-quality empirical studies are needed in the future to assess the efficacy of a combination of gamification and wearable activity devices to promote PA, and further exploration is needed to investigate the optimal implementation of these features of game elements and theories to enhance PA participation. %M 35113034 %R 10.2196/27794 %U https://mhealth.jmir.org/2022/2/e27794 %U https://doi.org/10.2196/27794 %U http://www.ncbi.nlm.nih.gov/pubmed/35113034 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e30811 %T Interactive Mobile Phone HIV Adherence Support for Men Who Have Sex With Men in the Philippines Connect for Life Study: Mixed Methods Approach to Intervention Development and Pilot Testing %A O'Connor,Cara %A Leyritana,Katerina %A Doyle,Aoife M %A Lewis,James J %A Gill,Randeep %A Salvaña,Edsel Maurice %+ Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 791336248, caraoc@gmail.com %K mHealth %K adherence %K HIV %K antiretroviral therapy %K intervention development %K mobile phone %D 2022 %7 3.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The HIV epidemic in the Philippines is one of the fastest growing epidemics globally, and infections among men who have sex with men are rising at an alarming rate. The World Health Organization recommends the use of mobile health (mHealth) technologies to engage patients in care and ensure high levels of adherence to antiretroviral therapy (ART). Existing mHealth interventions can be adapted and tailored to the context and population served. Objective: This study aims to create a locally tailored intervention using a mobile phone platform to support treatment adherence for HIV patients on ART in the Philippines. Methods: A mixed methods approach guided by the Behavior Change Wheel framework was used to adapt an existing mHealth adherence support platform for the local setting and target population. A literature review, retrospective clinical record review, and focus group discussions with patients were conducted to understand the drivers of ART adherence and tailor the intervention accordingly. The resulting intervention was pilot-tested for 8 weeks, followed by focus group discussions with patients who received the intervention to assess the acceptability of the design. Results: Key issues contributing to nonadherence included side effects, lack of behavioral skills for pill taking, social support, mental health, and substance use. Patients identified mHealth as an acceptable mode of intervention delivery and wanted mHealth services to be highly personalizable. The study team, clinicians, and software developers integrated these findings into the intervention, which included a menu of services as follows: pill reminders, health tips, adherence feedback, appointment reminders, and symptom reporting. During the pilot phase, technical issues in the interactive voice response system (IVRS) were identified and addressed. Patients who participated in the pilot phase expressed a preference for SMS text messaging over the IVRS. Patients responded positively to the appointment reminders and health tips, whereas patient feedback on daily and weekly pill reminders and adherence feedback was mixed. Conclusions: The mobile phone–based SMS text messaging and IVRS intervention was acceptable to men who have sex with men in Manila, the Philippines, and qualitative analysis suggested that the intervention helped promote ART adherence and appointment attendance. %M 35113030 %R 10.2196/30811 %U https://formative.jmir.org/2022/2/e30811 %U https://doi.org/10.2196/30811 %U http://www.ncbi.nlm.nih.gov/pubmed/35113030 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32982 %T A Digital Therapeutic Intervention Delivering Biofeedback for Panic Attacks (PanicMechanic): Feasibility and Usability Study %A McGinnis,Ellen %A O'Leary,Aisling %A Gurchiek,Reed %A Copeland,William E %A McGinnis,Ryan %+ M-Sense Research Group, University of Vermont, 33 Colchester Avenue, Burlington, VT, 05401, United States, 1 2025095783, ryan.mcginnis@uvm.edu %K mental health %K mHealth %K biofeedback %K panic attack %K digital medicine %K app %K mobile health %K application %K biofeedback %K mobile phone %D 2022 %7 3.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Panic attacks (PAs) are an impairing mental health problem that affects >11% of adults every year. PAs are episodic, and it is difficult to predict when or where they may occur; thus, they are challenging to study and treat. Objective: The aim of this study is to present PanicMechanic, a novel mobile health app that captures heart rate–based data and delivers biofeedback during PAs. Methods: In our first analysis, we leveraged this tool to capture profiles of real-world PAs in the largest sample to date (148 attacks from 50 users). In our second analysis, we present the results from a pilot study to assess the usefulness of PanicMechanic as a PA intervention (N=18). Results: The results demonstrate that heart rate fluctuates by about 15 beats per minute during a PA and takes approximately 30 seconds to return to baseline from peak, cycling approximately 4 times during each attack despite the consistently decreasing anxiety ratings. Thoughts about health were the most common trigger and potential lifestyle contributors include slightly worse stress, sleep, and eating habits and slightly less exercise and drug or alcohol consumption than typical. Conclusions: The pilot study revealed that PanicMechanic is largely feasible to use but would be made more so with modifications to the app and the integration of consumer wearables. Similarly, participants found PanicMechanic useful, with 94% (15/16) indicating that they would recommend PanicMechanic to others who have PAs. These results highlight the need for future development and a controlled trial to establish the effectiveness of this digital therapeutic for preventing PAs. %M 35113031 %R 10.2196/32982 %U https://formative.jmir.org/2022/2/e32982 %U https://doi.org/10.2196/32982 %U http://www.ncbi.nlm.nih.gov/pubmed/35113031 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e34574 %T Behavioral Efficacy of a Sexual Health Mobile App for Men Who Have Sex With Men: Randomized Controlled Trial of Mobile Messaging for Men %A Sullivan,Patrick Sean %A Stephenson,Rob %A Hirshfield,Sabina %A Mehta,Cyra Christina %A Zahn,Ryan %A Bauermeister,Jose A %A Horvath,Keith %A Chiasson,Mary Ann %A Gelaude,Deborah %A Mullin,Shelby %A Downing Jr,Martin J %A Olansky,Evelyn Jolene %A Wiatrek,Sarah %A Rogers,Erin Q %A Rosenberg,Eli %A Siegler,Aaron J %A Mansergh,Gordon %+ Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 404 210 6039, pssulli@emory.edu %K HIV prevention %K mHealth %K tool %K video %K randomized clinical trial %K app %K prevention %K HIV %K PrEP %K STI %K testing %K behavior %K efficacy %K men who have sex with men %K MSM %K sexuality %K gay %K bisexual %K United States %D 2022 %7 2.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Gay, bisexual, and other men who have sex with men (GBMSM) face the highest burden of HIV in the United States, and there is a paucity of efficacious mobile health (mHealth) HIV prevention and care interventions tailored specifically for GBMSM. We tested a mobile app combining prevention messages and access to core prevention services for GBMSM. Objective: This study aims to measure the efficacy of the Mobile Messaging for Men (M-cubed) app and related services to increase HIV prevention and care behaviors in diverse US GBMSM. Methods: We conducted a randomized open-label study with a waitlist control group among GBMSM in 3 groups (low-risk HIV-negative group, high-risk HIV-negative group, and living-with-HIV [LWH] group) recruited online and in venues in Atlanta, Detroit, and New York City. Participants were randomly assigned to receive access to the app immediately or at 9 months after randomization. The app provided prevention messages in 6 domains of sexual health and offered ordering of at-home HIV and sexually transmitted infection test kits, receiving preexposure prophylaxis (PrEP) evaluations and navigation, and service locators. Serostatus- and risk-specific prevention outcomes were evaluated at baseline, at the end of the intervention period, and at 3, 6, and 9 months after the intervention period. Results: In total, 1226 GBMSM were enrolled and randomized; of these 611 (49.84%) were assigned to the intervention group and 608 (99.51%) were analyzed, while 615 (50.16%) were assigned to the control group and 612 (99.51%) were analyzed. For high-risk GBMSM, allocation to the intervention arm was associated with higher odds of HIV testing during the intervention period (adjusted odds ratio [aOR] 2.02, 95% CI 1.11-3.66) and with higher odds of using PrEP in the 3 months after the intervention period (aOR 2.41, 95% CI 1.00-5.76, P<.05). No changes in HIV prevention or care were associated with allocation to the intervention arm for the low-risk HIV-negative and LWH groups. Conclusions: Access to the M-cubed app was associated with increased HIV testing and PrEP use among high-risk HIV-negative GBMSM in 3 US cities. The app could be made available through funded HIV prevention providers; additional efforts are needed to understand optimal strategies to implement the app outside of the research setting. Trial Registration: ClinicalTrials.gov NCT03666247; https://clinicaltrials.gov/ct2/show/NCT03666247 International Registered Report Identifier (IRRID): RR2-10.2196/16439 %M 35025755 %R 10.2196/34574 %U https://www.jmir.org/2022/2/e34574 %U https://doi.org/10.2196/34574 %U http://www.ncbi.nlm.nih.gov/pubmed/35025755 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e30416 %T Long-term Effectiveness of a Smartphone App Combined With a Smart Band on Weight Loss, Physical Activity, and Caloric Intake in a Population With Overweight and Obesity (Evident 3 Study): Randomized Controlled Trial %A Lugones-Sanchez,Cristina %A Recio-Rodriguez,Jose I %A Agudo-Conde,Cristina %A Repiso-Gento,Irene %A G Adalia,Esther %A Ramirez-Manent,José Ignacio %A Sanchez-Calavera,Maria Antonia %A Rodriguez-Sanchez,Emiliano %A Gomez-Marcos,Manuel A %A Garcia-Ortiz,Luis %A , %+ Primary Care Research Unit of Salamanca (APISAL), Institute of Biomedical Research of Salamanca, Health Service of Castilla y León, Avda Portugal 83, 2nd Fl., Salamanca, 37005, Spain, 34 923291100 ext 54750, crislugsa@gmail.com %K mobile app %K telemedicine %K eHealth %K weight control %K exercise %K obesity %K mobile phone %D 2022 %7 1.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Multicomponent mobile health approaches can improve lifestyle intervention results, although little is known about their long-term effectiveness. Objective: This study aims to evaluate the long-term effectiveness (12 months) of a multicomponent mobile health intervention—combining a smartphone app, an activity tracker wristband, and brief counseling, compared with a brief counseling group only—on weight loss and improving body composition, physical activity, and caloric intake in Spanish sedentary adults with overweight or obesity. Methods: We conducted a randomized controlled, multicenter clinical trial (Evident 3). A total of 650 participants were recruited from 5 primary care centers, with 318 participants in the intervention group (IG) and 332 in the control group (CG). All participants were briefly counseled about a healthy diet and physical activity at the baseline visit. For the 3-month intervention period, the IG received training to use the app to promote healthy lifestyles and the smart band (Mi Band 2, Xiaomi). All measurements were performed at baseline and at 3 and 12 months. Physical activity was measured using the International Physical Activity Questionnaire–Short Form. Nutritional habits were assessed using the Food Frequency Questionnaire and Adherence to Mediterranean diet questionnaire. Results: Of the 650 participants included, 563 (86.6%) completed the 3-month visit and 443 (68.2%) completed the 12-month visit. After 12 months, the IG showed net differences in weight (−0.26, 95% CI −1.21 to 0.70 kg; P=.02), BMI (−0.06, 95% CI −0.41 to 0.28 points; P=.01), waist-height ratio (−0.25, 95% CI −0.94 to 0.44; P=.03), body adiposity index (−0.33, 95% CI −0.77 to 0.11; P=.03), waist circumference (−0.48, 95% CI −1.62 to 0.66 cm, P=.04) and hip circumference (−0.69, 95% CI –1.62 to 0.25 cm; P=.03). Both groups lowered daily caloric intake and increased adherence to the Mediterranean diet, with no differences between the groups. The IG increased light physical activity time (32.6, 95% CI −30.3 to 95.04 min/week; P=.02) compared with the CG. Analyses by subgroup showed changes in body composition variables in women, people aged >50 years, and married people. Conclusions: The low-intensity intervention of the Evident 3 study showed, in the IG, benefits in weight loss, some body composition variables, and time spent in light physical activity compared with the CG at 3 months, but once the devices were collected, the downward trend was not maintained at the 12-month follow-up. No differences in nutritional outcomes were observed between the groups. Trial Registration: ClinicalTrials.gov NCT03175614; https://clinicaltrials.gov/ct2/show/NCT03175614 International Registered Report Identifier (IRRID): RR2-10.1097/MD.0000000000009633 %M 35103609 %R 10.2196/30416 %U https://www.jmir.org/2022/2/e30416 %U https://doi.org/10.2196/30416 %U http://www.ncbi.nlm.nih.gov/pubmed/35103609 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e33747 %T Daily Level Association of Physical Activity and Performance on Ecological Momentary Cognitive Tests in Free-living Environments: A Mobile Health Observational Study %A Zlatar,Zvinka Z %A Campbell,Laura M %A Tang,Bin %A Gabin,Spenser %A Heaton,Anne %A Higgins,Michael %A Swendsen,Joel %A Moore,David J %A Moore,Raeanne C %+ Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr, MC 0811, La Jolla, CA, 92093, United States, 1 858 822 7737, zzlatar@health.ucsd.edu %K smartphones %K neuropsychology %K ecological momentary assessment %K digital health %K exercise %K people living with HIV %K aging %K wearables %K mobile cognition %K mobile phone %D 2022 %7 31.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Research suggests that physical activity (PA) has both acute and chronic beneficial effects on cognitive function in laboratory settings and under supervised conditions. Mobile health technologies make it possible to reliably measure PA and cognition in free-living environments, thus increasing generalizability and reach. Research is needed to determine whether the benefits of PA on cognitive function extend from the laboratory to real-world contexts. Objective: This observational study aims to examine the association between daily fluctuations in PA and cognitive performance using mobile health technologies in free-living environments. Methods: A total of 90 adults (mean age 59, SD 6.3 years; 65/90, 72% men) with various comorbidities (eg, cardiovascular risk and HIV) and different levels of baseline cognition (ranging from cognitively normal to impaired) completed ecological momentary cognitive tests (EMCTs) on a smartphone twice daily while wearing an accelerometer to capture PA levels for 14 days. Linear mixed-effects models examined the daily associations of PA with executive function and verbal learning EMCTs. Moderation analyses investigated whether the relationship between daily PA and daily performance on EMCTs changed as a function of baseline cognition, cardiovascular risk, and functional status (independent vs dependent). Results: Days with greater PA were associated with better (faster) performance on an executive function EMCT after covariate adjustment (estimate −0.013; β=−.16; P=.04). Moderation analyses (estimate 0.048; β=.58; P=.001) indicated that days with greater PA were associated with better (faster) executive function performance in individuals who were functionally dependent (effect size −0.53; P<.001) and not in functionally independent adults (effect size −0.01; P=.91). Conclusions: EMCTs may be a sensitive tool for capturing daily-level PA-related fluctuations in cognitive performance in real-world contexts and could be a promising candidate for tracking cognitive performance in digital health interventions aimed at increasing PA. Further research is needed to determine individual characteristics that may moderate the association between daily PA and EMCT performance in free-living environments. %M 35099402 %R 10.2196/33747 %U https://mhealth.jmir.org/2022/1/e33747 %U https://doi.org/10.2196/33747 %U http://www.ncbi.nlm.nih.gov/pubmed/35099402 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e30583 %T Investigating When, Which, and Why Users Stop Using a Digital Health Intervention to Promote an Active Lifestyle: Secondary Analysis With A Focus on Health Action Process Approach–Based Psychological Determinants %A Schroé,Helene %A Crombez,Geert %A De Bourdeaudhuij,Ilse %A Van Dyck,Delfien %+ Department of Movement and Sports Sciences, Faculty of Medicine and Health, Ghent University, Watersportlaan 2, Ghent, 9000, Belgium, 32 9264 63 63, helene.schroe@ugent.be %K digital health %K psychosocial determinants %K health action process approach %K physical activity %K sedentary behavior %K attrition %K dropout %K mobile health %K healthy life style %K health behaviors %D 2022 %7 31.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital health interventions have gained momentum to change health behaviors such as physical activity (PA) and sedentary behavior (SB). Although these interventions show promising results in terms of behavior change, they still suffer from high attrition rates, resulting in a lower potential and accessibility. To reduce attrition rates in the future, there is a need to investigate the reasons why individuals stop using the interventions. Certain demographic variables have already been related to attrition; however, the role of psychological determinants of behavior change as predictors of attrition has not yet been fully explored. Objective: The aim of this study was to examine when, which, and why users stopped using a digital health intervention. In particular, we aimed to investigate whether psychological determinants of behavior change were predictors for attrition. Methods: The sample consisted of 473 healthy adults who participated in the intervention MyPlan 2.0 to promote PA or reduce SB. The intervention was developed using the health action process approach (HAPA) model, which describes psychological determinants that guide individuals in changing their behavior. If participants stopped with the intervention, a questionnaire with 8 question concerning attrition was sent by email. To analyze when users stopped using the intervention, descriptive statistics were used per part of the intervention (including pre- and posttest measurements and the 5 website sessions). To analyze which users stopped using the intervention, demographic variables, behavioral status, and HAPA-based psychological determinants at pretest measurement were investigated as potential predictors of attrition using logistic regression models. To analyze why users stopped using the intervention, descriptive statistics of scores to the attrition-related questionnaire were used. Results: The study demonstrated that 47.9% (227/473) of participants stopped using the intervention, and drop out occurred mainly in the beginning of the intervention. The results seem to indicate that gender and participant scores on the psychological determinants action planning, coping planning, and self-monitoring were predictors of first session, third session, or whole intervention completion. The most endorsed reasons to stop using the intervention were the time-consuming nature of questionnaires (55%), not having time (50%), dissatisfaction with the content of the intervention (41%), technical problems (39%), already meeting the guidelines for PA/SB (31%), and, to a lesser extent, the experience of medical/emotional problems (16%). Conclusions: This study provides some directions for future studies. To decrease attrition, it will be important to personalize interventions on different levels, questionnaires (either for research purposes or tailoring) should be kept to a minimum especially in the beginning of interventions by, for example, using objective monitoring devices, and technical aspects of digital health interventions should be thoroughly tested in advance. Trial Registration: ClinicalTrials.gov NCT03274271; https://clinicaltrials.gov/ct2/show/NCT03274271 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3456-7 %M 35099400 %R 10.2196/30583 %U https://mhealth.jmir.org/2022/1/e30583 %U https://doi.org/10.2196/30583 %U http://www.ncbi.nlm.nih.gov/pubmed/35099400 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e28095 %T The Association Between Home Stay and Symptom Severity in Major Depressive Disorder: Preliminary Findings From a Multicenter Observational Study Using Geolocation Data From Smartphones %A Laiou,Petroula %A Kaliukhovich,Dzmitry A %A Folarin,Amos A %A Ranjan,Yatharth %A Rashid,Zulqarnain %A Conde,Pauline %A Stewart,Callum %A Sun,Shaoxiong %A Zhang,Yuezhou %A Matcham,Faith %A Ivan,Alina %A Lavelle,Grace %A Siddi,Sara %A Lamers,Femke %A Penninx,Brenda WJH %A Haro,Josep Maria %A Annas,Peter %A Cummins,Nicholas %A Vairavan,Srinivasan %A Manyakov,Nikolay V %A Narayan,Vaibhav A %A Dobson,Richard JB %A Hotopf,Matthew %A , %+ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Memory Lane, London, SE5 8AF, United Kingdom, 44 20 7848 0002, petroula.laiou@kcl.ac.uk %K major depressive disorder %K PHQ-8 %K smartphone %K GPS %K home stay %K mobile phone %D 2022 %7 28.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Most smartphones and wearables are currently equipped with location sensing (using GPS and mobile network information), which enables continuous location tracking of their users. Several studies have reported that various mobility metrics, as well as home stay, that is, the amount of time an individual spends at home in a day, are associated with symptom severity in people with major depressive disorder (MDD). Owing to the use of small and homogeneous cohorts of participants, it is uncertain whether the findings reported in those studies generalize to a broader population of individuals with MDD symptoms. Objective: The objective of this study is to examine the relationship between the overall severity of depressive symptoms, as assessed by the 8-item Patient Health Questionnaire, and median daily home stay over the 2 weeks preceding the completion of a questionnaire in individuals with MDD. Methods: We used questionnaire and geolocation data of 164 participants with MDD collected in the observational Remote Assessment of Disease and Relapse–Major Depressive Disorder study. The participants were recruited from three study sites: King’s College London in the United Kingdom (109/164, 66.5%); Vrije Universiteit Medisch Centrum in Amsterdam, the Netherlands (17/164, 10.4%); and Centro de Investigación Biomédica en Red in Barcelona, Spain (38/164, 23.2%). We used a linear regression model and a resampling technique (n=100 draws) to investigate the relationship between home stay and the overall severity of MDD symptoms. Participant age at enrollment, gender, occupational status, and geolocation data quality metrics were included in the model as additional explanatory variables. The 95% 2-sided CIs were used to evaluate the significance of model variables. Results: Participant age and severity of MDD symptoms were found to be significantly related to home stay, with older (95% CI 0.161-0.325) and more severely affected individuals (95% CI 0.015-0.184) spending more time at home. The association between home stay and symptoms severity appeared to be stronger on weekdays (95% CI 0.023-0.178, median 0.098; home stay: 25th-75th percentiles 17.8-22.8, median 20.9 hours a day) than on weekends (95% CI −0.079 to 0.149, median 0.052; home stay: 25th-75th percentiles 19.7-23.5, median 22.3 hours a day). Furthermore, we found a significant modulation of home stay by occupational status, with employment reducing home stay (employed participants: 25th-75th percentiles 16.1-22.1, median 19.7 hours a day; unemployed participants: 25th-75th percentiles 20.4-23.5, median 22.6 hours a day). Conclusions: Our findings suggest that home stay is associated with symptom severity in MDD and demonstrate the importance of accounting for confounding factors in future studies. In addition, they illustrate that passive sensing of individuals with depression is feasible and could provide clinically relevant information to monitor the course of illness in patients with MDD. %M 35089148 %R 10.2196/28095 %U https://mhealth.jmir.org/2022/1/e28095 %U https://doi.org/10.2196/28095 %U http://www.ncbi.nlm.nih.gov/pubmed/35089148 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e31712 %T Social Equity in the Efficacy of Computer-Based and In-Person Brief Alcohol Interventions Among General Hospital Patients With At-Risk Alcohol Use: A Randomized Controlled Trial %A Freyer-Adam,Jennis %A Baumann,Sophie %A Bischof,Gallus %A Staudt,Andreas %A Goeze,Christian %A Gaertner,Beate %A John,Ulrich %+ Institute for Medical Psychology, University Medicine Greifswald, Walther-Rathenau-Str. 48, Greifswald, 17475, Germany, 49 3834865606, Jennis.Freyer-Adam@med.uni-greifswald.de %K brief alcohol intervention %K electronic %K eHealth %K digital %K motivational interviewing %K socioeconomic status %K equity %K social inequality %K transtheoretical model %K moderator %K mental health %K public health %K alcohol interventions %K digital intervention %K digital health intervention %K alcohol use %D 2022 %7 28.1.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Social equity in the efficacy of behavior change intervention is much needed. While the efficacy of brief alcohol interventions (BAIs), including digital interventions, is well established, particularly in health care, the social equity of interventions has been sparsely investigated. Objective: We aim to investigate whether the efficacy of computer-based versus in-person delivered BAIs is moderated by the participants’ socioeconomic status (ie, to identify whether general hospital patients with low-level education and unemployed patients may benefit more or less from one or the other way of delivery compared to patients with higher levels of education and those that are employed). Methods: Patients with nondependent at-risk alcohol use were identified through systematic offline screening conducted on 13 general hospital wards. Patients were approached face-to-face and asked to respond to an app for self-assessment provided by a mobile device. In total, 961 (81% of eligible participants) were randomized and received their allocated intervention: computer-generated and individually tailored feedback letters (CO), in-person counseling by research staff trained in motivational interviewing (PE), or assessment only (AO). CO and PE were delivered on the ward and 1 and 3 months later, were based on the transtheoretical model of intentional behavior change and required the assessment of intervention data prior to each intervention. In CO, the generation of computer-based feedback was created automatically. The assessment of data and sending out feedback letters were assisted by the research staff. Of the CO and PE participants, 89% (345/387) and 83% (292/354) received at least two doses of intervention, and 72% (280/387) and 54% (191/354) received all three doses of intervention, respectively. The outcome was change in grams of pure alcohol per day after 6, 12, 18, and 24 months, with the latter being the primary time-point of interest. Follow-up interviewers were blinded. Study group interactions with education and employment status were tested as predictors of change in alcohol use using latent growth modeling. Results: The efficacy of CO and PE did not differ by level of education (P=.98). Employment status did not moderate CO efficacy (Ps≥.66). Up to month 12 and compared to employed participants, unemployed participants reported significantly greater drinking reductions following PE versus AO (incidence rate ratio 0.44, 95% CI 0.21-0.94; P=.03) and following PE versus CO (incidence rate ratio 0.48, 95% CI 0.24–0.96; P=.04). After 24 months, these differences were statistically nonsignificant (Ps≥.31). Conclusions: Computer-based and in-person BAI worked equally well independent of the patient’s level of education. Although findings indicate that in the short-term, unemployed persons may benefit more from BAI when delivered in-person rather than computer-based, the findings suggest that both BAIs have the potential to work well among participants with low socioeconomic status. Trial Registration: ClinicalTrials.gov NCT01291693; https://clinicaltrials.gov/ct2/show/NCT01291693 %M 35089156 %R 10.2196/31712 %U https://mental.jmir.org/2022/1/e31712 %U https://doi.org/10.2196/31712 %U http://www.ncbi.nlm.nih.gov/pubmed/35089156 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e33596 %T A Novel, Scalable Social Media–Based Intervention (“Warna-Warni Waktu”) to Reduce Body Dissatisfaction Among Young Indonesian Women: Protocol for a Parallel Randomized Controlled Trial %A Garbett,Kirsty May %A Craddock,Nadia %A Haywood,Sharon %A Nasution,Kholisah %A White,Paul %A Saraswati,L Ayu %A Medise,Bernie Endyarni %A , %A , %A Diedrichs,Phillippa C %A Williamson,Heidi %+ Centre for Appearance Research, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom, 44 1173282911, Kirsty.garbett@uwe.ac.uk %K body image %K body dissatisfaction %K Indonesia %K adolescent %K mental health %K randomized controlled trial %K study protocol %K eHealth intervention %K Southeast Asia %K young adult %K teenager %K women %K social media %K intervention %K image %K protocol %K mood %K satisfaction %D 2022 %7 28.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite the prevalence of body dissatisfaction among young Indonesian women and its consequential negative impacts, there are currently no evidence-based, culturally appropriate interventions to tackle this issue. Therefore, there is a need to develop scalable, cost-effective, and accessible interventions to improve body image among this population. Objective: This paper describes the study protocol of a parallel randomized controlled trial to evaluate the effectiveness of Warna-Warni Waktu, a social media–based intervention that aims to reduce state and trait body dissatisfaction and improve mood among young Indonesian women aged 15-19 years. Methods: The trial will take place online. Approximately 1800 young women from 10 cities in Indonesia, evenly split across the ages of 15-19 years, will be recruited via a local research agency’s established research panel. Participants will be randomly allocated to the intervention condition or a waitlist control condition. The intervention consists of six 5-minute videos, with each video supplemented with up to five brief interactive activities. The videos (and associated activities) will be delivered at a rate of one per day across 6 days. All participants will complete three self-report assessments: at baseline (Day 1), 1 day following the intervention (Day 9), and 1 month following the intervention (Day 36). The primary outcome will be change in trait body dissatisfaction. Secondary outcomes include change in internalization of appearance ideals, trait mood, and skin shade satisfaction. Intervention effectiveness on these outcomes will be analyzed using linear mixed models by a statistician blinded to the randomized condition. Intervention participants will also complete state measures of body satisfaction and mood before and after watching each video to assess the immediate impact of each video. This secondary analysis of state measures will be conducted at the within-group level. Results: Recruitment began in October 2021, with baseline assessments underway shortly thereafter. The results of the study will be submitted for publication in 2022. Conclusions: This is the first study to evaluate an eHealth intervention aimed at reducing body dissatisfaction among young Indonesian women. If effective, the intervention will be disseminated to over half a million young women in Indonesia via Facebook, Instagram, and YouTube. Trial Registration: ClinicalTrials.gov NCT05023213; https://clinicaltrials.gov/ct2/show/NCT05023213 International Registered Report Identifier (IRRID): PRR1-10.2196/33596 %M 35089154 %R 10.2196/33596 %U https://www.researchprotocols.org/2022/1/e33596 %U https://doi.org/10.2196/33596 %U http://www.ncbi.nlm.nih.gov/pubmed/35089154 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e29621 %T Impact of Smartphone App–Based Psychological Interventions for Reducing Depressive Symptoms in People With Depression: Systematic Literature Review and Meta-analysis of Randomized Controlled Trials %A Serrano-Ripoll,Maria J %A Zamanillo-Campos,Rocío %A Fiol-DeRoque,Maria A %A Castro,Adoración %A Ricci-Cabello,Ignacio %+ Balearic Islands Health Services, Primary Care Research Unit of Mallorca, Escola Graduada, 3, Palma de Mallorca, 07002, Spain, 34 971175883, mjserranor@yahoo.es %K smartphone technology %K mental health interventions %K depression %K eHealth %K mHealth %K apps %K systematic review %K meta-analysis %K mobile phone %D 2022 %7 27.1.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Depression is a serious, disabling mental disorder that severely affects quality of life. Patients with depression often do not receive adequate treatment. App-based psychotherapy is considered to have great potential to treat depression owing to its reach and easy accessibility. Objective: We aim to analyze the impact of app-based psychological interventions for reducing depressive symptoms in people with depression. Methods: We conducted a systematic literature review and meta-analysis. We searched Medline, Embase, PsycINFO, Web of Science, and Cochrane Central Register of Controlled Trials from inception to December 23, 2020. We selected randomized controlled trials to examine the impact of app-based psychological interventions for reducing depressive symptoms in people with depression. Study selection, data extraction, and critical appraisal (using the Cochrane Risk of Bias tool for randomized studies and the ROBINS-I tool for nonrandomized studies) were conducted independently by 2 reviewers. Where possible, we pooled data using random effects meta-analyses to obtain estimates of the effect size of the intervention. We conducted post hoc meta-regression analyses to explore the factors associated with intervention success. Results: After screening 3468 unique references retrieved from bibliographic searches and assessing the eligibility of 79 full texts, we identified 12 trials (2859 participants) evaluating 14 different interventions. Of 14 trials, 7 (58%) were conducted in the United States; 3 (25%) trials, in Asia (Japan, South Korea, and China); 1 (8%) trial, in Australia; and 1 (8%) trial, in Germany. Of the 12 trials, 5 (42%) trials presented a low risk of bias. The mean duration of the interventions was 6.6 (SD 2.8) weeks. Two-thirds of the interventions were based on cognitive behavioral therapy alone or included it in combination with cognitive control therapy, positive psychology, brief behavioral activation, or mindfulness- and acceptance-based therapy. With no evidence of publication bias, a pooled analysis of 83% (10/12) of the trials and 86% (12/14) of the interventions showed that app-based interventions, compared with a control group receiving usual care or minimal intervention, produced a moderate reduction in depressive symptoms (standardized mean difference [SMD] −0.51, 95% CI −0.69 to −0.33; 2018/2859, 70.58% of the participants; I2=70%). Our meta-regression analyses indicated that there was a greater reduction in symptoms of depression (P=.04) in trials that included participants with moderate to severe depression (SMD −0.67, 95% CI −0.79 to −0.55), compared with trials with participants exhibiting mild to moderate depression (SMD −0.15, 95% CI −0.43 to −0.12). Conclusions: App-based interventions targeted at people with depression produce moderate reductions in the symptoms of depression. More methodologically robust trials are needed to confirm our findings, determine which intervention features are associated with greater improvements, and identify those populations most likely to benefit from this type of intervention. Trial Registration: PROSPERO CRD42019145689; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=145689 %M 35084346 %R 10.2196/29621 %U https://mhealth.jmir.org/2022/1/e29621 %U https://doi.org/10.2196/29621 %U http://www.ncbi.nlm.nih.gov/pubmed/35084346 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e15413 %T Understanding Current Needs and Future Expectations of Informal Caregivers for Technology to Support Health and Well-being: National Survey Study %A Egan,Kieren J %A Clark,Patricia %A Deen,Zahid %A Paputa Dutu,Carmen %A Wilson,Graham %A McCann,Lisa %A Lennon,Marilyn %A Maguire,Roma %+ Digital Health and Wellness Group, Department of Computing and Information Sciences, University of Strathclyde, 16 Richmond Street, Glasgow, G1 1XQ, United Kingdom, 44 141 548 3589, roma.maguire@strath.ac.uk %K caregiving %K technology %K health %K well-being %K digital health %K co-design %K mobile phone %D 2022 %7 27.1.2022 %9 Original Paper %J JMIR Aging %G English %X Background: There are approximately 6.5 million informal (unpaid) caregivers in the United Kingdom. Each caregiver plays a critical role in the society, supporting the health and well-being of those who are ill, disabled, or older and who need frequent support. Digital technologies are becoming a ubiquitous part of everyday life for many, but little is known about the real-world impact of technology for those in a caring role, including the abilities of technologies to address the mental and physical impacts of caregiving. Objective: This study aims to understand the current and future technology use of caregivers, including digital technologies used to care for themselves and the person they look after. Methods: We codeveloped a wide range of questions with caregivers and care professionals and delivered this survey both on the web and in paper format (eg, using social networks such as Twitter alongside in-person events). Questions were focused on providing care and looking after caregiver health and well-being. Analyses focused on both quantitative outcomes (frequency counts and Likert questions) and explored free text entries (thematic analysis). Results: From 356 respondents, we identified that caregivers were receptive to, and largely positive about current and future use of technology both for their own care and their caring role (eg, checking in from distance). There were notable concerns, including the risk that technology could replace human contact. We identified several key areas for future work, including communication with health and social care professionals, and the potential for technology to help caregivers with their own health. We also identified several stakeholders (eg, care workers, pharmacy staff, and general practitioners) who could act as suitable points for technology signposting and support. Conclusions: Caregivers are a transient, often difficult to reach population, and this work has collated a large body of knowledge across a diverse group of individuals. Many caregivers, like the rest of society, are realizing the benefits of using everyday technology to help deliver care. It is clear that there is already a high level of dependency on technologies, where future expectations will grow. However, many barriers to digital technology use remain, including a lack of ongoing technology support. Preventive measures linked to technology that can help look after a caregiver’s own health appear acceptable, particularly for communicative tools. This collated caregiver knowledge is a call for all stakeholders—academics, policy makers, and practitioners—to take note of these specific challenges, and to ensure that caregiver voices are both heard and fully integrated within the emerging digital health agenda. %M 35084339 %R 10.2196/15413 %U https://aging.jmir.org/2022/1/e15413 %U https://doi.org/10.2196/15413 %U http://www.ncbi.nlm.nih.gov/pubmed/35084339 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30360 %T Feasibility, Acceptability, and Design of a Mobile Ecological Momentary Assessment for High-Risk Men Who Have Sex With Men in Hanoi, Vietnam: Qualitative Study %A Trang,Kathy %A Le,Lam X %A Brown,Carolyn A %A To,Margaret Q %A Sullivan,Patrick S %A Jovanovic,Tanja %A Worthman,Carol M %A Giang,Le Minh %+ Global TIES for Children, New York University, 627 Broadway, New York City, NY, 10012, United States, 1 212 998 1212, kathytrang.kt@gmail.com %K men who have sex with men %K HIV %K mental disorder %K ecological momentary assessment %K mobile phone %K mHealth %K sexual minorities %K pilot projects %D 2022 %7 27.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Men who have sex with men (MSM) are at a disproportionate risk for HIV infection and common mental disorders worldwide. In the context of HIV, common mental disorders are important and are frequent drivers of suboptimal prevention and treatment outcomes. Mobile ecological momentary assessments (EMAs), or the repeated sampling of people’s behaviors and psychological states in their daily lives using mobile phones, can clarify the triggers and HIV-related sequelae of depressive-anxious symptoms and contribute toward the design of ecological momentary interventions (EMIs) that cater to the contextually varying needs of individuals to optimize prevention and treatment outcomes. Objective: This study aims to characterize the feasibility and acceptability of mobile EMA among high-risk MSM in Hanoi, Vietnam. It aims to evaluate the perceived relevance, usability, and concerns of this group with regard to the content and delivery of mobile EMA and the potential of leveraging such platforms in the future to deliver EMIs. Methods: Between January and April 2018, a total of 46 participants were recruited. The participants completed 6 to 8 mobile EMA surveys daily for 7 days. Surveys occurred once upon waking, 4 to 6 times throughout the day, and once before sleeping. All surveys queried participants’ perceived safety, social interactions, psychological state, and mental health symptoms. The morning survey further queried on sleep and medication use within the past 24 hours, whereas the night survey queried on sexual activity and substance use and allowed participants to share an audio recording of a stressful experience they had that day. At the end of the week, participants were interviewed about their experiences with using the app. Results: Participants completed an average of 21.7 (SD 12.7) prompts over the 7-day period. Excluding nonresponders, the average compliance rate was 61.8% (SD 26.6%). A thematic analysis of qualitative interviews suggested an overall positive reception of the app and 5 recurring themes, which were centered on the relevance of psychological and behavioral items to daily experiences (eg, mental health symptoms and audio recording), benefits of using the app (eg, increased self-understanding), worries and concerns (eg, privacy), usability (eg, confusion about the interface), and recommendations for future design (eg, integrating more open-ended questions). Conclusions: Mobile EMA is feasible and acceptable among young MSM in Vietnam; however, more research is needed to adapt EMA protocols to this context and enhance compliance. Most participants eagerly provided information about their mental health status and daily activities. As several participants looked toward the app for further mental health and psychosocial support, EMIs have the potential to reduce HIV and mental health comorbidity among MSM. %M 35084340 %R 10.2196/30360 %U https://formative.jmir.org/2022/1/e30360 %U https://doi.org/10.2196/30360 %U http://www.ncbi.nlm.nih.gov/pubmed/35084340 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e30566 %T The Effectiveness of Sequentially Delivered Web-Based Interventions on Promoting Physical Activity and Fruit-Vegetable Consumption Among Chinese College Students: Mixed Methods Study %A Duan,Yanping %A Liang,Wei %A Wang,Yanping %A Lippke,Sonia %A Lin,Zhihua %A Shang,Borui %A Baker,Julien Steven %+ Department of Sport, Physical Education and Health, Faculty of Social Sciences, Hong Kong Baptist University, 12/F Hong Kong Baptist University Shek Mun Campus, 8 On Muk Street, Shek Mun, Shatin, Hong Kong, HKG, China (Hong Kong), 852 34113038, duanyp@hkbu.edu.hk %K web-based intervention %K physical activity %K fruit-vegetable consumption %K college students %K health action process approach %K mixed methods %K quantitative research %K qualitative research %D 2022 %7 26.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based interventions for multiple health behavior change (MHBC) appear to be a promising approach to change unhealthy habits. Limited research has tested this assumption in promoting physical activity (PA) and fruit-vegetable consumption (FVC) among Chinese college students. Moreover, the timing of MHBC intervention delivery and the order of components need to be addressed. Objective: This study aims to examine the effectiveness of 2 sequentially delivered 8-week web-based interventions on physical activity, FVC, and health-related outcomes (BMI, depression, and quality of life) and the differences in the intervention effects between the 2 sequential delivery patterns. The study also aims to explore participants’ experiences of participating in the health program. Methods: We conducted a randomized controlled trial, in which 552 eligible college students (mean 19.99, SD 1.04 years, 322/552, 58.3% female) were randomly assigned to 1 of 3 groups: PA-first group (4 weeks of PA followed by 4 weeks of FVC intervention), FVC-first group (4 weeks of FVC followed by 4 weeks of PA intervention), and a control group (8 weeks of placebo treatment unrelated to PA and FVC). The treatment content of two intervention groups was designed based on the Health Action Process Approach (HAPA) framework. A total of four web-based assessments were conducted: at baseline (T1, n=565), after 4 weeks (T2, after the first behavior intervention, n=486), after 8 weeks (T3, after the second behavior intervention, n=420), and after 12 weeks (T4, 1-month postintervention follow-up, n=348). In addition, after the completion of the entire 8-week intervention, 18 participants (mean 19.56, SD 1.04 years, 10/18, 56% female) who completed the whole program were immediately invited to attend one-to-one and face-to-face semistructured interviews. The entire study was conducted during the fall semester of 2017. Results: The quantitative data supported superior effects on physical activity, FVC, and BMI in the 2 sequential intervention groups compared with the control group. There were no significant differences in physical activity, FVC, and health-related outcomes between the 2 intervention groups after 8 weeks. The FVC-first group contributed to more maintenance of FVC compared with the PA-first group after 12 weeks. Four major themes with several subthemes were identified in the qualitative thematic analysis: PA and FVC behavior, health-related outcomes, correlates of behavior change, and contamination detection. Conclusions: This study provides empirical evidence for the effectiveness of sequentially delivered, web-based MHBC interventions on PA and FVC among Chinese college students. The timing issue of MHBC intervention delivery was preliminarily addressed. Qualitative findings provide an in-depth understanding and supplement the quantitative findings. Overall, this study may contribute considerably to future web-based MHBC interventions. Trial Registration: ClinicalTrials.gov NCT03627949; https://clinicaltrials.gov/ct2/show/NCT03627949 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7438-1 %M 35080497 %R 10.2196/30566 %U https://www.jmir.org/2022/1/e30566 %U https://doi.org/10.2196/30566 %U http://www.ncbi.nlm.nih.gov/pubmed/35080497 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e26652 %T Usability, Acceptability, and Satisfaction of a Wearable Activity Tracker in Older Adults: Observational Study in a Real-Life Context in Northern Portugal %A Domingos,Célia %A Costa,Patrício %A Santos,Nadine Correia %A Pêgo,José Miguel %+ Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Largo do Paço, Braga, 4710-057, Portugal, 351 253 604 800, jmpego@med.uminho.pt %K user experience %K Technology Acceptance Model %K health monitoring %K fitness trackers %K aging %K seniors %D 2022 %7 26.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of activity trackers has significantly increased over the last few years. This technology has the potential to improve the levels of physical activity and health-related behaviors in older adults. However, despite the potential benefits, the rate of adoption remains low among older adults. Therefore, understanding how technology is perceived may potentially offer insight to promote its use. Objective: This study aimed to (1) assess acceptability, usability, and user satisfaction with the Xiaomi Mi Band 2 in Portuguese community-dwelling older adults in a real-world context; (2) explore the mediating effect of the usability on the relationship between user characteristics and satisfaction; and (3) examine the moderating effect of user characteristics on the relationship between usability and user satisfaction. Methods: Older adults used the Xiaomi Mi Band 2 over 15 days. The user experience was evaluated through the Technology Acceptance Model 3, System Usability Scale, and User Satisfaction Evaluation Questionnaire. An integrated framework for usability and user satisfaction was used to explore user experience. Statistical data analysis included descriptive data analysis, reliability analysis, confirmatory factor analysis, and mediation and moderation analyses. Results: A sample of 110 older adults with an average age of 68.41 years (SD 3.11) completed the user experience questionnaires. Mean user acceptance was very high—perceived ease of use: 6.45 (SD 0.78); perceptions of external control: 6.74 (SD 0.55); computer anxiety: 6.85 (SD 0.47); and behavioral intention: 6.60 (SD 0.97). The usability was excellent with an average score of 92.70 (SD 10.73), and user satisfaction was classified as a good experience 23.30 (SD 2.40). The mediation analysis confirmed the direct positive effect of usability on satisfaction (β=.530; P<.01) and the direct negative effect of depression on usability (β=–.369; P<.01). Lastly, the indirect effect of usability on user satisfaction was higher in individuals with lower Geriatric Depression Scale levels. Conclusions: Findings demonstrate that the Xiaomi Mi Band 2 is suitable for older adults. Furthermore, the results confirmed usability as a determinant of satisfaction with the technology and extended the existing knowledge about wearable activity trackers in older adults. %M 35080503 %R 10.2196/26652 %U https://www.jmir.org/2022/1/e26652 %U https://doi.org/10.2196/26652 %U http://www.ncbi.nlm.nih.gov/pubmed/35080503 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e29644 %T Mobile Phone App Use Among Pregnant Women in China and Associations Between App Use and Perinatal Outcomes: Retrospective Study %A Zhang,Puhong %A Chen,Huan %A Shang,Jie %A Ge,Jun %A Zhang,Huichen %A Xu,Mingjun %A Bian,Cui %A Zhao,Yang %A Chen,Minyuan %A Hirst,Jane Elizabeth %+ The George Institute for Global Health at Peking University Health Science Center, Room 011, Unit 2, Tayuan Diplomatic Office Building, No. 14 Liangmahe Nan Lu, Chaoyang District, Beijing, 100600, China, 86 13691270366, zpuhong@georgeinstitute.org.cn %K maternal and child health %K mHealth %K mobile apps %K retrospective study %K pregnancy outcomes %D 2022 %7 25.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Maternal and child health (MCH)–related mobile apps are becoming increasingly popular among pregnant women; however, few apps have demonstrated that they lead to improvements in pregnancy outcomes. Objective: This study aims to investigate the use of MCH apps among pregnant women in China and explore associations with pregnancy outcomes. Methods: A retrospective study was conducted at 6 MCH hospitals in northern China. Women who delivered a singleton baby at >28 weeks’ gestation at the study hospitals were sequentially recruited from postnatal wards from October 2017 to January 2018. Information was collected on the women’s self-reported MCH app use during their pregnancy, along with clinical outcomes. Women were categorized as nonusers of MCH apps and users (further divided into intermittent users and continuous users). The primary outcome was a composite adverse pregnancy outcome (CAPO) comprising preterm birth, birth weight <2500 g, birth defects, stillbirth, and neonatal asphyxia. The association between app use and CAPO was explored using multivariable logistic analysis. Results: The 1850 participants reported using 127 different MCH apps during pregnancy. App use frequency was reported as never, 24.7% (457/1850); intermittent, 47.4% (876/1850); and continuous, 27.9% (517/1850). Among app users, the most common reasons for app use were health education (1393/1393, 100%), self-monitoring (755/1393, 54.2%), and antenatal appointment reminders (602/1393, 43.2%). Nonusers were older, with fewer years of education, lower incomes, and higher parity (P<.01). No association was found between any app use and CAPO (6.8% in nonusers compared with 6.3% in any app users; odds ratio 0.77, 95% CI 0.48-1.25). Conclusions: Women in China access a large number of different MCH apps, with social disparities in access and frequency of use. Any app use was not found to be associated with improved pregnancy outcomes, highlighting the need for rigorous development and testing of apps before recommendation for use in clinical settings. %M 35076402 %R 10.2196/29644 %U https://formative.jmir.org/2022/1/e29644 %U https://doi.org/10.2196/29644 %U http://www.ncbi.nlm.nih.gov/pubmed/35076402 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33798 %T Active Use and Engagement in an mHealth Initiative Among Young Men With Obesity: Mixed Methods Study %A Gorny,Alexander Wilhelm %A Chee,Wei Chian Douglas %A Müller-Riemenschneider,Falk %+ Centre of Excellence for Soldier Performance, Singapore Armed Forces, Pasir Laba Camp, Blk 130 #03-09, Singapore, 637901, Singapore, 65 81337238, alexander_gorny@u.nus.edu %K mHealth %K physical activity %K health promoting financial incentives %K weight loss maintenance %K young men %D 2022 %7 25.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The effectiveness of mobile health (mHealth) approaches that employ wearable technology to promote physical activity have been the subject of concern due to the declining active use observed in trial settings. Objective: To better contextualize active use, this study aimed to identify the barriers and enablers to engagement in a tracker-based mHealth initiative among young men who had recently completed a 19-week residential weight loss program. Methods: A mixed methods study was conducted among 167 young men who had voluntarily enrolled in the national steps challenge (NSC), an mHealth physical activity promotion initiative, following a residential weight loss intervention. A subsample of 29 enrollees with a body mass index of 29.6 (SD 3.1) participated in semistructured interviews and additional follow-up assessments. Quantitative systems data on daily step count rates were used to describe active use. Qualitative data were coded and analyzed to elicit barriers and enablers to microlevel engagement in relation to the NSC, focusing on tracker and smartphone use. We further elicited barriers and enablers to macrolevel engagement by exploring attitudes and behaviors toward the NSC. Using triangulation, we examined how qualitative engagement in the NSC could account for quantitative findings on active use. Using integration of findings, we discussed how the mHealth intervention might have changed physical activity behavior. Results: Among the 167 original enrollees, active use declined from 72 (47%) in week 1 to 27 (17%) in week 21. Mean daily step counts peaked in week 1 at 10,576 steps per day and were variable throughout the NSC. Barriers to engagement had occurred in the form of technical issues leading to abandonment, device switching, and offline tracking. Passive attitudes toward step counting and disinterest in the rewards had also prevented deeper engagement. Enablers of engagement included self-monitoring and coaching features, while system targets and the implicit prospect of reward had fostered new physical activity behaviors. Conclusions: Our study showed that as the NSC is implemented in this population, more emphasis should be placed on technical support and personalized activity targets to promote lasting behavior change. %M 35076399 %R 10.2196/33798 %U https://formative.jmir.org/2022/1/e33798 %U https://doi.org/10.2196/33798 %U http://www.ncbi.nlm.nih.gov/pubmed/35076399 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e33631 %T Effectiveness of Internet-Based Cognitive Behavioral Therapy With Telephone Support for Noncardiac Chest Pain: Randomized Controlled Trial %A Thesen,Terje %A Himle,Joseph A %A Martinsen,Egil W %A Walseth,Liv T %A Thorup,Frode %A Gallefoss,Frode %A Jonsbu,Egil %+ Distriktspsykiatrisk senter Solvang, Sørlandet Hospital, Sørlandet sykehus Helse Foretak, Servicebox 416, Kristiansand, 4604, Norway, 47 38174800, terje.thesen@sshf.no %K noncardiac chest pain %K internet-based treatment %K internet-assisted treatment %K cognitive behavioral therapy %K psychosomatic medicine %K randomized controlled trial %K pain %K treatment %K internet-based cognitive behavioral therapy %K effectiveness %K support %K intervention %D 2022 %7 24.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Noncardiac chest pain has a high prevalence and is associated with reduced quality of life, anxiety, avoidance of physical activity, and high societal costs. There is a lack of an effective, low-cost, easy to distribute intervention to assist patients with noncardiac chest pain. Objective: In this study, we aimed to investigate the effectiveness of internet-based cognitive behavioral therapy with telephone support for noncardiac chest pain. Methods: We conducted a randomized controlled trial, with a 12-month follow-up period, to compare internet-based cognitive behavioral therapy to a control condition (treatment as usual). A total of 162 participants aged 18 to 70 years with a diagnosis of noncardiac chest pain were randomized to either internet-based cognitive behavioral therapy (n=81) or treatment as usual (n=81). The participants in the experimental condition received 6 weekly sessions of internet-based cognitive behavioral therapy. The sessions covered different topics related to coping with noncardiac chest pain (education about the heart, physical activity, interpretations/attention, physical reactions to stress, optional panic treatment, and maintaining change). Between sessions, the participants also engaged in individually tailored physical exercises with increasing intensity. In addition to internet-based cognitive behavioral therapy sessions, participants received a brief weekly call from a clinician to provide support, encourage adherence, and provide access to the next session. Participants in the treatment-as-usual group received standard care for their noncardiac chest pain without any restrictions. Primary outcomes were cardiac anxiety, measured with the Cardiac Anxiety Questionnaire, and fear of bodily sensations, measured with the Body Sensations Questionnaire. Secondary outcomes were depression, measured using the Patient Health Questionnaire; health-related quality of life, measured using the EuroQol visual analog scale; and level of physical activity, assessed with self-report question. Additionally, a subgroup analysis of participants with depressive symptoms at baseline (PHQ-9 score ≥5) was conducted. Assessments were conducted at baseline, posttreatment, and at 3- and 12-month follow-ups. Linear mixed models were used to evaluate treatment effects. Cohen d was used to calculate effect sizes. Results: In the main intention-to-treat analysis at the 12-month follow-up time point, participants in the internet-based cognitive behavioral therapy group had significant improvements in cardiac anxiety (–3.4 points, 95% CI –5.7 to –1.1; P=.004, d=0.38) and a nonsignificant improvement in fear of bodily sensations (–2.7 points, 95% CI –5.6 to 0.3; P=.07) compared with the treatment-as-usual group. Health-related quality of life at the 12-month follow-up improved with statistical and clinical significance in the internet-based cognitive behavioral therapy group (8.8 points, 95% CI 2.8 to 14.8; P=.004, d=0.48) compared with the treatment-as-usual group. Physical activity had significantly (P<.001) increased during the 6-week intervention period for the internet-based cognitive behavioral therapy group. Depression significantly improved posttreatment (P=.003) and at the 3-month follow-up (P=.03), but not at the 12-month follow-up (P=.35). Participants with depressive symptoms at baseline seemed to have increased effect of the intervention on cardiac anxiety (d=0.55) and health-related quality of life (d=0.71) at the 12-month follow-up. In the internet-based cognitive behavioral therapy group, 84% of the participants (68/81) completed at least 5 of the 6 sessions. Conclusions: This study provides evidence that internet-based cognitive behavioral therapy with minimal therapist contact and a focus on physical activity is effective in reducing cardiac anxiety and increasing health related quality of life in patients with noncardiac chest pain. Trial Registration: ClinicalTrials.gov NCT03096925; http://clinicaltrials.gov/ct2/show/NCT03096925 %M 35072641 %R 10.2196/33631 %U https://www.jmir.org/2022/1/e33631 %U https://doi.org/10.2196/33631 %U http://www.ncbi.nlm.nih.gov/pubmed/35072641 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e29718 %T Health-Related Quality of Life Among Pregnant Women With Pre-pregnancy Smoking and Smoking Cessation During Pregnancy in China: National Cross-sectional Study %A Hu,Kadi %A Zou,Shiqian %A Zhang,Casper JP %A Wu,Huailiang %A Akinwunmi,Babatunde %A Wang,Zilian %A Ming,Wai-Kit %+ Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, To Yuen Building, 31 To Yuen Street, Hong Kong, China, 852 34426956, wkming2@cityu.edu.hk %K health-related quality of life %K pregnant women %K smoking status %K pre-pregnancy smoking %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Previous studies have hardly explored the influence of pre-pregnancy smoking and smoking cessation during pregnancy on the health-related quality of life (HRQoL) of pregnant women, which is a topic that need to be addressed. In addition, pregnant women in China constitute a big population in the largest developing country of the world and cannot be neglected. Objective: This study aims to evaluate the HRQoL of pregnant women in China with different smoking statuses and further estimate the association between pre-pregnancy smoking, smoking cessation, and the HRQoL. Methods: A nationwide cross-sectional study was conducted to determine the association between different smoking statuses (smoking currently, quit smoking, never smoking) and the HRQoL in pregnant women across mainland China. A web-based questionnaire was delivered through the Banmi Online Maternity School platform, including questions about demographics, smoking status, and the HRQoL. EuroQoL Group’s 5-dimension 5-level (EQ-5D-5L) scale with EuroQoL Group’s visual analog scale (EQ-VAS) was used for measuring the HRQoL. Ethical approval was granted by the institutional review board of the First Affiliated Hospital of Sun Yat-sen University (ICE-2017-296). Results: From August to September 2019, a total of 16,483 participants from 31 provinces were included, of which 93 (0.56%) were smokers, 731 (4.43%) were ex-smokers, and 15,659 (95%) were nonsmokers. Nonsmokers had the highest EQ-VAS score (mean 84.49, SD 14.84), smokers had the lowest EQ-VAS score (mean 77.38, SD 21.99), and the EQ-VAS score for ex-smokers was in between (mean 81.04, SD 17.68). A significant difference in EQ-VAS scores was detected between nonsmokers and ex-smokers (P<.001), which indicated that pre-pregnancy smoking does have a negative impact on the HRQoL (EQ-VAS) of pregnant women. Compared with nonsmokers, ex-smokers suffered from more anxiety/depression problems (P=.001, odds ratio [OR] 1.29, 95% CI 1.12-1.50). Among ex-smokers, the increased cigarette consumption was associated with a lower EQ-5D index (P=.007) and EQ-VAS score (P=.01) of pregnant women. Compared to smokers, no significant difference was found in the ex-smokers’ EQ-5D index and EQ-VAS score (P=.33). Conclusions: Smoking history is associated with a lower HRQoL in pregnant Chinese women. Pre-pregnancy smoking is related to a lower HRQoL (EQ-VAS) and a higher incidence of depression/anxiety problems. Smoking cessation during pregnancy does not significantly improve the HRQoL of pregnant Chinese women. Among ex-smokers, the more cigarettes they smoke, the lower HRQoL they have during pregnancy. We suggest that the Chinese government should strengthen the education on quitting smoking and avoiding second-hand smoke for women who have pregnancy plans and their family members. %M 35072649 %R 10.2196/29718 %U https://publichealth.jmir.org/2022/1/e29718 %U https://doi.org/10.2196/29718 %U http://www.ncbi.nlm.nih.gov/pubmed/35072649 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e29008 %T Effectiveness, User Engagement and Experience, and Safety of a Mobile App (Lumi Nova) Delivering Exposure-Based Cognitive Behavioral Therapy Strategies to Manage Anxiety in Children via Immersive Gaming Technology: Preliminary Evaluation Study %A Lockwood,Joanna %A Williams,Laura %A Martin,Jennifer L %A Rathee,Manjul %A Hill,Claire %+ National Institute of Health Research MindTech MedTech Co-operative, School of Medicine, University of Nottingham, Institute of Mental Health, Jubilee Campus, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 115 8231294, joanna.lockwood@nottingham.ac.uk %K anxiety %K children %K exposure therapy %K cognitive behavioral therapy %K immersive gaming %K digital intervention %K app %K smartphone %K mobile phone %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Childhood anxiety disorders are a prevalent mental health problem that can be treated effectively with cognitive behavioral therapy, in which exposure is a key component; however, access to treatment is poor. Mobile-based apps on smartphones or tablets may facilitate the delivery of evidence-based therapy for child anxiety, thereby overcoming the access and engagement barriers of traditional treatment. Apps that deliver therapeutic content via immersive gaming technology could offer an effective, highly engaging, and flexible treatment proposition. Objective: In this paper, we aim to describe a preliminary multi-method evaluation of Lumi Nova, a mobile app intervention targeting mild to moderate anxiety problems in children aged 7-12 years using exposure therapy delivered via an immersive game. The primary objective is to evaluate the effectiveness, user engagement and experience, and safety of the beta version of Lumi Nova. Methods: Lumi Nova was co-designed with children, parents, teachers, clinicians, game industry experts, and academic partnerships. In total, 120 community-based children with mild to moderate anxiety and their guardians were enrolled to participate in an 8-week pilot study. The outcome measures captured the app’s effectiveness (anxiety symptoms, child-identified goal-based outcomes, and functional impairment), user engagement (game play data and ease-of-use ratings), and safety (mood ratings and adverse events). The outcome measures before and after the intervention were available for 30 children (age: mean 9.8, SD 1.7 years; girls: 18/30, 60%; White: 24/30, 80%). Additional game play data were automatically generated for 67 children (age: mean 9.6, SD 1.53 years; girls: 35/67, 52%; White: 42/67, 63%). Postintervention open-response data from 53% (16/30) of guardians relating to the primary objectives were also examined. Results: Playing Lumi Nova was effective in reducing anxiety symptom severity over the 8-week period of game play (t29=2.79; P=.009; Cohen d=0.35) and making progress toward treatment goals (z=2.43; P=.02), but there were no improvements in relation to functional impairment. Children found it easy to play the game and engaged safely with therapeutic content. However, the positive effects were small, and there were limitations to the game play data. Conclusions: This preliminary study provides initial evidence that an immersive mobile game app may safely benefit children experiencing mild to moderate anxiety. It also demonstrates the value of the rigorous evaluation of digital interventions during the development process to rapidly improve readiness for full market launch. %M 35072644 %R 10.2196/29008 %U https://mental.jmir.org/2022/1/e29008 %U https://doi.org/10.2196/29008 %U http://www.ncbi.nlm.nih.gov/pubmed/35072644 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e33944 %T Use of Mobile Apps for Self-care in People With Parkinson Disease: Systematic Review %A Lee,JuHee %A Yeom,Insun %A Chung,Misook L %A Kim,Yielin %A Yoo,Subin %A Kim,Eunyoung %+ Brain Korea 21 FOUR Project, College of Nursing, Yonsei University, College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, Republic of Korea, 82 10 2816 2884, key7481@daum.net %K systematic review %K Parkinson disease %K motor symptoms %K nonmotor symptoms %K smartphone %K mobile phone %K mobile health %K mobile apps %K self-care %K symptom %K monitoring %K review %K disability %K app %K care %K quality of life %K self-management %D 2022 %7 21.1.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Self-care is essential for people with Parkinson disease (PD) to minimize their disability and adapt to alterations in physical abilities due to this progressive neurodegenerative disorder. With rapid developments in mobile technology, many health-related mobile apps for PD have been developed and used. However, research on mobile app–based self-care in PD is insufficient. Objective: This study aimed to explore the features and characteristics of mobile apps for self-care in people with PD. Methods: This study was performed sequentially according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Web of Science, and PsycINFO were searched in consultation with a librarian on June 8, 2021. We used keywords including ”Parkinson disease” and ”mobile.” Results: A total of 17 studies were selected based on the inclusion criteria, including 3 randomized controlled trials and 14 observational studies or quasi-experimental studies. The use of mobile apps for self-care in people with PD focused on symptom monitoring, especially motor symptoms. Motor symptoms were objectively measured mainly through the sensors of smartphones or wearable devices and task performance. Nonmotor symptoms were monitored through task performance or self-reported questionnaires in mobile apps. Most existing studies have focused on clinical symptom assessment in people with PD, and there is a lack of studies focusing on symptom management. Conclusions: Mobile apps for people with PD have been developed and used, but strategies for self-management are insufficient. We recommend the development of mobile apps focused on self-care that can enhance symptom management and health promotion practices. Studies should also evaluate the effects of mobile apps on symptom improvement and quality of life in people with PD. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021267374; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021267374. %M 35060910 %R 10.2196/33944 %U https://mhealth.jmir.org/2022/1/e33944 %U https://doi.org/10.2196/33944 %U http://www.ncbi.nlm.nih.gov/pubmed/35060910 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e30682 %T Promoting Physical Activity and Weight Loss With mHealth Interventions Among Workers: Systematic Review and Meta-analysis of Randomized Controlled Trials %A Jung,Jiyeon %A Cho,Inhae %+ College of Nursing, Korea University, 145 Anam-ro Sungbuk-gu, Seoul, 02841, Republic of Korea, 82 2 3290 4912, inhae05@gmail.com %K mHealth %K physical activity %K obesity %K weight loss %K workforce %K workplace health promotion %K mobile phone %D 2022 %7 21.1.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Physical activity (PA) is a vital factor in promoting health in the workforce. Mobile health (mHealth) interventions have recently emerged in workplace health promotion as an effective strategy for inducing changes in health behaviors among workers; however, the effectiveness of mHealth interventions in promoting PA and weight loss for workers is unclear. Objective: This study aims to provide a comprehensive analysis of current evidence on the effectiveness of mHealth interventions in promoting PA and weight loss among workers. Methods: We searched relevant databases, including PubMed, Embase, CINAHL Complete, and the Cochrane Library, for publications on mHealth interventions in the English or Korean language from inception to December 2020. Randomized controlled trials that evaluated the effectiveness of mHealth in improving PA and weight loss were retrieved. A meta-analysis with a random effects model and subgroup analyses was performed on PA types and mHealth intervention characteristics. Results: A total of 8 studies were included in this analysis. More than half of the studies (5/8, 63%) were identified as having a high risk of bias. The mHealth intervention group showed a significant improvement in PA (standardized mean difference [SMD] 0.22, 95% CI 0.03-0.41; P<.001; I2=78%). No significant difference in weight loss was observed when comparing the intervention group with the control groups (SMD 0.02, 95% CI –0.07 to 0.10; P=.48; I2=0%). A subgroup analysis was also performed; walking activity (SMD 0.70, 95% CI 0.21-1.19; P<.001; I2=83.3%), a multicomponent program (SMD 0.19, 95% CI 0.05-0.33; P=.03; I2=57.4%), objective measurement (SMD 0.58, 95% CI 0.05-1.10; P<.001; I2=87.3%), and 2 or more delivery modes (SMD 0.44, 95% CI 0.01-0.87; P<.001; I2=85.1%) were significantly associated with an enhancement in PA. Conclusions: This study suggests that mHealth interventions are effective for improving PA among workers. Future studies that assess long-term efficacy with a larger population are recommended. %M 35060913 %R 10.2196/30682 %U https://mhealth.jmir.org/2022/1/e30682 %U https://doi.org/10.2196/30682 %U http://www.ncbi.nlm.nih.gov/pubmed/35060913 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e28661 %T Listening to Stakeholders Involved in Speech-Language Therapy for Children With Communication Disorders: Content Analysis of Apple App Store Reviews %A Du,Yao %A Choe,Sarah %A Vega,Jennifer %A Liu,Yusa %A Trujillo,Adrienne %+ Monmouth University, 400 Cedar Ave, West Long Branch, NJ, 07764, United States, 1 7329234616, yadu@monmouth.edu %K eHealth %K mobile health %K mHealth %K mobile app %K communication disorders %K speech therapy %K language therapy %K children %K mobile phone %D 2022 %7 21.1.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: With the plethora of mobile apps available on the Apple App Store, more speech-language pathologists (SLPs) have adopted apps for speech-language therapy services, especially for pediatric clients. App Store reviews are publicly available data sources that can not only create avenues for communication between technology developers and consumers but also enable stakeholders such as parents and clinicians to share their opinions and view opinions about the app content and quality based on user experiences. Objective: This study examines the Apple App Store reviews from multiple key stakeholders (eg, parents, educators, and SLPs) to identify and understand user needs and challenges of using speech-language therapy apps (including augmentative and alternative communication [AAC] apps) for pediatric clients who receive speech-language therapy services. Methods: We selected 16 apps from a prior interview study with SLPs that covered multiple American Speech-Language-Hearing Association Big Nine competencies, including articulation, receptive and expressive language, fluency, voice, social communication, and communication modalities. Using an automatic Python (Python Software Foundation) crawler developed by our research team and a Really Simple Syndication feed generator provided by Apple, we extracted a total of 721 app reviews from 2009 to 2020. Using qualitative coding to identify emerging themes, we conducted a content analysis of 57.9% (418/721) reviews and synthesized user feedback related to app features and content, usability issues, recommendations for improvement, and multiple influential factors related to app design and use. Results: Our analyses revealed that key stakeholders such as family members, educators, and individuals with communication disorders have used App Store reviews as a platform to share their experiences with AAC and speech-language apps. User reviews for AAC apps were primarily written by parents who indicated that AAC apps consistently exhibited more usability issues owing to violations of design guidelines in areas of aesthetics, user errors, controls, and customization. Reviews for speech-language apps were primarily written by SLPs and educators who requested and recommended specific app features (eg, customization of visuals, recorded feedback within the app, and culturally diverse character roles) based on their experiences working with a diverse group of pediatric clients with a variety of communication disorders. Conclusions: To our knowledge, this is the first study to compile and analyze publicly available App Store reviews to identify areas for improvement within mobile apps for pediatric speech-language therapy apps from children with communication disorders and different stakeholders (eg, clinicians, parents, and educators). The findings contribute to the understanding of apps for children with communication disorders regarding content and features, app usability and accessibility issues, and influential factors that impact both AAC apps and speech-language apps for children with communication disorders who need speech therapy. %M 35060912 %R 10.2196/28661 %U https://pediatrics.jmir.org/2022/1/e28661 %U https://doi.org/10.2196/28661 %U http://www.ncbi.nlm.nih.gov/pubmed/35060912 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32404 %T Exploring Children’s Engagement in Monitoring Indoor Air Quality: Longitudinal Study %A Kim,Sunyoung %A Sohanchyk,Gregory %+ School of Communication and Information, Rutgers University, 4 Huntington Street, New Brunswick, NJ, 08901, United States, 1 8489327585, sunyoung.kim@rutgers.edu %K children %K indoor air quality %K mobile app %K awareness %K longitudinal deployment %D 2022 %7 21.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Indoor air pollution is harmful to everyone, but children are of particular concern, as they are more vulnerable to its adverse health effects from air pollutants. Although mobile technology is increasingly being designed to support monitoring and improving air quality indoors, little attention has been paid to its use by and for children. Previously, we created inAirKids, a child-friendly device to promote children’s engagement with monitoring indoor air quality through a participatory design process. The next step is to evaluate its usability in the real world. Objective: The aim of this study is to investigate how inAirKids affects children’s understanding of and engagement with indoor air quality through a longitudinal field deployment study. Methods: We deployed inAirKids in the homes of 9 children aged between 6 and 7 years, and investigated their use for up to 16 weeks by conducting semistructured, biweekly interviews. Results: The results show that participants promptly engaged with inAirKids but quickly lost interest in it owing to the lack of engaging factors to sustain engagement. In addition, we identified 2 design considerations that can foster sustained engagement of children with monitoring indoor air quality: design interactivity for engaging in continuity and corporate hands-on activities as part of indoor air quality monitoring for experiential learning. Conclusions: Our findings shed light on the potential to promote the engagement of children in indoor air quality as well as considerations for designing a child-friendly digital device. To the best of our knowledge, this is the first longitudinal field deployment to investigate how to engage children in monitoring indoor air quality. %M 35060916 %R 10.2196/32404 %U https://formative.jmir.org/2022/1/e32404 %U https://doi.org/10.2196/32404 %U http://www.ncbi.nlm.nih.gov/pubmed/35060916 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33449 %T An Acceptance and Commitment Therapy Prototype Mobile Program for Individuals With a Visible Difference: Mixed Methods Feasibility Study %A Zucchelli,Fabio %A Donnelly,Olivia %A Rush,Emma %A White,Paul %A Gwyther,Holly %A Williamson,Heidi %A , %+ Health and Applied Sciences, University of the West of England, Frenchay Campus, Bristol, BS16 1QY, United Kingdom, 44 7816449143, fabio.zucchelli@uwe.ac.uk %K mobile health %K acceptance and commitment therapy %K appearance %K mixed methods %K mobile phone %D 2022 %7 21.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile apps may offer a valuable platform for delivering evidence-based psychological interventions for individuals with atypical appearances, or visible differences, who experience psychosocial appearance concerns such as appearance-based social anxiety and body dissatisfaction. Before this study, researchers and stakeholders collaboratively designed an app prototype based on acceptance and commitment therapy (ACT), an evidence-based form of cognitive behavioral therapy that uses strategies such as mindfulness, clarification of personal values, and value-based goal setting. The intervention also included social skills training, an established approach for increasing individuals’ confidence in managing social interactions, which evoke appearance-based anxiety for many. Objective: In this study, the authors aim to evaluate the feasibility of an ACT-based app prototype via the primary objectives of user engagement and acceptability and the secondary feasibility objective of clinical safety and preliminary effectiveness. Methods: To address the feasibility objectives, the authors used a single-group intervention design with mixed methods in a group of 36 participants who have a range of visible differences. The authors collected quantitative data via measures of program use, satisfaction ratings, and changes over 3 time points spanning 12 weeks in outcomes, including selected ACT process measures (experiential avoidance, cognitive defusion, and valued action), scales of appearance concerns (appearance-based life disengagement, appearance-fixing behaviors, appearance self-evaluation, and fear of negative appearance evaluation), and clinical well-being (depression and anxiety). Semistructured exit interviews with a subsample of 12 participants provided qualitative data to give a more in-depth understanding of participants’ views and experiences of the program. Results: In terms of user engagement, adherence rates over 6 sessions aligned with the upper boundary of those reported across mobile mental health apps, with over one-third of participants completing all sessions over 12 weeks, during which a steady decline in adherence was observed. Time spent on sessions matched design intentions, and engagement frequencies highlighted semiregular mindfulness practice, mixed use of value-based goal setting, and high engagement with social skills training. The findings indicate a good overall level of program acceptability via satisfaction ratings, and qualitative interview findings offer positive feedback as well as valuable directions for revisions. Overall, testing for clinical safety and potential effectiveness showed encouraging changes over time, including favorable changes in appearance-related life disengagement, appearance-fixing behaviors, and selected ACT measures. No iatrogenic effects were indicated for depression or anxiety. Conclusions: An ACT-based mobile program for individuals struggling with visible differences shows promising proof of concept in addressing appearance concerns, although further revisions and development are required before further development and more rigorous evaluation. %M 35060908 %R 10.2196/33449 %U https://formative.jmir.org/2022/1/e33449 %U https://doi.org/10.2196/33449 %U http://www.ncbi.nlm.nih.gov/pubmed/35060908 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e25384 %T Encouraging Behavior Changes and Preventing Cardiovascular Diseases Using the Prevent Connect Mobile Health App: Conception and Evaluation of App Quality %A Agher,Dahbia %A Sedki,Karima %A Despres,Sylvie %A Albinet,Jean-Pierre %A Jaulent,Marie-Christine %A Tsopra,Rosy %+ Inserm, University Sorbonne Paris Nord, Sorbonne University, Laboratory of Medical Informatics and Knowledge Engineering in e-Health, LIMICS, 15 Rue de l'école de Médecine, Paris, 75006, France, 33 0619260049, agherdahbia2@gmail.com %K digital health %K mHealth, mobile application %K IT %K technology %K prevention %K cardiovascular risk factor %K behavior change %K primary care %D 2022 %7 20.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Cardiovascular diseases are a major cause of death worldwide. Mobile health apps could help in preventing cardiovascular diseases by improving modifiable risk factors such as eating habits, physical activity levels, and alcohol or tobacco consumption. Objective: The aim of this study was to design a mobile health app, Prevent Connect, and to assess its quality for (1) assessing patient behavior for 4 cardiovascular risk factors (unhealthy eating, sedentary lifestyle, alcohol, and tobacco consumption) and (2) suggesting personalized recommendations and mobile health interventions for risky behaviors. Methods: The knowledge base of the app is based on French national recommendations for healthy eating, physical activity, and limiting alcohol and tobacco consumption. It contains a list of patient behaviors and related personalized recommendations and digital health interventions. The interface was designed according to usability principles. Its quality was assessed by a panel of 52 users in a 5-step process: completion of the demographic form, visualization of a short presentation of the app, testing of the app, completion of the user version of the Mobile App Rating Scale (uMARS), and an open group discussion. Results: This app assesses patient behaviors through specific questionnaires about 4 risk factors (unhealthy eating, sedentary lifestyle, alcohol, and tobacco consumption) and suggests personalized recommendations and digital health interventions for improving behavior. The app was deemed to be of good quality, with a mean uMARS quality score of 4 on a 5-point Likert scale. The functionality and information content of the app were particularly appreciated, with a mean uMARS score above 4. Almost all the study participants appreciated the navigation system and found the app easy to use. More than three-quarters of the study participants found the app content relevant, concise, and comprehensive. The aesthetics and the engagement of the app were also appreciated (uMARS score, 3.7). Overall, 80% (42/52) of the study participants declared that the app helped them to become aware of the importance of addressing health behavior, and 65% (34/52) said that the app helped motivate them to change lifestyle habits. Conclusions: The app assessed the risky behaviors of the patients and delivered personalized recommendations and digital health interventions for multiple risk factors. The quality of the app was considered to be good, but the impact of the app on behavior changes is yet to be demonstrated and will be assessed in further studies. %M 35049508 %R 10.2196/25384 %U https://www.jmir.org/2022/1/e25384 %U https://doi.org/10.2196/25384 %U http://www.ncbi.nlm.nih.gov/pubmed/35049508 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e31607 %T Evaluating Evidence-Based Content, Features of Exercise Instruction, and Expert Involvement in Physical Activity Apps for Pregnant Women: Systematic Search and Content Analysis %A Hayman,Melanie J %A Alfrey,Kristie-Lee %A Waters,Kim %A Cannon,Summer %A Mielke,Gregore I %A Keating,Shelley E %A Mena,Gabriela P %A Mottola,Michelle F %A Evenson,Kelly R %A Davenport,Margie H %A Barlow,S Ariel %A Budzynski-Seymour,Emily %A Comardelle,Natalie %A Dickey,Madison %A Harrison,Cheryce L %A Kebbe,Maryam %A Moholdt,Trine %A Moran,Lisa J %A Nagpal,Taniya S %A Schoeppe,Stephanie %A Alley,Stephanie %A Brown,Wendy J %A Williams,Susan %A Vincze,Lisa %+ Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Bruce Highway, Building 7/LG.12, North Rockhampton Campus, Rockhampton, 4701, Australia, 61 749306912, m.j.hayman@cqu.edu.au %K apps %K exercise %K mobile health %K mHealth %K mobile phone %K physical activity %K pregnancy %K exercise prescription %K evidence-based guidelines %K app development %K systematic review %K mobile phone %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Guidelines for physical activity and exercise during pregnancy recommend that all women without contraindications engage in regular physical activity to improve both their own health and the health of their baby. Many women are uncertain how to safely engage in physical activity and exercise during this life stage and are increasingly using mobile apps to access health-related information. However, the extent to which apps that provide physical activity and exercise advice align with current evidence-based pregnancy recommendations is unclear. Objective: This study aims to conduct a systematic search and content analysis of apps that promote physical activity and exercise in pregnancy to examine the alignment of the content with current evidence-based recommendations; delivery, format, and features of physical activity and exercise instruction; and credentials of the app developers. Methods: Systematic searches were conducted in the Australian App Store and Google Play Store in October 2020. Apps were identified using combinations of search terms relevant to pregnancy and exercise or physical activity and screened for inclusion (with a primary focus on physical activity and exercise during pregnancy, free to download or did not require immediate paid subscription, and an average user rating of ≥4 out of 5). Apps were then independently reviewed using an author-designed extraction tool. Results: Overall, 27 apps were included in this review (Google Play Store: 16/27, 59%, and App Store: 11/27, 41%). Two-thirds of the apps provided some information relating to the frequency, intensity, time, and type principles of exercise; only 11% (3/27) provided this information in line with current evidence-based guidelines. Approximately one-third of the apps provided information about contraindications to exercise during pregnancy and referenced the supporting evidence. None of the apps actively engaged in screening for potential contraindications. Only 15% (4/27) of the apps collected information about the user’s current exercise behaviors, 11% (3/27) allowed users to personalize features relating to their exercise preferences, and a little more than one-third provided information about developer credentials. Conclusions: Few exercise apps designed for pregnancy aligned with current evidence-based physical activity guidelines. None of the apps screened users for contraindications to physical activity and exercise during pregnancy, and most lacked appropriate personalization features to account for an individual’s characteristics. Few involved qualified experts during the development of the app. There is a need to improve the quality of apps that promote exercise in pregnancy to ensure that women are appropriately supported to engage in exercise and the potential risk of injury, complications, and adverse pregnancy outcomes for both mother and child is minimized. This could be done by providing expert guidance that aligns with current recommendations, introducing screening measures and features that enable personalization and tailoring to individual users, or by developing a recognized system for regulating apps. %M 35044318 %R 10.2196/31607 %U https://mhealth.jmir.org/2022/1/e31607 %U https://doi.org/10.2196/31607 %U http://www.ncbi.nlm.nih.gov/pubmed/35044318 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e26453 %T Efficacy, Effectiveness, and Quality of Resilience-Building Mobile Health Apps for Military, Veteran, and Public Safety Personnel Populations: Scoping Literature Review and App Evaluation %A Voth,Melissa %A Chisholm,Shannon %A Sollid,Hannah %A Jones,Chelsea %A Smith-MacDonald,Lorraine %A Brémault-Phillips,Suzette %+ Heroes in Mind, Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, 1-94 Corbett Hall, 8205 - 114 Street Edmonton, Edmonton, AB, T6G 2G4, Canada, 1 7804920404, cweiman@ualberta.ca %K occupational stress injury %K trauma %K mHealth %K resilience %K mental health %K military %K veteran %K public safety personnel %K OSI %K PTSD %K mental health intervention %K mobile phone %D 2022 %7 19.1.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Military members (MMs) and public safety personnel (PSP) are vulnerable to occupational stress injuries because of their job demands. When MMs and PSP transition out of these professions, they may continue to experience mental health challenges. The development and implementation of resilience-building mobile health (mHealth) apps as an emergent mental health intervention platform has allowed for targeted, cost-effective, and easily accessible treatment when in-person therapy may be limited or unavailable. However, current mHealth app development is not regulated, and often lacks both clear evidence-based research and the input of health care professionals. Objective: This study aims to evaluate the evidence-based quality, efficacy, and effectiveness of resilience-building mobile apps targeted toward the MMs, PSP, and veteran populations via a scoping literature review of the current evidence base regarding resilience apps for these populations and an evaluation of free resilience apps designed for use among these populations. Methods: The studies were selected using a comprehensive search of MEDLINE, CINAHL Plus, PsycINFO, SocINDEX, Academic Search Complete, Embase, and Google and were guided by PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A narrative synthesis of the resulting papers was performed. The Alberta Rating Index for Apps was used to conduct a review of each of the identified apps. The inclusion criteria consisted of apps that were free to download in either the Google Play Store or the Apple App Store; updated within the last 3 years; available in English and in Canada; and intended for use by MMs, veterans, and PSP. Results: In total, 22 apps met the inclusion criteria for evaluation. The resilience strategies offered by most apps included psychoeducation, mindfulness, cognitive behavioral therapy, and acceptance and commitment therapy. Overall, 50% (11/22) of apps had been tested in randomized controlled trials, 7 (32%) apps had been evaluated using other research methods, and 5 (23%) apps had not been studied. Using the Alberta Rating Index for Apps, the app scores ranged from 37 to 56 out of 72, with higher rated apps demonstrating increased usability and security features. Conclusions: The mHealth apps reviewed are well-suited to providing resilience strategies for MMs, PSP, and veterans. They offer easy accessibility to evidence-based tools while working to encourage the use of emotional and professional support with safety in mind. Although not intended to function as a substitute for professional services, research has demonstrated that mHealth apps have the potential to foster a significant reduction in symptom severity for posttraumatic stress disorder, depression, anxiety, and other mental health conditions. In clinical practice, apps can be used to supplement treatment and provide clients with population-specific confidential tools to increase engagement in the treatment process. %M 35044307 %R 10.2196/26453 %U https://mhealth.jmir.org/2022/1/e26453 %U https://doi.org/10.2196/26453 %U http://www.ncbi.nlm.nih.gov/pubmed/35044307 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 1 %P e29434 %T Machine Learning for Cardiovascular Outcomes From Wearable Data: Systematic Review From a Technology Readiness Level Point of View %A Naseri Jahfari,Arman %A Tax,David %A Reinders,Marcel %A van der Bilt,Ivo %+ Pattern Recognition and Bioinformatics, Delft University of Technology, van Mourik Broekmanweg 6, Delft, 2628 XE, Netherlands, 31 152786052, a.naserijahfari@tudelft.nl %K mHealth %K wearable %K machine learning %K cardiovascular disease %K digital health %K review %K mobile phone %D 2022 %7 19.1.2022 %9 Review %J JMIR Med Inform %G English %X Background: Wearable technology has the potential to improve cardiovascular health monitoring by using machine learning. Such technology enables remote health monitoring and allows for the diagnosis and prevention of cardiovascular diseases. In addition to the detection of cardiovascular disease, it can exclude this diagnosis in symptomatic patients, thereby preventing unnecessary hospital visits. In addition, early warning systems can aid cardiologists in timely treatment and prevention. Objective: This study aims to systematically assess the literature on detecting and predicting outcomes of patients with cardiovascular diseases by using machine learning with data obtained from wearables to gain insights into the current state, challenges, and limitations of this technology. Methods: We searched PubMed, Scopus, and IEEE Xplore on September 26, 2020, with no restrictions on the publication date and by using keywords such as “wearables,” “machine learning,” and “cardiovascular disease.” Methodologies were categorized and analyzed according to machine learning–based technology readiness levels (TRLs), which score studies on their potential to be deployed in an operational setting from 1 to 9 (most ready). Results: After the removal of duplicates, application of exclusion criteria, and full-text screening, 55 eligible studies were included in the analysis, covering a variety of cardiovascular diseases. We assessed the quality of the included studies and found that none of the studies were integrated into a health care system (TRL<6), prospective phase 2 and phase 3 trials were absent (TRL<7 and 8), and group cross-validation was rarely used. These issues limited these studies’ ability to demonstrate the effectiveness of their methodologies. Furthermore, there seemed to be no agreement on the sample size needed to train these studies’ models, the size of the observation window used to make predictions, how long participants should be observed, and the type of machine learning model that is suitable for predicting cardiovascular outcomes. Conclusions: Although current studies show the potential of wearables to monitor cardiovascular events, their deployment as a diagnostic or prognostic cardiovascular clinical tool is hampered by the lack of a realistic data set and proper systematic and prospective evaluation. %M 35044316 %R 10.2196/29434 %U https://medinform.jmir.org/2022/1/e29434 %U https://doi.org/10.2196/29434 %U http://www.ncbi.nlm.nih.gov/pubmed/35044316 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e31989 %T A Remote Health Coaching, Text-Based Walking Program in Ethnic Minority Primary Care Patients With Overweight and Obesity: Feasibility and Acceptability Pilot Study %A Smart,Mary H %A Nabulsi,Nadia A %A Gerber,Ben S %A Gupta,Itika %A Di Eugenio,Barbara %A Ziebart,Brian %A Sharp,Lisa K %+ Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, 833 South Wood St, Chicago, IL, 60612, United States, 1 312 355 3569, sharpl@uic.edu %K mHealth %K Fitbit %K SMART goals %K texting %K health coach %K mobile phone %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Over half of US adults have at least one chronic disease, including obesity. Although physical activity is an important component of chronic disease self-management, few reach the recommended physical activity goals. Individuals who identify as racial and ethnic minorities are disproportionally affected by chronic diseases and physical inactivity. Interventions using consumer-based wearable devices have shown promise for increasing physical activity among patients with chronic diseases; however, populations with the most to gain, such as minorities, have been poorly represented to date. Objective: This study aims to assess the feasibility, acceptability, and preliminary outcomes of an 8-week text-based coaching and Fitbit program aimed at increasing the number of steps in a predominantly overweight ethnic minority population. Methods: Overweight patients (BMI >25 kg/m2) were recruited from an internal medicine clinic located in an inner-city academic medical center. Fitbit devices were provided. Using 2-way SMS text messaging, health coaches (HCs) guided patients to establish weekly step goals that were specific, measurable, attainable, realistic, and time-bound. SMS text messaging and Fitbit activities were managed using a custom-designed app. Program feasibility was assessed via the recruitment rate, retention rate (the proportion of eligible participants completing the 8-week program), and patient engagement (based on the number of weekly text message goals set with the HC across the 8-week period). Acceptability was assessed using a qualitative, summative evaluation. Exploratory statistical analysis included evaluating the average weekly steps in week 1 compared with week 8 using a paired t test (2-tailed) and modeling daily steps over time using a linear mixed model. Results: Of the 33 patients initially screened; 30 (91%) patients were enrolled in the study. At baseline, the average BMI was 39.3 (SD 9.3) kg/m2, with 70% (23/33) of participants presenting as obese. A total of 30% (9/30) of participants self-rated their health as either fair or poor, and 73% (22/30) of participants set up ≥6 weekly goals across the 8-week program. In total, 93% (28/30) of participants completed a qualitative summative evaluation, and 10 themes emerged from the evaluation: patient motivation, convenient SMS text messaging experience, social support, supportive accountability, technology support, self-determined goals, achievable goals, feedback from Fitbit, challenges, and habit formation. There was no significant group change in the average weekly steps for week 1 compared with week 8 (mean difference 7.26, SD 6209.3; P=.99). However, 17% (5/30) of participants showed a significant increase in their daily steps. Conclusions: Overall, the results demonstrate the feasibility and acceptability of a remotely delivered walking study that included an HC; SMS text messaging; a wearable device (Fitbit); and specific, measurable, attainable, realistic, and time-bound goals within an ethnic minority patient population. Results support further development and testing in larger samples to explore efficacy. %M 35044308 %R 10.2196/31989 %U https://formative.jmir.org/2022/1/e31989 %U https://doi.org/10.2196/31989 %U http://www.ncbi.nlm.nih.gov/pubmed/35044308 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e28300 %T A Transdiagnostic, Emotion Regulation App (Eda) for Children: Design, Development, and Lessons Learned %A Moltrecht,Bettina %A Patalay,Praveetha %A Bear,Holly Alice %A Deighton,Jessica %A Edbrooke-Childs,Julian %+ Evidence-based practice unit, Department of Clinical, Educational and Health Psychology, University College London, 4-8 Rodney Street, London, N19JH, United Kingdom, 44 0207794 ext 2313, bettina.moltrecht.16@ucl.ac.uk %K mHealth %K participatory design %K emotion regulation %K interdisciplinary development %K child mental health %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital interventions, including mobile apps, represent a promising means of providing effective mental health support to children and young people. Despite the increased availability of mental health apps, there is a significant gap for this age group, especially for children (aged 10-12 years). Research investigating the effectiveness and development process of child mental health apps is limited, and the field faces persistent issues in relation to low user uptake and engagement, which is assumed to be a result of limited user involvement in the design process. Objective: This study aims to present the development and design process of a new mental health app for children that targets their emotion regulation abilities. We describe the creation of a new interdisciplinary development framework to guide the design process and explain how each activity informed different app features. Methods: The first 2 stages of the framework used a variety of methods, including weekly classroom observations over a 6-month period (20 in total); public engagement events with the target group (N=21); synthesis of the existing evidence as part of a meta-analysis; a series of co-design and participatory workshops with young users (N=33), clinicians (N=7), researchers (N=12), app developers (N=1), and designers (N=2); and finally, testing of the first high-tech prototype (N=15). Results: For the interdisciplinary framework, we drew on methods derived from the Medical Research Council framework for complex interventions, the patient–clinician framework, and the Druin cooperative inquiry. The classroom observations, public engagement events, and synthesis of the existing evidence informed the first key pillars of the app and wireframes. Subsequently, a series of workshops shaped and reshaped the content and app features, including games, psychoeducational films, and practice modules. On the basis of the prototype testing sessions, we made further adjustments to improve the app. Conclusions: Although mobile apps could be highly suitable to support children’s mental health on a wider scale, there is little guidance on how these interventions could be designed and developed. The involvement of young users across different design activities is very valuable. We hope that our interdisciplinary framework and description of the used methods will be helpful to others who are hoping to develop mental health apps for children and young people. %M 35044312 %R 10.2196/28300 %U https://formative.jmir.org/2022/1/e28300 %U https://doi.org/10.2196/28300 %U http://www.ncbi.nlm.nih.gov/pubmed/35044312 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e29703 %T Adherence, Efficacy, and Safety of Wearable Technology–Assisted Combined Home-Based Exercise in Chinese Patients With Ankylosing Spondylitis: Randomized Pilot Controlled Clinical Trial %A Wang,Yiwen %A Liu,Xingkang %A Wang,Weimin %A Shi,Yanyun %A Ji,Xiaojian %A Hu,Lidong %A Wang,Lei %A Yin,Yiquan %A Xie,Siyuan %A Zhu,Jian %A Zhang,Jianglin %A Jiao,Wei %A Huang,Feng %+ Department of Rheumatology and Immunology, First Medical Center, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China, 86 010 5549 9314, fhuang@301hospital.com.cn %K ankylosing spondylitis %K wearable technology %K home-based exercise %K combined exercise %K randomized controlled trial %K RCT %K exercise %K wearable %K photoplethysmography %K spondyloarthritis %D 2022 %7 18.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinical practice guidelines recommend that exercise is essential in the self-management of ankylosing spondylitis (AS). Attending supervised interventions requiring periodic medical center visits can be difficult and patients may decline participation, whereas effective home-based exercise interventions that do not require regular medical center visits are likely to be more accessible for AS patients. Objective: The goal of the research was to investigate the adherence, efficacy, and safety of a wearable technology–assisted combined home-based exercise program in AS. Methods: This was a 16-week investigator-initiated, assessor-blinded, randomized, pilot controlled trial conducted at Chinese People’s Liberation Army General Hospital. We enrolled patients with AS who had no regular exercise habits and had been stable in drug treatment for the preceding month. Patients were randomly assigned (1:1) using a computer algorithm. An exercise program consisting of moderate-intensity aerobic exercise and functional exercise was given to the patients in the intervention group. The exercise intensity was controlled by a Mio FUSE Heart Rate Monitor wristband, which uses photoplethysmography to measure heart rate. Patients in the control group received usual care. The primary outcome was the difference in the Ankylosing Spondylitis Disease Activity Score (ASDAS). The secondary outcomes were patient global assessment (PGA), physician global assessment (PhGA), total pain, nocturnal pain, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), BAS Functional Index (BASFI), BAS Metrology Index (BASMI), Spondyloarthritis International Society Health Index (ASAS HI), 36-item Short Form Survey (SF-36), maximal oxygen uptake (VO2) max, body composition, range of motion of joints, and muscle endurance tests. Retention rate, adherence rate, barriers to being active, and adverse events were also assessed. Results: A total of 77 patients were screened, of whom 55 (71%) patients were enrolled; 2% (1/55) withdrew without treatment after randomization. Patients were assigned to the intervention (n=26) or control group (n=28). The median adherence rate of the prescribed exercise protocol was 84.2% (IQR 48.7%-97.9%). For the primary outcome, between-group difference of ASDAS was significant, favoring the intervention (–0.2, 95% CI –0.4 to 0.02, P=.03). For the secondary outcomes, significant between-group differences at 16 weeks were detected in PGA, PhGA, total pain, BASDAI, BASDAI-fatigue, BASDAI–spinal pain, BASDAI–morning stiffness intensity, BASFI, and BASMI. Moreover, the frequency of difficulty in ASAS HI-motivation at 16 weeks was less in the intervention group (P=.03). Between-group difference for change from baseline were also detected in VO2 max, SF-36, back extensor endurance test, and the range of motion of cervical lateral flexion at 16 weeks. Lack of time, energy, and willpower were the most distinct barriers to being active. Incidences of adverse events were similar between groups (P=.11). Conclusions: Our pilot study suggests that this technology-assisted combined home-based exercise program can improve the clinical outcomes of patients with AS who have no exercise habit, with good adherence and safety profile. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900024244; http://www.chictr.org.cn/showproj.aspx?proj=40176 %M 35040798 %R 10.2196/29703 %U https://www.jmir.org/2022/1/e29703 %U https://doi.org/10.2196/29703 %U http://www.ncbi.nlm.nih.gov/pubmed/35040798 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e27095 %T Applying an Extended UTAUT2 Model to Explain User Acceptance of Lifestyle and Therapy Mobile Health Apps: Survey Study %A Schomakers,Eva-Maria %A Lidynia,Chantal %A Vervier,Luisa Sophie %A Calero Valdez,André %A Ziefle,Martina %+ Human-Computer Interaction Center, RWTH Aachen University, Campus-Boulevard 57, Aachen, 52074, Germany, 49 17662315488, schomakers@comm.rwth-aachen.de %K technology acceptance %K UTAUT2 %K mHealth %K privacy concerns %K trust %D 2022 %7 18.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) care apps are a promising technology to monitor and control health individually and cost-effectively with a technology that is widely used, affordable, and ubiquitous in many people’s lives. Download statistics show that lifestyle apps are widely used by young and healthy users to improve fitness, nutrition, and more. While this is an important aspect for the prevention of future chronic diseases, the burdened health care systems worldwide may directly profit from the use of therapy apps by those patients already in need of medical treatment and monitoring. Objective: We aimed to compare the factors influencing the acceptance of lifestyle and therapy apps to better understand what drives and hinders the use of mHealth apps. Methods: We applied the established unified theory of acceptance and use of technology 2 (UTAUT2) technology acceptance model to evaluate mHealth apps via an online questionnaire with 707 German participants. Moreover, trust and privacy concerns were added to the model and, in a between-subject study design, the influence of these predictors on behavioral intention to use apps was compared between lifestyle and therapy apps. Results: The results show that the model only weakly predicted the intention to use mHealth apps (R2=0.019). Only hedonic motivation was a significant predictor of behavioral intentions regarding both app types, as determined by path coefficients of the model (lifestyle: 0.196, P=.004; therapy: 0.344, P<.001). Habit influenced the behavioral intention to use lifestyle apps (0.272, P<.001), while social influence (0.185, P<.001) and trust (0.273, P<.001) predicted the intention to use therapy apps. A further exploratory correlation analysis of the relationship between user factors on behavioral intention was calculated. Health app familiarity showed the strongest correlation to the intention to use (r=0.469, P<.001), stressing the importance of experience. Also, age (r=–0.15, P=.004), gender (r=–0.075, P=.048), education level (r=0.088, P=.02), app familiarity (r=0.142, P=.007), digital health literacy (r=0.215, P<.001), privacy disposition (r=–0.194, P>.001), and the propensity to trust apps (r=0.191, P>.001) correlated weakly with behavioral intention to use mHealth apps. Conclusions: The results indicate that, rather than by utilitarian factors like usefulness, mHealth app acceptance is influenced by emotional factors like hedonic motivation and partly by habit, social influence, and trust. Overall, the findings give evidence that for the health care context, new and extended acceptance models need to be developed with an integration of user diversity, especially individuals’ prior experience with apps and mHealth. %M 35040801 %R 10.2196/27095 %U https://mhealth.jmir.org/2022/1/e27095 %U https://doi.org/10.2196/27095 %U http://www.ncbi.nlm.nih.gov/pubmed/35040801 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e30724 %T mHealth Solutions for Perinatal Mental Health: Scoping Review and Appraisal Following the mHealth Index and Navigation Database Framework %A Spadaro,Benedetta %A Martin-Key,Nayra A %A Funnell,Erin %A Bahn,Sabine %+ Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223 334151, sb209@cam.ac.uk %K digital mental health %K perinatal mental health %K pregnancy %K MIND %K mobile phone %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The ever-increasing pressure on health care systems has resulted in the underrecognition of perinatal mental disorders. Digital mental health tools such as apps could provide an option for accessible perinatal mental health screening and assessment. However, there is a lack of information regarding the availability and features of perinatal app options. Objective: This study aims to evaluate the current state of diagnostic and screening apps for perinatal mental health available on the Google Play Store (Android) and Apple App Store (iOS) and to review their features following the mHealth Index and Navigation Database framework. Methods: Following a scoping review approach, the Apple App Store and Google Play Store were systematically searched to identify perinatal mental health assessment apps. A total of 14 apps that met the inclusion criteria were downloaded and reviewed in a standardized manner using the mHealth Index and Navigation Database framework. The framework comprised 107 questions, allowing for a comprehensive assessment of app origin, functionality, engagement features, security, and clinical use. Results: Most apps were developed by for-profit companies (n=10), followed by private individuals (n=2) and trusted health care companies (n=2). Out of the 14 apps, 3 were available only on Android devices, 4 were available only on iOS devices, and 7 were available on both platforms. Approximately one-third of the apps (n=5) had been updated within the last 180 days. A total of 12 apps offered the Edinburgh Postnatal Depression Scale in its original version or in rephrased versions. Engagement, input, and output features included reminder notifications, connections to therapists, and free writing features. A total of 6 apps offered psychoeducational information and references. Privacy policies were available for 11 of the 14 apps, with a median Flesch-Kincaid reading grade level of 12.3. One app claimed to be compliant with the Health Insurance Portability and Accountability Act standards and 2 apps claimed to be compliant with General Data Protection Regulation. Of the apps that could be accessed in full (n=10), all appeared to fulfill the claims stated in their description. Only 1 app referenced a relevant peer-reviewed study. All the apps provided a warning for use, highlighting that the mental health assessment result should not be interpreted as a diagnosis or as a substitute for medical care. Only 3 apps allowed users to export or email their mental health test results. Conclusions: These results indicate that there are opportunities to improve perinatal mental health assessment apps. To this end, we recommend focusing on the development and validation of more comprehensive assessment tools, ensuring data protection and safety features are adequate for the intended app use, and improving data sharing features between users and health care professionals for timely support. %M 35037894 %R 10.2196/30724 %U https://mhealth.jmir.org/2022/1/e30724 %U https://doi.org/10.2196/30724 %U http://www.ncbi.nlm.nih.gov/pubmed/35037894 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e34103 %T A New Digital Assessment of Mental Health and Well-being in the Workplace: Development and Validation of the Unmind Index %A Sierk,Anika %A Travers,Eoin %A Economides,Marcos %A Loe,Bao Sheng %A Sun,Luning %A Bolton,Heather %+ Unmind Ltd, 180 Borough High Street, London, SE1 1LB, United Kingdom, eoin.travers@unmind.com %K mental health %K well-being %K mHealth %K measurement %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Unmind is a workplace, digital, mental health platform with tools to help users track, maintain, and improve their mental health and well-being (MHWB). Psychological measurement plays a key role on this platform, providing users with insights on their current MHWB, the ability to track it over time, and personalized recommendations, while providing employers with aggregate information about the MHWB of their workforce. Objective: Due to the limitations of existing measures for this purpose, we aimed to develop and validate a novel well-being index for digital use, to capture symptoms of common mental health problems and key aspects of positive well-being. Methods: In Study 1A, questionnaire items were generated by clinicians and screened for face validity. In Study 1B, these items were presented to a large sample (n=1104) of UK adults, and exploratory factor analysis was used to reduce the item pool and identify coherent subscales. In Study 2, the final measure was presented to a new nationally representative UK sample (n=976), along with a battery of existing measures, with 238 participants retaking the Umind Index after 1 week. The factor structure and measurement invariance of the Unmind Index was evaluated using confirmatory factor analysis, convergent and discriminant validity by estimating correlations with existing measures, and reliability by examining internal consistency and test-retest intraclass correlations. Results: Studies 1A and 1B yielded a 26-item measure with 7 subscales: Calmness, Connection, Coping, Happiness, Health, Fulfilment, and Sleep. Study 2 showed that the Unmind Index is fitted well by a second-order factor structure, where the 7 subscales all load onto an overall MHWB factor, and established measurement invariance by age and gender. Subscale and total scores correlate well with existing mental health measures and generally diverge from personality measures. Reliability was good or excellent across all subscales. Conclusions: The Unmind Index is a robust measure of MHWB that can help to identify target areas for intervention in nonclinical users of a mental health app. We argue that there is value in measuring mental ill health and mental well-being together, rather than treating them as separate constructs. %M 35037895 %R 10.2196/34103 %U https://mental.jmir.org/2022/1/e34103 %U https://doi.org/10.2196/34103 %U http://www.ncbi.nlm.nih.gov/pubmed/35037895 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e33118 %T Development of a Community-Based e-Health Program for Older Adults With Chronic Diseases: Pilot Pre-Post Study %A Wu,Vivien Xi %A Dong,Yanhong %A Tan,Poh Choo %A Gan,Peiying %A Zhang,Di %A Chi,Yuchen %A Chao,Felicia Fang Ting %A Lu,Jinhua %A Teo,Boon Heng Dennis %A Tan,Yue Qian %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 66012756, nurwux@nus.edu.sg %K eHealth %K self-management %K older adults %K chronic disease %K community care %K elderly %K community %K innovation %K development %K pilot %K evaluation %K health literacy %K empowerment %K feasibility %K engagement %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Chronic diseases may impact older adults’ health outcomes, health care costs, and quality of life. Self-management is expected to encourage individuals to make autonomous decisions, adhere to treatment plans, deal with emotional and social consequences, and provide choices for healthy lifestyle. New eHealth solutions significantly increase the health literacy and empower patients in self-management of chronic conditions. Objective: This study aims to develop a Community-Based e-Health Program (CeHP) for older adults with chronic diseases and conduct a pilot evaluation. Methods: A pilot study with a 2-group pre- and posttest repeated measures design was adopted. Community-dwelling older adults with chronic diseases were recruited from senior activity centers in Singapore. A systematic 3-step process of developing CeHP was coupled with a smart-device application. The development of the CeHP intervention consists of theoretical framework, client-centric participatory action research process, content validity assessment, and pilot testing. Self-reported survey questionnaires and health outcomes were measured before and after the CeHP. The instruments used were the Self-care of Chronic Illness Inventory (SCCII), Healthy Aging Instrument (HAI), Short-Form Health Literacy Scale, 12 Items (HLS-SF 12), Patient Empowerment Scale (PES), and Social Support Questionnaire, 6 items. The following health outcomes were measured: Montreal Cognitive Assessment, Symbol Digit Modalities Test, total cholesterol (TC), high-density lipoproteins, low-density lipoproteins/very-low-density lipoproteins (LDL/VLDL), fasting glucose, glycated hemoglobin (HbA1c), and BMI. Results: The CeHP consists of health education, monitoring, and an advisory system for older adults to manage their chronic conditions. It is an 8-week intensive program, including face-to-face and eHealth (Care4Senior App) sessions. Care4Senior App covers health education topics focusing on the management of hypertension, hyperlipidemia, and diabetes, brain health, healthy diet, lifestyle modification, medication adherence, exercise, and mindfulness practice. Content validity assessment indicated that the content of the CeHP is valid, with a content validity index (CVI) ranging 0.86-1 and a scale-CVI of 1. Eight participants in the CeHP group and 4 in the control group completed both baseline and post intervention assessments. Participants in the CeHP group showed improvements in fasting glucose, HbA1c, TC, LDL/VLDL, BMI, SCCII indices (Maintenance, Monitoring, and Management), HAI, and PES scores post intervention, although these changes were not significant. For the participants in the control group, the scores for SCCII (management and confidence) and HLS-SF 12 decreased post intervention. Conclusions: The CeHP is feasible, and it engages and empowers community-dwelling older adults to manage their chronic conditions. The rigorous process of program development and pilot evaluation provided valid evidence to expand the CeHP to a larger-scale implementation to encourage self-management, reduce debilitating complications of poorly controlled chronic diseases, promote healthy longevity and social support, and reduce health care costs. %M 35037882 %R 10.2196/33118 %U https://aging.jmir.org/2022/1/e33118 %U https://doi.org/10.2196/33118 %U http://www.ncbi.nlm.nih.gov/pubmed/35037882 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e29512 %T Human-Centered Design of Mobile Health Apps for Older Adults: Systematic Review and Narrative Synthesis %A Nimmanterdwong,Zethapong %A Boonviriya,Suchaya %A Tangkijvanich,Pisit %+ Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Padtayapatana Building, 11th Floor, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand, 66 868622188, zethapong@gmail.com %K connected health %K development %K elderly %K HCD %K mHealth %K older adults %K review %K telehealth %K UCD %K usability %K design %K human-centered %K app %D 2022 %7 14.1.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The world is aging. The number of older patients is on the rise, and along with it comes the burden of noncommunicable diseases, both clinical and economic. Attempts with mobile health (mHealth) have been made to remedy the situation with promising outcomes. Researchers have adopted human-centered design (HCD) in mHealth creation to ensure those promises become a reality. Objective: This systematic review aims to explore existing literature on relevant primary research and case studies to (1) illustrate how HCD can be used to create mHealth solutions for older adults and (2) summarize the overall process with recommendations specific to the older population. Methods: We conducted a systematic review to address the study objectives. IEEE Xplore, Medline via Ovid, PubMed, and Scopus were searched for HCD research of mHealth solutions for older adults. Two independent reviewers then included the papers if they (1) were written in English, (2) included participants equal to or older than 60 years old, (3) were primary research, and (4) reported about mHealth apps and their HCD developments from start to finish. The 2 reviewers continued to assess the included studies’ qualities using the Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was then carried out and completed. Results: Eight studies passed the eligibility criteria: 5 were mixed methods studies and 3 were case studies. Some studies were about the same mHealth projects with a total of 5 mHealth apps. The included studies differed in HCD goals, target groups, and details of their HCD methodologies. The HCD process was explored through narrative synthesis in 4 steps according to the International Standardization Organization (ISO) standard 9241-210: (1) understand and specify the context of use, (2) specify the user requirements, (3) produce design solutions to meet these requirements, and (4) evaluate the designs against requirements. The overall process and recommendations unique to older adults are summarized logically with structural order and time order based on the Minto pyramid principle and ISO 9241-210. Conclusions: Findings show that HCD can be used to create mHealth solutions for older adults with positive outcomes. This review has also summarized practical HCD steps and additional suggestions based on existing literature in the subfield. However, evidence-based results are still limited because most included studies lacked details about their sampling methods and did not set objective and quantifiable goals, leading to failure to draw significant conclusions. More studies of HCD application on mHealth for older adults with measurable design goals and rigorous research strategy are warranted. %M 35029535 %R 10.2196/29512 %U https://mhealth.jmir.org/2022/1/e29512 %U https://doi.org/10.2196/29512 %U http://www.ncbi.nlm.nih.gov/pubmed/35029535 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32273 %T A Smartphone App to Increase Immunizations in the Pediatric Solid Organ Transplant Population: Development and Initial Usability Study %A Feldman,Amy G %A Moore,Susan %A Bull,Sheana %A Morris,Megan A %A Wilson,Kumanan %A Bell,Cameron %A Collins,Margaret M %A Denize,Kathryn M %A Kempe,Allison %+ Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO, 80045, United States, 1 720 777 5354, amy.feldman@childrenscolorado.org %K vaccinations %K transplantation %K mobile app %K agile development %K immunization %K mHealth %K mobile health %K children %K transplant recipients %K pediatric transplant recipients %K pediatrics %D 2022 %7 13.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Vaccine-preventable infections result in significant morbidity, mortality, and costs in pediatric transplant recipients. However, at the time of transplant, less than 20% of children are up-to-date for age-appropriate immunizations that could prevent these diseases. Smartphone apps have the potential to increase immunization rates through their ability to provide vaccine education, send vaccine reminders, and facilitate communication between parents and a multidisciplinary medical group. Objective: The aim of this study was to describe the development of a smartphone app, Immunize PediatricTransplant, to promote pretransplant immunization and to report on app functionality and usability when applied to the target population. Methods: We used a mixed methods study design guided by the Mobile Health Agile Development and Evaluation Lifecycle. We first completed a formative research including semistructured interviews with transplant stakeholders (12 primary care physicians, 40 parents or guardians of transplant recipients, 11 transplant nurse coordinators, and 19 transplant subspecialists) to explore the acceptability of an immunization app to be used in the pretransplant period. Based on these findings, CANImmunize Inc developed the Immunize PediatricTransplant app. We next held 2 focus group discussions with 5-6 transplant stakeholders/group (n=11; 5 parents of transplant recipients, 2 primary care physicians, 2 transplant nurse coordinators, and 2 transplant subspecialists) to receive feedback on the app. After the app modifications were made, alpha testing was conducted on the functional prototype. We then implemented beta testing with 12 stakeholders (6 parents of transplant recipients, 2 primary care doctors, 2 transplant nurse coordinators, and 2 transplant subspecialists) to refine the app through an iterative process. Finally, the stakeholders completed the user version of the Mobile Application Rating Scale (uMARS) to assess the functionality and quality of the app. Results: A new Android- and Apple-compatible app, Immunize PediatricTransplant, was developed to improve immunization delivery in the pretransplant period. The app contains information about vaccine use in the pretransplant period, houses a complete immunization record for each child, includes a communication tool for parents and care providers, and sends automated reminders to parents and care providers when immunizations are due. During usability testing, the stakeholders were able to enter a mock vaccine record containing 16 vaccines in an average of 8.1 minutes (SD 1.8) with 87% accuracy. The stakeholders rated engagement, functionality, aesthetics, and information quality of the app as 4.2/5, 4.5/5, 4.6/5, and 4.8/5, respectively. All participants reported that they would recommend this app to families and care teams with a child awaiting solid organ transplant. Conclusions: Through a systematic, user-centered, agile, iterative approach, the Immunize PediatricTransplant app was developed to improve immunization delivery in the pretransplant period. The app tested well with end users. Further testing and agile development among patients awaiting transplant are needed to understand real-world acceptability and effectiveness in improving immunization rates in children awaiting transplant. %M 35023840 %R 10.2196/32273 %U https://formative.jmir.org/2022/1/e32273 %U https://doi.org/10.2196/32273 %U http://www.ncbi.nlm.nih.gov/pubmed/35023840 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30640 %T Toward Designs of Workplace Stress Management Mobile Apps for Frontline Health Workers During the COVID-19 Pandemic and Beyond: Mixed Methods Qualitative Study %A Chaudhry,Beenish Moalla %A Islam,Ashraful %A Matthieu,Monica %+ University of Louisiana at Lafayette, School of Computing and Informatics, 104 E University Circle, Lafayette, LA, 70508, United States, 1 4134616440, Beenish.chaudhry@louisiana.edu %K mental health %K stress %K mHealth %K frontline health worker %K design requirements %K pandemic %K COVID-19 %K design %K intervention %K burnout %K perspective %K need %K user design %D 2022 %7 13.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, mobile apps have been developed to prevent burnout, promote anxiety management, and provide health education to workers in various workplace settings. However, there remains a paucity of such apps for frontline health workers (FHWs), even though FHWs are the most susceptible to stress due to the nature of their jobs. Objective: The goal of this study was to provide suggestions for designing stress management apps to address workplace stressors of FHWs based on the understanding of their needs from FHWs’ own perspectives and theories of stress. Methods: A mixed methods qualitative study was conducted. Using a variety of search strings, we first collected 41 relevant web-based news articles published between December 2019 and May 2020 through the Google search engine. We then conducted a cross-sectional survey with 20 FHWs. Two researchers independently conducted qualitative analysis of all the collected data using a deductive followed by an inductive approach. Results: Prevailing uncertainty and fear of contracting the infection was causing stress among FHWs. Moral injury associated with seeing patients die from lack of care and lack of experience in handling various circumstances were other sources of stress. FHWs mentioned 4 coping strategies. Quick coping strategies such as walking away from stressful situations, entertainment, and exercise were the most common ways to mitigate the impact of stress at work. Peer support and counseling services were other popular methods. Building resilience and driving oneself forward using internal motivation were also meaningful ways of overcoming stressful situations. Time constraints and limited management support prevented FHWs from engaging in stress management activities. Conclusions: Our study identified stressors, coping strategies, and challenges with applying coping strategies that can guide the design of stress management apps for FHWs. Given that the pandemic is ongoing and health care crises continue, FHWs remain a vulnerable population in need of attention. %M 34806985 %R 10.2196/30640 %U https://formative.jmir.org/2022/1/e30640 %U https://doi.org/10.2196/30640 %U http://www.ncbi.nlm.nih.gov/pubmed/34806985 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e30026 %T Engagement Strategies to Improve Adherence and Retention in Web-Based Mindfulness Programs: Systematic Review %A Winter,Natalie %A Russell,Lahiru %A Ugalde,Anna %A White,Victoria %A Livingston,Patricia %+ Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, 3220, Australia, 61 3 5227 1100, n.heynsbergh@deakin.edu.au %K chronic disease %K chronic illness %K digital health %K digital technology %K internet mindfulness %K mindfulness based stress reduction %K patient dropouts %K mobile phone %D 2022 %7 12.1.2022 %9 Review %J J Med Internet Res %G English %X Background: Web-based mindfulness programs may be beneficial in improving the well-being outcomes of those living with chronic illnesses. Adherence to programs is a key indicator in improving outcomes; however, with the digitization of programs, it is necessary to enhance engagement and encourage people to return to digital health platforms. More information is needed on how engagement strategies have been used in web-based mindfulness programs to encourage adherence. Objective: The aim of this study is to develop a list of engagement strategies for web-based mindfulness programs and evaluate the impact of engagement strategies on adherence. Methods: A narrative systematic review was conducted across the MEDLINE Complete, CINAHL Complete, APA PsycINFO, and Embase databases and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Articles were screened using the population, intervention, comparator, and outcome framework. Adults aged >18 years with chronic health conditions were included in the study. Mindfulness interventions, including those in combination with mindfulness-based cognitive therapy, delivered on the web through the internet or smartphone technology were included. Interventions lasted at least 2 weeks. Studies with a randomized controlled trial design or a pilot randomized controlled trial design were included. Engagement strategies, including web-based program features and facilitator-led strategies, adherence, and retention, were included. Results: A total of 1265 articles were screened, of which 19 were relevant and were included in the review. On average, 70.98% (2258/3181) of the study participants were women with a mean age of 46 (SD 13) years. Most commonly, mindfulness programs were delivered to people living with mental health conditions (8/19, 42%). Of the 19 studies, 8 (42%) used only program features to encourage adherence, 5 (26%) used facilitator-led strategies, and 6 (32%) used a combination of the two. Encouraging program adherence was the most common engagement strategy used, which was used in 77% (10/13) of the facilitator-led studies and 57% (8/14) of the program feature studies. Nearly two-thirds (63%) of the studies provided a definition of adherence, which varied between 50% and 100% completion across studies. The overall mean participant compliance to the mindfulness programs was 56% (SD 15%). Most studies (10/19, 53%) had a long-term follow-up, with the most common follow-up period being 12 weeks after intervention (3/10, 30%). After the intervention, the mean retention was 78% (SD 15%). Conclusions: Engagement strategies in web-based mindfulness programs comprise reminders to use the program. Other features may be suitable for encouraging adherence to interventions, and a facilitator-led component may result in higher retention. There is variance in the way adherence is measured, and intervention lengths and follow-up periods are inconsistent. More thorough reporting and a standardized framework for measuring adherence are needed to more accurately assess adherence and engagement strategies. %M 35019851 %R 10.2196/30026 %U https://www.jmir.org/2022/1/e30026 %U https://doi.org/10.2196/30026 %U http://www.ncbi.nlm.nih.gov/pubmed/35019851 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e31576 %T Feasibility and Acceptability of a Physical Activity Tracker and Text Messages to Promote Physical Activity During Chemotherapy for Colorectal Cancer: Pilot Randomized Controlled Trial (Smart Pace II) %A Van Blarigan,Erin L %A Dhruva,Anand %A Atreya,Chloe E %A Kenfield,Stacey A %A Chan,June M %A Milloy,Alexandra %A Kim,Iris %A Steiding,Paige %A Laffan,Angela %A Zhang,Li %A Piawah,Sorbarikor %A Fukuoka,Yoshimi %A Miaskowski,Christine %A Hecht,Frederick M %A Kim,Mi-Ok %A Venook,Alan P %A Van Loon,Katherine %+ Department of Epidemiology and Biostatistics, University of California, San Francisco, UCSF Box 0560, 550 16th St. 2nd Floor, San Francisco, CA, 94158, United States, 1 415 476 1111 ext 13608, erin.vanblarigan@ucsf.edu %K exercise %K treatment %K colon cancer %K rectal cancer %K digital health %K wearables %K SMS %D 2022 %7 11.1.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: We conducted a pilot 2-arm randomized controlled trial to assess the feasibility of a digital health intervention to increase moderate-to-vigorous physical activity in patients with colorectal cancer (CRC) during chemotherapy. Objective: This study aimed to determine whether a digital health physical activity intervention is feasible and acceptable during chemotherapy for CRC. Methods: Potentially eligible patients with CRC expected to receive at least 12 weeks of chemotherapy were identified in person at the University of California, San Francisco, and on the web through advertising. Eligible patients were randomized 1:1 to a 12-week intervention (Fitbit Flex, automated SMS text messages) versus usual care. At 0 and 12 weeks, patients wore an Actigraph GT3X+ accelerometer for 7 days and completed surveys, body size measurements, and an optional 6-minute walk test. Participants could not be masked to their intervention arm, but people assessing the body size and 6-minute walk test outcomes were masked. The primary outcomes were adherence (eg, Fitbit wear and text response rate) and self-assessed acceptability of the intervention. The intervention would be considered feasible if we observed at least 80% complete follow-up and 70% adherence and satisfaction, a priori. Results: From 2018 to 2020, we screened 240 patients; 53.3% (128/240) of patients were ineligible and 26.7% (64/240) declined to participate. A total of 44 patients (44/240, 18%) were randomized to the intervention (n=22) or control (n=22) groups. Of these, 57% (25/44) were women; 68% (30/44) identified as White and 25% (11/44) identified as Asian American or Pacific Islander; and 77% (34/44) had a 4-year college degree. The median age at enrollment was 54 years (IQR 45-62 years). Follow-up at 12 weeks was 91% (40/44) complete. In the intervention arm, patients wore Fitbit devices on a median of 67 out of 84 (80%) study days and responded to a median of 17 out of 27 (63%) questions sent via SMS text message. Among 19 out of 22 (86%) intervention patients who completed the feedback survey, 89% (17/19) were satisfied with the Fitbit device; 63% (12/19) were satisfied with the SMS text messages; 68% (13/19) said the SMS text messages motivated them to exercise; 74% (14/19) said the frequency of SMS text messages (1-3 days) was ideal; and 79% (15/19) said that receiving SMS text messages in the morning and evening was ideal. Conclusions: This pilot study demonstrated that many people receiving chemotherapy for CRC are interested in participating in digital health physical activity interventions. Fitbit adherence was high; however, participants indicated a desire for more tailored SMS text message content. Studies with more socioeconomically diverse patients with CRC are required. Trial Registration: ClinicalTrials.gov NCT03524716; https://clinicaltrials.gov/ct2/show/NCT03524716 %M 35014958 %R 10.2196/31576 %U https://cancer.jmir.org/2022/1/e31576 %U https://doi.org/10.2196/31576 %U http://www.ncbi.nlm.nih.gov/pubmed/35014958 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e29302 %T Users’ Experiences With the NoHoW Web-Based Toolkit With Weight and Activity Tracking in Weight Loss Maintenance: Long-term Randomized Controlled Trial %A Mattila,Elina %A Hansen,Susanne %A Bundgaard,Lise %A Ramsey,Lauren %A Dunning,Alice %A Silva,Marlene N %A Harjumaa,Marja %A Ermes,Miikka %A Marques,Marta M %A Matos,Marcela %A Larsen,Sofus C %A Encantado,Jorge %A Santos,Inês %A Horgan,Graham %A O'Driscoll,Ruairi %A Turicchi,Jake %A Duarte,Cristiana %A Palmeira,António L %A Stubbs,R James %A Heitmann,Berit Lilienthal %A Lähteenmäki,Liisa %+ VTT Technical Research Centre of Finland Ltd, Tekniikantie 21, Espoo, 02150, Finland, 358 407162230, elina.m.mattila@vtt.fi %K digital behavior change intervention %K user experience %K technology acceptance %K weight-loss maintenance %K focus groups %K mixed methods %K mobile phone %D 2022 %7 10.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital behavior change interventions (DBCIs) offer a promising channel for providing health promotion services. However, user experience largely determines whether they are used, which is a precondition for effectiveness. Objective: The primary aim of this study is to evaluate user experiences with the NoHoW Toolkit (TK)—a DBCI that targets weight loss maintenance—over a 12-month period by using a mixed methods approach and to identify the main strengths and weaknesses of the TK and the external factors affecting its adoption. The secondary aim is to objectively describe the measured use of the TK and its association with user experience. Methods: An 18-month, 2×2 factorial randomized controlled trial was conducted. The trial included 3 intervention arms receiving an 18-week active intervention and a control arm. The user experience of the TK was assessed quantitatively through electronic questionnaires after 1, 3, 6, and 12 months of use. The questionnaires also included open-ended items that were thematically analyzed. Focus group interviews were conducted after 6 months of use and thematically analyzed to gain deeper insight into the user experience. Log files of the TK were used to evaluate the number of visits to the TK, the total duration of time spent in the TK, and information on intervention completion. Results: The usability level of the TK was rated as satisfactory. User acceptance was rated as modest; this declined during the trial in all the arms, as did the objectively measured use of the TK. The most appreciated features were weekly emails, graphs, goal setting, and interactive exercises. The following 4 themes were identified in the qualitative data: engagement with features, decline in use, external factors affecting user experience, and suggestions for improvements. Conclusions: The long-term user experience of the TK highlighted the need to optimize the technical functioning, appearance, and content of the DBCI before and during the trial, similar to how a commercial app would be optimized. In a trial setting, the users should be made aware of how to use the intervention and what its requirements are, especially when there is more intensive intervention content. Trial Registration: ISRCTN Registry ISRCTN88405328; https://www.isrctn.com/ISRCTN88405328 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-029425 %M 35006081 %R 10.2196/29302 %U https://www.jmir.org/2022/1/e29302 %U https://doi.org/10.2196/29302 %U http://www.ncbi.nlm.nih.gov/pubmed/35006081 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e31058 %T Russian-Language Mobile Apps for Reducing Alcohol Use: Systematic Search and Evaluation %A Bunova,Anna %A Wiemker,Veronika %A Gornyi,Boris %A Ferreira-Borges,Carina %A Neufeld,Maria %+ National Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian Federation, Petroverigskiy Pereulok 10, Moscow, 101990, Russian Federation, 7 9151416154, asbunova@gmail.com %K alcohol %K mHealth %K mobile applications %K screening and brief intervention %K Mobile Application Rating Scale %K App Behavior Change Scale %K mobile phone %D 2022 %7 10.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Personalized prevention tools such as mobile apps designed to reduce alcohol consumption are widespread in mobile app stores accessible in Russia. However, the quality and content of these mobile apps have not been systematically evaluated. Objective: This study aimed to identify Russian-language mobile apps for reducing alcohol use and to evaluate their quality and potential to change alcohol-related health behavior. It further aimed to identify apps that could facilitate screening and brief interventions in primary health care in Russia. Methods: A systematic search for mobile apps available in Russia was carried out between April 1 and 15, 2020, December 1 and 15, 2020, and in March 2021 in the iPhone App Store, Google Play Store, and the 4PDA forum. App quality was assessed using the Mobile App Rating Scale (MARS), and structured searches in electronic libraries and bibliographic databases were used to evaluate the apps’ evidence base. The number of features facilitating changes in lifestyle behavior was assessed using the App Behavior Change Scale (ABACUS). Results: We identified 63 mobile apps for reducing alcohol use. The mean MARS quality ratings were high for the subscales of functionality (3.92 out of 5, SD 0.58) and aesthetics (2.96, SD 0.76) and low for engagement (2.42, SD 0.76) and information (1.65, SD 0.60). Additional searches in electronic libraries and bibliographic databases (eLibrary, CyberLeninka, Google Scholar) yielded no studies involving the identified apps. ABACUS scores ranged from 1 to 15 out of 25, with a mean of 5 (SD 3.24). Two of the identified apps might be useful for screening and brief interventions in Russian primary health care after improvements in content and scientific testing. Conclusions: Russian-language mobile apps for reducing alcohol use are accessible in the app stores. Many of them are aesthetically pleasing, functional, and easy to use. However, information about their scientific trialing or testing is lacking. Most apps contain a low number of features that facilitate changes in lifestyle behavior. Further research should examine the context of Russian-language mobile apps for reducing alcohol use. Our findings underline the need to develop evidence-based apps to mitigate alcohol consumption in Russia and elsewhere. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020167458; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=167458 %M 35006083 %R 10.2196/31058 %U https://mhealth.jmir.org/2022/1/e31058 %U https://doi.org/10.2196/31058 %U http://www.ncbi.nlm.nih.gov/pubmed/35006083 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e31875 %T Nutrient and Food Group Prediction as Orchestrated by an Automated Image Recognition System in a Smartphone App (CALO mama): Validation Study %A Sasaki,Yuki %A Sato,Koryu %A Kobayashi,Satomi %A Asakura,Keiko %+ Link & Communication Inc, Kioicho 4-1, Chiyoda-ku, Tokyo, 102-0094, Japan, 81 3 5210 2721, y.sasaki@linkncom.co.jp %K health app %K image recognition %K automatic calculation %K nutrient and food contents %K validity %K mobile phone %K mHealth %K validation %K nutrition %K diet %K food %D 2022 %7 10.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: A smartphone image recognition app is expected to be a novel tool for measuring nutrients and food intake, but its performance has not been well evaluated. Objective: We assessed the accuracy of the performance of an image recognition app called CALO mama in terms of the nutrient and food group contents automatically estimated by the app. Methods: We prepared 120 meal samples for which the nutrients and food groups were calculated. Next, we predicted the nutrients and food groups included in the meals from their photographs by using (1) automated image recognition only and (2) manual modification after automatic identification. Results: Predictions generated using only image recognition were similar to the actual data on the weight of meals and were accurate for 11 out of 30 nutrients and 4 out of 15 food groups. The app underestimated energy, 19 nutrients, and 9 food groups, while it overestimated dairy products and confectioneries. After manual modification, the predictions were similar for energy, accurately capturing the nutrients for 29 out of 30 of meals and the food groups for 10 out of 15 meals. The app underestimated pulses, fruits, and meats, while it overestimated weight, vitamin C, vegetables, and confectioneries. Conclusions: The results of this study suggest that manual modification after prediction using image recognition improves the performance of the app in assessing the nutrients and food groups of meals. Our findings suggest that image recognition has the potential to achieve a description of the dietary intakes of populations by using “precision nutrition” (a comprehensive and dynamic approach to developing tailored nutritional recommendations) for individuals. %M 35006077 %R 10.2196/31875 %U https://formative.jmir.org/2022/1/e31875 %U https://doi.org/10.2196/31875 %U http://www.ncbi.nlm.nih.gov/pubmed/35006077 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e26526 %T Use of a Mobile Peer Support App Among Young People With Nonsuicidal Self-injury: Small-scale Randomized Controlled Trial %A Kruzan,Kaylee Payne %A Whitlock,Janis %A Bazarova,Natalya N %A Bhandari,Aparajita %A Chapman,Julia %+ Center for Behavioral Intervention Technologies, Northwestern University, 750 N Lake Shore Drive, Chicago, IL, 60611, United States, 1 312 503 6585, kaylee.kruzan@northwestern.edu %K nonsuicidal self-injury %K randomized controlled trial %K mobile app %K peer support %K urges %K digital intervention %D 2022 %7 10.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Nonsuicidal self-injury (NSSI) is a widespread behavior among adolescents and young adults. Although many individuals who self-injure do not seek treatment, there is evidence for web-based help-seeking through web-based communities and mobile peer support networks. However, few studies have rigorously tested the efficacy of such platforms on outcomes relevant for NSSI recovery. Objective: The aim of this small-scale preregistered randomized controlled trial is to provide preliminary insight into the shorter- and longer-term efficacy of the use of a peer support app, TalkLife, in reducing NSSI frequency and urges and increasing readiness to change. In addition, we explore contact with informal support, interest in therapy, and attitudes toward professional help–seeking. Methods: Individuals aged 16-25 years with current (within 3 months) and chronic (>6 episodes in the past year) NSSI history were eligible to participate in this study. After baseline assessments, the intervention group was instructed to use the app actively (eg, post or comment at least three times per week) and the control group received weekly psychoeducational materials through email, for 8 weeks. Follow-up was assessed at 1 month and 2 months. Linear mixed modeling was used to evaluate condition and time point effects for the primary outcomes of NSSI frequency and urges, readiness to change, contact with informal support, interest in therapy, and attitudes toward professional help–seeking. Results: A total of 131 participants were included in the analysis. We evidenced a significant effect of condition on NSSI frequency such that the participants using the peer support app self-injured less over the course of the study (mean 1.30, SE 0.18) than those in the control condition (mean 1.62, SE 0.18; P=.02; η2=0.02). We also evidenced a significant condition effect of readiness to change such that the treatment participants reported greater confidence in their ability to change their NSSI behavior (mean 6.28, SE 0.41) than the control participants (mean 5.67, SE 0.41; P=.04; η2=0.02). No significant differences were observed for contact with informal support, interest in therapy, or attitudes toward professional help–seeking. Conclusions: Use of the peer support app was related to reduced NSSI frequency and greater confidence in one’s ability to change NSSI behavior over the course of the study period, but no effects on NSSI urges, contact with informal support, interest in therapy, or attitudes toward professional help–seeking were observed. The findings provide preliminary support for considering the use of mobile peer support apps as a supplement to NSSI intervention and point to the need for larger-scale trials. Trial Registration: Open Science Foundation; https://osf.io/3uay9 %M 35006076 %R 10.2196/26526 %U https://formative.jmir.org/2022/1/e26526 %U https://doi.org/10.2196/26526 %U http://www.ncbi.nlm.nih.gov/pubmed/35006076 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e30557 %T Enabling Research and Clinical Use of Patient-Generated Health Data (the mindLAMP Platform): Digital Phenotyping Study %A Vaidyam,Aditya %A Halamka,John %A Torous,John %+ Beth Israel Deaconess Medical Center, 330 Brrokline Avenue, Boston, MA, 02215, United States, 1 6176676700, jtorous@bidmc.harvard.edu %K digital phenotyping %K mHealth %K apps %K FHIR %K digital health %K health data %K patient-generated health data %K mobile health %K smartphones %K wearables %K mobile apps %K mental health, mobile phone %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a growing need for the integration of patient-generated health data (PGHD) into research and clinical care to enable personalized, preventive, and interactive care, but technical and organizational challenges, such as the lack of standards and easy-to-use tools, preclude the effective use of PGHD generated from consumer devices, such as smartphones and wearables. Objective: This study outlines how we used mobile apps and semantic web standards such as HTTP 2.0, Representational State Transfer, JSON (JavaScript Object Notation), JSON Schema, Transport Layer Security (version 1.3), Advanced Encryption Standard-256, OpenAPI, HTML5, and Vega, in conjunction with patient and provider feedback to completely update a previous version of mindLAMP. Methods: The Learn, Assess, Manage, and Prevent (LAMP) platform addresses the abovementioned challenges in enhancing clinical insight by supporting research, data analysis, and implementation efforts around PGHD as an open-source solution with freely accessible and shared code. Results: With a simplified programming interface and novel data representation that captures additional metadata, the LAMP platform enables interoperability with existing Fast Healthcare Interoperability Resources–based health care systems as well as consumer wearables and services such as Apple HealthKit and Google Fit. The companion Cortex data analysis and machine learning toolkit offer robust support for artificial intelligence, behavioral feature extraction, interactive visualizations, and high-performance data processing through parallelization and vectorization techniques. Conclusions: The LAMP platform incorporates feedback from patients and clinicians alongside a standards-based approach to address these needs and functions across a wide range of use cases through its customizable and flexible components. These range from simple survey-based research to international consortiums capturing multimodal data to simple delivery of mindfulness exercises through personalized, just-in-time adaptive interventions. %M 34994710 %R 10.2196/30557 %U https://mhealth.jmir.org/2022/1/e30557 %U https://doi.org/10.2196/30557 %U http://www.ncbi.nlm.nih.gov/pubmed/34994710 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e31482 %T App-Based Relaxation Exercises for Patients With Chronic Neck Pain: Pragmatic Randomized Trial %A Pach,Daniel %A Blödt,Susanne %A Wang,Jiani %A Keller,Theresa %A Bergmann,Beatrice %A Rogge,Alizé A %A Barth,Jürgen %A Icke,Katja %A Roll,Stephanie %A Witt,Claudia M %+ Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Sonneggstrasse 6, Zurich, 8091, Switzerland, 41 44 2552396, claudia.witt@uzh.ch %K neck pain %K relaxation %K RCT %K mHealth %K smartphone app %K mobile phone %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic neck pain is a highly prevalent condition. Learning a relaxation technique is recommended by numerous guidelines for chronic neck pain. Smartphone apps can provide relaxation exercises; however, their effectiveness, especially in a self-care setting, is unclear. Objective: The aim of this pragmatic randomized trial is to evaluate whether app-based relaxation exercises, including audio-based autogenic training, mindfulness meditation, or guided imagery, are more effective in reducing chronic neck pain than usual care alone. Methods: Smartphone owners aged 18 to 65 years with chronic (>12 weeks) neck pain and the previous week’s average neck pain intensity ≥4 on the Numeric Rating Scale (0=no pain to 10=worst possible pain) were randomized into either an intervention group to practice app-based relaxation exercises or a control group (usual care and app for data entry only). For both groups, the follow-up data were collected using app-based diaries and questionnaires. The primary outcome was the mean neck pain intensity during the first 3 months based on daily measurements. Secondary outcomes included neck pain based on weekly measurements, pain acceptance, neck pain–related stress, sick-leave days, pain medication intake, and adherence, which were all measured until the 6-month follow-up. For the primary analysis, analysis of covariance adjusted for baseline neck pain intensity was used. Results: We screened 748 participants and enrolled 220 participants (mean age 38.9, SD 11.3 years; mean baseline neck pain 5.7, SD 1.3 points). The mean neck pain intensity in both groups decreased over 3 months; however, no statistically significant difference between the groups was found (intervention: 4.1 points, 95% CI 3.8-4.4; control: 3.8 points, 95% CI 3.5-4.1; group difference: 0.3 points, 95% CI −0.2 to 0.7; P=.23). In addition, no statistically significant between-group differences regarding neck pain intensity after 6 months, responder rate, pain acceptance, pain medication intake, or sick-leave days were observed. There were no serious adverse events that were considered related to the trial intervention. In week 12, only 40% (44/110) of the participants in the intervention group continued to practice the exercises with the app. Conclusions: The study app did not effectively reduce chronic neck pain or keep the participants engaged in exercising in a self-care setting. Future studies on app-based relaxation interventions should take into account the most recent scientific findings for behavior change techniques. Trial Registration: ClinicalTrials.gov NCT02019134; https://clinicaltrials.gov/ct2/show/NCT02019134 International Registered Report Identifier (IRRID): RR2-10.1186/1745-6215-15-490 %M 34994708 %R 10.2196/31482 %U https://mhealth.jmir.org/2022/1/e31482 %U https://doi.org/10.2196/31482 %U http://www.ncbi.nlm.nih.gov/pubmed/34994708 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e32550 %T A Text Messaging–Enhanced Intervention for African American Patients With Heart Failure, Depression, and Anxiety (TXT COPE-HF): Protocol for a Pilot Feasibility Study %A Cornelius,Judith %A Whitaker-Brown,Charlene %A Smoot,Jaleesa %A Hart,Sonia %A Lewis,Zandria %A Smith,Olivia %+ School of Nursing, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, United States, 1 7046877978, jbcornel@uncc.edu %K African American %K heart failure %K depression %K anxiety %K assessment %K decision %K administration %K production %K topical expert %K integration %K training and testing model %K text messaging %K SMS %K minorities %K behavior therapy %D 2022 %7 7.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: African Americans have a higher incidence rate of heart failure (HF) and an earlier age of HF onset compared to those of other racial and ethnic groups. Scientific literature suggests that by 2030, African Americans will have a 30% increased prevalence rate of HF coupled with depression. In addition to depression, anxiety is a predictor of worsening functional capacity, decreased quality of life, and increased hospital readmission rates. There is no consensus on the best way to treat patients with HF, depression, and anxiety. One promising type of treatment—cognitive behavioral therapy (CBT)—has been shown to significantly improve patients’ quality of life and treatment compliance, but CBT has not been used with SMS text messaging reminders to enhance the effect of reducing symptoms of depression and anxiety in racial and ethnic minority patients with HF. Objective: The objectives of our study are to (1) adapt and modify the Creating Opportunities for Personal Empowerment (COPE) curriculum for delivery to patients with HF by using an SMS text messaging component to improve depression and anxiety symptoms, (2) administer the adapted intervention to 10 patients to examine the feasibility and acceptability of the approach and modify it as needed, and (3) examine trends in depression and anxiety symptoms postintervention. We hypothesize that patients will show an improvement in depression scores and anxiety symptoms postintervention. Methods: The study will comprise a mixed methods approach. We will use the eight steps of the ADAPT-ITT (assessment, decision, administration, production, topical expert, integration, training, and testing) model to adapt the intervention. The first step in this feasibility study will involve assembling individuals from the target population (n=10) to discuss questions on a specific topic. In phase 2, we will examine the feasibility and acceptability of the enhanced SMS text messaging intervention (TXT COPE-HF [Texting With COPE for Patients With HF]) and its preliminary effects with 10 participants. The Beck Depression Inventory will be used to assess depression, the State-Trait Anxiety Inventory will be used to assess anxiety, and the Healthy Beliefs and Lifestyle Behavior surveys will be used to assess participants’ lifestyle beliefs and behavior changes. Changes will be compared from baseline to end point by using paired 2-tailed t tests. An exit focus group (n=10) will be held to examine facilitators and barriers to the SMS text messaging protocol. Results: The pilot feasibility study was funded by the Academy for Clinical Research and Scholarship. Institutional review board approval was obtained in April 2021. Data collection and analysis are expected to conclude by November 2021 and April 2022, respectively. Conclusions: The study results will add to the literature on the effectiveness of an SMS text messaging CBT-enhanced intervention in reducing depression and anxiety among African American patients with HF. International Registered Report Identifier (IRRID): PRR1-10.2196/32550 %M 34994709 %R 10.2196/32550 %U https://www.researchprotocols.org/2022/1/e32550 %U https://doi.org/10.2196/32550 %U http://www.ncbi.nlm.nih.gov/pubmed/34994709 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e27418 %T The Views and Needs of People With Parkinson Disease Regarding Wearable Devices for Disease Monitoring: Mixed Methods Exploration %A Kenny,Lorna %A Moore,Kevin %A O' Riordan,Clíona %A Fox,Siobhan %A Barton,John %A Tedesco,Salvatore %A Sica,Marco %A Crowe,Colum %A Alamäki,Antti %A Condell,Joan %A Nordström,Anna %A Timmons,Suzanne %+ Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, St Finbarr's Hospital, Douglas Road, Cork, T12 XH60, Ireland, 353 851085070, lorna.kenny@ucc.ie %K Parkinson disease %K wearable devices %K technology %K mixed method %K focus group %K survey %K mobile phone %D 2022 %7 6.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Wearable devices can diagnose, monitor, and manage neurological disorders such as Parkinson disease. With a growing number of wearable devices, it is no longer a case of whether a wearable device can measure Parkinson disease motor symptoms, but rather which features suit the user. Concurrent with continued device development, it is important to generate insights on the nuanced needs of the user in the modern era of wearable device capabilities. Objective: This study aims to understand the views and needs of people with Parkinson disease regarding wearable devices for disease monitoring and management. Methods: This study used a mixed method parallel design, wherein survey and focus groups were concurrently conducted with people living with Parkinson disease in Munster, Ireland. Surveys and focus group schedules were developed with input from people with Parkinson disease. The survey included questions about technology use, wearable device knowledge, and Likert items about potential device features and capabilities. The focus group participants were purposively sampled for variation in age (all were aged >50 years) and sex. The discussions concerned user priorities, perceived benefits of wearable devices, and preferred features. Simple descriptive statistics represented the survey data. The focus groups analyzed common themes using a qualitative thematic approach. The survey and focus group analyses occurred separately, and results were evaluated using a narrative approach. Results: Overall, 32 surveys were completed by individuals with Parkinson disease. Four semistructured focus groups were held with 24 people with Parkinson disease. Overall, the participants were positive about wearable devices and their perceived benefits in the management of symptoms, especially those of motor dexterity. Wearable devices should demonstrate clinical usefulness and be user-friendly and comfortable. Participants tended to see wearable devices mainly in providing data for health care professionals rather than providing feedback for themselves, although this was also important. Barriers to use included poor hand function, average technology confidence, and potential costs. It was felt that wearable device design that considered the user would ensure better compliance and adoption. Conclusions: Wearable devices that allow remote monitoring and assessment could improve health care access for patients living remotely or are unable to travel. COVID-19 has increased the use of remotely delivered health care; therefore, future integration of technology with health care will be crucial. Wearable device designers should be aware of the variability in Parkinson disease symptoms and the unique needs of users. Special consideration should be given to Parkinson disease–related health barriers and the users’ confidence with technology. In this context, a user-centered design approach that includes people with Parkinson disease in the design of technology will likely be rewarded with improved user engagement and the adoption of and compliance with wearable devices, potentially leading to more accurate disease management, including self-management. %M 34989693 %R 10.2196/27418 %U https://formative.jmir.org/2022/1/e27418 %U https://doi.org/10.2196/27418 %U http://www.ncbi.nlm.nih.gov/pubmed/34989693 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e25586 %T Dose–Response Effects of Patient Engagement on Health Outcomes in an mHealth Intervention: Secondary Analysis of a Randomized Controlled Trial %A Li,Yiran %A Guo,Yan %A Hong,Y Alicia %A Zeng,Yu %A Monroe-Wise,Aliza %A Zeng,Chengbo %A Zhu,Mengting %A Zhang,Hanxi %A Qiao,Jiaying %A Xu,Zhimeng %A Cai,Weiping %A Li,Linghua %A Liu,Cong %+ Department of Medical Statistics, School of Public Health, 74 Zhongshan 2nd Road, Guangzhou, 510080, China, 86 020 87333239, Yan.Guo1@umassmed.edu %K mHealth %K patient engagement %K dose–response relationship %K long-term effect %K generalized linear mixed effects model %D 2022 %7 4.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The dose–response relationship between patient engagement and long-term intervention effects in mobile health (mHealth) interventions are understudied. Studies exploring long-term and potentially changing relationships between patient engagement and health outcomes in mHealth interventions are needed. Objective: This study aims to examine dose–response relationships between patient engagement and 3 psychosocial outcomes in an mHealth intervention, Run4Love, using repeated measurements of outcomes at baseline and 3, 6, and 9 months. Methods: This study is a secondary analysis using longitudinal data from the Run4Love trial, a randomized controlled trial with 300 people living with HIV and elevated depressive symptoms to examine the effects of a 3-month mHealth intervention on reducing depressive symptoms and improving quality of life (QOL). We examined the relationships between patient engagement and depressive symptoms, QOL, and perceived stress in the intervention group (N=150) using 4–time-point outcome measurements. Patient engagement was assessed using the completion rate of course assignments and frequency of items completed. Cluster analysis was used to categorize patients into high- and low-engagement groups. Generalized linear mixed effects models were conducted to investigate the dose–response relationships between patient engagement and outcomes. Results: The cluster analysis identified 2 clusters that were distinctively different from each other. The first cluster comprised 72 participants with good compliance to the intervention, completing an average of 74% (53/72) of intervention items (IQR 0.22). The second cluster comprised 78 participants with low compliance to the intervention, completing an average of 15% (11/72) of intervention items (IQR 0.23). Results of the generalized linear mixed effects models showed that, compared with the low-engagement group, the high-engagement group had a significant reduction in more depressive symptoms (β=−1.93; P=.008) and perceived stress (β=−1.72; P<.001) and an improved QOL (β=2.41; P=.01) over 9 months. From baseline to 3, 6, and 9 months, the differences in depressive symptoms between the 2 engagement groups were 0.8, 1.6, 2.3, and 3.7 points, respectively, indicating widening between-group differences over time. Similarly, between-group differences in QOL and perceived stress increased over time (group differences in QOL: 0.9, 1.9, 4.7, and 5.1 points, respectively; group differences in the Perceived Stress Scale: 0.9, 1.4, 2.3, and 3.0 points, respectively). Conclusions: This study revealed a positive long-term dose–response relationship between patient engagement and 3 psychosocial outcomes among people living with HIV and elevated depressive symptoms in an mHealth intervention over 9 months using 4 time-point repeat measurement data. The high- and low-engagement groups showed significant and widening differences in depressive symptoms, QOL, and perceived stress at the 3-, 6-, and 9-month follow-ups. Future mHealth interventions should improve patient engagement to achieve long-term and sustained intervention effects. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://www.chictr.org.cn/showproj.aspx?proj=21019 %M 34982724 %R 10.2196/25586 %U https://mhealth.jmir.org/2022/1/e25586 %U https://doi.org/10.2196/25586 %U http://www.ncbi.nlm.nih.gov/pubmed/34982724 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e25375 %T Ecological Momentary Assessment of Physical Activity and Wellness Behaviors in College Students Throughout a School Year: Longitudinal Naturalistic Study %A Bai,Yang %A Copeland,William E %A Burns,Ryan %A Nardone,Hilary %A Devadanam,Vinay %A Rettew,Jeffrey %A Hudziak,James %+ Department of Health and Kinesiology, College of Health, University of Utah, HPER-North, Room 204, Salt Lake City, UT, 84102, United States, 1 8015870482, yang.bai@utah.edu %K young adulthood %K wellness %K substance use %K Apple Watch %D 2022 %7 4.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Wellness Environment app study is a longitudinal study focused on promoting health in college students. Objective: The two aims of this study were (1) to assess physical activity (PA) variation across the days of the week and throughout the academic year and (2) to explore the correlates that were associated with PA, concurrently and longitudinally. Methods: The participants were asked to report their wellness and risk behaviors on a 14-item daily survey through a smartphone app. Each student was provided an Apple Watch to track their real time PA. Data were collected from 805 college students from Sept 2017 to early May 2018. PA patterns across the days of the week and throughout the academic year were summarized. Concurrent associations of daily steps with wellness or risk behavior were tested in the general linear mixed-effects model. The longitudinal, reciprocal association between daily steps and health or risk behaviors were tested with cross-lagged analysis. Results: Female college students were significantly more active than male ones. The students were significantly more active during the weekday than weekend. Temporal patterns also revealed that the students were less active during Thanksgiving, winter, and spring breaks. Strong concurrent positive correlations were found between higher PA and self-reported happy mood, 8+ hours of sleep, ≥1 fruit and vegetable consumption, ≥4 bottles of water intake, and ≤2 hours of screen time (P<.001). Similar longitudinal associations found that the previous day’s wellness behaviors independently predicted the following day’s higher PA except for mood. Conversely, the higher previous-day PA levels were associated with better mood, more fruit and vegetable consumption, and playing less music, but with higher liquor consumption the next day. Conclusions: This study provides a comprehensive surveillance of longitudinal PA patterns and their independent association with a variety of wellness and risk behaviors in college students. %M 34982721 %R 10.2196/25375 %U https://publichealth.jmir.org/2022/1/e25375 %U https://doi.org/10.2196/25375 %U http://www.ncbi.nlm.nih.gov/pubmed/34982721 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e34054 %T Multipurpose Mobile Apps for Mental Health in Chinese App Stores: Content Analysis and Quality Evaluation %A Wu,Xiaoqian %A Xu,Lin %A Li,PengFei %A Tang,TingTing %A Huang,Cheng %+ College of Medical Informatics, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China, 86 023 6848 0060, huangcheng@cqmu.edu.cn %K mobile apps %K app %K mental health %K mHealth %K content analysis %D 2022 %7 4.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental disorders impose varying degrees of burden on patients and their surroundings. However, people are reluctant to take the initiative to seek mental health services because of the uneven distribution of resources and stigmatization. Thus, mobile apps are considered an effective way to eliminate these obstacles and improve mental health awareness. Objective: This study aims to evaluate the quality, function, privacy measures, and evidence-based and professional background of multipurpose mental health apps in Chinese commercial app stores. Methods: A systematic search was conducted on iOS and Android platforms in China to identify multipurpose mental health apps. Two independent reviewers evaluated the identified mobile apps using the Mobile App Rating Scale (MARS). Each app was downloaded, and the general characteristics, privacy and security measures, development background, and functional characteristics of each app were evaluated. Results: A total of 40 apps were analyzed, of which 35 (87.5%) were developed by companies and 33 (82.5%) provided links to access the privacy policy; 21 (52.5%) apps did not mention the involvement of relevant professionals or the guidance of a scientific basis in the app development process. The main built-in functions of these apps include psychological education (38/40, 95%), self-assessment (34/40, 85%), and counseling (33/40, 82.5%). The overall quality average MARS score of the 40 apps was 3.54 (SD 0.39), and the total score was between 2.96 and 4.30. The total MARS score was significantly positively correlated with the scores of each subscale (r=0.62-0.88, P<.001). However, the user score of the app market was not significantly correlated with the total MARS score (r=0.17, P=.33). Conclusions: The quality of multipurpose mental health apps in China’s main app market is generally good. However, health professionals are less involved in the development of these apps, and the privacy protection policy of the apps also needs to be described in more detail. This study provides a reference for the development of multipurpose mental health apps. %M 34982717 %R 10.2196/34054 %U https://mhealth.jmir.org/2022/1/e34054 %U https://doi.org/10.2196/34054 %U http://www.ncbi.nlm.nih.gov/pubmed/34982717 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e30352 %T A Mobile App to Increase Fruit and Vegetable Acceptance Among Finnish and Polish Preschoolers: Randomized Trial %A Vepsäläinen,Henna %A Skaffari,Essi %A Wojtkowska,Katarzyna %A Barlińska,Julia %A Kinnunen,Satu %A Makkonen,Riikka %A Heikkilä,Maria %A Lehtovirta,Mikko %A Ray,Carola %A Suhonen,Eira %A Nevalainen,Jaakko %A Sajaniemi,Nina %A Erkkola,Maijaliisa %+ Department of Food and Nutrition, University of Helsinki, PO Box 66, Helsinki, 00014, Finland, 358 443581467, henna.vepsalainen@helsinki.fi %K gamification %K intervention %K behavior change %K health game %K games for health %K smartphone app %K mobile phone %D 2022 %7 4.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Early childhood education and care (ECEC) centers are ideal venues for food education. As smartphones and tablets are becoming increasingly popular in ECEC centers, technology can be used to deliver such pedagogical content. Evidence suggests that video games can affect fruit and vegetable (FV) consumption among 9- to 12-year-old children, but studies among preschoolers are scarce. Objective: This paper describes the development of the Mole’s Veggie Adventures app and its effectiveness in increasing FV acceptance among Finnish and Polish preschoolers aged 3 to 6 years. Methods: A multiprofessional team created an app to be used in ECEC centers in groups of 3 to 10 children. The app aimed to increase vegetable acceptance, and it was built using elements that support the development of self-regulation and social skills. Altogether, 7 Finnish and 4 Polish ECEC centers participated in the study. Before randomization, parents reported background factors and their children’s willingness to taste different FVs. The ECEC professionals in the intervention arm were instructed to use the app at least once a week during the 3- to 4-week intervention period. The main outcomes in this unblinded, cluster-randomized study were FV acceptance and relative FV acceptance. The first was calculated as a sum variable describing the children’s willingness to taste 25 different FVs, the second as FV acceptance divided by the number of FVs served. We used analysis of covariance to compare the FV acceptance and relative FV acceptance scores between the intervention and control groups at follow-up. Results: A total of 221 children were included in the analysis. At follow-up, the intervention group (115/221, 52%) had higher FV acceptance scores (baseline adjusted difference of mean 7.22; 95% CI 1.41-13.03) than the control group (106/221, 48%). The intervention effect was parallel for relative FV acceptance scores (baseline adjusted difference of mean 0.28; 95% CI 0.05-0.52). Conclusions: The Mole’s Veggie Adventures app has the potential to increase FV acceptance among preschoolers and can be a valuable tool in supporting food education in ECEC centers. Furthermore, the app can be feasibly incorporated into preschool routines in countries with different educational environments. Trial Registration: ClinicalTrials.gov NCT05173311; https://tinyurl.com/4vfbh283 %M 34982718 %R 10.2196/30352 %U https://mhealth.jmir.org/2022/1/e30352 %U https://doi.org/10.2196/30352 %U http://www.ncbi.nlm.nih.gov/pubmed/34982718 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e22582 %T A Smartphone App for Attentional Bias Retraining in Smokers: Mixed Methods Pilot Study %A Choo,Carol C %A Tan,Yi Zhuang %A Zhang,Melvyn W B %+ Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Level 18 Family Medicine and Primary Care, Singapore, 308322, Singapore, 65 63892000, melvynzhangweibin@gmail.com %K attentional bias retraining %K smartphone app %K mixed methods %K smoking %K mobile phone %D 2022 %7 3.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is a global health threat. Attentional bias influences smoking behaviors. Although attentional bias retraining has shown benefits and recent advances in technology suggest that attentional bias retraining can be delivered via smartphone apps, there is a paucity of research on this topic. Objective: This study aims to address this gap by exploring the use of attentional bias retraining via a novel smartphone app using a mixed methods pilot study. In the quantitative phase, it is hypothesized that participants in the training group who undertake attentional bias retraining via the app should have decreased levels of attentional bias, subjective craving, and smoking frequency, compared with those in the control group who do not undertake attentional bias retraining. The qualitative phase explores how the participants perceive and experience the novel app. Methods: In all, 10 adult smokers (3 females and 7 males) between the ages of 26 and 56 years (mean 34.4 years, SD 9.97 years) were recruited. The participants were randomly allocated to the training and control groups. In weeks 1 and 3, participants from both groups attempted the standard visual probe task and rated their smoking frequency and subjective craving. In week 2, the participants in the training group attempted the modified visual probe task. After week 3, participants from both groups were interviewed about their views and experiences of the novel app. Results: The results of the quantitative analysis did not support this study’s hypothesis. The qualitative data were analyzed using thematic analysis. The results yielded 5 themes: ease, helpfulness, unhelpful aspects, barriers, and refinement. Conclusions: Findings from the qualitative study were consistent with those from previous studies on health-related smartphone apps. The qualitative results were helpful in understanding the user perspectives and experiences of the novel app, indicating that future research in this innovative area is necessary. %M 34982037 %R 10.2196/22582 %U https://formative.jmir.org/2022/1/e22582 %U https://doi.org/10.2196/22582 %U http://www.ncbi.nlm.nih.gov/pubmed/34982037 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e31890 %T Detection of Clenbuterol-Induced Changes in Heart Rate Using At-Home Recorded Smartwatch Data: Randomized Controlled Trial %A Elzinga,Willem O %A Prins,Samantha %A Borghans,Laura G J M %A Gal,Pim %A Vargas,Gabriel A %A Groeneveld,Geert J %A Doll,Robert J %+ Centre for Human Drug Research, Zernikedreef 8, Leiden, 2333CL, Netherlands, 31 715246400, rjdoll@chdr.nl %K photoplethysmography %K smartwatch %K wearable %K at-home %K heart rate %K RCT %K wearable device %K digital health %K cardiovascular %K cardiology %K sensors %K heart rate sensor %K smart technology %D 2021 %7 30.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Although electrocardiography is the gold standard for heart rate (HR) recording in clinical trials, the increasing availability of smartwatch-based HR monitors opens up possibilities for drug development studies. Smartwatches allow for inexpensive, unobtrusive, and continuous HR estimation for potential detection of treatment effects outside the clinic, during daily life. Objective: The aim of this study is to evaluate the repeatability and sensitivity of smartwatch-based HR estimates collected during a randomized clinical trial. Methods: The data were collected as part of a multiple-dose, investigator-blinded, randomized, placebo-controlled, parallel-group study of 12 patients with Parkinson disease. After a 6-day baseline period, 4 and 8 patients were treated for 7 days with an ascending dose of placebo and clenbuterol, respectively. Throughout the study, the smartwatch provided HR and sleep state estimates. The HR estimates were quantified as the 2.5th, 50th, and 97.5th percentiles within awake and asleep segments. Linear mixed models were used to calculate the following: (1) the intraclass correlation coefficient (ICC) of estimated sleep durations, (2) the ICC and minimum detectable effect (MDE) of the HR estimates, and (3) the effect sizes of the HR estimates. Results: Sleep duration was moderately repeatable (ICC=0.64) and was not significantly affected by study day (P=.83), clenbuterol (P=.43), and study day by clenbuterol (P=.73). Clenbuterol-induced changes were detected in the asleep HR as of the first night (+3.79 beats per minute [bpm], P=.04) and in the awake HR as of the third day (+8.79 bpm, P=.001). The median HR while asleep had the highest repeatability (ICC=0.70). The MDE (N=12) was found to be smaller when patients were asleep (6.8 bpm to 11.7 bpm) than while awake (10.7 bpm to 22.1 bpm). Overall, the effect sizes for clenbuterol-induced changes were higher while asleep (0.49 to 2.75) than while awake (0.08 to 1.94). Conclusions: We demonstrated the feasibility of using smartwatch-based HR estimates to detect clenbuterol-induced changes during clinical trials. The asleep HR estimates were most repeatable and sensitive to treatment effects. We conclude that smartwatch-based HR estimates obtained during daily living in a clinical trial can be used to detect and track treatment effects. Trial Registration: Netherlands Trials Register NL8002; https://www.trialregister.nl/trial/8002 %M 34967757 %R 10.2196/31890 %U https://formative.jmir.org/2021/12/e31890 %U https://doi.org/10.2196/31890 %U http://www.ncbi.nlm.nih.gov/pubmed/34967757 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e24792 %T Evaluation of a Healthy Relationship Smartphone App With Indigenous Young People: Protocol for a Co-designed Stepped Wedge Randomized Trial %A Koziol-McLain,Jane %A Wilson,Denise %A Vandal,Alain C %A Eruera,Moana %A Nada-Raja,Shyamala %A Dobbs,Terry %A Roguski,Michael %A Barbarich-Unasa,Te Wai %+ Centre for Interdisciplinary Trauma Research, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand, 64 211213474, jane.koziol-mclain@aut.ac.nz %K indigenous %K Māori %K young people %K relationships %K school %K mHealth %K smartphone app %K mobile phone %D 2021 %7 30.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: We co-designed a smartphone app, Harmonised, with taitamariki (young people aged 13-17 years) to promote healthy intimate partner relationships. The app also provides a pathway for friends and family, or whānau (indigenous Māori extended family networks), to learn how to offer better support to taitamariki. Objective: The aim of our taitamariki- and Māori-centered study is to evaluate the implementation of the app in secondary schools. The study tests the effectiveness of the app in promoting taitamariki partner relationship self-efficacy (primary outcome). Methods: We co-designed a pragmatic, randomized, stepped wedge trial (retrospectively registered on September 12, 2019) for 8 Aotearoa, New Zealand, secondary schools (years 9 through 13). The schools were randomly assigned to implement the app in 1 of the 2 school terms. A well-established evaluation framework (RE-AIM [Reach, Effectiveness, Adoption, Implementation, Maintenance]) guided the selection of mixed data collection methods. Our target sample size is 600 taitamariki enrolled across the 8 schools. Taitamariki will participate by completing 5 web-based surveys over a 15-month trial period. Taitamariki partner relationship self-efficacy (primary outcome) and well-being, general health, cybersafety management, and connectedness (secondary outcomes) will be assessed with each survey. The general effectiveness hypotheses will be tested by using a linear mixed model with nested participant, year-group, and school random effects. The primary analysis will also include testing effectiveness in the Māori subgroup. Results: The study was funded by the New Zealand Ministry of Business, Innovation, and Employment in October 2015 and approved by the Auckland University of Technology Ethics Committee on May 3, 2017 (application number: 17/71). Conclusions: This study will generate robust evidence evaluating the impact of introducing a healthy relationship app in secondary schools on taitamariki partner relationship self-efficacy, well-being, general health, cybersafety management, and connectedness. This taitamariki- and indigenous Māori–centered research fills an important gap in developing and testing strengths-based mobile health interventions in secondary schools. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001262190; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377584 International Registered Report Identifier (IRRID): RR1-10.2196/24792 %M 34967750 %R 10.2196/24792 %U https://www.researchprotocols.org/2021/12/e24792 %U https://doi.org/10.2196/24792 %U http://www.ncbi.nlm.nih.gov/pubmed/34967750 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e26356 %T Personalized Reminders for Immunization Using Short Messaging Systems to Improve Human Papillomavirus Vaccination Series Completion: Parallel-Group Randomized Trial %A Wynn,Chelsea S %A Catallozzi,Marina %A Kolff,Chelsea A %A Holleran,Stephen %A Meyer,Dodi %A Ramakrishnan,Rajasekhar %A Stockwell,Melissa S %+ Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, 622 W 168th St, VC 417, New York, NY, 10032, United States, 1 212 342 5732, mss2112@cumc.columbia.edu %K text messaging %K mobile reminders %K human papillomavirus %K adolescent %K text reminders %K vaccine completion %K vaccine decision-making %K vaccine education %K transtheoretical model %K mobile phone %K smartphone %K mHealth %K mobile health %K minority health %D 2021 %7 27.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Completion rates among adolescents who initiate the human papillomavirus (HPV) vaccine 3-dose series are low. SMS text message vaccine reminders are effective, but less is known about the best types for HPV series completion or the ability to assess and target vaccine decision-making stage. Objective: The aim of this study is to compare the effectiveness of HPV vaccine series completion in minority adolescents who received precision and educational versus conventional SMS text message reminders. Methods: Enrolled parents of adolescents aged 9-17 years who received the first HPV vaccine dose at 1 of the 4 academic-affiliated community health clinics in New York City were randomized 1:1 to 1 of the 2 parallel, unblinded arms: precision SMS text messages (which included stage-targeted educational information, next dose due date, and site-specific walk-in hours) or conventional SMS text messages without educational information. Randomization was stratified according to gender, age, and language. The primary outcome was series completion within 12 months. In post hoc analysis, enrollees were compared with concurrent nonenrollees and historical controls. Results: Overall, 956 parents were enrolled in the study. The precision (475 families) and conventional (481 families) SMS text message arms had similarly high series completion rates (344/475, 72.4% vs 364/481, 75.7%). A total of 42 days after the first dose, two-thirds of families, not initially in the preparation stage, moved to preparation or vaccinated stage. Those in either SMS text message arm had significantly higher completion rates than nonenrollees (708/1503, 47.1% vs 679/1503, 45.17%; P<.001). Even after removing those needing only 2 HPV doses, adolescents receiving any SMS text messages had higher completion rates than historical controls (337/2823, 11.93% vs 981/2823, 34.75%; P<.001). A population-wide effect was seen from 2014 to 2016, above historical trends. Conclusions: SMS text message reminders led to timely HPV vaccine series completion in a low-income, urban, minority study population and also led to population-wide effects. Educational information did not provide an added benefit to this population. Trial Registration: ClinicalTrials.gov NCT02236273; https://clinicaltrials.gov/ct2/show/NCT02236273 %M 34958306 %R 10.2196/26356 %U https://mhealth.jmir.org/2021/12/e26356 %U https://doi.org/10.2196/26356 %U http://www.ncbi.nlm.nih.gov/pubmed/34958306 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e30767 %T Perceptions of Older Men Using a Mobile Health App to Monitor Lower Urinary Tract Symptoms and Tamsulosin Side Effects: Mixed Methods Study %A Wang,Elizabeth Y %A Breyer,Benjamin N %A Lee,Austin W %A Rios,Natalie %A Oni-Orisan,Akinyemi %A Steinman,Michael A %A Sim,Ida %A Kenfield,Stacey A %A Bauer,Scott R %+ University of California San Francisco, 550 16th St, 6th floor, Box 1695, San Francisco, CA, 94121, United States, 1 4152214810 ext 24322, Scott.Bauer@ucsf.edu %K BPH %K mobile health %K mHealth %K telehealth %K telemedicine %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile health (mHealth) apps may provide an efficient way for patients with lower urinary tract symptoms (LUTS) to log and communicate symptoms and medication side effects with their clinicians. Objective: The aim of this study was to explore the perceptions of older men with LUTS after using an mHealth app to track their symptoms and tamsulosin side effects. Methods: Structured phone interviews were conducted after a 2-week study piloting the daily use of a mobile app to track the severity of patient-selected LUTS and tamsulosin side effects. Quantitative and qualitative data were considered. Results: All 19 (100%) pilot study participants completed the poststudy interviews. Most of the men (n=13, 68%) reported that the daily questionnaires were the right length, with 32% (n=6) reporting that the questionnaires were too short. Men with more severe symptoms were less likely to report changes in perception of health or changes in self-management; 47% (n=9) of the men reported improved awareness of symptoms and 5% (n=1) adjusted fluid intake based on the questionnaire. All of the men were willing to share app data with their clinicians. Thematic analysis of qualitative data yielded eight themes: (1) orientation (setting up app, format, symptom selection, and side-effect selection), (2) triggers (routine or habit and symptom timing), (3) daily questionnaire (reporting symptoms, reporting side effects, and tailoring), (4) technology literacy, (5) perceptions (awareness, causation or relevance, data quality, convenience, usefulness, and other apps), (6) self-management, (7) clinician engagement (communication and efficiency), and (8) improvement (reference materials, flexibility, language, management recommendations, and optimize clinician engagement). Conclusions: We assessed the perceptions of men using an mHealth app to monitor and improve management of LUTS and medication side effects. LUTS management may be further optimized by tailoring the mobile app experience to meet patients’ individual needs, such as tracking a greater number of symptoms and integrating the app with clinicians’ visits. mHealth apps are likely a scalable modality to monitor symptoms and improve care of older men with LUTS. Further study is required to determine the best ways to tailor the mobile app and to communicate data to clinicians or incorporate data into the electronical medical record meaningfully. %M 34951599 %R 10.2196/30767 %U https://humanfactors.jmir.org/2021/4/e30767 %U https://doi.org/10.2196/30767 %U http://www.ncbi.nlm.nih.gov/pubmed/34951599 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e32932 %T A Smartphone-Based Self-management Intervention for Individuals With Bipolar Disorder (LiveWell): Protocol Development for an Expert System to Provide Adaptive User Feedback %A Goulding,Evan H %A Dopke,Cynthia A %A Michaels,Tania %A Martin,Clair R %A Khiani,Monika A %A Garborg,Christopher %A Karr,Chris %A Begale,Mark %+ Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Suite 7-102, 303 East Chicago Ave, Chicago, IL, 60611, United States, 1 312 503 1189, e-goulding@fsm.northwestern.edu %K adaptive %K personalized %K self-management %K smartphone %K behavioral intervention technology %K mHealth %K bipolar disorder %K depression %K mania %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Bipolar disorder is a severe mental illness that results in significant morbidity and mortality. While pharmacotherapy is the primary treatment, adjunctive psychotherapy can improve outcomes. However, access to therapy is limited. Smartphones and other technologies can increase access to therapeutic strategies that enhance self-management while simultaneously augmenting care by providing adaptive delivery of content to users as well as alerts to providers to facilitate clinical care communication. Unfortunately, while adaptive interventions are being developed and tested to improve care, information describing the components of adaptive interventions is often not published in sufficient detail to facilitate replication and improvement of these interventions. Objective: To contribute to and support the improvement and dissemination of technology-based mental health interventions, we provide a detailed description of the expert system for adaptively delivering content and facilitating clinical care communication for LiveWell, a smartphone-based self-management intervention for individuals with bipolar disorder. Methods: Information from empirically supported psychotherapies for bipolar disorder, health psychology behavior change theories, and chronic disease self-management models was combined with user-centered design data and psychiatrist feedback to guide the development of the expert system. Results: Decision points determining the timing of intervention option adaptation were selected to occur daily and weekly based on self-report data for medication adherence, sleep duration, routine, and wellness levels. These data were selected for use as the tailoring variables determining which intervention options to deliver when and to whom. Decision rules linking delivery of options and tailoring variable thresholds were developed based on existing literature regarding bipolar disorder clinical status and psychiatrist feedback. To address the need for treatment adaptation with varying clinical statuses, decision rules for a clinical status state machine were developed using self-reported wellness rating data. Clinical status from this state machine was incorporated into hierarchal decision tables that select content for delivery to users and alerts to providers. The majority of the adaptive content addresses sleep duration, medication adherence, managing signs and symptoms, building and utilizing support, and keeping a regular routine, as well as determinants underlying engagement in these target behaviors as follows: attitudes and perceptions, knowledge, support, evaluation, and planning. However, when problems with early warning signs, symptoms, and transitions to more acute clinical states are detected, the decision rules shift the adaptive content to focus on managing signs and symptoms, and engaging with psychiatric providers. Conclusions: Adaptive mental health technologies have the potential to enhance the self-management of mental health disorders. The need for individuals with bipolar disorder to engage in the management of multiple target behaviors and to address changes in clinical status highlights the importance of detailed reporting of adaptive intervention components to allow replication and improvement of adaptive mental health technologies for complex mental health problems. %M 34951598 %R 10.2196/32932 %U https://formative.jmir.org/2021/12/e32932 %U https://doi.org/10.2196/32932 %U http://www.ncbi.nlm.nih.gov/pubmed/34951598 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30578 %T A Pragmatic Intervention Using Financial Incentives for Pregnancy Weight Management: Feasibility Randomized Controlled Trial %A Krukowski,Rebecca %A Johnson,Brandi %A Kim,Hyeonju %A Sen,Saunak %A Homsi,Riad %+ Department of Public Health Science, University of Virginia, PO Box 800765, Charlottesville, VA, 22908-0765, United States, 1 434 924 1000, bkrukowski@virginia.edu %K pregnancy %K weight %K physical activity %K self-weighing %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Excessive gestational weight gain (GWG) is common and can result in maternal and child health complications. Pragmatic behavioral interventions that can be incorporated into standard obstetric care are needed, and financial incentives are a promising approach. Objective: The aim of this study is to evaluate the feasibility of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, in a behavioral program. The program provided small incentives for meeting behavioral goals of self-weighing and physical activity as well as larger outcome incentives for meeting GWG goals. Methods: We recruited 40 adult women in their first trimester of pregnancy from February 2019 to September 2019 at an obstetric clinic. Participants were randomized to 3 intervention components using a 2×2×2 factorial design: daily incentives for self-weighing (lottery vs certain loss), incentives for adhering to the Institute of Medicine’s GWG guidelines based on BMI category (monthly vs overall), and incentives for reaching physical activity goals (yes vs no). Participants were asked to complete daily weigh-ins using the Withings Body wireless scale provided by the study, as well as wear a physical activity tracker (Fitbit Flex 2). Feasibility outcomes of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, were assessed. Weight assessments were conducted at baseline, 32-week gestation, and 36-week gestation. Results: Participants were enrolled at, on average, 9.6 (SD 1.8) weeks’ gestation. Of the 39 participants who were oriented to their condition and received the intervention, 24 (62%) were Black or African American, 30 (77%) were not married, and 29 (74%) had an annual household income of less than US $50,000. Of the 39 participants, 35 (90%) completed the follow-up data collection visit. Participants were generally quite positive about the intervention components, with a particular emphasis on the helpfulness of, and the enjoyment of using, the e-scale in both the quantitative and qualitative feedback. Participants who received the loss incentive, on average, had 2.86 times as many days of self-weighing as those who received the lottery incentive. Participants had a relatively low level of activity, with no difference between those who received a physical activity incentive and those who did not. Conclusions: A financial incentive–based pragmatic intervention was feasible and acceptable for pregnant women for promoting self-weighing, physical activity, and healthy GWG. Participants were successfully recruited early in their first trimester of pregnancy and retained for follow-up data collection in the third trimester. Participants demonstrated promising engagement in self-weighing, particularly with loss-based incentives, and reported finding the self-weighing especially helpful. This study supports further investigation of pragmatic, clinic-based financial incentive–based interventions for healthy GWG behaviors. Trial Registration: ClinicalTrials.gov NCT03834194; https://clinicaltrials.gov/ct2/show/NCT03834194 %M 34951594 %R 10.2196/30578 %U https://formative.jmir.org/2021/12/e30578 %U https://doi.org/10.2196/30578 %U http://www.ncbi.nlm.nih.gov/pubmed/34951594 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30268 %T Acceptability of an mHealth App for Youth With Substance Use and Mental Health Needs: Iterative, Mixed Methods Design %A Adams,Zachary %A Grant,Miyah %A Hupp,Samantha %A Scott,Taylor %A Feagans,Amanda %A Phillips,Meredith Lois %A Bixler,Kristina %A Nallam,Phani Teja %A La Putt,Dorothy %+ Department of Psychiatry, Indiana University School of Medicine, 340 W 10th St., Indianapolis, IN, 46202, United States, 1 317 278 0591, zwadams@iu.edu %K mobile health %K user-centered design %K adolescents %K substance use disorders %K mental health %K mHealth %K cognitive behavioral therapy %K homework %K technology acceptance model %K trauma %K mobile phone %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Treating substance use disorders (SUDs) during adolescence can prevent adult addiction and improve youth outcomes. However, it can be challenging to keep adolescents with SUDs engaged in ongoing services, thus limiting potential benefits. Developmentally appropriate tools are needed to improve treatment engagement during and between sessions for youth with SUDs and mental health disorders. Mobile health apps may augment or replace psychotherapy components; however, few have been developed specifically for youth with SUDs following user-guided design principles, which may limit their appropriateness and utility. Formative research on acceptability to intended end users is needed before the efficacy of such tools can be examined. Objective: This study involves user-centered, iterative development and initial user testing of a web-based app for adolescents with SUDs and mental health concerns. Methods: Adolescents aged 14 to 17 years with past-year involvement in outpatient psychotherapy and behavioral health clinicians with adolescent SUD treatment caseloads were recruited. Across 2 assessment phases, 40 participants (alpha: 10 youths and 10 clinicians; beta: 10 youths and 10 clinicians) viewed an app demonstration and completed semistructured interviews and questionnaires about app content and functionality. Results: Participants expressed positive impressions of the app and its potential utility in augmenting outpatient therapy for youth with SUDs and mental health concerns. Noted strengths included valuable educational content, useful embedded resources, and a variety of activities. Adolescents and clinicians favored the app over conventional (paper-and-pencil) modalities, citing convenience and familiarity. The app was found to be user-friendly and likely to improve treatment engagement. Adolescents suggested the inclusion of privacy settings, and clinicians recommended more detailed instructions and simplified language. Conclusions: The novel app developed here appears to be a promising, acceptable, and highly scalable resource to support adolescents with SUDs and mental health concerns. Future studies should test the efficacy of such apps in enhancing adolescent behavioral health treatment engagement and outcomes. %M 34951593 %R 10.2196/30268 %U https://formative.jmir.org/2021/12/e30268 %U https://doi.org/10.2196/30268 %U http://www.ncbi.nlm.nih.gov/pubmed/34951593 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e31618 %T Identifying Data Quality Dimensions for Person-Generated Wearable Device Data: Multi-Method Study %A Cho,Sylvia %A Weng,Chunhua %A Kahn,Michael G %A Natarajan,Karthik %+ Department of Biomedical Informatics, Columbia University, 622 West 168th Street PH20, New York, NY, 10032, United States, 1 212 305 5334, sc3901@cumc.columbia.edu %K patient-generated health data %K data accuracy %K data quality %K wearable device %K fitness trackers %K qualitative research %D 2021 %7 23.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a growing interest in using person-generated wearable device data for biomedical research, but there are also concerns regarding the quality of data such as missing or incorrect data. This emphasizes the importance of assessing data quality before conducting research. In order to perform data quality assessments, it is essential to define what data quality means for person-generated wearable device data by identifying the data quality dimensions. Objective: This study aims to identify data quality dimensions for person-generated wearable device data for research purposes. Methods: This study was conducted in 3 phases: literature review, survey, and focus group discussion. The literature review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline to identify factors affecting data quality and its associated data quality challenges. In addition, we conducted a survey to confirm and complement results from the literature review and to understand researchers’ perceptions on data quality dimensions that were previously identified as dimensions for the secondary use of electronic health record (EHR) data. We sent the survey to researchers with experience in analyzing wearable device data. Focus group discussion sessions were conducted with domain experts to derive data quality dimensions for person-generated wearable device data. On the basis of the results from the literature review and survey, a facilitator proposed potential data quality dimensions relevant to person-generated wearable device data, and the domain experts accepted or rejected the suggested dimensions. Results: In total, 19 studies were included in the literature review, and 3 major themes emerged: device- and technical-related, user-related, and data governance–related factors. The associated data quality problems were incomplete data, incorrect data, and heterogeneous data. A total of 20 respondents answered the survey. The major data quality challenges faced by researchers were completeness, accuracy, and plausibility. The importance ratings on data quality dimensions in an existing framework showed that the dimensions for secondary use of EHR data are applicable to person-generated wearable device data. There were 3 focus group sessions with domain experts in data quality and wearable device research. The experts concluded that intrinsic data quality features, such as conformance, completeness, and plausibility, and contextual and fitness-for-use data quality features, such as completeness (breadth and density) and temporal data granularity, are important data quality dimensions for assessing person-generated wearable device data for research purposes. Conclusions: In this study, intrinsic and contextual and fitness-for-use data quality dimensions for person-generated wearable device data were identified. The dimensions were adapted from data quality terminologies and frameworks for the secondary use of EHR data with a few modifications. Further research on how data quality can be assessed with respect to each dimension is needed. %M 34941540 %R 10.2196/31618 %U https://mhealth.jmir.org/2021/12/e31618 %U https://doi.org/10.2196/31618 %U http://www.ncbi.nlm.nih.gov/pubmed/34941540 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e22107 %T Effectiveness and Moderators of an Internet-Based Mobile-Supported Stress Management Intervention as a Universal Prevention Approach: Randomized Controlled Trial %A Ebert,David Daniel %A Franke,Marvin %A Zarski,Anna-Carlotta %A Berking,Matthias %A Riper,Heleen %A Cuijpers,Pim %A Funk,Burkhardt %A Lehr,Dirk %+ Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, TUM Campus D, Munich, 80992, Germany, 49 15116781057, david.daniel.ebert@tum.de %K stress management intervention %K universal prevention %K occupational health %K moderators %D 2021 %7 22.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Emerging evidence indicates the effectiveness of internet-based mobile-supported stress management interventions (iSMIs) in highly stressed employees. It is yet unclear, however, whether iSMIs are also effective without a preselection process in a universal prevention approach, which more closely resembles routine occupational health care. Moreover, evidence for whom iSMIs might be suitable and for whom not is scarce. Objective: The aim of this study was to evaluate the iSMI GET.ON Stress in a universal prevention approach without baseline inclusion criteria and to examine the moderators of the intervention effects. Methods: A total of 396 employees were randomly assigned to the intervention group or the 6-month waiting list control group. The iSMI consisted of 7 sessions and 1 booster session and offered no therapeutic guidance. Self-report data were assessed at baseline, 7 weeks, and at 6 months following randomization. The primary outcome was perceived stress. Several a priori defined moderators were explored as potential effect modifiers. Results: Participants in the intervention group reported significantly lower perceived stress at posttreatment (d=0.71, 95% CI 0.51-0.91) and at 6-month follow-up (d=0.61, 95% CI 0.41-0.81) compared to those in the waiting list control group. Significant differences with medium-to-large effect sizes were found for all mental health and most work-related outcomes. Resilience (at 7 weeks, P=.04; at 6 months, P=.01), agreeableness (at 7 weeks, P=.01), psychological strain (at 6 months, P=.04), and self-regulation (at 6 months, P=.04) moderated the intervention effects. Conclusions: This study indicates that iSMIs can be effective in a broad range of employees with no need for preselection to achieve substantial effects. The subgroups that might not profit had extreme values on the respective measures and represented only a very small proportion of the investigated sample, thereby indicating the broad applicability of GET.ON Stress. Trial Registration: German Clinical Trials Register DRKS00005699; https://www.drks.de/DRKS00005699 %M 34941541 %R 10.2196/22107 %U https://www.jmir.org/2021/12/e22107 %U https://doi.org/10.2196/22107 %U http://www.ncbi.nlm.nih.gov/pubmed/34941541 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e32794 %T Using Personalized Anchors to Establish Routine Meditation Practice With a Mobile App: Randomized Controlled Trial %A Stecher,Chad %A Sullivan,Mariah %A Huberty,Jennifer %+ College of Health Solutions, Arizona State University, 550 North 3rd Str, Phoenix, AZ, 85004, United States, 1 602 496 0957, chad.stecher@asu.edu %K mindfulness %K meditation %K mobile meditation app %K behavioral persistence %K habit formation %K randomized controlled trial %K mental health %K physical health %K app engagement %K routine %D 2021 %7 22.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical and mental health benefits can be attained from persistent, long-term performance of mindfulness meditation with a mobile meditation app, but in general, few mobile health app users persistently engage at a level necessary to attain the corresponding health benefits. Anchoring or pairing meditation with a mobile app to an existing daily routine can establish an unconsciously initiated meditation routine that may improve meditation persistence. Objective: The purpose of this study was to test the use of either personalized anchors or fixed anchors for establishing a persistent meditation app routine with the mobile app, Calm. Methods: We conducted a randomized controlled trial and randomly assigned participants to one of 3 study groups: (1) a personalized anchor (PA) group, (2) fixed anchor (FA) group, or (3) control group that did not use the anchoring strategy. All participants received app-delivered reminder messages to meditate for at least 10 minutes a day using the Calm app for an 8-week intervention period, and app usage data continued to be collected for an additional 8-week follow-up period to measure meditation persistence. Baseline, week 8, and week 16 surveys were administered to assess demographics, socioeconomic status, and changes in self-reported habit strength. Results: A total of 101 participants across the 3 study groups were included in the final analysis: (1) PA (n=56), (2) FA (n=49), and (3) control group (n=62). Participants were predominantly White (83/101, 82.2%), female (77/101, 76.2%), and college educated (ie, bachelor’s or graduate degree; 82/101, 81.2%). The FA group had a significantly higher average odds of daily meditation during the intervention (1.14 odds ratio [OR]; 95% CI 1.02-1.33; P=.04), and all participants experienced a linear decline in their odds of daily meditation during the 8-week intervention (0.96 OR; 95% CI 0.95-0.96; P<.001). Importantly, the FA group showed a significantly smaller decline in the linear trend of their odds of daily meditation during the 8-week follow-up (their daily trend increased by 1.04 OR from their trend during the intervention; 95% CI 1.01-1.06; P=.03). Additionally, those who more frequently adhered to their anchoring strategy during the intervention typically used anchors that occurred in the morning and showed a significantly smaller decline in their odds of daily meditation during the 8-week follow-up period (1.13 OR; 95% CI 1.02-1.35; P=.007). Conclusions: The FA group had more persistent meditation with the app, but participants in the FA or PA groups who more frequently adhered to their anchoring strategy during the intervention had the most persistent meditation routines, and almost all of these high anchorers used morning anchors. These findings suggest that the anchoring strategy can create persistent meditation routines with a mobile app. However, future studies should combine anchoring with additional intervention tools (eg, incentives) to help more participants successfully establish an anchored meditation routine. Trial Registration: ClinicalTrials.gov NCT04378530; https://clinicaltrials.gov/ct2/show/NCT04378530 %M 34941558 %R 10.2196/32794 %U https://mhealth.jmir.org/2021/12/e32794 %U https://doi.org/10.2196/32794 %U http://www.ncbi.nlm.nih.gov/pubmed/34941558 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e32653 %T Exploring the Effects of In-App Components on Engagement With a Symptom-Tracking Platform Among Participants With Major Depressive Disorder (RADAR-Engage): Protocol for a 2-Armed Randomized Controlled Trial %A White,Katie M %A Matcham,Faith %A Leightley,Daniel %A Carr,Ewan %A Conde,Pauline %A Dawe-Lane,Erin %A Ranjan,Yatharth %A Simblett,Sara %A Henderson,Claire %A Hotopf,Matthew %+ Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, 16 de Crespigny Park, London, SE5 8AF, United Kingdom, 44 7850684847, katie.white@kcl.ac.uk %K app %K engagement %K major depressive disorder %K remote measurement technologies %K research %K mobile phone %D 2021 %7 21.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Multi-parametric remote measurement technologies (RMTs) comprise smartphone apps and wearable devices for both active and passive symptom tracking. They hold potential for understanding current depression status and predicting future depression status. However, the promise of using RMTs for relapse prediction is heavily dependent on user engagement, which is defined as both a behavioral and experiential construct. A better understanding of how to promote engagement in RMT research through various in-app components will aid in providing scalable solutions for future remote research, higher quality results, and applications for implementation in clinical practice. Objective: The aim of this study is to provide the rationale and protocol for a 2-armed randomized controlled trial to investigate the effect of insightful notifications, progress visualization, and researcher contact details on behavioral and experiential engagement with a multi-parametric mobile health data collection platform, Remote Assessment of Disease and Relapse (RADAR)–base. Methods: We aim to recruit 140 participants upon completion of their participation in the RADAR Major Depressive Disorder study in the London site. Data will be collected using 3 weekly tasks through an active smartphone app, a passive (background) data collection app, and a Fitbit device. Participants will be randomly allocated at a 1:1 ratio to receive either an adapted version of the active app that incorporates insightful notifications, progress visualization, and access to researcher contact details or the active app as usual. Statistical tests will be used to assess the hypotheses that participants using the adapted app will complete a higher percentage of weekly tasks (behavioral engagement: primary outcome) and score higher on self-awareness measures (experiential engagement). Results: Recruitment commenced in April 2021. Data collection was completed in September 2021. The results of this study will be communicated via publication in 2022. Conclusions: This study aims to understand how best to promote engagement with RMTs in depression research. The findings will help determine the most effective techniques for implementation in both future rounds of the RADAR Major Depressive Disorder study and, in the long term, clinical practice. Trial Registration: ClinicalTrials.gov NCT04972474; http://clinicaltrials.gov/ct2/show/NCT04972474 International Registered Report Identifier (IRRID): DERR1-10.2196/32653 %M 34932005 %R 10.2196/32653 %U https://www.researchprotocols.org/2021/12/e32653 %U https://doi.org/10.2196/32653 %U http://www.ncbi.nlm.nih.gov/pubmed/34932005 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31702 %T Prescribing Smartphone Apps for Physical Activity Promotion in Primary Care: Modeling Study of Health Gain and Cost Savings %A Grout,Leah %A Telfer,Kendra %A Wilson,Nick %A Cleghorn,Christine %A Mizdrak,Anja %+ Burden of Disease Epidemiology, Equity and Cost-Effectiveness Program, University of Otago Wellington, 23A Mein Street, Newtown, Wellington, 6242, New Zealand, 64 49186192, anja.mizdrak@otago.ac.nz %K physical activity %K smartphone apps %K mobile health %K mHealth %K modeling %K primary care %K mobile phone %D 2021 %7 20.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Inadequate physical activity is a substantial cause of health loss worldwide, and this loss is attributable to diseases such as coronary heart disease, diabetes, stroke, and certain forms of cancer. Objective: This study aims to assess the potential impact of the prescription of smartphone apps in primary care settings on physical activity levels, health gains (in quality-adjusted life years [QALYs]), and health system costs in New Zealand (NZ). Methods: A proportional multistate lifetable model was used to estimate the change in physical activity levels and predict the resultant health gains in QALYs and health system costs over the remaining life span of the NZ population alive in 2011 at a 3% discount rate. Results: The modeled intervention resulted in an estimated 430 QALYs gained (95% uncertainty interval 320-550), with net cost savings of 2011 NZ $2.2 million (2011 US $1.5 million) over the remaining life span of the 2011 NZ population. On a per capita basis, QALY gains were generally larger in women than in men and larger in Māori than in non-Māori. The health impact and cost-effectiveness of the intervention were highly sensitive to assumptions on intervention uptake and decay. For example, the scenario analysis with the largest benefits, which assumed a 5-year maintenance of additional physical activity levels, delivered 1750 QALYs and 2011 NZ $22.5 million (2011 US $15.1 million) in cost savings. Conclusions: The prescription of smartphone apps for promoting physical activity in primary care settings is likely to generate modest health gains and cost savings at the population level in this high-income country. Such gains may increase with ongoing improvements in app design and increased health worker promotion of the apps to patients. %M 34931993 %R 10.2196/31702 %U https://www.jmir.org/2021/12/e31702 %U https://doi.org/10.2196/31702 %U http://www.ncbi.nlm.nih.gov/pubmed/34931993 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e19543 %T Co-designing an Adaption of a Mobile App to Enhance Communication, Safety, and Well-being Among People Living at Home With Early-Stage Dementia: Protocol for an Exploratory Multiple Case Study %A Davies,Karen %A Cheraghi-Sohi,Sudeh %A Ong,Bie Nio %A Cheraghi-Sohi,Sudeh %A Perryman,Katherine %A Sanders,Caroline %+ National Institute for Health Research Patient Safety Research Translation Centre, University of Manchester, Oxford Rd, Manchester, United Kingdom, 44 1612767665, sudeh.cheraghi-sohi@manchester.ac.uk %K design research %K co-design %K dementia %K mobile app %K communication %K safety %K mobile phone %D 2021 %7 20.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a growing interest in using mobile apps to support communication, safety, and well-being. Evidence directly from people with dementia regarding the usability, usefulness, and relevance of mobile apps is limited. Objective: This paper describes the protocol of a study that will evaluate an app designed for supporting communication, safety, and well-being among people living with dementia. The study aims to understand if the app can enhance safety through improved communication among users. Methods: The study will use participatory qualitative methods over 3 cycles of evaluation with co-designers (service users, their families, and care practitioners). The study will be developed in partnership with a specialist home care service in England. Purposive case selection will be performed to ensure that the cases exemplify differences in experiences. The app will be evaluated in a walk-through workshop by people living with early-stage dementia and then trialed at home by up to 12 families in a try-out cycle. An amended version will be evaluated in a final walk-through workshop during cycle 3. Data will be collected from at least 4 data sources during the try-out phase and analyzed thematically. An explanatory multiple case study design will be used to synthesize and present the evidence from the three cycles, drawing on the Normalization Process Theory to support the interpretation of the findings. Results: The study is ready to be implemented, but it was paused to protect vulnerable individuals during the COVID-19 pandemic in 2020. The findings will be particularly relevant for understanding how to support vulnerable people living in the community during social distancing and the period following the pandemic as well as for providing insight into the challenges of social isolation that arise from living with dementia. Conclusions: Evaluating a mobile app for enhancing communication, safety, and well-being among people living with dementia contributes to the key ambitions enshrined in policy and practice—championing the use of digital technology and supporting people with dementia to live safely in their own homes. The study will involve co-designers living with dementia, so that the voices of service users can be used to highlight the benefits and challenges of assistive technology and shape the future development of apps that enhance safety by improving communication. International Registered Report Identifier (IRRID): PRR1-10.2196/19543 %M 34932011 %R 10.2196/19543 %U https://www.researchprotocols.org/2021/12/e19543 %U https://doi.org/10.2196/19543 %U http://www.ncbi.nlm.nih.gov/pubmed/34932011 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e29731 %T Toward a Behavior Theory–Informed and User-Centered Mobile App for Parents to Prevent Infant Falls: Development and Usability Study %A Cooray,Nipuna %A Sun,Si Louise %A Ho,Catherine %A Adams,Susan %A Keay,Lisa %A Nassar,Natasha %A Brown,Julie %+ The George Institute for Global Health, Faculty of Medicine and Health, UNSW Sydney, Level 5/1, King Street, Newtown, 2042, Australia, 61 468311723, ncooray@georgeinstitute.org.au %K child injury %K Behaviour Change Wheel %K mobile app %K mobile phone %D 2021 %7 20.12.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Falls account for approximately 50% of infant injury hospitalizations, and caretaker behavior is central to preventing infant falls. Behavior theory–informed interventions for injury prevention have been suggested, but to date, few have been reported. The potential of using smartphones for injury prevention intervention delivery is also underexploited. Objective: This study aims to develop a behavior theory– and evidence-based as well as user-centered digital intervention as a mobile app for parents to prevent infant falls following agile development practices. Methods: Infant falls while feeding was selected as the fall mechanism to demonstrate the approach being taken to develop this intervention. In phase 1, the Behaviour Change Wheel was used as a theoretical framework supported by a literature review to define intervention components that were then implemented as a mobile app. In phase 2, after the person-based approach, user testing through think-aloud interviews and comprehension assessments were used to refine the content and implementation of the intervention. Results: The target behaviors identified in phase 1 were adequate rest for the newborn’s mother and safe feeding practices defined as prepare, position, and place. From behavioral determinants and the Behaviour Change Wheel, the behavior change functions selected to achieve these target behaviors were psychological capability, social opportunity, and reflective motivation. The selected behavior change techniques aligned with these functions were providing information on health consequences, using a credible source, instruction on performing each behavior, and social support. The defined intervention was implemented in a draft Android app. In phase 2, 4 rounds of user testing were required to achieve the predefined target comprehension level. The results from the think-aloud interviews were used to refine the intervention content and app features. Overall, the results from phase 2 revealed that users found the information provided to be helpful. Features such as self-tracking and inclusion of the social and environmental aspects of falls prevention were liked by the participants. Important feedback for the successful implementation of the digital intervention was also obtained from the user testing. Conclusions: To our knowledge, this is the first study to apply the Behaviour Change Wheel to develop a digital intervention for child injury prevention. This study provides a detailed example of evidence-based development of a behavior theory–informed mobile intervention for injury prevention refined using the person-based approach. %M 34932004 %R 10.2196/29731 %U https://pediatrics.jmir.org/2021/4/e29731 %U https://doi.org/10.2196/29731 %U http://www.ncbi.nlm.nih.gov/pubmed/34932004 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e17723 %T Recruitment and Retention of Parents of Adolescents in a Text Messaging Trial (MyTeen): Secondary Analysis From a Randomized Controlled Trial %A Chu,Joanna Ting Wai %A Wadham,Angela %A Jiang,Yannan %A Stasiak,Karolina %A Shepherd,Matthew %A Bullen,Christopher %+ The National Institute for Health Innovation, School of Population Health, University of Auckland, Private Bag 92019 Victoria Street West, Auckland, 1142, New Zealand, 64 3737599, jt.chu@auckland.ac.nz %K parenting %K mHealth %K text messaging %K recruitment %D 2021 %7 20.12.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parenting programs are well established as an effective strategy for enhancing both parenting skills and the well-being of the child. However, recruitment for family programs in clinical and nonclinical settings remains low. Objective: This study aims to describe the recruitment and retention methods used in a text messaging program (MyTeen) trial for parents of adolescents (10-15 years) and identify key lessons learned. We aim to provide insights and direction for researchers who seek to recruit parents and build on the limited literature on recruitment and retention strategies for parenting program trials. Methods: A recruitment plan was developed, monitored, and modified as needed throughout the course of the project. Strategies to facilitate recruitment were identified (eg, program content and recruitment material, staff characteristics, and study procedures). Traditional and web-based recruitment strategies were used. Results: Over a 5-month period, 319 parents or caregivers expressed interest in our study, of which 221 agreed to participate in the study, exceeding our recruitment target of 214 participants. Attrition was low at the 1-month (4.5% overall; intervention group: n=5, 4.6%; control group: n=5, 4.5%) and 3-month follow-ups (9% overall; intervention group: n=10, 9.2%; control group: n=10, 8.9%). Conclusions: The use of web-based recruitment strategies appeared to be most effective for recruiting and retaining parents in a text-messaging program trial. However, we encountered recruitment challenges (ie, underrepresentation of ethnic minority groups and fathers) similar to those reported in the literature. Therefore, efforts to engage ethnic minorities and fathers are needed. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000117213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374307 %M 34932007 %R 10.2196/17723 %U https://pediatrics.jmir.org/2021/4/e17723 %U https://doi.org/10.2196/17723 %U http://www.ncbi.nlm.nih.gov/pubmed/34932007 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e28128 %T A Wearable Activity Tracker Intervention With and Without Weekly Behavioral Support Emails to Promote Physical Activity Among Women Who Are Overweight or Obese: Randomized Controlled Trial %A Black,Melissa %A Brunet,Jennifer %+ School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, 125 University Private, Ottawa, ON, K1N6N5, Canada, 1 6135625800 ext 3068, jennifer.brunet@uottawa.ca %K behavior change %K motivation %K obesity %K physical activity %K women %K mobile phone %D 2021 %7 16.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity (PA) plays a fundamental role in combating the current obesity epidemic; however, most women who are overweight or obese are generally physically inactive. Wearable activity tracker interventions can help increase the PA levels in this population. Supplementing such interventions with behavioral support emails may further improve their effectiveness, but this remains to be confirmed. Objective: This study aims to determine if adding behavioral support emails to a wearable activity tracker intervention can further increase PA levels among women who are overweight or obese in comparison to a wearable activity tracker–only intervention and a control condition. Methods: Women with a BMI ≥25 kg/m2 who were not meeting the Canadian PA guidelines for aerobic and strength training were randomized into 1 of 3 groups. Group 1 received 6 weekly behavioral support emails, a wearable activity tracker, and a copy of the Canadian PA guidelines. Group 2 received a wearable activity tracker and a copy of the Canadian PA guidelines, and group 3 (control condition) received a copy of the Canadian PA guidelines. Self-reported data for walking and moderate to vigorous intensity PA were collected preintervention (week 0; prerandomization), postintervention (7 weeks postrandomization), and at follow-up (21 weeks postrandomization) and analyzed as metabolic equivalent of task minutes per week. In addition, potential mechanisms of behavior change (ie, basic psychological needs satisfaction and motivational regulations) were assessed for within- and between-group differences at all 3 time points. Data were analyzed using nonparametric statistical tests. Results: A total of 49 women were recruited; data from 47 women (mean age 37.57 years, SD 11.78 years; mean BMI 31.69 kg/m2, SD 5.97 kg/m2) were available for analysis. Group 1 reported a significant increase in walking from preintervention to postintervention (χ22=7.5; P=.02) but not in moderate to vigorous intensity PA (P=.24). Group 1 also reported significant increases in perceptions of competence from preintervention to follow-up (χ22=7.6; P=.02) and relatedness from preintervention to follow-up (χ22=8.7; P=.005). Increases in perceived autonomy were observed for group 2 (χ22=7.0) and group 3 (χ22=10.6). There were no significant changes in the motivational regulations within the groups. The difference between the groups was not significant for any outcome variable. Conclusions: The results suggest that adding behavioral support emails to a wearable activity tracker intervention may help to increase time spent walking and perceptions of competence and relatedness for PA among women who are overweight or obese. Trial Registration: ClinicalTrials.gov NCT03601663; http://clinicaltrials.gov/ct2/show/NCT03601663 %M 34927590 %R 10.2196/28128 %U https://mhealth.jmir.org/2021/12/e28128 %U https://doi.org/10.2196/28128 %U http://www.ncbi.nlm.nih.gov/pubmed/34927590 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e29098 %T Perceptions of Factors Influencing Engagement With Health and Well-being Apps in the United Kingdom: Qualitative Interview Study %A Szinay,Dorothy %A Perski,Olga %A Jones,Andy %A Chadborn,Tim %A Brown,Jamie %A Naughton,Felix %+ School of Health Sciences, University of East Anglia, Norwich Research Park, Earlham Road, Norwich, NR4 7TJ, United Kingdom, 44 1603593064, d.szinay@uea.ac.uk %K behavior change %K health apps %K mHealth %K smartphone app %K framework analysis %K COM-B %K TDF %K user engagement %K motivation %K usability %K engagement %K mobile phone %D 2021 %7 16.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital health devices, such as health and well-being smartphone apps, could offer an accessible and cost-effective way to deliver health and well-being interventions. A key component of the effectiveness of health and well-being apps is user engagement. However, engagement with health and well-being apps is typically poor. Previous studies have identified a list of factors that could influence engagement; however, most of these studies were conducted on a particular population or for an app targeting a particular behavior. An understanding of the factors that influence engagement with a wide range of health and well-being apps can inform the design and the development of more engaging apps in general. Objective: The aim of this study is to explore user experiences of and reasons for engaging and not engaging with a wide range of health and well-being apps. Methods: A sample of adults in the United Kingdom (N=17) interested in using a health or well-being app participated in a semistructured interview to explore experiences of engaging and not engaging with these apps. Participants were recruited via social media platforms. Data were analyzed with the framework approach, informed by the Capability, Opportunity, Motivation–Behaviour (COM-B) model and the Theoretical Domains Framework, which are 2 widely used frameworks that incorporate a comprehensive set of behavioral influences. Results: Factors that influence the capability of participants included available user guidance, statistical and health information, reduced cognitive load, well-designed reminders, self-monitoring features, features that help establish a routine, features that offer a safety net, and stepping-stone app characteristics. Tailoring, peer support, and embedded professional support were identified as important factors that enhance user opportunities for engagement with health and well-being apps. Feedback, rewards, encouragement, goal setting, action planning, self-confidence, and commitment were judged to be the motivation factors that affect engagement with health and well-being apps. Conclusions: Multiple factors were identified across all components of the COM-B model that may be valuable for the development of more engaging health and well-being apps. Engagement appears to be influenced primarily by features that provide user guidance, promote minimal cognitive load, support self-monitoring (capability), provide embedded social support (opportunity), and provide goal setting with action planning (motivation). This research provides recommendations for policy makers, industry, health care providers, and app developers for increasing effective engagement. %M 34927597 %R 10.2196/29098 %U https://mhealth.jmir.org/2021/12/e29098 %U https://doi.org/10.2196/29098 %U http://www.ncbi.nlm.nih.gov/pubmed/34927597 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e32441 %T Using Interactive Text Messaging to Improve Diet Quality and Increase Redemption of Foods Approved by the Special Supplemental Nutrition Program for Women, Infants, and Children: Protocol for a Cohort Feasibility Study %A Kay,Melissa C %A Hammad,Nour M %A Herring,Sharon J %A Bennett,Gary G %+ Duke University, 310 Trent Dr., Durham, NC, 27708, United States, 1 7812493062, melissa.kay@duke.edu %K WIC %K diet quality %K digital health %K text messaging %K mothers %K postpartum %K child obesity %K mobile phone %D 2021 %7 15.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Children in the United States eat too few fruits, vegetables, and whole grains and too many energy-dense foods; these dietary behaviors are associated with increased risk of obesity. Maternal diet plays a key role in shaping children's diets; however, many mothers have poor diet quality, especially those living in low-income households. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal nutrition assistance program that provides mothers and children with nutrient-dense foods, and those who participate have better diet quality. However, many mothers do not redeem all their WIC-approved foods. Thus, there is a need to create effective interventions to improve diet quality, especially among low-income children and families. Objective: This paper aims to describe the development and protocol for a study to evaluate the feasibility, satisfaction, and preliminary efficacy of a fully automated text messaging intervention as a strategy to improve maternal diet quality and the redemption of WIC-approved foods. Methods: We describe the use of the framework developed for the description of nonrandomized feasibility studies. Using an observational, prospective cohort study design, we will recruit mothers enrolled in WIC with a child aged ≤2 years. Participants will receive automated SMS text messages aimed at improving the redemption of WIC-approved foods to improve the participants’ diet quality for 12 weeks. All outcome measures will be analyzed using descriptive and inferential statistics. Qualitative data will be analyzed using thematic analysis. Results: Data collection for this study began in March 2021. We expect the study results to be available within 9 months of study commencement. The results will shed light on the feasibility, acceptability, and effectiveness of using automated text messages as a behavior change strategy for mothers enrolled in WIC. Conclusions: The results of this pilot study will explore whether this digital behavioral intervention, which will deliver nutrition guidance in accordance with the Dietary Guidelines for Americans using interactive self-monitoring and feedback, is feasible and acceptable. This will lay the foundation for a larger evaluation to determine efficacy for improving diet quality in those most at risk for obesity. Trial Registration: ClinicalTrials.gov NCT04098016; https://clinicaltrials.gov/ct2/show/NCT04098016 International Registered Report Identifier (IRRID): DERR1-10.2196/32441 %M 34914616 %R 10.2196/32441 %U https://www.researchprotocols.org/2021/12/e32441 %U https://doi.org/10.2196/32441 %U http://www.ncbi.nlm.nih.gov/pubmed/34914616 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e29190 %T Willingness to Share Data From Wearable Health and Activity Trackers: Analysis of the 2019 Health Information National Trends Survey Data %A Rising,Camella J %A Gaysynsky,Anna %A Blake,Kelly D %A Jensen,Roxanne E %A Oh,April %+ Behavioral Research Program, Division of Cancer Control and Population Sciences, US National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, United States, 1 240 276 5262, camella.rising@nih.gov %K mobile health %K population health %K health communication %K survey methodology %K mobile apps %K devices %K online social networking %K mobile phone %D 2021 %7 13.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Sharing data from wearable health and activity trackers (wearables) with others may improve the health and behavioral outcomes of wearable users by generating social support and improving their ability to manage their health. Investigating individual factors that influence US adults’ willingness to share wearable data with different types of individuals may provide insights about the population subgroups that are most or least likely to benefit from wearable interventions. Specifically, it is necessary to identify digital health behaviors potentially associated with willingness to share wearable data given that the use of and engagement with various technologies may broadly influence web-based health information–sharing behaviors. Objective: This study aims to identify sociodemographic, health, and digital health behavior correlates of US adults’ willingness to share wearable data with health care providers and family or friends. Methods: Data for the analytic sample (N=1300) were obtained from the 2019 Health Information National Trends Survey of the National Cancer Institute. Digital health behavior measures included frequency of wearable device use, use of smartphones or tablets to help communicate with providers, use of social networking sites to share health information, and participation in a web-based health community. Multivariable logistic regression analysis of weighted data examined the associations between digital health behaviors and willingness to share wearable device data, controlling for sociodemographics and health-related characteristics. Results: Most US adults reported willingness to share wearable data with providers (81.86%) and with family or friends (69.51%). Those who reported higher health self-efficacy (odds ratio [OR] 1.97, 95% CI 1.11-3.51), higher level of trust in providers as a source of health information (OR 1.98, 95% CI 1.12-3.49), and higher level of physical activity (OR 2.00, 95% CI 1.21-3.31) had greater odds of willingness to share data with providers. In addition, those with a higher frequency of wearable use (OR 2.15, 95% CI 1.35-3.43) and those who reported use of smartphones or tablets to help communicate with providers (OR 1.99, 95% CI 1.09-3.63) had greater odds of willingness to share data with providers. Only higher level of physical activity was associated with greater odds of willingness to share wearable data with family or friends (OR 1.70, 95% CI 1.02-2.84). Sociodemographic factors were not significantly associated with willingness to share wearable data. Conclusions: The findings of this study suggest that, among US adult wearable users, behavior-related factors, rather than sociodemographic characteristics, are key drivers of willingness to share health information obtained from wearables with others. Moreover, behavioral correlates of willingness to share wearable data are unique to the type of recipient (ie, providers vs family or friends). Future studies could use these findings to inform the development of interventions that aim to improve the use of patient-generated data from wearable devices in health care settings. %M 34898448 %R 10.2196/29190 %U https://mhealth.jmir.org/2021/12/e29190 %U https://doi.org/10.2196/29190 %U http://www.ncbi.nlm.nih.gov/pubmed/34898448 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e26439 %T An Intelligent Individualized Cardiovascular App for Risk Elimination (iCARE) for Individuals With Coronary Heart Disease: Development and Usability Testing Analysis %A Chen,Yuling %A Ji,Meihua %A Wu,Ying %A Wang,Qingyu %A Deng,Ying %A Liu,Yong %A Wu,Fangqin %A Liu,Mingxuan %A Guo,Yiqiang %A Fu,Ziyuan %A Zheng,Xiaoying %+ School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Feng-tai District, Beijing, 100069, China, 86 83911766, helenywu@vip.163.com %K mobile health %K health behavior %K system %K development %K usability %K coronary heart disease %D 2021 %7 13.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Death and disability from coronary heart disease (CHD) can be largely reduced by improving risk factor management. However, adhering to evidence-based recommendations is challenging and requires interventions at the level of the patient, provider, and health system. Objective: The aim of this study was to develop an Intelligent Individualized Cardiovascular App for Risk Elimination (iCARE) to facilitate adherence to health behaviors and preventive medications, and to test the usability of iCARE. Methods: We developed iCARE based on a user-centered design approach, which included 4 phases: (1) function design, (2) iterative design, (3) expert inspections and walkthroughs of the prototypes, and (4) usability testing with end users. The usability testing of iCARE included 2 stages: stage I, which included a task analysis and a usability evaluation (January to March 2019) of the iCARE patient app using the modified Health Information Technology Usability Survey (Health-ITUES); and stage II (June 2020), which used the Health-ITUES among end users who used the app for 6 months. The end users were individuals with a confirmed diagnosis of CHD from 2 university-affiliated hospitals in Beijing, China. Results: iCARE consists of a patient app, a care provider app, and a cloud platform. It has a set of algorithms that trigger tailored feedback and can send individualized interventions based on data from initial assessment and health monitoring via manual entry or wearable devices. For stage I usability testing, 88 hospitalized patients (72% [63/88] male; mean age 60 [SD 9.9] years) with CHD were included in the study. The mean score of the usability testing was 90.1 (interquartile range 83.3-99.0). Among enrolled participants, 90% (79/88) were satisfied with iCARE; 94% (83/88) and 82% (72/88) reported that iCARE was useful and easy to use, respectively. For stage II usability testing, 61 individuals with CHD (85% [52/61] male; mean age 53 [SD 8.2] years) who were from an intervention arm and used iCARE for at least six months were included. The mean total score on usability testing based on the questionnaire was 89.0 (interquartile distance: 77.0-99.5). Among enrolled participants, 89% (54/61) were satisfied with the use of iCARE, 93% (57/61) perceived it as useful, and 70% (43/61) as easy to use. Conclusions: This study developed an intelligent, individualized, evidence-based, and theory-driven app (iCARE) to improve patients’ adherence to health behaviors and medication management. iCARE was identified to be highly acceptable, useful, and easy to use among individuals with a diagnosis of CHD. Trial Registration: Chinese Clinical Trial Registry ChiCTR-INR-16010242; https://tinyurl.com/2p8bkrew %M 34898449 %R 10.2196/26439 %U https://mhealth.jmir.org/2021/12/e26439 %U https://doi.org/10.2196/26439 %U http://www.ncbi.nlm.nih.gov/pubmed/34898449 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e32450 %T The Life Goals Self-Management Mobile App for Bipolar Disorder: Consumer Feasibility, Usability, and Acceptability Study %A Ryan,Kelly A %A Smith,Shawna N %A Yocum,Anastasia K %A Carley,Isabel %A Liebrecht,Celeste %A Navis,Bethany %A Vest,Erica %A Bertram,Holli %A McInnis,Melvin G %A Kilbourne,Amy M %+ Department of Psychiatry, University of Michigan, 2101 Commonwealth Blvd, Suite C, Ann Arbor, MI, 48105, United States, 1 734 936 5524, karyan@umich.edu %K self-management %K app %K bipolar disorder %K symptom management %K mental health %K feasibility %K usability %K acceptability %K intervention %K bipolar %K coping %K survey %K engagement %D 2021 %7 13.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Life Goals is an evidence-based self-management intervention that assists individuals with bipolar disorder (BD) by aligning BD symptom coping strategies with their personal goals. The intervention can be availed via in-person and telephonic sessions, and it has been recently developed as an individualized, customizable mobile app. Objective: We examined the feasibility, usability, and acceptability of the Life Goals self-management app among individuals diagnosed with BD who used the app for up to 6 months. Methods: A total of 28 individuals with BD used the Life Goals app on their personal smartphone for 6 months. They completed key clinical outcome measurements of functioning, disability, and psychiatric symptoms at baseline, 3 months, and 6 months, in addition to a poststudy survey about usability and satisfaction. Results: Participants used the app for a median of 25 times (IQR 13-65.75), and for a longer time during the first 3 months of the study. The modules on depression and anxiety were the most frequently used, accounting for 35% and 22% of total usage, respectively. Overall, the study participants found the app useful (15/25, 60%) and easy to use (18/25, 72%), and they reported that the screen displayed the material adequately (22/25, 88%). However, less than half of the participants found the app helpful in managing their health (10/25, 40%) or in making progress on their wellness goals (9/25, 36%). Clinical outcomes showed a trend for improvements in mental and physical health and mania-related well-being. Conclusions: The Life Goals app showed feasibility of use among individuals with BD. Higher user engagement was observed in the initial 3 months with users interested more frequently in the mood modules than other wellness modules. Participants reported acceptability with the ease of app use and satisfaction with the app user interface, but the app showed low success in encouraging self-management within this small sample. The Life Goals app is a mobile health technology that can provide individuals with serious mental illness with more flexible access to evidence-based treatments. %M 34898452 %R 10.2196/32450 %U https://formative.jmir.org/2021/12/e32450 %U https://doi.org/10.2196/32450 %U http://www.ncbi.nlm.nih.gov/pubmed/34898452 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e17839 %T The Effect of an Automated Mobile Patient Engagement Application on Emergency Department Revisits: Prospective Observational Study %A Chatterjee,Pothik %A Beck,Adam M %A Brager,Jenna Ashley Levenson %A Durand,Daniel J %A D'Adamo,Christopher R %+ Innovation and Research Department, LifeBridge Health, 2401 W. Belvedere Ave, Baltimore, MD, 21215, United States, 1 410 601 1083, pchatter@lifebridgehealth.org %K patient engagement %K value-based care %K digital health %K mobile app %K automation %K readmission %K revisit %K emergency department %D 2021 %7 13.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Revisits within 30 days to an emergency department (ED), observation care unit, or inpatient setting following patient discharge continue to be a challenge, especially in urban settings. In addition to the consequences for the patient, these revisits have a negative impact on a health system’s finances in a value-based care or global budget environment. LifeBridge Health, a community health system in Maryland, United States, implemented an automated mobile patient engagement application as part of our enterprise-wide digital health strategy to improve patient engagement and reduce revisits to the ED. Objective: The aim of this paper was to evaluate the effectiveness of a customized automated digital patient engagement application (GetWell Loop) to reduce 30-day revisits after home discharge from an ED. Methods: The LifeBridge Health Innovation Department and ED staff from 2 participating health system hospitals collaborated with GetWellNetwork to customize their patient engagement application with automated check-in questions and other on-demand resources (eg, streaming content explaining aspects of self-care during COVID-19). An application link was emailed to adult patients discharged home from the ED. A study of ED visits for patients treated for general medicine and cardiology conditions between August 1, 2018, and July 31, 2019, was conducted using CRISP (Chesapeake Regional Information System for our Patients), Maryland’s state-designated health information exchange. We also used data within GetWell Loop (GetWellNetwork) to track patient activation and engagement. The primary outcome was the number of ED patients who experienced a 30-day revisit and who did or did not activate their GetWell Loop account. Secondary outcomes included the overall activation rate and the rate of engagement as measured by the number of logins, alerts, and comments generated by patients through the application. Bivariate analysis comparing outcomes among patients who activated the GetWell Loop application to patients who did not was conducted using the Fisher exact test. Multivariate logistic regression modeling with elastic net regularization was also performed to account for potential confounders and potential collinearity of covariates. Results: During this 1-year study, 1062 (27.4%) of 3866 of all emergency patients treated for general medicine or cardiology conditions, who received an invite to use the digital application, activated their account. The patients discharged from the ED, who were treated for general medicine conditions (n=2087) and who activated their GetWell Loop account, experienced a 30-day revisit rate of 17.3% (n=101) compared with 24.6% (n=369) for those who did not activate their account (P<.001). Of the patients treated for cardiology conditions (n=1779), 12.8% (n=61) of those who activated their GetWell account experienced a 30-day revisit compared with 17.7% (n=231) of those who did not activate their account (P=.01). The significance of these findings persisted after adjustment for confounding variables including age, race, sex, and payor in logistic regression modeling (adjusted odds ratio 0.75, 95% CI 0.62-0.92; P=.006). Conclusions: Our results suggest that a significant percentage of patients are willing to utilize a digital application following ED discharge to better engage in their own care, and that usage of such digital applications may significantly reduce 30-day revisit rates. LifeBridge Health’s experience demonstrates that health care systems can leverage automated mobile apps to improve patient engagement and successfully impact clinical outcomes at scale. %M 34898451 %R 10.2196/17839 %U https://formative.jmir.org/2021/12/e17839 %U https://doi.org/10.2196/17839 %U http://www.ncbi.nlm.nih.gov/pubmed/34898451 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e31353 %T A Personalized Approach Bias Modification Smartphone App (“SWiPE”) to Reduce Alcohol Use: Open-Label Feasibility, Acceptability, and Preliminary Effectiveness Study %A Manning,Victoria %A Piercy,Hugh %A Garfield,Joshua Benjamin Bernard %A Clark,Stuart Gregory %A Andrabi,Mah Noor %A Lubman,Dan Ian %+ Turning Point, Eastern Health, 110 Church St, Richmond, Melbourne, 3121, Australia, 61 0428337961, victoria.manning@monash.edu %K alcohol %K hazardous alcohol use %K alcohol use disorder %K approach bias modification %K cognitive bias modification %K smartphone app %K ehealth %K mobile phone app %K mhealth %K digital health %D 2021 %7 10.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Approach bias modification (ApBM), a computerized cognitive intervention that trains people to “avoid” alcohol-related images and “approach” nonalcohol images, reduces the likelihood of relapse when administered during residential alcohol treatment. However, most individuals experiencing alcohol problems do not require, do not seek, or have difficulty accessing residential treatment. Smartphone-delivered ApBM could offer an easily accessible intervention to reduce alcohol consumption that can be personalized (eg, allowing selection of personally relevant alcohol and positive nonalcohol training images) and gamified to optimize engagement. Objective: We examined the feasibility, acceptability, and preliminary effectiveness of “SWiPE,” a gamified, personalized alcohol ApBM smartphone app, and explored alcohol consumption and craving outcomes in people drinking at hazardous levels or above (Alcohol Use Disorders Identification Test [AUDIT] score ≥8) who wanted to reduce their alcohol use. Methods: In this open-label trial, frequency and quantity of alcohol consumption, alcohol dependence severity, and craving were measured prior to participants downloading SWiPE. Participants (n=1309) were instructed to complete at least 2 sessions per week for 4 weeks. Recruitment and completion rates were indicators of feasibility. Functionality, aesthetics, and quality ratings were indicators of acceptability. Participants were prompted to report frequency and quantity of alcohol consumption weekly during training and 1 month after training. They completed measures of craving and dependence after 4 weeks of training. Results: We recruited 1309 participants (mean age 47.0, SD 10.0 years; 758/1309, 57.9% female; mean AUDIT score 21.8, SD 6.5) over 6 months. Participants completed a median of 5 sessions (IQR 2-9); 31.2% (409/1309) completed ≥8 sessions; and 34.8% (455/1309) completed the posttraining survey. Mean Mobile Application Rating Scale scores indicated good acceptability for functionality and aesthetics and fair acceptability for subjective quality. Among those who completed the posttraining assessment, mean past-week drinking days reduced from 5.1 (SD 2.0) pre-training to 4.2 (SD 2.3) in week 4 (t454=7.87; P<.001), and mean past-week standard drinks reduced from 32.8 (SD 22.1) to 24.7 (SD 20.1; t454=8.58; P<.001). Mean Craving Experience Questionnaire frequency scores reduced from 4.5 (SD 2.0) to 2.8 (SD 1.8; t435=19.39; P<.001). Severity of Dependence scores reduced from 7.7 (SD 3.0) to 6.0 (SD 3.2; t435=12.44; P<.001). For the 19.4% (254/1309) of participants who completed a 1-month follow-up, mean past-week drinking days and standard drinks were 3.9 (SD 2.5) and 23.9 (SD 20.7), respectively, both significantly lower than at baseline (P<.001). Conclusions: The findings suggest SWiPE is feasible and acceptable and may be effective at reducing alcohol consumption and craving in a predominantly nontreatment-seeking sample of adult Australians drinking at hazardous levels. SWiPE’s efficacy, relative to a control condition, now needs establishing in a randomized controlled trial. Smartphone-delivered personalized ApBM could be a highly scalable, widely accessible support tool for reducing alcohol use. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000638932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p International Registered Report Identifier (IRRID): RR2-10.2196/21278 %M 34890355 %R 10.2196/31353 %U https://mhealth.jmir.org/2021/12/e31353 %U https://doi.org/10.2196/31353 %U http://www.ncbi.nlm.nih.gov/pubmed/34890355 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e25129 %T Behavioral Theories and Motivational Features Underlying eHealth Interventions for Adolescent Antiretroviral Adherence: Systematic Review %A Bezabih,Alemitu Mequanint %A Gerling,Kathrin %A Abebe,Workeabeba %A Abeele,Vero Vanden %+ Department of Computer Science, e-Media Research Lab, Katholieke Universiteit Leuven, Andreas Vesaliusstraat 13, Leuven, 3000, Belgium, 32 0485949954, alem.bezabih@kuleuven.be %K HIV %K adolescents %K ART adherence %K eHealth %K health theories %K behavior change techniques %K motivational design principles %D 2021 %7 10.12.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: eHealth systems provide new opportunities for the delivery of antiretroviral therapy (ART) adherence interventions for adolescents. They may be more effective if grounded in health behavior theories and behavior change techniques (BCTs). Prior reviews have examined the effectiveness, feasibility, and acceptability of these eHealth systems. However, studies have not systematically explored the use of health behavior theories and BCTs in the design of these applications. Objective: The purpose of this review was to explore whether health behavior theories and BCTs were considered to ground designs of eHealth systems supporting adolescents’ (10-24 years) ART adherence. More specifically, we examined which specific theories and BCTs were applied, and how these BCTs were implemented as design features. Additionally, we investigated the quality and effect of eHealth systems. Methods: A systematic search was performed on IEEE Xplore, ACM, ScienceDirect, PubMed, Scopus, and Web of Science databases from 2000 to 2020. Theory use and BCTs were coded using the Theory Coding Scheme and the Behavior Change Technique Taxonomy version 1 (BCTTv1), respectively. Design features were identified using the lenses of motivational design for mobile health (mHealth). The number of BCTs and design features for each eHealth system and their prevalence across all systems were assessed. Results: This review identified 16 eHealth systems aiming to support ART adherence among adolescents. System types include SMS text message reminders (n=6), phone call reminders (n=3), combined SMS text message and phone call reminders (n=1), electronic adherence monitoring devices (n=3), smartphone apps (n=1), smartphone serious games (n=1), gamified smartphone apps (n=1), leveraging existing social media (n=2), web-based applications (n=1), videoconferencing (n=1), and desktop applications (n=1). Nine were grounded in theory, of which 3 used theories extensively. The impact of adolescent developmental changes on ART adherence was not made explicit. A total of 42 different BCTs and 24 motivational design features were used across systems. Ten systems reported positive effects on 1 or more outcomes; however, of these ten systems, only 3 reported exclusively positive effects on all the outcomes they measured. As much as 6 out of 16 reported purely no effect in all the outcomes measured. Conclusions: Basic applications (SMS text messaging and phone calls) were most frequent, although more advanced systems such as mobile apps and games are also emerging. This review indicated gaps in the use of theory and BCTs, and particularly the impact of developmental changes on ART adherence was not adequately considered. Together with adopting a developmental orientation, future eHealth systems should effectively leverage health theories and consider developing more advanced systems that open the door to using BCTs more comprehensively. Overall, the impact of eHealth systems on adolescent ART adherence and its mediators is promising, but conclusive evidence on effect still needs to be provided. %M 34890353 %R 10.2196/25129 %U https://mhealth.jmir.org/2021/12/e25129 %U https://doi.org/10.2196/25129 %U http://www.ncbi.nlm.nih.gov/pubmed/34890353 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e32165 %T An Alternative to the Light Touch Digital Health Remote Study: The Stress and Recovery in Frontline COVID-19 Health Care Workers Study %A Goodday,Sarah M %A Karlin,Emma %A Alfarano,Alexandria %A Brooks,Alexa %A Chapman,Carol %A Desille,Rachelle %A Rangwala,Shazia %A Karlin,Daniel R %A Emami,Hoora %A Woods,Nancy Fugate %A Boch,Adrien %A Foschini,Luca %A Wildman,Mackenzie %A Cormack,Francesca %A Taptiklis,Nick %A Pratap,Abhishek %A Ghassemi,Marzyeh %A Goldenberg,Anna %A Nagaraj,Sujay %A Walsh,Elaine %A , %A Friend,Stephen %+ 4YouandMe, 2901 Third Ave Suite 330, Seattle, WA, 98121, United States, 1 2069288254, sarah@4youandme.org %K stress %K wearable %K digital health %K frontline %K COVID-19 %K health care worker %K alternative %K design %K app %K assessment %K sensor %K engagement %K support %K knowledge %D 2021 %7 10.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Several app-based studies share similar characteristics of a light touch approach that recruit, enroll, and onboard via a smartphone app and attempt to minimize burden through low-friction active study tasks while emphasizing the collection of passive data with minimal human contact. However, engagement is a common challenge across these studies, reporting low retention and adherence. Objective: This study aims to describe an alternative to a light touch digital health study that involved a participant-centric design including high friction app-based assessments, semicontinuous passive data from wearable sensors, and a digital engagement strategy centered on providing knowledge and support to participants. Methods: The Stress and Recovery in Frontline COVID-19 Health Care Workers Study included US frontline health care workers followed between May and November 2020. The study comprised 3 main components: (1) active and passive assessments of stress and symptoms from a smartphone app, (2) objective measured assessments of acute stress from wearable sensors, and (3) a participant codriven engagement strategy that centered on providing knowledge and support to participants. The daily participant time commitment was an average of 10 to 15 minutes. Retention and adherence are described both quantitatively and qualitatively. Results: A total of 365 participants enrolled and started the study, and 81.0% (n=297) of them completed the study for a total study duration of 4 months. Average wearable sensor use was 90.6% days of total study duration. App-based daily, weekly, and every other week surveys were completed on average 69.18%, 68.37%, and 72.86% of the time, respectively. Conclusions: This study found evidence for the feasibility and acceptability of a participant-centric digital health study approach that involved building trust with participants and providing support through regular phone check-ins. In addition to high retention and adherence, the collection of large volumes of objective measured data alongside contextual self-reported subjective data was able to be collected, which is often missing from light touch digital health studies. Trial Registration: ClinicalTrials.gov NCT04713111; https://clinicaltrials.gov/ct2/show/NCT04713111 %M 34726607 %R 10.2196/32165 %U https://formative.jmir.org/2021/12/e32165 %U https://doi.org/10.2196/32165 %U http://www.ncbi.nlm.nih.gov/pubmed/34726607 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e32842 %T An App-Based Just-in-Time Adaptive Self-management Intervention for Care Partners (CareQOL): Protocol for a Pilot Trial %A Carlozzi,Noelle E %A Choi,Sung Won %A Wu,Zhenke %A Miner,Jennifer A %A Lyden,Angela K %A Graves,Christopher %A Wang,Jitao %A Sen,Srijan %+ Department of Physical Medicine and Rehabilitation, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI, 48109, United States, 1 7347638917, carlozzi@med.umich.edu %K caregivers %K quality of life %K spinal cord injuries %K Huntington disease %K hematopoietic stem cell transplantation %K feasibility studies %K self-management %K mobile apps %K outcome assessment %K mobile phone %D 2021 %7 9.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Care partners (ie, informal family caregivers) of individuals with health problems face considerable physical and emotional stress, often with a substantial negative impact on the health-related quality of life (HRQOL) of both care partners and care recipients. Given that these individuals are often overwhelmed by their caregiving responsibilities, low-burden self-management interventions are needed to support care partners to ensure better patient outcomes. Objective: The primary objective of this study is to describe an intensive data collection protocol that involves the delivery of a personalized just-in-time adaptive intervention that incorporates passive mobile sensor data feedback (sleep and activity data from a Fitbit [Fitbit LLC]) and real time self-reporting of HRQOL via a study-specific app called CareQOL (University of Michigan) to provide personalized feedback via app alerts. Methods: Participants from 3 diverse care partner groups will be enrolled (care partners of persons with spinal cord injury, care partners of persons with Huntington disease, and care partners of persons with hematopoietic cell transplantation). Participants will be randomized to either a control group, where they will wear the Fitbit and provide daily reports of HRQOL over a 3-month (ie, 90 days) period (without personalized feedback), or the just-in-time adaptive intervention group, where they will wear the Fitbit, provide daily reports of HRQOL, and receive personalized push notifications for 3 months. At the end of the study, participants will complete a feasibility and acceptability questionnaire, and metrics regarding adherence and attrition will be calculated. Results: This trial opened for recruitment in November 2020. Data collection was completed in June 2021, and the primary results are expected to be published in 2022. Conclusions: This trial will determine the feasibility and acceptability of an intensive app-based intervention in 3 distinct care partner groups: care partners for persons with a chronic condition that was caused by a traumatic event (ie, spinal cord injury); care partners for persons with a progressive, fatal neurodegenerative disease (ie, Huntington disease); and care partners for persons with episodic cancer conditions that require intense, prolonged inpatient and outpatient treatment (persons with hematopoietic cell transplantation). Trial Registration: ClinicalTrials.gov NCT04556591; https://clinicaltrials.gov/ct2/show/NCT04556591 International Registered Report Identifier (IRRID): DERR1-10.2196/32842 %M 34889775 %R 10.2196/32842 %U https://www.researchprotocols.org/2021/12/e32842 %U https://doi.org/10.2196/32842 %U http://www.ncbi.nlm.nih.gov/pubmed/34889775 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e29573 %T Mobile Intervention to Improve Sleep and Functional Health of Veterans With Insomnia: Randomized Controlled Trial %A Reilly,Erin Dawna %A Robinson,Stephanie A %A Petrakis,Beth Ann %A Gardner,Melissa M %A Wiener,Renda Soylemez %A Castaneda-Sceppa,Carmen %A Quigley,Karen S %+ Mental Illness Research, Education, and Clinical Center, VA Bedford Healthcare System, 200 Springs Road, Bedford, MA, 01730, United States, 1 781 687 4191, erin.reilly@va.gov %K cognitive behavioral therapy %K mobile app %K physical activity %K insomnia %D 2021 %7 9.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Insomnia is a prevalent and debilitating disorder among veterans. Cognitive behavioral therapy for insomnia (CBTI) can be effective for treating insomnia, although many cannot access this care. Technology-based solutions and lifestyle changes, such as physical activity (PA), offer affordable and accessible self-management alternatives to in-person CBTI. Objective: This study aims to extend and replicate prior pilot work to examine whether the use of a mobile app for CBTI (cognitive behavioral therapy for insomnia coach app [CBT-i Coach]) improves subjective and objective sleep outcomes. This study also aims to investigate whether the use of the CBT-i Coach app with adjunctive PA improves sleep outcomes more than CBT-i Coach alone. Methods: A total of 33 veterans (mean age 37.61 years, SD 9.35 years) reporting chronic insomnia were randomized to use either the CBT-i Coach app alone or the CBT-i Coach app with a PA intervention over 6 weeks, with outcome measures of objective and subjective sleep at pre- and posttreatment. Results: Although the PA manipulation was unsuccessful, both groups of veterans using the CBT-i Coach app showed significant improvement from baseline to postintervention on insomnia (P<.001), sleep quality (P<.001), and functional sleep outcomes (P=.002). Improvements in subjective sleep outcomes were similar in those with and without posttraumatic stress disorder and mild-to-moderate sleep apnea. We also observed a significant but modest increase in objective sleep efficiency (P=.02). Conclusions: These findings suggest that the use of a mobile app–delivered CBTI is feasible and beneficial for improving sleep outcomes in veterans with insomnia, including those with comorbid conditions such as posttraumatic stress disorder or mild-to-moderate sleep apnea. Trial Registration: ClinicalTrials.gov NCT03305354; https://clinicaltrials.gov/ct2/show/NCT03305354 %M 34889746 %R 10.2196/29573 %U https://formative.jmir.org/2021/12/e29573 %U https://doi.org/10.2196/29573 %U http://www.ncbi.nlm.nih.gov/pubmed/34889746 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e29047 %T Patient-Facing Mobile Apps to Support Physiotherapy Care: Protocol for a Systematic Review of Apps Within App Stores %A Merolli,Mark %A Francis,Jill J %A Vallance,Patrick %A Bennell,Kim L %A Malliaras,Peter %A Hinman,Rana S %+ Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, 161 Barry Street, Melbourne, 3053, Australia, 61 408513984, merollim@unimelb.edu.au %K physiotherapy %K physical therapy %K digital health intervention %K mobile app %K eHealth %K behavior change technique %K behavior change %K exercise %K digital health %K mHealth %D 2021 %7 9.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Care delivered by physiotherapists aims to facilitate engagement in positive health behaviors by patients (eg, adherence to exercise). However, research suggests that behavioral interventions are frequently omitted from care. Hence, better understanding of strategies that can be used by physiotherapists to support patients to engage in positive behaviors is important and likely to optimize outcomes. Digital health interventions delivered via mobile apps are garnering attention for their ability to support behavior change. They have potential to incorporate numerous behavior change techniques (BCTs) to support goals of physiotherapy care, including but not limited to self-monitoring, goal setting, and prompts/alerts. Despite their potential to support physiotherapy care, much is still unknown about what apps are available to consumers, the BCTs they use, their quality, and their potential to change behaviors. Objective: The primary aim of this study is to systematically review the mobile apps available in app stores that are intended for use by patients to support physiotherapy care, including the BCTs within these apps. The secondary aims are to evaluate the quality and behavior change potential of these apps. Methods: A systematic review of mobile apps in app stores will be undertaken. This will be guided by recommendations for systematic reviews in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement but adapted to suit our app store search, consistent with similar systematic reviews of apps published in the Journal of Medical Internet Research. Apple Store and Google Play will be searched with a two-step search strategy, using terms relevant to physiotherapy, physiotherapists, and common physiotherapy care. Key eligibility criteria will include apps that are intended for use by patients and are self-contained or stand-alone without the need of additional wearable devices or other add-ons. Included apps will be coded for BCTs and rated for quality using the Mobile Application Rating Scale (MARS) and for potential to change behavior using the App Behavior Change Scale (ABACUS). Results: App store search and screening are expected to be completed in 2021. Data extraction and quality appraisal are expected to commence by November 2021. The study results are expected to be published in a subsequent paper in 2022. Conclusions: Knowledge gained from this review will support clinical practice and inform research by providing a greater understanding of the quality of currently available mobile apps and their potential to support patient behavior change goals of physiotherapy care. International Registered Report Identifier (IRRID): PRR1-10.2196/29047 %M 34889767 %R 10.2196/29047 %U https://www.researchprotocols.org/2021/12/e29047 %U https://doi.org/10.2196/29047 %U http://www.ncbi.nlm.nih.gov/pubmed/34889767 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e17314 %T Evaluation of a Web-Based Stress Management Program for Persons Experiencing Work-Related Stress in Sweden (My Stress Control): Randomized Controlled Trial %A Eklund,Caroline %A Söderlund,Anne %A Elfström,Magnus L %+ Department of Physical Therapy, School of Health, Care and Social Welfare, Mälardalen University, Box 883, Västerås, 72123, Sweden, 46 736484426, caroline.eklund@mdh.se %K behavior change %K behavior medicine %K internet %K stress prevention %D 2021 %7 9.12.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Stress is one of the most common reasons for sick leave. Web-based interventions have the potential to reach an unlimited number of users at a low cost and have been shown to be effective in addressing several health-related problems. Handling stress on an individual level is related to behavior change. To support behavioral changes in stress management, My Stress Control (MSC) was developed. The development of MSC was based on several health psychology theories and models; however, central in the development were Social Cognitive Theory, Theory of Reasoned Action, Theory of Planned Behavior, Transactional Theory of Stress and Coping, and the Transtheoretical Model and Stages of Change. MSC is a fully automated program. The program is tailored to the user’s specific needs for stress management and behavior change. Objective: In this study, we aim to conduct a randomized controlled trial to evaluate the extent to which MSC affects perceived stress in persons experiencing work-related stress. Methods: This was a randomized controlled trial with 2 arms. Study participants were recruited by visiting the worksites and workplace meetings. Participants were assigned to the intervention or wait-list group. Web-based questionnaires were used before and after the intervention to collect data. Perceived stress measured using the Perceived Stress Scale-14 was the primary outcome measurement. Analyses were conducted for both between-group and within-group changes. Results: A total of 92 participants were included in this study: 48 (52%) in the intervention group and 44 (48%) in the wait-list group. Overall, 25% (12/48) of participants in the intervention group and 43% (19/44) of participants in the wait-list group completed the postintervention assessment. There were no significant effects on perceived stress between the intervention and wait-list groups or within the groups. A small effect size (Cohen d=0.25) was found when comparing mean change over time on the primary outcome measure between the intervention and wait-list groups. In addition, a small effect size was found between pre- and postintervention assessments within the intervention group (Cohen d=0.38) as well as within the wait-list group (Cohen d=0.25). Conclusions: The effect of MSC on perceived stress remains uncertain. As adherence was low in the intervention group, elements or features that facilitate adherence and engagement must be further developed before firmer conclusions regarding the effect of MSC can be made. Trial Registration: ClinicalTrials.gov NCT03077568; https://clinicaltrials.gov/ct2/show/NCT03077568 %M 34889772 %R 10.2196/17314 %U https://mental.jmir.org/2021/12/e17314 %U https://doi.org/10.2196/17314 %U http://www.ncbi.nlm.nih.gov/pubmed/34889772 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e27645 %T Technology Support Challenges and Recommendations for Adapting an Evidence-Based Exercise Program for Remote Delivery to Older Adults: Exploratory Mixed Methods Study %A Gell,Nancy %A Hoffman,Elise %A Patel,Kushang %+ Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, Box 356540, Seattle, WA, 98195-6540, United States, 1 2066168052, kvpatel@uw.edu %K tele-exercise %K technology %K older adults %K adult learning theory %K knee osteoarthritis %K mobile phone %D 2021 %7 9.12.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Tele-exercise has emerged as a means for older adults to participate in group exercise during the COVID-19 pandemic. However, little is known about the technology support needs of older adults for accessing tele-exercise. Objective: This study aims to examine the needs of older adults for transition to tele-exercise, identify barriers to and facilitators of tele-exercise uptake and continued participation, and describe technology support challenges and successes encountered by older adults starting tele-exercise. Methods: We used an exploratory, sequential mixed methods study design. Participants were older adults with symptomatic knee osteoarthritis (N=44) who started participating in a remotely delivered program called Enhance Fitness. Before the start of the classes, a subsample of the participants (n=10) completed semistructured phone interviews about their technology support needs and the barriers to and facilitators for technology adoption. All of the participants completed the surveys including the Senior Technology Acceptance Model scale and a technology needs assessment. The study team recorded the technology challenges encountered and the attendance rates for 48 sessions delivered over 16 weeks. Results: Four themes emerged from the interviews: participants desire features in a tele-exercise program that foster accountability, direct access to helpful people who can troubleshoot and provide guidance with technology is important, opportunities to participate in high-value activities motivate willingness to persevere through the technology concerns, and belief in the ability to learn new things supersedes technology-related frustration. Among the participants in the tele-exercise classes (mean age 74, SD 6.3 years; 38/44, 86% female; mean 2.5, SD 0.9 chronic conditions), 71% (31/44) had a computer with a webcam, but 41% (18/44) had little or no experience with videoconferencing. The initial technology orientation sessions lasted on average 19.3 (SD 10.3) minutes, and 24% (11/44) required a follow-up assistance call. During the first 2 weeks of tele-exercise, 47% of participants (21/44) required technical assistance, which decreased to 12% (5/44) during weeks 3 to 16. The median attendance was 100% for the first 6 sessions and 93% for the subsequent 42 sessions. Conclusions: With appropriate support, older adults can successfully participate in tele-exercise. Recommendations include individualized technology orientation sessions, experiential learning, and availability of standby technical assistance, particularly during the first 2 weeks of classes. Continued development of best practices in this area may allow previously hard-to-reach populations of older adults to participate in health-enhancing, evidence-based exercise programs. %M 34889743 %R 10.2196/27645 %U https://aging.jmir.org/2021/4/e27645 %U https://doi.org/10.2196/27645 %U http://www.ncbi.nlm.nih.gov/pubmed/34889743 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e29916 %T Adoption and Appropriateness of mHealth for Weight Management in the Real World: A Qualitative Investigation of Patient Perspectives %A Breland,Jessica Y %A Agha,Khizran %A Mohankumar,Rakshitha %+ Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, United States, 1 650 493 5000, jessica.breland@va.gov %K mHealth %K implementation %K adoption %K engagement %K weight management %K obesity %K weight loss %K mobile health %K veterans %K barriers %D 2021 %7 8.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) interventions for weight management can result in weight loss outcomes comparable to in-person treatments. However, there is little information on implementing these treatments in real-world settings. Objective: This work aimed to answer two implementation research questions related to mHealth for weight management: (1) what are barriers and facilitators to mHealth adoption (initial use) and engagement (continued use)? and (2) what are patient beliefs about the appropriateness (ie, perceived fit, relevance, or compatibility) of mHealth for weight management? Methods: We conducted semistructured interviews with patients with obesity at a single facility in an integrated health care system (the Veterans Health Administration). All participants had been referred to a new mHealth program, which included access to a live coach. We performed a rapid qualitative analysis of interviews to identify themes related to the adoption of, engagement with, and appropriateness of mHealth for weight management. Results: We interviewed 24 veterans, seven of whom used the mHealth program. Almost all participants were ≥45 years of age and two-thirds were White. Rapid analysis identified three themes: (1) coaching both facilitates and prevents mHealth adoption and engagement by promoting accountability but leading to guilt among those not meeting goals; (2) preferences regarding the mode of treatment delivery, usability, and treatment content were barriers to mHealth appropriateness and adoption, including preferences for in-person care and a dislike of self-monitoring; and (3) a single invitation was not sufficient to facilitate adoption of a new mHealth program. Themes were unrelated to participants’ age, race, or ethnicity. Conclusions: In a study assessing real-world use of mHealth in a group of middle-aged and older adults, we found that—despite free access to mHealth with a live coach—most did not complete the registration process. Our findings suggest that implementing mHealth for weight management requires more than one information session. Findings also suggest that focusing on the coaching relationship and how users’ lives and goals change over time may be an important way to facilitate engagement and improved health. Most participants thought mHealth was appropriate for weight management, with some nevertheless preferring in-person care. Therefore, the best way to guarantee equitable care will be to ensure multiple routes to achieving the same behavioral health goals. Veterans Health Administration patients have the option of using mHealth for weight management, but can also attend group weight management programs or single-session nutrition classes or access fitness facilities. Health care policy does not allow such access for most people in the United States; however, expanded access to behavioral weight management is an important long-term goal to ensure health for all. %M 34889761 %R 10.2196/29916 %U https://formative.jmir.org/2021/12/e29916 %U https://doi.org/10.2196/29916 %U http://www.ncbi.nlm.nih.gov/pubmed/34889761 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e32587 %T Investigating the Use of Digital Health Technology to Monitor COVID-19 and Its Effects: Protocol for an Observational Study (Covid Collab Study) %A Stewart,Callum %A Ranjan,Yatharth %A Conde,Pauline %A Rashid,Zulqarnain %A Sankesara,Heet %A Bai,Xi %A Dobson,Richard J B %A Folarin,Amos A %+ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 20 7848 0924, amos.folarin@kcl.ac.uk %K mobile health %K COVID-19 %K digital health %K smartphone %K wearable devices %K mental health %K wearable %K data %K crowdsourced %K monitoring %K surveillance %K observational %K feasibility %K infectious disease %K recovery %K mobile phone %D 2021 %7 8.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The ubiquity of mobile phones and increasing use of wearable fitness trackers offer a wide-ranging window into people’s health and well-being. There are clear advantages in using remote monitoring technologies to gain an insight into health, particularly under the shadow of the COVID-19 pandemic. Objective: Covid Collab is a crowdsourced study that was set up to investigate the feasibility of identifying, monitoring, and understanding the stratification of SARS-CoV-2 infection and recovery through remote monitoring technologies. Additionally, we will assess the impacts of the COVID-19 pandemic and associated social measures on people’s behavior, physical health, and mental well-being. Methods: Participants will remotely enroll in the study through the Mass Science app to donate historic and prospective mobile phone data, fitness tracking wearable data, and regular COVID-19–related and mental health–related survey data. The data collection period will cover a continuous period (ie, both before and after any reported infections), so that comparisons to a participant’s own baseline can be made. We plan to carry out analyses in several areas, which will cover symptomatology; risk factors; the machine learning–based classification of illness; and trajectories of recovery, mental well-being, and activity. Results: As of June 2021, there are over 17,000 participants—largely from the United Kingdom—and enrollment is ongoing. Conclusions: This paper introduces a crowdsourced study that will include remotely enrolled participants to record mobile health data throughout the COVID-19 pandemic. The data collected may help researchers investigate a variety of areas, including COVID-19 progression; mental well-being during the pandemic; and the adherence of remote, digitally enrolled participants. International Registered Report Identifier (IRRID): DERR1-10.2196/32587 %M 34784292 %R 10.2196/32587 %U https://www.researchprotocols.org/2021/12/e32587 %U https://doi.org/10.2196/32587 %U http://www.ncbi.nlm.nih.gov/pubmed/34784292 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28040 %T Test-Retest Reliability of Home-Based Fitness Assessments Using a Mobile App (R Plus Health) in Healthy Adults: Prospective Quantitative Study %A Lin,I-I %A Chen,You-Lin %A Chuang,Li-Ling %+ School of Physical Therapy & Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, No. 259 Wen-hua 1st Rd, Guishan Dist, Taoyuan, 33302, Taiwan, 886 3 2118800 ext 3177, lchuang@gap.cgu.edu.tw %K mobile health app %K reliability %K home-based fitness assessments %K healthy adults %K mobile phone %K digital health %D 2021 %7 8.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor physical fitness has a negative impact on overall health status. An increasing number of health-related mobile apps have emerged to reduce the burden of medical care and the inconvenience of long-distance travel. However, few studies have been conducted on home-based fitness tests using apps. Insufficient monitoring of physiological signals during fitness assessments have been noted. Therefore, we developed R Plus Health, a digital health app that incorporates all the components of a fitness assessment with concomitant physiological signal monitoring. Objective: The aim of this study is to investigate the test-retest reliability of home-based fitness assessments using the R Plus Health app in healthy adults. Methods: A total of 31 healthy young adults self-executed 2 fitness assessments using the R Plus Health app, with a 2- to 3-day interval between assessments. The fitness assessments included cardiorespiratory endurance, strength, flexibility, mobility, and balance tests. The intraclass correlation coefficient was computed as a measure of the relative reliability of the fitness assessments and determined their consistency. The SE of measurement, smallest real difference at a 90% CI, and Bland–Altman analyses were used to assess agreement, sensitivity to real change, and systematic bias detection, respectively. Results: The relative reliability of the fitness assessments using R Plus Health was moderate to good (intraclass correlation coefficient 0.8-0.99 for raw scores, 0.69-0.99 for converted scores). The SE of measurement and smallest real difference at a 90% CI were 1.44-6.91 and 3.36-16.11, respectively, in all fitness assessments. The 95% CI of the mean difference indicated no significant systematic error between the assessments for the strength and balance tests. The Bland–Altman analyses revealed no significant systematic bias between the assessments for all tests, with a few outliers. The Bland–Altman plots illustrated narrow limits of agreement for upper extremity strength, abdominal strength, and right leg stance tests, indicating good agreement between the 2 assessments. Conclusions: Home-based fitness assessments using the R Plus Health app were reliable and feasible in young, healthy adults. The results of the fitness assessments can offer a comprehensive understanding of general health status and help prescribe safe and suitable exercise training regimens. In future work, the app will be tested in different populations (eg, patients with chronic diseases or users with poor fitness), and the results will be compared with clinical test results. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000030905; http://www.chictr.org.cn/showproj.aspx?proj=50229 %M 34657835 %R 10.2196/28040 %U https://formative.jmir.org/2021/12/e28040 %U https://doi.org/10.2196/28040 %U http://www.ncbi.nlm.nih.gov/pubmed/34657835 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e29167 %T Gender-Specific Impact of Self-Monitoring and Social Norm Information on Walking Behavior Among Chinese College Students Assessed Using WeChat: Longitudinal Tracking Study %A Xu,Yuepei %A Yue,Ling-Zi %A Wang,Wei %A Wu,Xiao-Ju %A Liang,Zhu-Yuan %+ CAS Key Laboratory of Behavioral Science, Institute of Psychology, 16 Lincui Road, Chaoyang District, Beijing, 100101, China, 86 10 64841536, liangzy@psych.ac.cn %K self-monitoring %K social norm %K group identity %K gender differences %K mHealth %K mobile health %D 2021 %7 7.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Walking is a simple but beneficial form of physical activity (PA). Self-monitoring and providing information about social norms are the 2 most widely used “mobile health (mHealth)” strategies to promote walking behavior. However, previous studies have failed to discriminate the effect of self-monitoring from the combination of the 2 strategies, and provide practical evidence within Chinese culture. Some essential moderators, such as gender and group identity, were also overlooked. Objective: We aimed to investigate the effectiveness of social norm and self-monitoring interventions for walking behavior and assess the moderating effects of gender and group identity, which could guide optimal mHealth intervention projects in China. Methods: In 2 longitudinal tracking studies (study 1, 22 days; study 2, 31 days), Chinese college students wore trackers for at least 8 hours per day (MASAI 3D Pedometer and Xiaomi Wristband 2) to record their daily step counts in baseline, intervention, and follow-up stages. In each study, participants (study 1: n=117, 54% female, mean age 25.60 years; study 2: n=180, 51% female, mean age 22.60 years) were randomly allocated to 1 of the following 3 groups: a self-monitoring group and 2 social norm intervention groups. In the 2 intervention groups and during the intervention stage, participants received different social norm information regarding group member step rankings corresponding to their grouping type of social norm information. In study 1, participants were grouped by within-group member PA levels (PA consistent vs PA inconsistent), and in study 2, participants were grouped by their received gender-specific social norm information (gender consistent vs gender inconsistent). Piece-wise linear mixed models were used to compare the difference in walking steps between groups. Results: In study 1, for males in the self-monitoring group, walking steps significantly decreased from the baseline stage to the intervention stage (change in slope=−1422.16; P=.02). However, additional social norm information regardless of group consistency kept their walking unchanged. For females, social norm information did not provide any extra benefit beyond self-monitoring. Females exposed to PA-inconsistent social norm information even walked less (slope during the intervention=−122.18; P=.03). In study 2, for males, a similar pattern was observed, with a decrease in walking steps in the self-monitoring group (change in slope=−151.33; P=.08), but there was no decrease in the 2 social norm intervention groups. However, for females, gender-consistent social norm information decreased walking steps (slope during the intervention=−143.68; P=.03). Conclusions: Both gender and group identity moderated the effect of social norm information on walking. Among females, social norm information showed no benefit for walking behavior and may have exerted a backfire effect. Among males, while walking behavior decreased with self-monitoring only, the inclusion of social norm information held the level of walking behavior steady. %M 34878992 %R 10.2196/29167 %U https://www.jmir.org/2021/12/e29167 %U https://doi.org/10.2196/29167 %U http://www.ncbi.nlm.nih.gov/pubmed/34878992 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e33123 %T A Multimodal Messaging App (MAAN) for Adults With Autism Spectrum Disorder: Mixed Methods Evaluation Study %A Hijab,Mohamad Hassan Fadi %A Al-Thani,Dena %A Banire,Bilikis %+ Division of Information and Computer Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Education City, Doha, 34110, Qatar, 974 50677321, mhhijab@hbku.edu.qa %K autism %K assistive technology %K mobile app %K social and communication skills %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with autism spectrum disorder (ASD) often exhibit difficulties in social and communication skills. For more than 30 years, specialists, parents, and caregivers have used techniques, such as applied behavioral analysis, augmentative and alternative communication, and the picture exchange communication system to support the social and communication skills of people with ASD. Even though there are many techniques devised to enhance communication, these techniques are not considered in existing social media apps for people with ASD. Objective: This study aimed to investigate the effect of adding accessibility features, such as text-to-speech (TTS), speech-to-text (STT), and communication symbols (CS), to a messaging app (MAAN). We hypothesized that these accessibility features can enhance the social and communication skills of adults with ASD. We also hypothesized that usage of this app can reduce social loneliness in adults with ASD. Methods: Semistructured interviews were conducted with 5 experts working in fields related to ASD to help design the app. Seven adults with ASD participated in the study for a period of 10 to 16 weeks. Data logs of participants’ interactions with the app were collected. Additionally, 6 participants’ parents and 1 caregiver were asked to complete a short version of the Social and Emotional Loneliness Scale for Adults (SELSA-S) questionnaire to compare pre-post study results. The Mobile Application Rating Scale: user version questionnaire was also used to evaluate the app’s usability. Following the study, interviews were conducted with participants to discuss their experiences with the app. Results: The SELSA-S questionnaire results showed no change in the family subscale; however, the social loneliness subscale showed a difference between prestudy and poststudy. The Wilcoxon signed-rank test indicated that poststudy SELSA-S results were statistically significantly higher than prestudy results (z=−2.047; P=.04). Point-biserial correlation indicated that the SELSA-S rate of change was strongly related to usage of the TTS feature (r=0.708; P=.04) and CS feature (r=−0.917; P=.002), and moderately related to usage of the STT feature (r=0.428; P=.17). Lastly, we adopted grounded theory to analyze the interview data, and the following 5 categories emerged: app support, feature relevance, user interface design, overall feedback, and recommendations. Conclusions: This study discusses the potential for improving the communication skills of adults with ASD through special features in mobile messaging apps. The developed app aims to support the inclusion and independent life of adults with ASD. The study results showed the importance of using TTS, STT, and CS features to enhance social and communication skills, as well as reduce social loneliness in adults with ASD. %M 34878998 %R 10.2196/33123 %U https://formative.jmir.org/2021/12/e33123 %U https://doi.org/10.2196/33123 %U http://www.ncbi.nlm.nih.gov/pubmed/34878998 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e29563 %T Prospective Prediction of Lapses in Opioid Use Disorder: Protocol for a Personal Sensing Study %A Moshontz,Hannah %A Colmenares,Alejandra J %A Fronk,Gaylen E %A Sant'Ana,Sarah J %A Wyant,Kendra %A Wanta,Susan E %A Maus,Adam %A Gustafson Jr,David H %A Shah,Dhavan %A Curtin,John J %+ Department of Psychology, University of Wisconsin-Madison, 1202 W Johnson St, Madison, WI, 53706, United States, 1 (608) 262 1040, jjcurtin@wisc.edu %K digital therapeutics %K risk prediction %K opioid lapse %K mobile phone %D 2021 %7 7.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Successful long-term recovery from opioid use disorder (OUD) requires continuous lapse risk monitoring and appropriate use and adaptation of recovery-supportive behaviors as lapse risk changes. Available treatments often fail to support long-term recovery by failing to account for the dynamic nature of long-term recovery. Objective: The aim of this protocol paper is to describe research that aims to develop a highly contextualized lapse risk prediction model that forecasts the ongoing probability of lapse. Methods: The participants will include 480 US adults in their first year of recovery from OUD. Participants will report lapses and provide data relevant to lapse risk for a year with a digital therapeutic smartphone app through both self-report and passive personal sensing methods (eg, cellular communications and geolocation). The lapse risk prediction model will be developed using contemporary rigorous machine learning methods that optimize prediction in new data. Results: The National Institute of Drug Abuse funded this project (R01DA047315) on July 18, 2019 with a funding period from August 1, 2019 to June 30, 2024. The University of Wisconsin-Madison Health Sciences Institutional Review Board approved this project on July 9, 2019. Pilot enrollment began on April 16, 2021. Full enrollment began in September 2021. Conclusions: The model that will be developed in this project could support long-term recovery from OUD—for example, by enabling just-in-time interventions within digital therapeutics. International Registered Report Identifier (IRRID): DERR1-10.2196/29563 %M 34559061 %R 10.2196/29563 %U https://www.researchprotocols.org/2021/12/e29563 %U https://doi.org/10.2196/29563 %U http://www.ncbi.nlm.nih.gov/pubmed/34559061 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e32407 %T Accuracy of Self-reported Human Papillomavirus Vaccination Status Among Gay and Bisexual Adolescent Males: Cross-sectional Study %A Chow,Eric PF %A Fairley,Christopher K %A Wigan,Rebecca %A Hocking,Jane S %A Garland,Suzanne M %A Cornall,Alyssa M %A Tabrizi,Sepehr N %A Chen,Marcus Y %+ Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Melbourne, 3053, Australia, 61 393416233, eric.chow@monash.edu %K human papillomavirus %K vaccination %K accuracy %K self-reported %K men who have sex with men %K immunisation %K public health %K immunization %K HPV vaccination %K bisexual adolescents %K bisexual men %D 2021 %7 6.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Men who have sex with men are a risk group for anal human papillomavirus (HPV) and anal cancer. Australia introduced a universal school-based HPV vaccination program in 2013. Self-reported HPV vaccination status has been widely used in clinical and research settings, but its accuracy is understudied. Objective: We aimed to examine the accuracy of self-reported HPV vaccination status among gay and bisexual adolescent males. Methods: We included 192 gay and bisexual males aged 16-20 years from the Human Papillomavirus in Young People Epidemiological Research 2 (HYPER2) study in Melbourne, Australia. All participants had been eligible for the universal school-based HPV vaccination program implemented in 2013 and were asked to self-report their HPV vaccination status. Written informed consent was obtained to verify their HPV vaccination status using records at the National HPV Vaccination Program Register and the Australian Immunisation Register. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of self-reported HPV vaccination status. Results: The median age of the 192 males was 19 (IQR 18-20) years. There were 128 males (67%) who had HPV vaccination records documented on either registry. Self-reported HPV vaccination had a sensitivity of 47.7% (95% CI 38.8%-56.7%; 61/128), a specificity of 85.9% (95% CI 75.0%-93.4%; 55/64), a positive predictive value of 87.1% (95% CI 77.0%-93.9%; 61/70), and a negative predictive value of 45.1% (95% CI 36.1%-54.3%; 55/122). Conclusions: Self-reported HPV vaccination status among Australian gay and bisexual adolescent males underestimates actual vaccination and may be inaccurate for clinical and research purposes. %M 34874884 %R 10.2196/32407 %U https://publichealth.jmir.org/2021/12/e32407 %U https://doi.org/10.2196/32407 %U http://www.ncbi.nlm.nih.gov/pubmed/34874884 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e26988 %T Use of Natural Spoken Language With Automated Mapping of Self-reported Food Intake to Food Composition Data for Low-Burden Real-time Dietary Assessment: Method Comparison Study %A Taylor,Salima %A Korpusik,Mandy %A Das,Sai %A Gilhooly,Cheryl %A Simpson,Ryan %A Glass,James %A Roberts,Susan %+ Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, 02111, United States, 1 617 556 3238, susan.roberts@tufts.edu %K energy intake %K macronutrient intakes %K 24-hour recall %K machine learning %K convolutional neural networks %K nutrition %K diet %K app %K natural language processing %D 2021 %7 6.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Self-monitoring food intake is a cornerstone of national recommendations for health, but existing apps for this purpose are burdensome for users and researchers, which limits use. Objective: We developed and pilot tested a new app (COCO Nutritionist) that combines speech understanding technology with technologies for mapping foods to appropriate food composition codes in national databases, for lower-burden and automated nutritional analysis of self-reported dietary intake. Methods: COCO was compared with the multiple-pass, interviewer-administered 24-hour recall method for assessment of energy intake. COCO was used for 5 consecutive days, and 24-hour dietary recalls were obtained for two of the days. Participants were 35 women and men with a mean age of 28 (range 20-58) years and mean BMI of 24 (range 17-48) kg/m2. Results: There was no significant difference in energy intake between values obtained by COCO and 24-hour recall for days when both methods were used (mean 2092, SD 1044 kcal versus mean 2030, SD 687 kcal, P=.70). There were also no significant differences between the methods for percent of energy from protein, carbohydrate, and fat (P=.27-.89), and no trend in energy intake obtained with COCO over the entire 5-day study period (P=.19). Conclusions: This first demonstration of a dietary assessment method using natural spoken language to map reported foods to food composition codes demonstrates a promising new approach to automate assessments of dietary intake. %M 34874885 %R 10.2196/26988 %U https://www.jmir.org/2021/12/e26988 %U https://doi.org/10.2196/26988 %U http://www.ncbi.nlm.nih.gov/pubmed/34874885 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e33568 %T Optimizing a Just-in-Time Adaptive Intervention to Improve Dietary Adherence in Behavioral Obesity Treatment: Protocol for a Microrandomized Trial %A Goldstein,Stephanie P %A Zhang,Fengqing %A Klasnja,Predrag %A Hoover,Adam %A Wing,Rena R %A Thomas,John Graham %+ Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903, United States, 1 4017939727, stephanie_goldstein@brown.edu %K obesity %K weight loss %K dietary adherence %K just-in-time adaptive intervention %K microrandomized trial %K mobile phone %D 2021 %7 6.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Behavioral obesity treatment (BOT) is a gold standard approach to weight loss and reduces the risk of cardiovascular disease. However, frequent lapses from the recommended diet stymie weight loss and prevent individuals from actualizing the health benefits of BOT. There is a need for innovative treatment solutions to improve adherence to the prescribed diet in BOT. Objective: The aim of this study is to optimize a smartphone-based just-in-time adaptive intervention (JITAI) that uses daily surveys to assess triggers for dietary lapses and deliver interventions when the risk of lapse is high. A microrandomized trial design will evaluate the efficacy of any interventions (ie, theory-driven or a generic alert to risk) on the proximal outcome of lapses during BOT, compare the effects of theory-driven interventions with generic risk alerts on the proximal outcome of lapse, and examine contextual moderators of interventions. Methods: Adults with overweight or obesity and cardiovascular disease risk (n=159) will participate in a 6-month web-based BOT while using the JITAI to prevent dietary lapses. Each time the JITAI detects elevated lapse risk, the participant will be randomized to no intervention, a generic risk alert, or 1 of 4 theory-driven interventions (ie, enhanced education, building self-efficacy, fostering motivation, and improving self-regulation). The primary outcome will be the occurrence of lapse in the 2.5 hours following randomization. Contextual moderators of intervention efficacy will also be explored (eg, location and time of day). The data will inform an optimized JITAI that selects the theory-driven approach most likely to prevent lapses in a given moment. Results: The recruitment for the microrandomized trial began on April 19, 2021, and is ongoing. Conclusions: This study will optimize a JITAI for dietary lapses so that it empirically tailors the provision of evidence-based intervention to the individual and context. The finalized JITAI will be evaluated for efficacy in a future randomized controlled trial of distal health outcomes (eg, weight loss). Trial Registration: ClinicalTrials.gov NCT04784585; http://clinicaltrials.gov/ct2/show/NCT04784585 International Registered Report Identifier (IRRID): DERR1-10.2196/33568 %M 34874892 %R 10.2196/33568 %U https://www.researchprotocols.org/2021/12/e33568 %U https://doi.org/10.2196/33568 %U http://www.ncbi.nlm.nih.gov/pubmed/34874892 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e25305 %T A Theory- and Evidence-Based Digital Intervention Tool for Weight Loss Maintenance (NoHoW Toolkit): Systematic Development and Refinement Study %A Marques,Marta M %A Matos,Marcela %A Mattila,Elina %A Encantado,Jorge %A Duarte,Cristiana %A Teixeira,Pedro J %A Stubbs,R James %A Sniehotta,Falko F %A Ermes,Miikka %A Harjumaa,Marja %A Leppänen,Juha %A Välkkynen,Pasi %A Silva,Marlene N %A Ferreira,Cláudia %A Carvalho,Sérgio %A Palmeira,Lara %A Horgan,Graham %A Heitmann,Berit Lilienthal %A Evans,Elizabeth H %A Palmeira,António L %+ Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Rua do Instituto Bacteriológico, nº 5 l, Lisbon, 1150-190, Portugal, 351 218803105, mmarques@nms.unl.pt %K mHealth %K behavior change techniques %K weight management %K motivation %K self-regulation %K emotion regulation %K self-monitoring %K user testing %K logic models %D 2021 %7 3.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Many weight loss programs show short-term effectiveness, but subsequent weight loss maintenance is difficult to achieve. Digital technologies offer a promising means of delivering behavior change approaches at low costs and on a wide scale. The Navigating to a Healthy Weight (NoHoW) project, which was funded by the European Union’s Horizon 2020 research and innovation program, aimed to develop, test, and evaluate a digital toolkit designed to promote successful long-term weight management. The toolkit was tested in an 18-month, large-scale, international, 2×2 factorial (motivation and self-regulation vs emotion regulation) randomized controlled trial that was conducted on adults with overweight or obesity who lost ≥5% of their body weight in the preceding 12 months before enrollment into the intervention. Objective: This paper aims to describe the development of the NoHoW Toolkit, focusing on the logic models, content, and specifications, as well as the results from user testing. Methods: The toolkit was developed by using a systematic approach, which included the development of the theory-based logic models, the selection of behavior change techniques, the translation of these techniques into a web-based app (NoHoW Toolkit components), technical development, and the user evaluation and refinement of the toolkit. Results: The toolkit included a set of web-based tools and inputs from digital tracking devices (smart scales and activity trackers) and modules that targeted weight, physical activity, and dietary behaviors. The final toolkit comprised 34 sessions that were distributed through 15 modules and provided active content over a 4-month period. The motivation and self-regulation arm consisted of 8 modules (17 sessions), the emotion regulation arm was presented with 7 modules (17 sessions), and the combined arm received the full toolkit (15 modules; 34 sessions). The sessions included a range of implementations, such as videos, testimonies, and questionnaires. Furthermore, the toolkit contained 5 specific data tiles for monitoring weight, steps, healthy eating, mood, and sleep. Conclusions: A systematic approach to the development of digital solutions based on theory, evidence, and user testing may significantly contribute to the advancement of the science of behavior change and improve current solutions for sustained weight management. Testing the toolkit by using a 2×2 design provided a unique opportunity to examine the effect of motivation and self-regulation and emotion regulation separately, as well as the effect of their interaction in weight loss maintenance. %M 34870602 %R 10.2196/25305 %U https://www.jmir.org/2021/12/e25305 %U https://doi.org/10.2196/25305 %U http://www.ncbi.nlm.nih.gov/pubmed/34870602 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e29964 %T Using the Behaviour Change Wheel Program Planning Model to Design Games for Health: Development Study %A Robertson,Michael C %A Baranowski,Tom %A Thompson,Debbe %A Basen-Engquist,Karen M %A Swartz,Maria Chang %A Lyons,Elizabeth J %+ Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch at Galveston, 301 University Blvd, Galveston, TX, 77555, United States, 1 409 772 2578, ellyons@utmb.edu %K physical activity %K video games %K eHealth %K intervention %K behavior and behavior mechanisms %K psychological theory %K serious games %K gamification %K older women %K older adults %K behavior change %K behavioral interventions %K mobile phone %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Games for health are a promising approach to health promotion. Their success depends on achieving both experiential (game) and instrumental (health) objectives. There is little to guide game for health (G4H) designers in integrating the science of behavior change with the art of game design. Objective: The aim of this study is to extend the Behaviour Change Wheel program planning model to develop Challenges for Healthy Aging: Leveraging Limits for Engaging Networked Game-Based Exercise (CHALLENGE), a G4H centered on increasing physical activity in insufficiently active older women. Methods: We present and apply the G4H Mechanics, Experiences, and Change (MECHA) process, which supplements the Behaviour Change Wheel program planning model. The additional steps are centered on identifying target G4H player experiences and corresponding game mechanics to help game designers integrate design elements and G4H objectives into behavioral interventions. Results: We identified a target behavior of increasing moderate-intensity walking among insufficiently active older women and key psychosocial determinants of this behavior from self-determination theory (eg, autonomy). We used MECHA to map these constructs to intervention functions (eg, persuasion) and G4H target player experiences (eg, captivation). Next, we identified behavior change techniques (eg, framing or reframing) and specific game mechanics (eg, transforming) to help realize intervention functions and elicit targeted player experiences. Conclusions: MECHA can help researchers map specific linkages between distal intervention objectives and more proximal game design mechanics in games for health. This can facilitate G4H program planning, evaluation, and clearer scientific communication. %M 34870604 %R 10.2196/29964 %U https://games.jmir.org/2021/4/e29964 %U https://doi.org/10.2196/29964 %U http://www.ncbi.nlm.nih.gov/pubmed/34870604 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e27956 %T Conversational Agent for Healthy Lifestyle Behavior Change: Web-Based Feasibility Study %A Dhinagaran,Dhakshenya Ardhithy %A Sathish,Thirunavukkarasu %A Soong,AiJia %A Theng,Yin-Leng %A Best,James %A Tudor Car,Lorainne %+ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Clinical Sciences Building, 11 Mandalay Road, Singapore, 308232, Singapore, 65 69041258, lorainne.tudor.car@ntu.edu.sg %K chatbot %K conversational agents %K behavior change %K healthy lifestyle behavior change %K pilot study %K feasibility trial %K usability %K acceptability %K preliminary efficacy %K mobile phone %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The rising incidence of chronic diseases is a growing concern, especially in Singapore, which is one of the high-income countries with the highest prevalence of diabetes. Interventions that promote healthy lifestyle behavior changes have been proven to be effective in reducing the progression of prediabetes to diabetes, but their in-person delivery may not be feasible on a large scale. Novel technologies such as conversational agents are a potential alternative for delivering behavioral interventions that promote healthy lifestyle behavior changes to the public. Objective: The aim of this study is to assess the feasibility and acceptability of using a conversational agent promoting healthy lifestyle behavior changes in the general population in Singapore. Methods: We performed a web-based, single-arm feasibility study. The participants were recruited through Facebook over 4 weeks. The Facebook Messenger conversational agent was used to deliver the intervention. The conversations focused on diet, exercise, sleep, and stress and aimed to promote healthy lifestyle behavior changes and improve the participants’ knowledge of diabetes. Messages were sent to the participants four times a week (once for each of the 4 topics of focus) for 4 weeks. We assessed the feasibility of recruitment, defined as at least 75% (150/200) of our target sample of 200 participants in 4 weeks, as well as retention, defined as 33% (66/200) of the recruited sample completing the study. We also assessed the participants’ satisfaction with, and usability of, the conversational agent. In addition, we performed baseline and follow-up assessments of quality of life, diabetes knowledge and risk perception, diet, exercise, sleep, and stress. Results: We recruited 37.5% (75/200) of the target sample size in 1 month. Of the 75 eligible participants, 60 (80%) provided digital informed consent and completed baseline assessments. Of these 60 participants, 56 (93%) followed the study through till completion. Retention was high at 93% (56/60), along with engagement, denoted by 50% (30/60) of the participants communicating with the conversational agent at each interaction. Acceptability, usability, and satisfaction were generally high. Preliminary efficacy of the intervention showed no definitive improvements in health-related behavior. Conclusions: The delivery of a conversational agent for healthy lifestyle behavior change through Facebook Messenger was feasible and acceptable. We were unable to recruit our planned sample solely using the free options in Facebook. However, participant retention and conversational agent engagement rates were high. Our findings provide important insights to inform the design of a future randomized controlled trial. %M 34870611 %R 10.2196/27956 %U https://formative.jmir.org/2021/12/e27956 %U https://doi.org/10.2196/27956 %U http://www.ncbi.nlm.nih.gov/pubmed/34870611 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e27462 %T Effects of a Novel, Transdiagnostic, Hybrid Ecological Momentary Intervention for Improving Resilience in Youth (EMIcompass): Protocol for an Exploratory Randomized Controlled Trial %A Schick,Anita %A Paetzold,Isabell %A Rauschenberg,Christian %A Hirjak,Dusan %A Banaschewski,Tobias %A Meyer-Lindenberg,Andreas %A Boehnke,Jan R %A Boecking,Benjamin %A Reininghaus,Ulrich %+ Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, Mannheim, 68159, Germany, 49 621 1703 1930, ulrich.reininghaus@zi-mannheim.de %K experience sampling methodology (ESM) %K ecological momentary assessment (EMA) %K mobile intervention %K at-risk individuals %K smartphone training %K blended care %K mental health %K stress reactivity %K mobile phone %D 2021 %7 3.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Most mental disorders first emerge in youth and, in their early stages, surface as subthreshold expressions of symptoms comprising a transdiagnostic phenotype of psychosis, mania, depression, and anxiety. Elevated stress reactivity is one of the most widely studied mechanisms underlying psychotic and affective mental health problems. Thus, targeting stress reactivity in youth is a promising indicated and translational preventive strategy for adverse mental health outcomes that could develop later in life and for improving resilience. Compassion-focused interventions offer a wide range of innovative therapeutic techniques that are particularly amenable to being implemented as ecological momentary interventions (EMIs), a specific type of mobile health intervention, to enable youth to access interventions in a given moment and context in daily life. This approach may bridge the current gap in youth mental health care. Objective: This study aims to investigate the clinical feasibility, candidate underlying mechanisms, and initial signals of the efficacy of a novel, transdiagnostic, hybrid EMI for improving resilience to stress in youth—EMIcompass. Methods: In an exploratory randomized controlled trial, youth aged between 14 and 25 years with current distress, a broad Clinical High At-Risk Mental State, or the first episode of a severe mental disorder will be randomly allocated to the EMIcompass intervention (ie, EMI plus face-to-face training sessions) in addition to treatment as usual or a control condition of treatment as usual only. Primary (stress reactivity) and secondary candidate mechanisms (resilience, interpersonal sensitivity, threat anticipation, negative affective appraisals, and momentary physiological markers of stress reactivity), as well as primary (psychological distress) and secondary outcomes (primary psychiatric symptoms and general psychopathology), will be assessed at baseline, postintervention, and at the 4-week follow-up. Results: The first enrollment was in August 2019, and as of May 2021, enrollment and randomization was completed (N=92). We expect data collection to be completed by August 2021. Conclusions: This study is the first to establish feasibility, evidence on underlying mechanisms, and preliminary signals of the efficacy of a compassion-focused EMI in youth. If successful, a confirmatory randomized controlled trial will be warranted. Overall, our approach has the potential to significantly advance preventive interventions in youth mental health provision. Trial Registration: German Clinical Trials Register DRKS00017265; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017265 International Registered Report Identifier (IRRID): DERR1-10.2196/27462 %M 34870613 %R 10.2196/27462 %U https://www.researchprotocols.org/2021/12/e27462 %U https://doi.org/10.2196/27462 %U http://www.ncbi.nlm.nih.gov/pubmed/34870613 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e26987 %T Clinical Efficacy and Psychological Mechanisms of an App-Based Digital Therapeutic for Generalized Anxiety Disorder: Randomized Controlled Trial %A Roy,Alexandra %A Hoge,Elizabeth A %A Abrante,Pablo %A Druker,Susan %A Liu,Tao %A Brewer,Judson A %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, United States, 1 401 863 2826, judson_brewer@brown.edu %K anxiety %K generalized anxiety disorder %K worry %K mindfulness %K mHealth %K digital therapeutics %K mobile phone %D 2021 %7 2.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Current treatments for generalized anxiety disorder (GAD) often yield suboptimal outcomes, partly because of insufficient targeting of underlying psychological mechanisms (eg, avoidance reinforcement learning). Mindfulness training (MT) has shown efficacy for anxiety; yet, widespread adoption has been limited, partly because of the difficulty in scaling in-person–based delivery. Digital therapeutics are emerging as potentially viable treatments; however, very few have been empirically validated. Objective: The aim of this study is to test the efficacy and mechanism of an app-delivered MT that was designed to target a potential mechanism of anxiety (reinforcement learning), based on which previous studies have shown concern regarding feedback and the perpetuation of anxiety through negative reinforcement. Methods: Individuals with GAD were recruited using social media advertisements and randomized during an in-person visit to receive treatment as usual (n=33) or treatment as usual+app−delivered MT (Unwinding Anxiety; n=32). The latter was composed of 30 modules to be completed over a 2-month period. Associated changes in outcomes were assessed using self-report questionnaires 1 and 2 months after treatment initiation. Results: We randomized 65 participants in this study, and a modified intent-to-treat approach was used for analysis. The median number of modules completed by the MT group was 25.5 (IQR 17) out of 30; 46% (13/28) of the participants completed the program. In addition, the MT group demonstrated a significant reduction in anxiety (GAD-7) compared with the control group at 2 months (67% vs 14%; median change in GAD-7: –8.5 [IQR 6.5] vs –1.0 [IQR 5.0]; P<.001; 95% CI 6-10). Increases in mindfulness at 1 month (nonreactivity subscale) mediated decreases in worry at 2 months (Penn State Worry Questionnaire; P=.02) and decreases in worry at 1 month mediated reductions in anxiety at 2 months (P=.03). Conclusions: To our knowledge, this is the first report on the efficacy and mechanism of an app-delivered MT for GAD. These findings demonstrate the clinical efficacy of MT as a digital therapeutic for individuals with anxiety (number needed to treat=1.6). These results also link recent advances in our mechanistic understanding of anxiety with treatment development, showing that app-delivered MT targets key reinforcement learning pathways, resulting in tangible, clinically meaningful reductions in worry and anxiety. Evidence-based, mechanistically targeted digital therapeutics have the potential to improve health at a population level at a low cost. Trial Registration: ClinicalTrials.gov NCT03683472; https://clinicaltrials.gov/ct2/show/NCT03683472 %M 34860673 %R 10.2196/26987 %U https://www.jmir.org/2021/12/e26987 %U https://doi.org/10.2196/26987 %U http://www.ncbi.nlm.nih.gov/pubmed/34860673 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e27512 %T The Use of Food Images and Crowdsourcing to Capture Real-time Eating Behaviors: Acceptability and Usability Study %A Harrington,Katharine %A Zenk,Shannon N %A Van Horn,Linda %A Giurini,Lauren %A Mahakala,Nithya %A Kershaw,Kiarri N %+ Northwestern University Feinberg School of Medicine, 680 N Lake Shore, Suite 1400, Chicago, IL, 60611, United States, 1 312 503 4014, k-kershaw@northwestern.edu %K ecological momentary assessment %K eating behaviors %K crowdsourcing %K food consumption images %K food image processing %K mobile phone %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As poor diet quality is a significant risk factor for multiple noncommunicable diseases prevalent in the United States, it is important that methods be developed to accurately capture eating behavior data. There is growing interest in the use of ecological momentary assessments to collect data on health behaviors and their predictors on a micro timescale (at different points within or across days); however, documenting eating behaviors remains a challenge. Objective: This pilot study (N=48) aims to examine the feasibility—usability and acceptability—of using smartphone-captured and crowdsource-labeled images to document eating behaviors in real time. Methods: Participants completed the Block Fat/Sugar/Fruit/Vegetable Screener to provide a measure of their typical eating behavior, then took pictures of their meals and snacks and answered brief survey questions for 7 consecutive days using a commercially available smartphone app. Participant acceptability was determined through a questionnaire regarding their experiences administered at the end of the study. The images of meals and snacks were uploaded to Amazon Mechanical Turk (MTurk), a crowdsourcing distributed human intelligence platform, where 2 Workers assigned a count of food categories to the images (fruits, vegetables, salty snacks, and sweet snacks). The agreement among MTurk Workers was assessed, and weekly food counts were calculated and compared with the Screener responses. Results: Participants reported little difficulty in uploading photographs and remembered to take photographs most of the time. Crowdsource-labeled images (n=1014) showed moderate agreement between the MTurk Worker responses for vegetables (688/1014, 67.85%) and high agreement for all other food categories (871/1014, 85.89% for fruits; 847/1014, 83.53% for salty snacks, and 833/1014, 81.15% for sweet snacks). There were no significant differences in weekly food consumption between the food images and the Block Screener, suggesting that this approach may measure typical eating behaviors as accurately as traditional methods, with lesser burden on participants. Conclusions: Our approach offers a potentially time-efficient and cost-effective strategy for capturing eating events in real time. %M 34860666 %R 10.2196/27512 %U https://formative.jmir.org/2021/12/e27512 %U https://doi.org/10.2196/27512 %U http://www.ncbi.nlm.nih.gov/pubmed/34860666 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e27208 %T Walking and Daily Affect Among Sedentary Older Adults Measured Using the StepMATE App: Pilot Randomized Controlled Trial %A Bisson,Alycia N %A Sorrentino,Victoria %A Lachman,Margie E %+ Psychiatry Department, Brigham and Women’s Hospital, Room 394, 221 Longwood Ave, Boston, MA, 02115, United States, 1 5082598151, alyciansullivan@brandeis.edu %K physical activity %K fitness technology %K intervention %K behavioral science %K aging %K mobile phone %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although fitness technology can track and encourage increases in physical activity, few smartphone apps are based on behavior change theories. Apps that do include behavioral components tend to be costly and often do not include strategies to help those who are unsure of how to increase their physical activity. Objective: The aim of this pilot study is to test the efficacy of a new app, StepMATE, for increasing daily walking in a sample of inactive adults and to examine daily relationships between walking and self-reported mood and energy. Methods: The participants were middle-aged and older adults aged ≥50 years (mean 61.64, SD 7.67 years). They were randomly assigned to receive either a basic, pedometer-like version of the app or a version with supports to help them determine where, when, and with whom to walk. Of the 96 participants randomized to 1 of 2 conditions, 87 (91%) completed pretest assessments and 81 (84%) successfully downloaded the app. Upon downloading the app, step data from the week prior were automatically recorded. The participants in both groups were asked to set a daily walking goal, which they could change at any point during the intervention. They were asked to use the app as much as possible over the next 4 weeks. Twice per day, pop-up notifications assessed mood and energy levels. Results: Although one group had access to additional app features, both groups used the app in a similar way, mainly using just the walk-tracking feature. Multilevel models revealed that both groups took significantly more steps during the 4-week study than during the week before downloading the app (γ=0.24; P<.001). During the study, the participants in both groups averaged 5248 steps per day compared with an average of 3753 steps per day during the baseline week. Contrary to predictions, there were no differences in step increases between the two conditions. Cognition significantly improved from pre- to posttest (γ=0.17; P=.02). Across conditions, on days in which the participants took more steps than average, they reported better mood and higher energy levels on the same day and better mood on the subsequent day. Daily associations among walking, mood, and energy were significant for women but not for men and were stronger for older participants (those aged ≥62 years) than for the younger participants. Conclusions: Both groups increased their steps to a similar extent, suggesting that setting and monitoring daily walking goals was sufficient for an initial increase and maintenance of steps. Across conditions, walking had benefits for positive mood and energy levels, particularly for women and older participants. Further investigations should identify other motivating factors that could lead to greater and more sustained increases in physical activity. Trial Registration: ClinicalTrials.gov NCT03124537; https://clinicaltrials.gov/ct2/show/NCT03124537 %M 34855609 %R 10.2196/27208 %U https://mhealth.jmir.org/2021/12/e27208 %U https://doi.org/10.2196/27208 %U http://www.ncbi.nlm.nih.gov/pubmed/34855609 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 2 %P e31985 %T Toward the Value Sensitive Design of eHealth Technologies to Support Self-management of Cardiovascular Diseases: Content Analysis %A Cruz-Martínez,Roberto Rafael %A Wentzel,Jobke %A Bente,Britt Elise %A Sanderman,Robbert %A van Gemert-Pijnen,Julia EWC %+ Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Cubicus Bldg, 10, De Zul, Enschede, 7522 NJ, Netherlands, 31 683186149, r.cruzmartinez@utwente.nl %K eHealth %K self-management %K self-care %K cardiovascular diseases %K value sensitive design %K values %K content analysis %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: eHealth can revolutionize the way self-management support is offered to chronically ill individuals such as those with a cardiovascular disease (CVD). However, patients’ fluctuating motivation to actually perform self-management is an important factor for which to account. Tailoring and personalizing eHealth to fit with the values of individuals promises to be an effective motivational strategy. Nevertheless, how specific eHealth technologies and design features could potentially contribute to values of individuals with a CVD has not been explicitly studied before. Objective: This study sought to connect a set of empirically validated, health-related values of individuals with a CVD with existing eHealth technologies and their design features. The study searched for potential connections between design features and values with the goal to advance knowledge about how eHealth technologies can actually be more meaningful and motivating for end users. Methods: Undertaking a technical investigation that fits with the value sensitive design framework, a content analysis of existing eHealth technologies was conducted. We matched 11 empirically validated values of CVD patients with 70 design features from 10 eHealth technologies that were previously identified in a systematic review. The analysis consisted mainly of a deductive coding stage performed independently by 3 members of the study team. In addition, researchers and developers of 6 of the 10 reviewed technologies provided input about potential feature-value connections. Results: In total, 98 connections were made between eHealth design features and patient values. This meant that some design features could contribute to multiple values. Importantly, some values were more often addressed than others. CVD patients’ values most often addressed were related to (1) having or maintaining a healthy lifestyle, (2) having an overview of personal health data, (3) having reliable information and advice, (4) having extrinsic motivators to accomplish goals or health-related activities, and (5) receiving personalized care. In contrast, values less often addressed concerned (6) perceiving low thresholds to access health care, (7) receiving social support, (8) preserving a sense of autonomy over life, and (9) not feeling fear, anxiety, or insecurity about health. Last, 2 largely unaddressed values were related to (10) having confidence and self-efficacy in the treatment or ability to achieve goals and (11) desiring to be seen as a person rather than a patient. Conclusions: Positively, existing eHealth technologies could be connected with CVD patients’ values, largely through design features that relate to educational support, self-monitoring support, behavior change support, feedback, and motivational incentives. Other design features such as reminders, prompts or cues, peer-based or expert-based human support, and general system personalization were also connected with values but in narrower ways. In future studies, the inferred feature-value connections must be validated with empirical data from individuals with a CVD or similar chronic conditions. %M 34855608 %R 10.2196/31985 %U https://cardio.jmir.org/2021/2/e31985 %U https://doi.org/10.2196/31985 %U http://www.ncbi.nlm.nih.gov/pubmed/34855608 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30053 %T A Conversational Artificial Intelligence Agent for a Mental Health Care App: Evaluation Study of Its Participatory Design %A Danieli,Morena %A Ciulli,Tommaso %A Mousavi,Seyed Mahed %A Riccardi,Giuseppe %+ Speech and Interactive Signal Lab, Department of Engineering and Computer Science, Università degli Studi di Trento, Via Sommarive 5, Povo di Trento, Trento, 38123, Italy, 39 0461282087, morena.danieli@unitn.it %K mental health care %K conversational AI %K mHealth %K personal health care agents %K participatory design %K psychotherapy %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile apps for mental health are available on the market. Although they seem to be promising for improving the accessibility of mental health care, little is known about their acceptance, design methodology, evaluation, and integration into psychotherapy protocols. This makes it difficult for health care professionals to judge whether these apps may help them and their patients. Objective: Our aim is to describe and evaluate a protocol for the participatory design of mobile apps for mental health. In this study, participants and psychotherapists are engaged in the early phases of the design and development of the app empowered by conversational artificial intelligence (AI). The app supports interventions for stress management training based on cognitive behavioral theory. Methods: A total of 21 participants aged 33-61 years with mild to moderate levels of stress, anxiety, and depression (assessed by administering the Italian versions of the Symptom Checklist-90-Revised, Occupational Stress Indicator, and Perceived Stress Scale) were assigned randomly to 2 groups, A and B. Both groups received stress management training sessions along with cognitive behavioral treatment, but only participants assigned to group A received support through a mobile personal health care agent, designed for mental care and empowered by AI techniques. Psychopathological outcomes were assessed at baseline (T1), after 8 weeks of treatment (T2), and 3 months after treatment (T3). Focus groups with psychotherapists who administered the therapy were held after treatment to collect their impressions and suggestions. Results: Although the intergroup statistical analysis showed that group B participants could rely on better coping strategies, group A participants reported significant improvements in obsessivity and compulsivity and positive distress symptom assessment. The psychotherapists’ acceptance of the protocol was good. In particular, they were in favor of integrating an AI-based mental health app into their practice because they could appreciate the increased engagement of patients in pursuing their therapy goals. Conclusions: The integration into practice of an AI-based mobile app for mental health was shown to be acceptable to both mental health professionals and users. Although it was not possible in this experiment to show that the integration of AI-based conversational technologies into traditional remote psychotherapy significantly decreased the participants’ levels of stress and anxiety, the experimental results showed significant trends of reduction of symptoms in group A and their persistence over time. The mental health professionals involved in the experiment reported interest in, and acceptance of, the proposed technology as a promising tool to be included in a blended model of psychotherapy. %M 34855607 %R 10.2196/30053 %U https://formative.jmir.org/2021/12/e30053 %U https://doi.org/10.2196/30053 %U http://www.ncbi.nlm.nih.gov/pubmed/34855607 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e30525 %T Ecological Momentary Assessment of Weight-Related Behaviors in the Home Environment of Children From Low-Income and Racially and Ethnically Diverse Households: Development and Usability Study %A Trofholz,Amanda %A Tate,Allan %A Janowiec,Mark %A Fertig,Angela %A Loth,Katie %A de Brito,Junia N %A Berge,Jerica %+ Humphrey School of Public Affairs, University of Minnestoa, 717 Delaware St SE, Room 454, Minneapolis, MN, 55414, United States, 1 6126247129, trofh002@umn.edu %K methods %K ecological momentary assessment %K weight-related behaviors %K racially and ethnically diverse %K children %K mobile phone %D 2021 %7 1.12.2021 %9 Early Report %J JMIR Res Protoc %G English %X Background: Ecological momentary assessment (EMA) is an innovative tool for capturing in-the-moment health behaviors as people go about their daily lives. EMA is an ideal tool to measure weight-related behaviors, such as parental feeding practices, stress, and dietary intake, as these occur on a daily basis and vary across time and context. A recent systematic review recommended standardized reporting of EMA design for studies that address weight-related behaviors. Objective: To answer the call for reporting study designs using EMA, this paper describes in detail the EMA design of the Family Matters study and how it was adapted over time to improve functionality and meet the needs of a racially, ethnically, and socioeconomically diverse sample. Methods: Family Matters is an incremental, 2-phased, mixed methods study, conducted with a racially and ethnically diverse, immigrant and refugee sample from largely low-income households, designed to examine risk and protective factors for child weight and weight-related behaviors in the home environment. The Family Matters study intentionally recruited White, Black, Hmong, Latino, Native American, and Somali parents with young children. Parents in phase 1 of the study completed 8 days of EMA on their smartphones, which included signal-contingent surveys (eg, asking about the parent’s stress at the time of the survey), event-contingent surveys (eg, descriptions of the meal the child ate), and end-of-day surveys (eg, overall assessment of the child’s day). Results: A detailed description of EMA strategies, protocols, and methods used in phase 1 of the Family Matters study is provided. Compliance with EMA surveys and participants’ time spent completing EMA surveys are presented and stratified by race and ethnicity. In addition, lessons learned while conducting phase 1 EMA are shared to document how EMA methods were improved and expanded upon for phase 2 of the Family Matters study. Conclusions: The results from this study provided an important next step in identifying best practices for EMA use in assessing weight-related behaviors in the home environment. International Registered Report Identifier (IRRID): DERR1-10.2196/30525 %M 34855612 %R 10.2196/30525 %U https://www.researchprotocols.org/2021/12/e30525 %U https://doi.org/10.2196/30525 %U http://www.ncbi.nlm.nih.gov/pubmed/34855612 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e29423 %T Incorporating African American Veterans’ Success Stories for Hypertension Management: Developing a Behavioral Support Texting Protocol %A DeLaughter,Kathryn L %A Fix,Gemmae M %A McDannold,Sarah E %A Pope,Charlene %A Bokhour,Barbara G %A Shimada,Stephanie L %A Calloway,Rodney %A Gordon,Howard S %A Long,Judith A %A Miano,Danielle A %A Cutrona,Sarah L %+ Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Rd, Bedford, MA, 01730, United States, 1 781 687 2559, kathryn.delaughter@va.gov %K texting %K African American %K hypertension %K self-management %K mobile phone %D 2021 %7 1.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Peer narratives engage listeners through personally relevant content and have been shown to promote lifestyle change and effective self-management among patients with hypertension. Incorporating key quotations from these stories into follow-up text messages is a novel way to continue the conversation, providing reinforcement of health behaviors in the patients’ daily lives. Objective: In our previous work, we developed and tested videos in which African American Veterans shared stories of challenges and success strategies related to hypertension self-management. This study aims to describe our process for developing a text-messaging protocol intended for use after viewing videos that incorporate the voices of these Veterans. Methods: We used a multistep process, transforming video-recorded story excerpts from 5 Veterans into 160-character texts. We then integrated these into comprehensive 6-month texting protocols. We began with an iterative review of story transcripts to identify vernacular features and key self-management concepts emphasized by each storyteller. We worked with 2 Veteran consultants who guided our narrative text message development in substantive ways, as we sought to craft culturally sensitive content for texts. Informed by Veteran input on timing and integration, supplementary educational and 2-way interactive assessment text messages were also developed. Results: Within the Veterans Affairs texting system Annie, we programmed five 6-month text-messaging protocols that included cycles of 3 text message types: narrative messages, nonnarrative educational messages, and 2-way interactive messages assessing self-efficacy and behavior related to hypertension self-management. Each protocol corresponds to a single Veteran storyteller, allowing Veterans to choose the story that most resonates with their own life experiences. Conclusions: We crafted a culturally sensitive text-messaging protocol using narrative content referenced in Veteran stories to support effective hypertension self-management. Integrating narrative content into a mobile health texting intervention provides a low-cost way to support longitudinal behavior change. A randomized trial is underway to test its impact on the lifestyle changes and blood pressure of African American Veterans. Trial Registration: ClinicalTrials.gov NCT03970590; https://clinicaltrials.gov/ct2/show/NCT03970590 International Registered Report Identifier (IRRID): DERR1-10.2196/29423 %M 34855617 %R 10.2196/29423 %U https://www.researchprotocols.org/2021/12/e29423 %U https://doi.org/10.2196/29423 %U http://www.ncbi.nlm.nih.gov/pubmed/34855617 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 2 %P e26597 %T Patient Engagement in the Design of a Mobile Health App That Supports Enhanced Recovery Protocols for Cardiac Surgery: Development Study %A Chudyk,Anna M %A Ragheb,Sandra %A Kent,David %A Duhamel,Todd A %A Hyra,Carole %A Dave,Mudra G %A Arora,Rakesh C %A Schultz,Annette SH %+ Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, CR3023-369 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada, 1 7783876969, anna.chudyk@umanitoba.ca %K cardiac surgery %K perioperative care %K enhanced recovery protocols %K mobile app %K smartphone app %K mHealth %K development %K patient and public involvement %K patient engagement in research %D 2021 %7 30.11.2021 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Despite the importance of their perspectives, end users (eg, patients, caregivers) are not typically engaged by academic researchers in the development of mobile health (mHealth) apps for perioperative cardiac surgery settings. Objective: The aim of this study was to describe a process for and the impact of patient engagement in the development of an mHealth app that supports patient and caregiver involvement with enhanced recovery protocols during the perioperative period of cardiac surgery. Methods: Engagement occurred at the level of consultation and took the form of an advisory panel. Patients who underwent cardiac surgery (2017-2018) at St. Boniface Hospital (Winnipeg, Manitoba) and their caregivers were approached for participation. A qualitative exploration determined the impact of patient engagement on the development (ie, design and content) of the mHealth app. This included a description of (1) the key messages generated by the advisory panel, (2) how key messages were incorporated into the development of the mHealth app, and (3) feedback from the developers of the mHealth app about the key messages generated by the advisory panel. Results: The advisory panel (N=10) generated 23 key messages to guide the development of the mHealth app. Key design-specific messages (n=7) centered around access, tracking, synchronization, and reminders. Key content-specific messages (n=16) centered around medical terms, professional roles, cardiac surgery procedures and recovery, educational videos, travel, nutrition, medications, resources, and physical activity. This information was directly incorporated into the design of the mHealth app as long as it was supported by the existing functionalities of the underlying platform. For example, the platform did not support the scheduling of reminders by users, identifying drug interactions, or synchronizing with other devices. The developers of the mHealth app noted that key messages resulted in the integration of a vast range and volume of information and resources instead of ones primarily focused on surgical information, content geared toward expectations management, and an expanded focus to include caregivers and other family members, so that these stakeholders may be directly included in the provision of information, allowing them to be better informed, prepare along with the patient, and be involved in recovery planning. Conclusions: Patient engagement may facilitate the development of a detail-oriented and patient-centered mHealth app whose design and content are driven by the lived experiences of end users. %M 34851299 %R 10.2196/26597 %U https://periop.jmir.org/2021/2/e26597 %U https://doi.org/10.2196/26597 %U http://www.ncbi.nlm.nih.gov/pubmed/34851299 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e29742 %T Mechanisms of Change in Digital Health Interventions for Mental Disorders in Youth: Systematic Review %A Domhardt,Matthias %A Engler,Sophie %A Nowak,Hannah %A Lutsch,Arne %A Baumel,Amit %A Baumeister,Harald %+ Department of Clinical Psychology and Psychotherapy, Ulm University, Lise-Meitner-Str. 16, Ulm, D-89081, Germany, 49 73150 32803, matthias.domhardt@uni-ulm.de %K children and adolescents %K mental disorders %K mediator %K mechanisms of change %K digital health intervention %K psychotherapy %K mobile phone %D 2021 %7 26.11.2021 %9 Review %J J Med Internet Res %G English %X Background: Digital health interventions (DHIs) are efficacious for several mental disorders in youth; however, integrated, evidence-based knowledge about the mechanisms of change in these interventions is lacking. Objective: This systematic review aims to comprehensively evaluate studies on mediators and mechanisms of change in different DHIs for common mental disorders in children and adolescents. Methods: A systematic literature search of the electronic databases Cochrane Central Register of Controlled Trials, Embase, MEDLINE, and PsycINFO was conducted, complemented by backward and forward searches. Two independent reviewers selected studies for inclusion, extracted the data, and rated the methodological quality of eligible studies (ie, risk of bias and 8 quality criteria for process research). Results: A total of 25 studies that have evaluated 39 potential mediators were included in this review. Cognitive mediators were the largest group of examined intervening variables, followed by a broad range of emotional and affective, interpersonal, parenting behavior, and other mediators. The mediator categories with the highest percentages of significant intervening variables were the groups of affective mediators (4/4, 100%) and combined cognitive mediators (13/19, 68%). Although more than three-quarters of the eligible studies met 5 or more quality criteria, causal conclusions have been widely precluded. Conclusions: The findings of this review might guide the empirically informed advancement of DHIs, contributing to improved intervention outcomes, and the discussion of methodological recommendations for process research might facilitate mediation studies with more pertinent designs, allowing for conclusions with higher causal certainty in the future. %M 34842543 %R 10.2196/29742 %U https://www.jmir.org/2021/11/e29742 %U https://doi.org/10.2196/29742 %U http://www.ncbi.nlm.nih.gov/pubmed/34842543 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e28577 %T Feasibility, Usability, and Effectiveness of a Machine Learning–Based Physical Activity Chatbot: Quasi-Experimental Study %A To,Quyen G %A Green,Chelsea %A Vandelanotte,Corneel %+ Physical Activity Research Group, Appleton Institute, Central Queensland University, 554-700 Yaamba Rd, Norman Gardens, Rockhampton, 4701, Australia, 61 7 4930 6456, q.to@cqu.edu.au %K conversational agent %K virtual coach %K intervention %K exercise %K acceptability %K mobile phone %D 2021 %7 26.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Behavioral eHealth and mobile health interventions have been moderately successful in increasing physical activity, although opportunities for further improvement remain to be discussed. Chatbots equipped with natural language processing can interact and engage with users and help continuously monitor physical activity by using data from wearable sensors and smartphones. However, a limited number of studies have evaluated the effectiveness of chatbot interventions on physical activity. Objective: This study aims to investigate the feasibility, usability, and effectiveness of a machine learning–based physical activity chatbot. Methods: A quasi-experimental design without a control group was conducted with outcomes evaluated at baseline and 6 weeks. Participants wore a Fitbit Flex 1 (Fitbit LLC) and connected to the chatbot via the Messenger app. The chatbot provided daily updates on the physical activity level for self-monitoring, sent out daily motivational messages in relation to goal achievement, and automatically adjusted the daily goals based on physical activity levels in the last 7 days. When requested by the participants, the chatbot also provided sources of information on the benefits of physical activity, sent general motivational messages, and checked participants’ activity history (ie, the step counts/min that were achieved on any day). Information about usability and acceptability was self-reported. The main outcomes were daily step counts recorded by the Fitbit and self-reported physical activity. Results: Among 116 participants, 95 (81.9%) were female, 85 (73.3%) were in a relationship, 101 (87.1%) were White, and 82 (70.7%) were full-time workers. Their average age was 49.1 (SD 9.3) years with an average BMI of 32.5 (SD 8.0) kg/m2. Most experienced technical issues were due to an unexpected change in Facebook policy (93/113, 82.3%). Most of the participants scored the usability of the chatbot (101/113, 89.4%) and the Fitbit (99/113, 87.6%) as at least “OK.” About one-third (40/113, 35.4%) would continue to use the chatbot in the future, and 53.1% (60/113) agreed that the chatbot helped them become more active. On average, 6.7 (SD 7.0) messages/week were sent to the chatbot and 5.1 (SD 7.4) min/day were spent using the chatbot. At follow-up, participants recorded more steps (increase of 627, 95% CI 219-1035 steps/day) and total physical activity (increase of 154.2 min/week; 3.58 times higher at follow-up; 95% CI 2.28-5.63). Participants were also more likely to meet the physical activity guidelines (odds ratio 6.37, 95% CI 3.31-12.27) at follow-up. Conclusions: The machine learning–based physical activity chatbot was able to significantly increase participants’ physical activity and was moderately accepted by the participants. However, the Facebook policy change undermined the chatbot functionality and indicated the need to use independent platforms for chatbot deployment to ensure successful delivery of this type of intervention. %M 34842552 %R 10.2196/28577 %U https://mhealth.jmir.org/2021/11/e28577 %U https://doi.org/10.2196/28577 %U http://www.ncbi.nlm.nih.gov/pubmed/34842552 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e29758 %T Using Methods From Computational Decision-making to Predict Nonadherence to Fitness Goals: Protocol for an Observational Study %A McCarthy,Marie %A Zhang,Lili %A Monacelli,Greta %A Ward,Tomas %+ Insight Centre For Data Analytics, Dublin City University, Collins Ave Ext, Whitehall, Dublin, D9, Ireland, 353 12912500, marie.mccarthy65@mail.dcu.ie %K decision-making games %K computational psychology %K fitness goals %K advanced analytics %K mobile app %K computational modeling %K fitness tracker %K mobile phone %D 2021 %7 26.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Can methods from computational models of decision-making be used to build a predictive model to identify individuals most likely to be nonadherent to personal fitness goals? Such a model may have significant value in the global battle against obesity. Despite growing awareness of the impact of physical inactivity on human health, sedentary behavior is increasingly linked to premature death in the developed world. The annual impact of sedentary behavior is significant, causing an estimated 2 million deaths. From a global perspective, sedentary behavior is one of the 10 leading causes of mortality and morbidity. Annually, considerable funding and countless public health initiatives are applied to promote physical fitness, with little impact on sustained behavioral change. Predictive models developed from multimodal methodologies combining data from decision-making tasks with contextual insights and objective physical activity data could be used to identify those most likely to abandon their fitness goals. This has the potential to enable development of more targeted support to ensure that those who embark on fitness programs are successful. Objective: The aim of this study is to determine whether it is possible to use decision-making tasks such as the Iowa Gambling Task to help determine those most likely to abandon their fitness goals. Predictive models built using methods from computational models of decision-making, combining objective data from a fitness tracker with personality traits and modeling from decision-making games delivered via a mobile app, will be used to ascertain whether a predictive algorithm can identify digital personae most likely to be nonadherent to self-determined exercise goals. If it is possible to phenotype these individuals, it may be possible to tailor initiatives to support these individuals to continue exercising. Methods: This is a siteless study design based on a bring your own device model. A total of 200 healthy adults who are novice exercisers and own a Fitbit (Fitbit Inc) physical activity tracker will be recruited via social media for this study. Participants will provide consent via the study app, which they will download from the Google Play store (Alphabet Inc) or Apple App Store (Apple Inc). They will also provide consent to share their Fitbit data. Necessary demographic information concerning age and sex will be collected as part of the recruitment process. Over 12 months, the scheduled study assessments will be pushed to the subjects to complete. The Iowa Gambling Task will be administered via a web app shared via a URL. Results: Ethics approval was received from Dublin City University in December 2020. At manuscript submission, study recruitment was pending. The expected results will be published in 2022. Conclusions: It is hoped that the study results will support the development of a predictive model and the study design will inform future research approaches. Trial Registration: ClinicalTrials.gov NCT04783298; https://clinicaltrials.gov/ct2/show/NCT04783298 %M 34842557 %R 10.2196/29758 %U https://www.researchprotocols.org/2021/11/e29758 %U https://doi.org/10.2196/29758 %U http://www.ncbi.nlm.nih.gov/pubmed/34842557 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e31307 %T Designing Ruby: Protocol for a 2-Arm, Brief, Digital Randomized Controlled Trial for Internalized Weight Bias %A Hopkins,Christina M %A Miller,Hailey N %A Brooks,Taylor L %A Mo-Hunter,Lihua %A Steinberg,Dori M %A Bennett,Gary G %+ Duke Global Digital Health Science Center, Duke University, Rueben-Cooke Building, Suite 048, 417 Chapel Drive, Durham, NC, 27708, United States, 1 2152034945, christina.m.hopkins@duke.edu %K obesity %K stigma %K mHealth %K mindfulness %K self-compassion %K mobile phone %D 2021 %7 25.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Weight bias internalization, also known as weight self-stigma, is a serious health concern for individuals with higher body weight. Weight bias internalization is associated with the greater avoidance of health care and health-promoting activities, disordered eating, social isolation, and weight gain. Elevated weight bias internalization has been associated with low self-compassion, yet few investigations have explored self-compassion as a potential mechanism for reducing internalized weight bias. Objective: Ruby is a 2-arm randomized controlled trial that was designed to test the efficacy of a 4-week digital self-compassion intervention to reduce internalized weight bias compared with a wait-list control. Methods: Adults with elevated internalized weight bias and a BMI of >30 kg/m2 (N=80) were recruited. Ruby is a standalone digital trial that will be delivered entirely via a smartphone and will involve web-based data collection and text messages. The intervention content will include psychoeducation and daily mindfulness practices with a focus on self-compassion and body concerns. We will use intent-to-treat analyses to examine changes in weight bias internalization throughout time by treatment arm. The analyses will be conducted by using one-way analysis of covariance models and linear mixed models. Results: The protocol was designed in May 2020 and approved in December 2020. Data collection is currently underway. Conclusions: Ruby will be the first digital standalone, self-compassion–based intervention designed to reduce internalized weight bias. Owing to its standalone digital delivery, Ruby may be a highly scalable treatment for internalized weight bias that can be delivered on its own or combined with other treatments. We expect Ruby to be accessible to many, as participants can access the digital intervention at times of the day that are the most convenient in their schedule and are not burdened by in-person time commitments, which can be a barrier for participants with competing demands on their time and resources. If efficacious, Ruby will be poised to expand a burgeoning body of literature related to psychological intervention in this area. Trial Registration: ClinicalTrials.gov NCT04678973; https://clinicaltrials.gov/ct2/show/NCT04678973 International Registered Report Identifier (IRRID): DERR1-10.2196/31307 %M 34842549 %R 10.2196/31307 %U https://www.researchprotocols.org/2021/11/e31307 %U https://doi.org/10.2196/31307 %U http://www.ncbi.nlm.nih.gov/pubmed/34842549 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e30160 %T Digital Interventions to Promote Healthy Eating in Children: Umbrella Review %A Prowse,Rachel %A Carsley,Sarah %+ Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada, 1 709 864 6622, rprowse@mun.ca %K children %K healthy eating %K eHealth %K nutrition intervention %K nutrition education %K food literacy %K digital health %K virtual delivery %K digital interventions %K nutrition interventions %K best practices %K education %K mobile phone %D 2021 %7 25.11.2021 %9 Review %J JMIR Pediatr Parent %G English %X Background: eHealth and web-based service delivery have become increasingly common during the COVID-19 pandemic. Digital interventions may be highly appealing to young people; however, their effectiveness compared with that of the usual face-to-face interventions is unknown. As nutrition interventions merge with the digital world, there is a need to determine the best practices for digital interventions for children. Objective: The aim of this study is to examine the effectiveness of digital nutrition interventions for children on dietary outcomes compared with status quo interventions (eg, conventional face-to-face programming or nondigital support). Methods: We conducted an umbrella review of systematic reviews of studies assessing primary research on digital interventions aimed at improving food and nutrition outcomes for children aged <18 years compared with conventional nutrition education were eligible for inclusion. Results: In total, 11 systematic reviews published since 2015 were included (7/11, 64%, were of moderate quality). Digital interventions ranged from internet, computer, or mobile interventions to websites, programs, apps, email, videos, CD-ROMs, games, telehealth, SMS text messages, and social media, or a combination thereof. The dose and duration of the interventions varied widely (single to multiple exposures; 1-60 minutes). Many studies have been informed by theory or used behavior change techniques (eg, feedback, goal-setting, and tailoring). The effect of digital nutrition interventions for children on dietary outcomes is small and inconsistent. Digital interventions seemed to be the most promising for improving fruit and vegetable intake compared with other nutrition outcomes; however, reviews have found mixed results. Conclusions: Owing to the heterogeneity and duration of digital interventions, follow-up evaluations, comparison groups, and outcomes measured, the effectiveness of these interventions remains unclear. High-quality evidence with common definitions for digital intervention types evaluated with validated measures is needed to improve the state of evidence, to inform policy and program decisions for health promotion in children. Now is the time for critical, robust evaluation of the adopted digital interventions during and after the COVID-19 pandemic to establish best practices for nutrition interventions for children. %M 34842561 %R 10.2196/30160 %U https://pediatrics.jmir.org/2021/4/e30160 %U https://doi.org/10.2196/30160 %U http://www.ncbi.nlm.nih.gov/pubmed/34842561 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30495 %T Patients’ Use of Mobile Health for Self-management of Knee Osteoarthritis: Results of a 6-Week Pilot Study %A Shewchuk,Brittany %A Green,Lee A %A Barber,Tanya %A Miller,Jean %A Teare,Sylvia %A Campbell-Scherer,Denise %A Mrklas,Kelly J %A Li,Linda C %A Marlett,Nancy %A Wasylak,Tracy %A Lopatina,Elena %A McCaughey,Deirdre %A Marshall,Deborah A %+ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3C58 Health Research Innovation Centre, 3230 Hospital Drive, Calgary, AB, T2N 4Z6, Canada, 1 403 210 6377, damarsha@ucalgary.ca %K mobile health %K mHealth %K app %K self-management %K osteoarthritis %D 2021 %7 25.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In a previous study, a prototype mobile health (mHealth) app was co-designed with patients, family physicians, and researchers to enhance self-management and optimize conservative management for patients with mild to moderate knee osteoarthritis (OA). Objective: This study aims to evaluate the overall usability, quality, and effectiveness of the mHealth app prototype for aiding knee OA self-management from the perspectives of patients with OA and health care providers (HCPs). Methods: Using methods triangulation of qualitative and quantitative data, we conducted a pilot evaluation of an mHealth app prototype that was codeveloped with patients and HCPs. We recruited adult patients aged ≥20 years with early knee OA (n=18) who experienced knee pain on most days of the month at any time in the past and HCPs (n=7) to participate. In the qualitative assessment, patient and HCP perspectives were elicited on the likeability and usefulness of app features and functionalities and the perceived impact of the app on patient-HCP communication. The quantitative assessment involved evaluating the app using usability, quality, and effectiveness metrics. Patient baseline assessments included a semistructured interview and survey to gather demographics and assess the quality of life (European Quality-of-Life 5-Dimension 5-Level Questionnaire [EQ-5D-5L]) and patient activation (patient activation measure [PAM]). Following the 6-week usability trial period, a follow-up survey assessed patients’ perceptions of app usability and quality and longitudinal changes in quality of life and patient activation. Semistructured interviews and surveys were also conducted with HCPs (n=7) at baseline to evaluate the usability and quality of the app prototype. Results: Interviews with patients and HCPs revealed overall positive impressions of the app prototype features and functionalities related to likeability and usefulness. Between the baseline and follow-up patient assessments, the mean EQ-5D-5L scores improved from 0.77 to 0.67 (P=.04), and PAM scores increased from 80.4 to 87.9 (P=.01). Following the 6-week evaluation, patients reported a mean System Usability Scale (SUS) score of 57.8, indicating marginal acceptability according to SUS cutoffs. The mean number of goals set during the usability period was 2.47 (SD 3.08), and the mean number of activities completed for knee OA self-management during the study period was 22.2 (SD 17.8). Spearman rank correlation (rs) calculations revealed that the follow-up PAM scores were weakly correlated (rs=−0.32) with the number of goals achieved and the number (rs=0.19) of activities performed during the 6-week usability period. HCPs reported a mean SUS score of 39.1, indicating unacceptable usability. Conclusions: This evidence-based and patient-centered app prototype represents a potential use of mHealth for improving outcomes and enhancing conservative care by promoting patient activation and patient-HCP communication regarding OA management. However, future iterations of the app prototype are required to address the limitations related to usability and quality. %M 34842526 %R 10.2196/30495 %U https://formative.jmir.org/2021/11/e30495 %U https://doi.org/10.2196/30495 %U http://www.ncbi.nlm.nih.gov/pubmed/34842526 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29214 %T mHealth-Based Health Promotion Intervention to Improve Use of Maternity Care Services Among Women in Rural Southwestern Uganda: Iterative Development Study %A Atukunda,Esther Cathyln %A Matthews,Lynn T %A Musiimenta,Angella %A Mugyenyi,Godfrey Rwambuka %A Mugisha,Samuel %A Ware,Norma C %A Obua,Celestino %A Siedner,Mark J %+ Mbarara University of Science and Technology, Faculty of Medicine, Plot 11-18, Kabale Road, P O Box 1410, Mbarara City, Uganda, 256 702949832, eatukunda@must.ac.ug %K mHealth app %K app development %K messaging %K health education %K health promotion %K mobile phone %D 2021 %7 25.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Antenatal care (ANC) prevents perinatal morbidity and mortality, but use of these services in Uganda remains low and maternal mortality rates are among the highest in the world. There is growing evidence that mobile health (mHealth) approaches improve timely communication of health-related information and produce positive health behavior change as well as health outcomes. However, there are limited data to guide development of such interventions in settings where ANC attendance and uptake of skilled maternity care are low. Objective: The aim of this study is to develop a novel patient-centered mHealth intervention to encourage and support women to use maternity care services in Mbarara district, southwestern Uganda. Methods: Using an iterative development approach, we conducted formative stakeholder interviews with 30 women and 5 health care providers (HCPs) to identify preferred key ANC topics and characterize the preferred messaging intervention; developed content for SMS text messaging and audio messaging with the help of 4 medical experts based on the identified topics; designed an app prototype through partnership with an mHealth development company; and pilot-tested the prototype and sought user experiences and feedback to refine the intervention through 3 sets of iterative interviews, a focus group discussion, and 5 cognitive interviews. Qualitative data were coded and analyzed using NVivo (version 12.0; QSR International). Results: Of the 75 women who completed interviews during the development of the prototype, 39 (52%) had at least a primary education and 75 (100%) had access to a mobile phone. The formative interviews identified 20 preferred perinatal health topics, ranging from native medicine use to comorbid disorders and danger signs during pregnancy. In all, 6 additional topics were identified by the interviewed HCPs, including birth preparedness, skilled delivery, male partner’s involvement, HCP interaction, immunization, and caring for the baby. Positive audio messaging and SMS text messaging content without authoritative tones was developed as characterized by the interviewed women. The postpilot iterative interviews and focus group discussion revealed a preference for customized messaging, reflecting an individual need to be included and connected. The women preferred short, concise, clear actionable messages that guided, supported, and motivated them to keep alert and seek professional help. Complementary weekly reminders to the women’s significant others were also preferred to encourage continuity or prompt the needed social support for care seeking. Conclusions: We used an iterative approach with diffuse stakeholders to develop a patient-centered audio messaging and SMS text messaging app designed to communicate important targeted health-related information and support rural pregnant women in southwestern Uganda. Involving both HCPs and end users in developing and formulating the mHealth intervention allowed us to tailor the intervention characteristics to the women’s preferences. Future work will address the feasibility, acceptability, and effectiveness of this design approach. %M 34842541 %R 10.2196/29214 %U https://formative.jmir.org/2021/11/e29214 %U https://doi.org/10.2196/29214 %U http://www.ncbi.nlm.nih.gov/pubmed/34842541 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e23359 %T Objective Measurements of Physical Activity and Sedentary Behavior Using Wearable Devices in Patients With Axial Spondyloarthritis: Protocol for a Systematic Review %A Carlin,Thomas %A Soulard,Julie %A Aubourg,Timothée %A Knitza,Johannes %A Vuillerme,Nicolas %+ AGEIS, Université Grenoble Alpes, Faculty of Medicine, La Tronche, 38706, France, 33 476637104, nicolas.vuillerme@univ-grenoble-alpes.fr %K axial spondyloarthritis %K rheumatology %K physical activity %K sedentary behavior %K objective measures %K wearable %K systematic review %D 2021 %7 25.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Axial spondyloarthritis (axSpA) is a subgroup of inflammatory rheumatic diseases. Practicing regular exercise is critical to manage pain and stiffness, reduce disease activity, and improve physical functioning, spinal mobility, and cardiorespiratory function. Accordingly, monitoring physical activity and sedentary behavior in patients with axSpA is relevant for clinical outcomes and disease management. Objective: This review aims to determine which wearable devices, assessment methods, and associated metrics are commonly used to quantify physical activity or sedentary behavior in patients with axSpA. Methods: The PubMed, Physiotherapy Evidence Database (PEDro), and Cochrane electronic databases will be searched, with no limit on publication date, to identify all the studies matching the inclusion criteria. Only original English-language articles published in a peer-reviewed journal will be included. The search strategy will include a combination of keywords related to the study population, wearable devices, physical activity, and sedentary behavior. We will use the Boolean operators “AND” and “OR” to combine keywords as well as Medical Subject Headings terms. Results: Search strategy was completed in June 2020 with 23 records obtained. Data extraction and synthesis are currently ongoing. Dissemination of study results in peer-reviewed journals is expected at the end of 2021. Conclusions: This review will provide a comprehensive and detailed synthesis of published studies that examine the use of wearable devices for objective assessment of physical activity and sedentary behavior in patients with axSpA. Trial Registration: PROSPERO CRD42020182398; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=182398 International Registered Report Identifier (IRRID): PRR1-10.2196/23359 %M 34842559 %R 10.2196/23359 %U https://www.researchprotocols.org/2021/11/e23359 %U https://doi.org/10.2196/23359 %U http://www.ncbi.nlm.nih.gov/pubmed/34842559 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e29666 %T Effects of Internet-Based Cognitive Behavioral Therapy for Harmful Alcohol Use and Alcohol Dependence as Self-help or With Therapist Guidance: Three-Armed Randomized Trial %A Johansson,Magnus %A Berman,Anne H %A Sinadinovic,Kristina %A Lindner,Philip %A Hermansson,Ulric %A Andréasson,Sven %+ Department of Global Public Health, Karolinska Institutet, Solnavägen 1E, Stockholm, 11365, Sweden, 46 727249971, magnus.johansson.1@ki.se %K alcohol dependence %K alcohol use disorders %K internet-based interventions %K internet-based cognitive behavioral therapy %K ICBT %K cognitive behavioral therapy %K CBT %K eHealth %K alcohol use %K substance abuse %K outcomes %K help-seeking behavior %K internet-based interventions %K alcohol dependence %K mobile phone %D 2021 %7 24.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Alcohol use is a major contributor to health loss. Many persons with harmful use or alcohol dependence do not obtain treatment because of limited availability or stigma. They may use internet-based interventions as an alternative way of obtaining support. Internet-based interventions have previously been shown to be effective in reducing alcohol consumption in studies that included hazardous use; however, few studies have been conducted with a specific focus on harmful use or alcohol dependence. The importance of therapist guidance in internet-based cognitive behavioral therapy (ICBT) programs is still unclear. Objective: This trial aims to investigate the effects of a web-based alcohol program with or without therapist guidance among anonymous adult help-seekers. Methods: A three-armed randomized controlled trial was conducted to compare therapist-guided ICBT and self-help ICBT with an information-only control condition. Swedish-speaking adult internet users with alcohol dependence (3 or more International Classification of Diseases, Tenth Revision criteria) or harmful alcohol use (alcohol use disorder identification test>15) were included in the study. Participants in the therapist-guided ICBT and self-help ICBT groups had 12-week access to a program consisting of 5 main modules, as well as a drinking calendar with automatic feedback. Guidance was given by experienced therapists trained in motivational interviewing. The primary outcome measure was weekly alcohol consumption in standard drinks (12 g of ethanol). Secondary outcomes were alcohol-related problems measured using the total alcohol use disorder identification test-score, diagnostic criteria for alcohol dependence and alcohol use disorder, depression, anxiety, health, readiness to change, and access to other treatments or support. Follow-up was conducted 3 (posttreatment) and 6 months after recruitment. Results: During the recruitment period, from March 2015 to March 2017, 1169 participants were included. Participants had a mean age of 45 (SD 13) years, and 56.72% (663/1169) were women. At the 3-month follow-up, the therapist-guided ICBT and control groups differed significantly in weekly alcohol consumption (−3.84, 95% Cl −6.53 to −1.16; t417=2.81; P=.005; Cohen d=0.27). No significant differences were found in weekly alcohol consumption between the self-help ICBT group and the therapist-guided ICBT at 3 months, between the self-help ICBT and the control group at 3 months, or between any of the groups at the 6-month follow-up. A limitation of the study was the large number of participants who were completely lost to follow-up (477/1169, 40.8%). Conclusions: In this study, a therapist-guided ICBT program was not found to be more effective than the same program in a self-help ICBT version for reducing alcohol consumption or other alcohol-related outcomes. In the short run, therapist-guided ICBT was more effective than information. Only some internet help-seekers may need a multisession program and therapist guidance to change their drinking when they use internet-based interventions. Trial Registration: ClinicalTrials.gov NCT02377726; https://clinicaltrials.gov/ct2/show/NCT02377726 %M 34821563 %R 10.2196/29666 %U https://www.jmir.org/2021/11/e29666 %U https://doi.org/10.2196/29666 %U http://www.ncbi.nlm.nih.gov/pubmed/34821563 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e28317 %T Impact of the COVID-19 Pandemic on Objectively Measured Physical Activity and Sedentary Behavior Among Overweight Young Adults: Yearlong Longitudinal Analysis %A Lawhun Costello,Victoria %A Chevance,Guillaume %A Wing,David %A Mansour-Assi,Shadia J %A Sharp,Sydney %A Golaszewski,Natalie M %A Young,Elizabeth A %A Higgins,Michael %A Ibarra,Anahi %A Larsen,Britta %A Godino,Job G %+ Center for Wireless and Population Health Systems, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, United States, 1 8582463302, jobg@fhcsd.org %K COVID-19 %K young adults %K physical activity %K sedentary behavior %K activity monitor %K public health %K wearable %K activity monitors %K wrist worn %K sedentary %K lifestyle %K pandemic %D 2021 %7 24.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has impacted multiple aspects of daily living, including behaviors associated with occupation, transportation, and health. It is unclear how these changes to daily living have impacted physical activity and sedentary behavior. Objective: In this study, we add to the growing body of research on the health impact of the COVID-19 pandemic by examining longitudinal changes in objectively measured daily physical activity and sedentary behavior among overweight or obese young adults participating in an ongoing weight loss trial in San Diego, California. Methods: Data were collected from 315 overweight or obese (BMI: range 25.0-39.9 kg/m2) participants aged from 18 to 35 years between November 1, 2019, and October 30, 2020, by using the Fitbit Charge 3 (Fitbit LLC). After conducting strict filtering to find valid data on consistent wear (>10 hours per day for ≥250 days), data from 97 participants were analyzed to detect multiple structural changes in time series of physical activity and sedentary behavior. An algorithm was designed to detect multiple structural changes. This allowed for the automatic identification and dating of these changes in linear regression models with CIs. The number of breakpoints in regression models was estimated by using the Bayesian information criterion and residual sum of squares; the optimal segmentation corresponded to the lowest Bayesian information criterion and residual sum of squares. To quantify the changes in each outcome during the periods identified, linear mixed effects analyses were conducted. In terms of key demographic characteristics, the 97 participants included in our analyses did not differ from the 210 participants who were excluded. Results: After the initiation of the shelter-in-place order in California on March 19, 2021, there were significant decreases in step counts (−2872 steps per day; 95% CI −2734 to −3010), light physical activity times (−41.9 minutes; 95% CI −39.5 to −44.3), and moderate-to-vigorous physical activity times (−12.2 minutes; 95% CI −10.6 to −13.8), as well as significant increases in sedentary behavior times (+52.8 minutes; 95% CI 47.0-58.5). The decreases were greater than the expected declines observed during winter holidays, and as of October 30, 2020, they have not returned to the levels observed prior to the initiation of shelter-in-place orders. Conclusions: Among overweight or obese young adults, physical activity times decreased and sedentary behavior times increased concurrently with the implementation of COVID-19 mitigation strategies. The health conditions associated with a sedentary lifestyle may be additional, unintended results of the COVID-19 pandemic. %M 34665759 %R 10.2196/28317 %U https://publichealth.jmir.org/2021/11/e28317 %U https://doi.org/10.2196/28317 %U http://www.ncbi.nlm.nih.gov/pubmed/34665759 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e25618 %T Mobile Text Messaging for Tobacco Risk Communication Among Young Adult Community College Students: Randomized Trial of Project Debunk %A Prokhorov,Alexander V %A Calabro,Karen Sue %A Arya,Ashish %A Russell,Sophia %A Czerniak,Katarzyna W %A Botello,Gabrielle C %A Chen,Minxing %A Yuan,Ying %A Perez,Adriana %A Vidrine,Damon J %A Perry,Cheryl L %A Khalil,Georges Elias %+ Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Clinical and Translational Science Building, 2004 Mowry Road Office 2252, Gainesville, FL, 32610, United States, 1 3522948415, gkhalil@ufl.edu %K tobacco use %K risk communication %K text messaging %K message framing %K regulatory science %K young adults %K vaping %K mobile phone %D 2021 %7 24.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of new and emerging tobacco products (NETPs) and conventional tobacco products (CTPs) has been linked to several alarming medical conditions among young adults (YAs). Considering that 96% of YAs own mobile phones, SMS text messaging may be an effective strategy for tobacco risk communication. Objective: Project Debunk is a community-based randomized trial aiming to identify specific types of messages that effectively improve perceived NETP and CTP risk among YAs in community colleges. Methods: With YAs recruited offline from 3 campuses at the Houston Community College (September 2016 to July 2017), we conducted a 6-month randomized trial with 8 arms based on the combination of 3 message categories: framing (gain-framed vs loss-framed), depth (simple vs complex), and appeal (emotional vs rational). Participants received fully automated web-based SMS text messages in two 30-day campaigns (2 messages per day). We conducted repeated-measures mixed-effect models stratified by message type received, predicting perceived CTP and NETP risks. Owing to multiple testing with 7 models, an association was deemed significant for P<.007 (.05 divided by 7). Results: A total of 636 participants completed the baseline survey, were randomized to 1 of 8 conditions (between 73 and 86 participants per condition), and received messages from both campaigns. By the 2-month post campaign 2 assessment point, 70.1% (446/636) completed all outcome measures. By the end of both campaigns, participants had a significant increase in perceived NETP risk over time (P<.001); however, participants had a marginal increase in perceived CTP risk (P=.008). Separately for each group, there was a significant increase in perceived NETP risk among participants who received rational messages (P=.005), those who received emotional messages (P=.006), those who received simple messages (P=.003), and those who received gain-framed messages (P=.003). Conclusions: In this trial, YAs had an increase in perceived NETP risk. However, with stratification, we observed a significant increase in perceived NETP risk upon exposure to rational, emotional, simple, and gain-framed messages. In addition, YAs generally had an increase in perceived CTP risk and presented nonsignificant but observable improvement upon exposure to emotional, complex, and loss-framed messages. With the results of this study, researchers and practitioners implementing mobile health programs may take advantage of our tailored messages through larger technology-based programs such as smartphone apps and social media campaigns. Trial Registration: ClinicalTrials.gov NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480 International Registered Report Identifier (IRRID): RR2-10.2196/10977 %M 34822339 %R 10.2196/25618 %U https://mhealth.jmir.org/2021/11/e25618 %U https://doi.org/10.2196/25618 %U http://www.ncbi.nlm.nih.gov/pubmed/34822339 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29267 %T Development of a Wearable Biocueing App (Sense-IT) Among Forensic Psychiatric Outpatients With Aggressive Behavior: Design and Evaluation Study %A ter Harmsel,Annemieke %A van der Pol,Thimo %A Swinkels,Lise %A Goudriaan,Anna E %A Popma,Arne %A Noordzij,Matthijs L %+ Inforsa, Forensic Mental Health Care, Vlaardingenlaan 5, Amsterdam, 1059 GL, Netherlands, 31 653810776, annemieke.ter.harmsel@inforsa.nl %K biocueing %K biosensing %K biofeedback %K aggression %K forensic psychiatry %K wearable technology %K mobile apps %K usability %K evaluation %K mHealth %D 2021 %7 24.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The ability to regulate anger is often impaired in forensic psychiatric patients, frequently resulting in aggressive behavior. Although some treatment programs are partially successful in enhancing aggression regulation and reducing recidivism among specific subgroups, generalizable conclusions on the effectiveness of these interventions cannot be drawn to date. In forensic outpatient care, low treatment adherence and a predominant focus on cognitive control in most treatment programs may entail some of the factors impeding treatment. Technology-based interventions may address some of these treatment challenges. Objective: The aim of this study is to explore whether a new technology-based biocueing intervention, the Sense-IT app, can be a valuable addition to aggression regulation treatment programs in forensic outpatient care. The Sense-IT app, which provides the user with real-time physiological feedback and behavioral support, is developed to strengthen emotional awareness and facilitate real-life practice. In this study, we aim to develop and evaluate an updated version of the Sense-IT app that is suitable for forensic outpatients with aggressive behavior. Methods: First, we conducted a design study to assess the attitudes of forensic professionals and patients toward biocueing and to collect requirements for a biocueing app for this specific population. On the basis of this information, we developed an updated version of the Sense-IT app. In an evaluation study, 10 forensic outpatients used the app for 2 weeks. The app’s acceptability, usability, and clinical outcomes (aggression, anger, and recognition of bodily signals related to anger) were measured before and after the intervention using both quantitative and qualitative measures. Results: The design study revealed a cautiously positive attitude toward the use of biocueing as an addition to aggression regulation therapy. The evaluation study among forensic outpatients demonstrated moderate acceptability and adequate usability for the new version of the Sense-IT app. Exploratory analysis revealed a significant decrease in trait aggression postintervention; no significant changes were found in other anger-related clinical outcomes. To further increase acceptability and usability, a stable functioning app with self-adjustable settings, the use of smartwatches with a longer battery life, and the use of the patient’s own smartphone devices were recommended. Conclusions: This study, which is one of the first attempts to enroll and evaluate the real-life use of a biocueing intervention among forensic outpatients, emphasized the importance of involving both patients and therapists throughout the development and implementation process. In the future, experimental studies, including single-case experimental designs using ecological momentary assessment, should be performed to evaluate the effectiveness of the Sense-IT intervention on clinical outcomes. An open attitude toward new technology, allowing exploration of the potential benefits of the Sense-IT app case-by-case, and training of therapists in using the app are expected to facilitate its integration in therapy. %M 34821567 %R 10.2196/29267 %U https://formative.jmir.org/2021/11/e29267 %U https://doi.org/10.2196/29267 %U http://www.ncbi.nlm.nih.gov/pubmed/34821567 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e28204 %T Outcomes of Digital Biomarker–Based Interventions: Protocol for a Systematic Review of Systematic Reviews %A Motahari-Nezhad,Hossein %A Péntek,Márta %A Gulácsi,László %A Zrubka,Zsombor %+ Health Economics Research Center, University Research and Innovation Center, Obuda University, Bécsi út 96/b, Budapest, 1034, Hungary, 36 30 202 9415, zsombor.zrubka@uni-corvinus.hu %K digital biomarker %K outcome %K systematic review %K meta-analysis %K digital health %K mobile health %K Grading of Recommendations, Assessment, Development and Evaluation %K AMSTAR-2 %K review %K biomarkers %K clinical outcome %K interventions %K wearables %K portables %K digestables %K implants %D 2021 %7 24.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital biomarkers are defined as objective, quantifiable, physiological, and behavioral data that are collected and measured using digital devices such as portables, wearables, implantables, or digestibles. For their widespread adoption in publicly financed health care systems, it is important to understand how their benefits translate into improved patient outcomes, which is essential for demonstrating their value. Objective: The paper presents the protocol for a systematic review that aims to assess the quality and strength of the evidence reported in systematic reviews regarding the impact of digital biomarkers on clinical outcomes compared to interventions without digital biomarkers. Methods: A comprehensive search for reviews from 2019 to 2020 will be conducted in PubMed and the Cochrane Library using keywords related to digital biomarkers and a filter for systematic reviews. Original full-text English publications of systematic reviews comparing clinical outcomes of interventions with and without digital biomarkers via meta-analysis will be included. The AMSTAR-2 tool will be used to assess the methodological quality of these reviews. To assess the quality of evidence, we will evaluate the systematic reviews using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. To detect the possible presence of reporting bias, we will determine whether a protocol was published prior to the start of the studies. A qualitative summary of the results by digital biomarker technology and outcomes will be provided. Results: This protocol was submitted before data collection. Search, screening, and data extraction will commence in December 2021 in accordance with the published protocol. Conclusions: Our study will provide a comprehensive summary of the highest level of evidence available on digital biomarker interventions, providing practical guidance for health care providers. Our results will help identify clinical areas in which the use of digital biomarkers has led to favorable clinical outcomes. In addition, our findings will highlight areas of evidence gaps where the clinical benefits of digital biomarkers have not yet been demonstrated. International Registered Report Identifier (IRRID): PRR1-10.2196/28204 %M 34821568 %R 10.2196/28204 %U https://www.researchprotocols.org/2021/11/e28204 %U https://doi.org/10.2196/28204 %U http://www.ncbi.nlm.nih.gov/pubmed/34821568 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e26397 %T A Mobile Intervention for Self-Efficacious and Goal-Directed Smartphone Use in the General Population: Randomized Controlled Trial %A Keller,Jan %A Roitzheim,Christina %A Radtke,Theda %A Schenkel,Konstantin %A Schwarzer,Ralf %+ Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, Berlin, 14195, Germany, 49 30 8385 4906, jan.keller@fu-berlin.de %K problematic smartphone use %K smartphone unlocks %K smartphone time %K behavior change %K self-efficacy %K action planning %K digital detox %K time-out %K randomized controlled trial %D 2021 %7 23.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: People spend large parts of their everyday life using their smartphones. Despite various advantages of the smartphone for daily life, problematic forms of smartphone use exist that are related to negative psychological and physiological consequences. To reduce problematic smartphone use, existing interventions are oftentimes app-based and include components that help users to monitor and restrict their smartphone use by setting timers and blockers. These kinds of digital detox interventions, however, fail to exploit psychological resources, such as through promoting self-efficacious and goal-directed smartphone use. Objective: The aim of this study is to evaluate the theory-based smartphone app “Not Less But Better” that was developed to make people aware of psychological processes while using the smartphone and to support them in using their smartphone in accordance with their goals and values. Methods: In a randomized controlled trial, effects of a 20-day intervention app consisting of five 4-day training modules to foster a goal-directed smartphone use were evaluated. In the active control condition (treatment as usual), participants received a digital detox treatment and planned daily time-outs of at least 1 hour per day. Up to a 3-week follow-up, self-reported problematic smartphone use, objectively measured daily smartphone unlocks, time of smartphone use, self-efficacy, and planning towards goal-directed smartphone use were assessed repeatedly. Linear 2-level models tested intervention effects. Mediation models served to analyze self-efficacy and planning as potential mechanisms of the intervention. Results: Out of 232 enrolled participants, 110 (47.4%; 55 participants in each condition) provided data at postintervention and 88 (37.9%; 44 participants in each condition) at 3-week follow-up. Both conditions manifested substantial reductions in problematic smartphone use and in the amount of time spent with the smartphone. The number of daily unlocks did not change over time. Further, modelling changes in self-efficacy as a mediator between the intervention and problematic smartphone use at follow-up fit well to the data and showed an indirect effect (b=–0.09; 95% bias-corrected bootstrap CI –0.26 to –0.01), indicating that self-efficacy was an important intervention mechanism. Another mediation model revealed an indirect effect from changes in planning via smartphone unlocks at postintervention on problematic smartphone use at follow-up (b=–0.029, 95% bias-corrected bootstrap CI –0.078 to –0.003). Conclusions: An innovative, theory-based intervention app on goal-directed smartphone use has been found useful in lowering problematic smartphone use and time spent with the smartphone. However, observed reductions in both outcomes were not superior to the active control condition (ie, digital detox treatment). Nonetheless, the present findings highlight the importance in promoting self-efficacy and planning goal-directed smartphone use to achieve improvements in problematic smartphone use. This scalable intervention app appears suitable for practical use and as an alternative to common digital detox apps. Future studies should address issues of high attrition by adding just-in-time procedures matched to smartphone users’ needs. Trial Registration: German Clinical Trials Register DRKS00017606; https://tinyurl.com/27c9kmwy %M 34817388 %R 10.2196/26397 %U https://mhealth.jmir.org/2021/11/e26397 %U https://doi.org/10.2196/26397 %U http://www.ncbi.nlm.nih.gov/pubmed/34817388 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 6 %N 4 %P e28920 %T Understanding “Atmosome”, the Personal Atmospheric Exposome: Comprehensive Approach %A Bhimaraju,Hari %A Nag,Nitish %A Pandey,Vaibhav %A Jain,Ramesh %+ Donald Bren School of Information and Computer Sciences, University of California, Donald Bren Hall, 6210, Irvine, CA, 92697, United States, 1 949 824 7427, hari.bhimaraju@columbia.edu %K exposome %K exposomics %K personal health %K indoor air quality %K health state estimation %K health informatics %K public health policy %K epidemiology %K embedded systems %K internet of things %D 2021 %7 23.11.2021 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Modern environmental health research extensively focuses on outdoor air pollutants and their effects on public health. However, research on monitoring and enhancing individual indoor air quality is lacking. The field of exposomics encompasses the totality of human environmental exposures and its effects on health. A subset of this exposome deals with atmospheric exposure, termed the “atmosome.” The atmosome plays a pivotal role in health and has significant effects on DNA, metabolism, skin integrity, and lung health. Objective: The aim of this work is to develop a low-cost, comprehensive measurement system for collecting and analyzing atmosomic factors. The research explores the significance of the atmosome in personalized and preventive care for public health. Methods: An internet of things microcontroller-based system is introduced and demonstrated. The system collects real-time indoor air quality data and posts it to the cloud for immediate access. Results: The experimental results yield air quality measurements with an accuracy of 90% when compared with precalibrated commercial devices and demonstrate a direct correlation between lifestyle and air quality. Conclusions: Quantifying the individual atmosome is a monumental step in advancing personalized health, medical research, and epidemiological research. The 2 main goals in this work are to present the atmosome as a measurable concept and to demonstrate how to implement it using low-cost electronics. By enabling atmosome measurements at a communal scale, this work also opens up potential new directions for public health research. Researchers will now have the data to model the impact of indoor air pollutants on the health of individuals, communities, and specific demographics, leading to novel approaches for predicting and preventing diseases. %M 38907376 %R 10.2196/28920 %U https://biomedeng.jmir.org/2021/4/e28920 %U https://doi.org/10.2196/28920 %U http://www.ncbi.nlm.nih.gov/pubmed/38907376 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e31908 %T Promoting Safe Sleep, Tobacco Cessation, and Breastfeeding to Rural Women During the COVID-19 Pandemic: Quasi-Experimental Study %A Ahlers-Schmidt,Carolyn R %A Schunn,Christy %A Hervey,Ashley M %A Torres,Maria %A Nelson,Jill Elizabeth V %+ Center for Research for Infant Birth and Survival, University of Kansas School of Medicine-Wichita, 3242 E. Murdock St., Suite 602, Wichita, KS, United States, 1 3169627923, cschmidt3@kumc.edu %K COVID-19 %K SIDS %K sudden infant death syndrome %K safe sleep %K tobacco cessation %K breastfeeding %K virtual education %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Safe Sleep Community Baby Showers address strategies to prevent sleep-related infant deaths. Due to the COVID-19 pandemic, these events transitioned from in-person to virtual. Objective: This study describes outcomes of transitioning Safe Sleep Community Baby Showers to a virtual format and compares outcomes to previous in-person events. Methods: Participants from four rural Kansas counties were emailed the presurvey, provided educational materials (videos, livestream, or digital documents), and completed a postsurvey. Those who completed both surveys received a portable crib and wearable blanket. Within-group comparisons were assessed between pre- and postsurveys; between-group comparisons (virtual vs in-person) were assessed by postsurveys. Results: Based on data from 145 in-person and 74 virtual participants, virtual participants were more likely to be married (P<.001) and have private insurance (P<.001), and were less likely to report tobacco use (P<.001). Both event formats significantly increased knowledge and intentions regarding safe sleep and avoidance of secondhand smoke (all P≤.001). Breastfeeding intentions did not change. Differences were observed between in-person and virtual meetings regarding confidence in the ability to avoid secondhand smoke (in-person: 121/144, 84% vs virtual: 53/74, 72%; P=.03), intention to breastfeed ≥6 months (in-person: 79/128, 62% vs virtual: 52/66, 79%; P=.008), and confidence in the ability to breastfeed ≥6 months (in-person: 58/123, 47% vs virtual: 44/69, 64%; P=.02). Conclusions: Although both event formats demonstrated increased knowledge/intentions to follow safe sleep recommendations, virtual events may further marginalize groups who are at high risk for poor birth outcomes. Strategies to increase technology access, recruit priority populations, and ensure disparities are not exacerbated will be critical for the implementation of future virtual events. %M 34550075 %R 10.2196/31908 %U https://pediatrics.jmir.org/2021/4/e31908 %U https://doi.org/10.2196/31908 %U http://www.ncbi.nlm.nih.gov/pubmed/34550075 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e29330 %T Effects of an Immersive Virtual Reality Exergame on University Students’ Anxiety, Depression, and Perceived Stress: Pilot Feasibility and Usability Study %A Xu,Wenge %A Liang,Hai-Ning %A Baghaei,Nilufar %A Ma,Xiaoyue %A Yu,Kangyou %A Meng,Xuanru %A Wen,Shaoyue %+ Department of Computing, School of Advanced Technology, Xi'an Jiaotong-Liverpool University, 111 Renai Road, Suzhou Industrial Park, Suzhou, 215123, China, 86 51288161516, haining.liang@xjtlu.edu.cn %K university students %K depression %K anxiety %K stress %K immersive virtual reality %K exergame %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: In recent years, there has been an increase in the number of students with depression, anxiety, and perceived stress. A solution that has been increasingly used for improving health and well-being is exergaming. The effects and acceptability of exergames have been studied widely but mostly with older adults. The feasibility and usability of exergames among university students, especially those of immersive virtual reality (iVR) exergames, remain unexplored. Objective: This study aimed to explore the feasibility of a 6-week iVR exergame–based intervention in reducing anxiety, depression, and perceived stress among university students and to examine the usability and acceptability of such games. Methods: A total of 31 university students were recruited to participate in a 6-week study in which they needed to play a boxing-style iVR exergame called FitXR (FitXR Limited) twice per week (30 minutes per session). Their anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory-II), and perceived stress (Perceived Stress Scale) levels were measured before and after intervention. Results: A total of 15 participants completed the 6-week study. Our results suggested that participants’ mean depression scores decreased significantly from 8.33 (SD 5.98) to 5.40 (SD 5.14) after the intervention (P=.01). In addition, most participants (14/15, 93%) believed that the iVR exergame has good usability. Furthermore, most participants (14/15, 93%) were satisfied with the iVR gameplay experience and would play the iVR exergame again in the future. Of the 15 participants, 11 (73%) would recommend the iVR exergame to their friends. Conclusions: The results gained from this study show that the iVR exergame has good usability, is highly acceptable, and has the potential to reduce depression levels among university students. %M 34813487 %R 10.2196/29330 %U https://games.jmir.org/2021/4/e29330 %U https://doi.org/10.2196/29330 %U http://www.ncbi.nlm.nih.gov/pubmed/34813487 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e26252 %T mHealth for Anemia Reduction: Protocol for an Entertainment Education–Based Dual Intervention %A Pant,Ichhya %A Rimal,Rajiv %A Yilma,Hagere %A Bingenheimer,Jeffrey %A Sedlander,Erica %A Behera,Sibabrata %+ Department of Prevention and Community Health, School of Public Health, George Washington University, 950 New Hampshire Ave NW #2, Washington, DC, 20052, United States, 1 4044619851, ipant@gwu.edu %K mHealth %K interactive %K voice response %K entertainment %K education %K rural %K anemia %K bystander %K violence against women %D 2021 %7 22.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: More than half of the women of reproductive age (aged 15-49 years) are anemic in India. The uptake of and adherence to iron folic acid (IFA) supplements remain low despite sustained efforts to increase their use. With India’s burgeoning digital environment, mobile phones offer a potential medium for increasing their uptake, especially when combined with interactive voice messages that deliver entertaining stories infused with norms-based educational messages. Objective: This study aims to investigate whether a norms-based entertainment education mobile health intervention can increase self-efficacy for IFA adherence among women of reproductive age in Odisha, India. Methods: Mobile reduction in anemia through normative innovations (mRANI) is a randomized 2-arm study that includes assessments before and after the intervention. All study participants will be recruited from the intervention arm of the parent reduction in anemia through normative innovations trial only. Although the usual practice is to randomize participants either to a treatment arm or a usual care control arm, we will assign the mRANI control group to another entertainment education–based treatment group that is designed to improve bystander intervention to reduce violence against women. Data collection for the mRANI study is embedded in the parent trial and will include baseline and end line assessments. The primary outcomes are self-efficacy for IFA adherence and violence against women–related bystander intervention. The inclusion criteria for the mRANI study are participation in the parent trial and phone ownership. Women (approximately n=400) who meet the mRANI inclusion criteria will be randomly assigned to the IFA arm or the bystander arm. Ordinary least squares regression with robust SEs will be conducted to assess between-group comparisons at the end line. A mediation analysis will be conducted to examine whether social norms and interactivity mediate the relationship between intervention exposure and primary outcomes in both arms. Real-time monitoring data will offer insights into intervention receptivity and audience engagement. Results: Data collection for the mRANI study is integrated within the parent trial. Household surveys were conducted between February and March of 2021. Responses on the mRANI study’s primary and secondary outcomes were collected from 381 participants. The data analysis is expected to be completed by October 2021. Conclusions: This study will provide evidence on whether a mobile health norms–based entertainment education intervention can increase self-efficacy for IFA adherence and violence against women–related bystander intervention. International Registered Report Identifier (IRRID): PRR1-10.2196/26252 %M 34812735 %R 10.2196/26252 %U https://www.researchprotocols.org/2021/11/e26252 %U https://doi.org/10.2196/26252 %U http://www.ncbi.nlm.nih.gov/pubmed/34812735 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e22890 %T Smartphone-Delivered Ecological Momentary Interventions Based on Ecological Momentary Assessments to Promote Health Behaviors: Systematic Review and Adapted Checklist for Reporting Ecological Momentary Assessment and Intervention Studies %A Dao,Kim Phuong %A De Cocker,Katrien %A Tong,Huong Ly %A Kocaballi,A Baki %A Chow,Clara %A Laranjo,Liliana %+ Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Rm No 2041, Research & Education Network, Westmead Hospital, Cnr Darcy and Hawkesbury Roads, Sydney, 2145, Australia, 61 413461852, liliana.laranjo@sydney.edu.au %K ecological momentary assessment %K ecological momentary intervention %K behavior change %K health behavior %K mHealth %K mobile health %K smartphone apps %K mobile phone %D 2021 %7 19.11.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Healthy behaviors are crucial for maintaining a person’s health and well-being. The effects of health behavior interventions are mediated by individual and contextual factors that vary over time. Recently emerging smartphone-based ecological momentary interventions (EMIs) can use real-time user reports (ecological momentary assessments [EMAs]) to trigger appropriate support when needed in daily life. Objective: This systematic review aims to assess the characteristics of smartphone-delivered EMIs using self-reported EMAs in relation to their effects on health behaviors, user engagement, and user perspectives. Methods: We searched MEDLINE, Embase, PsycINFO, and CINAHL in June 2019 and updated the search in March 2020. We included experimental studies that incorporated EMIs based on EMAs delivered through smartphone apps to promote health behaviors in any health domain. Studies were independently screened. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. We performed a narrative synthesis of intervention effects, user perspectives and engagement, and intervention design and characteristics. Quality appraisal was conducted for all included studies. Results: We included 19 papers describing 17 unique studies and comprising 652 participants. Most studies were quasi-experimental (13/17, 76%), had small sample sizes, and great heterogeneity in intervention designs and measurements. EMIs were most popular in the mental health domain (8/17, 47%), followed by substance abuse (3/17, 18%), diet, weight loss, physical activity (4/17, 24%), and smoking (2/17, 12%). Of the 17 studies, the 4 (24%) included randomized controlled trials reported nonstatistically significant effects on health behaviors, and 4 (24%) quasi-experimental studies reported statistically significant pre-post improvements in self-reported primary outcomes, namely depressive (P<.001) and psychotic symptoms (P=.03), drinking frequency (P<.001), and eating patterns (P=.01). EMA was commonly used to capture subjective experiences as well as behaviors, whereas sensors were rarely used. Generally, users perceived EMIs to be helpful. Common suggestions for improvement included enhancing personalization, multimedia and interactive capabilities (eg, voice recording), and lowering the EMA reporting burden. EMI and EMA components were rarely reported and were not described in a standardized manner across studies, hampering progress in this field. A reporting checklist was developed to facilitate the interpretation and comparison of findings and enhance the transparency and replicability of future studies using EMAs and EMIs. Conclusions: The use of smartphone-delivered EMIs using self-reported EMAs to promote behavior change is an emerging area of research, with few studies evaluating efficacy. Such interventions could present an opportunity to enhance health but need further assessment in larger participant cohorts and well-designed evaluations following reporting checklists. Future research should explore combining self-reported EMAs of subjective experiences with objective data passively collected via sensors to promote personalization while minimizing user burden, as well as explore different EMA data collection methods (eg, chatbots). Trial Registration: PROSPERO CRD42019138739; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=138739 %M 34806995 %R 10.2196/22890 %U https://mhealth.jmir.org/2021/11/e22890 %U https://doi.org/10.2196/22890 %U http://www.ncbi.nlm.nih.gov/pubmed/34806995 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 4 %P e26612 %T Digital Therapeutic Care and Decision Support Interventions for People With Low Back Pain: Systematic Review %A Lewkowicz,Daniel %A Slosarek,Tamara %A Wernicke,Sarah %A Winne,Antonia %A Wohlbrandt,Attila M %A Bottinger,Erwin %+ Digital Health Center, Hasso Plattner Institute, University of Potsdam, Prof.-Dr.-Helmert-Str. 2-3, Potsdam, 14482, Germany, 49 (0)331 55094843, daniel.lewkowicz@hpi.de %K digital therapeutic care %K decision support interventions %K low back pain %K behavior change techniques %K back %K orthopedic %K systematic review %K digital therapy %K decision support %K mobile phone %D 2021 %7 19.11.2021 %9 Review %J JMIR Rehabil Assist Technol %G English %X Background: Low back pain (LBP) is the leading cause of worldwide years lost because of disability, with a tremendous economic burden for health care systems. Digital therapeutic care (DTC) programs provide a scalable, universally accessible, and low-cost approach to the multidisciplinary treatment of LBP. Moreover, novel decision support interventions such as personalized feedback messages, push notifications, and data-driven activity recommendations amplify DTC by guiding the user through the program while aiming to increase overall engagement and sustainable behavior change. Objective: This systematic review aims to synthesize recent scientific literature on the impact of DTC apps for people with LBP and outline the implementation of add-on decision support interventions, including their effect on user retention and attrition rates. Methods: We searched bibliographic databases, including MEDLINE, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database, from March 1, 2016, to October 15, 2020, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and conducted this review based on related previously published systematic reviews. Besides randomized controlled trials (RCTs), we also included study designs with the evidence level of at least a retrospective comparative study. This enables the consideration of real-world user-generated data and provides information regarding the adoption and effectiveness of DTC apps in a real-life setting. For the appraisal of the risk of bias, we used the Risk of Bias 2 Tool and the Risk of Bias in Non-Randomized Studies of Interventions Tool for the RCTs and nonrandomized trials, respectively. The included studies were narratively synthesized regarding primary and secondary outcome measures, DTC components, applied decision support interventions, user retention, and attrition rates. Results: We retrieved 1388 citations, of which 12 studies are included in this review. Of the 12 studies, 6 (50%) were RCTs and 6 (50%) were nonrandomized trials. In all included studies, lower pain levels and increased functionality compared with baseline values were observed in the DTC intervention group. A between-group comparison revealed significant improvements in pain and functionality levels in 67% (4/6) of the RCTs. The study population was mostly homogeneous, with predominantly female, young to middle-aged participants of normal to moderate weight. The methodological quality assessment revealed moderate to high risks of biases, especially in the nonrandomized trials. Conclusions: This systematic review demonstrates the benefits of DTC for people with LBP. There is also evidence that decision support interventions benefit overall engagement with the app and increase participants’ ability to self-manage their recovery process. Finally, including retrospective evaluation studies of real-world user-generated data in future systematic reviews of digital health intervention trials can reveal new insights into the benefits, challenges, and real-life adoption of DTC programs. %M 34807837 %R 10.2196/26612 %U https://rehab.jmir.org/2021/4/e26612 %U https://doi.org/10.2196/26612 %U http://www.ncbi.nlm.nih.gov/pubmed/34807837 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e30191 %T Health Education Through a Campaign and mHealth to Enhance Knowledge and Quality of Life Among Patients With Chronic Kidney Disease in Bangladesh: Protocol for a Randomized Controlled Trial %A Sarker,Mohammad Habibur Rahman %A Moriyama,Michiko %A Rashid,Harun Ur %A Rahman,Md Moshiur %A Chisti,Mohammod Jobayer %A Das,Sumon Kumar %A Jahan,Yasmin %A Saha,Samir Kumar %A Arifeen,Shams El %A Ahmed,Tahmeed %A Faruque,A S G %+ Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8553, Japan, 81 09028602013, d185558@hiroshima-u.ac.jp %K chronic kidney disease %K campaign %K mHealth %K knowledge %K Bangladesh %D 2021 %7 19.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite the growing burden of chronic kidney disease (CKD), disease knowledge and understanding are still lacking, especially in Bangladesh. Objective: The aim of this study was to evaluate the outcome of a health education intervention in order to enhance knowledge, health-related quality of life (QOL), and motivation regarding healthy lifestyles among rural and periurban adults suffering from CKD. Methods: A parallel-group (1:1) randomized controlled trial is ongoing in the Mirzapur subdistrict, Bangladesh, where two groups of patients with CKD are being compared. Patients aged 18 years and over with CKD (stages 1-3) were enrolled in November 2020. Patients were randomly allocated into either the intervention group (n=63) or the control group (n=63). The control group received usual treatment, while the intervention group received health education through a CKD campaign facilitated by a nephrologist and via mHealth (ie, periodic mobile phone calls) from community health workers. Both groups were followed up for a period of 6 months. The primary endpoint is patients’ increased knowledge measured using the Chronic Kidney Disease Knowledge Questionnaire. The secondary endpoints are improved QOL measured using the standardized EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire as well as improvements in the levels of blood pressure, BMI, serum creatinine, fasting blood sugar, hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen, and albumin to creatinine ratio. Results: Enrollment of participants began in November 2020; the intervention and follow-up were completed in May 2021. We enrolled 126 patients in the study. Patients’ mean ages were 57.97 (SD 15.03) years in the control group and 57.32 (SD 14.37) years in the intervention group. There were 45 out of 63 (71%) females in the control group and 38 out of 63 (60%) females in the intervention group. In addition, there were 38 out of 63 (60%) literate patients in the control group and 33 out of 63 (52%) literate patients in the intervention group. Conclusions: It is expected that a combined approach, incorporating both a CKD campaign and mHealth, for health education may be an effective tool for increasing knowledge and improving QOL among patients with CKD. Trial Registration: ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831 International Registered Report Identifier (IRRID): DERR1-10.2196/30191 %M 34806998 %R 10.2196/30191 %U https://www.researchprotocols.org/2021/11/e30191 %U https://doi.org/10.2196/30191 %U http://www.ncbi.nlm.nih.gov/pubmed/34806998 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28846 %T Informing Content and Feature Design of a Parent-Focused Human Papillomavirus Vaccination Digital Behavior Change Intervention: Synchronous Text-Based Focus Group Study %A Becker,Elisabeth RB %A Shegog,Ross %A Savas,Lara S %A Frost,Erica L %A Healy,C Mary %A Spinner,Stanley W %A Vernon,Sally W %+ The University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, United States, 1 713 500 4472, elisabeth.becker@uth.tmc.edu %K human papillomavirus %K vaccination %K qualitative %K focus groups %K sexually transmitted infection %D 2021 %7 19.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Human papillomavirus (HPV) is a common and preventable sexually transmitted infection; however, vaccination rates in the United States among the target age group, which is 11-12 years, are lower than national goals. Interventions that address the barriers to and facilitators of vaccination are important for improving HPV vaccination rates. Web-based, text-based focus groups are becoming a promising method that may be well suited for conducting formative research to inform the design of digital behavior change intervention (DBCI) content and features that address HPV vaccination decision-making. Objective: This study aims to explore parental HPV vaccination decision-making processes using a web-based, text-based focus group protocol to inform content and feature recommendations for an HPV prevention DBCI. Methods: We conducted 4 web-based, text-based synchronous focus groups via Skype with the parents of patients aged 11-13 years within a large urban US pediatric clinic network. Results: The 22 parents were mostly female, White, non-Hispanic college graduates, and they mostly had private health insurance for their children. Approximately half (14/25, 56%) of the parents' 11-13 year old children had initiated HPV vaccination. Most parents had experience using Skype (19/22, 86%). Approximately half (8/17, 47%) of parents expressed no preference for the focus group format, whereas 47% (8/17) requested a text-only chat format and 6% (1/17) requested an audiovisual format. The three main themes from the qualitative data were barriers to HPV vaccination, facilitators of HPV vaccination, and suggestions for improving the HPV vaccination clinic experience. A total of 11 intervention content and feature recommendations emerged from the themes, including addressing HPV knowledge barriers using trusted sources, designing for a family audience, focusing on the framing of messages, reporting reputable HPV research in a comprehensible format, and expanding the clinic visit experience. Conclusions: Synchronous text-based focus groups are feasible for conducting formative research on HPV vaccination decision-making. Among well-educated and well-resourced parents, there are barriers such as misinformation and facilitators such as pediatrician recommendations that influence HPV vaccination decision-making. Parents want to conduct their own HPV research as well as receive relevant HPV vaccination advice from their child’s pediatrician. In addition, parents want an enhanced clinic visit experience that lets them access and connect to tailored information before and after clinic visits. The results gathered provide guidance for content and features that may inform a more responsive DBCI to address HPV vaccination decision-making among parents. %M 34806991 %R 10.2196/28846 %U https://formative.jmir.org/2021/11/e28846 %U https://doi.org/10.2196/28846 %U http://www.ncbi.nlm.nih.gov/pubmed/34806991 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30995 %T Integrating SMS Text Messages Into a Preventive Intervention for Postpartum Depression Delivered via In-Home Visitation Programs: Feasibility and Acceptability Study %A Barrera,Alinne Z %A Hamil,Jaime %A Tandon,Darius %+ Department of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, United States, 1 6504333854, abarrera@paloaltou.edu %K perinatal mental health %K postpartum depression %K public health %K SMS %K technology %D 2021 %7 18.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The Mothers and Babies (MB) Course is recognized by the US Preventive Services Task Force as an evidence-based preventive intervention for postpartum depression (PPD) that should be recommended to pregnant women at risk for PPD. Objective: This report examines the feasibility and acceptability of enhancing the MB 1-on-1 intervention by adding 36 SMS text messages that target 3 areas: reinforcement of skills, between-session homework reminders, and responding to self-monitoring texts (ie, MB Plus Text Messaging [MB-TXT]). Methods: In partnership with 9 home visiting programs, 28 ethnically and racially diverse pregnant women (mean 25.6, SD 9.0 weeks) received MB-TXT. Feasibility was defined by home visitors’ adherence to logging into the HealthySMS platform to enter session data and trigger SMS text messages within 7 days of the in-person session. The acceptability of MB-TXT was measured by participants’ usefulness and understanding ratings of the SMS text messages and responses to the self-monitoring SMS text messages. Results: On average, home visitors followed the study protocol and entered session-specific data between 5.50 and 61.17 days following the MB 1-on-1 sessions. A high proportion of participants responded to self-monitoring texts (25/28, 89%) and rated the text message content as very useful and understandable. Conclusions: This report contributes to a growing body of research focusing on digital adaptations of the MB course. SMS is a low-cost, accessible digital tool that can be integrated into existing interventions. With appropriate resources to support staff, it can be implemented in community-based organizations and health care systems that serve women at risk for PPD. Trial Registration: ClinicalTrials.gov NCT03420755; https://clinicaltrials.gov/ct2/show/NCT03420755 %M 34792478 %R 10.2196/30995 %U https://formative.jmir.org/2021/11/e30995 %U https://doi.org/10.2196/30995 %U http://www.ncbi.nlm.nih.gov/pubmed/34792478 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e29003 %T Effectiveness of Information and Communication Technology on Obesity in Childhood and Adolescence: Systematic Review and Meta-analysis %A Park,Jihyun %A Park,Mi-Jeong %A Seo,Young-Gyun %+ Department of Family Medicine, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang, 14068, Republic of Korea, 82 31 380 3805, yg035@daum.net %K ICT %K eHealth %K mHealth %K weight loss %K obesity %K BMI %K meta-analysis %K randomized controlled trial %K children %K adolescents %K mobile phone %D 2021 %7 17.11.2021 %9 Review %J J Med Internet Res %G English %X Background: Internet or mobile device use as a form of information and communication technology (ICT) can be more effective in weight loss and weight maintenance than traditional obesity interventions. Objective: The study aims to assess the effectiveness of child-centered ICT interventions on obesity-related outcomes. Methods: Articles were retrieved from the Cochrane Central Register of Controlled Trials, Embase, and PubMed web-based databases. We selected randomized controlled trials in which the participants were aged <18 years. The primary outcomes were BMI, body weight, BMI z-score, waist circumference, and percentage body fat. Results: In total, 10 of the initial 14,867 studies identified in the databases were selected according to the inclusion criteria. A total of 640 participants were included in the intervention group and 619 in the comparator group. Meta-analyses were conducted considering various subgroups (intervention type, comparator type, target participants, mean age, sex, BMI status, and follow-up period). Overall, ICT interventions demonstrated no significant effect on BMI, body weight, BMI z-score, waist circumference, and percentage body fat. Subgroup analyses revealed that the effect of the intervention was statistically significant for the following: web intervention (weighted mean difference [WMD]=−1.26 kg/m2, 95% CI −2.24 to −0.28), lifestyle modification comparator (WMD=−1.75, 95% CI −2.76 to −0.74), intervention involving both boys and girls (WMD=−1.30, 95% CI −2.14 to −0.46), and intervention involving obesity only (WMD=−1.92, 95% CI −3.75 to −0.09). Conclusions: The meta-analysis results for children with obesity who used the web intervention program confirmed significant effects on BMI reduction compared with lifestyle modification. Evidence from the meta-analysis identified internet technology as a useful tool for weight loss in children with obesity. %M 34787572 %R 10.2196/29003 %U https://www.jmir.org/2021/11/e29003 %U https://doi.org/10.2196/29003 %U http://www.ncbi.nlm.nih.gov/pubmed/34787572 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e26931 %T Digital Interventions on Healthy Lifestyle Management: Systematic Review %A Chatterjee,Ayan %A Prinz,Andreas %A Gerdes,Martin %A Martinez,Santiago %+ Department for Information and Communication Technologies, Centre for e-Health, University of Agder, Jon Lilletuns Vei 9, Grimstad, 4879, Norway, 47 94719372, ayan.chatterjee@uia.no %K eHealth %K digital intervention %K lifestyle %K obesity %K challenges %K mobile phone %D 2021 %7 17.11.2021 %9 Review %J J Med Internet Res %G English %X Background: Digital interventions have tremendous potential to improve well-being and health care conveyance by improving adequacy, proficiency, availability, and personalization. They have gained acknowledgment in interventions for the management of a healthy lifestyle. Therefore, we are reviewing existing conceptual frameworks, digital intervention approaches, and associated methods to identify the impact of digital intervention on adopting a healthier lifestyle. Objective: This study aims to evaluate the impact of digital interventions on weight management in maintaining a healthy lifestyle (eg, regular physical activity, healthy habits, and proper dietary patterns). Methods: We conducted a systematic literature review to search the scientific databases (Nature, SpringerLink, Elsevier, IEEE Xplore, and PubMed) that included digital interventions on healthy lifestyle, focusing on preventing obesity and being overweight as a prime objective. Peer-reviewed articles published between 2015 and 2020 were included. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and a framework for an evidence-based systematic review. Furthermore, we improved the review process by adopting the Rayyan tool and the Scale for the Assessment of Narrative Review Articles. Results: Our initial searches identified 780 potential studies through electronic and manual searches; however, 107 articles in the final stage were cited following the specified inclusion and exclusion criteria. The identified methods for a successful digital intervention to promote a healthy lifestyle are self-monitoring, self-motivation, goal setting, personalized feedback, participant engagement, psychological empowerment, persuasion, digital literacy, efficacy, and credibility. In this study, we identified existing conceptual frameworks for digital interventions, different approaches to provide digital interventions, associated methods, and execution challenges and their impact on the promotion of healthy lifestyle management. Conclusions: This systematic literature review selected intervention principles (rules), theories, design features, ways to determine efficient interventions, and weaknesses in healthy lifestyle management from established digital intervention approaches. The results help us understand how digital interventions influence lifestyle management and overcome the existing shortcomings. It serves as a basis for further research with a focus on designing, developing, testing, and evaluating the generation of personalized lifestyle recommendations as a part of digital health interventions. %M 34787575 %R 10.2196/26931 %U https://www.jmir.org/2021/11/e26931 %U https://doi.org/10.2196/26931 %U http://www.ncbi.nlm.nih.gov/pubmed/34787575 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29760 %T A Smoking Cessation App for Nondaily Smokers (Version 2 of the Smiling Instead of Smoking App): Acceptability and Feasibility Study %A Hoeppner,Bettina B %A Siegel,Kaitlyn R %A Carlon,Hannah A %A Kahler,Christopher W %A Park,Elyse R %A Hoeppner,Susanne S %+ Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, 151 Merrimac Street, 6th Floor, Boston, MA, 02114, United States, 1 617 643 1988, bhoeppner@mgh.harvard.edu %K nondaily %K smoking cessation %K smartphone app %K positive psychology %K mHealth %K happiness %K mobile phone %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Recent evidence highlights the significant detrimental impact of nondaily smoking on health and its disproportionate prevalence in underserved populations; however, little work has been done to develop treatments specifically geared toward quitting nondaily smoking. Objective: This study aims to test the feasibility, acceptability, and conceptual underpinnings of version 2 of the Smiling Instead of Smoking (SiS2) smartphone app, which was developed specifically for nondaily smokers and uses a positive psychology approach. Methods: In a prospective, single-group study, nondaily smokers (N=100) were prescribed use of the SiS2 app for 7 weeks while undergoing a quit attempt. The app assigned daily positive psychology exercises and behavioral tasks every 2 to 3 days, which guided smokers through using the smoking cessation tools offered in the app. Participants answered surveys at baseline and at 2, 6, 12, and 24 weeks postquit. Feasibility was evaluated based on app use and acceptability based on survey responses. The underlying conceptual framework was tested by examining whether theorized within-person changes occurred from baseline to end of treatment on scales measuring self-efficacy, desire to smoke, and processing of self-relevant health information (ie, pros and cons of smoking, importance of the pros and cons of quitting, and motivation). Results: Participants used the SiS2 app on an average of 24.7 (SD 13.8) days out of the 49 prescribed days. At the end of treatment, most participants rated the functions of the app as very easy to use (eg, 70/95, 74% regarding cigarette log and 59/95, 62% regarding happiness exercises). The average score on the System Usability Scale was 79.8 (SD 17.3; A grade; A+ ≥84.1, B+ <78.8). Most participants reported that the app helped them in their quit attempt (83/95, 87%), and helped them stay positive while quitting (78/95, 82%). Large effects were found for within-person decreases in the desire to smoke (b=−1.5, 95% CI −1.9 to −1.1; P<.001; gav=1.01), the importance of the pros of smoking (b=-20.7, 95% CI −27.2 to −14.3; P<.001; gav=0.83), and perceived psychoactive benefits of smoking (b=−0.8, 95% CI −1.0 to −0.5; P<.001; gav=0.80). Medium effects were found for increases in self-efficacy for remaining abstinent when encountering internal (b=13.1, 95% CI 7.6 to 18.7; P<.001; gav=0.53) and external (b=11.2, 95% CI 6.1 to 16.1; P<.001; gav=0.49) smoking cues. Smaller effects, contrary to expectations, were found for decreases in motivation to quit smoking (P=.005) and the perceived importance of the pros of quitting (P=.009). Self-reported 30-day point prevalence abstinence rates were 40%, 56%, and 56% at 6, 12, and 24 weeks after the quit day, respectively. Conclusions: The SiS2 app was feasible and acceptable, showed promising changes in constructs relevant to smoking cessation, and had high self-reported quit rates by nondaily smokers. The SiS2 app warrants testing in a randomized controlled trial. %M 34787577 %R 10.2196/29760 %U https://formative.jmir.org/2021/11/e29760 %U https://doi.org/10.2196/29760 %U http://www.ncbi.nlm.nih.gov/pubmed/34787577 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e27995 %T Content, Behavior Change Techniques, and Quality of Pregnancy Apps in Spain: Systematic Search on App Stores %A Muñoz-Mancisidor,Aranzazu %A Martin-Payo,Ruben %A Gonzalez-Mendez,Xana %A Fernández-Álvarez,María Del Mar %+ Universidad de Oviedo, Calle Julián Clavería s/n, Campus del Cristo, Oviedo, 33006, Spain, 34 985 103 147, martinruben@uniovi.es %K pregnancy %K mobile apps %K behavior %K technology assessment, biomedical %K telemedicine %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Women consult information in mobile apps (apps) during pregnancy, and even obstetrics specialists highlight that pregnancy is the ideal moment for the use of apps as consultation sources. However, the high number of apps designed for pregnancy requires a careful assessment to determine their suitability before recommendation. Objective: The aim of this study is to identify the apps available in Spanish that can be recommended based on their content, behavior change techniques (BCTs), and quality as a complementary tool during pregnancy. Methods: A systematic search on app stores to identify apps was performed in the Apple App Store and Google Play with the subject term “pregnancy.” The apps meeting the following criteria were chosen: pregnancy-related content, free, and available in Spanish. An app was excluded if it was classified as a game or entertainment and thus lacking an educational or health aim and if it did not target the population under study. The selected apps were downloaded, and their quality was assessed using the Mobile Application Rating Scale (MARS), with the BCTs included evaluated using the BCT taxonomy version 1 and its content. Results: A total of 457 apps were identified, 25 of which were downloaded for assessment (5.6%). The median for objective and subjective quality was 2.94 (IQR 2.71-3.46) and 1.75 (IQR 1.25-2.25), respectively. Regarding content, the median of topics included in the apps was 23 (IQR 16-23), with weight gain, nutrition, fetal development, and physical activity being the most common. The median number of BCTs was 12 (IQR 0.5-3.5). The most frequently identified BCTs in the apps were “Self-Monitoring of Outcomes,” followed by “Goal Behavior” and “Instructions.” Statistically significant correlations were observed between objective quality and content (ρ=0.624; P=.001), subjective quality and content (ρ=0.638; P=.001), objective quality and BCTs (ρ=0.672; P<.001), subjective quality and BCTs (ρ=0.623; P<.001), and BCTs and content (ρ=0.580; P=.002). Conclusions: The results of this study suggest that only a small percentage of free pregnancy apps available in Spanish should be recommended. The apps with the best MARS scores were those that addressed a higher number of topics and included a higher number of BCTs. Those with the best content and quality, and a higher number of BCTs included could be recommended by health professionals. %M 34787587 %R 10.2196/27995 %U https://mhealth.jmir.org/2021/11/e27995 %U https://doi.org/10.2196/27995 %U http://www.ncbi.nlm.nih.gov/pubmed/34787587 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e29207 %T Identification of the Most Suitable App to Support the Self-Management of Hypertension: Systematic Selection Approach and Qualitative Study %A Alessa,Tourkiah %A Hawley,Mark %A de Witte,Luc %+ Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield City Centre, Sheffield, S1 4DA, United Kingdom, 44 114 222 1726, talessa@KSU.EDU.SA %K app %K hypertension %K self-management %K mHealth %K blood pressure %K support %K Saudi Arabia %K cardiology %K heart %K effective %K security %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone apps are increasingly being used to aid in hypertension self-management, and a large and ever-growing number of self-management apps have been commercially released. However, very few of these are potentially effective and secure, and researchers have yet to establish the suitability of specific hypertension apps to particular contexts. Objective: The aim of this study is to identify the most suitable hypertension app in the context of Saudi Arabia and its health system. Methods: This study used a 2-stage approach to selecting the most suitable app for hypertension self-management. First, a systematic selection approach was followed to identify a shortlist of the most suitable apps according to the criteria of potential effectiveness, theoretical underpinning, and privacy and security. Second, an exploratory qualitative study was conducted to select the most suitable from the shortlist: 12 doctors were interviewed, and 22 patients participated in 4 focus groups. These explored participants’ attitudes towards self-management apps in general, and their views towards the apps identified via the systematic selection process. The qualitative data were analyzed using framework analysis. Results: In the first stage, only 5 apps were found to be potentially effective while also having a theoretical underpinning and protecting users’ data. In the second stage, both doctors and patients were generally interested in using hypertension apps, but most had no experience with these apps due to a lack of awareness of their availability and suitability. Patients and doctors liked apps that combine intuitive interfaces with a pleasant and clear visual design, in-depth features (eg, color-coded feedback accompanied with textual explanations), activity-specific reminders, and educational content regarding hypertension and potential complications. When the pros and cons of the 5 apps were discussed, 3 apps were identified as being more suitable, with Cora Health rated the highest by the participants. Conclusions: Only 5 apps were deemed potentially effective and secure. Patients’ and doctors’ discussions of the pros and cons of these 5 apps revealed that 3 out of the 5 are clearly more suitable, with the Cora Health app being judged most suitable overall. %M 34787586 %R 10.2196/29207 %U https://mhealth.jmir.org/2021/11/e29207 %U https://doi.org/10.2196/29207 %U http://www.ncbi.nlm.nih.gov/pubmed/34787586 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30991 %T A Technology-Based Pregnancy Health and Wellness Intervention (Two Happy Hearts): Case Study %A Jimah,Tamara %A Borg,Holly %A Kehoe,Priscilla %A Pimentel,Pamela %A Turner,Arlene %A Labbaf,Sina %A Asgari Mehrabadi,Milad %A Rahmani,Amir M. %A Dutt,Nikil %A Guo,Yuqing %+ Sue & Bill Gross School of Nursing, University of California, Irvine, 299D Berk Hall, Irvine, CA, 92697, United States, 1 949 824 9057, tjimah@hs.uci.edu %K ecological momentary assessment %K heart rate %K mHealth %K physical activity %K pregnancy %K sleep %K wearable electronic device %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The physical and emotional well-being of women is critical for healthy pregnancy and birth outcomes. The Two Happy Hearts intervention is a personalized mind-body program coached by community health workers that includes monitoring and reflecting on personal health, as well as practicing stress management strategies such as mindful breathing and movement. Objective: The aims of this study are to (1) test the daily use of a wearable device to objectively measure physical and emotional well-being along with subjective assessments during pregnancy, and (2) explore the user’s engagement with the Two Happy Hearts intervention prototype, as well as understand their experiences with various intervention components. Methods: A case study with a mixed design was used. We recruited a 29-year-old woman at 33 weeks of gestation with a singleton pregnancy. She had no medical complications or physical restrictions, and she was enrolled in the Medi-Cal public health insurance plan. The participant engaged in the Two Happy Hearts intervention prototype from her third trimester until delivery. The Oura smart ring was used to continuously monitor objective physical and emotional states, such as resting heart rate, resting heart rate variability, sleep, and physical activity. In addition, the participant self-reported her physical and emotional health using the Two Happy Hearts mobile app–based 24-hour recall surveys (sleep quality and level of physical activity) and ecological momentary assessment (positive and negative emotions), as well as the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. Engagement with the Two Happy Hearts intervention was recorded via both the smart ring and phone app, and user experiences were collected via Research Electronic Data Capture satisfaction surveys. Objective data from the Oura ring and subjective data on physical and emotional health were described. Regression plots and Pearson correlations between the objective and subjective data were presented, and content analysis was performed for the qualitative data. Results: Decreased resting heart rate was significantly correlated with increased heart rate variability (r=–0.92, P<.001). We found significant associations between self-reported responses and Oura ring measures: (1) positive emotions and heart rate variability (r=0.54, P<.001), (2) sleep quality and sleep score (r=0.52, P<.001), and (3) physical activity and step count (r=0.77, P<.001). In addition, deep sleep appeared to increase as light and rapid eye movement sleep decreased. The psychological measures of stress, depression, and anxiety appeared to decrease from baseline to post intervention. Furthermore, the participant had a high completion rate of the components of the Two Happy Hearts intervention prototype and shared several positive experiences, such as an increased self-efficacy and a normal delivery. Conclusions: The Two Happy Hearts intervention prototype shows promise for potential use by underserved pregnant women. %M 34787576 %R 10.2196/30991 %U https://formative.jmir.org/2021/11/e30991 %U https://doi.org/10.2196/30991 %U http://www.ncbi.nlm.nih.gov/pubmed/34787576 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30572 %T Evaluating a Strengths-Based mHealth Tool (MyStrengths): Explorative Feasibility Trial %A Jessen,Stian %A Mirkovic,Jelena %A Halvorsen Brendmo,Elanor %A Solberg Nes,Lise %+ Department of Digital Health Research, Division of Medicine, Oslo University Hospital HF, Aker Sykehus, Trondheimsveien 23, Oslo, 0586, Norway, 47 9804 9759, stian.jessen@rr-research.no %K mHealth %K personal strengths %K gameful design %K gamification %K user engagement %K explorative %K feasibility %K usefulness %K usability %K design %K self-management %K chronic illness %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As the number of people living with chronic illnesses increases, providing wide-reaching and easy-to-use support tools is becoming increasingly important. Supporting people in this group to recognize and use more of their personal strengths has the potential to improve their quality of life. With this in mind, we have developed the MyStrengths app prototype, a gamefully designed app aimed at aiding users in both identifying their strengths and using these strengths more actively in their daily life. Objective: The goal of this study was to evaluate the user-reported feasibility and usefulness of the MyStrengths app. The study additionally aimed to explore whether the use of MyStrengths could be associated with selected psychosocial outcomes. Methods: A 31-day explorative feasibility trial with a pretest-posttest design and an optional end of study interview was conducted. Data collection included system-use log data, demographic information, pre– and post–psychosocial measures (ie, strengths use, self-efficacy, health-related quality of life, depression), user experience measures (ie, usability, engagement, flow), and interview data. Results: In total, 34 people with at least 1 chronic condition were enrolled in the study, with 26 participants (mean age 48 years, range 29-62 years; 1 male) completing the trial. Among these individuals, 18 were also interviewed posttrial. Participants used the MyStrengths app an average of 6 days during the trial period, with 54% (14/26) using the app over a period of at least 19 days. In total, 8738 unique app actions were registered. Of the psychosocial outcome measures, only 1 subscale, general health in the RAND 36-Item Health Survey, yielded significant pre- and posttest changes. Posttrial interviews showed that the number of participants who considered the MyStrengths app to be useful, somewhat useful, or not useful was evenly distributed across 3 groups. However, every participant did voice support for the strengths approach. All participants were able to identify a multitude of personal strengths using the MyStrengths app. Most participants that reported it to be useful had little or no previous experience with the personal strengths approach. A multitude of users welcomed the gameful design choices, particularly the rolling die feature, suggesting strengths exercises, activities that use a specific strength, were well received. Conclusions: Although the reported usefulness and feedback from use varied, most participants were favorable to the strengths-focused approach to care and support. Consequently, low-threshold and wide-reaching mobile health tools that use a strengths-focused approach, such as MyStrengths, hold the potential to support people living with chronic illness in performing self-management and achieving mastery of their life. %M 34787580 %R 10.2196/30572 %U https://formative.jmir.org/2021/11/e30572 %U https://doi.org/10.2196/30572 %U http://www.ncbi.nlm.nih.gov/pubmed/34787580 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e33183 %T Evaluating the Efficacy of Automated Smoking Treatment for People With HIV: Protocol for a Randomized Controlled Trial %A Vidrine,Damon J %A Bui,Thanh C %A Businelle,Michael S %A Shih,Ya-Chen Tina %A Sutton,Steven K %A Shahani,Lokesh %A Hoover,Diana Stewart %A Bowles,Kristina %A Vidrine,Jennifer I %+ Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4115 E Fowler Avenue, Tampa, FL, 33617, United States, 1 813 745 7937, damon.vidrine@moffitt.org %K smoking cessation %K health disparities %K HIV/AIDS %K mHealth %K mobile phone %D 2021 %7 17.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smoking prevalence rates among people with HIV are nearly 3 times higher than those in the general population. Nevertheless, few smoking cessation trials targeting smokers with HIV have been reported in the literature. Efforts to develop and evaluate sustainable, low-cost, and evidence-based cessation interventions for people with HIV are needed. Given the widespread proliferation of mobile phones, the potential of using mobile health apps to improve the reach and efficacy of cessation interventions is promising, but evidence of efficacy is lacking, particularly among people with HIV. Objective: This study will consist of a 2-group randomized controlled trial to evaluate a fully automated smartphone intervention for people with HIV seeking cessation treatment. Methods: Participants (N=500) will be randomized to receive either standard treatment (ST; 250/500, 50%) or automated treatment (AT; 250/500, 50%). ST participants will be connected to the Florida Quitline and will receive nicotine replacement therapy in the form of transdermal patches and lozenges. This approach, referred to as Ask Advise Connect, was developed by our team and has been implemented in numerous health systems. ST will be compared with AT, a fully automated behavioral treatment approach. AT participants will receive nicotine replacement therapy and an interactive smartphone-based intervention that comprises individually tailored audiovisual and text content. The major goal is to determine whether AT performs better in terms of facilitating long-term smoking abstinence than the more resource-intensive ST approach. Our primary aim is to evaluate the efficacy of AT in facilitating smoking cessation among people with HIV. As a secondary aim, we will explore potential mediators and moderators and conduct economic evaluations to assess the cost and cost-effectiveness of AT compared with ST. Results: The intervention content has been developed and finalized. Recruitment and enrollment will begin in the fall of 2021. Conclusions: There is a critical need for efficacious, cost-effective, and sustainable cessation treatments for people with HIV who smoke. The AT intervention was designed to help fill this need. If efficacy is established, the AT approach will be readily adoptable by HIV clinics and community-based organizations, and it will offer an efficient way to allocate limited public health resources to tobacco control interventions. Trial Registration: ClinicalTrials.gov NCT05014282; https://clinicaltrials.gov/ct2/show/NCT05014282 International Registered Report Identifier (IRRID): PRR1-10.2196/33183 %M 34787590 %R 10.2196/33183 %U https://www.researchprotocols.org/2021/11/e33183 %U https://doi.org/10.2196/33183 %U http://www.ncbi.nlm.nih.gov/pubmed/34787590 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29128 %T A Two-Minute Walking Test With a Smartphone App for Persons With Multiple Sclerosis: Validation Study %A van Oirschot,Pim %A Heerings,Marco %A Wendrich,Karine %A den Teuling,Bram %A Dorssers,Frank %A van Ee,René %A Martens,Marijn Bart %A Jongen,Peter Joseph %+ Orikami Digital Health Products, Ridderstraat 29, Nijmegen, 6511 TM, Netherlands, 31 24 301 0100, pim@mssherpa.nl %K multiple sclerosis %K relapsing remitting %K mobility %K mobile phone %K 2-Minute Walking Test %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Walking disturbances are a common dysfunction in persons with multiple sclerosis (MS). The 2-Minute Walking Test (2MWT) is widely used to quantify walking speed. We implemented a smartphone-based 2MWT (s2MWT) in MS sherpa, an app for persons with MS. When performing the s2MWT, users of the app are instructed to walk as fast as safely possible for 2 minutes in the open air, while the app records their movement and calculates the distance walked. Objective: The aim of this study is to investigate the concurrent validity and test-retest reliability of the MS sherpa s2MWT. Methods: We performed a validation study on 25 persons with relapsing-remitting MS and 79 healthy control (HC) participants. In the HC group, 21 participants were matched to the persons with MS based on age, gender, and education and these followed the same assessment schedule as the persons with MS (the HC-matched group), whereas 58 participants had a less intense assessment schedule to determine reference values (the HC-normative group). Intraclass correlation coefficients (ICCs) were determined between the distance measured by the s2MWT and the distance measured using distance markers on the pavement during these s2MWT assessments. ICCs were also determined for test-retest reliability and derived from 10 smartphone tests per study participant, with 3 days in between each test. We interviewed 7 study participants with MS regarding their experiences with the s2MWT. Results: In total, 755 s2MWTs were completed. The adherence rate for the persons with MS and the participants in the HC-matched group was 92.4% (425/460). The calculated distance walked on the s2MWT was, on average, 8.43 m or 5% (SD 18.9 m or 11%) higher than the distance measured using distance markers (n=43). An ICC of 0.817 was found for the concurrent validity of the s2MWT in the combined analysis of persons with MS and HC participants. Average ICCs of 9 test-retest reliability analyses of the s2MWT for persons with MS and the participants in the HC-matched group were 0.648 (SD 0.150) and 0.600 (SD 0.090), respectively, whereas the average ICC of 2 test-retest reliability analyses of the s2MWT for the participants in the HC-normative group was 0.700 (SD 0.029). The interviewed study participants found the s2MWT easy to perform, but they also expressed that the test results can be confronting and that a pressure to reach a certain distance can be experienced. Conclusions: The high correlation between s2MWT distance and the conventional 2MWT distance indicates a good concurrent validity. Similarly, high correlations underpin a good test-retest reliability of the s2MWT. We conclude that the s2MWT can be used to measure the distance that the persons with MS walk in 2 minutes outdoors near their home, from which both clinical studies and clinical practice can benefit. %M 34787581 %R 10.2196/29128 %U https://formative.jmir.org/2021/11/e29128 %U https://doi.org/10.2196/29128 %U http://www.ncbi.nlm.nih.gov/pubmed/34787581 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e25824 %T The 4 Youth By Youth mHealth Photo Verification App for HIV Self-testing in Nigeria: Qualitative Analysis of User Experiences %A Oladele,David %A Iwelunmor,Juliet %A Gbajabiamila,Titilola %A Obiezu-Umeh,Chisom %A Okwuzu,Jane Ogoamaka %A Nwaozuru,Ucheoma %A Musa,Adesola Zaidat %A Idigbe,Ifeoma %A Tahlil,Kadija %A Tang,Weiming %A Conserve,Donaldson F %A Rosenberg,Nora E %A David,Agatha N %A Tucker,Joseph %A Ezechi,Oliver %+ Department of Behavioral Science and Health Education, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, United States, 1 3149773280, juliet.iwelunmor@slu.edu %K HIV self-testing %K adolescents %K young people %K photo verification %K mobile app %K Nigeria %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the global expansion of HIV self-testing (HIVST), many research studies still rely on self-reported outcomes. New HIVST verification methods are needed, especially in resource-limited settings. Objective: This study aims to evaluate the user experience of a mobile health (mHealth) app to enhance HIVST result reporting and verification. Methods: Semistructured, in-depth interviews were used to evaluate the user experience of the 4 Youth By Youth mHealth photo verification app for HIVST. We used a think-aloud approach, and participants performed usability tasks and completed a qualitative exit interview. The app included HIV educational resources, step-by-step video instructions for performing HIVST, a 20-minute timer, a guide on interpreting results with linkages to care, an offline version, and a photo verification system. Demographic characteristics were reported by using descriptive statistics. Qualitative data were analyzed by using thematic analysis. Results: A total of 19 users—12 women and 7 men—with a mean age of 22 years, participated in the study. The users completed the usability tasks and successfully uploaded a photo of their test results by using the app without assistance. Four main themes were identified in the data. First, in terms of user-friendly design, the participants noted the user-friendly features of the offline version and the app’s low data use. However, some wanted the app to work in the background when using their mobile phone, and the font used should be more youth friendly. Second, in terms of ease of use, participants remarked that the app’s self-explanatory nature and instructions that guided them on how to use the app enhanced its use. Third, in terms of a user’s privacy, many participants reinforced the importance of privacy settings and tools that protect confidentiality among users. Finally, in terms of linkage to care, participants noted that the app’s linkage to care features were useful, particularly in relation to referrals to trained counselors upon the completion of the test. All the participants noted that the app provided a convenient and private means of verifying the HIV test results. Conclusions: Our findings demonstrated the importance of engaging end users in the development phase of health technology innovations that serve youth. Clinical trials are needed to determine the efficacy of using an mHealth app to verify HIVST results among young people. %M 34787579 %R 10.2196/25824 %U https://formative.jmir.org/2021/11/e25824 %U https://doi.org/10.2196/25824 %U http://www.ncbi.nlm.nih.gov/pubmed/34787579 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e28185 %T Efficacy of Interventions That Incorporate Mobile Apps in Facilitating Weight Loss and Health Behavior Change in the Asian Population: Systematic Review and Meta-analysis %A Ang,Siew Min %A Chen,Juliana %A Liew,Jia Huan %A Johal,Jolyn %A Dan,Yock Young %A Allman-Farinelli,Margaret %A Lim,Su Lin %+ Department of Dietetics, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore, 65 67725166, siew_min_ang@nuhs.edu.sg %K systematic review %K meta-analysis %K mobile app %K obesity %K weight loss %K Asian %K diet %K physical activity %K adults %K mobile phone %D 2021 %7 16.11.2021 %9 Review %J J Med Internet Res %G English %X Background: Smartphone apps have shown potential in enhancing weight management in Western populations in the short to medium term. With a rapidly growing obesity burden in Asian populations, researchers are turning to apps as a service delivery platform to reach a larger target audience to efficiently address the problem. Objective: This systematic review and meta-analysis aims to determine the efficacy of interventions that incorporate apps in facilitating weight loss and health behavior change in the Asian population. Methods: A total of 6 databases were searched in June 2020. The eligible studies included controlled trials in which an app was used in the intervention. The participants were aged 18 years or older and were of Asian ethnicity. A meta-analysis to test intervention efficacy, subgroup analyses, and post hoc analyses was conducted to determine the effects of adding an app to usual care and study duration. The primary outcome was absolute or percentage weight change, whereas the secondary outcomes were changes to lifestyle behaviors. Results: A total of 21 studies were included in this review, and 17 (81%) were selected for the meta-analysis. The pooled effect size across 82% (14/17) of the randomized controlled trials for weight change was small to moderate (Hedges g=–0.26; 95% CI –0.41 to –0.11), indicating slightly greater weight loss achieved in the intervention group; however, this may not be representative of long-term studies (lasting for more than a year). Supplementing multicomponent usual care with an app led to greater weight loss (Hedges g=–0.28; 95% CI –0.47 to –0.09). Asian apps were largely culturally adapted and multifunctional, with the most common app features being communication with health professionals and self-monitoring of behaviors and outcomes. Conclusions: More evidence is required to determine the efficacy of apps in the long term and address the low uptake of apps to maximize the potential of the intervention. Future research should determine the efficacy of each component of the multicomponent intervention to facilitate the designing of studies that are most effective and cost-efficient for weight management. Trial Registration: PROSPERO CRD42020165240; https://tinyurl.com/2db4tvn6 %M 34783674 %R 10.2196/28185 %U https://www.jmir.org/2021/11/e28185 %U https://doi.org/10.2196/28185 %U http://www.ncbi.nlm.nih.gov/pubmed/34783674 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e28956 %T Designing Better Exposure Notification Apps: The Role of Persuasive Design %A Oyibo,Kiemute %A Morita,Plinio Pelegrini %+ School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 41372, plinio.morita@uwaterloo.ca %K contact tracing app %K exposure notification app %K COVID Alert %K COVID-19 %K persuasive technology %K behavior change %D 2021 %7 16.11.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Background: Digital contact tracing apps have been deployed worldwide to limit the spread of COVID-19 during this pandemic and to facilitate the lifting of public health restrictions. However, due to privacy-, trust-, and design-related issues, the apps are yet to be widely adopted. This calls for an intervention to enable a critical mass of users to adopt them. Objective: The aim of this paper is to provide guidelines to design contact tracing apps as persuasive technologies to make them more appealing and effective. Methods: We identified the limitations of the current contact tracing apps on the market using the Government of Canada’s official exposure notification app (COVID Alert) as a case study. Particularly, we identified three interfaces in the COVID Alert app where the design can be improved. The interfaces include the no exposure status interface, exposure interface, and diagnosis report interface. We propose persuasive technology design guidelines to make them more motivational and effective in eliciting the desired behavior change. Results: Apart from trust and privacy concerns, we identified the minimalist and nonmotivational design of exposure notification apps as the key design-related factors that contribute to the current low uptake. We proposed persuasive strategies such as self-monitoring of daily contacts and exposure time to make the no exposure and exposure interfaces visually appealing and motivational. Moreover, we proposed social learning, praise, and reward to increase the diagnosis report interface’s effectiveness. Conclusions: We demonstrated that exposure notification apps can be designed as persuasive technologies by incorporating key persuasive features, which have the potential to improve uptake, use, COVID-19 diagnosis reporting, and compliance with social distancing guidelines. %M 34783673 %R 10.2196/28956 %U https://publichealth.jmir.org/2021/11/e28956 %U https://doi.org/10.2196/28956 %U http://www.ncbi.nlm.nih.gov/pubmed/34783673 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e32521 %T Smartband-Based Automatic Smoking Detection and Real-time Mindfulness Intervention: Protocol for a Feasibility Trial %A Horvath,Mark %A Grutman,Aurora %A O'Malley,Stephanie S %A Gueorguieva,Ralitza %A Khan,Nashmia %A Brewer,Judson A %A Garrison,Kathleen A %+ Department of Psychiatry, Yale School of Medicine, 1 Church Street #730, New Haven, CT, 06510, United States, 1 4152608618, kathleen.garrison@yale.edu %K smartband %K smartphone %K smoking %K mindfulness %K craving %K mHealth %D 2021 %7 16.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smoking is the leading cause of preventable death in the United States. Smoking cessation interventions delivered by smartphone apps are a promising tool for helping smokers quit. However, currently available smartphone apps for smoking cessation have not exploited their unique potential advantages to aid quitting. Notably, few to no available apps use wearable technologies, most apps require users to self-report their smoking, and few to no apps deliver treatment automatically contingent upon smoking. Objective: This pilot trial tests the feasibility of using a smartband and smartphone to monitor and detect smoking and deliver brief mindfulness interventions in real time to reduce smoking. Methods: Daily smokers (N=100, ≥5 cigarettes per day) wear a smartband for 60 days to monitor and detect smoking, notify them about their smoking events in real time, and deliver real-time brief mindfulness exercises triggered by detected smoking events or targeted at predicted smoking events. Smokers set a quit date at 30 days. A three-step intervention to reduce smoking is tested. First, participants wear a smartband to monitor and detect smoking, and notify them of smoking events in real time to bring awareness to smoking and triggers for 21 days. Next, a “mindful smoking” exercise is triggered by detected smoking events to bring a clear recognition of the actual effects of smoking for 7 days. Finally, after their quit date, a “RAIN” (recognize, allow, investigate, nonidentification) exercise is delivered to predicted smoking events (based on the initial 3 weeks of tracking smoking data) to help smokers learn to work mindfully with cravings rather than smoke for 30 days. The primary outcomes are feasibility measures of treatment fidelity, adherence, and acceptability. The secondary outcomes are smoking rates at end of treatment. Results: Recruitment for this trial started in May 2021 and will continue until November 2021 or until enrollment is completed. Data monitoring and management are ongoing for enrolled participants. The final 60-day end of treatment data is anticipated in January 2022. We expect that all trial results will be available in April 2022. Conclusions: Findings will provide data and information on the feasibility of using a smartband and smartphone to monitor and detect smoking and deliver real-time brief mindfulness interventions, and whether the intervention warrants additional testing for smoking cessation. Trial Registration: ClinicalTrials.gov NCT03995225; https://clinicaltrials.gov/ct2/show/NCT03995225 International Registered Report Identifier (IRRID): DERR1-10.2196/32521 %M 34783663 %R 10.2196/32521 %U https://www.researchprotocols.org/2021/11/e32521 %U https://doi.org/10.2196/32521 %U http://www.ncbi.nlm.nih.gov/pubmed/34783663 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e31843 %T Game Plan, a Web-Based Intervention to Improve Adherence and Persistence to HIV Pre-exposure Prophylaxis and Reduce Heavy Drinking in Gay, Bisexual, and Other Men Who Have Sex With Men: Usability and User Experience Testing %A Wray,Tyler B %A Chan,Philip A %A Kahler,Christopher W %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main Street, Box G-S121-5, Providence, RI, 02903, United States, 1 4018636659, tyler_wray@brown.edu %K pre-exposure prophylaxis %K HIV %K HIV prevention %K mHealth %K mobile health %K eHealth %K mobile phone %D 2021 %7 16.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Encouraging consistent use of pre-exposure prophylaxis (PrEP) is essential for reducing HIV incidence, particularly among gay, bisexual, and other men who have sex with men (GBM), and especially those who engage in heavy drinking. Although practice guidelines recommend providing adherence counseling to PrEP patients, clinics and providers may not have the resources or expertise to provide it. Internet-facilitated interventions have been shown to improve HIV prevention outcomes, including medication and care adherence. Game Plan is a website we created to help users make a tangible plan for reducing their HIV risk. We designed additional components of Game Plan to address key individual level barriers to PrEP use. Objective: The aim of this mixed methods research is to test the usability and user experience of these components with intended users: GBM who drink heavily and are on PrEP. Methods: In study 1 (usability), we completed a detailed individual interview in which participants (n=10) walked through a prototype of the website, thinking aloud as they did, and completed a follow-up interview and web-based survey afterward. Study 2 (user experience) involved providing participants (n=40) with a link to the prototype website to explore on their own and asking them to complete the same follow-up survey afterward. Qualitative data were analyzed using thematic analysis, and descriptive statistics were used to analyze quantitative data. Results: Users in both studies gave the website excellent ratings for usability, overall satisfaction, and quality, and most often described the site as informative, helpful, and supportive. Users also rated the site’s content and feel as respectful of them and their autonomy, empathetic, and they stated that it conveyed confidence in their ability to change. The study 1 interviews highlighted the importance of the website’s esthetics to the participants’ engagement with it and its credibility in prompting genuine reflection. Conclusions: GBM who reported heavy drinking and used PrEP generally found a website focused on helping them to create a plan to use PrEP consistently to be helpful. Adopting user-centered design methods and attending to the esthetics of mobile health interventions are important steps toward encouraging engagement and reducing at-risk behaviors. %M 34783662 %R 10.2196/31843 %U https://formative.jmir.org/2021/11/e31843 %U https://doi.org/10.2196/31843 %U http://www.ncbi.nlm.nih.gov/pubmed/34783662 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e31611 %T The Efficacy of a Personalized mHealth Coaching Program During Pregnancy on Maternal Diet, Supplement Use, and Physical Activity: Protocol for a Parallel-Group Randomized Controlled Trial %A Nuruddin,Rozina %A Vadsaria,Khadija %A Mohammed,Nuruddin %A Sayani,Saleem %+ Department of Community Health Sciences, Medical College, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan, 92 21 3486 ext 4833, rozina.nuruddin@aku.edu %K coaching %K compliance %K diet %K maternal health %K mobile health %K offspring health %K physical activity %K pregnancy %K supplement use %K usability %D 2021 %7 16.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adequate intake of macro- and micronutrients and adoption of an active lifestyle during pregnancy are essential for optimum maternal and fetal health and offspring development. Dietary counseling and advice regarding adequate physical activity are integral components of antenatal care. Personalized coaching through the use of mobile health (mHealth) that supports behavior modification is an innovative approach that needs exploration. Objective: Our primary aim is to assess the efficacy of an mHealth program in improving diet, supplement use, and physical activity during pregnancy. Secondary objectives include evaluation of the program’s effect on maternal and offspring health outcomes and assessment of its compliance and usability. Methods: A randomized controlled trial was initiated at the Aga Khan University Hospital in Karachi, Pakistan, in January 2020. We aim to recruit 300 pregnant women in their first trimester who have smartphones, do not have comorbidities, and are not taking medications. The intervention group will be trained to use an mHealth app called PurUmeed Aaghaz. Through this app, the subjects will report information about their diet, supplement use, and physical activity and will receive personalized advice and three push messages as weekly reminders. The research assistant will obtain similar information from the control group via a paperless questionnaire; this group will receive standard face-to-face counseling regarding diet, supplement use, and physical activity. Data will be collected at enrollment and during four follow-up sessions scheduled 6 weeks apart. Primary study outcomes include improvements in diet (ie, change in mean dietary risk score from baseline to each follow-up), supplement use (ie, changes in mean supplement use score and biochemical levels of folic acid, iron, calcium, and vitamin D on a study subset), and mean duration of reported physical activity (minutes). Secondary study outcomes relate to maternal health (ie, gestational diabetes mellitus, gestational hypertension, pre-eclampsia, and gestational weight gain), newborn health (ie, birth weight and length and gestational age at delivery), and infant health (ie, BMI and blood pressure at 1 year of age). Compliance will be determined by the proportion of participants who complete the 6-month coaching program. Usability will be assessed based on features related to design, interface, content, coaching, perception, and personal benefit. Results: The study was approved by the Ethics Review Committee of the Aga Khan University in 2017. The recruitment of study participants was completed in September 2021. All follow-ups and outcome assessments are expected to be completed by March 2023 and analysis is expected to be completed by June 2023. We expect the results to be published by the end of 2023. Conclusions: This study will be an important step toward evaluating the role of mHealth in improving behaviors related to a healthy diet, supplement use, and promotion of physical activity during pregnancy, as well as in influencing maternal and offspring outcomes. If proven effective, mHealth interventions can be scaled up and included in antenatal care packages at tertiary care hospitals of low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT04216446; https://clinicaltrials.gov/ct2/show/NCT04216446 International Registered Report Identifier (IRRID): DERR1-10.2196/31611 %M 34783675 %R 10.2196/31611 %U https://www.researchprotocols.org/2021/11/e31611 %U https://doi.org/10.2196/31611 %U http://www.ncbi.nlm.nih.gov/pubmed/34783675 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e28608 %T Consumption of Ultraprocessed Foods in a Sample of Adolescents With Obesity and Its Association With the Food Educational Style of Their Parent: Observational Study %A Borloz,Sylvie %A Bucher Della Torre,Sophie %A Collet,Tinh-Hai %A Jotterand Chaparro,Corinne %+ Pediatric Service, Department Woman-Mother-Child, Lausanne University Hospital (CHUV), Montetan 14, Lausanne, 1004, Switzerland, 41 795568409, sylvie.borloz@chuv.ch %K adolescent %K obesity %K ultraprocessed foods %K qualitative food intake %K food educational style %K smartphone application %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Both parental education and the food environment influence dietary intake and may therefore contribute to childhood obesity. Objective: We aimed to assess the consumption of ultraprocessed foods (UPFs) in a convenience sample of adolescents with obesity and to determine its association with the food educational style of their parent. Methods: This observational study included 24 participants, 12 adolescents (8 boys and 4 girls) aged from 12 to 14 years and their 12 parents, who were followed in a specialized pediatric obesity clinic in the French-speaking part of Switzerland. The adolescents were asked to take a photograph with a smartphone application of all meals and beverages consumed in their daily routine over 14 consecutive days. They evaluated their parent’s food educational style using the Kids’ Child Feeding Questionnaire. The parent who was present at the study visits also completed the Feeding Style Questionnaire. A dietitian analyzed the pictures to extract food group portions and to identify UPFs using the NOVA classification. A nonparametric statistical test was used to investigate associations between UPF intake and food educational style. Results: Overall, the adolescents had unbalanced dietary habits compared to national recommendations. They consumed an insufficient quantity of vegetables, fruits, dairy products, and starchy foods and an excessive amount of meat portions and sugary and fatty products compared to the current Swiss recommendations. Their consumption of UPFs accounted for 20% of their food intake. All adolescents defined their parent as being restrictive in terms of diet, with a mean parental restriction score of 3.3±SD 0.4 (norm median=2.1). No parent reported a permissive food educational style. A higher intake of UPFs was associated with a lower parental restriction score (P=.04). Conclusions: Despite being followed in a specialized pediatric obesity clinic, this small group of adolescents had an unbalanced diet, which included 20% UPFs. The intake of UPFs was lower in participants whose parent was more restrictive, suggesting the importance of parents as role models and to provide adequate food at home. Trial Registration: ClinicalTrials.gov NCT03241121; https://clinicaltrials.gov/ct2/show/NCT03241121 %M 34779776 %R 10.2196/28608 %U https://pediatrics.jmir.org/2021/4/e28608 %U https://doi.org/10.2196/28608 %U http://www.ncbi.nlm.nih.gov/pubmed/34779776 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e27297 %T Infant Safe Sleep Practices as Portrayed on Instagram: Observational Study %A Chin,Samuel %A Carlin,Rebecca %A Mathews,Anita %A Moon,Rachel %+ Department of Pediatrics, University of Virginia School of Medicine, PO Box 800386, Charlottesville, VA, 22908, United States, 1 4349245521, rym4z@virginia.edu %K sleep position %K bed-sharing %K social norms %K social media %K safe sleep %K bedding %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parenting practices are highly influenced by perceived social norms. Social norms and American Academy of Pediatrics (AAP) guidelines for infant safe sleep practices are often inconsistent. Instagram has become one of the most popular social media websites among young adults (including many expectant and new parents). We hypothesized that the majority of Instagram images of infant sleep and sleep environments are inconsistent with AAP guidelines, and that the number of “likes” for each image would not correlate with adherence of the image to these guidelines. Objective: The objective of this study was to determine the extent of adherence of Instagram images of infant sleep and sleep environments to safe infant sleep guidelines. Methods: We searched Instagram using hashtags that were relevant to infant sleeping practices and environments. We then used an open-source web scraper to collect images and the number of “likes” for each image from 27 hashtags. Images were analyzed for adherence to AAP safe sleep guidelines. Results: A total of 1563 images (1134 of sleeping infant; 429 of infant sleep environment without sleeping infant) met inclusion criteria and were analyzed. Only 117 (7.49%) of the 1563 images were consistent with AAP guidelines. The most common reasons for inconsistency with AAP guidelines were presence of bedding (1173/1563, 75.05%) and nonrecommended sleep position (479/1134, 42.24%). The number of “likes” was not correlated with adherence of the image to AAP guidelines. Conclusions: Although individuals who use Instagram and post pictures of sleeping infants or infant sleep environments may not actually use these practices regularly, the consistent portrayal of images inconsistent with AAP guidelines reinforces that these practices are normative and may influence the practice of young parents. %M 34779783 %R 10.2196/27297 %U https://pediatrics.jmir.org/2021/4/e27297 %U https://doi.org/10.2196/27297 %U http://www.ncbi.nlm.nih.gov/pubmed/34779783 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e28024 %T Improvements in Diet and Physical Activity–Related Psychosocial Factors Among African Americans Using a Mobile Health Lifestyle Intervention to Promote Cardiovascular Health: The FAITH! (Fostering African American Improvement in Total Health) App Pilot Study %A Cyriac,Jissy %A Jenkins,Sarah %A Patten,Christi A %A Hayes,Sharonne N %A Jones,Clarence %A Cooper,Lisa A %A Brewer,LaPrincess C %+ Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN, 55905, United States, 1 507 266 1376, brewer.laprincess@mayo.edu %K African Americans %K cardiovascular health disparities %K mHealth lifestyle intervention %K diet %K physical activity %K mobile phone %D 2021 %7 12.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: African Americans continue to have suboptimal cardiovascular health (CVH) related to diet and physical activity (PA) behaviors compared with White people. Mobile health (mHealth) interventions are innovative platforms to improve diet and PA and have the potential to mitigate these disparities. However, these are understudied among African Americans. Objective: This study aims to examine whether an mHealth lifestyle intervention is associated with improved diet and PA-related psychosocial factors in African Americans and whether these changes correlate with diet and PA behavioral change. Methods: This study is a retrospective analysis evaluating changes in diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors (daily fruit and vegetable intake and moderate-intensity PA [MPA] per week) in 45 African American adults (mean age 48.7 years, SD 12.9 years; 33/45, 73% women) enrolled in the FAITH! (Fostering African American Improvement in Total Health) app pilot study. The intervention is a 10-week, behavioral theory–informed, community-based mHealth lifestyle intervention delivered through a mobile app platform. Participants engaged with 3 core FAITH! app features: multimedia education modules focused on CVH with self-assessments of CVH knowledge, self-monitoring of daily fruit and vegetable intake and PA, and a sharing board for social networking. Changes in self-reported diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors were assessed by electronic surveys collected at baseline and 28 weeks postintervention. Changes in diet and PA-related psychosocial factors from pre- to postintervention were assessed using paired 2-tailed t tests. The association of changes in diet and PA-related psychosocial variables with daily fruit and vegetable intake and MPA per week was assessed using Spearman correlation. Associations between baseline and 28-week postintervention changes in diet and PA-related psychosocial measures and CVH behaviors with covariates were assessed by multivariable linear regression. Results: Participants reported improvements in 2 subscales of diet self-regulation (decrease fat and calorie intake, P=.01 and nutrition tracking, P<.001), one subscale of social support for healthy diet (friend discouragement, P=.001), perceived barriers to healthy diet (P<.001), and daily fruit and vegetable intake (P<.001). Improvements in diet self-regulation (increase fruit, vegetable, and grain intake, and nutrition tracking) and social support for healthy diet (friend encouragement) had moderate positive correlations with daily fruit and vegetable intake (r=0.46, r=0.34, and r=0.43, respectively). A moderate negative correlation was observed between perceived barriers to healthy diet and daily fruit and vegetable intake (r=−0.25). Participants reported increases in PA self-regulation (P<.001). Increase in social support subscales for PA (family and friend participation) had a moderate positive correlation with MPA per week (r=0.51 and r=0.61, respectively). Conclusions: Our findings highlight key diet and PA-related psychosocial factors to target in future mHealth lifestyle interventions aimed at promoting CVH in African Americans. %M 34766917 %R 10.2196/28024 %U https://mhealth.jmir.org/2021/11/e28024 %U https://doi.org/10.2196/28024 %U http://www.ncbi.nlm.nih.gov/pubmed/34766917 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e22218 %T Predicting Participant Compliance With Fitness Tracker Wearing and Ecological Momentary Assessment Protocols in Information Workers: Observational Study %A Martinez,Gonzalo J %A Mattingly,Stephen M %A Robles-Granda,Pablo %A Saha,Koustuv %A Sirigiri,Anusha %A Young,Jessica %A Chawla,Nitesh %A De Choudhury,Munmun %A D'Mello,Sidney %A Mark,Gloria %A Striegel,Aaron %+ Computer Science and Engineering, University of Notre Dame, 400 Main Building, Notre Dame, IN, 46556, United States, 1 574 631 5000, gmarti11@nd.edu %K adherence %K compliance %K wearables %K smartphones %K research design %K ecological momentary assessment %K mobile sensing %K mobile phone %D 2021 %7 12.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Studies that use ecological momentary assessments (EMAs) or wearable sensors to track numerous attributes, such as physical activity, sleep, and heart rate, can benefit from reductions in missing data. Maximizing compliance is one method of reducing missing data to increase the return on the heavy investment of time and money into large-scale studies. Objective: This paper aims to identify the extent to which compliance can be prospectively predicted from individual attributes and initial compliance. Methods: We instrumented 757 information workers with fitness trackers for 1 year and conducted EMAs in the first 56 days of study participation as part of an observational study. Their compliance with the EMA and fitness tracker wearing protocols was analyzed. Overall, 31 individual characteristics (eg, demographics and personalities) and behavioral variables (eg, early compliance and study portal use) were considered, and 14 variables were selected to create beta regression models for predicting compliance with EMAs 56 days out and wearable compliance 1 year out. We surveyed study participation and correlated the results with compliance. Results: Our modeling indicates that 16% and 25% of the variance in EMA compliance and wearable compliance, respectively, could be explained through a survey of demographics and personality in a held-out sample. The likelihood of higher EMA and wearable compliance was associated with being older (EMA: odds ratio [OR] 1.02, 95% CI 1.00-1.03; wearable: OR 1.02, 95% CI 1.01-1.04), speaking English as a first language (EMA: OR 1.38, 95% CI 1.05-1.80; wearable: OR 1.39, 95% CI 1.05-1.85), having had a wearable before joining the study (EMA: OR 1.25, 95% CI 1.04-1.51; wearable: OR 1.50, 95% CI 1.23-1.83), and exhibiting conscientiousness (EMA: OR 1.25, 95% CI 1.04-1.51; wearable: OR 1.34, 95% CI 1.14-1.58). Compliance was negatively associated with exhibiting extraversion (EMA: OR 0.74, 95% CI 0.64-0.85; wearable: OR 0.67, 95% CI 0.57-0.78) and having a supervisory role (EMA: OR 0.65, 95% CI 0.54-0.79; wearable: OR 0.66, 95% CI 0.54-0.81). Furthermore, higher wearable compliance was negatively associated with agreeableness (OR 0.68, 95% CI 0.56-0.83) and neuroticism (OR 0.85, 95% CI 0.73-0.98). Compliance in the second week of the study could help explain more variance; 62% and 66% of the variance in EMA compliance and wearable compliance, respectively, was explained. Finally, compliance correlated with participants’ self-reflection on the ease of participation, usefulness of our compliance portal, timely resolution of issues, and compensation adequacy, suggesting that these are avenues for improving compliance. Conclusions: We recommend conducting an initial 2-week pilot to measure trait-like compliance and identify participants at risk of long-term noncompliance, performing oversampling based on participants’ individual characteristics to avoid introducing bias in the sample when excluding data based on noncompliance, using an issue tracking portal, and providing special care in troubleshooting to help participants maintain compliance. %M 34766911 %R 10.2196/22218 %U https://mhealth.jmir.org/2021/11/e22218 %U https://doi.org/10.2196/22218 %U http://www.ncbi.nlm.nih.gov/pubmed/34766911 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e22369 %T Remote Digital Psychiatry for Mobile Mental Health Assessment and Therapy: MindLogger Platform Development Study %A Klein,Arno %A Clucas,Jon %A Krishnakumar,Anirudh %A Ghosh,Satrajit S %A Van Auken,Wilhelm %A Thonet,Benjamin %A Sabram,Ihor %A Acuna,Nino %A Keshavan,Anisha %A Rossiter,Henry %A Xiao,Yao %A Semenuta,Sergey %A Badioli,Alessandra %A Konishcheva,Kseniia %A Abraham,Sanu Ann %A Alexander,Lindsay M %A Merikangas,Kathleen R %A Swendsen,Joel %A Lindner,Ariel B %A Milham,Michael P %+ MATTER Lab, Child Mind Institute, 101 East 56th Street, New York, NY, 10022, United States, 1 347 577 2091, arno@childmind.org %K mental health %K mHealth %K mobile health %K digital health %K eHealth %K digital psychiatry %K digital phenotyping %K teletherapy %K mobile device %K mobile phone %K smartphone %K ecological momentary assessment %K ecological momentary intervention %K EMA %K EMI %K ESM %K experience sampling %K experience sampling methods %D 2021 %7 11.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Universal access to assessment and treatment of mental health and learning disorders remains a significant and unmet need. There are many people without access to care because of economic, geographic, and cultural barriers, as well as the limited availability of clinical experts who could help advance our understanding and treatment of mental health. Objective: This study aims to create an open, configurable software platform to build clinical measures, mobile assessments, tasks, and interventions without programming expertise. Specifically, our primary requirements include an administrator interface for creating and scheduling recurring and customized questionnaires where end users receive and respond to scheduled notifications via an iOS or Android app on a mobile device. Such a platform would help relieve overwhelmed health systems and empower remote and disadvantaged subgroups in need of accurate and effective information, assessment, and care. This platform has the potential to advance scientific research by supporting the collection of data with instruments tailored to specific scientific questions from large, distributed, and diverse populations. Methods: We searched for products that satisfy these requirements. We designed and developed a new software platform called MindLogger, which exceeds the requirements. To demonstrate the platform’s configurability, we built multiple applets (collections of activities) within the MindLogger mobile app and deployed several of them, including a comprehensive set of assessments underway in a large-scale, longitudinal mental health study. Results: Of the hundreds of products we researched, we found 10 that met our primary requirements with 4 that support end-to-end encryption, 2 that enable restricted access to individual users’ data, 1 that provides open-source software, and none that satisfy all three. We compared features related to information presentation and data capture capabilities; privacy and security; and access to the product, code, and data. We successfully built MindLogger mobile and web applications, as well as web browser–based tools for building and editing new applets and for administering them to end users. MindLogger has end-to-end encryption, enables restricted access, is open source, and supports a variety of data collection features. One applet is currently collecting data from children and adolescents in our mental health study, and other applets are in different stages of testing and deployment for use in clinical and research settings. Conclusions: We demonstrated the flexibility and applicability of the MindLogger platform through its deployment in a large-scale, longitudinal, mobile mental health study and by building a variety of other mental health–related applets. With this release, we encourage a broad range of users to apply the MindLogger platform to create and test applets to advance health care and scientific research. We hope that increasing the availability of applets designed to assess and administer interventions will facilitate access to health care in the general population. %M 34762054 %R 10.2196/22369 %U https://www.jmir.org/2021/11/e22369 %U https://doi.org/10.2196/22369 %U http://www.ncbi.nlm.nih.gov/pubmed/34762054 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e29866 %T The Influence of Gender and Age on the Outcomes of and Adherence to a Digital Interdisciplinary Mental Health Promotion Intervention in an Australasian Nonclinical Setting: Cohort Study %A Przybylko,Geraldine %A Morton,Darren %A Morton,Jason %A Renfrew,Melanie %+ Lifestyle Medicine and Health Research Centre, Avondale University, 582 Freemans Drive, Cooranbong, 2265, Australia, 61 418574001, geraldineprzybylko@eliawellness.com %K age %K gender %K adherence %K digital health %K interdisciplinary %K mental health %K promotion %K intervention %K lifestyle medicine %K positive psychology %K multicomponent %K lifestyle %K outcome %K cohort study %D 2021 %7 11.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The global prevalence of mental health disorders is at a crisis point, particularly in the wake of COVID-19, prompting calls for the development of digital interdisciplinary mental health promotion interventions (MHPIs) for nonclinical cohorts. However, the influence of gender and age on the outcomes of and adherence to MHPIs is not well understood. Objective: The aim of this study was to determine the influence of gender and age on the outcomes of and adherence to a 10-week digital interdisciplinary MHPI that integrates strategies from positive psychology and lifestyle medicine and utilizes persuasive systems design (PSD) principles in a nonclinical setting. Methods: This study involved 488 participants who completed the digital interdisciplinary MHPI. Participants completed a pre and postintervention questionnaire that used: (1) the “mental health” and “vitality” subscales from the Short Form 36 (SF-36) Health Survey; (2) the Depression, Anxiety and Stress Scale (DASS-21); and (3) Satisfaction With Life Scale (SWL). Adherence to the digital interdisciplinary MHPI was measured by the number of educational videos the participants viewed and the extent to which they engaged in experiential challenge activities offered as part of the program. Results: On average, the participants (N=488; mean age 47.1 years, SD 14.1; 77.5% women) demonstrated statistically significant improvements in all mental health and well-being outcome measures, and a significant gender and age interaction was observed. Women tended to experience greater improvements than men in the mental health and well-being measures, and older men experienced greater improvements than younger men in the mental health and vitality subscales. Multiple analysis of variance results of the adherence measures indicated a significant difference for age but not gender. No statistically significant interaction between gender and age was observed for adherence measures. Conclusions: Digital interdisciplinary MHPIs that utilize PSD principles can improve the mental health and well-being of nonclinical cohorts, regardless of gender or age. Hence, there may be a benefit in utilizing PSD principles to develop universal MHPIs such as that employed in this study, which can be used across gender and age groups. Future research should examine which PSD principles optimize universal digital interdisciplinary MHPIs. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000993190; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377889 and Australian New Zealand Clinical Trials Registry ACTRN12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx %M 34762058 %R 10.2196/29866 %U https://mental.jmir.org/2021/11/e29866 %U https://doi.org/10.2196/29866 %U http://www.ncbi.nlm.nih.gov/pubmed/34762058 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30435 %T Public Perceptions of Diabetes, Healthy Living, and Conversational Agents in Singapore: Needs Assessment %A Dhinagaran,Dhakshenya Ardhithy %A Sathish,Thirunavukkarasu %A Kowatsch,Tobias %A Griva,Konstadina %A Best,James Donovan %A Tudor Car,Lorainne %+ Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11 Mandalay Road, Singapore, 308232, Singapore, 65 69041258, lorainne.tudor.car@ntu.edu.sg %K conversational agents %K chatbots %K diabetes %K prediabetes %K healthy lifestyle change %K mobile phone %D 2021 %7 11.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The incidence of chronic diseases such as type 2 diabetes is increasing in countries worldwide, including Singapore. Health professional–delivered healthy lifestyle interventions have been shown to prevent type 2 diabetes. However, ongoing personalized guidance from health professionals is not feasible or affordable at the population level. Novel digital interventions delivered using mobile technology, such as conversational agents, are a potential alternative for the delivery of healthy lifestyle change behavioral interventions to the public. Objective: We explored perceptions and experiences of Singaporeans on healthy living, diabetes, and mobile health (mHealth) interventions (apps and conversational agents). This study was conducted to help inform the design and development of a conversational agent focusing on healthy lifestyle changes. Methods: This qualitative study was conducted in August and September 2019. A total of 20 participants were recruited from relevant healthy living Facebook pages and groups. Semistructured interviews were conducted in person or over the telephone using an interview guide. Interviews were transcribed and analyzed in parallel by 2 researchers using Burnard’s method, a structured approach for thematic content analysis. Results: The collected data were organized into 4 main themes: use of conversational agents, ubiquity of smartphone apps, understanding of diabetes, and barriers and facilitators to a healthy living in Singapore. Most participants used health-related mobile apps as well as conversational agents unrelated to health care. They provided diverse suggestions for future conversational agent-delivered interventions. Participants also highlighted several knowledge gaps in relation to diabetes and healthy living. Regarding barriers to healthy living, participants mentioned frequent dining out, high stress levels, lack of work-life balance, and lack of free time to engage in physical activity. In contrast, discipline, preplanning, and sticking to a routine were important for enabling a healthy lifestyle. Conclusions: Participants in this study commonly used mHealth interventions and provided important insights into their knowledge gaps and needs in relation to changes in healthy lifestyle behaviors. Future digital interventions such as conversational agents focusing on healthy lifestyle and diabetes prevention should aim to address the barriers highlighted in our study and motivate individuals to adopt healthy lifestyle behavior. %M 34762053 %R 10.2196/30435 %U https://formative.jmir.org/2021/11/e30435 %U https://doi.org/10.2196/30435 %U http://www.ncbi.nlm.nih.gov/pubmed/34762053 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e15220 %T Feasibility of Real-time Behavior Monitoring Via Mobile Technology in Czech Adults Aged 50 Years and Above: 12-Week Study With Ecological Momentary Assessment %A Elavsky,Steriani %A Klocek,Adam %A Knapova,Lenka %A Smahelova,Martina %A Smahel,David %A Cimler,Richard %A Kuhnova,Jitka %+ Department of Human Movement Studies, University of Ostrava, Varenska 40a, Ostrava, 70200, Czech Republic, 420 553462588, steriani.elavsky@osu.cz %K mHealth %K mobile phone %K older adults %K health behavior %K physical activity %K Fitbit %D 2021 %7 10.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Czech older adults have lower rates of physical activity than the average population and lag behind in the use of digital technologies, compared with their peers from other European countries. Objective: This study aims to assess the feasibility of intensive behavior monitoring through technology in Czech adults aged ≥50 years. Methods: Participants (N=30; mean age 61.2 years, SD 6.8 years, range 50-74 years; 16/30, 53% male; 7/30, 23% retired) were monitored for 12 weeks while wearing a Fitbit Charge 2 monitor and completed three 8-day bursts of intensive data collection through surveys presented on a custom-made mobile app. Web-based surveys were also completed before and at the end of the 12-week period (along with poststudy focus groups) to evaluate participants’ perceptions of their experience in the study. Results: All 30 participants completed the study. Across the three 8-day bursts, participants completed 1454 out of 1744 (83% compliance rate) surveys administered 3 times per day on a pseudorandom schedule, 451 out of 559 (81% compliance rate) end-of-day surveys, and 736 episodes of self-reported planned physical activity (with 29/736, 3.9% of the reports initiated but returned without data). The overall rating of using the mobile app and Fitbit was above average (74.5 out of 100 on the System Usability Scale). The majority reported that the Fitbit (27/30, 90%) and mobile app (25/30, 83%) were easy to use and rated their experience positively (25/30, 83%). Focus groups revealed that some surveys were missed owing to notifications not being noticed or that participants needed a longer time window for survey completion. Some found wearing the monitor in hot weather or at night uncomfortable, but overall, participants were highly motivated to complete the surveys and be compliant with the study procedures. Conclusions: The use of a mobile survey app coupled with a wearable device appears feasible for use among Czech older adults. Participants in this study tolerated the intensive assessment schedule well, but lower compliance may be expected in studies of more diverse groups of older adults. Some difficulties were noted with the pairing and synchronization of devices on some types of smartphones, posing challenges for large-scale studies. %M 34757317 %R 10.2196/15220 %U https://aging.jmir.org/2021/4/e15220 %U https://doi.org/10.2196/15220 %U http://www.ncbi.nlm.nih.gov/pubmed/34757317 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28951 %T Validation of a Mobile Health Technology Platform (FeverTracker) for Malaria Surveillance in India: Development and Usability Study %A Pal Bhowmick,Ipsita %A Chutia,Dibyajyoti %A Chouhan,Avinash %A Nishant,Nilay %A Raju,P L N %A Narain,Kanwar %A Kaur,Harpreet %A Pebam,Rocky %A Debnath,Jayanta %A Tripura,Rabindra %A Gogoi,Kongkona %A Ch Nag,Suman %A Nath,Aatreyee %A Tripathy,Debabrata %A Debbarma,Jotish %A Das,Nirapada %A Sarkar,Ujjwal %A Debbarma,Rislyn %A Roy,Rajashree %A Debnath,Bishal %A Dasgupta,Dipanjan %A Debbarma,Suraj %A Joy Tripura,Kamal %A Reang,Guneram %A Sharma,Amit %A Rahi,Manju %A Chhibber-Goel,Jyoti %+ International Centre for Genetic Engineering and Biotechnology, Vasant Kunj, New Delhi, 110067, India, 91 011 26741358 ext 170, jyotichhibbergoel@gmail.com %K fever %K health system %K mHealth app %K malaria %K surveillance %K mobile phone %D 2021 %7 10.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: A surveillance system is the foundation for disease prevention and control. Malaria surveillance is crucial for tracking regional and temporal patterns in disease incidence, assisting in recorded details, timely reporting, and frequency of analysis. Objective: In this study, we aim to develop an integrated surveillance graphical app called FeverTracker, which has been designed to assist the community and health care workers in digital surveillance and thereby contribute toward malaria control and elimination. Methods: FeverTracker uses a geographic information system and is linked to a web app with automated data digitization, SMS text messaging, and advisory instructions, thereby allowing immediate notification of individual cases to district and state health authorities in real time. Results: The use of FeverTracker for malaria surveillance is evident, given the archaic paper-based surveillance tools used currently. The use of the app in 19 tribal villages of the Dhalai district in Tripura, India, assisted in the surveillance of 1880 suspected malaria patients and confirmed malaria infection in 93.4% (114/122; Plasmodium falciparum), 4.9% (6/122; P vivax), and 1.6% (2/122; P falciparum/P vivax mixed infection) of cases. Digital tools such as FeverTracker will be critical in integrating disease surveillance, and they offer instant data digitization for downstream processing. Conclusions: The use of this technology in health care and research will strengthen the ongoing efforts to eliminate malaria. Moreover, FeverTracker provides a modifiable template for deployment in other disease systems. %M 34757321 %R 10.2196/28951 %U https://formative.jmir.org/2021/11/e28951 %U https://doi.org/10.2196/28951 %U http://www.ncbi.nlm.nih.gov/pubmed/34757321 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e27897 %T Mediating Effects of Stigma and Depressive Symptoms in a Social Media–Based Intervention to Improve Long-term Quality of Life Among People Living With HIV: Secondary Analysis of a Randomized Controlled Trial %A Li,Yiran %A Guo,Yan %A Hong,Y Alicia %A Zeng,Chengbo %A Zeng,Yu %A Zhang,Hanxi %A Zhu,Mengting %A Qiao,Jiaying %A Cai,Weiping %A Li,Linghua %A Liu,Cong %+ Department of Medical Statistics, School of Public Health, Sun Yat-sen University, #74 2nd Zhongshan Road, Guangzhou, 510080, China, 86 020 87334202, guoy8@mail.sysu.edu.cn %K mHealth %K HIV %K depressive symptoms %K quality of life %K structural equation model %D 2021 %7 9.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health (mHealth) interventions have been shown to effectively improve the quality of life (QOL) among people living with HIV. However, little is known about the long-term effects of mHealth interventions. Objective: This study aims to explore the intervention mechanisms of a social media–based intervention, Run4Love, on the QOL of people with HIV over across a 9-month follow-up period. Methods: We recruited people living with HIV who were concurrently experiencing elevated depressive symptoms from an HIV outpatient clinic in South China. A total of 300 eligible participants were randomized either to the intervention group or the control group in a 1:1 ratio after they provided informed consent and completed a baseline survey. The intervention group received a 3-month WeChat-based intervention, comprising cognitive-behavioral stress management (CBSM) courses and physical activity promotion. The control group received a printed brochure on nutrition guidelines in addition to the usual care for HIV treatment. Neither participants nor the research staff were blinded to group assignment. All patients were followed at 3, 6, and 9 months. The primary outcome was depressive symptoms. Structural equation model (SEM) with longitudinal data was conducted to examine the sequential mediating effects of HIV-related stigma and depressive symptoms on the long-term intervention effects on participants’ QOL. Results: About 91.3% (274/300), 88.3% (265/300), and 86.7% (260/300) of all participants completed follow-up surveys at 3, 6, and 9 months, respectively. Results showed that the intervention had significantly improved participants' QOL at 9 months, via complete mediating effects of reduced HIV-related stigma at 3 months and decreased depressive symptoms at 6 months. No adverse events were reported. Conclusions: These findings underscore the critical roles of HIV-related stigma and depressive symptoms in an mHealth intervention with long-term effects on QOL improvements. We call for targeted mHealth interventions to improve QOL among people living with HIV, especially social media–based interventions that can address HIV-related stigma and alleviate depressive symptoms. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://www.chictr.org.cn/showproj.aspx?proj=21019 %M 34751654 %R 10.2196/27897 %U https://www.jmir.org/2021/11/e27897 %U https://doi.org/10.2196/27897 %U http://www.ncbi.nlm.nih.gov/pubmed/34751654 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e32847 %T Mechanisms of Smartphone Apps for Cigarette Smoking Cessation: Results of a Serial Mediation Model From the iCanQuit Randomized Trial %A Bricker,Jonathan B %A Levin,Michael %A Lappalainen,Raimo %A Mull,Kristin %A Sullivan,Brianna %A Santiago-Torres,Margarita %+ Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M3-B232, Seattle, WA, 98109, United States, 1 2066675074, jbricker@fredhutch.org %K mediation %K engagement %K digital %K mHealth: smartphone %K acceptance %K smoking %K cessation %K app %K randomized controlled trial %K model %K intervention %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Engagement with digital interventions is a well-known predictor of treatment outcomes, but this knowledge has had limited actionable value. Instead, learning why engagement with digital interventions impact treatment outcomes can lead to targeted improvements in their efficacy. Objective: This study aimed to test a serial mediation model of an Acceptance and Commitment Therapy (ACT) smartphone intervention for smoking cessation. Methods: In this randomized controlled trial, participants (N=2415) from 50 US states were assigned to the ACT-based smartphone intervention (iCanQuit) or comparison smartphone intervention (QuitGuide). Their engagement with the apps (primary measure: number of logins) was measured during the first 3 months, ACT processes were measured at baseline and 3 months (acceptance of internal cues to smoke, valued living), and smoking cessation was measured at 12 months with 87% follow-up retention. Results: There was a significant serial mediation effect of iCanQuit on smoking cessation through multiple indicators of intervention engagement (ie, total number of logins, total number of minutes used, and total number of unique days of use) and in turn through increases in mean acceptance of internal cues to smoke from baseline to 3 months. Analyses of the acceptance subscales showed that the mediation was through acceptance of physical sensations and emotions, but not acceptance of thoughts. There was no evidence that the effect of the iCanQuit intervention was mediated through changes in valued living. Conclusions: In this first study of serial mediators underlying the efficacy of smartphone apps for smoking cessation, our results suggest the effect of the iCanQuit ACT-based smartphone app on smoking cessation was mediated through multiple indicators of engagement and in turn through increases in the acceptance of physical sensations and emotions that cue smoking. Trial Registration: Clinical Trials.gov NCT02724462; https://clinicaltrials.gov/ct2/show/NCT02724462 %M 34751662 %R 10.2196/32847 %U https://mhealth.jmir.org/2021/11/e32847 %U https://doi.org/10.2196/32847 %U http://www.ncbi.nlm.nih.gov/pubmed/34751662 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30580 %T A Text Message Intervention for Adolescents With Depression and Their Parents or Caregivers to Overcome Cognitive Barriers to Mental Health Treatment Initiation: Focus Groups and Pilot Trial %A Suffoletto,Brian %A Goldstein,Tina %A Brent,David %+ Department of Emergency Medicine, Stanford University, 900 Welch Road, Suite 350, Palo Alto, CA, 94304, United States, 1 4129016892, suffbp@stanford.edu %K adolescent %K depression %K help seeking %K text message %K intervention %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Many adolescents with depression do not pursue mental health treatment following a health care provider referral. We developed a theory-based automated SMS text message intervention (Text to Connect [T2C]) that attempts to reduce cognitive barriers to the initiation of mental health care. Objective: In this two-phase study, we seek to first understand the potential of T2C and then test its engagement, usability, and potential efficacy among adolescents with depression and their parents or caregivers. Methods: In phase 1, we conducted focus groups with adolescents with depression (n=9) and their parents or caregivers (n=9) separately, and transcripts were examined to determine themes. In phase 2, we conducted an open trial of T2C comprising adolescents with depression referred to mental health care (n=43) and their parents or caregivers (n=28). We assessed usability by examining program engagement, usability ratings, and qualitative feedback at the 4-week follow-up. We also assessed potential effectiveness by examining changes in perceived barriers to treatment and mental health care initiation from baseline to 4 weeks. Results: In phase 1, we found that the themes supported the T2C approach. In phase 2, we observed high engagement with daily negative affect check-ins, high usability ratings, and decreased self-reported barriers to mental health treatment over time among adolescents. Overall, 52% (22/42) of the adolescents who completed follow-up reported that they had attended an appointment with a mental health care specialist. Of the 20 adolescents who had not attended a mental health care appointment, 5% (1/20) reported that it was scheduled for a future date, 10% (2/20) reported that the primary care site did not have the ability to help them schedule a mental health care appointment, and 15% (3/20) reported that they were no longer interested in receiving mental health care. Conclusions: The findings from this study suggest that T2C is acceptable to adolescents with depression and most parents or caregivers; it is used at high rates; and it may be helpful to reduce cognitive barriers to mental health care initiation. %M 34751665 %R 10.2196/30580 %U https://formative.jmir.org/2021/11/e30580 %U https://doi.org/10.2196/30580 %U http://www.ncbi.nlm.nih.gov/pubmed/34751665 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e30350 %T Development and Validation of a Mobile Game for Culturally Sensitive Child Sexual Abuse Prevention Education in Tanzania: Mixed Methods Study %A Malamsha,Maria Proches %A Sauli,Elingarami %A Luhanga,Edith Talina %+ School of Computation and Communication Science and Engineering, Nelson Mandela African Institution of Science and Technology, PO Box 447, Nelson Mandela Rd, Arusha, United Republic of Tanzania, 255 715261702, selestinapro@gmail.com %K child sexual abuse %K social cultural belief %K ecological setting %K prevention %K parents %K caretakers %K child experts %K mobile game %D 2021 %7 8.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Globally, 3 out of 20 children experience sexual abuse before the age of 18 years. Educating children about sexual abuse and prevention is an evidence-based strategy that is recommended for ending child sexual abuse. Digital games are increasingly being used to influence healthy behaviors in children and could be an efficient and friendly approach to educating children about sexual abuse prevention. However, little is known on the best way to develop a culturally sensitive game that targets children in Africa—where sexual education is still taboo—that would be engaging, effective, and acceptable to parents and caretakers. Objective: This study aimed to develop a socioculturally appropriate, mobile-based game for educating young children (<5 years) and parents and caretakers in Tanzania on sexual abuse prevention. Methods:  HappyToto children’s game was co-designed with 111 parents and caretakers (females: n=58, 52.3%; male: n=53, 47.7%) of children below 18 years of age and 24 child experts in Tanzania through surveys and focus group discussions conducted from March 2020 to April 2020. From these, we derived an overview of topics, sociocultural practices, social environment, and game interface designs that should be considered when designing child sexual abuse prevention (CSAP) education interventions. We also conducted paper prototyping and storyboarding sessions for the game’s interface, storylines, and options. To validate the application’s prototype, 32 parents (females: n=18, 56%; males: n=14, 44%) of children aged 3-5 years and 5 children (females: n=2, 40%; males: n=3, 60%) of the same age group played the game for half an hour on average. The parents undertook a pre-post intervention assessment on confidence and ability to engage in CSAP education conversations, as well as exit surveys on the usability and sociocultural acceptability of the game, while children were quizzed on the topics covered and their enjoyment of the game. Results: Parents and caregivers showed interest in the developed game during the conducted surveys, and each parent on average navigated through all the parts of the game. The confidence level of parents in talking about CSAP increased from an average of 3.56 (neutral) before using the game to 4.9 (confident) after using the game. The ability scores, calculated based on a range of topics included in CSAP education talks with children, also increased from 5.67 (out of 10) to 8.8 (out of 10) after the game was played. Both confidence level and ability scores were statistically significant (P<.001). All 5 children were interested in the game and enjoyed the game-provided activities. Conclusions: The HappyToto game can thus be an effective technology-based intervention for improving the knowledge and skills of parents and children in CSAP education. %M 34747703 %R 10.2196/30350 %U https://games.jmir.org/2021/4/e30350 %U https://doi.org/10.2196/30350 %U http://www.ncbi.nlm.nih.gov/pubmed/34747703 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e31170 %T Mobile Apps That Promote Emotion Regulation, Positive Mental Health, and Well-being in the General Population: Systematic Review and Meta-analysis %A Eisenstadt,Mia %A Liverpool,Shaun %A Infanti,Elisa %A Ciuvat,Roberta Maria %A Carlsson,Courtney %+ Evidence Based Practice Unit, Anna Freud National Centre for Children and Families and University College London, 4-8 Rodney Street, London, N1 9JH, United Kingdom, 44 7989165986, mia.eisenstadt@annafreud.org %K systematic review %K MHapp, mHealth %K mental health %K well-being %K emotion regulation %K mobile apps %K effectiveness %K monitoring %K management %K mental health app %D 2021 %7 8.11.2021 %9 Review %J JMIR Ment Health %G English %X Background: Among the general public, there appears to be a growing need and interest in receiving digital mental health and well-being support. In response to this, mental health apps (MHapps) are becoming available for monitoring, managing, and promoting positive mental health and well-being. Thus far, evidence supports favorable outcomes when users engage with MHapps, yet there is a relative paucity of reviews on apps that support positive mental health and well-being. Objective: We aimed to systematically review the available research on MHapps that promote emotion regulation, positive mental health, and well-being in the general population aged 18-45 years. More specifically, the review aimed at providing a systematic description of the theoretical background and features of MHapps while evaluating any potential effectiveness. Methods: A comprehensive literature search of key databases, including MEDLINE (via Ovid), EMBASE (via Ovid), PsycINFO (via Ovid), Web of Science, and the Cochrane Register of Controlled Trials (CENTRAL), was performed until January 2021. Studies were included if they described standalone mental health and well-being apps for adults without a formal mental health diagnosis. The quality of all studies was assessed against the Mixed Methods Appraisal Tool. In addition, the Cochrane Risk-of-Bias tool (RoB-2) was used to assess randomized control trials (RCTs). Data were extracted using a modified extraction form from the Cochrane Handbook of Systematic Reviews. A narrative synthesis and meta-analysis were then undertaken to address the review aims. Results: In total, 3156 abstracts were identified. Of these, 52 publications describing 48 MHapps met the inclusion criteria. Together, the studies evaluated interventions across 15 countries. Thirty-nine RCTs were identified suggesting some support for the role of individual MHapps in improving and promoting mental health and well-being. Regarding the pooled effect, MHapps, when compared to controls, showed a small effect for reducing mental health symptoms (k=19, Hedges g=–0.24, 95% CI –0.34 to –0.14; P<.001) and improving well-being (k=13, g=0.17, 95% CI 0.05-0.29, P=.004), and a medium effect for emotion regulation (k=6, g=0.49, 95% CI 0.23-0.74, P<.001). There is also a wide knowledge base of creative and innovative ways to engage users in techniques such as mood monitoring and guided exercises. Studies were generally assessed to contribute unclear or a high risk of bias, or to be of medium to low methodological quality. Conclusions: The emerging evidence for MHapps that promote positive mental health and well-being suggests promising outcomes. Despite a wide range of MHapps, few apps specifically promote emotion regulation. However, our findings may position emotion regulation as an important mechanism for inclusion in future MHapps. A fair proportion of the included studies were pilot or feasibility trials (k=17, 33%), and full-scale RCTs reported high attrition rates and nondiverse samples. Given the number and pace at which MHapps are being released, further robust research is warranted to inform the development and testing of evidence-based programs. %M 34747713 %R 10.2196/31170 %U https://mental.jmir.org/2021/11/e31170 %U https://doi.org/10.2196/31170 %U http://www.ncbi.nlm.nih.gov/pubmed/34747713 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e30622 %T The Relationship Between Weight Loss Outcomes and Engagement in a Mobile Behavioral Change Intervention: Retrospective Analysis %A Carey,Alissa %A Yang,Qiuchen %A DeLuca,Laura %A Toro-Ramos,Tatiana %A Kim,Youngin %A Michaelides,Andreas %+ Academic Research, Noom Inc, Fl 9, 229 W 28th St, New York, NY, 10001, United States, 1 631 938 1248, andreas@noom.com %K engagement %K mHealth %K obesity %K weight management %K Noom %K application %K app %K behavioral change %K digital behavior change interventions %D 2021 %7 8.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is large variance in weight loss outcomes of digital behavior change interventions (DBCIs). It has been suggested that different patterns of engagement in the program could be responsible for this variance in outcomes. Previous studies have found that the amount of engagement on DBCIs, such as the number of meals logged or articles read, is positively associated with weight loss. Objective: This retrospective study extends previous research by observing how important weight loss outcomes (high weight loss: 10% or greater body weight loss; moderate weight loss: between 5% to 10%; stable weight: 0 plus or minus 1%) are associated with engagement on a publicly available mobile DBCI (Noom) from 9 to 52 weeks. Methods: Engagement and weight data for eligible participants (N=11,252) were extracted from the Noom database. Engagement measures included the number of articles read, meals logged, steps recorded, messages to coach, exercise logged, weigh-ins, and days with 1 meal logged per week. Weight was self-reported on the program. Multiple linear regressions examined how weight loss outcome (moderate and high vs stable) was associated with each engagement measure across 3 study time periods: 9-16 weeks, 17-32 weeks, and 33-52 weeks. Results: At 9-16 weeks, among the 11,252 participants, 2594 (23.05%) had stable weight, 6440 (57.23%) had moderate weight loss, and 2218 (19.71%) had high weight loss. By 33-52 weeks, 525 (18.21%) had stable weight, 1214 (42.11%) had moderate weight loss, and 1144 (39.68%) had high weight loss. Regression results showed that moderate weight loss and high weight loss outcomes were associated with all engagement measures to a significantly greater degree than was stable weight (all P values <.001). These differences held across all time periods with the exception of exercise for the moderate weight loss category at 1 time period of 33-52 weeks. Exercise logging increased from 9 to 52 weeks regardless of the weight loss group. Conclusions: Our results suggest that these clinically important weight loss outcomes are related to the number of articles read, meals logged, steps recorded, messages to coach, exercise logged, weigh-ins, and days with 1 meal logged per week both in the short-term and long-term (ie, 1 year) on Noom. This provides valuable data on engagement patterns over time on a self-directed mobile DBCI, can help inform how interventions tailor recommendations for engagement depending on how much weight individuals have lost, and raises important questions for future research on engagement in DBCIs. %M 34747706 %R 10.2196/30622 %U https://mhealth.jmir.org/2021/11/e30622 %U https://doi.org/10.2196/30622 %U http://www.ncbi.nlm.nih.gov/pubmed/34747706 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e31586 %T A Digital Human for Delivering a Remote Loneliness and Stress Intervention to At-Risk Younger and Older Adults During the COVID-19 Pandemic: Randomized Pilot Trial %A Loveys,Kate %A Sagar,Mark %A Pickering,Isabella %A Broadbent,Elizabeth %+ Department of Psychological Medicine, The University of Auckland, Building 507, Level 3, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 9 923 0003, e.broadbent@auckland.ac.nz %K COVID-19 %K loneliness %K stress %K well-being %K eHealth %K digital human %K conversational agent %K older adults %K chronic illness %D 2021 %7 8.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Loneliness is a growing public health issue that has been exacerbated in vulnerable groups during the COVID-19 pandemic. Computer agents are capable of delivering psychological therapies through the internet; however, there is limited research on their acceptability to date. Objective: The objectives of this study were to evaluate (1) the feasibility and acceptability of a remote loneliness and stress intervention with digital human delivery to at-risk adults and (2) the feasibility of the study methods in preparation for a randomized controlled trial. Methods: A parallel randomized pilot trial with a mixed design was conducted. Participants were adults aged 18 to 69 years with an underlying medical condition or aged 70 years or older with a Mini-Mental State Examination score of >24 (ie, at greater risk of developing severe COVID-19). Participants took part from their place of residence (independent living retirement village, 20; community dwelling, 7; nursing home, 3). Participants were randomly allocated to the intervention or waitlist control group that received the intervention 1 week later. The intervention involved completing cognitive behavioral and positive psychology exercises with a digital human facilitator on a website for at least 15 minutes per day over 1 week. The exercises targeted loneliness, stress, and psychological well-being. Feasibility was evaluated using dropout rates and behavioral observation data. Acceptability was evaluated from behavioral engagement data, the Friendship Questionnaire (adapted), self-report items, and qualitative questions. Psychological measures were administered to evaluate the feasibility of the trial methods and included the UCLA Loneliness Scale, the 4-item Perceived Stress Scale, a 1-item COVID-19 distress measure, the Flourishing Scale, and the Scale of Positive and Negative Experiences. Results: The study recruited 30 participants (15 per group). Participants were 22 older adults and 8 younger adults with a health condition. Six participants dropped out of the study. Thus, the data of 24 participants were analyzed (intervention group, 12; waitlist group, 12). The digital human intervention and trial methods were generally found to be feasible and acceptable in younger and older adults living independently, based on intervention completion, and behavioral, qualitative, and some self-report data. The intervention and trial methods were less feasible to nursing home residents who required caregiver assistance. Acceptability could be improved with additional content, tailoring to the population, and changes to the digital human’s design. Conclusions: Digital humans are a promising and novel technological solution for providing at-risk adults with access to remote psychological support during the COVID-19 pandemic. Research should further examine design techniques to improve their acceptability in this application and investigate intervention effectiveness in a randomized controlled trial. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12620000786998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380113 %M 34596572 %R 10.2196/31586 %U https://mental.jmir.org/2021/11/e31586 %U https://doi.org/10.2196/31586 %U http://www.ncbi.nlm.nih.gov/pubmed/34596572 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e29044 %T Feasibility of a Sensor-Controlled Digital Game for Heart Failure Self-management: Randomized Controlled Trial %A Radhakrishnan,Kavita %A Julien,Christine %A Baranowski,Tom %A O'Hair,Matthew %A Lee,Grace %A Sagna De Main,Atami %A Allen,Catherine %A Viswanathan,Bindu %A Thomaz,Edison %A Kim,Miyong %+ School of Nursing, The University of Texas Austin, 1710 Red River St, Austin, TX, 78701, United States, 1 512 471 7936, Kradhakrishnan@mail.nur.utexas.edu %K heart failure %K digital game %K sensor %K self-management %K older adults %K weight monitoring %K physical activity %K behaviors %K mobile phone %D 2021 %7 8.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Poor self-management of heart failure (HF) contributes to devastating health consequences. Our innovative sensor-controlled digital game (SCDG) integrates data from sensors to trigger game rewards, progress, and feedback based on the real-time behaviors of individuals with HF. Objective: The aim of this study is to compare daily weight monitoring and physical activity behavior adherence by older adults using an SCDG intervention versus a sensors-only intervention in a feasibility randomized controlled trial. Methods: English-speaking adults with HF aged 55 years or older who owned a smartphone and could walk unassisted were recruited from Texas and Oklahoma from November 2019 to August 2020. Both groups were given activity trackers and smart weighing scales to track behaviors for 12 weeks. The feasibility outcomes of recruitment, retention, intervention engagement, and satisfaction were assessed. In addition to daily weight monitoring and physical activity adherence, the participants’ knowledge, functional status, quality of life, self-reported HF behaviors, motivation to engage in behaviors, and HF-related hospitalization were also compared between the groups at baseline and at 6, 12, and 24 weeks. Results: A total of 38 participants with HF—intervention group (IG; 19/38, 50%) and control group (CG; 19/38, 50%)—were enrolled in the study. Of the 38 participants, 18 (47%) were women, 18 (47%) were aged 65 years or older, 21 (55%) had been hospitalized with HF in the past 6 months, and 29 (76%) were White. Furthermore, of these 38 participants, 31 (82%)—IG (15/19, 79%) and CG (16/19, 84%)—had both weight monitoring and physical activity data at the end of 12 weeks, and 27 (71%)—IG (14/19, 74%) and CG (13/19, 68%)—participated in follow-up assessments at 24 weeks. For the IG participants who installed the SCDG app (15/19, 79%), the number of days each player opened the game app was strongly associated with the number of days the player engaged in weight monitoring (r=0.72; P=.04) and the number of days with physical activity step data (r=0.9; P<.001). The IG participants who completed the satisfaction survey (13/19, 68%) reported that the SCDG was easy to use. Trends of improvement in daily weight monitoring and physical activity in the IG, as well as within-group improvements in HF functional status, quality of life, knowledge, self-efficacy, and HF hospitalization in both groups, were observed in this feasibility trial. Conclusions: Playing an SCDG on smartphones was feasible and acceptable for older adults with HF for motivating daily weight monitoring and physical activity. A larger efficacy trial of the SCDG intervention will be needed to validate trends of improvement in daily weight monitoring and physical activity behaviors. Trial Registration: ClinicalTrials.gov NCT03947983; https://clinicaltrials.gov/ct2/show/NCT03947983 %M 34747701 %R 10.2196/29044 %U https://games.jmir.org/2021/4/e29044 %U https://doi.org/10.2196/29044 %U http://www.ncbi.nlm.nih.gov/pubmed/34747701 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e31789 %T An App-Based Intervention for Adolescents Exposed to Cyberbullying in Norway: Protocol for a Randomized Controlled Trial %A Kaiser,Sabine %A Martinussen,Monica %A Adolfsen,Frode %A Breivik,Kyrre %A Kyrrestad,Henriette %+ Regional Centre for Child and Youth Mental Health and Child Welfare - North, UiT The Arctic University of Norway, Campus Tromsø, Breivika, Tromsø, 9019, Norway, 47 77645850, sabine.kaiser@uit.no %K cyberbullying %K intervention %K mobile app %K adolescents %K NettOpp %K mental health %K adolescents %K health care %D 2021 %7 8.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescents exposed to negative online events are at high risk to develop mental health problems. Little is known about what is effective for treatment in this group. NettOpp is a new mobile app for adolescents who have been exposed to cyberbullying or negative online experiences in Norway. Objective: The aim of this paper is to provide a description of the content of the intervention and about a randomized controlled trial that will be conducted to examine the effectiveness of NettOpp. This protocol is written in accordance with the Spirit 2013 Checklist. Methods: An effectiveness study with a follow-up examination after 3 months will be conducted to evaluate the mobile app. Adolescents will be recruited through schools and will be randomly assigned to the intervention (NettOpp) group and a waiting-list control group. The adolescents (aged 11 to 16 years) will respond to self-report questionnaires on the internet. Primary outcomes will be changes in mental health assessed with the Strengths and Difficulties Questionnaire, the WHO-Five Well-being Index, and the Child and Adolescent Trauma Screen. Results: Recruitment will start in January 2022. The results from this study will be available in 2023. Conclusions: There are few published evaluation studies on app-based interventions. This project and its publications will contribute new knowledge to the field. Trial Registration: ClinicalTrials.gov NCT04176666; https://clinicaltrials.gov/ct2/show/NCT04176666 International Registered Report Identifier (IRRID): PRR1-10.2196/31789 %M 34747704 %R 10.2196/31789 %U https://www.researchprotocols.org/2021/11/e31789 %U https://doi.org/10.2196/31789 %U http://www.ncbi.nlm.nih.gov/pubmed/34747704 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e29788 %T Clinicians and Older Adults’ Perceptions of the Utility of Patient-Generated Health Data in Caring for Older Adults: Exploratory Mixed Methods Study %A Kim,Ben %A Ghasemi,Peyman %A Stolee,Paul %A Lee,Joon %+ Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada, 1 403 220 2968, joonwu.lee@ucalgary.ca %K mobile health %K mHealth %K older adults %K wearables %K patient generated health data %K chronic disease management %K home care %K self-care %K activities of daily living %K sleep %D 2021 %7 5.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Many people are motivated to self-track their health and optimize their well-being through mobile health apps and wearable devices. The diversity and complexity of these systems have evolved over time, resulting in a large amount of data referred to as patient-generated health data (PGHD), which has recently emerged as a useful set of data elements in health care systems around the world. Despite the increased interest in PGHD, clinicians and older adults’ perceptions of PGHD are poorly understood. In particular, although some clinician barriers to using PGHD have been identified, such as concerns about data quality, ease of use, reliability, privacy, and regulatory issues, little is known from the perspectives of older adults. Objective: This study aims to explore the similarities and differences in the perceptions of older adults and clinicians with regard to how various types of PGHD can be used to care for older adults. Methods: A mixed methods study was conducted to explore clinicians and older adults’ perceptions of PGHD. Focus groups were conducted with older adults and health care providers from the Greater Toronto area and the Kitchener-Waterloo region. The participants were asked to discuss their perceptions of PGHD, including facilitators and barriers. A questionnaire aimed at exploring the perceived usefulness of a range of different PGHD was also embedded in the study design. Focus group interviews were transcribed for thematic analysis, whereas the questionnaire results were analyzed using descriptive statistics. Results: Of the 9 participants, 4 (44%) were clinicians (average age 38.3 years, SD 7 years), and 5 (56%) were older adults (average age 81.0 years, SD 9.1 years). Four main themes were identified from the focus group interviews: influence of PGHD on patient-provider trust, reliability of PGHD, meaningful use of PGHD and PGHD-based decision support systems, and perceived clinical benefits and intrusiveness of PGHD. The questionnaire results were significantly correlated with the frequency of PGHD mentioned in the focus group interviews (r=0.42; P=.03) and demonstrated that older adults and clinicians perceived blood glucose, step count, physical activity, sleep, blood pressure, and stress level as the most useful data for managing health and delivering high-quality care. Conclusions: This embedded mixed methods study generated several important findings about older adults and clinicians’ perceptions and perceived usefulness of a range of PGHD. Owing to the exploratory nature of this study, further research is needed to understand the concerns about data privacy, potential negative impact on the trust between older adults and clinicians, data quality and quantity, and usability of PGHD-related technologies for older adults. %M 34738913 %R 10.2196/29788 %U https://aging.jmir.org/2021/4/e29788 %U https://doi.org/10.2196/29788 %U http://www.ncbi.nlm.nih.gov/pubmed/34738913 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e27282 %T Identifying App-Based Meditation Habits and the Associated Mental Health Benefits: Longitudinal Observational Study %A Stecher,Chad %A Berardi,Vincent %A Fowers,Rylan %A Christ,Jaclyn %A Chung,Yunro %A Huberty,Jennifer %+ College of Health Solutions, Arizona State University, 500 N 3rd Street, Phoenix, AZ, 85003, United States, 1 6024960957, chad.stecher@asu.edu %K behavioral habits %K habit formation %K mindfulness meditation %K mental health %K mHealth %K mobile health %K dynamic time warping %K mobile phone %D 2021 %7 4.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Behavioral habits are often initiated by contextual cues that occur at approximately the same time each day; so, it may be possible to identify a reflexive habit based on the temporal similarity of repeated daily behavior. Mobile health tools provide the detailed, longitudinal data necessary for constructing such an indicator of reflexive habits, which can improve our understanding of habit formation and help design more effective mobile health interventions for promoting healthier habits. Objective: This study aims to use behavioral data from a commercial mindfulness meditation mobile phone app to construct an indicator of reflexive meditation habits based on temporal similarity and estimate the association between temporal similarity and meditation app users’ perceived health benefits. Methods: App-use data from June 2019 to June 2020 were analyzed for 2771 paying subscribers of a meditation mobile phone app, of whom 86.06% (2359/2771) were female, 72.61% (2012/2771) were college educated, 86.29% (2391/2771) were White, and 60.71% (1664/2771) were employed full-time. Participants volunteered to complete a survey assessing their perceived changes in physical and mental health from using the app. Receiver operating characteristic curve analysis was used to evaluate the ability of the temporal similarity measure to predict future behavior, and variable importance statistics from random forest models were used to corroborate these findings. Logistic regression was used to estimate the association between temporal similarity and self-reported physical and mental health benefits. Results: The temporal similarity of users’ daily app use before completing the survey, as measured by the dynamic time warping (DTW) distance between app use on consecutive days, significantly predicted app use at 28 days and at 6 months after the survey, even after controlling for users’ demographic and socioeconomic characteristics, total app sessions, duration of app use, and number of days with any app use. In addition, the temporal similarity measure significantly increased in the area under the receiver operating characteristic curve (AUC) for models predicting any future app use in 28 days (AUC=0.868 with DTW and 0.850 without DTW; P<.001) and for models predicting any app use in 6 months (AUC=0.821 with DTW and 0.802 without DTW; P<.001). Finally, a 1% increase in the temporal similarity of users’ daily meditation practice with the app over 6 weeks before the survey was associated with increased odds of reporting mental health improvements, with an odds ratio of 2.94 (95% CI 1.832-6.369). Conclusions: The temporal similarity of the meditation app use was a significant predictor of future behavior, which suggests that this measure can identify reflexive meditation habits. In addition, temporal similarity was associated with greater perceived mental health benefits, which demonstrates that additional mental health benefits may be derived from forming reflexive meditation habits. %M 34734826 %R 10.2196/27282 %U https://www.jmir.org/2021/11/e27282 %U https://doi.org/10.2196/27282 %U http://www.ncbi.nlm.nih.gov/pubmed/34734826 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e23852 %T Adaptation of a Theory-Based Social Networking and Gamified App-Based Intervention to Improve Pre-Exposure Prophylaxis Adherence Among Young Men Who Have Sex With Men in Bangkok, Thailand: Qualitative Study %A Songtaweesin,Wipaporn Natalie %A LeGrand,Sara %A Bandara,Shashika %A Piccone,Caitlin %A Wongharn,Prissana %A Moonwong,Juthamanee %A Jupimai,Thidarat %A Saisaengjan,Chutima %A Theerawit,Tuangtip %A Muessig,Kathryn %A Hightow-Weidman,Lisa %A Puthanakit,Thanyawee %A Phanuphak,Nittaya %A Tangmunkongvorakul,Arunrat %+ Research Institute for Health Sciences, Chiang Mai University, 110 Intavarorot Road, Tambol Siphum, Amphur Muang, Chiang Mai, 50200, Thailand, 66 815942773, arunrat@rihes.org %K mobile health %K young men who have sex with men %K pre-exposure prophylaxis %K adherence %K mobile phone %D 2021 %7 4.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: HIV disproportionately affects young Thai men who have sex with men (YMSM). Recent studies report a high incidence and prevalence of HIV among Thai YMSM. The Thai national guidelines have recommended pre-exposure prophylaxis (PrEP) since 2014 for key populations; free PrEP has been piloted since 2019. Smartphone-based mobile health (mHealth) interventions provide an optimal platform for innovative PrEP adherence interventions for Thai YMSM. Objective: This study aims to adapt the P3 (Prepared, Protected, emPowered) app, developed with YMSM and transwomen in the United States to improve PrEP adherence and persistence for YMSM in Thailand. The app aims to provide daily adherence support and addresses gaps in staff available for large-scale PrEP rollout needed to see population-level effects of HIV prevention. Methods: We conducted focus group discussions (FGDs) with YMSM and key informant interviews (KIIs) with PrEP care providers in Bangkok, Thailand, to investigate PrEP adherence facilitators and barriers, preferences for functions and features in mHealth apps among YMSM, and how to best adapt the P3 app to the Thai context. We conducted four FGDs with 4-8 participants per group and 15 KIIs. Results: For FGDs, 23 YMSM participated with a mean age of 20 years (range 18-21), 96% (22/23) enrolled in full-time education, and all owned smartphones. The mean age of KII participants was 40 (range 26-60) years; most were state health service providers, with the majority being counselors (6/15, 40%) and physicians (6/15, 40%). Overall, the facilitators and barriers for PrEP adherence identified were similar to those of MSM and YMSM globally including the United States. Key themes included general recommendations for improving mHealth apps in Thailand, such as presenting reliable information in an appealing format, minimizing privacy risks, and addressing connectivity challenges. Additional themes focused on P3 Thailand adaptations and were related to cultural and stylistic preferences, engagement strategies, and recommendations for new functions. To develop the adapted app, P3 Thailand, these findings were balanced with resource limitations resulting in the prioritization of minor modifications: changes in app esthetics (color scheme, iconography, and imagery) and changes in the presentation of information in two of the app’s features. FGDs identified similar PrEP adherence facilitators and barriers to those already addressed within the app. Conclusions: The core elements of the P3 app address major PrEP facilitators and barriers for Thai YMSM; however, changes to the app features, including stylistic presentation, were needed to appropriately customize the app to the Thai context. Given the similarities of facilitators and barriers for PrEP adherence globally, adapting existing PrEP mHealth solutions based on input from end users and key informants provides a promising approach. However, partnerships with local app designers and developers can improve the adaptation process and final product. Trial Registration: ClinicalTrials.gov NCT04413708; http://clinicaltrials.gov/ct2/show/NCT04413708 %M 34734828 %R 10.2196/23852 %U https://www.jmir.org/2021/11/e23852 %U https://doi.org/10.2196/23852 %U http://www.ncbi.nlm.nih.gov/pubmed/34734828 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e25553 %T GPS Mobile Health Intervention Among People Experiencing Homelessness: Pre-Post Study %A Moczygemba,Leticia R %A Thurman,Whitney %A Tormey,Kyler %A Hudzik,Anthony %A Welton-Arndt,Lauren %A Kim,Elizabeth %+ Health Outcomes Division, College of Pharmacy, University of Texas at Austin, 1 University Station, Austin, TX, 78712, United States, 1 5122326880, lrmoczygemba@austin.utexas.edu %K GPS %K mHealth %K care coordination %K people experiencing homelessness %K homelessness %K emergency department %K health outcomes %K health care costs %K mobile phone %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: People experiencing homelessness are at risk for gaps in care after an emergency department (ED) or hospital visit, which leads to increased use, poor health outcomes, and high health care costs. Most people experiencing homelessness have a mobile phone of some type, which makes mobile health (mHealth) interventions a feasible way to connect a person experiencing homelessness with providers. Objective: This study aims to investigate the accuracy, acceptability, and preliminary outcomes of a GPS-enabled mHealth (GPS-mHealth) intervention designed to alert community health paramedics when people experiencing homelessness are in the ED or hospital. Methods: This study was a pre-post design with baseline and 4-month postenrollment assessments. People experiencing homelessness, taking at least 2 medications for chronic conditions, scoring at least 10 on the Patient Health Questionnaire-9, and having at least 2 ED or hospital visits in the previous 6 months were eligible. Participants were issued a study smartphone with a GPS app programmed to alert a community health paramedic when a participant entered an ED or hospital. For each alert, community health paramedics followed up via telephone to assess care coordination needs. Participants also received a daily email to assess medication adherence. GPS alerts were compared with ED and hospital data from the local health information exchange (HIE) to assess accuracy. Paired t tests compared scores on the Patient Health Questionnaire-9, Medical Outcomes Study Social Support Survey, and Adherence Starts with Knowledge-12 adherence survey at baseline and exit. Semistructured exit interviews examined the perceptions and benefits of the intervention. Results: In total, 30 participants were enrolled; the mean age was 44.1 (SD 9.7) years. Most participants were male (20/30, 67%), White (17/30, 57%), and not working (19/30, 63%). Only 19% (3/16) of the ED or hospital visit alerts aligned with HIE data, mainly because of patients not having the smartphone with them during the visit, the smartphone being off, and gaps in GPS technology. There was a significant difference in depressive symptoms between baseline (mean 16.9, SD 5.8) and exit (mean 12.7, SD 8.2; t19=2.9; P=.009) and a significant difference in adherence barriers between baseline (mean 2.4, SD 1.4) and exit (mean 1.5, SD 1.5; t17=2.47; P=.03). Participants agreed that the app was easy to use (mean 4.4/5, SD 1.0, with 5=strongly agree), and the email helped them remember to take their medications (mean 4.6/5, SD 0.6). Qualitative data indicated that unlimited smartphone access allowed participants to meet social needs and maintain contact with case managers, health care providers, family, and friends. Conclusions: mHealth interventions are acceptable to people experiencing homelessness. HIE data provided more accurate ED and hospital visit information; however, unlimited access to reliable communication provided benefits to participants beyond the study purpose of improving care coordination. %M 34730550 %R 10.2196/25553 %U https://mhealth.jmir.org/2021/11/e25553 %U https://doi.org/10.2196/25553 %U http://www.ncbi.nlm.nih.gov/pubmed/34730550 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e25749 %T A Mobile App to Enhance Behavioral Activation Treatment for Substance Use Disorder: App Design, Use, and Integration Into Treatment in the Context of a Randomized Controlled Trial %A Paquette,Catherine E %A Rubalcava,Dillon T %A Chen,Yun %A Anand,Deepika %A Daughters,Stacey B %+ Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC, 27599-3270, United States, 1 919 962 9924, daughter@unc.edu %K substance use disorder %K smartphone app %K mHealth %K behavioral activation %K mobile phone %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Group-based formats typically used in low-resource substance use disorder (SUD) treatment settings result in little individual attention to help reinforce and guide skill use, which may contribute to poor posttreatment outcomes. Smartphone apps offer a convenient, user-friendly, and cost-effective tool that can extend the reach of effective SUD treatments. A smartphone app was developed and integrated into a group-based, brief behavioral activation (BA) treatment for SUD to increase engagement in treatment skills outside clinician-administered sessions. Objective: This study aims to describe the features of the app and its use and integration into treatment, report the participants’ self-reported feasibility and acceptability of the app, and discuss challenges and provide recommendations for future smartphone app integration into behavioral treatments for SUD. Methods: A total of 56 individuals recruited from intensive outpatient SUD treatment received a smartphone-enhanced BA treatment, the Life Enhancement Treatment for Substance Use. Self-reported weekly app use and reasons for nonuse were assessed at posttreatment and at 1- and 3-month follow-ups. In addition, 2-tailed t tests and chi-square tests compared the self-reported use of each app component and overall app use over time. Results: Participant feedback suggested that the integration of the smartphone app into the Life Enhancement Treatment for Substance Use was feasible and well accepted, and participants found the app useful for planning value-based activities outside of sessions. Self-reported app engagement decreased over the follow-up period: 72% (39/54) of participants reported using the app at posttreatment, decreasing to 69% (37/54) at the 1-month follow-up and 37% (20/54) at the 3-month follow-up. Participants reported forgetting to use the app as a primary reason for nonuse. Conclusions: This study provides support for the feasibility and acceptability of smartphone-enhanced BA treatment, offering promise for future research testing the integration of technology into SUD treatment. Design decisions may help streamline smartphone integration into treatment, for example, allowing participants to download the treatment app on their own phones or use a low-cost study smartphone (or offering both options). Long-term app engagement may be increased via built-in reminders, alerts, and in-app messages. Trial Registration: ClinicalTrials.gov NCT02707887; https://clinicaltrials.gov/ct2/show/study/NCT02707887 %M 34730535 %R 10.2196/25749 %U https://formative.jmir.org/2021/11/e25749 %U https://doi.org/10.2196/25749 %U http://www.ncbi.nlm.nih.gov/pubmed/34730535 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e29188 %T Adapting Chinese Qigong Mind-Body Exercise for Healthy Aging in Older Community-Dwelling Low-income Latino Adults: Pilot Feasibility Study %A Yin,Zenong %A Martinez,Cristina E %A Li,Shiyu %A Martinez,Martha %A Peng,Kezhi %A Land,William M %A Ullevig,Sarah L %A Cantu,Adelita %A Falk,Sharon %A Hernández,Arthur E %A Ortega,Catherine %A Parra-Medina,Deborah %A Simmonds,Maureen J %+ Department of Public Health, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, United States, 1 210 458 5650, zenong.yin@utsa.edu %K mHealth %K community-based participatory research %K five animal play %K wuqinxi %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Research translating the evidence for the benefit of mind-body exercise in older Latinos with limited access to community-based healthy aging programs is sparse. Objective: This study aimed to evaluate the feasibility of Function Improvement Exercises for Older Sedentary Community-Dwelling Latino Residents (FITxOlder), a Community Health Worker (CHW)-led, mobile technology-facilitated Chinese Qigong mind-body exercise program for healthy aging and to explore its impact on physical and cognitive function and quality of life (QoL) in older community-dwelling low-income Latino adults. Methods: This study was designed as a Stage 1 feasibility study to develop and pilot-test FITxOlder. In Phase 1 (Stage 1A), a working group of seniors, CHWs, and senior center staff guided the adaptation of Chinese Qigong into a healthy aging program. In Phase 2 (Stage 1B), 49 older Latino adults participated in a 3-arm controlled study to test the feasibility and preliminary effect of CHW-led FITxOlder on physical and cognitive function and QoL measures over 16 weeks. Results: Although the COVID-19 pandemic disrupted the implementation of the study protocol, we found favorable results regarding participant recruitment, retention, and fidelity of implementation. Notable findings included an 89.3% participant retention, 79.4% of the participants completed at least 70% of the weekly exercise goal, and no report of adverse events. The effects on intervention outcome measures were modest. Conclusions: FITxOlder is feasible for promoting healthy aging in older Latino adults; future research needs to compare its feasibility with other low-impact exercise programs for healthy aging using a randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04284137; https://clinicaltrials.gov/ct2/show/NCT04284137 %M 34723824 %R 10.2196/29188 %U https://aging.jmir.org/2021/4/e29188 %U https://doi.org/10.2196/29188 %U http://www.ncbi.nlm.nih.gov/pubmed/34723824 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e25298 %T A Text Messaging Intervention (StayWell at Home) to Counteract Depression and Anxiety During COVID-19 Social Distancing: Pre-Post Study %A Aguilera,Adrian %A Hernandez-Ramos,Rosa %A Haro-Ramos,Alein Y %A Boone,Claire Elizabeth %A Luo,Tiffany Christina %A Xu,Jing %A Chakraborty,Bibhas %A Karr,Chris %A Darrow,Sabrina %A Figueroa,Caroline Astrid %+ School of Social Welfare, University of California, Berkeley, 120 Haviland Hall, MC7400, School of Social Welfare, Berkeley, CA, 94720, United States, 1 (510) 642 8564, aguila@berkeley.edu %K mobile health %K COVID-19 %K text messaging %K cognitive behavioral therapy %K anxiety %K depression %K microrandomized trials %K mHealth %K intervention %K mental health %K SMS %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Social distancing and stay-at-home orders are critical interventions to slow down person-to-person transmission of COVID-19. While these societal changes help contain the pandemic, they also have unintended negative consequences, including anxiety and depression. We developed StayWell, a daily skills-based SMS text messaging program, to mitigate COVID-19–related depression and anxiety symptoms among people who speak English and Spanish in the United States. Objective: This paper describes the changes in StayWell participants’ anxiety and depression levels after 60 days of exposure to skills-based SMS text messages. Methods: We used self-administered, empirically supported web-based questionnaires to assess the demographic and clinical characteristics of StayWell participants. Anxiety and depression were measured using the 2-item Generalized Anxiety Disorder (GAD-2) scale and the 8-item Patient Health Questionnaire-8 (PHQ-8) scale at baseline and 60-day timepoints. We used 2-tailed paired t tests to detect changes in PHQ-8 and GAD-2 scores from baseline to follow-up measured 60 days later. Results: The analytic sample includes 193 participants who completed both the baseline and 60-day exit questionnaires. At the 60-day time point, there were significant reductions in both PHQ-8 and GAD-2 scores from baseline. We found an average reduction of –1.72 (95% CI –2.35 to –1.09) in PHQ-8 scores and –0.48 (95% CI –0.71 to –0.25) in GAD-2 scores. These improvements translated to an 18.5% and 17.2% reduction in mean PHQ-8 and GAD-2 scores, respectively. Conclusions: StayWell is an accessible, low-intensity population-level mental health intervention. Participation in StayWell focused on COVID-19 mental health coping skills and was related to improved depression and anxiety symptoms. In addition to improvements in outcomes, we found high levels of engagement during the 60-day intervention period. Text messaging interventions could serve as an important public health tool for disseminating strategies to manage mental health. Trial Registration: ClinicalTrials.gov NCT04473599; https://clinicaltrials.gov/ct2/show/NCT04473599 International Registered Report Identifier (IRRID): RR2-10.2196/23592 %M 34543230 %R 10.2196/25298 %U https://mental.jmir.org/2021/11/e25298 %U https://doi.org/10.2196/25298 %U http://www.ncbi.nlm.nih.gov/pubmed/34543230 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e31064 %T Acceptability, Engagement, and Exploratory Outcomes of an Emotional Well-being App: Mixed Methods Preliminary Evaluation and Descriptive Analysis %A Eisenstadt,Amelia %A Liverpool,Shaun %A Metaxa,Athina-Marina %A Ciuvat,Roberta Maria %A Carlsson,Courtney %+ Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, The Kantor Centre of Excellence, 4-8 Rodney Street, London, N1 9JH, United Kingdom, 44 20 7794 2313, mia.eisenstadt@annafreud.org %K smartphone %K app %K well-being %K awareness %K mental health %K formative %K mobile phone %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There is growing evidence suggesting that the emotional well-being of the public has been negatively affected in the past year. Consequently, demand for well-being support has increased. Although there is substantial empirical support for mental health apps that target diagnosed conditions, there is less research on emotional well-being apps. Among existing well-being apps, few studies have been conducted on apps that are based on lived experience and those that seek to enhance users’ understanding of their emotional patterns. Thus, the acceptability of these novel apps requires further evaluation before upscaling. Objective: This evaluation aims to describe the acceptability, engagement, and preliminary outcomes of using an app (Paradym) designed to promote emotional well-being and positive mental health. Methods: This is a pre-post, mixed-methods, single-arm evaluation that is aggregated with digital analytics data. We anonymously collected real-world data on the demographics and well-being of the participants as well as the usability and acceptance of the app using validated questionnaires and open-ended questions. Participants tested the app for a minimum of 2 weeks before completing the follow-up measures. Google Analytics was used to record the level of app engagement. Chi-square and 2-tailed t tests were conducted to analyze quantitative data, and a thematic analysis approach was adopted for qualitative data. Results: A total of 115 participants completed baseline questionnaires, of which 79.1% (91/115) users downloaded the app. The sample was diverse in terms of ethnicity, including 43.4% (50/115) people who self-identified as belonging to minority ethnic groups. Most of the participants were female (78/115, 67.8%) and between the ages of 18 and 25 years (39/115, 33.9%). A total of 34 app users who completed questionnaires at baseline and follow-up provided valuable feedback to inform the future directions of Paradym. Favorable themes emerged describing the app’s content, functionality, and underlying principles. Although usability feedback varied across items, a considerable number of participants (22/34, 64%) found that the app was easy to use. Google Analytics revealed that at least 79% (27/34) of people used the app daily. On the basis of preliminary observations, app users experience increased mental well-being. Post hoc analyses indicated that the reduction in depression scores (t33=−2.16) and the increase in the well-being measures (t33=2.87) were statistically significant. No adverse events were reported during the follow-up period. Conclusions: The findings of this evaluation are encouraging and document positive preliminary evidence for the Paradym app. %M 34569466 %R 10.2196/31064 %U https://formative.jmir.org/2021/11/e31064 %U https://doi.org/10.2196/31064 %U http://www.ncbi.nlm.nih.gov/pubmed/34569466 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29755 %T Multiparameter Continuous Physiological Monitoring Technologies in Neonates Among Health Care Providers and Caregivers at a Private Tertiary Hospital in Nairobi, Kenya: Feasibility, Usability, and Acceptability Study %A Ginsburg,Amy Sarah %A Kinshella,Mai-Lei Woo %A Naanyu,Violet %A Rigg,Jessica %A Chomba,Dorothy %A Coleman,Jesse %A Hwang,Bella %A Ochieng,Roseline %A Ansermino,J Mark %A Macharia,William M %+ Department of Obstetrics and Gynecology, British Columbia Children’s and Women’s Hospital and The University of British Columbia, V344 - 950 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada, 1 6048752253, maggie.kinshella@cw.bc.ca %K infants %K Africa %K medical technology design %K user perspectives %K in-depth interviews %K direct observations %D 2021 %7 28.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Continuous physiological monitoring technologies are important for strengthening hospital care for neonates, particularly in resource-constrained settings, and understanding user perspectives is critical for informing medical technology design, development, and optimization. Objective: This study aims to assess the feasibility, usability, and acceptability of 2 noninvasive, multiparameter, continuous physiological monitoring technologies for use in neonates in an African health care setting. Methods: We assessed 2 investigational technologies from EarlySense and Sibel, compared with the reference Masimo Rad-97 technology through in-depth interviews and direct observations. A purposive sample of health care administrators, health care providers, and caregivers at Aga Khan University Hospital, a tertiary, private hospital in Nairobi, Kenya, were included. Data were analyzed using a thematic approach in NVivo 12 software. Results: Between July and August 2020, we interviewed 12 health care providers, 5 health care administrators, and 10 caregivers and observed the monitoring of 12 neonates. Staffing and maintenance of training in neonatal units are important feasibility considerations, and simple training requirements support the feasibility of the investigational technologies. Key usability characteristics included ease of use, wireless features, and reduced number of attachments connecting the neonate to the monitoring technology, which health care providers considered to increase the efficiency of care. The main factors supporting acceptability included caregiver-highlighted perceptions of neonate comfort and health care respondent technology familiarity. Concerns about the side effects of wireless connections, electromagnetic fields, and mistrust of unfamiliar technologies have emerged as possible acceptability barriers to investigational technologies. Conclusions: Overall, respondents considered the investigational technologies feasible, usable, and acceptable for the care of neonates at this health care facility. Our findings highlight the potential of different multiparameter continuous physiological monitoring technologies for use in different neonatal care settings. Simple and user-friendly technologies may help to bridge gaps in current care where there are many neonates; however, challenges in maintaining training and ensuring feasibility within resource-constrained health care settings warrant further research. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-035184 %M 34709194 %R 10.2196/29755 %U https://www.jmir.org/2021/10/e29755 %U https://doi.org/10.2196/29755 %U http://www.ncbi.nlm.nih.gov/pubmed/34709194 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e31086 %T Pilot Evaluations of Two Bluetooth Contact Tracing Approaches on a University Campus: Mixed Methods Study %A Shelby,Tyler %A Caruthers,Tyler %A Kanner,Oren Y %A Schneider,Rebecca %A Lipnickas,Dana %A Grau,Lauretta E %A Manohar,Rajit %A Niccolai,Linda %+ Epidemiology of Microbial Diseases Department, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT, United States, 1 6202284003, tyler.shelby@yale.edu %K mHealth %K digital contact tracing %K Bluetooth %K COVID-19 %K mixed methods %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Many have proposed the use of Bluetooth technology to help scale up contact tracing for COVID-19. However, much remains unknown about the accuracy of this technology in real-world settings, the attitudes of potential users, and the differences between delivery formats (mobile app vs carriable or wearable devices). Objective: We pilot tested 2 separate Bluetooth contact tracing technologies on a university campus to evaluate their sensitivity and specificity, and to learn from the experiences of the participants. Methods: We used a convergent mixed methods study design, and participants included graduate students and researchers working on a university campus during June and July 2020. We conducted separate 2-week pilot studies for each Bluetooth technology. The first was for a mobile phone app (“app pilot”), and the second was for a small electronic “tag” (“tag pilot”). Participants validated a list of Bluetooth-identified contacts daily and reported additional close contacts not identified by Bluetooth. We used these data to estimate sensitivity and specificity. Participants completed a postparticipation survey regarding appropriateness, usability, acceptability, and adherence, and provided additional feedback via free text. We used tests of proportions to evaluate differences in survey responses between participants from each pilot, paired t tests to measure differences between compatible survey questions, and qualitative analysis to evaluate the survey’s free-text responses. Results: Among 25 participants in the app pilot, 53 contact interactions were identified by Bluetooth and an additional 61 by self-report. Among 17 participants in the tag pilot, 171 contact interactions were identified by Bluetooth and an additional 4 by self-report. The tag had significantly higher sensitivity compared with the app (46/49, 94% vs 35/61, 57%; P<.001), as well as higher specificity (120/126, 95% vs 123/141, 87%; P=.02). Most participants felt that Bluetooth contact tracing was appropriate on campus (26/32, 81%), while significantly fewer participants felt that using other technologies, such as GPS or Wi-Fi, was appropriate (17/31, 55%; P=.02). Most participants preferred technology developed and managed by the university rather than a third party (27/32, 84%) and preferred not to have tracing apps on their personal phones (21/32, 66%), due to “concerns with privacy.” There were no significant differences in self-reported adherence rates across pilots. Conclusions: Convenient and carriable Bluetooth technology may improve tracing efficiency while alleviating privacy concerns by shifting data collection away from personal devices. With accuracy comparable to, and in this case, superior to, mobile phone apps, such approaches may be suitable for workplace or school settings with the ability to purchase and maintain physical devices. %M 34586078 %R 10.2196/31086 %U https://formative.jmir.org/2021/10/e31086 %U https://doi.org/10.2196/31086 %U http://www.ncbi.nlm.nih.gov/pubmed/34586078 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e20970 %T WhatsApp-Based Focus Groups Among Mexican-Origin Women in Zika Risk Area: Feasibility, Acceptability, and Data Quality %A Anderson,Elizabeth %A Koss,Mary %A Castro Luque,Ana Lucía %A Garcia,David %A Lopez,Elise %A Ernst,Kacey %+ Department of Health Promotion Sciences, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85721, United States, 1 5205050040, andersone@email.arizona.edu %K WhatsApp %K synchronous text-based focus groups %K Zika %K Mexican-origin Latinas %K social media %K mHealth %K focus groups %K smartphones %K mobile phone %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite unprecedented advances in worldwide access to the internet via smartphones, barriers to engaging hard-to-reach populations remain in many methods of health research. A potential avenue for conducting qualitative research is via participatory web-based media, including the free, popular social platform WhatsApp. However, despite the clear advantages of engaging with participants over a well-established web-based platform, logistical challenges remain. Objective: This study aims to report evidence on the feasibility and acceptability of WhatsApp as a method to conduct focus groups. Methods: A pilot focus group was conducted with Spanish-speaking women near the US–Mexico border. The content focus was knowledge and perceived risks for exposure to the Zika virus during pregnancy. Results: Evidence was obtained regarding WhatsApp as a low-cost, logistically feasible methodology that resulted in rich qualitative data from a population that is often reticent to engage in traditional research. A total of 5 participants participated in a focus group, of whom all 5 consistently contributed to the focus group chat in WhatsApp, which was conducted over 3 consecutive days. Conclusions: The findings are noteworthy at a time when face-to-face focus groups, the gold standard, are risky or precluded by safe COVID-19 guidelines. Other implications include more applications and evaluations of WhatsApp for delivering one-on-one or group health education interventions on sensitive topics. This paper outlines the key steps and considerations for the replication or adaptation of methods. %M 34709185 %R 10.2196/20970 %U https://formative.jmir.org/2021/10/e20970 %U https://doi.org/10.2196/20970 %U http://www.ncbi.nlm.nih.gov/pubmed/34709185 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e25730 %T The Use of Cannabinoids for Insomnia in Daily Life: Naturalistic Study %A Kuhathasan,Nirushi %A Minuzzi,Luciano %A MacKillop,James %A Frey,Benicio N %+ Mood Disorders Program and Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada, 1 905 522 1155, freybn@mcmaster.ca %K medicinal cannabis %K insomnia %K symptom management %K linear mixed-effects %D 2021 %7 27.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Insomnia is a prevalent condition that presents itself at both the symptom and diagnostic levels. Although insomnia is one of the main reasons individuals seek medicinal cannabis, little is known about the profile of cannabinoid use or the perceived benefit of the use of cannabinoids in daily life. Objective: We conducted a retrospective study of medicinal cannabis users to investigate the use profile and perceived efficacy of cannabinoids for the management of insomnia. Methods: Data were collected using the Strainprint app, which allows medicinal cannabis users to log conditions and symptoms, track cannabis use, and monitor symptom severity pre- and postcannabis use. Our analyses examined 991 medicinal cannabis users with insomnia across 24,189 tracked cannabis use sessions. Sessions were analyzed, and both descriptive statistics and linear mixed-effects modeling were completed to examine use patterns and perceived efficacy. Results: Overall, cannabinoids were perceived to be efficacious across all genders and ages, and no significant differences were found among product forms, ingestion methods, or gender groups. Although all strain categories were perceived as efficacious, predominant indica strains were found to reduce insomnia symptomology more than cannabidiol (CBD) strains (estimated mean difference 0.59, SE 0.11; 95% CI 0.36-0.81; adjusted P<.001) and predominant sativa strains (estimated mean difference 0.74, SE 0.16; 95% CI 0.43-1.06; adjusted P<.001). Indica hybrid strains also presented a greater reduction in insomnia symptomology than CBD strains (mean difference 0.52, SE 0.12; 95% CI 0.29-0.74; adjusted P<.001) and predominant sativa strains (mean difference 0.67, SE 0.16; 95% CI 0.34-1.00; adjusted P=.002). Conclusions: Medicinal cannabis users perceive a significant improvement in insomnia with cannabinoid use, and this study suggests a possible advantage with the use of predominant indica strains compared with predominant sativa strains and exclusively CBD in this population. This study emphasizes the need for randomized placebo-controlled trials assessing the efficacy and safety profile of cannabinoids for the treatment of insomnia. %M 34704957 %R 10.2196/25730 %U https://www.jmir.org/2021/10/e25730 %U https://doi.org/10.2196/25730 %U http://www.ncbi.nlm.nih.gov/pubmed/34704957 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e30169 %T A Chatbot to Engage Parents of Preterm and Term Infants on Parental Stress, Parental Sleep, and Infant Feeding: Usability and Feasibility Study %A Wong,Jill %A Foussat,Agathe C %A Ting,Steven %A Acerbi,Enzo %A van Elburg,Ruurd M %A Mei Chien,Chua %+ Department of Neonatology, KK Women’s and Children’s Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore, 65 6394 1240, chua.mei.chien@singhealth.com.sg %K chatbot %K parental stress %K parental sleep %K infant feeding %K preterm infants %K term infants %K sleep %K stress %K eHealth %K support %K anxiety %K usability %D 2021 %7 26.10.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parents commonly experience anxiety, worry, and psychological distress in caring for newborn infants, particularly those born preterm. Web-based therapist services may offer greater accessibility and timely psychological support for parents but are nevertheless labor intensive due to their interactive nature. Chatbots that simulate humanlike conversations show promise for such interactive applications. Objective: The aim of this study is to explore the usability and feasibility of chatbot technology for gathering real-life conversation data on stress, sleep, and infant feeding from parents with newborn infants and to investigate differences between the experiences of parents with preterm and term infants. Methods: Parents aged ≥21 years with infants aged ≤6 months were enrolled from November 2018 to March 2019. Three chatbot scripts (stress, sleep, feeding) were developed to capture conversations with parents via their mobile devices. Parents completed a chatbot usability questionnaire upon study completion. Responses to closed-ended questions and manually coded open-ended responses were summarized descriptively. Open-ended responses were analyzed using the latent Dirichlet allocation method to uncover semantic topics. Results: Of 45 enrolled participants (20 preterm, 25 term), 26 completed the study. Parents rated the chatbot as “easy” to use (mean 4.08, SD 0.74; 1=very difficult, 5=very easy) and were “satisfied” (mean 3.81, SD 0.90; 1=very dissatisfied, 5 very satisfied). Of 45 enrolled parents, those with preterm infants reported emotional stress more frequently than did parents of term infants (33 vs 24 occasions). Parents generally reported satisfactory sleep quality. The preterm group reported feeding problems more frequently than did the term group (8 vs 2 occasions). In stress domain conversations, topics linked to “discomfort” and “tiredness” were more prevalent in preterm group conversations, whereas the topic of “positive feelings” occurred more frequently in the term group conversations. Interestingly, feeding-related topics dominated the content of sleep domain conversations, suggesting that frequent or irregular feeding may affect parents’ ability to get adequate sleep or rest. Conclusions: The chatbot was successfully used to collect real-time conversation data on stress, sleep, and infant feeding from a group of 45 parents. In their chatbot conversations, term group parents frequently expressed positive emotions, whereas preterm group parents frequently expressed physical discomfort and tiredness, as well as emotional stress. Overall, parents who completed the study gave positive feedback on their user experience with the chatbot as a tool to express their thoughts and concerns. Trial Registration: ClinicalTrials.gov NCT03630679; https://clinicaltrials.gov/ct2/show/NCT03630679 %M 34544679 %R 10.2196/30169 %U https://pediatrics.jmir.org/2021/4/e30169 %U https://doi.org/10.2196/30169 %U http://www.ncbi.nlm.nih.gov/pubmed/34544679 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e29397 %T Predictors of Booster Engagement Following a Web-Based Brief Intervention for Alcohol Misuse Among National Guard Members: Secondary Analysis of a Randomized Controlled Trial %A Coughlin,Lara N %A Blow,Frederic C %A Walton,Maureen %A Ignacio,Rosalinda V %A Walters,Heather %A Massey,Lynn %A Barry,Kristen L %A McCormick,Richard %+ Addiction Center, Department of Psychiatry, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI, 48109, United States, 1 734 615 4774, laraco@med.umich.edu %K alcohol use %K National Guard %K brief intervention %K boosters %K engagement %D 2021 %7 26.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Alcohol misuse is a major health concern among military members. Reserve component members face unique barriers as they live off base with limited access to behavioral health services. Web and app-based brief interventions are a promising means to improve access to treatment for those who misuse alcohol, with the use of booster sessions to enhance effectiveness, solidify gains, and reinforce changes. However, little is known about who will engage in booster sessions. Objective: This study aims to evaluate booster engagement across booster delivery modalities (Web and Peer) and identify participant-specific factors associated with booster session engagement. Methods: Following a brief web-based alcohol misuse intervention in National Guard members (N=739), we examined engagement in a series of three booster sessions. Using unadjusted and adjusted models, demographic and clinical characteristics that may serve as predictors of booster session engagement were examined across the 2 arms of the trial with different types of booster sessions: peer-delivered (N=245) and web-delivered (N=246). Results: Booster session completion was greater for Peer than Web Booster sessions, with 142 (58%) service members in the Peer Booster arm completing all three boosters compared with only 108 (44%) of participants in the Web Booster arm (χ23=10.3; P=.006). In a model in which the 2 groups were combined, socioeconomic factors predicted booster engagement. In separate models, the demographic and clinical predictors of booster engagement varied between the 2 delivery modalities. Conclusions: The use of peer-delivered boosters, especially among subsets of reserve members at risk of lack of engagement, may foster greater uptake and improve treatment outcomes. Trial Registration: ClinicalTrials.gov NCT02181283; https://clinicaltrials.gov/ct2/show/NCT02181283 %M 34698652 %R 10.2196/29397 %U https://mental.jmir.org/2021/10/e29397 %U https://doi.org/10.2196/29397 %U http://www.ncbi.nlm.nih.gov/pubmed/34698652 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e20638 %T A Mobile Sensing App to Monitor Youth Mental Health: Observational Pilot Study %A MacLeod,Lucy %A Suruliraj,Banuchitra %A Gall,Dominik %A Bessenyei,Kitti %A Hamm,Sara %A Romkey,Isaac %A Bagnell,Alexa %A Mattheisen,Manuel %A Muthukumaraswamy,Viswanath %A Orji,Rita %A Meier,Sandra %+ Department of Psychiatry, Dalhousie University, 5850/5980 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada, 1 782414 ext 8054, sandra.m.meier@gmail.com %K mobile sensing %K youth %K psychiatry %K feasibility %K mobile phone %D 2021 %7 26.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Internalizing disorders are the most common psychiatric problems observed among youth in Canada. Sadly, youth with internalizing disorders often avoid seeking clinical help and rarely receive adequate treatment. Current methods of assessing internalizing disorders usually rely on subjective symptom ratings, but internalizing symptoms are frequently underreported, which creates a barrier to the accurate assessment of these symptoms in youth. Therefore, novel assessment tools that use objective data need to be developed to meet the highest standards of reliability, feasibility, scalability, and affordability. Mobile sensing technologies, which unobtrusively record aspects of youth behaviors in their daily lives with the potential to make inferences about their mental health states, offer a possible method of addressing this assessment barrier. Objective: This study aims to explore whether passively collected smartphone sensor data can be used to predict internalizing symptoms among youth in Canada. Methods: In this study, the youth participants (N=122) completed self-report assessments of symptoms of anxiety, depression, and attention-deficit hyperactivity disorder. Next, the participants installed an app, which passively collected data about their mobility, screen time, sleep, and social interactions over 2 weeks. Then, we tested whether these passive sensor data could be used to predict internalizing symptoms among these youth participants. Results: More severe depressive symptoms correlated with more time spent stationary (r=0.293; P=.003), less mobility (r=0.271; P=.006), higher light intensity during the night (r=0.227; P=.02), and fewer outgoing calls (r=−0.244; P=.03). In contrast, more severe anxiety symptoms correlated with less time spent stationary (r=−0.249; P=.01) and greater mobility (r=0.234; P=.02). In addition, youths with higher anxiety scores spent more time on the screen (r=0.203; P=.049). Finally, adding passively collected smartphone sensor data to the prediction models of internalizing symptoms significantly improved their fit. Conclusions: Passively collected smartphone sensor data provide a useful way to monitor internalizing symptoms among youth. Although the results replicated findings from adult populations, to ensure clinical utility, they still need to be replicated in larger samples of youth. The work also highlights intervention opportunities via mobile technology to reduce the burden of internalizing symptoms early on. %M 34698650 %R 10.2196/20638 %U https://mhealth.jmir.org/2021/10/e20638 %U https://doi.org/10.2196/20638 %U http://www.ncbi.nlm.nih.gov/pubmed/34698650 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e28149 %T Impact of an eHealth Smartphone App on the Mental Health of Patients With Psoriasis: Prospective Randomized Controlled Intervention Study %A Domogalla,Lena %A Beck,Alena %A Schulze-Hagen,Theresa %A Herr,Raphael %A Benecke,Johannes %A Schmieder,Astrid %+ Department of Dermatology, University Hospital Würzburg, Josef-Schneider-Straße 2, Haus D8, Würzburg, Germany, 49 931 201 26235, astrid.schmieder@umm.de %K psoriasis %K eHealth %K mHealth %K telemedicine %K teledermatology %K patient educational program %K disease management %K smartphone app %K mental health %K mobile phone %D 2021 %7 25.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Psoriasis has a negative impact on patients’ physical and mental health and can lead to anxiety and depression. Disease management strategies, including educational programs and eHealth devices, have been shown to improve health care for several chronic diseases. However, such disease management strategies are lacking in the routine care of patients with psoriasis. Objective: This study aims to study the impact of a novel intervention that combines an educational program with a disease management smartphone app on the mental health of patients with psoriasis. Methods: Patients with psoriasis in the intervention group received an educational program; attended visits on weeks 0, 12, 24, 36, and 60; and had access to the study app. Patients in the control group only attended the visits. The primary endpoint was a significant reduction of scores on the Hospital Anxiety and Depression Scale (HADS). Secondary end points were reductions in Dermatology Life Quality Index score, Psoriasis Area and Severity Index score, pruritus, and pain, as well as improvements in mood and daily activities. In addition, modulating effects of sex, age, disease duration, and app use frequency were evaluated. Results: A total of 107 patients were included in the study and randomized into the control group (53/107, 49.5%) or intervention group (54/107, 50.5%). Approximately 71.9% (77/107) of the patients completed the study. A significant reduction in HADS-Depression (HADS-D) in the intervention group was found at weeks 12 (P=.04) and 24 (P=.005) but not at weeks 36 (P=.12) and 60 (P=.32). Patient stratification according to app use frequency showed a significant improvement in HADS-D score at weeks 36 (P=.004) and 60 (P=.04) and in HADS-Anxiety (HADS-A) score at weeks 36 (P=.04) and 60 (P=.05) in the group using the app less than once every 5 weeks. However, in patients using the app more than once every 5 weeks, no significant reduction in HADS-D (P=.84) or HADS-A (P=.20) score was observed over the 60-week study period compared with that observed in patients in the control group. All findings were independent of sex, age, and disease duration. Conclusions: These findings support the use of a disease management smartphone app as a valid tool to achieve long-term improvement in the mental health of patients with psoriasis if it is not used too frequently. Further studies are needed to analyze the newly observed influence of app use frequency. Trial Registration: Deutsches Register Klinischer Studien DRKS00020755; https://tinyurl.com/nyzjyvvk %M 34431478 %R 10.2196/28149 %U https://mhealth.jmir.org/2021/10/e28149 %U https://doi.org/10.2196/28149 %U http://www.ncbi.nlm.nih.gov/pubmed/34431478 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e24872 %T Digital Biomarkers for Depression Screening With Wearable Devices: Cross-sectional Study With Machine Learning Modeling %A Rykov,Yuri %A Thach,Thuan-Quoc %A Bojic,Iva %A Christopoulos,George %A Car,Josip %+ Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Rd, Clinical Sciences Building, Level 18, Singapore, 308232, Singapore, 65 +85291725838, josip.car@gmail.com %K depression %K digital biomarkers %K screening %K wearable electronic device %K fitness tracker %K circadian rhythm %K rest-activity rhythm %K heart rate %K machine learning %D 2021 %7 25.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Depression is a prevalent mental disorder that is undiagnosed and untreated in half of all cases. Wearable activity trackers collect fine-grained sensor data characterizing the behavior and physiology of users (ie, digital biomarkers), which could be used for timely, unobtrusive, and scalable depression screening. Objective: The aim of this study was to examine the predictive ability of digital biomarkers, based on sensor data from consumer-grade wearables, to detect risk of depression in a working population. Methods: This was a cross-sectional study of 290 healthy working adults. Participants wore Fitbit Charge 2 devices for 14 consecutive days and completed a health survey, including screening for depressive symptoms using the 9-item Patient Health Questionnaire (PHQ-9), at baseline and 2 weeks later. We extracted a range of known and novel digital biomarkers characterizing physical activity, sleep patterns, and circadian rhythms from wearables using steps, heart rate, energy expenditure, and sleep data. Associations between severity of depressive symptoms and digital biomarkers were examined with Spearman correlation and multiple regression analyses adjusted for potential confounders, including sociodemographic characteristics, alcohol consumption, smoking, self-rated health, subjective sleep characteristics, and loneliness. Supervised machine learning with statistically selected digital biomarkers was used to predict risk of depression (ie, symptom severity and screening status). We used varying cutoff scores from an acceptable PHQ-9 score range to define the depression group and different subsamples for classification, while the set of statistically selected digital biomarkers remained the same. For the performance evaluation, we used k-fold cross-validation and obtained accuracy measures from the holdout folds. Results: A total of 267 participants were included in the analysis. The mean age of the participants was 33 (SD 8.6, range 21-64) years. Out of 267 participants, there was a mild female bias displayed (n=170, 63.7%). The majority of the participants were Chinese (n=211, 79.0%), single (n=163, 61.0%), and had a university degree (n=238, 89.1%). We found that a greater severity of depressive symptoms was robustly associated with greater variation of nighttime heart rate between 2 AM and 4 AM and between 4 AM and 6 AM; it was also associated with lower regularity of weekday circadian rhythms based on steps and estimated with nonparametric measures of interdaily stability and autocorrelation as well as fewer steps-based daily peaks. Despite several reliable associations, our evidence showed limited ability of digital biomarkers to detect depression in the whole sample of working adults. However, in balanced and contrasted subsamples comprised of depressed and healthy participants with no risk of depression (ie, no or minimal depressive symptoms), the model achieved an accuracy of 80%, a sensitivity of 82%, and a specificity of 78% in detecting subjects at high risk of depression. Conclusions: Digital biomarkers that have been discovered and are based on behavioral and physiological data from consumer wearables could detect increased risk of depression and have the potential to assist in depression screening, yet current evidence shows limited predictive ability. Machine learning models combining these digital biomarkers could discriminate between individuals with a high risk of depression and individuals with no risk. %M 34694233 %R 10.2196/24872 %U https://mhealth.jmir.org/2021/10/e24872 %U https://doi.org/10.2196/24872 %U http://www.ncbi.nlm.nih.gov/pubmed/34694233 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30901 %T Function and Emotion in Everyday Life With Type 1 Diabetes (FEEL-T1D): Protocol for a Fully Remote Intensive Longitudinal Study %A Pyatak,Elizabeth Ann %A Hernandez,Raymond %A Pham,Loree T %A Mehdiyeva,Khatira %A Schneider,Stefan %A Peters,Anne %A Ruelas,Valerie %A Crandall,Jill %A Lee,Pey-Jiuan %A Jin,Haomiao %A Hoogendoorn,Claire J %A Crespo-Ramos,Gladys %A Mendez-Rodriguez,Heidy %A Harmel,Mark %A Walker,Martha %A Serafin-Dokhan,Sara %A Gonzalez,Jeffrey S %A Spruijt-Metz,Donna %+ Chan Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar St, CHP-133, Los Angeles, CA, 90089-9003, United States, 1 3107741228, beth.pyatak@usc.edu %K ecological momentary assessments %K type 1 diabetes %K patient-centered outcomes research %K actigraphy %K ambulatory monitoring %K continuous glucose monitoring %K EMA %K diabetes %K patient-centered outcome %K outcome %K monitoring %K function %K emotion %K longitudinal %K well-being %D 2021 %7 22.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although short-term blood glucose levels and variability are thought to underlie diminished function and emotional well-being in people with type 1 diabetes (T1D), these relationships are poorly understood. The Function and Emotion in Everyday Life with T1D (FEEL-T1D) study focuses on investigating these short-term dynamic relationships among blood glucose levels, functional ability, and emotional well-being in adults with T1D. Objective: The aim of this study is to present the FEEL-T1D study design, methods, and study progress to date, including adaptations necessitated by the COVID-19 pandemic to implement the study fully remotely. Methods: The FEEL-T1D study will recruit 200 adults with T1D in the age range of 18-75 years. Data collection includes a comprehensive survey battery, along with 14 days of intensive longitudinal data using blinded continuous glucose monitoring, ecological momentary assessments, ambulatory cognitive tasks, and accelerometers. All study procedures are conducted remotely by mailing the study equipment and by using videoconferencing for study visits. Results: The study received institutional review board approval in January 2019 and was funded in April 2019. Data collection began in June 2020 and is projected to end in December 2021. As of June 2021, after 12 months of recruitment, 124 participants have enrolled in the FEEL-T1D study. Approximately 87.6% (7082/8087) of ecological momentary assessment surveys have been completed with minimal missing data, and 82.0% (82/100) of the participants provided concurrent continuous glucose monitoring data, ecological momentary assessment data, and accelerometer data for at least 10 of the 14 days of data collection. Conclusions: Thus far, our reconfiguration of the FEEL-T1D protocol to be implemented remotely during the COVID-19 pandemic has been a success. The FEEL-T1D study will elucidate the dynamic relationships among blood glucose levels, emotional well-being, cognitive function, and participation in daily activities. In doing so, it will pave the way for innovative just-in-time interventions and produce actionable insights to facilitate tailoring of diabetes treatments to optimize the function and well-being of individuals with T1D. International Registered Report Identifier (IRRID): DERR1-10.2196/30901 %M 34463626 %R 10.2196/30901 %U https://www.researchprotocols.org/2021/10/e30901 %U https://doi.org/10.2196/30901 %U http://www.ncbi.nlm.nih.gov/pubmed/34463626 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e32100 %T Outcomes of a Blended Care Coaching Program for Clients Presenting With Moderate Levels of Anxiety and Depression: Pragmatic Retrospective Study %A Wu,Monica S %A Chen,Shih-Yin %A Wickham,Robert E %A O’Neil-Hart,Shane %A Chen,Connie %A Lungu,Anita %+ Lyra Health, 287 Lorton Ave, Burlingame, CA, 94010, United States, 1 877 505 7147, mwu@lyrahealth.com %K blended care %K coaching %K cognitive %K behavior %K depression %K anxiety %K digital health %K retrospective %K mental health %K CBT %K cognitive behavioral therapy %K outcome %K video conference %D 2021 %7 21.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depression and anxiety are leading causes of disability worldwide, but access to quality mental health care is limited by myriad factors. Cognitive-behavioral coaching is rooted in evidence-based principles and has the potential to address some of these unmet care needs. Harnessing technology to facilitate broader dissemination within a blended care model shows additional promise for overcoming barriers to care. Objective: The aim of this study is to evaluate the outcomes of a blended care coaching (BCC) program for clients presenting with moderate levels of anxiety and depression in real-world settings. Methods: This study examined retrospective data from US-based individuals (N=1496) who presented with moderate levels of depression and anxiety symptoms and who received blended care coaching services. Using a short-term framework, clients met with coaches via a secure video conference platform and also received digital video lessons and exercises. To evaluate the effectiveness of the BCC program, mixed effects modeling was used to examine growth trajectories of anxiety and depression scores over the course of care. Results: Out of the total sample of 1496 clients, 75.9% (n=1136) demonstrated reliable improvement, and 88.6% (n=1326) recovered based on either the Generalized Anxiety Disorder-7 scale (anxiety) or Patient Health Questionnaire-9 (depression). On average, clients exhibited a significant decline in anxiety and depression symptoms during the initial weeks of coaching, with a continued decline over subsequent weeks at a lower rate. Engaging in a coaching session was associated with lower anxiety (b=–1.04) and depression (b=–0.79) symptoms in the same week, as well as lower anxiety (b=–0.74) and depression (b=–0.91) symptoms the following week (P<.001). Conclusions: The BCC program demonstrated strong outcomes in decreasing symptomology for clients presenting with moderate levels of anxiety and depression. When clients received coaching sessions, significant decreases in symptoms were observed, reflecting the importance of session attendance. Additionally, the steepest declines in symptoms tended to occur during the initial weeks of coaching, emphasizing the importance of client buy-in and early engagement. Collectively, these findings have implications for addressing unmet mental health care needs in a more accessible, cost-effective manner. %M 34673534 %R 10.2196/32100 %U https://mental.jmir.org/2021/10/e32100 %U https://doi.org/10.2196/32100 %U http://www.ncbi.nlm.nih.gov/pubmed/34673534 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e28124 %T Smartphone-Assisted High-Intensity Interval Training in Inflammatory Rheumatic Disease Patients: Randomized Controlled Trial %A Haglo,Håvard %A Wang,Eivind %A Berg,Ole Kristian %A Hoff,Jan %A Helgerud,Jan %+ Myworkout, Medical Rehabilitation Clinic, Ingvald Ystgaards veg 23, Trondheim, Norway, 47 92621619, havard@treningsklinikken.no %K VO2max %K maximal oxygen uptake %K mobile app %K cardiovascular health %K quality of life %K endurance training %D 2021 %7 21.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Patients with inflammatory rheumatic diseases (IRDs) experience disease-related barriers to physical training. Compared with the general population, IRD patients are reported to have reduced maximal oxygen uptake (VO2max) and physical activity levels. Supervised high-intensity interval training (HIIT) is documented to counteract the reduced VO2max and poor cardiovascular health associated with IRDs. However, supervised HIIT is resource demanding. Objective: This study sought to investigate if self-administered 4×4-min HIIT guided by a smartphone app (Myworkout GO) could yield similar HIIT-induced effects as standard 4×4-min HIIT performed under the guidance and supervision of health care professionals. The effects studied were on VO2max and health-related quality of life (HRQoL). Methods: Forty patients (33 female patients, mean age 48 years, SD 12 years; 7 male patients, mean age 52 years, SD 11 years) diagnosed with rheumatoid arthritis, spondyloarthritis, or systemic lupus erythematosus were randomized to a supervised group (SG) or an app group (AG). Both groups were instructed to perform 4×4-min intervals with a rate of perceived exertion of 16 to 17, corresponding to 85% to 95% of the maximal heart rate, twice a week for 10 weeks. Treadmill VO2max and HRQoL measured using RAND-36 were assessed before and after the exercise period. Results: VO2max increased (P<.001) in both groups after 10 weeks of HIIT, with improvements of 3.6 (SD 1.3) mL/kg/min in the SG and 3.7 (SD 1.5) mL/kg/min in the AG. This was accompanied by increases in oxygen pulse in both groups (P<.001), with no between-group differences apparent for either measure. Improvements in the HRQoL dimensions of bodily pain, vitality, and social functioning were observed for both groups (P<.001 to P=.04). Again, no between-group differences were detected. Conclusions: High-intensity 4×4-min interval training increased VO2max and HRQoL, contributing to patients’ reduced cardiovascular disease risk, improved health and performance, and enhanced quality of life. Similar improvements were observed following HIIT when IRD patients were guided using perceived exertion by health care professionals or the training was self-administered and guided by the app Myworkout GO. Utilization of the app may help reduce the cost of HIIT as a treatment strategy in this patient population. Trial Registration: ClinicalTrials.gov NCT04649528; https://clinicaltrials.gov/ct2/show/NCT04649528 %M 34673536 %R 10.2196/28124 %U https://mhealth.jmir.org/2021/10/e28124 %U https://doi.org/10.2196/28124 %U http://www.ncbi.nlm.nih.gov/pubmed/34673536 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e26233 %T A Mobile Health Salt Reduction Intervention for People With Hypertension: Results of a Feasibility Randomized Controlled Trial %A Payne Riches,Sarah %A Piernas,Carmen %A Aveyard,Paul %A Sheppard,James P %A Rayner,Mike %A Albury,Charlotte %A Jebb,Susan A %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 1865 289300, susan.jebb@phc.ox.ac.uk %K salt reduction %K behavior change %K mobile health %K mHealth %K smartphone app %K mobile phone %D 2021 %7 21.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A high-salt diet is a risk factor for hypertension and cardiovascular disease; therefore, reducing dietary salt intake is a key part of prevention strategies. There are few effective salt reduction interventions suitable for delivery in the primary care setting, where the majority of the management and diagnosis of hypertension occurs. Objective: The aim of this study is to assess the feasibility of a complex behavioral intervention to lower salt intake in people with elevated blood pressure and test the trial procedures for a randomized controlled trial to investigate the intervention’s effectiveness. Methods: This feasibility study was an unblinded, randomized controlled trial of a mobile health intervention for salt reduction versus an advice leaflet (control). The intervention was developed using the Behavior Change Wheel and comprised individualized, brief advice from a health care professional with the use of the SaltSwap app. Participants with an elevated blood pressure recorded in the clinic were recruited through primary care practices in the United Kingdom. Primary outcomes assessed the feasibility of progression to a larger trial, including follow-up attendance, fidelity of intervention delivery, and app use. Secondary outcomes were objectively assessed using changes in salt intake (measured via 24-hour urine collection), salt content of purchased foods, and blood pressure. Qualitative outcomes were assessed using the think-aloud method, and the process outcomes were evaluated. Results: A total of 47 participants were randomized. All progression criteria were met: follow-up attendance (45/47, 96%), intervention fidelity (25/31, 81%), and app use (27/31, 87%). There was no evidence that the intervention significantly reduced the salt content of purchased foods, salt intake, or blood pressure; however, this feasibility study was not powered to detect changes in secondary outcomes. Process and qualitative outcomes demonstrated that the trial design was feasible and the intervention was acceptable to both individuals and practitioners and positively influenced salt intake behaviors. Conclusions: The intervention was acceptable and feasible to deliver within primary care; the trial procedures were practicable, and there was sufficient signal of potential efficacy to change salt intake. With some improvements to the intervention app, a larger trial to assess intervention effectiveness for reducing salt intake and blood pressure is warranted. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 20910962; https://www.isrctn.com/ISRCTN20910962 %M 34673535 %R 10.2196/26233 %U https://mhealth.jmir.org/2021/10/e26233 %U https://doi.org/10.2196/26233 %U http://www.ncbi.nlm.nih.gov/pubmed/34673535 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e29913 %T Six-Month Outcomes from the NEXit Junior Trial of a Text Messaging Smoking Cessation Intervention for High School Students: Randomized Controlled Trial With Bayesian Analysis %A Bendtsen,Marcus %A Bendtsen,Preben %A Müssener,Ulrika %+ Department of Health, Medicine and Caring Sciences, Linköping University, Building 511, Linköping, 58183, Sweden, 46 13286975, marcus.bendtsen@liu.se %K smoking %K cessation %K text messaging %K high school %K randomized controlled trial %K intervention %K student %K young adult %K teenager %K outcome %K Bayesian %K Sweden %K prevalence %K lifestyle %K behavior %D 2021 %7 21.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The prevalence of daily or occasional smoking among high school students in Sweden was approximately 20% in 2019, which is problematic since lifestyle behaviors are established in adolescence and track into adulthood. The Nicotine Exit (NEXit) Junior trial was conducted in response to a lack of evidence for the effects of text message smoking cessation interventions among high school students in Sweden. Objective: The aim of this study was to estimate the 3- and 6-month effects of a text messaging intervention among high school students in Sweden on smoking cessation outcomes. Methods: A 2-arm, single-blind randomized controlled trial was employed to estimate the effects of the intervention on smoking cessation in comparison to treatment as usual. Participants were recruited from high schools in Sweden using advertising and promotion by school staff from January 10, 2018, to January 10, 2019. Weekly or daily smokers who were willing to make a quit attempt were eligible for inclusion. Prolonged abstinence and point prevalence of smoking cessation were measured at 3 and 6 months after randomization. Results: Complete case analysis was possible on 57.9% (310/535) of the participants at 6 months, with no observed statistically significant effect on 5-month prolonged abstinence (odds ratio [OR] 1.27, 95% CI 0.73-2.20; P=.39) or 4-week smoking cessation (OR 1.42; 95% CI 0.83-2.46; P=.20). Sensitivity analyses using imputation yielded similar findings. Unplanned Bayesian analyses showed that the effects of the intervention were in the anticipated direction. The findings were limited by the risk of bias induced by high attrition (42.1%). The trial recruited high school students in a pragmatic setting and included both weekly and daily smokers; thus, generalization to the target population is more direct compared with findings obtained under more strict study procedures. Conclusions: Higher than expected attrition rates to follow-up 6 months after randomization led to null hypothesis tests being underpowered; however, unplanned Bayesian analyses found that the effects of the intervention were in the anticipated direction. Future trials of smoking cessation interventions targeting high school students should aim to prepare strategies for increasing retention to mid- and long-term follow-up. Trial Registration: IRCTN Registry ISRCTN15396225; https://www.isrctn.com/ISRCTN15396225 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-3028-2 %M 34673532 %R 10.2196/29913 %U https://mhealth.jmir.org/2021/10/e29913 %U https://doi.org/10.2196/29913 %U http://www.ncbi.nlm.nih.gov/pubmed/34673532 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e28622 %T Reach Outcomes and Costs of Different Physician Referral Strategies for a Weight Management Program Among Rural Primary Care Patients: Type 3 Hybrid Effectiveness-Implementation Trial %A Porter,Gwenndolyn %A Michaud,Tzeyu L %A Schwab,Robert J %A Hill,Jennie L %A Estabrooks,Paul A %+ Department of Health Promotion, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198, United States, 1 4025591082, gwenndolyn.porter@unmc.edu %K weight management %K rural %K RE-AIM %K hybrid effectiveness-implementation %K primary care %K obesity %K physicians %K digital health %K health technology %K mobile phone %D 2021 %7 20.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Rural residents are at high risk for obesity; however, little resources exist to address this disproportional burden of disease. Primary care may provide an opportunity to connect primary care patients with overweight and obesity to effective weight management programming. Objective: The purpose of this study is to examine the utility of different physician referral and engagement processes for improving the reach of an evidence-based and technology-delivered weight management program with counseling support for rural primary care patients. Methods: A total of 5 rural primary care physicians were randomly assigned a sequence of four referral strategies: point-of-care (POC) referral with active telephone follow-up (ATF); POC referral, no ATF; a population health registry–derived letter referral with ATF; and letter referral, no ATF. For registry-derived referrals, physicians screened a list of patients with BMI ≥25 and approved patients for participation to receive a personalized referral letter via mail. Results: Out of a potential 991 referrals, 573 (57.8%) referrals were made over 16 weeks, and 98 (9.9%) patients were enrolled in the program (58/98, 59.2% female). Differences based on letter (485/991, 48.9%) versus POC (506/991, 51.1%) referrals were identified for completion (100% vs 7%; P<.001) and for proportion screened (36% vs 12%; P<.001) but not for proportion enrolled (12% vs 8%; P=.10). Patients receiving ATF were more likely to be screened (47% vs 7%; P<.001) and enrolled (15% vs 7%; P<.001) than those not receiving ATF. On the basis of the number of referrals made in each condition, we found variations in the proportion and number of enrollees (POC with ATF: 27/190, 50%; POC no ATF: 14/316, 41%; letter ATF: 30/199; 15.1%; letter no ATF: 27/286, 9.4%). Across all conditions, participants were representative of the racial and ethnic characteristics of the region (60% female, P=.15; 94% White individuals, P=.60; 94% non-Hispanic, P=.19). Recruitment costs totaled US $6192, and the overall recruitment cost per enrolled participant was US $63. Cost per enrolled participant ranged from POC with ATF (US $47), registry-derived letter without ATF (US $52), and POC without ATF (US $56) to registry-derived letter with ATF (US $91). Conclusions: Letter referral with ATF appears to be the best option for enrolling a large number of patients in a digitally delivered weight management program; however, POC with ATF and letters without ATF yielded similar numbers at a lower cost. The best referral option is likely dependent on the best fit with clinical resources. Trial Registration: ClinicalTrials.gov NCT03690557; http://clinicaltrials.gov/ct2/show/NCT03690557 %M 34668873 %R 10.2196/28622 %U https://formative.jmir.org/2021/10/e28622 %U https://doi.org/10.2196/28622 %U http://www.ncbi.nlm.nih.gov/pubmed/34668873 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29441 %T Characteristics of Acute Childhood Illness Apps for Parents: Environmental Scan %A Benoit,James %A Hartling,Lisa %A Chan,Michelle %A Scott,Shannon %+ Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 4-472 Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, AB, T6G 1C9, Canada, 1 780 492 6124, hartling@ualberta.ca %K internet %K mHealth %K mobile health %K digital health %K ehealth %K app %K mobile application %K Android %K Apple %K marketplace %K environmental scan %K review %K acute childhood illness %K knowledge translation %K child %K parent %K caregiver %K mobile phone %D 2021 %7 19.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Providing parents with resources that aid in the identification and management of acute childhood illnesses helps those parents feel better equipped to assess their children’s health and significantly changes parental health-seeking behaviors. Some of these resources are limited by accessibility and scalability. Remote locations and staffing limitations create challenges for parents aiming to access their child’s health information. Mobile health apps offer a scalable, accessible solution for improving health literacy by enabling access to health information through mobile devices.  Objective: The aim of our study is to create an inventory of acute childhood illness apps that are available to North American parents and caregivers, assess their quality, and identify the areas in which future apps can be improved. Methods: We conducted an environmental scan to identify and summarize app information for parents and digital health researchers. The Google and Apple app marketplaces were used as search platforms. We built a list of search terms and searched the platforms for apps targeted at parents and related to acute pediatric illnesses in the United States and Canada. We assessed apps meeting the inclusion criteria using the Mobile App Rating Scale (MARS), a validated tool for assessing the quality of health apps. The MARS examines apps on 5 subscales: engagement, functionality, aesthetics, information quality, and subjective quality. Data were analyzed by MARS subscale averages and individual item scores. Results: Overall, 650 unique apps were screened, and 53 (8.2%) were included. On a scale of 1-5, apps had an average engagement score of 2.82/5 (SD 0.86), functionality score of 3.98/5 (SD 0.72), aesthetics score of 3.09/5 (SD 0.87), information quality score of 2.73/5 (SD 1.32), and subjective quality score of 2.20/5 (SD 0.79). On the same scale of 1-5, app scores ranged from 2.2/5 to 4.5/5 (mean 3.2, SD 0.6). The top 3 MARS-scored apps were Baby and Child First Aid (4.5/5), Ada (4.5/5), and HANDi Paediatric (4.2/5). Taken together, the top 3 apps covered topics of emergency pediatric first aid, identification of (and appropriate response to) common childhood illnesses, a means of checking symptoms, and a means of responding to emergency situations. There was a lack of Canadian-based app content available to parents in both marketplaces; this space was filled with content originating primarily in the United Kingdom and the United States. In addition, published evidence of the impact of the included apps was poor: of 53 apps, only 5 (9%) had an evidence base showing that the app had been trialed for usability or efficacy. Conclusions: There is a need for evidence-based acute childhood illness apps of Canadian origin. This environmental scan offers a comprehensive picture of the health app landscape by examining trends in acute childhood illness apps that are readily available to parents and by identifying gaps in app design. %M 34665144 %R 10.2196/29441 %U https://www.jmir.org/2021/10/e29441 %U https://doi.org/10.2196/29441 %U http://www.ncbi.nlm.nih.gov/pubmed/34665144 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e29160 %T A Mobile App to Identify Lifestyle Indicators Related to Undergraduate Mental Health (Smart Healthy Campus): Observational App-Based Ecological Momentary Assessment %A Brogly,Chris %A Shoemaker,J Kevin %A Lizotte,Daniel J %A Kueper,Jacqueline K %A Bauer,Michael %+ Faculty of Information and Media Studies, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada, 1 (519) 661 2111, cbrogly@uwo.ca %K smartphones %K undergraduates %K mental health %K lifestyle %K postsecondary institutions %K mHealth %K mobile application %K ecological momentary assessment %K mobile phone %D 2021 %7 19.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Undergraduate studies are challenging, and mental health issues can frequently occur in undergraduate students, straining campus resources that are already in demand for somatic problems. Cost-effective measures with ubiquitous devices, such as smartphones, offer the potential to deliver targeted interventions to monitor and affect lifestyle, which may result in improvements to student mental health. However, the avenues by which this can be done are not particularly well understood, especially in the Canadian context. Objective: The aim of this study is to deploy an initial version of the Smart Healthy Campus app at Western University, Canada, and to analyze corresponding data for associations between psychosocial factors (measured by a questionnaire) and behaviors associated with lifestyle (measured by smartphone sensors). Methods: This preliminary study was conducted as an observational app-based ecological momentary assessment. Undergraduate students were recruited over email, and sampling using a custom 7-item questionnaire occurred on a weekly basis. Results: First, the 7-item Smart Healthy Campus questionnaire, derived from fully validated questionnaires—such as the Brief Resilience Scale; General Anxiety Disorder-7; and Depression, Anxiety, and Stress Scale–21—was shown to significantly correlate with the mental health domains of these validated questionnaires, illustrating that it is a viable tool for a momentary assessment of an overview of undergraduate mental health. Second, data collected through the app were analyzed. There were 312 weekly responses and 813 sensor samples from 139 participants from March 2019 to March 2020; data collection concluded when COVID-19 was declared a pandemic. Demographic information was not collected in this preliminary study because of technical limitations. Approximately 69.8% (97/139) of participants only completed one survey, possibly because of the absence of any incentive. Given the limited amount of data, analysis was not conducted with respect to time, so all data were analyzed as a single collection. On the basis of mean rank, students showing more positive mental health through higher questionnaire scores tended to spend more time completing questionnaires, showed more signs of physical activity based on pedometers, and had their devices running less and plugged in charging less when sampled. In addition, based on mean rank, students on campus tended to report more positive mental health through higher questionnaire scores compared with those who were sampled off campus. Some data from students found in or near residences were also briefly examined. Conclusions: Given these limited data, participants tended to report a more positive overview of mental health when on campus and when showing signs of higher levels of physical activity. These early findings suggest that device sensors related to physical activity and location are useful for monitoring undergraduate students and designing interventions. However, much more sensor data are needed going forward, especially given the sweeping changes in undergraduate studies due to COVID-19. %M 34665145 %R 10.2196/29160 %U https://formative.jmir.org/2021/10/e29160 %U https://doi.org/10.2196/29160 %U http://www.ncbi.nlm.nih.gov/pubmed/34665145 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 6 %N 4 %P e29739 %T A Novel Mobile Health App to Educate and Empower Young People With Type 1 Diabetes to Exercise Safely: Prospective Single-Arm Mixed Methods Pilot Study %A Shetty,Vinutha B %A Soon,Wayne H K %A Roberts,Alison G %A Fried,Leanne %A Roby,Heather C %A Smith,Grant J %A Fournier,Paul A %A Jones,Timothy W %A Davis,Elizabeth A %+ Department of Endocrinology and Diabetes, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Perth, 6009, Australia, 61 864562222, vinutha.shetty@health.wa.gov.au %K mobile health app %K exercise %K acT1ve %K type 1 diabetes %K young people %K blood glucose level %D 2021 %7 14.10.2021 %9 Original Paper %J JMIR Diabetes %G English %X Background: Empowering young people with type 1 diabetes (T1D) to manage their blood glucose levels during exercise is a complex challenge faced by health care professionals due to the unpredictable nature of exercise and its effect on blood glucose levels. Mobile health (mHealth) apps would be useful as a decision-support aid to effectively contextualize a blood glucose result and take appropriate action to optimize glucose levels during and after exercise. A novel mHealth app acT1ve was recently developed, based on expert consensus exercise guidelines, to provide real-time support for young people with T1D during exercise. Objective: Our aim was to pilot acT1ve in a free-living setting to assess its acceptability and functionality, and gather feedback on the user experience before testing it in a larger clinical trial. Methods: A prospective single-arm mixed method design was used. Ten participants with T1D (mean age 17.7 years, SD 4.2 years; mean HbA1c, 54 mmol/mol, SD 5.5 mmol/mol [7.1%, SD 0.5%]) had acT1ve installed on their phones, and were asked to use the app to guide their exercise management for 6 weeks. At the end of 6 weeks, participants completed both a semistructured interview and the user Mobile Application Rating Scale (uMARS). All semistructured interviews were transcribed. Thematic analysis was conducted whereby interview transcripts were independently analyzed by 2 researchers to uncover important and relevant themes. The uMARS was scored for 4 quality subscales (engagement, functionality, esthetics, and information), and a total quality score was obtained from the weighted average of the 4 subscales. Scores for the 4 objective subscales were determined by the mean score of each of its individual questions. The perceived impact and subjective quality of acT1ve for each participant were calculated by averaging the scores of their related questions, but were not considered in the total quality score. All scores have a maximal possible value of 5, and they are presented as medians, IQRs, and ranges. Results: The main themes arising from the interview analysis were “increased knowledge,” “increased confidence to exercise,” and “suitability” for people who were less engaged in exercise. The uMARS scores for acT1ve were high (out of 5) for its total quality (median 4.3, IQR 4.2-4.6), engagement (median 3.9, IQR 3.6-4.2), functionality (median 4.8, IQR 4.5-4.8), information (median 4.6, IQR 4.5-4.8), esthetics (median 4.3, IQR 4.0-4.7), subjective quality (median 4.0, IQR 3.8-4.2), and perceived impact (median 4.3, IQR 3.6-4.5). Conclusions: The acT1ve app is functional and acceptable, with a high user satisfaction. The efficacy and safety of this app will be tested in a randomized controlled trial in the next phase of this study. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001414101; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378373 %M 34647896 %R 10.2196/29739 %U https://diabetes.jmir.org/2021/4/e29739 %U https://doi.org/10.2196/29739 %U http://www.ncbi.nlm.nih.gov/pubmed/34647896 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e30404 %T Characteristics and Quality of Mobile Apps Containing Prenatal Genetic Testing Information: Systematic App Store Search and Assessment %A Wu,Ko-Lin %A Alegria,Rebeca %A Gonzalez,Jazzlyn %A Hu,Harrison %A Wang,Haocen %A Page,Robin %A Robbins-Furman,Patricia %A Ma,Ping %A Tseng,Tung-Sung %A Chen,Lei-Shih %+ Department of Health and Kinesiology, Texas A&M University, 4243 TAMU, College Station, TX, 77840, United States, 1 979 862 2912, lacechen@tamu.edu %K mobile applications %K prenatal genetic testing %K pregnancy %K review %K evaluation %D 2021 %7 14.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Prenatal genetic testing is an essential part of routine prenatal care. Yet, obstetricians often lack the time to provide comprehensive prenatal genetic testing education to their patients. Pregnant women lack prenatal genetic testing knowledge, which may hinder informed decision-making during their pregnancies. Due to the rapid growth of technology, mobile apps are a potentially valuable educational tool through which pregnant women can learn about prenatal genetic testing and improve the quality of their communication with obstetricians. The characteristics, quality, and number of available apps containing prenatal genetic testing information are, however, unknown. Objective: This study aims to conduct a firstreview to identify, evaluate, and summarize currently available mobile apps that contain prenatal genetic testing information using a systematic approach. Methods: We searched both the Apple App Store and Google Play for mobile apps containing prenatal genetic testing information. The quality of apps was assessed based on the criteria adopted from two commonly used and validated mobile app scoring systems, including the Mobile Application Rating Scale (MARS) and the APPLICATIONS evaluation criteria. Results: A total of 64 mobile apps were identified. Of these, only 2 apps were developed for a specific prenatal genetic test. All others were either pregnancy-related (61/64, 95%) or genetics-related (1/64, 2%) apps that provided prenatal genetic testing information. The majority of the apps (49/64, 77%) were developed by commercial companies. The mean quality assessment score of the included apps was 13.5 (SD 2.9), which was equal to the average of possible theoretical score. Overall, the main weaknesses of mobile apps in this review included the limited number of prenatal genetic tests mentioned; incomprehensiveness of testing information; unreliable and missing information sources; absence of developmental testing with users (not evidence based); high level of readability; and the lack of visual information, customization, and a text search field. Conclusions: Our findings suggest that the quality of mobile apps with prenatal genetic testing information must be improved and that pregnant women should be cautious when using these apps for prenatal genetic testing information. Obstetricians should carefully examine mobile apps before referring any of them to their patients for use as an educational tool. Both improving the quality of existing mobile apps, and developing new, evidence-based, high-quality mobile apps targeting all prenatal genetic tests should be the focus of mobile app developers going forward. %M 34647898 %R 10.2196/30404 %U https://mhealth.jmir.org/2021/10/e30404 %U https://doi.org/10.2196/30404 %U http://www.ncbi.nlm.nih.gov/pubmed/34647898 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e18403 %T Circadian Rhythm Analysis Using Wearable Device Data: Novel Penalized Machine Learning Approach %A Li,Xinyue %A Kane,Michael %A Zhang,Yunting %A Sun,Wanqi %A Song,Yuanjin %A Dong,Shumei %A Lin,Qingmin %A Zhu,Qi %A Jiang,Fan %A Zhao,Hongyu %+ Department of Biostatistics, Yale School of Public Health, 300 George Street, Suite 503, New Haven, CT, 06511, United States, 1 203 785 3613, hongyu.zhao@yale.edu %K wearable device %K actigraphy %K circadian rhythm %K physical activity %K early childhood development %D 2021 %7 14.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Wearable devices have been widely used in clinical studies to study daily activity patterns, but the analysis remains a major obstacle for researchers. Objective: This study proposes a novel method to characterize sleep-activity rhythms using actigraphy and further use it to describe early childhood daily rhythm formation and examine its association with physical development. Methods: We developed a machine learning–based Penalized Multiband Learning (PML) algorithm to sequentially infer dominant periodicities based on the Fast Fourier Transform (FFT) algorithm and further characterize daily rhythms. We implemented and applied the algorithm to Actiwatch data collected from a cohort of 262 healthy infants at ages 6, 12, 18, and 24 months, with 159, 101, 111, and 141 participants at each time point, respectively. Autocorrelation analysis and Fisher test in harmonic analysis with Bonferroni correction were applied for comparison with the PML. The association between activity rhythm features and early childhood motor development, assessed using the Peabody Developmental Motor Scales-Second Edition (PDMS-2), was studied through linear regression analysis. Results: The PML results showed that 1-day periodicity was most dominant at 6 and 12 months, whereas one-day, one-third–day, and half-day periodicities were most dominant at 18 and 24 months. These periodicities were all significant in the Fisher test, with one-fourth–day periodicity also significant at 12 months. Autocorrelation effectively detected 1-day periodicity but not the other periodicities. At 6 months, PDMS-2 was associated with the assessment seasons. At 12 months, PDMS-2 was associated with the assessment seasons and FFT signals at one-third–day periodicity (P<.001) and half-day periodicity (P=.04), respectively. In particular, the subcategories of stationary, locomotion, and gross motor were associated with the FFT signals at one-third–day periodicity (P<.001). Conclusions: The proposed PML algorithm can effectively conduct circadian rhythm analysis using time-series wearable device data. The application of the method effectively characterized sleep-wake rhythm development and identified the association between daily rhythm formation and motor development during early childhood. %M 34647895 %R 10.2196/18403 %U https://www.jmir.org/2021/10/e18403 %U https://doi.org/10.2196/18403 %U http://www.ncbi.nlm.nih.gov/pubmed/34647895 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e29495 %T Text Messaging Versus Email Messaging to Support Patients With Major Depressive Disorder: Protocol for a Randomized Hybrid Type II Effectiveness-Implementation Trial %A Adu,Medard Kofi %A Shalaby,Reham %A Eboreime,Ejemai %A Sapara,Adegboyega %A Nkire,Nnamdi %A Chawla,Rajan %A Chima,Chidi %A Achor,Michael %A Osiogo,Felix %A Chue,Pierre %A Greenshaw,Andrew J %A Agyapong,Vincent Israel %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor Abbie J. Lane Memorial Building QEII Health Sciences Centre, Halifax, NS, T6G 2B7, Canada, 1 7807144315, vincent.agyapong@nshealth.ca %K email messaging %K text messaging %K supportive %K major depressive disorder %K randomized trial %K mental health %K digital health %K mobile health %K mHealth %K patient care %K health policy %K decision-making %K health care resources %D 2021 %7 13.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Major depressive disorder (MDD) accounts for 40.5% of disability-adjusted life years caused by mental and substance use disorders. Barriers such as stigma and financial and physical access to care have been reported, highlighting the need for innovative, accessible, and cost-effective psychological interventions. The effectiveness of supportive SMS text messaging in alleviating depression symptoms has been proven in clinical trials, but this approach can only help those with mobile phones. Objective: This paper presents the protocol for a study that will aim to evaluate the feasibility, comparative effectiveness, and user satisfaction of daily supportive email messaging as an effective strategy compared to daily supportive text messaging as part of the treatment of patients with MDD. Methods: This trial will be carried out using a hybrid type II implementation-effectiveness design. This design evaluates the effectiveness of an implementation strategy or intervention, while also evaluating the implementation context associated with the intervention. Patients with MDD receiving usual care will be randomized to receive either daily supportive email messaging or daily supportive text messaging of the same content for 6 months. The Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the 5-item World Health Organization Well-Being Index will be used to evaluate the effectiveness of both strategies. The implementation evaluation will be guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, as well as the Consolidated Framework for Implementation Research. All outcome measures will be analyzed using descriptive and inferential statistics. Qualitative data will be analyzed using thematic analysis. Results: Data collection for this trial began in April 2021. We expect the study results to be available within 18 months of study commencement. The results will shed light on the feasibility, acceptability, and effectiveness of using automated emails as a strategy for delivering supportive messages to patients with MDD in comparison to text messaging. Conclusions: The outcome of this trial will have translational impact on routine patient care and access to mental health, as well as potentially support mental health policy decision-making for health care resource allocation. Trial Registration: ClinicalTrials.gov NCT04638231; https://clinicaltrials.gov/ct2/show/NCT04638231 International Registered Report Identifier (IRRID): DERR1-10.2196/29495 %M 34643541 %R 10.2196/29495 %U https://www.researchprotocols.org/2021/10/e29495 %U https://doi.org/10.2196/29495 %U http://www.ncbi.nlm.nih.gov/pubmed/34643541 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e25772 %T The Use of Task Shifting to Improve Treatment Engagement in an Internet-Based Mindfulness Intervention Among Chinese University Students: Randomized Controlled Trial %A Rodriguez,Marcus %A Eisenlohr-Moul,Tory A %A Weisman,Jared %A Rosenthal,M Zachary %+ Pitzer College, 1050 N Mills Ave, BN 205, Claremont, CA, 91711, United States, 1 9784605088, jweisman@pitzer.edu %K mindfulness %K mental health %K social support %K internet-based intervention %K treatment outcome %K university students %K smartphone %K mobile phone %D 2021 %7 13.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Traditional in-person psychotherapies are incapable of addressing global mental health needs. Use of computer-based interventions is one promising solution for closing the gap between the amount of global mental health treatment needed and received. Objective: Although many meta-analyses have provided evidence supporting the efficacy of self-guided, computer-based interventions, most report low rates of treatment engagement (eg, high attrition and low adherence). The aim of this study is to investigate the efficacy of an adjunctive treatment component that uses task shifting, wherein mental health care is provided by nonspecialist peer counselors to enhance engagement in an internet-based, self-directed, evidence-based mindfulness intervention among Chinese university students. Methods: From 3 universities across China, 54 students who reported at least mild stress, anxiety, or depression were randomly assigned to a 4-week internet-based mindfulness intervention (MIND) or to the intervention plus peer counselor support (MIND+), respectively. Be Mindful delivers all the elements of mindfulness-based cognitive therapy in an internet-based, 4-week course. Participants completed daily monitoring of mindfulness practice and mood, as well as baseline and posttreatment self-reported levels of depression, anxiety, stress, and trait mindfulness. We screened 56 volunteer peer counselor candidates who had no former training in the delivery of mental health services. Of these, 10 were invited to participate in a day-long training, and 4 were selected. Peer counselors were instructed to provide 6 brief (15-20 minute) sessions each week, to help encouraging participants to complete the internet-based intervention. Peer counselors received weekly web-based group supervision. Results: For both conditions, participation in the internet-based intervention was associated with significant improvements in mindfulness and mental health outcomes. The pre-post effect sizes (Cohen d) for mindfulness, depression, anxiety, and stress were 0.55, 0.95, 0.89, and 1.13, respectively. Participants assigned to the MIND+ (vs MIND) condition demonstrated significantly less attrition and more adherence, as indicated by a greater likelihood of completing posttreatment assessments (16/27, 59% vs 7/27, 26%; χ21=6.1; P=.01) and a higher percentage of course completion (72.6/100, 72.6% vs 50.7/100, 50.7%; t52=2.10; P=.04), respectively. No significant between-group differences in daily frequency and duration of mindfulness practice were observed. Multilevel logistic growth models showed that MIND+ participants reported significantly greater pre-post improvements in daily stress ratings (interaction estimate 0.39, SE 0.18; t317=2.29; P=.02) and depression (interaction estimate 0.38, SE 0.16; t330=2.37; P=.02) than those in the MIND condition. Conclusions: This study provides new insights into effective ways of leveraging technology and task shifting to implement large-scale mental health initiatives that are financially feasible, easily transportable, and quickly scalable in low-resource settings. The findings suggest that volunteer peer counselors receiving low-cost, low-intensity training and supervision may significantly improve participants’ indices of treatment engagement and mental health outcomes in an internet-based mindfulness intervention among Chinese university students. %M 34643532 %R 10.2196/25772 %U https://formative.jmir.org/2021/10/e25772 %U https://doi.org/10.2196/25772 %U http://www.ncbi.nlm.nih.gov/pubmed/34643532 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e26164 %T A Mobile Health Intervention for Patients With Depressive Symptoms: Protocol for an Economic Evaluation Alongside Two Randomized Trials in Brazil and Peru %A Vera Cruz dos Santos,Daniela %A Coelho de Soárez,Patrícia %A Cavero,Victoria %A U Rocha,Thaís I %A Aschar,Suzana %A Daley,Kate Louise %A Garcia Claro,Heloísa %A Abud Scotton,George %A Fernandes,Ivan %A Diez-Canseco,Francisco %A Brandt,Lena Rebeca %A Toyama,Mauricio %A Martins Castro,Hellen Carolina %A Miranda,J Jaime %A Araya,Ricardo %A Quayle,Julieta %A Rossi Menezes,Paulo %+ Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo, 455 2º andar sala 2228, São Paulo, 01246-903, Brazil, 55 1130617444, patricia.soarez@usp.br %K cost-effectiveness %K depression %K diabetes %K hypertension %K noncommunicable diseases %K randomized trials %K low- and middle-income countries %K mHealth %K task shifting %K behavioral activation %D 2021 %7 13.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mobile health interventions provide significant strategies for improving access to health services, offering a potential solution to reduce the mental health treatment gap. Economic evaluation of this intervention is needed to help inform local mental health policy and program development. Objective: This paper presents the protocol for an economic evaluation conducted alongside 2 randomized controlled trials (RCTs) to evaluate the cost-effectiveness of a psychological intervention delivered through a technological platform (CONEMO) to treat depressive symptoms in people with diabetes, hypertension, or both. Methods: The economic evaluation uses a within-trial analysis to evaluate the incremental costs and health outcomes of CONEMO plus enhanced usual care in comparison with enhanced usual care from public health care system and societal perspectives. Participants are patients of the public health care services for hypertension, diabetes, or both conditions in São Paulo, Brazil (n=880) and Lima, Peru (n=432). Clinical effectiveness will be measured by reduction in depressive symptoms and gains in health-related quality of life. We will conduct cost-effectiveness and cost-utility analyses, providing estimates of the cost per at least 50% reduction in 9-item Patient Health Questionnaire scores, and cost per quality-adjusted life year gained. The measurement of clinical effectiveness and resource use will take place over baseline, 3-month follow-up, and 6-month follow-up in the intervention and control groups. We will use a mixed costing methodology (ie, a combination of top–down and bottom–up approaches) considering 4 cost categories: intervention (CONEMO related) costs, health care costs, patient and family costs, and productivity costs. We will collect unit costs from the RCTs and national administrative databases. The multinational economic evaluations will be fully split analyses with a multicountry costing approach. We will calculate incremental cost-effectiveness ratios and present 95% CIs from nonparametric bootstrapping (1000 replicates). We will perform deterministic and probabilistic sensitivity analyses. Finally, we will present cost-effectiveness acceptability curves to compare a range of possible cost-effectiveness thresholds. Results: The economic evaluation project had its project charter in June 2018 and is expected to be completed in September 2021. The final results will be available in the second half of 2021. Conclusions: We expect to assess whether CONEMO plus enhanced usual care is a cost-effective strategy to improve depressive symptoms in this population compared with enhanced usual care. This study will contribute to the evidence base for health managers and policy makers in allocating additional resources for mental health initiatives. It also will provide a basis for further research on how this emerging technology and enhanced usual care can improve mental health and well-being in low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT12345678 (Brazil) and NCT03026426 (Peru); https://clinicaltrials.gov/ct2/show/NCT02846662 and https://clinicaltrials.gov/ct2/show/NCT03026426 International Registered Report Identifier (IRRID): DERR1-10.2196/26164 %M 34643538 %R 10.2196/26164 %U https://www.researchprotocols.org/2021/10/e26164 %U https://doi.org/10.2196/26164 %U http://www.ncbi.nlm.nih.gov/pubmed/34643538 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e27298 %T Brain Mechanisms of Virtual Reality Breathing Versus Traditional Mindful Breathing in Pain Modulation: Observational Functional Near-infrared Spectroscopy Study %A Hu,Xiao-Su %A Beard,Katherine %A Sherbel,Mary Catherine %A Nascimento,Thiago D %A Petty,Sean %A Pantzlaff,Eddie %A Schwitzer,David %A Kaciroti,Niko %A Maslowski,Eric %A Ashman,Lawrence M %A Feinberg,Stephen E %A DaSilva,Alexandre F %+ Headache & Orofacial Pain Effort Lab, Biologic and Materials Sciences & Prosthodontics Department, University of Michigan School of Dentistry, 205 Zina Pitcher Pl, room 1021, Ann Arbor, MI, 48109-5720, United States, 1 734 615 3807, adasilva@umich.edu %K virtual reality breathing %K traditional mindful breathing %K pain %K functional near-infrared spectroscopy %K mobile phone %D 2021 %7 12.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Pain is a complex experience that involves sensory-discriminative and cognitive-emotional neuronal processes. It has long been known across cultures that pain can be relieved by mindful breathing (MB). There is a common assumption that MB exerts its analgesic effect through interoception. Interoception refers to consciously refocusing the mind’s attention to the physical sensation of internal organ function. Objective: In this study, we dissect the cortical analgesic processes by imaging the brains of healthy subjects exposed to traditional MB (TMB) and compare them with another group for which we augmented MB to an outside sensory experience via virtual reality breathing (VRB). Methods: The VRB protocol involved in-house–developed virtual reality 3D lungs that synchronized with the participants’ breathing cycles in real time, providing them with an immersive visual-auditory exteroception of their breathing. Results: We found that both breathing interventions led to a significant increase in pain thresholds after week-long practices, as measured by a thermal quantitative sensory test. However, the underlying analgesic brain mechanisms were opposite, as revealed by functional near-infrared spectroscopy data. In the TMB practice, the anterior prefrontal cortex uniquely modulated the premotor cortex. This increased its functional connection with the primary somatosensory cortex (S1), thereby facilitating the S1-based sensory-interoceptive processing of breathing but inhibiting its other role in sensory-discriminative pain processing. In contrast, virtual reality induced an immersive 3D exteroception with augmented visual-auditory cortical activations, which diminished the functional connection with the S1 and consequently weakened the pain processing function of the S1. Conclusions: In summary, our study suggested two analgesic neuromechanisms of VRB and TMB practices—exteroception and interoception—that distinctively modulated the S1 processing of the ascending noxious inputs. This is in line with the concept of dualism (Yin and Yang). %M 34636731 %R 10.2196/27298 %U https://www.jmir.org/2021/10/e27298 %U https://doi.org/10.2196/27298 %U http://www.ncbi.nlm.nih.gov/pubmed/34636731 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e27267 %T Mobile Safety Alarms Based on GPS Technology in the Care of Older Adults: Systematic Review of Evidence Based on a General Evidence Framework for Digital Health Technologies %A Ehn,Maria %A Richardson,Matt X %A Landerdahl Stridsberg,Sara %A Redekop,Ken %A Wamala-Andersson,Sarah %+ School of Innovation, Design and Engineering, Mälardalen University, Box 883, Västerås, SE-721 23, Sweden, 46 21 107093, maria.ehn@mdh.se %K GPS %K older adults %K dementia %K evidence %K digital health %K NICE %K mobile phone %D 2021 %7 11.10.2021 %9 Review %J J Med Internet Res %G English %X Background: GPS alarms aim to support users in independent activities. Previous systematic reviews have reported a lack of clear evidence of the effectiveness of GPS alarms for the health and welfare of users and their families and for social care provision. As GPS devices are currently being implemented in social care, it is important to investigate whether the evidence of their clinical effectiveness remains insufficient. Standardized evidence frameworks have been developed to ensure that new technologies are clinically effective and offer economic value. The frameworks for analyzing existing evidence of the clinical effectiveness of GPS devices can be used to identify the risks associated with their implementation and demonstrate key aspects of successful piloting or implementation. Objective: The principal aim of this study is to provide an up-to-date systematic review of evidence based on existing studies of the effects of GPS alarms on health, welfare, and social provision in the care of older adults compared with non–GPS-based standard care. In addition, the study findings were assessed by using the evidence standards framework for digital health technologies (DHTs) established by the National Institute for Health and Care Excellence (NICE) in the United Kingdom. Methods: This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Primary studies published in peer-reviewed journals and gray literature from January 2005 to August 2020 were identified through searches in 13 databases and several sources of gray literature. Included studies had individuals (aged ≥50 years) who were receiving social care for older adults or for persons with dementia; used GPS devices as an intervention; were performed in Canada, the United States, European Union, Singapore, Australia, New Zealand, Hong Kong, South Korea, or Japan; and addressed quantitative outcomes related to health, welfare, and social care. The study findings were analyzed by using the NICE framework requirements for active monitoring DHTs. Results: Of the screened records, 1.6% (16/986) were included. Following the standards of the NICE framework, practice evidence was identified for the tier 1 categories Relevance to current pathways in health/social care system and Acceptability with users, and minimum evidence was identified for the tier 1 category Credibility with health, social care professionals. However, several evidence categories for tiers 1 and 2 could not be assessed, and no clear evidence demonstrating effectiveness could be identified. Thus, the evidence required for using DHTs to track patient location according to the NICE framework was insufficient. Conclusions: Evidence of the beneficial effects of GPS alarms on the health and welfare of older adults and social care provision remains insufficient. This review illustrated the application of the NICE framework in analyses of evidence, demonstrated successful piloting and acceptability with users of GPS devices, and identified implications for future research. %M 34633291 %R 10.2196/27267 %U https://www.jmir.org/2021/10/e27267 %U https://doi.org/10.2196/27267 %U http://www.ncbi.nlm.nih.gov/pubmed/34633291 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e25163 %T Digital Tracking of Physical Activity, Heart Rate, and Inhalation Behavior in Patients With Pulmonary Arterial Hypertension Treated With Inhaled Iloprost: Observational Study (VENTASTEP) %A Stollfuss,Barbara %A Richter,Manuel %A Drömann,Daniel %A Klose,Hans %A Schwaiblmair,Martin %A Gruenig,Ekkehard %A Ewert,Ralf %A Kirchner,Martin C %A Kleinjung,Frank %A Irrgang,Valeska %A Mueller,Christian %+ Bayer Vital GmbH, Building K 56, 1D321, Leverkusen, 51368, Germany, 49 2143046587, christian.mueller4@bayer.com %K 6-minute walk distance %K 6MWD %K Breelib %K daily physical activity %K digital monitoring %K health-related quality of life %K iloprost %K Ventavis %K inhalation behavior %K mobile phone %K pulmonary arterial hypertension %K PAH %K sleeping behavior %K behavior %K sleep %K monitoring %K physical activity %K heart %K cardiology %D 2021 %7 8.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Pulmonary arterial hypertension restricts the ability of patients to perform routine physical activities. As part of pulmonary arterial hypertension treatment, inhaled iloprost can be administered via a nebulizer that tracks inhalation behavior. Pulmonary arterial hypertension treatment is guided by intermittent clinical measurements, such as 6-minute walk distance, assessed during regular physician visits. Continuous digital monitoring of physical activity may facilitate more complete assessment of the impact of pulmonary arterial hypertension on daily life. Physical activity tracking with a wearable has not yet been assessed with simultaneous tracking of pulmonary arterial hypertension medication intake. Objective: We aimed to digitally track the physical parameters of patients with pulmonary arterial hypertension who were starting treatment with iloprost using a Breelib nebulizer. The primary objective was to investigate correlations between changes in digital physical activity measures and changes in traditional clinical measures and health-related quality of life over 3 months. Secondary objectives were to evaluate inhalation behavior, adverse events, and changes in heart rate and sleep quality. Methods: We conducted a prospective, multicenter observational study of adults with pulmonary arterial hypertension in World Health Organization functional class III who were adding inhaled iloprost to existing pulmonary arterial hypertension therapy. Daily distance walked, step count, number of standing-up events, heart rate, and 6-minute walk distance were digitally captured using smartwatch (Apple Watch Series 2) and smartphone (iPhone 6S) apps during a 3-month observation period (which began when iloprost treatment began). Before and at the end of the observation period (within 2 weeks), we also evaluated 6-minute walk distance, Borg dyspnea, functional class, B-type natriuretic peptide (or N-terminal pro–B-type natriuretic peptide) levels, health-related quality of life (EQ-5D questionnaire), and sleep quality (Pittsburgh Sleep Quality Index). Results: Of 31 patients, 18 were included in the full analysis (observation period: median 91.5 days, IQR 88.0 to 92.0). Changes from baseline in traditional and digital 6-minute walk distance were moderately correlated (r=0.57). Physical activity (daily distance walked: median 0.4 km, IQR –0.2 to 1.9; daily step count: median 591, IQR −509 to 2413) and clinical measures (traditional 6-minute walk distance: median 26 m, IQR 0 to 40) changed concordantly from baseline to the end of the observation period. Health-related quality of life showed little change. Total sleep score and resting heart rate slightly decreased. Distance walked and step count showed short-term increases after each iloprost inhalation. No new safety signals were identified (safety analysis set: n=30). Conclusions: Our results suggest that despite challenges, parallel monitoring of physical activity, heart rate, and iloprost inhalation is feasible in patients with pulmonary arterial hypertension and may complement traditional measures in guiding treatment; however, the sample size of this study limits generalizability. Trial Registration: ClinicalTrials.gov NCT03293407; https://clinicaltrials.gov/ct2/show/NCT03293407 International Registered Report Identifier (IRRID): RR2-10.2196/12144 %M 34623313 %R 10.2196/25163 %U https://www.jmir.org/2021/10/e25163 %U https://doi.org/10.2196/25163 %U http://www.ncbi.nlm.nih.gov/pubmed/34623313 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e27478 %T Adaptation and Assessment of a Text Messaging Smoking Cessation Intervention in Vietnam: Pilot Randomized Controlled Trial %A Jiang,Nan %A Nguyen,Nam %A Siman,Nina %A Cleland,Charles M %A Nguyen,Trang %A Doan,Hue Thi %A Abroms,Lorien C %A Shelley,Donna R %+ Department of Population Health, Grossman School of Medicine, New York University, 180 Madison Ave, Room #17-54, New York, NY, 10016, United States, 1 646 501 3553, Nan.Jiang@nyulangone.org %K smoking cessation %K text messaging %K mHealth %K mobile health %K low- and middle-income country %K smoking %K developing countries %K SMS %K Vietnam %D 2021 %7 8.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Text message (ie, short message service, SMS) smoking cessation interventions have demonstrated efficacy in high-income countries but are less well studied in low- and middle-income countries, including Vietnam. Objective: The goal of the research is to assess the feasibility, acceptability, and preliminary efficacy of a fully automated bidirectional SMS cessation intervention adapted for Vietnamese smokers. Methods: The study was conducted in 3 phases. In phase 1, we adapted the SMS library from US-based SMS cessation programs (ie, SmokefreeTXT and Text2Quit). The adaptation process consisted of 7 focus groups with 58 smokers to provide data on culturally relevant patterns of tobacco use and assess message preferences. In phase 2, we conducted a single-arm pilot test of the SMS intervention with 40 smokers followed by in-depth interviews with 10 participants to inform additional changes to the SMS library. In phase 3, we conducted a 2-arm pilot randomized controlled trial (RCT) with 100 smokers. Participants received either the SMS program (intervention; n=50) or weekly text assessment on smoking status (control; n=50). The 6-week SMS program consisted of a 2-week prequit period and a 4-week postquit period. Participants received 2 to 4 automated messages per day. The main outcomes were engagement and acceptability which were assessed at 6 weeks (end of intervention). We assessed biochemically confirmed smoking abstinence at 6 weeks and 12 weeks. Postintervention in-depth interviews explored user experiences among a random sample of 16 participants in the intervention arm. Results: Participants in both arms reported high levels of engagement and acceptability. Participants reported using the program for an average of 36.4 (SD 3.4) days for the intervention arm and 36.0 (SD 3.9) days for the control arm. Four of the 50 participants in the intervention arm (8%) reset the quit date and 19 (38%) texted the keyword TIPS. The majority of participants in both arms reported that they always or usually read the text messages. Compared to the control arm, a higher proportion of participants in the intervention arm reported being satisfied with the program (98% [49/50] vs 82% [41/50]). Biochemically verified abstinence was higher in the intervention arm at 6 weeks (20% [10/50] vs 2% [1/50]; P=.01), but the effect was not significant at 12 weeks (12% [6/50] vs 6% [3/50]; P=.49). In-depth interviews conducted after the RCT suggested additional modifications to enhance the program including tailoring the timing of messages, adding more opportunities to interact with the program, and placing a greater emphasis on messages that described the harms of smoking. Conclusions: The study supported the feasibility and acceptability of an SMS program adapted for Vietnamese smokers. Future studies need to assess whether, with additional modifications, the program is associated with prolonged abstinence. Trial Registration: ClinicalTrials.gov NCT03219541; https://clinicaltrials.gov/ct2/show/NCT03219541 %M 34623318 %R 10.2196/27478 %U https://mhealth.jmir.org/2021/10/e27478 %U https://doi.org/10.2196/27478 %U http://www.ncbi.nlm.nih.gov/pubmed/34623318 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e23204 %T Development of a Mobile Health Application for HIV Prevention Among At-Risk Populations in Urban Settings in East Africa: A Participatory Design Approach %A Mauka,Wilhellmuss %A Mbotwa,Christopher %A Moen,Kåre %A Lichtwarck,Hanne Ochieng %A Haaland,Inga %A Kazaura,Method %A Leyna,Germana H %A Leshabari,Melkizedeck T %A Mmbaga,Elia J %+ Department of Behavioural Science, Muhimbili University of Health and Allied Sciences, PO Box 65015, Dar es Salaam, United Republic of Tanzania, 255 763225717, wilhemauka@yahoo.com %K mHealth application %K participatory design %K HIV %K pre-exposure prophylaxis %K Africa %K female sex workers %K sex and gender minorities %D 2021 %7 7.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There is limited evidence in Africa on the design and development of mobile health (mHealth) applications to guide best practices and ensure effectiveness. A pragmatic trial for HIV pre-exposure prophylaxis roll-out among key populations in Tanzania is needed. Objective: We present the results of the development of a mobile app (Jichunge) intended to promote adherence to pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and female sex workers (FSW) in Tanzania. Methods: A participatory design approach was employed and guided by the information system research framework. MSM and FSW were the target populations. A total of 15 MSM and 15 FSW were engaged in the relevance and design cycles, while the piloting phase included 10 MSM and 20 FSW. Results: The relevance cycle enabled the description of the existing problem, provided the compatible app features for the target population, and identified the need to develop an mHealth app that provides health services in a stigmatizing and discriminating environment. User involvement in the app’s design and evaluation provided an opportunity to incorporate social, cultural, and community-specific features that ensured usability. In addition, the participants suggested valuable information to inform the app, text message services, medication registration, and chat platform designs. Conclusions: The participatory design approach in the development of mHealth apps is useful in identifying and validating population-specific functional features, improve usability, and ensuring future health impacts. Through this participatory process, the Jichunge app took end-user needs, perspectives, and experiences into account, eliciting enthusiasm regarding its potential role in supporting pre-exposure prophylaxis adherence for HIV and related behavioral change promotion. Trial Registration: International Clinical Trials Registry Platform PACTR202003823226570; https://trialsearch.who.int/Trial2.aspx?TrialID=PACTR202003823226570 %M 34617904 %R 10.2196/23204 %U https://formative.jmir.org/2021/10/e23204 %U https://doi.org/10.2196/23204 %U http://www.ncbi.nlm.nih.gov/pubmed/34617904 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30947 %T mHealth Messaging to Motivate Quitline Use and Quitting: Protocol for a Community-Based Randomized Controlled Trial in Rural Vietnam %A Larkin,Celine %A Wijesundara,Jessica %A Nguyen,Hoa L %A Ha,Duc Anh %A Vuong,Anh %A Nguyen,Cuong Kieu %A Amante,Daniel %A Ngo,Chau Quy %A Phan,Phuong Thu %A Pham,Quyen Thi Le %A Nguyen,Binh Ngoc %A Nguyen,Anh Thi Phuong %A Nguyen,Phuong Thi Thu %A Person,Sharina %A Allison,Jeroan J %A Houston,Thomas K %A Sadasivam,Rajani %+ Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 5084211436, celine.larkin@umassmed.edu %K tobacco cessation %K smoking cessation %K mHealth %K global health %K Vietnam %K randomized controlled trial %D 2021 %7 7.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tobacco kills more than 8 million people each year, mostly in low- and middle-income countries. In Vietnam, 1 in every 2 male adults smokes tobacco. Vietnam has set up telephone Quitline counseling that is available to all smokers, but it is underused. We previously developed an automated and effective motivational text messaging system to support smoking cessation among US smokers. Objective: The aim of this study is to adapt the aforementioned system for rural Vietnamese smokers to promote cessation of tobacco use, both directly and by increasing the use of telephone Quitline counseling services and nicotine replacement therapy. Moreover, we seek to enhance research and health service capacity in Vietnam. Methods: We are testing the effectiveness of our culturally adapted motivational text messaging system by using a community-based randomized controlled trial design (N=600). Participants were randomly allocated to the intervention (regular motivational and assessment text messages) or control condition (assessment text messages only) for a period of 6 months. Trial recruitment took place in four communes in the Hung Yen province in the Red River Delta region of Vietnam. Recruitment events were advertised to the local community, facilitated by community health workers, and occurred in the commune health center. We are assessing the impact of the texting system on 6-month self-reported and biochemically verified smoking cessation, as well as smoking self-efficacy, uptake of the Quitline, and use of nicotine replacement therapy. In addition to conducting the trial, the research team also provided ongoing training and consultation with the Quitline during the study period. Results: Site preparation, staff training, intervention adaptation, participant recruitment, and baseline data collection were completed. The study was funded in August 2017; it was reviewed and approved by the University of Massachusetts Medical School Institutional Review Board in 2017. Recruitment began in November 2018. A total of 750 participants were recruited from four communes, and 700 (93.3%) participants completed follow-up by March 2021. An analysis of the trial results is in progress; results are expected to be published in late 2022. Conclusions: This study examines the effectiveness of mobile health interventions for smoking in rural areas in low- and middle-income countries, which can be implemented nationwide if proven effective. In addition, it also facilitates significant collaboration and capacity building among a variety of international partners, including researchers, policy makers, Quitline counselors, and community health workers. Trial Registration: ClinicalTrials.gov NCT03567993; https://clinicaltrials.gov/ct2/show/NCT03567993. International Registered Report Identifier (IRRID): DERR1-10.2196/30947 %M 34617915 %R 10.2196/30947 %U https://www.researchprotocols.org/2021/10/e30947 %U https://doi.org/10.2196/30947 %U http://www.ncbi.nlm.nih.gov/pubmed/34617915 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e26712 %T The Functionality of Mobile Apps for Anxiety: Systematic Search and Analysis of Engagement and Tailoring Features %A Balaskas,Andreas %A Schueller,Stephen M %A Cox,Anna L %A Doherty,Gavin %+ School of Computer Science and Statistics, Trinity College Dublin, College Green, Dublin, Ireland, 353 01 8963858, Gavin.Doherty@tcd.ie %K mental health %K cognitive behavioral therapy %K mobile apps %K anxiety %K stress %K mHealth %K mobile phone %D 2021 %7 6.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A range of mobile apps for anxiety have been developed in response to the high prevalence of anxiety disorders. Although the number of publicly available apps for anxiety is increasing, attrition rates among mobile apps are high. These apps must be engaging and relevant to end users to be effective; thus, engagement features and the ability to tailor delivery to the needs of individual users are key. However, our understanding of the functionality of these apps concerning engagement and tailoring features is limited. Objective: The aim of this study is to review how cognitive behavioral elements are delivered by anxiety apps and their functionalities to support user engagement and tailoring based on user needs. Methods: A systematic search for anxiety apps described as being based on cognitive behavioral therapy (CBT) was conducted on Android and iPhone marketplaces. Apps were included if they mentioned the use of CBT for anxiety-related disorders. We identified 597 apps, of which 36 met the inclusion criteria and were reviewed through direct use. Results: Cognitive behavioral apps for anxiety incorporate a variety of functionalities, offer several engagement features, and integrate low-intensity CBT exercises. However, the provision of features to support engagement is highly uneven, and support is provided only for low-intensity CBT treatment. Cognitive behavioral elements combine various modalities to deliver intervention content and support the interactive delivery of these elements. Options for personalization are limited and restricted to goal selection upon beginning use or based on self-monitoring entries. Apps do not appear to provide individualized content to users based on their input. Conclusions: Engagement and tailoring features can be significantly expanded in existing apps, which make limited use of social features and clinical support and do not use sophisticated features such as personalization based on sensor data. To guide the evolution of these interventions, further research is needed to explore the effectiveness of different types of engagement features and approaches to tailoring therapeutic content. %M 34612833 %R 10.2196/26712 %U https://mhealth.jmir.org/2021/10/e26712 %U https://doi.org/10.2196/26712 %U http://www.ncbi.nlm.nih.gov/pubmed/34612833 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e26226 %T Features That Middle-aged and Older Cancer Survivors Want in Web-Based Healthy Lifestyle Interventions: Qualitative Descriptive Study %A Ivankova,Nataliya V %A Rogers,Laura Q %A Herbey,Ivan I %A Martin,Michelle Y %A Pisu,Maria %A Pekmezi,Dorothy %A Thompson,Lieu %A Schoenberger-Godwin,Yu-Mei M %A Oster,Robert A %A Fontaine,Kevin %A Anderson,Jami L %A Kenzik,Kelly %A Farrell,David %A Demark-Wahnefried,Wendy %+ Department of Health Services Administration, University of Alabama at Birmingham, SHPB 569, 1720 2nd Avenue South, Birmingham, AL, 35294-1212, United States, 1 12059962422, nivankov@uab.edu %K cancer survivors %K diet %K physical activity %K lifestyle %K internet %K interventions %K qualitative %K eHealth %K mobile phone %D 2021 %7 6.10.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: With the increasing number of older cancer survivors, it is imperative to optimize the reach of interventions that promote healthy lifestyles. Web-based delivery holds promise for increasing the reach of such interventions with the rapid increase in internet use among older adults. However, few studies have explored the views of middle-aged and older cancer survivors on this approach and potential variations in these views by gender or rural and urban residence. Objective: The aim of this study was to explore the views of middle-aged and older cancer survivors regarding the features of web-based healthy lifestyle programs to inform the development of a web-based diet and exercise intervention. Methods: Using a qualitative descriptive approach, we conducted 10 focus groups with 57 cancer survivors recruited from hospital cancer registries in 1 southeastern US state. Data were analyzed using inductive thematic and content analyses with NVivo (version 12.5, QSR International). Results: A total of 29 male and 28 female urban and rural dwelling Black and White survivors, with a mean age of 65 (SD 8.27) years, shared their views about a web-based healthy lifestyle program for cancer survivors. Five themes emerged related to program content, design, delivery, participation, technology training, and receiving feedback. Cancer survivors felt that web-based healthy lifestyle programs for cancer survivors must deliver credible, high-quality, and individually tailored information, as recommended by health care professionals or content experts. Urban survivors were more concerned about information reliability, whereas women were more likely to trust physicians’ recommendations. Male and rural survivors wanted information to be tailored to the cancer type and age group. Privacy, usability, interaction frequency, and session length were important factors for engaging cancer survivors with a web-based program. Female and rural participants liked the interactive nature and visual appeal of the e-learning sessions. Learning from experts, an attractive design, flexible schedule, and opportunity to interact with other cancer survivors in Facebook closed groups emerged as factors promoting program participation. Low computer literacy, lack of experience with web program features, and concerns about Facebook group privacy were important concerns influencing cancer survivors’ potential participation. Participants noted the importance of technology training, preferring individualized help to standardized computer classes. More rural cancer survivors acknowledged the need to learn how to use computers. The receipt of regular feedback about progress was noted as encouragement toward goal achievement, whereas women were particularly interested in receiving immediate feedback to stay motivated. Conclusions: Important considerations for designing web-based healthy lifestyle interventions for middle-aged and older cancer survivors include program quality, participants’ privacy, ease of use, attractive design, and the prominent role of health care providers and content experts. Cancer survivors’ preferences based on gender and residence should be considered to promote program participation. %M 34612832 %R 10.2196/26226 %U https://cancer.jmir.org/2021/4/e26226 %U https://doi.org/10.2196/26226 %U http://www.ncbi.nlm.nih.gov/pubmed/34612832 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e25217 %T Feasibility of a Mobile Health App for Routine Outcome Monitoring and Feedback in SMART Recovery Mutual Support Groups: Stage 1 Mixed Methods Pilot Study %A Kelly,Peter J %A Beck,Alison K %A Deane,Frank P %A Larance,Briony %A Baker,Amanda L %A Hides,Leanne %A Manning,Victoria %A Shakeshaft,Anthony %A Neale,Joanne %A Kelly,John F %A Oldmeadow,Christopher %A Searles,Andrew %A Palazzi,Kerrin %A Lawson,Kenny %A Treloar,Carla %A Gray,Rebecca M %A Argent,Angela %A McGlaughlin,Ryan %+ School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Northfields Ave, Wollongong, 2522, Australia, 61 2 4239 2382, alisonbe@uow.edu.au %K mHealth %K SMART Recovery %K mutual support group %K mutual aid %K routine outcome monitoring %K treatment progress feedback %K addiction %K mobile phone %D 2021 %7 6.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mutual support groups are an important source of long-term help for people impacted by addictive behaviors. Routine outcome monitoring (ROM) and feedback are yet to be implemented in these settings. SMART Recovery mutual support groups focus on self-empowerment and use evidence-based techniques (eg, motivational and behavioral strategies). Trained facilitators lead all SMART Recovery groups, providing an opportunity to implement ROM. Objective: The aim of this stage 1 pilot study is to explore the feasibility, acceptability, and preliminary outcomes of a novel, purpose-built mobile health ROM and feedback app (SMART Track) in mutual support groups coordinated by SMART Recovery Australia (SRAU) over 8 weeks. Methods: SMART Track was developed during phase 1 of this study using participatory design methods and an iterative development process. During phase 2, 72 SRAU group participants were recruited to a nonrandomized, prospective, single-arm trial of the SMART Track app. Four modes of data collection were used: ROM data directly entered by participants into the app; app data analytics captured by Amplitude Analytics (number of visits, number of unique users, visit duration, time of visit, and user retention); baseline, 2-, and 8-week follow-up assessments conducted through telephone; and qualitative telephone interviews with a convenience sample of study participants (20/72, 28%) and facilitators (n=8). Results: Of the 72 study participants, 68 (94%) created a SMART Track account, 64 (88%) used SMART Track at least once, and 42 (58%) used the app for more than 5 weeks. During week 1, 83% (60/72) of participants entered ROM data for one or more outcomes, decreasing to 31% (22/72) by the end of 8 weeks. The two main screens designed to provide personal feedback data (Urges screen and Overall Progress screen) were the most frequently visited sections of the app. Qualitative feedback from participants and facilitators supported the acceptability of SMART Track and the need for improved integration into the SRAU groups. Participants reported significant reductions between the baseline and 8- week scores on the Severity of Dependence Scale (mean difference 1.93, SD 3.02; 95% CI 1.12-2.73) and the Kessler Psychological Distress Scale-10 (mean difference 3.96, SD 8.31; 95% CI 1.75-6.17), but no change on the Substance Use Recovery Evaluator (mean difference 0.11, SD 7.97; 95% CI –2.02 to 2.24) was reported. Conclusions: Findings support the feasibility, acceptability, and utility of SMART Track. Given that sustained engagement with mobile health apps is notoriously difficult to achieve, our findings are promising. SMART Track offers a potential solution for ROM and personal feedback, particularly for people with substance use disorders who attend mutual support groups. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000686101; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377336 International Registered Report Identifier (IRRID): RR2-10.2196/15113 %M 34612829 %R 10.2196/25217 %U https://www.jmir.org/2021/10/e25217 %U https://doi.org/10.2196/25217 %U http://www.ncbi.nlm.nih.gov/pubmed/34612829 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e31273 %T Supporting Mental Health During the COVID-19 Pandemic Using a Digital Behavior Change Intervention: An Open-Label, Single-Arm, Pre-Post Intervention Study %A Summers,Charlotte %A Wu,Philip %A Taylor,Alisdair J G %+ DDM Health, Technology House, Science Park, University of Warwick, Coventry, CV4 7EZ, United Kingdom, 44 7969091134, charlotte@ddm.health %K stress %K mental health %K COVID-19 %K digital therapy %K mHealth %K support %K behavior %K intervention %K online intervention %K outcome %K wellbeing %K sleep %K activity %K nutrition %D 2021 %7 6.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic is taking a toll on people’s mental health, particularly as people are advised to adhere to social distancing, self-isolation measures, and government-imposed national lockdowns. Digital health technologies have an important role to play in keeping people connected and in supporting their mental health and well-being. Even before the COVID-19 pandemic, mental health and social services were already strained. Objective: Our objective was to evaluate the 12-week outcomes of the digitally delivered Gro Health intervention, a holistic digital behavior change app designed for self-management of mental well-being, sleep, activity, and nutrition. Methods: The study used a quasi-experimental research design consisting of an open-label, single-arm, pre-post intervention engagement using a convenience sample. Adults who had joined the Gro Health app (intervention) and had a complete baseline dataset (ie, 7-item Generalized Anxiety Disorder scale, Perceived Stress Scale, and 9-item Patient Health Questionnaire) were followed up at 12 weeks (n=273), including 33 (12.1%) app users who reported a positive COVID-19 diagnosis during the study period. User engagement with the Gro Health platform was tracked by measuring total minutes of app engagement. Paired t tests were used to compare pre-post intervention scores. Linear regression analysis was performed to assess the relationship between minutes of active engagement with the Gro Health app and changes in scores across the different mental health measures. Results: Of the 347 study participants, 273 (78.67%) completed both the baseline and follow-up surveys. Changes in scores for anxiety, perceived stress, and depression were predicted by app engagement, with the strongest effect observed for changes in perceived stress score (F1,271=251.397; R2=0.479; P<.001). Conclusions: A digital behavior change platform that provides remote mental well-being support can be effective in managing depression, anxiety, and perceived stress during times of crisis such as the current COVID-19 pandemic. The outcomes of this study may also support the implementation of remote digital health apps supporting behavior change and providing support for low levels of mental health within the community. %M 34459740 %R 10.2196/31273 %U https://formative.jmir.org/2021/10/e31273 %U https://doi.org/10.2196/31273 %U http://www.ncbi.nlm.nih.gov/pubmed/34459740 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e27417 %T Smoking Protective and Risk Factors Among Transgender and Gender-Expansive Individuals (Project SPRING): Qualitative Study Using Digital Photovoice %A Tan,Andy SL %A Gazarian,Priscilla K %A Darwish,Sabreen %A Hanby,Elaine %A Farnham,Bethany C %A Koroma-Coker,Faith A %A Potter,Jennifer %A Ballout,Suha %+ Annenberg School for Communication, University of Pennsylvania, 3620 Walnut Street, Annenberg School at UPenn, Philadelphia, PA, 19104, United States, 1 4436161129, andy.tan@asc.upenn.edu %K transgender and gender expansive populations %K tobacco-related health disparities %K United States %D 2021 %7 6.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Transgender and gender-expansive (TGE) adults are twice as likely to smoke cigarettes than cisgender individuals. There is a critical gap in research on effective and culturally sensitive approaches to reduce smoking prevalence among TGE adults. Objective: This study aims to qualitatively examine the risk and protective factors of cigarette smoking among TGE adults through real-world exemplars. Methods: We conducted a digital photovoice study among a purposeful sample of 47 TGE adults aged ≥18 years and currently smoking in the United States (March 2019-April 2020). Participants uploaded photos daily that depicted smoking risk and protective factors they experienced over 21 days on either private Facebook or Instagram groups. Next, we conducted separate focus group discussions to explore the experiences of these factors among a subset of participants from each group. We analyzed participants’ photos, captions, and focus group transcripts and generated themes associated with smoking risk and protective factors. Results: We identified 6 major themes of risk and protective factors of smoking among TGE individuals: experience of stress, gender affirmation, health consciousness, social influences, routine behaviors, and environmental cues. We describe and illustrate each theme using exemplar photos and quotes. Conclusions: The findings of this study will inform future community-engaged research to develop culturally tailored interventions to reduce smoking prevalence among TGE individuals. %M 34612842 %R 10.2196/27417 %U https://publichealth.jmir.org/2021/10/e27417 %U https://doi.org/10.2196/27417 %U http://www.ncbi.nlm.nih.gov/pubmed/34612842 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30339 %T A Guided Internet-Based Problem-Solving Intervention Delivered Through Smartphones for Secondary School Pupils During the COVID-19 Pandemic in India: Protocol for a Pilot Randomized Controlled Trial %A Gonsalves,Pattie P %A Sharma,Rhea %A Hodgson,Eleanor %A Bhat,Bhargav %A Jambhale,Abhijeet %A Weiss,Helen A %A Fairburn,Christopher G %A Cavanagh,Kate %A Cuijpers,Pim %A Michelson,Daniel %A Patel,Vikram %+ Sangath, E-5, Lane 1, Westend Marg, Saiyad ul ajaib, Saket, New Delhi, 110030, India, 91 9899419704, pattie.gonsalves@sangath.in %K randomized controlled trial %K internet-based intervention %K smartphone %K adolescent %K schools %K mental health %K COVID-19 %K app %K protocol %K problem-solving %K intervention %K teenager %K young adult %K India %K feasibility %K effective %D 2021 %7 6.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: “POD Adventures” is a gamified mental health intervention delivered via a smartphone app and supported by counsellors for a target population of secondary school students in India. This paper describes the protocol for a pilot randomized controlled trial of a remotely delivered version of the intervention in the context of COVID-19 restrictions. Objective: Our objectives are to assess the feasibility of research procedures and intervention delivery and to generate preliminary estimates of the effectiveness of the intervention to inform the sample size calculation of a full-scale trial. Methods: We will conduct a parallel, 2-arm, individually randomized pilot controlled trial in 11 secondary schools in Goa, India. This pilot trial aims to recruit 70 participants with a felt need for psychological support. Participants will receive either the POD Adventures intervention delivered over 4 weeks or usual care comprising information about local mental health services and national helplines. Outcomes will be assessed at two timepoints: baseline and 6 weeks post randomization. Results: The first participant was enrolled on January 28, 2021, and 6-week assessment completed on April 4, 2021. Owing to a second wave of the COVID-19 pandemic in India, schools in Goa were closed on April 22, 2021. Trial participants are currently receiving the intervention or completing follow-up assessments. Conclusions: This pilot trial will help understand the feasibility of implementing and evaluating a remotely delivered digital mental health intervention in a low-resource setting. Our findings will be used to design future trials that can address difficulties of accessing psychosocial support in-person and support wider efforts to scale up evidence-based mental health interventions for young people. Trial Registration: ClinicalTrials.gov NCT04672486; https://clinicaltrials.gov/ct2/show/NCT04672486 International Registered Report Identifier (IRRID): DERR1-10.2196/30339 %M 34586075 %R 10.2196/30339 %U https://www.researchprotocols.org/2021/10/e30339 %U https://doi.org/10.2196/30339 %U http://www.ncbi.nlm.nih.gov/pubmed/34586075 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e30871 %T Post-COVID Public Health Surveillance and Privacy Expectations in the United States: Scenario-Based Interview Study %A Seberger,John S %A Patil,Sameer %+ College of Communication Arts & Sciences, Michigan State University, 404 Wilson Rd, East Lansing, MI, 48824, United States, 1 (517) 416 0743, seberge1@msu.edu %K COVID-19 %K pandemic-tracking apps %K privacy concerns %K infrastructure %K health surveillance %K scenario %K interview %K thematic analysis %D 2021 %7 5.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone-based apps designed and deployed to mitigate the COVID-19 pandemic may become infrastructure for postpandemic public health surveillance in the United States. Through the lenses of privacy concerns and user expectations of digital pandemic mitigation techniques, we identified possible long-term sociotechnical implications of such an infrastructure. Objective: We explored how people in the United States perceive the possible routinization of pandemic tracking apps for public health surveillance in general. Our interdisciplinary analysis focused on the interplay between privacy concerns, data practices of surveillance capitalism, and trust in health care providers. We conducted this analysis to achieve a richer understanding of the sociotechnical issues raised by the deployment and use of technology for pandemic mitigation. Methods: We conducted scenario-based, semistructured interviews (n=19) with adults in the United States. The interviews focused on how people perceive the short- and long-term privacy concerns associated with a fictional smart thermometer app deployed to mitigate the “outbreak of a contagious disease.” In order to elicit future-oriented discussions, the scenario indicated that the app would continue functioning “after the disease outbreak has dissipated.” We analyzed interview transcripts using reflexive thematic analysis. Results: In the context of pandemic mitigation technology, including app-based tracking, people perceive a core trade-off between public health and personal privacy. People tend to rationalize this trade-off by invoking the concept of “the greater good.” The interplay between the trade-off and rationalization forms the core of sociotechnical issues that pandemic mitigation technologies raise. Participants routinely expected that data collected through apps related to public health would be shared with unknown third parties for the financial gain of the app makers. This expectation suggests a perceived alignment between an app-based infrastructure for public health surveillance and the broader economics of surveillance capitalism. Our results highlight unintended and unexpected sociotechnical impacts of routinizing app-based tracking on postpandemic life, which are rationalized by invoking a nebulous concept of the greater good. Conclusions: While technologies such as app-based tracking could be useful for pandemic mitigation and preparedness, the routinization of such apps as a form of public health surveillance may have broader, unintentional sociotechnical implications for individuals and the societies in which they live. Although technology has the potential to increase the efficacy of pandemic mitigation, it exists within a broader network of sociotechnical concerns. Therefore, it is necessary to consider the long-term implications of pandemic mitigation technologies beyond the immediate needs of addressing the COVID-19 pandemic. Potential negative consequences include the erosion of patient trust in health care systems and providers, grounded in concerns about privacy violations and overly broad surveillance. %M 34519667 %R 10.2196/30871 %U https://mhealth.jmir.org/2021/10/e30871 %U https://doi.org/10.2196/30871 %U http://www.ncbi.nlm.nih.gov/pubmed/34519667 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e17811 %T Young People’s Experiences of Engaging With Fitspiration on Instagram: Gendered Perspective %A Mayoh,Joanne %A Jones,Ian %+ Department of Sport and Event Management, Bournemouth University, Fern Barrow, Poole, BH12 5BB, United Kingdom, 44 1202968385, jmayoh@bournemouth.ac.uk %K social media %K gender %K physical fitness %K women’s health %K men’s health %K body ideals %D 2021 %7 4.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Fitness inspiration or fitspiration is a term used to describe web-based images of fit people, people in the gym, health foods, or inspirational quotes relating to diet and fitness being shared and consumed via visual social media. The popularity of this content is most notable via the Instagram platform. Currently, the majority of fitspiration research has focused on women’s experiences; however, increasingly, studies have pointed to the need to explore the gendered ways by which people engage with this content. Objective: The aim of this study is to explore how young men and women engage in fitspiration content on Instagram and provide a gendered analysis of how and why they consume this content. Methods: This study used a cross-sectional web-based survey (N=1213) of UK-based fitspiration users aged 18-24 years consisting of closed-ended questions to capture quantitative data. Results: The majority actively using Instagram for fitspiration (therefore eligible participants) were women (826/1175, 70.30%). Men were more likely to view content posted by athletes (χ21, N=1153=71.8; P=.001) and bodybuilders (χ21, N=1153=32.8; P<.001), whereas women were more likely to view content related to weight loss (χ21, N=1153=36.8; P<.001), diet plans (χ21, N=1153=11.9; P<.001), and celebrities’ content (χ21, N=1153=33.5; P<.001). Men were more likely to use fitspiration as a source of inspiration to exercise to gain muscle or get stronger (χ21, N=1147=17.9; P<.001), whereas women were more likely to use fitspiration as inspiration for healthy eating (χ21, N=1147=37.7; P<.001), or to exercise to diet or lose weight (χ21, N=1147=13.5; P<.001). Women were more likely to engage in passive behaviors such as viewing content on their feed (χ21, N=1139=7.9; P=.005) or scrolling through accounts (χ21, N=1139=15.2; P<.001), whereas men were more likely to engage in active consumption by tagging fitspiration accounts in posts (χ21, N=1139=7.2; P=.007), commenting on posts (χ21, N=1139=8.1; P=.004), and posting fitspiration content (χ21, N=1139=6.4; P=.01). Conclusions: Female fitspiration consumers engaged with content that reinforced the feminine thin but shapely ideal, whereas male users sought out content that reinforced the masculine muscular ideal. Male users were more likely to engage actively with content (eg, posting fitspiration content), while female users were more likely to engage passively (eg, scrolling through accounts, posts, or images). Future research should consider how fitspiration consumption reflects and reproduces oppressive gender ideology. %M 34605768 %R 10.2196/17811 %U https://www.jmir.org/2021/10/e17811 %U https://doi.org/10.2196/17811 %U http://www.ncbi.nlm.nih.gov/pubmed/34605768 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e27769 %T Delivery Outcomes During the COVID-19 Pandemic as Reported in a Pregnancy Mobile App: Retrospective Cohort Study %A Noddin,Katie %A Bradley,Dani %A Wolfberg,Adam %+ Ovia Health, 308 Congress St, Boston, MA, 02210, United States, 1 3392032545, katie@oviahealth.com %K digital health %K COVID-19 %K maternal health %K obstetrics %K COVID %K pandemic %K pregnant women %K birth %K hospital %K delivery %K women's health %K Cesarean sections %D 2021 %7 4.10.2021 %9 Short Paper %J JMIR Pediatr Parent %G English %X Background: The COVID-19 pandemic has presented obstacles for providers and patients in the maternal health care setting, causing changes to many pregnant women’s birth plans, as well as abrupt changes in hospital labor and delivery policies and procedures. Few data exist on the effects of the COVID-19 pandemic on the maternal health care landscape at the national level in the United States. Objective: The aim of this study is to assess the incidence of key obstetrics outcomes (preterm delivery, Cesarean sections, and home births) and length of hospital stay during the COVID-19 pandemic as compared to the 6 months prior. Methods: We conducted a retrospective cohort study of women aged 18-44 years in the United States who delivered between October 1, 2019, and September 30, 2020, had singleton deliveries, and completed a birth report in the Ovia Pregnancy mobile app. Women were assigned to the prepandemic cohort if they delivered between October 2019 and March 2020, and the pandemic cohort if they delivered between April and September 2020. Gestational age at delivery, delivery method, delivery facility type, and length of hospital stay were compared. Results: A total of 304,023 birth reports were collected, with 152,832 (50.26%) in the prepandemic cohort and 151,191 (49.73%) in the pandemic cohort. Compared to the prepandemic cohort, principal findings indicate a 5.67% decrease in preterm delivery rates in the pandemic cohort (P<.001; odds ratio [OR] 0.94, 95% CI 0.91-0.96), a 30.0% increase in home birth rates (P<.001; OR 1.3, 95% CI 1.23-1.4), and a 7.81% decrease in the average hospital length of stay postdelivery (mean 2.48 days, SD 1.35). There were no overall changes in Cesarean section rates between cohorts, but differences were observed between age, race, and ethnicity subgroups. Conclusions: Results suggest a need for continuous monitoring of maternal health trends as the COVID-19 pandemic progresses and underline the important role of digital data collection, particularly during the pandemic. %M 34509975 %R 10.2196/27769 %U https://pediatrics.jmir.org/2021/4/e27769 %U https://doi.org/10.2196/27769 %U http://www.ncbi.nlm.nih.gov/pubmed/34509975 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e27358 %T A Novel Mobile App (“CareFit”) to Support Informal Caregivers to Undertake Regular Physical Activity From Home During and Beyond COVID-19 Restrictions: Co-design and Prototype Development Study %A Egan,Kieren J %A Hodgson,William %A Dunlop,Mark D %A Imperatore,Gennaro %A Kirk,Alison %A Maguire,Roma %+ Department of Computer and Information Science, University of Strathclyde, Livingstone Tower, 26 Richmond Street, Glasgow, G1 1XH, United Kingdom, 44 0141 548 3138, kieren.egan@strath.ac.uk %K physical activity %K Android %K COVID-19 %K intervention %K co-design %K exercise %K app %K development %K support %K caregiver %D 2021 %7 1.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Informal caregivers, or carers (unpaid family members and friends), are instrumental to millions worldwide for the ongoing delivery of health and well-being needs. The risk of crisis points (eg, hospitalizations) for caregivers increases with the absence of physical activity. The COVID-19 pandemic is highly likely to have increased the risk of crisis points for caregivers by increasing the amount of time spent indoors due to shielding and lockdown restrictions. Thus, accessible evidence-based tools to facilitate physical activity for caregivers indoors are urgently needed. Objective: The aim of this study was to co-design and develop a novel mobile app to educate and support carers in the undertaking of regular physical activity at home during and beyond COVID-19 restrictions via integration of the transtheoretical model of behavior change and UK physical activity guidelines. Methods: We co-designed a mobile app, “CareFit,” by directly involving caregivers, health care professionals, and social care professionals in the requirements, capturing, and evaluation phases of three Agile Scrum design and development sprints. Seven participants representing multistakeholder views took part in three co-design sessions, each of which was followed by a development sprint. Requirements for CareFit were grounded in a combination of behavioral change science and UK government guidelines for physical activity. Results: Participants identified different barriers and enablers to physical activity, such as a lack of time, recognition of existing activities, and concerns regarding safely undertaking physical activity. Requirements analysis highlighted the importance of simplicity in design and a need to anchor development around the everyday needs of caregivers (eg, easy-to-use video instructions). Our final prototype app integrated guidance for undertaking physical activity at home through educational, physical activity, and communication components. Conclusions: Integrating government guidelines with models of behavioral change into a mobile app to support the physical activity of carers is novel. We found that integrating core physical activity guidelines into a co-designed smartphone app with functionality such as a weekly planner and educational material for users is feasible. This work holds promise to fill the gap of effective physical activity solutions for caregivers both during and beyond the COVID-19 pandemic. Further work is now needed to explore the feasibility, acceptability, and usability of the approach in real-world settings. %M 34406969 %R 10.2196/27358 %U https://formative.jmir.org/2021/10/e27358 %U https://doi.org/10.2196/27358 %U http://www.ncbi.nlm.nih.gov/pubmed/34406969 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26418 %T Psychoeducational Messaging to Reduce Alcohol Use for College Students With Type 1 Diabetes: Internet-Delivered Pilot Trial %A Wisk,Lauren E %A Magane,Kara M %A Nelson,Eliza B %A Tsevat,Rebecca K %A Levy,Sharon %A Weitzman,Elissa R %+ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, United States, 1 3102675308, lwisk@mednet.ucla.edu %K adolescent %K young adult %K diabetes mellitus %K type 1 %K binge drinking %K alcohol drinking %K self care %K risk-taking %K universities %K students %K attitude %K mobile phone %D 2021 %7 30.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: College environments promote high-volume or binge alcohol consumption among youth, which may be especially harmful to those with type 1 diabetes (T1D). Little is known about the acceptability and effectiveness of interventions targeting reduced alcohol use by college students with T1D, and it is unclear whether intervention framing (specifically, the narrator of intervention messages) matters with respect to affecting behavior change. Interventions promoted by peer educators may be highly relatable and socially persuasive, whereas those delivered by clinical providers may be highly credible and motivating. Objective: The aim of this study is to determine the acceptability and impacts of an alcohol use psychoeducational intervention delivered asynchronously through web-based channels to college students with T1D. The secondary aim is to compare the impacts of two competing versions of the intervention that differed by narrator (peer vs clinician). Methods: We recruited 138 college students (aged 17-25 years) with T1D through web-based channels and delivered a brief intervention to participants randomly assigned to 1 of 2 versions that differed only with respect to the audiovisually recorded narrator. We assessed the impacts of the exposure to the intervention overall and by group, comparing the levels of alcohol- and diabetes-related knowledge, perceptions, and use among baseline, immediately after the intervention, and 2 weeks after intervention delivery. Results: Of the 138 enrolled participants, 122 (88.4%) completed all follow-up assessments; the participants were predominantly women (98/122, 80.3%), were White non-Hispanic (102/122, 83.6%), and had consumed alcohol in the past year (101/122, 82.8%). Both arms saw significant postintervention gains in the knowledge of alcohol’s impacts on diabetes-related factors, health-protecting attitudes toward drinking, and concerns about drinking. All participants reported significant decreases in binge drinking 2 weeks after the intervention (21.3%; odds ratio 0.48, 95% CI 0.31-0.75) compared with the 2 weeks before the intervention (43/122, 35.2%). Changes in binge drinking after the intervention were affected by changes in concerns about alcohol use and T1D. Those who viewed the provider narrator were significantly more likely to rate their narrator as knowledgeable and trustworthy; there were no other significant differences in intervention effects by the narrator. Conclusions: The intervention model was highly acceptable and effective at reducing self-reported binge drinking at follow-up, offering the potential for broad dissemination and reach given the web-based format and contactless, on-demand content. Both intervention narrators increased knowledge, improved health-protecting attitudes, and increased concerns regarding alcohol use. The participants’ perceptions of expertise and credibility differed by narrator. Trial Registration: ClinicalTrials.gov NCT02883829; https://clinicaltrials.gov/ct2/show/NCT02883829 International Registered Report Identifier (IRRID): RR2-10.1177/1932296819839503 %M 34591022 %R 10.2196/26418 %U https://www.jmir.org/2021/9/e26418 %U https://doi.org/10.2196/26418 %U http://www.ncbi.nlm.nih.gov/pubmed/34591022 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27093 %T Exploring the Associations Between Self-reported Tendencies Toward Smartphone Use Disorder and Objective Recordings of Smartphone, Instant Messaging, and Social Networking App Usage: Correlational Study %A Marengo,Davide %A Sariyska,Rayna %A Schmitt,Helena Sophia %A Messner,Eva-Maria %A Baumeister,Harald %A Brand,Matthias %A Kannen,Christopher %A Montag,Christian %+ Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, Helmholtzstraße 8/1, Ulm, 89081, Germany, 49 07315026550, christian.montag@uni-ulm.de %K smartphone use disorder %K smartphone use %K social media %K objective measures %K mediation model %K smartphone %K web-based communication %K social networking %K mobile phone %D 2021 %7 30.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Social communication via instant messaging (IM) and social networking (SN) apps makes up a large part of the time that smartphone users spend on their devices. Previous research has indicated that the excessive use of these apps is positively associated with problematic smartphone use behaviors. In particular, image-based SN apps, such as Instagram (Facebook Inc) and Snapchat (Snap Inc), have been shown to exert stronger detrimental effects than those exerted by traditional apps, such as Facebook (Facebook Inc) and Twitter (Twitter Inc). Objective: In this study, we investigated the correlation between individuals’ tendencies toward smartphone use disorder (SmUD) and objective measures of the frequency of smartphone usage. Additionally, we put to test the hypothesis that the pathway linking the frequency of actual smartphone usage to self-reported tendencies toward SmUD was mediated by the increased frequency of IM and SN app usage. Methods: We recruited a sample of 124 adult smartphone users (females: 78/124, 62.9%; age: mean 23.84 years, SD 8.29 years) and collected objective information about the frequency of smartphone and SN app usage over 1 week. Participants also filled in a self-report measure for assessing the multiple components of tendencies toward SmUD. Bivariate associations were investigated by using Spearman correlation analyses. A parallel mediation analysis was conducted via multiple regression analysis. Results: The frequency of smartphone usage, as well as the use of IM apps (Messenger, Telegram, and WhatsApp [Facebook Inc]), Facebook, and image-based apps (Instagram and Snapchat), had significant positive associations with at least 1 component of SmUD, and the cyberspace-oriented relationships factor exhibited the strongest associations overall. We found support for an indirect effect that linked actual smartphone usage to SmUD tendencies via the frequency of the use of image-based SN apps. Conclusions: Our novel results shed light on the factors that promote SmUD tendencies and essentially indicate that image-based SN apps seem to be more strongly associated with problematic smartphone behaviors compared to IM apps and traditional SN apps, such as Facebook. %M 34591025 %R 10.2196/27093 %U https://www.jmir.org/2021/9/e27093 %U https://doi.org/10.2196/27093 %U http://www.ncbi.nlm.nih.gov/pubmed/34591025 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e24560 %T Prevention of Suicidal Relapses in Adolescents With a Smartphone Application: Bayesian Network Analysis of a Preclinical Trial Using In Silico Patient Simulations %A Mouchabac,Stephane %A Leray,Philippe %A Adrien,Vladimir %A Gollier-Briant,Fanny %A Bonnot,Olivier %+ Department of Child and Adolescent Psychiatry, Centre hospitalier universitaire de Nantes, 30 boulevard Jean Monnet, Nantes, 44000, France, 33 4323232, olivier.bonnot@chu-nantes.fr %K suicide %K bayesian network %K smartphone application %K digital psychiatry %K artificial intelligence %D 2021 %7 30.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Recently, artificial intelligence technologies and machine learning methods have offered attractive prospects to design and manage crisis response processes, especially in suicide crisis management. In other domains, most algorithms are based on big data to help diagnose and suggest rational treatment options in medicine. But data in psychiatry are related to behavior and clinical evaluation. They are more heterogeneous, less objective, and incomplete compared to other fields of medicine. Consequently, the use of psychiatric clinical data may lead to less accurate and sometimes impossible-to-build algorithms and provide inefficient digital tools. In this case, the Bayesian network (BN) might be helpful and accurate when constructed from expert knowledge. Medical Companion is a government-funded smartphone application based on repeated questions posed to the subject and algorithm-matched advice to prevent relapse of suicide attempts within several months. Objective: Our paper aims to present our development of a BN algorithm as a medical device in accordance with the American Psychiatric Association digital healthcare guidelines and to provide results from a preclinical phase. Methods: The experts are psychiatrists working in university hospitals who are experienced and trained in managing suicidal crises. As recommended when building a BN, we divided the process into 2 tasks. Task 1 is structure determination, representing the qualitative part of the BN. The factors were chosen for their known and demonstrated link with suicidal risk in the literature (clinical, behavioral, and psychometrics) and therapeutic accuracy (advice). Task 2 is parameter elicitation, with the conditional probabilities corresponding to the quantitative part. The 4-step simulation (use case) process allowed us to ensure that the advice was adapted to the clinical states of patients and the context. Results: For task 1, in this formative part, we defined clinical questions related to the mental state of the patients, and we proposed specific factors related to the questions. Subsequently, we suggested specific advice related to the patient’s state. We obtained a structure for the BN with a graphical representation of causal relations between variables. For task 2, several runs of simulations confirmed the a priori model of experts regarding mental state, refining the precision of our model. Moreover, we noticed that the advice had the same distribution as the previous state and was clinically relevant. After 2 rounds of simulation, the experts found the exact match. Conclusions: BN is an efficient methodology to build an algorithm for a digital assistant dedicated to suicidal crisis management. Digital psychiatry is an emerging field, but it needs validation and testing before being used with patients. Similar to psychotropics, any medical device requires a phase II (preclinical) trial. With this method, we propose another step to respond to the American Psychiatric Association guidelines. Trial Registration: ClinicalTrials.gov NCT03975881; https://clinicaltrials.gov/ct2/show/NCT03975881 %M 34591030 %R 10.2196/24560 %U https://www.jmir.org/2021/9/e24560 %U https://doi.org/10.2196/24560 %U http://www.ncbi.nlm.nih.gov/pubmed/34591030 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e31185 %T A Technology-Based Training Tool for a Health Promotion and Sex Education Program for Justice-Involved Youth: Development and Usability Study %A Snow-Hill,Nyssa L %A Donenberg,Geri %A Feil,Edward G %A Smith,David R %A Floyd,Brenikki R %A Leve,Craig %+ Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois at Chicago, 818 South Wolcott Avenue, MC 579 Box #7, SRH 6th Floor, Chicago, IL, 60612, United States, 1 312 413 2712, nyssa@uic.edu %K health education %K sexual behavior %K juvenile delinquency %K feasibility studies %K evidence-based practice %K adolescent health services %K inservice training %K implementation science %K organizational innovation %K technology %K risk reduction behavior %K mobile phone %K health technology %K health promotion %K sexual health %D 2021 %7 30.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Justice-involved youth are especially vulnerable to mental health distress, substance misuse, and risky sexual activity, amplifying the need for evidence-based programs (EBPs). Yet, uptake of EBPs in the justice system is challenging because staff training is costly in time and effort. Hence, justice-involved youth experience increasing health disparities despite the availability of EBPs. Objective: To counter these challenges, this study develops and pilot-tests a prototype of a technology-based training tool that teaches juvenile justice staff to deliver a uniquely tailored EBP for justice-involved youth—PHAT (Preventing HIV/AIDS Among Teens) Life. PHAT Life is a comprehensive sex education, mental health, and substance use EBP collaboratively designed and tested with guidance from key stakeholders and community members. The training tool addresses implementation barriers that impede uptake and sustainment of EBPs, including staff training and support and implementation costs. Methods: Staff (n=11) from two juvenile justice settings pilot-tested the technology-based training tool, which included five modules. Participants completed measures of HIV and sexually transmitted infection (STI) knowledge, sex education confidence, and implementation outcomes such as training satisfaction, adoption, implementation, acceptability, appropriateness, and sustainability. PHAT Life trainers assessed fidelity through two activity role plays participants submitted upon completing the training modules. Results: Participants demonstrated increases in HIV and STI knowledge (t10=3.07; P=.01), and were very satisfied (mean 4.42, SD 0.36) with the training tool and the PHAT Life curriculum. They believed that the training tool and curriculum could be adopted, implemented, and sustained within their settings as an appropriate and acceptable intervention and training. Conclusions: Overall, the results from this pilot test demonstrate feasibility and support continuing efforts toward completing the training tool and evaluating it within a fully powered randomized controlled trial. Ultimately, this study will provide a scalable option for disseminating an EBP and offers a more cost-effective and sustainable way to train staff in an EBP. %M 34591028 %R 10.2196/31185 %U https://formative.jmir.org/2021/9/e31185 %U https://doi.org/10.2196/31185 %U http://www.ncbi.nlm.nih.gov/pubmed/34591028 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27801 %T Remote Patient Monitoring and Incentives to Support Smoking Cessation Among Pregnant and Postpartum Medicaid Members: Three Randomized Controlled Pilot Studies %A Joyce,Caroline M %A Saulsgiver,Kathryn %A Mohanty,Salini %A Bachireddy,Chethan %A Molfetta,Carin %A Steffy,Mary %A Yoder,Alice %A Buttenheim,Alison M %+ Department of Epidemiology, Faculty of Medicine, McGill University, 845 Sherbrooke Street W, Montreal, QC, H3A 0G4, Canada, 1 514 398 6258, Caroline.joyce@mail.mcgill.ca %K maternal smoking %K smoking cessation %K financial incentives %K smoking %K pregnant %K postpartum %K incentives %K mHealth %K mobile health %K mobile phone %K smart devices %D 2021 %7 30.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking rates among low-income individuals, including those eligible for Medicaid, have not shown the same decrease that is observed among high-income individuals. The rate of smoking among pregnant women enrolled in Medicaid is almost twice that among privately insured women, which leads to significant disparities in birth outcomes and a disproportionate cost burden placed on Medicaid. Several states have identified maternal smoking as a key target for improving birth outcomes and reducing health care expenditures; however, efficacious, cost-effective, and feasible cessation programs have been elusive. Objective: This study aims to examine the feasibility, acceptability, and effectiveness of a smartwatch-enabled, incentive-based smoking cessation program for Medicaid-eligible pregnant smokers. Methods: Pilot 1 included a randomized pilot study of smartwatch-enabled remote monitoring versus no remote monitoring for 12 weeks. Those in the intervention group also received the SmokeBeat program. Pilot 2 included a randomized pilot study of pay-to-wear versus pay-to-quit for 4 weeks. Those in a pay-to-wear program could earn daily incentives for wearing the smartwatch, whereas those in pay-to-quit program could earn daily incentives if they wore the smartwatch and abstained from smoking. Pilot 3, similar to pilot 2, had higher incentives and a duration of 3 weeks. Results: For pilot 1 (N=27), self-reported cigarettes per week among the intervention group declined by 15.1 (SD 27) cigarettes over the study; a similar reduction was observed in the control group with a decrease of 17.2 (SD 19) cigarettes. For pilot 2 (N=8), self-reported cigarettes per week among the pay-to-wear group decreased by 43 cigarettes (SD 12.6); a similar reduction was seen in the pay-to-quit group, with an average of 31 (SD 45.6) fewer cigarettes smoked per week. For pilot 3 (N=4), one participant in the pay-to-quit group abstained from smoking for the full study duration and received full incentives. Conclusions: Decreases in smoking were observed in both the control and intervention groups during all pilots. The use of the SmokeBeat program did not significantly improve cessation. The SmokeBeat program, remote cotinine testing, and remote delivery of financial incentives were considered feasible and acceptable. Implementation challenges remain for providing evidence-based cessation incentives to low-income pregnant smokers. The feasibility and acceptability of the SmokeBeat program were moderately high. Moreover, the feasibility and acceptability of remote cotinine testing and the remotely delivered contingent financial incentives were successful. Trial Registration: ClinicalTrials.gov NCT03209557; https://clinicaltrials.gov/ct2/show/NCT03209557. %M 34591023 %R 10.2196/27801 %U https://formative.jmir.org/2021/9/e27801 %U https://doi.org/10.2196/27801 %U http://www.ncbi.nlm.nih.gov/pubmed/34591023 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27787 %T Smartphone Technology to Empower People Experiencing Homelessness: Secondary Analysis %A Thurman,Whitney %A Semwal,Monika %A Moczygemba,Leticia R %A Hilbelink,Mark %+ School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, 78701, United States, 1 5126573855, wthurman@utexas.edu %K homelessness %K self-management %K smartphone technology %K social needs %K mobile phone %D 2021 %7 29.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In the United States, the number of people experiencing homelessness has continually increased over the last 3 years. Homelessness is associated with poor health, and people experiencing homelessness are often burdened with high rates of chronic and mental health conditions, functional limitations, and cognitive impairment. Despite the high burden of chronic illness and functional limitations, there is limited literature exploring self-management among homeless populations. Objective: This study aims to investigate how access to smartphone technology facilitates self-management, including the attainment of social needs within the context of homelessness. Methods: A secondary analysis of 33 exit interviews from 2 feasibility studies related to mobile health interventions among people experiencing homelessness was conducted. Iterative thematic analysis was used to identify themes representative of participants’ experiences using smartphone technology. Results: Collectively, participants revealed not only how the context of homelessness constrained their ability to engage in activities necessary to self-manage health and meet social needs but also how consistent and predictable access to the tools available through a smartphone changed their behaviors and outlook. The global theme of empowered by technology was identified and defined as how having a smartphone with a plan for unlimited text, calling, data, and transportation allowed participants to navigate homelessness and facilitated self-management. Conclusions: People experiencing homelessness used the tools on a smartphone to make decisions, take action, solve problems, and use the resources—skills necessary for fulfilling tasks required for effective self-management. Further, consistent access to smartphone technology and transportation empowered participants to meet the requirements for the attainment of social needs. %M 34586073 %R 10.2196/27787 %U https://www.jmir.org/2021/9/e27787 %U https://doi.org/10.2196/27787 %U http://www.ncbi.nlm.nih.gov/pubmed/34586073 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e25837 %T Development, Feasibility, Acceptability, and Utility of an Expressive Speech-Enabled Digital Health Agent to Deliver Online, Brief Motivational Interviewing for Alcohol Misuse: Descriptive Study %A Boustani,Maya %A Lunn,Stephanie %A Visser,Ubbo %A Lisetti,Christine %+ Department of Psychology, Loma Linda University, 11130 Anderson St, Suite 117, Loma Linda, CA, 92350, United States, 1 909 558 7680, mboustani@llu.edu %K digital health agent %K virtual health assistant %K online intervention %K alcohol abuse %K brief intervention %K motivational interviewing %K intelligent virtual agent %K embodied conversational agent %D 2021 %7 29.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health agents — embodied conversational agents designed specifically for health interventions — provide a promising alternative or supplement to behavioral health services by reducing barriers to access to care. Objective: Our goals were to (1) develop an expressive, speech-enabled digital health agent operating in a 3-dimensional virtual environment to deliver a brief behavioral health intervention over the internet to reduce alcohol use and to (2) understand its acceptability, feasibility, and utility with its end users. Methods: We developed an expressive, speech-enabled digital health agent with facial expressions and body gestures operating in a 3-dimensional virtual office and able to deliver a brief behavioral health intervention over the internet to reduce alcohol use. We then asked 51 alcohol users to report on the digital health agent acceptability, feasibility, and utility. Results: The developed digital health agent uses speech recognition and a model of empathetic verbal and nonverbal behaviors to engage the user, and its performance enabled it to successfully deliver a brief behavioral health intervention over the internet to reduce alcohol use. Descriptive statistics indicated that participants had overwhelmingly positive experiences with the digital health agent, including engagement with the technology, acceptance, perceived utility, and intent to use the technology. Illustrative qualitative quotes provided further insight about the potential reach and impact of digital health agents in behavioral health care. Conclusions: Web-delivered interventions delivered by expressive, speech-enabled digital health agents may provide an exciting complement or alternative to traditional one-on-one treatment. They may be especially helpful for hard-to-reach communities with behavioral workforce shortages. %M 34586074 %R 10.2196/25837 %U https://www.jmir.org/2021/9/e25837 %U https://doi.org/10.2196/25837 %U http://www.ncbi.nlm.nih.gov/pubmed/34586074 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e23237 %T Introducing an Integrated Model of Adults’ Wearable Activity Tracker Use and Obesity Information–Seeking Behaviors From a National Quota Sample Survey %A Kim,Bokyung %A Hong,Seoyeon %A Kim,Sungwook %+ Department of Public Relations & Advertising, Ric Edelman College of Communication & Creative Arts, Rowan University, 301 High St, Room 322, Glassboro, NJ, 08028, United States, 1 8562564293, kimb@rowan.edu %K wearable activity tracker %K wearable health technology %K obesity %K health belief %K health belief model %K Technology Acceptance Model %K online information seeking %D 2021 %7 29.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Research from multiple perspectives to investigate adults’ use of wearable activity-tracking devices is limited. We offer a multiperspective model and provide empirical evidence of what leads to frequent usage of wearable health technologies from a large, nationally representative survey sample. Objective: This study aims to explore factors affecting the use of wearable activity-tracking devices among health consumers from the perspectives of individual health beliefs (perceived severity, perceived susceptibility, perceived benefits, and self-efficacy) and information-seeking behaviors. Methods: Our Integrated Model of Wearable Activity Tracker (IMWAT) use and proposed hypotheses were validated and tested with data collected from a telephone survey with a national quota sample. The data were analyzed using a variety of statistical techniques, including structural equation analysis. Results: The sample comprised 2006 participants. Our results showed that the perceived benefits of physical activity, perceived susceptibility, and self-efficacy toward obesity were significant predictors of information-seeking behaviors, which, in turn, mediated their effects on the use of wearable activity trackers. Perceptions of obesity severity directly promoted wearable device usage. Conclusions: This study provided a new and powerful theoretical model that combined the health beliefs and information-seeking behaviors behind the use of wearable activity trackers in the adult population. The findings provide meaningful implications for developers and designers of wearable health technology products and will assist health informatics practitioners and obesity prevention communicators. %M 34586076 %R 10.2196/23237 %U https://formative.jmir.org/2021/9/e23237 %U https://doi.org/10.2196/23237 %U http://www.ncbi.nlm.nih.gov/pubmed/34586076 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29412 %T Just-in-Time Adaptive Mechanisms of Popular Mobile Apps for Individuals With Depression: Systematic App Search and Literature Review %A Teepe,Gisbert W %A Da Fonseca,Ashish %A Kleim,Birgit %A Jacobson,Nicholas C %A Salamanca Sanabria,Alicia %A Tudor Car,Lorainne %A Fleisch,Elgar %A Kowatsch,Tobias %+ Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Weinbergstrasse 56/58, Zurich, 8092, Switzerland, 41 76 419 09 91, gteepe@ethz.ch %K depression %K digital mental health %K smartphone applications %K just-in-time adaptive interventions %K effectiveness %K mobile phone %D 2021 %7 28.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of smartphone apps that focus on the prevention, diagnosis, and treatment of depression is increasing. A promising approach to increase the effectiveness of the apps while reducing the individual’s burden is the use of just-in-time adaptive intervention (JITAI) mechanisms. JITAIs are designed to improve the effectiveness of the intervention and reduce the burden on the person using the intervention by providing the right type of support at the right time. The right type of support and the right time are determined by measuring the state of vulnerability and the state of receptivity, respectively. Objective: The aim of this study is to systematically assess the use of JITAI mechanisms in popular apps for individuals with depression. Methods: We systematically searched for apps addressing depression in the Apple App Store and Google Play Store, as well as in curated lists from the Anxiety and Depression Association of America, the United Kingdom National Health Service, and the American Psychological Association in August 2020. The relevant apps were ranked according to the number of reviews (Apple App Store) or downloads (Google Play Store). For each app, 2 authors separately reviewed all publications concerning the app found within scientific databases (PubMed, Cochrane Register of Controlled Trials, PsycINFO, Google Scholar, IEEE Xplore, Web of Science, ACM Portal, and Science Direct), publications cited on the app’s website, information on the app’s website, and the app itself. All types of measurements (eg, open questions, closed questions, and device analytics) found in the apps were recorded and reviewed. Results: None of the 28 reviewed apps used JITAI mechanisms to tailor content to situations, states, or individuals. Of the 28 apps, 3 (11%) did not use any measurements, 20 (71%) exclusively used self-reports that were insufficient to leverage the full potential of the JITAIs, and the 5 (18%) apps using self-reports and passive measurements used them as progress or task indicators only. Although 34% (23/68) of the reviewed publications investigated the effectiveness of the apps and 21% (14/68) investigated their efficacy, no publication mentioned or evaluated JITAI mechanisms. Conclusions: Promising JITAI mechanisms have not yet been translated into mainstream depression apps. Although the wide range of passive measurements available from smartphones were rarely used, self-reported outcomes were used by 71% (20/28) of the apps. However, in both cases, the measured outcomes were not used to tailor content and timing along a state of vulnerability or receptivity. Owing to this lack of tailoring to individual, state, or situation, we argue that the apps cannot be considered JITAIs. The lack of publications investigating whether JITAI mechanisms lead to an increase in the effectiveness or efficacy of the apps highlights the need for further research, especially in real-world apps. %M 34309569 %R 10.2196/29412 %U https://www.jmir.org/2021/9/e29412 %U https://doi.org/10.2196/29412 %U http://www.ncbi.nlm.nih.gov/pubmed/34309569 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e20520 %T Use of a Mobile Lifestyle Intervention App as an Early Intervention for Adolescents With Obesity: Single-Cohort Study %A Chew,Chu Shan Elaine %A Davis,Courtney %A Lim,Jie Kai Ethel %A Lim,Chee Meng Micheal %A Tan,Yi Zhen Henny %A Oh,Jean Yin %A Rajasegaran,Kumudhini %A Chia,Yong Hwa Michael %A Finkelstein,Eric Andrew %+ KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore, 65 62255554, elaine.chew.c.s@singhealth.com.sg %K pediatric obesity %K mobile health %K apps %K health behavior %K mHealth %K obesity %K adolescent %K lifestyle %K well-being %K mobile phone %D 2021 %7 28.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective, resource-efficient treatment is urgently needed to address the high rates of pediatric and adolescent obesity. This need has been accelerated by the COVID-19 pandemic. The use of a mobile health tool as an early intervention before a clinic-based multidisciplinary weight management program could be an effective treatment strategy that is appropriate during a pandemic. Objective: This study aims to assess the effectiveness of and adolescent engagement with a mobile app–based lifestyle intervention program as an early intervention before enrollment in a clinic-based multidisciplinary weight management program. Methods: This prospective single-cohort study involved adolescents, aged 10-16 years, who were overweight and obese (defined as BMI percentile above the 85th percentile). Participants used the mobile Kurbo app as an early intervention before enrolling in a clinic-based multidisciplinary weight management program. Kurbo’s health coaches provided weekly individual coaching informed by a model of supportive accountability via video chat, and participants self-monitored their health behavior. The implementation of Kurbo as an early intervention was evaluated using the reach, effectiveness, adoption, implementation, and maintenance framework by reach (number who consented to participate out of all patients approached), implementation (Kurbo engagement and evaluation), and effectiveness as measured by the primary outcome of the BMI z-score at 3 months. Secondary outcome measures included changes in body fat percentage, nutrition and physical activity levels, and quality of life at 3 months. Maintenance was defined as the outcome measures at 6-month follow-up. Results: Of the 73 adolescents who were approached for enrollment, 40 (55%) of adolescents were recruited. The mean age was 13.8 (SD 1.7) years, and the mean BMI z-score was 2.07 (SD 0.30). In the multiethnic Asian sample, 83% (33/40) of the participants had household incomes below the national median. Kurbo engagement was high, with 83% (33/40) of participants completing at least 7 coaching sessions. In total, 78% (18/23) of participants rated the app as good to excellent and 70% (16/23) stated that they would recommend it to others. There were no statistically significant changes in BMI z-scores at 3 months (P=.19) or 6 months (P=.27). Participants showed statistically significant improvements in measured body fat percentage, self-reported quality of life, and self-reported caloric intake from the 3-day food diaries at 3 and 6 months. Conclusions: The use of Kurbo before enrollment in an outpatient multidisciplinary clinical care intervention is a feasible strategy to expand the reach of adolescent obesity management services to a low-income and racially diverse population. Although there was no significant change in BMI z-scores, the use of Kurbo as an early intervention could help to improve quality of life and reduce body fat percentage and total caloric intake. %M 34581672 %R 10.2196/20520 %U https://www.jmir.org/2021/9/e20520 %U https://doi.org/10.2196/20520 %U http://www.ncbi.nlm.nih.gov/pubmed/34581672 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e28538 %T Health Care Provider Perspectives on the Use of a Digital Behavioral Health App to Support Patients: Qualitative Study %A Silfee,Valerie %A Williams,Kelly %A Leber,Brett %A Kogan,Jane %A Nikolajski,Cara %A Szigethy,Eva %A Serio,Catherine %+ UPMC Health Plan, U.S. Steel Tower, 600 Grant Street, Pittsburgh, PA, 15219, United States, 1 4124549008, silfeev@upmc.edu %K digital health %K mHealth %K implementation %K cognitive behavioral therapy %K anxiety %K depression %K smartphone %K mobile phone %D 2021 %7 28.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the growing evidence indicating the efficacy of digital cognitive behavioral interventions (dCBIs) for behavioral health (BH) treatment, broad and consistent use of such interventions has been limited by knowledge obtained in real-world settings, including factors that impact provider uptake/referral. Engaging providers early in the implementation process offers an opportunity to explore their needs and behaviors, integrate interventions into workflows, and better understand provider setting capabilities. Objective: This study assessed providers’ views on the feasibility and acceptability of delivering a cognitive behavioral therapy (CBT)-based mobile app in multiple care settings. Methods: Participating providers included BH and physical health (PH) providers from a women’s health center, an outpatient BH clinic, and both rural/urban primary care settings. All participating providers cocreated workflows through facilitated workshops, including establishing feedback loops between the project team and providers and identifying clinical champions at each site. Over a 12-week period, the providers referred adult patients experiencing anxiety or depression to a mobile app-based dCBI, RxWell, and provided other indicated treatments as part of usual care. Referrals were completed by the providers through the electronic medical record. To better understand facilitators of and challenges in integrating RxWell into routine practice and perceptions of sustainability, a series of qualitative interviews was conducted. Interview data were analyzed to identify major themes using an inductive content analysis approach. Results: A total of 19 provider interviews were conducted to discover motivators and barriers for referring RxWell. The providers benefited from a focused discussion on how to incorporate the referral process into their workflow, and knowing the app content was rooted in evidence. Although the providers believed engaging in experiential learning was important, they indicated that more education on the digital health coach role and how to monitor patient progress is needed. The providers thought patient engagement may be impacted by motivation, a lack of comfort using a smartphone, or preference for in-person therapy. The providers also expressed enthusiasm in continuing to refer the app. They liked the ability to provide patients with support between sessions, to have an extra treatment option that teaches BH exercises, and to have a CBT treatment option that overcomes barriers (eg, wait times, copays, travel) to traditional therapy modalities. Conclusions: Digital intervention success in health care settings relies heavily on engagement of key stakeholders, such as providers, in both design and implementation of the intervention and focused evaluation within intended care setting(s). Scaling digital interventions to meet the mental health needs of patients in usual care settings leans on thoughtfully constructed and streamlined workflows to enable seamless referral of patients by providers. Our findings strongly suggest that providers are supportive of digital tool integration to support the mental health of patients and endorse its use within their routine workflow. %M 34529583 %R 10.2196/28538 %U https://formative.jmir.org/2021/9/e28538 %U https://doi.org/10.2196/28538 %U http://www.ncbi.nlm.nih.gov/pubmed/34529583 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e29694 %T Reactivity to UV Radiation Exposure Monitoring Using Personal Exposure Devices for Skin Cancer Prevention: Longitudinal Observational Study %A Parsons,Bridget G %A Nagelhout,Elizabeth S %A Wankier,Ali P %A Hu,Nan %A Lensink,Riley %A Zhu,Angela %A Nottingham,Katy %A Grossman,Douglas %A Jensen,Jakob D %A Wu,Yelena P %+ Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, United States, 1 801 213 5653, yelena.wu@utah.edu %K ultraviolet radiation exposure %K wearable device %K melanoma %K melanoma prevention %K mHealth %K digital health %K eHealth %K UVR monitoring %K mobile phone %D 2021 %7 28.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Emerging UV radiation (UVR) monitoring devices may present an opportunity to integrate such technology into skin cancer prevention interventions. However, little is known about the effects of using a wearable UVR monitor on adults’ and children’s sun protection–related behaviors and attitudes (eg, cancer worry and perceived risk). Understanding the potential role of reactivity and seasonal effects will help inform the use of objective monitors in the context of skin cancer prevention research, including intervention studies. Objective: The aim of this study is to examine the potential reactivity associated with a wearable personal UVR monitor, specifically the effects associated with reported sun-protective behaviors and skin cancer–related attitudes, which are often the targets of skin cancer preventive interventions. Methods: Child-parent dyads (n=97 dyads) were asked to wear a UVR monitoring device during waking hours for 2 weeks. Participants were asked to sync the device daily with a smartphone app that stored the UVR exposure data. Participants were blinded to their UVR exposure data during the 2-week period; thus, the smartphone app provided no feedback to the participants on their UVR exposure. Participants completed self-report questionnaires assessing sun-protective behaviors, sunburn, tanning, skin self-examination, skin cancer–related knowledge, perceived risk, cancer worry, response efficacy, and intentions to change behaviors over the 2-week period. Linear regressions were conducted to investigate changes in the outcomes over time and to account for the role of the season of study participation. Results: Regression results revealed that there was a significant decrease over time for several sun protection outcomes in children, including time spent outdoors on weekends (P=.02) and weekdays (P=.008), sunscreen use (P=.03), reapplication (P<.001), and unintentional tanning (P<.001). There were no significant changes over time in children’s and parents’ UVR exposure, sunburn occurrence, or sun protection attitudes. Season of participation was associated with several outcomes, including lower sunscreen use (P<.001), reapplication (P<.001), sunburns (P=.01), intentions to change sun-protective behaviors (P=.02), and intentional (P=.008) and unintentional tanning (P=.01) for participants who participated in the fall versus the summer. Conclusions: The findings from this study suggest that daily use of a UVR monitoring device over a 2-week period may result in changes in certain sun-protective behaviors. These results highlight the importance of identifying and addressing potential reactivity to UVR monitoring devices, especially in the context of skin cancer preventive intervention research. Ultimately, objectively assessed UVR exposure could be integrated into the outcome assessment for future testing of skin cancer prevention interventions. %M 34581683 %R 10.2196/29694 %U https://mhealth.jmir.org/2021/9/e29694 %U https://doi.org/10.2196/29694 %U http://www.ncbi.nlm.nih.gov/pubmed/34581683 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e27535 %T Effects of an Artificial Intelligence–Assisted Health Program on Workers With Neck/Shoulder Pain/Stiffness and Low Back Pain: Randomized Controlled Trial %A Anan,Tomomi %A Kajiki,Shigeyuki %A Oka,Hiroyuki %A Fujii,Tomoko %A Kawamata,Kayo %A Mori,Koji %A Matsudaira,Ko %+ Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan, 81 93 691 7523, skajiki@med.uoeh-u.ac.jp %K neck pain %K shoulder pain %K shoulder stiffness %K low back pain %K musculoskeletal symptoms %K digital intervention %K mobile app %K mHealth %K eHealth %K digital health %K mobile phone %D 2021 %7 24.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Musculoskeletal symptoms such as neck and shoulder pain/stiffness and low back pain are common health problems in the working population. They are the leading causes of presenteeism (employees being physically present at work but unable to be fully engaged). Recently, digital interventions have begun to be used to manage health but their effectiveness has not yet been fully verified, and adherence to such programs is always a problem. Objective: This study aimed to evaluate the improvements in musculoskeletal symptoms in workers with neck/shoulder stiffness/pain and low back pain after the use of an exercise-based artificial intelligence (AI)–assisted interactive health promotion system that operates through a mobile messaging app (the AI-assisted health program). We expected that this program would support participants’ adherence to exercises. Methods: We conducted a two-armed, randomized, controlled, and unblinded trial in workers with either neck/shoulder stiffness/pain or low back pain or both. We recruited participants with these symptoms through email notifications. The intervention group received the AI-assisted health program, in which the chatbot sent messages to users with the exercise instructions at a fixed time every day through the smartphone’s chatting app (LINE) for 12 weeks. The program was fully automated. The control group continued with their usual care routines. We assessed the subjective severity of the neck and shoulder pain/stiffness and low back pain of the participants by using a scoring scale of 1 to 5 for both the intervention group and the control group at baseline and after 12 weeks of intervention by using a web-based form. We used a logistic regression model to calculate the odds ratios (ORs) of the intervention group to achieve to reduce pain scores with those of the control group, and the ORs of the subjective assessment of the improvement of the symptoms compared to the intervention and control groups, which were performed using Stata software (version 16, StataCorp LLC). Results: We analyzed 48 participants in the intervention group and 46 participants in the control group. The adherence rate was 92% (44/48) during the intervention. The participants in the intervention group showed significant improvements in the severity of the neck/shoulder pain/stiffness and low back pain compared to those in the control group (OR 6.36, 95% CI 2.57-15.73; P<.001). Based on the subjective assessment of the improvement of the pain/stiffness at 12 weeks, 36 (75%) out of 48 participants in the intervention group and 3 (7%) out of 46 participants in the control group showed improvements (improved, slightly improved) (OR 43.00, 95% CI 11.25-164.28; P<.001). Conclusions: This study shows that the short exercises provided by the AI-assisted health program improved both neck/shoulder pain/stiffness and low back pain in 12 weeks. Further studies are needed to identify the elements contributing to the successful outcome of the AI-assisted health program. Trial Registration: University hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) 000033894; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000038307. %M 34559054 %R 10.2196/27535 %U https://mhealth.jmir.org/2021/9/e27535 %U https://doi.org/10.2196/27535 %U http://www.ncbi.nlm.nih.gov/pubmed/34559054 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e29928 %T mHealth Interventions for Lifestyle and Risk Factor Modification in Coronary Heart Disease: Randomized Controlled Trial %A Bae,Jang-Whan %A Woo,Seoung-Il %A Lee,Joongyub %A Park,Sang-Don %A Kwon,Sung Woo %A Choi,Seong Huan %A Yoon,Gwang-Seok %A Kim,Mi-Sook %A Hwang,Seung-Sik %A Lee,Won Kyung %+ Department of Prevention and Management, School of Medicine, Inha University Hospital, Inha University, 27 Inhang-Ro, Jung-Gu, Incheon, Republic of Korea, 82 10 6360 7965, bluewhale65@gmail.com %K coronary heart disease %K prevention %K lifestyle modification %K mobile health %K text message %K mHealth %D 2021 %7 24.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Self-management of lifestyle and cardiovascular disease risk factors is challenging in older patients with coronary heart disease (CHD). SMS text messaging could be a potential support tool for self-management and the most affordable and accessible method through a mobile phone. High-quality evidence had been lacking, and previous studies evaluated the effects of SMS text messaging on the subjective measures of short-term outcomes. Recently, a large-sized randomized controlled trial in Australia reported promising findings on the objective measures upon 6-month follow-up. However, an examination of the effectiveness of such interventions in an Asian population with unique demographic characteristics would be worthwhile. Objective: This study examined the effectiveness of a 1-way SMS text messaging program to modify the lifestyle and cardiovascular disease risk factors of patients who underwent the first percutaneous coronary intervention (PCI). Methods: A parallel, single-blinded, 1:1 random allocation clinical trial was conducted with 879 patients treated through PCI. They were recruited during hospital admission from April 2017 to May 2020 at 2 university hospitals in the Republic of Korea. In addition to standard care, the intervention group received access to a supporting website and 4 SMS text messages per week for 6 months regarding a healthy diet, physical activity, smoking cessation, and cardiovascular health. Random allocation upon study enrollment and SMS text messaging after hospital discharge were performed automatically using a computer program. The coprimary outcomes were low-density-lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), and BMI. The secondary outcomes were change in lifestyle and adherence to the recommended health behaviors. Results: Of the eligible population, 440 and 439 patients who underwent PCI were assigned to the intervention and control groups, respectively. The 1-way SMS text messaging program significantly enhanced physical activity (P=.02), healthy diet (P<.01), and medication adherence (P<.04) among patients with CHD. Hence, more people were likely to control their cardiovascular disease risk factors per the recommendations. The intervention group was more likely to control all 5 risk factors by 62% (relative risk 1.62, 95% CI 1.05-2.50) per the recommendations. On the other hand, physiological measures of the primary outcomes, including LDL-C levels, SBP, and BMI, were not significant. Most participants found the SMS text messaging program useful and helpful in motivating lifestyle changes. Conclusions: Lifestyle-focused SMS text messages were effective in the self-management of a healthy diet, exercise, and medication adherence, but their influence on the physiological measures was not significant. One-way SMS text messages can be used as an affordable adjuvant method for lifestyle modification to help prevent the recurrence of cardiovascular disease. Trial Registration: Clinical Research Information Service (CRiS) KCT0005087; https://cris.nih.go.kr/cris/search/detailSearch.do/19282 %M 34559058 %R 10.2196/29928 %U https://mhealth.jmir.org/2021/9/e29928 %U https://doi.org/10.2196/29928 %U http://www.ncbi.nlm.nih.gov/pubmed/34559058 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e24671 %T Attitudes Toward the Environment and Use of Information and Communication Technologies to Address Environmental Health Risks in Marginalized Communities: Prospective Cohort Study %A Perez-Ramos,Jose G %A McIntosh,Scott %A Barrett,Emily S %A Velez Vega,Carmen M %A Dye,Timothy D %+ Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Ave, Box 668, Rochester, NY, 14622, United States, 1 5852768755, j.perezramos@rochester.edu %K community engagement %K environmental health risk %K epidemiology %K ICT %K mHealth %K mobile phone %K Puerto Rico %D 2021 %7 23.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Information and communication technologies, including mobile health (mHealth), can help isolated communities address environmental health challenges. The Puerto Rican island of Culebra has faced multiple sociopolitical and economic factors that have distressed the island’s environment and health. Culebrenses are technologically engaged and have demonstrated a use of technology that transcends socioeconomic barriers. As a result, technological interventions could potentially help manage environmental risks on the island. Objective: This study aims to test and evaluate the potential benefits of an mHealth tool, termed ¡mZAP! (Zonas, Acción y Protección), for engaging communities with environmental risks through technology. Methods: Participants using ¡mZAP! (N=111) were surveyed. Bivariate analyses were used to examine associations of mHealth use with sociodemographics, technology use, an adapted environmental attitudes inventory, and the multidimensional health locus of control. Logistic regression was used to examine associations between attitudes toward environmental health risks and mHealth use. Results: Higher positive attitudes toward the environment were significantly associated with the use of ¡mZAP! (odds ratio 5.3, 95% CI 1.6-17.0). Environmental attitudes were also associated with the multidimensional health locus of control powerful others subscale (P=.02), indicating that attitudes toward the environment become more negative as feelings controlled by others increase. Participants felt that the authorities would resolve the challenges (63/111, 56.7%). Conclusions: Perceived lack of control could present barriers to collective actions to address salient environmental health challenges in communities. The ongoing dependency on government-based solutions to community problems is worrisome, especially after the hurricane experiences of 2017 (which may potentially continue to be an issue subsequent to the more recent 2020 earthquakes). %M 34554103 %R 10.2196/24671 %U https://www.jmir.org/2021/9/e24671 %U https://doi.org/10.2196/24671 %U http://www.ncbi.nlm.nih.gov/pubmed/34554103 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e29110 %T Low Carb Program Health App Within a Hospital-Based Obesity Setting: Observational Service Evaluation %A Hanson,Petra %A Summers,Charlotte %A Panesar,Arjun %A Oduro-Donkor,Dominic %A Lange,Maria %A Menon,Vinod %A Barber,Thomas M %+ DDM Health, Technology House, Science Park, University of Warwick, Coventry, CV4 7EZ, United Kingdom, 44 2476712201, charlotte@ddm.health %K obesity %K low carb program %K eHealth %K mobile app %K digital health %K health intervention %K mobile health %K COVID-19 %D 2021 %7 23.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Obesity underlies much chronic disease. Digitalization of obesity management provides an opportunity to innovate our traditional model of health care delivery within this setting, and to transform its scalability potentially to the population level. Objective: The objective was to assess the feasibility and effectiveness of the Low Carb Program app for weight loss, applied within our hospital-based (tier 3) obesity service. Due to the disrupting effects of the COVID-19 pandemic on our obesity service, we compared the clinical outcomes from the Low Carb Program app applied in the context of remote patient appointments over the telephone with the prepandemic traditional standard of care. Methods: We invited patients who attended our hospital-based obesity service to engage with the Low Carb Program smartphone app. We combined this approach with remote delivery (over the telephone) of obesity management from medical and psychology members of our obesity team during the COVID-19 pandemic. Outcome variables included changes in body weight and changes in HbA1c as a marker of glycemic control. We compared data from the Low Carb Program group with a retrospective control group (n=126) that had received traditional face-to-face obesity management from our team without concomitant use of the Low Carb Program app in the pre–COVID-19 era. T test comparisons were employed, with P<.05 considered significant. Results: The mean weight of participants (n=105) was 130.2 kg, with 59% (n=62) females and a mean age of 48.8 years. Most participants (90/105, 86%) completed the Low Carb Program app registration process and engaged with the Low Carb Program app program; at follow-up, most participants (88/105, 84%) had actively engaged with the Low Carb Program app within the prior 30 days. The majority of participants (58/105, 55%) self-reported outcomes within the app. Mean duration of clinical follow-up for recruited participants who received the app was 7.4 months. Paired data were available for 48 participants for body weight and 41 participants for HbA1c. Paired sample t test analysis revealed a statistically significant mean loss of body weight of 2.7 kg (P=.001) and improvement in HbA1c of 3.3 mmol/mol (P=.01). The mean weight of control group patients (n=126) was 137.1 kg, with 74% (93/126) females and a mean age of 44.4 years. The mean follow-up for this group was 6 months. Data comparisons between the app user group and the pre–COVID-19 retrospective control group revealed equivalence for loss of body weight and change in HbA1c between the two groups. Conclusions: We provide evidence to support the feasibility of implementing the Low Carb Program app combined with remote management; this is the first proof of concept for digitalized management within a hospital-based (tier 3) obesity service. We demonstrate the potential clinical efficacy of the approach in terms of improvements in body weight and glycemic control. %M 34449405 %R 10.2196/29110 %U https://formative.jmir.org/2021/9/e29110 %U https://doi.org/10.2196/29110 %U http://www.ncbi.nlm.nih.gov/pubmed/34449405 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e25922 %T Facilitator Contact, Discussion Boards, and Virtual Badges as Adherence Enhancements to a Web-Based, Self-guided, Positive Psychological Intervention for Depression: Randomized Controlled Trial %A Moskowitz,Judith Tedlie %A Addington,Elizabeth L %A Shiu,Eva %A Bassett,Sarah M %A Schuette,Stephanie %A Kwok,Ian %A Freedman,Melanie E %A Leykin,Yan %A Saslow,Laura R %A Cohn,Michael A %A Cheung,Elaine O %+ Department of Medical Social Sciences, Osher Center for Integrative Medicine, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Suite 2700, Chicago, IL, 60611, United States, 1 3125037712, judith.moskowitz@northwestern.edu %K mHealth %K adherence %K depression %K discussion board %K gamification %K positive psychological intervention %K mobile phone %D 2021 %7 22.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Adherence to self-guided interventions tends to be very low, especially in people with depression. Prior studies have demonstrated that enhancements may increase adherence, but little is known about the efficacy of various enhancements in comparison to, or in combination with, one another. Objective: The aim of our study is to test whether 3 enhancements—facilitator contact (FC), an online discussion board, and virtual badges (VB)—alone, or in combination, improve adherence to a self-guided, web-based intervention for depression. We also examined whether age, gender, race, ethnicity, comfort with technology, or baseline depression predicted adherence or moderated the effects that each enhancement had on adherence. Methods: Participants were recruited through web-based sources and, after completing at least 4 out of 7 daily emotion reports, were sequentially assigned to 1 of 9 conditions—the intervention alone; the intervention plus 1, 2, or all 3 enhancements; or an emotion reporting control condition. The intervention was a positive psychological program consisting of 8 skills that specifically targeted positive emotions, and it was delivered over 5 weeks in a self-guided, web-based format. We operationalized adherence as the number of skills accessed. Results: A total of 602 participants were enrolled in this study. Participants accessed, on average, 5.61 (SD 2.76) of 8 skills. The total number of enhancements participants received (0-3) did not predict the number of skills accessed. Participants who were assigned to the VB+FC condition accessed significantly more skills than those in the intervention only conditions. Furthermore, participants in arms that received the combination of both the VB and FC enhancements (VB+FC and VB+FC+online discussion board) accessed a greater number of skills relative to the number of skills accessed by participants who received either VB or FC without the other. Moderation analyses revealed that the receipt of VB (vs no VB) predicted higher adherence among participants with moderately severe depression at baseline. Conclusions: The results suggested that the VB+FC combination significantly increased the number of skills accessed in a self-guided, web-based intervention for elevated depression. We have provided suggestions for refinements to these enhancements, which may further improve adherence. Trial Registration: ClinicalTrials.gov NCT02861755; http://clinicaltrials.gov/ct2/show/NCT02861755 %M 34550076 %R 10.2196/25922 %U https://www.jmir.org/2021/9/e25922 %U https://doi.org/10.2196/25922 %U http://www.ncbi.nlm.nih.gov/pubmed/34550076 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e25558 %T Development of Digital Health Messages for Rural Populations in Tanzania: Multi- and Interdisciplinary Approach %A Holst,Christine %A Isabwe,Ghislain Maurice Norbert %A Sukums,Felix %A Ngowi,Helena %A Kajuna,Flora %A Radovanović,Danica %A Mansour,Wisam %A Mwakapeje,Elibariki %A Cardellichio,Peter %A Ngowi,Bernard %A Noll,Josef %A Winkler,Andrea Sylvia %+ Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postbox 1130, Blindern, Oslo, 0318, Norway, 47 48234044, christine.holst@medisin.uio.no %K digital health %K eHealth %K mHealth %K Tanzania %K health education %K HIV/AIDS %K tuberculosis %K cysticercosis %K tapeworm %K anthrax %K mobile phone %D 2021 %7 22.9.2021 %9 Tutorial %J JMIR Mhealth Uhealth %G English %X Background: Health workers have traditionally delivered health promotion and education to rural communities in the Global South in paper leaflet formats or orally. With the rise of digital technologies, health promotion and education can be provided in innovative and more effective formats, which are believed to have a higher impact on disease prevention and treatment. Objective: The aim of this tutorial is to illustrate how a multi- and interdisciplinary approach can be applied in the design process of digital health messages for use in the Global South. Methods: The multi- and interdisciplinary team of the Non-discriminating access for Digital Inclusion (DigI) project digitalized and customized available government-approved paper-based health promotion messages into a screen-suitable format. The team worked closely together and used its diverse expertise to develop digital health messages with disease-specific content in Tanzania’s national language (Swahili) as well as English. The development process included the following phases: a local needs assessment; identification of government-approved health promotion materials in a nondigital format; identification of key health messages; creation of a practical and engaging story, easy to understand for the general public; drafting of a storyboard for an animated video with review, feedback, and revisions; forward and backward translation; audio recording of the story in both languages; finalization and presentation of the animations; development of relevant questions related to the health messages in each domain; and development of web and mobile apps to access the digital health messages. Results: Between 2017 and 2019, we developed key health messages, quizzes, and animated health videos to address HIV/AIDS, tuberculosis, Taenia solium cysticercosis and taeniasis, and anthrax, all of which are of public health importance in Tanzania. Feedback from local stakeholders and test users was included in various phases of the process. The 4 videos and other content are available in local information spots on a digital health platform (DigI platform), established by the DigI project, in both Tanzanian Swahili and English. Conclusions: Our methodological multi- and interdisciplinary approach ensures that the digital health messages for the public are clear, high quality, and align with the government’s objectives for health promotion. It also demonstrates the diversity of scientific disciplines required when collaborating on a digital health project. We recommend this approach to be applied to the development of other digital health messages for a wide range of diseases. International Registered Report Identifier (IRRID): RR2-10.2196/25128 %M 34550081 %R 10.2196/25558 %U https://mhealth.jmir.org/2021/9/e25558 %U https://doi.org/10.2196/25558 %U http://www.ncbi.nlm.nih.gov/pubmed/34550081 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27447 %T Designing an Indoor Air Quality Monitoring App for Asthma Management in Children: User-Centered Design Approach %A Kim,Sunyoung %A Park,Yunoh %A Ackerman,Matthew K %+ School of Communication and Information, Rutgers University, 4 Huntington Street, New Brunswick, NJ, United States, 1 848 932 7585, sunyoung.kim@rutgers.edu %K asthma %K children %K indoor air quality %K mobile app %K smartphone %K user-centered design %D 2021 %7 22.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Indoor air pollution is a well-known risk factor that triggers and exacerbates asthma, the most common pediatric chronic disease. Using a mobile app to monitor indoor air quality could be promising in engaging children in keeping their indoor air quality clean and healthy as secondary environmental prevention for asthma management. However, no app is available to allow children to monitor, assess, and improve their indoor air quality. Objective: This study aims to design a mobile app that encourages children to monitor indoor air quality and track their asthma conditions through a user-centered, iterative design approach. Methods: We reviewed existing apps for indoor air quality monitoring or asthma management for children and conducted two sets of semistructured interviews with 12 children with asthma. We then iteratively created prototypes and evaluated and revised them. Results: Participants raised a series of outstanding questions on the prototype features and content that described their needs and perspectives, which informed the final designs. Following the identified requirements and recommendations, we developed two versions of the app: AirBuddy for presenting concrete information for indoor air quality and AirPet for gamifying the practice of monitoring indoor air quality. Conclusions: By following an iterative, user-centered design process, we developed two versions of an app to encourage children with asthma to monitor indoor air quality and track their asthma condition. The user-centered design approach revealed two crucial aspects that require deeper consideration when creating a child-friendly app, including balancing brevity and expressivity and considering the longitudinal effects of gamification. As a next step, we plan to conduct a longitudinal deployment study to evaluate the real-world effects of our apps. %M 34550080 %R 10.2196/27447 %U https://formative.jmir.org/2021/9/e27447 %U https://doi.org/10.2196/27447 %U http://www.ncbi.nlm.nih.gov/pubmed/34550080 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e28524 %T An Activity Tracker–Guided Physical Activity Program for Patients Undergoing Radiotherapy: Protocol for a Prospective Phase III Trial (OnkoFit I and II Trials) %A Hauth,Franziska %A Gehler,Barbara %A Nieß,Andreas Michael %A Fischer,Katharina %A Toepell,Andreas %A Heinrich,Vanessa %A Roesel,Inka %A Peter,Andreas %A Renovanz,Mirjam %A Hartkopf,Andreas %A Stengel,Andreas %A Zips,Daniel %A Gani,Cihan %+ Department of Radiation Oncology, University Hospital Tübingen, Hoppe-Seyler-Str 3, Tuebingen, 72076, Germany, 49 70712985900, franziska.hauth@med.uni-tuebingen.de %K cancer %K fatigue %K physical activity %K quality of life %K activity tracker %K exercise program %K radiotherapy %K digital health %D 2021 %7 22.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The positive impact that physical activity has on patients with cancer has been shown in several studies over recent years. However, supervised physical activity programs have several limitations, including costs and availability. Therefore, our study proposes a novel approach for the implementation of a patient-executed, activity tracker–guided exercise program to bridge this gap. Objective: Our trial aims to investigate the impact that an activity tracker–guided, patient-executed exercise program for patients undergoing radiotherapy has on cancer-related fatigue, health-related quality of life, and preoperative health status. Methods: Patients receiving postoperative radiotherapy for breast cancer (OnkoFit I trial) or neoadjuvant, definitive, or postoperative treatment for other types of solid tumors (OnkoFit II trial) will be randomized (1:1:1) into 3-arm studies. Target accrual is 201 patients in each trial (50 patients per year). After providing informed consent, patients will be randomized into a standard care arm (arm A) or 1 of 2 interventional arms (arms B and C). Patients in arms B and C will wear an activity tracker and record their daily step count in a diary. Patients in arm C will receive personalized weekly targets for their physical activity. No further instructions will be given to patients in arm B. The target daily step goals for patients in arm C will be adjusted weekly and will be increased by 10% of the average daily step count of the past week until they reach a maximum of 6000 steps per day. Patients in arm A will not be provided with an activity tracker. The primary end point of the OnkoFit I trial is cancer-related fatigue at 3 months after the completion of radiotherapy. This will be measured by the Functional Assessment of Chronic Illness Therapy-Fatigue questionnaire. For the OnkoFit II trial, the primary end point is the overall quality of life, which will be assessed with the Functional Assessment of Cancer Therapy-General sum score at 6 months after treatment to allow for recovery after possible surgery. In parallel, blood samples from before, during, and after treatment will be collected in order to assess inflammatory markers. Results: Recruitment for both trials started on August 1, 2020, and to date, 49 and 12 patients have been included in the OnkoFit I and OnkoFit II trials, respectively. Both trials were approved by the institutional review board prior to their initiation. Conclusions: The OnkoFit trials test an innovative, personalized approach for the implementation of an activity tracker–guided training program for patients with cancer during radiotherapy. The program requires only a limited amount of resources. Trial Registration: ClinicalTrials.gov NCT04506476; https://clinicaltrials.gov/ct2/show/NCT04506476. ClinicalTrials.gov NCT04517019; https://clinicaltrials.gov/ct2/show/NCT04517019. International Registered Report Identifier (IRRID): DERR1-10.2196/28524 %M 34550079 %R 10.2196/28524 %U https://www.researchprotocols.org/2021/9/e28524 %U https://doi.org/10.2196/28524 %U http://www.ncbi.nlm.nih.gov/pubmed/34550079 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27570 %T Evaluation of a Commercial Mobile Health App for Depression and Anxiety (AbleTo Digital+): Retrospective Cohort Study %A Anton,Margaret T %A Greenberger,Heidi Mochari %A Andreopoulos,Evie %A Pande,Reena L %+ AbleTo, Inc, 320 W, 37th Street, 5th floor, New York, NY, 10018, United States, 1 (347) 926 5527, margaret.anton@ableto.com %K digital mental health %K mHealth %K iCBT %K coaching %K depression %K generalized anxiety %K social anxiety %K mobile phone %D 2021 %7 21.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital solutions, such as web-based and mobile interventions, have the potential to streamline pathways to mental health services and improve access to mental health care. Although a growing number of randomized trials have established the efficacy of digital interventions for common mental health problems, less is known about the real-world impact of these tools. AbleTo Digital+, a commercially available mental health app for depression and anxiety, offers a unique opportunity to understand the clinical impact of such tools delivered in a real-world context. Objective: The primary aim of this study is to examine the magnitude of change in depression and anxiety symptoms among individuals who used AbleTo Digital+ programs. The secondary aim is to evaluate Digital+ module completion, including the use of 1:1 coaching. Methods: In this retrospective cohort study, we analyzed previously collected and permanently deidentified data from a consecutive cohort of 1896 adults who initiated using one of the three Digital+ eight-module programs (depression, generalized anxiety, or social anxiety) between January 1 and June 30, 2020. Depression, generalized anxiety, and social anxiety symptoms were assessed within each program using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the Social Phobia Inventory, respectively. Linear mixed effects models were built to assess the association between module completion and symptom change among users who completed at least four modules and had at least mild baseline symptom elevations, controlling for age, gender, and baseline symptom severity. Digital+ use, including module completion, 1:1 coaching calls, and in-app coach messaging, was also evaluated. Results: Significant effects were observed among depression (Cohen d=1.5), generalized anxiety (Cohen d=1.2), and social anxiety (Cohen d=1.0) program participants who completed at least four modules and had mild baseline elevations (n=470). Associations between module completion and change in depression (β=−1.2; P<.001), generalized anxiety (β=−1.1; P<.001), and social anxiety (β=−2.4; P<.001) symptom scores retained significance with covariate adjustment. Participants completed an average of 2.6 (SD 2.7) modules. The average total length of app use was 52.2 (SD 83.5) days. Approximately two-thirds of the users engaged in at least 1 coaching call (66.82%, 1267/1896) or in-app text messaging (66.09%, 1253/1896). Participants who completed at least four modules participated in significantly more coaching calls per module (mean 1.1, SD 0.7) than users who completed fewer than four modules (mean 1.0, SD 1.2; t1407=−2.1; P=.03). Conclusions: This study demonstrated that AbleTo Digital+ users experienced significant reductions in depression, generalized anxiety, and social anxiety symptoms throughout the program. %M 34546170 %R 10.2196/27570 %U https://formative.jmir.org/2021/9/e27570 %U https://doi.org/10.2196/27570 %U http://www.ncbi.nlm.nih.gov/pubmed/34546170 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e25171 %T How Self-tracking and the Quantified Self Promote Health and Well-being: Systematic Review %A Feng,Shan %A Mäntymäki,Matti %A Dhir,Amandeep %A Salmela,Hannu %+ Department of Management and Entrepreneurship, Turku School of Economics, University of Turku, Rehtorinpellonkatu 3, Turku, 20500, Finland, 358 504867657, matti.mantymaki@utu.fi %K self-tracking %K quantified self %K health %K well-being %K systematic literature review %K literature review %D 2021 %7 21.9.2021 %9 Review %J J Med Internet Res %G English %X Background: Self-tracking technologies are widely used in people’s daily lives and health care. Academic research on self-tracking and the quantified self has also accumulated rapidly in recent years. Surprisingly, there is a paucity of research that reviews, classifies, and synthesizes the state of the art with respect to self-tracking and the quantified self. Objective: Our objective was to identify the state of the art of self-tracking and the quantified self in terms of health and well-being. Methods: We have undertaken a systematic literature review on self-tracking and the quantified self in promoting health and well-being. After a rigorous literature search, followed by inclusions, exclusions, and the application of article quality assessment protocols, 67 empirical studies qualified for the review. Results: Our results demonstrate that prior research has focused on 3 stakeholders with respect to self-tracking and the quantified self, namely end users, patients and people with illnesses, and health care professionals and caregivers. We used these stakeholder groups to cluster the research themes of the reviewed studies. We identified 11 research themes. There are 6 themes under the end-user cluster: user motivation and goal setting, usage and effects of self-tracking, continuance intention and long-term usage, management of personal data, rejection and discontinuance, and user characteristics. The patient and people with illnesses cluster contains three themes: usage experience of patients and people with illnesses, management of patient-generated data, and advantages and disadvantages in the clinical context. The health care professional and caregiver cluster contains two themes: collaboration among patients, health care professionals, and caregivers, and changes in the roles of patients and professionals. Moreover, we classified the future research suggestions given in the literature into 5 directions in terms of research designs and research topics. Finally, based on our reflections on the observations from the review, we suggest four future research directions: (1) users’ cognitions and emotions related to processing and interpreting the information produced by tracking devices and apps; (2) the dark side of self-tracking (eg, its adverse psychosocial consequences); (3) self-tracking as a societal phenomenon; and (4) systemic impacts of self-tracking on health care and the actors involved. Conclusions: This systematic literature review contributes to research and practice by assisting future research activities and providing practitioners with a concise overview of the state of the art of self-tracking and the quantified self. %M 34546176 %R 10.2196/25171 %U https://www.jmir.org/2021/9/e25171 %U https://doi.org/10.2196/25171 %U http://www.ncbi.nlm.nih.gov/pubmed/34546176 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e26603 %T Psychoeducational Social Anxiety Mobile Apps: Systematic Search in App Stores, Content Analysis, and Evaluation %A Hammond,Trent Ernest %A Lampe,Lisa %A Campbell,Andrew %A Perisic,Steve %A Brakoulias,Vlasios %+ Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, 62 Derby Street, Kingswood, New South Wales, 2747, Australia, 61 431931448, trent.hammond@sydney.edu.au %K anxiety %K app %K cell phone %K mobile app %K mobile phone %K SAD %K smartphone %K social anxiety %K social phobia %K tablet %D 2021 %7 21.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The wide use of mobile health apps has created new possibilities in social anxiety education and treatment. However, the content and quality of social anxiety apps have been quite unclear, which makes it difficult for people to choose appropriate apps to use on smartphones and tablets. Objective: This study aims to identify the psychoeducational social anxiety apps in the two most popular Australian app stores, report the descriptive and technical information provided in apps exclusively for social anxiety, evaluate app quality, and identify whether any apps would be appropriate for people with social anxiety or others who know someone with social anxiety. Methods: This systematic stepwise app search was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards and entailed searching for, identifying, and selecting apps in the Australian Apple App and Google Play Stores; downloading, using, and reviewing the identified apps; reporting technical and descriptive information in the app stores, an online app warehouse, and individual apps; evaluating app quality; and deciding whether to recommend the use of the apps. Results: In the app stores, 1043 apps were identified that contained the keywords social anxiety, social phobia, or shyness in their names or descriptions. Of these, 1.15% (12/1043) were evaluated (3 iOS apps and 9 Android apps). At the time of evaluation, the apps were compatible with smartphones and tablet devices; 9 were free to download from the app stores, whereas 3 were priced between US $2.95 (Aus $3.99) and US $3.69 (Aus $5.00). Among the evaluated apps, 3 were intended for treatment purposes, 3 provided supportive resources, 1 was intended for self-assessment, and the remaining 5 were designed for multiple purposes. At the time of downloading, app store ratings were available for 5 apps. The overall app quality was acceptable according to the Mobile App Rating Scale (MARS). On the basis of the MARS app quality rating subscale (sections A-D), the apps functioned well in performance, ease of use, navigation, and gestural design. However, app quality was less favorable when rated using the MARS app subjective quality subscale (section E). Conclusions: The psychoeducational social anxiety apps evaluated in our study may benefit people with social anxiety, health professionals, and other community members. However, given that none of the apps appeared to contain empirical information or were shown to clinically reduce social anxiety (or aid in managing social anxiety), we cannot recommend their use. App accessibility could be improved by developing apps that are free and available for a wider range of operating systems, both between and within countries and regions. Information communication and technology professionals should collaborate with academics, mental health clinicians, and end users (ie, co-design) to develop current, evidence-based apps. %M 34546179 %R 10.2196/26603 %U https://mhealth.jmir.org/2021/9/e26603 %U https://doi.org/10.2196/26603 %U http://www.ncbi.nlm.nih.gov/pubmed/34546179 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26224 %T Understanding Preferences for Lifestyle-Focused Visual Text Messages in Patients With Cardiovascular and Chronic Respiratory Disease: Discrete Choice Experiment %A Choi,Michael %A Raeside,Rebecca %A Hyun,Karice %A Partridge,Stephanie R %A Thiagalingam,Aravinda %A Redfern,Julie %+ Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Level 6, Block K, Westmead Hospital, Westmead, Sydney, 2154, Australia, 61 88909214, julie.redfern@sydney.edu.au %K mHealth %K cardiovascular disease %K respiratory disease %K visual communication %K lifestyle change %K consumer preferences %K secondary prevention %K rehabilitation %K persuasive health technology %D 2021 %7 20.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Supporting healthy lifestyle changes is a key aim of cardiovascular and pulmonary rehabilitation programs. SMS text messaging programs have demonstrated effectiveness in cardiovascular disease risk reduction, weight loss, increasing physical activity, and smoking cessation. The optimization of SMS text messaging programs may deliver greater population benefits as mobile phone use becomes ubiquitous. Visual messaging (ie, image-based messages) has the potential to communicate health messages via digital technology and result in enhanced engagement. Objective: This study aims to determine and understand patient preferences for lifestyle-focused visual text messages that support cardiovascular and pulmonary rehabilitation. Methods: A discrete choice experiment was conducted in a 4-stage iterative process to elicit patient preferences for visual message features. Attribute and level development yielded 3 attributes (purpose, image type, and web address), and 16 choice sets were subsequently constructed according to a full factorial design. Patients participating in cardiovascular and pulmonary rehabilitation were surveyed (on the web) for their preferences regarding the visual message choice sets. Respondents were asked to choose among 16 pairs of visual messages regarding key lifestyle behaviors, namely, physical activity and nutrition. The data were analyzed using a conditional logit model. Results: There was a total of 1728 observations from 54 unique respondents. Two factors that were associated with patient preference were gain-framed purpose compared with no purpose (odds ratio [OR] 1.93, 95% CI 1.40-2.65) and real images compared with cartoon images (OR 1.26, 95% CI 1.04-1.54). A loss-framed purpose was less preferred than no purpose (OR 0.55, 95% CI 0.42-0.74). Overall, patients preferred positive images that were colorful and engaged with text that supported the image and had a preference for images of real people rather than cartoons. Conclusions: A discrete choice experiment is a scientific method for eliciting patient preferences for a visual messaging intervention that is designed to support changes in lifestyle behaviors. SMS text messaging programs that use visual aids may result in greater patient satisfaction by using a gain frame, using real images, and avoiding a loss frame. Further research is needed to explore the feasibility of implementation and the health and behavioral outcomes associated with such visual messaging programs. %M 34542413 %R 10.2196/26224 %U https://www.jmir.org/2021/9/e26224 %U https://doi.org/10.2196/26224 %U http://www.ncbi.nlm.nih.gov/pubmed/34542413 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 3 %P e28852 %T Current Evidence and Directions for Future Research in eHealth Physical Activity Interventions for Adults Affected by Cancer: Systematic Review %A Ester,Manuel %A Eisele,Maximilian %A Wurz,Amanda %A McDonough,Meghan H %A McNeely,Margaret %A Culos-Reed,S Nicole %+ Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada, 1 403 210 8482, manuel.ester@ucalgary.ca %K eHealth %K electronic health %K mHealth %K cancer %K oncology %K physical activity %K exercise %K systematic review %K mobile phone %D 2021 %7 20.9.2021 %9 Review %J JMIR Cancer %G English %X Background: Physical activity (PA) interventions can increase PA and improve well-being among adults affected by cancer; however, most adults do not meet cancer-specific PA recommendations. Lack of time, facility access, and travel distances are barriers to participation in PA interventions. eHealth technologies may address some of these barriers, serving as a viable way to promote PA behavior change in this population. However, no review from July 2018 has synthesized available evidence across eHealth and cancer types or examined the use of behavioral theory and behavior change techniques (BCTs), leaving important gaps in knowledge. Objective: This review aims to provide a comprehensive, updated overview of evidence on eHealth PA interventions for adults with cancer by describing the current state of the literature, exploring associations between intervention characteristics and effectiveness, and identifying future research needs. Methods: MEDLINE, Embase, CINAHL, SportDiscus, Scopus, and CENTRAL were searched for eHealth PA interventions for adults affected by cancer. Study selection and data extraction were performed in duplicate, with consultation from the senior author (NCR). BCT coding, risk of bias, and completeness of reporting were performed using standardized tools. Results were summarized via narrative synthesis and harvest plots. Weight analyses were conducted to explore the associations between intervention characteristics and effectiveness. Results: A total of 71 articles (67 studies) involving 6655 participants (mean age 56.7 years, SD 8.2) were included. Nearly 50% (32/67) of the articles were published after July 2018. Significant postintervention PA increases were noted in 52% (35/67) of the studies, and PA maintenance was noted in 41% (5/12) of the studies that included a follow-up. Study duration, primary objectives, and eHealth modality (eg, websites, activity trackers, and SMS text messaging) varied widely. Social cognitive theory (23/67, 34%) was the most used theory. The mean number of BCTs used across the studies was 13.5 (SD 5.5), with self-monitoring, credible sources, and goal setting being used in >90% of studies. Weight analyses showed the greatest associations between increased PA levels and PA as a primary outcome (0.621), interventions using websites (0.656) or mobile apps (0.563), interventions integrating multiple behavioral theories (0.750), and interventions using BCTs of problem solving (0.657) and action planning (0.645). All studies had concerns with high risk of bias, mostly because of the risk of confounding, measurement bias, and incomplete reporting. Conclusions: A range of eHealth PA interventions may increase PA levels among adults affected by cancer, and specific components (eg, websites, use of theory, and action planning) may be linked to greater effectiveness. However, more work is needed to ascertain and optimize effectiveness, measure long-term effects, and address concerns with bias and incomplete reporting. This evidence is required to support arguments for integrating eHealth within PA promotion in oncology. %M 34542415 %R 10.2196/28852 %U https://cancer.jmir.org/2021/3/e28852 %U https://doi.org/10.2196/28852 %U http://www.ncbi.nlm.nih.gov/pubmed/34542415 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e24307 %T Virtual Reality Technology Use in Cigarette Craving and Smoking Interventions (I “Virtually” Quit): Systematic Review %A Keijsers,Merel %A Vega-Corredor,Maria Cecilia %A Tomintz,Melanie %A Hoermann,Simon %+ School of Product Design, College of Engineering, University of Canterbury, 9 Engineering Road, Christchurch, 8041, New Zealand, 64 3 369 2457, simon.hoermann@canterbury.ac.nz %K virtual reality technology %K nicotine dependency %K nicotine addiction %K smoking addiction %K smoking intervention %K smoking therapy %K Electronic Nicotine Delivery Systems %D 2021 %7 17.9.2021 %9 Review %J J Med Internet Res %G English %X Background: Over the last 2 decades, virtual reality technologies (VRTs) have been proposed as a way to enhance and improve smoking cessation therapy. Objective: This systematic review aims to evaluate and summarize the current knowledge on the application of VRT in various smoking cessation therapies, as well as to explore potential directions for future research and intervention development. Methods: A literature review of smoking interventions using VRT was conducted. Results: Not all intervention studies included an alternative therapy or a placebo condition against which the effectiveness of the intervention could be benchmarked, or a follow-up measure to ensure that the effects were lasting. Virtual reality (VR) cue exposure therapy was the most extensively studied intervention, but its effect on long-term smoking behavior was inconsistent. Behavioral therapies such as a VR approach-avoidance task or gamified interventions were less common but reported positive results. Notably, only 1 study combined Electronic Nicotine Delivery Devices with VRT. Conclusions: The inclusion of a behavioral component, as is done in the VR approach-avoidance task and gamified interventions, may be an interesting avenue for future research on smoking interventions. As Electronic Nicotine Delivery Devices are still the subject of much controversy, their potential to support smoking cessation remains unclear. For future research, behavioral or multicomponent interventions are promising avenues of exploration. Future studies should improve their validity by comparing their intervention group with at least 1 alternative or placebo control group, as well as incorporating follow-up measures. %M 34533471 %R 10.2196/24307 %U https://www.jmir.org/2021/9/e24307 %U https://doi.org/10.2196/24307 %U http://www.ncbi.nlm.nih.gov/pubmed/34533471 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e24352 %T Using Acoustic Speech Patterns From Smartphones to Investigate Mood Disorders: Scoping Review %A Flanagan,Olivia %A Chan,Amy %A Roop,Partha %A Sundram,Frederick %+ Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Building 507, Level 3, 28 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 9 923 7521, f.sundram@auckland.ac.nz %K smartphone %K data science %K speech patterns %K mood disorders %K diagnosis %K monitoring %D 2021 %7 17.9.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mood disorders are commonly underrecognized and undertreated, as diagnosis is reliant on self-reporting and clinical assessments that are often not timely. Speech characteristics of those with mood disorders differs from healthy individuals. With the wide use of smartphones, and the emergence of machine learning approaches, smartphones can be used to monitor speech patterns to help the diagnosis and monitoring of mood disorders. Objective: The aim of this review is to synthesize research on using speech patterns from smartphones to diagnose and monitor mood disorders. Methods: Literature searches of major databases, Medline, PsycInfo, EMBASE, and CINAHL, initially identified 832 relevant articles using the search terms “mood disorders”, “smartphone”, “voice analysis”, and their variants. Only 13 studies met inclusion criteria: use of a smartphone for capturing voice data, focus on diagnosing or monitoring a mood disorder(s), clinical populations recruited prospectively, and in the English language only. Articles were assessed by 2 reviewers, and data extracted included data type, classifiers used, methods of capture, and study results. Studies were analyzed using a narrative synthesis approach. Results: Studies showed that voice data alone had reasonable accuracy in predicting mood states and mood fluctuations based on objectively monitored speech patterns. While a fusion of different sensor modalities revealed the highest accuracy (97.4%), nearly 80% of included studies were pilot trials or feasibility studies without control groups and had small sample sizes ranging from 1 to 73 participants. Studies were also carried out over short or varying timeframes and had significant heterogeneity of methods in terms of the types of audio data captured, environmental contexts, classifiers, and measures to control for privacy and ambient noise. Conclusions: Approaches that allow smartphone-based monitoring of speech patterns in mood disorders are rapidly growing. The current body of evidence supports the value of speech patterns to monitor, classify, and predict mood states in real time. However, many challenges remain around the robustness, cost-effectiveness, and acceptability of such an approach and further work is required to build on current research and reduce heterogeneity of methodologies as well as clinical evaluation of the benefits and risks of such approaches. %M 34533465 %R 10.2196/24352 %U https://mhealth.jmir.org/2021/9/e24352 %U https://doi.org/10.2196/24352 %U http://www.ncbi.nlm.nih.gov/pubmed/34533465 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e30504 %T An App-Based Surveillance System for Undergraduate Students’ Mental Health During the COVID-19 Pandemic: Protocol for a Prospective Cohort Study %A Brogly,Chris %A Bauer,Michael A %A Lizotte,Daniel J %A Press,MacLean L %A MacDougall,Arlene %A Speechley,Mark %A Huner,Erin %A Mitchell,Marc %A Anderson,Kelly K %A Pila,Eva %+ School of Kinesiology, Faculty of Health Sciences, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada, 1 519 661 2111, epila@uwo.ca %K undergraduate %K mental health %K smartphone %K app %K COVID-19 %K postsecondary institutions %K mobile apps %K mHealth %K mobile health %D 2021 %7 17.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic is a public health emergency that poses challenges to the mental health of approximately 1.4 million university students in Canada. Preliminary evidence has shown that the COVID-19 pandemic had a detrimental impact on undergraduate student mental health and well-being; however, existing data are predominantly limited to cross-sectional survey-based studies. Owing to the evolving nature of the pandemic, longer-term prospective surveillance efforts are needed to better anticipate risk and protective factors during a pandemic. Objective: The overarching aim of this study is to use a mobile (primarily smartphone-based) surveillance system to identify risk and protective factors for undergraduate students’ mental health. Factors will be identified from weekly self-report data (eg, affect and living accommodation) and device sensor data (eg, physical activity and device usage) to prospectively predict self-reported mental health and service utilization. Methods: Undergraduate students at Western University (London, Ontario, Canada), will be recruited via email to complete an internet-based baseline questionnaire with the option to participate in the study on a weekly basis, using the Student Pandemic Experience (SPE) mobile app for Android/iOS. The app collects sensor samples (eg, GPS coordinates and steps) and self-reported weekly mental health and wellness surveys. Student participants can opt in to link their mobile data with campus-based administrative data capturing health service utilization. Risk and protective factors that predict mental health outcomes are expected to be estimated from (1) cross-sectional associations among students’ characteristics (eg, demographics) and key psychosocial factors (eg, affect, stress, and social connection), and behaviors (eg, physical activity and device usage) and (2) longitudinal associations between psychosocial and behavioral factors and campus-based health service utilization. Results: Data collection began November 9, 2020, and will be ongoing through to at least October 31, 2021. Retention from the baseline survey (N=427) to app sign-up was 74% (315/427), with 175-215 (55%-68%) app participants actively responding to weekly surveys. From November 9, 2020, to August 8, 2021, a total of 4851 responses to the app surveys and 25,985 sensor samples (consisting of up to 68 individual data items each; eg, GPS coordinates and steps) were collected from the 315 participants who signed up for the app. Conclusions: The results of this real-world longitudinal cohort study of undergraduate students’ mental health based on questionnaires and mobile sensor metrics is expected to show psychosocial and behavioral patterns associated with both positive and negative mental health–related states during pandemic conditions at a relatively large, public, and residential Canadian university campus. The results can be used to support decision-makers and students during the ongoing COVID-19 pandemic and similar future events. For comparable settings, new interventions (digital or otherwise) might be designed using these findings as an evidence base. International Registered Report Identifier (IRRID): DERR1-10.2196/30504 %M 34516391 %R 10.2196/30504 %U https://www.researchprotocols.org/2021/9/e30504 %U https://doi.org/10.2196/30504 %U http://www.ncbi.nlm.nih.gov/pubmed/34516391 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26317 %T Privacy Practices of Health Information Technologies: Privacy Policy Risk Assessment Study and Proposed Guidelines %A LaMonica,Haley M %A Roberts,Anna E %A Lee,Grace Yeeun %A Davenport,Tracey A %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, 88 Mallett Street, Camperdown, 2050, Australia, 61 0426955658, haley.lamonica@sydney.edu.au %K privacy %K mental health %K technology %K digital tools %K smartphone %K apps %D 2021 %7 16.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Along with the proliferation of health information technologies (HITs), there is a growing need to understand the potential privacy risks associated with using such tools. Although privacy policies are designed to inform consumers, such policies have consistently been found to be confusing and lack transparency. Objective: This study aims to present consumer preferences for accessing privacy information; develop and apply a privacy policy risk assessment tool to assess whether existing HITs meet the recommended privacy policy standards; and propose guidelines to assist health professionals and service providers with understanding the privacy risks associated with HITs, so that they can confidently promote their safe use as a part of care. Methods: In phase 1, participatory design workshops were conducted with young people who were attending a participating headspace center, their supportive others, and health professionals and service providers from the centers. The findings were knowledge translated to determine participant preferences for the presentation and availability of privacy information and the functionality required to support its delivery. Phase 2 included the development of the 23-item privacy policy risk assessment tool, which incorporated material from international privacy literature and standards. This tool was then used to assess the privacy policies of 34 apps and e-tools. In phase 3, privacy guidelines, which were derived from learnings from a collaborative consultation process with key stakeholders, were developed to assist health professionals and service providers with understanding the privacy risks associated with incorporating HITs as a part of clinical care. Results: When considering the use of HITs, the participatory design workshop participants indicated that they wanted privacy information to be easily accessible, transparent, and user-friendly to enable them to clearly understand what personal and health information will be collected and how these data will be shared and stored. The privacy policy review revealed consistently poor readability and transparency, which limited the utility of these documents as a source of information. Therefore, to enable informed consent, the privacy guidelines provided ensure that health professionals and consumers are fully aware of the potential for privacy risks in using HITs to support health and well-being. Conclusions: A lack of transparency in privacy policies has the potential to undermine consumers’ ability to trust that the necessary measures are in place to secure and protect the privacy of their personal and health information, thus precluding their willingness to engage with HITs. The application of the privacy guidelines will improve the confidence of health professionals and service providers in the privacy of consumer data, thus enabling them to recommend HITs to provide or support care. %M 34528895 %R 10.2196/26317 %U https://www.jmir.org/2021/9/e26317 %U https://doi.org/10.2196/26317 %U http://www.ncbi.nlm.nih.gov/pubmed/34528895 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e28044 %T Testing the Differential Impact of an Internet-Based Mental Health Intervention on Outcomes of Well-being and Psychological Distress During COVID-19: Uncontrolled Intervention Study %A van Agteren,Joep %A Ali,Kathina %A Fassnacht,Daniel B %A Iasiello,Matthew %A Furber,Gareth %A Howard,Alexis %A Woodyatt,Lydia %A Musker,Michael %A Kyrios,Mike %+ Wellbeing and Resilience Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, 5000, Australia, 61 881284944, joep.vanagteren@sahmri.com %K COVID-19 %K internet-based interventions %K mental health %K well-being %K intervention %K study %K impact %K internet %K online intervention %K distress %K resilience %K depression %K anxiety %K stress %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: During COVID-19, the psychological distress and well-being of the general population has been precarious, increasing the need to determine the impact of complementary internet-based psychological interventions on both positive mental health as well as distress states. Psychological distress and mental well-being represent distinct dimensions of our mental health, and congruent changes in outcomes of distress and well-being do not necessarily co-occur within individuals. When testing intervention impact, it is therefore important to assess change in both outcomes at the individual level, rather than solely testing group differences in average scores at the group level. Objective: This study set out to investigate the differential impact of an internet-based group mental health intervention on outcomes of positive mental health (ie, well-being, life satisfaction, resilience) and indicators of psychological distress (ie, depression, anxiety, stress). Methods: A 5-week mental health intervention was delivered to 89 participants using the Zoom platform during 2020. Impact on outcomes of distress, well-being, and resilience was assessed at the start and end of the program with multiple analysis of variance (MANOVA) and reliable change indices (RCIs) being used to determine program impact at the group and individual levels, respectively. Results: The intervention significantly improved all mental health outcomes measured, (F6,83=5.60, P<.001; Wilks Λ=.71; partial η2=.29) showing small to moderate effect sizes on individual outcomes. The largest effect sizes were observed for life satisfaction and overall well-being (η2=.22 and η2=.2, respectively). Larger effect sizes were noted for those with problematic mental health scores at baseline. A total of 92% (82/89) of participants demonstrated reliable change in at least one mental health outcome. Differential response patterns using RCI revealed that more than one-half of the participants showed improvement in both mental well-being and psychological distress, over one-quarter in outcomes of well-being only, and almost one-fifth in distress only. Conclusions: The results provide evidence for the significant impact of an internet-based mental health intervention during COVID-19 and indicate the importance of assessing dimensions of both well-being and distress when determining mental health intervention effectiveness. %M 34357876 %R 10.2196/28044 %U https://mental.jmir.org/2021/9/e28044 %U https://doi.org/10.2196/28044 %U http://www.ncbi.nlm.nih.gov/pubmed/34357876 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e27803 %T Mobile App for Parental Empowerment for Caregivers of Children With Autism Spectrum Disorders: Prospective Open Trial %A Bonnot,Olivier %A Adrien,Vladimir %A Venelle,Veronique %A Bonneau,Dominique %A Gollier-Briant,Fanny %A Mouchabac,Stephane %+ Child and Adolescent Psychiatry Department, Centre Hospitalier Universitaire de Nantes, 30 Boulevard Jean Monnet, Nantes, 440000, France, 33 637702571, olivier.bonnot@gmail.com %K autism spectrum disorders %K empowerment, smartphone application %K autism %K smartphone %K app %K children %K caregivers %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Conflicting data emerge from literature regarding the actual use of smartphone apps in medicine; some considered the introduction of smartphone apps in medicine to be a breakthrough, while others suggested that, in real-life, the use of smartphone apps in medicine is disappointingly low. Yet, digital tools become more present in medicine daily. To empower parents of a child with autism spectrum disorder, we developed the Smartautism smartphone app, which asks questions and provides feedback, using a screen with simple curves. Objective: The purpose of this study was to evaluate usage of the app by caregivers of individuals with autism spectrum disorders. Methods: We conducted a prospective longitudinal exploratory open study with families that have a child with autism spectrum disorder. Data were recorded over a period of 6 months, and the outcome criteria were (1) overall response rates for a feedback screen and qualitative questionnaires, and (2) response rates by degree of completion and by user interest, based on attrition. Results: Participants (n=65) had a very high intent to use the app during the 6-month period (3698/3900 instances, 94.8%); however, secondary analysis showed that only 46% of participants (30/65) had constant response rates over 50%. Interestingly, these users were characterized by higher use and satisfaction with the feedback screen when compared to low (P<.001) and moderate (P=.007) users. Conclusions: We found that real or perceived utility is an important incentive for parents who use empowerment smartphone apps. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2016-012135 %M 34524101 %R 10.2196/27803 %U https://mental.jmir.org/2021/9/e27803 %U https://doi.org/10.2196/27803 %U http://www.ncbi.nlm.nih.gov/pubmed/34524101 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26158 %T Efficacy of an mHealth Intervention (BRAVE) to Promote Mental Wellness for American Indian and Alaska Native Teenagers and Young Adults: Randomized Controlled Trial %A Craig Rushing,Stephanie %A Kelley,Allyson %A Bull,Sheana %A Stephens,David %A Wrobel,Julia %A Silvasstar,Joshva %A Peterson,Roger %A Begay,Corey %A Ghost Dog,Thomas %A McCray,Celena %A Love Brown,Danica %A Thomas,Morgan %A Caughlan,Colbie %A Singer,Michelle %A Smith,Paige %A Sumbundu,Kanku %+ Northwest Portland Area Indian Health Board, 2121 SW Broadway #300, Portland, OR, 97201, United States, 1 503 228 4185, SCraig@npaihb.org %K American Indian %K Alaska Native %K adolescent %K mental health %K help-seeking skills, text messaging %K mHealth, behavioral intervention %K Indian health %K mobile phone %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Culturally relevant interventions are needed to help American Indian and Alaska Native (AI/AN) teenagers and young adults navigate common risky situations involving family and friends, including drug and alcohol misuse, dating violence, and suicidality. Leveraging We R Native, a multimedia health resource for Native teenagers and young adults, staff of the Northwest Portland Area Indian Health Board designed the BRAVE intervention for Native youth. The program is delivered via SMS text messaging and includes role model videos, mental wellness strategies, links to culturally relevant resources, and social support from family and friends. Objective: We aim to conduct a randomized controlled trial of the BRAVE intervention among AI/AN teenagers and young adults (aged 15-24 years) to assess its impact on their physical, mental, and spiritual health; their resilience and self-esteem; and their coping and help-seeking skills. Methods: From October to December 2019, we recruited 2334 AI/AN teenagers and young adults nationwide via social media channels and SMS text messages and enrolled 1044 participants. AI/AN teenagers and young adults enrolled in the study received either BRAVE SMS text messages, designed to improve mental health, help-seeking skills, and cultural resilience, or 8 weeks of science, technology, engineering, and math (STEM) SMS text messages, designed to elevate and reaffirm Native voices in STEM and medicine and then received the BRAVE SMS text messages. The impacts of the BRAVE intervention were tested using linear mixed-effect models and linear regressions. Results: A total of 833 AI/AN teenagers and young adults were included in the analysis. Individuals in the BRAVE and STEM arms showed significant positive trends over the course of the study for all outcomes, except cultural identity and help-seeking behavior. Mean scores were significantly different for health (P<.001), resilience (P<.001), negative coping (P=.03), positive coping (P<.001), self-efficacy (P=.02), and self-esteem (P<.001). Changes in help-seeking self-efficacy were significant in those exhibiting risky behaviors at baseline to exit (P=.01). Those who reported positive coping scores at baseline also reported better health on average; however, no difference was found in risky drug and alcohol use (P<.001). The number of participants who used SMS text messages to help themselves increased from 69.1% (427/618) at 3 months to 76% (381/501; P<.001) at 8 months. Similarly, the number of participants who used SMS text messages to help friends or family members increased from 22.4% (138/616) at 3 months to 54.6% (272/498) at 8 months. Conclusions: This is the first national randomized controlled trial of a mobile health intervention among AI/AN teenagers and young adults to test the efficacy of a mental wellness intervention in relation to STEM career messages. This study provides new insights for supporting the next generation of AI/AN changemakers. Trial Registration: ClinicalTrials.gov NCT04979481; https://clinicaltrials.gov/ct2/show/NCT04979481 %M 34524092 %R 10.2196/26158 %U https://mental.jmir.org/2021/9/e26158 %U https://doi.org/10.2196/26158 %U http://www.ncbi.nlm.nih.gov/pubmed/34524092 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26029 %T A Cyberbullying Media-Based Prevention Intervention for Adolescents on Instagram: Pilot Randomized Controlled Trial %A Kutok,Emily R %A Dunsiger,Shira %A Patena,John V %A Nugent,Nicole R %A Riese,Alison %A Rosen,Rochelle K %A Ranney,Megan L %+ Brown-Lifespan Center for Digital Health, 139 Point Street, Providence, RI, 02903, United States, 1 (401) 444 2557, megan_ranney@brown.edu %K cyberbullying %K adolescents %K mobile application %K messaging %K brief interventions %K social media %K recruitment %K mobile phone %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Between 15% and 70% of adolescents report experiencing cybervictimization. Cybervictimization is associated with multiple negative consequences, including depressed mood. Few validated, easily disseminated interventions exist to prevent cybervictimization and its consequences. With over 97% of adolescents using social media (such as YouTube, Facebook, Instagram, or Snapchat), recruiting and delivering a prevention intervention through social media and apps may improve accessibility of prevention tools for at-risk youth. Objective: This study aims to evaluate the feasibility and acceptability of and obtain preliminary outcome data on IMPACT (Intervention Media to Prevent Adolescent Cyber-Conflict Through Technology), a brief, remote app-based intervention to prevent and reduce the effect of cyberbullying. Methods: From January 30, 2020, to May 3, 2020, a national sample of 80 adolescents with a history of past-year cybervictimization was recruited through Instagram for a randomized control trial of IMPACT, a brief, remote research assistant–led intervention and a fully automated app-based program, versus enhanced web-based resources (control). Feasibility and acceptability were measured by consent, daily use, and validated surveys. Although not powered for efficacy, outcomes (victimization, bystander self-efficacy, and well-being) were measured using validated measures at 8 and 16 weeks and evaluated using a series of longitudinal mixed models. Results: Regarding feasibility, 24.5% (121/494) of eligible participants provided contact information; of these, 69.4% (84/121) completed full enrollment procedures. Of the participants enrolled, 45% (36/80) were randomized into the IMPACT intervention and 55% (44/80) into the enhanced web-based resources groups. All participants randomized to the intervention condition completed the remote intervention session, and 89% (77/80) of the daily prompts were answered. The retention rate was 99% (79/80) at 8 weeks and 96% (77/80) at 16 weeks for all participants. Regarding acceptability, 100% (36/36) of the intervention participants were at least moderately satisfied with IMPACT overall, and 92% (33/36) of the participants were at least moderately satisfied with the app. At both 8 and 16 weeks, well-being was significantly higher (β=1.17, SE 0.87, P=.02 at 8 weeks and β=3.24, SE 0.95, P<.001 at 16 weeks) and psychological stress was lower (β=−.66, SE 0.08, P=.04 at 8 weeks and β=−.89, SE 0.09, P<.001 at 16 weeks) among IMPACT users than among control group users. Participants in the intervention group attempted significantly more bystander interventions than those in the control group at 8 weeks (β=.82, SE 0.42; P=.02). Conclusions: This remote app-based intervention for victims of cyberbullying was feasible and acceptable, increased overall well-being and bystander interventions, and decreased psychological stress. Our findings are especially noteworthy given that the trial took place during the COVID-19 pandemic. The use of Instagram to recruit adolescents can be a successful strategy for identifying and intervening with those at the highest risk of cybervictimization. Trial Registration: ClinicalTrials.gov NCT04259216; http://clinicaltrials.gov/ct2/show/NCT04259216. %M 34524103 %R 10.2196/26029 %U https://mental.jmir.org/2021/9/e26029 %U https://doi.org/10.2196/26029 %U http://www.ncbi.nlm.nih.gov/pubmed/34524103 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e31621 %T Pediatric Weight Management Through mHealth Compared to Face-to-Face Care: Cost Analysis of a Randomized Control Trial %A Tully,Louise %A Sorensen,Jan %A O'Malley,Grace %+ Obesity Research and Care Group, Division of Population Health Sciences, School of Physiotherapy, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Beaux Lane House, Level -1, Mercer St, Dublin, D02 DH60, Ireland, 353 014022100, louisetully@rcsi.com %K childhood obesity %K pediatric weight management %K economic evaluation %K digital health %K telemedicine %K mHealth %D 2021 %7 14.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) may improve pediatric weight management capacity and the geographical reach of services, and overcome barriers to attending physical appointments using ubiquitous devices such as smartphones and tablets. This field remains an emerging research area with some evidence of its effectiveness; however, there is a scarcity of literature describing economic evaluations of mHealth interventions. Objective: We aimed to assess the economic viability of using an mHealth approach as an alternative to standard multidisciplinary care by evaluating the direct costs incurred within treatment arms during a noninferiority randomized controlled trial (RCT). Methods: A digitally delivered (via a smartphone app) maintenance phase of a pediatric weight management program was developed iteratively with patients and families using evidence-based approaches. We undertook a microcosting exercise and budget impact analysis to assess the costs of delivery from the perspective of the publicly funded health care system. Resource use was analyzed alongside the RCT, and we estimated the costs associated with the staff time and resources for service delivery per participant. Results: In total, 109 adolescents participated in the trial, and 84 participants completed the trial (25 withdrew from the trial). We estimated the mean direct cost per adolescent attending usual care at €142 (SD 23.7), whereas the cost per adolescent in the mHealth group was €722 (SD 221.1), with variations depending on the number of weeks of treatment completion. The conversion rate for the reference year 2013 was $1=€0.7525. The costs incurred for those who withdrew from the study ranged from €35 to €681, depending on the point of dropout and study arm. The main driver of the costs in the mHealth arm was the need for health professional monitoring and support for patients on a weekly basis. The budget impact for offering the mHealth intervention to all newly referred patients in a 1-year period was estimated at €59,046 using the assessed approach. Conclusions: This mHealth approach was substantially more expensive than usual care, although modifications to the intervention may offer opportunities to reduce the mHealth costs. The need for monitoring and support from health care professionals (HCPs) was not eliminated using this delivery model. Further research is needed to explore the cost-effectiveness and economic impact on families and from a wider societal perspective. Trial Registration: ClinicalTrials.gov NCT01804855; https://clinicaltrials.gov/ct2/show/NCT01804855 %M 34519665 %R 10.2196/31621 %U https://mhealth.jmir.org/2021/9/e31621 %U https://doi.org/10.2196/31621 %U http://www.ncbi.nlm.nih.gov/pubmed/34519665 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27745 %T Understanding Mental Health App Use Among Community College Students: Web-Based Survey Study %A Borghouts,Judith %A Eikey,Elizabeth V %A Mark,Gloria %A De Leon,Cinthia %A Schueller,Stephen M %A Schneider,Margaret %A Stadnick,Nicole %A Zheng,Kai %A Mukamel,Dana B %A Sorkin,Dara H %+ Department of Medicine, University of California, Irvine, 100 Theory, Irvine, CA, 92617, United States, 1 9498240246, jborghou@uci.edu %K mHealth %K mental health %K community college %K students %K structural equation modeling %K mobile apps %K services %K mental health services %K stress %K privacy %D 2021 %7 14.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health concerns are a significant issue among community college students, who often have less access to resources than traditional university college students. Mobile apps have the potential to increase access to mental health care, but there has been little research investigating factors associated with mental health app use within the community college population. Objective: This study aimed to understand facilitators of and barriers to mental health app use among community college students. Methods: A web-based survey was administered to a randomly selected sample of 500 community college students from April 16 to June 30, 2020. Structural equation modeling was used to test the relationships between the use of mental health apps, perceived stress, perceived need to seek help for mental health concerns, perceived stigma, past use of professional mental health services, privacy concerns, and social influence of other people in using mental health apps. Results: Of the 500 participants, 106 (21.2%) reported use of mental health apps. Perceived stress, perceived need to seek help, past use of professional services, and social influence were positively associated with mental health app use. Furthermore, the effect of stress was mediated by a perceived need to seek help. Privacy concerns were negatively associated with mental health app use. Stigma, age, and gender did not have a statistically significant effect. Conclusions: These findings can inform development of new digital interventions and appropriate outreach strategies to engage community college students in using mental health apps. %M 34519668 %R 10.2196/27745 %U https://www.jmir.org/2021/9/e27745 %U https://doi.org/10.2196/27745 %U http://www.ncbi.nlm.nih.gov/pubmed/34519668 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e25486 %T Promoting Physical Activity Through Conversational Agents: Mixed Methods Systematic Review %A Luo,Tiffany Christina %A Aguilera,Adrian %A Lyles,Courtney Rees %A Figueroa,Caroline Astrid %+ School of Social Welfare, University of California, Berkeley, Haviland Hall, Berkeley, CA, 94720-7400, United States, 1 650 228 3514, tiffany.luo@berkeley.edu %K physical activity %K health behavior %K behavior change %K conversational agent %K virtual agent %K chatbot %K digital health %K eHealth %K mHealth %K mobile health %K mobile phone %D 2021 %7 14.9.2021 %9 Review %J J Med Internet Res %G English %X Background: Regular physical activity (PA) is crucial for well-being; however, healthy habits are difficult to create and maintain. Interventions delivered via conversational agents (eg, chatbots or virtual agents) are a novel and potentially accessible way to promote PA. Thus, it is important to understand the evolving landscape of research that uses conversational agents. Objective: This mixed methods systematic review aims to summarize the usability and effectiveness of conversational agents in promoting PA, describe common theories and intervention components used, and identify areas for further development. Methods: We conducted a mixed methods systematic review. We searched seven electronic databases (PsycINFO, PubMed, Embase, CINAHL, ACM Digital Library, Scopus, and Web of Science) for quantitative, qualitative, and mixed methods studies that conveyed primary research on automated conversational agents designed to increase PA. The studies were independently screened, and their methodological quality was assessed using the Mixed Methods Appraisal Tool by 2 reviewers. Data on intervention impact and effectiveness, treatment characteristics, and challenges were extracted and analyzed using parallel-results convergent synthesis and narrative summary. Results: In total, 255 studies were identified, 7.8% (20) of which met our inclusion criteria. The methodological quality of the studies was varied. Overall, conversational agents had moderate usability and feasibility. Those that were evaluated through randomized controlled trials were found to be effective in promoting PA. Common challenges facing interventions were repetitive program content, high attrition, technical issues, and safety and privacy concerns. Conclusions: Conversational agents hold promise for PA interventions. However, there is a lack of rigorous research on long-term intervention effectiveness and patient safety. Future interventions should be based on evidence-informed theories and treatment approaches and should address users’ desires for program variety, natural language processing, delivery via mobile devices, and safety and privacy concerns. %M 34519653 %R 10.2196/25486 %U https://www.jmir.org/2021/9/e25486 %U https://doi.org/10.2196/25486 %U http://www.ncbi.nlm.nih.gov/pubmed/34519653 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 3 %P e22803 %T The Impact of a Gameful Breathing Training Visualization on Intrinsic Experiential Value, Perceived Effectiveness, and Engagement Intentions: Between-Subject Online Experiment %A Lukic,Yanick Xavier %A Klein,Shari Shirin %A Brügger,Victoria %A Keller,Olivia Clare %A Fleisch,Elgar %A Kowatsch,Tobias %+ Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Weinbergstrasse 56/58, Zurich, 8092, Switzerland, 41 446328638, ylukic@ethz.ch %K breathing training %K serious game %K digital health %K mobile health %K mHealth %K mobile phone %K experiential value %K instrumental value %K online experiment %D 2021 %7 14.9.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Slow-paced breathing has been shown to be positively associated with psychological and physiological health. In practice, however, there is little long-term engagement with breathing training, as shown by the usage statistics of breathing training apps. New research suggests that gameful smartphone-delivered breathing training may address this challenge. Objective: This study assesses the impact of breathing training, guided by a gameful visualization, on perceived experiential and instrumental values and the intention to engage in such training. Methods: A between-subject online experiment with 170 participants was conducted, and one-way multiple analysis of variance and two-tailed t test analyses were used to test for any difference in intrinsic experiential value, perceived effectiveness, and the intention to engage in either a breathing training with a gameful or a nongameful guidance visualization. Moreover, prior experience in gaming and meditation practices were assessed as moderator variables for a preliminary analysis. Results: The intrinsic experiential value for the gameful visualization was found to be significantly higher compared to the nongameful visualization (P=.001), but there was no difference in either perceived effectiveness (P=.50) or the intention to engage (P=.44). The preliminary analysis of the influence of meditation and gaming experience on the outcomes indicates that people with more meditation experience yielded higher intrinsic experiential values from using the gameful visualization than people with no or little meditation experience (P=.03). This analysis did not find any additional evidence of gaming time or meditation experience impacting the outcomes. Conclusions: The gameful visualization was found to increase the intrinsic experiential value of the breathing training without decreasing the perceived effectiveness. However, there were no differences in intentions to engage in both breathing training conditions. Furthermore, gaming and meditation experiences seem to have no or only a small positive moderating effect on the relationship between the gameful visualization and the intrinsic experiential value. Future longitudinal field studies are required to assess the impact of gameful breathing training on actual behavior, that is, long-term engagement and outcomes. %M 34519662 %R 10.2196/22803 %U https://games.jmir.org/2021/3/e22803 %U https://doi.org/10.2196/22803 %U http://www.ncbi.nlm.nih.gov/pubmed/34519662 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e23916 %T An mHealth-Based Intervention for Adolescents With Type 1 Diabetes and Their Parents: Pilot Feasibility and Efficacy Single-Arm Study %A Holtz,Bree %A Mitchell,Katharine M %A Holmstrom,Amanda J %A Cotten,Shelia R %A Dunneback,Julie K %A Jimenez-Vega,Jose %A Ellis,Deborah A %A Wood,Michael A %+ Department of Advertising and Public Relations, Michigan State University, 404 Wilson Road, Room 309, East Lansing, MI, 48824, United States, 1 5178844537, bholtz@msu.edu %K mobile health (mHealth) %K adolescents %K type 1 diabetes %K mobile phone %K parent-adolescent %K chronic disease %K feasibility %K diabetes management %D 2021 %7 14.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Type 1 diabetes (T1D) affects more than 165,000 individuals younger than 20 years in the United States of America. The transition from parent management to parent-child team management, with the child taking on increased levels of self-care, can be stressful and is associated with a deterioration in self-management behaviors. Therefore, a mobile app intervention, MyT1DHero, was designed to facilitate diabetes-specific positive parent-adolescent communication and improve diabetes-related outcomes. The MyT1DHero intervention links an adolescent with T1D and their parent through 2 separate app interfaces and is designed to promote positive communication regarding T1D management. Objective: The aim of this pilot study was to determine (1) the initial efficacy of the MyT1DHero intervention in improving diabetes outcomes in adolescents, specifically the hemoglobin A1c (HbA1c) levels, diabetes care adherence, and quality of life, and (2) the adolescents’ overall satisfaction with this intervention. Methods: This pilot study included 30 adolescent-parent pairs who used the MyT1DHero app in a 12-week single-arm clinical trial. Participants were recruited from the local pediatric endocrinology subspecialty clinic via snowball sampling. HbA1c levels, diabetes care adherence, quality of life, family conflict, and satisfaction levels were measured and analyzed using paired sample two-sided t tests and linear regression analyses. Results: The final analysis included 25 families. The mean age of the adolescents was 12.28 (SD 1.62) years. Half of the participants (13/25) reported a diabetes diagnosis of less than 5 years. After 12 weeks of the intervention, diabetes care adherence significantly improved (before the study: mean 3.87 [SD 0.59]; after the study: mean 4.19 [SD 0.65]; t21=–2.52, P=.02, d=0.52) as did quality of life (before the study: mean 4.02 [SD 0.84]; after the study: mean 4.27 [SD 0.73]; t24=2.48, P=.01, d=0.32). HbA1c levels (before the study: mean 8.94 [SD 1.46]; after the study: mean 8.87 [SD 1.29]; t24=0.67, P=.51, d=0.04) and family conflict (before the study: mean 2.45 [SD 0.55]; after the study: mean 2.61 [SD 0.45]; t23=0.55, P=.14, d=0.32) changed in the hypothesized direction, but the change was not significant. However, higher use of the mobile app was associated with more improvement in HbA1c levels (F1,20=9.74, P<.005; R2=0.33). Overall, the adolescents were satisfied with the app intervention. Conclusions: In a 12-week pilot study of the mobile app intervention designed to facilitate parent-adolescent communication for improving diabetes outcomes, significant benefits were demonstrated in self-care adherence and quality of life. A randomized controlled trial with a longer intervention is needed to replicate these findings and to determine the stability of the intervention effects. Trial Registration: ClinicalTrials.gov NCT03436628; https://clinicaltrials.gov/ct2/show/NCT03436628 %M 34519670 %R 10.2196/23916 %U https://mhealth.jmir.org/2021/9/e23916 %U https://doi.org/10.2196/23916 %U http://www.ncbi.nlm.nih.gov/pubmed/34519670 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e31295 %T Factors Associated With Longitudinal Psychological and Physiological Stress in Health Care Workers During the COVID-19 Pandemic: Observational Study Using Apple Watch Data %A Hirten,Robert P %A Danieletto,Matteo %A Tomalin,Lewis %A Choi,Katie Hyewon %A Zweig,Micol %A Golden,Eddye %A Kaur,Sparshdeep %A Helmus,Drew %A Biello,Anthony %A Pyzik,Renata %A Calcagno,Claudia %A Freeman,Robert %A Sands,Bruce E %A Charney,Dennis %A Bottinger,Erwin P %A Murrough,James W %A Keefer,Laurie %A Suarez-Farinas,Mayte %A Nadkarni,Girish N %A Fayad,Zahi A %+ The Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, United States, 1 212 241 0150, robert.hirten@mountsinai.org %K wearable device %K COVID-19 %K stress %K heart rate variability %K psychological %K psychology %K physiology %K mental health %K health care worker %K observational %K app %K heart rate %K nervous system %K resilience %K emotion %K support %K quality of life %D 2021 %7 13.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has resulted in a high degree of psychological distress among health care workers (HCWs). There is a need to characterize which HCWs are at an increased risk of developing psychological effects from the pandemic. Given the differences in the response of individuals to stress, an analysis of both the perceived and physiological consequences of stressors can provide a comprehensive evaluation of its impact. Objective: This study aimed to determine characteristics associated with longitudinal perceived stress in HCWs and to assess whether changes in heart rate variability (HRV), a marker of autonomic nervous system function, are associated with features protective against longitudinal stress. Methods: HCWs across 7 hospitals in New York City, NY, were prospectively followed in an ongoing observational digital study using the custom Warrior Watch Study app. Participants wore an Apple Watch for the duration of the study to measure HRV throughout the follow-up period. Surveys measuring perceived stress, resilience, emotional support, quality of life, and optimism were collected at baseline and longitudinally. Results: A total of 361 participants (mean age 36.8, SD 10.1 years; female: n=246, 69.3%) were enrolled. Multivariate analysis found New York City’s COVID-19 case count to be associated with increased longitudinal stress (P=.008). Baseline emotional support, quality of life, and resilience were associated with decreased longitudinal stress (P<.001). A significant reduction in stress during the 4-week period after COVID-19 diagnosis was observed in the highest tertial of emotional support (P=.03) and resilience (P=.006). Participants in the highest tertial of baseline emotional support and resilience had a significantly different circadian pattern of longitudinally collected HRV compared to subjects in the low or medium tertial. Conclusions: High resilience, emotional support, and quality of life place HCWs at reduced risk of longitudinal perceived stress and have a distinct physiological stress profile. Our findings support the use of these characteristics to identify HCWs at risk of the psychological and physiological stress effects of the pandemic. %M 34379602 %R 10.2196/31295 %U https://www.jmir.org/2021/9/e31295 %U https://doi.org/10.2196/31295 %U http://www.ncbi.nlm.nih.gov/pubmed/34379602 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26315 %T Smartphone-Based Interventions to Reduce Sedentary Behavior and Promote Physical Activity Using Integrated Dynamic Models: Systematic Review %A Daryabeygi-Khotbehsara,Reza %A Shariful Islam,Sheikh Mohammed %A Dunstan,David %A McVicar,Jenna %A Abdelrazek,Mohamed %A Maddison,Ralph %+ Institute for Physical Activity and Nutrition, Deakin University, 75 Pigdons Road, Waurn Ponds Victoria, Geelong, 3216, Australia, 61 3 924 45936, reza.d@deakin.edu.au %K smartphone %K mobile phone %K physical activity %K sedentary behavior %K computational models %K control systems %K systematic review %D 2021 %7 13.9.2021 %9 Review %J J Med Internet Res %G English %X Background: Traditional psychological theories are inadequate to fully leverage the potential of smartphones and improve the effectiveness of physical activity (PA) and sedentary behavior (SB) change interventions. Future interventions need to consider dynamic models taken from other disciplines, such as engineering (eg, control systems). The extent to which such dynamic models have been incorporated in the development of interventions for PA and SB remains unclear. Objective: This review aims to quantify the number of studies that have used dynamic models to develop smartphone-based interventions to promote PA and reduce SB, describe their features, and evaluate their effectiveness where possible. Methods: Databases including PubMed, PsycINFO, IEEE Xplore, Cochrane, and Scopus were searched from inception to May 15, 2019, using terms related to mobile health, dynamic models, SB, and PA. The included studies involved the following: PA or SB interventions involving human adults; either developed or evaluated integrated psychological theory with dynamic theories; used smartphones for the intervention delivery; the interventions were adaptive or just-in-time adaptive; included randomized controlled trials (RCTs), pilot RCTs, quasi-experimental, and pre-post study designs; and were published from 2000 onward. Outcomes included general characteristics, dynamic models, theory or construct integration, and measured SB and PA behaviors. Data were synthesized narratively. There was limited scope for meta-analysis because of the variability in the study results. Results: A total of 1087 publications were screened, with 11 publications describing 8 studies included in the review. All studies targeted PA; 4 also included SB. Social cognitive theory was the major psychological theory upon which the studies were based. Behavioral intervention technology, control systems, computational agent model, exploit-explore strategy, behavioral analytic algorithm, and dynamic decision network were the dynamic models used in the included studies. The effectiveness of quasi-experimental studies involved reduced SB (1 study; P=.08), increased light PA (1 study; P=.002), walking steps (2 studies; P=.06 and P<.001), walking time (1 study; P=.02), moderate-to-vigorous PA (2 studies; P=.08 and P=.81), and nonwalking exercise time (1 study; P=.31). RCT studies showed increased walking steps (1 study; P=.003) and walking time (1 study; P=.06). To measure activity, 5 studies used built-in smartphone sensors (ie, accelerometers), 3 of which used the phone’s GPS, and 3 studies used wearable activity trackers. Conclusions: To our knowledge, this is the first systematic review to report on smartphone-based studies to reduce SB and promote PA with a focus on integrated dynamic models. These findings highlight the scarcity of dynamic model–based smartphone studies to reduce SB or promote PA. The limited number of studies that incorporate these models shows promising findings. Future research is required to assess the effectiveness of dynamic models in promoting PA and reducing SB. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42020139350; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=139350. %M 34515637 %R 10.2196/26315 %U https://www.jmir.org/2021/9/e26315 %U https://doi.org/10.2196/26315 %U http://www.ncbi.nlm.nih.gov/pubmed/34515637 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 6 %N 3 %P e25751 %T Evaluation of the Low Carb Program Digital Intervention for the Self-Management of Type 2 Diabetes and Prediabetes in an NHS England General Practice: Single-Arm Prospective Study %A Summers,Charlotte %A Tobin,Simon %A Unwin,David %+ DDM Health, Technology House, Science Park, University of Warwick, Coventry, CV4 7EZ, United Kingdom, 44 7969091134, Charlotte@ddm.health %K Low Carb Program %K low carbohydrate %K diabetes %K type 2 diabetes intervention %K diabetes prevention %K self-management %K behavior change %K prediabetes %D 2021 %7 9.9.2021 %9 Original Paper %J JMIR Diabetes %G English %X Background: Type 2 diabetes mellitus has serious health consequences, including blindness, amputation, and stroke. Researchers and clinicians are increasingly in agreement that type 2 diabetes may be effectively treated with a carbohydrate-reduced diet. Digital apps are increasingly used as an adjunct to traditional health care provisions to support remote self-management of long-term health conditions. Objective: Our objective was to evaluate the real-world 12-month outcomes of patients prescribed the Low Carb Program digital health intervention at a primary care National Health Service (NHS) site. The Low Carb Program is a nutritionally focused, 12-session, digitally delivered, educational behavior change intervention for glycemic control and weight loss for adults with prediabetes and type 2 diabetes. The program educates and supports sustainable dietary changes focused on carbohydrate restriction by utilizing behavior change techniques, including goal setting, peer support, and behavioral self-monitoring, as well as personalized downloadable resources, including recipes and meal plans tailored to ethnicity, weekly shopping budget, and dietary preferences. Methods: This study evaluated the real-world outcomes of patients recruited to the Low Carb Program at an NHS general practice in Southport, United Kingdom. All of the NHS patients recruited to the program were diagnosed with type 2 diabetes or prediabetes and were given access to the program at no cost. A total of 45 participants, with a mean age of 54.8 years (SD 13.2), were included in the study. Women made up 42% (19/45) of the sample. The mean hemoglobin A1c (HbA1c) of the sample was 56.7 mmol/mol (SD 16.95) and the mean body weight was 89.4 kg (SD 13.8). Results: Of the 45 study participants recruited to the program, all of them (100%) activated their accounts and 37 (82%) individuals reported outcomes at 12 months. All 45 (100%) patients completed at least 40% of the lessons and 32 (71%) individuals completed more than nine out of 12 core lessons of the program. Glycemic control and weight loss improved, particularly for participants who completed more than nine core lessons in the program over 12 months. The mean HbA1c went from 58.8 mmol/mol at baseline to 54.0 mmol/mol, representing a mean reduction of 4.78 mmol/mol (SD 4.60; t31=5.87; P<.001). Results showed an average total body weight reduction of 4.17%, with an average weight reduction of 3.85 kg (SD 2.49; t31=9.27; P<.001) at the 12-month follow-up point. Conclusions: A digital app prescribed to adults with type 2 diabetes and prediabetes in a primary care setting supporting a transition to a low-carbohydrate diet has been shown to be effective in improving glycemic control and enabling weight loss. Further research to understand more about factors affecting engagement with the app and further positive health implications would be valuable. %M 34499035 %R 10.2196/25751 %U https://diabetes.jmir.org/2021/3/e25751 %U https://doi.org/10.2196/25751 %U http://www.ncbi.nlm.nih.gov/pubmed/34499035 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27162 %T Effectiveness of a Dyadic Buddy App for Smoking Cessation: Randomized Controlled Trial %A Schwaninger,Philipp %A Berli,Corina %A Scholz,Urte %A Lüscher,Janina %+ Applied Social and Health Psychology, Department of Psychology, University of Zurich, Binzmühlestrasse 14/14, Zurich, 8050, Switzerland, 41 44 635 72 25, philipp.schwaninger@psychologie.uzh.ch %K mHealth %K smartphone app %K smoking cessation %K buddy %K social support %K mobile phone %D 2021 %7 9.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Tobacco smoking is one of the biggest public health threats. Smartphone apps offer new promising opportunities for supporting smoking cessation in real time. This randomized controlled trial investigated the effectiveness of an app that encourages individuals to quit smoking with the help of a social network member (buddy) in daily life. Objective: The objective of this study is to test the effectiveness of the SmokeFree buddy app compared with a control group with self-reported smoking abstinence and carbon monoxide (CO)–verified smoking abstinence as primary outcomes and self-reports of smoked cigarettes per day (CPD) as a secondary outcome. Methods: A total of 162 adults who smoked participated in this single-blind, two-arm, parallel-group, intensive longitudinal randomized controlled trial. Around a self-set quit date (ie, 7 days before the self-set quit date and 20 days after) and 6 months later, participants of the intervention and control groups reported on daily smoking abstinence and CPD in end-of-day diaries. Daily smoking abstinence was verified via daily exhaled CO assessments. This assessment was administered via an app displaying results of exhaled CO, thus addressing self-monitoring in both groups. In addition, participants in the intervention group used the SmokeFree buddy app, a multicomponent app that facilitates social support from a buddy of choice. Results: A significant reduction in CPD from baseline to the 6-month follow-up was observed among participants in both groups. Multilevel analyses revealed no significant intervention effect on self-reported and CO-verified daily smoking abstinence at the quit date and 3 weeks later. However, CPD was lower at the quit date and 3 weeks later in the intervention group than in the control group. No significant differences between groups were found for any outcome measures 6 months after the quit date. Overall, low app engagement and low perceived usefulness were observed. Conclusions: Despite some encouraging short-term findings on the amount of smoking, the SmokeFree buddy app did not have beneficial effects on smoking abstinence over and above the self-monitoring control condition. Future studies should examine whether and what support processes can be effectively stimulated and how app use can be improved to better achieve this goal. Trial Registration: ISRCTN Registry 11154315; https://www.isrctn.com/ISRCTN11154315 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7723-z %M 34499045 %R 10.2196/27162 %U https://www.jmir.org/2021/9/e27162 %U https://doi.org/10.2196/27162 %U http://www.ncbi.nlm.nih.gov/pubmed/34499045 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27985 %T Technology Acceptance Among Patients With Hemophilia in Hong Kong and Their Expectations of a Mobile Health App to Promote Self-management: Survey Study %A Cheung,Yin Ting %A Lam,Pok Hong %A Lam,Teddy Tai-Ning %A Lam,Henry Hon Wai %A Li,Chi Kong %+ School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Rm 801, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Shatin, New Territories, Hong Kong SAR, Hong Kong, 852 39436833, yinting.cheung@cuhk.edu.hk %K mobile health %K mHealth %K patients %K expectations %K hemophilia %K chronic diseases %K rare diseases %K self-management %D 2021 %7 9.9.2021 %9 Short Paper %J JMIR Form Res %G English %X Background: The lifelong management of hemophilia is demanding and complex. In July 2019, we published a review in the Journal of Medical Internet Research, summarizing telehealth interventions that facilitate monitoring of bleeding events and promoting the appropriate use of clotting factors among patients with hemophilia. This work has led to the development of a community program that aims to harness technology to promote self-management among patients with hemophilia in Hong Kong. Objective: Before the inception of this program, we conducted a cross-sectional survey to evaluate the patients’ level of technology acceptance and identify their expectations of the use of mobile technology for self-management of hemophilia. Methods: In total, 56 participants (75% adult patients and 25% parents of pediatric patients; 87.5% with moderate to severe disease) were recruited from a local nongovernmental organization that serves patients with hemophilia. They rated their perceived confidence and acceptance in using the new mobile technology (score 1 to 5 for each item, with a higher score indicating better acceptance) using a structured questionnaire (adapted from the Technology Acceptance Model). They also identified the top features that they perceived to be the most important components of a mobile app for the self-management of hemophilia. The Mann–Whitney U test was used to compare technology acceptance scores across subgroups of different clinical and socioeconomic characteristics. Results: In general, the participants considered themselves skilled in using mobile apps (mean 4.3, 95% CI 4.1-4.5). They were willing to learn to use the new mobile app to organize their bleeding records (mean 4.0, 95% CI 3.7-4.3) and to manage their health (mean 4.2, 95% CI 4.1-4.5). Participants who lived in public housing (a surrogate marker for lower socioeconomic status in Hong Kong) reported lower technology acceptance than those who lived in private housing (P=.04). The most important features identified by the participants concerned documenting of infusion logs (n=49, 87.5%), bleeding events (n=48, 85.7%), and the secure delivery of the bleeding information to health care professionals (n=40, 71.4%). Conclusions: It is encouraging to infer that patients with hemophilia in Hong Kong are receptive to the use of mobile health technology. The findings of this survey are applicable in designing the key features of a patient-centered, multimodal program harnessing mobile technology to promote self-management among patients with hemophilia. Future studies should evaluate participants’ acceptability and perceived usability of the mobile app via user metrics and assess clinical and humanistic outcomes of this program. %M 34499034 %R 10.2196/27985 %U https://formative.jmir.org/2021/9/e27985 %U https://doi.org/10.2196/27985 %U http://www.ncbi.nlm.nih.gov/pubmed/34499034 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28320 %T Implementing mHealth-Enabled Integrated Care for Complex Chronic Patients With Osteoarthritis Undergoing Primary Hip or Knee Arthroplasty: Prospective, Two-Arm, Parallel Trial %A Colomina,Jordi %A Drudis,Reis %A Torra,Montserrat %A Pallisó,Francesc %A Massip,Mireia %A Vargiu,Eloisa %A Nadal,Nuria %A Fuentes,Araceli %A Ortega Bravo,Marta %A Miralles,Felip %A Barbé,Ferran %A Torres,Gerard %A de Batlle,Jordi %A , %+ Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomedica de Lleida (IRBLleida), Rovira Roure 80, Lleida, 25198, Spain, 34 645624734, jordidebatlle@gmail.com %K mHealth %K osteoarthritis %K arthroplasty %K health plan implementation %K chronic disease %K mobile phone %D 2021 %7 2.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Osteoarthritis is a disabling condition that is often associated with other comorbidities. Total hip or knee arthroplasty is an effective surgical treatment for osteoarthritis when indicated, but comorbidities can impair their results by increasing complications and social and economic costs. Integrated care (IC) models supported by eHealth can increase efficiency through defragmentation of care and promote patient-centeredness. Objective: This study aims to assess the effectiveness and cost-effectiveness of implementing a mobile health (mHealth)–enabled IC model for complex chronic patients undergoing primary total hip or knee arthroplasty. Methods: As part of the Horizon 2020 Personalized Connected Care for Complex Chronic Patients (CONNECARE) project, a prospective, pragmatic, two-arm, parallel implementation trial was conducted in the rural region of Lleida, Catalonia, Spain. For 3 months, complex chronic patients undergoing total hip or knee arthroplasty and their caregivers received the combined benefits of the CONNECARE organizational IC model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care (UC). We assessed changes in health status (12-item short-form survey [SF-12]), unplanned visits and admissions during a 6-month follow-up, and the incremental cost-effectiveness ratio. Results: A total of 29 patients were recruited for the mHealth-enabled IC arm, and 30 patients were recruited for the UC arm. Both groups were statistically comparable for baseline characteristics, such as age; sex; type of arthroplasty; and Charlson index, American Society of Anesthesiologists classification, Barthel index, Hospital Anxiety and Depression scale, Western Ontario and McMaster Universities Osteoarthritis Index, and Pfeiffer mental status questionnaire scores. Patients in both groups had significant increases in the SF-12 physical domain and total SF-12 score, but differences in differences between the groups were not statistically significant. IC patients had 50% fewer unplanned visits (P=.006). Only 1 hospital admission was recorded during the follow-up (UC arm). The IC program generated savings in different cost scenarios, and the incremental cost-effectiveness ratio demonstrated cost-effectiveness. Conclusions: Chronic patients undergoing hip or knee arthroplasty can benefit from the implementation of patient-centered mHealth-enabled IC models aimed at empowering patients and facilitating transitions from specialized hospital care to primary care. Such models can reduce unplanned contacts with the health system and reduce overall health costs, proving to be cost-effective. Overall, our findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement IC for patients undergoing elective surgery. %M 34473068 %R 10.2196/28320 %U https://www.jmir.org/2021/9/e28320 %U https://doi.org/10.2196/28320 %U http://www.ncbi.nlm.nih.gov/pubmed/34473068 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27403 %T Consumer Perspectives on Maternal and Infant Health Apps: Qualitative Content Analysis %A Biviji,Rizwana %A Williams,Karmen S %A Vest,Joshua R %A Dixon,Brian E %A Cullen,Theresa %A Harle,Christopher A %+ Science of Healthcare Delivery, College of Health Solutions, Arizona State University, 550 North 3rd Street, Phoenix, AZ, 85004, United States, 1 602 496 3300, Rizwana.Biviji@asu.edu %K mHealth %K mobile applications %K maternal and infant health %K smartphones %K mobile phone %D 2021 %7 1.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the popularity of maternal and infant health mobile apps, ongoing consumer engagement and sustained app use remain barriers. Few studies have examined user experiences or perceived benefits of maternal and infant health app use from consumer perspectives. Objective: This study aims to assess users’ self-reported experiences with maternal and infant health apps, perceived benefits, and general feedback by analyzing publicly available user reviews on two popular app stores—Apple App Store and Google Play Store. Methods: We conducted a qualitative assessment of publicly available user reviews (N=2422) sampled from 75 maternal and infant health apps designed to provide health education or decision-making support to pregnant women or parents and caregivers of infants. The reviews were coded and analyzed using a general inductive qualitative content analysis approach. Results: The three major themes included the following: app functionality, where users discussed app features and functions; technical aspects, where users talked about technology-based aspects of an app; and app content, where users specifically focused on the app content and the information it provides. The six minor themes included the following: patterns of use, where users highlighted the frequency and type of use; social support, where users talked about receiving social support from friends, family and community of other users; app cost, where users talked about the cost of an app within the context of being cost-effective or a potential waste of money; app comparisons, where users compared one app with others available in app stores; assistance in health care, where users specifically highlighted the role of an app in offering clinical assistance; and customer care support, where users specifically talked about their interaction with the app customer care support team. Conclusions: Users generally tend to value apps that are of low cost and preferably free, with high-quality content, superior features, enhanced technical aspects, and user-friendly interfaces. Users also find app developer responsiveness to be integral, as it offers them an opportunity to engage in the app development and delivery process. These findings may be beneficial for app developers in designing better apps, as no best practice guidelines currently exist for the app environment. %M 34468323 %R 10.2196/27403 %U https://www.jmir.org/2021/9/e27403 %U https://doi.org/10.2196/27403 %U http://www.ncbi.nlm.nih.gov/pubmed/34468323 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e28784 %T A Smartphone App to Support Adherence to Inhaled Corticosteroids in Young Adults With Asthma: Multi-Methods Feasibility Study %A Murphy,Jane %A McSharry,Jenny %A Hynes,Lisa %A Molloy,Gerard J %+ School of Psychology, National University of Ireland, Galway, University Rd, Galway, H91 TK33, Ireland, 353 91 524411, j.murphy51@nuigalway.ie %K asthma %K young adult %K medication adherence %K self-management %K mobile applications %K mHealth %K intervention %K usability %K acceptability %K feasibility %K multi-methods %K mobile phone %D 2021 %7 1.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Young adults with asthma often report low adherence to inhaled corticosteroids (ICS), leading to uncontrolled symptoms and poor disease outcomes. Technology-enabled digital supports such as mobile health (mHealth) asthma smartphone apps have the potential to support adherence to ICS and asthma self-management. There is a need for feasibility studies to determine the usability, acceptability, and feasibility of these interventions. In addition, it is essential to determine the feasibility of recruiting and retaining young adults to plan future efficacy and effectiveness trials and therefore, establish evidence-based asthma apps. Objective: This study aimed to determine (1) the feasibility of recruiting and retaining young adults to a trial and (2) the usability, acceptability, and feasibility of using the AsthmaMD app to support adherence to ICS in a population of young adults living with asthma. Methods: A multi-methods feasibility study was conducted. Young adults aged 18-30 years with asthma and current prescription for ICS were eligible and invited to take part through a university circular email, social media, and general practice sites. Participation involved completing a baseline self-report questionnaire, downloading and using the AsthmaMD app for 2 weeks, and completing the follow-up assessment, including self-report and open-ended questions about participants’ experience of using the app. Primary outcomes included participant recruitment and retention and the usability, acceptability, and feasibility of using AsthmaMD. Quantitative self-report data were analyzed using descriptive statistics, and qualitative open-ended data were analyzed using inductive reflexive thematic analysis. Results: A total of 122 young adults (females, n=101, 82.8%) with a mean age of 24.4 (SD 3.8) years were recruited and they completed baseline measures. Of the 122 young adults, 59 (48.4%) completed the study. The AsthmaMD app received a mean score of 63.1/100 (SD 20.1) on the System Usability Scale (ie, a standardized measure of usability for technology-based apps), and an overall user satisfaction score of 5.8/10 (SD 2.2). Of the 59 participants who completed the study, 49 (83%) participants used the app ≥1 day per week. Two main themes were identified in the qualitative analysis of user experiences: (1) learning how to use the app to suit the individual and (2) benefits and relevance of using the app. Conclusions: The findings from this study indicate that it is feasible to recruit and retain young adults to examine efficacy and effectiveness in a future trial and that young adults living with asthma may find AsthmaMD to be usable, acceptable, and feasible to support adherence to ICS. Our findings also identified opportunities to further optimize the usability of AsthmaMD and similar apps. Based on our findings, we recommend providing more accessible information on how to use the app and replacing medical terminology with simplified language within the app to improve usability. Trial Registration: ISRCTN Registry ISRCTN11295269; https://www.isrctn.com/ISRCTN11295269 %M 34468325 %R 10.2196/28784 %U https://formative.jmir.org/2021/9/e28784 %U https://doi.org/10.2196/28784 %U http://www.ncbi.nlm.nih.gov/pubmed/34468325 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e27926 %T Factors Associated With Intention to Adopt mHealth Apps Among Dementia Caregivers With a Chronic Condition: Cross-sectional, Correlational Study %A Mendez,Kyra Jennifer Waligora %A Budhathoki,Chakra %A Labrique,Alain Bernard %A Sadak,Tatiana %A Tanner,Elizabeth K %A Han,Hae Ra %+ School of Nursing, Johns Hopkins University, 525 N Wolfe St, Baltimore, MD, 21205, United States, 1 410 929 4327, kwaligo1@jhu.edu %K mHealth applications %K mobile health %K intention to adopt mHealth applications %K dementia caregivers %K family caregiving %K chronic disease self-management %K mobile phone %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the United States, nearly 80% of family caregivers of people with dementia have at least one chronic condition. Dementia caregivers experience high stress and burden that adversely affect their health and self-management. mHealth apps can improve health and self-management among dementia caregivers with a chronic condition. However, mHealth app adoption by dementia caregivers is low, and reasons for this are not well understood. Objective: The purpose of this study is to explore factors associated with dementia caregivers’ intention to adopt mHealth apps for chronic disease self-management. Methods: We conducted a cross-sectional, correlational study and recruited a convenience sample of dementia caregivers. We created a survey using validated instruments and collected data through computer-assisted telephone interviews and web-based surveys. Before the COVID-19 pandemic, we recruited dementia caregivers through community-based strategies, such as attending community events. After nationwide closures due to the pandemic, the team focused on web-based recruitment. Multiple logistic regression analyses were used to test the relationships between the independent and dependent variables. Results: Our sample of 117 caregivers had an average age of 53 (SD 17.4) years, 16 (SD 3.3) years of education, and 4 (SD 2.5) chronic conditions. The caregivers were predominantly women (92/117, 78.6%) and minorities (63/117, 53.8%), experienced some to extreme income difficulties (64/117, 54.7%), and were the child or child-in-law (53/117, 45.3%) of the person with dementia. In logistic regression models adjusting for the control variables, caregiver burden (odds ratio [OR] 1.3, 95% CI 0.57-2.8; P=.57), time spent caregiving per week (OR 1.7, 95% CI 0.77-3.9; P=.18), and burden of chronic disease and treatment (OR 2.3, 95% CI 0.91-5.7; P=.08) were not significantly associated with the intention to adopt mHealth apps. In the final multiple logistic regression model, only perceived usefulness (OR 23, 95% CI 5.6-97; P<.001) and the interaction term for caregivers’ education and burden of chronic disease and treatment (OR 31, 95% CI 2.2-430; P=.01) were significantly associated with their intention to adopt mHealth apps. Perceived ease of use (OR 2.4, 95% CI 0.67-8.7; P=.18) and social influence (OR 1.8, 95% CI 0.58-5.7; P=.31) were not significantly associated with the intention to adopt mHealth apps. Conclusions: When designing mHealth app interventions for dementia caregivers with a chronic condition, it is important to consider caregivers’ perceptions about how well mHealth apps can help their self-management and which app features would be most useful for self-management. Caregiving factors may not be relevant to caregivers’ intention to adopt mHealth apps. This is promising because mHealth strategies may overcome barriers to caregivers’ self-management. Future research should investigate reasons why caregivers with a low education level and low burden of chronic disease and treatment have significantly lower intention to adopt mHealth apps for self-management. %M 34463637 %R 10.2196/27926 %U https://mhealth.jmir.org/2021/8/e27926 %U https://doi.org/10.2196/27926 %U http://www.ncbi.nlm.nih.gov/pubmed/34463637 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e21088 %T Usefulness of Smartphone Apps for Improving Nutritional Status of Pancreatic Cancer Patients: Randomized Controlled Trial %A Keum,Jiyoung %A Chung,Moon Jae %A Kim,Youngin %A Ko,Hyunyoung %A Sung,Min Je %A Jo,Jung Hyun %A Park,Jeong Youp %A Bang,Seungmin %A Park,Seung Woo %A Song,Si Young %A Lee,Hee Seung %+ Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 1050586865, LHS6865@yuhs.ac %K pancreatic ductal adenocarcinoma %K mobile app %K nutritional support %K quality of life %K chemotherapy %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Approximately 80% of pancreatic ductal adenocarcinoma (PDAC) patients suffer from anorexia, weight loss, and asthenia. Most PDAC patients receive chemotherapy, which often worsens their nutritional status owing to the adverse effects of chemotherapy. Malnutrition of PDAC patients is known to be associated with poor prognosis; therefore, nutritional management during chemotherapy is a key factor influencing the outcome of the treatment. Mobile apps have the potential to provide readily accessible nutritional support for patients with PDAC. Objective: We aimed to evaluate the efficacy of a mobile app–based program, Noom, in patients receiving chemotherapy for PDAC. Methods: We prospectively enrolled 40 patients who were newly diagnosed with unresectable PDAC from a single university-affiliated hospital in South Korea, and randomly assigned them into a Noom user group (n=20) and a non-Noom user group (n=20). The 12-week in-app interventions included meal and physical activity logging as well as nutritional education feedback from dietitians. The non-Noom user group did not receive any nutrition intervention. The primary outcomes were the changes in the nutritional status and quality of life (QoL) from the baseline to 12 weeks. The secondary outcomes included the changes in the skeletal muscle index (SMI) from the baseline to 12 weeks. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) and the Patient-Generated Subjective Global Assessment (PG-SGA) were used as paper questionnaires to assess the QoL and nutritional status of the patients. Intention-to-treat and per-protocol analyses were conducted. Regarding the study data collection time points, we assessed the nutritional status and QoL at the baseline (T0), and at 4 (T1), 8 (T2), and 12 (T3) weeks. Abdominal computed tomography (CT) imaging was conducted at the baseline and after 8 weeks for tumor response and SMI evaluation. The skeletal muscle area (cm2) was calculated using routine CT images. The cross-sectional areas (cm2) of the L3 skeletal muscles were analyzed. Results: Between February 2017 and January 2018, 48 patients were assessed for eligibility. Totally 40 patients with pancreatic cancer were included by random allocation. Only 17 participants in the Noom user group and 16 in the non-Noom user group completed all follow-ups. All the study participants showed a significant improvement in the nutritional status according to the PG-SGA score regardless of Noom app usage. Noom users showed statistically significant improvements on the global health status (GHS) and QoL scales compared to non-Noom users, based on the EORTC QLQ (P=.004). The SMI decreased in both groups during chemotherapy (Noom users, 49.08±12.27 cm2/m2 to 46.08±10.55 cm2/m2; non-Noom users, 50.60±9.05 cm2/m2 to 42.97±8.12 cm2/m2). The decrement was higher in the non-Noom user group than in the Noom user group, but it was not statistically significant (-13.96% vs. -3.27%; P=.11). Conclusions: This pilot study demonstrates that a mobile app–based approach is beneficial for nutritional and psychological support for PDAC patients receiving chemotherapy. Trial Registration: ClinicalTrials.gov NCT04109495; https://clinicaltrials.gov/ct2/show/NCT04109495. %M 34463630 %R 10.2196/21088 %U https://mhealth.jmir.org/2021/8/e21088 %U https://doi.org/10.2196/21088 %U http://www.ncbi.nlm.nih.gov/pubmed/34463630 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e26861 %T A Mobile Health App (WYZ) for Engagement in Care and Antiretroviral Therapy Adherence Among Youth and Young Adults Living With HIV: Single-Arm Pilot Intervention Study %A Saberi,Parya %A Lisha,Nadra E %A Erguera,Xavier A %A Hudes,Estie Sid %A Johnson,Mallory O %A Ruel,Theodore %A Neilands,Torsten B %+ Department of Medicine, University of California, San Francisco, 550 16th street, San Francisco, CA, 94143, United States, 1 415 502 1000 ext 17171, Parya.Saberi@ucsf.edu %K youth living with HIV %K mobile health %K mobile app %K engagement in care %K antiretroviral therapy adherence %K pilot %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Youth are globally recognized as being vulnerable to HIV. Younger age has been correlated with worse health outcomes. Mobile health (mHealth) interventions have the potential to interact with youth where they are, using a device they already access. Objective: Using predefined benchmarks, we sought to evaluate the feasibility and acceptability of WYZ, an mHealth app, for improved engagement in care and antiretroviral therapy (ART) adherence among youth and young adults living with HIV. WYZ was designed and developed with input from youth and young adults living with HIV using a human-centered design approach and was based on the information, motivation, and behavioral skills framework to address common barriers to care and ART adherence among youth and young adults living with HIV. Methods: We recruited youth and young adults living with HIV (18-29 years old) from the San Francisco Bay Area to take part in a 6-month pilot trial. Their participation included completing baseline and exit surveys, and participating in seven phone check-ins about their use of WYZ. Results: Youth and young adults living with HIV (N=79) reported high levels of feasibility and acceptability with WYZ use. We met predefined benchmarks for recruitment (79/84, 94%), mean logins per week (5.3), tracking ART adherence (5442/9393, 57.9%), posting chat topics per week (4.8), and app crashes reported per week (0.24). The ease of app download, install, and setup, and comfort with security, privacy, and anonymity were highly rated (all over 91%). Additionally, participants reported high satisfaction for a research project that was remotely conducted. Participants used the app for shorter timeframes compared to the predefined benchmark. Conclusions: We noted high feasibility and acceptability with WYZ. Further research to examine the efficacy of WYZ will enable youth and young adults living with HIV and their providers to make informed decisions when using, recommending, and prescribing the app for improved engagement in HIV care and ART adherence. Trial Registration: ClinicalTrials.gov NCT03587857; https://clinicaltrials.gov/ct2/show/NCT03587857 %M 34463622 %R 10.2196/26861 %U https://formative.jmir.org/2021/8/e26861 %U https://doi.org/10.2196/26861 %U http://www.ncbi.nlm.nih.gov/pubmed/34463622 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e28075 %T Scoping the Need for a Tailored mHealth App to Improve Health and Well-being Behavioral Transformation in the Police: Exploring the Views of UK Police Workers via Web-Based Surveys and Client Meetings %A Swanston,Emma %A Pulman,Andy %A Dogan,Huseyin %A Murphy,Jane %A Bitters,Fiona %+ Faculty of Science and Technology, Bournemouth University, Poole House, Talbot Campus,, Fern Barrow, Poole, BH12 5BB, United Kingdom, 44 1202 961047, apulman@bournemouth.ac.uk %K nutrition %K food %K behavior change %K mobile health %K police %K lifestyle management %K well-being %K mobile phone %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Police officers often work long, unsocial hours in a highly pressurized environment and may experience difficulties in managing their health and well-being. Their jobs can be highly stressful and feature unusual working hours and multiple shift patterns. When considering the policing environment of 2021, many roles that were previously the domain of warranted officers are now being carried out by nonwarranted police staff equivalents. These police staff roles are relatively new to policing but put staff under some of the same stresses as police officers. A UK police force requested help to investigate technologies that could be used to improve health and well-being and research how these technologies could be used to measure and track health behavior change. Objective: Historical research studies need to be appraised in light of this new policing environment, and new research also needs to include this shift in dynamics when considering aspects of policing, including their health and well-being. This study explores police officer and staff attitudes toward and their use of existing health-related technology, highlights existing practices, and gathers views about how technology could be used more effectively. Methods: A web-based survey was completed by police officers and staff (N=213) during the initial period of the UK lockdown in 2020. The survey was designed to find the solutions that participants used outside of those supplied by their employer, identify issues or problems, and find what they would like a hypothetical app to focus on. Additional requirements data were captured through client meetings, including discussions concerning previously attempted solutions and those currently in place. Thematic analysis was undertaken to identify the key themes. Results: Attitudes toward and uses of existing health-related technology were captured, and existing practices were highlighted. Participants identified a need for an app to consider that a user was on shift—an important point, as many issues and problems with elements of their health and well-being involved shift work. Data also highlighted that a multifunctional tool would be more beneficial to participants than focusing on just 1 element. The key features and four domains were identified for app coverage. The prioritized order of importance of the four domains was activity, food and diet, sleep, and fluid intake. Conclusions: For police officers and staff, research data suggest that there is a previously unidentified requirement for a mobile app that could provide an easily accessible platform for them to use, regardless of the current location; one that could provide guidelines on diet, lifestyle habits, and health behavior to help the user make informed decisions to assist in personalized behavior change. Notably, one which is multifunctional and which also aligns effectively with the irregular shift patterns of its users. %M 34463625 %R 10.2196/28075 %U https://formative.jmir.org/2021/8/e28075 %U https://doi.org/10.2196/28075 %U http://www.ncbi.nlm.nih.gov/pubmed/34463625 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e28104 %T Supporting Women Undergoing IVF Treatment With Timely Patient Information Through an App: Randomized Controlled Trial %A Timmers,Thomas %A Keijsers,Manouk %A Kremer,Jan A M %A Janssen,Loes %A Smeenk,Jesper %+ IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, Netherlands, 31 24 3615305, thomas@interactivestudios.nl %K patient education %K fertilization in vitro %K mobile health %K health literacy %K gynecology %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Since the introduction of assisted reproductive technologies in 1978, over 2 million in vitro fertilization (IVF) babies have been born worldwide. Patients play a vital role in the success of this treatment. They are required to take fertility medication (hormone injections) to activate the ovaries to produce a sufficient number of oocytes. Later, they need to take medication to increase the chance of the embryo surviving inside the uterus. Patients are educated during an intake consultation at the start of the treatment to minimize the emotional burden and reduce noncompliance. The consultation lasts about 30 to 45 minutes and covers all essential subjects. Even though ample time and energy is spent on patient education, patients still feel anxious, unknowledgeable, and unsupported. As such, electronic health utilizing a smartphone or tablet app can offer additional support, as it allows health care professionals to provide their patients with the correct information at the right time by using push notifications. Objective: This randomized controlled trial aimed to evaluate the capacity of an app to support IVF patients throughout the different phases of their treatment and assess its effectiveness. The study's primary outcome was to determine the patients’ level of satisfaction with the information provided. The secondary outcomes included their level of knowledge, ability to administer the medication, overall experienced quality of the treatment, health care consumption, and app usage. Methods: This study was performed at a specialized fertility clinic of the nonacademic teaching hospital Elisabeth-TweeSteden Ziekenhuis in Tilburg, the Netherlands. Patients who were scheduled for IVF or intracytoplasmic sperm injection treatments between April 2018 and August 2019 were invited to participate in a physician-blinded, randomized controlled trial. Results: In total, 54 patients participated (intervention group: n=29). Patients in the intervention group demonstrated a higher level of satisfaction on a 0 to 10 scale (mean 8.43, SD 1.03 vs mean 7.70, SD 0.66; P=.004). In addition, they were more knowledgeable about the different elements of the treatment on a 7 to 35 scale (mean 27.29, SD 2.94 vs mean 23.05, SD 2.76; P<.001). However, the difference disappeared over time. There were no differences between the two patient groups on the other outcomes. In total, 25 patients in the intervention group used the app 1425 times, an average of 57 times per patient. Conclusions: Our study demonstrates that, in comparison with standard patient education, using an app to provide patients with timely information increases their level of satisfaction. Furthermore, using the app leads to a higher level of knowledge about the steps and procedures of IVF treatment. Finally, the app’s usage statistics demonstrate patients’ informational needs and their willingness to use an electronic health application as part of their treatment. Trial Registration: Netherlands Trial Register (NTR) 6959; https://www.trialregister.nl/trial/6959 %M 34448725 %R 10.2196/28104 %U https://mhealth.jmir.org/2021/8/e28104 %U https://doi.org/10.2196/28104 %U http://www.ncbi.nlm.nih.gov/pubmed/34448725 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28974 %T Diagnostic Accuracy of Smartwatches for the Detection of Cardiac Arrhythmia: Systematic Review and Meta-analysis %A Nazarian,Scarlet %A Lam,Kyle %A Darzi,Ara %A Ashrafian,Hutan %+ Imperial College London, 10th Floor QEQM Building, St Mary’s Hospital, Praed Street, London, W2 1NY, United Kingdom, 44 7799 871 597, hutan@researchtrials.net %K wearables %K smartwatch %K cardiac arrhythmia %K atrial fibrillation %K cardiology %K mHealth %K wearable devices %K screening %K diagnostics %K accuracy %D 2021 %7 27.8.2021 %9 Review %J J Med Internet Res %G English %X Background: Significant morbidity, mortality, and financial burden are associated with cardiac rhythm abnormalities. Conventional investigative tools are often unsuccessful in detecting cardiac arrhythmias because of their episodic nature. Smartwatches have gained popularity in recent years as a health tool for the detection of cardiac rhythms. Objective: This study aims to systematically review and meta-analyze the diagnostic accuracy of smartwatches in the detection of cardiac arrhythmias. Methods: A systematic literature search of the Embase, MEDLINE, and Cochrane Library databases was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify studies reporting the use of a smartwatch for the detection of cardiac arrhythmia. Summary estimates of sensitivity, specificity, and area under the curve were attempted using a bivariate model for the diagnostic meta-analysis. Studies were examined for quality using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Results: A total of 18 studies examining atrial fibrillation detection, bradyarrhythmias and tachyarrhythmias, and premature contractions were analyzed, measuring diagnostic accuracy in 424,371 subjects in total. The signals analyzed by smartwatches were based on photoplethysmography. The overall sensitivity, specificity, and accuracy of smartwatches for detecting cardiac arrhythmias were 100% (95% CI 0.99-1.00), 95% (95% CI 0.93-0.97), and 97% (95% CI 0.96-0.99), respectively. The pooled positive predictive value and negative predictive value for detecting cardiac arrhythmias were 85% (95% CI 0.79-0.90) and 100% (95% CI 1.0-1.0), respectively. Conclusions: This review demonstrates the evolving field of digital disease detection. The current diagnostic accuracy of smartwatch technology for the detection of cardiac arrhythmias is high. Although the innovative drive of digital devices in health care will continue to gain momentum toward screening, the process of accurate evidence accrual and regulatory standards ready to accept their introduction is strongly needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020213237; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=213237. %M 34448706 %R 10.2196/28974 %U https://www.jmir.org/2021/8/e28974 %U https://doi.org/10.2196/28974 %U http://www.ncbi.nlm.nih.gov/pubmed/34448706 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28695 %T Feasibility of an Interactive Health Coaching Mobile App to Prevent Malnutrition and Muscle Loss in Esophageal Cancer Patients Receiving Neoadjuvant Concurrent Chemoradiotherapy: Prospective Pilot Study %A Yang,Kyungmi %A Oh,Dongryul %A Noh,Jae Myoung %A Yoon,Han Gyul %A Sun,Jong-Mu %A Kim,Hong Kwan %A Zo,Jae Ill %A Shim,Young Mog %A Ko,Hyunyoung %A Lee,Jungeun %A Kim,Youngin %+ Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea, 82 2 3410 2612, dongryul.oh@samsung.com %K esophageal cancer %K malnutrition %K muscle loss %K sarcopenia %K mobile app %K mHealth %D 2021 %7 27.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Excessive muscle loss is an important prognostic factor in esophageal cancer patients undergoing neoadjuvant chemoradiotherapy (NACRT), as reported in our previous research. Objective: In this pilot study, we prospectively tested the feasibility of a health coaching mobile app for preventing malnutrition and muscle loss in this patient population. Methods: Between July 2019 and May 2020, we enrolled 38 male patients with esophageal cancer scheduled for NACRT. For 8 weeks from the start of radiotherapy (RT), the patients used Noom, a health coaching mobile app that interactively provided online advice about food intake, exercise, and weight changes. The skeletal muscle index (SMI) measured based on computed tomography and nutrition-related laboratory markers were assessed before and after RT. We evaluated the changes in the SMI, nutrition, and inflammatory factors between the patient group that used the mobile app (mHealth group) and our previous study cohort (usual care group). Additionally, we analyzed the factors associated with walk steps recorded in the app. Results: Two patients dropped out of the study (no app usage; treatment changed to a definitive aim). The use (or activation) of the app was noted in approximately 70% (25/36) of the patients until the end of the trial. Compared to the 1:2 matched usual care group by propensity scores balanced with their age, primary tumor location, tumor stage, pre-RT BMI, and pre-RT SMI level, 30 operable patients showed less aggravation of the prognostic nutritional index (PNI) (–6.7 vs –9.8; P=.04). However, there was no significant difference in the SMI change or the number of patients with excessive muscle loss (∆SMI/50 days >10%). In patients with excessive muscle loss, the walk steps significantly decreased in the last 4 weeks compared to those in the first 4 weeks. Age affected the absolute number of walk steps (P=.01), whereas pre-RT sarcopenia was related to the recovery of the reduced walk steps (P=.03). Conclusions: For esophageal cancer patients receiving NACRT, a health care mobile app helped nutritional self-care with less decrease in the PNI, although it did not prevent excessive muscle loss. An individualized care model with proper exercise as well as nutritional support may be required to reduce muscle loss and malnutrition. %M 34448714 %R 10.2196/28695 %U https://www.jmir.org/2021/8/e28695 %U https://doi.org/10.2196/28695 %U http://www.ncbi.nlm.nih.gov/pubmed/34448714 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28192 %T Using a Smartphone Application for the Accurate and Rapid Diagnosis of Acute Anterior Intracranial Arterial Occlusion: Usability Study %A Komatsu,Teppei %A Sakai,Kenichiro %A Iguchi,Yasuyuki %A Takao,Hiroyuki %A Ishibashi,Toshihiro %A Murayama,Yuichi %+ Department of Neurology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan, 81 334331111, teppeinoieni.coicoi@jikei.ac.jp %K stroke %K infarction %K teleradiology %K smartphone %K telehealth %K reperfusion %K neurology %K mHealth %K application %K mobile health %K mobile applications %K diagnosis %K diagnostics %D 2021 %7 27.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Telestroke has developed rapidly as an assessment tool for patients eligible for reperfusion therapy. Objective: To investigate whether vascular neurologists can diagnose intracranial large vessel occlusion (LVO) as quickly and accurately using a smartphone application compared to a hospital-based desktop PC monitor. Methods: We retrospectively enrolled 108 consecutive patients with acute ischemic stroke in the middle cerebral artery territory who underwent magnetic resonance imaging (MRI) within 24 hours of their stroke onset. Two vascular neurologists, blinded to all clinical information, independently evaluated magnetic resonance angiography and fluid-attenuated inversion recovery images for the presence or absence of LVO in the internal carotid artery and middle cerebral artery (M1, M2, or M3) on both a smartphone application (Smartphone-LVO) and a hospital-based desktop PC monitor (PC-LVO). To evaluate the accuracy of an arterial occlusion diagnosis, interdevice variability between Smartphone-LVO and PC-LVO was analyzed using κ statistics, and image interpretation time was compared between Smartphone-LVO and PC-LVO. Results: There was broad agreement between Smartphone-LVO and PC-LVO evaluations regarding the presence or absence of arterial occlusion (Reader 1: κ=0.94; P<.001 vs Reader 2: κ=0.89; P<.001), and interpretation times were similar between Smartphone-LVO and PC-LVO. Conclusions: The results indicate the evaluation of neuroimages using a smartphone application can provide an accurate and timely diagnosis of anterior intracranial arterial occlusion that can be shared immediately with members of the stroke team to support the management of patients with hyperacute ischemic stroke. %M 34448716 %R 10.2196/28192 %U https://www.jmir.org/2021/8/e28192 %U https://doi.org/10.2196/28192 %U http://www.ncbi.nlm.nih.gov/pubmed/34448716 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e23425 %T Enhancing Healthcare Access–Smartphone Apps in Arrhythmia Screening: Viewpoint %A Książczyk,Marcin %A Dębska-Kozłowska,Agnieszka %A Warchoł,Izabela %A Lubiński,Andrzej %+ Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Ul. Żeromskiego 113, Łódź, 90-549, Poland, 48 42 639 35 63, marcin_ksiazczyk@interia.pl %K arrhythmia screening %K atrial fibrillation %K mobile electrocardiography %K mobile health %K phonocardiography %K photoplethysmography %K seismocardiography %K stroke prevention %D 2021 %7 27.8.2021 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Atrial fibrillation is the most commonly reported arrhythmia and, if undiagnosed or untreated, may lead to thromboembolic events. It is therefore desirable to provide screening to patients in order to detect atrial arrhythmias. Specific mobile apps and accessory devices, such as smartphones and smartwatches, may play a significant role in monitoring heart rhythm in populations at high risk of arrhythmia. These apps are becoming increasingly common among patients and professionals as a part of mobile health. The rapid development of mobile health solutions may revolutionize approaches to arrhythmia screening. In this viewpoint paper, we assess the availability of smartphone and smartwatch apps and evaluate their efficacy for monitoring heart rhythm and arrhythmia detection. The findings obtained so far suggest they are on the right track to improving the efficacy of early detection of atrial fibrillation, thus lowering the risk of stroke and reducing the economic burden placed on public health. %M 34448723 %R 10.2196/23425 %U https://mhealth.jmir.org/2021/8/e23425 %U https://doi.org/10.2196/23425 %U http://www.ncbi.nlm.nih.gov/pubmed/34448723 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e27709 %T A Machine Learning Approach to Passively Informed Prediction of Mental Health Risk in People with Diabetes: Retrospective Case-Control Analysis %A Yu,Jessica %A Chiu,Carter %A Wang,Yajuan %A Dzubur,Eldin %A Lu,Wei %A Hoffman,Julia %+ Livongo Health, Inc, 150 W Evelyn Ave, Ste 150, Mountain View, CA, 94041, United States, 1 6508048434, jessica.yu@livongo.com %K diabetes mellitus %K mental health %K risk detection %K passive sensing %K ecological momentary assessment %K machine learning %D 2021 %7 27.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Proactive detection of mental health needs among people with diabetes mellitus could facilitate early intervention, improve overall health and quality of life, and reduce individual and societal health and economic burdens. Passive sensing and ecological momentary assessment are relatively newer methods that may be leveraged for such proactive detection. Objective: The primary aim of this study was to conceptualize, develop, and evaluate a novel machine learning approach for predicting mental health risk in people with diabetes mellitus. Methods: A retrospective study was designed to develop and evaluate a machine learning model, utilizing data collected from 142,432 individuals with diabetes enrolled in the Livongo for Diabetes program. First, participants’ mental health statuses were verified using prescription and medical and pharmacy claims data. Next, four categories of passive sensing signals were extracted from the participants’ behavior in the program, including demographics and glucometer, coaching, and event data. Data sets were then assembled to create participant-period instances, and descriptive analyses were conducted to understand the correlation between mental health status and passive sensing signals. Passive sensing signals were then entered into the model to train and test its performance. The model was evaluated based on seven measures: sensitivity, specificity, precision, area under the curve, F1 score, accuracy, and confusion matrix. SHapley Additive exPlanations (SHAP) values were computed to determine the importance of individual signals. Results: In the training (and validation) and three subsequent test sets, the model achieved a confidence score greater than 0.5 for sensitivity, specificity, area under the curve, and accuracy. Signals identified as important by SHAP values included demographics such as race and gender, participant’s emotional state during blood glucose checks, time of day of blood glucose checks, blood glucose values, and interaction with the Livongo mobile app and web platform. Conclusions: Results of this study demonstrate the utility of a passively informed mental health risk algorithm and invite further exploration to identify additional signals and determine when and where such algorithms should be deployed. %M 34448707 %R 10.2196/27709 %U https://www.jmir.org/2021/8/e27709 %U https://doi.org/10.2196/27709 %U http://www.ncbi.nlm.nih.gov/pubmed/34448707 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e22909 %T Digital Natives’ Preferences on Mobile Artificial Intelligence Apps for Skin Cancer Diagnostics: Survey Study %A Haggenmüller,Sarah %A Krieghoff-Henning,Eva %A Jutzi,Tanja %A Trapp,Nicole %A Kiehl,Lennard %A Utikal,Jochen Sven %A Fabian,Sascha %A Brinker,Titus Josef %+ Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg, 69120, Germany, 49 6221 32 19 304, titus.brinker@dkfz.de %K artificial intelligence %K skin cancer %K skin cancer screening %K diagnostics %K digital natives %K acceptance %K concerns %K preferences %K online survey %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Artificial intelligence (AI) has shown potential to improve diagnostics of various diseases, especially for early detection of skin cancer. Studies have yet to investigate the clear application of AI technology in clinical practice or determine the added value for younger user groups. Translation of AI-based diagnostic tools can only be successful if they are accepted by potential users. Young adults as digital natives may offer the greatest potential for successful implementation of AI into clinical practice, while at the same time, representing the future generation of skin cancer screening participants. Objective: We conducted an anonymous online survey to examine how and to what extent individuals are willing to accept AI-based mobile apps for skin cancer diagnostics. We evaluated preferences and relative influences of concerns, with a focus on younger age groups. Methods: We recruited participants below 35 years of age using three social media channels—Facebook, LinkedIn, and Xing. Descriptive analysis and statistical tests were performed to evaluate participants’ attitudes toward mobile apps for skin examination. We integrated an adaptive choice-based conjoint to assess participants’ preferences. We evaluated potential concerns using maximum difference scaling. Results: We included 728 participants in the analysis. The majority of participants (66.5%, 484/728; 95% CI 0.631-0.699) expressed a positive attitude toward the use of AI-based apps. In particular, participants residing in big cities or small towns (P=.02) and individuals that were familiar with the use of health or fitness apps (P=.02) were significantly more open to mobile diagnostic systems. Hierarchical Bayes estimation of the preferences of participants with a positive attitude (n=484) revealed that the use of mobile apps as an assistance system was preferred. Participants ruled out app versions with an accuracy of ≤65%, apps using data storage without encryption, and systems that did not provide background information about the decision-making process. However, participants did not mind their data being used anonymously for research purposes, nor did they object to the inclusion of clinical patient information in the decision-making process. Maximum difference scaling analysis for the negative-minded participant group (n=244) showed that data security, insufficient trust in the app, and lack of personal interaction represented the dominant concerns with respect to app use. Conclusions: The majority of potential future users below 35 years of age were ready to accept AI-based diagnostic solutions for early detection of skin cancer. However, for translation into clinical practice, the participants’ demands for increased transparency and explainability of AI-based tools seem to be critical. Altogether, digital natives between 18 and 24 years and between 25 and 34 years of age expressed similar preferences and concerns when compared both to each other and to results obtained by previous studies that included other age groups. %M 34448722 %R 10.2196/22909 %U https://mhealth.jmir.org/2021/8/e22909 %U https://doi.org/10.2196/22909 %U http://www.ncbi.nlm.nih.gov/pubmed/34448722 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e28163 %T Evaluation and Refinement of a Bank of SMS Text Messages to Promote Behavior Change Adherence Following a Diabetes Prevention Program: Survey Study %A MacPherson,Megan %A Cranston,Kaela %A Johnston,Cara %A Locke,Sean %A Jung,Mary E %+ School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada, 1 250 807 9670, mary.jung@ubc.ca %K text messaging %K prediabetic state %K telemedicine %K telecommunications %K exercise %K diet %K preventive medicine %K mHealth %K intervention development %K behavior change %K mobile phone %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: SMS text messaging is a low-cost and far-reaching modality that can be used to augment existing diabetes prevention programs and improve long-term diet and exercise behavior change adherence. To date, little research has been published regarding the process of SMS text message content development. Understanding how interventions are developed is necessary to evaluate their evidence base and to guide the implementation of effective and scalable mobile health interventions in public health initiatives and in future research. Objective: This study aims to describe the development and refinement of a bank of SMS text messages targeting diet and exercise behavior change to be implemented following a diabetes prevention program. Methods: A bank of 124 theory-based SMS text messages was developed using the Behaviour Change Wheel and linked to active intervention components (behavior change techniques [BCTs]). The Behaviour Change Wheel is a theory-based framework that provides structure to intervention development and can guide the use of evidence-based practices in behavior change interventions. Once the messages were written, 18 individuals who either participated in a diabetes prevention program or were a diabetes prevention coach evaluated the messages on their clarity, utility, and relevance via survey using a 5-point Likert scale. Messages were refined according to participant feedback and recoded to obtain an accurate representation of BCTs in the final bank. Results: 76/124 (61.3%) messages were edited, 4/124 (3.2%) were added, and 8/124 (6.5%) were removed based on participant scores and feedback. Of the edited messages, 43/76 (57%) received minor word choice and grammar alterations while retaining their original BCT code; the remaining 43% (33/76, plus the 4 newly written messages) were recoded by a reviewer trained in BCT identification. Conclusions: This study outlines the process used to develop and refine a bank of SMS text messages to be implemented following a diabetes prevention program. This resulted in a bank of 120 theory-based, user-informed SMS text messages that were overall deemed clear, useful, and relevant by both individuals who will be receiving and delivering them. This formative development process can be used as a blueprint in future SMS text messaging development to ensure that message content is representative of the evidence base and is also grounded in theory and evaluated by key knowledge users. %M 34448713 %R 10.2196/28163 %U https://formative.jmir.org/2021/8/e28163 %U https://doi.org/10.2196/28163 %U http://www.ncbi.nlm.nih.gov/pubmed/34448713 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e27454 %T Dietary Intake and Health Status of Elderly Patients With Type 2 Diabetes Mellitus: Cross-sectional Study Using a Mobile App in Primary Care %A Coleone,Joane Diomara %A Bellei,Ericles Andrei %A Roman,Mateus Klein %A Kirsten,Vanessa Ramos %A De Marchi,Ana Carolina Bertoletti %+ Institute of Exact Sciences and Geosciences, University of Passo Fundo, B5 Building, São José, Highway BR285, Km 292, Passo Fundo, RS, 99052-900, Brazil, 55 5433168354, 168729@upf.br %K eating %K mobile applications %K primary health care %K aged %K type 2 diabetes mellitus %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Healthy dietary intake reduces the risk of complications of diabetes mellitus. Using assessment methods helps to understand these circumstances, and an electronic application may optimize this practice. Objective: In this study, we aimed to (1) assess the dietary intake and health status of elderly patients with type 2 diabetes mellitus (T2DM) in primary care, (2) use a mobile app as a tool for data collection and analysis in the context of primary care, and (3) verify the perceptions of multidisciplinary health professionals regarding app use. Methods: First, we developed a mobile app comprised of the questions of the Food and Nutrition Surveillance System (SISVAN) of Brazil, which includes a food frequency questionnaire of food categories with a recall of the previous 7 days. Thereafter, we used the app to collect data on the health status and dietary intake of 154 participants, aged 60-96 years, diagnosed with T2DM, and under treatment in primary care centers in the northern region of Rio Grande do Sul, Brazil. We also collected participants’ demographic, anthropometric, biochemical, and lifestyle variables. The associations between dietary intake and other variables were tested using chi-square tests with a 5% significance level. Regarding the app, we assessed usability and acceptance with 20 health professionals. Results: Between August 2018 and December 2018, participants had an intake in line with recommended guidelines for raw salads (57.1%), fruits (76.6%), milk products (68.2%), fried foods (72.7%), savory biscuits (60.4%), cookies or sweets (72.1%), and sugary drinks (92.9%) Meanwhile, the consumption of beans (59.7%), pulses and cooked vegetables (73.4%), and processed meat products (59.7%) was not in line with the guidelines. There were statistically significant differences in meeting the recommended guidelines among participants of different genders (P=.006 and P=.035 for the intake of fried foods and sugary drinks, respectively), place of residence (P=.034 for the intake of cookies and sweets), family history of diabetes (P<.001 for the intake of beans), physical activity engagement (P=.003 for the intake fresh fruits), history of smoking (P=.001 for the intake of raw salads), and presence of coronary disease (P=.050 for the intake of pulses and cooked vegetables). The assessment of usability resulted in a mean score of 71.75 points. Similarly, the assessment of the 15 acceptance questions revealed high scores, and the qualitative questions revealed positive perceptions. Conclusions: We identified that most participants complied with recommended intake guidelines for 7 of 10 categories in the SISVAN guidelines. However, most participants were overweight and had nutritional and clinical disorders, which justifies further investigations in this population. The app was well-rated by health professionals and considered a useful and promising tool for collecting and analyzing data in primary care settings. %M 34448711 %R 10.2196/27454 %U https://formative.jmir.org/2021/8/e27454 %U https://doi.org/10.2196/27454 %U http://www.ncbi.nlm.nih.gov/pubmed/34448711 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e25900 %T Cyberbullying Prevention for Adolescents: Iterative Qualitative Methods for Mobile Intervention Design %A Ranney,Megan L %A Pittman,Sarah K %A Moseley,Isabelle %A Morgan,Kristen E %A Riese,Alison %A Ybarra,Michele %A Cunningham,Rebecca %A Rosen,Rochelle %+ Center for Digital Health, Brown University, 139 Point St, Providence, RI, 02903, United States, 1 4014445159, megan_ranney@brown.edu %K adolescent %K mobile health %K digital health %K cyberbullying %K user-centered design %K qualitative %K mobile phone %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Cybervictimization among adolescents is associated with multiple negative mental health consequences. Although pediatricians often screen for cyberbullying, validated and acceptable programs to reduce the frequency and impact of adolescent cybervictimization are lacking. Objective: This study uses agile qualitative methods to refine and evaluate the acceptability of a mixed-modality intervention, initiated within the context of usual pediatric care, for adolescents with a history of cyberharassment and cyberbullying victimization. Methods: Three groups of adolescents were successively recruited from an urban primary care clinic to participate in three consecutive iterations (1, 2, and 3) of the program, which consisted of a brief in-clinic intervention followed by 8 weeks of daily, automated SMS text messaging. After 2 weeks of messaging, iteration 1 (I1) participants completed semistructured interviews regarding intervention experiences. Participant feedback was evaluated via framework matrix analysis to guide changes to the program for iteration 2 (I2). Feedback from 2-week interviews of I2 participants was similarly used to improve the program before initiating iteration 3 (I3). Participants in all 3 iterations completed the interviews after completing the program (8 weeks). Daily response rates assessed participant engagement, and satisfaction questionnaires assessed acceptability. Results: A total of 19 adolescents (aged 13-17 years) reporting past-year cybervictimization were enrolled: 7 in I1, 4 in I2, and 8 in I3. Demographic variables included the following: a mean age of 15 (SD 1.5) years; 58% (11/19) female, 42% (8/19) male, 63% (12/19) Hispanic, 37% (7/19) non-Hispanic, 79% (15/19) people of color, and 21% (4/19) White. A total of 73% (14/19) self-identified as having a low socioeconomic status, and 37% (7/19) self-identified as lesbian, gay, or bisexual. The average past 12-month cybervictimization score at baseline was 8.2 (SD 6.58; range 2-26). Participant feedback was used to iteratively refine intervention content and design. For example, participants in I1 recommended that the scope of the intervention be expanded to include web-based conflicts and drama, rather than narrowly focusing on cyberbullying prevention. On the basis of this feedback, the I2 content was shifted toward more general de-escalation skills and bystander empowerment. Overall, 88.34% (940/1064) of the daily queries sent to participants across all 3 iterations received a reply. Participant satisfaction improved considerably with each iteration; 0% (0/7) of I1 participants rated the overall quality of Intervention to Prevent Adolescent Cybervictimization with Text message as excellent, compared to 50% (2/4) of I2 participants and 86% (6/7) of I3 participants. Engagement also improved between the first and third iterations, with participants replying to 59.9% (235/392) of messages in I1, compared to 79.9% (358/488) of messages in I3. Conclusions: This study shows the value of structured participant feedback gathered in an agile intervention refinement methodology for the development of a technology-based intervention targeting adolescents. %M 34448702 %R 10.2196/25900 %U https://formative.jmir.org/2021/8/e25900 %U https://doi.org/10.2196/25900 %U http://www.ncbi.nlm.nih.gov/pubmed/34448702 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e14004 %T Preferences for Digital Smartphone Mental Health Apps Among Adolescents: Qualitative Interview Study %A Ribanszki,Robert %A Saez Fonseca,Jose Andres %A Barnby,Joseph Matthew %A Jano,Kimberly %A Osmani,Fatima %A Almasi,Soma %A Tsakanikos,Elias %+ Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Kings' College London, UK, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 000 000 000, elias.tsakanikos@kcl.ac.uk %K qualitative %K adolescents %K mental health %K digital smartphone app %K digital mental health %K mobile phone %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health digital apps hold promise for providing scalable solutions to individual self-care, education, and illness prevention. However, a problem with these apps is that they lack engaging user interfaces and experiences and thus potentially result in high attrition. Although guidelines for new digital interventions for adults have begun to examine engagement, there is a paucity of evidence on how to best address digital interventions for adolescents. As adolescence is a period of transition, during which the onset of many potentially lifelong mental health conditions frequently occurs, understanding how best to engage this population is crucial. Objective: The study aims to detect potential barriers to engagement and to gather feedback on the current elements of app design regarding user experience, user interface, and content. Methods: This study used a qualitative design. A sample of 14 adolescents was asked to use the app for 1 week and was interviewed using a semistructured interview schedule. The interviews were transcribed and analyzed using thematic analysis. Results: Overall, 13 participants completed the interviews. The authors developed 6 main themes and 20 subthemes based on the data that influenced engagement with and the perceived usefulness of the app. Our main themes were timing, stigma, perception, congruity, usefulness, and user experience. Conclusions: In line with previous research, we suggest how these aspects of app development should be considered for future apps that aim to prevent and manage mental health conditions. %M 34128814 %R 10.2196/14004 %U https://formative.jmir.org/2021/8/e14004 %U https://doi.org/10.2196/14004 %U http://www.ncbi.nlm.nih.gov/pubmed/34128814 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 3 %P e30672 %T Active Video Gaming Using an Adapted Gaming Mat in Youth and Adults With Physical Disabilities: Observational Study %A Malone,Laurie A %A Davlyatov,Ganisher K %A Padalabalanarayanan,Sangeetha %A Thirumalai,Mohanraj %+ University of Alabama at Birmingham/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, 3810 Ridgeway Dr., Birmingham, AL, 35209, United States, 1 205 975 6432, lamalone@uab.edu %K exergaming %K video games %K disability %K exercise %K physical activity %K enjoyment %K dance mat %K serious games %K gaming mat %K mobility impairment %K physical impairment %D 2021 %7 26.8.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: A common leisure-time activity amongst youth and adults in the United States is video gameplay. Playing video games is typically a sedentary endeavor; however, to encourage an increased level of physical activity in an engaging and enjoyable way, active video gaming has become popular. Unfortunately, the accessibility of gaming controllers is often an issue for persons with disabilities. A commercial off-the-shelf (OTS) gaming mat was adapted to facilitate use by individuals with mobility impairments to address this issue. Objective: Our study aimed to examine energy expenditure, enjoyment, and gameplay experience in youth and adults with mobility impairment during active video gaming using an OTS and adapted versions of a gaming mat. Methods: The study used an observational design. During visit 1, physical function was assessed, and participants were given a familiarization period with the gaming system. For visit 2, based on observation during the physical function tests and discussion with the participant, it was decided whether the participant would play in a standing or seated position. For standing gameplay, the mat was placed on the floor, and for seated play, the mat was placed on a height-adjustable and tilt-adjustable tabletop. Metabolic data were collected during a 20-minute baseline and four 10-minute bouts of Wii Fit Plus gameplay, with 2 bouts on each of the mats (adapted and OTS). During gameplay, the research staff observed and rated participants’ ability to use the game controller (mat) and the quality of gameplay. At the end of each game set, participants reported their rating of perceived exertion on a scale from 0 to 10. During rest, participants completed the physical activity enjoyment scale. Participants also answered additional questions regarding the system's usability with each controller (adapted mat and OTS mat). Statistical analyses were computed using Stata 16 (version 16.1; StataCorp). Linear mixed-effects maximum likelihood regression was performed separately for individuals who could play standing and for those who played seated. Results: A convenience sample of 78 individuals with mobility impairments between the ages of 12 and 60 years (mean 39.6, SD 15.8) participated in the study. Of the sample, 48 participants played the video games in a seated position, while 30 played the games standing. Energy expenditure and heart rate tended to be higher in the OTS mat condition for seated players, while values were similar for both conditions among standing players. However, seated participants reported greater gameplay experience, and both groups exhibited a higher quality of gameplay during the adapted mat condition. Conclusions: Active video gaming using an adapted gaming mat provided an enjoyable exercise activity for individuals with mobility impairments. The use of the adapted controller provides a means by which this population can engage in light to moderate intensity active video gaming, thereby reducing sedentary leisure time. Trial Registration: ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199 %M 34435962 %R 10.2196/30672 %U https://games.jmir.org/2021/3/e30672 %U https://doi.org/10.2196/30672 %U http://www.ncbi.nlm.nih.gov/pubmed/34435962 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e26982 %T Exergaming Using Postural Feedback From Wearable Sensors and Exercise Therapy to Improve Postural Balance in People With Nonspecific Low Back Pain: Protocol for a Factorial Pilot Randomized Controlled Trial %A Meinke,Anita %A Peters,Rick %A Knols,Ruud %A Karlen,Walter %A Swanenburg,Jaap %+ Mobile Health Systems Lab, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Balgrist Campus, BAA, Lengghalde 5, Zurich, 8008, Switzerland, 41 78 705 22 95, anita.meinke@hest.ethz.ch %K low back pain %K exercise therapy %K postural balance %K postural feedback %K motor control %K fear of movement %K exergame %K randomized controlled trial %K physical activity %K smartphone %K sensors %K activity tracker %K mobile phone %D 2021 %7 26.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical exercise is a common treatment for people with low back pain (LBP). Wearable sensors that provide feedback on body movements and posture during exercise may enhance postural balance and motor control in people with LBP. Objective: This study aims to investigate whether physical exercising with postural feedback (EPF) improves postural balance, motor control, and patient-reported outcomes in people with LBP. Methods: The study was an assessor-blinded 2×2 factorial trial. We planned to recruit 80 participants with nonspecific LBP who did not receive treatment for LBP. In addition, we aimed to recruit 40 patients with chronic, nonspecific LBP who were receiving exercise therapy (ET) at the University Hospital Zurich. Both ET patients and participants without treatment were randomized to receive either an additional EPF intervention or no additional intervention. This resulted in four different combinations of interventions: ET+EPF, ET, EPF, and no intervention. The participants underwent outcome assessments at inclusion (T1); 3 weeks later, at randomization (T2); after an intervention period of 3 weeks with a predefined exercise schedule for participants receiving EPF (T3); and after an additional 6 weeks, during which participants assigned to the EPF groups could exercise as much as they wished (T4). Patients receiving ET completed their regularly prescribed therapies during the study period. Balance was assessed during quiet standing on a force platform, and motor control was assessed during a lifting task and a waiter’s bow task. Physical activity was recorded using an activity tracker and the participants’ mobile phones during the study. The predefined EPF schedule consisted of nine sessions of 20 minutes of exercise with a tablet and inertial measurement unit sensors at home. Participants performed a series of trunk and hip movements and received feedback on their movements in a gamified environment displayed on the tablet. Results: The first participant was recruited in May 2019. Data collection was completed in October 2020, with 3 patients and 32 eligible people without therapy who passed the eligibility check. Conclusions: Although it will not be possible to investigate differences in patients and people without other therapies, we expect this pilot study to provide insights into the potential of EPF to improve balance in people with LBP and adherence to such interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/26982 %M 34435954 %R 10.2196/26982 %U https://www.researchprotocols.org/2021/8/e26982 %U https://doi.org/10.2196/26982 %U http://www.ncbi.nlm.nih.gov/pubmed/34435954 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e26930 %T An Ecological Monitoring and Management App (EMMA) for Older Adults With Chronic Pain: Protocol for a Design and Feasibility Study %A Ledermann,Katharina %A Abou Khaled,Omar %A Caon,Maurizio %A Berger,Thomas %A Chabwine,Joelle N %A Wicht,Joachim %A Martin-Soelch,Chantal %+ Department of Consiliar and Liaison Psychiary, University Hospital Zurich, Culmannstrasse 8, Zurich, 8091, Switzerland, 41 0765330316, katharina.ledermann@hotmail.com %K chronic pain %K older adults %K mHealth %K online intervention %K self-management %D 2021 %7 26.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic pain is a complex problem for many older adults that affects both physical functioning and psychological well-being. Mobile health (mHealth) technologies have shown promise in supporting older persons in managing chronic conditions. Cognitive behavior therapy is recommended for older people with chronic pain. However, web-based treatment programs for chronic pain are not aimed at the needs of older people and offer standard therapies without providing tailored treatment for this population. Objective: To address this problem, we aim to develop a psychological web-based intervention for ecological monitoring of daily life experiences with chronic pain called EMMA to support self-management of chronic pain in older adults. Methods: The key clinical and engagement features of the intervention were established through the integration of evidence-based material from cognitive behavioral therapy for the treatment of chronic pain in older adults. The development process uses a co-design approach and actively involves end-users in the design process by incorporating feedback from focus groups with older adults in order to inform a user-centered intervention design. For the co-design process, we will include 10 older adults with chronic pain, who will discuss the requirements for the app in workshops in order to ensure suitability of the app for older adults with chronic pain. In order to test the feasibility and acceptability of the intervention, we will include a sample of 30 older adults with chronic pain who will test all features of the intervention for a period of 8 consecutive weeks. After the trial period, validated instruments will be used to assess usability and acceptability, as well as influence on pain levels and associated physical and psychological symptoms. Participants will be invited to take part in a semistructured telephone interviews after the trial period to explore their experiences using the app. Results: Digitalization of the pain diary and psychotherapeutic content has started. Recruitment of participants for the co-design workshops will start as soon as we have a functioning prototype of the electronic pain diary and EMMA intervention, which is expected to be in September 2021. The feasibility study will start as soon as the co-design process is finished and required changes have been implemented into the pain diary and the EMMA intervention. We expect to start the feasibility study early in 2022. Conclusions: Required changes to assure usability and acceptability will be directly implemented in the app. EMMA brings together a strong body of evidence using cognitive behavioral and self-management theory with contemporary mHealth principles, allowing for a cost-effective intervention that can be used to target chronic pain anywhere and anytime by older adults. Given the ubiquity of mHealth interventions for chronic conditions, the results of this study may serve to inform the development of tailored self-management interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/26930 %M 34435969 %R 10.2196/26930 %U https://www.researchprotocols.org/2021/8/e26930 %U https://doi.org/10.2196/26930 %U http://www.ncbi.nlm.nih.gov/pubmed/34435969 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e27455 %T Feasibility and Effectiveness of Assessing Subhealth Using a Mobile Health Management App (MibyeongBogam) in Early Middle-Aged Koreans: Randomized Controlled Trial %A Baek,Younghwa %A Jeong,Kyoungsik %A Lee,Siwoo %A Kim,Hoseok %A Seo,Bok-Nam %A Jin,Hee-Jeong %+ Korean Medicine Data Division, Korea Institute of Oriental Medicine, 1672 Yuseongdae-ro, Yuseong-gu, Daejeon, Daejeon, 34054, Republic of Korea, 82 42 868 9305, hjjin@kiom.re.kr %K mobile health %K health status %K mobile app %K middle-aged group %K subhealth %K Korean medicine %D 2021 %7 19.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) is a major source of health management systems. Moreover, the demand for mHealth, which is in need of change due to the COVID-19 pandemic, is increasing worldwide. Accordingly, interest in health care in everyday life and the importance of mHealth are growing. Objective: We developed the MibyeongBogam (MBBG) app that evaluates the user’s subhealth status via a smartphone and provides a health management method based on that user’s subhealth status for use in everyday life. Subhealth is defined as a state in which the capacity to recover to a healthy state is diminished, but without the presence of clinical disease. The objective of this study was to compare the awareness and status of subhealth after the use of the MBBG app between intervention and control groups, and to evaluate the app’s practicality. Methods: This study was a prospective, open-label, parallel group, randomized controlled trial. The study was conducted at two hospitals in Korea with 150 healthy people in their 30s and 40s, at a 1:1 allocation ratio. Participants visited the hospital three times as follows: preintervention, intermediate visit 6 weeks after the intervention, and final visit 12 weeks after the intervention. Key endpoints were measured at the first visit before the intervention and at 12 weeks after the intervention. The primary outcome was the awareness of subhealth, and the secondary outcomes were subhealth status, health-promoting behaviors, and motivation to engage in healthy behaviors. Results: The primary outcome, subhealth awareness, tended to slightly increase for both groups after the uncompensated intervention, but there was no significant difference in the score between the two groups (intervention group: mean 23.69, SD 0.25 vs control group: mean 23.1, SD 0.25; P=.09). In the case of secondary outcomes, only some variables of the subhealth status showed significant differences between the two groups after the intervention, and the intervention group showed an improvement in the total scores of subhealth (P=.03), sleep disturbance (P=.02), depression (P=.003), anger (P=.01), and anxiety symptoms (P=.009) compared with the control group. Conclusions: In this study, the MBBG app showed potential for improving the health, especially with regard to sleep disturbance and depression, of individuals without particular health problems. However, the effects of the app on subhealth awareness and health-promoting behaviors were not clearly evaluated. Therefore, further studies to assess improvements in health after the use of personalized health management programs provided by the MBBG app are needed. The MBBG app may be useful for members of the general public, who are not diagnosed with a disease but are unable to lead an optimal daily life due to discomfort, to seek strategies that can improve their health. Trial Registration: Clinical Research Information Service KCT0003488; https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=14379 %M 34420922 %R 10.2196/27455 %U https://mhealth.jmir.org/2021/8/e27455/ %U https://doi.org/10.2196/27455 %U http://www.ncbi.nlm.nih.gov/pubmed/34420922 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e31072 %T Optimizing Social-Emotional-Communication Development in Infants of Mothers With Depression: Protocol for a Randomized Controlled Trial of a Mobile Intervention Targeting Depression and Responsive Parenting %A Baggett,Kathleen M %A Davis,Betsy %A Sheeber,Lisa %A Miller,Katy %A Leve,Craig %A Mosley,Elizabeth A %A Landry,Susan H %A Feil,Edward G %+ Georgia State University, 14 Marietta St NW, Atlanta, GA, 30303, United States, 1 404 413 1571, kbaggett@gsu.edu %K maternal depression %K parenting %K infant social-emotional and social-communication development %K mobile intervention %K remote coaching %K trial protocol %K mobile phone %D 2021 %7 18.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Postpartum depression interferes with maternal engagement in interventions that are effective in improving infant social-emotional and social-communication outcomes. There is an absence of integrated interventions with demonstrated effectiveness in both reducing maternal depression and promoting parent-mediated practices that optimize infant social-emotional and social-communication competencies. Interventions targeting maternal depression are often separate from parent-mediated interventions. To address the life course needs of depressed mothers and their infants, we need brief, accessible, and integrated interventions that target both maternal depression and specific parent practices shown to improve infant social-emotional and social-communication trajectories. Objective: The aim of this study is to evaluate the efficacy of a mobile internet intervention, Mom and Baby Net, with remote coaching to improve maternal mood and promote parent practices that optimize infant social-emotional and social-communication development. Methods: This is a two-arm, randomized controlled intent-to-treat trial. Primary outcomes include maternal depression symptoms and observed parent and infant behaviors. Outcomes are measured via direct observational assessments and standardized questionnaires. The sample is being recruited from the urban core of a large southern city in the United States. Study enrollment was initiated in 2017 and concluded in 2020. Participants are biological mothers with elevated depression symptoms, aged 18 years or older, and who have custody of an infant less than 12 months of age. Exclusion criteria at the time of screening include maternal homelessness or shelter residence, inpatient mental health or substance abuse treatment, or maternal or infant treatment of a major mental or physical illness that would hinder meaningful study participation. Results: The start date of this grant-funded randomized controlled trial (RCT) was September 1, 2016. Data collection is ongoing. Following the institutional review board (IRB)–approved pilot work, the RCT was approved by the IRB on November 17, 2017. Recruitment was initiated immediately following IRB approval. Between February 15, 2018, and March 11, 2021, we successfully recruited a sample of 184 women and their infants into the RCT. The sample is predominantly African American and socioeconomically disadvantaged. Conclusions: Data collection is scheduled to be concluded in March 2022. We anticipate that relative to the attention control condition, which is focused on education around maternal depression and infant developmental milestones with matching technology and coaching structure, mothers in the Mom and Baby Net intervention will experience greater reductions in depression and gains in sensitive and responsive parent practices and that their infants will demonstrate greater gains in social-emotional and social-communication behavior. Trial Registration: ClinicalTrials.gov NCT03464630; https://clinicaltrials.gov/ct2/show/NCT03464630 International Registered Report Identifier (IRRID): DERR1-10.2196/31072 %M 34406122 %R 10.2196/31072 %U https://www.researchprotocols.org/2021/8/e31072 %U https://doi.org/10.2196/31072 %U http://www.ncbi.nlm.nih.gov/pubmed/34406122 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e25425 %T Mobile Apps as Audience-Centered Health Communication Platforms %A Mackert,Michael %A Mandell,Dorothy %A Donovan,Erin %A Walker,Lorraine %A Henson-García,Mike %A Bouchacourt,Lindsay %+ Stan Richards School of Advertising and Public Relations, The University of Texas at Austin, 300 W Dean Keeton St, Austin, TX, 78712, United States, 1 512 348 8490, mackert@utexas.edu %K health communication %K mHealth %K mobile apps %K mobile health %K prenatal health %K pregnancy %K audience-centered %D 2021 %7 17.8.2021 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Health communication campaigns often suffer from the shortcomings of a limited budget and limited reach, resulting in a limited impact. This paper suggests a shift of these campaigns to audience-centered communication platforms—particularly, apps on mobile phones. By using a common platform, multiple interventions and campaigns can combine resources and increase user engagement, resulting in a larger impact on health behavior. Given the widespread use of mobile phones, mobile apps can be an effective and efficient tool to provide health interventions. One such platform is Father’s Playbook, a mobile app designed to encourage men to be more involved during their partner’s pregnancy. Health campaigns and interventions looking to reach expectant fathers can use Father’s Playbook as a vehicle for their messages. %M 34402797 %R 10.2196/25425 %U https://mhealth.jmir.org/2021/8/e25425 %U https://doi.org/10.2196/25425 %U http://www.ncbi.nlm.nih.gov/pubmed/34402797 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e30239 %T Utilization of a Directly Supervised Telehealth-Based Exercise Training Program in Patients With Nonalcoholic Steatohepatitis: Feasibility Study %A Motz,Victoria %A Faust,Alison %A Dahmus,Jessica %A Stern,Benjamin %A Soriano,Christopher %A Stine,Jonathan G %+ Penn State Milton S Hershey Medical Center, 500 University Dr, Hershey, PA, 17033, United States, 1 717 531 1017, jstine@pennstatehealth.psu.edu %K physical activity %K fatty liver %K telemedicine %K liver %K nonalcoholic fatty liver disease %K liver disease %K fatty liver disease %K aerobic training %K telehealth %K fitness %K feasibility %K steatohepatitis %D 2021 %7 17.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Most patients with nonalcoholic fatty liver disease (NAFLD) are physically inactive despite the well-known benefits of physical activity. Telehealth offers promise as a novel way to deliver an exercise training program and increase physical activity. However, the feasibility, safety, and efficacy of telehealth-based exercise programs is unknown in patients with NAFLD. Objective: The aim of this study was to determine the feasibility of a directly supervised exercise training program delivered exclusively with telehealth to patients with nonalcoholic steatohepatitis (NASH), the progressive form of NAFLD. Methods: In response to COVID-19 research restrictions, we adapted an existing clinical trial and delivered 20 weeks of moderate-intensity aerobic training 5 days a week under real-time direct supervision using an audio–visual telehealth platform. Aerobic training was completed by walking outdoors or using a home treadmill. Fitness activity trackers with heart rate monitors ensured exercise was completed at the prescribed intensity with real-time feedback from an exercise physiologist. Results: Three female patients with biopsy-proven NASH were enrolled with a mean age of 52 (SD 14) years. The mean body mass index was 31.9 (SD 5.1) kg/m2. All patients had metabolic syndrome. All patients completed over 80% of exercise sessions (mean 84% [SD 3%]) and no adverse events occurred. Body weight (mean –5.1% [SD 3.7%]), body fat (mean –4.4% [SD 2.3%]), and waist circumference (mean –1.3 in. [SD 1.6 in.]) all improved with exercise. The mean relative reduction in magnetic resonance imaging-proton density fat fraction (MRI-PDFF) was 35.1% (SD 8.8%). Mean reductions in hemoglobin A1c and Homeostatic Model Assessment for Insulin Resistance were also observed (–0.5% [SD 0.2%] and –4.0 [SD 1.2], respectively). The mean peak oxygen consumption (VO2peak) improved by 9.9 (SD 6.6) mL/kg/min. Conclusions: This proof-of-concept study found that supervised exercise training delivered via telehealth is feasible and safe in patients with NASH. Telehealth-based exercise training also appears to be highly efficacious in patients with NASH, but this will need to be confirmed by future large-scale trials. Trial Registration: ClinicalTrials.gov NCT03518294; https://clinicaltrials.gov/ct2/show/NCT03518294 %M 34402795 %R 10.2196/30239 %U https://formative.jmir.org/2021/8/e30239 %U https://doi.org/10.2196/30239 %U http://www.ncbi.nlm.nih.gov/pubmed/34402795 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 2 %P e22583 %T Patients’ Experiences of Using Skin Self-monitoring Apps With People at Higher Risk of Melanoma: Qualitative Study %A Habgood,Emily %A McCormack,Christopher %A Walter,Fiona M %A Emery,Jon D %+ Department of General Practice and Centre for Cancer Research, University of Melbourne, Level 10 Grattan Street, Melbourne, 3000, Australia, 61 0385597044, emily.habgood@unimelb.edu.au %K melanoma %K skin cancer %K early detection %K mobile apps %K qualitative %K mHealth %K mobile phone %D 2021 %7 13.8.2021 %9 Original Paper %J JMIR Dermatol %G English %X Background: Melanoma is the fourth most commonly diagnosed cancer in Australia. Up to 75% of melanomas are first detected by patients or their family or friends. Many mobile apps for melanoma exist, including apps to encourage skin self-monitoring to improve the likelihood of early detection. Previous research in this area has focused on their development, diagnostic accuracy, or validation. Little is known about patients’ views and experiences of using these apps. Objective: This study aims to understand patients’ views and experiences of using commercially available melanoma skin self-monitoring mobile apps for a period of 3 months. Methods: This qualitative study was conducted in two populations: primary care (where the MelatoolsQ tool was used to identify patients who were at increased risk of melanoma) and secondary care (where patients had a previous diagnosis of melanoma, stages T0-T3a). Participants downloaded 2 of the 4 mobile apps for skin self-monitoring (SkinVision, UMSkinCheck, Mole Monitor, or MySkinPal) and were encouraged to use them for 3 months. After 3 months, a semistructured interview was conducted with participants to discuss their experiences of using the skin self-monitoring mobile apps. Results: A total of 54 participants were recruited in the study, with 37% (20) of participants from primary care and 62% (34) from secondary care. Interviews were conducted with 34 participants when data saturation was reached. Most participants did not use the apps at all (n=12) or tried them once but did not continue (n=14). Only 8 participants used the apps to assist with skin self-monitoring for the entire duration of the study. Patients discussed the apps in the context of the importance of early detection and their current skin self-monitoring behaviors. A range of features of perceived quality of each app affected engagement to support skin self-monitoring. Participants described their skin self-monitoring routines and potential mismatches with the app reminders. They also described the technical and practical difficulties experienced when using the apps for skin self-monitoring. The app’s positioning within existing relationships with health care providers was crucial to understand the use of the apps. Conclusions: This study of patients at increased risk of melanoma highlights several barriers to engagement with apps to support skin self-monitoring. The results highlight the wide-ranging and dynamic influences on engagement with mobile apps, which extend beyond app design and relate to broader contextual factors about skin self-monitoring routines and relationships with health care providers. %M 37632821 %R 10.2196/22583 %U https://derma.jmir.org/2021/2/e22583 %U https://doi.org/10.2196/22583 %U http://www.ncbi.nlm.nih.gov/pubmed/37632821 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e20678 %T Artificial Intelligence–Based Chatbot for Anxiety and Depression in University Students: Pilot Randomized Controlled Trial %A Klos,Maria Carolina %A Escoredo,Milagros %A Joerin,Angela %A Lemos,Viviana Noemí %A Rauws,Michiel %A Bunge,Eduardo L %+ Interdisciplinary Center for Research in Health and Behavioral Sciences (CIICSAC), Universidad Adventista del Plata (UAP)., National Scientific and Technical Research Council (CONICET)., 25 de Mayo 99, Libertador San Martín, Entre Ríos, 3103, Argentina, 54 3435064263, mcarolinaklos@gmail.com %K artificial intelligence %K chatbots %K conversational agents %K mental health %K anxiety %K depression %K college students %D 2021 %7 12.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence–based chatbots are emerging as instruments of psychological intervention; however, no relevant studies have been reported in Latin America. Objective: The objective of the present study was to evaluate the viability, acceptability, and potential impact of using Tess, a chatbot, for examining symptoms of depression and anxiety in university students. Methods: This was a pilot randomized controlled trial. The experimental condition used Tess for 8 weeks, and the control condition was assigned to a psychoeducation book on depression. Comparisons were conducted using Mann-Whitney U and Wilcoxon tests for depressive symptoms, and independent and paired sample t tests to analyze anxiety symptoms. Results: The initial sample consisted of 181 Argentinian college students (158, 87.2% female) aged 18 to 33. Data at week 8 were provided by 39 out of the 99 (39%) participants in the experimental condition and 34 out of the 82 (41%) in the control group. On an average, 472 (SD 249.52) messages were exchanged, with 116 (SD 73.87) of the messages sent from the users in response to Tess. A higher number of messages exchanged with Tess was associated with positive feedback (F2,36=4.37; P=.02). No significant differences between the experimental and control groups were found from the baseline to week 8 for depressive and anxiety symptoms. However, significant intragroup differences demonstrated that the experimental group showed a significant decrease in anxiety symptoms; no such differences were observed for the control group. Further, no significant intragroup differences were found for depressive symptoms. Conclusions: The students spent a considerable amount of time exchanging messages with Tess and positive feedback was associated with a higher number of messages exchanged. The initial results show promising evidence for the usability and acceptability of Tess in the Argentinian population. Research on chatbots is still in its initial stages and further research is needed. %M 34092548 %R 10.2196/20678 %U https://formative.jmir.org/2021/8/e20678 %U https://doi.org/10.2196/20678 %U http://www.ncbi.nlm.nih.gov/pubmed/34092548 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e29368 %T Understanding People’s Use of and Perspectives on Mood-Tracking Apps: Interview Study %A Schueller,Stephen M %A Neary,Martha %A Lai,Jocelyn %A Epstein,Daniel A %+ Department of Psychological Science, University of California, Irvine, 4201 Social and Behavioral Sciences Gateway, Irvine, CA, 92697, United States, 1 9498243850, s.schueller@uci.edu %K mental health %K mobile apps %K mHealth %K emotions %K affect %K self-tracking %D 2021 %7 11.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Supporting mental health and wellness is of increasing interest due to a growing recognition of the prevalence and burden of mental health issues. Mood is a central aspect of mental health, and several technologies, especially mobile apps, have helped people track and understand it. However, despite formative work on and dissemination of mood-tracking apps, it is not well understood how mood-tracking apps used in real-world contexts might benefit people and what people hope to gain from them. Objective: To address this gap, the purpose of this study was to understand motivations for and experiences in using mood-tracking apps from people who used them in real-world contexts. Methods: We interviewed 22 participants who had used mood-tracking apps using a semistructured interview and card sorting task. The interview focused on their experiences using a mood-tracking app. We then conducted a card sorting task using screenshots of various data entry and data review features from mood-tracking apps. We used thematic analysis to identify themes around why people use mood-tracking apps, what they found useful about them, and where people felt these apps fell short. Results: Users of mood-tracking apps were primarily motivated by negative life events or shifts in their own mental health that prompted them to engage in tracking and improve their situation. In general, participants felt that using a mood-tracking app facilitated self-awareness and helped them to look back on a previous emotion or mood experience to understand what was happening. Interestingly, some users reported less inclination to document their negative mood states and preferred to document their positive moods. There was a range of preferences for personalization and simplicity of tracking. Overall, users also liked features in which their previous tracked emotions and moods were visualized in figures or calendar form to understand trends. One gap in available mood-tracking apps was the lack of app-facilitated recommendations or suggestions for how to interpret their own data or improve their mood. Conclusions: Although people find various features of mood-tracking apps helpful, the way people use mood-tracking apps, such as avoiding entering negative moods, tracking infrequently, or wanting support to understand or change their moods, demonstrate opportunities for improvement. Understanding why and how people are using current technologies can provide insights to guide future designs and implementations. %M 34383678 %R 10.2196/29368 %U https://mental.jmir.org/2021/8/e29368 %U https://doi.org/10.2196/29368 %U http://www.ncbi.nlm.nih.gov/pubmed/34383678 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e29151 %T Gaps and Future Challenges of Italian Apps for Pregnancy and Postnatal Care: Systematic Search on App Stores %A Brunelli,Laura %A De Vita,Chiara %A Cenedese,Fabrizio %A Cinello,Michela %A Paris,Marta %A Samogizio,Francesca %A Starec,Anja %A Bava,Michele %A Dal Cin,Margherita %A Zanchiello,Sara %A Stampalija,Tamara %+ Department of Medical, Surgical and Health Sciences, University of Trieste, Via dell'Istria, 65, Trieste, 34137, Italy, 39 0432554768, laura.brunelli@phd.units.it %K pregnancy %K postnatal care %K app %K mHealth %K mobile health %K newborn %D 2021 %7 10.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the availability of thousands of health apps worldwide, when considering those addressing children’s first 1000 days of life, most apps fail to consider the continuity between the prenatal and postnatal stages, and their joint impact on maternal and child health. The reliability, quality, and effectiveness of these apps are largely unknown, and the provided content seems questionable in terms of completeness, updating, and trustworthiness. Objective: This study evaluates available Italian pregnancy and postnatal care apps to highlight the main gaps to be overcome and the resulting future challenges to be met in this mobile health–related field. Methods: A systematic search was conducted on the Apple App Store and Google Play Store, and basic information was collected for all identified apps. After deduplication and further selection based on the exclusion criteria, an in-depth analysis of each app was performed by two researchers independently. A 71-item six-domain questionnaire about the desirable features of apps was used to assess information, functionalities, and technical features, while the Mobile Application Rating Scale (MARS) was employed for app quality evaluation. Results: From an initial sample of 684 apps, 22 were deeply analyzed. Most apps did not fulfill the expectations, as just one achieved 50% of all desirable aspects. Postnatal care and counselling for both the mother and child was the least accomplished domain. Moreover, the quality of app information was generally rated more negatively than the quality of their functionality and esthetic features. The lacking aspects were information about methods for postpartum family planning and birth spacing (1/22, 5%) and immunization (2/22, 9%). Conclusions: The identified gaps could serve as a basis for designing and implementing increasingly high-quality, targeted, and effective apps for pregnancy and postnatal health care, which provide comprehensive, reliable, and evidence-based information, as well as appropriate esthetic and functional characteristics, with relevant implications in terms of maternal and newborn health prevention and promotion. %M 34383668 %R 10.2196/29151 %U https://www.jmir.org/2021/8/e29151 %U https://doi.org/10.2196/29151 %U http://www.ncbi.nlm.nih.gov/pubmed/34383668 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e27589 %T Toward a Mobile Platform for Real-world Digital Measurement of Depression: User-Centered Design, Data Quality, and Behavioral and Clinical Modeling %A Nickels,Stefanie %A Edwards,Matthew D %A Poole,Sarah F %A Winter,Dale %A Gronsbell,Jessica %A Rozenkrants,Bella %A Miller,David P %A Fleck,Mathias %A McLean,Alan %A Peterson,Bret %A Chen,Yuanwei %A Hwang,Alan %A Rust-Smith,David %A Brant,Arthur %A Campbell,Andrew %A Chen,Chen %A Walter,Collin %A Arean,Patricia A %A Hsin,Honor %A Myers,Lance J %A Marks Jr,William J %A Mega,Jessica L %A Schlosser,Danielle A %A Conrad,Andrew J %A Califf,Robert M %A Fromer,Menachem %+ Verily Life Sciences, 269 E Grand Ave, South San Francisco, CA, 94080, United States, 1 833 391 8633, stefnickels@verily.com %K mental health %K mobile sensing %K mobile phone %K mHealth %K depression %K location %K GPS %K app usage %K voice diaries %K adherence %K engagement %K mobility %K sleep %K physical activity %K digital phenotyping %K user-centered design %D 2021 %7 10.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Although effective mental health treatments exist, the ability to match individuals to optimal treatments is poor, and timely assessment of response is difficult. One reason for these challenges is the lack of objective measurement of psychiatric symptoms. Sensors and active tasks recorded by smartphones provide a low-burden, low-cost, and scalable way to capture real-world data from patients that could augment clinical decision-making and move the field of mental health closer to measurement-based care. Objective: This study tests the feasibility of a fully remote study on individuals with self-reported depression using an Android-based smartphone app to collect subjective and objective measures associated with depression severity. The goals of this pilot study are to develop an engaging user interface for high task adherence through user-centered design; test the quality of collected data from passive sensors; start building clinically relevant behavioral measures (features) from passive sensors and active inputs; and preliminarily explore connections between these features and depression severity. Methods: A total of 600 participants were asked to download the study app to join this fully remote, observational 12-week study. The app passively collected 20 sensor data streams (eg, ambient audio level, location, and inertial measurement units), and participants were asked to complete daily survey tasks, weekly voice diaries, and the clinically validated Patient Health Questionnaire (PHQ-9) self-survey. Pairwise correlations between derived behavioral features (eg, weekly minutes spent at home) and PHQ-9 were computed. Using these behavioral features, we also constructed an elastic net penalized multivariate logistic regression model predicting depressed versus nondepressed PHQ-9 scores (ie, dichotomized PHQ-9). Results: A total of 415 individuals logged into the app. Over the course of the 12-week study, these participants completed 83.35% (4151/4980) of the PHQ-9s. Applying data sufficiency rules for minimally necessary daily and weekly data resulted in 3779 participant-weeks of data across 384 participants. Using a subset of 34 behavioral features, we found that 11 features showed a significant (P<.001 Benjamini-Hochberg adjusted) Spearman correlation with weekly PHQ-9, including voice diary–derived word sentiment and ambient audio levels. Restricting the data to those cases in which all 34 behavioral features were present, we had available 1013 participant-weeks from 186 participants. The logistic regression model predicting depression status resulted in a 10-fold cross-validated mean area under the curve of 0.656 (SD 0.079). Conclusions: This study finds a strong proof of concept for the use of a smartphone-based assessment of depression outcomes. Behavioral features derived from passive sensors and active tasks show promising correlations with a validated clinical measure of depression (PHQ-9). Future work is needed to increase scale that may permit the construction of more complex (eg, nonlinear) predictive models and better handle data missingness. %M 34383685 %R 10.2196/27589 %U https://mental.jmir.org/2021/8/e27589 %U https://doi.org/10.2196/27589 %U http://www.ncbi.nlm.nih.gov/pubmed/34383685 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e23896 %T General Practitioners' Perceptions of the Use of Wearable Electronic Health Monitoring Devices: Qualitative Analysis of Risks and Benefits %A Volpato,Lucia %A del Río Carral,María %A Senn,Nicolas %A Santiago Delefosse,Marie %+ Research Centre for Psychology of Health, Aging and Sport Examination, Institute of Psychology, University of Lausanne, Géopolis Quartier UNIL - Mouline, Lausanne, 1015, Switzerland, 41 21 692 32 67, maria.delriocarral@unil.ch %K mHealth %K wearable devices %K health wearables %K activity trackers %K health monitoring %K self-tracking %K general practitioners %K mind maps %K qualitative research %K health psychology %D 2021 %7 9.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The rapid diffusion of wearable electronic health monitoring devices (wearable devices or wearables) among lay populations shows that self-tracking and self-monitoring are pervasively expanding, while influencing health-related practices. General practitioners are confronted with this phenomenon, since they often are the expert-voice that patients will seek. Objective: This article aims to explore general practitioners’ perceptions of the role of wearable devices in family medicine and of their benefits, risks, and challenges associated with their use. It also explores their perceptions of the future development of these devices. Methods: Data were collected during a medical conference among 19 Swiss general practitioners through mind maps. Maps were first sketched at the conference and their content was later compared with notes and reports written during the conference, which allowed for further integration of information. This tool represents an innovative methodology in qualitative research that allows for time-efficient data collection and data analysis. Results: Data analysis highlighted that wearable devices were described as user-friendly, adaptable devices that could enable performance monitoring and support medical research. Benefits included support for patients’ empowerment and education, behavior change facilitation, better awareness of personal medical history and body functioning, efficient information transmission, and connection with the patient’s medical network; however, general practitioners were concerned by a lack of scientific validation, lack of clarity over data protection, and the risk of stakeholder-associated financial interests. Other perceived risks included the promotion of an overly medicalized health culture and the risk of supporting patients’ self-diagnosis and self-medication. General practitioners also feared increased pressure on their workload and a compromised doctor–patient relationship. Finally, they raised important questions that can guide wearables’ future design and development, highlighting a need for general practitioners and medical professionals to be involved in the process. Conclusions: Wearables play an increasingly central role in daily health-related practices, and general practitioners expressed a desire to become more involved in the development of such technologies. Described as useful information providers, wearables were generally positively perceived and did not seem to pose a threat to the doctor–patient relationship. However, general practitioners expressed their concern that wearables may fuel a self-monitoring logic, to the detriment of patients’ autonomy and overall well-being. While wearables can contribute to health promotion, it is crucial to clarify the logic underpinning the design of such devices. Through the analysis of group discussions, this study contributes to the existing literature by presenting general practitioners’ perceptions of wearable devices. This paper provides insight on general practitioners’ perception to be considered in the context of product development and marketing. %M 34383684 %R 10.2196/23896 %U https://mhealth.jmir.org/2021/8/e23896 %U https://doi.org/10.2196/23896 %U http://www.ncbi.nlm.nih.gov/pubmed/34383684 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e24909 %T Mobile App (WHEELS) to Promote a Healthy Lifestyle in Wheelchair Users With Spinal Cord Injury or Lower Limb Amputation: Usability and Feasibility Study %A Hoevenaars,Dirk %A Holla,Jasmijn F M %A te Loo,Leonie %A Koedijker,Johan M %A Dankers,Sarah %A Houdijk,Han %A Visser,Bart %A Janssen,Thomas W J %A de Groot,Sonja %A Deutekom,Marije %A , %+ Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Blijdorplaan 15, Haarlem, 2015 CE, Netherlands, 31 621115227, jasmijn.holla@inholland.nl %K mHealth %K mobile app %K lifestyle %K usability %K feasibility %K wheelchair users %K spinal cord injury %K lower limb amputation %D 2021 %7 9.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Maintaining a healthy lifestyle is important for wheelchair users’ well-being, as it can have a major impact on their daily functioning. Mobile health (mHealth) apps can support a healthy lifestyle; however, these apps are not necessarily suitable for wheelchair users with spinal cord injury or lower limb amputation. Therefore, a new mHealth app (WHEELS) was developed to promote a healthy lifestyle for this population. Objective: The objectives of this study were to develop the WHEELS mHealth app, and explore its usability, feasibility, and effectiveness. Methods: The WHEELS app was developed using the intervention mapping framework. Intervention goals were determined based on a needs assessment, after which behavior change strategies were selected to achieve these goals. These were applied in an app that was pretested on ease of use and satisfaction, followed by minor adjustments. Subsequently, a 12-week pre-post pilot study was performed to explore usability, feasibility, and effectiveness of the app. Participants received either a remote-guided or stand-alone intervention. Responses to semistructured interviews were analyzed using content analysis, and questionnaires (System Usability Score [SUS], and Usefulness, Satisfaction, and Ease) were administered to investigate usability and feasibility. Effectiveness was determined by measuring outcomes on physical activity, nutrition, sleep quality (Pittsburgh Sleep Quality Index), body composition, and other secondary outcomes pre and post intervention, and by calculating effect sizes (Hedges g). Results: Sixteen behavior change strategies were built into an app to change the physical activity, dietary, sleep, and relaxation behaviors of wheelchair users. Of the 21 participants included in the pilot study, 14 participants completed the study. The interviews and questionnaires showed a varied user experience. Participants scored a mean of 58.6 (SD 25.2) on the SUS questionnaire, 5.4 (SD 3.1) on ease of use, 5.2 (SD 3.1) on satisfaction, and 5.9 (3.7) on ease of learning. Positive developments in body composition were found on waist circumference (P=.02, g=0.76), fat mass percentage (P=.004, g=0.97), and fat-free mass percentage (P=.004, g=0.97). Positive trends were found in body mass (P=.09, g=0.49), BMI (P=.07, g=0.53), daily grams of fat consumed (P=.07, g=0.56), and sleep quality score (P=.06, g=0.57). Conclusions: The WHEELS mHealth app was successfully developed. The interview outcomes and usability scores are reasonable. Although there is room for improvement, the current app showed promising results and seems feasible to deploy on a larger scale. %M 34379056 %R 10.2196/24909 %U https://formative.jmir.org/2021/8/e24909 %U https://doi.org/10.2196/24909 %U http://www.ncbi.nlm.nih.gov/pubmed/34379056 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e25650 %T A Compassion-Focused Ecological Momentary Intervention for Enhancing Resilience in Help-Seeking Youth: Uncontrolled Pilot Study %A Rauschenberg,Christian %A Boecking,Benjamin %A Paetzold,Isabell %A Schruers,Koen %A Schick,Anita %A van Amelsvoort,Thérèse %A Reininghaus,Ulrich %+ Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, Mannheim, 68159, Germany, 49 621 1703 1930, ulrich.reininghaus@zi-mannheim.de %K mental health %K adolescent psychopathology %K digital interventions %K mobile health %K self-compassion %K ecological momentary assessment %K mobile phone %D 2021 %7 5.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Digital interventions offer new avenues for low-threshold prevention and treatment in young people. Ecological momentary interventions (EMIs) represent a powerful approach that allows for adaptive, real-time, and real-world delivery of intervention components in daily life by real-time processing of ecological momentary assessment (EMA) data. Compassion-focused interventions (CFIs) may be particularly amenable to translation into an EMI to strengthen emotional resilience and modify putative risk mechanisms, such as stress sensitivity, in the daily lives of young help-seeking individuals. Objective: This study aims to investigate the feasibility, safety, and initial therapeutic effects of a novel, accessible, transdiagnostic, ecological momentary CFI for improving emotional resilience to stress (EMIcompass). Methods: In this uncontrolled pilot study, help-seeking youth with psychotic, depressive, or anxiety symptoms were offered the EMIcompass intervention in addition to treatment as usual. The EMIcompass intervention consisted of a 3-week EMI (including enhancing, consolidating, and EMA-informed interactive tasks) administered through a mobile health app and three face-to-face sessions with a trained psychologist intended to provide guidance and training on the CFI exercises presented in the app (ie, training session, follow-up booster session, and review session). Results: In total, 10 individuals (mean age 20.3 years, SD 3.8; range 14-25) were included in the study. Most (8/10, 80%) participants were satisfied and reported a low burden of app usage. No adverse events were observed. In approximately one-third of all EMAs, individuals scored high on stress, negative affect, or threat anticipation during the intervention period, resulting in real-time, interactive delivery of the CFI intervention components in addition to weekly enhancing and daily consolidating tasks. Although the findings should be interpreted with caution because of the small sample size, reduced stress sensitivity, momentary negative affect, and psychotic experiences, along with increased positive affect, were found at postintervention and the 4-week follow-up. Furthermore, reductions in psychotic, anxiety, and depressive symptoms were found (r=0.30-0.65). Conclusions: Our findings provide evidence on the feasibility and safety of the EMIcompass intervention for help-seeking youth and lend initial support to beneficial effects on stress sensitivity and mental health outcomes. An exploratory randomized controlled trial is warranted to establish the feasibility and preliminary evidence of its efficacy. %M 34383687 %R 10.2196/25650 %U https://mental.jmir.org/2021/8/e25650 %U https://doi.org/10.2196/25650 %U http://www.ncbi.nlm.nih.gov/pubmed/34383687 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e30813 %T Smartphone Delivery of Cognitive Behavioral Therapy for Postintensive Care Syndrome-Family: Protocol for a Pilot Study %A Petrinec,Amy B %A Hughes,Joel W %A Zullo,Melissa D %A Wilk,Cindy %A George,Richard L %+ College of Nursing, Kent State University, Henderson Hall, 1375 University Esplanade, Kent, OH, 44242, United States, 1 3307152987, apetrine@kent.edu %K postintensive care syndrome-family %K mobile health app %K cognitive behavioral therapy %K mobile phone %D 2021 %7 4.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Family members of critically ill patients experience symptoms of postintensive care syndrome-family (PICS-F), including anxiety, depression, and posttraumatic stress disorder. Postintensive care syndrome-family reduces the quality of life of the families of critically ill patients and may impede the recovery of such patients. Cognitive behavioral therapy has become a first-line nonpharmacological treatment of many psychological symptoms and disorders, including anxiety, depression, and posttraumatic stress. With regard to managing mild-to-moderate symptoms, the delivery of cognitive behavioral therapy via mobile technology without input from a clinician has been found to be feasible and well accepted, and its efficacy rivals that of face-to-face therapy. Objective: The purpose of our pilot study is to examine the efficacy of using a smartphone mobile health (mHealth) app to deliver cognitive behavioral therapy and diminish the severity and prevalence of PICS-F symptoms in family members of critically ill patients. Methods: For our pilot study, 60 family members of critically ill patients will be recruited. A repeated-measures longitudinal study design that involves the randomization of participants to 2 groups (the control and intervention groups) will be used. The intervention group will receive cognitive behavioral therapy, which will be delivered via a smartphone mHealth app. Bandura’s social cognitive theory and an emphasis on mental health self-efficacy form the theoretical framework of the study. Results: Recruitment for the study began in August 2020. Data collection and analysis are expected to be completed by March 2022. Conclusions: The proposed study represents a novel approach to the treatment of PICS-F symptoms and is an extension of previous work conducted by the research team. The study will be used to plan a fully powered randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04316767; https://clinicaltrials.gov/ct2/show/NCT04316767 International Registered Report Identifier (IRRID): DERR1-10.2196/30813 %M 34346900 %R 10.2196/30813 %U https://www.researchprotocols.org/2021/8/e30813 %U https://doi.org/10.2196/30813 %U http://www.ncbi.nlm.nih.gov/pubmed/34346900 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e24112 %T Mobile Health for Smoking Cessation Among Disadvantaged Young Women During and After Pregnancy: User-Centered Design and Usability Study %A Derksen,Marloes E %A Jaspers,Monique WM %A van Strijp,Sander %A Fransen,Mirjam P %+ Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 20 5664494, m.e.derksen@amsterdamumc.nl %K think aloud %K heuristic evaluation %K usability %K mHealth %K game elements %K smoking prevention %K user-centered design %K mobile phone %D 2021 %7 4.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking prevalence during and after pregnancy remains high among socioeconomically disadvantaged women. Mobile health (mHealth) apps with game and social support elements seem promising to support smoking cessation. Objective: This study aims to describe the user-centered design and usability evaluation of Kindle, an mHealth app with game and social support elements, to support disadvantaged young women during and after pregnancy through the first stages of smoking cessation. Methods: Disadvantaged women (n=9), members of their social networks (n=4), and nurses supporting these women (n=51) were informants throughout the iterative prototype development of Kindle according to the International Organization for Standardization 9241-11:2018. Specific phases included understanding the context of use through secondary analysis of qualitative interview data (phase 1), establishing the user and organizational requirements (phase 2), production of design solutions (phase 3), and usability inspection of the prototype through a heuristic evaluation (3 experts) along with user testing by a think aloud method (5 disadvantaged women and 5 nurses; phase 4). Usability problems were categorized according to the principles of the Healthcare Information and Management Systems Society. Results: Phase 1 resulted in an understanding of the VoorZorg program and the needs of VoorZorg nurses and clients (eg, focus on early stages of change and building new supportive networks to aid clients in smoking cessation). In phase 2, we established requirements (n=22; eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring at early stages of change in smoking cessation). Phase 3 resulted in a prototype of Kindle, combining the interface for nurses and clients, including the following functionalities: personal goal setting with earning points; secured chat function between nurses and other clients; and tips, diary, and profile creation. The heuristic evaluation and thinking aloud method in phase 4 revealed 78 usability problems in the interfaces. Most usability problems concerned simplicity (eg, unclear clickable button) and naturalness (eg, unclear icon). Conclusions: The user-centered design and usability testing of the mHealth app Kindle yielded useful insights. The involvement of end users, specifically socioeconomically disadvantaged women during and after their pregnancy, resulted in a prototype that met their needs and requirements (eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring to the early stages of change in smoking cessation) to achieve readiness for smoking cessation. Moreover, the usability evaluation by end users and experts revealed unique usability problems for this population. These insights allow for further optimization of Kindle and encourage future studies to engage disadvantaged populations in all phases of mHealth intervention design and usability testing. %M 34346895 %R 10.2196/24112 %U https://formative.jmir.org/2021/8/e24112 %U https://doi.org/10.2196/24112 %U http://www.ncbi.nlm.nih.gov/pubmed/34346895 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e27885 %T Perspectives and Preferences of Adult Smartphone Users Regarding Nutrition and Diet Apps: Web-Based Survey Study %A Vasiloglou,Maria F %A Christodoulidis,Stergios %A Reber,Emilie %A Stathopoulou,Thomai %A Lu,Ya %A Stanga,Zeno %A Mougiakakou,Stavroula %+ ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland, 41 316327592, stavroula.mougiakakou@artorg.unibe.ch %K dietary assessment %K end-users %K mHealth %K mobile apps %K smartphone %K survey %K apps %K nutrition %K diet %K mobile health %K users %K behavior %K behavior change %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital technologies have evolved dramatically in recent years, finding applications in a variety of aspects of everyday life. Smartphones and mobile apps are being used for a steadily increasing number of tasks, including health monitoring. A large number of nutrition and diet apps are available, and some of them are very popular in terms of user downloads, highlighting a trend toward diet monitoring and assessment. Objective: We sought to explore the perspectives of end users on the features, current use, and acceptance of nutrition and diet mHealth apps with a survey. We expect that this study can provide user insights to assist researchers and developers in achieving innovative dietary assessments. Methods: A multidisciplinary team designed and compiled the survey. Before its release, it was pilot-tested by 18 end users. A 19-question survey was finally developed and was translated into six languages: English, German, French, Spanish, Italian, and Greek. The participants were mainly recruited via social media platforms and mailing lists of universities, university hospitals, and patient associations. Results: A total of 2382 respondents (1891 female, 79.4%; 474 male, 19.9%; and 17 neither, 0.7%) with a mean age of 27.2 years (SD 8.5) completed the survey. Approximately half of the participants (1227/2382, 51.5%) had used a nutrition and diet app. The primary criteria for selecting such an app were ease of use (1570/2382, 65.9%), free cost (1413/2382, 59.3%), and ability to produce automatic readings of caloric content (1231/2382, 51.7%) and macronutrient content (1117/2382, 46.9%) (ie, food type and portion size are estimated by the system without any contribution from the user). An app was less likely to be selected if it incorrectly estimated portion size, calories, or nutrient content (798/2382, 33.5%). Other important limitations included the use of a database that does not include local foods (655/2382, 27.5%) or that may omit major foods (977/2382, 41%). Conclusions: This comprehensive study in a mostly European population assessed the preferences and perspectives of potential nutrition and diet app users. Understanding user needs will benefit researchers who develop tools for innovative dietary assessment as well as those who assist research on behavioral changes related to nutrition. %M 34328425 %R 10.2196/27885 %U https://mhealth.jmir.org/2021/7/e27885 %U https://doi.org/10.2196/27885 %U http://www.ncbi.nlm.nih.gov/pubmed/34328425 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e21202 %T Preadolescent Students’ Engagement With an mHealth Intervention Fostering Social Comparison for Health Behavior Change: Crossover Experimental Study %A Nuijten,Raoul Ceasar Yannic %A Van Gorp,Pieter %A Borghouts,Tom %A Le Blanc,Pascale %A Van den Berg,Pauline %A Kemperman,Astrid %A Hadian,Ehsan %A Simons,Monique %+ Department of Industrial Engineering, Eindhoven University of Technology, Groene Loper 3, Eindhoven, 5612 AE, Netherlands, 31 0614906142, r.c.y.nuijten@tue.nl %K mHealth %K health promotion %K social comparison %K competitiveness %K collaboration %K gamification %K preadolescents %K high school students %D 2021 %7 29.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Contemporary mobile health (mHealth) interventions use various behavior change techniques to promote healthier lifestyles. Social comparison is one of the techniques that is consensually agreed to be effective in engaging the general population in mHealth interventions. However, it is unclear how this strategy can be best used to engage preadolescents. Nevertheless, this strategy has great potential for this target audience, as they are particularly developing their social skills. Objective: This study aims to evaluate how social comparison drives preadolescents’ engagement with an mHealth app. Methods: We designed a 12-week crossover experiment in which we studied 3 approaches to implementing behavior change via social comparison. This study was hosted in a school environment to leverage naturally existing social structures among preadolescents. During the experiment, students and teachers used an mHealth tool that awarded points for performing healthy activities. Participants could read their aggregated scores on a leaderboard and compare their performance with others. In particular, these leaderboards were tweaked to implement 3 approaches of the social comparison technique. The first approach focused on intragroup comparison (ie, students and teachers competing against each other to obtain the most points), whereas the other two approaches focused on intergroup comparison (ie, classes of students and their mentoring teachers collaborating to compete against other classes). Additionally, in the third approach, the performance of teachers was highlighted to further increase students’ engagement through teachers’ natural exemplary function. To obtain our results, we used linear modeling techniques to analyze the dropout rates and engagement levels for the different approaches. In such analyses, we also considered individual participant traits. Results: Our sample included 313 participants—290 students (92.7%) and 23 teachers (7.3%). It was found that student engagement levels dropped over time and declined during holidays. However, students seemed to monitor the intergroup competitions more closely than the intragroup competitions, as they, on average, checked the mHealth app more often when they were engaged in team-based comparisons. Students, on average, performed the most unique activities when they were engaged in the second intergroup setting, perhaps because their teachers were most active in this setting. Moreover, teachers seemed to play an important role in engaging their students, as their relationship with their students influenced the engagement of the students. Conclusions: When using social comparison to engage preadolescents with an mHealth tool, an intergroup setting, rather than an intragroup competition, motivated them to engage with the app but did not necessarily motivate them to perform more activities. It seems that the number of unique activities that preadolescents perform depends on the activeness of a role model. Moreover, this effect is amplified by preadolescents’ perceptions of closeness to that role model. %M 34326041 %R 10.2196/21202 %U https://www.jmir.org/2021/7/e21202 %U https://doi.org/10.2196/21202 %U http://www.ncbi.nlm.nih.gov/pubmed/34326041 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e31013 %T Practitioners’ and Policymakers’ Successes, Challenges, Innovations, and Learning in Promoting Children’s Well-being During COVID-19: Protocol for a Multinational Smartphone App Survey %A Davidson,Jennifer C %A Karadzhov,Dimitar %A Wilson,Graham %+ Institute for Inspiring Children's Futures, School of Social Work and Social Policy, University of Strathclyde, Curran Building, Level 6, 94 Cathedral Street, Glasgow, G4 0LG, United Kingdom, 44 141 444 8513, jennifer.davidson@strath.ac.uk %K mobile phones %K smartphone app %K qualitative %K mixed method %K international %K survey %K service providers %K policy %K practice %K children’s rights %K well-being %K COVID-19 %K pandemic %K app %K mHealth %K children %D 2021 %7 29.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The advent of COVID-19 abruptly thrust the health and safety of children and families into greater risk around the world. As regional and local governments, nongovernmental organizations, communities, families, and children grapple with the immediate public health impact of COVID-19, the rights and well-being of children, especially those who are already marginalized, have been overlooked. Those working with children have likely encountered unprecedented challenges and responded in innovative ways in efforts to address the needs and rights of all children. Objective: This paper presents a protocol for a large-scale, multinational study using a new smartphone app to capture the real-time experiences and perspectives of practitioners and policymakers supporting children and families during the COVID-19 pandemic around the globe in relation to a children’s human rights 4P framework of protection, provision, prevention, and participation. Methods: This protocol describes a mixed methods survey utilizing a custom-built iOS and Android smartphone app called the COVID 4P Log for Children’s Wellbeing, which was developed in close consultation with 17 international key partner organizations. Practitioners and policymakers working with and for children’s well-being across 29 countries and 5 continents were invited to download the app and respond to questions over the course of 8 weeks. The anticipated large amount of qualitative and quantitative response data will be analyzed using content analysis, descriptive statistics, and word frequencies. Results: Formal data collection took place from October 2020 until March 2021. Data analysis was completed in July 2021. Conclusions: The findings will directly inform the understanding of the ways in which COVID-19 has impacted practitioners’, managers’, and policymakers’ efforts to support children’s well-being in their practices, services, and policies, respectively. Innovative and ambitious in its scope and use of smartphone technology, this project also aims to inform and inspire future multinational research using app-based methodologies—the demand for which is likely to continue to dramatically rise in the COVID-19 era. Mitigating the risks of longitudinal remote data collection will help maximize the acceptability of the app, respondents’ sustained engagement, and data quality. International Registered Report Identifier (IRRID): DERR1-10.2196/31013 %M 34323850 %R 10.2196/31013 %U https://www.researchprotocols.org/2021/7/e31013 %U https://doi.org/10.2196/31013 %U http://www.ncbi.nlm.nih.gov/pubmed/34323850 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e25548 %T Efficacy and Safety of Text Messages Targeting Adherence to Cardiovascular Medications in Secondary Prevention: TXT2HEART Colombia Randomized Controlled Trial %A Bermon,Anderson %A Uribe,Ana Fernanda %A Pérez-Rivero,Paula Fernanda %A Prieto-Merino,David %A Saaibi,Jose Federico %A Silva,Federico Arturo %A Canon,Diana Ivonne %A Castillo-Gonzalez,Karol Melissa %A Cáceres-Rivera,Diana Isabel %A Guio,Elizabeth %A Meneses-Castillo,Karen Janneth %A Castillo-Meza,Alberto %A Atkins,Louise %A Horne,Robert %A Murray,Elizabeth %A Serrano,Norma Cecilia %A Free,Caroline %A Casas,Juan Pablo %A Perel,Pablo %+ Research Center, Fundación Cardiovascular de Colombia, Calle 155A #23-58, Floridablanca, 681001, Colombia, 57 3002053041, andebermon@gmail.com %K randomized controlled trial %K Colombia %K text messaging %K cardiovascular disease %K secondary prevention %D 2021 %7 28.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality worldwide, with a prevalence of approximately 100 million patients. There is evidence that antiplatelet agents and antihypertensive medications could reduce the risk of new vascular events in this population; however, treatment adherence is very low. An SMS text messaging intervention was recently developed based on behavior change techniques to increase adherence to pharmacological treatment among patients with a history of ASCVD. Objective: This study aims to evaluate the efficacy and safety of an SMS text messaging intervention to improve adherence to cardiovascular medications in patients with ASCVD. Methods: A randomized controlled clinical trial for patients with a prior diagnosis of cardiovascular events, such as acute myocardial infarction, unstable angina, cerebrovascular disease, or peripheral artery disease, in one center in Colombia was conducted. Patients randomized to the intervention arm were assigned to receive SMS text messages daily for the first 4 weeks, 5 SMS text messages on week 5, 3 SMS text messages each in weeks 6 and 7, and 1 SMS text message weekly from week 8 until week 52. In contrast, patients in the control arm received a monthly SMS text message reminding them of the next study appointment and the importance of the study, requesting information about changes in their phone number, and thanking them for participating in the study. The primary endpoint was the change in low-density lipoprotein cholesterol (LDL-C) levels, whereas the secondary endpoints were the changes in thromboxane B2 levels, heart rate, systolic and diastolic blood pressure, medication adherence, cardiac and noncardiac mortality, and hospitalization. Linear regression analyses and bivariate tests were performed. Results: Of the 930 randomized patients, 805 (86.5%) completed follow-up and were analyzed for the primary endpoint. There was no evidence that the intervention changed the primary outcome (LDL-C levels; P=.41) or any of the secondary outcomes evaluated (all P>.05). There was also no evidence that the intervention was associated with adverse events. Conclusions: In this study, there was no evidence that a behavior modification intervention delivered by SMS text messaging improved LDL-C levels, blood pressure levels, or adherence at 12 months. More research is needed to evaluate whether different SMS text messaging strategies, including personalized messages and different timings, are effective; future studies should include mixed methods to better understand why, for whom, and in which context (eg, health system or social environment) SMS text messaging interventions work (or not) to improve adherence in patients with ASCVD. Trial Registration: ClinicalTrials.gov NCT03098186; https://clinicaltrials.gov/ct2/show/NCT03098186 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-028017 %M 34319247 %R 10.2196/25548 %U https://mhealth.jmir.org/2021/7/e25548 %U https://doi.org/10.2196/25548 %U http://www.ncbi.nlm.nih.gov/pubmed/34319247 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e29858 %T Design, Implementation, and Examination of a Remote Patient Monitoring System for Pediatric Obesity: Protocol for an Open Trial Pilot Study %A Lim,Crystal %A Rutledge,Laura %A Sandridge,Shanda %A King,Krista %A Jefferson,Darryl %A Tucker,Tanya %+ Department of Psychiatry & Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, United States, 1 601 815 1021, cstacklim@umc.edu %K digital health %K eHealth %K obesity %K pediatric obesity %K pediatrics %K remote patient monitoring %K telemedicine %K weight management %D 2021 %7 28.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Pediatric obesity is a critical public health issue. Augmenting care in multidisciplinary pediatric obesity clinics with innovative evidence-based technology to improve weight status and health outcomes is needed. Objective: This study describes the design and methods of an open trial pilot study to examine a remote patient monitoring system (RPMS) for children aged 8-17 years who are receiving treatment in a multidisciplinary pediatric obesity clinic. Methods: Participants will include 45 youth with obesity and their parents. Families will receive standard care in the clinic and the RPMS for 3 months. The RPMS consists of a tablet, weight scale, and pedometer. The system provides daily educational content and involves the use of the pedometer and weekly weigh-ins. Children and parents will complete baseline, posttreatment (month 3), and follow-up assessments (month 6). The primary aim of the study is to examine feasibility and satisfaction with the RPMS and assess its initial effectiveness. Results: We hypothesize high feasibility and satisfaction, with rates over 75%. Furthermore, after RPMS treatment, children will exhibit improved weight status, health outcomes, dietary intake, physical activity, health-related quality of life, self-efficacy, and home-food environment compared to before treatment. These gains are expected to persist at follow-up. Conclusions: This study is novel in that it is the first to design, implement, and examine an RPMS in a pediatric obesity clinic. If the RPMS is feasible, effective, and easily accessible, it may prove to be a practical, acceptable, and cost-effective weight management treatment for youth seeking treatment for severe obesity. Trial Registration: ClinicalTrials.gov NCT04029597; https://clinicaltrials.gov/ct2/show/NCT04029597 International Registered Report Identifier (IRRID): DERR1-10.2196/29858 %M 34319245 %R 10.2196/29858 %U https://www.researchprotocols.org/2021/7/e29858 %U https://doi.org/10.2196/29858 %U http://www.ncbi.nlm.nih.gov/pubmed/34319245 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e26690 %T Evaluating Digital Program Support for the Physical Activity 4 Everyone (PA4E1) School Program: Mixed Methods Study %A Mclaughlin,Matthew %A Duff,Jed %A McKenzie,Tom %A Campbell,Elizabeth %A Sutherland,Rachel %A Wiggers,John %A Wolfenden,Luke %+ School of Medicine and Public Health, University of Newcastle, University Dr, Callaghan, 2308, Australia, 61 402448504, Matthew.Mclaughlin1@health.nsw.gov.au %K process evaluation %K engagement %K think-aloud methodology %K mixed methods %K physical activity %K website %K digital health intervention %K implementation support %K delivery mode %K scale-up %D 2021 %7 26.7.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Effectively scaled-up physical activity interventions are urgently needed to address the high prevalence of physical inactivity. To facilitate scale-up of an efficacious school-based physical activity program (Physical Activity 4 Everyone [PA4E1]), provision of implementation support to physical education (PE) teachers was adapted from face-to-face and paper-based delivery modes to partial delivery via a website. A lack of engagement (usage and subjective experience) with digital delivery modes, including websites, may in part explain the typical reduction in effectiveness of scaled-up interventions that use digital delivery modes. A process evaluation focused on the PA4E1 website was undertaken. Objective: The 2 objectives were to (1) describe the usage of the PA4E1 program website by in-school champions (PE teachers leading the program within their schools) and PE teachers using quantitative methods; (2) examine the usage, subjective experience, and usability of the PA4E1 program website from the perspective of in-school champions using mixed methods. Methods: The first objective used website usage data collected across all users (n=273) throughout the 9 school terms of the PA4E1 implementation support. The 4 usage measures were sessions, page views, average session duration, and downloads. Descriptive statistics were calculated and explored across the duration of the 26-month program. The second objective used mixed methods, triangulating data from the first objective with data from a think-aloud survey and usability test completed by in-school champions (n=13) at 12 months. Qualitative data were analyzed thematically alongside descriptive statistics from the quantitative data in a triangulation matrix, generating cross-cutting themes using the “following a thread” approach. Results: For the first objective, in-school champions averaged 48.0 sessions per user, PE teachers 5.8 sessions. PE teacher sessions were of longer duration (10.5 vs 7.6 minutes) and included more page views (5.4 vs 3.4). The results from the mixed methods analysis for the second objective found 9 themes and 2 meta-themes. The first meta-theme indicated that the website was an acceptable and appropriate delivery mode, and usability of the website was high. The second meta-theme found that the website content was acceptable and appropriate, and identified specific suggestions for improvement. Conclusions: Digital health interventions targeting physical activity often experience issues of lack of user engagement. By contrast, the findings from both the quantitative and mixed methods analyses indicate high usage and overall acceptability and appropriateness of the PA4E1 website to school teachers. The findings support the value of the website within a multidelivery mode implementation intervention to support schools to implement physical activity promoting practices. The analysis identified suggested intervention refinements, which may be adopted for future iterations and further scale-up of the PA4E1 program. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617000681358; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372870 %M 34309565 %R 10.2196/26690 %U https://pediatrics.jmir.org/2021/3/e26690 %U https://doi.org/10.2196/26690 %U http://www.ncbi.nlm.nih.gov/pubmed/34309565 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e26297 %T Development of a Mobile App for Ecological Momentary Assessment of Circadian Data: Design Considerations and Usability Testing %A Woolf,Thomas B %A Goheer,Attia %A Holzhauer,Katherine %A Martinez,Jonathan %A Coughlin,Janelle W %A Martin,Lindsay %A Zhao,Di %A Song,Shanshan %A Ahmad,Yanif %A Sokolinskyi,Kostiantyn %A Remayeva,Tetyana %A Clark,Jeanne M %A Bennett,Wendy %A Lehmann,Harold %+ Department of Physiology, Johns Hopkins University School of Medicine, 725 N Wolfe St, Baltimore, MD, 21205, United States, 1 410 416 2643, twoolf@jhu.edu %K mhealth %K circadian %K sleep %K ecological momentary assessment %K timing of eating %K mobile applications %K habits %K body weight %K surveys and questionnaires %D 2021 %7 23.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Collecting data on daily habits across a population of individuals is challenging. Mobile-based circadian ecological momentary assessment (cEMA) is a powerful frame for observing the impact of daily living on long-term health. Objective: In this paper, we (1) describe the design, testing, and rationale for specifications of a mobile-based cEMA app to collect timing of eating and sleeping data and (2) compare cEMA and survey data collected as part of a 6-month observational cohort study. The ultimate goal of this paper is to summarize our experience and lessons learned with the Daily24 mobile app and to highlight the pros and cons of this data collection modality. Methods: Design specifications for the Daily24 app were drafted by the study team based on the research questions and target audience for the cohort study. The associated backend was optimized to provide real-time data to the study team for participant monitoring and engagement. An external 8-member advisory board was consulted throughout the development process, and additional test users recruited as part of a qualitative study provided feedback through in-depth interviews. Results: After ≥4 days of at-home use, 37 qualitative study participants provided feedback on the app. The app generally received positive feedback from test users for being fast and easy to use. Test users identified several bugs and areas where modifications were necessary to in-app text and instructions and also provided feedback on the engagement strategy. Data collected through the mobile app captured more variability in eating windows than data collected through a one-time survey, though at a significant cost. Conclusions: Researchers should consider the potential uses of a mobile app beyond the initial data collection when deciding whether the time and monetary expenditure are advisable for their situation and goals. %M 34296999 %R 10.2196/26297 %U https://formative.jmir.org/2021/7/e26297 %U https://doi.org/10.2196/26297 %U http://www.ncbi.nlm.nih.gov/pubmed/34296999 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e17780 %T Measuring the Healthiness of Ready-to-Eat Child-Targeted Cereals: Evaluation of the FoodSwitch Platform in Sweden %A Mottas,Antoine %A Lappi,Veli-Matti %A Sundström,Johan %A Neal,Bruce %A Mhurchu,Cliona Ni %A Löf,Marie %A Rådholm,Karin %+ Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SE-58183, Sweden, 46 13 281756, karin.radholm@liu.se %K breakfast cereals %K child-targeted cereals %K front-of-pack labels %K Keyhole symbol %K Health Star Rating %K FoodSwitch %K diet %K food intake %D 2021 %7 22.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Childhood obesity is a major public health issue. The increase in the consumption of foods with poor nutritional value, such as processed foods, contributes to this. Breakfast cereals are often advertised as a healthy way to start the day, but the healthiness of these products varies greatly. Objective: Our main objective was to gather information about the nutritional characteristics of ready-to-eat breakfast cereals in Sweden and to investigate the healthiness of products targeted at children compared to other cereals by use of the FoodSwitch platform. A secondary objective was to evaluate the alignment between the Keyhole symbol and the Health Star Rating. Methods: The FoodSwitch app is a mobile health (mHealth) tool used to present nutrition data and healthier alternative products to consumers. Ready-to-eat breakfast cereals from the largest Swedish grocery retailers were collected using the FoodSwitch platform. Products were defined as targeting children if they presented features addressing children on the package. Results: Overall, information on 261 ready-to-eat cereals was examined. Of this total, 8% (n=21) were targeted at children. Child-targeted cereals were higher in sugar (22.3 g/100 g vs 12.8 g/100 g, P<.001) and lower in fiber (6.2 g/100 g vs 9.8 g/100 g, P<.001) and protein (8.1 g/100 g vs 10.5 g/100 g, P<.001). Total fat (3 g/100 g vs 10.5 g/100 g, P<.001) and saturated fat (0.8 g/100 g vs 2.6 g/100 g, P<.001) were also lower. No difference was found in salt content (P=.61). Fewer child-targeted breakfast cereals displayed an on-pack Keyhole label (n=1, 5% vs n=53, 22%; P=.06), and the mean Health Star Rating value was 3.5 for child-targeted cereals compared to others (mean 3.8, P=.07). A correlation was found between the Keyhole symbol and the Health Star Rating. Conclusions: Ready-to-eat breakfast cereals targeted at children were less healthy in terms of sugar and fiber content compared to products not targeted at children. There is a need to improve the nutritional quality of child-targeted cereals. %M 34292165 %R 10.2196/17780 %U https://mhealth.jmir.org/2021/7/e17780 %U https://doi.org/10.2196/17780 %U http://www.ncbi.nlm.nih.gov/pubmed/34292165 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e24308 %T Smartphone-Based Interventions for Physical Activity Promotion: Scoping Review of the Evidence Over the Last 10 Years %A Domin,Alex %A Spruijt-Metz,Donna %A Theisen,Daniel %A Ouzzahra,Yacine %A Vögele,Claus %+ Research Group: Self-Regulation and Health, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Maison des Sciences Humaines, 11, Porte des Sciences, Esch-sur-Alzette, L-4366, Luxembourg, 352 46 66 44 9389, alex.domin@uni.lu %K scoping review %K smartphone application %K physical activity %K behavior change %K mobile health %K research design %K mHealth %K adolescents %K adults %K BCT %K mobile phonescoping review %K smartphone application %K physical activity %K behavior change %K mobile health %K research design %K mHealth %K adolescents %K adults %K BCT %K mobile phone %D 2021 %7 21.7.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Several reviews of mobile health (mHealth) physical activity (PA) interventions suggest their beneficial effects on behavior change in adolescents and adults. Owing to the ubiquitous presence of smartphones, their use in mHealth PA interventions seems obvious; nevertheless, there are gaps in the literature on the evaluation reporting processes and best practices of such interventions. Objective: The primary objective of this review is to analyze the development and evaluation trajectory of smartphone-based mHealth PA interventions and to review systematic theory- and evidence-based practices and methods that are implemented along this trajectory. The secondary objective is to identify the range of evidence (both quantitative and qualitative) available on smartphone-based mHealth PA interventions to provide a comprehensive tabular and narrative review of the available literature in terms of its nature, features, and volume. Methods: We conducted a scoping review of qualitative and quantitative studies examining smartphone-based PA interventions published between 2008 and 2018. In line with scoping review guidelines, studies were not rejected based on their research design or quality. This review, therefore, includes experimental and descriptive studies, as well as reviews addressing smartphone-based mHealth interventions aimed at promoting PA in all age groups (with a subanalysis conducted for adolescents). Two groups of studies were additionally included: reviews or content analyses of PA trackers and meta-analyses exploring behavior change techniques and their efficacy. Results: Included articles (N=148) were categorized into 10 groups: commercial smartphone app content analyses, smartphone-based intervention review studies, activity tracker content analyses, activity tracker review studies, meta-analyses of PA intervention studies, smartphone-based intervention studies, qualitative formative studies, app development descriptive studies, qualitative follow-up studies, and other related articles. Only 24 articles targeted children or adolescents (age range: 5-19 years). There is no agreed evaluation framework or taxonomy to code or report smartphone-based PA interventions. Researchers did not state the coding method, used various evaluation frameworks, or used different versions of behavior change technique taxonomies. In addition, there is no consensus on the best behavior change theory or model that should be used in smartphone-based interventions for PA promotion. Commonly reported systematic practices and methods have been successfully identified. They include PA recommendations, trial designs (randomized controlled trials, experimental trials, and rapid design trials), mixed methods data collection (surveys, questionnaires, interviews, and focus group discussions), scales to assess app quality, and industry-recognized reporting guidelines. Conclusions: Smartphone-based mHealth interventions aimed at promoting PA showed promising results for behavior change. Although there is a plethora of published studies on the adult target group, the number of studies and consequently the evidence base for adolescents is limited. Overall, the efficacy of smartphone-based mHealth PA interventions can be considerably improved through a more systematic approach of developing, reporting, and coding of the interventions. %M 34287209 %R 10.2196/24308 %U https://mhealth.jmir.org/2021/7/e24308 %U https://doi.org/10.2196/24308 %U http://www.ncbi.nlm.nih.gov/pubmed/34287209 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e27891 %T Associations Between Physiological Signals Captured Using Wearable Sensors and Self-reported Outcomes Among Adults in Alcohol Use Disorder Recovery: Development and Usability Study %A Alinia,Parastoo %A Sah,Ramesh Kumar %A McDonell,Michael %A Pendry,Patricia %A Parent,Sara %A Ghasemzadeh,Hassan %A Cleveland,Michael John %+ Department of Human Development, Washington State University, 501 Johnson Tower, Pullman, WA, 99164, United States, 1 509 335 2870, michael.cleveland@wsu.edu %K alcohol relapse prevention %K stress markers %K alcohol consumption %K electrodermal activity %K heart rate variability %K emotion %K mobile phone %D 2021 %7 21.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Previous research has highlighted the role of stress in substance misuse and addiction, particularly for relapse risk. Mobile health interventions that incorporate real-time monitoring of physiological markers of stress offer promise for delivering tailored interventions to individuals during high-risk states of heightened stress to prevent alcohol relapse. Before such interventions can be developed, measurements of these processes in ambulatory, real-world settings are needed. Objective: This research is a proof-of-concept study to establish the feasibility of using a wearable sensor device to continuously monitor stress in an ambulatory setting. Toward that end, we first aimed to examine the quality of 2 continuously monitored physiological signals—electrodermal activity (EDA) and heart rate variability (HRV)—and show that the data follow standard quality measures according to the literature. Next, we examined the associations between the statistical features extracted from the EDA and HRV signals and self-reported outcomes. Methods: Participants (N=11; female: n=10) were asked to wear an Empatica E4 wearable sensor for continuous unobtrusive physiological signal collection for up to 14 days. During the same time frame, participants responded to a daily diary study using ecological momentary assessment of self-reported stress, emotions, alcohol-related cravings, pain, and discomfort via a web-based survey, which was conducted 4 times daily. Participants also participated in structured interviews throughout the study to assess daily alcohol use and to validate self-reported and physiological stress markers. In the analysis, we first used existing artifact detection methods and physiological signal processing approaches to assess the quality of the physiological data. Next, we examined the descriptive statistics for self-reported outcomes. Finally, we investigated the associations between the features of physiological signals and self-reported outcomes. Results: We determined that 87.86% (1,032,265/1,174,898) of the EDA signals were clean. A comparison of the frequency of skin conductance responses per minute with previous research confirmed that the physiological signals collected in the ambulatory setting were successful. The results also indicated that the statistical features of the EDA and HRV measures were significantly correlated with the self-reported outcomes, including the number of stressful events marked on the sensor device, positive and negative emotions, and experienced pain and discomfort. Conclusions: The results demonstrated that the physiological data collected via an Empatica E4 wearable sensor device were consistent with previous literature in terms of the quality of the data and that features of these physiological signals were significantly associated with several self-reported outcomes among a sample of adults diagnosed with alcohol use disorder. These results suggest that ambulatory assessment of stress is feasible and can be used to develop tailored mobile health interventions to enhance sustained recovery from alcohol use disorder. %M 34287205 %R 10.2196/27891 %U https://formative.jmir.org/2021/7/e27891 %U https://doi.org/10.2196/27891 %U http://www.ncbi.nlm.nih.gov/pubmed/34287205 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 7 %P e31385 %T The Digital Therapeutic Alliance: Prospects and Considerations %A Lederman,Reeva %A D'Alfonso,Simon %+ School of Computing and Information Systems, The University of Melbourne, Melbourne Connect, 700 Swanston Street, Carlton, 3053, Australia, 61 390355511, dalfonso@unimelb.edu.au %K therapeutic alliance %K digital therapeutic alliance %K digital mental health %K mental health apps %K teletherapy %K chatbots %D 2021 %7 20.7.2021 %9 Editorial %J JMIR Ment Health %G English %X The growing prevalence of digital approaches to mental health care raises a range of questions and considerations. A notion that has recently emerged is that of the digital therapeutic alliance, prompting consideration of whether and how the concept of therapeutic alliance, which has proven to be a central ingredient of successful traditional psychotherapy, could translate to mental health care via digital technologies. This special issue editorial article outlines the topic of digital therapeutic alliance and introduces the five articles that comprise the special issue. %M 34283035 %R 10.2196/31385 %U https://mental.jmir.org/2021/7/e31385 %U https://doi.org/10.2196/31385 %U http://www.ncbi.nlm.nih.gov/pubmed/34283035 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e25437 %T Evaluating Quality, Usability, Evidence-Based Content, and Gamification Features in Mobile Learning Apps Designed to Teach Children Basic Life Support: Systematic Search in App Stores and Content Analysis %A Fijačko,Nino %A Masterson Creber,Ruth %A Gosak,Lucija %A Štiglic,Gregor %A Egan,Dominic %A Chaka,Brian %A Debeljak,Nika %A Strnad,Matej %A Skok,Pavel %+ Faculty of Health Sciences, University of Maribor, Žitna 15, Maribor, 2000, Slovenia, 386 23004764, nino.fijacko@um.si %K cardiopulmonary resuscitation %K basic life support %K mobile learning %K mobile phone %K gamification %K schoolchildren %D 2021 %7 20.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Globally, 3.7 million people die of sudden cardiac death annually. Following the World Health Organization endorsement of the Kids Save Lives statements, initiatives to train school-age children in basic life support (BLS) have been widespread. Mobile phone apps, combined with gamification, represent an opportunity for including mobile learning (m-learning) in teaching schoolchildren BLS as an additional teaching method; however, the quality of these apps is questionable. Objective: This study aims to systematically evaluate the quality, usability, evidence-based content, and gamification features (GFs) of commercially available m-learning apps for teaching guideline-directed BLS knowledge and skills to school-aged children. Methods: We searched the Google Play Store and Apple iOS App Store using multiple terms (eg, cardiopulmonary resuscitation [CPR] or BLS). Apps meeting the inclusion criteria were evaluated by 15 emergency health care professionals using the user version of the Mobile Application Rating Scale and System Usability Scale. We modified a five-finger mnemonic for teaching schoolchildren BLS and reviewed the apps’ BLS content using standardized criteria based on three CPR guidelines. GFs in the apps were evaluated using a gamification taxonomy. Results: Of the 1207 potentially relevant apps, only 6 (0.49%) met the inclusion criteria. Most apps were excluded because the content was not related to teaching schoolchildren BLS. The mean total scores for the user version of the Mobile Application Rating Scale and System Usability Scale score were 3.2/5 points (95% CI 3.0-3.4) and 47.1/100 points (95% CI 42.1-52.1), respectively. Half of the apps taught hands-only CPR, whereas the other half also included ventilation. All the apps indicated when to start chest compressions, and only 1 app taught BLS using an automated external defibrillator. Gamification was well integrated into the m-learning apps for teaching schoolchildren BLS, whereas the personal and fictional, educational, and performance gamification groups represented most GFs. Conclusions: Improving the quality and usability of BLS content in apps and combining them with GFs can offer educators novel m-learning tools to teach schoolchildren BLS skills. %M 34283034 %R 10.2196/25437 %U https://mhealth.jmir.org/2021/7/e25437 %U https://doi.org/10.2196/25437 %U http://www.ncbi.nlm.nih.gov/pubmed/34283034 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e28680 %T Pregnant Women’s Attitudes Toward and Experiences With a Tablet Intervention to Promote Safety Behaviors in a Randomized Controlled Trial: Qualitative Study %A Walter,Bente %A Indreboe,Hege %A Lukasse,Mirjam %A Henriksen,Lena %A Garnweidner-Holme,Lisa %+ Department of Nursing and Health Promotion, Oslo Metropolitan University, St Olavs Plass, PO Box 4, Oslo, 0130, Norway, 47 +4748091956, lgarnwei@oslomet.no %K intimate partner violence %K eHealth %K pregnancy %K antenatal care, safety behaviors %K tablet intervention %D 2021 %7 20.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Intimate partner violence (IPV) is recognized as a global health problem. Women with low education and limited resources are more vulnerable, as are immigrant women. There is a lack of evidence on how health care professionals should communicate about and intervene against IPV during pregnancy. Earlier research has shown that when women manage digital questionnaires, they are more likely to disclose IPV. However, little is known about how women experience eHealth interventions with safety behaviors to prevent IPV. Objective: The aim of this study was to explore pregnant women’s attitudes toward and experiences with a tablet intervention to promote safety behaviors in a randomized controlled trial (RCT) in antenatal care. Methods: Individual semistructured interviews were conducted with 10 women who participated in the Safe Pregnancy Study. The Safe Pregnancy Study was a randomized controlled trial (RCT) using a tablet intervention containing IPV questions and a film to promote safety behaviors. Six women from the intervention group and four women from the control group were recruited. The content was available in Norwegian, Somali, and Urdu. Five of the women participating in the interviews spoke Norwegian at home and five spoke another language. The majority of the women who did not speak Norwegian at home perceived themselves as relatively well integrated. The interviews were conducted at different maternal and child health centers (MCHCs) in Norway between March 2020 and June 2020. The analysis was guided by thematic analysis. Results: Women who participated in the tablet intervention appreciated being asked questions about IPV on a tablet. However, it was important to supplement the tablet intervention with face-to-face communication with a midwife. The MCHC was regarded as a suitable place to answer questions and watch a film about safety behaviors. Women suggested making the tablet intervention available in other settings where women meet health care professionals. Some women expressed uncertainty about their anonymity regarding their answers in the questionnaire. We found no real differences between ethnic Norwegian and immigrant women’s attitudes toward and experiences with the tablet intervention. Conclusions: Questions about IPV and a film about safety behaviors on a tablet, as a supplement to face-to-face communication, might initiate and facilitate communication about IPV in antenatal care. Uncertainty regarding anonymity has to be addressed when questions about IPV are being asked on a tablet. Trial Registration: ClinicalTrials.gov NCT03397277; https://clinicaltrials.gov/ct2/show/NCT03397277 %M 34283023 %R 10.2196/28680 %U https://formative.jmir.org/2021/7/e28680 %U https://doi.org/10.2196/28680 %U http://www.ncbi.nlm.nih.gov/pubmed/34283023 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e22968 %T Exploring the Constituent Elements of a Successful Mobile Health Intervention for Prediabetic Patients in King Saud University Medical City Hospitals in Saudi Arabia: Cross-sectional Study %A Alshehri,Fayz %A Alshaikh,Fahdah %+ Executive Department of Information Technology, King Saud University Medical City, King Saud University, King Abdulaziz University Hospital, Building 4, Level 3, King Abdulaziz Road, Riyadh, 12629, Saudi Arabia, 966 118067119, afayz@ksu.edu.sa %K prediabetes %K mHealth %K CeHRes roadmap %K Saudi Arabia %D 2021 %7 20.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-management of prediabetic patients is crucial since they are at high risk of developing type 2 diabetes. Mobile health (mHealth) apps could contribute to potentially reducing the burden of diabetes by supporting the self-management of prediabetic patients. Objective: This study aimed to explore the constituent elements of a successful mHealth intervention for prediabetic patients in King Saud University Medical City (KSUMC) hospitals in Saudi Arabia using the Centre for eHealth Research (CeHRes) roadmap. Methods: This study used the CeHRes roadmap as a developmental guideline for proposing mHealth app features for self-management of prediabetic patients and was performed in 3 phases with one round in each phase. First, a contextual inquiry was conducted via an online self-administered questionnaire for both health care providers and patients. Second, the value specification phase elaborated on the outcomes from the contextual inquiry phase. Finally, prototype user design was performed in cocreation with end users. The design phase was also conducted via an online self-administered questionnaire to evaluate the proposed features of mHealth apps by prediabetic patients. Results: A total of 20 health care providers participated in the study. The results revealed that the most powerful intervention for prediabetes was a combination of medication, physical activity, and healthy diet plans (12/20, 60%). Furthermore, the most common challenge faced by prediabetes patients was patient adherence to healthy diet and physical activity recommendations (10/20, 50%). Almost all patients believed that mHealth apps would be useful for prediabetic patients. A total of 48 prediabetic patients participated in the study. The results indicated that the most powerful intervention for prediabetic patients is a combination of healthy diet and physical activity plans (21/48, 44%), and the most frequent challenge that may lead the patients to discontinue the current intervention was the commitment to a physical activity plan (35/48, 75%). Furthermore, 15% (17/48) of patients use well-being and health apps to manage their current health status. The most common difficulties faced by the patients were navigating app features (mean 2.02 [SD 1.7]) followed by the app language (mean 1.88 [SD 2.0]); these difficulties occurred at a significantly higher rate among those with secondary or lower educational levels as compared to undergraduate and postgraduate levels (P<.05). Finally, the features proposed in the prototype design scored more than 2.5 points higher and indicate the need for these features to be included in the mHealth app. Conclusions: This study aimed to provide real-world insights into the development of an mHealth app for a diabetes prevention intervention by involving both health care providers and prediabetic patients in KSUMC hospitals. Therefore, the proposed app, which comprises all necessary features, may aid patients with prediabetes in self-management and making changes in their lifestyle. %M 34061762 %R 10.2196/22968 %U https://formative.jmir.org/2021/7/e22968 %U https://doi.org/10.2196/22968 %U http://www.ncbi.nlm.nih.gov/pubmed/34061762 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e22693 %T Mobile Ecological Momentary Assessment and Intervention and Health Behavior Change Among Adults in Rakai, Uganda: Pilot Randomized Controlled Trial %A Beres,Laura K %A Mbabali,Ismail %A Anok,Aggrey %A Katabalwa,Charles %A Mulamba,Jeremiah %A Thomas,Alvin G %A Bugos,Eva %A Nakigozi,Gertrude %A Grabowski,Mary K %A Chang,Larry W %+ Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E5031, Baltimore, MD, 21205, United States, 1 410 955 7159, laura.beres@jhu.edu %K ecological momentary assessment %K ecological momentary intervention %K mHealth %K digital health %K smartphone %K mobile phone %K randomized trial %K Uganda %K Africa %D 2021 %7 20.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: An extraordinary increase in mobile phone ownership has revolutionized the opportunities to use mobile health approaches in lower- and middle-income countries (LMICs). Ecological momentary assessment and intervention (EMAI) uses mobile technology to gather data and deliver timely, personalized behavior change interventions in an individual’s natural setting. To our knowledge, there have been no previous trials of EMAI in sub-Saharan Africa. Objective: To advance the evidence base for mobile health (mHealth) interventions in LMICs, we conduct a pilot randomized trial to assess the feasibility of EMAI and establish estimates of the potential effect of EMAI on a range of health-related behaviors in Rakai, Uganda. Methods: This prospective, parallel-group, randomized pilot trial compared health behaviors between adult participants submitting ecological momentary assessment (EMA) data and receiving behaviorally responsive interventional health messaging (EMAI) with those submitting EMA data alone. Using a fully automated mobile phone app, participants submitted daily reports on 5 different health behaviors (fruit consumption, vegetable consumption, alcohol intake, cigarette smoking, and condomless sex with a non–long-term partner) during a 30-day period before randomization (P1). Participants were then block randomized to the control arm, continuing EMA reporting through exit, or the intervention arm, EMA reporting and behavioral health messaging receipt. Participants exited after 90 days of follow-up, divided into study periods 2 (P2: randomization + 29 days) and 3 (P3: 30 days postrandomization to exit). We used descriptive statistics to assess the feasibility of EMAI through the completeness of data and differences in reported behaviors between periods and study arms. Results: The study included 48 participants (24 per arm; 23/48, 48% women; median age 31 years). EMA data collection was feasible, with 85.5% (3777/4418) of the combined days reporting behavioral data. There was a decrease in the mean proportion of days when alcohol was consumed in both arms over time (control: P1, 9.6% of days to P2, 4.3% of days; intervention: P1, 7.2% of days to P3, 2.4% of days). Decreases in sex with a non–long-term partner without a condom were also reported in both arms (P1 to P3 control: 1.9% of days to 1% of days; intervention: 6.6% of days to 1.3% of days). An increase in vegetable consumption was found in the intervention (vegetable: 65.6% of days to 76.6% of days) but not in the control arm. Between arms, there was a significant difference in the change in reported vegetable consumption between P1 and P3 (control: 8% decrease in the mean proportion of days vegetables consumed; intervention: 11.1% increase; P=.01). Conclusions: Preliminary estimates suggest that EMAI may be a promising strategy for promoting behavior change across a range of behaviors. Larger trials examining the effectiveness of EMAI in LMICs are warranted. Trial Registration: ClinicalTrials.gov NCT04375423; https://www.clinicaltrials.gov/ct2/show/NCT04375423 %M 34283027 %R 10.2196/22693 %U https://formative.jmir.org/2021/7/e22693 %U https://doi.org/10.2196/22693 %U http://www.ncbi.nlm.nih.gov/pubmed/34283027 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e29013 %T Building on Lessons Learned in a Mobile Intervention to Reduce Pain and Improve Health (MORPH): Protocol for the MORPH-II Trial %A Fanning,Jason %A Brooks,Amber K %A Hsieh,Katherine L %A Kershner,Kyle %A Furlipa,Joy %A Nicklas,Barbara J %A Rejeski,W Jack %+ Department of Health and Exercise Science, Wake Forest University, Worrell Professional Center 2164B, PO Box 7868, Winston-Salem, NC, United States, 1 336 758 5042, fanninjt@wfu.edu %K aging %K physical activity %K sedentary behavior %K weight loss %K chronic pain %K mHealth %D 2021 %7 19.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Engaging in sufficient levels of physical activity, guarding against sustained sitting, and maintaining a healthy body weight represent important lifestyle strategies for managing older adults’ chronic pain. Our first Mobile Health Intervention to Reduce Pain and Improve Health (MORPH) randomized pilot study demonstrated that a partially remote group-mediated diet and daylong activity intervention (ie, a focus on moving often throughout the day) can lead to improved physical function, weight loss, less pain intensity, and fewer minutes of sedentary time. We also identified unique delivery challenges that limited the program’s scalability and potential efficacy. Objective: The purpose of the MORPH-II randomized pilot study is to refine the MORPH intervention package based on feedback from MORPH and evaluate the feasibility, acceptability, and preliminary efficacy of this revised package prior to conducting a larger clinical trial. Methods: The MORPH-II study is an iteration on MORPH designed to pilot a refined framework, enhance scalability through fully remote delivery, and increase uptake of the daylong movement protocol through revised education content and additional personalized remote coaching. Older, obese, and low-active adults with chronic multisite pain (n=30) will be randomly assigned to receive a 12-week remote group-mediated physical activity and dietary weight loss intervention followed by a 12-week maintenance period or a control condition. Those in the intervention condition will partake in weekly social cognitive theory–based group meetings via teleconference software plus one-on-one support calls on a tapered schedule. They will also engage with a tablet application paired with a wearable activity monitor and smart scale designed to provide ongoing social and behavioral support throughout the week. Those in the control group will receive only the self-monitoring tools. Results: Recruitment is ongoing as of January 2021. Conclusions: Findings from MORPH-II will help guide other researchers working to intervene on sedentary behavior through frequent movement in older adults with chronic pain. Trial Registration: ClinicalTrials.gov NCT04655001; https://clinicaltrials.gov/ct2/show/NCT04655001 International Registered Report Identifier (IRRID): PRR1-10.2196/29013 %M 34279241 %R 10.2196/29013 %U https://www.researchprotocols.org/2021/7/e29013 %U https://doi.org/10.2196/29013 %U http://www.ncbi.nlm.nih.gov/pubmed/34279241 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e25796 %T Development of Automated Reinforcement Management System (ARMS): Protocol for a Phase I Feasibility and Usability Study %A Miguel,Andre %A Smith,Crystal %A Perea,Nicole %A Johnson,Kim %A McDonell,Michael %A McPherson,Sterling %+ Elson S Floyd College of Medicine, Washington State University, 665 N Riverpoint Blvd, Office 406, Spokane, WA, 99202, United States, 1 5096866896, andre.miguel@wsu.edu %K alcohol use disorder %K contingency management %K ecological momentary assessment %K treatment %D 2021 %7 19.7.2021 %9 Protocol %J JMIR Form Res %G English %X Background: Alcohol use is directly related to over 3 million deaths worldwide every year. Contingency management is a cost-effective treatment for substance use disorders; however, few studies have examined its efficacy for alcohol use disorder. Recent technological advances have enabled the combined use of mobile apps and low-cost electronic breathalyzer devices to remotely monitor alcohol use. Leveraging this type of technology, our study group has recently developed an integrated contingency management system that would enable community treatment programs to remotely deliver contingency management to anyone who owns a smartphone. Objective: In this paper, we present a full description of our integrated contingency management system, Automated Reinforcement Management System (ARMS), and describe a protocol that will evaluate its feasibility and usability. Methods: Initially, 6 clinicians will participate in a 1-hour focus group where the study staff will navigate through ARMS as it would be used by clinicians and patients. Clinicians will provide feedback on the intervention in general, which will be used to modify ARMS to make it more user friendly, time saving, and relevant to treatment. A second focus group will summarize the changes made following the initial clinician feedback and will provide additional input regarding the potential utilization of ARMS. Thereafter, the clinicians’ acceptability of ARMS will be evaluated using the System Usability Scale. Following the clinicians’ assessments of ARMS and final modifications, the system will be evaluated in terms of feasibility and patient usability by using an A-B-A within-subject experimental design wherein 20 treatment-seeking individuals with alcohol use disorder will be recruited. The two A phases (control conditions) will each last 2 weeks, and the B phase (contingency management condition) will last 4 weeks. During all phases, participants will be asked to use the ARMS app to submit three breathalyzer samples per day (at 10 AM, 2 PM, and 8 PM). Participants will be prompted by the ARMS app at these predetermined times to record and submit their breathalyzer samples. During the A phases, participants will earn vouchers for every breathalyzer sample submitted, independent of their sample results. During the B phase, vouchers will be provided contingent upon the submission of alcohol-negative breathalyzer samples (breath alcohol content = 0.00). At the end of the A-B-A experiment trial, patients’ usability of the ARMS app will be evaluated using the System Usability Scale. Feasibility will be measured based on whether the ARMS app helped significantly increase alcohol abstinence. Results: Recruitment for this study began in January 2021 and is expected to be completed by December 2021. Conclusions: This study will provide the baseline capability for the implementation of a remotely monitored contingency management platform. If successful, ARMS has the potential to provide effective treatment for alcohol use disorders to individuals living in remote rural areas. %M 34279238 %R 10.2196/25796 %U https://formative.jmir.org/2021/7/e25796 %U https://doi.org/10.2196/25796 %U http://www.ncbi.nlm.nih.gov/pubmed/34279238 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e26098 %T The Value of Mobile Health in Improving Breastfeeding Outcomes Among Perinatal or Postpartum Women: Systematic Review and Meta-analysis of Randomized Controlled Trials %A Qian,Jiafen %A Wu,Tingting %A Lv,Meina %A Fang,Zongwei %A Chen,Mingrong %A Zeng,Zhiwei %A Jiang,Shaojun %A Chen,Wenjun %A Zhang,Jinhua %+ Department of Pharmacy, Fujian Medical University Union Hospital, #29 Xinquan Road, Fuzhou, 350001, China, 86 591 83357896 83, pollyzhang2006@126.com %K mHealth %K breastfeeding %K randomized controlled trial %K meta-analysis %D 2021 %7 16.7.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Breastfeeding is essential for maintaining the health of mothers and babies. Breastfeeding can reduce the infection rate and mortality in newborns, and can reduce the chances of overweight and obesity in children and adolescents. For mothers, a longer duration of breastfeeding can reduce the risk of breast cancer, ovarian cancer, and type 2 diabetes. Although breastfeeding has many benefits, the global breastfeeding rate is low. With the progress of time, the popularity of mobile devices has increased rapidly, and interventions based on mobile health (mHealth) may have the potential to facilitate the improvement of the breastfeeding status. Objective: The main objective of this study was to analyze the existing evidence to determine whether mHealth-based interventions can improve the status of breastfeeding. Methods: We systematically searched multiple electronic databases (PubMed, Web of Science, The Cochrane Library, Embase, CNKI, WanFang, and Vip ) to identify eligible studies published from 1966 to October 29, 2020. Included studies were randomized controlled trials (RCTs) studying the influence of mHealth on breastfeeding. The Cochrane Collaboration Risk of Bias tool was used to examine the risk of publication bias. RevMan 5.3 was used to analyze the data. Results: A total of 15 RCTs with a total sample size of 4366 participates met the inclusion criteria. Compared with usual care, interventions based on mHealth significantly increased the postpartum exclusive breastfeeding rate (odds ratio [OR] 3.18, 95% CI 2.20-4.59; P<.001), enhanced breastfeeding self-efficacy (mean difference [MD] 8.15, 95% CI 3.79-12.51; P=.002; I2=88%), reduced health problems in infants (OR 0.62, 95% CI 0.43-0.90; P=.01; I2=0%), and improved participants’ attitudes toward breastfeeding compared with usual care (MD 3.94, 95% CI 1.95-5.92; P<.001; I2=0%). There was no significant difference in the initiation of breastfeeding within an hour of birth between the intervention group and the usual care group (OR 1.26, 95% CI 0.55-2.90; P=.59). In addition, subgroup analysis was carried out according to different subjects and publication times. The results showed that the breastfeeding rate was not limited by the types of subjects. The breastfeeding rate based on mHealth at 1 month and 2 months after delivery did not change over the time of publication (2009 to 2020), and the breastfeeding rate based on mHealth at 3 months and 6 months after delivery gradually increased with time (2009 to 2020). Conclusions: Interventions based on mHealth can significantly improve the rate of postpartum exclusive breastfeeding, breastfeeding efficacy, and participants’ attitudes toward breastfeeding, and reduce health problems in infants. Therefore, encouraging women to join the mHealth team is feasible, and breastfeeding-related information can be provided through simple measures, such as text messages, phone calls, and the internet, to improve the health of postpartum women and their babies. %M 34269681 %R 10.2196/26098 %U https://mhealth.jmir.org/2021/7/e26098 %U https://doi.org/10.2196/26098 %U http://www.ncbi.nlm.nih.gov/pubmed/34269681 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e29689 %T Popular Evidence-Based Commercial Mental Health Apps: Analysis of Engagement, Functionality, Aesthetics, and Information Quality %A Lau,Nancy %A O'Daffer,Alison %A Yi-Frazier,Joyce P %A Rosenberg,Abby R %+ Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, 1920 Terry Ave, Seattle, WA, 98101, United States, 1 2068840569, nancy.lau@seattlechildrens.org %K mobile health %K mental health %K behavioral health %K user-centered design %K evidence-based health management %K smartphones %K mobile phones %D 2021 %7 14.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a robust market for mobile health (mHealth) apps focused on self-guided interventions to address a high prevalence of mental health disorders and behavioral health needs in the general population. Disseminating mental health interventions via mHealth technologies may help overcome barriers in access to care and has broad consumer appeal. However, development and testing of mental health apps in formal research settings are limited and far outpaced by everyday consumer use. In addition to prioritizing efficacy and effectiveness testing, researchers should examine and test app design elements that impact the user experience, increase engagement, and lead to sustained use over time. Objective: The aim of this study was to evaluate the objective and subjective quality of apps that are successful across both research and consumer sectors, and the relationships between objective app quality, subjective user ratings, and evidence-based behavior change techniques. This will help inform user-centered design considerations for mHealth researchers to maximize design elements and features associated with consumer appeal, engagement, and sustainability. Methods: We conducted a user-centered design analysis of popular consumer apps with scientific backing utilizing the well-validated Mobile Application Rating Scale (MARS). Popular consumer apps with research support were identified via a systematic search of the App Store iOS (Apple Inc) and Google Play (Google LLC) and literature review. We evaluated the quality metrics of 19 mental health apps along 4 MARS subscales, namely, Engagement, Functionality, Aesthetics, and Information Quality. MARS total and subscale scores range from 1 to 5, with higher scores representing better quality. We then extracted user ratings from app download platforms and coded apps for evidence-based treatment components. We calculated Pearson correlation coefficients to identify associations between MARS scores, App Store iOS/Google Play consumer ratings, and number of evidence-based treatment components. Results: The mean MARS score was 3.52 (SD 0.71), consumer rating was 4.22 (SD 0.54), and number of evidence-based treatment components was 2.32 (SD 1.42). Consumer ratings were significantly correlated with the MARS Functionality subscale (r=0.74, P<.001), Aesthetics subscale (r=0.70, P<.01), and total score (r=0.58, P=.01). Number of evidence-based intervention components was not associated with MARS scores (r=0.085, P=.73) or consumer ratings (r=–0.329, P=.16). Conclusions: In our analysis of popular research-supported consumer apps, objective app quality and subjective consumer ratings were generally high. App functionality and aesthetics were highly consistent with consumer appeal, whereas evidence-based components were not. In addition to designing treatments that work, we recommend that researchers prioritize aspects of app design that impact the user experience for engagement and sustainability (eg, ease of use, navigation, visual appeal). This will help translate evidence-based interventions to the competitive consumer app market, thus bridging the gap between research development and real-world implementation. %M 34259639 %R 10.2196/29689 %U https://mhealth.jmir.org/2021/7/e29689 %U https://doi.org/10.2196/29689 %U http://www.ncbi.nlm.nih.gov/pubmed/34259639 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e25428 %T Acceptability of an mHealth App That Provides Harm Reduction Services Among People Who Inject Drugs: Survey Study %A Shelby,Tyler %A Zhou,Xin %A Barber,Douglas %A Altice,Frederick %+ Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, 60 College Street, New Haven, CT, 06510, United States, 1 6202284003, tyler.shelby@yale.edu %K people who inject drugs %K mHealth %K patient preferences %K syringe services programs %K service access %K mobile phone %D 2021 %7 14.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Harm reduction services reduce the negative consequences of drug injection and are often embedded within syringe service programs (SSPs). However, people who inject drugs (PWID) suboptimally engage with such services because of stigma, fear, transportation restrictions, and limited hours of operation. Mobile health (mHealth) apps may provide an opportunity to overcome these barriers and extend the reach of SSPs beyond that of the traditional brick-and-mortar models. Objective: This study aims to assess the prevalence of smartphone ownership, the level of comfort in providing the personal information required to use mHealth apps, and interest in using an mHealth app to access harm reduction services among PWID to guide the development of an app. Methods: We administered a survey to 115 PWID who were enrolled via respondent-driven sampling from July 2018 to July 2019. We examined the extent to which PWID had access to smartphones; were comfortable in providing personal information such as name, email, and address; and expressed interest in various app-based services. We measured participant characteristics (demographics, health status, and behaviors) and used binary logistic and Poisson regressions to identify independent correlates of mHealth-related variables. The primary regression outcomes included summary scores for access, comfort, and interest. The secondary outcomes included binary survey responses for individual comfort or interest components. Results: Most participants were White (74/105, 70.5%), male (78/115, 67.8%), and middle-aged (mean=41.7 years), and 67.9% (74/109) owned a smartphone. Participants reported high levels of comfort in providing personal information to use an mHealth app, including name (96/109, 88.1%), phone number (92/109, 84.4%), email (85/109, 77.9%), physical address (85/109, 77.9%), and linkage to medical records (72/109, 66.1%). Participants also reported strong interest in app-based services, including medication or sterile syringe delivery (100/110, 90.9%), lab or appointment scheduling (90/110, 81.8%), medication reminders (77/110, 70%), educational material (65/110, 59.1%), and group communication forums (64/110, 58.2%). Most participants were comfortable with the idea of home delivery of syringes (93/109, 85.3%). Homeless participants had lower access to smartphones (adjusted odds ratio [AOR] 0.15, 95% CI 0.05-0.46; P=.001), but no other participant characteristics were associated with primary outcomes. Among secondary outcomes, recent SSP use was positively associated with comfort with the home delivery of syringes (AOR 3.29, 95% CI 1.04-10.3 P=.04), and being older than 50 years was associated with an increased interest in educational materials (AOR 4.64, 95% CI 1.31-16.5; P=.02) and group communication forums (AOR 3.69, 95% CI 1.10-12.4; P=.04). Conclusions: Our findings suggest that aside from those experiencing homelessness or unstable housing, PWID broadly have access to smartphones, are comfortable with sharing personal information, and express interest in a wide array of services within an app. Given the suboptimal access to and use of SSPs among PWID, an mHealth app has a high potential to address the harm reduction needs of this vulnerable population. %M 34259640 %R 10.2196/25428 %U https://www.jmir.org/2021/7/e25428 %U https://doi.org/10.2196/25428 %U http://www.ncbi.nlm.nih.gov/pubmed/34259640 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e21837 %T A School-Based Mobile App Intervention for Enhancing Emotion Regulation in Children: Exploratory Trial %A Moltrecht,Bettina %A Patalay,Praveetha %A Deighton,Jessica %A Edbrooke-Childs,Julian %+ Evidence-based Practice Unit, University College London & Anna Freud National Centre, 4-8 Rodney Street, London, N1 9JH, United Kingdom, 44 020 7794 ext 2313, Julian.childs@annafreud.org %K emotion regulation %K digital mental health %K mhealth %K school intervention %K child mental health %K mobile phone %D 2021 %7 14.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Most mental health disorders are first experienced in childhood. The rising rates of mental health difficulties in children highlight the need for innovative approaches to supporting children and preventing these difficulties. School-based digital interventions that address shared risk factors and symptoms, such as emotion dysregulation, present exciting opportunities to enhance mental health support for children on a larger scale. Objective: This study investigates the use of a new app-based intervention designed to support children’s emotion regulation in schools. The aim is to optimize the usability, acceptability, and utility of the app and explore its scope for implementation with the target user in the school context. Methods: As part of an interdisciplinary development framework, the app is being evaluated in a 3-month trial across 4 primary schools. In total, 144 children (aged 10-12 years) took part and accessed the intervention app in the classroom or at home. Outcomes regarding usability, acceptability, and implementation opportunities were assessed through digital user data, self-report questionnaires (132/144, 91.6%), and semistructured interviews with children (19/144, 13.2%) and teachers (6/8, 75%). Results: The app usage data showed that 30% (128/426) of the users were returning users. Self-report data indicated that 40.1% (53/132) of the children had not used the app, whereas 57.5% (76/132) had used it once or more. Of the children who had used the app, 67% (51/76) reported that the app was helpful. Interviews with children and teachers suggested positive experiences with the app and that it helped them to calm down and relax. Children reported that they perceived the app as acceptable, usable, and helpful. In terms of the intervention’s usability, most features functioned well; however, certain technical issues were reported, which may have led to reduced engagement levels. Teachers not only reported overall positive experiences but also discussed access difficulties and reported a lack of content as one of the main barriers to implementing the app. Having a web-based app significantly enhanced accessibility across devices and settings and provided teachers with more opportunities to use it. We identified the need for new, activating app features in addition to the existing, primarily relaxing ones. The findings indicated that it is possible to use and evaluate an app intervention in the school context and that the app could help enhance children’s emotion regulation. We discuss areas for improvement regarding the app, study design, and future implementation strategies. Conclusions: We share important insights with regard to the development, implementation, and evaluation of a new app for supporting children’s emotion regulation in schools. Our results demonstrate that mental health apps represent a promising means to facilitate effective mental health service provision in and outside of the school context. Important lessons learned are shared to support other researchers and clinicians on similar journeys. %M 34259642 %R 10.2196/21837 %U https://mhealth.jmir.org/2021/7/e21837 %U https://doi.org/10.2196/21837 %U http://www.ncbi.nlm.nih.gov/pubmed/34259642 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e18741 %T Assessing the Contribution of Self-Monitoring Through a Commercial Weight Loss App: Mediation and Predictive Modeling Study %A Farage,Gregory %A Simmons,Courtney %A Kocak,Mehmet %A Klesges,Robert C %A Talcott,G Wayne %A Richey,Phyllis %A Hare,Marion %A Johnson,Karen C %A Sen,Saunak %A Krukowski,Rebecca %+ Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, 66 N Pauline St, Memphis, TN, 38163, United States, 1 901 448 2426, rkrukows@uthsc.edu %K weight loss %K self-monitoring %K obesity %K apps %K behavioral intervention %D 2021 %7 14.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Electronic self-monitoring technology has the potential to provide unique insights into important behaviors for inducing weight loss. Objective: The aim of this study is to investigate the effects of electronic self-monitoring behavior (using the commercial Lose It! app) and weight loss interventions (with differing amounts of counselor feedback and support) on 4- and 12-month weight loss. Methods: In this secondary analysis of the Fit Blue study, we compared the results of two interventions of a randomized controlled trial. Counselor-initiated participants received consistent support from the interventionists, and self-paced participants received assistance upon request. The participants (N=191), who were active duty military personnel, were encouraged to self-monitor their diet and exercise with the Lose It! app or website. We examined the associations between intervention assignment and self-monitoring behaviors. We conducted a mediation analysis of the intervention assignment for weight loss through multiple mediators—app use (calculated from the first principal component [PC] of electronically collected variables), number of weigh-ins, and 4-month weight change. We used linear regression to predict weight loss at 4 and 12 months, and the accuracy was measured using cross-validation. Results: On average, the counselor-initiated–treatment participants used the app more frequently than the self-paced–treatment participants. The first PC represented app use frequencies, the second represented calories recorded, and the third represented reported exercise frequency and exercise caloric expenditure. We found that 4-month weight loss was partially mediated through app use (ie, the first PC; 60.3%) and the number of weigh-ins (55.8%). However, the 12-month weight loss was almost fully mediated by 4-month weight loss (94.8%). Linear regression using app data from the first 8 weeks, the number of self–weigh-ins at 8 weeks, and baseline data explained approximately 30% of the variance in 4-month weight loss. App use frequency (first PC; P=.001), self-monitored caloric intake (second PC; P=.001), and the frequency of self-weighing at 8 weeks (P=.008) were important predictors of 4-month weight loss. Predictions for 12-month weight with the same variables produced an R2 value of 5%; only the number of self–weigh-ins was a significant predictor of 12-month weight loss. The R2 value using 4-month weight loss as a predictor was 31%. Self-reported exercise did not contribute to either model (4 months: P=.77; 12 months: P=.15). Conclusions: We found that app use and daily reported caloric intake had a substantial impact on weight loss prediction at 4 months. Our analysis did not find evidence of an association between participant self-monitoring exercise information and weight loss. As 12-month weight loss was completely mediated by 4-month weight loss, intervention targets should focus on promoting early and frequent dietary intake self-monitoring and self-weighing to promote early weight loss, which leads to long-term success. Trial Registration: ClinicalTrials.gov NCT02063178; https://clinicaltrials.gov/ct2/show/NCT02063178 %M 34259635 %R 10.2196/18741 %U https://mhealth.jmir.org/2021/7/e18741 %U https://doi.org/10.2196/18741 %U http://www.ncbi.nlm.nih.gov/pubmed/34259635 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e22510 %T Promoting Collaborative Goal Setting for Cancer Prevention Among Primary Care Patients Through mHealth: Mixed Methods Evaluation of a New App %A Resnick,Daniel %A Schapira,Marilyn M %A Smith,Jazmine M %A Bautista,Allison %A Xu,Chang %A Jones,Liz %A Aysola,Jaya %+ Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 1229 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, United States, 1 215 573 9475, jaysola@upenn.edu %K mHealth %K cancer prevention %K goal setting %K social networks %K health disparities %K mobile phone %D 2021 %7 14.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Many newly diagnosed cancers are associated with modifiable lifestyle behaviors, such as diet, exercise, smoking cessation, and maintaining a healthy weight. However, primary care providers rarely discuss cancer prevention behaviors with their patients. Objective: This study aims to assess the usability, acceptability, and user engagement of the Healthier Together mobile app, which is designed to promote cancer prevention behaviors among non-Hispanic Black primary care patients, by using social networks and goal-setting theories of behavior change. Methods: In an 8-week pilot study, we enrolled primary care patients (N=41) and provided them with a cancer prevention mobile app that allowed them to select, track, and share progress on cancer prevention goals with other users. App usability was assessed using the System Usability Scale. We assessed the app’s acceptability by qualitatively analyzing open-ended responses regarding participants’ overall experience with the app. We assessed participants’ engagement by analyzing the built-in data capture device, which included the number of times participants checked in (out of a maximum of 8) during the study. Results: The mean age of the 41 participants was 51 years (SD 12), and 76% (31/41) were women. App use data were captured from all participants, and 83% (34/41) completed the exit survey and interview. The mean System Usability Scale score was 87 (SD 12; median 90; IQR 78-95). The analysis of open-ended responses revealed several key themes, and participants complemented the app’s ease of use and health behavior–promoting features while also commenting on the need for more feedback and social interactions through the app. On average, participants checked in 5.7 times (SD 2.7) out of 8 possible opportunities. Of the 41 participants, 76% (31/41) checked in during at least 4 of the 8 weeks. Secondary analyses revealed that participants often accomplished their set goals (mean 5.1, SD 2.7) for each week. The qualitative analysis of comments given by participants within the app after each weekly check-in revealed several themes on how the app assisted participants in behavioral change, highlighting that some participants created exercise programs, ate healthier foods, lost a significant amount of weight, and stopped smoking during this study. Conclusions: The implementation of a mobile cancer prevention goal–setting app in a primary care setting was feasible, and the app achieved high usability, acceptability, and engagement among participants. User feedback revealed an influence on health behaviors. These findings suggest the promise of the Healthier Together app in facilitating behavioral change to reduce cancer risk among non-Hispanic Black primary care patients. %M 34259162 %R 10.2196/22510 %U https://formative.jmir.org/2021/7/e22510 %U https://doi.org/10.2196/22510 %U http://www.ncbi.nlm.nih.gov/pubmed/34259162 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e26658 %T App-Based Feedback for Rehabilitation Exercise Correction in Patients With Knee or Hip Osteoarthritis: Prospective Cohort Study %A Biebl,Johanna Theresia %A Rykala,Marzena %A Strobel,Maximilian %A Kaur Bollinger,Pawandeep %A Ulm,Bernhard %A Kraft,Eduard %A Huber,Stephan %A Lorenz,Andreas %+ Department of Orthopaedics, Physical Medicine, and Rehabilitation, University Hospital, Ludwig Maximilians University of Munich, Marchioninistr. 15, Munich, 81377, Germany, 49 89440074070, johanna.biebl@med.uni-muenchen.de %K mHealth %K digital health %K digital rehabilitation %K machine learning %K smartphone %K osteoarthritis %K exercise therapy %D 2021 %7 13.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of digital therapeutic solutions for rehabilitation of conditions such as osteoarthritis provides scalable access to rehabilitation. Few validated technological solutions exist to ensure supervision of users while they exercise at home. Motion Coach (Kaia Health GmbH) provides audiovisual feedback on exercise execution in real time on conventional smartphones. Objective: We hypothesized that the interrater agreement between physiotherapists and Motion Coach would be noninferior to physiotherapists’ interrater agreement for exercise evaluations in a cohort with osteoarthritis. Methods: Patients diagnosed with osteoarthritis of the knee or hip were recruited at a university hospital to perform a set of 6 exercises. Agreement between Motion Coach and 2 physiotherapists’ corrections for segments of the exercises were compared using Cohen κ and percent agreement. Results: Participants (n=24) were enrolled and evaluated. There were no significant differences between interrater agreements (Motion Coach app vs physiotherapists: percent agreement 0.828; physiotherapist 1 vs physiotherapist 2: percent agreement 0.833; P<.001). Age (70 years or under, older than 70 years), gender (male, female), or BMI (30 kg/m2 or under, greater than 30 kg/m2) subgroup analysis revealed no detectable difference in interrater agreement. There was no detectable difference in levels of interrater agreement between Motion Coach vs physiotherapists and between physiotherapists in any of the 6 exercises. Conclusions: The results demonstrated that Motion Coach is noninferior to physiotherapist evaluations. Interrater agreement did not differ between 2 physiotherapists or between physiotherapists and the Motion Coach app. This finding was valid for all investigated exercises and subgroups. These results confirm the ability of Motion Coach to detect user form during exercise and provide valid feedback to users with musculoskeletal disorders. %M 34255677 %R 10.2196/26658 %U https://www.jmir.org/2021/7/e26658 %U https://doi.org/10.2196/26658 %U http://www.ncbi.nlm.nih.gov/pubmed/34255677 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e26063 %T Determinants of Fitness App Usage and Moderating Impacts of Education-, Motivation-, and Gamification-Related App Features on Physical Activity Intentions: Cross-sectional Survey Study %A Yang,Yanxiang %A Koenigstorfer,Joerg %+ Chair of Sport and Health Management, Technical University of Munich, Georg-Brauchle-Ring 60/62, Campus D – Uptown Munich, Munich, 80992, Germany, 49 89 289 24559, joerg.koenigstorfer@tum.de %K smartphone %K fitness applications %K mHealth %K technology acceptance %K Unified Theory of Acceptance and Use of Technology 2 %K physical activity %K determinants of app usage %K education-related app features %K motivation-related app features %K gamification-related app features %K mobile phone %D 2021 %7 13.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphone fitness apps are considered promising tools for promoting physical activity and health. However, it is unclear which user-perceived factors and app features encourage users to download apps with the intention of being physically active. Objective: Building on the second version of the Unified Theory of Acceptance and Use of Technology, this study aims to examine the association of the seven determinants of the second version of the Unified Theory of Acceptance and Use of Technology with the app usage intentions of the individuals and their behavioral intentions of being physically active as well as the moderating effects of different smartphone fitness app features (ie, education, motivation, and gamification related) and individual differences (ie, age, gender, and experience) on these intentions. Methods: Data from 839 US residents who reported having used at least one smartphone fitness app were collected via a web-based survey. A confirmatory factor analysis was performed, and path modeling was used to test the hypotheses and explore the influence of moderators on structural relationships. Results: The determinants explain 76% of the variance in the behavioral intention to use fitness apps. Habit (β=.42; P<.001), performance expectancy (β=.36; P<.001), facilitating conditions (β=.15; P<.001), price value (β=.13; P<.001), and effort expectancy (β=.09; P=.04) were positively related to behavioral intention to use fitness apps, whereas social influence and hedonic motivation were nonsignificant predictors. Behavioral intentions to use fitness apps were positively related to intentions of being physically active (β=.12; P<.001; R2=0.02). Education-related app features moderated the association between performance expectancy and habit and app usage intentions; motivation-related features moderated the association of performance expectancy, facilitating conditions, and habit with usage intentions; and gamification-related features moderated the association between hedonic motivation and usage intentions. Age moderated the association between effort expectancy and usage intentions, and gender moderated the association between performance expectancy and habit and usage intentions. User experience was a nonsignificant moderator. Follow-up tests were used to describe the nature of significant interaction effects. Conclusions: This study identifies the drivers of the use of fitness apps. Smartphone app features should be designed to increase the likelihood of app usage, and hence physical activity, by supporting users in achieving their goals and facilitating habit formation. Target group–specific preferences for education-, motivation-, and gamification-related app features, as well as age and gender differences, should be considered. Performance expectancy had a high predictive power for intended usage for male (vs female) users who appreciated motivation-related features. Thus, apps targeting these user groups should focus on goal achievement–related features (eg, goal setting and monitoring). Future research could examine the mechanisms of these moderation effects and their long-term influence on physical activity. %M 34255656 %R 10.2196/26063 %U https://www.jmir.org/2021/7/e26063 %U https://doi.org/10.2196/26063 %U http://www.ncbi.nlm.nih.gov/pubmed/34255656 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e26951 %T A Mobile Phone–Based Life-Skills Training Program for Substance Use Prevention Among Adolescents: Cluster-Randomized Controlled Trial %A Haug,Severin %A Paz Castro,Raquel %A Wenger,Andreas %A Schaub,Michael Patrick %+ Swiss Research Institute for Public Health and Addiction at Zurich University, Konradstrasse 32, Zurich, 8005, Switzerland, 41 444481174, severin.haug@isgf.uzh.ch %K life skills %K substance use %K prevention %K adolescents %K mobile phone %D 2021 %7 13.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Life skills are abilities for adaptive and positive behavior that enable individuals to deal effectively with the demands and challenges of everyday life. Life-skills training programs conducted within the school curriculum are effective in preventing the onset and escalation of substance use among adolescents. However, their dissemination is impeded due to their large resource requirements. Life-skills training provided via mobile phones may provide a more economic and scalable approach. Objective: The goal of this study was to test the appropriateness (ie, acceptance, use, and evaluation) and short-term efficacy of a mobile phone–based life-skills training program to prevent substance use among adolescents within a controlled trial. Methods: The study design was a two-arm, parallel-group, cluster-randomized controlled trial with assessments at baseline and follow-up assessments after 6 and 18 months. This report includes outcomes measured up to the 6-month follow-up. The efficacy of the intervention was tested in comparison to an assessment-only control group. The automated intervention program SmartCoach included online feedback and individually tailored text messages provided over 22 weeks. The contents were based on social cognitive theory and addressed self-management skills, social skills, and substance use resistance skills. Linear mixed models and generalized linear mixed models, as well as logistic or linear regressions, were used to investigate changes between baseline and 6-month follow-up in the following outcomes: 30-day prevalence rates of problem drinking, tobacco use, and cannabis use as well as quantity of alcohol use, quantity of cigarettes smoked, cannabis use days, perceived stress, well-being, and social skills. Results: A total of 1759 students from 89 Swiss secondary and upper secondary school classes were invited to participate in the study. Of these, 1473 (83.7%) students participated in the study; the mean age was 15.4 years (SD 1.0) and 55.2% (813/1473) were female. Follow-up assessments at 6 months were completed by 1233 (83.7%) study participants. On average, program participants responded to half (23.6 out of 50) of the prompted activities. Program evaluations underlined its appropriateness for the target group of secondary school students, with the majority rating the program as helpful and individually tailored. The results concerning the initial effectiveness of this program based on 6-month follow-up data are promising, with three of nine outcomes of the intention-to-treat analyses showing beneficial developments of statistical significance (ie, quantity of alcohol use, quantity of tobacco use, and perceived stress; P<.05) and another three outcomes (ie, problem drinking prevalence, cannabis use days, and social skills) showing beneficial developments of borderline significance (P<.10). Conclusions: The results showed good acceptance of this intervention program that could be easily and economically implemented in school classes. Initial results on program efficacy indicate that it might be effective in both preventing or reducing substance use and fostering life skills; however, data from the final 18-month follow-up assessments will be more conclusive. Trial Registration: ISRCTN Registry ISRCTN41347061; https://doi.org/10.1186/ISRCTN41347061 %M 34255703 %R 10.2196/26951 %U https://mhealth.jmir.org/2021/7/e26951 %U https://doi.org/10.2196/26951 %U http://www.ncbi.nlm.nih.gov/pubmed/34255703 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 7 %P e24633 %T Digital Medical Device Companion (MyIUS) for New Users of Intrauterine Systems: App Development Study %A Karakoyun,Toeresin %A Podhaisky,Hans-Peter %A Frenz,Ann-Kathrin %A Schuhmann-Giampieri,Gabriele %A Ushikusa,Thais %A Schröder,Daniel %A Zvolanek,Michal %A Lopes Da Silva Filho,Agnaldo %+ eHealth and Medical Software Solutions, Bayer AG, eHealth & Medical Software Solutions, Building 0459, Wuppertal, 42096, Germany, 49 152 23914568, toeresin.karakoyun@bayer.com %K medical device %K levonorgestrel-releasing intrauterine system %K mobile medical app %K mobile phone %D 2021 %7 13.7.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Women choosing a levonorgestrel-releasing intrauterine system may experience changes in their menstrual bleeding pattern during the first months following placement. Objective: Although health care professionals (HCPs) can provide counseling, no method of providing individualized information on the expected bleeding pattern or continued support is currently available for women experiencing postplacement bleeding changes. We aim to develop a mobile phone–based medical app (MyIUS) to meet this need and provide a digital companion to women after the placement of the intrauterine system. Methods: The MyIUS app is classified as a medical device and uses an artificial intelligence–based bleeding pattern prediction algorithm to estimate a woman’s future bleeding pattern in terms of intensity and regularity. We developed the app with the help of a multidisciplinary team by using a robust and high-quality design process in the context of a constantly evolving regulatory landscape. The development framework consisted of a phased approach including ideation, feasibility and concept finalization, product development, and product deployment or localization stages. Results: The MyIUS app was considered useful by HCPs and easy to use by women who were consulted during the development process. Following the launch of the sustainable app in selected pilot countries, performance metrics will be gathered to facilitate further technical and feature updates and enhancements. A real-world performance study will also be conducted to allow us to upgrade the app in accordance with the new European Commission Medical Device legislation and to validate the bleeding pattern prediction algorithm in a real-world setting. Conclusions: By providing a meaningful estimation of bleeding patterns and allowing an individualized approach to counseling and discussions about contraceptive method choice, the MyIUS app offers a useful tool that may benefit both women and HCPs. Further work is needed to validate the performance of the prediction algorithm and MyIUS app in a real-world setting. %M 34255688 %R 10.2196/24633 %U https://medinform.jmir.org/2021/7/e24633 %U https://doi.org/10.2196/24633 %U http://www.ncbi.nlm.nih.gov/pubmed/34255688 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e26498 %T A Mobile-Based Intervention to Increase Self-esteem in Students With Depressive Symptoms: Randomized Controlled Trial %A Bruhns,Alina %A Lüdtke,Thies %A Moritz,Steffen %A Bücker,Lara %+ University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, Hamburg, 20251, Germany, 49 40741055868, l.buecker@uke.de %K mHealth %K depression %K depressive symptoms %K students’ mental health %K self-help smartphone app %K mobile phone %K self-esteem %D 2021 %7 12.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Depressive symptoms are one of the most common and ever-increasing mental health problems among students worldwide. Conventional treatment options, particularly psychotherapy, do not reach all students in need of help. Internet- and mobile-based interventions are promising alternatives for narrowing the treatment gap. Objective: In the framework of a randomized controlled trial, we aim to investigate the effectiveness, acceptance, and side effects of a self-help smartphone app (MCT & More) based on cognitive behavioral therapy, mindfulness, acceptance and commitment therapy, and metacognitive training in a sample of students with self-reported depressive symptoms. Furthermore, we were interested in examining the influence of treatment expectations and attitudes toward internet- and mobile-based interventions on treatment adherence and effectiveness. Methods: A total of 400 students were recruited via open access websites and randomized to either the intervention group (n=200), who received access to the self-help smartphone app MCT & More for a period of 4 weeks, or to a wait-list control group (n=200). The Patient Health Questionnaire-9 (depression) served as the primary outcome parameter, and the Rosenberg Self-esteem Scale (self-esteem) and the global item of the World Health Organization Quality of Life-abbreviated version (quality of life) served as the secondary outcome parameters. The Attitudes Towards Psychological Online Interventions was used to measure attitudes toward internet- and mobile-based interventions. Outcome expectations were assessed using the Patient Questionnaire on Therapy Expectation and Evaluation, and side effects were assessed using the Inventory for Assessing Negative Effects of Psychotherapy. Results: Per-protocol (PP), complete-case, and intention-to-treat analyses showed a significantly higher reduction in depressive symptoms (PP: F1,222=3.98; P=.047; d=0.26) and a significantly higher increase in self-esteem (PP: F1,220=8.79; P=.003; d=0.40) in the intervention group than in the wait-list control group. Most participants regularly used the self-help smartphone app (91/120, 75.8%, at least once a week). The more positive the attitude toward internet- and mobile-based interventions (r=0.260; P=.004) and the more positive the outcome expectation (r=0.236; P=.009), the more frequently the self-help smartphone app was used. Conclusions: The effectiveness of the self-help smartphone app MCT & More was demonstrated among students with depressive symptoms compared with a wait-list control group. The app could be offered regularly as a low-threshold intervention to enhance students’ health. Trial Registration: German Clinical Trials Register DRKS00020941; https://tinyurl.com/pr84w6er %M 34255711 %R 10.2196/26498 %U https://mhealth.jmir.org/2021/7/e26498 %U https://doi.org/10.2196/26498 %U http://www.ncbi.nlm.nih.gov/pubmed/34255711 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e13496 %T Effect of Adherence to Smartphone App Use on the Long-term Effectiveness of Weight Loss in Developing and OECD Countries: Retrospective Cohort Study %A Han,Myeunghee %A Rhee,Sang Youl %+ Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, 23 Kyungheedae-ro, Seoul, 02447, Korea, Seoul, Republic of Korea, 82 029610274, bard95@hanmail.net %K low-income countries %K Organization for Economic Co-operation and Development %K body weight %K mobile app self-management %K diet %K exercise %K mobile phone %D 2021 %7 12.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Globally, 71% of deaths occur due to noncommunicable diseases (NCDs). Poor diet quality and physical activity have a significant impact on NCDs. At present, behavior change interventions using smartphone apps have rapidly increased worldwide to prevent NCDs. However, most previous studies on the use and effectiveness of apps have been conducted in Organization for Economic Co-operation and Development (OECD) countries. As such, relevant research in low-income countries is scarce. Objective: This retrospective cohort study aims to investigate the characteristics of adherence to the use of the Noom app. We also aim to compare the effects of using the app on body weight changes over time according to adherence to the use of the app between users in low-income and OECD countries. In addition, the differences in weight loss are compared among users who use the free and paid versions of the app. Methods: A secondary data analysis was conducted using repeated measures. The data were collected from users in low-income countries (n=312) and OECD countries (n=8041) who used the app for 12 months. The app provided programs for the self-monitoring of physical activity, dietary intake, and body weight. Descriptive statistics, independent two-tailed t tests, chi-square tests, and linear mixed models were used for the analysis. Results: During the first 3 months of using the Noom app, users from OECD countries entered data into the app more frequently; however, users in low-income countries entered data more frequently from 3 months to 12 months. Users in OECD countries consumed significantly more calories than those in low-income countries for 12 months. The body weight of all users significantly decreased over time (−1.8 kg; P<.001); however, no statistically significant differences in the change in body weight for 12 months were observed between users from low-income and OECD countries (β=−.2; P=.19). The users who frequently monitored their lunch (β=−.1; P<.001), dinner (β=−.1; P<.001), body weight (β=−.1; P<.001), evening snack (β=−.1; P<.001), and exercise (β=−.03; P<.001) exhibited significant weight loss over time. We found no significant differences in the body weight changes between users who used the free and paid versions of the app (β=−.2; P=.19). Conclusions: This study found that using the app has a significant effect on weight loss regardless of users’ country of residence. The results of this study suggest that the frequency of monitoring health-related behaviors by entering data into the app plays a pivotal role in losing weight. In conclusion, regardless of where users live and what versions of the app they use, it is important to monitor health-related behaviors by frequently entering data into the app to efficiently lose weight. %M 34255708 %R 10.2196/13496 %U https://mhealth.jmir.org/2021/7/e13496 %U https://doi.org/10.2196/13496 %U http://www.ncbi.nlm.nih.gov/pubmed/34255708 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e26290 %T Exploring Associations Between Children’s Obesogenic Behaviors and the Local Environment Using Big Data: Development and Evaluation of the Obesity Prevention Dashboard %A Filos,Dimitris %A Lekka,Irini %A Kilintzis,Vasileios %A Stefanopoulos,Leandros %A Karavidopoulou,Youla %A Maramis,Christos %A Diou,Christos %A Sarafis,Ioannis %A Papapanagiotou,Vasileios %A Alagialoglou,Leonidas %A Ioakeimidis,Ioannis %A Hassapidou,Maria %A Charmandari,Evangelia %A Heimeier,Rachel %A O'Malley,Grace %A O’Donnell,Shane %A Doyle,Gerardine %A Delopoulos,Anastasios %A Maglaveras,Nicos %+ Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, Aristotle University, University Campus, Box 323, Thessaloniki, 54124, Greece, 30 2310999281, nicmag@auth.gr %K public health authorities %K childhood obesity %K children’s behavior %K environment %K COVID-19 %K big data %K mHealth %K uHealth %K intervention %D 2021 %7 9.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obesity is a major public health problem globally and in Europe. The prevalence of childhood obesity is also soaring. Several parameters of the living environment are contributing to this increase, such as the density of fast food retailers, and thus, preventive health policies against childhood obesity must focus on the environment to which children are exposed. Currently, there are no systems in place to objectively measure the effect of living environment parameters on obesogenic behaviors and obesity. The H2020 project “BigO: Big Data Against Childhood Obesity” aims to tackle childhood obesity by creating new sources of evidence based on big data. Objective: This paper introduces the Obesity Prevention dashboard (OPdashboard), implemented in the context of BigO, which offers an interactive data platform for the exploration of objective obesity-related behaviors and local environments based on the data recorded using the BigO mHealth (mobile health) app. Methods: The OPdashboard, which can be accessed on the web, allows for (1) the real-time monitoring of children’s obesogenic behaviors in a city area, (2) the extraction of associations between these behaviors and the local environment, and (3) the evaluation of interventions over time. More than 3700 children from 33 schools and 2 clinics in 5 European cities have been monitored using a custom-made mobile app created to extract behavioral patterns by capturing accelerometer and geolocation data. Online databases were assessed in order to obtain a description of the environment. The dashboard’s functionality was evaluated during a focus group discussion with public health experts. Results: The preliminary association outcomes in 2 European cities, namely Thessaloniki, Greece, and Stockholm, Sweden, indicated a correlation between children’s eating and physical activity behaviors and the availability of food-related places or sports facilities close to schools. In addition, the OPdashboard was used to assess changes to children’s physical activity levels as a result of the health policies implemented to decelerate the COVID-19 outbreak. The preliminary outcomes of the analysis revealed that in urban areas the decrease in physical activity was statistically significant, while a slight increase was observed in the suburbs. These findings indicate the importance of the availability of open spaces for behavioral change in children. Discussions with public health experts outlined the dashboard’s potential to aid in a better understanding of the interplay between children’s obesogenic behaviors and the environment, and improvements were suggested. Conclusions: Our analyses serve as an initial investigation using the OPdashboard. Additional factors must be incorporated in order to optimize its use and obtain a clearer understanding of the results. The unique big data that are available through the OPdashboard can lead to the implementation of models that are able to predict population behavior. The OPdashboard can be considered as a tool that will increase our understanding of the underlying factors in childhood obesity and inform the design of regional interventions both for prevention and treatment. %M 34048353 %R 10.2196/26290 %U https://mhealth.jmir.org/2021/7/e26290 %U https://doi.org/10.2196/26290 %U http://www.ncbi.nlm.nih.gov/pubmed/34048353 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e28677 %T User Perspectives on a Resilience-Building App (JoyPop): Qualitative Study %A Mushquash,Aislin R %A Pearson,Erin S %A Waddington,Kayla %A MacIsaac,Angela %A Mohammed,Shakira %A Grassia,Elizabeth %A Smith,Savanah %A Wekerle,Christine %+ Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON, , Canada, 1 807 343 8771, aislin.mushquash@lakeheadu.ca %K resilience %K smartphone %K app %K innovation %K qualitative %K perspective %K mHealth %K emotion %K mental health %D 2021 %7 8.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Resilience is the capability, resources, and processes that are available to a person or system to adapt successfully in the face of stress or adversity. Given that resilience can be enhanced, using advances in technology to deliver and evaluate the impact of resilience interventions is warranted. Evidence supports the effectiveness of the resilience-building JoyPop app in improving resilience-related outcomes after use; however, experiential data from users is also needed to provide a more comprehensive account of its utility. Objective: The aim of this study was to explore users’ experiences with the JoyPop app and their perspectives on its utility. Methods: This qualitative description study involved a combination of group and one-on-one semistructured interviews with a subset of first-year undergraduate students who participated in a larger evaluation of the JoyPop app. Participants used the app for a 4-week period and were subsequently asked about their frequency of app use, most and least used features (and associated reasons), most and least helpful features (and associated reasons), barriers to use, facilitators of use and continuation, and recommendations for improvement. Data were coded and categorized through inductive content analysis. Results: The sample of 30 participants included 24 females and 6 males, with a mean age of 18.77 years (SD 2.30). App use ranged from 1 to 5 times daily (mean 2.11, SD 0.74), with the majority indicating that they used the app at least twice daily. The Rate My Mood, Journal, and SquareMoves features were reported to be used most often, while the Rate My Mood, Journal, and Breathing Exercises features were identified as the most helpful. A number of themes and subthemes pertaining to facilitators of app use (prompts, creating routine, self-monitoring opportunities, expressive opportunities), barriers to app use (editing, lack of variety, student lifestyle), outcomes of app use (increased awareness, checking in with oneself, helpful distraction, emotional control), and recommendations for app improvement (adding more features, enhancing existing features, enhancing tracking abilities, providing personalization) were identified. Conclusions: This study provides insight into the aspects of the JoyPop app that motivated and benefitted users, as well as measures that can be taken to improve user experiences and promote longer-term uptake. Users were willing to engage with the app and incorporate it into their routine, and they valued the ability to self-monitor, express emotion, and engage in distraction. %M 34255696 %R 10.2196/28677 %U https://mhealth.jmir.org/2021/7/e28677 %U https://doi.org/10.2196/28677 %U http://www.ncbi.nlm.nih.gov/pubmed/34255696 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 3 %P e18130 %T MI-PACE Home-Based Cardiac Telerehabilitation Program for Heart Attack Survivors: Usability Study %A Ding,Eric Y %A Erskine,Nathaniel %A Stut,Wim %A McManus,David D %A Peterson,Amy %A Wang,Ziyue %A Escobar Valle,Jorge %A Albuquerque,Daniella %A Alonso,Alvaro %A Botkin,Naomi F %A Pack,Quinn R %A McManus,David D %+ Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, United States, 1 5088561984, eric.ding@umassmed.edu %K cardiac rehabilitation %K telerehabilitation %K health watch %K mHealth %K exercise %D 2021 %7 8.7.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Cardiac rehabilitation programs, consisting of exercise training and disease management interventions, reduce morbidity and mortality after acute myocardial infarction. Objective: In this pilot study, we aimed to developed and assess the feasibility of delivering a health watch–informed 12-week cardiac telerehabilitation program to acute myocardial infarction survivors who declined to participate in center-based cardiac rehabilitation. Methods: We enrolled patients hospitalized after acute myocardial infarction at an academic medical center who were eligible for but declined to participate in center-based cardiac rehabilitation. Each participant underwent a baseline exercise stress test. Participants received a health watch, which monitored heart rate and physical activity, and a tablet computer with an app that displayed progress toward accomplishing weekly walking and exercise goals. Results were transmitted to a cardiac rehabilitation nurse via a secure connection. For 12 weeks, participants exercised at home and also participated in weekly phone counseling sessions with the nurse, who provided personalized cardiac rehabilitation solutions and standard cardiac rehabilitation education. We assessed usability of the system, adherence to weekly exercise and walking goals, counseling session attendance, and disease-specific quality of life. Results: Of 18 participants (age: mean 59 years, SD 7) who completed the 12-week telerehabilitation program, 6 (33%) were women, and 6 (33%) had ST-elevation myocardial infarction. Participants wore the health watch for a median of 12.7 hours (IQR 11.1, 13.8) per day and completed a median of 86% of exercise goals. Participants, on average, walked 121 minutes per week (SD 175) and spent 189 minutes per week (SD 210) in their target exercise heart rate zone. Overall, participants found the system to be highly usable (System Usability Scale score: median 83, IQR 65, 100). Conclusions: This pilot study established the feasibility of delivering cardiac telerehabilitation at home to acute myocardial infarction survivors via a health watch–based program and telephone counseling sessions. Usability and adherence to health watch use, exercise recommendations, and counseling sessions were high. Further studies are warranted to compare patient outcomes and health care resource utilization between center-based rehabilitation and telerehabilitation. %M 34255660 %R 10.2196/18130 %U https://humanfactors.jmir.org/2021/3/e18130 %U https://doi.org/10.2196/18130 %U http://www.ncbi.nlm.nih.gov/pubmed/34255660 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 7 %P e26873 %T Usability and Acceptability of Two Smartphone Apps for Smoking Cessation Among Young Adults With Serious Mental Illness: Mixed Methods Study %A Gowarty,Minda A %A Longacre,Meghan R %A Vilardaga,Roger %A Kung,Nathan J %A Gaughan-Maher,Ashley E %A Brunette,Mary F %+ Departments of Internal Medicine and Community and Family Medicine, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, United States, 1 6036536868, minda.a.gowarty@hitchcock.org %K smoking cessation %K mHealth %K serious mental illness %K smartphone application %K digital health %K psychiatric illness %K tobacco treatment %K mobile phone %D 2021 %7 7.7.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Young adults with serious mental illness (SMI) have higher smoking rates and lower cessation rates than young adults without SMI. Scalable interventions such as smartphone apps with evidence-based content (eg, the National Cancer Institute’s [NCI’s] QuitGuide and quitSTART) could increase access to potentially appealing and effective treatment for this group but have yet to be tested in this population. Objective: The goal of this user-centered design study is to determine the user experience (including usability and acceptability) of 2 widely available apps developed by the NCI—QuitGuide and quitSTART—among young adult tobacco users with SMI. Methods: We conducted usability and acceptability testing of QuitGuide and quitSTART among participants with SMI aged between 18 and 35 years who were stable in community mental health treatment between 2019 and 2020. Participants were randomly assigned to use QuitGuide or quitSTART on their smartphones. App usability was evaluated at baseline and following a 2-week field test of independent use via a video-recorded task completion protocol. Using a mixed method approach, we triangulated 4 data sources: nonparticipant observation, open-ended interviews, structured interviews (including the System Usability Scale [SUS]), and backend app use data obtained from the NCI. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using thematic analysis. Results: Participants were 17 smokers who were not interested in quitting, with a mean age of 29 (SD 4) years; 41% (n=7) presented with psychotic disorders. Participants smoked an average of 15 (SD 7) cigarettes per day. The mean SUS scores for QuitGuide were similar at visits one and two (mean 64, SD 18 and mean 66, SD 18, respectively). The mean SUS scores for quitSTART numerically increased from visit one (mean 55, SD 20) to visit two (mean 64, SD 16). Acceptability scores followed the same pattern. Observed task completion rates were at least 75% (7/9 for QuitGuide, 6/8 for quitSTART) for both apps at both visits for all but 2 tasks. During the 13-day trial period, QuitGuide and quitSTART users interacted with their assigned app on an average of 4.6 (SD 2.8) days versus 10.8 (SD 3.5) days, for a mean total of 5.6 (SD 3.8) interactions versus 41 (SD 26) interactions, and responded to a median of 1 notification (range 0-8) versus 18.5 notifications (range 0-37), respectively. Qualitative comments indicated moderate to high satisfaction overall but also included concerns about the accuracy of the apps’ feedback. Conclusions: Both QuitGuide and quitSTART had acceptable levels of usability and mixed levels of acceptability among young adults with SMI. The higher level of engagement with quitSTART suggests that quitSTART may be a favorable tool for young adult smokers with SMI. However, clinical support or coaching may be needed to overcome initial usability issues. %M 34255699 %R 10.2196/26873 %U https://mental.jmir.org/2021/7/e26873 %U https://doi.org/10.2196/26873 %U http://www.ncbi.nlm.nih.gov/pubmed/34255699 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e26485 %T Digital Technology Use and BMI: Evidence From a Cross-sectional Analysis of an Adolescent Cohort Study %A Shen,Chen %A Dumontheil,Iroise %A Thomas,Michael %A Röösli,Martin %A Elliott,Paul %A Toledano,Mireille %+ MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, Norfolk Place, London, London, W2 1PG, United Kingdom, 44 02075943298, m.toledano@imperial.ac.uk %K adolescent %K digital technology %K obesity %K insufficient sleep %K mediation analysis %K mobile phone %D 2021 %7 5.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of digital technology such as mobile phones is ubiquitous in adolescents. However, excessive use may have adverse health effects, possibly partially mediated by disruptions to sleep. Objective: This study aims to assess the social predictors of digital technology use and their cross-sectional association with BMI z scores and being overweight in a large sample of adolescents. Methods: We used baseline data from a subset of a large adolescent cohort from 39 schools across Greater London who participated in the Study of Cognition, Adolescents and Mobile Phones (n=1473). Digital technology use included phone calls, internet use on mobile phones, and video gaming on any device. Multilevel regression was used to assess the associations between digital technology use and age-specific and sex-specific BMI z scores and being overweight (including obesity). Measurements were derived from height and weight, obtained by the Tanita BC-418 Body Composition Analyzer. We examined whether these associations were mediated by insufficient sleep. Results: Generally, participants with lower socioeconomic status reported more use of digital technology. Controlling for socioeconomic status, internet use on mobile phones for more than 3 hours per day was associated with higher BMI z scores (adjusted β=.30, 95% CI 0.11-0.48) and greater odds of being overweight (adjusted odds ratio 1.60, 95% CI 1.09-2.34), compared with low use (≤30 minutes). Similar associations were found between video gaming and BMI z scores and being overweight. The BMI z score was more strongly related to weekday digital technology use (internet use on mobile phones and video gaming) than weekend use. Insufficient sleep partly mediated the associations between digital technology use and BMI z scores (proportion of mediation from 8.6% to 17.8%) by an indirect effect. Conclusions: We found an association between digital technology use and BMI in adolescents, partly mediated by insufficient sleep, suggesting that the underlying mechanisms may be multifactorial. Further research with longitudinal data is essential to explore the direction of the relationships. %M 35143408 %R 10.2196/26485 %U https://www.jmir.org/2021/7/e26485 %U https://doi.org/10.2196/26485 %U http://www.ncbi.nlm.nih.gov/pubmed/35143408 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e25850 %T Studying Microtemporal, Within-Person Processes of Diet, Physical Activity, and Related Factors Using the APPetite-Mobile-App: Feasibility, Usability, and Validation Study %A Ruf,Alea %A Koch,Elena Doris %A Ebner-Priemer,Ulrich %A Knopf,Monika %A Reif,Andreas %A Matura,Silke %+ Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Heinrich-Hoffmann-Straße 10, Frankfurt, 60528, Germany, 49 69 6301 83348, alea.ruf@kgu.de %K diet %K physical activity %K microtemporal processes %K within-person factors %K ecological momentary assessment %K smartphone-app %K mobile phone %K mHealth %K dietary assessment %K feasibility %K usability %K validity %D 2021 %7 5.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Diet and physical activity (PA) have a major impact on physical and mental health. However, there is a lack of effective strategies for sustaining these health-protective behaviors. A shift to a microtemporal, within-person approach is needed to capture dynamic processes underlying eating behavior and PA, as they change rapidly across minutes or hours and differ among individuals. However, a tool that captures these microtemporal, within-person processes in daily life is currently not present. Objective: The APPetite-mobile-app is developed for the ecological momentary assessment of microtemporal, within-person processes of complex dietary intake, objectively recorded PA, and related factors. This study aims to evaluate the feasibility and usability of the APPetite-mobile-app and the validity of the incorporated APPetite-food record. Methods: The APPetite-mobile-app captures dietary intake event-contingently through a food record, captures PA continuously through accelerometers, and captures related factors (eg, stress) signal-contingently through 8 prompts per day. Empirical data on feasibility (n=157), usability (n=84), and validity (n=44) were collected within the Eat2beNICE-APPetite-study. Feasibility and usability were examined in healthy participants and psychiatric patients. The relative validity of the APPetite-food record was assessed with a subgroup of healthy participants by using a counterbalanced crossover design. The reference method was a 24-hour recall. In addition, the energy intake was compared with the total energy expenditure estimated from accelerometry. Results: Good feasibility, with compliance rates above 80% for prompts and the accelerometer, as well as reasonable average response and recording durations (prompt: 2.04 min; food record per day: 17.66 min) and latencies (prompts: 3.16 min; food record: 58.35 min) were found. Usability was rated as moderate, with a score of 61.9 of 100 on the System Usability Scale. The evaluation of validity identified large differences in energy and macronutrient intake between the two methods at the group and individual levels. The APPetite-food record captured higher dietary intakes, indicating a lower level of underreporting, compared with the 24-hour recall. Energy intake was assessed fairly accurately by the APPetite-food record at the group level on 2 of 3 days when compared with total energy expenditure. The comparison with mean total energy expenditure (2417.8 kcal, SD 410) showed that the 24-hour recall (1909.2 kcal, SD 478.8) underestimated habitual energy intake to a larger degree than the APPetite-food record (2146.4 kcal, SD 574.5). Conclusions: The APPetite-mobile-app is a promising tool for capturing microtemporal, within-person processes of diet, PA, and related factors in real time or near real time and is, to the best of our knowledge, the first of its kind. First evidence supports the good feasibility and moderate usability of the APPetite-mobile-app and the validity of the APPetite-food record. Future findings in this context will build the foundation for the development of personalized lifestyle modification interventions, such as just-in-time adaptive interventions. %M 34342268 %R 10.2196/25850 %U https://www.jmir.org/2021/7/e25850 %U https://doi.org/10.2196/25850 %U http://www.ncbi.nlm.nih.gov/pubmed/34342268 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 3 %P e28282 %T The Influence of Gamification and Information Technology Identity on Postadoption Behaviors of Health and Fitness App Users: Empirical Study in the United States %A Esmaeilzadeh,Pouyan %+ Department of Information Systems and Business Analytics, College of Business, Florida International University, Modesto A Maidique Campus 11200 SW 8th St, RB 261 B, Miami, FL, 33199, United States, 1 3053483302, pesmaeil@fiu.edu %K gamification %K health and fitness apps %K IT identity %K continued intention to use %K information-sharing tendency %K mHealth %K app design %K user interaction %D 2021 %7 5.7.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: The use of health and fitness apps has been on the rise to monitor personal fitness and health parameters. However, recent research discovered that many users discontinue using these apps after only a few months. Gamification has been suggested as a technique to increase users’ interactions with apps. Nevertheless, it is still not clear how gamification mechanisms encourage continued use and inspire user self-management. Objective: The main objective of this study was to articulate how gamification mechanisms in studies of designing and using health and fitness apps can contribute to the realization of information technology (IT) identity and positive behavioral outcomes. The broader goal was to shed light on how gamification mechanisms will translate into positive use behaviors in the context of mobile health apps. Methods: Data were collected from 364 users of health and fitness apps through an online survey to empirically examine the proposed model. Results: Based on identity theories, this study suggests the fully mediating role of IT identity to describe how gamification elements can lead to continued intention to use health and fitness apps, and increase users’ tendency for information sharing through the apps. The findings indicate that perceived gamification can increase users’ IT identity. In turn, a higher IT identity would encourage users to continue using the apps and share more personal health information with others through the apps. Conclusions: The results of this study can have practical implications for app designers to use gamification elements to increase users’ dependency, relatedness, and emotional energy associated with health apps. Moreover, the findings can have theoretical contributions for researchers to help better articulate the process in which gamification can be translated into positive use behaviors. %M 34812736 %R 10.2196/28282 %U https://games.jmir.org/2021/3/e28282/ %U https://doi.org/10.2196/28282 %U http://www.ncbi.nlm.nih.gov/pubmed/34812736 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e27774 %T Time to Change for Mental Health and Well-being via Virtual Professional Coaching: Longitudinal Observational Study %A Jeannotte,Alexis M %A Hutchinson,Derek M %A Kellerman,Gabriella R %+ BetterUp, Inc, 1200 Folsom Street, San Francisco, CA, 94103, United States, 1 7034022166, ajeannotte28@gmail.com %K professional coaching %K virtual coaching %K mental health %K psychological well-being %K stress %K resilience %K life satisfaction %K longitudinal %K intervention %K well-being %K satisfaction %K coach %K observational %D 2021 %7 5.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Optimal mental health yields many benefits and reduced costs to employees and organizations; however, the workplace introduces challenges to building and maintaining mental health that affect well-being. Although many organizations have introduced programming to aid employee mental health and well-being, the uptake and effectiveness of these efforts vary. One barrier to developing more effective interventions is a lack of understanding about how to improve well-being over time. This study examined not only whether employer-provided coaching is an effective strategy to improve mental health and well-being in employees but also how this intervention changes well-being in stages over time. Objective: The goal of this study was to determine whether BetterUp, a longitudinal one-on-one virtual coaching intervention, improves components of mental health and psychological well-being, and whether the magnitude of changes vary in stages over time. This is the first research study to evaluate the effectiveness of professional coaching through three repeated assessments, moving beyond a pre-post intervention design. The outcomes of this study will enable coaches and employers to design more targeted interventions by outlining when to expect maximal growth in specific outcomes throughout the coaching engagement. Methods: Three identical assessments were completed by 391 users of BetterUp: prior to the start of coaching, after approximately 3-4 months of coaching, and again after 6-7 months of coaching. Three scales were used to evaluate psychological and behavioral dimensions that support management of mental health: stress management, resilience, and life satisfaction. Six additional scales were used to assess psychological well-being: emotional regulation, prospection ability, finding purpose and meaning, self-awareness, self-efficacy, and social connection. Results: Using mixed-effects modeling, varying rates of change were observed in several dimensions of mental health and psychological well-being. Initial rapid improvements in the first half of the intervention, followed by slower growth in the second half of the intervention were found for prospection ability, self-awareness, self-efficacy, social connection, emotional regulation, and a reduction in stress (range of unstandardized β values for each assessment: .10-.19). Life satisfaction improved continuously throughout the full intervention period (β=.13). Finding purpose in meaning at work and building resilience both grew continuously throughout the coaching intervention, but larger gains were experienced in the second half of the intervention (β=.08-.18), requiring the full length of the intervention to realize maximal growth. Conclusions: The results demonstrate the effectiveness of BetterUp virtual one-on-one coaching to improve psychological well-being, while mitigating threats to mental health such as excessive and prolonged stress, low resilience, and poor satisfaction with life. The improvements across the collection of outcomes were time-dependent, and provide important insights to users and practitioners about how and when to expect maximal improvements in a range of interrelated personal and professional outcomes. %M 33993102 %R 10.2196/27774 %U https://www.jmir.org/2021/7/e27774 %U https://doi.org/10.2196/27774 %U http://www.ncbi.nlm.nih.gov/pubmed/33993102 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 3 %P e25327 %T Decreasing COVID-19 Risk Factors for Older Adults by Using Digital Technology to Implement a Plant-Based-Diet: An Opinion %A Benavides,Heidi Lynn %A Meireles,Christiane Lumachi %A Benavente,Viola %A Mays,Mary Helen %A Wang,Jing %+ School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, United States, 1 2103232289, benavidesh@uthscsa.edu %K COVID-19 %K coronavirus %K older adult %K plant-based diet %K eating patterns %K whole foods %K Mediterranean diet %K obesity %K pandemic %K ethnic minorities %K telehealth %K digital technology %K racial disparities %K aging %D 2021 %7 5.7.2021 %9 Viewpoint %J JMIR Aging %G English %X A disproportionate number of COVID-19 cases affect older, minority populations. Obese older adults are at higher risk of developing severe COVID-19 complications and lower survival rates, and minority older adults often experience higher rates of obesity. A plant-based diet intervention may improve COVID-19-related modifiable risk factors for obesity. Encouraging the consumption of plant-based diets comprising vegetables, fruits, whole grains, legumes, seeds, and nuts by utilizing community outreach strategies and digital technology can contribute to improving COVID-19 risk factors among this population. %M 34081595 %R 10.2196/25327 %U https://aging.jmir.org/2021/3/e25327 %U https://doi.org/10.2196/25327 %U http://www.ncbi.nlm.nih.gov/pubmed/34081595 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e24915 %T Examining the Impact of an mHealth Behavior Change Intervention With a Brief In-Person Component for Cancer Survivors With Overweight or Obesity: Randomized Controlled Trial %A Walsh,Jane C %A Richmond,Janice %A Mc Sharry,Jenny %A Groarke,AnnMarie %A Glynn,Liam %A Kelly,Mary Grace %A Harney,Owen %A Groarke,Jenny M %+ Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, David Keir Building, Belfast, BT7 1NN, United Kingdom, 44 02890974886, j.groarke@qub.ac.uk %K cancer survivors %K overweight %K obesity %K health behavior %K goals %K accelerometry %K text messaging %K technology %K Ireland %K self-management %K mobile phone %D 2021 %7 5.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cancer survivorship in Ireland is increasing in both frequency and longevity. However, a significant proportion of cancer survivors do not reach the recommended physical activity levels and have overweight. This has implications for both physical and psychological health, including an increased risk of subsequent and secondary cancers. Mobile health (mHealth) interventions demonstrate potential for positive health behavior change, but there is little evidence for the efficacy of mobile technology in improving health outcomes in cancer survivors with overweight or obesity. Objective: This study aims to investigate whether a personalized mHealth behavior change intervention improves physical and psychological health outcomes in cancer survivors with overweight or obesity. Methods: A sample of 123 cancer survivors (BMI≥25 kg/m2) was randomly assigned to the standard care control (n=61) or intervention (n=62) condition. Group allocation was unblinded. The intervention group attended a 4-hour tailored lifestyle education and information session with physiotherapists, a dietician, and a clinical psychologist to support self-management of health behavior. Over the following 12 weeks, participants engaged in personalized goal setting to incrementally increase physical activity (with feedback and review of goals through SMS text messaging contact with the research team). Direct measures of physical activity were collected using a Fitbit accelerometer. Data on anthropometric, functional exercise capacity, dietary behavior, and psychological measures were collected at face-to-face assessments in a single hospital site at baseline (T0), 12 weeks (T1; intervention end), and 24 weeks (T2; follow-up). Results: The rate of attrition was 21% (13/61) for the control condition and 14% (9/62) for the intervention condition. Using intent-to-treat analysis, significant reductions in BMI (F2,242=4.149; P=.02; ηp2=0.033) and waist circumference (F2,242=3.342; P=.04; ηp2=0.027) were observed in the intervention group. Over the 24-week study, BMI was reduced by 0.52 in the intervention condition, relative to a nonsignificant reduction of 0.11 in the control arm. Waist circumference was reduced by 3.02 cm in the intervention condition relative to 1.82 cm in the control condition. Physical activity level was significantly higher in the intervention group on 8 of the 12 weeks of the intervention phase and on 5 of the 12 weeks of the follow-up period, accounting for up to 2500 additional steps per day (mean 2032, SD 270). Conclusions: The results demonstrate that for cancer survivors with a BMI≥25 kg/m2, lifestyle education and personalized goal setting using mobile technology can yield significant changes in clinically relevant health indicators. Further research is needed to elucidate the mechanisms of behavior change and explore the capacity for mHealth interventions to improve broader health and well-being outcomes in the growing population of cancer survivors. Trial Registration: ISRCTN Registry ISRCTN18676721; https://www.isrctn.com/ISRCTN18676721 International Registered Report Identifier (IRRID): RR2-10.2196/13214 %M 36260394 %R 10.2196/24915 %U https://mhealth.jmir.org/2021/7/e24915 %U https://doi.org/10.2196/24915 %U http://www.ncbi.nlm.nih.gov/pubmed/36260394 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e28175 %T Supportive Accountability and Mobile App Use in a Tobacco Control Intervention Targeting Low-Income Minority Mothers Who Smoke: Observational Study %A Lepore,Stephen J %A Collins,Bradley N %A Killam,Howard W %A Barry,Barbara %+ Department of Social and Behavioral Sciences, Temple University, 975 Ritter Annex, 1301 Cecil B Moore Ave, Philadelphia, PA, 19122, United States, 1 215 204 9422, slepore@temple.edu %K tobacco cessation %K smoking %K mHealth %K mobile apps %K smartphone %K mobile phone %K adherence %K engagement %K minority health %D 2021 %7 2.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone mobile apps are frequently used in standalone or multimodal smoking cessation interventions. However, factors that impede or improve app usage are poorly understood. Objective: This study used the supportive accountability model to investigate factors that influence app usage in the context of a trial designed to reduce maternal smoking in low-income and predominantly minority communities. Methods: We conducted a secondary analysis of data (N=181) from a randomized controlled trial that included a smoking cessation app (QuitPal-m). Supportive accountability was measured by the number of times a participant was advised by their cessation counselor to use QuitPal-m. Participants reported app use helpfulness and barriers. Investigators tracked reported phone and technical problems that impeded app use. Results: Most participants rated the app as very helpful (103/155, 66.5%), but daily use declined rapidly over time. App use was positively related to the level of perceived app helpfulness (P=.02) and education (P=.002) and inversely related to perceived barriers (P=.003), phone technical problems (P<.001), and cigarettes smoked per day at the end of treatment (P<.001). Participants used the app a greater proportion of the days following app advice than those preceding app advice (0.45 versus 0.34; P<.001). The positive relation between counselor app advice and app usage 24 hours after receiving advice was stronger among smokers with no plan to quit than in those planning to quit (P=.03), independent of education and phone or app problems. Conclusions: Findings show the utility of supportive accountability for increasing smoking cessation app use in a predominantly low-income, minority population, particularly if quit motivation is low. Results also highlight the importance of addressing personal and phone/technical barriers in addition to adding supportive accountability. Trial Registration: ClinicalTrials.gov NCT02602288; https://clinicaltrials.gov/ct2/show/NCT02602288 %M 34255698 %R 10.2196/28175 %U https://mhealth.jmir.org/2021/7/e28175 %U https://doi.org/10.2196/28175 %U http://www.ncbi.nlm.nih.gov/pubmed/34255698 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e25808 %T Effects of Mobile App–Based Intervention for Depression in Middle-Aged and Older Adults: Mixed Methods Feasibility Study %A Gould,Christine E %A Carlson,Chalise %A Ma,Flora %A Forman-Hoffman,Valerie %A Ranta,Kristian %A Kuhn,Eric %+ Geriatric Research, Education, and Clinical Center, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA, 94304, United States, 1 6504935000 ext 68899, cegould@stanford.edu %K aging %K depression %K digital health %K digital therapeutics %K mHealth %K mobile phone %D 2021 %7 29.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health interventions may help middle-aged and older adults with depression overcome barriers to accessing traditional care, but few studies have investigated their use in this population. Objective: This pilot study examines the feasibility, acceptability, and potential efficacy of the Meru Health Program, an 8-week mobile app–delivered intervention. Methods: A total of 20 community-dwelling middle-aged and older adults (age: mean 61.7 years, SD 11.3) with elevated depressive symptoms participated in a single-arm pilot study investigating the Meru Health Program, an app-delivered intervention supported by remote therapists. The program primarily uses mindfulness and cognitive behavioral skills to target depressive symptoms. A semistructured interview was completed at the baseline to establish current psychiatric diagnoses. Depressive symptoms were measured using the Patient Health Questionnaire and Patient-Reported Outcomes Measurement Information System (PROMIS) depression measures. Anxiety symptoms were measured using the Generalized Anxiety Disorder Scale and the PROMIS Anxiety measure. User experience and acceptability were examined through surveys and qualitative interviews. Results: In total, 90% (18/20) of the participants completed the program, with 75% (15/20) completing at least 7 of the 8 introductory weekly lessons. On average, participants completed 60 minutes of practice and exchanged 5 messages with their therapists every week. The app was rated as helpful by 89% (17/19) participants. Significant decreases in depressive (P=.03) and anxiety symptom measures (P=.01) were found; 45% (9/20) of participants showed clinically significant improvement in either depressive symptoms or anxiety symptoms. Conclusions: The findings suggest that the commercially available Meru Health Program may be feasible, acceptable, and potentially beneficial to middle-aged and older adults. Although larger controlled trials are needed to demonstrate efficacy, these findings suggest that digital health interventions may benefit adults of all ages. %M 34185000 %R 10.2196/25808 %U https://formative.jmir.org/2021/6/e25808 %U https://doi.org/10.2196/25808 %U http://www.ncbi.nlm.nih.gov/pubmed/34185000 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e29561 %T Monitoring Beliefs and Physiological Measures Using Wearable Sensors and Smartphone Technology Among Students at Risk of COVID-19: Protocol for a mHealth Study %A Cislo,Christine %A Clingan,Caroline %A Gilley,Kristen %A Rozwadowski,Michelle %A Gainsburg,Izzy %A Bradley,Christina %A Barabas,Jenny %A Sandford,Erin %A Olesnavich,Mary %A Tyler,Jonathan %A Mayer,Caleb %A DeMoss,Matthew %A Flora,Christopher %A Forger,Daniel B %A Cunningham,Julia Lee %A Tewari,Muneesh %A Choi,Sung Won %+ Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan, 1500 E Medical Center Dr, D4118 Medical Professional Building, Ann Arbor, MI, 48109, United States, 1 7342165349, sungchoi@med.umich.edu %K college students %K COVID-19 %K global pandemic %K mental health %K mHealth %K pandemic %K risk monitoring %K wearable sensors %K well-being %D 2021 %7 24.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has significantly impacted lives and greatly affected the mental health and public safety of an already vulnerable population—college students. Social distancing and isolation measures have presented challenges to students’ mental health. mHealth apps and wearable sensors may help monitor students at risk of COVID-19 and support their mental well-being. Objective: This study aimed to monitor students at risk of COVID-19 by using a wearable sensor and a smartphone-based survey. Methods: We conducted a prospective study on undergraduate and graduate students at a public university in the Midwest United States. Students were instructed to download the Fitbit, Social Rhythms, and Roadmap 2.0 apps onto their personal smartphone devices (Android or iOS). Subjects consented to provide up to 10 saliva samples during the study period. Surveys were administered through the Roadmap 2.0 app at five timepoints: at baseline, 1 month later, 2 months later, 3 months later, and at study completion. The surveys gathered information regarding demographics, COVID-19 diagnoses and symptoms, and mental health resilience, with the aim of documenting the impact of COVID-19 on the college student population. Results: This study enrolled 2158 college students between September 2020 and January 2021. Subjects are currently being followed-up for 1 academic year. Data collection and analysis are currently underway. Conclusions: This study examined student health and well-being during the COVID-19 pandemic and assessed the feasibility of using a wearable sensor and a survey in a college student population, which may inform the role of our mHealth tools in assessing student health and well-being. Finally, using data derived from a wearable sensor, biospecimen collection, and self-reported COVID-19 diagnosis, our results may provide key data toward the development of a model for the early prediction and detection of COVID-19. Trial Registration: ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788 International Registered Report Identifier (IRRID): DERR1-10.2196/29561 %R 10.2196/29561 %U https://www.researchprotocols.org/2021/6/e29561/ %U https://doi.org/10.2196/29561 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27218 %T Machine Learning Analysis to Identify Digital Behavioral Phenotypes for Engagement and Health Outcome Efficacy of an mHealth Intervention for Obesity: Randomized Controlled Trial %A Kim,Meelim %A Yang,Jaeyeong %A Ahn,Woo-Young %A Choi,Hyung Jin %+ Department of Biomedical Sciences, Seoul National University College of Medicine, 28 Yungun-Dong, Chongno-Gu, Seoul, Republic of Korea, 82 27408204, hjchoi@snu.ac.kr %K digital phenotype %K clinical efficacy %K in-app engagement %K machine learning analysis %K mobile phone %D 2021 %7 24.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The digital health care community has been urged to enhance engagement and clinical outcomes by analyzing multidimensional digital phenotypes. Objective: This study aims to use a machine learning approach to investigate the performance of multivariate phenotypes in predicting the engagement rate and health outcomes of digital cognitive behavioral therapy. Methods: We leveraged both conventional phenotypes assessed by validated psychological questionnaires and multidimensional digital phenotypes within time-series data from a mobile app of 45 participants undergoing digital cognitive behavioral therapy for 8 weeks. We conducted a machine learning analysis to discriminate the important characteristics. Results: A higher engagement rate was associated with higher weight loss at 8 weeks (r=−0.59; P<.001) and 24 weeks (r=−0.52; P=.001). Applying the machine learning approach, lower self-esteem on the conventional phenotype and higher in-app motivational measures on digital phenotypes commonly accounted for both engagement and health outcomes. In addition, 16 types of digital phenotypes (ie, lower intake of high-calorie food and evening snacks and higher interaction frequency with mentors) predicted engagement rates (mean R2 0.416, SD 0.006). The prediction of short-term weight change (mean R2 0.382, SD 0.015) was associated with 13 different digital phenotypes (ie, lower intake of high-calorie food and carbohydrate and higher intake of low-calorie food). Finally, 8 measures of digital phenotypes (ie, lower intake of carbohydrate and evening snacks and higher motivation) were associated with a long-term weight change (mean R2 0.590, SD 0.011). Conclusions: Our findings successfully demonstrated how multiple psychological constructs, such as emotional, cognitive, behavioral, and motivational phenotypes, elucidate the mechanisms and clinical efficacy of a digital intervention using the machine learning method. Accordingly, our study designed an interpretable digital phenotype model, including multiple aspects of motivation before and during the intervention, predicting both engagement and clinical efficacy. This line of research may shed light on the development of advanced prevention and personalized digital therapeutics. Trial Registration: ClinicalTrials.gov NCT03465306; https://clinicaltrials.gov/ct2/show/NCT03465306 %M 34184991 %R 10.2196/27218 %U https://www.jmir.org/2021/6/e27218/ %U https://doi.org/10.2196/27218 %U http://www.ncbi.nlm.nih.gov/pubmed/34184991 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e25482 %T Semantic Linkages of Obsessions From an International Obsessive-Compulsive Disorder Mobile App Data Set: Big Data Analytics Study %A Feusner,Jamie D %A Mohideen,Reza %A Smith,Stephen %A Patanam,Ilyas %A Vaitla,Anil %A Lam,Christopher %A Massi,Michelle %A Leow,Alex %+ Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 300 UCLA Medical Plaza, Suite 2200, Los Angeles, CA, 90095, United States, 1 3102064951, jfeusner@mednet.ucla.edu %K OCD %K natural language processing %K clinical subtypes %K semantic %K word embedding %K clustering %D 2021 %7 21.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Obsessive-compulsive disorder (OCD) is characterized by recurrent intrusive thoughts, urges, or images (obsessions) and repetitive physical or mental behaviors (compulsions). Previous factor analytic and clustering studies suggest the presence of three or four subtypes of OCD symptoms. However, these studies have relied on predefined symptom checklists, which are limited in breadth and may be biased toward researchers’ previous conceptualizations of OCD. Objective: In this study, we examine a large data set of freely reported obsession symptoms obtained from an OCD mobile app as an alternative to uncovering potential OCD subtypes. From this, we examine data-driven clusters of obsessions based on their latent semantic relationships in the English language using word embeddings. Methods: We extracted free-text entry words describing obsessions in a large sample of users of a mobile app, NOCD. Semantic vector space modeling was applied using the Global Vectors for Word Representation algorithm. A domain-specific extension, Mittens, was also applied to enhance the corpus with OCD-specific words. The resulting representations provided linear substructures of the word vector in a 100-dimensional space. We applied principal component analysis to the 100-dimensional vector representation of the most frequent words, followed by k-means clustering to obtain clusters of related words. Results: We obtained 7001 unique words representing obsessions from 25,369 individuals. Heuristics for determining the optimal number of clusters pointed to a three-cluster solution for grouping subtypes of OCD. The first had themes relating to relationship and just-right; the second had themes relating to doubt and checking; and the third had themes relating to contamination, somatic, physical harm, and sexual harm. All three clusters showed close semantic relationships with each other in the central area of convergence, with themes relating to harm. An equal-sized split-sample analysis across individuals and a split-sample analysis over time both showed overall stable cluster solutions. Words in the third cluster were the most frequently occurring words, followed by words in the first cluster. Conclusions: The clustering of naturally acquired obsessional words resulted in three major groupings of semantic themes, which partially overlapped with predefined checklists from previous studies. Furthermore, the closeness of the overall embedded relationships across clusters and their central convergence on harm suggests that, at least at the level of self-reported obsessional thoughts, most obsessions have close semantic relationships. Harm to self or others may be an underlying organizing theme across many obsessions. Notably, relationship-themed words, not previously included in factor-analytic studies, clustered with just-right words. These novel insights have potential implications for understanding how an apparent multitude of obsessional symptoms are connected by underlying themes. This observation could aid exposure-based treatment approaches and could be used as a conceptual framework for future research. %M 33892466 %R 10.2196/25482 %U https://www.jmir.org/2021/6/e25482 %U https://doi.org/10.2196/25482 %U http://www.ncbi.nlm.nih.gov/pubmed/33892466 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e24659 %T Professionals’ and Students’ Perceived Needs for an Online Supportive Application for Reducing School Absence and Stimulating Reintegration: Concept Mapping Study %A Hoogsteder,Mariette H H %A Douma,Linda N %A Eskens,Charlotte G A %A Berendsen,Renske L %A Vanneste,Yvonne T M %A Schaafsma,Frederieke G %+ Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (UMC), Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, Netherlands, 31 20 4445965, m.hoogsteder@amsterdamumc.nl %K medical absenteeism %K secondary education %K eHealth %K mHealth %K mobile health %K students %K schools, health occupations %K youth health physicians %K concept mapping %D 2021 %7 21.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: To limit students’ medical absenteeism and premature school dropout in the Netherlands, the Medical Advice for Sick-reported Students (MASS) intervention was developed to enhance collaboration between students, parents, school, and health care professionals. MASS reduces medical absenteeism. However, it does not yet optimally support professionals in monitoring students nor automatically stimulating students’ autonomy regarding their situation. Objective: This study aimed to identify professionals’ and students’ perceived need for an online supportive application to monitor and reduce absenteeism and stimulate student autonomy and school reintegration. Methods: Concept mapping sessions were held with professionals (n=23) and secondary school students (n=27) in group meetings or online to identify their perspectives and needs. Multidimensional scaling and hierarchical clustering were done with Ariadne 3.0 software. The resulting concept maps were reclustered and interpreted by 4 researchers. Results: Three heterogeneous groups of professionals generated 17 clusters (135 unique statements), with a mean importance rating ranging from 2.9 to 4.6 on a Likert scale with scores ranging from 1 to 5. Three heterogeneous groups of secondary school students generated 18 clusters (95 unique statements), with a mean importance rating ranging from 3.2 to 4.6. Professionals considered as most important the following: easily accessible contact with students; supporting, motivating, and rewarding students; monitoring absent students; providing information to students and their parents; exchanging information between professionals. Students considered as most important the following: better teacher-student communication and respect; communication between school professionals on the one hand and parents, other professionals, and students on the other hand; guidance in missed learning materials and tests. Students perceived an online format for support as the obvious option. Conclusions: Both professionals and students were positive about an online application to support students in dealing with medical absenteeism, especially considering the need for better and easily accessible contact between students and professionals. An eHealth or mobile health (mHealth) application addressing these aspects could stimulate student autonomy and have positive effects on medical absenteeism. %M 34152275 %R 10.2196/24659 %U https://formative.jmir.org/2021/6/e24659 %U https://doi.org/10.2196/24659 %U http://www.ncbi.nlm.nih.gov/pubmed/34152275 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e22151 %T The Association Between Logging Steps Using a Website, App, or Fitbit and Engaging With the 10,000 Steps Physical Activity Program: Observational Study %A Rayward,Anna T %A Vandelanotte,Corneel %A Van Itallie,Anetta %A Duncan,Mitch J %+ School of Health, Medical and Applied Sciences, Central Queensland University, Bruce Highway, Rockhampton, 4700, Australia, 61 240553239, anna.rayward@newcastle.edu.au %K physical activity intervention %K activity trackers %K engagement %K Fitbit %K pedometer %K eHealth %K mobile phone %D 2021 %7 18.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Engagement is positively associated with the effectiveness of digital health interventions. It is unclear whether tracking devices that automatically synchronize data (eg, Fitbit) produce different engagement levels compared with manually entering data. Objective: This study examines how different step logging methods in the freely available 10,000 Steps physical activity program differ according to age and gender and are associated with program engagement. Methods: A subsample of users (n=22,142) of the free 10,000 Steps physical activity program were classified into one of the following user groups based on the step-logging method: Website Only (14,617/22,142, 66.01%), App Only (2100/22,142, 9.48%), Fitbit Only (1705/22,142, 7.7%), Web and App (2057/22,142, 9.29%), and Fitbit Combination (combination of web, app, and Fitbit; 1663/22,142, 7.51%). Generalized linear regression and binary logistic regression were used to examine differences between user groups’ engagement and participation parameters. The time to nonusage attrition was assessed using Cox proportional hazards regression. Results: App Only users were significantly younger and Fitbit user groups had higher proportions of women compared with other groups. The following outcomes were significant and relative to the Website Only group. The App Only group had fewer website sessions (odds ratio [OR] −6.9, 95% CI −7.6 to −6.2), whereas the Fitbit Only (OR 10.6, 95% CI 8.8-12.3), Web and App (OR 1.5, 95% CI 0.4-2.6), and Fitbit Combination (OR 8.0; 95% CI 6.2-9.7) groups had more sessions. The App Only (OR −0.7, 95% CI −0.9 to −0.4) and Fitbit Only (OR −0.5, 95% CI −0.7 to −0.2) groups spent fewer minutes on the website per session, whereas the Fitbit Combination group (OR 0.2, 95% CI 0.0-0.5) spent more minutes. All groups, except the Fitbit Combination group, viewed fewer website pages per session. The mean daily step count was lower for the App Only (OR −201.9, 95% CI −387.7 to −116.0) and Fitbit Only (OR −492.9, 95% CI −679.9 to −305.8) groups but higher for the Web and App group (OR 258.0, 95% CI 76.9-439.2). The Fitbit Only (OR 5.0, 95% CI 3.4-6.6), Web and App (OR 7.2, 95% CI 5.9-8.6), and Fitbit Combination (OR 15.6, 95% CI 13.7-17.5) groups logged a greater number of step entries. The App Only group was less likely (OR 0.65, 95% CI 0.46-0.94) and other groups were more likely to participate in Challenges. The mean time to nonusage attrition was 35 (SD 26) days and was lower than average in the Website Only and App Only groups and higher than average in the Web and App and Fitbit Combination groups. Conclusions: Using a Fitbit in combination with the 10,000 Steps app or website enhanced engagement with a real-world physical activity program. Integrating tracking devices that synchronize data automatically into real-world physical activity interventions is one strategy for improving engagement. %M 34142966 %R 10.2196/22151 %U https://www.jmir.org/2021/6/e22151 %U https://doi.org/10.2196/22151 %U http://www.ncbi.nlm.nih.gov/pubmed/34142966 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e27603 %T Effect of Mobile Phone Text Message Reminders on the Completion and Timely Receipt of Routine Childhood Vaccinations: Superiority Randomized Controlled Trial in Northwest Ethiopia %A Mekonnen,Zeleke Abebaw %A Gelaye,Kassahun Alemu %A Were,Martin %A Tilahun,Binyam %+ Department of Health Informatics, Institute of Public Health, University of Gondar, Chechela Street, Gondar, 196, Ethiopia, 251 913747092, zelekeabebaw7@gmail.com %K mHealth %K eHealth %K mobile phone %K text message %K short message service %K reminder %K immunization %K vaccination %K Ethiopia %D 2021 %7 15.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nonattendance at vaccination appointments is a big challenge for health workers as it is difficult to track routine vaccination schedules. In Ethiopia, 3 out of 10 children have incomplete vaccination and the timely receipt of the recommended vaccines is low. Thus, innovative strategies are required to reach the last mile where mobile technology can be effectively utilized to achieve better compliance. Despite this promising technology, little is known about the role of text message–based mobile health interventions in improving the complete and timely receipt of routine childhood vaccinations in Ethiopia. Objective: This trial aimed to determine the effect of mobile phone text message reminders on the completion and timely receipt of routine childhood vaccinations in northwest Ethiopia. Methods: A two-arm, parallel, superiority randomized controlled trial was conducted in 9 health facilities in northwest Ethiopia. A sample size of 434 mother-infant pairs was considered in this trial. Randomization was applied in selected health facilities during enrollment with a 1:1 allocation ratio by using sealed and opaque envelopes. Participants assigned to the intervention group received mobile phone text message reminders one day before the scheduled vaccination visits. Owing to the nature of the intervention, blinding of participants was not possible. Primary outcomes of full and timely completion of vaccinations were measured objectively at 12 months. A two-sample test of proportion and log-binomial regression analyses were used to compare the outcomes between the study groups. A modified intention-to-treat analysis approach was applied and a one-tailed test was reported, considering the superiority design of the trial. Results: A total of 426 participants were included for the analysis. We found that a higher proportion of infants in the intervention group received Penta-3 (204/213, 95.8% vs 185/213, 86.9%, respectively; P<.001), measles (195/213, 91.5% vs 169/213, 79.3%, respectively; P<.001), and full vaccination (176/213, 82.6% vs 151/213, 70.9%, respectively; P=.002; risk ratio 1.17, 95% lower CI 1.07) compared to infants in the usual care group. Similarly, a higher proportion of infants in the intervention group received Penta-3 (181/204, 88.7% vs 128/185, 69.2%, respectively; P<.001), measles (170/195, 87.1% vs 116/169, 68.6%, respectively; P<.001), and all scheduled vaccinations (135/213, 63.3% vs 85/213, 39.9%, respectively; P<.001; risk ratio 1.59, 95% lower CI 1.35) on time compared to infants in the usual care group. Of the automatically sent 852 mobile phone text messages, 764 (89.7%) were delivered successfully to the participants. Conclusions: Mobile phone text message reminders significantly improved complete and timely receipt of all recommended vaccines. Besides, they had a significant effect in improving the timely receipt of specific vaccines. Thus, text message reminders can be used to supplement the routine immunization program in resource-limited settings. Considering different contexts, studies on the implementation challenges of mobile health interventions are recommended. Trial Registration: Pan African Clinical Trial Registry PACTR201901533237287; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5839 %M 34128813 %R 10.2196/27603 %U https://mhealth.jmir.org/2021/6/e27603 %U https://doi.org/10.2196/27603 %U http://www.ncbi.nlm.nih.gov/pubmed/34128813 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 6 %P e27475 %T Preliminary Outcomes of an Ecological Momentary Intervention for Social Functioning in Schizophrenia: Pre-Post Study of the Motivation and Skills Support App %A Fulford,Daniel %A Gard,David E %A Mueser,Kim T %A Mote,Jasmine %A Gill,Kathryn %A Leung,Lawrence %A Mow,Jessica %+ Department of Occupational Therapy, Boston University, 635 Commonwealth Avenue, Boston, MA, 02215, United States, 1 6173582889, dfulford@bu.edu %K schizophrenia %K psychosis %K social functioning %K social skills %K motivation %K mHealth %K smartphone %K mobile phone %D 2021 %7 15.6.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: People with schizophrenia and other serious mental illnesses often lack access to evidence-based interventions, particularly interventions that target meaningful recovery outcomes such as social functioning and quality of life. Mobile technologies, including smartphone apps, have the potential to provide scalable support that places elements of evidence-based interventions at the palm of patients’ hands. Objective: We aim to develop a smartphone app—called Motivation and Skills Support—to provide targeted social goal support (eg, making new friends and improving existing relationships) for people with schizophrenia enrolled in a stand-alone open trial. Methods: In this paper, we presented preliminary outcomes of 31 participants who used the Motivation and Skills Support app for 8 weeks, including social functioning pre- to postintervention, and momentary reports of treatment targets (eg, social motivation and appraisals) during the intervention. Results: The findings suggest that the intervention improved self-reported social functioning from baseline to treatment termination, particularly in female participants. Gains were not maintained at the 3-month follow-up. Furthermore, increased social functioning was predicted by momentary reports of social appraisals, including perceived social competence and the extent to which social interactions were worth the effort. Conclusions: The implications of these findings and future directions for addressing social functioning in schizophrenia using mobile technology have been discussed. Trial Registration: ClinicalTrials.gov NCT03404219; https://clinicaltrials.gov/ct2/show/NCT03404219 %M 34128812 %R 10.2196/27475 %U https://mental.jmir.org/2021/6/e27475 %U https://doi.org/10.2196/27475 %U http://www.ncbi.nlm.nih.gov/pubmed/34128812 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e26195 %T An mHealth Physical Activity Intervention for Latina Adolescents: Iterative Design of the Chicas Fuertes Study %A Larsen,Britta %A Greenstadt,Emily D %A Olesen,Brittany L %A Marcus,Bess H %A Godino,Job %A Zive,Michelle M %+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 9500 Gilman Dr., San Diego, CA, United States, 1 8585348429, blarsen@ucsd.edu %K mobile health %K human-centered design %K qualitative research %K adolescent health %K health disparities %K mobile phone %D 2021 %7 15.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Only 3% of Latina teens meet the national physical activity (PA) guidelines, and these habits appear to persist into adulthood. Developing effective interventions to increase PA in Latina teens is necessary to prevent disease and reduce disparities. Mobile technologies may be especially appropriate for this population, but mobile health (mHealth) intervention content must be designed in collaboration with the target population. Objective: This study aims to develop an mHealth PA intervention for Latina adolescents using a multistage iterative process based on the principles of human-centered design and multiple iterations of the design phase of the IDEAS (Integrate, Design, Assess, Share) framework. Methods: On the basis of the feedback from a previous pilot study, the planned intervention included visual social media posts and text messaging, a commercial wearable tracker, and a primarily visual website. The development of the requested mHealth intervention components was accomplished through the following 2 phases: conducting focus groups with the target population and testing the usability of the final materials with a youth advisory board (YAB) comprising Latina adolescents. Participants for focus groups (N=50) were girls aged 13-18 years who could speak and read in English and who were recruited from local high schools and after-school programs serving a high proportion of Latinos. Facilitated discussions focused on experience with PA and social media apps and specific feedback on intervention material prototypes and possible names and logos. Viable products were designed based on their feedback and then tested for usability by the YAB. YAB members (n=4) were Latinas aged 13-18 years who were not regularly active and were recruited via word of mouth and selected through an application process. Results: The focus group discussions yielded the following findings: PA preferences included walking, running, and group fitness classes, whereas the least popular activities were running, swimming, and biking. Most participants (n=48, 96%) used some form of social media, with Instagram being the most favored. Participants preferred text messages to be sent no more than once per day, be personalized, and be positively worded. The focus group participants preferred an intervention directly targeting Latinas and social media posts that were brightly colored, included girls of all body types, and provided specific tips and information. Modified intervention materials were generally perceived favorably by the YAB members, who provided suggestions for further refinement, including the shortening of texts and the incorporation of some Spanish phrases. Conclusions: Latina teens were generally enthusiastic about an mHealth PA intervention, provided that the materials were targeted specifically to them and their preferences. Through multiple iterations of development and feedback from the target population, we gained insight into the needs of Latina teens and joined with industry partners to build a viable final product. %M 34128823 %R 10.2196/26195 %U https://formative.jmir.org/2021/6/e26195 %U https://doi.org/10.2196/26195 %U http://www.ncbi.nlm.nih.gov/pubmed/34128823 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e24115 %T Adaptation of the World Health Organization Electronic Mental Health Gap Action Programme Intervention Guide App for Mobile Devices in Nepal and Nigeria: Protocol for a Feasibility Cluster Randomized Controlled Trial %A Taylor Salisbury,Tatiana %A Kohrt,Brandon A %A Bakolis,Ioannis %A Jordans,Mark JD %A Hull,Louise %A Luitel,Nagendra P %A McCrone,Paul %A Sevdalis,Nick %A Pokhrel,Pooja %A Carswell,Kenneth %A Ojagbemi,Akin %A Green,Eric P %A Chowdhary,Neerja %A Kola,Lola %A Lempp,Heidi %A Dua,Tarun %A Milenova,Maria %A Gureje,Oye %A Thornicroft,Graham %+ Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF, United Kingdom, 44 0207 848 5071, tatiana.salisbury@kcl.ac.uk %K mental health %K community mental health %K digital technology %K primary health care %K intervention %K eHealth %K mHealth %K LMIC %K remote supervision %K training %K mobile phone %D 2021 %7 15.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a growing global need for scalable approaches to training and supervising primary care workers (PCWs) to deliver mental health services. Over the past decade, the World Health Organization Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) and associated training and implementation guidance have been disseminated to more than 100 countries. On the basis of the opportunities provided by mobile technology, an updated electronic Mental Health Gap Action Programme Intervention Guide (e-mhGAP-IG) is now being developed along with a clinical dashboard and guidance for the use of mobile technology in supervision. Objective: This study aims to assess the feasibility, acceptability, adoption, and other implementation parameters of the e-mhGAP-IG for diagnosis and management of depression in 2 lower-middle-income countries (Nepal and Nigeria) and to conduct a feasibility cluster randomized controlled trial (cRCT) to evaluate trial procedures for a subsequent fully powered trial comparing the clinical effectiveness and cost-effectiveness of the e-mhGAP-IG and remote supervision with standard mhGAP-IG implementation. Methods: A feasibility cRCT will be conducted in Nepal and Nigeria to evaluate the feasibility of the e-mhGAP-IG for use in depression diagnosis and treatment. In each country, an estimated 20 primary health clinics (PHCs) in Nepal and 6 PHCs in Nigeria will be randomized to have their staff trained in e-mhGAP-IG or the paper version of mhGAP-IG v2.0. The PHC will be the unit of clustering. All PCWs within a facility will receive the same training (e-mhGAP-IG vs paper mhGAP-IG). Approximately 2-5 PCWs, depending on staffing, will be recruited per clinic (estimated 20 health workers per arm in Nepal and 15 per arm in Nigeria). The primary outcomes of interest will be the feasibility and acceptability of training, supervision, and care delivery using the e-mhGAP-IG. Secondary implementation outcomes include the adoption of the e-mhGAP-IG and feasibility of trial procedures. The secondary intervention outcome—and the primary outcome for a subsequent fully powered trial—will be the accurate identification of depression by PCWs. Detection rates before and after training will be compared in each arm. Results: To date, qualitative formative work has been conducted at both sites to prepare for the pilot feasibility cRCT, and the e-mhGAP-IG and remote supervision guidelines have been developed. Conclusions: The incorporation of mobile digital technology has the potential to improve the scalability of mental health services in primary care and enhance the quality and accuracy of care. Trial Registration: ClinicalTrials.gov NCT04522453; https://clinicaltrials.gov/ct2/show/NCT04522453. International Registered Report Identifier (IRRID): PRR1-10.2196/24115 %M 34128819 %R 10.2196/24115 %U https://www.researchprotocols.org/2021/6/e24115 %U https://doi.org/10.2196/24115 %U http://www.ncbi.nlm.nih.gov/pubmed/34128819 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e28884 %T Motivation and Problem Solving Versus Mobile 360° Videos to Promote Enrollment in the National Diabetes Prevention Program’s Lifestyle Change Program Among People With Prediabetes: Protocol for a Randomized Trial %A Gibson,Bryan %A Simonsen,Sara %A Barton,Jonathan %A Zhang,Yue %A Altizer,Roger %A Lundberg,Kelly %A Wetter,David W %+ Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Salt Lake City, UT, 84148, United States, 1 801 585 0929, Bryan.Gibson@utah.edu %K diabetes prevention program %K mobile video %K motivation and problem solving %K program enrollment %K participant engagement %K prediabetes %D 2021 %7 14.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: More than 88 million Americans are at risk of developing type 2 diabetes mellitus (T2DM). The National Diabetes Prevention Program’s Lifestyle Change Program (DPP LCP) has been shown to be effective in reducing the risk of progressing from prediabetes to T2DM. However, most individuals who could benefit from the program do not enroll. Objective: The aim of this trial is to test the real-world efficacy of 3 mobile phone–based approaches to increasing enrollment in the DPP LCP including a best-practice condition and 2 novel approaches. Methods: We will conduct a 3-armed randomized clinical trial comparing enrollment and 1-month engagement in the DPP LCP among adults with prediabetes from 2 health care settings. Participants in the best-practice condition will receive SMS-based notifications that they have prediabetes and a link to a website that explains prediabetes, T2DM, and the DPP LCP. This will be followed by a single question survey, “Would you like the DPP LCP to call you to enroll?” Participants in the 2 intervention arms will receive the same best-practice intervention plus either 2 mobile 360° videos or up to 5 brief phone calls from a health coach trained in a motivational coaching approach known as Motivation and Problem Solving (MAPS). We will collect measures of diabetes-related knowledge, beliefs in the controllability of risk for T2DM, risk perceptions for T2DM, and self-efficacy for lifestyle change pre-intervention and 4 weeks later. The primary outcomes of the study are enrollment in the DPP LCP and 4-week engagement in the DPP LCP. In addition, data on the person-hours needed to deliver the interventions as well as participant feedback about the interventions and their acceptability will be collected. Our primary hypotheses are that the 2 novel interventions will lead to higher enrollment and engagement in the DPP LCP than the best-practice intervention. Secondary hypotheses concern the mechanisms of action of the 2 intervention arms: (1) whether changes in risk perception are associated with program enrollment among participants in the mobile 360° video group and (2) whether changes in self-efficacy for lifestyle change are associated with program enrollment among participants in the MAPS coaching group. Finally, exploratory analyses will examine the cost effectiveness and acceptability of the interventions. Results: The project was funded in September 2020; enrollment began in February 2021 and is expected to continue through July 2022. Conclusions: We are conducting a test of 2 novel, scalable, mobile phone–based interventions to increase enrollment in the DPP LCP. If effective, they have tremendous potential to be scaled up to help prevent T2DM nationwide. Trial Registration: ClinicalTrials.gov NCT04746781; https://clinicaltrials.gov/ct2/show/NCT04746781 International Registered Report Identifier (IRRID): DERR1-10.2196/28884 %M 34125075 %R 10.2196/28884 %U https://www.researchprotocols.org/2021/6/e28884 %U https://doi.org/10.2196/28884 %U http://www.ncbi.nlm.nih.gov/pubmed/34125075 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e17418 %T Acceptability of a Mobile Phone Support Tool (Call for Life Uganda) for Promoting Adherence to Antiretroviral Therapy Among Young Adults in a Randomized Controlled Trial: Exploratory Qualitative Study %A Twimukye,Adelline %A Bwanika Naggirinya,Agnes %A Parkes-Ratanshi,Rosalind %A Kasirye,Ronnie %A Kiragga,Agnes %A Castelnuovo,Barbara %A Wasswa,Jacob %A Nabaggala,Maria Sarah %A Katabira,Elly %A Lamorde,Mohammed %A King,Rachel Lisa %+ Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O. Box 22418, University Hall Lane, Kampala, 10218, Uganda, 256 256 312 307000, anaggirinya@idi.co.ug %K HIV %K mHealth %K young adults %K adherence %K qualitative %K Uganda %D 2021 %7 14.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adherence to treatment is critical for successful treatment outcomes. Although factors influencing antiretroviral therapy (ART) adherence vary, young adults are less likely to adhere owing to psychosocial issues such as stigma, ART-related side effects, and a lack of access to treatment. The Call for Life Uganda (CFLU) mobile health (mHealth) tool is a mobile phone–based technology that provides text messages or interactive voice response functionalities through a web interface and offers 4 modules of support. Objective: This study aims to describe the acceptability and feasibility of a mobile phone support tool to promote adherence to ART among young adults in a randomized controlled trial. Methods: An exploratory qualitative design with a phenomenological approach at 2 study sites was used. A total of 17 purposively selected young adults with HIV infection who had used the mHealth tool CFLU from 2 clinics were included. In total, 11 in-depth interviews and 1 focus group discussion were conducted to examine the following topics: experience with the CFLU tool (benefits and challenges), components of the tool, the efficiency of the system (level of comfort, ease, or difficulty in using the system), how CFLU resolved adherence challenges, and suggestions to improve CFLU. Participants belonged to 4 categories of interest: young adults on ART for the prevention of mother-to-child transmission, young adults switching to or on the second-line ART, positive partners in an HIV-discordant relationship, and young adults initiating the first-line ART. All young adults had 12 months of daily experience using the tool. Data were analyzed using NVivo version 11 software (QSR International Limited) based on a thematic approach. Results: The CFLU mHealth tool was perceived as an acceptable intervention; young adults reported improvement in medication adherence, strengthened clinician-patient relationships, and increased health knowledge from health tips. Appointment reminders and symptom reporting were singled out as beneficial and helped to address the problems of forgetfulness and stigma-related issues. HIV-related stigma was reported by a few young people. Participants requested extra support for scaling up CFLU to make it more youth friendly. Improving the tool to reduce technical issues, including network outages and a period of software failure, was suggested. They suggested that in addition to digital solutions, other support, including the promotion of peer support meetings and the establishment of a designated space and staff members for youth, was also important. Conclusions: This mHealth tool was an acceptable and feasible strategy for improving ART adherence and retention among young adults in resource-limited settings. Trial Registration: ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080 %M 34121665 %R 10.2196/17418 %U https://mhealth.jmir.org/2021/6/e17418 %U https://doi.org/10.2196/17418 %U http://www.ncbi.nlm.nih.gov/pubmed/34121665 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e26095 %T Efficacy of Mobile Health in Patients With Low Back Pain: Systematic Review and Meta-analysis of Randomized Controlled Trials %A Chen,Mingrong %A Wu,Tingting %A Lv,Meina %A Chen,Chunmei %A Fang,Zongwei %A Zeng,Zhiwei %A Qian,Jiafen %A Jiang,Shaojun %A Chen,Wenjun %A Zhang,Jinhua %+ Department of Pharmacy, Fujian Medical University Union Hospital, #29 Xinquan Road, Fuzhou, 350001, China, 86 591 83357896 ext 8301, pollyzhang2006@126.com %K mobile health %K mHealth %K low back pain %K meta-analysis %K pain intensity %K disability %D 2021 %7 11.6.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Low back pain is one of the most common health problems and a main cause of disability, which imposes a great burden on patients. Mobile health (mHealth) affects many aspects of people’s lives, and it has progressed rapidly, showing promise as an effective intervention for patients with low back pain. However, the efficacy of mHealth interventions for patients with low back pain remains unclear; thus, further exploration is necessary. Objective: The purpose of this study was to evaluate the efficacy of mHealth interventions in patients with low back pain compared to usual care. Methods: This was a systematic review and meta-analysis of randomized controlled trials designed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement standard. We searched for studies published in English before October 2020 in the PubMed, EMBASE, Web of Science, and Cochrane Library databases. Two researchers independently scanned the literature, extracted data, and assessed the methodological quality of the included studies. Bias risks were assessed using the Cochrane Collaboration tool. We used RevMan 5.4 software to perform the meta-analysis. Results: A total of 9 studies with 792 participants met the inclusion criteria. The simultaneous use of mHealth and usual care showed a better reduction in pain intensity than usual care alone, as measured by the numeric rating scale (mean difference [MD] –0.85, 95% CI –1.29 to –0.40; P<.001), and larger efficacy in reducing disability, as measured by the Rolland-Morris Disability Questionnaire (MD –1.54, 95% CI –2.35 to –0.73; P<.001). Subgroup analyses showed that compared with usual care, mHealth using telephone calls significantly reduced pain intensity (MD –1.12, 95% CI –1.71 to –0.53; P<.001) and disability score (MD –1.68, 95% CI –2.74 to –0.63; P<.001). However, without the use of telephone calls, mHealth had no obvious advantage over usual care in improving pain intensity (MD –0.48, 95% CI –1.16 to 0.20; P=.16) and the disability score (MD –0.41, 95% CI –1.88 to 1.05; P=.58). The group that received a more sensitive feedback intervention showed a significantly reduced disability score (MD –4.30, 95% CI –6.95 to –1.69; P=.001). Conclusions: The use of simultaneous mHealth and usual care interventions has better efficacy than usual care alone in reducing pain intensity and disability in patients with low back pain. Moreover, the results of subgroup analysis revealed that mHealth using telephone calls might play a positive role in improving pain intensity and disability in patients with low back pain. %M 34114965 %R 10.2196/26095 %U https://mhealth.jmir.org/2021/6/e26095 %U https://doi.org/10.2196/26095 %U http://www.ncbi.nlm.nih.gov/pubmed/34114965 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e26264 %T Using a Tailored Digital Health Intervention for Family Communication and Cascade Genetic Testing in Swiss and Korean Families With Hereditary Breast and Ovarian Cancer: Protocol for the DIALOGUE Study %A Kim,Sue %A Aceti,Monica %A Baroutsou,Vasiliki %A Bürki,Nicole %A Caiata-Zufferey,Maria %A Cattaneo,Marco %A Chappuis,Pierre O %A Ciorba,Florina M %A Graffeo-Galbiati,Rossella %A Heinzelmann-Schwarz,Viola %A Jeong,Joon %A Jung,MiSook M %A Kim,Sung-Won %A Kim,Jisun %A Lim,Myong Cheol %A Ming,Chang %A Monnerat,Christian %A Park,Hyung Seok %A Park,Sang Hyung %A Pedrazzani,Carla A %A Rabaglio,Manuela %A Ryu,Jai Min %A Saccilotto,Ramon %A Wieser,Simon %A Zürrer-Härdi,Ursina %A Katapodi,Maria C %+ Department of Clinical Research, University of Basel, Missionstrasse 64, Basel, 4055, Switzerland, 41 61 207 0430, maria.katapodi@unibas.ch %K HBOC %K proportion of informed at-risk relatives %K coping %K communicating %K decisional conflict %K cultural and linguistic adaptation %K implementation %K RE-AIM %K mobile phone %D 2021 %7 11.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In hereditary breast and ovarian cancer (HBOC), family communication of genetic test results is essential for cascade genetic screening, that is, identifying and testing blood relatives of known mutation carriers to determine whether they also carry the pathogenic variant, and to propose preventive and clinical management options. However, up to 50% of blood relatives are unaware of relevant genetic information, suggesting that potential benefits of genetic testing are not communicated effectively within family networks. Technology can facilitate communication and genetic education within HBOC families. Objective: The aims of this study are to develop the K-CASCADE (Korean–Cancer Predisposition Cascade Genetic Testing) cohort in Korea by expanding an infrastructure developed by the CASCADE (Cancer Predisposition Cascade Genetic Testing) Consortium in Switzerland; develop a digital health intervention to support the communication of cancer predisposition for Swiss and Korean HBOC families, based on linguistic and cultural adaptation of the Family Gene Toolkit; evaluate its efficacy on primary (family communication of genetic results and cascade testing) and secondary (psychological distress, genetic literacy, active coping, and decision making) outcomes; and explore its translatability using the reach, effectiveness, adoption, implementation, and maintenance framework. Methods: The digital health intervention will be available in French, German, Italian, Korean, and English and can be accessed via the web, mobile phone, or tablet (ie, device-agnostic). K-CASCADE cohort of Korean HBOC mutation carriers and relatives will be based on the CASCADE infrastructure. Narrative data collected through individual interviews or mini focus groups from 20 to 24 HBOC family members per linguistic region and 6-10 health care providers involved in genetic services will identify the local cultures and context, and inform the content of the tailored messages. The efficacy of the digital health intervention against a comparison website will be assessed in a randomized trial with 104 HBOC mutation carriers (52 in each study arm). The translatability of the digital health intervention will be assessed using survey data collected from HBOC families and health care providers. Results: Funding was received in October 2019. It is projected that data collection will be completed by January 2023 and results will be published in fall 2023. Conclusions: This study addresses the continuum of translational research, from developing an international research infrastructure and adapting an existing digital health intervention to testing its efficacy in a randomized controlled trial and exploring its translatability using an established framework. Adapting existing interventions, rather than developing new ones, takes advantage of previous valid experiences without duplicating efforts. Culturally sensitive web-based interventions that enhance family communication and understanding of genetic cancer risk are timely. This collaboration creates a research infrastructure between Switzerland and Korea that can be scaled up to cover other hereditary cancer syndromes. Trial Registration: ClinicalTrials.gov NCT04214210; https://clinicaltrials.gov/ct2/show/NCT04214210 and CRiS KCT0005643; https://cris.nih.go.kr/cris/ International Registered Report Identifier (IRRID): PRR1-10.2196/26264 %M 34114954 %R 10.2196/26264 %U https://www.researchprotocols.org/2021/6/e26264 %U https://doi.org/10.2196/26264 %U http://www.ncbi.nlm.nih.gov/pubmed/34114954 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e22587 %T Quality of Physical Activity Apps: Systematic Search in App Stores and Content Analysis %A Paganini,Sarah %A Terhorst,Yannik %A Sander,Lasse Bosse %A Catic,Selma %A Balci,Sümeyye %A Küchler,Ann-Marie %A Schultchen,Dana %A Plaumann,Katrin %A Sturmbauer,Sarah %A Krämer,Lena Violetta %A Lin,Jiaxi %A Wurst,Ramona %A Pryss,Rüdiger %A Baumeister,Harald %A Messner,Eva-Maria %+ Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str 16, Ulm, 89081, Germany, 49 7315032802, eva-maria.messner@uni-ulm.de %K sports %K exercise %K mobile apps %K mHealth %K quality indicators %K systematic review %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical inactivity is a major contributor to the development and persistence of chronic diseases. Mobile health apps that foster physical activity have the potential to assist in behavior change. However, the quality of the mobile health apps available in app stores is hard to assess for making informed decisions by end users and health care providers. Objective: This study aimed at systematically reviewing and analyzing the content and quality of physical activity apps available in the 2 major app stores (Google Play and App Store) by using the German version of the Mobile App Rating Scale (MARS-G). Moreover, the privacy and security measures were assessed. Methods: A web crawler was used to systematically search for apps promoting physical activity in the Google Play store and App Store. Two independent raters used the MARS-G to assess app quality. Further, app characteristics, content and functions, and privacy and security measures were assessed. The correlation between user star ratings and MARS was calculated. Exploratory regression analysis was conducted to determine relevant predictors for the overall quality of physical activity apps. Results: Of the 2231 identified apps, 312 met the inclusion criteria. The results indicated that the overall quality was moderate (mean 3.60 [SD 0.59], range 1-4.75). The scores of the subscales, that is, information (mean 3.24 [SD 0.56], range 1.17-4.4), engagement (mean 3.19 [SD 0.82], range 1.2-5), aesthetics (mean 3.65 [SD 0.79], range 1-5), and functionality (mean 4.35 [SD 0.58], range 1.88-5) were obtained. An efficacy study could not be identified for any of the included apps. The features of data security and privacy were mainly not applied. Average user ratings showed significant small correlations with the MARS ratings (r=0.22, 95% CI 0.08-0.35; P<.001). The amount of content and number of functions were predictive of the overall quality of these physical activity apps, whereas app store and price were not. Conclusions: Apps for physical activity showed a broad range of quality ratings, with moderate overall quality ratings. Given the present privacy, security, and evidence concerns inherent to most rated apps, their medical use is questionable. There is a need for open-source databases of expert quality ratings to foster informed health care decisions by users and health care providers. %M 34106073 %R 10.2196/22587 %U https://mhealth.jmir.org/2021/6/e22587 %U https://doi.org/10.2196/22587 %U http://www.ncbi.nlm.nih.gov/pubmed/34106073 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e24952 %T An Intervention to Improve Medication Adherence in People With Heart Disease (Text4HeartII): Randomized Controlled Trial %A Maddison,Ralph %A Jiang,Yannan %A Stewart,Ralph %A Scott,Tony %A Kerr,Andrew %A Whittaker,Robyn %A Benatar,Jocelyn %A Rolleston,Anna %A Estabrooks,Paul %A Dale,Leila %+ Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, 61 3 924 46218, ralph.maddison@deakin.edu.au %K cardiovascular disease %K self-management %K text messaging %K risk factors %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health technologies have the potential to improve the reach and delivery of interventions for promoting long-term secondary prevention of coronary heart disease. Objective: This study aims to determine the effectiveness of an SMS text messaging intervention (Text4HeartII) for improving adherence to medication and lifestyle changes over and above usual care in people with coronary heart disease at 24 and 52 weeks. Methods: A two-arm, parallel, randomized controlled trial was conducted in New Zealand. Participants with a recent acute coronary syndrome were randomized to receive usual cardiac services alone (control, n=153) or a 24-week SMS text message program for supporting self-management plus usual cardiac services (n=153). The primary outcome was adherence to medication at 24 weeks, defined as a medication possession ratio of 80% or more for aspirin, statin, and antihypertensive therapy. Secondary outcomes included medication possession ratio at 52 weeks, self-reported medication adherence, adherence to healthy lifestyle behaviors, and health-related quality of life at 24 and 52 weeks. Results: Participants were predominantly male (113/306, 80.3%) and European New Zealanders (210/306, 68.6%), with a mean age of 61 years (SD 11 years). Groups were comparable at baseline. National hospitalization and pharmacy dispensing records were available for all participants; 92% (282/306, 92.1%) of participants completed a 24-week questionnaire and 95.1% (291/306) of participants completed a 52-week questionnaire. Adherence with 3 medication classes were lower in the intervention group than in the control group (87/153, 56.8% vs 105/153, 68.6%, odds ratio 0.60, 95% CI 0.38-0.96; P=.03) and 52 weeks (104/153, 67.9% vs 83/153, 54.2%; odds ratio 0.56, 95% CI 0.35-0.89; P=.01). Self-reported medication adherence scores showed the same trend at 52 weeks (mean difference 0.3; 95% CI 0.01-0.59; P=.04). Moreover, self-reported adherence to health-related behaviors was similar between groups. Conclusions: Text4HeartII did not improve dispensed medication or adherence to a favorable lifestyle over and above usual care. This finding contrasts with previous studies and highlights that the benefits of text interventions may depend on the context in which they are used. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000422426; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370398. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2468-z %M 34106081 %R 10.2196/24952 %U https://mhealth.jmir.org/2021/6/e24952 %U https://doi.org/10.2196/24952 %U http://www.ncbi.nlm.nih.gov/pubmed/34106081 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e20710 %T The Accuracy of Wrist Skin Temperature in Detecting Ovulation Compared to Basal Body Temperature: Prospective Comparative Diagnostic Accuracy Study %A Zhu,Tracy Y %A Rothenbühler,Martina %A Hamvas,Györgyi %A Hofmann,Anja %A Welter,JoEllen %A Kahr,Maike %A Kimmich,Nina %A Shilaih,Mohaned %A Leeners,Brigitte %+ Department of Reproductive Endocrinology, University Hospital Zurich, Rämistrasse 100, Zurich, 8091, Switzerland, 41 44 225 50 01, Brigitte.Leeners@usz.ch %K ovulation %K basal body temperature %K BBT %K oral temperature %K wrist skin temperature %K diagnostic accuracy %K thermometer %K fertility %K menstruation %K wearable %K sensor %K mobile phone %D 2021 %7 8.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: As a daily point measurement, basal body temperature (BBT) might not be able to capture the temperature shift in the menstrual cycle because a single temperature measurement is present on the sliding scale of the circadian rhythm. Wrist skin temperature measured continuously during sleep has the potential to overcome this limitation. Objective: This study compares the diagnostic accuracy of these two temperatures for detecting ovulation and to investigate the correlation and agreement between these two temperatures in describing thermal changes in menstrual cycles. Methods: This prospective study included 193 cycles (170 ovulatory and 23 anovulatory) collected from 57 healthy women. Participants wore a wearable device (Ava Fertility Tracker bracelet 2.0) that continuously measured the wrist skin temperature during sleep. Daily BBT was measured orally and immediately upon waking up using a computerized fertility tracker with a digital thermometer (Lady-Comp). An at-home luteinizing hormone test was used as the reference standard for ovulation. The diagnostic accuracy of using at least one temperature shift detected by the two temperatures in detecting ovulation was evaluated. For ovulatory cycles, repeated measures correlation was used to examine the correlation between the two temperatures, and mixed effect models were used to determine the agreement between the two temperature curves at different menstrual phases. Results: Wrist skin temperature was more sensitive than BBT (sensitivity 0.62 vs 0.23; P<.001) and had a higher true-positive rate (54.9% vs 20.2%) for detecting ovulation; however, it also had a higher false-positive rate (8.8% vs 3.6%), resulting in lower specificity (0.26 vs 0.70; P=.002). The probability that ovulation occurred when at least one temperature shift was detected was 86.2% for wrist skin temperature and 84.8% for BBT. Both temperatures had low negative predictive values (8.8% for wrist skin temperature and 10.9% for BBT). Significant positive correlation between the two temperatures was only found in the follicular phase (rmcorr correlation coefficient=0.294; P=.001). Both temperatures increased during the postovulatory phase with a greater increase in the wrist skin temperature (range of increase: 0.50 °C vs 0.20 °C). During the menstrual phase, the wrist skin temperature exhibited a greater and more rapid decrease (from 36.13 °C to 35.80 °C) than BBT (from 36.31 °C to 36.27 °C). During the preovulatory phase, there were minimal changes in both temperatures and small variations in the estimated daily difference between the two temperatures, indicating an agreement between the two curves. Conclusions: For women interested in maximizing the chances of pregnancy, wrist skin temperature continuously measured during sleep is more sensitive than BBT for detecting ovulation. The difference in the diagnostic accuracy of these methods was likely attributed to the greater temperature increase in the postovulatory phase and greater temperature decrease during the menstrual phase for the wrist skin temperatures. %M 34100763 %R 10.2196/20710 %U https://www.jmir.org/2021/6/e20710 %U https://doi.org/10.2196/20710 %U http://www.ncbi.nlm.nih.gov/pubmed/34100763 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 6 %P e23986 %T Factors Predicting Trial Engagement, Treatment Satisfaction, and Health-Related Quality of Life During a Web-Based Treatment and Social Networking Trial for Binge Drinking and Depression in Young Adults: Secondary Analysis of a Randomized Controlled Trial %A Sanatkar,Samineh %A Heinsch,Milena %A Baldwin,Peter Andrew %A Rubin,Mark %A Geddes,Jenny %A Hunt,Sally %A Baker,Amanda L %A Woodcock,Kathryn %A Lewin,Terry J %A Brady,Kathleen %A Deady,Mark %A Thornton,Louise %A Teesson,Maree %A Kay-Lambkin,Frances %+ Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 02 9065 9179, samineh.sanatkar@uon.edu.au %K digital mental health %K personality %K negative affect %K study engagement %K life quality %D 2021 %7 7.6.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health and alcohol use problems are among the most common causes of disease burden in young Australians, frequently co-occur (comorbidity), and lead to significant lifetime burden. However, comorbidities remain significantly underdetected and undertreated in health settings. Digital mental health tools designed to identify at-risk individuals, encourage help-seeking, or deliver treatment for comorbidity have the potential to address this service gap. However, despite a strong body of evidence that digital mental health programs provide an effective treatment option for a range of mental health and alcohol use problems in young adults, research shows that uptake rates can be low. Thus, it is important to understand the factors that influence treatment satisfaction and quality-of-life outcomes for young adults who access e–mental health interventions for comorbidity. Objective: In this study, we seek to understand the factors that influence treatment satisfaction and quality-of-life outcomes for young adults who access e–mental health interventions for comorbid alcohol and mood disorders. The aim is to determine the importance of personality (ie, Big Five personality traits and intervention attitudes), affective factors (ie, depression, anxiety, and stress levels), and baseline alcohol consumption in predicting intervention trial engagement at sign-up, satisfaction with the online tool, and quality of life at the end of the iTreAD (Internet Treatment for Alcohol and Depression) trial. Methods: Australian adults (N=411) aged between 18 and 30 years who screened positive for depression and alcohol use problems signed up for the iTreAD project between August 2014 and October 2015. During registration, participants provided information about their personality, current affective state, alcohol use, treatment expectations, and basic demographic information. Subsequent follow-up surveys were used to gauge the ongoing trial engagement. The last follow-up questionnaire, completed at 64 weeks, assessed participants’ satisfaction with web-based treatment and quality-of-life outcomes. Results: Multiple linear regression analyses were used to assess the relative influence of predictor variables on trial engagement, treatment satisfaction, and quality-of-life outcomes. The analyses revealed that the overall predictive effects of personality and affective factors were 20% or lower. Neuroticism constituted a unique predictor of engagement with the iTreAD study in that neuroticism facilitated the return of web-based self-assessments during the study. The return of incentivized follow-up assessments predicted treatment satisfaction, and state-based depression predicted variance in quality-of-life reports at study completion. Conclusions: Our findings suggest that traditional predictors of engagement observed in face-to-face research may not be easily transferable to digital health interventions, particularly those aimed at comorbid mental health concerns and alcohol misuse among young adults. More research is needed to identify what determines engagement in this population to optimally design and execute digital intervention studies with multiple treatment aims. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN): 12614000310662; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365137&isReview=true. International Registered Report Identifier (IRRID): RR2-10.1186/s12889-015-2365-2 %M 34096873 %R 10.2196/23986 %U https://mental.jmir.org/2021/6/e23986 %U https://doi.org/10.2196/23986 %U http://www.ncbi.nlm.nih.gov/pubmed/34096873 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e25687 %T Racial Discrimination, Sedentary Time, and Physical Activity in African Americans: Quantitative Study Combining Ecological Momentary Assessment and Accelerometers %A Nam,Soohyun %A Jeon,Sangchoon %A Ash,Garrett %A Whittemore,Robin %A Vlahov,David %+ School of Nursing, Yale University, 400 West Campus Dr, West Haven, CT, 06516, United States, 1 203 737 2822, soohyun.nam@yale.edu %K racial discrimination %K physical activity %K ecological momentary assessment %K African American %K pilot study %K mobile phone %D 2021 %7 7.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: A growing number of studies indicate that exposure to social stress, such as perceived racial discrimination, may contribute to poor health, health behaviors, and health disparities. Increased physical activity (PA) may buffer the impact of social stress resulting from racial discrimination. However, to date, data on the relationship between racial discrimination and PA have been mixed. Part of the reason is that the effect of perceived racial discrimination on PA has primarily been examined in cross-sectional studies that captured retrospective measures of perceived racial discrimination associated with individuals’ current PA outcomes. The association between real-time perceived racial discrimination and PA among African Americans remains unclear. Objective: The purpose of this study is to examine the relationship among demographic, anthropometric and clinical, and psychological factors with lifetime racial discrimination and examine the within- and between-person associations between daily real-time racial discrimination and PA outcomes (total energy expenditure, sedentary time, and moderate-to-vigorous PA patterns) measured by ecological momentary assessment (EMA) and accelerometers in healthy African Americans. Methods: This pilot study used an intensive, observational, case-crossover design of African Americans (n=12) recruited from the community. After participants completed baseline surveys, they were asked to wear an accelerometer for 7 days to measure their PA levels. EMA was sent to participants 5 times per day for 7 days to assess daily real-time racial discrimination. Multilevel models were used to examine the within- and between-person associations of daily racial discrimination on PA. Results: More EMA-reported daily racial discrimination was associated with younger age (r=0.75; P=.02). Daily EMA-reported microaggression was associated with depressive symptoms (r=0.66; P=.05), past race-related events (r=0.82; P=.004), and lifetime discrimination (r=0.78; P=.01). In the within-person analyses, the day-level association of racial discrimination and sedentary time was significant (β=.30, SE 0.14; P=.03), indicating that on occasions when participants reported more racial discrimination than usual, more sedentary time was observed. Between-person associations of racial discrimination (β=−.30, SE 0.28; P=.29) or microaggression (β=−.34, SE 0.36; P=.34) with total energy expenditure were suggestive but inconclusive. Conclusions: Concurrent use of EMA and accelerometers is a feasible method to examine the relationship between racial discrimination and PA in real time. Examining daily processes at the within-person level has the potential to elucidate the mechanisms of which racial discrimination may have on health and health behaviors and to guide the development of personalized interventions for increasing PA in racial ethnic minorities. Future studies with a precision health approach, incorporating within- and between-person associations, are warranted to further elucidate the effects of racial discrimination and PA. International Registered Report Identifier (IRRID): RR2-10.1002/nur.22068 %M 34096870 %R 10.2196/25687 %U https://formative.jmir.org/2021/6/e25687 %U https://doi.org/10.2196/25687 %U http://www.ncbi.nlm.nih.gov/pubmed/34096870 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e29750 %T A Mobile Intervention to Promote Low-Risk Drinking Habits in Young Adults: Protocol for a Randomized Controlled Trial %A Boumparis,Nikolaos %A Schulte,Mieke H %A Kleiboer,Annet %A Huizink,Anja %A Riper,Heleen %+ Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, Netherlands, 31 631673537, h.riper@vu.nl %K alcohol %K lifestyle %K drinking %K young adults %K digital %K mobile app %K COVID-19 %D 2021 %7 7.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young adults’ drinking habits commonly exceed recommendations for low-risk drinking, which may have a negative effect on their mental, social, and physical health. As smartphones are highly accessible to young adults, mobile apps could be used to support young adults to develop low-risk drinking habits and improve their general health. Objective: The objective of this study is to evaluate the effectiveness of Boozebuster, a self-guided mobile app based on healthy lifestyle–related components that aim to develop and maintain low-risk drinking habits among young adults. Methods: This two-arm, parallel-group randomized controlled trial will investigate whether a 6-week self-guided mobile intervention (Boozebuster) targeting drinking behavior is more effective than a minimal intervention consisting of an educational website on alcohol use and its consequences for young adults. We will recruit 506 young adults (aged 18-30 years) from the Netherlands via an open recruitment strategy by using an open access website. All outcomes will be self-assessed through questionnaires. The primary outcome is the quantity and frequency of alcohol consumption in standard drinks (10 g ethanol per standard drink) per month (timeline follow-back [TLFB]). Secondary outcomes include binge-drinking sessions per month, alcohol-related problem severity (Rutgers Alcohol Problem Index), cannabis use frequency and quantity in grams (TLFB), depressive symptoms (Center for Epidemiological Studies Depression Scale), perceived stress (Perceived Stress Scale), engagement (Twente Engagement with eHealth Technologies Scale), readiness to change (Readiness to Change Questionnaire), mental well-being (Warwick-Edinburgh Mental Wellbeing Scale), trauma and COVID-19–related trauma (Short-Form Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), impulsivity (Urgency, Premeditation, Perseverance, Sensation Seeking, Positive Urgency Impulsive Behavior Scale), study or work performance (Individual Work Performance Questionnaire), and treatment adherence. Baseline (T0), 6-week postbaseline (T1), and 3-month postbaseline (T2) assessments will be conducted and analyzed on the basis of the intention-to-treat principle using multilevel mixed modeling analyses. Results: Recruitment began in September 2020. We received 933 registrations via our study information website; 506 participants have completed the T0 assessment, 336 participants have completed the T1 assessment, and 308 participants have completed the T2 assessment as of May 2021. The study is still in progress, and results will be reported in 2021 and 2022. Conclusions: Self-guided mobile interventions based on a lifestyle approach might be an attractive approach for young adults due to their preference on self-reliance, healthy living, and increased perceived anonymity. Such interventions are yet understudied, and it is known that interventions addressing solely problem drinking are less appealing to young adults. We hypothesize that the Boozebuster mobile app will effectively reduce drinking levels compared to an alcohol educational website (control condition). If effective, our intervention could be an inexpensive and scalable public health intervention to improve drinking habits in young adults. Trial Registration: Netherlands Trial Register NL8828; https://www.trialregister.nl/trial/8828 International Registered Report Identifier (IRRID): DERR1-10.2196/29750 %M 34033583 %R 10.2196/29750 %U https://www.researchprotocols.org/2021/6/e29750 %U https://doi.org/10.2196/29750 %U http://www.ncbi.nlm.nih.gov/pubmed/34033583 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e26421 %T Influence of Baseline User Characteristics and Early Use Patterns (24-Hour) on Long-Term Adherence and Effectiveness of a Web-Based Weight Loss Randomized Controlled Trial: Latent Profile Analysis %A Andrade,Andre Q %A Beleigoli,Alline %A Diniz,Maria De Fatima %A Ribeiro,Antonio Luiz %+ Flinders Digital Health Research Centre, Flinders University, Tonsley Boulevard, Tonsley, Adelaide, , Australia, 61 08 2013303, alline.beleigoli@flinders.edu.au %K obesity %K overweight %K web platform %K digital health %K engagement %K latent profile analysis %K online interventions %K use data %K weight loss %K weight loss platform %D 2021 %7 3.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Low adherence to real-world online weight loss interventions reduces long-term efficacy. Baseline characteristics and use patterns are determinants of long-term adherence, but we lack cohesive models to guide how to adapt interventions to users’ needs. We also lack information whether very early use patterns (24 hours) help describe users and predict interventions they would benefit from. Objective: We aim to understand the impact of users’ baseline characteristics and early (initial 24 hours) use patterns of a web platform for weight loss on user adherence and weight loss in the long term (24 weeks). Methods: We analyzed data from the POEmaS randomized controlled trial, a study that compared the effectiveness of a weight loss platform with or without coaching and a control approach. Data included baseline behavior and use logs from the initial 24 hours after platform access. Latent profile analysis (LPA) was used to identify classes, and Kruskal-Wallis was used to test whether class membership was associated with long-term (24 weeks) adherence and weight loss. Results: Among 828 participants assigned to intervention arms, 3 classes were identified through LPA: class 1 (better baseline health habits and high 24-hour platform use); class 2 (better than average health habits, but low 24-hour platform use); class 3 (worse baseline health habits and low 24-hour platform use). Class membership was associated with long-term adherence (P<.001), and class 3 members had the lowest adherence. Weight loss was not associated with class membership (P=.49), regardless of the intervention arm (platform only or platform + coach). However, class 2 users assigned to platform + coach lost more weight than those assigned to platform only (P=.02). Conclusions: Baseline questionnaires and use data from the first 24 hours after log-in allowed distinguishing classes, which were associated with long-term adherence. This suggests that this classification might be a useful guide to improve adherence and assign interventions to individual users. Trial Registration: ClinicalTrials.gov NCT03435445; https://clinicaltrials.gov/ct2/show/NCT03435445 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5882-y %M 34081012 %R 10.2196/26421 %U https://www.jmir.org/2021/6/e26421 %U https://doi.org/10.2196/26421 %U http://www.ncbi.nlm.nih.gov/pubmed/34081012 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e23473 %T Application of the eHealth Literacy Model in Digital Health Interventions: Scoping Review %A El Benny,Mariam %A Kabakian-Khasholian,Tamar %A El-Jardali,Fadi %A Bardus,Marco %+ Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, PO-Box 11-0236, Riad-El-Solh, Beirut, 1107 2020, Lebanon, 961 1 350 0000 ext 4694, marco.bardus@gmail.com %K eHealth literacy %K digital health interventions %K consumer health information %K scoping review %K mHealth %K mobile phone %D 2021 %7 3.6.2021 %9 Review %J J Med Internet Res %G English %X Background: Digital health interventions (DHIs) are increasingly being adopted globally to address various public health issues. DHIs can be categorized according to four main types of technology: mobile based, web based, telehealth, and electronic health records. In 2006, Norman and Skinner introduced the eHealth literacy model, encompassing six domains of skills and abilities (basic, health, information, scientific, media, and computer) needed to effectively understand, process, and act on health-related information. Little is known about whether these domains are assessed or accounted for in DHIs. Objective: This study aims to explore how DHIs assess and evaluate the eHealth literacy model, describe which health conditions are addressed, and which technologies are used. Methods: We conducted a scoping review of the literature on DHIs, based on randomized controlled trial design and reporting the assessment of any domain of the eHealth literacy model. MEDLINE, CINAHL, Embase, and Cochrane Library were searched. A duplicate selection and data extraction process was performed; we charted the results according to the country of origin, health condition, technology used, and eHealth literacy domain. Results: We identified 131 unique DHIs conducted in 26 different countries between 2001 and 2020. Most DHIs were conducted in English-speaking countries (n=81, 61.8%), delivered via the web (n=68, 51.9%), and addressed issues related to noncommunicable diseases (n=57, 43.5%) or mental health (n=26, 19.8%). None of the interventions assessed all six domains of the eHealth literacy model. Most studies focused on the domain of health literacy (n=96, 73.2%), followed by digital (n=19, 14.5%), basic and media (n=4, 3%), and information and scientific literacy (n=1, 0.7%). Of the 131 studies, 7 (5.3%) studies covered both health and digital literacy. Conclusions: Although many selected DHIs assessed health or digital literacy, no studies comprehensively evaluated all domains of the eHealth literacy model; this evidence might be overlooking important factors that can mediate or moderate the effects of these interventions. Future DHIs should comprehensively assess the eHealth literacy model while developing or evaluating interventions to understand how and why interventions can be effective. %M 34081023 %R 10.2196/23473 %U https://www.jmir.org/2021/6/e23473 %U https://doi.org/10.2196/23473 %U http://www.ncbi.nlm.nih.gov/pubmed/34081023 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e19941 %T Motivating Adherence to Exercise Plans Through a Personalized Mobile Health App: Enhanced Action Design Research Approach %A Sun,Ruo-Ting %A Han,Wencui %A Chang,Hsin-Lu %A Shaw,Michael J %+ Department of Management Information Systems, National Chengchi University, 64, Sec 2, Chinan Rd,, Taipei, 116, Taiwan, 886 2 29393091 ext 81214, hlchang@nccu.edu.tw %K adherence %K mobile health %K motivation %K personality %K MBTI %K action design research %K mobile phone %D 2021 %7 2.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical inactivity is a global issue that affects people’s health and productivity. With the advancement of mobile technologies, many apps have been developed to facilitate health self-management. However, few studies have examined the effectiveness of these mobile health (mHealth) apps in motivating exercise adherence. Objective: This study aims to demonstrate the enhanced action design research (ADR) process and improve the design of mHealth apps for exercise self-management. Specifically, we investigate whether sending motivational messages improves adherence to exercise plans, whether the motivational effect is affected by personality, the impact of message type and repetition, and the process of involving a field experiment in the design process and learning new design principles from the results. Methods: This formative research was conducted by proposing an enhanced ADR process. We incorporated a field experiment into the process to iteratively refine and evaluate the design until it converges into a final mHealth app. We used the Apple ResearchKit to develop the mHealth app and promoted it via trainers at their gyms. We targeted users who used the app for at least two months. Participants were randomly assigned to 1 of the 12 groups in a 2×3×2 factorial design and remained blinded to the assigned intervention. The groups were defined based on personality type (thinking or feeling), message type (emotional, logical, or none), and repetition (none or once). Participants with different personality types received tailored and repeated messages. Finally, we used the self-reported completion rate to measure participants’ adherence level to exercise plans. By analyzing users’ usage patterns, we could verify, correct, and enhance the mHealth app design principles. Results: In total, 160 users downloaded the app, and 89 active participants remained during the 2-month period. The results suggest a significant main effect of personality type and repetition and a significant interaction effect between personality type and repetition. The adherence rate of people with feeling personality types was 18.15% higher than that of people with thinking types. Emotional messages were more effective than logical messages in motivating exercise adherence. Although people received repeated messages, they were more likely to adhere to exercise plans. With repeated reminders, the adherence rates of people with thinking personality types were significantly improved by 27.34% (P<.001). Conclusions: This study contributes to the literature on mHealth apps. By incorporating a field experiment into the ADR process, we demonstrate the benefit of combining design science and field experiments. This study also contributes to the research on mHealth apps. The principles learned from this study can be applied to improve the effectiveness of mHealth apps. The app design can be considered a foundation for the development of more advanced apps for specific diseases, such as diabetes and asthma, in future research. %M 34076580 %R 10.2196/19941 %U https://mhealth.jmir.org/2021/6/e19941 %U https://doi.org/10.2196/19941 %U http://www.ncbi.nlm.nih.gov/pubmed/34076580 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e24937 %T Multicultural Adaptation of Mighty Girls for Widespread Dissemination: Pilot Study, App Development and Usability Testing, and Gauging Parent Support With Focus Groups %A Norris,Anne E %A Thalasinos,Roxana Delcampo %A Hecht,Michael L %+ REAL Prevention, LLC, 817 Kingsbridge Dr, Oviedo, FL, 32765, United States, 1 4074161727, anne@real-prevention.com %K implementation science %K mobile apps %K peer influence %K early intervention %K adolescent health %D 2021 %7 2.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Taking evidence-based interventions to scale is a challenge for prevention science. Mighty Girls is an evidence-based sexual health intervention program that combines classroom sessions with novel, cutting-edge technology (digital puppetry). The program was developed for 7th grade Latinas, but US school and community demographics rarely allow interventions targeting a single ethnic group. Additionally, digital puppetry is costly to scale up, and parent disapproval often prevents successful dissemination of adolescent sexual health programs. Intervening steps along the scaling-up pathway are needed to adapt the program prior to scaling up for dissemination. Objective: The aims of this study were to create a multicultural adaptation of the Mighty Girls program using a mobile app that is less costly to disseminate and is acceptable to parents of 7th grade girls. Methods: This study used a three-phase process to adapt Mighty Girls into Mighty Teens. All phases used purposive (nonprobability) sampling of low-income, multicultural, urban metropolitan groups (7th grade girls and their parents) within central Florida. Phase 1 involved two videotaped implementations of a multicultural adaptation of the classroom sessions, one involving focus groups (N=14) and the other serving as a single-group pretest-posttest pilot study (N=23). Phase 2 involved development of a narrative cell phone app prototype, which was subjected to usability testing (N=25). App usability and engagement were assessed qualitatively (observation, focus group, open-ended questions) and quantitatively. Phase 3 used focus groups to assess parent support for the program (N=6). Qualitative data were analyzed using descriptive content analysis. Quantitative data were analyzed using descriptive statistics and paired t tests. Results: Qualitative findings supported classroom sessions being multicultural, and identified simple changes to improve engagement and learning. Quantitative findings from the second classroom session implementation pilot study indicated a significant pre-post difference in intention to delay sexual intercourse (P=.04). App usability and appeal were supported by a System Usability Scale score of 76 (exceeding 68 per the industry standard) and 83% (20/24) of participants agreeing they would recommend the app to friends. Parents (mothers) expressed only positive regard for program goals, and classroom session and app activities. Conclusions: This study adapted Mighty Girls into an engaging, easier-to-disseminate, multicultural program, termed Mighty Teens, that uses a narrative-generating app to support behavior change, and is likely to be accepted by parents of 7th grade girls. This study also provides evidence of the preliminary effectiveness of Mighty Teens classroom sessions. The sampling method and sample size were appropriate for adaptation, but research involving a more representative US sample is needed to confirm multicultural fit, parent receptivity, and program effectiveness. Study implications include integrating app use throughout the classroom sessions to build narrative-generating skills across the program and increasing the number of narratives produced, which should in turn increase the program’s behavior change potency. %M 34076578 %R 10.2196/24937 %U https://formative.jmir.org/2021/6/e24937 %U https://doi.org/10.2196/24937 %U http://www.ncbi.nlm.nih.gov/pubmed/34076578 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e24156 %T Perceptions and Acceptability of a Smartphone App Intervention (ChildSafe) in Malaysia: Qualitative Exploratory Study %A Yong,Teresa Sui Mien %A Perialathan,Komathi %A Ahmad,Masitah %A Juatan,Nurashma %A Abdul Majid,Liana %A Johari,Mohammad Zabri %+ Institute for Health Behavioural Research, National Institutes of Health, Ministry of Health Malaysia, Block B3, No 1, Jalan Setia Murni U13/52, Section U13, Shah Alam, 40170, Malaysia, 60 333627600 ext 8612, teresa_yong@yahoo.co.uk %K child safety %K unintentional injuries %K consolidated framework for implementation research (CFIR) %K characteristics of individuals %K Mobile App Rating Scale (MARS) %D 2021 %7 1.6.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Home is a vulnerable place for accidental child injuries. Unintentional injuries are a leading cause of death, hospitalization, and disabilities. These injuries are considered preventable and if not tackled, they will continue to be a persisting problem. Smartphones have become increasingly important in our everyday life and is an important tool not only for communication but also for other purposes—they have apps that can be used for various purposes. Therefore, an app-based intervention (ChildSafe) was developed to assess and reduce child injury at home. Objective: This study aimed to evaluate the acceptance of the ChildSafe smartphone app intervention by parents/guardians. Methods: This study was conducted using a qualitative exploratory approach on selected participants of the ChildSafe intervention app study. A total of 27 semistructured in-depth interviews were carried out among parents or guardians who have at least one child between the age of 0 and 59 months in the area of Sungai Buloh, Selangor, between November 2017 and March 2018. Interview questions were developed from the consolidated framework for implementation research (CFIR). Interviews were recorded, transcribed verbatim, and data were thematically analyzed guided by CFIR. Results: The study revealed users’ perception on usability, feasibility, and acceptability toward the ChildSafe app. Three CFIR domains were identified: intervention characteristics, inner setting, and characteristics of individuals. A total of 5 constructs were revealed under intervention characteristics: evidence strength and quality, relative advantage, adaptability, trialability, and design quality and packaging; 2 under inner setting: implementation climate and readiness for implementation; and 4 under characteristics of individuals: knowledge and beliefs about the intervention, self-efficacy, individual stage of change, and other personal attributes. In general, participants felt the app is extremely useful and effective, easy to use, and purposeful in achieving home safety assessment via reminders. The app replaces the need for participants to search for information on home safety and dangers, as the app itself was designed as a tool to assess for this specific purpose. Even at the nascent stage and despite its limitations, the app has prompted users to consider and make changes around their own home. However, future versions of the app should be expanded to make it more attractive to users as it lacks interactive feedback and additional features. Conclusions: Parents/guardians are accepting the use of the ChildSafe app to prevent child injury at home. However, further expansion and improvements are needed to increase the acceptability of this app by parents/guardians. %M 34061039 %R 10.2196/24156 %U https://pediatrics.jmir.org/2021/2/e24156 %U https://doi.org/10.2196/24156 %U http://www.ncbi.nlm.nih.gov/pubmed/34061039 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e17858 %T Adequate Management of Phosphorus in Patients Undergoing Hemodialysis Using a Dietary Smartphone App: Prospective Pilot Study %A Fakih El Khoury,Cosette %A Crutzen,Rik %A Schols,Jos MGA %A Halfens,Ruud JG %A Karavetian,Mirey %+ Department of Health Sciences, Zayed University, Academic city PO Box 19282, Dubai, United Arab Emirates, 971 562446865, kmirey@gmail.com %K renal diet %K mhealth %K dietary app %D 2021 %7 1.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The renal diet is complex and requires alterations of the diet and careful monitoring of various nutrients. Elevated serum phosphorus is common among patients undergoing hemodialysis, and it is associated with many complications. Smartphone technology could be used to support both dietitians and patients by providing a source of accessible and reliable information. Objective: The aim of this pilot is to assess the potential efficacy of an intervention using the educational and self-monitoring mobile app KELA.AE on the phosphorous management in hemodialysis patients. Results will be used to improve both the app and a planned, rigorous large-scale trial intended to assess app efficacy. Methods: This is a prospective pilot study performed at the hemodialysis unit of Al Qassimi Hospital (Emirate of Sharjah, United Arab Emirates). All patients were assessed for eligibility and, based on inclusion criteria, considered for enrollment. Participants met with a dietitian once a week and used the mobile app regularly for 2 weeks. Outcomes (knowledge, self-reported nonadherence, dietary intake, anthropometry, and biochemical data) were measured. This pilot is reported as per guidelines for nonrandomized pilot and feasibility studies and in line with the CONSORT (Consolidated Standards of Reporting Trials) 2010 checklist for reporting pilot or feasibility trials. Results: Of 26 subjects, 23 successfully completed the pilot. Patient dietary knowledge about phosphorous management improved from 51.4% (SD 13.9) to 68.1% (SD 13.3) after intervention with a large effect size (d=1.22, 95% CI 0.59 to 1.85). Dietary protein intake increased from a mean of 0.9 g/kg (SD 0.3) per day to a mean of 1.3 g/kg (SD 0.5) per day with a large effect size (d=1.07, 95% CI 0.45 to 1.69). Phosphorus to protein ratio dropped from a mean of 18.4 mg/g protein to 13.5 mg/g protein with a large effect size (d=0.83, 95% CI 0.22 to 1.43). There was no evidence of change in phosphorous intake, self-reported nonadherence, and serum phosphorus. Conclusions: The findings of this prospective pilot reveal the potential efficacy of a smartphone app as a supportive nutrition education tool for phosphorus management in patients undergoing hemodialysis. This pilot study showed that the KELA.AE app has the potential to improve knowledge and dietary choices. A rigorous randomized controlled trial should be performed to evaluate the efficacy, assessing app use of a long-term intervention. %M 34061034 %R 10.2196/17858 %U https://formative.jmir.org/2021/6/e17858 %U https://doi.org/10.2196/17858 %U http://www.ncbi.nlm.nih.gov/pubmed/34061034 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e18410 %T Physical Activity Together for People With Multiple Sclerosis and Their Care Partners: Protocol for a Feasibility Randomized Controlled Trial of a Dyadic Intervention %A Fakolade,Afolasade %A Cameron,Julie %A McKenna,Odessa %A Finlayson,Marcia L %A Freedman,Mark S %A Latimer-Cheung,Amy E %A Pilutti,Lara A %+ School of Rehabilitation Therapy, Queen's University, Louise D Acton Building, 31 George Street, Kingston, ON, K7L 3N6, Canada, 1 613 533 6000 ext 77893, a.fakolade@queensu.ca %K multiple sclerosis %K advanced disability %K care partners %K physical activity %K dyadic intervention %K feasibility randomized controlled trial %D 2021 %7 1.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical activity (PA) is beneficial for all people; however, people affected by multiple sclerosis (MS) find regular PA challenging. These people may include individuals with advanced disabilities and their care partners. Objective: The objective of this study is to determine the feasibility of a dyadic PA intervention for people with advanced MS and their care partners. Methods: This study is a randomized controlled feasibility trial of a 12-week intervention, with 1:1 allocation into an immediate intervention condition or delayed control condition. A target of 20 people with MS–care partner dyads will be included. The outcomes will be indicators of process, resources, management, and scientific feasibility. Participant satisfaction with the intervention components will be evaluated using a satisfaction survey. The subjective experience of participation in the study will be explored using semistructured interviews. Results: The project is funded by the Consortium of Multiple Sclerosis Centers. This protocol was approved by the Ottawa Hospital Research Ethics Board (20190329-01H) and the University of Ottawa Research Ethics Board (H-09-19-4886). The study protocol was registered with ClinicalTrials.gov in February 2020. The findings of this feasibility trial will be disseminated through presentations at community events to engage the MS population in the interpretation of our results and in the next steps. The results will also be published in peer-reviewed journals and presented to the scientific community at national and international MS conferences. Conclusions: The data collected from this feasibility trial will be used to refine the intervention and materials in preparation for a pilot randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04267185; https://clinicaltrials.gov/ct2/show/NCT04267185. International Registered Report Identifier (IRRID): PRR1-10.2196/18410 %M 34061040 %R 10.2196/18410 %U https://www.researchprotocols.org/2021/6/e18410 %U https://doi.org/10.2196/18410 %U http://www.ncbi.nlm.nih.gov/pubmed/34061040 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26282 %T Perceptions of Mobile Health Apps and Features to Support Psychosocial Well-being Among Frontline Health Care Workers Involved in the COVID-19 Pandemic Response: Qualitative Study %A Yoon,Sungwon %A Goh,Hendra %A Nadarajan,Gayathri Devi %A Sung,Sharon %A Teo,Irene %A Lee,Jungup %A Ong,Marcus E H %A Graves,Nicholas %A Teo,Tess Lin %+ Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore, , Singapore, 65 66013198, sungwon.yoon@duke-nus.edu.sg %K COVID-19 %K frontline health care workers %K mHealth %K well-being %K psychosocial %D 2021 %7 31.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Frontline health care workers are experiencing a myriad of physical and psychosocial challenges amid the COVID-19 pandemic. There is growing recognition that digital technologies have the potential to improve the well-being of frontline workers. However, there has been limited development of wellness interventions using mobile health (mHealth) technology. More importantly, little research has been conducted on how frontline workers perceive mHealth-based support to promote their well-being. Objective: This study aimed to explore frontline workers’ experience of conventional psychological wellness programs and their perceptions of the usefulness of mHealth apps and features for promoting well-being. It also sought to identify factors that could potentially influence uptake and retention of an mHealth-based wellness program. Methods: We conducted semistructured interviews using purposive sampling with frontline workers involved in the COVID-19 response. Various visual materials, collated from existing mHealth app features, were presented to facilitate discussion. Interviews were audio-recorded and transcribed verbatim. Thematic analysis based on grounded theory was undertaken. Themes were subsequently mapped to key nudge strategies—those commonly used for mHealth development—to assess participants’ preferences for particular features and their reasoning. Results: A total of 42 frontline workers participated in 12 one-on-one interviews or focus group discussions. Frontline workers generally had a limited ability to identify their own psychological problems and liked the reminders functionality of the app to track their mood over time. A personalized goal-setting feature (ie, tailoring) and in-app resources were generally valued, while frequent coaching and messages (ie, framing) were seen as a distraction. The majority of participants desired a built-in chat function with a counselor (ie, guidance) for reasons of accessibility and protection of privacy. Very few participants appreciated a gamification function. Frontline workers commonly reported the need for ongoing social support and desired access to an in-app peer support community (ie, social influence). There were, however, concerns regarding potential risks from virtual peer interactions. Intrinsic motivational factors, mHealth app technicality, and tangible rewards were identified as critical for uptake and retention. Conclusions: Our study highlights the potential of mHealth apps with relevant features to be used as wellness tools by frontline health care workers. Future work should focus on developing a nonintrusive and personalized mHealth app with in-app counseling, peer support to improve well-being, and tangible and extrinsic rewards to foster continued use. %M 33979296 %R 10.2196/26282 %U https://www.jmir.org/2021/5/e26282 %U https://doi.org/10.2196/26282 %U http://www.ncbi.nlm.nih.gov/pubmed/33979296 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e18261 %T A Clinician-Controlled Just-in-time Adaptive Intervention System (CBT+) Designed to Promote Acquisition and Utilization of Cognitive Behavioral Therapy Skills in Bulimia Nervosa: Development and Preliminary Evaluation Study %A Juarascio,Adrienne %A Srivastava,Paakhi %A Presseller,Emily %A Clark,Kelsey %A Manasse,Stephanie %A Forman,Evan %+ Center for Weight, Eating and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton Hall, Suite 232, Philadelphia, PA, 19104, United States, 1 2678156511, ps887@drexel.edu %K eating disorders %K telemedicine %K mobile phone %K smartphone %K technology %K cognitive behavioral therapy %D 2021 %7 31.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Cognitive behavioral therapy (CBT) for bulimia nervosa (BN) is most effective when patients demonstrate adequate skill utilization (ie, the frequency with which a patient practices or uses therapeutic skills) and skill acquisition (ie, the ability to successfully perform a skill learned in treatment). However, rates of utilization and acquisition of key treatment skills (eg, regular eating, urge management skills, and mood management skills) by the end of the treatment are frequently low; as a result, outcomes from CBT for BN are affected. Just-in-time adaptive interventions (JITAIs) may improve skill acquisition and utilization by delivering real-time interventions during algorithm-identified opportunities for skill practice. Objective: In this manuscript, we describe a newly developed JITAI system called CBT+ that is designed to facilitate the acquisition and utilization of CBT for BN treatment skills when used as a treatment augmentation. We also present feasibility, acceptability, and preliminary outcomes data from a small proof-of-concept pilot trial (n=5 patients and n=3 clinicians) designed to identify opportunities for iterative development of CBT+ ahead of a larger ongoing randomized controlled trial. Methods: A total of 5 individuals with BN received 16 sessions of outpatient CBT for BN while using the CBT+ app. Data were collected from patients and clinicians to evaluate the feasibility (eg, app use and user adherence), acceptability (eg, qualitative patient and clinician feedback, including usefulness ratings of CBT+ on a 6-point Likert scale ranging from 1=extremely useless to 6=extremely useful), and preliminary outcomes (eg, improvements in skill utilization and acquisition and BN symptoms) of the CBT+ system. Results: Patients reported that CBT+ was a relatively low burden (eg, quick and easy-to-use self-monitoring interface), and adherence to in-app self-monitoring was high (mean entries per day 3.13, SD 1.03). JITAIs were perceived as useful by both patients (median rating 5/6) and clinicians (median rating 5/6) for encouraging the use of CBT skills. Large improvements in CBT skills and clinically significant reductions in BN symptoms were observed post treatment. Although preliminary findings indicated that the CBT+ system was acceptable to most patients and clinicians, the overall study dropout was relatively high (ie, 2/5, 40% patients), which could indicate some moderate concerns regarding feasibility. Conclusions: CBT+, the first-ever JITAI system designed to facilitate the acquisition and utilization of CBT for BN treatment skills when used as a treatment augmentation, was shown to be feasible and acceptable. The results indicate that the CBT+ system should be subjected to more rigorous evaluations with larger samples and should be considered for wider implementation if found effective. Areas for iterative improvement of the CBT+ system ahead of a randomized controlled trial are also discussed. %M 34057416 %R 10.2196/18261 %U https://formative.jmir.org/2021/5/e18261 %U https://doi.org/10.2196/18261 %U http://www.ncbi.nlm.nih.gov/pubmed/34057416 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e27965 %T Engagement and Effectiveness of a Healthy-Coping Intervention via Chatbot for University Students During the COVID-19 Pandemic: Mixed Methods Proof-of-Concept Study %A Gabrielli,Silvia %A Rizzi,Silvia %A Bassi,Giulia %A Carbone,Sara %A Maimone,Rosa %A Marchesoni,Michele %A Forti,Stefano %+ Digital Health Lab, Fondazione Bruno Kessler, Via Sommarive 18, Trento, 38123, Italy, 39 0461 312 47 ext 247, sgabrielli@fbk.eu %K mobile mental health %K chatbots %K anxiety %K stress %K university students %K digital health %K healthy-coping intervention %K COVID-19 %D 2021 %7 28.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: University students are increasingly reporting common mental health problems, such as stress, anxiety, and depression, and they frequently face barriers to seeking psychological support because of stigma, cost, and availability of mental health services. This issue is even more critical in the challenging time of the COVID-19 pandemic. Digital mental health interventions, such as those delivered via chatbots on mobile devices, offer the potential to achieve scalability of healthy-coping interventions by lowering cost and supporting prevention. Objective: The goal of this study was to conduct a proof-of-concept evaluation measuring the engagement and effectiveness of Atena, a psychoeducational chatbot supporting healthy coping with stress and anxiety, among a population of university students. Methods: In a proof-of-concept study, 71 university students were recruited during the COVID-19 pandemic; 68% (48/71) were female, they were all in their first year of university, and their mean age was 20.6 years (SD 2.4). Enrolled students were asked to use the Atena psychoeducational chatbot for 4 weeks (eight sessions; two per week), which provided healthy-coping strategies based on cognitive behavioral therapy, positive psychology, and mindfulness techniques. The intervention program consisted of conversations combined with audiovisual clips delivered via the Atena chatbot. Participants were asked to complete web-based versions of the 7-item Generalized Anxiety Disorder scale (GAD-7), the 10-item Perceived Stress Scale (PSS-10), and the Five-Facet Mindfulness Questionnaire (FFMQ) at baseline and postintervention to assess effectiveness. They were also asked to complete the User Engagement Scale–Short Form at week 2 to assess engagement with the chatbot and to provide qualitative comments on their overall experience with Atena postintervention. Results: Participants engaged with the Atena chatbot an average of 78 (SD 24.8) times over the study period. A total of 61 out of 71 (86%) participants completed the first 2 weeks of the intervention and provided data on engagement (10/71, 14% attrition). A total of 41 participants out of 71 (58%) completed the full intervention and the postintervention questionnaires (30/71, 42% attrition). Results from the completer analysis showed a significant decrease in anxiety symptoms for participants in more extreme GAD-7 score ranges (t39=0.94; P=.009) and a decrease in stress symptoms as measured by the PSS-10 (t39=2.00; P=.05) for all participants postintervention. Participants also improved significantly in the describing and nonjudging facets, based on their FFMQ subscale scores, and asked for some improvements in the user experience with the chatbot. Conclusions: This study shows the benefit of deploying a digital healthy-coping intervention via a chatbot to support university students experiencing higher levels of distress. While findings collected during the COVID-19 pandemic show promise, further research is required to confirm conclusions. %M 33950849 %R 10.2196/27965 %U https://mhealth.jmir.org/2021/5/e27965 %U https://doi.org/10.2196/27965 %U http://www.ncbi.nlm.nih.gov/pubmed/33950849 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e24076 %T Examining the Impact of a Mobile Health App on Functional Movement and Physical Fitness: Pilot Pragmatic Randomized Controlled Trial %A Stork,Matthew Jordan %A Bell,Ethan Gordon %A Jung,Mary Elizabeth %+ School of Health and Exercise Sciences, The University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1VY, Canada, 1 250 807 9670, mary.jung@ubc.ca %K mHealth %K functional movement %K flexibility %K strength %K cardiovascular fitness %D 2021 %7 28.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Numerous mobile apps available for download are geared toward health and fitness; however, limited research has evaluated the real-world effectiveness of such apps. The movr app is a mobile health app designed to enhance physical functioning by prescribing functional movement training based on individualized movement assessments. The influence of the movr app on functional movement and physical fitness (flexibility, strength, and cardiovascular fitness) has not yet been established empirically. Objective: This study aims to examine the real-world impact of the movr app on functional movement, flexibility, strength, and cardiovascular fitness. Methods: A total of 48 healthy adults (24 women and 24 men; mean age 24, SD 5 years) completed an 8-week pilot pragmatic randomized controlled trial in which they were randomly assigned to either 8-week use of the movr app (n=24) or 8-week waitlist control (n=24). Measures of functional movement (Functional Movement Screen [FMS]), strength (push-ups, handgrip strength, and countermovement jump), flexibility (shoulder flexibility, sit and reach, active straight leg raise [ASLR], and half-kneeling dorsiflexion), and cardiovascular fitness (maximal oxygen uptake []) were collected at baseline and the 8-week follow-up. Results: Repeated measures analyses of variance revealed significant group-by-time interactions for the 100-point FMS (P<.001), shoulder flexibility (P=.01), ASLR (P=.001), half-kneeling dorsiflexion (P<.001), and push-up tests (P=.03). Pairwise comparisons showed that FMS scores increased from pre- to postintervention for those in the movr group (P<.001) and significantly decreased for those in the control group (P=.04). For shoulder flexibility, ASLR, half-kneeling dorsiflexion, and push-up tests, improvements from pre- to postintervention were found in the movr group (all values of P<.05) but not in the control group (all values of P>.05). There were no changes in the sit and reach or handgrip strength test scores for either group (all values of P>.05). A significant main effect of time was found for the countermovement jump (P=.02), such that scores decreased from pre- to postintervention in the control group (P=.02) but not in the movr group (P=.38). Finally, a significant group-by-time interaction was found for (P=.001), revealing that scores decreased pre- to postintervention in the control group (P<.001), but not in the movr group (P=.54). Conclusions: The findings revealed that movr improved indices of functional movement (FMS), flexibility (shoulder, ASLR, and dorsiflexion), and muscular endurance (push-ups) over an 8-week period compared with the control group while maintaining handgrip strength, lower body power (countermovement jump), and cardiovascular fitness (). Thus, this study provides initial evidence of the effectiveness of the movr app for enhancing functional movement and physical fitness among healthy adults. Trial Registration: ClinicalTrials.gov NCT04865666; https://clinicaltrials.gov/ct2/show/NCT04865666 %M 34047704 %R 10.2196/24076 %U https://mhealth.jmir.org/2021/5/e24076 %U https://doi.org/10.2196/24076 %U http://www.ncbi.nlm.nih.gov/pubmed/34047704 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e23411 %T Use of Fitbit Devices in Physical Activity Intervention Studies Across the Life Course: Narrative Review %A St Fleur,Ruth Gaelle %A St George,Sara Mijares %A Leite,Rafael %A Kobayashi,Marissa %A Agosto,Yaray %A Jake-Schoffman,Danielle E %+ Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, United States, 1 305 2432000, s.stgeorge@med.miami.edu %K physical activity %K Fitbit %K eHealth %K life course %K mobile phone %D 2021 %7 28.5.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Commercial off-the-shelf activity trackers (eg, Fitbit) allow users to self-monitor their daily physical activity (PA), including the number of steps, type of PA, amount of sleep, and other features. Fitbits have been used as both measurement and intervention tools. However, it is not clear how they are being incorporated into PA intervention studies, and their use in specific age groups across the life course is not well understood. Objective: This narrative review aims to characterize how PA intervention studies across the life course use Fitbit devices by synthesizing and summarizing information on device selection, intended use (intervention vs measurement tool), participant wear instructions, rates of adherence to device wear, strategies used to boost adherence, and the complementary use of other PA measures. This review provides intervention scientists with a synthesis of information that may inform future trials involving Fitbit devices. Methods: We conducted a search of the Fitabase Fitbit Research Library, a database of studies published between 2012 and 2018. Of the 682 studies available on the Fitabase research library, 60 interventions met the eligibility criteria and were included in this review. A supplemental search in PubMed resulted in the inclusion of 15 additional articles published between 2019 and 2020. A total of 75 articles were reviewed, which represented interventions conducted in childhood; adolescence; and early, middle, and older adulthood. Results: There was considerable heterogeneity in the use of Fitbit within and between developmental stages. Interventions for adults typically required longer wear periods, whereas studies on children and adolescents tended to have more limited device wear periods. Most studies used developmentally appropriate behavior change techniques and device wear instructions. Regardless of the developmental stage and intended Fitbit use (ie, measurement vs intervention tool), the most common strategies used to enhance wear time included sending participants reminders through texts or emails and asking participants to log their steps or synchronize their Fitbit data daily. The rates of adherence to the wear time criteria were reported using varying metrics. Most studies supplemented the use of Fitbit with additional objective or self-reported measures for PA. Conclusions: Overall, the heterogeneity in Fitbit use across PA intervention studies reflects its relative novelty in the field of research. As the use of monitoring devices continues to expand in PA research, the lack of uniformity in study protocols and metrics of reported measures represents a major issue for comparability purposes. There is a need for increased transparency in the prospective registration of PA intervention studies. Researchers need to provide a clear rationale for the use of several PA measures and specify the source of their main PA outcome and how additional measures will be used in the context of Fitbit-based interventions. %M 34047705 %R 10.2196/23411 %U https://mhealth.jmir.org/2021/5/e23411 %U https://doi.org/10.2196/23411 %U http://www.ncbi.nlm.nih.gov/pubmed/34047705 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e26110 %T Person-Generated Health Data in Women’s Health: Protocol for a Scoping Review %A Karim,Jalisa Lynn %A Talhouk,Aline %+ Department of Obstetrics and Gynecology, University of British Columbia, 593-828 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada, 1 604 875 4111, a.talhouk@ubc.ca %K digital health %K women’s health %K mobile health %K health app %K wearables %K femtech %K self-tracking %K personalized health %K person-generated health data %K patient-generated health data %K scoping review %D 2021 %7 28.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Due to their ability to collect person-generated health data, digital tools and connected health devices may hold great utility in disease prevention, chronic disease self-monitoring and self-tracking, as well as in tailoring information and educational content to fit individual needs. Facilitators and barriers to the use of digital health technologies vary across demographics, including sex. The “femtech” market is growing rapidly, and women are some of the largest adopters of digital health technologies. Objective: This paper aims to provide the background and methods for conducting a scoping review on the use of person-generated health data from connected devices in women’s health. The objectives of the scoping review are to identify the various contexts of digital technologies in women’s health and to consolidate women’s views on the usability and acceptability of the devices. Methods: Searches were conducted in the following databases: Medline, Embase, APA PsycInfo, CINAHL Complete, and Web of Science Core Collection. We included articles from January 2015 to February 2020. Screening of articles was done independently by at least two authors in two stages. Data charting is being conducted in duplicate. Results will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. Results: Our search identified 9102 articles after deduplication. As of November 2020, the full-text screening stage is almost complete and data charting is in progress. The scoping review is expected to be completed by Fall 2021. Conclusions: This scoping review will broadly map the literature regarding the contexts and acceptability of digital health tools for women. The results from this review will be useful in guiding future digital health and women’s health research. International Registered Report Identifier (IRRID): DERR1-10.2196/26110 %M 34047708 %R 10.2196/26110 %U https://www.researchprotocols.org/2021/5/e26110 %U https://doi.org/10.2196/26110 %U http://www.ncbi.nlm.nih.gov/pubmed/34047708 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 5 %P e25708 %T Social Representations of e-Mental Health Among the Actors of the Health Care System: Free-Association Study %A Morgiève,Margot %A Mesdjian,Pierre %A Las Vergnas,Olivier %A Bury,Patrick %A Demassiet,Vincent %A Roelandt,Jean-Luc %A Sebbane,Déborah %+ WHO Collaborating Centre for Research and Training in Mental Health, EPSM Lille Metropole, 211 rue Roger Salengro, Hellemmes, 59260, France, 33 320437100, deborah.sebbane@ghtpy-npdc.fr %K e-mental health %K social representations %K free association task %K psychiatry %K mental health %K mental health service users %K technology %K digital health %D 2021 %7 27.5.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Electronic mental (e-mental) health offers an opportunity to overcome many challenges such as cost, accessibility, and the stigma associated with mental health, and most people with lived experiences of mental problems are in favor of using applications and websites to manage their mental health problems. However, the use of these new technologies remains weak in the area of mental health and psychiatry. Objective: This study aimed to characterize the social representations associated with e-mental health by all actors to implement new technologies in the best possible way in the health system. Methods: A free-association task method was used. The data were subjected to a lexicometric analysis to qualify and quantify words by analyzing their statistical distribution, using the ALCESTE method with the IRaMuTeQ software. Results: In order of frequency, the terms most frequently used to describe e-mental health in the whole corpus are: “care” (n=21), “internet” (n=21), “computing” (n=15), “health” (n=14), “information” (n=13), “patient” (n=12), and “tool” (n=12). The corpus of text is divided into 2 themes, with technological and computing terms on one side and medical and public health terms on the other. The largest family is focused on “care,” “advances,” “research,” “life,” “quality,” and “well-being,” which was significantly associated with users. The nursing group used very medical terms such as “treatment,” “diagnosis,” “psychiatry”,” and “patient” to define e-mental health. Conclusions: This study shows that there is a gap between the representations of users on e-mental health as a tool for improving their quality of life and those of health professionals (except nurses) that are more focused on the technological potential of these digital care tools. Developers, designers, clinicians, and users must be aware of the social representation of e-mental health conditions uses and intention of use. This understanding of everyone’s stakes will make it possible to redirect the development of tools to adapt them as much as possible to the needs and expectations of the actors of the mental health system. %M 34042591 %R 10.2196/25708 %U https://mental.jmir.org/2021/5/e25708 %U https://doi.org/10.2196/25708 %U http://www.ncbi.nlm.nih.gov/pubmed/34042591 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 5 %P e27400 %T A Web-Based Group Cognitive Behavioral Therapy Intervention for Symptoms of Anxiety and Depression Among University Students: Open-Label, Pragmatic Trial %A Bantjes,Jason %A Kazdin,Alan E %A Cuijpers,Pim %A Breet,Elsie %A Dunn-Coetzee,Munita %A Davids,Charl %A Stein,Dan J %A Kessler,Ronald C %+ Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch, 7602, South Africa, 27 832345554, jbantjes@sun.ac.za %K anxiety %K cognitive behavioral therapy %K depression %K e-intervention %K group therapy %K web-based %K university students %K South Africa %D 2021 %7 27.5.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Anxiety and depression are common among university students, and university counseling centers are under pressure to develop effective, novel, and sustainable interventions that engage and retain students. Group interventions delivered via the internet could be a novel and effective way to promote student mental health. Objective: We conducted a pragmatic open trial to investigate the uptake, retention, treatment response, and level of satisfaction with a remote group cognitive behavioral therapy intervention designed to reduce symptoms of anxiety and depression delivered on the web to university students during the COVID-19 pandemic. Methods: Preintervention and postintervention self-reported data on anxiety and depression were collected using the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. Satisfaction was assessed postintervention using the Client Satisfaction with Treatment Questionnaire. Results: A total of 175 students were enrolled, 158 (90.3%) of whom initiated treatment. Among those initiating treatment, 86.1% (135/158) identified as female, and the mean age was 22.4 (SD 4.9) years. The mean number of sessions attended was 6.4 (SD 2.8) out of 10. Among participants with clinically significant symptoms at baseline, mean symptom scores decreased significantly for anxiety (t56=11.6; P<.001), depression (t61=7.8; P<.001), and composite anxiety and depression (t60=10.7; P<.001), with large effect sizes (d=1-1.5). Remission rates among participants with clinically significant baseline symptoms were 67.7%-78.9% and were not associated with baseline symptom severity. High overall levels of satisfaction with treatment were reported. Conclusions: The results of this study serve as a proof of concept for the use of web-based group cognitive behavioral therapy to promote the mental health of university students. %M 34042598 %R 10.2196/27400 %U https://mental.jmir.org/2021/5/e27400 %U https://doi.org/10.2196/27400 %U http://www.ncbi.nlm.nih.gov/pubmed/34042598 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e26037 %T Associations Between Rural or Urban Status, Health Outcomes and Behaviors, and COVID-19 Perceptions Among Meditation App Users: Longitudinal Survey Study %A Bhuiyan,Nishat %A Puzia,Megan %A Stecher,Chad %A Huberty,Jennifer %+ College of Health Solutions, Arizona State University, 500 North 3rd Street, Phoenix, AZ, 85004, United States, 1 480 406 2644, nbhuiyan@asu.edu %K mHealth %K rural health %K physical activity %K mental health %K COVID-19 %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Rural and urban differences in health outcomes and behaviors have been well-documented, with significant rural health disparities frequently highlighted. Mobile health (mHealth) apps, such as meditation apps, are a novel method for improving health and behaviors. These apps may be a critical health promotion strategy during the COVID-19 pandemic and could potentially be used to address rural health disparities. However, limited research has assessed whether meditation app health outcomes are associated with rural and urban residence, and it is unclear whether disparities in health and behaviors between rural and urban populations would persist among meditation app users. Objective: We aimed to explore associations between rural or urban status, psychological outcomes, and physical activity among users of a mobile meditation app. We further aimed to explore associations between rural or urban status and perceived effects of COVID-19 on stress, mental health, and physical activity, and to explore changes in these outcomes in rural versus urban app users over time. Methods: This study was a secondary analysis of a national survey conducted among subscribers to the meditation app Calm. Eligible participants completed online baseline surveys from April to June 2020, and follow-up surveys from June to September 2020, assessing demographics, psychological outcomes, physical activity, and perceived effects of COVID-19 on stress, mental health, and physical activity. Results: Participants (N=8392) were mostly female (7041/8392, 83.9%), non-Hispanic (7855/8392, 93.6%), and White (7704/8392, 91.8%); had high socioeconomic status (income ≥US $100,000: 4389/8392, 52.3%; bachelor’s degree or higher: 7251/8392, 86.4%); and resided in a metropolitan area core (rural-urban commuting area code 1: 7192/8392, 85.7%). Rural or urban status was not associated with baseline stress, depression, anxiety, pre–COVID-19 and current physical activity, or perceived effects of COVID-19 on stress, mental health, and physical activity. Repeated-measures models showed overall decreases in depression, anxiety, and perceived effects of COVID-19 on physical activity from baseline to follow-up, and no significant changes in stress or perceived effects of COVID-19 on stress and mental health over time. Models also showed no significant main effects of rural or urban status, COVID-19 statewide prevalence at baseline, or change in COVID-19 statewide prevalence. Conclusions: We did not find associations between rural or urban status and psychological outcomes (ie, stress, depression, and anxiety), physical activity, or perceived effects of COVID-19 on stress, mental health, and physical activity. Rural or urban status does not appear to drive differences in outcomes among meditation app users, and the use of mHealth apps should continue to be explored as a health promotion strategy in both rural and urban populations. Furthermore, our results did not show negative cumulative effects of COVID-19 on psychological outcomes and physical activity among app users in our sample, the majority of whom were urban, White, female, and of high socioeconomic status. Further research is needed to investigate meditation app use as a health promotion strategy in rural and urban populations. %M 33900930 %R 10.2196/26037 %U https://mhealth.jmir.org/2021/5/e26037 %U https://doi.org/10.2196/26037 %U http://www.ncbi.nlm.nih.gov/pubmed/33900930 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 1 %P e24653 %T Assessing Sunscreen Protection Using UV Photography: Descriptive Study %A Horsham,Caitlin %A Ford,Helen %A Herbert,Jeremy %A Wall,Alexander %A Walpole,Sebastian %A Hacker,Elke %+ School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, 4059, Australia, 61 731389674, elke.hacker@qut.edu.au %K skin neoplasms %K melanoma %K health promotion %K public health %K preventive medicine %K sunburn %K sunscreening agents %K UV photography %K mobile phone %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Dermatol %G English %X Background: Photography using a UV transmitting filter allows UV light to pass and can be used to illuminate UV blocking lotions such as sunscreens. Objective: The aim of this study is to compare currently available UV photography cameras and assess whether these devices can be used as visualization tools for adequate coverage of sun protection lotions. Methods: This study was conducted in 3 parts: in phase 1, 3 different UV cameras were tested; in phase 2, we explored whether UV photography could work on a range of sun protection products; and in phase 3, a UV webcam was developed and was field-tested in a beach setting. In phase 1, volunteers were recruited, and researchers applied 3 sun protection products (ranging from sun protection factor [SPF] 15 to 50+) to the participants’ faces and arms. UV photography was performed using 3 UV cameras, and the subsequent images were compared. In phase 2, volunteers were recruited and asked to apply their own SPF products to their faces in their usual manner. UV photographs were collected in the morning and afternoon to assess whether the coverage remained over time. Qualitative interviews were conducted to assess the participants’ level of satisfaction with the UV image. In phase 3, a small portable UV webcam was designed using a plug-and-play approach to enable the viewing of UV images on a larger screen. The developed webcam was deployed at a public beach setting for use by the public for 7 days. Results: The 3 UV camera systems tested during phase 1 identified the application of a range of sun protection lotions of SPF 15 to 50+. The sensitivity of the UV camera devices was shown to be adequate, with SPF-containing products applied at concentrations of 2 and 1 mg/cm2 clearly visible and SPF-containing products applied at a concentration of 0.4 mg/cm2 having lower levels of coverage. Participants in phase 2 reported high satisfaction with the UV photography images, with 83% (29/35) of participants likely to use UV photography in the future. During phase 2, it was noted that many participants used tinted SPF-containing cosmetics, and several tinted products were further tested. However, it was observed that UV photography could not identify the areas missed for all tinted products. During phase 3, the electrical components of the UV webcam remained operational, and the camera was used 233 times by the public during field-testing. Conclusions: In this study, we found that UV photography could identify the areas missed by sun protection lotions with chemical filters, and participants were engaged with personalized feedback. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619000975190; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377089 ; Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619000145101; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376672. %M 37632801 %R 10.2196/24653 %U https://derma.jmir.org/2021/1/e24653 %U https://doi.org/10.2196/24653 %U http://www.ncbi.nlm.nih.gov/pubmed/37632801 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e25078 %T Changes in Perceived Stress Following a 10-Week Digital Mindfulness-Based Stress Reduction Program: Retrospective Study %A Venkatesan,Aarathi %A Krymis,Holly %A Scharff,Jenny %A Waber,Art %+ Vida Health, 100 Montgomery St #750, San Francisco, CA, 94104, United States, 1 (415) 989 1017, aarathi.venkatesan@vida.com %K perceived stress %K health coaching %K digital mental health intervention %K digital therapeutics %K mobile phone %D 2021 %7 25.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As the need for effective scalable interventions for mental health conditions such as depression, anxiety, and stress has grown, the digital delivery of mindfulness-based stress reduction (MBSR) has gained interest as a promising intervention in this domain. Objective: This study aims to evaluate the changes in perceived stress following a 10-week digital MBSR program that combined an app-based digital program with weekly one-on-one remote sessions with a health coach. Methods: This study used a retrospective, observational design. A total of 229 participants with moderate-to-high perceived stress scores as assessed by the Perceived Stress Scale (PSS)-10 enrolled in the 10-week Vida Health MBSR program. The program included weekly remote sessions with a certified health coach and digital content based on concepts fundamental to mindfulness practice. The PSS-10 was used to evaluate perceived stress. Of the 229 participants, 131 (57.2%) were considered program completers and provided at least one follow-up PSS-10. A secondary analysis examined the changes in stress scores at 6 months. This analysis was restricted to participants who had been enrolled in the program for at least 6 months (n=121). To account for random and fixed effects, linear mixed effects modeling was used to assess changes in stress scores over time. An intention-to-treat approach was used to evaluate the changes in perceived stress across the entire study cohort, including those who were lost to follow-up. In addition, a reliable change index was computed to evaluate the changes in scores from the baseline. Results: The findings revealed a significant positive association between program time and stress reduction (B=−0.365; P<.001) at 12 weeks. We observed an average reduction in stress scores of 3.17 points (95% CI −3.93 to −2.44) by program week 6 and 4.86 points (95% CI −5.86 to −3.85) by program week 12. Overall, 83.2% (109/131) of participants showed a reduction in stress scores by week 12, with 40.5% (53/131) of participants showing reliable improvement at 12 weeks and 47.8% (56/131) of participants showing a shift to a lower stress level category (ie, moderate-to-low stress). The intention-to-treat analysis revealed a significant, although attenuated, reduction in stress scores at 12 weeks (B=−0.23; P<.001). Participants who completed more lessons had an increased likelihood of moving down at least one stress level category (odds ratio 1.512, 95% CI 1.056 to 2.166; P=.02). In assessing medium-term outcomes, among participants who had completed at least 6 months in the program, 48.8% (59/121) of members provided a 6-month assessment. We observed a significant reduction in stress scores at 6 months (t58=10.24; P<.001), with 61% (36/59) of participants showing reliable improvement. Conclusions: The findings of this retrospective, observational study suggest that a blended, digital mindfulness-based intervention may support program uptake and meaningful, sustained reduction in stress outcomes. %M 34032571 %R 10.2196/25078 %U https://formative.jmir.org/2021/5/e25078 %U https://doi.org/10.2196/25078 %U http://www.ncbi.nlm.nih.gov/pubmed/34032571 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e26716 %T A Nurse Case Management HIV Prevention Intervention (Come As You Are) for Youth Experiencing Homelessness: Protocol for a Randomized Wait-list Controlled Trial %A Santa Maria,Diane %A Lightfoot,Marguerita %A Nyamathi,Adey %A Businelle,Michael %A Paul,Mary %A Quadri,Yasmeen %A Padhye,Nikhil %A Jones,Jennifer %A Calvo Armijo,Margarita %+ Cizik School of Nursing, University of Texas Health Science Center at Houston, 6901 Bertner Ave, Houston, TX, 77030, United States, 1 713 500 2190, diane.m.santamaria@uth.tmc.edu %K HIV prevention %K nurse case management %K motivational interviewing %K homelessness %K youth %K just-in-time-adaptive intervention %K ecological momentary assessment %D 2021 %7 21.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Youth experiencing homelessness are more likely than housed youth to experience premature death, suicide, drug overdose, pregnancy, substance use, and mental illness. Yet while youth experiencing homelessness are 6 to 12 times more likely to become infected with HIV than housed youth, with HIV prevalence as high as 16%, many do not access the prevention services they need. Despite adversities, youth experiencing homelessness are interested in health promotion programs, can be recruited and retained in interventions and research studies, and demonstrate improved outcomes when programs are tailored and relevant to them. Objective: The study aims to compare the efficacy of a nurse case management HIV prevention and care intervention, titled Come As You Are, with that of usual care among youth experiencing homelessness aged 16 to 25 years. Methods: The study is designed as a 2-armed randomized wait-list controlled trial. Participants (n=450) will be recruited and followed up for 9 months after the intervention for a total study period of 12 months. Come As You Are combines nurse case management with a smartphone-based daily ecological momentary assessment to develop participant-driven HIV prevention behavioral goals that can be monitored in real-time. Youth in the city of Houston, Texas will be recruited from drop-in centers, shelters, street outreach programs, youth-serving organizations, and clinics. Results: Institutional review board approval (Committee for the Protection of Human Subjects, University of Texas Health Science Center at Houston) was obtained in November 2018. The first participant was enrolled in November 2019. Data collection is ongoing. To date, 123 participants have consented to participate in the study, 89 have been enrolled, and 15 have completed their final follow-up. Conclusions: There is a paucity of HIV prevention research regarding youth experiencing homelessness. Novel and scalable interventions that address the full continuum of behavioral and biomedical HIV prevention are needed. This study will determine whether a personalized and mobile HIV prevention approach can reduce HIV risk among a hard-to-reach, transient population of youth at high risk. International Registered Report Identifier (IRRID): DERR1-10.2196/26716 %M 34018967 %R 10.2196/26716 %U https://www.researchprotocols.org/2021/5/e26716 %U https://doi.org/10.2196/26716 %U http://www.ncbi.nlm.nih.gov/pubmed/34018967 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e26152 %T Efficacy of Zemedy, a Mobile Digital Therapeutic for the Self-management of Irritable Bowel Syndrome: Crossover Randomized Controlled Trial %A Hunt,Melissa %A Miguez,Sofia %A Dukas,Benji %A Onwude,Obinna %A White,Sarah %+ Department of Psychology, University of Pennsylvania, 425 S University Ave, Levin Building, Philadelphia, PA, 19104-6018, United States, 1 2158986478, mhunt@psych.upenn.edu %K digital health %K irritable bowel syndrome %K cognitive behavioral therapy %K CBT %K efficacy %K mHealth %K self-management %K IBS %K randomized controlled trial %K app %D 2021 %7 20.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Patients with irritable bowel syndrome (IBS) experience abdominal pain, altered bowel habits, and defecation-related anxiety, which can result in reduced productivity and impaired health-related quality of life (HRQL). Cognitive behavioral therapy (CBT) has been shown to reduce symptoms of IBS and to improve HRQL, but access to qualified therapists is limited. Smartphone-based digital therapeutic interventions have potential to increase access to guided CBT at scale, but require careful study to assess their benefits and risks. Objective: The aim of this study was to test the efficacy of a novel app, Zemedy, as a mobile digital therapeutic that delivers a comprehensive CBT program to individuals with IBS. Methods: This was a crossover randomized controlled trial. Participants were recruited online and randomly allocated to either immediate treatment (n=62) or waitlist control (n=59) groups. The Zemedy app consists of 8 modules focusing on psychoeducation, relaxation training, exercise, the cognitive model of stress management, applying CBT to IBS symptoms, reducing avoidance through exposure therapy, behavioral experiments, and information about diet. Users interact with a chatbot that presents the information and encourages specific plans, homework, and exercises. The treatment was fully automated, with no therapist involvement or communication. At baseline and after 8 weeks, participants were asked to complete the battery of primary (Irritable Bowel Syndrome Quality of Life [IBS-QOL], Gastrointestinal Symptom Rating Scale [GSRS]) and secondary (Fear of Food Questionnaire [FFQ], Visceral Sensitivity Index [VSI], Gastrointestinal Cognition Questionnaire [GI-COG], Depression Anxiety Stress Scale [DASS], and Patient Health Questionnaire-9 [PHQ-9]) outcome measures. Waitlist controls were then offered the opportunity to crossover to treatment. All participants were assessed once more at 3 months posttreatment. Results: Both intention-to-treat and completer analyses at posttreatment revealed significant improvement for the immediate treatment group compared to the waitlist control group on both primary and secondary outcome measures. Gains were generally maintained at 3 months posttreatment. Scores on the GSRS, IBS-QoL, GI-COG, VSI, and FFQ all improved significantly more in the treatment group (F1,79=20.49, P<.001, Cohen d=1.01; F1,79=20.12, P<.001, d=1.25; F1,79=34.71, P<.001, d=1.47; F1,79=18.7, P<.001, d=1.07; and F1,79=12.13, P=.001, d=0.62, respectively). Depression improved significantly as measured by the PHQ-9 (F1,79=10.5, P=.002, d=1.07), and the DASS Depression (F1,79=6.03, P=.02, d=.83) and Stress (F1,79=4.47, P=.04, d=0.65) subscales in the completer analysis but not in the intention-to-treat analysis. The impact of treatment on HRQL was mediated by reductions in catastrophizing and visceral sensitivity. Conclusions: Despite its relatively benign physical profile, IBS can be an extraordinarily debilitating condition. Zemedy is an effective modality to deliver CBT for individuals with IBS, and could increase accessibility of this evidence-based treatment. Trial Registration: ClinicalTrials.gov NCT04170686; https://www.clinicaltrials.gov/ct2/show/NCT04170686 %M 33872182 %R 10.2196/26152 %U https://mhealth.jmir.org/2021/5/e26152 %U https://doi.org/10.2196/26152 %U http://www.ncbi.nlm.nih.gov/pubmed/33872182 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e25401 %T Leveraging Genomic Associations in Precision Digital Care for Weight Loss: Cohort Study %A Sinha,Ranjan %A Kachru,Dashyanng %A Ricchetti,Roshni Ray %A Singh-Rambiritch,Simitha %A Muthukumar,Karthik Marimuthu %A Singaravel,Vidhya %A Irudayanathan,Carmel %A Reddy-Sinha,Chandana %A Junaid,Imran %A Sharma,Garima %A Francis-Lyon,Patricia Alice %+ Digbi Health, 13105 Delson Ct, Los Altos, CA, 94022, United States, 1 510 883 3721, patricia@digbihealth.com %K obesity %K digital therapeutics %K precision nutrition %K nutrigenomics %K personalized nutrition %K mHealth %K mobile apps %K gut microbiota %K machine learning %K health coaching %K lifestyle medicine %K mobile phone %D 2021 %7 19.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has highlighted the urgency of addressing an epidemic of obesity and associated inflammatory illnesses. Previous studies have demonstrated that interactions between single-nucleotide polymorphisms (SNPs) and lifestyle interventions such as food and exercise may vary metabolic outcomes, contributing to obesity. However, there is a paucity of research relating outcomes from digital therapeutics to the inclusion of genetic data in care interventions. Objective: This study aims to describe and model the weight loss of participants enrolled in a precision digital weight loss program informed by the machine learning analysis of their data, including genomic data. It was hypothesized that weight loss models would exhibit a better fit when incorporating genomic data versus demographic and engagement variables alone. Methods: A cohort of 393 participants enrolled in Digbi Health’s personalized digital care program for 120 days was analyzed retrospectively. The care protocol used participant data to inform precision coaching by mobile app and personal coach. Linear regression models were fit of weight loss (pounds lost and percentage lost) as a function of demographic and behavioral engagement variables. Genomic-enhanced models were built by adding 197 SNPs from participant genomic data as predictors and refitted using Lasso regression on SNPs for variable selection. Success or failure logistic regression models were also fit with and without genomic data. Results: Overall, 72.0% (n=283) of the 393 participants in this cohort lost weight, whereas 17.3% (n=68) maintained stable weight. A total of 142 participants lost 5% bodyweight within 120 days. Models described the impact of demographic and clinical factors, behavioral engagement, and genomic risk on weight loss. Incorporating genomic predictors improved the mean squared error of weight loss models (pounds lost and percent) from 70 to 60 and 16 to 13, respectively. The logistic model improved the pseudo R2 value from 0.193 to 0.285. Gender, engagement, and specific SNPs were significantly associated with weight loss. SNPs within genes involved in metabolic pathways processing food and regulating fat storage were associated with weight loss in this cohort: rs17300539_G (insulin resistance and monounsaturated fat metabolism), rs2016520_C (BMI, waist circumference, and cholesterol metabolism), and rs4074995_A (calcium-potassium transport and serum calcium levels). The models described greater average weight loss for participants with more risk alleles. Notably, coaching for dietary modification was personalized to these genetic risks. Conclusions: Including genomic information when modeling outcomes of a digital precision weight loss program greatly enhanced the model accuracy. Interpretable weight loss models indicated the efficacy of coaching informed by participants’ genomic risk, accompanied by active engagement of participants in their own success. Although large-scale validation is needed, our study preliminarily supports precision dietary interventions for weight loss using genetic risk, with digitally delivered recommendations alongside health coaching to improve intervention efficacy. %M 33849843 %R 10.2196/25401 %U https://www.jmir.org/2021/5/e25401 %U https://doi.org/10.2196/25401 %U http://www.ncbi.nlm.nih.gov/pubmed/33849843 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e24810 %T Agent-Oriented Goal Models in Developing Information Systems Supporting Physical Activity Among Adolescents: Literature Review and Expert Interviews %A Mooses,Kerli %A Taveter,Kuldar %+ Institute of Computer Science, University of Tartu, Narva Maantee 18, Tartu, 51009, Estonia, 372 5526542, kerli.mooses@ut.ee %K agent-oriented goal models %K physical activity %K adolescent %D 2021 %7 19.5.2021 %9 Review %J J Med Internet Res %G English %X Background: Information and communication technologies (ICTs) are becoming increasingly popular in supporting the fight against low physical activity (PA) levels among adolescents. However, several ICT solutions lack evidence-based content. Therefore, there is a need to identify important features that have the potential to efficiently and consistently support the PA of adolescents using ICT solutions. Objective: This study aims to create evidence-based models of requirements for ICT solutions supporting PA by combining scientific evidence from literature and health experts. In addition, we test the suitability of agent-oriented goal models in this type of modeling process. Methods: A literature search of PubMed, Web of Science, and Scopus databases was conducted to identify evidence-based functional, quality, and emotional goals that have previously been proven to be relevant in supporting PAs among youth using ICT solutions. The identified goals were presented in the form of goal models. These models were used to collaborate with health experts to receive their input on the topic and suggestions for improvement. The initial goal models were improved based on the feedback from the experts. Results: The results indicated that agent-oriented goal modeling is a suitable method for merging information from the literature and experts. One strength of agent-oriented goal models is that they present emotional requirements together with quality and functional requirements. Another strength is the possibility of presenting results from a literature review in a systematic manner and using them thereafter in the communication process with stakeholders. Agent-oriented goal models that were created were easy to understand for health experts without previous experience in requirements engineering, which facilitates and supports collaboration with nontechnical stakeholders. Conclusions: The proposed agent-oriented goal models effectively merged information from scientific literature and experts in the field and presented early functional, quality, and emotional requirements in a holistic and coherent manner. We believe that the created models have high potential to help requirements engineers and developers to provide more efficient ICT solutions that support PA among adolescents in the future. %M 34009127 %R 10.2196/24810 %U https://www.jmir.org/2021/5/e24810 %U https://doi.org/10.2196/24810 %U http://www.ncbi.nlm.nih.gov/pubmed/34009127 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e21177 %T Developing Messaging Content for a Physical Activity Smartphone App Tailored to Low-Income Patients: User-Centered Design and Crowdsourcing Approach %A Pathak,Laura Elizabeth %A Aguilera,Adrian %A Williams,Joseph Jay %A Lyles,Courtney Rees %A Hernandez-Ramos,Rosa %A Miramontes,Jose %A Cemballi,Anupama Gunshekar %A Figueroa,Caroline Astrid %+ School of Social Welfare, University of California, Berkeley, 120 Haviland Hall, MC 7400, Berkeley, CA, 94720, United States, 1 510 642 8564, aguila@berkeley.edu %K user centered design %K mHealth %K text messaging %K crowdsourcing %K mobile phone %D 2021 %7 19.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Text messaging interventions can be an effective and efficient way to improve health behavioral changes. However, most texting interventions are neither tested nor designed with diverse end users, which could reduce their impact, and there is limited evidence regarding the optimal design methodology of health text messages tailored to low-income, low–health literacy populations and non-English speakers. Objective: This study aims to combine participant feedback, crowdsourced data, and researcher expertise to develop motivational text messages in English and Spanish that will be used in a smartphone app–based texting intervention that seeks to encourage physical activity in low-income minority patients with diabetes diagnoses and depression symptoms. Methods: The design process consisted of 5 phases and was iterative in nature, given that the findings from each step informed the subsequent steps. First, we designed messages to increase physical activity based on the behavior change theory and knowledge from the available evidence. Second, using user-centered design methods, we refined these messages after a card sorting task and semistructured interviews (N=10) and evaluated their likeability during a usability testing phase of the app prototype (N=8). Third, the messages were tested by English- and Spanish-speaking participants on the Amazon Mechanical Turk (MTurk) crowdsourcing platform (N=134). Participants on MTurk were asked to categorize the messages into overarching theoretical categories based on the capability, opportunity, motivation, and behavior framework. Finally, each coauthor rated the messages for their overall quality from 1 to 5. All messages were written at a sixth-grade or lower reading level and culturally adapted and translated into neutral Spanish by bilingual research staff. Results: A total of 200 messages were iteratively refined according to the feedback from target users gathered through user-centered design methods, crowdsourced results of a categorization test, and an expert review. User feedback was leveraged to discard unappealing messages and edit the thematic aspects of messages that did not resonate well with the target users. Overall, 54 messages were sorted into the correct theoretical categories at least 50% of the time in the MTurk categorization tasks and were rated 3.5 or higher by the research team members. These were included in the final text message bank, resulting in 18 messages per motivational category. Conclusions: By using an iterative process of expert opinion, feedback from participants that were reflective of our target study population, crowdsourcing, and feedback from the research team, we were able to acquire valuable inputs for the design of motivational text messages developed in English and Spanish with a low literacy level to increase physical activity. We describe the design considerations and lessons learned for the text messaging development process and provide a novel, integrative framework for future developers of health text messaging interventions. %M 34009130 %R 10.2196/21177 %U https://mhealth.jmir.org/2021/5/e21177 %U https://doi.org/10.2196/21177 %U http://www.ncbi.nlm.nih.gov/pubmed/34009130 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e27039 %T A Mobile Phone–Based Intervention to Reduce Mental Health Problems in Health Care Workers During the COVID-19 Pandemic (PsyCovidApp): Randomized Controlled Trial %A Fiol-DeRoque,Maria Antònia %A Serrano-Ripoll,Maria Jesús %A Jiménez,Rafael %A Zamanillo-Campos,Rocío %A Yáñez-Juan,Aina María %A Bennasar-Veny,Miquel %A Leiva,Alfonso %A Gervilla,Elena %A García-Buades,M Esther %A García-Toro,Mauro %A Alonso-Coello,Pablo %A Pastor-Moreno,Guadalupe %A Ruiz-Pérez,Isabel %A Sitges,Carolina %A García-Campayo,Javier %A Llobera-Cánaves,Joan %A Ricci-Cabello,Ignacio %+ Health Research Institute of the Balearic Islands, Edificio S, Hospital Universitario Son Espases, Carretera de Valldemossa, Palma de Mallorca, 07120, Spain, 34 +34610753696, mariajesus.serranoripoll@ssib.es %K COVID-19 %K randomized controlled trial %K mental health %K health care workers %K mHealth %K app %D 2021 %7 18.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The global health emergency generated by the COVID-19 pandemic is posing an unprecedented challenge to health care workers, who are facing heavy workloads under psychologically difficult situations. Mental mobile Health (mHealth) interventions are now being widely deployed due to their attractive implementation features, despite the lack of evidence about their efficacy in this specific population and context. Objective: The aim of this trial is to evaluate the effectiveness of a psychoeducational, mindfulness-based mHealth intervention to reduce mental health problems in health care workers during the COVID-19 pandemic. Methods: We conducted a blinded, parallel-group, controlled trial in Spain. Health care workers providing face-to-face health care to patients with COVID-19 were randomly assigned (1:1) to receive the PsyCovidApp intervention (an app targeting emotional skills, healthy lifestyle behavior, burnout, and social support) or a control app (general recommendations about mental health care) for 2 weeks. The participants were blinded to their group allocation. Data were collected telephonically at baseline and after 2 weeks by trained health psychologists. The primary outcome was a composite of depression, anxiety, and stress (overall score on the Depression Anxiety Stress Scale-21 [DASS-21]). Secondary outcomes were insomnia (Insomnia Severity Index), burnout (Maslach Burnout Inventory Human Services Survey), posttraumatic stress (Davidson Trauma Scale), self-efficacy (General Self-Efficacy Scale), and DASS-21 individual scale scores. Differences between groups were analyzed using general linear modeling according to an intention-to-treat protocol. Additionally, we measured the usability of the PsyCovidApp (System Usability Scale). The outcome data collectors and trial statisticians were unaware of the treatment allocation. Results: Between May 14 and July 25, 2020, 482 health care workers were recruited and randomly assigned to PsyCovidApp (n=248) or the control app (n=234). At 2 weeks, complete outcome data were available for 436/482 participants (90.5%). No significant differences were observed between the groups at 2 weeks in the primary outcome (standardized mean difference –0.04; 95% CI –0.11 to 0.04; P=.15) or in the other outcomes. In our prespecified subgroup analyses, we observed significant improvements among health care workers consuming psychotropic medications (n=79) in the primary outcome (–0.29; 95% CI –0.48 to –0.09; P=.004), and in posttraumatic stress, insomnia, anxiety, and stress. Similarly, among health care workers receiving psychotherapy (n=43), we observed improvements in the primary outcome (–0.25; 95% CI –0.49 to –0.02; P=.02), and in insomnia, anxiety, and stress. The mean usability score of PsyCovidApp was high (87.21/100, SD 12.65). After the trial, 208/221 participants in the intervention group (94.1%) asked to regain access to PsyCovidApp, indicating high acceptability. Conclusions: In health care workers assisting patients with COVID-19 in Spain, PsyCovidApp, compared with a control app, reduced mental health problems at 2 weeks only among health care workers receiving psychotherapy or psychotropic medications. Trial Registration: ClinicalTrials.gov NCT04393818; https://clinicaltrials.gov/ct2/show/NCT04393818. %M 33909587 %R 10.2196/27039 %U https://mhealth.jmir.org/2021/5/e27039 %U https://doi.org/10.2196/27039 %U http://www.ncbi.nlm.nih.gov/pubmed/33909587 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e19262 %T Effects of Psychoeducational Interventions Using Mobile Apps and Mobile-Based Online Group Discussions on Anxiety and Self-Esteem in Women With Breast Cancer: Randomized Controlled Trial %A Ghanbari,Elaheh %A Yektatalab,Shahrzad %A Mehrabi,Manoosh %+ Department of Mental Health and Psychiatric Nursing, School of Nursing and Midwifery, Community-Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Zand Street, Namazee Square, Shiraz, Iran, 98 917 710 6721, shahrzadyekta@yahoo.com %K anxiety %K breast cancer %K education %K mobile app %K self-esteem %D 2021 %7 18.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Psychoeducation has turned into an effective tool in taking care of cancer patients and improving their psychophysical symptoms and quality of life. Despite the growing use of mobile phone apps in medical settings for improving health, evidence supporting their effectiveness in the psychoeducation of patients with breast cancer is rarely available. Objective: This study was conducted to investigate the effect of psychoeducational interventions on anxiety and self-esteem in women with breast cancer using a mobile app and an online support group. Methods: An unblinded randomized controlled trial based on mobile phones was conducted in Shiraz, Iran. A research assistant recruited 82 women with nonmetastatic breast cancer aged 20 to 60 years were from clinics during a face-to-face visit at the point of care and randomly assigned to an intervention group (n=41) and a wait-list control group (n=41) through blocked randomization. The intervention group received psychoeducational interventions through a mobile phone app and participated in nurse-assisted online mobile support sessions for a total four weeks, whereas the control group was put on a waiting list. The State-Trait Anxiety Inventory (STAI) and the Rosenberg Self-Esteem Scale (RSES) were used to measure the levels of anxiety and self-esteem as the main outcomes at baseline and one week after the intervention. Results: A total of 82 patients with a mean age of 46.45 (SD 9.29) years recruited in Winter 2016 were randomly assigned to a wait-list control group (n=41) and intervention group (n=41). Five patients dropped out for different reasons. Comparing the postintervention mean scores of anxiety and its subscales using the independent t test showed statistically significant differences between the mobile psychoeducation group and controls (P<.001). The paired t test used to compare the postintervention mean scores of anxiety with its preintervention scores in the intervention group showed significant reductions in the scores of anxiety (95% CI –17.44 to –8.90, P<.001, d=1.02) and its two subscales (state anxiety: 95% CI –9.20 to –4.21, P<.001, d=0.88 and trait anxiety: 95% CI –8.50 to –4.12, P<.001, d=0.94). Comparing the postintervention mean scores of self-esteem showed statistically insignificant differences between the control and intervention groups (16.87 vs 17.97, P=.24). In contrast with the controls, using the paired t test showed that the increase in the postintervention mean scores of self-esteem were statistically significant in the intervention group compared with the preintervention scores (mean difference 2.05, 95% CI 1.28 to 2.82, P<.001). Conclusions: This study demonstrated the key role of mobile apps in decreasing anxiety and improving self-esteem in women with breast cancer through psychoeducational interventions. Similar studies with longer follow-ups are recommended that be conducted in this context. Trial Registration: Iranian Registry of Clinical Trials IRCT2015072123279N2; https://en.irct.ir/trial/19882 %M 34003138 %R 10.2196/19262 %U https://mhealth.jmir.org/2021/5/e19262 %U https://doi.org/10.2196/19262 %U http://www.ncbi.nlm.nih.gov/pubmed/34003138 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e24236 %T Understanding Barriers to Novel Data Linkages: Topic Modeling of the Results of the LifeInfo Survey %A Clarke,Holly %A Clark,Stephen %A Birkin,Mark %A Iles-Smith,Heather %A Glaser,Adam %A Morris,Michelle A %+ Leeds Institute for Data Analytics, University of Leeds, Level 11, Worsley Building, Claredon Way, Leeds, LS2 9NL, United Kingdom, 44 0113 343 9680, M.Morris@leeds.ac.uk %K topic modeling %K text analysis %K lifestyle data %K consumer data %K mHealth %K loyalty card %K fitness tracker %K data linkage %K data sharing %K public attitudes %K public opinion %D 2021 %7 17.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Novel consumer and lifestyle data, such as those collected by supermarket loyalty cards or mobile phone exercise tracking apps, offer numerous benefits for researchers seeking to understand diet- and exercise-related risk factors for diseases. However, limited research has addressed public attitudes toward linking these data with individual health records for research purposes. Data linkage, combining data from multiple sources, provides the opportunity to enhance preexisting data sets to gain new insights. Objective: The aim of this study is to identify key barriers to data linkage and recommend safeguards and procedures that would encourage individuals to share such data for potential future research. Methods: The LifeInfo Survey consulted the public on their attitudes toward sharing consumer and lifestyle data for research purposes. Where barriers to data sharing existed, participants provided unstructured survey responses detailing what would make them more likely to share data for linkage with their health records in the future. The topic modeling technique latent Dirichlet allocation was used to analyze these textual responses to uncover common thematic topics within the texts. Results: Participants provided responses related to sharing their store loyalty card data (n=2338) and health and fitness app data (n=1531). Key barriers to data sharing identified through topic modeling included data safety and security, personal privacy, requirements of further information, fear of data being accessed by others, problems with data accuracy, not understanding the reason for data linkage, and not using services that produce these data. We provide recommendations for addressing these issues to establish the best practice for future researchers interested in using these data. Conclusions: This study formulates a large-scale consultation of public attitudes toward this kind of data linkage, which is an important first step in understanding and addressing barriers to participation in research using novel consumer and lifestyle data. %M 33998998 %R 10.2196/24236 %U https://www.jmir.org/2021/5/e24236 %U https://doi.org/10.2196/24236 %U http://www.ncbi.nlm.nih.gov/pubmed/33998998 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e15649 %T Effectiveness of eHealth Nutritional Interventions for Middle-Aged and Older Adults: Systematic Review and Meta-analysis %A Robert,Caroline %A Erdt,Mojisola %A Lee,James %A Cao,Yuanyuan %A Naharudin,Nurhazimah Binte %A Theng,Yin-Leng %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, Singapore, 637331, Singapore, 65 69083444, carolinerobertjong@gmail.com %K eHealth %K mHealth %K nutritional intervention %K nutrition apps %K middle-aged %K older adults %K systematic review %K meta-analysis %D 2021 %7 17.5.2021 %9 Review %J J Med Internet Res %G English %X Background: The risk of development of chronic diseases related to poor nutrition increases with age. In the face of an aging population, it is important for health care sectors to find solutions in delivering health services efficiently and effectively to middle-aged and older adults. Objective: The aim of this systematic review and meta-analysis was to consolidate the literature that reported the effectiveness of eHealth apps in delivering nutritional interventions for middle-aged and older adults. Methods: A literature search from five databases (PubMed, CINAHL, Cochrane, Web of Science, and Global Health) from the past 5 years was performed. Studies were selected for inclusion that used eHealth to deliver nutritional interventions to adults aged 40 years and above, and reported health and behavioral outcomes. Two independent reviewers searched for research articles and assessed the eligibility of studies to be included in the review. A third reviewer resolved disagreements on study inclusion. We also assessed the quality of the included studies using the CONSORT 2010 checklist. Results: A total of 70 studies were included for analysis. The study quality ranged from 44% to 85%. The most commonly used eHealth intervention type was mobile apps (22/70, 31%). The majority of studies (62/70, 89%) provided multicomponent health interventions, which aimed to improve nutrition and other health behaviors (eg, exercise, smoking cessation, medication adherence). Meta-analysis results indicated high and significant heterogeneity; hence, conclusions based on these results should be considered with caution. Nonetheless, the results generally showed that eHealth interventions improved anthropometric and clinical outcomes, but not behavioral outcomes such as fruit and vegetable consumption. Conclusions: The use of eHealth apps to deliver health interventions has been increasing in recent years, and these apps have the potential to deliver health services to a larger group of people. Our findings showed that the effectiveness of eHealth apps to deliver health interventions for middle-aged to older adults was supported by the improvement of anthropometric and clinical outcomes. Future work could aim to develop research frameworks in administering eHealth interventions to address heterogeneity in this field of research. %M 33999005 %R 10.2196/15649 %U https://www.jmir.org/2021/5/e15649 %U https://doi.org/10.2196/15649 %U http://www.ncbi.nlm.nih.gov/pubmed/33999005 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 10 %N 2 %P e25371 %T A Handheld Metabolic Device (Lumen) to Measure Fuel Utilization in Healthy Young Adults: Device Validation Study %A Lorenz,Kent Arnold %A Yeshurun,Shlomo %A Aziz,Richard %A Ortiz-Delatorre,Julissa %A Bagley,James Robert %A Mor,Merav %A Kern,Marialice %+ Department of Kinesiology, San Francisco State University, 1600 Holloway Ave, GYM 101, San Francisco, CA, 94132, United States, 1 4153382244, kalorenz@sfsu.edu %K resting metabolic rate %K Lumen %K ParvoMedics TrueOne 2400 %K validation %K respiratory exchange ratio %K metabolism %K fuel utilization %K indirect calorimetry %K breath %K lung %K respiratory %K young adult %K measurement %K testing %D 2021 %7 17.5.2021 %9 Original Paper %J Interact J Med Res %G English %X Background: Metabolic carts measure the carbon dioxide (CO2) produced and oxygen consumed by an individual when breathing to assess metabolic fuel usage (carbohydrates versus fats). However, these systems are expensive, time-consuming, and only available in health care laboratory settings. A small handheld device capable of determining metabolic fuel usage via CO2 from exhaled air has been developed. Objective: The aim of this study is to evaluate the validity of a novel handheld device (Lumen) for measuring metabolic fuel utilization in healthy young adults. Methods: Metabolic fuel usage was assessed in healthy participants (n=33; mean age 23.1 years, SD 3.9 years) via respiratory exchange ratio (RER) values obtained from a metabolic cart as well as % CO2 from the Lumen device. Measurements were performed at rest in two conditions: fasting, and after consuming 150 grams of glucose, in order to determine changes in metabolic fuel usage. Reduced major axis regression and simple linear regression were performed to test for agreement between RER and Lumen % CO2. Results: Both RER and Lumen % CO2 significantly increased after glucose intake (P<.001 for both) compared with fasting conditions, by 0.089 and 0.28, respectively. Regression analyses revealed an agreement between the two measurements (F1,63=18.54; P<.001). Conclusions: This study shows the validity of Lumen for detecting changes in metabolic fuel utilization in a comparable manner with a laboratory standard metabolic cart, providing the ability for real-time metabolic information for users under any circumstances. %M 33870899 %R 10.2196/25371 %U https://www.i-jmr.org/2021/2/e25371 %U https://doi.org/10.2196/25371 %U http://www.ncbi.nlm.nih.gov/pubmed/33870899 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e24802 %T An App-Based Parenting Program to Promote Healthy Energy Balance–Related Parenting Practices to Prevent Childhood Obesity: Protocol Using the Intervention Mapping Framework %A Karssen,Levie T %A Vink,Jacqueline M %A de Weerth,Carolina %A Hermans,Roel C J %A de Kort,Carina P M %A Kremers,Stef PJ %A Ruiter,Emilie L M %A Larsen,Junilla K %+ Behavioural Science Institute, Radboud University, Postbus 9104, Nijmegen, 6500 HE, Netherlands, 31 0640969305, l.karssen@bsi.ru.nl %K childhood obesity %K preventive intervention %K parenting practices %K energy-balance related behavior %K socio-economic position %K mHealth %K behavior change %K mobile phone %D 2021 %7 14.5.2021 %9 Protocol %J JMIR Form Res %G English %X Background: The family environment plays an important role in the development of children’s energy balance–related behaviors. As a result, parents’ energy balance–related parenting practices are important targets of preventive childhood obesity programs. Families with a lower socioeconomic position (SEP) may benefit from participating in such programs but are generally less well reached than families with a higher SEP. Objective: This paper describes the application of the Intervention Mapping Protocol (IMP) for the development of an app-based preventive intervention program to promote healthy energy balance–related parenting practices among parents of children (aged 0-4 years) with a lower SEP. Methods: The 6 steps of the IMP were used as a theory- and evidence-based framework to guide the development of an app-based preventive intervention program. Results: In step 1, behavioral outcomes for the app-based program (ie, children have a healthy dietary intake, sufficient sleep, and restricted screen time and sufficient physical activity) and sociocognitive (ie, knowledge, attitudes, and self-efficacy) and automatic (ie, habitual behaviors) determinants of energy balance–related parenting were identified through a needs assessment. In step 2, the behavioral outcomes were translated into performance objectives. To influence these objectives, in step 3, theory-based intervention methods were selected for each of the determinants. In step 4, the knowledge derived from the previous steps allowed for the development of the app-based program Samen Happie! through a process of continuous cocreation with parents and health professionals. In step 5, community health services were identified as potential adopters for the app. Finally, in step 6, 2 randomized controlled trials were designed to evaluate the process and effects of the app among Dutch parents of infants (trial 1) and preschoolers (trial 2). These trials were completed in November 2019 (trial 1) and February 2020 (trial 2). Conclusions: The IMP allowed for the effective development of the app-based parenting program Samen Happie! to promote healthy energy balance–related parenting practices among parents of infants and preschoolers. Through the integration of theory, empirical evidence, and data from the target population, as well as the process of continued cocreation, the program specifically addresses parents with a lower SEP. This increases the potential of the program to prevent the development of obesity in early childhood among families with a lower SEP. Trial Registration: Netherlands Trial Register NL6727, https://www.trialregister.nl/trial/6727; Netherlands Trial Register NL7371, https://www.trialregister.nl/trial/7371. %M 33988510 %R 10.2196/24802 %U https://formative.jmir.org/2021/5/e24802 %U https://doi.org/10.2196/24802 %U http://www.ncbi.nlm.nih.gov/pubmed/33988510 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e29014 %T Comparing the Effectiveness of Education Versus Digital Cognitive Behavioral Therapy for Adults With Sickle Cell Disease: Protocol for the Cognitive Behavioral Therapy and Real-time Pain Management Intervention for Sickle Cell via Mobile Applications (CaRISMA) Study %A Badawy,Sherif M %A Abebe,Kaleab Z %A Reichman,Charlotte A %A Checo,Grace %A Hamm,Megan E %A Stinson,Jennifer %A Lalloo,Chitra %A Carroll,Patrick %A Saraf,Santosh L %A Gordeuk,Victor R %A Desai,Payal %A Shah,Nirmish %A Liles,Darla %A Trimnell,Cassandra %A Jonassaint,Charles R %+ Center for Research on Media, Technology, and Health, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, United States, 1 412 586 9850, cjonassaint@pitt.edu %K sickle cell anemia %K sickle cell disease %K pain %K depression %K depressive symptoms %K quality of life %K digital %K mHealth %K eHealth %K CBT %K cognitive behavioral therapy %K education %K mobile phone %D 2021 %7 14.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients with sickle cell disease (SCD) experience significant medical and psychological stressors that affect their mental health, well-being, and disease outcomes. Digital cognitive behavioral therapy (CBT) has been used in other patient populations and has demonstrated clinical benefits. Although evidence-based, nonpharmacological interventions for pain management are widely used in other populations, these treatments have not been well studied in SCD. Currently, there are no adequately powered large-scale clinical trials to evaluate the effectiveness and dissemination potential of behavioral pain management for adults with SCD. Furthermore, some important details regarding behavioral therapies in SCD remain unclear—in particular, what works best for whom and when. Objective: Our primary goal is to compare the effectiveness of two smartphone–delivered programs for reducing SCD pain symptoms: digital CBT versus pain and SCD education (Education). Our secondary goal is to assess whether baseline depression symptoms moderate the effect of interventions on pain outcomes. We hypothesize that digital CBT will confer greater benefits on pain outcomes and depressive symptoms at 6 months and a greater reduction in health care use (eg, opioid prescriptions or refills or acute care visits) over 12 months. Methods: The CaRISMA (Cognitive Behavioral Therapy and Real-time Pain Management Intervention for Sickle Cell via Mobile Applications) study is a multisite comparative effectiveness trial funded by the Patient-Centered Outcomes Research Institute. CaRISMA is conducted at six clinical academic sites, in partnership with four community-based organizations. CaRISMA will evaluate the effectiveness of two 12-week health coach–supported digital health programs with a total of 350 participants in two groups: CBT (n=175) and Education (n=175). Participants will complete a series of questionnaires at baseline and at 3, 6, and 12 months. The primary outcome will be the change in pain interference between the study arms. We will also evaluate changes in pain intensity, depressive symptoms, other patient-reported outcomes, and health care use as secondary outcomes. We have 80% power to detect a difference of 0.37 SDs between study arms on 6-month changes in the outcomes with 15% expected attrition at 6 months. An exploratory analysis will examine whether baseline depression symptoms moderate the effect of the intervention on pain interference. Results: This study will be conducted from March 2021 through February 2022, with results expected to be available in February 2023. Conclusions: Patients with SCD experience significant disease burden, psychosocial stress, and impairment of their quality of life. CaRISMA proposes to leverage digital technology and overcome barriers to the routine use of behavioral treatments for pain and depressive symptoms in the treatment of adults with SCD. The study will provide data on the comparative effectiveness of digital CBT and Education approaches and evaluate the potential for implementing evidence-based behavioral interventions to manage SCD pain. Trial Registration: ClinicalTrials.gov NCT04419168; https://clinicaltrials.gov/ct2/show/NCT04419168. International Registered Report Identifier (IRRID): PRR1-10.2196/29014 %M 33988517 %R 10.2196/29014 %U https://www.researchprotocols.org/2021/5/e29014 %U https://doi.org/10.2196/29014 %U http://www.ncbi.nlm.nih.gov/pubmed/33988517 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e19688 %T Effectiveness of Digital Interventions for Reducing Behavioral Risks of Cardiovascular Disease in Nonclinical Adult Populations: Systematic Review of Reviews %A Gold,Natalie %A Yau,Amy %A Rigby,Benjamin %A Dyke,Chris %A Remfry,Elizabeth Alice %A Chadborn,Tim %+ Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, United Kingdom, 44 9767839044, n.gold@lse.ac.uk %K alcohol %K behavior change %K cardiovascular disease %K diet %K digital interventions %K digital medicine %K internet interventions %K mHealth %K mobile interventions %K physical activity %K smoking %K tobacco %K mobile phone %D 2021 %7 14.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health interventions are increasingly being used as a supplement or replacement for face-to-face services as a part of predictive prevention. They may be offered to those who are at high risk of cardiovascular disease and need to improve their diet, increase physical activity, stop smoking, or reduce alcohol consumption. Despite the popularity of these interventions, there is no overall summary and comparison of the effectiveness of different modes of delivery of a digital intervention to inform policy. Objective: This review aims to summarize the effectiveness of digital interventions in improving behavioral and health outcomes related to physical activity, smoking, alcohol consumption, or diet in nonclinical adult populations and to identify the effectiveness of different modes of delivery of digital interventions. Methods: We reviewed articles published in the English language between January 1, 2009, and February 25, 2019, that presented a systematic review with a narrative synthesis or meta-analysis of any study design examining digital intervention effectiveness; data related to adults (≥18 years) in high-income countries; and data on behavioral or health outcomes related to diet, physical activity, smoking, or alcohol, alone or in any combination. Any time frame or comparator was considered eligible. We searched MEDLINE, Embase, PsycINFO, Cochrane Reviews, and gray literature. The AMSTAR-2 tool was used to assess review confidence ratings. Results: We found 92 reviews from the academic literature (47 with meta-analyses) and 2 gray literature items (1 with a meta-analysis). Digital interventions were typically more effective than no intervention, but the effect sizes were small. Evidence on the effectiveness of digital interventions compared with face-to-face interventions was mixed. Most trials reported that intent-to-treat analysis and attrition rates were often high. Studies with long follow-up periods were scarce. However, we found that digital interventions may be effective for up to 6 months after the end of the intervention but that the effects dissipated by 12 months. There were small positive effects of digital interventions on smoking cessation and alcohol reduction; possible effectiveness in combined diet and physical activity interventions; no effectiveness for interventions targeting physical activity alone, except for when interventions were delivered by mobile phone, which had medium-sized effects; and no effectiveness observed for interventions targeting diet alone. Mobile interventions were particularly effective. Internet-based interventions were generally effective. Conclusions: Digital interventions have small positive effects on smoking, alcohol consumption, and in interventions that target a combination of diet and physical activity. Small effects may have been due to the low efficacy of treatment or due to nonadherence. In addition, our ability to make inferences from the literature we reviewed was limited as those interventions were heterogeneous, many reviews had critically low AMSTAR-2 ratings, analysis was typically intent-to-treat, and follow-up times were relatively short. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019126074; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=126074. %M 33988126 %R 10.2196/19688 %U https://www.jmir.org/2021/5/e19688 %U https://doi.org/10.2196/19688 %U http://www.ncbi.nlm.nih.gov/pubmed/33988126 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e26082 %T Behavior Change Techniques in Popular Mobile Apps for Smoking Cessation in France: Content Analysis %A Bustamante,Luz Adriana %A Gill Ménard,Cédric %A Julien,Sabrina %A Romo,Lucia %+ Laboratoire EA 4430-Clinique Psychanalyse Developpement, Department of Psychology, University of Paris Nanterre, 200, Avenue de la Republique, Nanterre, Ile-de-France, 92000, France, 33 783192547, adriana.bustamante93@gmail.com %K smartphone app %K smoking cessation %K mHealth %K app quality %K user engagement %K behavior change technique taxonomy %D 2021 %7 13.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The mobile app market differs from country to country, and to date, no previous review of the content quality of smoking cessation apps has been conducted in France. Objective: This study aimed to examine the general quality of the most popular smoking cessation apps in France and also determine the degree to which apps adhere to established behavioral and cognitive techniques (BCTs) proven effective in clinical practice. Methods: A systematic research of smoking cessation apps was conducted in both the Google Play Store and Apple Store in the French market. The general quality of popular apps was rated with the Mobile App Rating Scale (MARS), and the therapeutic quality was assessed with the ratio of adherence of the behavior change technique taxonomy for smoking cessation treatment. Results: A total of 14 mobile apps met all the inclusion criteria of the content analysis. The interrater reliability varied from “substantial” (0.79) to “almost perfect” (0.9) for the two measures. The mean MARS score was 3.5 out of 5 (median 3.6, IQR 0.6 [3.2-3.8]). The findings suggest that popular apps focus primarily on the functionality dimension of the MARS scale (4.2/5). The mean number of BCTs was 22, with a large difference between apps (minimum 4, maximum 38). At least half of the apps addressed motivation (8.8/14, 63%) and advised on using behavioral skills in order to quit smoking or stay a nonsmoker (8.7/14, 62%). However, only a handful of apps gathered important information (5.9/14, 42%) in order to deliver proper advice regarding the use of approved medication or the implementation of behavioral techniques (4.3/14, 31%). The mean MARS score was positively correlated with the price (r=0.70, P=.007) and the number of BCTs used (r=0.67, P=.01). User rating was not correlated with any quality scale (P=.67). Conclusions: The content quality of popular smoking cessation apps in France varied by app type and price. Most popular apps propose in general good quality content but lack implementation of evidence-based BCTs associated with effectiveness on smoking cessation treatment. Further research is needed to evaluate the improvement in the content quality of smoking cessation apps in France. %M 33983130 %R 10.2196/26082 %U https://mhealth.jmir.org/2021/5/e26082 %U https://doi.org/10.2196/26082 %U http://www.ncbi.nlm.nih.gov/pubmed/33983130 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e28684 %T Interrupting Sitting Time in Postmenopausal Women: Protocol for the Rise for Health Randomized Controlled Trial %A Hartman,Sheri J %A Dillon,Lindsay W %A LaCroix,Andrea Z %A Natarajan,Loki %A Sears,Dorothy D %A Owen,Neville %A Dunstan,David W %A Sallis,James F %A Schenk,Simon %A Allison,Matthew %A Takemoto,Michelle %A Herweck,Alexandra M %A Nguyen,Bao %A Rosenberg,Dori E %+ Hebert Wertheim School of Public Health, University of California, San Diego, 3855 Health Sciences Drive, Mail Code 0901, La Jolla, CA, , United States, 1 858 534 9235, sjhartman@ucsd.edu %K sedentary behavior %K cardiometabolic health %K older adults %K physical function %K cognitive function %K biomarkers %D 2021 %7 13.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Many older adults spend the majority of their waking hours sitting, which increases their risk of chronic diseases. Given the challenges that many older adults face when engaging in moderate-to-vigorous physical activity, understanding the health benefits of decreasing sitting time and increasing the number of sit-to-stand transitions is needed to address this growing public health concern. Objective: The aim of this 3-arm randomized controlled trial is to investigate how changes in sitting time and brief sit-to-stand transitions impact biomarkers of healthy aging and physical, emotional, and cognitive functioning compared with a healthy attention control arm. Methods: Sedentary and postmenopausal women (N=405) will be recruited and randomly assigned to 1 of the 3 study conditions for 3 months: healthy living attention control (Healthy Living), reduce sitting time (Reduce Sitting), and increase sit-to-stand transitions (Increase Transitions). Assessments conducted at baseline and 3 months included fasting blood draw, blood pressure, anthropometric measurements, physical functioning, cognitive testing, and 7 days of a thigh-worn accelerometer (activPAL) and a hip-worn accelerometer (ActiGraph). Blood-based biomarkers of healthy aging included those associated with glycemic control (glycated hemoglobin, fasting plasma insulin and glucose, and homeostatic model assessment of insulin resistance). Results: Recruitment began in May 2018. The intervention is ongoing, with data collection expected to continue through the end of 2022. Conclusions: The Rise for Health study is designed to test whether 2 different approaches to interrupting sitting time can improve healthy aging in postmenopausal women. Results from this study may inform the development of sedentary behavior guidelines and interventions to reduce sitting time in older adults. Trial Registration: ClinicalTrials.gov NCT03473145; https://clinicaltrials.gov/ct2/show/NCT03473145 International Registered Report Identifier (IRRID): DERR1-10.2196/28684 %M 33983131 %R 10.2196/28684 %U https://www.researchprotocols.org/2021/5/e28684 %U https://doi.org/10.2196/28684 %U http://www.ncbi.nlm.nih.gov/pubmed/33983131 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26283 %T Influence of COVID-19 Lockdowns on the Usage of a Vision Assistance App Among Global Users With Visual Impairment: Big Data Analytics Study %A Luo,Gang %A Pundlik,Shrinivas %+ Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, United States, 1 617 912 2529, gang_luo@meei.harvard.edu %K assistance %K assistive technology %K COVID-19 %K development %K eye %K low vision %K needs %K smartphone apps %K usage %K vision assistance %K vision %K visual impairment %D 2021 %7 12.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Millions of individuals with visual impairment use vision assistance apps to help with their daily activities. The most widely used vision assistance apps are magnifier apps. It is still largely unknown what the apps are used for. Lack of insight into the visual needs of individuals with visual impairment is a hurdle for the development of more effective assistive technologies. Objective: This study aimed to investigate how needs for visual aids may vary with social activities, by observing the changes in the usage of a smartphone magnifier app when many users take breaks from work. Methods: The number of launches of the SuperVision Magnifier app was determined retrospectively from 2018 to 2020 from among active users worldwide. The fluctuation in app usage was examined by comparing weekday vs weekend periods, Christmas and new year vs nonholiday seasons, and COVID-19 lockdowns vs the easing of restriction during the pandemic. Results: On average, the app was used 262,466 times by 38,237 users each month in 2020 worldwide. There were two major trough points on the timeline of weekly app usage, one aligned with the COVID-19 lockdowns in April 2020 and another aligned with the Christmas and new year week in 2018 and 2019. The app launches declined by 6947 (11% decline; P<.001) during the lockdown and by 5212 (9% decline; P=.001) during the holiday weeks. There was no significant decline during March to May 2019. App usage compensated for seasonal changes was 8.6% less during weekends than during weekdays (P<.001). Conclusions: The need for vision assistance technology was slightly lower during breaks and lockdowns, probably because the activities at home were different and less visually demanding. Nevertheless, for the entire user population, the needs for visual aids are still substantial. %M 33945492 %R 10.2196/26283 %U https://www.jmir.org/2021/5/e26283 %U https://doi.org/10.2196/26283 %U http://www.ncbi.nlm.nih.gov/pubmed/33945492 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e17189 %T Acceptability of the Pregnancy, Exercise, and Nutrition Research Study With Smartphone App Support (PEARS) and the Use of Mobile Health in a Mixed Lifestyle Intervention by Pregnant Obese and Overweight Women: Secondary Analysis of a Randomized Controlled Trial %A Greene,Ellen M %A O'Brien,Eileen C %A Kennelly,Maria A %A O'Brien,Orna A %A Lindsay,Karen L %A McAuliffe,Fionnuala M %+ UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Dublin 2, Ireland, 353 637 3216, fionnuala.mcauliffe@ucd.ie %K pregnancy %K mHealth %K nutrition %K lifestyle %K acceptability %K app %K mobile phone %D 2021 %7 12.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dietary interventions can improve pregnancy outcomes among women with increased BMI. Although the interest in mobile health interventions is growing, little is known about the acceptability of smartphone apps to support lifestyle interventions in such a cohort. Objective: We aimed to assess the acceptability of the pregnancy, exercise, and nutrition research study with smartphone app support (PEARS) and the use of mobile health in a mixed lifestyle intervention delivered to overweight and obese pregnant women. Methods: PEARS was a randomized controlled trial of a low glycemic index dietary intervention with exercise prescription and a smartphone app, which was delivered to pregnant women who were overweight or obese. Acceptability questionnaires were completed by the intervention group at 28 weeks of gestation (n=149) and at postintervention (n=123). Maternal characteristics were recorded (ie, age, ethnicity, BMI, socioeconomic status). Associations between maternal characteristics and acceptability of the intervention and app were analyzed using two-tailed t tests, Mann-Whitney U tests, chi-square test, and logistic regression. One-on-one semistructured interviews were conducted with a subcohort of the intervention participants (n=28) at 34 weeks of gestation, in which the participants shared their experiences of the PEARS intervention. Results: The intervention was generally accepted, with respondents agreeing that the diet was easy to follow (98/148, 68.5%), enjoyable (106/148, 74.1%), and affordable (110/148, 76.9%). Qualitative and quantitative results were consistent with each another, both demonstrating that app acceptability was high. The participants agreed that the app was enjoyable (96/120, 80.0%) and easy to use (116/119, 97.5%). Compared to those with tertiary education, those with lower education levels were more likely to enjoy the dietary changes (P=.04). Enjoyment of the app was associated with disadvantaged neighborhood deprivation index (P=.01) and higher BMI (P=.03). Conclusions: The PEARS intervention and use of a supportive smartphone app were accepted by pregnant women, particularly by those from vulnerable subgroups of this population. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 29316280; https://www.isrctn.com/ISRCTN29316280 %M 33978597 %R 10.2196/17189 %U https://mhealth.jmir.org/2021/5/e17189 %U https://doi.org/10.2196/17189 %U http://www.ncbi.nlm.nih.gov/pubmed/33978597 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e13391 %T Predictors of Walking App Users With Comparison of Current Users, Previous Users, and Informed Nonusers in a Sample of Dutch Adults: Questionnaire Study %A De Bruijn,Gert-Jan %A Dallinga,Joan Martine %A Deutekom,Marije %+ Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Nieuwe Achtergracht 166, Amsterdam, 1018 WV, Netherlands, 31 205252636, g.j.debruijn@uva.nl %K technology %K walking %K health %K adult %K survey %K questionnaires %D 2021 %7 12.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The last decade has seen a substantial increase in the use of mobile health apps and research into the effects of those apps on health and health behaviors. In parallel, research has aimed at identifying population subgroups that are more likely to use those health apps. Current evidence is limited by two issues. First, research has focused on broad health apps, and little is known about app usage for a specific health behavior. Second, research has focused on comparing current users and current nonusers, without considering subgroups of nonusers. Objective: We aimed to provide profile distributions of current users, previous users, and informed nonusers, and to identify predictor variables relevant for profile classification. Methods: Data were available from 1683 people who participated in a Dutch walking event in Amsterdam that was held in September 2017. They provided information on demographics, self-reported walking behavior, and walking app usage, as well as items from User Acceptance of Information Technology, in an online survey. Data were analyzed using discriminant function analysis and multinomial logistic regression analysis. Results: Most participants were current walking app users (899/1683, 53.4%), while fewer participants were informed nonusers (663/1683, 39.4%) and very few were previous walking app users (121/1683, 7.2%). Current walking app users were more likely to report walking at least 5 days per week and for at least 30 minutes per bout (odds ratio [OR] 1.44, 95% CI 1.11-1.85; P=.005) and more likely to be overweight (OR 1.72, 95% CI 1.24-2.37; P=.001) or obese (OR 1.49, 95% CI 1.08-2.08; P=.005) as compared with informed nonusers. Further, current walking app users perceived their walking apps to be less boring, easy to use and retrieve information, and more helpful to achieve their goals. Effect sizes ranged from 0.10 (95% CI 0.08-0.30) to 1.58 (95% CI 1.47-1.70). Conclusions: The distributions for walking app usage appeared different from the distributions for more general health app usage. Further, the inclusion of two specific subgroups of nonusers (previous users and informed nonusers) provides important information for health practitioners and app developers to stimulate continued walking app usage, including making information in those apps easy to understand and making it easy to obtain information from the apps, as well as preventing apps from becoming boring and difficult to use for goal attainment. %M 33978595 %R 10.2196/13391 %U https://mhealth.jmir.org/2021/5/e13391 %U https://doi.org/10.2196/13391 %U http://www.ncbi.nlm.nih.gov/pubmed/33978595 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e29562 %T Monitoring Health Care Workers at Risk for COVID-19 Using Wearable Sensors and Smartphone Technology: Protocol for an Observational mHealth Study %A Clingan,Caroline A %A Dittakavi,Manasa %A Rozwadowski,Michelle %A Gilley,Kristen N %A Cislo,Christine R %A Barabas,Jenny %A Sandford,Erin %A Olesnavich,Mary %A Flora,Christopher %A Tyler,Jonathan %A Mayer,Caleb %A Stoneman,Emily %A Braun,Thomas %A Forger,Daniel B %A Tewari,Muneesh %A Choi,Sung Won %+ Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Michigan, 1500 E Medical Center Dr, D4118 Medical Professional Building, Ann Arbor, MI, 48109, United States, 1 734 615 5707, sungchoi@med.umich.edu %K mobile health %K app %K mHealth %K wearable %K sensor %K COVID-19 %K health care worker %K frontline worker %K smartphone %K digital health %D 2021 %7 12.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health care workers (HCWs) have been working on the front lines of the COVID-19 pandemic with high risks of viral exposure, infection, and transmission. Standard COVID-19 testing is insufficient to protect HCWs from these risks and prevent the spread of disease. Continuous monitoring of physiological data with wearable sensors, self-monitoring of symptoms, and asymptomatic COVID-19 testing may aid in the early detection of COVID-19 in HCWs and may help reduce further transmission among HCWs, patients, and families. Objective: By using wearable sensors, smartphone-based symptom logging, and biospecimens, this project aims to assist HCWs in self-monitoring COVID-19. Methods: We conducted a prospective, longitudinal study of HCWs at a single institution. The study duration was 1 year, wherein participants were instructed on the continuous use of two wearable sensors (Fitbit Charge 3 smartwatch and TempTraq temperature patches) for up to 30 days. Participants consented to provide biospecimens (ie, nasal swabs, saliva swabs, and blood) for up to 1 year from study entry. Using a smartphone app called Roadmap 2.0, participants entered a daily mood score, submitted daily COVID-19 symptoms, and completed demographic and health-related quality of life surveys at study entry and 30 days later. Semistructured qualitative interviews were also conducted at the end of the 30-day period, following completion of daily mood and symptoms reporting as well as continuous wearable sensor use. Results: A total of 226 HCWs were enrolled between April 28 and December 7, 2020. The last participant completed the 30-day study procedures on January 16, 2021. Data collection will continue through January 2023, and data analyses are ongoing. Conclusions: Using wearable sensors, smartphone-based symptom logging and survey completion, and biospecimen collections, this study will potentially provide data on the prevalence of COVID-19 infection among HCWs at a single institution. The study will also assess the feasibility of leveraging wearable sensors and self-monitoring of symptoms in an HCW population. Trial Registration: ClinicalTrials.gov NCT04756869; https://clinicaltrials.gov/ct2/show/NCT04756869 International Registered Report Identifier (IRRID): DERR1-10.2196/29562 %M 33945497 %R 10.2196/29562 %U https://www.researchprotocols.org/2021/5/e29562 %U https://doi.org/10.2196/29562 %U http://www.ncbi.nlm.nih.gov/pubmed/33945497 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e24494 %T Improving Medication Adherence Through Adaptive Digital Interventions (iMedA) in Patients With Hypertension: Protocol for an Interrupted Time Series Study %A Etminani,Kobra %A Göransson,Carina %A Galozy,Alexander %A Norell Pejner,Margaretha %A Nowaczyk,Sławomir %+ Center for Applied Intelligent Systems Research, Halmstad University, Kristian IV:s väg 3, Halmstad, 30118, Sweden, 46 35167332, kobra.etminani@hh.se %K medication adherence %K hypertension %K digital intervention %K mHealth %K artificial intelligence %D 2021 %7 12.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a strong need to improve medication adherence (MA) for individuals with hypertension in order to reduce long-term hospitalization costs. We believe this can be achieved through an artificial intelligence agent that helps the patient in understanding key individual adherence risk factors and designing an appropriate intervention plan. The incidence of hypertension in Sweden is estimated at approximately 27%. Although blood pressure control has increased in Sweden, barely half of the treated patients achieved adequate blood pressure levels. It is a major risk factor for coronary heart disease and stroke as well as heart failure. MA is a key factor for good clinical outcomes in persons with hypertension. Objective: The overall aim of this study is to design, develop, test, and evaluate an adaptive digital intervention called iMedA, delivered via a mobile app to improve MA, self-care management, and blood pressure control for persons with hypertension. Methods: The study design is an interrupted time series. We will collect data on a daily basis, 14 days before, during 6 months of delivering digital interventions through the mobile app, and 14 days after. The effect will be analyzed using segmented regression analysis. The participants will be recruited in Region Halland, Sweden. The design of the digital interventions follows the just-in-time adaptive intervention framework. The primary (distal) outcome is MA, and the secondary outcome is blood pressure. The design of the digital intervention is developed based on a needs assessment process including a systematic review, focus group interviews, and a pilot study, before conducting the longitudinal interrupted time series study. Results: The focus groups of persons with hypertension have been conducted to perform the needs assessment in a Swedish context. The design and development of digital interventions are in progress, and the interventions are planned to be ready in November 2020. Then, the 2-week pilot study for usability evaluation will start, and the interrupted time series study, which we plan to start in February 2021, will follow it. Conclusions: We hypothesize that iMedA will improve medication adherence and self-care management. This study could illustrate how self-care management tools can be an additional (digital) treatment support to a clinical one without increasing burden on health care staff. Trial Registration: ClinicalTrials.gov NCT04413500; https://clinicaltrials.gov/ct2/show/NCT04413500 International Registered Report Identifier (IRRID): DERR1-10.2196/24494 %M 33978593 %R 10.2196/24494 %U https://www.researchprotocols.org/2021/5/e24494 %U https://doi.org/10.2196/24494 %U http://www.ncbi.nlm.nih.gov/pubmed/33978593 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e26163 %T A Smartphone App (TRIANGLE) to Change Cardiometabolic Risk Behaviors in Women Following Gestational Diabetes Mellitus: Intervention Mapping Approach %A Potzel,Anne Lotte %A Gar,Christina %A Seissler,Jochen %A Lechner,Andreas %+ Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstr. 1, Munich, 80336, Germany, 49 894 400 521 85, andreas.lechner@med.uni-muenchen.de %K mHealth %K diabetes prevention %K health behavior %K cardiometabolic disease %K gestational diabetes mellitus %K smartphone app %K intervention mapping %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Gestational diabetes mellitus (GDM) is the most common complication during pregnancy and is associated with an increased risk for the development of cardiometabolic diseases. Behavioral interventions can reduce this risk, but current solutions insufficiently address the requirements for such a program. The systematic development of a scalable mobile health (mHealth) promotion program for mothers during the first years post-GDM may contribute to solving this problem. Objective: The aim of this project was to systematically plan and develop a theory- and evidence-based mHealth intervention to change cardiometabolic risk behaviors in women during the first 5 years post-GDM that meets women’s expected standards of commercial health apps. Methods: The intervention mapping steps 1 to 4 structured the systematic planning and development of the mHealth program described in this paper. Steps 1 and 2 led to a theory- and evidence-based logic model of change for cardiometabolic health. Based on this model, the prevention program was designed (step 3) and produced (step 4) in cooperation with industrial partners to ensure a high technological standard of the resulting smartphone app for the iPhone (Apple Inc). Step 4 included a user study with women during the first 5 years post-GDM once a beta version of the app (“TRIANGLE”) was available. The user study comprised 2 test rounds of 1 week (n=5) and 4 weeks (n=6), respectively. The tests included validated questionnaires on user acceptance, user logs, and think-alouds with semistructured interviews. Results: The novel TRIANGLE app is among the first self-paced smartphone apps for individual habit change in the 3 lifestyle areas of physical activity, nutrition, and psychosocial well-being. The 3 core features—a challenge system, human coaching, and a library—address 11 behavioral determinants with 39 behavior change methods to support lifestyle changes. Participants in the user study showed a high acceptance, high perceived quality, and high perceived impact of the TRIANGLE app on their health behaviors. Participants tested the app regularly, used it intuitively, and suggested improvements. We then adapted the TRIANGLE app according to the insights from the user study before the full TRIANGLE program production. Conclusions: The intervention mapping approach was feasible to plan and develop an innovative and scalable smartphone solution for women during the first 5 years post-GDM. The resulting TRIANGLE intervention has the potential to support behavior change for cardiometabolic disease prevention. However, the app needs further refinement and testing in clinical trials. Intervention mapping steps 5 (implementation plan) and 6 (evaluation plan) may support the integration of the TRIANGLE intervention into routine care. Trial Registration: German Clinical Trials Register DRKS00012736; https://www.drks.de/DRKS00012736 %M 33973864 %R 10.2196/26163 %U https://mhealth.jmir.org/2021/5/e26163 %U https://doi.org/10.2196/26163 %U http://www.ncbi.nlm.nih.gov/pubmed/33973864 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e26387 %T Exploring Breaks in Sedentary Behavior of Older Adults Immediately After Receiving Personalized Haptic Feedback: Intervention Study %A Compernolle,Sofie %A Van Dyck,Delfien %A Cardon,Greet %A Brondeel,Ruben %+ Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, Ghent, 9000, Belgium, 32 92646323, sofie.compernolle@ugent.be %K tactile feedback %K sitting behavior %K sedentary behavior %K older adults %K mHealth intervention %K self-monitoring %D 2021 %7 10.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: “Push” components of mobile health interventions may be promising to create conscious awareness of habitual sedentary behavior; however, the effect of these components on the near-time, proximal outcome, being breaks in sedentary behavior immediately after receiving a push notification, is still unknown, especially in older adults. Objective: The aims of this study are to examine if older adults break their sedentary behavior immediately after receiving personalized haptic feedback on prolonged sedentary behavior and if the percentage of breaks differs depending on the time of the day when the feedback is provided. Methods: A total of 26 Flemish older adults (mean age 64.4 years, SD 3.8) wore a triaxial accelerometer (Activator, PAL Technologies Ltd) for 3 weeks. The accelerometer generated personalized haptic feedback by means of vibrations each time a participant sat for 30 uninterrupted minutes. Accelerometer data on sedentary behavior were used to estimate the proximal outcome, which was sedentary behavior breaks immediately (within 1, 3, and 5 minutes) after receiving personalized haptic feedback. Generalized estimating equations were used to investigate whether or not participants broke up their sedentary behavior immediately after receiving haptic feedback. A time-related variable was added to the model to investigate if the sedentary behavior breaks differed depending on the time of day. Results: A total of 2628 vibrations were provided to the participants during the 3-week intervention period. Of these 2628 vibrations, 379 (14.4%), 570 (21.7%), and 798 (30.4%) resulted in a sedentary behavior break within 1, 3 and 5 minutes, respectively. Although the 1-minute interval did not reveal significant differences in the percentage of breaks depending on the time at which the haptic feedback was provided, the 3- and 5-minute intervals did show significant differences in the percentage of breaks depending on the time at which the haptic feedback was provided. Concretely, the percentage of sedentary behavior breaks was significantly higher if personalized haptic feedback was provided between noon and 3 PM compared to if the feedback was provided between 6 and 9 AM (odds ratio 1.58, 95% CI 1.01-2.47, within 3 minutes; odds ratio 1.78, 95% CI 1.11-2.84, within 5 minutes). Conclusions: The majority of haptic vibrations, especially those in the morning, did not result in a break in the sedentary behavior of older adults. As such, simply bringing habitual sedentary behavior into conscious awareness seems to be insufficient to target sedentary behavior. More research is needed to optimize push components in interventions aimed at the reduction of the sedentary behavior of older adults. Trial Registration: ClinicalTrials.gov NCT04003324; https://clinicaltrials.gov/ct2/show/NCT04003324 %M 33970109 %R 10.2196/26387 %U https://mhealth.jmir.org/2021/5/e26387 %U https://doi.org/10.2196/26387 %U http://www.ncbi.nlm.nih.gov/pubmed/33970109 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e23809 %T Integrating User-Centered Design and Behavioral Science to Design a Mobile Intervention for Obesity and Binge Eating: Mixed Methods Analysis %A Graham,Andrea K %A Munson,Sean A %A Reddy,Madhu %A Neubert,Sarah W %A Green,Emilie A %A Chang,Angela %A Spring,Bonnie %A Mohr,David C %A Wildes,Jennifer E %+ Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 312 503 5266, andrea.graham@northwestern.edu %K obesity %K binge eating %K user-centered design %K mobile intervention %K engagement %K experimental therapeutics %D 2021 %7 10.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Accounting for how end users engage with technologies is imperative for designing an efficacious mobile behavioral intervention. Objective: This mixed methods analysis examined the translational potential of user-centered design and basic behavioral science to inform the design of a new mobile intervention for obesity and binge eating. Methods: A total of 22 adults (7/22, 32% non-Hispanic White; 8/22, 36% male) with self-reported obesity and recurrent binge eating (≥12 episodes in 3 months) who were interested in losing weight and reducing binge eating completed a prototyping design activity over 1 week. Leveraging evidence from behavioral economics on choice architecture, participants chose treatment strategies from 20 options (aligned with treatment targets composing a theoretical model of the relation between binge eating and weight) to demonstrate which strategies and treatment targets are relevant to end users. The process by which participants selected and implemented strategies and their change in outcomes were analyzed. Results: Although prompted to select one strategy, participants selected between 1 and 3 strategies, citing perceived achievability, helpfulness, or relevance as selection reasons. Over the week, all practiced a strategy at least once; 82% (18/22) struggled with implementation, and 23% (5/22) added a new strategy. Several themes emerged on successes and challenges with implementation, yielding design implications for supporting users in behavior change. In postexperiment reflections, 82% (18/22) indicated the strategy was helpful, and 86% (19/22) planned to continue use. One-week average within-subject changes in weight (–2.2 [SD –5.0] pounds) and binge eating (–1.6 [SD –1.8] episodes) indicated small clinical improvement. Conclusions: Applying user-centered design and basic behavioral science yielded design insights to incorporate personalization through user choice with guidance, which may enhance engagement with and potential efficacy of digital health interventions. %M 33970114 %R 10.2196/23809 %U https://formative.jmir.org/2021/5/e23809 %U https://doi.org/10.2196/23809 %U http://www.ncbi.nlm.nih.gov/pubmed/33970114 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e22990 %T Commercially Available Apps to Support Healthy Family Meals: User Testing of App Utility, Acceptability, and Engagement %A Mauch,Chelsea E %A Laws,Rachel A %A Prichard,Ivanka %A Maeder,Anthony J %A Wycherley,Thomas P %A Golley,Rebecca K %+ Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, 5001, Australia, 61 8 83038988, chelsea.mauch@csiro.au %K diet %K nutrition %K family %K mobile applications %K behavior modification %D 2021 %7 7.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Parents juggling caregiving and paid employment encounter a range of barriers in providing healthy food to their families. Mobile apps have the potential to help parents in planning, purchasing, and preparing healthy family food. The utility and acceptability of apps for supporting parents are unknown. User perspectives of existing technology, such as commercially available apps, can guide the development of evidence-based apps in the future. Objective: This study aims to determine the feasibility of existing commercially available apps for supporting the healthy food provision practices of working parents. Methods: Working parents (N=133) were recruited via the web and completed a 10-item Capability, Opportunity, Motivation, and Behavior (COM-B) self-evaluation survey assessing their needs in relation to the provision of healthy family meals. A total of 5 apps were selected for testing, including a meal planning app, recipe app, recipe manager app, family organizer app, and barcode scanning app. Survey items were mapped to app features, with a subsample of parents (67/133, 50.4%) allocated 2 apps each to trial simultaneously over 4 weeks. A semistructured interview exploring app utility and acceptability and a web-based survey, including the System Usability Scale and the user version of the Mobile App Rating Scale, followed app testing. The interview data were analyzed using a theoretical thematic approach. Results: Survey participants (N=133; mean age 34 years, SD 4 years) were mainly mothers (130/133, 97.7%) and partnered (122/133, 91.7%). Participants identified a need for healthy recipes (109/133, 82% agreed or strongly agreed) and time for food provision processes (107/133, 80.5%). Engagement quality was the lowest rated domain of the user version of the Mobile App Rating Scale across all 5 apps (mean score per app ranging from 3.0 to 3.7 out of a maximum of 5). The family organizer, requiring a high level of user input, was rated the lowest for usability (median 48, IQR 34-73). In the interviews, participants weighed the benefits of the apps (ie, time saving) against the effort involved in using them in determining their acceptability. Organization was a subtheme emerging from interviews, associated with the use of meal planners and shopping lists. Meal planners and shopping lists were used in time, while behavior was occurring. Conclusions: Meal planning apps and features promoting organization present feasible, time-saving solutions to support healthy food provision practices. Attention must be paid to enhancing app automation and integration, as well as recipe and nutrition content, to ensure that apps do not add to the time burden of food provision and are supportive of healthy food provision behavior in time. %M 33960951 %R 10.2196/22990 %U https://mhealth.jmir.org/2021/5/e22990 %U https://doi.org/10.2196/22990 %U http://www.ncbi.nlm.nih.gov/pubmed/33960951 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 2 %P e25703 %T Mobile App–Reported Use of Traditional Medicine for Maintenance of Health in India During the COVID-19 Pandemic: Cross-sectional Questionnaire Study %A Srikanth,N %A Rana,Rakesh %A Singhal,Richa %A Jameela,Sophia %A Singh,Rajeshwari %A Khanduri,Shruti %A Tripathi,Arunabh %A Goel,Sumeet %A Chhatre,Leena %A Chandra,Ashwin %A Rao,B C S %A Dhiman,K S %+ Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Janakpuri, Delhi, 110058, India, 91 9818478514, rkrana2000@gmail.com %K AYUSH Sanjivani app %K COVID-19 %K traditional medicine %K Ayurveda %K Siddha %K Unani %K homeopathy %D 2021 %7 7.5.2021 %9 Original Paper %J JMIRx Med %G English %X Background: India follows a pluralistic system for strategic and focused health care delivery in which traditional systems of medicine such as Ayurveda, yoga and naturopathy, Unani, Siddha, Sowa Rigpa, and homoeopathy (AYUSH) coexist with contemporary medicine, and this system functions under the Ministry of AYUSH (MoA). The MoA developed a mobile app, called AYUSH Sanjivani, to document the trends of the use of AYUSH-based traditional and holistic measures by the public across India. Analysis of the data generated through this app can help monitor the extent of the use of AYUSH measures for maintenance of health during the COVID-19 pandemic and aid effective health promotion and communication efforts focused on targeted health care delivery during the pandemic. Objective: The purpose of the study was to determine the extent of use of AYUSH measures by the public in India for maintenance of health during the COVID-19 pandemic as reported through the AYUSH Sanjivani mobile app. Methods: Cross-sectional analysis of the data generated through the Ayush Sanjivani app from May 4 to July 31, 2020, was performed to study the pattern and extent of the use of AYUSH-based measures by the Indian population. The responses of the respondents in terms of demographic profile, use pattern, and benefits obtained; the association between the use of AYUSH-based measures and symptomatic status; and the association between the duration of use of AYUSH-based measures and the outcome of COVID-19 testing were evaluated based on bivariate and multivariate logistic regression analysis. Results: Data from 723,459 respondents were used for the analysis, among whom 616,295 (85.2%) reported that they had been using AYUSH measures for maintenance of health during the COVID-19 pandemic. Among these 616,295 users, 553,801 (89.8%) either strongly or moderately agreed to have benefitted from AYUSH measures. Ayurveda and homeopathic measures and interventions were the most preferred by the respondents across India. Among the 359,785 AYUSH users who described their overall improvement in general health, 144,927 (40.3%) rated it as good, 30,848 (8.6%) as moderate, and 133,046 (40.3%) as slight. Respondents who had been using AYUSH measures for less than 30 days were more likely to be COVID-19–positive among those who were tested (odds ratio 1.52, 95% CI 1.44-1.60). The odds of nonusers of AYUSH measures being symptomatic if they tested positive were greater than those of AYUSH users (odds ratio 4.01, 95% CI 3.61-4.59). Conclusions: The findings of this cross-sectional analysis assert that a large proportion of the representative population practiced AYUSH measures across different geographic locations of the country during the COVID-19 pandemic and benefitted considerably in terms of general well-being, with a possible impact on their quality of life and specific domains of health. %M 34032815 %R 10.2196/25703 %U https://xmed.jmir.org/2021/2/e25703 %U https://doi.org/10.2196/25703 %U http://www.ncbi.nlm.nih.gov/pubmed/34032815 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e25895 %T Real-Time UV Measurement With a Sun Protection System for Warning Young Adults About Sunburn: Prospective Cohort Study %A Robinson,June K %A Patel,Shiv %A Heo,Seung Yun %A Gray,Elizabeth %A Lim,Jaeman %A Kwon,Kyeongha %A Christiansen,Zach %A Model,Jeffrey %A Trueb,Jacob %A Banks,Anthony %A Kwasny,Mary %A Rogers,John A %+ Northwestern University Feinberg School of Medicine, 132 East Delaware Place, #5806, Chicago, IL, 60611, United States, 1 3129433703, june-robinson@northwestern.edu %K sun protection %K UV dosimeter %K health promotion technology %K melanoma %K sunburn %K preventive medicine %K mobile phone %D 2021 %7 6.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Melanoma is attributable to predisposing phenotypical factors, such as skin that easily sunburns and unprotected exposure to carcinogenic UV radiation. Reducing the proportion of young adults who get sunburned may reduce the incidence of melanoma, a deadly form of skin cancer. Advances in technology have enabled the delivery of real-time UV light exposure and content-relevant health interventions. Objective: This study aims to examine the feasibility of young adults performing the following tasks daily: wearing a UV dosimeter, receiving text messages and real-time UV-B doses on their smartphone, and responding to daily web-based surveys about sunburn and sun protection. Methods: Young adults aged 18-39 years (n=42) were recruited in the United States in June 2020 via social media. Participants received the UV Guard sun protection system, which consisted of a UV dosimeter and a smartphone app. During 3 consecutive periods, intervention intensity increased as follows: real-time UV-B dose; UV-B dose and daily behavioral facilitation text messages; and UV-B dose, goal setting, and daily text messages to support self-efficacy and self-regulation. Data were self-reported through daily web-based surveys for 28 days, and UV-B doses were transmitted to cloud-based storage. Results: Patients’ median age was 22 years (IQR 20, 29), and all patients had sun-sensitive skin. Sunburns were experienced during the study by fewer subjects (n=18) than those in the preceding 28 days (n=30). In July and August, the face was the most commonly sunburned area among 13 body locations; 52% (22/42) of sunburns occurred before the study and 45% (19/42) occurred during the study. The mean daily UV-B dose decreased during the 3 periods; however, this was not statistically significant. Young adults were most often exercising outdoors from 2 to 6 PM, walking from 10 AM to 6 PM, and relaxing from noon to 2 PM. Sunburn was most often experienced during exercise (odds ratio [OR] 5.65, 95% CI 1.60-6.10) and relaxation (OR 3.69, 95% CI 1.03-4.67) relative to those that did not exercise or relax in each category. The self-reported exit survey indicated that participants felt that they spent less time outdoors this summer compared to the last summer because of the COVID-19 pandemic and work. In addition, 38% (16/42) of the participants changed their use of sun protection based on their app-reported UV exposure, and 48% (20/42) shifted the time they went outside to periods with less-intense UV exposure. A total of 79% (33/42) of the participants were willing to continue using the UV Guard system outside of a research setting. Conclusions: In this proof-of-concept research, young adults demonstrated that they used the UV Guard system; however, optimization was needed. Although some sun protection behaviors changed, sunburn was not prevented in all participants, especially during outdoor exercise. Trial Registration: ClinicalTrials.gov NCT03344796; http://clinicaltrials.gov/ct2/show/NCT03344796 %M 33955844 %R 10.2196/25895 %U https://mhealth.jmir.org/2021/5/e25895 %U https://doi.org/10.2196/25895 %U http://www.ncbi.nlm.nih.gov/pubmed/33955844 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e22929 %T Meal-time Smartphone Use in an Obesogenic Environment: Two Longitudinal Observational Studies %A Yong,Joceline Y Y %A Tong,Eddie M W %A Liu,Jean C J %+ Division of Social Sciences, Yale–National University of Singapore College, 16 College Avenue West #01-220, Singapore, 128527, Singapore, 65 6601 3694, jeanliu@yale-nus.edu.sg %K screen time %K mobile phones %K technology %K obesogenic environment %K young adults %D 2021 %7 6.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite a large volume of research on the impact of other digital screens (eg, televisions) on eating behavior, little is known about the nature and impact of mealtime smartphone use. Objective: We investigated how smartphones are used in everyday meals, whether phone users differ according to mealtime phone use patterns, and whether specific phone functions (particularly food photography) would affect the amount and enjoyment of food eaten. Methods: Across 2 studies, we used the experience sampling method to track 1780 meals in situ. In study 1, a total 137 young adults reported on their mealtime smartphone use 3 times per day over 7 consecutive days. This corresponded to each main meal, with participants recording whether they used their phones and what phone functions they engaged in while eating. In study 2, a total of 71 young adults were similarly tracked for 3 meals per day over 7 days. Across the week, participants’ meals were randomized to 1 of 3 smartphone conditions: food photography while eating, nonfood photography while eating, or no phone use. As the outcome measures, participants reported on the amount and enjoyment of food they ate. Results: During the week-long tracking, most participants (110/129, 85.3%) recorded at least one instance of mealtime smartphone use, with an average frequency of 1 in 3 meals where phones were used (27.1%; 95% CI 23.6-30.6). Unlike traditional digital screens, mealtime phone use encompassed a wide range of social and nonsocial activities. Further, specific forms of phone use behaviors influenced food intake in different ways. Specifically, in study 2, participants showed the typical pattern of increased food intake across the day when they engaged in nonfood photography during a meal (P<.001); however, this pattern was disrupted when they engaged in food photography (P=.73). Conclusions: Our findings underscore the prevalence and multifaceted nature of mealtime phone use, distinguishing mobile phones from traditional forms of digital screens. Trial Registration: ClinicalTrials.gov NCT03299075; https://www.clinicaltrials.gov/ct2/show/NCT03299075 and ClinicalTrials.gov NCT03346785; https://clinicaltrials.gov/ct2/show/NCT03346785 %M 33955842 %R 10.2196/22929 %U https://mhealth.jmir.org/2021/5/e22929 %U https://doi.org/10.2196/22929 %U http://www.ncbi.nlm.nih.gov/pubmed/33955842 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e23681 %T The Effect of Sensor Placement and Number on Physical Activity Recognition and Energy Expenditure Estimation in Older Adults: Validation Study %A Davoudi,Anis %A Mardini,Mamoun T %A Nelson,David %A Albinali,Fahd %A Ranka,Sanjay %A Rashidi,Parisa %A Manini,Todd M %+ Department of Biomedical Engineering, University of Florida, M542, Stetson Medical Science Building, 1345 Center Dr, Gainesville, FL, 32610, United States, 1 352 294 5086, anisdavoudi@ufl.edu %K human activity recognition %K machine learning %K wearable accelerometers %K mobile phone %D 2021 %7 3.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Research has shown the feasibility of human activity recognition using wearable accelerometer devices. Different studies have used varying numbers and placements for data collection using sensors. Objective: This study aims to compare accuracy performance between multiple and variable placements of accelerometer devices in categorizing the type of physical activity and corresponding energy expenditure in older adults. Methods: In total, 93 participants (mean age 72.2 years, SD 7.1) completed a total of 32 activities of daily life in a laboratory setting. Activities were classified as sedentary versus nonsedentary, locomotion versus nonlocomotion, and lifestyle versus nonlifestyle activities (eg, leisure walk vs computer work). A portable metabolic unit was worn during each activity to measure metabolic equivalents (METs). Accelerometers were placed on 5 different body positions: wrist, hip, ankle, upper arm, and thigh. Accelerometer data from each body position and combinations of positions were used to develop random forest models to assess activity category recognition accuracy and MET estimation. Results: Model performance for both MET estimation and activity category recognition were strengthened with the use of additional accelerometer devices. However, a single accelerometer on the ankle, upper arm, hip, thigh, or wrist had only a 0.03-0.09 MET increase in prediction error compared with wearing all 5 devices. Balanced accuracy showed similar trends with slight decreases in balanced accuracy for the detection of locomotion (balanced accuracy decrease range 0-0.01), sedentary (balanced accuracy decrease range 0.05-0.13), and lifestyle activities (balanced accuracy decrease range 0.04-0.08) compared with all 5 placements. The accuracy of recognizing activity categories increased with additional placements (accuracy decrease range 0.15-0.29). Notably, the hip was the best single body position for MET estimation and activity category recognition. Conclusions: Additional accelerometer devices slightly enhance activity recognition accuracy and MET estimation in older adults. However, given the extra burden of wearing additional devices, single accelerometers with appropriate placement appear to be sufficient for estimating energy expenditure and activity category recognition in older adults. %M 33938809 %R 10.2196/23681 %U https://mhealth.jmir.org/2021/5/e23681 %U https://doi.org/10.2196/23681 %U http://www.ncbi.nlm.nih.gov/pubmed/33938809 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26699 %T Long-term Effectiveness of mHealth Physical Activity Interventions: Systematic Review and Meta-analysis of Randomized Controlled Trials %A Mönninghoff,Annette %A Kramer,Jan Niklas %A Hess,Alexander Jan %A Ismailova,Kamila %A Teepe,Gisbert W %A Tudor Car,Lorainne %A Müller-Riemenschneider,Falk %A Kowatsch,Tobias %+ Institute for Customer Insight, University of St. Gallen, Bahnhofstrasse 8, St. Gallen, 9000, Switzerland, 41 76 229 3150, Annette.Moenninghoff@unisg.ch %K mHealth %K physical activity %K systematic review %K meta-analysis %K mobile phone %D 2021 %7 30.4.2021 %9 Review %J J Med Internet Res %G English %X Background: Mobile health (mHealth) interventions can increase physical activity (PA); however, their long-term impact is not well understood. Objective: The primary aim of this study is to understand the immediate and long-term effects of mHealth interventions on PA. The secondary aim is to explore potential effect moderators. Methods: We performed this study according to the Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched PubMed, the Cochrane Library, SCOPUS, and PsycINFO in July 2020. Eligible studies included randomized controlled trials of mHealth interventions targeting PA as a primary outcome in adults. Eligible outcome measures were walking, moderate-to-vigorous physical activity (MVPA), total physical activity (TPA), and energy expenditure. Where reported, we extracted data for 3 time points (ie, end of intervention, follow-up ≤6 months, and follow-up >6 months). To explore effect moderators, we performed subgroup analyses by population, intervention design, and control group type. Results were summarized using random effects meta-analysis. Risk of bias was assessed using the Cochrane Collaboration tool. Results: Of the 2828 identified studies, 117 were included. These studies reported on 21,118 participants with a mean age of 52.03 (SD 14.14) years, of whom 58.99% (n=12,459) were female. mHealth interventions significantly increased PA across all the 4 outcome measures at the end of intervention (walking standardized mean difference [SMD] 0.46, 95% CI 0.36-0.55; P<.001; MVPA SMD 0.28, 95% CI 0.21-0.35; P<.001; TPA SMD 0.34, 95% CI 0.20-0.47; P<.001; energy expenditure SMD 0.44, 95% CI 0.13-0.75; P=.01). Only 33 studies reported short-term follow-up measurements, and 8 studies reported long-term follow-up measurements in addition to end-of-intervention results. In the short term, effects were sustained for walking (SMD 0.26, 95% CI 0.09-0.42; P=.002), MVPA (SMD 0.20, 95% CI 0.05-0.35; P=.008), and TPA (SMD 0.53, 95% CI 0.13-0.93; P=.009). In the long term, effects were also sustained for walking (SMD 0.25, 95% CI 0.10-0.39; P=.001) and MVPA (SMD 0.19, 95% CI 0.11-0.27; P<.001). We found the study population to be an effect moderator, with higher effect scores in sick and at-risk populations. PA was increased both in scalable and nonscalable mHealth intervention designs and regardless of the control group type. The risk of bias was rated high in 80.3% (94/117) of the studies. Heterogeneity was significant, resulting in low to very low quality of evidence. Conclusions: mHealth interventions can foster small to moderate increases in PA. The effects are maintained long term; however, the effect size decreases over time. The results encourage using mHealth interventions in at-risk and sick populations and support the use of scalable mHealth intervention designs to affordably reach large populations. However, given the low evidence quality, further methodologically rigorous studies are warranted to evaluate the long-term effects. %M 33811021 %R 10.2196/26699 %U https://www.jmir.org/2021/4/e26699 %U https://doi.org/10.2196/26699 %U http://www.ncbi.nlm.nih.gov/pubmed/33811021 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e25030 %T Self-Efficacy and Motivation to Quit of Smokers Seeking to Quit: Quantitative Assessment of Smoking Cessation Mobile Apps %A Rajani,Nikita B %A Mastellos,Nikolaos %A Filippidis,Filippos T %+ Department of Primary Care and Public Health, Imperial College London, School of Public Health, St Dunstan's Road, London, W6 8RP, United Kingdom, 44 7427615928, nikita.rajani14@imperial.ac.uk %K smoking cessation %K mobile applications %K self-efficacy %K motivation to quit %K mHealth %K mobile phone %D 2021 %7 30.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Decreasing trends in the number of individuals accessing face-to-face support are leaving a significant gap in the treatment options for smokers seeking to quit. Face-to-face behavioral support and other interventions attempt to target psychological factors such as the self-efficacy and motivation to quit of smokers, as these factors are associated with an increased likelihood of making quit attempts and successfully quitting. Although digital interventions, such as smoking cessation mobile apps, could provide a promising avenue to bridge the growing treatment gap, little is known about their impact on psychological factors that are vital for smoking cessation. Objective: This study aims to better understand the possible impact of smoking cessation mobile apps on important factors for successful cessation, such as self-efficacy and motivation to quit. Our aim is to assess the self-efficacy and motivation to quit levels of smokers before and after the use of smoking cessation mobile apps. Methods: Smokers seeking to quit were recruited to participate in a 4-week app-based study. After screening, eligible participants were asked to use a mobile app (Kwit or Quit Genius). The smoking self-efficacy questionnaire and the motivation to stop smoking scale were used to measure the self-efficacy and motivation to quit, respectively. Both were assessed at baseline (before app use), midstudy (2 weeks after app use), and end-study (4 weeks after app use). Paired sample two-tailed t tests were used to investigate whether differences in self-efficacy and motivation between study time points were statistically significant. Linear regression models investigated associations between change in self-efficacy and change in motivation to quit before and after app use with age, gender, and nicotine dependence. Results: A total of 116 participants completed the study, with the majority being male (71/116, 61.2%), employed (76/116, 65.6%), single (77/116, 66.4%), and highly educated (87/116, 75.0%). A large proportion of participants had a low to moderate dependence on nicotine (107/116, 92.2%). A statistically significant increase of 5.09 points (95% CI 1.83-8.34) from 37.38 points at baseline in self-efficacy was found at the end of the study. Statistically significant increases were also found for the subcomponents of self-efficacy (intrinsic and extrinsic self-efficacies). Similarly, a statistically significant increase of 0.38 points (95% CI 0.06-0.70) from 5.94 points at baseline in motivation to quit was found at the end of the study. Gender, age, and nicotine dependence were not statistically significantly associated with changes in self-efficacy and motivation to quit. Conclusions: The assessed mobile apps positively impacted the self-efficacy and motivation to quit of smokers making quit attempts. This has important implications on the possible future use of digitalized interventions and how they could influence important psychological factors for quitting such as self-efficacy and motivation. However, further research is needed to assess whether digital interventions can supplement or replace traditional forms of therapy. %M 33929336 %R 10.2196/25030 %U https://mhealth.jmir.org/2021/4/e25030 %U https://doi.org/10.2196/25030 %U http://www.ncbi.nlm.nih.gov/pubmed/33929336 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25140 %T mHealth Interventions for Self-Harm: Scoping Review %A Cliffe,Bethany %A Tingley,Jessica %A Greenhalgh,Isobel %A Stallard,Paul %+ Department for Health, University of Bath, Claverton Down, Bath, , United Kingdom, 44 01225 388388, bc731@bath.ac.uk %K mHealth %K self-harm %K digital interventions %K self-injury %K NSSI %K mobile phone %D 2021 %7 30.4.2021 %9 Review %J J Med Internet Res %G English %X Background: Self-harm is a growing issue with increasing prevalence rates; however, individuals who self-harm do not often receive treatment. Mobile health (mHealth) interventions are a possible solution to some of the barriers that individuals face when seeking support, and they have also been found to be effective in improving mental health. Thus far, reviews of mHealth interventions for self-harm have been limited by study type. Therefore, we determined that a broader scoping review will provide a more exhaustive understanding of mHealth interventions for self-harm. Objective: This scoping review aims to identify mHealth interventions for self-harm within the literature, understand the types and features of interventions that have been developed and evaluated, highlight research findings around mHealth interventions for self-harm, and determine what outcomes are typically used to assess the efficacy of interventions. Methods: A search was conducted using Embase, PubMed, PsycINFO, PsycEXTRA, Web of Science, and the Cochrane Library. Studies were included if they described an mHealth intervention designed to have a direct (ie, if the intervention was designed for self-harm or for people who self-harm) or indirect (ie, if self-harm was measured as an outcome) treatment effect and if the paper was available in English. There were no exclusion criteria based on the study design. Results: A total of 36 papers were included in the review, and most of them were randomized controlled trials published within the last 4 years. The interventions were mostly smartphone apps and calling or texting services, with 62% (21/34) having underlying therapeutic models to inform the intervention content. They were generally shown to be promising and appealing, but only 5 were widely available for use. Outcomes focused on a reduction of self-harm and suicidality, mood, and the users’ experiences of the intervention. Samples were typically nondiverse, and there was limited variety in the study designs and in the measurements of self-harm recovery. Conclusions: Promising and appealing mHealth interventions have been developed but are not widely available. Research could benefit from greater diversity as well as a broader and more nuanced understanding of recovery from self-harm. %M 33929329 %R 10.2196/25140 %U https://www.jmir.org/2021/4/e25140 %U https://doi.org/10.2196/25140 %U http://www.ncbi.nlm.nih.gov/pubmed/33929329 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e22487 %T Accuracy of Smart Scales on Weight and Body Composition: Observational Study %A Frija-Masson,Justine %A Mullaert,Jimmy %A Vidal-Petiot,Emmanuelle %A Pons-Kerjean,Nathalie %A Flamant,Martin %A d'Ortho,Marie-Pia %+ Physiologie-Explorations Fonctionnelles, Fédération Hospitalo-Universitaire APOLLO (Personalised medicine in chronic cardiovascular, respiratory, renal diseases and organ transplantation), Hôpital Bichat Claude Bernard, Assistance Publique Hôpitaux de Paris, 46 rue Henri Huchard, Paris, France, 33 01 40 25 85 18, justine.frija@aphp.fr %K smart scales %K DEXA %K obesity %D 2021 %7 30.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smart scales are increasingly used at home by patients to monitor their body weight and body composition, but scale accuracy has not often been documented. Objective: The goal of the research was to determine the accuracy of 3 commercially available smart scales for weight and body composition compared with dual x-ray absorptiometry (DEXA) as the gold standard. Methods: We designed a cross-sectional study in consecutive patients evaluated for DEXA in a physiology unit in a tertiary hospital in France. There were no exclusion criteria except patient declining to participate. Patients were weighed with one smart scale immediately after DEXA. Three scales were compared (scale 1: Body Partner [Téfal], scale 2: DietPack [Terraillon], and scale 3: Body Cardio [Nokia Withings]). We determined absolute error between the gold standard values obtained from DEXA and the smart scales for body mass, fat mass, and lean mass. Results: The sample for analysis included 53, 52, and 48 patients for each of the 3 tested smart scales, respectively. The median absolute error for body weight was 0.3 kg (interquartile range [IQR] –0.1, 0.7), 0 kg (IQR –0.4, 0.3), and 0.25 kg (IQR –0.10, 0.52), respectively. For fat mass, absolute errors were –2.2 kg (IQR –5.8, 1.3), –4.4 kg (IQR –6.6, 0), and –3.7 kg (IQR –8.0, 0.28), respectively. For muscular mass, absolute errors were –2.2 kg (IQR –5.8, 1.3), –4.4 kg (IQR –6.6, 0), and –3.65 kg (IQR –8.03, 0.28), respectively. Factors associated with fat mass measurement error were weight for scales 1 and 2 (P=.03 and P<.001, respectively), BMI for scales 1 and 2 (P=.034 and P<.001, respectively), body fat for scale 1 (P<.001), and muscular and bone mass for scale 2 (P<.001 for both). Factors associated with muscular mass error were weight and BMI for scale 1 (P<.001 and P=.004, respectively), body fat for scales 1 and 2 (P<.001 for both), and muscular and bone mass for scale 2 (P<.001 and P=.002, respectively). Conclusions: Smart scales are not accurate for body composition and should not replace DEXA in patient care. Trial Registration: ClinicalTrials.gov NCT03803098; https://clinicaltrials.gov/ct2/show/NCT03803098 %M 33929337 %R 10.2196/22487 %U https://mhealth.jmir.org/2021/4/e22487 %U https://doi.org/10.2196/22487 %U http://www.ncbi.nlm.nih.gov/pubmed/33929337 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e17581 %T Using a Mobile Phone App to Analyze the Relationship Between Planned and Performed Physical Activity in University Students: Observational Study %A Stewart,Matthew T %A Nezich,Taylor %A Lee,Joyce M %A Hasson,Rebecca E %A Colabianchi,Natalie %+ School of Kinesiology, University of Michigan, 1402 Washington Heights, Ann Arbor, MI, 48109, United States, 1 (734) 647 3543, colabian@umich.edu %K mobile phone application %K physical activity %K intention-behavior relationship %D 2021 %7 29.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The relationship between intention and behavior has been well researched, but most studies fail to capture dynamic, time-varying contextual factors. Ecological momentary assessment through mobile phone technology is an innovative method for collecting data in real time, including time-use data. However, only a limited number of studies have examined day-level plans to be physically active and subsequent physical activity behavior using real-time time-use data to better understand this relationship. Objective: This study aims to examine whether plans to be physically active (recorded in advance on an electronic calendar) were associated with objectively assessed physical activity (accelerometry), to identify activities that replaced planned periods of physical activity by using the mobile app Life in a Day (LIAD), and to test the feasibility and acceptability of LIAD for collecting real-time time-use data. Methods: The study included 48 university students who were randomly assigned to 1 of 3 protocols, which were defined by 1, 3, or 5 days of data collection. Participants were asked to record their planned activities on a Google Calendar and were provided with mobile phones with LIAD to complete time-use entries in real time for a set of categories (eg, exercise or sports, eating or cooking, school, or personal care). Participants were instructed to wear an accelerometer on their nondominant wrist during the protocol period. A total of 144 days of protocol data were collected from the 48 participants. Results: Protocol data for 123 days were eligible for analysis. A Fisher exact test showed a statistically significant association between plans and physical activity behavior (P=.02). The congruence between plans and behavior was fair (Cohen κ=0.220; 95% CI 0.028-0.411). Most participants did not plan to be active, which occurred on 75.6% (93/123) of days. Of these 93 days, no physical activity occurred on 76 (81.7%) days, whereas some physical activity occurred on 17 (18.3%) days. On the remaining 24.4% (30/123) of days, some physical activity was planned. Of these 30 days, no physical activity occurred on 18 (60%) days, whereas some physical activity occurred on 12 (40%) days. LIAD data indicated that activities related to screen time most often replaced planned physical activity, whereas unplanned physical activity was often related to active transport. Feasibility analyses indicated little difficulty in using LIAD, and there were no significant differences in feasibility by protocol length. Conclusions: Consistent with previous literature, physical activity plans and physical activity behaviors were linked, but not strongly linked. LIAD offers insight into the relationship between plans and behavior, highlighting the importance of active transport for physical activity and the influence of screen-related behaviors on insufficient physical activity. LIAD is a feasible and practical method for collecting time-use data in real time. %M 33913812 %R 10.2196/17581 %U https://mhealth.jmir.org/2021/4/e17581 %U https://doi.org/10.2196/17581 %U http://www.ncbi.nlm.nih.gov/pubmed/33913812 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e19163 %T An Implementation Strategy to Expand Mobile Health Use in HIV Care Settings: Rapid Evaluation Study Using the Consolidated Framework for Implementation Research %A Cohn,Wendy F %A Canan,Chelsea E %A Knight,Sarah %A Waldman,Ava Lena %A Dillingham,Rebecca %A Ingersoll,Karen %A Schexnayder,Julie %A Flickinger,Tabor E %+ Department of Public Health Sciences, University of Virginia Cancer Center, University of Virginia, 560 Ray C Hunt Dr, PO Box 800765, Charlottesville, VA, 22908, United States, 1 434 964 7811, wfc2r@virginia.edu %K mHealth %K smartphone %K mobile health %K implementation strategy %K implementation science %K Consolidated Framework for Implementation Research %K HIV care engagement %K viral suppression %D 2021 %7 28.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps can provide support to people living with a chronic disease by offering resources for communication, self-management, and social support. PositiveLinks (PL) is a clinic-deployed mHealth app designed to improve the health of people with HIV. In a pilot study, PL users experienced considerable improvements in care engagement and viral load suppression. To promote its expansion to other HIV clinics, we developed an implementation strategy consisting of training resources and on-demand program support. Objective: The objective of our study was to conduct an interim analysis of the barriers and facilitators to PL implementation at early adopting sites to guide optimization of our implementation strategy. Methods: Semistructured interviews with stakeholders at PL expansion sites were conducted. Analysis of interviews identified facilitators and barriers that were mapped to 22 constructs of the Consolidated Framework for Implementation Research (CFIR). The purpose of the analysis was to identify the facilitators and barriers to PL implementation in order to adapt the PL implementation strategy. Four Ryan White HIV clinics were included. Interviews were conducted with one health care provider, two clinic managers, and five individuals who coordinated site PL activities. Results: Ten common facilitators and eight common barriers were identified. Facilitators to PL implementation included PL’s fit with patient and clinic needs, PL training resources, and sites’ early engagement with their information technology personnel. Most barriers were specific to mHealth, including access to Wi-Fi networks, maintaining patient smartphone access, patient privacy concerns, and lack of clarity on how to obtain approvals for mHealth use. Conclusions: The CFIR is a useful framework for evaluating mHealth interventions. Although PL training resources were viewed favorably, we identified important barriers to PL implementation in a sample of Ryan White clinics. This enabled our team to expand guidance on identifying information technology stakeholders and procuring and managing mobile resources. Ongoing evaluation results continue to inform improvements to the PL implementation strategy, facilitating PL access for future expansion sites. %M 33908893 %R 10.2196/19163 %U https://mhealth.jmir.org/2021/4/e19163 %U https://doi.org/10.2196/19163 %U http://www.ncbi.nlm.nih.gov/pubmed/33908893 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e27173 %T Influences on the Uptake of Health and Well-being Apps and Curated App Portals: Think-Aloud and Interview Study %A Szinay,Dorothy %A Perski,Olga %A Jones,Andy %A Chadborn,Tim %A Brown,Jamie %A Naughton,Felix %+ School of Health Sciences, University of East Anglia, , Norwich , United Kingdom, 44 1603593064, d.szinay@uea.ac.uk %K behavior change %K health apps %K mHealth %K smartphone app %K framework analysis %K Capability, Opportunity, Motivation-Behavior model %K Theoretical Domains Framework %K think aloud %K mobile phone %D 2021 %7 27.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health and well-being smartphone apps can provide a cost-effective solution to addressing unhealthy behaviors. The selection of these apps tends to occur in commercial app stores, where thousands of health apps are available. Their uptake is often influenced by popularity indicators. However, these indicators are not necessarily associated with app effectiveness or evidence-based content. Alternative routes to app selection are increasingly available, such as via curated app portals, but little is known about people’s experiences of them. Objective: The aim of this study is to explore how people select health apps on the internet and their views on curated app portals. Methods: A total of 18 UK-based adults were recruited through social media and asked during an in-person meeting to verbalize their thoughts while searching for a health or well-being app on the internet on a platform of their choice. The search was then repeated on 2 curated health app portals: the National Health Service Apps Library and the Public Health England One You App portal. This was followed by semistructured interviews. Data were analyzed using framework analysis, informed by the Capability, Opportunity, Motivation-Behavior model and the Theoretical Domains Framework. Results: Searching for health and well-being apps on the internet was described as a minefield. App uptake appeared to be influenced by participants’ capabilities such as app literacy skills and health and app awareness, and opportunities including the availability of apps, app esthetics, the price of an app, and social influences. Motivation factors that seemed to affect the uptake were perceived competence, time efficiency, perceived utility and accuracy of an app, transparency about data protection, commitment and social identity, and a wide range of emotions. Social influences and the perceived utility of an app were highlighted as particularly important. Participants were not previously aware of curated portals but found the concept appealing. Curated health app portals appeared to engender trust and alleviate data protection concerns. Although apps listed on these were perceived as more trustworthy, their presentation was considered disappointing. This disappointment seemed to stem from the functionality of the portals, lack of user guidance, and lack of tailored content to an individual’s needs. Conclusions: The uptake of health and well-being apps appears to be primarily affected by social influences and the perceived utility of an app. App uptake via curated health app portals perceived as credible may mitigate concerns related to data protection and accuracy, but their implementation must better meet user needs and expectations. %M 33904827 %R 10.2196/27173 %U https://mhealth.jmir.org/2021/4/e27173 %U https://doi.org/10.2196/27173 %U http://www.ncbi.nlm.nih.gov/pubmed/33904827 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e27290 %T Impact of Gamification on the Self-Efficacy and Motivation to Quit of Smokers: Observational Study of Two Gamified Smoking Cessation Mobile Apps %A Rajani,Nikita B %A Mastellos,Nikolaos %A Filippidis,Filippos T %+ Department of Primary Care and Public Health, Imperial College London, School of Public Health, St. Dunstan's Road, London, W6 8RP, United Kingdom, 44 7427615928, nikita.rajani14@imperial.ac.uk %K gamification %K smoking cessation %K mobile applications %K self-efficacy %K motivation to quit %K mHealth %K mobile phone %D 2021 %7 27.4.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: The proportion of smokers making quit attempts and the proportion of smokers successfully quitting have been decreasing over the past few years. Previous studies have shown that smokers with high self-efficacy and motivation to quit have an increased likelihood of quitting and staying quit. Consequently, further research on strategies that can improve the self-efficacy and motivation of smokers seeking to quit could lead to substantially higher cessation rates. Some studies have found that gamification can positively impact the cognitive components of behavioral change, including self-efficacy and motivation. However, the impact of gamification in the context of smoking cessation and mobile health has been sparsely investigated. Objective: This study aims to examine the association between perceived usefulness, perceived ease of use, and frequency of use of gamification features embedded in smoking cessation apps on self-efficacy and motivation to quit smoking. Methods: Participants were assigned to use 1 of the 2 mobile apps for a duration of 4 weeks. App-based questionnaires were provided to participants before app use and 2 weeks and 4 weeks after they started using the app. Gamification was quantitatively operationalized based on the Cugelman gamification framework and concepts from the technology acceptance model. The mean values of perceived frequency, ease of use, and usefulness of gamification features were calculated at midstudy and end-study. Two linear regression models were used to investigate the impact of gamification on self-efficacy and motivation to quit. Results: A total of 116 participants completed the study. The mean self-efficacy increased from 37.38 (SD 13.3) to 42.47 (SD 11.5) points and motivation to quit increased from 5.94 (SD 1.4) to 6.32 (SD 1.7) points after app use. Goal setting was perceived to be the most useful gamification feature, whereas sharing was perceived to be the least useful. Participants self-reported that they used the progress dashboards the most often, whereas they used the sharing feature the least often. The average perceived frequency of gamification features was statistically significantly associated with change in self-efficacy (β=3.35; 95% CI 0.31-6.40) and change in motivation to quit (β=.54; 95% CI 0.15-0.94) between baseline and end-study. Conclusions: Gamification embedded in mobile apps can have positive effects on self-efficacy and motivation to quit smoking. The findings of this study can provide important insights for tobacco control policy makers, mobile app developers, and smokers seeking to quit. %M 33904824 %R 10.2196/27290 %U https://games.jmir.org/2021/2/e27290 %U https://doi.org/10.2196/27290 %U http://www.ncbi.nlm.nih.gov/pubmed/33904824 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e25462 %T Evaluation of the Implementation and Effectiveness of Community-Based Brain-Computer Interface Cognitive Group Training in Healthy Community-Dwelling Older Adults: Randomized Controlled Implementation Trial %A Yeo,Pei Shi %A Nguyen,Tu Ngoc %A Ng,Mary Pei Ern %A Choo,Robin Wai Munn %A Yap,Philip Lin Kiat %A Ng,Tze Pin %A Wee,Shiou Liang %+ Geriatric Education and Research Institute, 2 Yishun Central 2, Tower E, Level 4, Singapore, 768024, Singapore, 65 6592 4606, weeshiouliang@gmail.com %K group-based computerized cognitive training %K cognition %K gait %K community program implementation %K healthy older adults %K cognitive %K community program %K cognitive training %K elderly %K aging %D 2021 %7 27.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Cognitive training can improve cognition in healthy older adults. Objective: The objectives are to evaluate the implementation of community-based computerized cognitive training (CCT) and its effectiveness on cognition, gait, and balance in healthy older adults. Methods: A single-blind randomized controlled trial with baseline and follow-up assessments was conducted at two community centers in Singapore. Healthy community-dwelling adults aged 55 years and older participated in a 10-week CCT program with 2-hour instructor-led group classes twice a week. Participants used a mobile app to play games targeting attention, memory, decision making, visuospatial abilities, and cognitive flexibility. Implementation was assessed at the participant, provider, and community level (eg, reach, implementation, and facilitators and barriers). Effectiveness measures were the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Color Trails Test 2 (CTT-2), Berg Balance Scale, and GAITRite walkway measures (single and dual task gait speed, dual task cost, and single and dual task gait variability index [GVI]). Results: A total of 94 healthy community-dwelling adults participated in the CCT program (mean age 68.8 [SD 6.3] years). Implementation measures revealed high reach (125/155, 80.6%) and moderate adherence but poor penetration of sedentary older adults (43/125, 34.4%). The effectiveness data were based on intention-to-treat (ITT) and per-protocol (PP) analysis. In the ITT analysis, single task GVI increased (b=2.32, P=.02, 95% CI [0.30 to 4.35]) and RBANS list recognition subtest deteriorated (b=–0.57, P=.01, 95% CI [–1.00 to –0.14]) in both groups. In the PP analysis, time taken to complete CTT-2 (b=–13.5, P=.01, 95% CI [–23.95 to –3.14]; Cohen d effect size = 0.285) was faster in the intervention group. Single task gait speed was not statistically significantly maintained in the intervention group (b=5.38, P=.06, 95% CI [–0.30 to 11.36]) and declined in the control group (Cohen d effect size = 0.414). PP analyses also showed interaction terms for RBANS list recall subtest (b=–0.36, P=.08, 95% CI [–0.75 to 0.04]) and visuospatial domain (b=0.46, P=.08, 95% CI [–0.05 to 0.96]) that were not statistically significant. Conclusions: CCT can be implemented in community settings to improve attention and executive function among healthy older adults. Findings help to identify suitable healthy aging programs that can be implemented on a larger scale within communities. Trial Registration: ClinicalTrials.gov NCT04439591; https://clinicaltrials.gov/ct2/show/NCT04439591 %M 33904819 %R 10.2196/25462 %U https://formative.jmir.org/2021/4/e25462 %U https://doi.org/10.2196/25462 %U http://www.ncbi.nlm.nih.gov/pubmed/33904819 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e21622 %T Effects of an mHealth App (Kencom) With Integrated Functions for Healthy Lifestyles on Physical Activity Levels and Cardiovascular Risk Biomarkers: Observational Study of 12,602 Users %A Hamaya,Rikuta %A Fukuda,Hiroshi %A Takebayashi,Masaki %A Mori,Masaki %A Matsushima,Ryuji %A Nakano,Ken %A Miyake,Kuniaki %A Tani,Yoshiaki %A Yokokawa,Hirohide %+ Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 900 Commonwealth Avenue, Boston, MA, 02215, United States, 1 617 732 4965, rktrocky@gmail.com %K mHealth %K app %K cardiovascular disease %K physical activity %K smartphone %K mobile phone %D 2021 %7 26.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health (mHealth) apps are considered to be potentially powerful tools for improving lifestyles and preventing cardiovascular disease (CVD), although only few have undergone large, well-designed epidemiological research. “kencom” is a novel mHealth app with integrated functions for healthy lifestyles such as monitoring daily health/step data, providing tailored health information, or facilitating physical activity through group-based game events. The app is linked to large-scale Japanese insurance claims databases and annual health check-up databases, thus comprising a large longitudinal cohort. Objective: We aimed to assess the effects of kencom on physical activity levels and CVD risk factors such as obesity, hypertension, dyslipidemia, and diabetes mellitus in a large population in Japan. Methods: Daily step count, annual health check-up data, and insurance claim data of the kencom users were integrated within the kencom system. Step analysis was conducted by comparing the 1-year average daily step count before and after kencom registration. In the CVD risk analysis, changes in CVD biomarkers following kencom registration were evaluated among the users grouped into the quintile according to their change in step count. Results: A total of 12,602 kencom users were included for the step analysis and 5473 for the CVD risk analysis. The participants were generally healthy and their mean age was 44.1 (SD 10.2) years. The daily step count significantly increased following kencom registration by a mean of 510 steps/day (P<.001). In particular, participation in “Arukatsu” events held twice a year within the app was associated with a remarkable increase in step counts. In the CVD risk analysis, the users of the highest quintile in daily step change had, compared with those of the lowest quartile, a significant reduction in weight (–0.92 kg, P<.001), low-density lipoprotein cholesterol (–2.78 mg/dL, P=.004), hemoglobin A1c (HbA1c; –0.04%, P=.004), and increase in high-density lipoprotein cholesterol (+1.91 mg/dL, P<.001) after adjustment of confounders. Conclusions: The framework of kencom successfully integrated the Japanese health data from multiple data sources to generate a large, longitudinal data set. The use of the kencom app was significantly associated with enhanced physical activity, which might lead to weight loss and improvement in lipid profile. %M 33900203 %R 10.2196/21622 %U https://www.jmir.org/2021/4/e21622 %U https://doi.org/10.2196/21622 %U http://www.ncbi.nlm.nih.gov/pubmed/33900203 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e24180 %T Mobile Sensing Apps and Self-management of Mental Health During the COVID-19 Pandemic: Web-Based Survey %A Suruliraj,Banuchitra %A Bessenyei,Kitti %A Bagnell,Alexa %A McGrath,Patrick %A Wozney,Lori %A Orji,Rita %A Meier,Sandra %+ Department of Psychiatry, Dalhousie University, 5850/5980 University Avenue, PO Box 970, Halifax, NS, B3K 6R8, Canada, 1 782 414 8054, sandra.m.meier@gmail.com %K app %K awareness %K behavior %K COVID-19 %K helpfulness %K mobile health %K mobile sensing %K self-management %K sensing %K web-based survey %D 2021 %7 26.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, people had to adapt their daily life routines to the currently implemented public health measures, which is likely to have resulted in a lack of in-person social interactions, physical activity, or sleep. Such changes can have a significant impact on mental health. Mobile sensing apps can passively record the daily life routines of people, thus making them aware of maladaptive behavioral adjustments to the pandemic. Objective: This study aimed to explore the views of people on mobile sensing apps that passively record behaviors and their potential to increase awareness and helpfulness for self-managing mental health during the pandemic. Methods: We conducted an anonymous web-based survey including people with and those without mental disorders, asking them to rate the helpfulness of mobile sensing apps for the self-management of mental health during the COVID-19 pandemic. The survey was conducted in May 2020. Results: The majority of participants, particularly those with a mental disorder (n=106/148, 72%), perceived mobile sensing apps as very or extremely helpful for managing their mental health by becoming aware of maladaptive behaviors. The perceived helpfulness of mobile sensing apps was also higher among people who experienced a stronger health impact of the COVID-19 pandemic (β=.24; 95% CI 0.16-0.33; P<.001), had a better understanding of technology (β=.17; 95% CI 0.08-0.25; P<.001), and had a higher education (β=.1; 95% CI 0.02-0.19; P=.02). Conclusions: Our findings highlight the potential of mobile sensing apps to assist in mental health care during the pandemic. %M 33872181 %R 10.2196/24180 %U https://formative.jmir.org/2021/4/e24180 %U https://doi.org/10.2196/24180 %U http://www.ncbi.nlm.nih.gov/pubmed/33872181 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e27106 %T Evaluation of Mood Check-in Feature for Participation in Meditation Mobile App Users: Retrospective Longitudinal Analysis %A Huberty,Jennifer %A Green,Jeni %A Puzia,Megan %A Stecher,Chad %+ College of Health Solutions, Arizona State University, 500 N 3rd St, Phoenix, AZ, 85004, United States, 1 8019278558, jeni.green@asu.edu %K adherence %K meditation %K mindfulness %K mood %K smartphone application %K app %K engagement %K mHealth %K mental health %K behavior %D 2021 %7 23.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mindfulness meditation smartphone apps may improve mental health but lack evidence-based behavioral strategies to encourage their regular use for attaining mental health benefits. In October 2019, the Calm mindfulness meditation app introduced a mood check-in feature, but its effects on participation in meditation have yet to be tested. Objective: The objective of this study was to investigate how a mood check-in feature impacts meditation behavior in Calm app subscribers. Methods: This was a retrospective longitudinal analysis of mobile app usage data from a random sample of first-time subscribers to the Calm app (n=2600) who joined in summer 2018 or summer 2019. The mood check-in feature allows users to rate their mood using an emoji after completing a meditation session and displays a monthly calendar of their past mood check-ins. Regression analyses were used to compare the rate of change in meditation behavior before and after the introduction of mood check-ins and to estimate how usage of mood check-ins was associated with individuals’ future meditation behavior (ie, intent-to-treat effects). Additional regression models examined the heterogenous effect of mood check-ins between subscribers who were active or inactive users prior to the introduction to mood check-ins (ie, above or below the median number of weeks with any meditation within their cohort). In order to confirm the specific associations between mood check-ins and meditation engagement, we modeled the direct relationship between the use of mood check-ins in previous weeks and subsequent meditation behavior (ie, treatment on the treated effects). Results: During the first 9 months of their subscription, the 2019 cohort completed an average of 0.482 more sessions per week (95% CI 0.309 to 0.655) than the 2018 cohort; however, across both cohorts, average weekly meditation declined (–0.033 sessions per week, 95% CI –0.035 to –0.031). Controlled for trends in meditation before mood check-ins and aggregate differences between the 2018 and 2019 samples, the time trend in the number of weekly meditation sessions increased by 0.045 sessions among the 2019 cohort after the introduction of mood check-ins (95% CI 0.039 to 0.052). This increase in meditation was most pronounced among the inactive subscribers (0.063 sessions, 95% CI 0.052 to 0.074). When controlled for past-week meditation, use of mood check-ins during the previous week was positively associated with the likelihood of meditating the following week (odds ratio 1.132, 95% CI 1.059 to 1.211); however, these associations were not sustained beyond 1 week. Conclusions: Using mood check-ins increases meditation participation in Calm app subscribers and may be especially beneficial for inactive subscribers. Mobile apps should consider incorporating mood check-ins to help better engage a wider range of users in app-based meditation, but more research is warranted. %M 33890865 %R 10.2196/27106 %U https://mhealth.jmir.org/2021/4/e27106 %U https://doi.org/10.2196/27106 %U http://www.ncbi.nlm.nih.gov/pubmed/33890865 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e24254 %T A Technology-Based Physical Activity Intervention for Patients With Metastatic Breast Cancer (Fit2ThriveMB): Protocol for a Randomized Controlled Trial %A Phillips,Siobhan %A Solk,Payton %A Welch,Whitney %A Auster-Gussman,Lisa %A Lu,Marilyn %A Cullather,Erin %A Torre,Emily %A Whitaker,Madelyn %A Izenman,Emily %A La,Jennifer %A Lee,Jungwha %A Spring,Bonnie %A Gradishar,William %+ Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611-4407, United States, 1 13125034235, smphillips@northwestern.edu %K physical activity %K metastatic breast cancer %K technology %K randomized controlled trial %K mobile phone %D 2021 %7 23.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Increased incidence and life expectancy have resulted in a growing population of patients with metastatic breast cancer, and these patients experience high rates of morbidity and premature mortality. Increased physical activity (PA) is consistently associated with improved health and disease outcomes among early-stage survivors. However, there is a paucity of research on PA in patients with metastatic breast cancer, and existing PA interventions have exhibited low feasibility because of their focus on intense PA and/or requirement of on-site visits. Mobile health (mHealth)–based PA interventions may be particularly useful for patients with metastatic breast cancer because they allow for remote monitoring, which facilitates individual tailoring of PA recommendations to patients’ abilities and may minimize participant burden. However, no studies have examined mHealth PA interventions in patients with metastatic breast cancer. Objective: We aim to address these critical research gaps by testing a highly tailored technology-based intervention to promote PA of any intensity (ie, light, moderate, or vigorous) by increasing daily steps in patients with metastatic breast cancer. The primary aim of this study is to test the feasibility and acceptability of the Fit2ThriveMB intervention. We will also examine outcome patterns suggesting the efficacy of Fit2ThriveMB on symptom burden, quality of life, and functional performance. Methods: The Fit2ThriveMB trial is a two-arm pilot randomized controlled trial that will compare the effects of a smartphone-delivered, home-based PA intervention and an attention-control education condition on PA and quality of life in low-active female patients with metastatic breast cancer. A subsample (n=25) will also complete functional performance measures. This innovative trial will recruit 50 participants who will be randomized into the study’s intervention or control arm. The intervention will last 12 weeks. The Fit2ThriveMB intervention consists of a Fitbit, coaching calls, and the Fit2ThriveMB smartphone app that provides self-monitoring, a tailored goal-setting tool, real-time tailored feedback, app notifications, and a group message board. Assessments will occur at baseline and post intervention. Results: The Fit2ThriveMB study is ongoing. Data collection ended in February 2021. Conclusions: Data from this study will provide the preliminary effect sizes needed to assemble an intervention that is to be evaluated in a fully powered trial. In addition, these data will provide essential evidence to support the feasibility and acceptability of using a technology-based PA promotion intervention, a scalable strategy that could be easily integrated into care, among patients with metastatic breast cancer. Trial Registration: ClinicalTrials.gov NCT04129346; https://clinicaltrials.gov/ct2/show/NCT04129346 International Registered Report Identifier (IRRID): DERR1-10.2196/24254 %M 33890857 %R 10.2196/24254 %U https://www.researchprotocols.org/2021/4/e24254 %U https://doi.org/10.2196/24254 %U http://www.ncbi.nlm.nih.gov/pubmed/33890857 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e27383 %T Results of a Culturally Tailored Smartphone-Delivered Physical Activity Intervention Among Midlife African American Women: Feasibility Trial %A Joseph,Rodney P %A Ainsworth,Barbara E %A Hollingshead,Kevin %A Todd,Michael %A Keller,Colleen %+ Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N 3rd St, Phoenix, AZ, 85004, United States, 1 602 496 0772, rodney.joseph@asu.edu %K exercise %K physical activity %K minority health %K women’s health %K mHealth %K mobile phone %D 2021 %7 22.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Regular aerobic physical activity (PA) is an important component of healthy aging. However, only 27%-40% of African American women achieve national PA guidelines. Available data also show a clear decline in PA as African American women transition from young adulthood (ie, 25-44 years) into midlife. This decline in PA during midlife coincides with an increased risk for African American women developing cardiometabolic disease conditions, including obesity, type 2 diabetes, and cardiovascular disease. Thus, effective efforts are needed to promote PA among sedentary African American women during midlife. Objective: This study aims to examine the acceptability and feasibility of a culturally tailored, smartphone-delivered PA intervention, originally developed to increase PA among African American women aged 24-49 years, among a slightly older sample of midlife African American women aged 50-65 years. Methods: A single-arm pretest-posttest study design was implemented. In total, 20 insufficiently active African American (ie, ≤60 min per week of PA) women between the ages of 50-65 years participated in the 4-month feasibility trial. The Smart Walk intervention was delivered through the study Smart Walk smartphone app and text messages. Features available on the Smart Walk app include personal profile pages, multimedia PA promotion modules, discussion board forums, and an activity tracking feature that integrates with Fitbit activity monitors. Self-reported PA and social cognitive theory mediators targeted by the intervention (ie, self-regulation, behavioral capability, outcome expectations, self-efficacy, and social support) were assessed at baseline and at 4 months. Feasibility and acceptability were assessed using a postintervention satisfaction survey that included multiple-choice and open-ended questions evaluating participant perceptions of the intervention and suggestions for intervention improvement. Wilcoxon signed-rank tests were used to examine pre- and postintervention changes in the PA and social cognitive theory variables. The effect size estimates were calculated using the Pearson r test statistic. Results: Participants increased moderate-to-vigorous PA (median 30 minutes per week increase; r=0.503; P=.002) and reported improvements in 2 theoretical mediators (self-regulation: r=0.397; P=.01; behavioral capability: r=0.440; P=.006). Nearly all participants (14/15, 93% completing the satisfaction survey) indicated that they would recommend the intervention to a friend. Participants’ suggestions for improving the intervention included enhancing the intervention’s provisions of social support for PA. Conclusions: The results provide preliminary support for the feasibility of the smartphone-based approach to increase PA among midlife African American women. However, before larger-scale implementation among midlife African American women, enhancements to the social support components of the intervention are warranted. Trial Registration: ClinicalTrials.gov NCT04073355; https://clinicaltrials.gov/ct2/show/NCT04073355 %M 33885368 %R 10.2196/27383 %U https://mhealth.jmir.org/2021/4/e27383 %U https://doi.org/10.2196/27383 %U http://www.ncbi.nlm.nih.gov/pubmed/33885368 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25160 %T User Perspectives of Diet-Tracking Apps: Reviews Content Analysis and Topic Modeling %A Zečević,Mila %A Mijatović,Dejan %A Kos Koklič,Mateja %A Žabkar,Vesna %A Gidaković,Petar %+ School of Economics and Business, University of Ljubljana, Kardeljeva ploscad 17, Ljubljana, 1000, Slovenia, 386 15892429, mila.zecevic@ef.uni-lj.si %K diet-tracking apps %K mobile apps %K user reviews %K topic modeling %K n-grams %K mHealth %K nutrition %K diet %K well-being %D 2021 %7 22.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The availability and use of mobile apps in health and nutrition management are increasing. Ease of access and user friendliness make diet-tracking apps an important ally in their users’ efforts to lose and manage weight. To foster motivation for long-term use and to achieve goals, it is necessary to better understand users’ opinions and needs for dietary self-monitoring. Objective: The aim of this study was to identify the key topics and issues that users highlight in their reviews of diet-tracking apps on Google Play Store. Identifying the topics that users frequently mention in their reviews of these apps, along with the user ratings for each of these apps, allowed us to identify areas where further improvement of the apps could facilitate app use, and support users’ weight loss and intake management efforts. Methods: We collected 72,084 user reviews from Google Play Store for 15 diet-tracking apps that allow users to track and count calories. After a series of text processing operations, two text-mining techniques (topic modeling and topical n-grams) were applied to the corpus of user reviews of diet-tracking apps. Results: Using the topic modeling technique, 11 separate topics were extracted from the pool of user reviews. Most of the users providing feedback were generally satisfied with the apps they use (average rating of 4.4 out of 5 for the 15 apps). Most topics referred to the positive evaluation of the apps and their functions. Negatively rated topics mostly referred to app charges and technical difficulties encountered. We identified the positive and negative topic trigrams (3-word combinations) among the most frequently mentioned topics. Usability and functionality (tracking options) of apps were rated positively on average. Negative ratings were associated with trigrams related to adding new foods, technical issues, and app charges. Conclusions: Motivating users to use an app over time could help them better achieve their nutrition goals. Although user reviews generally showed positive opinions and ratings of the apps, developers should pay more attention to users’ technical problems and inform users about expected payments, along with their refund and cancellation policies, to increase user loyalty. %M 33885375 %R 10.2196/25160 %U https://www.jmir.org/2021/4/e25160 %U https://doi.org/10.2196/25160 %U http://www.ncbi.nlm.nih.gov/pubmed/33885375 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e25128 %T Digital Health Intervention to Increase Health Knowledge Related to Diseases of High Public Health Concern in Iringa, Tanzania: Protocol for a Mixed Methods Study %A Holst,Christine %A Sukums,Felix %A Ngowi,Bernard %A Diep,Lien My %A Kebede,Tewodros Aragie %A Noll,Josef %A Winkler,Andrea Sylvia %+ Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, Oslo, 0318, Norway, 47 48234044, christine.holst@medisin.uio.no %K digital health %K eHealth %K mHealth %K DigI %K Tanzania %K digital health messages %K digital health promotion %K digital health education %K HIV/AIDS %K tuberculosis %D 2021 %7 22.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Traditionally, health promotion and health education have been provided to communities in the global south in the form of leaflets or orally by health care workers. Digital health interventions (DHIs) such as digital health messages accessed by smartphones have the potential to reach more people at a lower cost and to contribute to strengthening of health care systems. The DHI in this study focuses on disseminating digital health education regarding 3 disease complexes of high public health concern: HIV/AIDS, tuberculosis, and Taenia solium (neuro)cysticercosis or taeniasis, a parasitic zoonotic disease that requires a One Health approach. The DHI presents the participants with animated health videos (animations) and provides access to information spots (InfoSpots) with a free-of-charge digital health platform containing messages about health to rural Tanzanian communities. Objective: The objective of this study is to measure the effect of the DHI on health knowledge uptake and retention over time in the rural communities. Methods: This is a mixed methods study including a nonrandomized controlled trial and qualitative interviews conducted in rural Tanzania. A health platform containing digital health messages for the communities was developed prior to the study. The health messages consist of text, pictures, quizzes, and animations of everyday stories, aimed at disease prevention and early treatment. The baseline and immediate postintervention assessments were completed in Iringa, Tanzania in May 2019. The participants were interviewed by enumerators and completed questionnaires regarding health knowledge. Participants in the intervention group were exposed to 3 different health animations once on a tablet device. The participants’ health knowledge was assessed again immediately after the exposure. The first follow-up survey was undertaken in August 2019. The InfoSpots with the digital health platform were thereafter launched in the intervention villages in November 2019. Qualitative interviews were undertaken in February 2020. The second follow-up was completed in June 2020. Results: A total of 600 participants have been enrolled in the trial. We will assess (1) the difference in knowledge scores between baseline and the immediate postintervention assessments in the intervention group and (2) the difference in knowledge scores between the intervention and control groups at baseline, 3 and 6 months post-DHI rollout. Since a randomized design did not prove feasible, potential confounders (eg, age, gender, education, and time of exposure) may be introduced, and results will be adjusted. Data analysis for the 35 qualitative interviews is currently ongoing, and perspectives and experiences related to use and nonuse of the InfoSpots are being explored. Conclusions: The data have been collected, and the analysis is ongoing in this digital health study, aimed at evaluating the effects of a DHI based on relevant health messages. The publications of results can be expected this year. Trial Registration: ClinicalTrials.gov NCT03808597; https://clinicaltrials.gov/ct2/show/NCT03808597 International Registered Report Identifier (IRRID): RR1-10.2196/25128 %M 33885369 %R 10.2196/25128 %U https://www.researchprotocols.org/2021/4/e25128 %U https://doi.org/10.2196/25128 %U http://www.ncbi.nlm.nih.gov/pubmed/33885369 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 4 %P e24482 %T Youth and Provider Perspectives on Behavior-Tracking Mobile Apps: Qualitative Analysis %A Armstrong,Courtney C %A Odukoya,Erica J %A Sundaramurthy,Keerthi %A Darrow,Sabrina M %+ Department of Psychology, University of California, Berkeley, 2121 Berkeley Way, University of California, Berkeley, CA, 94720, United States, 1 9178417015, courtney.armstrong@berkeley.edu %K qualitative %K mHealth %K mobile phone %K behavior monitoring %K youth %D 2021 %7 22.4.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mobile health apps stand as one possible means of improving evidence-based mental health interventions for youth. However, a better understanding of youth and provider perspectives is necessary to support widespread implementation. Objective: The objective of this research was to explore both youth and provider perspectives on using mobile apps to enhance evidence-based clinical care, with an emphasis on gathering perspectives on behavior-tracking apps. Methods: Inductive qualitative analysis was conducted on data obtained from semistructured interviews held with 10 youths who received psychotherapy and 12 mental health care providers who conducted therapy with youths aged 13-26 years. Interviews were independently coded by multiple coders and consensus meetings were held to establish reliability. Results: During the interviews, the youths and providers broadly agreed on the benefits of behavior tracking and believed that tracking via app could be more enjoyable and accessible. Providers and youths also shared similar concerns that negative emotions and user burden could limit app usage. Participants also suggested potential app features that, if implemented, would help meet the clinical needs of providers and support long-term use among youth. Such features included having a pleasant user interface, reminders for clients, and graphical output of data to clients and providers. Conclusions: Youths and providers explained that the integration of mobile health into psychotherapy has the potential to make treatment, particularly behavior tracking, easy and more accessible. However, both groups had concerns about the increased burden that could be placed on the clients and providers. %M 33885364 %R 10.2196/24482 %U https://mental.jmir.org/2021/4/e24482 %U https://doi.org/10.2196/24482 %U http://www.ncbi.nlm.nih.gov/pubmed/33885364 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e23432 %T A Mental Health–Informed Physical Activity Intervention for First Responders and Their Partners Delivered Using Facebook: Mixed Methods Pilot Study %A McKeon,Grace %A Steel,Zachary %A Wells,Ruth %A Newby,Jill %A Hadzi-Pavlovic,Dusan %A Vancampfort,Davy %A Rosenbaum,Simon %+ School of Psychiatry, University of New South Wales, Level 1, AGSM, Botany Street, Sydney, 2031, Australia, 61 9065 9097, g.mckeon@unsw.edu.au %K physical activity %K PTSD %K social media %K first responders %K mental health %K families %K online %K exercise %D 2021 %7 22.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: First responders (eg, police, firefighters, and paramedics) are at high risk of experiencing poor mental health. Physical activity interventions can help reduce symptoms and improve mental health in this group. More research is needed to evaluate accessible, low-cost methods of delivering programs. Social media may be a potential platform for delivering group-based physical activity interventions. Objective: This study aims to examine the feasibility and acceptability of delivering a mental health–informed physical activity program for first responders and their self-nominated support partners. This study also aims to assess the feasibility of applying a novel multiple time series design and to explore the impact of the intervention on mental health symptoms, sleep quality, quality of life, and physical activity levels. Methods: We co-designed a 10-week web-based physical activity program delivered via a private Facebook group. We provided education and motivation around different topics weekly (eg, goal setting, overcoming barriers to exercise, and reducing sedentary behavior) and provided participants with a Fitbit. A multiple time series design was applied to assess psychological distress levels, with participants acting as their own control before the intervention. Results: In total, 24 participants (12 first responders and 12 nominated support partners) were recruited, and 21 (88%) completed the postassessment questionnaires. High acceptability was observed in the qualitative interviews. Exploratory analyses revealed significant reductions in psychological distress during the intervention. Preintervention and postintervention analysis showed significant improvements in quality of life (P=.001; Cohen d=0.60); total depression, anxiety, and stress scores (P=.047; Cohen d=0.35); and minutes of walking (P=.04; Cohen d=0.55). Changes in perceived social support from family (P=.07; Cohen d=0.37), friends (P=.10; Cohen d=0.38), and sleep quality (P=.28; Cohen d=0.19) were not significant. Conclusions: The results provide preliminary support for the use of social media and a multiple time series design to deliver mental health–informed physical activity interventions for first responders and their support partners. Therefore, an adequately powered trial is required. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN): 12618001267246; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001267246. %M 33885376 %R 10.2196/23432 %U https://formative.jmir.org/2021/4/e23432 %U https://doi.org/10.2196/23432 %U http://www.ncbi.nlm.nih.gov/pubmed/33885376 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e21678 %T Chatbot-Based Assessment of Employees’ Mental Health: Design Process and Pilot Implementation %A Hungerbuehler,Ines %A Daley,Kate %A Cavanagh,Kate %A Garcia Claro,Heloísa %A Kapps,Michael %+ Vitalk, TNH Health, R. Pais Leme, 215 - Sala 2504, Pinheiros, São Paulo, 05424-150, Brazil, 55 11963883018, drkatedaley@gmail.com %K chatbot %K conversational agent %K online %K digital health %K mobile phone %K mental health %K workplace %K work stress %K survey %K response rate %D 2021 %7 21.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Stress, burnout, and mental health problems such as depression and anxiety are common, and can significantly impact workplaces through absenteeism and reduced productivity. To address this issue, organizations must first understand the extent of the difficulties by mapping the mental health of their workforce. Online surveys are a cost-effective and scalable approach to achieve this but typically have low response rates, in part due to a lack of interactivity. Chatbots offer one potential solution, enhancing engagement through simulated natural human conversation and use of interactive features. Objective: The aim of this study was to explore if a text-based chatbot is a feasible approach to engage and motivate employees to complete a workplace mental health assessment. This paper describes the design process and results of a pilot implementation. Methods: A fully automated chatbot (“Viki”) was developed to evaluate employee risks of suffering from depression, anxiety, stress, insomnia, burnout, and work-related stress. Viki uses a conversation style and gamification features to enhance engagement. A cross-sectional analysis was performed to gain first insights of a pilot implementation within a small to medium–sized enterprise (120 employees). Results: The response rate was 64.2% (77/120). In total, 98 employees started the assessment, 77 of whom (79%) completed it. The majority of participants scored in the mild range for anxiety (20/40, 50%) and depression (16/28, 57%), in the moderate range for stress (10/22, 46%), and at the subthreshold level for insomnia (14/20, 70%) as defined by their questionnaire scores. Conclusions: A chatbot-based workplace mental health assessment seems to be a highly engaging and effective way to collect anonymized mental health data among employees with response rates comparable to those of face-to-face interviews. %M 33881403 %R 10.2196/21678 %U https://formative.jmir.org/2021/4/e21678 %U https://doi.org/10.2196/21678 %U http://www.ncbi.nlm.nih.gov/pubmed/33881403 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e21085 %T Development of the Niggle App for Supporting Young People on Their Dynamic Journey to Well-being: Co-design and Qualitative Research Study %A Stoyanov,Stoyan R %A Zelenko,Oksana %A Staneva,Aleksandra %A Kavanagh,David J %A Smith,Calvin %A Sade,Gavin %A Cheers,Jessica %A Hides,Leanne %+ QUT Design Lab, Creative Industries Faculty, Queensland University of Technology, 2 George Street, Brisbane, 4000, Australia, 61 31380316, stoyan.stoyanov@qut.edu.au %K mHealth %K adolescence %K youth %K young people %K well-being %K co-design %K participatory design %K qualitative research %K thematic analysis %K recovery %K visual methods %D 2021 %7 20.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adolescence is a life stage characterized by intense development and increased vulnerability. Yet, young people rarely seek help for mental health, often due to stigma and embarrassment. Alarmingly, even those who do seek help may not be able to receive it. Interventions focused on well-being offer a protective factor against adversity. Highly effective, innovative, theoretically sound, accessible, and engaging mobile health (mHealth) interventions that can be used to look beyond mental ill-health and toward mental well-being are urgently needed. Objective: We aimed to explore how young Australians conceptualize and construct recovery journeys from feeling unwell to being well in order to inform the conceptual design of a youth-led information-, resource-, and support-focused mHealth intervention. Methods: A sample of young people, grouped by age (12-15 years, 16-19 years, and 20-25 years), took part in 3 in-person participatory design workshops (per group). Young people’s understanding and representation of well-being, feeling unwell, and the recovery journey were investigated using visual and linguistic data collection methods: photo elicitation and journey mapping. A social constructionist perspective was used for thematic analysis to produce a conceptual model of the recovery journey. A mobile app was co-designed and all app functions were mapped through iterative development and testing by young people and a team of psychology, research, design and information technology experts. Results: Young people (n=25) described a 6-stage journey with specific barriers and coping strategies. The findings, when situated within the personal recovery framework in mental health, emphasize the cyclic and iterative model of change. Through co-design, the new app—Niggle—was conceptualized as a visual representation of an amorphous problem, which can be addressed through app functions corresponding to the most helpful strategies that young people used to progress through the stages of their recovery journey. Conclusions: Niggle is available to offer support to young people for a range of problems and provides a hot link to counseling services in Australia. This paper elaborates on the process of in-depth qualitative data collection through visual, linguistic, and co-design methods. The findings of this study give insight into young people’s understanding of well-being and recovery. This paper could aid the development of high-quality personalized mHealth interventions and support resources. %M 33877050 %R 10.2196/21085 %U https://mhealth.jmir.org/2021/4/e21085 %U https://doi.org/10.2196/21085 %U http://www.ncbi.nlm.nih.gov/pubmed/33877050 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e21087 %T Feasibility and Preliminary Efficacy of a Community-Based Addiction Rehabilitation Electronic System in Substance Use Disorder: Pilot Randomized Controlled Trial %A Xu,Xiaomin %A Chen,Shujuan %A Chen,Junning %A Chen,Zhikang %A Fu,Liming %A Song,Dingchen %A Zhao,Min %A Jiang,Haifeng %+ Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, , China, 86 180 1731 1330, dragonjhf@hotmail.com %K mobile health %K drug use %K rehabilitation %K community health service %K China %D 2021 %7 16.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Drug use disorder has high potential for relapse and imposes an enormous burden on public health in China. Since the promulgation of the Anti-drug law in 2008, community-based rehabilitation has become the primary approach to treat drug addiction. However, multiple problems occurred in the implementation process, leading to a low detoxification rate in the community. Mobile health (mHealth) serves as a promising tool to improve the effectiveness and efficiency of community-based rehabilitation. Community-based addiction rehabilitation electronic system (CAREs) is an interactive system for drug users and their assigned social workers. Objective: The study aimed to examine the feasibility and preliminary efficacy of CAREs in community-based rehabilitation from the perspective of drug users and social workers in Shanghai, China. Methods: In this pilot randomized controlled trial, 40 participants were recruited from the community in Shanghai from January to May 2019. Participants randomized to the intervention group (n=20) received CAREs + community-based rehabilitation, while participants in the control group (n=20) received community-based rehabilitation only for 6 months. CAREs provided education, assessment, and SOS (support) functions for drug users. The assigned social workers provided service and monitored drug use behavior as usual except that the social workers in the intervention group could access the webpage end to obtain drug users’ information and fit their routine workflow into CAREs. The primary outcome was the feasibility of CAREs, reflected in the overall proportion and frequency of CAREs features used in both app and webpage end. The secondary outcomes were the effectiveness of CAREs, including the percentage of drug-positive samples, longest period of abstinence, contact times with social workers, and the change of Addiction Severity Index (ASI) from baseline to the 6-month follow-up. Results: The number of participants logged in to the app ranged from 7 to 20 per week, and CAREs had relatively high levels of continued patient use. Drug users preferred assessment and education features in the app end while their social workers showed high levels of use in urine results record and viewing assessment results on the webpage end. After the 6-month intervention, 3.3% (17/520) of samples in the intervention group and 7.5% (39/520) in the control group were drug-positive (F=4.358, P=.04). No significant differences were noted between the control and intervention groups in terms of longest duration of abstinence, number of contact times and ASI composite scores. Conclusions: The study preliminarily demonstrated that with relatively good feasibility and acceptability, CAREs may improve the effectiveness and efficiency of the community-based rehabilitation, which provided instruction for further improvement of the system. Trial Registration: ClinicalTrials.gov NCT03451344; https://clinicaltrials.gov/ct2/show/NCT03451344 International Registered Report Identifier (IRRID): RR2-10.3389/fpsyt.2018.00556 %M 33861211 %R 10.2196/21087 %U https://mhealth.jmir.org/2021/4/e21087 %U https://doi.org/10.2196/21087 %U http://www.ncbi.nlm.nih.gov/pubmed/33861211 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e20468 %T Mobile Health Intervention Promoting Physical Activity in Adults Post Cardiac Rehabilitation: Pilot Randomized Controlled Trial %A Park,Linda G %A Elnaggar,Abdelaziz %A Lee,Sei J %A Merek,Stephanie %A Hoffmann,Thomas J %A Von Oppenfeld,Julia %A Ignacio,Nerissa %A Whooley,Mary A %+ Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way, Room 531A, San Francisco, CA, United States, 1 415 221 4810 ext 22573, abdelaziz.elnaggar@ucsf.edu %K physical activity %K cardiac rehabilitation %K digital health %K mobile app %K wearable device %K mHealth %D 2021 %7 16.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Cardiac rehabilitation (CR) is an exercise-based program prescribed after cardiac events associated with improved physical, mental, and social functioning; however, many patients return to a sedentary lifestyle leading to deteriorating functional capacity after discharge from CR. Physical activity (PA) is critical to avoid recurrence of cardiac events and mortality and maintain functional capacity. Leveraging mobile health (mHealth) strategies to increase adherence to PA is a promising approach. Based on the social cognitive theory, we sought to determine whether mHealth strategies (Movn mobile app for self-monitoring, supportive push-through messages, and wearable activity tracker) would improve PA and functional capacity over 2 months. Objective: The objectives of this pilot randomized controlled trial were to examine preliminary effects of an mHealth intervention on group differences in PA and functional capacity and group differences in depression and self-efficacy to maintain exercise after CR. Methods: During the final week of outpatient CR, patients were randomized 1:1 to the intervention group or usual care. The intervention group downloaded the Movn mobile app, received supportive push-through messages on motivation and educational messages related to cardiovascular disease (CVD) management 3 times per week, and wore a Charge 2 (Fitbit Inc) activity tracker to track step counts. Participants in the usual care group wore a pedometer and recorded their daily steps in a diary. Data from the 6-minute walk test (6MWT) and self-reported questionnaires were collected at baseline and 2 months. Results: We recruited 60 patients from 2 CR sites at a community hospital in Northern California. The mean age was 68.0 (SD 9.3) years, and 23% (14/60) were female; retention rate was 85% (51/60). Our results from 51 patients who completed follow-up showed the intervention group had a statistically significant higher mean daily step count compared with the control (8860 vs 6633; P=.02). There was no difference between groups for the 6MWT, depression, or self-efficacy to maintain exercise. Conclusions: This intervention addresses a major public health initiative to examine the potential for mobile health strategies to promote PA in patients with CVD. Our technology-based pilot mHealth intervention provides promising results on a pragmatic and contemporary approach to promote PA by increasing daily step counts after completing CR. Trial Registration: ClinicalTrials.gov NCT03446313; https://clinicaltrials.gov/ct2/show/NCT03446313 %M 33861204 %R 10.2196/20468 %U https://formative.jmir.org/2021/4/e20468 %U https://doi.org/10.2196/20468 %U http://www.ncbi.nlm.nih.gov/pubmed/33861204 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e25668 %T Baby Buddy App for Breastfeeding and Behavior Change: Retrospective Study of the App Using the Behavior Change Wheel %A Musgrave,Loretta M %A Baum,Alison %A Perera,Nilushka %A Homer,Caroline SE %A Gordon,Adrienne %+ Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Building 10, Level 11, 235 Jones St, Ultimo NSW, 2006, Australia, 61 (02) 9514 5069, loretta.musgrave@uts.edu.au %K breastfeeding %K app %K digital health %K smartphone app %K behavior change wheel %K digital behavior change intervention %D 2021 %7 15.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Breastfeeding plays a major role in the health of mothers and babies and has the potential to positively shape an individual’s life both in the short and long term. In the United Kingdom (UK), although 81% of women initiate breastfeeding, only 1% of women breastfeed exclusively to 6 months as recommended by the World Health Organization. In the UK, women who are socially disadvantaged and younger are less likely to breastfeed at 6 to 8 weeks postpartum. One strategy that aims to improve these statistics is the Baby Buddy app, which has been designed and implemented by the UK charity Best Beginnings to be a universal intervention to help reduce health inequalities, including those in breastfeeding. Objective: This study aimed to retrospectively examine the development of Baby Buddy by applying the Behavior Change Wheel (BCW) framework to understand how it might increase breastfeeding self-efficacy, knowledge, and confidence. Methods: Retrospective application of the BCW was completed after the app was developed and embedded into maternity services. A three-stage process evaluation used triangulation methods and formalized tools to gain an understanding of the potential mechanisms and behaviors used in apps that are needed to improve breastfeeding rates in the UK. First, we generated a behavioral analysis by mapping breastfeeding barriers and enablers onto the Capability, Opportunity, and Motivation-Behavior (COM-B) system using documents provided by Best Beginnings. Second, we identified the intervention functions and policy categories used. Third, we linked these with the behavior change techniques identified in the app breastfeeding content using the Behavior Change Techniques Taxonomy (BCTTv1). Results: Baby Buddy is a well-designed platform that could be used to change breastfeeding behaviors. Findings from stage one showed that Best Beginnings had defined breastfeeding as a key behavior requiring support and demonstrated a thorough understanding of the context in which breastfeeding occurs, the barriers and enablers of breastfeeding, and the target actions needed to support breastfeeding. In stage two, Best Beginnings had used intervention and policy functions to address the barriers and enablers of breastfeeding. In stage three, Baby Buddy had been assessed for acceptability, practicability, effectiveness, affordability, safety, and equity. Several behavior change techniques that could assist women with decision making around breastfeeding (eg, information about health consequences and credible sources) and possibly affect attitudes and self-efficacy were identified. Of the 39 videos in the app, 19 (49%) addressed physical capabilities related to breastfeeding and demonstrated positive breastfeeding behaviors. Conclusions: Applying a theoretical framework retrospectively to a mobile app is possible and results in useful information to understand potential health benefits and to inform future development. Future research should assess which components and behavioral techniques in the app are most effective in changing behavior and supporting breastfeeding. %M 33856351 %R 10.2196/25668 %U https://mhealth.jmir.org/2021/4/e25668 %U https://doi.org/10.2196/25668 %U http://www.ncbi.nlm.nih.gov/pubmed/33856351 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e25385 %T Associations of Physical Activity Level and Variability With 6-Month Weight Change Among 26,935 Users of Connected Devices: Observational Real-Life Study %A El Fatouhi,Douae %A Delrieu,Lidia %A Goetzinger,Catherine %A Malisoux,Laurent %A Affret,Aurélie %A Campo,David %A Fagherazzi,Guy %+ Department of Population Health, Luxembourg Institute of Health, 1 A-B Rue Thomas Edison, Strassen, L-1445, Luxembourg, 352 26 97 04 57, guy.fagherazzi@lih.lu %K connected devices %K Withings %K physical activity %K step count %K wearable activity trackers %K digital health %K free-living %K weight loss %K digital scale %K mobile phone %D 2021 %7 15.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity (PA) is a modifiable lifestyle factor that can be targeted to increase energy expenditure and promote weight loss. However, the amount of PA required for weight loss remains inconsistent. Wearable activity trackers constitute a valuable opportunity to obtain objective measurements of PA and study large populations in real-life settings. Objective: We aim to study the associations of initial device-assessed PA characteristics (average step counts and step count variability) and their evolution with 6-month weight change. Methods: We analyzed data from 26,935 Withings-connected device users (wearable activity trackers and digital scales). To assess the initial PA characteristics and their 6-month changes, we used data recorded during the first and sixth 30-day periods of activity tracker use. For each of these periods, we used the monthly mean of daily step values as a proxy for PA level and derived the monthly coefficient of variation (CV) of daily step values to estimate PA level variability. Associations between initial PA characteristics and 6-month weight change were assessed using multivariable linear regression analyses controlled for age, sex, blood pressure, heart rate, and the predominant season. Restricted cubic spline regression was performed to better characterize the continuous shape of the associations between PA characteristics and weight change. Secondary analyses were performed by analyzing the 6-month evolution of PA characteristics in relation to weight change. Results: Our results revealed that both a greater PA level and lower PA level variability were associated with weight loss. Compared with individuals who were initially in the sedentary category (<5000 steps/day), individuals who were low active (5000-7499 steps/day), somewhat active (7500-9999 steps/day), and active (≥10,000 steps/day) had a 0.21-kg, a 0.52-kg, and a 1.17-kg greater decrease in weight, respectively (95% CI −0.36 to −0.06, −0.70 to −0.33, and −1.42 to −0.93, respectively). Compared with users whose PA level CV was >63%, users whose PA level CV ranged from 51% to 63%, 40% to 51%, and was ≤40%, had a 0.19-kg, a 0.23-kg, and a 0.33-kg greater decrease in weight, respectively (95% CI −0.38 to −0.01, −0.41 to −0.04, and −0.53 to −0.13, respectively). We also observed that each 1000 steps/day increase in PA level over the 6-month follow-up was associated with a 0.26-kg (95% CI −0.29 to −0.23) decrease in weight. No association was found between the 6-month changes in PA level variability and weight change. Conclusions: Our results add to the current body of knowledge that health benefits can be observed below the 10,000 steps/day threshold and suggest that not only increased mean PA level but also greater regularity of the PA level may play important roles in short-term weight loss. %M 33856352 %R 10.2196/25385 %U https://mhealth.jmir.org/2021/4/e25385 %U https://doi.org/10.2196/25385 %U http://www.ncbi.nlm.nih.gov/pubmed/33856352 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e24184 %T Gender Differences in Satisfaction With a Text Messaging Program (Text4Hope) and Anticipated Receptivity to Technology-Based Health Support During the COVID-19 Pandemic: Cross-sectional Survey Study %A Shalaby,Reham %A Vuong,Wesley %A Hrabok,Marianne %A Gusnowski,April %A Mrklas,Kelly %A Li,Daniel %A Snaterse,Mark %A Surood,Shireen %A Cao,Bo %A Li,Xin-Min %A Greiner,Russell %A Greenshaw,Andrew James %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 7807144315, agyapong@ualberta.ca %K COVID-19 %K Text4Hope %K satisfaction %K mobile phone %K text %K anxiety %K depression %K stress, pandemic %K e-mental health %K gender %D 2021 %7 15.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In March 2020, Text4Hope—a community health service—was provided to Alberta residents. This free service aims to promote psychological resilience and alleviate pandemic-associated stress, anxiety, and depression symptoms during the COVID-19 pandemic. Objective: This study aimed to evaluate the feedback, satisfaction, experience, and perceptions of Text4Hope subscribers and to examine any differences based on gender after subscribers received 6 weeks of daily supportive text messages. Additionally, this study examined subscribers’ anticipated receptivity to technology-based medical services that could be offered during major crises, emergencies, or pandemics. Methods: Individuals self-subscribed to Text4Hope to receive daily supportive text messages for 3 months. Subscribers were invited to complete a web-based survey at 6 weeks postintervention to provide service satisfaction–related information. Overall satisfaction was assessed on a scale of 0-10, and satisfaction scores were analyzed using a related-measures t test. Likert scale satisfaction responses were used to assess various aspects of the Text4Hope program. Gender differences were analyzed using one-way analysis of variance (ANOVA) and Chi-square analyses. Results: A total of 2032 subscribers completed the baseline and 6-week surveys; 1788 (88%) were female, 219 (10.8%) were male, and 25 (1.2%) were other gender. The mean age of study participants was 44.58 years (SD 13.45 years). The mean overall satisfaction score was 8.55 (SD 1.78), suggesting high overall satisfaction with Text4Hope. The ANOVA analysis, which was conducted using the Welch test (n=1716), demonstrated that females had significantly higher mean satisfaction scores than males (8.65 vs 8.11, respectively; mean difference=0.546; 95% CI 0.19 to 0.91; P<.001) and nonsignificantly lower satisfaction scores than other gender respondents (mean difference=−0.938; 95% CI −0.37 to 2.25; P=.15). More than 70% of subscribers agreed that Text4Hope helped them cope with stress (1334/1731, 77.1%) and anxiety (1309/1728, 75.8%), feel connected to a support system (1400/1729, 81%), manage COVID-19–related issues (1279/1728, 74%), and improve mental well-being (1308/1731, 75.6%). Similarly, subscribers agreed that messages were positive, affirmative, and succinct. Messages were always or often read by 97.9% (1681/1716) of respondents, and more than 20% (401/1716, 23.4%) always or often returned to messages. The majority of subscribers (1471/1666, 88.3%) read the messages and either reflected upon them or took a positive action. Subscribers welcomed almost all technology-based services as part of their health care during crisis or emergency situations. Text4Hope was perceived to be effective by many female subscribers, who reported higher satisfaction and improved coping after receiving text messages for 6 weeks. Conclusions: Respondents affirmed the high quality of the text messages with their positive feedback. Technology-based services can provide remotely accessible and population-level interventions that align with the recommended physical distancing practices for pandemics. Text4Hope subscriber feedback revealed high satisfaction and acceptance at 6 weeks postintervention. International Registered Report Identifier (IRRID): RR2-10.2196/19292 %M 33750738 %R 10.2196/24184 %U https://mhealth.jmir.org/2021/4/e24184 %U https://doi.org/10.2196/24184 %U http://www.ncbi.nlm.nih.gov/pubmed/33750738 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 4 %P e17503 %T A User-Centered Chatbot (Wakamola) to Collect Linked Data in Population Networks to Support Studies of Overweight and Obesity Causes: Design and Pilot Study %A Asensio-Cuesta,Sabina %A Blanes-Selva,Vicent %A Conejero,J Alberto %A Frigola,Ana %A Portolés,Manuel G %A Merino-Torres,Juan Francisco %A Rubio Almanza,Matilde %A Syed-Abdul,Shabbir %A Li,Yu-Chuan (Jack) %A Vilar-Mateo,Ruth %A Fernandez-Luque,Luis %A García-Gómez,Juan M %+ Instituto de Tecnologías de la Información y Comunicaciones, Universitat Politècnica de València, Camino de Vera s/n, Valencia, 46022, Spain, 34 96 387 70 07 ext 71846, sasensio@dpi.upv.es %K mHealth %K obesity %K overweight %K chatbot %K assessment %K public health %K Telegram %K user-centered design %K Social Network Analysis %D 2021 %7 14.4.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Obesity and overweight are a serious health problem worldwide with multiple and connected causes. Simultaneously, chatbots are becoming increasingly popular as a way to interact with users in mobile health apps. Objective: This study reports the user-centered design and feasibility study of a chatbot to collect linked data to support the study of individual and social overweight and obesity causes in populations. Methods: We first studied the users’ needs and gathered users’ graphical preferences through an open survey on 52 wireframes designed by 150 design students; it also included questions about sociodemographics, diet and activity habits, the need for overweight and obesity apps, and desired functionality. We also interviewed an expert panel. We then designed and developed a chatbot. Finally, we conducted a pilot study to test feasibility. Results: We collected 452 answers to the survey and interviewed 4 specialists. Based on this research, we developed a Telegram chatbot named Wakamola structured in six sections: personal, diet, physical activity, social network, user's status score, and project information. We defined a user's status score as a normalized sum (0-100) of scores about diet (frequency of eating 50 foods), physical activity, BMI, and social network. We performed a pilot to evaluate the chatbot implementation among 85 healthy volunteers. Of 74 participants who completed all sections, we found 8 underweight people (11%), 5 overweight people (7%), and no obesity cases. The mean BMI was 21.4 kg/m2 (normal weight). The most consumed foods were olive oil, milk and derivatives, cereals, vegetables, and fruits. People walked 10 minutes on 5.8 days per week, slept 7.02 hours per day, and were sitting 30.57 hours per week. Moreover, we were able to create a social network with 74 users, 178 relations, and 12 communities. Conclusions: The Telegram chatbot Wakamola is a feasible tool to collect data from a population about sociodemographics, diet patterns, physical activity, BMI, and specific diseases. Besides, the chatbot allows the connection of users in a social network to study overweight and obesity causes from both individual and social perspectives. %M 33851934 %R 10.2196/17503 %U https://medinform.jmir.org/2021/4/e17503 %U https://doi.org/10.2196/17503 %U http://www.ncbi.nlm.nih.gov/pubmed/33851934 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e24976 %T Feasibility and Acceptability of a Smoking Cessation Smartphone App (My QuitBuddy) in Older Persons: Pilot Randomized Controlled Trial %A Peek,Jenny %A Hay,Karen %A Hughes,Pauline %A Kostellar,Adrienne %A Kumar,Subodh %A Bhikoo,Zaheerodin %A Serginson,John %A Marshall,Henry M %+ The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Level 2, Admin Building, Rode Rd, Chermside, 4032, Australia, 61 (07) 3139 6802, jenny.peek@health.qld.gov.au %K mHealth %K mobile apps %K motivation %K smartphone %K smoking cessation %K tobacco smoking %D 2021 %7 14.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Although many smoking cessation smartphone apps exist, few have been independently evaluated, particularly in older populations. In 2017, of the 112 commercially available smoking cessation apps in Australia, only 6 were deemed to be of high quality, in that they partially adhered to Australian guidelines. Mobile health (mHealth) apps have the potential to modify smoking behavior at a relatively low cost; however, their acceptability in older smokers remains unknown. Rigorous scientific evaluation of apps is thus urgently needed to assist smokers and clinicians alike. Objective: We conducted a pilot randomized controlled trial to evaluate the feasibility of a large-scale trial to assess the use and acceptability of a high-quality smoking cessation app in older smokers. Methods: Adult inpatient and outpatient smokers with computer and smartphone access were recruited face to face and via telephone interviews from Metropolitan Hospitals in Brisbane, Australia. Participants were randomized 1:1 to the intervention (requested to download the “My QuitBuddy” smoking cessation app on their smartphone) or the control group (provided access to a tailored smoking cessation support webpage [Quit HQ]). The My QuitBuddy app is freely available from app stores and provides personalized evidenced-based smoking cessation support. Quit HQ offers regular email support over 12 weeks. No training or instructions on the use of these e-resources were given to participants. Outcomes at 3 months included recruitment and retention rates, use and acceptability of e-resource (User Version of the Mobile App Rating Scale [uMARS]), changes in quitting motivation (10-point scale), and self-reported smoking abstinence. Results: We randomized 64 of 231 potentially eligible individuals (27.7%). The mean age of participants was 62 (SD 8). Nicotine dependence was moderate (mean Heaviness of Smoking Index [HSI] 2.8 [SD 1.2]). At 3 months the retention rate was (58/64, 91%). A total of 15 of 31 participants in the intervention arm (48%) used the app at least once, compared with 10 of 33 (30%) in the control arm. uMARS scores for e-resource use and acceptability were statistically similar (P=.29). Motivation to quit was significantly higher in the intervention arm compared with the control arm (median 6 [IQR 4-8] versus 4 [IQR 4-5], respectively, P=.02). According to the intention-to-treat analysis, smoking abstinence was nonsignificantly higher in the intervention group (4/31 [13%], 95% CI 4%-30%, versus 2/33 [6%], 95% CI 1%-20%; P=.42). The estimated number needed to treat was 14. Conclusions: Internet and mHealth smoking cessation resources appear acceptable to a minority of older smokers. Smokers who engaged with the allocated e-resources rated them equally, and there were trends toward greater uptake, increased motivation, and higher abstinence rates in the app group; however, only the change in motivation reached statistical significance (median score 6 versus 4, respectively, P=.02). This results of this pilot study suggest that apps may improve quit outcomes in older adults who are willing to use them. Further research into user–app interactions should be undertaken to facilitate improvements in app design and consumer engagement. These favorable trends should be explored in larger trials with sufficient statistical power. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000159156; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376849&isReview=true %M 33851923 %R 10.2196/24976 %U https://formative.jmir.org/2021/4/e24976 %U https://doi.org/10.2196/24976 %U http://www.ncbi.nlm.nih.gov/pubmed/33851923 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e24998 %T Virtual Reality App for Treating Eating Behavior in Eating Disorders: Development and Usability Study %A Langlet,Billy Sundström %A Odegi,Dorothy %A Zandian,Modjtaba %A Nolstam,Jenny %A Södersten,Per %A Bergh,Cecilia %+ Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Hälsovägen 7, 3rd floor, Stockholm, 141 52, Sweden, 46 852488034, billy.langlet@ki.se %K feeding and eating disorders %K anorexia nervosa %K bulimia nervosa %K binge eating disorder %K immersive virtual reality %K eating disorders %K virtual reality %D 2021 %7 13.4.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Anorexia nervosa is one of the more severe eating disorders, which is characterized by reduced food intake, leading to emaciation and psychological maladjustment. Treatment outcomes are often discouraging, with most interventions displaying a recovery rate below 50%, a dropout rate from 20% to 50%, and a high risk of relapse. Patients with anorexia nervosa often display anxiety and aversive behaviors toward food. Virtual reality has been successful in treating vertigo, anxiety disorder, and posttraumatic stress syndrome, and could potentially be used as an aid in treating eating disorders. Objective: The aim of this study was to evaluate the feasibility and usability of an immersive virtual reality technology administered through an app for use by patients with eating disorders. Methods: Twenty-six participants, including 19 eating disorder clinic personnel and 5 information technology personnel, were recruited through emails and personal invitations. Participants handled virtual food and utensils on an app using immersive virtual reality technology comprising a headset and two hand controllers. In the app, the participants learned about the available actions through a tutorial and they were introduced to a food challenge. The challenge consisted of a meal type (meatballs, potatoes, sauce, and lingonberries) that is typically difficult for patients with anorexia nervosa to eat in real life. Participants were instructed, via visual feedback from the app, to eat at a healthy rate, which is also a challenge for patients. Participants rated the feasibility and usability of the app by responding to the mHealth Evidence Reporting and Assessment checklist, the 10-item System Usability Scale, and the 20-point heuristic evaluation questionnaire. A cognitive walkthrough was performed using video recordings of participant interactions in the virtual environment. Results: The mean age of participants was 37.9 (SD 9.7) years. Half of the participants had previous experience with virtual reality. Answers to the mHealth Evidence Reporting and Assessment checklist suggested that implementation of the app would face minor infrastructural, technological, interoperability, financial, and adoption problems. There was some disagreement on intervention delivery, specifically regarding frequency of use; however, most of the participants agreed that the app should be used at least once per week. The app received a mean score of 73.4 (range 55-90), earning an overall “good” rating. The mean score of single items of the heuristic evaluation questionnaire was 3.6 out of 5. The lowest score (2.6) was given to the “accuracy” item. During the cognitive walkthrough, 32% of the participants displayed difficulty in understanding what to do at the initial selection screen. However, after passing the selection screen, all participants understood how to progress through the tasks. Conclusions: Participants found the app to be usable and eating disorder personnel were positive regarding its fit with current treatment methods. Along with the food item challenges in the current app, participants considered that the app requires improvement to offer environmental and social (eg, crowded room vs eating alone) challenges. %M 33847593 %R 10.2196/24998 %U https://games.jmir.org/2021/2/e24998 %U https://doi.org/10.2196/24998 %U http://www.ncbi.nlm.nih.gov/pubmed/33847593 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e19511 %T Mobile Phone Intervention Based on an HIV Risk Prediction Tool for HIV Prevention Among Men Who Have Sex With Men in China: Randomized Controlled Trial %A Yun,Ke %A Chu,Zhenxing %A Zhang,Jing %A Geng,Wenqing %A Jiang,Yongjun %A Dong,Willa %A Shang,Hong %A Xu,Junjie %+ NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, China, 86 8328 2634, hongshang100@hotmail.com %K eHealth intervention %K high-risk behavior intervention %K HIV risk prediction %K men who have sex with men %D 2021 %7 13.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: eHealth interventions based on risk stratification have not been extensively applied for HIV behavioral interventions among HIV-negative men who have sex with men (MSM). Objective: This study aimed to evaluate the efficacy of a mobile phone intervention based on an HIV risk prediction tool in promoting HIV testing and reducing high-risk behavior among HIV-negative MSM in China. Methods: We performed a mobile phone–based randomized controlled clinical trial for 12 weeks. A comprehensive intervention package deployed on Jinshuju—an online survey platform—was developed and consisted of 4 components: (1) a validated HIV risk prediction tool that provides information on personalized risk reduction interventions; (2) a map of individualized HIV testing facilities based on their geographic location; (3) a QR code for free resources on HIV prevention, including condoms and HIV self-testing kits; and (4) general resources for HIV health education. MSM participants recruited from WeChat/QQ groups were randomly assigned to the intervention or control group at a 1:1 ratio. The staff sent the QR code for the comprehensive intervention package to MSM in the intervention group over WeChat and sent the QR code only for the resources on HIV health education to those in the control group. At baseline and 12-week follow-up, data on HIV-related risk behavior and HIV testing behavior were collected through the Jinshuju online survey platform. Results: In total, 192 MSM were recruited and assigned to the intervention or control group (n=96 each). At week 12, the total clinical trial retention rate was 87.5%. The number of male sexual partners of the MSM in the past 3 months was significantly lower in the intervention group than in the control group (3.51, SD 4.1 vs 6.01, SD 11.4, respectively; mean difference −2.5; 95% CI −5.12 to 0.12; P=.05); the rate of condom use with casual sexual partners was higher in the intervention group than in the control group (87%, n=66/76 vs 70%, n=54/77 respectively; odds ratio 2.81, 95% CI 1.23-6.39; P=.01). The proportion of individuals intending to undergo HIV testing after in the following 30 days was marginally higher in the intervention group than in the control group (90%, n=77/86 vs 79%, n=65/82 respectively; odds ratio 2.20, 95% CI 0.90-5.35; P=.07). The incremental cost-effectiveness ratio of eHealth intervention was US $131.60 on reducing 1 sexual partner and US $19.70 for a 1% increment in condom usage with casual partners. Conclusions: A comprehensive intervention based on an HIV risk prediction tool can reduce the number of male sexual partners among MSM and increase the rate of condom use with casual partners. Hence, this intervention is a very promising preventive strategy for HIV among MSM, especially in areas with a prominent HIV epidemic. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800017268; http://www.chictr.org.cn/showprojen.aspx?proj=29271 %M 33847597 %R 10.2196/19511 %U https://mhealth.jmir.org/2021/4/e19511 %U https://doi.org/10.2196/19511 %U http://www.ncbi.nlm.nih.gov/pubmed/33847597 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 2 %P e18819 %T A Home-Based Mobile Health Intervention to Replace Sedentary Time With Light Physical Activity in Older Cancer Survivors: Randomized Controlled Pilot Trial %A Blair,Cindy K %A Harding,Elizabeth %A Wiggins,Charles %A Kang,Huining %A Schwartz,Matthew %A Tarnower,Amy %A Du,Ruofei %A Kinney,Anita Y %+ Department of Internal Medicine, University of New Mexico, 1 University of New Mexico, MSC07-4025, Albuquerque, NM, United States, 1 5059257907, CiBlair@salud.unm.edu %K light-intensity physical activity %K physical activity %K sedentary behavior %K mobile health %K cancer survivors %K consumer wearable %K activity monitor %K mobile phone %D 2021 %7 13.4.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Older cancer survivors are at risk of the development or worsening of both age- and treatment-related morbidity. Sedentary behavior increases the risk of or exacerbates these chronic conditions. Light-intensity physical activity (LPA) is more common in older adults and is associated with better health and well-being. Thus, replacing sedentary time with LPA may provide a more successful strategy to reduce sedentary time and increase physical activity. Objective: This study primarily aims to evaluate the feasibility, acceptability, and preliminary efficacy of a home-based mobile health (mHealth) intervention to interrupt and replace sedentary time with LPA (standing and stepping). The secondary objective of this study is to examine changes in objective measures of physical activity, physical performance, and self-reported quality of life. Methods: Overall, 54 cancer survivors (aged 60-84 years) were randomized in a 1:1:1 allocation to the tech support intervention group, tech support plus health coaching intervention group, or waitlist control group. Intervention participants received a Jawbone UP2 activity monitor for use with their smartphone app for 13 weeks. Tech support and health coaching were provided via 5 telephone calls during the 13-week intervention. Sedentary behavior and physical activity were objectively measured using an activPAL monitor for 7 days before and after the intervention. Results: Participants included survivors of breast cancer (21/54, 39%), prostate cancer (16/54, 30%), and a variety of other cancer types; a mean of 4.4 years (SD 1.6) had passed since their cancer diagnosis. Participants, on average, were 70 years old (SD 4.8), 55% (30/54) female, 24% (13/54) Hispanic, and 81% (44/54) overweight or obese. Malfunction of the Jawbone trackers occurred in one-third of the intervention group, resulting in enrollment stopping at 54 rather than the initial goal of 60 participants. Despite these technical issues, the retention in the intervention was high (47/54, 87%). Adherence was high for wearing the tracker (29/29, 100%) and checking the app daily (28/29, 96%) but low for specific aspects related to the sedentary features of the tracker and app (21%-25%). The acceptability of the intervention was moderately high (81%). There were no significant between-group differences in total sedentary time, number of breaks, or number of prolonged sedentary bouts. There were no significant between-group differences in physical activity. The only significant within-group change occurred within the health coaching group, which increased by 1675 daily steps (95% CI 444-2906; P=.009). This increase was caused by moderate-intensity stepping rather than light-intensity stepping (+15.2 minutes per day; 95% CI 4.1-26.2; P=.008). Conclusions: A home-based mHealth program to disrupt and replace sedentary time with stepping was feasible among and acceptable to older cancer survivors. Future studies are needed to evaluate the optimal approach for replacing sedentary behavior with standing and/or physical activity in this population. Trial Registration: ClinicalTrials.gov NCT03632694; https://clinicaltrials.gov/ct2/show/NCT03632694 %M 33847588 %R 10.2196/18819 %U https://cancer.jmir.org/2021/2/e18819 %U https://doi.org/10.2196/18819 %U http://www.ncbi.nlm.nih.gov/pubmed/33847588 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 2 %P e20461 %T A Physical Activity Mobile Game for Hematopoietic Stem Cell Transplant Patients: App Design, Development, and Evaluation %A Cerbas,Shannon %A Kelemen,Arpad %A Liang,Yulan %A Sik-Lanyi,Cecilia %A Van de Castle,Barbara %+ University of Maryland, Baltimore, 655 W Lombard St, Baltimore, MD, 21201, United States, 1 410 706 4812, liang@umaryland.edu %K cancer %K mobile app %K gamification %K bone marrow transplant %K alpha testing %K physical activity %D 2021 %7 13.4.2021 %9 Original Paper %J JMIRx Med %G English %X Background: Physical activity mobile apps may encourage patients with cancer to increase exercise uptake, consequently decreasing cancer-related fatigue. While many fitness apps are currently available for download, most are not suitable for patients with cancer due to the unique barriers these patients face, such as fatigue, pain, and nausea. Objective: The aim of this study is to design, develop, and perform alpha testing of a physical activity mobile health game for hematopoietic stem cell transplant (HSCT) patients. The ultimate future goal of this project is to motivate HSCT patients to increase physical activity and provide them with a safe and fun way to exercise. Methods: A mobile health game called Walking Warrior was designed as a puzzle game where tiles are moved and matched. Walking Warrior interfaces with an open-source step counter and communicates with a central online MySQL database to record game play and walking performance. The game came to fruition after following an iterative process model with several prototypes. Game developers and bone marrow transplant nurses were recruited to perform an expert usability evaluation of the Walking Warrior prototype by completing a heuristic questionnaire and providing qualitative suggestions for improvement. Experts also made qualitative recommendations for improvements on speed, movement of tiles, appearance, and accuracy of the step counter. We recruited 5 additional usability evaluators who searched for and compared 4 open-source step counter programs, then qualitatively compared them for accuracy, robustness, cheat proofing, ease of use, and battery drain issues. Patient recruitment is planned at a later stage in this project. This paper only describes software design, development, and evaluation, rather than behavioral evaluation (ie, impact on physical activity), which is the long-term goal of this project. Results: Internal consistency and the instrument’s reliability evaluation results from 1 clinical expert and 4 technical experts were deemed excellent (Cronbach α=.933). A hierarchical cluster analysis of the questionnaire item responses for similarity/dissimilarity among the experts indicated that the two expert groups were not clustered into two separate groups in the dendrogram. This indicates that the item responses were not affected by profession. Factor analyses indicate that responses from the 40-item questionnaire were classified into five primary factors. The associated descriptive statistics for each of these categories were as follows (on a scale of 1 to 5): clarity and ease (median 4; mean 3.7, SD 0.45), appropriateness (median 4; mean 3.7, SD 0.49), game quality (median 3.5; mean 3.3, SD 0.42), motivation to walk (median 3; mean 3.1, SD 0.58), and mental effort (median 3.5; mean 3.1, SD 1.27). Conclusions: The evaluation from experts and clinicians provided qualitative information to further improve game design and development. Findings from the expert usability evaluation suggest the game’s assets of clarity, ease of use, appropriateness, quality, motivation to walk, and mental effort were all favorable. This mobile game could ultimately help patients increase physical activity as an aid to recovery. %M 37725560 %R 10.2196/20461 %U https://xmed.jmir.org/2021/2/e20461 %U https://doi.org/10.2196/20461 %U http://www.ncbi.nlm.nih.gov/pubmed/37725560 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 2 %P e24828 %T Associations Among Wearable Activity Tracker Use, Exercise Motivation, and Physical Activity in a Cohort of Cancer Survivors: Secondary Data Analysis of the Health Information National Trends Survey %A De La Torre,Steven %A Spruijt-Metz,Donna %A Farias,Albert J %+ Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto St., Los Angeles, CA, 90033, United States, 1 323 442 7252, albertfa@usc.edu %K mHealth %K mobile health %K cancer survivors %K exercise %K physical activity %K motivation %K wearable electronic devices %K fitness trackers %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Cancer survivors who meet physical activity (PA) recommendations (≥150 minutes of moderate-to-vigorous physical activity [MVPA] per week) experience better health outcomes. With the growing availability of wearable activity trackers (WATs), it may be easier to track PA. However, it is unknown what motivates survivors to use these devices. Objective: The aim of this study is to investigate the associations among motivations for exercise, previous WAT use for tracking a health goal or activity, and meeting the recommended amount of PA among a cohort of cancer survivors. Methods: Data on WAT users who reported having a previous cancer diagnosis were analyzed from the National Cancer Institute’s Health Information National Trends Survey 5 Cycle 3. All survivors with complete information on demographics, exercise motivations (internal guilt, external pressure, physical appearance, and exercise enjoyment), previous WAT use (yes or no), and minutes of MVPA per week (N=608) were included. Multivariate logistic regression models were used to test these associations. A separate cluster analysis was conducted to identify the profiles of exercise motivation that were associated with reporting WAT use. Results: The mean age of the cohort was 66.9 years (SD 12.1). The majority were non-Hispanic White (473/608, 78.8%) and female (322/608, 54.9%), and skin cancer was the most commonly reported diagnosed cancer (154/608, 27.8%). Survivors who reported using WATs to track a health goal or activity were 1.6 times more likely to meet MVPA recommendations than those who did not use WATs (odds ratio [OR] 1.65, 95% CI 1.03-2.65; P=.04). When exercise motivations were assessed independently, survivors who reported not feeling any internal guilt as an exercise motivation were 73% less likely to report having used a WAT than those who felt any internal guilt (OR 0.27, 95% CI 0.14-0.54; P<.001). A total of 3 distinct motivational profiles emerged from the cluster analysis. WAT users had an increased probability of membership in profile 3, which was characterized as being strongly motivated to exercise by internal guilt, physical appearance, and exercise enjoyment (OR 4.5, 95% CI 2.1-9.7; P<.001). Conclusions: Among this cohort, survivors who reported using WATs to track a health goal or activity were significantly more likely to report meeting PA recommendations. Survivors who reported feeling internal guilt as an exercise motivation were significantly more likely to report using WATs to track a health goal or activity. When examining clusters of motivation, survivors who reported previous WAT use were more likely to report being motivated to exercise by a mix of intrinsic and extrinsic motivations, including internal guilt, exercise enjoyment, and physical appearance. Given the health benefits of PA for cancer survivors, technology-focused interventions that use WATs and target exercise motivation may aid in cancer survivors meeting the level of recommended PA. %M 33843595 %R 10.2196/24828 %U https://cancer.jmir.org/2021/2/e24828 %U https://doi.org/10.2196/24828 %U http://www.ncbi.nlm.nih.gov/pubmed/33843595 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e24579 %T Impact of a Face-To-Face Versus Smartphone App Versus Combined Breastfeeding Intervention Targeting Fathers: Randomized Controlled Trial %A Scott,Jane Anne %A Burns,Sharyn K %A Hauck,Yvonne L %A Giglia,Roslyn C %A Jorgensen,Anita M %A White,Becky Kate %A Martin,Annegret %A Robinson,Suzanne %A Dhaliwal,Satvinder S %A Binns,Colin W %A Maycock,Bruce R %+ School of Population Health, Curtin University, Kent Street, Bentley, Perth, Australia, 61 040 413 0489, jane.scott@curtin.edu.au %K breastfeeding %K fathers %K peer support %K mHealth, smartphone app %K infants %K social support %K feeding %K smartphone %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite the recognized health and economic benefits of exclusive breastfeeding, few Australian infants are exclusively breastfed beyond 5 months of age. Social support for breastfeeding, in particular the support of an infant’s father, has been identified as a crucial element for successful breastfeeding. Objective: The objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes. Methods: The study was a 4-arm, factorial, randomized controlled trial conducted in Perth, Australia. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator; Milk Man, a breastfeeding smartphone app designed specifically for fathers; and a combination of both interventions. Expecting couples were recruited from hospital-based antenatal classes and block randomized to 1 of the 4 arms. Each partner completed surveys at recruitment and at 6 weeks and 26 weeks postpartum. Primary outcomes were duration of exclusive and any breastfeeding. Secondary outcomes included age of introduction of formula and complementary foods, maternal breastfeeding self-efficacy, and partner postpartum support. Results: A total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years; the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers. Conclusions: This study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically diverse populations that are likely to benefit most from additional partner supports. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614000605695; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000605695 International Registered Report Identifier (IRRID): RR2-10.1186/s12884-015-0601-5 %M 33843604 %R 10.2196/24579 %U https://pediatrics.jmir.org/2021/2/e24579 %U https://doi.org/10.2196/24579 %U http://www.ncbi.nlm.nih.gov/pubmed/33843604 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e19875 %T Combining Web-Based Gamification and Physical Nudges With an App (MoveMore) to Promote Walking Breaks and Reduce Sedentary Behavior of Office Workers: Field Study %A Mamede,André %A Noordzij,Gera %A Jongerling,Joran %A Snijders,Merlijn %A Schop-Etman,Astrid %A Denktas,Semiha %+ Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, 3062 PA, Netherlands, 31 10 408 8789, mamedesoaresbraga@essb.eur.nl %K internet %K eHealth %K mHealth %K mobile phone %K lifestyle %K obesity %K social network %K multilevel analysis %K physical exercise %D 2021 %7 12.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Sedentary behavior (SB) and lack of physical activity (PA) have been associated with poorer health outcomes and are increasingly prevalent in individuals working in sedentary occupations such as office jobs. Gamification and nudges have attracted attention as promising strategies to promote changes in health behavior. However, most effectiveness studies thus far lacked active controls, and few studies have tested interventions combining these strategies. Objective: This study investigates the effectiveness of combining a gamified digital app with physical nudges to increase PA and reduce SB in Dutch office workers. Methods: Employees in the municipality of Rotterdam (N=298) from two office locations were randomized at the location level to either a 10-week intervention, combining a 5-week gamification phase encompassing a gamified digital app with social support features and a 5-week physical nudges phase, or to an active control (ie, basic digital app with self-monitoring and goal setting). The primary outcome was the daily step count, objectively measured via accelerometers. Secondary outcomes were self-reported PA and SB measured at baseline and at 5, 10, and 14 weeks. Mixed effects models were used to analyze the effects of the intervention on the outcome measures. Results: A total of 78.5% (234/298) of participants completed the study and provided accelerometer data, whereas 36.9% (110/298) participants completed the self-report measures at 14 weeks. In the gamification phase, step count data were missing for 13.5% (473/3492) of observations in the control and 11.4% (445/3888) in the intervention condition; however, these percentages increased to 39.6% (1154/2910) and 59.6% (1932/3492) at follow-up, respectively. During the gamification phase, intervention participants increased their number of daily steps by 634 (95% CI 154.2-1113.8; P=.01) more than participants in the control group, after controlling for relevant factors. Improvements were not sustained during the physical nudges phase (P=.76) or follow-up (P=.88). Conclusions: A digital intervention with gamification and social support features significantly increased the step count of office workers compared with an active control. Physical nudges in the workplace were insufficient to promote the maintenance of behavioral changes achieved in the gamification phase. Future research should explore the long-term effectiveness of similar gamified digital interventions. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 49129401; https://www.isrctn.com/ISRCTN14881571 %M 33843593 %R 10.2196/19875 %U https://www.jmir.org/2021/4/e19875 %U https://doi.org/10.2196/19875 %U http://www.ncbi.nlm.nih.gov/pubmed/33843593 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e25513 %T A Multiple Health Behavior Change, Self-Monitoring Mobile App for Adolescents: Development and Usability Study of the Health4Life App %A Thornton,Louise %A Gardner,Lauren Anne %A Osman,Bridie %A Green,Olivia %A Champion,Katrina Elizabeth %A Bryant,Zachary %A Teesson,Maree %A Kay-Lambkin,Frances %A Chapman,Cath %A , %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building (G02), 160 City Road, Sydney, 2006, Australia, 61 286279012, lauren.gardner@sydney.edu.au %K mHealth %K mobile phone %K chronic disease %K adolescents %K health promotion %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The link between chronic diseases and the Big 6 lifestyle risk behaviors (ie, poor diet, physical inactivity, smoking, alcohol use, sedentary recreational screen time, and poor sleep) is well established. It is critical to target these lifestyle risk behaviors, as they often co-occur and emerge in adolescence. Smartphones have become an integral part of everyday life, and many adolescents already use mobile apps to monitor their lifestyle behaviors and improve their health. Smartphones may be a valuable platform for engaging adolescents with interventions to prevent key chronic disease risk behaviors. Objective: The aim of this paper is to describe the development, usability, and acceptability of the Health4Life app, a self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. Methods: The development of the Health4Life app was an iterative process conducted in collaboration with adolescents and experts. The development process consisted of three stages: scoping the literature; end user consultations, which included a web-based survey (N=815; mean age 13.89, SD 0.89 years) and a focus group (N=12) among adolescents; and app development and beta testing. Following this development work, 232 adolescents were asked to rate the usability and acceptability of the app. Results: The process resulted in a self-monitoring smartphone app that allows adolescent users to track and set goals for the Big 6 health behaviors, using in-app rewards and notifications to enhance engagement. The overall adolescent feedback was positive in terms of user-friendly design, content, relevance, and helpfulness. Commonly identified areas for improvement were to increase interactive features and display recorded health behaviors differently to improve interpretability. Conclusions: The Health4Life app is a co-designed, self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. Adolescents rated the app as highly acceptable and usable. The app has the potential to efficiently and effectively modify important risk factors for chronic disease among young people and is currently being evaluated in a world-first trial of 6640 secondary school students in 71 schools across Australia. %M 33843590 %R 10.2196/25513 %U https://formative.jmir.org/2021/4/e25513 %U https://doi.org/10.2196/25513 %U http://www.ncbi.nlm.nih.gov/pubmed/33843590 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 4 %P e20424 %T A Smartphone-Based Self-management Intervention for Bipolar Disorder (LiveWell): User-Centered Development Approach %A Jonathan,Geneva K %A Dopke,Cynthia A %A Michaels,Tania %A Bank,Andrew %A Martin,Clair R %A Adhikari,Krina %A Krakauer,Rachel L %A Ryan,Chloe %A McBride,Alyssa %A Babington,Pamela %A Frauenhofer,Ella %A Silver,Jamilah %A Capra,Courtney %A Simon,Melanie %A Begale,Mark %A Mohr,David C %A Goulding,Evan H %+ Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States, 1 3125031189, e-goulding@fsm.northwestern.edu %K behavioral intervention technology %K mHealth %K bipolar disorder %K depression %K illness management %K smartphone %K behavior change %K early warning signs %K self-management %K qualitative %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Bipolar disorder is a serious mental illness that results in significant morbidity and mortality. Pharmacotherapy is the primary treatment for bipolar disorder; however, adjunctive psychotherapy can help individuals use self-management strategies to improve outcomes. Yet access to this therapy is limited. Smartphones and other technologies have the potential to increase access to therapeutic strategies that enhance self-management while simultaneously providing real-time user feedback and provider alerts to augment care. Objective: This paper describes the user-centered development of LiveWell, a smartphone-based self-management intervention for bipolar disorder, to contribute to and support the ongoing improvement and dissemination of technology-based mental health interventions. Methods: Individuals with bipolar disorder first participated in a field trial of a simple smartphone app for self-monitoring of behavioral targets. To develop a complete technology-based intervention for bipolar disorder, this field trial was followed by design sessions, usability testing, and a pilot study of a smartphone-based self-management intervention for bipolar disorder. Throughout all phases of development, intervention revisions were made based on user feedback. Results: The core of the LiveWell intervention consists of a daily self-monitoring tool, the Daily Check-in. This self-monitoring tool underwent multiple revisions during the user-centered development process. Daily Check-in mood and thought rating scales were collapsed into a single wellness rating scale to accommodate user development of personalized scale anchors. These anchors are meant to assist users in identifying early warning signs and symptoms of impending episodes to take action based on personalized plans. When users identified personal anchors for the wellness scale, the anchors most commonly reflected behavioral signs and symptoms (40%), followed by cognitive (25%), mood (15%), physical (10%), and motivational (7%) signs and symptoms. Changes to the Daily Check-in were also made to help users distinguish between getting adequate sleep and keeping a regular routine. At the end of the pilot study, users reported that the Daily Check-in made them more aware of early warning signs and symptoms and how much they were sleeping. Users also reported that they liked personalizing their anchors and plans and felt this process was useful. Users experienced some difficulties with developing, tracking, and achieving target goals. Users also did not consistently follow up with app recommendations to contact providers when Daily Check-in data suggested they needed additional assistance. As a result, the human support roles for the technology were expanded beyond app use support to include support for self-management and clinical care communication. The development of these human support roles was aided by feedback on the technology's usability from the users and the coaches who provided the human support. Conclusions: User input guided the development of intervention content, technology, and coaching support for LiveWell. Users valued the provision of monitoring tools and the ability to personalize plans for staying well, supporting the role of monitoring and personalization as important features of digital mental health technologies. Users also valued human support of the technology in the form of a coach, and user difficulties with aspects of self-management and care-provider communication led to an expansion of the coach's support roles. Obtaining feedback from both users and coaches played an important role in the development of both the LiveWell technology and human support. Attention to all stakeholders involved in the use of mental health technologies is essential for optimizing intervention development. %M 33843607 %R 10.2196/20424 %U https://mental.jmir.org/2021/4/e20424 %U https://doi.org/10.2196/20424 %U http://www.ncbi.nlm.nih.gov/pubmed/33843607 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e25927 %T Usability and Acceptability of a Mobile App for the Self-Management of Alcohol Misuse Among Veterans (Step Away): Pilot Cohort Study %A Malte,Carol A %A Dulin,Patrick L %A Baer,John S %A Fortney,John C %A Danner,Anissa N %A Lott,Aline M K %A Hawkins,Eric J %+ Center of Excellence in Substance Addiction Treatment and Education (CESATE), Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, MS 116 ATC, Seattle, WA, 98108, United States, 1 206 277 3780, carol.malte@va.gov %K mobile apps %K alcohol misuse %K smartphone %K veterans %K access %D 2021 %7 8.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Alcohol misuse is common among Operation Enduring Freedom and Operation Iraqi Freedom veterans, yet barriers limit treatment participation. Mobile apps hold promise as means to deliver alcohol interventions to veterans who prefer to remain anonymous, have little time for conventional treatments, or live too far away to attend treatment in person. Objective: This pilot study evaluated the usability and acceptability of Step Away, a mobile app designed to reduce alcohol-related risks, and explored pre-post changes on alcohol use, psychological distress, and quality of life. Methods: This single-arm pilot study recruited Operation Enduring Freedom and Operation Iraqi Freedom veterans aged 18 to 55 years who exceeded National Institute on Alcohol Abuse and Alcoholism drinking guidelines and owned an iPhone. Enrolled veterans (N=55) completed baseline and 1-, 3-, and 6-month assessments. The System Usability Scale (scaled 1-100, ≥70 indicating acceptable usability) assessed the effectiveness, efficiency, and satisfaction dimensions of usability, while a single item (scaled 1-9) measured the attractiveness of 10 screenshots. Learnability was assessed by app use during week 1. App engagement (proportion of participants using Step Away, episodes of use, and minutes per episode per week) over 6 months measured acceptability. Secondary outcomes included pre-post change on heavy drinking days (men: ≥5 drinks per day; women: ≥4 drinks per day) and Short Inventory of Problems–Revised, Kessler-10, and brief World Health Organization Quality of Life Questionnaire scores. Results: Among the 55 veterans enrolled in the study, the mean age was 37.4 (SD 7.6), 16% (9/55) were women, 82% (45/55) were White, and 82% (45/55) had an alcohol use disorder. Step Away was used by 96% (53/55) of participants in week 1, 55% (30/55) in week 4, and 36% (20/55) in week 24. Step Away use averaged 55.1 minutes (SD 57.6) in week 1 and <15 minutes per week in weeks 2 through 24. Mean System Usability Scale scores were 69.3 (SD 19.7) and 71.9 (SD 15.8) at 1 and 3 months, respectively. Median attractiveness scores ranged from 5 to 8, with lower ratings for text-laden screens. Heavy drinking days decreased from 29.4% (95% CI 23.4%-35.4%) at baseline to 16.2% (95% CI 9.9%-22.4%) at 6 months (P<.001). Likewise, over 6 months, Short Inventory of Problems–Revised scores decreased from 6.3 (95% CI 5.1-7.5) to 3.6 (95% CI 2.4-4.9) (P<.001) and Kessler-10 scores decreased from 18.8 (95% CI 17.4-20.1) to 17.3 (95% CI 15.8-18.7) (P=.046). Changes were not detected on quality of life scores. Conclusions: Operation Enduring Freedom and Operation Iraqi Freedom veterans found the usability of Step Away to be acceptable and engaged in the app over the 6-month study. Reductions were seen in heavy drinking days, alcohol-related problems, and Kessler-10 scores. A larger randomized trial is warranted to confirm our findings. %M 33830064 %R 10.2196/25927 %U https://mhealth.jmir.org/2021/4/e25927 %U https://doi.org/10.2196/25927 %U http://www.ncbi.nlm.nih.gov/pubmed/33830064 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e24628 %T An Individual Cognitive Stimulation Therapy App for People With Dementia and Their Carers: Protocol for a Feasibility Randomized Controlled Trial %A Rai,Harleen Kaur %A Schneider,Justine %A Orrell,Martin %+ Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Jubilee Campus, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 1157484252, Harleen.Rai@nottingham.ac.uk %K dementia %K cognitive stimulation therapy %K touchscreen technology %K feasibility trial %K quality of life %K mHealth %K apps %D 2021 %7 8.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a need for more resources to support the cognition and quality of life of people with dementia. The individual cognitive stimulation therapy (iCST) app aims to provide cognitive stimulation and social interaction to people with dementia and carers through interactive touchscreen technology. The iCST app has been developed according to the principles of CST and iCST, which have previously shown to improve the cognition and quality of life of people with dementia and benefit the relationship between the person with dementia and his/her carer. The iCST app has also shown to improve the quality of the carer’s life. Objective: The aim of this study is to evaluate the usability of the iCST app intervention and the feasibility of conducting a full-scale randomized controlled trial (RCT) to assess the clinical effectiveness of the iCST app intervention compared to that of treatment-as-usual for people with mild-to-moderate dementia. Methods: We aim to recruit 60 people with mild-to-moderate dementia and their informal carers as dyads in a multi-center feasibility RCT with a treatment-as-usual control group. Both parties must be able to provide informed consent and participate in the intervention. Dyads will complete a baseline assessment that will include cognition and quality of life measures and they will subsequently be randomized (1:1) to the iCST app intervention in addition to usual care or to usual care only. All participants will be followed up at 5 weeks and at 11 weeks after the baseline assessments. A range of feasibility outcomes will be assessed, including recruitment and retention rates, intervention fidelity and usability, and acceptability of the outcome measures. A sample of the experimental group will be invited to a semistructured posttrial interview to further examine the experience of using the iCST app. Results: This study received funding in May 2015 and obtained ethical approval in March 2018. Data collection began in November 2018 and was completed in March 2020 with a total of 61 dyads recruited. Data analyses are in progress and the final results are expected to be available in the spring of 2021. Conclusions: This study will investigate whether it is feasible to conduct a full-scale RCT to evaluate the clinical effectiveness of the iCST app in comparison to that of usual care alone. In addition, this study will examine the usability of the iCST app. The data will provide information on potential modifications to be made to the intervention, study design, and study process. Trial Registration: ClinicalTrials.gov NCT03282877; https://clinicaltrials.gov/ct2/show/NCT03282877 International Registered Report Identifier (IRRID): DERR1-10.2196/24628 %M 33830058 %R 10.2196/24628 %U https://www.researchprotocols.org/2021/4/e24628 %U https://doi.org/10.2196/24628 %U http://www.ncbi.nlm.nih.gov/pubmed/33830058 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e22759 %T Respondent Characteristics and Dietary Intake Data Collected Using Web-Based and Traditional Nutrition Surveillance Approaches: Comparison and Usability Study %A Timon,Claire M %A Walton,Janette %A Flynn,Albert %A Gibney,Eileen R %+ Institute of Food and Health, University College Dublin, Institute of Food and Health, University College Dublin, Belfield, Dublin, 4, Ireland, 353 17162819, eileen.gibney@ucd.ie %K diet %K survey and questionnaire %K technology %K nutrition surveillance %D 2021 %7 7.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: There are many constraints to conducting national food consumption surveys for national nutrition surveillance, including cost, time, and participant burden. Validated web-based dietary assessment technologies offer a potential solution to many of these constraints. Objective: This study aims to investigate the feasibility of using a previously validated, web-based, 24-hour recall dietary assessment tool (Foodbook24) for nutrition surveillance by comparing the demographic characteristics and the quality of dietary intake data collected from a web-based cohort of participants in Ireland to those collected from the most recent Irish National Adult Nutrition Survey (NANS). Methods: Irish adult participants (aged ≥18 years) were recruited to use Foodbook24 (a web-based tool) between March and October 2016. Demographic and dietary intake (assessed by means of 2 nonconsecutive, self-administered, 24-hour recalls) data were collected using Foodbook24. Following the completion of the study, the dietary intake data collected from the web-based study were statistically weighted to represent the age-gender distribution of intakes reported in the NANS (2008-2010) to facilitate the controlled comparison of intake data. The demographic characteristics of the survey respondents were investigated using descriptive statistics. The controlled comparison of weighted mean daily nutrient intake data collected from the Foodbook24 web-based study (329 plausible reporters of a total of 545 reporters) and the mean daily nutrient intake data collected from the NANS (1051 plausible reporters from 1500 reporters) was completed using the Wilcoxon–Mann-Whitney U test in Creme Nutrition software. Results: Differences between the demographic characteristics of the survey participants across the 2 surveys were observed. Notable differences included a lower proportion of adults aged ≥65 years and a higher proportion of females who participated in the web-based Foodbook24 study relative to the NANS study (P<.001). Similar ranges of mean daily intake for the majority of nutrients and food groups were observed (eg, energy [kilocalorie per day] and carbohydrate [gram per day]), although significant differences for some nutrients (eg, riboflavin [mg/10 MJ], P<.001 and vitamin B12 [µg/10 MJ], P<.001) and food groups were identified. A high proportion of participants (200/425, 47.1%) reported a willingness to continue using Foodbook24 for an additional 6 months. Conclusions: These findings suggest that by using targeted recruitment strategies in the future to ensure the recruitment of a more representative sample, there is potential for web-based methodologies such as Foodbook24 to be used for nutrition surveillance efforts in Ireland. %M 33825694 %R 10.2196/22759 %U https://publichealth.jmir.org/2021/4/e22759 %U https://doi.org/10.2196/22759 %U http://www.ncbi.nlm.nih.gov/pubmed/33825694 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e27381 %T Technology-Based Fall Risk Assessments for Older Adults in Low-Income Settings: Protocol for a Cross-sectional Study %A Thiamwong,Ladda %A Stout,Jeffrey R %A Park,Joon-Hyuk %A Yan,Xin %+ College of Nursing, University of Central Florida, 12201 Research Parkway, Orlando, FL, 32826, United States, 1 4072830470, ladda.thiamwong@ucf.edu %K body composition %K falls %K risk assessment %K technology %K wearable devices %K accidental falls %K fear %D 2021 %7 7.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: One-third of older adults have maladaptive fall risk appraisal (FRA), a condition in which there is a discrepancy between the level of fear of falling (FOF) and physiological fall risk (balance performance). Older adults who overestimate their physiological fall risk and report a high FOF are less likely to participate in physical activity. Limited data suggest that the association among FOF, body composition, and physical activity intensity differs by fear severity. Objective: This study aims to examine the associations among FRA, body composition, and physical activity using assistive health technology, including the BTrackS balance system, bioelectrical impedance analysis, and activity monitoring devices. This study also aims to examine the feasibility of recruitment and acceptability of technologies and procedures for use among older adults in low-income settings. Methods: This cross-sectional study will be conducted in older adults’ homes or apartments in low-income settings in Central Florida, United States. Following consent, participants will be contacted, and our team will visit them twice. The first visit includes questionnaire completion (eg, sociodemographic or FOF) and balance performance test using the BTrackS balance system. The participants will be stratified by the FRA matrix. In addition, they will perform hand grip strength and dynamic balance performance tests. Participants will then be asked to wear the ActiGraph GT9X Link wireless activity monitor on the nondominant wrist for 7 consecutive days. The second visit includes body composition testing and a structured interview about the acceptability of the technologies and procedures. Results: Ethical approval was obtained from the institutional review board of the University of Central Florida (protocol number 2189; September 10, 2020). As of December 2020, participation enrollment is ongoing and the results are expected to be published in Summer 2022. Conclusions: Accurate FRA is essential for implementing physical activity programs, especially in older adults with low income. This study will provide data for developing technology-based fall risk assessments to improve participation in physical activity, thus enhancing healthy longevity among older adults in low-income settings. International Registered Report Identifier (IRRID): PRR1-10.2196/27381 %M 33825688 %R 10.2196/27381 %U https://www.researchprotocols.org/2021/4/e27381 %U https://doi.org/10.2196/27381 %U http://www.ncbi.nlm.nih.gov/pubmed/33825688 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e23649 %T Quality, Features, and Presence of Behavior Change Techniques in Mobile Apps Designed to Improve Physical Activity in Pregnant Women: Systematic Search and Content Analysis %A Hayman,Melanie %A Alfrey,Kristie-Lee %A Cannon,Summer %A Alley,Stephanie %A Rebar,Amanda L %A Williams,Susan %A Short,Camille E %A Altazan,Abby %A Comardelle,Natalie %A Currie,Sinead %A Denton,Caitlin %A Harrison,Cheryce L %A Lamerton,Tayla %A Mena,Gabriela P %A Moran,Lisa %A Mottola,Michelle %A Nagpal,Taniya S %A Vincze,Lisa %A Schoeppe,Stephanie %+ School of Health, Medical and Applied Sciences, CQUniversity, Bruce Highway, Rockhampton, 4701, Australia, 61 49306912 ext 56912, m.j.hayman@cqu.edu.au %K pregnancy %K exercise %K physical activity %K mobile health (mHealth) %K applications %K MARS %K behavior change techniques %K mobile phone %D 2021 %7 7.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity during pregnancy is associated with several health benefits for the mother and child. However, very few women participate in regular physical activity during pregnancy. eHealth platforms (internet and mobile apps) have become an important information source for pregnant women. Although the use of pregnancy-related apps has significantly increased among pregnant women, very little is known about their theoretical underpinnings, including their utilization of behavior change techniques (BCTs). This is despite research suggesting that inclusion of BCTs in eHealth interventions are important for promoting healthy behaviors, including physical activity. Objective: The aim of this study was to conduct a systematic search and content analysis of app quality, features, and the presence of BCTs in apps designed to promote physical activity among pregnant women. Methods: A systematic search in the Australian App Store and Google Play store using search terms relating to exercise and pregnancy was performed. App quality and features were assessed using the 19-item Mobile App Rating Scale (MARS), and a taxonomy of BCTs was used to determine the presence of BCTs (26 items). BCTs previously demonstrating efficacy in behavior changes during pregnancy were also identified from a literature review. Spearman correlations were used to investigate the relationships between app quality, app features, and number of BCTs identified. Results: Nineteen exercise apps were deemed eligible for this review and they were accessed via Google Play (n=13) or App Store (n=6). The MARS overall quality scores indicated moderate app quality (mean 3.5 [SD 0.52]). Functionality was the highest scoring MARS domain (mean 4.2 [SD 0.5]), followed by aesthetics (mean 3.7 [SD 0.6]) and information quality (mean 3.16 [SD 0.42]). Subjective app quality (mean 2.54 [SD 0.64]) and likelihood for behavioral impact (mean 2.5 [SD 0.6]) were the lowest scoring MARS domains. All 19 apps were found to incorporate at least two BCTs (mean 4.74, SD 2.51; range 2-10). However, only 11 apps included BCTs that previously demonstrated efficacy for behavior change during pregnancy, the most common being provide opportunities for social comparison (n=8) and prompt self-monitoring of behavior (n=7). There was a significant positive correlation between the number of BCTs with engagement and aesthetics scores, but the number of BCTs was not significantly correlated with functionality, information quality, total MARS quality, or subjective quality. Conclusions: Our findings showed that apps designed to promote physical activity among pregnant women were functional and aesthetically pleasing, with overall moderate quality. However, the incorporation of BCTs was low, with limited prevalence of BCTs previously demonstrating efficacy in behavior change during pregnancy. Future app development should identify and adopt factors that enhance and encourage user engagement, including the use of BCTs, especially those that have demonstrated efficacy for promoting physical activity behavior change among pregnant women. %M 33825693 %R 10.2196/23649 %U https://mhealth.jmir.org/2021/4/e23649 %U https://doi.org/10.2196/23649 %U http://www.ncbi.nlm.nih.gov/pubmed/33825693 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e21638 %T Perceived Impacts, Acceptability, and Recommendations for Ecological Momentary Assessment Among Youth Experiencing Homelessness: Qualitative Study %A Acorda,Darlene %A Businelle,Michael %A Santa Maria,Diane %+ Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Avenue, Houston, TX, 77030, United States, 1 832 824 1179, darlene.e.acorda@uth.tmc.edu %K youth experiencing homelessness %K ecological momentary assessment %K mobile apps %K behavior change %D 2021 %7 6.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of ecological momentary assessment (EMA) to study youth experiencing homelessness (YEH) behaviors is an emerging area of research. Despite high rates of participation and potential clinical utility, few studies have investigated the acceptability and recommendations for EMA from the YEH perspective. Objective: This study aimed to describe the perceived benefits, usability, acceptability, and barriers to the use of EMA from the homeless youth perspective. Methods: YEH were recruited from a larger EMA study. Semistructured exit interviews were performed using an interview guide that focused on the YEH experience with the EMA app, and included perceived barriers and recommendations for future studies. Data analyses used an inductive approach with thematic analysis to identify major themes and subthemes. Results: A total of 18 YEH aged 19-24 years participated in individual and group exit interviews. The EMA was highly acceptable to YEH and they found the app and EMA surveys easy to navigate. Perceived benefits included increased behavioral and emotional awareness with some YEH reporting a decrease in their high-risk behaviors as a result of participation. Another significant perceived benefit was the ability to use the phones for social support and make connections to family, friends, and potential employers. Barriers were primarily survey and technology related. Survey-related barriers included the redundancy of questions, the lack of customizable responses, and the timing of survey prompts. Technology-related barriers included the “freezing” of the app, battery charge, and connectivity issues. Recommendations for future studies included the need to provide real-time mental health support for symptomatic youth, to create individually customized questions, and to test the use of personalized motivational messages that respond to the EMA data in real time. Conclusions: YEH are highly receptive to the use of EMA in studies. Further studies are warranted to understand the impact of EMA on YEH behaviors. Incorporating the YEH perspective into the design and implementation of EMA studies may help minimize barriers, increase acceptability, and improve participation rates in this hard-to-reach, disconnected population. %M 33821805 %R 10.2196/21638 %U https://formative.jmir.org/2021/4/e21638 %U https://doi.org/10.2196/21638 %U http://www.ncbi.nlm.nih.gov/pubmed/33821805 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e19439 %T A Mobile App for Self-management of Urgency and Mixed Urinary Incontinence in Women: Randomized Controlled Trial %A Wadensten,Towe %A Nyström,Emma %A Franzén,Karin %A Lindam,Anna %A Wasteson,Elisabet %A Samuelsson,Eva %+ Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, SE-90187, Sweden, 46 907855000, towe.wadensten@umu.se %K eHealth %K mHealth %K urinary incontinence %K urgency urinary incontinence %K mixed urinary incontinence %K self-management %K mobile app %K smartphone app %K women %D 2021 %7 5.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Many women experience urgency (UUI) and mixed (MUI) urinary incontinence but commonly hesitate to seek care. Treatment access and self-management for these conditions can be supported through eHealth approaches. Objective: This study aimed to investigate the efficacy of the mobile app Tät II for self-management of UUI and MUI in women. Methods: This randomized controlled trial included women ≥18 years old with UUI or MUI and ≥2 leakages per week. Those with red-flag symptoms were excluded. Participants were recruited via analog and digital advertisements and screened for initial selection through a web-based questionnaire. Data were collected using another questionnaire and a 2-day bladder diary. A telephone interview confirmed the symptom diagnosis. Participants were randomized (1:1) to receive access to a treatment app (including pelvic floor muscle training, bladder training, psychoeducation, lifestyle advice, tailored advice, exercise log, reinforcement messages, and reminders) or an information app (control group), with no external treatment guidance provided. The primary outcome was incontinence symptoms at the 15-week follow-up, measured using the International Consultation on Incontinence Questionnaire (ICIQ)−Urinary Incontinence Short Form (ICIQ-UI SF). Urgency symptoms were assessed using the ICIQ−Overactive Bladder Module (ICIQ-OAB) and quality of life using the ICIQ−Lower Urinary Tract Symptoms Quality of Life Module (ICIQ-LUTSqol). Incontinence episode frequency (IEF) was calculated per bladder diary entries. Improvement was measured using the Patient’s Global Impression of Improvement. All outcomes were self-reported. Cure was defined as no leakages per the bladder diary. Intention-to-treat analysis was performed. Results: Between April 2017 and March 2018, 123 women (mean age 58.3, SD 9.6 years) were randomized to the treatment (n=60, 2 lost to follow-up) or information (n=63) group. Of these, 35 (28%) women had UUI, and 88 (72%) had MUI. Mean ICIQ-UI SF score at follow-up was lower in the treatment group than in the information group (estimated difference −3.1, 95% CI −4.8 to −1.3). The estimated between-group difference was −1.8 (95% CI −2.8 to −0.99) for mean ICIQ-OAB score and −6.3 (95% CI −10.5 to −2.1) for the mean ICIQ-LUTSqol score at follow-up. IEF reduction from baseline to follow-up was greater in the treatment group (−10.5, IQR −17.5 to −3.5) than in the information group (P<.001). Improvement was reported by 87% (52/60) of treatment group participants and by 30% (19/63) of information group participants. The cure rate was 32% in the treatment group, and 6% in the information group (odds ratio 5.4, 95% CI 1.9-15.6; P=.002). About 67% (40/60) of the treatment group participants used the app more than thrice a week. Conclusions: The treatment app was effective for improving urgency and mixed incontinence in women. When self-management is appropriate, this app may be a good alternative to pharmacological treatment or other conservative management, thus increasing access to care. Trial Registration: ClinicalTrials.gov NCT03097549; https://clinicaltrials.gov/ct2/show/NCT03097549 %M 33818395 %R 10.2196/19439 %U https://www.jmir.org/2021/4/e19439 %U https://doi.org/10.2196/19439 %U http://www.ncbi.nlm.nih.gov/pubmed/33818395 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 4 %P e23447 %T Postsecondary Student Engagement With a Mental Health App and Online Platform (Thought Spot): Qualitative Study of User Experience %A Wong,Howard W %A Lo,Brian %A Shi,Jenny %A Hollenberg,Elisa %A Abi-Jaoude,Alexxa %A Johnson,Andrew %A Chaim,Gloria %A Cleverley,Kristin %A Henderson,Joanna %A Levinson,Andrea %A Robb,Janine %A Voineskos,Aristotle %A Wiljer,David %+ UHN Digital, University Health Network, R. Fraser Elliott Building RFE 3-411, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada, 1 416 340 6322, david.wiljer@uhn.ca %K transition-aged youth %K qualitative study %K user experience %K help-seeking %K mental health %K postsecondary %K mobile apps %K adolescent %D 2021 %7 2.4.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: There is growing interest in using mobile apps and online tools to support postsecondary student mental health, but most of these solutions have suboptimal user engagement in real-world settings. Poor engagement can limit long-term effectiveness and usefulness of these tools. Previous literature has proposed several theories that link factors such as low usability and poor user-centered design to app disengagement. However, few studies provide direct evidence showing what factors contribute to suboptimal user engagement in the context of mobile mental health apps for postsecondary students. Objective: This study focuses on understanding postsecondary students’ attitudes and behaviors when using Thought Spot, a co-designed mental health app and online platform, to understand factors related to engagement and user experience. Methods: Students who were given access to Thought Spot for 6 months during a randomized trial of the intervention were invited to participate in one-on-one semistructured interviews. The interviews explored participants’ overall experiences and perceptions of the app, along with factors that affected their usage of various features. All interviews were recorded, and template analysis was used to analyze transcripts. Results: User satisfaction was mixed among users of Thought Spot. The degree of engagement with the app appeared to be affected by factors that can be grouped into 5 themes: (1) Students valued detailed, inclusive, and relevant content; (2) Technical glitches and a lack of integration with other apps affected the overall user experience and satisfaction with the app; (3) Using the app to support peers or family can increase engagement; (4) Crowdsourced information from peers about mental health resources drove user engagement, but was difficult to obtain; and (5) Users often turned to the app when they had an immediate need for mental health information, rather than using it to track mental health information over time. Conclusions: Content, user experience, user-centeredness, and peer support are important determinants of user engagement with mobile mental health apps among postsecondary students. In this study, participants disengaged when the app did not meet their expectations on these determinants. Future studies on user engagement should further explore the effectiveness of different features and the relative importance of various criteria for high-quality apps. Further focus on these issues may inform the creation of interventions that increase student engagement and align with their mental health needs. Trial Registration: ClinicalTrials.gov NCT03412461; https://clinicaltrials.gov/ct2/show/NCT03412461 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.6446 %M 33797395 %R 10.2196/23447 %U https://mental.jmir.org/2021/4/e23447 %U https://doi.org/10.2196/23447 %U http://www.ncbi.nlm.nih.gov/pubmed/33797395 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e24249 %T Slip Buddy App for Weight Management: Randomized Feasibility Trial of a Dietary Lapse Tracking App %A Pagoto,Sherry %A Tulu,Bengisu %A Waring,Molly E %A Goetz,Jared %A Bibeau,Jessica %A Divito,Joseph %A Groshon,Laurie %A Schroeder,Matthew %+ University of Connecticut, Department of Allied Health Sciences, 2006 Hillside Road, Unit 1248, Room 22, Storrs, CT, 06269, United States, 1 5084864900, Sherry.Pagoto@uconn.edu %K mobile app %K mHealth %K weight loss %K obesity %K diet %K mobile phone %D 2021 %7 1.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although calorie tracking is one of the strongest predictors of weight loss in behavioral weight loss interventions, low rates of adherence are common. Objective: This study aims to examine the feasibility and acceptability of using the Slip Buddy app during a 12-week web-based weight loss program. Methods: We conducted a randomized pilot trial to evaluate the feasibility and acceptability of using the Slip Buddy app compared with a popular commercial calorie tracking app during a counselor-led, web-based behavioral weight loss intervention. Adults who were overweight or obese were recruited on the web and randomized into a 12-week web-based weight loss intervention that included either the Slip Buddy app or a commercial calorie tracking app. Feasibility outcomes included retention, app use, usability, slips reported, and contextual factors reported at slips. Acceptability outcomes included ratings of how helpful, tedious, taxing, time consuming, and burdensome using the assigned app was. We described weight change from baseline to 12 weeks in both groups as an exploratory outcome. Participants using the Slip Buddy app provided feedback on how to improve it during the postintervention focus groups. Results: A total of 75% (48/64) of the participants were female and, on average, 39.8 (SD 11.0) years old with a mean BMI of 34.2 (SD 4.9) kg/m2. Retention was high in both conditions, with 97% (31/32) retained in the Slip Buddy condition and 94% (30/32) retained in the calorie tracking condition. On average, participants used the Slip Buddy app on 53.8% (SD 31.3%) of days, which was not significantly different from those using the calorie tracking app (mean 57.5%, SD 28.4% of days), and participants who recorded slips (30/32, 94%) logged on average 17.9 (SD 14.4) slips in 12 weeks. The most common slips occurred during snack times (220/538, 40.9%). Slips most often occurred at home (297/538, 55.2%), while working (153/538, 28.4%), while socializing (130/538, 24.2%), or during screen time (123/538, 22.9%). The conditions did not differ in participants’ ratings of how their assigned app was tedious, taxing, or time consuming (all values of P>.05), but the calorie tracking condition gave their app higher helpfulness and usability ratings (all values of P<.05). Technical issues were the most common type of negative feedback, whereas simplicity was the most common type of positive feedback. Weight losses of ≥5% of baseline weight were achieved by 31% (10/32) of Slip Buddy participants and 34% (11/32) of calorie tracking participants. Conclusions: Self-monitoring of dietary lapses and the contextual factors associated with them may be an alternative for people who do not prefer calorie tracking. Future research should examine patient characteristics associated with adherence to different forms of dietary self-monitoring. Trial Registration: ClinicalTrials.gov NCT02615171; https://clinicaltrials.gov/ct2/show/NCT02615171 %M 33792547 %R 10.2196/24249 %U https://mhealth.jmir.org/2021/4/e24249 %U https://doi.org/10.2196/24249 %U http://www.ncbi.nlm.nih.gov/pubmed/33792547 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e23989 %T Text Messaging Intervention for Young Smokers Experiencing Homelessness: Lessons Learned From a Randomized Controlled Trial %A Linnemayr,Sebastian %A Zutshi,Rushil %A Shadel,William %A Pedersen,Eric %A DeYoreo,Maria %A Tucker,Joan %+ RAND Corporation, 1776 Main Street, Santa Monica, CA, , United States, 1 310 393 0411 ext 6734, slinnema@rand.org %K smokers %K quitting %K text messaging %K homeless %K young adults %K cessation resources %K peer support %K smoking rate %K smartphone %D 2021 %7 1.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smoking rates are significantly higher among young people experiencing homelessness than in the general population. Despite a willingness to quit, homeless youth have little success in doing so on their own, and existing cessation resources tailored to this population are lacking. Homeless youth generally enjoy the camaraderie and peer support that group-based programs offer, but continuous in-person support during a quit attempt can be prohibitively expensive. Objective: This study aimed to assess the feasibility and acceptability of an automated text messaging intervention (TMI) as an adjunct to group-based cessation counseling and provision of nicotine patches to help homeless youth quit smoking. This paper outlines the lessons learned from the implementation of the TMI intervention. Methods: Homeless youth smokers aged 18 to 25 years who were interested in quitting (n=77) were recruited from drop-in centers serving homeless youth in the Los Angeles area. In this pilot randomized controlled trial, all participants received a group-based cessation counseling session and nicotine patches, with 52% (40/77) randomly assigned to receive 6 weeks of text messages to provide additional support for their quit attempt. Participants received text messages on their own phone rather than receiving a study-issued phone for the TMI. We analyzed baseline and follow-up survey data as well as back-end data from the messaging platform to gauge the acceptability and feasibility of the TMI among the 40 participants who received it. Results: Participants had widespread (smart)phone ownership—16.4% (36/219) were ineligible for study participation because they did not have a phone that could receive text messages. Participants experienced interruptions in their phone use (eg, 44% [16/36] changed phone numbers during the follow-up period) but reported being able to receive the majority of messages. These survey results were corroborated by back-end data (from the program used to administer the TMI) showing a message delivery rate of about 95%. Participant feedback points to the importance of carefully crafting text messages, which led to high (typically above 70%) approval of most text messaging components of the intervention. Qualitative feedback indicated that participants enjoyed the group counseling session that preceded the TMI and suggested including more such group elements into the intervention. Conclusions: The TMI was well accepted and feasible to support smoking cessation among homeless youth. Given high rates of smartphone ownership, the next generation of phone-based smoking cessation interventions for this population should consider using approaches beyond text messages and focus on finding ways to develop effective approaches to include group interaction using remote implementation. Given overall resource constraints and in particular the exigencies of the currently ongoing COVID-19 epidemic, phone-based interventions are a promising approach to support homeless youth, a population urgently in need of effective smoking cessation interventions. Trial Registration: ClinicalTrials.gov NCT03874585; https://clinicaltrials.gov/ct2/show/NCT03874585 International Registered Report Identifier (IRRID): RR2-10.1186/s13722-020-00187-6 %M 33792551 %R 10.2196/23989 %U https://mhealth.jmir.org/2021/4/e23989 %U https://doi.org/10.2196/23989 %U http://www.ncbi.nlm.nih.gov/pubmed/33792551 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e24455 %T The Geriatric Acute and Post-Acute Fall Prevention Intervention (GAPcare) II to Assess the Use of the Apple Watch in Older Emergency Department Patients With Falls: Protocol for a Mixed Methods Study %A Strauss,Daniel H %A Davoodi,Natalie M %A Healy,Margaret %A Metts,Christopher L %A Merchant,Roland C %A Banskota,Swechya %A Goldberg,Elizabeth M %+ Department of Emergency Medicine, Alpert Medical School of Brown University, 55 Claverick Street, Second Floor, Room 203, Providence, RI, 02903, United States, 1 401 527 1740, elizabeth_goldberg@brown.edu %K fall intervention %K geriatric care %K Apple Watch %K wearable technology %D 2021 %7 1.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Falls are a common problem among older adults that lead to injury, emergency department (ED) visits, and institutionalization. The Apple Watch can detect falls and alert caregivers and clinicians that help is needed; the device could also be used to objectively collect data on gait, fitness, and falls as part of clinical trials. However, little is known about the ease of use of this technology among older adult ED patients, a population at high risk of recurrent falls. Objective: The goal of this study—the Geriatric Acute and Post-Acute Fall Prevention Intervention (GAPcare) II—is to examine the feasibility, acceptability, and usability of the Apple Watch Series 4 paired with the iPhone and our research app Rhode Island FitTest (RIFitTest) among older adult ED patients seeking care for falls. Methods: We will conduct field-testing with older adult ED patients (n=25) who sustained a fall and their caregivers (n=5) to determine whether they can use the Apple Watch, iPhone, and app either (1) continuously or (2) periodically, with or without telephone assistance from the research staff, to assess gait, fitness, and/or falls over time. During the initial encounter, participants will receive training in the Apple Watch, iPhone, and our research app. They will receive an illustrated training manual and a number to call if they have questions about the research protocol or device usage. Participants will complete surveys and cognitive and motor assessments on the app during the study period. At the conclusion of the study, we will solicit participant feedback through semistructured interviews. Qualitative data will be summarized using framework matrix analyses. Sensor and survey response data will be analyzed using descriptive statistics. Results: Recruitment began in December 2019 and was on pause from April 2020 until September 2020 due to the COVID-19 pandemic. Study recruitment will continue until 30 participants are enrolled. This study has been approved by the Rhode Island Hospital Institutional Review Board (approval 1400781-16). Conclusions: GAPcare II will provide insights into the feasibility, acceptability, and usability of the Apple Watch, iPhone, and the RIFitTest app in the population most likely to benefit from the technology: older adults at high risk of recurrent falls. In the future, wearables could be used as part of fall prevention interventions to prevent injury before it occurs. Trial Registration: ClinicalTrials.gov NCT04304495; https://clinicaltrials.gov/ct2/show/NCT04304495 International Registered Report Identifier (IRRID): DERR1-10.2196/24455 %M 33792553 %R 10.2196/24455 %U https://www.researchprotocols.org/2021/4/e24455 %U https://doi.org/10.2196/24455 %U http://www.ncbi.nlm.nih.gov/pubmed/33792553 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e25699 %T Telehealth Diabetes Prevention Intervention for the Next Generation of African American Youth: Protocol for a Pilot Trial %A Gamble,Abigail %A Beech,Bettina M %A Wade,Breanna C %A Sutton,Victor D %A Lim,Crystal %A Sandridge,Shanda %A Welsch,Michael A %+ Department of Preventive Medicine, John D Bower School of Population Health, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216, United States, 1 6018159065, agamble2@umc.edu %K prediabetic state %K child obesity %K telehealth %K obesity management %K behavioral science %K implementation science %K Jackson Heart Study %K Centers for Disease Control and Prevention %K preventive medicine %K mobile phone %D 2021 %7 31.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In 1999, type 2 diabetes mellitus (T2DM) was identified as an emerging epidemic in youth, and racial and ethnic minority youth were identified with high risk. Two decades later, no gold standard T2DM prevention intervention has been established for this population. Objective: This study tests the efficacy of a telehealth diabetes prevention intervention for African American (AA) families with children with risk for T2DM. Concurrently, investigators aim to evaluate an implementation strategy for the uptake of the intervention by the University of Mississippi Medical Center’s (UMMC) pediatric weight management clinic. Methods: This single-arm trial will enroll 20 parents with overweight or obesity of children (8-11 years) with overweight or obesity, both of whom are at risk for T2DM. Parents will meet in small groups (5 parents per group) weekly for 11 weeks and then monthly for 4 monthly maintenance sessions via videoconference using Wi-Fi–enabled iPads with cellular connectivity. The intervention will be adapted from the National Diabetes Prevention Program and Power to Prevent, a diabetes prevention program tailored for AA families. The same lifestyle intervention facilitated by a racially concordant lifestyle coach trained in the Diabetes Prevention Program will be delivered to all groups (n=4). Participants will be recruited in-person during patient encounters at the UMMC’s pediatric weight management clinic. Sessions will consist of dietary and physical activity behavior change strategies facilitated using problem-solving and goal-setting skills. The implementation strategy has 2 targets: the pediatric weight management clinic site and clinical team and parents of children at risk for T2DM engaged in intensive obesity treatment to prevent T2DM. The multifaceted implementation protocol includes 4 discrete strategies: creating a new clinical team, changing the service site, intervening with families, and promoting organizational readiness for change. Results: Recruitment and enrollment began in December 2020, and the intervention is scheduled to be delivered to the first cohort of parents in March 2021. The results are expected to be submitted for publication beginning in November 2021 through 2022. The primary outcome measure for the pilot trial will include changes from baseline to 12 and 30 weeks in the child BMI z score and parent BMI. The implementation evaluation will include multiple measures of feasibility, acceptability, appropriateness, fidelity, and efficacy. This protocol was approved by the UMMC’s Institutional Review Board (#2020V0249). Conclusions: The proposed intervention approach is supported by the scientific literature and is scalable given the current and future health care subsidies for telehealth. Findings from this pilot trial will begin to address critical barriers to defining a gold standard lifestyle intervention for AA families with children at risk for T2DM. If effective, the intervention could be feasibly disseminated to treat obesity and prevent T2DM in high-risk AA pediatric populations. International Registered Report Identifier (IRRID): PRR1-10.2196/25699 %M 33787504 %R 10.2196/25699 %U https://www.researchprotocols.org/2021/3/e25699 %U https://doi.org/10.2196/25699 %U http://www.ncbi.nlm.nih.gov/pubmed/33787504 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25933 %T Voice-Based Conversational Agents for the Prevention and Management of Chronic and Mental Health Conditions: Systematic Literature Review %A Bérubé,Caterina %A Schachner,Theresa %A Keller,Roman %A Fleisch,Elgar %A v Wangenheim,Florian %A Barata,Filipe %A Kowatsch,Tobias %+ Center for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, WEV G 214, Weinbergstrasse 56/58, Zurich, 8092, Switzerland, 41 44 633 8419, berubec@ethz.ch %K voice %K speech %K delivery of health care %K noncommunicable diseases %K conversational agents %K mobile phone %K smart speaker %K monitoring %K support %K chronic disease %K mental health %K systematic literature review %D 2021 %7 29.3.2021 %9 Review %J J Med Internet Res %G English %X Background: Chronic and mental health conditions are increasingly prevalent worldwide. As devices in our everyday lives offer more and more voice-based self-service, voice-based conversational agents (VCAs) have the potential to support the prevention and management of these conditions in a scalable manner. However, evidence on VCAs dedicated to the prevention and management of chronic and mental health conditions is unclear. Objective: This study provides a better understanding of the current methods used in the evaluation of health interventions for the prevention and management of chronic and mental health conditions delivered through VCAs. Methods: We conducted a systematic literature review using PubMed MEDLINE, Embase, PsycINFO, Scopus, and Web of Science databases. We included primary research involving the prevention or management of chronic or mental health conditions through a VCA and reporting an empirical evaluation of the system either in terms of system accuracy, technology acceptance, or both. A total of 2 independent reviewers conducted the screening and data extraction, and agreement between them was measured using Cohen kappa. A narrative approach was used to synthesize the selected records. Results: Of 7170 prescreened papers, 12 met the inclusion criteria. All studies were nonexperimental. The VCAs provided behavioral support (n=5), health monitoring services (n=3), or both (n=4). The interventions were delivered via smartphones (n=5), tablets (n=2), or smart speakers (n=3). In 2 cases, no device was specified. A total of 3 VCAs targeted cancer, whereas 2 VCAs targeted diabetes and heart failure. The other VCAs targeted hearing impairment, asthma, Parkinson disease, dementia, autism, intellectual disability, and depression. The majority of the studies (n=7) assessed technology acceptance, but only few studies (n=3) used validated instruments. Half of the studies (n=6) reported either performance measures on speech recognition or on the ability of VCAs to respond to health-related queries. Only a minority of the studies (n=2) reported behavioral measures or a measure of attitudes toward intervention-targeted health behavior. Moreover, only a minority of studies (n=4) reported controlling for participants’ previous experience with technology. Finally, risk bias varied markedly. Conclusions: The heterogeneity in the methods, the limited number of studies identified, and the high risk of bias show that research on VCAs for chronic and mental health conditions is still in its infancy. Although the results of system accuracy and technology acceptance are encouraging, there is still a need to establish more conclusive evidence on the efficacy of VCAs for the prevention and management of chronic and mental health conditions, both in absolute terms and in comparison with standard health care. %M 33658174 %R 10.2196/25933 %U https://www.jmir.org/2021/3/e25933 %U https://doi.org/10.2196/25933 %U http://www.ncbi.nlm.nih.gov/pubmed/33658174 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e22183 %T Interpretable Conditional Recurrent Neural Network for Weight Change Prediction: Algorithm Development and Validation Study %A Kim,Ho Heon %A Kim,Youngin %A Park,Yu Rang %+ Department of Biomedical Systems Informatics, College of Medicine, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 0222282493, yurangpark@yuhs.ac %K explainable AI %K interpretable AI %K mHealth %K obesity %K behavior modification %K artificial intelligence %K development %K validation %K weight %K intervention %D 2021 %7 29.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In recent years, mobile-based interventions have received more attention as an alternative to on-site obesity management. Despite increased mobile interventions for obesity, there are lost opportunities to achieve better outcomes due to the lack of a predictive model using current existing longitudinal and cross-sectional health data. Noom (Noom Inc) is a mobile app that provides various lifestyle-related logs including food logging, exercise logging, and weight logging. Objective: The aim of this study was to develop a weight change predictive model using an interpretable artificial intelligence algorithm for mobile-based interventions and to explore contributing factors to weight loss. Methods: Lifelog mobile app (Noom) user data of individuals who used the weight loss program for 16 weeks in the United States were used to develop an interpretable recurrent neural network algorithm for weight prediction that considers both time-variant and time-fixed variables. From a total of 93,696 users in the coaching program, we excluded users who did not take part in the 16-week weight loss program or who were not overweight or obese or had not entered weight or meal records for the entire 16-week program. This interpretable model was trained and validated with 5-fold cross-validation (training set: 70%; testing: 30%) using the lifelog data. Mean absolute percentage error between actual weight loss and predicted weight was used to measure model performance. To better understand the behavior factors contributing to weight loss or gain, we calculated contribution coefficients in test sets. Results: A total of 17,867 users’ data were included in the analysis. The overall mean absolute percentage error of the model was 3.50%, and the error of the model declined from 3.78% to 3.45% by the end of the program. The time-level attention weighting was shown to be equally distributed at 0.0625 each week, but this gradually decreased (from 0.0626 to 0.0624) as it approached 16 weeks. Factors such as usage pattern, weight input frequency, meal input adherence, exercise, and sharp decreases in weight trajectories had negative contribution coefficients of –0.021, –0.032, –0.015, and –0.066, respectively. For time-fixed variables, being male had a contribution coefficient of –0.091. Conclusions: An interpretable algorithm, with both time-variant and time-fixed data, was used to precisely predict weight loss while preserving model transparency. This week-to-week prediction model is expected to improve weight loss and provide a global explanation of contributing factors, leading to better outcomes. %M 33779574 %R 10.2196/22183 %U https://mhealth.jmir.org/2021/3/e22183 %U https://doi.org/10.2196/22183 %U http://www.ncbi.nlm.nih.gov/pubmed/33779574 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25786 %T A Smartphone-Delivered Ecological Momentary Intervention for Problem Gambling (GamblingLess: Curb Your Urge): Single-Arm Acceptability and Feasibility Trial %A Hawker,Chloe O %A Merkouris,Stephanie S %A Youssef,George J %A Dowling,Nicki A %+ Deakin University, 1 Gheringhap St, Geelong, 3220, Australia, 61 03 9244 5610, chawker@deakin.edu.au %K gambling %K craving %K urge %K self-efficacy %K relapse %K smartphone %K self-help %K treatment %K ecological momentary assessment %K ecological momentary intervention %K mobile phone %D 2021 %7 26.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Low uptake rates of traditional gambling treatments highlight the need for innovative treatment modalities. Smartphone apps can provide unprecedented access to real-time ecological momentary interventions (EMIs) delivered in people’s everyday lives. Objective: This study aims to examine the acceptability, feasibility, and preliminary effectiveness of GamblingLess: Curb Your Urge, the first smartphone app–delivered EMI that aims to prevent gambling episodes by reducing craving intensity in people seeking help for gambling problems. Methods: This study was a single-arm, 5-week acceptability and feasibility trial (1-week baseline and 4-week intervention periods) involving ecological momentary assessments (EMAs) delivered 3 times daily. The EMAs measured gambling episodes, cravings, and self-efficacy. Web-based evaluations at baseline, postintervention, and 1-month follow-up measured gambling outcomes (severity, cravings, frequency, expenditure, and self-efficacy) and the intervention’s perceived helpfulness, relevance, burden, satisfaction, and impact in relation to gambling cravings. Results: A total of 36 participants, of whom 22/36 (61%) were male and 34/36 (94%) were problem gamblers, completed the baseline measures, with 61% (22/36) completing the postintervention evaluation and 58% (21/36) completing the follow-up evaluation. The intervention was considered acceptable, as participants perceived all intervention content to be above average in helpfulness and the EMA to be highly relevant but somewhat burdensome. Participants reported that they were satisfied with the intervention and that the intervention improved their knowledge, attitudes, awareness, behavior change, intention to change, and help-seeking behavior for gambling cravings. Regarding the intervention’s feasibility, compliance rates for the EMA (51%) and EMI (15%) were low; however, the intervention was used 166 times, including 59 uses within 60 minutes of EMA completion and 107 on-demand uses. Regarding the intervention’s preliminary effectiveness, descriptive EMA data showed that, compared with the baseline period, 71% and 72% reductions in the average number of gambling episodes and craving occurrences were reported in the intervention period, respectively. In addition, clustered paired-sample two-tailed t tests revealed a significant 5.4% reduction in real-time craving intensity (P=.01) immediately after intervention use, which increased to 10.5% (P=.01), where use was recommended based on craving occurrence. At the group level, significant medium-to-large reductions were observed in mean gambling symptom severity (P=.01 and .003), cravings (P=.03 and .02), frequency (P=.01 and .004), and expenditure (P=.04 and .003) at postintervention and follow-up; moreover, increased mean gambling self-efficacy and craving self-efficacy (P=.01 and .01) were observed at postintervention and increased gambling self-efficacy (P=.04) was observed at follow-up. At the individual level, over a quarter of participants (6/22, 27% to 10/21, 48%) could be categorized as recovered or improved regarding their gambling symptom severity and cravings. Conclusions: The results support the acceptability, feasibility, and preliminary effectiveness of this app-delivered EMI for preventing gambling episodes through craving management in people with gambling problems, which has implications for extending the reach of evidence-based treatment to moments of vulnerability in people’s everyday lives. %M 33769294 %R 10.2196/25786 %U https://www.jmir.org/2021/3/e25786 %U https://doi.org/10.2196/25786 %U http://www.ncbi.nlm.nih.gov/pubmed/33769294 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e18460 %T System Architecture for "Support Through Mobile Messaging and Digital Health Technology for Diabetes" (SuMMiT-D): Design and Performance in Pilot and Randomized Controlled Feasibility Studies %A Chi,Yuan %A Velardo,Carmelo %A Allen,Julie %A Robinson,Stephanie %A Riga,Evgenia %A Judge,David %A Tarassenko,Lionel %A Farmer,Andrew J %+ Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Old Road Campus Research Building, Headington, Oxford, OX3 7DQ, United Kingdom, 44 01865 617675, yuan.chi@eng.ox.ac.uk %K type 2 diabetes %K short message service %K health-related behavior %K mobile health %K mHealth %K mobile phone %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes is a highly prevalent long-term condition with high morbidity and mortality rates. People with diabetes commonly worry about their diabetes medicines and do not always take them regularly as prescribed. This can lead to poor diabetes control. The Support Through Mobile Messaging and Digital Health Technology for Diabetes (SuMMiT-D) study aims to deliver brief messages as tailored interventions to support people with type 2 diabetes in better use of their diabetes medicines and to improve treatment adherence and health outcomes. Objective: This paper describes the overall architecture of a tailored intervention delivery system used in the pilot and randomized controlled feasibility studies of SuMMiT-D and reports its performance. Methods: The SuMMiT-D system includes several platforms and resources to recruit participants and deliver messages as tailored interventions. Its core component is called the clinical system and is responsible for interacting with the participants by receiving and sending SMS text messages from and to them. The personalization and tailoring of brief messages for each participant is based on a list of built-in commands that they can use. Results: For the pilot study, a total of 48 participants were recruited; they had a median age of 64 years (first quartile, third quartile [Q1, Q3: 54.5, 69]). For the feasibility study, a total of 209 participants were recruited and randomly assigned to either the control or intervention group; they had a median age of 65 years (Q1, Q3: 56, 71), with 41.1% (86/209) being female. The participants used the SuMMiT-D system for up to 6 months (26 weeks) and had a wide range of different interactions with the SuMMiT-D system while tailored interventions were being delivered. For both studies, we had low withdrawal rates: only 4.2% and 5.3% for the pilot and feasibility studies, respectively. Conclusions: A system was developed to successfully deliver brief messages as tailored health interventions to more than 250 people with type 2 diabetes via SMS text messages. On the basis of the low withdrawal rates and positive feedback received, it can be inferred that the SuMMiT-D system is robust, user-friendly, useful, and positive for most participants. From the two studies, we found that online recruitment was more efficient than recruitment via postal mail; a regular SMS text reminder (eg, every 4 weeks) can potentially increase the participants’ interactions with the system. Trial Registration: ISRCTN Registry ISRCTN13404264; http://www.isrctn.com/ISRCTN13404264 %M 33769299 %R 10.2196/18460 %U https://formative.jmir.org/2021/3/e18460 %U https://doi.org/10.2196/18460 %U http://www.ncbi.nlm.nih.gov/pubmed/33769299 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e25313 %T Measurement of Heart Rate Using the Polar OH1 and Fitbit Charge 3 Wearable Devices in Healthy Adults During Light, Moderate, Vigorous, and Sprint-Based Exercise: Validation Study %A Muggeridge,David Joseph %A Hickson,Kirsty %A Davies,Aimie Victoria %A Giggins,Oonagh M %A Megson,Ian L %A Gorely,Trish %A Crabtree,Daniel R %+ Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4BN, United Kingdom, 44 7979086243, d.muggeridge@napier.ac.uk %K heart rate %K photoplethysmography %K wearable electronic devices %K validation study %K exercise %K mobile phone %D 2021 %7 25.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Accurate, continuous heart rate measurements are important for health assessment, physical activity, and sporting performance, and the integration of heart rate measurements into wearable devices has extended its accessibility. Although the use of photoplethysmography technology is not new, the available data relating to the validity of measurement are limited, and the range of activities being performed is often restricted to one exercise domain and/or limited intensities. Objective: The primary objective of this study was to assess the validity of the Polar OH1 and Fitbit Charge 3 devices for measuring heart rate during rest, light, moderate, vigorous, and sprint-type exercise. Methods: A total of 20 healthy adults (9 female; height: mean 1.73 [SD 0.1] m; body mass: mean 71.6 [SD 11.0] kg; and age: mean 40 [SD 10] years) volunteered and provided written informed consent to participate in the study consisting of 2 trials. Trial 1 was split into 3 components: 15-minute sedentary activities, 10-minute cycling on a bicycle ergometer, and incremental exercise test to exhaustion on a motorized treadmill (18-42 minutes). Trial 2 was split into 2 components: 4 × 15-second maximal sprints on a cycle ergometer and 4 × 30- to 50-m sprints on a nonmotorized resistance treadmill. Data from the 3 devices were time-aligned, and the validity of Polar OH1 and Fitbit Charge 3 was assessed against Polar H10 (criterion device). Validity was evaluated using the Bland and Altman analysis, Pearson moment correlation coefficient, and mean absolute percentage error. Results: Overall, there was a very good correlation between the Polar OH1 and Polar H10 devices (r=0.95), with a mean bias of −1 beats·min-1 and limits of agreement of −20 to 19 beats·min-1. The Fitbit Charge 3 device underestimated heart rate by 7 beats·min-1 compared with Polar H10, with a limit of agreement of −46 to 33 beats·min-1 and poor correlation (r=0.8). The mean absolute percentage error for both devices was deemed acceptable (<5%). Polar OH1 performed well across each phase of trial 1; however, validity was worse for trial 2 activities. Fitbit Charge 3 performed well only during rest and nonsprint-based treadmill activities. Conclusions: Compared with our criterion device, Polar OH1 was accurate at assessing heart rate, but the accuracy of Fitbit Charge 3 was generally poor. Polar OH1 performed worse during trial 2 compared with the activities in trial 1, and the validity of the Fitbit Charge 3 device was particularly poor during our cycling exercises. %M 33764310 %R 10.2196/25313 %U https://mhealth.jmir.org/2021/3/e25313 %U https://doi.org/10.2196/25313 %U http://www.ncbi.nlm.nih.gov/pubmed/33764310 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e27138 %T Effectiveness of a Postpartum Text Message Program (Essential Coaching for Every Mother) on Maternal Psychosocial Outcomes: Protocol for a Randomized Controlled Trial %A Dol,Justine %A Aston,Megan %A McMillan,Douglas %A Tomblin Murphy,Gail %A Campbell-Yeo,Marsha %+ Faculty of Health, Dalhousie University, 6299 South St, Halifax, NS, B3H 4R2, Canada, 1 902 470 2640, Justine.dol@dal.ca %K text message %K mobile health %K postpartum education %K self-efficacy %K social support %K postpartum anxiety %K postpartum depression %D 2021 %7 25.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Women experience changes both physically and psychologically during their transition to motherhood. The postnatal period is a critical time for women to develop maternal self-efficacy. Mobile health interventions may offer a way to reach women during this critical period to offer support and information. Essential Coaching for Every Mother is a text message program that seeks to educate and support women during the first 6 weeks postpartum. Objective: The primary effectiveness objective is to compare the effectiveness of the Essential Coaching for Every Mother program on maternal psychosocial outcomes (self-efficacy, social support, postpartum depression, and postpartum anxiety) immediately after the intervention and 6 months postpartum, collectively as well as stratified by parity. The primary implementation objective is to evaluate the implementation extent and quality of the Essential Coaching for Every Mother program. Methods: This will be a hybrid type 1 effectiveness-implementation randomized controlled trial. A total of 140 mothers-to-be or new mothers from Nova Scotia will be recruited and randomized to the intervention or control arm, stratified by parity. The intervention arm will receive the Essential Coaching for Every Mother program, which consists of 53 messages sent twice a day for the first 2 weeks and daily for weeks 3 through 6. The control group will receive usual care. Messages are personalized based on the infant’s age and the woman’s self-selected preference for breastfeeding or formula feeding and tailored with the infant’s name and gender. Women can enroll in the program if they are ≥37 weeks pregnant or within 10 days postpartum, with the first message designed to be sent on the second evening after birth. The actual number of messages received will vary based on the timing of enrollment and the infant’s date of birth. Participants will complete questionnaires assessing self-efficacy, social support, and postpartum depression and anxiety at baseline (enrollment after birth) and 6 weeks (postintervention) and 6 months postpartum. Implementation data will be collected throughout the trial, and evaluation feedback will be collected at 6 weeks from women who received the intervention. Results: Recruitment for this study started on January 5, 2021, and is currently ongoing, with an anticipated date of recruitment completion of January 2022. Conclusions: This study will assess the effectiveness of a postpartum text message program to improve maternal self-efficacy and social support while decreasing postpartum depression and anxiety. It will also shed light on the implementation effectiveness of the program. Trial Registration: ClinicalTrials.gov NCT04730570; https://clinicaltrials.gov/ct2/show/NCT04730570 International Registered Report Identifier (IRRID): DERR1-10.2196/27138 %M 33764309 %R 10.2196/27138 %U https://www.researchprotocols.org/2021/3/e27138 %U https://doi.org/10.2196/27138 %U http://www.ncbi.nlm.nih.gov/pubmed/33764309 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e25810 %T Development of Coaching Support for LiveWell: A Smartphone-Based Self-Management Intervention for Bipolar Disorder %A Dopke,Cynthia A %A McBride,Alyssa %A Babington,Pamela %A Jonathan,Geneva K %A Michaels,Tania %A Ryan,Chloe %A Duffecy,Jennifer %A Mohr,David C %A Goulding,Evan H %+ Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 303 E Chicago Ave., Suite 7-102, Chicago, IL, 60611, United States, 1 3125031189, e-goulding@fsm.northwestern.edu %K human support %K adherence %K self-management %K behavior change %K mHealth %K bipolar disorder %D 2021 %7 24.3.2021 %9 Viewpoint %J JMIR Form Res %G English %X Despite effective pharmacological treatment, bipolar disorder is a leading cause of disability due to recurrence of episodes, long episode durations, and persistence of interepisode symptoms. While adding psychotherapy to pharmacotherapy improves outcomes, the availability of adjunctive psychotherapy is limited. To extend the accessibility and functionality of psychotherapy for bipolar disorder, we developed LiveWell, a smartphone-based self-management intervention. Unfortunately, many mental health technology interventions suffer from high attrition rates, with users rapidly failing to maintain engagement with the intervention technology. Human support reduces this commonly observed engagement problem but does not consistently improve clinical and recovery outcomes. To facilitate ongoing efforts to develop human support for digital mental health technologies, this paper describes the design decisions, theoretical framework, content, mode, timing of delivery, and the training and supervision for coaching support of the LiveWell technology. This support includes clearly defined and structured roles that aim to encourage the use of the technology, self-management strategies, and communication with care providers. A clear division of labor is established between the coaching support roles and the intervention technology to allow lay personnel to serve as coaches and thereby maximize accessibility to the LiveWell intervention. %M 33759798 %R 10.2196/25810 %U https://formative.jmir.org/2021/3/e25810 %U https://doi.org/10.2196/25810 %U http://www.ncbi.nlm.nih.gov/pubmed/33759798 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24023 %T Development of a Smartphone App to Predict and Improve the Rates of Suicidal Ideation Among Transgender Persons (TransLife): Qualitative Study %A Dubov,Alex %A Fraenkel,Liana %A Goldstein,Zil %A Arroyo,Hansel %A McKellar,Derek %A Shoptaw,Steve %+ School of Behavioral Health, Loma Linda University, 11065 Campus Street, Loma Linda, CA, 92350, United States, 1 9095581900, adubov@llu.edu %K mobile health %K mHealth %K mobile app %K pilot study %K qualitative research %K user-centered design %K acceptability study %K health services for transgender persons %K suicide prevention %K mental health %K mobile phone %D 2021 %7 24.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Transgender people are at a high risk of suicidal ideation, suicide attempts, and deaths. Among transgender individuals, 77% and 41% engage in suicidal ideation and suicide attempt in their lifetime, respectively, which exceeds the general population rates (9.2% and 2.7%, respectively). Traditionally, suicide risk factors have been studied over a long period between measurements, making it difficult to understand the short-term variability in suicide risk. Mobile phone apps offer an opportunity to understand the immediate precursors of suicidality through the assessment of behaviors and moods in real time. This is the first study to use a mobile phone app (TransLife) to understand the short-term risk factors for suicide among transgender individuals. Objective: This study aims to beta test the usability of an evidence-informed mobile health (mHealth) suicide prevention phone app, TransLife. The primary aims are to obtain preliminary data on user engagement and satisfaction with the app, and to assess the feasibility of completing ecological momentary assessments (mood logs) within the app. Methods: We used qualitative methods and an exploratory research approach that combined naturalistic app use, focus groups, and semistructured phone interviews. The focus group was informed about the development of the prototype. We conducted a 3-week evaluation to determine engagement and obtain detailed user feedback about the app. After participation in the pilot, phone-based, semistructured, and audio-recorded exit interviews were conducted with the research participants. Results: In total, 16 transgender individuals participated in this study. On average, users logged in 4 (SD 2.7) times a week and spent approximately 5 (SD 3.5) minutes on the app per log-in. A total of 6 major themes emerged in this study. These themes focused on the app’s functionality, satisfaction with using the app, perceived ease of use, perceived safety of providing personal data within the app, trusting the app enough to share personal feelings, and features that make this app engaging. These themes suggest that TransLife is an engaging, useful, and acceptable mHealth intervention. Participants reported that the app was easy to use and understand, supported mental self-care, promoted self-awareness, and helped them identify triggers of negative moods. Conclusions: The results of this pilot study indicate that TransLife is an engaging, acceptable, and potentially effective mHealth intervention. Transgender participants reported many advantages of using TransLife, such as being able to track their mood, connecting to the community, and accessing local resources. This study provides initial support for the acceptability and usability of TransLife as an mHealth intervention designed for the transgender community. %M 33596181 %R 10.2196/24023 %U https://www.jmir.org/2021/3/e24023 %U https://doi.org/10.2196/24023 %U http://www.ncbi.nlm.nih.gov/pubmed/33596181 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23533 %T Human Coaching Methodologies for Automatic Electronic Coaching (eCoaching) as Behavioral Interventions With Information and Communication Technology: Systematic Review %A Chatterjee,Ayan %A Gerdes,Martin %A Prinz,Andreas %A Martinez,Santiago %+ Department for Information and Communication Technologies, Centre for e-Health, University of Agder, Jon Lilletuns Vei 9, Grimstad, 4879, Norway, 47 38141000, ayan.chatterjee@uia.no %K coaching %K electronic coaching %K human behavior %K healthy lifestyle %K persuasive technology %D 2021 %7 24.3.2021 %9 Review %J J Med Internet Res %G English %X Background: We systematically reviewed the literature on human coaching to identify different coaching processes as behavioral interventions and methods within those processes. We then reviewed how those identified coaching processes and the used methods can be utilized to improve an electronic coaching (eCoaching) process for the promotion of a healthy lifestyle with the support of information and communication technology (ICT). Objective: This study aimed to identify coaching and eCoaching processes as behavioral interventions and the methods behind these processes. Here, we mainly looked at processes (and corresponding models that describe coaching as certain processes) and the methods that were used within the different processes. Several methods will be part of multiple processes. Certain processes (or the corresponding models) will be applicable for both human coaching and eCoaching. Methods: We performed a systematic literature review to search the scientific databases EBSCOhost, Scopus, ACM, Nature, SpringerLink, IEEE Xplore, MDPI, Google Scholar, and PubMed for publications that included personal coaching (from 2000 to 2019) and persuasive eCoaching as behavioral interventions for a healthy lifestyle (from 2014 to 2019). The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework was used for the evidence-based systematic review and meta-analysis. Results: The systematic search resulted in 79 publications, including 72 papers and seven books. Of these, 53 were related to behavioral interventions by eCoaching and the remaining 26 were related to human coaching. The most utilized persuasive eCoaching methods were personalization (n=19), interaction and cocreation (n=17), technology adoption for behavior change (n= 17), goal setting and evaluation (n=16), persuasion (n=15), automation (n=14), and lifestyle change (n=14). The most relevant methods for human coaching were behavior (n=23), methodology (n=10), psychology (n=9), and mentoring (n=6). Here, “n” signifies the total number of articles where the respective method was identified. In this study, we focused on different coaching methods to understand the psychology, behavioral science, coaching philosophy, and essential coaching processes for effective coaching. We have discussed how we can integrate the obtained knowledge into the eCoaching process for healthy lifestyle management using ICT. We identified that knowledge, coaching skills, observation, interaction, ethics, trust, efficacy study, coaching experience, pragmatism, intervention, goal setting, and evaluation of coaching processes are relevant for eCoaching. Conclusions: This systematic literature review selected processes, associated methods, strengths, and limitations for behavioral interventions from established coaching models. The identified methods of coaching point toward integrating human psychology in eCoaching to develop effective intervention plans for healthy lifestyle management and overcome the existing limitations of human coaching. %M 33759793 %R 10.2196/23533 %U https://www.jmir.org/2021/3/e23533 %U https://doi.org/10.2196/23533 %U http://www.ncbi.nlm.nih.gov/pubmed/33759793 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e21128 %T Challenges of and Solutions for Developing Tailored Video Interventions That Integrate Multiple Digital Assets to Promote Engagement and Improve Health Outcomes: Tutorial %A Harshbarger,Camilla %A Burrus,Olivia %A Rangarajan,Sivakumar %A Bollenbacher,John %A Zulkiewicz,Brittany %A Verma,Rohit %A Galindo,Carla A %A Lewis,Megan A %+ Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, MS8-5, Atlanta, GA, United States, 1 404 639 4267, uzz9@cdc.gov %K HIV video intervention %K patient-provider communication %K ART adherence %K digital interventions %K mobile interventions %K computer based interventions %K interactive technologies %D 2021 %7 23.3.2021 %9 Tutorial %J JMIR Mhealth Uhealth %G English %X Background: Video is a versatile and popular medium for digital health interventions. As mobile device and app technology advances, it is likely that video-based interventions will become increasingly common. Although clinic waiting rooms are complex and busy environments, they offer the opportunity to facilitate engagement with video-based digital interventions as patients wait to see their providers. However, to increase efficiency in public health, leverage the scalability and low cost of implementing digital interventions, and keep up with rapidly advancing technology and user needs, more design and development guidance is needed for video-based tailored interventions. Objective: We provide a tutorial for digital intervention researchers and developers to efficiently design and develop video-based tailored digital health interventions. We describe the challenges and solutions encountered with Positive Health Check (PHC), a hybrid app used to deliver a brief, interactive, individually tailored video-based HIV behavioral counseling intervention. PHC uses video clips and multimedia digital assets to deliver intervention content, including interactive tailored messages and graphics, a repurposed animated video, and patient and provider handouts generated in real time by PHC. Methods: We chronicle multiple challenges and solutions for the following: (1) using video as a medium to enhance user engagement, (2) navigating the complexity of linking a database of video clips with other digital assets, and (3) identifying the main steps involved in building an app that will seamlessly deliver to users individually tailored messages, graphics, and handouts. Results: We leveraged video to enhance user engagement by featuring “video doctors,” full-screen video, storyboards, and streamlined scripts. We developed an approach to link the database of video clips with other digital assets through script coding and flow diagrams of algorithms to deliver a tailored user experience. We identified the steps to app development by using keyframes to design the integration of video and digital assets, using agile development methods to gather iterative feedback from multidisciplinary teams, and creating an intelligent data-driven back-end solution to tailor message delivery to individual users. Conclusions: Video-based digital health interventions will continue to play an important role in the future of HIV prevention and treatment, as well as other clinical health practices. However, facilitating the adoption of an HIV video intervention in HIV clinical settings is a work in progress. Our experience in designing and developing PHC presented unique challenges due to the extensive use of a large database of videos tailored individually to each user. Although PHC focuses on promoting the health and well-being of persons with HIV, the challenges and solutions presented in this tutorial are transferable to the design and development of video-based digital health interventions focused on other areas of health. %M 33755025 %R 10.2196/21128 %U https://mhealth.jmir.org/2021/3/e21128 %U https://doi.org/10.2196/21128 %U http://www.ncbi.nlm.nih.gov/pubmed/33755025 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e22498 %T Gender Differences in Adolescent Sleep Disturbance and Treatment Response to Smartphone App–Delivered Cognitive Behavioral Therapy for Insomnia: Exploratory Study %A Li,Sophie H %A Graham,Bronwyn M %A Werner-Seidler,Aliza %+ Black Dog Institute, University of New South Wales, Hospital Road, Randwick, 2031, Australia, 61 2 9382 4530, s.h.li@blackdog.org.au %K insomnia %K gender differences %K adolescents %K sleep disturbance %K sleep quality %K sleep %K gender %K digital interventions %D 2021 %7 23.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Insomnia and sleep disturbance are pervasive and debilitating conditions affecting up to 40% of adolescents. Women and girls are at greater risk of insomnia, yet differences in treatment responsiveness between genders have not been adequately investigated. Additionally, while women report greater symptom severity and burden of illness than men, this discrepancy requires further examination in adolescents. Objective: The purpose of this study was to examine gender differences in sleep symptom profiles and treatment response in adolescents. Methods: Digital cognitive behavioral therapy for insomnia (CBT-I) treatment responsiveness, as indexed by changes in Insomnia Severity Index (ISI) and Global Pittsburgh Sleep Quality Index (PSQI) scores, was compared in boys and girls (aged 12-16 years; N=49) who participated in a pilot evaluation of the Sleep Ninja smartphone app. Gender differences in self-reported baseline insomnia symptom severity (ISI), sleep quality (PSQI), and sleep characteristics derived from sleep diaries were also examined. Results: Compared with boys, we found that girls reported greater symptom severity (P=.04) and nighttime wakefulness (P=.01 and P=.04) and reduced sleep duration (P=.02) and efficiency (P=.03), but not poorer sleep quality (P=.07), more nighttime awakenings (P=.16), or longer time to get to sleep (P=.21). However, gender differences in symptom severity and sleep duration were accounted for by boys being marginally younger in age. Treatment response to CBT-I was equivalent between boys and girls when comparing reductions in symptom severity (P=.32); there was a trend showing gender differences in improvements in sleep quality, but this was not statistically significant (P=.07). Conclusions: These results demonstrate the presence of gender differences in insomnia symptoms and severity in adolescents and suggest further research is required to understand gender differences in insomnia symptom profiles to inform the development of gender-specific digital interventions delivered to adolescents. %M 33755029 %R 10.2196/22498 %U https://formative.jmir.org/2021/3/e22498 %U https://doi.org/10.2196/22498 %U http://www.ncbi.nlm.nih.gov/pubmed/33755029 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e28314 %T A Smartphone App for Engaging Patients With Catheter-Associated Urinary Tract Infections: Protocol for an Interrupted Time-Series Analysis %A Bentvelsen,Robbert Gerard %A Veldkamp,Karin Ellen %A Chavannes,Niels H %+ Department of Medical Microbiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands, 31 7152 61652, rbentvelsen@gmail.com %K catheter-associated urinary tract infections %K infection control %K patient empowerment %K urinary catheter %K eHealth %D 2021 %7 23.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Catheter-associated urinary tract infections (CAUTIs) are the main cause of health care–associated infections, and they increase the disease burden, antibiotic usage, and hospital stay. Inappropriate placement and unnecessarily prolonged usage of a catheter lead to an elevated and preventable risk of infection. The smartphone app Participatient has been developed to involve hospitalized patients in communication and decision-making related to catheter use and to control unnecessary (long-term) catheter use to prevent CAUTIs. Sustained behavioral changes for infection prevention can be promoted by empowering patients through Participatient. Objective: The primary aim of our multicenter prospective interrupted time-series analysis is to reduce inappropriate catheter usage by 15%. We will evaluate the efficacy of Participatient in this quality improvement study in clinical wards. Our secondary endpoints are to reduce CAUTIs and to increase patient satisfaction, involvement, and trust with health care services. Methods: We will conduct a multicenter interrupted time-series analysis—a strong study design when randomization is not feasible—consisting of a pre- and postintervention point-prevalence survey distributed among participating wards to investigate the efficacy of Participatient in reducing the inappropriate usage of catheters. After customizing Participatient to the wards’ requirements, it will be implemented with a catheter indication checklist among clinical wards in 4 large hospitals in the Netherlands. We will collect clinical data every 2 weeks for 6 months in the pre- and postintervention periods. Simultaneously, we will assess the impact of Participatient on patient satisfaction with health care services and providers and the patients’ perceived involvement in health care through questionnaires, and the barriers and facilitators of eHealth implementation through interviews with health care workers. Results: To reduce the inappropriate use of approximately 40% of catheters (currently in use) by 15%, we aim to collect 9-12 data points from 70-100 patients per survey date per hospital. Thereafter, we will conduct an interrupted time-series analysis and present the difference between the unadjusted and adjusted rate ratios with a corresponding 95% CI. Differences will be considered significant when P<.05. Conclusions: Our protocol may help reduce the inappropriate use of catheters and subsequent CAUTIs. By sharing reliable information and daily checklists with hospitalized patients via an app, we aim to provide them a tool to be involved in health care–related decision-making and to increase the quality of care. Trial Registration: Netherlands Trial Register NL7178; https://www.trialregister.nl/trial/7178 International Registered Report Identifier (IRRID): DERR1-10.2196/28314 %M 33755026 %R 10.2196/28314 %U https://www.researchprotocols.org/2021/3/e28314 %U https://doi.org/10.2196/28314 %U http://www.ncbi.nlm.nih.gov/pubmed/33755026 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e25838 %T Effects of a School-Based Physical Activity Intervention for Obesity and Health-Related Physical Fitness in Adolescents With Intellectual Disability: Protocol for a Randomized Controlled Trial %A Wang,Aiwei %A Gao,Yang %A Wang,Jingjing %A Tong,Tomas K %A Sun,Yan %A Yu,Siyue %A Zhao,Hong %A Zou,Daozhi %A Zhang,Ziheng %A Qi,Yuling %A Zuo,Nan %A Bu,Danran %A Zhang,Dexing %A Xie,Yaojie %A Baker,Julien S %+ Department of Sport, Physical Education and Health, Hong Kong Baptist University, AAB 927 Academic and Administration Building, 15 Baptist University Road, Hong Kong, China, 852 34113082, gaoyang@hkbu.edu.hk %K children %K intellectual disability %K physical activity %K overweight %K obesity %K intervention %D 2021 %7 22.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Childhood obesity accompanied by lower levels of health-related physical fitness (HRPF) is a major threat to public health both internationally and locally. Children with intellectual disability, especially adolescents, have a higher risk of being overweight/obese and having poor HRPF levels. Therefore, more interventions are needed to help this population attain their optimal health levels. However, there has been relatively limited research on this population compared with on their typically developing peers. Objective: The proposed study aims to fill this knowledge gap by developing and examining the success of a physical activity (PA) intervention for the target population. Methods: The proposed study will be a 12-week, school-based randomized controlled trial. The participants (N=48) will be recruited from special schools for students with mild intellectual disability and then randomly allocated to either the intervention group (IG) or the wait-list control group (CG). During the intervention period, the participants in the IG will receive a fun game–based moderate-to-vigorous PA (MVPA) training program (2 sessions/week, 60 minutes/session, for a total of 24 sessions). The intensity of the activities will increase in a progressive manner. Participants in the CG will receive no program during the study period, but the same PA program will be provided to them after the completion of the study. To observe and evaluate the sustaining effects of the intervention, follow-up testing will be scheduled for the participants 12 weeks after the intervention concludes. The study outcomes will include primary outcomes (obesity- and fitness-related outcomes) and a secondary outcome (blood pressure). All of the measurements will be taken at 3 time points. After the follow-up tests, the same PA training program will be provided to the participants in the CG. Results: This study is ongoing. The participants were recruited from October 2020 to November 2020. The total duration of the study is 13 months. Study results are expected at the end of 2021. Conclusions: The proposed study is expected to reduce obesity and improve HRPF levels in children with intellectual disability. If proven effective, the intervention will be made accessible to more special schools and mainstream schools with students with intellectual disability. Furthermore, the study can serve as an example for international researchers, policy makers, and members of the public who are seeking to tackle the problem of obesity and poor HRPF among children with intellectual disability. Trial Registration: ClinicalTrials.gov NCT04554355; https://www.clinicaltrials.gov/ct2/show/NCT04554355 International Registered Report Identifier (IRRID): PRR1-10.2196/25838 %M 33749611 %R 10.2196/25838 %U https://www.researchprotocols.org/2021/3/e25838 %U https://doi.org/10.2196/25838 %U http://www.ncbi.nlm.nih.gov/pubmed/33749611 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 1 %P e23927 %T Use of mHealth to Increase Physical Activity Among Breast Cancer Survivors With Fatigue: Qualitative Exploration %A Martin,Elise %A Di Meglio,Antonio %A Charles,Cecile %A Ferreira,Arlindo %A Gbenou,Arnauld %A Blond,Marine %A Fagnou,Benoit %A Arvis,Johanna %A Pistilli,Barbara %A Saghatchian,Mahasti %A Vaz Luis,Ines %+ Institute Gustave Roussy, 114 rue Edouard Vaillant, Villejuif, , France, 33 078 740 9282, INES-MARIA.VAZ-DUARTE-LUIS@gustaveroussy.fr %K mHealth %K physical activity %K breast cancer %K cancer-related fatigue %K qualitative study %K survivorship %D 2021 %7 22.3.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Physical activity has shown beneficial effects in the treatment of breast cancer fatigue; nevertheless, a significant portion of patients remain insufficiently physically active after breast cancer. Currently most patients have a smartphone, and therefore mobile health (mHealth) holds the promise of promoting health behavior uptake for many of them. Objective: In this study, we explored representations, levers, and barriers to physical activity and mHealth interventions among inactive breast cancer patients with fatigue. Methods: This was an exploratory, qualitative study including breast cancer patients from a French cancer center. A total of 4 focus groups were conducted with 9 patients; 2 independent groups of patients (groups A and B) were interviewed at 2 consecutive times (sessions 1 to 4), before and after their participation in a 2-week mHealth group experience consisting of (1) a competitive virtual exercise group activity (a fictitious world tour), (2) participation in a daily chat network, and (3) access to physical activity information and world tour classification feedback. We used a thematic content analysis. Results: Several physical activity levers emerged including (1) physical factors such as perception of physical benefit and previous practice, (2) psychological factors such as motivation increased by provider recommendations, (3) social factors such as group practice, and (4) organizational factors including preplanning physical activity sessions. The main barriers to physical activity identified included late effects of cancer treatment, lack of motivation, and lack of time. The lack of familiarity with connected devices was perceived as the main barrier to the use of mHealth as a means to promote physical activity. The tested mHealth group challenge was associated with several positive representations including well-being and good habit promotion and being a motivational catalyzer. Following feedback, modifications were implemented into the mHealth challenge. Conclusions: mHealth-based, easily accessed group challenges were perceived as levers for the practice of physical activity in this population. mHealth-based group challenges should be explored as options to promote physical activity in a population with fatigue after breast cancer. %M 33749606 %R 10.2196/23927 %U https://cancer.jmir.org/2021/1/e23927 %U https://doi.org/10.2196/23927 %U http://www.ncbi.nlm.nih.gov/pubmed/33749606 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e24465 %T Predicting Emotional States Using Behavioral Markers Derived From Passively Sensed Data: Data-Driven Machine Learning Approach %A Sükei,Emese %A Norbury,Agnes %A Perez-Rodriguez,M Mercedes %A Olmos,Pablo M %A Artés,Antonio %+ Signal Theory and Communications Department, Universidad Carlos III de Madrid, Torres Quevedo Bldg, Av de la Universidad, 30, Leganés, 28911, Spain, 34 916248839, esukei@tsc.uc3m.es %K mental health %K affect %K mobile health %K mobile phone %K digital phenotype %K machine learning %K Bayesian analysis %K probabilistic models %K personalized models %D 2021 %7 22.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental health disorders affect multiple aspects of patients’ lives, including mood, cognition, and behavior. eHealth and mobile health (mHealth) technologies enable rich sets of information to be collected noninvasively, representing a promising opportunity to construct behavioral markers of mental health. Combining such data with self-reported information about psychological symptoms may provide a more comprehensive and contextualized view of a patient’s mental state than questionnaire data alone. However, mobile sensed data are usually noisy and incomplete, with significant amounts of missing observations. Therefore, recognizing the clinical potential of mHealth tools depends critically on developing methods to cope with such data issues. Objective: This study aims to present a machine learning–based approach for emotional state prediction that uses passively collected data from mobile phones and wearable devices and self-reported emotions. The proposed methods must cope with high-dimensional and heterogeneous time-series data with a large percentage of missing observations. Methods: Passively sensed behavior and self-reported emotional state data from a cohort of 943 individuals (outpatients recruited from community clinics) were available for analysis. All patients had at least 30 days’ worth of naturally occurring behavior observations, including information about physical activity, geolocation, sleep, and smartphone app use. These regularly sampled but frequently missing and heterogeneous time series were analyzed with the following probabilistic latent variable models for data averaging and feature extraction: mixture model (MM) and hidden Markov model (HMM). The extracted features were then combined with a classifier to predict emotional state. A variety of classical machine learning methods and recurrent neural networks were compared. Finally, a personalized Bayesian model was proposed to improve performance by considering the individual differences in the data and applying a different classifier bias term for each patient. Results: Probabilistic generative models proved to be good preprocessing and feature extractor tools for data with large percentages of missing observations. Models that took into account the posterior probabilities of the MM and HMM latent states outperformed those that did not by more than 20%, suggesting that the underlying behavioral patterns identified were meaningful for individuals’ overall emotional state. The best performing generalized models achieved a 0.81 area under the curve of the receiver operating characteristic and 0.71 area under the precision-recall curve when predicting self-reported emotional valence from behavior in held-out test data. Moreover, the proposed personalized models demonstrated that accounting for individual differences through a simple hierarchical model can substantially improve emotional state prediction performance without relying on previous days’ data. Conclusions: These findings demonstrate the feasibility of designing machine learning models for predicting emotional states from mobile sensing data capable of dealing with heterogeneous data with large numbers of missing observations. Such models may represent valuable tools for clinicians to monitor patients’ mood states. %M 33749612 %R 10.2196/24465 %U https://mhealth.jmir.org/2021/3/e24465 %U https://doi.org/10.2196/24465 %U http://www.ncbi.nlm.nih.gov/pubmed/33749612 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e25309 %T Remote and Long-Term Self-Monitoring of Electroencephalographic and Noninvasive Measurable Variables at Home in Patients With Epilepsy (EEG@HOME): Protocol for an Observational Study %A Biondi,Andrea %A Laiou,Petroula %A Bruno,Elisa %A Viana,Pedro F %A Schreuder,Martijn %A Hart,William %A Nurse,Ewan %A Pal,Deb K %A Richardson,Mark P %+ Institute of Psychiatry, Psychology & Neuroscience, King's College London, 5 Cutcombe Rd, London, SE5 9RT, United Kingdom, 44 7753986485, andrea.2.biondi@kcl.ac.uk %K epilepsy %K EEG %K electroencephalography %K brain ictogenicity %K wearables %K seizure prediction %K brain %K seizures %K mobile technology %D 2021 %7 19.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Epileptic seizures are spontaneous events that severely affect the lives of patients due to their recurrence and unpredictability. The integration of new wearable and mobile technologies to collect electroencephalographic (EEG) and extracerebral signals in a portable system might be the solution to prospectively identify times of seizure occurrence or propensity. The performances of several seizure detection devices have been assessed by validated studies, and patient perspectives on wearables have been explored to better match their needs. Despite this, there is a major gap in the literature on long-term, real-life acceptability and performance of mobile technology essential to managing chronic disorders such as epilepsy. Objective: EEG@HOME is an observational, nonrandomized, noninterventional study that aims to develop a new feasible procedure that allows people with epilepsy to independently, continuously, and safely acquire noninvasive variables at home. The data collected will be analyzed to develop a general model to predict periods of increased seizure risk. Methods: A total of 12 adults with a diagnosis of pharmaco-resistant epilepsy and at least 20 seizures per year will be recruited at King’s College Hospital, London. Participants will be asked to self-apply an easy and portable EEG recording system (ANT Neuro) to record scalp EEG at home twice daily. From each serial EEG recording, brain network ictogenicity (BNI), a new biomarker of the propensity of the brain to develop seizures, will be extracted. A noninvasive wrist-worn device (Fitbit Charge 3; Fitbit Inc) will be used to collect non-EEG biosignals (heart rate, sleep quality index, and steps), and a smartphone app (Seer app; Seer Medical) will be used to collect data related to seizure occurrence, medication taken, sleep quality, stress, and mood. All data will be collected continuously for 6 months. Standardized questionnaires (the Post-Study System Usability Questionnaire and System Usability Scale) will be completed to assess the acceptability and feasibility of the procedure. BNI, continuous wrist-worn sensor biosignals, and electronic survey data will be correlated with seizure occurrence as reported in the diary to investigate their potential values as biomarkers of seizure risk. Results: The EEG@HOME project received funding from Epilepsy Research UK in 2018 and was approved by the Bromley Research Ethics Committee in March 2020. The first participants were enrolled in October 2020, and we expect to publish the first results by the end of 2022. Conclusions: With the EEG@HOME study, we aim to take advantage of new advances in remote monitoring technology, including self-applied EEG, to investigate the feasibility of long-term disease self-monitoring. Further, we hope our study will bring new insights into noninvasively collected personalized risk factors of seizure occurrence and seizure propensity that may help to mitigate one of the most difficult aspects of refractory epilepsy: the unpredictability of seizure occurrence. International Registered Report Identifier (IRRID): PRR1-10.2196/25309 %M 33739290 %R 10.2196/25309 %U https://www.researchprotocols.org/2021/3/e25309 %U https://doi.org/10.2196/25309 %U http://www.ncbi.nlm.nih.gov/pubmed/33739290 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e21116 %T Intermittent Versus Continuous Low-Energy Diet in Patients With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial %A McDiarmid,Sarah %A Harvie,Michelle %A Johnson,Rhona %A Vyas,Avni %A Aglan,Azza %A Moran,Jacqui %A Ruane,Helen %A Hulme,Amanda %A Sellers,Katharine %A Issa,Basil %+ The Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe Hospital, Manchester, M23 9LT, United Kingdom, 44 1612914412, sarah.mcdiarmid@mft.nhs.uk %K type 2 diabetes %K diabetes %K diabetic diet %K low-energy diet %K low calorie diet %K intermittent energy restriction %K intermittent fasting %K diabetes remission %K smartphone %K mobile phone %K mHealth %K mobile health %D 2021 %7 19.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Intensive face-to-face weight loss programs using continuous low-energy diets (CLEDs) providing approximately 800 kcal per day (3347 kJ per day) can produce significant weight loss and remission from type 2 diabetes (T2D). Intermittent low-energy diets (ILEDs) and remotely delivered programs could be viable alternatives that may support patient choice and adherence. Objective: This paper describes the protocol of a pilot randomized controlled trial to test the feasibility and potential efficacy of remotely supported isocaloric ILED and CLED programs among patients with overweight and obesity and T2D. Methods: A total of 79 participants were recruited from primary care, two National Health Service hospital trusts, and a voluntary T2D research register in the United Kingdom. The participants were randomized to a remotely delivered ILED (n=39) or CLED (n=40). The active weight loss phase of CLED involved 8 weeks of Optifast 820 kcal/3430 kJ formula diet, followed by 4 weeks of food reintroduction. The active weight loss phase of ILED (n=39) comprised 2 days of Optifast 820 kcal/3430 kJ diet and 5 days of a portion-controlled Mediterranean diet for 28 weeks. Both groups were asked to complete 56 Optifast 820 kcal/3430 kJ days during their active weight loss phase with an equivalent energy deficit. The diets were isocaloric for the remainder of the 12 months. CLED participants were asked to follow a portion-controlled Mediterranean diet 7 days per week. ILED followed 1-2 days per week of a food-based 820 kcal/3430 kJ diet and a portion-controlled Mediterranean diet for 5-6 days per week. Participants received high-frequency (weekly, fortnightly, or monthly depending on the stage of the trial) multidisciplinary remote support from a dietitian, nurse, exercise specialist, and psychologist via telephone or the Oviva smartphone app. The primary outcomes of the study were uptake, weight loss, and changes in glycated hemoglobin at 12 months. An outcome assessment of trial retention was retrospectively added. Secondary outcomes included an assessment of adherence and adverse events. A qualitative evaluation was undertaken via interviews with participants and health care professionals who delivered the intervention. Results: A total of 79 overweight or obese participants aged 18-75 years and diagnosed with T2D in the last 8 years were recruited to the Manchester Intermittent and Daily Diet Diabetes App Study (MIDDAS). Recruitment began in February 2018, and data collection was completed in February 2020. Data analysis began in June 2020, and the first results are expected to be submitted for publication in 2021. Conclusions: The outcomes of the MIDDAS study will inform the feasibility of remotely delivered ILED and CLED programs in clinical practice and the requirement for a larger-scale randomized controlled trial. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 15394285; http://www.isrctn.com/ISRCTN15394285 International Registered Report Identifier (IRRID): DERR1-10.2196/21116 %M 33739297 %R 10.2196/21116 %U https://www.researchprotocols.org/2021/3/e21116 %U https://doi.org/10.2196/21116 %U http://www.ncbi.nlm.nih.gov/pubmed/33739297 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e24667 %T A Mobile Patient-Facing App for Tracking Patient-Reported Outcomes in Head and Neck Cancer Survivors: Single-Arm Feasibility Study %A Teckie,Sewit %A Solomon,Jeffrey %A Kadapa,Karthik %A Sanchez,Keisy %A Orner,David %A Kraus,Dennis %A Kamdar,Dev P %A Pereira,Lucio %A Frank,Douglas %A Diefenbach,Michael %+ Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 130 East 77th Street, New York, NY, 10010, United States, 1 212 434 2919, steckie@northwell.edu %K mHealth %K ePROs %K head and neck cancer %K mobile phone %D 2021 %7 19.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with head and neck cancer (HNC) frequently experience disease-related symptoms and treatment adverse effects that impact their overall quality of life. Cancer-specific mobile health apps for patient-related outcomes allow patients to communicate with their clinicians and proactively track their symptoms, which have been shown to improve clinical management and disease outcomes. Objective: The purpose of this study was to evaluate the feasibility of LogPAL, a novel iPhone-based mobile health app designed to help HNC survivors track and manage their posttreatment symptoms. Methods: Patients who completed curative treatment for HNC in the preceding 24 months were recruited from 2 clinical sites within a single institution. Upon enrollment, participants completed a brief sociodemographic survey, downloaded the app onto their iPhone devices, and were asked to complete a series of biweekly questionnaires (based on the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events) via the app for an 8-week study period. The primary feasibility endpoints included retention (retaining >80% of the enrolled participants for the duration of the study period), adherence (>50% of the participants completing 100% of the questionnaires over the study period), and usability (a mean system usability scale [SUS] score >68). Additional postintervention questions were collected to assess perceived usefulness, acceptance, and overall satisfaction. Results: Between January and October 2019, 38 participants were enrolled in the study. Three participants dropped out, and 3 were classified as nonusers. The remaining 32 (87%) were eligible for analysis. Their mean age was 57.8 (SD 12.3) years (range 24-77 years, 81% [26/32] male). Overall, 375 of 512 (73.2%) questionnaires were completed, with 17 (53%) of the 32 participants adherent. Participant-reported usability was acceptable; the mean SUS score was 71.9 (95% CI 64.3-79.5) with high satisfaction of LogPAL usefulness and likelihood to recommend to other cancer survivors. Conclusions: This single-arm prospective pilot study showed that LogPAL is a feasible, regularly used, accepted app for HNC survivors, justifying a full-scale pilot. Based on the findings from this study, future iterations will aim to improve usability and test intervention efficacy. %M 33739291 %R 10.2196/24667 %U https://formative.jmir.org/2021/3/e24667 %U https://doi.org/10.2196/24667 %U http://www.ncbi.nlm.nih.gov/pubmed/33739291 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e24799 %T Internet-Based Individualized Cognitive Behavioral Therapy for Shift Work Sleep Disorder Empowered by Well-Being Prediction: Protocol for a Pilot Study %A Ito-Masui,Asami %A Kawamoto,Eiji %A Sakamoto,Ryota %A Yu,Han %A Sano,Akane %A Motomura,Eishi %A Tanii,Hisashi %A Sakano,Shoko %A Esumi,Ryo %A Imai,Hiroshi %A Shimaoka,Motomu %+ Departments of Molecular and Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan, 81 59 232 5036, a_2.uk@mac.com %K shift work sleep disorders %K health care workers %K wearable sensors %K shift work %K sleep disorder %K medical safety %K safety issue %K shift workers %K sleep %K safety %K cognitive behavioral therapy %K CBT %K online intervention %K pilot study %K machine learning %K well-being %D 2021 %7 18.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Shift work sleep disorders (SWSDs) are associated with the high turnover rates of nurses, and are considered a major medical safety issue. However, initial management can be hampered by insufficient awareness. In recent years, it has become possible to visualize, collect, and analyze the work-life balance of health care workers with irregular sleeping and working habits using wearable sensors that can continuously monitor biometric data under real-life settings. In addition, internet-based cognitive behavioral therapy for psychiatric disorders has been shown to be effective. Application of wearable sensors and machine learning may potentially enhance the beneficial effects of internet-based cognitive behavioral therapy. Objective: In this study, we aim to develop and evaluate the effect of a new internet-based cognitive behavioral therapy for SWSD (iCBTS). This system includes current methods such as medical sleep advice, as well as machine learning well-being prediction to improve the sleep durations of shift workers and prevent declines in their well-being. Methods: This study consists of two phases: (1) preliminary data collection and machine learning for well-being prediction; (2) intervention and evaluation of iCBTS for SWSD. Shift workers in the intensive care unit at Mie University Hospital will wear a wearable sensor that collects biometric data and answer daily questionnaires regarding their well-being. They will subsequently be provided with an iCBTS app for 4 weeks. Sleep and well-being measurements between baseline and the intervention period will be compared. Results: Recruitment for phase 1 ended in October 2019. Recruitment for phase 2 has started in October 2020. Preliminary results are expected to be available by summer 2021. Conclusions: iCBTS empowered with well-being prediction is expected to improve the sleep durations of shift workers, thereby enhancing their overall well-being. Findings of this study will reveal the potential of this system for improving sleep disorders among shift workers. Trial Registration: UMIN Clinical Trials Registry UMIN000036122 (phase 1), UMIN000040547 (phase 2); https://tinyurl.com/dkfmmmje, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046284 International Registered Report Identifier (IRRID): DERR1-10.2196/24799 %M 33626497 %R 10.2196/24799 %U https://www.researchprotocols.org/2021/3/e24799 %U https://doi.org/10.2196/24799 %U http://www.ncbi.nlm.nih.gov/pubmed/33626497 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e24726 %T eHealth Program to Reduce Hospitalizations Due to Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Retrospective Study %A van Buul,Amanda R %A Derksen,Caroline %A Hoedemaker,Ouke %A van Dijk,Oscar %A Chavannes,Niels H %A Kasteleyn,Marise J %+ Department of Pulmonology, Leiden University Medical Center, Leiden, Netherlands, 31 715297550, a.r.van_buul@lumc.nl %K COPD %K eHealth %K exacerbations %K hospitalizations %K mHealth %D 2021 %7 18.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Hospitalization for acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with poor prognosis. eHealth interventions might improve outcomes and decrease costs. Objective: This study aimed to evaluate the effect of an eHealth program on COPD hospitalizations and exacerbations. Methods: This was a real-world study conducted from April 2018 to December 2019 in the Bravis Hospital, the Netherlands. An eHealth program (EmmaCOPD) was offered to COPD patients at risk of exacerbations. EmmaCOPD consisted of an app that used questionnaires (to monitor symptoms) and a step counter (to monitor the number of steps) to detect exacerbations. Patients and their buddies received feedback when their symptoms worsened or the number of steps declined. Generalized estimating equations were used to compare the number of days admitted to the hospital and the total number of exacerbations 12 months before and (max) 18 months after the start of EmmaCOPD. We additionally adjusted for the potential confounders of age, sex, COPD severity, and inhaled corticosteroid use. Results: The 29 included patients had a mean forced expiratory volume in 1 second of 45.5 (SD 17.7) %predicted. In the year before the intervention, the median total number of exacerbations was 2.0 (IQR 2.0-3.0). The median number of hospitalized days was 8.0 days (IQR 6.0-16.5 days). Afterwards, there was a median 1.0 (IQR 0.0-2.0) exacerbation and 2.0 days (IQR 0.0-4.0 days) of hospitalization. After initiation of EmmaCOPD, both the number of hospitalized days and total number of exacerbations decreased significantly (incidence rate ratio 0.209, 95% CI 0.116-0.382; incidence rate ratio 0.310, 95% CI 0.219-0.438). Adjustment for confounders did not affect the results. Conclusions: The eHealth program seems to reduce the number of total exacerbations and number of days of hospitalization due to exacerbations of COPD. %M 33734091 %R 10.2196/24726 %U https://formative.jmir.org/2021/3/e24726 %U https://doi.org/10.2196/24726 %U http://www.ncbi.nlm.nih.gov/pubmed/33734091 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e24755 %T Intention to Adopt mHealth Apps Among Informal Caregivers: Cross-Sectional Study %A Ghahramani,Fereshteh %A Wang,Jingguo %+ College of Computing and Digital Media, DePaul University, 243 South Wabash Ave, Chicago, IL, 60604, United States, 1 3123628381, fereshteh.ghahramani@depaul.edu %K mobile health %K cross-sectional study %K informal caregivers %K mobile app %K caregiving app %K mobile phone %D 2021 %7 17.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Caregiving responsibility can change caregivers’ lives; modify their emotions; and make them feel frustrated, fearful, and nervous, thereby imposing physical and mental stress. Caregiving-related mobile apps provide a platform for obtaining valuable and trusted information, connecting more easily with other caregivers, monitoring medications, and managing appointments, and assessing health requirements and conditions of care receivers. Such apps also incorporate valuable resources that address care for the caregivers. Despite the potential benefits of caregiving-related apps, only a limited number of caregivers have adopted and used them. Objective: The aim of this study is to explore the important factors that affect caregivers’ intentions to integrate related mobile apps into their routine caregiving responsibilities. Methods: Using the protection motivation theory, we conducted a cross-sectional study among 249 participants. Purposive sampling was used to target participants who met 4 inclusion criteria: US residents, owning and using a smartphone, informal caregivers (individuals who give care to a friend or family member without payment) who provided at least 8 hours of care per week in the past year, and those currently not using any mobile app for caregiving purposes. We created a survey using Qualtrics and posted it on Amazon’s Mechanical Turk website. Participants received monetary compensation after successful completion of the survey. Results: We found that capabilities and skills of caregivers to use mobile apps, the app’s effectiveness in responding to the needs of caregivers, the degree of control of caregivers over their responsibilities, and the decisions they make for their care receivers can predict their willingness to adopt caregiving-related apps. In addition, the severity of health status and vulnerability of care receivers to unexpected health changes indirectly shape their caregivers’ decisions to adopt and use mobile apps for caregiving purposes. Conclusions: This study explores the important factors that affect informal caregivers’ intentions to adopt related mobile apps into their routine caregiving responsibilities. The results contribute to both mobile health adoption and the caregiving literature, and they offer significant implications for developers, health care practitioners, and policy makers. %M 33729166 %R 10.2196/24755 %U https://mhealth.jmir.org/2021/3/e24755 %U https://doi.org/10.2196/24755 %U http://www.ncbi.nlm.nih.gov/pubmed/33729166 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e24738 %T Using a Personal Health Library–Enabled mHealth Recommender System for Self-Management of Diabetes Among Underserved Populations: Use Case for Knowledge Graphs and Linked Data %A Ammar,Nariman %A Bailey,James E %A Davis,Robert L %A Shaban-Nejad,Arash %+ Oak Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, The University of Tennessee Health Science Center, 50 N Dunlap Street, Memphis, TN, 38103, United States, 1 901 287 5863, ashabann@uthsc.edu %K personal health library %K mobile health %K personal health knowledge graph %K patient-centered design %K personalized health %K recommender system %K observations of daily living %K Semantic Web %K privacy %D 2021 %7 16.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Traditionally, digital health data management has been based on electronic health record (EHR) systems and has been handled primarily by centralized health providers. New mechanisms are needed to give patients more control over their digital health data. Personal health libraries (PHLs) provide a single point of secure access to patients' digital health data and enable the integration of knowledge stored in their digital health profiles with other sources of global knowledge. PHLs can help empower caregivers and health care providers to make informed decisions about patients’ health by understanding medical events in the context of their lives. Objective: This paper reports the implementation of a mobile health digital intervention that incorporates both digital health data stored in patients’ PHLs and other sources of contextual knowledge to deliver tailored recommendations for improving self-care behaviors in diabetic adults. Methods: We conducted a thematic assessment of patient functional and nonfunctional requirements that are missing from current EHRs based on evidence from the literature. We used the results to identify the technologies needed to address those requirements. We describe the technological infrastructures used to construct, manage, and integrate the types of knowledge stored in the PHL. We leverage the Social Linked Data (Solid) platform to design a fully decentralized and privacy-aware platform that supports interoperability and care integration. We provided an initial prototype design of a PHL and drafted a use case scenario that involves four actors to demonstrate how the proposed prototype can be used to address user requirements, including the construction and management of the PHL and its utilization for developing a mobile app that queries the knowledge stored and integrated into the PHL in a private and fully decentralized manner to provide better recommendations. Results: To showcase the main features of the mobile health app and the PHL, we mapped those features onto a framework comprising the user requirements identified in a use case scenario that features a preventive intervention from the diabetes self-management domain. Ongoing development of the app requires a formative evaluation study and a clinical trial to assess the impact of the digital intervention on patient-users. We provide synopses of both study protocols. Conclusions: The proposed PHL helps patients and their caregivers take a central role in making decisions regarding their health and equips their health care providers with informatics tools that support the collection and interpretation of the collected knowledge. By exposing the PHL functionality as an open service, we foster the development of third-party applications or services and provide motivational technological support in several projects crossing different domains of interest. %M 33724197 %R 10.2196/24738 %U https://formative.jmir.org/2021/3/e24738 %U https://doi.org/10.2196/24738 %U http://www.ncbi.nlm.nih.gov/pubmed/33724197 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e22147 %T A Smartphone App to Restore Optimal Weight (SPAROW) in Women With Recent Gestational Diabetes Mellitus: Randomized Controlled Trial %A Lim,Karen %A Chan,Shiao-Yng %A Lim,Su Lin %A Tai,Bee Choo %A Tsai,Cammy %A Wong,Su Ren %A Ang,Siew Min %A Yew,Tong Wei %A Tai,E Shyong %A Yong,Eu Leong %+ Department of Obstetrics and Gynecology, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore, 65 81125777, obgyel@nus.edu.sg %K randomized controlled trial %K gestational diabetes mellitus %K prevention %K weight loss %K mobile phone %D 2021 %7 16.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Women with a history of gestational diabetes mellitus (GDM) are at an increased risk of developing type 2 diabetes mellitus (T2DM). Lifestyle interventions aimed at postpartum weight loss to reduce T2DM risk have been reported, but poor compliance remains a barrier. Smartphone-based interventions may improve compliance, but data on its use in women with recent GDM are limited. Objective: This trial aimed to investigate the efficacy of a smartphone app in restoring optimal weight following delivery in women with GDM, in the setting of a population with high rates of GDM and type 2 diabetes. Methods: In this unblinded randomized controlled trial, 200 women with GDM were randomized to receive the intervention or standard care following delivery. The intervention enabled logging of weight, meals, and activity, with web-based interaction with a team comprising dieticians, a physiotherapist, and an occupational therapist. The primary outcome was an achievement of optimal weight (defined as the restoration of first trimester weight if first trimester BMI≤23 kg/m2 or weight loss of at least 5% from first trimester weight if first trimester BMI>23 kg/m2) at 4 months post partum. Secondary outcome measures included absolute weight loss, serum metabolic markers, self-reported nutritional intake, health education, and quality of life via questionnaires and user engagement in the intervention group. Results: In total, 40% (38/96) of women in the intervention group achieved optimal weight at 4 months post delivery compared with 32% (28/93) in the control group (P=.27). Compared with the control group, women in the intervention group reported significantly reduced caloric intake at 4 months after delivery (P<.001) and higher health-directed behavior scores (P=.045). The intervention group also reported increased emotional distress scores (P=.01). At 4 months, participant engagement with the intervention was maintained at 60.8% (SD 33.9%). Conclusions: Although a statistically significant increase in women achieving healthy weight was not observed, this app remains promising, as women in the intervention group reported improved health behaviors and lower caloric intake. Importantly, the high retention rates suggest that a larger study with a longer follow-up period might confirm the effectiveness of this app for weight management. Trial Registration: ClinicalTrials.gov NCT03324737; https://clinicaltrials.gov/ct2/show/NCT03324737 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7691-3 %M 33724204 %R 10.2196/22147 %U https://mhealth.jmir.org/2021/3/e22147 %U https://doi.org/10.2196/22147 %U http://www.ncbi.nlm.nih.gov/pubmed/33724204 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24905 %T Effort-Optimized Intervention Model: Framework for Building and Analyzing Digital Interventions That Require Minimal Effort for Health-Related Gains %A Baumel,Amit %A Muench,Frederick J %+ Partnership to End Addiction, 711 Third Avenue, New York, NY, 10017, United States, 1 9175320623, fmuench@toendaddiction.org %K behavior change %K digital health %K mental health %K addiction %K intervention %K behavioral health %K effort %K salience %K persuasive design %D 2021 %7 12.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X The majority of digital health interventions lean on the promise of bringing health and self-care into people’s homes and hands. However, these interventions are delivered while people are in their triggering environments, which places competing demands on their attention. Individuals struggling to change or learn a new behavior have to work hard to achieve even a minor change because of the automatic forces propelling them back to their habitual behaviors. We posit that effort and burden should be explored at the outset and throughout the digital intervention development process as a core therapeutic mechanism, beyond the context of design or user experience testing. In effort-focused conceptualization, it is assumed that, even though goals are rational and people want to achieve them, they are overtaken by competing cognitive, emotional, and environmental processes. We offer the term effort-optimized intervention to describe interventions that focus on user engagement in the face of competing demands. We describe design components based on a 3-step process for planning an effort-optimized intervention: (1) nurturing effortless cognitive and environmental salience to help people keep effort-related goals prominent despite competition; (2) making it as effortless as possible to complete therapeutic activities to avoid ego depletion and self-efficacy reduction; and (3) turning the necessary effortful activities into sustainable assets. We conclude by presenting an example of designing a digital health intervention based on the effort-optimized intervention model. %M 33709943 %R 10.2196/24905 %U https://www.jmir.org/2021/3/e24905 %U https://doi.org/10.2196/24905 %U http://www.ncbi.nlm.nih.gov/pubmed/33709943 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 3 %P e25542 %T Feasibility and Initial Outcomes of a Group-Based Teletherapy Psychiatric Day Program for Adults With Serious Mental Illness: Open, Nonrandomized Trial in the Context of COVID-19 %A Puspitasari,Ajeng J %A Heredia,Dagoberto %A Coombes,Brandon J %A Geske,Jennifer R %A Gentry,Melanie T %A Moore,Wendy R %A Sawchuk,Craig N %A Schak,Kathryn M %+ Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, 1 507 538 8730, puspitasari.ajeng@mayo.edu %K COVID-19 %K teletherapy %K intensive outpatient %K serious mental illness %K mental health %K therapy %K telemedicine %K telehealth %K feasibility %K outcome %K behavioral science %K pilot %K implementation %K effective %D 2021 %7 11.3.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: In the context of the COVID-19 pandemic, many behavioral health services have transitioned to teletherapy to continue delivering care for patients with mental illness. Studies that evaluate the outcome of this rapid teletherapy adoption and implementation are pertinent. Objective: This single-arm, nonrandomized pilot study aimed to assess the feasibility and initial patient-level outcomes of a psychiatric transitional day program that switched from an in-person group to a video teletherapy group during the COVID-19 pandemic. Methods: Patients with transdiagnostic conditions who were at risk of psychiatric hospitalization were referred to the Adult Transitions Program (ATP) at a large academic medical center in the United States. ATP was a 3-week intensive outpatient program that implemented group teletherapy guided by cognitive and behavioral principles delivered daily for 3 hours per day. Feasibility was assessed via retention, attendance rate, and rate of securing aftercare appointments prior to ATP discharge. Patients completed standardized patient-reported outcome measures at admission and discharge to assess the effectiveness of the program for improving quality of mental health, depression, anxiety, and suicide risk. Results: Patients (N=76) started the program between March and August of 2020. Feasibility was established, with 70 of the 76 patients (92%) completing the program and a mean attendance of 14.43 days (SD 1.22); also, 71 patients (95%) scheduled at least one behavioral health aftercare service prior to ATP discharge. All patient-level reported outcomes demonstrated significant improvements in depression (95% CI –3.6 to –6.2; Cohen d=0.77; P<.001), anxiety (95% CI –3.0 to –4.9; Cohen d=0.74; P<.001), overall suicide risk (95% CI –0.5 to –0.1; Cohen d=0.41; P=.02), wish to live (95% CI 0.3 to 1.0; Cohen d=0.39; P<.001), wish to die (95% CI –0.2 to –1.4; Cohen d=0.52; P=.01), and overall mental health (95% CI 1.5 to 4.5; Cohen d=0.39; P<.001) from admission to discharge. Conclusions: Rapid adoption and implementation of a group-based teletherapy day program for adults at risk of psychiatric hospitalization appeared to be feasible and effective. Patients demonstrated high completion and attendance rates and reported significant improvements in psychosocial outcomes. Larger trials should be conducted to further evaluate the efficacy and effectiveness of the program through randomized controlled trials. %M 33651706 %R 10.2196/25542 %U https://mental.jmir.org/2021/3/e25542 %U https://doi.org/10.2196/25542 %U http://www.ncbi.nlm.nih.gov/pubmed/33651706 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e26091 %T Effectiveness of a Smartphone App to Promote Healthy Weight Gain, Diet, and Physical Activity During Pregnancy (HealthyMoms): Randomized Controlled Trial %A Sandborg,Johanna %A Söderström,Emmie %A Henriksson,Pontus %A Bendtsen,Marcus %A Henström,Maria %A Leppänen,Marja H %A Maddison,Ralph %A Migueles,Jairo H %A Blomberg,Marie %A Löf,Marie %+ Department of Biosciences and Nutrition, Karolinska Institutet, Group/MLÖ, Huddinge, SE-141 83, Sweden, 46 733285912, johanna.sandborg@ki.se %K gestational weight gain %K physical activity %K diet %K pregnancy %K mHealth %K smartphone app %K mobile phone app %K telemedicine %K randomized controlled trial %D 2021 %7 11.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Excessive gestational weight gain (GWG) during pregnancy is a major public health concern associated with negative health outcomes for both mother and child. Scalable interventions are needed, and digital interventions have the potential to reach many women and promote healthy GWG. Most previous studies of digital interventions have been small pilot studies or have not included women from all BMI categories. We therefore examined the effectiveness of a smartphone app in a large sample (n=305) covering all BMI categories. Objective: To investigate the effectiveness of a 6-month intervention (the HealthyMoms app) on GWG, body fatness, dietary habits, moderate-to-vigorous physical activity (MVPA), glycemia, and insulin resistance in comparison to standard maternity care. Methods: A 2-arm parallel randomized controlled trial was conducted. Women in early pregnancy at maternity clinics in Östergötland, Sweden, were recruited. Eligible women who provided written informed consent completed baseline measures, before being randomized in a 1:1 ratio to either an intervention (n=152) or control group (n=153). The control group received standard maternity care while the intervention group received the HealthyMoms smartphone app for 6 months (which includes multiple features, eg, information; push notifications; self-monitoring; and feedback features for GWG, diet, and physical activity) in addition to standard care. Outcome measures were assessed at Linköping University Hospital at baseline (mean 13.9 [SD 0.7] gestational weeks) and follow-up (mean 36.4 [SD 0.4] gestational weeks). The primary outcome was GWG and secondary outcomes were body fatness (Bod Pod), dietary habits (Swedish Healthy Eating Index) using the web-based 3-day dietary record Riksmaten FLEX, MVPA using the ActiGraph wGT3x-BT accelerometer, glycemia, and insulin resistance. Results: Overall, we found no statistically significant effect on GWG (P=.62); however, the data indicate that the effect of the intervention differed by pre-pregnancy BMI, as women with overweight and obesity before pregnancy gained less weight in the intervention group as compared with the control group in the imputed analyses (–1.33 kg; 95% CI –2.92 to 0.26; P=.10) and completers-only analyses (–1.67 kg; 95% CI –3.26 to –0.09; P=.031]). Bayesian analyses showed that there was a 99% probability of any intervention effect on GWG among women with overweight and obesity, and an 81% probability that this effect was over 1 kg. The intervention group had higher scores for the Swedish Healthy Eating Index at follow-up than the control group (0.27; 95% CI 0.05-0.50; P=.017). We observed no statistically significant differences in body fatness, MVPA, glycemia, and insulin resistance between the intervention and control group at follow up (P≥.21). Conclusions: Although we found no overall effect on GWG, our results demonstrate the potential of a smartphone app (HealthyMoms) to promote healthy dietary behaviors as well as to decrease weight gain during pregnancy in women with overweight and obesity. Trial Registration: ClinicalTrials.gov NCT03298555; https://clinicaltrials.gov/ct2/show/NCT03298555 International Registered Report Identifier (IRRID): RR2-10.2196/13011 %M 33704075 %R 10.2196/26091 %U https://mhealth.jmir.org/2021/3/e26091 %U https://doi.org/10.2196/26091 %U http://www.ncbi.nlm.nih.gov/pubmed/33704075 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e23391 %T Measuring Criterion Validity of Microinteraction Ecological Momentary Assessment (Micro-EMA): Exploratory Pilot Study With Physical Activity Measurement %A Ponnada,Aditya %A Thapa-Chhetry,Binod %A Manjourides,Justin %A Intille,Stephen %+ Khoury College of Computer Sciences, Bouve College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, , United States, 1 617 306 1610, ponnada.a@northeastern.edu %K ecological momentary assessment (EMA) %K experience sampling %K physical activity %K smartwatch %K microinteractions %K criterion validity %K activity monitor %K μEMA %D 2021 %7 10.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Ecological momentary assessment (EMA) is an in situ method of gathering self-report on behaviors using mobile devices. In typical phone-based EMAs, participants are prompted repeatedly with multiple-choice questions, often causing participation burden. Alternatively, microinteraction EMA (micro-EMA or μEMA) is a type of EMA where all the self-report prompts are single-question surveys that can be answered using a 1-tap glanceable microinteraction conveniently on a smartwatch. Prior work suggests that μEMA may permit a substantially higher prompting rate than EMA, yielding higher response rates and lower participation burden. This is achieved by ensuring μEMA prompt questions are quick and cognitively simple to answer. However, the validity of participant responses from μEMA self-report has not yet been formally assessed. Objective: In this pilot study, we explored the criterion validity of μEMA self-report on a smartwatch, using physical activity (PA) assessment as an example behavior of interest. Methods: A total of 17 participants answered 72 μEMA prompts each day for 1 week using a custom-built μEMA smartwatch app. At each prompt, they self-reported whether they were doing sedentary, light/standing, moderate/walking, or vigorous activities by tapping on the smartwatch screen. Responses were compared with a research-grade activity monitor worn on the dominant ankle simultaneously (and continuously) measuring PA. Results: Participants had an 87.01% (5226/6006) μEMA completion rate and a 74.00% (5226/7062) compliance rate taking an average of only 5.4 (SD 1.5) seconds to answer a prompt. When comparing μEMA responses with the activity monitor, we observed significantly higher (P<.001) momentary PA levels on the activity monitor when participants self-reported engaging in moderate+vigorous activities compared with sedentary or light/standing activities. The same comparison did not yield any significant differences in momentary PA levels as recorded by the activity monitor when the μEMA responses were randomly generated (ie, simulating careless taps on the smartwatch). Conclusions: For PA measurement, high-frequency μEMA self-report could be used to capture information that appears consistent with that of a research-grade continuous sensor for sedentary, light, and moderate+vigorous activity, suggesting criterion validity. The preliminary results show that participants were not carelessly answering μEMA prompts by randomly tapping on the smartwatch but were reporting their true behavior at that moment. However, more research is needed to examine the criterion validity of μEMA when measuring vigorous activities. %M 33688843 %R 10.2196/23391 %U https://mhealth.jmir.org/2021/3/e23391 %U https://doi.org/10.2196/23391 %U http://www.ncbi.nlm.nih.gov/pubmed/33688843 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e24534 %T The Impact of a Web-Based Mindfulness, Nutrition, and Physical Activity Platform on the Health Status of First-Year University Students: Protocol for a Randomized Controlled Trial %A Trottier,Claire F %A Lieffers,Jessica R L %A Johnson,Steven T %A Mota,João F %A Gill,Roshni K %A Prado,Carla M %+ Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, 2-004 Li Ka Shing Centre for Health and Innovation, 8602 - 112 Street, Edmonton, AB, T6G 2R3, Canada, 1 780 492 7934, cprado@ualberta.ca %K internet-based intervention %K wellness programs %K dietary intake %K physical activity %K mindfulness %K quality of life %K randomized controlled trial %D 2021 %7 10.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: First-year university students are at an increased risk for developing mental health issues and a poor nutritional status. Self-care plays an essential role in optimizing mental health and can prevent or manage stress, anxiety, and depression. Web-based self-monitoring of diet and physical activity can lead to similar or improved health outcomes compared with conventional methods. Such tools are also popular among university students. Objective: The primary aim of this 12-week randomized controlled trial is to assess the impact of a web-based wellness platform on perceived stress among first-year university students. The secondary aim is to assess the effects of the platform on diet quality. The exploratory objectives are to explore the effects of the platform on body composition, health-related quality of life, mindfulness, mental well-being, and physical activity. Methods: A total of 97 first-year undergraduate students were randomized to either the intervention (n=48) or control (n=49) group. The intervention consisted of access to a web-based platform called My Viva Plan (MVP), which aims to support healthy living by focusing on the topics of mindfulness, nutrition, and physical activity. The platform is fully automated and guided by the principles of cognitive behavioral theory. Participants in the intervention group were instructed to use the MVP as frequently as possible over 12 weeks. The control group did not receive access to MVP. Perceived stress was assessed using the Stress Indicators Questionnaire at baseline, week 6, and week 12. Three-day food records were used to analyze the dietary intake at baseline and week 12. Health-related quality of life, mindfulness, mental well-being, and physical activity questionnaires were completed at baseline, week 6, and week 12. Body composition was assessed at baseline and week 12. Study assessments were completed in person at baseline and week 12 and electronically at week 6. Results: Study recruitment started in August 2018, with batch enrollment for students registered in the fall (September 2018 to December 2018) and winter (January 2019 to April 2019) academic terms at the University of Alberta, Edmonton, Alberta. Conclusions: This study is the first to explore the impact of a web-based platform designed to promote health and wellness on perceived stress and diet quality among first-year university students. Trial Registration: ClinicalTrials.gov NCT03579264; https://clinicaltrials.gov/ct2/show/NCT03579264. International Registered Report Identifier (IRRID): DERR1-10.2196/24534 %M 33688844 %R 10.2196/24534 %U https://www.researchprotocols.org/2021/3/e24534 %U https://doi.org/10.2196/24534 %U http://www.ncbi.nlm.nih.gov/pubmed/33688844 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e22771 %T Mobile App-Based Intervention for Pregnant Women With Stress Urinary Incontinence: Protocol for a Hybrid Effectiveness-Implementation Trial %A Li,Tiantian %A Chen,Xiaomin %A Wang,Jia %A Chen,Ling %A Cai,Wenzhi %+ Department of Nursing, Shenzhen Hospital, Southern Medical University, Number 1333, Xinhu Road, Baoán District Shenzhen, Guangdong, Shenzhen, 518101, China, 86 13078484316, caiwzh@smu.edu.cn %K mHealth %K stress urinary incontinence %K pregnancy %K randomized controlled trial %K process evaluation %K mixed methods %K study protocol %D 2021 %7 10.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Stress urinary incontinence (SUI) is a common source of distress among women during and after pregnancy. It has a negative effect on quality of life but with poor care-seeking. Mobile health (mHealth) may be a promising solution with potential advantages. However, there is uncertainty whether a mobile app is effective for SUI symptom improvement during and after pregnancy. The implementation is also unclear. We developed an app named UIW (Urinary Incontinence for Women) aimed at improving perinatal incontinence. Objective: The objective of this study is to evaluate the effectiveness of the UIW app-based intervention in improving SUI symptoms among pregnant women and explore the facilitators and barriers to using the UIW app to help refine and optimize the intervention. Methods: This study is a hybrid effectiveness-implementation trial with a randomized controlled trial alongside a mixed-methods process evaluation according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Pregnant women with SUI (n=336) will be recruited from a university-affiliated hospital in China. They will be randomly allocated (1:1) to either the intervention group that receive usual care plus UIW app or control group that receive usual care alone. The intervention period will last 2 months. The 5 dimensions of the RE-AIM framework will be evaluated at recruitment (-T1), baseline (T0), immediately after intervention (T1), 42 days after delivery (T2), 3 months after delivery (T3), and 6 months after delivery (T4) through project documents, online questionnaires and a pelvic floor muscle training diary, surface electromyography, log data in the background management system, and qualitative interviews. Data analysis will follow the intention-to-treat principle. Descriptive statistics, t tests, chi-square tests, and a linear mixed model will be used to analyze the quantitative data. Deductive and inductive content analysis will be used to analyze the qualitative data. Results: The effectiveness-implementation trial started in June 2020, trial recruitment was completed in October 2020, and the intervention will last for a 2-month period. Completion of the 6-month follow-up will be in July 2021, and we anticipate that the results of this study will be published in December 2021. Conclusions: This study will evaluate both effectiveness and implementation of the UIW app-based intervention among pregnant women. The hybrid effectiveness-implementation trial design according to the RE-AIM framework with a mixed-methods approach will give valuable insights into the effects as well as facilitators and barriers to the implementation that will influence the effects of the UIW app-based intervention. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800016171; http://www.chictr.org.cn/showproj.aspx?proj=27455 International Registered Report Identifier (IRRID): PRR1-10.2196/22771 %M 33688842 %R 10.2196/22771 %U https://www.researchprotocols.org/2021/3/e22771 %U https://doi.org/10.2196/22771 %U http://www.ncbi.nlm.nih.gov/pubmed/33688842 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e17170 %T A Pharmacist and Health Coach–Delivered Mobile Health Intervention for Type 2 Diabetes: Protocol for a Randomized Controlled Crossover Study %A Sharp,Lisa Kay %A Biggers,Alana %A Perez,Rosanne %A Henkins,Julia %A Tilton,Jessica %A Gerber,Ben S %+ Department of Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, 833 S Wood St, Chicago, IL, 60611, United States, 1 3123553569, sharpl@uic.edu %K mHealth %K type 2 diabetes mellitus %K community health workers %K clinical pharmacists %D 2021 %7 10.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Aggressive management of blood glucose, blood pressure, and cholesterol through medication and lifestyle adherence is necessary to minimize the adverse health outcomes of type 2 diabetes. However, numerous psychosocial and environmental barriers to adherence prevent low-income, urban, and ethnic minority populations from achieving their management goals, resulting in diabetes complications. Health coaches working with clinical pharmacists represent a promising strategy for addressing common diabetes management barriers. Mobile health (mHealth) tools may further enhance their ability to support vulnerable minority populations in diabetes management. Objective: The aim of this study is to evaluate the impact of an mHealth clinical pharmacist and health coach–delivered intervention on hemoglobin A1c (HbA1c, primary outcome), blood pressure, and low-density lipoprotein (secondary outcomes) in African-Americans and Latinos with poorly controlled type 2 diabetes. Methods: A 2-year, randomized controlled crossover study will evaluate the effectiveness of an mHealth diabetes intervention delivered by a health coach and clinical pharmacist team compared with usual care. All patients will receive 1 year of team intervention, including lifestyle and medication support delivered in the home with videoconferencing and text messages. All patients will also receive 1 year of usual care without team intervention and no home visits. The order of the conditions received will be randomized. Our recruitment goal is 220 urban African-American or Latino adults with uncontrolled type 2 diabetes (HbA1c ≥8%) receiving care from a largely minority-serving, urban academic medical center. The intervention includes the following: health coaches supporting patients through home visits, phone calls, and text messaging and clinical pharmacists supporting patients through videoconferences facilitated by health coaches. Data collection includes physiologic (HbA1c, blood pressure, weight, and lipid profile) and survey measures (medication adherence, diabetes-related behaviors, and quality of life). Data collection during the second year of study will determine the maintenance of any physiological improvement among participants receiving the intervention during the first year. Results: Participant enrollment began in March 2017. We have recruited 221 patients. Intervention delivery and data collection will continue until November 2021. The results are expected to be published by May 2022. Conclusions: This is among the first trials to incorporate health coaches, clinical pharmacists, and mHealth technologies to increase access to diabetes support among urban African-Americans and Latinos to achieve therapeutic goals. International Registered Report Identifier (IRRID): DERR1-10.2196/17170 %M 33688847 %R 10.2196/17170 %U https://www.researchprotocols.org/2021/3/e17170 %U https://doi.org/10.2196/17170 %U http://www.ncbi.nlm.nih.gov/pubmed/33688847 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e23613 %T Development of a Web-Based Intervention Course to Promote Students’ Well-Being and Studying in Universities: Protocol for an Experimental Study Design %A Asikainen,Henna %A Katajavuori,Nina %+ Faculty of Educational Sciences, University of Helsinki, Viikinkaari 9, PO Box 59, Helsinki, 00014, Finland, 358 445532494, henna.asikainen@helsinki.fi %K approaches to learning %K psychological flexibility %K well-being %K online intervention tool %K peer support %K reflection %D 2021 %7 9.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The decline in the well-being among university students well as increasing dropouts has become a serious issue in universities around the world. Thus, effective ways to support students’ well-being and their ability to study are highly needed. Objective: The purpose of this study was to build an intervention course for university students, which promotes both students’ well-being as well as their learning and study skills, and to describe the experimental study design that explores the effects of this intervention course. Methods: Research has shown that psychological flexibility has a great effect on the well-being as well as the study skills of students pursuing higher education. The basis of our intervention course was to promote psychological flexibility and students’ study skills with the help of peer support and reflection. Results: This course was offered as a voluntary course to all the students at the University of Helsinki twice during the academic year 2020-2021. The first course was from October to December and the second course was from January to March. This course was advertised in fall 2020 through social media and by different student organizations and program leaders at different faculties of the University of Helsinki. As of October 2020, we enrolled 566 students comprising 310 students for the course in fall 2020 and 256 students for the course in spring 2021. Of the 256 students who enrolled in the second course, 170 students voluntarily participated in this study and they answered the questionnaires, including all the measures, simultaneously with the participants in the first group and thus served as the control group. The effect of this course will be measured with multiple data, including questionnaire data, reflective journals, and physiological data of well-being with a longitudinal experimental design. This research very strictly follows the ethical guidelines drawn up by the Finnish National Board on Research Integrity. We expect to publish the results of this study in fall 2021 at the latest. Conclusions: We argue that a web-based, 8-week intervention course, which promotes both student well-being and their study skills, is a good way to support students pursuing higher education, and both aspects should be considered when supporting university students. International Registered Report Identifier (IRRID): DERR1-10.2196/23613 %M 33687336 %R 10.2196/23613 %U https://www.researchprotocols.org/2021/3/e23613 %U https://doi.org/10.2196/23613 %U http://www.ncbi.nlm.nih.gov/pubmed/33687336 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e26159 %T Participants’ Engagement and Satisfaction With a Smartphone App Intended to Support Healthy Weight Gain, Diet, and Physical Activity During Pregnancy: Qualitative Study Within the HealthyMoms Trial %A Sandborg,Johanna %A Henriksson,Pontus %A Larsen,Erica %A Lindqvist,Anna-Karin %A Rutberg,Stina %A Söderström,Emmie %A Maddison,Ralph %A Löf,Marie %+ Department of Biosciences and Nutrition, Karolinska Institutet, Group/MLÖ, Huddinge, SE-141 83, Sweden, 46 733285912, johanna.sandborg@ki.se %K pregnancy %K gestational weight gain %K mHealth %K telemedicine %K digital health %K mobile health %K eHealth %K smartphone intervention %K mobile application %K smartphone application %K engagement %K physical activity %K exercise %K nutrition %K diet %K qualitative %K thematic analysis %D 2021 %7 5.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Excessive gestational weight gain (GWG) is common and associated with negative health outcomes for both mother and child. Mobile health–delivered lifestyle interventions offer the potential to mitigate excessive GWG. The effectiveness of a smartphone app (HealthyMoms) was recently evaluated in a randomized controlled trial. To explore the users’ experiences of using the app, a qualitative study within the HealthyMoms trial was performed. Objective: This qualitative study explored participants’ engagement and satisfaction with the 6-month usage of the HealthyMoms app. Methods: A total of 19 women (mean age: 31.7, SD 4.4 years; mean BMI: 24.6, SD 3.4 kg/m2; university degree attainment: 13/19, 68%; primiparous: 11/19, 58%) who received the HealthyMoms app in a randomized controlled trial completed semistructured exit interviews. The interviews were audiorecorded and fully transcribed, coded, and analyzed using thematic analysis with an inductive approach. Results: Thematic analysis revealed a main theme and 2 subthemes. The main theme, “One could suit many: a multifunctional tool to strengthen women’s health during pregnancy,” and the 2 subthemes, “Factors within and beyond the app influence app engagement” and “Trust, knowledge, and awareness: aspects that can motivate healthy habits,” illustrated that a trustworthy and appreciated health and pregnancy app that is easy to use can inspire a healthy lifestyle during pregnancy. The first subtheme discussed how factors within the app (eg, regular updates and feedback) were perceived to motivate both healthy habits and app engagement. Additionally, factors beyond the app were described to both motivate (eg, interest, motivation, and curiosity) and limit (eg, pregnancy-related complications, lack of time) app engagement. The second subtheme reflected important aspects, such as high trustworthiness of the app, increased knowledge, and awareness from using the app, which motivated participants to improve or maintain healthy habits during pregnancy. Conclusions: The HealthyMoms app was considered a valuable and trustworthy tool to mitigate excessive GWG, with useful features and relevant information to initiate and maintain healthy habits during pregnancy. Trial Registration: ClinicalTrials.gov NCT03298555; https://clinicaltrials.gov/ct2/show/NCT03298555 International Registered Report Identifier (IRRID): RR2-10.2196/13011 %M 33666554 %R 10.2196/26159 %U https://mhealth.jmir.org/2021/3/e26159 %U https://doi.org/10.2196/26159 %U http://www.ncbi.nlm.nih.gov/pubmed/33666554 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e18433 %T Association of Spontaneous and Induced Self-Affirmation With Smoking Cessation in Users of a Mobile App: Randomized Controlled Trial %A Seaman,Elizabeth L %A Robinson,Cendrine D %A Crane,David %A Taber,Jennifer M %A Ferrer,Rebecca A %A Harris,Peter R %A Klein,William M P %+ CDC Foundation, 600 Peachtree Street NE, Suite 1000, Atlanta, GA, 30308, United States, 1 4438524139, eseaman@cdcfoundation.org %K smoking cessation %K smartphone %K mHealth %K sadness %K self-affirmation %K spontaneous self-affirmation %K apps %K mobile phone %D 2021 %7 5.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Most smokers attempt to stop using cigarettes numerous times before successfully quitting. Cigarette cravings may undermine perceived competence to quit and thus constitute psychological threats to the individual’s self-concept. Self-affirmation may promote smoking cessation by offsetting these threats. Objective: This study examines whether self-affirmation is associated with smoking cessation in the context of a cessation app. Two types of self-affirmation are examined: tendency to spontaneously self-affirm, and self-affirmation inductions added to a publicly available smoking cessation app (Smoke-Free Quit Smoking Now). In addition, this study explores whether optimism and emotional states (happiness, anger, anxiousness, hopefulness, sadness) predict smoking cessation. Methods: All users who met the inclusion criteria, provided consent to participate, and completed a baseline assessment, including all individual difference measures, were randomized to 1 of 4 conditions. Half of the participants were randomly assigned to complete a self-affirmation induction upon study entry. Orthogonally, half of the participants were randomly assigned to receive self-affirming text notifications during their quit attempt or to receive conventional notifications. The induction and the text notifications were fully automated, and all data were collected through self-assessments in the app. Self-reported smoking cessation was assessed 1 month and 3 months following study entry. Results: The study enrolled 7899 participants; 647 completed the 1-month follow-up. Using an intent-to-treat analysis at the 1-month follow-up, 7.2% (569/7899) of participants self-reported not smoking in the previous week and 6.4% (503/7899) self-reported not smoking in the previous month. Greater tendency to spontaneously self-affirm predicted a greater likelihood of cessation (P<.001) at 1 month after controlling for smoking-related variables. Neither self-affirmation induction influenced cessation. In addition, spontaneous self-affirmation did not moderate the relationship between self-affirmation inductions and cessation. Greater baseline sadness was associated with a lower likelihood of reporting successful cessation. Optimism predicted past-week cessation at the 1-month follow-up, and both happiness and anger predicted past-month cessation at the 1-month follow-up; however, none of these potential predictors moderated the relationship between self-affirmation conditions and successful cessation. Conclusions: Spontaneous self-affirmation may be an important psychological resource for managing threats to self-concept during the smoking cessation process. Sadness may hinder quit attempts. Future research can explicate how spontaneous versus induced self-affirmation can promote smoking cessation and examine boundary conditions for the effectiveness of disseminated self-affirmation interventions. Trial Registration: ISRCTN Registry 56646695; https://www.isrctn.com/ISRCTN56646695 %M 33666561 %R 10.2196/18433 %U https://www.jmir.org/2021/3/e18433 %U https://doi.org/10.2196/18433 %U http://www.ncbi.nlm.nih.gov/pubmed/33666561 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e24194 %T Measurement of Human Walking Movements by Using a Mobile Health App: Motion Sensor Data Analysis %A Lee,Sungchul %A Walker,Ryan M %A Kim,Yoohwan %A Lee,Hyunhwa %+ School of Computing and Information Systems, Grand Valley State University, D-2-206 Mackinac Hall, Allendale, MI, 49401, United States, 1 616 331 4372, lees2@gvsu.edu %K mobile health %K mHealth %K walking balance %K smartphone %K motion sensor %K sensor %K walking %K walking balance %K mobile phone %D 2021 %7 5.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: This study presents a new approach to measure and analyze the walking balance of humans by collecting motion sensor data in a smartphone. Objective: We aimed to develop a mobile health (mHealth) app that can measure the walking movements of human individuals and analyze the differences in the walking movements of different individuals based on their health conditions. A smartphone’s motion sensors were used to measure the walking movements and analyze the rotation matrix data by calculating the variation of each xyz rotation, which shows the variables in walking-related movement data over time. Methods: Data were collected from 3 participants, that is, 2 healthy individuals (1 female and 1 male) and 1 male with back pain. The participant with back pain injured his back during strenuous exercise but he did not have any issues in walking. The participants wore the smartphone in the middle of their waistline (as the center of gravity) while walking. They were instructed to walk straight at their own pace in an indoor hallway of a building. The walked a distance of approximately 400 feet. They walked for 2-3 minutes in a straight line and then returned to the starting location. A rotation vector in the smartphone, calculated by the rotation matrix, was used to measure the pitch, roll, and yaw angles of the human body while walking. Each xyz-rotation vector datum was recalculated to find the variation in each participant’s walking movement. Results: The male participant with back pain showed a diminished level of walking balance with a wider range of xyz-axis variations in the rotations compared to those of the healthy participants. The standard deviation in the xyz-axis of the male participant with back pain was larger than that of the healthy male participant. Moreover, the participant with back pain had the widest combined range of right-to-left and forward-to-backward motions. The healthy male participant showed smaller standard deviation while walking than the male participant with back pain and the female healthy participant, indicating that the healthy male participant had a well-balanced walking movement. The walking movement of the female healthy participant showed symmetry in the left-to-right (x-axis) and up-to-down (y-axis) motions in the x-y variations of rotation vectors, indicating that she had lesser bias in gait than the others. Conclusions: This study shows that our mHealth app based on smartphone sensors and rotation vectors can measure the variations in the walking movements of different individuals. Further studies are needed to measure and compare walking movements by age, gender, as well as types of health problems or disease. This app can help in finding differences in gait in people with diseases that affect gait. %M 33666557 %R 10.2196/24194 %U https://mhealth.jmir.org/2021/3/e24194 %U https://doi.org/10.2196/24194 %U http://www.ncbi.nlm.nih.gov/pubmed/33666557 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e21795 %T Attitudes of General Practitioners Toward Prescription of Mobile Health Apps: Qualitative Study %A Sarradon-Eck,Aline %A Bouchez,Tiphanie %A Auroy,Lola %A Schuers,Matthieu %A Darmon,David %+ Aix Marseille University, INSERM, IRD, SESSTIM, UMR1252-CanBios-SESSTIM, 232 Bb Ste Marguerite, Marseille, 13009, France, 33 4 91 22 33 09, aline.sarradon@inserm.fr %K mobile applications %K qualitative research %K general practitioners %K France %K mobile phone %D 2021 %7 4.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps are a potential means of empowering patients, especially in the case of multimorbidity, which complicates patients’ care needs. Previous studies have shown that general practitioners (GPs) have both expectations and concerns regarding patients’ use of mHealth apps that could impact their willingness to recommend the apps to patients. Objective: The aim of this qualitative study is to investigate French GPs’ attitudes toward the prescription of mHealth apps or devices aimed toward patients by analyzing GPs’ perceptions and expectations of mHealth technologies. Methods: A total of 36 GPs were interviewed individually (n=20) or in a discussion group (n=16). All participants were in private practice. A qualitative analysis of each interview and focus group was conducted using grounded theory analysis. Results: Considering the value assigned to mHealth apps by participants and their willingness or resistance to prescribe them, 3 groups were defined based on the attitudes or positions adopted by GPs: digital engagement (favorable attitude; mHealth apps are perceived as additional resources and complementary tools that facilitate the medical work, the follow-up care, and the monitoring of patients; and apps increase patients’ compliance and empowerment); patient protection (related to the management of patient care and fear of risks for patients, concerns about patient data privacy and security, doubt about the usefulness for empowering patients, standardization of the medical decision process, overmedicalization, risks for individual freedom, and increasing social inequalities in health); doctor protection (fear of additional tasks and burden, doubt about the actionability of patient-gathered health data, risk for medical liability, dehumanization of the patient-doctor relationship, fear of increased drug prescription, and commodification of patient data). Conclusions: A deep understanding of both the expectations and fears of GPs is essential to motivate them to recommend mHealth apps to their patients. The results of this study show the need to provide appropriate education and training to enhance GPs’ digital skills. Certification of the apps by an independent authority should be encouraged to reassure physicians about ethical and data security issues. Our results highlight the need to overcome technical issues such as interoperability between data collection and medical records to limit the disruption of medical work because of data flow. %M 33661123 %R 10.2196/21795 %U https://mhealth.jmir.org/2021/3/e21795 %U https://doi.org/10.2196/21795 %U http://www.ncbi.nlm.nih.gov/pubmed/33661123 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e20175 %T Medical Food Assessment Using a Smartphone App With Continuous Glucose Monitoring Sensors: Proof-of-Concept Study %A Roux de Bézieux,Hector %A Bullard,James %A Kolterman,Orville %A Souza,Michael %A Perraudeau,Fanny %+ Pendulum Therapeutics, Inc, 933 20th Street, San Francisco, CA, 94107, United States, 1 650 276 6517, fanny.perraudeau@pendulum.co %K clinical trials %K continuous glucose monitoring %K lifestyle modification %K mobile app %K telemedicine %K diabetes %D 2021 %7 4.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Novel wearable biosensors, ubiquitous smartphone ownership, and telemedicine are converging to enable new paradigms of clinical research. A new generation of continuous glucose monitoring (CGM) devices provides access to clinical-grade measurement of interstitial glucose levels. Adoption of these sensors has become widespread for the management of type 1 diabetes and is accelerating in type 2 diabetes. In parallel, individuals are adopting health-related smartphone-based apps to monitor and manage care. Objective: We conducted a proof-of-concept study to investigate the potential of collecting robust, annotated, real-time clinical study measures of glucose levels without clinic visits. Methods: Self-administered meal-tolerance tests were conducted to assess the impact of a proprietary synbiotic medical food on glucose control in a 6-week, double-blind, placebo-controlled, 2×2 cross-over pilot study (n=6). The primary endpoint was incremental glucose measured using Abbott Freestyle Libre CGM devices associated with a smartphone app that provided a visual diet log. Results: All subjects completed the study and mastered CGM device usage. Over 40 days, 3000 data points on average per subject were collected across three sensors. No adverse events were recorded, and subjects reported general satisfaction with sensor management, the study product, and the smartphone app, with an average self-reported satisfaction score of 8.25/10. Despite a lack of sufficient power to achieve statistical significance, we demonstrated that we can detect meaningful changes in the postprandial glucose response in real-world settings, pointing to the merits of larger studies in the future. Conclusions: We have shown that CGM devices can provide a comprehensive picture of glucose control without clinic visits. CGM device usage in conjunction with our custom smartphone app can lower the participation burden for subjects while reducing study costs, and allows for robust integration of multiple valuable data types with glucose levels remotely. Trial Registration: ClinicalTrials.gov NCT04424888; http://clinicaltrials.gov/ct2/show/NCT04424888. %M 33661120 %R 10.2196/20175 %U https://formative.jmir.org/2021/3/e20175 %U https://doi.org/10.2196/20175 %U http://www.ncbi.nlm.nih.gov/pubmed/33661120 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e21061 %T Digital Technology Interventions for Risk Factor Modification in Patients With Cardiovascular Disease: Systematic Review and Meta-analysis %A Akinosun,Adewale Samuel %A Polson,Rob %A Diaz - Skeete,Yohanca %A De Kock,Johannes Hendrikus %A Carragher,Lucia %A Leslie,Stephen %A Grindle,Mark %A Gorely,Trish %+ Department of Nursing and Midwifery, Institute of Health Research and Innovation, Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom, 44 07727867360, 18026171@uhi.ac.uk %K digital technologies %K mHealth %K eHealth %K risk factors %K cardiovascular diseases %K telehealth %K cardiac rehabilitation %K behavior %K systematic review %K meta-analysis %K mobile phone %D 2021 %7 3.3.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Approximately 50% of cardiovascular disease (CVD) cases are attributable to lifestyle risk factors. Despite widespread education, personal knowledge, and efficacy, many individuals fail to adequately modify these risk factors, even after a cardiovascular event. Digital technology interventions have been suggested as a viable equivalent and potential alternative to conventional cardiac rehabilitation care centers. However, little is known about the clinical effectiveness of these technologies in bringing about behavioral changes in patients with CVD at an individual level. Objective: The aim of this study is to identify and measure the effectiveness of digital technology (eg, mobile phones, the internet, software applications, wearables, etc) interventions in randomized controlled trials (RCTs) and determine which behavior change constructs are effective at achieving risk factor modification in patients with CVD. Methods: This study is a systematic review and meta-analysis of RCTs designed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement standard. Mixed data from studies extracted from selected research databases and filtered for RCTs only were analyzed using quantitative methods. Outcome hypothesis testing was set at 95% CI and P=.05 for statistical significance. Results: Digital interventions were delivered using devices such as cell phones, smartphones, personal computers, and wearables coupled with technologies such as the internet, SMS, software applications, and mobile sensors. Behavioral change constructs such as cognition, follow-up, goal setting, record keeping, perceived benefit, persuasion, socialization, personalization, rewards and incentives, support, and self-management were used. The meta-analyzed effect estimates (mean difference [MD]; standard mean difference [SMD]; and risk ratio [RR]) calculated for outcomes showed benefits in total cholesterol SMD at −0.29 [−0.44, −0.15], P<.001; high-density lipoprotein SMD at –0.09 [–0.19, 0.00], P=.05; low-density lipoprotein SMD at −0.18 [−0.33, −0.04], P=.01; physical activity (PA) SMD at 0.23 [0.11, 0.36], P<.001; physical inactivity (sedentary) RR at 0.54 [0.39, 0.75], P<.001; and diet (food intake) RR at 0.79 [0.66, 0.94], P=.007. Initial effect estimates showed no significant benefit in body mass index (BMI) MD at −0.37 [−1.20, 0.46], P=.38; diastolic blood pressure (BP) SMD at −0.06 [−0.20, 0.08], P=.43; systolic BP SMD at −0.03 [−0.18, 0.13], P=.74; Hemoglobin A1C blood sugar (HbA1c) RR at 1.04 [0.40, 2.70], P=.94; alcohol intake SMD at −0.16 [−1.43, 1.10], P=.80; smoking RR at 0.87 [0.67, 1.13], P=.30; and medication adherence RR at 1.10 [1.00, 1.22], P=.06. Conclusions: Digital interventions may improve healthy behavioral factors (PA, healthy diet, and medication adherence) and are even more potent when used to treat multiple behavioral outcomes (eg, medication adherence plus). However, they did not appear to reduce unhealthy behavioral factors (smoking, alcohol intake, and unhealthy diet) and clinical outcomes (BMI, triglycerides, diastolic and systolic BP, and HbA1c). %M 33656444 %R 10.2196/21061 %U https://mhealth.jmir.org/2021/3/e21061 %U https://doi.org/10.2196/21061 %U http://www.ncbi.nlm.nih.gov/pubmed/33656444 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 3 %P e26550 %T Digital Interventions to Support Population Mental Health in Canada During the COVID-19 Pandemic: Rapid Review %A Strudwick,Gillian %A Sockalingam,Sanjeev %A Kassam,Iman %A Sequeira,Lydia %A Bonato,Sarah %A Youssef,Alaa %A Mehta,Rohan %A Green,Nadia %A Agic,Branka %A Soklaridis,Sophie %A Impey,Danielle %A Wiljer,David %A Crawford,Allison %+ Centre for Addiction and Mental Health, 1001 Queen St W, Toronto, ON, M6J 1H4, Canada, 1 416 535 8501, gillian.strudwick@camh.ca %K digital health %K psychiatry %K mental health %K informatics %K pandemic %K COVID-19 %K telemedicine %K eHealth %K public health %K virtual care %K mobile apps %K population health %D 2021 %7 2.3.2021 %9 Review %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has resulted in a number of negative health related consequences, including impacts on mental health. More than 22% of Canadians reported that they had felt depressed in the last week, in response to a December 2020 national survey. Given the need to physically distance during the pandemic, and the increase in demand for mental health services, digital interventions that support mental health and wellness may be beneficial. Objective: The purpose of this research was to identify digital interventions that could be used to support the mental health of the Canadian general population during the COVID-19 pandemic. The objectives were to identify (1) the populations these interventions were developed for, inclusive of exploring areas of equity such as socioeconomic status, sex/gender, race/ethnicity and culture, and relevance to Indigenous peoples and communities; (2) the effect of the interventions; and (3) any barriers or facilitators to the use of the intervention. Methods: This study was completed using a Cochrane Rapid Review methodology. A search of Embase, PsycInfo, Medline, and Web of Science, along with Google, Million Short, and popular mobile app libraries, was conducted. Two screeners were involved in applying inclusion criteria using Covidence software. Academic articles and mobile apps identified were screened using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields resource, the American Psychiatric Association App Evaluation Framework, and the Mental Health Commission of Canada’s guidance on app assessment and selection. Results: A total of 31 mobile apps and 114 web-based resources (eg, telemedicine, virtual peer support groups, discussion forums, etc) that could be used to support the mental health of the Canadian population during the pandemic were identified. These resources have been listed on a publicly available website along with search tags that may help an individual make a suitable selection. Variability exists in the populations that the interventions were developed for, and little assessment has been done with regard to areas of equity. The effect of the interventions was not reported for all those identified in this synthesis; however, for those that did report the effect, it was shown that they were effective in the context that they were used. A number of barriers and facilitators to using these interventions were identified, such as access, cost, and connectivity. Conclusions: A number of digital interventions that could support population mental health in Canada during the global COVID-19 pandemic were identified, indicating that individuals have several options to choose from. These interventions vary in their purpose, approach, design, cost, and targeted user group. While some research and digital interventions addressed equity-related considerations, more research and focused attention should be given to this area. %M 33650985 %R 10.2196/26550 %U https://mental.jmir.org/2021/3/e26550 %U https://doi.org/10.2196/26550 %U http://www.ncbi.nlm.nih.gov/pubmed/33650985 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e24322 %T Health Apps for Combating COVID-19: Descriptive Review and Taxonomy %A Almalki,Manal %A Giannicchi,Anna %+ Department of Health Informatics, Faculty of Public Health and Tropical Medicine, Jazan University, Gizan, Jazan, 82726, Saudi Arabia, 966 597636563, manal_almalki@hotmail.com %K app %K COVID-19 %K corona %K self-care %K personal tracking %K review %K mHealth %K track %K surveillance %K awareness %K exposure %K consumer health informatics %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone apps have been leveraged to combat the spread of COVID-19. However, little is known about these technologies’ characteristics, technical features, and various applications in health care when responding to this public health crisis. The lack of understanding has led developers and governments to make poor choices about apps’ designs, which resulted in creating less useful apps that are overall less appealing to consumers due to their technical flaws. Objective: This review aims to identify, analyze, and categorize health apps related to COVID-19 that are currently available for consumers in app stores; in particular, it focuses on exploring their key technical features and classifying the purposes that these apps were designed to serve. Methods: A review of health apps was conducted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The Apple Store and Google Play were searched between April 20 and September 11, 2020. An app was included if it was dedicated for this disease and was listed under the health and medical categories in these app stores. The descriptions of these apps were extracted from the apps’ web pages and thematically analyzed via open coding to identify both their key technical features and overall purpose. The characteristics of the included apps were summarized and presented with descriptive statistics. Results: Of the 298 health apps that were initially retrieved, 115 met the inclusion criteria. A total of 29 technical features were found in our sample of apps, which were then categorized into five key purposes of apps related to COVID-19. A total of 77 (67%) apps were developed by governments or national authorities and for the purpose of promoting users to track their personal health (9/29, 31%). Other purposes included raising awareness on how to combat COVID-19 (8/29, 27%), managing exposure to COVID-19 (6/29, 20%), monitoring health by health care professionals (5/29, 17%), and conducting research studies (1/29, 3.5%). Conclusions: This study provides an overview and taxonomy of the health apps currently available in the market to combat COVID-19 based on their differences in basic technical features and purpose. As most of the apps were provided by governments or national authorities, it indicates the essential role these apps have as tools in public health crisis management. By involving most of the population in self-tracking their personal health and providing them with the technology to self-assess, the role of these apps is deemed to be a key driver for a participatory approach to curtail the spread of COVID-19. Further effort is required from researchers to evaluate these apps’ effectiveness and from governmental organizations to increase public awareness of these digital solutions. %M 33626017 %R 10.2196/24322 %U https://mhealth.jmir.org/2021/3/e24322 %U https://doi.org/10.2196/24322 %U http://www.ncbi.nlm.nih.gov/pubmed/33626017 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 3 %P e19832 %T Characterizing Emotional State Transitions During Prolonged Use of a Mindfulness and Meditation App: Observational Study %A Athanas,Argus %A McCorrison,Jamison %A Campistron,Julie %A Bender,Nick %A Price,Jamie %A Smalley,Susan %A Schork,Nicholas J %+ Department of Quantitative Medicine, The Translational Genomics Research Institute, An Affiliate of the City of Hope National Medical Center, Translational Genomics Research Institute Headquarters, 445 N Fifth Street, Phoenix, AZ, 85004, United States, 1 602 343 8429, nschork@tgen.org %K mental health %K mobile apps %K smartphone %K mobile phone %K emotional distress %K mindfulness %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The increasing demand for mental health care, a lack of mental health care providers, and unequal access to mental health care services have created a need for innovative approaches to mental health care. Digital device apps, including digital therapeutics, that provide recommendations and feedback for dealing with stress, depression, and other mental health issues can be used to adjust mood and ultimately show promise to help meet this demand. In addition, the recommendations delivered through such apps can also be tailored to an individual’s needs (ie, personalized) and thereby potentially provide greater benefits than traditional “one-size-fits-all” recommendations. Objective: This study aims to characterize individual transitions from one emotional state to another during the prolonged use of a digital app designed to provide a user with guided meditations based on their initial, potentially negative, emotional state. Understanding the factors that mediate such transitions can lead to improved recommendations for specific mindfulness and meditation interventions or activities (MMAs) provided in mental health apps. Methods: We analyzed data collected during the use of the Stop, Breathe & Think (SBT) mindfulness app. The SBT app prompts users to input their emotional state before and immediately after engaging with MMAs recommended by the app. Data were collected from more than 650,000 SBT users engaging in nearly 5 million MMAs. We limited the scope of our analysis to users with 10 or more MMA sessions that included at least 6 basal emotional state evaluations. Using clustering techniques, we grouped emotions recorded by individual users and then applied longitudinal mixed effect models to assess the associations between individual recommended MMAs and transitions from one group of emotions to another. Results: We found that basal emotional states have a strong influence on transitions from one emotional state to another after MMA engagement. We also found that different MMAs impact these transitions, and many were effective in eliciting a healthy transition but only under certain conditions. In addition, we observed gender and age effects on these transitions. Conclusions: We found that the initial emotional state of an SBT app user determines the type of SBT MMAs that will have a favorable effect on their transition from one emotional state to another. Our results have implications for the design and use of guided mental health recommendations for digital device apps. %M 33650986 %R 10.2196/19832 %U https://mental.jmir.org/2021/3/e19832 %U https://doi.org/10.2196/19832 %U http://www.ncbi.nlm.nih.gov/pubmed/33650986 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24134 %T A Novel Mobile App (Heali) for Disease Treatment in Participants With Irritable Bowel Syndrome: Randomized Controlled Pilot Trial %A Rafferty,Aaron J %A Hall,Rick %A Johnston,Carol S %+ College of Health Solutions, Arizona State University, HLTHN 532 Phoenix Downtown Campus, Phoenix, AZ, 85004, United States, 1 602 496 2539, Carol.johnston@asu.edu %K irritable bowel syndrome %K artificial intelligence %K mobile app %K low FODMAP diet %K randomized controlled trial %D 2021 %7 2.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: A diet high in fermentable, oligo-, di-, monosaccharides and polyols (FODMAPs) has been shown to exacerbate symptoms of irritable bowel syndrome (IBS). Previous literature reports significant improvement in IBS symptoms with initiation of a low FODMAP diet (LFD) and monitored reintroduction. However, dietary adherence to the LFD is difficult, with patients stating that the information given by health care providers is often generalized and nonspecific, requiring them to search for supplementary information to fit their needs. Objective: The aim of our study was to determine whether Heali, a novel artificial intelligence dietary mobile app can improve adherence to the LFD, IBS symptom severity, and quality of life outcomes in adults with IBS or IBS-like symptoms over a 4-week period. Methods: Participants were randomized into 2 groups: the control group (CON), in which participants received educational materials, and the experimental group (APP), in which participants received access to the mobile app and educational materials. Over the course of this unblinded online trial, all participants completed a battery of 5 questionnaires at baseline and at the end of the trial to document IBS symptoms, quality of life, LFD knowledge, and LFD adherence. Results: We enrolled 58 participants in the study (29 in each group), and 25 participants completed the study in its entirety (11 and 14 for the CON and APP groups, respectively). Final, per-protocol analyses showed greater improvement in quality of life score for the APP group compared to the CON group (31.1 and 11.8, respectively; P=.04). Reduction in total IBS symptom severity score was 24% greater for the APP group versus the CON group. Although this did not achieve significance (–170 vs –138 respectively; P=.37), the reduction in the subscore for bowel habit dissatisfaction was 2-fold greater for the APP group than for the CON group (P=.05). Conclusions: This initial study provides preliminary evidence that Heali may provide therapeutic benefit to its users, specifically improvements in quality of life and bowel habits. Although this study was underpowered, findings from this study warrant further research in a larger sample of participants to test the efficacy of Heali app use to improve outcomes for patients with IBS. Trial Registration: ClinicalTrials.gov NCT04256551; https://clinicaltrials.gov/ct2/show/NCT04256551 %M 33650977 %R 10.2196/24134 %U https://www.jmir.org/2021/3/e24134 %U https://doi.org/10.2196/24134 %U http://www.ncbi.nlm.nih.gov/pubmed/33650977 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e22950 %T Older Adult Peer Support Specialists’ Age-Related Contributions to an Integrated Medical and Psychiatric Self-Management Intervention: Qualitative Study of Text Message Exchanges %A Mbao,Mbita %A Collins-Pisano,Caroline %A Fortuna,Karen %+ Dartmouth College, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States, 1 603 722 5727, karen.L.Fortuna@dartmouth.edu %K older adults %K peer support %K self-management %K mobile technology %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Middle-aged and older adults with mental health conditions have a high likelihood of experiencing comorbid physical health conditions, premature nursing home admissions, and early death compared with the general population of adults aged 50 years or above. An emerging workforce of peer support specialists aged 50 years or above or “older adult peer support specialists” is increasingly using technology to deliver peer support services to address both the mental health and physical health needs of middle-aged and older adults with a diagnosis of a serious mental illness. Objective: This exploratory qualitative study examined older adult peer support specialists’ text message exchanges with middle-aged and older adults with a diagnosis of a serious mental illness and their nonmanualized age-related contributions to a standardized integrated medical and psychiatric self-management intervention. Methods: Older adult peer support specialists exchanged text messages with middle-aged and older adults with a diagnosis of a serious mental illness as part of a 12-week standardized integrated medical and psychiatric self-management smartphone intervention. Text message exchanges between older adult peer support specialists (n=3) and people with serious mental illnesses (n=8) were examined (mean age 68.8 years, SD 4.9 years). A total of 356 text messages were sent between older adult peer support specialists and service users with a diagnosis of a serious mental illness. Older adult peer support specialists sent text messages to older participants’ smartphones between 8 AM and 10 PM on weekdays and weekends. Results: Five themes emerged from text message exchanges related to older adult peer support specialists’ age-related contributions to integrated self-management, including (1) using technology to simultaneously manage mental health and physical health issues; (2) realizing new coping skills in late life; (3) sharing roles as parents and grandparents; (4) wisdom; and (5) sharing lived experience of difficulties with normal age-related changes (emerging). Conclusions: Older adult peer support specialists’ lived experience of aging successfully with a mental health challenge may offer an age-related form of peer support that may have implications for promoting successful aging in older adults with a serious mental illness. %M 33650979 %R 10.2196/22950 %U https://formative.jmir.org/2021/3/e22950 %U https://doi.org/10.2196/22950 %U http://www.ncbi.nlm.nih.gov/pubmed/33650979 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e25775 %T Assessing the Mental Health of Emerging Adults Through a Mental Health App: Protocol for a Prospective Pilot Study %A Yunusova,Asal %A Lai,Jocelyn %A Rivera,Alexander P %A Hu,Sirui %A Labbaf,Sina %A Rahmani,Amir M %A Dutt,Nikil %A Jain,Ramesh C %A Borelli,Jessica L %+ Department of Psychological Science, University of California, Irvine, 4552 Social and Behavioral Sciences Gateway, Irvine, CA, United States, 1 9498243002, Jessica.borelli@uci.edu %K ecological momentary assessment %K stress %K digital mental health %K college student %K mental health %K protocol %K prospective %K feasibility %K individual %K factors %K sleepy %K physiology %K activity %K COVID-19 %D 2021 %7 2.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Individuals can experience different manifestations of the same psychological disorder. This underscores the need for a personalized model approach in the study of psychopathology. Emerging adulthood is a developmental phase wherein individuals are especially vulnerable to psychopathology. Given their exposure to repeated stressors and disruptions in routine, the emerging adult population is worthy of investigation. Objective: In our prospective study, we aim to conduct multimodal assessments to determine the feasibility of an individualized approach for understanding the contextual factors of changes in daily affect, sleep, physiology, and activity. In other words, we aim to use event mining to predict changes in mental health. Methods: We expect to have a final sample size of 20 participants. Recruited participants will be monitored for a period of time (ie, between 3 and 12 months). Participants will download the Personicle app on their smartphone to track their activities (eg, home events and cycling). They will also be given wearable sensor devices (ie, devices that monitor sleep, physiology, and physical activity), which are to be worn continuously. Participants will be asked to report on their daily moods and provide open-ended text responses on a weekly basis. Participants will be given a battery of questionnaires every 3 months. Results: Our study has been approved by an institutional review board. The study is currently in the data collection phase. Due to the COVID-19 pandemic, the study was adjusted to allow for remote data collection and COVID-19–related stress assessments. Conclusions: Our study will help advance research on individualized approaches to understanding health and well-being through multimodal systems. Our study will also demonstrate the benefit of using individualized approaches to study interrelations among stress, social relationships, technology, and mental health. International Registered Report Identifier (IRRID): DERR1-10.2196/25775 %M 33513124 %R 10.2196/25775 %U https://www.researchprotocols.org/2021/3/e25775 %U https://doi.org/10.2196/25775 %U http://www.ncbi.nlm.nih.gov/pubmed/33513124 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26559 %T Exploring Usage of COVID Coach, a Public Mental Health App Designed for the COVID-19 Pandemic: Evaluation of Analytics Data %A Jaworski,Beth K %A Taylor,Katherine %A Ramsey,Kelly M %A Heinz,Adrienne %A Steinmetz,Sarah %A Pagano,Ian %A Moraja,Giovanni %A Owen,Jason E %+ National Center for PTSD, Dissemination & Training Division, US Department of Veterans Affairs, 795 Willow Road, Menlo Park, CA, 94025, United States, 1 650 308 9437, beth.jaworski@va.gov %K COVID-19 %K coronavirus %K mobile app %K mHealth %K digital health %K mental health %K public mental health %K stress %K coping %K public health %K app %D 2021 %7 1.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has significantly impacted mental health and well-being. Mobile mental health apps can be scalable and useful tools in large-scale disaster responses and are particularly promising for reaching vulnerable populations. COVID Coach is a free, evidence-informed mobile app designed specifically to provide tools and resources for addressing COVID-19–related stress. Objective: The purpose of this study was to characterize the overall usage of COVID Coach, explore retention and return usage, and assess whether the app was reaching individuals who may benefit from mental health resources. Methods: Anonymous usage data collected from COVID Coach between May 1, 2020, through October 31, 2020, were extracted and analyzed for this study. The sample included 49,287 unique user codes and 3,368,931 in-app events. Results: Usage of interactive tools for coping and stress management comprised the majority of key app events (n=325,691, 70.4%), and the majority of app users tried a tool for managing stress (n=28,009, 58.8%). COVID Coach was utilized for ≤3 days by 80.9% (n=34,611) of the sample whose first day of app use occurred within the 6-month observation window. Usage of the key content in COVID Coach predicted returning to the app for a second day. Among those who tried at least one coping tool on their first day of app use, 57.2% (n=11,444) returned for a second visit; whereas only 46.3% (n=10,546) of those who did not try a tool returned (P<.001). Symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) were prevalent among app users. For example, among app users who completed an anxiety assessment on their first day of app use (n=4870, 11.4% of users), 55.1% (n=2680) reported levels of anxiety that were moderate to severe, and 29.9% (n=1455) of scores fell into the severe symptom range. On average, those with moderate levels of depression on their first day of app use returned to the app for a greater number of days (mean 3.72 days) than those with minimal symptoms (mean 3.08 days; t1=3.01, P=.003). Individuals with significant PTSD symptoms on their first day of app use utilized the app for a significantly greater number of days (mean 3.79 days) than those with fewer symptoms (mean 3.13 days; t1=2.29, P=.02). Conclusions: As the mental health impacts of the pandemic continue to be widespread and increasing, digital health resources, such as apps like COVID Coach, are a scalable way to provide evidence-informed tools and resources. Future research is needed to better understand for whom and under what conditions the app is most helpful and how to increase and sustain engagement. %M 33606656 %R 10.2196/26559 %U https://www.jmir.org/2021/3/e26559 %U https://doi.org/10.2196/26559 %U http://www.ncbi.nlm.nih.gov/pubmed/33606656 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e22571 %T A Fitness App for Monitoring Walking Behavior and Perception (Runkeeper): Mixed Methods Pilot Study %A Hollander,Justin B %A Folta,Sara C %A Graves,Erin Michelle %A Allen,Jennifer D %A Situ,Minyu %+ Department of Urban and Environmental Policy and Planning, School of Arts and Sciences, Tufts University, 97 Talbot Avenue, Medford, MA, 02155, United States, 1 6176273394, justin.hollander@tufts.edu %K physical activity %K smartphone %K mobile app %K sense of belongingness %K community cohesion %D 2021 %7 1.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical activity has a strong positive impact on both physical and mental health, and public health interventions often encourage walking as a means to promote physical activity. Social connectivity, such as that among spouses, families, friends, and colleagues, highly influences physical activity. Although technology-based interventions have some influence on human behavior, they have not been fully implemented and evaluated for their influence on walking through social connectivity. Objective: We aimed to pilot-test the organization of neighborhood walking clubs and use of a mobile app (Runkeeper) to encourage social connectedness and neighborhood cohesion, as well as to increase physical activity. Methods: We used a convenience sampling method to recruit 46 adults from an urban location in Greater Boston, Massachusetts. We assigned participants to teams based on their geographic location and neighborhood and required them to use the app (Runkeeper). Participants completed 2 self-administered web-based surveys before and after the intervention period. The surveys included standard measures to evaluate physical activity, social connectedness, perceived social support, and neighborhood cohesion (Buckner Neighborhood Cohesion Scale) before and after the intervention. Following the intervention, we randomly selected 14 participants to participate in postintervention, in-depth phone interviews to gain an understanding of their experiences. Results: This study was approved by the institutional review board in June 2018 and funded in January 2018. Recruitment started in May 2019 and lasted for 2 months. Data were collected from July 2019 to January 2020. In this study, Runkeeper was of limited feasibility as an app for measuring physical activity or promoting social connectedness. Data from the app recorded sparse and uneven walking behaviors among the participants. Qualitative interviews revealed that users experienced difficulties in using the settings and features of the app. In the questionnaire, there was no change between pre-post assessments in walking minutes (b=−.79; 95% CI −4.0 to 2.4; P=.63) or miles (b=−.07; 95% CI −0.15 to 0.01; P=.09). We observed a pre-post increase in social connectedness and a decrease in neighborhood cohesion. Both quantitative and qualitative results indicated that the psychosocial aspects of walking motivated the participants and helped them relieve stress. Interview results showed that participants felt a greater virtual connection in their assigned groups and enhanced connections with friends and family members. Conclusions: Our study found that Runkeeper created a virtual connection among walking group members and its data sharing and ranking motivated walking. Participants felt that walking improved their mental health, helped to relieve stress, and made them feel more connected with friends or family members. In future studies, it will be important to use an app that integrates with a wearable physical activity device. There is also a need to develop and test intervention components that might be more effective in fostering neighborhood cohesion. %M 33646132 %R 10.2196/22571 %U https://formative.jmir.org/2021/3/e22571 %U https://doi.org/10.2196/22571 %U http://www.ncbi.nlm.nih.gov/pubmed/33646132 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e25289 %T Using Fitbit as an mHealth Intervention Tool to Promote Physical Activity: Potential Challenges and Solutions %A Balbim,Guilherme M %A Marques,Isabela G %A Marquez,David X %A Patel,Darshilmukesh %A Sharp,Lisa K %A Kitsiou,Spyros %A Nyenhuis,Sharmilee M %+ Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W Taylor St (MC 530), Chicago, IL, 60612, United States, 1 312 355 3519, skitsiou@uic.edu %K physical activity %K fitness trackers %K Fitbit %K smartphones %K interventional studies %K adults %K older adults %K wearable %K intervention %D 2021 %7 1.3.2021 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Consumer-based physical activity (PA) trackers, also known as wearables, are increasingly being used in research studies as intervention or measurement tools. One of the most popular and widely used brands of PA trackers is Fitbit. Since the release of the first Fitbit in 2009, hundreds of experimental studies have used Fitbit devices to facilitate PA self-monitoring and behavior change via goal setting and feedback tools. Fitbit’s ability to capture large volumes of PA and physiological data in real time creates enormous opportunities for researchers. At the same time, however, it introduces a number of challenges (eg, technological, operational, logistical), most of which are not sufficiently described in study publications. Currently, there are no technical reports, guidelines, nor other types of publications discussing some of these challenges and offering guidance to researchers on how to best incorporate Fitbit devices in their study design and intervention to achieve their research goals. As a result, researchers are often left alone to discover and address some of these issues during the study through “trial and error.” This paper aims to address this gap. Drawing on our cumulative experience of conducting multiple studies with various Fitbit PA trackers over the years, we present and discuss various key challenges associated with the use of Fitbit PA trackers in research studies. Difficulties with the use of Fitbit PA trackers are encountered throughout the entire research process. Challenges and solutions are categorized in 4 main categories: study preparation, intervention delivery, data collection and analysis, and study closeout. Subsequently, we describe a number of empirically tested strategies used in 4 of our interventional studies involving participants from a broad range of demographic characteristics, racial/ethnic backgrounds, and literacy levels. Researchers should be prepared to address challenges and issues in a timely fashion to ensure that the Fitbit effectively assists participants and researchers in achieving research and outcome goals. %M 33646135 %R 10.2196/25289 %U https://mhealth.jmir.org/2021/3/e25289 %U https://doi.org/10.2196/25289 %U http://www.ncbi.nlm.nih.gov/pubmed/33646135 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e18853 %T Rural Residents’ Perspectives on an mHealth or Personalized Health Coaching Intervention: Qualitative Study With Focus Groups and Key Informant Interviews %A Schoenberg,Nancy %A Dunfee,Madeline %A Yeager,Hannah %A Rutledge,Matthew %A Pfammatter,Angela %A Spring,Bonnie %+ Department of Behavior Science, University of Kentucky, 760 Press Avenue, 372 Healthy Kentucky Research Building, Lexington, KY, 40536, United States, 1 859 323 8175, nesch@uky.edu %K rural populations %K technology %K exercise %K diet %K community-based participatory research %K mobile phone %D 2021 %7 26.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Compared with national averages, rural Appalachians experience extremely elevated rates of premature morbidity and mortality. New opportunities, including approaches incorporating personal technology, may help improve lifestyles and overcome health inequities. Objective: This study aims to gather perspectives on whether a healthy lifestyle intervention, specifically an app originally designed for urban users, may be feasible and acceptable to rural residents. In addition to a smartphone app, this program—Make Better Choices 2—consists of personalized health coaching, accelerometer use, and financial incentives. Methods: We convened 4 focus groups and 16 key informant interviews with diverse community stakeholders to assess perspectives on this novel, evidence-based diet and physical activity intervention. Participants were shown a slide presentation and asked open-ended follow-up questions. The focus group and key informant interview sessions were audiotaped, transcribed, and subjected to thematic analysis. Results: We identified 3 main themes regarding Appalachian residents’ perspectives on this mobile health (mHealth) intervention: personal technology is feasible and desirable; challenges persist in implementing mHealth lifestyle interventions in Appalachian communities; and successful mHealth interventions should include personal connections, local coaches, and educational opportunities. Although viewed as feasible and acceptable overall, lack of healthy lifestyle awareness, habitual behavior, and financial constraints may challenge the success of mHealth lifestyle interventions in Appalachia. Finally, participants described several minor elements that require modification, including expanding the upper age inclusion, providing extra coaching on technology use, emphasizing personal and supportive connections, employing local coaches, and ensuring adequate educational content for the program. Conclusions: Blending new technologies, health coaching, and other features is not only acceptable but may be essential to reach vulnerable rural residents. %M 33635278 %R 10.2196/18853 %U https://formative.jmir.org/2021/2/e18853 %U https://doi.org/10.2196/18853 %U http://www.ncbi.nlm.nih.gov/pubmed/33635278 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e26557 %T A Multimodal Mobile Sleep Intervention for Young Adults Engaged in Risky Drinking: Protocol for a Randomized Controlled Trial %A Fucito,Lisa M %A Ash,Garrett I %A DeMartini,Kelly S %A Pittman,Brian %A Barnett,Nancy P %A Li,Chiang-Shan R %A Redeker,Nancy S %A O'Malley,Stephanie S %+ Department of Psychiatry, Yale University School of Medicine, 20 York Street, Fitkin Building, F619, New Haven, CT, 06510, United States, 1 2032001470, lisa.fucito@yale.edu %K sleep %K binge drinking %K young adults %K mHealth %K biosensor %K behavior therapy %K mobile phone %D 2021 %7 26.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: This paper describes the research protocol for a randomized controlled trial of a multimodal mobile sleep intervention for heavy-drinking young adults. Young adults report the highest rates of heavy, risky alcohol consumption and are a priority population for alcohol prevention and intervention efforts. Alcohol strategies that leverage other health concerns and use technology may offer an innovative solution. Poor sleep is common among young adults and is a risk factor for developing an alcohol use disorder. Moreover, young adults are interested in information to help them sleep better, and behavioral sleep interventions address alcohol use as a standard practice. Objective: The primary aim of this study is to assess the effectiveness of a 2-week multimodal mobile sleep intervention for reducing drinks consumed per week among heavy-drinking young adults. We will explore the effects on alcohol-related consequences, assessing quantitative and qualitative sleep characteristics as secondary aims. The study’s goals are to identify the optimal combination of sleep intervention components for improving drinking outcomes, the feasibility and acceptability of these components, and the potential mechanisms by which these components may promote alcohol behavior change. Methods: Young adults (aged 18-25 years) who report recent heavy drinking will be randomly assigned to one of three conditions: mobile sleep hygiene advice (n=30), mobile sleep hygiene advice and sleep and alcohol diary self-monitoring (n=30), or mobile sleep hygiene advice, sleep and alcohol diary self-monitoring, and sleep and alcohol data feedback (n=60). For the feedback component, participants will complete two web-based sessions with a health coach during which they will receive summaries of their sleep and alcohol data, and the potential association between them along with brief advice tailored to their data. All participants will wear sleep and alcohol biosensors daily for 2 weeks for objective assessments of these outcomes. Results: The study was funded by the National Institutes of Health in May 2018. Recruitment began in December 2018 and will be concluded in Spring 2021. As of February 4, 2021, we have enrolled 110 participants. Conclusions: Ultimately, this research could result in an efficacious, low-cost intervention with broad population reach through the use of technology. In addition, this intervention may substantially impact public health by reducing alcohol use disorder risk at a crucial developmental stage. Trial Registration: ClinicalTrials.gov NCT03658954; https://clinicaltrials.gov/ct2/show/NCT03658954 International Registered Report Identifier (IRRID): DERR1-10.2196/26557 %M 33635276 %R 10.2196/26557 %U https://www.researchprotocols.org/2021/2/e26557 %U https://doi.org/10.2196/26557 %U http://www.ncbi.nlm.nih.gov/pubmed/33635276 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e24165 %T Effects of COVID-19 Emergency Alert Text Messages on Practicing Preventive Behaviors: Cross-sectional Web-Based Survey in South Korea %A Lee,Minjung %A You,Myoungsoon %+ Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 880 2773, msyou@snu.ac.kr %K COVID-19 %K coronavirus %K preventive behaviors %K text message %K mobile phone %K alert %K prevention %K behavior %K public health %K survey %D 2021 %7 25.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Sending emergency messages via mobile phone text messaging can be a promising communication tool to rapidly disseminate information and promote preventive behavior among the public during epidemic outbreaks. The battle to overcome COVID-19 is not yet over; thus, it is essential that the public practices preventive measures to prevent the spread of COVID-19. Objective: This study aimed to investigate the effectiveness of reading and obtaining information via emergency alert SMS text messages and their effects on the individual's practice of preventive behaviors during the early stages of the COVID-19 outbreak in South Korea. Methods: A cross-sectional web-based survey comprising 990 participants was conducted over 3 days (March 25-27, 2020). A multivariable logistic regression analysis revealed the sociodemographic factors that might influence the behavior of reading emergency alert text messages. A hierarchical linear regression model estimated the associations between reading emergency alert text messages for each precautionary behavior practiced against COVID-19. Additionally, the indirect effects of reading the text messages on each precautionary behavior via psychological factors (ie, perceived risk and response efficacy) were calculated. All data were weighted according to the 2019 Korea census data. Results: Overall, 49.2% (487/990) of the participants reported that they always read emergency alert text messages and visited the linked website to obtain more information. Factors such as female sex (odds ratio [OR] 1.68, 95% CI 1.28-2.21) and older age (30-39 years: OR 2.02, 95% CI 1.25-3.28; 40-49 years: OR 2.84, 95% CI 1.80-4.47; 50-59 years: OR 3.19, 95% CI 2.01-5.06; 60 years and above: OR 3.12, 95% CI 2.00-4.86 versus 18-29 years) were identified to be associated with a higher frequency of reading the text messages. Participants who always read the text messages practiced wearing facial masks (β=.074, P=.01) more frequently than those who did not. In terms of social distancing, participants who reported they always read the text messages avoided crowded places (β=.078, P=.01) and canceled or postponed social gatherings (β=.103, P<.001) more frequently than those who did not read the text messages. Furthermore, reading text messages directly and indirectly affected practicing precautionary behaviors, as the mediation effect of response efficacy between reading text messages and practicing preventive behaviors was significant. Conclusions: Our findings suggest that emergency alert text messages sent to individuals' mobile phones are timely and effective strategies for encouraging preventive behavior in public. Sending emergency alert text messages to provide the public with accurate and reliable information could be positively considered by the health authorities, which might reduce the negative impact of infodemics. %M 33544691 %R 10.2196/24165 %U https://www.jmir.org/2021/2/e24165 %U https://doi.org/10.2196/24165 %U http://www.ncbi.nlm.nih.gov/pubmed/33544691 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e17492 %T The Kurbo App: The Freemium Model and Developmental Behavior Concerns. Comment on “Impact of a Mobile App–Based Health Coaching and Behavior Change Program on Participant Engagement and Weight Status of Overweight and Obese Children: Retrospective Cohort Study” %A Vitolo,Marcia Regina %+ Federal University of Health Sciences of Porto Alegre, Rua Sarmento Leite 245, Porto Alegre, 90050170, Brazil, 55 1138651010, marciavitolo@hotmail.com %K childhood obesity %K intervention %K app %D 2021 %7 25.2.2021 %9 Letter to the Editor %J JMIR Mhealth Uhealth %G English %X %M 33629965 %R 10.2196/17492 %U https://mhealth.jmir.org/2021/2/e17492 %U https://doi.org/10.2196/17492 %U http://www.ncbi.nlm.nih.gov/pubmed/33629965 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e14179 %T Ecological Momentary Assessment Using Smartphones in Patients With Depression: Feasibility Study %A Maatoug,Redwan %A Peiffer-Smadja,Nathan %A Delval,Guillaume %A Brochu,Térence %A Pitrat,Benjamin %A Millet,Bruno %+ Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013, 47-83 Boulevard de l'hôpital, Paris, 75013, France, 33 682476484, redwanmaatoug@gmail.com %K ecological momentary assessment %K depression %K smartphone %K feasibility study %K user experience %D 2021 %7 24.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Ecological momentary assessment (EMA) is a promising tool in the management of psychiatric disorders and particularly depression. It allows for a real-time evaluation of symptoms and an earlier detection of relapse or treatment efficacy. The generalization of the smartphone in the modern world offers a new, large-scale support for EMA. Objective: The main objective of this study was twofold: (1) to assess patients’ compliance with an EMA smartphone app defined by the number of EMAs completed, and (2) to estimate the external validity of the EMA using a correlation between self-esteem/guilt/mood variables and Hamilton Depression Rating Scale (HDRS) score. Methods: Eleven patients at the Pitié-Salpêtrière Hospital, Paris, France, were monitored for 28 days by means of a smartphone app. Every patient enrolled in the study had two types of assessment: (1) three outpatient consultations with a psychiatrist at three different time points (days 1, 15, and 28), and (2) real-time data collection using an EMA smartphone app with a single, fixed notification per day at 3 pm for 28 days. The results of the real-time data collected were reviewed during the three outpatient consultations by a psychiatrist using a dashboard that aggregated all of the patients’ data into a user-friendly format. Results: Of the 11 patients in the study, 6 patients attended the 3 outpatient consultations with the psychiatrist and completed the HDRS at each consultation. We found a positive correlation between the HDRS score and the variables of self-esteem, guilt, and mood (Spearman correlation coefficient 0.57). Seven patients completed the daily EMAs for 28 days or longer, with an average response rate to the EMAs of 62.5% (175/280). Furthermore, we observed a positive correlation between the number of responses to EMAs and the duration of follow-up (Spearman correlation coefficient 0.63). Conclusions: This preliminary study with a prolonged follow-up demonstrates significant patient compliance with the smartphone app. In addition, the self-assessments performed by patients seemed faithful to the standardized measurements performed by the psychiatrist. The results also suggest that for some patients it is more convenient to use the smartphone app than to attend outpatient consultations. %M 33625367 %R 10.2196/14179 %U https://formative.jmir.org/2021/2/e14179 %U https://doi.org/10.2196/14179 %U http://www.ncbi.nlm.nih.gov/pubmed/33625367 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e22877 %T Smoking Cessation Using Wearable Sensors: Protocol for a Microrandomized Trial %A Hernandez,Laura M %A Wetter,David W %A Kumar,Santosh %A Sutton,Steven K %A Vinci,Christine %+ Moffitt Cancer Center, 4115 E. Fowler Avenue, Tampa, FL, 33617, United States, 1 813 745 5421, Christine.Vinci@moffitt.org %K mHealth %K microrandomized trial %K smoking cessation %K mindfulness %K tobacco %K mobile phone %D 2021 %7 24.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cigarette smoking has numerous health consequences and is the leading cause of morbidity and mortality in the United States. Mindfulness has the ability to enhance resilience to stressors and can strengthen an individual’s ability to deal with discomfort, which may be particularly useful when managing withdrawal and craving to smoke. Objective: This study aims to evaluate feasibility results from an intervention that provides real-time, real-world mindfulness strategies to a sample of racially and ethnically diverse smokers making a quit attempt. Methods: This study uses a microrandomized trial design to deliver mindfulness-based strategies in real time to individuals attempting to quit smoking. Data will be collected via wearable sensors, a study smartphone, and questionnaires filled out during the in-person study visits. Results: Recruitment is complete, and data management is ongoing. Conclusions: The data collected during this feasibility trial will provide preliminary findings about whether mindfulness strategies delivered in real time are a useful quit smoking aid that warrants additional investigation. Trial Registration: Clinicaltrials.gov NCT03404596; https://clinicaltrials.gov/ct2/show/NCT03404596 International Registered Report Identifier (IRRID): DERR1-10.2196/22877 %M 33625366 %R 10.2196/22877 %U https://www.researchprotocols.org/2021/2/e22877 %U https://doi.org/10.2196/22877 %U http://www.ncbi.nlm.nih.gov/pubmed/33625366 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e17262 %T Evaluating a Mobile Phone–Delivered Text Message Reminder Intervention to Reduce Infant Vaccination Dropout in Arua, Uganda: Protocol for a Randomized Controlled Trial %A Ehlman,Daniel C %A Magoola,Joseph %A Tanifum,Patricia %A Wallace,Aaron S %A Behumbiize,Prosper %A Mayanja,Robert %A Luzze,Henry %A Yukich,Joshua %A Daniels,Danni %A Mugenyi,Kevin %A Baryarama,Fulgentius %A Ayebazibwe,Nicholas %A Conklin,Laura %+ Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, United States, 1 4046398224, dehlman@cdc.gov %K immunization %K vaccination %K reminder system %K mHealth %K short message service %K text messages %K cell phone %K mobile phone %K vaccination dropout %K vaccination timeliness %D 2021 %7 24.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, suboptimal vaccine coverage is a public health concern. According to Uganda’s 2016 Demographic and Health Survey, only 49% of 12- to 23-month-old children received all recommended vaccinations by 12 months of age. Innovative ways are needed to increase coverage, reduce dropout, and increase awareness among caregivers to bring children for timely vaccination. Objective: This study evaluates a personalized, automated caregiver mobile phone–delivered text message reminder intervention to reduce the proportion of children who start but do not complete the vaccination series for children aged 12 months and younger in select health facilities in Arua district. Methods: A two-arm, multicenter, parallel group randomized controlled trial was conducted in four health facilities providing vaccination services in and around the town of Arua. Caregivers of children between 6 weeks and 6 months of age at the time of their first dose of pentavalent vaccine (Penta1; containing diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type b antigens) were recruited and interviewed. All participants received the standard of care, defined as the health worker providing child vaccination home-based records to caregivers as available and providing verbal instruction of when to return for the next visit. At the end of each day, caregivers and their children were randomized by computer either to receive or not receive personalized, automated text message reminders for their subsequent vaccination visits according to the national schedule. Text message reminders for Penta2 were sent 2 days before, on the day of, and 2 days after the scheduled vaccination visit. Reminders for Penta3 and the measles-containing vaccine were sent on the scheduled day of vaccination and 5 and 7 days after the scheduled day. Study personnel conducted postintervention follow-up interviews with participants at the health facilities during the children’s measles-containing vaccine visit. In addition, focus group discussions were conducted to assess caregiver acceptability of the intervention, economic data were collected to evaluate the incremental costs and cost-effectiveness of the intervention, and health facility record review forms were completed to capture service delivery process indicators. Results: Of the 3485 screened participants, 1961 were enrolled from a sample size of 1962. Enrollment concluded in August 2016. Follow-up interviews of study participants, including data extraction from the children’s vaccination cards, data extraction from the health facility immunization registers, completion of the health facility record review forms, and focus group discussions were completed by December 2017. The results are expected to be released in 2021. Conclusions: Prompting health-seeking behavior with reminders has been shown to improve health intervention uptake. Mobile phone ownership continues to grow in Uganda, so their use in vaccination interventions such as this study is logical and should be evaluated with scientifically rigorous study designs. Trial Registration: ClinicalTrials.gov NCT04177485; https://clinicaltrials.gov/ct2/show/NCT04177485 International Registered Report Identifier (IRRID): DERR1-10.2196/17262 %M 33625372 %R 10.2196/17262 %U https://www.researchprotocols.org/2021/2/e17262 %U https://doi.org/10.2196/17262 %U http://www.ncbi.nlm.nih.gov/pubmed/33625372 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e20445 %T Effects of Smartphone-Based Stress Management on Improving Work Engagement Among Nurses in Vietnam: Secondary Analysis of a Three-Arm Randomized Controlled Trial %A Sasaki,Natsu %A Imamura,Kotaro %A Tran,Thuy Thi Thu %A Nguyen,Huong Thanh %A Kuribayashi,Kazuto %A Sakuraya,Asuka %A Bui,Thu Minh %A Nguyen,Quynh Thuy %A Nguyen,Nga Thi %A Nguyen,Giang Thi Huong %A Zhang,Melvyn Weibin %A Minas,Harry %A Sekiya,Yuki %A Watanabe,Kazuhiro %A Tsutsumi,Akizumi %A Shimazu,Akihito %A Kawakami,Norito %+ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, , Japan, 81 3 5841 3522, nkawakami@m.u-tokyo.ac.jp %K stress management %K mental health %K occupational health %K digital health %K workplace %K LMICs %K South-East Asia %K health care professionals %D 2021 %7 23.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Work engagement is important for employee well-being and work performance. However, no intervention study has investigated the effect of an eMental Health intervention on work engagement among workers in low- and middle-income countries (LMICs). Objective: The aim of the study was to examine the effects of a newly developed smartphone-based stress management program (ABC Stress Management) on improving work engagement among hospital nurses in Vietnam, an LMIC. Methods: Full-time registered nurses (n=949) were randomly assigned to one of 2 intervention groups or a control group. The intervention groups were a 6-week, 6-lesson program offering basic cognitive behavioral therapy (CBT-based stress management skills), provided in either free-choice (program A) or fixed order (program B). Work engagement was assessed at baseline and 3-month and 7-month follow-ups in each of the 3 groups. Results: The scores of work engagement in both intervention groups improved from baseline to 3-month follow-up, and then decreased at the 7-month follow-up, while the score steadily increased from baseline to 7-month follow-up in the control group. Program B showed a significant intervention effect on improving work engagement at the 3-month follow-up (P=.049) with a small effect size (Cohen d= 0.16; 95% CI 0.001 to 0.43]). Program A showed nonsignificant trend (d=0.13; 95% CI –0.014 to 0.41; P=.07) toward improved engagement at 3 months. Neither program achieved effectiveness at the 7-month follow-up. Conclusions: The study demonstrated that a fixed order (program B) delivery of a smartphone-based stress management program was effective in improving work engagement in nurses in Vietnam. However, the effect was small and only temporary. Further improvement of this program is required to achieve a greater effect size and more sustained, longer lasting impact on work engagement. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000033139; tinyurl.com/55gxo253 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-025138 %M 33620328 %R 10.2196/20445 %U https://www.jmir.org/2021/2/e20445 %U https://doi.org/10.2196/20445 %U http://www.ncbi.nlm.nih.gov/pubmed/33620328 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e27109 %T A Digital Health Intervention (SweetGoals) for Young Adults With Type 1 Diabetes: Protocol for a Factorial Randomized Trial %A Stanger,Catherine %A Kowatsch,Tobias %A Xie,Haiyi %A Nahum-Shani,Inbal %A Lim-Liberty,Frances %A Anderson,Molly %A Santhanam,Prabhakaran %A Kaden,Sarah %A Rosenberg,Briana %+ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 46 Centerra Parkway, Lebanon, NH, , United States, 1 603 646 7023, Catherine.stanger@dartmouth.edu %K type 1 diabetes %K mhealth %K incentives %K health coaching %K young adults %D 2021 %7 23.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Many young adults with type 1 diabetes (T1D) struggle with the complex daily demands of adherence to their medical regimen and fail to achieve target range glycemic control. Few interventions, however, have been developed specifically for this age group. Objective: In this randomized trial, we will provide a mobile app (SweetGoals) to all participants as a “core” intervention. The app prompts participants to upload data from their diabetes devices weekly to a device-agnostic uploader (Glooko), automatically retrieves uploaded data, assesses daily and weekly self-management goals, and generates feedback messages about goal attainment. Further, the trial will test two unique intervention components: (1) incentives to promote consistent daily adherence to goals, and (2) web health coaching to teach effective problem solving focused on personalized barriers to self-management. We will use a novel digital direct-to-patient recruitment method and intervention delivery model that transcends the clinic. Methods: A 2x2 factorial randomized trial will be conducted with 300 young adults ages 19-25 with type 1 diabetes and (Hb)A1c ≥ 8.0%. All participants will receive the SweetGoals app that tracks and provides feedback about two adherence targets: (a) daily glucose monitoring; and (b) mealtime behaviors. Participants will be randomized to the factorial combination of incentives and health coaching. The intervention will last 6 months. The primary outcome will be reduction in A1c. Secondary outcomes include self-regulation mechanisms in longitudinal mediation models and engagement metrics as a predictor of outcomes. Participants will complete 6- and 12-month follow-up assessments. We hypothesize greater sustained A1c improvements in participants who receive coaching and who receive incentives compared to those who do not receive those components. Results: Data collection is expected to be complete by February 2025. Analyses of primary and secondary outcomes are expected by December 2025. Conclusions: Successful completion of these aims will support dissemination and effectiveness studies of this intervention that seeks to improve glycemic control in this high-risk and understudied population of young adults with T1D. Trial Registration: ClinicalTrials.gov NCT04646473; https://clinicaltrials.gov/ct2/show/NCT04646473 International Registered Report Identifier (IRRID): PRR1-10.2196/27109 %M 33620330 %R 10.2196/27109 %U https://www.researchprotocols.org/2021/2/e27109 %U https://doi.org/10.2196/27109 %U http://www.ncbi.nlm.nih.gov/pubmed/33620330 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23612 %T Hybrid Ubiquitous Coaching With a Novel Combination of Mobile and Holographic Conversational Agents Targeting Adherence to Home Exercises: Four Design and Evaluation Studies %A Kowatsch,Tobias %A Lohse,Kim-Morgaine %A Erb,Valérie %A Schittenhelm,Leo %A Galliker,Helen %A Lehner,Rea %A Huang,Elaine M %+ Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, WEV-G, Weinbergstrasse 56/58, Zurich, 8092, Switzerland, 41 712247244, tkowatsch@ethz.ch %K ubiquitous coaching %K augmented reality %K health care %K treatment adherence %K design science research %K physiotherapy %K chronic back pain %K pain %K chronic pain %K exercise %K adherence %K treatment %K conversational agent %K smartphone %K mobile phone %D 2021 %7 22.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective treatments for various conditions such as obesity, cardiac heart diseases, or low back pain require not only personal on-site coaching sessions by health care experts but also a significant amount of home exercises. However, nonadherence to home exercises is still a serious problem as it leads to increased costs due to prolonged treatments. Objective: To improve adherence to home exercises, we propose, implement, and assess the novel coaching concept of hybrid ubiquitous coaching (HUC). In HUC, health care experts are complemented by a conversational agent (CA) that delivers psychoeducation and personalized motivational messages via a smartphone, as well as real-time exercise support, monitoring, and feedback in a hands-free augmented reality environment. Methods: We applied HUC to the field of physiotherapy and conducted 4 design-and-evaluate loops with an interdisciplinary team to assess how HUC is perceived by patients and physiotherapists and whether HUC leads to treatment adherence. A first version of HUC was evaluated by 35 physiotherapy patients in a lab setting to identify patients’ perceptions of HUC. In addition, 11 physiotherapists were interviewed about HUC and assessed whether the CA could help them build up a working alliance with their patients. A second version was then tested by 15 patients in a within-subject experiment to identify the ability of HUC to address adherence and to build a working alliance between the patient and the CA. Finally, a 4-week n-of-1 trial was conducted with 1 patient to show one experience with HUC in depth and thereby potentially reveal real-world benefits and challenges. Results: Patients perceived HUC to be useful, easy to use, and enjoyable, preferred it to state-of-the-art approaches, and expressed their intentions to use it. Moreover, patients built a working alliance with the CA. Physiotherapists saw a relative advantage of HUC compared to current approaches but initially did not see the potential in terms of a working alliance, which changed after seeing the results of HUC in the field. Qualitative feedback from patients indicated that they enjoyed doing the exercise with an augmented reality–based CA and understood better how to do the exercise correctly with HUC. Moreover, physiotherapists highlighted that HUC would be helpful to use in the therapy process. The longitudinal field study resulted in an adherence rate of 92% (11/12 sessions; 330/360 repetitions; 33/36 sets) and a substantial increase in exercise accuracy during the 4 weeks. Conclusions: The overall positive assessments from both patients and health care experts suggest that HUC is a promising tool to be applied in various disorders with a relevant set of home exercises. Future research, however, must implement a variety of exercises and test HUC with patients suffering from different disorders. %M 33461957 %R 10.2196/23612 %U https://www.jmir.org/2021/2/e23612 %U https://doi.org/10.2196/23612 %U http://www.ncbi.nlm.nih.gov/pubmed/33461957 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e23080 %T Effect of an mHealth Intervention on Hepatitis C Testing Uptake Among People With Opioid Use Disorder: Randomized Controlled Trial %A Hochstatter,Karli R %A Gustafson Sr,David H %A Landucci,Gina %A Pe-Romashko,Klaren %A Cody,Olivia %A Maus,Adam %A Shah,Dhavan V %A Westergaard,Ryan P %+ School of Social Work, Columbia University, 1255 Amsterdam Ave, New York, NY, 10027, United States, 1 9209600002, khochsta@medicine.wisc.edu %K intravenous injections %K mHealth %K hepatitis C virus %K opioid use disorder %K mobile phone %D 2021 %7 22.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The growing epidemic of opioid use disorder (OUD) and associated injection drug use has resulted in a surge of new hepatitis C virus (HCV) infections. Approximately half of the people with HCV infection are unaware of their HCV status. Improving HCV awareness and increasing screening among people with OUD are critical. Addiction-Comprehensive Health Enhancement Support System (A-CHESS) is an evidence-based, smartphone-delivered relapse prevention system that has been implemented among people with OUD who are receiving medications for addiction treatment (MAT) to improve long-term recovery. Objective: We incorporated HCV-related content and functionality into A-CHESS to characterize the HCV care continuum among people in early remission and receiving MAT for OUD and to determine whether incorporating such content and functionality into A-CHESS increases HCV testing. Methods: HCV intervention content, including dissemination of educational information, private messages tailored to individuals’ stage of HCV care, and a public discussion forum, was implemented into the A-CHESS platform. Between April 2016 and April 2020, 416 participants with OUD were enrolled in this study. Participants were randomly assigned to receive MAT alone (control arm) or MAT+A-CHESS (experimental arm). Quarterly telephone interviews were conducted from baseline to month 24 to assess risk behaviors and HCV testing history. Cox proportional hazards regression was used to assess whether participants who used A-CHESS were tested for HCV (either antibody [Ab] or RNA testing) at a higher rate than those in the control arm. To assess the effect of A-CHESS on subsets of participants at the highest risk for HCV, additional analyses were performed to examine the effect of the intervention among participants who injected drugs and shared injection equipment. Results: Overall, 44.2% (184/416) of the study participants were HCV Ab positive, 30.3% (126/416) were HCV Ab negative, and 25.5% (106/416) were considered untested at baseline. At month 24, there was no overall difference in HCV testing uptake between the intervention and control participants. However, among the subset of 109 participants who engaged in injection drug use, there was a slight trend toward increased HCV testing uptake among those who used A-CHESS (89% vs 85%; hazard ratio: 1.34; 95% CI 0.87-2.05; P=.18), and a stronger trend was observed when focusing on the subset of 32 participants who reported sharing injection equipment (87% vs 56%; hazard ratio: 2.92; 95% CI 0.959-8.86; P=.06). Conclusions: Incorporating HCV prevention and care information into A-CHESS may increase the uptake of HCV testing while preventing opioid relapse when implemented among populations who engage in high-risk behaviors such as sharing contaminated injection equipment. However, more studies that are powered to detect differences in HCV testing among high-risk groups are needed. Trial Registration: ClinicalTrials.gov NCT02712034; https://clinicaltrials.gov/ct2/show/NCT02712034 International Registered Report Identifier (IRRID): RR2-10.2196/12620 %M 33616545 %R 10.2196/23080 %U https://mhealth.jmir.org/2021/2/e23080 %U https://doi.org/10.2196/23080 %U http://www.ncbi.nlm.nih.gov/pubmed/33616545 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23786 %T Effects of eHealth-Based Multiple Health Behavior Change Interventions on Physical Activity, Healthy Diet, and Weight in People With Noncommunicable Diseases: Systematic Review and Meta-analysis %A Duan,Yanping %A Shang,Borui %A Liang,Wei %A Du,Gaohui %A Yang,Min %A Rhodes,Ryan E %+ Department of Social Sciences, Hebei Sport University, 82 Xuefu Road, Shijiazhuang, 050041, China, 86 15383112089, borui_shang_pe@qq.com %K systematic review %K meta-analysis %K noncommunicable disease %K multiple health behavior change %K weight-related %K physical activity %K healthy diet %K eHealth %D 2021 %7 22.2.2021 %9 Review %J J Med Internet Res %G English %X Background: Noncommunicable diseases (NCDs) are associated with the burden of premature deaths and huge medical costs globally. There is an increasing number of studies combining a multiple health behavior change (MHBC) intervention paradigm with eHealth approaches to jointly promote weight-related health behaviors among people with NCD; yet, a comprehensive summary of these studies is lacking. Objective: This review aims to meta-analyze the effectiveness and systematically summarize the characteristics of the relevant intervention studies for improving the outcomes of physical activity, healthy diet, and weight among people with NCD. Methods: Following PRISMA guidelines, 4 electronic databases (PsycINFO, PubMed, Scopus, SPORTDiscus) were systematically searched to identify eligible articles based on a series of inclusion and exclusion criteria. Article selection, quality assessment, and data extraction were independently performed by 2 authors. The standardized mean difference (SMD) was calculated to evaluate the effectiveness of interventions for 3 intervention outcomes (physical activity, healthy diet, and weight), and subsequent subgroup analyses were performed for gender, age, intervention duration, channel, and theory. Calculations were conducted, and figures were produced in SPSS 22 and Review Manager 5.3. Results: Of the 664 original hits generated by the systematic searches, 15 eligible studies with moderate to high quality were included. No potential publication bias was detected using statistical analyses. Studies varied in intervention channel, intensity, and content. The meta-analysis revealed that the eHealth MHBC interventions significantly promoted physical activity (SMD 0.85, 95% CI 0.23 to 1.47, P=.008) and healthy diet (SMD 0.78, 95% CI 0.13 to 1.43, P=.02), but did not contribute to a healthy weight status (SMD –0.13, 95% CI= –0.47 to 0.20, P=.43) among people with NCDs, compared to the control conditions. Results from subgroup analysis indicated that theory-based interventions achieved greater effect than nontheory-based interventions in promoting physical activity, and interventions with traditional approaches (SMS, telephone) were more effective than those with modern internet-based approaches in promoting healthy diet. Conclusions: The results of this review indicates that eHealth MHBC interventions achieve preliminary success in promoting physical activity and healthy diet behaviors among people with NCD. Future studies could improve the intervention design to achieve better intervention effectiveness. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019118629; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=118629 %M 33616534 %R 10.2196/23786 %U https://www.jmir.org/2021/2/e23786 %U https://doi.org/10.2196/23786 %U http://www.ncbi.nlm.nih.gov/pubmed/33616534 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e22572 %T A Theory-Based mHealth Intervention (Getting Off) for Methamphetamine-Using Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial %A Reback,Cathy J %A Fletcher,Jesse B %A Mata,Raymond P %+ Friends Research Institution, Inc, 6910 Santa Monica Blvd, Los Angeles, CA, 90038, United States, 1 323 463 1601, rmata@friendsresearch.org %K HIV %K AIDS %K methamphetamine %K mHealth %K mobile app %K ART %K mobile phone %D 2021 %7 22.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Methamphetamine (meth) use among men who have sex with men (MSM) is associated with increased HIV prevalence and transmission and substandard advancement along the HIV prevention and care continuum. Given the growth of mobile health (mHealth) technologies, it is no longer necessary to limit meth treatment options to physical, brick-and-mortar sites, and administration using generic, nontailored content. Objective: In a 2-arm randomized controlled trial (RCT; N=300), we aim to evaluate the use of an mHealth intervention (Getting Off) to assess the impact and noninferiority of a cross-platform app (developed from a manualized meth treatment intervention) to help MSM reduce meth use and HIV sexual risk behaviors and improve their advancement along the HIV prevention and care continuum (HIV testing, pre-exposure prophylaxis uptake and persistence, and antiretroviral therapy uptake and adherence). Methods: Participants will be randomized into 2 arms: arm A, with immediate access to the app (immediate delivery: n=150), or arm B, with delayed access to the app after a 30-day period (delayed delivery: n=150). Participants in both arms will use the same Getting Off app and will have 30 days to complete the 24 sessions. Participants will be assessed at the 1-, 2- (delayed delivery arm only), 3-, 6-, and 9-month timepoints to determine observed treatment effects and will be compared with a historical matched sample of participants (n=~600) who received the brick-and-mortar group-based Getting Off intervention. Results: Recruitment began in January 2019 for phase 1, the formative phase. In January and February 2019, 4 focus groups (N=36) were formed to provide input on the adaptation of the group-based manual intervention to a mobile app. Data collection for phase 2, the RCT, is expected to be completed in January 2023. The final results are anticipated in April 2023. Conclusions: By creating a culturally responsive mobile app, Getting Off aims to reduce meth use and improve sexual health outcomes among meth-using MSM. The Getting Off app could have significant public health impact by greatly expanding access to effective, affordable, private, culturally competent, and highly scalable meth treatment for MSM. Trial Registration: Clinicaltrials.gov NCT03884946; https://clinicaltrials.gov/ct2/show/NCT03884946 International Registered Report Identifier (IRRID): DERR1-10.2196/22572 %M 33616547 %R 10.2196/22572 %U https://www.researchprotocols.org/2021/2/e22572 %U https://doi.org/10.2196/22572 %U http://www.ncbi.nlm.nih.gov/pubmed/33616547 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e22277 %T Characteristics of the Users of Troubled Desire, a Web-Based Self-management App for Individuals With Sexual Interest in Children: Descriptive Analysis of Self-assessment Data %A Schuler,Miriam %A Gieseler,Hannes %A Schweder,Katharina W %A von Heyden,Maximilian %A Beier,Klaus M %+ Department of Health and Human Sciences, Institute of Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin, Charitépl 1, Berlin, 10117, Germany, 49 30 450 520 339, miriam.schuler@charite.de %K pedophilia %K hebephilia %K child sexual offenses %K child sexual abuse material %K web-based assessment %K web-based treatment %D 2021 %7 19.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite the high prevalence of child sexual offenses and the increasing amounts of available child sexual abuse material, there is a global shortage of preventive interventions focusing on individuals at risk of sexual offending. The web-based app Troubled Desire aims to address this shortage by offering self-assessments and self-management training modules in different languages to individuals with sexual interests in prepubescent and early pubescent children (ie, those with pedophilic and hebephiliac sexual interest, respectively). Objective: The aim of this study was to describe the characteristics of the users of the Troubled Desire app. Methods: The fully completed self-assessment data gathered within the first 30 months of this study from October 25, 2017 to April 25, 2020 were investigated. The main outcome measures were (1) sociodemographic information and (2) sexual interests and sexual behaviors of the users of Troubled Desire. Results: The self-assessment was completed by 4161 users. User accesses were mainly from Germany (2277/4161, 54.7%) and the United States (474/4161, 11.4%). Approximately 78.9% (3281/4161) of the users reported sexual interest in children; these users were significantly more likely to report distress and trouble owing to their sexual interest. Further, child sexual offenses and consumption of child sexual abuse material were significantly more common among users with sexual interest in children than among users with no sexual interest in children. Additionally, the majority of the offenses were not known to legal authorities. Conclusions: The Troubled Desire app is useful in reaching out to individuals with sexual interest in prepubescent and early pubescent children. However, future research is warranted to understand the prospective relevance of the Troubled Desire app in the prevention of child sexual offending. %M 33605895 %R 10.2196/22277 %U http://mental.jmir.org/2021/2/e22277/ %U https://doi.org/10.2196/22277 %U http://www.ncbi.nlm.nih.gov/pubmed/33605895 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23180 %T Associations Between Digital Health Intervention Engagement, Physical Activity, and Sedentary Behavior: Systematic Review and Meta-analysis %A Mclaughlin,Matthew %A Delaney,Tessa %A Hall,Alix %A Byaruhanga,Judith %A Mackie,Paul %A Grady,Alice %A Reilly,Kathryn %A Campbell,Elizabeth %A Sutherland,Rachel %A Wiggers,John %A Wolfenden,Luke %+ School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 02 4924 6477, Matthew.Mclaughlin1@health.nsw.gov.au %K engagement %K adherence %K digital health intervention %K digital behavior change intervention %K physical activity %K sedentary behavior %K mobile phone %D 2021 %7 19.2.2021 %9 Review %J J Med Internet Res %G English %X Background: The effectiveness of digital health interventions is commonly assumed to be related to the level of user engagement with the digital health intervention, including measures of both digital health intervention use and users’ subjective experience. However, little is known about the relationships between the measures of digital health intervention engagement and physical activity or sedentary behavior. Objective: This study aims to describe the direction and strength of the association between engagement with digital health interventions and physical activity or sedentary behavior in adults and explore whether the direction of association of digital health intervention engagement with physical activity or sedentary behavior varies with the type of engagement with the digital health intervention (ie, subjective experience, activities completed, time, and logins). Methods: Four databases were searched from inception to December 2019. Grey literature and reference lists of key systematic reviews and journals were also searched. Studies were eligible for inclusion if they examined a quantitative association between a measure of engagement with a digital health intervention targeting physical activity and a measure of physical activity or sedentary behavior in adults (aged ≥18 years). Studies that purposely sampled or recruited individuals on the basis of pre-existing health-related conditions were excluded. In addition, studies were excluded if the individual engaging with the digital health intervention was not the target of the physical activity intervention, the study had a non–digital health intervention component, or the digital health interventions targeted multiple health behaviors. A random effects meta-analysis and direction of association vote counting (for studies not included in meta-analysis) were used to address objective 1. Objective 2 used vote counting on the direction of the association. Results: Overall, 10,653 unique citations were identified and 375 full texts were reviewed. Of these, 19 studies (26 associations) were included in the review, with no studies reporting a measure of sedentary behavior. A meta-analysis of 11 studies indicated a small statistically significant positive association between digital health engagement (based on all usage measures) and physical activity (0.08, 95% CI 0.01-0.14, SD 0.11). Heterogeneity was high, with 77% of the variation in the point estimates explained by the between-study heterogeneity. Vote counting indicated that the relationship between physical activity and digital health intervention engagement was consistently positive for three measures: subjective experience measures (2 of 3 associations), activities completed (5 of 8 associations), and logins (6 of 10 associations). However, the direction of associations between physical activity and time-based measures of usage (time spent using the intervention) were mixed (2 of 5 associations supported the hypothesis, 2 were inconclusive, and 1 rejected the hypothesis). Conclusions: The findings indicate a weak but consistent positive association between engagement with a physical activity digital health intervention and physical activity outcomes. No studies have targeted sedentary behavior outcomes. The findings were consistent across most constructs of engagement; however, the associations were weak. %M 33605897 %R 10.2196/23180 %U http://www.jmir.org/2021/2/e23180/ %U https://doi.org/10.2196/23180 %U http://www.ncbi.nlm.nih.gov/pubmed/33605897 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 6 %N 1 %P e24030 %T Role of Digital Engagement in Diabetes Care Beyond Measurement: Retrospective Cohort Study %A Fundoiano-Hershcovitz,Yifat %A Hirsch,Abigail %A Dar,Sharon %A Feniger,Eitan %A Goldstein,Pavel %+ DarioHealth, Hatochen, 8, Caesarea, 3088900, Israel, 972 525296979, Yifat@mydario.com %K blood glucose %K mHealth %K diabetes %K self-management %K digital engagement %D 2021 %7 18.2.2021 %9 Original Paper %J JMIR Diabetes %G English %X Background: The use of remote data capture for monitoring blood glucose and supporting digital apps is becoming the norm in diabetes care. One common goal of such apps is to increase user awareness and engagement with their day-to-day health-related behaviors (digital engagement) in order to improve diabetes outcomes. However, we lack a deep understanding of the complicated association between digital engagement and diabetes outcomes. Objective: This study investigated the association between digital engagement (operationalized as tagging of behaviors alongside glucose measurements) and the monthly average blood glucose level in persons with type 2 diabetes during the first year of managing their diabetes with a digital chronic disease management platform. We hypothesize that during the first 6 months, blood glucose levels will drop faster and further in patients with increased digital engagement and that difference in outcomes will persist for the remainder of the year. Finally, we hypothesize that disaggregated between- and within-person variabilities in digital engagement will predict individual-level changes in blood glucose levels. Methods: This retrospective real-world analysis followed 998 people with type 2 diabetes who regularly tracked their blood glucose levels with the Dario digital therapeutics platform for chronic diseases. Subjects included “nontaggers” (users who rarely or never used app features to notice and track mealtime, food, exercise, mood, and location, n=585) and “taggers” (users who used these features, n=413) representing increased digital engagement. Within- and between-person variabilities in tagging behavior were disaggregated to reveal the association between tagging behavior and blood glucose levels. The associations between an individual’s tagging behavior in a given month and the monthly average blood glucose level in the following month were analyzed for quasicausal effects. A generalized mixed piecewise statistical framework was applied throughout. Results: Analysis revealed significant improvement in the monthly average blood glucose level during the first 6 months (t=−10.01, P<.001), which was maintained during the following 6 months (t=−1.54, P=.12). Moreover, taggers demonstrated a significantly steeper improvement in the initial period relative to nontaggers (t=2.15, P=.03). Additional findings included a within-user quasicausal nonlinear link between tagging behavior and glucose control improvement with a 1-month lag. More specifically, increased tagging behavior in any given month resulted in a 43% improvement in glucose levels in the next month up to a person-specific average in tagging intensity (t=−11.02, P<.001). Above that within-person mean level of digital engagement, glucose levels remained stable but did not show additional improvement with increased tagging (t=0.82, P=.41). When assessed alongside within-person effects, between-person changes in tagging behavior were not associated with changes in monthly average glucose levels (t=1.30, P=.20). Conclusions: This study sheds light on the source of the association between user engagement with a diabetes tracking app and the clinical condition, highlighting the importance of within-person changes versus between-person differences. Our findings underscore the need for and provide a basis for a personalized approach to digital health. %M 33599618 %R 10.2196/24030 %U http://diabetes.jmir.org/2021/1/e24030/ %U https://doi.org/10.2196/24030 %U http://www.ncbi.nlm.nih.gov/pubmed/33599618 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e20217 %T eHealth Intervention to Improve Health Habits in the Adolescent Population: Mixed Methods Study %A Benavides,Carmen %A Benítez-Andrades,José Alberto %A Marqués-Sánchez,Pilar %A Arias,Natalia %+ SALBIS Research Group, Department of Electric, Systems and Automatics Engineering, University of León, Campus de Vegazana s/n, León, Spain, 34 987293628, jbena@unileon.es %K adolescent behaviors %K BMI %K diet %K healthy habits %K intervention %K leader %K physical activity %K social network analysis %K adolescent %K social network %K behavior %D 2021 %7 18.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Technology has provided a new way of life for the adolescent population. Indeed, strategies aimed at improving health-related behaviors through digital platforms can offer promising results. However, since it has been shown that peers are capable of modifying behaviors related to food and physical exercise, it is important to study whether digital interventions based on peer influence are capable of improving the weight status of adolescents. Objective: The purpose of this study was to assess the effectiveness of an eHealth app in an adolescent population in terms of improvements in their age- and sex-adjusted BMI percentiles. Other goals of the study were to examine the social relationships of adolescents pre- and postintervention, and to identify the group leaders and study their profiles, eating and physical activity habits, and use of the web app. Methods: The BMI percentiles were calculated in accordance with the reference guidelines of the World Health Organization. Participants’ diets and levels of physical activity were assessed using the Mediterranean Diet Quality Index (KIDMED) questionnaire and the Physical Activity Questionnaire for Adolescents (PAQ-A), respectively. The variables related to social networks were analyzed using the social network analysis (SNA) methodology. In this respect, peer relationships that were considered reciprocal friendships were used to compute the “degree” measure, which was used as an indicative parameter of centrality. Results: The sample population comprised 210 individuals in the intervention group (IG) and 91 individuals in the control group (CG). A participation rate of 60.1% (301/501) was obtained. After checking for homogeneity between the IG and the CG, it was found that adolescents in the IG at BMI percentiles both below and above the 50th percentile (P50) modified their BMI to approach this reference value (with a significance of P<.001 among individuals with an initial BMI below the P50 and P=.04 for those with an initial BMI above the P50). The diet was also improved in the IG compared with the CG (P<.001). After verifying that the social network had increased postintervention, it was seen that the group leaders (according to the degree SNA measure) were also leaders in physical activity performed (P=.002) and use of the app. Conclusions: The eHealth app was able to modify behaviors related to P50 compliance and exert a positive influence in relation to diet and physical exercise. Digital interventions in the adolescent population, based on the improvement in behaviors related to healthy habits and optimizing the social network, can offer promising results that help in the fight against obesity. %M 33599616 %R 10.2196/20217 %U http://mhealth.jmir.org/2021/2/e20217/ %U https://doi.org/10.2196/20217 %U http://www.ncbi.nlm.nih.gov/pubmed/33599616 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e24607 %T Framework for the Design Engineering and Clinical Implementation and Evaluation of mHealth Apps for Sleep Disturbance: Systematic Review %A Aji,Melissa %A Gordon,Christopher %A Stratton,Elizabeth %A Calvo,Rafael A %A Bartlett,Delwyn %A Grunstein,Ronald %A Glozier,Nick %+ Brain and Mind Center, The University of Sydney, Level 5, Professor Marie Bashir Centre, Missenden Road, Camperdown, 2050, Australia, 61 29515 1596, nick.glozier@sydney.edu.au %K mobile applications %K sleep %K insomnia %K internet-based intervention %K mHealth %K mobile health %K systematic review %D 2021 %7 17.2.2021 %9 Review %J J Med Internet Res %G English %X Background: Mobile health (mHealth) apps offer a scalable option for treating sleep disturbances at a population level. However, there is a lack of clarity about the development and evaluation of evidence-based mHealth apps. Objective: The aim of this systematic review was to provide evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. Methods: A systematic search of studies published from the inception of databases through February 2020 was conducted using 5 databases (MEDLINE, Embase, Cochrane Library, PsycINFO, and CINAHL). Results: A total of 6015 papers were identified using the search strategy. After screening, 15 papers were identified that examined the design engineering and clinical implementation and evaluation of 8 different mHealth apps for sleep disturbance. Most of these apps delivered cognitive behavioral therapy for insomnia (CBT-I, n=4) or modified CBT-I (n=2). Half of the apps (n=4) identified adopting user-centered design or multidisciplinary teams in their design approach. Only 3 papers described user and data privacy. End-user acceptability and engagement were the most frequently assessed implementation metrics. Only 1 app had available evidence assessing all 4 implementation metrics (ie, acceptability, engagement, usability, and adherence). Most apps were prototype versions (n=5), with few matured apps. A total of 6 apps had supporting papers that provided a quantitative evaluation of clinical outcomes, but only 1 app had a supporting, adequately powered randomized controlled trial. Conclusions: This is the first systematic review to synthesize and examine evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. The minimal number of apps with published evidence for design engineering and clinical implementation and evaluation contrasts starkly with the number of commercial sleep apps available. Moreover, there appears to be no standardization and consistency in the use of best practice design approaches and implementation assessments, along with very few rigorous efficacy evaluations. To facilitate the development of successful and evidence-based apps for sleep disturbance, we developed a high-level framework to guide researchers and app developers in the end-to-end process of app development and evaluation. %M 33595441 %R 10.2196/24607 %U http://www.jmir.org/2021/2/e24607/ %U https://doi.org/10.2196/24607 %U http://www.ncbi.nlm.nih.gov/pubmed/33595441 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e21432 %T Usage and Weekly Attrition in a Smartphone-Based Health Behavior Intervention for Adolescents: Pilot Randomized Controlled Trial %A Egilsson,Erlendur %A Bjarnason,Ragnar %A Njardvik,Urdur %+ Department of Psychology, University of Iceland, Sturlugata 1, Reykjavik, 101, Iceland, 354 6184805, erlendu@hi.is %K mHealth %K intervention %K adolescent %K attrition %K self-efficacy %K mental health %K physical activity %K young adult %K behavior %D 2021 %7 17.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The majority of adolescents own smartphones, although only 8% of them use health apps. Attrition rates from adolescent mobile health (mHealth) interventions for treating mental health problems such as anxiety and depression are an issue with a high degree of variation. Attrition in mHealth interventions targeting adolescent populations is frequently presented in a two-point fashion, from initiation of the intervention to the end of treatment, lacking more time-specific information on usage and times of attrition. Self-efficacy could provide an avenue to lower attrition rates, although a better understanding of the relationship between mental health factors and time-specific attrition rates is needed. Objective: The aims of this study were to obtain time-specific attrition rates among adolescents in an mHealth intervention, and to describe the intervention’s usage and feasibility in relation to adolescent self-efficacy levels, and emotional and physical health. Methods: A single-center randomized controlled public school pilot trial was undertaken with 41 adolescents. Outcome measures were assessed at baseline and after 6 weeks, while in-app activity and attrition rates were continually assessed throughout the intervention period. The primary outcome was attrition based on time and type of in-app health behavior usage, and feasibility of the mHealth app. Secondary outcome measures were self-efficacy levels, depressive and anxiety symptoms, as well as standardized BMI and sleep. Analyses of group mean variances with adjusted α levels through Bonferroni corrections were used to assess main outcome effects. Results: The attrition from initiation of the intervention to 6-week follow up was 35%. Attrition started in the third week of the intervention and was related to daily time of app usage (Rt=0.43, P<.001). The number of average weekly in-app health exercises completed decreased significantly from the first week of the intervention (mean 55.25, SD 10.96) to the next week (mean 13.63, SD 2.94). However, usage increased by 22% between week 2 and the last week of the intervention (mean 16.69, SD 8.37). Usability measures revealed satisfactory scores (mean 78.09, SD 9.82) without gender differences (P=.85). Self-reported daily physical activity increased by 19.61% in the intervention group but dropped by 26.21% among controls. Self-efficacy levels increased by 8.23% in the invention arm compared to a 3.03% decrease in the control group. Conclusions: This pilot study demonstrated the feasibility and usability of an mHealth intervention among adolescent participants. Indications were toward beneficial effects on physical and mental health that warrant further research. Focus on time-specific attrition measures alongside daily times of usage and ways to increase participants’ self-efficacy levels appear to be a promising avenue for research on mHealth interventions for adolescent populations with the aim to ultimately lower attrition rates. %M 33481750 %R 10.2196/21432 %U http://formative.jmir.org/2021/2/e21432/ %U https://doi.org/10.2196/21432 %U http://www.ncbi.nlm.nih.gov/pubmed/33481750 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e20700 %T Sociodemographic, Health and Lifestyle, Sampling, and Mental Health Determinants of 24-Hour Motor Activity Patterns: Observational Study %A Difrancesco,Sonia %A Riese,Harriëtte %A Merikangas,Kathleen R %A Shou,Haochang %A Zipunnikov,Vadim %A Antypa,Niki %A van Hemert,Albert M %A Schoevers,Robert A %A Penninx,Brenda W J H %A Lamers,Femke %+ Amsterdam Public Health Research Institute, Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Oldenaller 1, Amsterdam, 1078XL, Netherlands, 31 643193730, s.difrancesco@ggzingeest.nl %K actigraphy %K functional data analysis %K mental health %K well-being %K activity %D 2021 %7 17.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Analyzing actigraphy data using standard circadian parametric models and aggregated nonparametric indices may obscure temporal information that may be a hallmark of the circadian impairment in psychiatric disorders. Functional data analysis (FDA) may overcome such limitations by fully exploiting the richness of actigraphy data and revealing important relationships with mental health outcomes. To our knowledge, no studies have extensively used FDA to study the relationship between sociodemographic, health and lifestyle, sampling, and psychiatric clinical characteristics and daily motor activity patterns assessed with actigraphy in a sample of individuals with and without depression/anxiety. Objective: We aimed to study the association between daily motor activity patterns assessed via actigraphy and (1) sociodemographic, health and lifestyle, and sampling factors, and (2) psychiatric clinical characteristics (ie, presence and severity of depression/anxiety disorders). Methods: We obtained 14-day continuous actigraphy data from 359 participants from the Netherlands Study of Depression and Anxiety with current (n=93), remitted (n=176), or no (n=90) depression/anxiety diagnosis, based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Associations between patterns of daily motor activity, quantified via functional principal component analysis (fPCA), and sociodemographic, health and lifestyle, sampling, and psychiatric clinical characteristics were assessed using generalized estimating equation regressions. For exploratory purposes, function-on-scalar regression (FoSR) was applied to quantify the time-varying association of sociodemographic, health and lifestyle, sampling, and psychiatric clinical characteristics on daily motor activity. Results: Four components of daily activity patterns captured 77.4% of the variability in the data: overall daily activity level (fPCA1, 34.3% variability), early versus late morning activity (fPCA2, 16.5% variability), biphasic versus monophasic activity (fPCA3, 14.8% variability), and early versus late biphasic activity (fPCA4, 11.8% variability). A low overall daily activity level was associated with a number of sociodemographic, health and lifestyle, and psychopathology variables: older age (P<.001), higher education level (P=.005), higher BMI (P=.009), greater number of chronic diseases (P=.02), greater number of cigarettes smoked per day (P=.02), current depressive and/or anxiety disorders (P=.05), and greater severity of depressive symptoms (P<.001). A high overall daily activity level was associated with work/school days (P=.02) and summer (reference: winter; P=.03). Earlier morning activity was associated with older age (P=.02), having a partner (P=.009), work/school days (P<.001), and autumn and spring (reference: winter; P=.02 and P<.001, respectively). Monophasic activity was associated with older age (P=.005). Biphasic activity was associated with work/school days (P<.001) and summer (reference: winter; P<.001). Earlier biphasic activity was associated with older age (P=.005), work/school days (P<.001), and spring and summer (reference: winter; P<.001 and P=.005, respectively). In FoSR analyses, age, work/school days, and season were the main determinants having a time-varying association with daily motor activity (all P<.05). Conclusions: Features of daily motor activity extracted with fPCA reflect commonly studied factors such as the intensity of daily activity and preference for morningness/eveningness. The presence and severity of depression/anxiety disorders were found to be associated mainly with a lower overall activity pattern but not with the time of the activity. Age, work/school days, and season were the variables most strongly associated with patterns and time of activity, and thus future epidemiological studies on motor activity in depression/anxiety should take these variables into account. %M 33595445 %R 10.2196/20700 %U http://www.jmir.org/2021/2/e20700/ %U https://doi.org/10.2196/20700 %U http://www.ncbi.nlm.nih.gov/pubmed/33595445 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e18899 %T Addressing Care Continuity and Quality Challenges in the Management of Hypertension: Case Study of the Private Health Care Sector in Kenya %A Walcott-Bryant,Aisha %A Ogallo,William %A Remy,Sekou L %A Tryon,Katherine %A Shena,Winnie %A Bosker-Kibacha,Marloes %+ IBM Research Africa, Catholic University of Eastern Africa, Nairobi, , Kenya, 254 703023000, william.ogallo@ibm.com %K hypertension %K health information systems %K mobile phone %K private sector %K Kenya %D 2021 %7 17.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Hypertension is a major risk factor of cardiovascular disease and a leading cause of morbidity and mortality globally. In Kenya, the rise of hypertension strains an already stretched health care system that has traditionally focused on the management of infectious diseases. Health care provision in this country remains fragmented, and little is known about the role of health information technology in care coordination. Furthermore, there is a dearth of literature on the experiences, challenges, and solutions for improving the management of hypertension and other noncommunicable diseases in the Kenyan private health care sector. Objective: The aim of this study is to assess stakeholders’ perspectives on the challenges associated with the management of hypertension in the Kenyan private health care sector and to derive recommendations for the design and functionality of a digital health solution for addressing the care continuity and quality challenges in the management of hypertension. Methods: We conducted a qualitative case study. We collected data using in-depth interviews with 18 care providers and 8 business leads, and direct observations at 18 private health care institutions in Nairobi, Kenya. We analyzed the data thematically to identify the key challenges and recommendations for technology-enabled solutions to support the management of hypertension in the Kenyan private health sector. We subsequently used the generated insights to derive and describe the design and range of functions of a digital health wallet platform for enabling care quality and continuity. Results: The management of hypertension in the Kenyan private health care sector is characterized by challenges such as high cost of care, limited health care literacy, lack of self-management support, ineffective referral systems, inadequate care provider training, and inadequate regulation. Care providers lack the tools needed to understand their patients’ care histories and effectively coordinate efforts to deliver high-quality hypertension care. The proposed digital health platform was designed to support hypertension care coordination and continuity through clinical workflow orchestration, decision support, and patient-mediated data sharing with privacy preservation, auditability, and trust enabled by blockchain technology. Conclusions: The Kenyan private health care sector faces key challenges that require significant policy, organizational, and infrastructural changes to ensure care quality and continuity in the management of hypertension. Digital health data interoperability solutions are needed to improve hypertension care coordination in the sector. Additional studies should investigate how patients can control the sharing of their data while ensuring that care providers have a holistic view of the patient during any encounter. %M 33595446 %R 10.2196/18899 %U http://www.jmir.org/2021/2/e18899/ %U https://doi.org/10.2196/18899 %U http://www.ncbi.nlm.nih.gov/pubmed/33595446 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e20329 %T Induction of Efficacy Expectancies in an Ambulatory Smartphone-Based Digital Placebo Mental Health Intervention: Randomized Controlled Trial %A Stalujanis,Esther %A Neufeld,Joel %A Glaus Stalder,Martina %A Belardi,Angelo %A Tegethoff,Marion %A Meinlschmidt,Gunther %+ Department of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University Berlin, Stromstraße 1, Berlin, 10555, Germany, 49 30 300117 710, gunther.meinlschmidt@ipu-berlin.de %K digital placebo effect %K efficacy expectancies %K ecological momentary assessment %K mHealth %K mobile phone %K placebo effect %K randomized controlled trial %K smartphone-based intervention %D 2021 %7 17.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is certain evidence on the efficacy of smartphone-based mental health interventions. However, the mechanisms of action remain unclear. Placebo effects contribute to the efficacy of face-to-face mental health interventions and may also be a potential mechanism of action in smartphone-based interventions. Objective: This study aimed to investigate whether different types of efficacy expectancies as potential factors underlying placebo effects could be successfully induced in a smartphone-based digital placebo mental health intervention, ostensibly targeting mood and stress. Methods: We conducted a randomized, controlled, single-blinded, superiority trial with a multi-arm parallel design. Participants underwent an Android smartphone-based digital placebo mental health intervention for 20 days. We induced prospective efficacy expectancies via initial instructions on the purpose of the intervention and retrospective efficacy expectancies via feedback on the success of the intervention at days 1, 4, 7, 10, and 13. A total of 132 healthy participants were randomized to a prospective expectancy–only condition (n=33), a retrospective expectancy–only condition (n=33), a combined expectancy condition (n=34), or a control condition (n=32). As the endpoint, we assessed changes in efficacy expectancies with the Credibility Expectancy Questionnaire, before the intervention and on days 1, 7, 14, and 20. For statistical analyses, we used a random effects model for the intention-to-treat sample, with intervention day as time variable and condition as two factors: prospective expectancy (yes vs no) and retrospective expectancy (yes vs no), allowed to vary over participant and intervention day. Results: Credibility (β=−1.63; 95% CI −2.37 to −0.89; P<.001) and expectancy (β=−0.77; 95% CI −1.49 to −0.05; P=.04) decreased across the intervention days. For credibility and expectancy, we found significant three-way interactions: intervention day×prospective expectancy×retrospective expectancy (credibility: β=2.05; 95% CI 0.60-3.50; P=.006; expectancy: β=1.55; 95% CI 0.14-2.95; P=.03), suggesting that efficacy expectancies decreased least in the combined expectancy condition and the control condition. Conclusions: To our knowledge, this is the first empirical study investigating whether efficacy expectancies can be successfully induced in a specifically designed placebo smartphone-based mental health intervention. Our findings may pave the way to diminish or exploit digital placebo effects and help to improve the efficacy of digital mental health interventions. Trial Registration: Clinicaltrials.gov NCT02365220; https://clinicaltrials.gov/ct2/show/NCT02365220. %M 33594991 %R 10.2196/20329 %U http://mhealth.jmir.org/2021/2/e20329/ %U https://doi.org/10.2196/20329 %U http://www.ncbi.nlm.nih.gov/pubmed/33594991 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e18288 %T Acceptability of a Mobile Health Behavior Change Intervention for Cancer Survivors With Obesity or Overweight: Nested Mixed Methods Study Within a Randomized Controlled Trial %A Groarke,Jenny M %A Richmond,Janice %A Mc Sharry,Jenny %A Groarke,AnnMarie %A Harney,Owen M %A Kelly,Mary Grace %A Walsh,Jane C %+ Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, 18-30 Malone Road, Belfast, BT71NN, United Kingdom, 44 28 90974886, j.groarke@qub.ac.uk %K mHealth %K self-management %K text messaging %K activity tracker %K exercise %K diet %K overweight %K obesity %K cancer survivors %K qualitative research %K mobile phone %D 2021 %7 16.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A significant proportion of cancer survivors have overweight or obesity. Although this has negative implications for health, weight management is not a standard component of oncology aftercare. Mobile health (mHealth) technology, in combination with behavior change techniques (BCTs), has the potential to support positive lifestyle changes. Few studies have been carried out with cancer survivors; therefore, the acceptability of these tools and techniques requires further investigation. Objective: The aim of this study is to examine the acceptability of a behavior change intervention using mHealth for cancer survivors with a BMI of 25 or more and to gather constructive feedback from participants. Methods: The intervention consisted of educational sessions and an 8-week physical activity goal setting intervention delivered using mobile technology (ie, Fitbit activity monitor plus SMS contact). In the context of a two-arm randomized controlled trial, semistructured interviews were conducted to assess the retrospective acceptability of the intervention from the perspective of the recipients. The theoretical framework for the acceptability of health care interventions was used to inform a topic guide. The interviews were transcribed and analyzed using thematic analysis. A quantitative survey was also conducted to determine the acceptability of the intervention. A total of 13 participants were interviewed, and 36 participants completed the quantitative survey. Results: The results strongly support the acceptability of the intervention. The majority of the survey respondents held a positive attitude toward the intervention (35/36, 97%). In qualitative reports, many of the intervention components were enjoyed and the mHealth components (ie, Fitbit and goal setting through text message contact) were rated especially positively. Responses were mixed as to whether the burden of participating in the intervention was high (6/36, 17%) or low (5/36, 14%). Participants perceived the intervention as having high efficacy in improving health and well-being (34/36, 94%). Most respondents said that they understood how the intervention works (35/36, 97%), and qualitative data show that participants’ understanding of the aim of the intervention was broader than weight management and focused more on moving on psychologically from cancer. Conclusions: On the basis of the coherence of responses with theorized aspects of intervention acceptability, we are confident that this intervention using mHealth and BCTs is acceptable to cancer survivors with obesity or overweight. Participants made several recommendations concerning the additional provision of social support. Future studies are needed to assess the feasibility of delivery in clinical practice and the acceptability of the intervention to those delivering the intervention. International Registered Report Identifier (IRRID): RR2-10.2196/13214 %M 33591290 %R 10.2196/18288 %U http://mhealth.jmir.org/2021/2/e18288/ %U https://doi.org/10.2196/18288 %U http://www.ncbi.nlm.nih.gov/pubmed/33591290 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e23912 %T mHealth Strategies Related to HIV Postexposure Prophylaxis Knowledge and Access: Systematic Literature Review, Technology Prospecting of Patent Databases, and Systematic Search on App Stores %A Queiroz,Artur Acelino Francisco Luz Nunes %A Mendes,Isabel Amélia Costa %A de Godoy,Simone %A Velez Lapão,Luís %A Dias,Sónia %+ Department of General and Specialized Nursing, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, R Prof Hélio Lourenço, 3900 - Vila Monte Alegre, Ribeirão Preto, 14040-902, Brazil, 55 16 3315 4321, arturqueiroz@usp.br %K HIV %K eHealth %K mHealth %K postexposure prophylaxis %K PEP %K prevention %K mobile phone %D 2021 %7 16.2.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Globally, the number of HIV cases continue to increase, despite the development of multiple prevention strategies. New cases of HIV have been reported disproportionately more in men who have sex with men and other vulnerable populations. Issues such as internalized and structural homophobia prevent these men from accessing prevention strategies such as postexposure prophylaxis (PEP). Mobile health (mHealth) interventions are known to be one of the newest and preferred options to enhance PEP knowledge and access. Objective: The aim of this study was to identify and analyze the mobile apps addressing PEP for HIV infections. Methods: We conducted a descriptive exploratory study in 3 sequential phases: systematic literature review, patent analysis, and systematic search of app stores. For the systematic review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines adapted for an integrative review in the databases of PubMed, Web of Knowledge, Scopus, Cochrane, Embase, Science Direct, Eric, Treasure, and CINAHL. The patent analysis was performed by exploring the databases of the Brazilian National Institute of Industrial Property, the United States Patent and Trademark Office, and the European Patent Office. For the systematic search, we analyzed mHealth apps related to HIV in 2 major app libraries, that is, Google Play Store and App Store. The apps were evaluated by name, characteristics, functions, and availability in iPhone operating system/Android phones. Results: We analyzed 22 studies, of which 2 were selected for the final stage. Both studies present the use of apps as mHealth strategies aimed at improving the sexual health of men who have sex with men, and they were classified as decision support systems. The search in the patent databases showed only 1 result, which was not related to the topic since it was a drug intervention. In the app libraries, 25 apps were found and analyzed, with 15 (60%) apps available for Android systems but only 3 (12%) addressing PEP. In general, the apps inform about HIV and HIV prevention and treatment, with the focus users being health care providers, people with HIV, or the general population, but they have only limited features available, that is, mainly text, images, and videos. The 3 apps exclusively focusing on PEP were created by researchers from Brazilian universities. Conclusions: Our review found no connection between the scientific studies, registered patents, and the available apps related to PEP; this finding indicates that these available apps do not have a theoretical or a methodological background in their creation. Thus, since the scientific knowledge on HIV is not translated into technological products, preventing the emergence of new infections, especially in the more vulnerable groups, is difficult. In the future, researchers and the community must work in synergy to create more mHealth tools aimed at PEP. %M 33591289 %R 10.2196/23912 %U http://mhealth.jmir.org/2021/2/e23912/ %U https://doi.org/10.2196/23912 %U http://www.ncbi.nlm.nih.gov/pubmed/33591289 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e25655 %T Development and Validation of Risk Scores for All-Cause Mortality for a Smartphone-Based “General Health Score” App: Prospective Cohort Study Using the UK Biobank %A Clift,Ashley K %A Le Lannou,Erwann %A Tighe,Christian P %A Shah,Sachin S %A Beatty,Matthew %A Hyvärinen,Arsi %A Lane,Stephen J %A Strauss,Tamir %A Dunn,Devin D %A Lu,Jiahe %A Aral,Mert %A Vahdat,Dan %A Ponzo,Sonia %A Plans,David %+ Huma Therapeutics, 13th Floor Millbank Tower, 21-24 Millbank, London, United Kingdom, 44 7527 016574, david.plans@huma.com %K C-Score %K mortality %K risk score %K smartphone %K health score %K medical informatics %K public health %K mobile health %K development %K validation %K app %K prospective %K cohort %K machine learning %D 2021 %7 16.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Given the established links between an individual’s behaviors and lifestyle factors and potentially adverse health outcomes, univariate or simple multivariate health metrics and scores have been developed to quantify general health at a given point in time and estimate risk of negative future outcomes. However, these health metrics may be challenging for widespread use and are unlikely to be successful at capturing the broader determinants of health in the general population. Hence, there is a need for a multidimensional yet widely employable and accessible way to obtain a comprehensive health metric. Objective: The objective of the study was to develop and validate a novel, easily interpretable, points-based health score (“C-Score”) derived from metrics measurable using smartphone components and iterations thereof that utilize statistical modeling and machine learning (ML) approaches. Methods: A literature review was conducted to identify relevant predictor variables for inclusion in the first iteration of a points-based model. This was followed by a prospective cohort study in a UK Biobank population for the purposes of validating the C-Score and developing and comparatively validating variations of the score using statistical and ML models to assess the balance between expediency and ease of interpretability and model complexity. Primary and secondary outcome measures were discrimination of a points-based score for all-cause mortality within 10 years (Harrell c-statistic) and discrimination and calibration of Cox proportional hazards models and ML models that incorporate C-Score values (or raw data inputs) and other predictors to predict the risk of all-cause mortality within 10 years. Results: The study cohort comprised 420,560 individuals. During a cohort follow-up of 4,526,452 person-years, there were 16,188 deaths from any cause (3.85%). The points-based model had good discrimination (c-statistic=0.66). There was a 31% relative reduction in risk of all-cause mortality per decile of increasing C-Score (hazard ratio of 0.69, 95% CI 0.663-0.675). A Cox model integrating age and C-Score had improved discrimination (8 percentage points; c-statistic=0.74) and good calibration. ML approaches did not offer improved discrimination over statistical modeling. Conclusions: The novel health metric (“C-Score”) has good predictive capabilities for all-cause mortality within 10 years. Embedding the C-Score within a smartphone app may represent a useful tool for democratized, individualized health risk prediction. A simple Cox model using C-Score and age balances parsimony and accuracy of risk predictions and could be used to produce absolute risk estimations for app users. %M 33591285 %R 10.2196/25655 %U http://mhealth.jmir.org/2021/2/e25655/ %U https://doi.org/10.2196/25655 %U http://www.ncbi.nlm.nih.gov/pubmed/33591285 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e24080 %T Effectiveness of Mobile Health–Based Exercise Interventions for Patients with Peripheral Artery Disease: Systematic Review and Meta-Analysis %A Kim,Mihui %A Kim,Changhwan %A Kim,Eunkyo %A Choi,Mona %+ College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 3341, monachoi@yuhs.ac %K peripheral artery disease %K mobile health %K exercise %K adherence %K meta-analysis %D 2021 %7 15.2.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Peripheral artery disease (PAD) affects over 236 million people worldwide, and exercise interventions are commonly used to alleviate symptoms of this condition. However, no previous systematic review has evaluated the effects of mobile health (mHealth)–based exercise interventions for patients with PAD. Objective: This study aimed to assess the effect of mHealth-based exercise interventions on walking performance, functional status, and quality of life in patients with PAD. Methods: A systematic review and meta-analysis were conducted. We searched in seven databases to identify randomized controlled trials of patients with PAD published in English up to December 4, 2020. Studies were included if patients participated in mHealth-based exercise interventions and were assessed for walking performance. We analyzed pooled effect size on walking performance, functional status, and quality of life based on the standardized mean differences between groups. Results: A total of seven studies were selected for the systematic review, and six studies were included in the meta-analysis. The duration of interventions in the included studies was 12 to 48 weeks. In the pooled analysis, when compared with the control groups, the mHealth-based exercise intervention groups were associated with significant improvements in pain-free walking (95% CI 0.13-0.88), maximal walking (95% CI 0.03-0.87), 6-minute walk test (6MWT) distance (95% CI 0.59-1.24), and walking distance (95% CI 0.02-0.49). However, benefits of the interventions on walking speed, stair-climbing ability, and quality of life were not observed. Conclusions: mHealth-based exercise interventions for patients with PAD were beneficial for improving pain-free walking, maximal walking, and 6MWT distance. We found that exercise interventions using mHealth are an important strategy for improving the exercise effectiveness and adherence rate of patients with PAD. Future studies should consider the use of various and suitable functions of mHealth that can increase the adherence rates and improve the effectiveness of exercise. %M 33587042 %R 10.2196/24080 %U http://mhealth.jmir.org/2021/2/e24080/ %U https://doi.org/10.2196/24080 %U http://www.ncbi.nlm.nih.gov/pubmed/33587042 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25578 %T Durability of Abstinence After Completing a Comprehensive Digital Smoking Cessation Program Incorporating a Mobile App, Breath Sensor, and Coaching: Cohort Study %A Marler,Jennifer D %A Fujii,Craig A %A Galanko,Joseph A %A Balbierz,Daniel J %A Utley,David S %+ Carrot Inc., 1400A Seaport Blvd, Suite 501, Redwood City, CA, 94063, United States, 1 415 757 7696, marler@carrot.co %K smoking cessation %K digital health %K smartphone %K digital sensor %K carbon monoxide %K breath sensor %K biofeedback %K mobile apps %K health promotion %K app %D 2021 %7 15.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite decreasing prevalence over the last several decades, cigarette smoking remains the leading cause of preventable death and disease, underscoring the need for innovative, effective solutions. Pivot is a novel, inclusive smoking cessation program designed for smokers along the entire spectrum of readiness to quit. Pivot leverages proven methods and technological advancements, including a personal portable breath carbon monoxide sensor, smartphone app, and in-app text-based coaching. We previously reported outcomes from the end of active Pivot program participation in 319 adult smokers. Herein, we report longer-term follow up in this cohort. Objective: The aim of this study was to assess and report participant outcomes 3 months after completion of Pivot, including smoking behavior, quit rates, continuous abstinence rates and durability, and predictors of abstinence. Methods: This prospective remote cohort study included US-based cigarette smokers aged 18 to 65 years who smoked ≥5 cigarettes per day (CPD). Three months after completion of active participation in Pivot, final follow-up data were collected via an online questionnaire. Outcomes included smoking behavior (CPD and quit attempts), self-reported quit rates (7- and 30-day point prevalence abstinence [PPA]), and continuous abstinence rates (proportion who achieved uninterrupted abstinence) and duration. Exploratory regression analyses were performed to identify baseline characteristics associated with achievement of 7-day PPA, 30-day PPA, and continuous abstinence. Results: A total of 319 participants completed onboarding (intention-to-treat [ITT]); 288/319 participants (90.3%) completed follow up (completers) at a mean of 7.2 (SD 1.2) months after onboarding. At final follow up, CPD were reduced by 52.6% (SE 2.1; P<.001) among all 319 participants, and most completers (152/288, 52.8%) reduced their CPD by at least 50%. Overall, most completers (232/288, 80.6%) made at least one quit attempt. Quit rates increased after the end of Pivot; using ITT analyses, 35.4% (113/319) achieved 7-day PPA and 31.3% (100/319) achieved 30-day PPA at final follow up compared with 32.0% (102/319) and 27.6% (88/319), respectively, at the end of the Pivot program. Continuous abstinence was achieved in about a quarter of those who onboarded (76/319, 23.8%) and in most who reported 30-day PPA at the end of Pivot (76/88, 86.4%), with a mean abstinence duration of 5.8 (SD 0.6) months. In exploratory regression analyses, lower baseline CPD, more positive baseline attitudes reflecting higher self-efficacy (higher confidence to quit and lower perceived difficulty of quitting), and higher education were associated with achieving abstinence. Conclusions: This study provides the first longer-term outcomes of the Pivot smoking cessation program. At final follow up, quit rates increased and continuous abstinence was favorable; the majority who achieved abstinence at the end of Pivot sustained abstinence throughout follow up. Decreases in CPD persisted and most participants made a quit attempt. Overall, final follow-up outcomes were stable or improved when compared to previous outcomes from the end of the program. These findings validate earlier results, and suggest that Pivot is an effective and durable solution for smoking cessation. Trial Registration: ClinicalTrials.gov NCT03295643; https://clinicaltrials.gov/ct2/show/NCT03295643 %M 33482628 %R 10.2196/25578 %U http://www.jmir.org/2021/2/e25578/ %U https://doi.org/10.2196/25578 %U http://www.ncbi.nlm.nih.gov/pubmed/33482628 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e24703 %T Effectiveness of Smartphone-Based Cognitive Behavioral Therapy Among Patients With Major Depression: Systematic Review of Health Implications %A Hrynyschyn,Robert %A Dockweiler,Christoph %+ Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Health and Nursing Science, Campus Virchow Klinikum, Berlin, 13353, Germany, 49 30 450 529 124, robert.hrynyschyn@charite.de %K mobile health %K depression %K cognitive behavioral therapy %K systematic review %K mobile phone %D 2021 %7 10.2.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Depression is often associated with rapid changes in mood and quality of life that persist for a period of 2 weeks. Despite medical innovations, there are problems in the provision of care. Long waiting times for treatment and high recurrence rates of depression cause enormous costs for health care systems. At the same time, comprehensive limitations in physical, psychological, and social dimensions are observed for patients with depression, which significantly reduce their quality of life. In addition to patient-specific limitations, undersupply and inappropriate health care have been determined. For this reason, new forms of care are discussed. Smartphone-based therapy is considered to have great potential due to its reach and easy accessibility. Low socioeconomic groups, which are always difficult to reach for public health interventions, can now be accessed due to the high dispersion of smartphones. There is still little information about the impact and mechanisms of smartphone-based therapy on depression. In a systematic literature review, the health implications of smartphone-based therapy were presented in comparison with standard care. Objective: The objective of this review was to identify and summarize the existing evidence regarding smartphone-based cognitive behavioral therapy for patients with depression and to present the health implications of smartphone-based cognitive behavioral therapy of considered endpoints. Methods: A systematic literature review was conducted to identify relevant studies by means of inclusion and exclusion criteria. For this purpose, the PubMed and Psyndex databases were systematically searched using a search syntax. The endpoints of depressive symptoms, depression-related anxiety, self-efficacy or self-esteem, and quality of life were analyzed. Identified studies were evaluated for study quality and risk of bias. After applying the inclusion and exclusion criteria, 8 studies were identified. Results: The studies examined in this review reported contradictory results regarding the investigated endpoints. In addition, due to clinical and methodological heterogeneity, it was difficult to derive evident results. All included studies reported effects on depressive symptoms. The other investigated endpoints were only reported by isolated studies. Only 50% (4/8) of the studies reported effects on depression-related anxiety, self-efficacy or self-esteem, and quality of life. Conclusions: No clear implications of smartphone-based cognitive behavioral therapy could be established. Evidence for the treatment of depression using smartphone-based cognitive behavioral therapy is limited. Additional research projects are needed to demonstrate the effects of smartphone-based cognitive behavioral therapy in the context of evidence-based medicine and to enable its translation into standard care. Participatory technology development might help to address current problems in mobile health intervention studies. %M 33565989 %R 10.2196/24703 %U http://mhealth.jmir.org/2021/2/e24703/ %U https://doi.org/10.2196/24703 %U http://www.ncbi.nlm.nih.gov/pubmed/33565989 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e19210 %T An Innovative Wearable Device For Monitoring Continuous Body Surface Temperature (HEARThermo): Instrument Validation Study %A Yeh,Chun-Yin %A Chung,Yi-Ting %A Chuang,Kun-Ta %A Shu,Yu-Chen %A Kao,Hung-Yu %A Chen,Po-Lin %A Ko,Wen-Chien %A Ko,Nai-Ying %+ Department of Nursing, National Cheng Kung University, No 1, University Road, Tainan, 701, Taiwan, 886 6 2353535 ext 5838, nyko@mail.ncku.edu.tw %K body surface temperature %K wearable device %K validation %K continuous monitoring %D 2021 %7 10.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Variations in body temperature are highly informative during an illness. To date, there are not many adequate studies that have investigated the feasibility of a wearable wrist device for the continuous monitoring of body surface temperatures in humans. Objective: The objective of this study was to validate the performance of HEARThermo, an innovative wearable device, which was developed to continuously monitor the body surface temperature in humans. Methods: We implemented a multi-method research design in this study, which included 2 validation studies—one in the laboratory and one with human subjects. In validation study I, we evaluated the test-retest reliability of HEARThermo in the laboratory to measure the temperature and to correct the values recorded by each HEARThermo by using linear regression models. We conducted validation study II on human subjects who wore HEARThermo for the measurement of their body surface temperatures. Additionally, we compared the HEARThermo temperature recordings with those recorded by the infrared skin thermometer simultaneously. We used intraclass correlation coefficients (ICCs) and Bland-Altman plots to analyze the criterion validity and agreement between the 2 measurement tools. Results: A total of 66 participants (age range, 10-77 years) were recruited, and 152,881 completed data were analyzed in this study. The 2 validation studies in the laboratory and on human skin indicated that HEARThermo showed a good test-retest reliability (ICC 0.96-0.98) and adequate criterion validity with the infrared skin thermometer at room temperatures of 20°C-27.9°C (ICC 0.72, P<.001). The corrected measurement bias averaged –0.02°C, which was calibrated using a water bath ranging in temperature from 16°C to 40°C. The values of each HEARThermo improved by the regression models were not significantly different from the temperature of the water bath (P=.19). Bland-Altman plots showed no visualized systematic bias. HEARThermo had a bias of 1.51°C with a 95% limit of agreement between –1.34°C and 4.35°C. Conclusions: The findings of our study show the validation of HEARThermo for the continuous monitoring of body surface temperatures in humans. %M 33565990 %R 10.2196/19210 %U http://mhealth.jmir.org/2021/2/e19210/ %U https://doi.org/10.2196/19210 %U http://www.ncbi.nlm.nih.gov/pubmed/33565990 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e19430 %T App-Based Salt Reduction Intervention in School Children and Their Families (AppSalt) in China: Protocol for a Mixed Methods Process Evaluation %A Sun,Yuewen %A Luo,Rong %A Li,Yuan %A He,Feng J %A Tan,Monique %A MacGregor,Graham A %A Liu,Hueiming %A Zhang,Puhong %+ The George Institute for Global Health, Peking University Health Science Center, Room 011, Unit 2, Tayuan Diplomatic Office Building No. 14 Liangmahe Nan Lu, Beijing, 100600, China, 86 10 8280 0177, zpuhong@georgeinstitute.org.cn %K mobile health %K mobile phone %K process evaluation %K salt reduction %K health education %D 2021 %7 10.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The app-based salt reduction intervention program in school children and their families (AppSalt) is a multicomponent mobile health (mHealth) intervention program, which involves multiple stakeholders, including students, parents, teachers, school heads, and local health and education authorities. The complexity of the AppSalt program highlights the need for process evaluation to investigate how the implementation will be achieved at different sites. Objective: This paper presents a process evaluation protocol of the AppSalt program, which aims to monitor the implementation of the program, explain its causal mechanisms, and provide evidence for scaling up the program nationwide. Methods: A mixed methods approach will be used to collect data relating to five process evaluation dimensions: fidelity, dose delivered, dose received, reach, and context. Quantitative data, including app use logs, activity logs, and routine monitoring data, will be collected alongside the intervention process to evaluate the quantity and quality of intervention activities. The quantitative data will be summarized as medians, means, and proportions as appropriate. Qualitative data will be collected through semistructured interviews of purposely selected intervention participants and key stakeholders from local health and education authorities. The thematic analysis technique will be used for analyzing the qualitative data with the support of NVivo 12. The qualitative data will be triangulated with the quantitative data during the interpretation phase to explain the 5 process evaluation dimensions. Results: The intervention activities of the AppSalt program were initiated at 27 primary schools in three cities since October 2018. We have completed the 1-year intervention of this program. The quantitative data for this study, including app use log, activity logs, and the routine monitoring data, were collected and organized during the intervention process. After completing the intervention, we conducted semistructured interviews with 32 students, 32 parents, 9 teachers, 9 school heads, and 8 stakeholders from local health and education departments. Data analysis is currently underway. Conclusions: Using mHealth technology for salt reduction among primary school students is an innovation in China. The findings of this study will help researchers understand the implementation of the AppSalt program and similar mHealth interventions in real-world settings. Furthermore, this process evaluation will be informative for other researchers and policy makers interested in replicating the AppSalt program and designing their salt reduction intervention. International Registered Report Identifier (IRRID): DERR1-10.2196/19430 %M 33565991 %R 10.2196/19430 %U http://www.researchprotocols.org/2021/2/e19430/ %U https://doi.org/10.2196/19430 %U http://www.ncbi.nlm.nih.gov/pubmed/33565991 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e23338 %T Efficiency of an mHealth App and Chest-Wearable Remote Exercise Monitoring Intervention in Patients With Type 2 Diabetes: A Prospective, Multicenter Randomized Controlled Trial %A Li,Jing %A Wei,Dong %A Liu,Shuyi %A Li,Mingxia %A Chen,Xi %A Chen,Li %A Wu,Yuelei %A Zhou,Wen %A Ouyang,Lingyun %A Tan,Cuixia %A Meng,Hongdao %A Tong,Nanwei %+ Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, 37 Guoxue Road, Wuhou District, Chengdu, 610041, China, 86 18980601196, tongnw@scu.edu.cn %K type 2 diabetes %K fitness app %K heart rate band %K exercise monitoring %K randomized controlled trial %K mobile phone %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Exercise has been recommended as a cornerstone for diabetes management. Supervised exercise is more efficient than unsupervised exercise but is less convenient and accessible. Objective: We aimed to determine the efficiency of exercise using a fitness app and heart rate band to remotely monitor patients with type 2 diabetes in comparison with that of traditional exercise. Methods: Patients with type 2 diabetes without severe complications or comorbidities were recruited to participate in this multicenter randomized controlled trial and were allocated to either the intervention or control group (1:1 ratio). Participants in both groups were asked to engage in moderate to vigorous physical activity for at least 150 minutes per week; each participant was prescribed individualized exercises. Participants in the intervention group were asked to follow exercise videos on the app and to wear a chest band; heart rate, exercise duration, and exercise intensity were recorded by the app. Participants in the control group self-reported exercise intensity and duration. Cardiopulmonary endurance, body composition, blood glucose level, and insulin level were assessed before and after a 3-month exercise program. Results: Of the 101 participants who were enrolled, the majority of them (85/101, 84.2%) completed the study. Both groups had similar baseline characteristics, with the exception that participants in the intervention group were slightly younger and less likely to have hypertension. Self-reported exercise duration was longer than app-recorded exercise duration (control: mean 214 minutes/week; intervention: mean 193 minutes/week); in addition, a higher proportion of participants in the control group (29/41, 71%) than in the intervention group (18/44, 41%) met the 150-minute target for moderate to vigorous physical activity. However, compared with the control group, the intervention group had a larger increase in cardiopulmonary endurance (mean difference –2.0 bpm [beats per minute] vs 1.0 bpm; P=.02) and a larger decrease in body fat percentage (mean difference –1.8% vs –0.8%; P=.01). There was no difference in hemoglobin A1c level reduction between the two groups, yet more participants in the intervention group stopped taking their antidiabetic drugs or had their dosages lowered by an endocrinologist, compared with those in the control group. There were no serious adverse events in either group. Conclusions: This was the first randomized controlled trial in China, to our knowledge, to test the efficiency of exercise using a fitness app and heart rate band to remotely monitor prescribed exercise in patients with type 2 diabetes. The findings of our study suggest that exercise programs may be more efficient if participants are remotely monitored with an app and heart rate band than if participants are not monitored. Trial Registration: Chinese Clinical Trial Register ChiCTR1800015963; http://www.chictr.org.cn/showprojen.aspx?proj=27080 %M 33560244 %R 10.2196/23338 %U https://mhealth.jmir.org/2021/2/e23338 %U https://doi.org/10.2196/23338 %U http://www.ncbi.nlm.nih.gov/pubmed/33560244 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e24177 %T Using a Commercially Available App for the Self-Management of Hypertension: Acceptance and Usability Study in Saudi Arabia %A Alessa,Tourkiah %A S Hawley,Mark %A Alsulamy,Nouf %A de Witte,Luc %+ Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, The Innovation Centre, 217 Portobello, Sheffield, S1 4DP, United Kingdom, 966 559346711, talessa1@sheffield.ac.uk %K mHealth %K mobile phone %K hypertension %K usability %K acceptance %K user satisfaction %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of smartphone apps to assist in the self-management of hypertension is becoming increasingly common, but few commercially available apps have the potential to be effective along with adequate security and privacy measures in place. In a previous study, we identified 5 apps that are potentially effective and safe, and based on the preferences of doctors and patients, one (Cora Health) was selected as the most suitable app for use in a Saudi context. However, there is currently no evidence of its usability and acceptance among potential users. Indeed, there has been little research into the usability and acceptance of hypertension apps in general, and less research considers this in the Gulf Region. Objective: This study aims to evaluate the acceptance and usability of the selected app in the Saudi context. Methods: This study used a mixed methods approach with 2 studies: a usability test involving patients in a controlled setting performing predefined tasks and a real-world usability study where patients used the app for 4 weeks. In the usability test, participants were asked to think aloud while performing the tasks, and an observer recorded the number of tasks they completed. At the end of the real-world pilot study, participants were interviewed, and the mHealth App Usability Questionnaire was completed. Descriptive statistics were used to analyze quantitative data, and thematic analysis was used to analyze qualitative data. Results: In total, 10 patients completed study 1. The study found that app usability was moderate and that participants needed some familiarization time before they could use the app proficiently. Some usability issues were revealed, related to app accessibility and navigation, and a few tasks remained uncompleted by most people. A total of 20 patients completed study 2, with a mean age of 51.6 (SD 11.7) years. Study 2 found that the app was generally acceptable and easy to use, with some similar usability issues identified. Participants stressed the importance of practice and training to use it more easily and proficiently. Participants had a good engagement level with 48% retention at the end of study 2, with most participants’ engagement being classed as meaningful. The most recorded data were blood pressure, followed by stress and medication, and the most accessed feature was viewing graphs of data trends. Conclusions: This study shows that a commercially available app can be usable and acceptable in the self-management of hypertension but also found a considerable number of possibilities for improvement, which needs to be considered in future app development. The results show that there is potential for a commercially available app to be used in large-scale studies of hypertension self-management if suggestions for improvements are addressed. %M 33560237 %R 10.2196/24177 %U http://mhealth.jmir.org/2021/2/e24177/ %U https://doi.org/10.2196/24177 %U http://www.ncbi.nlm.nih.gov/pubmed/33560237 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e21737 %T Development and Feasibility of a Digital Acceptance and Commitment Therapy–Based Intervention for Generalized Anxiety Disorder: Pilot Acceptability Study %A Hemmings,Nicola R %A Kawadler,Jamie M %A Whatmough,Rachel %A Ponzo,Sonia %A Rossi,Alessio %A Morelli,Davide %A Bird,Geoffrey %A Plans,David %+ Department of Organizational Psychology, Birkbeck University of London, Malet St, London, WC1E 7HX, United Kingdom, 44 7716362200, nhemmi01@mail.bbk.ac.uk %K anxiety %K depression %K acceptance and commitment therapy %K person-based approach %K mHealth %K mental health %K digital %K remote %K smartphone %K mobile phone %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Generalized anxiety disorder (GAD) is characterized by excessive worry that is difficult to control and has high comorbidity with mood disorders including depression. Individuals experience long wait times for diagnosis and often face accessibility barriers to treatment. There is a need for a digital solution that is accessible and acceptable to those with GAD. Objective: This paper aims to describe the development of a digital intervention prototype of acceptance and commitment therapy (ACT) for GAD that sits within an existing well-being app platform, BioBase. A pilot feasibility study evaluating acceptability and usability is conducted in a sample of adults with a diagnosis of GAD, self-referred to the study. Methods: Phase 1 applied the person-based approach (creation of guiding principles, intervention design objectives, and the key intervention features). In Phase 2 participants received the app-based therapeutic and paired wearable for 2 weeks. Self-report questionnaires were obtained at baseline and posttreatment. The primary outcome was psychological flexibility (Acceptance and Action Questionnaire-II [AAQ-II]) as this is the aim of ACT. Mental well-being (Warwick-Edinburgh Mental Well-being Scale [WEMWBS]) and symptoms of anxiety (7-item Generalized Anxiety Disorder Assessment [GAD-7]) and depression (9-item Patient Health Questionnaire [PHQ-9]) were also assessed. Posttreatment usability was assessed via self-report measures (System Usability Scale [SUS]) in addition to interviews that further explored feasibility of the digital intervention in this sample. Results: The app-based therapeutic was well received. Of 13 participants, 10 (77%) completed the treatment. Results show a high usability rating (83.5). Participants found the digital intervention to be relevant, useful, and helpful in managing their anxiety. Participants had lower anxiety (d=0.69) and depression (d=0.84) scores at exit, and these differences were significantly different from baseline (P=.03 and .008 for GAD-7 and PHQ-9, respectively). Participants had higher psychological flexibility and well-being scores at exit, although these were not significantly different from baseline (P=.11 and .55 for AAQ-II and WEMWBS, respectively). Conclusions: This ACT prototype within BioBase is an acceptable and feasible digital intervention in reducing symptoms of anxiety and depression. This study suggests that this intervention warrants a larger feasibility study in adults with GAD. %M 33560232 %R 10.2196/21737 %U https://formative.jmir.org/2021/2/e21737 %U https://doi.org/10.2196/21737 %U http://www.ncbi.nlm.nih.gov/pubmed/33560232 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e12218 %T Effectiveness of Text Message Reminders on Adherence to Inhaled Therapy in Patients With Asthma: Prospective Multicenter Randomized Clinical Trial %A Almonacid,Carlos %A Melero,Carlos %A López Viña,Antolín %A Cisneros,Carolina %A Pérez de Llano,Luis %A Plaza,Vicente %A García-Rivero,Juan Luis %A Romero Falcón,Auxiliadora %A Ramos,Jacinto %A Bazús González,Teresa %A Andrés Prado,María %A Muriel,Alfonso %+ Department of Respiratory Medicine, Instituto Ramón y Cajal de Investigación Sanitaria, University of Alcala de Henares, Ctra. De Colmenar Viejo, km. 9,100, Madrid, , Spain, 34 655 534 475, caralmsan@gmail.com %K asthma %K adherence %K SMS %K control %K cell phone %K inhaler %K Smartinhaler %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor adherence to inhaled medication in asthma patients is of great concern. It is one of the main reasons for inadequate asthma control. Objective: The goal of the research was to determine if motivational messages using short message service (SMS, or text) improved adherence to inhaled medication in patients with asthma. Methods: A prospective multicenter randomized parallel-group clinical trial was conducted in 10 asthma clinics in Spain. Adherence was assessed with electronic monitors (Smartinhaler, Adherium Ltd) connected to inhalers. Patients in the SMS group received psychologist-developed motivational messages every 3 days for 6 months. Results: There were 53 patients in the SMS group and 88 patients in the control group. After 6 months, mean electronic adherence was 70% (SD 17%) in the intervention group and 69% (SD 17%) in the control group (P=.82). Significant differences between the study groups in morning and evening adherence to inhaled therapy, asthma control, exhaled nitric oxide levels, or improvement of lung functions were not observed. Conclusions: Motivational messages were not useful to improve adherence to inhaled asthma medication compared with usual care. %M 33560235 %R 10.2196/12218 %U http://formative.jmir.org/2021/2/e12218/ %U https://doi.org/10.2196/12218 %U http://www.ncbi.nlm.nih.gov/pubmed/33560235 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e20630 %T Five Lessons Learned From Randomized Controlled Trials on Mobile Health Interventions: Consensus Procedure on Practical Recommendations for Sustainable Research %A Pach,Daniel %A Rogge,Alizé A %A Wang,Jiani %A Witt,Claudia M %+ Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Luisenstraße 57, Berlin, 10117, Germany, daniel.pach@charite.de %K mHealth %K mobile apps %K pain %K behavior change techniques (BCTs) %K recommendations %D 2021 %7 8.2.2021 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Background: Clinical research on mobile health (mHealth) interventions is too slow in comparison to the rapid speed of technological advances, thereby impeding sustainable research and evidence-based implementation of mHealth interventions. Objective: We aimed to establish practical lessons from the experience of our working group, which might accelerate the development of future mHealth interventions and their evaluation by randomized controlled trials (RCTs). Methods: This paper is based on group and expert discussions, and focuses on the researchers’ perspectives after four RCTs on mHealth interventions for chronic pain. Results: The following five lessons are presented, which are based on practical application, increase of speed, and sustainability: (1) explore stakeholder opinions, (2) develop the mHealth app and trial simultaneously, (3) minimize complexity, (4) manage necessary resources, and (5) apply behavior change techniques. Conclusions: The five lessons developed may lead toward an agile research environment. Agility might be the key factor in the development and research process of a potentially sustainable and evidence-based mHealth intervention. %M 33555263 %R 10.2196/20630 %U https://mhealth.jmir.org/2021/2/e20630 %U https://doi.org/10.2196/20630 %U http://www.ncbi.nlm.nih.gov/pubmed/33555263 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 1 %P e22802 %T Physiological Responses and User Feedback on a Gameful Breathing Training App: Within-Subject Experiment %A Lukic,Yanick Xavier %A Shih,Chen-Hsuan (Iris) %A Hernandez Reguera,Alvaro %A Cotti,Amanda %A Fleisch,Elgar %A Kowatsch,Tobias %+ Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Weinbergstrasse 56/58, Zurich, 8092, Switzerland, 41 446328638, ylukic@ethz.ch %K breathing training %K serious game %K biofeedback %K mobile health %K mHealth %K mobile phone %D 2021 %7 8.2.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Slow-paced breathing training (6 breaths per minute [BPM]) improves physiological and psychological well-being by inducing relaxation characterized by increased heart rate variability (HRV). However, classic breathing training has a limited target group, and retention rates are very low. Although a gameful approach may help overcome these challenges, it is crucial to enable breathing training in a scalable context (eg, smartphone only) and ensure that they remain effective. However, despite the health benefits, no validated mobile gameful breathing training featuring a biofeedback component based on breathing seems to exist. Objective: This study aims to describe the design choices and their implementation in a concrete mobile gameful breathing training app. Furthermore, it aims to deliver an initial validation of the efficacy of the resulting app. Methods: Previous work was used to derive informed design choices, which, in turn, were applied to build the gameful breathing training app Breeze. In a pretest (n=3), design weaknesses in Breeze were identified, and Breeze was adjusted accordingly. The app was then evaluated in a pilot study (n=16). To ascertain that the effectiveness was maintained, recordings of breathing rates and HRV-derived measures (eg, root mean square of the successive differences [RMSSDs]) were collected. We compared 3 stages: baseline, standard breathing training deployed on a smartphone, and Breeze. Results: Overall, 5 design choices were made: use of cool colors, natural settings, tightly incorporated game elements, game mechanics reflecting physiological measures, and a light narrative and progression model. Breeze was effective, as it resulted in a slow-paced breathing rate of 6 BPM, which, in turn, resulted in significantly increased HRV measures compared with baseline (P<.001 for RMSSD). In general, the app was perceived positively by the participants. However, some criticized the somewhat weaker clarity of the breathing instructions when compared with a standard breathing training app. Conclusions: The implemented breathing training app Breeze maintained its efficacy despite the use of game elements. Moreover, the app was positively perceived by participants although there was room for improvement. %M 33555264 %R 10.2196/22802 %U http://games.jmir.org/2021/1/e22802/ %U https://doi.org/10.2196/22802 %U http://www.ncbi.nlm.nih.gov/pubmed/33555264 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e18773 %T Digital Health Interventions for Cardiac Rehabilitation: Systematic Literature Review %A Wongvibulsin,Shannon %A Habeos,Evagelia E %A Huynh,Pauline P %A Xun,Helen %A Shan,Rongzi %A Porosnicu Rodriguez,Kori A %A Wang,Jane %A Gandapur,Yousuf K %A Osuji,Ngozi %A Shah,Lochan M %A Spaulding,Erin M %A Hung,George %A Knowles,Kellen %A Yang,William E %A Marvel,Francoise A %A Levin,Eleanor %A Maron,David J %A Gordon,Neil F %A Martin,Seth S %+ Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Carnegie 591, Baltimore, MD, 21287, United States, 1 410 502 0469, smart100@jhmi.edu %K cardiac rehabilitation %K telemedicine %K digital technologies %K mHealth %K mobile phone %D 2021 %7 8.2.2021 %9 Review %J J Med Internet Res %G English %X Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Despite strong evidence supporting the benefits of cardiac rehabilitation (CR), over 80% of eligible patients do not participate in CR. Digital health technologies (ie, the delivery of care using the internet, wearable devices, and mobile apps) have the potential to address the challenges associated with traditional facility-based CR programs, but little is known about the comprehensiveness of these interventions to serve as digital approaches to CR. Overall, there is a lack of a systematic evaluation of the current literature on digital interventions for CR. Objective: The objective of this systematic literature review is to provide an in-depth analysis of the potential of digital health technologies to address the challenges associated with traditional CR. Through this review, we aim to summarize the current literature on digital interventions for CR, identify the key components of CR that have been successfully addressed through digital interventions, and describe the gaps in research that need to be addressed for sustainable and scalable digital CR interventions. Methods: Our strategy for identifying the primary literature pertaining to CR with digital solutions (defined as technology employed to deliver remote care beyond the use of the telephone) included a consultation with an expert in the field of digital CR and searches of the PubMed (MEDLINE), Embase, CINAHL, and Cochrane databases for original studies published from January 1990 to October 2018. Results: Our search returned 31 eligible studies, of which 22 were randomized controlled trials. The reviewed CR interventions primarily targeted physical activity counseling (31/31, 100%), baseline assessment (30/31, 97%), and exercise training (27/31, 87%). The most commonly used modalities were smartphones or mobile devices (20/31, 65%), web-based portals (18/31, 58%), and email-SMS (11/31, 35%). Approximately one-third of the studies addressed the CR core components of nutrition counseling, psychological management, and weight management. In contrast, less than a third of the studies addressed other CR core components, including the management of lipids, diabetes, smoking cessation, and blood pressure. Conclusions: Digital technologies have the potential to increase access and participation in CR by mitigating the challenges associated with traditional, facility-based CR. However, previously evaluated interventions primarily focused on physical activity counseling and exercise training. Thus, further research is required with more comprehensive CR interventions and long-term follow-up to understand the clinical impact of digital interventions. %M 33555259 %R 10.2196/18773 %U https://www.jmir.org/2021/2/e18773 %U https://doi.org/10.2196/18773 %U http://www.ncbi.nlm.nih.gov/pubmed/33555259 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e14378 %T A Brief Mobile-Augmented Suicide Prevention Intervention for People With Psychotic Disorders in Transition From Acute to Ongoing Care: Protocol for a Pilot Trial %A Depp,Colin %A Ehret,Blaire %A Villa,Jennifer %A Perivoliotis,Dimitri %A Granholm,Eric %+ Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093-0603, United States, 1 858 822 4251, cdepp@ucsd.edu %K prevention %K mental health services %K psychosis %K technology %D 2021 %7 8.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: People with serious mental illnesses (SMIs) are at exceptionally high risk for lifetime suicidal ideation and behavior compared with the general population. The transition period between urgent evaluation and ongoing care could provide an important setting for brief suicide-specific interventions for SMIs. To address this concern, this trial, SafeTy and Recovery Therapy (START), involves a brief suicide-specific cognitive behavioral intervention for SMIs that is augmented with mobile phone interactions. Objective: The primary aim of this pilot trial is to evaluate the feasibility, acceptability, and preliminary effectiveness of the intervention. Methods: A 6-month pilot trial with 70 participants with a diagnosis of bipolar disorder, schizophrenia or schizoaffective disorder, and current active suicidal ideation were randomized to START or START with mobile augmentation. START consists of 4 weekly sessions addressing early warning signs and triggers, symptoms influencing suicidal thinking, and social relationships. Recovery planning is followed by biweekly telephone coaching. START with mobile augmentation includes personalized automated cognitive behavioral therapy scripts that build from in-person content. Participants were evaluated at baseline, 4 weeks (end of in-person sessions), 12 weeks (end of telephone coaching), and 24 weeks. In addition to providing point estimates of feasibility and acceptability, the primary outcome of the trial was the change in severity of suicidal ideation as measured with the Scale for Suicide Ideation (SSI) and secondary outcome included the rate of outpatient engagement. Results: The trial is ongoing. Feasibility and acceptability across conditions will be assessed using t tests or Mann-Whitney tests or chi-square tests. The reduction of SSI over time will be assessed using hierarchical linear models. Conclusions: The design considerations and results of this trial may be informative for adapted suicide prevention in psychotic disorders in applied community settings. Trial Registration: ClinicalTrials.gov NCT03198364; http://clinicaltrials.gov/ct2/show/NCT03198364 International Registered Report Identifier (IRRID): DERR1-10.2196/14378 %M 33555265 %R 10.2196/14378 %U https://www.researchprotocols.org/2021/2/e14378 %U https://doi.org/10.2196/14378 %U http://www.ncbi.nlm.nih.gov/pubmed/33555265 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e20464 %T Quantification of Smoking Characteristics Using Smartwatch Technology: Pilot Feasibility Study of New Technology %A Cole,Casey Anne %A Powers,Shannon %A Tomko,Rachel L %A Froeliger,Brett %A Valafar,Homayoun %+ Department of Computer Science and Engineering, University of South Carolina, 1400 Assembly Street, Columbia, SC, 29208, United States, 1 9372067968, coleca@email.sc.edu %K smartwatch %K CReSS %K smoking topography %K ASPIRE %K automated %K wearable technology %K wearable computing %K smoking %D 2021 %7 5.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: While there have been many technological advances in studying the neurobiological and clinical basis of tobacco use disorder and nicotine addiction, there have been relatively minor advances in technologies for monitoring, characterizing, and intervening to prevent smoking in real time. Better understanding of real-time smoking behavior can be helpful in numerous applications without the burden and recall bias associated with self-report. Objective: The goal of this study was to test the validity of using a smartwatch to advance the study of temporal patterns and characteristics of smoking in a controlled laboratory setting prior to its implementation in situ. Specifically, the aim was to compare smoking characteristics recorded by Automated Smoking PerceptIon and REcording (ASPIRE) on a smartwatch with the pocket Clinical Research Support System (CReSS) topography device, using video observation as the gold standard. Methods: Adult smokers (N=27) engaged in a video-recorded laboratory smoking task using the pocket CReSS while also wearing a Polar M600 smartwatch. In-house software, ASPIRE, was used to record accelerometer data to identify the duration of puffs and interpuff intervals (IPIs). The recorded sessions from CReSS and ASPIRE were manually annotated to assess smoking topography. Agreement between CReSS-recorded and ASPIRE-recorded smoking behavior was compared. Results: ASPIRE produced more consistent number of puffs and IPI durations relative to CReSS, when comparing both methods to visual puff count. In addition, CReSS recordings reported many implausible measurements in the order of milliseconds. After filtering implausible data recorded from CReSS, ASPIRE and CReSS produced consistent results for puff duration (R2=.79) and IPIs (R2=.73). Conclusions: Agreement between ASPIRE and other indicators of smoking characteristics was high, suggesting that the use of ASPIRE is a viable method of passively characterizing smoking behavior. Moreover, ASPIRE was more accurate than CReSS for measuring puffs and IPIs. Results from this study provide the foundation for future utilization of ASPIRE to passively and accurately monitor and quantify smoking behavior in situ. %M 33544083 %R 10.2196/20464 %U https://formative.jmir.org/2021/2/e20464 %U https://doi.org/10.2196/20464 %U http://www.ncbi.nlm.nih.gov/pubmed/33544083 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e21977 %T Effectiveness of a Mobile Health and Self-Management App for High-Risk Patients With Chronic Obstructive Pulmonary Disease in Daily Clinical Practice: Mixed Methods Evaluation Study %A Kooij,Laura %A Vos,Petra J E %A Dijkstra,Antoon %A van Harten,Wim H %+ Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815AD, Netherlands, 31 88 005 7544, WvanHarten@rijnstate.nl %K chronic obstructive pulmonary disease %K mHealth %K self-management %K mobile app %K mobile phone %D 2021 %7 4.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health and self-management interventions may positively affect behavioral change and reduce hospital admissions for patients with chronic obstructive pulmonary disease (COPD). However, not all patients qualify for these interventions, and systematic, comprehensive information on implementation- and compliance-related aspects of mobile self-management apps is lacking. Due to the tendency to target digital services to patients in stable phases of disease, it is especially relevant to focus on the use of these services in broad clinical practice for patients recently discharged from hospital. Objective: This study aims to evaluate the effects of a mobile health and self-management app in clinical practice for recently discharged patients with COPD on use of the app, self-management, expectations, and experiences (technology acceptance); patients’ and nurses’ satisfaction; and hospital readmissions. Methods: A prototype of the app was pilot tested with 6 patients with COPD. The COPD app consisted of an 8-week program including the Lung Attack Action Plan, education, medication overview, video consultation, and questionnaires (monitored by nurses). In the feasibility study, adult patients with physician-diagnosed COPD, access to a mobile device, and proficiency of the Dutch language were included from a large teaching hospital during hospital admission. Self-management (Partners in Health Scale), technology acceptance (Unified Theory Acceptance and Use of Technology model), and satisfaction were assessed using questionnaires at baseline, after 8 weeks, and 20 weeks. Use was assessed with log data, and readmission rates were extracted from the electronic medical record. Results: A total of 39 patients were included; 76.4% (133/174) of patients had to be excluded from participation, and 48.9% of those patients (65/133) were excluded because of lack of digital skills, access to a mobile device, or access to the internet. The COPD app was opened most often in the first week (median 6.0; IQR 3.5-10.0), but its use decreased over time. The self-management element knowledge and coping increased significantly over time (P=.04). The COPD app was rated on a scale of 1-10, with an average score by patients of 7.7 (SD 1.7) and by nurses of 6.3 (SD 1.2). Preliminary evidence about the readmission rate showed that 13% (5/39) of patients were readmitted within 30 days; 31% (12/39) of patients were readmitted within 20 weeks, compared with 14.1% (48/340) and 21.8% (74/340) in a preresearch cohort, respectively. Conclusions: The use of a mobile self-management app after hospital discharge seems to be feasible only for a small number of patients with COPD. Patients were satisfied with the service; however, use decreased over time, and only knowledge and coping changed significantly over time. Therefore, future research on digital self-management interventions in clinical practice should focus on including more difficult subgroups of target populations, a multidisciplinary approach, technology-related aspects (such as acceptability), and fine-tuning its adoption in clinical pathways. Trial Registration: Clinicaltrials.gov NCT04540562; https://clinicaltrials.gov/ct2/show/NCT04540562. %M 33538699 %R 10.2196/21977 %U http://mhealth.jmir.org/2021/2/e21977/ %U https://doi.org/10.2196/21977 %U http://www.ncbi.nlm.nih.gov/pubmed/33538699 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 1 %P e18834 %T User Engagement With Smartphone Apps and Cardiovascular Disease Risk Factor Outcomes: Systematic Review %A Spaulding,Erin M %A Marvel,Francoise A %A Piasecki,Rebecca J %A Martin,Seth S %A Allen,Jerilyn K %+ Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21205, United States, 1 603 724 0604, espauld2@jhu.edu %K mHealth %K smartphone %K mobile phone %K engagement %K cardiovascular disease %K health behaviors %K risk factors %D 2021 %7 3.2.2021 %9 Review %J JMIR Cardio %G English %X Background: The use of mobile health (mHealth) interventions, including smartphone apps, for the prevention of cardiovascular disease (CVD) has demonstrated mixed results for obesity, hypercholesterolemia, diabetes, and hypertension management. A major factor attributing to the variation in mHealth study results may be mHealth user engagement. Objective: This systematic review aims to determine if user engagement with smartphone apps for the prevention and management of CVD is associated with improved CVD health behavior change and risk factor outcomes. Methods: We conducted a comprehensive search of PubMed, CINAHL, and Embase databases from 2007 to 2020. Studies were eligible if they assessed whether user engagement with a smartphone app used by an individual to manage his or her CVD risk factors was associated with the CVD health behavior change or risk factor outcomes. For eligible studies, data were extracted on study and sample characteristics, intervention description, app user engagement measures, and the relationship between app user engagement and the CVD risk factor outcomes. App user engagement was operationalized as general usage (eg, number of log-ins or usage days per week) or self-monitoring within the app (eg, total number of entries made in the app). The quality of the studies was assessed. Results: Of the 24 included studies, 17 used a randomized controlled trial design, 4 used a retrospective analysis, and 3 used a single-arm pre- and posttest design. Sample sizes ranged from 55 to 324,649 adults, with 19 studies recruiting participants from a community setting. Most of the studies assessed weight loss interventions, with 6 addressing additional CVD risk factors, including diabetes, sleep, stress, and alcohol consumption. Most of the studies that assessed the relationship between user engagement and reduction in weight (9/13, 69%), BMI (3/4, 75%), body fat percentage (1/2, 50%), waist circumference (2/3, 67%), and hemoglobin A1c (3/5, 60%) found statistically significant results, indicating that greater app user engagement was associated with better outcomes. Of 5 studies, 3 (60%) found a statistically significant relationship between higher user engagement and an increase in objectively measured physical activity. The studies assessing the relationship between user engagement and dietary and diabetes self-care behaviors, blood pressure, and lipid panel components did not find statistically significant results. Conclusions: Increased app user engagement for prevention and management of CVD may be associated with improved weight and BMI; however, only a few studies assessed other outcomes, limiting the evidence beyond this. Additional studies are needed to assess user engagement with smartphone apps targeting other important CVD risk factors, including dietary behaviors, hypercholesterolemia, diabetes, and hypertension. Further research is needed to assess mHealth user engagement in both inpatient and outpatient settings to determine the effect of integrating mHealth interventions into the existing clinical workflow and on CVD outcomes. %M 33533730 %R 10.2196/18834 %U http://cardio.jmir.org/2021/1/e18834/ %U https://doi.org/10.2196/18834 %U http://www.ncbi.nlm.nih.gov/pubmed/33533730 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e24382 %T Using Information Technology to Assess Patient Risk Factors in Primary Care Clinics: Pragmatic Evaluation %A Kosowan,Leanne %A Katz,Alan %A Halas,Gayle %A LaBine,Lisa %A Singer,Alexander %+ Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada, 1 204 789 3442, Alan.katz@umanitoba.ca %K risk factors %K information technology %K primary health care %K primary prevention %D 2021 %7 2.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Tobacco use, physical inactivity, and poor diet are associated with morbidity and premature death. Health promotion and primary prevention counseling, advice, and support by a primary care provider lead to behavior change attempts among patients. However, although physicians consider preventative health important, there is often a larger focus on symptom presentation, acute care, and medication review. Objective: This study evaluated the feasibility, adoption, and integration of the tablet-based Risk Factor Identification Tool (RFIT) that uses algorithmic information technology to support obtainment of patient risk factor information in primary care clinics. Methods: This is a pragmatic developmental evaluation. Each clinic developed a site-specific implementation plan adapted to their workflow. The RFIT was implemented in 2 primary care clinics located in Manitoba. Perceptions of 10 clinic staff and 8 primary care clinicians informed this evaluation. Results: Clinicians reported a smooth and fast transfer of RFIT responses to an electronic medical record encounter note. The RFIT was used by 207 patients, with a completion rate of 86%. Clinic staff reported that approximately 3%-5% of patients declined the use of the RFIT or required assistance to use the tablet. Among the 207 patients that used the RFIT, 22 (12.1%) smoked, 39 (21.2%) felt their diet could be improved, 20 (12.0%) reported high alcohol consumption, 103 (56.9%) reported less than 150 minutes of physical activity a week, and 6 (8.2%) patients lived in poverty. Clinicians suggested that although a wide variety of patients were able to use the tablet-based RFIT, implemented surveys should be tailored to patient subgroups. Conclusions: Clinicians and clinic staff positively reviewed the use of information technology in primary care. Algorithmic information technology can collect, organize, and synthesize individual health information to inform and tailor primary care counseling to the patients’ context and readiness to change. The RFIT is a user-friendly tool that provides an effective method for obtaining risk factor information from patients. It is particularly useful for subsets of patients lacking continuity in the care they receive. When implemented within a context that can support practical interventions to address identified risk factors, the RFIT can inform brief interventions within primary care. %M 33528376 %R 10.2196/24382 %U https://formative.jmir.org/2021/2/e24382 %U https://doi.org/10.2196/24382 %U http://www.ncbi.nlm.nih.gov/pubmed/33528376 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e25443 %T mHealth-Supported Delivery of an Evidence-Based Family Home-Visiting Intervention in Sierra Leone: Protocol for a Pilot Randomized Controlled Trial %A Desrosiers,Alethea %A Schafer,Carolyn %A Esliker,Rebecca %A Jambai,Musu %A Betancourt,Theresa S %+ Boston College, School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 01778, United States, 1 617 552 8398, alethea.desrosiers@bc.edu %K mHealth %K caregiver mental health %K family functioning %K early childhood development %K community health workers %D 2021 %7 2.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Past trauma and exposure to violence have been related to poor emotion regulation and household violence, which can have persistent mental health effects across generations. The Family Strengthening Intervention for Early Childhood Development (FSI-ECD/called Sugira Muryango in Rwanda) is an evidence-based behavioral home-visiting intervention to promote caregiver mental health, positive parenting practices, and early childhood development among families facing adversity. In Sierra Leone and other lower- and middle-income countries, mobile health (mHealth) technology has the potential to improve health care delivery and health outcomes. Objective: This study aims to (1) apply a user-centered design to develop and test mHealth tools to improve supervision and fidelity monitoring of community health workers (CHWs) delivering the FSI-ECD and (2) conduct a pilot randomized controlled trial of the FSI-ECD to assess feasibility, acceptability, and preliminary effects on caregiver mental health, emotion regulation, caregiving behaviors, and family violence in high-risk families with children aged 6-36 months in comparison with control families receiving standard care. Methods: We will recruit and enroll CHWs, supervisors, and families with a child aged 6-36 months from community health clinics in Sierra Leone. CHWs and supervisors will participate in 1 problem analysis focus group and 2 user interface/user experience cycles to provide feedback on mHealth tool prototypes. Families will be randomized to mHealth-supported FSI-ECD or standard maternal and child health services. We will collect quantitative data on caregiver mental health, emotion regulation, caregiving behaviors, and family functioning at baseline, postintervention, and 3-month follow up. We will use a mixed methods approach to explore feasibility and acceptability of mHealth tools and the FSI-ECD. Mixed effects linear modeling will assess FSI-ECD effects on caregiver outcomes. Cost-effectiveness analysis will estimate costs across FSI-ECD versus standard care. Results: Funding for this study was received from the National Institutes of Mental Health on August 17, 2020. Institutional Review Board approval was received on September 4, 2020. Data collection is projected to begin on December 15, 2020. Conclusions: This study will provide important data on the feasibility, acceptability, and preliminary efficacy of mHealth-supported delivery of an evidence-based family home-visiting intervention in a postconflict LMIC. Trial Registration: ClinicalTrials.gov NCT04481399; https://clinicaltrials.gov/ct2/show/NCT04481399. International Registered Report Identifier (IRRID): PRR1-10.2196/25443 %M 33528371 %R 10.2196/25443 %U https://www.researchprotocols.org/2021/2/e25443 %U https://doi.org/10.2196/25443 %U http://www.ncbi.nlm.nih.gov/pubmed/33528371 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23389 %T The Use of Digital Platforms for Adults’ and Adolescents’ Physical Activity During the COVID-19 Pandemic (Our Life at Home): Survey Study %A Parker,Kate %A Uddin,Riaz %A Ridgers,Nicola D %A Brown,Helen %A Veitch,Jenny %A Salmon,Jo %A Timperio,Anna %A Sahlqvist,Shannon %A Cassar,Samuel %A Toffoletti,Kim %A Maddison,Ralph %A Arundell,Lauren %+ Institute for Physical Activity and Nutrition, Deakin University, 75 Pigdons Rd, Geelong, Australia, 61 92468094, k.parker@deakin.edu.au %K digital health %K moderate- to vigorous-intensity physical activity %K muscle-strengthening exercise %K online platforms %K COVID-19 %D 2021 %7 1.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Government responses to managing the COVID-19 pandemic may have impacted the way individuals were able to engage in physical activity. Digital platforms are a promising way to support physical activity levels and may have provided an alternative for people to maintain their activity while at home. Objective: This study aimed to examine associations between the use of digital platforms and adherence to the physical activity guidelines among Australian adults and adolescents during the COVID-19 stay-at-home restrictions in April and May 2020. Methods: A national online survey was distributed in May 2020. Participants included 1188 adults (mean age 37.4 years, SD 15.1; 980/1188, 82.5% female) and 963 adolescents (mean age 16.2 years, SD 1.2; 685/963, 71.1% female). Participants reported demographic characteristics, use of digital platforms for physical activity over the previous month, and adherence to moderate- to vigorous-intensity physical activity (MVPA) and muscle-strengthening exercise (MSE) guidelines. Multilevel logistic regression models examined differences in guideline adherence between those who used digital platforms (ie, users) to support their physical activity compared to those who did not (ie, nonusers). Results: Digital platforms include streaming services for exercise (eg, YouTube, Instagram, and Facebook); subscriber fitness programs, via an app or online (eg, Centr and MyFitnessPal); facilitated online live or recorded classes, via platforms such as Zoom (eg, dance, sport training, and fitness class); sport- or activity-specific apps designed by sporting organizations for participants to keep up their skills (eg, TeamBuildr); active electronic games (eg, Xbox Kinect); and/or online or digital training or racing platforms (eg, Zwift, FullGaz, and Rouvy). Overall, 39.5% (469/1188) of adults and 26.5% (255/963) of adolescents reported using digital platforms for physical activity. Among adults, MVPA (odds ratio [OR] 2.0, 95% CI 1.5-2.7), MSE (OR 3.3, 95% CI 2.5-4.5), and combined (OR 2.7, 95% CI 2.0-3.8) guideline adherence were higher among digital platform users relative to nonusers. Adolescents’ MVPA (OR 2.4, 95% CI 1.3-4.3), MSE (OR 3.1, 95% CI 2.1-4.4), and combined (OR 4.3, 95% CI 2.1-9.0) guideline adherence were also higher among users of digital platforms relative to nonusers. Conclusions: Digital platform users were more likely than nonusers to meet MVPA and MSE guidelines during the COVID-19 stay-at-home restrictions in April and May 2020. Digital platforms may play a critical role in helping to support physical activity engagement when access to facilities or opportunities for physical activity outside the home are restricted. %M 33481759 %R 10.2196/23389 %U https://www.jmir.org/2021/2/e23389 %U https://doi.org/10.2196/23389 %U http://www.ncbi.nlm.nih.gov/pubmed/33481759 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e22601 %T Effects of Smartphone-Based Interventions on Physical Activity in Children and Adolescents: Systematic Review and Meta-analysis %A He,Zihao %A Wu,Hua %A Yu,Fengyu %A Fu,Jinmei %A Sun,Shunli %A Huang,Ting %A Wang,Runze %A Chen,Delong %A Zhao,Guanggao %A Quan,Minghui %+ School of Kinesiology, Shanghai University of Sport, No 399 Chang Hai Road, Shanghai, 200438, China, 86 021 65507367, quanminghui@163.com %K adolescents %K children %K mHealth %K physical activity %K smartphone %D 2021 %7 1.2.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: About 70% of children and adolescents worldwide do not meet the recommended level of physical activity (PA), which is closely associated with physical, psychological, and cognitive well-being. Nowadays, the use of technologies to change PA is of interest due to the need for novel, more effective intervention approaches. The previous meta-analyses have examined smartphone-based interventions and their impact on PA in adults, but evidence in children and adolescents still needs further research. Objective: This systematic review and meta-analysis aimed to determine the effectiveness of smartphone-based interventions for improving PA in children and adolescents. Methods: Five electronic databases (PubMed, Web of Science, OVID, Scopus, and the China National Knowledge Infrastructure) were searched up to June 29, 2020. Randomized controlled trials with a control group that examine the effect of smartphone interventions on PA among children and adolescents were included. Bias risks were assessed using the Cochrane collaboration tool. Meta-analysis was performed to assess the pooled effect on PA using a random effects model. Subgroup analyses were conducted to examine the potential modifying effects of different factors (eg, types of intervention, intervention duration, age, measurement, study quality). Results: A total of 9 studies were included in this review, including 4 mobile app interventions, 3 SMS text messaging interventions, and 2 app + SMS text messaging interventions. In general, the risk of bias of included studies was low. Compared with the control group, the use of smartphone intervention significantly improved PA (standardized mean difference [SMD] 0.44, 95% CI 0.11-0.77, P=.009), especially for total PA (TPA; weighted mean difference [WMD] 32.35, 95% CI 10.36-54.33, P=.004) and daily steps (WMD 1185, 95% CI 303-2068, P=.008), but not for moderate-to-vigorous PA (WMD 3.91, 95% CI –1.99 to 9.81, P=.19). High statistical heterogeneity was detected (I2=73.9%, P<.001) for PA. Meta-regression showed that duration (β=–.08, 95% CI –0.15 to –0.01, n=16) was a potential factor for high heterogeneity. The results of subgroup analyses indicated that app intervention (SMD 0.76, 95% CI 0.23-1.30, P=.005), children (SMD 0.64, 95% CI 0.10-1.18, P=.02), “≤8 weeks” (SMD 0.76, 95% CI 0.23-1.30, P=.005), objective measurement (SMD 0.50, 95% CI 0.09-0.91, P=.02), and low risk of bias (SMD 0.96, 95% CI 0.38-1.54, P=.001) can significantly improve PA. Conclusions: The evidence of meta-analysis shows that smartphone-based intervention may be a promising strategy to increase TPA and steps in children and adolescents. Currently, app intervention may be a more effective strategy among smartphone intervention technologies. To extend the promise of smartphone intervention, the future needs to design comparative trials among different smartphone technologies. Trial Registration: PROSPERO CRD42019148261; https://tinyurl.com/y5modsrd %M 33522980 %R 10.2196/22601 %U https://mhealth.jmir.org/2021/2/e22601 %U https://doi.org/10.2196/22601 %U http://www.ncbi.nlm.nih.gov/pubmed/33522980 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e21636 %T Factors Associated With Dropout of Participants in an App-Based Child Injury Prevention Study: Secondary Data Analysis of a Cluster Randomized Controlled Trial %A Li,Jie %A Ning,Peishan %A Cheng,Peixia %A Schwebel,David C %A Yang,Yang %A Wei,Xiang %A He,Jieyi %A Wang,Wanhui %A Li,Ruotong %A Hu,Guoqing %+ Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, China, 86 731 84805414, huguoqing009@gmail.com %K app-based intervention %K unintentional injury %K attrition %K influencing factors %D 2021 %7 29.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health (mHealth) interventions offer great potential to reach large populations and improve public health. However, high attrition rates threaten evaluation and implementation of mHealth intervention studies. Objective: We explored factors associated with attrition of study participants in an mHealth randomized controlled trial (RCT) evaluating an intervention to reduce unintentional child injury risk in China. Methods: The cluster RCT compared two groups of an app-based intervention for caregivers of 3-6–year-old children (Bao Hu San). The intervention group received unintentional child injury and parenting education, whereas only parenting education was implemented in the control group. The trial included 2920 study participants in Changsha, China, and lasted 6 months. Data on participant engagement (using the app) were collected electronically throughout the 6-month period. Associations between participant attrition and demographic characteristics, and between attrition and intervention engagement were tested and quantified separately for the intervention and control groups using the adjusted odds ratio (aOR) based on generalized linear mixed models. Results: In total, 2920 caregivers from 20 eligible preschools participated, with 1510 in the intervention group and 1410 in the control group. The 6-month attrition rate differed significantly between the two groups (P<.001), at 28.9% (437/1510) in the intervention group and 35.7% (503/1410) in the control group. For the intervention group, the only significant predictor of attrition risk was participants who learned fewer knowledge segments (aOR 2.69, 95% CI 1.19-6.09). For the control group, significant predictors of attrition risk were lower monthly login frequency (aOR 1.48, 95% CI 1.00-2.18), learning fewer knowledge segments (aOR 1.70, 95% CI 1.02-2.81), and shorter learning durations during app engagement (aOR 2.39, 95% CI 1.11-5.15). Demographic characteristics were unrelated to attrition. Conclusions: Engagement in the app intervention was associated with participant attrition. Researchers and practitioners should consider how to best engage participants in app-based interventions to reduce attrition. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IOR-17010438; http://www.chictr.org.cn/showproj.aspx?proj=17376 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5790-1 %M 33512318 %R 10.2196/21636 %U https://www.jmir.org/2021/1/e21636 %U https://doi.org/10.2196/21636 %U http://www.ncbi.nlm.nih.gov/pubmed/33512318 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e22723 %T Smartphone-Detected Ambient Speech and Self-Reported Measures of Anxiety and Depression: Exploratory Observational Study %A Di Matteo,Daniel %A Wang,Wendy %A Fotinos,Kathryn %A Lokuge,Sachinthya %A Yu,Julia %A Sternat,Tia %A Katzman,Martin A %A Rose,Jonathan %+ The Centre for Automation of Medicine, The Edward S Rogers Sr Department of Electrical and Computer Engineering, University of Toronto, DL Pratt Building, 6 King's College Road, Toronto, ON, M5S 3H5, Canada, 1 416 978 6992, dandm@ece.utoronto.ca %K mobile sensing %K passive sensing %K psychiatric assessment %K mood and anxiety disorders %K mobile apps %K linguistics %K speech recognition %K speech content %K lexical choice %D 2021 %7 29.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The ability to objectively measure the severity of depression and anxiety disorders in a passive manner could have a profound impact on the way in which these disorders are diagnosed, assessed, and treated. Existing studies have demonstrated links between both depression and anxiety and the linguistic properties of words that people use to communicate. Smartphones offer the ability to passively and continuously detect spoken words to monitor and analyze the linguistic properties of speech produced by the speaker and other sources of ambient speech in their environment. The linguistic properties of automatically detected and recognized speech may be used to build objective severity measures of depression and anxiety. Objective: The aim of this study was to determine if the linguistic properties of words passively detected from environmental audio recorded using a participant’s smartphone can be used to find correlates of symptom severity of social anxiety disorder, generalized anxiety disorder, depression, and general impairment. Methods: An Android app was designed to collect periodic audiorecordings of participants’ environments and to detect English words using automatic speech recognition. Participants were recruited into a 2-week observational study. The app was installed on the participants’ personal smartphones to record and analyze audio. The participants also completed self-report severity measures of social anxiety disorder, generalized anxiety disorder, depression, and functional impairment. Words detected from audiorecordings were categorized, and correlations were measured between words counts in each category and the 4 self-report measures to determine if any categories could serve as correlates of social anxiety disorder, generalized anxiety disorder, depression, or general impairment. Results: The participants were 112 adults who resided in Canada from a nonclinical population; 86 participants yielded sufficient data for analysis. Correlations between word counts in 67 word categories and each of the 4 self-report measures revealed a strong relationship between the usage rates of death-related words and depressive symptoms (r=0.41, P<.001). There were also interesting correlations between rates of word usage in the categories of reward-related words with depression (r=–0.22, P=.04) and generalized anxiety (r=–0.29, P=.007), and vision-related words with social anxiety (r=0.31, P=.003). Conclusions: In this study, words automatically recognized from environmental audio were shown to contain a number of potential associations with severity of depression and anxiety. This work suggests that sparsely sampled audio could provide relevant insight into individuals’ mental health. %M 33512325 %R 10.2196/22723 %U http://formative.jmir.org/2021/1/e22723/ %U https://doi.org/10.2196/22723 %U http://www.ncbi.nlm.nih.gov/pubmed/33512325 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 1 %P e23796 %T The Use of Telehealth Technology to Support Health Coaching for Older Adults: Literature Review %A Markert,Carl %A Sasangohar,Farzan %A Mortazavi,Bobak J %A Fields,Sherecce %+ Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, TX, 77843, United States, 1 9794582337, sasangohar@tamu.edu %K telemedicine %K remote sensing technology %K health coaching %K decision support systems %K clinical %K older adults %D 2021 %7 29.1.2021 %9 Review %J JMIR Hum Factors %G English %X Background: Health coaching is an intervention process for driving behavior change through goal-setting, education, encouragement, and feedback on health-related behaviors. Telehealth systems that include health coaching and remote monitoring are making inroads in managing chronic conditions and may be especially suited for older populations. Objective: This literature review aimed to investigate the current status of health coaching interventions incorporating telehealth technology and the associated effectiveness of this intervention to deliver health care with an emphasis on older adults (aged 65 and older). Methods: A literature review was conducted to identify the research conducted on health coaching combined with remote monitoring for delivering health care to older adults. The Ovid MEDLINE and CINAHL databases were queried using a combination of relevant search terms (including middle aged, aged, older adult, elderly, health coaching, and wellness coaching). The search retrieved 196 papers published from January 2010 to September 2019 in English. Following a systematic review process, the titles and abstracts of the papers retrieved were screened for applicability to health coaching for older adults to define a subset for further review. Papers were excluded if the studied population did not include older adults. The full text of the 42 papers in this subset was then reviewed, and 13 papers related to health coaching combined with remote monitoring for older adults were included in this review. Results: Of the 13 studies reviewed, 10 found coaching supported by telehealth technology to provide effective outcomes. Effectiveness outcomes assessed in the studies included hospital admissions/re-admissions, mortality, hemoglobin A1c (HbA1c) level, body weight, blood pressure, physical activity level, fatigue, quality of life, and user acceptance of the coaching program and technology. Conclusions: Telehealth systems that include health coaching have been implemented in older populations as a viable intervention method for managing chronic conditions with mixed results. Health coaching combined with telehealth may be an effective solution for providing health care to older adults. However, health coaching is predominantly performed by human coaches with limited use of technology to augment or replace the human coach. The opportunity exists to expand health coaching to include automated coaching. %M 33512322 %R 10.2196/23796 %U http://humanfactors.jmir.org/2021/1/e23796/ %U https://doi.org/10.2196/23796 %U http://www.ncbi.nlm.nih.gov/pubmed/33512322 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e22041 %T A Relaxation App (HeartBot) for Stress and Emotional Well-Being Over a 21-Day Challenge: Randomized Survey Study %A Iyer,Laya %A Iyer,Ranjani B %A Kumar,Vetriliaa %+ Heartfulness Program for Schools, Heartfulness Institute, 24977 Glenda St, Novi, MI, 48375, United States, 1 2482559635, ranjani.heartfulness@gmail.com %K Heartfulness %K stress management %K iOS app %K social-emotional %K mental health %D 2021 %7 29.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: HeartBot is an app designed to enable people 14 years and older to use relaxation tools offered by Heartfulness Institute to deal with daily stress and anxiety in a healthy, productive manner. These tools have proven effective in stress management and mental wellness when administered in a controlled environment by a certified proctor. Objective: This study aimed to explore the app’s effectiveness and evaluate the implementation of the tools. Methods: In this study, 88 participants were recruited and randomly sorted into 2 groups, the HeartBot intervention group (n=46) and the waitlist control group (n=42). Pre- and postsurveys measured participants’ stress levels using the Perceived Stress Scale (PSS) and their social-emotional well-being using the EPOCH (Engagement, Perseverance, Optimism, Connectedness, and Happiness) Measure of Adolescent Well-Being before and after they used the app for 21 days for 30 minutes every day. Results: The study received institutional review board approval on August 18, 2019. Participant recruitment lasted from the approval date until September 30, 2019. The 21-day challenge started on October 1, 2019. Of the 135 people who signed up, 88 completed the study. There was a statistically significant difference in the mean PSS scores before and after the intervention (from 18.3 to 7.89; P<.001). The paired Wilcoxon rank sum test on the EPOCH scores indicated a significant difference in the medians of the total scores (W=411.5, P<.001). Conclusions: Evidence from this study shows that HeartBot is an effective app that can be used to manage stress and improve positive characteristics of emotional wellness. Future research and widespread usage of the app under this study are encouraged based on this preliminary evidence of its effectiveness. Trial Registration: ClinicalTrials.gov NCT04589520; https://clinicaltrials.gov/ct2/show/NCT04589520 %M 33455902 %R 10.2196/22041 %U http://formative.jmir.org/2021/1/e22041/ %U https://doi.org/10.2196/22041 %U http://www.ncbi.nlm.nih.gov/pubmed/33455902 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e21854 %T Examining the Relationship Between the Use of a Mobile Peer-Support App and Self-Injury Outcomes: Longitudinal Mixed Methods Study %A Kruzan,Kaylee Payne %A Whitlock,Janis %A Bazarova,Natalya N %+ Center for Behavioral Intervention Technologies, Northwestern University, 750 N Lake Shore Dr, 10th Fl, Chicago, IL, United States, 1 312 503 6585, kaylee.kruzan@northwestern.edu %K self-injury %K mobile apps %K peer support %K mHealth %D 2021 %7 28.1.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Many individuals who self-injure seek support and information through online communities and mobile peer-support apps. Although researchers have identified risks and benefits of participation, empirical work linking participation in these web-based spaces to self-injury behaviors and thoughts is limited. Objective: This study aims to investigate the relationship between behavioral and linguistic traces on a mobile peer support app and self-injury outcomes. Methods: Natural use data and web-based surveys (N=697) assessing self-injury outcomes were collected from 268 users (aged 13-38 years; median 19; 149/268, 55.6% female) of a mobile peer-support app for 4 months. Participants were identified as having posted self-injury content using an internal classifier. Natural log data was used to predict self-injury outcomes in a series of multilevel logistic and linear regressions. Results: Greater engagement on a mobile peer-support app was associated with a decreased likelihood of self-injury thoughts (odds ratio [OR] 0.25, 95% CI 0.09-0.73) and fewer intentions to self-injure (b=−0.37, SE 0.09), whereas posting triggering content was associated with an increased likelihood of engaging in behaviors (OR 5.37, 95% CI 1.25-23.05) and having self-injury thoughts (OR 17.87, 95% CI 1.64-194.15). Moreover, viewing triggering content was related to both a greater ability to resist (b=1.39, SE 0.66) and a greater intention to self-injure (b=1.50, SE 0.06). Conclusions: To our knowledge, this is the first study to connect naturally occurring log data to survey data assessing self-injury outcomes over time. This work provides empirical support for the relationship between participation in online forums and self-injury outcomes, and it articulates mechanisms contributing to this relationship. %M 33507154 %R 10.2196/21854 %U http://mental.jmir.org/2021/1/e21854/ %U https://doi.org/10.2196/21854 %U http://www.ncbi.nlm.nih.gov/pubmed/33507154 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e21926 %T Deep Learning–Based Multimodal Data Fusion: Case Study in Food Intake Episodes Detection Using Wearable Sensors %A Bahador,Nooshin %A Ferreira,Denzil %A Tamminen,Satu %A Kortelainen,Jukka %+ Faculty of Information Technology and Electrical Engineering, University of Oulu, Pentti Kaiteran katu 1, Oulu, FIN-90570, Finland, 358 417246274, nooshin.bahador@oulu.fi %K deep learning %K image processing %K data fusion %K covariance distribution %K food intake episode %K wearable sensors %D 2021 %7 28.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Multimodal wearable technologies have brought forward wide possibilities in human activity recognition, and more specifically personalized monitoring of eating habits. The emerging challenge now is the selection of most discriminative information from high-dimensional data collected from multiple sources. The available fusion algorithms with their complex structure are poorly adopted to the computationally constrained environment which requires integrating information directly at the source. As a result, more simple low-level fusion methods are needed. Objective: In the absence of a data combining process, the cost of directly applying high-dimensional raw data to a deep classifier would be computationally expensive with regard to the response time, energy consumption, and memory requirement. Taking this into account, we aimed to develop a data fusion technique in a computationally efficient way to achieve a more comprehensive insight of human activity dynamics in a lower dimension. The major objective was considering statistical dependency of multisensory data and exploring intermodality correlation patterns for different activities. Methods: In this technique, the information in time (regardless of the number of sources) is transformed into a 2D space that facilitates classification of eating episodes from others. This is based on a hypothesis that data captured by various sensors are statistically associated with each other and the covariance matrix of all these signals has a unique distribution correlated with each activity which can be encoded on a contour representation. These representations are then used as input of a deep model to learn specific patterns associated with specific activity. Results: In order to show the generalizability of the proposed fusion algorithm, 2 different scenarios were taken into account. These scenarios were different in terms of temporal segment size, type of activity, wearable device, subjects, and deep learning architecture. The first scenario used a data set in which a single participant performed a limited number of activities while wearing the Empatica E4 wristband. In the second scenario, a data set related to the activities of daily living was used where 10 different participants wore inertial measurement units while performing a more complex set of activities. The precision metric obtained from leave-one-subject-out cross-validation for the second scenario reached 0.803. The impact of missing data on performance degradation was also evaluated. Conclusions: To conclude, the proposed fusion technique provides the possibility of embedding joint variability information over different modalities in just a single 2D representation which results in obtaining a more global view of different aspects of daily human activities at hand, and yet preserving the desired performance level in activity recognition. %M 33507156 %R 10.2196/21926 %U http://mhealth.jmir.org/2021/1/e21926/ %U https://doi.org/10.2196/21926 %U http://www.ncbi.nlm.nih.gov/pubmed/33507156 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e23410 %T Effectiveness of Smartphone-Based Mindfulness Training on Maternal Perinatal Depression: Randomized Controlled Trial %A Sun,Yaoyao %A Li,Yanyan %A Wang,Juan %A Chen,Qingyi %A Bazzano,Alessandra N %A Cao,Fenglin %+ School of Nursing and Rehabilitation, Shandong University, 44 Wenhua Xi Road, Jinan, 250012, China, 86 053188382291, caofenglin2008@126.com %K mindfulness %K pregnancy %K perinatal care %K depression %K mHealth %K mobile health %K psychosocial intervention %D 2021 %7 27.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite potential for benefit, mindfulness remains an emergent area in perinatal mental health care, and evidence of smartphone-based mindfulness training for perinatal depression is especially limited. Objective: The objective of this study was to evaluate the effectiveness of a smartphone-based mindfulness training intervention during pregnancy on perinatal depression and other mental health problems with a randomized controlled design. Methods: Pregnant adult women who were potentially at risk of perinatal depression were recruited from an obstetrics clinic and randomized to a self-guided 8-week smartphone-based mindfulness training during pregnancy group or attention control group. Mental health indicators were surveyed over five time points through the postpartum period by online self-assessment. The assessor who collected the follow-up data was blind to the assignment. The primary outcome was depression as measured by symptoms, and secondary outcomes were anxiety, stress, affect, sleep, fatigue, memory, and fear. Results: A total of 168 participants were randomly allocated to the mindfulness training (n=84) or attention control (n=84) group. The overall dropout rate was 34.5%, and 52.4% of the participants completed the intervention. Mindfulness training participants reported significant improvement of depression (group × time interaction χ24=16.2, P=.003) and secondary outcomes (χ24=13.1, P=.01 for anxiety; χ24=8.4, P=.04 for positive affect) compared to attention control group participants. Medium between-group effect sizes were found on depression and positive affect at postintervention, and on anxiety in late pregnancy (Cohen d=0.47, –0.49, and 0.46, respectively). Mindfulness training participants reported a decreased risk of positive depressive symptom (Edinburgh Postnatal Depression Scale [EPDS] score>9) compared to attention control participants postintervention (odds ratio [OR] 0.391, 95% CI 0.164-0.930) and significantly higher depression symptom remission with different EPDS reduction scores from preintervention to postintervention (OR 3.471-27.986). Parity did not show a significant moderating effect; however, for nulliparous women, mindfulness training participants had significantly improved depression symptoms compared to nulliparous attention control group participants (group × time interaction χ24=18.1, P=.001). Conclusions: Smartphone-based mindfulness training is an effective intervention in improving maternal perinatal depression for those who are potentially at risk of perinatal depression in early pregnancy. Nulliparous women are a promising subgroup who may benefit more from mindfulness training. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900028521; http://www.chictr.org.cn/showproj.aspx?proj=33474 %M 33502326 %R 10.2196/23410 %U http://www.jmir.org/2021/1/e23410/ %U https://doi.org/10.2196/23410 %U http://www.ncbi.nlm.nih.gov/pubmed/33502326 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e15369 %T A Smartphone App to Support Sedentary Behavior Change by Visualizing Personal Mobility Patterns and Action Planning (SedVis): Development and Pilot Study %A Wang,Yunlong %A König,Laura M. %A Reiterer,Harald %+ Department of Computer and Information Science, University of Konstanz, Universitätsstraße 10, Konstanz, 78457, Germany, 49 7531 88 3704, yunlong.wang@uni-konstanz.de %K sedentary behavior %K data visualization %K mobile app %K action planning %K human mobility patterns %K mobile phone %D 2021 %7 27.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Prolonged sedentary behavior is related to a number of risk factors for chronic diseases. Given the high prevalence of sedentary behavior in daily life, simple yet practical solutions for behavior change are needed to avoid detrimental health effects. Objective: The mobile app SedVis was developed based on the health action process approach. The app provides personal mobility pattern visualization (for both physical activity and sedentary behavior) and action planning for sedentary behavior change. The primary aim of the study is to investigate the effect of mobility pattern visualization on users’ action planning for changing their sedentary behavior. The secondary aim is to evaluate user engagement with the visualization and user experience of the app. Methods: A 3-week user study was conducted with 16 participants who had the motivation to reduce their sedentary behavior. Participants were allocated to either an active control group (n=8) or an intervention group (n=8). In the 1-week baseline period, none of the participants had access to the functions in the app. In the following 2-week intervention period, only the intervention group was given access to the visualizations, whereas both groups were asked to make action plans every day and reduce their sedentary behavior. Participants’ sedentary behavior was estimated based on the sensor data of their smartphones, and their action plans and interaction with the app were also recorded by the app. Participants’ intention to change their sedentary behavior and user experience of the app were assessed using questionnaires. Results: The data were analyzed using both traditional null hypothesis significance testing (NHST) and Bayesian statistics. The results suggested that the visualizations in SedVis had no effect on the participants’ action planning according to both the NHST and Bayesian statistics. The intervention involving visualizations and action planning in SedVis had a positive effect on reducing participants’ sedentary hours, with weak evidence according to Bayesian statistics (Bayes factor, BF+0=1.92; median 0.52; 95% CI 0.04-1.25), whereas no change in sedentary time was more likely in the active control condition (BF+0=0.28; median 0.18; 95% CI 0.01-0.64). Furthermore, Bayesian analysis weakly suggested that the more frequently the users checked the app, the more likely they were to reduce their sedentary behavior (BF−0=1.49; r=−0.50). Conclusions: Using a smartphone app to collect data on users’ mobility patterns and provide real-time feedback using visualizations may be a promising method to induce changes in sedentary behavior and may be more effective than action planning alone. Replications with larger samples are needed to confirm these findings. %M 33502322 %R 10.2196/15369 %U http://formative.jmir.org/2021/1/e15369/ %U https://doi.org/10.2196/15369 %U http://www.ncbi.nlm.nih.gov/pubmed/33502322 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e25456 %T It Is Time to REACT: Opportunities for Digital Mental Health Apps to Reduce Mental Health Disparities in Racially and Ethnically Minoritized Groups %A Friis-Healy,Elsa A %A Nagy,Gabriela A %A Kollins,Scott H %+ Department of Psychiatry and Behavioral Services, Duke University School of Medicine, 2608 Erwin Road, Durham, NC, 27705, United States, 1 919 681 0014, eaf23@duke.edu %K digital health %K app %K public mental health %K health disparities %K COVID-19 %K pandemic %K mental health %K disparity %K behavior %D 2021 %7 26.1.2021 %9 Viewpoint %J JMIR Ment Health %G English %X The behavioral health toll of the COVID-19 pandemic and systemic racism has directed increased attention to the potential of digital health as a way of improving access to and quality of behavioral health care. However, as the pandemic continues to widen health disparities in racially and ethnically minoritized groups, concerns arise around an increased reliance on digital health technologies exacerbating the digital divide and reinforcing rather than mitigating systemic health inequities in communities of color. As funding for digital mental health continues to surge, we offer five key recommendations on how the field can “REACT” to ensure the development of approaches that increase health equity by increasing real-world evidence, educating consumers and providers, utilizing adaptive interventions to optimize care, creating for diverse populations, and building trust. Recommendations highlight the need to take a strengths-based view when designing for racially and ethnically diverse populations and embracing the potential of digital approaches to address complex challenges. %M 33406050 %R 10.2196/25456 %U http://mental.jmir.org/2021/1/e25456/ %U https://doi.org/10.2196/25456 %U http://www.ncbi.nlm.nih.gov/pubmed/33406050 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e20314 %T Mobile Phone Use and Acceptability for the Delivery of Mental Health Information Among Perinatal Adolescents in Nigeria: Survey Study %A Kola,Lola %A Abiona,Dolapo %A Adefolarin,Adeyinka Olufolake %A Ben-Zeev,Dror %+ University of Ibadan, Department of Psychiatry, College of Medicine, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Ibadan, , Nigeria, 234 8057943775, lola_kola2004@yahoo.com %K mHealth %K perinatal adolescent %K perinatal depression %K community %K low income %D 2021 %7 26.1.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: There are several barriers that may hamper adolescent mothers’ utilization of available health interventions for perinatal depression. Innovative treatment approaches are needed to increase adolescent mothers’ access to mental health care for improved maternal and child health outcomes. Mobile phones have the potential to serve as important conduits to mental health care in Africa. However, mobile phone use patterns and needs among young mothers in Nigeria are not well documented. Objective: This study sought to determine the prevalence of mobile phone use among perinatal adolescents and report patterns of use, as well as to assess the openness of young mothers to mobile health (mHealth) mental health interventions. Methods: We surveyed 260 adolescent mothers (ages 16-19 years) in their perinatal or postnatal periods of pregnancies in 33 primary health care clinics in Ibadan, Oyo State, Nigeria in 2020. Respondents were included if they were pregnant with a gestation age of greater than or equal to 4 weeks, or had babies (which they had birthed) that were younger than 12 months. Results: The total study sample consisted of 260 adolescent mothers with a mean age of 18.4 (SD 0.88) years. The majority of the respondents (233/260, 89.6%) owned mobile phones (eg, keypad, keypad and internet, smartphones); 22 (8.5%) of the 260 mothers had access to phones that belonged to relatives who lived in the same household, while 5 (1.9%) had access only to public paid phones. Only 23% (54/233) of phone owners (which is 20.5% of the total study population) had smartphones. On average, respondents reported first using mobile phones at 15.5 (SD 2.06) years old. The majority of respondents (222/260, 85.4%) reported using their phones for an average of 45 minutes daily for calls to family members. Facebook was the social media platform that was most often used among respondents who had phones with internet access (122/146 minutes per day, 83.4%). The majority of the sample responded as being “interested” and “very interested” in the use of mobile phones for preventive interventions (250/260, 96.2%) and treatment (243/260, 93.5%) information on mental illness such as depression and “hearing voices.” Half of the respondents (126/233, 50.4%) preferred to receive such information in the form of text messages. Conclusions: Findings from this study suggest that the vast majority of perinatal adolescents in Nigeria own and use mobile phones and that they are interested in leveraging these devices for prevention, treatment, and informational campaigns focused on mental health. The use of smartphones in this population is relatively low, and health intervention through text messages were favored by the women. %M 33496678 %R 10.2196/20314 %U http://mental.jmir.org/2021/1/e20314/ %U https://doi.org/10.2196/20314 %U http://www.ncbi.nlm.nih.gov/pubmed/33496678 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e24662 %T Association Between Care Utilization and Anxiety Outcomes in an On-Demand Mental Health System: Retrospective Observational Study %A Kunkle,Sarah %A Yip,Manny %A Hunt,Justin %A Ξ,Watson %A Udall,Dana %A Arean,Patricia %A Nierenberg,Andrew %A Naslund,John A %+ Ginger, 116 New Montgomery Street, San Francisco, CA, United States, 1 7175197355, sarah@ginger.io %K mental health %K digital health %K anxiety %K telehealth %K virtual care %K utilization %K outcome %K retrospective %K observational %D 2021 %7 26.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Anxiety is an extremely prevalent condition, and yet, it has received notably less attention than depression and other mental health conditions from a research, clinical, and public health perspective. The COVID-19 pandemic has only exacerbated growing concerns about the burden of anxiety due to the confluence of physical health risks, economic stressors, social isolation, and general disruption of daily activities. Objective: This study examines differences in anxiety outcomes by care modality (coaching, teletherapy and telepsychiatry, and combined care) within an on-demand mental health system. We also explore the association between levels of engagement within each care modality and odds of improvement in symptoms of anxiety. Methods: We conducted a retrospective observational study of individuals who accessed Ginger, an on-demand mental health system. Data were collected from 1611 Ginger members between January 1, 2018, and December 31, 2019. We used logistic regression to assess the association between care modality and improvement in anxiety symptoms. Within each modality, we assessed the association between level of engagement and improvement. Results: Of 1611 Ginger members, 761 (47.0%) experienced a decrease in anxiety symptoms, as measured by a change from a positive to a negative 2-item Generalized Anxiety Disorder (GAD-2) screen. Among members who still screened positive at follow-up (865/1611, 53%), a total of 192 members (11.9%) experienced a clinically significant score reduction in the full GAD-7 (ie, a score reduction of >5 points), even though their GAD-2 scores were still positive. All modalities showed increased odds of improvement compared to those who were not engaged with coaching or clinical services (“app-only”). Higher GAD-7 intake scores were also associated with decreased odds of improvement. Conclusions: This study found increased odds of anxiety improvement for all care modalities compared to those who did not engage in care, with larger effect sizes for higher utilization within all care modalities. Additionally, there is a promising observation that those engaged in combined care (teletherapy and text-based coaching) had the greatest odds of anxiety improvement. Future directions include more detailed classifications of utilization patterns and an exploration of explanations and solutions for lower-utilization members. %M 33496679 %R 10.2196/24662 %U http://formative.jmir.org/2021/1/e24662/ %U https://doi.org/10.2196/24662 %U http://www.ncbi.nlm.nih.gov/pubmed/33496679 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e24736 %T Examining a Digital Health Approach for Advancing Schizophrenia Illness Self-Management and Provider Engagement: Protocol for a Feasibility Trial %A Kidd,Sean %A McKenzie,Kwame %A Wang,Wei %A Agrawal,Sacha %A Voineskos,Aristotle %+ Department of Psychiatry, University of Toronto, CAMH, 1001 Queen Street West, 2-1, Toronto, ON, Canada, 1 647 239 1296, sean.kidd@camh.ca %K schizophrenia %K psychosis %K digital health %K mobile health %K smartphone %D 2021 %7 25.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In schizophrenia spectrum populations, adherence to treatment is poor, community-based supports are limited, and efforts to foster illness self-management have had limited success. These challenges contribute to frequent, lengthy, and costly hospital readmissions and poor functional outcomes. Digital health strategies, in turn, hold considerable promise in the effort to address these problems. Objective: This feasibility trial will examine a digital health platform called App4Independence (A4i), which was designed to enhance illness self-management and treatment engagement for individuals with schizophrenia. Methods: Feasibility metrics in this single-blind, randomized trial include study recruitment and retention, rate of technology use, safety, and utility in clinical interactions. Other outcome metrics include symptomatology, treatment adherence, patient-provider alliance, and quality of life. In this trial, 160 study participants with schizophrenia spectrum diagnoses will be randomized to either treatment or control conditions, with pretest-posttest outcomes measured over a 6-month period. Results: This study was funded by the Canadian Institutes of Health Research in January 2020 and received Institutional Review Board approval on August 13, 2020. This study plans to begin recruiting in January 2021 and will be completed within 3 years. Data collection is projected to begin in January 2021. Conclusions: This research will provide critical information for the development of this new technology in the larger effort to address a key problem in the schizophrenia field—how to leverage technology to enhance illness self-management and care engagement in resource-limited service contexts. International Registered Report Identifier (IRRID): PRR1-10.2196/24736 %M 33492235 %R 10.2196/24736 %U http://www.researchprotocols.org/2021/1/e24736/ %U https://doi.org/10.2196/24736 %U http://www.ncbi.nlm.nih.gov/pubmed/33492235 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e21708 %T A Mobile App–Based Intervention Program for Nonprofessional Caregivers to Promote Positive Mental Health: Randomized Controlled Trial %A Ferré-Grau,Carme %A Raigal-Aran,Laia %A Lorca-Cabrera,Jael %A Lluch-Canut,Teresa %A Ferré-Bergadà,Maria %A Lleixá-Fortuño,Mar %A Puig-Llobet,Montserrat %A Miguel-Ruiz,Maria Dolores %A Albacar-Riobóo,Núria %+ Department of Nursing, Universitat Rovira i Virgili, 35, Catalunya Avenue, Tarragona, 43002, Spain, 34 977558000, laia.raigal@urv.cat %K clinical trial %K caregiver %K mobile phone app %K intervention program %K positive mental health %K mobile health %K health promotion %K randomized controlled trial %K nursing %K caregiving %K technology %D 2021 %7 22.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: While nonprofessional caregivers often experience a sense of fulfillment when they provide care, there is also a significant risk of emotional and physical burnout. Consequently, this can negatively affect both the caregiver and the person being cared for. Intervention programs can help empower nonprofessional caregivers of people with chronic diseases and develop solutions to decrease the physical and psychological consequences resulting from caregiving. However, most clinically tested intervention programs for nonprofessional caregivers require face-to-face training, and many caregivers encounter obstacles that hinder their participation in such programs. Consequently, it is necessary to design internet-based intervention programs for nonprofessional caregivers that address their needs and test the efficacy of the programs. Objective: The aim of this study was to evaluate the effectiveness of a smartphone app–based intervention program to increase positive mental health for nonprofessional caregivers. Methods: This study was a randomized controlled trial of 3 months’ duration. A total of 152 caregivers over 18 years of age with a minimum of 4 months’ experience as nonprofessional caregivers were recruited from primary health care institutions. Nonprofessional caregivers were randomized into two groups. In the intervention group, each caregiver installed a smartphone app and used it for 28 days. This app offered them daily activities that were based on 10 recommendations to promote positive mental health. The level of positive mental health, measured using the Positive Mental Health Questionnaire (PMHQ), and caregiver burden, measured using the 7-item short-form version of the Zarit Caregiver Burden Interview (ZBI-7), were the primary outcomes. Users’ satisfaction was also measured. Results: In all, 113 caregivers completed the study. After the first month of the intervention, only one factor of the PMHQ, F1–Personal satisfaction, showed a significant difference between the groups, but it was not clinically relevant (0.96; P=.03). However, the intervention group obtained a higher mean change for the overall PMHQ score (mean change between groups: 1.40; P=.24). The results after the third month of the intervention showed an increment of PMHQ scores. The mean difference of change in the PMHQ score showed a significant difference between the groups (11.43; P<.001; d=0.82). Significant changes were reported in 5 of the 6 factors, especially F5–Problem solving and self-actualization (5.69; P<.001; d=0.71), F2–Prosocial attitude (2.47; P<.001; d=1.18), and F3–Self-control (0.76; P=.03; d=0.50). The results of the ZBI-7 showed a decrease in caregiver burden in the intervention group, although the results were inconclusive. Approximately 93.9% (46/49) of the app users indicated that they would recommend the app to other caregivers and 56.3% (27/49) agreed that an extension of the program’s duration would be beneficial. Conclusions: The app-based intervention program analyzed in this study was effective in promoting positive mental health and decreasing the burden of caregivers and achieved a high range of user satisfaction. This study provides evidence that mobile phone app–based intervention programs may be useful tools for increasing nonprofessional caregivers’ well-being. The assessment of the effectiveness of intervention programs through clinical trials should be a focus to promote internet-based programs in health policies. Trial Registration: ISRCTN Registry ISRCTN14818443; http://www.isrctn.com/ISRCTN14818443 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7264-5 %M 33480852 %R 10.2196/21708 %U http://mhealth.jmir.org/2021/1/e21708/ %U https://doi.org/10.2196/21708 %U http://www.ncbi.nlm.nih.gov/pubmed/33480852 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e25018 %T The Digital Marshmallow Test (DMT) Diagnostic and Monitoring Mobile Health App for Impulsive Behavior: Development and Validation Study %A Sobolev,Michael %A Vitale,Rachel %A Wen,Hongyi %A Kizer,James %A Leeman,Robert %A Pollak,J P %A Baumel,Amit %A Vadhan,Nehal P %A Estrin,Deborah %A Muench,Frederick %+ The Partnership to End Addiction, 485 Lexington Avenue, 3rd Floor, New York, NY, 10017, United States, 1 9175320623, fmuench@toendaddiction.org %K impulse control %K impulsivity %K self-regulation %K self-control %K mobile health %K mHealth %K ecological momentary assessment %K active task %K ResearchKit %D 2021 %7 22.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The classic Marshmallow Test, where children were offered a choice between one small but immediate reward (eg, one marshmallow) or a larger reward (eg, two marshmallows) if they waited for a period of time, instigated a wealth of research on the relationships among impulsive responding, self-regulation, and clinical and life outcomes. Impulsivity is a hallmark feature of self-regulation failures that lead to poor health decisions and outcomes, making understanding and treating impulsivity one of the most important constructs to tackle in building a culture of health. Despite a large literature base, impulsivity measurement remains difficult due to the multidimensional nature of the construct and limited methods of assessment in daily life. Mobile devices and the rise of mobile health (mHealth) have changed our ability to assess and intervene with individuals remotely, providing an avenue for ambulatory diagnostic testing and interventions. Longitudinal studies with mobile devices can further help to understand impulsive behaviors and variation in state impulsivity in daily life. Objective: The aim of this study was to develop and validate an impulsivity mHealth diagnostics and monitoring app called Digital Marshmallow Test (DMT) using both the Apple and Android platforms for widespread dissemination to researchers, clinicians, and the general public. Methods: The DMT app was developed using Apple’s ResearchKit (iOS) and Android’s ResearchStack open source frameworks for developing health research study apps. The DMT app consists of three main modules: self-report, ecological momentary assessment, and active behavioral and cognitive tasks. We conducted a study with a 21-day assessment period (N=116 participants) to validate the novel measures of the DMT app. Results: We used a semantic differential scale to develop self-report trait and momentary state measures of impulsivity as part of the DMT app. We identified three state factors (inefficient, thrill seeking, and intentional) that correlated highly with established measures of impulsivity. We further leveraged momentary semantic differential questions to examine intraindividual variability, the effect of daily life, and the contextual effect of mood on state impulsivity and daily impulsive behaviors. Our results indicated validation of the self-report sematic differential and related results, and of the mobile behavioral tasks, including the Balloon Analogue Risk Task and Go-No-Go task, with relatively low validity of the mobile Delay Discounting task. We discuss the design implications of these results to mHealth research. Conclusions: This study demonstrates the potential for assessing different facets of trait and state impulsivity during everyday life and in clinical settings using the DMT mobile app. The DMT app can be further used to enhance our understanding of the individual facets that underlie impulsive behaviors, as well as providing a promising avenue for digital interventions. Trial Registration: ClinicalTrials.gov NCT03006653; https://www.clinicaltrials.gov/ct2/show/NCT03006653 %M 33480854 %R 10.2196/25018 %U http://mhealth.jmir.org/2021/1/e25018/ %U https://doi.org/10.2196/25018 %U http://www.ncbi.nlm.nih.gov/pubmed/33480854 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 6 %N 1 %P e19088 %T Physical Activity Evaluation Using a Voice Recognition App: Development and Validation Study %A Namba,Hideyuki %+ Physical Education Lab., College of Science and Technology, Nihon University, 7-24-1 Narashinodai-Funabashi, Chiba, 274-8501, Japan, 81 47 469 5518, nanba.hideyuki@nihon-u.ac.jp %K voice recognition %K smartphone %K physical activity %K accelerometer %K application %D 2021 %7 21.1.2021 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Historically, the evaluation of physical activity has involved a variety of methods such as the use of questionnaires, accelerometers, behavior records, and global positioning systems, each according to the purpose of the evaluation. The use of web-based physical activity evaluation systems has been proposed as an easy method for collecting physical activity data. Voice recognition technology not only eliminates the need for questionnaires during physical activity evaluation but also enables users to record their behavior without physically touching electronic devices. The use of a web-based voice recognition system might be an effective way to record physical activity and behavior. Objective: The purpose of this study was to develop a physical activity evaluation app to record behavior using voice recognition technology and to examine the app’s validity by comparing data obtained using both the app and an accelerometer simultaneously. Methods: A total of 20 participants (14 men, 6 women; mean age 19.1 years, SD 0.9) wore a 3-axis accelerometer and inputted behavioral data into their smartphones for a period of 7 days. We developed a behavior-recording system with a voice recognition function using a voice recognition application programming interface. The exercise intensity was determined from the text data obtained by the voice recognition program. The measure of intensity was metabolic equivalents (METs). Results: From the voice input data of the participants, 601 text-converted data could be confirmed, of which 471 (78.4%) could be automatically converted into behavioral words. In the time-matched analysis, the mean daily METs values measured by the app and the accelerometer were 1.64 (SD 0.20) and 1.63 (SD 0.20), respectively, between which there was no significant difference (P=.57). There was a significant correlation between the average METs obtained from the voice recognition app and the accelerometer in the time-matched analysis (r=0.830, P<.001). In the Bland-Altman plot for METs measured by the voice recognition app as compared with METs measured by accelerometer, the mean difference between the two methods was very small (0.02 METs), with 95% limits of agreement from –0.26 to 0.22 METs between the two methods. Conclusions: The average METs value measured by the voice recognition app was consistent with that measured by the 3-axis accelerometer and, thus, the data gathered by the two measurement methods showed a high correlation. The voice recognition method also demonstrated the ability of the system to measure the physical activity of a large number of people at the same time with less burden on the participants. Although there were still issues regarding the improvement of automatic text data classification technology and user input compliance, this research proposes a new method for evaluating physical activity using voice recognition technology. %M 38907383 %R 10.2196/19088 %U http://biomedeng.jmir.org/2021/1/e19088/ %U https://doi.org/10.2196/19088 %U http://www.ncbi.nlm.nih.gov/pubmed/38907383 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e23778 %T Comparing Effectiveness Between a Mobile App Program and Traditional Cognitive Behavior Therapy in Obsessive-Compulsive Disorder: Evaluation Study %A Hwang,Hyunchan %A Bae,Sujin %A Hong,Ji Sun %A Han,Doug Hyun %+ Department of Psychiatry, Chung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea, 82 262993132, hduk70@gmail.com %K obsessive-compulsive disorder %K exposure and response prevention %K cognitive behavior therapy %K cortico-striato-thalamo-cortical tract %K functional connectivity %K prevention %K cognitive %K mental illness %K behavior therapy %D 2021 %7 19.1.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: This study proposes a digital program for the treatment of mental illness that could increase motivation and improve learning outcomes for patients. Several studies have already applied this method by using an exposure and response prevention–inspired serious game to treat patients with obsessive-compulsive disorder (OCD). Objective: We hypothesized that a mobile cognitive behavior therapy (CBT) program would be as effective in treating OCD as traditional offline CBT. In addition, the treatment efficacy in response to mobile CBT for OCD might be associated with increased brain activity within the cortico-striato-thalamo-cortical (CSTC) tract. Methods: The digital CBT treatment program for OCD, OCfree, consists of 6 education sessions, 10 quests, and 7 casual games. Information was gathered from 27 patients with OCD (15 offline CBT and 12 OCfree CBT). During the 6-week intervention period, changes in clinical symptoms and brain function activity were analyzed. Results: There was no significant difference in the change in OCD symptoms and depressive symptoms between the two groups. However, the OCfree group showed greater improvement in anxiety symptoms compared to the offline CBT group. Both offline CBT and OCfree CBT increased the functional connectivity within the CSTC tract in all patients with OCD. However, CBT using OCfree showed greater changes in brain connectivity within the thalamus and insula, compared to offline CBT. Conclusions: OCfree, an OCD treatment app program, was effective in the treatment of drug-naïve patients with OCD. The treatment effects of OCfree are associated with increased brain connectivity within the CSTC tract. Multisensory stimulation by education, quests, and games in OCfree increases the activity within the thalamus and insula in patients with OCD. %M 33464208 %R 10.2196/23778 %U http://mental.jmir.org/2021/1/e23778/ %U https://doi.org/10.2196/23778 %U http://www.ncbi.nlm.nih.gov/pubmed/33464208 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 1 %P e16054 %T Electromyography-Driven Exergaming in Wheelchairs on a Mobile Platform: Bench and Pilot Testing of the WOW-Mobile Fitness System %A Enciso,James %A Variya,Dhruval %A Sunthonlap,James %A Sarmiento,Terrence %A Lee,Ka Mun %A Velasco,James %A Pebdani,Roxanna N %A de Leon,Ray D %A Dy,Christine %A Keslacy,Stefan %A Won,Deborah Soonmee %+ Department of Electrical and Computer Engineering, California State University, Los Angeles, 5151 State University Dr., Los Angeles, CA, 90032, United States, 1 323 343 5908, dwon@calstatela.edu %K exergaming %K gamercising %K mobile health %K wheelchair exercises %K wireless electromyography %K mobile phone %D 2021 %7 19.1.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Implementing exercises in the form of video games, otherwise known as exergaming, has gained recent attention as a way to combat health issues resulting from sedentary lifestyles. However, these exergaming apps have not been developed for exercises that can be performed in wheelchairs, and they tend to rely on whole-body movements. Objective: This study aims to develop a mobile phone app that implements electromyography (EMG)-driven exergaming, to test the feasibility of using this app to enable people in wheelchairs to perform exergames independently and flexibly in their own home, and to assess the perceived usefulness and usability of this mobile health system. Methods: We developed an Android mobile phone app (Workout on Wheels, WOW-Mobile) that senses upper limb muscle activity (EMG) from wireless body-worn sensors to drive 3 different video games that implement upper limb exercises designed for people in wheelchairs. Cloud server recordings of EMG enabled long-term monitoring and feedback as well as multiplayer gaming. Bench testing of data transmission and power consumption were tested. Pilot testing was conducted on 4 individuals with spinal cord injury. Each had a WOW-Mobile system at home for 8 weeks. We measured the minutes for which the app was used and the exergames were played, and we integrated EMG as a measure of energy expended. We also conducted a perceived usefulness and usability questionnaire. Results: Bench test results revealed that the app meets performance specifications to enable real-time gaming, cloud storage of data, and live cloud server transmission for multiplayer gaming. The EMG sampling rate of 64 samples per second, in combination with zero-loss data communication with the cloud server within a 10-m range, provided seamless control over the app exergames and allowed for offline data analysis. Each participant successfully used the WOW-Mobile system at home for 8 weeks, using the app for an average of 146 (range 89-267) minutes per week with the system, actively exergaming for an average of 53% of that time (39%-59%). Energy expenditure, as measured by integrated EMG, was found to be directly proportional to the time spent on the app (Pearson correlation coefficient, r=0.57-0.86, depending on the game). Of the 4 participants, 2 did not exercise regularly before the study; these 2 participants increased from reportedly exercising close to 0 minutes per week to exergaming 58 and 158 minutes on average using the WOW-Mobile fitness system. The perceived usefulness of WOW-Mobile in motivating participants to exercise averaged 4.5 on a 5-point Likert scale and averaged 5 for the 3 participants with thoracic level injuries. The mean overall ease of use score was 4.25 out of 5. Conclusions: Mobile app exergames driven by EMG have promising potential for encouraging and facilitating fitness for individuals in wheelchairs who have maintained arm and hand mobility. %M 33464221 %R 10.2196/16054 %U http://rehab.jmir.org/2021/1/e16054/ %U https://doi.org/10.2196/16054 %U http://www.ncbi.nlm.nih.gov/pubmed/33464221 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e16282 %T Unraveling Mobile Health Exercise Interventions for Adults: Scoping Review on the Implementations and Designs of Persuasive Strategies %A Sporrel,Karlijn %A Nibbeling,Nicky %A Wang,Shihan %A Ettema,Dick %A Simons,Monique %+ Faculty of Geosciences, Utrecht University, PO Box 80115, Princetonlaan 8a, Utrecht, 3584 CB, Netherlands, 31 642514287, k.sporrel@uu.nl %K mobile health %K physical activity %K goals %K feedback %K rewards %K reminder systems %K social support %K adult %D 2021 %7 18.1.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: It is unclear why some physical activity (PA) mobile health (mHealth) interventions successfully promote PA whereas others do not. One possible explanation is the variety in PA mHealth interventions—not only do interventions differ in the selection of persuasive strategies but also the design and implementation of persuasive strategies can vary. However, limited studies have examined the different designs and technical implementations of strategies or explored if they indeed influenced the effectiveness of the intervention. Objective: This scoping review sets out to explore the different technical implementations and design characteristics of common and likely most effective persuasive strategies, namely, goal setting, monitoring, reminders, rewards, sharing, and social comparison. Furthermore, this review aims to explore whether previous mHealth studies examined the influence of the different design characteristics and technical operationalizations of common persuasive strategies on the effectiveness of the intervention to persuade the user to engage in PA. Methods: An unsystematic snowball and gray literature search was performed to identify the literature that evaluated the persuasive strategies in experimental trials (eg, randomized controlled trial, pre-post test). Studies were included if they targeted adults, if they were (partly) delivered by a mobile system, if they reported PA outcomes, if they used an experimental trial, and when they specifically compared the effect of different designs or implementations of persuasive strategies. The study methods, implementations, and designs of persuasive strategies, and the study results were systematically extracted from the literature by the reviewers. Results: A total of 29 experimental trials were identified. We found a heterogeneity in how the strategies are being implemented and designed. Moreover, the findings indicated that the implementation and design of the strategy has an influence on the effectiveness of the PA intervention. For instance, the effectiveness of rewarding was shown to vary between types of rewards; rewarding goal achievement seems to be more effective than rewarding each step taken. Furthermore, studies comparing different ways of goal setting suggested that assigning a goal to users might appear to be more effective than letting the user set their own goal, similar to using adaptively tailored goals as opposed to static generic goals. This study further demonstrates that only a few studies have examined the influence of different technical implementations on PA behavior. Conclusions: The different implementations and designs of persuasive strategies in mHealth interventions should be critically considered when developing such interventions and before drawing conclusions on the effectiveness of the strategy as a whole. Future efforts are needed to examine which implementations and designs are most effective to improve the translation of theory-based persuasive strategies into practical delivery forms. %M 33459598 %R 10.2196/16282 %U http://mhealth.jmir.org/2021/1/e16282/ %U https://doi.org/10.2196/16282 %U http://www.ncbi.nlm.nih.gov/pubmed/33459598 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e20819 %T A Mindfulness-Based Brain-Computer Interface to Augment Mandala Coloring for Depression: Protocol for a Single-Case Experimental Design %A Daudén Roquet,Claudia %A Sas,Corina %+ School of Computing and Communications, Lancaster University, InfoLab21, Lancaster University, Lancaster, LA1 4WA, United Kingdom, 44 01524510321, c.daudenroquet1@lancaster.ac.uk %K brain-computer interface %K mental well-being %K depression %K mindfulness %K mandala coloring %D 2021 %7 18.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The regular practice of mindfulness has been shown to provide benefits for mental well-being and prevent depression relapse. Technology-mediated interventions can facilitate the uptake and sustained practice of mindfulness, yet the evaluation of interactive systems, such as brain-computer interfaces, has been little explored. Objective: The objective of this paper is to present an interactive mindfulness-based technology to improve mental well-being in people who have experienced depression. The system, Anima, is a brain-computer interface that augments mandala coloring by providing a generative color palette based on the unfolding mindfulness states during the practice. In addition, this paper outlines a multiple-baseline, single-case experimental design methodology to evaluate training effectiveness. Methods: Adult participants who have experienced depression in the past, have finished treatment within the last year, and can provide informed consent will be able to be recruited. The Anima system, consisting of 2 tablets and a nonintrusive mental activity headband, will be delivered to participants to use during the study. Measures include state and trait mindfulness, depression symptoms, mental well-being, and user experience, and these measures will be taken throughout the baseline, intervention, and monitoring phases. The data collection will take place in the form of a questionnaire before and after each mandala-coloring session and a semistructured interview every 2 weeks. Trial results will be analyzed using structured visual analysis, supplemented with statistical analysis appropriate to single-case methodology. Results: Study results will offer new insights into the deployment and evaluation of novel interactive brain-computer interfaces for mindfulness training in the context of mental health. Moreover, findings will validate the effectiveness of this training protocol to improve the mental well-being of people who have had depression. Participants will be recruited locally through the National Health Service. Conclusions: Evidence will assist in the design and evaluation of brain-computer interfaces and mindfulness technologies for mental well-being and the necessary services to support people who have experienced depression. International Registered Report Identifier (IRRID): PRR1-10.2196/20819 %M 33459604 %R 10.2196/20819 %U http://www.researchprotocols.org/2021/1/e20819/ %U https://doi.org/10.2196/20819 %U http://www.ncbi.nlm.nih.gov/pubmed/33459604 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e19506 %T Optimizing an Obesity Treatment Using the Multiphase Optimization Strategy Framework: Protocol for a Randomized Factorial Trial %A Bennett,Gary G %A Steinberg,Dori %A Bolton,Jamiyla %A Gallis,John A %A Treadway,Cayla %A Askew,Sandy %A Kay,Melissa C %A Pollak,Kathryn I %A Turner,Elizabeth L %+ Duke Global Health Institute, Duke University, 310 Trent Drive, Room 236, Durham, NC, 27708, United States, 1 9193954119, jamiyla.bolton@duke.edu %K text message %K digital health %K weight loss %K personalized %D 2021 %7 18.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Effective weight loss interventions exist, yet few can be scaled up for wide dissemination. Further, none has been fully delivered via text message. We used the multiphase optimization strategy (MOST) to develop multicomponent interventions that consist only of active components, those that have been experimentally determined to impact the chosen outcome. Objective: The goal of this study is to optimize a standalone text messaging obesity intervention, Charge, using the MOST framework to experimentally determine which text messaging components produce a meaningful contribution to weight change at 6 months. Methods: We designed a 6-month, weight loss texting intervention based on our interactive obesity treatment approach (iOTA). Participants are randomized to one of 32 experimental conditions to test which standalone text messaging intervention components produce a meaningful contribution to weight change at 6 months. Results: The project was funded in February 2017; enrollment began in January 2018 and data collection was completed in June 2019. Data analysis is in progress and first results are expected to be submitted for publication in 2021. Conclusions: Full factorial trials are particularly efficient in terms of cost and logistics when leveraged for standalone digital treatments. Accordingly, MOST has the potential to promote the rapid advancement of digital health treatments. Subject to positive findings, the intervention will be low cost, immediately scalable, and ready for dissemination. This will be of great potential use to the millions of Americans with obesity and the providers who treat them. Trial Registration: ClinicalTrials.gov NCT03254940; https://clinicaltrials.gov/ct2/show/NCT03254940 International Registered Report Identifier (IRRID): RR1-10.2196/19506 %M 33459600 %R 10.2196/19506 %U http://www.researchprotocols.org/2021/1/e19506/ %U https://doi.org/10.2196/19506 %U http://www.ncbi.nlm.nih.gov/pubmed/33459600 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e23771 %T Technology Enabled Clinical Care (TECC): Protocol for a Prospective Longitudinal Cohort Study of Smartphone-Augmented Mental Health Treatment %A Rauseo-Ricupero,Natali %A Torous,John %+ Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Rabb Building, Boston, MA, 02446, United States, 1 617 667 6700, jtorous@bidmc.harvard.edu %K mental health care %K access %K multi-language %K smartphone %K app %K quality improvement %K protocol %K mental health %K treatment %K acceptability %K efficacy %K COVID-19 %D 2021 %7 14.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Even before COVID-19, there has been an urgent need to expand access to and quality of mental health care. This paper introduces an 8-week treatment protocol to realize that vision—Technology Enabled Clinical Care (TECC). TECC offers innovation in clinical assessment, monitoring, and interventions for mental health. TECC uses the mindLAMP app to enable digital phenotyping, clinical communication, and smartphone-based exercises that will augment in-person or telehealth virtual visits. TECC exposes participants to an array of evidence-based treatments (cognitive behavioral therapy, dialectical behavior therapy, acceptance and commitment therapy) introduced through clinical sessions and then practiced through interactive activities provided through a smartphone app called mindLAMP. Objective: TECC will test the feasibility of providing technology-enabled mental health care within an outpatient clinic; explore the practicality for providing this care to individuals with limited English proficiency; and track anxiety, depression, and mood symptoms for participants to measure the effectiveness of the TECC design. Methods: The TECC study will assess the acceptability and efficacy of this care model in 50 participants as compared to an age- and gender-matched cohort of patients presenting with similar clinical severity of depression, anxiety, or psychotic symptoms. Participants will be recruited from clinics in the Metro Boston area. Aspects of TECC will be conducted in both Spanish and English to ensure wide access to care for multiple populations. Results: The results of the TECC study will be used to support or adapt this model of care and create training resources to ensure its dissemination. The study results will be posted on ClinicalTrials.gov, with primary outcomes related to changes in mood, anxiety, and stress, and secondary outcomes related to engagement, alliance, and satisfaction. Conclusions: TECC combines new digital mental health technology with updated clinical protocols and workflows designed to ensure patients can benefit from innovation in digital mental health. Supporting multiple languages, TECC is designed to ensure digital health equity and highlights how mobile health can bridge, not expand, gaps in care for underserved populations. International Registered Report Identifier (IRRID): PRR1-10.2196/23771 %M 33296869 %R 10.2196/23771 %U https://www.researchprotocols.org/2021/1/e23771 %U https://doi.org/10.2196/23771 %U http://www.ncbi.nlm.nih.gov/pubmed/33296869 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e24807 %T A Self-Help App for Syrian Refugees With Posttraumatic Stress (Sanadak): Randomized Controlled Trial %A Röhr,Susanne %A Jung,Franziska U %A Pabst,Alexander %A Grochtdreis,Thomas %A Dams,Judith %A Nagl,Michaela %A Renner,Anna %A Hoffmann,Rahel %A König,Hans-Helmut %A Kersting,Anette %A Riedel-Heller,Steffi G %+ Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Strasse 55, Leipzig, Germany, 49 341 97 24568, susanne.roehr@medizin.uni-leipzig.de %K app %K cost-utility analysis %K mHealth %K posttraumatic stress %K PTSD %K quality-adjusted life years %K randomized controlled trial %K refugees %K stimga %K Syrian refugees %K usability %D 2021 %7 13.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Syrian refugees residing in Germany often develop posttraumatic stress as a result of the Syrian civil war, their escape, and postmigration stressors. At the same time, there is a lack of adequate treatment options. The smartphone-based app Sanadak was developed to provide cognitive behavioral therapy–based self-help in the Arabic language for Syrian refugees with posttraumatic stress. Objective: The aim of this study was to evaluate the effectiveness and cost-effectiveness of the app. Methods: In a randomized controlled trial, eligible individuals were randomly allocated to the intervention group (IG; app use) or control group (CG; psychoeducational reading material). Data were collected during structured face-to-face interviews at 3 assessments (preintervention/baseline, postintervention/after 4 weeks, follow-up/after 4 months). Using adjusted mixed-effects linear regression models, changes in posttraumatic stress and secondary outcomes were investigated as intention-to-treat (ITT) and per-protocol (PP) analysis. Cost-effectiveness was evaluated based on adjusted mean total costs, quality-adjusted life years (QALYs), and cost-effectiveness acceptability curves using the net benefit approach. Results: Of 170 screened individuals (aged 18 to 65 years), 133 were eligible and randomized to the IG (n=65) and CG (n=68). Although there was a pre-post reduction in posttraumatic stress, ITT showed no significant differences between the IG and CG after 4 weeks (Posttraumatic Diagnostic Scale for DSM-5, Diff –0.90, 95% CI –0.24 to 0.47; P=.52) and after 4 months (Diff –0.39, 95% CI –3.24 to 2.46; P=.79). The same was true for PP. Regarding secondary outcomes, ITT indicated a treatment effect for self-stigma: after 4 weeks (Self-Stigma of Mental Illness Scale/SSMIS–stereotype agreement: d=0.86, 95% CI 0.46 to 1.25; stereotype application: d=0.60, 95% CI 0.22 to 0.99) and after 4 months (d=0.52, 95% CI 0.12 to 0.92; d=0.50, 95% CI 0.10 to 0.90), the IG showed significantly lower values in self-stigma than the CG. ITT showed no significant group differences in total costs and QALYs. The probability of cost-effectiveness was 81% for a willingness-to-pay of €0 per additional QALY but decreased with increasing willingness-to-pay. Conclusions: Sanadak was not more effective in reducing mild to moderate posttraumatic stress in Syrian refugees than the control condition nor was it likely to be cost-effective. Therefore, Sanadak is not suitable as a standalone treatment. However, as the app usability was very good, no harms detected, and stigma significantly reduced, Sanadak has potential as a bridging aid within a stepped and collaborative care approach. Trial Registration: German Clinical Trials Register DRKS00013782; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013782 International Registered Report Identifier (IRRID): RR2-10.1186/s12888-019-2110-y %M 33439140 %R 10.2196/24807 %U http://mhealth.jmir.org/2021/1/e24807/ %U https://doi.org/10.2196/24807 %U http://www.ncbi.nlm.nih.gov/pubmed/33439140 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e24467 %T The Human Factor in Automated Image-Based Nutrition Apps: Analysis of Common Mistakes Using the goFOOD Lite App %A Vasiloglou,Maria F %A van der Horst,Klazine %A Stathopoulou,Thomai %A Jaeggi,Michael P %A Tedde,Giulia S %A Lu,Ya %A Mougiakakou,Stavroula %+ ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, Bern, 3008, Switzerland, 41 6327592, stavroula.mougiakakou@artorg.unibe.ch %K mHealth %K dietary assessment %K smartphone %K apps %K human mistakes %K mobile phone %D 2021 %7 13.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Technological advancements have enabled nutrient estimation by smartphone apps such as goFOOD. This is an artificial intelligence–based smartphone system, which uses food images or video captured by the user as input and then translates these into estimates of nutrient content. The quality of the data is highly dependent on the images the user records. This can lead to a major loss of data and impaired quality. Instead of removing these data from the study, in-depth analysis is needed to explore common mistakes and to use them for further improvement of automated apps for nutrition assessment. Objective: The aim of this study is to analyze common mistakes made by participants using the goFOOD Lite app, a version of goFOOD, which was designed for food-logging, but without providing results to the users, to improve both the instructions provided and the automated functionalities of the app. Methods: The 48 study participants were given face-to-face instructions for goFOOD Lite and were asked to record 2 pictures (1 recording) before and 2 pictures (1 recording) after the daily consumption of each food or beverage, using a reference card as a fiducial marker. All pictures that were discarded for processing due to mistakes were analyzed to record the main mistakes made by users. Results: Of the 468 recordings of nonpackaged food items captured by the app, 60 (12.8%) had to be discarded due to errors in the capturing procedure. The principal problems were as follows: wrong fiducial marker or improper marker use (19 recordings), plate issues such as a noncompatible or nonvisible plate (8 recordings), a combination of various issues (17 recordings), and other reasons such as obstacles (hand) in front of the camera or matching recording pairs (16 recordings). Conclusions: No other study has focused on the principal problems in the use of automatic apps for assessing nutritional intake. This study shows that it is important to provide study participants with detailed instructions if high-quality data are to be obtained. Future developments could focus on making it easier to recognize food on various plates from its color or shape and on exploring alternatives to using fiducial markers. It is also essential for future studies to understand the training needed by the participants as well as to enhance the app’s user-friendliness and to develop automatic image checks based on participant feedback. %M 33439139 %R 10.2196/24467 %U http://mhealth.jmir.org/2021/1/e24467/ %U https://doi.org/10.2196/24467 %U http://www.ncbi.nlm.nih.gov/pubmed/33439139 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e21094 %T Feasibility, Usability, and Enjoyment of a Home-Based Exercise Program Delivered via an Exercise App for Musculoskeletal Health in Community-Dwelling Older Adults: Short-term Prospective Pilot Study %A Daly,Robin M %A Gianoudis,Jenny %A Hall,Travis %A Mundell,Niamh L %A Maddison,Ralph %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, 3125, Australia, 61 392446040, rmdaly@deakin.edu.au %K home exercise %K multicomponent exercise %K mobile health %K musculoskeletal %K adherence %K usability %K older adults %K physical activity enjoyment %D 2021 %7 13.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many older adults choose and prefer to exercise at home, but to attain the greatest benefits, the correct type and dose of exercise should be prescribed and adherence maintained. Advances in digital health technologies now provide the opportunity for exercise professionals to deliver and monitor personalized, evidence-based exercise programs to anyone at any time. Objective: The aim of this study was to evaluate the feasibility, usability, and enjoyment of a web-based exercise prescription app as a platform for exercise professionals to remotely deliver and monitor an individually tailored, home-based multicomponent exercise program (delivered through tablet computers) to older adults living independently in the community. Methods: This was an 8-week, prospective single-arm pilot study in 20 adults aged ≥65 years living independently in the community: 10 owned a tablet computer (tablet owners) and 10 did not own tablets (tablet nonowners). All participants were prescribed a home-based, muscle strengthening, weight-bearing impact and challenging balance/mobility program (3 days/week) using a commercial exercise prescription app on a tablet computer. Study endpoints were feasibility (retention, adherence, adverse events), usability (System Usability Scale), physical activity enjoyment (Physical Activity Enjoyment Scale), changes in lower extremity function (Short Physical Performance Battery [SPPB]), and level of physical activity (questionnaire). Process measures related to the participants' experiences and perceptions of the exercise program and web-based app were also included. Results: A total of 19 participants (mean age, 70 years) completed the study (19/20, 95%), and mean adherence to the exercise program was 84% (95% CI 70%-97%). There were 2 minor adverse events in 2 participants from 401 completed sessions. Mean weekly walking time increased by 78 minutes (95% CI 0-156, P=.049) and moderate-to-vigorous physical activity time by 41 minutes (95% CI –8 to 90, P=.09). For SPPB scores, there was a 0.3 point (95% CI –0.1 to 0.7, P=.17) modest sized (effect size, d=0.42) improvement after 8 weeks. Mean (SD) system usability was high (86 [10] with 100 best imaginable). There was no change in the overall physical activity enjoyment scores after 8 weeks, but participants reported that they enjoyed using the web-based exercise app and the exercise program (median score 4 on a 5-point Likert scale). For all measures, there were no differences between previous tablet owners and nonowners. Conclusions: This pilot feasibility study indicates that it is safe and feasible for community-dwelling older adults to participate in a home-based, multicomponent exercise program targeting musculoskeletal health and function that was delivered and monitored remotely by exercise professionals using a tablet-based exercise prescription app. %M 33439147 %R 10.2196/21094 %U http://mhealth.jmir.org/2021/1/e21094/ %U https://doi.org/10.2196/21094 %U http://www.ncbi.nlm.nih.gov/pubmed/33439147 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e19958 %T Mobile Apps for Dental Caries Prevention: Systematic Search and Quality Evaluation %A Chen,Rebecca %A Santo,Karla %A Wong,Grace %A Sohn,Woosung %A Spallek,Heiko %A Chow,Clara %A Irving,Michelle %+ Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, REN Building, Darcy Road, Westmead, 2145, Australia, 61 8890 3125, rebecca.chen@sydney.edu.au %K dental caries %K oral hygiene %K self-management %K mobile applications %D 2021 %7 13.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dental caries is the most common multifactorial oral disease; it affects 60% to 90% of the global population. Dental caries is highly preventable through prevention behaviors aimed at improving oral hygiene, adequate fluoride usage, and dietary intake. Mobile apps have the potential to support patients with dental caries; however, little is known about the availability, target audience, quality, and features of these apps. Objective: This review aims to systematically examine dental caries prevention apps; to describe their content, availability, target audience, and features; and to assess their quality. Methods: We systematically identified and evaluated apps in a process paralleling a systematic review. This included a search strategy using search terms; an eligibility assessment using inclusion and exclusion criteria focused on accessibility and dental caries self-management behaviors, including oral hygiene, dietary intake, and fluoride usage; data extraction on app characteristics, including app store metrics; prevention behavior categorization; feature identification and description; a quality appraisal of all apps using the validated Mobile App Rating Scale (MARS) assessment tool; and data comparison and analysis. Results: Using our search strategy, we retrieved 562 apps from the Google Play Store and iTunes available in Australia. Of these, 7.1% (40/562) of the apps fit our eligibility criteria, of which 55% (22/40) targeted adults, 93% (37/40) were free to download, and 65% (26/40) were recently updated. Oral hygiene was the most common dental caries prevention behavior domain, addressed in 93% (37/40) of the apps, while dietary intake was addressed in 45% (18/40) of the apps and fluoride usage was addressed in 42% (17/40) of the apps. Overall, 50% (20/40) of the apps addressed only 1 behavior, and 38% (15/40) of the apps addressed all 3 behaviors. The mean MARS score was 2.9 (SD 0.7; range 1.8-4.4), with 45% (18/40) of the apps categorized as high quality, with a rating above 3.0 out of 5.0. We identified 21 distinctive features across all dental caries prevention behaviors; however, the top 5 most common features focused on oral hygiene. The highest-ranking app was the Brush DJ app, with an overall MARS score of 4.4 and with the highest number of features (n=13). We did not find any apps that adequately addressed dental caries prevention behaviors in very young children. Conclusions: Apps addressing dental caries prevention commonly focus on oral hygiene and target young adults; however, many are not of high quality. These apps use a range of features to support consumer engagement, and some of these features may be helpful for specific patient populations. However, it remains unclear how effective these apps are in improving dental caries outcomes, and further evaluation is required before they are widely recommended. %M 33439141 %R 10.2196/19958 %U http://mhealth.jmir.org/2021/1/e19958/ %U https://doi.org/10.2196/19958 %U http://www.ncbi.nlm.nih.gov/pubmed/33439141 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e22575 %T Participant Engagement in a Transmedia Storytelling Web-Based App Intervention for Mental Health of Latina Women: Qualitative Analysis %A Soderlund,Patricia D %A Martinez Hollingsworth,Adrienne S %A Heilemann,MarySue V %+ School of Nursing, University of California, Los Angeles, Factor Building, Box 6919, Los Angeles, CA, 90095-6919, United States, 1 310 206 4735, mheilema@sonnet.ucla.edu %K transmedia %K Latina %K mental health %K mobile applications %K internet %K depression %K anxiety %K storytelling %K mobile phone %D 2021 %7 13.1.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Stigma, fear, and lack of knowledge regarding treatment options or where to get help create delays for Latina women in accessing needed mental health help. Story-based media interventions hold appeal for Latina women. Thus, we drew upon the Social Cognitive Theory by Bandura to create an evidence-based, transmedia storytelling web-based app for mental health called Catalina: Confronting My Emotions to connect Latina women to a curated set of mental health resources. Understanding how Latina women perceive various aspects of the web-based app will help design future expansions. Objective: A previously published analysis led to the development of a category on how participants related to the lead character (Catalina) in the story line of the web-based app as a real person. However, the purpose of this analysis was to gain an understanding of participants’ experiences with the extension of the dramatic story line of the web-based app beyond Catalina to a Latina nurse-therapist character named Veronica, who was featured prominently in the app’s interactive content and bonus videos. Methods: Qualitative analyses were conducted with interview data from a community-based sample of 28 English-speaking Latina women aged between 21 and 50 years who scored above the threshold for anxiety (Generalized Anxiety Disorder-7) and/or depression (Patient Health Questionnaire-9) but were not suicidal at screening. Data were collected 72 hours after participants engaged with our transmedia storytelling web-based app for mental health. Grounded theory methodology guided the analysis and interpretation of data that had been collected telephonically, recorded, and transcribed with identifiers removed. Analyses included initial and focused coding using process codes (gerund form of verbs in codes focused on action), informed by symbolic interactionism, and the development of categories with properties through constant comparison, memo writing, and the use of charts and diagrams. Results: Our participants experienced a multiphase process that was most heavily related to Veronica, the Latina nurse-therapist character in our web-based app, who led them through a process to a place of action. We conceptualized this process as moving from passive viewer to active participant of a transmedia storytelling web-based app intervention. Overall, 3 new conceptual categories provided insight into women’s experiences, including encountering a trustworthy nurse-therapist character, taking in messages that dispel old beliefs, and preparing when and how to take action. Each category has nuanced properties that reflect participants’ experiences. Conclusions: Active engagement with our web-based app led our sample to successfully transition from the viewpoint of the observer to the viewpoint of the experiencer, moving from a passive position of watching to active engagement that involved imagining, thinking, reflecting, and acting. Careful development of dramatic material for health-related web-based apps using transmedia story extension and bonus videos needs to be based on input from the target group from the start of development through evaluation and testing. %M 33439137 %R 10.2196/22575 %U http://mental.jmir.org/2021/1/e22575/ %U https://doi.org/10.2196/22575 %U http://www.ncbi.nlm.nih.gov/pubmed/33439137 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 1 %P e16785 %T Effects and Implementation of a Mindfulness and Relaxation App for Patients With Cancer: Mixed Methods Feasibility Study %A Mikolasek,Michael %A Witt,Claudia Margitta %A Barth,Jürgen %+ Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Sonneggstrasse 6, Zurich, 8091, Switzerland, 41 44 255 51 49, michael.mikolasek@usz.ch %K mobile app %K mobile phone %K mindfulness %K relaxation %K cancer %K qualitative research %K implementation science %K mHealth %K evaluation study %K patient compliance %K patient participation %K patient preference %D 2021 %7 13.1.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Cancer diagnosis and cancer treatment can cause high levels of distress, which is often not sufficiently addressed in standard medical care. Therefore, a variety of supportive nonpharmacological treatments have been suggested to reduce distress in patients with cancer. However, not all patients use these interventions because of limited access or lack of awareness. To overcome these barriers, mobile health may be a promising way to deliver the respective supportive treatments. Objective: The aim of this study is to evaluate the effects and implementation of a mindfulness and relaxation app intervention for patients with cancer as well as patients’ adherence to such an intervention. Methods: In this observational feasibility study with a mixed methods approach, patients with cancer were recruited through the web and through hospitals in Switzerland. All enrolled patients received access to a mindfulness and relaxation app. Patients completed self-reported outcomes (general health, health-related quality of life, anxiety, depression, distress, mindfulness, and fear of progression) at baseline and at weeks 4, 10, and 20. The frequency of app exercise usage was gathered directly through the app to assess the adherence of patients. In addition, we conducted interviews with 5 health professionals for their thoughts on the implementation of the app intervention in standard medical care. We analyzed patients’ self-reported outcomes using linear mixed models (LMMs) and qualitative data with content analysis. Results: A total of 100 patients with cancer (74 female) with a mean age of 53.2 years (SD 11.6) participated in the study, of which 25 patients used the app regularly until week 20. LMM analyses revealed improvements in anxiety (P=.04), distress (P<.001), fatigue (P=.01), sleep disturbance (P=.02), quality of life (P=.03), and mindfulness (P<.001) over the course of 20 weeks. Further LMM analyses revealed a larger improvement in distress (P<.001), a moderate improvement in anxiety (P=.001), and a larger improvement in depression (P=.03) in patients with high levels of symptoms at baseline in the respective domains. The interviews revealed that the health professionals perceived the app as a helpful addition to standard care. They also made suggestions for improvements, which could facilitate the implementation of and adherence to such an app. Conclusions: This study indicates that a mindfulness and relaxation app for patients with cancer can be a feasible and effective way to deliver a self-care intervention, especially for highly distressed patients. Future studies should investigate if the appeal of the app can be increased with more content, and the effectiveness of such an intervention needs to be tested in a randomized controlled trial. %M 33439132 %R 10.2196/16785 %U https://cancer.jmir.org/2021/1/e16785 %U https://doi.org/10.2196/16785 %U http://www.ncbi.nlm.nih.gov/pubmed/33439132 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e24806 %T Wrist-Worn Activity Trackers in Laboratory and Free-Living Settings for Patients With Chronic Pain: Criterion Validity Study %A Sjöberg,Veronica %A Westergren,Jens %A Monnier,Andreas %A Lo Martire,Riccardo %A Hagströmer,Maria %A Äng,Björn Olov %A Vixner,Linda %+ School of Education, Health and Social Studies, Dalarna University, Högskolegatan 2, Falun, SE-791 88, Sweden, 46 23 77 87 57, vsj@du.se %K chronic pain %K energy expenditure %K heart rate %K physical activity %K step count %K validity %K wearable devices %K wearable %K pain %K rehabilitation %D 2021 %7 12.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity is evidently a crucial part of the rehabilitation process for patients with chronic pain. Modern wrist-worn activity tracking devices seemingly have a great potential to provide objective feedback and assist in the adoption of healthy physical activity behavior by supplying data of energy expenditure expressed as metabolic equivalent of task units (MET). However, no studies of any wrist-worn activity tracking devices’ have examined criterion validity in estimating energy expenditure, heart rate, or step count in patients with chronic pain. Objective: The aim was to determine the criterion validity of wrist-worn activity tracking devices for estimations of energy expenditure, heart rate, and step count in a controlled laboratory setting and free-living settings for patients with chronic pain. Methods: In this combined laboratory and field validation study, energy expenditure, heart rate, and step count were simultaneously estimated by a wrist-worn activity tracker (Fitbit Versa), indirect calorimetry (Jaeger Oxycon Pro), and a research-grade hip-worn accelerometer (ActiGraph GT3X) during treadmill walking at 3 speeds (3.0 km/h, 4.5 km/h, and 6.0 km/h) in the laboratory setting. Energy expenditure and step count were also estimated by the wrist-worn activity tracker in free-living settings for 72 hours. The criterion validity of each measure was determined using intraclass and Spearman correlation, Bland-Altman plots, and mean absolute percentage error. An analysis of variance was used to determine whether there were any significant systematic differences between estimations. Results: A total of 42 patients (age: 25-66 years; male: 10/42, 24%; female: 32/42, 76%), living with chronic pain (duration, in years: mean 9, SD 6.72) were included. At baseline, their mean pain intensity was 3.5 (SD 1.1) out of 6 (Multidimensional Pain Inventory, Swedish version). Results showed that the wrist-worn activity tracking device (Fitbit Versa) systematically overestimated energy expenditure when compared to the criterion standard (Jaeger Oxycon Pro) and the relative criterion standard (ActiGraph GT3X). Poor agreement and poor correlation were shown between Fitbit Versa and both Jaeger Oxycon Pro and ActiGraph GT3X for estimated energy expenditure at all treadmill speeds. Estimations of heart rate demonstrated poor to fair agreement during laboratory-based treadmill walks. For step count, the wrist-worn devices showed fair agreement and fair correlation at most treadmill speeds. In free-living settings; however, the agreement for step count between the wrist-worn device and waist-worn accelerometer was good, and the correlation was excellent. Conclusions: The wrist-worn device systematically overestimated energy expenditure and showed poor agreement and correlation compared to the criterion standard (Jaeger Oxycon Pro) and the relative criterion standard (ActiGraph GT3X), which needs to be considered when used clinically. Step count measured with a wrist-worn device, however, seemed to be a valid estimation, suggesting that future guidelines could include such variables in this group with chronic pain. %M 33433391 %R 10.2196/24806 %U http://mhealth.jmir.org/2021/1/e24806/ %U https://doi.org/10.2196/24806 %U http://www.ncbi.nlm.nih.gov/pubmed/33433391 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e24333 %T Smartphone-Based Self-Reports of Depressive Symptoms Using the Remote Monitoring Application in Psychiatry (ReMAP): Interformat Validation Study %A Goltermann,Janik %A Emden,Daniel %A Leehr,Elisabeth Johanna %A Dohm,Katharina %A Redlich,Ronny %A Dannlowski,Udo %A Hahn,Tim %A Opel,Nils %+ Department of Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Münster, 48149, Germany, 49 251 8356610, n_opel01@uni-muenster.de %K mobile monitoring %K smartphone %K digital biomarkers %K digital phenotyping %K course of illness %K psychometric quality %K mood disorders %K depression %K affective disorders %K mobile phone %D 2021 %7 12.1.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Smartphone-based symptom monitoring has gained increased attention in psychiatric research as a cost-efficient tool for prospective and ecologically valid assessments based on participants’ self-reports. However, a meaningful interpretation of smartphone-based assessments requires knowledge about their psychometric properties, especially their validity. Objective: The goal of this study is to systematically investigate the validity of smartphone-administered assessments of self-reported affective symptoms using the Remote Monitoring Application in Psychiatry (ReMAP). Methods: The ReMAP app was distributed to 173 adult participants of ongoing, longitudinal psychiatric phenotyping studies, including healthy control participants, as well as patients with affective disorders and anxiety disorders; the mean age of the sample was 30.14 years (SD 11.92). The Beck Depression Inventory (BDI) and single-item mood and sleep information were assessed via the ReMAP app and validated with non–smartphone-based BDI scores and clinician-rated depression severity using the Hamilton Depression Rating Scale (HDRS). Results: We found overall high comparability between smartphone-based and non–smartphone-based BDI scores (intraclass correlation coefficient=0.921; P<.001). Smartphone-based BDI scores further correlated with non–smartphone-based HDRS ratings of depression severity in a subsample (r=0.783; P<.001; n=51). Higher agreement between smartphone-based and non–smartphone-based assessments was found among affective disorder patients as compared to healthy controls and anxiety disorder patients. Highly comparable agreement between delivery formats was found across age and gender groups. Similarly, smartphone-based single-item self-ratings of mood correlated with BDI sum scores (r=–0.538; P<.001; n=168), while smartphone-based single-item sleep duration correlated with the sleep item of the BDI (r=–0.310; P<.001; n=166). Conclusions: These findings demonstrate that smartphone-based monitoring of depressive symptoms via the ReMAP app provides valid assessments of depressive symptomatology and, therefore, represents a useful tool for prospective digital phenotyping in affective disorder patients in clinical and research applications. %M 33433392 %R 10.2196/24333 %U https://mental.jmir.org/2021/1/e24333 %U https://doi.org/10.2196/24333 %U http://www.ncbi.nlm.nih.gov/pubmed/33433392 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e23699 %T The Effects of Downloading a Government-Issued COVID-19 Contact Tracing App on Psychological Distress During the Pandemic Among Employed Adults: Prospective Study %A Kawakami,Norito %A Sasaki,Natsu %A Kuroda,Reiko %A Tsuno,Kanami %A Imamura,Kotaro %+ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan, 81 358413521, nkawakami@m.u-tokyo.ac.jp %K coronavirus disease %K digital contact tracing %K mental health %K working population %K longitudinal study %K COVID-19 %K contact tracing %K surveillance %K tracking %K anxiety %K distress %D 2021 %7 12.1.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Downloading a COVID-19 contact tracing app may be effective in reducing users’ worry about COVID-19 and psychological distress. Objective: This 2.5-month prospective study aimed to investigate the association of downloading a COVID-19 contact tracing app, the COVID-19 Contact Confirming Application (COCOA), released by the Japanese government, with worry about COVID-19 and psychological distress in a sample of employed adults in Japan. Methods: A total of 996 full-time employed respondents to an online survey conducted May 22-26, 2020 (baseline), were invited to participate in a follow-up survey August 7-12, 2020 (follow-up). A high level of worrying about COVID-19 and high psychological distress were defined by baseline and follow-up scores on a single-item scale and the Kessler 6 (K6) scale, respectively. The app was released between the two surveys, on June 17. Participants were asked at follow-up if they downloaded the app. Results: A total of 902 (90.6%) of 996 baseline participants responded to the follow-up survey. Among them, 184 (20.4%) reported that they downloaded the app. Downloading of the contact tracing app was significantly negatively associated with psychological distress at follow-up after controlling for baseline variables, but not with worry about COVID-19. Conclusions: This study provides the first evidence that using a government-issued COVID-19 contact tracing app may be beneficial for the mental health of employed adults during the COVID-19 pandemic. %M 33347424 %R 10.2196/23699 %U http://mental.jmir.org/2021/1/e23699/ %U https://doi.org/10.2196/23699 %U http://www.ncbi.nlm.nih.gov/pubmed/33347424 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e21563 %T Effectiveness of Mobile Apps to Promote Health and Manage Disease: Systematic Review and Meta-analysis of Randomized Controlled Trials %A Iribarren,Sarah J %A Akande,Tokunbo O %A Kamp,Kendra J %A Barry,Dwight %A Kader,Yazan G %A Suelzer,Elizabeth %+ Department of Biobehavioral Nursing and Health Informatics, University of Washington, Health Science Building, T602C, Box 357266, 1959 NE Pacific Street, Seattle, WA, 98195, United States, 1 2065435211, sjiribar@uw.edu %K systematic review %K mobile apps %K mobile phone %D 2021 %7 11.1.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Interventions aimed at modifying behavior for promoting health and disease management are traditionally resource intensive and difficult to scale. Mobile health apps are being used for these purposes; however, their effects on health outcomes have been mixed. Objective: This study aims to summarize the evidence of rigorously evaluated health-related apps on health outcomes and explore the effects of features present in studies that reported a statistically significant difference in health outcomes. Methods: A literature search was conducted in 7 databases (MEDLINE, Scopus, PsycINFO, CINAHL, Global Index Medicus, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews). A total of 5 reviewers independently screened and extracted the study characteristics. We used a random-effects model to calculate the pooled effect size estimates for meta-analysis. Sensitivity analysis was conducted based on follow-up time, stand-alone app interventions, level of personalization, and pilot studies. Logistic regression was used to examine the structure of app features. Results: From the database searches, 8230 records were initially identified. Of these, 172 met the inclusion criteria. Studies were predominantly conducted in high-income countries (164/172, 94.3%). The majority had follow-up periods of 6 months or less (143/172, 83.1%). Over half of the interventions were delivered by a stand-alone app (106/172, 61.6%). Static/one-size-fits-all (97/172, 56.4%) was the most common level of personalization. Intervention frequency was daily or more frequent for the majority of the studies (123/172, 71.5%). A total of 156 studies involving 21,422 participants reported continuous health outcome data. The use of an app to modify behavior (either as a stand-alone or as part of a larger intervention) confers a slight/weak advantage over standard care in health interventions (standardized mean difference=0.38 [95% CI 0.31-0.45]; I2=80%), although heterogeneity was high. Conclusions: The evidence in the literature demonstrates a steady increase in the rigorous evaluation of apps aimed at modifying behavior to promote health and manage disease. Although the literature is growing, the evidence that apps can improve health outcomes is weak. This finding may reflect the need for improved methodological and evaluative approaches to the development and assessment of health care improvement apps. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42018106868; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=106868 %M 33427672 %R 10.2196/21563 %U https://mhealth.jmir.org/2021/1/e21563 %U https://doi.org/10.2196/21563 %U http://www.ncbi.nlm.nih.gov/pubmed/33427672 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e16490 %T Smartphone-Based Interventions and Internalizing Disorders in Youth: Systematic Review and Meta-analysis %A Buttazzoni,Adrian %A Brar,Keshbir %A Minaker,Leia %+ School of Planning, University of Waterloo, 200 University Avenue W, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567 ext 46564, anbuttazzoni@uwaterloo.ca %K mental health %K meta-analysis %K mobile phone %K smartphone %K systematic review %K youth %D 2021 %7 11.1.2021 %9 Review %J J Med Internet Res %G English %X Background: Mental health disorders in youth are a global issue that have important implications for the future quality of life and morbidity of affected individuals. In the context of public health initiatives, smartphone-based interventions have been suggested to hold the potential to be an effective strategy to reduce the symptoms of mental health disorders in youth; however, further evaluation is needed to confirm their effectiveness. This systematic review and meta-analysis documents and synthesizes existing research on smartphone-based interventions targeting internalizing disorders in youth populations. Objective: This study aims to synthesize existing research on smartphone-based interventions targeting internalizing disorders in youth populations. Methods: PubMed and SCOPUS were searched in 2019, and 4334 potentially relevant articles were found. A total of 12 studies were included in the final synthesis. We used the Hedges g meta-analysis approach and a random effects model for analysis. Results: The results of this review note that depression and anxiety are the most commonly targeted symptoms, and unlike other similar topics, most studies reviewed were linked to a proven treatment. The overall pooled effect from the meta-analysis showed small but significant effects (κ=12; N=1370; Hedges g=0.20; 95% CI 0.02-0.38) for interventions in reducing the symptoms of internalizing disorders. In total, 4 subgroup analyses examining specific symptoms and intervention styles found varied small significant and nonsignificant effects. Conclusions: Future research should focus on developing robust evaluative frameworks and examining interventions among more diverse populations and settings. More robust research is needed before smartphone-based interventions are scaled up and used at the population level to address youth internalizing disorders. %M 33427682 %R 10.2196/16490 %U http://www.jmir.org/2021/1/e16490/ %U https://doi.org/10.2196/16490 %U http://www.ncbi.nlm.nih.gov/pubmed/33427682 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e21727 %T Evaluation of Self-Care Activities and Quality of Life in Patients With Type 2 Diabetes Mellitus Treated With Metformin Using the 2D Matrix Code of Outer Drug Packages as Patient Identifier: Protocol for the DePRO Proof-of-Concept Observational Study %A Mueller,Christian %A Schauerte,Isabel %A Martin,Stephan %+ Pharmaceuticals Medicine, Pharmaceuticals, Medical Excellence & Innovation Management, Data Generation, Bayer Vital GmbH, Building K 56, 1D321, Leverkusen, 51368, Germany, 49 214 30 46587, christian.mueller4@bayer.com %K self-care activities %K quality of life %K type 2 diabetes mellitus %K patient-reported outcome measures %K digital observational study %K bring your own device %D 2021 %7 11.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Diabetes mellitus (DM) is one of the most common noncommunicable diseases. DM has a substantial negative impact on patients’ quality of life, which is measured using a variety of diabetes-specific measures covering multiple aspects of patients’ psychological state, behavior, and treatment satisfaction. A fully digital data collection system, including patient identification, would represent a substantial advance in how these patient-reported outcome (PRO) data are measured. Within the European Union, one way to identify patients without the involvement of health care professionals is to use the unique 2D matrix codes on the packaging of prescription medication—for example, metformin, the recommended initial treatment for patients with type 2 DM (T2DM). Objective: In the DePRO study we aim to (1) describe the self-care activities of patients with T2DM using metformin-containing medication; (2) describe the self-reported health status (eg, presence of diabetes complications and quality of life) of these patients; (3) describe associations between self-care activities and demographics and disease characteristics; and (4) assess the usability of the my ePRO app. Methods: DePRO is an observational, multicenter, cross-sectional, digital, patient-driven study conducted in Germany. Patients with a prescription for a metformin-containing medication will be given a postcard by their pharmacist, which will include a download link for the my ePRO app. In total, 12 diabetes-focused pharmacies, selected to represent urban and rural areas, will be recruited. Participants will use their own mobile device (bring your own device) to download the my ePRO app and access the DePRO study, for which they can register using the 2D matrix code on their medication. An electronic informed consent form will be displayed to the patients and only after giving consent will patients be able to complete the study questionnaires. The PRO instruments used in the study are the Summary of Diabetes Self-Care Activities Scale, the Diabetes Treatment Satisfaction Questionnaire, and the 5 level, 5-dimension EuroQol Questionnaire. Patients will also be asked to complete a questionnaire with items addressing demographics, patient characteristics, disease history, complications, and concomitant medications. Data will be transferred to the study database by the app upon completion of each questionnaire. Statistical analyses of primary and secondary endpoints will be exploratory and descriptive. Results: Enrollment began in June 2020. The estimated study completion date is December 31, 2020, and the planned sample size is 300 patients. Conclusions: The DePRO study uses completely digital data collection, including authentication of eligible patients and completion of the study questionnaires. Therefore, the design of the DePRO study represents a substantial advance in the evaluation of the digital capturing of PRO data. Trial Registration: ClinicalTrials.gov NCT04383041; https://clinicaltrials.gov/ct2/show/NCT04383041 International Registered Report Identifier (IRRID): PRR1-10.2196/21727 %M 33427685 %R 10.2196/21727 %U http://www.researchprotocols.org/2021/1/e21727/ %U https://doi.org/10.2196/21727 %U http://www.ncbi.nlm.nih.gov/pubmed/33427685 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e14864 %T Smartphone App (2kmFIT-App) for Measuring Cardiorespiratory Fitness: Validity and Reliability Study %A Muntaner-Mas,Adria %A Martinez-Nicolas,Antonio %A Quesada,Alberto %A Cadenas-Sanchez,Cristina %A Ortega,Francisco B %+ Department of Physical Education and Sports, Faculty of Education, University of Balearic Islands, Valldemossa Road, km 7.5, Palma, Spain, 34 971172875, adria.muntaner@uib.es %K exercise test %K mobile apps %K reproducibility of results %K physical fitness %K telemedicine %K cardiorespiratory fitness %D 2021 %7 8.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is strong evidence suggesting that higher levels of cardiorespiratory fitness (CRF) are associated with a healthier metabolic profile, and that CRF can serve as a powerful predictor of morbidity and mortality. In this context, a smartphone app based on the 2-km walk test (UKK test) would provide the possibility to assess CRF remotely in individuals geographically distributed around a country or continent, and even between continents, with minimal equipment and low costs. Objective: The overall aim of this study was to evaluate the validity and reliability of 2kmFIT-App developed for Android and iOS mobile operating systems to estimate maximum oxygen consumption (VO2max) as an indicator of CRF. The specific aims of the study were to determine the validity of 2kmFIT-App to track distance and calculate heart rate (HR). Methods: Twenty participants were included for field-testing validation and reliability analysis. The participants completed the UKK test twice using 2kmFIT-App. Distance and HR were measured with the app as well as with accurate methods, and VO2max was estimated using the UKK test equation. Results: The validity results showed the following mean differences (app minus criterion): distance (–70.40, SD 51.47 meters), time (–0.59, SD 0.45 minutes), HR (–16.75, SD 9.96 beats/minute), and VO2max (3.59, SD 2.01 ml/kg/min). There was moderate validity found for HR (intraclass correlation coefficient [ICC] 0.731, 95% CI –0.211 to 0.942) and good validity found for VO2max (ICC 0.878, 95% CI –0.125 to 0.972). The reliability results showed the following mean differences (retest minus test): app distance (25.99, SD 43.21 meters), app time (–0.15, SD 0.94 seconds), pace (–0.18, SD 0.33 min/km), app HR (–4.5, 13.44 beats/minute), and app VO2max (0.92, SD 3.04 ml/kg/min). There was good reliability for app HR (ICC 0.897, 95% CI 0.742-0.959) and excellent validity for app VO2max (ICC 0.932, 95% CI 0.830-0.973). All of these findings were observed when using the app with an Android operating system, whereas validity was poor when the app was used with iOS. Conclusions: This study shows that 2kmFIT-App is a new, scientifically valid and reliable tool able to objectively and remotely estimate CRF, HR, and distance with an Android but not iOS mobile operating system. However, certain limitations such as the time required by 2kmFIT-App to calculate HR or the temperature environment should be considered when using the app. %M 33416503 %R 10.2196/14864 %U http://mhealth.jmir.org/2021/1/e14864/ %U https://doi.org/10.2196/14864 %U http://www.ncbi.nlm.nih.gov/pubmed/33416503 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e23402 %T Usability and Preliminary Effectiveness of a Preoperative mHealth App for People Undergoing Major Surgery: Pilot Randomized Controlled Trial %A van der Velde,Miriam %A Valkenet,Karin %A Geleijn,Edwin %A Kruisselbrink,Marjoke %A Marsman,Marije %A Janssen,Liedewij MJ %A Ruurda,Jelle P %A van der Peet,Donald L %A Aarden,Jesse J %A Veenhof,Cindy %A van der Leeden,Marike %+ Innovation of Human Movement Care Research Group, HU University of Applied Sciences, Heidelberglaan 7, Utrecht, , Netherlands, 31 064 221 4251, miriam.vandervelde@hu.nl %K preoperative care %K smartphone %K mhealth %K risk behavior %K prehabilitation %K usability %D 2021 %7 7.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Major surgery is associated with negative postoperative outcomes such as complications and delayed or poor recovery. Multimodal prehabilitation can help to reduce the negative effects of major surgery. Offering prehabilitation by means of mobile health (mHealth) could be an effective new approach. Objective: The objectives of this pilot study were to (1) evaluate the usability of the Be Prepared mHealth app prototype for people undergoing major surgery, (2) explore whether the app was capable of bringing about a change in risk behaviors, and (3) estimate a preliminary effect of the app on functional recovery after major surgery. Methods: A mixed-methods pilot randomized controlled trial was conducted in two Dutch academic hospitals. In total, 86 people undergoing major surgery participated. Participants in the intervention group received access to the Be Prepared app, a smartphone app using behavior change techniques to address risk behavior prior to surgery. Both groups received care as usual. Usability (System Usability Scale), change in risk behaviors 3 days prior to surgery, and functional recovery 30 days after discharge from hospital (Patient-Reported Outcomes Measurement Information System physical functioning 8-item short form) were assessed using online questionnaires. Quantitative data were analyzed using descriptive statistics, chi-square tests, and multivariable linear regression. Semistructured interviews about the usability of the app were conducted with 12 participants in the intervention group. Thematic analysis was used to analyze qualitative data. Results: Seventy-nine people—40 in the intervention group and 39 in the control group—were available for further analysis. Participants had a median age of 61 (interquartile range 51.0-68.0) years. The System Usability Scale showed that patients considered the Be Prepared app to have acceptable usability (mean 68.2 [SD 18.4]). Interviews supported the usability of the app. The major point of improvement identified was further personalization of the app. Compared with the control group, the intervention group showed an increase in self-reported physical activity and muscle strengthening activities prior to surgery. Also, 2 of 2 frequent alcohol users in the intervention group versus 1 of 9 in the control group drank less alcohol in the run-up to surgery. No difference was found in change of smoking cessation. Between-group analysis showed no meaningful differences in functional recovery after correction for baseline values (β=–2.4 [95% CI –5.9 to 1.1]). Conclusions: The Be Prepared app prototype shows potential in terms of usability and changing risk behavior prior to major surgery. No preliminary effect of the app on functional recovery was found. Points of improvement have been identified with which the app and future research can be optimized. Trial Registration: Netherlands Trial Registry NL8623; https://www.trialregister.nl/trial/8623 %M 33410758 %R 10.2196/23402 %U http://mhealth.jmir.org/2021/1/e23402/ %U https://doi.org/10.2196/23402 %U http://www.ncbi.nlm.nih.gov/pubmed/33410758 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 1 %P e24714 %T Digital Tools to Support Family-Based Weight Management for Children: Mixed Methods Pilot and Feasibility Study %A Staiano,Amanda E %A Shanley,Jenelle R %A Kihm,Holly %A Hawkins,Keely R %A Self-Brown,Shannon %A Höchsmann,Christoph %A Osborne,Melissa C %A LeBlanc,Monique M %A Apolzan,John W %A Martin,Corby K %+ Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA, 70808, United States, 1 2257632729, amanda.staiano@pbrc.edu %K parent training %K weight loss %K telehealth %K obesity %K SafeCare %D 2021 %7 7.1.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Family-based behavioral therapy is an efficacious approach to deliver weight management counseling to children and their parents. However, most families do not have access to in-person, evidence-based treatment. We previously developed and tested DRIVE (Developing Relationships that Include Values of Eating and Exercise), a home-based parent training program to maintain body weight among children at risk for obesity, with the intent to eventually disseminate it nationally alongside SafeCare, a parent support program that focuses on parent-child interactions. Currently the DRIVE program has only been tested independently of SafeCare. This study created the “mHealth DRIVE” program by further adapting DRIVE to incorporate digital and mobile health tools, including remotely delivered sessions, a wireless scale that enabled a child-tailored weight graph, and a pedometer. Telehealth delivery via mHealth platforms and other digital tools can improve program cost-effectiveness, deliver long-term care, and directly support both families and care providers. Objective: The objective of this study was to examine preliminary acceptability and effectiveness of the mHealth DRIVE program among children and parents who received it and among SafeCare providers who potentially could deliver it. Methods: Study 1 was a 13-week pilot study of a remotely delivered mHealth family-based weight management program. Satisfaction surveys were administered, and height and weight were measured pre- and post-study. Study 2 was a feasibility/acceptability survey administered to SafeCare providers. Results: Parental and child satisfaction (mean of 4.9/6.0 and 3.8/5.0, respectively) were high, and children’s (N=10) BMI z-scores significantly decreased (mean –0.14, SD 0.17; P=.025). Over 90% of SafeCare providers (N=74) indicated that SafeCare families would benefit from learning how to eat healthily and be more active, and 80% of providers reported that they and the families would benefit from digital tools to support child weight management. Conclusions: Pediatric mHealth weight management interventions show promise for effectiveness and acceptability by families and providers. Trial Registration: Clinicaltrials.gov NCT03297541, https://clinicaltrials.gov/ct2/show/NCT03297541. %M 33410760 %R 10.2196/24714 %U https://pediatrics.jmir.org/2021/1/e24714 %U https://doi.org/10.2196/24714 %U http://www.ncbi.nlm.nih.gov/pubmed/33410760 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e22184 %T Lifelog Data-Based Prediction Model of Digital Health Care App Customer Churn: Retrospective Observational Study %A Kwon,Hongwook %A Kim,Ho Heon %A An,Jaeil %A Lee,Jae-Ho %A Park,Yu Rang %+ Department of Biomedical Systems Informatics, College of Medicine, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 2493, yurangpark@yuhs.ac %K churn prediction %K digital health care %K life-log data %K topic modeling %K recurrent neural network %K deep learning interpretation %K attribution method %K integrated gradients %K digital health %K prediction %K model %K data %K app %K observational %K time-series %K neural network %D 2021 %7 6.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Customer churn is the rate at which customers stop doing business with an entity. In the field of digital health care, user churn prediction is important not only in terms of company revenue but also for improving the health of users. Churn prediction has been previously studied, but most studies applied time-invariant model structures and used structured data. However, additional unstructured data have become available; therefore, it has become essential to process daily time-series log data for churn predictions. Objective: We aimed to apply a recurrent neural network structure to accept time-series patterns using lifelog data and text message data to predict the churn of digital health care users. Methods: This study was based on the use data of a digital health care app that provides interactive messages with human coaches regarding food, exercise, and weight logs. Among the users in Korea who enrolled between January 1, 2017 and January 1, 2019, we defined churn users according to the following criteria: users who received a refund before the paid program ended and users who received a refund 7 days after the trial period. We used long short-term memory with a masking layer to receive sequence data with different lengths. We also performed topic modeling to vectorize text messages. To interpret the contributions of each variable to model predictions, we used integrated gradients, which is an attribution method. Results: A total of 1868 eligible users were included in this study. The final performance of churn prediction was an F1 score of 0.89; that score decreased by 0.12 when the data of the final week were excluded (F1 score 0.77). Additionally, when text data were included, the mean predicted performance increased by approximately 0.085 at every time point. Steps per day had the largest contribution (0.1085). Among the topic variables, poor habits (eg, drinking alcohol, overeating, and late-night eating) showed the largest contribution (0.0875). Conclusions: The model with a recurrent neural network architecture that used log data and message data demonstrated high performance for churn classification. Additionally, the analysis of the contribution of the variables is expected to help identify signs of user churn in advance and improve the adherence in digital health care. %M 33404511 %R 10.2196/22184 %U https://www.jmir.org/2021/1/e22184 %U https://doi.org/10.2196/22184 %U http://www.ncbi.nlm.nih.gov/pubmed/33404511 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e18686 %T Effects of Activity Tracker Use With Health Professional Support or Telephone Counseling on Maintenance of Physical Activity and Health Outcomes in Older Adults: Randomized Controlled Trial %A Brickwood,Katie-Jane %A Ahuja,Kiran D K %A Watson,Greig %A O'Brien,Jane A %A Williams,Andrew D %+ School of Health Sciences, College of Health and Medicine, University of Tasmania, Newnham Drive, Launceston, 7250, Australia, 61 0363245487, katiejane.brickwood@utas.edu.au %K physical activity %K fitness trackers %K telemedicine %K feedback %K older adults %K eHealth %K mobile phone %D 2021 %7 5.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite a range of efforts to increase physical activity participation in Australia, inactivity levels in older adults have remained high over recent decades, contributing to increased rates of chronic health conditions. Lifestyle interventions, including telephone counseling (TC), improve physical activity participation and associated health outcomes over the short term; however, ongoing feedback and support is required to maintain these changes. Newer technologies such as wearable activity trackers (ATs) may offer an alternative method for providing ongoing support. Objective: This study aims to investigate whether newer technologies such as wearable ATs assist in providing ongoing support to maintain physical activity levels and health outcomes. Methods: Older adults aged >60 years who had just completed a 12-week face-to-face individualized community exercise program in Tasmania, Australia, participated in the study. They were randomized to receive AT, TC, or usual care (UC). All groups received a home exercise program and an optional referral to a community-based exercise program. The AT group also received an AT and text message feedback from an accredited exercise physiologist (AEP). The TC group received phone calls from an AEP throughout the 12-month intervention. The primary outcome was daily steps measured by an ActivPAL (TM) accelerometer at baseline and at 3, 6, and 12 months. Secondary outcome measures included body composition, blood pressure, 10-time sit-to-stand (TTSTS) test, timed up and go test, and cardiorespiratory fitness. This trial was approved by the Tasmanian Health and Medical Human Research Ethics Committee (H0014713). Results: A total of 117 participants were randomized to the study (AT, n=37; TC, n=38; UC, n=42). At baseline, the participants (75/117, 64.1% female; mean age 72.4 years, SD 6.4) completed an average of 6136 steps (SD 2985) per day. Although there were no significant differences between groups, the TC and AT groups maintained daily step counts (mean difference [MD] −79 steps, 95% CI −823 to 663 steps; P=.81; and MD −588 steps, 95% CI −1359 to 182 steps; P=.09), and UC showed a reduction in daily steps (MD 981 steps, 95% CI −1668 to −294 steps; P=.003) during the 12-month period. Diastolic blood pressure was significantly higher after AT than after UC (MD 5.62 mm Hg, 95% CI 1.30 to 9.94 mm Hg; P=.01), and TTSTS was significantly slower on TC compared with UC (MD 2.36 seconds, 95% CI −0.14 to 4.87 seconds; P=.03). Conclusions: The use of an AT with AEP support or TC is effective at maintaining daily step count in older adults over a 12-month period, suggesting that wearable ATs are as effective as TC. Further research to investigate which option is more cost-effective would be beneficial. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12615001104549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369118 %M 33399541 %R 10.2196/18686 %U https://mhealth.jmir.org/2021/1/e18686 %U https://doi.org/10.2196/18686 %U http://www.ncbi.nlm.nih.gov/pubmed/33399541 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e25372 %T A Novel Artificial Intelligence-Powered Emotional Intelligence and Mindfulness App (Ajivar) for the College Student Population During the COVID-19 Pandemic: Quantitative Questionnaire Study %A Sturgill,Ronda %A Martinasek,Mary %A Schmidt,Trine %A Goyal,Raj %+ Department of Health Sciences and Human Performance, The University of Tampa, 401 West Kennedy Blvd, Box 30F, Tampa, FL, 33606, United States, 1 8132573445, rsturgill@ut.edu %K mindfulness %K COVID-19 %K college students %K emotional intelligence %D 2021 %7 5.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Emotional intelligence (EI) and mindfulness can impact the level of anxiety and depression that an individual experiences. These symptoms have been exacerbated among college students during the COVID-19 pandemic. Ajivar is an app that utilizes artificial intelligence (AI) and machine learning to deliver personalized mindfulness and EI training. Objective: The main objective of this research study was to determine the effectiveness of delivering an EI curriculum and mindfulness techniques using an AI conversation platform, Ajivar, to improve symptoms of anxiety and depression during this pandemic. Methods: A total of 99 subjects, aged 18 to 29 years, were recruited from a second-semester group of freshmen students. All participants completed the online TestWell Wellness Inventory at the start and end of the 14-week semester. The comparison group members (49/99, 49%) were given routine mental wellness instruction. The intervention group members (50/99, 51%) were required to complete Ajivar activities in addition to routine mental wellness instruction during the semester, which coincided with the onset of the COVID-19 pandemic. This group also completed assessments to evaluate for anxiety, using the 7-item Generalized Anxiety Disorder (GAD-7) scale, and depression, using the 9-item Patient Health Questionnaire (PHQ-9). Results: Study participants reported a mean age of 19.9 (SD 1.94) years; 27% (27/99) of the group were male and 60% (59/99) identified as Caucasian. No significant demographic differences existed between the comparison and intervention groups. Subjects in the intervention group interacted with Ajivar for a mean time of 1424 (SD 1168) minutes. There was a significant decrease in anxiety, as measured by the GAD-7: the mean score was 11.47 (SD 1.85) at the start of the study compared to 6.27 (SD 1.44) at the end (P<.001). There was a significant reduction in the symptoms of depression measured by the PHQ-9: the mean score was 10.69 (SD 2.04) at the start of the study compared to 6.69 (SD 2.41) at the end (P=.001). Both the intervention and comparison groups independently had significant improvements in the TestWell Wellness Inventory from pretest to posttest. The subgroups in the social awareness and spirituality inventories showed significant improvement in the intervention group. In a subgroup of participants (11/49, 22%) where the GAD-7 was available during the onset of the COVID-19 pandemic, there was an increase in anxiety from the start of the study (mean score 11.63, SD 2.16) to mid-March (ie, onset of the pandemic) (mean score 13.03, SD 1.48; P=.23), followed by a significant decrease at the end of the study period (mean score 5.9, SD 1.44; P=.001). Conclusions: It is possible to deliver EI and mindfulness training in a scalable way using the Ajivar app during the COVID-19 pandemic, resulting in improvements in anxiety, depression, and EI in the college student population. %M 33320822 %R 10.2196/25372 %U http://formative.jmir.org/2021/1/e25372/ %U https://doi.org/10.2196/25372 %U http://www.ncbi.nlm.nih.gov/pubmed/33320822 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e25087 %T Adverse Childhood Experiences and Building Resilience With the JoyPop App: Evaluation Study %A MacIsaac,Angela %A Mushquash,Aislin R %A Mohammed,Shakira %A Grassia,Elizabeth %A Smith,Savanah %A Wekerle,Christine %+ Lakehead University, 955 Oliver Road, Thunder Bay, ON, , Canada, 1 8073438771, aislin.mushquash@lakeheadu.ca %K adverse childhood experiences %K resilience %K emotion regulation %K smartphone %K app %K childhood %K emotion %K mental health %K transition %K innovation %K intervention %D 2021 %7 4.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The effects of adverse childhood experiences (ACEs) on mental health, self-regulatory capacities, and overall resilience are well-known. Given such effects, ACEs may play a role in how individuals adjust to challenges later in life. Of interest in this study is the transition to university, a time of heightened stress when adapting to circumstances is required and when those with ACEs may need additional in-the-moment support to exercise resilience. A smartphone app may provide a worthwhile and readily accessible medium for a resilience intervention, provided behavioral outcomes are adequately evaluated. Objective: This study evaluates the impact of an innovative, smartphone app–based resilience intervention. The JoyPop app was designed to promote resilience through the use of self-regulatory skills such as emotion regulation and executive functioning. Among a sample of first-year undergraduate students, we explored whether use of the app would be associated with positive changes in resilience and related outcomes, and whether these benefits were influenced by level of childhood adversity. Methods: Participants (N=156) were requested to use the JoyPop app for 4 weeks, at least twice daily. Changes in resilience, emotion regulation, executive functioning, and depression were assessed after 2 and 4 weeks of app usage using multilevel modeling. Results: The sample of 156 participants included 123 females and 33 males, with a mean age of 19.02 years (SD 2.90). On average participants used the app on 20.43 of the possible 28 days (SD 7.14). App usage was associated with improvements in emotion regulation (χ21=44.46; P<.001), such that it improved by 0.25 points on the 18-point scale for each additional day of app usage, and symptoms of depression (χ21=25.12; P<.001), such that depression symptoms were reduced by .08 points on the 9-point scale with each additional day of app usage. An interaction between ACEs and days of app usage existed for emotion regulation, such that participants with more adversity evidenced a faster rate of change in emotion regulation (P=.02). Conclusions: Results highlight that daily incorporation of an app-based resilience intervention can help youth who have experienced adversity to improve emotion regulation skills and experience reductions in depression. The JoyPop app represents an important step forward in the integration of resilience intervention research with a technology-based medium that provides in-the-moment support. %M 33393908 %R 10.2196/25087 %U http://mhealth.jmir.org/2021/1/e25087/ %U https://doi.org/10.2196/25087 %U http://www.ncbi.nlm.nih.gov/pubmed/33393908 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e20642 %T COVID-19–Related Disruptions and Increased mHealth Emergency Use Intention: Experience Sampling Method Study %A Zhang,Zhenduo %A Zhang,Li %A Zheng,Junwei %A Xiao,Huan %A Li,Zhigang %+ School of Economics and Management, Beijing Polytechnic, No 9, Liangshuihe 1st Street, Beijing Economic and Technological Development Zone, Beijing, China, 86 13651205747, lizhigang@bpi.edu.cn %K mobile health services %K emergency use intention %K event disruption %K COVID-19–induced strain %K promotion regulatory focus %K mHealth %K COVID-19 %D 2020 %7 30.12.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic has become a global public health event, which has raised concerns regarding individuals’ health. Individuals need to cope with the COVID-19 pandemic with guidelines on symptom recognition, home isolation, and maintain mental health. Besides routine use of mobile health (mHealth) such as accessing information to keep healthy, individuals can use mHealth services in situations requiring urgent medical care, which is defined as mHealth emergency use. It is not known whether individuals have increased their daily mHealth services emergency use as a result of disruptions caused by the COVID-19 pandemic. Objective: The purpose of this diary analysis study is to assess the influences of daily disruptions related to the COVID-19 pandemic on individuals’ mHealth emergency use. The secondary purpose of this study is to explore the mediating role of COVID-19–induced strain and the moderating role of promotion regulatory focus in the relationship between daily disruptions of COVID-19 and mHealth emergency use. Drawing from the cognitive activation theory of stress, we investigated the underlying mechanism and boundary condition of the influence of COVID-19–related disruptions on daily mHealth emergency use. Methods: To test the proposed model, this study adopts the experience sampling method to collect daily data. The experience sampling method helps researchers to capture participants’ fluctuations in emotions, mental engagement in an activity, and experienced stress. This study collected 550 cases nested in 110 samples in mainland China to test the conceptual model. In addition, we employed hierarchical linear modeling analysis to test the effect of COVID-19–related disruptions on mHealth emergency use. Results: We found that COVID-19–related disruptions increased COVID-19–induced strain (γ=0.24, P<.001) and mHealth emergency use on a daily basis (γ=0.28, P<.001). COVID-19–induced daily strain mediated this relationship (effect=0.09, 95% CI 0.05-0.14). Promotion regulatory focus moderated the relationship between COVID-19–induced strain and mHealth emergency use (γ=0.35, P=.02). In addition, the indirect relationship between disruptions and mHealth emergency use intentions through COVID-19–induced strain is contingent upon promotion regulatory focus: this relationship was stronger in those with high promotion regulatory focus (effect=0.12, 95% CI 0.06-0.19) than in those with low promotion regulatory focus (effect=0.06, 95% CI 0.02-0.11). Conclusions: Event disruption of the COVID-19 pandemic induced mHealth emergency use intention through increased psychological strain. Furthermore, individuals’ promotion regulatory focus amplified this indirect relationship. Our findings extend our understanding of the factors underlying mHealth emergency use intention and illustrate the potential contingent role of promotion regulatory focus in the cognitive activation theory of stress. This study also opens avenues for future research on mHealth emergency use intention in other countries and cultural settings. %M 33315579 %R 10.2196/20642 %U http://mhealth.jmir.org/2020/12/e20642/ %U https://doi.org/10.2196/20642 %U http://www.ncbi.nlm.nih.gov/pubmed/33315579 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e22201 %T Promotion of Physical Activity in Older People Using mHealth and eHealth Technologies: Rapid Review of Reviews %A McGarrigle,Lisa %A Todd,Chris %+ School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 1613067865, chris.todd@manchester.ac.uk %K physical activity %K mHealth %K eHealth %K app %K accelerometer %K pedometer %K technology %K COVID-19 %D 2020 %7 29.12.2020 %9 Review %J J Med Internet Res %G English %X Background: Older people are at increased risk of adverse health events because of reduced physical activity. There is concern that activity levels are further reduced in the context of the COVID-19 pandemic, as many older people are practicing physical and social distancing to minimize transmission. Mobile health (mHealth) and eHealth technologies may offer a means by which older people can engage in physical activity while physically distancing. Objective: The objective of this study was to assess the evidence for mHealth or eHealth technology in the promotion of physical activity among older people aged 50 years or older. Methods: We conducted a rapid review of reviews using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched for systematic reviews published in the English language in 3 electronic databases: MEDLINE, CINAHL Plus, and Scopus. Two reviewers used predefined inclusion criteria to select relevant reviews and extracted data on review characteristics and intervention effectiveness. Two independent raters assessed review quality using the AMSTAR-2 tool. Results: Titles and abstracts (n=472) were screened, and 14 full-text reviews were assessed for eligibility. Initially, we included 5 reviews but excluded 1 from the narrative as it was judged to be of critically low quality. Three reviews concluded that mHealth or eHealth interventions were effective in increasing physical activity. One review found that the evidence was inconclusive. Conclusions: There is low to moderate evidence that interventions delivered via mHealth or eHealth approaches may be effective in increasing physical activity in older adults in the short term. Components of successful interventions include self-monitoring, incorporation of theory and behavior change techniques, and social and professional support. %M 33372894 %R 10.2196/22201 %U http://www.jmir.org/2020/12/e22201/ %U https://doi.org/10.2196/22201 %U http://www.ncbi.nlm.nih.gov/pubmed/33372894 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e22090 %T Comparison of the Physical Activity Measured by a Consumer Wearable Activity Tracker and That Measured by Self-Report: Cross-Sectional Analysis of the Health eHeart Study %A Beagle,Alexander J %A Tison,Geoffrey H %A Aschbacher,Kirstin %A Olgin,Jeffrey E %A Marcus,Gregory M %A Pletcher,Mark J %+ Department of Medicine, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, United States, 1 9098165831, alexanderjbeagle@gmail.com %K exercise %K body mass index %K overweight %K obesity %K fitness trackers %K self-report %K adult %K mHealth %K public health %K cardiovascular diseases %D 2020 %7 29.12.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Commercially acquired wearable activity trackers such as the Fitbit provide objective, accurate measurements of physically active time and step counts, but it is unclear whether these measurements are more clinically meaningful than self-reported physical activity. Objective: The aim of this study was to compare self-reported physical activity to Fitbit-measured step counts and then determine which is a stronger predictor of BMI by using data collected over the same period reflecting comparable physical activities. Methods: We performed a cross-sectional analysis of data collected by the Health eHeart Study, a large mobile health study of cardiovascular health and disease. Adults who linked commercially acquired Fitbits used in free-living conditions with the Health eHeart Study and completed an International Physical Activity Questionnaire (IPAQ) between 2013 and 2019 were enrolled (N=1498). Fitbit step counts were used to quantify time by activity intensity in a manner comparable to the IPAQ classifications of total active time and time spent being sedentary, walking, or doing moderate activities or vigorous activities. Fitbit steps per day were computed as a measure of the overall activity for exploratory comparisons with IPAQ-measured overall activity (metabolic equivalent of task [MET]-h/wk). Measurements of physical activity were directly compared by Spearman rank correlation. Strengths of associations with BMI for Fitbit versus IPAQ measurements were compared using multivariable robust regression in the subset of participants with BMI and covariates measured. Results: Correlations between synchronous paired measurements from Fitbits and the IPAQ ranged in strength from weak to moderate (0.09-0.48). In the subset with BMI and covariates measured (n=586), Fitbit-derived predictors were generally stronger predictors of BMI than self-reported predictors. For example, an additional hour of Fitbit-measured vigorous activity per week was associated with nearly a full point reduction in BMI (–0.84 kg/m2, 95% CI –1.35 to –0.32) in adjusted analyses, whereas the association between self-reported vigorous activity measured by IPAQ and BMI was substantially smaller in magnitude (–0.17 kg/m2, 95% CI –0.34 to –0.00; P<.001 versus Fitbit) and was dominated by the Fitbit-derived predictor when compared head-to-head in a single adjusted multivariable model. Similar patterns of associations with BMI, with Fitbit dominating self-report, were seen for moderate activity and total active time and in comparisons between overall Fitbit steps per day and IPAQ MET-h/wk on standardized scales. Conclusions: Fitbit-measured physical activity was more strongly associated with BMI than self-reported physical activity, particularly for moderate activity, vigorous activity, and summary measures of total activity. Consumer-marketed wearable activity trackers such as the Fitbit may be useful for measuring health-relevant physical activity in clinical practice and research. %M 33372896 %R 10.2196/22090 %U http://mhealth.jmir.org/2020/12/e22090/ %U https://doi.org/10.2196/22090 %U http://www.ncbi.nlm.nih.gov/pubmed/33372896 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e21733 %T Improving Heart Disease Risk Through Quality-Focused Diet Logging: Pre-Post Study of a Diet Quality Tracking App %A Kwon,Bum Chul %A VanDam,Courtland %A Chiuve,Stephanie E %A Choi,Hyung Wook %A Entler,Paul %A Tan,Pang-Ning %A Huh-Yoo,Jina %+ College of Computing and Informatics, Drexel University, 3675 Market St, Philadelphia, PA, 19104, United States, 1 2158952474, jinahuhyoo@drexel.edu %K mHealth %K diet monitoring %K diet tracking %K food tracking %K CVD %K heart disease risk %K health risk communication %K human-computer interaction %K user study %K mobile phone %D 2020 %7 23.12.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Diet-tracking mobile apps have gained increased interest from both academic and clinical fields. However, quantity-focused diet tracking (eg, calorie counting) can be time-consuming and tedious, leading to unsustained adoption. Diet quality—focusing on high-quality dietary patterns rather than quantifying diet into calories—has shown effectiveness in improving heart disease risk. The Healthy Heart Score (HHS) predicts 20-year cardiovascular risks based on the consumption of foods from quality-focused food categories, rather than detailed serving sizes. No studies have examined how mobile health (mHealth) apps focusing on diet quality can bring promising results in health outcomes and ease of adoption. Objective: This study aims to design a mobile app to support the HHS-informed quality-focused dietary approach by enabling users to log simplified diet quality and view its real-time impact on future heart disease risks. Users were asked to log food categories that are the main predictors of the HHS. We measured the app’s feasibility and efficacy in improving individuals’ clinical and behavioral factors that affect future heart disease risks and app use. Methods: We recruited 38 participants who were overweight or obese with high heart disease risk and who used the app for 5 weeks and measured weight, blood sugar, blood pressure, HHS, and diet score (DS)—the measurement for diet quality—at baseline and week 5 of the intervention. Results: Most participants (30/38, 79%) used the app every week and showed significant improvements in DS (baseline: mean 1.31, SD 1.14; week 5: mean 2.36, SD 2.48; 2-tailed t test t29=−2.85; P=.008) and HHS (baseline: mean 22.94, SD 18.86; week 4: mean 22.15, SD 18.58; t29=2.41; P=.02) at week 5, although only 10 participants (10/38, 26%) checked their HHS risk scores more than once. Other outcomes, including weight, blood sugar, and blood pressure, did not show significant changes. Conclusions: Our study showed that our logging tool significantly improved dietary choices. Participants were not interested in seeing the HHS and perceived logging diet categories irrelevant to improving the HHS as important. We discuss the complexities of addressing health risks and quantity- versus quality-based health monitoring and incorporating secondary behavior change goals that matter to users when designing mHealth apps. %M 33355537 %R 10.2196/21733 %U http://mhealth.jmir.org/2020/12/e21733/ %U https://doi.org/10.2196/21733 %U http://www.ncbi.nlm.nih.gov/pubmed/33355537 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 5 %N 4 %P e20888 %T Relationship Between Diabetes, Stress, and Self-Management to Inform Chronic Disease Product Development: Retrospective Cross-Sectional Study %A Yu,Jessica S %A Xu,Tong %A James,Roberta A %A Lu,Wei %A Hoffman,Julia E %+ Livongo Health, 150 W. Evelyn Ave, Mountain View, CA, 94041, United States, 1 866 435 5643, jessica.yu@livongo.com %K diabetes mellitus %K behavioral health %K mental health %K stress %K technology %D 2020 %7 23.12.2020 %9 Original Paper %J JMIR Diabetes %G English %X Background: Technology is rapidly advancing our understanding of how people with diabetes mellitus experience stress. Objective: The aim of this study was to explore the relationship between stress and sequelae of diabetes mellitus within a unique data set composed of adults enrolled in a digital diabetes management program, Livongo, in order to inform intervention and product development. Methods: Participants included 3263 adults under age 65 who were diagnosed with diabetes mellitus and had access to Livongo through their employer between June 2015 and August 2018. Data were collected at time of enrollment and 12 months thereafter, which included demographic information, glycemic control, presence of stress, diabetes distress, diabetes empowerment, behavioral health diagnosis, and utilization of behavioral health-related medication and services. Analysis of variance and chi-square tests compared variables across groups that were based on presence of stress and behavioral health diagnosis or utilization. Results: Fifty-five percent of participants (1808/3263) reported stress at the time of at least 1 blood glucose reading. Fifty-two percent of participants (940/1808) also received at least 1 behavioral health diagnosis or intervention. Compared to their peers, participants with stress reported greater diabetes distress, lower diabetes empowerment, greater insulin use, and poorer glycemic control. Participants with stress and a behavioral health diagnosis/utilization additionally had higher body mass index and duration of illness. Conclusions: Stress among people with diabetes mellitus is associated with reduced emotional and physical health. Digital products that focus on the whole person by offering both diabetes mellitus self-management tools and behavioral health skills and support can help improve disease-specific and psychosocial outcomes. %M 33355538 %R 10.2196/20888 %U http://diabetes.jmir.org/2020/4/e20888/ %U https://doi.org/10.2196/20888 %U http://www.ncbi.nlm.nih.gov/pubmed/33355538 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e18937 %T Interrelationships Between Patients’ Data Tracking Practices, Data Sharing Practices, and Health Literacy: Onsite Survey Study %A Luo,Yuhan %A Oh,Chi Young %A Jean,Beth St %A Choe,Eun Kyoung %+ College of Information Studies, University of Maryland, 4130 Campus Drive, Hornbake Library South, College Park, MD, , United States, 1 3014051085, choe@umd.edu %K consumer health informatics %K patient-generated health data %K self-tracking %K doctor-patient data sharing %K health literacy %K surveys and questionnaires %D 2020 %7 22.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Although the use of patient-generated data (PGD) in the optimization of patient care shows great promise, little is known about whether patients who track their PGD necessarily share the data with their clinicians. Meanwhile, health literacy—an important construct that captures an individual’s ability to manage their health and to engage with their health care providers—has often been neglected in prior studies focused on PGD tracking and sharing. To leverage the full potential of PGD, it is necessary to bridge the gap between patients’ data tracking and data sharing practices by first understanding the interrelationships between these practices and the factors contributing to these practices. Objective: This study aims to systematically examine the interrelationships between PGD tracking practices, data sharing practices, and health literacy among individual patients. Methods: We surveyed 109 patients at the time they met with a clinician at a university health center, unlike prior research that often examined patients’ retrospective experience after some time had passed since their clinic visit. The survey consisted of 39 questions asking patients about their PGD tracking and sharing practices based on their current clinical encounter. The survey also contained questions related to the participants’ health literacy. All the participants completed the survey on a tablet device. The onsite survey study enabled us to collect ecologically valid data based on patients’ immediate experiences situated within their clinic visit. Results: We found no evidence that tracking PGD was related to self-reports of having sufficient information to manage one’s health; however, the number of data types participants tracked positively related to their self-assessed ability to actively engage with health care providers. Participants’ data tracking practices and their health literacy did not relate to their data sharing practices; however, their ability to engage with health care providers positively related to their willingness to share their data with clinicians in the future. Participants reported several benefits of, and barriers to, sharing their PGD with clinicians. Conclusions: Although tracking PGD could help patients better engage with health care providers, it may not provide patients with sufficient information to manage their health. The gaps between tracking and sharing PGD with health care providers call for efforts to inform patients of how their data relate to their health and to facilitate efficient clinician-patient communication. To realize the full potential of PGD and to promote individuals’ health literacy, empowering patients to effectively track and share their PGD is important—both technologies and health care providers can play important roles. %M 33350960 %R 10.2196/18937 %U http://www.jmir.org/2020/12/e18937/ %U https://doi.org/10.2196/18937 %U http://www.ncbi.nlm.nih.gov/pubmed/33350960 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e20061 %T Integrating Key User Characteristics in User-Centered Design of Digital Support Systems for Seniors’ Physical Activity Interventions to Prevent Falls: Protocol for a Usability Study %A Revenäs,Åsa %A Johansson,Ann-Christin %A Ehn,Maria %+ Center for Clinical Research, Region Västmanland-Uppsala University, Hospital of Västmanland Västerås, Västerås Hospital, Entrance 29, Västerås, 72189, Sweden, 46 764959223, asa.revenas@regionvastmanland.se %K eHealth %K mobile health %K internet-based interventions %K physical activity %K exercise %K older adults %K gender %K user feedback %K user involvement %K user-centered design %D 2020 %7 21.12.2020 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The goal of user-centered design (UCD) is to understand the users’ perspective and to use that knowledge to shape more effective solutions. The UCD approach provides insight into users’ needs and requirements and thereby improves the design of the developed services. However, involving users in the development process does not guarantee that feedback from different subgroups of users will shape the development in ways that will make the solutions more useful for the entire target user population. Objective: The aim of this study was to describe a protocol for systematic analysis and prioritization of feedback from user subgroups in the usability testing of a digital motivation support for fall-preventive physical activity (PA) interventions in seniors (aged 65 years and older). This protocol can help researchers and developers to systematically exploit feedback from relevant user subgroups in UCD. Methods: Gender, PA level, and level of technology experience have been identified in the literature to influence users’ experience and use of digital support systems for fall-preventive PA interventions in seniors. These 3 key user characteristics were dichotomized and used to define 8 (ie, 23) possible user subgroups. The presented method enables systematic tracking of the user subgroups’ contributions in iterative development. The method comprises (1) compilation of difficulties and deficiencies in the digital applications identified in usability testing, (2) clustering of the identified difficulties and deficiencies, and (3) prioritization of deficiencies to be rectified. Tracking user subgroup representation in the user feedback ensures that the development process is prioritized according to the needs of different subgroups. Mainly qualitative data collection methods are used. Results: A protocol was developed to ensure that feedback from users representing all possible variants of 3 selected key user characteristics (gender, PA level, and level of technology experience) is considered in the iterative usability testing of a digital support for seniors’ PA. The method was applied in iterative usability testing of two digital applications during spring/summer 2018. Results from the study on the users’ experiences and the iterative modification of the digital applications are expected to be published during 2021. Conclusions: Methods for systematic collection, analysis, and prioritization of feedback from user subgroups might be particularly important in heterogenous user groups (eg, seniors). This study can contribute to identifying and improving the understanding of potential differences between user subgroups of seniors in their use and experiences of digital support for fall-preventive PA interventions. This knowledge may be relevant for developing digital support systems that are appropriate, useful, and attractive to users and for enabling the design of digital support systems that target specific user subgroups (ie, tailoring of the support). The protocol needs to be further used and investigated in order to validate its potential value. International Registered Report Identifier (IRRID): RR1-10.2196/20061 %M 33346732 %R 10.2196/20061 %U http://www.researchprotocols.org/2020/12/e20061/ %U https://doi.org/10.2196/20061 %U http://www.ncbi.nlm.nih.gov/pubmed/33346732 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24268 %T Smartphone-Based Virtual Agents to Help Individuals With Sleep Concerns During COVID-19 Confinement: Feasibility Study %A Philip,Pierre %A Dupuy,Lucile %A Morin,Charles M %A de Sevin,Etienne %A Bioulac,Stéphanie %A Taillard,Jacques %A Serre,Fuschia %A Auriacombe,Marc %A Micoulaud-Franchi,Jean-Arthur %+ USR 3413 SANPSY, University of Bordeaux, Bordeaux, France, 33 557571100, lucile.dupuy@u-bordeaux.fr %K COVID-19 %K virtual agent %K sleep disorders %K technology acceptance %K agent %K sleep %K smartphone %K mobile phone %K eHealth %K feasibility %K stress %K app %K intervention %K behavior %D 2020 %7 18.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 crisis and consequent confinement restrictions have caused significant psychosocial stress and reports of sleep complaints, which require early management, have increased during recent months. To help individuals concerned about their sleep, we developed a smartphone-based app called KANOPEE that allows users to interact with a virtual agent dedicated to autonomous screening and delivering digital behavioral interventions. Objective: Our objective was to assess the feasibility of this app, in terms of inclusion rate, follow-up rate, perceived trust and acceptance of the virtual agent, and effects of the intervention program, in the context of COVID-19 confinement in France. Methods: The virtual agent is an artificial intelligence program using decision tree architecture and interacting through natural body motion and natural voice. A total of 2069 users aged 18 years and above downloaded the free app during the study period (April 22 to May 5, 2020). These users first completed a screening interview based on the Insomnia Severity Index (ISI) conducted by the virtual agent. If the users were positive for insomnia complaints (ISI score >14), they were eligible to join the 2-stage intervention program: (1) complete an electronic sleep diary for 1 week and (2) follow personalized sleep recommendations for 10 days. We collected and analyzed the following measures: sociodemographic information, ISI scores and sleep/wake schedules, and acceptance and trust of the agent. Results: Approximately 76% (1574/2069) of the app users completed the screening interview with the virtual agent. The virtual agent was well accepted by 27.4% (431/1574) of the users who answered the acceptance and trust questionnaires on its usability, satisfaction, benevolence, and credibility. Of the 773 screened users who reported sleep complaints (ISI score >14), 166 (21.5%) followed Step 1 of the intervention, and only 47 of those (28.3%) followed Step 2. Users who completed Step 1 found that their insomnia complaints (baseline mean ISI score 18.56, mean ISI score after Step 1 15.99; P<.001) and nocturnal sleep quality improved significantly after 1 week. Users who completed Step 2 also showed an improvement compared to the initial measures (baseline mean ISI score 18.87, mean ISI score after Step 2 14.68; P<.001). Users that were most severely affected (ISI score >21) did not respond to either intervention. Conclusions: These preliminary results suggest that the KANOPEE app is a promising solution to screen populations for sleep complaints and that it provides acceptable and practical behavioral advice for individuals reporting moderately severe insomnia. %M 33264099 %R 10.2196/24268 %U http://www.jmir.org/2020/12/e24268/ %U https://doi.org/10.2196/24268 %U http://www.ncbi.nlm.nih.gov/pubmed/33264099 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e19888 %T Evaluation of a Mobile App to Enhance Relational Awareness and Change During Cognitive Analytic Therapy: Mixed Methods Case Series %A Kellett,Stephen %A Easton,Katherine %A Cooper,Martin %A Millings,Abigail %A Simmonds-Buckley,Melanie %A Parry,Glenys %+ Sheffield Health & Social Care NHS Foundation Trust, University of Sheffield, 1 Vicar Lane, Sheffield, S1 2LT, United Kingdom, 44 114 222 6537, s.kellett@sheffield.ac.uk %K cognitive analytic therapy %K case series %K effectiveness %K outcome %K eHealth %K app %K awareness %K mHealth %K innovation %K therapy %D 2020 %7 18.12.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: There has been a lack of technological innovation regarding improving the delivery of integrative psychotherapies. This project sought to evaluate an app designed to replace previous paper-based methods supporting relational awareness and change during cognitive analytic therapy (CAT). Objective: We aimed to assess patients’ and therapists’ experience of using the technology (ie, the “CAT-App”) and to evaluate the relationship between app usage and clinical outcome. Methods: The design was a mixed methods case series. Patients completed the Clinical Outcomes in Routine Evaluation-Outcome Measure pre- and post-CAT. Mood data plus the frequency and effectiveness of relational awareness and change were collected via the app. Therapists and patients were interviewed about their experiences using the app. Results: Ten patients (treated by 3 therapists) were enrolled; seven completed treatment and 4 had a reliable improvement in their mental health. App usage and mood change did not differ according to clinical outcome, but there was a statistically significant difference in app usage between completers and dropouts. The qualitative themes described by the therapists were (1) the challenge of incorporating the technology into their clinical practice and (2) the barriers and benefits of the technology. Clients’ themes were (1) data protection, (2) motivation and engagement, and (3) restrictions versus flexibility. Conclusions: The CAT-App is capable of supporting relational awareness and change and is an upgrade on older, paper-based formats. Further clinical evaluation is required. %M 33337342 %R 10.2196/19888 %U http://mental.jmir.org/2020/12/e19888/ %U https://doi.org/10.2196/19888 %U http://www.ncbi.nlm.nih.gov/pubmed/33337342 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 12 %P e20597 %T Missing-Data Handling Methods for Lifelogs-Based Wellness Index Estimation: Comparative Analysis With Panel Data %A Kim,Ki-Hun %A Kim,Kwang-Jae %+ Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, Delft, 2628 CE, Netherlands, 31 625244785, K.Kim-1@tudelft.nl %K lifelogs-based wellness index %K missing-data handling %K health behavior lifelogs %K panel data %K smart wellness service %D 2020 %7 17.12.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: A lifelogs-based wellness index (LWI) is a function for calculating wellness scores based on health behavior lifelogs (eg, daily walking steps and sleep times collected via a smartwatch). A wellness score intuitively shows the users of smart wellness services the overall condition of their health behaviors. LWI development includes estimation (ie, estimating coefficients in LWI with data). A panel data set comprising health behavior lifelogs allows LWI estimation to control for unobserved variables, thereby resulting in less bias. However, these data sets typically have missing data due to events that occur in daily life (eg, smart devices stop collecting data when batteries are depleted), which can introduce biases into LWI coefficients. Thus, the appropriate choice of method to handle missing data is important for reducing biases in LWI estimations with panel data. However, there is a lack of research in this area. Objective: This study aims to identify a suitable missing-data handling method for LWI estimation with panel data. Methods: Listwise deletion, mean imputation, expectation maximization–based multiple imputation, predictive-mean matching–based multiple imputation, k-nearest neighbors–based imputation, and low-rank approximation–based imputation were comparatively evaluated by simulating an existing case of LWI development. A panel data set comprising health behavior lifelogs of 41 college students over 4 weeks was transformed into a reference data set without any missing data. Then, 200 simulated data sets were generated by randomly introducing missing data at proportions from 1% to 80%. The missing-data handling methods were each applied to transform the simulated data sets into complete data sets, and coefficients in a linear LWI were estimated for each complete data set. For each proportion for each method, a bias measure was calculated by comparing the estimated coefficient values with values estimated from the reference data set. Results: Methods performed differently depending on the proportion of missing data. For 1% to 30% proportions, low-rank approximation–based imputation, predictive-mean matching–based multiple imputation, and expectation maximization–based multiple imputation were superior. For 31% to 60% proportions, low-rank approximation–based imputation and predictive-mean matching–based multiple imputation performed best. For over 60% proportions, only low-rank approximation–based imputation performed acceptably. Conclusions: Low-rank approximation–based imputation was the best of the 6 data-handling methods regardless of the proportion of missing data. This superiority is generalizable to other panel data sets comprising health behavior lifelogs given their verified low-rank nature, for which low-rank approximation–based imputation is known to perform effectively. This result will guide missing-data handling in reducing coefficient biases in new development cases of linear LWIs with panel data. %M 33331831 %R 10.2196/20597 %U http://medinform.jmir.org/2020/12/e20597/ %U https://doi.org/10.2196/20597 %U http://www.ncbi.nlm.nih.gov/pubmed/33331831 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e24693 %T Attitudes Toward Using COVID-19 mHealth Tools Among Adults With Chronic Health Conditions: Secondary Data Analysis of the COVID-19 Impact Survey %A Camacho-Rivera,Marlene %A Islam,Jessica Yasmine %A Rivera,Argelis %A Vidot,Denise Christina %+ Department of Community Health Sciences, State University of New York Downstate Health Sciences University, 450 Clarkson Avenue, MSC 43, Brooklyn, NY, 11203, United States, 1 7182704386, marlene.camacho-rivera@downstate.edu %K smartphone %K mHealth %K COVID-19 %K chronic health conditions %K health disparities %K chronic disease %K attitude %K perception %K data analysis %K contact tracing %K mobile app %K disparity %D 2020 %7 17.12.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adults with chronic conditions are disproportionately burdened by COVID-19 morbidity and mortality. Although COVID-19 mobile health (mHealth) apps have emerged, research on attitudes toward using COVID-19 mHealth tools among those with chronic conditions is scarce. Objective: This study aimed to examine attitudes toward COVID-19, identify determinants of COVID-19 mHealth tool use across demographic and health-related characteristics, and evaluate associations between chronic health conditions and attitudes toward using COVID-19 mHealth tools (eg, mHealth or web-based methods for tracking COVID-19 exposures, symptoms, and recommendations). Methods: We used nationally representative data from the COVID-19 Impact Survey collected from April to June 2020 (n=10,760). Primary exposure was a history of chronic conditions, which were defined as self-reported diagnoses of cardiometabolic, respiratory, immune-related, and mental health conditions and overweight/obesity. Primary outcomes were attitudes toward COVID-19 mHealth tools, including the likelihood of using (1) a mobile phone app to track COVID-19 symptoms and receive recommendations; (2) a website to track COVID-19 symptoms, track location, and receive recommendations; and (3) an app using location data to track potential COVID-19 exposure. Outcome response options for COVID-19 mHealth tool use were extremely/very likely, moderately likely, or not too likely/not likely at all. Multinomial logistic regression was used to compare the likelihood of COVID-19 mHealth tool use between people with different chronic health conditions, with not too likely/not likely at all responses used as the reference category for each outcome. We evaluated the determinants of each COVID-19 mHealth intervention using Poisson regression. Results: Of the 10,760 respondents, 21.8% of respondents were extremely/very likely to use a mobile phone app or a website to track their COVID-19 symptoms and receive recommendations. Additionally, 24.1% of respondents were extremely/very likely to use a mobile phone app to track their location and receive push notifications about whether they have been exposed to COVID-19. After adjusting for age, race/ethnicity, sex, socioeconomic status, and residence, adults with mental health conditions were the most likely to report being extremely/very or moderately likely to use each mHealth intervention compared to those without such conditions. Adults with respiratory-related chronic diseases were extremely/very (conditional odds ratio 1.16, 95% CI 1.00-1.35) and moderately likely (conditional odds ratio 1.23, 95% CI 1.04-1.45) to use a mobile phone app to track their location and receive push notifications about whether they have been exposed to COVID-19. Conclusions: Our study demonstrates that attitudes toward using COVID-19 mHealth tools vary widely across modalities (eg, web-based method vs app) and chronic health conditions. These findings may inform the adoption of long-term engagement with COVID-19 apps, which is crucial for determining their potential in reducing disparities in COVID-19 morbidity and mortality among individuals with chronic health conditions. %M 33301415 %R 10.2196/24693 %U http://mhealth.jmir.org/2020/12/e24693/ %U https://doi.org/10.2196/24693 %U http://www.ncbi.nlm.nih.gov/pubmed/33301415 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e17317 %T Mentoring Young African American Men and Transgender Women Who Have Sex With Men on Sexual Health: Formative Research for an HIV Mobile Health Intervention for Mentors %A Kaufman,Michelle R %A Casella,Albert %A Wiginton,John Mark %A Xu,Wenjian %A DuBois,David L %A Arrington-Sanders,Renata %A Simon,Jeannette %A Levine,Deb %+ Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 257, Baltimore, MD, 21205, United States, 1 4109552313, michellekaufman@jhu.edu %K mentoring %K HIV %K mobile app %K mHealth %K men who have sex with men %K transgender %K African Americans %D 2020 %7 17.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: African American men who have sex with men (MSM) and transgender women bear a disproportionate burden of HIV. Young MSM account for 75% of this burden for youth. When youths lack socially protective resources such as strong networks of adults, including parents, teachers, or community members, mentors may play a critical role in promoting health behaviors. This is especially true for youth at risk for HIV, such as African American youth with sexual and gender minority (SGM) identities. In the past decade, natural mentoring and mentoring programs have proliferated as a key prevention and intervention strategy to improve outcomes for young people at risk for poor academic, social, and health issues. Mentors appear to be able to facilitate health promotion among young SGM by modeling healthy behaviors; however, mentors’ knowledge and resource needs regarding sexual health topics including HIV are understudied, as is the potential role of mobile technology in enhancing mentoring relationships and the ability of mentors to learn about sensitive issues faced by youth. Objective: The aim of this study is to explore how mentoring plays a role in the sexual health of African American SGM youth and understand how mentoring relationships can be strengthened through mobile technology to promote youth HIV prevention behaviors. Methods: In-depth interviews were conducted with African American SGM youth mentees (n=17) and mentors (n=20) to such youths in 3 Mid-Atlantic cities. Mentee interviews focused on discussions regarding sexual health and HIV and how a mentor could broach such topics. Mentor interviews explored whether sexual health and HIV are currently mentoring topics, mentors’ knowledge and confidence in mentoring on these issues, and barriers to discussions. All participants were asked if a mobile app could help facilitate mentoring on sensitive health issues, particularly HIV and sexual health. Data were transcribed, coded, and analyzed for relevant themes. Results: Sexual health was a common topic in mentoring relationships, occurring more in natural mentorships than in mentoring program pairs. Mentors and mentees felt positive about such discussions. Mentors expressed having limited knowledge beyond condom use and HIV testing, and expressed a need for more complete resources. Both mentors and mentees had mixed comfort levels when discussing sexual health. Sufficient trust and shared lived experiences made discussions easier. Mentees have multifaceted needs; however, mentors stated that an app resource that provided self-training, resources, support from other mentors, and tips for better mentoring could prove beneficial. Conclusions: For the African American SGM community, access to natural mentors is crucial for young people to learn healthy behaviors. A mobile resource to assist mentors in confidently having discussions with mentees may be a promising way to promote healthy practices. %M 33331822 %R 10.2196/17317 %U https://formative.jmir.org/2020/12/e17317 %U https://doi.org/10.2196/17317 %U http://www.ncbi.nlm.nih.gov/pubmed/33331822 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 4 %P e23734 %T Effects of a Mobile App Called Quittr, Which Utilizes Premium Currency and Games Features, on Improving Engagement With Smoking Cessation Intervention: Pilot Randomized Controlled Trial %A Bindoff,Ivan %A Ling,Tristan R %A Gee,Peter %A Geelan,Benjamin %A Ferguson,Stuart G %A Peterson,Gregory M %+ School of Pharmacy and Pharmacology, University of Tasmania, 1 Churchill Ave, Sandy Bay, 7005, Australia, 61 408528276, Ivan.Bindoff@utas.edu.au %K smoking %K cessation %K Quittr %K engagement %K retention %K churn %K cigarette %K mHealth %K game %D 2020 %7 14.12.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Numerous mobile health (mHealth) apps have been developed to support smokers attempting to quit smoking. Although these apps have been reported to be successful, only modest improvements in the quit rate have been measured. It has been proposed that efforts to improve user engagement and retention may improve the quit rate further. Owing to the high cost of smoking-related disease, it is considered worthwhile to pursue even small improvements. Objective: The aim of this study was to test a novel smartphone app that leverages premium currency strategies developed by the mobile games industry in an attempt to improve engagement and retention with a smoking cessation intervention. Methods: We designed and developed a smoking cessation app called “Quittr” in line with previously developed smoking cessation mHealth apps. In addition to this established framework, we added a stand-alone fully featured city-building clicker-style game called “Tappy Town,” and a premium virtual currency called “QuitCoins.” The user earns QuitCoins for using the app in a way that contributes positively toward their quit attempt, and they can redeem these coins in Tappy Town for bonuses. To establish whether these features improved engagement and retention, we ran a 5-month randomized controlled trial where the intervention group had the full app with the extra games features, while the control group had the standard app only. Recruitment was performed via web-based advertising. Participants (N=175) had no direct contact with the researchers or other support staff. Results: No significant differences in terms of engagement, retention, or smoking outcomes were found between the control and intervention groups. However, survey data indicated that the majority of the participants valued Tappy Town (10/17, 59%) and the QuitCoins rewards system (13/17, 77%). Usage data also suggested that Tappy Town was widely played and was generally appealing to users (mean total time spent in app, control group: 797 seconds vs intervention group: 3502 seconds, P<.001). Analysis of the results suggests that users in the intervention group may have been negatively affected by the aspects of the chosen design, and some theories were explored to explain this unexpected outcome. Conclusions: Although the novel features of the Quittr app failed to improve the key outcomes measured in this study, there were enough positive indications to warrant further exploration of the concept. Additional research will be required to identify and correct any design flaws that may have adversely affected our participants before a follow-up study can be completed. Trial Registration: Australian and New Zealand Clinical Trials Register ACTRN12617000491369; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372661&isReview=true %M 33315016 %R 10.2196/23734 %U http://games.jmir.org/2020/4/e23734/ %U https://doi.org/10.2196/23734 %U http://www.ncbi.nlm.nih.gov/pubmed/33315016 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e23369 %T Engagement With a Behavior Change App for Alcohol Reduction: Data Visualization for Longitudinal Observational Study %A Bell,Lauren %A Garnett,Claire %A Qian,Tianchen %A Perski,Olga %A Williamson,Elizabeth %A Potts,Henry WW %+ Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 02076368636, lauren.bell@lshtm.ac.uk %K mobile health %K behavior change %K apps %K digital health %K data visualizations %K engagement %K micro-randomized trial %K push notifications %K just-in-time adaptive interventions %D 2020 %7 11.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Behavior change apps can develop iteratively, where the app evolves into a complex, dynamic, or personalized intervention through cycles of research, development, and implementation. Understanding how existing users engage with an app (eg, frequency, amount, depth, and duration of use) can help guide further incremental improvements. We aim to explore how simple visualizations can provide a good understanding of temporal patterns of engagement, as usage data are often longitudinal and rich. Objective: This study aims to visualize behavioral engagement with Drink Less, a behavior change app to help reduce hazardous and harmful alcohol consumption in the general adult population of the United Kingdom. Methods: We explored behavioral engagement among 19,233 existing users of Drink Less. Users were included in the sample if they were from the United Kingdom; were 18 years or older; were interested in reducing their alcohol consumption; had a baseline Alcohol Use Disorders Identification Test score of 8 or above, indicative of excessive drinking; and had downloaded the app between May 17, 2017, and January 22, 2019 (615 days). Measures of when sessions begin, length of sessions, time to disengagement, and patterns of use were visualized with heat maps, timeline plots, k-modes clustering analyses, and Kaplan-Meier plots. Results: The daily 11 AM notification is strongly associated with a change in engagement in the following hour; reduction in behavioral engagement over time, with 50.00% (9617/19,233) of users disengaging (defined as no use for 7 or more consecutive days) 22 days after download; identification of 3 distinct trajectories of use, namely engagers (4651/19,233, 24.18% of users), slow disengagers (3679/19,233, 19.13% of users), and fast disengagers (10,903/19,233, 56.68% of users); and limited depth of engagement with 85.076% (7,095,348/8,340,005) of screen views occurring within the Self-monitoring and Feedback module. In addition, a peak of both frequency and amount of time spent per session was observed in the evenings. Conclusions: Visualizations play an important role in understanding engagement with behavior change apps. Here, we discuss how simple visualizations helped identify important patterns of engagement with Drink Less. Our visualizations of behavioral engagement suggest that the daily notification substantially impacts engagement. Furthermore, the visualizations suggest that a fixed notification policy can be effective for maintaining engagement for some users but ineffective for others. We conclude that optimizing the notification policy to target both effectiveness and engagement is a worthwhile investment. Our future goal is to both understand the causal effect of the notification on engagement and further optimize the notification policy within Drink Less by tailoring to contextual circumstances of individuals over time. Such tailoring will be informed from the findings of our micro-randomized trial (MRT), and these visualizations were useful in both gaining a better understanding of engagement and designing the MRT. %M 33306026 %R 10.2196/23369 %U http://www.jmir.org/2020/12/e23369/ %U https://doi.org/10.2196/23369 %U http://www.ncbi.nlm.nih.gov/pubmed/33306026 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e18513 %T Mobile Health Apps for Medical Emergencies: Systematic Review %A Plaza Roncero,Alejandro %A Marques,Gonçalo %A Sainz-De-Abajo,Beatriz %A Martín-Rodríguez,Francisco %A del Pozo Vegas,Carlos %A Garcia-Zapirain,Begonya %A de la Torre-Díez,Isabel %+ eVIDA Research Group, University of Deusto, Avda/ Universidades 24, Bilbao, 48007, Spain, 34 619967223, mbgarciazapi@deusto.es %K mobile health %K mHealth %K eHealth %K Android %K iOS %K medical emergencies %K mobile apps %D 2020 %7 11.12.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile health apps are used to improve the quality of health care. These apps are changing the current scenario in health care, and their numbers are increasing. Objective: We wanted to perform an analysis of the current status of mobile health technologies and apps for medical emergencies. We aimed to synthesize the existing body of knowledge to provide relevant insights for this topic. Moreover, we wanted to identify common threads and gaps to support new challenging, interesting, and relevant research directions. Methods: We reviewed the main relevant papers and apps available in the literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was used in this review. The search criteria were adopted using systematic methods to select papers and apps. On one hand, a bibliographic review was carried out in different search databases to collect papers related to each application in the health emergency field using defined criteria. On the other hand, a review of mobile apps in two virtual storage platforms (Google Play Store and Apple App Store) was carried out. The Google Play Store and Apple App Store are related to the Android and iOS operating systems, respectively. Results: In the literature review, 28 papers in the field of medical emergency were included. These studies were collected and selected according to established criteria. Moreover, we proposed a taxonomy using six groups of applications. In total, 324 mobile apps were found, with 192 identified in the Google Play Store and 132 identified in the Apple App Store. Conclusions: We found that all apps in the Google Play Store were free, and 73 apps in the Apple App Store were paid, with the price ranging from US $0.89 to US $5.99. Moreover, 39% (11/28) of the included studies were related to warning systems for emergency services and 21% (6/28) were associated with disaster management apps. %M 33306037 %R 10.2196/18513 %U http://mhealth.jmir.org/2020/12/e18513/ %U https://doi.org/10.2196/18513 %U http://www.ncbi.nlm.nih.gov/pubmed/33306037 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e23157 %T Experiences, Attitudes, and Needs of Users of a Pregnancy and Parenting App (Baby Buddy) During the COVID-19 Pandemic: Mixed Methods Study %A Rhodes,Alexandra %A Kheireddine,Sara %A Smith,Andrea D %+ Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 20 7679 2000, alexandra.rhodes.15@ucl.ac.uk %K pregnancy %K parenting %K app %K COVID-19 %K pregnancy support %K postnatal support %K perinatal %K mental well-being %K physical well-being %K support %K well-being %K experience %K attitude %K needs %D 2020 %7 9.12.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic has impacted the lives of expectant parents and parents of young babies, with disruptions in health care provision and loss of social support. Objective: This study investigated the impact of the COVID-19 pandemic and its associated lockdown on this population through the lens of users of the UK National Health Service–approved pregnancy and parenting smartphone app, Baby Buddy. The study aims were threefold: to gain insights into the attitudes and experiences of expectant and recent parents (with babies under 24 weeks of age) during the COVID-19 pandemic; to investigate whether Baby Buddy is meeting users’ needs during this time; and to identify ways to revise the content of Baby Buddy to better support its users now and in future. Methods: A mixed methods study design combining a web-based survey with semistructured telephone interviews among Baby Buddy users in the United Kingdom was applied. Data were collected from April 15 to mid-June 2020, corresponding to weeks 4-13 of the lockdown in the United Kingdom. Results: A total of 436 expectant (n=244, 56.0%) and recent (n=192, 44.0%) parents responded to the web-based survey, of which 79.1% (n=345) were aged 25-39 years and 17.2% (n=75) spoke English as their second language. Of the 436 respondents, 88.5% (386/436) reported increased levels of anxiety around pregnancy, birth, and being a new parent, and 58.0% (253/436) were concerned about their emotional and mental health. Of the 244 pregnant respondents, 43.4% (n=106) were concerned about their physical health. Telephone interviews with 13 pregnant women and 19 recent parents revealed similarly increased levels of anxiety due to reduced health care provision and loss of support from friends and family. Although a minority of respondents identified some positive outcomes of lockdown, such as family bonding, many telephone interviewees reported feeling isolated, disregarded, and overwhelmed. Recent parents were particularly anxious about the impact of the lockdown on their baby’s development and socialization. Many interviewees were also concerned about their physical health as a consequence of both limited access to face-to-face medical appointments and their own poorer dietary and physical activity behaviors. Across both samples, 97.0% (423/436) of respondents reported that Baby Buddy was currently helping them, with many commenting that its role was even more important given the lack of face-to-face support from health care and parenting organizations. Greater speed in updating digital content to reflect changes due to the pandemic was suggested. Conclusions: The COVID-19 pandemic has created heightened anxiety and stress among expectant parents and those with a young baby, and for many, lockdown has had an adverse impact on their physical and mental well-being. With reductions in health care and social support, expectant and new parents are increasingly relying on web-based resources. As a free, evidence-based app, Baby Buddy is well positioned to meet this need. The app could support its users even more by actively directing them to the wealth of existing content relevant to their concerns and by adding content to give users the knowledge and confidence to meet new challenges. %M 33264100 %R 10.2196/23157 %U http://mhealth.jmir.org/2020/12/e23157/ %U https://doi.org/10.2196/23157 %U http://www.ncbi.nlm.nih.gov/pubmed/33264100 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e19991 %T A Mobile Social Networking App for Weight Management and Physical Activity Promotion: Results From an Experimental Mixed Methods Study %A Laranjo,Liliana %A Quiroz,Juan C %A Tong,Huong Ly %A Arevalo Bazalar,Maria %A Coiera,Enrico %+ Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera road, Sydney, 2113, Australia, 61 413461852, liliana.laranjo@mq.edu.au %K mobile apps %K fitness trackers %K exercise %K social networking %K body weight maintenance %K mobile phone %D 2020 %7 8.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphone apps, fitness trackers, and online social networks have shown promise in weight management and physical activity interventions. However, there are knowledge gaps in identifying the most effective and engaging interventions and intervention features preferred by their users. Objective: This 6-month pilot study on a social networking mobile app connected to wireless weight and activity tracking devices has 2 main aims: to evaluate changes in BMI, weight, and physical activity levels in users from different BMI categories and to assess user perspectives on the intervention, particularly on social comparison and automated self-monitoring and feedback features. Methods: This was a mixed methods study involving a one-arm, pre-post quasi-experimental pilot with postintervention interviews and focus groups. Healthy young adults used a social networking mobile app intervention integrated with wireless tracking devices (a weight scale and a physical activity tracker) for 6 months. Quantitative results were analyzed separately for 2 groups—underweight-normal and overweight-obese BMI—using t tests and Wilcoxon sum rank, Wilcoxon signed rank, and chi-square tests. Weekly BMI change in participants was explored using linear mixed effects analysis. Interviews and focus groups were analyzed inductively using thematic analysis. Results: In total, 55 participants were recruited (mean age of 23.6, SD 4.6 years; 28 women) and 45 returned for the final session (n=45, 82% retention rate). There were no differences in BMI from baseline to postintervention (6 months) and between the 2 BMI groups. However, at 4 weeks, participants’ BMI decreased by 0.34 kg/m2 (P<.001), with a loss of 0.86 kg/m2 in the overweight-obese group (P=.01). Participants in the overweight-obese group used the app significantly less compared with individuals in the underweight-normal BMI group, as they mentioned negative feelings and demotivation from social comparison, particularly from upward comparison with fitter people. Participants in the underweight-normal BMI group were avid users of the app’s self-monitoring and feedback (P=.02) and social (P=.04) features compared with those in the overweight-obese group, and they significantly increased their daily step count over the 6-month study duration by an average of 2292 steps (95% CI 898-3370; P<.001). Most participants mentioned a desire for a more personalized intervention. Conclusions: This study shows the effects of different interventions on participants from higher and lower BMI groups and different perspectives regarding the intervention, particularly with respect to its social features. Participants in the overweight-obese group did not sustain a short-term decrease in their BMI and mentioned negative emotions from app use, while participants in the underweight-normal BMI group used the app more frequently and significantly increased their daily step count. These differences highlight the importance of intervention personalization. Future research should explore the role of personalized features to help overcome personal barriers and better match individual preferences and needs. %M 33289670 %R 10.2196/19991 %U http://www.jmir.org/2020/12/e19991/ %U https://doi.org/10.2196/19991 %U http://www.ncbi.nlm.nih.gov/pubmed/33289670 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e18439 %T A Mobile Phone–Based App for Use During Cognitive Behavioral Therapy for Adolescents With Anxiety (MindClimb): User-Centered Design and Usability Study %A Newton,Amanda %A Bagnell,Alexa %A Rosychuk,Rhonda %A Duguay,Janelle %A Wozney,Lori %A Huguet,Anna %A Henderson,Joanna %A Curran,Janet %+ Department of Psychiatry, Dalhousie University, PO Box 9700, 5850/5980 University Avenue, Halifax, NS, B3K 6R8, Canada, 1 902 470 8087, Alexa.Bagnell@iwk.nshealth.ca %K anxiety disorders %K mobile apps %K adolescents %K usability testing %K development %K design %K anxiety %D 2020 %7 8.12.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile device–based tools to help adolescents practice skills outside of cognitive behavioral therapy (CBT) sessions for treating an anxiety disorder may lead to greater treatment gains. Objective: This study aimed to develop, design, and test the acceptability, learnability, heuristics, and usability of MindClimb, a smartphone-based app for adolescents with anxiety to use between CBT sessions to plan and complete exposure activities using skills (cognitive, relaxation, exposure practice, and reward) learned in treatment. Methods: This 3-phase study took place from August 2015 to December 2018. In phase 1, the app was designed and developed in consultation with young people and CBT therapists to identify desired functions and content. Feedback was subjected to thematic analysis using a general inductive approach. In phase 2, we conducted 2 high-fidelity testing sessions using the think-aloud approach (acceptability, learnability, usability) and 10-item System Usability Scale with 10 adolescents receiving CBT. The high-fidelity MindClimb app was evaluated by 5 app developers based on Nielsen’s usability heuristics and 5-point severity ranking scale. In phase 3, a total of 8 adolescents and 3 therapists assessed the usability of MindClimb during CBT sessions by recording the frequency of skills practice, use of MindClimb features, satisfaction with the app, and barriers and facilitators to app use during treatment. Results: Feedback from phase 1 consultations indicated that the app should (1) be responsive to user needs and preferences, (2) be easy to use and navigate, (3) have relevant content to the practice of CBT for anxiety, and (4) be aesthetically appealing. Using this feedback as a guide, a fully functional app prototype for usability testing and heuristic evaluation was developed. In phase 2, think-aloud and usability data resulted in minor revisions to the app, including refinement of exposure activities. The average system usability score was 77 in both testing cycles, indicating acceptable usability. The heuristic evaluation by app developers identified only minor errors (eg, loading speed of app content, with a score of 1 on the severity ranking scale). In phase 3, adolescents considered app features for completing exposure (6.2/10) and relaxation (6.4/10) modestly helpful. Both adolescents (average score 11.3/15, SD 1.6) and therapists (average score 10.0/12, 2.6 SD) reported being satisfied with the app. Conclusions: The user-centered approach to developing and testing MindClimb resulted in a mobile health app that can be used by adolescents during CBT for anxiety. Evaluation of the use of this app in a clinical practice setting demonstrated that adolescents and therapists generally felt it was helpful for CBT practice outside of therapy sessions. Implementation studies with larger youth samples are necessary to evaluate how to optimize the use of technology in clinical care and examine the impact of the app plus CBT on clinical care processes and patient outcomes. %M 33289671 %R 10.2196/18439 %U https://mhealth.jmir.org/2020/12/e18439 %U https://doi.org/10.2196/18439 %U http://www.ncbi.nlm.nih.gov/pubmed/33289671 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e17536 %T Feasibility of a Digital Health Intervention to Improve Diet Quality Among Women With High Blood Pressure: Randomized Controlled Feasibility Trial %A Steinberg,Dori M %A Kay,Melissa C %A Svetkey,Laura P %A Askew,Sandy %A Christy,Jacob %A Burroughs,Jasmine %A Ahmed,Hira %A Bennett,Gary G %+ Duke University School of Nursing, 307 Trent Drive, DUMC 3322, Durham, NC, 27710, United States, 1 919 613 9439, dori.steinberg@duke.edu %K hypertension %K DASH dietary pattern %K digital health %K nutrition %K women’s health %K mHealth %D 2020 %7 7.12.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Over 100 million individuals have high blood pressure, and more than half of them are women. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is a proven lifestyle approach to lower blood pressure, yet population-level adherence is poor. Innovative strategies that promote DASH are needed. Objective: This paper aims to improve adherence to the DASH diet among women with hypertension or prehypertension. Methods: We conducted a 3-month randomized controlled feasibility trial comparing app-based diet tracking (active comparator) to app-based diet tracking plus feedback on DASH adherence via text message (intervention). The intervention platform extracted nutrient data from the app, compared it to DASH recommendations, and sent tailored feedback text messages. Outcomes included the number of days participants tracked their diet, changes in their DASH adherence score, and blood pressure. Results: The women (N=59) had a mean age of 49.9 (SD 11.9) years and were primarily non-Hispanic White (41/59, 69%) and college educated (49/59, 83%). The mean baseline DASH score was 2.3 (SD 1.3). At 3 months, the intervention and active comparator participants had similar mean days tracked per week (4.2, SD 2.1 days vs 4.6, SD 2.7 days; P=.54) and mean changes in their DASH score (0.8, 95% CI 0.2-1.5 vs 0.8, 95% CI 0.4-1.2; P=.75). Intervention participants had lower systolic (mean difference: –2.8 mmHg, 95% CI –1.8 to 7.4; P=.23) and diastolic (mean difference: –3.6 mmHg, 95% CI –0.2 to 7.3; P=.07) blood pressure compared with active comparator participants. Most intervention participants (23/29, 79%) said they would recommend the DASH Cloud intervention to a friend or family member. However, only 34% (10/59) indicated that the feedback text messages helped them reach their diet goals. Conclusions: A digital health intervention to improve DASH adherence is feasible and produces moderately high engagement among women with elevated blood pressure. The intervention did not enhance DASH adherence over diet tracking alone but resulted in greater reductions in blood pressure. Larger studies are needed to determine how digital health interventions can improve population-level adherence to DASH. Trial Registration: ClinicalTrials.gov NCT03215472; https://clinicaltrials.gov/ct2/show/study/NCT03215472 %M 33284116 %R 10.2196/17536 %U https://mhealth.jmir.org/2020/12/e17536 %U https://doi.org/10.2196/17536 %U http://www.ncbi.nlm.nih.gov/pubmed/33284116 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e15602 %T Use of Different Food Image Recognition Platforms in Dietary Assessment: Comparison Study %A Van Asbroeck,Stephanie %A Matthys,Christophe %+ Department of Chronic Diseases and Metabolism, Clinical and Experimental Endocrinology, KU Leuven, Herestraat 49, DIEET, Leuven, Belgium, 32 016 34 26 55, christophe.matthys@uzleuven.be %K image recognition %K dietary assessment %K automated food recognition %K accuracy %D 2020 %7 7.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: In the domain of dietary assessment, there has been an increasing amount of criticism of memory-based techniques such as food frequency questionnaires or 24 hour recalls. One alternative is logging pictures of consumed food followed by an automatic image recognition analysis that provides information on type and amount of food in the picture. However, it is currently unknown how well commercial image recognition platforms perform and whether they could indeed be used for dietary assessment. Objective: This is a comparative performance study of commercial image recognition platforms. Methods: A variety of foods and beverages were photographed in a range of standardized settings. All pictures (n=185) were uploaded to selected recognition platforms (n=7), and estimates were saved. Accuracy was determined along with totality of the estimate in the case of multiple component dishes. Results: Top 1 accuracies ranged from 63% for the application programming interface (API) of the Calorie Mama app to 9% for the Google Vision API. None of the platforms were capable of estimating the amount of food. These results demonstrate that certain platforms perform poorly while others perform decently. Conclusions: Important obstacles to the accurate estimation of food quantity need to be overcome before these commercial platforms can be used as a real alternative for traditional dietary assessment methods. %M 33284118 %R 10.2196/15602 %U https://formative.jmir.org/2020/12/e15602 %U https://doi.org/10.2196/15602 %U http://www.ncbi.nlm.nih.gov/pubmed/33284118 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e22996 %T An Artificial Intelligence–Based, Personalized Smartphone App to Improve Childhood Immunization Coverage and Timelines Among Children in Pakistan: Protocol for a Randomized Controlled Trial %A Kazi,Abdul Momin %A Qazi,Saad Ahmed %A Khawaja,Sadori %A Ahsan,Nazia %A Ahmed,Rao Moueed %A Sameen,Fareeha %A Khan Mughal,Muhammad Ayub %A Saqib,Muhammad %A Ali,Sikander %A Kaleemuddin,Hussain %A Rauf,Yasir %A Raza,Mehreen %A Jamal,Saima %A Abbasi,Munir %A Stergioulas,Lampros K %+ Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan, 92 2134864232, momin.kazi@aku.edu %K artificial intelligence %K AI %K routine childhood immunization %K EPI %K LMICs %K mHealth %K Pakistan %K personalized messages %K routine immunization %K smartphone apps %K vaccine-preventable illnesses %D 2020 %7 4.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The immunization uptake rates in Pakistan are much lower than desired. Major reasons include lack of awareness, parental forgetfulness regarding schedules, and misinformation regarding vaccines. In light of the COVID-19 pandemic and distancing measures, routine childhood immunization (RCI) coverage has been adversely affected, as caregivers avoid tertiary care hospitals or primary health centers. Innovative and cost-effective measures must be taken to understand and deal with the issue of low immunization rates. However, only a few smartphone-based interventions have been carried out in low- and middle-income countries (LMICs) to improve RCI. Objective: The primary objectives of this study are to evaluate whether a personalized mobile app can improve children’s on-time visits at 10 and 14 weeks of age for RCI as compared with standard care and to determine whether an artificial intelligence model can be incorporated into the app. Secondary objectives are to determine the perceptions and attitudes of caregivers regarding childhood vaccinations and to understand the factors that might influence the effect of a mobile phone–based app on vaccination improvement. Methods: A mixed methods randomized controlled trial was designed with intervention and control arms. The study will be conducted at the Aga Khan University Hospital vaccination center. Caregivers of newborns or infants visiting the center for their children’s 6-week vaccination will be recruited. The intervention arm will have access to a smartphone app with text, voice, video, and pictorial messages regarding RCI. This app will be developed based on the findings of the pretrial qualitative component of the study, in addition to no-show study findings, which will explore caregivers’ perceptions about RCI and a mobile phone–based app in improving RCI coverage. Results: Pretrial qualitative in-depth interviews were conducted in February 2020. Enrollment of study participants for the randomized controlled trial is in process. Study exit interviews will be conducted at the 14-week immunization visits, provided the caregivers visit the immunization facility at that time, or over the phone when the children are 18 weeks of age. Conclusions: This study will generate useful insights into the feasibility, acceptability, and usability of an Android-based smartphone app for improving RCI in Pakistan and in LMICs. Trial Registration: ClinicalTrials.gov NCT04449107; https://clinicaltrials.gov/ct2/show/NCT04449107 International Registered Report Identifier (IRRID): DERR1-10.2196/22996 %M 33274726 %R 10.2196/22996 %U https://www.researchprotocols.org/2020/12/e22996 %U https://doi.org/10.2196/22996 %U http://www.ncbi.nlm.nih.gov/pubmed/33274726 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e22757 %T Web-Based Relaxation Intervention for Stress During Social Isolation: Randomized Controlled Trial %A Pizzoli,Silvia Francesca Maria %A Marzorati,Chiara %A Mazzoni,Davide %A Pravettoni,Gabriella %+ University of Milan, Department of Oncology and Hematology-Oncology, Via Festa del Perdono 7, Milan, 20122, Italy, 39 0294372099, silviafrancescamaria.pizzoli@ieo.it %K relaxation %K guided meditation %K web-based intervention %K social isolation %K intervention %K COVID-19 %K anxiety %K stress %K internet %D 2020 %7 3.12.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Relaxation practices might be helpful exercises for coping with anxiety and stressful sensations. They may be of particular utility when used in web-based interventions during periods of social isolation. Objective: This randomized study aimed to test whether web-based relaxation practices like natural sounds, deep respiration, and body scans can promote relaxation and a positive emotional state, and reduce psychomotor activation and preoccupation related to the COVID-19 pandemic. Methods: Participants were randomly assigned to one of three experimental conditions. Each condition was characterized by a single online session of a guided square breathing exercise, a guided body scan exercise, or natural sounds. The participants listened to one of the fully automated audio clips for 7 minutes and pre-post completed self-assessed scales on perceived relaxation, psychomotor activation, level of preoccupation associated with COVID-19, and emotional state. At the end of the session, qualitative reports on subjective experience were also collected. Results: Overall, 294 participants completed 75% of the survey and 240 completed the entire survey as well as one of three randomly assigned interventions. Perceived relaxation, psychomotor activation/stress, and preoccupation related to COVID-19 showed a positive improvement after participants listened to the audio clips. The same pattern was observed for the valence and perceived dominance of the emotional state. The square breathing and body scan exercises yielded superior results compared to natural sounds in lowering perceived stress. Conclusions: This study provides a novel insight that can guide the development of future low-cost web-based interventions to reduce preoccupation and stress in the general population. International Registered Report Identifier (IRRID): RR2-10.2196/19236 %M 33200990 %R 10.2196/22757 %U https://mental.jmir.org/2020/12/e22757 %U https://doi.org/10.2196/22757 %U http://www.ncbi.nlm.nih.gov/pubmed/33200990 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e23273 %T Effectiveness of WeChat for Improving Exclusive Breastfeeding in Huzhu County China: Randomized Controlled Trial %A Wu,Qiong %A Huang,Yiwen %A Liao,Zijun %A van Velthoven,Michelle Helena %A Wang,Wei %A Zhang,Yanfeng %+ Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, China, 86 10 85695554, summyzh@126.com %K breastfeeding %K exclusive breastfeeding %K WeChat %K mHealth %K randomized controlled trial %D 2020 %7 3.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The benefits of breastfeeding for both infants and mothers have been well recognized. However, the exclusive breastfeeding rate in China is low and decreasing. Mobile technologies have rapidly developed; communication apps such as WeChat (one of the largest social networking platforms in China) are widely used and have the potential to conveniently improve health behaviors. Objective: This study aimed to assess the effectiveness of using WeChat to improve breastfeeding practices. Methods: This 2-arm randomized controlled trial was conducted among pregnant women from May 2019 to April 2020 in Huzhu County, Qinghai Province, China. Pregnant women were eligible to participate if they were aged 18 years or older, were 11 to 37 weeks pregnant with a singleton fetus, had no known illness that could limit breastfeeding after childbirth, used WeChat through their smartphone, and had access to the internet. A total of 344 pregnant women were recruited at baseline, with 170 in the intervention group and 174 in the control group. Women in the intervention group received breastfeeding knowledge and promotion information weekly through a WeChat official account from their third month of pregnancy to 6 months postpartum. The primary outcome of exclusive and predominant breastfeeding rate was measured 0-1 month, 2-3 months, and 4-5 months postpartum. Results: At 0-1 month postpartum, the exclusive breastfeeding rate was significantly higher in the intervention group than that in the control group (81.1% vs 63.3%; odds ratio [OR] 2.75, 95% CI 1.58-4.78; P<.001). Similarly, mothers in the intervention group were more likely to provide predominantly breast milk (OR 2.77, 95% CI 1.55-4.96; P<.001) and less likely to give dairy products to their children (OR 0.40, 95% CI 0.21-0.75; P=.005). There was no statistically significant difference for exclusive breastfeeding rate 2-3 months (P=.09) and 4-5 months postpartum (P=.27), though more children in the intervention group were exclusively breastfed than those in the control group 2-3 months postpartum (intervention: 111/152, 73.0%; control: 96/152, 63.2%) and 4-5 months postpartum(intervention: 50/108, 46.3%; control: 46/109, 42.2%). Conclusions: This study is the first effort to promote exclusive breastfeeding through WeChat in China, which proved to be an effective method of promoting exclusive breastfeeding in early life. WeChat health education can be used in addition to local breastfeeding promotion programs. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800017364; http://www.chictr.org.cn/showproj.aspx?proj=29325 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7676-2 %M 33270026 %R 10.2196/23273 %U https://www.jmir.org/2020/12/e23273 %U https://doi.org/10.2196/23273 %U http://www.ncbi.nlm.nih.gov/pubmed/33270026 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e18950 %T Outcomes of the Deployment of the Auto-Visual Acute Flaccid Paralysis Detection and Reporting (AVADAR) System for Strengthening Polio Surveillance in Africa From 2017 to 2018: Evaluation Study %A Ticha,Johnson Muluh %A Akpan,Godwin Ubong %A Paige,Lara MF %A Senouci,Kamel %A Stein,Andrew %A Briand,Patrick %A Tuma,Jude %A Oyaole,Daniel Rasheed %A Ngofa,Reuben %A Maleghemi,Sylvester %A Touray,Kebba %A Salihu,Abdullahi Ahmed %A Diallo,Mamadou %A Tegegne,Sisay Gashu %A Bello,Isah Mohammed %A Idris,Umar Kabo %A Maduka,Omosivie %A Manengu,Casimir %A Shuaib,Faisal %A Galway,Michael %A Mkanda,Pascal %+ World Health Organization Regional Office for Africa, Cite Du Djoue, Brazzaville, 500101, Congo, 242 055736476, akpang@who.int %K Auto-Visual Acute Flaccid Paralysis Detection and Reporting %K surveillance %K informants %K acute flaccid paralysis %K smartphones %K polio %D 2020 %7 2.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As we move toward a polio-free world, the challenge for the polio program is to create an unrelenting focus on smaller areas where the virus is still present, where children are being repeatedly missed, where immunity levels are low, and where surveillance is weak. Objective: This article aimed to describe a possible solution to address weak surveillance systems and document the outcomes of the deployment of the Auto-Visual Acute Flaccid Paralysis Detection and Reporting (AVADAR) project. Methods: This intervention was implemented in 99 targeted high-risk districts with concerns for silent polio circulation from eight countries in Africa between August 1, 2017, and July 31, 2018. A total of 6954 persons (5390 community informants and 1564 health workers) were trained and equipped with a smartphone on which the AVADAR app was configured to allow community informants to send alerts on suspected acute flaccid paralysis (AFP) and allow health worker to use electronic checklists for investigation of such alerts. The AVADAR and Open Data Kit ONA servers were at the center of the entire process. A dashboard system and coordination teams for monitoring and supervision were put in place at all levels. Results: Overall, 96.44% (24,142/25,032) of potential AFP case alerts were investigated by surveillance personnel, yielding 1414 true AFP cases. This number (n=1414) reported through AVADAR was higher than the 238 AFP cases expected during the study period in the AVADAR districts and the 491 true AFP cases reported by the traditional surveillance system. A total of 203 out of the 1414 true AFP cases reported were from special population settings, such as refugee camps and insecure areas. There was an improvement in reporting in silent health areas in all the countries using the AVADAR system. Finally, there were 23,473 reports for other diseases, such as measles, diarrhea, and cerebrospinal meningitis, using the AVADAR platform. Conclusions: This article demonstrates the added value of AVADAR to rapidly improve surveillance sensitivity. AVADAR is capable of supporting countries to improve surveillance sensitivity within a short interval before and beyond polio-free certification. %M 33263550 %R 10.2196/18950 %U http://publichealth.jmir.org/2020/4/e18950/ %U https://doi.org/10.2196/18950 %U http://www.ncbi.nlm.nih.gov/pubmed/33263550 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e20325 %T Care Me Too, a Mobile App for Engaging Chinese Immigrant Caregivers in Self-Care: Qualitative Usability Study %A Liu,Mandong %A Jiang,Tongge %A Yu,Kexin %A Wu,Shinyi %A Jordan-Marsh,Maryalice %A Chi,Iris %+ Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W 34th St, Los Angeles, CA, 90089, United States, 86 176 6259 0259, mandongl@usc.edu %K mHealth %K co-design %K usability %K acceptability %K immigrant %K caregiver %K mobile phone %D 2020 %7 2.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Caregiving and self-care are challenging for Chinese immigrants in the United States due to limited accessible support and resources. Few interventions exist to assist Chinese immigrant caregivers in better performing self-care. To address this gap in the literature, our team developed the Care Me Too app to engage Chinese immigrant caregivers in self-care and conducted a user experience test to assess its usability and acceptability. Objective: This paper aims to report the results of the app’s usability and acceptability testing with Chinese immigrant caregivers and to solicit participants’ feedback of the app design and functions. Methods: A total of 22 Mandarin-speaking Chinese caregivers participated in the study, which consisted of 2 parts: the in-lab testing and the 1-week at-home testing. In-depth face-to-face interviews and follow-up phone interviews were used to assess user experience of the app’s usability and acceptability and to solicit feedback for app design and functions. Directed content analysis was used to analyze the qualitative data. Results: Among the 22 participants, the average age was 60.5 (SD 8.1) years, ranging from 46 to 80 years; 17 (77%) participants were women and 14 (64%) had an associate degree or higher. Participants reported uniformly positive ratings of the usability and acceptability of the app and provided detailed suggestions for app improvement. We generated guidelines for mobile health (mHealth) app designs targeting immigrant caregivers, including weighing flexibility versus majority preferences, increasing text sizes, using colors effectively, providing engaging and playful visual designs and functions, simplifying navigation, simplifying the log-in process, improving access to and the content on the help document, designing functions to cater to the population’s context, and ensuring offline access. Conclusions: The main contribution of this study is the improved understanding of Chinese caregivers’ user experiences with a language-appropriate mHealth app for a population that lacks accessible caregiving and self-care resources and support. It is recommended that future researchers and app designers consider the proposed guidelines when developing mHealth apps for their population to enhance user experience and harness mHealth’s value. %M 33263552 %R 10.2196/20325 %U https://formative.jmir.org/2020/12/e20325 %U https://doi.org/10.2196/20325 %U http://www.ncbi.nlm.nih.gov/pubmed/33263552 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e14296 %T Usage and Acceptability of the iBobbly App: Pilot Trial for Suicide Prevention in Aboriginal and Torres Strait Islander Youth %A Tighe,Joseph %A Shand,Fiona %A McKay,Kathy %A Mcalister,Taylor-Jai %A Mackinnon,Andrew %A Christensen,Helen %+ Black Dog Institute, Hospital Rd, Randwick, Sydney, Australia, 61 292824530, joetighe@hotmail.com %K mHealth %K suicide %K depression %K eHealth %K Indigenous %K Aboriginal %K First Nations %K mental health %K suicide ideation %K apps %D 2020 %7 1.12.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: The proliferation of mental health apps purporting to target and improve psychological wellbeing is ever-growing and also concerning: Few apps have been rigorously evaluated, and, indeed, the safety of the vast majority of them has not been determined. Over 10,000 self-help apps exist but most are not used much after being downloaded. Gathering and analyzing usage data and the acceptability of apps are critical to inform consumers, researchers, and app developers. Objective: This paper presents pilot usage and acceptability data from the iBobbly suicide prevention app, an app distributed through a randomized controlled trial. Methods: Aboriginal and Torres Strait Islander participants from the Kimberley region of Western Australia completed a survey measuring their technology use in general (n=13), and data on their experiences with and views of the iBobbly app were also collected in semistructured interviews (n=13) and thematically analyzed. Finally, engagement with the app, such as the number of sessions completed and time spent on various acceptance-based therapeutic activities, was analyzed (n=18). Both groups were participants in the iBobbly app pilot randomized controlled trial (n=61) completed in 2015. Results: Regression analysis indicated that app use improved psychological outcomes, although only minimally, and effects were not significant. However, results of the thematic analysis indicated that the iBobbly app was deemed effective, acceptable, and culturally appropriate by those interviewed. Conclusions: There is a scarcity of randomized controlled trials and eHealth interventions in Indigenous communities, while extremely high rates of psychological distress and suicide persist. In this environment, studies that can add evidence from mixed-methods approaches are important. While the regression analysis in this study did not indicate a significant effect of app use on psychological wellbeing, this was predictable considering the small sample size (n=18) and typically brief app use. The results on engagement with the iBobbly app were however positive. This study showed that Indigenous youth are early and frequent users of technology in general, and they regarded the iBobbly app to be culturally safe and of therapeutic value. Qualitative analyses demonstrated that iBobbly app use was associated with self-reported improvements in psychological wellbeing, mental health literacy, and reductions in shame. Importantly, participants reported that they would recommend other similar apps if available to their peers. %M 33258782 %R 10.2196/14296 %U https://mental.jmir.org/2020/12/e14296 %U https://doi.org/10.2196/14296 %U http://www.ncbi.nlm.nih.gov/pubmed/33258782 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 11 %P e23377 %T The Reach, Use, and Impact of a Free mHealth Mindfulness App in the General Population: Mobile Data Analysis %A Kozlov,Elissa %A Bantum,Erin %A Pagano,Ian %A Walser,Robyn %A Ramsey,Kelly %A Taylor,Katherine %A Jaworski,Beth %A Owen,Jason %+ Institute for Health, Health Policy and Aging Research, Rutgers University, 112 Paterson St, New Brunswick, NJ, 08901, United States, 1 9147153012, elissa.kozlov@rutgers.edu %K mHealth %K mindfulness %K mHealth psychotherapy %K mHealth mindfulness %K public health %K self-management %K mental health %D 2020 %7 27.11.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: As smartphones are now used by most Americans, it is increasingly possible for mental health mobile apps to be disseminated to the general public. However, little is known about how mobile mental health apps are used by the general population outside of a controlled research design. Objective: Our objective is to describe how the general population engages with Mindfulness Coach, an iOS- and Android-based app designed to deliver a mindfulness training course. Methods: Using anonymous download and analytics data, we characterized the reach, usage, retention, and impact of Mindfulness Coach. We included mobile analytics data from all unique downloads of Mindfulness Coach between August 1, 2018, and April 8, 2019 (N=104,067) as well as starred reviews from all Mindfulness Coach users who provided reviews of the app as of March 1, 2020. Mindfulness characteristics were measured by an in-app assessment using the Five-Facet Mindfulness Questionnaire–Short Form (FFMQ-SF). Results: Users engaged, on average, in 4.3 visits to the app (SD 8.8; median 2; 90th percentile 8) and associated with an average total of 49.2 interactions with the app (ie, clicks within the app) (SD 113.8; median 19; 90th percentile 105). Users spent an average of 16.2 minutes (SD 63.1) engaged with the app over the full study time period. There were strong linear effects of app engagement on total FFMQ-SF scores. For example, FFMQ-SF scores were associated with more time spent engaged with the app (R2=.23; P<.001). Mindfulness Coach has been reviewed in the Google Play Store 3415 times, with an average rating of 4.7 out of 5 stars, and over 2000 times in the Apple App Store, with an average rating of 4.8 out of 5 stars. Conclusions: These findings suggest that Mindfulness Coach has achieved substantial and sustained reach in the general population; however, it was used less frequently by many downloaders than researchers and designers intended. There was a subpopulation of users who engaged in the app regularly over an extended period of time, and there was a clear relationship between app use and improvements in mindfulness. To strengthen Mindfulness Coach’s public health impact, more research is needed to understand who is using the app and how, and to design strategies to increase user engagement in order for users to receive a larger dose of mindfulness treatment. %M 33245289 %R 10.2196/23377 %U http://mental.jmir.org/2020/11/e23377/ %U https://doi.org/10.2196/23377 %U http://www.ncbi.nlm.nih.gov/pubmed/33245289 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e18889 %T Self-Monitoring App Preferences for Sun Protection: Discrete Choice Experiment Survey Analysis %A Nittas,Vasileios %A Mütsch,Margot %A Braun,Julia %A Puhan,Milo Alan %+ Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, 8001, Switzerland, 41 44 63 44946, vasileios.nittas@uzh.ch %K preventive medicine %K mHealth %K telemedicine %K health informatics %K health economics %K preferences %K sun protection %D 2020 %7 27.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The availability and use of health apps continues to increase, revolutionizing the way mobile health interventions are delivered. Apps are increasingly used to prevent disease, improve well-being, and promote healthy behavior. On a similar rise is the incidence of skin cancers. Much of the underlying risk can be prevented through behavior change and adequate sun protection. Self-monitoring apps have the potential to facilitate prevention by measuring risk (eg, sun intensity) and encouraging protective behavior (eg, seeking shade). Objective: Our aim was to assess health care consumer preferences for sun protection with a self-monitoring app that tracks the duration and intensity of sun exposure and provides feedback on when and how to protect the skin. Methods: We conducted an unlabeled discrete choice experiment with 8 unique choice tasks, in which participants chose among 2 app alternatives, consisting of 5 preidentified 2-level attributes (self-monitoring method, privacy control, data sharing with health care provides, reminder customizability, and costs) that were the result of a multistep and multistakeholder qualitative approach. Participant preferences, and thus, the relative importance of attributes and their levels were estimated using conditional logit modeling. Analyses consisted of 200 usable surveys, yielding 3196 observations. Results: Our respondents strongly preferred automatic over manually operated self-monitoring (odds ratio [OR] 2.37, 95% CI 2.06-2.72) and no cost over a single payment of 3 Swiss francs (OR 1.72, 95% CI 1.49-1.99). They also preferred having over not having the option of sharing their data with a health care provider of their choice (OR 1.66, 95% CI 1.40-1.97), repeated over single user consents, whenever app data are shared with commercial thirds (OR 1.57, 95% CI 1.31-1.88), and customizable over noncustomizable reminders (OR 1.30, 95% CI 1.09-1.54). While most participants favored thorough privacy infrastructures, the attribute of privacy control was a relatively weak driver of app choice. The attribute of self-monitoring method significantly interacted with gender and perceived personal usefulness of health apps, suggesting that female gender and lower perceived usefulness are associated with relatively weaker preferences for automatic self-monitoring. Conclusions: Based on the preferences of our respondents, we found that the utility of a self-monitoring sun protection app can be increased if the app is simple and adjustable; requires minimal effort, time, or expense; and has an interoperable design and thorough privacy infrastructure. Similar features might be desirable for preventive health apps in other areas, paving the way for future discrete choice experiments. Nonetheless, to fully understand these preference dynamics, further qualitative or mixed method research on mobile self-monitoring-based sun protection and broader preventive mobile self-monitoring is required. International Registered Report Identifier (IRRID): RR2-10.2196/16087 %M 33245282 %R 10.2196/18889 %U http://www.jmir.org/2020/11/e18889/ %U https://doi.org/10.2196/18889 %U http://www.ncbi.nlm.nih.gov/pubmed/33245282 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e24718 %T Comparison of Mobile Health Technology Use for Self-Tracking Between Older Adults and the General Adult Population in Canada: Cross-Sectional Survey %A Jaana,Mirou %A Paré,Guy %+ Telfer School of Management, University of Ottawa, 55 Laurier Ave East, Ottawa, ON, K1N 6N5, Canada, 1 16135625800 ext 3400, jaana@telfer.uottawa.ca %K mobile health %K older adults %K self-tracking %K wearable technology %K smart devices %K mobile apps %K survey %K mobile phone %K seniors %K elderly %D 2020 %7 27.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The burden of population aging and chronic conditions has been reported worldwide. Older adults, especially those with high needs, experience social isolation and have high rates of emergency visits and limited satisfaction with the care they receive. Mobile health (mHealth) technologies present opportunities to address these challenges. To date, limited information is available on Canadian older adults’ attitudes toward and use of mHealth technologies for self-tracking purposes—an area that is increasingly important and relevant during the COVID-19 era. Objective: This study presents contributions to an underresearched area on older adults and mHealth technology use. The aim of this study was to compare older adults’ use of mHealth technologies to that of the general adult population in Canada and to investigate the factors that affect their use. Methods: A cross-sectional survey on mHealth and digital self-tracking was conducted. A web-based questionnaire was administered to a national sample of 4109 Canadian residents who spoke either English or French. The survey instrument consisted of 3 sections assessing the following items: (1) demographic characteristics, health status, and comorbidities; (2) familiarity with and use of mHealth technologies (ie, mobile apps, consumer smart devices/wearables such as vital signs monitors, bathroom scales, fitness trackers, intelligent clothing); and (3) factors influencing the continued use of mHealth technologies. Results: Significant differences were observed between the older adults and the general adult population in the use of smart technologies and internet (P<.001). Approximately 47.4% (323/682) of the older adults in the community reported using smartphones and 49.8% (340/682) indicated using digital tablets. Only 19.6% (91/463) of the older adults using smartphones/digital tablets reported downloading mobile apps, and 12.3% (47/383) of the older adults who heard of smart devices/wearables indicated using them. The majority of the mobile apps downloaded by older adults was health-related; interestingly, their use was sustained over a longer period of time (P=.007) by the older adults compared to that by the general population. Approximately 62.7% (428/682) of the older adults reported tracking their health measures, but the majority did so manually. Older adults with one or more chronic conditions were mostly nontrackers (odds ratio 0.439 and 0.431 for traditional trackers and digital trackers, respectively). No significant differences were observed between the older adults and the general adult population with regard to satisfaction with mHealth technologies and their intention to continue using them. Conclusions: Leveraging mHealth technologies in partnership with health care providers and sharing of health/well-being data with health care professionals and family members remain very limited. A culture shift in the provision of care to older adults is deemed necessary to keep up with the development of mHealth technologies and the changing demographics and expectations of patients and their caregivers. %M 33104517 %R 10.2196/24718 %U http://mhealth.jmir.org/2020/11/e24718/ %U https://doi.org/10.2196/24718 %U http://www.ncbi.nlm.nih.gov/pubmed/33104517 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e21771 %T Effectiveness of an mHealth Intervention Combining a Smartphone App and Smart Band on Body Composition in an Overweight and Obese Population: Randomized Controlled Trial (EVIDENT 3 Study) %A Lugones-Sanchez,Cristina %A Sanchez-Calavera,Maria Antonia %A Repiso-Gento,Irene %A Adalia,Esther G %A Ramirez-Manent,J Ignacio %A Agudo-Conde,Cristina %A Rodriguez-Sanchez,Emiliano %A Gomez-Marcos,Manuel Angel %A Recio-Rodriguez,Jose I %A Garcia-Ortiz,Luis %A , %+ Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Health Service of Castilla y León (SACyL), Av. Portugal 83, 2nd Fl., Salamanca, 37005, Spain, 34 923 291100 ext 54750, crislugsa@gmail.com %K diet records %K mobile app %K telemedicine %K electric impedance %K obesity %K body fat distribution %K weight control %D 2020 %7 26.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) is currently among the supporting elements that may contribute to an improvement in health markers by helping people adopt healthier lifestyles. mHealth interventions have been widely reported to achieve greater weight loss than other approaches, but their effect on body composition remains unclear. Objective: This study aimed to assess the short-term (3 months) effectiveness of a mobile app and a smart band for losing weight and changing body composition in sedentary Spanish adults who are overweight or obese. Methods: A randomized controlled, multicenter clinical trial was conducted involving the participation of 440 subjects from primary care centers, with 231 subjects in the intervention group (IG; counselling with smartphone app and smart band) and 209 in the control group (CG; counselling only). Both groups were counselled about healthy diet and physical activity. For the 3-month intervention period, the IG was trained to use a smartphone app that involved self-monitoring and tailored feedback, as well as a smart band that recorded daily physical activity (Mi Band 2, Xiaomi). Body composition was measured using the InBody 230 bioimpedance device (InBody Co., Ltd), and physical activity was measured using the International Physical Activity Questionnaire. Results: The mHealth intervention produced a greater loss of body weight (–1.97 kg, 95% CI –2.39 to –1.54) relative to standard counselling at 3 months (–1.13 kg, 95% CI –1.56 to –0.69). Comparing groups, the IG achieved a weight loss of 0.84 kg more than the CG at 3 months. The IG showed a decrease in body fat mass (BFM; –1.84 kg, 95% CI –2.48 to –1.20), percentage of body fat (PBF; –1.22%, 95% CI –1.82% to 0.62%), and BMI (–0.77 kg/m2, 95% CI –0.96 to 0.57). No significant changes were observed in any of these parameters in men; among women, there was a significant decrease in BMI in the IG compared with the CG. When subjects were grouped according to baseline BMI, the overweight group experienced a change in BFM of –1.18 kg (95% CI –2.30 to –0.06) and BMI of –0.47 kg/m2 (95% CI –0.80 to –0.13), whereas the obese group only experienced a change in BMI of –0.53 kg/m2 (95% CI –0.86 to –0.19). When the data were analyzed according to physical activity, the moderate-vigorous physical activity group showed significant changes in BFM of –1.03 kg (95% CI –1.74 to –0.33), PBF of –0.76% (95% CI –1.32% to –0.20%), and BMI of –0.5 kg/m2 (95% CI –0.83 to –0.19). Conclusions: The results from this multicenter, randomized controlled clinical trial study show that compared with standard counselling alone, adding a self-reported app and a smart band obtained beneficial results in terms of weight loss and a reduction in BFM and PBF in female subjects with a BMI less than 30 kg/m2 and a moderate-vigorous physical activity level. Nevertheless, further studies are needed to ensure that this profile benefits more than others from this intervention and to investigate modifications of this intervention to achieve a global effect. Trial Registration: Clinicaltrials.gov NCT03175614; https://clinicaltrials.gov/ct2/show/NCT03175614. International Registered Report Identifier (IRRID): RR2-10.1097/MD.0000000000009633 %M 33242020 %R 10.2196/21771 %U http://mhealth.jmir.org/2020/11/e21771/ %U https://doi.org/10.2196/21771 %U http://www.ncbi.nlm.nih.gov/pubmed/33242020 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e18809 %T Evaluation of the MoMba Live Long Remote Smoking Detection System During and After Pregnancy: Development and Usability Study %A Valencia,Stephanie %A Callinan,Laura %A Shic,Frederick %A Smith,Megan %+ Department of Psychiatry, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT, 06519, United States, 1 203 764 8655, megan.smith@yale.edu %K breath carbon monoxide %K contingency management %K smoking cessation %K pregnancy %K mobile-based sensor %K mobile phone %D 2020 %7 24.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The smoking relapse rate during the first 12 months after pregnancy is around 80% in the United States. Delivering remote smoking cessation interventions to women in the postpartum period can reduce the burden associated with frequent office visits and can enable remote communication and support. Developing reliable, remote, smoking measuring instruments is a crucial step in achieving this vision. Objective: The study presents the evaluation of the MoMba Live Long system, a smartphone-based breath carbon monoxide (CO) meter and a custom iOS smartphone app. We report on how our smoking detection system worked in a controlled office environment and in an out-of-office environment to examine its potential to deliver a remote contingency management intervention. Methods: In-office breath tests were completed using both the MoMba Live Long system and a commercial monitor, the piCO+ Smokerlyzer. In addition, each participant provided a urine test for smoking status validation through cotinine. We used in-office test data to verify the validity of the MoMba Live Long smoking detection system. We also collected out-of-office tests to assess how the system worked remotely and enabled user verification. Pregnant adult women in their second or third trimester participated in the study for a period of 12 weeks. This study was carried out in the United States. Results: Analyses of in-office tests included 143 breath tests contributed from 10 participants. CO readings between the MoMba Live Long system and the piCO+ were highly correlated (r=.94). In addition, the MoMba Live Long system accurately distinguished smokers from nonsmokers with a sensitivity of 0.91 and a specificity of 0.94 when the piCO+ was used as a gold standard, and a sensitivity of 0.81 and specificity of 1.0 when cotinine in urine was used to confirm smoking status. All participants indicated that the system was easy to use. Conclusions: Relatively inexpensive portable and internet-connected CO monitors can enable remote smoking status detection in a wide variety of nonclinical settings with reliable and valid measures comparable to a commercially available CO monitor. Trial Registration: ClinicalTrials.gov NCT02237898; https://clinicaltrials.gov/ct2/show/NCT02237898 %M 33231550 %R 10.2196/18809 %U https://mhealth.jmir.org/2020/11/e18809 %U https://doi.org/10.2196/18809 %U http://www.ncbi.nlm.nih.gov/pubmed/33231550 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e17156 %T Mobile Apps to Reduce Tobacco, Alcohol, and Illicit Drug Use: Systematic Review of the First Decade %A Staiger,Petra Karin %A O'Donnell,Renee %A Liknaitzky,Paul %A Bush,Rachel %A Milward,Joanna %+ School of Psychology, Deakin University, Faculty of Health, Locked Bag 20000, Geelong, 3220, Australia, 61 3 9244 6876, petra.staiger@deakin.edu.au %K smartphone app %K mobile phone %K mobile app %K problematic substance use %K addiction %K systematic review %K mHealth %K ecological momentary intervention %K alcohol %K tobacco %K smoking %K illicit drugs %D 2020 %7 24.11.2020 %9 Review %J J Med Internet Res %G English %X Background: Mobile apps for problematic substance use have the potential to bypass common barriers to treatment seeking. Ten years following the release of the first app targeting problematic tobacco, alcohol, and illicit drug use, their effectiveness, use, and acceptability remains unclear. Objective: This study aims to conduct a systematic literature review of trials evaluating mobile app interventions for problematic tobacco, alcohol, and illicit drug use. Methods: The review was conducted according to recommended guidelines. Relevant databases were searched, and articles were included if the mobile app study was a controlled intervention trial and reported alcohol, tobacco, or illicit drug consumption as outcomes. Results: A total of 20 studies met eligibility criteria across a range of substances: alcohol (n=11), tobacco (n=6), alcohol and tobacco (n=1), illicit drugs (n=1), and illicit drugs and alcohol (n=1). Samples included the general community, university students, and clinical patients. The analyzed intervention sample sizes ranged from 22 to 14,228, and content was considerably diverse, from simple stand-alone apps delivering self-monitoring or psychoeducation to multicomponent apps with interactive features and audio content, or used as adjuncts alongside face-to-face treatment. Intervention duration ranged from 1 to 35 weeks, with notifications ranging from none to multiple times per day. A total of 6 of the 20 app interventions reported significant reductions in substance use at post or follow-up compared with a comparison condition, with small to moderate effect sizes. Furthermore, two other app interventions reported significant reductions during the intervention but not at post treatment, and a third reported a significant interaction of two app intervention components. Conclusions: Although most app interventions were associated with reductions in problematic substance use, less than one-third were significantly better than the comparison conditions at post treatment. A total of 5 out of the 6 apps that reported intervention effects targeted alcohol (of those, one targeted alcohol and illicit drugs and another alcohol and tobacco) and 1 targeted tobacco. Moreover, 3 out of 6 apps included feedback (eg, personalized) and 2 had high risk of bias, 1 some risk, and 3 low risk. All 6 apps included interventions of 6 weeks or longer. Common study limitations were small sample sizes; risk of bias; lack of relevant details; and, in some cases, poorly balanced comparison conditions. Appropriately powered trials are required to understand which app interventions are most effective, length of engagement required, and subgroups most likely to benefit. In sum, evidence to date for the effectiveness of apps targeting problematic substance use is not compelling, although the heterogeneous comparison conditions and trial designs across studies limit the ability to compare efficacy between apps. We discuss potential approaches that can help ascertain whether the promise of mobile app interventions for problematic substance use can be fulfilled. %M 33231555 %R 10.2196/17156 %U http://www.jmir.org/2020/11/e17156/ %U https://doi.org/10.2196/17156 %U http://www.ncbi.nlm.nih.gov/pubmed/33231555 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e19570 %T Pre-Conception Interventions for Subfertile Couples Undergoing Assisted Reproductive Technology Treatment: Modeling Analysis %A Steegers-Theunissen,Régine %A Hoek,Annemieke %A Groen,Henk %A Bos,Annelies %A van den Dool,Grada %A Schoonenberg,Marieke %A Smeenk,Jesper %A Creutzberg,Eva %A Vecht,Loes %A Starmans,Luc %A Laven,Joop %+ Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Office EE-2271a, Dr.Molewaterplein 40, 3015 GD, Rotterdam, Netherlands, 31 107038255, r.steegers@erasmusmc.nl %K fertility, periconception, pregnancy chance, Smarter Pregnancy, cost-effectiveness, nutrition, obesity, IVF treatment %K mobile and web-based lifestyle apps %D 2020 %7 23.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Approximately 1 in 7 couples experience subfertility, many of whom have lifestyles that negatively affect fertility, such as poor nutrition, low physical activity, obesity, smoking, or alcohol consumption. Reducing lifestyle risk factors prior to pregnancy or assisted reproductive technology treatment contributes to the improvement of reproductive health, but cost-implications are unknown. Objective: The goal of this study was to evaluate reproductive, maternal pregnancy, and birth outcomes, as well as the costs of pre-conception lifestyle intervention programs in subfertile couples and obese women undergoing assisted reproductive technology. Methods: Using a hypothetical model based on quantitative parameters from published literature and expert opinion, we evaluated the following lifestyle intervention programs: (1) Smarter Pregnancy, an online tool; (2) LIFEstyle, which provides outpatient support for obese women; (3) concurrent use of both Smarter Pregnancy and LIFEstyle for obese women; (4) smoking cessation in men; and (5) a mindfulness mental health support program using group therapy sessions. The model population was based on data from the Netherlands. Results: All model-based analyses of the lifestyle interventions showed a reduction in the number of in vitro fertilization, intracytoplasmic sperm injection, or intrauterine insemination treatments required to achieve pregnancy and successful birth for couples in the Netherlands. Smarter Pregnancy was modeled to have the largest increase in spontaneous pregnancy rate (13.0%) and the largest absolute reduction in potential assisted reproductive technology treatments. Among obese subfertile women, LIFEstyle was modeled to show a reduction in the occurrence of gestational diabetes, maternal hypertensive pregnancy complications, and preterm births by 4.4%, 3.8%, and 3.0%, respectively, per couple. Modeled cost savings per couple per year were €41 (US $48.66), €360 (US $427.23), €513 (US $608.80), €586 (US $695.43), and €1163 (US $1380.18) for smoking cessation, mindfulness, Smarter Pregnancy, combined Smarter Pregnancy AND LIFEstyle, and LIFEstyle interventions, respectively. Conclusions: Although we modeled the potential impact on reproductive outcomes and costs of fertility treatment rather than collecting real-world data, our model suggests that of the lifestyle interventions for encouraging healthier behaviors, all are likely to be cost effective and appear to have positive effects on reproductive, maternal pregnancy, and birth outcomes. Further real-world data are required to determine the cost-effectiveness of pre-conception lifestyle interventions, including mobile apps and web-based tools that help improve lifestyle, and their effects on reproductive health. We believe that further implementation of the lifestyle app Smarter Pregnancy designed for subfertile couples seeking assistance to become pregnant is likely to be cost-effective and would allow reproductive health outcomes to be collected. %M 33226349 %R 10.2196/19570 %U https://mhealth.jmir.org/2020/11/e19570 %U https://doi.org/10.2196/19570 %U http://www.ncbi.nlm.nih.gov/pubmed/33226349 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e20820 %T Behavior Change Techniques in Wrist-Worn Wearables to Promote Physical Activity: Content Analysis %A Düking,Peter %A Tafler,Marie %A Wallmann-Sperlich,Birgit %A Sperlich,Billy %A Kleih,Sonja %+ Integrative and Experimental Exercise Science, Department of Sport Science, University of Würzburg, Würzburg, 97082, Germany, 49 931 31 84792, peterdueking@gmx.de %K cardiorespiratory fitness %K innovation %K smartwatch %K technology %K wearable %K eHealth %K mHealth %D 2020 %7 19.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Decreasing levels of physical activity (PA) increase the incidences of noncommunicable diseases, obesity, and mortality. To counteract these developments, interventions aiming to increase PA are urgently needed. Mobile health (mHealth) solutions such as wearable sensors (wearables) may assist with an improvement in PA. Objective: The aim of this study is to examine which behavior change techniques (BCTs) are incorporated in currently available commercial high-end wearables that target users’ PA behavior. Methods: The BCTs incorporated in 5 different high-end wearables (Apple Watch Series 3, Garmin Vívoactive 3, Fitbit Versa, Xiaomi Amazfit Stratos 2, and Polar M600) were assessed by 2 researchers using the BCT Taxonomy version 1 (BCTTv1). Effectiveness of the incorporated BCTs in promoting PA behavior was assessed by a content analysis of the existing literature. Results: The most common BCTs were goal setting (behavior), action planning, review behavior goal(s), discrepancy between current behavior and goal, feedback on behavior, self-monitoring of behavior, and biofeedback. Fitbit Versa, Garmin Vívoactive 3, Apple Watch Series 3, Polar M600, and Xiaomi Amazfit Stratos 2 incorporated 17, 16, 12, 11, and 11 BCTs, respectively, which are proven to effectively promote PA. Conclusions: Wearables employ different numbers and combinations of BCTs, which might impact their effectiveness in improving PA. To promote PA by employing wearables, we encourage researchers to develop a taxonomy specifically designed to assess BCTs incorporated in wearables. We also encourage manufacturers to customize BCTs based on the targeted populations. %M 33211023 %R 10.2196/20820 %U http://mhealth.jmir.org/2020/11/e20820/ %U https://doi.org/10.2196/20820 %U http://www.ncbi.nlm.nih.gov/pubmed/33211023 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e15717 %T Impact of Pediatric Mobile Game Play on Healthy Eating Behavior: Randomized Controlled Trial %A Kato-Lin,Yi-Chin %A Kumar,Uttara Bharath %A Sri Prakash,Bhargav %A Prakash,Bhairavi %A Varadan,Vasini %A Agnihotri,Sanjeeta %A Subramanyam,Nrutya %A Krishnatray,Pradeep %A Padman,Rema %+ The Heinz College of Information Systems and Public Policy, Carnegie Mellon University, 5000 Forbes Ave, Pittsburgh, PA, , United States, 1 412 268 2180, rpadman@cmu.edu %K pediatric obesity %K mobile games %K implicit learning %K healthy eating behavior evaluation %K game telemetry analysis %D 2020 %7 18.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Video and mobile games have been shown to have a positive impact on behavior change in children. However, the potential impact of game play patterns on outcomes of interest are yet to be understood, especially for games with implicit learning components. Objective: This study investigates the immediate impact of fooya!, a pediatric dietary mobile game with implicit learning components, on food choices. It also quantifies children’s heterogeneous game play patterns using game telemetry and determines the effects of these patterns on players’ food choices. Methods: We analyzed data from a randomized controlled trial (RCT) involving 104 children, aged 10 to 11 years, randomly assigned to the treatment group (played fooya!, a dietary mobile game developed by one of the authors) or the control group (played Uno, a board game without dietary education). Children played the game for 20 minutes each in two sessions. After playing the game in each session, the children were asked to choose 2 out of 6 food items (3 healthy and 3 unhealthy choices). The number of healthy choices in both sessions was used as the major outcome. We first compared the choice and identification of healthy foods between treatment and control groups using statistical tests. Next, using game telemetry, we determined the variability in game play patterns by quantifying game play measures and modeled the process of game playing at any level across all students as a Markov chain. Finally, correlation tests and regression models were used to establish the relationship between game play measures and actual food choices. Results: We saw a significant main effect of the mobile game on number of healthy foods actually chosen (treatment 2.48, control 1.10; P<.001; Cohen d=1.25) and identified (treatment 7.3, control 6.94; P=.048; Cohen d=.25). A large variation was observed in children’s game play patterns. Children played an average of 15 game levels in 2 sessions, with a range of 2 to 23 levels. The greatest variation was noted in the proportion of scoring activities that were highly rewarded, with an average of 0.17, ranging from 0.003 to 0.98. Healthy food choice was negatively associated with the number of unhealthy food facts that children read in the game (Kendall τ=–.32, P=.04), even after controlling for baseline food preference. Conclusions: A mobile video game embedded with implicit learning components showed a strong positive impact on children’s food choices immediately following the game. Game telemetry captured children’s different play patterns and was associated with behavioral outcomes. These results have implications for the design and use of mobile games as an intervention to improve health behaviors, such as the display of unhealthy food facts during game play. Longitudinal RCTs are needed to assess long-term impact. Trial Registration: ClinicalTrials.gov NCT04082195; https://clinicaltrials.gov/ct2/show/NCT04082195, registered retrospectively. %M 33206054 %R 10.2196/15717 %U http://mhealth.jmir.org/2020/11/e15717/ %U https://doi.org/10.2196/15717 %U http://www.ncbi.nlm.nih.gov/pubmed/33206054 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e21450 %T A Cardiovascular Health and Wellness Mobile Health Intervention Among Church-Going African Americans: Formative Evaluation of the FAITH! App %A Brewer,LaPrincess C %A Kumbamu,Ashok %A Smith,Christina %A Jenkins,Sarah %A Jones,Clarence %A Hayes,Sharonne N %A Burke,Lora %A Cooper,Lisa A %A Patten,Christi A %+ Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, 1 507 538 0325, brewer.laprincess@mayo.edu %K mobile health %K eHealth %K community-based participatory research %K health promotion %K African Americans %K mobile phone %D 2020 %7 17.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: In light of the scarcity of culturally tailored mobile health (mHealth) lifestyle interventions for African Americans, we designed and pilot tested the Fostering African-American Improvement in Total Health (FAITH!) App in a community-based participatory research partnership with African American churches to promote cardiovascular health and wellness in this population. Objective: This report presents the results of a formative evaluation of the FAITH! App from participants in an intervention pilot study. Methods: We included 2 semistructured focus groups (n=4 and n=5) to explore participants’ views on app functionality, utility, and satisfaction as well as its impact on healthy lifestyle change. Sessions were audio-recorded and transcribed verbatim, and qualitative data were analyzed by using general inductive analysis to generate themes. Results: In total, 6 overarching themes emerged among the 9 participants: overall impression, content usefulness, formatting, implementation, impact, and suggestions for improvement. Underpinning the themes was a high level of agreement that the intervention facilitated healthy behavioral change through cultural tailoring, multimedia education modules, and social networking. Suggestions for improvement were streamlining the app self-monitoring features, prompts to encourage app use, and personalization based on individuals’ cardiovascular risk. Conclusions: This formative evaluation found that the FAITH! App had high reported satisfaction and impact on the health-promoting behaviors of African Americans, thereby improving their overall cardiovascular health. Further development and testing of the app among African Americans is warranted. Trial Registration: ClinicalTrials.gov NCT03084822; https://clinicaltrials.gov/ct2/show/NCT03084822. %M 33200999 %R 10.2196/21450 %U http://formative.jmir.org/2020/11/e21450/ %U https://doi.org/10.2196/21450 %U http://www.ncbi.nlm.nih.gov/pubmed/33200999 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e20460 %T Engagement Features in Physical Activity Smartphone Apps: Focus Group Study With Sedentary People %A D'Addario,Marco %A Baretta,Dario %A Zanatta,Francesco %A Greco,Andrea %A Steca,Patrizia %+ Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1, Milan, 20126, Italy, 39 3920317007, francesco.zanatta@unimib.it %K physical activity %K smartphone app %K engagement %K co-design %K thematic analysis %K mobile phone %D 2020 %7 16.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Engagement with physical activity mobile apps has been reported to be a core precondition for their effectiveness in digital behavior change interventions. However, to date, little attention has been paid to understanding the perspectives, needs, expectations, and experiences of potential users with physical activity mobile apps. Objective: The aim of this study was to investigate the features that are judged to be important for engagement with a physical activity mobile app and the reasons for their importance. Methods: A qualitative focus-group methodology with elements of co-design was adopted in this study. Participants reporting sedentary lifestyles and willingness to improve their physical activity behavior through mobile technology were recruited. The focus group sessions consisted of 13 participants (8 men and 5 women, mean [SD] age 41.9 [7.1] years). Two researchers conducted the data analysis independently by using the inductive thematic approach. Results: Four main themes emerged in relation to the research question and were named as follows: “physical activity participation motives,” “autonomy and self-regulation,” “need for relatedness,” and “smart.” Additionally, 2 subthemes originated from “physical activity participation motives” (ie, “medical guidance” and “weight loss and fitness for health”) and “smart” (ie, “action planning” and “adaptable and tailored”). Conclusions: Features enhancing autonomy and self-regulation and positively affecting health and physical well-being as well as the need for relatedness, adaptability, and flexibility should be considered as core elements in the engagement of potential users with physical activity mobile apps. The emerged findings may orient future research and interventions aiming to foster engagement of potential users with physical activity apps. %M 33196450 %R 10.2196/20460 %U http://mhealth.jmir.org/2020/11/e20460/ %U https://doi.org/10.2196/20460 %U http://www.ncbi.nlm.nih.gov/pubmed/33196450 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e18609 %T A Smartphone-Based Technique to Detect Dynamic User Preferences for Tailoring Behavioral Interventions: Observational Utility Study of Ecological Daily Needs Assessment %A Nicol,Ginger E %A Ricchio,Amanda R %A Metts,Christopher L %A Yingling,Michael D %A Ramsey,Alex T %A Schweiger,Julia A %A Miller,J Philip %A Lenze,Eric J %+ Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, 600 South Taylor Avenue, Suite 121, St. Louis, MO, 63110, United States, 1 314 362 5939, nicolg@wustl.edu %K mobile health %K telemedicine %K needs assessment %K healthy lifestyle %K ecological momentary assessment %K mobile applications %K behavior intervention %K behavior therapy %D 2020 %7 13.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health apps are promising vehicles for delivering scalable health behavior change interventions to populations that are otherwise difficult to reach and engage, such as young adults with psychiatric conditions. To improve uptake and sustain consumer engagement, mobile health interventions need to be responsive to individuals’ needs and preferences, which may change over time. We previously created an ecological daily needs assessment to capture microprocesses influencing user needs and preferences for mobile health treatment adaptation. Objective: The objective of our study was to test the utility of a needs assessment anchored within a mobile app to capture individualized, contextually relevant user needs and preferences within the framework of a weight management mobile health app. Methods: Participants with an iOS device could download the study app via the study website or links from social media. In this fully remote study, we screened, obtained informed consent from, and enrolled participants through the mobile app. The mobile health framework included daily health goal setting and self-monitoring, with up to 6 daily prompts to determine in-the-moment needs and preferences for mobile health–assisted health behavior change. Results: A total of 24 participants downloaded the app and provided e-consent (22 female; 2 male), with 23 participants responding to at least one prompt over 2 weeks. The mean length of engagement was 5.6 (SD 4.7) days, with a mean of 2.8 (1.1) responses per day. We observed individually dynamic needs and preferences, illustrating daily variability within and between individuals. Qualitative feedback indicated preferences for self-adapting features, simplified self-monitoring, and the ability to personalize app-generated message timing and content. Conclusions: The technique provided an individually dynamic and contextually relevant alternative and complement to traditional needs assessment for assessing individually dynamic user needs and preferences during treatment development or adaptation. The results of this utility study suggest the importance of personalization and learning algorithms for sustaining app engagement in young adults with psychiatric conditions. Further study in broader user populations is needed. %M 33055063 %R 10.2196/18609 %U http://mhealth.jmir.org/2020/11/e18609/ %U https://doi.org/10.2196/18609 %U http://www.ncbi.nlm.nih.gov/pubmed/33055063 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e24536 %T Parents’ Perceptions of Their Children’s Engagement in a Consumer-Based Meditation Mobile App: Cross-Sectional Survey Study %A Puzia,Megan %A Laird,Breanne %A Green,Jeni %A Huberty,Jennifer %+ Behavioral Research and Analytics LLC, 154 S Street, Salt Lake City, UT, 84103, United States, 1 7046043782, meganpuzia@gmail.com %K mindfulness %K meditation %K children %K mental health %K sleep %K mHealth %D 2020 %7 13.11.2020 %9 Short Paper %J JMIR Pediatr Parent %G English %X Background: In the United States, nearly half (48%) of school-aged children experience sleep disturbance that results in less than the recommended sleep duration, which may negatively impact mental health and behavior. Mindfulness interventions may improve sleep and mental health in youth. However, there are gaps in the literature regarding how children (2-12 years) and adolescents (13-17 years) practice mindfulness and the extent to which they benefit from these practices. Objective: The purpose of this study was to determine parents’ perceptions of their children’s engagement with a consumer-based mindfulness meditation app and the extent to which they believe their children have benefitted from using the app, particularly with regard to sleep. Methods: This study is a secondary analysis of a cross-sectional survey in adult subscribers (N=11,108) to the mindfulness meditation mobile app Calm. Participants who indicated that they had a child or children younger than 18 years (2944/11,108) who used the Calm app were asked additional questions related to their perceptions of their children’s engagement with Calm. Descriptive statistics were used to assess children’s app engagement, and chi-square tests and binary logistic regression models were used to assess differences in children’s usage based on gender and age. Results: Among the survey respondents, approximately half of the parents (1537/2944, 52.21%) reported that their children used Calm. Children used Calm mostly for (1) sleep (1168/1537, 75.99%), (2) stress (491/1537, 31.95%), (3) depression or anxiety (430/1537, 27.98%), and (4) improvement of overall health (215/1537,13.99%). Older children were more likely to begin using Calm to reduce stress, depression, or anxiety, whereas younger children were more likely begin using Calm to improve sleep. Most children used Calm when lying down to go to bed (1113/1529, 72.79%). Children were most likely to use sleep stories at night (1144/1207, 94.78%), followed by music and soundscapes (749/1114, 67.24%), meditations (736/1120, 65.71%), and breathing exercises (610/1092, 55.86%). Nearly all parents believed that using sleep stories was helpful for their children’s sleep (1090/1128, 96.63%), and the majority of parents felt that the other components were also helpful for their children’s sleep (music and soundscapes [570/728, 78.30%], meditations [445/696, 63.94%], and breathing exercises [610/1092, 55.86%]). Conclusions: To our knowledge, this is the first study to explore parents’ perceptions of how their children or adolescents use a popular consumer-based mindfulness mobile app (ie, Calm). As the majority of children use the app for sleep, mindfulness meditation mobile apps should consider incorporating age-appropriate sleep content to meet the needs of this audience. More research is needed to confirm the feasibility and effectiveness of mindfulness meditation apps for improving sleep and mental health in children and adolescents. %M 33185564 %R 10.2196/24536 %U http://pediatrics.jmir.org/2020/2/e24536/ %U https://doi.org/10.2196/24536 %U http://www.ncbi.nlm.nih.gov/pubmed/33185564 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e19508 %T Use of the Consumer-Based Meditation App Calm for Sleep Disturbances: Cross-Sectional Survey Study %A Huberty,Jennifer %A Puzia,Megan E %A Larkey,Linda %A Irwin,Michael R %A Vranceanu,Ana-Maria %+ College of Health Solutions, Arizona State University, 550 North 3rd St., Phoenix, AZ, 85004, United States, 1 602 827 2456, jennifer.huberty@asu.edu %K insomnia %K mental health %K mindfulness %K meditation %K mobile apps %K consumer behavior %K mobile phone %D 2020 %7 13.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Over 30% of Americans report regular sleep disturbance, and consumers are increasingly seeking strategies to improve sleep. Self-guided mindfulness mobile apps may help individuals improve their sleep. Despite the recent proliferation of sleep content within commercially available mindfulness apps, there is little research on how consumers are using these apps for sleep. Objective: We conducted a cross-sectional survey among subscribers to Calm, a popular, consumer-based, mindfulness-based meditation app, and described and compared how good sleepers, poor sleepers, and those with self-reported insomnia use the app for sleep. Methods: Participants who were paying subscribers of Calm and had used a sleep component of Calm in the last 90 days were invited to complete an investigator-developed survey that included questions about sleep disturbance and the use of Calm for sleep. Based on self-reports of sleep disturbances and of insomnia diagnosis, participants were categorized as “good sleepers,” “poor sleepers,” or “those with insomnia diagnosis.” Chi-square tests compared reasons for downloading the app and usage patterns across participants with and without sleep disturbance. Results: There was a total of 9868 survey respondents. Approximately 10% of participants (1008/9868, 10.21%) were good sleepers, 78% were poor sleepers (7565/9868, 77.66%), and 11% reported a diagnosis of insomnia (1039/9868, 10.53%). The sample was mostly White (8185/9797, 83.55%), non-Hispanic (8929/9423, 94.76%), and female (8166/9578, 85.26%). The most common reasons for sleep disturbances were racing thoughts (7084/8604, 82.33%), followed by stress or anxiety (6307/8604, 73.30%). Poor sleepers and those with insomnia were more likely than good sleepers to have downloaded Calm to improve sleep (χ22=1548.8, P<.001), reduce depression or anxiety (χ22=15.5, P<.001), or improve overall health (χ22=57.6, P<.001). Respondents with insomnia used Calm most often (mean 5.417 days/week, SD 1.936), followed by poor sleepers (mean 5.043 days/week, SD 2.027; F2=21.544, P<.001). The most common time to use Calm was while lying down to sleep (7607/9686, 78.54%), and bedtime use was more common among poor sleepers and those with insomnia (χ22=382.7, P<.001). Compared to good and poor sleepers, those with insomnia were more likely to use Calm after waking up at night (χ22=410.3, P<.001). Most participants tried to use Calm on a regular basis (5031/8597, 58.52%), but regular nighttime use was most common among those with insomnia (646/977, 66.1%), followed by poor sleepers (4040/6930, 58.30%; χ22=109.3, P<.001). Conclusions: Of the paying subscribers to Calm who have used one of the sleep components, approximately 90% have sleep difficulties, and 77% started using Calm primarily for sleep. These descriptive data point to areas of focus for continued refinement of app features and content, followed by prospective trials testing efficacy of consumer-based meditation mobile apps for improving sleep. %M 33185552 %R 10.2196/19508 %U http://formative.jmir.org/2020/11/e19508/ %U https://doi.org/10.2196/19508 %U http://www.ncbi.nlm.nih.gov/pubmed/33185552 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 11 %P e17405 %T A Mobile Health Mindfulness Intervention for Women With Moderate to Moderately Severe Postpartum Depressive Symptoms: Feasibility Study %A Avalos,Lyndsay A %A Aghaee,Sara %A Kurtovich,Elaine %A Quesenberry Jr,Charles %A Nkemere,Linda %A McGinnis,MegAnn K %A Kubo,Ai %+ Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA, 94612, United States, 1 510 891 3426, Lyndsay.A.Avalos@kp.org %K depression %K postpartum %K health services, mental %K eHealth %K mental health %K internet-based intervention %K mindfulness %K behavioral intervention %K mobile phone %D 2020 %7 12.11.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Approximately 20% of women suffer from postpartum depression (PPD). Due to barriers such as limited access to care, half of the women with PPD do not receive treatment. Therefore, it is critical to identify effective and scalable interventions. Traditional mindfulness programs have been effective in reducing depressive symptoms, however access remains a barrier. A self-paced mobile health (mHealth) mindfulness program may fit the lifestyle of busy mothers who are unable to attend in-person classes. However, little is known regarding the feasibility or efficacy of mHealth mindfulness interventions in postpartum women with depressive symptoms. Objective: This study aims to assess the feasibility, acceptability, and preliminary efficacy of an mHealth mindfulness intervention for postpartum women with moderate to moderately severe depressive symptoms. Methods: We conducted a single-arm feasibility trial of an mHealth mindfulness intervention within Kaiser Permanente Northern California (KPNC), a large integrated health care system. Participants were identified through clinician referral and electronic health records via KPNC's universal perinatal depression screening program and recruited by the study team. Inclusion criteria included the following: English-speaking, up to 6 months postpartum with a Patient Health Questionnaire (PHQ-8) score of 10 to 19, and no regular mindfulness/meditation practice. Participants were asked to use a mindfulness app, Headspace, 10 to 20 min/day for 6 weeks. Baseline and postintervention surveys captured data on patient-reported outcomes (depression and stress symptoms, sleep quality, and mindfulness). Semistructured interviews captured acceptability. Retention and adherence were used to assess feasibility. Results: Of the 115 women who were contacted and met the eligibility criteria or declined participation before eligibility assessment, 27 (23%) were enrolled. In addition, 70% (19/27) completed the study. The mean age of participants was 31 years (SD 5.2), 30% (8/27) were non-Hispanic White, and, on average, participants were 12.3 weeks postpartum (SD 5.7). Of the women who completed the study, 100% (19/19) used the Headspace app at least once, and nearly half (9/19, 47%) used the app on ≥50% of the days during the 6-week intervention period. Of the 16 participants who completed the postintervention interview, 69% (11/16) reported that they were very or extremely satisfied with the app. Interviews indicated that women appreciated the variety of meditations and felt that the program led to reduced anxiety and improved sleep. Significant improvements in pre- and postintervention scores were observed for depressive symptoms (PHQ-8: −3.8, P=.004), perceived stress (10-item Perceived Stress Scale: −6.0, P=.005), and sleep quality (Pittsburgh Sleep Quality Index: −2.1, P=.02, indicating less sleep disturbance). Improvements in mindfulness were also significant (Five Facet Mindfulness Questionnaire-Short Form: 10.9, P=.01). Conclusions: An mHealth mindfulness intervention for postpartum women with moderate to moderately severe depressive symptoms is feasible and acceptable. An efficacy trial is warranted. %M 33180028 %R 10.2196/17405 %U https://mental.jmir.org/2020/11/e17405 %U https://doi.org/10.2196/17405 %U http://www.ncbi.nlm.nih.gov/pubmed/33180028 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e19836 %T Standalone Smartphone Cognitive Behavioral Therapy–Based Ecological Momentary Interventions to Increase Mental Health: Narrative Review %A Marciniak,Marta Anna %A Shanahan,Lilly %A Rohde,Judith %A Schulz,Ava %A Wackerhagen,Carolin %A Kobylińska,Dorota %A Tuescher,Oliver %A Binder,Harald %A Walter,Henrik %A Kalisch,Raffael %A Kleim,Birgit %+ University of Zurich, Psychiatric University Hospital, Lenggstrasse 31, Zurich, 8032, Switzerland, 41 44 384 23 51, birgit.kleim@uzh.ch %K mHealth %K mobile app %K ecological momentary intervention %K EMI %K cognitive behavioral therapy %K CBT %K COVID-19 %K mobile phone %K smartphone %D 2020 %7 12.11.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: A growing number of psychological interventions are delivered via smartphones with the aim of increasing the efficacy and effectiveness of these treatments and providing scalable access to interventions for improving mental health. Most of the scientifically tested apps are based on cognitive behavioral therapy (CBT) principles, which are considered the gold standard for the treatment of most mental health problems. Objective: This review investigates standalone smartphone-based ecological momentary interventions (EMIs) built on principles derived from CBT that aim to improve mental health. Methods: We searched the MEDLINE, PsycINFO, EMBASE, and PubMed databases for peer-reviewed studies published between January 1, 2007, and January 15, 2020. We included studies focusing on standalone app-based approaches to improve mental health and their feasibility, efficacy, or effectiveness. Both within- and between-group designs and studies with both healthy and clinical samples were included. Blended interventions, for example, app-based treatments in combination with psychotherapy, were not included. Selected studies were evaluated in terms of their design, that is, choice of the control condition, sample characteristics, EMI content, EMI delivery characteristics, feasibility, efficacy, and effectiveness. The latter was defined in terms of improvement in the primary outcomes used in the studies. Results: A total of 26 studies were selected. The results show that EMIs based on CBT principles can be successfully delivered, significantly increase well-being among users, and reduce mental health symptoms. Standalone EMIs were rated as helpful (mean 70.8%, SD 15.3; n=4 studies) and satisfying for users (mean 72.6%, SD 17.2; n=7 studies). Conclusions: Study quality was heterogeneous, and feasibility was often not reported in the reviewed studies, thus limiting the conclusions that can be drawn from the existing data. Together, the studies show that EMIs may help increase mental health and thus support individuals in their daily lives. Such EMIs provide readily available, scalable, and evidence-based mental health support. These characteristics appear crucial in the context of a global crisis such as the COVID-19 pandemic but may also help reduce personal and economic costs of mental health impairment beyond this situation or in the context of potential future pandemics. %M 33180027 %R 10.2196/19836 %U https://mhealth.jmir.org/2020/11/e19836 %U https://doi.org/10.2196/19836 %U http://www.ncbi.nlm.nih.gov/pubmed/33180027 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e20534 %T Effects of a Collective Family-Based Mobile Health Intervention Called “SMARTFAMILY” on Promoting Physical Activity and Healthy Eating: Protocol for a Randomized Controlled Trial %A Wunsch,Kathrin %A Eckert,Tobias %A Fiedler,Janis %A Cleven,Laura %A Niermann,Christina %A Reiterer,Harald %A Renner,Britta %A Woll,Alexander %+ Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, Karlsruhe, 76131, Germany, 49 72160845431, kathrin.wunsch@kit.edu %K mobile app %K telemedicine %K behavior change %K health behavior %K family %K primary prevention %K exercise %K food and nutrition %K randomized controlled trial %K accelerometer %K wearable electronic devices %K social cognitive determinants %K just-in-time adaptive intervention %K digital intervention %K mobile phone %D 2020 %7 11.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Numerous smartphone apps are targeting physical activity and healthy eating, but empirical evidence on their effectiveness for initialization and maintenance of behavior change, especially in children and adolescents, is still limited. Objective: The aim of this study was to conceptualize a theory-based and evidence-based mHealth intervention called SMARTFAMILY (SF) that targets physical activity and healthy eating in a collective family-based setting. Subsequently, the app will be refined and re-evaluated to analyze additional effects of just-in-time adaptive interventions (JITAIs) and gamification features. Methods: A smartphone app based on behavior change theories and behavior change techniques was developed and implemented and will be evaluated with family members individually and cooperatively (SF trial). Existing evidence and gained results were used to refine and will be used to re-evaluate the app (SF2.0 trial). Both trials are cluster randomized controlled trials with 3 measurement occasions. The intervention group uses the app for 3 consecutive weeks, whereas the control group receives no treatment. Baseline measurements (T0) and postintervention measurements (T1) include physical activity (ie, self-reported and accelerometry) and healthy eating measurements (ie, self-reported fruit and vegetable intake) as the primary outcomes. The secondary outcomes (ie, self-reported) are intrinsic motivation, behavior-specific self-efficacy, and the family health climate, complemented by an intentional measure in SF2.0. Four weeks following T1, a follow-up assessment (T2) is completed by the participants, consisting of all questionnaire items to assess the stability of the intervention effects. Mixed-method analysis of covariance will be used to calculate the primary intervention effects (ie, physical activity, fruit and vegetable intake) while controlling for covariates, including family health climate, behavior-specific self-efficacy, and intrinsic motivation. Results: This study is funded by the German Federal Ministry of Education and Research and ethically approved by the Karlsruhe Institute of Technology. For both trials, it is hypothesized that the apps will positively influence physical activity and healthy eating in the whole family. Furthermore, SF2.0 is expected to produce stronger effects (ie, higher effect sizes) compared to SF. SF app development and piloting are completed. Data acquisition for the SF trial is terminated and discontinued due to the COVID-19 pandemic. SF2.0 app development and piloting are completed, while data acquisition is ongoing. Participant recruitment for the SF 2.0 trial started in February 2020. The results for SF are expected to be published in mid-2021, and the results of SF2.0 are expected to be published in mid-2022. Conclusions: In this study, it is hypothesized that targeting the whole family will facilitate behavior change at the individual level and the family level, as the implemented strategies address changes in daily family life. Furthermore, subsequent app development (SF2.0) with supplementary addition of motivation-enhancing features and a JITAI approach is expected to enhance positive intervention effects. Trial Registration: German Clinical Trials Register DRKS00010415; https://tinyurl.com/yyo87yyu International Registered Report Identifier (IRRID): DERR1-10.2196/20534 %M 33174849 %R 10.2196/20534 %U http://www.researchprotocols.org/2020/11/e20534/ %U https://doi.org/10.2196/20534 %U http://www.ncbi.nlm.nih.gov/pubmed/33174849 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e16517 %T Patient Perception of Mobile Phone Apps for the Care and Prevention of Sexually Transmitted Diseases: Cross-Sectional Study %A Jakob,Lena %A Steeb,Theresa %A Fiocco,Zeno %A Pumnea,Teodora %A Jakob,Sophia Nomi %A Wessely,Anja %A Rothenberger,Christoph Clemens %A Brinker,Titus Josef %A French,Lars Einar %A Berking,Carola %A Heppt,Markus Vincent %+ Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany, 49 913185 ext 45810, markus.heppt@uk-erlangen.de %K sexually transmitted diseases %K sexually transmitted infection %K mobile phone apps %K health apps %D 2020 %7 10.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the emerging era of digitalization and electronic health, various health-related apps have been launched, including apps for sexually transmitted diseases. Until now, little has been known about how patients perceive the value of such apps. Objective: To investigate patient’s attitudes and awareness toward sexually transmitted disease–related apps in an outpatient sexually transmitted disease clinic setting. Methods: A cross-sectional study was conducted at a dermatovenereological outpatient unit between April and July 2019. Patients completed a self-administered questionnaire on their perceptions of the popularity and usefulness of sexually transmitted disease–related apps. Descriptive analysis was performed with expression of categorical variables as frequencies and percentages. For continuous variables, the median, range, and interquartile range were indicated. Contingency tables and chi-square tests were used to investigate associations between sociodemographic data and items of the questionnaire. Results: A total of 226 patients were surveyed (heterosexual: 137/193, 71.0%; homosexual: 44/193, 22.8%; bisexual: 12/193, 6.2%); 11.9% (27/225) had previously used health-related apps. Nearly half of the patients (97/214, 45.3%) specifically considered sexually transmitted disease–related apps useful, 47.8% (100/209) voted that they could supplement or support the consultation of a physician. Interestingly, only 35.1% (74/211) preferred a printed patient brochure on sexually transmitted diseases over downloading and using an app, but 64.0% (134/209) would download a sexually transmitted disease–related app recommended by their physician. General information regarding sexually transmitted diseases (93/167, 55.7%), evaluation of skin diseases based on photos or videos (78/167, 53.3%), information on the prevention of sexually transmitted diseases (76/167, 45.5%), mediation of nearby contact points or test sites (74/167, 44.3%), anonymous medical advice (69/167, 41.3%), and calculation of the risk of having a sexually transmitted disease (63/167, 37.3%) were rated as the most important features. Men were more likely than women to find sexually transmitted disease–related apps useful in general (P=.04; χ2=6.28) and to pay for such apps (P=.01; χ2=9.19). Patients aged <40 years would rather download an app recommended by their physician (P=.03; χ2=7.23), whereas patients aged >40 years preferred reading a patient brochure on sexually transmitted diseases (P=.02; χ2=8.14). Conclusions: This study demonstrated high general interest in the use of sexually transmitted disease–related apps in this sample of dermatovenereological outpatients. In particular, young age and male sex were significantly associated with a positive perception, underlining the high potential of apps in the prevention and early recognition of sexually transmitted diseases in this group. Future studies are warranted to validate these findings in other populations. %M 33170133 %R 10.2196/16517 %U https://mhealth.jmir.org/2020/11/e16517 %U https://doi.org/10.2196/16517 %U http://www.ncbi.nlm.nih.gov/pubmed/33170133 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e18067 %T Effectiveness of a Smartphone App (BioBase) for Reducing Anxiety and Increasing Mental Well-Being: Pilot Feasibility and Acceptability Study %A Kawadler,Jamie M %A Hemmings,Nicola Rose %A Ponzo,Sonia %A Morelli,Davide %A Bird,Geoffrey %A Plans,David %+ Huma Therapeutics Limited, 13th Floor Millbank Tower, 21-24 Millbank, , London, , United Kingdom, 44 7527016574, jamie@biobeats.com %K health and well-being %K health promotion %K organizational and leadership support %K workplace %D 2020 %7 10.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of workplace-related stress and anxiety is high, resulting in stress-related physical and mental illness. Digital self-guided interventions aimed at key areas of workplace design may be able to provide remote anxiolytic effects. Objective: The aim of this feasibility study is to assess changes in anxiety and mental well-being after use of the BioBase programme, a mobile phone platform for psycho-educational modules, tools, and real-time feedback of physiological data. Methods: A 4-week observational study was carried out in 55 healthy adults who were screened for stress with the Depression Anxiety Stress Scale (DASS) Stress subscale. Participants completed anxiety (6-item State-Trait Anxiety Inventory [STAI]) and mental well-being (Warwick-Edinburgh Mental Well-being Scale [WEMWBS]) questionnaires at baseline and at 4 weeks. Feedback questionnaires were administered after 4 weeks. Results: After 4 weeks of using the programme and controlling for any effect of being paid to take part in the study, STAI significantly decreased (baseline mean 45.52 [SD 13.2]; 4-week mean 39.82 [SD 11.2]; t54=–3.51; P<.001; CI –8.88 to –2.52; Cohen d=0.96) and WEMWBS significantly increased (baseline mean 48.12 [SD 6.4]; 4-week mean 50.4 [SD 6.9]; t53=2.41; P=.019; CI 0.44-4.23; Cohen d=0.66). Further, higher baseline stress was significantly associated with a greater decrease in STAI (t53=–3.41; P=.001; CI –8.10 to –2.10; R2=0.180) and a greater increase in WEMWBS (t52=2.41; P=.019; CI 0.38-4.11, R2=0.101). On feedback, participants found the programme easy to use/navigate, with the content being acceptable and relevant to workplace-related stressors; 70% (21/30) of participants would recommend the programme to a friend. Conclusions: The BioBase programme is a potentially effective intervention in decreasing anxiety and increasing mental well-being, with larger changes in those with higher baseline levels of stress. %M 32969341 %R 10.2196/18067 %U https://formative.jmir.org/2020/11/e18067 %U https://doi.org/10.2196/18067 %U http://www.ncbi.nlm.nih.gov/pubmed/32969341 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e19488 %T EatSmart, a Web-Based and Mobile Healthy Eating Intervention for Disadvantaged People With Type 2 Diabetes: Protocol for a Pilot Mixed Methods Intervention Study %A Karimi,Nazgol %A Crawford,David %A Opie,Rachelle %A Maddison,Ralph %A O’Connell,Stella %A Hamblin,Peter Shane %A Ng,Ashley Huixian %A Steele,Cheryl %A Rasmussen,Bodil %A Ball,Kylie %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Building J, SENS, 221 Burwood Highway, Burwood, Melbourne, 3125, Australia, 61 410825300, Karimin@deakin.edu.au %K type 2 diabetes %K healthy eating %K diet %K low socioeconomic position %K self-management %K digitally delivered %K internet %K website %K mobile phone %K text message %D 2020 %7 6.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: People of low socioeconomic position (SEP) are disproportionately affected by type 2 diabetes (T2D), partly due to unhealthy eating patterns that contribute to inadequate disease self-management and prognosis. Digital technologies have the potential to provide a suitable medium to facilitate diabetes education, support self-management, and address some of the barriers to healthy eating, such as lack of nutritional knowledge or shopping or cooking skills, in this target group. Objective: This study aims to test the feasibility, appeal, and potential effectiveness of EatSmart, a 12-week, evidence-based, theoretically grounded, fully automated web-based and mobile-delivered healthy eating behavior change program to help disadvantaged people living with T2D to eat healthily on a budget and improve diabetes self-management. Methods: EatSmart is a mixed methods (quantitative and qualitative) pre-post design pilot study. Sixty socioeconomically disadvantaged people with T2D aged 18 to 75 years will be recruited. Participants will complete self-reported baseline assessments of their basic demographic and clinical data, dietary intake, dietary self-efficacy, and barriers to healthy eating. They will be provided with login access to the EatSmart web program, which includes six progressive skill-based modules covering healthy eating planning; smart food budgeting and shopping; time-saving meal strategies, healthy cooking methods, modifying recipes; and a final reinforcement and summary module. Over the 3-month intervention, participants will also receive 3 text messages weekly, encouraging them to review goals, continue to engage with different components of the EatSmart web program, and eat healthily. Participants will undertake follow-up assessments directly following the intervention 3 months post baseline and again after a 6-month postintervention follow-up period (9 months post baseline). Feasibility will be evaluated using the number of participants recruited and retained and objective indicators of engagement with the website. Program appeal and potential effects on primary and secondary outcomes will be assessed via the same surveys used at baseline, with additional questions asking about experience with and perceptions of the program. In-depth qualitative interviews will also be conducted 6 months post intervention to provide deeper insight into experiences with EatSmart and a more comprehensive description of the program’s appeal. Results: The EatSmart website has been developed, and all participants have viewed the modules as of May 2020. Results are expected to be submitted for publication in December 2020. Conclusions: This study will provide data to address the currently limited evidence regarding whether disadvantaged populations with T2D may benefit from digitally delivered behavior change programs that facilitate eating healthily on a budget. Trial Registration: Australian New Zealand Clinical Trials Registry, ACTRN12619001111167; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001111167 International Registered Report Identifier (IRRID): DERR1-10.2196/19488 %M 33155571 %R 10.2196/19488 %U https://www.researchprotocols.org/2020/11/e19488 %U https://doi.org/10.2196/19488 %U http://www.ncbi.nlm.nih.gov/pubmed/33155571 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e16632 %T Usability and Acceptability of a Mobile App to Help Emerging Adults Address their Friends' Substance Use (Harbor): Quantitative Study %A Bennett,Kyle Michael %A Clary,Kelly Lynn %A Smith,Douglas Cary %A Lee,Carol Ann %+ University of Illinois Urbana-Champaign, 1010 West Nevada Street, Urbana, IL, 61801, United States, 1 2177660755, kmbennet@illinois.edu %K young adults %K substance abuse %K peer influence %K mobile applications %K mobile phone %K community-based participatory research %K crowdsourcing %D 2020 %7 5.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Technology-assisted intervention and prevention strategies present opportunities for substance use–related research with emerging adults (EAs) and their peers. Emerging adulthood is a developmentally distinct period in which individuals between the ages of 18 and 29 years undergo unique emotional, cultural, developmental, and biological changes as they transition into adulthood. Crowdsourcing, or gathering feedback from a large group within web-based communities, offers researchers a unique and cost-effective way to obtain large amounts of information in a short period. Objective: This paper presents market feedback obtained via Amazon’s Mechanical Turk from EAs (N=458) on the acceptability and utility of brief intervention scripts for a smartphone app currently under development. The mobile app, Harbor, teaches friends of EAs with substance use problems effective and supportive strategies for helping their friend make changes in their substance use behavior. Methods: We examined feedback on the wording of the intervention scripts and estimated the market size of EAs who may use this app. Furthermore, we calculated correlations between script ratings and measures of personal risky drinking (ie, Alcohol Use Disorder Identification Test) and the participants’ use of confrontational, enabling, or supportive behaviors with an existing friend. Results: Approximately half of our sample (208/458, 45.4%) indicated that they had a close friend for whom they had concerns about their substance use, suggesting a potentially high demand for an app such as Harbor. Initial findings suggest that peers who engage in less enabling behaviors with friends who have a substance use problem exhibited lower risky drinking behaviors overall (r206=−0.501; P<.001). Concerning acceptability, 98.0% (449/458) of the sample rated the scripts’ dialogue as either somewhat, moderately, or extremely realistic (mean 3.92, SD 0.48) on 5-point Likert scale items. Finally, 95.4% (437/454) of respondents indicated that the scripts would be at least slightly helpful for training peers to help their friends with substance use issues. Finally, individuals who were better able to identify enabling language in enabling scripts self-reported fewer enabling behaviors toward their friend’s substance use (r206=−0.236; P=.001). Conclusions: There exists a demonstrated level of desirability and acceptability among EAs for a mobile app such as Harbor. EAs who wish to engage in more supportive behaviors with their friends who engage in substance use and who are amenable to assisting their friends with sobriety likely would use and benefit from this app. %M 33151158 %R 10.2196/16632 %U https://www.jmir.org/2020/11/e16632 %U https://doi.org/10.2196/16632 %U http://www.ncbi.nlm.nih.gov/pubmed/33151158 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e19159 %T Network Support Using Social Networking Services to Increase Exercise Adherence Among Korean-Chinese Middle-Aged Migrant Women: Mixed Methods Study %A Lee,Hyeyeon %A Lee,Hyeonkyeong %A Kim,Youlim %A Kim,Sookyung %A Lee,Young-Me %+ Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1 Yonse-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2228 3373, hlee39@yuhs.ac %K SNS %K social support %K network support %K exercise adherence %K social-cognitive factors %K text mining %D 2020 %7 5.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Social networking services (SNSs) are recognized to be a promising approach to easily deliver health interventions and to enhance social support for exercise adherence. However, the patterns and aspects of social support through SNSs have not been reported and their influence on other social-cognitive factors remains inconclusive. Objective: Our objective is to explore how social support delivered through SNSs impacts interactions among Korean-Chinese (KC) middle-aged women and to identify how this approach influences social-cognitive factors for exercise (eg, sense of community, self-efficacy for exercise, and social support for exercise). Methods: A mixed methods design was used. Text analysis of SNS messages and text mining using the Korean Natural Language Application (KoALA) were conducted. Social-cognitive factors (eg, sense of community, self-efficacy for exercise, and social support for exercise) were assessed at baseline and after 12 weeks using a structured questionnaire. A comparison of social-cognitive factors at baseline and at 12 weeks was conducted to identify any potential significant changes, using the Wilcoxon signed-rank test. Results: A total of 259 SNS messages were collected from 24 KC women, distributed among four chat groups, who participated in a 12-week walking intervention program between August and October 2018. The individual average frequency of chatting via the SNS was 10.79 (range 0-34) and the most frequent type of social support through the SNS was network support (172/259, 66.4%). The most common words extracted from the SNS were Health, Exercise, Participation, and We. Overall, the perceived levels of sense of community (P<.001) and social support for exercise (P=.002) were significantly increased at 12 weeks compared with baseline. Group 1 (P=.03) and Group 4 (P=.03), whose members demonstrated the highest frequency of network support, experienced a significant increase only in the level of sense of community. Conclusions: By integrating these data and conducting a mixed methods analysis, we observed that among the types of social support, network support was a key point for the promotion of social-cognitive factors in increasing exercise adherence. Therefore, network support through SNS-based interventions should be considered as a useful strategy to help vulnerable migrant populations make changes to exercise behaviors. %M 33151155 %R 10.2196/19159 %U https://mhealth.jmir.org/2020/11/e19159 %U https://doi.org/10.2196/19159 %U http://www.ncbi.nlm.nih.gov/pubmed/33151155 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22878 %T Mobile App Strategy to Facilitate Human Papillomavirus Vaccination Among Young Men Who Have Sex With Men: Pilot Intervention Study %A Fontenot,Holly B %A White,Bradley Patrick %A Rosenberger,Joshua G %A Lacasse,Hailee %A Rutirasiri,Chokdee %A Mayer,Kenneth H %A Zimet,Gregory %+ School of Nursing and Dental Hygiene, University of Hawaii at Manoa, 2528 McCarthy Mall, Webster Hall 412, Honolulu, HI, 96822, United States, 1 808 956 4917, hbfont@hawaii.edu %K human papillomavirus %K men who have sex with men %K vaccination %K mobile health tool %K mHealth %D 2020 %7 4.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile app-based interventions have been identified as potential facilitators for vaccination among young men who have sex with men (MSM). Objective: This pilot study aimed to test the feasibility of a theoretically informed mobile health (mHealth) tool designed to reduce health disparities and facilitate human papillomavirus (HPV) vaccination among a sample of young MSM. Methods: The development of the mHealth tool was guided by previous research, implementation intention theory, and design thinking. We recruited MSM aged 18-26 years through a popular online dating app and linked participants to our mHealth tool, which provided HPV vaccine information and fostered access to care. Results: A total of 42 young MSM participated in this pilot study in Boston, Massachusetts. Participants reported variable HPV knowledge (ie, high knowledge of HPV risk factors and low knowledge of HPV-related cancer risks for men) and positive vaccine beliefs and attitudes. Of those who were either unvaccinated, not up to date, or did not report vaccine status, 23% (8/35) utilized the mHealth tool to obtain HPV vaccination. Participants primarily utilized the tool’s (1) educational components and (2) capabilities facilitating concrete vaccine action plans. Conclusions: We recruited an underserved at-risk population of youth via an online dating app for our mHealth intervention that resulted in in-person health care delivery. This study was limited by enrollment challenges, including low willingness to download the mHealth tool to mobile devices. %M 33146621 %R 10.2196/22878 %U https://www.jmir.org/2020/11/e22878 %U https://doi.org/10.2196/22878 %U http://www.ncbi.nlm.nih.gov/pubmed/33146621 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e20251 %T Engaging Unmotivated Smokers to Move Toward Quitting: Design of Motivational Interviewing–Based Chatbot Through Iterative Interactions %A Almusharraf,Fahad %A Rose,Jonathan %A Selby,Peter %+ The Edward S. Rogers Sr. Department of Electrical & Computer Engineering, Faculty of Applied Science & Engineering, University of Toronto, 10 King's College Road, Toronto, ON, M5S 3G4, Canada, 1 4169786992, jonathan.rose@ece.utoronto.ca %K smoking cessation %K motivational interviewing %K chatbot %K natural language processing %D 2020 %7 3.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: At any given time, most smokers in a population are ambivalent with no motivation to quit. Motivational interviewing (MI) is an evidence-based technique that aims to elicit change in ambivalent smokers. MI practitioners are scarce and expensive, and smokers are difficult to reach. Smokers are potentially reachable through the web, and if an automated chatbot could emulate an MI conversation, it could form the basis of a low-cost and scalable intervention motivating smokers to quit. Objective: The primary goal of this study is to design, train, and test an automated MI-based chatbot capable of eliciting reflection in a conversation with cigarette smokers. This study describes the process of collecting training data to improve the chatbot’s ability to generate MI-oriented responses, particularly reflections and summary statements. The secondary goal of this study is to observe the effects on participants through voluntary feedback given after completing a conversation with the chatbot. Methods: An interdisciplinary collaboration between an MI expert and experts in computer engineering and natural language processing (NLP) co-designed the conversation and algorithms underlying the chatbot. A sample of 121 adult cigarette smokers in 11 successive groups were recruited from a web-based platform for a single-arm prospective iterative design study. The chatbot was designed to stimulate reflections on the pros and cons of smoking using MI’s running head start technique. Participants were also asked to confirm the chatbot’s classification of their free-form responses to measure the classification accuracy of the underlying NLP models. Each group provided responses that were used to train the chatbot for the next group. Results: A total of 6568 responses from 121 participants in 11 successive groups over 14 weeks were received. From these responses, we were able to isolate 21 unique reasons for and against smoking and the relative frequency of each. The gradual collection of responses as inputs and smoking reasons as labels over the 11 iterations improved the F1 score of the classification within the chatbot from 0.63 in the first group to 0.82 in the final group. The mean time spent by each participant interacting with the chatbot was 21.3 (SD 14.0) min (minimum 6.4 and maximum 89.2). We also found that 34.7% (42/121) of participants enjoyed the interaction with the chatbot, and 8.3% (10/121) of participants noted explicit smoking cessation benefits from the conversation in voluntary feedback that did not solicit this explicitly. Conclusions: Recruiting ambivalent smokers through the web is a viable method to train a chatbot to increase accuracy in reflection and summary statements, the building blocks of MI. A new set of 21 smoking reasons (both for and against) has been identified. Initial feedback from smokers on the experience shows promise toward using it in an intervention. %M 33141095 %R 10.2196/20251 %U https://www.jmir.org/2020/11/e20251 %U https://doi.org/10.2196/20251 %U http://www.ncbi.nlm.nih.gov/pubmed/33141095 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e19869 %T A Mobile-Based Intervention for Dietary Behavior and Physical Activity Change in Individuals at High Risk for Type 2 Diabetes Mellitus: Randomized Controlled Trial %A Xu,Zidu %A Geng,Ji %A Zhang,Shuai %A Zhang,Kexin %A Yang,Lin %A Li,Jing %A Li,Jiao %+ School of Nursing, Peking Union Medical College, No 33, Badachu Road, Shijingshan District, Beijing, 100144, China, 86 1088771124, annelee13@126.com %K transtheoretical model %K type 2 diabetes mellitus %K high risk %K social media %K dietary behavior %K physical activity %D 2020 %7 3.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Intensive lifestyle modifications have proved effective in preventing type 2 diabetes mellitus (T2DM), yet the efficiency and effectiveness of these modifications need to be improved. Emerging social media interventions are considered useful in promoting these lifestyles; nevertheless, few studies have investigated the effectiveness of combining them with behavior theory. Objective: This study aims to examine the effectiveness of a 6-month mobile-based intervention (DHealthBar, a WeChat applet) combined with behavioral theory compared with a printed intervention in improving dietary behaviors, physical activity, and intention to change these behaviors among populations at high risk for T2DM. Methods: Participants aged 23 to 67 years were recruited offline in Beijing, China, and were randomized into the intervention group or the control group, which received educational content via DHealthBar or a printed handbook, respectively. Educational materials were culturally tailored recommendations on improving dietary behaviors, physical activity, and intention to change based on the transtheoretical model. Participants in the intervention arm received push notifications twice per week on WeChat and had access to the educational content for the 6-month study period. Participants in the control arm received the same intervention content through printed materials. The outcomes of participants’ behavior change, intention to change behavior, and anthropometric characteristics were collected via online measuring tools at baseline, 3 months, and 6 months. Results: In this study, 79 enrolled individuals completed baseline information collection (control: n=38 vs intervention: n=41), and 96% (76/79) completed the 6-month follow-up visit. Attrition rates did not differ significantly between the 2 groups (χ21=0.0, P=.61). Baseline equivalence was found. Participants in both groups reported a statistically significant decrease in energy intake at the 2 follow-up assessments compared with baseline (3 months, control: exp[β]=0.83, 95% CI 0.74-0.92 vs intervention: exp[β]=0.76, 95% CI 0.68-0.85; 6 months, control: exp[β]=0.87, 95% CI 0.78-0.96 vs intervention: exp[β]=0.57, 95% CI 0.51-0.64). At 6 months, a significantly larger decrease was observed in the intervention group in energy, fat, and carbohydrate intake, accompanied with a significantly larger increase in moderate-intensity physical activity compared with the control group (energy: exp[β]=0.66, 95% CI 0.56-0.77; fat: exp[β]=0.71, 95% CI 0.54-0.95; carbohydrates: exp[β]=0.83, 95% CI 0.66-1.03; moderate-intensity physical activity: exp[β]=2.05, 95% CI 1.23-3.44). After 6 months of the intervention, participants in the intervention group were more likely to be at higher stages of dietary behaviors (exp[β]=26.80, 95% CI 3.51-204.91) and physical activity (exp[β]=15.60, 95% CI 2.67-91.04) than the control group. Conclusions: DHealthBar was initially effective in improving dietary behavior, physical activity, and intention to change these behaviors among populations who were at high risk of developing T2DM, with significant differences in the changes of outcomes over the 6-month intervention period. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000032323; https://tinyurl.com/y4h8q4uf %M 33141092 %R 10.2196/19869 %U https://mhealth.jmir.org/2020/11/e19869 %U https://doi.org/10.2196/19869 %U http://www.ncbi.nlm.nih.gov/pubmed/33141092 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e15116 %T A Mobile App, KhunLook, to Support Thai Parents and Caregivers With Child Health Supervision: Development, Validation, and Acceptability Study %A Areemit,Rosawan %A Lumbiganon,Pagakrong %A Suphakunpinyo,Chanyut %A Jetsrisuparb,Arunee %A Sutra,Sumitr %A Sripanidkulchai,Kunwadee %+ Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Phayatai Road, Wang Mai, Pathumwan, Bangkok, 10330, Thailand, 66 2 218 6998, kunwadee@cp.eng.chula.ac.th %K mobile app %K mHealth %K KhunLook %K child health supervision %K maternal and child health handbook %K feasibility %K acceptability %K Thailand %K mobile phone %D 2020 %7 30.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In Thailand, children born in government hospitals receive a maternal and child health handbook (MCHH). However, when a new MCHH edition is released, those with the previous editions do not have access to the updated information. A mobile app is an appealing platform to fill this gap. We developed a mobile app called “KhunLook” as an interactive electronic MCHH intended to assist parents in child health supervision. Objective: This study describes the user requirements and development of the KhunLook mobile app, validity of parents’ growth assessments, and parents’ evaluation of feasibility and acceptability of the app. Methods: Phase 1 was a qualitative study using individual interviews. The interview data were used to revise the prototype. In phase 2, parents were randomly assigned to assess their children’s growth with the app or the MCHH. The outcomes were compared to those of the physician’s assessment, and congruence was determined. In phase 3, parents evaluated the feasibility and acceptability of the app in comparison to the MCHH through a web-based survey. Results: Four health care providers and 8 parents participated in phase 1. Two themes were identified: (1) the mobile app potentially counters parents’ infrequent use of the MCHH with accuracy, attractiveness, convenience, and simplicity, and (2) health supervision needs to be standard, up-to-date, and understandable. KhunLook was publicly launched with a family page and 7 key features: growth and nutrition, development, immunizations, oral health, reminders for the next appointment, memories, and health advice. In phase 2, 56 parents participated in the growth parameter assessments; 34 were in the App group and 22 in the MCHH group. The outcomes of the growth parameter assessments between parents and physicians in both the App and MCHH groups were not significantly different. The congruence proportions were higher in the App group for weight and head circumference, but the differences were not statistically significant. In phase 3, 356 parents from all over Thailand participated in a web-based survey. Parents rated the app feasibility as “very easy to easy” to use at higher proportions than the MCHH in all health assessment domains (growth, development, and immunizations) and ease-of-use domains with statistical significance (P<.001). The KhunLook app received a significantly higher mean score (8.59/10) than the MCHH (7.6/10) (P<.001). Most parents (317/356, 89.0%) preferred the app over MCHH. Further, 93.5% (333/356) of the parents stated that they would continue to use the app and 96.9% (345/356) would recommend others to use it. Conclusions: KhunLook, a Thai mobile app for child health supervision, was developed, validated for growth assessments, and was well accepted for ease-of-use by parents. Further studies should be conducted with a large scale of users, and the impact of this app on health behaviors and health outcomes must be evaluated. %M 33124989 %R 10.2196/15116 %U http://mhealth.jmir.org/2020/10/e15116/ %U https://doi.org/10.2196/15116 %U http://www.ncbi.nlm.nih.gov/pubmed/33124989 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21159 %T Primary Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus Using Mobile Health Technology: Systematic Review of the Literature %A Buss,Vera Helen %A Leesong,Stuart %A Barr,Margo %A Varnfield,Marlien %A Harris,Mark %+ Centre for Primary Health Care and Equity, University of New South Wales, Level 3, AGSM Building, UNSW Sydney, Sydney, 2052, Australia, 61 293851547, v.buss@student.unsw.edu.au %K systematic review %K mobile health %K telemedicine %K primary prevention %K cardiovascular diseases %K diabetes mellitus, type 2 %D 2020 %7 29.10.2020 %9 Review %J J Med Internet Res %G English %X Background: Digital technology is an opportunity for public health interventions to reach a large part of the population. Objective: This systematic literature review aimed to assess the effectiveness of mobile health–based interventions in reducing the risk of cardiovascular disease and type 2 diabetes mellitus. Methods: We conducted the systematic search in 7 electronic databases using a predefined search strategy. We included articles published between inception of the databases and March 2019 if they reported on the effectiveness of an intervention for prevention of cardiovascular disease or type 2 diabetes via mobile technology. One researcher performed the search, study selection, data extraction, and methodological quality assessment. The steps were validated by the other members of the research team Results: The search yielded 941 articles for cardiovascular disease, of which 3 met the inclusion criteria, and 732 for type 2 diabetes, of which 6 met the inclusion criteria. The methodological quality of the studies was low, with the main issue being nonblinding of participants. Of the selected studies, 4 used SMS text messaging, 1 used WhatsApp, and the remaining ones used specific smartphone apps. Weight loss and reduction in BMI were the most reported successful outcomes (reported in 4 studies). Conclusions: Evidence on the effectiveness of mobile health-based interventions in reducing the risk for cardiovascular disease and type 2 diabetes is low due to the quality of the studies and the small effects that were measured. This highlights the need for further high-quality research to investigate the potential of mobile health interventions. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42019135405; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=135405 %M 33118936 %R 10.2196/21159 %U http://www.jmir.org/2020/10/e21159/ %U https://doi.org/10.2196/21159 %U http://www.ncbi.nlm.nih.gov/pubmed/33118936 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e20847 %T Relationship Between Patient Engagement and Depressive Symptoms Among People Living With HIV in a Mobile Health Intervention: Secondary Analysis of a Randomized Controlled Trial %A Zeng,Yu %A Guo,Yan %A Li,Linghua %A Hong,Y Alicia %A Li,Yiran %A Zhu,Mengting %A Zeng,Chengbo %A Zhang,Hanxi %A Cai,Weiping %A Liu,Cong %A Wu,Shaomin %A Chi,Peilian %A Monroe-Wise,Aliza %A Hao,Yuantao %A Ho,Rainbow Tin Hung %+ Department of Medical Statistics, School of Public Health, Sun Yat-sen University, No.74, 2nd Zhongshan Road, Guangzhou, 510000, China, 86 13501502582, guoy8@mail.sysu.edu.cn %K mHealth %K patient engagement %K latent growth curve model %K depressive symptoms %K HIV %D 2020 %7 29.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Associations between higher levels of patient engagement and better health outcomes have been found in face-to-face interventions; studies on such associations with mobile health (mHealth) interventions have been limited and the results are inconclusive. Objective: The objective of this study is to investigate the relationship between patient engagement in an mHealth intervention and depressive symptoms using repeated measures of both patient engagement and patient outcomes at 4 time points. Methods: Data were drawn from a randomized controlled trial (RCT) of an mHealth intervention aimed at reducing depressive symptoms among people living with HIV and elevated depressive symptoms. We examined the association between patient engagement and depressive symptoms in the intervention group (n=150) where participants received an adapted cognitive-behavioral stress management (CBSM) course and physical activity promotion on their WeChat social media app. Depressive symptoms were repeatedly measured using the Patient Health Questionnaire (PHQ-9) at baseline and 1 month, 2 months, and 3 months. Patient engagement was correspondingly measured by the completion rate, frequency of items completed, and time spent on the program at 1 month, 2 months, and 3 months. Latent growth curve models (LGCMs) were used to explore the relationship between patient engagement and depressive symptoms at multiple time points in the intervention. Results: The mean PHQ-9 scores were 10.2 (SD 4.5), 7.7 (SD 4.8), 6.5 (SD 4.7), and 6.7 (SD 4.1) at baseline, 1 month, 2 months, and 3 months, respectively. The mean completion rates were 50.6% (SD 31.8%), 51.5% (SD 32.2%), and 50.8% (SD 33.7%) at 1, 2, and 3 months, respectively; the average frequencies of items completed were 18.0 (SD 14.6), 32.6 (SD 24.8), and 47.5 (SD 37.2) at 1, 2, and 3 months, respectively, and the mean times spent on the program were 32.7 (SD 66.7), 65.4 (SD 120.8), and 96.4 (SD 180.4) minutes at 1, 2, and 3 months, respectively. LGCMs showed good model fit and indicated that a higher completion rate (β at 3 months=–2.184, P=.048) and a greater frequency of items completed (β at 3 months=–0.018, P=.04) were associated with fewer depressive symptoms at 3 months. Although not significant, similar trends were found in the abovementioned relationships at 1 and 2 months. There was no significant relationship between time spent on the program and depressive symptoms. Conclusions: This study revealed a positive association between patient engagement and health outcomes at 3 months of an mHealth intervention using LGCMs and repeated measures data. The results underscore the importance of improving patient engagement in mHealth interventions to improve patient-centered health outcomes. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://tinyurl.com/yxb64mef International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5693-1 %M 33118956 %R 10.2196/20847 %U http://mhealth.jmir.org/2020/10/e20847/ %U https://doi.org/10.2196/20847 %U http://www.ncbi.nlm.nih.gov/pubmed/33118956 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e18653 %T Engagement, Acceptability, Usability, and Preliminary Efficacy of a Self-Monitoring Mobile Health Intervention to Reduce Sedentary Behavior in Belgian Older Adults: Mixed Methods Study %A Compernolle,Sofie %A Cardon,Greet %A van der Ploeg,Hidde P %A Van Nassau,Femke %A De Bourdeaudhuij,Ilse %A Jelsma,Judith J %A Brondeel,Ruben %A Van Dyck,Delfien %+ Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, Ghent, 9000, Belgium, 32 092646323, sofie.compernolle@ugent.be %K mHealth %K older adults %K self-monitoring %K perceptions %K engagement %K acceptability %K mixed methods %D 2020 %7 29.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although healthy aging can be stimulated by the reduction of sedentary behavior, few interventions are available for older adults. Previous studies suggest that self-monitoring might be a promising behavior change technique to reduce older adults’ sedentary behavior. However, little is known about older adults’ experiences with a self-monitoring–based intervention aimed at the reduction of sedentary behavior. Objective: The aim of this study is to evaluate engagement, acceptability, usability, and preliminary efficacy of a self-monitoring–based mHealth intervention developed to reduce older adults’ sedentary behavior. Methods: A mixed methods study was performed among 28 community-dwelling older adults living in Flanders, Belgium. The 3-week intervention consisted of general sedentary behavior information as well as visual and tactile feedback on participants’ sedentary behavior. Semistructured interviews were conducted to explore engagement with, and acceptability and usability of, the intervention. Sitting time was measured using the thigh-worn activPAL (PAL Technologies) accelerometer before and after the intervention. System usage data of the app were recorded. Quantitative data were analyzed using descriptive statistics and paired-samples t tests; qualitative data were thematically analyzed and presented using pen profiles. Results: Participants mainly reported positive feelings regarding the intervention, referring to it as motivating, surprising, and interesting. They commonly reported that the intervention changed their thinking (ie, they became more aware of their sedentary behavior) but not their actual behavior. There were mixed opinions on the kind of feedback (ie, tactile vs visual) that they preferred. The intervention was considered easy to use, and the design was described as clear. Some problems were noticed regarding attaching and wearing the self-monitoring device. System usage data showed that the median frequency of consulting the app widely differed among participants, ranging from 0 to 20 times a day. No significant reductions were found in objectively measured sitting time. Conclusions: Although the intervention was well perceived by the majority of older adults, no reductions in sitting time were found. Possible explanations for the lack of reductions might be the short intervention duration or the fact that only bringing the habitual sedentary behavior into conscious awareness might not be sufficient to achieve behavior change. Trial Registration: ClinicalTrials.gov NCT04003324; https://tinyurl.com/y2p4g8hx %M 33118951 %R 10.2196/18653 %U http://mhealth.jmir.org/2020/10/e18653/ %U https://doi.org/10.2196/18653 %U http://www.ncbi.nlm.nih.gov/pubmed/33118951 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e19503 %T Vaccipack, A Mobile App to Promote Human Papillomavirus Vaccine Uptake Among Adolescents Aged 11 to 14 Years: Development and Usability Study %A Teitelman,Anne M %A Gregory,Emily F %A Jayasinghe,Joshua %A Wermers,Zara %A Koo,Ja H %A Morone,Jennifer F %A Leri,Damien C %A Davis,Annet %A Feemster,Kristen A %+ University of Pennsylvania, School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104, United States, 1 2158981910, teitelm@nursing.upenn.edu %K cervical cancer %K prevention %K mobile health %K parents %K adolescent health %K vaccine %K human papillomavirus %D 2020 %7 29.10.2020 %9 Original Paper %J JMIR Nursing %G English %X Background: More than 90% of human papillomavirus (HPV)-related cancers could be prevented by widespread uptake of the HPV vaccine, yet vaccine use in the United States falls short of public health goals. Objective: The purpose of this study was to describe the development, acceptability, and intention to use the mobile app Vaccipack, which was designed to promote uptake and completion of the adolescent HPV vaccine series. Methods: Development of the mobile health (mHealth) content was based on the integrated behavioral model (IBM). The technology acceptance model (TAM) was used to guide the app usability evaluation. App design utilized an iterative process involving providers and potential users who were parents and adolescents. App features include a vaccine-tracking function, a discussion forum, and stories with embedded messages to promote intention to vaccinate. Parents and adolescents completed surveys before and after introducing the app in a pediatric primary care setting with low HPV vaccination rates. Results: Surveys were completed by 54 participants (20 adolescents aged 11 to 14 years and 34 parents). Notably, 75% (15/20) of adolescents and 88% (30/34) of parents intended to use the app in the next 2 weeks. Acceptability of the app was high among both groups: 88% (30/34) of parents and 75% (15/20) of adolescents indicated that Vaccipack was easy to use, and 82% (28/34) of parents and 85% (17/20) of adolescents perceived the app to be beneficial. Higher levels of app acceptability were found among parents with strong intentions to use the app (P=.09; 95% CI –2.15 to 0.15). Conclusions: mHealth technology, such as Vaccipack, may be an acceptable and nimble platform for providing information to parents and adolescents and advancing the uptake of important vaccines. %M 34345789 %R 10.2196/19503 %U https://nursing.jmir.org/2020/1/e19503/ %U https://doi.org/10.2196/19503 %U http://www.ncbi.nlm.nih.gov/pubmed/34345789 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e17470 %T Patients’ Experiences of Using Smartphone Apps to Support Self-Management and Improve Medication Adherence in Hypertension: Qualitative Study %A McBride,Ciara M %A Morrissey,Eimear C %A Molloy,Gerard J %+ School of Psychology, National Univeristy of Ireland Galway, University Road, Galway, H91 TK33, Ireland, 353 91524411, mcbrideciara5@gmail.com %K hypertension %K self-management %K mobile applications %K feasibility %K usability %K medication adherence %K qualitative research %K digital technology %K mobile phone %D 2020 %7 28.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Worldwide, hypertension control rates remain suboptimal despite clinically effective antihypertensive drug therapy. Patient failure to take medication as prescribed (ie, nonadherence) is the most important factor contributing to poor control. Smartphone apps can facilitate the delivery of evidence-based behavior change techniques to improve adherence and may provide a scalable, usable, and feasible method to deliver self-management support. Objective: The aim of this study is to explore patients’ experiences of the usability and feasibility of smartphone apps to support self-management and improve medication adherence in hypertension. Methods: A qualitative descriptive study was conducted. A total of 11 people living with hypertension from the West of Ireland were sampled purposively and interviewed about their experience of using a self-management app for a 4-week period, which included two key functionalities: self-monitoring of blood pressure (BP) and medication reminders. Thematic analysis was carried out on the semistructured interview data. Results: Participants’ age ranged from 43 to 74 years (mean 62 years, SD 9.13). Three themes were identified: digital empowerment of self-management, human versus digital systems, and digital sustainability. Although patients’ experience of using the technology to self-monitor BP was one of empowerment, characterized by an enhanced insight and understanding into their condition, control, and personal responsibility, the reminder function was only feasible for patients who reported unintentional nonadherence to treatment. Patients experienced the app as a sustainable tool to support self-management and found it easy to use, including those with limited technological competence. Conclusions: The study’s findings provide new insights into the experience of using apps to support medication adherence in hypertension. Overall, the data support apps as a usable and feasible method to aid self-management of hypertension and highlight the need for personalized functionality, particularly with regard to medication adherence reminder strategies. The study’s findings challenge the perspective that the use of these technologies to support self-management can inevitably add to the burden of treatment experienced by patients. %M 33112251 %R 10.2196/17470 %U http://mhealth.jmir.org/2020/10/e17470/ %U https://doi.org/10.2196/17470 %U http://www.ncbi.nlm.nih.gov/pubmed/33112251 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e19844 %T Weight Management Apps in Saudi Arabia: Evaluation of Features and Quality %A Alshathri,Dalal M %A Alhumaimeedy,Abeer S %A Al-Hudhud,Ghada %A Alsaleh,Aseel %A Al-Musharaf,Sara %A Aljuraiban,Ghadeer S %+ Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Turki Alawwal, Riyadh , Saudi Arabia, 966 50 301 2345, galjuraiban@ksu.edu.sa %K mHealth %K eHealth %K smartphone %K obesity %K weight management %K mobile apps %K MARS %K six sigma %D 2020 %7 26.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Weight management apps may provide support and management options for individuals with overweight and obesity. Research on the quality of weight management mHealth apps among the Saudi population is insufficient despite frequent use. Objective: The aims of this study were to explore user perceptions of weight management apps, explore reasons for starting and stopping app use, appraise the quality of weight management apps available in the App Store, and compare the features currently available within the app market and those that are most desirable to weight management app users. Methods: A web-based survey consisted of 31 open and closed questions about sociodemographic information, general health questions, app use, app user perceptions, and discontinuation of app use. The quality of the weight management apps available on the App Store was assessed using the Mobile App Rating Scale and evidence-based strategies. We also used six sigma evaluations to ensure that the quality measured by the tools consistently meets customer expectations. Results: Data from the survey were analyzed. Of the respondents, 30.17% (324/1074) had used a weight management app, 18.16% (195/1074) used the apps and stopped, and 51.68% (555/1074) had never used a weight management app. Of apps mentioned, 23 met the inclusion criteria. The overall average Mobile App Rating Scale quality of apps was acceptable; 30% (7/23) received a quality mean score of 4 or higher (out of 5), and 30% (7/23) did not meet the acceptability score of 3 or higher. Evidence-based strategy results showed that feedback was not observed in any of the apps, and motivation strategy was observed in only 1 app. The sigma results of evidence-based strategies reflect that most of the apps fail to pass the mean. Conclusions: App users desired a feature that allows them to communicate with a specialist, which is a missing in the available free apps. Despite the large number and accessibility of weight management apps, the quality and features of most are variable. It can be concluded from six sigma results that passing the mean does not ensure that the quality is consistently distributed through all app quality properties and Mobile App Rating Scale and evidence-based strategies do not give developers an indication of the acceptance of their apps by mobile users. This finding stresses the importance of reevaluating the passing criterion, which is ≥50% for designing an effective app. %M 33104013 %R 10.2196/19844 %U http://mhealth.jmir.org/2020/10/e19844/ %U https://doi.org/10.2196/19844 %U http://www.ncbi.nlm.nih.gov/pubmed/33104013 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e17522 %T Mobile Social Network–Based Smoking Cessation Intervention for Chinese Male Smokers: Pilot Randomized Controlled Trial %A Chen,Jinsong %A Ho,Elsie %A Jiang,Yannan %A Whittaker,Robyn %A Yang,Tingzhong %A Bullen,Christopher %+ National Institute for Health Innovation, School of Population Health, University of Auckland, 22-30 Park Ave, Grafton, Auckland, 1023, New Zealand, 64 0220951065, jinsong.chen@auckland.ac.nz %K mHealth %K mobile smoking cessation %K social network-based intervention %K smoking cessation %K public health %K gamified health interventions %D 2020 %7 23.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Around 2 million Chinese people, mostly men, die annually from tobacco-related diseases; yet, fewer than 8% of Chinese smokers ever receive any smoking cessation support. Objective: This study aimed to test the preliminary effectiveness and feasibility for a mobile social network (WeChat)–based smoking cessation intervention (SCAMPI program) among Chinese male smokers. Methods: Chinese male smokers aged 25-44 years were recruited online from WeChat, the most widely used social media platform in China. Individuals using other smoking cessation interventions or who lacked capacity to provide online informed consent were excluded. Participants were randomly assigned (1:1) to intervention or control groups. Neither participants nor researchers were masked to assignment. The trial was fully online. All data were collected via WeChat. The intervention group received access to the full-version SCAMPI program, a Chinese-language smoking cessation program based on the Behaviour Change Wheel framework and relevant cessation guidelines. Specific intervention functions used in the program include: planning to help users make quitting plans, calculator to record quitting benefits, calendar to record progress, gamification to facilitate quitting, information about smoking harms, motivational messages to help users overcome urges, standardized tests for users to assess their levels of nicotine dependence and lung health, as well as a social platform to encourage social support between users. The control group had access to a static WeChat page of contacts for standard smoking cessation care. Both groups received incentive credit payments for participating. The primary outcome was 30-day biochemically verified smoking abstinence at 6 weeks after randomization, with missing data treated as not quitting. Secondary outcomes were other smoking status measures, reduction of cigarette consumption, study feasibility (recruitment and retention rate), and acceptability of and satisfaction with the program. Results: The program recorded 5736 visitors over a 13-day recruitment period. We recruited 80 participants who were randomly allocated to two arms (n=40 per arm). At 6 weeks, 36 of 40 (90%) intervention participants and 35 of 40 (88%) control participants provided complete self-reported data on their daily smoking status via WeChat. Biochemically verified smoking abstinence at 6 weeks was determined for 10 of 40 (25%) intervention participants and 2 of 40 (5%) control participants (RR=5, 95% CI 1.2-21.4, P=.03). In the intervention group, the calculator function, motivational messages, and health tests were underused (less than once per week per users). Participants rated their satisfaction with the intervention program as 4.56 out of 5.00. Conclusions: Our program is a novel, accessible, and acceptable smoking cessation intervention for Chinese male smokers. A future trial with a greater sample size and longer follow-up will identify if it is as effective as these preliminary data suggest. Trial Registration: ANZCTR registry, ACTRN12618001089224; https://tinyurl.com/y536n7sx International Registered Report Identifier (IRRID): RR2-18071 %M 33095184 %R 10.2196/17522 %U http://mhealth.jmir.org/2020/10/e17522/ %U https://doi.org/10.2196/17522 %U http://www.ncbi.nlm.nih.gov/pubmed/33095184 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 10 %P e14322 %T Use of a Smartphone App to Increase Physical Activity Levels in Insufficiently Active Adults: Feasibility Sequential Multiple Assignment Randomized Trial (SMART) %A Gonze,Bárbara De Barros %A Padovani,Ricardo Da Costa %A Simoes,Maria Do Socorro %A Lauria,Vinicius %A Proença,Neli Leite %A Sperandio,Evandro Fornias %A Ostolin,Thatiane Lopes Valentim Di Paschoale %A Gomes,Grace Angélica De Oliveira %A Castro,Paula Costa %A Romiti,Marcello %A Gagliardi,Antonio %A Arantes,Rodolfo Leite %A Dourado,Victor Zuniga %+ Laboratory of Epidemiology and Human Movement (EPIMOV), Department of Human Movement Sciences, Federal University of São Paulo, Rua Silva Jardim 136, Vila Mathias, Santos, 11015-020, Brazil, 55 1332290203, victor.dourado@unifesp.br %K tailored messages %K gamification %K steps per day %D 2020 %7 23.10.2020 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The sequential multiple assignment randomized trial (SMART) design allows for changes in the intervention during the trial period. Despite its potential and feasibility for defining the best sequence of interventions, so far, it has not been utilized in a smartphone/gamified intervention for physical activity. Objective: We aimed to investigate the feasibility of the SMART design for assessing the effects of a smartphone app intervention to improve physical activity in adults. We also aimed to describe the participants’ perception regarding the protocol and the use of the app for physical activity qualitatively. Methods: We conducted a feasibility 24-week/two-stage SMART in which 18 insufficiently active participants (<10,000 steps/day) were first randomized to group 1 (smartphone app only), group 2 (smartphone app + tailored messages), and a control group (usual routine during the protocol). Participants were motivated to increase their step count by at least 2000 steps/day each week. Based on the 12-week intermediate outcome, responders continued the intervention and nonresponders were rerandomized to subsequent treatment, including a new group 3 (smartphone app + tailored messages + gamification) in which they were instructed to form groups to use several game elements available in the chosen app (Pacer). We considered responders as those with any positive slope in the linear relationship between weeks and steps per day at the end of the first stage of the intervention. We compared the accelerometer-based steps per day before and after the intervention, as well as the slopes of the app-based steps per day between the first and second stages of the intervention. Results: Twelve participants, including five controls, finished the intervention. We identified two responders in group 1. We did not observe relevant changes in the steps per day either throughout the intervention or compared with the control group. However, the rerandomization of five nonresponders led to a change in the slope of the steps per day (median −198 steps/day [IQR −279 to −103] to 20 steps/day [IQR −204 to 145]; P=.08). Finally, in three participants from group 2, we observed an increase in the number of steps per day up to the sixth week, followed by an inflection to baseline values or even lower (ie, a quadratic relationship). The qualitative analysis showed that participants’ reports could be classified into the following: (1) difficulty in managing the app and technology or problems with the device, (2) suitable response to the app, and (3) difficulties to achieve the goals. Conclusions: The SMART design was feasible and changed the behavior of steps per day after rerandomization. Rerandomization should be implemented earlier to take advantage of tailored messages. Additionally, difficulties with technology and realistic and individualized goals should be considered in interventions for physical activity using smartphones. Trial Registration: Brazilian Registry of Clinical Trials RBR-8xtc9c; http://www.ensaiosclinicos.gov.br/rg/RBR-8xtc9c/. %M 33094733 %R 10.2196/14322 %U https://www.researchprotocols.org/2020/10/e14322 %U https://doi.org/10.2196/14322 %U http://www.ncbi.nlm.nih.gov/pubmed/33094733 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e20982 %T Using mHealth to Provide Mobile App Users With Visualization of Health Checkup Data and Educational Videos on Lifestyle-Related Diseases: Methodological Framework for Content Development %A Aida,Azusa %A Svensson,Thomas %A Svensson,Akiko Kishi %A Urushiyama,Hirokazu %A Okushin,Kazuya %A Oguri,Gaku %A Kubota,Naoto %A Koike,Kazuhiko %A Nangaku,Masaomi %A Kadowaki,Takashi %A Yamauchi,Toshimasa %A Chung,Ung-Il %+ Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan, 81 3 5841 4737, akiko-kishi@umin.ac.jp %K apps %K educational videos %K health checkup %K lifestyle-related disease %K mHealth, prevention %K telehealth %K visualization %D 2020 %7 21.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The number of people with lifestyle-related diseases continues to increase worldwide. Improving lifestyle behavior with health literacy may be the key to address lifestyle-related diseases. The delivery of educational videos using mobile health (mHealth) services can replace the conventional way of educating individuals, and visualization can replace the provision of health checkup data. Objective: This paper aimed to describe the development of educational content for MIRAMED, a mobile app aimed at improving users’ lifestyle behaviors and health literacy for lifestyle-related diseases. Methods: All videos were based on a single unified framework to provide users with a consistent flow of information. The framework was later turned into a storyboard. The final video contents were created based on this storyboard and further discussions with leading experts and specialist physicians on effective communication with app users about lifestyle-related diseases. Results: The app uses visualization of personal health checkup data and educational videos on lifestyle-related diseases based on the current health guidelines, scientific evidence, and expert opinions of leading specialist physicians in the respective fields. A total of 8 videos were created for specific lifestyle-related diseases affecting 8 organs: (1) brain–cerebrovascular disorder, (2) eyes–diabetic retinopathy, (3) lungs–chronic obstructive pulmonary disease, (4) heart–ischemic heart disease, (5) liver–fatty liver, (6) kidneys–chronic kidney disease (diabetic kidney disease), (7) blood vessels–peripheral arterial disease, and (8) nerves–diabetic neuropathy. Conclusions: Providing enhanced mHealth education using novel digital technologies to visualize conventional health checkup data and lifestyle-related diseases is an innovative strategy. Future studies to evaluate the efficacy of the developed content are planned. %M 33084586 %R 10.2196/20982 %U http://mhealth.jmir.org/2020/10/e20982/ %U https://doi.org/10.2196/20982 %U http://www.ncbi.nlm.nih.gov/pubmed/33084586 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e18915 %T Feasibility and Acceptability of a Counseling- and mHealth-Based Physical Activity Intervention for Pregnant Women With Diabetes: The Fit for Two Pilot Study %A Larsen,Britta %A Micucci,Stephanie %A Hartman,Sheri J %A Ramos,Gladys %+ Department of Family Medicine & Public Health, University of California, San Diego, 9500 Gilman Dr, San Diego, CA, 92093-0725, United States, 1 8585348429, blarsen@ucsd.edu %K exercise %K behavioral medicine %K mHealth %K gestational diabetes %K type 2 diabetes %K mobile phone %D 2020 %7 21.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Diabetes during pregnancy poses serious health risks to both mother and child. Regular physical activity can reduce these risks, yet few clinic-based interventions of physical activity for pregnant women with diabetes have been attempted. Objective: The purpose of this single-arm pilot trial is to assess the feasibility and acceptability, and explore the potential efficacy of a counseling- and mobile health–based physical activity intervention for pregnant women with diabetes. Methods: Participants (N=17) who had type 2 or gestational diabetes, could read and speak in English or Spanish, and were between 10 and 27 weeks of gestation were recruited from the University of California San Diego Diabetes and Pregnancy Program. Participants engaged in a one-on-one counseling and goal-setting session immediately following a clinic visit with their physician. They were given a Fitbit and shown how to use the Fitbit app, including entering personalized step goals, and were encouraged to build up to 10,000 daily steps. Daily steps were recorded for 12 weeks, until they were 36 weeks’ gestation, or until 1 week before they gave birth, whichever came first. Feasibility was measured by recruitment, retention, and adherence, and acceptability was measured using consumer satisfaction questionnaires and follow-up interviews. Potential efficacy was explored by examining changes in daily steps over time. Results: The participants were primarily Hispanic (13/17, 76%), had public insurance (15/17, 88%), and had type 2 diabetes (12/17, 71%). Of the 17 patients who began the intervention, 76% (13/17) completed a follow-up visit, and 71% (12/17) continued wearing the Fitbit regularly after 8 weeks in the intervention. Adherence in wearing the Fitbit was relatively high, with a median wear adherence of 90% of days. The intervention was generally well accepted, with 85% (11/13) indicating that they were motivated to exercise more following the counseling session, 85% (11/13) indicating that the Fitbit helped increase their activity, and 92% (12/13) recommending the program overall. Mean daily steps increased from baseline (mean 6122, SD 2439) to week 3 (mean 6269, SD 2166) and then decreased through week 12 (mean 4191, SD 2228). Conclusions: High acceptability, retention, and adherence suggest that this may be a promising approach to delivering a simple, low-burden intervention in a clinical setting to a high-risk, underserved population. A randomized controlled trial is needed to determine whether this approach is effective in slowing the reduction in activity typically seen throughout pregnancy. Trial Registration: ClinicalTrials.gov NCT03302377; https://clinicaltrials.gov/ct2/show/NCT03302377 %M 33084584 %R 10.2196/18915 %U http://mhealth.jmir.org/2020/10/e18915/ %U https://doi.org/10.2196/18915 %U http://www.ncbi.nlm.nih.gov/pubmed/33084584 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e18237 %T Accuracy of Nutrient Calculations Using the Consumer-Focused Online App MyFitnessPal: Validation Study %A Evenepoel,Charlotte %A Clevers,Egbert %A Deroover,Lise %A Van Loo,Wendy %A Matthys,Christophe %A Verbeke,Kristin %+ Translational Research in Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Herestraat 49, TARGID, O&N1, box 701, Leuven, 3000, Belgium, 32 16330150, kristin.verbeke@kuleuven.be %K dietary assessment %K MyFitnessPal %K Nubel %K nutrition %K online application %K diet %D 2020 %7 21.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital food registration via online platforms that are coupled to large food databases obviates the need for manual processing of dietary data. The reliability of such platforms depends on the quality of the associated food database. Objective: In this study, we validate the database of MyFitnessPal versus the Belgian food composition database, Nubel. Methods: After carefully given instructions, 50 participants used MyFitnessPal to each complete a 4-day dietary record 2 times (T1 and T2), with 1 month in between T1 and T2. Nutrient intake values were calculated either manually, using the food composition database Nubel, or automatically, using the database coupled to MyFitnessPal. First, nutrient values from T1 were used as a training set to develop an algorithm that defined upper limit values for energy intake, carbohydrates, fat, protein, fiber, sugar, cholesterol, and sodium. These limits were applied to the MyFitnessPal dataset extracted at T2 to remove extremely high and likely erroneous values. Original and cleaned T2 values were correlated with the Nubel calculated values. Bias was estimated using Bland-Altman plots. Finally, we simulated the impact of using MyFitnessPal for nutrient analysis instead of Nubel on the power of a study design that correlates nutrient intake to a chosen outcome variable. Results: Per food portion, the following upper limits were defined: 1500 kilocalories for total energy intake, 95 grams (g) for carbohydrates, 92 g for fat, 52 g for protein, 22 g for fiber, 70 g for sugar, 600 mg for cholesterol, and 3600 mg for sodium. Cleaning the dataset extracted at T2 resulted in a 2.8% rejection. Cleaned MyFitnessPal values demonstrated strong correlations with Nubel for energy intake (r=0.96), carbohydrates (r=0.90), fat (r=0.90), protein (r=0.90), fiber (r=0.80), and sugar (r=0.79), but weak correlations for cholesterol (ρ=0.51) and sodium (ρ=0.53); all P values were ≤.001. No bias was found between both methods, except for a fixed bias for fiber and a proportional bias for cholesterol. A 5-10% power loss should be taken into account when correlating energy intake and macronutrients obtained with MyFitnessPal to an outcome variable, compared to Nubel. Conclusions: Dietary analysis with MyFitnessPal is accurate and efficient for total energy intake, macronutrients, sugar, and fiber, but not for cholesterol and sodium. %M 33084583 %R 10.2196/18237 %U http://www.jmir.org/2020/10/e18237/ %U https://doi.org/10.2196/18237 %U http://www.ncbi.nlm.nih.gov/pubmed/33084583 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 10 %P e21496 %T Smartphone App to Address Loneliness Among College Students: Pilot Randomized Controlled Trial %A Bruehlman-Senecal,Emma %A Hook,Cayce J %A Pfeifer,Jennifer H %A FitzGerald,Caroline %A Davis,Brittany %A Delucchi,Kevin L %A Haritatos,Jana %A Ramo,Danielle E %+ Hopelab, 100 California Street #1150, San Francisco, CA, 94111, United States, 1 415 728 8387, dramo@hopelab.org %K loneliness %K mental health %K smartphone app %K college %K app %K student %K young adult %K randomized controlled trial %K efficacy %K feasibility %K desirability %D 2020 %7 20.10.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Loneliness is a widespread and significant problem on college campuses. Prolonged loneliness in young adulthood is a risk factor for concurrent and future mental health problems and attrition, making college a critical time for support. Cognitive and behavioral interventions show promise for decreasing loneliness and can be widely disseminated through technology. Objective: This pilot randomized controlled trial was conducted to examine the initial efficacy, feasibility, and desirability of a smartphone app, Nod, designed to deliver cognitive and behavioral skill-building exercises to reduce loneliness during the transition to college. Methods: First-year college students (N=221, mean age 18.7 years, 59% female) were recruited online during incoming student orientation, and randomized to either receive immediate access to Nod (experimental group, n=100) or access after 4 weeks (control group, n=121). The app delivered skills via fully automated (1) “social challenges,” suggested activities designed to build social connections; (2) reflections, brief cognitive reframing exercises; and (3) student testimonials that encouraged a growth mindset toward social connection building. Main intention-to-treat analyses were used to compare the conditions on self-assessed loneliness, depressive symptoms, and other mental health and college adjustment outcomes at week 4, controlling for baseline values on those variables. Analyses were also performed to test the hypothesis that the treatment benefits would be particularly pronounced for participants with heightened psychological vulnerability at baseline (ie, higher baseline depressive symptoms and loneliness). Results: Retention was 97% at week 4, and participants viewed an average 36.7 pages of app content. There were no significant condition differences in loneliness at week 4 (F1, 211=0.05, P=.82; ηp2 <.001). However, there was a significant condition-by-baseline depression interaction to predict week-4 loneliness (F1,209=9.65, P=.002; ηp2 =.04). Simple slope analyses indicated that baseline depression positively predicted week-4 loneliness among control participants (r=0.30, t209=3.81, P<.001), but not among experimental participants (r=–0.09, t209=–0.84, P=.40), suggesting that Nod buffered participants with high baseline depression scores from experiencing heightened midquarter loneliness. Similarly, there were no significant condition differences in other week-4 outcomes. However, moderation by baseline vulnerability was found for week-4 depressive symptoms, sleep quality, and indices of college adjustment (eg, perceived social support and campus belonging). Conclusions: Although Nod exposure did not impact outcomes for the full sample, these results provide initial evidence of its benefit for vulnerable students. The results of this trial suggest that cognitive and behavioral skills delivered via a mobile app can buffer psychologically vulnerable college students against heightened loneliness and depressive symptoms, as well as other negative college adjustment outcomes. Future work will aim to improve upon app engagement, and to address loneliness among other key populations. Trial Registration: ClinicalTrials.gov NCT04164654; https://clinicaltrials.gov/ct2/show/NCT04164654 %M 33079071 %R 10.2196/21496 %U http://mental.jmir.org/2020/10/e21496/ %U https://doi.org/10.2196/21496 %U http://www.ncbi.nlm.nih.gov/pubmed/33079071 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e21759 %T The Effect of Smartphone App–Based Interventions for Patients With Hypertension: Systematic Review and Meta-Analysis %A Xu,Hongxuan %A Long,Huanyu %+ The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, National Health Commission, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No 1 DaHua Road, Dong Dan, Beijing, 100730, China, 86 13524791942, xueramber@gmail.com %K hypertension %K smartphone %K blood pressure %K mobile %K lifestyle %K adherence %K smartphone app %K medication adherence %D 2020 %7 19.10.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Hypertension is a major cause of cardiovascular disease, which is the leading cause of premature death. People with hypertension who do not comply with recommended treatment strategies have a higher risk of heart attacks and strokes, leading to hospitalization and consequently greater health care costs. The smartphone, which is now ubiquitous, offers a convenient tool to aid in the treatment of hypertension through the use of apps targeting lifestyle management, and such app-based interventions have shown promising results. In particular, recent evidence has shown the feasibility, acceptability, and success of digital interventions in changing the behavior of people with chronic conditions. Objective: The aim of this study was to systematically compile available evidence to determine the overall effect of smartphone apps on blood pressure control, medication adherence, and lifestyle changes for people with hypertension. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines. Databases were searched to identify randomized controlled trials related to the influence of an app-based intervention in people with hypertension. Data extracted from the included studies were subjected to a meta-analysis to compare the effects of the smartphone app intervention to a control. Results: Eight studies with a total of 1657 participants fulfilled the inclusion criteria. Pooled analysis of 6 studies assessing systolic blood pressure showed a significant overall effect in favor of the smartphone intervention (weighted mean difference –2.28, 95% CI –3.90-0.66). Pooled analysis of studies assessing medication adherence demonstrated a significant effect (P<.001) in favor of the intervention group (standard mean difference 0.38, 95% CI 0.26-0.50) with low heterogeneity (I2=0%). No difference between groups was demonstrated with respect to physical activity. Conclusions: A smartphone intervention leads to a reduction in blood pressure and an increase in medication adherence for people with hypertension. Future research should focus on the effect of behavior coaching apps on medication adherence, lifestyle change, and blood pressure reduction. %M 33074161 %R 10.2196/21759 %U http://mhealth.jmir.org/2020/10/e21759/ %U https://doi.org/10.2196/21759 %U http://www.ncbi.nlm.nih.gov/pubmed/33074161 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e19280 %T Archetypes of Gamification: Analysis of mHealth Apps %A Schmidt-Kraepelin,Manuel %A Toussaint,Philipp A %A Thiebes,Scott %A Hamari,Juho %A Sunyaev,Ali %+ Department of Economics and Management, Karlsruhe Institute of Technology, Kaiserstraße 89, Karlsruhe, D-76133, Germany, 49 72160846037, sunyaev@kit.edu %K mHealth %K smartphones %K mobile phones %K gamification %K quantified-self %K exergames, persuasive technology %D 2020 %7 19.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nowadays, numerous health-related mobile apps implement gamification in an attempt to draw on the motivational potential of video games and thereby increase user engagement or foster certain health behaviors. However, research on effective gamification is still in its infancy and researchers increasingly recognize methodological shortcomings of existing studies. What we actually know about the phenomenon today stems from fragmented pieces of knowledge, and a variety of different perspectives. Existing research primarily draws on conceptual knowledge that is gained from research prototypes, and isolated from industry best practices. We still lack knowledge on how gamification has been successfully designed and implemented within the industry and whether certain gamification approaches have shown to be particularly suitable for certain health behaviors. Objective: We address this lack of knowledge concerning best practices in the design and implementation of gamification for health-related mobile apps by identifying archetypes of gamification approaches that have emerged in pertinent health-related mobile apps and analyzing to what extent those gamification approaches are influenced by the underlying desired health-related outcomes. Methods: A 3-step research approach is employed. As a first step, a database of 143 pertinent gamified health-related mobile apps from the Apple App Store and Google Play Store is set up. Second, the gamification approach of each app within the database is classified based on an established taxonomy for gamification in health-related apps. Finally, a 2-step cluster analysis is conducted in order to identify archetypes of the most dominant gamification approaches in pertinent gamified health-related mobile apps. Results: Eight archetypes of gamification emerged from the analysis of health-related mobile apps: (1) competition and collaboration, (2) pursuing self-set goals without rewards, (3) episodical compliance tracking, (4) inherent gamification for external goals, (5) internal rewards for self-set goals, (6) continuous assistance through positive reinforcement, (7) positive and negative reinforcement without rewards, and (8) progressive gamification for health professionals. The results indicate a close relationship between the identified archetypes and the actual health behavior that is being targeted. Conclusions: By unveiling salient best practices and discussing their relationship to targeted health behaviors, this study contributes to a more profound understanding of gamification in mobile health. The results can serve as a foundation for future research that advances the knowledge on how gamification may positively influence health behavior change and guide practitioners in the design and development of highly motivating and effective health-related mobile health apps. %M 33074155 %R 10.2196/19280 %U https://mhealth.jmir.org/2020/10/e19280 %U https://doi.org/10.2196/19280 %U http://www.ncbi.nlm.nih.gov/pubmed/33074155 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e17881 %T Light-Induced Fluorescence-Based Device and Hybrid Mobile App for Oral Hygiene Management at Home: Development and Usability Study %A Kim,Jun-Min %A Lee,Woo Ram %A Kim,Jun-Ho %A Seo,Jong-Mo %A Im,Changkyun %+ Dental Life Science Research Institute, Seoul National University Dental Hospital, 601 Seoul National University Dental Hospital, 1 Gwanak-ro, Gwanak-Gu, Seoul, , Republic of Korea, 82 2 6747 6587, changkyun@snu.ac.kr %K dental plaque %K oral hygiene %K red fluorescence %K mobile health %K deep learning %K object detection %K instance segmentation %D 2020 %7 16.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dental diseases can be prevented through the management of dental plaques. Dental plaque can be identified using the light-induced fluorescence (LIF) technique that emits light at 405 nm. The LIF technique is more convenient than the commercial technique using a disclosing agent, but the result may vary for each individual as it still requires visual identification. Objective: The objective of this study is to introduce and validate a deep learning–based oral hygiene monitoring system that makes it easy to identify dental plaques at home. Methods: We developed a LIF-based system consisting of a device that can visually identify dental plaques and a mobile app that displays the location and area of dental plaques on oral images. The mobile app is programmed to automatically determine the location and distribution of dental plaques using a deep learning–based algorithm and present the results to the user as time series data. The mobile app is also built with convergence of naive and web applications so that the algorithm is executed on a cloud server to efficiently distribute computing resources. Results: The location and distribution of users’ dental plaques could be identified via the hand-held LIF device or mobile app. The color correction filter in the device was developed using a color mixing technique. The mobile app was built as a hybrid app combining the functionalities of a native application and a web application. Through the scrollable WebView on the mobile app, changes in the time series of dental plaque could be confirmed. The algorithm for dental plaque detection was implemented to run on Amazon Web Services for object detection by single shot multibox detector and instance segmentation by Mask region-based convolutional neural network. Conclusions: This paper shows that the system can be used as a home oral care product for timely identification and management of dental plaques. In the future, it is expected that these products will significantly reduce the social costs associated with dental diseases. %M 33064097 %R 10.2196/17881 %U https://mhealth.jmir.org/2020/10/e17881 %U https://doi.org/10.2196/17881 %U http://www.ncbi.nlm.nih.gov/pubmed/33064097 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e19412 %T Exploring the Effects of a Brief Biofeedback Breathing Session Delivered Through the BioBase App in Facilitating Employee Stress Recovery: Randomized Experimental Study %A Chelidoni,Olga %A Plans,David %A Ponzo,Sonia %A Morelli,Davide %A Cropley,Mark %+ Faculty of Health and Medical Sciences, School of Psychology, University of Surrey, Stag Hill, Guildford, GU2 7XH, United Kingdom, 44 01483686928, mark.cropley@surrey.ac.uk %K breathing %K biofeedback %K smartphone %K heart rate variability %K recovery %K mindfulness %K stress %K mobile phone %D 2020 %7 15.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Recovery from stress is a predictive factor for cardiovascular health, and heart rate variability (HRV) is suggested to be an index of how well people physiologically recover from stress. Biofeedback and mindfulness interventions that include guided breathing have been shown to be effective in increasing HRV and facilitating stress recovery. Objective: This study aims to assess the effectiveness of a brief app-based breathing intervention (BioBase) in enhancing physiological recovery among employees who were induced to cognitive and emotional stress. Methods: In total, we recruited 75 full-time employees. Interbeat (RR) intervals were recorded continuously for 5 min at baseline and during cognitive and emotional stress induction. The session ended with a 5-min recovery period during which participants were randomly allocated into 3 conditions: app-based breathing (BioBase), mindfulness body scan, or control. Subjective tension was assessed at the end of each period. Results: Subjective tension significantly increased following stress induction. HRV significantly decreased following the stress period. In the recovery phase, the root mean square of successive RR interval differences (P=.002), the percentage of successive RR intervals that differed by >50 ms (P=.008), and high frequency (P=.01) were significantly higher in the BioBase breathing condition than in the mindfulness body scan and the control groups. Conclusions: Biofeedback breathing interventions digitally delivered through a commercially available app can be effective in facilitating stress recovery among employees. These findings contribute to the mobile health literature on the beneficial effects of brief app-based breathing interventions on employees’ cardiovascular health. %M 33055072 %R 10.2196/19412 %U http://mhealth.jmir.org/2020/10/e19412/ %U https://doi.org/10.2196/19412 %U http://www.ncbi.nlm.nih.gov/pubmed/33055072 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 10 %P e19044 %T Rationale and Design of the Women’s Health And Daily Experiences Project: Protocol for an Ecological Momentary Assessment Study to Identify Real-Time Predictors of Midlife Women’s Physical Activity %A Arigo,Danielle %A Brown,Megan M %A Pasko,Kristen %A Ainsworth,Matthew Cole %A Travers,Laura %A Gupta,Adarsh %A Downs,Danielle Symons %A Smyth,Joshua M %+ Department of Psychology, Rowan University, 201 Mullica Hill Road, Robinson 116G, Robinson H109, Glassboro, NJ, 08028, United States, 1 8562564500 ext 53775, arigo@rowan.edu %K women's health %K midlife %K cardiovascular risk %K physical activity %K ecological momentary assessment %K mobile phone %D 2020 %7 15.10.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Midlife women are at an elevated risk for cardiovascular disease (CVD) and associated mortality. Those who have additional risk conditions such as obesity or hypertension report specific barriers to engaging in cardioprotective behaviors such as physical activity (PA). Considerable effort has been devoted to understanding PA determinants and designing interventions for midlife women, although with suboptimal success, as increasing PA could meaningfully attenuate CVD risk. An updated approach to understanding PA among midlife women could improve upon existing resources by focusing on novel psychosocial influences on PA in this population (ie, body satisfaction, social interactions, social comparisons, mood state) and within-person relations between these influences and PA in the natural environment. Objective: The overarching goal of Project WHADE (Women’s Health And Daily Experiences) is to use an ecological momentary assessment (EMA) approach to capture ecologically valid relations between midlife women’s psychosocial experiences and PA as they engage in their normal daily activities. The primary aim of the study is to identify within-person psychosocial predictors of variability in PA (ie, experiences associated with higher vs lower PA for a given individual). Methods: Midlife women (aged 40-60 years) with one or more additional risk markers for CVD (eg, hypertension) will be recruited from primary care clinics and the general community (target n=100). Eligible women will complete an initial survey and a face-to-face baseline session before engaging in a 10-day EMA protocol. Psychosocial experiences will be assessed using a brief self-report via a smartphone 5 times per day, and PA will be assessed throughout waking hours using a research-grade monitor. Participants will return for a brief exit interview at the end of 10 days. Multilevel models that address the nested structure of EMA data will be used to evaluate the study aims. Results: Recruitment and enrollment are ongoing, and a total of 75 women have completed the protocol to date. Data collection is expected to be completed in Fall 2020. Conclusions: Project WHADE is designed to identify naturally occurring psychosocial experiences that predict short-term variability in midlife women’s PA. As such, the results of this study should advance the current understanding of PA among midlife women by providing further insight into within-person psychosocial influences on PA in this group. In the future, this information could help inform the design of interventions for this population. International Registered Report Identifier (IRRID): DERR1-10.2196/19044 %M 33055065 %R 10.2196/19044 %U http://www.researchprotocols.org/2020/10/e19044/ %U https://doi.org/10.2196/19044 %U http://www.ncbi.nlm.nih.gov/pubmed/33055065 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e20720 %T Association Between Usage of an App to Redeem Prescribed Food Benefits and Redemption Behaviors Among the Special Supplemental Nutrition Program for Women, Infants, and Children Participants: Cross-Sectional Study %A Zhang,Qi %A Zhang,Junzhou %A Park,Kayoung %A Tang,Chuanyi %+ School of Community and Environmental Health, Old Dominion University, 3130 Health Sciences Building, Old Dominion University, Norfolk, VA, 23529, United States, 1 7576836870, qzhang@odu.edu %K mobile phone app %K WIC %K EBT %K benefit redemption %K mobile phone %D 2020 %7 14.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is one of the most important food assistance programs in the United States, serving 6.4 million low-income, eligible women, infants, and children under 5 years of age in 2019. In the program, participants are prescribed a list of food benefits, which can be redeemed in WIC-authorized stores. However, there are multiple behavioral barriers in the program and the stores that prevent participants from redeeming the benefits fully. Objective: This study aims to examine the relationship between the use of a widely used mobile phone app, WICShopper, and the redemption of the prescribed food packages. Methods: WIC administrative data were obtained from West Virginia for the period January 2019 to January 2020 and included 30,440 WIC households that had received food benefits in that period. The redemption rates of 18 WIC food benefits were compared between app users and nonapp users, that is, those who never used the app in the study period. The use behaviors were defined for the app users, including the number of active use benefit cycles, active benefit cycle rates, number of active use days in the cycle, and proportion rates of daytime use. Panel linear regressions were applied to examine how the redemption rates were related to these behaviors over time. Results: App users consistently had higher average redemption rates than nonapp users; the difference ranged from 3.6% (4.8% relative) for infant formula to 14.3% (40.7% relative) for fish. After controlling for sociodemographics, the coefficients of app use were significantly positive for all benefit categories except for WIC-eligible nutritionals. More active cycles and active days in the cycle were significantly related to redemption rates for all categories, except for frozen juice (coefficient=−0.002, P=.09). Daytime app access was positively associated with redemption rates for most food benefits except only a few, such as infant formula (coefficient=−0.03, P<.001). Conclusions: Use of the WIC app was significantly related to higher redemption rates across food benefits, although the association varied across benefit categories. More active days were positively related to benefit redemptions across food categories, and the app’s daytime use was positively associated with the redemption of most benefit categories. These findings suggest that the WIC app can be an important tool for the promotion of benefit redemption among WIC participants. %M 33052133 %R 10.2196/20720 %U http://mhealth.jmir.org/2020/10/e20720/ %U https://doi.org/10.2196/20720 %U http://www.ncbi.nlm.nih.gov/pubmed/33052133 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e18545 %T App-Based Delivery of Clinical Emotional Freedom Techniques: Cross-Sectional Study of App User Self-Ratings %A Church,Dawson %A Stapleton,Peta %A Sabot,Debbie %+ School of Psychology, Faculty of Society & Design, Bond University, 14 University Drive, Robina, 4226, Australia, 61 755952515, dsabot@bond.edu.au %K anxiety %K stress %K meditation %K mobile health %K Emotional Freedom Techniques (EFT) %K mobile phone %D 2020 %7 14.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The burgeoning area of mobile health (mHealth) has experienced rapid growth in mobile apps designed to address mental health issues. Although abundant apps offer strategies for managing symptoms of anxiety and stress, information regarding their efficacy is scarce. Objective: This study aimed to assess the effect of an mHealth app on user self-ratings of psychological distress in a sample of 270,461 app users. The Tapping Solution App guides users through the therapeutic protocols of Clinical Emotional Freedom Techniques (EFT), an evidence-based psychophysiological intervention that combines acupressure with elements of cognitive and exposure therapies. Methods: App users provided self-ratings of emotional intensity before and after app sessions (termed “tapping meditations”) using an 11-point Subjective Units of Distress scale. App user data for 23 tapping meditations, which addressed psychological symptoms of anxiety and stress, were gathered between October 2018 and October 2019, totaling 380,034 completed app sessions. Results: Across 12 anxiety-tapping meditations, the difference in emotional intensity ratings from presession (mean 6.66, SD 0.25) to postsession (mean 3.75, SD 0.30) was statistically significant (P<.001; 95% CI −2.92 to −2.91). Across 11 stress-tapping meditations, a statistically significant difference was also found from presession (mean 6.91, SD 0.48) to postsession (mean 3.83, SD 0.54; P<.001; 95% CI −3.08 to −3.07). The results are consistent with the literature on the efficacy of Clinical EFT for anxiety and stress when offered in conventional therapeutic formats. Conclusions: The findings provide preliminary support for the effectiveness of the mHealth app in the immediate reduction of self-rated psychological distress. As an adjunct to professional mental health care, the app promises accessible and convenient therapeutic benefits. %M 32862128 %R 10.2196/18545 %U http://mhealth.jmir.org/2020/10/e18545/ %U https://doi.org/10.2196/18545 %U http://www.ncbi.nlm.nih.gov/pubmed/32862128 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e17377 %T Challenges in Acceptance and Compliance in Digital Health Assessments During Pregnancy: Prospective Cohort Study %A Brusniak,Katharina %A Arndt,Hannah Maria %A Feisst,Manuel %A Haßdenteufel,Kathrin %A Matthies,Lina Maria %A Deutsch,Thomas Maximilian %A Hudalla,Hannes %A Abele,Harald %A Wallwiener,Markus %A Wallwiener,Stephanie %+ Department of Gynecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, Heidelberg, 69120, Germany, 49 6221 5637551, Stephanie.Wallwiener@med.uni-heidelberg.de %K eHealth %K compliance %K pregnancy %K digital assessments %D 2020 %7 14.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pregnant women are increasingly using mobile apps to access health information during the antenatal period. Therefore, digital health solutions can potentially be used as monitoring instruments during pregnancy. However, a main factor of success is high user engagement. Objective: The aim of this study was to analyze engagement and factors influencing compliance in a longitudinal study targeting pregnant women using a digital health app with self-tracking. Methods: Digitally collected data concerning demographics, medical history, technical aspects, and mental health from 585 pregnant women were analyzed. Patients filling out ≥80% of items at every study visit were considered to be highly compliant. Factors associated with high compliance were identified using logistic regression. The effect of a change in mental and physical well-being on compliance was assessed using a one-sample t test. Results: Only 25% of patients could be considered compliant. Overall, 63% left at least one visit blank. Influential variables for higher engagement included higher education, higher income, private health insurance, nonsmoking, and German origin. There was no relationship between a change in the number of physical complaints or depressive symptoms and study dropout. Conclusions: Maintaining high engagement with digital monitoring devices over a long time remains challenging. As cultural and socioeconomic background factors had the strongest influence, more effort needs to be directed toward understanding the needs of patients from different demographic backgrounds to ensure high-quality care for all patients. More studies need to report on compliance to disclose potential demographic bias. %M 33052134 %R 10.2196/17377 %U https://mhealth.jmir.org/2020/10/e17377 %U https://doi.org/10.2196/17377 %U http://www.ncbi.nlm.nih.gov/pubmed/33052134 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e15430 %T Occurrence of and Reasons for “Missing Events” in Mobile Dietary Assessments: Results From Three Event-Based Ecological Momentary Assessment Studies %A Ziesemer,Katrin %A König,Laura Maria %A Boushey,Carol Jo %A Villinger,Karoline %A Wahl,Deborah Ronja %A Butscher,Simon %A Müller,Jens %A Reiterer,Harald %A Schupp,Harald Thomas %A Renner,Britta %+ Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, PO Box 47, Konstanz, 78457, Germany, 49 7531884679, britta.renner@uni-konstanz.de %K dietary assessment %K diet records %K mobile phone %K mobile applications %K technology %K adherence %K compliance %K missing events %K Ecological Momentary Assessment %K mHealth %D 2020 %7 14.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Establishing a methodology for assessing nutritional behavior comprehensively and accurately poses a great challenge. Mobile technologies such as mobile image-based food recording apps enable eating events to be assessed in the moment in real time, thereby reducing memory biases inherent in retrospective food records. However, users might find it challenging to take images of the food they consume at every eating event over an extended period, which might lead to incomplete records of eating events (missing events). Objective: Analyzing data from 3 studies that used mobile image-based food recording apps and varied in their technical enrichment, this study aims to assess how often eating events (meals and snacks) were missed over a period of 8 days in a naturalistic setting by comparing the number of recorded events with the number of normative expected events, over time, and with recollections of missing events. Methods: Participants in 3 event-based Ecological Momentary Assessment (EMA) studies using mobile image-based dietary assessments were asked to record all eating events (study 1, N=38, 1070 eating events; study 2, N=35, 934 eating events; study 3, N=110, 3469 eating events). Study 1 used a basic app; study 2 included 1 fixed reminder and the possibility to add meals after the actual eating events occurred instead of in the moment (addendum); and study 3 included 2 fixed reminders, an addendum feature, and the option to record skipped meals. The number of recalled missed events and their reasons were assessed by semistructured interviews after the EMA period (studies 1 and 2) and daily questionnaires (study 3). Results: Overall, 183 participants reported 5473 eating events. Although the momentary adherence rate as indexed by a comparison with normative expected events was generally high across all 3 studies, a differential pattern of results emerged with a higher rate of logged meals in the more technically intensive study 3. Multilevel models for the logging trajectories of reported meals in all 3 studies showed a significant, albeit small, decline over time (b=−.11 to −.14, Ps<.001, pseudo-R²=0.04-0.06), mainly because of a drop in reported snacks between days 1 and 2. Intraclass coefficients indicated that 38% or less of the observed variance was because of individual differences. The most common reasons for missing events were competing activities and technical issues, whereas situational barriers were less important. Conclusions: Three different indicators (normative, time stability, and recalled missing events) consistently indicated missing events. However, given the intensive nature of diet EMA protocols, the effect sizes were rather small and the logging trajectories over time were remarkably stable. Moreover, the individual’s actual state and context seemed to exert a greater influence on adherence rates than stable individual differences, which emphasizes the need for a more nuanced understanding of the factors that affect momentary adherence. %M 33052123 %R 10.2196/15430 %U https://mhealth.jmir.org/2020/10/e15430 %U https://doi.org/10.2196/15430 %U http://www.ncbi.nlm.nih.gov/pubmed/33052123 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e23954 %T Fitbit-Based Interventions for Healthy Lifestyle Outcomes: Systematic Review and Meta-Analysis %A Ringeval,Mickael %A Wagner,Gerit %A Denford,James %A Paré,Guy %A Kitsiou,Spyros %+ Research Chair in Digital Health, HEC Montreal, 3000, Cote-Sainte-Catherine Road, Montreal, QC, H1Y3K9, Canada, 1 514 882 8672, guy.pare@hec.ca %K Fitbit %K wearables %K healthy lifestyle %K meta-analysis %K literature review %K fuzzy-set qualitative comparative analysis %D 2020 %7 12.10.2020 %9 Review %J J Med Internet Res %G English %X Background: Unhealthy behaviors, such as physical inactivity, sedentary lifestyle, and unhealthful eating, remain highly prevalent, posing formidable challenges in efforts to improve cardiovascular health. While traditional interventions to promote healthy lifestyles are both costly and effective, wearable trackers, especially Fitbit devices, can provide a low-cost alternative that may effectively help large numbers of individuals become more physically fit and thereby maintain a good health status. Objective: The objectives of this meta-analysis are (1) to assess the effectiveness of interventions that incorporate a Fitbit device for healthy lifestyle outcomes (eg, steps, moderate-to-vigorous physical activity, and weight) and (2) to identify which additional intervention components or study characteristics are the most effective at improving healthy lifestyle outcomes. Methods: A systematic review was conducted, searching the following databases from 2007 to 2019: MEDLINE, EMBASE, CINAHL, and CENTRAL (Cochrane). Studies were included if (1) they were randomized controlled trials, (2) the intervention involved the use of a Fitbit device, and (3) the reported outcomes were related to healthy lifestyles. The main outcome measures were related to physical activity, sedentary behavior, and weight. All the studies were assessed for risk of bias using Cochrane criteria. A random-effects meta-analysis was conducted to estimate the treatment effect of interventions that included a Fitbit device compared with a control group. We also conducted subgroup analysis and fuzzy-set qualitative comparative analysis (fsQCA) to further disentangle the effects of intervention components. Results: Our final sample comprised 41 articles reporting the results of 37 studies. For Fitbit-based interventions, we found a statistically significant increase in daily step count (mean difference [MD] 950.54, 95% CI 475.89-1425.18; P<.001) and moderate-to-vigorous physical activity (MD 6.16, 95% CI 2.80-9.51; P<.001), a significant decrease in weight (MD −1.48, 95% CI −2.81 to −0.14; P=.03), and a nonsignificant decrease in objectively assessed and self-reported sedentary behavior (MD −10.62, 95% CI −35.50 to 14.27; P=.40 and standardized MD −0.11, 95% CI −0.48 to 0.26; P=.56, respectively). In general, the included studies were at low risk for bias, except for performance bias. Subgroup analysis and fsQCA demonstrated that, in addition to the effects of the Fitbit devices, setting activity goals was the most important intervention component. Conclusions: The use of Fitbit devices in interventions has the potential to promote healthy lifestyles in terms of physical activity and weight. Fitbit devices may be useful to health professionals for patient monitoring and support. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019145450; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019145450 %M 33044175 %R 10.2196/23954 %U http://www.jmir.org/2020/10/e23954/ %U https://doi.org/10.2196/23954 %U http://www.ncbi.nlm.nih.gov/pubmed/33044175 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 10 %P e21075 %T Examining an App-Based Mental Health Self-Care Program, IntelliCare for College Students: Single-Arm Pilot Study %A Lattie,Emily %A Cohen,Katherine A %A Winquist,Nathan %A Mohr,David C %+ Department of Medical Social Sciences, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 3125033741, emily.lattie@northwestern.edu %K mHealth %K college students %K depression %K anxiety %K mobile phone %D 2020 %7 10.10.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: In recent years, there has been an increase in symptoms of depression, anxiety, and other mental illnesses in college student populations alongside a steady rise in the demand for counseling services. Digital mental health programs, such as those delivered through mobile apps, can add to the array of available services but must be tested for usability and acceptability before implementation. Objective: This study aims to examine how students used IntelliCare for College Students over an 8-week period to examine the preliminary associations between app use and psychosocial targets and to gather user feedback about usability issues that need to be remedied before a larger implementation study. Methods: IntelliCare for College Students is an app-based platform that provides symptom assessments with personalized feedback, information about campus resources, lessons on mental health and wellness topics, and access to the suite of interactive skill–focused IntelliCare apps. A total of 20 students were recruited to participate in an 8-week study. To test for a broad range of potential users, we recruited a mixed sample of students with elevated symptoms of depression or anxiety and students without elevated symptoms. Participants completed psychosocial questionnaires at baseline, week 4, and week 8. Participants also completed user feedback interviews at weeks 4 and 8 in which they provided feedback on their experience using the app and suggestions for changes they would like to be made to the app. Results: Of the 20 students who downloaded the app, 19 completed the study, indicating a high rate of retention. Over the study period, participants completed an average of 5.85 (SD 2.1; range 1-8) symptom assessments. Significant improvements were observed in the Anxiety Literacy Questionnaire scores (Z=−2.006; P=.045) and in the frequency with which participants used both cognitive (Z=−2.091; P=.04) and behavioral (Z=−2.249; P=.03) coping skills. In the feedback interviews, we identified a high degree of usability with minor bugs in the app software, which were quickly fixed. Furthermore, in feedback interviews, we identified that users found the app to be convenient and appreciated the ability to use the program in short bursts of time. Conclusions: The findings indicate that the IntelliCare for College Students program was perceived as largely usable and engaging. Although the program demonstrated usability and preliminary benefits to students, further testing is needed to determine its clinical utility among college students. Trial Registration: ClinicalTrials.gov NCT04035577; https://clinicaltrials.gov/ct2/show/NCT04035577 %M 33037874 %R 10.2196/21075 %U http://mental.jmir.org/2020/10/e21075/ %U https://doi.org/10.2196/21075 %U http://www.ncbi.nlm.nih.gov/pubmed/33037874 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e15741 %T A Digital Companion, the Emma App, for Ecological Momentary Assessment and Prevention of Suicide: Quantitative Case Series Study %A Morgiève,Margot %A Genty,Catherine %A Azé,Jérôme %A Dubois,Jonathan %A Leboyer,Marion %A Vaiva,Guillaume %A Berrouiguet,Sofian %A Courtet,Philippe %+ Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, INSERM, Univ Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, 371 Av. du Doyen Gaston Giraud, Montpellier, 34090, France, 33 609596532, margotmorgieve@yahoo.fr %K suicide %K ecological momentary assessment %K prediction %K prevention %K mobile health %K mHealth %K case reports %K ecological momentary intervention %D 2020 %7 9.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many suicide risk factors have been identified, but traditional clinical methods do not allow for the accurate prediction of suicide behaviors. To face this challenge, emma, an app for ecological momentary assessment (EMA), ecological momentary intervention (EMI), and prediction of suicide risk in high-risk patients, was developed. Objective: The aim of this case report study was to describe how subjects at high risk of suicide use the emma app in real-world conditions. Methods: The Ecological Mental Momentary Assessment (EMMA) study is an ongoing, longitudinal, interventional, multicenter trial in which patients at high risk for suicide are recruited to test emma, an app designed to be used as a self-help tool for suicidal crisis management. Participants undergo clinical assessment at months 0, 1, 3, and 6 after inclusion, mainly to assess and characterize the presence of mental disorders and suicidal thoughts and behaviors. Patient recruitment is still ongoing. Some data from the first 14 participants who already completed the 6-month follow-up were selected for this case report study, which evaluated the following: (1) data collected by emma (ie, responses to EMAs), (2) metadata on emma use, (3) clinical data, and (4) qualitative assessment of the participants' experiences. Results: EMA completion rates were extremely heterogeneous with a sharp decrease over time. The completion rates of the weekly EMAs (25%-87%) were higher than those of the daily EMAs (0%-53%). Most patients (10/14, 71%) answered the EMA questionnaires spontaneously. Similarly, the use of the Safety Plan Modules was very heterogeneous (2-75 times). Specifically, 11 patients out of 14 (79%) used the Call Module (1-29 times), which was designed by our team to help them get in touch with health care professionals and/or relatives during a crisis. The diversity of patient profiles and use of the EMA and EMI modules proposed by emma were highlighted by three case reports. Conclusions: These preliminary results indicate that patients have different clinical and digital profiles and needs that require a highly scalable, interactive, and customizable app. They also suggest that it is possible and acceptable to collect longitudinal, fine-grained, contextualized data (ie, EMA) and to offer personalized intervention (ie, EMI) in real time to people at high risk of suicide. To become a complementary tool for suicide prevention, emma should be integrated into existing emergency procedures. Trial Registration: ClinicalTrials.gov NCT03410381; https://clinicaltrials.gov/ct2/show/NCT03410381 %M 33034567 %R 10.2196/15741 %U https://mhealth.jmir.org/2020/10/e15741 %U https://doi.org/10.2196/15741 %U http://www.ncbi.nlm.nih.gov/pubmed/33034567 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e17435 %T Effect of Smartphone-Based Lifestyle Coaching App on Community-Dwelling Population With Moderate Metabolic Abnormalities: Randomized Controlled Trial %A Cho,So Mi Jemma %A Lee,Jung Hyun %A Shim,Jee-Seon %A Yeom,Hyungseon %A Lee,Su Jin %A Jeon,Yong Woo %A Kim,Hyeon Chang %+ Department of Preventive Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 1873, hckim@yuhs.ac %K metabolic health %K health behavior %K lifestyle modification %K mobile health %D 2020 %7 9.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Metabolic disorders are established precursors to cardiovascular diseases, yet they can be readily prevented with sustained lifestyle modifications. Objective: We assessed the effectiveness of a smartphone-based weight management app on metabolic parameters in adults at high-risk, yet without physician diagnosis nor pharmacological treatment for metabolic syndrome, in a community setting. Methods: In this 3-arm parallel-group, single-blind, randomized controlled trial, we recruited participants aged 30 to 59 years with at least 2 conditions defined by the Third Report of the National Cholesterol Education Program expert panel (abdominal obesity, high blood pressure, high triglycerides, low high-density lipoprotein cholesterol, and high fasting glucose level). Participants were randomly assigned (1:1:1) by block randomization to either the nonuser group (control), the app-based diet and exercise self-logging group (app only), or the app-based self-logging and personalized coaching from professional dieticians and exercise coordinators group (app with personalized coaching). Assessments were performed at baseline, week 6, week 12, and week 24. The primary outcome was change in systolic blood pressure (between baseline and follow-up assessments). Secondary outcomes were changes in diastolic blood pressure, body weight, body fat mass, waist circumference, homeostatic model of assessment of insulin resistance, triglyceride level, and high-density lipoprotein cholesterol level between baseline and follow-up assessments. Analysis was performed using intention-to-treat. Results: Between October 28, 2017 and May 28, 2018, 160 participants participated in the baseline screening examination. Participants (129/160, 80.6%) who satisfied the eligibility criteria were assigned to control (n=41), app only (n=45), or app with personalized coaching (n=43) group. In each group, systolic blood pressure showed decreasing trends from baseline (control: mean –10.95, SD 2.09 mmHg; app only: mean –7.29, SD 1.83 mmHg; app with personalized coaching: mean –7.19, SD 1.66 mmHg), yet without significant difference among the groups (app only: P=.19; app with personalized coaching: P=.16). Instead, those in the app with personalized coaching group had greater body weight reductions (control: mean –0.12, SD 0.30 kg; app only: mean –0.35, SD 0.36 kg, P=.67; app with personalized coaching: mean –0.96, SD 0.37 kg; P=.08), specifically by body fat mass reduction (control: mean –0.13, SD 0.34 kg; app only: mean –0.64, SD 0.38 kg, P=.22; app with personalized coaching: mean –0.79, SD 0.38 kg; P=.08). Conclusions: Simultaneous diet and exercise self-logging and persistent lifestyle modification coaching were ineffective in lowering systolic blood pressure but effective in losing weight and reducing body fat mass. These results warrant future implementation studies of similar models of care on a broader scale in the context of primary prevention. Trial Registration: ClinicalTrials.gov NCT03300271; http://clinicaltrials.gov/ct2/show/NCT03300271 %M 33034564 %R 10.2196/17435 %U https://www.jmir.org/2020/10/e17435 %U https://doi.org/10.2196/17435 %U http://www.ncbi.nlm.nih.gov/pubmed/33034564 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 10 %P e23716 %T Coping Skills Mobile App to Support the Emotional Well-Being of Young People During the COVID-19 Pandemic: Protocol for a Mixed Methods Study %A Serlachius,Anna %A Schache,Kiralee %A Boggiss,Anna %A Lim,David %A Wallace-Boyd,Kate %A Brenton-Peters,Jennifer %A Buttenshaw,Elise %A Chadd,Stephanie %A Cavadino,Alana %A Cao,Nicholas %A Morunga,Eva %A Thabrew,Hiran %+ Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand, 64 09 923 3073, a.serlachius@auckland.ac.nz %K COVID-19 %K pandemic %K mental health %K mobile applications %K apps %K mHealth %K coping skills %K wellbeing %K adolescent %K young adult %K coping %D 2020 %7 8.10.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic is likely to increase anxiety and distress in young people worldwide. It is important to prioritize mental health during crisis events to mitigate the negative and often long-term effects of the crises on young people, families, and society. Mental health and well-being apps represent a scalable approach for improving psychological outcomes in young people and have potential to improve the equity of service access. Objective: The Whitu: 7 Ways in 7 Days well-being app was recently developed by our group to address the urgent need for innovative approaches to reach young New Zealanders who are struggling to cope with the COVID-19 pandemic. The aim of this study is twofold: to evaluate the acceptability of the prototype app and to examine the effectiveness of the refined app at improving mental and emotional well-being and reducing depression, anxiety, and stress in young people in New Zealand. Methods: A two-phase mixed methods study will be undertaken to achieve these aims. During the first phase, 20 young people aged 16-30 years (including those of Māori and Pacific ethnicity) will participate in a qualitative study to help refine the prototype app. During the second phase, 90 young people aged 16-30 years will participate in a randomized waitlist-controlled trial (RCT) to evaluate the efficacy of the refined Whitu app at 4 weeks and 3 months after baseline. Outcomes will be evaluated using validated web-based questionnaires at baseline, 4 weeks, and 3 months. Results: The study received ethics approval in May 2020, and recruitment for the focus groups commenced in June 2020. Recruitment for the RCT is expected to commence in October 2020. Participants for both study phases will be recruited via social media and web-based communities. Data collection for the RCT is expected to be completed by January 2021, and analyses are expected to be completed by March 2021. Linear mixed modelling will be used to determine between-group differences in psychological outcomes. Conclusions: There is an urgent need to develop culturally appropriate, scalable mental health interventions to address the psychological consequences of the COVID-19 pandemic. In this study, we will develop and test an evidence-based well-being app that, if effective, can be made available to all young people in New Zealand and internationally. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12620000516987); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379597. International Registered Report Identifier (IRRID): PRR1-10.2196/23716 %M 32991303 %R 10.2196/23716 %U https://www.researchprotocols.org/2020/10/e23716 %U https://doi.org/10.2196/23716 %U http://www.ncbi.nlm.nih.gov/pubmed/32991303 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e16911 %T Adoption of Mobile Health Apps in Dietetic Practice: Case Study of Diyetkolik %A Akdur,Gorkem %A Aydin,Mehmet Nafiz %A Akdur,Gizdem %+ Department of Management Information Systems, Kadir Has University, Kadir Has St., Cibali / Fatih, Istanbul, 34083, Turkey, 90 5360662866, gorkemakdur@gmail.com %K mHealth %K technology acceptance %K user acceptance %K mobile apps %K diet apps %K Technology Acceptance Model %K TAM %K dietetics %D 2020 %7 2.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dietetics mobile health apps provide lifestyle tracking and support on demand. Mobile health has become a new trend for health service providers through which they have been shifting their services from clinical consultations to online apps. These apps usually offer basic features at no cost and charge a premium for advanced features. Although diet apps are now more common and have a larger user base, in general, there is a gap in literature addressing why users intend to use diet apps. We used Diyetkolik, Turkey’s most widely used online dietetics platform for 7 years, as a case study to understand the behavioral intentions of users. Objective: The aim of this study was to investigate the factors that influence the behavioral intentions of users to adopt and use mobile health apps. We used the Technology Acceptance Model and extended it by exploring other factors such as price-value, perceived risk, and trust factors in order to assess the technology acceptance of users. Methods: We conducted quantitative research on the Diyetkolik app users by using random sampling. Valid data samples gathered from 658 app users were analyzed statistically by applying structural equation modeling. Results: Statistical findings suggested that perceived usefulness (P<.001), perceived ease of use (P<.001), trust (P<.001), and price-value (P<.001) had significant relationships with behavioral intention to use. However, no relationship between perceived risk and behavioral intention was found (P=.99). Additionally, there was no statistical significance for age (P=.09), gender (P=.98), or previous app use experience (P=.14) on the intention to use the app. Conclusions: This research is an invaluable addition to Technology Acceptance Model literature. The results indicated that 2 external factors (trust and price-value) in addition to Technology Acceptance Model factors showed statistical relevance with behavioral intention to use and improved our understanding of user acceptance of a mobile health app. The third external factor (perceived risk) did not show any statistical relevance regarding behavioral intention to use. Most users of the Diyetkolik dietetics app were hesitant in purchasing dietitian services online. Users should be frequently reassured about the security of the platform and the authenticity of the platform’s dietitians to ensure that users’ interactions with the dietitians are based on trust for the platform and the brand. %M 33006566 %R 10.2196/16911 %U https://mhealth.jmir.org/2020/10/e16911 %U https://doi.org/10.2196/16911 %U http://www.ncbi.nlm.nih.gov/pubmed/33006566 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e19860 %T Perceptions of Mobile Apps for Smoking Cessation Among Young People in Community Mental Health Care: Qualitative Study %A Gowarty,Minda A %A Kung,Nathan J %A Maher,Ashley E %A Longacre,Meghan R %A Brunette,Mary F %+ Departments of Internal Medicine and Community and Family Medicine, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, United States, 1 6036536868, minda.a.gowarty@hitchcock.org %K smoking cessation %K mHealth %K serious mental illness %K smartphone application %K digital health %K psychiatric illness %K tobacco treatment %D 2020 %7 2.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Young adults with serious mental illness are over twice as likely to have tobacco use disorder than those in the general population and are less likely to utilize proven treatment methods during quit attempts. However, little research has evaluated the efficacy of interventions for this group. Smartphone apps may be an underutilized tool for tobacco use disorder among young adults with serious mental illness. Objective: The aim of this study was to explore attitudes toward smoking cessation apps and preferences regarding app design in young adult smokers with serious mental illness. Methods: Five focus groups involving 25- to 35-year-old adults with serious mental illness receiving treatment at a community mental health center were conducted between May 2019 and August 2019. Three researchers independently coded transcripts and identified themes using thematic analysis. Results: Participants (n=22) were individuals who smoke daily: 10 (46%) self-identified as female, 18 (82%) self-identified as White, and 9 (41%) had psychotic disorders. Key themes that emerged included a general interest in using health apps; a desire for apps to provide ongoing motivation during a quit attempt via social support, progress tracking, and rewards; a desire for apps to provide distraction from smoking; concerns about app effectiveness due to a lack of external accountability; and concerns that apps could trigger cravings or smoking behavior by mentioning cigarettes or the act of smoking. Conclusions: Apps have the potential to support smoking cessation or reduction efforts among young adults with serious mental illness. However, they may require tailoring, optimization, and clinical support to effectively promote cessation in this population. %M 33006560 %R 10.2196/19860 %U https://formative.jmir.org/2020/10/e19860 %U https://doi.org/10.2196/19860 %U http://www.ncbi.nlm.nih.gov/pubmed/33006560 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 10 %P e19720 %T Evaluating the Efficacy of a Mobile App (Drinks:Ration) and Personalized Text and Push Messaging to Reduce Alcohol Consumption in a Veteran Population: Protocol for a Randomized Controlled Trial %A Leightley,Daniel %A Rona,Roberto J %A Shearer,James %A Williamson,Charlotte %A Gunasinghe,Cerisse %A Simms,Amos %A Fear,Nicola T %A Goodwin,Laura %A Murphy,Dominic %+ King's College London, King's Centre for Military Health Research, 10 Cutcombe Road, London, SE5 9RJ, United Kingdom, 44 20 7848 5351, daniel.leightley@kcl.ac.uk %K alcohol misuse %K smartphone %K intervention %K SMS text messaging %K push notifications %D 2020 %7 2.10.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol misuse is higher in the UK Armed Forces than in the general population. Previous research has shown that interventions delivered via smartphones are efficacious in promoting self-monitoring of alcohol use, have utility in reducing alcohol consumption, and have a broad reach. Objective: This single-blinded randomized controlled trial (RCT) aims to assess the efficacy of a 28-day brief alcohol intervention delivered via a smartphone app (Drinks:Ration) in reducing weekly self-reported alcohol consumption between baseline and 3-month follow-up among veterans who drink at a hazardous or harmful level and receive or have received support for mental health symptoms in a clinical setting. Methods: In this two-arm, single-blinded RCT, a smartphone app that includes interactive features designed to enhance participants’ motivation and personalized messaging is compared with a smartphone app that provides only government guidance on alcohol consumption. The trial will be conducted in a veteran population that has sought help through Combat Stress, a UK veteran’s mental health charity. Recruitment, consent, and data collection will be carried out automatically through the Drinks:Ration platform. The primary outcome is the change in self-reported weekly alcohol consumption between baseline (day 0) and 3-month follow-up (day 84) as measured using the Time-Line Follow back for Alcohol Consumption. Secondary outcome measures include (1) change in the baseline to 3-month follow-up (day 84) Alcohol Use Disorder Identification Test score and (2) change in the baseline to 3-month follow-up (day 84) World Health Organization Quality of Life-BREF score to assess the quality of adjusted life years. Process evaluation measures include (1) app use and (2) usability ratings as measured by the mHealth App Usability Questionnaire. The primary and secondary outcomes will also be reassessed at the 6-month follow-up (day 168) to assess the longer-term benefits of the intervention, which will be reported as a secondary outcome. Results: The study will begin recruitment in October 2020 and is expected to require 12 months to complete. The study results will be published in 2022. Conclusions: This study assesses whether a smartphone app is efficacious in reducing self-reported alcohol consumption in a veteran population that has sought help through Combat Stress using personalized messaging and interactive features. This innovative approach, if successful, may provide a means to deliver a low-cost health promotion program that has the potential to reach large groups, in particular those who are geographically dispersed, such as military personnel. Trial Registration: ClinicalTrials.gov NCT04494594; https://clinicaltrials.gov/ct2/show/NCT04494594 International Registered Report Identifier (IRRID): PRR1-10.2196/19720 %M 33006569 %R 10.2196/19720 %U https://www.researchprotocols.org/2020/10/e19720 %U https://doi.org/10.2196/19720 %U http://www.ncbi.nlm.nih.gov/pubmed/33006569 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e16780 %T User Experiences of a Smartphone-Based Attentive Eating App and Their Association With Diet and Weight Loss Outcomes: Thematic and Exploratory Analyses From a Randomized Controlled Trial %A Whitelock,Victoria %A Kersbergen,Inge %A Higgs,Suzanne %A Aveyard,Paul %A Halford,Jason CG %A Robinson,Eric %+ Department of Psychological Sciences, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, United Kingdom, 44 (0)151 794 1187, eric.robinson@liv.ac.uk %K attentive eating %K weight loss %K smartphone app %K eHealth %K mHealth %K food intake %K obesity %K overweight %K focused attention %K participant experience %D 2020 %7 2.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Short-term laboratory studies suggest that eating attentively can reduce food intake. However, in a recent randomized controlled trial we found no evidence that using an attentive eating smartphone app outside of the laboratory had an effect on energy intake or weight loss over 8 weeks. Objective: This research examined trial participants’ experiences of using an attentive eating smartphone app and whether app usage was associated with energy intake and weight loss outcomes over 8 weeks. Methods: We conducted thematic analysis of semistructured interviews (N=38) among participants in the attentive eating smartphone app group of the trial who completed the 8-week assessment. Linear regression models examined the associations between energy intake and weight loss outcomes at 8 weeks and app usage. Results: Participants reported several barriers and facilitators to using the smartphone app, including repetition of app content, social setting, motivation, and habitual use of the app. Participants believed that using the app had some beneficial effects on their eating behavior and diet. Exploratory analyses indicated that more frequent recording of eating episodes in the app was associated with lower body weight (B=–0.02, P=.004) and greater self-reported energy intake (B=5.98, P=.01) at 8 weeks, but not body fat percentage or taste-test energy intake. Total audio clip plays, gallery views, and percentage of food entries recorded using an image were not significantly associated with energy intake or weight. Conclusions: Frequent recording of eating episodes in a smartphone app was associated with greater weight loss. There are barriers and facilitators to frequent use of an attentive eating smartphone app that may be useful to address when designing dietary behavior change smartphone apps. Trial Registration: ClinicalTrials.gov NCT03602001; https://clinicaltrials.gov/ct2/show/NCT03602001; Open Science Framework DOI 10.17605/osf.io/btzhw; https://osf.io/btzhw/ %M 33006564 %R 10.2196/16780 %U https://mhealth.jmir.org/2020/10/e16780 %U https://doi.org/10.2196/16780 %U http://www.ncbi.nlm.nih.gov/pubmed/33006564 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e21676 %T Development and Acceptability of a Method to Investigate Prescription Drug Misuse in Daily Life: Ecological Momentary Assessment Study %A Papp,Lauren M %A Barringer,Alexandra %A Blumenstock,Shari M %A Gu,Pamela %A Blaydes,Madison %A Lam,Jaime %A Kouros,Chrystyna D %+ Department of Human Development and Family Studies, University of Wisconsin-Madison, 1300 Linden Drive, Madison, WI, 53706, United States, 1 608 262 8611, papp@wisc.edu %K compliance %K ecological momentary assessment %K prescription drug misuse %K young adult %D 2020 %7 1.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Prescription drug misuse and abuse is an established public health challenge, and young adults are particularly affected. There is a striking lack of real-time, naturalistic data collection assessing intentions to misuse and other precipitating factors at the time of actual misuse, leaving the conditions under which individuals are most likely to misuse prescription medications unknown. Ecological momentary assessment (EMA) apps and protocols designed to capture this information would accelerate and expand the knowledge base and could directly contribute to prevention and treatment efforts. Objective: The objectives of this study are to describe the development and administration of a mobile app and the EMA protocol designed to collect real-time factors associated with college students’ prescription drug misuse intentions and behaviors in daily life; present completion rates, compliance, acceptability, and reactivity associated with the EMA protocol for participants who endorsed recent prescription drug misuse at screening (ie, risk group; n=300) and those who did not (ie, nonrisk group; n=55); and establish initial construct validity by linking the reports of misuse behaviors in daily life collected via the EMA app to prescription drug misuse reported on a standard survey. Methods: An EMA data collection app and protocol were designed specifically to capture hypothesized contextual factors along with prescription drug misuse intentions and behaviors in daily life. Using this protocol, young adult college students (N=352) completed signal- and event-contingent reports over a 28-day period. When the intention to misuse a prescription drug was endorsed, a brief follow-up prompt was sent 15 min later to collect participants’ indications of whether or not misuse had occurred. Results: Risk-group participants were significantly more likely than nonrisk counterparts to endorse any prescription drug misuse intentions in daily life (P<.001), to complete one or more follow-up reports (P<.001), and to endorse any prescription drug misuse behavior in daily life on the follow-ups (P<.001). Overall, participants demonstrated consistent engagement with the EMA procedures and returned an average of 74.5 (SD 23.82; range 10-122) reports. Participants in the risk and nonrisk groups did not differ in the number of reports they completed (P=.12), the number of their reporting days (P=.32), or their average completion rates (P=.14). The results indicated some evidence of reactivity to the momentary reporting procedure. Participants reported uniformly positive experiences and remained highly engaged throughout the reporting protocol and broader study. Conclusions: The novel EMA app and protocol provide an effective way to assess real-time factors associated with prescription drug misuse intentions and behaviors in daily life. The resulting investigations offer the potential to provide highly translatable information for research and prevention efforts. %M 32877351 %R 10.2196/21676 %U https://mhealth.jmir.org/2020/10/e21676 %U https://doi.org/10.2196/21676 %U http://www.ncbi.nlm.nih.gov/pubmed/32877351 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e18505 %T Excessive Smartphone Use and Self-Esteem Among Adults With Internet Gaming Disorder: Quantitative Survey Study %A Kim,Hyunmin %A Choi,In Young %A Kim,Dai-Jin %+ Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, 222 Banpo-daero, Seocho-gu, Seoul, Republic of Korea, 82 2258 7870, iychoi@catholic.ac.kr %K excessive smartphone use %K internet gaming disorder %K smartphone overuse %K self-esteem %K mental health %K gender difference %K Korean smartphone addiction proneness scale %K smartphone %K gaming %K young adult %K adult %K gender %D 2020 %7 29.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone overuse can harm individual health and well-being. Although several studies have explored the relationship between problematic or excessive smartphone use and mental health, much less is known about effects on self-esteem, which is essential in having a healthy life, among adults with mental health disorders, including internet gaming disorder. Furthermore, given that smartphone usage differs by gender, little is known about gender differences in the relationship between smartphone overuse and self-esteem. Objective: The objective of this study was to assess self-esteem among individuals with mental health disorders and explore the relationship with excessive smartphone use. Methods: Participants were selected based on their responses to the internet gaming disorder assessment, which includes 9 items developed based on Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria, from among a Korean cohort of smartphone users aged 20-40 years, resulting in a sample of 189 participants (men:120, women: 69). The Rosenberg self-esteem scale and the Korean smartphone addiction proneness scale were utilized to assess the outcome self-esteem with excessive smartphone use as the primary independent variable. Guided by the Bowlby attachment theory and prior studies, we selected several covariates. Generalized linear regression analyses, as well as subgroup analyses by gender, were performed. Results: Among adults with internet gaming disorder, the average Korean smartphone addiction proneness scale score was significantly higher in women than that in men (41.30 vs. 37.94; P=.001), and excessive smartphone use was significantly more prevalent in women than it was in men (30.43% vs. 20.83%; P=.02). Our findings from the generalized linear regression analyses indicated that an increase in Korean smartphone addiction proneness scale score had a negative relationship with self-esteem among those with internet gaming disorder (β=–0.18, P=.001). Furthermore, our interaction models showed that, among those with internet gaming disorder, more men than women had lower self-esteem associated with an increase in Korean smartphone addiction proneness scale score and a high degree of smartphone overuse (β=–0.19, P=.004; β=–3.73, P<.001). Conclusions: Excessive smartphone use was found to be adversely associated with self-esteem among young and middle-aged adults with internet gaming disorder; notably, more men than women were negatively influenced (regarding self-esteem) by smartphone overuse. Based on our findings, more efforts should be made to reduce excessive or problematic smartphone use by considering developing public health interventions or policy, particularly among those with mental health disorders such as internet gaming disorder. %M 32990637 %R 10.2196/18505 %U https://mhealth.jmir.org/2020/9/e18505 %U https://doi.org/10.2196/18505 %U http://www.ncbi.nlm.nih.gov/pubmed/32990637 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e22142 %T The Relation Between Official WhatsApp-Distributed COVID-19 News Exposure and Psychological Symptoms: Cross-Sectional Survey Study %A Liu,Jean C J %A Tong,Eddie M W %+ Yale-NUS College, 02-221, 16 College Avenue West, Singapore, 138527, Singapore, 65 66013694, jeanliu@yale-nus.edu.sg %K mental health %K social media %K pandemic %K depression %K anxiety %K stress %K COVID-19 %K app %K risk factor %K psychology %D 2020 %7 25.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In a global pandemic, digital technology offers innovative methods to disseminate public health messages. As an example, the messenger app WhatsApp was adopted by both the World Health Organization and government agencies to provide updates on the coronavirus disease (COVID-19). During a time when rumors and excessive news threaten psychological well-being, these services allow for rapid transmission of information and may boost resilience. Objective: In this study, we sought to accomplish the following: (1) assess well-being during the pandemic; (2) replicate prior findings linking exposure to COVID-19 news with psychological distress; and (3) examine whether subscription to an official WhatsApp channel can mitigate this risk. Methods: Across 8 weeks of the COVID-19 outbreak (March 7 to April 21, 2020), we conducted a survey of 1145 adults in Singapore. As the primary outcome measure, participants completed the Depression, Anxiety, and Stress Scale (DASS-21). As predictor variables, participants also answered questions pertaining to the following: (1) their exposure to COVID-19 news; (2) their use of the Singapore government’s WhatsApp channel; and (3) their demographics. Results: Within the sample, 7.9% of participants had severe or extremely severe symptoms on at least one DASS-21 subscale. Depression scores were associated with increased time spent receiving COVID-19 updates, whereas use of the official WhatsApp channel emerged as a protective factor (b=–0.07, t[863]=–2.04, P=.04). Similarly, increased anxiety scores were associated with increased exposure to both updates and rumors, but this risk was mitigated by trust in the government’s WhatsApp messages (b=–0.05, t[863]=–2.13, P=.03). Finally, although stress symptoms increased with the amount of time spent receiving updates, these symptoms were not significantly related to WhatsApp use. Conclusions: Our findings suggest that messenger apps may be an effective medium for disseminating pandemic-related information, allowing official agencies to reach a broad sector of the population rapidly. In turn, this use may promote public well-being amid an “infodemic.” Trial Registration: ClinicalTrials.gov NCT04305574; https://clinicaltrials.gov/ct2/show/NCT04305574 %M 32877349 %R 10.2196/22142 %U http://www.jmir.org/2020/9/e22142/ %U https://doi.org/10.2196/22142 %U http://www.ncbi.nlm.nih.gov/pubmed/32877349 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19992 %T Using Smartphones and Wearable Devices to Monitor Behavioral Changes During COVID-19 %A Sun,Shaoxiong %A Folarin,Amos A %A Ranjan,Yatharth %A Rashid,Zulqarnain %A Conde,Pauline %A Stewart,Callum %A Cummins,Nicholas %A Matcham,Faith %A Dalla Costa,Gloria %A Simblett,Sara %A Leocani,Letizia %A Lamers,Femke %A Sørensen,Per Soelberg %A Buron,Mathias %A Zabalza,Ana %A Guerrero Pérez,Ana Isabel %A Penninx,Brenda WJH %A Siddi,Sara %A Haro,Josep Maria %A Myin-Germeys,Inez %A Rintala,Aki %A Wykes,Til %A Narayan,Vaibhav A %A Comi,Giancarlo %A Hotopf,Matthew %A Dobson,Richard JB %A , %+ The Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, PO Box 80 De Crespigny Park, Denmark Hill, London, SE58AF, United Kingdom, 44 02078480951, shaoxiong.sun@kcl.ac.uk %K mobile health %K COVID-19 %K behavioral monitoring %K smartphones %K wearable devices %K mobility %K phone use %D 2020 %7 25.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In the absence of a vaccine or effective treatment for COVID-19, countries have adopted nonpharmaceutical interventions (NPIs) such as social distancing and full lockdown. An objective and quantitative means of passively monitoring the impact and response of these interventions at a local level is needed. Objective: We aim to explore the utility of the recently developed open-source mobile health platform Remote Assessment of Disease and Relapse (RADAR)–base as a toolbox to rapidly test the effect and response to NPIs intended to limit the spread of COVID-19. Methods: We analyzed data extracted from smartphone and wearable devices, and managed by the RADAR-base from 1062 participants recruited in Italy, Spain, Denmark, the United Kingdom, and the Netherlands. We derived nine features on a daily basis including time spent at home, maximum distance travelled from home, the maximum number of Bluetooth-enabled nearby devices (as a proxy for physical distancing), step count, average heart rate, sleep duration, bedtime, phone unlock duration, and social app use duration. We performed Kruskal-Wallis tests followed by post hoc Dunn tests to assess differences in these features among baseline, prelockdown, and during lockdown periods. We also studied behavioral differences by age, gender, BMI, and educational background. Results: We were able to quantify expected changes in time spent at home, distance travelled, and the number of nearby Bluetooth-enabled devices between prelockdown and during lockdown periods (P<.001 for all five countries). We saw reduced sociality as measured through mobility features and increased virtual sociality through phone use. People were more active on their phones (P<.001 for Italy, Spain, and the United Kingdom), spending more time using social media apps (P<.001 for Italy, Spain, the United Kingdom, and the Netherlands), particularly around major news events. Furthermore, participants had a lower heart rate (P<.001 for Italy and Spain; P=.02 for Denmark), went to bed later (P<.001 for Italy, Spain, the United Kingdom, and the Netherlands), and slept more (P<.001 for Italy, Spain, and the United Kingdom). We also found that young people had longer homestay than older people during the lockdown and fewer daily steps. Although there was no significant difference between the high and low BMI groups in time spent at home, the low BMI group walked more. Conclusions: RADAR-base, a freely deployable data collection platform leveraging data from wearables and mobile technologies, can be used to rapidly quantify and provide a holistic view of behavioral changes in response to public health interventions as a result of infectious outbreaks such as COVID-19. RADAR-base may be a viable approach to implementing an early warning system for passively assessing the local compliance to interventions in epidemics and pandemics, and could help countries ease out of lockdown. %M 32877352 %R 10.2196/19992 %U https://www.jmir.org/2020/9/e19992 %U https://doi.org/10.2196/19992 %U http://www.ncbi.nlm.nih.gov/pubmed/32877352 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19716 %T Mobile Insight in Risk, Resilience, and Online Referral (MIRROR): Psychometric Evaluation of an Online Self-Help Test %A van Herpen,Merel Marjolein %A Boeschoten,Manon A %A te Brake,Hans %A van der Aa,Niels %A Olff,Miranda %+ ARQ Centre of Expertise for the Impact of Disasters and Crises, Nienoord 5, Diemen, , Netherlands, 31 610082023, m.van.herpen@impact.arq.org %K potentially traumatic events %K mobile mental health %K self-help %K online %K resilience %K posttraumatic stress disorder %D 2020 %7 25.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Most people who experience a potentially traumatic event (PTE) recover on their own. A small group of individuals develops psychological complaints, but this is often not detected in time or guidance to care is suboptimal. To identify these individuals and encourage them to seek help, a web-based self-help test called Mobile Insight in Risk, Resilience, and Online Referral (MIRROR) was developed. MIRROR takes an innovative approach since it integrates both negative and positive outcomes of PTEs and time since the event and provides direct feedback to the user. Objective: The goal of this study was to assess MIRROR’s use, examine its psychometric properties (factor structure, internal consistency, and convergent and divergent validity), and evaluate how well it classifies respondents into different outcome categories compared with reference measures. Methods: MIRROR was embedded in the website of Victim Support Netherlands so visitors could use it. We compared MIRROR’s outcomes to reference measures of PTSD symptoms (PTSD Checklist for DSM-5), depression, anxiety, stress (Depression Anxiety Stress Scale–21), psychological resilience (Resilience Evaluation Scale), and positive mental health (Mental Health Continuum Short Form). Results: In 6 months, 1112 respondents completed MIRROR, of whom 663 also completed the reference measures. Results showed good internal consistency (interitem correlations range .24 to .55, corrected item-total correlations range .30 to .54, and Cronbach alpha coefficient range .62 to .68), and convergent and divergent validity (Pearson correlations range –.259 to .665). Exploratory and confirmatory factor analyses (EFA+CFA) yielded a 2-factor model with good model fit (CFA model fit indices: χ219=107.8, P<.001, CFI=.965, TLI=.948, RMSEA=.065), conceptual meaning, and parsimony. MIRROR correctly classified respondents into different outcome categories compared with the reference measures. Conclusions: MIRROR is a valid and reliable self-help test to identify negative (PTSD complaints) and positive outcomes (psychosocial functioning and resilience) of PTEs. MIRROR is an easily accessible online tool that can help people who have experienced a PTE to timely identify psychological complaints and find appropriate support, a tool that might be highly needed in times like the coronavirus pandemic. %M 32975521 %R 10.2196/19716 %U http://www.jmir.org/2020/9/e19716/ %U https://doi.org/10.2196/19716 %U http://www.ncbi.nlm.nih.gov/pubmed/32975521 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e18491 %T Development and Evaluation of an Accelerometer-Based Protocol for Measuring Physical Activity Levels in Cancer Survivors: Development and Usability Study %A Crane,Tracy E %A Skiba,Meghan B %A Miller,Austin %A Garcia,David O %A Thomson,Cynthia A %+ Department of Biobehavioral Health Sciences, College of Nursing, University of Arizona, 1305 N Martin Ave, Tucson, AZ, 85721, United States, 1 5203310120, tecrane@email.arizona.edu %K wearable electronic devices %K physical activity %K cancer survivors %K activity trackers %K mobile phone %D 2020 %7 24.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The collection of self-reported physical activity using validated questionnaires has known bias and measurement error. Objective: Accelerometry, an objective measure of daily activity, increases the rigor and accuracy of physical activity measurements. Here, we describe the methodology and related protocols for accelerometry data collection and quality assurance using the Actigraph GT9X accelerometer data collection in a convenience sample of ovarian cancer survivors enrolled in GOG/NRG 0225, a 24-month randomized controlled trial of diet and physical activity intervention versus attention control. Methods: From July 2015 to December 2019, accelerometers were mailed on 1337 separate occasions to 580 study participants to wear at 4 time points (baseline, 6, 12, and 24 months) for 7 consecutive days. Study staff contacted participants via telephone to confirm their availability to wear the accelerometers and reviewed instructions and procedures regarding the return of the accelerometers and assisted with any technology concerns. Results: We evaluated factors associated with wear compliance, including activity tracking, use of a mobile app, and demographic characteristics with chi-square tests and logistic regression. Compliant data, defined as ≥4 consecutive days with ≥10 hours daily wear time, exceeded 90% at all study time points. Activity tracking, but no other characteristics, was significantly associated with compliant data at all time points (P<.001). This implementation of data collection through accelerometry provided highly compliant and usable activity data in women who recently completed treatment for ovarian cancer. Conclusions: The high compliance and data quality associated with this protocol suggest that it could be disseminated to support researchers who seek to collect robust objective activity data in cancer survivors residing in a wide geographic area. %M 32969828 %R 10.2196/18491 %U http://mhealth.jmir.org/2020/9/e18491/ %U https://doi.org/10.2196/18491 %U http://www.ncbi.nlm.nih.gov/pubmed/32969828 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e17685 %T Mobile Fitness and Weight Management Apps: Protocol for a Quality Evaluation %A Milne-Ives,Madison %A Lam,Ching %A van Velthoven,Michelle %A Meinert,Edward %+ Centre for Health Technology, Faculty of Health, University of Plymouth, 6 Kirkby Place, Plymouth, PL4 8AA, United Kingdom, 44 1752 600600, edward.meinert@plymouth.ac.uk %K mobile apps %K telemedicine %K smartphone %K exercise %K weight loss %K obesity %K physical fitness %K fitness trackers %D 2020 %7 24.9.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Obesity is a contributing factor for many noncommunicable diseases and a growing problem worldwide. Many mobile apps have been developed to help users improve their fitness and weight management behaviors. However, the speed at which apps are created and updated means that it is important to periodically assess their quality. Objective: The purpose of this study is to evaluate the quality of fitness and weight management mobile health apps using the Mobile Application Rating Scale (MARS). It will also describe the features of the included apps and compare the results to a previous evaluation conducted in 2015. Methods: Searches for “fitness,” “weight,” “exercise,” “physical activity,” “diet,” “eat*,” and “food” will be conducted in the Apple App Store and Google Play. Apps that have been updated over the past 5 years will be included. Two reviewers will rate the apps’ quality using the MARS objective and subjective quality subscales. Interrater reliability will also be assessed. Features included in high-quality apps will be assessed, and changes in quality, features, and behavior change techniques made during the past 5 years will be described. Results: The results will be included in the evaluation paper, which we aim to publish in 2020. Conclusions: This evaluation will assess the quality of currently available fitness and weight management apps. International Registered Report Identifier (IRRID): PRR1-10.2196/17685 %M 32969830 %R 10.2196/17685 %U http://www.researchprotocols.org/2020/9/e17685/ %U https://doi.org/10.2196/17685 %U http://www.ncbi.nlm.nih.gov/pubmed/32969830 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e16958 %T SMS Text Messages for Parents for the Prevention of Child Drowning in Bangladesh: Acceptability Study %A Hossain,Md Mosharaf %A Mani,Kulanthayan %A Mat Min,Ruhani %+ Safe Kids Malaysia and Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia, 60 0397692398, kulan@upm.edu.my %K acceptability %K SMS %K drowning %K parents %D 2020 %7 23.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In many cases, greater use is being made of mobile phone text messages as a means of communication between patients and health care providers in countries around the world. Objective: We studied the use of mobile phones and the factors related to the acceptability of text messages for parents for the prevention of child drowning in Bangladesh. Methods: From a randomized controlled trial involving 800 parents, 10% (80/800) were selected, and socioeconomic status, mobile phone use, and acceptability of SMS text messages for drowning prevention were measured. Participants with at least one child under 5 years of age were selected from rural areas in Rajshahi District in Bangladesh. Mobile phone–based SMS text messages were sent to the participants. Multivariate regression was used to determine the factors related to the acceptability of text messages for the prevention of child drowning in Bangladesh. Results: The acceptability of SMS text messages for the prevention of child drowning in Bangladesh was significantly lower among women (odds ratio [OR] 0.50, 95% CI 0.12-1.96, P=.02) than among men, lower for parents older than 30 years (OR 0.17, 95% CI 0.14-1.70, P=.01) compared to parents younger than 30 years, higher among parents who had an education (OR 1.63, 95% CI 1.11-5.80, P=.04) than among illiterate parents, and higher among parents with a monthly household income over 7000 Bangladeshi Taka (approximately US $82.54; OR 1.27, 95% CI 1.06-1.96, P=.05) than among parents whose monthly income was less than 7000 Bangladeshi Taka. Conclusions: The high percentage of mobile phone use and the acceptability of SMS text messages for parents for the prevention of child drowning are encouraging, in terms of identifying the best strategy for using such technologies, and deserve further evaluation. %M 32965224 %R 10.2196/16958 %U http://mhealth.jmir.org/2020/9/e16958/ %U https://doi.org/10.2196/16958 %U http://www.ncbi.nlm.nih.gov/pubmed/32965224 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 3 %N 2 %P e16639 %T Feasibility of Using a Single Heart Rate–Based Measure for Real-time Feedback in a Voluntary Deep Breathing App for Children: Data Collection and Algorithm Development %A Petersen,Christian L %A Görges,Matthias %A Todorova,Evgenia %A West,Nicholas C %A Newlove,Theresa %A Ansermino,J Mark %+ Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Rm V3-324, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada, 1 6048752000 ext 5616, mgorges@bcchr.ca %K pediatric pain %K respiratory sinus arrhythmia %K biofeedback %K pulse oximetry %K mobile health %K anxiety %K diaphragmatic breathing %K self-regulation %D 2020 %7 23.9.2020 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Deep diaphragmatic breathing, also called belly breathing, is a popular behavioral intervention that helps children cope with anxiety, stress, and their experience of pain. Combining physiological monitoring with accessible mobile technology can motivate children to comply with this intervention through biofeedback and gaming. These innovative technologies have the potential to improve patient experience and compliance with strategies that reduce anxiety, change the experience of pain, and enhance self-regulation during distressing medical procedures. Objective: The aim of this paper was to describe a simple biofeedback method for quantifying breathing compliance in a mobile smartphone app. Methods: A smartphone app was developed that combined pulse oximetry with an animated protocol for paced deep breathing. We collected photoplethysmogram data during spontaneous and subsequently paced deep breathing in children. Two measures, synchronized respiratory sinus arrhythmia (RSAsync) and the corresponding relative synchronized inspiration/expiration heart rate ratio (HR-I:Esync), were extracted from the photoplethysmogram. Results: Data collected from 80 children aged 5-17 years showed a positive RSAsync effect in all participants during paced deep breathing, with a median (IQR; range) HR-I:Esync ratio of 1.26 (1.16-1.35; 1.01-1.60) during paced deep breathing compared to 0.98 (0.96-1.02; 0.82-1.18) during spontaneous breathing (median difference 0.25, 95% CI 0.23-0.30; P<.001). The measured HR-I:Esync values appeared to be independent of age. Conclusions: An HR-I:Esync level of 1.1 was identified as an age-independent threshold for programming the breathing pattern for optimal compliance in biofeedback. %M 33393917 %R 10.2196/16639 %U http://periop.jmir.org/2020/2/e16639/ %U https://doi.org/10.2196/16639 %U http://www.ncbi.nlm.nih.gov/pubmed/33393917 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19923 %T Determinants of Scale-up From a Small Pilot to a National Electronic Immunization Registry in Vietnam: Qualitative Evaluation %A Dang,Huyen %A Dao,Sang %A Carnahan,Emily %A Kawakyu,Nami %A Duong,Hong %A Nguyen,Trung %A Nguyen,Doan %A Nguyen,Linh %A Rivera,Maya %A Ngo,Tuan %A Werner,Laurie %A Nguyen,Nga %+ PATH, #1101, 11th Floor, Hanoi Towers, 49 Hai Bai Trung Street, Hoan Kiem District, Hanoi, , Vietnam, 84 24 3936 2216 ext 105, ntnguyen@path.org %K immunization %K immunization information system %K electronic immunization registry %K scale-up %K digital health intervention %K mHealth %K eHealth %D 2020 %7 22.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health innovations can improve health system performance, yet previous experience has shown that many innovations do not advance beyond the pilot stage to achieve scale. Vietnam’s National Immunization Information System (NIIS) began as a series of digital health pilots, first initiated in 2010, and was officially launched nationwide in 2017. The NIIS is one of the few examples of an electronic immunization registry (EIR) at national scale in low- and middle-income countries. Objective: The aim of this study was to understand the determinants of scale-up of the national EIR in Vietnam. Methods: This qualitative study explored the facilitators and barriers to national scale-up of the EIR in Vietnam. Qualitative data were collected from October to December 2019 through in-depth key informant interviews and desk review. The mHealth Assessment and Planning for Scale (MAPS) Toolkit guided the development of the study design, interview guides, and analytic framework. MAPS defines the key determinants of success, or the “axes of scale,” to be groundwork, partnerships, financial health, technology and architecture, operations, and monitoring and evaluation. Results: The partnership and operations axes were critical to the successful scale-up of the EIR in Vietnam, while the groundwork and monitoring and the evaluation axes were considered to be strong contributors in the success of all the other axes. The partnership model leveraged complementary strengths of the technical working group partners: the Ministry of Health General Department of Preventive Medicine, the National Expanded Program on Immunization, Viettel (the mobile network operator), and PATH. The operational approach to introducing the NIIS with lean, iterative, and integrated training and supervision was also a key facilitator to successful scale-up. The financial health, technology and architecture, and operations axes were identified as barriers to successful deployment and scale-up. Key barriers to scale-up included insufficient estimates of operational costs, unanticipated volume of data storage and transmission, lack of a national ID to support interoperability, and operational challenges among end users. Overall, the multiple phases of EIR deployment and scale-up from 2010 to 2017 allowed for continuous learning and improvement that strengthened all the axes and contributed to successful scale-up. Conclusions: The results highlight the importance of the measured, iterative approach that was taken to gradually expand a series of small pilots to nationwide scale. The findings from this study can be used to inform other countries considering, introducing, or in the process of scaling an EIR or other digital health innovations. %M 32960184 %R 10.2196/19923 %U http://www.jmir.org/2020/9/e19923/ %U https://doi.org/10.2196/19923 %U http://www.ncbi.nlm.nih.gov/pubmed/32960184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e15307 %T Identifying Mobile Health Engagement Stages: Interviews and Observations for Developing Brief Message Content %A Burns,Kara %A Nicholas,Rebekah %A Beatson,Amanda %A Chamorro-Koc,Marianella %A Blackler,Alethea %A Gottlieb,Udo %+ School of Advertising, Marketing and Public Relations, QUT Business School, Queensland University of Technology, George St, Brisbane, QLD, 4000, Australia, 61 414294967, drkaraburns@gmail.com %K mobile health %K text messaging %K social media %K mobile phone %K health communication %D 2020 %7 22.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Interest in mobile health (mHealth) has increased recently, and research suggests that mHealth devices can enhance end-user engagement, especially when used in conjunction with brief message content. Objective: This research aims to explore the stages of engagement framework for mHealth devices and develop a method to generate brief message content to promote sustained user engagement. This study uses the framework by O’Brien and Toms as a point of departure, where engagement is defined as the uptake or the use of an mHealth device. The framework is a linear repeatable process, including point of engagement, period of engagement, disengagement, and re-engagement. Each stage is characterized by attributes related to a person’s technology experience. Although the literature has identified stages of engagement for health-related technology, few studies explore mHealth engagement. Furthermore, little research has determined a method for creating brief message content at each stage in this engagement journey. Methods: Interviews and observations from 19 participants who used mHealth technologies (apps, devices, or wellness websites) in a solo capacity were recruited for sample group 1. In sample group 2, interviews, and observations from 25 participants using mHealth technologies in a group capacity through the Global Corporate Challenge were used. These samples were investigated at 3 time points in both research contexts. The results underwent deductive-inductive thematic analysis for the engagement stages’ framework and attributes. Results: In addition to the 4 stages identified by O’Brien and Toms, 2 additional stages, self-management and limited engagement, were identified. Self-management captures where users had disengaged from their technology but were still engaged with their health activity. Limited engagement captures where group mHealth users had minimal interaction with their mHealth technology but continued to engage in a group fitness activity. The results revealed that mHealth engagement stages were nonlinear and embedded in a wider engagement context and that each stage was characterized by a combination of 49 attributes that could be organized into 8 themes. Themes documented the total user experience and included technology usability, technology features, technology aesthetics, use motivations, health awareness, goal setting, social support, and interruptions. Different themes were found to have more relevance at different engagement stages. Knowing themes and attributes at all engagement stages allows technology developers and health care professionals to generate relevant brief message content informed by a person-centered approach. Conclusions: This research extends an existing engagement stages framework and identifies attributes and themes relevant to mHealth technology users’ total user experience and incorporates concepts derived from health, business studies, and information systems literature. In addition, we offer a practical 5-step process based on a person-centered approach to develop mHealth technology brief message content for sustained engagement. %M 32960181 %R 10.2196/15307 %U http://www.jmir.org/2020/9/e15307/ %U https://doi.org/10.2196/15307 %U http://www.ncbi.nlm.nih.gov/pubmed/32960181 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e18106 %T Mobile-Enhanced Prevention Support Study for Men Who Have Sex With Men and Transgender Women Leaving Jail: Protocol for a Randomized Controlled Trial %A Edwards,Gabriel G %A Reback,Cathy J %A Cunningham,William E %A Hilliard,Charles L %A McWells,Charles %A Mukherjee,Sukrit %A Weiss,Robert E %A Harawa,Nina T %+ Department of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, 1100 Glendon Ave Suite 850, Los Angeles, CA, 90024, United States, 1 310 267 0609, gedwards@mednet.ucla.edu %K HIV %K MSM %K transgender women %K peer navigation %K jail %K substance use disorder %K eHealth %K PrEP %K sexually transmitted infections %K hepatitis C %K mobile phone %K smartphone %D 2020 %7 22.9.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Men who have sex with men (MSM) and transgender women, particularly those who have experienced criminal justice involvement, have particularly high HIV burdens, and a majority of those in jail have substance use disorders (SUDs). MSM and transgender women also experience elevated rates of incarceration. Once community re-entry occurs, individuals are in a critical period for addressing potential risks of HIV and sexually transmitted infection (STI) acquisition and negative sequelae of substance use. Further, the impact experienced by one’s social and sexual networks experienced at the time of detention and release have important health implications for MSM and transgender women. Objective: The purpose of this study is to test a new intervention—Mobile-Enhanced Prevention Support (MEPS)—that involves a GPS-based mobile app called GeoPassport (referred to as GeoPass in practice), incentives, and peer support for promoting HIV prevention, substance use treatment, and use of related services. Methods: A two-arm, unblinded, randomized controlled trial will seek to enroll 300 HIV-negative MSM and transgender women, aged 18-49 years, with SUDs, who are either in jail or have recently left jail. Participants will be enrolled by study staff and randomized to the MEPS intervention group or usual care group. The intervention group will receive customized wellness goals in addition to GeoPass, cash incentives, and the support of a trained peer mentor for 6 months. Data collection will consist of a baseline survey and three follow-up surveys at 3, 6, and 9 months postenrollment, either in person or by phone or videoconference when necessary. The primary outcomes include establishing a primary care provider; being prescribed and adhering to pre-exposure prophylaxis (PrEP) for HIV; screening for HIV, STIs, and hepatitis C virus; and engagement in recommended treatment for SUDs. Secondary outcomes include obtaining treatment for any identified infections and avoiding recidivism. Results: Enrollment began in November 2019 and study completion is expected in 2023. Conclusions: This study will advance our knowledge base on patient navigation and peer mentor interventions. Peer navigation services have been studied for the treatment of HIV, but less often in the context of HIV and STI prevention among sexual and gender minority populations at the time of re-entry into the community from jail. The MEPS study will examine the acceptability and feasibility of combining peer mentor services with a mobile app to facilitate service utilization and participant–peer mentor communication. MEPS will assess patterns of PrEP uptake and utilization in MSM and transgender women leaving jail. The study will provide heretofore unavailable data from persons leaving jail regarding HIV PrEP, STI screening, substance abuse treatment, and service utilization patterns and experiences, including geocoded data for those in the intervention arm. Trial Registration: ClinicalTrials.gov (NCT04036396); https://www.clinicaltrials.gov/ct2/show/NCT04036396 International Registered Report Identifier (IRRID): PRR1-10.2196/18106 %M 32959786 %R 10.2196/18106 %U http://www.researchprotocols.org/2020/9/e18106/ %U https://doi.org/10.2196/18106 %U http://www.ncbi.nlm.nih.gov/pubmed/32959786 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e20356 %T Social and Behavior Change Communication Interventions Delivered Face-to-Face and by a Mobile Phone to Strengthen Vaccination Uptake and Improve Child Health in Rural India: Randomized Pilot Study %A Johri,Mira %A Chandra,Dinesh %A Kone,Karna Georges %A Sylvestre,Marie-Pierre %A Mathur,Alok K %A Harper,Sam %A Nandi,Arijit %+ Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), 850, rue St-Denis, Montréal, QC, H2X0A9, Canada, 1 514 343 7318, mira.johri@umontreal.ca %K randomized controlled trial %K immunization programs %K child health %K mHealth %K health promotion %K health services accessibility %K implementation science %K pilot projects %K developing countries %K global health %D 2020 %7 21.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In resource-poor settings, lack of awareness and low demand for services constitute important barriers to expanding the coverage of effective interventions. In India, childhood immunization is a priority health strategy with suboptimal uptake. Objective: To assess study feasibility and key implementation outcomes for the Tika Vaani model, a new approach to educate and empower beneficiaries to improve immunization and child health. Methods: A cluster-randomized pilot trial with a 1:1 allocation ratio was conducted in rural Uttar Pradesh, India, from January to September 2018. Villages were randomly assigned to either the intervention or control group. In each participating village, surveyors conducted a complete enumeration to identify eligible households and requested participation before randomization. Interventions were designed through formative research using a social marketing approach and delivered over 3 months using strategies adapted to disadvantaged populations: (1) mobile health (mHealth): entertaining educational audio capsules (edutainment) and voice immunization reminders via mobile phone and (2) face-to-face: community mobilization activities, including 3 small group meetings offered to each participant. The control group received usual services. The main outcomes were prespecified criteria for feasibility of the main study (recruitment, randomization, retention, contamination, and adoption). Secondary endpoints tested equity of coverage and changes in intermediate outcomes. Statistical methods included descriptive statistics to assess feasibility, penalized logistic regression and ordered logistic regression to assess coverage, and generalized estimating equation models to assess changes in intermediate outcomes. Results: All villages consented to participate. Gaps in administrative data hampered recruitment; 14.0% (79/565) of recorded households were nonresident. Only 1.4% (8/565) of households did not consent. A total of 387 households (184 intervention and 203 control) with children aged 0 to 12 months in 26 villages (13 intervention and 13 control) were included and randomized. The end line survey occurred during the flood season; 17.6% (68/387) of the households were absent. Contamination was less than 1%. Participation in one or more interventions was 94.0% (173/184), 78.3% (144/184) for the face-to-face strategy, and 67.4% (124/184) for the mHealth strategy. Determinants including place of residence, mobile phone access, education, and female empowerment shaped intervention use; factors operated differently for face-to-face and mHealth strategies. For 11 of 13 intermediate outcomes, regression results showed significantly higher basic health knowledge among the intervention group, supporting hypothesized causal mechanisms. Conclusions: A future trial of a new intervention model is feasible. The interventions could strengthen the delivery of immunization and universal primary health care. Social and behavior change communication via mobile phones proved viable and contributed to standardization and scalability. Face-to-face interactions remain necessary to achieve equity and reach, suggesting the need for ongoing health system strengthening to accompany the introduction of communication technologies. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 44840759; https://doi.org/10.1186/ISRCTN44840759 %M 32955455 %R 10.2196/20356 %U http://mhealth.jmir.org/2020/9/e20356/ %U https://doi.org/10.2196/20356 %U http://www.ncbi.nlm.nih.gov/pubmed/32955455 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e18867 %T Breast Cancer Survivors’ Perspectives on Motivational and Personalization Strategies in Mobile App–Based Physical Activity Coaching Interventions: Qualitative Study %A Monteiro-Guerra,Francisco %A Signorelli,Gabriel Ruiz %A Rivera-Romero,Octavio %A Dorronzoro-Zubiete,Enrique %A Caulfield,Brian %+ Salumedia Tecnologías, Avda. República Argentina, nº 24 Edificio Torre de los Remedios, 5ª planta - módulo A, Seville, 41011, Spain, 34 672787858, francisco.guerra@ucdconnect.ie %K mHealth %K mobile app %K mobile phone %K coaching %K physical activity %K breast cancer %D 2020 %7 21.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite growing evidence supporting the vital benefits of physical activity (PA) for breast cancer survivors, the majority do not meet the recommended levels of activity. Mobile app–based PA coaching interventions might be a feasible strategy to facilitate adherence of breast cancer survivors to the PA guidelines. To engage these individuals, PA apps need to be specifically designed based on their needs and preferences and to provide targeted support and motivation. However, more information is needed to understand how these technologies can provide individual and relevant experiences that have the ability to increase PA adherence and retain the individual’s interest in the long term. Objective: The aim of this study is to explore insights from breast cancer survivors on motivational and personalization strategies to be used in PA coaching apps and interventions. Methods: A qualitative study was conducted, using individual semistructured interviews, with 14 breast cancer survivors. The moderator asked open-ended questions and made use of a slideshow presentation to elicit the participants’ perspectives on potential mobile app–based intervention features. Transcribed interviews were evaluated by 3 reviewers using thematic content analysis. Results: Participants (mean age 53.3, SD 8.7 years) were White women. In total, 57% (8/14) of the participants did not adhere to the PA guidelines. In general, participants had access to and were interested in using technology. The identified themes included (1) barriers to PA, (2) psychological mediators of PA motivation, (3) needs and suggestions for reinforcing motivation support, (4) personalization aspects of the PA coaching experience, and (5) technology trustworthiness. Motivational determinants included perceived control, confidence and perceived growth, and connectedness. Participants were interested in having a straightforward app for monitoring and goal setting, which would include a prescribed activity program and schedule, and positive communication. Opinions varied in terms of social and game-like system possibilities. In addition, they expressed a desire for a highly personalized coaching experience based on as much information collected from them as possible (eg, disease stage, physical limitations, preferences) to provide individualized progress information, dynamic adjustment of the training plan, and context-aware activity suggestions (eg, based on weather and location). Participants also wanted the app to be validated or backed by professionals and were willing to share their data in exchange for a more personalized experience. Conclusions: This work suggests the need to develop simple, guiding, encouraging, trustworthy, and personalized PA coaching apps. The findings are in line with behavioral and personalization theories and methods that can be used to inform intervention design decisions. This paper opens new possibilities for the design of personalized and motivating PA coaching app experiences for breast cancer survivors, which might ultimately facilitate the sustained adherence of these individuals to the recommended levels of activity. %M 32955446 %R 10.2196/18867 %U https://mhealth.jmir.org/2020/9/e18867 %U https://doi.org/10.2196/18867 %U http://www.ncbi.nlm.nih.gov/pubmed/32955446 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e17563 %T Implementing Facilitated Access to a Text Messaging, Smoking Cessation Intervention Among Swedish Patients Having Elective Surgery: Qualitative Study of Patients’ and Health Care Professionals’ Perspectives %A Thomas,Kristin %A Bendtsen,Marcus %A Linderoth,Catharina %A Bendtsen,Preben %+ Department of Health, Medicine and Caring Sciences, Linköping University, 58381, Linköping, , Sweden, 46 13282546, kristin.thomas@liu.se %K mHealth %K mobile health %K text messages %K health care %K smoking cessation %K patients with elective surgery %K implementation %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is strong evidence that short-term smoking cessation before surgery can reduce postoperative morbidity. There are, however, several structural problems in health care systems concerning how to implement smoking cessation interventions in routine practice for preoperative patients. Objective: This study aimed to analyze the implementation of a text messaging, smoking cessation intervention targeting patients having elective surgery. Implementation of facilitated access (ie, referral from practitioners) and the perceived usefulness among patients were investigated. Elective surgery is defined as scheduled, nonacute surgery. Methods: A qualitative study was carried out at two medium-sized hospitals in the south of Sweden. The implementation of facilitated access was investigated during a 12-month period from April 2018 to April 2019. Facilitated access was conceptualized as specialists recommending the text messaging intervention to patients having elective surgery. Implementation was explored in terms of perceptions about the intervention and behaviors associated with implementation; that is, how patients used the intervention and how specialists behaved in facilitating usage among patients. Two focus groups with smoking cessation specialists and 10 individual interviews with patients were carried out. Qualitative content analysis was used to analyze the data. Results: Two main categories were identified from the focus group data with smoking cessation specialists: implementation approach and perceptions about the intervention. The first category, implementation approach, referred to how specialists adapted their efforts to situational factors and to the needs and preferences of patients, and how building of trust with patients was prioritized. The second category, perceptions about the intervention, showed that specialists thought the content and structure of the text messaging intervention felt familiar and worked well as a complement to current practice. Two categories were identified from the patient interview data: incorporating new means of support from health care and determinants of use. The first category referred to how patients adopted and incorporated the intervention into their smoking cessation journey. Patients were receptive, shared the text messages with friends and family, humanized the text messages, and used the messages as a complement to other strategies to quit smoking. The second category, determinants of use, referred to aspects that influenced how and when patients used the intervention and included the following: timing of the intervention and text messages, motivation to change, and perceptions of the mobile phone medium. Conclusions: Smoking cessation specialists adopted an active role in implementing the intervention by adapting their approach and fitting the intervention into existing routines. Patients showed strong motivation to change and openness to incorporate the intervention into their behavior change journey; however, the timing of the intervention and messages were important in optimizing the support. A text messaging, smoking cessation intervention can be a valuable and feasible way to reach smoking patients having elective surgery. %M 32945772 %R 10.2196/17563 %U https://mhealth.jmir.org/2020/9/e17563 %U https://doi.org/10.2196/17563 %U http://www.ncbi.nlm.nih.gov/pubmed/32945772 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e19288 %T Promoting Health and Well-Being Through Mobile Health Technology (Roadmap 2.0) in Family Caregivers and Patients Undergoing Hematopoietic Stem Cell Transplantation: Protocol for the Development of a Mobile Randomized Controlled Trial %A Rozwadowski,Michelle %A Dittakavi,Manasa %A Mazzoli,Amanda %A Hassett,Afton L %A Braun,Thomas %A Barton,Debra L %A Carlozzi,Noelle %A Sen,Srijan %A Tewari,Muneesh %A Hanauer,David A %A Choi,Sung Won %+ Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States, 1 73461505707, sungchoi@med.umich.edu %K family caregivers %K mobile health app %K mHealth %K randomized controlled trial %K wearable wrist sensor %K hematopoietic stem cell transplantation %K HSCT %D 2020 %7 18.9.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer patients who undergo allogeneic hematopoietic stem cell transplantation are among the most medically fragile patient populations with extreme demands for caregivers. Indeed, with earlier hospital discharges, the demands placed on caregivers continue to intensify. Moreover, an increased number of allogeneic hematopoietic stem cell transplantations are being performed worldwide, and this expensive procedure has significant economic consequences. Thus, the health and well-being of family caregivers have attracted widespread attention. Mobile health technology has been shown to deliver flexible, and time- and cost-sparing interventions to support family caregivers across the care trajectory. Objective: This protocol aims to leverage technology to deliver a novel caregiver-facing mobile health intervention named Roadmap 2.0. We will evaluate the effectiveness of Roadmap 2.0 in family caregivers of patients undergoing hematopoietic stem cell transplantation. Methods: The Roadmap 2.0 intervention will consist of a mobile randomized trial comparing a positive psychology intervention arm with a control arm in family caregiver-patient dyads. The primary outcome will be caregiver health-related quality of life, as assessed by the PROMIS Global Health scale at day 120 post-transplant. Secondary outcomes will include other PROMIS caregiver- and patient-reported outcomes, including companionship, self-efficacy for managing symptoms, self-efficacy for managing daily activities, positive affect and well-being, sleep disturbance, depression, and anxiety. Semistructured qualitative interviews will be conducted among participants at the completion of the study. We will also measure objective physiological markers (eg, sleep, activity, heart rate) through wearable wrist sensors and health care utilization data through electronic health records. Results: We plan to enroll 166 family caregiver-patient dyads for the full data analysis. The study has received Institutional Review Board approval as well as Code Review and Information Assurance approval from our health information technology services. Owing to the COVID-19 pandemic, the study has been briefly put on hold. However, recruitment began in August 2020. We have converted all recruitment, enrollment, and onboarding processes to be conducted remotely through video telehealth. Consent will be obtained electronically through the Roadmap 2.0 app. Conclusions: This mobile randomized trial will determine if positive psychology-based activities delivered through mobile health technology can improve caregiver health-related quality of life over a 16-week study period. This study will provide additional data on the effects of wearable wrist sensors on caregiver and patient self-report outcomes. Trial Registration: ClinicalTrials.gov NCT04094844; https://www.clinicaltrials.gov/ct2/show/NCT04094844 International Registered Report Identifier (IRRID): PRR1-10.2196/19288 %M 32945777 %R 10.2196/19288 %U https://www.researchprotocols.org/2020/9/e19288 %U https://doi.org/10.2196/19288 %U http://www.ncbi.nlm.nih.gov/pubmed/32945777 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e18071 %T A Mobile Social Network–Based Smoking Cessation Intervention for Chinese Male Smokers: Protocol for a Pilot Randomized Controlled Trial %A Chen,Jinsong %A Ho,Elsie %A Jiang,Yannan %A Whittaker,Robyn %A Yang,Tingzhong %A Bullen,Christopher %+ The National Institute for Health Innovation, The University of Auckland, 507, University of Auckland, 22-30 Park Ave, Grafton, Auckland, 1023, New Zealand, 64 093737599, jinsong.chen@auckland.ac.nz %K mHealth %K mobile phone %K smoking cessation %K public health %D 2020 %7 18.9.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Approximately 2 million Chinese people die annually from tobacco-related diseases, mostly men; yet, fewer than 8% of Chinese smokers ever receive any smoking cessation advice or support. A social network–based gamified smoking cessation intervention (SCAMPI: Smoking Cessation App for Chinese Male: Pilot Intervention) is designed to help Chinese male smokers to quit smoking. Objective: This paper aims to present the protocol of a study examining the preliminary effectiveness of SCAMPI by comparing the prolonged abstinence rate of a group of users with a comparator group during a 6-week follow-up period. Methods: A two-arm pilot randomized controlled trial was conducted to assess the preliminary effectiveness and acceptability of the SCAMPI program as a smoking cessation intervention. After initial web-based screening, the first 80 eligible individuals who had gone through the required registration process were registered as participants of the trial. Participants were randomly allocated to the intervention group (n=40) and the control group (n=40). Participants in the intervention group used the full version of the SCAMPI program, which is a Chinese smoking cessation program developed based on the Behavior Change Wheel framework and relevant smoking cessation and design guidelines with involvement of target users. The program delivers a range of smoking cessation approaches, including helping users to make quitting plans, calculator to record quitting benefits, calendar to record progress, gamification to facilitate quitting, providing information about smoking harms, motivational messages to help users overcome urges, providing standardized tests to users for assessing their levels of nicotine dependence and lung health, and providing a platform to encourage social support between users. Participants in the control group used the restricted version of the SCAMPI program (placebo app). Results: Recruitment for this project commenced in January 2019 and proceeded until March 2019. Follow-up data collection was commenced and completed by June 2019. The primary outcome measure of the study was the 30-day bio-verified smoking abstinence at the 6-week follow-up (self-reported data verified by the Nicotine Cotinine Saliva Test). The secondary outcome measures of the study included participants’ cigarette consumption reduction (compared baseline daily cigarette consumption with end-of-trial daily cigarette consumption), participants’ 7-day smoking abstinence at 4-week and 6-week follow-up (self-reported), participants’ 30-day smoking abstinence at 6-week follow-up (self-reported data only), and participants’ acceptability and satisfaction levels of using the SCAMPI program (measured by the Mobile App Rating Scale questionnaire). Conclusions: If the SCAMPI program is shown to be preliminary effective, the study will be rolled out to be a future trial with a larger sample size and longer follow-up (6 months) to identify if it is an effective social network–based tool to support Chinese male smokers to quit smoking. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001089224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375381 International Registered Report Identifier (IRRID): RR1-10.2196/18071 %M 32945261 %R 10.2196/18071 %U http://www.researchprotocols.org/2020/9/e18071/ %U https://doi.org/10.2196/18071 %U http://www.ncbi.nlm.nih.gov/pubmed/32945261 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19627 %T Adherence of HIV Self-Testing Among Men Who Have Sex With Men in China: Longitudinal Study %A Yan,Xiangyu %A Su,Hexuan %A Zhang,Bo %A Li,Yongjie %A Zhang,Lingling %A Jia,Zhongwei %+ National Institute on Drug Dependence, Peking University, 38 Xueyuan Road, Haidian District, Beijing, , China, 86 10 82802457, urchinjj@163.com %K HIV self-testing %K adherence %K men who have sex with men %K HIV infection %K condom use %K mobile app %D 2020 %7 17.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The World Health Organization recommended HIV self-testing (HIVST) for individuals practicing unsafe sexual behaviors; however, the adherence to HIV testing has not been reported. Objective: In this study, we attempted to determine the adherence to HIVST among men who have sex with men (MSM), as well as the impact factors and potential effects of their adherence. Methods: We conducted a longitudinal study among MSM in Harbin, Heilongjiang province, China from July 1, 2017 to June 30, 2018. A mobile app system was used to provide the “Mailing rapid test reagent kit” for the HIVST service. The proportion of those who adhered to HIV testing every 3 months was calculated. Logistic regression was used to explore the impact factors related to adherence to HIVST. Rates of HIV infection between MSM who adhered to HIVST and those who did not were compared using Cox proportional hazards regression. Changes of condom use behaviors between the two groups were also compared using the chi-square test. Results: A total of 1315 MSM who received the HIVST service through the app were included in the study. Overall, 10% of the MSM adhered to HIVST, and the proportion of adhering tests was only 34.9%. Adherence of HIVST was associated with marital status (adjusted odds ratio [OR]unmarried vs married 2.31, 95% CI 1.13-4.71) and the number of HIV tests they received (adjusted OR3 times vs 2 times or below 3.36, 95% CI 2.01-5.63; adjusted OR4 times or above vs 2 times or below 7.30, 95% CI 4.67-11.42). Twenty HIV seroconversions were observed during 1-year follow up. The rate of HIV infection in the adherence group (17.10 per 100 person years, 95% CI 8.80-30.84) was significantly higher than that in the nonadherence group (4.80 per 100 person years, 95% CI 2.77-7.88; adjusted hazard ratio 3.33, 95% CI 1.35-8.20). Those who adhered to HIV testing were more likely to improve condom use behaviors, although the difference was not statistically significant. Conclusions: Regular HIV testing is necessary for early detection of HIV infection among MSM. Given the poor adherence, a new internet-based management paradigm for MSM is needed to raise their health awareness to optimize the implementation of HIVST. %M 32940619 %R 10.2196/19627 %U http://www.jmir.org/2020/9/e19627/ %U https://doi.org/10.2196/19627 %U http://www.ncbi.nlm.nih.gov/pubmed/32940619 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 3 %P e17416 %T Embedding the Pillars of Quality in Health Information Technology Solutions Using “Integrated Patient Journey Mapping” (IPJM): Case Study %A McCarthy,Stephen %A O'Raghallaigh,Paidi %A Woodworth,Simon %A Lim,Yoke Yin %A Kenny,Louise C %A Adam,Frédéric %+ Department of Business Information Systems, Cork University Business School, University College Cork, Western Road, Cork, T12 K8AF, Ireland, 353 21 490 ext 3214, stephen.mccarthy@ucc.ie %K health information technology %K health care quality %K data analytics %K multidisciplinary research %K mobile phone %D 2020 %7 17.9.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Health information technology (HIT) and associated data analytics offer significant opportunities for tackling some of the more complex challenges currently facing the health care sector. However, to deliver robust health care service improvements, it is essential that HIT solutions be designed by parallelly considering the 3 core pillars of health care quality: clinical effectiveness, patient safety, and patient experience. This requires multidisciplinary teams to design interventions that both adhere to medical protocols and achieve the tripartite goals of effectiveness, safety, and experience. Objective: In this paper, we present a design tool called Integrated Patient Journey Mapping (IPJM) that was developed to assist multidisciplinary teams in designing effective HIT solutions to address the 3 core pillars of health care quality. IPJM is intended to support the analysis of requirements as well as to promote empathy and the emergence of shared commitment and understanding among multidisciplinary teams. Methods: A 6-month, in-depth case study was conducted to derive findings on the use of IPJM during Learning to Evaluate Blood Pressure at Home (LEANBH), a connected health project that developed an HIT solution for the perinatal health context. Data were collected from over 700 hours of participant observations and 10 semistructured interviews. Results: The findings indicate that IPJM offered a constructive tool for multidisciplinary teams to work together in designing an HIT solution, through mapping the physical and emotional journey of patients for both the current service and the proposed connected health service. This allowed team members to consider the goals, tasks, constraints, and actors involved in the delivery of this journey and to capture requirements for the digital touchpoints of the connected health service. Conclusions: Overall, IPJM facilitates the design and implementation of complex HITs that require multidisciplinary participation. %M 32940610 %R 10.2196/17416 %U http://humanfactors.jmir.org/2020/3/e17416/ %U https://doi.org/10.2196/17416 %U http://www.ncbi.nlm.nih.gov/pubmed/32940610 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e21243 %T Testing Wearable UV Sensors to Improve Sun Protection in Young Adults at an Outdoor Festival: Field Study %A Horsham,Caitlin %A Antrobus,Jodie %A Olsen,Catherine M %A Ford,Helen %A Abernethy,David %A Hacker,Elke %+ School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, 4059, Australia, 61 731389674, elke.hacker@qut.edu.au %K melanoma %K health promotion %K public health %K preventive medicine %K sunlight %K sunburn %K adolescents %D 2020 %7 16.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Australia and New Zealand have the highest skin cancer incidence rates worldwide, and sun exposure is the main risk factor for developing skin cancer. Sun exposure during childhood and adolescence is a critical factor in developing skin cancer later in life. Objective: This study aims to test the effectiveness of wearable UV sensors to increase sun protection habits (SPH) and prevent sunburn in adolescents. Methods: During the weeklong school leavers outdoor festival (November 2019) at the Gold Coast, Australia, registered attendees aged 15-19 years were recruited into the field study. Participants were provided with a wearable UV sensor and free sunscreen. The primary outcome was sun exposure practices using the SPH index. Secondary outcomes were self-reported sunburns, sunscreen use, and satisfaction with the wearable UV sensor. Results: A total of 663 participants were enrolled in the study, and complete data were available for 188 participants (188/663, 28.4% response rate). Participants provided with a wearable UV sensor significantly improved their use of sunglasses (P=.004) and sunscreen use both on the face (P<.001) and on other parts of the body (P=.005). However, the use of long-sleeve shirts (P<.001) and the use of a hat (P<.001) decreased. During the study period, 31.4% (59/188) of the participants reported receiving one or more sunburns. Satisfaction with the wearable UV sensor was high, with 73.4% (138/188) of participants reporting the UV sensor was helpful to remind them to use sun protection. Conclusions: Devices that target health behaviors when outdoors, such as wearable UV sensors, may improve use of sunscreen and sunglasses in adolescents. %M 32936083 %R 10.2196/21243 %U http://mhealth.jmir.org/2020/9/e21243/ %U https://doi.org/10.2196/21243 %U http://www.ncbi.nlm.nih.gov/pubmed/32936083 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e18339 %T Mobile Phone Apps for Food Allergies or Intolerances in App Stores: Systematic Search and Quality Assessment Using the Mobile App Rating Scale (MARS) %A Mandracchia,Floriana %A Llauradó,Elisabet %A Tarro,Lucia %A Valls,Rosa Maria %A Solà,Rosa %+ Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, C/Sant Llorenç, 21, Reus, Spain, 34 977758920, lucia.tarro@urv.cat %K food allergy %K food hypersensitivity %K food intolerance %K allergens %K mobile applications %K mobile health %K mHealth %K eHealth. %D 2020 %7 16.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Food allergies and intolerances are increasing worldwide, and mobile phone apps could be a promising tool for self-management of these issues. Objective: This study aimed to systemically search and assess food allergy or intolerance apps in app stores using the multidimensional Mobile App Rating Scale (MARS) to rate the objective and subjective quality and to identify critical points for future improvements. Methods: This systematic search identified apps through the keywords “food allergy,” “food intolerance,” and “allergens” in English, Spanish, and Italian in the Apple App Store (iOS) and Google Play Store (Android). The inclusion criteria were a user star rating of ≥3 (of 5 stars) to limit the selection to the most highly rated apps; ≥1000 reviews as an indicator of reliability; and the most recent update performed up to 2017. Then, the apps were divided according to their purpose (searching for allergen-free “food products,” “restaurants,” or recipes in “meal planners”) and evaluated on a scale of 1 to 5 points using the MARS in terms of (1) app classification category with a descriptive aim; (2) app subjective and objective quality categories comprised of engagement, functionality, esthetics, and information sections (Medline was searched for eligible apps to check whether they had been tested in trials); and (3) an optional app-specific section. Furthermore, the output and input features were evaluated. Differences between MARS sections and between app purposes and correlations among MARS sections, star ratings, and numbers of reviews were evaluated. Results: Of the 1376 apps identified, 14 were included: 12 related to food allergies and intolerances that detect 2-16 food allergens and 2 related only to gluten intolerance. The mean (SD) MARS scores (maximum 5 points) were 3.8 (SD 0.4) for objective quality, highlighting whether any app had been tested in trials; 3.5 (SD 0.6) for subjective quality; and 3.6 (SD 0.7) for the app-specific section. Therefore, a rating ≥3 points indicated overall acceptable quality. From the between-section comparison, engagement (mean 3.5, SD 0.6) obtained significantly lower scores than functionality (mean 4.1, SD 0.6), esthetics (mean 4, SD 0.5), and information (mean 3.8, SD 0.4). However, when the apps were compared by purpose, critical points were identified: meal planner apps showed significantly higher engagement (mean 4.1, SD 0.4) than food product (mean 3.0, SD 0.6; P=.05) and restaurant (mean 3.2, SD 0.3; P=.02) apps. Conclusions: In this systematic search of food allergy or intolerance apps, acceptable MARS quality was identified, although the engagement section for food product and restaurant purpose apps should be improved and the included apps should be tested in trials. The critical points identified in this systematic search can help improve the innovativeness and applicability of future food allergy and intolerance apps. %M 32936078 %R 10.2196/18339 %U http://mhealth.jmir.org/2020/9/e18339/ %U https://doi.org/10.2196/18339 %U http://www.ncbi.nlm.nih.gov/pubmed/32936078 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e17977 %T Data Imputation and Body Weight Variability Calculation Using Linear and Nonlinear Methods in Data Collected From Digital Smart Scales: Simulation and Validation Study %A Turicchi,Jake %A O'Driscoll,Ruairi %A Finlayson,Graham %A Duarte,Cristiana %A Palmeira,A L %A Larsen,Sofus C %A Heitmann,Berit L %A Stubbs,R James %+ School of Psychology, The University of Leeds, 2 Lifton Place, Leeds, LS2 9JS, United Kingdom, 44 7718300764, psjt@leeds.ac.uk %K weight variability %K weight fluctuation %K weight cycling %K weight instability %K imputation %K validation %K digital tracking %K smart scales %K body weight %K energy balance %D 2020 %7 11.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Body weight variability (BWV) is common in the general population and may act as a risk factor for obesity or diseases. The correct identification of these patterns may have prognostic or predictive value in clinical and research settings. With advancements in technology allowing for the frequent collection of body weight data from electronic smart scales, new opportunities to analyze and identify patterns in body weight data are available. Objective: This study aims to compare multiple methods of data imputation and BWV calculation using linear and nonlinear approaches Methods: In total, 50 participants from an ongoing weight loss maintenance study (the NoHoW study) were selected to develop the procedure. We addressed the following aspects of data analysis: cleaning, imputation, detrending, and calculation of total and local BWV. To test imputation, missing data were simulated at random and using real patterns of missingness. A total of 10 imputation strategies were tested. Next, BWV was calculated using linear and nonlinear approaches, and the effects of missing data and data imputation on these estimates were investigated. Results: Body weight imputation using structural modeling with Kalman smoothing or an exponentially weighted moving average provided the best agreement with observed values (root mean square error range 0.62%-0.64%). Imputation performance decreased with missingness and was similar between random and nonrandom simulations. Errors in BWV estimations from missing simulated data sets were low (2%-7% with 80% missing data or a mean of 67, SD 40.1 available body weights) compared with that of imputation strategies where errors were significantly greater, varying by imputation method. Conclusions: The decision to impute body weight data depends on the purpose of the analysis. Directions for the best performing imputation methods are provided. For the purpose of estimating BWV, data imputation should not be conducted. Linear and nonlinear methods of estimating BWV provide reasonably accurate estimates under high proportions (80%) of missing data. %M 32915155 %R 10.2196/17977 %U http://mhealth.jmir.org/2020/9/e17977/ %U https://doi.org/10.2196/17977 %U http://www.ncbi.nlm.nih.gov/pubmed/32915155 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e17919 %T Design and Development of a Digital Weight Management Intervention (ToDAy): Qualitative Study %A Shoneye,Charlene L %A Mullan,Barbara %A Begley,Andrea %A Pollard,Christina M %A Jancey,Jonine %A Kerr,Deborah A %+ School of Public Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia, 61 61892664122, D.Kerr@curtin.edu.au %K obesity %K diet %K physical activity %K sedentary behavior %K digital behavioral interventions %K health behavior %K wearable activity monitor %K health %K mobile food record %K clinical trial %K focus group %K qualitative research %K mobile phone %D 2020 %7 9.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Tailored Diet and Activity (ToDAy) study aims to build on the campaign by adding a digital intervention with the potential to provide wide-reaching, cost-effective weight management support. Objective: The ToDAy study aims to build a tailored intervention using mobile technology to improve diet and physical activity behaviours in adults with overweight and obesity. The main objectives were to identify behavior change techniques for diet and physical activity (PA) change for weight loss and explore preferences for digital intervention features that would be effective in changing diet and PA behaviors. Methods: This qualitative study uses the principles of a person-based approach to intervention development; the behavioral intervention technology framework; and the capability, opportunity, motivation, and behavior (COM-B) framework. Focus groups and telephone interviews were conducted with 56 adults in Western Australia. Open-ended questions and example intervention features were used to explore the usability and acceptability of the self-monitoring tools, knowledge about effective weight-loss strategies, and acceptability of tailored feedback. Findings from the focus groups and interviews were analyzed using thematic analysis. Results: Qualitative findings revealed an awareness of key public health messages but a lack of confidence in how to perform these behaviors to help manage their weight. A total of 4 major themes were identified and mapped to the domains of the COM-B framework: (1) misinformation, (2) environmental support, (3) social norms, and (4) confidence. Conclusions: This study explores users’ capability, opportunity, and motivation to perform the target behaviors for weight loss. The findings suggested that a digital weight management intervention using a mobile food record and activity trackers to inform tailored feedback may be acceptable and feasible. Participants expressed a preference for simple expert advice, digital self-monitoring tools, and visual feedback. International Registered Report Identifier (IRRID): RR2-10.2196/12782 %M 32641284 %R 10.2196/17919 %U https://mhealth.jmir.org/2020/9/e17919 %U https://doi.org/10.2196/17919 %U http://www.ncbi.nlm.nih.gov/pubmed/32641284 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e18253 %T Relationship Between Chronic Stress and Heart Rate Over Time Modulated by Gender in a Cohort of Office Workers: Cross-Sectional Study Using Wearable Technologies %A van Kraaij,Alex Wilhelmus Jacobus %A Schiavone,Giuseppina %A Lutin,Erika %A Claes,Stephan %A Van Hoof,Chris %+ OnePlanet Research Center, imec-the Netherlands, Bronland 10, Wageningen, 6708 WH, Netherlands, 31 404020400, alex.vankraaij@imec.nl %K chronic stress %K heart rate %K circadian rhythm %K gender %K age %K wearable device %D 2020 %7 9.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic stress is increasing in prevalence and is associated with several physical and mental disorders. Although it is proven that acute stress changes physiology, much less is known about the relationship between physiology and long-term stress. Continuous measurement of vital signs in daily life and chronic stress detection algorithms could serve this purpose. For this, it is paramount to model the effects of chronic stress on human physiology and include other cofounders, such as demographics, enabling the enrichment of a population-wide approach with individual variations. Objective: The main objectives of this study were to investigate the effect of chronic stress on heart rate (HR) over time while correcting for weekdays versus weekends and to test a possible modulation effect by gender and age in a healthy cohort. Methods: Throughout 2016 and 2017, healthy employees of technology companies were asked to participate in a 5-day observation stress study. They were required to wear two wearables, of which one included an electrocardiogram sensor. The derived HR was averaged per hour and served as an output for a mixed design model including a trigonometric fit over time with four harmonics (periods of 24, 12, 8, and 6 hours), gender, age, whether it was a workday or weekend day, and a chronic stress score derived from the Perceived Stress Scale (PSS) as predictors. Results: The study included 328 subjects, of which 142 were female and 186 were male participants, with a mean age of 38.9 (SD 10.2) years and a mean PSS score of 13.7 (SD 6.0). As main effects, gender (χ21=24.02, P<.001); the hour of the day (χ21=73.22, P<.001); the circadian harmonic (χ22=284.4, P<.001); and the harmonic over 12 hours (χ22=242.1, P<.001), over 8 hours (χ22=23.78, P<.001), and over 6 hours (χ22=82.96, P<.001) had a significant effect on HR. Two three-way interaction effects were found. The interaction of age, whether it was a workday or weekend day, and the circadian harmonic over time were significantly correlated with HR (χ22=7.13, P=.03), as well as the interaction of gender, PSS score, and the circadian harmonic over time (χ22=7.59, P=.02). Conclusions: The results show a relationship between HR and the three-way interaction of chronic stress, gender, and the circadian harmonic. The modulation by gender might be related to evolution-based energy utilization strategies, as suggested in related literature studies. More research, including daily cortisol assessment, longer recordings, and a wider population, should be performed to confirm this interpretation. This would enable the development of more complete and personalized models of chronic stress. %M 32902392 %R 10.2196/18253 %U http://www.jmir.org/2020/9/e18253/ %U https://doi.org/10.2196/18253 %U http://www.ncbi.nlm.nih.gov/pubmed/32902392 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e16953 %T Validity and Usability of a Smartphone Image-Based Dietary Assessment App Compared to 3-Day Food Diaries in Assessing Dietary Intake Among Canadian Adults: Randomized Controlled Trial %A Ji,Yuwei %A Plourde,Hugues %A Bouzo,Valerie %A Kilgour,Robert D %A Cohen,Tamara R %+ Faculty of Land and Food Systems, Food, Nutrition and Health, University of British Columbia, 218-2205 East Mall, Vancouver, BC, V6T 1Z4, Canada, 1 604 827 0362, tamara.cohen@ubc.ca %K mobile food record %K validity %K image-based dietary assessment %K healthy adults %K 3-day food diary %K diet %K application %K nutrition %K mHealth %K Canada %D 2020 %7 9.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Accurate dietary assessment is needed in studies that include analysis of nutritional intake. Image-based dietary assessment apps have gained in popularity for assessing diet, which may ease researcher and participant burden compared to traditional pen-to-paper methods. However, few studies report the validity of these apps for use in research. Keenoa is a smartphone image-based dietary assessment app that recognizes and identifies food items using artificial intelligence and permits real-time editing of food journals. Objective: This study aimed to assess the relative validity of an image-based dietary assessment app — Keenoa — against a 3-day food diary (3DFD) and to test its usability in a sample of healthy Canadian adults. Methods: We recruited 102 participants to complete two 3-day food records. For 2 weeks, on 2 non-consecutive days and 1 weekend day, in random order, participants completed a traditional pen-to-paper 3DFD and the Keenoa app. At the end of the study, participants completed the System Usability Scale. The nutrient analyses of the 3DFD and Keenoa data before (Keenoa-participant) and after they were reviewed by dietitians (Keenoa-dietitian) were analyzed using analysis of variance. Multiple tests, including the Pearson coefficient, cross-classification, kappa score, % difference, paired t test, and Bland-Altman test, were performed to analyze the validity of Keenoa (Keenoa-dietitian). Results: The study was completed by 72 subjects. Most variables were significantly different between Keenoa-participant and Keenoa-dietitian (P<.05) except for energy, protein, carbohydrates, fiber, vitamin B1, vitamin B12, vitamin C, vitamin D, and potassium. Significant differences in total energy, protein, carbohydrates, % fat, saturated fatty acids, iron, and potassium were found between the 3DFD and Keenoa-dietitian data (P<.05). The Pearson correlation coefficients between the Keenoa-dietitian and 3DFD ranged from .04 to .51. Differences between the mean intakes assessed by the 3DFD and Keenoa-dietitian were within 10% except for vitamin D (misclassification rate=33.8%). The majority of nutrients were within an acceptable range of agreement in the Bland-Altman analysis; no agreements were seen for total energy, protein, carbohydrates, fat (%), saturated fatty acids, iron, potassium, and sodium (P<.05). According to the System Usability Scale, 34.2% of the participants preferred using Keenoa, while 9.6% preferred the 3DFD. Conclusions: The Keenoa app provides acceptable relative validity for some nutrients compared to the 3DFD. However, the average intake of some nutrients, including energy, protein, carbohydrates, % fat, saturated fatty acids, and iron, differed from the average obtained using the 3DFD. These findings highlight the importance of verifying data entries of participants before proceeding with nutrient analysis. Overall, Keenoa showed better validity at the group level than the individual level, suggesting it can be used when focusing on the dietary intake of the general population. Further research is recommended with larger sample sizes and objective dietary assessment approaches. %M 32902389 %R 10.2196/16953 %U https://mhealth.jmir.org/2020/9/e16953 %U https://doi.org/10.2196/16953 %U http://www.ncbi.nlm.nih.gov/pubmed/32902389 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 7 %N 2 %P e18729 %T Usability and Acceptability of an App (SELFBACK) to Support Self-Management of Low Back Pain: Mixed Methods Study %A Nordstoga,Anne Lovise %A Bach,Kerstin %A Sani,Sadiq %A Wiratunga,Nirmalie %A Mork,Paul Jarle %A Villumsen,Morten %A Cooper,Kay %+ Department of Public Health and Nursing, Norwegian University of Science and Technology, Håkon Jarls gate 11, Trondheim, 7030, Norway, 47 99268260, anne.l.nordstoga@ntnu.no %K low back pain %K self-management %K physical activity %K exercise %K patient education %K smartphone %K mHealth %K eHealth %K digital health %K case-based reasoning %D 2020 %7 9.9.2020 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Self-management is the key recommendation for managing nonspecific low back pain (LBP). However, there are well-documented barriers to self-management; therefore, methods of facilitating adherence are required. Smartphone apps are increasingly being used to support self-management of long-term conditions such as LBP. Objective: The aim of this study was to assess the usability and acceptability of the SELFBACK smartphone app, designed to support and facilitate self-management of non-specific LBP. The app provides weekly self-management plans, comprising physical activity, strength and flexibility exercises, and patient education. The plans are tailored to the patient’s characteristics and symptom progress by using case-based reasoning methodology. Methods: The study was carried out in 2 stages using a mixed-methods approach. All participants undertook surveys, and semistructured telephone interviews were conducted with a subgroup of participants. Stage 1 assessed an app version with only the physical activity component and a web questionnaire that collects information necessary for tailoring the self-management plans. The physical activity component included monitoring of steps recorded by a wristband, goal setting, and a scheme for sending personalized, timely, and motivational notifications to the user’s smartphone. Findings from Stage 1 were used to refine the app and inform further development. Stage 2 investigated an app version that incorporated 3 self-management components (physical activity, exercises, and education). A total of 16 participants (age range 23-71 years) with ongoing or chronic nonspecific LBP were included in Stage 1, and 11 participants (age range 32-56 years) were included in Stage 2. Results: In Stage 1, 15 of 16 participants reported that the baseline questionnaire was easy to answer, and 84% (13/16) found the completion time to be acceptable. Overall, participants were positive about the usability of the physical activity component but only 31% (5/16) found the app functions to be well integrated. Of the participants, 90% (14/16) were satisfied with the notifications, and they were perceived as being personalized (12/16, 80%). In Stage 2, all participants reported that the web questionnaire was easy to answer and the completion time acceptable. The physical activity and exercise components were rated useful by 80% (8/10), while 60% (6/10) rated the educational component useful. Overall, participants were satisfied with the usability of the app; however, only 50% (5/10) found the functions to be well integrated, and 20% (2/10) found them to be inconsistent. Overall, 80% (8/10) of participants reported it to be useful for self-management. The interviews largely reinforced the survey findings in both stages. Conclusions: This study has demonstrated that participants considered the SELFBACK app to be acceptable and usable and that they thought it would be useful for supporting self-management of LBP. However, we identified some limitations and suggestions useful to guide further development of the SELFBACK app and other mobile health interventions. %M 32902393 %R 10.2196/18729 %U http://rehab.jmir.org/2020/2/e18729/ %U https://doi.org/10.2196/18729 %U http://www.ncbi.nlm.nih.gov/pubmed/32902393 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e18142 %T Neural Network–Based Algorithm for Adjusting Activity Targets to Sustain Exercise Engagement Among People Using Activity Trackers: Retrospective Observation and Algorithm Development Study %A Mohammadi,Ramin %A Atif,Mursal %A Centi,Amanda Jayne %A Agboola,Stephen %A Jethwani,Kamal %A Kvedar,Joseph %A Kamarthi,Sagar %+ Northeastern University, 360 Huntington Ave, Boston, MA, 02115, United States, 1 6173733070, sagar@coe.neu.edu %K activity tracker %K exercise engagement %K dynamic activity target %K neural network %K activity target prediction %K machine learning %D 2020 %7 8.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: It is well established that lack of physical activity is detrimental to the overall health of an individual. Modern-day activity trackers enable individuals to monitor their daily activities to meet and maintain targets. This is expected to promote activity encouraging behavior, but the benefits of activity trackers attenuate over time due to waning adherence. One of the key approaches to improving adherence to goals is to motivate individuals to improve on their historic performance metrics. Objective: The aim of this work was to build a machine learning model to predict an achievable weekly activity target by considering (1) patterns in the user’s activity tracker data in the previous week and (2) behavior and environment characteristics. By setting realistic goals, ones that are neither too easy nor too difficult to achieve, activity tracker users can be encouraged to continue to meet these goals, and at the same time, to find utility in their activity tracker. Methods: We built a neural network model that prescribes a weekly activity target for an individual that can be realistically achieved. The inputs to the model were user-specific personal, social, and environmental factors, daily step count from the previous 7 days, and an entropy measure that characterized the pattern of daily step count. Data for training and evaluating the machine learning model were collected over a duration of 9 weeks. Results: Of 30 individuals who were enrolled, data from 20 participants were used. The model predicted target daily count with a mean absolute error of 1545 (95% CI 1383-1706) steps for an 8-week period. Conclusions: Artificial intelligence applied to physical activity data combined with behavioral data can be used to set personalized goals in accordance with the individual’s level of activity and thereby improve adherence to a fitness tracker; this could be used to increase engagement with activity trackers. A follow-up prospective study is ongoing to determine the performance of the engagement algorithm. %M 32897235 %R 10.2196/18142 %U https://mhealth.jmir.org/2020/9/e18142 %U https://doi.org/10.2196/18142 %U http://www.ncbi.nlm.nih.gov/pubmed/32897235 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e17646 %T Mobile Health App for Self-Learning on HIV Prevention Knowledge and Services Among a Young Indonesian Key Population: Cohort Study %A Garg,Priyanka Rani %A Uppal,Leena %A Mehra,Sunil %A Mehra,Devika %+ MAMTA Health Institute for Mother and Child, B-5, Greater Kailash Enclave-II, New Delhi, 110048, India, 91 11 29220210, leena@mamtahimc.org %K mHealth %K Indonesia %K HIV %K key populations %D 2020 %7 8.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Indonesia is the only country in the Asia Pacific region where the incidence of HIV is still on the rise, and its prevalence is extremely high among the key populations such as men who have sex with men, transgender women, and people who inject/use drugs. Mobile health (mHealth) apps provide an innovative platform for delivering tailored HIV prevention and care among these populations more efficiently than possible through the direct face-to-face approach. Objective: The aim of this study was to assess the role of a peer-customized mobile app based on the principle of self-learning for improving HIV prevention knowledge and access to health services among men who have sex with men, transgender women (known as Waria in Indonesia), and people who use drugs in Indonesia. Methods: A prospective intervention cohort study was conducted among the key populations in five provinces of Indonesia (Jakarata, West Java, East Java, Special Region of Yogyakarta, and Bali). The data were evaluated using a pre-post assessment survey conducted on a sample of 200 unique users, including 50 men who have sex with men and transgender women each, and 100 people who use drugs, with a follow-up response rate of 98% and 70%, respectively. An mHealth app named RUMAH SELA was developed and implemented among the key populations. Results: From baseline to the endpoint of the study, there was a significant increase in comprehensive HIV-related knowledge from 20% (10/49) to 60% (29/49), 22% (11/49) to 57% (28/49), and 49% (34/70) to 74% (52/70) among men who have sex with men (P=.004), transgender women (P<.001), and people who use drugs (P<.001), respectively. There was also a reduction in sexual activities without condom use from 22% (11/49) to 19% (9/49), 18% (9/49) to 12% (6/49), and 21% (15/70) to 10% (7/70) among men who have sex with men (P=.45), transgender women (P=.25), and people who use drugs (P<.001), respectively. There was an uptake of HIV testing by 31% (15/49) for men who have sex with men, 49% (24/49) for transgender women, and 26% (18/70) for people who use drugs after using the app. There was a reduction in injecting drugs with a used needle in drug users from 45/70 (78%) to 15/70 (26%). Measures of self-esteem increased among men who have sex with men (mean 26.4 vs mean 27.1), transgender women (mean 26.5 vs mean 27.8; P=.02), and people who use drugs (mean 24.0 vs mean 25.0). In addition, 27% (7/24) of men who have sex with men, 25% (4/15) of transgender women, and 11% (2/18) of drug users made an appointment for an HIV test through the app. The app was quite highly accepted by the key populations as nearly a quarter felt that they became more confident in discussing issues about sexuality, more than 80% found that the app provided sufficient knowledge about HIV, and more than half of the participants found the app to be user friendly. Conclusions: This one-of-a-kind mHealth intervention with an mHealth app as a self-learning tool is effective in increasing HIV-related knowledge and behavior, and access to services with strong acceptability by the community. There is a need to scale up such interventions for efficacy testing in a larger population to provide evidence for national-level mHealth programs addressing HIV. %M 32896831 %R 10.2196/17646 %U https://mhealth.jmir.org/2020/9/e17646 %U https://doi.org/10.2196/17646 %U http://www.ncbi.nlm.nih.gov/pubmed/32896831 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e20581 %T Digital Interventions for Screening and Treating Common Mental Disorders or Symptoms of Common Mental Illness in Adults: Systematic Review and Meta-analysis %A Sin,Jacqueline %A Galeazzi,Gian %A McGregor,Elicia %A Collom,Jennifer %A Taylor,Anna %A Barrett,Barbara %A Lawrence,Vanessa %A Henderson,Claire %+ School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Whiteknights, Reading, RG6 6AL, United Kingdom, 44 7817027035, jacqueline.sin@reading.ac.uk %K eHealth %K mHealth %K psychiatric illness %K mental disorders %K common mental illness %K depression %K anxiety %K self-care %D 2020 %7 2.9.2020 %9 Review %J J Med Internet Res %G English %X Background: Digital interventions targeting common mental disorders (CMDs) or symptoms of CMDs are growing rapidly and gaining popularity, probably in response to the increased prevalence of CMDs and better awareness of early help-seeking and self-care. However, no previous systematic reviews that focus on these novel interventions were found. Objective: This systematic review aims to scope entirely web-based interventions that provided screening and signposting for treatment, including self-management strategies, for people with CMDs or subthreshold symptoms. In addition, a meta-analysis was conducted to evaluate the effectiveness of these interventions for mental well-being and mental health outcomes. Methods: Ten electronic databases including MEDLINE, PsycINFO, and EMBASE were searched from January 1, 1999, to early April 2020. We included randomized controlled trials (RCTs) that evaluated a digital intervention (1) targeting adults with symptoms of CMDs, (2) providing both screening and signposting to other resources including self-care, and (3) delivered entirely through the internet. Intervention characteristics including target population, platform used, key design features, and outcome measure results were extracted and compared. Trial outcome results were included in a meta-analysis on the effectiveness of users’ well-being and mental health outcomes. We also rated the meta-analysis results with the Grading of Recommendations, Assessment, Development, and Evaluations approach to establish the quality of the evidence. Results: The electronic searches yielded 21 papers describing 16 discrete digital interventions. These interventions were investigated in 19 unique trials including 1 (5%) health economic study. Most studies were conducted in Australia and North America. The targeted populations varied from the general population to allied health professionals. All interventions offered algorithm-driven screening with measures to assess symptom levels and to assign treatment options including automatic web-based psychoeducation, self-care strategies, and signposting to existing services. A meta-analysis of usable trial data showed that digital interventions improved well-being (3 randomized controlled trials [RCTs]; n=1307; standardized mean difference [SMD] 0.40; 95% CI 0.29 to 0.51; I2=28%; fixed effect), symptoms of mental illness (6 RCTs; n=992; SMD −0.29; 95% CI −0.49 to −0.09; I2=51%; random effects), and work and social functioning (3 RCTs; n=795; SMD −0.16; 95% CI −0.30 to −0.02; I2=0%; fixed effect) compared with waitlist or attention control. However, some follow-up data failed to show any sustained effects beyond the post intervention time point. Data on mechanisms of change and cost-effectiveness were also lacking, precluding further analysis. Conclusions: Digital mental health interventions to assess and signpost people experiencing symptoms of CMDs appear to be acceptable to a sufficient number of people and appear to have enough evidence for effectiveness to warrant further study. We recommend that future studies incorporate economic analysis and process evaluation to assess the mechanisms of action and cost-effectiveness to aid scaling of the implementation. %M 32876577 %R 10.2196/20581 %U https://www.jmir.org/2020/9/e20581 %U https://doi.org/10.2196/20581 %U http://www.ncbi.nlm.nih.gov/pubmed/32876577 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19634 %T Weight Reduction Through a Digital Nutrition and Food Purchasing Platform Among Users With Obesity: Longitudinal Study %A Hu,Emily A %A Nguyen,Viet %A Langheier,Jason %A Shurney,Dexter %+ Zipongo, Inc, DBA Foodsmart, 600 California Street, 11th Floor, San Francisco, CA, 94108, United States, 1 415 604 4122, emily.hu@zipongo.com %K digital %K nutrition %K meal planning %K weight loss %K obese %K food environment %K food ordering %K food purchasing %K behavioral economics %K behavior change %K eating behavior %K mHealth %K app %D 2020 %7 2.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital nutrition apps that monitor or provide recommendations on diet have been found to be effective in behavior change and weight reduction among individuals with obesity. However, there is less evidence on how integration of personalized nutrition recommendations and changing the food purchasing environment through online meal planning and grocery delivery, meal kits, and grocery incentives impacts weight loss among individuals with obesity. Objective: The objective of this observational longitudinal study was to examine weight loss and predictors of weight loss among individuals with obesity who are users of a digital nutrition platform that integrates tools to provide nutrition recommendations and changes in the food purchasing environment grounded in behavioral theory. Methods: We included 8977 adults with obesity who used the digital Foodsmart platform, created by Zipongo, Inc, DBA Foodsmart between January 2013 and April 2020. We retrospectively analyzed user characteristics and their associations with weight loss. Participants reported age, gender, height, at least 2 measures of weight, and usual dietary intake. Healthy Diet Score, a score to measure overall diet quality, was calculated based on responses to a food frequency questionnaire. We used paired t tests to compare differences in baseline and final weights and baseline and final Healthy Diet Scores. We used univariate and multivariate logistic regression models to estimate odds ratios and 95% CI of achieving 5% weight loss by gender, age, baseline BMI, Healthy Diet Score, change in Healthy Diet Score, and duration of enrollment. We conducted stratified analyses to examine mean percent weight change by enrollment duration and gender, age, baseline BMI, and change in Healthy Diet Score. Results: Over a median (IQR) of 9.9 (0.03-54.7) months of enrollment, 59% of participants lost weight. Of the participants who used the Foodsmart platform for at least 24 months, 33.3% achieved 5% weight loss. In the fully adjusted logistic regression model, we found that baseline BMI (OR 1.02, 95% CI 1.02-1.03; P<.001), baseline Healthy Diet Score (OR 1.06, 95% CI 1.05-1.08; P<.001), greater change in Healthy Diet Score (OR 1.12, 95% CI 1.11-1.14; P<.001), and enrollment length (OR 1.28, 95% CI 1.23-1.32; P<.001) were all significantly associated with higher odds of achieving at least 5% weight loss. Conclusions: This study found that a digital app that provides personalized nutrition recommendations and change in one’s food purchasing environment appears to be successful in meaningfully reducing weight among individuals with obesity. %M 32792332 %R 10.2196/19634 %U http://www.jmir.org/2020/9/e19634/ %U https://doi.org/10.2196/19634 %U http://www.ncbi.nlm.nih.gov/pubmed/32792332 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e18509 %T Clusters of Adolescent Physical Activity Tracker Patterns and Their Associations With Physical Activity Behaviors in Finland and Ireland: Cross-Sectional Study %A Ng,Kwok %A Kokko,Sami %A Tammelin,Tuija %A Kallio,Jouni %A Belton,Sarahjane %A O'Brien,Wesley %A Murphy,Marie %A Powell,Cormac %A Woods,Catherine %+ School of Educational Sciences and Psychology, University of Eastern Finland, PO Box 111, Joensuu, 80101, Finland, 358 504724051, kwok.ng@hbsc.org %K wearables %K children %K activity trackers %K active travel %K organised sport %K self-quantification %D 2020 %7 1.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Physical activity trackers (PATs) such as apps and wearable devices (eg, sports watches, heart rate monitors) are increasingly being used by young adolescents. Despite the potential of PATs to help monitor and improve moderate-to-vigorous physical activity (MVPA) behaviors, there is a lack of research that confirms an association between PAT ownership or use and physical activity behaviors at the population level. Objective: The purpose of this study was to examine the ownership and use of PATs in youth and their associations with physical activity behaviors, including daily MVPA, sports club membership, and active travel, in 2 nationally representative samples of young adolescent males and females in Finland and Ireland. Methods: Comparable data were gathered in the 2018 Finnish School-aged Physical Activity (F-SPA 2018, n=3311) and the 2018 Irish Children’s Sport Participation and Physical Activity (CSPPA 2018, n=4797) studies. A cluster analysis was performed to obtain the patterns of PAT ownership and usage by adolescents (age, 11-15 years). Four similar clusters were identified across Finnish and Irish adolescents: (1) no PATs, (2) PAT owners, (3) app users, and (4) wearable device users. Adjusted binary logistic regression analyses were used to evaluate how PAT clusters were associated with physical activity behaviors, including daily MVPA, membership of sports clubs, and active travel, after stratification by gender. Results: The proportion of app ownership among Finnish adolescents (2038/3311, 61.6%) was almost double that of their Irish counterparts (1738/4797, 36.2%). Despite these differences, the clustering patterns of PATs were similar between the 2 countries. App users were more likely to take part in daily MVPA (males, odds ratio [OR] 1.27, 95% CI 1.04-1.55; females, OR 1.49, 95% CI 1.20-1.85) and be members of sports clubs (males, OR 1.37, 95% CI 1.15-1.62; females, OR 1.25, 95% CI 1.07-1.50) compared to the no PATs cluster, after adjusting for country, age, family affluence, and disabilities. These associations, after the same adjustments, were even stronger for wearable device users to participate in daily MVPA (males, OR 1.83, 95% CI 1.49-2.23; females, OR 2.25, 95% CI 1.80-2.82) and be members of sports clubs (males, OR 1.88, 95% CI 1.55-2.88; females, OR 2.07, 95% CI 1.71-2.52). Significant associations were observed between male users of wearable devices and taking part in active travel behavior (OR 1.39, 95% CI 1.04-1.86). Conclusions: Although Finnish adolescents report more ownership of PATs than Irish adolescents, the patterns of use and ownership remain similar among the cohorts. The findings of our study show that physical activity behaviors were positively associated with wearable device users and app users. These findings were similar between males and females. Given the cross-sectional nature of this data, the relationship between using apps or wearable devices and enhancing physical activity behaviors requires further investigation. %M 32667894 %R 10.2196/18509 %U https://www.jmir.org/2020/9/e18509 %U https://doi.org/10.2196/18509 %U http://www.ncbi.nlm.nih.gov/pubmed/32667894 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17790 %T Effectiveness of Mobile Health Interventions Promoting Physical Activity and Lifestyle Interventions to Reduce Cardiovascular Risk Among Individuals With Metabolic Syndrome: Systematic Review and Meta-Analysis %A Sequi-Dominguez,Irene %A Alvarez-Bueno,Celia %A Martinez-Vizcaino,Vicente %A Fernandez-Rodriguez,Rubén %A del Saz Lara,Alicia %A Cavero-Redondo,Iván %+ Universidad de Castilla-La Mancha, Health and Social Research Center, Edificio Melchor Cano Campus Universitario de Cuenca, Camino de Pozuelo, s/n, Cuenca, 16071, Spain, 34 969 179 100 ext 4659, celia.alvarezbueno@uclm.es %K mobile health %K mobile technology %K telemedicine %K metabolic syndrome %K physical activity %K lifestyle intervention %K systematic review %K meta-analysis %D 2020 %7 31.8.2020 %9 Review %J J Med Internet Res %G English %X Background: Physical activity and lifestyle interventions, such as a healthy diet, have been proven to be effective approaches to manage metabolic syndrome. However, these interventions require great commitment from patients and clinicians owing to their economic costs, time consumption, and lack of immediate results. Objective: The aim of this systematic review and meta-analysis was to analyze the effect of mobile-based health interventions for reducing cardiometabolic risk through the promotion of physical activity and healthy lifestyle behaviors. Methods: PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and SPORTdiscus databases were searched for experimental studies evaluating cardiometabolic risk indicators among individuals with metabolic syndrome who were included in technology-assisted physical activity and lifestyle interventions. Effect sizes, pooled mean changes, and their respective 95% CIs were calculated using the DerSimonian and Laird method. Outcomes included the following clinical and biochemical parameters: body composition (waist circumference [WC] and BMI), blood pressure (systolic blood pressure [SBP] and diastolic blood pressure [DBP]), glucose tolerance (fasting plasma glucose [FPG] and glycated hemoglobin A1c [HbA1c]), and lipid profile (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol [HDL-C], and triglycerides). Results: A total of nine studies were included in the meta-analysis. Owing to the scarcity of studies, only pooled mean pre-post changes in the intervention groups were estimated. Significant mean changes were observed for BMI (−1.70 kg/m2, 95% CI −3.20 to −0.20; effect size: −0.46; P=.03), WC (−5.77 cm, 95% CI −9.76 to −1.77; effect size: −0.54; P=.005), SBP (−7.33 mmHg, 95% CI −13.25 to −1.42; effect size: −0.43; P=.02), DBP (−3.90 mmHg, 95% CI −7.70 to −0.11; effect size: −0.44; P=.04), FPG (−3.65 mg/dL, 95% CI −4.79 to −2.51; effect size: −0.39; P<.001), and HDL-C (4.19 mg/dL, 95% CI 2.43-5.95; effect size: 0.23; P<.001). Conclusions: Overall, mobile-based health interventions aimed at promoting physical activity and healthy lifestyle changes had a strong positive effect on cardiometabolic risk indicators among individuals with metabolic syndrome. Nevertheless, further research is required to compare this approach with usual care in order to support the incorporation of these technologies in health systems. Trial Registration: PROSPERO CRD42019125461; https://tinyurl.com/y3t4wog4. %M 32865503 %R 10.2196/17790 %U http://www.jmir.org/2020/8/e17790/ %U https://doi.org/10.2196/17790 %U http://www.ncbi.nlm.nih.gov/pubmed/32865503 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 5 %N 3 %P e21183 %T Technology-Assisted Self-Monitoring of Lifestyle Behaviors and Health Indicators in Diabetes: Qualitative Study %A Du,Yan %A Dennis,Brittany %A Rhodes,Shanae Lakel %A Sia,Michelle %A Ko,Jisook %A Jiwani,Rozmin %A Wang,Jing %+ Center on Smart and Connected Health Technologies, School of Nursing, University of Texas Health Science Center at San Antonio, 7739 Floyd Dr, San Antonio, TX, United States, 1 210 450 8561, wangj1@uthscsa.edu %K technology %K monitoring %K lifestyle %K diet %K exercise %K weight %K glucose %K diabetes management %D 2020 %7 28.8.2020 %9 Original Paper %J JMIR Diabetes %G English %X Background: Self-monitoring is key to successful behavior change in diabetes and obesity, and the use of traditional paper-based methods of self-monitoring may be time-consuming and burdensome. Objective: This study aimed to explore participant experiences while using technology-assisted self-monitoring of lifestyle behaviors and health indicators among overweight or obese adults with type 2 diabetes. Methods: Qualitative data collected from the intervention group of a 6-month, three-arm (control, paper diary, and technology-assisted self-monitoring groups) randomized clinical trial were analyzed. Study participants in the intervention group monitored their diet, exercise, and weight using the LoseIt! app, and their blood glucose levels using a glucometer and the Diabetes Connect app. Semistructured group discussions were conducted at 6 weeks (n=10) from the initiation of the behavioral lifestyle intervention and again at 6 months (n=9). All group interviews were audiotaped and transcribed verbatim. Using a combination of thematic and comparative analysis approaches, two trained professionals coded the transcriptions independently and then discussed and concluded common themes for the 6-week and 6-month discussions separately. Results: The sample (n=10), which primarily involved African American participants (n=7) and female participants (n=8), had a mean age of 59.4 years. The following eight themes emerged: (1) perceived benefits of technology-assisted self-monitoring; (2) perceived ease of use (eg, barriers: technical difficulties and lack of self-discipline; facilitators: help from family, friends, and the program); (3) use of technology-assisted self-monitoring; (4) facilitators of engaging in healthy lifestyle behaviors (eg, visualization and awareness of calorie input/expenditure); (5) positive lifestyle change; (6) barriers of engaging in healthy lifestyle behaviors (eg, event influence); (7) learning curve; and (8) monitored data sharing. The first six of these themes were shared between the 6-week and 6-month timepoints, but the codes within these themes were not all the same and differed slightly between the two timepoints. These differences provide insights into the evolution of participant thoughts and perceptions on using technology for self-monitoring and subsequent behavioral lifestyle changes while participating in lifestyle interventions. The findings from the 6-week and 6-month data helped to paint a picture of participant comfort and the integration of technology and knowledge overtime, and clarified participant attitudes, difficulties, behavioral processes, and modifications, as well as health indicators that were experienced throughout the study. Conclusions: Although there were some barriers, participants were able to identify various individual and external facilitators to adjust to and engage in technology-assisted self-monitoring, and it was concluded that the technology-assisted self-monitoring approach was beneficial, safe, and feasible to use for positive lifestyle change. These patient perspectives need to be considered in future research studies when investigating the effectiveness of using technology-assisted self-monitoring, as well as in clinical practice when recommending technology-assisted self-monitoring of lifestyle behaviors and health indicators to improve health outcomes. %M 32857056 %R 10.2196/21183 %U http://diabetes.jmir.org/2020/3/e21183/ %U https://doi.org/10.2196/21183 %U http://www.ncbi.nlm.nih.gov/pubmed/32857056 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e21784 %T Development of a Mobile Health Intervention with Personal Experiments for Smokers Who Are Ambivalent About Quitting: Formative Design and Testing %A Heffner,Jaimee L %A Catz,Sheryl L %A Klasnja,Predrag %A Tiffany,Brooks %A McClure,Jennifer B %+ Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, United States, 1 206 287 2737, Jennifer.B.McClure@kp.org %K tobacco %K nicotine %K smoking %K cessation %K smartphone %K motivation %K mHealth %K intervention %K formative %K development %D 2020 %7 27.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The majority of cigarette smokers want to quit someday but are not ready to commit to long-term abstinence. However, available smoking cessation treatments are not well-suited to meet the needs of these ambivalent smokers. Low-cost, high-reach mobile health (mHealth) interventions may be a cost-efficient means of offering assistance to ambivalent smokers, yet there are currently no evidence-based options available for this group. Objective: The aim of this study was to develop and preliminarily evaluate the core content for an mHealth program targeting adult smokers who are ambivalent about quitting. The core content consisted of a series of “personal experiments” similar to those tested as part of a counseling intervention in prior work, including brief cognitive or behavioral tasks designed to boost readiness for changing smoking behavior. Methods: We conducted individual user interviews (N=3) to refine program content, and then conducted a one-arm pilot study (N=25) to assess user receptivity and the potential impact of the experiments on motivation and self-efficacy to quit or reduce smoking. Results: In user interviews, participants liked the concept of the personal experiments. Participants in the pilot study found a medium-fidelity prototype to be highly acceptable. After watching a brief orientation video that explained how the program works, most participants (80%, 20/25) indicated that it sounded interesting, primarily because it did not require any commitment to quit. All participants (100%, 25/25) completed all 7 experiments, including a 24-hour quit attempt, although not all were able to refrain from smoking for a full day based on qualitative feedback on the experiment. The mean rating of usefulness of the overall program was 4.12 (SD 1.09) out of 5, and the average rating of the difficulty of the experiments was 2.16 (SD 1.18) out of 5. At the last assessment point, 92% (23/25) of the participants indicated that they were more interested in either quitting or cutting back than when they began the program, and 72% (18/25) said that if the program had included a free trial of nicotine replacement therapy, they would have used it to try to quit smoking. Conclusions: This formative work confirmed that ambivalent smokers are willing to use and will remain engaged with an mHealth intervention that employs the novel concept of personal experiments to enhance their motivation for and ability to quit smoking. The addition of action-oriented treatment (self-help and free nicotine replacement therapy, quitline referral) could further support users’ efforts to stop smoking and remain quit. %M 32852278 %R 10.2196/21784 %U http://formative.jmir.org/2020/8/e21784/ %U https://doi.org/10.2196/21784 %U http://www.ncbi.nlm.nih.gov/pubmed/32852278 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 8 %P e21304 %T Digital Cognitive Behavior Therapy Intervention for Depression and Anxiety: Retrospective Study %A Venkatesan,Aarathi %A Rahimi,Lily %A Kaur,Manpreet %A Mosunic,Christopher %+ Vida Health, 100 Montgomery St, Ste 750, San Francisco, CA, 94104, United States, 1 (415) 989 1017, aarathi.venkatesan@vida.com %K depression %K anxiety %K CBT %K digital mental health intervention %K digital therapeutics %K cognitive behavioral therapy %K therapy %K digital health %K intervention %K mental health %D 2020 %7 26.8.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Digital mental health interventions offer a scalable solution that reduces barriers to seeking care for clinical depression and anxiety. Objective: We aimed to examine the effectiveness of a 12-week therapist supported, app-based cognitive behavioral therapy program in improving symptoms of depression and anxiety within 9 months. Methods: A total of 323 participants with mild to moderately severe depression or anxiety were enrolled in a 12-week digital cognitive behavior therapy program. The analysis was restricted to participants who provided at least one follow-up assessment after baseline. As a result, 146 participants (45.2%) were included in the analysis—74 (50.7%) participants completed assessments at 3 months, 31 participants (21.2%) completed assessments at 6 months, and 21 participants (14.4%) completed assessments at 9 months. The program included structured lessons and tools (ie, exercises and practices) as well as one-on-one weekly video counseling sessions with a licensed therapist for 12 weeks and monthly check-in sessions for 1 year. The clinically validated Patient Health Questionnaire (PHQ-8) and Generalized Anxiety Disorder Scale (GAD-7) were used to assess depression and anxiety, respectively. Linear mixed-effects modeling was employed to examine changes in depression and anxiety over time. Results: We observed a significant positive effect of program time on improvement in depression (β=–0.12, P<.001) and anxiety scores (β=–0.10, P<.001). At the end of the 12-week intervention, we observed an average reduction of 3.76 points (95% CI –4.76 to –2.76) in PHQ-8 scores. Further reductions in depression were seen at program month 6 (4.75-point reduction, 95% CI –6.61 to –2.88) and program month 9 (6.42-point reduction, 95% CI –8.66 to –6.55, P<.001). A similar pattern of improvement emerged for anxiety, with a 3.17-point reduction at the end of the 12-week intervention (95% CI –4.21 to –2.13). These improvements were maintained at program month 6 (4.87-point reduction, 95% CI –6.85 to –2.87) and program month 9 (5.19-point, 95% –6.85 to 4.81). In addition, greater program engagement during the first 12 weeks predicted a greater reduction in depression (β=–0.29, P<.001) Conclusions: The results suggest that digital interventions can support sustained and clinically meaningful improvements in depression and anxiety. Furthermore, it appears that strong initial digital mental health intervention engagement may facilitate this effect. However, the study was limited by postintervention participant attrition as well as the retrospective observational study design. %M 32845246 %R 10.2196/21304 %U http://mental.jmir.org/2020/8/e21304/ %U https://doi.org/10.2196/21304 %U http://www.ncbi.nlm.nih.gov/pubmed/32845246 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e19269 %T Harnessing Phones to Target Pediatric Populations with Socially Complex Needs: Systematic Review %A Stiles-Shields,Colleen %A Potthoff,Lauren M %A Bounds,Dawn T %A Burns,Maureen T S %A Draxler,Janel M %A Otwell,Caitlin H %A Wolodiger,Emily D %A Westrick,Jennifer %A Karnik,Niranjan S %+ Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W Jackson Blvd, Chicago, IL, 60612-3227, United States, 1 3129429998, colleen_stiles-shields@rush.edu %K underserved youth %K digital mental health %K mHealth %K telehealth %K health disparities %D 2020 %7 26.8.2020 %9 Review %J JMIR Pediatr Parent %G English %X Background: Mobile and smartphones are owned and accessed by many, making them a potentially optimal delivery mechanism to reach pediatric patients with socially complex needs (ie, pediatric populations who face overlapping adversities). Objective: To address the specialized needs of youth from such groups, this review synthesized the literature exploring the use of phone-based delivery to access pediatric populations with socially complex needs, targeting mental and behavioral health outcomes. The purpose of this synthesis was to provide recommendations for future research developing phone-based interventions for youth with socially complex needs. Methods: A trained medical librarian conducted the search strategy in the following databases: PubMed, Scopus, CINAHL, PsycINFO, Cochrane CENTRAL Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar. Studies targeting youth with socially complex needs were defined by recruiting samples that were primarily from traditionally underserved populations (ie, sex/gender minorities, racial/ethnic background, low socioeconomic status, rural/remote location, and sexual orientation). A systematic narrative framework was utilized and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed (registration number CRD42020141212). Results: A total of 14 studies met the inclusion criteria, with 3 depicting the use of phones to complete assessment and tracking goals and 11 to intervene on mental and behavioral health targets. Conclusions: The literature indicates important directions for future research, including (1) involving diverse and representative teens (ie, the likely users of the interventions), stakeholders, and clinical/research staff; (2) integrating evidence-based therapies with minority-focused theories; (3) harnessing mobile device capabilities; and (4) considering and assessing for potential costs in phones as delivery mechanisms. Trial Registration: PROSPERO CRD42020141212; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=141212 %M 32845244 %R 10.2196/19269 %U http://pediatrics.jmir.org/2020/2/e19269/ %U https://doi.org/10.2196/19269 %U http://www.ncbi.nlm.nih.gov/pubmed/32845244 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 5 %N 1 %P e20921 %T Current Status and Future Challenges of Sleep Monitoring Systems: Systematic Review %A Pan,Qiang %A Brulin,Damien %A Campo,Eric %+ LAAS-CNRS, University of Toulouse, 7, avenue du Colonel Roche, Toulouse, 31400, France, 33 561 337 961, eric.campo@univ-tlse2.fr %K EEG %K ECG %K classification %K mobile phone %D 2020 %7 26.8.2020 %9 Review %J JMIR Biomed Eng %G English %X Background: Sleep is essential for human health. Considerable effort has been put into academic and industrial research and in the development of wireless body area networks for sleep monitoring in terms of nonintrusiveness, portability, and autonomy. With the help of rapid advances in smart sensing and communication technologies, various sleep monitoring systems (hereafter, sleep monitoring systems) have been developed with advantages such as being low cost, accessible, discreet, contactless, unmanned, and suitable for long-term monitoring. Objective: This paper aims to review current research in sleep monitoring to serve as a reference for researchers and to provide insights for future work. Specific selection criteria were chosen to include articles in which sleep monitoring systems or devices are covered. Methods: This review investigates the use of various common sensors in the hardware implementation of current sleep monitoring systems as well as the types of parameters collected, their position in the body, the possible description of sleep phases, and the advantages and drawbacks. In addition, the data processing algorithms and software used in different studies on sleep monitoring systems and their results are presented. This review was not only limited to the study of laboratory research but also investigated the various popular commercial products available for sleep monitoring, presenting their characteristics, advantages, and disadvantages. In particular, we categorized existing research on sleep monitoring systems based on how the sensor is used, including the number and type of sensors, and the preferred position in the body. In addition to focusing on a specific system, issues concerning sleep monitoring systems such as privacy, economic, and social impact are also included. Finally, we presented an original sleep monitoring system solution developed in our laboratory. Results: By retrieving a large number of articles and abstracts, we found that hotspot techniques such as big data, machine learning, artificial intelligence, and data mining have not been widely applied to the sleep monitoring research area. Accelerometers are the most commonly used sensor in sleep monitoring systems. Most commercial sleep monitoring products cannot provide performance evaluation based on gold standard polysomnography. Conclusions: Combining hotspot techniques such as big data, machine learning, artificial intelligence, and data mining with sleep monitoring may be a promising research approach and will attract more researchers in the future. Balancing user acceptance and monitoring performance is the biggest challenge in sleep monitoring system research. %R 10.2196/20921 %U http://biomedeng.jmir.org/2020/1/e20921/ %U https://doi.org/10.2196/20921 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e13637 %T Recruiting Student Health Coaches to Improve Digital Blood Pressure Management: Randomized Controlled Pilot Study %A Vasti,Elena %A Pletcher,Mark J %+ University of California, San Francisco School of Medicine, Stanford Internal Medicine Residency, 300 N Pasteur Dr s101, Stanford, CA, 94305, United States, 1 2094703263, ecvasti@stanford.edu %K mobile health %K hypertension %K coaching %K health-related behavior %K mobile phone %D 2020 %7 25.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Hypertension is a significant problem in the United States, affecting 1 in 3 adults aged above 18 years and is associated with a higher risk for cardiovascular disease and stroke. The prevalence of hypertension has increased in medically underserved areas (MUAs). Mobile health technologies, such as digital self-monitoring devices, have been shown to improve the management of chronic health conditions. However, patients from MUAs have reduced access to these devices because of limited resources and low health literacy. Health coaches and peer training programs are a potentially cost-effective solution for the shortage of physicians available to manage hypertension in MUAs. Activating young people as student health coaches (SHCs) is a promising strategy to improve community health. Objective: This pilot study aims to assess (1) the feasibility of training high school students as health technology coaches in MUAs and (2) whether the addition of SHCs to digital home monitoring improves the frequency of self-monitoring and overall blood pressure (BP) control. Methods: In total, 15 high school students completed 3-day health coach training. Patients who had a documented diagnosis of hypertension were randomly assigned to 1 of the 3 intervention arms. The QardioArm alone (Q) group was provided a QardioArm cuff only for convenience. The SHC alone (S) group was instructed to meet with a health coach for 30 min once a week for 5 weeks to create action plans for reducing BP. The student+QardioArm (S+Q) group received both interventions. Results: Participants (n=27) were randomly assigned to 3 groups in a ratio of 9:9:9. All 15 students completed training, of which 40% (6/15) of students completed all the 5 meetings with their assigned patient. Barriers to feasibility included transportation and patient response drop-off at the end of the study. Overall, 92% (11/12) of the students rated their experience as very good or higher and 69% (9/13) reported that this experience made them more likely to go into the medical field. There was a statistically significant difference in the frequency of cuff use (S+Q vs Q groups: 37 vs 17; P<.001). Participants in the S+Q group reported better BP control after the intervention compared with the other groups. The average BP at the end of the intervention was 145/84 (SD 9/18) mm Hg, 150/85 (SD 18/12) mm Hg, and 128/69 (SD 20/14) mm Hg in the Q, S, and S+Q groups, respectively. Conclusions: This pilot study demonstrates the feasibility of pairing technology with young student coaches, although challenges existed. The S+Q group used their cuff more than the Q group. Patients were more engaged in the S+Q group, reporting higher satisfaction with their SHC and better control of their BP. %M 32840489 %R 10.2196/13637 %U https://formative.jmir.org/2020/8/e13637 %U https://doi.org/10.2196/13637 %U http://www.ncbi.nlm.nih.gov/pubmed/32840489 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e17755 %T Mobile App Use for Insomnia Self-Management in Urban Community-Dwelling Older Korean Adults: Retrospective Intervention Study %A Chung,Kyungmi %A Kim,Seoyoung %A Lee,Eun %A Park,Jin Young %+ Department of Psychiatry, Yonsei University College of Medicine, Yongin Severance Hospital, Yonsei University Health System, Department of Psychiatry, Yongin Severance Hospital, 363, Dongbaekjukjeon-daero, Giheung-gu, Yongin, 16995, Republic of Korea, 82 2 2228 0972, empathy@yuhs.ac %K sleep hygiene %K cognitive behavioral therapy %K sleep initiation and maintenance disorders %K telemedicine %K mobile apps %K treatment adherence and compliance %K health education %K health services for the aged %K community mental health services %K health care quality, access, and evaluation %D 2020 %7 24.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As an evidence-based psychotherapy for treating insomnia, cognitive behavioral therapy for insomnia (CBT-I), which helps people with sleep problems to change their unhelpful sleep-related beliefs and habits, has been well-established in older adults. Recently, the utilization of mobile CBT-I apps has been getting attention from mental health professionals and researchers; however, whether mobile CBT-I apps are usable among older users has yet to be determined. Objective: The aims of this study were to explore the relationships between subjective sleep quality and subjective memory complaints and depressive symptoms; to explore the relationship between perceived difficulty in mobile app use and usability of the mobile phone–based self-help CBT-I app, named MIND MORE, in urban community-dwelling Korean older adults; to compare changes in subjective sleep quality from pre-intervention to post-intervention, during which they used the mobile app over a 1-week intervention period; and evaluate adherence to the app. Methods: During the 2-hour training program delivered on 1 day titled “Overcoming insomnia without medication: How to use the ‘MIND MORE’ mobile app for systematic self-management of insomnia” (pre-intervention), 41 attendants were asked to gain hands-on experience with the app facilitated by therapists and volunteer workers. They were then asked to complete questionnaires on sociodemographic characteristics, subjective evaluation of mental health status (ie, depression, memory loss and impairment, and sleep problems), and app usability. For the 1-week home-based self-help CBT-I using the app (post-intervention), 9 of the 41 program attendants, who had already signed up for the pre-intervention, were guided to complete the given questionnaires on subjective evaluation of sleep quality after the 1-week intervention, specifically 8 days after the training program ended. Results: Due to missing data, 40 of 41 attendants were included in the data analysis. The main findings of this study were as follows. First, poor subjective sleep quality was associated with higher ratings of depressive symptoms (40/40; ρ=.60, P<.001) and memory complaints (40/40; ρ=.46, P=.003) at baseline. Second, significant improvements in subjective sleep quality from pre-intervention to post-intervention were observed in the older adults who used the MIND MORE app only for the 1-week intervention period (9/9; t8=3.74, P=.006). Third, apart from the program attendants who did not have a smartphone (2/40) or withdrew from their MIND MORE membership (3/40), those who attended the 1-day sleep education program adhered to the app from at least 2 weeks (13/35, 37%) to 8 weeks (2/35, 6%) without any further contact. Conclusions: This study provides empirical evidence that the newly developed MIND MORE app not only is usable among older users but also could improve subjective sleep quality after a 1-week self-help intervention period. %M 32831177 %R 10.2196/17755 %U http://mhealth.jmir.org/2020/8/e17755/ %U https://doi.org/10.2196/17755 %U http://www.ncbi.nlm.nih.gov/pubmed/32831177 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e18583 %T A Mobile Health Intervention for Adolescents Exposed to Secondhand Smoke: Pilot Feasibility and Efficacy Study %A Nardone,Natalie %A Giberson,Jeremy %A Prochaska,Judith J %A Jain,Shonul %A Benowitz,Neal L %+ Clinical Pharmacology Research Program, Division of Cardiology, Department of Medicine, University of California, Building 30, Room 3316, 1001 Potrero Ave, San Francisco, CA, 94110, United States, 1 628 206 8324, neal.benowitz@ucsf.edu %K secondhand smoke %K adolescents %K cotinine %K mHealth %K intervention %D 2020 %7 19.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Secondhand smoke (SHS) exposure in children and adolescents has adverse health effects. For adolescents of lower socioeconomic status (SES), exposure is widespread, evidenced in the measurement of urinary cotinine, a major metabolite of nicotine. Direct intervention with exposed children has been proposed as a novel method, yet there is minimal evidence of its efficacy. Combining this approach with a mobile health (mHealth) intervention may be more time and cost-effective and feasible for adolescent populations. Objective: In this pilot study, we assessed the feasibility and preliminary evidence of efficacy of a 30-day text message–based mHealth intervention targeted at reducing SHS exposure in adolescent populations of low SES. Methods: For the study, 14 nonsmoking and nonvaping participants between the ages of 12-21 years exposed to SHS were enrolled. The intervention consisted of a daily text message sent to the participants over the course of a month. Text message types included facts and information about SHS, behavioral methods for SHS avoidance, or true-or-false questions. Participants were asked to respond to each message within 24 hours as confirmation of receipt. Feasibility outcomes included completion of the 30-day intervention, receiving and responding to text messages, and feedback on the messages. Efficacy outcomes included a reduction in urinary cotinine, accuracy of true-or-false responses, and participants’ perceptions of effectiveness. Results: Of the 14 participants that were enrolled, 13 completed the intervention. Though not required, all participants had their own cell phones with unlimited text messaging plans. Of the total number of text messages sent to the 13 completers, 91% (372/407) of them received on-time responses. Participant feedback was generally positive, with most requesting more informational and true-or-false questions. In terms of efficacy, 54% (6/11) of participants reduced their cotinine levels (however, change for the group overall was not statistically significant (P=.33) and 45% (5/11) of participants increased their cotinine levels. Of the total number of true-or-false questions sent across all completers, 77% (56/73) were answered correctly. Participants’ ratings of message effectiveness averaged 85 on a scale of 100. Conclusions: In this pilot study, the intervention was feasible as the majority of participants had access to a cell phone, completed the study, and engaged by responding to the messages. The efficacy of the study requires further replication, as only half of the participants reduced their cotinine levels. However, participants answered the majority of true-or-false questions accurately and reported that the messages were helpful. %M 32812888 %R 10.2196/18583 %U http://formative.jmir.org/2020/8/e18583/ %U https://doi.org/10.2196/18583 %U http://www.ncbi.nlm.nih.gov/pubmed/32812888 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 8 %P e21278 %T Personalized Approach Bias Modification Smartphone App (“SWIPE”) to Reduce Alcohol Use Among People Drinking at Hazardous or Harmful Levels: Protocol for an Open-Label Feasibility Study %A Manning,Victoria %A Piercy,Hugh %A Garfield,Joshua Benjamin Bernard %A Lubman,Dan Ian %+ Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Turning Point, 110 Church Street, Richmond, Victoria, 3121, Australia, 61 3 8413 8724, victoria.manning@monash.edu %K alcohol %K hazardous alcohol use %K alcohol use disorder %K approach bias modification %K cognitive bias modification %K smartphone app %K eHealth %K mobile phone app %K mHealth %K digital health %D 2020 %7 14.8.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol accounts for 5.1% of the global burden of disease and injury, and approximately 1 in 10 people worldwide develop an alcohol use disorder. Approach bias modification (ABM) is a computerized cognitive training intervention in which patients are trained to “avoid” alcohol-related images and “approach” neutral or positive images. ABM has been shown to reduce alcohol relapse rates when delivered in residential settings (eg, withdrawal management or rehabilitation). However, many people who drink at hazardous or harmful levels do not require residential treatment or choose not to access it (eg, owing to its cost, duration, inconvenience, or concerns about privacy). Smartphone app–delivered ABM could offer a free, convenient intervention to reduce cravings and consumption that is accessible regardless of time and place, and during periods when support is most needed. Importantly, an ABM app could also easily be personalized (eg, allowing participants to select personally relevant images as training stimuli) and gamified (eg, by rewarding participants for the speed and accuracy of responses) to encourage engagement and training completion. Objective: We aim to test the feasibility and acceptability of “SWIPE,” a gamified, personalized alcohol ABM smartphone app, assess its preliminary effectiveness, and explore in which populations the app shows the strongest indicators of effectiveness. Methods: We aim to recruit 500 people who drink alcohol at hazardous or harmful levels (Alcohol Use Disorders Identification Test score≥8) and who wish to reduce their drinking. Recruitment will be conducted through social media and websites. The participants’ intended alcohol use goal (reduction or abstinence), motivation to change their consumption, and confidence to change their consumption will be measured prior to training. Participants will be instructed to download the SWIPE app and complete at least 2 ABM sessions per week for 4 weeks. Recruitment and completion rates will be used to assess feasibility. Four weeks after downloading SWIPE, participants will be asked to rate SWIPE’s functionality, esthetics, and quality to assess acceptability. Alcohol consumption, craving, and dependence will be measured prior to commencing the first session of ABM and 4 weeks later to assess whether these variables change significantly over the course of ABM. Results: We expect to commence recruitment in August 2020 and complete data collection in March 2021. Conclusions: This will be the first study to test the feasibility, acceptability, and preliminary effectiveness of a personalized, gamified ABM intervention smartphone app for hazardous or harmful drinkers. Results will inform further improvements to the app, as well as the design of a statistically powered randomized controlled trial to test its efficacy relative to a control condition. Ultimately, we hope that SWIPE will extend the benefits of ABM to the millions of individuals who consume alcohol at hazardous levels and wish to reduce their use but cannot or choose not to access treatment. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000638932p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p International Registered Report Identifier (IRRID): PRR1-10.2196/21278 %M 32795989 %R 10.2196/21278 %U http://www.researchprotocols.org/2020/8/e21278/ %U https://doi.org/10.2196/21278 %U http://www.ncbi.nlm.nih.gov/pubmed/32795989 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 8 %P e19624 %T App Technology to Support Physical Activity and Intake of Vitamins and Minerals After Bariatric Surgery (the PromMera Study): Protocol of a Randomized Controlled Clinical Trial %A Bonn,Stephanie Erika %A Hult,Mari %A Spetz,Kristina %A Löf,Marie %A Andersson,Ellen %A Wiren,Mikael %A Trolle Lagerros,Ylva %+ Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, Karolinska University Hospital, KEP T2:02, Stockholm, 171 76, Sweden, 46 851779173, stephanie.bonn@ki.se %K adults %K body composition %K exercise %K metabolic health %K obesity %K randomized controlled trial %K smartphones %K vitamin intake %K mobile phone %D 2020 %7 14.8.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: To optimize postoperative outcomes after bariatric surgery, lifestyle changes including increased physical activity are needed. Micronutrient deficiency after surgery is also common and daily supplementation is recommended. Objective: The aim of the PromMera study is to evaluate the effects of a 12-week smartphone app intervention on promotion of physical activity (primary outcome) and adherence to postsurgery vitamin and mineral supplementation, as well as on other lifestyle factors and overall health in patients undergoing bariatric surgery. Methods: The PromMera study is a two-arm, randomized controlled trial comprising patients undergoing bariatric surgery. Participants are randomized postsurgery 1:1 to either the intervention group (ie, use of the PromMera app for 12 weeks) or the control group receiving only standard care. Clinical and lifestyle variables are assessed pre- and postsurgery after 18 weeks (postintervention assessment), 6 months, 1 year, and 2 years. Assessments include body composition using Tanita or BOD POD analyzers, muscle function using handgrip, biomarkers in blood, and an extensive questionnaire on lifestyle factors. Physical activity is objectively measured using the ActiGraph wGT3X-BT triaxial accelerometer. Results: A total of 154 participants have been enrolled in the study. The last study participant was recruited in May 2019. Data collection will be complete in May 2021. Conclusions: Implementing lifestyle changes are crucial after bariatric surgery and new ways to reach patients and support such changes are needed. An app-based intervention is easily delivered at any time and can be a key factor in the adoption of healthier behavioral patterns in this rapidly growing group of patients. Trial Registration: ClinicalTrials.gov NCT03480464; https://clinicaltrials.gov/ct2/show/NCT03480464 International Registered Report Identifier (IRRID): DERR1-10.2196/19624 %M 32795990 %R 10.2196/19624 %U http://www.researchprotocols.org/2020/8/e19624/ %U https://doi.org/10.2196/19624 %U http://www.ncbi.nlm.nih.gov/pubmed/32795990 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17521 %T Understanding Time Series Patterns of Weight and Meal History Reports in Mobile Weight Loss Intervention Programs: Data-Driven Analysis %A Kim,Junetae %A Kam,Hye Jin %A Kim,Youngin %A Lee,Yura %A Lee,Jae-Ho %+ Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea, 82 3010 3350, rufiji@gmail.com %K weight loss %K self-reporting %K adherence %K mobile weight loss intervention %K diet %D 2020 %7 11.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile apps for weight loss provide users with convenient features for recording lifestyle and health indicators; they have been widely used for weight loss recently. Previous studies in this field generally focused on the relationship between the cumulative nature of self-reported data and the results in weight loss at the end of the diet period. Therefore, we conducted an in-depth study to explore the relationships between adherence to self-reporting and weight loss outcomes during the weight reduction process. Objective: We explored the relationship between adherence to self-reporting and weight loss outcomes during the time series weight reduction process with the following 3 research questions: “How does adherence to self-reporting of body weight and meal history change over time?”, “How do weight loss outcomes depend on weight changes over time?”, and “How does adherence to the weight loss intervention change over time by gender?” Methods: We analyzed self-reported data collected weekly for 16 weeks (January 2017 to March 2018) from 684 Korean men and women who participated in a mobile weight loss intervention program provided by a mobile diet app called Noom. Analysis of variance (ANOVA) and chi-squared tests were employed to determine whether the baseline characteristics among the groups of weight loss results were different. Based on the ANOVA results and slope analysis of the trend indicating participant behavior along the time axis, we explored the relationship between adherence to self-reporting and weight loss results. Results: Adherence to self-reporting levels decreased over time, as previous studies have found. BMI change patterns (ie, absolute BMI values and change in BMI values within a week) changed over time and were characterized in 3 time series periods. The relationships between the weight loss outcome and both meal history and self-reporting patterns were gender-dependent. There was no statistical association between adherence to self-reporting and weight loss outcomes in the male participants. Conclusions: Although mobile technology has increased the convenience of self-reporting when dieting, it should be noted that technology itself is not the essence of weight loss. The in-depth understanding of the relationship between adherence to self-reporting and weight loss outcome found in this study may contribute to the development of better weight loss interventions in mobile environments. %M 32780028 %R 10.2196/17521 %U https://www.jmir.org/2020/8/e17521 %U https://doi.org/10.2196/17521 %U http://www.ncbi.nlm.nih.gov/pubmed/32780028 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e15506 %T Mobile App for Mental Health Monitoring and Clinical Outreach in Veterans: Mixed Methods Feasibility and Acceptability Study %A Betthauser,Lisa M %A Stearns-Yoder,Kelly A %A McGarity,Suzanne %A Smith,Victoria %A Place,Skyler %A Brenner,Lisa A %+ Veterans Affairs, Rocky Mountain Mental Illness Research Education and Clinical Center, 1700 N Wheeling St, Aurora, CO, 80045, United States, 1 720 723 4867, lisa.betthauser@va.gov %K veterans %K mobile app %K smartphone %K mental health %K acceptability %K feasibility %D 2020 %7 11.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Advances in mobile health (mHealth) technology have made it possible for patients and health care providers to monitor and track behavioral health symptoms in real time. Ideally, mHealth apps include both passive and interactive monitoring and demonstrate high levels of patient engagement. Digital phenotyping, the measurement of individual technology usage, provides insight into individual behaviors associated with mental health. Objective: Researchers at a Veterans Affairs Medical Center and Cogito Corporation sought to explore the feasibility and acceptability of an mHealth app, the Cogito Companion. Methods: A mixed methodological approach was used to investigate the feasibility and acceptability of the app. Veterans completed clinical interviews and self-report measures, at baseline and at a 3-month follow-up. During the data collection period, participants were provided access to the Cogito Companion smartphone app. The mobile app gathered passive and active behavioral health indicators. Data collected (eg, vocal features and digital phenotyping of everyday social signals) are analyzed in real time. Passive data collected include location via global positioning system (GPS), phone calls, and SMS text message metadata. Four primary model scores were identified as being predictive of the presence or absence of depression or posttraumatic stress disorder (PTSD). Veterans Affairs clinicians monitored a provider dashboard and conducted clinical outreach when indicated. Results: Findings suggest that use of the Cogito Companion app was feasible and acceptable. Veterans (n=83) were interested in and used the app; however, active use declined over time. Nonetheless, data were passively collected, and outreach occurred throughout the study period. On the Client Satisfaction Questionnaire–8, 79% (53/67) of the sample reported scores demonstrating acceptability of the app (mean 26.2, SD 4.3). Many veterans reported liking specific app features (day-to-day monitoring) and the sense of connection they felt with the study clinicians who conducted outreach. Only a small percentage (4/67, 6%) reported concerns regarding personal privacy. Conclusions: Feasibility and acceptability of the Cogito Corporation platform to monitor mental health symptoms, behaviors, and facilitate follow-up in a sample of veterans were supported. Clinically, platforms such as the Cogito Companion system may serve as useful methods to promote monitoring, thereby facilitating early identification of risk and mitigating negative psychiatric outcomes, such as suicide. %M 32779572 %R 10.2196/15506 %U https://www.jmir.org/2020/8/e15506 %U https://doi.org/10.2196/15506 %U http://www.ncbi.nlm.nih.gov/pubmed/32779572 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e16696 %T Effects of a Novel Contextual Just-In-Time Mobile App Intervention (LowSalt4Life) on Sodium Intake in Adults With Hypertension: Pilot Randomized Controlled Trial %A Dorsch,Michael P %A Cornellier,Maria L %A Poggi,Armella D %A Bilgen,Feriha %A Chen,Peiyu %A Wu,Cindy %A An,Lawrence C %A Hummel,Scott L %+ University of Michigan College of Pharmacy, 428 Church Street, Ann Arbor, MI, 48109, United States, 1 734 647 1452, mdorsch@med.umich.edu %K hypertension %K sodium intake %K geofencing %K mHealth %D 2020 %7 10.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: High dietary sodium intake is a significant public health problem in the United States. High sodium consumption is associated with high blood pressure and high risk of cardiovascular disease. Objective: The aim of this study was to evaluate the effect of a just-in-time adaptive mobile app intervention, namely, LowSalt4Life, on reducing sodium intake in adults with hypertension. Methods: In this study, 50 participants aged ≥18 years who were under treatment for hypertension were randomized (1:1, stratified by gender) into 2 groups, namely, the App group (LowSalt4Life intervention) and the No App group (usual dietary advice) in a single-center, prospective, open-label randomized controlled trial for 8 weeks. The primary endpoint was the change in the 24-hour urinary sodium excretion estimated from spot urine by using the Kawasaki equation, which was analyzed using unpaired two-sided t tests. Secondary outcomes included the change in the sodium intake measured by the food frequency questionnaire (FFQ), the 24-hour urinary sodium excretion, blood pressure levels, and the self-reported confidence in following a low-sodium diet. Results: From baseline to week 8, there was a significant reduction in the Kawasaki-estimated 24-hour urinary sodium excretion calculated from spot urine in the App group compared to that in the No App group (–462 [SD 1220] mg vs 381 [SD 1460] mg, respectively; P=.03). The change in the 24-hour urinary sodium excretion was –637 (SD 1524) mg in the App group and –322 (SD 1485) mg in the No App group (P=.47). The changes in the estimated sodium intake as measured by 24-hour dietary recall and by FFQ in the App group were –1537 (SD 2693) mg and –1553 (SD 1764) mg while those in the No App group were –233 (SD 2150) mg and –515 (SD 1081) mg, respectively (P=.07 and P=.01, respectively). The systolic blood pressure change from baseline to week 8 in the App group was –7.5 mmHg while that in the No App group was –0.7 mmHg (P=.12), but the self-confidence in following a low-sodium diet was not significantly different between the 2 groups. Conclusions: This study shows that a contextual just-in-time mobile app intervention resulted in a greater reduction in the dietary sodium intake in adults with hypertension than that in the control group over a 8-week period, as measured by the estimated 24-hour urinary sodium excretion from spot urine and FFQ. The intervention group did not show a significant difference from the control group in the self-confidence in following a low sodium diet and in the 24-hour urinary sodium excretion or dietary intake of sodium as measured by the 24-hour dietary recall. A larger clinical trial is warranted to further elucidate the effects of the LowSalt4Life intervention on sodium intake and blood pressure levels in adults with hypertension. Trial Registration: ClinicalTrials.gov NCT03099343; https://clinicaltrials.gov/ct2/show/NCT03099343 International Registered Report Identifier (IRRID): RR2-10.2196/11282 %M 32663139 %R 10.2196/16696 %U http://mhealth.jmir.org/2020/8/e16696/ %U https://doi.org/10.2196/16696 %U http://www.ncbi.nlm.nih.gov/pubmed/32663139 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e16797 %T Examining Responsiveness to an Incentive-Based Mobile Health App: Longitudinal Observational Study %A Brower,Jacob %A LaBarge,Monica C %A White,Lauren %A Mitchell,Marc S %+ Smith School of Business, Queen's University, 805 Johnson St, Kingston, ON, K7L2B6, Canada, 1 6132174726, jbrower@queensu.ca %K mHealth %K behavioral economics %K public health %K incentives %K mobile apps %K mobile phone %D 2020 %7 10.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The Carrot Rewards app was developed as part of a public-private partnership to reward Canadians with loyalty points for downloading the app, referring friends, completing educational health quizzes, and health-related behaviors with long-term objectives of increasing health knowledge and encouraging healthy behaviors. During the first 3 months after program rollout in British Columbia, a number of program design elements were adjusted, creating observed differences between groups of users with respect to the potential impact of program features on user engagement levels. Objective: This study examines the impact of reducing reward size over time and explored the influence of other program features such as quiz timing, health intervention content, and type of reward program on user engagement with a mobile health (mHealth) app. Methods: Participants in this longitudinal, nonexperimental observational study included British Columbia citizens who downloaded the app between March and July 2016. A regression methodology was used to examine the impact of changes to several program design features on quiz offer acceptance and engagement with this mHealth app. Results: Our results, based on the longitudinal app use of 54,917 users (mean age 35, SD 13.2 years; 65.03% [35,647/54,917] female), indicated that the key drivers of the likelihood of continued user engagement, in order of greatest to least impact, were (1) type of rewards earned by users (eg, movies [+355%; P<.001], air travel [+210%; P<.001], and grocery [+140%; P<.001] relative to gas), (2) time delay between early offers (−64%; P<.001), (3) the content of the health intervention (eg, healthy eating [−10%; P<.001] vs exercise [+20%, P<.001] relative to health risk assessments), and (4) changes in the number of points offered. Our results demonstrate that reducing the number of points associated with a particular quiz by 10% only led to a 1% decrease in the likelihood of offer response (P<.001) and that each of the other design features had larger impacts on participant retention than did changes in the number of points. Conclusions: The results of this study demonstrate that this program, built around the principles of behavioral economics in the form of the ongoing awarding of a small number of reward points instantly following the completion of health interventions, was able to drive significantly higher engagement levels than those demonstrated in previous literature exploring the intersection of mHealth apps and financial incentives. Previous studies have demonstrated the presence of incentive matters to user engagement; however, our results indicate that the number of points offered for these reward point–based health interventions is less important than other program design features such as the type of reward points being offered, the timing of intervention and reward offers, and the content of the health interventions in driving continued engagement by users. %M 32773371 %R 10.2196/16797 %U https://www.jmir.org/2020/8/e16797 %U https://doi.org/10.2196/16797 %U http://www.ncbi.nlm.nih.gov/pubmed/32773371 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e16239 %T #BlackBreastsMatter: Process Evaluation of Recruitment and Engagement of Pregnant African American Women for a Social Media Intervention Study to Increase Breastfeeding %A Dauphin,Cassy %A Clark,Nikia %A Cadzow,Renee %A Saad-Harfouche,Frances %A Rodriguez,Elisa %A Glaser,Kathryn %A Kiviniemi,Marc %A Keller,Maria %A Erwin,Deborah %+ Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, United States, 1 716 845 2927, deborah.erwin@roswellpark.org %K breastfeeding %K breast cancer education %K African American mothers %K Facebook %K mobile phone, social media %D 2020 %7 10.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In the United States, there are lower rates of breastfeeding among African American mothers, particularly those who are younger women. Recent epidemiological studies have shown a strong association of more aggressive types of breast cancer (estrogen receptor negative) among African American women, with a higher risk in African American women who did not breastfeed their children. Objective: This study aims to describe the process evaluation of recruitment and educational strategies to engage pregnant African American participants for a pilot study designed to determine whether social media messaging about breast cancer risk reduction through breastfeeding may positively influence breastfeeding rates. Methods: This pilot study is conducted in collaboration with a local Women, Infants, and Children (WIC) organization and hospital and prenatal clinics of a local health care network. To engage African American women to enroll in the study, several methods and monitoring processes were explored, including WIC electronic text-based messages sent out to all phones of current WIC recipients (referred to as e-blasts); keyword responses to texts from flyers and posters in local community-based organizations, hospitals, and prenatal clinics; keyword responses using electronic links posted in established Facebook groups; and snowball recruitment of other pregnant women by current participants through Facebook. Once enrolled, participants were randomized to 2 study conditions: (1) an intervention group receiving messages about breast cancer risk reduction and breastfeeding or (2) a control group receiving breastfeeding-only messages. Data were obtained through electronic monitoring, SurveyMonkey, qualitative responses on Facebook, focus groups, and interviews. Results: More than 3000 text messages were sent and received through WIC e-blasts and keyword responses from flyers. A total of 472 women were recruited through WIC e-blast, and 161 responded to flyers and contacts through the local health care network, community-based organizations, Facebook, and friend referrals. A total of 633 women were assessed for eligibility to participate in the study. A total of 288 pregnant African American women were enrolled, consented, and completed presurvey assessments (102.8% of the goal), and 22 participants attended focus groups or interviews reporting on their experiences with Facebook and the educational messages. Conclusions: This process evaluation suggests that using electronic, smartphone apps with social media holds promise for both recruitment and conduct of health education intervention studies for pregnant African American women. Providing messaging and resources through social media to reinforce and educate women about breastfeeding and potentially provide lactation support is intriguing. Convenience (for researchers and participants) is an attribute of social media for this demographic of women and worthy of further research as an educational tool. Trial Registration: ClinicalTrials.gov NCT03680235; https://clinicaltrials.gov/ct2/show/NCT03680235 %M 32773377 %R 10.2196/16239 %U https://www.jmir.org/2020/8/e16239 %U https://doi.org/10.2196/16239 %U http://www.ncbi.nlm.nih.gov/pubmed/32773377 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e18347 %T Perceptions and Attitudes Toward a Mobile Phone App for Mental Health for College Students: Qualitative Focus Group Study %A Holtz,Bree E %A McCarroll,Alexis M %A Mitchell,Katharine M %+ Michigan State University, 404 Wilson Road, Room 309, East Lansing, MI, United States, 1 5178844537, bholtz@msu.edu %K mental health %K mobile phone %K mHealth %D 2020 %7 7.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Many college students who have mental health issues do not receive professional care for various reasons. Students who do not receive help often have both short- and long-term adverse health outcomes. Mobile apps for mental health services such as MySSP, a service provided to college students through their university, may help eliminate barriers to seeking mental health care and result in more positive outcomes for college students. Objective: This qualitative study aims to better understand college students’ perceptions and attitudes toward the adoption and use of a mobile phone app for mental health, MySSP, using the technology acceptance model (TAM). Methods: A series of nine focus groups were conducted with college students (N=30) between February and May 2019 at a large, public Midwestern university. The moderator’s guide was based on the TAM, and focus group sessions primarily focused on the use and knowledge of apps for mental health, specifically, MySSP. The focus group transcriptions were hand-coded to develop a set of themes that encompassed students’ perceptions and attitudes toward MySSP. Results: The analysis of the focus groups suggested the following themes: (1) existing awareness of the app, (2) perceived usefulness, (3) perceived ease of use, (4) attitudes toward apps for mental health and MySSP, and (5) social influence. Conclusions: The results of this study provide deeper insights into the perceptions of a mobile app for mental health among college students. Future research should explore the specific contexts in which an app for mental health will be most effective for college students. %M 32667892 %R 10.2196/18347 %U https://formative.jmir.org/2020/8/e18347 %U https://doi.org/10.2196/18347 %U http://www.ncbi.nlm.nih.gov/pubmed/32667892 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e20596 %T Mobile Health Apps That Help With COVID-19 Management: Scoping Review %A John Leon Singh,Hanson %A Couch,Danielle %A Yap,Kevin %+ Department of Public Health, School of Psychology and Public Health, La Trobe University, Health Sciences 2 Building, Melbourne, 3086, Australia, 61 3 9479 6068, kevinyap.ehealth@gmail.com %K COVID-19 %K mobile apps %K mHealth %K contact tracing %K symptom monitoring %K information provision %K mobile health %D 2020 %7 6.8.2020 %9 Review %J JMIR Nursing %G English %X Background: Mobile health (mHealth) apps have played an important role in mitigating the coronavirus disease (COVID-19) response. However, there is no resource that provides a holistic picture of the available mHealth apps that have been developed to combat this pandemic. Objective: Our aim is to scope the evidence base on apps that were developed in response to COVID-19. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews, literature searches were conducted on Google Search, Google Scholar, and PubMed using the country’s name as keywords and “coronavirus,” “COVID-19,” “nCOV19,” “contact tracing,” “information providing apps,” “symptom tracking,” “mobile apps,” “mobile applications,” “smartphone,” “mobile phone,” and “mHealth.” Countries most affected by COVID-19 and those that first rolled out COVID-19–related apps were included. Results: A total of 46 articles were reviewed from 19 countries, resulting in a total of 29 apps. Among them, 15 (52%) apps were on contact tracing, 7 (24%) apps on quarantine, 7 (24%) on symptom monitoring, and 1 (3%) on information provision. More than half (n=20, 69%) were from governmental sources, only 3 (10%) were from private organizations, and 3 (10%) from universities. There were 6 (21%) apps available on either Android or iOS, and 10 (34%) were available on both platforms. Bluetooth was used in 10 (34%) apps for collecting data, 12 (41%) apps used GPS, and 12 (41%) used other forms of data collection. Conclusions: This review identifies that the majority of COVID-19 apps were for contact tracing and symptom monitoring. However, these apps are effective only if taken up by the community. The sharing of good practices across different countries can enable governments to learn from each other and develop effective strategies to combat and manage this pandemic. %M 32897271 %R 10.2196/20596 %U https://nursing.jmir.org/2020/1/e20596/ %U https://doi.org/10.2196/20596 %U http://www.ncbi.nlm.nih.gov/pubmed/32897271 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e18370 %T Wearable Device Heart Rate and Activity Data in an Unsupervised Approach to Personalized Sleep Monitoring: Algorithm Validation %A Liu,Jiaxing %A Zhao,Yang %A Lai,Boya %A Wang,Hailiang %A Tsui,Kwok Leung %+ Centre for Systems Informatics Engineering, City University of Hong Kong, Tat Chee Avenue, Kowloon, 999077, China (Hong Kong), 852 34425792, yang.zhao@my.cityu.edu.hk %K sleep/wake identification %K hidden Markov model %K personalized health %K unsupervised learning %K sleep %K physical activity %K wearables %K heart rate %D 2020 %7 5.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The proliferation of wearable devices that collect activity and heart rate data has facilitated new ways to measure sleeping and waking durations unobtrusively and longitudinally. Most existing sleep/wake identification algorithms are based on activity only and are trained on expensive and laboriously annotated polysomnography (PSG). Heart rate can also be reflective of sleep/wake transitions, which has motivated its investigation herein in an unsupervised algorithm. Moreover, it is necessary to develop a personalized approach to deal with interindividual variance in sleep/wake patterns. Objective: We aimed to develop an unsupervised personalized sleep/wake identification algorithm using multifaceted data to explore the benefits of incorporating both heart rate and activity level in these types of algorithms and to compare this approach’s output with that of an existing commercial wearable device’s algorithms. Methods: In this study, a total of 14 community-dwelling older adults wore wearable devices (Fitbit Alta; Fitbit Inc) 24 hours a day and 7 days a week over period of 3 months during which their heart rate and activity data were collected. After preprocessing the data, a model was developed to distinguish sleep/wake states based on each individual’s data. We proposed the use of hidden Markov models and compared different modeling schemes. With the best model selected, sleep/wake patterns were characterized by estimated parameters in hidden Markov models, and sleep/wake states were identified. Results: When applying our proposed algorithm on a daily basis, we found there were significant differences in estimated parameters between weekday models and weekend models for some participants. Conclusions: Our unsupervised approach can be effectively implemented based on an individual’s multifaceted sleep-related data from a commercial wearable device. A personalized model is shown to be necessary given the interindividual variability in estimated parameters. %M 32755887 %R 10.2196/18370 %U https://mhealth.jmir.org/2020/8/e18370 %U https://doi.org/10.2196/18370 %U http://www.ncbi.nlm.nih.gov/pubmed/32755887 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e17699 %T Using Smart Bracelets to Assess Heart Rate Among Students During Physical Education Lessons: Feasibility, Reliability, and Validity Study %A Sun,Jiangang %A Liu,Yang %+ School of Physical Education and Sport Training, Shanghai University of Sport, 650 Qingyuanhuan Rd, Shanghai, 200438, China, 86 21 6550 7989, docliuyang@hotmail.com %K physical education %K heart rate %K validation %K feasibility %K reliability %K Fizzo %K Polar %K wrist-worn devices %K physical education lesson %K monitoring %D 2020 %7 5.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: An increasing number of wrist-worn wearables are being examined in the context of health care. However, studies of their use during physical education (PE) lessons remain scarce. Objective: We aim to examine the reliability and validity of the Fizzo Smart Bracelet (Fizzo) in measuring heart rate (HR) in the laboratory and during PE lessons. Methods: In Study 1, 11 healthy subjects (median age 22.0 years, IQR 3.75 years) twice completed a test that involved running on a treadmill at 6 km/h for 12 minutes and 12 km/h for 5 minutes. During the test, participants wore two Fizzo devices, one each on their left and right wrists, to measure their HR. At the same time, the Polar Team2 Pro (Polar), which is worn on the chest, was used as the standard. In Study 2, we went to 10 schools and measured the HR of 24 students (median age 14.0 years, IQR 2.0 years) during PE lessons. During the PE lessons, each student wore a Polar device on their chest and a Fizzo on their right wrist to measure HR data. At the end of the PE lessons, the students and their teachers completed a questionnaire where they assessed the feasibility of Fizzo. The measurements taken by the left wrist Fizzo and the right wrist Fizzo were compared to estimate reliability, while the Fizzo measurements were compared to the Polar measurements to estimate validity. To measure reliability, intraclass correlation coefficients (ICC), mean difference (MD), standard error of measurement (SEM), and mean absolute percentage errors (MAPE) were used. To measure validity, ICC, limits of agreement (LOA), and MAPE were calculated and Bland-Altman plots were constructed. Percentage values were used to estimate the feasibility of Fizzo. Results: The Fizzo showed excellent reliability and validity in the laboratory and moderate validity in a PE lesson setting. In Study 1, reliability was excellent (ICC>0.97; MD<0.7; SEM<0.56; MAPE<1.45%). The validity as determined by comparing the left wrist Fizzo and right wrist Fizzo was excellent (ICC>0.98; MAPE<1.85%). Bland-Altman plots showed a strong correlation between left wrist Fizzo measurements (bias=0.48, LOA=–3.94 to 4.89 beats per minute) and right wrist Fizzo measurements (bias=0.56, LOA=–4.60 to 5.72 beats per minute). In Study 2, the validity of the Fizzo was lower compared to that found in Study 1 but still moderate (ICC>0.70; MAPE<9.0%). The Fizzo showed broader LOA in the Bland-Altman plots during the PE lessons (bias=–2.60, LOA=–38.89 to 33.69 beats per minute). Most participants considered the Fizzo very comfortable and easy to put on. All teachers thought the Fizzo was helpful. Conclusions: When participants ran on a treadmill in the laboratory, both left and right wrist Fizzo measurements were accurate. The validity of the Fizzo was lower in PE lessons but still reached a moderate level. The Fizzo is feasible for use during PE lessons. %M 32663136 %R 10.2196/17699 %U http://mhealth.jmir.org/2020/8/e17699/ %U https://doi.org/10.2196/17699 %U http://www.ncbi.nlm.nih.gov/pubmed/32663136 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e19380 %T User Perception of a Smartphone App to Promote Physical Activity Through Active Transportation: Inductive Qualitative Content Analysis Within the Smart City Active Mobile Phone Intervention (SCAMPI) Study %A Lindqvist,Anna-Karin %A Rutberg,Stina %A Söderström,Emmie %A Ek,Anna %A Alexandrou,Christina %A Maddison,Ralph %A Löf,Marie %+ Division of Health, Medicine and Rehabilitation, Department of Health Sciences, Luleå University of Technology, Luleå, 971 87, Sweden, 46 0725390660, anna-karin.lindqvist@ltu.se %K behavior change %K smartphone intervention %K physical activity %K user perception %K active transportation %K mobile app %K inductive qualitative content analysis %K mobile health %K social cognitive theory %K mHealth %D 2020 %7 5.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical inactivity is globally recognized as a major risk factor for morbidity, particularly the incidence of noncommunicable diseases. Increasing physical activity (PA) is therefore a public health priority. Engaging in active transportation (AT) is a viable approach for promoting daily PA levels. Mobile health interventions enable the promotion of AT to a larger population. The Smart City Active Mobile Phone Intervention (SCAMPI) study was a randomized controlled trial designed to evaluate the ability of a behavior change program delivered via a smartphone app to motivate participants to increase their PA by engaging in AT. Objective: This qualitative study aims to examine the acceptance and user experience of the app promoting AT that was used in the SCAMPI trial (the TRavelVU Plus app). Methods: A total of 17 residents of Stockholm County (13 women; age range 25-61 years) who completed the 3-month app-based behavioral change program (delivered through the TRavelVU Plus app) in the SCAMPI randomized controlled trial during 2018 agreed to participate in a semistructured telephone-based interview. These participants were well representative of the whole intervention group (n=127) in terms of baseline characteristics such as age, sex, and area of residence. The interviews were audiorecorded, transcribed verbatim, and analyzed using an inductive qualitative content analysis. Results: The content analysis revealed 2 themes and 4 subcategories. The first theme, “main motivators: monitoring and messages,” highlighted that monitoring AT and being able to set weekly goals using the app were the primary motivators reported by study participants. The second theme, “acceptable but modifiable,” reflects that the app was well accepted and effectively encouraged many participants to use more AT. Nevertheless, there were functions in the app that require modification. For example, while the semiautomated travel tracking feature was appreciated, participants found it time-consuming and unreliable at times. Conclusions: This study contributes novel insight into adults’ experiences of using a mobile app to promote the use of AT. The results showed that the app was well accepted and that self-monitoring and goal setting were the main motivators to engage in more AT. The semiautomated tracking of AT was appreciated; however, it was also reported to be energy- and time-consuming when it failed to work. Thus, this feature should be improved going forward. Trial Registration: ClinicalTrials.gov NCT03086837; https://clinicaltrials.gov/ct2/show/NCT03086837 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5658-4 %M 32755889 %R 10.2196/19380 %U https://mhealth.jmir.org/2020/8/e19380 %U https://doi.org/10.2196/19380 %U http://www.ncbi.nlm.nih.gov/pubmed/32755889 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e15156 %T Rams Have Heart, a Mobile App Tracking Activity and Fruit and Vegetable Consumption to Support the Cardiovascular Health of College Students: Development and Usability Study %A Krzyzanowski,Michelle C %A Kizakevich,Paul N %A Duren-Winfield,Vanessa %A Eckhoff,Randall %A Hampton,Joel %A Blackman Carr,Loneke T %A McCauley,Georgia %A Roberson,Kristina B %A Onsomu,Elijah O %A Williams,John %A Price,Amanda Alise %+ RTI International, 3040 Conwallis Rd, Research Triangle Park, NC, 27709, United States, 1 919 485 5648, mkrzyzanowski@rti.org %K exercise %K cardiovascular disease %K diary %K diet %K mHealth %K mobile phone %D 2020 %7 5.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the increasing use of mobile devices to access the internet and as the main computing system of apps, there is a growing market for mobile health apps to provide self-care advice. Their effectiveness with regard to diet and fitness tracking, for example, needs to be examined. The majority of American adults fail to meet daily recommendations for healthy behavior. Testing user engagement with an app in a controlled environment can provide insight into what is effective and not effective in an app focused on improving diet and exercise. Objective: We developed Rams Have Heart, a mobile app, to support a cardiovascular disease (CVD) intervention course. The app tracks healthy behaviors, including fruit and vegetable consumption and physical activity, throughout the day. This paper aimed to present its functionality and evaluated adherence among the African American college student population. Methods: We developed the app using the Personal Health Informatics and Intervention Toolkit, a software framework. Rams Have Heart integrates self-reported health screening with health education, diary tracking, and user feedback modules to acquire data and assess progress. The parent study, conducted at a historically black college and university-designated institution in southeastern United States, consisted of a semester-long intervention administered as an academic course in the fall, for 3 consecutive years. Changes were made after the cohort 1 pilot study, so results only include cohorts 2 and 3, comprising a total of 115 students (n=55 intervention participants and n=54 control participants) aged from 17 to 24 years. Data collected over the study period were transferred using the secure Hypertext Transfer Protocol Secure protocol and stored in a secure Structured Query Language server database accessible only to authorized persons. SAS software was used to analyze the overall app usage and the specific results collected. Results: Of the 55 students in the intervention group, 27 (49%) students in cohort 2 and 25 (45%) in cohort 3 used the Rams Have Heart app at least once. Over the course of the fall semester, app participation dropped off gradually until exam week when most students no longer participated. The average fruit and vegetable intake increased slightly, and activity levels decreased over the study period. Conclusions: Rams Have Heart was developed to allow daily tracking of fruit and vegetable intake and physical activity to support a CVD risk intervention for a student demographic susceptible to obesity, heart disease, and type 2 diabetes. We conducted an analysis of app usage, function, and user results. Although a mobile app provides privacy and flexibility for user participation in a research study, Rams Have Heart did not improve compliance or user outcomes. Health-oriented research studies relying on apps in support of user goals need further evaluation. %M 32755883 %R 10.2196/15156 %U https://mhealth.jmir.org/2020/8/e15156 %U https://doi.org/10.2196/15156 %U http://www.ncbi.nlm.nih.gov/pubmed/32755883 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19216 %T Effect of Adding Telephone-Based Brief Coaching to an mHealth App (Stay Strong) for Promoting Physical Activity Among Veterans: Randomized Controlled Trial %A Damschroder,Laura J %A Buis,Lorraine R %A McCant,Felicia A %A Kim,Hyungjin Myra %A Evans,Richard %A Oddone,Eugene Z %A Bastian,Lori A %A Hooks,Gwendolyn %A Kadri,Reema %A White-Clark,Courtney %A Richardson,Caroline R %A Gierisch,Jennifer M %+ Veterans Affairs Center for Clinical Management Research, Ann Arbor Healthcare System, 2215 Fuller Rd (152), Ann Arbor, MI, 48105, United States, 1 7348453603, laura.damschroder@va.gov %K exercise %K veterans %K smartphones %K wearable physical activity tracker %K behavior change %K mobile phone %K online %K app %K mobile app %K wearable %D 2020 %7 4.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Though maintaining physical conditioning and a healthy weight are requirements of active military duty, many US veterans lose conditioning and rapidly gain weight after discharge from active duty service. Mobile health (mHealth) interventions using wearable devices are appealing to users and can be effective especially with personalized coaching support. We developed Stay Strong, a mobile app tailored to US veterans, to promote physical activity using a wrist-worn physical activity tracker, a Bluetooth-enabled scale, and an app-based dashboard. We tested whether adding personalized coaching components (Stay Strong+Coaching) would improve physical activity compared to Stay Strong alone. Objective: The goal of this study is to compare 12-month outcomes from Stay Strong alone versus Stay Strong+Coaching. Methods: Participants (n=357) were recruited from a national random sample of US veterans of recent wars and randomly assigned to the Stay Strong app alone (n=179) or Stay Strong+Coaching (n=178); both programs lasted 12 months. Personalized coaching components for Stay Strong+Coaching comprised of automated in-app motivational messages (3 per week), telephone-based human health coaching (up to 3 calls), and personalized weekly goal setting. All aspects of the enrollment process and program delivery were accomplished virtually for both groups, except for the telephone-based coaching. The primary outcome was change in physical activity at 12 months postbaseline, measured by average weekly Active Minutes, captured by the Fitbit Charge 2 device. Secondary outcomes included changes in step counts, weight, and patient activation. Results: The average age of participants was 39.8 (SD 8.7) years, and 25.2% (90/357) were female. Active Minutes decreased from baseline to 12 months for both groups (P<.001) with no between-group differences at 6 months (P=.82) or 12 months (P=.98). However, at 12 months, many participants in both groups did not record Active Minutes, leading to missing data in 67.0% (120/179) for Stay Strong and 61.8% (110/178) for Stay Strong+Coaching. Average baseline weight for participants in Stay Strong and Stay Strong+Coaching was 214 lbs and 198 lbs, respectively, with no difference at baseline (P=.54) or at 6 months (P=.28) or 12 months (P=.18) postbaseline based on administrative weights, which had lower rates of missing data. Changes in the number of steps recorded and patient activation also did not differ by arm. Conclusions: Adding personalized health coaching comprised of in-app automated messages, up to 3 coaching calls, plus automated weekly personalized goals, did not improve levels of physical activity compared to using a smartphone app alone. Physical activity in both groups decreased over time. Sustaining long-term adherence and engagement in this mHealth intervention proved difficult; approximately two-thirds of the trial’s 357 participants failed to sync their Fitbit device at 12 months and, thus, were lost to follow-up. Trial Registration: ClinicalTrials.gov NCT02360293; https://clinicaltrials.gov/ct2/show/NCT02360293 International Registered Report Identifier (IRRID): RR2-10.2196/12526 %M 32687474 %R 10.2196/19216 %U http://www.jmir.org/2020/8/e19216/ %U https://doi.org/10.2196/19216 %U http://www.ncbi.nlm.nih.gov/pubmed/32687474 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e15338 %T Monitoring Occupational Sitting, Standing, and Stepping in Office Employees With the W@W-App and the MetaWearC Sensor: Validation Study %A Bort-Roig,Judit %A Chirveches-Pérez,Emilia %A Garcia-Cuyàs,Francesc %A Dowd,Kieran P %A Puig-Ribera,Anna %+ Sport and Physical Activity Research Group, Centre for Health and Social Care Research, University of Vic-Central University of Catalonia, Miquel Martí i Pol, 1, Vic, 08500, Spain, 34 938863342, annam.puig@uvic.cat %K validity %K self-monitoring %K sedentary behavior %K physical activity %K smartphone %K mobile phone %K device-based measure %D 2020 %7 4.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Replacing occupational sitting time with active tasks has several proposed health benefits for office employees. Mobile phones and motion sensors can provide objective information in real time on occupational sitting behavior. However, the validity and feasibility of using mobile health (mHealth) devices to quantify and modify occupational sedentary time is unclear. Objective: The aim of this study is to validate the new Walk@Work-Application (W@W-App)—including an external motion sensor (MetaWearC) attached to the thigh—for measuring occupational sitting, standing, and stepping in free-living conditions against the activPAL3M, the current gold-standard, device-based measure for postural behaviors. Methods: In total, 20 office workers (16 [80%] females; mean age 39.5, SD 8.1 years) downloaded the W@W-App to their mobile phones, wore a MetaWearC sensor attached to their thigh using a tailored band, and wore the activPAL3M for 3-8 consecutive working hours. Differences between both measures were examined using paired-samples t tests and Wilcoxon signed-rank tests. Agreement between measures was examined using concordance correlation coefficients (CCCs), 95% CIs, Bland-Altman plots (mean bias, 95% limits of agreement [LoA]), and equivalence testing techniques. Results: The median recording time for the W@W-App+MetaWearC and the activPAL3M was 237.5 (SD 132.8) minutes and 240.0 (SD 127.5) minutes, respectively (P<.001). No significant differences between sitting (P=.53), standing (P=.12), and stepping times (P=.61) were identified. The CCC identified substantial agreement between both measures for sitting (CCC=0.98, 95% CI 0.96-0.99), moderate agreement for standing (CCC=0.93, 95% CI 0.81-0.97), and poor agreement for stepping (CCC=0.74, 95% CI 0.47-0.88). Bland-Altman plots indicated that sitting time (mean bias –1.66 minutes, 95% LoA –30.37 to 20.05) and standing time (mean bias –4.85 minutes, 95% LoA –31.31 to 21.62) were underreported. For stepping time, a positive mean bias of 1.15 minutes (95% LoA –15.11 to 17.41) was identified. Equivalence testing demonstrated that the estimates obtained from the W@W-App+MetaWearC and the activPAL3M were considered equivalent for all variables excluding stepping time. Conclusions: The W@W-App+MetaWearC is a low-cost tool with acceptable levels of accuracy that can objectively quantify occupational sitting, standing, stationary, and upright times in real time. Due to the availability of real-time feedback for users, this tool can positively influence occupational sitting behaviors in future interventions. Trial Registration: ClinicalTrials.gov NCT04092738; https://clinicaltrials.gov/ct2/show/NCT04092738 %M 32459625 %R 10.2196/15338 %U https://mhealth.jmir.org/2020/8/e15338 %U https://doi.org/10.2196/15338 %U http://www.ncbi.nlm.nih.gov/pubmed/32459625 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e17281 %T Prescribing Behavior Change: Opportunities and Challenges for Clinicians to Embrace Digital and Mobile Health %A Agarwal,Anish %A Patel,Mitesh %+ Department of Emergency Medicine, University of Pennsylvania, Blockley Hall, Room 428, 423 Guardian Drive, Philadelphia, PA, 19146, United States, 1 610 304 2318, anish.agarwal@pennmedicine.upenn.edu %K digital health %K behavior change %K mobile health %K patient-centered data collection %D 2020 %7 4.8.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Individual behaviors impact physical and mental health. Everyday behaviors such as physical activity, diet, sleep, and tobacco use have been associated with a range of acute and chronic medical conditions. Educating, motivating, and promoting sustained healthy behaviors can be challenging for clinical providers attempting to manage their patients’ health. The ubiquity and integration of mobile and digital health devices (eg, wearable step counters, smartphone-based apps) allow for individuals to generate and record enormous amounts of patient-generated health data. Research studies have begun to reveal how mobile and digital devices offer promise in motivating individual behavior change but they have not had consistent results. In this viewpoint, we discuss the potential synergy of digital health modalities and behavioral strategies as an approach for clinicians to prescribe, motivate, monitor, and sustain healthy behaviors. We discuss the strengths, challenges, and opportunities for the future of promoting health behaviors. %M 32749997 %R 10.2196/17281 %U https://mhealth.jmir.org/2020/8/e17281 %U https://doi.org/10.2196/17281 %U http://www.ncbi.nlm.nih.gov/pubmed/32749997 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e16924 %T Digital Behavior Change Interventions for Younger Children With Chronic Health Conditions: Systematic Review %A Brigden,Amberly %A Anderson,Emma %A Linney,Catherine %A Morris,Richard %A Parslow,Roxanne %A Serafimova,Teona %A Smith,Lucie %A Briggs,Emily %A Loades,Maria %A Crawley,Esther %+ Centre for Academic Child Health, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, United Kingdom, 44 0117 42 83080, amberly.brigden@bristol.ac.uk %K mobile phone %K mHealth %K mobile health %K eHealth %K electronic health %K digital health %K behavior %K pediatrics %K chronic illness %K systematic review %D 2020 %7 31.7.2020 %9 Review %J J Med Internet Res %G English %X Background: The prevalence of chronic health conditions in childhood is increasing, and behavioral interventions can support the management of these conditions. Compared with face-to-face treatment, the use of digital interventions may be more cost-effective, appealing, and accessible, but there has been inadequate attention to their use with younger populations (children aged 5-12 years). Objective: This systematic review aims to (1) identify effective digital interventions, (2) report the characteristics of promising interventions, and (3) describe the user’s experience of the digital intervention. Methods: A total of 4 databases were searched (Excerpta Medica Database [EMBASE], PsycINFO, Medical Literature Analysis and Retrieval System Online [MEDLINE], and the Cochrane Library) between January 2014 and January 2019. The inclusion criteria for studies were as follows: (1) children aged between 5 and 12 years, (2) interventions for behavior change, (3) randomized controlled trials, (4) digital interventions, and (5) chronic health conditions. Two researchers independently double reviewed papers to assess eligibility, extract data, and assess quality. Results: Searches run in the databases identified 2643 papers. We identified 17 eligible interventions. The most promising interventions (having a beneficial effect and low risk of bias) were 3 targeting overweight or obesity, using exergaming or social media, and 2 for anxiety, using web-based cognitive behavioral therapy (CBT). Characteristics of promising interventions included gaming features, therapist support, and parental involvement. Most were purely behavioral interventions (rather than CBT or third wave), typically using the behavior change techniques (BCTs) feedback and monitoring, shaping knowledge, repetition and substitution, and reward. Three papers included qualitative data on the user’s experience. We developed the following themes: parental involvement, connection with a health professional is important for engagement, technological affordances and barriers, and child-centered design. Conclusions: Of the 17 eligible interventions, digital interventions for anxiety and overweight or obesity had the greatest promise. Using qualitative methods during digital intervention development and evaluation may lead to more meaningful, usable, feasible, and engaging interventions, especially for this underresearched younger population. The following characteristics could be considered when developing digital interventions for younger children: involvement of parents, gaming features, additional therapist support, behavioral (rather than cognitive) approaches, and particular BCTs (feedback and monitoring, shaping knowledge, repetition and substitution, and reward). This review suggests a model for improving the conceptualization and reporting of behavioral interventions involving children and parents. %M 32735227 %R 10.2196/16924 %U http://www.jmir.org/2020/7/e16924/ %U https://doi.org/10.2196/16924 %U http://www.ncbi.nlm.nih.gov/pubmed/32735227 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17857 %T An App for Classifying Personal Mental Illness at Workplace Using Fit Statistics and Convolutional Neural Networks: Survey-Based Quantitative Study %A Yan,Yu-Hua %A Chien,Tsair-Wei %A Yeh,Yu-Tsen %A Chou,Willy %A Hsing,Shu-Chen %+ Respiratory Therapy Unit, Chi Mei Medical Center, No 901, Chung Hwa Road, Yung Kung Dist, Tainan, 710, Taiwan, 886 +886937399106, rtlisa1965@gmail.com %K respiratory therapist %K ELMI app %K Rasch analysis %K convolutional neural network %K mental health %K mobile phone %D 2020 %7 31.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental illness (MI) is common among those who work in health care settings. Whether MI is related to employees’ mental status at work is yet to be determined. An MI app is developed and proposed to help employees assess their mental status in the hope of detecting MI at an earlier stage. Objective: This study aims to build a model using convolutional neural networks (CNNs) and fit statistics based on 2 aspects of measures and outfit mean square errors for the automatic detection and classification of personal MI at the workplace using the emotional labor and mental health (ELMH) questionnaire, so as to equip the staff in assessing and understanding their own mental status with an app on their mobile device. Methods: We recruited 352 respiratory therapists (RTs) working in Taiwan medical centers and regional hospitals to fill out the 44-item ELMH questionnaire in March 2019. The exploratory factor analysis (EFA), Rasch analysis, and CNN were used as unsupervised and supervised learnings for (1) dividing RTs into 4 classes (ie, MI, false MI, health, and false health) and (2) building an ELMH predictive model to estimate 108 parameters of the CNN model. We calculated the prediction accuracy rate and created an app for classifying MI for RTs at the workplace as a web-based assessment. Results: We observed that (1) 8 domains in ELMH were retained by EFA, (2) 4 types of mental health (n=6, 63, 265, and 18 located in 4 quadrants) were classified using the Rasch analysis, (3) the 44-item model yields a higher accuracy rate (0.92), and (4) an MI app available for RTs predicting MI was successfully developed and demonstrated in this study. Conclusions: The 44-item model with 108 parameters was estimated by using CNN to improve the accuracy of mental health for RTs. An MI app developed to help RTs self-detect work-related MI at an early stage should be made more available and viable in the future. %M 32735232 %R 10.2196/17857 %U https://mhealth.jmir.org/2020/7/e17857 %U https://doi.org/10.2196/17857 %U http://www.ncbi.nlm.nih.gov/pubmed/32735232 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16596 %T Effects of an mHealth Brisk Walking Intervention on Increasing Physical Activity in Older People With Cognitive Frailty: Pilot Randomized Controlled Trial %A Kwan,Rick YC %A Lee,Deborah %A Lee,Paul H %A Tse,Mimi %A Cheung,Daphne SK %A Thiamwong,Ladda %A Choi,Kup-Sze %+ Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, Hong Kong (China), 852 27666546 ext 6546, rick.kwan@polyu.edu.hk %K cognitive frailty %K brisk walking %K smartphone %K moderate-to-vigorous physical activity %K older people %D 2020 %7 31.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cognitive frailty is the coexistence of physical frailty and cognitive impairment and is an at-risk state for many adverse health outcomes. Moderate-to-vigorous physical activity (MVPA) is protective against the progression of cognitive frailty. Physical inactivity is common in older people, and brisk walking is a feasible form of physical activity that can enhance their MVPA. Mobile health (mHealth) employing persuasive technology has been successful in increasing the levels of physical activity in older people. However, its feasibility and effects on older people with cognitive frailty are unclear. Objective: We aimed to identify the issues related to the feasibility of an mHealth intervention and the trial (ie, recruitment, retention, participation, and compliance) and to examine the effects of the intervention on cognitive function, physical frailty, walking time, and MVPA. Methods: An open-label, parallel design, randomized controlled trial (RCT) was employed. The eligibility criteria for the participants were age ≥60 years, having cognitive frailty, and having physical inactivity. In the intervention group, participants received both conventional behavior change intervention and mHealth (ie, smartphone-assisted program using Samsung Health and WhatsApp) interventions. In the control group, participants received conventional behavior change intervention only. The outcomes included cognitive function, frailty, walking time, and MVPA. Permuted block randomization in 1:1 ratio was used. The feasibility issue was described in terms of participant recruitment, retention, participation, and compliance. Wilcoxon signed-rank test was used to test the within-group effects in both groups separately. Results: We recruited 99 participants; 33 eligible participants were randomized into either the intervention group (n=16) or the control (n=17) group. The median age was 71.0 years (IQR 9.0) and the majority of them were females (28/33, 85%). The recruitment rate was 33% (33/99), the participant retention rate was 91% (30/33), and the attendance rate of all the face-to-face sessions was 100% (33/33). The majority of the smartphone messages were read by the participants within 30 minutes (91/216, 42.1%). ActiGraph (58/66 days, 88%) and smartphone (54/56 days, 97%) wearing compliances were good. After the interventions, cognitive function improvement was significant in both the intervention (P=.003) and the control (P=.009) groups. The increase in frailty reduction (P=.005), walking time (P=.03), step count (P=.02), brisk walking time (P=.009), peak cadence (P=.003), and MVPA time (P=.02) were significant only in the intervention group. Conclusions: Our mHealth intervention is feasible for implementation in older people with cognitive impairment and is effective at enhancing compliance with the brisk walking training program delivered by the conventional behavior change interventions. We provide preliminary evidence that this mHealth intervention can increase MVPA time to an extent sufficient to yield clinical benefits (ie, reduction in cognitive frailty). A full-powered and assessor-blinded RCT should be employed in the future to warrant these effects. Trial Registration: HKU Clinical Trials Registry HKUCTR-2283; http://www.hkuctr.com/Study/Show/31df4708944944bd99e730d839db4756 %M 32735218 %R 10.2196/16596 %U https://mhealth.jmir.org/2020/7/e16596 %U https://doi.org/10.2196/16596 %U http://www.ncbi.nlm.nih.gov/pubmed/32735218 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e15418 %T Effectiveness of a Mobile App Intervention for Anxiety and Depression Symptoms in University Students: Randomized Controlled Trial %A McCloud,Tayla %A Jones,Rebecca %A Lewis,Gemma %A Bell,Vaughan %A Tsakanikos,Elias %+ Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom, 44 2031087765, t.mccloud@ucl.ac.uk %K anxiety %K depression %K cognitive behavioral therapy %K eHealth %K online intervention %K mobile apps %K randomized controlled trial %K mobile phone %D 2020 %7 31.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Depression and anxiety symptoms are common among university students, but many do not receive treatment. This is often because of lack of availability, reluctance to seek help, and not meeting the diagnostic criteria required to access services. Internet-based interventions, including smartphone apps, can overcome these issues. However, a large number of apps are available, each with little evidence of their effectiveness. Objective: This study aims to evaluate for the first time the effectiveness of a self-guided mobile app, Feel Stress Free, for the treatment of depression and anxiety symptoms in students. Methods: A web-based randomized controlled trial compared a cognitive behavioral therapy (CBT)–based mobile app Feel Stress Free with a wait-list control. University students self-identified as experiencing symptoms of anxiety or depression and were randomized to 6 weeks of intervention (n=84) or control (n=84), unblinded. The app is self-guided and incorporates behavioral relaxation activities, mood tracking and thought challenging, and minigames. Participants completed the Hospital Anxiety and Depression Scale online at baseline and every fortnight. Results: At week 6, the primary end point, there was evidence that the Feel Stress Free app reduced depression symptoms (mean difference −1.56; 95% CI −2.67 to −0.44; P=.006) but only very weak evidence that it reduced anxiety symptoms (mean difference −1.36; 95% CI −2.93 to 0.21; P=.09). At week 4, there was evidence to support the effectiveness of the intervention for anxiety symptoms (mean difference −1.94; 95% CI −3.11 to −0.77; P=.001) and, though weaker, depression symptoms (mean difference −1.08; 95% CI −2.12 to −0.04; P=.04). At week 6, 83% (34/41) of participants indicated that they were using the app weekly or more frequently. Conclusions: The Feel Stress Free app is a promising mobile intervention for treating symptoms of anxiety and depression in students and overcomes many of the barriers to traditional CBT. Further research is needed to establish its effectiveness at and beyond 6 weeks. Trial Registration: ClinicalTrials.gov NCT03032952; https://clinicaltrials.gov/ct2/show/NCT03032952 %M 32735221 %R 10.2196/15418 %U http://mhealth.jmir.org/2020/7/e15418/ %U https://doi.org/10.2196/15418 %U http://www.ncbi.nlm.nih.gov/pubmed/32735221 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e14013 %T Use of a Smartphone App for Weight Loss Versus a Paper-Based Dietary Diary in Overweight Adults: Randomized Controlled Trial %A Ahn,Jeong Sun %A Lee,Heejin %A Kim,Jiae %A Park,Haemin %A Kim,Dong Woo %A Lee,Jung Eun %+ Department of Food and Nutrition, College of Human Ecology, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 2 880 6834, jungelee@snu.ac.kr %K smartphone app %K mobile phone %K dietary self-monitoring %K randomized controlled trial %K weight loss %D 2020 %7 31.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) tools may be useful platforms for dietary monitoring and assessment. Objective: This study aims to evaluate the effectiveness of a mobile dietary self-monitoring app for weight loss versus a paper-based diary among adults with a BMI of 23 kg/m2 or above. Methods: A total of 33 men and 17 women aged 18-39 years participated in a 6-week randomized controlled trial. We randomly assigned participants to one of two groups: (1) a smartphone app group (n=25) or (2) a paper-based diary group (n=25). The smartphone app group recorded foods and dietary supplements that they consumed and received immediate dietary feedback using Well-D, a dietary self-monitoring app developed by our team. The paper-based diary group was instructed to record foods or supplements that they consumed using a self-recorded diary. The primary outcomes were weight, BMI, waist circumference, body fat mass, and skeletal muscle mass. We also examined changes in nutrient intake, including energy, carbohydrate, protein, fat, dietary fiber, vitamins, and minerals, using 3-day 24-hour recalls. Differences in changes between the two groups were analyzed using independent t tests or Wilcoxon Mann-Whitney tests. All of the data were analyzed using intent-to-treat analysis. Results: The mean number of days recorded was 18.5 (SD 14.1) for the app group and 15.5 (SD 10.1) for the paper-based diary group. The differences in changes in weight, BMI, and waist circumference were not significantly different between the app group and paper-based diary group (P=.33, .34, and .70, respectively). Similarly, changes in body fat mass or skeletal muscle mass did not differ between the two groups (P=.71 and .054, respectively). Although energy intake was reduced in both groups, there was no significant difference in changes in energy intake between the two groups (P=.98). Conclusions: There were no differences in changes in anthropometric measures and nutrient intake between the app group and the paper-based diary group. Both mobile dietary self-monitoring app and paper-based diary may be useful for improving anthropometric measures. Trial Registration: Clinical Research Information Service KCT0003170; https://cris.nih.go.kr/cris/search/search_result_st01_en.jsp?seq=11642<ype=&rtype= %M 32735225 %R 10.2196/14013 %U http://mhealth.jmir.org/2020/7/e14013/ %U https://doi.org/10.2196/14013 %U http://www.ncbi.nlm.nih.gov/pubmed/32735225 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17031 %T Effects of the e-Motivate4Change Program on Metabolic Syndrome in Young Adults Using Health Apps and Wearable Devices: Quasi-Experimental Study %A Lee,Ji-Soo %A Kang,Min-Ah %A Lee,Soo-Kyoung %+ Keimyung University, 1095 Dalgubeol-daero, Dalseo-Gu, Daegu, 42601, Republic of Korea, 82 53 258 7665, soo1005s@gmail.com %K metabolic syndrome %K telemedicine %K mobile apps %K preventive care %K wearable electronic devices %D 2020 %7 30.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The health behaviors of young adults lag behind those of other age groups, and active health management is needed to improve health behaviors and prevent chronic diseases. In addition, developing good lifestyle habits earlier in life could reduce the risk of metabolic syndrome (MetS) later on. Objective: The aim of this study is to investigate the effects of the e-Motivate4Change program, for which health apps and wearable devices were selected based on user needs. The program was developed for the prevention and management of MetS in young adults. Methods: This experimental study used a nonequivalent control group. In total, 59 students from 2 universities in Daegu, Korea participated in the study (experimental group n=30; control group n=29). Data were collected over 4 months, from June 1 to September 30, 2018. The experimental group received a 12-week e-Motivate4Change program intervention, and the control group received MetS education and booklets without the e-Motivate4Change program intervention. Results: After the program, the experimental group had significantly higher scores for health-related lifestyle (t=3.86; P<.001) and self-efficacy (t=6.00; P<.001) than did the control group. Concerning BMI, there were significant effects by group (F=1.01; P<.001) and for the group × time interaction (F=4.71; P=.034). Concerning cholesterol, there were significant main effects for group (F=4.32; P=.042) and time (F=9.73; P<.001). Conclusions: The e-Motivate4Change program effectively improved participants’ health-related lifestyle scores and self-efficacy, and significantly reduced their BMI and cholesterol levels. The program can be used to identify and prevent MetS among young adults. %M 32729838 %R 10.2196/17031 %U http://www.jmir.org/2020/7/e17031/ %U https://doi.org/10.2196/17031 %U http://www.ncbi.nlm.nih.gov/pubmed/32729838 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17571 %T Virtual Reality Smartphone-Based Intervention for Smoking Cessation: Pilot Randomized Controlled Trial on Initial Clinical Efficacy and Adherence %A Goldenhersch,Emilio %A Thrul,Johannes %A Ungaretti,Joaquín %A Rosencovich,Nicolas %A Waitman,Cristian %A Ceberio,Marcelo Rodriguez %+ Laboratorio de Investigación en Neurociencia y Ciencias Sociales, Universidad de Flores, Avenida Rivadavia 5741, Ciudad Autónoma de Buenos Aires, CP 1414, Argentina, 1 4808860102, emiliogolden@gmail.com %K smoking cessation %K nicotine dependence %K craving %K virtual reality %K mindfulness %K digital therapy %K mHealth %K mobile phone %D 2020 %7 29.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Obstacles to current tobacco cessation programs include limited access and adherence to effective interventions. Digital interventions offer a great opportunity to overcome these difficulties, yet virtual reality has not been used as a remote and self-administered tool to help increase adherence and effectiveness of digital interventions for tobacco cessation. Objective: This study aimed to evaluate participant adherence and smoking cessation outcomes in a pilot randomized controlled trial of the digital intervention Mindcotine (MindCotine Inc) using a self-administered treatment of virtual reality combined with mindfulness. Methods: A sample of 120 participants was recruited in the city of Buenos Aires, Argentina (mean age 43.20 years, SD 9.50; 57/120, 47.5% female). Participants were randomly assigned to a treatment group (TG), which received a self-assisted 21-day program based on virtual reality mindful exposure therapy (VR-MET) sessions, daily surveys, and online peer-to-peer support moderated by psychologists, or a control group (CG), which received the online version of the smoking cessation manual from the Argentine Ministry of Health. Follow-up assessments were conducted by online surveys at postintervention and 90-day follow-up. The primary outcome was self-reported abstinence at postintervention, with missing data assumed as still smoking. Secondary outcomes included sustained abstinence at 90-day follow-up, adherence to the program, and readiness to quit. Results: Follow-up rates at day 1 were 93% (56/60) for the TG and 100% (60/60) for the CG. At postintervention, the TG reported 23% (14/60) abstinence on that day compared with 5% (3/60) in the CG. This difference was statistically significant (χ21=8.3; P=.004). The TG reported sustained abstinence of 33% (20/60) at 90 days. Since only 20% (12/60) of participants in the CG completed the 90-day follow-up, we did not conduct a statistical comparison between groups at this follow-up time point. Among participants still smoking at postintervention, the TG was significantly more ready to quit compared to the CG (TG: mean 7.71, SD 0.13; CG: mean 7.16, SD 0.13; P=.005). A total of 41% (23/56) of participants completed the treatment in the time frame recommended by the program. Conclusions: Results provide initial support for participant adherence to and efficacy of Mindcotine and warrant testing the intervention in a fully powered randomized trial. However, feasibility of trial follow-up assessment procedures for control group participants needs to be improved. Further research is needed on the impact of VR-MET on long-term outcomes. Trial Registration: ISRCTN Registry ISRCTN50586181; http://www.isrctn.com/ISRCTN50586181 %M 32723722 %R 10.2196/17571 %U http://www.jmir.org/2020/7/e17571/ %U https://doi.org/10.2196/17571 %U http://www.ncbi.nlm.nih.gov/pubmed/32723722 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17914 %T Using Internet of Things to Reduce Office Workers’ Sedentary Behavior: Intervention Development Applying the Behavior Change Wheel and Human-Centered Design Approach %A Huang,Yitong %A Benford,Steve %A Price,Dominic %A Patel,Roma %A Li,Benqian %A Ivanov,Alex %A Blake,Holly %+ School of Media and Communication, Shanghai Jiaotong University, 800 Dongchuan Road, Shanghai, , China, 86 57782665881, huang.yitong@foxmail.com %K sedentary behavior %K workplace %K just-in-time adaptive intervention %K internet of things %D 2020 %7 29.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Sedentary behavior (SB) is associated with various adverse health outcomes. The prevalence of prolonged sitting at work among office workers makes a case for SB interventions to target this setting and population. Everyday mundane objects with embedded microelectronics and ubiquitous computing represent a novel mode of delivering health behavior change interventions enabled by internet of things (IoTs). However, little is known about how to develop interventions involving IoT technologies. Objective: This paper reports the design and development of an IoT-enabled SB intervention targeting office workers. Methods: The process was guided by the behavior change wheel (BCW), a systematic framework for theory-informed and evidence-based development of behavior change interventions, complemented by the human-centered design (HCD) approach. Intervention design was shaped by findings from a diary-probed interview study (n=20), a stakeholder design workshop (n=8), and a series of theoretical mapping and collaborative technical design activities. Results: The resulting intervention named WorkMyWay targets a reduction in office workers’ prolonged stationary behaviors at work and an increase in regular breaks by modifying behavioral determinants in 11 theoretical domains with 17 behavior change techniques. The delivery technology consists of a wearable activity tracker, a light-emitting diode reminder device attached to a vessel (ie, water bottle or cup), and a companion Android app connected to both devices over Bluetooth. The delivery plan consists of a 2-week baseline assessment, a 30-min face-to-face action planning session, and 6-week self-directed use of the delivery technology. Conclusions: This is the first study to demonstrate that it is possible to develop a complex IoT-enabled intervention by applying a combination of the BCW and HCD approaches. The next step is to assess the feasibility of WorkMyWay prior to testing intervention efficacy in a full-scale trial. The intervention mapping table that links individual intervention components with hypothesized mechanisms of action can serve as the basis for testing and clarifying theory-based mechanisms of action in future studies on WorkMyWay. %M 32723716 %R 10.2196/17914 %U http://mhealth.jmir.org/2020/7/e17914/ %U https://doi.org/10.2196/17914 %U http://www.ncbi.nlm.nih.gov/pubmed/32723716 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 2 %P e18008 %T Inferring Destinations and Activity Types of Older Adults From GPS Data: Algorithm Development and Validation %A Bayat,Sayeh %A Naglie,Gary %A Rapoport,Mark J %A Stasiulis,Elaine %A Chikhaoui,Belkacem %A Mihailidis,Alex %+ Institute of Biomaterials and Biomedical Engineering, University of Toronto, 550 University Avenue, Toronto, ON, Canada, 1 416 597 3422 ext 7345, sayeh.bayat@mail.utoronto.ca %K outdoor mobility %K older adults %K GPS %K life space %K activity types %K machine learning %D 2020 %7 28.7.2020 %9 Original Paper %J JMIR Aging %G English %X Background: Outdoor mobility is an important aspect of older adults’ functional status. GPS has been used to create indicators reflecting the spatiotemporal dimensions of outdoor mobility for applications in health and aging. However, outdoor mobility is a multidimensional construct. There is, as of yet, no classification algorithm that groups and characterizes older adults’ outdoor mobility based on its semantic aspects (ie, mobility intentions and motivations) by integrating geographic and domain knowledge. Objective: This study assesses the feasibility of using GPS to determine semantic dimensions of older adults’ outdoor mobility, including destinations and activity types. Methods: A total of 5 healthy individuals, aged 65 years or older, carried a GPS device when traveling outside their homes for 4 weeks. The participants were also given a travel diary to record details of all excursions from their homes, including date, time, and destination information. We first designed and implemented an algorithm to extract destinations and infer activity types (eg, food, shopping, and sport) from the GPS data. We then evaluated the performance of the GPS-derived destination and activity information against the traditional diary method. Results: Our results detected the stop locations of older adults from their GPS data with an F1 score of 87%. On average, the extracted home locations were within a 40.18-meter (SD 1.18) distance of the actual home locations. For the activity-inference algorithm, our results reached an F1 score of 86% for all participants, suggesting a reasonable accuracy against the travel diary recordings. Our results also suggest that the activity inference’s accuracy measure differed by neighborhood characteristics (ie, Walk Score). Conclusions: We conclude that GPS technology is accurate for determining semantic dimensions of outdoor mobility. However, further improvements may be needed to develop a robust application of this system that can be adopted in clinical practice. %M 32720647 %R 10.2196/18008 %U http://aging.jmir.org/2020/2/e18008/ %U https://doi.org/10.2196/18008 %U http://www.ncbi.nlm.nih.gov/pubmed/32720647 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16783 %T The Cedar Project - Mobile Phone Use and Acceptability of Mobile Health Among Young Indigenous People Who Have Used Drugs in British Columbia, Canada: Mixed Methods Exploratory Study %A Jongbloed,Kate %A Pearce,Margo E %A Thomas,Vicky %A Sharma,Richa %A Pooyak,Sherri %A Demerais,Lou %A Lester,Richard T %A Schechter,Martin T %A Spittal,Patricia M %A , %+ School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada, 1 604 875 2345 ext 5944, spittal@sm.hivnet.ubc.ca %K Indigenous %K mobile health %K mHealth %K text messaging %K substance use %K HIV/AIDS %D 2020 %7 27.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Indigenous leaders continue to be concerned about high rates of HIV and barriers to HIV treatment among young Indigenous people involved in substance use. Growing evidence suggests that using mobile phones for health (mHealth) may be a powerful way to support connection with health services, including HIV prevention and treatment. Objective: This study examined the patterns of mobile phone ownership and use among young Indigenous people who have used drugs living with or vulnerable to HIV and explored the acceptability of mHealth to support access to health care in this population. Methods: The Cedar Project is a cohort study involving young Indigenous people who have used drugs in Vancouver and Prince George, British Columbia. This mixed methods exploratory study involved 131 Cedar Project participants enrolled in our WelTel mHealth program. At enrollment, participants completed a questionnaire related to mobile phone use and interest in mHealth. Data were linked to Cedar Project questionnaires and serodata. We present comparative statistics (quantitative) and results of a rapid thematic analysis (qualitative) related to mobile phone patterns and interest in receiving mHealth. Results: Less than half of the participants (59/130; 45.4%) reported owning a phone. Among those with a phone, the majority owned a smartphone (46/59; 78%). Most participants with a phone reported having an unlimited texting plan (39/55; 71%), using the internet on their phone (44/59; 75%), and texting daily (44/55; 80%). A majority reported that using a mobile phone for health would be invaluable (120/130; 92.3%). There were no differences in mHealth acceptance between participants who owned a phone and those who did not (P>.99). All but one participant living with HIV felt using a mobile phone would be helpful for their health, while a small proportion of HIV-negative participants remained unsure (1.9% vs 11.7%; P=.047). In response to open-ended questions asking why using a mobile phone may be helpful for health, participants identified a diverse set of anticipated benefits: (1) connection for emotional, mental, and spiritual support, (2) connection to family, (3) staying in touch and/or being reachable, (4) overcoming current barriers to phone use, (5) convenience, privacy, and safety, and (6) access to health care and emergency services. Conclusions: We observed high acceptance and interest in using mobile phone technology for health despite low rates of personal mobile phone connectivity among young Indigenous people who have used drugs living with and vulnerable to HIV in British Columbia, Canada. Mobile phones were viewed as a way to support connections and relationships that are seen as critical to health and well-being among young Indigenous people in this study. Findings may be useful for health care providers preparing to scale up mHealth programs to support HIV prevention and treatment in this population. %M 32716311 %R 10.2196/16783 %U https://mhealth.jmir.org/2020/7/e16783 %U https://doi.org/10.2196/16783 %U http://www.ncbi.nlm.nih.gov/pubmed/32716311 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e14223 %T An mHealth Intervention (ReZone) to Help Young People Self-Manage Overwhelming Feelings: Cluster-Randomized Controlled Trial %A Edridge,Chloe %A Wolpert,Miranda %A Deighton,Jessica %A Edbrooke-Childs,Julian %+ Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 020 7443 2218, Chloe.edridge@annafreud.org %K cluster trial %K behavioral difficulties %K schools %K mHealth %K digital %K mental health %D 2020 %7 27.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health difficulties in young people are increasing, and there is a need for evidence on the effectiveness of digital interventions to increase opportunities for supporting mental health in young people. Such studies are complicated due to issues of implementation and adoption, outcome measurement, and appropriate study designs. Objective: The objective of this study was to examine the effectiveness of an mHealth intervention (ReZone) in reducing mental health difficulties in young people. Methods: The cluster-randomized controlled trial enrolled 409 participants aged 10-15 years, and classes were allocated to ReZone or management as usual. Self-reported questionnaires were completed at baseline and 3-month follow-up. Results: There were no significant differences between the ReZone condition and management as usual in the self-reported outcome measures. However, there were 3467 usage sessions, which corresponds to 16.9 times per student (total of 205 students) in classes allocated to ReZone. Conclusions: It is essential to publish studies that do not show significant differences, as these findings can still contribute to the literature, help in learning, and inform the direction of future work. The results reported in this paper could be due to a range of reasons, including whether ReZone has the scope to impact change or limitations related to the setting, context, and appropriateness of an RCT. The findings of this study suggest that ReZone was implemented and adopted. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.7019 %M 32716299 %R 10.2196/14223 %U http://www.jmir.org/2020/7/e14223/ %U https://doi.org/10.2196/14223 %U http://www.ncbi.nlm.nih.gov/pubmed/32716299 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e18437 %T A Community-Engaged Approach to Creating a Mobile HIV Prevention App for Black Women: Focus Group Study to Determine Preferences via Prototype Demos %A Chandler,Rasheeta %A Hernandez,Natalie %A Guillaume,Dominique %A Grandoit,Shanaika %A Branch-Ellis,Desiré %A Lightfoot,Marguerita %+ Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, 30322, United States, 1 404 727 8164, r.d.chandler@emory.edu %K mHealth app %K mobile technology %K Black women %K HIV prevention %K reproductive health %K women’s health %D 2020 %7 24.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Black women are an important but relatively overlooked at-risk group in HIV prevention efforts. Although there is an aggregate decline of HIV diagnoses among women in the United States, there are persistent disparate rates of new HIV infections among Black women compared to any other cisgender female subgroup. Strategies to end the HIV epidemic—as outlined in the Ending the HIV Epidemic initiative—for all communities must consider HIV prevention messaging and message delivery mediums that are created with community input. Although mobile health (mHealth) is a popular platform for delivering HIV interventions, there are currently no mobile apps that consider cisgender Black women with the goal of promoting a comprehensive women’s reproductive health and HIV prevention lifestyle. Previous research recommends inclusion of the target population from project inception and iteratively throughout development, to promote use of the intervention. Objective: The purpose of this study is to understand cisgender Black women’s preferences for functionality, format, and design of a mobile HIV prevention app and to examine their willingness to use an app for HIV prevention. Methods: We conducted a series of four focus groups with 23 Black cisgender women. Focus groups included discussion and demonstration elements to address cisgender women’s general preference for apps, HIV prevention content that would be useful in an app, and preferred app features that would promote use of an HIV-centric app. During focus group discussions, participants were shown narrated, custom wireframes of HIV prevention app prototypes to demonstrate potential app function. Results: Findings indicated the presence of eight subthemes within the coding structure of three overall themes: (1) health content within the mobile app, (2) mobile app functionality, format, and design, and (3) other suggested features. Specifically, participants detailed preferred educational content, content distribution, app aesthetics, privacy considerations, and marketing of the app. Conclusions: Findings suggest that Black cisgender women preferred an app that integrated HIV prevention and optimal sexual health promotion. Participants provided a range of preferences for content integration and facilitators of app engagement with an HIV prevention app. Preferences centered on gender and cultural congruency of information and content, evidenced by visuals, language, and resources. Black cisgender women are viable consumers for a mobile app–based HIV prevention intervention. %M 32706723 %R 10.2196/18437 %U http://mhealth.jmir.org/2020/7/e18437/ %U https://doi.org/10.2196/18437 %U http://www.ncbi.nlm.nih.gov/pubmed/32706723 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 7 %P e17541 %T Efficacy of a Smartphone App Intervention for Reducing Caregiver Stress: Randomized Controlled Trial %A Fuller-Tyszkiewicz,Matthew %A Richardson,Ben %A Little,Keriann %A Teague,Samantha %A Hartley-Clark,Linda %A Capic,Tanja %A Khor,Sarah %A Cummins,Robert A %A Olsson,Craig A %A Hutchinson,Delyse %+ Deakin University, 1 Gheringhap Street, Geelong, 3220, Australia, 61 3 9251 7344, matthewf@deakin.edu.au %K mHealth %K mobile phone %K caregiver %K psychological stress %K mental health %D 2020 %7 24.7.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Caregivers play a pivotal role in maintaining an economically viable health care system, yet they are characterized by low levels of psychological well-being and consistently report unmet needs for psychological support. Mobile app–based (mobile health [mHealth]) interventions present a novel approach to both reducing stress and improving well-being. Objective: This study aims to evaluate the effectiveness of a self-guided mobile app–based psychological intervention for people providing care to family or friends with a physical or mental disability. Methods: In a randomized, single-blind, controlled trial, 183 caregivers recruited through the web were randomly allocated to either an intervention (n=73) or active control (n=110) condition. The intervention app contained treatment modules combining daily self-monitoring with third-wave (mindfulness-based) cognitive-behavioral therapies, whereas the active control app contained only self-monitoring features. Both programs were completed over a 5-week period. It was hypothesized that intervention app exposure would be associated with decreases in depression, anxiety, and stress, and increases in well-being, self-esteem, optimism, primary and secondary control, and social support. Outcomes were assessed at baseline, postintervention, and 3-4 months postintervention. App quality was also assessed. Results: In total, 25% (18/73) of the intervention participants were lost to follow-up at 3 months, and 30.9% (34/110) of the participants from the wait-list control group dropped out before the postintervention survey. The intervention group experienced reductions in stress (b=−2.07; P=.04) and depressive symptoms (b=−1.36; P=.05) from baseline to postintervention. These changes were further enhanced from postintervention to follow-up, with the intervention group continuing to report lower levels of depression (b=−1.82; P=.03) and higher levels of emotional well-being (b=6.13; P<.001), optimism (b=0.78; P=.007), self-esteem (b=−0.84; P=.005), support from family (b=2.15; P=.001), support from significant others (b=2.66; P<.001), and subjective well-being (b=4.82; P<.001). On average, participants completed 2.5 (SD 1.05) out of 5 treatment modules. The overall quality of the app was also rated highly, with a mean score of 3.94 out of a maximum score of 5 (SD 0.58). Conclusions: This study demonstrates that mHealth psychological interventions are an effective treatment option for caregivers experiencing high levels of stress. Recommendations for improving mHealth interventions for caregivers include offering flexibility and customization in the treatment design. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12616000996460; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371170 %M 32706716 %R 10.2196/17541 %U http://mental.jmir.org/2020/7/e17541/ %U https://doi.org/10.2196/17541 %U http://www.ncbi.nlm.nih.gov/pubmed/32706716 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17238 %T Worldwide Prevalence of Hearing Loss Among Smartphone Users: Cross-Sectional Study Using a Mobile-Based App %A Masalski,Marcin %A Morawski,Krzysztof %+ Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Wroclaw Medical University, Wybrzeze Ludwika Pasteura 1, Wroclaw, 50-367, Poland, 48 515086252, marcin.masalski@pwr.edu.pl %K hearing loss %K epidemiology %K mobile-based %K hearing test %K pure-tone audiometry %D 2020 %7 23.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In addition to the aging process, risk factors for hearing loss in adults include, among others, exposure to noise, use of ototoxic drugs, genetics, and limited access to medical care. Differences in exposure to these factors are bound to be reflected in the prevalence of hearing loss. Assessment of hearing loss can easily be carried out on a large scale and at low cost using mobile apps. Objective: This study aimed to conduct a worldwide assessment of the differences in hearing loss prevalence between countries in a group of mobile device users. Methods: Hearing tests were conducted using the open-access Android-based mobile app Hearing Test. The app is available free of charge in the Google Play store, provided that consent to the use of the results for scientific purposes is given. This study included hearing tests carried out on device models supported by the app with bundled headphones in the set. Calibration factors for supported models were determined using the biological method. The tests consisted of self-determining the quietest audible tone in the frequency range from 250 Hz to 8 kHz by adjusting its intensity using the buttons. The ambient noise level was optionally monitored using a built-in microphone. Following the test, the user could compare his hearing threshold against age norms by providing his or her age. The user's location was identified based on the phone’s IP address. Results: From November 23, 2016 to November 22, 2019, 733,716 hearing tests were conducted on 236,716 mobile devices across 212 countries. After rejecting the tests that were incomplete, performed with disconnected headphones, not meeting the time criterion, repeated by the same user, or carried out regularly on one device, 116,733 of 733,716 tests (15.9%) were qualified for further analysis. The prevalence of hearing loss, defined as the average threshold at frequencies 0.5 kHz, 1 kHz, 2 kHz, and 4 kHz above 25 dB HL in the better ear, was calculated at 15.6% (95% CI 15.4-15.8). Statistically significant differences were found between countries (P<.001), with the highest prevalences for Bangladesh, Pakistan, and India (>28%) and the lowest prevalences for Taiwan, Finland, and South Korea (<11%). Conclusions: Hearing thresholds measured by means of mobile devices were congruent with the literature data on worldwide hearing loss prevalence. Uniform recruitment criteria simplify the comparison of the hearing loss prevalence across countries. Hearing testing on mobile devices may be a valid tool in epidemiological studies carried out on a large scale. %M 32706700 %R 10.2196/17238 %U http://www.jmir.org/2020/7/e17238/ %U https://doi.org/10.2196/17238 %U http://www.ncbi.nlm.nih.gov/pubmed/32706700 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e16380 %T Evaluation of a Blended Physical Activity Intervention for Older Adults: Mixed Methods Study %A Mehra,Sumit %A van den Helder,Jantine %A Visser,Bart %A Engelbert,Raoul H H %A Weijs,Peter J M %A Kröse,Ben J A %+ Applied Psychology, Faculty of Applied Social Sciences and Law, Amsterdam University of Applied Sciences, Wibautstraat 3b, Amsterdam, 1091 GH, Netherlands, 31 0621156956, s.mehra@hva.nl %K frail elderly %K aged %K activities of daily living %K exercise %K health behavior %K telemedicine %K mobile devices %K tablet computers %K usability testing %K evaluation %D 2020 %7 23.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Physical activity can prolong the ability of older adults to live independently. Home-based exercises can help achieve the recommended physical activity levels. A blended intervention was developed to support older adults in performing home-based exercises. A tablet and a personal coach were provided to facilitate the self-regulation of exercise behavior. Objective: In line with the Medical Research Council framework, this study aimed to carry out process evaluation of a blended intervention. The objectives were (1) to assess the long-term usability of the tablet adopted in the blended intervention and (2) to explore how the tablet, in conjunction with a personal coach, supported older adults in performing home-based exercises. Methods: The process evaluation was conducted with a mixed-methods approach. At baseline, older adults participating in the blended intervention were asked to fill out a questionnaire about their general experience with information and communication technology (ICT) devices and rate their own skill level. After 6 months, participants filled out the Usefulness, Satisfaction, and Ease of use (USE) questionnaire to assess the usefulness, satisfaction, and ease of use of the tablet. With a random selection of participants, in-depth interviews were held to explore how the tablet and coach supported the self-regulation. The interviews were double coded and analyzed with the directed content analysis method. Results: At baseline, 29% (65/224) of participants who started the intervention (mean age 72 years) filled out the ICT survey and 36% (37/103) of participants who used the tablet for 6 months (mean age 71 years) filled out the USE questionnaire. Furthermore, with 17% (18/103) of participants (mean age 73 years), follow-up interviews were held. The results of the baseline questionnaire showed that the large majority of participants already had experience with a tablet, used it regularly, and reported being skillful in operating ICT devices. After 6 months of use, the participants rated the usefulness, satisfaction, and ease of use of the tablet on average as 3.8, 4.2, and 4.1, respectively, on a 5-point scale. The analysis of the interviews showed that the participants felt that the tablet supported action planning, behavior execution, and self-monitoring. On the other hand, especially during the first few months, the personal coach added value during the goal setting, behavior execution, and evaluation phases of self-regulation. Conclusions: The results of the process evaluation showed that older adults who participated in the study were positive about the blended intervention that was designed to support them in performing home-based exercises. Participants reported that the tablet helped them to perform the exercises better, more frequently, and safely. It supported them in various phases of self-regulation. The availability of a personal coach was nevertheless crucial. To support physical activity in older adults, a blended approach is promising. %M 32459652 %R 10.2196/16380 %U http://www.jmir.org/2020/7/e16380/ %U https://doi.org/10.2196/16380 %U http://www.ncbi.nlm.nih.gov/pubmed/32459652 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 7 %P e17075 %T Design, Recruitment, and Baseline Characteristics of a Virtual 1-Year Mental Health Study on Behavioral Data and Health Outcomes: Observational Study %A Kumar,Shefali %A Tran,Jennifer L A %A Ramirez,Ernesto %A Lee,Wei-Nchih %A Foschini,Luca %A Juusola,Jessie L %+ Evidation Health, 167 2nd Ave, San Mateo, CA, 94401, United States, 1 650 279 8855, jjuusola@evidation.com %K mental health %K anxiety %K depression %K behavioral data %D 2020 %7 23.7.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depression and anxiety greatly impact daily behaviors, such as sleep and activity levels. With the increasing use of activity tracking wearables among the general population, there has been a growing interest in how data collected from these devices can be used to further understand the severity and progression of mental health conditions. Objective: This virtual 1-year observational study was designed with the objective of creating a longitudinal data set combining self-reported health outcomes, health care utilization, and quality of life data with activity tracker and app-based behavioral data for individuals with depression and anxiety. We provide an overview of the study design, report on baseline health and behavioral characteristics of the study population, and provide initial insights into how behavioral characteristics differ between groups of individuals with varying levels of disease severity. Methods: Individuals who were existing members of an online health community (Achievement, Evidation Health Inc) and were 18 years or older who had self-reported a diagnosis of depression or anxiety were eligible to enroll in this virtual 1-year study. Participants agreed to connect wearable activity trackers that captured data related to physical activity and sleep behavior. Mental health outcomes such as the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Questionnaire (GAD-7), mental health hospitalizations, and medication use were captured with surveys completed at baseline and months 3, 6, 9, and 12. In this analysis, we report on baseline characteristics of the sample, including mental health disease severity and health care utilization. Additionally, we explore the relationship between passively collected behavioral data and baseline mental health status and health care utilization. Results: Of the 1304 participants enrolled in the study, 1277 individuals completed the baseline survey and 1068 individuals had sufficient activity tracker data. Mean age was 33 (SD 9) years, and the majority of the study population was female (77.2%, 994/1288) and identified as Caucasian (88.3%, 1137/1288). At baseline, 94.8% (1211/1277) of study participants reported experiencing depression or anxiety symptoms in the last year. This baseline analysis found that some passively tracked behavioral traits are associated with more severe forms of anxiety or depression. Individuals with depressive symptoms were less active than those with minimal depressive symptoms. Severe forms of depression were also significantly associated with inconsistent sleep patterns and more disordered sleep. Conclusions: These initial findings suggest that longitudinal behavioral and health outcomes data may be useful for developing digital measures of health for mental health symptom severity and progression. %M 32706712 %R 10.2196/17075 %U http://mental.jmir.org/2020/7/e17075/ %U https://doi.org/10.2196/17075 %U http://www.ncbi.nlm.nih.gov/pubmed/32706712 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17039 %T Use of Mobile Phone App Interventions to Promote Weight Loss: Meta-Analysis %A Islam,Md Mohaimenul %A Poly,Tahmina Nasrin %A Walther,Bruno Andres %A (Jack) Li,Yu-Chuan %+ Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan, 886 886 2 2736166, jaak88@gmail.com %K mobile app %K mHealth %K obesity %K physical activity %K weight gain prevention %D 2020 %7 22.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obesity and lack of physical activity are major health risk factors for many life-threatening diseases, such as cardiovascular diseases, type 2 diabetes, and cancer. The use of mobile app interventions to promote weight loss and boost physical activity among children and adults is fascinating owing to the demand for cutting-edge and more efficient interventions. Previously published studies have examined different types of technology-based interventions and their impact on weight loss and increase in physical activity, but evidence regarding the impact of only a mobile phone app on weight loss and increase in physical activity is still lacking. Objective: The main objective of this study was to assess the efficacy of a mobile phone app intervention for reducing body weight and increasing physical activity among children and adults. Methods: PubMed, Google Scholar, Scopus, EMBASE, and the Web of Science electronic databases were searched for studies published between January 1, 2000, and April 30, 2019, without language restrictions. Two experts independently screened all the titles and abstracts to find the most appropriate studies. To be included, studies had to be either a randomized controlled trial or a case-control study that assessed a mobile phone app intervention with body weight loss and physical activity outcomes. The Cochrane Collaboration Risk of Bias tool was used to examine the risk of publication bias. Results: A total of 12 studies involving a mobile phone app intervention were included in this meta-analysis. Compared with the control group, the use of a mobile phone app was associated with significant changes in body weight (−1.07 kg, 95% CI −1.92 to −0.21, P=.01) and body mass index (−0.45 kg/m2, 95% CI −0.78 to −0.12, P=.008). Moreover, a nonsignificant increase in physical activity was observed (0.17, 95% CI −2.21 to 2.55, P=.88). Conclusions: The findings of this study demonstrate the promising and emerging efficacy of using mobile phone app interventions for weight loss. Future studies are needed to explore the long-term efficacy of mobile app interventions in larger samples. %M 32706724 %R 10.2196/17039 %U https://mhealth.jmir.org/2020/7/e17039 %U https://doi.org/10.2196/17039 %U http://www.ncbi.nlm.nih.gov/pubmed/32706724 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16971 %T A Mobile App to Rapidly Appraise the In-Store Food Environment: Reliability, Utility, and Construct Validity Study %A McMahon,Emma Joy %A Jaenke,Rachael %A Brimblecombe,Julie %+ Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Building Red 9, Casuarina campus, Ellengowan Drive, Darwin, 0810, Australia, 61 731694202, e.j.mcmahon@outlook.com %K mobile apps %K reliability and validity %K food %K diet %K environment and public health %D 2020 %7 22.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Consumer food environments are increasingly being recognized as influential determinants of food purchasing and subsequent intake and health. We developed a tool to enable efficient, but relatively comprehensive, appraisal of the in-store food environment. The Store Scout mobile app facilitates the evaluation of product (availability and range), placement (visibility, accessibility, proximity to high-traffic areas, and location relative to other products), price (price promotion), and promotion (displays and advertising) across 7 categories of food products, with appraisal given immediately as scores (0-100, where a higher score is more in line with best practice). Primary end users are public health nutritionists and nutritionists employed by store organizations; however, store managers and staff are also potential end users. Objective: This study aims to evaluate the reliability (interrater reliability and internal consistency), utility (distribution of scores), and construct validity (score by store type) of measurements using the Store Scout mobile app. Methods: The Store Scout mobile app was used independently by 2 surveyors to evaluate the store environment in 54 stores: 34 metropolitan stores (9 small and 11 large supermarkets, 10 convenience stores, and 4 petrol stations) in Brisbane, Australia, and 20 remote stores (19 small supermarkets and 1 petrol station) in Indigenous Australian communities in Northern Australia. The agreement between surveyors in the overall and category scores was evaluated using intraclass correlation coefficients (ICCs). Interrater reliability of measurement items was assessed using percentage agreement and the Gwet agreement coefficient (AC). Internal consistency was assessed by comparing the responses of items measuring similar aspects of the store environment. We examined the distribution of score values using boxplots and differences by store type using the Kruskal-Wallis test. Results: The median difference in the overall score between surveyors was 4.4 (range 0.0-11.1), with an ICC of 0.954 (95% CI 0.914-0.975). Most measurement items had very good (n=74/196, 37.8%) or good (n=81/196, 41.3%) interrater reliability using the Gwet AC. A minimal inconsistency of measurement was found. Overall scores ranged from 19.2 to 81.6. There was a significant difference in score by store type (P<.001). Large Brisbane supermarkets scored highest (median 77.4, range 53.2-81.6), whereas small Brisbane supermarkets (median 63.9, range 41.0-71.3) and small remote supermarkets (median 63.8, range 56.5-74.9) scored significantly higher than Brisbane petrol stations (median 33.1, range 19.2-37.8) and convenience stores (median 39.0, range 22.4-63.8). Conclusions: These findings suggest good reliability and internal consistency of food environment measurements using the Store Scout mobile app. We identified specific aspects that can be improved to further increase the reliability of this tool. We found a good distribution of score values and evidence that scoring could capture differences by store type in line with previous evidence, which gives an indication of construct validity. The Store Scout mobile app shows promise in its capability to measure and track the health-enabling characteristics of store environments. %M 32706683 %R 10.2196/16971 %U https://mhealth.jmir.org/2020/7/e16971 %U https://doi.org/10.2196/16971 %U http://www.ncbi.nlm.nih.gov/pubmed/32706683 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16899 %T Evaluation Criteria for Weight Management Apps: Validation Using a Modified Delphi Process %A Robles,Noemí %A Puigdomènech Puig,Elisa %A Gómez-Calderón,Corpus %A Saigí-Rubió,Francesc %A Cuatrecasas Cambra,Guillem %A Zamora,Alberto %A Moharra,Montse %A Paluzié,Guillermo %A Balfegó,Mariona %A Carrion,Carme %+ Agència de Qualitat i Avaluació Sanitàries de Catalunya, Carrer Roc Boronat 81-95, Barcelona, E08005, Spain, 34 93 5513476, epuigdomenech@gencat.cat %K mHealth %K technology assessment %K obesity %K overweight %K Delphi technique %K consensus %D 2020 %7 22.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of apps for weight management has increased over recent years; however, there is a lack of evidence regarding the efficacy and safety of these apps. The EVALAPPS project will develop and validate an assessment instrument to specifically assess the safety and efficacy of weight management apps. Objective: The aim of this study was to reach a consensus among stakeholders on a comprehensive set of criteria to guide development of the EVALAPPS assessment instrument. A modified Delphi process was used in order to verify the robustness of the criteria that had been identified through a literature review and to prioritize a set of the identified criteria. Methods: Stakeholders (n=31) were invited to participate in a 2-round Delphi process with 114 initial criteria that had been identified from the literature. In round 1, participants rated criteria according to relevance on a scale from 0 (“I suggest this criterion is excluded”) to 5 (“This criterion is extremely relevant”). A criterion was accepted if the median rating was 4 or higher and if the relative intraquartile range was equal to 0.67 or lower. In round 2, participants were asked about criteria that had been discarded in round 1. A prioritization strategy was used to identify crucial criteria according to (1) the importance attributed by participants (criteria with a mean rating of 4.00 or higher), (2) the level of consensus (criteria with a score of 4 or 5 by at least 80% of the participants). Results: The response rate was 83.9% (26/31) in round 1 and 90.3% (28/31) in round 2. A total of 107 out of 114 criteria (93.9%) were accepted by consensus—105 criteria in round 1 and 2 criteria in round 2. After prioritization, 53 criteria were deemed crucial. These related mainly to the dimensions of security and privacy (13/53, 24.5%) and usability (9/53, 17.0%), followed by activity data (5/53, 9.4%), clinical effectiveness (5/53, 9.4%), and reliability (5/53, 9.4%). Conclusions: Results confirmed the robustness of the criteria that were identified, with those relating to security and privacy being deemed most relevant by stakeholders. Additionally, a specific set of criteria based on health indicators (activity data, physical state data, and personal data) was also prioritized. %M 32706689 %R 10.2196/16899 %U http://mhealth.jmir.org/2020/7/e16899/ %U https://doi.org/10.2196/16899 %U http://www.ncbi.nlm.nih.gov/pubmed/32706689 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16405 %T Wearable Technology to Quantify the Nutritional Intake of Adults: Validation Study %A Dimitratos,Sarah M %A German,J Bruce %A Schaefer,Sara E %+ Foods for Health Institute, University of California, 2141 Robert Mondavi Institute, North Building, 1 Shields Ave, Davis, CA, 95616, United States, 1 530 574 0797, seschaefer@ucdavis.edu %K wearable technology %K mobile health %K mobile phone %K food intake %K validation study %D 2020 %7 22.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable and mobile sensor technologies can be useful tools in precision nutrition research and practice, but few are reliable for obtaining accurate and precise measurements of diet and nutrition. Objective: This study aimed to assess the ability of wearable technology to monitor the nutritional intake of adult participants. This paper describes the development of a reference method to validate the wristband’s estimation of daily nutritional intake of 25 free-living study participants and to evaluate the accuracy (kcal/day) and practical utility of the technology. Methods: Participants were asked to use a nutrition tracking wristband and an accompanying mobile app consistently for two 14-day test periods. A reference method was developed to validate the estimation of daily nutritional intake of participants by the wristband. The research team collaborated with a university dining facility to prepare and serve calibrated study meals and record the energy and macronutrient intake of each participant. A continuous glucose monitoring system was used to measure adherence with dietary reporting protocols, but these findings are not reported. Bland-Altman tests were used to compare the reference and test method outputs (kcal/day). Results: A total of 304 input cases were collected of daily dietary intake of participants (kcal/day) measured by both reference and test methods. The Bland-Altman analysis had a mean bias of −105 kcal/day (SD 660), with 95% limits of agreement between −1400 and 1189. The regression equation of the plot was Y=−0.3401X+1963, which was significant (P<.001), indicating a tendency for the wristband to overestimate for lower calorie intake and underestimate for higher intake. Researchers observed transient signal loss from the sensor technology of the wristband to be a major source of error in computing dietary intake among participants. Conclusions: This study documents high variability in the accuracy and utility of a wristband sensor to track nutritional intake, highlighting the need for reliable, effective measurement tools to facilitate accurate, precision-based technologies for personal dietary guidance and intervention. %M 32706729 %R 10.2196/16405 %U https://mhealth.jmir.org/2020/7/e16405 %U https://doi.org/10.2196/16405 %U http://www.ncbi.nlm.nih.gov/pubmed/32706729 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e15948 %T Comparison of Geographic Information System and Subjective Assessments of Momentary Food Environments as Predictors of Food Intake: An Ecological Momentary Assessment Study %A Elliston,Katherine G %A Schüz,Benjamin %A Albion,Tim %A Ferguson,Stuart G %+ College of Health and Medicine, University of Tasmania, 17 Liverpool Street, Hobart, 7000, Australia, 61 362264259, katherine.elliston@utas.edu.au %K ecological momentary assessment %K mHealth %K geographic information systems %K food intake %K mobile phone %D 2020 %7 22.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: It has been observed that eating is influenced by the presence and availability of food. Being aware of the presence of food in the environment may enable mobile health (mHealth) apps to use geofencing techniques to determine the most appropriate time to proactively deliver interventions. To date, however, studies on eating typically rely on self-reports of environmental contexts, which may not be accurate or feasible for issuing mHealth interventions. Objective: This study aimed to compare the subjective and geographic information system (GIS) assessments of the momentary food environment to explore the feasibility of using GIS data to predict eating behavior and inform geofenced interventions. Methods: In total, 72 participants recorded their food intake in real-time for 14 days using an ecological momentary assessment approach. Participants logged their food intake and responded to approximately 5 randomly timed assessments each day. During each assessment, the participants reported the number and type of food outlets nearby. Their electronic diaries simultaneously recorded their GPS coordinates. The GPS data were later overlaid with a GIS map of food outlets to produce an objective count of the number of food outlets within 50 m of the participant. Results: Correlations between self-reported and GIS counts of food outlets within 50 m were only of a small size (r=0.17; P<.001). Logistic regression analyses revealed that the GIS count significantly predicted eating similar to the self-reported counts (area under the curve for the receiver operating characteristic curve [AUC-ROC] self-report=0.53, SE 0.00 versus AUC-ROC 50 m GIS=0.53, SE 0.00; P=.41). However, there was a significant difference between the GIS-derived and self-reported counts of food outlets and the self-reported type of food outlets (AUC-ROC self-reported outlet type=0.56, SE 0.01; P<.001). Conclusions: The subjective food environment appears to predict eating better than objectively measured food environments via GIS. mHealth apps may need to consider the type of food outlets rather than the raw number of outlets in an individual’s environment. %M 32706728 %R 10.2196/15948 %U https://mhealth.jmir.org/2020/7/e15948 %U https://doi.org/10.2196/15948 %U http://www.ncbi.nlm.nih.gov/pubmed/32706728 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e15576 %T Effectiveness of Wearable Trackers on Physical Activity in Healthy Adults: Systematic Review and Meta-Analysis of Randomized Controlled Trials %A Tang,Matilda Swee Sun %A Moore,Katherine %A McGavigan,Andrew %A Clark,Robyn A %A Ganesan,Anand N %+ College of Medicine and Public Health, Flinders University, Level 5, Room 5E209 Flinders Medical Centre, Adelaide, Australia, 61 (08) 7221 8200, anand.ganesan@flinders.edu.au %K wearable activity tracker %K physical activity %K healthy adults %K randomized controlled trials %D 2020 %7 22.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable trackers are an increasingly popular tool among healthy adults and are used to facilitate self-monitoring of physical activity. Objective: We aimed to systematically review the effectiveness of wearable trackers for improving physical activity and weight reduction among healthy adults. Methods: This review used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology and reporting criteria. English-language randomized controlled trials with more than 20 participants from MEDLINE, CINAHL, Cochrane Library, Web of Science, PubMed, and Scopus (2000-2017) were identified. Studies were eligible for inclusion if they reported an intervention group using wearable trackers, reporting steps per day, total moderate-to-vigorous physical activity, activity, physical activity, energy expenditure, and weight reduction. Results: Twelve eligible studies with a total of 1693 participants met the inclusion criteria. The weighted average age was 40.7 years (95% CI 31.1-50.3), with 64.4% women. The mean intervention duration was 21.4 weeks (95% CI 6.1-36.7). The usage of wearable trackers was associated with increased physical activity (standardized mean difference 0.449, 95% CI 0.10-0.80; P=.01). In the subgroup analyses, however, wearable trackers demonstrated no clear benefit for physical activity or weight reduction. Conclusions: These data suggest that the use of wearable trackers in healthy adults may be associated with modest short-term increases in physical activity. Further data are required to determine if a sustained benefit is associated with wearable tracker usage. %M 32706685 %R 10.2196/15576 %U http://mhealth.jmir.org/2020/7/e15576/ %U https://doi.org/10.2196/15576 %U http://www.ncbi.nlm.nih.gov/pubmed/32706685 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e18068 %T Acceptability and Usability of the Mobile Digital Health App NoObesity for Families and Health Care Professionals: Protocol for a Feasibility Study %A Meinert,Edward %A Rahman,Em %A Potter,Alison %A Lawrence,Wendy %A Van Velthoven,Michelle %+ Digitally Enabled PrevenTative Health (DEPTH) Research Group, Department of Paediatrics, Univeristy of Oxford, John Radcliffe Hospital, Oxford, United Kingdom, 44 7824446808, e.meinert14@imperial.ac.uk %K mHealth %K mobile health %K digital health %K digital technology %K weight loss %K obesity %K overweight %K child health %K cell phone %K telecommunication %D 2020 %7 22.7.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Almost a quarter or more than a fifth of children in the United Kingdom are overweight or obese by the time they start school. The UK Department of Health and Social Care’s national policy for combating childhood obesity has critical outcomes centered on sugar and caloric consumption reduction. Health Education England has developed two digital apps for families with children up to 15 years and for their associated health care professionals to provide a digital learning resource and tool aimed at encouraging healthy lifestyles to prevent obesity. Objective: This feasibility study assesses the usability and acceptability of Health Education England’s NoObesity app for undertaking activities to improve families’ diet and physical activity. The purpose of the study is to evaluate the app’s influence on self-efficacy and goal setting and to determine what can be learnt to improve its design for future studies, if there is evidence of adoption and sustainability. Methods: The study population will include 20 to 40 families and their linked health care professionals. Considering issues related to digital access associated with socioeconomic status and the impact on information technology use, study recruitment will be regionally focused in a low socioeconomic status area. The study will last for 9 months (3-month intervention period and 6-month follow-up). The evaluations of feasibility, acceptability, and usability will be conducted using the following scales and theoretical frameworks: (1) system usability scale; (2) Reach Effectiveness Adoption Implementation Maintenance framework; (3) Bandura model of health promotion; and (4) Nonadoption, Abandonment, and Challenges to the Scale-up, Spread, and Suitability framework. App use will be captured and quantitatively analyzed for net use patterns (eg, number of screens viewed, number of logins, cumulative minutes using the app, number of plans made, and number of times goals met) and to triangulate qualitative feedback from study participants. Results: This study was funded in March 2019 by Health Education England and received University of Oxford Medical Sciences Interdivisional Research Ethics Committee approval on January 31, 2020 (R62092/RE001). At manuscript submission, study recruitment is pending, and expected results will be published in 2021. Conclusions: This study will provide evidence on the NoObesity app’s influence on self-efficacy and goal-setting and determine what can be learnt to improve its design for future studies, if there is evidence of adoption and sustainability. International Registered Report Identifier (IRRID): PRR1-10.2196/18068 %M 32706703 %R 10.2196/18068 %U http://www.researchprotocols.org/2020/7/e18068/ %U https://doi.org/10.2196/18068 %U http://www.ncbi.nlm.nih.gov/pubmed/32706703 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e19364 %T A Novel Educational Control Group Mobile App for Meditation Interventions: Single-Group Feasibility Trial %A Huberty,Jennifer %A Eckert,Ryan %A Puzia,Megan %A Laird,Breanne %A Larkey,Linda %A Mesa,Ruben %+ College of Health Solutions, Arizona State University, 500 North 3rd Street, Phoenix, AZ, 85004, United States, 1 402 301 1304, jhuberty@asu.edu %K feasibility %K smartphone %K mHealth %K digital health %K cancer %K beta test %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphone ownership is becoming ubiquitous among US adults, making the delivery of health interventions via a mobile app (ie, mobile health [mHealth]) attractive to many researchers and clinicians. Meditation interventions have become popular and have been delivered to study participants via mobile apps to improve a range of health outcomes in both healthy adults and those with chronic diseases. However, these meditation mHealth interventions have been limited by a lack of high-quality control groups. More specifically, these studies have lacked consistency in their use of active, time-matched, and attention-matched control groups. Objective: The purpose of this study is to beta test a novel health education podcast control condition delivered via a smartphone app that would be a strong comparator to be used in future studies of app-based meditation interventions. Methods: Patients with myeloproliferative neoplasm (MPN) cancer were recruited nationally. Upon enrollment, participants were informed to download the investigator-developed health education podcast app onto their mobile phone and listen to ~60 min/week of cancer-related educational podcasts for 12 weeks. The benchmarks for feasibility included ≥70% of participants completing ≥70% of the prescribed 60 min/week of podcasts, ≥70% of participants reporting that they were satisfied with the intervention, and ≥70% of participants reporting that they enjoyed the health education podcasts. Results: A total of 96 patients with MPN were enrolled in the study; however, 19 never began the intervention. Of the 77 patients who participated in the intervention, 39 completed the entire study (ie, sustained participation through the follow-up period). Participation averaged 103.2 (SD 29.5) min/week. For 83.3% (10/12) of the weeks, at least 70% of participants completed at least 70% of their total prescribed use. Almost half of participants reported that they enjoyed the health education podcasts (19/39, 48.7%) and were satisfied with the intervention (17/39, 43.6%). There were no significant changes in cancer-related outcomes from baseline to postintervention. Conclusions: A 12-week, health education podcast mobile app was demanded but not accepted in a sample of patients with cancer. Using the mobile app was not associated with significant changes in cancer-related symptoms. Based on findings from this study, a health education podcast mobile app may be a feasible option as a time- and attention-matched control group for efficacy trials with more extensive formative research for the content of the podcasts and its acceptability by the specific population. Trial Registration: ClinicalTrials.gov NCT03907774; https://clinicaltrials.gov/ct2/show/NCT03907774 %M 32706719 %R 10.2196/19364 %U http://formative.jmir.org/2020/7/e19364/ %U https://doi.org/10.2196/19364 %U http://www.ncbi.nlm.nih.gov/pubmed/32706719 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e18495 %T Smartphone Apps Targeting Physical Activity in People With Rheumatoid Arthritis: Systematic Quality Appraisal and Content Analysis %A Bearne,Lindsay M %A Sekhon,Mandeep %A Grainger,Rebecca %A La,Anthony %A Shamali,Mehrdad %A Amirova,Aliya %A Godfrey,Emma L %A White,Claire M %+ Department of Population Health Sciences, School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, 2nd Floor, Addison House, Guy's Campus, London, SE1 1UL, United Kingdom, 44 02078486283, lindsay.bearne@kcl.ac.uk %K rheumatoid arthritis %K physical activity %K exercise %K mobile applications %K behavior change techniques %K mobile phone %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Rheumatoid arthritis (RA) is a disabling, inflammatory joint condition affecting 0.5%-1% of the global population. Physical activity (PA) and exercise are recommended for people with RA, but uptake and adherence tend to be low. Smartphone apps could assist people with RA to achieve PA recommendations. However, it is not known whether high quality, evidence-informed PA apps that include behavior change techniques (BCTs) previously identified as effective for PA adherence are available for people with RA. Objective: This study aims to systematically identify apps that include goals to facilitate PA for adults with RA and assess app quality and content for the inclusion of relevant BCTs against recommendations for cardiorespiratory, resistance, flexibility, and neuromotor PA and exercise. Methods: A systematic search of the Apple App Store and Google Play Store in the United Kingdom was conducted to identify English language apps that promote PA for adults with RA. Two researchers independently assessed app quality (mobile app rating scale [MARS]; range 0-5) and content (BCT Taxonomy version 1, World Health Organization, the American College of Sports Medicine, and the European League against Rheumatism recommendations for PA). The completeness of reporting of PA prescription was evaluated using a modified version of the Consensus on Exercise Reporting Template (CERT; range 0-14). Results: A total of 14,047 apps were identified. Following deduplication, 2737 apps were screened for eligibility; 6 apps were downloaded (2 on the Apple App Store and 4 on the Google Play Store), yielding 4 unique apps. App quality varied (MARS score 2.25-4.17). Only 1 app was congruent with all aspects of the PA recommendations. All apps completely or partially recommended flexibility and resistance exercises, 3 apps completely or partially advised some form of neuromotor exercise, but only 2 offered full or partial guidance on cardiorespiratory exercise. Completeness of exercise reporting was mixed (CERT scores 7-14 points) and 3-7 BCTs were identified. Two BCTs were common to all apps (information about health consequences and instruction on how to perform behavior). Higher quality apps included a greater number of BCTs and were more closely aligned to PA guidance. No published trials evaluating the effect of the included apps were identified. Conclusions: This review identifies 4 PA apps of mixed quality and content for use by people with RA. Higher quality apps were more closely aligned to PA guidance and included a greater number of BCTs. One high-quality app (Rheumatoid Arthritis Information Support and Education) included 7 BCTs and was fully aligned with PA and exercise guidance. The effect of apps on PA adherence should be established before implementation. %M 32706727 %R 10.2196/18495 %U http://mhealth.jmir.org/2020/7/e18495/ %U https://doi.org/10.2196/18495 %U http://www.ncbi.nlm.nih.gov/pubmed/32706727 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e15331 %T Usability of Wearable Devices With a Novel Cardiac Force Index for Estimating the Dynamic Cardiac Function: Observational Study %A Hsiao,Po-Jen %A Chiu,Chih-Chien %A Lin,Ke-Hsin %A Hu,Fu-Kang %A Tsai,Pei-Jan %A Wu,Chun-Ting %A Pang,Yuan-Kai %A Lin,Yu %A Kuo,Ming-Hao %A Chen,Kang-Hua %A Wu,Yi-Syuan %A Wu,Hao-Yi %A Chang,Ya-Ting %A Chang,Yu-Tien %A Cheng,Chia-Shiang %A Chuu,Chih-Pin %A Lin,Fu-Huang %A Chang,Chi-Wen %A Li,Yuan-Kuei %A Chan,Jenq-Shyong %A Chu,Chi-Ming %+ Division of Biostatistics and Medical Informatics, Department of Epidemiology, School of Public Health, National Defense Medical Center, Neihu 114, Taipei, Taiwan, 1 886 2 87923100, chuchiming@web.de %K cardiac force %K running %K acceleration %K physical activity %K heart rate %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Long-distance running can be a form of stress to the heart. Technological improvements combined with the public’s gradual turn toward mobile health (mHealth), self-health, and exercise effectiveness have resulted in the widespread use of wearable exercise products. The monitoring of dynamic cardiac function changes during running and running performance should be further studied. Objective: We investigated the relationship between dynamic cardiac function changes and finish time for 3000-meter runs. Using a wearable device based on a novel cardiac force index (CFI), we explored potential correlations among 3000-meter runners with stronger and weaker cardiac functions during running. Methods: This study used the American product BioHarness 3.0 (Zephyr Technology Corporation), which can measure basic physiological parameters including heart rate, respiratory rate, temperature, maximum oxygen consumption, and activity. We investigated the correlations among new physiological parameters, including CFI = weight * activity / heart rate, cardiac force ratio (CFR) = CFI of running / CFI of walking, and finish times for 3000-meter runs. Results: The results showed that waist circumference, smoking, and CFI were the significant factors for qualifying in the 3000-meter run. The prediction model was as follows: ln (3000 meters running performance pass probability / fail results probability) = –2.702 – 0.096 × [waist circumference] – 1.827 × [smoke] + 0.020 × [ACi7]. If smoking and the ACi7 were controlled, contestants with a larger waist circumference tended to fail the qualification based on the formula above. If waist circumference and ACi7 were controlled, smokers tended to fail more often than nonsmokers. Finally, we investigated a new calculation method for monitoring cardiac status during exercise that uses the CFI of walking for the runner as a reference to obtain the ratio between the cardiac force of exercise and that of walking (CFR) to provide a standard for determining if the heart is capable of exercise. A relationship is documented between the CFR and the performance of 3000-meter runs in a healthy 22-year-old person. During the running period, data are obtained while participant slowly runs 3000 meters, and the relationship between the CFR and time is plotted. The runner’s CFR varies with changes in activity. Since the runner’s acceleration increases, the CFR quickly increases to an explosive peak, indicating the runner’s explosive power. At this period, the CFI revealed a 3-fold increase (CFR=3) in a strong heart. After a time lapse, the CFR is approximately 2.5 during an endurance period until finishing the 3000-meter run. Similar correlation is found in a runner with a weak heart, with the CFR at the beginning period being 4 and approximately 2.5 thereafter. Conclusions: In conclusion, the study results suggested that measuring the real-time CFR changes could be used in a prediction model for 3000-meter running performance. %M 32706725 %R 10.2196/15331 %U https://mhealth.jmir.org/2020/7/e15331 %U https://doi.org/10.2196/15331 %U http://www.ncbi.nlm.nih.gov/pubmed/32706725 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e14778 %T Formative Evaluation of a Smartphone App for Monitoring Daily Meal Distribution and Food Selection in Adolescents: Acceptability and Usability Study %A Langlet,Billy %A Maramis,Christos %A Diou,Christos %A Maglaveras,Nikolaos %A Fagerberg,Petter %A Heimeier,Rachel %A Lekka,Irini %A Delopoulos,Anastasios %A Ioakimidis,Ioannis %+ The Innovative Use of Mobile Phones to Promote Physical Activity and Nutrition Across the Lifespan Research Group, Department of Biosciences and Nutrition, Karolinska Institutet, Blickagången 16, Huddinge, , Sweden, 46 08 524 810 95, billy.langlet@ki.se %K mHealth %K eHealth %K dietary behavior %K lifestyle behavioral monitoring %K lifestyle interventions %K obesity %K mobile phone %K smartphone %K weight management %K overweight %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obesity interventions face the problem of weight regain after treatment as a result of low compliance. Mobile health (mHealth) technologies could potentially increase compliance and aid both health care providers and patients. Objective: This study aimed to evaluate the acceptability and usability and define system constraints of an mHealth system used to monitor dietary habits of adolescents in real life, as a first step in the development of a self-monitoring and lifestyle management system against adolescent obesity. Methods: We recruited 26 students from a high school in Stockholm, Sweden. After a 30-minute information meeting and 5-minute individual instruction on how to use an mHealth system (smartphone with app and two external sensors), participants used it for 2-3 weeks to objectively collect dietary habits. The app and sensors were used by the participants, without supervision, to record as many main meals and snacks as possible in real life. Feasibility was assessed following the “mHealth evidence reporting and assessment checklist,” and usability was assessed by questionnaires. Compliance was estimated based on system use, where a registration frequency of 3 main meals (breakfast, lunch, and dinner) per day for the period of the experiment, constituted 100% compliance. Results: Participants included in the analysis had a mean age of 16.8 years (SD 0.7 years) and BMI of 21.9 kg/m2 (SD 4.1 kg/m2). Due to deviations from study instructions, 2 participants were excluded from the analysis. During the study, 6 participants required additional information on system use. The system received a ‘Good’ grade (77.1 of 100 points) on the System Usability Scale, with most participants reporting that they were comfortable using the smartphone app. Participants expressed a willingness to use the app mostly at home, but also at school; most of their improvement suggestions concerned design choices for the app. Of all main meals, the registration frequency increased from 70% the first week to 76% the second week. Participants reported that 40% of the registered meals were home-prepared, while 34% of the reported drinks contained sugar. On average, breakfasts took place at 8:30 AM (from 5:00 AM to 2:00 PM), lunches took place at 12:15 PM (from 10:15 AM to 6:15 PM), and dinners took place at 7:30 PM (from 3:00 PM to 11:45 PM). When comparing meal occurrence during weekdays vs weekends, breakfasts and lunches were eaten 3 hours later during weekends, while dinner timing was unaffected. Conclusions: From an infrastructural and functional perspective, system use was feasible in the current context. The smartphone app appears to have high acceptability and usability in high school students, which are the intended end-users. The system appears promising as a relatively low-effort method to provide real-life dietary habit measurements associated with overweight and obesity risk. %M 32706684 %R 10.2196/14778 %U http://mhealth.jmir.org/2020/7/e14778/ %U https://doi.org/10.2196/14778 %U http://www.ncbi.nlm.nih.gov/pubmed/32706684 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e18012 %T Mobile Personal Health Care System for Noninvasive, Pervasive, and Continuous Blood Pressure Monitoring: Development and Usability Study %A Mena,Luis J %A Félix,Vanessa G %A Ostos,Rodolfo %A González,Armando J %A Martínez-Peláez,Rafael %A Melgarejo,Jesus D %A Maestre,Gladys E %+ Academic Unit of Computing, Master Program in Applied Sciences, Universidad Politecnica de Sinaloa, Carretera Municipal Libre Mazatlan-Higueras Km. 3, Mazatlan, 82199, Mexico, 52 6691800695 ext 140, lmena@upsin.edu.mx %K mHealth %K photoplethysmography %K blood pressure monitoring %K hypertension %D 2020 %7 20.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone-based blood pressure (BP) monitoring using photoplethysmography (PPG) technology has emerged as a promising approach to empower users with self-monitoring for effective diagnosis and control of hypertension. Objective: This study aimed to develop a mobile personal health care system for noninvasive, pervasive, and continuous estimation of BP level and variability, which is user friendly for elderly people. Methods: The proposed approach was integrated by a self-designed cuffless, calibration-free, wireless, and wearable PPG-only sensor and a native purposely designed smartphone app using multilayer perceptron machine learning techniques from raw signals. We performed a development and usability study with three older adults (mean age 61.3 years, SD 1.5 years; 66% women) to test the usability and accuracy of the smartphone-based BP monitor. Results: The employed artificial neural network model had good average accuracy (>90%) and very strong correlation (>0.90) (P<.001) for predicting the reference BP values of our validation sample (n=150). Bland-Altman plots showed that most of the errors for BP prediction were less than 10 mmHg. However, according to the Association for the Advancement of Medical Instrumentation and British Hypertension Society standards, only diastolic blood pressure prediction met the clinically accepted accuracy thresholds. Conclusions: With further development and validation, the proposed system could provide a cost-effective strategy to improve the quality and coverage of health care, particularly in rural zones, areas lacking physicians, and areas with solitary elderly populations. %M 32459642 %R 10.2196/18012 %U https://mhealth.jmir.org/2020/7/e18012 %U https://doi.org/10.2196/18012 %U http://www.ncbi.nlm.nih.gov/pubmed/32459642 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17665 %T The Effect of Women’s Differential Access to Messages on Their Adoption of Mobile Health Services and Pregnancy Behavior in Bangladesh: Retrospective Cross-Sectional Study %A Alam,Mafruha %A Banwell,Cathy %A Lokuge,Kamalini %+ Australian National University, 62 Mills Road, National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, ACT, 2601, Australia, 61 6125 5602, mafruha.alam@gmail.com %K mHealth %K inequality %K access %K pregnancy %D 2020 %7 20.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Text or voice messages have been used as a popular method for improving women’s knowledge on birth preparedness and newborn health care practices worldwide. The Aponjon service in Bangladesh provides twice-weekly messages to female subscribers about their pregnancy and newborn care on mobile phones that they own or share with family members. It is important to understand whether women’s singular access to a phone affects their service satisfaction and the adoption of health messages before deploying such interventions in resource-limited settings. Objective: This study aims to evaluate the effect of women’s singular and shared access to mobile phone messages on their service utilization and perceived behavioral change around birth preparedness and pregnancy care. Methods: In 2014, Aponjon conducted a retrospective cross-sectional survey of 459 female subscribers who received text or voice messages during their pregnancy by themselves (n=253) or with family members (n=206). We performed multivariable regression analyses to investigate the association between pregnant women’s differential access to messages and other socioeconomic factors and outcomes of service satisfaction, ability to recall service short code, ability to identify danger signs of pregnancy, preference for skilled delivery, arrangement of a blood donor for delivery and pregnancy complications, maternal nutrition, use of potable drinking water, and washing hands with soap for hygiene. Results: In the multivariable analysis, women who had singular access to messages had higher odds of reporting high satisfaction (odds ratio [OR] 1.72, 95% CI 1.12-2.63; P=.01), recalling the service short code (OR 2.88, 95% CI 1.90-4.36; P<.001), consuming nutritious food 5 times a day (OR 1.58, 95% CI 1.04-2.40; P=.03), and following the instructions of Aponjon on drinking potable water (OR 1.90, 95% CI 1.17-3.09; P=.01) than women who shared access with family members. Women’s differential access to messages did not affect their knowledge of danger signs and preparedness around delivery. Adolescent women and women aged 20-24 years had lower odds of planning safe deliveries than older women (aged≥25 years). Secondary education was statistically significantly associated with women’s ability to recall the short code and pregnancy danger signs, plan safe delivery, and select blood donors for emergencies. Higher family income was associated with women’s satisfaction, recognition of danger signs, and arrangement of blood donors and nutritious diet. Women who received more than 4 antenatal care visits had higher odds of liking the service, preferring skilled delivery, recalling danger signs, and consuming nutritious food. Conclusions: The capacity of women to independently access mobile phone messages can improve their adoption of mobile health services and some pregnancy health care practices. A holistic approach and equitable support are required to improve access to resources and knowledge of delivery preparedness among low-literate and younger women in low-income households. %M 32706694 %R 10.2196/17665 %U https://mhealth.jmir.org/2020/7/e17665 %U https://doi.org/10.2196/17665 %U http://www.ncbi.nlm.nih.gov/pubmed/32706694 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17535 %T Feasibility and Acceptability of an Adapted Mobile Phone Message Program and Changes in Maternal and Newborn Health Knowledge in Four Provinces of Afghanistan: Single-Group Pre-Post Assessment Study %A Lebrun,Victoria %A Dulli,Lisa %A Alami,Sayed Omar %A Sidiqi,Arzoo %A Sultani,Ahmad Shah %A Rastagar,Sayed Haroon %A Halimzai,Iftikhar %A Ahmadzai,Sharif %A Todd,Catherine S %+ Global Health, Population, and Nutrition, FHI 360, 359 Blackwell St #200, Durham, NC, 27701, United States, 1 9195447040 ext 11640, vlebrun@fhi360.org %K Afghanistan %K mobile apps %K pregnant women %K maternal health %K newborn health %K social and behavior change %K mHealth %K voice message %K SMS %D 2020 %7 20.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone apps for health promotion have expanded in many low- and middle-income countries. Afghanistan, with high maternal and newborn morbidity and mortality rates, a fragile health infrastructure, and high levels of mobile phone ownership, is an ideal setting to examine the utility of such programs. We adapted messages of the Mobile Alliance for Maternal Action (MAMA) program, which was designed to promote healthy behaviors during pregnancy and a newborn’s first year of life, to the Afghan context. We then piloted and assessed the program in the provinces of Kabul, Herat, Kandahar, and Balkh. Objective: The aim of this study was to assess the feasibility and acceptability of the MAMA pilot program, and to examine changes in reported maternal, newborn, and child health (MNCH) knowledge and attitudes among participants from baseline to follow up. Methods: We conducted a single-group study with data collected within 10 weeks of enrollment, and data collection was repeated approximately 6 months later. Data were collected through face-to-face interviews using structured questionnaires. Eligible participants included pregnant women who had registered to receive fully automated mobile health messages and their husbands. Assessment questionnaires queried sociodemographic details; knowledge, attitudes, and health care-seeking practices; and intervention experience and acceptability at follow up. The number of messages received by a given phone number was extracted from the program database. We descriptively analyzed the feasibility and acceptability data and compared the change in MNCH knowledge between baseline and follow-up measures using the McNemar Chi square test. Results: Overall, 895 women were enrolled in the MAMA program. Data from 453/625 women (72.5% of the pretest sample) who received voice (n=302) or text (n=151) messages, and 276/427 men (64.6% of the pretest sample) who received voice (n=185) or text (n=91) messages contributing data at both time points were analyzed. At follow up, 699/729 (95.9%) participants were still enrolled in the MAMA program; voice message and SMS text messaging subscribers received 43 and 69 messages on average over the 6-month period, respectively. Participants who were voice message subscribers and female participants more commonly reported missing messages compared with the text message subscribers and men; predominant reasons for missed messages were the subscribers being busy with chores or not having their shared phone with them. Over 90% of men and women reported experiencing benefits from the program, mainly increased knowledge, and 226/453 (49.9%) of the female participants reported referring someone else to the program. Most of the participants (377/453, 83.2% women and 258/276, 93.5% men) believed it was beneficial to include husbands in the program. Joint decision making regarding maternal and child health care increased overall. The proportions of participants with correct knowledge significantly increased for all but one MNCH measure at follow up. Conclusions: This assessment indicates that the pilot MAMA program is feasible and acceptable in the Afghan context. Further research should be conducted to determine whether program participation leads to improved MNCH knowledge, health practices, and health service utilization in this fragile setting prior to larger scale up. %M 32706690 %R 10.2196/17535 %U https://mhealth.jmir.org/2020/7/e17535 %U https://doi.org/10.2196/17535 %U http://www.ncbi.nlm.nih.gov/pubmed/32706690 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17552 %T A Personalized Physical Activity Coaching App for Breast Cancer Survivors: Design Process and Early Prototype Testing %A Monteiro-Guerra,Francisco %A Signorelli,Gabriel Ruiz %A Tadas,Shreya %A Dorronzoro Zubiete,Enrique %A Rivera Romero,Octavio %A Fernandez-Luque,Luis %A Caulfield,Brian %+ Salumedia Tecnologias, Salumedia Tecnologías S.L.U., Avda. República Argentina, nº 24 Edificio Torre de los Remedios, 5ª planta módulo A, Seville, 41011, Spain, 34 656930901, luis@salumedia.com %K user-centered design %K physical activity %K coaching %K behavior change %K mobile app %K mobile phone %K breast cancer %K usability %D 2020 %7 15.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Existing evidence supports the many benefits of physical activity (PA) in breast cancer survival. However, few breast cancer survivors adhere to the recommended levels of activity. A PA coaching app that provides personalized feedback, guidance, and motivation to the user might have the potential to engage these individuals in a more active lifestyle, in line with the general recommendations. To develop a successful tool, it is important to involve the end users in the design process and to make theoretically grounded design decisions. Objective: This study aimed to execute the design process and early prototype evaluation of a personalized PA coaching app for posttreatment breast cancer survivors. In particular, the study explored a design combining behavioral theory and tailored coaching strategies. Methods: The design process was led by a multidisciplinary team, including technical and health professionals, and involved input from a total of 22 survivors. The process comprised 3 stages. In stage 1, the literature was reviewed and 14 patients were interviewed to understand the needs and considerations of the target population toward PA apps. In stage 2, the global use case for the tool was defined, the features were ideated and refined based on theory, and a digital interactive prototype was created. In stage 3, the prototype went through usability testing with 8 patients and was subjected to quality and behavior change potential evaluations by 2 human-computer interaction experts. Results: The design process has led to the conceptualization of a personalized coaching app for walking activities that addresses the needs of breast cancer survivors. The main features of the tool include a training plan and schedule, adaptive goal setting, real-time feedback and motivation during walking sessions, activity status through the day, activity history, weekly summary reports, and activity challenges. The system was designed to measure users’ cadence during walking, use this measure to infer their training zone, and provide real-time coaching to control the intensity of the walking sessions. The outcomes from user testing and expert evaluation of the digital prototype were very positive, with scores from the system usability scale, mobile app rating scale, and app behavior change scale of 95 out of 100, 4.6 out of 5, and 15 out of 21, respectively. Conclusions: Implementing a user-centered design approach for the development and early evaluation of an app brings essential considerations to tailor the solution to the user’s needs and context. In addition, informing the design on behavioral and tailored coaching theories supports the conceptualization of the PA coaching system. This is critical for optimizing the usability, acceptability, and long-term effectiveness of the tool. After successful early in-laboratory testing, the app will be developed and evaluated in a pilot study in a real-world setting. %M 32673271 %R 10.2196/17552 %U https://mhealth.jmir.org/2020/7/e17552 %U https://doi.org/10.2196/17552 %U http://www.ncbi.nlm.nih.gov/pubmed/32673271 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e18255 %T Exclusively Digital Health Interventions Targeting Diet, Physical Activity, and Weight Gain in Pregnant Women: Systematic Review and Meta-Analysis %A Rhodes,Alexandra %A Smith,Andrea D %A Chadwick,Paul %A Croker,Helen %A Llewellyn,Clare H %+ University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 207679 1720, alexandra.rhodes.15@ucl.ac.uk %K gestational weight gain %K digital interventions %K behavior change techniques %K user engagement %K smartphone %K mobile phone %D 2020 %7 10.7.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Interventions to promote a healthy diet, physical activity, and weight management during pregnancy are increasingly embracing digital technologies. Although some interventions have combined digital with interpersonal (face-to-face or telephone) delivery, others have relied exclusively on digital delivery. Exclusively digital interventions have the advantages of greater cost-effectiveness and broader reach and as such can be a valuable resource for health care providers. Objective: This systematic review aims to focus on exclusively digital interventions to determine their effectiveness, identify behavior change techniques (BCTs), and investigate user engagement. Methods: A total of 6 databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulated Index to Nursing and Allied Health Literature [CINAHL] Plus, Web of Science, and ProQuest) were searched for randomized controlled trials or pilot control trials of exclusively digital interventions to encourage healthy eating, physical activity, or appropriate weight gain during pregnancy. The outcome measures were gestational weight gain (GWG) and changes in physical activity and dietary behaviors. Study quality was assessed using the Cochrane Risk of Bias tool 2.0. Where possible, pooled effect sizes were calculated using a random effects meta-analysis. Results: In total, 11 studies met the inclusion criteria. The risk of bias was mostly high (n=5) or moderate (n=3). Of the 11 studies, 6 reported on GWG as the primary outcome, 4 of which also measured changes in physical activity and dietary behaviors, and 5 studies focused either on dietary behaviors only (n=2) or physical activity only (n=3). The meta-analyses showed no significant benefit of interventions on total GWG for either intention-to-treat data (−0.28 kg; 95% CI −1.43 to 0.87) or per-protocol data (−0.65 kg; 95% CI −1.98 to 0.67). Substantial heterogeneity in outcome measures of change in dietary behaviors and physical activity precluded further meta-analyses. BCT coding identified 7 BCTs that were common to all effective interventions. Effective interventions averaged over twice as many BCTs from the goals and planning, and feedback and monitoring domains as ineffective interventions. Data from the 6 studies reporting on user engagement indicated a positive association between high engagement with key BCTs and greater intervention effectiveness. Interventions using proactive messaging and feedback appeared to have higher levels of engagement. Conclusions: In contrast to interpersonal interventions, there is little evidence of the effectiveness of exclusively digital interventions to encourage a healthy diet, physical activity, or weight management during pregnancy. In this review, effective interventions used proactive messaging, such as reminders to engage in BCTs, feedback on progress, or tips, suggesting that interactivity may drive engagement and lead to greater effectiveness. Given the benefits of cost and reach of digital interventions, further research is needed to understand how to use advancing technologies to enhance user engagement and improve effectiveness. %M 32673251 %R 10.2196/18255 %U https://mhealth.jmir.org/2020/7/e18255 %U https://doi.org/10.2196/18255 %U http://www.ncbi.nlm.nih.gov/pubmed/32673251 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17558 %T A Physical Activity and Diet Program Delivered by Artificially Intelligent Virtual Health Coach: Proof-of-Concept Study %A Maher,Carol Ann %A Davis,Courtney Rose %A Curtis,Rachel Grace %A Short,Camille Elizabeth %A Murphy,Karen Joy %+ Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, 5001, Australia, 61 883022315, carol.maher@unisa.edu.au %K virtual assistant %K chatbot %K Mediterranean diet %K physical activity %K lifestyle %D 2020 %7 10.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Poor diet and physical inactivity are leading modifiable causes of death and disease. Advances in artificial intelligence technology present tantalizing opportunities for creating virtual health coaches capable of providing personalized support at scale. Objective: This proof of concept study aimed to test the feasibility (recruitment and retention) and preliminary efficacy of physical activity and Mediterranean-style dietary intervention (MedLiPal) delivered via artificially intelligent virtual health coach. Methods: This 12-week single-arm pre-post study took place in Adelaide, Australia, from March to August 2019. Participants were inactive community-dwelling adults aged 45 to 75 years, recruited through news stories, social media posts, and flyers. The program included access to an artificially intelligent chatbot, Paola, who guided participants through a computer-based individualized introductory session, weekly check-ins, and goal setting, and was available 24/7 to answer questions. Participants used a Garmin Vivofit4 tracker to monitor daily steps, a website with educational materials and recipes, and a printed diet and activity log sheet. Primary outcomes included feasibility (based on recruitment and retention) and preliminary efficacy for changing physical activity and diet. Secondary outcomes were body composition (based on height, weight, and waist circumference) and blood pressure. Results: Over 4 weeks, 99 potential participants registered expressions of interest, with 81 of those screened meeting eligibility criteria. Participants completed a mean of 109.8 (95% CI 1.9-217.7) more minutes of physical activity at week 12 compared with baseline. Mediterranean diet scores increased from a mean of 3.8 out of 14 at baseline, to 9.6 at 12 weeks (mean improvement 5.7 points, 95% CI 4.2-7.3). After 12 weeks, participants lost an average 1.3 kg (95% CI –0.1 to –2.5 kg) and 2.1 cm from their waist circumference (95% CI –3.5 to –0.7 cm). There were no significant changes in blood pressure. Feasibility was excellent in terms of recruitment, retention (90% at 12 weeks), and safety (no adverse events). Conclusions: An artificially intelligent virtual assistant-led lifestyle-modification intervention was feasible and achieved measurable improvements in physical activity, diet, and body composition at 12 weeks. Future research examining artificially intelligent interventions at scale, and for other health purposes, is warranted. %M 32673246 %R 10.2196/17558 %U https://mhealth.jmir.org/2020/7/e17558 %U https://doi.org/10.2196/17558 %U http://www.ncbi.nlm.nih.gov/pubmed/32673246 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e17044 %T High School Students’ Preferences and Design Recommendations for a Mobile Phone–Based Intervention to Improve Psychological Well-Being: Mixed Methods Study %A Müssener,Ulrika %A Thomas,Kristin %A Bendtsen,Preben %A Bendtsen,Marcus %+ Department of Medical and Health Sciences, Linköping University, Sandbäcksgatan 1, Linköping, 58183, Sweden, 46 732702426, ulrika.mussener@liu.se %K mental health %K stress %K high school students %K intervention %K mHealth %D 2020 %7 9.7.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Young adults’ mental health is characterized by relatively high rates of stress and anxiety and low levels of help-seeking behavior. Mobile health (mHealth) interventions could offer a cost-effective and readily available avenue to provide personalized support to young adults. More research needs to be directed at the development of mHealth interventions targeting youths specifically, as well as at determining how to reach young people and how to effectively intervene to improve psychological well-being. Objective: The objective was to gather perceptions from high school students to inform the development of a prototype mHealth intervention aiming to promote psychological well-being. Methods: A mixed methods design was used to (1) investigate high school students’ perceptions about stress and its consequences in daily life, as well as their ability to cope with stress, and (2) explore their preferences and design recommendations for an mHealth intervention to improve psychological well-being. Students from two high schools in the southeast of Sweden were invited to take part in the study. Recruitment of high school students was completed over a 6-week period, between October 25 and December 7, 2018. Recruitment entailed inviting students to complete a stress test (ie, screening and feedback) on their mobile phones. After completing the stress test, all participants were invited to complete a follow-up questionnaire and take part in telephone interviews. Results: A total of 149 high school students completed the stress test, of which 68 completed the questionnaire. There were 67 free-text comments distributed across the items. The majority of participants (55/68, 81%) stated that they coped with stress better or in the same way after engaging in the stress test, due to time management, dialogue with others, and self-refection. A total of 4 out of 68 participants (6%)—3 female students (75%) and 1 male student (25%)—took part in telephone interviews. Three main themes were identified from the interview data: perceptions about stress, design features, and intervention features. Conclusions: Stress was described by the students as a condition caused by high demands set by oneself and the social environment that impacted their physical health, personal relationships, school performance, and emotional well-being. Participants claimed that mHealth interventions need to be clearly tailored to a young age group, be evidence based, and offer varied types of support, such as information about stress, exercises to help organize tasks, self-assessment, coping tools, and recommendations of other useful websites, literature, blogs, self-help books, or role models. Mobile phones seemed to be a feasible and acceptable platform for the delivery of an intervention. %M 32673268 %R 10.2196/17044 %U https://pediatrics.jmir.org/2020/2/e17044 %U https://doi.org/10.2196/17044 %U http://www.ncbi.nlm.nih.gov/pubmed/32673268 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e16699 %T Preventing Cardiovascular Disease Among Urban African Americans With a Mobile Health App (the MOYO App): Protocol for a Usability Study %A Taylor Jr,Herman A %A Francis,Sherilyn %A Evans,Chad Ray %A Harvey,Marques %A Newton,Brittney A %A Jones,Camara P %A Akintobi,Tabia Henry %A Clifford,Gari %+ Cardiovascular Research Institute, Morehouse School of Medicine, 720 West View Drive, Atlanta, GA, United States, 1 404 752 1978, htaylor@msm.edu %K African Americans %K mHealth %K community-based participatory research %K agile design %K cardiovascular %D 2020 %7 9.7.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cardiovascular disease (CVD) disparities are a particularly devastating manifestation of health inequity. Despite advancements in prevention and treatment, CVD is still the leading cause of death in the United States. Additionally, research indicates that African American (AA) and other ethnic-minority populations are affected by CVD at earlier ages than white Americans. Given that AAs are the fastest-growing population of smartphone owners and users, mobile health (mHealth) technologies offer the unparalleled potential to prevent or improve self-management of chronic disease among this population. Objective: To address the unmet need for culturally tailored primordial prevention CVD–focused mHealth interventions, the MOYO app was cocreated with the involvement of young people from this priority community. The overall project aims to develop and evaluate the effectiveness of a novel smartphone app designed to reduce CVD risk factors among urban-AAs, 18-29 years of age. Methods: The theoretical underpinning will combine the principles of community-based participatory research and the agile software development framework. The primary outcome goals of the study will be to determine the usability, acceptability, and functionality of the MOYO app, and to build a cloud-based data collection infrastructure suitable for digital epidemiology in a disparity population. Changes in health-related parameters over a 24-week period as determined by both passive (eg, physical activity levels, sleep duration, social networking) and active (eg, use of mood measures, surveys, uploading pictures of meals and blood pressure readings) measures will be the secondary outcome. Participants will be recruited from a majority AA “large city” school district, 2 historically black colleges or universities, and 1 urban undergraduate college. Following baseline screening for inclusion (administered in person), participants will receive the beta version of the MOYO app. Participants will be monitored during a 24-week pilot period. Analyses of varying data including social network dynamics, standard metrics of activity, percentage of time away from a given radius of home, circadian rhythm metrics, and proxies for sleep will be performed. Together with external variables (eg, weather, pollution, and socioeconomic indicators such as food access), these metrics will be used to train machine-learning frameworks to regress them on the self-reported quality of life indicators. Results: This 5-year study (2015-2020) is currently in the implementation phase. We believe that MOYO can build upon findings of classical epidemiology and longitudinal studies like the Jackson Heart Study by adding greater granularity to our knowledge of the exposures and behaviors that affect health and disease, and creating a channel for outreach capable of launching interventions, clinical trials, and enhancements of health literacy. Conclusions: The results of this pilot will provide valuable information about community cocreation of mHealth programs, efficacious design features, and essential infrastructure for digital epidemiology among young AA adults. International Registered Report Identifier (IRRID): DERR1-10.2196/16699 %M 32673258 %R 10.2196/16699 %U https://www.researchprotocols.org/2020/7/e16699 %U https://doi.org/10.2196/16699 %U http://www.ncbi.nlm.nih.gov/pubmed/32673258 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e18543 %T Improving the Quality of Antenatal Care Using Mobile Health in Madagascar: Five-Year Cross-Sectional Study %A Benski,Anne Caroline %A Schmidt,Nicole C %A Viviano,Manuela %A Stancanelli,Giovanna %A Soaroby,Adelia %A Reich,Michael R %+ Takemi Program in International Health, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, United States, 1 787397261, cbenski@hsph.harvard.edu %K mobile health %K maternal health %K antenatal care %K quality of care %K mobile phone %D 2020 %7 8.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite many efforts, maternal mortality remains a major burden in most developing countries. Mobile health (mHealth) has the potential to improve access to obstetric care through apps that help patients and providers. Objective: This study aimed to use mHealth to provide antenatal care (ANC) to 1446 pregnant women in a rural area in Madagascar and evaluate the quality of ANC provided by an mHealth system designed to change the behaviors of providers and patients. Methods: We included 1446 women who attended ANC visits in rural Madagascar from 2015 to 2019 using an mHealth system called Pregnancy and Newborn Diagnostic Assessment (PANDA). This cross-sectional study used data from different participants, with information collected over several years, to analyze the outputs related to the quality of ANC over time. Specifically, we examined the timing of the first ANC visit, the relationship between the visit duration and the risk factors among pregnant women, and the number of ANC visits per woman. Results: Following the implementation of the mHealth system in 2015, we observed that women started to come earlier for their first ANC visit; more women attended their first ANC visit in the second trimester of pregnancy in 2019 than in the previous years (P<.001). In 2019, fewer women attended their first ANC visit in the third trimester (57/277, 20.6%) than in 2015 (147/343, 42.9%). There were statistically significant associations between the ANC visit durations and the risk factors, including age (>35 years; 25.0 min, 95% CI 24.0-25.9), educational level (longer visit for women with lower than primary education and for women who attended university and shorter for women with primary school–level education; 40.7 min, 95% CI 30.2-51.3 and 25.3 min, 95% CI 24.4-26.3 vs 23.3 min, 95% CI 22.9-23.8; P=.001), experience of domestic violence during pregnancy, gravidity, parity, infectious diseases (HIV, malaria, and syphilis), and level of anemia. Statistically significant associations were observed for all quality indicator variables. We observed a statistically significant increase in the number of ANC visits per woman over time from 2015 to 2017; the number of ANC visits per woman then became stable after the third year of implementing the PANDA mHealth system. Conclusions: This study shows the potential of an mHealth system to improve the quality of ANC, change provider behavior by standardizing ANC visits, and change patient behavior by increasing the willingness to return for subsequent visits and encouraging ANC attendance early in pregnancy. As this is an exploratory study, further studies are necessary to better understand how mHealth can change behavior and identify the conditions required for behavioral changes to persist over time. %M 32673263 %R 10.2196/18543 %U https://mhealth.jmir.org/2020/7/e18543 %U https://doi.org/10.2196/18543 %U http://www.ncbi.nlm.nih.gov/pubmed/32673263 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17842 %T Mobile Delivery of the Diabetes Prevention Program in People With Prediabetes: Randomized Controlled Trial %A Toro-Ramos,Tatiana %A Michaelides,Andreas %A Anton,Maria %A Karim,Zulekha %A Kang-Oh,Leah %A Argyrou,Charalambos %A Loukaidou,Elisavet %A Charitou,Marina M %A Sze,Wilson %A Miller,Joshua D %+ Noom, Inc, 229 W 28th St, New York, NY, , United States, 1 5168087328, andreas@noom.com %K prediabetes %K body weight %K mHealth %K mobile app %K mobile phone %K randomized controlled trial %D 2020 %7 8.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Centers for Disease Control and Prevention (CDC) diabetes prevention program (DPP) has formed the foundation for Type 2 Diabetes Mellitus (T2DM) prevention efforts and lifestyle change modifications in multiple care settings. To our knowledge, no randomized controlled trial has verified the efficacy of a fully mobile version of CDC’s diabetes prevention program (DPP). Objective: This study aimed to investigate the long-term weight loss and glycemic efficacy of a mobile-delivered DPP compared with a control group receiving usual medical care. Methods: Adults with prediabetes (N=202) were recruited from a clinic and randomized to either a mobile-delivered, coach-guided DPP (Noom) or a control group that received regular medical care including a paper-based DPP curriculum and no formal intervention. The intervention group learned how to use the Noom program, how to interact with their coach, and the importance of maintaining motivation. They had access to an interactive coach-to-participant interface and group messaging, daily challenges for behavior change, DPP-based education articles, food logging, and automated feedback. Primary outcomes included changes in weight and hemoglobin A1c (HbA1c) levels at 6 and 12 months, respectively. Exploratory secondary outcomes included program engagement as a predictor of changes in weight and HbA1c levels. Results: A total of 202 participants were recruited and randomized into the intervention (n=101) or control group (n=99). In the intention-to-treat (ITT) analyses, changes in the participants’ weight and BMI were significantly different at 6 months between the intervention and control groups, but there was no difference in HbA1c levels (mean difference 0.004%, SE 0.05; P=.94). Weight and BMI were lower in the intervention group by −2.64 kg (SE 0.71; P<.001) and −0.99 kg/m2 (SE 0.29; P=.001), respectively. These differences persisted at 12 months. However, in the analyses that did not involve ITT, program completers achieved a significant weight loss of 5.6% (SE 0.81; P<.001) at 6 months, maintaining 4.7% (SE 0.88; P<.001) of their weight loss at 12 months. The control group lost −0.15% at 6 months (SE 0.64; P=.85) and gained 0.33% (SE 0.70; P=.63) at 12 months. Those randomized to the intervention group who did not start the program had no meaningful weight or HbA1c level change, similar to the control group. At 1 year, the intervention group showed a 0.23% reduction in HbA1c levels; those who completed the intervention showed a 0.28% reduction. Those assigned to the control group had a 0.16% reduction in HbA1c levels. Conclusions: This novel mobile-delivered DPP achieved significant weight loss reductions for up to 1 year compared with usual care. This type of intervention reduces the risk of overt diabetes without the added barriers of in-person interventions. Trial Registration: ClinicalTrials.gov NCT03865342; https://clinicaltrials.gov/ct2/show/NCT03865342 %M 32459631 %R 10.2196/17842 %U https://mhealth.jmir.org/2020/7/e17842 %U https://doi.org/10.2196/17842 %U http://www.ncbi.nlm.nih.gov/pubmed/32459631 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16365 %T The Effects of Gamification and Oral Self-Care on Oral Hygiene in Children: Systematic Search in App Stores and Evaluation of Apps %A Fijačko,Nino %A Gosak,Lucija %A Cilar,Leona %A Novšak,Alenka %A Creber,Ruth Masterson %A Skok,Pavel %A Štiglic,Gregor %+ Faculty of Health Sciences, University of Maribor, Žitna 15, Maribor, Slovenia, 386 23004764, nino.fijacko@um.si %K mobile health %K oral health care %K gamification %K mobile store %K evidence-based dentistry %K behavior change technique %K Mobile Application Rating Scale user version %D 2020 %7 8.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Poor oral hygiene is a great public health problem worldwide. Oral health care education is a public health priority as the maintenance of oral hygiene is integral to overall health. Maintaining optimal oral hygiene among children is challenging and can be supported by using relevant motivational approaches. Objective: The primary aim of this study was to identify mobile smartphone apps that include gamification features focused on motivating children to learn, perform, and maintain optimal oral hygiene. Methods: We searched six online app stores using four search terms (“oral hygiene game,” “oral hygiene gamification,” “oral hygiene brush game,” and “oral hygiene brush gamification”). We identified gamification features, identified whether apps were consistent with evidence-based dentistry, performed a quality appraisal with the Mobile App Rating Scale user version (uMARS), and quantified behavior scores (Behavior Change score, uMARS score, and Coventry, Aberdeen, and London-Refined [CALO-RE] score) using three different instruments that measure behavior change. Results: Of 612 potentially relevant apps included in the analysis, 17 met the inclusion criteria. On average, apps included 6.87 (SD 4.18) out of 31 possible gamification features. The most frequently used gamification features were time pressure (16/17, 94%), virtual characters (14/17, 82%), and fantasy (13/17, 76%). The most common oral hygiene evidence-based recommendation was brushing time (2-3 minutes), which was identified in 94% (16/17) of apps. The overall mean uMARS score for app quality was high (4.30, SD 0.36), with good mean subjective quality (3.79, SD 0.71) and perceived impact (3.58, SD 0.44). Sufficient behavior change techniques based on three taxonomies were detected in each app. Conclusions: The majority of the analyzed oral hygiene apps included gamification features and behavior change techniques to perform and maintain oral hygiene in children. Overall, the apps contained some educational content consistent with evidence-based dentistry and high-quality background for oral self-care in children; however, there is scope for improvement. %M 32673235 %R 10.2196/16365 %U https://mhealth.jmir.org/2020/7/e16365 %U https://doi.org/10.2196/16365 %U http://www.ncbi.nlm.nih.gov/pubmed/32673235 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 7 %P e16341 %T Engagement and Clinical Improvement Among Older Adult Primary Care Patients Using a Mobile Intervention for Depression and Anxiety: Case Studies %A Orr,L Casey %A Graham,Andrea K %A Mohr,David C %A Greene,Carolyn J %+ Center for Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 W Markham #554, Little Rock, AR, 72205, United States, 1 5015512880, lcorr@ualr.edu %K mobile health %K older adults %K depression %K anxiety %K primary care %K smartphone %K mobile phone %K text messaging %D 2020 %7 8.7.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Technology-based mental health interventions are an increasingly attractive option for expanding access to mental health services within the primary care system. Older adults are among the groups that could potentially benefit from the growing ubiquity of technology-based mental health interventions; however, older adults are perceived to be averse to using technology and have reported barriers to use. Objective: The aim of this paper is to present a case study of 3 participants from a clinical trial evaluating IntelliCare, an evidence-based mobile intervention for depression and anxiety, among adults recruited from primary care clinics. Our report of these 3 participants, who were aged 60 years or older, focuses on their engagement with the IntelliCare service (ie, app use, coach communication) and clinical changes in depression or anxiety symptoms over the intervention period. Methods: The 3 case study participants were offered IntelliCare with coaching for 8 weeks. The intervention consisted of 5 treatment intervention apps that support a variety of psychological skills, a Hub app that contained psychoeducational content and administered weekly assessments, and coaching for encouragement, accountability, and technical assistance as needed. The 3 case study participants were selected to reflect the overall demographics of participants within the trial and because their interactions with IntelliCare provided a good illustration of varied experiences regarding engagement with the intervention. Results: The 3 participants’ unique experiences with the intervention are described. Despite potential barriers and experiencing some technical glitches, the participants showed proficient ability to use the apps, high levels of participation through frequent app use and coach interaction, and decreased depression and anxiety scores. At the end of the 8-week intervention, each of these 3 participants expressed great enthusiasm for the benefit of this program through feedback to their coach, and they each identified a number of ways they had seen improvements in themselves. Conclusions: These 3 cases provide examples of older individuals who engaged with and benefitted from the IntelliCare service. Although the results from these 3 cases may not generalize to others, they provide an important, informed perspective of the experiences that can contribute to our understanding of how older adults use and overcome barriers to mental health technologies. The findings also contribute toward the ultimate goal of ensuring that the IntelliCare intervention is appropriate for individuals of all ages. %M 32673236 %R 10.2196/16341 %U https://mental.jmir.org/2020/7/e16341 %U https://doi.org/10.2196/16341 %U http://www.ncbi.nlm.nih.gov/pubmed/32673236 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17183 %T Effect of a Health System–Sponsored Mobile App on Perinatal Health Behaviors: Retrospective Cohort Study %A Cawley,Caroline %A Buckenmeyer,Hannelore %A Jellison,Trina %A Rinaldi,Joseph B %A Vartanian,Keri B %+ Center for Outcomes Research and Education, Providence Portland Medical Center, 5251 NE Glisan Street, Portland, OR, 97213, United States, 1 503 215 2594, Keri.Vartanian@providence.org %K mobile health %K perinatal health %K health behaviors %D 2020 %7 6.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pregnancy mobile apps are becoming increasingly popular, with parents-to-be seeking information related to their pregnancy and their baby through mobile technology. This increase raises the need for prenatal apps with evidence-based content that is personalized and reliable. Previous studies have looked at whether prenatal apps impact health and behavior outcomes among pregnant and postpartum individuals; however, research has been limited. Objective: The primary objective of this study is to assess whether the use of a health system–sponsored mobile app—Circle by Providence—aimed at providing personalized and reliable health information on pregnancy, postpartum recovery, and infant care is associated with improved health outcomes and increased healthy behaviors and knowledge among users. Methods: This observational study compared app users and app nonusers using a self-reported survey and electronic medical records. The study took place over 18 months and was conducted at Providence St. Joseph Health in Portland, Oregon. The sample included patients who received prenatal care at one of seven Providence clinics and had a live birth at a Providence hospital. Recruitment occurred on a rolling basis and only those who completed the survey were included. Survey respondents were separated into app users and app nonusers, and survey responses and clinical outcomes were compared across groups using univariate and adjusted multivariate logistic regression. Results: A total of 567 participants were enrolled in the study—167 in the app user group and 400 in the nonuser group. We found statistically significant differences between the two groups for certain behavior outcomes: subjects who used the app had 75% greater odds of breastfeeding beyond 6 months postpartum (P=.012), were less likely to miss prenatal appointments (P=.046), and were 50% more likely to exercise 3 or more times a week during pregnancy (P=.04). There were no differences in nutritional measures, including whether they took prenatal vitamins, ate 5 fruits or vegetables a day, or drank caffeine. We found no differences in many of the infant care outcomes; however, there was an increase in awareness of “purple crying.” Finally, there were no significant differences in measured clinical health outcomes, including cesarean births, length of hospital stays (in minutes), low birth weight infants, preterm births, small-for-gestational-age births, large-for-gestational-age births, and neonatal intensive care unit stays. Conclusions: The use of the Circle app, which provides access to personalized and evidence-based health information, was associated with an increase in certain healthy behaviors and health knowledge, although there was no impact on clinical health outcomes. More research is needed to determine the impact of mobile prenatal apps on healthy pregnancies, clinical health outcomes, and infant care. %M 32628123 %R 10.2196/17183 %U https://mhealth.jmir.org/2020/7/e17183 %U https://doi.org/10.2196/17183 %U http://www.ncbi.nlm.nih.gov/pubmed/32628123 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e17159 %T Effectiveness of Using Mental Health Mobile Apps as Digital Antidepressants for Reducing Anxiety and Depression: Protocol for a Multiple Baseline Across-Individuals Design %A Marshall,Jamie M %A Dunstan,Debra A %A Bartik,Warren %+ School of Psychology, Faculty of Medicine and Health, University of New England, Armidale, 2351, Australia, 61 2 6773 3012, jmarsh21@une.edu.au %K mHealth %K eHealth %K mobile apps %K mobile phone %K anxiety %K depression %K single-case study %D 2020 %7 5.7.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The use of mental health mobile apps to treat anxiety and depression is widespread and growing. Several reviews have found that most of these apps do not have published evidence for their effectiveness, and existing research has primarily been undertaken by individuals and institutions that have an association with the app being tested. Another reason for the lack of research is that the execution of the traditional randomized controlled trial is time prohibitive in this profit-driven industry. Consequently, there have been calls for different methodologies to be considered. One such methodology is the single-case design, of which, to the best of our knowledge, no peer-reviewed published example with mental health apps for anxiety and/or depression could be located. Objective: The aim of this study is to examine the effectiveness of 5 apps (Destressify, MoodMission, Smiling Mind, MindShift, and SuperBetter) in reducing symptoms of anxiety and/or depression. These apps were selected because they are publicly available, free to download, and have published evidence of efficacy. Methods: A multiple baseline across-individuals design will be employed. A total of 50 participants will be recruited (10 for each app) who will provide baseline data for 20 days. The sequential introduction of an intervention phase will commence once baseline readings have indicated stability in the measures of participants’ mental health and will proceed for 10 weeks. Postintervention measurements will continue for a further 20 days. Participants will be required to provide daily subjective units of distress (SUDS) ratings via SMS text messages and will complete other measures at 5 different time points, including at 6-month follow-up. SUDS data will be examined via a time series analysis across the experimental phases. Individual analyses of outcome measures will be conducted to detect clinically significant changes in symptoms using the statistical approach proposed by Jacobson and Truax. Participants will rate their app on several domains at the end of the intervention. Results: Participant recruitment commenced in January 2020. The postintervention phase will be completed by June 2020. Data analysis will commence after this. A write-up for publication is expected to be completed after the follow-up phase is finalized in January 2021. Conclusions: If the apps prove to be effective as hypothesized, this will provide collateral evidence of their efficacy. It could also provide the benefits of (1) improved access to mental health services for people in rural areas, lower socioeconomic groups, and children and adolescents and (2) improved capacity to enhance face-to-face therapy through digital homework tasks that can be shared instantly with a therapist. It is also anticipated that this methodology could be used for other mental health apps to bolster the independent evidence base for this mode of treatment. International Registered Report Identifier (IRRID): PRR1-10.2196/17159 %M 32623368 %R 10.2196/17159 %U https://www.researchprotocols.org/2020/7/e17159 %U https://doi.org/10.2196/17159 %U http://www.ncbi.nlm.nih.gov/pubmed/32623368 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16159 %T Maintaining Physical Activity Level Through Team-Based Walking With a Mobile Health Intervention: Cross-Sectional Observational Study %A Hamamatsu,Yuri %A Ide,Hiroo %A Kakinuma,Michiru %A Furui,Yuji %+ Institute for Future Initiatives, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan, 81 3 5841 0934　, ide@ifi.u-tokyo.ac.jp %K mHealth %K physical activity %K walking %K team-based %K smartphone app %D 2020 %7 3.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The health conditions of Japanese salespersons may be adversely affected by their lifestyle. Face-to-face or on-site health interventions are not convenient for salespersons because of their tendency for out-of-office sales. Previous studies showed that mobile health (mHealth) interventions (compared to usual practice) have great potential to promote physical activity. For Japanese salespersons, mHealth can offer additional convenience to change their physical activity habits because they can access the mHealth contents anytime and anywhere. However, the specific elements that are most important to maintain physical activity levels using an mHealth approach remain unclear. Objective: We aimed to identify elements that account for both a high average physical activity level and can help to prevent a decrease in physical activity during a 9-week intervention period. Methods: Salespersons were recruited from 11 Japanese companies. A team-based walking intervention was held from October to December 2018 (for a total of 9 weeks), during which the walking step data were recorded by smartphone apps. Average walking steps of each participant during the intervention and the difference in walking steps between the initial and the final week were respectively used as dependent variables. The effects of team characteristics (ie, frequency of communication with team members and team size) and behavioral characteristics (ie, number of days with recorded steps on the apps) on the average walking steps, and the difference in walking steps between the initial and the final week were estimated using multiple and multilevel regression analyses. Results: Of the 416 participants, walking step data of 203 participants who completed postintervention assessments were included in the analyses. Multiple regression analysis of the average walking steps showed that the number of days with recorded steps was positively correlated with the log-transformed average walking steps (β=.01, P<.001). Multilevel analysis of the average walking steps considering the company level estimated that the intraclass correlation coefficient was 37%. This means that belonging to the same company largely affected an individual’s average walking steps. Multiple regression analysis of the difference in walking steps showed that communication with team members once or twice a week correlated with preventing a decrease in walking steps from the initial to the final week (β=1539.4, P=.03), and being on a larger team correlated with a decrease in walking steps from the initial to the final week (β=–328.4, P=.01). Conclusions: This study showed that the elements accounting for high average walking steps and those preventing the decrease in walking steps from the initial to the final week differed. Behavioral characteristics correlated positively with average walking steps. Team characteristics (ie, regular communication and a smaller team size) significantly correlated with preventing a decrease in walking steps. %M 32618576 %R 10.2196/16159 %U https://mhealth.jmir.org/2020/7/e16159 %U https://doi.org/10.2196/16159 %U http://www.ncbi.nlm.nih.gov/pubmed/32618576 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e18391 %T Designing for the Co-Use of Consumer Health Technology in Self-Management of Adolescent Overweight and Obesity: Mixed Methods Qualitative Study %A LeRouge,Cynthia M %A Hah,Hyeyoung %A Deckard,Gloria J %A Jiang,Haoqiang %+ Department of Information Systems and Business Analytics, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, United States, 1 3147090624, clerouge@fiu.edu %K consumer health technologies %K obesity care model %K chronic care model %K UTAUT %K qualitative research %K overweight %K mobile phone %K adolescent %K couse %K social support %K obesity %K social influence %K consumer health informatics %D 2020 %7 29.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Overweight and obesity in adolescents has reached epidemic proportions in the United States. Consumer health technology (CHT) can serve as a behavioral and social support tool for the management of overweight in adolescence. Recognizing CHT as a social support tool during design enables input from multiple stakeholders who engage in shared co-use to reinforce and empower adolescents in their self-management efforts. Objective: This study aimed to explore design requirements and enabling factors for the use of CHT as a social support tool for patients (as primary users) and parents and health care providers (as co-users). Our model incorporates key components of the unified theory of acceptance and use of technology (UTAUT) within the framework of the obesity care model (OCM) by recognizing patient self-management as the central process with the influence of their care support network on CHT use and outcomes. Methods: This study was part of a larger two-staged usability study combining focus group, semistructured interviews, and usability walkthroughs of CHT mockups from adolescents (BMI in the 85th-99th percentile range), parents, and physicians. In phase 1, 48 adolescents between the ages of 12 and 17 years, 10 of their parents, and 6 health care providers participated in identifying design requirements and enabling factors for the use of a potential CHT. In phase 2, 70 adolescents and 10 health care providers evaluated the CHT mockups and indicated enabling factors and willingness to use the proposed CHT. Results: Our qualitative analysis identified adolescents’ intention for the use of CHT in alignment with UTAUT elements of performance expectancy, effort expectancy, and facilitating conditions. Our reconceptualization of social influence identified the expectations and envisioned roles of parents and health care providers as co-users and influencing factors on the co-use of CHT in managing overweight in adolescence. Parents were expected to monitor, to provide guidance and motivation, and to suggest modifications in daily habits, for example, recipes and meals, whereas health care providers were expected to encourage and monitor progress in a clinical setting. These expected roles and co-use patterns were congruent among all 3 stakeholders; the co-use of CHT was desired to be minimally invasive for parents and health care providers and controlled by the adolescents. Conclusions: Our study integrates and extends the perspectives of 2 seminal models to explore design features and social influence roles for the successful user-centered design of CHT for weight self-management in adolescents. Although the co-users (ie, adolescents, parents, health care providers) suggested differing features consistent with their roles, role definitions were congruent. All users recognized the adolescent as the primary user with differential, supportive use from parents and health care providers. This multistakeholder approach can guide successful CHT design that reinforces the collective perspective of self-management. %M 32597788 %R 10.2196/18391 %U http://mhealth.jmir.org/2020/6/e18391/ %U https://doi.org/10.2196/18391 %U http://www.ncbi.nlm.nih.gov/pubmed/32597788 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e19213 %T Physical Activity With Tailored mHealth Support for Individuals With Intellectual Disabilities: Protocol for a Randomized Controlled Trial %A Michalsen,Henriette %A Wangberg,Silje Camilla %A Hartvigsen,Gunnar %A Jaccheri,Letizia %A Muzny,Miroslav %A Henriksen,André %A Olsen,Monica Isabel %A Thrane,Gyrd %A Jahnsen,Reidun Birgitta %A Pettersen,Gunn %A Arntzen,Cathrine %A Anke,Audny %+ Department of Rehabilitation, University Hospital of North Norway, Hansine Hansens vei 67, Tromsø, 9038, Norway, 47 41500304, henriette.michalsen@uit.no %K intellectual disability %K physical activity %K technology %K mHealth %K mobile phone %K goal attainment %K social support %K self-efficacy %D 2020 %7 29.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Individuals with intellectual disabilities (IDs) have lower levels of physical activity (PA) and greater barriers for participation in fitness activities compared with members of the general population. As increased PA has positive effects on cardiovascular and psychosocial health, it is exceedingly important to identify effective interventions for use in everyday settings. Mobile health (mHealth) methods such as motion sensor games (exergames) and smartphone reminders for PA have been explored and found to be promising in individuals with IDs. Objective: The purpose of this study is to examine the effectiveness of an individually tailored PA program with motivational mHealth support on daily levels of PA in youth and adults with IDs. Methods: The trial uses a randomized controlled design comprising 30 intervention participants and 30 control group participants, aged 16 to 60 years, with sedentary lifestyles or low PA levels. While the controls will receive standard care, the intervention aims to increase the level of PA, measured as steps per day, as the primary outcome. Secondary outcome variables are body mass index, blood pressure, physical performance, social support for PA, self-efficacy in a PA setting, behavior problems, and goal attainment. The intervention involves the delivery of tailored mHealth support, using smartphones or tablets to create structure with focus on the communicative abilities of individual participants. Rewards and feedback are provided in order to motivate individuals to increase participation in PA. Participants in the intervention group, their close relatives, and care staff will be invited to participate in a preintervention goal-setting meeting, where goal attainment scaling will be used to select the participants’ PA goals for the intervention period. All participants will be assessed at baseline, at 3 months, and at 6 months. Results: Enrollment was planned to start in April 2020 but will be delayed due to the pandemic situation. The main contribution of this paper is a detailed plan to run our study, which will produce new knowledge about tailored mHealth to support PA in individuals with intellectual disabilities. Conclusions: We expect the new intervention to perform better than standard care in terms of improved PA, improved self-efficacy, and social support for activities. Technology offers new opportunities to promote healthy behaviors. The results of the study will determine the effectiveness and sustainability of a tailored mHealth support intervention to increase PA in youth and adults with IDs. Trial Registration: ClinicalTrials.gov NCT04079439; https://clinicaltrials.gov/ct2/show/NCT04079439 International Registered Report Identifier (IRRID): PRR1-10.2196/19213 %M 32437328 %R 10.2196/19213 %U http://www.researchprotocols.org/2020/6/e19213/ %U https://doi.org/10.2196/19213 %U http://www.ncbi.nlm.nih.gov/pubmed/32437328 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e18996 %T Stratification of Individual Symptoms of Contact Lens–Associated Dry Eye Using the iPhone App DryEyeRhythm: Crowdsourced Cross-Sectional Study %A Inomata,Takenori %A Nakamura,Masahiro %A Iwagami,Masao %A Midorikawa-Inomata,Akie %A Sung,Jaemyoung %A Fujimoto,Keiichi %A Okumura,Yuichi %A Eguchi,Atsuko %A Iwata,Nanami %A Miura,Maria %A Fujio,Kenta %A Nagino,Ken %A Hori,Satoshi %A Tsubota,Kazuo %A Dana,Reza %A Murakami,Akira %+ Department of Ophthalmology, Juntendo University Faculty of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan, 81 3 3813 3111, tinoma@juntendo.ac.jp %K contact lens-associated dry eye %K mobile health %K ResearchKit %K smartphone app %K DryEyeRhythm %K subjective symptoms %K risk factors %K dry eye %K stratification %K mobile phone %D 2020 %7 26.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Discontinuation of contact lens use is mainly caused by contact lens–associated dry eye. It is crucial to delineate contact lens–associated dry eye's multifaceted nature to tailor treatment to each patient’s individual needs for future personalized medicine. Objective: This paper aims to quantify and stratify individual subjective symptoms of contact lens–associated dry eye and clarify its risk factors for future personalized medicine using the smartphone app DryEyeRhythm (Juntendo University). Methods: This cross-sectional study included iPhone (Apple Inc) users in Japan who downloaded DryEyeRhythm. DryEyeRhythm was used to collect medical big data related to contact lens–associated dry eye between November 2016 and January 2018. The main outcome measure was the incidence of contact lens–associated dry eye. Univariate and multivariate adjusted odds ratios of risk factors for contact lens–associated dry eye were determined by logistic regression analyses. The t-distributed Stochastic Neighbor Embedding algorithm was used to depict the stratification of subjective symptoms of contact lens–associated dry eye. Results: The records of 4454 individuals (median age 27.9 years, SD 12.6), including 2972 female participants (66.73%), who completed all surveys were included in this study. Among the included participants, 1844 (41.40%) were using contact lenses, and among those who used contact lenses, 1447 (78.47%) had contact lens–associated dry eye. Multivariate adjusted odds ratios of risk factors for contact lens–associated dry eye were as follows: younger age, 0.98 (95% CI 0.96-0.99); female sex, 1.53 (95% CI 1.05-2.24); hay fever, 1.38 (95% CI 1.10-1.74); mental illness other than depression or schizophrenia, 2.51 (95% CI 1.13-5.57); past diagnosis of dry eye, 2.21 (95% CI 1.63-2.99); extended screen exposure time >8 hours, 1.61 (95% CI 1.13-2.28); and smoking, 2.07 (95% CI 1.49-2.88). The t-distributed Stochastic Neighbor Embedding analysis visualized and stratified 14 groups based on the subjective symptoms of contact lens–associated dry eye. Conclusions: This study identified and stratified individuals with contact lens–associated dry eye and its risk factors. Data on subjective symptoms of contact lens–associated dry eye could be used for prospective prevention of contact lens–associated dry eye progression. %M 32589162 %R 10.2196/18996 %U http://www.jmir.org/2020/6/e18996/ %U https://doi.org/10.2196/18996 %U http://www.ncbi.nlm.nih.gov/pubmed/32589162 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e15563 %T The Adaptive Behavioral Components (ABC) Model for Planning Longitudinal Behavioral Technology-Based Health Interventions: A Theoretical Framework %A Young,Sean D %+ Institute for Prediction Technology, Department of Informatics, University of California, Irvine, Bren School of Information and Computer Science, Irvine, CA, 92617-4022, United States, 1 650 223 5448, syoung5@hs.uci.edu %K health behavior %K risk behavior %K behavioral medicine %K public health informatics %K consumer health informatics %K psychological theory %D 2020 %7 26.6.2020 %9 Viewpoint %J J Med Internet Res %G English %X A growing number of interventions incorporate digital and social technologies (eg, social media, mobile phone apps, and wearable devices) into their design for behavior change. However, because of a number of factors, including changing trends in the use of technology over time, results on the efficacy of these interventions have been mixed. An updated framework is needed to help researchers better plan behavioral technology interventions by anticipating the needed resources and potential changes in trends that may affect interventions over time. Focusing on the domain of health interventions as a use case, we present the Adaptive Behavioral Components (ABC) model for technology-based behavioral interventions. ABC is composed of five components: basic behavior change; intervention, or problem-focused characteristics; population, social, and behavioral characteristics; individual-level and personality characteristics; and technology characteristics. ABC was designed with the goals of (1) guiding high-level development for digital technology–based interventions; (2) helping interventionists consider, plan for, and adapt to potential barriers that may arise during longitudinal interventions; and (3) providing a framework to potentially help increase the consistency of findings among digital technology intervention studies. We describe the planning of an HIV prevention intervention as a case study for how to implement ABC into intervention design. Using the ABC model to plan future interventions might help to improve the design of and adherence to longitudinal behavior change intervention protocols; allow these interventions to adapt, anticipate, and prepare for changes that may arise over time; and help to potentially improve intervention behavior change outcomes. Additional research is needed on the influence of each of ABC’s components to help improve intervention design and implementation. %M 32589152 %R 10.2196/15563 %U https://www.jmir.org/2020/6/e15563 %U https://doi.org/10.2196/15563 %U http://www.ncbi.nlm.nih.gov/pubmed/32589152 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e15951 %T Evaluation of the Tobbstop Mobile App for Smoking Cessation: Cluster Randomized Controlled Clinical Trial %A Pallejà-Millán,Meritxell %A Rey-Reñones,Cristina %A Barrera Uriarte,Maria Luisa %A Granado-Font,Esther %A Basora,Josep %A Flores-Mateo,Gemma %A Duch,Jordi %+ Institut Català de la Salut, Unitat de Suport a la Recerca Camp de Tarragona, C/ Camí de Riudoms, 53, Reus, 43202, Spain, 34 977778515 ext 405, crey.tgn.ics@gencat.cat %K tobacco smoking %K tobacco use cessation %K mobile application %K primary public health %K clinical trial %K mobile phone %D 2020 %7 26.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps provide an accessible way to test new health-related methodologies. Tobacco is still the primary preventable cause of death in industrialized countries, constituting an important public health issue. New technologies provide novel opportunities that are effective in the cessation of smoking tobacco. Objective: This paper aims to evaluate the efficacy and usage of a mobile app for assisting adult smokers to quit smoking. Methods: We conducted a cluster randomized clinical trial. We included smokers older than 18 years who were motivated to stop smoking and used a mobile phone compatible with our mobile app. We carried out follow-up visits at 15, 30, and 45 days, and at 2, 3, 6, and 12 months. Participants of the intervention group had access to the Tobbstop mobile app designed by the research team. The primary outcomes were continuous smoking abstinence at 3 and 12 months. Results: A total of 773 participants were included in the trial, of which 602 (77.9%) began the study on their D-Day. Of participants in the intervention group, 34.15% (97/284) did not use the app. The continuous abstention level was significantly larger in the intervention group participants who used the app than in those who did not use the app at both 3 months (72/187, 38.5% vs 13/97, 13.4%; P<.001) and 12 months (39/187, 20.9% vs 8/97, 8.25%; P=.01). Participants in the intervention group who used the app regularly and correctly had a higher probability of not being smokers at 12 months (OR 7.20, 95% CI 2.14-24.20; P=.001) than the participants of the CG. Conclusions: Regular use of an app for smoking cessation is effective in comparison with standard clinical practice. Trial Registration: Clinicaltrials.gov NCT01734421; https://clinicaltrials.gov/ct2/show/NCT01734421 %M 32589153 %R 10.2196/15951 %U http://mhealth.jmir.org/2020/6/e15951/ %U https://doi.org/10.2196/15951 %U http://www.ncbi.nlm.nih.gov/pubmed/32589153 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 6 %P e15942 %T Surveying the Role of Analytics in Evaluating Digital Mental Health Interventions for Transition-Aged Youth: Scoping Review %A Lo,Brian %A Shi,Jenny %A Hollenberg,Elisa %A Abi-Jaoudé,Alexxa %A Johnson,Andrew %A Wiljer,David %+ Education, Technology and Innovation, University Health Network, 3-RFE-441, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada, 1 4163404800 ext 6322, David.Wiljer@uhn.ca %K user engagement %K mobile apps %K mHealth %K telemedicine %K mental health %K adolescent %K data analytics %D 2020 %7 25.6.2020 %9 Review %J JMIR Ment Health %G English %X Background: Consumer-facing digital health interventions provide a promising avenue to bridge gaps in mental health care delivery. To evaluate these interventions, understanding how the target population uses a solution is critical to the overall validity and reliability of the evaluation. As a result, usage data (analytics) can provide a proxy for evaluating the engagement of a solution. However, there is paucity of guidance on how usage data or analytics should be used to assess and evaluate digital mental health interventions. Objective: This review aimed to examine how usage data are collected and analyzed in evaluations of mental health mobile apps for transition-aged youth (15-29 years). Methods: A scoping review was conducted using the Arksey and O’Malley framework. A systematic search was conducted on 5 journal databases using keywords related to usage and engagement, mental health apps, and evaluation. A total of 1784 papers from 2008 to 2019 were identified and screened to ensure that they included analytics and evaluated a mental health app for transition-aged youth. After full-text screening, 49 papers were included in the analysis. Results: Of the 49 papers included in the analysis, 40 unique digital mental health innovations were evaluated, and about 80% (39/49) of the papers were published over the past 6 years. About 80% involved a randomized controlled trial and evaluated apps with information delivery features. There were heterogeneous findings in the concept that analytics was ascribed to, with the top 3 being engagement, adherence, and acceptability. There was also a significant spread in the number of metrics collected by each study, with 35% (17/49) of the papers collecting only 1 metric and 29% (14/49) collecting 4 or more analytic metrics. The number of modules completed, the session duration, and the number of log ins were the most common usage metrics collected. Conclusions: This review of current literature identified significant variability and heterogeneity in using analytics to evaluate digital mental health interventions for transition-aged youth. The large proportion of publications from the last 6 years suggests that user analytics is increasingly being integrated into the evaluation of these apps. Numerous gaps related to selecting appropriate and relevant metrics and defining successful or high levels of engagement have been identified for future exploration. Although long-term use or adoption is an important precursor to realizing the expected benefits of an app, few studies have examined this issue. Researchers would benefit from clarification and guidance on how to measure and analyze app usage in terms of evaluating digital mental health interventions for transition-aged youth. Given the established role of adoption in the success of health information technologies, understanding how to abstract and analyze user adoption for consumer digital mental health apps is also an emerging priority. %M 32348261 %R 10.2196/15942 %U https://mental.jmir.org/2020/6/e15942 %U https://doi.org/10.2196/15942 %U http://www.ncbi.nlm.nih.gov/pubmed/32348261 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17109 %T Menstrual Cycle Length and Patterns in a Global Cohort of Women Using a Mobile Phone App: Retrospective Cohort Study %A Grieger,Jessica A %A Norman,Robert J %+ Robinson Research Institute, University of Adelaide, North Terrace, Adelaide, 5000, Australia, 61 88137697, jessica.grieger@adelaide.edu.au %K body mass index %K follicular phase %K fertility %K luteal phase %K menstrual cycle %K mobile application %K internet %K ovulation %K mobile phone %D 2020 %7 24.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: There is increasing information characterizing menstrual cycle length in women, but less information is available on the potential differences across lifestyle variables. Objective: This study aimed to describe differences in menstrual cycle length, variability, and menstrual phase across women of different ages and BMI among a global cohort of Flo app users. We have also reported on demographic and lifestyle characteristics across median cycle lengths. Methods: The analysis was run based on the aggregated anonymized dataset from a menstrual cycle tracker and ovulation calendar that covers all phases of the reproductive cycle. Self-reported information is documented, including demographics, menstrual flow and cycle length, ovulation information, and reproductive health and diseases. Data from women aged ≥18 years and who had logged at least three cycles (ie, 2 completed cycles and 1 current cycle) in the Flo app were included (1,579,819 women). Results: Of the 1.5 million users, approximately half (638,683/1,579,819, 40.42%) were aged between 18 and 24 years. Just over half of those reporting BMIs were in the normal range (18.5-24.9 kg/m2; 202,420/356,598, 56.76%) and one-third were overweight or obese (>25 kg/m2; 120,983/356,598, 33.93%). A total of 16.32% (257,889/1,579,819) of women had a 28-day median cycle length. There was a higher percentage of women aged ≥40 years who had a 27-day median cycle length than those aged between 18 and 24 years (22,294/120,612, 18.48% vs 60,870/637,601, 9.55%), but a lower percentage with a 29-day median cycle length (10,572/120,612, 8.77% vs 79,626/637,601, 12.49%). There were a higher number of cycles with short luteal phases in younger women, whereas women aged ≥40 years had a higher number of cycles with longer luteal phases. Median menstrual cycle length and the length of the follicular and luteal phases were not remarkably different with increasing BMI, except for the heaviest women at a BMI of ≥50 kg/m2. Conclusions: On a global scale, we have provided extensive evidence on the characteristics of women and their menstrual cycle length and patterns across different age and BMI groups. This information is necessary to support updates of current clinical guidelines around menstrual cycle length and patterns for clinical use in fertility programs. %M 32442161 %R 10.2196/17109 %U http://www.jmir.org/2020/6/e17109/ %U https://doi.org/10.2196/17109 %U http://www.ncbi.nlm.nih.gov/pubmed/32442161 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e17118 %T Accuracy of Distance Recordings in Eight Positioning-Enabled Sport Watches: Instrument Validation Study %A Gilgen-Ammann,Rahel %A Schweizer,Theresa %A Wyss,Thomas %+ Swiss Federal Institute of Sport Magglingen, Hauptstrasse 247, Magglingen/Macolin, , Switzerland, 41 584676321, rahel.gilgen@baspo.admin.ch %K geographic information systems %K GPS measurement error %K sports %K geographic locations %K monitoring physical training %K movement analysis %D 2020 %7 24.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Elite athletes and recreational runners rely on the accuracy of global navigation satellite system (GNSS)–enabled sport watches to monitor and regulate training activities. However, there is a lack of scientific evidence regarding the accuracy of such sport watches. Objective: The aim was to investigate the accuracy of the recorded distances obtained by eight commercially available sport watches by Apple, Coros, Garmin, Polar, and Suunto when assessed in different areas and at different speeds. Furthermore, potential parameters that affect the measurement quality were evaluated. Methods: Altogether, 3 × 12 measurements in urban, forest, and track and field areas were obtained while walking, running, and cycling under various outdoor conditions. Results: The selected reference distances ranged from 404.0 m to 4296.9 m. For all the measurement areas combined, the recorded systematic errors (±limits of agreements) ranged between 3.7 (±195.6) m and –101.0 (±231.3) m, and the mean absolute percentage errors ranged from 3.2% to 6.1%. Only the GNSS receivers from Polar showed overall errors <5%. Generally, the recorded distances were significantly underestimated (all P values <.04) and less accurate in the urban and forest areas, whereas they were overestimated but with good accuracy in 75% (6/8) of the sport watches in the track and field area. Furthermore, the data assessed during running showed significantly higher error rates in most devices compared with the walking and cycling activities. Conclusions: The recorded distances might be underestimated by up to 9%. However, the use of all investigated sport watches can be recommended, especially for distance recordings in open areas. %M 32396865 %R 10.2196/17118 %U http://mhealth.jmir.org/2020/6/e17118/ %U https://doi.org/10.2196/17118 %U http://www.ncbi.nlm.nih.gov/pubmed/32396865 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e16429 %T A Pantheoretical Framework to Optimize Adherence to Healthy Lifestyle Behaviors and Medication Adherence: The Use of Personalized Approaches to Overcome Barriers and Optimize Facilitators to Achieve Adherence %A Seixas,Azizi %A Connors,Colleen %A Chung,Alicia %A Donley,Tiffany %A Jean-Louis,Girardin %+ NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, , United States, 1 9728490862, azizi.seixas@nyumc.org %K adherence %K mHealth %K management %K chronic diseases %K prevention %K technology %D 2020 %7 24.6.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Patient nonadherence to healthy lifestyle behaviors and medical treatments (like medication adherence) accounts for a significant portion of chronic disease burden. Despite the plethora of behavioral interventions to overcome key modifiable/nonmodifiable barriers and enable facilitators to adherence, short- and long-term adherence to healthy lifestyle behaviors and medical treatments is still poor. To optimize adherence, we aimed to provide a novel mobile health solution steeped in precision and personalized population health and a pantheoretical approach that increases the likelihood of adherence. We have described the stages of a pantheoretical approach utilizing tailoring, clustering/profiling, personalizing, and optimizing interventions/strategies to obtain adherence and highlight the minimal engineering needed to build such a solution. %M 32579121 %R 10.2196/16429 %U https://mhealth.jmir.org/2020/6/e16429 %U https://doi.org/10.2196/16429 %U http://www.ncbi.nlm.nih.gov/pubmed/32579121 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e19292 %T Closing the Psychological Treatment Gap During the COVID-19 Pandemic With a Supportive Text Messaging Program: Protocol for Implementation and Evaluation %A Agyapong,Vincent Israel Opoku %A Hrabok,Marianne %A Vuong,Wesley %A Gusnowski,April %A Shalaby,Reham %A Mrklas,Kelly %A Li,Daniel %A Urichuk,Liana %A Snaterse,Mark %A Surood,Shireen %A Cao,Bo %A Li,Xin-Min %A Greiner,Russ %A Greenshaw,Andrew James %+ Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 7807144315, agyapong@ualberta.ca %K COVID-19 %K Text4Hope %K mobile phones %K text %K anxiety %K depression %K stress %K pandemic %K e-mental health %D 2020 %7 22.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Coronavirus disease (COVID-19) has spread globally with far-reaching, significant, and unprecedented impacts on health and everyday life. Threats to mental health, psychological safety, and well-being are now emerging, increasing the impact of this virus on world health. Providing support for these challenges is difficult because of the high number of people requiring support in the context of a need to maintain physical distancing. This protocol describes the use of SMS text messaging (Text4Hope) as a convenient, cost-effective, and accessible population-level mental health intervention. This program is evidence-based, with prior research supporting good outcomes and high user satisfaction. Objective: The project goal is to implement a program of daily supportive SMS text messaging (Text4Hope) to reduce distress related to the COVID-19 crisis, initially among Canadians. The prevalence of stress, anxiety, and depressive symptoms; the demographic correlates of the same; and the outcomes of the Text4Hope intervention in mitigating distress will be evaluated. Methods: Self-administered anonymous online questionnaires will be used to assess stress (Perceived Stress Scale), anxiety (Generalized Anxiety Disorder-7 scale [GAD-7]), and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]). Data will be collected at baseline (onset of SMS text messaging), the program midpoint (6 weeks), and the program endpoint (12 weeks). Results: Data analysis will include parametric and nonparametric techniques, focusing on primary outcomes (ie, stress, anxiety, and depressive symptoms) and metrics of use, including the number of subscribers and user satisfaction. Given the large size of the data set, machine learning and data mining methods will also be used. Conclusions: This COVID-19 project will provide key information regarding prevalence rates of stress, anxiety, and depressive symptoms during the pandemic; demographic correlates of distress; and outcome data related to this scalable population-level intervention. Information from this study will be valuable for practitioners and useful for informing policy and decision making regarding psychological interventions during the pandemic. International Registered Report Identifier (IRRID): DERR1-10.2196/19292 %M 32501805 %R 10.2196/19292 %U http://www.researchprotocols.org/2020/6/e19292/ %U https://doi.org/10.2196/19292 %U http://www.ncbi.nlm.nih.gov/pubmed/32501805 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e15619 %T Rethinking the Use of Mobile Apps for Dietary Assessment in Medical Research %A Khazen,Wael %A Jeanne,Jean-François %A Demaretz,Laëtitia %A Schäfer,Florent %A Fagherazzi,Guy %+ Innovation Science and Nutrition, Danone Nutricia Research, RD 128 Avenue de la Vauve, Palaiseau, 91767, France, 33 622256853, florent.schafer@danone.com %K diet %K dietary assessment %K epidemiology %K clinical research %K mobile diet app %K academic apps %K consumer-grade apps %D 2020 %7 18.6.2020 %9 Viewpoint %J J Med Internet Res %G English %X Food intake and usual dietary intake are among the key determinants of health to be assessed in medical research and important confounding factors to be accounted for in clinical studies. Although various methods are available for gathering dietary data, those based on innovative technologies are particularly promising. With combined cost-effectiveness and ease of use, it is safe to assume that mobile technologies can now optimize tracking of eating occasions and dietary behaviors. Yet, choosing a dietary assessment tool that meets research objectives and data quality standards remains challenging. In this paper, we describe the purposes of collecting dietary data in medical research and outline the main considerations for using mobile dietary assessment tools based on participant and researcher expectations. %M 32554383 %R 10.2196/15619 %U https://www.jmir.org/2020/6/e15619 %U https://doi.org/10.2196/15619 %U http://www.ncbi.nlm.nih.gov/pubmed/32554383 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e16350 %T Optimizing Smartphone-Delivered Cognitive Behavioral Therapy for Body Dysmorphic Disorder Using Passive Smartphone Data: Initial Insights From an Open Pilot Trial %A Weingarden,Hilary %A Matic,Aleksandar %A Calleja,Roger Garriga %A Greenberg,Jennifer L %A Harrison,Oliver %A Wilhelm,Sabine %+ Massachusetts General Hospital/Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, United States, 1 6176436206, hilary_weingarden@mgh.harvard.edu %K body dysmorphic disorder %K cognitive behavioral therapy %K mobile health %K mobile phone %K patient engagement %D 2020 %7 18.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone-delivered cognitive behavioral therapy (CBT) is becoming more common, but research on the topic remains in its infancy. Little is known about how people typically engage with smartphone CBT or which engagement and mobility patterns may optimize treatment. Passive smartphone data offer a unique opportunity to gain insight into these knowledge gaps. Objective: This study aimed to examine passive smartphone data across a pilot course of smartphone CBT for body dysmorphic disorder (BDD), a psychiatric illness characterized by a preoccupation with a perceived defect in physical appearance, to inform hypothesis generation and the design of subsequent, larger trials. Methods: A total of 10 adults with primary diagnoses of BDD were recruited nationally and completed telehealth clinician assessments with a reliable evaluator. In a 12-week open pilot trial of smartphone CBT, we initially characterized natural patterns of engagement with the treatment and tested how engagement and mobility patterns across treatment corresponded with treatment response. Results: Most participants interacted briefly and frequently with smartphone-delivered treatment. More frequent app usage (r=–0.57), as opposed to greater usage duration (r=–0.084), correlated strongly with response. GPS-detected time at home, a potential digital marker of avoidance, decreased across treatment and correlated moderately with BDD severity (r=0.49). Conclusions: The sample was small in this pilot study; thus, results should be used to inform the hypotheses and design of subsequent trials. The results provide initial evidence that frequent (even if brief) practice of CBT skills may optimize response to smartphone CBT and that mobility patterns may serve as useful passive markers of symptom severity. This is one of the first studies to examine the value that passively collected sensor data may contribute to understanding and optimizing users’ response to smartphone CBT. With further validation, the results can inform how to enhance smartphone CBT design. %M 32554382 %R 10.2196/16350 %U http://mhealth.jmir.org/2020/6/e16350/ %U https://doi.org/10.2196/16350 %U http://www.ncbi.nlm.nih.gov/pubmed/32554382 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e20185 %T Mental Health and Behavior of College Students During the Early Phases of the COVID-19 Pandemic: Longitudinal Smartphone and Ecological Momentary Assessment Study %A Huckins,Jeremy F %A daSilva,Alex W %A Wang,Weichen %A Hedlund,Elin %A Rogers,Courtney %A Nepal,Subigya K %A Wu,Jialing %A Obuchi,Mikio %A Murphy,Eilis I %A Meyer,Meghan L %A Wagner,Dylan D %A Holtzheimer,Paul E %A Campbell,Andrew T %+ Department of Psychological and Brain Science, Dartmouth College, HB6207, Hanover, NH, 03755, United States, 1 508 657 4825, jeremy.f.huckins@dartmouth.edu %K COVID-19 %K depression %K anxiety %K mobile sensing %K sedentary %K phone usage %K mental health %K behavior %K pandemic %K app %D 2020 %7 17.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The vast majority of people worldwide have been impacted by coronavirus disease (COVID-19). In addition to the millions of individuals who have been infected with the disease, billions of individuals have been asked or required by local and national governments to change their behavioral patterns. Previous research on epidemics or traumatic events suggests that this can lead to profound behavioral and mental health changes; however, researchers are rarely able to track these changes with frequent, near-real-time sampling or compare their findings to previous years of data for the same individuals. Objective: By combining mobile phone sensing and self-reported mental health data among college students who have been participating in a longitudinal study for the past 2 years, we sought to answer two overarching questions. First, have the behaviors and mental health of the participants changed in response to the COVID-19 pandemic compared to previous time periods? Second, are these behavior and mental health changes associated with the relative news coverage of COVID-19 in the US media? Methods: Behaviors such as the number of locations visited, distance traveled, duration of phone usage, number of phone unlocks, sleep duration, and sedentary time were measured using the StudentLife smartphone sensing app. Depression and anxiety were assessed using weekly self-reported ecological momentary assessments of the Patient Health Questionnaire-4. The participants were 217 undergraduate students, with 178 (82.0%) students providing data during the Winter 2020 term. Differences in behaviors and self-reported mental health collected during the Winter 2020 term compared to previous terms in the same cohort were modeled using mixed linear models. Results: During the first academic term impacted by COVID-19 (Winter 2020), individuals were more sedentary and reported increased anxiety and depression symptoms (P<.001) relative to previous academic terms and subsequent academic breaks. Interactions between the Winter 2020 term and the week of the academic term (linear and quadratic) were significant. In a mixed linear model, phone usage, number of locations visited, and week of the term were strongly associated with increased amount of COVID-19–related news. When mental health metrics (eg, depression and anxiety) were added to the previous measures (week of term, number of locations visited, and phone usage), both anxiety (P<.001) and depression (P=.03) were significantly associated with COVID-19–related news. Conclusions: Compared with prior academic terms, individuals in the Winter 2020 term were more sedentary, anxious, and depressed. A wide variety of behaviors, including increased phone usage, decreased physical activity, and fewer locations visited, were associated with fluctuations in COVID-19 news reporting. While this large-scale shift in mental health and behavior is unsurprising, its characterization is particularly important to help guide the development of methods to reduce the impact of future catastrophic events on the mental health of the population. %M 32519963 %R 10.2196/20185 %U http://www.jmir.org/2020/6/e20185/ %U https://doi.org/10.2196/20185 %U http://www.ncbi.nlm.nih.gov/pubmed/32519963 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e18890 %T Adherence of the #Here4U App – Military Version to Criteria for the Development of Rigorous Mental Health Apps %A Linden,Brooke %A Tam-Seto,Linna %A Stuart,Heather %+ Health Services and Policy Research Institute, Queen's University, 21 Arch Street, Kingston, ON, K7L 3L3, Canada, 1 613 533 6387, brooke.linden@queensu.ca %K mental health services %K telemedicine %K mHealth %K chatbot %K e-solutions %K Canadian Armed Forces %K military health %K mobile phone %D 2020 %7 17.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Over the past several years, the emergence of mobile mental health apps has increased as a potential solution for populations who may face logistical and social barriers to traditional service delivery, including individuals connected to the military. Objective: The goal of the #Here4U App – Military Version is to provide evidence-informed mental health support to members of Canada’s military community, leveraging artificial intelligence in the form of IBM Canada’s Watson Assistant to carry on unique text-based conversations with users, identify presenting mental health concerns, and refer users to self-help resources or recommend professional health care where appropriate. Methods: As the availability and use of mental health apps has increased, so too has the list of recommendations and guidelines for efficacious development. We describe the development and testing conducted between 2018 and 2020 and assess the quality of the #Here4U App against 16 criteria for rigorous mental health app development, as identified by Bakker and colleagues in 2016. Results: The #Here4U App – Military Version met the majority of Bakker and colleagues’ criteria, with those unmet considered not applicable to this particular product or out of scope for research conducted to date. Notably, a formal evaluation of the efficacy of the app is a major priority moving forward. Conclusions: The #Here4U App – Military Version is a promising new mental health e-solution for members of the Canadian Armed Forces community, filling many of the gaps left by traditional service delivery. %M 32554374 %R 10.2196/18890 %U https://formative.jmir.org/2020/6/e18890 %U https://doi.org/10.2196/18890 %U http://www.ncbi.nlm.nih.gov/pubmed/32554374 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e16072 %T Low-Burden Mobile Monitoring, Intervention, and Real-Time Analysis Using the Wear-IT Framework: Example and Usability Study %A Brick,Timothy R %A Mundie,James %A Weaver,Jonathan %A Fraleigh,Robert %A Oravecz,Zita %+ Department of Human Development and Family Studies, Real-Time Science Laboratory, The Pennsylvania State University, 115 HHD Building, University Park, PA, , United States, 1 8148654868, tbrick@psu.edu %K smartphone apps %K ecological momentary assessment %K real-time analysis %K behavior change %D 2020 %7 17.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) methods often rely on active input from participants, for example, in the form of self-report questionnaires delivered via web or smartphone, to measure health and behavioral indicators and deliver interventions in everyday life settings. For short-term studies or interventions, these techniques are deployed intensively, causing nontrivial participant burden. For cases where the goal is long-term maintenance, limited infrastructure exists to balance information needs with participant constraints. Yet, the increasing precision of passive sensors such as wearable physiology monitors, smartphone-based location history, and internet-of-things devices, in combination with statistical feature selection and adaptive interventions, have begun to make such things possible. Objective: In this paper, we introduced Wear-IT, a smartphone app and cloud framework intended to begin addressing current limitations by allowing researchers to leverage commodity electronics and real-time decision making to optimize the amount of useful data collected while minimizing participant burden. Methods: The Wear-IT framework uses real-time decision making to find more optimal tradeoffs between the utility of data collected and the burden placed on participants. Wear-IT integrates a variety of consumer-grade sensors and provides adaptive, personalized, and low-burden monitoring and intervention. Proof of concept examples are illustrated using artificial data. The results of qualitative interviews with users are provided. Results: Participants provided positive feedback about the ease of use of studies conducted using the Wear-IT framework. Users expressed positivity about their overall experience with the framework and its utility for balancing burden and excitement about future studies that real-time processing will enable. Conclusions: The Wear-IT framework uses a combination of passive monitoring, real-time processing, and adaptive assessment and intervention to provide a balance between high-quality data collection and low participant burden. The framework presents an opportunity to deploy adaptive assessment and intervention designs that use real-time processing and provides a platform to study and overcome the challenges of long-term mHealth intervention. %M 32554373 %R 10.2196/16072 %U https://formative.jmir.org/2020/6/e16072 %U https://doi.org/10.2196/16072 %U http://www.ncbi.nlm.nih.gov/pubmed/32554373 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e14266 %T The Quality of Mobile Apps Used for the Identification of Pressure Ulcers in Adults: Systematic Survey and Review of Apps in App Stores %A Koepp,Janine %A Baron,Miriam Viviane %A Hernandes Martins,Paulo Ricardo %A Brandenburg,Cristine %A Kira,Ariane Tieko Frare %A Trindade,Vanessa Devens %A Ley Dominguez,Luis Manuel %A Carneiro,Marcelo %A Frozza,Rejane %A Possuelo,Lia Gonçalves %A De Mello Pinto,Marcus Vinicius %A Mahlmann Kipper,Liane %A Pinheiro da Costa,Bartira Ercília %+ University of Santa Cruz do Sul, Avenida Independência, 2293 - Block 35, Santa Cruz do Sul, 96816-501, Brazil, 55 51 99806 2275, janinekoepp@yahoo.com.br %K software %K portable app %K mobile app %K pressure sore %K decubitus ulcer %K wounds and injuries %D 2020 %7 16.6.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The increasing global use of smartphones has contributed to the growing use of apps for various health conditions, showing promising results. Through mobile apps, it is possible to perform chronological and iconographic follow-up of wounds, such as pressure ulcers, using a simple and practical tool. However, numerous surveys have pointed out issues related to the functionality, design, safety, and veracity of app information. Objective: The objective of this study was to perform a systematic review of published studies regarding mobile apps and a systematic survey in app stores looking for apps developed to identify, evaluate, treat, and/or prevent pressure ulcers in adults, and to evaluate those apps based on software quality characteristics. Methods: This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The main bibliographic databases were searched between January 1, 2007 and October 15, 2018, and an app survey was performed in app stores. The selected studies were evaluated according to software quality characteristics by the International Organization for Standardization/International Electrotechnical Commission (ie, ISO/IEC 25010:2011) that involve functionality, efficiency, compatibility, usability, reliability, safety, maintenance, and portability. Results: The search in databases and web-based app stores returned a total of 2075 studies. After removal of duplicates and screening of titles and abstracts, 48 complete articles were evaluated for eligibility, and among these, six were included for qualitative synthesis. Conclusions: In this review, it was observed that all studies involved the initial phase of app development or improvement, and therefore, the apps still need to be evaluated using different software quality characteristics, so that in the future, a gold standard can be approached. Therefore, the prescription of an app for the identification, evaluation, treatment, and/or prevention of pressure ulcers in adults is currently limited. However, the evaluated studies provided important insights for future research. It is of utmost importance that future surveys develop apps jointly with users, using collaborative and cocreative processes and assess patients in real-world situations across different service settings, and they should consider different ethnicities, so that apps are useful to end users, such as patients, family members, health professionals, and students, in the health area. In addition, it is necessary for studies to describe the methodological course of app development in a clear and objective way in order to ensure reproducibility of the study and to offer inputs to allow future research to approach the development of ideal apps that are geared to positively impact the health of end users. Trial Registration: PROSPERO CRD42018114137; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=114137 %M 32470916 %R 10.2196/14266 %U http://mhealth.jmir.org/2020/6/e14266/ %U https://doi.org/10.2196/14266 %U http://www.ncbi.nlm.nih.gov/pubmed/32470916 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e16720 %T A Mobile App Adopting an Identity Focus to Promote Physical Activity (MoveDaily): Iterative Design Study %A Hooglugt,Floris %A Ludden,Geke D S %+ Department of Design, Production and Management, University of Twente, Drienerlolaan 5, Enschede, 7522NB, Netherlands, 31 534892920, g.d.s.ludden@utwente.nl %K research through design %K physical activity %K habits %K identity %K behavior change %K mHealth %K design %D 2020 %7 15.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Web-based and mobile interventions to influence physical activity behavior have had limited effects on sustained behavior change. One reason may be that the interventions aim to change largely habitual behavior. Following an identity-oriented approach could be a successful strategy to behavior change because people are committed to behave in line with their self-perception of identity. Objective: In this paper, we take a closer look at the role of motivation in long-term adherence to lifestyle interventions. The paper outlines a method for web-based or mobile intervention development that allows exploration of integrating behavior change theory into the design process. We will describe the development of a mobile app that allows people to be self-determined and to value and self-regulate physical activity by adopting an identity-oriented approach. Methods: This paper describes a Research through Design (RtD) process in which design activities are carried out as part of the knowledge-generating process. Two RtD phases were completed, followed by a conceptual design phase. In the first RtD phase, 8 participants used diary cards to study initial attitudes toward starting with small changes in physical activity. In the second RtD phase, 26 participants used a web-based app to study changes in physical activity. We used an adapted version of the Self-Report Habit Index (SRHI) to evaluate individuals’ perceptions of a particular behavior with respect to the three facets of a habit. The conceptual design phase consolidated the results from first two RtD phases into a design of a mobile app that combines an identity approach with gamification principles. The conceptual design was evaluated in a user-experience study with 4 participants. Results: In the first RtD phase, we found that interacting daily with diary cards and reflecting on physical activity patterns is a promising strategy but works better through a digital medium. In the second RtD phase, SHRI ratings from all participants generally increased each week. In the conceptual design phase, we found that the concept of the mobile app was positively evaluated by participants. However, participants mentioned that terms such as “identity” do not resonate with them and that scenarios could be simpler. Conclusions: This paper provides deeper insights into designing for electronic health (eHealth) interventions and services and suggests a new way that motivation can be shaped by the design of an intervention and adherence to physical activity. To the best of our knowledge, this was the first iterative design study in which the effects of adopting an identity approach to both motivation and physical activity were included and observed. Initial promising results were found for using a web-based intervention where habits and identification with the personal importance of a behavior were repetitively triggered. %M 32538795 %R 10.2196/16720 %U http://mhealth.jmir.org/2020/6/e16720/ %U https://doi.org/10.2196/16720 %U http://www.ncbi.nlm.nih.gov/pubmed/32538795 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e14116 %T Continuous Measurement of Reconnaissance Marines in Training With Custom Smartphone App and Watch: Observational Cohort Study %A Saxon,Leslie %A DiPaula,Brooks %A Fox,Glenn R %A Ebert,Rebecca %A Duhaime,Josiah %A Nocera,Luciano %A Tran,Luan %A Sobhani,Mona %+ University of Southern California, Center for Body Computing, Keck School of Medicine, 12015 East Waterfront Drive, Playa Vista, CA, 90094, United States, 1 310 448 5373, saxon@usc.edu %K military %K marines %K wearable devices %K wearable technology %K smartphone %K mobile app %D 2020 %7 15.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Specialized training for elite US military units is associated with high attrition due to intense psychological and physical demands. The need to graduate more service members without degrading performance standards necessitates the identification of factors to predict success or failure in targeted training interventions. Objective: The aim of this study was to continuously quantify the mental and physical status of trainees of an elite military unit to identify novel predictors of success in training. Methods: A total of 3 consecutive classes of a specialized training course were provided with an Apple iPhone, Watch, and specially designed mobile app. Baseline personality assessments and continuous daily measures of mental status, physical pain, heart rate, activity, sleep, hydration, and nutrition were collected from the app and Watch data. Results: A total of 115 trainees enrolled and completed the study (100% male; age: mean 22 years, SD 4 years) and 64 (55.7%) successfully graduated. Most training withdrawals (27/115, 23.5%) occurred by day 7 (mean 5.5 days, SD 3.4 days; range 1-22 days). Extraversion, positive affect personality traits, and daily psychological profiles were associated with course completion; key psychological factors could predict withdrawals 1-2 days in advance (P=.009). Conclusions: Gathering accurate and continuous mental and physical status data during elite military training is possible with early predictors of withdrawal providing an opportunity for intervention. %M 32348252 %R 10.2196/14116 %U https://mhealth.jmir.org/2020/6/e14116 %U https://doi.org/10.2196/14116 %U http://www.ncbi.nlm.nih.gov/pubmed/32348252 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e17756 %T A Mobile Game (Safe City) Designed to Promote Children’s Safety Knowledge and Behaviors: Protocol for a Randomized Controlled Trial %A Wong,Rosa S %A Tung,Keith TS %A Wong,Hiu Tung %A Ho,Frederick KW %A Wong,Hing Sang %A Fu,King-Wa %A Pong,Ting Chuen %A Chan,Ko Ling %A Chow,Chun Bong %A Ip,Patrick %+ Department of Paediatrics & Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, China (Hong Kong), 852 2255 4090, patricip@hku.hk %K serious game %K safety training %K mobile game %K mobile phone %K injury prevention %K randomized controlled trial %K game-based intervention %D 2020 %7 12.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Children have high levels of curiosity and eagerness to explore. This makes them more vulnerable to danger and hazards, and they thus have a higher risk of injury. Safety education such as teaching safety rules and tips is vital to prevent children from injuries. Although game-based approaches have the potential to capture children’s attention and sustain their interest in learning, whether these new instructional approaches are more effective than traditional approaches in delivering safety messages to children remains uncertain. Objective: The aim of this study is to test the effectiveness of a game-based intervention in promoting safety knowledge and behaviors among Hong Kong school children in Grades 4-6. It will also examine the potential effect of the game-based intervention on these children’s functioning and psychosocial difficulties. Methods: This study comprises the development of a city-based role-playing game Safe City, where players are immersed as safety inspectors to prevent dangerous situations and promote safety behavior in a virtual city environment. The usability and acceptability tests will be conducted with children in Grades 4-6 who will trial the gameplay on a mobile phone. Adjustments will be made based on their feedback. A 4-week randomized controlled trial with children studying in Grades 4-6 in Hong Kong elementary schools will be conducted to assess the effectiveness of the Safe City game–based intervention. In this trial, 504 children will play Safe City, and 504 children will receive traditional instructional materials (electronic and printed safety information). The evaluation will be conducted using both child self-report and parent proxy-report data. Specifically, child safety knowledge and behaviors will be assessed by a questionnaire involving items on knowledge and behaviors, respectively, for home safety, road safety, and sport-related safety; child functioning will be assessed by PedsQL Generic Core Scales; and psychosocial difficulties will be assessed by the Strength and Difficulties Questionnaire. These questionnaires will be administered at 3 time points: before, 1 month, and 3 months after the intervention. Game usage statistics will also be reviewed. Results: This project was funded in September 2019. The design and development of the Safe City game are currently under way. Recruitment and data collection will begin from September 2020 and will continue up to March 1, 2021. Full analysis will be conducted after the end of the data collection period. Conclusions: If the Safe City game is found to be an effective tool to deliver safety education, it could be used to promote safety in children in the community and upgraded to incorporate more health-related topics to support education and empowerment for the larger public. Trial Registration: ClinicalTrials.gov NCT04096196; https://clinicaltrials.gov/ct2/show/NCT04096196 International Registered Report Identifier (IRRID): PRR1-10.2196/17756 %M 32530436 %R 10.2196/17756 %U http://www.researchprotocols.org/2020/6/e17756/ %U https://doi.org/10.2196/17756 %U http://www.ncbi.nlm.nih.gov/pubmed/32530436 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e19494 %T Influence of the SARS-CoV-2 Outbreak on the Uptake of a Popular Smoking Cessation App in UK Smokers: Interrupted Time Series Analysis %A Perski,Olga %A Herbeć,Aleksandra %A Shahab,Lion %A Brown,Jamie %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 020 7679 1258, olga.perski@ucl.ac.uk %K SARS-CoV-2 %K COVID-19 %K smoking cessation %K mobile health %K smartphone app %K time series analysis %K smoking %K public health %K app %D 2020 %7 11.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak may motivate smokers to attempt to stop in greater numbers. However, given the temporary closure of UK stop smoking services and vape shops, smokers attempting to quit may instead seek out mobile health support, such as smartphone apps. Objective: We examined, using an interrupted time series approach, whether the SARS-CoV-2 outbreak has been associated with a step change or increasing trend in UK downloads of an otherwise popular smoking cessation app, Smoke Free. Methods: Data were from daily and nondaily adult smokers in the United Kingdom who had downloaded the Smoke Free app between January 1, 2020, and March 31, 2020 (primary analysis), and January 1, 2019, and March 31, 2020 (secondary analysis). The outcome variable was the number of downloads aggregated at the 12-hourly (primary analysis) or daily level (secondary analysis). The explanatory variable was the start of the SARS-CoV-2 outbreak, operationalized as March 1, 2020 (primary analysis), and January 15, 2020 (secondary analysis). Generalized additive mixed models adjusted for relevant covariates were fitted. Results: Data were collected on 45,105 (primary analysis) and 119,881 (secondary analysis) users. In both analyses, there was no evidence for a step change or increasing trend in downloads attributable to the start of the SARS-CoV-2 outbreak. Calculation of Bayes factors (BFs) indicated that the data for the primary analysis favored the null hypothesis compared with large associations (for level, BF=0.25; for slope, BF=0.26) but were insensitive to the detection of small associations (for level, BF=0.78; for slope, BF=1.35). Conclusions: In the United Kingdom, between January 1, 2020, and March 31, 2020, and between January 1, 2019, and March 31, 2020, there was no evidence that the SARS-CoV-2 outbreak has been associated with a large step change or increasing trend in downloads of a popular smoking cessation app. Findings on the association of the SARS-CoV-2 outbreak with a small step change or increasing trend were inconclusive. %M 32463375 %R 10.2196/19494 %U http://mhealth.jmir.org/2020/6/e19494/ %U https://doi.org/10.2196/19494 %U http://www.ncbi.nlm.nih.gov/pubmed/32463375 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e18014 %T Health Gain, Cost Impacts, and Cost-Effectiveness of a Mass Media Campaign to Promote Smartphone Apps for Physical Activity: Modeling Study %A Mizdrak,Anja %A Telfer,Kendra %A Direito,Artur %A Cobiac,Linda J %A Blakely,Tony %A Cleghorn,Christine L %A Wilson,Nick %+ Department of Public Health, University of Otago Wellington, Department of Public Health, 23 Mein Street, Newtown, Wellington, 6021, New Zealand, 64 49186192, anja.mizdrak@otago.ac.nz %K physical activity %K mHealth %K mobile health %K smartphone apps %K modeling %K mass media campaigns %D 2020 %7 11.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity smartphone apps are a promising strategy to increase population physical activity, but it is unclear whether government mass media campaigns to promote these apps would be a cost-effective use of public funds. Objective: We aimed to estimate the health impacts, costs, and cost-effectiveness of a one-off national mass media campaign to promote the use of physical activity apps. Methods: We used an established multistate life table model to estimate the lifetime health gains (in quality-adjusted life years [QALYs]) that would accrue if New Zealand adults were exposed to a one-off national mass media campaign to promote physical activity app use, with a 1-year impact on physical activity, compared to business-as-usual. A health-system perspective was used to assess cost-effectiveness. and a 3% discount rate was applied to future health gains and health system costs. Results: The modeled intervention resulted in 28 QALYs (95% uncertainty interval [UI] 8-72) gained at a cost of NZ $81,000/QALY (2018 US $59,500; 95% UI 17,000-345,000), over the remaining life course of the 2011 New Zealand population. The intervention had a low probability (20%) of being cost-effective at a cost-effectiveness threshold of NZ $45,000 (US $32,900) per QALY. The health impact and cost-effectiveness of the intervention were highly sensitive to assumptions around the maintenance of physical activity behaviors beyond the duration of the intervention. Conclusions: A mass media campaign to promote smartphone apps for physical activity is unlikely to generate much health gain or be cost-effective at the population level. Other investments to promote physical activity, particularly those that result in sustained behavior change, are likely to have greater health impacts. %M 32525493 %R 10.2196/18014 %U http://mhealth.jmir.org/2020/6/e18014/ %U https://doi.org/10.2196/18014 %U http://www.ncbi.nlm.nih.gov/pubmed/32525493 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 6 %P e14913 %T Mobile App Integration Into Dialectical Behavior Therapy for Persons With Borderline Personality Disorder: Qualitative and Quantitative Study %A Austin,Stephen F %A Jansen,Jens Einar %A Petersen,Charlotte Juul %A Jensen,Rasmus %A Simonsen,Erik %+ Department of Psychiatric Research, Region Zealand Psychiatry, Faelledvej 6, Slagelse, 4200, Denmark, 45 5853 6000, stfa@regionsjaelland.dk %K dialectical behavior therapy %K mobile application %K blended intervention %K mHealth %K app %D 2020 %7 11.6.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: The advancement of and access to technology such as smartphones has implications for psychotherapeutic health care and how interventions for a range of mental health disorders are provided. Objective: The objective of this study was to describe the experiences of participants while using a mobile phone app that was designed to enhance and support dialectical behavior therapy for personality disorders. Methods: A combination of in-depth interviews and questionnaires were used to capture the experiences of participants who used the app while undergoing dialectical behavior therapy treatment. A mixed methods approach was used; qualitative data from the interviews were analyzed using thematic analysis and were combined with quantitative data from the questionnaires. Results: Participants (N=24) who were receiving dialectical behavior therapy used the trial app. Participants (n=20) completed an evaluation questionnaire and a subset of this group (n=8) participated in semistructured interviews. Major themes that were identified from the interviews were (1) an overall positive experience of using the app—participants perceived that the app facilitated access and implementation of dialectical behavior therapy strategies (to regulate mood and behavior in challenging situations)—and (2) that the app provided a common source of information for patient and therapist interactions—app-based interactions were perceived to facilitate therapeutic alliance. Qualitative themes from the interviews were largely congruent with the quantitative responses from the questionnaires. Conclusions: Participants welcomed the integration of technology as a supplement to clinical treatment. The app was perceived to facilitate and support many of the therapeutic techniques associated with dialectical behavior therapy treatment. The incorporation of technology into psychotherapeutic interventions may facilitate the transfer of knowledge and strategies that are learned in therapy to use in real-world settings thereby promoting recovery from mental health problems. %M 32525488 %R 10.2196/14913 %U http://mental.jmir.org/2020/6/e14913/ %U https://doi.org/10.2196/14913 %U http://www.ncbi.nlm.nih.gov/pubmed/32525488 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e16506 %T The Model of Gamification Principles for Digital Health Interventions: Evaluation of Validity and Potential Utility %A Floryan,Mark %A Chow,Philip I %A Schueller,Stephen M %A Ritterband,Lee M %+ Department of Computer Science, University of Virginia, 85 Engineer's Way, Charlottesville, VA, 22904, United States, 1 4342433087, mrf8t@virginia.edu %K gamification %K internet interventions %K eHealth %K mHealth %K digital health %D 2020 %7 10.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Although gamification continues to be a popular approach to increase engagement, motivation, and adherence to behavioral interventions, empirical studies have rarely focused on this topic. There is a need to empirically evaluate gamification models to increase the understanding of how to integrate gamification into interventions. Objective: The model of gamification principles for digital health interventions proposes a set of five independent yet interrelated gamification principles. This study aimed to examine the validity and reliability of this model to inform its use in Web- and mobile-based apps. Methods: A total of 17 digital health interventions were selected from a curated website of mobile- and Web-based apps (PsyberGuide), which makes independent and unbiased ratings on various metrics. A total of 133 independent raters trained in gamification evaluation techniques were instructed to evaluate the apps and rate the degree to which gamification principles are present. Multiple ratings (n≥20) were collected for each of the five gamification principles within each app. Existing measures, including the PsyberGuide credibility score, mobile app rating scale (MARS), and the app store rating of each app were collected, and their relationship with the gamification principle scores was investigated. Results: Apps varied widely in the degree of gamification implemented (ie, the mean gamification rating ranged from 0.17≤m≤4.65 out of 5). Inter-rater reliability of gamification scores for each app was acceptable (κ≥0.5). There was no significant correlation between any of the five gamification principles and the PsyberGuide credibility score (P≥.49 in all cases). Three gamification principles (supporting player archetypes, feedback, and visibility) were significantly correlated with the MARS score, whereas three principles (meaningful purpose, meaningful choice, and supporting player archetypes) were significantly correlated with the app store rating. One gamification principle was statistically significant with both the MARS and the app store rating (supporting player archetypes). Conclusions: Overall, the results support the validity and potential utility of the model of gamification principles for digital health interventions. As expected, there was some overlap between several gamification principles and existing app measures (eg, MARS). However, the results indicate that the gamification principles are not redundant with existing measures and highlight the potential utility of a 5-factor gamification model structure in digital behavioral health interventions. These gamification principles may be used to improve user experience and enhance engagement with digital health programs. %M 32519965 %R 10.2196/16506 %U https://www.jmir.org/2020/6/e16506 %U https://doi.org/10.2196/16506 %U http://www.ncbi.nlm.nih.gov/pubmed/32519965 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e17450 %T Developing Empirical Decision Points to Improve the Timing of Adaptive Digital Health Physical Activity Interventions in Youth: Survival Analysis %A Ortega,Adrian %A Cushing,Christopher C %+ Schiefelbusch Life Span Institute, University of Kansas, 1000 Sunnyside Avenue, Lawrence, KS, United States, 1 7858640713, christopher.cushing@ku.edu %K telemedicine %K exercise %K physical activity %K adolescent %D 2020 %7 10.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Current digital health interventions primarily use interventionist-defined rules to guide the timing of intervention delivery. As new temporally dense data sets become available, it is possible to make decisions about the intervention timing empirically. Objective: This study aimed to explore the timing of physical activity among youth to inform decision points (eg, timing of support) for future digital physical activity interventions. Methods: This study comprised 113 adolescents aged between 13 and 18 years (mean age 14.64, SD 1.48 years) who wore an accelerometer for 20 days. Multilevel survival analyses were used to estimate the most likely time of day (via odds ratios and hazard probabilities) when adolescents accumulated their average physical activity. The interacting effects of physical activity timing and moderating variables were calculated by entering predictors, such as gender, sports participation, and school day, into the model as main effects and tested for interactions with the time of day to determine conditional main effects of these predictors. Results: On average, the likelihood that a participant would accumulate a typical amount of moderate-to-vigorous physical activity increased and peaked between 6 PM and 8 PM before decreasing sharply after 9 PM. Hazard and survival probabilities suggest that optimal decision points for digital physical activity programs could occur between 5 PM and 8 PM. Conclusions: Overall, the findings of this study support the idea that the timing of physical activity can be empirically identified and that these markers may be useful as intervention triggers. %M 32519967 %R 10.2196/17450 %U https://mhealth.jmir.org/2020/6/e17450 %U https://doi.org/10.2196/17450 %U http://www.ncbi.nlm.nih.gov/pubmed/32519967 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e16721 %T The Mediating Role of Organizational Reputation and Trust in the Intention to Use Wearable Health Devices: Cross-Country Study %A Adebesin,Funmi %A Mwalugha,Revingstone %+ Department of Informatics, University of Pretoria, Corner of Lynwood and Roper Street, Hatfield, Pretoria, 0083, South Africa, 27 0124205667, funmi.adebesin@up.ac.za %K fitness trackers %K intention %K Kenya %K physical activity %K privacy %K South Africa %K trust %K regression analysis %D 2020 %7 9.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of consumer wearable health devices for fitness tracking has seen an upward trend across the globe. Previous studies have shown that trust is an important factor in the adoption and use of new technologies. However, little is known about the influence of organizational reputation and trust on the intention to use wearable health devices. Objective: This study aimed to investigate the mediating role of organizational reputation and trust in the intention to use wearable health devices and to examine the extent to which the country of residence influenced the effect of organizational reputation on consumers’ trust in and intention to use wearable health devices. Methods: We conducted a cross-country survey with participants from Kenya and South Africa using a Google Forms questionnaire derived from previously validated items. A series of mediation regression analyses were carried out using the PROCESS macro with the bootstrap CI procedure. A one-way, between-group multivariate analysis of variance (MANOVA) was also used to determine the key factors that distinguish Kenyans and South Africans in their intention to use wearable health devices. Results: A total of 232 questionnaire responses were collected. The results revealed that organizational reputation significantly mediates the relationship between trust propensity and trust, with an indirect effect of 0.22 (95% CI 0.143-0.309). Organizational reputation also plays a significant direct role in the intention to use a wearable health device, with a direct effect of 0.32 (95% CI 0.175-0.483). This role is regardless of participants’ country of residence. Furthermore, there is a significant mediating effect of trust on the relationship between trust propensity and the intention to use a wearable health device, with an indirect effect of 0.26 (95% CI 0.172-0.349); between perceived security and the intention to use a wearable health device, with an indirect effect of 0.36 (95% CI 0.255-0.461); and between perceived privacy and the intention to use a wearable health device, with an indirect effect of 0.42 (95% CI 0.282-0.557). The MANOVA test shows statistically significant differences in all variables for both groups, with the exception of organizational reputation where there is no significant difference between the two cohorts. Conclusions: Organizational reputation has a significant direct influence on participants’ trust in and the intention to use a wearable health device irrespective of their country of residence. Even in the presence of perceived security and perceived privacy, trust has a significant mediating effect on the intention to use a wearable health device. %M 32348260 %R 10.2196/16721 %U http://mhealth.jmir.org/2020/6/e16721/ %U https://doi.org/10.2196/16721 %U http://www.ncbi.nlm.nih.gov/pubmed/32348260 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e16059 %T Experiences of African American Breast Cancer Survivors Using Digital Scales and Activity Trackers in a Weight Gain Prevention Intervention: Qualitative Study %A Power,Julianne M %A Tate,Deborah F %A Valle,Carmina G %+ Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 302 Rosenau Hall, CB #7440, 135 Dauer Drive, Chapel Hill, NC, 27514, United States, 1 9199665852 ext 2, julma@live.unc.edu %K African American %K cancer survivors %K digital tools %K weight gain prevention %K qualitative %D 2020 %7 8.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of digital tools to promote daily self-weighing and daily activity tracking may be a promising strategy for weight control among African American breast cancer survivors (AABCS). There have been no studies exploring the acceptability and feasibility of using digital tools for weight control or qualitative studies characterizing perceptions of daily self-weighing and daily activity tracking among AABCS. Objective: This study aimed to explore the subjective experiences of daily self-weighing and daily activity tracking using digital tools, including wireless scales and activity trackers, in a sample of AABCS participating in two technology-based weight gain prevention interventions over 6 months. Methods: Semistructured interviews (N=21) were conducted in person or over the phone, were audio recorded, and then transcribed verbatim. Each transcript was read to identify key themes and develop a codebook. Each transcript was coded using Atlas.ti software, and code outputs were used to identify overarching themes and patterns in the data. Results: On average, participants were 52.6 (SD 8.3) years of age, with obesity at baseline (BMI 33.1 kg/m2, SD 5.9), and weighed on 123.4 (SD 48.0) days out of the 168 days (73.5%) in the study period. Women tended to attribute their weight gain to cancer treatment and framed program benefits in terms of improved quality of life and perceptions of prolonging their survival following treatment. Using the smart scale for daily self-weighing was viewed as the tool by which participants could control their weight and improve their health and well-being posttreatment. The activity tracker increased awareness of physical activity and motivated participants to be more active. Conclusions: Participants reported positive experiences and benefits from daily self-weighing and daily activity tracking. Findings suggest that daily self-weighing and daily activity tracking using digital tools are well-received, acceptable, and feasible intervention strategies for AABCS in the context of posttreatment weight management. %M 32510461 %R 10.2196/16059 %U https://mhealth.jmir.org/2020/6/e16059 %U https://doi.org/10.2196/16059 %U http://www.ncbi.nlm.nih.gov/pubmed/32510461 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e18531 %T Effectiveness of a 3-Month Mobile Phone–Based Behavior Change Program on Active Transportation and Physical Activity in Adults: Randomized Controlled Trial %A Ek,Anna %A Alexandrou,Christina %A Söderström,Emmie %A Bergman,Patrick %A Delisle Nyström,Christine %A Direito,Artur %A Eriksson,Ulf %A Henriksson,Pontus %A Maddison,Ralph %A Trolle Lagerros,Ylva %A Bendtsen,Marcus %A Löf,Marie %+ Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, 581 83, Sweden, 46 73 656 9338, marie.lof@liu.se %K behavior change %K mobile phone intervention %K physical activity %K active transportation %K mobile phone app %K smartphone app %D 2020 %7 8.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Active transportation (AT; ie, walking and cycling as a mode for transportation) has been associated with decreased morbidity and mortality; however, low-cost and scalable intervention programs are lacking. Objective: The goal of the research was to determine the effectiveness of a 3-month behavior change program delivered via a mobile phone app to promote AT (TravelVu Plus) on time spent in moderate-to-vigorous physical activity (MVPA). Methods: For this 2-arm parallel randomized controlled trial, we recruited a population-based sample of 254 adults from Stockholm County who were aged 20 to 65 years and had access to a smartphone. On completion of 1-week baseline measures, the 254 participants were randomized to either the control or intervention group (1:1 ratio). Both groups had access to the standard TravelVu app (Trivector AB) for monitoring their AT for 6 months. The intervention group also received a 3-month behavior change program to promote AT (TravelVu Plus app). Assessors of outcomes were blinded to group allocation. Outcomes were objectively measured MVPA at 3 (primary) and 6 months. Secondary outcomes were AT, attitudes toward AT, and health-related quality of life at 3 and 6 months. Results: No effect on MVPA was observed after 3 months (P=.29); however, at 6 months the intervention group had a greater improvement in MVPA than the controls (6.05 minutes per day [95% CI 0.36 to 11.74; P=.04]). A Bayesian analyses showed that there was a 98% probability that the intervention had any effect at 6 months, and a 63% probability that this effect was >5 minute MVPA per day. Conclusions: No effect on MVPA immediately after the intervention period (at 3 months) was observed; however, there was a delayed effect on MVPA (6 minutes per day) at 6 months, which corresponds to approximately 30% of the weekly MVPA recommendation. Our findings suggest that a behavior change program promoting AT delivered via an app may have a relevant effect on PA. Trial Registration: ClinicalTrials.gov NCT03086837; https://clinicaltrials.gov/ct2/show/NCT03086837 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5658-4 %M 32510462 %R 10.2196/18531 %U https://mhealth.jmir.org/2020/6/e18531 %U https://doi.org/10.2196/18531 %U http://www.ncbi.nlm.nih.gov/pubmed/32510462 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e18098 %T A Clinical Trial to Increase Self-Monitoring of Physical Activity and Eating Behaviors Among Adolescents: Protocol for the ImPACT Feasibility Study %A Moore,Justin B %A Dilley,Joshua R %A Singletary,Camelia R %A Skelton,Joseph A %A Miller Jr,David P %A Heboyan,Vahé %A De Leo,Gianluca %A Turner-McGrievy,Gabrielle %A McGrievy,Matthew %A Ip,Edward H %+ Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, 525 Vine St, Winston-Salem, NC, 27101, United States, 1 336 716 3702, jusmoore@wakehealth.edu %K physical activity %K obesity %K adolescence %K adult %K therapy, family %K mobile phone %D 2020 %7 5.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Severe obesity among youths (BMI for age≥120th percentile) has been steadily increasing. The home environment and parental behavioral modeling are two of the strongest predictors of child weight loss during weight loss interventions, which highlights that a family-based treatment approach is warranted. This strategy has been successful in our existing evidence-based pediatric weight management program, Brenner Families in Training (Brenner FIT). However, this program relies on face-to-face encounters, which are limited by the time constraints of the families enrolled in treatment. Objective: This study aims to refine and test a tailored suite of mobile health (mHealth) components to augment an existing evidence-based pediatric weight management program. Methods: Study outcomes will include acceptability from a patient and clinical staff perspective, feasibility, and economic costs relative to the established weight management protocol alone (ie, Brenner FIT vs Brenner FIT + mHealth [Brenner mFIT]). The Brenner mFIT intervention will consist of 6 mHealth components designed to increase patient and caregiver exposure to Brenner FIT programmatic content including the following: (1) a mobile-enabled website, (2) dietary and physical activity tracking, (3) caregiver podcasts (n=12), (4) animated videos (n=6) for adolescent patients, (5) interactive messaging, and (6) in-person tailored clinical feedback provided based on a web-based dashboard. For the study, 80 youths with obesity (aged 13-18 years) and caregiver dyads will be randomized to Brenner FIT or Brenner mFIT. All participants will complete baseline measures before randomization and at 3- and 6-month follow-up points. Results: This study was approved by the Institutional Review Board in July 2019, funded in August 2019, and will commence enrollment in April 2020. The results of the study are expected to be published in the fall/winter of 2021. Conclusions: The results of this study will be used to inform a large-scale implementation-effectiveness clinical trial. International Registered Report Identifier (IRRID): PRR1-10.2196/18098 %M 32348291 %R 10.2196/18098 %U https://www.researchprotocols.org/2020/6/e18098 %U https://doi.org/10.2196/18098 %U http://www.ncbi.nlm.nih.gov/pubmed/32348291 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e15752 %T Technologies for Opioid Use Disorder Management: Mobile App Search and Scoping Review %A Nuamah,Joseph %A Mehta,Ranjana %A Sasangohar,Farzan %+ Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, TX, 77843, United States, 1 9794582337, sasangohar@tamu.edu %K mHealth %K apps %K wearable sensors %K substance abuse disorder %K mobile phone %D 2020 %7 5.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Advances in technology engender the investigation of technological solutions to opioid use disorder (OUD). However, in comparison to chronic disease management, the application of mobile health (mHealth) to OUD has been limited. Objective: The overarching aim of our research was to design OUD management technologies that utilize wearable sensors to provide continuous monitoring capabilities. The objectives of this study were to (1) document the currently available opioid-related mHealth apps, (2) review past and existing technology solutions that address OUD, and (3) discuss opportunities for technological withdrawal management solutions. Methods: We used a two-phase parallel search approach: (1) an app search to determine the availability of opioid-related mHealth apps and (2) a scoping review of relevant literature to identify relevant technologies and mHealth apps used to address OUD. Results: The app search revealed a steady rise in app development, with most apps being clinician-facing. Most of the apps were designed to aid in opioid dose conversion. Despite the availability of these apps, the scoping review found no study that investigated the efficacy of mHealth apps to address OUD. Conclusions: Our findings highlight a general gap in technological solutions of OUD management and the potential for mHealth apps and wearable sensors to address OUD. %M 32501273 %R 10.2196/15752 %U https://mhealth.jmir.org/2020/6/e15752 %U https://doi.org/10.2196/15752 %U http://www.ncbi.nlm.nih.gov/pubmed/32501273 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17152 %T Associations Between Commercial App Use and Physical Activity: Cross-Sectional Study %A Petersen,Jasmine Maria %A Kemps,Eva %A Lewis,Lucy K %A Prichard,Ivanka %+ SHAPE Research Centre, Flinders University, GPO Box 2100, Adelaide, Australia, 61 8 82013713, jasmine.petersen@flinders.edu.au %K physical activity %K mobile applications %K social networking %D 2020 %7 3.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In today’s society, commercial physical activity apps (eg, Fitbit and Strava) are ubiquitous and hold considerable potential to increase physical activity behavior. Many commercial physical activity apps incorporate social components, in particular app-specific communities (allowing users to interact with other app users) or the capacity to connect to existing social networking platforms (eg, Facebook or Instagram). There is a growing need to gain greater insights into whether commercial physical activity apps and specific components of these apps (social components) are beneficial in facilitating physical activity. Objective: This study aimed to examine the relationship between the use of commercial physical activity apps and engagement in physical activity. The social components of commercial physical activity apps (app-specific communities and existing social networking platforms) were also explored. This involved isolating specific features (eg, sharing, providing, and receiving encouragement, comparisons, and competitions) of app-specific communities and existing social networking platforms that were most valuable in facilitating physical activity. Methods: A cross-sectional web-based survey was conducted. Participants were 1432 adults (mean age 34.1 years, 1256/1432, 88.00% female) who completed measures assessing physical activity, the use of commercial physical activity apps, and engagement with app-specific communities and existing social networking platforms. Results: Overall, 53.14% (761/1432) of the sample reported engaging with a commercial physical activity app. The most commonly used apps were Fitbit (171/761, 22.5%), Strava (130/761, 17.1%), and Garmin (102/761, 13.4%). The use of physical activity apps was significantly associated with physical activity. Notably, the use of app-specific communities and existing social networking platforms facilitated significantly greater engagement in physical activity. The features of app-specific communities that were most beneficial in promoting engagement in physical activity were providing encouragement to a partner, receiving encouragement from close friends and family, and engaging in competitions with members of public app-specific communities. In relation to existing social networking platforms, sharing physical activity posts predicted engagement in physical activity. Conclusions: The findings indicate that app-specific communities and existing social networking platforms are components of apps that are fundamental in facilitating physical activity. They further suggest that commercial physical activity apps afford high population level reach and hold great potential to promote engagement in physical activity, an important public health consideration. %M 32490836 %R 10.2196/17152 %U https://www.jmir.org/2020/6/e17152 %U https://doi.org/10.2196/17152 %U http://www.ncbi.nlm.nih.gov/pubmed/32490836 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e15943 %T Feasibility and Acceptability of a Mobile Mindfulness Meditation Intervention Among Women: Intervention Study %A Rung,Ariane Lisann %A Oral,Evrim %A Berghammer,Lara %A Peters,Edward S %+ Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center New Orleans, 2020 Gravier Street, 3rd Floor, New Orleans, LA, 70112, United States, 1 504 568 5709, abedim@lsuhsc.edu %K mindfulness %K mobile phone %K depressive symptoms %K women %K Louisiana %D 2020 %7 2.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Traditional mindfulness-based stress reduction programs are resource intensive for providers and time- and cost-intensive for participants, but the use of mobile technologies may be particularly convenient and cost-effective for populations that are busy, less affluent, or geographically distant from skilled providers. Women in southern Louisiana live in a vulnerable, disaster-prone region and are highly stressed, making a mobile program particularly suited to this population. Objective: This study aimed to (1) assess the feasibility and acceptability of a mobile mindfulness app in real-world conditions in a pilot study of a community sample of women residing in southern Louisiana, (2) describe predictors of app usage, and (3) assess the effect of the app on secondary health outcomes. Methods: Women were recruited from an oil spill study on health. A total of 236 women completed a baseline survey, were offered the mobile mindfulness program, and completed a follow-up survey. Subjects were asked to download and use the app for at least 30 days for 10 min. All study procedures were completed on the web. Primary outcomes were feasibility and acceptability of the app and characteristics of app utilization. Secondary outcomes included mindfulness, depression, perceived stress, sleep quality, physical activity, BMI, and healthy eating. Results: Overall, 74.2% (236/318) of subjects completed the follow-up survey, and 13.5% (43/318) used the app. The main barrier to app usage was lack of time, cited by 37% (16/43) of users and 48.7% (94/193) of nonusers of the app. Women who chose to use the app were more highly educated (16/43, 63% had a college education vs 65/193, 33.7% of nonparticipants; P<.001), had higher incomes (23/43, 58% had incomes >US $50,000 per year vs 77/193, 43.0% of nonparticipants), and were employed (34/43, 79% vs 122/193, 63.2% of nonparticipants; P=.047). Those who engaged with the app did so at high levels, with 72% (31/43) of participants self-reporting the completion of some or all sessions and 74% (32/43) reporting high levels of satisfaction with the app. Participation with the app had a beneficial impact on depression (odds ratio [OR] 0.3, 95% CI 0.11-0.81), sleep quality (OR 0.1, 95% CI 0.02-0.96), sleep duration (OR 0.3, 95% CI 0.07-0.86), sleep latency (OR 0.3, 95% CI 0.11-0.81), and physical activity (2.8 95% CI 1.0-7.8), but mindfulness scores did not change from baseline to follow-up. Conclusions: The Headspace mobile mindfulness app was easy and cost-effective to implement and acceptable to those who participated, but few women elected to try it. The unique characteristics of this southern Louisiana population suggest that more intense promotion of the benefits of mindfulness training is needed, perhaps in conjunction with some therapist or researcher support. Several short-term benefits of the app were identified, particularly for depression and sleep. %M 32442147 %R 10.2196/15943 %U https://mhealth.jmir.org/2020/6/e15943 %U https://doi.org/10.2196/15943 %U http://www.ncbi.nlm.nih.gov/pubmed/32442147 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e16497 %T mHealth App Prescription in Australian General Practice: Pre-Post Study %A Byambasuren,Oyungerel %A Beller,Elaine %A Hoffmann,Tammy %A Glasziou,Paul %+ Institute for Evidence-Based Healthcare, Bond University, 14 University Dr,, Robina, 4226, Australia, 61 755955518, obyambas@bond.edu.au %K mHealth apps %K app prescription %K general practice %D 2020 %7 1.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Evidence of effectiveness of mobile health (mHealth) apps as well as their usability as non-drug interventions in primary care are emerging around the globe. Objective: This study aimed to explore the feasibility of mHealth app prescription by general practitioners (GPs) and to evaluate the effectiveness of an implementation intervention to increase app prescription. Methods: A single-group, before-and-after study was conducted in Australian general practice. GPs were given prescription pads for 6 mHealth apps and reported the number of prescriptions dispensed for 4 months. After the reporting of month 2, a 2-minute video of one of the apps was randomly selected and sent to each GP. Data were collected through a prestudy questionnaire, monthly electronic reporting, and end-of-study interviews. The primary outcome was the number of app prescriptions (total, monthly, per GP, and per GP per fortnight). Secondary outcomes included confidence in prescribing apps (0-5 scale), the impact of the intervention video on subsequent prescription numbers, and acceptability of the interventions. Results: Of 40 GPs recruited, 39 commenced, and 36 completed the study. In total, 1324 app prescriptions were dispensed over 4 months. The median number of apps prescribed per GP was 30 (range 6-111 apps). The median number of apps prescribed per GP per fortnight increased from the pre-study level of 1.7 to 4.1. Confidence about prescribing apps doubled from a mean of 2 (not so confident) to 4 (very confident). App videos did not affect subsequent prescription rates substantially. Post-study interviews revealed that the intervention was highly acceptable. Conclusions: mHealth app prescription in general practice is feasible, and our implementation intervention was effective in increasing app prescription. GPs need more tailored education and training on the value of mHealth apps and knowledge of prescribable apps to be able to successfully change their prescribing habits to include apps. The future of sustainable and scalable app prescription requires a trustworthy electronic app repository of prescribable mHealth apps for GPs. %M 32478660 %R 10.2196/16497 %U https://mhealth.jmir.org/2020/6/e16497 %U https://doi.org/10.2196/16497 %U http://www.ncbi.nlm.nih.gov/pubmed/32478660 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e13808 %T Limitations of Existing Dialysis Diet Apps in Promoting User Engagement and Patient Self-Management: Quantitative Content Analysis Study %A Lim,Jun-Hao %A Lim,Cordelia-Kheng-May %A Ibrahim,Imliya %A Syahrul,Jazlina %A Mohamed Zabil,Mohd Hazli %A Zakaria,Nor Fadhlina %A Daud,Zulfitri Azuan Mat %+ Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Serdang, 43400, Malaysia, 60 397692431, zulfitri@upm.edu.my %K renal apps %K nutrition %K dialysis %K self-management %K mHealth %D 2020 %7 1.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the unprecedented growth of mobile technology, a plethora of dialysis diet apps have been developed to promote patient dietary self-management. Nevertheless, the utility of such apps remains questionable. Objective: This study aimed to evaluate the content, features, and quality of commercial dialysis diet apps for adult dialysis patients. Methods: This study consisted of a quantitative content analysis of commercial dialysis diet apps downloaded from Google Play and the Apple App Store available in the Asian marketplace, searched for using the following keywords in English: dialysis diet and diet for kidney disease. Free and paid apps available in English that provide nutrition information for adult dialysis patients were included. Apps that were not relevant to the dialysis diet, not meant for patient self-management, or redundant were excluded. Apps were evaluated for language medium (subscore=1), credibility (subscore=1), food database (subscore=1), valuable features (subscore=12), health-behavior theory constructs (subscore=60), and technical quality (subscore=25). The relationships among the variables of interest were determined by Pearson correlation. Stepwise multiple linear regression analysis was performed to identify the features that contribute to greater technical quality of dialysis diet apps. Statistical significance was defined as P<.05. Results: A total of 22 out of 253 apps (8.7%) were eligible for evaluation. Based on a 100-point scale, the mean overall score of the apps was 31.30 (SD 14.28). Only 5% (1/22) of the apps offered relevant language options, and 46% (10/22) contained food databases. In addition, 54% (12/22) of the apps were not credible. The mean score for valuable features was 3.45 (SD 1.63) out of 12, in which general education (16/22, 73%), free download (15/22, 68%), and usability (13/22, 59%) were the three most popular features. However, the apps scored a mean of 13.41 (SD 11.56) out of 60 for health-behavior theory constructs. The overall app technical quality was considered poor, with a mean score of 2.70 (SD 0.41) out of 5. The scores of valuable features (r=.65, P=.001) and health-behavior theory constructs (r=.55, P=.009) were positively correlated with the overall technical quality of the commercial dialysis diet apps. Features such as free download (β=.43, P=.03) and usability (β=.41, P=.03) could significantly determine the functional quality of the apps. Health-behavior theory constructs such as self-monitoring could significantly predict both the subjective quality (β=.55, P=.008) and the engagement quality (β=.66, P=.001) of the apps, whereas the information quality domain could be determined by plan or orders (β=.48, P=.007) and knowledge (β=.45, P=.01). Conclusions: Although most of the available commercial dialysis diet apps are free and easy to use, they are subject to theory deficiency, limited language options, and a lack of food databases, credibility, tailored education, and overall technical quality. %M 32478665 %R 10.2196/13808 %U https://mhealth.jmir.org/2020/6/e13808 %U https://doi.org/10.2196/13808 %U http://www.ncbi.nlm.nih.gov/pubmed/32478665 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e17572 %T Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review %A Szinay,Dorothy %A Jones,Andy %A Chadborn,Tim %A Brown,Jamie %A Naughton,Felix %+ School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR47TJ, United Kingdom, 44 1603593064 ext 3064, d.szinay@uea.ac.uk %K mHealth %K health app %K engagement %K uptake %K systematic review %K COM-B %K TDF %K digital health %K mobile phone %K smartphone %K smartphone app %D 2020 %7 29.5.2020 %9 Review %J J Med Internet Res %G English %X Background: The public health impact of health and well-being digital interventions is dependent upon sufficient real-world uptake and engagement. Uptake is currently largely dependent on popularity indicators (eg, ranking and user ratings on app stores), which may not correspond with effectiveness, and rapid disengagement is common. Therefore, there is an urgent need to identify factors that influence uptake and engagement with health and well-being apps to inform new approaches that promote the effective use of such tools. Objective: This review aimed to understand what is known about influences on the uptake of and engagement with health and well-being smartphone apps among adults. Methods: We conducted a systematic review of quantitative, qualitative, and mixed methods studies. Studies conducted on adults were included if they focused on health and well-being smartphone apps reporting on uptake and engagement behavior. Studies identified through a systematic search in Medical Literature Analysis and Retrieval System Online, or MEDLARS Online (MEDLINE), EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, Scopus, Cochrane library databases, DataBase systems and Logic Programming (DBLP), and Association for Computing Machinery (ACM) Digital library were screened, with a proportion screened independently by 2 authors. Data synthesis and interpretation were undertaken using a deductive iterative process. External validity checking was undertaken by an independent researcher. A narrative synthesis of the findings was structured around the components of the capability, opportunity, motivation, behavior change model and the theoretical domains framework (TDF). Results: Of the 7640 identified studies, 41 were included in the review. Factors related to uptake (U), engagement (E), or both (B) were identified. Under capability, the main factors identified were app literacy skills (B), app awareness (U), available user guidance (B), health information (E), statistical information on progress (E), well-designed reminders (E), features to reduce cognitive load (E), and self-monitoring features (E). Availability at low cost (U), positive tone, and personalization (E) were identified as physical opportunity factors, whereas recommendations for health and well-being apps (U), embedded health professional support (E), and social networking (E) possibilities were social opportunity factors. Finally, the motivation factors included positive feedback (E), available rewards (E), goal setting (E), and the perceived utility of the app (E). Conclusions: Across a wide range of populations and behaviors, 26 factors relating to capability, opportunity, and motivation appear to influence the uptake of and engagement with health and well-being smartphone apps. Our recommendations may help app developers, health app portal developers, and policy makers in the optimization of health and well-being apps. %M 32348255 %R 10.2196/17572 %U http://www.jmir.org/2020/5/e17572/ %U https://doi.org/10.2196/17572 %U http://www.ncbi.nlm.nih.gov/pubmed/32348255 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17458 %T Mobile Apps for Mental Health Issues: Meta-Review of Meta-Analyses %A Lecomte,Tania %A Potvin,Stéphane %A Corbière,Marc %A Guay,Stéphane %A Samson,Crystal %A Cloutier,Briana %A Francoeur,Audrey %A Pennou,Antoine %A Khazaal,Yasser %+ Department of Psychology, University of Montreal, 90 rue Vincent d'Indy, Bur C-358, CP 6128, Succ Centre-Ville, Montreal, QC, H3C 3J7, Canada, 1 343 6274, tania.lecomte@umontreal.ca %K apps %K mental health %K depression %K anxiety %K review %K meta %D 2020 %7 29.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental health apps have great potential to help people needing support to cope with distress or specific symptoms. In fact, there is an exponential increase in the number of mental health apps available on the internet, with less than 5% being actually studied. Objective: This study aimed to assess the quality of the available evidence regarding the use of mental health apps and to summarize the results obtained so far. Methods: Systematic reviews and meta-analyses were searched, specifically for mobile apps on mental health issues or symptoms, and rated using the Grading of Recommendations Assessment, Development and Evaluation system. Results: A total of 7 meta-analyses were carefully reviewed and rated. Although some meta-analyses looked at any mental health issue and analyzed the data together, these studies were of poorer quality and did not offer strong empirical support for the apps. Studies focusing specifically on anxiety symptoms or depressive symptoms were of moderate to high quality and generally had small to medium effect sizes. Similarly, the effects of apps on stress and quality of life tended to offer small to medium effects and were of moderate to high quality. Studies looking at stand-alone apps had smaller effect sizes but better empirical quality than studies looking at apps with guidance. The studies that included follow-ups mostly found a sustained impact of the app at an 11-week follow-up. Conclusions: This meta-review revealed that apps for anxiety and depression hold great promise with clear clinical advantages, either as stand-alone self-management or as adjunctive treatments. More meta-analyses and more quality studies are needed to recommend apps for other mental health issues or for specific populations. %M 32348289 %R 10.2196/17458 %U https://mhealth.jmir.org/2020/5/e17458 %U https://doi.org/10.2196/17458 %U http://www.ncbi.nlm.nih.gov/pubmed/32348289 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e16303 %T Ambiguity in Communicating Intensity of Physical Activity: Survey Study %A Kim,Hyeoneui %A Kim,Jaemin %A Taira,Ricky %+ School of Nursing, Duke University, 307 Trent Drive, Durham, NC, 27710, United States, 1 919 684 7534, hyeoneui.kim@duke.edu %K exercise %K health communication %K exercise intensity %D 2020 %7 28.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Communicating physical activity information with sufficient details, such as activity type, frequency, duration, and intensity, is vital to accurately delineate the attributes of physical activity that bring positive health impact. Unlike frequency and duration, intensity is a subjective concept that can be interpreted differently by people depending on demographics, health status, physical fitness, and exercise habits. However, activity intensity is often communicated using general degree modifiers, degree of physical exertion, and physical activity examples, which are the expressions that people may interpret differently. Lack of clarity in communicating the intensity level of physical activity is a potential barrier to an accurate assessment of exercise effect and effective imparting of exercise recommendations. Objective: This study aimed to assess the variations in people’s perceptions and interpretations of commonly used intensity descriptions of physical activities and to identify factors that may contribute to these variations. Methods: A Web-based survey with a 25-item questionnaire was conducted using Amazon Mechanical Turk, targeting adults residing in the United States. The questionnaire included questions on participants’ demographics, exercise habits, overall perceived health status, and perceived intensity of 10 physical activity examples. The survey responses were analyzed using the R statistical package. Results: The analyses included 498 responses. The majority of respondents were females (276/498, 55.4%) and whites (399/498, 79.9%). Numeric ratings of physical exertion after exercise were relatively well associated with the 3 general degree descriptors of exercise intensity: light, moderate, and vigorous. However, there was no clear association between the intensity expressed with those degree descriptors and the degree of physical exertion the participants reported to have experienced after exercise. Intensity ratings of various examples of physical activity differed significantly according to respondents’ characteristics. Regression analyses showed that those who reported good health or considered regular exercise was important for their health tended to rate the intensity levels of the activity examples significantly higher than their counterparts. The respondents’ age and race (white vs nonwhite) were not significant predictors of the intensity rating. Conclusions: This survey showed significant variations in how people perceive and interpret the intensity levels of physical activities described with general severity modifiers, degrees of physical exertion, and physical activity examples. Considering that these are among the most widely used methods of communicating physical activity intensity in current practice, a possible miscommunication in assessing and promoting physical activity seems to be a real concern. We need to adopt a method that represents activity intensity in a quantifiable manner to avoid unintended miscommunication. %M 32348256 %R 10.2196/16303 %U http://publichealth.jmir.org/2020/2/e16303/ %U https://doi.org/10.2196/16303 %U http://www.ncbi.nlm.nih.gov/pubmed/32348256 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15111 %T Mobile Phone–Based Behavioral Interventions in Pregnancy to Promote Maternal and Fetal Health in High-Income Countries: Systematic Review %A Hussain,Tasmeen %A Smith,Patricia %A Yee,Lynn M %+ Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior Street, #5-2145, Chicago, IL, United States, 1 312 472 4685, lynn.yee@northwestern.edu %K mHealth %K mobile health %K pregnancy %K smartphone %K text messaging %K mobile applications %K software %K chronic disease %K health behavior %D 2020 %7 28.5.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Chronic diseases have recently had an increasing effect on maternal-fetal health, especially in high-income countries. However, there remains a lack of discussion regarding health management with technological approaches, including mobile health (mHealth) interventions. Objective: This study aimed to systematically evaluate mHealth interventions used in pregnancy in high-income countries and their effects on maternal health behaviors and maternal-fetal health outcomes. Methods: This systematic review identified studies published between January 1, 2000, and November 30, 2018, in MEDLINE via PubMed, Cochrane Library, EMBASE, CINAHL, PsycINFO, Web of Science, and gray literature. Studies were eligible for inclusion if they included only pregnant women in high-income countries and evaluated stand-alone mobile phone interventions intended to promote healthy maternal beliefs, behaviors, and/or maternal-fetal health outcomes. Two researchers independently reviewed and categorized aspects of full-text articles, including source, study design, intervention and control, duration, participant age, attrition rate, main outcomes, and risk of bias. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the study was registered in PROSPERO before initiation. Results: Of the 2225 records examined, 28 studies were included and categorized into 4 themes: (1) gestational weight gain, obesity and physical activity (n=9); (2) smoking cessation (n=9); (3) influenza vaccination (n=2); and (4) general prenatal health, preventive strategies, and miscellaneous topics (n=8). Reported sample sizes ranged from 16 to 5243 with a median of 91. Most studies were performed in the United States (18/28, 64%) and were randomized controlled trials (21/28, 75%). All participants in the included studies were pregnant at the time of study initiation. Overall, 14% (4/28) of studies showed association between intervention use and improved health outcomes; all 4 studies focused on healthy gestational weight. Among those, 3 studies showed intervention use was associated with less overall gestational weight gain. These 3 studies involved interventions with text messaging or an app in combination with another communication strategy (Facebook or email). Regarding smoking cessation, influenza vaccination, and miscellaneous topics, there was some evidence of positive effects on health behaviors and beliefs, but very limited correlation with improved health outcomes. Data and interventions were heterogeneous, precluding a meta-analysis. Conclusions: In high-income countries, utilization of mobile phone–based health behavior interventions in pregnancy demonstrates some correlation with positive beliefs, behaviors, and health outcomes. More effective interventions are multimodal in terms of features and tend to focus on healthy gestational weight gain. %M 32463373 %R 10.2196/15111 %U https://mhealth.jmir.org/2020/5/e15111 %U https://doi.org/10.2196/15111 %U http://www.ncbi.nlm.nih.gov/pubmed/32463373 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17300 %T Content and Quality of Infant Feeding Smartphone Apps: Five-Year Update on a Systematic Search and Evaluation %A Cheng,Heilok %A Tutt,Alison %A Llewellyn,Catherine %A Size,Donna %A Jones,Jennifer %A Taki,Sarah %A Rossiter,Chris %A Denney-Wilson,Elizabeth %+ Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, 88 Mallett Street, Camperdown, 2050, Australia, 61 1800793864, jessica.cheng@sydney.edu.au %K breast feeding %K bottle feeding %K infant food %K readability %K consumer health information %K breastfeeding %K mobile apps %K smartphones %D 2020 %7 27.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Parents use apps to access information on child health, but there are no standards for providing evidence-based advice, support, and information. Well-developed apps that promote appropriate infant feeding and play can support healthy growth and development. A 2015 systematic assessment of smartphone apps in Australia about infant feeding and play found that most apps had minimal information, with poor readability and app quality. Objective: This study aimed to systematically evaluate the information and quality of smartphone apps providing information on breastfeeding, formula feeding, introducing solids, or infant play for consumers. Methods: The Google Play store and Apple App Store were searched for free and paid Android and iPhone Operating System (iOS) apps using keywords for infant feeding, breastfeeding, formula feeding, and tummy time. The apps were evaluated between September 2018 and January 2019 for information content based on Australian guidelines, app quality using the 5-point Mobile App Rating Scale, readability, and suitability of health information. Results: A total of 2196 unique apps were found and screened. Overall, 47 apps were evaluated, totaling 59 evaluations for apps across both the Android and iOS platforms. In all, 11 apps had affiliations to universities and health services as app developers, writers, or editors. Furthermore, 33 apps were commercially developed. The information contained within the apps was poor: 64% (38/59) of the evaluations found no or low coverage of information found in the Australian guidelines on infant feeding and activity, and 53% (31/59) of the evaluations found incomplete or incorrect information with regard to the depth of information provided. Subjective app assessment by health care practitioners on whether they would use, purchase, or recommend the app ranged from poor to acceptable (median 2.50). Objective assessment of the apps’ engagement, functionality, aesthetics, and information was scored as acceptable (median 3.63). The median readability score for the apps was at the American Grade 8 reading level. The suitability of health information was rated superior or adequate for content, reading demand, layout, and interaction with the readers. Conclusions: The quality of smartphone apps on infant feeding and activity was moderate based on the objective measurements of engagement, functionality, aesthetics, and information from a reliable source. The overall quality of information on infant feeding and activity was poor, indicated by low coverage of topics and incomplete or partially complete information. The key areas for improvement involved providing evidence-based information consistent with the Australian National Health and Medical Research Council’s Infant Feeding Guidelines. Apps supported and developed by health care professionals with adequate health service funding can ensure that parents are provided with credible and reliable resources. %M 32459187 %R 10.2196/17300 %U http://mhealth.jmir.org/2020/5/e17300/ %U https://doi.org/10.2196/17300 %U http://www.ncbi.nlm.nih.gov/pubmed/32459187 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16999 %T Effect of an mHealth Intervention Using a Pedometer App With Full In-Person Counseling on Body Composition of Overweight Adults: Randomized Controlled Weight Loss Trial %A Hernández-Reyes,Alberto %A Cámara-Martos,Fernando %A Molina-Luque,Rafael %A Moreno-Rojas,Rafael %+ Universidad de Córdoba, Darwin Building, Annex, Campus de Rabanales, Córdoba, 14014, Spain, 34 687376563, z52heloa@uco.es %K pedometer %K physical activity %K exercise prescription %K diet %K health behavior %D 2020 %7 27.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In clinical practice, it is difficult to convey the benefits of sustained physical activity to adult patients with excess weight or obesity. For this purpose, a goal-setting walking prescription may be an effective strategy. Objective: This study aimed to determine the efficacy of the intervention of a pedometer app in setting a goal to reach 10,000 steps per day in adults. Methods: Overweight adults (n=98; mean body mass index 32.53 [SD 4.92] kg/m2) were randomized to one of two conditions (control or intervention). Both groups downloaded a pedometer app that recorded their daily step counts and were given a daily walking goal of 10,000 steps. Subjects participated in a 24-week in-person behavioral weight control program and were asked to monitor their daily levels using the pedometer app. Baseline data were recorded and followed up weekly. Only the intervention group had structured information delivery, a personalized physical activity prescription, and follow-up on number of steps per day. Results: The results show that regardless of sex or age, prescribing walking increased the number of steps per day by 4806 step on average (standardized β coefficient=–0.813, SE=427.586, t=–11.242, P<.001). Conclusions: These results could have implications for improving self-monitoring in overweight adults during periods of weight loss. Health professionals should analyze the implementation of tools that permit them to prescribe, follow up, and encourage the achievement of a goal of physical activity in overweight or obese patients. Trial Registration: ClinicalTrials.gov NCT03845478; https://clinicaltrials.gov/ct2/show/NCT03845478 %M 32348263 %R 10.2196/16999 %U http://mhealth.jmir.org/2020/5/e16999/ %U https://doi.org/10.2196/16999 %U http://www.ncbi.nlm.nih.gov/pubmed/32348263 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15849 %T Effectiveness of Text Message Interventions for Weight Management in Adolescents: Systematic Review %A Partridge,Stephanie Ruth %A Raeside,Rebecca %A Singleton,Anna %A Hyun,Karice %A Redfern,Julie %+ The University of Sydney, Westmead Applied Research Centre, Faculty of Medicine and Health, Department of General Practice, Acacia House, Westmead Hospital, Sydney, 2145, Australia, 61 288908187, stephanie.partridge@sydney.edu.au %K adolescent %K text message %K obesity %K overweight %K prevention %K mHealth %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The incidence of obesity among adolescents is increasing. Text messages are a primary communication form for adolescents and potentially a scalable strategy for delivering population health interventions. Objective: This study aimed to determine the effectiveness of text message interventions in reducing BMI in adolescents and describe characteristics that are common to effective interventions. Methods: This systematic review included randomized controlled trials of text message lifestyle interventions involving adolescents aged 10 to 19 years with outcomes focused on obesity prevention or management. Primary outcome was objective or self-report change in BMI. Results: In total, 4362 records were identified, and 215 full-text articles were assessed for eligibility. A total of 8 unique studies were identified, including 767 participants, mean age 14.3 (SD 0.9) years, BMI 29.7 (SD 1.6) kg/m2 and 53.1% (407/767) female (31/101, 30.7%-172/172, 100.0%). All interventions were multicomponent. The median active intervention period was 4.5 months. During the active and extended intervention phases, text messages accounted for >50% (8 studies) and >85% (3 studies) of contact points, respectively. Text messages were heterogeneous, with a median of 1.5 text messages sent per week (range: 1-21). A total of 4 studies utilized two-way text message communication with health professionals Of the 8 studies, 7 demonstrated reductions in BMI or BMI z-score in the intervention group compared with the control at the end of the final follow-up. The effect was only statistically significant in 1 study at 6 months. Over 6 months, reductions in BMI (kg/m2) ranged from 1.3% to 4.5% and BMI z-score ranged from 4.2% to 28.1%. Overall quality of the studies was low. Conclusions: Further research is required to elucidate the effectiveness and potential impact of text message interventions on weight and weight-related behaviors in adolescents. %M 32348264 %R 10.2196/15849 %U http://mhealth.jmir.org/2020/5/e15849/ %U https://doi.org/10.2196/15849 %U http://www.ncbi.nlm.nih.gov/pubmed/32348264 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16937 %T Assessment of the Efficacy of a Mobile Phone–Delivered Just-in-Time Planning Intervention to Reduce Alcohol Use in Adolescents: Randomized Controlled Crossover Trial %A Haug,Severin %A Paz Castro,Raquel %A Scholz,Urte %A Kowatsch,Tobias %A Schaub,Michael Patrick %A Radtke,Theda %+ Swiss Research Institute for Public Health and Addiction, University of Zurich, Konradstrasse 32, Zurich, 8005, Switzerland, 41 444481174, severin.haug@isgf.uzh.ch %K alcohol %K adolescents %K planning intervention %K just-in-time intervention %K crossover trial %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Interventions to reduce alcohol use typically include several elements, such as information on the risks of alcohol consumption, planning for sensible drinking, and training of protective behavioral strategies. However, the effectiveness of these individual intervention elements within comprehensive programs has not been addressed so far, but it could provide valuable insights for the development of future interventions. Just-in-time interventions provided via mobile devices are intended to help people make healthy decisions in the moment and thus could influence health behavior. Objective: The aim of this study was to test the proximal effects of a mobile phone–delivered, just-in-time planning intervention to reduce alcohol use in adolescents who reported recent binge drinking. The efficacy of this individual intervention element was tested within a comprehensive intervention program to reduce problem drinking in adolescents. Methods: The study had an AB/BA crossover design, in which participants were randomly allocated to (1) a group receiving the planning intervention (A) in period 1 and assessment only (B) in period 2 or (2) a group receiving assessment only (B) in period 1 and the planning intervention (A) in period 2. The planning intervention included a text message to choose one of two predetermined if-then plans to practice sensible drinking with friends or when going out and a prompt to visualize the chosen plan. There was a washout period of at least 1 week between period 1 and period 2. Results: Out of 633 program participants who recently binge drank, 136 (21.5%) were receptive in both periods of time and provided data on the proximal outcome, which was the number of alcoholic drinks consumed with friends or when going out. After the planning intervention, the number of alcoholic drinks consumed was approximately one standard drink lower compared with the finding without the intervention (P=.01). Conclusions: A mobile phone–delivered, just-in-time, if-then planning intervention to practice sensible drinking with friends or when going out is effective in reducing alcohol consumption among adolescents who report recent binge drinking. Based on the relatively low percentage of participants with self-reported receptivity for the planning intervention, measures to increase the population impact of similar planning interventions should be implemented and tested in future trials. Trial Registration: ISRCTN Registry ISRCTN52150713; http://www.isrctn.com/ISRCTN52150713 %M 32452818 %R 10.2196/16937 %U http://mhealth.jmir.org/2020/5/e16937/ %U https://doi.org/10.2196/16937 %U http://www.ncbi.nlm.nih.gov/pubmed/32452818 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15112 %T A Pedometer-Guided Physical Activity Intervention for Obese Pregnant Women (the Fit MUM Study): Randomized Feasibility Study %A Darvall,Jai N %A Wang,Andrew %A Nazeem,Mohamed Nusry %A Harrison,Cheryce L %A Clarke,Lauren %A Mendoza,Chennelle %A Parker,Anna %A Harrap,Benjamin %A Teale,Glyn %A Story,David %A Hessian,Elizabeth %+ Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, 300 Grattan St, Parkville, Melbourne, 3050, Australia, 61 393427000, jai.darvall@mh.org.au %K gestational weight gain %K pregnancy %K maternal obesity %K lifestyle intervention %K pedometer %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obesity in pregnancy is a growing problem worldwide, with excessive gestational weight gain (GWG) occurring in the majority of pregnancies. This significantly increases risks to both mother and child. A major contributor to both prepregnancy obesity and excessive GWG is physical inactivity; however, past interventions targeting maternal weight gain and activity levels during the antenatal period have been ineffective in women who are already overweight. Pedometer-guided activity may offer a novel solution for increasing activity levels in this population. Objective: This initial feasibility randomized controlled trial aimed to test a pedometer-based intervention to increase activity and reduce excessive GWG in pregnant women. Methods: We supplied 30 pregnant women with obesity a Fitbit Zip pedometer and randomized them into 1 of 3 groups: control (pedometer only), app (pedometer synced to patients’ personal smartphone, with self-monitoring of activity), or app-coach (addition of a health coach–delivered behavioral change program). Feasibility outcomes included participant compliance with wearing pedometers (days with missing pedometer data), data syncing, and data integrity. Activity outcomes (step counts and active minutes) were analyzed using linear mixed models and generalized estimating equations. Results: A total of 30 participants were recruited within a 10-week period, with a dropout rate of 10% (3/30; 2 withdrawals and 1 stillbirth); 27 participants thus completed the study. Mean BMI in all groups was ≥35 kg/m2. Mean (SD) percentage of missing data days were 23.4% (20.6%), 39.5% (32.4%), and 21.1% (16.0%) in control, app group, and app-coach group patients, respectively. Estimated mean baseline activity levels were 14.5 active min/day and 5455 steps/day, with no significant differences found in activity levels between groups, with mean daily step counts in all groups remaining in the sedentary (5000 steps/day) or low activity (5000-7499 steps/day) categories for the entire study duration. There was a mean decrease of 7.8 steps/day for each increase in gestation day over the study period (95% CI 2.91 to 12.69, P=.002). Conclusions: Activity data syncing with a personal smartphone is feasible in a cohort of pregnant women with obesity. However, our results do not support a future definitive study in its present form. Recruitment and retention rates were adequate, as was activity data syncing to participants’ smartphones. A follow-up interventional trial seeking to reduce GWG and improve activity in this population must focus on improving compliance with activity data recording and behavioral interventions delivered. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12617000038392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370884 %M 32348280 %R 10.2196/15112 %U http://mhealth.jmir.org/2020/5/e15112/ %U https://doi.org/10.2196/15112 %U http://www.ncbi.nlm.nih.gov/pubmed/32348280 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17798 %T Android and iPhone Mobile Apps for Psychosocial Wellness and Stress Management: Systematic Search in App Stores and Literature Review %A Lau,Nancy %A O'Daffer,Alison %A Colt,Susannah %A Yi-Frazier,Joyce P %A Palermo,Tonya M %A McCauley,Elizabeth %A Rosenberg,Abby R %+ Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1900 Ninth Ave, JMB 10-C, Seattle, WA, 98101, United States, 1 2068840569, nancy.lau@seattlechildrens.org %K mHealth %K mobile health %K mental health %D 2020 %7 22.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In an oversaturated market of publicly available mobile apps for psychosocial self-care and stress management, health care providers, patients, and consumers interested in mental health–related apps may wonder which, if any, are efficacious. Readily available metrics for consumers include user popularity and media buzz rather than scientific evidence. Objective: This systematic review aimed to (1) examine the breadth of therapeutic contents and features of psychosocial wellness and stress management apps available to self-help seekers for public download and (2) determine which of these apps have original research support. Methods: First, we conducted a systematic review of publicly available apps on the iPhone App Store (Apple Inc) and Android Google Play (Google LLC) platforms using conventional self-help-seeking search terms related to wellness and stress. The results were limited to English-language apps available for free download. In total, 2 reviewers independently evaluated all apps and discussed the findings to reach 100% consensus regarding inclusion. Second, a literature review was conducted on the included apps to identify supporting studies with original data collection. Results: We screened 3287 apps and found 1009 psychosocial wellness and stress management apps. Content varied widely. The most common evidence-based strategy was mindfulness-meditation, followed by positive psychology and goal setting. Most apps were intended to be used as self-help interventions, with only 1.09% (11/1009) involving an electronic therapist and 1.88% (19/1009) designed as a supplement to in-person psychotherapy. Only 4.66% (47/1009) of apps targeted individuals with psychological disorders, and less than 1% of apps (6/1009, 0.59%) targeted individuals with other chronic illnesses. Approximately 2% (21/1009, 2.08%) were supported by original research publications, with a total of 25 efficacy studies and 10 feasibility studies. The Headspace mindfulness app had the most evidence, including 8 efficacy studies. Most other scientifically backed apps were supported by a single feasibility or efficacy study. Conclusions: Only 2.08% (21/1009) of publicly available psychosocial wellness and stress management mobile apps discoverable to self-help seekers have published, peer-reviewed evidence of feasibility and/or efficacy. Clinicians and investigators may use these findings to help patients and families navigate the volume of emerging digital health interventions for stress management and wellness. %M 32357125 %R 10.2196/17798 %U http://mhealth.jmir.org/2020/5/e17798/ %U https://doi.org/10.2196/17798 %U http://www.ncbi.nlm.nih.gov/pubmed/32357125 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16674 %T Low-Cost Consumer-Based Trackers to Measure Physical Activity and Sleep Duration Among Adults in Free-Living Conditions: Validation Study %A Degroote,Laurent %A Hamerlinck,Gilles %A Poels,Karolien %A Maher,Carol %A Crombez,Geert %A De Bourdeaudhuij,Ilse %A Vandendriessche,Ann %A Curtis,Rachel G %A DeSmet,Ann %+ Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, Ghent, Belgium, 32 9 264 62 99, laurent.degroote@ugent.be %K fitness trackers %K mobile phone %K accelerometry %K physical activity %K sleep %D 2020 %7 19.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable trackers for monitoring physical activity (PA) and total sleep time (TST) are increasingly popular. These devices are used not only by consumers to monitor their behavior but also by researchers to track the behavior of large samples and by health professionals to implement interventions aimed at health promotion and to remotely monitor patients. However, high costs and accuracy concerns may be barriers to widespread adoption. Objective: This study aimed to investigate the concurrent validity of 6 low-cost activity trackers for measuring steps, moderate-to-vigorous physical activity (MVPA), and TST: Geonaut On Coach, iWown i5 Plus, MyKronoz ZeFit4, Nokia GO, VeryFit 2.0, and Xiaomi MiBand 2. Methods: A free-living protocol was used in which 20 adults engaged in their usual daily activities and sleep. For 3 days and 3 nights, they simultaneously wore a low-cost tracker and a high-cost tracker (Fitbit Charge HR) on the nondominant wrist. Participants wore an ActiGraph GT3X+ accelerometer on the hip at daytime and a BodyMedia SenseWear device on the nondominant upper arm at nighttime. Validity was assessed by comparing each tracker with the ActiGraph GT3X+ and BodyMedia SenseWear using mean absolute percentage error scores, correlations, and Bland-Altman plots in IBM SPSS 24.0. Results: Large variations were shown between trackers. Low-cost trackers showed moderate-to-strong correlations (Spearman r=0.53-0.91) and low-to-good agreement (intraclass correlation coefficient [ICC]=0.51-0.90) for measuring steps. Weak-to-moderate correlations (Spearman r=0.24-0.56) and low agreement (ICC=0.18-0.56) were shown for measuring MVPA. For measuring TST, the low-cost trackers showed weak-to-strong correlations (Spearman r=0.04-0.73) and low agreement (ICC=0.05-0.52). The Bland-Altman plot revealed a variation between overcounting and undercounting for measuring steps, MVPA, and TST, depending on the used low-cost tracker. None of the trackers, including Fitbit (a high-cost tracker), showed high validity to measure MVPA. Conclusions: This study was the first to examine the concurrent validity of low-cost trackers. Validity was strongest for the measurement of steps; there was evidence of validity for measurement of sleep in some trackers, and validity for measurement of MVPA time was weak throughout all devices. Validity ranged between devices, with Xiaomi having the highest validity for measurement of steps and VeryFit performing relatively strong across both sleep and steps domains. Low-cost trackers hold promise for monitoring and measurement of movement and sleep behaviors, both for consumers and researchers. %M 32282332 %R 10.2196/16674 %U http://mhealth.jmir.org/2020/5/e16674/ %U https://doi.org/10.2196/16674 %U http://www.ncbi.nlm.nih.gov/pubmed/32282332 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15458 %T Associations Between Parent Self-Reported and Accelerometer-Measured Physical Activity and Sedentary Time in Children: Ecological Momentary Assessment Study %A de Brito,Junia N %A Loth,Katie A %A Tate,Allan %A Berge,Jerica M %+ Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware Street SE, Suite 400, Minneapolis, MN, 55414, United States, 1 612 625 0931, nogue013@umn.edu %K ecological momentary assessment %K accelerometry %K mobile devices %K physical activity %K sedentary behavior %K children %D 2020 %7 19.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Retrospective self-report questionnaires are the most common method for assessing physical activity (PA) and sedentary behavior (SB) in children when the use of objective assessment methods (eg, accelerometry) is cost prohibitive. However, self-report measures have limitations (eg, recall bias). The use of real-time, mobile ecological momentary assessment (EMA) has been proposed to address these shortcomings. The study findings will provide useful information for researchers interested in using EMA surveys for measuring PA and SB in children, particularly when reported by a parent or caregiver. Objective: This study aimed to examine the associations between the parent’s EMA report of their child’s PA and SB and accelerometer-measured sedentary time (ST), light-intensity PA (LPA), and moderate-to-vigorous–intensity PA (MVPA) and to examine if these associations differed by day of week, sex, and season. Methods: A total of 140 parent-child dyads (mean child age 6.4 years, SD 0.8; n=66 girls; n=21 African American; n=24 American Indian; n=25 Hispanic/Latino; n=24 Hmong; n=22 Somali; and n=24 white) participated in this study. During an 8-day period, parents reported child PA and SB via multiple daily signal contingent EMA surveys, and children wore a hip-mounted accelerometer to objectively measure ST, LPA, and MVPA. Accelerometer data was matched to the time period occurring before parent EMA-report of child PA and SB. Generalized estimating equations with interaction-term analyses were performed to determine whether the relationship between parent-EMA report of child PA and SB and accelerometer-measured ST and LPA and MVPA outcomes differed by day of the week, sex and season. Results: The parent’s EMA report of their child’s PA and SB was strongly associated with accelerometer-measured ST, LPA, and MVPA. The parent’s EMA report of their child’s PA was stronger during the weekend than on weekdays for accelerometer-measured ST (P≤.001) and LPA (P<.001). For the parent’s EMA report of their child’s SB, strong associations were observed with accelerometer-measured ST (P<.001), LPA (P=.005), and MVPA (P=.008). The findings related to sex-interaction terms indicated that the association between the parent-reported child’s PA via EMA and the accelerometer-measured MVPA was stronger for boys than girls (P=.02). The association between the parent’s EMA report of their child’s PA and SB and accelerometer-measured ST and PA was similar across seasons in this sample (all P values >.31). Conclusions: When the use of accelerometry-based methods is not feasible and in contexts where the parent is able to spend more proximate time observing the child’s PA and SB, the parent’s EMA report might be a superior method for measuring PA and SB in young children relative to self-report, given the EMA’s strong associations with accelerometer-measured PA and ST. %M 32348283 %R 10.2196/15458 %U http://mhealth.jmir.org/2020/5/e15458/ %U https://doi.org/10.2196/15458 %U http://www.ncbi.nlm.nih.gov/pubmed/32348283 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15085 %T Use of the Healthy Lifestyle Coaching Chatbot App to Promote Stair-Climbing Habits Among Office Workers: Exploratory Randomized Controlled Trial %A Piao,Meihua %A Ryu,Hyeongju %A Lee,Hyeongsuk %A Kim,Jeongeun %+ College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, 03080, Republic of Korea, 82 2 740 8803, rnyoo@snu.ac.kr %K exercise %K habits %K reward %K health behavior %K healthy lifestyle %D 2020 %7 19.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Lack of time for exercise is common among office workers given their busy lives. Because of occupational restrictions and difficulty in taking time off, it is necessary to suggest effective ways for workers to exercise regularly. Sustaining lifestyle habits that increase nonexercise activity in daily life can solve the issue of lack of exercise time. Healthy Lifestyle Coaching Chatbot is a messenger app based on the habit formation model that can be used as a tool to provide a health behavior intervention that emphasizes the importance of sustainability and involvement. Objective: This study aimed to assess the efficacy of the Healthy Lifestyle Coaching Chatbot intervention presented via a messenger app aimed at stair-climbing habit formation for office workers. Methods: From February 1, 2018, to April 30, 2018, a total of 106 people participated in the trial after online recruitment. Participants were randomly assigned to the intervention group (n=57) or the control group (n=49). The intervention group received cues and intrinsic and extrinsic rewards for the entire 12 weeks. However, the control group did not receive intrinsic rewards for the first 4 weeks and only received all rewards as in the intervention group from the fifth to twelfth week. The Self-Report Habit Index (SRHI) of participants was evaluated every week, and the level of physical activity was measured at the beginning and end of the trial. SPSS Statistics version 21 (IBM Corp) was used for statistical analysis. Results: After 4 weeks of intervention without providing the intrinsic rewards in the control group, the change in SRHI scores was 13.54 (SD 14.99) in the intervention group and 6.42 (SD 9.42) in the control group, indicating a significant difference between the groups (P=.04). When all rewards were given to both groups, from the fifth to twelfth week, the change in SRHI scores of the intervention and control groups was comparable at 12.08 (SD 10.87) and 15.88 (SD 13.29), respectively (P=.21). However, the level of physical activity showed a significant difference between the groups after 12 weeks of intervention (P=.045). Conclusions: This study provides evidence that intrinsic rewards are important to enhance the sustainability and effectiveness of an intervention. The Healthy Lifestyle Coaching Chatbot program can be a cost-effective method for healthy habit formation. Trial Registration: Clinical Research Information Service KCT0004009; https://tinyurl.com/w4oo7md %M 32427114 %R 10.2196/15085 %U https://mhealth.jmir.org/2020/5/e15085 %U https://doi.org/10.2196/15085 %U http://www.ncbi.nlm.nih.gov/pubmed/32427114 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17371 %T Use of Apps to Promote Childhood Vaccination: Systematic Review %A de Cock,Caroline %A van Velthoven,Michelle %A Milne-Ives,Madison %A Mooney,Mary %A Meinert,Edward %+ Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Children's Hospital, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom, 44 7824446808, e.meinert14@imperial.ac.uk %K vaccination %K vaccination coverage %K mobile apps %K infant %K childhood vaccination %K immunization %K smartphone technology %K mobile phone %D 2020 %7 18.5.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Vaccination is a critical step in reducing child mortality; however, vaccination rates have declined in many countries in recent years. This decrease has been associated with an increase in the outbreak of vaccine-preventable diseases. The potential for leveraging mobile platforms to promote vaccination coverage has been investigated in the development of numerous mobile apps. Although many are available for public use, there is little robust evaluation of these apps. Objective: This systematic review aimed to assess the effectiveness of apps supporting childhood vaccinations in improving vaccination uptake, knowledge, and decision making as well as the usability and user perceptions of these apps. Methods: PubMed, Excerpta Medica Database (EMBASE), Web of Science, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and Education Resources Information Center (ERIC) databases were systematically searched for studies published between 2008 and 2019 that evaluated childhood vaccination apps. Two authors screened and selected studies according to the inclusion and exclusion criteria. Data were extracted and analyzed, and the studies were assessed for risk of bias. Results: A total of 28 studies evaluating 25 apps met the inclusion criteria and were included in this analysis. Overall, 9 studies assessed vaccination uptake, of which 4 reported significant benefits (P<.001 or P=.03) of the implementation of the app. Similarly, 4 studies indicated a significant (P≤.054) impact on knowledge and on vaccination decision making. Patient perceptions, usability, and acceptability were generally positive. The quality of the included studies was found to be moderate to poor, with many aspects of the methodology being unclear. Conclusions: There is little evidence to support the use of childhood vaccination apps to improve vaccination uptake, knowledge, or decision making. Further research is required to understand the dichotomous effects of vaccination-related information provision and the evaluation of these apps in larger, more robust studies. The methodology of studies must be reported more comprehensively to accurately assess the effectiveness of childhood vaccination apps and the risk of bias of studies. International Registered Report Identifier (IRRID): RR2-10.2196/16929 %M 32421684 %R 10.2196/17371 %U https://mhealth.jmir.org/2020/5/e17371 %U https://doi.org/10.2196/17371 %U http://www.ncbi.nlm.nih.gov/pubmed/32421684 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15015 %T A Lower Leg Physical Activity Intervention for Individuals With Chronic Venous Leg Ulcers: Randomized Controlled Trial %A Kelechi,Teresa J %A Prentice,Margaret A %A Mueller,Martina %A Madisetti,Mohan %A Vertegel,Alexey %+ College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, MSC 160, Charleston, SC, 29425, United States, 1 843 792 4602, kelechtj@musc.edu %K leg ulcer %K physical activity %K exercise %K mHealth %K adherence %K randomized controlled trial %K feasibility %D 2020 %7 15.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Individuals with venous leg ulcers (VLUs) suffer disproportionately with multiple chronic conditions, are often physically deconditioned, and demonstrate high levels of physical inactivity. Objective: The primary objective of this randomized controlled trial was to establish the feasibility of a mobile health (mHealth) physical activity exercise app for individuals with VLUs to improve lower leg function. Methods: In a 6-week study, adults with VLUs were recruited from 2 wound centers in South Carolina, United States, and enrolled if they were aged 18 years or older with impaired functional mobility and an ankle-brachial index between 0.8 and 1.3. Participants were randomized 1:1 to receive evidence-based, phased, nonexertive physical conditioning activities for lower leg function (FOOTFIT) or FOOTFIT+ with an added patient-provider communication feature. The mHealth Conditioning Activities for Lower Leg Function app also provided automated educational and motivational messages and user reports. Foot movement on the VLU-affected leg was tracked by a Bluetooth-enabled triaxial accelerometer. The study was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to assess the feasibility of reach, adherence, acceptability, implementation, and maintenance. Results: A total of 24 patients were recruited, enrolled, and randomized in the study. Most patients reported difficulty following the protocol for exercising and using the accelerometer and mobile phone and did not use the provider contact feature. However, all patients were adherent to the 6-week exercise program more than 85% of the time for duration, whereas 33% (8/24) of patients adhered more than 85% for the frequency of performing the exercises. Across the three exercise levels, adherence did not differ between the two groups. Confidence limits around the difference in proportions ranged from −0.4 to 0.7. Providers in FOOTFIT+ were inconsistent in checking participant progress reports because of lack of time from competing work commitments. The technology became outdated quickly, making maintenance problematic. Participants said they would continue to exercise their foot and legs and liked being able to follow along with the demonstrations of each level of exercise provided through the app. Conclusions: The findings of this study suggest that despite initial interest in using the app, several components of the program as originally designed had limited acceptability and feasibility. Future refinements should include the use of more modern technology including smaller wearable accelerometers, mobile phones or tablets with larger screens, an app designed with larger graphics, automated reporting for providers, and more engaging user features. Trial Registration: ClinicalTrials.gov NTC02632695; https://clinicaltrials.gov/ct2/show/NCT02632695 %M 32412419 %R 10.2196/15015 %U https://mhealth.jmir.org/2020/5/e15015 %U https://doi.org/10.2196/15015 %U http://www.ncbi.nlm.nih.gov/pubmed/32412419 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17270 %T Efficacy of the Ascure Smoking Cessation Program: Retrospective Study %A Kato,Ayaka %A Tanigawa,Tomoyuki %A Satake,Kohta %A Nomura,Akihiro %+ Innovative Clinical Research Center, Kanazawa University, 13-1 Takara-machi, Kanazawa, Kanazawa, Ishikawa, 920-8641, Japan, 81 76 265 2049, anomura@med.kanazawa-u.ac.jp %K smoking cessation %K nicotine dependence %K telecare %K telemedicine %K mHealth %K digital therapeutics %K mobile phone %K smoking cessation program %K online counseling %D 2020 %7 14.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smoking cessation helps extend a healthy life span and reduces medical expenses. However, the standard 12-week smoking cessation program in Japan has several notable problems. First, only 30% of participants complete this program. Second, participants may choose not to participate unless they have a strong motivation to quit smoking, such as health problems. Third, the program does not provide enough support during the period between clinical visits and after 12 weeks. Objective: This study examined the efficacy of the 24-week ascure program to address the problems of accessibility and continuous support. The program combines online mentoring, over-the-counter pharmacotherapy, and a smartphone app. Methods: Using a retrospective study design, we investigated data for 177 adult smokers who were enrolled in the ascure smoking cessation program between August 2017 and August 2018. The primary outcomes were continuous abstinence rates (CARs) during weeks 9-12 and weeks 21-24. To confirm smoking status, we performed salivary cotinine testing at weeks 12 and 24. We also evaluated the program adherence rate. Finally, we performed exploratory analysis to determine the factors associated with continuous abstinence at weeks 21-24 to provide insights for assisting with long-term continuous abstinence. Results: The CARs of all participants for weeks 9-12 and weeks 21-24 were 48.6% (95% CI 41.2-56.0) and 47.5% (95% CI 40.0-54.8), respectively. Program adherence rates were relatively high throughout (72% at week 12 and 60% at week 24). In the analysis of the factors related to the CAR at weeks 21-24, the number of entries in the app’s digital diary and number of educational videos watched during the first 12 weeks were significant factors. Conclusions: The ascure program achieved favorable CARs, and participants showed high adherence. Proactive usage of the smartphone app may help contribute to smoking cessation success in the long-term. %M 32406856 %R 10.2196/17270 %U https://mhealth.jmir.org/2020/5/e17270 %U https://doi.org/10.2196/17270 %U http://www.ncbi.nlm.nih.gov/pubmed/32406856 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15888 %T A Sexual Health Promotion App for Transgender Women (Trans Women Connected): Development and Usability Study %A Sun,Christina J %A Anderson,Kirsten M %A Kuhn,Tamara %A Mayer,Liat %A Klein,Charles H %+ School of Public Health, Oregon Health & Science University-Portland State University, 506 SW Mill St., Suite 450, SCH, Portland, OR, 97201, United States, 1 503 725 8858, chrsun@pdx.edu %K transgender persons %K HIV %K sexual health %K minority health %K health care disparities %K health status disparities %D 2020 %7 12.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: HIV severely impacts the transgender communities in the United States, and transgender women have the highest HIV incidence rates among any identified risk group. Guided by formative research with transgender women and by an expert advisory panel of transgender women, we designed a prototype mobile app to promote HIV prevention among transgender women. Objective: This study aimed to develop and test the usability and acceptability of the prototype Trans Women Connected mobile app. Methods: We engaged in a 3-phase prototype development process. After conducting formative research about the health needs of this population, we outlined a theory-based app framework and developed three prototype activities (ie, a vision board, a pre-exposure prophylaxis [PrEP] education activity, and an interactive map). We then tested the usability and acceptability of the mobile app and activities with 16 transgender women using pre- and posttests, think-aloud protocols, and open-ended questions. Results: Participants reported high acceptability for the mobile app; the mean rating across all usability and likability questions was 5.9 out of 7. Service utilization intention, goal setting, and social support increased at posttest compared with pretest. Increases in self-efficacy in finding lesbian, gay, bisexual, transgender, and queer–friendly services; intention to seek online social support; and PrEP knowledge were statistically significant. Participants described the app as attractive and useful and perceived all three activities positively. Conclusions: This study describes the development and usability and acceptability evaluation of a prototype mobile app designed for and with transgender women for HIV prevention. The usability testing findings provided important insights toward refining and the further development of the Trans Women Connected mobile app. The results suggest that a mobile health intervention can support positive changes. The remaining development and efficacy randomized trial of the Trans Women Connected mobile app is currently underway. %M 32396131 %R 10.2196/15888 %U https://mhealth.jmir.org/2020/5/e15888 %U https://doi.org/10.2196/15888 %U http://www.ncbi.nlm.nih.gov/pubmed/32396131 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 5 %P e15178 %T A Smartphone App–Based Mindfulness Intervention for Cancer Survivors: Protocol for a Randomized Controlled Trial %A Subnis,Utkarsh B %A Farb,Norman AS %A Piedalue,Katherine-Ann Laura %A Speca,Michael %A Lupichuk,Sasha %A Tang,Patricia A %A Faris,Peter %A Thoburn,Mark %A Saab,Bechara J %A Carlson,Linda E %+ Department of Oncology, University of Calgary, 2202 2 Street SW, Calgary, AB, T2S 3C1, Canada, 1 4034762465, utkarsh.subnis@ucalgary.ca %K mobile health %K psycho-oncology %K mindfulness %K mind-body therapies %D 2020 %7 11.5.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer patients transitioning to survivorship after completing cancer treatments need psychosocial interventions to manage stressors such as anxiety, depression, and fear of cancer recurrence. Mindfulness-based interventions (MBIs) are effective for treating these symptoms; however, cancer survivors are often unable to participate in face-to-face interventions because of difficulties such as work and family commitments, treatment-related side-effects, scheduling conflicts, and geography. Smartphone app–based MBIs are an innovative way to deliver psychosocial cancer care and can overcome several such difficulties, since patients can participate at their own convenience. Objective: The SEAMLESS (Smartphone App–Based Mindfulness Intervention for Cancer Survivors) study aims to evaluate the efficacy of a tailored app-based mindfulness intervention for cancer survivors (the Am Mindfulness-Based Cancer Survivorship—MBCS—Journey) for treating (1) symptoms of stress (primary outcome), as well as (2) fear of cancer recurrence, anxiety, depression, fatigue, and overall physical functioning (secondary outcomes). This is the first Canadian efficacy trial of a tailored mindfulness app intervention in cancer survivors. Methods: This is a randomized waitlist-controlled trial, which will evaluate the effectiveness of Am MBCS for impacting the primary and secondary outcomes in cancer survivors who have completed all their cancer treatments. Outcomes will be assessed using web-based surveys with validated psychometric instruments at (1) baseline, (2) mid-intervention (2 weeks later), (3) immediately postintervention (4 weeks), (4) 3 months postbaseline, (5) 6 months postbaseline, and (6) 12 months postbaseline. The waitlist group will complete all assessments and will cross over to the intervention condition after the 3-month assessment. In addition, data will be obtained by the smartphone app itself, which includes users’ engagement with the app-based intervention, their emotional state (eg, angry and elated) from a user-inputted digital emotion-mapping board, and psychobiometric data using photoplethysmography technology. Results: The study received ethics approval in September 2018 and recruitment commenced in January 2019. Participants are being recruited through a provincial cancer registry, and the majority of participants currently enrolled are breast (44/83, 53%) or colorectal (17/83, 20%) cancer survivors, although some survivors of other cancer are also present. Data collection for analysis of the primary outcome time-point will be complete by September 2019, and the follow-up data will be collected and analyzed by September 2020. Data will be analyzed to determine group differences using linear mixed modelling statistical techniques. Conclusions: Cancer care providers are uncertain about the efficacy of app-based mindfulness interventions for patients, which are available in great supply in today’s digital world. This study will provide rigorously evaluated efficacy data for an app-based mindfulness intervention for cancer survivors, which if helpful, could be made available for psychosocial care at cancer centers worldwide. Trial Registration: ClinicalTrials.gov NCT03484000; https://clinicaltrials.gov/ct2/show/NCT03484000 International Registered Report Identifier (IRRID): DERR1-10.2196/15178 %M 32390591 %R 10.2196/15178 %U https://www.researchprotocols.org/2020/5/e15178 %U https://doi.org/10.2196/15178 %U http://www.ncbi.nlm.nih.gov/pubmed/32390591 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e13989 %T A Mobile Health Coaching Intervention for Controlling Hypertension: Single-Arm Pilot Pre-Post Study %A Weerahandi,Himali %A Paul,Soaptarshi %A Quintiliani,Lisa M %A Chokshi,Sara %A Mann,Devin M %+ Department of Medicine, NYU Grossman School of Medicine, 227 East 30th St, 6th Fl, New York, NY, 10016, United States, 1 212 263 8313, devin.mann@nyulangone.org %K eHealth %K mobile %K telemedicine %D 2020 %7 7.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The seminal Dietary Approaches to Stopping Hypertension (DASH) study demonstrated the effectiveness of diet to control hypertension; however, the effective implementation and dissemination of its principles have been limited. Objective: This study aimed to determine the feasibility and effectiveness of a DASH mobile health intervention. We hypothesized that combining Bluetooth-enabled data collection, social networks, and a human coach with a smartphone DASH app (DASH Mobile) would be an effective medium for the delivery of the DASH program. Methods: We conducted a single-arm pilot study from August 2015 through August 2016, using a pre-post evaluation design to evaluate the feasibility and preliminary effectiveness of a smartphone version of DASH that incorporated a human health coach. Participants were recruited both online and offline. Results: A total of 17 patients participated in this study; they had a mean age of 59 years (SD 6) and 10 (60%) were women. Participants were engaged with the app; in the 120 days of the study, the mean number of logged blood pressure measurements was 63 (SD 46), the mean number of recorded weight measurements was 52 (SD 45), and participants recorded a mean of 55 step counts (SD 36). Coaching phone calls had a high completion rate (74/102, 73%). The mean number of servings documented per patient for the dietary assessment was 709 (SD 541), and patients set a mean number of 5 (SD 2) goals. Mean systolic and diastolic blood pressure, heart rate, weight, body mass index, and step count did not significantly change over time (P>.10 for all parameters). Conclusions: In this pilot study, we found that participants were engaged with an interactive mobile app that promoted healthy behaviors to treat hypertension. We did not find a difference in the physiological outcomes, but were underpowered to identify such changes. %M 32379049 %R 10.2196/13989 %U http://formative.jmir.org/2020/5/e13989/ %U https://doi.org/10.2196/13989 %U http://www.ncbi.nlm.nih.gov/pubmed/32379049 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16207 %T Peer-to-Peer Social Media as an Effective Prevention Strategy: Quasi-Experimental Evaluation %A Evans,William %A Andrade,Elizabeth %A Pratt,Michaela %A Mottern,Alexandra %A Chavez,Sergio %A Calzetta-Raymond,Anthony %A Gu,Jiayan %+ Milken Institute School of Public Health, George Washington University, Washington, DC, United States, 1 2023519546, wdevans@gwu.edu %K social media %K substance use %K prevention %K marijuana %K opioids %K adolescent health %D 2020 %7 6.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Substance use by adolescents remains to be at unacceptably high levels, and there is evidence that teens’ social norms are becoming more favorable toward recreational use and perceived safety of substances such as marijuana and prescription opioids. Social media offer a low-cost, potentially high-impact approach to disseminate prevention messages. Objective: Living the Example (LTE) is a program that trains adolescent youth ambassadors to develop and disseminate prevention messages within their own social media networks and through in-school activities. This study aimed to evaluate the effects of exposure to LTE-based social media on students in the youth ambassadors’ networks. Methods: The George Washington (GW) University designed and implemented a quasi-experimental evaluation of the LTE program in 3 Maryland high schools. Before program launch, a sample of 826 students (wave 1) at the 3 schools, drawn from a census of freshmen enrolled in a class attended by all students at the grade level, completed a survey. A total of 584 students were surveyed at the wave 2 program midpoint and 542 at the wave 3 endpoint. The survey contained questions on drug use–related attitudes, beliefs, intentions, and behaviors, all based on validated measures. We evaluated the effects of LTE on the intended next 30-day drug use, and controlling for LTE self-reported exposure, age, and gender from waves 2 and 3 was appended into a single dataset. We first conducted ordinal logistic regressions for each drug use intention in wave 3 (ie, sell or distribute illegal drugs, smoke cigarettes, drink beer/wine/hard liquor when parents do not know about it, use marijuana, use lysergic acid diethylamide, cocaine, amphetamines or other illegal drugs, use heroin, use synthetic drugs, and use any prescription pills without a prescription) to examine the association between LTE exposure and drug use intentions. We included an interaction term for the study wave to examine intervention effects. Results: We found a significant positive effect of LTE exposure on all 8 measured drug use intentions: sell/distribute illegal drugs; smoke cigarettes; drink beer, wine, or liquor when my parents do not know about it; use marijuana; use cocaine, amphetamines, or other illegal drug; use heroin; use synthetic drugs; use any prescription pills without a prescription (all P<.05; odds ratios ranging from 2.12 to 3.71). We also found that boys were more likely than girls to exhibit reduced drug use intentions. We also found reductions in 30-day intentions between the second and third survey waves for all 8 measured drug use variables. Conclusions: Overall, the results are consistent with and indicate a stronger LTE effect in this study compared with a previous pilot study. LTE appears to offer a protective effect, with exposure to program messages leading to reduced/improved drug use intentions. %M 32374270 %R 10.2196/16207 %U https://mhealth.jmir.org/2020/5/e16207 %U https://doi.org/10.2196/16207 %U http://www.ncbi.nlm.nih.gov/pubmed/32374270 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16716 %T Wrist-Worn Wearables for Monitoring Heart Rate and Energy Expenditure While Sitting or Performing Light-to-Vigorous Physical Activity: Validation Study %A Düking,Peter %A Giessing,Laura %A Frenkel,Marie Ottilie %A Koehler,Karsten %A Holmberg,Hans-Christer %A Sperlich,Billy %+ Integrative and Experimental Exercise Science, Department of Sport Science, University of Würzburg, Judenbühlweg 11, Würzburg, 97082, Germany, 49 931 31 ext 8479, peterdueking@gmx.de %K cardiorespiratory fitness %K innovation %K smartwatch %K technology %K wearable %K digital health %D 2020 %7 6.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity reduces the incidences of noncommunicable diseases, obesity, and mortality, but an inactive lifestyle is becoming increasingly common. Innovative approaches to monitor and promote physical activity are warranted. While individual monitoring of physical activity aids in the design of effective interventions to enhance physical activity, a basic prerequisite is that the monitoring devices exhibit high validity. Objective: Our goal was to assess the validity of monitoring heart rate (HR) and energy expenditure (EE) while sitting or performing light-to-vigorous physical activity with 4 popular wrist-worn wearables (Apple Watch Series 4, Polar Vantage V, Garmin Fenix 5, and Fitbit Versa). Methods: While wearing the 4 different wearables, 25 individuals performed 5 minutes each of sitting, walking, and running at different velocities (ie, 1.1 m/s, 1.9 m/s, 2.7 m/s, 3.6 m/s, and 4.1 m/s), as well as intermittent sprints. HR and EE were compared to common criterion measures: Polar-H7 chest belt for HR and indirect calorimetry for EE. Results: While monitoring HR at different exercise intensities, the standardized typical errors of the estimates were 0.09-0.62, 0.13-0.88, 0.62-1.24, and 0.47-1.94 for the Apple Watch Series 4, Polar Vantage V, Garmin Fenix 5, and Fitbit Versa, respectively. Depending on exercise intensity, the corresponding coefficients of variation were 0.9%-4.3%, 2.2%-6.7%, 2.9%-9.2%, and 4.1%-19.1%, respectively, for the 4 wearables. While monitoring EE at different exercise intensities, the standardized typical errors of the estimates were 0.34-1.84, 0.32-1.33, 0.46-4.86, and 0.41-1.65 for the Apple Watch Series 4, Polar Vantage V, Garmin Fenix 5, and Fitbit Versa, respectively. Depending on exercise intensity, the corresponding coefficients of variation were 13.5%-27.1%, 16.3%-28.0%, 15.9%-34.5%, and 8.0%-32.3%, respectively. Conclusions: The Apple Watch Series 4 provides the highest validity (ie, smallest error rates) when measuring HR while sitting or performing light-to-vigorous physical activity, followed by the Polar Vantage V, Garmin Fenix 5, and Fitbit Versa, in that order. The Apple Watch Series 4 and Polar Vantage V are suitable for valid HR measurements at the intensities tested, but HR data provided by the Garmin Fenix 5 and Fitbit Versa should be interpreted with caution due to higher error rates at certain intensities. None of the 4 wrist-worn wearables should be employed to monitor EE at the intensities and durations tested. %M 32374274 %R 10.2196/16716 %U https://mhealth.jmir.org/2020/5/e16716 %U https://doi.org/10.2196/16716 %U http://www.ncbi.nlm.nih.gov/pubmed/32374274 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17320 %T A Mobile Technology for Collecting Patient-Reported Physical Activity and Distress Outcomes: Cross-Sectional Cohort Study %A Jung,Miyeon %A Lee,SaeByul %A Kim,Jisun %A Kim,HeeJeong %A Ko,BeomSeok %A Son,Byung Ho %A Ahn,Sei-Hyun %A Park,Yu Rang %A Cho,Daegon %A Chung,Haekwon %A Park,Hye Jin %A Lee,Minsun %A Lee,Jong Won %A Chung,Seockhoon %A Chung,Il Yong %+ Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, , Republic of Korea, 82 2 3010 3998, doorkeeper1@gmail.com %K telemedicine %K breast neoplasms %K mobile apps %K quality of life %K validation %K patient-reported outcome measures (PROMs) %K questionnaire %D 2020 %7 4.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Electronic patient-reported outcome (PROs) provides a fast and reliable assessment of a patient’s health-related quality of life. Nevertheless, using PRO in the traditional paper format is not practical for clinical practice due to the limitations associated with data analysis and management. A questionnaire app was developed to address the need for a practical way to group and use distress and physical activity assessment tools. Objective: The purpose of this study was to assess the level of agreement between electronic (mobile) and paper-and-pencil questionnaire responses. Methods: We validated the app version of the distress thermometer (DT), International Physical Activity Questionnaire (IPAQ), and Patient Health Questionnaire–9 (PHQ-9). A total of 102 participants answered the paper and app versions of the DT and IPAQ, and 96 people completed the PHQ-9. The study outcomes were the correlation of the data between the paper-and-pencil and app versions. Results: A total of 106 consecutive breast cancer patients were enrolled and analyzed for validation of paper and electronic (app) versions. The Spearman correlation values of paper and app surveys for patients who responded to the DT questionnaire within 7 days, within 3 days, and on the same day were .415 (P<.001), .437 (P<.001), and .603 (P<.001), respectively. Similarly, the paper and app survey correlation values of the IPAQ total physical activity metabolic equivalent of task (MET; Q2-6) were .291 (P=.003), .324 (P=.005), and .427 (P=.01), respectively. The correlation of the sum of the Patient Health Questionnaire–9 (Q1-9) according to the time interval between the paper-based questionnaire and the app-based questionnaire was .469 for 14 days (P<.001), .574 for 7 days (P<.001), .593 for 3 days (P<.001), and .512 for the same day (P=.03). These were all statistically significant. Similarly, the correlation of the PHQ (Q10) value according to the time interval between the paper-based questionnaire and the app-based questionnaire was .283 for 14 days (P=.005), .409 for 7 days (P=.001), .415 for 3 days (P=.009), and .736 for the same day (P=.001). These were all statistically significant. In the overall trend, the shorter the interval between the paper-and-pencil questionnaire and the app-based questionnaire, the higher the correlation value. Conclusions: The app version of the distress and physical activity questionnaires has shown validity and a high level of association with the paper-based DT, IPAQ (Q2-6), and PHQ-9. The app-based questionnaires were not inferior to their respective paper versions and confirm the feasibility for their use in clinical practice. The high correlation between paper and mobile app data allows the use of new mobile apps to benefit the overall health care system. Trial Registration: ClinicalTrials.gov NCT03072966; https://clinicaltrials.gov/ct2/show/NCT03072966 %M 32364508 %R 10.2196/17320 %U https://mhealth.jmir.org/2020/5/e17320 %U https://doi.org/10.2196/17320 %U http://www.ncbi.nlm.nih.gov/pubmed/32364508 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e15083 %T A Persuasive mHealth Behavioral Change Intervention for Promoting Physical Activity in the Workplace: Feasibility Randomized Controlled Trial %A Haque,Md Sanaul %A Kangas,Maarit %A Jämsä,Timo %+ Research Unit of Medical Imaging Physics and Technology, Faculty of Medicine, University of Oulu, PO Box 5000, Oulu, 90014, Finland, 358 469557272, md.haque@oulu.fi %K mHealth behavioral change intervention %K persuasive app %K UCD %K game elements %K physical activity %K SDT %D 2020 %7 4.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Employees in an office setting are more likely to remain physically inactive. Physical inactivity has become one of the major barriers to overcoming the risk factors for anxiety, depression, coronary heart disease, certain cancers, and type 2 diabetes. Currently, there is a gap in mobile health (mHealth) apps to promote physical activity (PA) for workers in the workplace. Studies on behavior change theories have concluded that health apps generally lack the use of theoretical constructs. Objective: The objective of this study was to study the feasibility of a persuasive app aimed at encouraging PA among employees and to understand the motivational aspects behind the implementation of mHealth apps among office workers. Methods: A 4-week study using a mixed methods (quantitative and qualitative) design was conducted with office-based employees in cities in 4 countries: Oulu, Finland; Carlow, Ireland; London, United Kingdom; and Dhaka, Bangladesh. Of the 220 invited participants (experimental group, n=115; control group, n=105), 84 participated (experimental group, n=56; control group, n=28), consisting of working-age volunteers working in an office setting. Participants used 2 different interventions: The experimental group used an mHealth app for PA motivation, and the control group used a paper diary. The purpose was to motivate employees to engage in healthier behavior regarding the promotion of PA in the workplace. A user-centered design process was followed to design, develop, and evaluate the mHealth app, incorporating self-determination theory (SDT) and using game elements. The paper diary had no specific theory-driven approach, design technique, nor game elements. Results: Compliance with app usage remained relatively low, with 27 participants (experimental group, n=20; control group, n=7) completing the study. The results support the original hypothesis that the mHealth app would help increase PA (ie, promoting daily walking in the workplace) in comparison to a paper diary (P=.033). The mHealth app supported 2 of the basic SDT psychological needs, namely autonomy (P=.004) and competence (P=.014), but not the needs of relatedness (P=.535). Conclusions: The SDT-based mHealth application motivated employees to increase their PA in the workplace. However, compliance with app usage remained low. Future research should further develop the app based on user feedback and test it in a larger sample. %M 32364506 %R 10.2196/15083 %U https://formative.jmir.org/2020/5/e15083 %U https://doi.org/10.2196/15083 %U http://www.ncbi.nlm.nih.gov/pubmed/32364506 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e14817 %T Multidimensional Cognitive Behavioral Therapy for Obesity Applied by Psychologists Using a Digital Platform: Open-Label Randomized Controlled Trial %A Kim,Meelim %A Kim,Youngin %A Go,Yoonjeong %A Lee,Seokoh %A Na,Myeongjin %A Lee,Younghee %A Choi,Sungwon %A Choi,Hyung Jin %+ Department of Biomedical Sciences, Seoul National University College of Medicine, 28 Yungun-Dong, Chongno-Gu, Seoul, Republic of Korea, 82 2 740 8204, hjchoi@snu.ac.kr %K obesity %K digital health care %K cognitive behavioral therapy %K mobile phone %D 2020 %7 30.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Developing effective, widely useful, weight management programs is a priority in health care because obesity is a major health problem. Objective: This study developed and investigated a new, comprehensive, multifactorial, daily, intensive, psychologist coaching program based on cognitive behavioral therapy (CBT) modules. The program was delivered via the digital health care mobile services Noom Coach and InBody. Methods: This was an open-label, active-comparator, randomized controlled trial. A total of 70 female participants with BMI scores above 24 kg/m2 and no clinical problems besides obesity were randomized into experimental and control groups. The experimental (ie, digital CBT) group (n=45) was connected with a therapist intervention using a digital health care service that provided daily feedback and assignments for 8 weeks. The control group (n=25) also used the digital health care service, but practiced self-care without therapist intervention. The main outcomes of this study were measured objectively at baseline, 8 weeks, and 24 weeks and included weight (kg) as well as other body compositions. Differences between groups were evaluated using independent t tests and a per-protocol framework. Results: Mean weight loss at 8 weeks in the digital CBT group was significantly higher than in the control group (–3.1%, SD 4.5, vs –0.7%, SD 3.4, P=.04). Additionally, the proportion of subjects who attained conventional 5% weight loss from baseline in the digital CBT group was significantly higher than in the control group at 8 weeks (32% [12/38] vs 4% [1/21], P=.02) but not at 24 weeks. Mean fat mass reduction in the digital CBT group at 8 weeks was also significantly greater than in the control group (–6.3%, SD 8.8, vs –0.8%, SD 8.1, P=.02). Mean leptin and insulin resistance in the digital CBT group at 8 weeks was significantly reduced compared to the control group (–15.8%, SD 29.9, vs 7.2%, SD 35.9, P=.01; and –7.1%, SD 35.1, vs 14.4%, SD 41.2, P=.04). Emotional eating behavior (ie, mean score) measured by questionnaire (ie, the Dutch Eating Behavior Questionnaire) at 8 weeks was significantly improved compared to the control group (–2.8%, SD 34.4, vs 21.6%, SD 56.9, P=.048). Mean snack calorie intake in the digital CBT group during the intervention period was significantly lower than in the control group (135.9 kcal, SD 86.4, vs 208.2 kcal, SD 166.3, P=.02). Lastly, baseline depression, anxiety, and self-esteem levels significantly predicted long-term clinical outcomes (24 weeks), while baseline motivation significantly predicted both short-term (8 weeks) and long-term clinical outcomes. Conclusions: These findings confirm that technology-based interventions should be multidimensional and are most effective with human feedback and support. This study is innovative in successfully developing and verifying the effects of a new CBT approach with a multidisciplinary team based on digital technologies rather than standalone technology-based interventions. Trial Registration: ClinicalTrials.gov NCT03465306; https://clinicaltrials.gov/ct2/show/NCT03465306 %M 32352391 %R 10.2196/14817 %U http://mhealth.jmir.org/2020/4/e14817/ %U https://doi.org/10.2196/14817 %U http://www.ncbi.nlm.nih.gov/pubmed/32352391 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e15282 %T Bridging the Digital Divide Among Racial and Ethnic Minority Men Who Have Sex With Men to Reduce Substance Use and HIV Risk: Mixed Methods Feasibility Study %A Hsiang,Elaine %A Offer,Claudine %A Prescott,Maximo %A Rodriguez,Amy %A Behar,Emily %A Matheson,Tim %A Santa Maria,Diane %A Santos,Glenn-Milo %+ School of Medicine, University of California San Francisco, Medical Student Center, S-245, 513 Parnassus Avenue, San Francisco, CA, 94122, United States, 1 626 632 1904, elaine.hsiang@ucsf.edu %K ecological momentary assessment %K men who have sex with men %K text messaging %K substance use %K HIV %K digital divide %K focus group %D 2020 %7 29.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Ecological momentary assessment (EMA) is a promising data collection tool for mobile health interventions targeting episodic health behaviors. For substance-using men who have sex with men (SUMSM), EMA is becoming more widely utilized in efforts to characterize substance use and sexual risk factors for HIV transmission. However, recent literature demonstrates emerging concerns over compliance and lower EMA engagement and data concordance among racial and ethnic minority SUMSM. Objective: This study aimed to provide a qualitative evaluation of the barriers and facilitators of EMA as a data collection tool among racial and ethnic minority SUMSM. Methods: Between October and November 2017, 45 racial and ethnic minority SUMSM were recruited from a list of prior research participants at the San Francisco Department of Public Health to participate in daily EMA surveys on their substance use and sexual health behaviors for 1 week, followed by in-person focus groups (FGs). A total of 4 FGs explored the participants’ experiences with the surveys, issues regarding privacy and confidentiality, and suggestions for improvement. Qualitative analysis was performed using content analysis. Descriptive statistics and Fisher exact tests were used to assess the associations between demographics or substance use behaviors and EMA completion. Results: Overall, 93.9% (295/314) of all delivered surveys were initiated, and of those, 98.0% (289/295) were completed. Neither participant demographics, including race (P=.65) or age (P=.43), nor substance use behaviors, including the frequency of alcohol (P=.40) or methamphetamine (P=.91) use or any cocaine (P=.28), crack (P=.99), or polysubstance use (P=.24), were found to be associated with survey completion. Overall, participants were receptive to the text message–based EMA surveys. Facilitators included survey timing, user-friendly survey design, survey-stimulated self-reflection, coding of sensitive phrases, and other privacy benefits of a mobile survey. Barriers included an inability to correct texting errors and participants’ perception of judgment or stigmatization related to questions about condomless sex. To improve EMA compliance and uptake, participants suggested adding response confirmations, clarifying survey language, and continuing to diversify the study audience. Conclusions: EMA appears to be feasible and acceptable among this sample of racial and ethnic minority SUMSM. Close attention to EMA study design and the development of nonjudgmental, contextualized questions regarding stigmatized health behaviors may be critical to further improve EMA compliance. %M 32347807 %R 10.2196/15282 %U http://mhealth.jmir.org/2020/4/e15282/ %U https://doi.org/10.2196/15282 %U http://www.ncbi.nlm.nih.gov/pubmed/32347807 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e14841 %T Step-Based Metrics and Overall Physical Activity in Children With Overweight or Obesity: Cross-Sectional Study %A Migueles,Jairo H %A Cadenas-Sanchez,Cristina %A Aguiar,Elroy J %A Molina-Garcia,Pablo %A Solis-Urra,Patricio %A Mora-Gonzalez,Jose %A García-Mármol,Eduardo %A Shiroma,Eric J %A Labayen,Idoia %A Chillón,Palma %A Löf,Marie %A Tudor-Locke,Catrine %A Ortega,Francisco B %+ PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Carretera Alfacar s/n, Granada, 18011, Spain, 34 958244353, jairohm@ugr.es %K motion sensor %K pedometer %K sedentary behavior %K MVPA %K cadence %D 2020 %7 28.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Best-practice early interventions to increase physical activity (PA) in children with overweight and obesity should be both feasible and evidence based. Walking is a basic human movement pattern that is practical, cost-effective, and does not require complex movement skills. However, there is still a need to investigate how much walking—as a proportion of total PA level—is performed by children who are overweight and obese in order to determine its utility as a public health strategy. Objective: This study aimed to (1) investigate the proportion of overall PA indicators that are explained by step-based metrics and (2) study step accumulation patterns relative to achievement of public health recommendations in children who are overweight and obese. Methods: A total of 105 overweight and obese children (mean 10.1 years of age [SD 1.1]; 43 girls) wore hip-worn accelerometers for 7 days. PA volumes were derived using the daily average of counts per 15 seconds, categorized using standard cut points for light-moderate-vigorous PA (LMVPA) and moderate-to-vigorous PA (MVPA). Derived step-based metrics included volume (steps/day), time in cadence bands, and peak 1-minute, 30-minute, and 60-minute cadences. Results: Steps per day explained 66%, 40%, and 74% of variance for counts per 15 seconds, LMVPA, and MVPA, respectively. The variance explained was increased up to 80%, 92%, and 77% by including specific cadence bands and peak cadences. Children meeting the World Health Organization recommendation of 60 minutes per day of MVPA spent less time at zero cadence and more time in cadence bands representing sporadic movement to brisk walking (ie, 20-119 steps/min) than their less-active peers. Conclusions: Step-based metrics, including steps per day and various cadence-based metrics, seem to capture a large proportion of PA for children who are overweight and obese. Given the availability of pedometers, step-based metrics could be useful in discriminating between those children who do or do not achieve MVPA recommendations. Trial Registration: ClinicalTrials.gov NCT02295072; https://clinicaltrials.gov/ct2/show/NCT02295072 %M 32343251 %R 10.2196/14841 %U http://mhealth.jmir.org/2020/4/e14841/ %U https://doi.org/10.2196/14841 %U http://www.ncbi.nlm.nih.gov/pubmed/32343251 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e18064 %T Comparison of a Collective Intelligence Tailored Messaging System on Smoking Cessation Between African American and White People Who Smoke: Quasi-Experimental Design %A Faro,Jamie M %A Nagawa,Catherine S %A Allison,Jeroan A %A Lemon,Stephenie C %A Mazor,Kathleen M %A Houston,Thomas K %A Sadasivam,Rajani S %+ Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation St, The Albert Sherman Center, Worcester, MA, United States, 1 774 455 4672, jamie.faro@umassmed.edu %K machine learning %K computer-tailored health communication %K smoking cessation %K health disparities %D 2020 %7 27.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Patient Experience Recommender System for Persuasive Communication Tailoring (PERSPeCT) is a machine learning recommender system with a database of messages to motivate smoking cessation. PERSPeCT uses the collective intelligence of users (ie, preferences and feedback) and demographic and smoking profiles to select motivating messages. PERSPeCT may be more beneficial for tailoring content to minority groups influenced by complex, personally relevant factors. Objective: The objective of this study was to describe and evaluate the use of PERSPeCT in African American people who smoke compared with white people who smoke. Methods: Using a quasi-experimental design, we compared African American people who smoke with a historical cohort of white people who smoke, who both received up to 30 emailed tailored messages over 65 days. People who smoke rated the daily message in terms of perceived influence on quitting smoking for 30 days. Our primary analysis compared daily message ratings between the two groups using a t test. We used a logistic model to compare 30-day cessation between the two groups and adjusted for covariates. Results: The study included 119 people who smoke (African Americans, 55/119; whites, 64/119). At baseline, African American people who smoke were significantly more likely to report allowing smoking in the home (P=.002); all other characteristics were not significantly different between groups. Daily mean ratings were higher for African American than white people who smoke on 26 of the 30 days (P<.001). Odds of quitting as measured by 30-day cessation were significantly higher for African Americans (odds ratio 2.3, 95% CI 1.04-5.53; P=.03) and did not change after adjusting for allowing smoking at home. Conclusions: Our study highlighted the potential of using a recommender system to personalize for African American people who smoke. Trial Registration: ClinicalTrials.gov NCT02200432; https://clinicaltrials.gov/ct2/show/NCT02200432 International Registered Report Identifier (IRRID): RR2-10.2196/jmir.6465 %M 32338619 %R 10.2196/18064 %U http://mhealth.jmir.org/2020/4/e18064/ %U https://doi.org/10.2196/18064 %U http://www.ncbi.nlm.nih.gov/pubmed/32338619 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e17530 %T A Mobile Health Solution Complementing Psychopharmacology-Supported Smoking Cessation: Randomized Controlled Trial %A Carrasco-Hernandez,Laura %A Jódar-Sánchez,Francisco %A Núñez-Benjumea,Francisco %A Moreno Conde,Jesús %A Mesa González,Marco %A Civit-Balcells,Antón %A Hors-Fraile,Santiago %A Parra-Calderón,Carlos Luis %A Bamidis,Panagiotis D %A Ortega-Ruiz,Francisco %+ Research and Innovation Group in Biomedical Informatics, Biomedical Engineering and Health Economy, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital, Spanish National Research Council, University of Seville, Avenida Manuel Siurot S/N, Seville, 41013, Spain, 34 670943651, francisco.jodar@juntadeandalucia.es %K smoking cessation %K behavioral change %K health recommender systems %K mHealth %K randomized controlled trial %D 2020 %7 27.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smoking cessation is a persistent leading public health challenge. Mobile health (mHealth) solutions are emerging to improve smoking cessation treatments. Previous approaches have proposed supporting cessation with tailored motivational messages. Some managed to provide short-term improvements in smoking cessation. Yet, these approaches were either static in terms of personalization or human-based nonscalable solutions. Additionally, long-term effects were neither presented nor assessed in combination with existing psychopharmacological therapies. Objective: This study aimed to analyze the long-term efficacy of a mobile app supporting psychopharmacological therapy for smoking cessation and complementarily assess the involved innovative technology. Methods: A 12-month, randomized, open-label, parallel-group trial comparing smoking cessation rates was performed at Virgen del Rocío University Hospital in Seville (Spain). Smokers were randomly allocated to a control group (CG) receiving usual care (psychopharmacological treatment, n=120) or an intervention group (IG) receiving psychopharmacological treatment and using a mobile app providing artificial intelligence–generated and tailored smoking cessation support messages (n=120). The secondary objectives were to analyze health-related quality of life and monitor healthy lifestyle and physical exercise habits. Safety was assessed according to the presence of adverse events related to the pharmacological therapy. Per-protocol and intention-to-treat analyses were performed. Incomplete data and multinomial regression analyses were performed to assess the variables influencing participant cessation probability. The technical solution was assessed according to the precision of the tailored motivational smoking cessation messages and user engagement. Cessation and no cessation subgroups were compared using t tests. A voluntary satisfaction questionnaire was administered at the end of the intervention to all participants who completed the trial. Results: In the IG, abstinence was 2.75 times higher (adjusted OR 3.45, P=.01) in the per-protocol analysis and 2.15 times higher (adjusted OR 3.13, P=.002) in the intention-to-treat analysis. Lost data analysis and multinomial logistic models showed different patterns in participants who dropped out. Regarding safety, 14 of 120 (11.7%) IG participants and 13 of 120 (10.8%) CG participants had 19 and 23 adverse events, respectively (P=.84). None of the clinical secondary objective measures showed relevant differences between the groups. The system was able to learn and tailor messages for improved effectiveness in supporting smoking cessation but was unable to reduce the time between a message being sent and opened. In either case, there was no relevant difference between the cessation and no cessation subgroups. However, a significant difference was found in system engagement at 6 months (P=.04) but not in all subsequent months. High system appreciation was reported at the end of the study. Conclusions: The proposed mHealth solution complementing psychopharmacological therapy showed greater efficacy for achieving 1-year tobacco abstinence as compared with psychopharmacological therapy alone. It provides a basis for artificial intelligence–based future approaches. Trial Registration: ClinicalTrials.gov NCT03553173; https://clinicaltrials.gov/ct2/show/NCT03553173 International Registered Report Identifier (IRRID): RR2-10.2196/12464 %M 32338624 %R 10.2196/17530 %U http://mhealth.jmir.org/2020/4/e17530/ %U https://doi.org/10.2196/17530 %U http://www.ncbi.nlm.nih.gov/pubmed/32338624 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e13536 %T Facilitators and Barriers to Chronic Disease Self-Management and Mobile Health Interventions for People Living With Diabetes and Hypertension in Cambodia: Qualitative Study %A Steinman,Lesley %A Heang,Hen %A van Pelt,Maurits %A Ide,Nicole %A Cui,Haixia %A Rao,Mayuree %A LoGerfo,James %A Fitzpatrick,Annette %+ Department of Health Services, University of Washington, 1107 NE 45th St Suite 400, Seattle, WA, 98105, United States, 1 2065439837, lesles@uw.edu %K diabetes mellitus %K hypertension %K chronic disease %K noncommunicable diseases %K health educators %K mHealth %K qualitative %K disease management %K developing countries %D 2020 %7 24.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In many low- and middle-income countries (LMICs), heart disease and stroke are the leading causes of death as cardiovascular risk factors such as diabetes and hypertension rapidly increase. The Cambodian nongovernmental organization, MoPoTsyo, trains local residents with diabetes to be peer educators (PEs) to deliver chronic disease self-management training and medications to 14,000 people with hypertension and/or diabetes in Cambodia. We collaborated with MoPoTsyo to develop a mobile-based messaging intervention (mobile health; mHealth) to link MoPoTsyo’s database, PEs, pharmacies, clinics, and people living with diabetes and/or hypertension to improve adherence to evidence-based treatment guidelines. Objective: This study aimed to understand the facilitators and barriers to chronic disease management and the acceptability, appropriateness, and feasibility of mHealth to support chronic disease management and strengthen community-clinical linkages to existing services. Methods: We conducted an exploratory qualitative study using semistructured interviews and focus groups with PEs and people living with diabetes and/or hypertension. Interviews were recorded and conducted in Khmer script, transcribed and translated into the English language, and uploaded into Atlas.ti for analysis. We used a thematic analysis to identify key facilitators and barriers to disease management and opportunities for mHealth content and format. The information-motivation-behavioral model was used to guide data collection, analysis, and message development. Results: We conducted six focus groups (N=59) and 11 interviews in one urban municipality and five rural operating districts from three provinces in October 2016. PE network participants desired mHealth to address barriers to chronic disease management through reminders about medications, laboratory tests and doctor’s consultations, education on how to incorporate self-management into their daily lives, and support for obstacles to disease management. Participants preferred mobile-based voice messages to arrive at dinnertime for improved phone access and family support. They desired voice messages over texts to communicate trust and increase accessibility for persons with limited literacy, vision, and smartphone access. PEs shared similar views and perceived mHealth as acceptable and feasible for supporting their work. We developed 34 educational, supportive, and reminder mHealth messages based on these findings. Conclusions: These mHealth messages are currently being tested in a cluster randomized controlled trial (#1R21TW010160) to improve diabetes and hypertension control in Cambodia. This study has implications for practice and policies in Cambodia and other LMICs and low-resource US settings that are working to engage PEs and build community-clinical linkages to facilitate chronic disease management. %M 32329737 %R 10.2196/13536 %U http://mhealth.jmir.org/2020/4/e13536/ %U https://doi.org/10.2196/13536 %U http://www.ncbi.nlm.nih.gov/pubmed/32329737 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e17816 %T Use of a Smartphone-Based Mobile App for Weight Management in Obese Minority Stroke Survivors: Pilot Randomized Controlled Trial With Open Blinded End Point %A Ifejika,Nneka L %A Bhadane,Minal %A Cai,Chunyan C %A Noser,Elizabeth A %A Grotta,James C %A Savitz,Sean I %+ Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, United States, 1 2146488762, nneka.ifejika@utsouthwestern.edu %K smartphone %K stroke %K obesity %K telemedicine %K minority groups %K cognitive dysfunction %K outcome assessment, health care %D 2020 %7 22.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Minorities have an increased incidence of early-onset, obesity-related cerebrovascular disease. Unfortunately, effective weight management in this vulnerable population has significant barriers. Objective: Our objective was to determine the feasibility and preliminary treatment effects of a smartphone-based weight loss intervention versus food journals to monitor dietary patterns in minority stroke patients. Methods: Swipe out Stroke was a pilot prospective randomized controlled trial with open blinded end point. Minority stroke patients and their caregivers were screened for participation using cluster enrollment. We used adaptive randomization for assignment to a behavior intervention with (1) smartphone-based self-monitoring or (2) food journal self-monitoring. The smartphone group used Lose it! to record meals and communicate with us. Reminder messages (first 30 days), weekly summaries plus reminder messages on missed days (days 31-90), and weekly summaries only (days 91-180) were sent via push notifications. The food journal group used paper diaries. Both groups received 4 in-person visits (baseline and 30, 90, and 180 days), culturally competent counseling, and educational materials. The primary outcome was reduced total body weight. Results: We enrolled 36 stroke patients (n=23, 64% African American; n=13, 36% Hispanic), 17 in the smartphone group, and 19 in the food journal group. Mean age was 54 (SD 9) years; mean body mass index was 35.7 (SD 5.7) kg/m2; education, employment status, and family history of stroke or obesity did not differ between the groups. Baseline rates of depression (Patient Health Questionnaire-9 [PHQ-9] score median 5.5, IQR 3.0-9.5), cognitive impairment (Montreal Cognitive Assessment score median 23.5, IQR 21-26), and inability to ambulate (5/36, 14% with modified Rankin Scale score 3) were similar. In total, 25 (69%) stroke survivors completed Swipe out Stroke (13/17 in the smartphone group, 12/19 in the food journal group); 1 participant in the smartphone group died. Median weight change at 180 days was 5.7 lb (IQR –2.4 to 8.0) in the smartphone group versus 6.4 lb (IQR –2.2 to 12.5; P=.77) in the food journal group. Depression was significantly lower at 30 days in the smartphone group than in the food journal group (PHQ-9 score 2 vs 8; P=.03). Clinically relevant depression rates remained in the zero to minimal range for the smartphone group compared with mild to moderate range in the food journal group at day 90 (PHQ-9 score 3.5 vs 4.5; P=.39) and day 180 (PHQ-9 score 3 vs 6; P=.12). Conclusions: In a population of obese minority stroke survivors, the use of a smartphone did not lead to a significant difference in weight change compared with keeping a food journal. The presence of baseline depression (19/36, 53%) was a confounding variable, which improved with app engagement. Future studies that include treatment of poststroke depression may positively influence intervention efficacy. Trial Registration: ClinicalTrials.gov NCT02531074; https://www.clinicaltrials.gov/ct2/show/NCT02531074 %M 32319963 %R 10.2196/17816 %U http://mhealth.jmir.org/2020/4/e17816/ %U https://doi.org/10.2196/17816 %U http://www.ncbi.nlm.nih.gov/pubmed/32319963 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e14270 %T Temporal Dynamics of Treatment Receipt in a Text Message Intervention for Physical Activity: Single-Group, Within-Person Trial %A Conroy,David E %A Yang,Chih-Hsiang %A Lanza,Stephanie T %A Smyth,Joshua M %A Lagoa,Constantino M %+ Department of Kinesiology, The Pennsylvania State University, 266 Rec Hall, University Park, PA, 16802, United States, 1 814 863 3451, conroy@psu.edu %K short message service %K patient engagement %K mHealth %K physical activity %K sedentary behavior %D 2020 %7 22.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile technology has increased the reach of health behavior interventions but raised new challenges in assessing the fidelity of treatment receipt. Fidelity can be compromised if participant fatigue or burden reduces engagement, leading to missed or delayed treatments for just-in-time interventions. Objective: This study aimed to investigate the temporal dynamics of text message receipt confirmations. Methods: Community-dwelling adults (N=10) were sent five text messages daily for 4 months (5598 messages sent in total), with a financial incentive to confirm receipt of 75% or more messages. Results: Overall, the message receipt confirmation rate was very high (5504/5598, 98.32%) and timely (eg, two-thirds of confirmations within 2 min). Confirmation times were slightly slower on weekends (vs weekdays) and as a function of the cumulative time in the study. Neither time of message delivery nor message content was associated with message confirmation latencies. Conclusions: Participants receiving financial incentives to confirm text message receipt exhibit extremely high and fast confirmation rates, although receipt confirmations were somewhat less timely on weekends (vs weekdays) and later in the intervention. The social calendar and treatment fatigue should be considered when planning text message–based interventions, especially if treatments are intended for a just-in-time delivery that requires extended engagement and precise timing. %M 32319957 %R 10.2196/14270 %U http://mhealth.jmir.org/2020/4/e14270/ %U https://doi.org/10.2196/14270 %U http://www.ncbi.nlm.nih.gov/pubmed/32319957 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e14595 %T Sustainability of mHealth Effects on Cardiometabolic Risk Factors: Five-Year Results of a Randomized Clinical Trial %A Bernabe-Ortiz,Antonio %A Pauschardt,Julia %A Diez-Canseco,Francisco %A Miranda,J Jaime %+ CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Avenida Armendáriz 445, Miraflores, Lima, 15074, Peru, 51 12416978, antonio.bernabe@upch.pe %K mHealth %K low- and middle-income countries %K blood pressure %K body weight %D 2020 %7 21.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The long-term effects of mobile health (mHealth) interventions have not been documented, especially in resource-constrained settings. Objective: This study aimed to assess the effects of a 1-year mHealth intervention on blood pressure levels and body weight in low-resource urban settings in Peru, 4 years after the completion of the original study. Methods: Four years after the original Grupo de Investigación en Salud Móvil en America Latina (GISMAL) study, we attempted to contact the 212 individuals originally enrolled in the study in Peru. The primary outcomes were systolic and diastolic blood pressure levels and hypertension incidence. Secondary outcome measures were body weight, BMI, and self-reported target behaviors. The study personnel collecting the data were masked to the group assignment. Linear mixed models were used to evaluate the effects of the intervention on primary and secondary outcomes in an intention-to-treat analysis. Results: Data from 164 (77.4%) of the 212 originally enrolled participants were available and analyzed (80 in the intervention group and 84 in the control group). The intervention did not result in changes in systolic (–2.54 mm Hg, 95% CI –8.23 to 3.15) or diastolic (3.41 mm Hg, 95% CI –0.75 to 7.57) blood pressure compared with the control group. The intervention reduced the risk of developing hypertension, but the result was not significant (risk ratio (RR) 0.76, 95% CI 0.45-1.28). However, those who received the intervention had lower body weight (–5.42 kg, 95% CI –10.4 to –0.48) and BMI (–2.56 kg/m2, 95% CI –4.46 to –0.66). In addition, compared to the control participants, those who received ≥50% of the scheduled calls during the intervention had greater reductions in body weight (–6.23 kg, 95% CI –11.47 to –0.99) and BMI (–2.81 kg/m2, 95% CI –4.77 to –0.85). Conclusions: An mHealth intervention comprising motivational interview calls and SMS text messaging appears to have effects on health 4 years after intervention completion. Although there were no effects on blood pressure levels, important reductions in body weight and BMI were seen 5 years after randomization. Thus, mHealth appears to be a promising preventive strategy for noncommunicable diseases in resource-constrained settings. Trial Registration: Clinicaltrials.gov NCT01295216; https://clinicaltrials.gov/ct2/show/NCT01295216 %M 32314970 %R 10.2196/14595 %U http://www.jmir.org/2020/4/e14595/ %U https://doi.org/10.2196/14595 %U http://www.ncbi.nlm.nih.gov/pubmed/32314970 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e17544 %T Consumer Perceptions of Wearable Technology Devices: Retrospective Review and Analysis %A Chong,Kimberly P L %A Guo,Julia Z %A Deng,Xiaomeng %A Woo,Benjamin K P %+ University of California, Los Angeles, 14445 Olive View Drive, Sylmar, CA, 91342, United States, 1 747 210 3830, juliaguo@mednet.ucla.edu %K wearable technology devices %K Fitbit %K Amazon %K sleep %D 2020 %7 20.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Individuals of all ages are becoming more health conscious, and wearable technology devices (eg, Fitbit and Apple Watch) are becoming increasingly popular in encouraging healthy lifestyles. Objective: The aim of this paper was to explore how consumers use wearable devices. Methods: A retrospective review was done on the top-rated verified purchase reviews of the Fitbit One posted on Amazon.com between January 2014 and August 2018. Relevant themes were identified by qualitatively analyzing open-ended reviews. Results: On retrieval, there were 9369 reviews with 7706 positive reviews and 1663 critical reviews. The top 100 positive and top 100 critical comments were subsequently analyzed. Four major themes were identified: sleep hygiene (“charts when you actually fall asleep, when you wake up during the night, when you're restless--and gives you a cumulative time of “actual sleep” as well as weekly averages.”), motivation (“25 lbs lost after 8 months – best motivator ever!”), accountability (“platform to connect with people you know and set little competitions or group…fun accountability if you set a goal with a friend/family.”), and discretion (“able to be clipped to my bra without being seen.”). Alternatively, negative reviewers felt that the wearable device’s various tracking functions, specifically steps and sleep, were inaccurate. Conclusions: Wearable technology devices are an affordable, user-friendly application that can support all individuals throughout their everyday lives and potentially be implemented into medical surveillance, noninvasive medical care, and mobile health and wellness monitoring. This study is the first to explore wearable technology device use among consumers, and further studies are needed to examine the limitless possibilities of wearable devices in health care. %M 32310148 %R 10.2196/17544 %U http://mhealth.jmir.org/2020/4/e17544/ %U https://doi.org/10.2196/17544 %U http://www.ncbi.nlm.nih.gov/pubmed/32310148 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 4 %P e14894 %T The Mobile Health Multiple Lifestyle Behavior Interventions Across the Lifespan (MoBILE) Research Program: Protocol for Development, Evaluation, and Implementation %A Bendtsen,Marcus %A Bendtsen,Preben %A Henriksson,Hanna %A Henriksson,Pontus %A Müssener,Ulrika %A Thomas,Kristin %A Löf,Marie %+ Department of Health, Medicine and Caring Sciences, Linköping University, 581 83 Linköping, Linköping, 58183, Sweden, 46 13281000, marcus.bendtsen@liu.se %K telemedicine %K mHealth %K eHealth %K life style %K randomized controlled trial %K focus groups %D 2020 %7 20.4.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Clustering of multiple lifestyle risk behaviors has been associated with a greater risk of noncommunicable diseases and mortality than one lifestyle risk behavior or no lifestyle risk behaviors. The National Board of Health and Welfare in Sweden reported in 2018 that it is important to provide additional support to individuals with multiple lifestyle risk behaviors, as risks from these behaviors are multiplicative rather than additive. However, the same report emphasized that there is a lack of knowledge regarding interventions that support changes to unhealthy lifestyle behaviors. Objective: The MoBILE (Mobile health Multiple lifestyle Behavior Interventions across the LifEspan) research program has brought together two Swedish research groups supported by international collaborators. Through this collaboration, we aim to design and evaluate a number of novel and tailored mobile health (mHealth) multiple lifestyle behavior interventions across the life span of different health care populations. In addition, the MoBILE research program will extend ongoing research to include mHealth interventions for migrant pregnant women and children. Methods: Each project within the MoBILE program will focus on a specific group: pregnant women, preschool children, high school and university students, and adults in primary and clinical care. All the projects will follow the same 4 phases: requirements, development, evaluation, and implementation. During the requirements phase, implementers and end users will aid the design of content and functionality of the interventions. In the development phase, findings from the first phase will be synthesized with expert domain knowledge and theoretical constructs to create interventions tailored to the target groups. The third phase, evaluation, will comprise randomized controlled trials conducted to estimate the effects of the interventions on multiple lifestyle risk behaviors (eg, alcohol, nutrition, physical activity, and smoking). The final phase will investigate how the interventions, if found effective, can be disseminated into different health care contexts. Results: The research program commenced in 2019, and the first results will be available in 2020. Projects involving pregnant women, preschool children, and high school and university students will be completed in the first 3 years, with the remaining projects being planned for the program’s final 3 years. Conclusions: The development of evidence-based digital tools is complex, as they should be guided by theoretical frameworks, and requires large interdisciplinary teams with competence in technology, behavioral science, and lifestyle-specific areas. Individual researchers or smaller research groups developing their own tools is not the way forward, as it means reinventing the wheel over and over again. The MoBILE research program therefore aims to join forces and learn from the past 10 years of mHealth research to maximize scientific outcomes, as well as the use of financial resources to expand the growing body of evidence for mHealth lifestyle behavior interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/14894 %M 32310147 %R 10.2196/14894 %U http://www.researchprotocols.org/2020/4/e14894/ %U https://doi.org/10.2196/14894 %U http://www.ncbi.nlm.nih.gov/pubmed/32310147 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e14726 %T Impact of a Mobile Phone App to Increase Vegetable Consumption and Variety in Adults: Large-Scale Community Cohort Study %A Hendrie,Gilly A %A Hussain,M Sazzad %A Brindal,Emily %A James-Martin,Genevieve %A Williams,Gemma %A Crook,Anna %+ Nutrition and Health Program, CSIRO Health & Biosecurity, PO BOX 10041, Adelaide, Australia, 61 88305 ext 0662, gilly.hendrie@csiro.au %K mHealth %K vegetables %K healthy diet %K intervention study %D 2020 %7 17.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Large-scale initiatives to improve diet quality through increased vegetable consumption have had small to moderate success. Digital technologies have features that are appealing for health-related behavior change interventions. Objective: This study aimed to describe the implementation and evaluation of a mobile phone app called VegEze, which aims to increase vegetable intake among Australian adults. Methods: To capture the impact of this app in a real-world setting, the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework was utilized. An uncontrolled, quantitative cohort study was conducted, with evaluations after 21 and 90 days. The app was available in the Apple App Store and was accompanied by television, radio, and social media promotion. Evaluation surveys were embedded into the app using ResearchKit. The primary outcomes were vegetable intake (servings per day) and vegetable variety (types per day). Psychological variables (attitudes, intentions, self-efficacy, and action planning) and app usage were also assessed. Descriptive statistics and multiple linear regression were used to describe the impact of the app on vegetable intake and to determine the characteristics associated with the increased intake. Results: Data were available from 5062 participants who completed the baseline survey; 1224 participants completed the 21-day survey, and 273 completed the 90-day survey. The participants resided across Australia and were mostly women (4265/5062, 84.3%) with a mean age of 48.2 years (SD 14.1). The mean increase in intake was 0.48 servings, from 3.06 servings at baseline to 3.54 servings at the end of the 21-day challenge (t1223=8.71; P<.001). The variety of vegetables consumed also increased by 0.35 types per day (t1123=9.59; P<.001). No changes in intake and variety were found from day 21 to the 90-day follow-up. Participants with the highest app usage increased their vegetable intake by 0.63 (SD 2.02) servings per day compared with 0.32 (SD 1.69) servings per day for those with the lowest app usage. On the basis of multiple linear regression, gender; age; BMI; psychological variables of self-efficacy, attitudes, intentions, and action planning specific to vegetable intake; baseline vegetable intake; and active days of app usage accounted for 23.3% of the variance associated with the change in intake (F9,1208=42.09; P<.001). Baseline vegetable intake was the strongest predictor of change in intake (beta=−.495; P<.001), with lower baseline intake associated with a greater change in intake. Self-efficacy (beta=.116; P<.001), action planning (beta=.066; P=.02), BMI (beta=.070; P=.01), and app usage (beta=.081; P=.002) were all significant predictors of the change in intake. Conclusions: The VegEze app was able to increase intake by half a serving in a large sample of Australian adults. Testing the app in a real-world setting and embedding the consent process allowed for greater reach and an efficient, robust evaluation. Further work to improve engagement is warranted. %M 32301739 %R 10.2196/14726 %U http://mhealth.jmir.org/2020/4/e14726/ %U https://doi.org/10.2196/14726 %U http://www.ncbi.nlm.nih.gov/pubmed/32301739 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e15960 %T Automated Mobile Delivery of Financial Incentives for Smoking Cessation Among Socioeconomically Disadvantaged Adults: Feasibility Study %A Kendzor,Darla E %A Businelle,Michael S %A Waring,Joseph J C %A Mathews,Ashley J %A Geller,Daryl W %A Barton,Jocelyn M %A Alexander,Adam C %A Hébert,Emily T %A Ra,Chaelin K %A Vidrine,Damon J %+ Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 4052718001 ext 50478, Darla-Kendzor@ouhsc.edu %K socioeconomic status %K smoking cessation %K incentives %K mobile health %K mobile phone %D 2020 %7 15.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Socioeconomic disadvantage is associated with a reduced likelihood of smoking cessation. Smartphone ownership is increasing rapidly, including among low-income adults, and smartphone interventions for smoking cessation may increase access to smoking cessation treatment among socioeconomically disadvantaged adults. Objective: This study aimed to evaluate the feasibility of an automated smartphone-based approach to delivering financial incentives for smoking cessation. Methods: Socioeconomically disadvantaged adults initiating tobacco cessation treatment were followed from 1 week before a scheduled quit attempt through 26 weeks after the quit date. Participants received telephone counseling and nicotine replacement therapy. Smoking cessation was verified 5 times per week via smartphone prompts to self-report smoking status and submit a breath sample via a portable carbon monoxide (CO) monitor that was connected with participants’ smartphones. Identity was verified during smoking status assessments using smartphone-based facial recognition software. When smoking abstinence and identity were verified, an automated credit card payment was triggered. Participants were incentivized for abstinence on the quit date and up to five days per week during the first 4 weeks after the scheduled quit date, with additional incentives offered during postquit weeks 8 and 12. In total, participants had the opportunity to earn up to US $250 in abstinence-contingent incentives over the first 12 weeks of the quit attempt. Results: Participants (N=16) were predominantly female (12/16, 75%) and non-Hispanic white (11/16, 69%), black (4/16, 25%), or Hispanic of any race (1/16, 6%). Most participants (9/16, 56%) reported an annual household income of 14 points on the Depression, Anxiety, and Stress Scale-21 items (DASS-21) stress subscale or >7 points on the DASS-21 anxiety subscale, (3) owned an iOS mobile phone, (4) did not have any previous psychiatric or neurological conditions, (6) were not pregnant at the time of testing, and (7) were able to read and understand English. Participants were encouraged to use BioBase daily and complete at least one course of therapeutic content. A P value ≤.05 was considered statistically significant. Results: We found that a 4-week intervention with the BioBase program significantly reduced anxiety and increased perceived well-being, with sustained effects at a 2-week follow-up. Furthermore, a significant reduction in depression levels was found following the 4-week usage of BioBase. Conclusions: This study shows the efficacy of a biofeedback digital intervention in reducing self-reported anxiety and increasing perceived well-being in UK university students. Results suggest that digital mental health interventions could constitute a novel approach to treat stress and anxiety in students, which could be combined or integrated with existing therapeutic pathways. Trial Registration: Open Science Framework (OSF.io) 2zd45; https://osf.io/2zd45/ %M 31926063 %R 10.2196/17767 %U https://mhealth.jmir.org/2020/4/e17767 %U https://doi.org/10.2196/17767 %U http://www.ncbi.nlm.nih.gov/pubmed/31926063 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e14897 %T Smartphone Apps for the Treatment of Mental Disorders: Systematic Review %A Miralles,Ignacio %A Granell,Carlos %A Díaz-Sanahuja,Laura %A Van Woensel,William %A Bretón-López,Juana %A Mira,Adriana %A Castilla,Diana %A Casteleyn,Sven %+ Universitat Jaume I, Av Vicent Sos Baynat, s/n, Castellón de la Plana, 12071, Spain, 34 964728000, mirallei@uji.es %K mental health %K mental disorders %K treatment %K intervention %K mHealth %K smartphone %K mobile phone %K mobile apps %K systematic review %D 2020 %7 2.4.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Smartphone apps are an increasingly popular means for delivering psychological interventions to patients suffering from a mental disorder. In line with this popularity, there is a need to analyze and summarize the state of the art, both from a psychological and technical perspective. Objective: This study aimed to systematically review the literature on the use of smartphones for psychological interventions. Our systematic review has the following objectives: (1) analyze the coverage of mental disorders in research articles per year; (2) study the types of assessment in research articles per mental disorder per year; (3) map the use of advanced technical features, such as sensors, and novel software features, such as personalization and social media, per mental disorder; (4) provide an overview of smartphone apps per mental disorder; and (5) provide an overview of the key characteristics of empirical assessments with rigorous designs (ie, randomized controlled trials [RCTs]). Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed. We performed searches in Scopus, Web of Science, American Psychological Association PsycNET, and Medical Literature Analysis and Retrieval System Online, covering a period of 6 years (2013-2018). We included papers that described the use of smartphone apps to deliver psychological interventions for known mental disorders. We formed multidisciplinary teams, comprising experts in psychology and computer science, to select and classify articles based on psychological and technical features. Results: We found 158 articles that met the inclusion criteria. We observed an increasing interest in smartphone-based interventions over time. Most research targeted disorders with high prevalence, that is, depressive (31/158,19.6%) and anxiety disorders (18/158, 11.4%). Of the total, 72.7% (115/158) of the papers focused on six mental disorders: depression, anxiety, trauma and stressor-related, substance-related and addiction, schizophrenia spectrum, and other psychotic disorders, or a combination of disorders. More than half of known mental disorders were not or very scarcely (<3%) represented. An increasing number of studies were dedicated to assessing clinical effects, but RCTs were still a minority (25/158, 15.8%). From a technical viewpoint, interventions were leveraging the improved modalities (screen and sound) and interactivity of smartphones but only sparingly leveraged their truly novel capabilities, such as sensors, alternative delivery paradigms, and analytical methods. Conclusions: There is a need for designing interventions for the full breadth of mental disorders, rather than primarily focusing on most prevalent disorders. We further contend that an increasingly systematic focus, that is, involving RCTs, is needed to improve the robustness and trustworthiness of assessments. Regarding technical aspects, we argue that further exploration and innovative use of the novel capabilities of smartphones are needed to fully realize their potential for the treatment of mental health disorders. %M 32238332 %R 10.2196/14897 %U https://mhealth.jmir.org/2020/4/e14897 %U https://doi.org/10.2196/14897 %U http://www.ncbi.nlm.nih.gov/pubmed/32238332 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e15841 %T Efficacy of a Theory-Based Cognitive Behavioral Technique App-Based Intervention for Patients With Insomnia: Randomized Controlled Trial %A Rajabi Majd,Nilofar %A Broström,Anders %A Ulander,Martin %A Lin,Chung-Ying %A Griffiths,Mark D %A Imani,Vida %A Ahorsu,Daniel Kwasi %A Ohayon,Maurice M %A Pakpour,Amir H %+ Department of Rehabilitation Sciences, Hong Kong Polytechnic University, ST534 Department of Rehabilitation Sciences, Hung Hom, , China (Hong Kong), 852 27666755, cylin36933@gmail.com %K app-based intervention %K cognitive behavioral therapy, insomnia %K sleep hygiene %K theory of planned behavior %D 2020 %7 1.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Sleep hygiene is important for maintaining good sleep and reducing insomnia. Objective: This study examined the long-term efficacy of a theory-based app (including cognitive behavioral therapy [CBT], theory of planned behavior [TPB], health action process approach [HAPA], and control theory [CT]) on sleep hygiene among insomnia patients. Methods: The study was a 2-arm single-blind parallel-group randomized controlled trial (RCT). Insomnia patients were randomly assigned to a treatment group that used an app for 6 weeks (ie, CBT for insomnia [CBT-I], n=156) or a control group that received only patient education (PE, n=156) through the app. Outcomes were assessed at baseline and 1 month, 3 months, and 6 months postintervention. Primary outcomes were sleep hygiene, insomnia, and sleep quality. Secondary outcomes included attitudes toward sleep hygiene behavior, perceived behavioral control, behavioral intention, action and coping planning, self-monitoring, behavioral automaticity, and anxiety and depression. Linear mixed models were used to evaluate the magnitude of changes in outcomes between the two groups and across time. Results: Sleep hygiene was improved in the CBT-I group compared with the PE group (P=.02 at 1 month, P=.04 at 3 months, and P=.02 at 6 months) as were sleep quality and severity of insomnia. Mediation analyses suggested that perceived behavioral control on sleep hygiene as specified by TPB along with self-regulatory processes from HAPA and CT mediated the effect of the intervention on outcomes. Conclusions: Health care providers might consider using a CBT-I app to improve sleep among insomnia patients. Trial Registration: ClinicalTrials.gov NCT03605732; https://clinicaltrials.gov/ct2/show/NCT03605732 %M 32234700 %R 10.2196/15841 %U http://www.jmir.org/2020/4/e15841/ %U https://doi.org/10.2196/15841 %U http://www.ncbi.nlm.nih.gov/pubmed/32234700 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e15608 %T Physician Anxiety and Burnout: Symptom Correlates and a Prospective Pilot Study of App-Delivered Mindfulness Training %A Roy,Alexandra %A Druker,Susan %A Hoge,Elizabeth A %A Brewer,Judson A %+ Brown University, Box 1875, Brown Mindfulness Center, Providence, RI, , United States, 1 401 863 2826, judson_brewer@brown.edu %K anxiety %K burnout %K mindfulness %K app %K mHealth %K physician %K smartphone %K digital therapeutics %D 2020 %7 1.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physician burnout is on the rise, yet little is known about its relationship to anxiety. Mindfulness-based stress reduction has demonstrated decreases in anxiety, yet physicians have reported reluctance to engage in it due to significant time commitments. Objective: The aims of this study are to assess whether app-based mindfulness training can reduce anxiety in physicians and to explore if anxiety and burnout are correlated, thus leading to a reduction in both anxiety and burnout. Methods: This was a nonrandomized pilot study comprised of 34 physicians who worked in a large US health care network and reported having anxiety. The intervention was an app-based mindfulness program. The main outcome measure was anxiety, measured by the Generalized Anxiety Disorder-7 (GAD-7). The secondary outcome measures assessed burnout: cynicism and emotional exhaustion items from the Maslach Burnout Inventory. Results: GAD-7 scores decreased significantly at posttreatment (1 month after treatment initiation, 48% reduction, P<.001) and at the 3-month follow-up (57% reduction, P<.001). There was a significant correlation between anxiety and burnout (cynicism: r=.43; P=.01; emotional exhaustion: r=.71; P<.001). There was also a significant decrease in cynicism (50% reduction, P=.003 at posttreatment; 50% reduction, P=.009 at follow-up) and emotional exhaustion at both time points (20% reduction, P<.001 at posttreatment; 20% reduction, P=.003 at follow-up). Conclusions: This pilot study is the first to test an app-based mindfulness training program targeted at reducing anxiety with physicians and to demonstrate that in physicians, anxiety is correlated with burnout. These findings suggest that this may be an effective tool to reduce anxiety and burnout in physicians. Trial Registration: ClinicalTrials.gov NCT04137081; https://www.clinicaltrials.gov/ct2/show/NCT04137081 %M 32234708 %R 10.2196/15608 %U https://mhealth.jmir.org/2020/4/e15608 %U https://doi.org/10.2196/15608 %U http://www.ncbi.nlm.nih.gov/pubmed/32234708 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e17613 %T Promoting Healthy Eating Habits for College Students Through Creating Dietary Diaries via a Smartphone App and Social Media Interaction: Online Survey Study %A Watanabe-Ito,Masako %A Kishi,Emiko %A Shimizu,Yoko %+ Department of Public Health Nursing, School of Nursing, Toho University, 4-16-20 Omori-Nishi, Ota, Tokyo, 143-0015, Japan, 81 3 3762 9881 ext 418, masako.watanabe@med.toho-u.ac.jp %K health promotion %K college students %K eating habits %K social media %K smartphone app %D 2020 %7 31.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Youth in developed countries face the contradictory health problems of obesity and an excessive desire for weight loss. Developing a better health attitude for college students is essential as this period of life establishes future lifestyle and habits. Online interaction on social media can help to improve eating habits by creating dietary diaries through a smartphone app; however, the effects of such interactions for college students have not been examined to date. Objective: The aim of this study was to evaluate the potential effectiveness of social media interactions with the use of dietary diaries on a smartphone app to motivate college students in raising self-awareness of their eating habits. Methods: Forty-two college students in the greater Tokyo area of Japan participated in the study by creating dietary diaries online through a smartphone app and then followed/interacted with each other using social media for 7 consecutive days in September to November 2017. Online surveys were administered at baseline, immediately after creating the dietary diaries, and at 1-month follow up. Participants rated their degree of interest and self-evaluation of eating habits using 7-point scales, and answered multiple choice questions related to their thoughts in choosing meals/drinks among 10 topics. Free descriptions about their overall experience throughout the project were also collected in the follow-up survey. Results: Data from 38 participants who completed all processes were analyzed. Over time, the mean score for degree of interest in eating habits increased from 4.6 to 6.2 (P<.001), while the self-evaluation score decreased from 4.5 to 3.6 (P<.001); these significant differences remained after 1 month (5.3, P=.002; 4.1, P=0.04, respectively). A weak negative correlation (P=.009) was observed between scores for degree of interest and self-evaluation. Participants with lower scores for degree of interest at baseline tended to increase their interest level by more than 2 points above the average (P<.001). Participants gradually thought more about their eating habits from various perspectives when choosing a meal/drink, particularly with respect to maintaining well-balanced diets and introducing diverse ingredients. Participants evaluated their experiences as interesting/fun and reported familiarity with using the smartphone app and social media as the preferred method to keep track of their eating. All participants welcomed communication with fellow participants on social media and motivated each other, in addition to monitoring their eating habits through online dietary diaries. Some participants experienced difficulty, especially when they were busy or faced a lack of internet access. Conclusions: Through interactions on social media, college students experienced encouragement and developed an interest and critical thinking with respect to their eating habits. This approach, which embraces peer education and peer support with social media, holds promise for the future of youth health promotion. Further examination will be needed to explore how to sustain this level of heightened awareness. %M 32229468 %R 10.2196/17613 %U http://mhealth.jmir.org/2020/3/e17613/ %U https://doi.org/10.2196/17613 %U http://www.ncbi.nlm.nih.gov/pubmed/32229468 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e15642 %T Social Comparison Features in Physical Activity Promotion Apps: Scoping Meta-Review %A Arigo,Danielle %A Brown,Megan M %A Pasko,Kristen %A Suls,Jerry %+ Department of Psychology, Rowan University, 201 Mullica Hill Road, Robinson 116G, Glassboro, NJ, 08028, United States, 1 8562564500 ext 53775, Arigo@Rowan.edu %K smartphone app %K physical activity %K mHealth %K social comparison %K behavior change technique %D 2020 %7 27.3.2020 %9 Review %J J Med Internet Res %G English %X Background: Smartphone apps promoting physical activity (PA) are abundant, but few produce substantial and sustained behavior change. Although many PA apps purport to induce users to compare themselves with others (by invoking social comparison processes), improvements in PA and other health behaviors are inconsistent. Existing literature suggests that social comparison may motivate PA for some people under some circumstances. However, 2 aspects of work that apply social comparison theory to PA apps remain unclear: (1) how comparison processes have been operationalized or harnessed in existing PA apps and (2) whether incorporating sources of variability in response to comparison have been used to tailor comparison features of apps, which could improve their effectiveness for promoting PA. Objective: The aim of this meta-review was to summarize existing systematic, quantitative, and narrative reviews of behavior change techniques in PA apps, with an emphasis on social comparison features, to examine how social comparison is operationalized and implemented. Methods: We searched PubMed, Web of Science, and PsycINFO for reviews of PA smartphone apps. Of the 3743 initial articles returned, 26 reviews met the inclusion criteria. Two independent raters extracted the data from these reviews, including the definition of social comparison used to categorize app features, the percentage of apps categorized as inducing comparison, specific features intended to induce comparison, and any mention of tailoring comparison features. For reference, these data were also extracted for related processes (such as behavioral modeling, norm referencing, and social networking). Results: Of the included review articles, 31% (8/26) categorized app features as prompting social comparison. The majority of these employed Abraham and Michie’s earliest definition of comparison, which differs from versions in later iterations of the same taxonomy. Very few reviews specified what dimension users were expected to compare (eg, steps, physical fitness) or which features of the apps were used to induce comparison (eg, leaderboards, message boards). No review referenced tailoring of comparison features. In contrast, 54% (14/26) reviews categorized features for prompting behavioral modeling and 31% (8/26) referenced tailoring app features for users’ personal goals or preferences. Conclusions: The heterogeneity across reviews of PA apps and the absence of relevant information (eg, about dimensions or features relevant for comparison) create confusion about how to best harness social comparison to increase PA and its effectiveness in future research. No evidence was found that important findings from the broader social comparison literature (eg, that people have differing preferences for and responses to social comparison information) have been incorporated in the design of existing PA apps. Greater integration of the mobile health (mHealth) and social comparison literatures may improve the effectiveness of PA apps, thereby increasing the public health impact of these mHealth tools. International Registered Report Identifier (IRRID): RR2-https://osf.io/nh4td/ %M 32217499 %R 10.2196/15642 %U http://www.jmir.org/2020/3/e15642/ %U https://doi.org/10.2196/15642 %U http://www.ncbi.nlm.nih.gov/pubmed/32217499 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 3 %P e16461 %T Evaluating Mobile Apps and Biosensing Devices to Monitor Physical Activity and Respiratory Function in Smokers With and Without Respiratory Symptoms or Chronic Obstructive Pulmonary Disease: Protocol for a Proof-of-Concept, Open-Label, Feasibility Study %A Sharman,Almaz %A Zhussupov,Baurzhan %A Sharman,Dana %A Kim,Irina %+ Kazakhstan Academy of Preventive Medicine, 66 Klochkov Street, Office 101, Almaty, 050008, Kazakhstan, 7 7771114202, asharman@zdrav.kz %K COPD %K mobile health apps %K mHealth %K smokers %K feasibility study %D 2020 %7 26.3.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic obstructive pulmonary disease (COPD) is a global public health problem, and continuous monitoring is essential for both its management as well as the management of other chronic diseases. Telemonitoring using mobile health (mHealth) devices has the potential to promote self-management, improve control, increase quality of life, and prevent hospital admissions. Objective: This study aims to demonstrate whether a large-scale study assessing the use of mHealth devices to improve the treatment, assessment, compliance, and outcomes of chronic diseases, particularly COPD and cardio-metabolic syndrome, is feasible. This will allow our team to select the appropriate design and characteristics for our large-scale study. Methods: A total of 3 cohorts, with 9 participants in each, will use mHealth devices for 90 days while undergoing the current standard of care. These groups are: 9 “non-COPD,” otherwise healthy, smokers; 9 “grey zone” smokers (forced expiratory volume in 1 second/ forced vital capacity ≥0.70 after bronchodilator treatment; COPD Assessment Test ≥10); and 9 smokers diagnosed with Stage 1-3 COPD. Rates of recruitment, retention, and adherence will be measured. Overall, two mHealth devices will be utilized in the study: the AnaMed Original Equipment Manufacturer device (measures distance, energy expenditure, heart rate, and heart rate variability) and the Air Next mobile spirometry device. The mHealth devices will be compared against industry standards. Additionally, a questionnaire will be administered to assess the participants’ perceptions of the mHealth technologies used. Results: The inclusion of participants started in June 2019. Study results will be published in peer-reviewed scientific journals. Conclusions: This study will demonstrate whether a large-scale study to assess the use of mHealth devices to improve the treatment, assessment, compliance, and outcomes of chronic diseases, particularly COPD and cardio-metabolic syndrome, is feasible. It will also allow the research team to select the appropriate design and characteristics for the large-scale study. Trial Registration: ClinicalTrials.gov NCT04081961; https://clinicaltrials.gov/ct2/show/NCT04081961 International Registered Report Identifier (IRRID): DERR1-10.2196/16461 %M 32213479 %R 10.2196/16461 %U http://www.researchprotocols.org/2020/3/e16461/ %U https://doi.org/10.2196/16461 %U http://www.ncbi.nlm.nih.gov/pubmed/32213479 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e15294 %T Volumetric Food Quantification Using Computer Vision on a Depth-Sensing Smartphone: Preclinical Study %A Herzig,David %A Nakas,Christos T %A Stalder,Janine %A Kosinski,Christophe %A Laesser,Céline %A Dehais,Joachim %A Jaeggi,Raphael %A Leichtle,Alexander Benedikt %A Dahlweid,Fried-Michael %A Stettler,Christoph %A Bally,Lia %+ Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, University of Bern, Freiburgstrasse 15, Bern, 3010, Switzerland, 41 31 632 36 77, lia.bally@insel.ch %K depth camera %K computer vision %K dietary assessment %K smartphone %D 2020 %7 25.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Quantification of dietary intake is key to the prevention and management of numerous metabolic disorders. Conventional approaches are challenging, laborious, and lack accuracy. The recent advent of depth-sensing smartphones in conjunction with computer vision could facilitate reliable quantification of food intake. Objective: The objective of this study was to evaluate the accuracy of a novel smartphone app combining depth-sensing hardware with computer vision to quantify meal macronutrient content using volumetry. Methods: The app ran on a smartphone with a built-in depth sensor applying structured light (iPhone X). The app estimated weight, macronutrient (carbohydrate, protein, fat), and energy content of 48 randomly chosen meals (breakfasts, cooked meals, snacks) encompassing 128 food items. The reference weight was generated by weighing individual food items using a precision scale. The study endpoints were (1) error of estimated meal weight, (2) error of estimated meal macronutrient content and energy content, (3) segmentation performance, and (4) processing time. Results: In both absolute and relative terms, the mean (SD) absolute errors of the app’s estimates were 35.1 g (42.8 g; relative absolute error: 14.0% [12.2%]) for weight; 5.5 g (5.1 g; relative absolute error: 14.8% [10.9%]) for carbohydrate content; 1.3 g (1.7 g; relative absolute error: 12.3% [12.8%]) for fat content; 2.4 g (5.6 g; relative absolute error: 13.0% [13.8%]) for protein content; and 41.2 kcal (42.5 kcal; relative absolute error: 12.7% [10.8%]) for energy content. Although estimation accuracy was not affected by the viewing angle, the type of meal mattered, with slightly worse performance for cooked meals than for breakfasts and snacks. Segmentation adjustment was required for 7 of the 128 items. Mean (SD) processing time across all meals was 22.9 seconds (8.6 seconds). Conclusions: This study evaluated the accuracy of a novel smartphone app with an integrated depth-sensing camera and found highly accurate volume estimation across a broad range of food items. In addition, the system demonstrated high segmentation performance and low processing time, highlighting its usability. %M 32209531 %R 10.2196/15294 %U http://mhealth.jmir.org/2020/3/e15294/ %U https://doi.org/10.2196/15294 %U http://www.ncbi.nlm.nih.gov/pubmed/32209531 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e17208 %T A Mobile Health Intervention for Mental Health Promotion Among University Students: Randomized Controlled Trial %A Bendtsen,Marcus %A Müssener,Ulrika %A Linderoth,Catharina %A Thomas,Kristin %+ Linköping University, 581 83 Linköping, Linköping, Sweden, 46 13282546, kristin.thomas@liu.se %K mHealth %K positive mental health %K university students %K randomized controlled trial %D 2020 %7 20.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: High positive mental health, including the ability to cope with the normal stresses of life, work productively, and be able to contribute to one’s community, has been associated with various health outcomes. The role of positive mental health is therefore increasingly recognized in national mental health promotion programs and policies. Mobile health (mHealth) interventions could be a cost-effective way to disseminate positive psychological interventions to the general population. Objective: The aim of this study was to estimate the effect of a fully automated mHealth intervention on positive mental health, and anxiety and depression symptomology among Swedish university students using a randomized controlled trial design. Methods: A 2-arm, single-blind (researchers), parallel-groups randomized controlled trial with an mHealth positive psychology program intervention group and a relevant online mental health information control group was employed to estimate the effect of the novel intervention. Participants were recruited using digital advertising through student health care centers in Sweden. Inclusion criteria were (1) university students, (2) able to read and understand Swedish, (3) and have access to a mobile phone. Exclusion criteria were high positive mental health, as assessed by the Mental Health Continuum Short Form (MHC-SF), or high depression and anxiety symptomology, as assessed by the Hospital Anxiety Depression Scale (HADS). The primary outcome was positive mental health (MHC-SF), and the secondary outcomes were depression and anxiety symptomatology (HADS). The subscales of MHC-SF were also analyzed as exploratory outcomes. Outcomes were measured 3 months after randomization through questionnaires completed on the participants’ mobile phones. Results: A total of 654 participants (median age 25 years), including 510 (78.0%) identifying as female, were randomized to either the intervention (n=348) or control group (n=306). At follow-up, positive mental health was significantly higher in the intervention group compared with the control group (incidence rate ratio [IRR]=1.067, 95% CI 1.024-1.112, P=.002). For both depression and anxiety symptomatology, the intervention group showed significantly lower scores at follow-up compared with the control group (depression: IRR=0.820, 95% CI 0.714-0.942, P=.005; anxiety: IRR=0.899, 95% CI 0.840-0.962, P=.002). Follow-up rates were lower than expected (58.3% for primary outcomes and 52.3% for secondary outcomes); however, attrition analyses did not identify any systematic attrition with respect to baseline variables. Conclusions: The mHealth intervention was estimated to be superior to usual care in increasing positive mental health among university students. A protective effect of the intervention was also found on depressive and anxiety symptoms. These findings demonstrate the feasibility of using an automated mobile phone format to enhance positive mental health, which offers promise for the use of mHealth solutions in public mental health promotion. Trial Registration: International Standard Randomized Controlled Trial Registry ISRCTN54748632; http://www.isrctn.com/ISRCTN54748632 %M 32196462 %R 10.2196/17208 %U http://mhealth.jmir.org/2020/3/e17208/ %U https://doi.org/10.2196/17208 %U http://www.ncbi.nlm.nih.gov/pubmed/32196462 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e17046 %T Mobile Apps for Health Behavior Change in Physical Activity, Diet, Drug and Alcohol Use, and Mental Health: Systematic Review %A Milne-Ives,Madison %A Lam,Ching %A De Cock,Caroline %A Van Velthoven,Michelle Helena %A Meinert,Edward %+ Digitally Enabled Preventative Health Research Group, Department of Paediatrics, University of Oxford, Headley Way, Headington, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom, 44 7824446808, e.meinert14@imperial.ac.uk %K telemedicine %K evidence-based medicine %K mobile health %K digital health %K mobile applications %K app %K cell phone %K smartphone %K mobile phone %K health behavior %K intervention %K behavior change %K systematic review %D 2020 %7 18.3.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: With a growing focus on patient interaction with health management, mobile apps are increasingly used to deliver behavioral health interventions. The large variation in these mobile health apps—their target patient group, health behavior, and behavioral change strategies—has resulted in a large but incohesive body of literature. Objective: This systematic review aimed to assess the effectiveness of mobile apps in improving health behaviors and outcomes and to examine the inclusion and effectiveness of behavior change techniques (BCTs) in mobile health apps. Methods: PubMed, EMBASE, CINAHL, and Web of Science were systematically searched for articles published between 2014 and 2019 that evaluated mobile apps for health behavior change. Two authors independently screened and selected studies according to the eligibility criteria. Data were extracted and the risk of bias was assessed by one reviewer and validated by a second reviewer. Results: A total of 52 randomized controlled trials met the inclusion criteria and were included in the analysis—37 studies focused on physical activity, diet, or a combination of both, 11 on drug and alcohol use, and 4 on mental health. Participant perceptions were generally positive—only one app was rated as less helpful and satisfactory than the control—and the studies that measured engagement and usability found relatively high study completion rates (mean 83%; n=18, N=39) and ease-of-use ratings (3 significantly better than control, 9/15 rated >70%). However, there was little evidence of changed behavior or health outcomes. Conclusions: There was no strong evidence in support of the effectiveness of mobile apps in improving health behaviors or outcomes because few studies found significant differences between the app and control groups. Further research is needed to identify the BCTs that are most effective at promoting behavior change. Improved reporting is necessary to accurately evaluate the mobile health app effectiveness and risk of bias. %M 32186518 %R 10.2196/17046 %U http://mhealth.jmir.org/2020/3/e17046/ %U https://doi.org/10.2196/17046 %U http://www.ncbi.nlm.nih.gov/pubmed/32186518 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e16251 %T Pilot Study of a Multilevel Mobile Health App for Substance Use, Sexual Risk Behaviors, and Testing for Sexually Transmitted Infections and HIV Among Youth: Randomized Controlled Trial %A Cordova,David %A Munoz-Velazquez,Jaime %A Mendoza Lua,Frania %A Fessler,Kathryn %A Warner,Sydni %A Delva,Jorge %A Adelman,Nicole %A , %A Fernandez,Angela %A Bauermeister,Jose %+ School of Social Work, University of Michigan, 1080 S University Ave, Room 2772, Ann Arbor, MI, 48109, United States, 1 734 763 6201, cordovad@umich.edu %K youth %K mHealth %K illicit drugs %K sex behavior %K HIV %K primary care %D 2020 %7 17.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Preventing and reducing substance use disorders, sexually transmitted infections (STIs)/HIV, and teen pregnancy, and the associated risk behaviors (ie, substance use and sexual risk behaviors) among youth remain public health priorities in the United States. Equally important is improving the uptake of STI/HIV testing among the youth. Mobile health (mHealth) apps may be a solution to ameliorate these public health concerns; however, few mHealth preventive interventions have demonstrated efficacy in reducing substance use or sexual risk behaviors or improving the uptake of STI/HIV testing among the youth, particularly in clinic settings. Objective: This small-scale study aimed to examine the feasibility of conducting a pilot randomized controlled trial (RCT). We evaluated the effects of Storytelling 4 Empowerment (S4E), relative to enhanced usual practice, on the potential mechanisms by which behavior change occurs, namely clinician-youth risk communication, prevention knowledge, and substance use and sexual risk refusal self-efficacy. We also assessed the ability to measure targeted outcomes of past 30-day substance use (ie, alcohol, tobacco, and other drug use), condomless sex, and alcohol or drug use before sex, as well as the uptake of STI/HIV testing. Methods: Employing community-based participatory research principles, 50 youths aged 13 to 21 years were recruited from a youth-centered community health clinic in Southeast Michigan, randomized sequentially to either S4E or enhanced usual practice, and assessed at baseline, immediately postintervention, and 30 days postintervention. S4E consists of 3 modules, including alcohol and drug use, tobacco, and STI/HIV. Results: Relative to youth in the enhanced usual practice group, S4E participants demonstrated higher youth-clinician risk communication (mean 3.22, SD 1.67) and increases in prevention knowledge (∆ score mean 0.36, SD 0.51) and self-efficacy (∆ score mean 0.16, SD 0.47). In addition, youth in the S4E group showed reductions in the proportions of past 30-day overall substance use (Cohen h=0.71, 95% CI 0.15 to 1.27), as well as past 30-day alcohol (Cohen h=0.71, 95% CI 0.15 to 1.27), tobacco (Cohen h=0.17, 95% CI −0.39 to 0.73), and drug use (Cohen h=1.28, 95% CI 0.72 to 1.84). The results also suggest a reduction in the proportion of youths who reported past 30-day condomless sex (Cohen h=0.18, 95% CI −0.38 to 0.74) and alcohol use before sex (Cohen h=0.44, 95% CI −0.12 to 1.00). Finally, the findings also demonstrated an increase in the proportion of youths who reported STI/HIV testing over time (Cohen h=0.16, 95% CI −0.39 to 0.72). Conclusions: The findings suggest the feasibility of a small-scale pilot RCT. S4E demonstrated shifts in the hypothesized direction, reducing substance use, sexual risk behaviors, and improving the uptake of STI/HIV testing among youth in a clinic setting. The findings suggest that a larger RCT may be warranted. Trial Registration: ClinicalTrails.gov NCT03855410, https://clinicaltrials.gov/ct2/show/NCT03855410. %M 32181747 %R 10.2196/16251 %U https://mhealth.jmir.org/2020/3/e16251 %U https://doi.org/10.2196/16251 %U http://www.ncbi.nlm.nih.gov/pubmed/32181747 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e15927 %T Incorporating Behavioral Trigger Messages Into a Mobile Health App for Chronic Disease Management: Randomized Clinical Feasibility Trial in Diabetes %A Sittig,Scott %A Wang,Jing %A Iyengar,Sriram %A Myneni,Sahiti %A Franklin,Amy %+ School of Computing, University of South Alabama, 150 Jaguar Drive, Mobile, AL, 36688, United States, 1 2514607576, sittig@southalabama.edu %K mHealth %K persuasive technology %K Fogg behavior model %K triggers %K messages %K interactive health communication application %K self-efficacy %K social cognitive theory %K self-management %K knowledge %D 2020 %7 16.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although there is a rise in the use of mobile health (mHealth) tools to support chronic disease management, evidence derived from theory-driven design is lacking. Objective: The objective of this study was to determine the impact of an mHealth app that incorporated theory-driven trigger messages. These messages took different forms following the Fogg behavior model (FBM) and targeted self-efficacy, knowledge, and self-care. We assess the feasibility of our app in modifying these behaviors in a pilot study involving individuals with diabetes. Methods: The pilot randomized unblinded study comprised two cohorts recruited as employees from within a health care system. In total, 20 patients with type 2 diabetes were recruited for the study and a within-subjects design was utilized. Each participant interacted with an app called capABILITY. capABILITY and its affiliated trigger (text) messages integrate components from social cognitive theory (SCT), FBM, and persuasive technology into the interactive health communications framework. In this within-subjects design, participants interacted with the capABILITY app and received (or did not receive) text messages in alternative blocks. The capABILITY app alone was the control condition along with trigger messages including spark and facilitator messages. A repeated-measures analysis of variance (ANOVA) was used to compare adherence with behavioral measures and engagement with the mobile app across conditions. A paired sample t test was utilized on each health outcome to determine changes related to capABILITY intervention, as well as participants’ classified usage of capABILITY. Results: Pre- and postintervention results indicated statistical significance on 3 of the 7 health survey measures (general diet: P=.03; exercise: P=.005; and blood glucose: P=.02). When only analyzing the high and midusers (n=14) of capABILITY, we found a statistically significant difference in both self-efficacy (P=.008) and exercise (P=.01). Although the ANOVA did not reveal any statistically significant differences across groups, there is a trend among spark conditions to respond more quickly (ie, shorter log-in lag) following the receipt of the message. Conclusions: Our theory-driven mHealth app appears to be a feasible means of improving self-efficacy and health-related behaviors. Although our sample size is too small to draw conclusions about the differential impact of specific forms of trigger messages, our findings suggest that spark triggers may have the ability to cue engagement in mobile tools. This was demonstrated with the increased use of capABILITY at the beginning and conclusion of the study depending on spark timing. Our results suggest that theory-driven personalization of mobile tools is a viable form of intervention. Trial Registration: ClinicalTrials.gov NCT04132089; http://clinicaltrials.gov/ct2/show/NCT004122089 %M 32175908 %R 10.2196/15927 %U http://mhealth.jmir.org/2020/3/e15927/ %U https://doi.org/10.2196/15927 %U http://www.ncbi.nlm.nih.gov/pubmed/32175908 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e14435 %T Efficacy and Safety of an mHealth App and Wearable Device in Physical Performance for Patients With Hepatocellular Carcinoma: Development and Usability Study %A Kim,Yoon %A Seo,Jinserk %A An,So-Yeon %A Sinn,Dong Hyun %A Hwang,Ji Hye %+ Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, Republic of Korea, 82 2 3410 2818, jhlee.hwang@samsung.com %K mHealth %K hepatocellular carcinoma %K rehabilitation %K exercise %K physical fitness %K physical activity %D 2020 %7 11.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Exercise is predicted to have a positive effect among hepatocellular carcinoma (HCC) patients. However, these patients are hesitant to start and build up an exercise program for one major reason: the vague fear of developing hepatic decompensation, a potentially fatal condition that can lead to death. Integrating mobile health (mHealth) with individualized exercise programs could be a possible option for promoting physical capacity among HCC patients. Objective: The aim of this study was to evaluate the efficacy and safety of rehabilitation exercises, which have been individually prescribed via an mHealth app, on physical fitness, body composition, biochemical profile, and quality of life among HCC patients. Methods: A total of 37 HCC patients were enrolled in a 12-week course with an mHealth app program targeted to HCC patients. The wearable wristband device Neofit (Partron Co) was provided to participants, and recorded daily physical data, such as the number of steps, calorie expenditure, exercise time, and heart rate. Each participant was given an individualized rehabilitation exercise program that was prescribed and adjusted at the 6-week midintervention period based on the assessment results. At baseline, 6-week, and 12-week sessions, participants’ physical fitness levels (ie, 6-minute walk test, grip strength test, and 30-second chair stand test) were measured. Physical activity levels, as measured by the International Physical Activity Questionnaire-Short Form (IPAQ-SF); body composition (ie, body mass index, body fat percentage, and muscle mass); biochemical profiles; and quality of life, as measured by the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30, were assessed at baseline and at the end point. At the 6-week midpoint, exercise intensity was individually adjusted. Results: Of the 37 patients, 31 (84%) completed the 12-week intervention. Grip strength improved significantly after 12 weeks of the intervention. The 30-second chair stand test and the 6-minute walk test showed significant improvement from 0 to 6 weeks, from 0 to 12 weeks, and from 6 to 12 weeks. Muscle mass and the IPAQ-SF score increased significantly after 12 weeks of the intervention without biochemical deterioration. Conclusions: Following 12 weeks of mHealth care, including an individually prescribed rehabilitation exercise program, we saw significant improvements in physical fitness, body composition, and physical activity without any complication or biochemical deterioration among compensated HCC patients who had completed therapy. %M 32159517 %R 10.2196/14435 %U http://mhealth.jmir.org/2020/3/e14435/ %U https://doi.org/10.2196/14435 %U http://www.ncbi.nlm.nih.gov/pubmed/32159517 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e16467 %T Quantitative Screening of Cervical Cancers for Low-Resource Settings: Pilot Study of Smartphone-Based Endoscopic Visual Inspection After Acetic Acid Using Machine Learning Techniques %A Bae,Jung Kweon %A Roh,Hyun-Jin %A You,Joon S %A Kim,Kyungbin %A Ahn,Yujin %A Askaruly,Sanzhar %A Park,Kibeom %A Yang,Hyunmo %A Jang,Gil-Jin %A Moon,Kyung Hyun %A Jung,Woonggyu %+ Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Rm#709, 110 Bldg, 50 Unist-gil, Ulsan, 44919, Republic of Korea, 82 1084640110, wgjung@unist.ac.kr %K smartphone-based endoscope %K smartphone VIA %K machine learning %K cervical cancer screening %K low-resource settings %D 2020 %7 11.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Approximately 90% of global cervical cancer (CC) is mostly found in low- and middle-income countries. In most cases, CC can be detected early through routine screening programs, including a cytology-based test. However, it is logistically difficult to offer this program in low-resource settings due to limited resources and infrastructure, and few trained experts. A visual inspection following the application of acetic acid (VIA) has been widely promoted and is routinely recommended as a viable form of CC screening in resource-constrained countries. Digital images of the cervix have been acquired during VIA procedure with better quality assurance and visualization, leading to higher diagnostic accuracy and reduction of the variability of detection rate. However, a colposcope is bulky, expensive, electricity-dependent, and needs routine maintenance, and to confirm the grade of abnormality through its images, a specialist must be present. Recently, smartphone-based imaging systems have made a significant impact on the practice of medicine by offering a cost-effective, rapid, and noninvasive method of evaluation. Furthermore, computer-aided analyses, including image processing–based methods and machine learning techniques, have also shown great potential for a high impact on medicinal evaluations. Objective: In this study, we demonstrate a new quantitative CC screening technique and implement a machine learning algorithm for smartphone-based endoscopic VIA. We also evaluated the diagnostic performance and practicability of the approach based on the results compared to the gold standard and from physicians’ interpretation. Methods: A smartphone-based endoscope system was developed and applied to the VIA screening. A total of 20 patients were recruited for this study to evaluate the system. Overall, five were healthy, and 15 were patients who had shown a low to high grade of cervical intraepithelial neoplasia (CIN) from both colposcopy and cytology tests. Endoscopic VIA images were obtained before a loop electrosurgical excision procedure for patients with abnormal tissues, and their histology tissues were collected. Endoscopic VIA images were assessed by four expert physicians relative to the gold standard of histopathology. Also, VIA features were extracted from multiple steps of image processing techniques to find the differences between abnormal (CIN2+) and normal (≤CIN1). By using the extracted features, the performance of different machine learning classifiers, such as k-nearest neighbors (KNN), support vector machine, and decision tree (DT), were compared to find the best algorithm for VIA. After determining the best performing classifying model, it was used to evaluate the screening performance of VIA. Results: An average accuracy of 78%, with a Cohen kappa of 0.571, was observed for the evaluation of the system by four physicians. Through image processing, 240 sliced images were obtained from the cervicogram at each clock position, and five features of VIA were extracted. Among the three models, KNN showed the best performance for finding VIA within holdout 10-fold cross-validation, with an accuracy of 78.3%, area under the curve of 0.807, a specificity of 80.3%, and a sensitivity of 75.0%, respectively. The trained model performed using an unprovided data set resulted in an accuracy of 80.8%, specificity of 84.1%, and sensitivity of 71.9%. Predictions were visualized with intuitive color labels, indicating the normal/abnormal tissue using a circular clock-type segmentation. Calculating the overlapped abnormal tissues between the gold standard and predicted value, the KNN model overperformed the average assessments of physicians for finding VIA. Conclusions: We explored the potential of the smartphone-based endoscopic VIA as an evaluation technique and used the cervicogram to evaluate normal/abnormal tissue using machine learning techniques. The results of this study demonstrate its potential as a screening tool in low-resource settings. %M 32159521 %R 10.2196/16467 %U http://mhealth.jmir.org/2020/3/e16467/ %U https://doi.org/10.2196/16467 %U http://www.ncbi.nlm.nih.gov/pubmed/32159521 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 3 %P e13900 %T A Walking Intervention Supplemented With Mobile Health Technology in Low-Active Urban African American Women With Asthma: Proof-of-Concept Study %A Nyenhuis,Sharmilee M %A Balbim,Guilherme Moraes %A Ma,Jun %A Marquez,David X %A Wilbur,JoEllen %A Sharp,Lisa K %A Kitsiou,Spyros %+ Department of Medicine, University of Illinois at Chicago, 840 S Wood St, MC 719, Chicago, IL, 60612, United States, 1 312 413 1655, snyenhui@uic.edu %K activity trackers %K text message %K physical activity %K asthma %K African-American %K women %K mHealth %K smartphone %K mobile phone %D 2020 %7 11.3.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical inactivity is associated with worse asthma outcomes. African American women experience disparities in both physical inactivity and asthma relative to their white counterparts. We conducted a modified evidence-based walking intervention supplemented with mobile health (mHealth) technologies to increase physical activity (PA). Objective: This study aimed to assess the preliminary feasibility of a 7-week walking intervention modified for African American women with asthma. Methods: African American women with suboptimally controlled asthma were identified from a health system serving low-income minorities. At a baseline data collection visit, participants performed spirometry and incremental shuttle walk test, completed questionnaires, and were given an accelerometer to wear for 1 week. The intervention comprised an informational study manual and 3 in-person group sessions over 7 weeks, led by a nurse interventionist, in a community setting. The supplemental mHealth tools included a wearable activity tracker device (Fitbit Charge HR) and one-way text messages related to PA and asthma 3 times per week. A secure Web-based research platform, iCardia, was used to obtain Fitbit data in real time (wear time, moderate-to-vigorous physical activity [MVPA] and sedentary time) and send text messages. The feasibility of the intervention was assessed in the domains of recruitment capability, acceptability (adherence, retention, engagement, text messaging, acceptability, complaints, and concerns), and preliminary outcome effects on PA behavior (change in steps, duration, and intensity). Results: We approached 22 women, of whom 10 were eligible; 7 consented, enrolled and completed the study. Group session attendance was 71% (5/7), 86% (6/7), and 86% (6/7), respectively, across the 3 sessions. All participants completed evaluations at each group session. The women reported being satisfied or very satisfied with the program (eg, location, time, and materials). None of them had concerns about using, charging, or syncing the Fitbit device and app. Participants wore their Fitbit device for at least 10 hours per day in 44 out of the 49 intervention days. There was an increase in Fitbit-measured MVPA from week 1 (19 min/week, SD 14 min/week) to the last week of intervention (22 min/week, SD 12 min/week; Cohen d=0.24, 95% CI 0.1 to 6.4). A slight decrease in step count was observed from week 1 (8926 steps/day, SD 2156 steps/day) to the last week of intervention (8517 steps/day, SD 1612 steps/day; Cohen d=−0.21, 95% CI −876.9 to 58.9). Conclusions: The initial feasibility results of a 7-week community-based walking intervention tailored for African American women with asthma and supplemented with mHealth tools are promising. Modifications to recruitment, retention, and the intervention itself are needed. These findings support the need to conduct a further modified pilot trial to collect additional data on feasibility and estimate the efficacy of the intervention on asthma and PA outcomes. %M 32159520 %R 10.2196/13900 %U https://formative.jmir.org/2020/3/e13900 %U https://doi.org/10.2196/13900 %U http://www.ncbi.nlm.nih.gov/pubmed/32159520 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e17084 %T Quality of Life of Women After a First Diagnosis of Breast Cancer Using a Self-Management Support mHealth App in Taiwan: Randomized Controlled Trial %A Hou,I-Ching %A Lin,Hsin-Yi %A Shen,Shan-Hsiang %A Chang,King-Jen %A Tai,Hao-Chih %A Tsai,Ay-Jen %A Dykes,Patricia C %+ School of Nursing, National Yang-Ming University, Number 155, Section 2, Linong Street, Beitou District, Taipei City, 11221, Taiwan, 886 28267000 ext 7315, evita@ym.edu.tw %K breast cancer %K mHealth app %K self-management %K quality of life %D 2020 %7 4.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There are over 2 million newly diagnosed patients with breast cancer worldwide with more than 10,000 cases in Taiwan each year. During 2017-2018, the National Yang-Ming University, the Taiwan University of Science and Technology, and the Taiwan Breast Cancer Prevention Foundation collaborated to develop a breast cancer self-management support (BCSMS) mHealth app for Taiwanese women with breast cancer. Objective: The aim of this study was to investigate the quality of life (QoL) of women with breast cancer in Taiwan after using the BCSMS app. Methods: After receiving a first diagnosis of breast cancer, women with stage 0 to III breast cancer, who were recruited from social networking sites or referred by their oncologists or oncology case managers, were randomized 1:1 into intervention and control groups. Intervention group subjects used the BCSMS app and the control group subjects received usual care. Two questionnaires—the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire Core 30 (QLQ-C30) and the EORTC Breast Cancer-Specific Quality-of-Life Questionnaire (QLQ-BR23)—were distributed to subjects in both arms. Paper-based questionnaires were used at baseline; paper-based or Web-based questionnaires were used at 1.5-month and 3-month follow-up evaluations. All evaluations were self-assessed and anonymous, and participants were blinded to their allocation groups. Descriptive analysis, the Pearson chi-square test, analysis of variance, and the generalized estimating equation were used to analyze the data. Missing values, with and without multi-imputation techniques, were used for sensitivity analysis. Results: A total of 112 women were enrolled and randomly allocated to either the experimental group (n=53) or control group (n=59). The follow-up completion rate was 89.3% (100/112). The demographic data showed homogeneity between the two groups in age (range 50-64 years), breast cancer stage (stage II), marital status (married), working status (employed), and treatment status (receiving treatments). The mean total QoL summary scores from the QLQ-C30 (83.45 vs 82.23, P=.03) and the QLQ-BR23 (65.53 vs 63.13, P=.04) were significantly higher among the experimental group versus the control group, respectively, at 3 months. Conclusions: This research provides support for using a mobile health care app to promote the QoL among women in Taiwan after a first diagnosis of breast cancer. The BCSMS app could be used to support disease self-management, and further evaluation of whether QoL is sustained is warranted. Trial Registration: ClinicalTrials.gov NCT004174248; https://clinicaltrials.gov/ct2/show/NCT04174248 %M 32130181 %R 10.2196/17084 %U http://mhealth.jmir.org/2020/3/e17084/ %U https://doi.org/10.2196/17084 %U http://www.ncbi.nlm.nih.gov/pubmed/32130181 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 5 %N 1 %P e15030 %T Novel Digital Architecture of a “Low Carb Program” for Initiating and Maintaining Long-Term Sustainable Health-Promoting Behavior Change in Patients with Type 2 Diabetes %A Summers,Charlotte %A Curtis,Kristina %+ Diabetes Digital Media, Technology House, Sir William Lyons Road,, University of Warwick Science Park, Coventry, CV4 7EZ, United Kingdom, 44 07969091134, Charlotte@ddm.health %K type 2 diabetes %K behaviour change %K nutrition %K digital intervention %K low carb %K type 2 diabetes remission %K eHealth %D 2020 %7 4.3.2020 %9 Viewpoint %J JMIR Diabetes %G English %X Globally, the burden of noncommunicable diseases such as type 2 diabetes is crippling health care systems. Type 2 diabetes, a disease linked with obesity, affects 1 in every 30 people today and is expected to affect 1 in 10 people by 2030. Current provisions are struggling to manage the trajectory of type 2 diabetes prevalence. Offline, face-to-face education for patients with type 2 diabetes has shown to lack long-term impact or the capacity for widespread democratized adoption. Digitally delivered interventions have been developed for patients with type 2 diabetes, and the evidence shows that some interventions provide the capacity to support hyperpersonalization and real-time continuous support to patients, which can result in significant engagement and health outcomes. However, digital health app engagement is notoriously difficult to achieve. This paper reviews the digital behavior change architecture of the Low Carb Program and the application of health behavioral theory underpinning its development and use in scaling novel methods of engaging the population with type 2 diabetes and supporting long-term behavior change. %M 32130113 %R 10.2196/15030 %U http://diabetes.jmir.org/2020/1/e15030/ %U https://doi.org/10.2196/15030 %U http://www.ncbi.nlm.nih.gov/pubmed/32130113 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e14118 %T A Mobile Phone Intervention to Improve Obesity-Related Health Behaviors of Adolescents Across Europe: Iterative Co-Design and Feasibility Study %A Martin,Anne %A Caon,Maurizio %A Adorni,Fulvio %A Andreoni,Giuseppe %A Ascolese,Antonio %A Atkinson,Sarah %A Bul,Kim %A Carrion,Carme %A Castell,Conxa %A Ciociola,Valentina %A Condon,Laura %A Espallargues,Mireia %A Hanley,Janet %A Jesuthasan,Nithiya %A Lafortuna,Claudio L %A Lang,Alexandra %A Prinelli,Federica %A Puidomenech Puig,Elisa %A Tabozzi,Sarah A %A McKinstry,Brian %+ UK Medical Research Council / Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX, United Kingdom, 44 141353 ext 7603, Anne.Martin@glasgow.ac.uk %K health behavior %K obesity %K co-design %K mHealth %K mobile app %K mobile phone %K adolescents %K youth %K focus groups %D 2020 %7 2.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Promotion of physical activity, healthy eating, adequate sleep, and reduced sedentary behavior in adolescents is a major priority globally given the current increase in population health challenges of noncommunicable diseases and risk factors such as obesity. Adolescents are highly engaged with mobile technology, but the challenge is to engage them with mobile health (mHealth) technology. Recent innovations in mobile technology provide opportunities to promote a healthy lifestyle in adolescents. An increasingly utilized approach to facilitate increased engagement with mHealth technology is to involve potential users in the creation of the technology. Objective: This study aimed to describe the process of and findings from co-designing and prototyping components of the PEGASO Fit for Future (F4F) mHealth intervention for adolescents from different cultural backgrounds. Methods: A total of 74 adolescents aged 13 to 16 years from Spain, Italy, and the United Kingdom participated in the co-design of the PEGASO F4F technology. In 3 iterative cycles over 12 months, participants were involved in the co-design, refinement, and feasibility testing of a system consisting of diverse mobile apps with a variety of functions and facilities to encourage healthy weight–promoting behaviors. In the first iteration, participants attended a single workshop session and were presented with mock-ups or early-version prototypes of different apps for user requirements assessment and review. During the second iteration, prototypes of all apps were tested by participants for 1 week at home or school. In the third iteration, further developed prototypes were tested for 2 weeks. Participants’ user experience feedback and development ideas were collected through focus groups and completion of questionnaires. Results: For the PEGASO F4F technology to be motivating and engaging, participants suggested that it should (1) allow personalization of the interface, (2) have age-appropriate and easy-to-understand language (of icons, labels, instructions, and notifications), (3) provide easily accessible tutorials on how to use the app or navigate through a game, (4) present a clear purpose and end goal, (5) have an appealing and self-explanatory reward system, (6) offer variation in gamified activities within apps and the serious game, and (7) allow to seek peer support and connect with peers for competitive activities within the technology. Conclusions: Incorporating adolescents’ preferences, the PEGASO F4F technology combines the functions of a self-monitoring, entertainment, advisory, and social support tool. This was the first study demonstrating that it is possible to develop a complex mobile phone-based technological system applying the principles of co-design to mHealth technology with adolescents across 3 countries. The findings from this study informed the development of an mHealth system for healthy weight promotion to be tested in a controlled multinational pilot trial. %M 32130179 %R 10.2196/14118 %U https://mhealth.jmir.org/2020/3/e14118 %U https://doi.org/10.2196/14118 %U http://www.ncbi.nlm.nih.gov/pubmed/32130179 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e15346 %T A Culturally Relevant Smartphone-Delivered Physical Activity Intervention for African American Women: Development and Initial Usability Tests of Smart Walk %A Joseph,Rodney P %A Keller,Colleen %A Vega-López,Sonia %A Adams,Marc A %A English,Rebekah %A Hollingshead,Kevin %A Hooker,Steven P %A Todd,Michael %A Gaesser,Glenn A %A Ainsworth,Barbara E %+ Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 N 3rd St, Phoenix, AZ, 85004, United States, 1 6024960772, rodney.joseph@asu.edu %K eHealth %K mHealth %K exercise %K minority health %K primary prevention %K heart diseases %K African-American %D 2020 %7 2.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smart Walk is a culturally relevant, social cognitive theory–based, smartphone-delivered intervention designed to increase physical activity (PA) and reduce cardiometabolic disease risk among African American (AA) women. Objective: This study aimed to describe the development and initial usability testing results of Smart Walk. Methods: Smart Walk was developed in 5 phases. Phases 1 to 3 focused on initial intervention development, phase 4 involved usability testing, and phase 5 included intervention refinement based on usability testing results. In phase 1, a series of 9 focus groups with 25 AA women (mean age 38.5 years, SD 7.8; mean BMI 39.4 kg/m2, SD 7.3) was used to identify cultural factors associated with PA and ascertain how constructs of social cognitive theory can be leveraged in the design of a PA intervention. Phase 2 included the analysis of phase 1 qualitative data and development of the structured PA intervention. Phase 3 focused on the technical development of the smartphone app used to deliver the intervention. Phase 4 consisted of a 1-month usability trial of Smart Walk (n=12 women; mean age 35.0 years, SD 8.5; mean BMI 40 kg/m2, SD 5.0). Phase 5 included refinement of the intervention based on the usability trial results. Results: The 5-phase process resulted in the development of the Smart Walk smartphone-delivered PA intervention. This PA intervention was designed to target social cognitive theory constructs of behavioral capability, outcome expectations, social support, self-efficacy, and self-regulation and address deep structure sociocultural characteristics of collectivism, racial pride, and body appearance preferences of AA women. Key features of the smartphone app included (1) personal profile pages, (2) multimedia PA promotion modules (ie, electronic text and videos), (3) discussion boards, and (4) a PA self-monitoring tool. Participants also received 3 PA promotion text messages each week. Conclusions: The development process of Smart Walk was designed to maximize the usability, cultural relevance, and impact of the smartphone-delivered PA intervention. %M 32130198 %R 10.2196/15346 %U https://mhealth.jmir.org/2020/3/e15346 %U https://doi.org/10.2196/15346 %U http://www.ncbi.nlm.nih.gov/pubmed/32130198 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 1 %P e15487 %T Effectiveness of the ColorApp Mobile App for Health Education and Promotion for Colorectal Cancer: Quasi-Experimental Study %A Yaacob,Nor Azwany %A Mohamad Marzuki,Muhamad Fadhil %A Yaacob,Najib Majdi %A Ahmad,Shahrul Bariyah %A Abu Hassan,Muhammad Radzi %+ Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia, 60 9767 6622 ext 6621, azwany@usm.my %K colorectal cancer %K mobile app %K effectiveness %K knowledge %K attitude %D 2020 %7 25.2.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Lack of knowledge and poor attitude are barriers to colorectal cancer screening participation. Printed material, such as pamphlets and posters, have been the main approach in health education on disease prevention in Malaysia. Current information technology advancements have led to an increasing trend of the public reading from websites and mobile apps using their mobile phones. Thus, health information dissemination should also be diverted to websites and mobile apps. Increasing knowledge and awareness could increase screening participation and prevent late detection of diseases such as colorectal cancer. Objective: This study aimed to assess the effectiveness of the ColorApp mobile app in improving the knowledge and attitude on colorectal cancer among users aged 50 years and older, who are the population at risk for the disease in Kedah. Methods: A quasi-experimental study was conducted with 100 participants in Kedah, Malaysia. Participants from five randomly selected community empowerment programs in Kota Setar district were in the intervention group; Kuala Muda district was the control group. Participants were given a self-administered validated questionnaire on knowledge and attitudes toward colorectal cancer. A mobile app, ColorApp (Colorectal Cancer Application), was developed as a new educational tool for colorectal cancer prevention. The intervention group used the app for two weeks. The same questionnaire was redistributed to both groups after two weeks. The mean percentage scores for knowledge and attitude between groups were compared using repeated measure ANCOVA. Results: There was no significant difference in age, sex, highest education level, current occupation, and diabetic status between the two groups. The number of smokers was significantly higher in the intervention group compared with the control group and was controlled for during analysis. The intervention group showed a significantly higher mean knowledge score compared with the control group with regards to time (Huynh-Feldt: F1,95=19.81, P<.001). However, there was no significant difference in mean attitude scores between the intervention and control groups with regards to time (F1,95=0.36, P=.55). Conclusions: The ColorApp mobile app may be an adjunct approach in educating the public on colorectal cancer. %M 32130119 %R 10.2196/15487 %U https://humanfactors.jmir.org/2020/1/e15487 %U https://doi.org/10.2196/15487 %U http://www.ncbi.nlm.nih.gov/pubmed/32130119 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e14466 %T Using Goal-Directed Design to Create a Mobile Health App to Improve Patient Compliance With Hypertension Self-Management: Development and Deployment %A Duan,Huilong %A Wang,Zheyu %A Ji,Yumeng %A Ma,Li %A Liu,Fang %A Chi,Mingwei %A Deng,Ning %A An,Jiye %+ College of Biomedical Engineering and Instrument Science, Ministry of Education Key Laboratory of Biomedical Engineering, Zhejiang University, 38 Zheda Rd, Zhouyiqing Bldg 512, Yuquan Campus, Hangzhou, China, 86 571 2295 2693, zju.dengning@gmail.com %K goal-directed design %K smartphone %K mobile health %K patients %K hypertension self-management %K mobile phone %D 2020 %7 25.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hypertension is a lifestyle-induced chronic disease that threatens the lives of patients. Control of hypertension requires patients to follow self-management regimes; unfortunately, however, patient compliance with hypertension self-management is low, especially in developing countries. Improvement of patient compliance is premised on meeting patient needs. Mobile health apps are becoming increasingly popular for self-management of chronic diseases. However, few mobile apps have been designed to meet patient needs for hypertension self-management. Objective: The goal of this study was to develop a mobile health app to improve patient compliance with hypertension self-management and evaluate the effectiveness of the app in terms of patient compliance. Methods: The goal-directed design method was applied to guide study design. We divided the study into 4 stages. Stages 1 to 3 comprised the development process. To improve the applicability of the goal-directed design method to chronic disease management, we extracted elements of user models concerned with patient compliance and defined a concrete process for user modeling. In stage 1, personas of hypertensive patients were built using qualitative and quantitative methods. Clustering methods based on questionnaire responses were used to group patients. Qualitative interviews were conducted to identify the needs of different groups. In stage 2, several functional modules were designed to meet the needs of different groups based on the results from stage 1. In stage 3, prototypes of functional modules were designed and implemented as a real app. Stage 4 was the deployment process, in which we conducted a pilot study to investigate patient compliance after using the app. Patient compliance was calculated through the frequency with which they took blood pressure measurements. In addition, qualitative interviews were conducted to learn the underlying reasons for the compliance results. Results: In stage 1, patients were divided into 3 groups based on 82 valid questionnaire responses. Eighteen patients from the different groups (7, 5, and 6 patients) were interviewed, and the needs of the groups were summarized as follows: improve self-management ability, enhance self-management motivation, and receive self-management support. In stages 2 and 3, 6 functional modules were designed and implemented based on specified needs, and the usability of the app was improved through usability tests. In stage 4, 143 patients were recruited to use different versions of the app for 2 months. Results show that patient compliance improved as functional modules were added (P<.001) and was maintained at a high level (rate of 0.73). Interview results from 32 patients show that the design of the app met different needs; thus, patients were more compliant with it. Conclusions: This study developed a mobile health app for hypertension self-management using the goal-directed design method. The app proved to be effective for improving patient compliance with hypertension self-management. %M 32130161 %R 10.2196/14466 %U http://mhealth.jmir.org/2020/2/e14466/ %U https://doi.org/10.2196/14466 %U http://www.ncbi.nlm.nih.gov/pubmed/32130161 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 2 %P e16231 %T A Theoretically Based Mobile App to Increase Pre-Exposure Prophylaxis Uptake Among Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial %A Jones,Jeb %A Dominguez,Karen %A Stephenson,Rob %A Stekler,Joanne D %A Castel,Amanda D %A Mena,Leandro A %A Jenness,Samuel M %A Siegler,Aaron J %A Sullivan,Patrick S %+ Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 4047122275, jeb.jones@emory.edu %K men who have sex with men %K pre-exposure prophylaxis %K mobile health %K electronic health %K HIV %D 2020 %7 21.2.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: HealthMindr is a mobile phone HIV prevention app for men who have sex with men (MSM). In a previous pilot study, HealthMindr was found to be acceptable among users and to demonstrate preliminary effectiveness for increasing pre-exposure prophylaxis (PrEP) uptake among MSM. PrEP is a highly effective HIV prevention intervention; however, uptake remains low. Objective: The aim of this study will be to assess the efficacy of a mobile app for increasing PrEP uptake among MSM in the southern United States. Methods: In this randomized controlled trial, we will assess the efficacy of HealthMindr for increasing PrEP uptake among MSM in the following three southern US cities: Atlanta, Georgia; Jackson, Mississippi; and Washington, DC. In total, 657 men will be recruited and randomized to intervention and control arms in a 2:1 ratio. Participants in the intervention arm will receive access to the full HealthMindr app, with information and resources about PrEP (eg, frequently asked questions, risk assessment tool, and PrEP provider locator), other HIV prevention information, ability to order free HIV/sexually transmitted infection test kits, and additional resources related to substance use and mental health. Participants in the control arm will use the HealthMindr app but will only have access to the study timeline and a message center to communicate with study staff. Participants will complete quarterly surveys to assess self-reported PrEP uptake over 12 months of follow-up. Self-reported PrEP uptake will be verified by dried blood spot testing and/or uploading a photograph of a PrEP prescription. Results: Participant recruitment began in January 2020. Conclusions: This trial will determine whether the HealthMindr app can increase PrEP uptake among MSM in the southern United States. Trial Registration: ClinicalTrials.gov NCT03763942; https://clinicaltrials.gov/ct2/show/NCT03763942 International Registered Report Identifier (IRRID): PRR1-10.2196/16231 %M 32130178 %R 10.2196/16231 %U http://www.researchprotocols.org/2020/2/e16231/ %U https://doi.org/10.2196/16231 %U http://www.ncbi.nlm.nih.gov/pubmed/32130178 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e14457 %T Protecting Men Who Have Sex With Men From HIV Infection With an mHealth App for Partner Notification: Observational Study %A Yan,Xiangyu %A Lu,Zuhong %A Zhang,Bo %A Li,Yongjie %A Tang,Wenjun %A Zhang,Lingling %A Jia,Zhongwei %+ National Institute on Drug Dependence, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, , China, 86 10 82802457, urchinjj@163.com %K partner notification %K men who have sex with men %K sexual network %K mobile phone app %D 2020 %7 19.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Traditional partner notification methods have been implemented for HIV-infected patients, as well as HIV treatment, in order to identify people at risk of HIV infection, especially men who have sex with men (MSM), since they are more likely to have casual sex partners. These traditional methods have some limitations. Objective: Our study focused on developing an mHealth app to improve partner notification in practice for MSM; the study then focused on evaluating the effects of the app. Methods: We developed an mHealth app with different modules using Java and HTML5 and tested it in an MSM community to prevent HIV transmission. The HIV incidence stratified by different follow-up periods were calculated. Poisson regression and social networks were used to estimate the risk ratios and to identify the connection among MSM, respectively. Results: In addition to the partner notification module, which is the kernel of the app, we developed a test result self-query module to enable MSM to get their approved test results in a timely manner, a prompt and warning module to alert users to protect themselves from high-risk conditions, and a health education module to teach users more skills regarding HIV/AIDS prevention. Over a 1-year duration, a total of 3186 MSM used the app, of which 678 had at least two HIV test results since becoming app users; they were included in the final analysis. Among 678 users, a total of 6473 self-queries and 623 partner notifications were recorded, which identified 180 social networks of MSM app users. Those who used the partner notification function were more likely to have self-queries (P<.001). The 678 MSM app users covered 296.47 person-years and contributed to 20 HIV seroconversions; the cumulative HIV infection incidence was estimated as 6.75 per 100 person-years (95% CI 4.38-10.01). We found that the longer the app was used, the lower the HIV incidence (>5 months vs ≤5 months: 2.22 per 100 person-years vs 6.99 per 100 person-years; risk ratio 0.32, 95% CI 0.12- 0.87). Conclusions: The app developed in this study is consistent with the World Health Organization’s sensitivity and confidentiality recommendations; it has the potential to reduce the risk of HIV infection among MSM. %M 32130147 %R 10.2196/14457 %U http://mhealth.jmir.org/2020/2/e14457/ %U https://doi.org/10.2196/14457 %U http://www.ncbi.nlm.nih.gov/pubmed/32130147 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 1 %P e16131 %T Descriptive Evaluation and Accuracy of a Mobile App to Assess Fall Risk in Seniors: Retrospective Case-Control Study %A Rabe,Sophie %A Azhand,Arash %A Pommer,Wolfgang %A Müller,Swantje %A Steinert,Anika %+ Lindera GmbH, Kottbusser Damm 79, Berlin, 10967, Germany, 49 030 12085471, sophie.rabe@lindera.de %K falls %K seniors %K fall risk assessment %K app %K mHealth %K retrospective cohort study %K discriminative ability %D 2020 %7 14.2.2020 %9 Original Paper %J JMIR Aging %G English %X Background: Fall-risk assessment is complex. Based on current scientific evidence, a multifactorial approach, including the analysis of physical performance, gait parameters, and both extrinsic and intrinsic risk factors, is highly recommended. A smartphone-based app was designed to assess the individual risk of falling with a score that combines multiple fall-risk factors into one comprehensive metric using the previously listed determinants. Objective: This study provides a descriptive evaluation of the designed fall-risk score as well as an analysis of the app’s discriminative ability based on real-world data. Methods: Anonymous data from 242 seniors was analyzed retrospectively. Data was collected between June 2018 and May 2019 using the fall-risk assessment app. First, we provided a descriptive statistical analysis of the underlying dataset. Subsequently, multiple learning models (Logistic Regression, Gaussian Naive Bayes, Gradient Boosting, Support Vector Classification, and Random Forest Regression) were trained on the dataset to obtain optimal decision boundaries. The receiver operating curve with its corresponding area under the curve (AUC) and sensitivity were the primary performance metrics utilized to assess the fall-risk score's ability to discriminate fallers from nonfallers. For the sake of completeness, specificity, precision, and overall accuracy were also provided for each model. Results: Out of 242 participants with a mean age of 84.6 years old (SD 6.7), 139 (57.4%) reported no previous falls (nonfaller), while 103 (42.5%) reported a previous fall (faller). The average fall risk was 29.5 points (SD 12.4). The performance metrics for the Logistic Regression Model were AUC=0.9, sensitivity=100%, specificity=52%, and accuracy=73%. The performance metrics for the Gaussian Naive Bayes Model were AUC=0.9, sensitivity=100%, specificity=52%, and accuracy=73%. The performance metrics for the Gradient Boosting Model were AUC=0.85, sensitivity=88%, specificity=62%, and accuracy=73%. The performance metrics for the Support Vector Classification Model were AUC=0.84, sensitivity=88%, specificity=67%, and accuracy=76%. The performance metrics for the Random Forest Model were AUC=0.84, sensitivity=88%, specificity=57%, and accuracy=70%. Conclusions: Descriptive statistics for the dataset were provided as comparison and reference values. The fall-risk score exhibited a high discriminative ability to distinguish fallers from nonfallers, irrespective of the learning model evaluated. The models had an average AUC of 0.86, an average sensitivity of 93%, and an average specificity of 58%. Average overall accuracy was 73%. Thus, the fall-risk app has the potential to support caretakers in easily conducting a valid fall-risk assessment. The fall-risk score’s prospective accuracy will be further validated in a prospective trial. %M 32130111 %R 10.2196/16131 %U http://aging.jmir.org/2020/1/e16131/ %U https://doi.org/10.2196/16131 %U http://www.ncbi.nlm.nih.gov/pubmed/32130111 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 2 %P e16090 %T Development and Field Evaluation of the INTER-ACT App, a Pregnancy and Interpregnancy Coaching App to Reduce Maternal Overweight and Obesity: Mixed Methods Design %A Bogaerts,Annick %A Bijlholt,Margriet %A Mertens,Lotte %A Braeken,Marijke %A Jacobs,Bart %A Vandenberghe,Bert %A Ameye,Lieveke %A Devlieger,Roland %+ Department of Development and Regeneration, University of Leuven, O&N IV Herestraat 49 - bus 805, Leuven, 3000, Belgium, 32 16 19 31 27, annick.bogaerts@kuleuven.be %K pregnancy %K postpartum %K coaching %K lifestyle %K mobile app %D 2020 %7 14.2.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The interpregnancy and pregnancy periods are important windows of opportunity to prevent excessive gestational weight retention. Despite an overwhelming number of existing health apps, validated apps to support a healthy lifestyle between and during pregnancies are lacking. Objective: To describe the development and evaluation of the INTER-ACT app, which is part of an interpregnancy and pregnancy lifestyle coaching module, to prevent excessive weight gain in pregnancy and enhance optimal weight and a healthy lifestyle in the interpregnancy period. Methods: A mixed methods design was used to identify the needs of health care providers and end users, according to 15 semistructured interviews, two focus groups, and two surveys. The user interface was evaluated in a pilot study (N=9). Results: Health care providers indicated that a mobile app can enhance a healthy lifestyle in pregnant and postpartum women. Pregnant women preferred graphic displays in the app, weekly notifications, and support messages according to their own goals. Both mothers and health care providers reported increased awareness and valued the combination of the app with face-to-face coaching. Conclusions: The INTER-ACT app was valued by its end users because it was offered in combination with face-to-face contact with a caregiver. %M 32130109 %R 10.2196/16090 %U http://formative.jmir.org/2020/2/e16090/ %U https://doi.org/10.2196/16090 %U http://www.ncbi.nlm.nih.gov/pubmed/32130109 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 2 %P e16087 %T Preferences for Sun Protection With a Self-Monitoring App: Protocol of a Discrete Choice Experiment Study %A Nittas,Vasileios %A Mütsch,Margot %A Puhan,Milo Alan %+ Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, 8001, Switzerland, 41 44 63 44946, vasileios.nittas@uzh.ch %K preventive medicine %K mobile health %K health informatics %K health economics %K patient preferences %K discrete choice experiment %D 2020 %7 8.2.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The incidence of sun-exposure-related skin conditions, such as melanoma, is a gradually increasing and largely preventable public health problem. Simultaneously, the availability of mobile apps that enable the self-monitoring of health behavior and outcomes is ever increasing. Inevitably, recent years have seen an emerging volume of electronic patient-generated health data (PGHD), as well as their targeted application across primary prevention areas, including sun protection and skin health. Despite their preventive potential, the actual impact of these apps relies on the engagement of health care consumers, who are primarily responsible for recording, sharing, and using their PGHD. Exploring preferences is a key step toward facilitating consumer engagement and ultimately realizing their potential. Objective: This paper describes an ongoing research project that aims to elicit the preferences of health care consumers for sun protection via app-based self-monitoring. Methods: A discrete choice experiment (DCE) will be conducted to explore how healthy consumers choose between two alternative preventive self-monitoring apps. DCE development and attribute selection were built on extensive qualitative work, consisting of the secondary use of a previously conducted scoping review, a rapid review of reviews, 13 expert interviews, and 12 health care consumer interviews, the results of which are reported in this paper. Following D-optimality criteria, a fractional factorial survey design was generated. The final DCE will be administered in the waiting room of a travel clinic, targeting a sample of 200 participants. Choice data will be analyzed with conditional logit and multinomial logit models, accounting for individual participant characteristics. Results: An ethics approval was waived by the Ethics Committee Zurich. The study started in September 2019 and estimated data collection and completion is set for January 2020. Five two-level attributes have been selected for inclusion in the DCE, addressing (1) data generation methods, (2) privacy control, (3) data sharing with general practitioner, (4) reminder timing, and (5) costs. Data synthesis, analysis, and reporting are planned for January and February 2020. Results are expected to be submitted for publication by February 2020. Conclusions: Our results will target technology developers, health care providers, and policy makers, potentially offering some guidance on how to design or use sun-protection-focused self-monitoring apps in ways that are responsive to consumer preferences. Preferences are ultimately linked to engagement and motivation, which are key elements for the uptake and success of digital health. Our findings will inform the design of person-centered apps, while also inspiring future preference-eliciting research in the field of emerging and complex eHealth services. International Registered Report Identifier (IRRID): PRR1-10.2196/16087 %M 32130187 %R 10.2196/16087 %U http://www.researchprotocols.org/2020/2/e16087/ %U https://doi.org/10.2196/16087 %U http://www.ncbi.nlm.nih.gov/pubmed/32130187 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e16062 %T From “Step Away” to “Stand Down”: Tailoring a Smartphone App for Self-Management of Hazardous Drinking for Veterans %A Blonigen,Daniel %A Harris-Olenak,Brooke %A Kuhn,Eric %A Humphreys,Keith %A Timko,Christine %A Dulin,Patrick %+ Department of Veterans Affairs Palo Alto Health Care System, 795 Willow Road, MPD-152, Menlo Park, CA, 94025, United States, 1 6504935000 ext 27828, daniel.blonigen@va.gov %K veterans %K hazardous drinking %K Step Away %K Stand Down %K peer support %D 2020 %7 13.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: US military veterans who screen positive for hazardous drinking during primary care visits may benefit from a mobile app. Step Away is an evidence-based mobile intervention system for the self-management of hazardous drinking. However, Step Away was not designed for veterans, and differences between veterans and civilians could limit the reach and effectiveness of the app with this population. Objective: The primary objective of this study was to repurpose Step Away to address the needs and preferences of the veteran primary care population. The Method for Program Adaptation through Community Engagement (M-PACE) model was used to guide the adaptation process. This model can serve as a generalizable approach that other researchers and intervention developers can follow to systematically tailor mobile health tools for a new population. Methods: Veteran patients who screened positive for hazardous drinking during a primary care visit (n=12) and peer providers employed by the US Veterans Health Administration (n=11) were recruited to systematically review Step Away and provide feedback on its content and presentation via Web-based surveys and a semistructured interview. Participant feedback was reviewed through an iterative process by key stakeholders who adjudicated which suggested modifications to the app could enhance engagement and effectiveness with veterans while maintaining program integrity. Results: Usability ratings of the individual modules of Step Away were uniformly positive across patients and peers, as was the perceived utility of the app overall. Personalized feedback on the health consequences and costs of drinking, options for customization, and the measurement-based care capabilities of the app were viewed as facilitators of engagement. Conversely, lengthy text, small font, and a lack of interactive features were viewed as potential barriers with the older primary care population. Modifications to create a veteran version of the app (Stand Down: Think Before You Drink) included altering the appearance of the app to incorporate more veteran-centric content, adding links and options for resources and activities for veterans, and reducing the amount of text and adding veteran-specific references and common concerns and triggers for drinking in this population. Conclusions: The M-PACE model provided a systematic approach to repurpose Step Away to fit the needs and preferences of veteran primary care patients who engage in hazardous drinking. Stand Down may serve as an innovative, low-cost means of expanding access to care for veterans who engage in hazardous drinking. %M 32053118 %R 10.2196/16062 %U http://mhealth.jmir.org/2020/2/e16062/ %U https://doi.org/10.2196/16062 %U http://www.ncbi.nlm.nih.gov/pubmed/32053118 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e13747 %T Push Notifications From a Mobile App to Improve the Body Composition of Overweight or Obese Women: Randomized Controlled Trial %A Hernández-Reyes,Alberto %A Cámara-Martos,Fernando %A Molina Recio,Guillermo %A Molina-Luque,Rafael %A Romero-Saldaña,Manuel %A Moreno Rojas,Rafael %+ Department of Bromatology and Food Technology, University of Córdoba, Campus Rabanales, Ed Darwin - Anexo, Córdoba, 14014, Spain, 34 957212001, hdezreyes2013@gmail.com %K exercise %K text message %K mobile phone %K mHealth %K health behavior %K behavior maintenance %K physical activity %K push %D 2020 %7 12.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Technology—in particular, access to the Internet from a mobile device—has forever changed the way we relate to others and how we behave in our daily life settings. In recent years, studies have been carried out to analyze the effectiveness of different actions via mobile phone in the field of health: telephone calls, short message service (SMS), telemedicine, and, more recently, the use of push notifications. We have continued to explore ways to increase user interaction with mobile apps, one of the pending subjects in the area of mHealth. By analyzing the data produced by subjects during a clinical trial, we were able to extract behavior patterns and, according to them, design effective protocols in weight loss programs. Objective: A clinical trial was proposed to (1) evaluate the efficacy of push notifications in an intervention aimed at improving the body composition of adult women who are overweight or obese, through a dietary procedure, and (2) analyze the evolution of body composition based on push notifications and prescribed physical activity (PA). Methods: A two-arm randomized controlled trial was carried out. A sample size of 117 adult obese women attended a face-to-face, 30-minute consultation once a week for 6 months. All patients were supplied with an app designed for this study and a pedometer. The control group did not have access to functionalities related to the self-monitoring of weight at home, gamification, or prescription of PA. The intervention group members were assigned objectives to achieve a degree of compliance with diet and PA through exclusive access to specific functionalities of the app and push notifications. The same diet was prescribed for all patients. Three possible PA scenarios were studied for both the control and intervention groups: light physical activity (LPA), moderate physical activity (MPA), and intense physical activity (IPA). For the analysis of three or more means, the analysis of variance (ANOVA) of repeated means was performed to evaluate the effects of the intervention at baseline and at 3 and 6 months. Results: Receiving notifications during the intervention increased body fat loss (mean -12.9% [SD 6.7] in the intervention group vs mean -7.0% [SD 5.7] in the control group; P<.001) and helped to maintain muscle mass (mean -0.8% [SD 4.5] in the intervention group vs mean -3.2% [SD 2.8] in the control group; P<.018). These variations between groups led to a nonsignificant difference in weight loss (mean -7.9 kg [SD 3.9] in the intervention group vs mean -7.1 kg [SD 3.4] in the control group; P>.05). Conclusions: Push notifications have proven effective in the proposed weight loss program, leading women who received them to achieve greater loss of fat mass and a maintenance or increase of muscle mass, specifically among those who followed a program of IPA. Future interventions should include a longer evaluation period; the impact of different message contents, as well as message delivery times and frequency, should also be researched. Trial Registration: ClinicalTrials.gov NCT03911583; https://www.clinicaltrials.gov/ct2/show/NCT03911583 %M 32049065 %R 10.2196/13747 %U http://mhealth.jmir.org/2020/2/e13747/ %U https://doi.org/10.2196/13747 %U http://www.ncbi.nlm.nih.gov/pubmed/32049065 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e16715 %T Effect of a WeChat-Based Intervention (Run4Love) on Depressive Symptoms Among People Living With HIV in China: Randomized Controlled Trial %A Guo,Yan %A Hong,Y Alicia %A Cai,Weiping %A Li,Linghua %A Hao,Yuantao %A Qiao,Jiaying %A Xu,Zhimeng %A Zhang,Hanxi %A Zeng,Chengbo %A Liu,Cong %A Li,Yiran %A Zhu,Mengting %A Zeng,Yu %A Penedo,Frank J %+ Department of Health Administration and Policy, College of Health and Human Services, George Mason University, 4400 University Dr MS 1J3, Fairfax, VA, United States, 1 7039931929, yhong22@gmu.edu %K HIV %K depression %K mHealth %K WeChat %K randomized controlled trial %D 2020 %7 11.2.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: People living with HIV (PLWH) have high rates of depressive symptoms. However, only a few effective mental health interventions exist for this vulnerable population. Objective: The aim of this study was to assess the efficacy of a WeChat-based intervention, Run4Love, with a randomized controlled trial among 300 people living with HIV and depression (PLWHD) in China. Methods: We recruited PLWH from the HIV outpatient clinic in South China. Participants were screened based on the Center for Epidemiologic Studies-Depression (CES-D) scale. Those who scored 16 or higher were eligible to participate. A total of 300 eligible patients were enrolled. After obtaining informed consent from the participants, completion of a baseline survey, and collection of participants’ hair samples for measuring cortisol, the participants were randomly assigned to an intervention or a control group in a 1:1 ratio. The intervention group received the Run4Love program, delivered via the popular social media app WeChat. Cognitive behavioral stress management courses and weekly reminders of exercise were delivered in a multimedia format. Participants’ progress was monitored with timely and tailored feedback. The control group received usual care and a brochure on nutrition for PLWH. Data were collected at 3, 6, and 9 months. The primary outcome was depression, which was measured by a validated instrument. Results: Participants in the intervention and control groups were comparable at baseline; about 91.3% (139/150), 88.3% (132/150), and 86.7% (130/150) participants completed the 3-, 6-, and 9-month follow-ups, respectively. At the 3-month follow-up, a significant reduction in CES-D score was observed in the intervention group (from 23.9 to 17.7 vs from 24.3 to 23.8; mean difference=−5.77, 95% CI −7.82 to −3.71; P<.001; standard effect size d=0.66). The mean changes in CES-D score from baseline to the 6- and 9-month follow-ups between the two groups remained statistically significant. No adverse events were reported. Conclusions: The WeChat-based mobile health (mHealth) intervention Run4Love significantly reduced depressive symptoms among PLWHD, and the effect was sustained. An app-based mHealth intervention could provide a feasible therapeutic option for many PLWHD in resource-limited settings. Further research is needed to assess generalizability and cost-effectiveness of this intervention. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IPR-17012606; http://www.chictr.org.cn/showproj.aspx?proj=21019 (Archived by WebCite at https://www.webcitation.org/78Bw2vouF) %R 10.2196/16715 %U https://www.jmir.org/2020/2/e16715 %U https://doi.org/10.2196/16715 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e14661 %T International ResearchKit App for Women with Menstrual Pain: Development, Access, and Engagement %A Wang,Jiani %A Rogge,Alizé A %A Armour,Mike %A Smith,Caroline A %A D’Adamo,Christopher R %A Pischke,Claudia R %A Yen,Hung-Rong %A Wu,Mei-Yao %A Moré,Ari Ojeda Ocampo %A Witt,Claudia M %A Pach,Daniel %+ Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute for Social Medicine, Epidemiology and Health Economics, Luisenstraße 57, Berlin, 10117, Germany, 49 30450529011, daniel.pach@charite.de %K dysmenorrhea %K mHealth %K mobile applications %K acupressure %K pain %K behavior change techniques (BCTs) %K ResearchKit %K recruitment %D 2020 %7 11.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Primary dysmenorrhea is a common condition in women of reproductive age. A previous app-based study undertaken by our group demonstrated that a smartphone app supporting self-acupressure introduced by a health care professional can reduce menstrual pain. Objective: This study aims to evaluate whether a specific smartphone app is effective in reducing menstrual pain in 18- to 34-year-old women with primary dysmenorrhea in a self-care setting. One group of women has access to the full-featured study app and will be compared with 2 control groups who have access to fewer app features. Here, we report the trial design, app development, user access, and engagement. Methods: On the basis of the practical implications of the previous app-based study, we revised and reengineered the study app and included the ResearchKit (Apple Inc) framework. Behavior change techniques (BCTs) were implemented in the app and validated by expert ratings. User access was estimated by assessing recruitment progress over time. User evolution and baseline survey respondent rate were assessed to evaluate user engagement. Results: The development of the study app for a 3-armed randomized controlled trial required a multidisciplinary team. The app is accessible for the target population free of charge via the Apple App Store. In Germany, within 9 months, the app was downloaded 1458 times and 328 study participants were recruited using it without external advertising. A total of 98.27% (5157/5248) of the app-based baseline questions were answered. The correct classification of BCTs used in the app required psychological expertise. Conclusions: Conducting an innovative app study requires multidisciplinary effort. Easy access and engagement with such an app can be achieved by recruitment via the App Store. Future research is needed to investigate the determinants of user engagement, optimal BCT application, and potential clinical and self-care scenarios for app use. Trial Registration: ClinicalTrials.gov NCT03432611; https://clinicaltrials.gov/ct2/show/NCT03432611 (Archived by WebCite at http://www.webcitation.org/75LLAcnCQ). %M 32058976 %R 10.2196/14661 %U https://mhealth.jmir.org/2020/2/e14661 %U https://doi.org/10.2196/14661 %U http://www.ncbi.nlm.nih.gov/pubmed/32058976 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 1 %P e16926 %T Cancer Patients’ and Survivors’ Perceptions of the Calm App: Cross-Sectional Descriptive Study %A Huberty,Jennifer %A Puzia,Megan %A Eckert,Ryan %A Larkey,Linda %+ College of Health Solutions, Arizona State University, 550 3rd St, Phoenix, AZ, 85004, United States, 1 6028272456, jhuberty@asu.edu %K cancer %K cancer survivors %K mindfulness %K meditation %K consumer behavior %K mobile apps %K health %K mental health %D 2020 %7 10.2.2020 %9 Original Paper %J JMIR Cancer %G English %X Background: There is a need for tools to decrease cancer patients’ and survivors’ long-term symptom burden. Complementary strategies, such as meditation, can accompany pharmacologic therapy to improve symptoms. Although support programs with targeted content have wider reach, higher adherence, and greater impact, there are no consumer-based meditation apps designed specifically for cancer. Objective: This study aimed to gather information to advise the development of a cancer-specific meditation app in a small convenience sample of cancer patients and survivors who currently use the Calm app. Methods: Adult cancer patients and survivors who are Calm users (N=82) were recruited through the Daily Calm Facebook page. Participants completed a Web-based survey related to Calm app use and satisfaction, interest in and ideas for a cancer-specific Calm app, and demographic characteristics. Open-ended responses were inductively coded. Results: Participants were aged between 18 and 72 years (mean 48.60 years, SD 15.20), mostly female (77/82, 94%), white (65/79, 82%), and non-Hispanic (70/75, 93%), and reported using Calm at least 5 times per week (49/82, 60%). Although rates of satisfaction with current Calm components were high (between 65/82, 79% and 51/81, 63%), only 49% (40/82) of participants used guided meditations that they felt specifically helped with their cancer-related symptoms and survivorship, and 40% (33/82) would prefer more cancer-related content, with guided meditations for cancer-specific anxieties (eg, fear of recurrence; n=15) and coping with strong emotions (n=12) being the most common suggestions. A majority of participants (51/82, 62%) reported that they would be interested in becoming a member of a Calm cancer community (eg, in-app discussion boards: 41/46, 89%; and social media communities: 35/42, 83%). Almost half of the participants (37/82, 45%) reported that they would benefit from features that tracked symptoms in concurrence with app usage, but respondents were divided on whether this information should be shared with health care providers through the app (49/82, 60% would share). Conclusions: Responses suggest ways in which the current Calm app could be adapted to better fit cancer patients’ and survivors’ needs and preferences, including adding cancer-specific content, increasing the amount of content focusing on coping with strong emotions, developing communities for Calm users who are cancer patients and survivors, and including features that track cancer-related symptoms. Given differences in opinions about which features were desirable or would be useful, there is a clear need for future cancer-specific apps to be customizable (eg, ability to turn different features on or off). Although future research should address these topics in larger, more diverse samples, these data will serve as a starting point for the development of cancer-specific meditation apps and provide a framework for evaluating their effects. %R 10.2196/16926 %U http://cancer.jmir.org/2020/1/e16926/ %U https://doi.org/10.2196/16926 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 1 %P e15750 %T A Novel Mobile Phone App Intervention With Phone Coaching to Reduce Symptoms of Depression in Survivors of Women’s Cancer: Pre-Post Pilot Study %A Chow,Philip I %A Drago,Fabrizio %A Kennedy,Erin M %A Cohn,Wendy F %+ University of Virginia, 560 Ray C Hunt Dr, Charlottesville, VA, 22903, United States, 1 9244345401, philip.i.chow@gmail.com %K mobile apps %K mental health %K mHealth %K women %K cancer survivors %D 2020 %7 6.2.2020 %9 Original Paper %J JMIR Cancer %G English %X Background: Psychological distress is a major issue among survivors of women’s cancer who face numerous barriers to accessing in-person mental health treatments. Mobile phone app–based interventions are scalable and have the potential to increase access to mental health care among survivors of women’s cancer worldwide. Objective: This study aimed to evaluate the acceptability and preliminary efficacy of a novel app-based intervention with phone coaching in a sample of survivors of women’s cancer. Methods: In a single-group, pre-post, 6-week pilot study in the United States, 28 survivors of women’s cancer used iCanThrive, a novel app intervention that teaches skills for coping with stress and enhancing well-being, with added phone coaching. The primary outcome was self-reported symptoms of depression (Center for Epidemiologic Studies Depression Scale). Emotional self-efficacy and sleep disruption were also assessed at baseline, 6-week postintervention, and 4 weeks after the intervention period. Feedback obtained at the end of the study focused on user experience of the intervention. Results: There were significant decreases in symptoms of depression and sleep disruption from baseline to postintervention. Sleep disruption remained significantly lower at 4-week postintervention compared with baseline. The iCanThrive app was launched a median of 20.5 times over the intervention period. The median length of use was 2.1 min. Of the individuals who initiated the intervention, 87% (20/23) completed the 6-week intervention. Conclusions: This pilot study provides support for the acceptability and preliminary efficacy of the iCanThrive intervention. Future work should validate the intervention in a larger randomized controlled study. It is important to develop scalable interventions that meet the psychosocial needs of different cancer populations. The modular structure of the iCanThrive app and phone coaching could impact a large population of survivors of women’s cancer. %R 10.2196/15750 %U http://cancer.jmir.org/2020/1/e15750/ %U https://doi.org/10.2196/15750 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 2 %P e16929 %T Use of Apps to Promote Childhood Vaccination: Protocol for a Systematic Review %A Van Velthoven,Michelle Helena %A Milne-Ives,Madison %A de Cock,Caroline %A Mooney,Mary %A Meinert,Edward %+ Digitally Enabled PrevenTative Health (DEPTH) Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom, 44 7824446808, e.meinert14@imperial.ac.uk %K app %K smartphone technology %K vaccination %K vaccines %K immunization %K children %K mobile phone %D 2020 %7 5.2.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The decline in the uptake of routine childhood vaccinations has resulted in outbreaks of vaccine-preventable diseases. Vaccination apps can be used as a tool to promote immunization through the provision of reminders, dissemination of information, peer support, and feedback. Objective: The aim of this review is to systematically review the evidence on the use of apps to support childhood vaccination uptake, information storage, and record sharing. Methods: We will identify relevant papers by searching the following electronic databases: PubMed, Embase by Ovid, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Education Resources Information Center (ERIC). We will review the reference lists of those studies that we include to identify relevant additional papers not initially identified using our search strategy. In addition to the use of electronic databases, we will search for grey literature on the topic. The search strategy will include only terms relating to or describing the intervention, which is app use. As almost all titles and abstracts are in English, 100% of these will be reviewed, but retrieval will be confined to papers written in the English language. We will record the search outcome on a specifically designed record sheet. Two reviewers will select observational and intervention studies, appraise the quality of the studies, and extract the relevant data. All studies will involve the use of apps relating to child vaccinations. The primary outcome is the uptake of vaccinations. Secondary outcomes are as follows: (1) use of app for sharing of information and providing vaccination reminders and (2) use of app for storage of vaccination information; knowledge and decision making by parents regarding vaccination (ie, risks and benefits of vaccination); costs and cost-effectiveness of vaccination apps; use of the app and measures of usability (eg, usefulness, acceptability, and experiences of different users: parents and health care professionals); use of technical standards for development of the app; and adverse events (eg, data leaks and misinformation). We will exclude studies that do not study an app. We anticipate a limited scope for meta-analysis and will provide a narrative overview of findings and tabular summaries of extracted data. Results: This project was funded by the Sir David Cooksey Fellowship in Healthcare Translation at the University of Oxford, Oxford, United Kingdom. We will submit the full systematic review for publication in the Journal of Medical Internet Research. Conclusions: This review will follow, where possible, the Cochrane Collaboration and the Centre for Review and Dissemination methodologies for conducting systematic reviews. We will report our findings based on guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The review results will be used to inform the development of a vaccination app. International Registered Report Identifier (IRRID): PRR1-10.2196/16929 %M 32022694 %R 10.2196/16929 %U https://www.researchprotocols.org/2020/2/e16929 %U https://doi.org/10.2196/16929 %U http://www.ncbi.nlm.nih.gov/pubmed/32022694 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e14615 %T The Effect of Smartphone Apps Versus Supervised Exercise on Physical Activity, Cardiorespiratory Fitness, and Body Composition Among Individuals With Mild-to-Moderate Mobility Disability: Randomized Controlled Trial %A Berglind,Daniel %A Yacaman-Mendez,Diego %A Lavebratt,Catharina %A Forsell,Yvonne %+ Department of Global Public Health, Karolinska Institutet, Solnavägen 1E, Eugeniavägen 3, Solna, Stockholm, SE-171 76, Sweden, +46 703644797, daniel.berglind@ki.se %K mobility disability %K physical activity %K cardiorespiratory fitness %K exercise %K randomized controlled trial %K app %K smartphone %D 2020 %7 4.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adequate levels of physical activity (PA) and good cardiorespiratory fitness (CRF) are associated with profound health benefits for individuals with mobility disability (MD). Despite the vast amount of research published in the field of PA interventions, little attention has been given to individuals with MD. Objective: The aim of this study was to examine the efficacy of an app-based versus a supervised exercise and health coaching program to support adults with MD to increase levels of PA, CRF, and improve body composition. Methods: Participants with self-perceived MD, aged 18 to 45 years, were included in this 12-week parallel-group randomized controlled trial and allocated at random to an app-based intervention, using commercially available apps—the Swedish Military training app (FMTK), the Acupedo walking app, and the LogMyFood food photography app—or a supervised exercise and health coaching intervention, including 1 weekly supervised exercise session and healthy lifestyle coaching. The primary outcome was the level of moderate-to-vigorous PA (MVPA) measured with accelerometers. Secondary outcomes included CRF measured by a submaximal test performed on a stationary bicycle and body composition measured by bioelectrical impedance. All outcomes were measured at baseline, 6 weeks, and 12 weeks. Linear mixed-effect models were used to assess the between-group differences, as well as the within-group changes through time, in each intervention group. Results: A total of 110 participants with MD were randomized to an app-based intervention (n=55) or a supervised exercise and health intervention (n=55). The mean age of participants was 34.9 years (SD 6.1), and 81.8% (90/110) of the participants were women. CRF showed a moderate increase in both groups after 12 weeks—1.07 (95% CI –0.14 to 2.27) mL/kg/min increase in the app-based group and 1.76 (95% CI 0.70 to 2.83) mLkg/min increase in the supervised exercise group. However, the intention-to-treat analysis showed no significant differences between the groups in MVPA or CRF after 12 weeks. Waist circumference was significantly lower in the app-based intervention group. Conclusions: Commercially available apps increased levels of CRF and improved body composition over 12 weeks to the same extent as supervised exercise sessions, showing that both are equally effective. However, neither the app-based intervention nor the supervised exercise intervention increased MVPA. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 22387524; http://isrctn.com/ISRCTN22387524. %M 32014846 %R 10.2196/14615 %U https://mhealth.jmir.org/2020/2/e14615 %U https://doi.org/10.2196/14615 %U http://www.ncbi.nlm.nih.gov/pubmed/32014846 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e12665 %T A Mobile Health Team Challenge to Promote Stepping and Stair Climbing Activities: Exploratory Feasibility Study %A Liew,Seaw Jia %A Gorny,Alex Wilhelm %A Tan,Chuen Seng %A Müller-Riemenschneider,Falk %+ Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Tahir Foundation Building (Block MD1), 12 Science Drive 2, #09-01v, Singapore, 117549, Singapore, 65 6601 3122, ephmf@nus.edu.sg %K behavior %K health %K physical activity %K wearables %D 2020 %7 4.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) approaches are growing in popularity as a means of addressing low levels of physical activity (PA). Objective: This study aimed to determine the validity of wearables in measuring step count and floor count per day and assess the feasibility and effects of a 6-week team challenge intervention delivered through smartphone apps. Methods: Staff and students from a public university were recruited between 2015 and 2016. In phase 1, everyone wore a Fitbit tracker (Charge or Charge HR) and an ActiGraph for 7 days to compare daily step count estimated by the two devices under free-living conditions. They were also asked to climb 4 bouts of floors in an indoor stairwell to measure floor count which was compared against direct observation. In phase 2, participants were allocated to either a control or intervention group and received a Fitbit tracker synced to the Fitbit app. Furthermore, the intervention group participants were randomized to 4 teams and competed in 6 weekly (Monday to Friday) real-time challenges. A valid day was defined as having 1500 steps or more per day. The outcomes were as follows: (1) adherence to wearing the Fitbit (ie, number of days in which all participants in each group were classified as valid users aggregated across the entire study period), (2) mean proportion of valid participants over the study period, and (3) the effects of the intervention on step count and floor count determined using multiple linear regression models and generalized estimating equations (GEEs) for longitudinal data analysis. Results: In phase 1, 32 of 40 eligible participants provided valid step count data, whereas all 40 participants provided valid floor count data. The Fitbit trackers demonstrated high correlations (step count: Spearman ρ=0.89; P<.001; floor count: Spearman ρ=0.98; P<.001). The trackers overestimated step count (median absolute error: 17%) but accurately estimated floor count. In phase 2, 20 participants each were allocated to an intervention or control group. Overall, 24 participants provided complete covariates and valid PA data for analyses. Multiple linear regressions revealed that the average daily steps was 15.9% higher for the intervention group (95% CI −8.9 to 47.6; P=.21) during the final two intervention weeks; the average daily floors climbed was 39.4% higher (95% CI 2.4 to 89.7; P=.04). GEE results indicated no significant interaction effects between groups and the intervention week for weekly step count, whereas a significant effect (P<.001) was observed for weekly floor count. Conclusions: The consumer wearables used in this study provided acceptable validity in estimating stepping and stair climbing activities, and the mHealth-based team challenge interventions were feasible. Compared with the control group, the participants in the intervention group climbed more stairs, so this can be introduced as an additional PA promotion target in the context of mHealth strategies. Methodologically rigorous studies are warranted to further strengthen this study’s findings. %M 32014845 %R 10.2196/12665 %U https://mhealth.jmir.org/2020/2/e12665 %U https://doi.org/10.2196/12665 %U http://www.ncbi.nlm.nih.gov/pubmed/32014845 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 1 %P e16931 %T Mobile Apps for Health Behavior Change: Protocol for a Systematic Review %A Milne-Ives,Madison %A Lam,Ching %A Van Velthoven,Michelle Helena %A Meinert,Edward %+ Department of Paediatrics, Digitally Enabled Preventative Health Research Group, University of Oxford, John Radcliffe Hospital, Oxford, , United Kingdom, 44 7824446808, e.meinert14@imperial.ac.uk %K telemedicine %K mobile health %K mobile apps %K cell phone %K health behavior %K intervention %D 2020 %7 30.1.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The popularity and ubiquity of mobile apps have rapidly expanded in the past decade. With a growing focus on patient interaction with health management, mobile apps are increasingly used to monitor health and deliver behavioral interventions. The considerable variation in these mobile health apps, from their target patient group to their health behavior, and their behavioral change strategy, has resulted in a large but incohesive body of literature. Objective: The purpose of this protocol is to provide an overview of the current landscape, theories behind, and effectiveness of mobile apps for health behavior change. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols will be used to structure this protocol. The focus of the systematic review is guided by a population, intervention, comparator, and outcome framework. A systematic search of Medline, EMBASE, CINAHL, and Web of Science will be conducted. Two authors will independently screen the titles and abstracts of identified references and select studies according to the eligibility criteria. Any discrepancies will then be discussed and resolved. One reviewer will extract data into a standardized form, which will be validated by a second reviewer. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias tool, and a descriptive analysis will summarize the effectiveness of all the apps. Results: As of November 2019, the systematic review has been completed and is in peer review for publication. Conclusions: This systematic review will summarize the current mobile app technologies and their effectiveness, usability, and coherence with behavior change theory. It will identify areas of improvement (where there is no evidence of efficacy) and help inform the development of more useful and engaging mobile health apps. Trial Registration: PROSPERO CRD42019155604; https://tinyurl.com/sno4lcu International Registered Report Identifier (IRRID): PRR1-10.2196/16931 %M 32012109 %R 10.2196/16931 %U http://www.researchprotocols.org/2020/1/e16931/ %U https://doi.org/10.2196/16931 %U http://www.ncbi.nlm.nih.gov/pubmed/32012109 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e12884 %T Engaging Users in the Behavior Change Process With Digitalized Motivational Interviewing and Gamification: Development and Feasibility Testing of the Precious App %A Nurmi,Johanna %A Knittle,Keegan %A Ginchev,Todor %A Khattak,Fida %A Helf,Christopher %A Zwickl,Patrick %A Castellano-Tejedor,Carmina %A Lusilla-Palacios,Pilar %A Costa-Requena,Jose %A Ravaja,Niklas %A Haukkala,Ari %+ Discipline of Social Psychology, Faculty of Social Sciences, University of Helsinki, Unioninkatu 37, PO Box 54, Helsinki, 00014, Finland, 358 44 504484297, johanna.nurmi@helsinki.fi %K health app %K mHealth %K human-computer interaction %K prevention %K service design %K usability design %K intrinsic motivation %K reflective processes %K spontaneous processes %K engagement %K self-determination theory %K autonomous motivation %K gamification %K physical activity %D 2020 %7 30.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Most adults do not engage in sufficient physical activity to maintain good health. Smartphone apps are increasingly used to support physical activity but typically focus on tracking behaviors with no support for the complex process of behavior change. Tracking features do not engage all users, and apps could better reach their targets by engaging users in reflecting their reasons, capabilities, and opportunities to change. Motivational interviewing supports this active engagement in self-reflection and self-regulation by fostering psychological needs proposed by the self-determination theory (ie, autonomy, competence, and relatedness). However, it is unknown whether digitalized motivational interviewing in a smartphone app engages users in this process. Objective: This study aimed to describe the theory- and evidence-based development of the Precious app and to examine how digitalized motivational interviewing using a smartphone app engages users in the behavior change process. Specifically, we aimed to determine if use of the Precious app elicits change talk in participants and how they perceive autonomy support in the app. Methods: A multidisciplinary team built the Precious app to support engagement in the behavior change process. The Precious app targets reflective processes with motivational interviewing and spontaneous processes with gamified tools, and builds on the principles of self-determination theory and control theory by using 7 relational techniques and 12 behavior change techniques. The feasibility of the app was tested among 12 adults, who were asked to interact with the prototype and think aloud. Semistructured interviews allowed participants to extend their statements. Participants’ interactions with the app were video recorded, transcribed, and analyzed with deductive thematic analysis to identify the theoretical themes related to autonomy support and change talk. Results: Participants valued the autonomy supportive features in the Precious app (eg, freedom to pursue personally relevant goals and receive tailored feedback). We identified the following five themes based on the theory-based theme autonomy support: valuing the chance to choose, concern about lack of autonomy, expecting controlling features, autonomous goals, and autonomy supportive feedback. The motivational interviewing features actively engaged participants in reflecting their outcome goals and reasons for activity, producing several types of change talk and very little sustain talk. The types of change talk identified were desire, need, reasons, ability, commitment, and taking steps toward change. Conclusions: The Precious app takes a unique approach to engage users in the behavior change process by targeting both reflective and spontaneous processes. It allows motivational interviewing in a mobile form, supports psychological needs with relational techniques, and targets intrinsic motivation with gamified elements. The motivational interviewing approach shows promise, but the impact of its interactive features and tailored feedback needs to be studied over time. The Precious app is undergoing testing in a series of n-of-1 randomized controlled trials. %M 32003750 %R 10.2196/12884 %U https://mhealth.jmir.org/2020/1/e12884 %U https://doi.org/10.2196/12884 %U http://www.ncbi.nlm.nih.gov/pubmed/32003750 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e12306 %T Feasibility and Health Benefits of an Individualized Physical Activity Intervention in Women With Metastatic Breast Cancer: Intervention Study %A Delrieu,Lidia %A Pialoux,Vincent %A Pérol,Olivia %A Morelle,Magali %A Martin,Agnès %A Friedenreich,Christine %A Febvey-Combes,Olivia %A Pérol,David %A Belladame,Elodie %A Clémençon,Michel %A Roitmann,Eva %A Dufresne,Armelle %A Bachelot,Thomas %A Heudel,Pierre Etienne %A Touillaud,Marina %A Trédan,Olivier %A Fervers,Béatrice %+ Department of Cancer and Environment, Léon Bérard Cancer Center, 28 rue Laënnec, Lyon, 69008, France, 33 0478782800, beatrice.fervers@lyon.unicancer.fr %K metastatic breast cancer %K physical activity %K activity trackers %K feasibility %K tumor progression %D 2020 %7 28.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is limited knowledge regarding the potential benefits of physical activity in patients with metastatic breast cancer. Objective: The Advanced stage Breast cancer and Lifestyle Exercise (ABLE) Trial aimed to assess the feasibility of a physical activity intervention in women with metastatic breast cancer and to explore the effects of physical activity on functional, psychological, and clinical parameters. Methods: The ABLE Trial was a single-arm, 6-month intervention study with a home-based, unsupervised, and personalized walking program using an activity tracker. At baseline and 6 months, we assessed anthropometrics, functional fitness, physical activity level, sedentary behavior, quality of life, fatigue, and tumor progression. Paired proportions were compared using the McNemar test and changes of parameters during the intervention were analyzed using the Wilcoxon signed-rank test, the Mann-Whitney test, and Spearman rank correlations. Results: Overall, 49 participants (mean age 55 years; recruitment rate 94%) were enrolled and 96% adhered to the exercise prescription (attrition rate 2%). Statistically significant improvements in the 6-minute walking distance test (+7%, P<.001) and isometric quadriceps strength (+22%, P<.001), as well as decreases in body mass index (-2.5%, P=.03) and hip circumference (-4.0%, P<.001) were observed at 6 months. Quality of life remained stable and a nonstatistically significant decrease (-16%, P=.07) in fatigue was observed. Conclusions: The high recruitment and adherence rates suggest the willingness of patients with metastatic breast cancer to participate in a physical activity program. The beneficial outcomes regarding physical fitness and anthropometry of this unsupervised physical activity program may encourage these patients to maintain a physically active lifestyle. Future randomized controlled trials with larger sample sizes are warranted. Trial Registration: ClinicalTrials.gov NCT03148886; https://clinicaltrials.gov/ct2/show/NCT03148886 %M 32012082 %R 10.2196/12306 %U https://mhealth.jmir.org/2020/1/e12306 %U https://doi.org/10.2196/12306 %U http://www.ncbi.nlm.nih.gov/pubmed/32012082 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e12917 %T Development of a Mobile Phone App to Promote Safe Sex Practice Among Youth in Stockholm, Sweden: Qualitative Study %A Nielsen,Anna %A Bågenholm,Aspasia %A De Costa,Ayesha %+ Karolinska Institutet, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, 17176, Sweden, 46 704078496, anna.nielsen.1@ki.se %K mHealth %K youth %K sexual health %K condoms %K Sweden %D 2020 %7 28.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) has been shown to be effective in increasing knowledge of sexual health among youth. To date, evaluations mostly refer to interventions delivered via computer, email, and text messages. The possibility of downloading apps on mobile devices has opened up opportunities to develop engaging interventions on safe sexual health promotion. To attract young users and have them engage with a sexual health app, it is important to involve youth in intervention development. Objective: This study aimed to obtain input from youth on the content of a mobile phone app intended to promote safe sex and increase condom use among youth in Stockholm. Methods: This study was conducted at the Youth Health Clinics (YHC) in Stockholm County, Sweden. A total of 15 individual in-depth interviews and 2 focus group discussions (with youth aged 18-23 years) were conducted at the YHC in Stockholm. Areas explored were: (1) youth perceptions of condom use (advantages and obstacles), (2) perceptions of mHealth to promote safe sexual practices, and (3) content development for a mobile phone app to promote safe sex. Results: The smartphone app was developed based on the categories that emerged from the data. With regard to content, youth requested sex education, including information on sexually transmitted infections. In addition, condom-specific information, including practical usage technique, advice on how to have the condom talk, and how to decrease shame related to condom use, was requested. Youth suggested different modes to deliver the content, including text messages, movie clips, and push notifications. It was suggested that the tone of the messages delivered should be fun, entertaining, and supportive. The inputs from youth influenced the development of the following sections of the app: Condom Obstacles and Solutions; Quiz; Games; Self-Refection; Challenges; Stories by Peers (stories from peers and information from a doctor); Condom Tips, Pep Talk, and Boosting; and Random Facts. Conclusions: It is important to use input from youth when developing a smartphone intervention since the success of the intervention largely depends on the level of engagement and usage by youth. Furthermore, if proven efficient in increasing condom use, it is important that the development, including content and mode, is thoroughly described so that the intervention can be replicated. Likewise, if proven inefficient, it is important to learn from mistakes to improve and adjust the intervention. The effect of this smartphone app on safe sexual practices among youth is being evaluated in a pragmatic randomized controlled trial in Stockholm (ISRCTN13212899) and will be reported separately. %M 32012038 %R 10.2196/12917 %U https://formative.jmir.org/2020/1/e12917 %U https://doi.org/10.2196/12917 %U http://www.ncbi.nlm.nih.gov/pubmed/32012038 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 1 %P e15321 %T Functionality of Top-Rated Mobile Apps for Depression: Systematic Search and Evaluation %A Qu,Chengcheng %A Sas,Corina %A Daudén Roquet,Claudia %A Doherty,Gavin %+ School of Computing and Communications, Lancaster University, Bailrigg, Lancaster, LA1 4YW, United Kingdom, 44 01524510321, c.qu3@lancaster.ac.uk %K mobile apps %K depression %K review %K ethics %K mHealth %D 2020 %7 24.1.2020 %9 Review %J JMIR Ment Health %G English %X Background: In the last decade, there has been a proliferation of mobile apps claiming to support the needs of people living with depression. However, it is unclear what functionality is actually provided by apps for depression, or for whom they are intended. Objective: This paper aimed to explore the key features of top-rated apps for depression, including descriptive characteristics, functionality, and ethical concerns, to better inform the design of apps for depression. Methods: We reviewed top-rated iPhone OS (iOS) and Android mobile apps for depression retrieved from app marketplaces in spring 2019. We applied a systematic analysis to review the selected apps, for which data were gathered from the 2 marketplaces and through direct use of the apps. We report an in-depth analysis of app functionality, namely, screening, tracking, and provision of interventions. Of the initially identified 482 apps, 29 apps met the criteria for inclusion in this review. Apps were included if they remained accessible at the moment of evaluation, were offered in mental health–relevant categories, received a review score greater than 4.0 out of 5.0 by more than 100 reviewers, and had depression as a primary target. Results: The analysis revealed that a majority of apps specify the evidence base for their intervention (18/29, 62%), whereas a smaller proportion describes receiving clinical input into their design (12/29, 41%). All the selected apps are rated as suitable for children and adolescents on the marketplace, but 83% (24/29) do not provide a privacy policy consistent with their rating. The findings also show that most apps provide multiple functions. The most commonly implemented functions include provision of interventions (24/29, 83%) either as a digitalized therapeutic intervention or as support for mood expression; tracking (19/29, 66%) of moods, thoughts, or behaviors for supporting the intervention; and screening (9/29, 31%) to inform the decision to use the app and its intervention. Some apps include overtly negative content. Conclusions: Currently available top-ranked apps for depression on the major marketplaces provide diverse functionality to benefit users across a range of age groups; however, guidelines and frameworks are still needed to ensure users’ privacy and safety while using them. Suggestions include clearly defining the age of the target population and explicit disclosure of the sharing of users’ sensitive data with third parties. In addition, we found an opportunity for apps to better leverage digital affordances for mitigating harm, for personalizing interventions, and for tracking multimodal content. The study further demonstrated the need to consider potential risks while using depression apps, including the use of nonvalidated screening tools, tracking negative moods or thinking patterns, and exposing users to negative emotional expression content. %M 32012079 %R 10.2196/15321 %U https://mental.jmir.org/2020/1/e15321 %U https://doi.org/10.2196/15321 %U http://www.ncbi.nlm.nih.gov/pubmed/32012079 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 1 %P e14045 %T Tracking and Predicting Depressive Symptoms of Adolescents Using Smartphone-Based Self-Reports, Parental Evaluations, and Passive Phone Sensor Data: Development and Usability Study %A Cao,Jian %A Truong,Anh Lan %A Banu,Sophia %A Shah,Asim A %A Sabharwal,Ashutosh %A Moukaddam,Nidal %+ Menninger Department of Psychiatry, Baylor College of Medicine, 1504 Taub Loop, NPC Bldg, Houston, TX, 77030, United States, 1 7138735270, nidalm@bcm.edu %K SOLVD-Teen and SOLVD-Parent App %K adolescent depression %K smartphone monitoring %K self-evaluation %K parental input %K sensory data %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depression carries significant financial, medical, and emotional burden on modern society. Various proof-of-concept studies have highlighted how apps can link dynamic mental health status changes to fluctuations in smartphone usage in adult patients with major depressive disorder (MDD). However, the use of such apps to monitor adolescents remains a challenge. Objective: This study aimed to investigate whether smartphone apps are useful in evaluating and monitoring depression symptoms in a clinically depressed adolescent population compared with the following gold-standard clinical psychometric instruments: Patient Health Questionnaire (PHQ-9), Hamilton Rating Scale for Depression (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A). Methods: We recruited 13 families with adolescent patients diagnosed with MDD with or without comorbid anxiety disorder. Over an 8-week period, daily self-reported moods and smartphone sensor data were collected by using the Smartphone- and OnLine usage–based eValuation for Depression (SOLVD) app. The evaluations from teens’ parents were also collected. Baseline depression and anxiety symptoms were measured biweekly using PHQ-9, HAM-D, and HAM-A. Results: We observed a significant correlation between the self-evaluated mood averaged over a 2-week period and the biweekly psychometric scores from PHQ-9, HAM-D, and HAM-A (0.45≤|r|≤0.63; P=.009, P=.01, and P=.003, respectively). The daily steps taken, SMS frequency, and average call duration were also highly correlated with clinical scores (0.44≤|r|≤0.72; all P<.05). By combining self-evaluations and smartphone sensor data of the teens, we could predict the PHQ-9 score with an accuracy of 88% (23.77/27). When adding the evaluations from the teens’ parents, the prediction accuracy was further increased to 90% (24.35/27). Conclusions: Smartphone apps such as SOLVD represent a useful way to monitor depressive symptoms in clinically depressed adolescents, and these apps correlate well with current gold-standard psychometric instruments. This is a first study of its kind that was conducted on the adolescent population, and it included inputs from both teens and their parents as observers. The results are preliminary because of the small sample size, and we plan to expand the study to a larger population. %M 32012072 %R 10.2196/14045 %U http://mental.jmir.org/2020/1/e14045/ %U https://doi.org/10.2196/14045 %U http://www.ncbi.nlm.nih.gov/pubmed/32012072 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e14082 %T Use of Evidence-Based Best Practices and Behavior Change Techniques in Breast Cancer Apps: Systematic Analysis %A Kalke,Kerstin %A Ginossar,Tamar %A Bentley,Joshua M %A Carver,Hannah %A Shah,Sayyed Fawad Ali %A Kinney,Anita Y %+ Department of Communication Studies, Northwestern University, 633 Clark St, Evanston, IL, 60208, United States, 1 5054489363, kerstinkalke2023@u.northwestern.edu %K mHealth %K breast cancer %K mobile apps %K health behavior %K health apps %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Theoretically designed mobile health (mHealth) breast cancer interventions are essential for achieving positive behavior change. In the case of breast cancer, they can improve the health outcomes of millions of women by increasing prevention and care efforts. However, little is known about the theoretical underpinnings of breast cancer apps available to the general public. Objective: Given that theories may strengthen mHealth interventions, this study aimed to identify breast cancer apps designed to support behavior change, to assess the extent to which they address content along the cancer care continuum and contain behavior change techniques, and to assess the degree to which star rating is related to theory-based design. Methods: Using a criteria-based screening process, we searched 2 major app stores for breast cancer apps designed to promote behavior change. Apps were coded for content along the cancer care continuum and analyzed for behavior change techniques. The Mann-Whitney U test was used to examine the relationship between star ratings and the use of behavior change techniques in apps with star ratings compared to those without ratings. Results: The search resulted in a total of 302 apps, of which 133 were identified as containing breast cancer content. Only 9.9% (30/302) of apps supported behavior change and were further analyzed. These apps were disproportionally focused on behaviors to enhance early detection, whereas only a few apps supported care management, treatment, and posttreatment behaviors. Regarding theories, 63% (19/30) of apps customized content to users, 70% (21/30) established a health-behavior link, and 80% (24/30) provided behavior change instructions. Of the 30 apps, 15 (50%) prompted intention formation whereas less than half of the apps included goal setting (9/30, 30%) and goal reviewing (7/30, 23%). Most apps did not provide information on peer behavior (7/30, 23%) or allow for social comparison (6/30, 20%). None of the apps mobilized social norms. Only half of the apps (15/30, 50%) were user rated. The results of the Mann-Whitney U test showed that apps with star ratings contained significantly more behavior change techniques (median 6.00) than apps without ratings. The analysis of behavior change techniques used in apps revealed their shortcomings in the use of goal setting and social influence features. Conclusions: Our findings indicate that commercially available breast cancer apps have not yet fully realized their potential to promote behavior change, with only a minority of apps focusing on behavior change, and even fewer including theoretical design to support behavior change along the cancer care continuum. These shortcomings are likely limiting the effectiveness of apps and their ability to improve public health. More attention needs to be paid to the involvement of professionals in app development and adherence to theories and best practices in app design to support individuals along the cancer care continuum. %M 32012084 %R 10.2196/14082 %U https://mhealth.jmir.org/2020/1/e14082 %U https://doi.org/10.2196/14082 %U http://www.ncbi.nlm.nih.gov/pubmed/32012084 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 1 %P e15290 %T Existing Mobile Phone Apps for Self-Care Management of People With Alzheimer Disease and Related Dementias: Systematic Analysis %A Guo,Yuqi %A Yang,Fan %A Hu,Fei %A Li,Wei %A Ruggiano,Nicole %A Lee,Hee Yun %+ Social Welfare Program, School of Public Administration, Dongbei University of Finance and Economics, 219 Quanxue Hall, 217 Jianshan Street, Shaohekou District, Dalian, 116025, China, 86 41184710562, fyang10@dufe.edu.cn %K alzheimer disease %K dementia %K self-care %K mobile phone apps %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Aging %G English %X Background: Alzheimer disease and related dementias (AD/RD) are progressive neurocognitive disorders that currently affect approximately 50 million people worldwide. Mobile phone apps have been well-integrated into daily lives and can be used to deliver and promote health care. There is an increase in the use of technology to provide care and support to AD/RD patients and their families. Objective: This study aimed to review apps designed for AD/RD patients and analyze the benefits of, and challenges to, such technological solutions. Methods: A systematic approach was applied to review the availability, content, features, and quality of mobile phone apps to support self-care among AD/RD patients. Results: The initial search for this review was conducted in January 2019, and the screening and analysis of the included apps were completed in May 2019. A total of 14 apps were included from an initial search of 245 apps. The top 3 features were alert (9/14, 64%), self-care tips (6/14, 42%), and social networking capacity (5/14, 35%). On average, the readability of the apps was a tenth-grade reading level (SD 3.06). The overall quality was 3.71 out of 5 (SD 1.37). Conclusions: Our findings suggest that currently available apps for AD/RD patients may not meet complex needs and may be challenging to use, given the possible impaired communication ability associated with AD/RD. Therefore, high-quality apps need to be developed and rigorously evaluated for feasibility and efficacy. %M 32012045 %R 10.2196/15290 %U http://aging.jmir.org/2020/1/e15290/ %U https://doi.org/10.2196/15290 %U http://www.ncbi.nlm.nih.gov/pubmed/32012045 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e13273 %T Effect of mHealth With Offline Antiobesity Treatment in a Community-Based Weight Management Program: Cross-Sectional Study %A Kim,Youngin %A Oh,Bumjo %A Shin,Hyun-Young %+ Department of Family Medicine, Myongji Hospital, College of Medicine, Hanyang University, 697-24 Hwajung-dong, Deokyang-gu, Goyang-Si, Gyeonggi-do 10475, Republic of Korea, 82 1090501098, shydeborah@gmail.com %K obesity %K mobile apps %K mobile health %K weight loss %D 2020 %7 21.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Weight loss interventions using mobile phone apps have recently shown promising results. Objective: This study aimed to analyze the short-term weight loss effect of a mobile coaching intervention when it is integrated with a local public health care center and a regional hospital’s antiobesity clinic as a multidisciplinary model. Methods: A total of 150 overweight or obese adults signed up to complete an 8-week antiobesity intervention program with human coaching through a mobile platform. Paired t tests and multiple linear regression analysis were used to identify the intervention factors related to weight change. Results: Among the 150 participants enrolled in this study, 112 completed the 8-week weight loss intervention. Weight (baseline: mean 77.5 kg, SD 12.9; after intervention: mean 74.8 kg, SD 12.6; mean difference −2.73 kg), body mass index, waist circumference, fat mass (baseline: mean 28.3 kg, SD 6.6; after intervention: mean 25.7 kg, SD 6.3; mean difference −2.65 kg), and fat percentage all showed a statistically significant decrease, and metabolic equivalent of task (MET) showed a statistically significant increase after intervention. In multiple linear regression analysis, age (beta=.07; P=.06), △MET (beta=−.0009; P=.10), number of articles read (beta=−.01; P=.04), and frequency of weight records (beta=−.05; P=.10; R2=0.4843) were identified as significant factors of weight change. Moreover, age (beta=.06; P=.03), sex (female; beta=1.16; P=.08), △MET (beta=−.0009; P<.001), and number of articles read (beta=−.02; P<.001; R2=0.3728) were identified as significant variables of fat mass change. Conclusions: The multidisciplinary approach, combining a mobile health (mHealth) care app by health care providers, was effective for short-term weight loss. Additional studies are needed to evaluate the efficacy of mHealth care apps in obesity treatment. %M 31961335 %R 10.2196/13273 %U http://mhealth.jmir.org/2020/1/e13273/ %U https://doi.org/10.2196/13273 %U http://www.ncbi.nlm.nih.gov/pubmed/31961335 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e12516 %T Mobile Health Technology Interventions for Suicide Prevention: Systematic Review %A Melia,Ruth %A Francis,Kady %A Hickey,Emma %A Bogue,John %A Duggan,Jim %A O'Sullivan,Mary %A Young,Karen %+ School of Psychology, National University of Ireland Galway, Arts Millennium Building, Galway, H91 TK33, Ireland, 353 877710431, ruth.melia@hse.ie %K mHealth %K systematic review %D 2020 %7 15.1.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Digital interventions are proposed as one way by which effective treatments for self-harm and suicidal ideation may be improved and their scalability enhanced. Mobile devices offer a potentially powerful medium to deliver evidence-based interventions with greater specificity to the individual when the intervention is needed. The recent proliferation of publicly available mobile apps designed for suicide prevention underlines the need for robust evidence to promote safe practice. Objective: This review aimed to examine the effectiveness of currently available mobile health (mHealth) technology tools in reducing suicide-specific outcomes. Methods: The following databases were searched: Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, EMBASE, PsycINFO, and relevant sources of gray literature. All published and unpublished randomized controlled trials (RCTs), pseudo-RCTs, and pre-post observational studies that evaluated the effectiveness of mHealth technology in suicide prevention delivered via mobile computing and communication technology were included. Studies were included if they measured at least one suicide outcome variable (ie, suicidal ideation, suicidal intent, nonsuicidal self-injurious behavior, and suicidal behavior). A total of 2 review authors independently extracted data and assessed study suitability, in accordance with the Cochrane Collaboration Risk of Bias Tool, on July 31, 2018. Owing to the heterogeneity of outcomes found across studies, results were not amenable for pooled synthesis, and a meta-analysis was not performed. A narrative synthesis of the available research is presented here. Results: A total of 7 studies met criteria for inclusion . Four published articles that reported on the effectiveness of the following mobile phone apps were included: iBobbly, Virtual Hope Box, BlueIce, and Therapeutic Evaluative Conditioning. Results demonstrated some positive impacts for individuals at elevated risk of suicide or self-harm, including reductions in depression, psychological distress, and self-harm and increases in coping self-efficacy. None of the apps evaluated demonstrated the ability to significantly decrease suicidal ideation compared with a control condition. In addition, 3 unpublished and recently completed trials also met criteria for inclusion in the review. Conclusions: Further research is needed to evaluate the efficacy of stand-alone mHealth technology–based interventions in suicide prevention. The small number of studies reported in this review tentatively indicate that such tools may have a positive impact on suicide-specific outcomes. Future mHealth intervention evaluations would benefit from addressing the following 3 main methodological limitations : (1) heterogeneity of outcomes: a lack of standardized measurement of suicide outcomes across studies; (2) ecological validity: the tendency to exclude potential participants because of the elevated suicide risk may reduce generalizability within clinical settings; and (3) app regulation and definition: the lack of a standardized classification system for mHealth intervention type points to the need for better definition of the scope of such technologies to promote safe practice. Trial Registration: PROSPERO CRD42017072899; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=72899 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8635 %M 31939744 %R 10.2196/12516 %U https://mhealth.jmir.org/2020/1/e12516 %U https://doi.org/10.2196/12516 %U http://www.ncbi.nlm.nih.gov/pubmed/31939744 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e13133 %T A Mobile Phone App to Improve the Mental Health of Taxi Drivers: Single-Arm Feasibility Trial %A Davidson,Sandra %A Fletcher,Susan %A Wadley,Greg %A Reavley,Nicola %A Gunn,Jane %A Wade,Darryl %+ Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, 3053, Australia, 61 3 8344 7276, sdav@unimelb.edu.au %K mental health %K eHealth %K taxi drivers %K immigrant %K help-seeking behavior %K self-help %D 2020 %7 15.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Psychological distress among taxi drivers is 5 times higher than that in the general population, and more than half of all drivers have experienced 3 or more potentially traumatic events in their lifetime. Nevertheless, help-seeking for mental health problems in this male-dominated, predominately immigrant workforce is low. Mobile technologies have the potential to increase mental health awareness, teach self-help skills, and encourage help-seeking in this hard-to-reach population. Objective: This study aimed to assess the feasibility, acceptability, and potential efficacy of Driving to Health, a mobile phone–friendly mental health website app designed for people working as taxi drivers. Methods: Drivers (n=46) were recruited from the Melbourne Airport Taxi Holding Yard to participate in a single-arm trial. Self-reported, paper-based assessments were completed at baseline and at 1 month. Feasibility was measured by completion rates, representativeness of study participants, and levels of use. Acceptability was assessed by measuring users’ perception of the quality of the app and anticipated levels of future use. The efficacy of Driving to Health to increase awareness, self-help behaviors, and intentions to seek help was assessed using the user version of the Mobile App Rating Scale (uMARS) and the General Help-Seeking Questionnaire (GHSQ). Psychological symptoms were measured using the short form of the Depression, Anxiety, and Stress Scale (DASS-21). Data were analyzed using complete case analysis. Results: In total, 42 participants comprising drivers from 10 different countries of origin, and 14 different languages, completed pre- and poststudy measures (42/46, 91% completion rate). Just under half (45%) of all users used the app more than once with an average visit of 4 min 8 seconds. Responding to the uMARS, 62% (26/42) of the participants said that they would recommend the app to many people. Nearly all (40/42, 95%) participants said that Driving to Health increased awareness of their own mental health; 86% (36/42) said that it increased their mental health knowledge; and 76% (32/42) said that it increased their self-help behaviors. Increases in help-seeking intentions on the GHSQ were not significant, and increases on all 3 scales of DASS-21 were not reliable or meaningful. Conclusions: This study suggests that Driving to Health is an acceptable and feasible electronic health intervention for a hard-to-reach population. Our findings also suggest that Driving to Health results in increases in mental health awareness, behaviors, and willingness to seek help. %M 31939743 %R 10.2196/13133 %U https://mhealth.jmir.org/2020/1/e13133 %U https://doi.org/10.2196/13133 %U http://www.ncbi.nlm.nih.gov/pubmed/31939743 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 1 %P e15058 %T Early Signs Monitoring to Prevent Relapse in Psychosis and Promote Well-Being, Engagement, and Recovery: Protocol for a Feasibility Cluster Randomized Controlled Trial Harnessing Mobile Phone Technology Blended With Peer Support %A Gumley,Andrew %A Bradstreet,Simon %A Ainsworth,John %A Allan,Stephanie %A Alvarez-Jimenez,Mario %A Beattie,Louise %A Bell,Imogen %A Birchwood,Max %A Briggs,Andrew %A Bucci,Sandra %A Castagnini,Emily %A Clark,Andrea %A Cotton,Sue M %A Engel,Lidia %A French,Paul %A Lederman,Reeva %A Lewis,Shon %A Machin,Matthew %A MacLennan,Graeme %A Matrunola,Claire %A McLeod,Hamish %A McMeekin,Nicola %A Mihalopoulos,Cathrine %A Morton,Emma %A Norrie,John %A Reilly,Frank %A Schwannauer,Matthias %A Singh,Swaran P %A Smith,Lesley %A Sundram,Suresh %A Thomson,David %A Thompson,Andrew %A Whitehill,Helen %A Wilson-Kay,Alison %A Williams,Christopher %A Yung,Alison %A Farhall,John %A Gleeson,John %+ Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Fleming Pavilion, West of Scotland Science Park (Todd Campus), Glasgow, G20 0XA, United Kingdom, 44 141 330 4852, a.gumley@clinmed.gla.ac.uk %K schizophrenia %K psychosis %K relapse %K mHealth %K randomized controlled trial %D 2020 %7 9.1.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Relapse in schizophrenia is a major cause of distress and disability and is predicted by changes in symptoms such as anxiety, depression, and suspiciousness (early warning signs [EWSs]). These can be used as the basis for timely interventions to prevent relapse. However, there is considerable uncertainty regarding the implementation of EWS interventions. Objective: This study was designed to establish the feasibility of conducting a definitive cluster randomized controlled trial comparing Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery (EMPOWER) against treatment as usual (TAU). Our primary outcomes are establishing parameters of feasibility, acceptability, usability, safety, and outcome signals of a digital health intervention as an adjunct to usual care that is deliverable in the UK National Health Service and Australian community mental health service (CMHS) settings. We will assess the feasibility of candidate primary outcomes, candidate secondary outcomes, and candidate mechanisms for a definitive trial. Methods: We will randomize CMHSs to EMPOWER or TAU. We aim to recruit up to 120 service user participants from 8 CMHSs and follow them for 12 months. Eligible service users will (1) be aged 16 years and above, (2) be in contact with local CMHSs, (3) have either been admitted to a psychiatric inpatient service or received crisis intervention at least once in the previous 2 years for a relapse, and (4) have an International Classification of Diseases-10 diagnosis of a schizophrenia-related disorder. Service users will also be invited to nominate a carer to participate. We will identify the feasibility of the main trial in terms of recruitment and retention to the study and the acceptability, usability, safety, and outcome signals of the EMPOWER intervention. EMPOWER is a mobile phone app that enables the monitoring of well-being and possible EWSs of relapse on a daily basis. An algorithm calculates changes in well-being based on participants’ own baseline to enable tailoring of well-being messaging and clinical triage of possible EWSs. Use of the app is blended with ongoing peer support. Results: Recruitment to the trial began September 2018, and follow-up of participants was completed in July 2019. Data collection is continuing. The database was locked in July 2019, followed by analysis and disclosing of group allocation. Conclusions: The knowledge gained from the study will inform the design of a definitive trial including finalizing the delivery of our digital health intervention, sample size estimation, methods to ensure successful identification, consent, randomization, and follow-up of participants, and the primary and secondary outcomes. The trial will also inform the final health economic model to be applied in the main trial. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 99559262; http://isrctn.com/ISRCTN99559262 International Registered Report Identifier (IRRID): DERR1-10.2196/15058 %M 31917372 %R 10.2196/15058 %U https://www.researchprotocols.org/2020/1/e15058 %U https://doi.org/10.2196/15058 %U http://www.ncbi.nlm.nih.gov/pubmed/31917372 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e15359 %T Development of a Living Lab for a Mobile-Based Health Program for Korean-Chinese Working Women in South Korea: Mixed Methods Study %A Kim,Youlim %A Lee,Hyeonkyeong %A Lee,Mi Kyung %A Lee,Hyeyeon %A Jang,Hyoeun %+ Mo-im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 222283373, hlee39@yuhs.ac %K mHealth %K living lab %K intervention mapping %K health promotion %D 2020 %7 8.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Korean-Chinese (KC) women make up the largest group of female migrants in South Korea. To prevent and manage chronic diseases in middle-aged KC women working full time, it is necessary to develop health promotion programs that utilize an online platform because such a platform would allow individuals to participate in health promotion interventions at their convenience. Objective: This study aimed to develop a living lab for a mobile-based health (LLm Health) program focused on improving the physical activity and cultural adaptation of KC women workers. Methods: We used a mixed methods design. Living lab principles were factored into the LLm Health program, including the use of multiple methods, user engagement, multistakeholder participants, real-life settings, and cocreation. The program was developed using the 4 steps of the intervention mapping method: needs assessment, setting of objectives, identification of intervention strategies, and intervention design. Needs assessment was conducted through a literature review, focus group interviews with a total of 16 middle-aged KC women, and an online survey related to health promotion of migrant workers given to 38 stakeholders. KC middle-aged women participated in the early stages of program development and provided the idea of developing programs and mobile apps to enhance physical activity and acculturation. The mobile app developed in the program was validated with the help of 12 KC women and 4 experts, including 3 nursing professors and a professor of physical education. They were asked to rate each item based on content, interface design, and technology on a 4-point scale using a 23-item Smartphone App Evaluation Tool for Health Care. Results: The LLm Health program comprised a 24-week walking program using Fitbit devices, the mobile app, and social cognitive interventions. The mobile app contained 6 components: a step counter, an exercise timer, an online chat function, health information, level of cardiovascular risk, and health status. The cultural aspects and lifestyles of KC women were accommodated in the entire process of program development. The content validity of the mobile app was found to be 0.90 and 0.96 according to the 12 KC women and 4 experts, respectively. Conclusions: The mobile app was found to be valid and acceptable for KC women. The living lab approach was a useful strategy for developing a culturally adaptive LLm Health program for KC women workers, leading to their active participation in the overall research process, including needs assessment, program composition, and pre-evaluation. %M 31913134 %R 10.2196/15359 %U https://mhealth.jmir.org/2020/1/e15359 %U https://doi.org/10.2196/15359 %U http://www.ncbi.nlm.nih.gov/pubmed/31913134 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e13191 %T Why We Eat What We Eat: Assessing Dispositional and In-the-Moment Eating Motives by Using Ecological Momentary Assessment %A Wahl,Deborah Ronja %A Villinger,Karoline %A Blumenschein,Michael %A König,Laura Maria %A Ziesemer,Katrin %A Sproesser,Gudrun %A Schupp,Harald Thomas %A Renner,Britta %+ Psychological Assessment and Health Psychology, Department of Psychology, University of Konstanz, PO Box 47, Konstanz, 78457, Germany, 49 7531 88 3977, deborah.wahl@uni-konstanz.de %K mHealth %K eating %K motivation %K mobile app %K EMA %K in-the-moment %K disposition %K trait %K state %D 2020 %7 7.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Why do we eat? Our motives for eating are diverse, ranging from hunger and liking to social norms and affect regulation. Although eating motives can vary from eating event to eating event, which implies substantial moment-to-moment differences, current ways of measuring eating motives rely on single timepoint questionnaires that assess eating motives as situation-stable dispositions (traits). However, mobile technologies including smartphones allow eating events and motives to be captured in real time and real life, thus capturing experienced eating motives in-the-moment (states). Objective: This study aimed to examine differences between why people think they eat (trait motives) and why they eat in the moment of consumption (state motives) by comparing a dispositional (trait) and an in-the-moment (state) assessment of eating motives. Methods: A total of 15 basic eating motives included in The Eating Motivation Survey (ie, liking, habit, need and hunger, health, convenience, pleasure, traditional eating, natural concerns, sociability, price, visual appeal, weight control, affect regulation, social norms, and social image) were assessed in 35 participants using 2 methodological approaches: (1) a single timepoint dispositional assessment and (2) a smartphone-based ecological momentary assessment (EMA) across 8 days (N=888 meals) capturing eating motives in the moment of eating. Similarities between dispositional and in-the-moment eating motive profiles were assessed according to 4 different indices of profile similarity, that is, overall fit, shape, scatter, and elevation. Moreover, a visualized person × motive data matrix was created to visualize and analyze between- and within-person differences in trait and state eating motives. Results: Similarity analyses yielded a good overall fit between the trait and state eating motive profiles across participants, indicated by a double-entry intraclass correlation of 0.52 (P<.001). However, although trait and state motives revealed a comparable rank order (r=0.65; P<.001), trait motives overestimated 12 of 15 state motives (P<.001; d=1.97). Specifically, the participants assumed that 6 motives (need and hunger, price, habit, sociability, traditional eating, and natural concerns) are more essential for eating than they actually were in the moment (d>0.8). Furthermore, the visualized person × motive data matrix revealed substantial interindividual differences in intraindividual motive profiles. Conclusions: For a comprehensive understanding of why we eat what we eat, dispositional assessments need to be extended by in-the-moment assessments of eating motives. Smartphone-based EMAs reveal considerable intra- and interindividual differences in eating motives, which are not captured by single timepoint dispositional assessments. Targeting these differences between why people think they eat what they eat and why they actually eat in the moment may hold great promise for tailored mobile health interventions facilitating behavior changes. %M 31909719 %R 10.2196/13191 %U https://mhealth.jmir.org/2020/1/e13191 %U https://doi.org/10.2196/13191 %U http://www.ncbi.nlm.nih.gov/pubmed/31909719 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e15337 %T Usability Evaluations of Mobile Mental Health Technologies: Systematic Review %A Inal,Yavuz %A Wake,Jo Dugstad %A Guribye,Frode %A Nordgreen,Tine %+ Department of Information Science and Media Studies, University of Bergen, Fosswinckels Gate 6, Bergen, 5020, Norway, 47 41301855, yavuz.inal@uib.no %K systematic review %K mobile %K mHealth %K mental health %K usability evaluation %D 2020 %7 6.1.2020 %9 Review %J J Med Internet Res %G English %X Background: Many mobile health (mHealth) apps for mental health have been made available in recent years. Although there is reason to be optimistic about their effect on improving health and increasing access to care, there is a call for more knowledge concerning how mHealth apps are used in practice. Objective: This study aimed to review the literature on how usability is being addressed and measured in mHealth interventions for mental health problems. Methods: We conducted a systematic literature review through a search for peer-reviewed studies published between 2001 and 2018 in the following electronic databases: EMBASE, CINAHL, PsycINFO, PubMed, and Web of Science. Two reviewers independently assessed all abstracts against the inclusion and exclusion criteria, following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Results: A total of 299 studies were initially identified based on the inclusion keywords. Following a review of the title, abstract, and full text, 42 studies were found that fulfilled the criteria, most of which evaluated usability with patients (n=29) and health care providers (n=11) as opposed to healthy users (n=8) and were directed at a wide variety of mental health problems (n=24). Half of the studies set out to evaluate usability (n=21), and the remainder focused on feasibility (n=10) or acceptability (n=10). Regarding the maturity of the evaluated systems, most were either prototypes or previously tested versions of the technology, and the studies included few accounts of sketching and participatory design processes. The most common reason referred to for developing mobile mental health apps was the availability of mobile devices to users, their popularity, and how people in general became accustomed to using them for various purposes. Conclusions: This study provides a detailed account of how evidence of usability of mHealth apps is gathered in the form of usability evaluations from the perspective of computer science and human-computer interaction, including how users feature in the evaluation, how the study objectives and outcomes are stated, which research methods and techniques are used, and what the notion of mobility features is for mHealth apps. Most studies described their methods as trials, gathered data from a small sample size, and carried out a summative evaluation using a single questionnaire, which indicates that usability evaluation was not the main focus. As many studies described using an adapted version of a standard usability questionnaire, there may be a need for developing a standardized mHealth usability questionnaire. %M 31904579 %R 10.2196/15337 %U https://www.jmir.org/2020/1/e15337 %U https://doi.org/10.2196/15337 %U http://www.ncbi.nlm.nih.gov/pubmed/31904579 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 4 %N 1 %P e14963 %T Using Mobile Health Tools to Assess Physical Activity Guideline Adherence and Smoking Urges: Secondary Analysis of mActive-Smoke %A Shan,Rongzi %A Yanek,Lisa R %A Silverman-Lloyd,Luke G %A Kianoush,Sina %A Blaha,Michael J %A German,Charles A %A Graham,Garth N %A Martin,Seth S %+ Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Carnegie 591, Baltimore, MD, 21287, United States, 1 4105020469, smart100@jhmi.edu %K physical activity %K smoking %K mHealth %K fitness trackers %K short message service %D 2020 %7 6.1.2020 %9 Original Paper %J JMIR Cardio %G English %X Background: Rates of cigarette smoking are decreasing because of public health initiatives, pharmacological aids, and clinician focus on smoking cessation. However, a sedentary lifestyle increases cardiovascular risk, and therefore, inactive smokers have a particularly enhanced risk of cardiovascular disease. Objective: In this secondary analysis of mActive-Smoke, a 12-week observational study, we investigated adherence to guideline-recommended moderate-to-vigorous physical activity (MVPA) in smokers and its association with the urge to smoke. Methods: We enrolled 60 active smokers (≥3 cigarettes per day) and recorded continuous step counts with the Fitbit Charge HR. MVPA was defined as a cadence of greater than or equal to 100 steps per minute. Participants were prompted to report instantaneous smoking urges via text message 3 times a day on a Likert scale from 1 to 9. We used a mixed effects linear model for repeated measures, controlling for demographics and baseline activity level, to investigate the association between MVPA and urge. Results: A total of 53 participants (mean age 40 [SD 12] years, 57% [30/53] women, 49% [26/53] nonwhite, and 38% [20/53] obese) recorded 6 to 12 weeks of data. Data from 3633 person-days were analyzed, with a mean of 69 days per participant. Among all participants, median daily MVPA was 6 min (IQR 2-13), which differed by sex (12 min [IQR 3-20] for men vs 3.5 min [IQR 1-9] for women; P=.004) and BMI (2.5 min [IQR 1-8.3] for obese vs 10 min [IQR 3-15] for nonobese; P=.04). The median total MVPA minutes per week was 80 (IQR 31-162). Only 10% (5/51; 95% CI 4% to 22%) of participants met national guidelines of 150 min per week of MVPA on at least 50% of weeks. Adjusted models showed no association between the number of MVPA minutes per day and mean daily smoking urge (P=.72). Conclusions: The prevalence of MVPA was low in adult smokers who rarely met national guidelines for MVPA. Given the poor physical activity attainment in smokers, more work is required to enhance physical activity in this population. %M 31904575 %R 10.2196/14963 %U https://cardio.jmir.org/2020/1/e14963 %U https://doi.org/10.2196/14963 %U http://www.ncbi.nlm.nih.gov/pubmed/31904575 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 12 %P e15707 %T Adults’ Preferences for Behavior Change Techniques and Engagement Features in a Mobile App to Promote 24-Hour Movement Behaviors: Cross-Sectional Survey Study %A DeSmet,Ann %A De Bourdeaudhuij,Ilse %A Chastin,Sebastien %A Crombez,Geert %A Maddison,Ralph %A Cardon,Greet %+ Clinical and Health Psychology, Université Libre de Bruxelles, Franklin Rooseveltlaan 50, Brussels, 1050, Belgium, 32 2 650 32 82, Ann.DeSmet@ulb.be %K physical activity %K sleep %K sedentary behavior %K 24-hour movement %K mobile health %K mobile apps %K behavior change technique %K engagement %K adult %D 2019 %7 20.12.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a limited understanding of components that should be included in digital interventions for 24-hour movement behaviors (physical activity [PA], sleep, and sedentary behavior [SB]). For intervention effectiveness, user engagement is important. This can be enhanced by a user-centered design to, for example, explore and integrate user preferences for intervention techniques and features. Objective: This study aimed to examine adult users’ preferences for techniques and features in mobile apps for 24-hour movement behaviors. Methods: A total of 86 participants (mean age 37.4 years [SD 9.2]; 49/86, 57% female) completed a Web-based survey. Behavior change techniques (BCTs) were based on a validated taxonomy v2 by Abraham and Michie, and engagement features were based on a list extracted from the literature. Behavioral data were collected using Fitbit trackers. Correlations, (repeated measures) analysis of variance, and independent sample t tests were used to examine associations and differences between and within users by the type of health domain and users’ behavioral intention and adoption. Results: Preferences were generally the highest for information on the health consequences of movement behavior self-monitoring, behavioral feedback, insight into healthy lifestyles, and tips and instructions. Although the same ranking was found for techniques across behaviors, preferences were stronger for all but one BCT for PA in comparison to the other two health behaviors. Although techniques fit user preferences for addressing PA well, supplemental techniques may be able to address preferences for sleep and SB in a better manner. In addition to what is commonly included in apps, sleep apps should consider providing tips for sleep. SB apps may wish to include more self-regulation and goal-setting techniques. Few differences were found by users’ intentions or adoption to change a particular behavior. Apps should provide more self-monitoring (P=.03), information on behavior health outcome (P=.048), and feedback (P=.04) and incorporate social support (P=.048) to help those who are further removed from healthy sleep. A virtual coach (P<.001) and video modeling (P=.004) may provide appreciated support to those who are physically less active. PA self-monitoring appealed more to those with an intention to change PA (P=.03). Social comparison and support features are not high on users’ agenda and may not be needed from an engagement point of view. Engagement features may not be very relevant for user engagement but should be examined in future research with a less reflective method. Conclusions: The findings of this study provide guidance for the design of digital 24-hour movement behavior interventions. As 24-hour movement guidelines are increasingly being adopted in several countries, our study findings are timely to support the design of interventions to meet these guidelines. %M 31859680 %R 10.2196/15707 %U http://mhealth.jmir.org/2019/12/e15707/ %U https://doi.org/10.2196/15707 %U http://www.ncbi.nlm.nih.gov/pubmed/31859680 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e15644 %T Clinically Meaningful Use of Mental Health Apps and its Effects on Depression: Mixed Methods Study %A Zhang,Renwen %A Nicholas,Jennifer %A Knapp,Ashley A %A Graham,Andrea K %A Gray,Elizabeth %A Kwasny,Mary J %A Reddy,Madhu %A Mohr,David C %+ Department of Communication Studies, Northwestern University, 2240 Campus Dr, MTS Program, Evanston, IL, 60208, United States, 1 8479976596, alicezhang@u.northwestern.edu %K mHealth %K mobile apps %K mental health %K engagement %D 2019 %7 20.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: User engagement is key to the effectiveness of digital mental health interventions. Considerable research has examined the clinical outcomes of overall engagement with mental health apps (eg, frequency and duration of app use). However, few studies have examined how specific app use behaviors can drive change in outcomes. Understanding the clinical outcomes of more nuanced app use could inform the design of mental health apps that are more clinically effective to users. Objective: This study aimed to classify user behaviors in a suite of mental health apps and examine how different types of app use are related to depression and anxiety outcomes. We also compare the clinical outcomes of specific types of app use with those of generic app use (ie, intensity and duration of app use) to understand what aspects of app use may drive symptom improvement. Methods: We conducted a secondary analysis of system use data from an 8-week randomized trial of a suite of 13 mental health apps. We categorized app use behaviors through a mixed methods analysis combining qualitative content analysis and principal component analysis. Regression analyses were used to assess the association between app use and levels of depression and anxiety at the end of treatment. Results: A total of 3 distinct clusters of app use behaviors were identified: learning, goal setting, and self-tracking. Each specific behavior had varied effects on outcomes. Participants who engaged in self-tracking experienced reduced depression symptoms, and those who engaged with learning and goal setting at a moderate level (ie, not too much or not too little) also had an improvement in depression. Notably, the combination of these 3 types of behaviors, what we termed “clinically meaningful use,” accounted for roughly the same amount of variance as explained by the overall intensity of app use (ie, total number of app use sessions). This suggests that our categorization of app use behaviors succeeded in capturing app use associated with better outcomes. However, anxiety outcomes were neither associated with specific behaviors nor generic app use. Conclusions: This study presents the first granular examination of user interactions with mental health apps and their effects on mental health outcomes. It has important implications for the design of mobile health interventions that aim to achieve greater user engagement and improved clinical efficacy. %M 31859682 %R 10.2196/15644 %U http://www.jmir.org/2019/12/e15644/ %U https://doi.org/10.2196/15644 %U http://www.ncbi.nlm.nih.gov/pubmed/31859682 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e16630 %T Old-Fashioned Technology in the Era of “Bling”: Is There a Future for Text Messaging in Health Care? %A Willcox,Jane C %A Dobson,Rosie %A Whittaker,Robyn %+ School of Allied Health, Human Services and Sport, La Trobe University, Plenty Rd, Bundoora, 3083, Australia, 61 94791520, j.willcox@latrobe.edu.au %K text messaging %K mHealth %K behavior change %K digital health %D 2019 %7 20.12.2019 %9 Viewpoint %J J Med Internet Res %G English %X In the quest to discover the next high-technology solution to solve many health problems, proven established technologies are often overlooked in favor of more “technologically advanced” systems that have not been fully explored for their applicability to support behavior change theory, or used by consumers. Text messages or SMS is one example of an established technology still used by consumers, but often overlooked as part of the mobile health (mHealth) toolbox. The purpose of this paper is to describe the benefits of text messages as a health promotion modality and to advocate for broader scale implementation of efficacious text message programs. Text messaging reaches consumers in a ubiquitous real-time exchange, contrasting the multistep active engagement required for apps and wearables. It continues to be the most widely adopted and least expensive mobile phone function. As an intervention modality, text messaging has taught researchers substantial lessons about tailored interactive health communication; reach and engagement, particularly in low-resource settings; and embedding of behavior change models into digital health. It supports behavior change techniques such as reinforcement, prompts and cues, goal setting, feedback on performance, support, and progress review. Consumers have provided feedback to indicate that text messages can provide them with useful information, increase perceived support, enhance motivation for healthy behavior change, and provide prompts to engage in health behaviors. Significant evidence supports the effectiveness of text messages alone as part of an mHealth toolbox or in combination with health services, to support healthy behavior change. Systematic reviews have consistently reported positive effects of text message interventions for health behavior change and disease management including smoking cessation, medication adherence, and self-management of long-term conditions and health, including diabetes and weight loss. However, few text message interventions are implemented on a large scale. There is still much to be learned from investing in text messaging delivered research. When a modality is known to be effective, we should be learning from large-scale implementation. Many other technologies currently suffer from poor long-term engagement, the digital divide within society, and low health and technology literacy of users. Investing in and incorporating the learnings and lessons from large-scale text message interventions will strengthen our way forward in the quest for the ultimate digitally delivered behavior change model. %M 31859678 %R 10.2196/16630 %U http://www.jmir.org/2019/12/e16630/ %U https://doi.org/10.2196/16630 %U http://www.ncbi.nlm.nih.gov/pubmed/31859678 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e13570 %T Perceptions and Experiences of Women Participating in a Digital Technology–Based Physical Activity Intervention (the mPED Trial): Qualitative Study %A Lindgren,Teri %A Hooper,Julie %A Fukuoka,Yoshimi %+ School of Nursing, University of California, San Francisco, 2 Koret Way, Box 0606, San Francisco, CA, 94143, United States, 1 4158456624, teri.lindgren@ucsf.edu %K mHealth %K randomized controlled trial %K behavior %K interview %K physical activity %K maintenance %K women %K motivation %K accountability %D 2019 %7 20.12.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite the benefits of regular physical activity, women in every age group have lower activity levels than men, and few women meet the recommended levels of physical activity. Digital technologies have been useful in increasing physical activity during the course of an interventional study. However, sustaining that activity once the clinical trial was complete was a major challenge. Objective: This study aimed to describe the experiences and perspectives of physically inactive women who completed the mobile phone–based physical activity education (mPED), a randomized controlled trial, at 12 months. Methods: Of 210 women who were enrolled in the mPED trial, 203 completed a 12-month open-ended exit interview and survey through phone. The participants were asked about their physical activity levels; their digital technology use; what they learned from, liked, and would change about the trial; their motivations to keep active post-trial; and their advice for other women. Interviews were transcribed verbatim and thematically analyzed using the brief survey qualitative description. Descriptive statistics were used to describe the survey data with the significance level set at P<.05. Results: In the 12-month survey, a greater proportion of the participants in the intervention group, compared with the control group, reported that they regularly wore a pedometer or physical activity tracker (49.3%, 66/143 vs 26.1%, 18/69; P=.002) and engaged in brisk walking (54.5%, 73/134 vs 30.4%, 21/69; P=.001). The experiences and perceptions of physical activity of physically inactive women over time were embedded in a complex interplay of internal and external factors. A total of 6 interactive themes emerged as critical in supporting continued engagement in physical activity postintervention: tracking, technology versus personal touch, accountability, resources and environment, motivation, and habit formation. Technology allowed for self-tracking, which supported internal accountability. However, tracking by another person (personal touch) was needed for external accountability. Resources and environment underpinned the relationship among the themes of tracking, technology versus personal touch, accountability, motivation, and habit formation. Conclusions: Future research is needed to identify the best ways to harness this dynamic process in promoting and sustaining physical activity among inactive women. Digital technology is evolving at an exponential rate and provides new opportunities to transform research into new approaches to promote physical activity. Trial Registration: ClinicalTrials.gov NCT01280812; https://clinicaltrials.gov/ct2/show/NCT01280812 International Registered Report Identifier (IRRID): RR2-10.1186/1471-2485-11-933 %M 31859677 %R 10.2196/13570 %U http://publichealth.jmir.org/2019/4/e13570/ %U https://doi.org/10.2196/13570 %U http://www.ncbi.nlm.nih.gov/pubmed/31859677 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 4 %P e13695 %T Development of a Mobile Game to Influence Behavior Determinants of HIV Service Uptake Among Key Populations in the Philippines: User-Centered Design Process %A Hemingway,Charlotte %A Baja,Emmanuel S %A Dalmacion,Godafreda V %A Medina,Paul Mark B %A Guevara,Ernest Genesis %A Sy,Tyrone Reden %A Dacombe,Russell %A Dormann,Claire %A Taegtmeyer,Miriam %+ Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L35QA, United Kingdom, 44 7942118311, charlotte.hemingway@lstmed.ac.uk %K HIV %K video games %K health communication %K persuasive communication %K games %K experimental %K user-centered design %D 2019 %7 20.12.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: Opportunities in digital distribution place mobile games as a promising platform for games for health. However, designing a game that can compete in the saturated mobile games market and deliver persuasive health messages can feel like an insurmountable challenge. Although user-centered design is widely advocated, factors such as the user’s subject domain expertise, budget constraints, and poor data collection methods can restrict the benefits of user involvement. Objective: This study aimed to develop a playable and acceptable game for health, targeted at young key populations in the Philippines. Methods: Authors identified a range of user-centered design methods to be used in tandem from published literature. The resulting design process involved a phased approach, with 40 primary and secondary users engaged during the initial ideation and prototype testing stages. Selected methods included participatory design workshops, playtests, playability heuristics, and focus group discussions. Subject domain experts were allocated roles in the development team. Data were analyzed using a framework approach. Conceptual frameworks in health intervention acceptability and game design guided the analysis. In-game events were captured through the Unity Analytics service to monitor uptake and game use over a 12-month period. Results: Early user involvement revealed a strong desire for online multiplayer gameplay, yet most reported that access to this type of game was restricted because of technical and economic constraints. A role-playing game (RPG) with combat elements was identified as a very appealing gameplay style. Findings guided us to a game that could be played offline and that blended RPG elements, such as narrative and turn-based combat, with match-3 puzzles. Although the game received a positive response during playtests, gameplay was at times perceived as repetitive and predicted to only appeal to casual gamers. Knowledge transfer was predominantly achieved through interpretation of the game’s narrative, highlighting this as an important design element. Uptake of the game was positive; between December 1, 2017, and December 1, 2018, 3325 unique device installs were reported globally. Game metrics provided evidence of adoption by young key populations in the Philippines. Game uptake and use were substantially higher in regions where direct engagement with target users took place. Conclusions: User-centered design activities supported the identification of important contextual requirements. Multiple data collection methods enabled triangulation of findings to mediate the inherent biases of the different techniques. Game acceptance is dependent on the ability of the development team to implement design solutions that address the needs and desires of target users. If target users are expected to develop design solutions, they must have adequate expertise and a significant role within the development team. Facilitating meaningful partnerships between health professionals, the games industry, and end users will support the games for health industry as it matures. %M 31859673 %R 10.2196/13695 %U http://games.jmir.org/2019/4/e13695/ %U https://doi.org/10.2196/13695 %U http://www.ncbi.nlm.nih.gov/pubmed/31859673 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 12 %P e15785 %T A Stress Relief App Intervention for Newly Employed Nursing Staff: Quasi-Experimental Design %A Chang,I-Chiu %A Cheng,Wei-Chen %A Kung,Wen-Chuan %+ Nursing Department, Hsinchu MacKay Memorial Hospital, No 690, Sec 2, Guangfu Rd, East Dist, Hsinchu City, 300, Taiwan, 886 3 688 9595, 6444@mmh.org.tw %K nursing staff %K occupational stress %K mobile app %D 2019 %7 18.12.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Most newly employed nurses have limited practical experience, lack problem-solving abilities, and have low resistance to stress, and therefore often opt to resign from the nursing profession. Objective: This study aimed to assess the effectiveness of a stress relief app (SR_APP) to monitor the stress levels of newly employed nurses. Methods: We conducted a quasi-experiment to assess changes in stress levels of newly employed nurses at a case hospital, in which the experimental group used the SR_APP and the control group did not. In-depth interviews were conducted to reveal insights regarding their stress. The app usage experiences of experimental group members were assessed via a questionnaire. Results: All the participants appreciated the experiment and were interested to know more about managing their stress. The experimental group members showed significant differences in heart rate variability scores before and after using the SR_APP, and they reported high levels of intention to use and satisfaction with regard to the SR_APP. Conclusions: The SR_APP can be effective in helping newly employed nurses to manage their stress. %M 31850848 %R 10.2196/15785 %U https://mhealth.jmir.org/2019/12/e15785 %U https://doi.org/10.2196/15785 %U http://www.ncbi.nlm.nih.gov/pubmed/31850848 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 12 %P e14854 %T Improving Pacific Adolescents’ Physical Activity Toward International Recommendations: Exploratory Study of a Digital Education App Coupled With Activity Trackers %A Galy,Olivier %A Yacef,Kalina %A Caillaud,Corinne %+ Interdisciplinary Laboratory for Research in Education, EA 7483, School of Education, The University of New Caledonia, Campus de Nouville, Noumea, New Caledonia, 687 815 602, olivier.galy@unc.nc %K exercise %K eHealth %K adolescents %K health education %K noncommunicable diseases %K iEngage %K data mining %K movement %K food %K Melanesia %D 2019 %7 11.12.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The prevalence of overweight and obesity in children and adolescents has dramatically increased in the Pacific Island countries and territories over the last decade. Childhood overweight and obesity not only have short-term consequences but are also likely to lead to noncommunicable diseases in adulthood. A major factor contributing to the rising prevalence is an insufficient amount of daily moderate-to-vigorous physical activity (MVPA). In the Pacific region, less than 50% of children and adolescents meet the international recommendations of 11,000 steps and 60 min of MVPA per day. Although studies have shown the potential of digital technologies to change behaviors, none has been proposed to guide adolescents toward achieving these recommendations. Objective: The aims of this study were (1) to investigate whether a technology-based educational program that combines education, objective measures of physical activity (PA), and self-assessment of goal achievement would be well received by Pacific adolescents and help change their PA behaviors toward the international PA recommendations and (2) to create more insightful data analysis methods to better understand PA behavior change. Methods: A total of 24 adolescents, aged 12 to 14 years, participated in a 4-week program comprising 8 1-hour modules designed to develop health literacy and physical skills. This self-paced user-centered program was delivered via an app and provided health-related learning content as well as goal setting and self-assessment tasks. PA performed during the 4-week program was captured by an activity tracker to support learning and help the adolescents self-assess their achievements against personal goals. The data were analyzed using a consistency rate and daily behavior clustering to reveal any PA changes, particularly regarding adherence to international recommendations. Results: The consistency rate of daily steps revealed that the adolescents reached 11,000 steps per day 48% (approximately 3.4 days per week) of the time in the first week of the program, and this peaked at 59% (approximately 4.1 days per week) toward the end of the program. PA data showed an overall increase during the program, particularly in the less active adolescents, who increased their daily steps by 15% and ultimately reached 11,000 steps more frequently. The consistency of daily behavior clustering showed a 27% increase in adherence to international recommendations in the least active adolescents. Conclusions: Technology-supported educational programs that include self-monitored PA via activity trackers can be successfully delivered to adolescents in schools in remote Pacific areas. New data mining techniques enable innovative analyses of PA engagement based on the international recommendations. %M 31825319 %R 10.2196/14854 %U http://mhealth.jmir.org/2019/12/e14854/ %U https://doi.org/10.2196/14854 %U http://www.ncbi.nlm.nih.gov/pubmed/31825319 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 12 %P e14119 %T Effects of a 12-Minute Smartphone-Based Mindful Breathing Task on Heart Rate Variability for Students With Clinically Relevant Chronic Pain, Depression, and Anxiety: Protocol for a Randomized Controlled Trial %A Azam,Muhammad Abid %A Latman,Vered Valeria %A Katz,Joel %+ York University, 4700 Keele Street, Toronto, ON, MJ3 1P3, Canada, 1 4163129252, abid.azam1@gmail.com %K mindfulness %K mobile apps %K heart rate variability %K chronic pain %K depression %K anxiety %D 2019 %7 2.12.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mindfulness meditation (MM) is a commonly used psychological intervention for pain, mood, and anxiety conditions, but can be challenging to practice with severe symptoms without proper training. The Mindfulness Meditation app (MMA) is a supportive training tool specifically developed for this study to aid in the practice of mindful breathing using a smartphone. Objective: This study aims to evaluate the psychophysiological effects of the MMA. Specifically, the study will assess parasympathetic functioning using heart rate variability (HRV; primary outcome), pain and mood symptoms, mind-wandering and present moment awareness, and breath focus in groups of undergraduate participants who self-report clinically-relevant symptoms of chronic pain (CP) and depression or anxiety (DA) and condition-free (CF) participants who do not meet either criteria. We hypothesize that use of the MMA by study groups will lead to improved HRV, pain, and mood symptoms compared with groups who do not use the app. Methods: This study is a two-arm randomized controlled trial (RCT) recruiting through a Web-based research participation pool at York University in Toronto, Canada. We are aiming for minimum 60 participants in each of CP, DA, and CF groups. Upon arriving to the laboratory, participants will be prescreened for classification into groups of CP, DA, or CF. Groups will be randomly assigned by a 1:1 ratio to an MMA (MMA+) condition or MM condition without the app (MMA−) after a brief stress induction procedure. In MMA+, participants will practice mindful breathing with a smartphone and press breath or other buttons at the sound of audio tones if their awareness was on breathing or another experience, respectively. HRV and respiration data will be obtained during rest (5 min), stress induction (5 min), and meditation conditions (12 min). Participants will complete psychological self-report inventories before and after the stress induction and after the meditation condition. Separate linear mixed models will be used to examine HRV and self-report inventories comparing groups and treatment conditions. Results: Recruitment for the study began in November 2017 and is expected to be completed in winter of 2019-2020. As of July 2019, 189 participants have been recruited. The study’s main findings are expected to reveal a positive pattern of HRV responses in the CP, DA, and CF groups, such that a significant increase in HRV (P<.05) is detected in those randomized to the MMA+ condition in comparison with those randomized to the MMA− condition. Conclusions: This RCT will contribute to the burgeoning health psychology literature regarding the clinical relevance of HRV in assessment and treatment of psychological and medical conditions. Furthermore, possible ways to inform designs of MM training tools delivered by apps and Web platforms for CP, depression, and anxiety conditions’ treatment will be discussed. Trial Registration: Clinicaltrials.gov NCT03296007; https://clinicaltrials.gov/ct2/show/NCT03296007. International Registered Report Identifier (IRRID): DERR1-10.2196/14119 %M 31789601 %R 10.2196/14119 %U https://www.researchprotocols.org/2019/12/e14119 %U https://doi.org/10.2196/14119 %U http://www.ncbi.nlm.nih.gov/pubmed/31789601 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14219 %T A Baby Formula Designed for Chinese Babies: Content Analysis of Milk Formula Advertisements on Chinese Parenting Apps %A Zhao,Jing %A Li,Mu %A Freeman,Becky %+ School of Public Health, Sydney Medical School, The University of Sydney, Edward Ford Building A27, Sydney, 2006, Australia, 61 04 0650 2156, jzha5010@uni.sydney.edu.au %K infant formula %K food policy %K health promotion %K marketing %K mobile app %K parenting %K breastfeeding %K advertisement %D 2019 %7 29.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: China is the largest market for infant formula. With the increasing use of smartphones, apps have become the latest tool used to promote milk formula. Formula manufacturers and distributors both have seized the popularity of apps as an avenue for marketing. Objective: This study aimed to identify and analyze milk formula ads featured on Chinese pregnancy and parenting apps, to build the first complete picture of app-based milk formula marketing techniques being used by milk formula brand variants on these apps, and to more fully understand the ad content that potentially undermines public health messaging about infant and young child feeding. Methods: We searched for free-to-download Chinese parenting apps in the 360 App Store, the biggest Android app store in China. The final sample consisted of 353 unique formula ads from the 79 apps that met the inclusion criteria. We developed a content analysis coding tool for categorizing the marketing techniques used in ads, which included a total of 22 coding options developed across 4 categories: emotional imagery, marketing elements, claims, and advertising disclosure. Results: The 353 milk formula ads were distributed across 31 companies, 44 brands, and 79 brand variants. Overall, 15 of 31 corporations were international with the remaining 16 being Chinese owned. An image of a natural pasture was the most commonly used emotional image among the brand variants (16/79). All variants included branding elements, and 75 variants linked directly to e-shops. Special price promotions were promoted by nearly half (n=39) of all variants. A total of 5 variants included a celebrity endorsement in their advertising. A total of 25 of the 79 variants made a product quality claim. Only 14 variants made a direct advertisement disclosure. Conclusions: The purpose of marketing messages is to widen the use of formula and normalize formula as an appropriate food for all infants and young children, rather than as a specialized food for those unable to breastfeed. Policy makers should take steps to establish an appropriate regulatory framework and provide detailed monitoring and enforcement to ensure that milk formula marketing practices do not undermine breastfeeding norms and behaviors. %M 31782743 %R 10.2196/14219 %U http://mhealth.jmir.org/2019/11/e14219/ %U https://doi.org/10.2196/14219 %U http://www.ncbi.nlm.nih.gov/pubmed/31782743 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 2 %P e14518 %T A Pragmatic Internet Intervention to Promote Positive Parenting and School Readiness in Early Childhood: Initial Evidence of Program Use and Satisfaction %A McGoron,Lucy %A Ratner,Hilary Horn %A Knoff,Kathryn AG %A Hvizdos,Erica %A Ondersma,Steven J %+ Wayne State University, The Merrill Palmer Skillman Institute for Child and Family Development, 71 E Ferry St, Detroit, MI, 48202, United States, 1 3136642553, Lucy.K.McGoron@wayne.edu %K child rearing %K child development %D 2019 %7 29.11.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Internet-based parenting programs have the potential to connect families to research-informed materials to promote positive child development. However, such programs can only succeed to the extent that the intended population engages with them. Objective: This study aimed to evaluate engagement in the 5-a-Day Parenting program, a technology-based program designed with low-income families in mind, to promote daily use of 5 specific parenting activities conducive to children’s school readiness. Following earlier pilot data, the program was enhanced with an initial motivational e-intervention and tailored text messages designed to promote engagement. Methods: Parents were recruited from local childcare centers and through a participant registry. We examined rates of receipt of program text messages and use of video-based content on the program website, 3 factors that may affect website use, and satisfaction with key program elements. Results: A total of 360 parents of young children learned about the study and had the opportunity to use the 5-a-Day Parenting website. Of these, 94 parents participated in the study, and 33% (31/94) accessed the video-based content on the website at least once. No association was found between website use and program recruitment approach, program-affiliation message, sociocontextual risk, and baseline use of the five parenting activities. Satisfaction with text messages and video-based content was high. Conclusions: For some parents, technology-based programs appear useful; however, engagement could still be enhanced. Additional research should seek innovative strategies for promoting engagement in Web-based parenting programs. %M 31782739 %R 10.2196/14518 %U http://pediatrics.jmir.org/2019/2/e14518/ %U https://doi.org/10.2196/14518 %U http://www.ncbi.nlm.nih.gov/pubmed/31782739 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e14343 %T Effects of Mobile Health App Interventions on Sedentary Time, Physical Activity, and Fitness in Older Adults: Systematic Review and Meta-Analysis %A Yerrakalva,Dharani %A Yerrakalva,Dhrupadh %A Hajna,Samantha %A Griffin,Simon %+ Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Cambridge, , United Kingdom, 44 1223 330300, dharaniyerrakalva@googlemail.com %K sedentary behavior %K physical activity %K physical fitness %K aged %K mHealth %K mobile apps %D 2019 %7 28.11.2019 %9 Review %J J Med Internet Res %G English %X Background: High sedentary time, low physical activity (PA), and low physical fitness place older adults at increased risk of chronic diseases, functional decline, and premature mortality. Mobile health (mHealth) apps, apps that run on mobile platforms, may help promote active living. Objective: We aimed to quantify the effect of mHealth app interventions on sedentary time, PA, and fitness in older adults. Methods: We systematically searched five electronic databases for trials investigating the effects of mHealth app interventions on sedentary time, PA, and fitness among community-dwelling older adults aged 55 years and older. We calculated pooled standardized mean differences (SMDs) in these outcomes between the intervention and control groups after the intervention period. We performed a Cochrane risk of bias assessment and Grading of Recommendations, Assessment, Development, and Evaluation certainty assessment. Results: Overall, six trials (486 participants, 66.7% [324/486] women; age mean 68 [SD 6] years) were included (five of these trials were included in the meta-analysis). mHealth app interventions may be associated with decreases in sedentary time (SMD=−0.49; 95% CI −1.02 to 0.03), increases in PA (506 steps/day; 95% CI −80 to 1092), and increases in fitness (SMD=0.31; 95% CI −0.09 to 0.70) in trials of 3 months or shorter and with increases in PA (753 steps/day; 95% CI −147 to 1652) in trials of 6 months or longer. Risk of bias was low for all but one study. The quality of evidence was moderate for PA and sedentary time and low for fitness. Conclusions: mHealth app interventions have the potential to promote changes in sedentary time and PA over the short term, but the results did not achieve statistical significance, possibly because studies were underpowered by small participant numbers. We highlight a need for larger trials with longer follow-up to clarify if apps deliver sustained clinically important effects. %M 31778121 %R 10.2196/14343 %U http://www.jmir.org/2019/11/e14343/ %U https://doi.org/10.2196/14343 %U http://www.ncbi.nlm.nih.gov/pubmed/31778121 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e14645 %T User Engagement and Attrition in an App-Based Physical Activity Intervention: Secondary Analysis of a Randomized Controlled Trial %A Edney,Sarah %A Ryan,Jillian C %A Olds,Tim %A Monroe,Courtney %A Fraysse,François %A Vandelanotte,Corneel %A Plotnikoff,Ronald %A Curtis,Rachel %A Maher,Carol %+ Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, North Terrace, Adelaide, Australia, 61 883026611, Sarah.Edney@mymail.unisa.edu.au %K physical activity %K smartphone %K behavior %D 2019 %7 27.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The success of a mobile phone app in changing health behavior is thought to be contingent on engagement, commonly operationalized as frequency of use. Objective: This subgroup analysis of the 2 intervention arms from a 3-group randomized controlled trial aimed to examine user engagement with a 100-day physical activity intervention delivered via an app. Rates of engagement, associations between user characteristics and engagement, and whether engagement was related to intervention efficacy were examined. Methods: Engagement was captured in a real-time log of interactions by users randomized to either a gamified (n=141) or nongamified version of the same app (n=160). Physical activity was assessed via accelerometry and self-report at baseline and 3-month follow-up. Survival analysis was used to assess time to nonuse attrition. Mixed models examined associations between user characteristics and engagement (total app use). Characteristics of super users (top quartile of users) and regular users (lowest 3 quartiles) were compared using t tests and a chi-square analysis. Linear mixed models were used to assess whether being a super user was related to change in physical activity over time. Results: Engagement was high. Attrition (30 days of nonuse) occurred in 32% and 39% of the gamified and basic groups, respectively, with no significant between-group differences in time to attrition (P=.17). Users with a body mass index (BMI) in the healthy range had higher total app use (mean 230.5, 95% CI 190.6-270.5; F2=8.67; P<.001), compared with users whose BMI was overweight or obese (mean 170.6, 95% CI 139.5-201.6; mean 132.9, 95% CI 104.8-161.0). Older users had higher total app use (mean 200.4, 95% CI 171.9-228.9; F1=6.385; P=.01) than younger users (mean 155.6, 95% CI 128.5-182.6). Super users were 4.6 years older (t297=3.6; P<.001) and less likely to have a BMI in the obese range (χ22=15.1; P<.001). At the 3-month follow-up, super users were completing 28.2 (95% CI 9.4-46.9) more minutes of objectively measured physical activity than regular users (F1,272=4.76; P=.03). Conclusions: Total app use was high across the 100-day intervention period, and the inclusion of gamified features enhanced engagement. Participants who engaged the most saw significantly greater increases to their objectively measured physical activity over time, supporting the theory that intervention exposure is linked to efficacy. Further research is needed to determine whether these findings are replicated in other app-based interventions, including those experimentally evaluating engagement and those conducted in real-world settings. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617000113358; https://www.anzctr.org.au/ACTRN12617000113358.aspx %M 31774402 %R 10.2196/14645 %U http://www.jmir.org/2019/11/e14645/ %U https://doi.org/10.2196/14645 %U http://www.ncbi.nlm.nih.gov/pubmed/31774402 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e14537 %T Connected Health User Willingness to Share Personal Health Data: Questionnaire Study %A Karampela,Maria %A Ouhbi,Sofia %A Isomursu,Minna %+ IT University of Copenhagen, Rued Langgaards Vej 7, Copenhagen S, , Denmark, 45 25 54 09 84, makar@itu.dk %K connected health %K personal health data %K data sharing %K questionnaire %D 2019 %7 27.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Connected health has created opportunities for leveraging health data to deliver preventive and personalized health care services. The increasing number of personal devices and advances in measurement technologies contribute to an exponential growth in digital health data. The practices for sharing data across the health ecosystem are evolving as there are more opportunities for using such data to deliver responsive health services. Objective: The objective of this study was to explore user attitudes toward sharing personal health data (PHD). The study was executed within the first year after the implementation of the new General Data Protection Regulation (GDPR) legal framework. Methods: The authors analyzed the results of an online questionnaire survey to explore the willingness of 8004 people using connected health services across four European countries to share their PHD and the conditions under which they would be willing to do so. Results: Our findings indicate that the majority of users are willing to share their personal PHD for scientific research (1811/8004, 22.63%). Age, education level, and occupation of the participants, in addition to the level of digitalization in their country were found to be associated with data sharing attitudes. Conclusions: Positive attitudes toward data sharing for scientific research can be perceived as an indication of trust established between users and academia. Nevertheless, the interpretation of data sharing attitudes is a complex process, related to and influenced by various factors. %M 31774410 %R 10.2196/14537 %U https://www.jmir.org/2019/11/e14537 %U https://doi.org/10.2196/14537 %U http://www.ncbi.nlm.nih.gov/pubmed/31774410 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13728 %T A Behavioral Activation Mobile Health App for Smokers With Depression: Development and Pilot Evaluation in a Single-Arm Trial %A Heffner,Jaimee L %A Watson,Noreen L %A Serfozo,Edit %A Mull,Kristin E %A MacPherson,Laura %A Gasser,Melissa %A Bricker,Jonathan B %+ Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M3-B232, PO Box 19024, Seattle, WA, , United States, 1 206 667 7314, jheffner@fredhutch.org %K tobacco %K nicotine %K smoking cessation %K depression %K smartphone %D 2019 %7 27.11.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The integration of Behavioral Activation Treatment for Depression (BAT-D) into smoking cessation interventions is a promising approach to address depression as a barrier to quitting. However, this approach has only been tested as a face-to-face intervention, which has low reach. Objective: The aims of the study were to develop a BAT-D mobile health app with high potential reach and determine its feasibility, acceptability, and preliminary effects on theory-based behavioral processes of behavioral activation, reduced depressive symptoms, and smoking cessation. Methods: Following a user-centered design process consisting of competitive analysis, focus groups, and prototype testing, we conducted a single-arm pilot trial of Actify!, a BAT-D app for depressed smokers. Participants used SmokefreeTXT along with Actify! to provide cessation content that had not yet been built into the app for this initial phase of pilot testing. Participants in the trial were current, daily smokers with mild to moderate depressive symptoms. We examined use outcomes for all enrolled participants and process and cessation outcomes at 6 weeks postenrollment for study completers (16/17, 94% retention). Results: Regarding acceptability, average number of log-ins per participant was 16.6 (SD 13.7), and 63% (10/16) reported being satisfied overall with the app. Posttreatment interviews identified some usability challenges (eg, high perceived burden of planning and scheduling values-based activities). There was a significant decrease in depressive symptoms from baseline to follow-up (mean change in Patient Health Questionnaire–9 scores was –4.5, 95% CI –7.7 to –1.3; P=.01). Additionally, carbon monoxide (CO)-confirmed, 7-day point prevalence abstinence (PPA) at 6-week follow-up was 31% (5/16), and the 30-day PPA was 19% (3/16). Conclusions: Results demonstrate promising engagement with Actify! and potential for impact on theory-based change processes and cessation outcomes. Preliminary quit rates compare favorably to previous trials of smoking cessation apps for the general population (ie, short-term, self-reported 30-day quit rates in the 8% to 18% range) and a previous trial of face-to-face BAT-D for depressed smokers (ie, CO-confirmed, 7-day PPA rate of 17% at end of treatment). %M 31774405 %R 10.2196/13728 %U http://formative.jmir.org/2019/4/e13728/ %U https://doi.org/10.2196/13728 %U http://www.ncbi.nlm.nih.gov/pubmed/31774405 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 4 %P e15974 %T Effect of Brief Biofeedback via a Smartphone App on Stress Recovery: Randomized Experimental Study %A Hunter,John F %A Olah,Meryl S %A Williams,Allison L %A Parks,Acacia C %A Pressman,Sarah D %+ Department of Psychological Science, University of California, Irvine, 4201 Social & Behavioral Sciences Gateway, Irvine, CA, 92697, United States, 1 9493459987, jhunter1@uci.edu %K heart rate variability biofeedback %K stress recovery %K salivary alpha amylase %K smartphone %K mHealth %D 2019 %7 26.11.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: Smartphones are often vilified for negatively influencing well-being and contributing to stress. However, these devices may, in fact, be useful in times of stress and, in particular, aid in stress recovery. Mobile apps that deliver evidence-based techniques for stress reduction, such as heart rate variability biofeedback (HRVB) training, hold promise as convenient, accessible, and effective stress-reducing tools. Numerous mobile health apps that may potentially aid in stress recovery are available, but very few have demonstrated that they can influence health-related physiological stress parameters (eg, salivary biomarkers of stress). The ability to recover swiftly from stress and reduce physiological arousal is particularly important for long-term health, and thus, it is imperative that evidence is provided to demonstrate the effectiveness of stress-reducing mobile health apps in this context. Objective: The purpose of this research was to investigate the physiological and psychological effects of using a smartphone app for HRVB training following a stressful experience. The efficacy of the gamified Breather component of the Happify mobile health app was examined in an experimental setting. Methods: In this study, participants (N=140) underwent a laboratory stressor and were randomly assigned to recover in one of three ways: with no phone present, with a phone present, with the HRBV game. Those in the no phone condition had no access to their phone. Those in the phone present condition had their phone but did not use it. Those in the HRVB game condition used the serious game Breather on the Happify app. Stress recovery was assessed via repeated measures of salivary alpha amylase, cortisol, and self-reported acute stress (on a 1-100 scale). Results: Participants in the HRVB game condition had significantly lower levels of salivary alpha amylase during recovery than participants in the other conditions (F2,133=3.78, P=.03). There were no significant differences among the conditions during recovery for salivary cortisol levels or self-reported stress. Conclusions: These results show that engaging in a brief HRVB training session on a smartphone reduces levels of salivary alpha amylase following a stressful experience, providing preliminary evidence for the effectiveness of Breather in improving physiological stress recovery. Given the known ties between stress recovery and future well-being, this study provides a possible mechanism by which gamified biofeedback apps may lead to better health. %M 31769761 %R 10.2196/15974 %U http://games.jmir.org/2019/4/e15974/ %U https://doi.org/10.2196/15974 %U http://www.ncbi.nlm.nih.gov/pubmed/31769761 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 11 %P e14972 %T Comparing a Tailored Self-Help Mobile App With a Standard Self-Monitoring App for the Treatment of Eating Disorder Symptoms: Randomized Controlled Trial %A Tregarthen,Jenna %A Paik Kim,Jane %A Sadeh-Sharvit,Shiri %A Neri,Eric %A Welch,Hannah %A Lock,James %+ Recovery Record, 2190 Beach Street, San Francisco, CA, 94123, United States, 1 6504047098, jenna@recoveryrecord.com %K mobile health %K smartphone %K mobile apps %K eating disorders %K cognitive behavioral therapy %K mental health %K intervention study %D 2019 %7 21.11.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Eating disorders severely impact psychological, physical, and social functioning, and yet, the majority of individuals with eating disorders do not receive treatment. Mobile health apps have the potential to decrease access barriers to care and reach individuals who have been underserved by traditional treatment modalities. Objective: The objective of this study was to evaluate the effectiveness of a tailored, fully automated self-help version of Recovery Record, an app developed for eating disorders management. We examined differences in eating disorder symptom change in app users that were randomized to receive either a standard, cognitive behavioral therapy–based version of the app or a tailored version that included algorithmically determined clinical content aligned with baseline and evolving user eating disorder symptom profiles. Methods: Participants were people with eating disorder symptoms who did not have access to traditional treatment options and were recruited via the open-access Recovery Record app to participate in this randomized controlled trial. We examined both continuous and categorical clinical improvement outcomes (measured with the self-report Eating Disorder Examination Questionnaire [EDE-Q]) in both intervention groups. Results: Between December 2016 and August 2018, 3294 Recovery Record app users were recruited into the study, out of which 959 were considered engaged, completed follow-up assessments, and were included in the analyses. Both study groups achieved significant overall outcome improvement, with 61.6% (180/292) of the tailored group and 55.4% (158/285) of the standard group achieving a clinically meaningful change in the EDE-Q, on average. There were no statistically significant differences between randomized groups for continuous outcomes, but a pattern of improvement being greater in the tailored group was evident. The rate of remission on the EDE-Q at 8 weeks was significantly greater in the group receiving the tailored version (d=0.22; P≤.001). Conclusions: This is the first report to compare the relative efficacy of two versions of a mobile app for eating disorders. The data suggest that underserved individuals with eating disorder symptoms may benefit clinically from a self-help app and that personalizing app content to specific clinical presentations may be more effective in promoting symptomatic remission on the EDE-Q than content that offers a generic approach. Trial Registration: ClinicalTrials.gov NCT02503098; https://clinicaltrials.gov/ct2/show/NCT02503098. %M 31750837 %R 10.2196/14972 %U http://mental.jmir.org/2019/11/e14972/ %U https://doi.org/10.2196/14972 %U http://www.ncbi.nlm.nih.gov/pubmed/31750837 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e16197 %T Assessing the Psychometric Properties of the Digital Behavior Change Intervention Engagement Scale in Users of an App for Reducing Alcohol Consumption: Evaluation Study %A Perski,Olga %A Lumsden,Jim %A Garnett,Claire %A Blandford,Ann %A West,Robert %A Michie,Susan %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 20 7679 1258, olga.perski@ucl.ac.uk %K engagement %K digital behaviour change interventions %K mHealth %K psychometrics %K self-report scale %K smartphone apps %K excessive alcohol consumption %D 2019 %7 20.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The level and type of engagement with digital behavior change interventions (DBCIs) are likely to influence their effectiveness, but validated self-report measures of engagement are lacking. The DBCI Engagement Scale was designed to assess behavioral (ie, amount, depth of use) and experiential (ie, attention, interest, enjoyment) dimensions of engagement. Objective: We aimed to assess the psychometric properties of the DBCI Engagement Scale in users of a smartphone app for reducing alcohol consumption. Methods: Participants (N=147) were UK-based, adult, excessive drinkers recruited via an online research platform. Participants downloaded the Drink Less app and completed the scale immediately after their first login in exchange for a financial reward. Criterion variables included the objectively recorded amount of use, depth of use, and subsequent login. Five types of validity (ie, construct, criterion, predictive, incremental, divergent) were examined in exploratory factor, correlational, and regression analyses. The Cronbach alpha was calculated to assess the scale’s internal reliability. Covariates included motivation to reduce alcohol consumption. Results: Responses on the DBCI Engagement Scale could be characterized in terms of two largely independent subscales related to experience and behavior. The experiential and behavioral subscales showed high (α=.78) and moderate (α=.45) internal reliability, respectively. Total scale scores predicted future behavioral engagement (ie, subsequent login) with and without adjusting for users’ motivation to reduce alcohol consumption (adjusted odds ratio [ORadj]=1.14; 95% CI 1.03-1.27; P=.01), which was driven by the experiential (ORadj=1.19; 95% CI 1.05-1.34; P=.006) but not the behavioral subscale. Conclusions: The DBCI Engagement Scale assesses behavioral and experiential aspects of engagement. The behavioral subscale may not be a valid indicator of behavioral engagement. The experiential subscale can predict subsequent behavioral engagement with an app for reducing alcohol consumption. Further refinements and validation of the scale in larger samples and across different DBCIs are needed. %M 31746771 %R 10.2196/16197 %U http://www.jmir.org/2019/11/e16197/ %U https://doi.org/10.2196/16197 %U http://www.ncbi.nlm.nih.gov/pubmed/31746771 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14380 %T An Interactive Mobile Phone App (SMART 5-A-DAY) for Increasing Knowledge of and Adherence to Fruit and Vegetable Recommendations: Development and Pilot Randomized Controlled Trial %A Appleton,Katherine Marie %A Passmore,David %A Burn,Isobel %A Pidgeon,Hanna %A Nation,Philippa %A Boobyer,Charlotte %A Jiang,Nan %+ Bournemouth University, Poole House, Fern Barrow, Poole, BH12 5BB, United Kingdom, 44 01202965985, k.appleton@bournemouth.ac.uk %K fruit %K vegetables %K diet therapy %K knowledge %K questionnaires %K portion sizes %D 2019 %7 20.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Fruit and vegetable consumption is important for health, but many individuals fail to consume adequate amounts for health benefits. Although many individuals are aware of current fruit and vegetable consumption recommendations, research suggests that adherence to these is hampered by low knowledge of the details of these recommendations. Objective: This paper reports the development and details of a pilot randomized controlled test of a novel interactive mobile phone app for addressing low knowledge of the UK 5-a-day fruit and vegetable recommendations. Methods: Requirements for the app were first defined by researchers and potential end users and prioritized using the MoSCoW (Must have, Should have, Could have, Won’t have) method. Second, a prototype mobile phone app was developed using an agile approach. Third, the prototype app was tested in a randomized controlled pilot trial for impacts on knowledge and intake of fruit and vegetables. Volunteers were randomized to either receive (n=50) or not receive the app (n=44) for 2 or 4 weeks, and fruit and vegetable knowledge, intake, and behavior were assessed at the beginning of the study and after 1 and 2 weeks or after 2 and 4 weeks, respectively. App usage and qualitative feedback were also investigated. All findings then informed the development of a final app. Results: Low knowledge of consumption recommendations centered around portion sizes and the need for variety, and an interactive mobile phone app was considered a suitable tool for improving this knowledge in a practical manner that would be available both at time of consumption and outside of these times. The pilot test revealed improved behavior after 2 weeks compared with baseline in volunteers who received the app, but improvements in knowledge on fruit and vegetable recommendations were found in both groups, and no improvements in fruit and vegetable intakes were found in formal measures. Patterns of app usage and qualitative feedback also suggested a number of modifications. The resultant final app incorporates several behavior change techniques (goal-setting, self-monitoring, and personalized feedback) as well as aiming to improve knowledge. Conclusions: A novel interactive mobile phone app was successfully developed based on requirements, and when tested in a pilot randomized controlled trial, this app was found to have some impacts on fruit and vegetable outcomes. Although benefits from the app were small, impacts will likely increase as a result of recent modifications. The final SMART 5-A-DAY app is available in the Google Play Store and now needs testing in the target population. Trial Registration: ClinicalTrials.gov NCT02779491; https://www.clinicaltrials.gov/ct2/show/NCT02779491 %M 31746766 %R 10.2196/14380 %U http://mhealth.jmir.org/2019/11/e14380/ %U https://doi.org/10.2196/14380 %U http://www.ncbi.nlm.nih.gov/pubmed/31746766 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14458 %T Impact of a Mobile App–Based Health Coaching and Behavior Change Program on Participant Engagement and Weight Status of Overweight and Obese Children: Retrospective Cohort Study %A Cueto,Victor %A Wang,C Jason %A Sanders,Lee Michael %+ Division of General Internal Medicine, Department of Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, H-251, Newark, NJ, 07101, United States, 1 973 972 5672, vcueto@alumni.stanford.edu %K child obesity %K mHealth %K mobile apps %K health coaching %K health behavior %K self-monitoring %K behavior change %D 2019 %7 15.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Effective treatment of obesity in children and adolescents traditionally requires frequent in-person contact, and it is often limited by low participant engagement. Mobile health tools may offer alternative models that enhance participant engagement. Objective: The aim of this study was to assess child engagement over time, with a mobile app–based health coaching and behavior change program for weight management, and to examine the association between engagement and change in weight status. Methods: This was a retrospective cohort study of user data from Kurbo, a commercial program that provides weekly individual coaching via video chat and supports self-monitoring of health behaviors through a mobile app. Study participants included users of Kurbo between March 2015 and March 2017, who were 5 to 18 years old and who were overweight or obese (body mass index; BMI ≥ 85th percentile or ≥ 95th percentile) at baseline. The primary outcome, engagement, was defined as the total number of health coaching sessions received. The secondary outcome was change in weight status, defined as the change in BMI as a percentage of the 95th percentile (%BMIp95). Analyses of outcome measures were compared across three initial commitment period groups: 4 weeks, 12 to 16 weeks, or 24 weeks. Multivariable linear regression models were constructed to adjust outcomes for the independent variables of sex, age group (5-11 years, 12-14 years, and 15-18 years), and commitment period. A sensitivity analysis was conducted, excluding a subset of participants involuntarily assigned to the 12- to 16-week commitment period by an employer or health plan. Results: A total of 1120 participants were included in analyses. At baseline, participants had a mean age of 12 years (SD 2.5), mean BMI percentile of 96.6 (SD 3.1), mean %BMIp95 of 114.5 (SD 16.5), and they were predominantly female 68.04% (762/1120). Participant distribution across commitment periods was 26.07% (292/1120) for 4 weeks, 61.61% (690/1120) for 12-16 weeks, and 12.32% (138/1120) for 24 weeks. The median coaching sessions (interquartile range) received were 8 (3-16) for the 4-week group, 9 (5-12) for the 12- to 16-week group, and 19 (11-25) for the 24-week group (P<.001). Adjusted for sex and age group, participants in the 4- and 12-week groups participated in –8.03 (95% CI –10.19 to –5.87) and –9.34 (95% CI –11.31 to –7.39) fewer coaching sessions, compared with those in the 24-week group (P<.001). Adjusted for commitment period, sex, and age group, the overall mean change in %BMIp95 was –0.21 (95% CI –0.25 to –0.17) per additional coaching session (P<.001). Conclusions: Among overweight and obese children using a mobile app–based health coaching and behavior change program, increased engagement was associated with longer voluntary commitment periods, and increased number of coaching sessions was associated with decreased weight status. %M 31730041 %R 10.2196/14458 %U http://mhealth.jmir.org/2019/11/e14458/ %U https://doi.org/10.2196/14458 %U http://www.ncbi.nlm.nih.gov/pubmed/31730041 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 11 %P e16439 %T HIV Prevention Via Mobile Messaging for Men Who Have Sex With Men (M-Cubed): Protocol for a Randomized Controlled Trial %A Sullivan,Patrick Sean %A Zahn,Ryan J %A Wiatrek,Sarah %A Chandler,Cristian J %A Hirshfield,Sabina %A Stephenson,Rob %A Bauermeister,Jose A %A Chiasson,Mary Ann %A Downing Jr,Martin J %A Gelaude,Deborah J %A Siegler,Aaron J %A Horvath,Keith %A Rogers,Erin %A Alas,Ana %A Olansky,Evelyn J %A Saul,Heather %A Rosenberg,Eli S %A Mansergh,Gordon %+ Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 404 727 2038, pssulli@emory.edu %K men who have sex with men %K HIV prevention %K HIV care %D 2019 %7 15.11.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Men who have sex with men (MSM) continue to be the predominately impacted risk group in the United States HIV epidemic and are a priority group for risk reduction in national strategic goals for HIV prevention. Modeling studies have demonstrated that a comprehensive package of status-tailored HIV prevention and care interventions have the potential to substantially reduce new infections among MSM. However, uptake of basic prevention services, including HIV testing, sexually transmitted infection (STI) testing, condom distribution, condom-compatible lubricant distribution, and preexposure prophylaxis (PrEP), is suboptimal. Further, stronger public health strategies are needed to promote engagement in HIV care and viral load suppression among MSM living with HIV. Mobile health (mHealth) tools can help inform and encourage MSM regarding HIV prevention, care, and treatment, especially among men who lack access to conventional medical services. This protocol details the design and procedures of a randomized controlled trial (RCT) of a novel mHealth intervention that comprises a comprehensive HIV prevention app and brief, tailored text- and video-based messages that are systematically presented to participants based on the participants’ HIV status and level of HIV acquisition risk. Objective: The objective of the RCT was to test the efficacy of the Mobile Messaging for Men (M-Cubed, or M3) app among at least 1200 MSM in Atlanta, Detroit, and New York. The goal was to determine its ability to increase HIV testing (HIV-negative men), STI testing (all men), condom use for anal sex (all men), evaluation for PrEP eligibility, uptake of PrEP (higher risk HIV-negative men), engagement in HIV care (men living with HIV), and uptake of and adherence to antiretroviral medications (men living with HIV). A unique benefit of this approach is the HIV serostatus-inclusiveness of the intervention, which includes both HIV-negative and HIV-positive MSM. Methods: MSM were recruited through online and venue-based approaches in Atlanta, Detroit, and New York City. Men who were eligible and consented were randomized to the intervention (immediate access to the M3 app for a period of three months) or to the waitlist-control (delayed access) group. Outcomes were evaluated immediately postintervention or control period, and again three and six months after the intervention period. Main outcomes will be reported as period prevalence ratios or hazards, depending on the outcome. Where appropriate, serostatus/risk-specific outcomes will be evaluated in relevant subgroups. Men randomized to the control condition were offered the opportunity to use (and evaluate) the M3 app for a three-month period after the final RCT outcome assessment. Results: M3 enrollment began in January 2018 and concluded in November 2018. A total of 1229 MSM were enrolled. Data collection was completed in September 2019. Conclusions: This RCT of the M3 mobile app seeks to determine the effects of an HIV serostatus–inclusive intervention on the use of multiple HIV prevention and care-related outcomes among MSM. A strength of the design is that it incorporates a large sample and broad range of MSM with differing prevention needs in three cities with high prevalence of HIV among MSM. Trial Registration: ClinicalTrials.gov NCT03666247; https://clinicaltrials.gov/ct2/show/NCT03666247 International Registered Report Identifier (IRRID): DERR1-10.2196/16439 %M 31730043 %R 10.2196/16439 %U http://www.researchprotocols.org/2019/11/e16439/ %U https://doi.org/10.2196/16439 %U http://www.ncbi.nlm.nih.gov/pubmed/31730043 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14641 %T Development of a Mobile Phone App for Measuring Striking Response Time in Combat Sports: Cross-Sectional Validation Study %A Coswig,Victor %A Sant' Ana,Jader %A Coelho,Maicon Nascimento %A Pereira Moro,Antonio Renato %A Diefenthaeler,Fernando %+ Universidade Federal de Santa Catarina, Departamento de Educação Física, Campus Universitário, Reitor João David Ferreira Lima, Florianopolis, 88040-900, Brazil, 55 4837219000 ext 4779, fernando.diefenthaeler@ufsc.br %K reaction time %K martial arts %K mobile apps %K software validation %D 2019 %7 11.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: TReaction is a mobile app developed to determine strike response time at low cost and with easy application in combat sports. However, the validity and accuracy of the response time obtained by the TReaction app has not yet been evaluated. Objective: This study aimed to test the validity and reliability of the TReaction app in measuring motor response time in combat sports. Methods: A total of two athletes performed 59 strikes to assess the response time upon visual stimulus using the TReaction app simultaneously with a high-speed camera. Accuracy of the measure was verified using a computer simulator programmed to discharge visual stimuli and obtain the response time. Pearson correlation, Student t test for dependent samples, and the Bland-Altman analysis were performed. Accuracy was verified using the intraclass correlation coefficient. Effect size (g) and the typical error of measurement (TEM) were calculated. The significance level was set at P<.05. Results: No significant difference (P=.56) was found between both systems. The methods presented a very strong correlation (r=0.993). The magnitude of differences was trivial (g<0.25), and TEM was 1.4%. These findings indicate a high accuracy between the computer screen and the mobile app measures to determine the beginning of the task and the response time. Conclusions: Our findings suggest that the TReaction app is a valid tool to evaluate the response time in combat sports athletes. %M 31710294 %R 10.2196/14641 %U http://mhealth.jmir.org/2019/11/e14641/ %U https://doi.org/10.2196/14641 %U http://www.ncbi.nlm.nih.gov/pubmed/31710294 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14247 %T An Interactive Parent-Targeted Text Messaging Intervention to Improve Oral Health in Children Attending Urban Pediatric Clinics: Feasibility Randomized Controlled Trial %A Borrelli,Belinda %A Henshaw,Michelle %A Endrighi,Romano %A Adams,William G %A Heeren,Timothy %A Rosen,Rochelle K %A Bock,Beth %A Werntz,Scott %+ Center for Behavioral Science Research, Boston University Henry M Goldman School of Dental Medicine, 560 Harrison Ave, 3rd floor, Boston, MA, 02118, United States, 1 617 358 3358, belindab@bu.edu %K oral health %K mHealth %K text message %K dental caries %K health behavior %D 2019 %7 11.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Effective preventive treatments for dental decay exist, but caries experience among preschoolers has not changed, with marked disparities in untreated decay. Despite near-universal use of SMS text messaging, there are no studies using text messages to improve the oral health of vulnerable children. Objective: This randomized controlled feasibility trial aimed to test the effects of oral health text messages (OHT) versus a control (child wellness text messages or CWT). OHT was hypothesized to outperform CWT on improving pediatric oral health behaviors and parent attitudes. Methods: Parents with a child aged <7 years were recruited at urban clinics during pediatric appointments (79% [41/52] below poverty line; 66% [36/55] black) and randomized to OHT (text messages on brushing, dental visits, bottle and sippy cups, healthy eating and sugary beverages, and fluoride) or CWT (text messages on reading, safety, physical activity and development, secondhand smoke, and stress) groups. Automated text messages based on Social Cognitive Theory were sent twice each day for 8-weeks. Groups were equivalent on the basis of the number of text messages sent, personalization, interactivity, and opportunity to earn electronic badges and unlock animated characters. Assessments were conducted at baseline and 8 weeks later. Data were analyzed with linear mixed–effects models. Results: A total of 55 participants were randomized (28 OHT and 27 CWT). Only one participant dropped out during the text message program and 47 (24 OHT and 23 CWT) completed follow up surveys. Response rates exceeded 68.78% (1040/1512) and overall program satisfaction was high (OHT mean 6.3; CWT mean 6.2; 1-7 scale range). Of the OHT group participants, 84% (21/25) would recommend the program to others. Overall program likeability scores were high (OHT mean 5.90; CWT mean 6.0; 1-7 scale range). Participants reported high perceived impact of the OHT program on brushing their child’s teeth, motivation to address their child's oral health, and knowledge of their child's oral health needs (mean 4.7, 4.6, and 4.6, respectively; 1-5 scale range). At follow up, compared with CWT, OHT group participants were more likely to brush their children’s teeth twice per day (odds ratio [OR] 1.37, 95% CI 0.28-6.50) and demonstrated improved attitudes regarding the use of fluoride (OR 3.82, 95% CI 0.9-16.8) and toward getting regular dental checkups for their child (OR 4.68, 95% CI 0.24-91.4). There were modest, but not significant, changes in motivation (F1,53=0.60; P=.45) and self–efficacy (F1,53=0.24; P=.63) to engage in oral health behaviors, favoring OHT (d=0.28 and d=0.16 for motivation and self–efficacy, respectively). Conclusions: The OHT program demonstrated feasibility was well utilized and appealing to the target population and showed promise for efficacy. %M 31710306 %R 10.2196/14247 %U https://mhealth.jmir.org/2019/11/e14247 %U https://doi.org/10.2196/14247 %U http://www.ncbi.nlm.nih.gov/pubmed/31710306 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 2 %P e13217 %T A Technology-Assisted, Brief Mind-Body Intervention to Improve the Waiting Room Experience for Chemotherapy Patients: Randomized Quality Improvement Study %A Bao,Ting %A Deng,Gary %A DeMarzo,Lauren A %A Zhi,W Iris %A DeRito,Janice L %A Blinder,Victoria %A Chen,Connie %A Li,Qing S %A Green,Jamie %A Pendleton,Eva %A Mao,Jun J %+ Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, United States, 1 646 888 0865, baot@mskcc.org %K mobile app %K acupressure %K meditation %K symptom relief %K chemotherapy %D 2019 %7 7.11.2019 %9 Original Paper %J JMIR Cancer %G English %X Background: Patients waiting for chemotherapy can experience stress, anxiety, nausea, and pain. Acupressure and meditation have been shown to control such symptoms. Objective: This study aimed to evaluate the feasibility and effectiveness of an integrative medicine app to educate patients about these self-care tools in chemotherapy waiting rooms. Methods: We screened and enrolled cancer patients in chemotherapy waiting rooms at two Memorial Sloan Kettering Cancer Center locations. Patients were randomly assigned into an intervention arm in which subjects watched acupressure and meditation instructional videos or a control arm in which they watched a time- and attention-matched integrative oncology lecture video. Before and after watching the videos, we asked the patients to rate four key symptoms: stress, anxiety, nausea, and pain. We performed the analysis of covariance to detect differences between the two arms postintervention while controlling for baseline symptoms. Results: A total of 223 patients were enrolled in the study: 113 patients were enrolled in the intervention arm and 110 patients were enrolled in the control arm. In both groups, patients showed significant reductions in stress and anxiety from baseline (all P<.05), with the treatment arm reporting greater stress and anxiety reduction than the control arm (1.64 vs 1.15 in stress reduction; P=.01 and 1.39 vs 0.78 in anxiety reduction; P=.002). The majority of patients reported that the videos helped them pass time and that they would watch the videos again. Conclusions: An integrative medicine self-care app in the waiting room improved patients’ experiences and reduced anxiety and stress. Future research could focus on expanding this platform to other settings to improve patients’ overall treatment experiences. %M 31697238 %R 10.2196/13217 %U http://cancer.jmir.org/2019/2/e13217/ %U https://doi.org/10.2196/13217 %U http://www.ncbi.nlm.nih.gov/pubmed/31697238 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e11158 %T A Mobile-Based Comprehensive Weight Reduction Program for the Workplace (Health-On): Development and Pilot Study %A Han,Min Kyu %A Cho,Belong %A Kwon,Hyuktae %A Son,Ki Young %A Lee,Hyejin %A Lee,Joo Kyung %A Park,Jinho %+ Department of Family Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea, 82 2 2072 0865, kkolzzi0@gmail.com %K weight loss programs %K smartphone %K mobile phone %K workplaces %K obesity %K obesity management %D 2019 %7 4.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a growing interest in mobile technology for obesity management. Despite the known effectiveness of workplace-based weight loss programs, there are few studies on mobile phone–delivered interventions. Objective: This study aimed to develop and verify an integrated and personalized mobile technology–based weight control program, named Health-On, optimized for workplaces. Methods: A weight reduction algorithm was developed for calorie prescription, continuous monitoring, periodic feedback and reevaluation, goal resetting, and offline intervention with behavior-changing strategies. A total of 30 obese volunteers (body mass index ≥25 kg/m2) participated in the 12-week Health-On pilot program. The primary outcome was weight reduction, and secondary outcomes were improved anthropometric measures, metabolic profiles, and fat computed tomography measures, all assessed pre- and postintervention. Results: Health-On incorporated proprietary algorithms and several strategies intended to maximize adherence, using compatible online and offline interventions. The mean weight of 30 participants decreased by 5.8%, and median weight also decreased from 81.3 kg (interquartile range [IQR] 77.1-87.8) before intervention to 76.6 kg (IQR 70.8-79.5) after the 12-week intervention period (P<.001). The metabolic profiles and fat measures (blood pressure, glycosylated hemoglobin, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, alanine aminotransferase, and visceral and subcutaneous adipose tissue; P<.05) also improved significantly. Conclusions: In this single-group evaluation of 30 participants before and after the Health-On program, body weight decreased and metabolic profiles and fat measures improved. Follow-up studies are needed to assess effectiveness and long-term adherence. %M 31682576 %R 10.2196/11158 %U https://mhealth.jmir.org/2019/11/e11158 %U https://doi.org/10.2196/11158 %U http://www.ncbi.nlm.nih.gov/pubmed/31682576 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e12966 %T A Mobile Phone App for the Provision of Personalized Food-Based Information in an Eating-Out Situation: Development and Initial Evaluation %A Appleton,Katherine Marie %A Bray,Jeff %A Price,Sarah %A Liebchen,Gernot %A Jiang,Nan %A Mavridis,Ioannis %A Saulais,Laure %A Giboreau,Agnès %A Perez-Cueto,Federico J A %A Coolen,Rebecca %A Ronge,Manfred %A Hartwell,Heather %+ Research Centre for Behaviour Change, Department of Psychology, Faculty of Science and Technology, Bournemouth University, Poole House, Fern Barrow, Poole, BH12 5BB, United Kingdom, 44 1202 965985, k.appleton@bournemouth.ac.uk %K eating %K eating behavior %K food %K diet %K mhealth %K mobile app %K digitalhealth %K smartphone %D 2019 %7 4.11.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Increasing pressure from governments, public health bodies, and consumers is driving a need for increased food-based information provision in eating-out situations. Meals eaten outside the home are known to be less healthy than meals eaten at home, and consumers can complain of poor information on the health impact and allergen content of meals eaten out. Objective: This paper aimed to describe the development and early assessment of a mobile phone app that allows the provision of accurate personalized food-based information while considering individual characteristics (allergies, diet type, and preferences) to enable informed consumer choice when eating out. Methods: An app was designed and developed to address these requirements using an agile approach. The developed app was then evaluated at 8 public engagement events using the System Usability Scale (SUS) questionnaire and qualitative feedback. Results: Consideration of the literature and consultation with consumers revealed a need for information provision for consumers in the eating-out situation, including the ability to limit the information provided to that which was personally relevant or interesting. The app was designed to provide information to consumers on the dishes available in a workplace canteen and to allow consumers the freedom to personalize the app and choose the information that they received. Evaluation using the SUS questionnaire revealed positive responses to the app from a range of potential users, and qualitative comments demonstrated broad interest in its use. Conclusions: This paper details the successful development and early assessment of a novel mobile phone app designed to provide food-based information in an eating-out situation in a personalized manner. %M 31682575 %R 10.2196/12966 %U http://formative.jmir.org/2019/4/e12966/ %U https://doi.org/10.2196/12966 %U http://www.ncbi.nlm.nih.gov/pubmed/31682575 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e15648 %T Characteristics and Usage Patterns Among 12,151 Paid Subscribers of the Calm Meditation App: Cross-Sectional Survey %A Huberty,Jennifer %A Vranceanu,Ana-Maria %A Carney,Colleen %A Breus,Michael %A Gordon,Michael %A Puzia,Megan Elizabeth %+ College of Health Solutions, Arizona State University, 550 3rd St, Phoenix, AZ, 85004, United States, 1 6028272456, jhuberty@asu.edu %K health %K psychological stress %K sleep %K mindfulness %K meditation %K consumer behavior %K mobile health %K mhealth %K digital health %D 2019 %7 3.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Meditation has become increasingly popular due to its health benefits; however, barriers to delivering meditation programs in traditional group-based formats limit the accessibility of these benefits. Smartphone-based meditation may increase the availability of these programs to larger, more diverse audiences; however, research on subscriber characteristics and usage patterns in meditation mobile apps is lacking. Objective: This study aimed to describe the demographics, clinical characteristics, and usage patterns of a convenience sample of Calm subscribers and explore the relationship between self-reported app usage and changes in health, stress, and sleep. Methods: Participants were 12,151 paying Calm subscribers (response rate=12.08%, 12,151/100,594) who completed an anonymous Web-based survey with 11 quantitative questions related to user engagement, reasons for starting Calm, and changes after using the app. Demographic characteristics, chronic health diagnoses, and sleep difficulties were also assessed. Chi-square tests were used to examine differences in app usage. Logistic regression models were used to examine demographic and health characteristics that may predict changes in health, stress, and sleep. Results: Respondents were 18-96 years old (mean 48.57 [SD 13.79]), primarily female (79.94%, 8778/10,981), white (81.41%, 8959/11,005), and most reported a chronic health diagnosis (56.86%, 6289/11,061). Mental health diagnoses (41.13%, 4549/11,061) were more common than physical health diagnoses (32.19%, 3560/11,061). Most respondents (76.31%, 8684/11,360) reported difficulties falling or staying asleep. On average, respondents had been using Calm for 11.49 months (SD 10.49), and 60.03% (7281/12,129) used it 5 or more times per week. Meditations (used by 80.02%, 9497/11,841) and Sleep Stories (55.66%, 6591/11,841) were the most popular components. The frequency of using Calm was associated with incremental increases in the likelihood of noticing changes in mental health (χ22=136.8; P<.001), physical health (χ22=102.8; P<.001), stress (χ22=128.1; P<.001), and sleep (χ22=141.4; P<.001). Respondents who had used Calm longer were also more likely to notice changes in mental health (OR 1.06 [95% CI 1.05 to 1.06]), physical health (OR 1.01 [95% CI 1.01 to 1.02]), stress (OR 1.04 [95% CI 1.04 to 1.05]), and sleep (OR 1.004 [95% CI 1.00 to 1.01]). Subscribers with sleep difficulties used Calm more frequently (χ82=11.5; P=.003), were more likely to use Sleep Stories (χ12=1590.2; P<.001), and were more likely to notice changes in their physical health (χ12=49.2; P<.001) and sleep (χ12=2391.1; P<.001). Conclusions: Results highlight important demographic characteristics and usage patterns among a self-selected sample of Calm subscribers. Mental health concerns and sleep appear to be top reasons for downloading Calm. Sleep Stories and meditations are the most popular app components. The frequency of using Calm was associated with incremental changes in outcomes. Findings support future randomized controlled trials testing the efficacy of Calm for health, stress, and sleep. Studies should also explore strategies to attract a more diverse sample of subscribers. %M 31682582 %R 10.2196/15648 %U https://mhealth.jmir.org/2019/11/e15648 %U https://doi.org/10.2196/15648 %U http://www.ncbi.nlm.nih.gov/pubmed/31682582 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e12298 %T Effects of a Smartphone-Based Approach-Avoidance Intervention on Chocolate Craving and Consumption: Randomized Controlled Trial %A Meule,Adrian %A Richard,Anna %A Dinic,Radomir %A Blechert,Jens %+ Schoen Clinic Roseneck, Am Roseneck 6, Prien am Chiemsee, 83209, Germany, 49 8051 68 100 174, ameule@med.lmu.de %K food %K chocolate %K craving %K smartphone %K mobile phone %K mhealth %K digital health %K eating behavior %D 2019 %7 1.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Repeatedly pushing high-calorie food stimuli away based on joystick movements has been found to reduce approach biases toward these stimuli. Some studies also found that such avoidance training reduced consumption of high-calorie foods. Objective: This study aimed to test effects of a smartphone-based approach-avoidance intervention on chocolate craving and consumption, to make such interventions suitable for daily use. Methods: Within a 10-day period, regular chocolate eaters (n=105, 86% female) performed five sessions during which they continuously avoided (ie, swiped upward) chocolate stimuli (experimental group, n=35), performed five sessions during which they approached and avoided chocolate stimuli equally often (placebo control group, n=35), or did not perform any training sessions (inactive control group, n=35). Training effects were measured during laboratory sessions before and after the intervention period and further continuously through daily ecological momentary assessment. Results: Self-reported chocolate craving and consumption as well as body fat mass significantly decreased from pre- to postmeasurement across all groups. Ecological momentary assessment reports evidenced no differences in chocolate craving and consumption between intervention days and rest days as a function of the group. Conclusions: A smartphone-based approach-avoidance training did not affect eating-related and anthropometric measures over and above measurement-based changes in this study. Future controlled studies need to examine whether other techniques of modifying food approach tendencies show an add-on benefit over conventional, monitoring-based intervention effects. Trial Registration: AsPredicted 8203; https://aspredicted.org/pt9df.pdf. %M 31682584 %R 10.2196/12298 %U https://mhealth.jmir.org/2019/11/e12298 %U https://doi.org/10.2196/12298 %U http://www.ncbi.nlm.nih.gov/pubmed/31682584 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e15018 %T Use of the Chatbot “Vivibot” to Deliver Positive Psychology Skills and Promote Well-Being Among Young People After Cancer Treatment: Randomized Controlled Feasibility Trial %A Greer,Stephanie %A Ramo,Danielle %A Chang,Yin-Juei %A Fu,Michael %A Moskowitz,Judith %A Haritatos,Jana %+ Hopelab, 100 California Street, Suite 1150, San Francisco, CA, 94111, United States, 1 415 818 8444, dramo@hopelab.org %K chatbot %K positive psychology %K young adult %K cancer %D 2019 %7 31.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Positive psychology interventions show promise for reducing psychosocial distress associated with health adversity and have the potential to be widely disseminated to young adults through technology. Objective: This pilot randomized controlled trial examined the feasibility of delivering positive psychology skills via the Vivibot chatbot and its effects on key psychosocial well-being outcomes in young adults treated for cancer. Methods: Young adults (age 18-29 years) were recruited within 5 years of completing active cancer treatment by using the Vivibot chatbot on Facebook messenger. Participants were randomized to either immediate access to Vivibot content (experimental group) or access to only daily emotion ratings and access to full chatbot content after 4 weeks (control). Created using a human-centered design process with young adults treated for cancer, Vivibot content includes 4 weeks of positive psychology skills, daily emotion ratings, video, and other material produced by survivors, and periodic feedback check-ins. All participants were assessed for psychosocial well-being via online surveys at baseline and weeks 2, 4, and 8. Analyses examined chatbot engagement and open-ended feedback on likability and perceived helpfulness and compared experimental and control groups with regard to anxiety and depression symptoms and positive and negative emotion changes between baseline and 4 weeks. To verify the main effects, follow-up analyses compared changes in the main outcomes between 4 and 8 weeks in the control group once participants had access to all chatbot content. Results: Data from 45 young adults (36 women; mean age: 25 [SD 2.9]; experimental group: n=25; control group: n=20) were analyzed. Participants in the experimental group spent an average of 74 minutes across an average of 12 active sessions chatting with Vivibot and rated their experience as helpful (mean 2.0/3, SD 0.72) and would recommend it to a friend (mean 6.9/10; SD 2.6). Open-ended feedback noted its nonjudgmental nature as a particular benefit of the chatbot. After 4 weeks, participants in the experimental group reported an average reduction in anxiety of 2.58 standardized t-score units, while the control group reported an increase in anxiety of 0.7 units. A mixed-effects models revealed a trend-level (P=.09) interaction between group and time, with an effect size of 0.41. Those in the experimental group also experienced greater reductions in anxiety when they engaged in more sessions (z=–1.9, P=.06). There were no significant (or trend level) effects by group on changes in depression, positive emotion, or negative emotion. Conclusions: The chatbot format provides a useful and acceptable way of delivering positive psychology skills to young adults who have undergone cancer treatment and supports anxiety reduction. Further analysis with a larger sample size is required to confirm this pattern. %M 31674920 %R 10.2196/15018 %U http://mhealth.jmir.org/2019/10/e15018/ %U https://doi.org/10.2196/15018 %U http://www.ncbi.nlm.nih.gov/pubmed/31674920 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e14074 %T Identifying the Most Autonomy-Supportive Message Frame in Digital Health Communication: A 2x2 Between-Subjects Experiment %A Smit,Eline Suzanne %A Zeidler,Chamoetal %A Resnicow,Ken %A de Vries,Hein %+ Department of Communication Science, Amsterdam School of Communication Research, University of Amsterdam, PO Box 15791, Amsterdam, 1001 NG, Netherlands, 31 (0)625258558, E.S.Smit@uva.nl %K health communication %K health behavior %K personal autonomy %K internet %K health promotion %K healthy diet %K self-determination theory %D 2019 %7 30.10.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The effectiveness of digital health communication may be increased by enhancing autonomy supportiveness. Objective: This study aimed to identify the most autonomy-supportive message frame within an intervention for increasing vegetable intake by testing the effect of the following 2 strategies: (1) using autonomy-supportive language and (2) providing choice. Methods: A Web-based 2 (autonomy-supportive vs controlling language)×2 (choice vs no choice) experiment was conducted among 526 participants, recruited via a research panel. The main outcome measures were perceived autonomy support (measured using the Virtual Care Climate Questionnaire, answered with scores 1 to 5), perceived relevance (measured with one question, answered with scores 1 to 5), and overall evaluation of the intervention (measured with 1 open-ended question, answered with scores 1 to 10). Results: Choice had a significant positive effect on the overall evaluation of the intervention (b=.12; P=.003), whereas for participants with a high need for autonomy, there was a significant positive effect on perceived relevance (b=.13; P=.02). The positive effect of choice on perceived autonomy support approached significance (b=.07; P=.07). No significant effects on any of the three outcomes were observed for language. Conclusions: Results suggest that provision of choice rather than the use of autonomy-supportive language can be an easy-to-implement strategy to increase the effectiveness of digital forms of health communication, especially for people with a high need for autonomy. %M 31670693 %R 10.2196/14074 %U http://www.jmir.org/2019/10/e14074/ %U https://doi.org/10.2196/14074 %U http://www.ncbi.nlm.nih.gov/pubmed/31670693 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e14926 %T An Ambulatory Blood Pressure Monitor Mobile Health System for Early Warning for Stroke Risk: Longitudinal Observational Study %A Wang,Guangyu %A Zhou,Silu %A Rezaei,Shahbaz %A Liu,Xin %A Huang,Anpeng %+ National Institute of Health Data Science, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China, 86 1062755832, hapku@pku.edu.cn %K ambulatory blood pressure monitor %K mHealth %K stroke-risk early warning %K abnormal blood pressure data analyzing %K longitudinal observational study %D 2019 %7 30.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Stroke, as a leading cause of death around the globe, has become a heavy burden on our society. Studies show that stroke can be predicted and prevented if a person’s blood pressure (BP) status is appropriately monitored via an ambulatory blood pressure monitor (ABPM) system. However, currently there exists no efficient and user-friendly ABPM system to provide early warning for stroke risk in real-time. Moreover, most existing ABPM devices measure BP during the deflation of the cuff, which fails to reflect blood pressure accurately. Objective: In this study, we sought to develop a new ABPM mobile health (mHealth) system that was capable of monitoring blood pressure during inflation and could detect early stroke-risk signals in real-time. Methods: We designed an ABPM mHealth system that is based on mobile network infrastructure and mobile apps. The proposed system contains two major parts: a new ABPM device in which an inflation-type BP measurement algorithm is embedded, and an abnormal blood pressure data analysis algorithm for stroke-risk prediction services at our health data service center. For evaluation, the ABPM device was first tested using simulated signals and compared with the gold standard of a mercury sphygmomanometer. Then, the performance of our proposed mHealth system was evaluated in an observational study. Results: The results are presented in two main parts: the device test and the longitudinal observational studies of the presented system. The average measurement error of the new ABPM device with the inflation-type algorithm was less than 0.55 mmHg compared to a reference device using simulated signals. Moreover, the results of correlation coefficients and agreement analyses show that there is a strong linear correlation between our device and the standard mercury sphygmomanometer. In the case of the system observational study, we collected a data set with 88 features, including real-time data, user information, and user records. Our abnormal blood pressure data analysis algorithm achieved the best performance, with an area under the curve of 0.904 for the low risk level, 0.756 for the caution risk level, and 0.912 for the high-risk level. Our system enables a patient to be aware of their risk in real-time, which improves medication adherence with risk self-management. Conclusions: To our knowledge, this device is the first ABPM device that measures blood pressure during the inflation process and has obtained a government medical license. Device tests and longitudinal observational studies were conducted in Peking University hospitals, and they showed the device’s high accuracy for BP measurements, its efficiency in detecting early signs of stroke, and its efficiency at providing an early warning for stroke risk. %M 31670694 %R 10.2196/14926 %U http://mhealth.jmir.org/2019/10/e14926/ %U https://doi.org/10.2196/14926 %U http://www.ncbi.nlm.nih.gov/pubmed/31670694 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e14195 %T Examining the Use of Glucose and Physical Activity Self-Monitoring Technologies in Individuals at Moderate to High Risk of Developing Type 2 Diabetes: Randomized Trial %A Whelan,Maxine E %A Orme,Mark W %A Kingsnorth,Andrew P %A Sherar,Lauren B %A Denton,Francesca L %A Esliger,Dale W %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 7435330992, maxine.whelan@phc.ox.ac.uk %K usage %K self-monitoring %K feedback %K behavior %K physiology, wearable electronic devices %K biobehavioral sciences %D 2019 %7 28.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Self-monitoring of behavior (namely, diet and physical activity) and physiology (namely, glucose) has been shown to be effective in type 2 diabetes (T2D) and prediabetes prevention. By combining self-monitoring technologies, the acute physiological consequences of behaviors could be shown, prompting greater consideration to physical activity levels today, which impact the risk of developing diabetes years or decades later. However, until recently, commercially available technologies have not been able to show individuals the health benefits of being physically active. Objective: The objective of this study was to examine the usage, feasibility, and acceptability of behavioral and physiological self-monitoring technologies in individuals at risk of developing T2D. Methods: A total of 45 adults aged ≥40 years and at moderate to high risk of T2D were recruited to take part in a 3-arm feasibility trial. Each participant was provided with a behavioral (Fitbit Charge 2) and physiological (FreeStyle Libre flash glucose monitor) monitor for 6 weeks, masked according to group allocation. Participants were allocated to glucose feedback (4 weeks) followed by glucose and physical activity (biobehavioral) feedback (2 weeks; group 1), physical activity feedback (4 weeks) followed by biobehavioral feedback (2 weeks; group 2), or biobehavioral feedback (6 weeks; group 3). Participant usage (including time spent on the apps and number of glucose scans) was the primary outcome. Secondary outcomes were the feasibility (including recruitment and number of sensor displacements) and acceptability (including monitor wear time) of the intervention. Semistructured qualitative interviews were conducted at the 6-week follow-up appointment. Results: For usage, time spent on the Fitbit and FreeStyle Libre apps declined over the 6 weeks for all groups. Of the FreeStyle Libre sensor scans conducted by participants, 17% (1798/10,582) recorded rising or falling trends in glucose, and 24% (13/45) of participants changed ≥1 of the physical activity goals. For feasibility, 49% (22/45) of participants completed the study using the minimum number of FreeStyle Libre sensors, and a total of 41 sensors were declared faulty or displaced. For acceptability, participants wore the Fitbit for 40.1 (SD 3.2) days, and 20% (9/45) of participants and 53% (24/45) of participants were prompted by email to charge or sync the Fitbit, respectively. Interviews unearthed participant perceptions on the study design by suggesting refinements to the eligibility criteria and highlighting important issues about the usability, wearability, and features of the technologies. Conclusions: Individuals at risk of developing T2D engaged with wearable digital health technologies providing behavioral and physiological feedback. Modifications are required to both the study and to commercially available technologies to maximize the chances of sustained usage and behavior change. The study and intervention were feasible to conduct and acceptable to most participants. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 17545949; isrctn.com/ISRCTN17545949 %M 31661077 %R 10.2196/14195 %U http://mhealth.jmir.org/2019/10/e14195/ %U https://doi.org/10.2196/14195 %U http://www.ncbi.nlm.nih.gov/pubmed/31661077 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e15733 %T Engagement With a Digital Platform for Multimodal Cognitive Assessment and Multidomain Intervention in a Japanese Population: Pilot, Quasi-Experimental, Longitudinal Study %A Glenn,Jordan %A Madero,Erica Nicole %A Gray,Michelle %A Fuseya,Nami %A Ikeda,Mari %A Kawamura,Tomoo %A Arita,Yoshiko %A Bott,Nick Thomas %+ Neurotrack Technologies Inc, 399 Bradford St, Suite 101, Redwood City, CA, 94063, United States, 1 15615133865, jordan@neurotrack.com %K cognitive decline %K Alzheimer disease %K lifestyle risk reduction %K digital health %K FINGER %K neurocognitive tests %K cognition %K dementia %D 2019 %7 25.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As the global prevalence of dementia continues to rise, multidomain lifestyle interventions that address modifiable risk factors associated with pathological cognitive decline are increasing. Although some digital options have been developed to increase the reach and scalability of these programs, because of cultural differences, the efficacy of the programs in one population cannot easily be generalized to populations in other countries. Objective: This investigation aimed to examine the usability and engagement of a digitally delivered multidomain cognitive lifestyle intervention developed in the United States for a Japanese population. Methods: This feasibility investigation utilized a quasi-experimental, single-arm, nonrandomized, longitudinal design where participants engaged in the behavioral intervention on a smartphone. Of the 559 participants that initially enrolled (age: mean 51 years, SD 7.5 years; 51.7% female [289/559]), 242 completed the final testing trial. Participants enrolled in a multidomain lifestyle program that consisted of (1) psychoeducational material, (2) physical activity tracker, (3) nutrition tracker, (4) audio-based meditations, and (5) health coaching. Engagement with the program was assessed through the total number of app sessions and the use of the exercise, diet, and meditation tracking features within the app. The total number of minutes exercised was collected through subjective user inputs, and nutrition was quantified by the Mediterranean-DASH Intervention for Neurodegenerative Delay diet adherence score. Results: Significant relationships existed between overall nutrition score and frequency of nutrition tracking (r=0.18), frequency of physical activity tracking (r=0.19), and the total number of minutes exercised (r=0.22). Total minutes exercised was significantly correlated with total app sessions (r=0.57), frequency of physical activity tracking (r=0.85), frequency of nutrition tracking (r=0.64), number of times participants meditated (r=0.46), and total lessons read (r=0.36). The number of completed lessons was significantly related to frequency of physical activity tracking (r=0.40), frequency of nutrition tracking (r=0.43), the total number of times participants meditated (r=0.35), and total minutes exercised (r=0.33). Dividing the cohort into two groups based on lesson completion (<10 lessons completed vs ≥10 lessons completed), significant differences were observed between the total minutes exercised, frequency of physical activity tracking, frequency of nutrition tracking, and total number of times participants meditated (all P values <.01). Conclusions: Overall, this cross-cultural feasibility study in Japanese users demonstrated that the various engagement metrics were significantly correlated, and greater engagement was related to improved nutrition scores and increased time exercising. In addition, the relationships between lesson completion and other engagement metrics suggest that there may be value in exploring mechanisms that enhance lesson completion. Future research should examine the program in randomized control trials to more rigorously evaluate program efficacy. %M 31654567 %R 10.2196/15733 %U http://mhealth.jmir.org/2019/10/e15733/ %U https://doi.org/10.2196/15733 %U http://www.ncbi.nlm.nih.gov/pubmed/31654567 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e12612 %T Assessment of the Efficacy, Safety, and Effectiveness of Weight Control and Obesity Management Mobile Health Interventions: Systematic Review %A Puigdomenech Puig,Elisa %A Robles,Noemí %A Saigí-Rubió,Francesc %A Zamora,Alberto %A Moharra,Montse %A Paluzie,Guillermo %A Balfegó,Mariona %A Cuatrecasas Cambra,Guillem %A Garcia-Lorda,Pilar %A Carrion,Carme %+ Faculty of Health Sciences, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, Barcelona, Spain, 34 934 505 254, mcarrionr@uoc.edu %K mHealth %K obesity %K overweight %K systematic review %K technology assessment %D 2019 %7 25.10.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The use of apps to tackle overweight and obesity by tracking physical and dietary patterns and providing recommendations and motivation strategies to achieve personalized goals has increased over recent years. However, evidence of the efficacy, effectiveness, and safety of these apps is severely lacking. Objective: The aim of this study was to identify efficacy, safety, and effectiveness criteria used to assess weight control, overweight, and obesity management in mobile health (mHealth) interventions through a systematic review. Methods: PubMed, PsycINFO, Scopus, UK Trial Database, ClinicalTrials.gov, and the Cochrane Library were surveyed up to May 2018. All types of clinical studies were considered. A total of 2 independent reviewers assessed quality using Scottish Intercollegiate Guidelines Network (SIGN) criteria. Ratings were used to provide an overall score for each study (low, moderate, or high). Data were synthesized in evidence tables. Results: From 233 potentially relevant publications, only 28 studies were included. Of these, 13 (46%) were randomized control trials, 11 were single-arm studies (39%), 3 were nonrandomized controlled trials (11%), and 1 study was a cluster randomized trial (4%). The studies were classified as low (15), high (7), and moderate (6) quality according to SIGN criteria. All studies focused on efficacy, with only 1 trial mentioning safety and another 1 effectiveness. In 11 studies, the apps were used as stand-alone interventions, the others were multicomponent studies that included other tools for support such as sensors or websites. The main management tool included in the apps was feedback messaging (24), followed by goal-setting mechanisms (20) and self-monitoring (19). The majority of studies took weight or body mass index loss as the main outcome (22) followed by changes in physical activity (14) and diet (12). Regarding outputs, usability, adherence, and engagement (17) were the most reported, followed by satisfaction (7) and acceptability (4). Conclusions: There is a remarkable heterogeneity among these studies and the majority have methodological limitations that leave considerable room for improvement. Further research is required to identify all relevant criteria for assessing the efficacy of mHealth interventions in the management of overweight and obesity. Trial Registration: PROSPERO CRD42017056761; https://tinyurl.com/y2zhxtjx %M 31654566 %R 10.2196/12612 %U http://mhealth.jmir.org/2019/10/e12612/ %U https://doi.org/10.2196/12612 %U http://www.ncbi.nlm.nih.gov/pubmed/31654566 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e15775 %T A Mobile Health App (Roadmap 2.0) for Patients Undergoing Hematopoietic Stem Cell Transplant: Qualitative Study on Family Caregivers' Perspectives and Design Considerations %A Chaar,Dima %A Shin,Ji Youn %A Mazzoli,Amanda %A Vue,Rebecca %A Kedroske,Jacob %A Chappell,Grant %A Hanauer,David A %A Barton,Debra %A Hassett,Afton L %A Choi,Sung Won %+ University of Michigan, Medical School, Blood and Marrow Transplantation Program, Medical Professional Building, D4118 SPC 5718, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, United States, 1 734 615 5707, sungchoi@umich.edu %K caregivers %K allogeneic hematopoietic stem cell transplant %K home interviews %K user experience %K mobile health apps %D 2019 %7 24.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hematopoietic stem cell transplantation (HCT), also referred to as blood and marrow transplantation (BMT), is a high-risk, but potentially curative therapy for a number of cancer and noncancer conditions. BMT Roadmap (Roadmap 1.0) is a mobile health app that was developed as a family caregiver–facing tool to provide informational needs about the health status of patients undergoing inpatient HCT. Objective: This study explored the views and perceptions of family caregivers of patients undergoing HCT and their input regarding further technology development and expansion of BMT Roadmap into the outpatient setting (referred to as Roadmap 2.0). Methods: Semistructured qualitative interviews were conducted among 24 family caregivers. Questions were developed from existing literature coupled with prior in-depth observations and interviews in hospital-based settings to explore the study objectives. Participants were recruited during routine outpatient clinic appointments of HCT patients, and all interviews were conducted in the participants’ homes, the setting in which Roadmap 2.0 is intended for use. A thematic analysis was performed using a consistent set of codes derived from our prior research. New emerging codes were also included, and the coding structure was refined with iterative cycles of coding and data collection. Results: Four major themes emerged through our qualitative analysis: (1) stress related to balancing caregiving duties; (2) learning and adapting to new routines (resilience); (3) balancing one’s own needs with the patient’s needs (insight); and (4) benefits of caregiving. When caregivers were further probed about their views on engagement with positive activity interventions (ie, pleasant activities that promote positive emotions and well-being such as expressing gratitude or engaging in activities that promote positive thoughts, emotions, and behaviors), they preferred a “menu” of positive activities to help support caregiver health and well-being. Conclusions: This study involved family caregivers as participants in the development of new components for Roadmap 2.0. Our research provided a further understanding of the many priorities that hematopoietic stem cell transplant family caregivers face while maintaining balance in their lives. Their schedules can often be unpredictable, even more so once the patient is discharged from the hospital. Our findings suggest that expanding Roadmap 2.0 into the outpatient setting may provide critical caregiver support and that HCT caregivers are interested in and willing to engage in positive activities that may enhance well-being and attenuate the stress associated with caregiving. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.4918 %M 31651402 %R 10.2196/15775 %U http://mhealth.jmir.org/2019/10/e15775/ %U https://doi.org/10.2196/15775 %U http://www.ncbi.nlm.nih.gov/pubmed/31651402 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e14769 %T Usability and Feasibility of a Smartphone App to Assess Human Behavioral Factors Associated with Tick Exposure (The Tick App): Quantitative and Qualitative Study %A Fernandez,Maria P %A Bron,Gebbiena M. %A Kache,Pallavi A %A Larson,Scott R %A Maus,Adam %A Gustafson Jr,David %A Tsao,Jean I %A Bartholomay,Lyric C %A Paskewitz,Susan M %A Diuk-Wasser,Maria A %+ Department of Ecology, Evolution and Environmental Biology, Columbia University, Schemerhorn Ext Building, 11th Floor, Room 1013, New York, NY, United States, 1 212 854 3355, mad2256@columbia.edu %K Lyme disease %K ticks %K ecological momentary assessment %K citizen science %D 2019 %7 24.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) technology takes advantage of smartphone features to turn them into research tools, with the potential to reach a larger section of the population in a cost-effective manner, compared with traditional epidemiological methods. Although mHealth apps have been widely implemented in chronic diseases and psychology, their potential use in the research of vector-borne diseases has not yet been fully exploited. Objective: This study aimed to assess the usability and feasibility of The Tick App, the first tick research–focused app in the United States. Methods: The Tick App was designed as a survey tool to collect data on human behaviors and movements associated with tick exposure while engaging users in tick identification and reporting. It consists of an enrollment survey to identify general risk factors, daily surveys to collect data on human activities and tick encounters (Tick Diaries), a survey to enter the details of tick encounters coupled with tick identification services provided by the research team (Report a Tick), and educational material. Using quantitative and qualitative methods, we evaluated the enrollment strategy (passive vs active), the user profile, location, longitudinal use of its features, and users’ feedback. Results: Between May and September 2018, 1468 adult users enrolled in the app. The Tick App users were equally represented across genders and evenly distributed across age groups. Most users owned a pet (65.94%, 962/1459; P<.001), did frequent outdoor activities (recreational or peridomestic; 75.24%, 1094/1454; P<.001 and 64.58%, 941/1457; P<.001, respectively), and lived in the Midwest (56.55%, 824/1457) and Northeast (33.0%, 481/1457) regions in the United States, more specifically in Wisconsin, southern New York, and New Jersey. Users lived more frequently in high-incidence counties for Lyme disease (incidence rate ratio [IRR] 3.5, 95% CI 1.8-7.2; P<.001) and in counties with cases recently increasing (IRR 1.8, 95% CI 1.1-3.2; P=.03). Recurring users (49.25%, 723/1468) had a similar demographic profile to all users but participated in outdoor activities more frequently (80.5%, 575/714; P<.01). The number of Tick Diaries submitted per user (median 2, interquartile range [IQR] 1-11) was higher for older age groups (aged >55 years; IRR 3.4, 95% CI 1.5-7.6; P<.001) and lower in the Northeast (IRR[NE] 0.4, 95% CI 0.3-0.7; P<.001), whereas the number of tick reports (median 1, IQR 1-2) increased with the frequency of outdoor activities (IRR 1.5, 95% CI 1.3-1.8; P<.001). Conclusions: This assessment allowed us to identify what fraction of the population used The Tick App and how it was used during a pilot phase. This information will be used to improve future iterations of The Tick App and tailor potential tick prevention interventions to the users’ characteristics. %M 31651409 %R 10.2196/14769 %U http://mhealth.jmir.org/2019/10/e14769/ %U https://doi.org/10.2196/14769 %U http://www.ncbi.nlm.nih.gov/pubmed/31651409 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e11603 %T Factors Influencing Exercise Engagement When Using Activity Trackers: Nonrandomized Pilot Study %A Centi,Amanda Jayne %A Atif,Mursal %A Golas,Sara Bersche %A Mohammadi,Ramin %A Kamarthi,Sagar %A Agboola,Stephen %A Kvedar,Joseph C %A Jethwani,Kamal %+ Pivot Labs, Partners Healthcare, 25 New Chardon St, Ste 300, 3rd Floor, Boston, MA, 02114, United States, 1 6177242158, acenti@partners.org %K activity trackers %K exercise %K engagement %D 2019 %7 24.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: It is well reported that tracking physical activity can lead to sustained exercise routines, which can decrease disease risk. However, most stop using trackers within a couple months of initial use. The reasons people stop using activity trackers can be varied and personal. Understanding the reasons for discontinued use could lead to greater acceptance of tracking and more regular exercise engagement. Objective: The aim of this study was to determine the individualistic reasons for nonengagement with activity trackers. Methods: Overweight and obese participants (n=30) were enrolled and allowed to choose an activity tracker of their choice to use for 9 weeks. Questionnaires were administered at the beginning and end of the study to collect data on their technology use, as well as social, physiological, and psychological attributes that may influence tracker use. Closeout interviews were also conducted to further identify individual influencers and attributes. In addition, daily steps were collected from the activity tracker. Results: The results of the study indicate that participants typically valued the knowledge of their activity level the activity tracker provided, but it was not a sufficient motivator to overcome personal barriers to maintain or increase exercise engagement. Participants identified as extrinsically motivated were more influenced by wearing an activity tracker than those who were intrinsically motivated. During the study, participants who reported either owning multiple technology devices or knowing someone who used multiple devices were more likely to remain engaged with their activity tracker. Conclusions: This study lays the foundation for developing a smart app that could promote individual engagement with activity trackers. %M 31651405 %R 10.2196/11603 %U https://mhealth.jmir.org/2019/10/e11603 %U https://doi.org/10.2196/11603 %U http://www.ncbi.nlm.nih.gov/pubmed/31651405 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13013 %T A Promising Food-Coaching Intervention Program to Achieve Optimal Gestational Weight Gain in Overweight and Obese Pregnant Women: Pilot Randomized Controlled Trial of a Smartphone App %A Li,Ling-Jun %A Aris,Izzuddin M %A Han,Wee Meng %A Tan,Kok Hian %+ Department of Obstetrics & Gynecology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Children's Tower Level 3, Singapore, 229899, Singapore, 65 63941099, queenie.li.l.j@gmail.com %K overweight, obesity, pregnant women %K gestational weight gain %K food diary %K randomized controlled trial %K smartphone app %K food coaching %K dietary recommendation %K feasibility %D 2019 %7 24.10.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Traditional dietary recommendations for achieving optimal gestational weight gain are ineffective for pregnant women due to the lack of real-time communication and tedious consultation processes. Objective: In this pilot study, we aimed to determine the feasibility of a novel food-coaching smartphone app for controlling gestational weight gain and macronutrient intake among overweight and obese pregnant women. Methods: We designed a randomized controlled trial and recruited 30 overweight and obese pregnant women (1:1 ratio) during 18-20 weeks of gestation and followed them up after 4 and 8 weeks, respectively. Both groups received standard pregnancy dietary orientation at recruitment, while the intervention group received 8 weeks of real-time food coaching via a smartphone app. This food-coaching smartphone app (Glycoleap, Holmusk, Singapore) aimed to improve care and outcomes for people with diabetes. Pregnant women using this app were able to upload food images (eg, a picture of a meal, a drink, or a dessert) and received real-time and detailed food-coaching comments and guidance provided by professional dietitians during the day (8 AM to 8 PM). We recorded detailed characteristics during recruitment and examined anthropometry at all visits. We compared the mean differences of the 8-week gestational weight gain and macronutrient intake between the two groups. Results: Upon study completion, three subjects dropped out from the intervention, and one gave birth prematurely in the control group. The acceptance rate of the smartphone app was 90%. More participants achieved optimal gestational weight gain per week in the intervention group (8/12, 67%) than in the control group (5/14, 36%). After the 8-week intervention, women in the intervention group appeared to have lower gestational weight gain (mean difference=–0.08 kg; 95% CI –1.80 to 1.63) and cholesterol intake (mean difference=–31.73 mg; 95% CI –102.91 to 39.45) than those in the control group. Conclusions: Our findings showed that this food-coaching smartphone app is feasible and favorable for weight gain control and cholesterol intake control among overweight and obese pregnant women. Although our results were not significant (perhaps, attributed to the small sample size), it provided proof of concept for the feasibility of applying such technology in future randomized controlled trials with a larger sample size, an earlier intervention onset, and a longer follow-up for overweight and obese pregnant women. %M 31651407 %R 10.2196/13013 %U http://formative.jmir.org/2019/4/e13013/ %U https://doi.org/10.2196/13013 %U http://www.ncbi.nlm.nih.gov/pubmed/31651407 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e13935 %T Mobile Health Coaching on Nutrition and Lifestyle Behaviors for Subfertile Couples Using the Smarter Pregnancy Program: Model-Based Cost-Effectiveness Analysis %A Oostingh,Elsje C %A Ophuis,Robbin H %A Koster,Maria PH %A Polinder,Suzanne %A Lingsma,Hester F %A Laven,Joop SE %A Steegers-Theunissen,Régine PM %+ Erasmus University Medical Center, Postbus 2040, Rotterdam, 3000 CA, Netherlands, 31 107038255, r.steegers@erasmusmc.nl %K preconception %K subfertility %K IVF treatment %K pregnancy %K cost-effectiveness %D 2019 %7 23.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The health care costs for reproductive care have substantially increased with the use of in vitro fertilization (IVF) treatment. The mobile health (mHealth) coaching program Smarter Pregnancy is an effective intervention to improve nutrition and lifestyle behaviors and pregnancy rates in (sub)fertile couples, including those who undergo IVF treatment. Therefore, we hypothesize that this mHealth program can also reduce health care costs associated with IVF treatment. Objective: This study aimed to evaluate the cost-effectiveness of the mHealth coaching program Smarter Pregnancy and compare it to usual care in women of subfertile couples who start their first IVF cycle. Methods: This model-based cost-effectiveness analysis was performed on data from couples undergoing IVF treatment at the Erasmus MC, University Medical Center Rotterdam. A decision tree model was used to assess the incremental cost-effectiveness ratio (ICER) of ongoing pregnancies and costs of use of the mHealth program as compared to usual care. A probabilistic sensitivity analysis was performed to consider the uncertainty surrounding the point estimates of the input parameters. Results: Based on our model including 793 subfertile women undergoing IVF treatment, use of the mHealth program resulted in 86 additional pregnancies and saved €270,000 compared to usual care after two IVF cycles, with an ICER of –€3050 (95% CI –3960 to –540) per additional pregnancy. The largest cost saving was caused by the avoided IVF treatment costs. Sensitivity analyses showed that the mHealth program needs to increase the ongoing pregnancy rate by at least 51% after two IVF cycles for cost saving. Conclusions: The mHealth coaching program Smarter Pregnancy is potentially cost saving for subfertile couples preceding their first IVF treatment. Implementation of this mHealth program in routine preconception care for subfertile couples should be seriously considered, given the relatively low costs and promising cost-effectiveness estimates. %M 31647476 %R 10.2196/13935 %U http://mhealth.jmir.org/2019/10/e13935/ %U https://doi.org/10.2196/13935 %U http://www.ncbi.nlm.nih.gov/pubmed/31647476 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e12335 %T Predicting Energy Expenditure During Gradient Walking With a Foot Monitoring Device: Model-Based Approach %A Kim,Soon Ho %A Kim,Jong Won %A Park,Jung-Jun %A Shin,Myung Jun %A Choi,MooYoung %+ Division of Sport Science, Pusan National University, 2, Busandaehak-ro 63beon-gil, Geumjeong-gu, Busan, 46241, Republic of Korea, 82 10 3285 1626, jjparkpnu@pusan.ac.kr %K energy expenditure %K physical activity %K human walking %K wearable devices %K mHealth %D 2019 %7 23.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many recent commercial devices aim at providing a practical way to measure energy expenditure. However, those devices are limited in accuracy. Objective: This study aimed to build a model of energy consumption during walking applicable to a range of sloped surfaces, used in conjunction with a simple, wearable device. Methods: We constructed a model of energy consumption during gradient walking by using arguments based in mechanics. We built a foot monitoring system that used pressure sensors on the foot insoles. We did experiments in which participants walked on a treadmill wearing the foot monitoring system, and indirect calorimetry was used for validation. We found the parameters of the model by fitting to the data. Results: When walking at 1.5 m/s, we found that the model predicted a calorie consumption rate of 5.54 kcal/min for a woman with average height and weight and 6.89 kcal/min for an average man. With the obtained parameters, the model predicted the data with a root-mean-square deviation of 0.96 kcal/min and median percent error of 12.4%. Conclusions: Our model was found to be an accurate predictor of energy consumption when walking on a range of slopes. The model uses few variables; thus, it can be used in conjunction with a convenient wearable device. %M 31647467 %R 10.2196/12335 %U https://mhealth.jmir.org/2019/10/e12335 %U https://doi.org/10.2196/12335 %U http://www.ncbi.nlm.nih.gov/pubmed/31647467 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e15019 %T Content and Feature Preferences for a Physical Activity App for Adults With Physical Disabilities: Focus Group Study %A Olsen,Sara H %A Saperstein,Sandra L %A Gold,Robert S %+ Department of Behavioral and Community Health, School of Public Health, University of Maryland, 4200 Valley Dr #1234, College Park, MD, 20742, United States, 1 301 405 2463, sara.olsen@gmail.com %K adapted sport %K disability %K physical activity %K focus group %K apps %K fitness %K user-centered design %K mHealth %D 2019 %7 11.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hundreds of thousands of mobile phone apps intended to improve health and fitness are available for download across platforms and operating systems; however, few have been designed with people with physical disabilities in mind, ignoring a large population that may benefit from an effective tool to increase physical activity. Objective: This study represents the first phase in the development process of a fitness tracking app for people with physical disabilities interested in nontraditional sport. The aim of this research was to explore user preferences for content, appearance, and operational features of a proposed physical activity app for people with physical disabilities to inform the design of a mobile phone app for increasing physical activity. Methods: Four focus groups were conducted with 15 adults with physical disabilities who currently participate in nontraditional, non-Paralympic sport. Data collected from the focus group sessions centered on content, functionality, and appearance of apps currently used by participants as well as preferences for a future app. Results: Participants (mean age 35.7, SD 9.2 years) were mostly white (13/15, 87%), and all were currently participating in CrossFit and at least one other sport. Five main themes were identified. Themes included preferences for (1) workout-specific features that were tailored or searchable by disability, (2) user experience that was intuitive and accessible, (3) profile personalization options, (4) gamification features that allowed for competition with self and other users, and (5) social features that allowed increased interaction among users. Participants expressed a primary interest in having a fitness app that was designed for people with physical disabilities such that the features present in other fitness tracking apps were relevant to them and their community of adaptive athletes. Conclusions: The results showed that features related to user experience, social engagement, and gamification are considered important to people with physical disabilities. Features highlighted by participants as most desired, from a consumer perspective, were in line with research identifying attributes of quality apps that use behavior change techniques to influence positive physical activity behavior change. Such insights should inform the development of any fitness app designed to integrate users with disabilities as a primary user base. %M 31605518 %R 10.2196/15019 %U https://mhealth.jmir.org/2019/10/e15019 %U https://doi.org/10.2196/15019 %U http://www.ncbi.nlm.nih.gov/pubmed/31605518 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 10 %P e15144 %T Automated Mobile Phone–Based Mental Health Resource for Homeless Youth: Pilot Study Assessing Feasibility and Acceptability %A Glover,Angela C %A Schueller,Stephen M %A Winiarski,Dominika A %A Smith,Dale L %A Karnik,Niranjan S %A Zalta,Alyson K %+ Department of Psychiatry & Behavioral Sciences, Rush Medical College, Rush University, 1645 West Jackson Blvd, Suite 600, Chicago, IL, 60612, United States, 1 312 942 8085, niranjan_karnik@rush.edu %K mental health %K young adult %K homelessness %K telemedicine %K treatment %K mHealth %K mobile phone %D 2019 %7 11.10.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Youth experiencing housing instability have higher rates of mental health problems than their housed peers. Few studies have evaluated technological resources for homeless youth to determine how to effectively engage and reach them. Objective: The primary aims of this pilot study were to establish the feasibility (as measured by phone retention rates) and acceptability (ie, participant ratings of resources) of delivering automated mental health resources via smartphone technology. Methods: Youth aged 16 to 25 years (N=100) were recruited through homeless shelter agencies in the Chicago metropolitan area. Eligible participants completed a baseline assessment and received a smartphone with a 3-month data plan. The phone was preloaded with several apps designed to promote mental health wellness and provide real-time resources. One app specifically designed for this study, Pocket Helper 2.0, sent participants daily surveys and tips via push notification. The tips focused on coping and motivation, and the surveys assessed mood. This app also included an automated self-help system with brief cognitive behavioral interventions (5-10 min) and access to several interactive mobile tools, including a crisis text line, a telephone hotline, a crowd-based emotional support tool, and an app providing up-to-date information on social service and mental health resources for homeless youth in Chicago. Participants completed assessments at 3 and 6 months. Results: Some individuals (23%, 23/100) experienced problems with the phones (eg, theft, loss, and technological issues) throughout the study. Participant retention at the midpoint was moderate, with 48% (48/100) of youth responding to the 3-month surveys. At 6 months, only 19% (19/100) of the total sample responded to the end point survey. Overall, 63% (30/48) to 68% (13/19) of respondents at both time points reported benefiting from the intervention; however, participant usage and satisfaction varied with the different features. At both time points, participants reported receiving the most benefit from the daily tips and daily surveys. Daily tips that were most preferred by participants involved motivational tips related to overcoming struggles and making progress in life. Aside from the tips and surveys, the most used features were the app providing up-to-date resources and the automated self-help system. Interactive features, including the telephone hotline and crowd-based emotional support tool, were the least used features and were rated as the least beneficial. Conclusions: Automated mental health interventions seem to be an acceptable way to engage homeless youth in mental health support. The participants preferred fully automated features and brief interventions over features requiring interaction with others or more engagement. Future research should explore ways to retain homeless youth in interventions and evaluate the clinical impact of automated technology-based interventions for improving mental health. Trial Registration: ClinicalTrials.gov NCT03776422; https://clinicaltrials.gov/ct2/show/NCT03776422 %M 31605516 %R 10.2196/15144 %U http://mental.jmir.org/2019/10/e15144/ %U https://doi.org/10.2196/15144 %U http://www.ncbi.nlm.nih.gov/pubmed/31605516 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e11205 %T Young People’s Attitudes and Motivations Toward Social Media and Mobile Apps for Weight Control: Mixed Methods Study %A Nikolaou,Charoula Konstantia %A Tay,Zoey %A Leu,Jodie %A Rebello,Salome Antonette %A Te Morenga,Lisa %A Van Dam,Rob M %A Lean,Michael Ernest John %+ Graduate School of Public Health, Department of Biostatistics and Bioinformatics, St Luke's International University, 3-6-2 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan, 81 08078059495, cknikolaou1@gmail.com %K weight gain %K young adults %K obesity %K public health %K focus groups %K mobile apps %K mHealth %D 2019 %7 10.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Effective prevention at a young enough age is critical to halt the obesity epidemic. Mobile health (mHealth) apps would potentially reach large numbers at low-cost. While there is already a profusion of lifestyle apps, they are mostly non-evidence-based and evidently ineffective against rising obesity prevalence. Objective: The aim of this study was to explore preferences and usage of lifestyle apps among young people in 6 countries. Methods: A mixed methods study was conducted among young people aged 13 to 24 years residing in the United Kingdom, Belgium, Finland, Greece, Singapore, and New Zealand. Participants were recruited from Web advertisements on Facebook, asking for volunteers interested in mobile apps in general, not specific to lifestyle or health, to complete a short survey comprising 18 questions on demographics, weight gain, and mobile app preferences and then to join English-language online focus groups, which were held during 2017, in password-protected Web rooms, moderated by an experienced researcher. Descriptive statistics were carried out for the survey, and thematic analysis was applied to transcripts. Results: A total of 2285 young people (610 adolescents aged 13-17 years and 1675 young adults aged 18-24 years) responded and completed the survey, with 72.0% (1645) reported being concerned about weight gain for themselves or friends. Later, 807 young people (376 adolescents and 431 young adults) were selected based on age and country to participate in 12 online focus groups, with 719 young people completing. Analysis revealed 4 main themes: (1) feelings toward personal weight; (2) perception of lifestyle apps and desired content for weight gain prevention; (3) social media apps, lifestyle apps, and motivation for downloading and retaining; and (4) data safety and data usage and confidentiality. Young people are interested in evidence-based advice in programs incorporating their preferences. Conclusions: Young people are commonly, and consistently across 6 countries, concerned about weight gain and obesity and would welcome evidence-based mHealth programs, provided the views of young people themselves are incorporated in the program content. %M 31603431 %R 10.2196/11205 %U https://mhealth.jmir.org/2019/10/e11205 %U https://doi.org/10.2196/11205 %U http://www.ncbi.nlm.nih.gov/pubmed/31603431 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 2 %P e15153 %T Exploring an Existing Weight Management App for Use With Adolescents and Young Adults With Spina Bifida: Usability Study %A Stiles-Shields,Colleen %A Garcia,Brittney %A Villota,Kimberly %A Wartman,Elicia %A Winning,Adrien M %A Holmbeck,Grayson N %+ Population Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W Jackson Blvd, Chicago, IL, 60612, United States, 1 3125631579, elizabeth_stiles-shields@rush.edu %K spina bifida occulta %K mHealth %K mobile apps %K usability testing %K adolescent %K young adult %K weight reduction programs %K body weight maintenance %D 2019 %7 10.10.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Adolescents and young adults with spina bifida (AYA-SBs) have unique user needs, given their variable and complex symptom profile. Owing to multiple barriers to prevention and intervention treatments for secondary conditions (eg, obesity), AYA-SBs may benefit from the use of behavioral intervention technologies (BITs). However, as BITs are often designed and tested with typically developing individuals, it is unclear if existing BITs may be usable for AYA-SBs. Objective: This study aimed to evaluate the usability of a high-quality, publicly available, weight management–focused mobile BIT (smartphone app) for AYA-SBs. Methods: Overall, 28 AYA-SBs attending a Young Men’s Christian Association–based summer camp completed 4 structured usability tasks using a weight management app designed for the general public called My Diet Coach (Bending Spoons). Learnability was measured by (1) time to complete task, (2) number of user errors, and (3) correct entry of data when requested by the app. Satisfaction and general usability were measured via self-reported questionnaires and qualitative feedback following interactions with the app. Results: The majority of the sample were able to complete the tasks, with increased completion rates and improved times on second attempts of the tasks (Ps<.05). Errors were common, and discrepancies emerged between quantitative and qualitative feedback such that self-reported measures indicated dissatisfaction but qualitative feedback was generally positive. Suggested improvements to the app included (1) tutorials, (2) simplifying the design, (3) more activity options for those who ambulate by wheelchair, and (4) notifications to prompt use. Conclusions: AYA-SBs were able to learn how to complete specific tasks independently on a weight management app, but design changes consistent with previously proposed user needs were recommended. Rather than designing entirely new BITs, it may be possible to adapt existing technologies to personalize BITs for specific populations such as AYA-SBs. %M 31603432 %R 10.2196/15153 %U https://pediatrics.jmir.org/2019/2/e15153 %U https://doi.org/10.2196/15153 %U http://www.ncbi.nlm.nih.gov/pubmed/31603432 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e14052 %T Understanding Health Behavior Technology Engagement: Pathway to Measuring Digital Behavior Change Interventions %A Cole-Lewis,Heather %A Ezeanochie,Nnamdi %A Turgiss,Jennifer %+ Johnson and Johnson Health and Wellness Solutions, Inc, 1 Johnson and Johnson Plaza, New Brunswick, NJ, 08933, United States, 1 7209330786, nezeanoc@its.jnj.com %K engagement %K user engagement %K health behavior %K health determinants %K digital behavior change intervention %K measurements %D 2019 %7 10.10.2019 %9 Viewpoint %J JMIR Form Res %G English %X Researchers and practitioners of digital behavior change interventions (DBCI) use varying and, often, incongruent definitions of the term “engagement,” thus leading to a lack of precision in DBCI measurement and evaluation. The objective of this paper is to propose discrete definitions for various types of user engagement and to explain why precision in the measurement of these engagement types is integral to ensuring the intervention is effective for health behavior modulation. Additionally, this paper presents a framework and practical steps for how engagement can be measured in practice and used to inform DBCI design and evaluation. The key purpose of a DBCI is to influence change in a target health behavior of a user, which may ultimately improve a health outcome. Using available literature and practice-based knowledge of DBCI, the framework conceptualizes two primary categories of engagement that must be measured in DBCI. The categories are health behavior engagement, referred to as “Big E,” and DBCI engagement, referred to as “Little e.” DBCI engagement is further bifurcated into two subclasses: (1) user interactions with features of the intervention designed to encourage frequency of use (ie, simple login, games, and social interactions) and make the user experience appealing, and (2) user interactions with behavior change intervention components (ie, behavior change techniques), which influence determinants of health behavior and subsequently influence health behavior. Achievement of Big E in an intervention delivered via digital means is contingent upon Little e. If users do not interact with DBCI features and enjoy the user experience, exposure to behavior change intervention components will be limited and less likely to influence the behavioral determinants that lead to health behavior engagement (Big E). Big E is also dependent upon the quality and relevance of the behavior change intervention components within the solution. Therefore, the combination of user interactions and behavior change intervention components creates Little e, which is, in turn, designed to improve Big E. The proposed framework includes a model to support measurement of DBCI that describes categories of engagement and details how features of Little e produce Big E. This framework can be applied to DBCI to support various health behaviors and outcomes and can be utilized to identify gaps in intervention efficacy and effectiveness. %M 31603427 %R 10.2196/14052 %U https://formative.jmir.org/2019/4/e14052 %U https://doi.org/10.2196/14052 %U http://www.ncbi.nlm.nih.gov/pubmed/31603427 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e14877 %T Mobile Health for First Nations Populations: Systematic Review %A Hobson,Georgina R %A Caffery,Liam J %A Neuhaus,Maike %A Langbecker,Danette H %+ Centre for Online Health, Centre for Health Services Research, The University of Queensland, Ground Floor, Building 33, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia, 61 731761685, g.hobson@uq.edu.au %K mHealth %K mobile health %K indigenous %K First Nations %K aboriginal %K humans %K systematic review %D 2019 %7 7.10.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The ubiquitous presence and functionality of mobile devices offers the potential for mobile health (mHealth) to create equitable health opportunities. While mHealth is used among First Nations populations to respond to health challenges, the characteristics, uptake, and effectiveness of these interventions are unclear. Objective: This review aimed to identify the characteristics of mHealth interventions (eg, study locations, health topic, and modality) evaluated with First Nations populations and to summarize the outcomes reported for intervention use, user perspectives including cultural responsiveness, and clinical effectiveness. In addition, the review sought to identify the presence of First Nations expertise in the design and evaluation of mHealth interventions with First Nations populations. Methods: The methods of this systematic review were detailed in a registered protocol with the International Prospective Register of Systematic Reviews (PROSPERO, CRD42019123276). Systematic searches of peer-reviewed, scientific papers were conducted across 7 databases in October 2018. Eligible studies had a primary focus on mHealth interventions with experimental or quasi-experimental design to respond to a health challenge with First Nations people from Canada, Australia, New Zealand, and the United States. Two authors independently screened records for eligibility and assessed risk of bias using the Joanna Briggs Institute checklists. Data were synthesized narratively owing to the mix of study designs, interventions, and outcomes. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results: Searches yielded 1053 unique records, after review and screening, 13 studies (5 randomized controlled trials and 8 quasi-experimental designs) were included in the final analysis. Studies were conducted in Australia (n=9), the United States (n=2), and New Zealand (n=2). The most common health challenge addressed was mental health and suicide (n=5). Intervention modalities included text messaging (n=5), apps (n=4), multimedia messaging (n=1), tablet software (n=1), or a combination of short messaging service (SMS) and apps (n=1). Results showed mixed engagement with the intervention (n=3); favorable user perspectives, including acceptability and cultural appropriateness (n=6); and mixed outcomes for clinical effectiveness (n=10). A diverse range of risks of bias were identified, the most common of which included a lack of clarity about allocation and blinding protocols and group treatment for randomized controlled trials and a lack of control group and single outcome measures for quasi-experimental designs. First Nations expertise informed all mHealth studies, through authorship (n=8), affiliation with First Nations bodies (n=3), participatory study design (n=5), First Nations reference groups (n=5), or a combination of these. Conclusions: mHealth modalities, including SMS and apps, appear favorable for delivery of health interventions with First Nations populations, particularly in the area of mental health and suicide prevention. Importantly, First Nations expertise was strongly embedded within the studies, augmenting favorable use and user engagement. However, evidence of efficacy is limited. %M 31593537 %R 10.2196/14877 %U https://mhealth.jmir.org/2019/10/e14877 %U https://doi.org/10.2196/14877 %U http://www.ncbi.nlm.nih.gov/pubmed/31593537 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e14699 %T Dropout and Abstinence Outcomes in a National Text Messaging Smoking Cessation Intervention for Pregnant Women, SmokefreeMOM: Observational Study %A Kamke,Kristyn %A Grenen,Emily %A Robinson,Cendrine %A El-Toukhy,Sherine %+ Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 7201 Wisconsin Ave, RM 533M, Bethesda, MD, 20814, United States, 1 301 594 4743, sherine.el-toukhy@nih.gov %K smoking cessation %K pregnancy %K women's health %K mHealth %K text messaging intervention %D 2019 %7 7.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Population-level text messaging smoking cessation interventions may reduce racial and ethnic differences in smoking among pregnant women. Objective: Our objective was to examine racial and ethnic differences in dropout, response, and abstinence rates among users of a US national, publicly available text messaging cessation intervention targeting pregnant women, SmokefreeMOM. Methods: Participants were online subscribers to SmokefreeMOM who set a prospective quit date within the 9 months before their due date. We examined demographics, smoking frequency, number of cigarettes smoked per day, and prequit time (up to 14 days of preparation time before quit date) as correlates of response rate and abstinence at 8 time points: quit date, day 7, day 14, day 21, day 28, day 35, day 42 (intervention end), and day 72 (1-month follow-up). We conducted survival analysis of time from quit date to dropout by race and ethnicity. Results: The mean age of the analytic sample of 1288 users was 29.46 (SD 7.11) years. Of these, 65.81% (848/1288) were white, 16.04% (207/1288) were black, 8.86% (114/1288) were Latina, and 9.29% (120/1288) were multiracial, American Indian/Alaska Native, Native Hawaiian Pacific Islander, or other; 82.68% (1065/1288) had some college education or less. Point-prevalence abstinence was 14.51% (157/1082) on quit day, 3.51% (38/1082) at intervention end, and 1.99% (21/1053) at 1-month follow-up. Black users (hazard ratio 0.68, 95% CI 0.51-0.91) and those with a high school degree or less (hazard ratio 0.66, 95% CI 0.49-0.89) or some college education (hazard ratio 0.75, 95% CI 0.57-0.99) were less likely to drop out than whites or users with a bachelor’s degree or higher. Response and abstinence rates were similar across race, ethnicity, and education. Conclusions: Enrollment was low among racial and ethnic minority women but high among less-educated women. Abstinence at intervention end and 1-month follow-up was lower than that in controlled trials of text messaging cessation interventions for pregnant women (range 7%-20%). Increasing the reach, engagement, and effectiveness of SmokefreeMOM, especially among women with high rates of smoking during pregnancy, must be prioritized. %M 31593542 %R 10.2196/14699 %U https://mhealth.jmir.org/2019/10/e14699 %U https://doi.org/10.2196/14699 %U http://www.ncbi.nlm.nih.gov/pubmed/31593542 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 10 %P e13557 %T Children Immunization App (CImA) Among Syrian Refugees in Zaatari Camp, Jordan: Protocol for a Cluster Randomized Controlled Pilot Trial Intervention Study %A Khader,Yousef S %A Laflamme,Lucie %A Schmid,Daniela %A El-Halabi,Soha %A Abu Khdair,Mohammad %A Sengoelge,Mathilde %A Atkins,Salla %A Tahtamouni,Manal %A Derrough,Tarik %A El-Khatib,Ziad %+ Department of Public Health Sciences, Karolinska Institutet, Stockholm,, Sweden, 46 6643461861, ziad.khatib@gmail.com %K mHealth %K refugees %K vaccines %K Jordan %K Syria %D 2019 %7 7.10.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: There are up to 19.4 million children who are still unvaccinated and face unnecessary deaths, especially among refugees. However, growing access to smartphones, among refugees, can be a leading factor to improve vaccination rates. Objective: This study aims to determine whether a smartphone app can improve the vaccination uptake among refugees and determine the app’s effectiveness in improving the documentation of vaccination records. Methods: We developed and planned to test an app through a cluster randomized trial that will be carried out at the Zaatari refugee camp in Jordan. The study will be open to all parents who carry Android smartphones, have at least one child, and agree to participate in the study. The parents will be recruited to the study by trained volunteers at the vaccination sites around the Zaatari camp. Inclusion criteria will be the following: having at least one child of 0 to 5 years, being a local resident of the camp, and having an Android smartphone. Results: The intervention includes an app that will allow storing Jordanian vaccination records, per child, on the parents’ smartphones in Arabic and English (in an interchangeable fashion). Every record will have a set of automated reminders before the appointment of each child. The app will summarize immunization records in form of due, taken, or overdue appointments, labeled in orange, green, and red, respectively. Baseline will include the collection of our primary and secondary outcomes that are needed for the pre and postdata measurements. This includes social demographic data, any previous vaccination history, and electronic health literacy. Participants, in both study arms, will be monitored for their follow-up visits to the clinic for vaccination doses. For the study outcome measures, we will measure any differences in the uptake of vaccinations. The secondary outcome is to analyze the effect of the children immunization app on visits for follow-up doses. Conclusions: Owing to the limited evidence of effective interventions for childhood vaccination among refugees, research in this area is greatly needed. The project will have a significant impact on the health of refugees and the public health system. In Jordan and the Middle East, the vaccination level is low. Given the influx of refugees from the area, it is crucial to ensure a high vaccination level among the children. International Registered Report Identifier (IRRID): PRR1-10.2196/13557 %M 31593549 %R 10.2196/13557 %U https://www.researchprotocols.org/2019/10/e13557 %U https://doi.org/10.2196/13557 %U http://www.ncbi.nlm.nih.gov/pubmed/31593549 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e14331 %T Nurse-Driven mHealth Implementation Using the Technology Inpatient Program for Smokers (TIPS): Mixed Methods Study %A Blok,Amanda C %A Sadasivam,Rajani S %A Hogan,Timothy P %A Patterson,Angela %A Day,Nicole %A Houston,Thomas K %+ Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, United States Department of Veterans Affairs, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, , United States, 1 734 845 3502, amanda.blok@va.gov %K implementation strategy %K telemedicine %K mHealth, tobacco use cessation %K care transition %K patient transfer %K smoking cessation %K mobile health %K smoking %K tobacco %D 2019 %7 4.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smoking is the leading cause of preventable death and disease, yet implementation of smoking cessation in inpatient settings is inconsistent. The Technology Inpatient Program for Smokers (TIPS) is an implementation program designed to reach smokers with a mobile health (mHealth) intervention using stakeholder-supported strategies. Objective: The purpose of this study was to determine the impact of the TIPS implementation strategies on smoker-level engagement of the mHealth intervention during care transition. Methods: We examined varying intensities (passive motivational posters only and posters + active nurse-led facilitation) of TIPS strategies on four hospital units located in two sites. Unit-level and smoker-level adoption was monitored during active implementation (30 weeks) and sustainability follow-up (30 weeks). Process measures reflecting the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework, stakeholder reported adaptations of strategies, and formative evaluation data were collected and analyzed. Results: For our smoker-level reach, 103 smokers signed up for the mHealth intervention in-hospital, with minimal decline during sustainability follow-up. While posters + nurse facilitation did not lead to higher reach than posters alone during active implementation (27 vs 30 signed up), it did lead to higher engagement of smokers (85.2% vs 73.3% completion of the full 2-week intervention). TIPS strategy adoption and fidelity varied by unit, including adoption of motivational posters (range: weeks 1 and 5), fidelity of posters (0.4% to 16.2% of posters missing per unit weekly) and internal facilitation of nurse training sessions (average of 2 vs 7.5 by site). Variable maintenance costs of the program totaled US $6.63 (US $683.28/103) per smoker reached. Reported family-member facilitation of mHealth sign-up was an observation of unintended behavior. Conclusions: TIPS is a feasible and low-cost implementation program that successfully engages smokers in an mHealth intervention and sustains engagement after discharge. Further testing of nurse facilitation and expanding reach to patient family and friends as an implementation strategy is needed. %M 31588908 %R 10.2196/14331 %U https://mhealth.jmir.org/2019/10/e14331 %U https://doi.org/10.2196/14331 %U http://www.ncbi.nlm.nih.gov/pubmed/31588908 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e13691 %T End User–Informed Mobile Health Intervention Development for Adolescent Cannabis Use Disorder: Qualitative Study %A Bagot,Kara %A Hodgdon,Elizabeth %A Sidhu,Natasha %A Patrick,Kevin %A Kelly,Mikaela %A Lu,Yang %A Bath,Eraka %+ University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive, MC 0405, La Jolla, CA, 92093, United States, 1 8582462553, kbagot@ucsd.edu %K adolescent %K cannabis %K mobile health %K treatment %K smartphone %D 2019 %7 4.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The rates of cannabis use continue to increase among adolescents and the current interventions have modest effects and high rates of relapse following treatment. There is increasing evidence for the efficacy of mobile technology–based interventions for adults with substance use disorders, but there is limited study of this technology in adolescents who use cannabis. Objective: The goal of our study was to elucidate elements of an app-based adjunctive intervention for cannabis cessation that resonate with adolescents who use cannabis. Methods: Adolescents, aged between 14 and 17 years, who used cannabis were recruited from San Diego County high schools. Semistructured focus groups (6 total; N=37) were conducted to examine the ways in which participants used smartphones, including the use of any health behavior change apps, as well as to elicit opinions about elements that would promote engagement with an app-based intervention for adolescent cannabis cessation. An iterative coding structure was used with first cycle structural coding, followed by pattern coding. Results: Themes that emerged from the analysis included (1) youth valued rewards to incentivize the progressive reduction of cannabis use, which included both nontangible rewards that mimic those obtained on social media platforms and prosocial activity-related rewards, (2) having the ability to self-monitor progression, (3) peer social support, (4) privacy and confidentiality discrete logo and name and usernames within the app, and (5) individualizing frequency and content of notifications and reminders. Conclusions: Integrating content, language, interfaces, delivery systems, and rewards with which adolescents who use cannabis are familiar, engage with on a day-to-day basis, and identify as relevant, may increase treatment engagement and retention for adolescents in substance use treatment. We may increase treatment effectiveness by adapting and individualizing current evidence-based interventions, so that they target the needs of adolescents and are more easily incorporated into their everyday routines. %M 31588909 %R 10.2196/13691 %U https://mhealth.jmir.org/2019/10/e13691 %U https://doi.org/10.2196/13691 %U http://www.ncbi.nlm.nih.gov/pubmed/31588909 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e12200 %T Design and Development of Smoking Cessation Apps Based on Smokers’ and Providers’ Perspectives in China: Survey Study %A Xu,Junfang %A Bricker,Jonathan %A Fu,Xiaoxing %A Su,Chunyan %A Wang,Peicheng %A Qi,Tengfei %A Cheng,Feng %+ Research Center for Public Health, School of Medicine, Tsinghua University, 30 Shuangqing Rd, Beijing, 100084, China, 86 010 6278 4700, fcheng@mail.tsinghua.edu.cn %K smoking cessation apps %K mHealth %K design %K smartphones %K China %D 2019 %7 4.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although there are more than 60 smartphone apps for smoking cessation in China, many of them do not include the content and features that health care professionals and smokers prefer—which may make them impractical, unengaging, and ineffective. Therefore, we investigated both health care providers’ and smokers’ preferences for features of future smoking cessation apps. Objective: This study aimed to investigate Chinese health care providers’ and smokers’ desired features of a smoking cessation app, with the goal of providing design recommendations for app designers and researchers. Methods: Both Chinese smokers who own smartphones (n=357) and Chinese health care providers (n=224) responded to a survey collecting data on their sociodemographic characteristics and opinions on the importance of 20 smoking cessation app design features studied in previous US research. Results: Chinese health care providers expressed strong support of smoking cessation apps on a number of attitude indicators (range 153/224, 68.3% to 204/224, 91.1%). They rated nearly all (18/20) features as very or extremely important (range 52.2%-83.4%) and rated nearly all features (17/20) as more important than the smokers did. More than 60% of smokers rated the following 4 features as very or extremely important: allow sharing the process of smoking cessation with family members and friends (216/319, 67.7%), helping smokers track their progress (such as the amount of smoking per day; 213/319, 66.8%), helping with the side effects of medications and nicotine withdrawal symptoms (201/319, 63.0%), and adapting to ongoing needs and interests of smokers (194/319, 60.8%). Contrary to a similar study of US smokers and health care providers, Chinese smokers and providers rated reputation and ability to communicate with family members and friends as important features, whereas Chinese smokers rated privacy and security as less important. Conclusions: The design of future smoking cessation and health behavior change apps should consider perspectives of both providers and smokers as well as the role of culture. %M 31588914 %R 10.2196/12200 %U https://mhealth.jmir.org/2019/10/e12200 %U https://doi.org/10.2196/12200 %U http://www.ncbi.nlm.nih.gov/pubmed/31588914 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e14098 %T Do Daily Fluctuations in Psychological and App-Related Variables Predict Engagement With an Alcohol Reduction App? A Series of N-Of-1 Studies %A Perski,Olga %A Naughton,Felix %A Garnett,Claire %A Blandford,Ann %A Beard,Emma %A West,Robert %A Michie,Susan %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, United Kingdom, 44 02076791258, olga.perski@ucl.ac.uk %K apps %K behavior change %K excessive alcohol consumption %K engagement %K mHealth %K n-of-1 %K time series analysis %D 2019 %7 2.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Previous studies have identified psychological and smartphone app–related predictors of engagement with alcohol reduction apps at a group level. However, strategies to promote engagement need to be effective at the individual level. Evidence as to whether group-level predictors of engagement are also predictive for individuals is lacking. Objective: The aim of this study was to examine whether daily fluctuations in (1) the receipt of a reminder, (2) motivation to reduce alcohol, (3) perceived usefulness of the app, (4) alcohol consumption, and (5) perceived lack of time predicted within-person variability in the frequency and amount of engagement with an alcohol reduction app. Methods: We conducted a series of observational N-of-1 studies. The predictor variables were measured twice daily for 28 days via ecological momentary assessments. The outcome variables were measured through automated recordings of the participants’ app screen views. A total of nine London-based adults who drank alcohol excessively and were willing to set a reduction goal took part. Each participant’s dataset was analyzed separately using generalized additive mixed models to derive incidence rate ratios (IRRs) for the within-person associations of the predictor and outcome variables. Debriefing interviews, analyzed using thematic analysis, were used to contextualize the findings. Results: Predictors of the frequency and amount of engagement differed between individuals, and for the variables 'perceived usefulness of the app' and 'perceived lack of time', the direction of associations also differed between individuals. The most consistent predictors of within-person variability in the frequency of engagement were the receipt of a daily reminder (IRR=1.80-3.88; P<.05) and perceived usefulness of the app (IRR=0.82-1.42; P<.05). The most consistent predictors of within-person variability in the amount of engagement were motivation to reduce alcohol (IRR=1.67-3.45; P<.05) and perceived usefulness of the app (IRR=0.52-137.32; P<.05). Conclusions: The utility of the selected psychological and app-related variables in predicting the frequency and amount of engagement with an alcohol reduction app differed at the individual level. This highlights that key within-person associations may be masked in group-level designs and suggests that different strategies to promote engagement may be required for different individuals. %M 31579022 %R 10.2196/14098 %U https://mhealth.jmir.org/2019/10/e14098 %U https://doi.org/10.2196/14098 %U http://www.ncbi.nlm.nih.gov/pubmed/31579022 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e13703 %T A Biofeedback App to Instruct Abdominal Breathing (Breathing-Mentor): Pilot Experiment %A Faust-Christmann,Corinna Anna %A Taetz,Bertram %A Zolynski,Gregor %A Zimmermann,Tobias %A Bleser,Gabriele %+ wearHEALTH, Department of Computer Science, Technische Universität Kaiserslautern, Gottlieb-Daimler-Str Gebäude 48, Kaiserslautern, 67663, Germany, 49 631 205 3456, christmann@cs.uni-kl.de %K mobile health %K relaxation %K pain management %K biofeedback %K respiration %K breathing exercises %K feasibility study %D 2019 %7 30.9.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Deep and slow abdominal breathing is an important skill for the management of stress and pain. However, despite multiple proofs on the effectiveness of biofeedback, most breathing apps remain limited to pacing specific breathing patterns, without sensor feedback on the actual breathing behavior. Objective: To fill this gap, an app named Breathing-Mentor was developed. This app combines effective visualization of the instruction with biofeedback on deep abdominal breathing, based on the mobile phone’s accelerometers. The aim of this pilot study was to investigate users’ feedback and breathing behavior during initial contact with the app. Methods: To reveal the possible effects of biofeedback, two versions of the mobile app were developed. Both contained the same visual instruction, but only the full version included additional biofeedback. In total, 40 untrained participants were randomly assigned to one of the two versions of the app. They had to follow the app’s instructions as closely as possible for 5 min. Results: The group with additional biofeedback showed an increased signal-to-noise ratio for instructed breathing frequency (0.1 Hz) compared with those using visual instruction without biofeedback (F1,37=4.18; P<.048). During this initial contact with the full version, self-reported relaxation effectivity was, however, lower than the group using visual instruction without biofeedback (t37=−2.36; P=.02), probably owing to increased cognitive workload to follow the instruction. Conclusions: This study supports the feasibility and usefulness of incorporating biofeedback in the Breathing-Mentor app to train abdominal breathing. Immediate effects on relaxation levels should, however, not be expected for untrained users. %M 31573919 %R 10.2196/13703 %U http://mhealth.jmir.org/2005/9/e13703/ %U https://doi.org/10.2196/13703 %U http://www.ncbi.nlm.nih.gov/pubmed/31573919 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e12137 %T Comparing the Efficacy of an Identical, Tailored Smoking Cessation Intervention Delivered by Mobile Text Messaging Versus Email: Randomized Controlled Trial %A Gram,Inger Torhild %A Larbi,Dillys %A Wangberg,Silje Camilla %+ Norwegian Centre for E-health Research, University Hospital of North Norway, SIVA Innovation Centre Tromsø, Sykehusvn 23, Tromsø, 9038, Norway, 47 92401177, inger.gram@ehealthresearch.no %K eHealth %K electronic mail %K mHealth %K mobile phones %K randomized controlled trial %K smoking cessation %K text-messaging %D 2019 %7 27.9.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a need to deliver smoking cessation support at a population level, both in developed and developing countries. Studies on internet-based and mobile phone–based smoking cessation interventions have shown that these methods can be as effective as other methods of support, and they can have a wider reach at a lower cost. Objective: This randomized controlled trial (RCT) aimed to compare, on a population level, the efficacy of an identical, tailored smoking cessation intervention delivered by mobile text messaging versus email. Methods: We conducted a nationwide 2-arm, double-blinded, fully automated RCT, close to a real-world setting, in Norway. We did not offer incentives to increase participation and adherence or to decrease loss to follow-up. We recruited users of the website, slutta.no, an open, free, multi-component Norwegian internet-based smoking cessation program, from May 2010 until October 2012. Enrolled smokers were considered as having completed a time point regardless of their response status if it was 1, 3, 6, or 12 months post cessation. We assessed 7315 participants using the following inclusion criteria: knowledge of the Norwegian language, age 16 years or older, ownership of a Norwegian cell phone, having an email account, current cigarette smoker, willingness to set a cessation date within 14 days (mandatory), and completion of a baseline questionnaire for tailoring algorithms. Altogether, 6137 participants were eligible for the study and 4378 participants (71.33%) provided informed consent to participate in the smoking cessation trial. We calculated the response rates for participants at the completed 1, 3, 6, and 12 months post cessation. For each arm, we conducted an intention-to-treat (ITT) analysis for each completed time point. The main outcome was 7-day self-reported point prevalence abstinence (PPA) at the completed 6 months post cessation. We calculated effect size of the 7-day self-reported PPA in the text message arm compared with the email arm as odds ratios (ORs) with 95% CIs for the 4 time points post cessation. Results: At 6 months follow-up, 21.06% (384/1823) of participants in the text message arm and 18.62% (333/1788) in the email arm responded (P=.07) to the surveys. In the ITT analysis, 11.46% (209/1823) of participants in the text message arm compared with 10.96% (196/1788) in the email arm (OR 1.05, 95% CI 0.86-1.30) reported to have achieved 7 days PPA. Conclusions: This nationwide, double-blinded, large, fully automated RCT found that 1 in 9 enrolled smokers reported 7-day PPA in both arms, 6 months post cessation. Our study found that identical smoking cessation interventions delivered by mobile text messaging and email may be equally successful at a population level. Trial Registration: ClinicalTrials.gov NCT01103427; https://clinicaltrials.gov/ct2/show/NCT01103427 %M 31573935 %R 10.2196/12137 %U https://mhealth.jmir.org/2019/9/e12137 %U https://doi.org/10.2196/12137 %U http://www.ncbi.nlm.nih.gov/pubmed/31573935 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e12407 %T Mobile Phone Access and Preference for Technology-Assisted Aftercare Among Low-Income Caregivers of Teens Enrolled in Outpatient Substance Use Treatment: Questionnaire Study %A Ryan-Pettes,Stacy R %A Lange,Lindsay L %A Magnuson,Katherine I %+ Department of Psychology and Neuroscience, Baylor University, One Bear Place 97334, Waco, TX, 76798-7334, United States, 1 2547102544, stacy_ryan@baylor.edu %K mobile phones %K text messaging %K substance use treatment %K mhealth %K parenting %K aftercare %D 2019 %7 26.9.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Improvements in parenting practices can positively mediate the outcomes of treatment for adolescent substance use disorder. Given the high rates of release among adolescents (ie, 60% within three months and 85% within one year), there is a critical need for interventions focused on helping parents achieve and maintain effective parenting practices posttreatment. Yet, research suggests that engaging parents in aftercare services is difficult, partly due to systemic-structural and personal barriers. One way to increase parent use of aftercare services may be to offer mobile health interventions, given the potential for wide availability and on-demand access. However, it remains unclear whether mobile phone–based aftercare support for caregivers of substance-using teens is feasible or desired. Therefore, formative work in this area is needed. Objective: This study aims to determine the feasibility and acceptability of mobile phone–based aftercare support in a population of caregivers with teens in treatment for substance use. Methods: Upon enrollment in a treatment program, 103 caregivers completed a mobile phone use survey, providing information about mobile phone ownership, access, and use. Caregivers also provided a response to items assessing desire for aftercare services, in general; desire for mobile phone–based aftercare services specifically; and desire for parenting specific content as part of aftercare services. Research assistants also monitored clinic calls made to caregivers’ mobile phones to provide an objective measure of the reliability of phone service. Results: Most participants were mothers (76.7%) and self-identified as Hispanic (73.8%). The average age was 42.60 (SD 9.28) years. A total of 94% of caregivers owned a mobile phone. Most had pay-as-you-go phone service (67%), and objective data suggest this did not impede accessibility. Older caregivers more frequently had a yearly mobile contract. Further, older caregivers and caregivers of adolescent girls had fewer disconnections. Bilingual caregivers used text messaging less often; however, caregivers of adolescent girls used text messaging more often. Although 72% of caregivers reported that aftercare was needed, 91% of caregivers endorsed a desire for mobile phone–based aftercare support in parenting areas that are targets of evidence-based treatments. Conclusions: The results suggest that mobile phones are feasible and desired to deliver treatments that provide support to caregivers of teens discharged from substance use treatment. Consideration should be given to the age of caregivers when designing these programs. Additional research is needed to better understand mobile phone use patterns based on a child’s gender and among bilingual caregivers. %M 31573920 %R 10.2196/12407 %U https://mhealth.jmir.org/2019/9/e12407 %U https://doi.org/10.2196/12407 %U http://www.ncbi.nlm.nih.gov/pubmed/31573920 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 9 %P e14567 %T Objective User Engagement With Mental Health Apps: Systematic Search and Panel-Based Usage Analysis %A Baumel,Amit %A Muench,Frederick %A Edan,Stav %A Kane,John M %+ Department of Community Mental Health, University of Haifa, Abba Khoushy Ave 199, Haifa, 3498838, Israel, 972 048240111, abaumel@univ.haifa.ac.il %K user engagement %K usage %K adherence %K retention %K mental health %K depression %K anxiety %K mHealth %D 2019 %7 25.09.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Understanding patterns of real-world usage of mental health apps is key to maximizing their potential to increase public self-management of care. Although developer-led studies have published results on the use of mental health apps in real-world settings, no study yet has systematically examined usage patterns of a large sample of mental health apps relying on independently collected data. Objective: Our aim is to present real-world objective data on user engagement with popular mental health apps. Methods: A systematic engine search was conducted using Google Play to identify Android apps with 10,000 installs or more targeting anxiety, depression, or emotional well-being. Coding of apps included primary incorporated techniques and mental health focus. Behavioral data on real-world usage were obtained from a panel that provides aggregated nonpersonal information on user engagement with mobile apps. Results: In total, 93 apps met the inclusion criteria (installs: median 100,000, IQR 90,000). The median percentage of daily active users (open rate) was 4.0% (IQR 4.7%) with a difference between trackers (median 6.3%, IQR 10.2%) and peer-support apps (median 17.0%) versus breathing exercise apps (median 1.6%, IQR 1.6%; all z≥3.42, all P<.001). Among active users, daily minutes of use were significantly higher for mindfulness/meditation (median 21.47, IQR 15.00) and peer support (median 35.08, n=2) apps than for apps incorporating other techniques (tracker, breathing exercise, psychoeducation: medians range 3.53-8.32; all z≥2.11, all P<.05). The medians of app 15-day and 30-day retention rates were 3.9% (IQR 10.3%) and 3.3% (IQR 6.2%), respectively. On day 30, peer support (median 8.9%, n=2), mindfulness/meditation (median 4.7%, IQR 6.2%), and tracker apps (median 6.1%, IQR 20.4%) had significantly higher retention rates than breathing exercise apps (median 0.0%, IQR 0.0%; all z≥2.18, all P≤.04). The pattern of daily use presented a descriptive peak toward the evening for apps incorporating most techniques (tracker, psychoeducation, and peer support) except mindfulness/meditation, which exhibited two peaks (morning and night). Conclusions: Although the number of app installs and daily active minutes of use may seem high, only a small portion of users actually used the apps for a long period of time. More studies using different datasets are needed to understand this phenomenon and the ways in which users self-manage their condition in real-world settings. %M 31573916 %R 10.2196/14567 %U http://www.jmir.org/2019/9/e14567/ %U https://doi.org/10.2196/14567 %U http://www.ncbi.nlm.nih.gov/pubmed/31573916 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e12606 %T The Association Among Social Support, Self-Efficacy, Use of Mobile Apps, and Physical Activity: Structural Equation Models With Mediating Effects %A Wang,Taotao %A Ren,Mengyuan %A Shen,Ying %A Zhu,Xiaorou %A Zhang,Xing %A Gao,Min %A Chen,Xueying %A Zhao,Ai %A Shi,Yuhui %A Chai,Weizhong %A Liu,Xinchuan %A Sun,Xinying %+ Department of Social Medicine and Health Education, School of Public Health, Peking University, No 38, Xueyuan Road, Haidian District, Beijing, 100191, China, 86 13691212050, xysun@bjmu.edu.cn %K mobile apps %K physical activity %K social support %K self-efficacy %K structural equation modeling %D 2019 %7 25.09.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical inactivity is a risk factor for chronic noncommunicable diseases. Insufficient physical activity has become an important public health problem worldwide. As mobile apps have rapidly developed, physical activity apps have the potential to improve the level of physical activity among populations. Objective: This study aimed to evaluate the effect of physical activity apps on levels of physical activity among college students. Methods: A Web-based questionnaire was used to survey college students in Beijing from December 27, 2017, to January 5, 2018. According to a previous survey, 43% of college students using physical activity apps and 36% of those who never used such apps achieved the physical activity recommendations. In this study, the sample size was calculated to be 500. The questionnaire consisted of 5 parts: the use of physical activity apps, sports habits, social support, self-efficacy, and social demographic information. Structural equation modeling was used to test the relationships between the use of physical activity apps, self-efficacy, social support, and level of physical activity. Results: Of the 1245 participants, 384 college students (30.8%) used physical activity apps (in the past month). Of these 384 students, 191 (49.7%) gained new friends via the app. College students who were using physical activity apps had a higher level of physical activity and higher scores for social support and self-efficacy (P<.001) than those who did not use such apps. The use of physical activity apps significantly affected the mediating effect of physical activity level through social support (beta=.126; P<.001) and self-efficacy (beta=.294; P<.001). Gender played an important role in app use, self-efficacy, and physical activity in the mediation model: male users spent more time on physical activity and had higher self-efficacy scores (P<.001). Conclusions: This study focused on college students in Beijing and found that the use of physical activity apps is associated with higher physical activity levels among these students. This effect is mainly through the mediation effect of social support and self-efficacy, rather than the direct effect of physical activity apps. The use of physical activity apps is associated with a higher social support level and higher self-efficacy score. Furthermore, a high social support level and high self-efficacy score are associated with higher physical activity levels. %M 31573936 %R 10.2196/12606 %U http://mhealth.jmir.org/2019/9/e12606/ %U https://doi.org/10.2196/12606 %U http://www.ncbi.nlm.nih.gov/pubmed/31573936 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e13127 %T Using the Unified Theory of Acceptance and Use of Technology (UTAUT) to Investigate the Intention to Use Physical Activity Apps: Cross-Sectional Survey %A Liu,Di %A Maimaitijiang,Remina %A Gu,Jing %A Zhong,Shuyi %A Zhou,Mengping %A Wu,Ziyue %A Luo,Ao %A Lu,Cong %A Hao,Yuantao %+ School of Public Health, Sun Yat-sen University, No. 74 Zhongshan Road II, Guangzhou, , China, 86 020 87335413, gujing5@mail.sysu.edu.cn %K intention %K physical activity apps %K university students %K UTAUT %D 2019 %7 10.9.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many university students are lacking adequate physical exercise and are failing to develop physical activity (PA) behaviors in China. PA app use could improve this situation. Objective: The aim of this study was to use the unified theory of acceptance and use of technology (UTAUT) to investigate the intention to use PA apps among university students in Guangzhou, China, and how body mass index (BMI) moderates the effects of UTAUT in explaining PA app use intention. Methods: A cross-sectional study was conducted among 1704 university students from different universities in Guangzhou, China. The UTAUT model was used to measure the determinants of intention to use PA apps. Results: Of the participants, 41.8% (611/1461) intended to use PA apps. All three UTAUT-related scales (performance expectancy, effort expectancy, and social influence) were positively associated with the intention to use PA apps after adjusting for background variables (adjusted odds ratio 1.10-1.31, P<.001). The performance expectancy scale had stronger associations with the intention to use PA apps among those whose BMI were beyond normal range compared with those whose BMI were within normal range (P<.001). Conclusions: UTAUT is useful for understanding university students’ intention to use PA apps. Potential moderating effects should be kept in mind when designing UTAUT-based interventions to improve PA via app use. %M 31507269 %R 10.2196/13127 %U https://mhealth.jmir.org/2019/9/e13127 %U https://doi.org/10.2196/13127 %U http://www.ncbi.nlm.nih.gov/pubmed/31507269 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 9 %P e13463 %T An Assessment of Physical Activity Data Collected via a Smartphone App and a Smart Band in Breast Cancer Survivors: Observational Study %A Chung,Il Yong %A Jung,Miyeon %A Lee,Sae Byul %A Lee,Jong Won %A Park,Yu Rang %A Cho,Daegon %A Chung,Haekwon %A Youn,Soyoung %A Min,Yul Ha %A Park,Hye Jin %A Lee,Minsun %A Chung,Seockhoon %A Son,Byung Ho %A Ahn,Sei-Hyun %+ Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505, Seoul,, Republic of Korea, 82 10 7209 4620, newstar153@hanmail.net %K telemedicine %K breast neoplasms %K mobile apps %K quality of life %K stress, psychological %K patient compliance %K smartphone %K mobile phone %K wearable electronic devices %K survivorship %D 2019 %7 06.09.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Although distress screening is crucial for cancer survivors, it is not easy for clinicians to recognize distress. Physical activity (PA) data collected by mobile devices such as smart bands and smartphone apps have the potential to be used to screen distress in breast cancer survivors. Objective: The aim of this study was to assess data collection rates of smartphone apps and smart bands in terms of PA data, investigate the correlation between PA data from mobile devices and distress-related questionnaires from smartphone apps, and demonstrate factors associated with data collection with smart bands and smartphone apps in breast cancer survivors. Methods: In this prospective observational study, patients who underwent surgery for breast cancer at Asan Medical Center, Seoul, Republic of Korea, between June 2017 and March 2018 were enrolled and asked to use both a smartphone app and smart band for 6 months. The overall compliance rates of the daily PA data collection via the smartphone walking apps and wearable smart bands were analyzed in a within-subject manner. The longitudinal daily collection rates were calculated to examine the dropout pattern. We also performed multivariate linear regression analysis to examine factors associated with compliance with daily collection. Finally, we tested the correlation between the count of daily average steps and distress level using Pearson correlation analysis. Results: A total of 160 female patients who underwent breast cancer surgeries were enrolled. The overall compliance rates for using a smartphone app and smart bands were 88.0% (24,224/27,513) and 52.5% (14,431/27,513), respectively. The longitudinal compliance rate for smartphone apps was 77.8% at day 180, while the longitudinal compliance rate for smart bands rapidly decreased over time, reaching 17.5% at day 180. Subjects who were young, with other comorbidities, or receiving antihormonal therapy or targeted therapy showed significantly higher compliance rates to the smartphone app. However, no factor was associated with the compliance rate to the smart band. In terms of the correlation between the count of daily steps and distress level, step counts collected via smart band showed a significant correlation with distress level. Conclusions: Smartphone apps or smart bands are feasible tools to collect data on the physical activity of breast cancer survivors. PA data from mobile devices are correlated with participants’ distress data, which suggests the potential role of mobile devices in the management of distress in breast cancer survivors. Trial Registration: ClinicalTrials.gov NCT03072966; https://clinicaltrials.gov/ct2/show/NCT03072966 %M 31493319 %R 10.2196/13463 %U https://www.jmir.org/2019/9/e13463 %U https://doi.org/10.2196/13463 %U http://www.ncbi.nlm.nih.gov/pubmed/31493319 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e12956 %T Effects of Mobile Health Prompts on Self-Monitoring and Exercise Behaviors Following a Diabetes Prevention Program: Secondary Analysis From a Randomized Controlled Trial %A MacPherson,Megan M %A Merry,Kohle J %A Locke,Sean R %A Jung,Mary E %+ School of Health and Exercise Sciences, University of British Columbia, Okanagan Campus, 3333 University Way, Kelowna, BC, V1V 1V7, Canada, 1 2508079670, mary.jung@ubc.ca %K self-monitoring %K health behavior %K prompts %K mHealth %K mobile apps %K exercise %K high-intensity interval training %K reminder system %D 2019 %7 05.09.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A number of mobile health (mHealth) apps exist that focus specifically on promoting exercise behavior. To increase user engagement, prompts, such as text messages, emails, or push notifications, are often used. To date, little research has been done to understand whether, and for how long, these prompts influence exercise behavior. Objective: This study aimed to assess the impact of prompts on mHealth self-monitoring and self-reported exercise in the days following a prompt and whether these effects differ based on exercise modality. Methods: Of the possible 99 adults at risk for developing type II diabetes who participated in a diabetes prevention program, 69 were included in this secondary analysis. Participants were randomly assigned to 1 of the following 2 exercise conditions: high-intensity interval training or moderate-intensity continuous training. In the year following a brief, community-based diabetes prevention program involving counseling and supervised exercise sessions, all participants self-monitored their daily exercise behaviors on an mHealth app in which they were sent personalized prompts at varying frequencies. mHealth self-monitoring and self-reported exercise data from the app were averaged over 1, 3, 5, and 7 days preceding and following a prompt and subsequently compared using t tests. Results: In the year following the diabetes prevention program, self-monitoring (t68=6.82; P<.001; d=0.46) and self-reported exercise (t68=2.16; P=.03; d=0.38) significantly increased in the 3 days following a prompt compared with the 3 days preceding. Prompts were most effective in the first half of the year, and there were no differences in self-monitoring or self-reported exercise behaviors between exercise modalities (P values >.05). In the first half of the year, self-monitoring was significant in the 3 days following a prompt (t68=8.61; P<.001; d=0.60), and self-reported exercise was significant in the 3 days (t68=3.7; P<.001; d=0.37), 5 days (t67=2.15; P=.04; d=0.14), and 7 days (t68=2.46; P=.02; d=0.15) following a prompt, whereas no significant changes were found in the second half of the year. Conclusions: This study provides preliminary evidence regarding the potential influence of prompts on mHealth self-monitoring and self-reported exercise and the duration for which prompts may be effective as exercise behavior change tools. Future studies should determine the optimal prompting frequency for influencing self-reported exercise behaviors. Optimizing prompt frequency can potentially reduce intervention costs and promote user engagement. Furthermore, it can encourage consumers to self-monitor using mHealth technology while ensuring prompts are sent when necessary and effective. International Registered Report Identifier (IRRID): DERR2-10.2196/11226 %M 31489842 %R 10.2196/12956 %U http://mhealth.jmir.org/2019/9/e12956/ %U https://doi.org/10.2196/12956 %U http://www.ncbi.nlm.nih.gov/pubmed/31489842 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e12882 %T A Mobile Phone App Designed to Support Weight Loss Maintenance and Well-Being (MotiMate): Randomized Controlled Trial %A Brindal,Emily %A Hendrie,Gilly A %A Freyne,Jill %A Noakes,Manny %+ Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, PO Box 10041, Adelaide, 5000, Australia, 61 088305 ext 0633, emily.brindal@csiro.au %K mobile phone %K body weight %K lifestyle %K mood %K happiness %D 2019 %7 04.09.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Few people successfully maintain lost weight over the longer term. Mobile phones have the potential to deliver weight loss management programs that can encourage self-monitoring while also providing some behavioral therapy to assist users in developing personal skills that may be necessary for improved longer term weight loss maintenance. Objective: The aim of this study was to evaluate a program supporting weight maintenance, which uses a behaviorally based mobile phone app to manage weight, food, exercise, mood, and stress. Methods: In a randomized controlled trial over 24 weeks, the full version of the app (MotiMate) was compared with a control app (monitoring only; excluding mood and stress) for its effect on weight, diet, and psychological well-being. Both apps had the same visual appearance and were designed to deliver all intervention content without face-to-face contact. The control version included features to track weight, food intake, and exercise with limited feedback and no encouraging/persuasive features. The intervention app included more persuasive and interactive features to help users track their weight, food intake, and physical activity and prompted users to enter data each day through notifications and included a mood and stress workshopping tool. Participants were recruited through advertising and existing databases. Clinic visits occurred at baseline, 4 weeks, 8 weeks, 12 weeks, and 24 weeks. At all visits, the clinical trial manager recorded body weight, and participants then completed a computer-delivered survey, which measured psychological and lifestyle outcomes. Objective app usage data were recorded throughout the trial. Results: A total of 88 adults who had lost and maintained at least 5% of their body weight within the last 2 years were randomized (45 MotiMate and 43 control). Overall, 75% (66/88) were female, and 69% (61/88) completed week 24 with no differences in dropout by condition (χ21,87=0.7, P=.49). Mixed models suggested no significant changes in weight or psychological outcomes over 24 weeks regardless of condition. Of 61 completers, 53% (32/61) remained within 2% of their starting weight. Significant increases occurred over 24 weeks for satisfaction with life and weight loss self-efficacy regardless of app condition. Diet and physical activity behaviors did not vary by app or week. Negative binomial models indicated that those receiving the full app remained active users of the app for 46 days longer than controls (P=.02). Users of the full version of the app also reported that they felt more supported than those with the control app (P=.01). Conclusions: Although some aspects of the intervention app such as usage and user feedback showed promise, there were few observable effects on behavioral and psychological outcomes. Future evaluation of the app should implement alternative research methods or target more specific populations to better understand the utility of the coping interface. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12614000474651; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366120 %M 31486407 %R 10.2196/12882 %U https://mhealth.jmir.org/2019/9/e12882/ %U https://doi.org/10.2196/12882 %U http://www.ncbi.nlm.nih.gov/pubmed/31486407 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 3 %P e14023 %T Tailoring of a Smartphone Smoking Cessation App (Kick.it) for Serious Mental Illness Populations: Qualitative Study %A Klein,Pauline %A Lawn,Sharon %A Tsourtos,George %A van Agteren,Joep %+ College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, 5001, Australia, 61 427 370 673, klei0081@flinders.edu.au %K mental health %K mHealth %K tobacco %K smoking cessation %K public health %K technology %D 2019 %7 03.09.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Smoking rates of Australians with severe mental illness (SMI) are disproportionately higher than the general population. Despite the rapid growth in mobile health (mHealth) apps, limited evidence exists to inform their design for SMI populations. Objective: This study aimed to explore the feasibility, acceptability, and utility of adapting a novel smoking cessation app (Kick.it) to assist smokers with SMI to prevent smoking relapse and quit. Methods: Using co-design, two in-depth interviews with 12 adult smokers and ex-smokers with SMI were conducted in this qualitative study. Stage 1 interviews explored participants’ smoking-related experiences and perceptions of social support for smoking cessation, informed the development of the stage 2 interview schedule, and provided context for participants’ responses to the second interview. Stage 2 interviews explored participants’ perceptions of the feasibility, utility, and acceptability of the app features for SMI populations. Results: People with SMI perceived mHealth interventions to support their quit smoking attempts as feasible, acceptable, and useful. Key emerging themes included personalization of the app to users’ psychosocial needs, a caring app to mediate self-esteem and self-efficacy, an app that normalizes smoking relapse and multiple quit attempts, a strong focus on user experience to improve usability, and a social network to enhance social support for smoking cessation. Conclusions: This study gained an in-depth understanding of the lived experiences of smoking and quitting among people with SMI and their perception of the Kick.it app features to help inform the tailoring of the app. Specific program tailoring is required to assist them in navigating the complex interactions between mental illness and smoking in relation to their psychosocial well-being and capacity to quit. This study describes the adaptations required for the Kick.it app to meet the specific needs and preferences of people with SMI. Results of this study will guide the tailoring of the Kick.it app for SMI populations. The study findings can also inform a co-design process for the future development and design of smoking cessation apps for SMI populations. %M 31482850 %R 10.2196/14023 %U https://humanfactors.jmir.org/2019/3/e14023 %U https://doi.org/10.2196/14023 %U http://www.ncbi.nlm.nih.gov/pubmed/31482850 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e14284 %T Long-Term Outcomes of a Therapist-Supported, Smartphone-Based Intervention for Elevated Symptoms of Depression and Anxiety: Quasiexperimental, Pre-Postintervention Study %A Economides,Marcos %A Ranta,Kristian %A Nazander,Albert %A Hilgert,Outi %A Goldin,Philippe R %A Raevuori,Anu %A Forman-Hoffman,Valerie %+ Meru Health Inc, 470 Ramona Street, Palo Alto, CA, 94301, United States, 1 (650) 740 9404, marcos@mhealthoutcomes.com %K digital health %K depression %K anxiety %K mindfulness %K CBT %K online intervention %K smartphone intervention %D 2019 %7 26.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Depression is one of the most common mental health disorders and severely impacts one’s physical, psychological, and social functioning. To address access barriers to care, we developed Ascend—a smartphone-delivered, therapist-supported, 8-week intervention based on several evidence-based psychological treatments for depression and anxiety. A previous feasibility study with 102 adults with elevated depression reported that Ascend is associated with a postintervention reduction in depression symptoms. Objective: We aimed to examine whether Ascend is associated with a reduction in symptoms of anxiety, and importantly, whether reductions in symptoms of depression and anxiety are maintained up to 12-months postintervention. Methods: We assessed whether the previously reported, end-of-treatment improvements seen in the 102 adults with elevated symptoms of depression extended up to 12 months posttreatment for depression symptoms (measured by the Patient Health Questionnaire-9 [PHQ-9]) and up to 6 months posttreatment for anxiety symptoms (added to the intervention later and measured using the Generalized Anxiety Disorder-7 [GAD-7] scale). We used linear mixed effects models with Tukey contrasts to compare time points and reported intention-to-treat statistics with a sensitivity analysis. Results: The intervention was associated with reductions in symptoms of depression that were maintained 12 months after the program (6.67-point reduction in PHQ-9 score, 95% CI 5.59-7.75; P<.001; Hedges g=1.14, 95% CI 0.78-1.49). A total of 60% of the participants with PHQ-9 scores above the cutoff for major depression at baseline (PHQ≥10) reported clinically significant improvement at the 12-month follow-up (at least 50% reduction in PHQ-9 score and postprogram score <10). Participants also reported reductions in symptoms of anxiety that were maintained for at least 6 months after the program (4.26-point reduction in GAD-7 score, 95% CI 3.14-5.38; P<.001; Hedges g=0.91, 95% CI 0.54-1.28). Conclusions: There is limited evidence on whether outcomes associated with smartphone-based interventions for common mental health problems are maintained posttreatment. Participants who enrolled in Ascend experienced clinically significant reductions in symptoms of depression and anxiety that were maintained for up to 1 year and 6 months after the intervention, respectively. Future randomized trials are warranted to test Ascend as a scalable solution to the treatment of depression and anxiety. %M 31452521 %R 10.2196/14284 %U http://mhealth.jmir.org/2019/8/e14284/ %U https://doi.org/10.2196/14284 %U http://www.ncbi.nlm.nih.gov/pubmed/31452521 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e13720 %T An Experimental Investigation of Human Presence and Mobile Technologies on College Students’ Sun Protection Intentions: Between-Subjects Study %A Niu,Zhaomeng %A Jeong,David C %A Coups,Elliot J %A Stapleton,Jerod L %+ Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ,, United States, 1 5093393076, zhaomeng.niu@rutgers.edu %K skin cancer %K mHealth %K education %K sunscreens %D 2019 %7 26.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health promotion and education programs are increasingly being adapted and developed for delivery through digital technologies. With this shift toward digital health approaches, it is important to identify design strategies in health education and promotion programs that enhance participant engagement and promote behavior change. Objective: This study aimed to examine the impact of an experiment testing various mobile health (mHealth) skin cancer prevention messages on sun protection intentions and message perceptions among American college students. Methods: A sample of 134 college students aged 18 years or older participated in a 2×2×2 between-subjects experimental study, designed to examine the individual and combinatory effects of multiple dimensions (human presence, screen size, and interactivity) of digital technologies. The primary study outcome was intention to use sun protection; secondary outcomes included attitudes toward the information, two dimensions of trust, and information processing. Results: Generally, intention to use sun protection was positively associated with the presence of human characters in the health educational messages (P<.001), delivering educational health messages on a large screen (ie, iPad; P<.001), and higher interactivity (P<.001). Only human presence produced more favorable attitudes (P=.02). Affective trust was positively associated with human presence (P=.006) and large screen size (P<.001), whereas cognitive trust was positively associated with human presence (P<.001) and small screen size (P=.007). Moreover, large screen size led to more heuristic processing (P=.03), whereas small screen size led to more systematic processing (P=.04). Conclusions: This experimental study demonstrates that the impact of mHealth skin cancer prevention messages differs based on platform and delivery design features. Effects on behavioral intentions, attitudes, and trust were found for conditions with human presence, highlighting the importance of including this feature in mHealth programs. Results from this experimental study can be used to optimize the design of mHealth educational interventions that promote sun protection. %M 31452523 %R 10.2196/13720 %U http://mhealth.jmir.org/2019/8/e13720/ %U https://doi.org/10.2196/13720 %U http://www.ncbi.nlm.nih.gov/pubmed/31452523 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 2 %P e12496 %T Social Support Patterns of Middle-Aged and Older Adults Within a Physical Activity App: Secondary Mixed Method Analysis %A Lewis,Zakkoyya H %A Swartz,Maria C %A Martinez,Eloisa %A Lyons,Elizabeth J %+ Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030-4009, United States, 1 713 745 3763, mchang1@mdanderson.org %K social support %K aged %K middle aged %K physical activity %K technology %K fitness tracker %D 2019 %7 23.08.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Physical activity (PA) is critical for maintaining independence and delaying mobility disability in aging adults. However, 27 to 44% of older adults in the United States are meeting the recommended PA level. Activity trackers are proving to be a promising tool to promote PA adherence through activity tracking and enhanced social interaction features. Although social support has been known to be an influential behavior change technique to promote PA, how middle-aged and older adults use the social interaction feature of mobile apps to provide virtual support to promote PA engagement remains mostly underexplored. Objective: This study aimed to describe the social support patterns of middle-aged and older adults using a mobile app as part of a behavioral PA intervention. Methods: Data from 35 participants (mean age 61.66 [SD 6] years) in a 12-week, home-based activity intervention were used for this secondary mixed method analysis. Participants were provided with a Jawbone Up24 activity monitor and an Apple iPad Mini installed with the UP app to facilitate self-monitoring and social interaction. All participants were given an anonymous account and encouraged to interact with other participants using the app. Social support features included comments and likes. Thematic coding was used to identify the type of social support provided within the UP app and characterize the levels of engagement from users. Participants were categorized as superusers or contributors, and passive participants were categorized as lurkers based on the literature. Results: Over the 12-week intervention, participants provided a total of 3153 likes and 1759 comments. Most participants (n=25) were contributors, with 4 categorized as superusers and 6 categorized as lurkers. Comments were coded as emotional support, informational support, instrumental support, self-talk, and other, with emotional support being the most prevalent type. Conclusions: Our cohort of middle-aged and older adults was willing to use the social network feature in an activity app to communicate with anonymous peers. Most of our participants were contributors. In addition, the social support provided through the activity app followed social support constructs. In sum, PA apps are a promising tool for delivering virtual social support to enhance PA engagement and have the potential to make a widespread impact on PA promotion. Trial Registration: ClinicalTrials.gov NCT01869348; https://clinicaltrials.gov/ct2/show/NCT01869348 %M 31518281 %R 10.2196/12496 %U http://aging.jmir.org/2019/2/e12496/ %U https://doi.org/10.2196/12496 %U http://www.ncbi.nlm.nih.gov/pubmed/31518281 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 8 %P e12820 %T Mindful Eating Mobile Health Apps: Review and Appraisal %A Lyzwinski,Lynnette Nathalie %A Edirippulige,Sisira %A Caffery,Liam %A Bambling,Matthew %+ Centre for Online Health, School of Medicine, University of Queensland, Princess Alexandria Hospital, Wooloongabba, 4102, Australia, 61 7 3176 7704, lynnettenathalie@icloud.com %K feeding behavior %K mindfulness %K mHealth %K diet %D 2019 %7 22.08.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mindful eating is an emerging area of research for managing unhealthy eating and weight-related behaviors such as binge eating and emotional eating. Although there are numerous commercial mindful eating apps available, their quality, effectiveness, and whether they are accurately based on mindfulness-based eating awareness are unknown. Objective: This review aimed to appraise the quality of the mindful eating apps and to appraise the quality of content on mindful eating apps. Methods: A review of mindful eating apps available on Apple iTunes was undertaken from March to April 2018. Relevant apps meeting the inclusion criteria were subjectively appraised for general app quality using the Mobile App Rating Scale (MARS) guidelines and for the quality of content on mindful eating. A total of 22 apps met the inclusion criteria and were appraised. Results: Many of the reviewed apps were assessed as functional and had moderate scores in aesthetics based on the criteria in the MARS assessment. However, some received lower scores in the domains of information and engagement. The majority of the apps did not teach users how to eat mindfully using all five senses. Hence, they were scored as incomplete in accurately providing mindfulness-based eating awareness. Instead, most apps were either eating timers, hunger rating apps, or diaries. Areas of potential improvement were in comprehensiveness and diversity of media, in the quantity and quality of information, and in the inclusion of privacy and security policies. To truly teach mindful eating, the apps need to provide guided examples involving the five senses beyond simply timing eating or writing in a diary. They also need to include eating meditations to assist people with their disordered eating such as binge eating, fullness, satiety, and craving meditations that may help them with coping when experiencing difficulties. They should also have engaging and entertaining features delivered through diverse media to ensure sustained use and interest by consumers. Conclusions: Future mindful eating apps could be improved by accurate adherence to mindful eating. Further improvement could be achieved by ameliorating the domains of information, engagement, and aesthetics and having adequate privacy policies. %M 31441431 %R 10.2196/12820 %U https://mental.jmir.org/2019/8/e12820/ %U https://doi.org/10.2196/12820 %U http://www.ncbi.nlm.nih.gov/pubmed/31441431 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e14668 %T The Elusive Path Toward Measuring Health Outcomes: Lessons Learned From a Pseudo-Randomized Controlled Trial of a Large-Scale Mobile Health Initiative %A Mechael,Patricia %A Kaonga,Nadi Nina %A Chandrasekharan,Subhashini %A Prakash,Muthu Perumal %A Peter,Joanne %A Ganju,Aakash %A Murthy,Nirmala %+ HealthEnabled, 4101 Albemarle St NW Apt 521, Washington, DC, 20016, United States, 1 9732228252, pmechael@gmail.com %K India %K mHealth %K maternal health %K child health %K research %D 2019 %7 21.08.2019 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Mobile health (mHealth) offers new opportunities to improve access to health services and health information. It also presents new challenges in evaluating its impact, particularly in linking the use of a technology intervention that aims to improve health behaviors with the health outcomes that are impacted by changed behaviors. The availability of data from a multitude of sources (paper-based and electronic) provides the conditions to facilitate making stronger connections between self-reported data and clinical outcomes. This commentary shares lessons and important considerations based on the experience of applying new research frameworks and incorporating maternal and child health records data into a pseudo-randomized controlled trial to evaluate the impact of mMitra, a stage-based voice messaging program to improve maternal, newborn, and child health outcomes in urban slums in India. %M 31436165 %R 10.2196/14668 %U http://mhealth.jmir.org/2019/8/e14668/ %U https://doi.org/10.2196/14668 %U http://www.ncbi.nlm.nih.gov/pubmed/31436165 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e10963 %T The Association Between Web-Based or Face-to-Face Lifestyle Interventions on the Perceived Benefits and Barriers to Exercise in Midlife Women: Three-Arm Equivalency Study %A McGuire,Amanda Mary %A Seib,Charrlotte %A Porter-Steele,Janine %A Anderson,Debra Jane %+ Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, 4215, Australia, 61 7 5552 8860, a.mcguire@griffith.edu.au %K exercise %K physical activity %K women %K health behavior %K behavioral medicine %K health promotion %K digital health %K benefits and barriers %D 2019 %7 21.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Noncommunicable diseases pose a significant threat to women’s health globally, with most diseases being attributed to modifiable risk factors such as physical inactivity. Women perceive a range of benefits and barriers to exercise; however, there is little evidence about the effect of different lifestyle intervention delivery modes on perceptions of exercise. Objective: This study aimed to compare the effect of a multiple health behavior change (MHBC) intervention called the Women’s Wellness Program. This intervention was delivered in 3 different modes on perceived exercise benefits, perceived exercise barriers, and actual physical activity and exercise in midlife women. Methods: Women aged 45 to 65 years were recruited via the study website. They were assigned in blocks to 3 different treatment groups (A: Web-based independent; B: face-to-face with nurse consultations; and C: Web-based with virtual nurse consultations). All participants received the 12-week intervention that utilizes principles from social-cognitive theory to provide a structured guide to promote healthy lifestyle behaviors with an emphasis on regular exercise and healthy eating. Data were collected using a self-report Web-based questionnaire at baseline (T1) and postintervention (T2) including perceived exercise benefits and barriers and exercise and physical activity. A data analysis examined both within- and between-group changes over time. Results: Participants in this study (N=225) had a mean age of 50.9 years (SD 5.9) and most were married or living with a partner (83.3%, 185/225). Attrition was 30.2% with 157 participants completing the final questionnaire. Women in all intervention groups reported a significant increase in positive perceptions of exercise (P<.05); a significant increase in exercise and overall physical activity (P<.01) with moderate-to-large effect sizes noted for overall physical activity (d=0.5 to d=0.87). Participants receiving support from registered nurses in the face-to-face and Web-based groups had a greater magnitude of change in benefit perceptions and physical activity than those in the Web-based independent group. There was no significant change in exercise barrier perceptions within or between groups over time. Conclusions: The results of this study suggest that the (MHBC) intervention is effective in increasing exercise benefit perceptions, overall physical activity, and exercise in midlife women. Although Web-based programs are cost-effective and flexible and can be delivered remotely, providing a range of options including face-to-face group delivery and personalized electronic health coaching from registered nurses has the potential to enhance participant engagement and motivation. %M 31436162 %R 10.2196/10963 %U https://www.jmir.org/2019/8/e10963/ %U https://doi.org/10.2196/10963 %U http://www.ncbi.nlm.nih.gov/pubmed/31436162 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e13793 %T A Mobile Phone App Featuring Cue Exposure Therapy As Aftercare for Alcohol Use Disorders: An Investigator-Blinded Randomized Controlled Trial %A Mellentin,Angelina Isabella %A Nielsen,Bent %A Nielsen,Anette Søgaard %A Yu,Fei %A Mejldal,Anna %A Nielsen,Dorthe Grüner %A Stenager,Elsebeth %+ Unit for Clinical Alcohol Research, Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, J.B. Winsløwsvej 18, Odense Center, 5000, Denmark, 45 50517901, amellentin@health.sdu.dk %K alcohol use disorder %K aftercare %K cue exposure therapy %K cognitive behavior therapy %K randomized controlled trial %K mobile phone app %D 2019 %7 16.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cue exposure therapy (CET) is a psychological approach developed to prepare individuals with alcohol use disorder (AUD) for confronting alcohol and associated stimuli in real life. CET has shown promise when treating AUD in group sessions, but it is unknown whether progressing from group sessions to using a mobile phone app is an effective delivery pathway. Objective: The objectives of this study were to investigate (1) whether CET as aftercare would increase the effectiveness of primary treatment with cognitive behavior therapy, and (2) whether CET delivered through a mobile phone app would be similarly effective to CET via group sessions. Methods: A total of 164 individuals with AUD were randomized to one of three groups: CET as group aftercare (CET group), CET as fully automated mobile phone app aftercare (CET app), or aftercare as usual. Study outcomes were assessed face-to-face at preaftercare, postaftercare, and again at 6 months after aftercare treatment. Generalized mixed models were used to compare the trajectories of the groups over time on drinking, cravings, and use of urge-specific coping skills (USCS). Results: In all, 153 of 164 individuals (93%) completed assessments both at posttreatment and 6-month follow-up assessments. No differences in the trajectories of predicted means were found between the experimental groups (CET group and app) compared with aftercare as usual on drinking and craving outcomes over time. Both CET group (predicted mean difference 5.99, SE 2.59, z=2.31, P=.02) and the CET app (predicted mean difference 4.90, SE 2.26, z=2.31, P=.02) showed increased use of USCS compared to aftercare as usual at posttreatment, but this effect was reduced at the 6-month follow-up. No differences were detected between the two experimental CET groups on any outcomes. Conclusions: CET with USCS delivered as aftercare either via group sessions or a mobile phone app did not increase the effectiveness of primary treatment. This suggests that CET with USCS may not be an effective psychological approach for the aftercare of individuals treated for AUD. Trial Registration: ClinicalTrials.gov NCT02298751; https://clinicaltrials.gov/ct2/show/NCT02298751 %M 31420960 %R 10.2196/13793 %U http://mhealth.jmir.org/2019/8/e13793/ %U https://doi.org/10.2196/13793 %U http://www.ncbi.nlm.nih.gov/pubmed/31420960 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e12687 %T A Comparison of Physical Activity Mobile Apps With and Without Existing Web-Based Social Networking Platforms: Systematic Review %A Petersen,Jasmine Maria %A Prichard,Ivanka %A Kemps,Eva %+ College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide,, Australia, 61 8 82013713, jasmine.petersen@flinders.edu.au %K physical activity %K mobile applications %K social networking %D 2019 %7 16.08.2019 %9 Review %J J Med Internet Res %G English %X Background: Physical activity mobile apps present a unique medium to disseminate scalable interventions to increase levels of physical activity. However, the effectiveness of mobile apps has previously been limited by low levels of engagement. Existing Web-based social networking platforms (eg, Facebook and Twitter) afford high levels of popularity, reach, and sustain engagement and, thus, may present an innovative strategy to enhance the engagement, and ultimately the effectiveness of mobile apps. Objective: This study aimed to comparatively examine the effectiveness of, and engagement with, interventions that incorporate physical activity mobile apps in conjunction with and without existing Web-based social networking platforms (eg, Facebook and Twitter). Methods: A systematic review was conducted by following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Guidelines. A systematic search of the following databases was conducted: Medline, PsycINFO, Web of Science, Scopus, CINAHL, ProQuest, SPORTDiscus, EMBASE, and Cochrane. According to the comparative objective of this review, 2 independent literature searches were conducted. The first incorporated terms related to apps and physical activity; the second also incorporated terms related to Web-based social networking. The results of the two searches were synthesized and compared narratively. Results: A total of 15 studies were identified, 10 incorporated a physical activity app alone and 5 incorporated an app in conjunction with an existing Web-based social networking platform. Overall, 10 of the 15 interventions were effective in improving one or more physical activity behaviors. Specifically, improvements in physical activity behaviors were reported in 7 of the 10 interventions incorporating physical activity apps alone and in 3 of the 5 interventions incorporating physical activity apps in conjunction with existing Web-based social networking platforms. Interventions incorporating physical activity apps alone demonstrated a decline in app engagement. In contrast, the physical activity apps in conjunction with existing Web-based social networking platforms showed increased and sustained intervention engagement. Conclusions: The interventions incorporating physical activity apps in conjunction with and without existing Web-based social networking platforms demonstrated effectiveness in improving physical activity behaviors. Notably, however, the interventions that incorporated existing Web-based social networking platforms achieved higher levels of engagement than those that did not. This review provides preliminary evidence that existing Web-based social networking platforms may be fundamental to increase engagement with physical activity interventions. %M 31420956 %R 10.2196/12687 %U https://www.jmir.org/2019/8/e12687/ %U https://doi.org/10.2196/12687 %U http://www.ncbi.nlm.nih.gov/pubmed/31420956 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e14318 %T Counseling With Guided Use of a Mobile Well-Being App for Students Experiencing Anxiety or Depression: Clinical Outcomes of a Feasibility Trial Embedded in a Student Counseling Service %A Broglia,Emma %A Millings,Abigail %A Barkham,Michael %+ Research Department, British Association for Counselling and Psychotherapy, 15 St John's Business Park, Lutterworth, Leicestershire,, United Kingdom, 44 1455 883318, emma.broglia@bacp.co.uk %K counseling %K students %K mental health %K mobile app %K feasibility studies %K outcome measures %K depressive symptoms %K generalized anxiety %K universities %D 2019 %7 15.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Anxiety and depression continue to be prominent experiences of students approaching their university counseling service. These services face unique challenges to ensure that they continue to offer quality support with fewer resources to a growing student population. The convenience and availability of mobile phone apps offer innovative solutions to address therapeutic challenges and expand the reach of traditional support. Objective: The primary aim of this study was to establish the feasibility of a trial in which guided use of a mobile phone well-being app was introduced into a student counseling service and offered as an adjunct to face-to-face counseling. Methods: The feasibility trial used a two-arm, parallel nonrandomized design comparing counseling alone (treatment as usual, or TAU) versus counseling supplemented with guided use of a mobile phone well-being app (intervention) for 38 university students experiencing moderate anxiety or depression. Students in both conditions received up to 6 sessions of face-to-face counseling within a 3-month period. Students who approached the counseling service and were accepted for counseling were invited to join the trial. Feasibility factors evaluated include recruitment duration, treatment preference, randomization acceptability, and intervention fidelity. Clinical outcomes and clinical change were assessed with routine clinical outcome measures administered every counseling session and follow-up phases at 3 and 6 months after recruitment. Results: Both groups demonstrated reduced clinical severity by the end of counseling. This was particularly noticeable for depression, social anxiety, and hostility, whereby clients moved from elevated clinical to low clinical or from low clinical to nonclinical by the end of the intervention. By the 6-month follow-up, TAU clients’ (n=18) anxiety had increased whereas intervention clients’ (n=20) anxiety continued to decrease, and this group difference was significant (Generalized Anxiety Disorder–7: t22=3.46, P=.002). This group difference was not replicated for levels of depression: students in both groups continued to decrease their levels of depression by a similar amount at the 6-month follow-up (Physical Health Questionnaire–9: t22=1.30, P=.21). Conclusion: Supplementing face-to-face counseling with guided use of a well-being app is a feasible and acceptable treatment option for university students experiencing moderate anxiety or depression. The feasibility trial was successfully embedded into a university counseling service without denying access to treatment and with minimal disruption to the service. This study provides preliminary evidence for using a well-being app to maintain clinical improvements for anxiety following the completion of counseling. The design of the feasibility trial provides the groundwork for the development of future pilot trials and definitive trials embedded in a student counseling service. Trial registration: ISRCTN registry ISRCTN55102899; http://www.isrctn.com/ISRCTN55102899 %M 31418424 %R 10.2196/14318 %U http://mhealth.jmir.org/2019/8/e14318/ %U https://doi.org/10.2196/14318 %U http://www.ncbi.nlm.nih.gov/pubmed/31418424 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 4 %N 3 %P e10324 %T Small Data and Its Visualization for Diabetes Self-Management: Qualitative Study %A Burford,Sally Jane %A Park,Sora %A Dawda,Paresh %+ News & Media Research Centre, Faculty of Arts and Design, University of Canberra, College St, Canberra, 2617, Australia, 61 62015958, sally.burford@canberra.edu.au %K mobile health %K type 2 diabetes %K health data %K mobile tablet devices %K self-management %D 2019 %7 13.08.2019 %9 Original Paper %J JMIR Diabetes %G English %X Background: As digital healthcare expands to include the use of mobile devices, there are opportunities to integrate these technologies into the self-management of chronic disease. Purpose built apps for diabetes self-management are plentiful and vary in functionality; they offer capability for individuals to record, manage, display, and interpret their own data. The optimal incorporation of mobile tablets into diabetes self-care is little explored in research, and guidelines for use are scant. Objective: The purpose of this study was to examine an individual’s use of mobile devices and apps in the self-management of type 2 diabetes to establish the potential and value of this ubiquitous technology for chronic healthcare. Methods: In a 9-month intervention, 28 patients at a large multidisciplinary healthcare center were gifted internet connected Apple iPads with preinstalled apps and given digital support to use them. They were invited to take up predefined activities, which included recording their own biometrics, monitoring their diet, and traditional online information seeking. Four online surveys captured the participants’ perceptions and health outcomes throughout the study. This article reports on the qualitative analysis of the open-ended responses in all four surveys. Results: Using apps, participants self-curated small data sets that included their blood glucose level, blood pressure, weight, and dietary intake. The dynamic visualizations of the data in the form of charts and diagrams were created using apps and participants were able to interpret the impact of their choices and behaviors from the diagrammatic form of their small personal data sets. Findings are presented in four themes: (1) recording personal data; (2) modelling and visualizing the data; (3) interpreting the data; and (4) empowering and improving health. Conclusions: The modelling capability of apps using small personal data sets, collected and curated by individuals, and the resultant graphical information that can be displayed on tablet screens proves a valuable asset for diabetes self-care. Informed by their own data, individuals are well-positioned to make changes in their daily lives that will improve their health. %M 31411137 %R 10.2196/10324 %U http://diabetes.jmir.org/2019/3/e10324/ %U https://doi.org/10.2196/10324 %U http://www.ncbi.nlm.nih.gov/pubmed/31411137 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e13519 %T An App-Based Intervention for Caregivers to Prevent Unintentional Injury Among Preschoolers: Cluster Randomized Controlled Trial %A Ning,Peishan %A Cheng,Peixia %A Schwebel,David C %A Yang,Yang %A Yu,Renhe %A Deng,Jing %A Li,Shukun %A Hu,Guoqing %+ Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, China, 86 731 84805414, huguoqing009@gmail.com %K unintentional injury %K preschoolers %K cluster randomized controlled trial %K app %K mobile health %K intervention %D 2019 %7 09.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: App-based interventions have the potential to reduce child injury in countries with limited prevention resources, but their effectiveness has not been rigorously examined. Objective: This study aimed to assess the effectiveness of an app-based intervention for caregivers of preschoolers to prevent unintentional injury among Chinese preschoolers. Methods: A 6-month cluster randomized controlled trial was conducted from December 2017 to June 2018. Recruitment was conducted through preschools, which were randomly allocated to either the control group (ie, app-based parenting education excluding unintentional injury prevention) or the intervention group (ie, app-based parenting education including unintentional injury prevention). A total of 2920 caregivers of preschoolers aged 3-6 years from 20 preschools in Changsha, China, were recruited offline through the schools. The primary outcome was unintentional injury incidences among preschoolers in the past 3 months; this measure was assessed through an online caregiver-report at the baseline visit and at 3-month and 6-month follow-up visits. Secondary outcome measures included caregivers’ self-reported attitudes and behaviors concerning child supervision during the last week. Generalized estimating equations (GEEs) were used to assess the effectiveness of the app-based intervention on responses at 3 and 6 months after adjusting for sociodemographic variables, baseline level of the outcome variable, and engagement with interventions in the assigned group. All analyses were intention-to-treat. A per-protocol sensitivity analysis was also conducted. Results: In total, 1980 of the 2920 caregivers completed the study. The mean age of participants was 32.0 years (SD 5.5) and 68.99% (1366/1980) of them were female. During the 6-month follow-up visit, unintentional injury incidence did not change significantly in either group: incidence in the intervention group went from 8.76% (94/1073) to 8.11% (87/1073), P=.59; incidence in the control group went from 9.4% (85/907) to 7.5% (69/907), P=.15. The changes did not differ between the groups (odds ratio [OR] 1.14, 95% CI 0.80-1.62). Changes in the average score in attitude concerning unintentional injury prevention were also similar between the groups (B .05, 95% CI -0.03 to 0.13). Changes in unintentional injury prevention behaviors were greater in the intervention group than in the control group after the intervention (B .87, 95% CI 0.33-1.42). Analyses of individual injury prevention behaviors showed that the intervention reduced three risky behaviors: unsafe feeding of children (OR 0.73, 95% CI 0.60-0.89); incorrectly placing children in cars (OR 0.73, 95% CI 0.57-0.93); and allowing children to ride bicycles, electric bicycles, or motorcycles unsupervised (OR 0.80, 95% CI 0.64-0.99). The intervention also improved scores on three safety-focused behaviors: testing water temperature before giving children a bath (OR 1.26, 95% CI 1.05-1.52); properly storing sharp objects (OR 1.24, 95% CI 1.01-1.52); and safely storing medicines, detergents, and pesticides (OR 1.24, 95% CI 1.02-1.51). Conclusions: The app-based intervention did not reduce unintentional injury incidence among preschoolers but significantly improved caregivers’ safety behaviors. This app-based intervention approach to improve caregiver behaviors surrounding child injury risk offers promise to be modified and ultimately disseminated broadly. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IOR-17010438; http://www.chictr.org.cn/showproj.aspx?proj=17376 (Archived by WebCite at http://www.webcitation.org/75jt17X84) International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5790-1 %M 31400105 %R 10.2196/13519 %U https://mhealth.jmir.org/2019/8/e13519/ %U https://doi.org/10.2196/13519 %U http://www.ncbi.nlm.nih.gov/pubmed/31400105 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e12672 %T Mobile Helpline and Reversible Contraception: Lessons From a Controlled Before-and-After Study in Rural India %A Kulathinal,Sangita %A Joseph,Bijoy %A Säävälä,Minna %+ The Family Federation of Finland (Väestöliitto), Kalevankatu 16, Helsinki, 00100, Finland, 358 405736557, minna.saavala@vaestoliitto.fi %K contraception behavior %K family planning services %K organizations, nonprofit %K cell phone use %K mobile phone %K information seeking behavior %K mHealth %K call center %K South Asia %K India %D 2019 %7 09.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Researchers and activists have expressed concerns over the lack of availability and nonuse of reversible, modern, contraceptive methods in India for decades. New attempts to increase access, availability, and acceptance of reversible contraceptives need to be developed, instead of relying solely on female sterilization. Mobile health (mHealth) initiatives may offer one way to serve underprivileged populations who face challenges in sexual and reproductive health (SRH) in countries such as India. Objective: This study aimed to examine the outcome of an mHealth intervention for enhancing knowledge of, and practices related to, reversible contraceptives in rural Western India. Methods: We implemented a nonrandomized controlled trial (before-and-after study in an intervention area and a control area) in the Indian state of Maharashtra. The intervention in this case was a mobile-based SRH helpline provided by a nongovernmental organization (NGO). Baseline and follow-up surveys were carried out in two government-run primary health center areas, one each in the intervention and control area, and 405 respondents were surveyed in the two rounds. An interview-based structured questionnaire suitable for a low-literacy environment was used to collect data. The effect of the intervention was estimated using logistic regression, adjusted for gender, by calculating robust standard errors to take into account the clustering of individuals by the area (intervention or control). In each regression model, the effect of intervention was estimated by including a term for interaction between the intervention area and the period before and after the intervention. The exponent of the regression coefficient of the interaction term corresponding to the period after the intervention, along with the 95% CI, is reported here. The odds ratio for the control village multiplied by this exponent gives the odds ratio for the intervention village. Calls received in the intervention were recorded and their topics analyzed. Results: The current use of reversible contraception (18% increase in intervention area vs 2% increase in control area; 95% CI) has seen changes. The proportion of respondents who had heard of contraception methods from an NGO rose in the intervention area by 23% whereas it decreased in the control area by 1% (95% CI). However, the general level of awareness of reversible contraception, shown by the first contraceptive method that came to respondents’ mind, did not improve. Demand for wider SRH information beyond contraception was high. Men and adolescents, in addition to married women, made use of the helpline. Conclusions: A mobile helpline that one can confidentially approach at a time most convenient to the client can help provide necessary information and support to those who need reversible contraception or other sexual health information. Services that integrate mHealth in a context-sensitive way to other face-to-face health care services add value to SRH services in rural India. %M 31400103 %R 10.2196/12672 %U https://mhealth.jmir.org/2019/8/e12672 %U https://doi.org/10.2196/12672 %U http://www.ncbi.nlm.nih.gov/pubmed/31400103 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e13938 %T Accuracy of 12 Wearable Devices for Estimating Physical Activity Energy Expenditure Using a Metabolic Chamber and the Doubly Labeled Water Method: Validation Study %A Murakami,Haruka %A Kawakami,Ryoko %A Nakae,Satoshi %A Yamada,Yosuke %A Nakata,Yoshio %A Ohkawara,Kazunori %A Sasai,Hiroyuki %A Ishikawa-Takata,Kazuko %A Tanaka,Shigeho %A Miyachi,Motohiko %+ Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku, Tokyo, 162-8636, Japan, 81 3 3203 8061 ext 4201, miyachi@nibiohn.go.jp %K physical activity %K accelerometry %K energy expenditure %K indirect calorimetry %K doubly labeled water %D 2019 %7 02.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Self-monitoring using certain types of pedometers and accelerometers has been reported to be effective for promoting and maintaining physical activity (PA). However, the validity of estimating the level of PA or PA energy expenditure (PAEE) for general consumers using wearable devices has not been sufficiently established. Objective: We examined the validity of 12 wearable devices for determining PAEE during 1 standardized day in a metabolic chamber and 15 free-living days using the doubly labeled water (DLW) method. Methods: A total of 19 healthy adults aged 21 to 50 years (9 men and 10 women) participated in this study. They followed a standardized PA protocol in a metabolic chamber for an entire day while simultaneously wearing 12 wearable devices: 5 devices on the waist, 5 on the wrist, and 2 placed in the pocket. In addition, they spent their daily lives wearing 12 wearable devices under free-living conditions while being subjected to the DLW method for 15 days. The PAEE criterion was calculated by subtracting the basal metabolic rate measured by the metabolic chamber and 0.1×total energy expenditure (TEE) from TEE. The TEE was obtained by the metabolic chamber and DLW methods. The PAEE values of wearable devices were also extracted or calculated from each mobile phone app or website. The Dunnett test and Pearson and Spearman correlation coefficients were used to examine the variables estimated by wearable devices. Results: On the standardized day, the PAEE estimated using the metabolic chamber (PAEEcha) was 528.8±149.4 kcal/day. The PAEEs of all devices except the TANITA AM-160 (513.8±135.0 kcal/day; P>.05), SUZUKEN Lifecorder EX (519.3±89.3 kcal/day; P>.05), and Panasonic Actimarker (545.9±141.7 kcal/day; P>.05) were significantly different from the PAEEcha. None of the devices was correlated with PAEEcha according to both Pearson (r=−.13 to .37) and Spearman (ρ=−.25 to .46) correlation tests. During the 15 free-living days, the PAEE estimated by DLW (PAEEdlw) was 728.0±162.7 kcal/day. PAEE values of all devices except the Omron Active style Pro (716.2±159.0 kcal/day; P>.05) and Omron CaloriScan (707.5±172.7 kcal/day; P>.05) were significantly underestimated. Only 2 devices, the Omron Active style Pro (r=.46; P=.045) and Panasonic Actimarker (r=.48; P=.04), had significant positive correlations with PAEEdlw according to Pearson tests. In addition, 3 devices, the TANITA AM-160 (ρ=.50; P=.03), Omron CaloriScan (ρ=.48; P=.04), and Omron Active style Pro (ρ=.48; P=.04), could be ranked in PAEEdlw. Conclusions: Most wearable devices do not provide comparable PAEE estimates when using gold standard methods during 1 standardized day or 15 free-living days. Continuous development and evaluations of these wearable devices are needed for better estimations of PAEE. %M 31376273 %R 10.2196/13938 %U https://mhealth.jmir.org/2019/8/e13938/ %U https://doi.org/10.2196/13938 %U http://www.ncbi.nlm.nih.gov/pubmed/31376273 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 8 %P e12620 %T A Mobile Health Intervention to Improve Hepatitis C Outcomes Among People With Opioid Use Disorder: Protocol for a Randomized Controlled Trial %A Hochstatter,Karli R %A Gustafson Sr,David H %A Landucci,Gina %A Pe-Romashko,Klaren %A Maus,Adam %A Shah,Dhavan V %A Taylor,Quinton A %A Gill,Emma K %A Miller,Rebecca %A Krechel,Sarah %A Westergaard,Ryan P %+ Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Ave, 5th Floor, Madison, WI, 53705, United States, 1 608 265 9611, khochsta@medicine.wisc.edu %K mHealth %K eHealth %K hepatitis C virus %K substance use %K continuum of care %D 2019 %7 01.08.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: People who inject drugs are at a disproportionate risk for contracting hepatitis C virus (HCV). However, use of HCV prevention and treatment services remains suboptimal among people with substance use disorders due to various health system, societal, and individual barriers. Mobile health applications offer promising strategies to support people in recovery from substance use disorders. We sought to determine whether the Addiction-Comprehensive Health Enhancement Support System (A-CHESS), an existing mobile health application for opioid use disorder, could be adapted to improve HCV screening and treatment. Objective: The goals of this paper are to describe: (1) the components and functionality of an HCV intervention incorporated into the existing A-CHESS system; and (2) how data are collected and will be used to evaluate HCV testing, linkage to care, and treatment. Methods: People with recent opioid use were enrolled in a randomized controlled trial to test whether A-CHESS reduced relapse. We developed and implemented HCV intervention content within the A-CHESS platform to simultaneously evaluate whether A-CHESS improved secondary outcomes related to HCV care. All A-CHESS users received the HCV intervention content, which includes educational information, private messages tailored to an individual’s stage of HCV care, and a public discussion forum. Data on patients’ HCV risk behaviors and stage of care were collected through quarterly telephone interviews and weekly surveys delivered through A-CHESS. The proportion of people with opioid use disorder who are HCV untested, HCV-negative, HCV antibody-positive, or HCV RNA–positive, as well as linked to care, treated and cured at baseline is described here. The 24-month follow-up is ongoing and will be completed in April 2020. Survey data will then be used to assess whether individuals who received the HCV-enhanced A-CHESS intervention were more likely to reduce risky injection behaviors, receive HCV testing, link to medical care, initiate treatment, and be cured of HCV compared to the control group. Results: Between April 2016 and April 2018, 416 individuals were enrolled and completed the baseline interview. Of these individuals, 207 were then randomly assigned to the control arm and 209 were assigned to the intervention arm. At baseline, 202 individuals (49%) self-reported ever testing HCV antibody-positive. Of those, 179 (89%) reported receiving HCV RNA confirmatory testing, 134 (66%) tested HCV RNA–positive, 125 (62%) were linked to medical care and 27 (13%) were treated and cured of HCV. Of the remaining 214 individuals who had never tested HCV antibody–positive, 129 (31%) had tested HCV antibody–negative within the past year and 85 (20%) had not been tested within the past year. Conclusions: The A-CHESS mobile health system allows for the implementation of a bundle of services as well as the collection of longitudinal data related to drug use and HCV care among people with opioid use disorders. This study will provide preliminary evidence to determine whether HCV-specific services embedded into the A-CHESS program can improve HCV outcomes for people engaged in addiction treatment. Trial Registration: ClinicalTrials.gov NCT02712034; https://clinicaltrials.gov/ct2/show/NCT02712034 International Registered Report Identifier (IRRID): DERR1-10.2196/12620 %M 31373273 %R 10.2196/12620 %U https://www.researchprotocols.org/2019/8/e12620/ %U https://doi.org/10.2196/12620 %U http://www.ncbi.nlm.nih.gov/pubmed/31373273 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e13261 %T Nutrition-Related Mobile Apps in the China App Store: Assessment of Functionality and Quality %A Li,Yuan %A Ding,Jingmin %A Wang,Yishan %A Tang,Chengyao %A Zhang,Puhong %+ The George Institute for Global Health at Peking University Health Science Center, Level 18, Tower B, Horizon Tower, No 6 Zhichun Rd, Beijing,, China, 86 108 280 0577 ext 512, zpuhong@georgeinstitute.org.cn %K mobile phone %K mobile apps %K apps %K nutrition %K diet %K food %K behavior change %D 2019 %7 30.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There are an increasing number of mobile apps that provide dietary guidance to support a healthy lifestyle and disease management. However, the characteristics of these nutrition-related apps are not well analyzed. Objective: This study aimed to evaluate the functionality and quality of nutrition-related apps in China. Methods: Mobile apps providing dietary guidance were screened in the Chinese iOS and Android app stores in November 2017, using stepwise searching criteria. The first screening consisted of extracting information from the app descriptions. Apps that (1) were free, (2) contain information on diet and nutrition, and (3) were last updated after January 1, 2016, were downloaded for further analysis. Nutritional functionalities were determined according to the Chinese Dietary Guidelines framework. Market-related functionalities were developed from previous studies and tailored to downloaded apps. The quality of apps was assessed with the user version of the Mobile App Rating Scale (uMARS). Results: Out of 628 dietary guidance apps screened, 44 were nutrition-related. Of these, guidance was provided on diet exclusively (11/44, 25%), fitness (17/44, 39%), disease management (11/44, 25%), or maternal health (5/44, 11%). Nutritional functionalities included nutritional information inquiry (40/44, 91%), nutrition education (35/44, 80%), food record (34/44, 77%), diet analysis (34/44, 77%), and personalized recipes (21/44, 48%). Dietary analysis and suggestions mainly focused on energy intake (33/44, 75%) and less on other factors such as dietary structure (10/44, 23%). Social communication functionalities were available in 42 apps (96%), user incentives were supported in 26 apps (59%), and intelligent recognition technology was available in 8 apps (18%). The median score for the quality of the 44 apps, as determined on a 5-point uMARS scale, was 3.6 (interquartile range 0.7). Conclusions: Most nutrition-related apps are developed for health management rather than for dietary guidance exclusively. Although basic principles of energy balance are used, their nutritional functionality was relatively limited and not individualized. More efforts should be made to develop nutrition-related apps with evidence-based nutritional knowledge, comprehensive and personalized dietary guidance, and innovative technology. %M 31364606 %R 10.2196/13261 %U http://mhealth.jmir.org/2019/7/e13261/ %U https://doi.org/10.2196/13261 %U http://www.ncbi.nlm.nih.gov/pubmed/31364606 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e14210 %T Effects of Digital Device Ownership on Cognitive Decline in a Middle-Aged and Elderly Population: Longitudinal Observational Study %A Jin,Yinzi %A Jing,Mingxia %A Ma,Xiaochen %+ China Center for Health Development Studies, Peking University, 38 Xueyuan Road, Haidian District, Beijing,, China, 86 10 82805706, xma@hsc.pku.edu.cn %K digital access %K cognitive decline %K China %D 2019 %7 29.07.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive decline is a major risk factor for disability and death and may serve as a precursor of dementia. Digital devices can provide a platform of cognitively stimulating activities which might help to slow cognitive decline during the process of normal aging. Objective: This longitudinal study aimed to examine the independent protective factors of desktop and cellphone ownership against cognitive decline in mid-life and older adulthood and to examine the combined effect of desktop and cellphone ownership on the same outcome. Methods: Data was obtained from a China Health and Retirement Longitudinal Studies (CHARLS) cohort made up of 13,457 community-dwelling adults aged 45 years or above in 2011-2012. They were followed for 4 years, with baseline measurements taken as well as 2 two-year follow-up visits. Cognitive function was tested during the baseline test and follow-up visits. A global cognition z-score was calculated based on two domains: word recall and mental intactness. The key independent variables were defined as: whether one had desktops with internet connection at home and whether one had a cellphone. An additional categorical variable of three values was constructed as: 0 (no desktop or cellphone), 1 (desktop or cellphone alone), and 2 (desktop and cellphone both). Mixed-effects regression was adjusted for demographic and health behavior as well as health condition risk factors. Results: Adjusted for demographic and health behavior as well as health condition risk factors, desktop and cellphone ownership were independently associated with subsequent decreased cognitive decline over the four-year period. Participants without a desktop at home had an adjusted cognitive decline of –0.16 standard deviations (95% CI –0.18 to –0.15), while participants with a desktop at home had an adjusted cognitive decline of –0.10 standard deviations (95% CI –0.14 to –0.07; difference of –0.06 standard deviations; P=.003). A similar pattern of significantly protective association of 0.06 standard deviations (95% CI 0.03-0.10; P<.001) between cellphone ownership and cognitive function was observed over the four-year period. Additionally, a larger longitudinal protective association on cognitive decline was observed among those with both of the digital devices, although the 95% CIs for the coefficients overlapped with those with a single digital device alone. Conclusions: Findings from this study underscored the importance of digital devices as platforms for cognitively stimulating activities to delay cognitive decline. Future studies focusing on use of digital devices are warranted to investigate their longitudinal protective factors against cognitive decline at mid- and later life. %M 31359864 %R 10.2196/14210 %U http://www.jmir.org/2019/7/e14210/ %U https://doi.org/10.2196/14210 %U http://www.ncbi.nlm.nih.gov/pubmed/31359864 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e13209 %T Identifying Behavioral Phenotypes of Loneliness and Social Isolation with Passive Sensing: Statistical Analysis, Data Mining and Machine Learning of Smartphone and Fitbit Data %A Doryab,Afsaneh %A Villalba,Daniella K %A Chikersal,Prerna %A Dutcher,Janine M %A Tumminia,Michael %A Liu,Xinwen %A Cohen,Sheldon %A Creswell,Kasey %A Mankoff,Jennifer %A Creswell,John D %A Dey,Anind K %+ School of Computer Science, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, United States, 1 4123045320, adoryab@gmail.com %K mobile health %K loneliness %K machine learning %K statistical data analysis %K data mining %K digital phenotyping %D 2019 %7 24.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Feelings of loneliness are associated with poor physical and mental health. Detection of loneliness through passive sensing on personal devices can lead to the development of interventions aimed at decreasing rates of loneliness. Objective: The aim of this study was to explore the potential of using passive sensing to infer levels of loneliness and to identify the corresponding behavioral patterns. Methods: Data were collected from smartphones and Fitbits (Flex 2) of 160 college students over a semester. The participants completed the University of California, Los Angeles (UCLA) loneliness questionnaire at the beginning and end of the semester. For a classification purpose, the scores were categorized into high (questionnaire score>40) and low (≤40) levels of loneliness. Daily features were extracted from both devices to capture activity and mobility, communication and phone usage, and sleep behaviors. The features were then averaged to generate semester-level features. We used 3 analytic methods: (1) statistical analysis to provide an overview of loneliness in college students, (2) data mining using the Apriori algorithm to extract behavior patterns associated with loneliness, and (3) machine learning classification to infer the level of loneliness and the change in levels of loneliness using an ensemble of gradient boosting and logistic regression algorithms with feature selection in a leave-one-student-out cross-validation manner. Results: The average loneliness score from the presurveys and postsurveys was above 43 (presurvey SD 9.4 and postsurvey SD 10.4), and the majority of participants fell into the high loneliness category (scores above 40) with 63.8% (102/160) in the presurvey and 58.8% (94/160) in the postsurvey. Scores greater than 1 standard deviation above the mean were observed in 12.5% (20/160) of the participants in both pre- and postsurvey scores. The majority of scores, however, fell between 1 standard deviation below and above the mean (pre=66.9% [107/160] and post=73.1% [117/160]). Our machine learning pipeline achieved an accuracy of 80.2% in detecting the binary level of loneliness and an 88.4% accuracy in detecting change in the loneliness level. The mining of associations between classifier-selected behavioral features and loneliness indicated that compared with students with low loneliness, students with high levels of loneliness were spending less time outside of campus during evening hours on weekends and spending less time in places for social events in the evening on weekdays (support=17% and confidence=92%). The analysis also indicated that more activity and less sedentary behavior, especially in the evening, was associated with a decrease in levels of loneliness from the beginning of the semester to the end of it (support=31% and confidence=92%). Conclusions: Passive sensing has the potential for detecting loneliness in college students and identifying the associated behavioral patterns. These findings highlight intervention opportunities through mobile technology to reduce the impact of loneliness on individuals’ health and well-being. %M 31342903 %R 10.2196/13209 %U http://mhealth.jmir.org/2019/7/e13209/ %U https://doi.org/10.2196/13209 %U http://www.ncbi.nlm.nih.gov/pubmed/31342903 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e12666 %T Tracker-Based Personal Advice to Support the Baby’s Healthy Development in a Novel Parenting App: Data-Driven Innovation %A Otte,Renée A %A van Beukering,Alice J E %A Boelens-Brockhuis,Lili-Marjan %+ Philips Research, Family Care Solutions, High Tech Campus 34, Room 3 065, Eindhoven, 5656AE, Netherlands, 31 402748877, renee.otte@philips.com %K data analytics %K data-driven science %K mHealth %K mobile apps %K infant development %K infant health %K parenting %D 2019 %7 24.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The current generation of millennial parents prefers digital communications and makes use of apps on a daily basis to find information about child-rearing topics. Given this, an increasing amount of parenting apps have become available. These apps also allow parents to track their baby’s development with increasing completeness and precision. The large amounts of data collected in this process provide ample opportunity for data-driven innovation (DDI). Subsequently, apps are increasingly personalized by offering information that is based on the data tracked in the app. In line with this, Philips Avent has developed the uGrow app, a medical-grade app dedicated to new parents for tracking their baby’s development. Through so-called insights, the uGrow app seeks to provide a data-driven solution by offering parents personal advice that is sourced from user-tracked behavioral and contextual data. Objective: The aim of this study was twofold. First, it aimed to give a description of the development process of the insights for the uGrow app. Second, it aimed to present results from a study about parents’ experiences with the insights. Methods: The development process comprised 3 phases: a formative phase, development phase, and summative phase. In the formative phase, 3 substudies were executed in series to understand and identify parents’ and health care professionals’ (HCPs) needs for insights, using qualitative and quantitative methods. After the formative phase, insights were created during the development phase. Subsequently, in the summative phase, these insights were validated against parents’ experience using a quantitative approach. Results: As part of the formative phase, parents indicated having a need for smart information based on a data analysis of the data they track in an app. HCPs supported the general concept of insights for the uGrow app, although specific types of insights were considered irrelevant or even risky. After implementing a preliminary set of insights in a prototype version of the uGrow app and testing it with parents, the majority of parents (87%) reported being satisfied with the insights. From these outcomes, a total of 89 insights were implemented in a final version of the uGrow app. In the summative phase, the majority of parents reported experiencing these insights as reassuring and useful (94%), as adding enjoyment (85%), and as motivating for continuing tracking for a longer period of time (77%). Conclusions: Parents experienced the insights in the uGrow app as useful and reassuring and as adding enjoyment to their use of the uGrow app and tracking their baby’s development. The insights development process we followed showed how the quality of insights can be guaranteed by ensuring that insights are relevant, appropriate, and evidence based. In this way, insights are an example of meaningful DDI. %M 31342901 %R 10.2196/12666 %U https://mhealth.jmir.org/2019/7/e12666/ %U https://doi.org/10.2196/12666 %U http://www.ncbi.nlm.nih.gov/pubmed/31342901 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e12768 %T Behavior Change Techniques Incorporated in Fitness Trackers: Content Analysis %A Chia,Gladys Lai Cheng %A Anderson,Angelika %A McLean,Louise Anne %+ Monash University, Wellington Road, Clayton,, Australia, 61 412965684, lai-cheng.chia@monash.edu %K behavioral medicine %K self-management %K fitness tracker %K physical activity %K sedentary behavior %D 2019 %7 23.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of fitness trackers as tools of self-management to promote physical activity is increasing. However, the content of fitness trackers remains unexplored. Objective: The aim of this study was to use the Behavior Change Technique Taxonomy v1 (BCTTv1) to examine if swim-proof fitness trackers below Aus $150 (US$ 105) incorporate behavior change techniques (BCTs) that relate to self-management strategies to increase physical activity and reduce sedentary behavior and to determine if content of the fitness trackers correspond to physical activity guidelines. Methods: A total of two raters used the BCTTv1 to code 6 fitness trackers that met the inclusion criteria. The inclusion criteria were the ability to track activity, be swim proof, be compatible with Android and Apple operating systems, and cost below Aus $150. Results: All fitness trackers contained BCTs known to promote physical activity, with the most frequently used BCTs overlapping with self-management strategies, including goal setting, self-monitoring, and feedback on behavior. Fitbit Flex 2 (Fitbit Inc) contained the most BCTs at 20. Huawei Band 2 Pro (Huawei Technologies) and Misfit Shine 2 (Fossil Group) contained the least BCTs at 11. Conclusions: Fitness trackers contain evidence-based BCTs that overlap with self-management strategies, which have been shown to increase physical activity and reduce sedentary behavior. Fitness trackers offer the prospect for physical activity interventions that are cost-effective and easily accessed by a wide population. %M 31339101 %R 10.2196/12768 %U http://mhealth.jmir.org/2019/7/e12768/ %U https://doi.org/10.2196/12768 %U http://www.ncbi.nlm.nih.gov/pubmed/31339101 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 2 %P e14292 %T Experiences of Using a Consumer-Based Mobile Meditation App to Improve Fatigue in Myeloproliferative Patients: Qualitative Study %A Huberty,Jennifer %A Eckert,Ryan %A Larkey,Linda %A Joeman,Lynda %A Mesa,Ruben %+ College of Health Solutions, Arizona State University, 500 North 3rd Street, Phoenix, AZ, 85281, United States, 1 402 301 1304, jhuberty@asu.edu %K mindfulness %K meditation %K mobile phone %K mHealth %K digital health %K cancer %D 2019 %7 22.07.2019 %9 Original Paper %J JMIR Cancer %G English %X Background: Myeloproliferative neoplasm (MPN) patients suffer from long-term symptoms and reduced quality of life. Mindfulness meditation is a complementary therapy shown to be beneficial for alleviating a range of cancer-related symptoms; however, in-person meditation interventions are difficult for cancer patients to attend. Meditation via a mobile phone app represents a novel approach in MPN patients for delivering meditation. Objective: The study aimed to report MPN patients’ (ie, naïve or nearly naïve meditators) perceptions of meditation and explore their experiences in the context of using a mobile phone for meditation after participation in an 8-week consumer-based meditation app feasibility study. Methods: MPN patients (n=128) were recruited nationally through organizational partners and social media. Eligible and consented patients were enrolled into 1 of 4 groups, 2 that received varying orders of 2 consumer-based apps (10% Happier and Calm) and 2 that received one of the apps alone for the second 4 weeks of the 8-week intervention after an educational control condition. Participants were asked to perform 10 min per day of mobile phone-based meditation, irrespective of the app and order in which they received the apps. At the conclusion of the study, participants were asked whether they would like to participate in a 20-min phone interview comprising 9 to 10 questions to discuss their perceptions and experiences while using the mobile phone meditation apps. The interviews were transcribed verbatim and imported into NVivo 12 (QSR International) for coding and analysis, using a combination of deductive and inductive methods to organize the data, generate categories, and develop themes and subthemes. Results: A total of 48 MPN patients completed postintervention interviews, of which 29% (14/48) of the patients only used the 10% Happier app, 21% (10/48) of the patients only used the Calm app, and 46% (22/48) of the patients used both apps during the 8-week intervention. Themes identified in the analysis of interview data related to (1) perceptions of meditation before, during, and after the study, (2) perceptions of the Calm app, (3) perceptions of the 10% Happier app, (4) perceived impacts of using the meditation apps, (5) overall experiences of participating in the study, (6) recommendations surrounding meditation for other MPN patients, and (7) plans to continue meditation. Conclusions: The qualitative findings of this study suggest that MPN patients who are naïve or nearly naïve meditators perceived mobile phone meditation as enjoyable, preferred the Calm app over the 10% Happier app, perceived the Calm app as more appealing (eg, narrator’s voice and different meditations or background sounds offered), and perceived beneficial effects of meditation on mental health, sleep, fatigue, and pain. Future research is needed to better understand the efficacy of mobile phone meditation on MPN patient outcomes and meditation app design features that enhance uptake among its users. %M 31333197 %R 10.2196/14292 %U http://cancer.jmir.org/2019/2/e14292/ %U https://doi.org/10.2196/14292 %U http://www.ncbi.nlm.nih.gov/pubmed/31333197 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e13503 %T A Smart and Multifaceted Mobile Health System for Delivering Evidence-Based Secondary Prevention of Stroke in Rural China: Design, Development, and Feasibility Study %A Wu,Na %A Gong,Enying %A Wang,Bo %A Gu,Wanbing %A Ding,Nan %A Zhang,Zhuoran %A Chen,Mengyao %A Yan,Lijing L %A Oldenburg,Brian %A Xu,Li-Qun %+ Center of Excellence for mHealth and Smart Healthcare, China Mobile Research Institute, China Mobile Communications Corporation, 32 Xuanwumen West Street, Xicheng District, Beijing, 100032, China, 86 158 0169 6688 ext 35971, xuliqun@chinamobile.com %K stroke %K secondary prevention %K rural health services %K mobile application %K software design %K China %D 2019 %7 19.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) technologies hold great promise in improving the delivery of high-quality health care services. Yet, there has been little research so far applying mHealth technologies in the context of delivering stroke care in resource-limited rural regions. Objective: This study aimed to introduce the design and development of an mHealth system targeting primary health care providers and to ascertain its feasibility in supporting the delivery of a System-Integrated techNology-Enabled Model of cAre (SINEMA) service for strengthening secondary prevention of stroke in rural China. Methods: The SINEMA mHealth system was designed by a multidisciplinary team comprising public health researchers, neurologists, and information and communication technology experts. The iterative co-design and development of the mHealth system involved the following 5 steps: (1) assessing the needs of relevant end users through in-depth interviews of stakeholders, (2) designing the functional modules and evidence-based care content, (3) designing and building the system and user interface, (4) improving and enhancing the system through a 3-month pilot test in 4 villages, and (5) finalizing the system and deploying it in field trial, and finally, evaluating its feasibility through a survey of the dominant user group. Results: From the in-depth interviews of 49 relevant stakeholders, we found that village doctors had limited capacity in caring for village-dwelling stroke patients in rural areas. Primary health care workers demonstrated real needs in receiving appropriate training and support from the mHealth system as well as great interests in using the mHealth technologies and tools. Using these findings, we designed a multifaceted mHealth system with 7 functional modules by following the iterative user-centered design and software development approach. The mHealth system, aimed at 3 different types of users (village doctors, town physicians, and county managers), was developed and utilized in a cluster-randomized controlled trial by 25 village doctors in a resource-limited county in rural China to manage 637 stroke patients between July 2017 and July 2018. In the end, a survey on the usability and functions of the mHealth system among village doctors (the dominant group of users, response rate=96%, 24/25) revealed that most of them were satisfied with the essential functions provided (71%) and were keen to continue using it (92%) after the study. Conclusions: The mHealth system was feasible for assisting primary health care providers in rural China in delivering the SINEMA service on the secondary prevention of stroke. Further research and initiatives in scaling up the SINEMA approach and this mHealth system to other resource-limited regions in China and beyond will likely enhance the quality and accessibility of essential secondary prevention among stroke patients. ClinicalTrial: ClinicalTrials.gov NCT03185858; https://clinicaltrials.gov/ct2/show/NCT03185858 International Registered Report Identifier (IRRID): RR2-10.1016/j.ahj.2018.08.015 %M 31325288 %R 10.2196/13503 %U http://mhealth.jmir.org/2019/7/e13503/ %U https://doi.org/10.2196/13503 %U http://www.ncbi.nlm.nih.gov/pubmed/31325288 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 7 %P e12853 %T Digital Games and Mindfulness Apps: Comparison of Effects on Post Work Recovery %A Collins,Emily %A Cox,Anna %A Wilcock,Caroline %A Sethu-Jones,Geraint %+ School of Management, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 01225 388388, e.i.m.collins@bath.ac.uk %K play %K occupational health %K mindfulness %D 2019 %7 18.07.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Engagement in activities that promote the dissipation of work stress is essential for post work recovery and consequently for well-being. Previous research suggests that activities that are immersive, active, and engaging are especially effective at promoting recovery. Therefore, digital games may be able to promote recovery, but little is known about how they compare with other popular mobile activities, such as mindfulness apps that are specifically designed to support well-being. Objective: The aim of this study was to investigate and compare the effectiveness of a digital game and mindfulness app in promoting post work recovery, first in a laboratory setting and then in a field study. Methods: Study 1 was a laboratory experiment (n=45) in which participants’ need for recovery was induced by a work task, before undertaking 1 of 3 interventions: a digital game (Block! Hexa Puzzle), a mindfulness app (Headspace), or a nonmedia control with a fidget spinner (a physical toy). Recovery in the form of how energized participants felt (energetic arousal) was compared before and after the intervention and how recovered participants felt (recovery experience) was compared across the conditions. Study 2 was a field study with working professionals (n=20), for which participants either played the digital game or used the mindfulness app once they arrived home after work for a period of 5 working days. Measures of energetic arousal were taken before and after the intervention, and the recovery experience was measured after the intervention along with measures of enjoyment and job strain. Results: A 3×2 mixed analysis of variance identified that, in study 1, the digital game condition increased energetic arousal (indicative of improved recovery) whereas the other 2 conditions decreased energetic arousal (F2,42=3.76; P=.03). However, there were no differences between the conditions in recovery experience (F2,42=.01; P=.99). In study 2, multilevel model comparisons identified that neither the intervention nor day of the week had a significant main effect on how energized participants felt. However, for those in the digital game condition, daily recovery experience increased during the course of the study, whereas for those in the mindfulness condition, it decreased (F1,18=9.97; P=.01). Follow-up interviews with participants identified 3 core themes: detachment and restoration, fluctuations and differences, and routine and scheduling. Conclusions: This study suggests that digital games may be effective in promoting post work recovery in laboratory contexts (study 1) and in the real world, although the effect in this case may be cumulative rather than instant (study 2). %M 31322125 %R 10.2196/12853 %U http://mental.jmir.org/2019/7/e12853/ %U https://doi.org/10.2196/12853 %U http://www.ncbi.nlm.nih.gov/pubmed/31322125 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 2 %N 1 %P e13376 %T Development of Smartphone Apps for Skin Cancer Risk Assessment: Progress and Promise %A de Carvalho,Tiago M %A Noels,Eline %A Wakkee,Marlies %A Udrea,Andreea %A Nijsten,Tamar %+ Department of Dermatology, Erasmus Medical Center, Doctor Molewaterplein 40, Rotterdam, 3015 GD, Netherlands, 31 649331937, t.decarvalho@erasmusmc.nl %K skin cancer %K early detection %K mhealth %K smartphone app %K mobile phone %D 2019 %7 11.07.2019 %9 Viewpoint %J JMIR Dermatol %G English %X Skin cancer is a growing public health problem. Early and accurate detection is important, since prognosis and cost of treatment are highly dependent on cancer stage at detection. However, access to specialized health care professionals is not always straightforward, and population screening programs are unlikely to become implemented. Furthermore, there is a wide margin for improving the efficiency of skin cancer diagnostics. Specifically, the diagnostic accuracy of general practitioners and family physicians in differentiating benign and malignant skin tumors is relatively low. Both access to care and diagnostic accuracy fuel interest in developing smartphone apps equipped with algorithms for image analyses of suspicious lesions to detect skin cancer. Based on a recent review, seven smartphone apps claim to perform image analysis for skin cancer detection, but as of October 2018, only three seemed to be active. These apps have been criticized in the past due to their lack of diagnostic accuracy. Here, we review the development of the SkinVision smartphone app, which has more than 900,000 users worldwide. The latest version of the SkinVision app (October 2018) has a 95% sensitivity (78% specificity) for detection of skin cancer. The current accuracy of the algorithm may warrant the use of this app as an aid by lay users or general practitioners. Nonetheless, for mobile health apps to become broadly accepted, further research is needed on their health impact on the health system and the user population. Ultimately, mobile health apps could become a powerful tool to reduce health care costs related to skin cancer management and minimize the morbidity of skin cancer in the population. %R 10.2196/13376 %U http://derma.jmir.org/2019/1/e13376/ %U https://doi.org/10.2196/13376 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e14090 %T A Combination of Indoor Localization and Wearable Sensor–Based Physical Activity Recognition to Assess Older Patients Undergoing Subacute Rehabilitation: Baseline Study Results %A Ramezani,Ramin %A Zhang,Wenhao %A Xie,Zhuoer %A Shen,John %A Elashoff,David %A Roberts,Pamela %A Stanton,Annette %A Eslami,Michelle %A Wenger,Neil %A Sarrafzadeh,Majid %A Naeim,Arash %+ Center for Smart Health, University of California, Los Angeles, , Los Angeles, CA,, United States, 1 4242997051, raminr@ucla.edu %K rehabilitation %K frailty %K remote sensing technology %K wearable electronic devices %K fitness trackers %K monitoring ambulatory %K smartwatches %K bluetooth low energy beacons %D 2019 %7 10.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health care, in recent years, has made great leaps in integrating wireless technology into traditional models of care. The availability of ubiquitous devices such as wearable sensors has enabled researchers to collect voluminous datasets and harness them in a wide range of health care topics. One of the goals of using on-body wearable sensors has been to study and analyze human activity and functional patterns, thereby predicting harmful outcomes such as falls. It can also be used to track precise individual movements to form personalized behavioral patterns, to standardize the concept of frailty, well-being/independence, etc. Most wearable devices such as activity trackers and smartwatches are equipped with low-cost embedded sensors that can provide users with health statistics. In addition to wearable devices, Bluetooth low-energy sensors known as BLE beacons have gained traction among researchers in ambient intelligence domain. The low cost and durability of newer versions have made BLE beacons feasible gadgets to yield indoor localization data, an adjunct feature in human activity recognition. In the studies by Moatamed et al and the patent application by Ramezani et al, we introduced a generic framework (Sensing At-Risk Population) that draws on the classification of human movements using a 3-axial accelerometer and extracting indoor localization using BLE beacons, in concert. Objective: The study aimed to examine the ability of combination of physical activity and indoor location features, extracted at baseline, on a cohort of 154 rehabilitation-dwelling patients to discriminate between subacute care patients who are re-admitted to the hospital versus the patients who are able to stay in a community setting. Methods: We analyzed physical activity sensor features to assess activity time and intensity. We also analyzed activities with regard to indoor localization. Chi-square and Kruskal-Wallis tests were used to compare demographic variables and sensor feature variables in outcome groups. Random forests were used to build predictive models based on the most significant features. Results: Standing time percentage (P<.001, d=1.51), laying down time percentage (P<.001, d=1.35), resident room energy intensity (P<.001, d=1.25), resident bed energy intensity (P<.001, d=1.23), and energy percentage of active state (P=.001, d=1.24) are the 5 most statistically significant features in distinguishing outcome groups at baseline. The energy intensity of the resident room (P<.001, d=1.25) was achieved by capturing indoor localization information. Random forests revealed that the energy intensity of the resident room, as a standalone attribute, is the most sensitive parameter in the identification of outcome groups (area under the curve=0.84). Conclusions: This study demonstrates that a combination of indoor localization and physical activity tracking produces a series of features at baseline, a subset of which can better distinguish between at-risk patients that can gain independence versus the patients that are rehospitalized. %M 31293244 %R 10.2196/14090 %U http://mhealth.jmir.org/2019/7/e14090/ %U https://doi.org/10.2196/14090 %U http://www.ncbi.nlm.nih.gov/pubmed/31293244 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e14602 %T A Pilot Randomized Controlled Trial of a Web-Based Growth Mindset Intervention to Enhance the Effectiveness of a Smartphone App for Smoking Cessation %A Sridharan,Vasundhara %A Shoda,Yuichi %A Heffner,Jaimee %A Bricker,Jonathan %+ University of Washington, Guthrie Hall, Seattle, WA, 98195, United States, 1 2067792248, vsri@u.washington.edu %K addictive behavior %K smoking behaviors %K smoking cessation %K health technology %K mobile apps %K psychological theory %D 2019 %7 09.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although smartphone apps have shown promise for smoking cessation, there is a need to enhance their low engagement rates. This study evaluated the application of the growth mindset theory, which has demonstrated the potential to improve persistence in behavior change in other domains, as a means to improve engagement and cessation. Objective: This study aimed to explore the feasibility, utility, and efficacy of a Web-based growth mindset intervention for addiction when used alongside a smoking cessation app. Methods: Daily smokers (N=398) were all recruited on the Web and randomly assigned to receive either a cessation app alone or the app plus a Web-delivered growth mindset intervention. The primary outcome was engagement, that is, the number of log-ins to the smoking cessation app. The secondary outcome was 30-day point prevalence abstinence at 2-month follow-up collected through a Web-based survey. Results: The 2-month outcome data retention rate was 91.5% (364/398). In addition, 77.9% (310/398) of the participants in the experimental arm viewed at least 1 page of their growth mindset intervention, and 21.1% (84/398) of the group viewed all the growth mindset intervention. The intention-to-treat analysis did not show statistically significant differences between the experimental and comparison arms on log-ins to the app (19.46 vs 21.61; P=.38). The experimental arm had cessation rates, which trended higher than the comparison arm (17% vs 13%; P=.10). The modified intent-to-treat analysis, including only participants who used their assigned intervention at least once (n=115 in experimental group and n=151 in the control group), showed that the experimental arm had a similar number of log-ins (32.31 vs 28.48; P=.55) but significantly higher cessation rates (21% vs 13%; P=.03) than the comparison arm. Conclusions: A growth mindset intervention for addiction did not increase engagement rates, although it may increase cessation rates when used alongside a smartphone app for smoking cessation. Future research is required to refine the intervention and assess efficacy with long-term follow-up to evaluate the efficacy of the mindset intervention. Trial Registration: ClinicalTrials.gov NCT03174730; https://clinicaltrials.gov/ct2/show/NCT03174730 %M 31290404 %R 10.2196/14602 %U http://mhealth.jmir.org/2019/7/e14602/ %U https://doi.org/10.2196/14602 %U http://www.ncbi.nlm.nih.gov/pubmed/31290404 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 2 %P e13543 %T Feasibility of a Mobile Phone App and Telephone Coaching Survivorship Care Planning Program Among Spanish-Speaking Breast Cancer Survivors %A Nápoles,Anna María %A Santoyo-Olsson,Jasmine %A Chacón,Liliana %A Stewart,Anita L %A Dixit,Niharika %A Ortiz,Carmen %+ Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Bldg 3, 5/E08, Bethesda, MD, 20892-0001, United States, 1 301 496 3348, anna.napoles@nih.gov %K Hispanic Americans %K cancer survivors %K mobile apps %K feasibility studies %D 2019 %7 09.07.2019 %9 Original Paper %J JMIR Cancer %G English %X Background: Spanish-speaking Latina breast cancer survivors experience disparities in knowledge of breast cancer survivorship care, psychosocial health, lifestyle risk factors, and symptoms compared with their white counterparts. Survivorship care planning programs (SCPPs) could help these women receive optimal follow-up care and manage their condition. Objective: This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of a culturally and linguistically suitable SCPP called the Nuevo Amanecer (New Dawn) Survivorship Care Planning Program for Spanish-speaking breast cancer patients in public hospital settings, approaching the end of active treatment. Methods: The 2-month intervention was delivered via a written bilingual survivorship care plan and booklet, Spanish-language mobile phone app with integrated activity tracker, and telephone coaching. This single-arm feasibility study used mixed methods to evaluate the intervention. Acceptability and feasibility were examined via tracking of implementation processes, debriefing interviews, and postintervention satisfaction surveys. Preliminary efficacy was assessed via baseline and 2-month interviews using structured surveys and pre- and postintervention average daily steps count based on activity tracker data. Primary outcomes were self-reported fatigue, health distress, knowledge of cancer survivorship care, and self-efficacy for managing cancer follow-up health care and self-care. Secondary outcomes were emotional well-being, depressive and somatic symptoms, and average daily steps. Results: All women (n=23) were foreign-born with limited English proficiency; 13 (57%) had an elementary school education or less, 16 (70%) were of Mexican origin, and all had public health insurance. Coaching calls lasted on average 15 min each (SD 3.4). A total of 19 of 23 participants (83%) completed all 5 coaching calls. The majority (n=17; 81%) rated the overall quality of the app as “very good” or “excellent” (all rated it as at least “good”). Women checked their daily steps graph on the app between 4.2 to 5.9 times per week. Compared with baseline, postintervention fatigue (B=–.26; P=.02; Cohen d=0.4) and health distress levels (B=–.36; P=.01; Cohen d=0.3) were significantly lower and knowledge of recommended follow-up care and resources (B=.41; P=.03; Cohen d=0.5) and emotional well-being improved significantly (B=1.42; P=.02; Cohen d=0.3); self-efficacy for managing cancer follow-up care did not change. Average daily steps increased significantly from 6157 to 7469 (B=1311.8; P=.02; Cohen d=0.5). Conclusions: We found preliminary evidence of program feasibility, acceptability, and efficacy, with significant 2-month improvements in fatigue, health distress, and emotional well-being and increased knowledge of recommended follow-up care and average daily steps. Tailored mobile phone and health coaching SCPPs could help to ensure equitable access to these services and improve symptoms and physical activity levels among Spanish-speaking Latina breast cancer survivors. %M 31290395 %R 10.2196/13543 %U http://cancer.jmir.org/2019/2/e13543/ %U https://doi.org/10.2196/13543 %U http://www.ncbi.nlm.nih.gov/pubmed/31290395 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e12445 %T Physical Activity Behavior Change Driven by Engagement With an Incentive-Based App: Evaluating the Impact of Sweatcoin %A Elliott,Mark %A Eck,Felicia %A Khmelev,Egor %A Derlyatka,Anton %A Fomenko,Oleg %+ Institute of Digital Healthcare, WMG, University of Warwick, International Digital Laboratory, Coventry, CV4 7AL, United Kingdom, 44 02476151604, m.t.elliott@warwick.ac.uk %K physical activity %K incentives %K rewards %D 2019 %7 08.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical inactivity, now the fourth leading cause of death, is a primary element of noncommunicable diseases. Despite a great number of attempts, there is still a lack of effective approaches that can motivate sedentary populations to increase their levels of physical activity over a sustained period. Incentives for exercise can provide an immediate reward for increasing activity levels, but because of limited funding to provide rewards, previous programs using this approach have only shown short-term changes in behavior. Sweatcoin (Sweatco Ltd, UK) is an app-based platform that converts physical movement into virtual currency. The currency can be exchanged for goods and services on their marketplace, providing a continuous incentive to be active. This study investigates the physical activity behavior change observed in Sweatcoin users over a 6-month period of app usage. Objective: The aim of this study was to investigate the change in physical activity (measured using daily step count) of a sample of Sweatcoin users, the longevity of the change, and whether this change can be predicted by demographic and other lifestyle variables. Methods: Activity data from a sample of 5892 Sweatcoin users were used to analyze daily step count. Activity change was measured in terms of the percentage change in average daily step count for each month after registration, relative to that in the 3 months before using the app. Users were grouped according to having no or negative, moderate, or high activity change. A subset of users completed a questionnaire that allowed differences between groups in terms of activity and demographic status to be investigated using regression analyses. Results: Daily step count increased by 19% on average over the 6 months following registration (P<.001). Of the questionnaire respondents, 728 were valid responses. A multinomial logistic regression identified the key drivers of moderate and high activity behavior change relative to no or negative change based on the defined groupings. There was a clear impact of seasonality, with those registering for the app in winter (odds ratio [OR] 4.67; P=.001) and spring (OR 5.05; P=.001) being more likely to show high positive activity behavior change than those registering in summer. More striking were the results identifying those classified as overweight (measured through body mass index [BMI]; OR 1.83; P=.02) and less active (based on a self-reported scale of physical activity; OR 0.88; P=.048), being most likely to show high levels of physical activity change following registration with the app. Conclusions: The results highlight that an incentives-based app can induce significant physical activity behavior change, sustained over a 6-month period. Importantly, the results suggest that those typically lacking motivation to exercise (sedentary and high BMI) are most likely to be incentivized to increase their activity levels. %M 31287064 %R 10.2196/12445 %U https://mhealth.jmir.org/2019/7/e12445/ %U https://doi.org/10.2196/12445 %U http://www.ncbi.nlm.nih.gov/pubmed/31287064 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e13194 %T Applying a User-Centered Approach to Building a Mobile Personal Health Record App: Development and Usability Study %A Zhou,Leming %A DeAlmeida,Dilhari %A Parmanto,Bambang %+ Department of Health Information Management, University of Pittsburgh, 6021 Forbes Tower, 3600 Forbes Avenue at Meyran Avenue, Pittsburgh, PA, 15260, United States, 1 412 383 6653, lmzhou@gmail.com %K mobile app %K personal health record %K needs assessment %D 2019 %7 05.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A personal health record (PHR) system encourages patients to engage with their own health care by giving them the ability to manage and keep track of their own health data. Of the numerous PHR systems available in the market, many are Web-based patient portals and a few are mobile apps. They have mainly been created by hospitals and electronic health record (EHR) vendors. One major limitation of these hospital-created PHR systems is that patients can only view specific health data extracted from their EHR. Patients do not have the freedom to add important personal health data they collect in their daily lives into their PHR. Therefore, there is an information gap between clinical visits. Objective: The aim of this study was to develop and evaluate a new mobile PHR app that can be easily used to manage various types of personal health data to fill the information gap. Methods: A user-centered approach was used to guide the development and evaluation of the new mobile PHR app. There were three steps in this study: needs assessment, app design and development, and conducting a usability study. First, a large-scale questionnaire study was conducted with the general population to gain an understanding of their needs and expectations with regard to a mobile PHR app. A mobile PHR app for personal medical data tracking and management was then created based on the results of the questionnaire study. End users were actively involved in all stages of the app development. Finally, a usability study was performed with participants to evaluate the usability of the mobile PHR app, which involved asking participants to finish a set of tasks and to respond to a usability questionnaire. Results: In the questionnaire study for needs assessment, there were 609 participants in total. The answers from these participants revealed that they wanted to manage various types of personal health data in a mobile PHR app. Participants also reported some features they desired to have in the app. On the basis of the needs assessment findings, a new mobile PHR app (PittPHR) was created with 6 major modules: health records, history, trackers, contacts, appointments, and resources. This app allows users to customize the trackers according to their needs. In the usability study, there were 15 participants. The usability study participants expressed satisfaction with the app and provided comments and suggestions for further development. Conclusions: This new mobile PHR app provides options for users to manage a wide range of personal health data conveniently in one place. The app fills the information gap between clinical visits. The study results indicated that this new mobile PHR app meets the need of users and that users welcome this app. %M 31278732 %R 10.2196/13194 %U https://mhealth.jmir.org/2019/7/e13194/ %U https://doi.org/10.2196/13194 %U http://www.ncbi.nlm.nih.gov/pubmed/31278732 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e11926 %T Using Health and Well-Being Apps for Behavior Change: A Systematic Search and Rating of Apps %A McKay,Fiona H %A Wright,Annemarie %A Shill,Jane %A Stephens,Hugh %A Uccellini,Mary %+ Deakin University, School of Health and Social Development, Burwood Hwy, Burwood, 3125, Australia, 61 392517183, fiona.mckay@deakin.edu.au %K smartphone %K mobile apps %K health promotion %K health behavior %K rating %D 2019 %7 04.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphones have allowed for the development and use of apps. There is now a proliferation of mobile health interventions for physical activity, healthy eating, smoking and alcohol cessation or reduction, and improved mental well-being. However, the strength or potential of these apps to lead to behavior change remains uncertain. Objective: The aim of this study was to review a large sample of healthy lifestyle apps at a single point in time (June to July 2018) to determine their potential for promoting health-related behavior change with a view to sharing this information with the public. In addition, the study sought to test a wide range of apps using a new scale, the App Behavior Change Scale (ABACUS). Methods: Apps focusing on 5 major modifiable lifestyle behaviors were identified using a priori key search terms across the Australian Apple iTunes and Google Play stores. Lifestyle behavior categories were selected for their impact on health and included smoking, alcohol use, physical activity, nutrition, and mental well-being. Apps were included if they had an average user rating between 3 and 5, if they were updated in the last 18 months, if the description of the app included 2 of 4 behavior change features, and if they were in English. The selected behavior change apps were rated in 2 ways using previously developed rating scales: the Mobile App Rating Scale (MARS) for functionality and the ABACUS for potential to encourage behavior change. Results: The initial search identified 212,352 apps. After applying the filtering criteria, 5018 apps remained. Of these, 344 were classified as behavior change apps and were reviewed and rated. Apps were given an average MARS score of 2.93 out of 5 (SD 0.58, range 1.42-4.16), indicating low-to-moderate functionality. Scores for the ABACUS ranged from 1 to 17, out of 21, with an average score of 7.8 (SD 2.8), indicating a low-to-moderate number of behavior change techniques included in apps. The ability of an app to encourage practice or rehearsal, in addition to daily activities, was the most commonly identified feature across all apps (310/344, 90.1%), whereas the second most common feature was the ability of the user to easily self-monitor behavior (289/344, 84.0%). Conclusions: The wide variety of apps included in this 2018 study and the limited number of behavior change techniques found in many apps suggest an opportunity for improvement in app design that will promote sustained and significant lifestyle behavior change and, therefore, better health. The use of the 2 scales for the review and rating of the apps was successful and provided a method that could be replicated and tested in other behavior change areas. %M 31274112 %R 10.2196/11926 %U https://mhealth.jmir.org/2019/7/e11926/ %U https://doi.org/10.2196/11926 %U http://www.ncbi.nlm.nih.gov/pubmed/31274112 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e13436 %T Leveraging Positive Psychology to Support Smoking Cessation in Nondaily Smokers Using a Smartphone App: Feasibility and Acceptability Study %A Hoeppner,Bettina B %A Hoeppner,Susanne S %A Carlon,Hannah A %A Perez,Giselle K %A Helmuth,Eric %A Kahler,Christopher W %A Kelly,John F %+ Recovery Research Institute, Massachusetts General Hospital, Harvard Medical School, 151 Merrimac Street, 6th Floor, Boston, MA, 02114, United States, 1 6176431988, bhoeppner@mgh.harvard.edu %K smartphone %K mHealth %K smoking cessation %K happiness %K cigarettes %D 2019 %7 03.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nondaily smoking is an increasingly prevalent smoking pattern that poses substantial health risks. Objective: We tested the feasibility of using a smartphone app with positive psychology exercises to support smoking cessation in nondaily smokers. Methods: In this prospective, single-group pilot study, nondaily smokers (n=30) used version 1 of the Smiling Instead of Smoking (SiS) app for 3 weeks while undergoing a quit attempt. The app assigned daily happiness exercises, provided smoking cessation tools, and made smoking cessation information available. Participants answered surveys at baseline and 2, 6, 12, and 24 weeks after their chosen quit day and participated in structured user feedback sessions 2 weeks after their chosen quit day. Results: App usage during the prescribed 3 weeks of use was high, with an average 84% (25.2/30) of participants using the app on any given day. App use was largely driven by completing happiness exercises (73%, 22/30) of participants per day), which participants continued to complete even after the end of the prescribed period. At the end of prescribed use, 90% (27/30) of participants reported that the app had helped them during their quit attempt, primarily by reminding them to stay on track (83%, 25/30) and boosting their confidence to quit (80%, 24/30) and belief that quitting was worthwhile (80%, 24/30). Happiness exercises were rated more favorably than user-initiated smoking cessation tools, and 80% (24/30) of participants proactively expressed in interviews that they liked them. App functionality to engage social support was not well received. Functionality to deal with risky times was rated useful but was rarely used. Within-person changes from baseline to the end of prescribed use were observed for several theorized mechanisms of behavior change, all in the expected direction: confidence increased (on a 0-100 scale, internal cues: b=16.7, 95% CI 7.2 to 26.3, P=.001; external cues: b=15.8, 95% CI 5.4 to 26.1, P=.004), urge to smoke decreased (on a 1-7 scale, b=−0.8, 95% CI −1.3 to −0.3, P=.002), and perceptions of smoking became less positive (on a 1-5 scale, psychoactive benefits: b=−0.5, 95% CI −0.9 to −0.2, P=.006; pleasure: b=−0.4, 95% CI −0.7 to −0.01, P=.03; on a 0-100 scale, importance of pros of smoking: b=−11.3, 95% CI −18.9 to −3.8, P=.004). Self-reported abstinence rates were 40% (12/30) and 53% (16/30) of participants 2 and 24 weeks post quit, respectively, with 30% (9/30) biochemically validated as abstinent 2 weeks post quit. Conclusions: A smartphone app using happiness exercises to aid smoking cessation was well received by nondaily smokers. Given the high nonadherence and dropout rates for technology-delivered interventions reported in the literature, the high engagement with positive psychology exercises is noteworthy. Observed within-person changes and abstinence rates are promising and warrant further development of this app. %M 31271147 %R 10.2196/13436 %U https://mhealth.jmir.org/2019/7/e13436/ %U https://doi.org/10.2196/13436 %U http://www.ncbi.nlm.nih.gov/pubmed/31271147 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e13844 %T Patient Attitudes and Their Awareness Towards Skin Cancer–Related Apps: Cross-Sectional Survey %A Steeb,Theresa %A Wessely,Anja %A Mastnik,Sebastian %A Brinker,Titus Josef %A French,Lars Einar %A Niesert,Anne-Charlotte %A Berking,Carola %A Heppt,Markus Vincent %+ Department of Dermatology and Allergy, University Hospital, LMU Munich, Frauenlobstr. 9-11, Munich, 80337, Germany, 49 89440056387, Markus.Heppt@med.uni-muenchen.de %K skin cancer %K melanoma %K mobile applications %K telemedicine %K awareness %K patient education %D 2019 %7 02.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the emerging era of digitalization and electronic health, skin cancer–related apps represent useful tools to support dermatologic consultation and examination. Yet, little is known about how patients perceive the value of such apps. Objective: The aim of this study was to investigate patient attitudes and their awareness toward skin cancer–related apps. Methods: A cross-sectional study including 200 patients from the oncological outpatient unit was conducted at the University Hospital (LMU Munich, Germany) between September and December 2018. Patients were asked to complete a self-administered questionnaire on the popularity and usefulness of health-related and skin cancer–related apps. A descriptive analysis was performed with the expression of categorical variables as frequencies and percentages. For continuous variables, the median and range were indicated. Contingency tables and chi-square tests were performed to investigate associations between sociodemographic data and selected items of the questionnaire. Results: A total of 98.9% (195/197) of patients had never used skin cancer–related apps or could not remember. In 49.7% (93/187) of cases, patients were unsure about the usefulness of skin cancer apps, whereas 42.6% (78/183) thought that skin cancer apps could supplement or support the professional skin examination performed by a physician. However, 47.9% (90/188) were interested in acquiring more information by their dermatologists about skin cancer apps. Young age (P=.002), male gender (P=.02), a previous history of melanoma (P=.004), and higher educational level (P=.002) were significantly associated with a positive attitude. Nevertheless, 55.9% (105/188) preferred a printed patient brochure on skin cancer to downloading and using an app. Conclusions: The experience and knowledge of skin cancer–related apps was surprisingly low in this population, although there was a high general interest in more information about such apps. Printed patient brochures were the preferred information source. %M 31267978 %R 10.2196/13844 %U https://mhealth.jmir.org/2019/7/e13844/ %U https://doi.org/10.2196/13844 %U http://www.ncbi.nlm.nih.gov/pubmed/31267978 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e12347 %T A Mobile Phone–Based Intervention to Improve Mental Health Among Homeless Young Adults: Pilot Feasibility Trial %A Schueller,Stephen M %A Glover,Angela C %A Rufa,Anne K %A Dowdle,Claire L %A Gross,Gregory D %A Karnik,Niranjan S %A Zalta,Alyson K %+ Department of Psychological Science, University of California Irvine, 4201 Social & Behavioral Sciences Gateway, University of California, Irvine, Irvine, CA, 92697, United States, 1 9498243850, s.schueller@uci.edu %K mental health %K homelessness %K telemedicine %K treatment %D 2019 %7 02.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Youth homelessness is a substantial issue, and many youths experiencing homelessness have mental health issues as both a cause and consequence of homelessness. These youths face many barriers to receiving traditional mental health services, and as a result, only a few youths experiencing homelessness receive any form of mental health care. Objective: This project aimed to develop and determine the feasibility and acceptability of engaging young adults (ie, individuals aged 18-24 years) experiencing homelessness in a remotely delivered mental health intervention. This intervention provided brief emotional support and coping skills, drawing from cognitive behavioral principles as an introduction into psychosocial support. The intervention was piloted in a homeless shelter network. Methods: A total of 35 young adults experiencing homelessness participated in a single-arm feasibility pilot trial. Participants received a mobile phone, a service and data plan, and 1 month of support from a coach consisting of up to 3 brief phone sessions, text messaging, and mobile mental health apps. We evaluated feasibility by looking at completion of sessions as well as the overall program and acceptability with satisfaction ratings. We also collected clinical symptoms at baseline and the end of the 1-month support period. We used validity items to identify participants who might be responding inappropriately and thus only report satisfaction ratings and clinical outcomes from valid responses. Results: Most participants (20/35, 57%) completed all 3 of their phone sessions, with an average of 2.09 sessions (SD 1.22) completed by each participant. Participants sent an average of 15.06 text messages (SD 12.62) and received an average of 19.34 messages (SD 12.70). We found higher rates of satisfaction among the participants with valid responses, with 100% (23/23) of such participants indicating that they would recommend participation to someone else and 52% (12/23) reporting that they were very or extremely satisfied with their participation. We found very little change from pre- to posttreatment on measures of depression (d=0.27), post-traumatic stress disorder (d=0.17), and emotion regulation (d=0.10). Conclusions: This study demonstrated that it was feasible to engage homeless young adults in mental health services in this technology-based intervention with high rates of satisfaction. We did not find changes in clinical outcomes; however, we had a small sample size and a brief intervention. Technology might be an important avenue to reach young adults experiencing homelessness, but additional work could explore proper interventions to deliver with such a platform. Trial Registration: ClinicalTrials.gov NCT03620682; https://clinicaltrials.gov/ct2/show/NCT03620682 %M 31267980 %R 10.2196/12347 %U https://mhealth.jmir.org/2019/7/e12347/ %U https://doi.org/10.2196/12347 %U http://www.ncbi.nlm.nih.gov/pubmed/31267980 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e11310 %T Evaluation of the Effectiveness of a Musical Cognitive Restructuring App for Black Inner-City Girls: Survey, Usage, and Focus Group Evaluation %A Neal-Barnett,Angela %A Stadulis,Robert %A Ellzey,Delilah %A Jean,Elizabeth %A Rowell,Tiffany %A Somerville,Keaton %A Petitti,Kallie %A Siglow,Benjamin %A Ruttan,Arden %A Hogue,Mary %+ Kent State University, Department of Psychological Sciences, Program for Research on Anxiety Disorders among African Americans, 600 Hilltop Dr, Kent, OH, 44242-0001, United States, 1 330 672 2166, aneal@kent.edu %K black girls %K musical cognitive restructuring %K mHealth %K negative thinking %D 2019 %7 27.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Research on mobile health (mHealth) app use during adolescence is growing; however, little attention has been paid to black adolescents, particularly black girls, who are generally underresearched and underserved in psychological intervention research. Cognitive restructuring is an important tool in anxiety and fear management and involves two parts: (1) recognizing and deconstructing erroneous thoughts and (2) replacing negative anxiety and stress-provoking thoughts with positive thoughts. In our work with black adolescent females, we found that cognitive restructuring is a difficult skill to practice on one’s own. Thus, drawing upon the importance of music in the black community, we developed the Build Your Own Theme Song (BYOTS) app to deliver a musical form of the technique to middle-school black girls. Objective: Our aim in this mixed methods study is to evaluate the effectiveness of the BYOTS app. We hypothesize that participants will expect the app to be effective in reducing negative thoughts and that the app will meet their expectations and data generated from the app will demonstrate a reduction in negative thinking and anxiety. Methods: A total of 72 black or biracial seventh- and eighth-grade adolescent females were enrolled in Sisters United Now (SUN), an eight-session culturally infused and app-augmented stress and anxiety sister circle intervention. Before using the BYOTS app, girls completed the Multidimensional Anxiety Scale for Children 2 and the App Expectations Survey. Usage data collected from the app included an assessment of negative thinking before and after listening to their song. After completion of the intervention, focus groups were held to gather qualitative data on participants’ app experience. Results: Results using paired sample t tests indicated negative thinking was significantly lower at day 7 than day 1 (t31=1.69, P=.05). Anxiety from preuse to postuse of the app was also reduced (t38=2.82, P=.004). Four effectiveness themes emerged from the focus groups: difference in behavior and temperament, promoted calmness, helpfulness in stressful home situations, and focused thinking via the SUN theme song. Conclusions: The BYOTS app is a useful tool for delivering musical cognitive restructuring to reduce negative thinking and anxiety in an underserved urban population. Changes were supported both quantitatively and qualitatively. Participants, their peers, and their family noted the difference. Findings support expanding the research to black girls of various socioeconomic statuses and geographic diversity. Currently, the app augments SUN, a culturally relevant intervention. Future research will explore BYOTS as a stand-alone app. %M 31188130 %R 10.2196/11310 %U http://mhealth.jmir.org/2019/6/e11310/ %U https://doi.org/10.2196/11310 %U http://www.ncbi.nlm.nih.gov/pubmed/31188130 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 6 %P e13717 %T Gamification in Apps and Technologies for Improving Mental Health and Well-Being: Systematic Review %A Cheng,Vanessa Wan Sze %A Davenport,Tracey %A Johnson,Daniel %A Vella,Kellie %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, Sydney,, Australia, 61 286276941, vanessa.cheng@sydney.edu.au %K well-being %K video games %K gamification %K mental health %K health behavior %K systematic review %K eHealth %K mHealth %K health informatics %D 2019 %7 26.06.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: There is little research on the application of gamification to mental health and well-being. Furthermore, usage of gamification-related terminology is inconsistent. Current applications of gamification for health and well-being have also been critiqued for adopting a behaviorist approach that relies on positive reinforcement and extrinsic motivators. Objective: This study aimed to analyze current applications of gamification for mental health and well-being by answering 3 research questions (RQs). RQ1: which gamification elements are most commonly applied to apps and technologies for improving mental health and well-being? RQ2: which mental health and well-being domains are most commonly targeted by these gamified apps and technologies? RQ3: what reasons do researchers give for applying gamification to these apps and technologies? A systematic review of the literature was conducted to answer these questions. Methods: We searched ACM Digital Library, CINAHL, Cochrane Library, EMBASE, IEEE Explore, JMIR, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science for qualifying papers published between the years 2013 and 2018. To answer RQ1 and RQ2, papers were coded for gamification elements and mental health and well-being domains according to existing taxonomies in the game studies and medical literature. During the coding process, it was necessary to adapt our coding frame and revise these taxonomies. Thematic analysis was conducted to answer RQ3. Results: The search and screening process identified 70 qualifying papers that collectively reported on 50 apps and technologies. The most commonly observed gamification elements were levels or progress feedback, points or scoring, rewards or prizes, narrative or theme, personalization, and customization; the least commonly observed elements were artificial assistance, unlockable content, social cooperation, exploratory or open-world approach, artificial challenge, and randomness. The most commonly observed mental health and well-being domains were anxiety disorders and well-being, whereas the least commonly observed domains were conduct disorder and bipolar disorders. Researchers’ justification for applying gamification to improving mental health and well-being was coded in 59% (41/70) of the papers and was broadly divided into 2 themes: (1) promoting engagement and (2) enhancing an intervention’s intended effects. Conclusions: Our findings suggest that the current application of gamification to apps and technologies for improving mental health and well-being does not align with the trend of positive reinforcement critiqued in the greater health and well-being literature. We also observed overlap between the most commonly used gamification techniques and existing behavior change frameworks. Results also suggest that the application of gamification is not driven by health behavior change theory, and that many researchers may treat gamification as a black box without consideration for its underlying mechanisms. We call for the inclusion of more comprehensive and explicit descriptions of how gamification is applied and the standardization of applied games terminology within and across fields. %M 31244479 %R 10.2196/13717 %U http://mental.jmir.org/2019/6/e13717/ %U https://doi.org/10.2196/13717 %U http://www.ncbi.nlm.nih.gov/pubmed/31244479 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 6 %P e13651 %T Feasibility and Clinical Relevance of a Mobile Intervention Using TrackPAD to Support Supervised Exercise Therapy in Patients With Peripheral Arterial Disease: Study Protocol for a Randomized Controlled Pilot Trial %A Paldán,Katrin %A Simanovski,Jan %A Ullrich,Greta %A Steinmetz,Martin %A Rammos,Christos %A Jánosi,Rolf Alexander %A Moebus,Susanne %A Rassaf,Tienush %A Lortz,Julia %+ Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstrass 55, Essen, 45147, Germany, 49 201723 ext 84995, julia.lortz@uk-essen.de %K peripheral arterial disease %K telemedicine %K patient participation %K patient compliance %K primary health care %D 2019 %7 26.06.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Peripheral arterial disease (PAD) is a common and severe disease with a highly increased cardiovascular morbidity and mortality. Through the circulatory disorder and the linked undersupply of oxygen carriers in the lower limbs, the ongoing decrease of the pain-free walking distance occurs with a significant reduction in patients’ quality of life. Studies including activity monitoring for patients with PAD are rare and digital support to increase activity via mobile health technologies is mainly targeted at patients with cardiovascular disease in general. The special requirement of patients with PAD is the need to reach a certain pain level to improve the pain-free walking distance. Unfortunately, both poor adherence and availability of institutional resources are major problems in patient-centered care. Objective: The objective of this trackPAD pilot study is to evaluate the feasibility of a mobile phone–based self tracking app to promote physical activity and supervised exercise therapy (SET) in particular. We also aim for a subsequent patient centered adjustment of the app prototype based on the results of the app evaluation and process evaluation. Methods: This study was designed as a closed user group trial, with assessors blinded, and parallel group study with face-to-face components for assessment with a follow-up of 3 months. Patients with symptomatic PAD (Fontaine stage IIa or IIb) and possession of a mobile phone were eligible. Eligible participants were randomly assigned into study and control group, stratified by their distance covered in the 6-min walk test, using the software TENALEA. Participants randomized to the study group received usual care and the mobile intervention (trackPAD) for the follow-up period of 3 months, whereas participants randomized to the control group received only usual care. TrackPAD records the frequency and duration of training sessions and pain level using manual user input. Clinical outcome data were collected at the baseline and after 3 months via validated tools (6-min walk test, ankle-brachial index, and duplex ultrasound at the lower arteries) and self-reported quality of life. Usability and quality of the app was determined using the user version of the Mobile Application Rating Scale. Results: The study enrolled 45 participants with symptomatic PAD (44% male). Of these participants, 21 (47%) were randomized to the study group and 24 (53%) were randomized to the control group. The distance walked in the 6-min walk test was comparable in both groups at baseline (study group: mean 368.1m [SD 77.6] vs control group: mean 394.6m [SD 100.6]). Conclusions: This is the first trial to test a mobile intervention called trackPAD that was designed especially for patients with PAD. Its results will provide important insights in terms of feasibility, effectiveness, and patient preferences of an app-based mobile intervention supporting SET for the conservative treatment of PAD. International Registered Report Identifier (IRRID): DERR1-10.2196/13651 %M 31244477 %R 10.2196/13651 %U http://www.researchprotocols.org/2019/6/e13651/ %U https://doi.org/10.2196/13651 %U http://www.ncbi.nlm.nih.gov/pubmed/31244477 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e14273 %T Efficacy of the Mindfulness Meditation Mobile App “Calm” to Reduce Stress Among College Students: Randomized Controlled Trial %A Huberty,Jennifer %A Green,Jeni %A Glissmann,Christine %A Larkey,Linda %A Puzia,Megan %A Lee,Chong %+ College of Health Solutions, Arizona State University, 500 North 3rd Street, Phoenix, AZ, 85004, United States, 1 602 827 2456, jhuberty@asu.edu %K meditation %K mental health %K mindfulness %K smartphone %K technology %K mobile phone %D 2019 %7 25.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: College students experience high levels of stress. Mindfulness meditation delivered via a mobile app may be an appealing, efficacious way to reduce stress in college students. Objective: We aimed to test the initial efficacy and sustained effects of an 8-week mindfulness meditation mobile app—Calm—compared to a wait-list control on stress, mindfulness, and self-compassion in college students with elevated stress. We also explored the intervention’s effect on health behaviors (ie, sleep disturbance, alcohol consumption [binge drinking], physical activity, and healthy eating [fruit and vegetable consumption]) and the feasibility and acceptability of the app. Methods: This study was a randomized, wait-list, control trial with assessments at baseline, postintervention (8 weeks), and at follow-up (12 weeks). Participants were eligible if they were current full-time undergraduate students and (1) at least 18 years of age, (2) scored ≥14 points on the Perceived Stress Scale, (3) owned a smartphone, (4) were willing to download the Calm app, (5) were willing to be randomized, and (7) were able to read and understand English. Participants were asked to meditate using Calm at least 10 minutes per day. A P value ≤.05 was considered statistically significant. Results: A total of 88 participants were included in the analysis. The mean age (SD) was 20.41 (2.31) years for the intervention group and 21.85 (6.3) years for the control group. There were significant differences in all outcomes (stress, mindfulness, and self-compassion) between the intervention and control groups after adjustment for covariates postintervention (all P<.04). These effects persisted at follow-up (all P<.03), except for the nonreacting subscale of mindfulness (P=.08). There was a significant interaction between group and time factors in perceived stress (P=.002), mindfulness (P<.001), and self-compassion (P<.001). Bonferroni posthoc tests showed significant within-group mean differences for perceived stress in the intervention group (P<.001), while there were no significant within-group mean differences in the control group (all P>.19). Similar results were found for mindfulness and self-compassion. Effect sizes ranged from moderate (0.59) to large (1.24) across all outcomes. A significant group×time interaction in models of sleep disturbance was found, but no significant effects were found for other health behaviors. The majority of students in the intervention group reported that Calm was helpful to reduce stress and stated they would use Calm in the future. The majority were satisfied using Calm and likely to recommend it to other college students. The intervention group participated in meditation for an average of 38 minutes/week during the intervention and 20 minutes/week during follow-up. Conclusions: Calm is an effective modality to deliver mindfulness meditation in order to reduce stress and improve mindfulness and self-compassion in stressed college students. Our findings provide important information that can be applied to the design of future studies or mental health resources in university programs. Trial Registration: ClinicalTrials.gov NCT03891810; https://clinicaltrials.gov/ct2/show/NCT03891810 %M 31237569 %R 10.2196/14273 %U http://mhealth.jmir.org/2019/6/e14273/ %U https://doi.org/10.2196/14273 %U http://www.ncbi.nlm.nih.gov/pubmed/31237569 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e14136 %T A Mobile System to Improve Quality of Life Via Energy Balance in Breast Cancer Survivors (BENECA mHealth): Prospective Test-Retest Quasiexperimental Feasibility Study %A Lozano-Lozano,Mario %A Cantarero-Villanueva,Irene %A Martin-Martin,Lydia %A Galiano-Castillo,Noelia %A Sanchez,Maria-José %A Fernández-Lao,Carolina %A Postigo-Martin,Paula %A Arroyo-Morales,Manuel %+ Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Avda de la Ilustración, 60, Granada,, Spain, 34 958248764, irenecantarero@ugr.es %K mHealth %K energy balance %K monitoring %K breast cancer %K survivors %K quality of life %D 2019 %7 25.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Energy balance is defined as the difference between energy expenditure and energy intake. The current state of knowledge supports the need to better integrate mechanistic approaches through effective studies of energy balance in the cancer population because of an observed significant lack of adherence to healthy lifestyle recommendations. To stimulate changes in breast cancer survivors’ lifestyles based on energy balance, our group developed the BENECA (Energy Balance on Cancer) mHealth app. BENECA has been previously validated as a reliable energy balance monitoring system. Objective: Based on our previous results, the goal of this study was to investigate the feasibility of BENECA mHealth in an ecological clinical setting with breast cancer survivors, by studying (1) its feasibility and (2) pretest-posttest differences with regard to breast cancer survivor lifestyles, quality of life (QoL), and physical activity (PA) motivation. Methods: Eighty breast cancer survivors diagnosed with stage I to IIIA and with a body mass index over 25 kg/m2 were enrolled in this prospective test-retest quasi-experimental study. Patients used BENECA mHealth for 8 weeks and were assessed at baseline and the postintervention period. Feasibility main outcomes included percentage of adoption, usage, and attrition; user app quality perception measured with the Mobile App Rating Scale (MARS); satisfaction with the Net Promoter Score (NPS); and barriers and facilitators of its use. Clinical main outcomes included measuring QoL with the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORT QLQ-C30), PA assessment with accelerometry, PA motivation measure with a Spanish self-efficacy scale for physical activity (EAF), and body composition with dual-energy x-ray absorptiometry. Statistical tests (using paired-sample t tests) and Kaplan-Meier survival curves were analyzed. Results: BENECA was considered feasible by the breast cancer survivors in terms of use (76%, 58/76), adoption (69%, 80/116), and satisfaction (positive NPS). The app quality score did not make it one of the best-rated apps (mean 3.71, SD 0.47 points out of 5). BENECA mHealth improved the QoL of participants (global health mean difference [MD] 12.83, 95% CI 8.95-16.71, P<.001), and EAF score (global MD 36.99, 95% CI 25.52-48.46, P<.001), daily moderate-to-vigorous PA (MD 7.38, 95% CI 0.39-14.37, P=.04), and reduced body weight (MD −1.42, 95% CI −1.97 to −0.87, P<.001). Conclusions: BENECA mHealth can be considered feasible in a real clinical context to promote behavioral changes in the lifestyles of breast cancer survivors, but it needs to be enhanced to improve user satisfaction with use and functionality. This study highlights the importance of the use of mobile apps based on energy balance and how the QoL of breast cancer survivors can be improved via monitoring. %M 31237570 %R 10.2196/14136 %U http://mhealth.jmir.org/2019/6/e14136/ %U https://doi.org/10.2196/14136 %U http://www.ncbi.nlm.nih.gov/pubmed/31237570 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13059 %T Mindfulness-Based Smoking Cessation Enhanced With Mobile Technology (iQuit Mindfully): Pilot Randomized Controlled Trial %A Spears,Claire Adams %A Abroms,Lorien C %A Glass,Carol R %A Hedeker,Donald %A Eriksen,Michael P %A Cottrell-Daniels,Cherell %A Tran,Binh Q %A Wetter,David W %+ Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, 140 Decatur St SE, Atlanta, GA, 30303, United States, 1 404 413 9335, cspears@gsu.edu %K text messaging %K smoking cessation %K low-income populations %D 2019 %7 24.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mindfulness training shows promise for improving smoking cessation and lapse recovery, and between-session mobile health messages could enhance treatment engagement and effectiveness. Personalized, in-the-moment text messaging support could be particularly useful for low-income smokers with fewer smoking cessation resources. Objective: This pilot study examined the feasibility of a text messaging program (iQuit Mindfully) as an adjunct to in-person Mindfulness-Based Addiction Treatment (MBAT) for smoking cessation. Methods: A total of 71 participants were randomly assigned to MBAT (n=33) or iQuit Mindfully (n=38; MBAT + between-session text messages); of these, 70% (50/71) were African American, and 61% (43/71) had an annual household income of US $30,000 or less. All participants received 8 weekly therapist-led group counseling sessions, nicotine patches, and self-help materials. Outcomes were feasibility (attrition, engagement, and participants’ ratings), participants’ feedback regarding the text messaging intervention, and smoking cessation (assessed in person). Results: Strong retention was achieved (76% [54/71] at the end of treatment, and 89% [63/71] at 1-month follow-up). In the iQuit Mindfully group, engagement was high (88% [29/33] indicated reading all or most texts, and 89% [34/38] engaged in interactive texting), and participants provided positive ratings (on a 1-10 scale, average rating for recommending the program to others was 8.4 [SD 2.5]). Participants indicated benefiting from the texts (eg, appreciating encouraging reminders, coping strategies, and social support) and suggested improvements (eg, more personalization). Overall, biochemically confirmed smoking cessation rates were 22% (12/55) at the end of treatment and 19% (12/62) at 1-month follow-up, with no differences between conditions. Living below the poverty level predicted worse cessation outcomes at 1-month follow-up among participants receiving in-person only treatment (P=.03) but not among those receiving iQuit Mindfully. Conclusions: Text messaging appears to be a feasible and acceptable modality for supporting mindfulness-based smoking cessation treatment. The availability of 24/7 text messaging might be particularly helpful for low-income smokers who have access to fewer cessation resources and experience significant day-to-day barriers to quitting. Trial Registration: ClinicalTrials.gov NCT03029819; https://clinicaltrials.gov/ct2/show/NCT03029819 %M 31237242 %R 10.2196/13059 %U http://mhealth.jmir.org/2019/6/e13059/ %U https://doi.org/10.2196/13059 %U http://www.ncbi.nlm.nih.gov/pubmed/31237242 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13987 %T Using the Extended Parallel Process Model to Examine the Nature and Impact of Breast Cancer Prevention Information on Mobile-Based Social Media: Content Analysis %A Chen,Liang %A Yang,Xiaodong %A Fu,Lunrui %A Liu,Xiaoming %A Yuan,Congyi %+ School of Journalism and Communication, Shandong University, No.57 Shanda South Road, Jinan, 250100, China, 86 531 88361159, XYANG012@e.ntu.edu.sg %K breast cancer %K prevention information %K mobile social media %K EPPM %D 2019 %7 24.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the rise of mobile technology, an increasing number of people use mobile-based social media to access health information. Many scholars have explored the nature of health information on social media; however, the impact of such information on people was understudied. Objective: This study aimed to examine the nature and impact of health information on mobile-based social media. Specifically, we investigated how the levels of threat and efficacy of breast cancer prevention information affect individuals’ engagement with the information, such as readings and likes. Methods: Breast cancer prevention articles posted on a Chinese mobile-based social media platform (ie, WeChat Subscription Account [WeChat SA]) from January 1 to December 31, 2017, were extracted using the Python Web Crawler. We used content analysis and analysis of covariance to analyze our data. Results: The results revealed that the vast majority of titles and main bodies of the articles involved one of the extended parallel process model components: threat or efficacy. Conclusions: Breast cancer prevention information on WeChat SA was well designed. Both threat and efficacy significantly affected the number of readings, whereas only efficacy had a significant effect on the number of likes. Moreover, breast cancer prevention information that contained both high levels of threat and efficacy gained the largest number of readings and likes. %M 31237239 %R 10.2196/13987 %U http://mhealth.jmir.org/2019/6/e13987/ %U https://doi.org/10.2196/13987 %U http://www.ncbi.nlm.nih.gov/pubmed/31237239 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 6 %P e13549 %T Protocol for the Development of a Behavioral Family Lifestyle Intervention Supported by Mobile Health to Improve Weight Self-Management in Children With Asthma and Obesity %A Fedele,David %A Lucero,Robert %A Janicke,David %A Abu-Hasan,Mutasim %A McQuaid,Elizabeth %A Moon,Jon %A Fidler,Andrea %A Wallace-Farquharson,Tanya %A Lindberg,David %+ Department of Clinical & Health Psychology, University of Florida, 101 S Newell Dr, Rm 3151, PO Box 100165, Gainesville, FL, 32610, United States, 1 352 294 5765, dfedele@phhp.ufl.edu %K asthma %K obesity %K child %K family %K program development %D 2019 %7 24.06.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Asthma is the most common chronic childhood illness and is a leading cause of emergency department visits in the United States. Obesity increases the risk of poor health outcomes, reduced quality of life, and increased health care expenditures among youth with asthma. Weight loss is crucial for improving asthma outcomes in children with obesity. Our study team developed the Childhood Health and Asthma Management Program (CHAMP), a 16-session behavioral family lifestyle intervention (BFI) for school-age children with asthma and obesity and evaluated CHAMP in a randomized controlled trial compared with attention control. There were medium effect sizes favoring CHAMP for changes in body mass index z-scores, asthma control, and lung function among completers (ie, those who attended ≥9 of 16 sessions). Despite high rates of satisfaction reported by families, attendance and trial attrition were suboptimal, which raised concerns regarding the feasibility of CHAMP. Qualitative feedback from participants indicated 3 areas for refinement: (1) a less burdensome intervention modality, (2) a more individually tailored intervention experience, and (3) that interventionists can better answer health-related questions. Objective: We propose to improve upon our pilot intervention by developing the Mobile Childhood Health and Asthma Management Program (mCHAMP), a nurse-delivered BFI, delivered to individual families, and supported by a mobile health (mHealth) app. This study aims to (1) identify structural components of mCHAMP and (2) develop and test the usability of our mCHAMP app. Methods: Participants will be recruited from an outpatient pediatric pulmonary clinic. We will identify the structural components of mCHAMP by conducting a needs assessment with parents of children with asthma and obesity. Subsequently, we will develop and test our mCHAMP app using an iterative process that includes usability testing with target users and pediatric nurses. Results: This study was funded in 2018; 13 parents of children with asthma and obesity participated in the needs assessment. Preliminary themes from focus groups and individual meetings included barriers to engaging in health-promoting behaviors, perceived relationships between asthma and obesity, facilitators to behavior change, and intervention preferences. Participatory design sessions and usability testing are expected to conclude in late 2019. Conclusions: Outcomes from this study are expected to include an mHealth app designed with direct participation from the target audience and usability data from stakeholders as well as potential end users. International Registered Report Identifier (IRRID): DERR1-10.2196/13549 %M 31237240 %R 10.2196/13549 %U http://www.researchprotocols.org/2019/6/e13549/ %U https://doi.org/10.2196/13549 %U http://www.ncbi.nlm.nih.gov/pubmed/31237240 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13084 %T Validity Evaluation of the Fitbit Charge2 and the Garmin vivosmart HR+ in Free-Living Environments in an Older Adult Cohort %A Tedesco,Salvatore %A Sica,Marco %A Ancillao,Andrea %A Timmons,Suzanne %A Barton,John %A O'Flynn,Brendan %+ Tyndall National Institute, University College Cork, Lee Maltings, Prospect Row, Cork, T12R5CP, Ireland, 353 212346286, salvatore.tedesco@tyndall.ie %K aging %K fitness trackers %K wristbands %K older adults %K wearable activity trackers %K Fitbit %K Garmin %K energy expenditure %K physical activity %K sleep %D 2019 %7 19.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Few studies have investigated the validity of mainstream wrist-based activity trackers in healthy older adults in real life, as opposed to laboratory settings. Objective: This study explored the performance of two wrist-worn trackers (Fitbit Charge 2 and Garmin vivosmart HR+) in estimating steps, energy expenditure, moderate-to-vigorous physical activity (MVPA) levels, and sleep parameters (total sleep time [TST] and wake after sleep onset [WASO]) against gold-standard technologies in a cohort of healthy older adults in a free-living environment. Methods: Overall, 20 participants (>65 years) took part in the study. The devices were worn by the participants for 24 hours, and the results were compared against validated technology (ActiGraph and New-Lifestyles NL-2000i). Mean error, mean percentage error (MPE), mean absolute percentage error (MAPE), intraclass correlation (ICC), and Bland-Altman plots were computed for all the parameters considered. Results: For step counting, all trackers were highly correlated with one another (ICCs>0.89). Although the Fitbit tended to overcount steps (MPE=12.36%), the Garmin and ActiGraph undercounted (MPE 9.36% and 11.53%, respectively). The Garmin had poor ICC values when energy expenditure was compared against the criterion. The Fitbit had moderate-to-good ICCs in comparison to the other activity trackers, and showed the best results (MAPE=12.25%), although it underestimated calories burned. For MVPA levels estimation, the wristband trackers were highly correlated (ICC=0.96); however, they were moderately correlated against the criterion and they overestimated MVPA activity minutes. For the sleep parameters, the ICCs were poor for all cases, except when comparing the Fitbit with the criterion, which showed moderate agreement. The TST was slightly overestimated with the Fitbit, although it provided good results with an average MAPE equal to 10.13%. Conversely, WASO estimation was poorer and was overestimated by the Fitbit but underestimated by the Garmin. Again, the Fitbit was the most accurate, with an average MAPE of 49.7%. Conclusions: The tested well-known devices could be adopted to estimate steps, energy expenditure, and sleep duration with an acceptable level of accuracy in the population of interest, although clinicians should be cautious in considering other parameters for clinical and research purposes. %M 31219048 %R 10.2196/13084 %U https://mhealth.jmir.org/2019/6/e13084/ %U https://doi.org/10.2196/13084 %U http://www.ncbi.nlm.nih.gov/pubmed/31219048 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e14239 %T Understanding the Role of Healthy Eating and Fitness Mobile Apps in the Formation of Maladaptive Eating and Exercise Behaviors in Young People %A Honary,Mahsa %A Bell,Beth T %A Clinch,Sarah %A Wild,Sarah E %A McNaney,Roisin %+ School of Computing and Communications, Lancaster University, InfoLab21, Lancaster, LA1 4WA, United Kingdom, 44 1524 593566, m.honary@lancaster.ac.uk %K weight loss %K mobile apps %K eating disorders %K body image diet %K exercise %K mental health %D 2019 %7 18.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Healthy eating and fitness mobile apps are designed to promote healthier living. However, for young people, body dissatisfaction is commonplace, and these types of apps can become a source of maladaptive eating and exercise behaviors. Furthermore, such apps are designed to promote continuous engagement, potentially fostering compulsive behaviors. Objective: The aim of this study was to identify potential risks around healthy eating and fitness app use and negative experience and behavior formation among young people and to inform the understanding around how current commercial healthy eating and fitness apps on the market may, or may not, be exasperating such behaviors. Methods: Our research was conducted in 2 phases. Through a survey (n=106) and 2 workshops (n=8), we gained an understanding of young people’s perceptions of healthy eating and fitness apps and any potential harm that their use might have; we then explored these further through interviews with experts (n=3) in eating disorder and body image. Using insights drawn from this initial phase, we then explored the degree to which leading apps are preventing, or indeed contributing to, the formation of maladaptive eating and exercise behaviors. We conducted a review of the top 100 healthy eating and fitness apps on the Google Play Store to find out whether or not apps on the market have the potential to elicit maladaptive eating and exercise behaviors. Results: Participants were aged between 18 and 25 years and had current or past experience of using healthy eating and fitness apps. Almost half of our survey participants indicated that they had experienced some form of negative experiences and behaviors through their app use. Our findings indicate a wide range of concerns around the wider impact of healthy eating and fitness apps on individuals at risk of maladaptive eating and exercise behavior, including (1) guilt formation because of the nature of persuasive models, (2) social isolation as a result of personal regimens around diet and fitness goals, (3) fear of receiving negative responses when targets are not achieved, and (4) feelings of being controlled by the app. The app review identified logging functionalities available across the apps that are used to promote the sustained use of the app. However, a significant number of these functionalities were seen to have the potential to cause negative experiences and behaviors. Conclusions: In this study, we offer a set of responsibility guidelines for future researchers, designers, and developers of digital technologies aiming to support healthy eating and fitness behaviors. Our study highlights the necessity for careful considerations around the design of apps that promote weight loss or body modification through fitness training, especially when they are used by young people who are vulnerable to the development of poor body image and maladaptive eating and exercise behaviors. %M 31215514 %R 10.2196/14239 %U http://mhealth.jmir.org/2019/6/e14239/ %U https://doi.org/10.2196/14239 %U http://www.ncbi.nlm.nih.gov/pubmed/31215514 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13381 %T Feedback on Physical Activity Through a Wearable Device Connected to a Mobile Phone App in Patients With Metabolic Syndrome: Pilot Study %A Huh,Up %A Tak,Young Jin %A Song,Seunghwan %A Chung,Sung Woon %A Sung,Sang Min %A Lee,Chung Won %A Bae,Miju %A Ahn,Hyo Young %+ Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, 179 Gudeok-Ro, Seo-gu, Busan, 49241, Republic of Korea, 82 51 240 7267, song77.sh@gmail.com %K electronic activity monitor %K wearable devices %K metabolic syndrome %K physical activity %D 2019 %7 18.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Little is known of the effect of wearable devices on metabolic impairments in clinical settings. We hypothesized that a wearable device that can monitor and provide feedback on physical activity may help resolve metabolic syndrome. Objective: This study aimed to examine the objective effects of the use of these devices on metabolic syndrome resolution. Methods: Patients diagnosed with metabolic syndrome were recruited. Participants were prescribed regular walking using a wearable device (Coffee WALKIE +Dv.3, GC Healthcare CI, Korea) on their wrist for 12 weeks. Participants received self-feedback on the amount of their exercise through an app on their mobile phone. The information on physical activities of the participants was uploaded automatically to a website. Thus, a trained nurse could provide individuals with feedback regarding the physical activity via telephone consultation on alternate weeks. Blood pressure (BP), body composition, fasting plasma glucose, and lipid profiles were recorded. The primary outcome was metabolic syndrome resolution. The secondary outcome was an improvement in the components of metabolic impairment. Results: Of the 53 participants recruited, 20 participants with a median age of 46 (range 36-50) years completed the trial. There was no significant difference in the amount of calorie expenditure at weeks 4, 8, and 12. After 12 weeks, metabolic syndrome was resolved in 9 of 20 participants (45%), and the mean number of metabolic impairment components per person decreased from 3.4 to 2.9. Particularly, the mean systolic and diastolic BP decreased from mean 136.6 (SD 18.5) mm Hg to mean 127.4 (SD 19.5) mm Hg and from mean 84.0 (SD 8.1) mm Hg to mean 77.4 (SD 14.4) mm Hg (both P=.02), respectively. Conclusions: This study found that a 12-week intervention via feedback, based on a wearable physical activity monitor, helped metabolic syndrome patients to be more engaged in regular walking and it improved impaired metabolic components, especially in BP. However, some practical challenges regarding patients’ adherence and sustained engagement were observed. %M 31215513 %R 10.2196/13381 %U http://mhealth.jmir.org/2019/6/e13381/ %U https://doi.org/10.2196/13381 %U http://www.ncbi.nlm.nih.gov/pubmed/31215513 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e12631 %T Understanding the Use of Smartphone Apps for Health Information Among Pregnant Chinese Women: Mixed Methods Study %A Wang,Na %A Deng,Zequn %A Wen,Li Ming %A Ding,Yan %A He,Gengsheng %+ Department of Nutrition and Food Hygiene, School of Public Health, Fudan University, No. 130 Dongan Road, Shanghai, 200032, China, 86 21 54237229, gshe@shmu.edu.cn %K mobile applications %K pregnancy %K consumer health information %K health promotion %D 2019 %7 18.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hospital-based health promotion resources to assist pregnant women in adopting a healthy lifestyle and optimizing gestational weight gain are important, but with limited effects. Increasingly, women are using mobile apps to access health information during the antenatal period. Objective: The aims of the study were to investigate app-usage by Chinese women during pregnancy and to gain a better understanding of their views and attitudes toward apps containing health information. Methods: A mixed methods study design was applied. Study participants were recruited from 2 maternity hospitals in Shanghai, China, between March and July 2018. A self-administered Web-based survey was conducted with 535 pregnant Chinese women on their sources of health information and reasons for using apps during pregnancy. A total of 4 semistructured focus groups were also conducted with the pregnant women (n=28). Results: The use of pregnancy-related apps and the internet was common among the respondents. Almost half of the women had used pregnancy-related apps. Specifically, the use of apps for health information declined as pregnancy progressed from 70% (35/50) in the first trimester to 41.3% (143/346) in the third trimester. The main reason for using an app was to monitor fetal development (436/535, 81.5%), followed by learning about nutrition and recording diet in pregnancy (140/535, 26.2%). The women found that the apps were useful and convenient and can support lifestyle modifications during pregnancy. However, some apps also contained misinformation or incorrect information that could cause anxiety as reported by the participants. Many women expressed the need for developing an app containing evidence-based, well-informed, and tailored health information to support them during pregnancy. Conclusions: The study suggests that apps were widely used by many Chinese women during pregnancy to monitor fetal development, to obtain diet and physical activity information, and to track their body changes. The women highly appreciated the evidence-based information, expert opinions, and tailored advice available on apps. Smartphone apps have the potential to deliver health information for pregnant women. %M 31215516 %R 10.2196/12631 %U http://mhealth.jmir.org/2019/6/e12631/ %U https://doi.org/10.2196/12631 %U http://www.ncbi.nlm.nih.gov/pubmed/31215516 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e13378 %T A Web-Based Mobile App With a Smartwatch to Support Social Engagement in Persons With Memory Loss: Pilot Randomized Controlled Trial %A McCarron,Hayley R %A Zmora,Rachel %A Gaugler,Joseph E %+ Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, D351 Mayo, 425 Delaware Street SE, Minneapolis, MN,, United States, 1 612 626 9552, mccar988@umn.edu %K Alzheimer disease %K dementia %K social support %K quality of life %K well-being %K technology %K social engagement %K facial recognition %K smartwatch %D 2019 %7 18.06.2019 %9 Original Paper %J JMIR Aging %G English %X Background: It is estimated that the number of individuals living with dementia worldwide will increase from 50 million in 2017 to 152 million by 2050. Assistive technology has been recognized as a promising tool to improve the lives of persons living with memory loss and their caregivers. The use of assistive technology in dementia care is expanding, although it is most often intended to manage care and promote safety. There is a lack of assistive technology designed to aid persons with memory loss in participating in meaningful activities. The Social Support Aid (SSA) is a mobile phone-based app that employs facial recognition software. It was designed to assist persons with memory loss remember the names and relationships of the people they interact with to promote social engagement. Objective: This study uses a pilot randomized controlled trial (RCT) design to evaluate the SSA. The objectives were to ascertain (1) the feasibility and utility of the SSA, (2) whether the outcomes of SSA use suggest potential benefits for persons living with memory loss and their care partners, and (3) how study design components could inform subsequent RCTs. Methods: Persons with memory loss were randomized to the SSA (n=20) or the usual care control group (n=28). Quantitative data were collected at three timepoints (baseline, 3 months, and 6 months). Participants in the intervention group participated in qualitative interviews following completion of their 6-month survey. Results: Participant eligibility, willingness to be randomized, and retention were not barriers to conducting a full-scale RCT; however, recruitment strategies should be addressed before doing so. Feasibility and utility scores indicated that participants felt neutral about the technology. Use of the SSA was not significantly associated with changes in quality of social interactions or quality of life measures over the 6 months of follow-up (P>.05). The qualitative analysis revealed three themes that described how and why the SSA worked or not: (1) outcomes, (2) reasons why it was or was not useful, and (3) recommendations. Conclusions: There is a need to develop effective assistive technology that improves the quality of life of persons with memory loss. Assistive technology that allows persons living with memory loss to maintain some level of autonomy should be a priority for future research. This study suggests reasons why the SSA facial recognition software did not appear to improve the quality of social interaction and quality of life of people with memory loss. Results also provide recommendations for future assistive technology development and evaluation. Trial Registration: ClinicalTrials.gov NCT03645694; https://clinicaltrials.gov/ct2/show/NCT03645694 (Archived by WebCite at http://www.webcitation.org/78dcVZIqq) %M 31518270 %R 10.2196/13378 %U http://aging.jmir.org/2019/1/e13378/ %U https://doi.org/10.2196/13378 %U http://www.ncbi.nlm.nih.gov/pubmed/31518270 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13327 %T Estimating Maximal Oxygen Uptake From Daily Activity Data Measured by a Watch-Type Fitness Tracker: Cross-Sectional Study %A Kwon,Soon Bin %A Ahn,Joong Woo %A Lee,Seung Min %A Lee,Joonnyong %A Lee,Dongheon %A Hong,Jeeyoung %A Kim,Hee Chan %A Yoon,Hyung-Jin %+ Interdisciplinary Program in Bioengineering, Seoul National University, 103 Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea, 82 2 740 8596, hjyoon@snu.ac.kr %K cardiorespiratory fitness %K oxygen consumption %K fitness tracker %D 2019 %7 13.6.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cardiorespiratory fitness (CRF), an important index of physical fitness, is the ability to inhale and provide oxygen to the exercising muscle. However, despite its importance, the current gold standard for measuring CRF is impractical, requiring maximal exercise from the participants. Objective: This study aimed to develop a convenient and practical estimation model for CRF using data collected from daily life with a wristwatch-type device. Methods: A total of 191 subjects, aged 20 to 65 years, participated in this study. Maximal oxygen uptake (VO2 max), a standard measure of CRF, was measured with a maximal exercise test. Heart rate (HR) and physical activity data were collected using a commercial wristwatch-type fitness tracker (Fitbit; Fitbit Charge; Fitbit) for 3 consecutive days. Maximal activity energy expenditure (aEEmax) and slope between HR and physical activity were calculated using a linear regression. A VO2 max estimation model was built using multiple linear regression with data on age, sex, height, percent body fat, aEEmax, and the slope. The result was validated with 2 different cross-validation methods. Results: aEEmax showed a moderate correlation with VO2 max (r=0.50). The correlation coefficient for the multiple linear regression model was 0.81, and the SE of estimate (SEE) was 3.518 mL/kg/min. The regression model was cross-validated through the predicted residual error sum of square (PRESS). The PRESS correlation coefficient was 0.79, and the PRESS SEE was 3.667 mL/kg/min. The model was further validated by dividing it into different subgroups and calculating the constant error (CE) where a low CE showed that the model does not significantly overestimate or underestimate VO2 max. Conclusions: This study proposes a CRF estimation method using data collected by a wristwatch-type fitness tracker without any specific protocol for a wide range of the population. %M 31199336 %R 10.2196/13327 %U https://mhealth.jmir.org/2019/6/e13327/ %U https://doi.org/10.2196/13327 %U http://www.ncbi.nlm.nih.gov/pubmed/31199336 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13256 %T Development of a Mobile Health Intervention to Promote Papanicolaou Tests and Human Papillomavirus Vaccination in an Underserved Immigrant Population: A Culturally Targeted and Individually Tailored Text Messaging Approach %A Lee,Hee Yun %A Lee,Mi Hwa %A Sharratt,Monica %A Lee,Sohye %A Blaes,Anne %+ School of Social Work, The University of Alabama, 1022 Little Hall Box 870314, Tuscaloosa, AL, 35401, United States, 1 205 348 6553, hlee94@ua.edu %K uterine cervical cancer %K papanicolaou test %K papillomavirus infections %K papillomavirus vaccines %K text messaging %K Asian American %K immigrants %D 2019 %7 6.6.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Disparities in cervical cancer incidence and mortality signify the need for intervention efforts targeting Korean American immigrant women. Objective: The purpose of this study was to demonstrate how a culturally targeted and tailored mobile text messaging intervention, mobile screening (mScreening), was developed to promote the uptake of Papanicolaou tests and human papillomavirus vaccine among young Korean American immigrant women. Methods: Guided by the Fogg behavior model, the mScreening intervention was developed through a series of focus groups. Braun and Clarke’s thematic analysis was used to identify core themes. Results: Overall, 4 themes were identified: (1) tailored message content (ie, basic knowledge about cervical cancer), (2) an interactive and visual message format (ie, age-appropriate and friendly messages using emoticons), (3) brief message delivery formats to promote participant engagement, and (4) use of an incentive to motivate participation (ie, gift cards). Conclusions: This study demonstrated the processes of gathering culturally relevant information to develop a mobile phone text messaging intervention and incorporating the target population’s perspectives into the development of the intervention. The findings of the study could help guide future intervention development targeting different types of cancer screening in other underserved racial or ethnic groups. %M 31199340 %R 10.2196/13256 %U https://mhealth.jmir.org/2019/6/e13256/ %U https://doi.org/10.2196/13256 %U http://www.ncbi.nlm.nih.gov/pubmed/31199340 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e11917 %T Weight Loss Following Use of a Smartphone Food Photo Feature: Retrospective Cohort Study %A Ben Neriah,Daniela %A Geliebter,Allan %+ Institute of Human Nutrition, Columbia University, 630 W 168th St #1512, New York, NY, 10032, United States, 1 2125234000, d.benneriah@caa.columbia.edu %K food intake %K digital photography %K app tracking %K dietary assessment %K free-living %D 2019 %7 29.5.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Tracking of dietary intake is key to enhancing weight loss. Mobile apps may be useful for tracking food intake and can provide feedback about calories and nutritional value. Recent technological developments have enabled image recognition to identify foods and track food intake. Objective: We aimed to determine the effectiveness of using photography as a feature of a smartphone weight loss app to track food intake in adults who were overweight or obese. Methods: We analyzed data from individuals (age, 18-65 years; body mass index≥25 kg/m2; ≥4 days of logged food intake; and ≥2 weigh-ins) who used a mobile-based weight loss app. In a retrospective study, we compared those who used the photo feature (n=9871) and those who did not use the feature (n=113,916). Linear regression analyses were used to assess use of the photo feature in relation to percent weight loss. Results: Weight loss was greater in the group using the photo feature (Δ=0.14%; 95% CI 0.06-0.22; P<.001). The photo feature group used the weight loss app for a longer duration (+3.5 days; 95% CI 2.61-4.37; P<.001) and logged their food intake on more days (+6.1 days; 95% CI 5.40-6.77; P<.001) than the nonusers. Mediation analysis showed that the weight loss effect was absent when controlling for either duration or number of logged days in the program. Conclusions: This study was the first to examine the effect of a food photo feature to track food intake on weight loss in a free-living setting. Use of photo recognition was associated with greater weight loss, which was mediated by the duration of app use and number of logged days in the program. %M 31199300 %R 10.2196/11917 %U https://mhealth.jmir.org/2019/6/e11917/ %U https://doi.org/10.2196/11917 %U http://www.ncbi.nlm.nih.gov/pubmed/31199300 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13301 %T Using Stakeholder Values to Promote Implementation of an Evidence-Based Mobile Health Intervention for Addiction Treatment in Primary Care Settings %A Quanbeck,Andrew %+ Department of Family Medicine and Community Health, University of Wisconsin-Madison, 800 University Bay Drive, Madison, WI, 53705, United States, 1 608 609 7308, arquanbe@wisc.edu %K implementation models %K implementation strategies %K mHealth %K behavioral economics %K game theory %K decision-framing %K primary care %K stakeholder engagement %D 2019 %7 07.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Most evidence-based practices (EBPs) do not find their way into clinical use, including evidence-based mobile health (mHealth) technologies. The literature offers implementers little practical guidance for successfully integrating mHealth into health care systems. Objective: The goal of this research was to describe a novel decision-framing model that gives implementers a method of eliciting the considerations of different stakeholder groups when they decide whether to implement an EBP. Methods: The decision-framing model can be generally applied to EBPs, but was applied in this case to an mHealth system (Seva) for patients with addiction. The model builds from key insights in behavioral economics and game theory. The model systematically identifies, using an inductive process, the perceived gains and losses of different stakeholder groups when they consider adopting a new intervention. The model was constructed retrospectively in a parent implementation research trial that introduced Seva to 268 patients in 3 US primary care clinics. Individual and group interviews were conducted to elicit stakeholder considerations from 6 clinic managers, 17 clinicians, and 6 patients who were involved in implementing Seva. Considerations were used to construct decision frames that trade off the perceived value of adopting Seva versus maintaining the status quo from each stakeholder group’s perspective. The face validity of the decision-framing model was assessed by soliciting feedback from the stakeholders whose input was used to build it. Results: Primary considerations related to implementing Seva were identified for each stakeholder group. Clinic managers perceived the greatest potential gain to be better care for patients and the greatest potential loss to be cost (ie, staff time, sustainability, and opportunity cost to implement Seva). All clinical staff considered time their foremost consideration—primarily in negative terms (eg, cognitive burden associated with learning a new system) but potentially in positive terms (eg, if Seva could automate functions done manually). Patients considered safety (anonymity, privacy, and coming from a trusted source) to be paramount. Though payers were not interviewed directly, clinic managers judged cost to be most important to payers—whether Seva could reduce total care costs or had reimbursement mechanisms available. This model will be tested prospectively in a forthcoming mHealth implementation trial for its ability to predict mHealth adoption. Overall, the results suggest that implementers proactively address the cost and burden of implementation and seek to promote long-term sustainability. Conclusions: This paper presents a model implementers may use to elicit stakeholders’ considerations when deciding to adopt a new technology, considerations that may then be used to adapt the intervention and tailor implementation, potentially increasing the likelihood of implementation success. Trial Registration: ClinicalTrials.gov NCT01963234; https://clinicaltrials.gov/ct2/show/NCT01963234 (Archived by WebCite at http://www.webcitation.org/78qXQJvVI) %M 31237841 %R 10.2196/13301 %U http://mhealth.jmir.org/2019/6/e13301/ %U https://doi.org/10.2196/13301 %U http://www.ncbi.nlm.nih.gov/pubmed/31237841 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13162 %T SmokefreeTXT for Homeless Smokers: Pilot Randomized Controlled Trial %A Baggett,Travis P %A McGlave,Claire %A Kruse,Gina R %A Yaqubi,Awesta %A Chang,Yuchiao %A Rigotti,Nancy A %+ Tobacco Research and Treatment Center, Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA, 02114, United States, 1 617 643 9314, tbaggett@mgh.harvard.edu %K homeless persons %K cigarette smoking %K smoking cessation %K text messaging %D 2019 %7 04.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Homeless smokers want to quit smoking but face numerous barriers to doing so, including pervasive smoking among peers and a lack of social support for quitting. An SMS (short message service) text messaging intervention could address these challenges by providing virtual daily support for homeless smokers who are trying to quit but coping with multiple triggers to smoke. Objective: This study aimed to assess whether a free SMS text messaging program, added to evidence-based pharmacotherapy and counseling, improved smoking abstinence among homeless adult smokers. Methods: From October 2015 to June 2016, we conducted an 8-week pilot randomized controlled trial (RCT) of nicotine patch therapy and weekly in-person counseling with (n=25) or without (n=25) SmokefreeTXT, a free SMS text messaging service administered by the National Cancer Institute (NCI) at Boston Health Care for the Homeless Program. All participants were provided with a mobile phone and a 2-month prepaid voice and text plan at no cost. SmokefreeTXT enrollees were sent 1 to 5 automated SMS text messages daily for up to 8 weeks and could receive on-demand tips for managing cravings, mood symptoms, and smoking lapses. The primary outcome was smoking abstinence, defined as an exhaled carbon monoxide count of <8 parts per million, assessed 14 times over 8 weeks of follow-up, and analyzed using repeated-measures logistic regression with generalized estimating equations. Other outcomes were use of SmokefreeTXT, assessed by data obtained from NCI; perceptions of SmokefreeTXT, assessed by surveys and qualitative interviews; and mobile phone retention, assessed by self-report. Results: Of the SmokefreeTXT arm participants (n=25), 88% (22) enrolled in the program, but only 56% (14) had confirmed enrollment for ≥2 weeks. Among 2-week enrollees, the median response rate to interactive messages from SmokefreeTXT was 2.1% (interquartile range 0-10.5%). Across all time points, smoking abstinence did not differ significantly between SmokefreeTXT and control arm participants (odds ratio 0.92, 95% CI 0.30-2.84). Of SmokefreeTXT enrollees who completed exit surveys (n=15), two-thirds were very or extremely satisfied with the program. However, qualitative interviews (n=14) revealed that many participants preferred in-person intervention formats over phone-based, found the SMS text messages impersonal and robotic, and felt that the messages were too frequent and repetitive. Only 40% (10/25) of SmokefreeTXT arm participants retained their study-supplied mobile phone for the 8-week duration of the trial, with phone theft being common. Storing and charging phones were cited as challenges. Conclusions: SmokefreeTXT, added to nicotine patch therapy and in-person counseling, did not significantly improve smoking abstinence in this 8-week pilot RCT for homeless smokers. SMS text messaging interventions for this population should be better tuned to the unique circumstances of homelessness and coupled with efforts to promote mobile phone retention over time. Trial Registration: ClinicalTrials.gov NCT02565381; https://clinicaltrials.gov/ct2/show/NCT02565381 (Archived by WebCite at http://www.webcitation.org/78PLpDptZ) %M 31165717 %R 10.2196/13162 %U https://mhealth.jmir.org/2019/6/e13162/ %U https://doi.org/10.2196/13162 %U http://www.ncbi.nlm.nih.gov/pubmed/31165717 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e11677 %T A Feasibility Trial of Power Up: Smartphone App to Support Patient Activation and Shared Decision Making for Mental Health in Young People %A Edbrooke-Childs,Julian %A Edridge,Chloe %A Averill,Phoebe %A Delane,Louise %A Hollis,Chris %A Craven,Michael P %A Martin,Kate %A Feltham,Amy %A Jeremy,Grace %A Deighton,Jessica %A Wolpert,Miranda %+ Evidence Based Practice Unit, University College London and the Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, Gower Street, London, WC1E 6BT, United Kingdom, 44 (0) 20 7794 2313, julian.edbrooke-childs@annafreud.org %K telemedicine %K patient participation %K mental health %K adolescent %D 2019 %7 04.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital tools have the potential to support patient activation and shared decision making in the face of increasing levels of mental health problems in young people. There is a need for feasibility trials of digital interventions to determine the usage and acceptability of interventions. In addition, there is a need to determine the ability to recruit and retain research participants to plan rigorous effectiveness trials and, therefore, develop evidence-based recommendations for practice. Objective: This study aimed to determine the feasibility of undertaking a cluster randomized controlled trial to test the effectiveness of a smartphone app, Power Up, co-designed with young people to support patient activation and shared decision making for mental health. Methods: Overall, 270 young people were screened for participation and 52.5% (142/270) were recruited and completed baseline measures across 8 specialist child mental health services (n=62, mean age 14.66 (SD 1.99) year; 52% [32/62] female) and 2 mainstream secondary schools (n=80; mean age 16.88 [SD 0.68] years; 46% [37/80] female). Young people received Power Up in addition to management as usual or received management as usual only. Posttrial interviews were conducted with 11 young people from the intervention arms (specialist services n=6; schools n=5). Results: Usage data showed that there were an estimated 50 (out of 64) users of Power Up in the intervention arms. Findings from the interviews indicated that young people found Power Up to be acceptable. Young people reported (1) their motivation for use of Power Up, (2) the impact of use, and (3) barriers to use. Out of the 142 recruited participants, 45.0% (64/142) completed follow-up measures, and the approaches to increase retention agreed by the steering group are discussed. Conclusions: The findings of this study indicate that the app is acceptable, and it is feasible to examine the effectiveness of Power Up in a prospective cluster randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT02552797; https://clinicaltrials.gov/ct2/show/NCT02552797 (Archived by WebCite at http://www.webcitation.org/6td6MINP0) %M 31165709 %R 10.2196/11677 %U https://mhealth.jmir.org/2019/6/e11677/ %U https://doi.org/10.2196/11677 %U http://www.ncbi.nlm.nih.gov/pubmed/31165709 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e13689 %T The Effectiveness of an App-Based Nurse-Moderated Program for New Mothers With Depression and Parenting Problems (eMums Plus): Pragmatic Randomized Controlled Trial %A Sawyer,Alyssa %A Kaim,Amy %A Le,Huynh-Nhu %A McDonald,Denise %A Mittinty,Murthy %A Lynch,John %A Sawyer,Michael %+ School of Public Health, University of Adelaide, Adelaide Health & Medical Sciences Building, 57 North Terrace, Mail Drop DX 650 550, Adelaide, 5005, Australia, 61 8 81617207, alyssa.sawyer@adelaide.edu.au %K mobile phone %K infant %K mother-child relations %K postnatal depression %K randomized controlled trial %D 2019 %7 04.06.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Postnatal depression and caregiving difficulties adversely affect mothers, infants, and later childhood development. In many countries, resources to help mothers and infants are limited. Online group–based nurse-led interventions have the potential to help address this problem by providing large numbers of mothers with access to professional and peer support during the postnatal period. Objective: This study tested the effectiveness of a 4-month online group–based nurse-led intervention delivered when infants were aged 2 to 6 months as compared with standard care outcomes. Methods: The study was a block randomized control trial. Mothers were recruited at the time they were contacted for the postnatal health check offered to all mothers in South Australia. Those who agreed to participate were randomly assigned to the intervention or standard care. The overall response rate was 63.3% (133/210). Primary outcomes were the level of maternal depressive symptoms assessed with the Edinburgh Postnatal Depression Scale (EPDS) and quality of maternal caregiving assessed using the Parenting Stress Index (PSI; competence and attachment subscales), the Parenting Sense of Competence Scale (PSCS), and the Nursing Child Assessment Satellite Training Scale. Assessments were completed at baseline (mean child age 4.9 weeks [SD 1.4]) and again when infants were aged 8 and 12 months. Results: Outcomes were evaluated using linear generalized estimating equations adjusting for postrandomization group differences in demographic characteristics and the outcome score at baseline. There were no significant differences in the intervention and standard care groups in scores on the PSI competence subscale (P=.69) nor in the PSCS (P=.11). Although the group by time interaction suggested there were differences over time between the EPDS and PSI attachment subscale scores in the intervention and standard care groups (P=.001 and P=.04, respectively), these arose largely because the intervention group had stable scores over time whereas the standard care group showed some improvements between baseline and 12 months. Mothers engaged well with the intervention with at least 60% (43/72) of mothers logging-in once per week during the first 11 weeks of the intervention. The majority of mothers also rated the intervention as helpful and user-friendly. Conclusions: Mothers reported that the intervention was helpful, and the app was described as easy to use. As such, it appears that support for mothers during the postnatal period, provided using mobile phone technology, has the potential to be an important addition to existing services. Possible explanations for the lack of differences in outcomes for the 2 groups in this study are the failure of many mothers to use key components of the intervention and residual differences between the intervention and standard care groups post randomization. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616001732471; http://www.ANZCTR.org.au/ACTRN12616001732471.aspx (archived on WebCite as http://www.webcitation.org/77zo30GDw) %M 31165715 %R 10.2196/13689 %U https://www.jmir.org/2019/6/e13689/ %U https://doi.org/10.2196/13689 %U http://www.ncbi.nlm.nih.gov/pubmed/31165715 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e12484 %T Characteristics of Adopters of an Online Social Networking Physical Activity Mobile Phone App: Cluster Analysis %A Sanders,Ilea %A Short,Camille E %A Bogomolova,Svetlana %A Stanford,Tyman %A Plotnikoff,Ronald %A Vandelanotte,Corneel %A Olds,Tim %A Edney,Sarah %A Ryan,Jillian %A Curtis,Rachel G %A Maher,Carol %+ Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide,, Australia, 61 8 8302 2315, carol.maher@unisa.edu.au %K k-medoid cluster analysis %K social marketing %K mobile phone app %K physical activity %K online social networking %D 2019 %7 03.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To date, many online health behavior programs developed by researchers have not been translated at scale. To inform translational efforts, health researchers must work with marketing experts to design cost-effective marketing campaigns. It is important to understand the characteristics of end users of a given health promotion program and identify key market segments. Objective: This study aimed to describe the characteristics of the adopters of Active Team, a gamified online social networking physical activity app, and identify potential market segments to inform future research translation efforts. Methods: Participants (N=545) were Australian adults aged 18 to 65 years who responded to general advertisements to join a randomized controlled trial (RCT) evaluating the Active Team app. At baseline they provided demographic (age, sex, education, marital status, body mass index, location of residence, and country of birth), behavioral (sleep, assessed by the Pittsburgh Quality Sleep Index) and physical activity (assessed by the Active Australia Survey), psychographic information (health and well-being, assessed by the PERMA [Positive Emotion, Engagement, Relationships, Meaning, Achievement] Profile; depression, anxiety and stress, assessed by the Depression, Anxiety, and Stress Scale [DASS-21]; and quality of life, assessed by the 12-Item Short Form Health Survey [SF-12]). Descriptive analyses and a k-medoids cluster analysis were performed using the software R 3.3.0 (The R Foundation) to identify key characteristics of the sample. Results: Cluster analyses revealed four clusters: (1) younger inactive women with poor well-being (218/545), characterized by a higher score on the DASS-21, low mental component summary score on the SF-12, and relatively young age; (2) older, active women (153/545), characterized by a lower score on DASS-21, a higher overall score on the SF-12, and relatively older age; (3) young, active but stressed men (58/545) with a higher score on DASS-21 and higher activity levels; and (4) older, low active and obese men (30/545), characterized by a high body mass index and lower activity levels. Conclusions: Understanding the characteristics of population segments attracted to a health promotion program will guide the development of cost-effective research translation campaigns. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12617000113358; https://www.anzctr.org .au/Trial/Registration/TrialReview.aspx?id=371463 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-017-4882-7 %M 31162130 %R 10.2196/12484 %U https://mhealth.jmir.org/2019/6/e12484/ %U https://doi.org/10.2196/12484 %U http://www.ncbi.nlm.nih.gov/pubmed/31162130 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e14386 %T Self-Administered Auricular Acupressure Integrated With a Smartphone App for Weight Reduction: Randomized Feasibility Trial %A Suen,Lorna %A Wang,Wenru %A Cheng,Kenneth King Yip %A Chua,Matthew Chin Heng %A Yeung,Jerry Wing Fai %A Koh,Wai Kin %A Yeung,Simon Kai Wang %A Ho,Janice Yuen Shan %+ School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong), 852 27667475, lorna.suen@polyu.edu.hk %K acupressure %K auriculotherapy %K overweight %K obesity %K smartphone %K leptin %K adiponectin %K randomized controlled trial %D 2019 %7 29.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obesity is a common global health problem and increases the risk of many chronic illnesses. Given the adverse effects of antiobesity agents and bariatric surgeries, the exploration of noninvasive and nonpharmacological complementary methods for weight reduction is warranted. Objective: The study aimed to determine whether self-administered auricular acupressure (AA) integrated with a smartphone app was more effective than using AA alone or the controls for weight reduction. Methods: This study is a 3-arm randomized waitlist-controlled feasibility trial. A total of 59 eligible participants were randomly divided into either group 1 (AA group, n=19), group 2 (AA plus smartphone app, n=19), or group 3 (waitlist control, n=21). A total of 6 reflective zones or acupoints for weight reduction were chosen. The smartphone app could send out daily messages to the subjects to remind them to perform self-pressing on the 6 ear acupoints. A “date picker” of the 8-week treatment course was used to enable the users to input the compliance of pressing and the number of bowel movement daily instead of using the booklet for recordings. The app also served as a reminder for the subjects regarding the dates for returning to the center for acupoint changing and assessments. Treatment was delivered 2 times a week, for 8 weeks. Generalized estimating equations were used to examine the interactions among the groups before and after intervention. Results: Subjects in group 2 expressed that the smartphone app was useful (7.41 out of 10). The most popular features were the daily reminders for performing self-pressing (88%), the ear diagram indicating the locations and functions of the 6 ear points (71%), and ear pressing method demonstrated in the video scripts (47%). Nearly 90% of the participants completed the 8-week intervention, with a high satisfaction toward the overall arrangement (8.37 out of 10). The subjects in group 1 and 2 achieved better therapeutic effects in terms of body weight, body mass index (BMI), waist circumference, and hip circumference and perceived more fullness before meals than the waitlist controls. Although no significant differences in the pairwise comparisons between the 2 groups were detected (P>.05), the decrease in body weight, BMI, body fat, visceral fat rating and leptin level, and increase in adiponectin level were notable in group 2 before and after the intervention. Conclusions: The high compliance rate and high satisfaction toward the trial arrangement indicate that AA can be used to achieve weight reduction and applied in future large-scale studies. AA integrated with the smartphone app has a more notable effect than using AA alone for weight reduction. Larger sample size should be considered in future trials to determine the causal relationship between treatment and effect. Trial Registration: ClinicalTrials.gov NCT03442712; https://clinicaltrials.gov/ct2/show/NCT03442712 (Archived by WebCite at http://www.webcitation.org/78L2tO8Ql) %M 31144666 %R 10.2196/14386 %U http://mhealth.jmir.org/2019/5/e14386/ %U https://doi.org/10.2196/14386 %U http://www.ncbi.nlm.nih.gov/pubmed/31144666 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e13153 %T The Use of Wireless, Smartphone App–Assisted Home Blood Pressure Monitoring Among Hypertensive Patients in Singapore: Pilot Randomized Controlled Trial %A Moon,Eui Whan %A Tan,Ngiap Chuan %A Allen,John Carson %A Jafar,Tazeen Hasan %+ Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore, 65 6601 2582, tazeen.jafar@duke-nus.edu.sg %K mHealth %K smartphone %K hypertension %K home blood pressure monitoring %K self blood pressure monitoring %K health informatics %K data collection methods %K personal health records %D 2019 %7 28.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Reliable home blood pressure monitoring (HBPM) is essential to effective hypertension management; however, manual recording is subject to underreporting and inaccuracies. Mobile health technologies hold great potential as HBPM tools, but the fidelity of a smartphone app in HBPM has not been adequately assessed. Objective: The primary aim of the trial was to compare the fidelity of a smartphone app to that of a handwritten logbook in making HBPM data available to clinicians at follow-up visits. Fidelity was defined as the percentage of scheduled blood pressure (BP) recordings over a 3-week period that were properly recorded and reported to the clinic. The secondary aims were to investigate patient factors associated with HBPM fidelity and to explore the effect of time on the fidelity. Methods: A 2-arm, parallel, unblinded, randomized controlled pilot trial was conducted in a government polyclinic in Singapore. Hypertensive adults, aged 40 to 70 years, who were on antihypertensive medication and owned a smartphone were recruited and randomized by a computer-generated randomization schedule to 3 weeks of either semiautomated HBPM utilizing a Bluetooth-enabled BP monitor and a smartphone app or a fully manual process utilizing a conventional handwritten logbook. The primary outcome was home BP recording fidelity. Results: Of the 80 patients randomized, 79 (smartphone app: 38 and logbook: 41) were included in the final analysis. Although fidelity was higher among the app users, it did not differ significantly between study arms (smartphone app: 66.7% and logbook: 52.4%; P=.21). Chinese and Indian ethnicities were associated with higher fidelity (absolute percent and 95% CI) by 35.6% (4.27 to 66.9) and 45.0% (8.69 to 81.3), respectively, in comparison with other ethnicities (P=.03); longer smartphone ownership increased fidelity on an average of 10.5% (0.83 to 20.2) per year (P=.03); the number of apps on the smartphone decreased fidelity at a rate of −0.32% (−0.58 to −0.05) per app (P=.02); years of hypertension morbidity increased fidelity at a rate of 1.56% (0.03 to 3.09) per year (P=.046); and the number of people working in the household decreased fidelity at a rate of −8.18% (−16.3 to −0.08) per additional working person (P=.048). The fidelity of the app was significantly higher in the first week (64.4%) than the second (55.1%, P=.001) and third (58.2%, P=.03) weeks of monitoring. Conclusions: Amid the increasing integration of health technologies into clinical practice, our study demonstrates the feasibility of smartphone app–assisted HBPM in hypertensive adults of Singapore. Our pilot study found no statistically significant difference in mean BP recording fidelity between a smartphone app and conventional handwritten logbook. However, the small sample size precludes definitive conclusions and highlights the need for a larger, adequately powered trial. Trial Registration: ClinicalTrials.gov NCT03209024; https://clinicaltrials.gov/ct2/show/NCT03209024 (Archived by WebCite at http://www.webcitation.org/78EVWBg0T) %M 30905872 %R 10.2196/13153 %U http://mhealth.jmir.org/2019/5/e13153/ %U https://doi.org/10.2196/13153 %U http://www.ncbi.nlm.nih.gov/pubmed/30905872 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e12293 %T Design and Implementation of a Novel System for Correcting Posture Through the Use of a Wearable Necklace Sensor %A Chung,Hung-Yuan %A Chung,Yao-Liang %A Liang,Chih-Yen %+ Department of Communications, Navigation and Control Engineering, National Taiwan Ocean University, No. 2, Beining Rd, Jhongjheng District, Keelung, 20224, Taiwan, 886 928738102, ylchung@email.ntou.edu.tw %K wearable sensing technology %K necklace %K posture correction %K image recognition %K internet of things %D 2019 %7 28.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To our knowledge, few studies have examined the use of wearable sensing devices to effectively integrate information communication technologies and apply them to health care issues (particularly those pertaining to posture correction). Objective: A novel system for posture correction involving the application of wearable sensing technology was developed in this study. The system was created with the aim of preventing the unconscious development of bad postures (as well as potential spinal diseases over the long term). Methods: The newly developed system consists of a combination of 3 subsystems, namely, a smart necklace, notebook computer, and smartphone. The notebook computer is enabled to use a depth camera to read the relevant data, to identify the skeletal structure and joint reference points of a user, and to compute calculations relating to those reference points, after which the computer then sends signals to the smart necklace to enable calibration of the smart necklace’s standard values (base values for posture assessment). The gravitational acceleration data of the user are collected and analyzed by a microprocessor unit-6050 sensor housed in the smart necklace when the smart necklace is worn, with those data being used by the smart necklace to determine the user’s body posture. When poor posture is detected by the smart necklace, the smart necklace sends the user’s smartphone a reminder to correct his or her posture; a mobile app that was also developed as part of the study allows the smart necklace to transmit such messages to the smartphone. Results: The system effectively enables a user to monitor and correct his or her own posture, which in turn will assist the user in preventing spine-related diseases and, consequently, in living a healthier life. Conclusions: The proposed system makes it possible for (1) the user to self-correct his or her posture without resorting to the use of heavy, thick, or uncomfortable corrective clothing; (2) the smart necklace’s standard values to be quickly calibrated via the use of posture imaging; and (3) the need for complex wiring to be eliminated through the effective application of the Internet of Things as well as by implementing wireless communication between the smart necklace, notebook computer, and smartphone. %M 31140439 %R 10.2196/12293 %U https://mhealth.jmir.org/2019/5/e12293/ %U https://doi.org/10.2196/12293 %U http://www.ncbi.nlm.nih.gov/pubmed/31140439 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e12691 %T Development of Comprehensive Personal Health Records Integrating Patient-Generated Health Data Directly From Samsung S-Health and Apple Health Apps: Retrospective Cross-Sectional Observational Study %A Jung,Se Young %A Kim,Jeong-Whun %A Hwang,Hee %A Lee,Keehyuck %A Baek,Rong-Min %A Lee,Ho-Young %A Yoo,Sooyoung %A Song,Wongeun %A Han,Jong Soo %+ Office of eHealth Research and Business, Seoul National University Bundang Hospital, 172 Dolma-ro, Bundang-gu, Seongnam-si, 13620, Republic of Korea, 82 31 787 0114, epilepsyguy@gmail.com %K personal health record %K patient generated health data %K lifelog %K electronic medical record %K mobile phone %D 2019 %7 28.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Patient-generated health data (PGHD), especially lifelog data, are important for managing chronic diseases. Additionally, personal health records (PHRs) have been considered an effective tool to engage patients more actively in the management of their chronic diseases. However, no PHRs currently integrate PGHD directly from Samsung S-Health and Apple Health apps. Objective: The purposes of this study were (1) to demonstrate the development of an electronic medical record (EMR)–tethered PHR system (Health4U) that integrates lifelog data from Samsung S-Health and Apple Health apps and (2) to explore the factors associated with the use rate of the functions. Methods: To upgrade conventional EMR-tethered PHRs, a task-force team (TFT) defined the functions necessary for users. After implementing a new system, we enrolled adults aged 19 years and older with prior experience of accessing Health4U in the 7-month period after November 2017, when the service was upgraded. Results: Of the 17,624 users, 215 (1.22%) integrated daily steps data, 175 (0.99%) integrated weight data, 51 (0.29%) integrated blood sugar data, and 90 (0.51%) integrated blood pressure data. Overall, 61.95% (10,919/17,624) had one or more chronic diseases. For integration of daily steps data, 48.3% (104/215) of patients used the Apple Health app, 43.3% (93/215) used the S-Health app, and 8.4% (18/215) entered data manually. To retrieve medical documentation, 324 (1.84%) users downloaded PDF files and 31 (0.18%) users integrated their medical records into the Samsung S-Health app via the Consolidated-Clinical Document Architecture download function. We found a consistent increase in the odds ratios for PDF downloads among patients with a higher number of chronic diseases. The age groups of ≥60 years and ≥80 years tended to use the download function less frequently than the others. Conclusions: This is the first study to examine the factors related to integration of lifelog data from Samsung S-Health and Apple Health apps into EMR-tethered PHRs and factors related to the retrieval of medical documents from PHRs. Our findings on the lifelog data integration can be used to design PHRs as a platform to integrate lifelog data in the future. %M 31140446 %R 10.2196/12691 %U http://mhealth.jmir.org/2019/5/e12691/ %U https://doi.org/10.2196/12691 %U http://www.ncbi.nlm.nih.gov/pubmed/31140446 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e10465 %T User Preferences and Persona Design for an mHealth Intervention to Support Adherence to Cardiovascular Disease Medication in Singapore: A Multi-Method Study %A Haldane,Victoria %A Koh,Joel Jun Kai %A Srivastava,Aastha %A Teo,Krichelle Wei Qi %A Tan,Yao Guo %A Cheng,Rui Xiang %A Yap,Yi Cheng %A Ong,Pei-Shi %A Van Dam,Rob M %A Foo,Jie Min %A Müller-Riemenschneider,Falk %A Koh,Gerald Choon-Huat %A Foong,Pin Sym %A Perel,Pablo %A Legido-Quigley,Helena %+ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, 4th Floor, Toronto, ON,, Canada, 1 416 978 4326, v.haldane@mail.utoronto.ca %K personas %K biopsychosocial personas %K qualitative %K ASCVD %K adherence %K patient perspectives %D 2019 %7 28.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of mobile health (mHealth) has gained popularity globally, including for its use in a variety of health interventions, particularly through short message service (SMS) text messaging. However, there are challenges to the use of mHealth, particularly among older users who have a large heterogeneity in usability and accessibility barriers when using technology. Objective: In order to better understand and conceptualize the diversity of users and give insight into their particular needs, we turned to persona creation. Personas are user archetypes created through data generated from multi-method inquiry with actual target users. Personas are an appropriate yet largely underutilized component of current mHealth research. Methods: Leveraging data from a multi-method study conducted in Singapore with an ethnically diverse population including Chinese, Malay, and Indian participants, we used a proforma to analyze data from the qualitative component (ie, 20 in-depth interviews) and quantitative component (ie, 100 interviewer-guided surveys). We then identified key characteristics, including technology use and preferences as well as adherence factors, to synthesize five personas reflective of persons over the age of 40 years in Singapore with atherosclerotic cardiovascular disease (ASCVD) or ASCVD risk factors, such as hypertension. Results: We present five personas typologized as (1) The Quiet Analog, (2) The Busy Grandparent, (3) The Socializer, (4) The Newly Diagnosed, and (5) The Hard-to-Reach. We report on four key characteristics: health care access, medication adherence, mobile phone technology usage (ie, ownership, access, and utilization), and interest in mHealth. Finally, we provide insights into how these personas may be used in the design and implementation of an mHealth intervention. Our work demonstrates how multi-method data can create biopsychosocial personas that can be used to explore and address the diversity in behaviors, preferences, and needs in user groups. Conclusions: With wider adoption of mHealth, it is important that we consider user-centered design techniques and design thinking in order to create meaningful, patient-centered interventions for adherence to medications. Future research in this area should include greater exploration of how these five personas can be used to better understand how and when is best to deliver mHealth interventions in Singapore and beyond. %M 31140445 %R 10.2196/10465 %U http://mhealth.jmir.org/2019/5/e10465/ %U https://doi.org/10.2196/10465 %U http://www.ncbi.nlm.nih.gov/pubmed/31140445 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e10923 %T The Twazon Arabic Weight Loss App: App-Based Intervention for Saudi Women With Obesity %A Alnasser,Aroub %A Kyle,Janet %A Aloumi,Najla %A Al-Khalifa,Abdulrahman %A Marais,Debbi %+ Food Science and Nutrition Dept, King Saud University, Riyadh,, Saudi Arabia, 966 118056476, aroub@ksu.edu.sa %K obesity %K weight loss %K mobile applications %K smartphone %K obesity management %K mHealth %D 2019 %7 28.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: By 2022, it is estimated that the rate of female obesity (78%) in Saudi Arabia will almost double that of males (41%). Despite being mainly attributed to poor diet, sedentary lifestyle, and a lack of health awareness, behavioral modification interventions are relatively new to the population; bariatric surgery continues to be the treatment of choice for comorbidities. However, neither pre nor postoperative diet and exercise are promoted. Evidence-informed mobile health (mHealth) weight loss apps and interventions may be an effective tool for delivering a culturally relevant intervention. Objective: This study aimed to determine the feasibility of a weight loss intervention that tests the effectiveness of Twazon, an originally designed Arabic weight-loss app that promotes lifestyle modification specific to Arab populations. Methods: A pre-post single‐arm pilot study was carried out among a sample of 240 overweight volunteer Saudi women residing in Riyadh, Saudi Arabia who used the Twazon app over a 4-month period. Anthropometric, diet, and physical activity measures were assessed 3 times: baseline, 2-months and 4-months; frequency of app use and system usability were evaluated during the 2 latter data collection periods. Repeated measures analysis of variance was used to identify changes over time. Results: A total of 40 participants completed the 4-month intervention with an attrition rate of 83%. An evaluation of the frequency of app use fostered 2 groups: engaged users (65%) and unengaged users (35%). At 4 months, the engaged users experienced more successful outcomes; body weight was lowered on average by 1.3 (SD 0.6) kg (P=.18), waist circumference (WC) was reduced by 4.9 (SD 1.1) cm (P<.001), and daily energy consumption was decreased by >600 calories (P=.002). Unengaged users experienced minor changes in body weight, WC, and reduced energy intake. Conclusions: The findings have demonstrated that engagement with the Twazon app renders positive changes in body weight, WC, and energy intake. mHealth weight loss apps and interventions have the potential to be effective in promoting weight loss and healthy lifestyle modification in Saudi Arabia and similar populations. %M 31140444 %R 10.2196/10923 %U http://mhealth.jmir.org/2019/5/e10923/ %U https://doi.org/10.2196/10923 %U http://www.ncbi.nlm.nih.gov/pubmed/31140444 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e12267 %T A Qualitative Evaluation of the Acceptability of a Tailored Smartphone Alcohol Intervention for a Military Population: Information About Drinking for Ex-Serving Personnel (InDEx) App %A Puddephatt,Jo-Anne %A Leightley,Daniel %A Palmer,Laura %A Jones,Norman %A Mahmoodi,Toktam %A Drummond,Colin %A Rona,Roberto J %A Fear,Nicola T %A Field,Matt %A Goodwin,Laura %+ Department of Psychological Sciences, Institute of Life and Human Sciences, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, United Kingdom, 44 151 794 1401, joannep@liverpool.ac.uk %K behavior %K alcohol drinking %K veterans %K interview %K smartphone %D 2019 %7 24.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Alcohol consumption in the UK Armed Forces is higher than in the general population, and this pattern continues after leaving the service. Smartphone apps may be useful to increase ex-serving personnel’s awareness of their alcohol consumption, support self-monitoring, and prompt a change in behavior. Objective: The study aimed to explore the acceptability of Information about Drinking in Ex-serving personnel (InDEx), a tailored smartphone app, combined with personalized short message service (SMS) text messaging designed to target ex-serving personnel who meet the criteria for hazardous alcohol use. Methods: The InDEx intervention included 4 key modules: (1) assessment and normative feedback, (2) self-monitoring and feedback, (3) goal setting and review, and (4) personalized SMS text messaging. A semistructured telephone interview study was conducted with ex-serving personnel after using the app for a 28-day period. Interviews were used to explore the acceptability of app modules and its functionality and the perceived changes in participant’s drinking. Interview transcripts were analyzed using inductive thematic analysis. Results: Overall, 94% (29/31) participants who used InDEx agreed to take part in a telephone interview. Overall, 4 themes were identified: Credibility, Meeting their needs, Simplicity, and Helpful for ex-serving personnel. The importance of credibility, functionality, and meeting the individual needs of ex-serving personnel was emphasized. Acceptability and engagement with specific modules of the app and text messages were influenced by the following: (1) if they felt it provided credible information, (2) whether the content was appropriately personalized to them, (3) the ease of use, and (4) beliefs about their own drinking behaviors. Participants recommended that the app would be most suitable for personnel about to leave the Armed Forces. Conclusions: InDEx was an acceptable smartphone app for ex-serving personnel for monitoring alcohol consumption and in providing meaningful feedback to the individual. Pages that met the participant’s interests and provided real time personalized, credible feedback on their drinking and text messages tailored to participant’s interactions with the app were particularly favored. %M 31127726 %R 10.2196/12267 %U http://mhealth.jmir.org/2019/5/e12267/ %U https://doi.org/10.2196/12267 %U http://www.ncbi.nlm.nih.gov/pubmed/31127726 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e13679 %T Who is Tracking Health on Mobile Devices: Behavioral Logfile Analysis in Hong Kong %A Guan,Lu %A Peng,Tai-Quan %A Zhu,Jonathan JH %+ Department of Communication, Michigan State University, 404 Wilson Road, East Lansing, MI, 48824, United States, 1 5173550221, winsonpeng@gmail.com %K mobile apps %K mHealth %K circadian rhythm %D 2019 %7 23.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health apps on mobile devices provide an unprecedented opportunity for ordinary people to develop social connections revolving around health issues. With increasing penetration of mobile devices and well-recorded behavioral data on such devices, it is desirable to employ digital traces on mobile devices rather than self-reported measures to capture the behavioral patterns underlying the use of mobile health (mHealth) apps in a more direct and valid way. Objective: The objectives of this study were to (1) assess the demographic predictors of the adoption of mHealth apps; (2) investigate the temporal pattern underlying the use of mHealth apps; and (3) explore the impacts of demographic variables, temporal features, and app genres on the use of mHealth apps. Methods: Logfile data of mobile devices were collected from a representative panel of about 2500 users in Hong Kong. Users’ mHealth app activities were analyzed. We first conducted a binary logistic regression analysis to uncover demographic predictors of users’ adoption status. Then we utilized a multilevel negative binomial regression to examine the impacts of demographic characteristics, temporal features, and app genres on mHealth app use. Results: It was found that 27.5% of mobile device users in Hong Kong adopt at least one genre of mHealth app. Adopters of mHealth apps tend to be female and better educated. However, demographic characteristics did not showcase the predictive powers on the use of mHealth apps, except for the gender effect (Bfemale vs Bmale=–0.18; P=.006). The use of mHealth apps demonstrates a significant temporal pattern, which is found to be moderately active during daytime and intensifying at weekends and at night. Such temporal patterns in mHealth apps use are moderated by individuals’ demographic characteristics. Finally, demographic characteristics were also found to condition the use of different genres of mHealth apps. Conclusions: Our findings suggest the importance of dynamic perspective in understanding users’ mHealth app activities. mHealth app developers should consider more the demographic differences in temporal patterns of mHealth apps in the development of mHealth apps. Furthermore, our research also contributes to the promotion of mHealth apps by emphasizing the differences of usage needs for various groups of users. %M 31120429 %R 10.2196/13679 %U http://mhealth.jmir.org/2019/5/e13679/ %U https://doi.org/10.2196/13679 %U http://www.ncbi.nlm.nih.gov/pubmed/31120429 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e13547 %T Automatic Identification of Physical Activity Type and Duration by Wearable Activity Trackers: A Validation Study %A Dorn,Diana %A Gorzelitz,Jessica %A Gangnon,Ronald %A Bell,David %A Koltyn,Kelli %A Cadmus-Bertram,Lisa %+ Department of Kinesiology, University of Wisconsin - Madison, 2000 Observatory Drive, Madison, WI, 53562, United States, 1 608 265 5946, cadmusbertra@wisc.edu %K fitness trackers %K exercise %K accelerometry %K data accuracy %D 2019 %7 23.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Activity trackers are now ubiquitous in certain populations, with potential applications for health promotion and monitoring and chronic disease management. Understanding the accuracy of this technology is critical to the appropriate and productive use of wearables in health research. Although other peer-reviewed validations have examined other features (eg, steps and heart rate), no published studies to date have addressed the accuracy of automatic activity type detection and duration accuracy in wearable trackers. Objective: The aim of this study was to examine the ability of 4 commercially available wearable activity trackers (Fitbits Flex 2, Fitbit Alta HR, Fitbit Charge 2, and Garmin Vívosmart HR), in a controlled setting, to correctly and automatically identify the type and duration of the physical activity being performed. Methods: A total of 8 activity types, including walking and running (on both a treadmill and outdoors), a run embedded in walking bouts, elliptical use, outdoor biking, and pool lap swimming, were tested by 28 to 34 healthy adult participants (69 total participants who participated in some to all activity types). Actual activity type and duration were recorded by study personnel and compared with tracker data using descriptive statistics and mean absolute percent error (MAPE). Results: The proportion of trials in which the activity type was correctly identified was 93% to 97% (depending on the tracker) for treadmill walking, 93% to 100% for treadmill running, 36% to 62% for treadmill running when preceded and followed by a walk, 97% to 100% for outdoor walking, 100% for outdoor running, 3% to 97% for using an elliptical, 44% to 97% for biking, and 87.5% for swimming. When activities were correctly identified, the MAPE of the detected duration versus the actual activity duration was between 7% and 7.9% for treadmill walking, 8.7% and 144.8% for treadmill running, 23.6% and 28.9% for treadmill running when preceded and followed by a walk, 4.9% and 11.8% for outdoor walking, 5.6% and 9.6% for outdoor running, 9.7% and 13% for using an elliptical, 9.5% and 17.7% for biking, and was 26.9% for swimming. Conclusions: In a controlled setting, wearable activity trackers provide accurate recognition of the type of some common physical activities, especially outdoor walking and running and walking on a treadmill. The accuracy of measurement of activity duration varied considerably by activity type and tracker model and was poor for complex sets of activity, such as a run embedded within 2 walking segments. %M 31124470 %R 10.2196/13547 %U http://mhealth.jmir.org/2019/5/e13547/ %U https://doi.org/10.2196/13547 %U http://www.ncbi.nlm.nih.gov/pubmed/31124470 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12276 %T Mobile Support for Older Adults and Their Caregivers: Dyad Usability Study %A Quinn,Charlene C %A Staub,Sheila %A Barr,Erik %A Gruber-Baldini,Ann %+ Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, 660 W Redwood St, HH 215, Baltimore, MD, 21201, United States, 1 4107062406, cquinn@som.umaryland.edu %K older adult %K caregiver %K mobile health %K patient engagement %D 2019 %7 23.05.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Evaluation of digital health applications to support older adults’ independence and family caregiving is needed. Digital health is increasingly providing opportunities for older adults and their family caregivers to educate, engage, and share health information across digital platforms. Few apps have documented evidence of usability by older adults and their caregivers. Objective: The objective of this study was to determine the usability of a mobile app in a community-based older adult population aged ≥65 years. The app was designed to improve engagement of the patient-informal caregiver team. Methods: This observational usability study was conducted in participants’ homes and independent living facilities in Baltimore, Maryland. Community-dwelling older adults aged ≥65 years and their caregivers enrolled as a dyad (n=24, 12 dyads). The usability evaluation was a mobile and Web-based app that allowed older adult users to record social and health information and share this information with their caregivers. The older adult-caregiver dyad downloaded the app to a smart phone or accessed the Web version, participated in training and onboarding, and used the app for a 1-month period. Participants responded to weekly surveys sent by app push notifications and to the usability and satisfaction surveys at the end of the study. Participant satisfaction and usability were assessed using the Modified Mobile Application Rating Scale (M-MARS) and the System Usability Scale (SUS). Results: The final sample comprised 16 people (8 dyads). Responses to the M-MARS were comparable between older adults and caregiver respondents in terms of engagement and functionality. Caregivers rated aesthetics slightly higher (mean 3.7) than older adult participants did (mean 3.3). Although most responses to the SUS were around the mean (2.3-3.4), older adults and their caregivers differed with regard to integration of app features (mean 3.7 vs 2.8) and the need to learn more before using the app (mean 2.3 vs 3.1). Conclusions: Technology ownership and use among older adults and caregivers was high. Usability and engagement of the mobile app was average. Additional training is recommended for older adults and their caregivers, including that on targeted behaviors for digital health record keeping. %M 31518271 %R 10.2196/12276 %U http://aging.jmir.org/2019/1/e12276/ %U https://doi.org/10.2196/12276 %U http://www.ncbi.nlm.nih.gov/pubmed/31518271 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e13049 %T A Smartphone Game to Prevent HIV Among Young Africans (Tumaini): Assessing Intervention and Study Acceptability Among Adolescents and Their Parents in a Randomized Controlled Trial %A Sabben,Gaëlle %A Mudhune,Victor %A Ondeng'e,Ken %A Odero,Isdorah %A Ndivo,Richard %A Akelo,Victor %A Winskell,Kate %+ Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 4046833103, gaelle.sabben@emory.edu %K HIV %K youth %K sub-Saharan Africa %K Kenya %K serious game %K narrative %K smartphone %K pilot study %K randomized controlled trial %K acceptability %D 2019 %7 21.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Young people aged 15 to 24 years account for one-third of new adult HIV infections. Controlling the HIV epidemic requires effective interventions targeted toward young people and their needs. Smartphone games offer a promising avenue for reaching this population with evidence-based HIV prevention interventions. It is crucial to the effectiveness of these interventions that they be acceptable and intrinsically motivating to adolescents as well as acceptable to their parents. Objective: Tumaini is a narrative-based smartphone game designed to help prevent HIV among young Africans aged 11 to 14 years by delaying first sex and increasing condom use at first sex. Following a 16-day feasibility study of Tumaini, we assessed the acceptability (1) of the intervention, where acceptability was operationalized as appeal, relevance, value, usability, and understandability, and (2) of this study and a planned future randomized controlled efficacy trial. Methods: During the randomized feasibility study (n=60) of Tumaini in western Kenya in spring 2017, 30 participants used the intervention on a study-provided smartphone. The app automatically logged participant interaction with the game in time-stamped log files. All 30 participants completed an Audio Computer-Assisted Self-Interview–based game experience survey, and 27 took part in 4 focus group discussions (FGDs) about the game’s appeal, relevance, value, usability, and understandability. Their parents (n=22) also participated in 4 FGDs about the acceptability of the intervention, of this study, and of a planned efficacy trial. Survey data were analyzed using SAS software (SAS Institute Inc); FGD transcripts were coded and analyzed in MAXQDA 12 (Verbi GmbH); and gameplay log files were analyzed using Microsoft Excel. Results: Adolescent participants’ survey responses indicated that Tumaini scored well with players on all indicators of acceptability (appeal, relevance, value, usability, and understandability). Focus group analyses aligned with these findings and emphasized a high degree of player engagement with the game, which was supported by log file analysis. Adolescent participants were eager for additional content, and parents were receptive to a longer study involving biomarkers, based on their positive experiences with this study. There is scope to improve communication with parents about their role in the intervention. As the game was tested in beta version, there is also scope to fine-tune some of the game mechanics to increase usability. Conclusions: This study shows the strong acceptability of an interactive smartphone-based game both to adolescents and their parents in western Kenya and that of the study methods used to pilot-test the intervention. It also suggests that longitudinal efficacy studies of this type of intervention, including those using biomarkers, have the potential to be acceptable among parents. Trial Registration: ClinicalTrials.gov NCT03054051; https://clinicaltrials.gov/ct2/show/NCT03054051 (Archived by WebCite at http://www.webcitation.org/70U2gCNtW) %M 31115348 %R 10.2196/13049 %U http://mhealth.jmir.org/2019/5/e13049/ %U https://doi.org/10.2196/13049 %U http://www.ncbi.nlm.nih.gov/pubmed/31115348 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e9232 %T A Focused Review of Smartphone Diet-Tracking Apps: Usability, Functionality, Coherence With Behavior Change Theory, and Comparative Validity of Nutrient Intake and Energy Estimates %A Ferrara,Giannina %A Kim,Jenna %A Lin,Shuhao %A Hua,Jenna %A Seto,Edmund %+ Department of Environmental & Occupational Health Sciences, University of Washington, 1959 NE Pacific Street, Campus Box 357234, Seattle, WA, 98195, United States, 1 206 543 1475, eseto@uw.edu %K diet %K nutrition assessment %K behavior and behavior mechanisms %D 2019 %7 17.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone diet-tracking apps may help individuals lose weight, manage chronic conditions, and understand dietary patterns; however, the usabilities and functionalities of these apps have not been well studied. Objective: The aim of this study was to review the usability of current iPhone operating system (iOS) and Android diet-tracking apps, the degree to which app features align with behavior change constructs, and to assess variations between apps in nutrient coding. Methods: The top 7 diet-tracking apps were identified from the iOS iTunes and Android Play online stores, downloaded and used over a 2-week period. Each app was independently scored by researchers using the System Usability Scale (SUS), and features were compared with the domains in an integrated behavior change theory framework: the Theoretical Domains Framework. An estimated 3-day food diary was completed using each app, and food items were entered into the United States Department of Agriculture (USDA) Food Composition Databases to evaluate their differences in nutrient data against the USDA reference. Results: Of the apps that were reviewed, LifeSum had the highest average SUS score of 89.2, whereas MyDietCoach had the lowest SUS score of 46.7. Some variations in features were noted between Android and iOS versions of the same apps, mainly for MyDietCoach, which affected the SUS score. App features varied considerably, yet all of the apps had features consistent with Beliefs about Capabilities and thus have the potential to promote self-efficacy by helping individuals track their diet and progress toward goals. None of the apps allowed for tracking of emotional factors that may be associated with diet patterns. The presence of behavior change domain features tended to be weakly correlated with greater usability, with R2 ranging from 0 to .396. The exception to this was features related to the Reinforcement domain, which were correlated with less usability. Comparing the apps with the USDA reference for a 3-day diet, the average differences were 1.4% for calories, 1.0% for carbohydrates, 10.4% for protein, and −6.5% for fat. Conclusions: Almost all reviewed diet-tracking apps scored well with respect to usability, used a variety of behavior change constructs, and accurately coded calories and carbohydrates, allowing them to play a potential role in dietary intervention studies. %M 31102369 %R 10.2196/mhealth.9232 %U http://mhealth.jmir.org/2019/5/e9232/ %U https://doi.org/10.2196/mhealth.9232 %U http://www.ncbi.nlm.nih.gov/pubmed/31102369 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e13421 %T Validation of the Mobile App–Recorded Circadian Rhythm by a Digital Footprint %A Lin,Yu-Hsuan %A Wong,Bo-Yu %A Pan,Yuan-Chien %A Chiu,Yu-Chuan %A Lee,Yang-Han %+ Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli, 35053, Taiwan, 886 37 246166 ext 36383, yuhsuanlin@nhri.org.tw %K circadian rhythm %K sleep %K smartphone %K mobile applications %D 2019 %7 16.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Modern smartphone use is pervasive and could be an accessible method of evaluating the circadian rhythm and social jet lag via a mobile app. Objective: This study aimed to validate the app-recorded sleep time with daily self-reports by examining the consistency of total sleep time (TST), as well as the timing of sleep onset and wake time, and to validate the app-recorded circadian rhythm with the corresponding 30-day self-reported midpoint of sleep and the consistency of social jetlag. Methods: The mobile app, Rhythm, recorded parameters and these parameters were hypothesized to be used to infer a relative long-term pattern of the circadian rhythm. In total, 28 volunteers downloaded the app, and 30 days of automatically recorded data along with self-reported sleep measures were collected. Results: No significant difference was noted between app-recorded and self-reported midpoint of sleep time and between app-recorded and self-reported social jetlag. The overall correlation coefficient of app-recorded and self-reported midpoint of sleep time was .87. Conclusions: The circadian rhythm for 1 month, daily TST, and timing of sleep onset could be automatically calculated by the app and algorithm. %M 31099340 %R 10.2196/13421 %U https://mhealth.jmir.org/2019/5/e13421/ %U https://doi.org/10.2196/13421 %U http://www.ncbi.nlm.nih.gov/pubmed/31099340 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e11967 %T Methodology Used in Ecological Momentary Assessment Studies About Sedentary Behavior in Children, Adolescents, and Adults: Systematic Review Using the Checklist for Reporting Ecological Momentary Assessment Studies %A Romanzini,Catiana Leila Possamai %A Romanzini,Marcelo %A Batista,Mariana Biagi %A Barbosa,Cynthia Correa Lopes %A Shigaki,Gabriela Blasquez %A Dunton,Genevieve %A Mason,Tyler %A Ronque,Enio Ricardo Vaz %+ Londrina State University, Department of Physical Education, Rodovia Celso Garcia Cid | Pr 445 Km 380 | Campus Universitário Cx Postal 10.011, Londrina, 86.057-970, Brazil, 55 4333714238, clpossamai@uel.br %K physical activity %K accelerometry %K health behavior %D 2019 %7 15.05.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of ecological momentary assessment (EMA) to measure sedentary behavior (SB) in children, adolescents, and adults can increase the understanding of the role of the context of SB in health outcomes. Objective: The aim of this study was to systematically review literature to describe EMA methodology used in studies on SB in youth and adults, verify how many studies adhere to the Methods aspect of the Checklist for Reporting EMA Studies (CREMAS), and detail measures used to assess SB and this associated context. Methods: A systematic literature review was conducted in the PubMed, Scopus, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and SPORTDiscus databases, covering the entire period of existence of the databases until January 2018. Results: This review presented information about the characteristics and methodology used in 21 articles that utilized EMA to measure SB in youth and adults. There were more studies conducted among youth compared with adults, and studies of youth included more waves and more participants (n=696) than studies with adults (n=97). Most studies (85.7%) adhered to the Methods aspect of the CREMAS. The main criteria used to measure SB in EMA were self-report (81%) with only 19% measuring SB using objective methods (eg, accelerometer). The main equipment to collect objective SB was the ActiGraph, and the cutoff point to define SB was <100 counts/min. Studies most commonly used a 15-min window to compare EMA and accelerometer data. Conclusions: The majority of studies in this review met minimum CREMAS criteria for studies conducted with EMA. Most studies measured SB with EMA self-report (n=17; 81.0%), and a few studies also used objective methods (n=4; 19%). The standardization of the 15-min window criteria to compare EMA and accelerometer data would lead to a comparison between these and new studies. New studies using EMA with mobile phones should be conducted as they can be considered an attractive method for capturing information about the specific context of SB activities of young people and adults in real time or very close to it. %M 31094349 %R 10.2196/11967 %U https://www.jmir.org/2019/5/e11967/ %U https://doi.org/10.2196/11967 %U http://www.ncbi.nlm.nih.gov/pubmed/31094349 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e12794 %T Using Smartphone-Based Psychoeducation to Reduce Postnatal Depression Among First-Time Mothers: Randomized Controlled Trial %A Chan,Ko Ling %A Leung,Wing Cheong %A Tiwari,Agnes %A Or,Ka Lun %A Ip,Patrick %+ Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong,, China (Hong Kong), 852 2766 5709, koling.chan@polyu.edu.hk %K smartphone technology %K postnatal depression %K psychoeducation %K randomized controlled trial %D 2019 %7 14.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone-based psychoeducation interventions may be a low-cost, user-friendly alternative to resource-consuming, face-to-face antenatal classes to educate expectant mothers. Objective: This study aimed to empirically examine whether such an intervention would lead to reduced postnatal depression, anxiety, or stress and result in a better health-related quality of life. Methods: A single-blind randomized controlled trial was conducted in Hong Kong. All first-time expectant mothers with less than 24 weeks of gestation remaining and attending the antenatal clinic at a public hospital were included. Participants were assigned to the intervention group or the control group by drawing lots. The lots, presented in sealed opaque envelopes, were randomly designated as “intervention” or “control” by stratified randomization. The intervention, a psychoeducational mobile app, was provided in addition to the treatment as usual (TAU) services from the hospital. Follow up with participants took place at 4 weeks postpartum. The primary outcome was the difference in the levels of antenatal and postnatal depression, assessed by the Edinburgh Postnatal Depression Scale (EPDS). The intention-to-treat approach was employed in the analyses. Results: The final sample was 660 expectant mothers (nintervention=330 and ncontrol=330). The mean difference in EPDS scores between the two groups was −0.65 (95% CI −1.29 to 0.00; P=.049) after adjusting for confounding factors. Associations were found between participation in the intervention and reduced depression, and attendance in TAU classes and increased stress levels. Conclusions: The smartphone-based intervention plus TAU services was effective in reducing postnatal depression at 4 weeks postpartum compared with a control condition of TAU only, making this a cost-effective alternative to TAU education for expectant mothers. Limitations of the study included the short postpartum period after which the follow-up assessment was conducted and the inclusion of first-time mothers rather than all mothers. Trial Registration: HKU Clinical Trials Registry HKUCTR-2024; http://www.hkuctr.com/Study/Show/ 34f62a2f6d594273a290491827206384 %M 31094354 %R 10.2196/12794 %U http://mhealth.jmir.org/2019/5/e12794/ %U https://doi.org/10.2196/12794 %U http://www.ncbi.nlm.nih.gov/pubmed/31094354 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 2 %P e12664 %T EasyDetectDisease: An Android App for Early Symptom Detection and Prevention of Childhood Infectious Diseases %A Ponum,Mahvish %A Hasan,Osman %A Khan,Saadia %+ School of Electrical Engineering and Computer Science, National University of Sciences and Technology, Islamabad, Pakistan, Islamabad, 440000, Pakistan, 92 3067826262, mponum.msit15seecs@seecs.edu.pk %K infectious diseases %K mHealth %K causes of death %D 2019 %7 14.05.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Infectious diseases often lead to death among children under 5 years in many underdeveloped and developing countries. One of the main reasons behind this is an unawareness of disease symptoms among mothers and child caregivers. To overcome this, we propose the EasyDetectDisease mobile health app to educate mothers about the early symptoms of pediatric diseases and to provide them with practical advice for preventing the spread of such diseases in children under 5 years. The EasyDetectDisease app includes detailed knowledge of infectious diseases, including the corresponding symptoms, causes, incubation period, preventive measures, nutritional guidelines such as breastfeeding, video tutorials of child patients, and video guidelines by pediatric health experts to promote child health. It also provides information on the diagnosis of the infectious diseases based on symptoms. Objective: The objective of this study was to evaluate the usability (eg, ease of use, easy detection of disease, functionality, and navigation of interfaces) of the EasyDetectDisease app among mothers of children under 5 years of age. Methods: Two health sessions, held in Pakistan, were used to evaluate the usability of EasyDetectDisease by 30 mothers of children under 5 years. The app was evaluated based on various quantitative and qualitative measures. Results: The participating mothers confirmed that they were able to diagnose diseases accurately and that after following the instructions provided, their children recovered rapidly without any nutritional deficiency. All participating mothers showed an interest in using the EasyDetectDisease app if made available by governmental public health agencies, and they suggested its inclusion in all mobile phones as a built-in health app in the future. Conclusions: EasyDetectDisease was modified into a user-friendly app based on feedback collected during the usability sessions. All participants found it acceptable and easy to use, especially illiterate mothers. The EasyDetectDisease app proved to be a useful tool for child health care at home and for the treatment of infectious diseases and is expected to reduce the mortality rate of children under 5 years of age. %M 31094329 %R 10.2196/12664 %U http://www.i-jmr.org/2019/2/e12664/ %U https://doi.org/10.2196/12664 %U http://www.ncbi.nlm.nih.gov/pubmed/31094329 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 5 %P e10039 %T Influence of Personality and Differences in Stress Processing Among Finnish Students on Interest to Use a Mobile Stress Management App: Survey Study %A Ervasti,Mari %A Kallio,Johanna %A Määttänen,Ilmari %A Mäntyjärvi,Jani %A Jokela,Markus %+ VTT Technical Research Centre of Finland Ltd, Kaitoväylä 1, Oulu, FI-90571, Finland, 358 207222434, johanna.kallio@vtt.fi %K mental health %K mobile applications %K psychological stress %K personality %K neuroticism %K mobile phone %K surveys and questionnaires %D 2019 %7 13.05.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Excessive stress has a negative impact on many aspects of life for both individuals and societies, from studying and working to health and well-being. Each individual has their unique level of stress-proneness, and positive or negative outcomes of stress may be affected by it. Technology-aided interventions have potential efficacy in the self-management of stress. However, current Web-based or mobile stress management solutions may not reach the individuals that would need them the most, that is, stress-sensitive people. Objective: The aim of this study was to examine how personality is associated with stress among Finnish university students and their interest to use apps that help in managing stress. Methods: We used 2 structured online questionnaires (combined, n=1001) that were advertised in the University of Helsinki’s mailing lists. The first questionnaire (n=635) was used to investigate intercorrelations between the Big Five personality variables (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and other stress-related background variables. The second questionnaire (n=366) was used to study intercorrelations between the above-mentioned study variables and interest in using stress management apps. Results: The quantitative findings of the first questionnaire showed that higher levels of extraversion, agreeableness, and conscientiousness were associated with lower self-reported stress. Neuroticism, in turn, was found to be strongly associated with rumination, anxiety, and depression. The findings of the second questionnaire indicated that individuals characterized by the Big Five personality traits of neuroticism and agreeableness were particularly interested to use stress management apps (r=.27, P<.001 and r=.11, P=.032, respectively). Moreover, the binary logistic regression analysis revealed that when a person’s neuroticism is one SD above average (ie, it is higher than among 84% of people), the person has roughly 2 times higher odds of being interested in using a stress management app. Respectively, when a person’s agreeableness is one SD above average, the person has almost 1.4 times higher odds of being interested in using a stress management app. Conclusions: Our results indicated that personality traits may have an influence on the adoption interest of stress management apps. Individuals with high neuroticism are, according to our results, adaptive in the sense that they are interested in using stress management apps that may benefit them. On the contrary, low agreeableness may lead to lower interest to use the mobile stress management apps. The practical implication is that future mobile stress interventions should meaningfully be adjusted to improve user engagement and support health even among less-motivated users, for instance, to successfully engage individuals with low agreeableness. %M 31094358 %R 10.2196/10039 %U https://mental.jmir.org/2019/5/e10039/ %U https://doi.org/10.2196/10039 %U http://www.ncbi.nlm.nih.gov/pubmed/31094358 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e12326 %T Development of the Top Tips Habit-Based Weight Loss App and Preliminary Indications of Its Usage, Effectiveness, and Acceptability: Mixed-Methods Pilot Study %A Kliemann,Nathalie %A Croker,Helen %A Johnson,Fiona %A Beeken,Rebecca J %+ Leeds Institute of Health Sciences, University of Leeds, Level 10, Worsley Building, Clarendon Way, Leeds, LS2 9NL, United Kingdom, 44 113 343 3228, r.beeken@leeds.ac.uk %K weight loss %K habits %K mobile apps %K mHealth %D 2019 %7 10.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Ten Top Tips (10TT) is an intervention based on the habit formation theory that promotes a set of weight management behaviors alongside advice about repetition in a consistent context. Overall, 3 studies have demonstrated that the 10TT can support individuals to lose weight when delivered in a leaflet format. Delivery of 10TT via new technology such as a mobile app could potentially improve its effectiveness and make it more convenient, appealing, and wide reaching. Objective: This study aimed to provide preliminary indications of the usage, effectiveness, and acceptability of an Android app of the 10TT intervention (Top Tips only app) and a second version including self-regulatory strategies for dealing with tempting foods (Top Tips plus app). Methods: The 3-month pilot randomized adults with overweight or obesity to (1) Top Tips only app, (2) Top Tips plus app, or (3) waiting list condition. Automated data from app users were collected. Validated questionnaires assessed self-regulatory skills, weight loss (kg), and behaviors at baseline and 3 months. Users’ feedback on their experience using the app was assessed using open questions. Results: A total of 81 participants took part in the pilot; 28 participants were randomized to the Top Tips only app, 27 to the Top Tips plus app, and 26 to the waiting list condition. On average, participants viewed a mean of 43.4 (SD 66.9) screens during a mean of 24.5 (SD 44.07) log-ins and used the app for 124.2 (SD 240.2) min over the 3-month period. Participants randomized to the Top Tips only app reported the greatest improvement in self-regulatory skills (mean 0.59, SD 1.0), weight loss (mean 4.5 kg, SD 5.2), and adherence to the target behaviors (mean 0.59, SD 0.49) compared with the Top Tips plus (meanself-regulation 0.15, SD 0.42; meanweight −1.9, SD 3.9; and meanbehaviors 0.29, SD 0.29) and waiting list condition (meanself-regulation −0.02, SD 0.29; meanweight −0.01, SD 0.51; and meanbehaviors 0.08, SD 0.38). Participants who reported the largest improvements, on average, viewed pages 2 to 3 times more, had 2 to 3 times more log-ins, logged their weight 2 to 3 times more, and achieved the tips more than those who reported smaller changes in these outcomes. According to users’ feedback, engagement with the app could be increased by making the app more interactive and allowing more tailoring. Conclusions: This study suggests that the Top Tips app could potentially be a useful intervention for promoting eating self-regulatory skills, weight loss, and weight management behaviors among adults with overweight or obesity. Future research should develop the app further based on user feedback and test it in larger sample sizes. Trial Registration: ISRCTN Registry ISRCTN10470937; http://www.isrctn.com/ISRCTN10470937 (Archived by Webcite at http://www.webcitation.org/76j6rQibI) %M 31094352 %R 10.2196/12326 %U https://mhealth.jmir.org/2019/5/e12326/ %U https://doi.org/10.2196/12326 %U http://www.ncbi.nlm.nih.gov/pubmed/31094352 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 4 %N 2 %P e11017 %T Enhanced Self-Efficacy and Behavioral Changes Among Patients With Diabetes: Cloud-Based Mobile Health Platform and Mobile App Service %A Chao,Dyna YP %A Lin,Tom MY %A Ma,Wen-Ya %+ Healthcare Solution Center, Health Inventor of Taipei, 5F, No.22, Fushan Rd, Wenshan Dist, Taipei City, 116, Taiwan, 886 917508975, dynachao@gmail.com %K type 2 diabetes mellitus %K self-management %K health literacy %K patient engagement %K intervention %K word-of-mouth %D 2019 %7 10.05.2019 %9 Original Paper %J JMIR Diabetes %G English %X Background: The prevalence of chronic disease is increasing rapidly. Health promotion models have shifted toward patient-centered care and self-efficacy. Devices and mobile app in the Internet of Things (IoT) have become critical self-management tools for collecting and analyzing personal data to improve individual health outcomes. However, the precise effects of Web-based interventions on self-efficacy and the related motivation factors behind individuals’ behavioral changes have not been determined. Objective: The objective of this study was to gain insight into patients' self-efficacy with newly diagnosed diabetes (type 2 diabetes mellitus) and analyze the association of patient-centered health promotion behavior and to examine the implications of the results for IoT and mobile health mobile app features. Methods: The study used data from the electronic health database (n=3128). An experimental design (n=121) and randomized controlled trials were employed to determine patient preferences in the health promotion program (n=62) and mobile self-management education (n=28). The transtheoretical model was used as a framework for observing self-management behavior for the improvement of individual health, and the theory of planned behavior was used to evaluate personal goals, execution, outcome, and personal preferences. A mobile app was used to determine individualized health promotion interventions and to apply these interventions to improve patients’ self-management and self-efficacy. Results: Mobile questionnaires were administered for pre- and postintervention assessment through mobile app. A dynamic questionnaire allocation method was used to follow up and monitor patient behavioral changes in the subsequent 6 to 18 months. Participants at a high risk of problems related to blood pressure (systolic blood pressure ≥120 mm Hg) and body mass index (≥23 kg/m2) indicated high motivation to change and to achieve high scores in the self-care knowledge assessment (n=49, 95% CI −0.26% to −0.24%, P=.052). The associated clinical outcomes in the case group with the mobile-based intervention were slightly better than in the control group (glycated hemoglobin mean −1.25%, 95% CI 6.36 to 7.47, P=.002). In addition, 86% (42/49) of the participants improved their health knowledge through the mobile-based app and information and communications technology. The behavior-change compliance rate was higher among the women than among the men. In addition, the personal characteristics of steadiness and dominance corresponded with a higher compliance rate in the dietary and wellness intervention (83%, 81/98). Most participants (71%, 70/98) also increased their attention to healthy eating, being active, and monitoring their condition (30% 21/70, 21% 15/70, and 20% 14/70, respectively). Conclusions: The overall compliance rate was discovered to be higher after the mobile app–based health intervention. Various intervention strategies based on patient characteristics, health care–related word-of-mouth communication, and social media may be used to increase self-efficacy and improve clinical outcomes. Additional research should be conducted to determine the most influential factors and the most effective adherence management techniques. %M 31094324 %R 10.2196/11017 %U http://diabetes.jmir.org/2019/2/e11017/ %U https://doi.org/10.2196/11017 %U http://www.ncbi.nlm.nih.gov/pubmed/31094324 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e13324 %T Young Adults’ Engagement With a Self-Monitoring App for Vegetable Intake and the Impact of Social Media and Gamification: Feasibility Study %A Nour,Monica %A Chen,Juliana %A Allman-Farinelli,Margaret %+ School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Level 4 EAST, Charles Perkins Centre D17 The University of Sydney, Camperdown, 2006, Australia, 61 403094095, mnou2973@uni.sydney.edu.au %K vegetables %K young adults %K mHealth %K social media %K experimental game %D 2019 %7 10.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media and gamification have been used in digital interventions for improving nutrition behaviors of young adults, but few studies measure engagement. Objective: This feasibility study aimed to explore user engagement with a 4-week smartphone program for improving vegetable intake. Methods: A goal setting and self-monitoring app was developed for feasibility testing. We assessed if additional components of gaming and/or social media support increased engagement. A 2 × 2 factorial study design was used with participants randomly allocated to each group. Engagement with the app (usage) was captured via inbuilt software, which recorded total days of app usage (duration) and the frequency of logging vegetable intake. Uptake of the social media (Facebook) content was measured by tracking views, likes, and comments on posts. Results: Out of the 110 potential participants who completed the prescreening questionnaire online, 97 were eligible (mean age 24.8 [SD 3.4]). In total, 49% (47/97) of participants were retained at 4 weeks. Attrition within the first week was the highest among users of the gamified app without social support (Facebook; P<.001). Over the intervention period, 64% (62/97) of participants logged into their app, with vegetable intake recorded on average for 11 out of 28 days. The frequency of recording decreased each week (mean 4 [SD 2] days in week 1 versus mean 2 [SD 2] days in week 4). No effects of gaming or social support on the frequency of recording vegetables or the duration of app engagement were found. However, regardless of the app type, the duration of app engagement was significantly associated with vegetable intake post intervention (P<.001). In total, 60% of Facebook posts were viewed by participants but engagement was limited to likes, with no comments or peer-to-peer interaction observed. Conclusions: As duration of usage was associated with vegetable intake, a deeper understanding of factors influencing engagement is needed. Dimensions such as personal attributes and the setting and context require further exploration in addition to content and delivery. %M 31094322 %R 10.2196/13324 %U http://formative.jmir.org/2019/2/e13324/ %U https://doi.org/10.2196/13324 %U http://www.ncbi.nlm.nih.gov/pubmed/31094322 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e11442 %T Usability and Usefulness of a Mobile Health App for Pregnancy-Related Work Advice: Mixed-Methods Approach %A van Beukering,Monique %A Velu,Adeline %A van den Berg,Liesbeth %A Kok,Marjolein %A Mol,Ben Willem %A Frings-Dresen,Monique %A de Leeuw,Robert %A van der Post,Joris %A Peute,Linda %+ Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Room H4-222, PO Box 22660, Amsterdam, 1100 DD, Netherlands, 31 657514795, m.d.vanbeukering@amc.uva.nl %K mHealth %K eHealth %K mobile phone %K pregnancy %K work %K occupation %K occupational exposure %K qualitative research %D 2019 %7 09.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pregnant women are often unaware of the potential risks that working conditions can cause to them and their unborn child. A mobile health (mHealth) app, the Pregnancy and Work (P and W) app, developed by a multidisciplinary team and based on an evidence-based guideline for occupational physicians, aims to provide advice on work adjustment during pregnancy. Objective: This study evaluates the usability of the mHealth P and W app and the perceived usefulness of the work advice, the main goal of the app, by potential end users. Methods: A total of 12 working pregnant women participated in think aloud usability sessions and performed 9 tasks. All think aloud sessions were recorded, transcribed, and coanalyzed. The usability problems were rated for their severity in accordance with Nielsen severity scale. The completion rates and time taken for completion of tasks were registered. In addition, participants were questioned on demographics and user characteristics and were asked to evaluate the value of the app by filling in the Intrinsic Motivation Inventory (IMI) score and the System Usability Scale (SUS) questionnaire. Results: In total, 82 usability problems with a severity ≥1 were identified, of which 40 had severity ≥3. The main usability problems concerned the interpretation of terminology used in the app’s questionnaires and difficulties in finding and understanding the work advice. Furthermore, 10 out of 12 participants were able to open the work advice page in the app. Only 7 out of these 10 participants understood and intended to follow the work advice. The overall mean IMI score was relatively high (5 out of 7), indicating that the participants did indeed value the use of the app. This IMI score corresponded to the overall mean SUS score (68 out of 100) and the mean grade given to the P and W app (7 out of 10). Conclusions: This think aloud usability study showed that the information provided in the P and W app was considered valuable by the end users, working pregnant women, and it meets their needs; however, usability issues severely impacted the perceived usefulness of the work advice given in the app. %M 31094353 %R 10.2196/11442 %U https://mhealth.jmir.org/2019/5/e11442/ %U https://doi.org/10.2196/11442 %U http://www.ncbi.nlm.nih.gov/pubmed/31094353 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 2 %P e13037 %T Interactive Narrative in a Mobile Health Behavioral Intervention (Tumaini): Theoretical Grounding and Structure of a Smartphone Game to Prevent HIV Among Young Africans %A Winskell,Kate %A Sabben,Gaëlle %A Obong'o,Christopher %+ Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 4047275286, swinske@emory.edu %K mHealth %K serious games %K games for health %K narrative %K HIV %K adolescence %K sub-Saharan Africa %K behavioral theory %K narrative theory %D 2019 %7 08.05.2019 %9 Viewpoint %J JMIR Serious Games %G English %X The increasing availability of smartphones, including in low-income countries, offers an unprecedented opportunity to reach individuals with innovative health promotion interventions. Electronic games delivered via smartphone offer promising avenues for sexual health promotion and HIV prevention, especially for young people. By giving players real agency in a virtual and safe environment, well-designed games can provide a level of experiential learning unparalleled by many other behavioral interventions. The design of effective games for health relies on multidisciplinary insight and expertise. However, relatively few studies discuss the theoretical understanding underlying their intervention. Making explicit the theoretical grounding of a game-based intervention allows articulation of assumptions and strategies, anticipation of outcomes, and evaluation of impacts (including intermediate effects), thereby increasing understanding of pathways to change, with a view to contributing to the development of more effective games. It also helps strengthen the credibility and improve the accountability of games for health. We present the multidisciplinary theoretical framework—integrating intervention design, mediators, and behavioral outcomes—and the structure of an HIV prevention game for young African adolescents that has shown promise in a randomized pilot study in Western Kenya. The central component of Tumaini (hope for the future in Kiswahili) is an interactive role-playing narrative in which the player makes choices for characters that determine how their paths unfold. In addition, a series of mini-games reinforce skills, and the “My Story” component links the game world to the player’s own life and goals, and a reward system motivates continued play. With its “choose-your-own-adventure” format, Tumaini is intended to be replayed so that players can experience the consequences resulting from different choices made in the role-playing narrative. Grounded in theories of narrative and applied communication and in social behavioral theories, especially Social Cognitive Theory, Tumaini is designed to help young adolescents acquire the information, skills, and motivation they need to avoid and reduce sexual risks. We close by situating Tumaini within discussion of the theory and practice of using interactive narrative in health promotion, with a view to furthering theoretical elaboration. %M 31066692 %R 10.2196/13037 %U http://games.jmir.org/2019/2/e13037/ %U https://doi.org/10.2196/13037 %U http://www.ncbi.nlm.nih.gov/pubmed/31066692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12679 %T Feasibility of a Mobile Phone App to Promote Adherence to a Heart-Healthy Lifestyle: Single-Arm Study %A Lunde,Pernille %A Nilsson,Birgitta Blakstad %A Bergland,Astrid %A Bye,Asta %+ Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, P50, PB 4, St Olavs Plass, Oslo,, Norway, 47 48 06 35 37, plunde@oslomet.no %K mHealth %K eHealth %K mobile phone app %K cardiac rehabilitation %D 2019 %7 19.4.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Long-term maintenance of preventive activities is fundamental for achieving improved outcomes in cardiac rehabilitation (CR). Despite this, it has been shown to be a major challenge for many patients to follow recommendations and thereby adhere to a heart-healthy lifestyle. Mobile phone apps have been emphasized as potential tools to promote preventive activities after attendance in a CR program. Before commencing a trial to assess the potential effect of using an app to promote long-term adherence to preventive activities after attendance in CR, a study to assess if it is feasible to use an app is warranted. Objective: The goal of the research is to assess if it is feasible to use a mobile phone app for promoting and monitoring patients’ adherence to a heart-healthy lifestyle after CR. Methods: The study included an experimental, pre-post single-arm trial lasting for 12 weeks. All patients received access to an app aimed to guide individuals to change or maintain a heart-healthy lifestyle. During the study period, patients received weekly, individualized monitoring through the app, based on their own goals. Feasibility outcomes assessed were recruitment rate, adherence to the app, resource requirements, and efficacy regarding capability to detect a change in quality of life, health status, and perceived goal achievement as well as evaluating ceiling and floor effect in these outcomes. Criteria for success were preset to be able to evaluate whether the app was feasible to use in a potential future RCT. Results: In total, 71% (17/24) of the patients who completed CR were eligible for a potential RCT as well as for this study. All 14 patients included in the study used the app to promote preventive activities throughout the study. Satisfaction with the technology was high, and the patients found the technology-based follow-up intervention both useful and motivational. Ceiling effect was present in more than 20% of the patients in several domains of the questionnaires evaluating quality of life (36-Item Short Form Health Survey and COOP/WONCA functional health assessments) and health status (EQ-5D). Overall self-rated health status (EuroQol Visual Analog Scale) and perceived goal achievement were found to be outcomes able to detect a change. Conclusions: Individual follow-up through an app after attendance in CR is feasible. All patients used the app for preventive activities and found the app both useful and motivating. Several points of guidance from the patients in the study have been adopted and incorporated into the final design of the RCT now in the field. %M 31066684 %R 10.2196/12679 %U http://formative.jmir.org/2019/2/e12679/ %U https://doi.org/10.2196/12679 %U http://www.ncbi.nlm.nih.gov/pubmed/31066684 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e10737 %T Change in Waist Circumference With Continuous Use of a Smart Belt: An Observational Study %A Lee,Myeonggyun %A Shin,Jaeyong %+ Department of Preventive Medicine, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-Gu, Suwon, 16499, Republic of Korea, 82 312197455, drshin@ajou.ac.kr %K smart health care %K wearable device %K obesity %K internet of things %K mHealth %K digital health care %K lifestyle modification %K metabolic syndrome %D 2019 %7 02.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health insurers and policymakers are trying to prevent and reduce cardiovascular diseases due to obesity. A smart belt that monitors activity and waist circumference is a new concept for conquering obesity and may be a promising new strategy for health insurers and policymakers. Objective: This preliminary study evaluated whether the use of a smart belt was associated with a decrease in waist circumference. Methods: In the manufacturer’s database, there were data on a total of 427 men at baseline. A total of 223, 81, and 27 users kept using the smart belt for 4, 8, and 12 weeks, respectively. Paired t tests and repeated measures analysis of variance (ANOVA) were used to identify the change in waist circumference at specified time intervals (at 4, 8, and 12 weeks). In addition, a linear mixed model was used to incorporate all users’ waist circumference data at each time point. Preexisting data on waist circumference and self-reported demographics were obtained from the manufacturer of the smart belt (WELT Corporation, South Korea). Results: Compared with baseline, the waist circumference (cm) decreased significantly at all time points: –0.270 for week 4, –0.761 for week 8, and –1.972 for week 12 (all P<.01). Although each paired t test had a different sample size because of loss to follow-up, the differences between baseline and each subsequent week increased. Equal continuous reduction in waist circumference was observed with the ANOVA and mixed model analysis (beta=–0.158 every week). Conclusions: The smart belt is a newly developed, wearable device that measures real-time steps, sedentary time, and waist circumference. In this study, we showed that wearing the smart belt was associated with reducing waist circumference over 12 weeks. This direct-to-consumer smart health device may contribute toward reducing the risk of obesity and related conditions and controlling increasing health costs for health insurers. %M 31045500 %R 10.2196/10737 %U http://mhealth.jmir.org/2019/5/e10737/ %U https://doi.org/10.2196/10737 %U http://www.ncbi.nlm.nih.gov/pubmed/31045500 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e12364 %T Features and Educational Content Related to Milk Production in Breastfeeding Apps: Content Analysis Informed by Social Cognitive Theory %A Sidhu,Suhail %A Ma,Kaoer %A Sadovnikova,Anna %+ LiquidGoldConcept, Inc, , Ypsilanti, MI,, United States, 1 916 905 3544, anna@liquidgoldconcept.com %K milk production %K milk supply %K human lactation %K breastfeeding %K breastfeeding app %K smartphone app %K Social Cognitive Theory %K breastfeeding self-efficacy %D 2019 %7 01.05.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Low milk production is one of the main reasons for premature breastfeeding cessation. Smartphone apps have the potential to assist mothers with promoting, interpreting, tracking, or learning about milk production. It is not known whether breastfeeding apps contain high-quality, engaging, and diverse content and features that could be used by mothers to increase their breastfeeding self-efficacy and answer their questions about milk production. Objective: The overarching objective of this study was to identify and evaluate features and content within breastfeeding apps that could be used by mothers to increase breastfeeding self-efficacy and answer their questions about milk production. The secondary objectives were to quantify the diversity of representation of breastfeeding experiences within breastfeeding apps and to define the type of organization that is most likely to create free apps and/or apps with high-quality, engaging, and diverse features and content related to milk production. Methods: Breastfeeding apps were identified in the Apple App Store. All features that assist mothers with tracking, promoting, or interpreting milk production in the first 0-6 months postpartum were noted. Every screen containing educational information about milk production was identified and saved for review. Images of mothers and caretakers within the selected screenshots were assessed. Three scoresheets informed by Social Cognitive Theory were created to evaluate all identified features, educational content, and images representing the breastfeeding experience. Results: Forty-one breastfeeding apps were reviewed. Only seven apps contained both features and educational content related to milk production. Thirteen apps that contained educational content related to milk production received a mean combined content and cultural diversity score of 15.3 of 78. Of the 48 photos reviewed in screenshots that contained educational content on milk production, 87.5% (n=42) were of white women and their infants. For-profit companies and large organizations were most likely to create free apps and apps that received high scores on the combined content and diversity or features scoresheet, respectively. Conclusions: Features and educational content related to milk production and breastfeeding imagery within breastfeeding apps were evaluated using three novel scoresheets informed by Social Cognitive Theory. Few apps contained both features that promote breastfeeding self-efficacy and high-quality, engaging, educational content with images of diverse caretakers. Thus, it is likely that parents, especially those from minority or low-income groups, have limited options when selecting a breastfeeding app. App developers could use the scoresheets and findings in this review to develop breastfeeding apps that assist mothers with interpreting, tracking, or learning about milk production through high-quality and engaging features, content, and imagery. %M 31518317 %R 10.2196/12364 %U http://pediatrics.jmir.org/2019/1/e12364/ %U https://doi.org/10.2196/12364 %U http://www.ncbi.nlm.nih.gov/pubmed/31518317 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e10520 %T A Mobile Prenatal Care App to Reduce In-Person Visits: Prospective Controlled Trial %A Marko,Kathryn I %A Ganju,Nihar %A Krapf,Jill M %A Gaba,Nancy D %A Brown,James A %A Benham,Joshua J %A Oh,Julia %A Richards,Lorna M %A Meltzer,Andrew C %+ Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, 2120 L Street NW, Suite 450, Washington, DC, 20037, United States, 1 202 741 2952, ameltzer@mfa.gwu.edu %K prenatal care %K mobile applications %K patient monitoring %K patient safety %K patient satisfaction %K technological innovations %K controlled clinical trial %K mobile health %D 2019 %7 01.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Risk-appropriate prenatal care has been asserted as a way for the cost-effective delivery of prenatal care. A virtual care model for prenatal care has the potential to provide patient-tailored, risk-appropriate prenatal educational content and may facilitate vital sign and weight monitoring between visits. Previous studies have demonstrated a safe reduction in the frequency of in-person prenatal care visits among low-risk patients but have noted a reduction in patient satisfaction. Objective: The primary objective of this study was to test the effectiveness of a mobile prenatal care app to facilitate a reduced in-person visit schedule for low-risk pregnancies while maintaining patient and provider satisfaction. Methods: This controlled trial compared a control group receiving usual care with an experimental group receiving usual prenatal care and using a mobile prenatal care app. The experimental group had a planned reduction in the frequency of in-person office visits, whereas the control group had the usual number of visits. The trial was conducted at 2 diverse outpatient obstetric (OB) practices that are part of a single academic center in Washington, DC, United States. Women were eligible for enrollment if they presented to care in the first trimester, were aged between 18 and 40 years, had a confirmed desired pregnancy, were not considered high-risk, and had an iOS or Android smartphone that they used regularly. We measured the effectiveness of a virtual care platform for prenatal care via the following measured outcomes: the number of in-person OB visits during pregnancy and patient satisfaction with prenatal care. Results: A total of 88 patients were enrolled in the study, 47 in the experimental group and 41 in the control group. For patients in the experimental group, the average number of in-person OB visits during pregnancy was 7.8 and the average number in the control group was 10.2 (P=.01). There was no statistical difference in patient satisfaction (P>.05) or provider satisfaction (P>.05) in either group. Conclusions: The use of a mobile prenatal care app was associated with reduced in-person visits, and there was no reduction in patient or provider satisfaction. Trial Registration: ClinicalTrials.gov NCT02914301; https://clinicaltrials.gov/ct2/show/NCT02914301 (Archived by WebCite at http://www.webcitation.org/76S55M517) %M 31042154 %R 10.2196/10520 %U https://mhealth.jmir.org/2019/5/e10520/ %U https://doi.org/10.2196/10520 %U http://www.ncbi.nlm.nih.gov/pubmed/31042154 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e11586 %T Feasibility Randomized Controlled Trial of ImpulsePal: Smartphone App–Based Weight Management Intervention to Reduce Impulsive Eating in Overweight Adults %A van Beurden,Samantha B %A Smith,Jane R %A Lawrence,Natalia S %A Abraham,Charles %A Greaves,Colin J %+ College of Medicine and Health, University of Exeter, Smeall Building, Heavitree Road, Exeter, EX1 2LU, United Kingdom, 44 139272 ext 6440, s.b.vanbeurden@exeter.ac.uk %K weight loss %K mHealth %K digital behavior change %K obesity %K dual-process %D 2019 %7 30.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: ImpulsePal is a theory-driven (dual-process), evidence-informed, and person-centered smartphone app intervention designed to help people manage impulsive processes that prompt unhealthy eating to facilitate dietary change and weight loss. Objective: The aims of this study were to (1) assess the feasibility of trial procedures for evaluation of the ImpulsePal intervention, (2) estimate standard deviations of outcomes, and (3) assess usability of, and satisfaction with, ImpulsePal. Methods: We conducted an individually randomized parallel two-arm nonblinded feasibility trial. The eligibility criteria included being aged ≥16 years, having a body mass index of ≥25 kg/m2, and having access to an Android-based device. Weight was measured (as the proposed primary outcome for a full-scale trial) at baseline, 1 month, and 3 months of follow-up. Participants were randomized in a 2:1 allocation ratio to the ImpulsePal intervention or a waiting list control group. A nested action-research study allowed for data-driven refinement of the intervention across 2 cycles of feedback. Results: We screened 179 participants for eligibility, and 58 were randomized to the intervention group and 30 to the control group. Data were available for 74 (84%, 74/88) participants at 1 month and 67 (76%, 67/88) participants at 3 months. The intervention group (n=43) lost 1.03 kg (95% CI 0.33 to 1.74) more than controls (n=26) at 1 month and 1.01 kg (95% CI −0.45 to 2.47) more than controls (n=43 and n=24, respectively) at 3 months. Feedback suggested changes to intervention design were required to (1) improve receipt and understanding of instructions and (2) facilitate further engagement with the app and its strategies. Conclusions: The evaluation methods and delivery of the ImpulsePal app intervention are feasible, and the trial procedures, measures, and intervention are acceptable and satisfactory to the participants. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 14886370; http://www.isrctn.com/ISRCTN14886370 (Archived by WebCite at http://www.webcitation.org/76WcEpZ51) %M 31038464 %R 10.2196/11586 %U https://formative.jmir.org/2019/2/e11586/ %U https://doi.org/10.2196/11586 %U http://www.ncbi.nlm.nih.gov/pubmed/31038464 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12662 %T Smartphone-Based Meditation for Myeloproliferative Neoplasm Patients: Feasibility Study to Inform Future Trials %A Huberty,Jennifer %A Eckert,Ryan %A Larkey,Linda %A Kurka,Jonathan %A Rodríguez De Jesús,Sue A %A Yoo,Wonsuk %A Mesa,Ruben %+ College of Health Solutions, Arizona State University, 500 North 3rd St, Phoenix, AZ, 85004, United States, 1 402 301 1304, jhuberty@asu.edu %K mindfulness %K meditation %K smartphone %K mHealth %K cancer %K quality of life %D 2019 %7 29.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Myeloproliferative neoplasm (MPN) patients often report high symptom burden that persists despite the best available pharmacologic therapy. Meditation has gained popularity in recent decades as a way to manage cancer patient symptoms. Objective: The aim of this study was to examine the feasibility of 2 different consumer-based meditation smartphone apps in MPN patients and to examine the limited efficacy of smartphone-based meditation on symptoms compared with an educational control group. Methods: Patients (n=128) were recruited nationally through organizational partners and social media. Eligible and consented patients were enrolled into 1 of 4 groups, 2 of which received varying orders of 2 consumer-based apps (10% Happier and Calm) and 2 that received one of the apps alone for the second 4 weeks of the 8-week intervention after an educational control condition. Participants were asked to perform 10 min of meditation per day irrespective of the app and the order in which they received the apps. Feasibility outcomes were measured at weeks 5 and 9 with a Web-based survey. Feasibility outcomes were acceptability, demand, and limited efficacy for depression, anxiety, pain intensity, sleep disturbance, sexual function, quality of life, global health, and total symptom burden. Results: A total of 128 patients were enrolled across all 4 groups, with 73.4% (94/128) patients completing the intervention. Of the participants who completed the 10% Happier app, 61% (46/76) enjoyed it, 66% (50/76) were satisfied with the content, and 77% (59/76) would recommend to others. Of those who completed the Calm app, 83% (56/68) enjoyed it, 84% (57/68) were satisfied with the content, and 97% (66/68) would recommend to others. Of those who completed the educational control, 91% (56/61) read it, 87% (53/61) enjoyed it, and 71% (43/61) learned something. Participants who completed the 10% Happier app averaged 31 (SD 33) min/week; patients completing the Calm app averaged 71 (SD 74) min/week. 10% Happier app participants saw small effects on anxiety (P<.001 d=−0.43), depression (P=.02; d=−0.38), sleep disturbance (P=.01; d=−0.40), total symptom burden (P=.13; d=−0.27), and fatigue (P=.06; d=−0.30), and moderate effects on physical health (P<.001; d=0.52). Calm app participants saw small effects on anxiety (P=.29; d=−0.22), depression (P=.09; d=−0.29), sleep disturbance (P=.002; d=−0.47), physical health (P=.005; d=0.44), total symptom burden (P=.13; d=−0.27), and fatigue (P=.13; d=−0.27). Educational control participants (n=61) did not have effects on any patient-reported outcome except for a moderate effect on physical health (P<.001; d=0.77). Conclusions: Delivering meditation via the Calm app is feasible and scored higher in terms of feasibility when compared with the 10% Happier app. The Calm app will be used to implement a randomized controlled trial, testing the effects of meditation on symptom burden in MPNs. Trial Registration: ClinicalTrials.gov NCT03726944; https://clinicaltrials.gov/ct2/show/NCT03726944 (Archived by WebCite at http://www.webcitation.org/77MVdFJwM) %M 31033443 %R 10.2196/12662 %U http://formative.jmir.org/2019/2/e12662/ %U https://doi.org/10.2196/12662 %U http://www.ncbi.nlm.nih.gov/pubmed/31033443 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 4 %P e11800 %T Expanding Access to Depression Treatment in Kenya Through Automated Psychological Support: Protocol for a Single-Case Experimental Design Pilot Study %A Green,Eric P %A Pearson,Nicholas %A Rajasekharan,Sathyanath %A Rauws,Michiel %A Joerin,Angela %A Kwobah,Edith %A Musyimi,Christine %A Bhat,Chaya %A Jones,Rachel M %A Lai,Yihuan %+ Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, United States, 1 919 681 7289, eric.green@duke.edu %K telemedicine %K mental health %K depression %K artificial intelligence %K Kenya %K text messaging %K chatbot %K conversational agent %D 2019 %7 29.04.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Depression during pregnancy and in the postpartum period is associated with a number of poor outcomes for women and their children. Although effective interventions exist for common mental disorders that occur during pregnancy and the postpartum period, most cases in low- and middle-income countries go untreated because of a lack of trained professionals. Task-sharing models such as the Thinking Healthy Program have shown great potential in feasibility and efficacy trials as a strategy for expanding access to treatment in low-resource settings, but there are significant barriers to scale-up. We are addressing this gap by adapting Thinking Healthy for automated delivery via a mobile phone. This new intervention, Healthy Moms, uses an existing artificial intelligence system called Tess (Zuri in Kenya) to drive conversations with users. Objective: The objective of this pilot study is to test the Healthy Moms perinatal depression intervention using a single-case experimental design with pregnant women and new mothers recruited from public hospitals outside of Nairobi, Kenya. Methods: We will invite patients to complete a brief, automated screening delivered via text messages to determine their eligibility. Enrolled participants will be randomized to a 1- or 2-week baseline period and then invited to begin using Zuri. Participants will be prompted to rate their mood via short message service every 3 days during the baseline and intervention periods. We will review system logs and conduct in-depth interviews with participants to study engagement with the intervention, feasibility, and acceptability. We will use visual inspection, in-depth interviews, and Bayesian estimation to generate preliminary data about the potential response to treatment. Results: Our team adapted the intervention content in April and May 2018 and completed an initial prepilot round of formative testing with 10 women from a private maternity hospital in May and June. In preparation for this pilot study, we used feedback from these users to revise the structure and content of the intervention. Recruitment for this protocol began in early 2019. Results are expected toward the end of 2019. Conclusions: The main limitation of this pilot study is that we will recruit women who live in urban and periurban centers in one part of Kenya. The results of this study may not generalize to the broader population of Kenyan women, but that is not an objective of this phase of work. Our primary objective is to gather preliminary data to know how to build and test a more robust service. We are working toward a larger study with a more diverse population. International Registered Report Identifier (IRRID): DERR1-10.2196/11800 %M 31033448 %R 10.2196/11800 %U http://www.researchprotocols.org/2019/4/e11800/ %U https://doi.org/10.2196/11800 %U http://www.ncbi.nlm.nih.gov/pubmed/31033448 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e12482 %T A Mobile Smoking Cessation Intervention for Mexico (Vive sin Tabaco... ¡Decídete!): Single-Arm Pilot Study %A Cupertino,Ana Paula %A Cartujano-Barrera,Francisco %A Ramírez,Mariana %A Rodríguez-Bolaños,Rosibel %A Thrasher,James F %A Pérez-Rubio,Gloria %A Falfán-Valencia,Ramcés %A Ellerbeck,Edward F %A Reynales-Shigematsu,Luz Myriam %+ Department of Tobacco Research, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, Mexico, 52 777 101 2977, lreynales@insp.mx %K smoking %K smoking cessation %K mHealth %K text messages %K global health %D 2019 %7 25.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Of the 14.3 million Mexicans who smoke, only a minority take advantage of evidence-based approaches to smoking cessation. Mobile health interventions have the potential to increase the reach of effective cessation interventions in Mexico. Objective: This study aimed to assess the feasibility and acceptability of an innovative, personalized, and interactive smoking cessation mobile intervention developed for Mexican smokers. Methods: We recruited 40 Mexican smokers to participate in Vive sin Tabaco... ¡Decídete!, a smoking cessation program that uses a tablet-based decision support software to drive a 12-week text messaging smoking cessation program and pharmacotherapy support. Outcome measures included participant text messaging interactivity with the program, participant satisfaction, and 12-week verified abstinence using urinary cotinine testing or exhaled carbon monoxide. Results: Average age of the participants was 36 years (SD 10.7), and they were primarily male (65%, 26/40) with at least an undergraduate degree (62%, 25/40). Most participants (95%, 38/40) smoked daily and were interested in quitting in the next 7 days. As an indicator of participant interactivity, participants sent an average of 21 text messages during the 12-week intervention (SD 17.62). Of the 843 messages that participants sent to the program, only 96 messages (11.3%, 96/843) used keywords. At 12 weeks, 40% (16/40) of participants were biochemically verified (87%, 35/40, follow-up rate). The majority of participants (85%, 30/35) reported being very satisfied or extremely satisfied with the program. Conclusions: The Vive sin Tabaco... ¡Decídete! smoking cessation mobile intervention was accepted by participants, generated high satisfaction and high text messaging interactivity, and resulted in a noteworthy cessation rate at the end of treatment. This intervention is a promising strategy for smoking cessation in Mexico. Additional testing as a formal randomized clinical trial appears warranted. %M 31021326 %R 10.2196/12482 %U http://mhealth.jmir.org/2019/4/e12482/ %U https://doi.org/10.2196/12482 %U http://www.ncbi.nlm.nih.gov/pubmed/31021326 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12982 %T An Adaptive Mobile Health System to Support Self-Management for Persons With Chronic Conditions and Disabilities: Usability and Feasibility Studies %A Setiawan,I Made Agus %A Zhou,Leming %A Alfikri,Zakiy %A Saptono,Andi %A Fairman,Andrea D %A Dicianno,Brad Edward %A Parmanto,Bambang %+ Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6025 Forbes Tower, Pittsburgh, PA, 15260, United States, 1 412 383 6649, parmanto@pitt.edu %K mHealth %K adaptive mHealth %K mobile apps %K telemedicine %K personalized medicine %K self-management %K self-care %K caregivers %K chronic disease %K persons with disabilities %D 2019 %7 25.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Persons with chronic conditions and disabilities (PwCCDs) are vulnerable to secondary complications. Many of these secondary complications are preventable with proactive self-management and proper support. To enhance PwCCDs' self-management skills and conveniently receive desired support, we have developed a mobile health (mHealth) system called iMHere. In 2 previous clinical trials, iMHere was successfully used to improve health outcomes of adult participants with spina bifida and spinal cord injury. To further expand use of iMHere among people with various types of disabilities and chronic diseases, the system needs to be more adaptive to address 3 unique challenges: 1) PwCCDs have very diverse needs with regards to self-management support, 2) PwCCDs’ self-management needs may change over time, and 3) it is a challenge to keep PwCCDs engaged and interested in long-term self-management. Objective: The aim of this study was to develop an adaptive mHealth system capable of supporting long-term self-management and adapting to the various needs and conditions of PwCCDs. Methods: A scalable and adaptive architecture was designed and implemented for the new version, iMHere 2.0. In this scalable architecture, a set of mobile app modules was created to provide various types of self-management support to PwCCDs with the ability to add more as needed. The adaptive architecture empowers PwCCDs with personally relevant app modules and allows clinicians to adapt these modules in response to PwCCDs’ evolving needs and conditions over time. Persuasive technologies, social support, and personalization features were integrated into iMHere 2.0 to engage and motivate PwCCDs and support long-term usage. Two initial studies were performed to evaluate the usability and feasibility of the iMHere 2.0 system. Results: The iMHere 2.0 system consists of cross-platform client and caregiver apps, a Web-based clinician portal, and a secure 2-way communication protocol for providing interactions among these 3 front-end components, all supported by a back-end server. The client and caregiver apps have 12 adaptive app modules to support various types of self-management tasks. The adaptive architecture makes it possible for PwCCDs to receive personalized app modules relevant to their conditions with or without support from various types of caregivers. The personalization and persuasive technologies in the architecture can be used to engage PwCCDs for long-term usage of the iMHere 2.0 system. Participants of the usability study were satisfied with the iMHere 2.0 client app. The feasibility evaluation revealed several practical issues to consider when implementing the system on a large scale. Conclusions: We developed an adaptive mHealth system as a novel method to support diverse needs in self-management for PwCCDs that can dynamically change over time. The usability of the client app is high, and it was feasible for PwCCDs to use in supporting personalized and evolving self-care needs. %M 31021324 %R 10.2196/12982 %U http://formative.jmir.org/2019/2/e12982/ %U https://doi.org/10.2196/12982 %U http://www.ncbi.nlm.nih.gov/pubmed/31021324 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e11832 %T Effect of Serial Anthropometric Measurements and Motivational Text Messages on Weight Reduction Among Workers: Pilot Randomized Controlled Trial %A Chan,Renee %A Nguyen,Matthew %A Smith,Rachel %A Spencer,Sarah %A Pit,Sabrina Winona %+ School Of Medicine, University Centre for Rural Health, Western Sydney University, 62 Uralba Street, Lismore, 2480, Australia, 61 266207570, sabrina.pit@sydney.edu.au %K text messages %K obesity %K waist-hip ratio %K weight reduction programs %K mHealth %D 2019 %7 24.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obesity is an endemic problem with significant health and financial consequences. Text messaging has been shown to be a simple and effective method of facilitating weight reduction. In addition, waist-to-hip ratio (WHR) has emerged as a significant anthropometric measure. However, few studies have examined the effect of serial anthropometric self-measurement combined with text messaging. Objective: The primary aim of this study was to assess whether an 8-week program, consisting of weekly serial self-measurements of waist and hip circumference, combined with motivational text messages, could reduce WHR among Australian workers. Methods: This was a community-based, participant-blinded, staggered-entry, parallel group study. Adult workers with access to mobile phones were eligible and recruited through an open access Web-based survey. Participants were randomly allocated to receive intervention or control messages for 8 weeks. Outcome data were self-assessed through a Web-based survey. Results: A total of 60 participants were randomized with 30 participants each allocated to a control and an intervention group. There was no significant change in WHR (P=.43), and all secondary outcome measures did not differ between the intervention group and the control group at the end of the 8-week intervention. Both groups, however, showed a significant decrease in burnout over time (mean [SE]: pre 4.80 [0.39] vs post 3.36 [0.46]; P=.004). The intervention uptake followed a downward trend. Peak participant replies to weekly self-measurements were received in week 3 (14/23, 61%) and the least in week 8 (8/23, 35%). No harm was found to result from this study. Conclusions: This study is an innovative pilot trial using text messaging and serial anthropometric measurements in weight management. No change was detected in WHRs in Australian workers over 8 weeks; therefore, it could not be concluded whether the intervention affected the primary outcome. However, these results should be interpreted in the context of limited sample size and decreasing intervention uptake over the course of the study. This pilot trial is useful for informing and contributing to the design of future studies and the growing body of literature on serial self-measurements combined with text messaging. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616001496404; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371696&isReview=true (Archived by WebCite at http://www.webcitation.org/73UkKFjSw) %M 31017585 %R 10.2196/11832 %U https://mhealth.jmir.org/2019/4/e11832/ %U https://doi.org/10.2196/11832 %U http://www.ncbi.nlm.nih.gov/pubmed/31017585 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e10755 %T Image-Based Mobile System for Dietary Management in an American Cardiology Population: Pilot Randomized Controlled Trial to Assess the Efficacy of Dietary Coaching Delivered via a Smartphone App Versus Traditional Counseling %A Choi,Brian G %A Dhawan,Tania %A Metzger,Kelli %A Marshall,Lorraine %A Akbar,Awdah %A Jain,Tushina %A Young,Heather A %A Katz,Richard J %+ Department of Medicine, School of Medicine & Health Sciences, The George Washington University, 2150 Pennsylvania Ave NW, Suite 4-417, Washington, DC, 20037, United States, 1 2027412323, bchoi@mfa.gwu.edu %K Mediterranean diet %K telemedicine %K cardiovascular disease %K randomized controlled trial %D 2019 %7 23.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Randomized controlled trials conducted in Mediterranean countries have shown that the Mediterranean diet lowers adverse cardiovascular events. In the American population, diet remains the biggest uncontrolled risk factor for cardiovascular disease. Objective: This study aimed to test the hypothesis that asynchronous dietary counseling supplied through a custom smartphone app results in better adherence to a Mediterranean diet in a non-Mediterranean population than traditional standard-of-care (SOC) counseling. Methods: In total, 100 patients presenting to the cardiology clinic of an academic medical center were randomized to either the SOC or smartphone app-based experimental (EXP) Mediterranean diet intervention after informed consent and 1 hour of individual face-to-face dietary counseling with a registered dietitian. Participants in EXP received a custom smartphone app that reinforced the Mediterranean diet, whereas participants in SOC received 2 additional sessions of in-person dietary counseling with the registered dietitian—30 min at 1 month and 30 min at 3 months. Preexisting knowledge of a Mediterranean diet was measured by the validated Mediterranean Diet Score (MDS) instrument. Baseline height, weight, blood pressure (BP), and laboratory biomarkers were collected. At 1, 3, and 6 months, participants presented for a follow-up appointment to assess compliance to the Mediterranean diet using the MDS as well as a patient satisfaction survey, BP, and weight. Repeat laboratory biomarkers were performed at 3 and 6 months. Results: Enrolled participants had a mean age with SE of 56.6 (SD 1.7) for SOC and 57.2 (SD 1.8) for EXP; 65.3% of SOC and 56.9% of EXP were male, and 20.4% of SOC and 35.3% of EXP had coronary artery disease. There were no significant differences between EXP and SOC with regard to BP, lipid parameters, hemoglobin A1c, or C-reactive protein (CRP). Participants in EXP achieved a significantly greater weight loss on average of 3.3 pounds versus 3.1 pounds for participants in SOC, P=.04. Adherence to the Mediterranean diet increased significantly over time for both groups (P<.001), but there was no significant difference between groups (P=.69). Similarly, there was no significant difference in diet satisfaction between EXP and SOC, although diet satisfaction increased significantly over time for both groups. The proportion of participants with high Mediterranean diet compliance (defined as the MDS ≥9) increased significantly over time (P<.001)—from 18.4% to 57.1% for SOC and 27.5% to 64.7% for EXP; however, there was no significant difference between the groups. Conclusions: Both traditional SOC counseling and smartphone-based counseling were effective in getting participants to adhere to a Mediterranean diet, and these dietary changes persisted even after counseling had ended. However, neither method was more effective than the other. This pilot study demonstrates that patients can change to and maintain a Mediterranean diet with either traditional or smartphone app-based nutrition counseling. Trial Registration: ClinicalTrials.gov NCT03897426;https://clinicaltrials.gov/ct2/show/NCT03897426 %M 31012860 %R 10.2196/10755 %U https://mhealth.jmir.org/2019/4/e10755/ %U https://doi.org/10.2196/10755 %U http://www.ncbi.nlm.nih.gov/pubmed/31012860 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e12223 %T Postvaccination Fever Response Rates in Children Derived Using the Fever Coach Mobile App: A Retrospective Observational Study %A Ahn,Sang Hyun %A Zhiang,Jooho %A Kim,Hyery %A Chang,Seyun %A Shin,Jaewon %A Kim,Myeongchan %A Lee,Yura %A Lee,Jae-Ho %A Park,Yu Rang %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2228 2493, yurangpark@yuhs.ac %K patient-generated health data %K vaccination %K postvaccination fever %K digital health care %K mobile app %D 2019 %7 22.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Postvaccination fever is a mild adverse event that naturally improves without complications, but is highly prevalent and can be accompanied by febrile convulsions in some cases. These adverse effects may cause parents to delay or avoid vaccinating their children. Objective: This study aimed to identify postvaccination fever patterns and the ability of antipyretics to affect changes in these patterns from data collected from a mobile app named Fever Coach. Methods: Data provided by parents of feverish children derived from a mobile app, Fever Coach, were used to identify postvaccination fever patterns according to vaccinations and the use of antipyretic drugs. We selected single vaccination records that contained five or more body temperature readings performed within 48 hours of vaccination, and we analyzed postvaccination fever onset, offset, duration, and maximum body temperature. Through observing the postvaccination fever response to vaccination, we identified the effects of antipyretic drugs on postvaccination fever onset, offset, and duration times; the extent of fever; and the rate of decline. We also performed logistic regression analysis to determine demographic variables (age, weight, and sex) involved in relatively high fevers (body temperature ≥39°C). Results: The total number of Fever Coach users was 25,037, with 3834 users having entered single vaccination records, including 4448 vaccinations and 55,783 body temperature records. Most records were obtained from children receiving the following vaccinations: pneumococcus (n=2069); Japanese encephalitis (n=911); influenza (n=669); diphtheria, tetanus, and pertussis (n=403); and hepatitis A (n=252). According to the 4448 vaccination records, 3427 (77.05%) children had taken antipyretic drugs, and 3238 (89.15%) children took antibiotics at body temperatures above 38°C. The number of children taking antipyretics at a body temperature of 38°C was more than four times that of those taking antipyretics at 37.9°C (307 vs 67 cases). The number of instances in which this temperature threshold was reached was more than four times greater than the number when the temperature was 37.9°C. A comparative analysis of antipyretic and nonantipyretic cases showed there was no difference in onset time; however, offset and duration times were significantly shorter in nonantipyretic cases than in antipyretic cases (P<.001). In nonantipyretic cases, offset times and duration times were 9.9 and 10.1 hours shorter, respectively, than in antipyretic cases. Body temperatures also decreased faster in nonantipyretic cases. Influenza vaccine-associated fevers lasted relatively longer, whereas pneumococcus vaccine-associated fevers were relatively short-lived. Conclusions: These findings suggest that postvaccination fever has its own fever pattern, which is dependent on vaccine type and the presence of antipyretic drugs, and that postvaccination temperature monitoring may ease fever phobia and reduce the unnecessary use of antipyretics in medical care. %M 31008712 %R 10.2196/12223 %U http://mhealth.jmir.org/2019/4/e12223/ %U https://doi.org/10.2196/12223 %U http://www.ncbi.nlm.nih.gov/pubmed/31008712 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e12081 %T Effectiveness of Low Glycemic Index Diet Consultations Through a Diet Glycemic Assessment App Tool on Maternal and Neonatal Insulin Resistance: A Randomized Controlled Trial %A Zhang,Yi %A Wang,Liping %A Yang,Wenhong %A Niu,Dayan %A Li,Chunying %A Wang,Liling %A Gu,Ping %A Xia,Yingqian %A Shen,Ying %A Yan,Juhua %A Zhao,Qian %A Mu,Kai %A Yan,Weili %+ Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China, 86 21064931215, yanwl@fudan.edu.cn %K glycemic index %K overweight %K pregnancy %K insulin resistance %K randomized controlled trial %D 2019 %7 18.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Low glycemic index (LGI) diet has shown to be effective in reducing maternal and neonatal complications in high-risk pregnancies. Objective: This trial aimed to examine the effectiveness of individualized LGI diet consultations based on the accurate diet glycemic load (GL) assessment tool on maternal and neonatal insulin resistance levels and diet behavior changes in overweight and obese pregnant women. Methods: Overweight and obese pregnant women were recruited before 16 weeks of gestation and randomized to the LGI diet arm or the control arm. All participants received standard dietary education according to the Chinese Dietary Guide for Pregnant Women. In the intervention arm, additional individualized dietary GL assessments were performed using an app and instructions of lowering diet glycemic index (GI) to achieve LGI diet were provided by a clinical dietitian at early, middle, and late gestation. Primary outcomes were serum insulin at late gestation, incidence of gestational diabetes mellitus (GDM) for mothers, and cord blood C-peptide level of neonates. Results: In total, 400 subjects were randomized and received different interventions. There were no significant differences in maternal serum insulin levels (13.2 [9.3−13.2] uU/mL vs 12.4 [10.5−12.4] uU/mL), incidence of GDM (45 [22.5%] vs 43 [21.5%]), or cord blood C-peptide levels (mean 0.9ng/mL [SD 0.7] vs mean 0.8ng/mL [SD 0.6]) in the intervention group compared with the controls. The diet GI at late gestation was similar (mean 63.2 [SD 10.4] vs mean 64.3 [SD 10.4]), whereas greater diet fiber intake was observed in the intervention group (mean 11.6 grams [SD 8.0] vs mean 9.0 grams [SD 5.6]; P=.006). Adherence measurements did not significantly differ between 2 groups. Conclusions: Individualized LGI diet consultations for overweight and obese pregnant women failed to make a significant difference in maternal or neonatal insulin resistance compared with the standard gestational diet consultation. Trial Registration: ClinicalTrials.gov NCT01628835; http://clinicaltrials.gov/ct2/show/NCT01628835 (Archived by WebCite at http://www.webcitation.org/77LHgWP0k) %M 30998227 %R 10.2196/12081 %U http://mhealth.jmir.org/2019/4/e12081/ %U https://doi.org/10.2196/12081 %U http://www.ncbi.nlm.nih.gov/pubmed/30998227 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 4 %P e13119 %T Reducing Alcohol Consumption Among Risky Drinkers in the General Population of Sweden Using an Interactive Mobile Health Intervention: Protocol for a Randomized Controlled Trial %A Bendtsen,Marcus %A McCambridge,Jim %+ Department of Medical and Health Sciences, Linköping University, Linköping University, Linköping, 58183, Sweden, 46 733140708, marcus.bendtsen@liu.se %K telemedicine %K alcohol drinking %K randomized controlled trial %D 2019 %7 18.04.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Harmful use of alcohol continues to be a leading contributor to premature deaths globally. Not only does harmful drinking have consequences for the individuals consuming at increased levels, but it may also result in a range of negative consequences for their family members and friends. Interventions delivered via mobile phones (mobile health [mHealth] interventions) could potentially support risky drinkers seeking help to reduce their alcohol consumption. Objective: This protocol describes a randomized controlled trial that aims to validly estimate the effect of a novel mHealth intervention targeting risky drinkers in the general population of Sweden. Nested within the trial are 3 substudies that focus on methodological and user satisfaction research questions. Methods: A 2-arm parallel group randomized controlled trial will be employed to estimate the effect of the novel intervention. Participants will be recruited through Web advertisements and social media. The inclusion criteria are as follows: 18 years or older, ownership of a mobile phone, and being classified as a risky drinker according to Swedish guidelines. Participants allocated to the intervention group will receive a novel mHealth intervention. The intervention consists of weekly screening, personalized feedback on current consumption, functions allowing for planning of future consumption, as well as a series of messages delivered throughout the week. Participants allocated to the control group will receive a short message regarding negative consequences of alcohol consumption and a hyperlink that offers more information. Following 2 and 4 months after randomization, both groups will be asked to complete follow-up questionnaires (2-month interval being primary). Primary outcomes are weekly alcohol consumption and heavy episodic drinking. Participants in the control group will be given access to the novel intervention after completing the 4-month follow-up. The trial includes 3 substudies: We will explore whether the mode of presenting information before participants giving informed consent affects participation rates and recall of trial parameters, investigate if the content of the short message received by the control group affects study outcomes and requests for more information, and explore user satisfaction with the intervention and reactions of the control group. Results: Participant recruitment is planned to begin in April 2019 and to last for a maximum of 24 months. The first dataset will be available approximately 2 months after the final participant has been recruited, and the final dataset will be available approximately 2 months later. No participants had been recruited at the time of submitting this protocol. Conclusions: If found effective, the intervention has the potential to reduce negative consequences of alcohol consumption for individuals. The technology has been designed to have potential for extensive reach among those who may benefit. Trial Registration: ISRCTN Registry ISRCTN48317451; http://www.isrctn.com/ISRCTN48317451 (Archived by WebCite at http://www.webcitation.org/779tKLsu3) International Registered Report Identifier (IRRID): PRR1-10.2196/13119 %M 30998221 %R 10.2196/13119 %U http://www.researchprotocols.org/2019/4/e13119/ %U https://doi.org/10.2196/13119 %U http://www.ncbi.nlm.nih.gov/pubmed/30998221 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e13250 %T Application of Mobile Health Technologies Aimed at Salt Reduction: Systematic Review %A Ali,Shahmir H %A Luo,Rong %A Li,Yuan %A Liu,Xiangjun %A Tang,Chengyao %A Zhang,Puhong %+ The George Institute for Global Health, Peking University Health Science Center, Level 18, Tower B, Horizon Tower, No 6 Zhichun Rd Haidian District, Beijing,, China, 86 10 8280 0577 ext 512, zpuhong@georgeinstitute.org.cn %K mobile health %K sodium %K diet %K cardiovascular diseases %K systematic review %D 2019 %7 17.04.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: High salt consumption has contributed to the rise of noncommunicable diseases around the world. The application of mobile health (mHealth) technologies has witnessed rapid growth in recent years. However, evidence to support mHealth interventions to confront the challenge of salt reduction has not yet been critically reviewed. Objective: The aim of this study was to identify, characterize, and evaluate mHealth interventions aimed at salt reduction across the world. Methods: A systematic search of studies in English or Chinese language published from January 1, 1992 to July 31, 2017 was conducted using 4 English databases (PubMed, MEDLINE, Global Health, and Cochrane) and 3 Chinese databases (Wanfang, China Science and Technology Journal, and China National Knowledge of Infrastructure). All studies directly using mobile technologies in health care with a primary or secondary objective of reducing dietary salt consumption were included. Results: A total of 1609 articles were found using the search strategy, with 11 full articles (8 English and 3 Chinese) being included for data extraction, including 11 interventional studies. Overall, few high-quality interventions were identified. Most interventions were limited by small study population sample sizes, lack of control groups, and short follow-up times, all of which were obstacles in generating long-term scalable approaches. Most interventions employed short message service as a platform for mHealth interventions, whereas some innovative mHealth technologies were also explored. Most interventions had a primary focus of improving awareness of dietary salt consumption. The outcome variables used to measure intervention effectiveness included 24-hour urinary sodium excretion, spot urine sampling, dietary records, and indirect behavior or knowledge indicators targeting salt consumption. Although most interventions displayed positive outcome results, none of them provided reliable evidence to evaluate the effectiveness of salt reduction. Conclusions: Salt reduction in mHealth initiatives remains relatively unexplored; however, studies that did intervene on salt-reduction show the potential of mHealth as an effective intervention method. We provide 3 recommendations for future mHealth interventions in salt reduction—(1) increased use of new, innovative, and interactive mHealth technologies; (2) development of mHealth interventions with primary prevention measures and goals of salt reduction; and (3) large-scale, rigorously designed, and object-targeted clinical trials of mHealth interventions with appropriate quantitative outcome variables, in particular 24-hour urine sodium. %M 30994467 %R 10.2196/13250 %U http://mhealth.jmir.org/2019/4/e13250/ %U https://doi.org/10.2196/13250 %U http://www.ncbi.nlm.nih.gov/pubmed/30994467 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e12512 %T Physical Activity and Mobile Phone Apps in the Preschool Age: Perceptions of Teachers and Parents %A Ek,Anna %A Sandborg,Johanna %A Delisle Nyström,Christine %A Lindqvist,Anna-Karin %A Rutberg,Stina %A Löf,Marie %+ Department of Biosciences and Nutrition, The Innovative Use of Mobile Phones to Promote Physical Activity and Nutrition Across the Lifespan Research Group, Karolinska Institutet, , Huddinge,, Sweden, 46 8 585 866 02, anna.ek@ki.se %K child, preschool %K mHealth %K physical activity %K parents %K school teachers %K qualitative research %D 2019 %7 17.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity (PA) is already beneficial at the preschool age. In many countries, young children spend most of their days in the preschool setting, making it a common arena for PA interventions. Mobile health tools are becoming increasingly popular to promote PA in different populations; however, little is known about the interest for and how the preschool setting could incorporate such a tool. Objective: This study aimed to examine how teachers and parents perceive PA in preschool-aged children in general and their perceptions of how a mobile phone app could be used to promote PA in the preschool setting. Methods: Semistructured interviews were conducted with 15 teachers (93%, [14/15] women, mean age 43.5 years, 47%, [7/15] with a university degree and 10 parents [91%, 9/10] women, mean age 38.9 years, all with a university degree) recruited from 2 urban preschools in central Sweden. The interviews were recorded, fully transcribed, coded, and analyzed using thematic analysis by means of an inductive approach. Results: The analysis revealed 4 themes: (1) children are physically active by nature, (2) the environment as a facilitator or a barrier, (3) prerequisites of the adult world, and (4) an app in the preschool setting—challenges and possibilities. Parents and teachers perceived preschoolers as being spontaneously physically active; however, high-intensity PA was perceived as low. The PA was specifically performed during the day in the preschool. Identified facilitators of PA were access to safe and engaging outdoor environments such as forests, spacious indoor areas, and adult involvement. Adult involvement was considered especially important for children preferring sedentary activities. Identified barriers for PA were restricted indoor and outdoor space, rules for indoor activities, and lack of adult involvement because of time constraints. The teachers perceived that they had limited skills and experiences using apps in general, although they also acknowledged the increasing role of technological tools in the curriculum. Thus, the teachers expressed an interest for an app designed as a support tool for them, especially for situations when PA was limited because of perceived barriers. They suggested the app to include accessible information regarding the health benefits of PA in children linked to a library of activities for different settings and seasons. Parents suggested interactive app features including problem-solving tasks and music and dance, but not video clips as they made children passive. Conclusions: Vigorous PA was perceived as low in preschool-aged children. Future tailoring of interventions in the preschool setting should work around barriers and support facilitators to PA, especially PA of high intensity. In such work, an app could serve as a source of inspiration for PA in different ages, settings, and seasons and thus reduce environmental and structural inequalities in the preschool setting. %M 30994465 %R 10.2196/12512 %U http://mhealth.jmir.org/2019/4/e12512/ %U https://doi.org/10.2196/12512 %U http://www.ncbi.nlm.nih.gov/pubmed/30994465 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e11879 %T Assessing the Need for Mobile Health (mHealth) in Monitoring the Diabetic Lower Extremity %A Wallace,David %A Perry,Julie %A Yu,Janelle %A Mehta,Joshua %A Hunter,Paul %A Cross,Karen Michelle %+ Division of Plastic Surgery, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada, 1 416 864 6060 ext 77074, karen@drkarencross.ca %K mHealth %K diabetes %K diabetic foot ulcers %D 2019 %7 16.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Complications of the diabetic lower extremity (such as diabetic foot ulcers, DFUs) occur when monitoring is infrequent, and often result in serious sequelae like amputation or even death. Objective: To evaluate the potential application of mobile health (mHealth) to diabetic foot monitoring. We surveyed the self-management routines of a group of diabetic patients, as well as patient and clinician opinions on the use of mHealth in this context. Methods: Patients with DFUs in Toronto, Ontario, Canada completed a 25-item questionnaire addressing their foot care practices, mobile phone use, and views on mHealth. Wound care clinicians across Canada were also surveyed using a 9-item questionnaire. Results: Of the patients surveyed, 59/115 (51.3%) spend less than a minute checking their feet, and 17/115 (15%) of patients find it difficult to see their doctor or get to the hospital regularly. Mobile phone use was widespread in our patient cohort (93/115, 80.9%). Of mobile phone users, 68/93 (73.1%) would use a device on their mobile phone to help them check their feet. Of the clinicians who completed the questionnaire, only 7/202 (3.5%) were familiar with mHealth; however, 181/202 (92%) of clinicians expressed interest in using mHealth to monitor their patients between visits. Conclusions: Patient education or motivation and clinician training were identified as the major barriers to mHealth use in the diabetic lower extremity, which may be a viable mechanism to improve DFU monitoring practices. %M 30990455 %R 10.2196/11879 %U https://mhealth.jmir.org/2019/4/e11879/ %U https://doi.org/10.2196/11879 %U http://www.ncbi.nlm.nih.gov/pubmed/30990455 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 4 %N 2 %P e12985 %T Short Message Service Text Message Support for Weight Loss in Patients With Prediabetes: Pragmatic Trial %A Fischer,Henry H %A Durfee,Michael J %A Raghunath,Silvia G %A Ritchie,Natalie D %+ Denver Health and Hospital Authority, 777 Bannock St, Denver, CO, United States, 1 3034364200, henry.fischer@dhha.org %K eHealth %K prediabetes %K texting %K weight loss %D 2019 %7 15.04.2019 %9 Original Paper %J JMIR Diabetes %G English %X Background: To reach all 84.1 million US adults estimated to have prediabetes warrants need for low-cost and less burdensome alternatives to the National Diabetes Prevention Program (NDPP). In a previous randomized controlled trial, we demonstrated the efficacy of a 12-month short message service text message support program called SMS4PreDM amongst individuals with prediabetes. Objective: The study aimed to evaluate the implementation and effectiveness of SMS4PreDM in a pragmatic study following dissemination in a safety net health care system. Methods: English- and Spanish-speaking patients at risk for diabetes (eg, glycated hemoglobin 5.7-6.4) were referred by their providers and offered either NDPP classes, SMS4PreDM, or both. This analysis focuses on weight change among 285 SMS4PreDM-only participants who began the year-long intervention between October 2015 and April 2017 with accompanying pre- and postweights, as compared with 1233 usual-care control patients at risk for diabetes, who were identified from electronic health records during this time but not referred. Weight outcomes included time-related mean weight change and frequency of either ≥3% weight loss or gain. Mixed linear models adjusted for age, gender, race, ethnicity, preferred language, and baseline weight. A secondary analysis was stratified by language. We also assessed implementation factors, including retention and cost. Results: SMS4PreDM participants had high retention (259 of 285 patients or 91.0% completion at 12-months, ) and a time-related mean weight loss of 1.3 pounds (SE 0.74), compared with the control group’s slight mean weight gain of 0.25 pounds (SE 0.59; P=.004). Spanish-speaking SMS4PreDM participants (n=130) had a time-related mean weight loss of 1.11 pounds (SE 1.22) compared with weight gain of 0.96 pounds (SE 1.14) in Spanish-speaking controls (n=382, P<.001). English-speaking intervention participants (n=155) had a comparable time-related mean weight change (–0.89 pounds; SE 0.93) as English-speaking controls (n=828; 0.31 pounds gained; SE 0.62, P=.14). Overall, frequency of achieving ≥3% weight loss was comparable between groups (54 of 285 or 19.0% of SMS4PreDM participants [95% CI 14.8-23.9] vs 266 of 1233 or 21.6% of controls [95% CI 19.3-24.0]; P=.33). Nonetheless, more controls had ≥3% weight gain compared with intervention participants (337 of 1233 or 27.3% of controls [95% CI 24.9-29.9] vs 57 of 285 or 20.0% of SMS4PreDM participants [95% CI 16.8-25.1]; P=.01). SMS4PreDM delivery costs were US $100.92 per participant. Conclusions: Although SMS4PreDM was relatively low cost to deliver and demonstrated high retention, weight loss outcomes may not be sufficient to serve as a population health strategy. %M 30985289 %R 10.2196/12985 %U http://diabetes.jmir.org/2019/2/e12985/ %U https://doi.org/10.2196/12985 %U http://www.ncbi.nlm.nih.gov/pubmed/30985289 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e11819 %T Consumer-Based Wearable Activity Trackers Increase Physical Activity Participation: Systematic Review and Meta-Analysis %A Brickwood,Katie-Jane %A Watson,Greig %A O'Brien,Jane %A Williams,Andrew D %+ School of Health Science, College of Health and Medicine, University of Tasmania, Newnham Drive, Newnham, 7250, Australia, 61 0363245487, katiejane.brickwood@utas.edu.au %K exercise %K fitness trackers %K telemedicine %K meta-analysis %D 2019 %7 12.04.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The range of benefits associated with regular physical activity participation is irrefutable. Despite the well-known benefits, physical inactivity remains one of the major contributing factors to ill-health throughout industrialized countries. Traditional lifestyle interventions such as group education or telephone counseling are effective at increasing physical activity participation; however, physical activity levels tend to decline over time. Consumer-based wearable activity trackers that allow users to objectively monitor activity levels are now widely available and may offer an alternative method for assisting individuals to remain physically active. Objective: This review aimed to determine the effects of interventions utilizing consumer-based wearable activity trackers on physical activity participation and sedentary behavior when compared with interventions that do not utilize activity tracker feedback. Methods: A systematic review was performed searching the following databases for studies that included the use of a consumer-based wearable activity tracker to improve physical activity participation: Cochrane Controlled Register of Trials, MEDLINE, PubMed, Scopus, Web of Science, Cumulative Index of Nursing and Allied Health Literature, SPORTDiscus, and Health Technology Assessments. Controlled trials of adults comparing the use of a consumer-based wearable activity tracker with other nonactivity tracker–based interventions were included. The main outcome measures were physical activity participation and sedentary behavior. All studies were assessed for risk of bias, and the Grades of Recommendation, Assessment, Development, and Evaluation system was used to rank the quality of evidence. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement were followed. A random-effects meta-analysis was completed on the included outcome measures to estimate the treatment effect of interventions that included an activity tracker compared with a control group. Results: There was a significant increase in daily step count (standardized mean difference [SMD] 0.24; 95% CI 0.16 to 0.33; P<.001), moderate and vigorous physical activity (SMD 0.27; 95% CI 0.15 to 0.39; P<.001), and energy expenditure (SMD 0.28; 95% CI 0.03 to 0.54; P=.03) and a nonsignificant decrease in sedentary behavior (SMD −0.20; 95% CI −0.43 to 0.03; P=.08) following the intervention versus control comparator across all studies in the meta-analyses. In general, included studies were at low risk of bias, except for performance bias. Heterogeneity varied across the included meta-analyses ranging from low (I2=3%) for daily step count through to high (I2=67%) for sedentary behavior. Conclusions: Utilizing a consumer-based wearable activity tracker as either the primary component of an intervention or as part of a broader physical activity intervention has the potential to increase physical activity participation. As the effects of physical activity interventions are often short term, the inclusion of a consumer-based wearable activity tracker may provide an effective tool to assist health professionals to provide ongoing monitoring and support. %M 30977740 %R 10.2196/11819 %U https://mhealth.jmir.org/2019/4/e11819/ %U https://doi.org/10.2196/11819 %U http://www.ncbi.nlm.nih.gov/pubmed/30977740 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e10809 %T Quality of Blood Pressure Tracking Apps for the iPhone: Content Analysis and Evaluation of Adherence With Home Blood Pressure Measurement Best Practices %A Leong,Amanda Y %A Makowsky,Mark J %+ Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, 3-171 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada, 1 (780) 492 1735, makowsky@ualberta.ca %K hypertension %K mobile apps %K self-management %K blood pressure monitoring, ambulatory %K cross-sectional studies %D 2019 %7 12.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Blood pressure (BP) tracking apps may aid in hypertension (HTN) self-management, but app quality may be problematic. Objective: This study aimed to develop a content-dependent rating system for BP tracking apps and systematically evaluate BP tracking features, content-independent quality, functional characteristics, and educational comprehensiveness of English language iPhone apps developed with the primary purpose of tracking a consumer’s BP measurements. Methods: We created a 28-item checklist reflecting overall app quality and a simplified 2-item checklist to assess adherence with home BP monitoring best practices. Apps with educational information were evaluated for comprehensiveness on a 7-point scale and for consistency with evidence-based guidelines. Higher scores represent better quality and comprehensiveness. We searched the Canadian App Store on June 28, 2016, using the keywords hypertension and blood pressure. A total of 2 reviewers independently assessed apps according to the standardized template. We determined if paid apps, educational apps, or those rated ≥4 stars were of higher quality. Results: Of the 948 apps screened, 62 met the inclusion criteria. The mean overall quality score was 12.2 (SD 4.6, out of 28) and 6 apps (10%, 6/62) met the home BP monitoring best practice criteria. In all, 12 apps contained educational content (mean comprehensiveness 2.4, SD 1.6 out of 14), most commonly, background information on HTN. Apps with educational content (mean 15.1, SD 3.8 vs 11.8, SD 4.8; P=.03) or a ≥4 star rating (median 19, interquartile range [IQR] 15-20, vs 12, IQR 9-15; P=.02) had higher overall quality. Conclusions: The BP tracking apps reviewed had variable quality and few met the home BP monitoring best practice criteria. When deciding to recommend a specific BP tracking app, we suggest clinicians should evaluate whether the app allows input of duplicate BP readings in the morning and evening for at least seven days and presents the mean BP value for user-specified dates. Greater attention to home BP measurement best practices is required during app development. %M 30977739 %R 10.2196/10809 %U https://mhealth.jmir.org/2019/4/e10809/ %U https://doi.org/10.2196/10809 %U http://www.ncbi.nlm.nih.gov/pubmed/30977739 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e12289 %T Effectiveness and Feasibility of a Remote Lifestyle Intervention by Dietitians for Overweight and Obese Adults: Pilot Study %A Haas,Karin %A Hayoz,Stefanie %A Maurer-Wiesner,Susanne %+ Applied Research & Development Nutrition and Dietetics, Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, Bern, 3014, Switzerland, 41 31 848 3553, karin.haas@bfh.ch %K remote consultation %K obesity %K weight loss %K mobile app %K behavior therapy %K healthy lifestyle %K healthy diet %D 2019 %7 11.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To tackle the problem of obesity and related diseases in Switzerland, cost-efficient, effective, and innovative primary health care interventions for weight management are required. In this context, Oviva has developed a scalable technology for registered dietitians to counsel overweight and obese patients via a mobile phone app. Objective: The aim of this study was to evaluate the effectiveness and feasibility of weight loss counseling by dietitians using a mobile phone app for patients with overweight and obesity. Methods: In this pre- and posttest pilot study, overweight and obese adults participated in a 1-year behavioral intervention to lose weight through remote counseling by dietitians in the German-speaking part of Switzerland. The study started in April 2016 and finished in May 2018. Participants received individual counseling through the app and the exchange with the dietitian focused on regular feedback on photo-based food log, motivation, and education. The contents were tailored to the individual lifestyle goal set. The predefined intensity of remote counseling decreased during the year. Group chat could be used. The outcomes examined were changes in weight (primary outcome), hemoglobin A1c, fasting glucose, fasting insulin, triglyceride, high-density lipoprotein cholesterol, blood pressure (BP), body mass index (BMI), waist circumference, body fat, and responses to a self-administered questionnaire with questions regarding participants’ physical activity, dietary assessment, and health-related quality of life. Changes were tested at baseline, after 3 months, and after 12 months, as well as between the third and the 12th month. Results: In total, 36 women and 7 men, with a mean age of 40.6 years, participated and 36 participants completed the study. Median weight change after the first 12 weeks was −3.8 kg (range: −15 to 2.4 and P<.001), between week 12 and week 52 it was −1.1 kg (range: −9.7 to 7 and P=.08), and the median change during the entire period of intervention was −4.9 kg (range: −21.9 to 7.5 and P<.001). Furthermore, changes in BMI, waist circumference, body fat, and BP between baseline and 12 weeks and between baseline and 52 weeks were also significant. Significant changes in certain eating habits were also demonstrated (higher frequency of vegetable, fruit, and breakfast consumption and lower frequency of alcohol, sweet, and fat consumption). Conclusions: In addition to the professional skills of a dietitian, a profession-specific app such as Oviva can provide effective support that meets the needs of dietitians and clients on the long path of behavioral change and sustainable weight reduction. Trial Registration: ClinicalTrials.gov NCT02694614; https://clinicaltrials.gov/ct2/show/NCT02694614 (Archived by WebCite at http://www.webcitation.org/76gYkGOIc) %M 30973338 %R 10.2196/12289 %U https://mhealth.jmir.org/2019/4/e12289/ %U https://doi.org/10.2196/12289 %U http://www.ncbi.nlm.nih.gov/pubmed/30973338 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e11664 %T Neighborhood Deprivation and the Effectiveness of Mobile Health Coaching to Improve Periconceptional Nutrition and Lifestyle in Women: Survey in a Large Urban Municipality in the Netherlands %A Gootjes,Dionne V %A van Dijk,Matthijs R %A Koster,Maria PH %A Willemsen,Sten P %A Steegers,Eric AP %A Steegers-Theunissen,Régine PM %+ Department of Obstetrics and Gynecology, Erasmus Medical Center, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, 3015 GD, Netherlands, 31 107043598, r.steegers@erasmusmc.nl %K pregnancy %K telemedicine %K lifestyle %K nutritional status %K preconception care %D 2019 %7 11.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In 2011, we launched the Smarter Pregnancy mobile health (mHealth) coaching program, which has shown to effectively improve inadequate nutrition and lifestyle behaviors in women before and during pregnancy. It is known that in deprived neighborhoods, risk factors for adverse pregnancy outcomes like inadequate nutrition and lifestyle behaviors accumulate. However, it has not yet been investigated whether the Smarter Pregnancy program is equally effective in women living in deprived neighborhoods. Objective: This paper aimed to study the associations between neighborhood deprivation and improvement of inadequate nutrition and lifestyle behaviors of women who were either contemplating pregnancy or already pregnant and subscribed to the Smarter Pregnancy program. Methods: We performed an additional analysis on data from women who used the Smarter Pregnancy program from 2011 to 2016. The program comprised 24 weeks of coaching on 5 nutrition and lifestyle behaviors, of which adequate intakes or lifestyle behaviors were defined as an intake of 200 grams or above of vegetables, 2 pieces of fruit, daily folic acid supplement use of 400 µg per day, and no smoking or alcohol consumption. Neighborhood deprivation was determined according to the status scores of the Netherlands Institute for Social Research. Logistic regression analyses and generalized estimating equation models were used to assess the associations between the neighborhood status score (NSS) and the improvement of inadequate nutrition and lifestyle behaviors, taking into account the behaviors at baseline. We adjusted the analyses for maternal age, body mass index, geographic origin, pregnancy status, and participation as a couple. Results: Of the 2554 women included, 521 participated with their male partner. Overall, daily vegetable intake was most frequently inadequate at the start of the program (77.72, 1985/2554). Women with a higher NSS (ie, nondeprived neighborhood) smoked less often (adjusted odds ratio [OR] 0.85; 95% CI 0.77-0.93), consumed alcohol more often (adjusted OR 1.14, 95% CI 1.04-1.24), and were less likely to complete the 24 weeks of coaching (OR 0.91, 95% CI 0.88-0.95) compared with women who lived in a neighborhood with a low NSS (ie, deprived). In the total group, the relative improvement of inadequate nutrition and lifestyle behaviors after 24 weeks of coaching was between 26% and 64%. NSS was negatively associated with this improvement, indicating that women with a higher NSS were less likely to improve inadequate nutrition and lifestyle behaviors, especially vegetable intake (adjusted OR 0.89, 95% CI 0.82-0.97). Conclusions: The Smarter Pregnancy mHealth coaching program empowers women to improve inadequate nutrition and lifestyle behaviors. Unexpectedly, the program seemed more effective in women living in deprived neighborhoods. It is important to unravel differences in needs and behaviors of specific target groups to further tailor the mHealth program on the basis of demographic characteristics like neighborhood deprivation. %M 30973345 %R 10.2196/11664 %U https://mhealth.jmir.org/2019/4/e11664/ %U https://doi.org/10.2196/11664 %U http://www.ncbi.nlm.nih.gov/pubmed/30973345 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e11531 %T Relative Validity of a Method Based on a Smartphone App (Electronic 12-Hour Dietary Recall) to Estimate Habitual Dietary Intake in Adults %A Béjar,Luis María %A García-Perea,María Dolores %A Reyes,Óscar Adrián %A Vázquez-Limón,Esther %+ Department of Preventive Medicine and Public Health, School of Medicine, University of Seville, Institute of Anatomy, 3rd Floor, Sánchez-Pizjuán Avenue, Seville, 41009, Spain, 34 954551771, lmbprado@us.es %K epidemiologic methods %K diet records %K mobile apps %K nutrition assessment %D 2019 %7 11.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Accurate dietary assessment is key to understanding nutrition-related outcomes and for estimating the dietary change in nutrition-based interventions. When researching the habitual consumption of selected food groups, it is essential to be aware of factors that could possibly affect reporting accuracy. Objective: This study aimed to evaluate the relative validity of the current-day dietary recall, a method based on a smartphone app called electronic 12-hour dietary recall (e-12HR), to categorize individuals according to habitual intake, in the whole sample of adults and in different strata thereof. Methods: University students and employees over 18 years recorded the consumption of 10 selected groups of food using e-12HR during 28 consecutive days. During this period, they also completed 4 dietary records. Once the period was finished, the subjects then completed a food frequency questionnaire (FFQ) and a usability-rating questionnaire for e-12HR. The food group intakes estimated by the e-12HR app, the dietary records, and the FFQ were categorized into sextiles: less than once a week, once or twice a week, 3-4 times a week, 5-6 times a week, once or twice a day, and 3 or more times a day. The 10 selected groups with e-12HR were compared with 4 dietary records and an FFQ reference method, in the whole sample and in different strata thereof: age (years): <25 and ≥25; gender: females and males; occupation: students and employees; smoking: no and yes; physical activity (minutes/week): ≥150 and <150; and body mass index (kg/m2): <25 and ≥25. The association between the different methods was assessed using Spearman correlation coefficient (SCC). Cross-classification and kappa statistic were used as a measure of agreement between the different methods. Results: In total, 203 participants completed the study (56.7% [115/203] women, and 43.3% [88/203] men). For all food groups and all participants, the mean SCC for e-12HR versus FFQ was 0.67 (≥0.62 for all strata). On average, 50.7% of participants were classified into the same category (≥47.0% for all strata) and 90.2% within the nearest category (≥88.6% for all strata). Mean weighted kappa was 0.49 (≥0.44 for all strata). For e-12HR versus RDs, mean SCC was 0.65 (≥0.57 for all strata). On average, 50.0% of participants were classified into the same category (≥47.0% for all strata) and 88.2% within the nearest category (≥86.1% for all strata). Mean weighted kappa was 0.50 (≥0.44 for all strata). Conclusions: The results indicate that e-12HR generated categories of dietary intake highly comparable with the 2 reference methods in the whole sample and in different strata thereof. The inclusion of photographs to facilitate estimation of the servings consumed generated correlation/agreement data between e-12HR and the FFQ that were similar to a previous study using an older version of the app, which did not include photographs. %M 30973343 %R 10.2196/11531 %U https://mhealth.jmir.org/2019/4/e11531/ %U https://doi.org/10.2196/11531 %U http://www.ncbi.nlm.nih.gov/pubmed/30973343 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e12210 %T The Mindfulness App Trial for Weight, Weight-Related Behaviors, and Stress in University Students: Randomized Controlled Trial %A Lyzwinski,Lynnette Nathalie %A Caffery,Liam %A Bambling,Matthew %A Edirippulige,Sisira %+ University of Queensland, School of Medicine, Centre for Online Health, Princess Alexandra Hospital, Building 33 Ground Floor, Woloongabba, 4102, Australia, 61 7 3176 7403, lynnette.lyzwinski@uqconnect.edu.au %K mobile applications %K mindfulness %K body weight %K feeding behavior %K exercise %K stress, psychological %K students %D 2019 %7 10.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: University students are at risk of weight gain during their studies. Key factors related to weight gain in this population include unhealthy weight-related behaviors because of stress. Mindfulness holds promise for weight management. However, there has not been any previous trial that has explored the effectiveness of a student-tailored mindfulness app for stress, weight-related behaviors, and weight. There is limited evidence that current mindfulness apps use evidence-based mindfulness techniques. A novel app was developed that combined evidence-based, mindfulness-based stress reduction and mindful eating (ME) techniques that were tailored to university students, with student-relevant themes for targeting weight behaviors, weight, and stress. Objectives: The aim of this study was to test the effectiveness, acceptability, and feasibility of a student-tailored mindfulness app for weight, weight-related behaviors, and stress. Testing this app in a rigorous randomized controlled trial (RCT) for these outcomes is a novelty and contribution to this emerging field. Methods: A 2-arm RCT of an 11-week duration was undertaken at the University of Queensland. Students were either randomized to the mindfulness app (n=45) or to a behavioral self-monitoring electronic diary (e-diary; n=45) for diet and exercise. Analysis of covariance was used to compare differences in weight, stress, mindfulness, ME, physical activity, and eating behaviors between both groups. Results: Neither the mindfulness app group nor the e-diary group lost weight and there were no differences between the groups at follow-up. The mindfulness app group had significantly lower stress levels (P=.02) (adherers only), lower emotional eating (P=.02), and uncontrolled eating (P=.02) as well as higher mindfulness (P≤.001) and ME levels overall (P≤.001). The e-diary group had higher metabolic equivalents of moderate activity levels (P≤.01). However, the effect sizes were small. Regular adherence to mindfulness exercises in the app was low in the group. The majority of students (94%) liked the app and found it to be acceptable. Compared with other exercises, the most helpful reported meditation was the short breathing exercise observing the breath (39.4% [13/33] preferred it). This was the first RCT that tested a mindfulness app for weight and weight-related behaviors in students. The modest level of user adherence likely contributes to the lack of effect on weight loss. However, there was a small, albeit promising, effect on weight-related eating behavior and stress. Conclusions: A mindfulness app demonstrated effectiveness for stress, eating behaviors, mindfulness, and ME, but the effect sizes were small. Future studies should be conducted over longer periods of time and with greater participant compliance. Trial Registration: Australian New Zealand Trial Registry ACTRN12616001349437; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371370 (Archived by WebCite at http://www.webcitation.org/761cc2K6ft) %M 30969174 %R 10.2196/12210 %U https://mhealth.jmir.org/2019/4/e12210/ %U https://doi.org/10.2196/12210 %U http://www.ncbi.nlm.nih.gov/pubmed/30969174 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e10859 %T Technology-Based Alcohol Interventions in Primary Care: Systematic Review %A Ramsey,Alex T %A Satterfield,Jason M %A Gerke,Donald R %A Proctor,Enola K %+ Department of Psychiatry, Washington University School of Medicine, 660 South Euclid, Campus Box 8134, St Louis, MO, 63110, United States, 1 3143625370, aramsey@wustl.edu %K alcohol drinking %K risky health behavior %K alcohol-related disorders %K internet %K computers %K mobile health %K primary health care %K implementation science %K review %D 2019 %7 08.04.2019 %9 Review %J J Med Internet Res %G English %X Background: Primary care settings are uniquely positioned to reach individuals at risk of alcohol use disorder through technology-delivered behavioral health interventions. Despite emerging effectiveness data, few efforts have been made to summarize the collective findings from these delivery approaches. Objective: The aim of this study was to review recent literature on the use of technology to deliver, enhance, or support the implementation of alcohol-related interventions in primary care. We focused on addressing questions related to (1) categorization or target of the intervention, (2) descriptive characteristics and context of delivery, (3) reported efficacy, and (4) factors influencing efficacy. Methods: We conducted a comprehensive search and systematic review of completed studies at the intersection of primary care, technology, and alcohol-related problems published from January 2000 to December 2018 within EBSCO databases, ProQuest Dissertations, and Cochrane Reviews. Of 2307 initial records, 42 were included and coded independently by 2 investigators. Results: Compared with the years of 2000 to 2009, published studies on technology-based alcohol interventions in primary care nearly tripled during the years of 2010 to 2018. Of the 42 included studies, 28 (64%) were randomized controlled trials. Furthermore, studies were rated on risk of bias and found to be predominantly low risk (n=18), followed by moderate risk (n=16), and high risk (n=8). Of the 24 studies with primary or secondary efficacy outcomes related to drinking and drinking-related harms, 17 (71%) reported reduced drinking or harm in all primary and secondary efficacy outcomes. Furthermore, of the 31 studies with direct comparisons with treatment as usual (TAU), 13 (42%) reported that at least half of the primary and secondary efficacy outcomes of the technology-based interventions were superior to TAU. High efficacy was associated with provider involvement and the reported use of an implementation strategy to deliver the technology-based intervention. Conclusions: Our systematic review has highlighted a pattern of growth in the number of studies evaluating technology-based alcohol interventions in primary care. Although these interventions appear to be largely beneficial in primary care, outcomes may be enhanced by provider involvement and implementation strategy use. This review enables better understanding of the typologies and efficacy of these interventions and informs recommendations for those developing and implementing technology-based alcohol interventions in primary care settings. %M 30958270 %R 10.2196/10859 %U https://www.jmir.org/2019/4/e10859/ %U https://doi.org/10.2196/10859 %U http://www.ncbi.nlm.nih.gov/pubmed/30958270 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 2 %P e8540 %T FightHPV: Design and Evaluation of a Mobile Game to Raise Awareness About Human Papillomavirus and Nudge People to Take Action Against Cervical Cancer %A Ruiz-López,Tomás %A Sen,Sagar %A Jakobsen,Elisabeth %A Tropé,Ameli %A Castle,Philip E %A Hansen,Bo Terning %A Nygård,Mari %+ HPV Research Group, Department of Research, Cancer Registry of Norway, Ullernchausseen 64, 0379 Oslo, Norway, Oslo,, Norway, 47 95181886, mari.nygard@kreftregisteret.no %K papillomavirus vaccines %K educational technology %K uterine cervical neoplasms %K papillomavirus infections %K primary prevention %K secondary prevention %K early detection of cancer %K mobile applications %K health education %K learning %D 2019 %7 08.04.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: Human papillomavirus (HPV) is the most common sexually transmitted infection globally. High-risk HPV types can cause cervical cancer, other anogenital cancer, and oropharyngeal cancer; low-risk HPV types can cause genital warts. Cervical cancer is highly preventable through HPV vaccination and screening; however, a lack of awareness and knowledge of HPV and these preventive strategies represents an important barrier to reducing the burden of the disease. The rapid development and widespread use of mobile technologies in the last few years present an opportunity to overcome this lack of knowledge and create new, effective, and modern health communication strategies. Objective: This study aimed to describe the development of a mobile app called FightHPV, a game-based learning tool that educates mobile technology users about HPV, the disease risks associated with HPV infection, and existing preventive methods. Methods: The first version of FightHPV was improved in a design-development-evaluation loop, which incorporated feedback from a beta testing study of 40 participants, a first focus group of 6 participants aged between 40 and 50 years and a second focus group of 23 participants aged between 16 and 18 years. Gameplay data from the beta testing study were collected using Google Analytics (Google), whereas feedback from focus groups was evaluated qualitatively. Of the 29 focus group participants, 26 returned self-administered questionnaires. HPV knowledge before and after playing the game was evaluated in the 22 participants from the second focus group who returned a questionnaire. Results: FightHPV communicates concepts about HPV, associated diseases and their prevention by representing relationships among 14 characters in 6 episodes of 10 levels each, with each level being represented by a puzzle. Main concepts were reinforced with text explanations. Beta testing revealed that many players either failed or had to retry several times before succeeding at the more difficult levels in the game. It also revealed that players gave up at around level 47 of 60, which prompted the redesign of FightHPV to increase accessibility to all episodes. Focus group discussions led to several improvements in the user experience and dissemination of health information in the game, such as making all episodes available from the beginning of the game and rewriting the information in a more appealing way. Among the 26 focus group participants who returned a questionnaire, all stated that FightHPV is an appealing educational tool, 69% (18/26) reported that they liked the game, and 81% (21/26) stated that the game was challenging. We observed an increase in HPV knowledge after playing the game (P=.001). Conclusions: FightHPV was easy to access, use, and it increased awareness about HPV infection, its consequences, and preventive measures. FightHPV can be used to educate people to take action against HPV and cervical cancer. %M 30958271 %R 10.2196/games.8540 %U https://games.jmir.org/2019/2/e8540/ %U https://doi.org/10.2196/games.8540 %U http://www.ncbi.nlm.nih.gov/pubmed/30958271 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e10874 %T Evaluating the Impact of the HeartHab App on Motivation, Physical Activity, Quality of Life, and Risk Factors of Coronary Artery Disease Patients: Multidisciplinary Crossover Study %A Sankaran,Supraja %A Dendale,Paul %A Coninx,Karin %+ Expertise Center for Digital Media, Hasselt University, Wetenschapspark 2, Diepenbeek, 3590, Belgium, 32 011 26 84 11, supraja.sankaran@uhasselt.be %K heart diseases %K cardiac rehabilitation %K human factors engineering %K evaluation studies %K telerehabilitation %K mobile app %K multidisciplinary research %D 2019 %7 04.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Telerehabilitation approaches have been successful in supporting coronary artery disease (CAD) patients to rehabilitate at home after hospital-based rehabilitation. However, on completing a telerehabilitation program, the effects are not sustained beyond the intervention period because of the lack of lifestyle adaptations. Furthermore, decline in patients’ motivation lead to recurrence of disease and increased rehospitalization rates. We developed HeartHab, using persuasive design principles and personalization, to enable sustenance of rehabilitation effects beyond the intervention period. HeartHab promotes patients’ understanding, motivates them to reach personalized rehabilitation goals, and helps to maintain positive lifestyle adaptations during telerehabilitation. Objective: This study aimed to investigate the impact of the HeartHab app on patients’ overall motivation, increasing physical activities, reaching exercise targets, quality of life, and modifiable risk factors in patients with CAD during telerehabilitation. The study also investigated carryover effects to determine the maintenance of effects after the conclusion of the intervention. Methods: A total of 32 CAD patients were randomized on a 1:1 ratio to telerehabilitation or usual care. We conducted a 4-month crossover study with a crossover point at 2 months using a mixed-methods approach for evaluation. We collected qualitative data on users’ motivation, user experience, and quality of life using questionnaires, semistructured interviews and context-based sentiment analysis. Quantitative data on health parameters, exercise capacity, and risk factors were gathered from blood tests and ergo-spirometry tests. Data procured during the app usage phase were compared against baseline values to assess the impact of the app on parameters such as motivation, physical activity, quality of life, and risk factors. Carryover effects were used to gather insights on the maintenance of effects. Results: The qualitative data showed that 75% (21/28) of patients found the HeartHab app motivating and felt encouraged to achieve their rehabilitation targets. 84% (21/25) of patients either reached or exceeded their prescribed physical activity targets. We found positive significant effects on glycated hemoglobin (P=.01; d=1.03; 95% CI 0.24-1.82) with a mean decrease of 1.5 mg/dL and high-density lipoprotein (HDL) cholesterol (P=.04; d=0.78; 95% CI 0.02-1.55) with a mean increase of 0.61 mg/dL after patients used the HeartHab app. We observed significant carryover effects on weight, HDL cholesterol, and maximal oxygen consumption (VO2 max), indicating the maintenance of effects. Conclusions: Persuasive design techniques integrated in HeartHab and tailoring of exercise targets were effective in motivating patients to reach their telerehabilitation targets. This study demonstrated significant effects on glucose and HDL cholesterol and positive carryover effects on weight, HDL cholesterol, and VO2 max. There was also a perceived improvement in quality of life. A longer-term evaluation with more patients could possibly reveal effectiveness on other risk factors and maintenance of the positive health behavior change. Trial Registration: ClinicalTrials.gov NCT03102671; https://clinicaltrials.gov/ct2/show/NCT03102671 (Archived by WebCite at http://www.webcitation.org/76gzI9Pvd) %M 30946021 %R 10.2196/10874 %U https://mhealth.jmir.org/2019/4/e10874/ %U https://doi.org/10.2196/10874 %U http://www.ncbi.nlm.nih.gov/pubmed/30946021 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e11244 %T The Comparative Effectiveness of Mobile Phone Interventions in Improving Health Outcomes: Meta-Analytic Review %A Yang,Qinghua %A Van Stee,Stephanie K %+ Department of Communication Studies, Bob Schieffer College of Communication, Texas Christian University, 2805 South University Drive, Moudy South, Room 315, Fort Worth, TX, 76129, United States, 1 9176804053, q.yang@tcu.edu %K meta-analysis %K mobile phones %K mHealth %K intervention study %D 2019 %7 03.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As mobile technology continues expanding, researchers have been using mobile phones to conduct health interventions (mobile health—mHealth—interventions). The multiple features of mobile phones offer great opportunities to disseminate large-scale, cost-efficient, and tailored messages to participants. However, the interventions to date have shown mixed results, with a large variance of effect sizes (Cohen d=−0.62 to 1.65). Objective: The study aimed to generate cumulative knowledge that informs mHealth intervention research. The aims were twofold: (1) to calculate an overall effect magnitude for mHealth interventions compared with alternative interventions or conditions, and (2) to analyze potential moderators of mHealth interventions’ comparative efficacy. Methods: Comprehensive searches of the Communication & Mass Media Complete, PsycINFO, Web of Knowledge, Academic Search Premier, PubMed and MEDLINE databases were conducted to identify potentially eligible studies in peer-reviewed journals, conference proceedings, and dissertations and theses. Search queries were formulated using a combination of search terms: “intervention” (Title or Abstract) AND “health” (Title or Abstract) AND “*phone*” OR “black-berr*” (OR mHealth OR “application*” OR app* OR mobile OR cellular OR “short messag*” OR palm* OR iPhone* OR MP3* OR MP4* OR iPod*) (Title or Abstract). Cohen d was computed as the basic unit of analysis, and the variance-weighted analysis was implemented to compute the overall effect size under a random-effects model. Analysis of variance–like and meta-regression models were conducted to analyze categorical and continuous moderators, respectively. Results: The search resulted in 3424 potential studies, the abstracts (and full text, as necessary) of which were reviewed for relevance. Studies were screened in multiple stages using explicit inclusion and exclusion criteria, and citations were evaluated for inclusion of qualified studies. A total of 64 studies were included in the current meta-analysis. Results showed that mHealth interventions are relatively more effective than comparison interventions or conditions, with a small but significant overall weighted effect size (Cohen d=0.31). In addition, the effects of interventions are moderated by theoretical paradigm, 3 engagement types (ie, changing personal environment, reinforcement tracking, social presentation), mobile use type, intervention channel, and length of follow-up. Conclusions: To the best of our knowledge, this is the most comprehensive meta-analysis to date that examined the overall effectiveness of mHealth interventions across health topics and is the first study that statistically tested moderators. Our findings not only shed light on intervention design using mobile phones, but also provide new directions for research in health communication and promotion using new media. Future research scholarship is needed to examine the effectiveness of mHealth interventions across various health issues, especially those that have not yet been investigated (eg, substance use, sexual health), engaging participants using social features on mobile phones, and designing tailored mHealth interventions for diverse subpopulations to maximize effects. %M 30942695 %R 10.2196/11244 %U https://mhealth.jmir.org/2019/4/e11244/ %U https://doi.org/10.2196/11244 %U http://www.ncbi.nlm.nih.gov/pubmed/30942695 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e10894 %T Context-Sensitive Ecological Momentary Assessment: Application of User-Centered Design for Improving User Satisfaction and Engagement During Self-Report %A Srinivas,Preethi %A Bodke,Kunal %A Ofner,Susan %A Keith,NiCole R %A Tu,Wanzhu %A Clark,Daniel O %+ Indiana University, Center for Aging Research, 1101 West 10th Street, Indianapolis, IN, 46202, United States, 1 3172749000, daniclar@iu.edu %K mhealth %K health status %K obesity %K ecological momentary assessment %D 2019 %7 03.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Ecological momentary assessment (EMA) can be a useful tool for collecting real-time behavioral data in studies of health and health behavior. However, EMA administered through mobile technology can be burdensome, and it tends to suffer from suboptimal user engagement, particularly in low health-literacy populations. Objective: This study aimed to report a case study involving the design and evaluation of a mobile EMA tool that supports context-sensitive EMA-reporting of location and social situations accompanying eating and sedentary behavior. Methods: An iterative, user-centered design process with obese, middle-aged women seeking care in a safety-net health system was used to identify the preferred format of self-report measures and the look, feel, and interaction of the mobile EMA tool. A single-arm feasibility field trial with 21 participants receiving 12 prompts each day for momentary self-reports over a 4-week period (336 total prompts per participant) was used to determine user satisfaction with interface quality and user engagement, operationalized as response rate. A second trial among 38 different participants randomized to receive or not to receive a feature designed to improve engagement was conducted. Results: The feasibility trial results showed high interface satisfaction and engagement, with an average response rate of 50% over 4 weeks. Qualitative feedback pointed to the need for auditory alerts. We settled on 3 alerts at 10-min intervals to accompany each EMA-reporting prompt. The second trial testing this feature showed a statistically significant increase in the response rate between participants randomized to receive repeat auditory alerts versus those who were not (60% vs 40%). Conclusions: This paper reviews the design research and a set of design constraints that may be considered in the creation of mobile EMA interfaces personalized to users’ preferences. Novel aspects of the study include the involvement of low health-literacy adults in design research, the capture of data on time, place, and social context of eating and sedentary behavior, and reporting prompts tailored to an individual’s location and schedule. Trial Registration: ClinicalTrials.gov NCT03083964; https://clinicaltrials.gov/ct2/show/NCT03083964 %M 30942698 %R 10.2196/10894 %U http://mhealth.jmir.org/2019/4/e10894/ %U https://doi.org/10.2196/10894 %U http://www.ncbi.nlm.nih.gov/pubmed/30942698 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e12745 %T A Smartphone App to Assist Smoking Cessation Among Aboriginal Australians: Findings From a Pilot Randomized Controlled Trial %A Peiris,David %A Wright,Lachlan %A News,Madeline %A Rogers,Kris %A Redfern,Julie %A Chow,Clara %A Thomas,David %+ The George Institute for Global Health, UNSW Sydney, 1 King St, Newtown,, Australia, 61 280524513, dpeiris@georgeinstitute.org %K smoking cessation %K oceanic ancestry group %K mobile apps %D 2019 %7 02.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps have the potential to increase smoking cessation, but little research has been conducted with Aboriginal communities in Australia. Objective: We conducted a pilot study to assess the feasibility and acceptability and explore the effectiveness of a novel mHealth app to assist Aboriginal people to quit smoking. Methods: A pilot randomized controlled trial (RCT) and process evaluation comprising usage analytics data and in-depth interviews was conducted. Current Aboriginal smokers (>16 years old), who were willing to make a quit attempt in the next month, were recruited from Aboriginal Community Controlled Health Services and a government telephone coaching service. The intervention was a multifaceted Android or iOS app comprising a personalized profile and quit plan, text and in-app motivational messages, and a challenge feature allowing users to compete with others. The comparator was usual cessation support services. Outcome data collection and analysis were conducted blinded to treatment allocation. The primary outcome was self-reported continuous smoking abstinence verified by carbon monoxide breath testing at 6 months. Secondary outcomes included point prevalence of abstinence and use of smoking cessation therapies and services. Results: A total of 49 participants were recruited. Competing service delivery priorities, the lack of resources for research, and lack of support for randomization to a control group were the major recruitment barriers. At baseline, 23/49 (47%) of participants had tried to quit in recent weeks. At 6-month follow-up, only 1 participant (intervention arm) was abstinent. The process evaluation highlighted low to moderate app usage (3-10 new users per month and 4-8 returning users per month), an average of 2.9 sessions per user per month and 6.3 min per session. Key themes from interviews with intervention participants (n=15) included the following: (1) the powerful influence of prevailing social norms around acceptability of smoking; (2) high usage of mobile devices for phone, text, and social media but very low use of other smartphone apps; (3) the role of family and social group support in supporting quit attempts; and (4) low awareness and utilization of smoking cessation support services. Despite the broad acceptability of the app, participants also recommended technical improvements to improve functionality, greater customization of text messages, integration with existing social media platforms, and gamification features. Conclusions: Smoking cessation apps need to be integrated with commonly used functions of mobile phones and draw on social networks to support their use. Although they have the potential to increase utilization of cessation support services and treatments, more research is needed to identify optimal implementation models. Robust evaluation is critical to determine their impact; however, an RCT design may not be feasible in this setting. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12616001550493; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371792 (Archived by WebCite at http://www.webcitation.org/76TiV7HA6). %M 30938691 %R 10.2196/12745 %U https://mhealth.jmir.org/2019/4/e12745/ %U https://doi.org/10.2196/12745 %U http://www.ncbi.nlm.nih.gov/pubmed/30938691 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e12374 %T Acceptability and Feasibility of Implementing Accelorometry-Based Activity Monitors and a Linked Web Portal in an Exercise Referral Scheme: Feasibility Randomized Controlled Trial %A Hawkins,Jemma %A Charles,Joanna M %A Edwards,Michelle %A Hallingberg,Britt %A McConnon,Linda %A Edwards,Rhiannon Tudor %A Jago,Russell %A Kelson,Mark %A Morgan,Kelly %A Murphy,Simon %A Oliver,Emily J %A Simpson,Sharon A %A Moore,Graham %+ Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, United Kingdom, 44 02920875184, hawkinsj10@cardiff.ac.uk %K exercise referral %K physical activity %K feasibility studies %K wearable technologies %K costs %K economic evaluation %K fitness trackers %K activity trackers %K exercise %K physical activity %K accelerometry %D 2019 %7 29.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Exercise referral schemes (ERSs) are recommended for patients with health conditions or risk factors. Evidence points to the initial effectiveness and cost-effectiveness of such schemes for increasing physical activity, but effects often diminish over time. Techniques such as goal setting, self-monitoring, and personalized feedback may support motivation for physical activity and maintenance of effects. Wearable technologies could provide an opportunity to integrate motivational techniques into exercise schemes. However, little is known about acceptability to exercise referral populations or implementation feasibility within exercise referral services. Objective: To determine the feasibility and acceptability of implementing an activity-monitoring device within the Welsh National ERS to inform a decision on whether and how to proceed to an effectiveness trial. Methods: We conducted a feasability randomized controlled trial with embedded mixed-methods process evaluation and an exploratory economic analysis. Adults (N=156) were randomized to intervention (plus usual practice; n=88) or usual practice only (n=68). Usual practice was a 16-week structured exercise program. The intervention group additionally received an accelerometry-based activity monitor (MyWellnessKey) and associated Web platform (MyWellnessCloud). The primary outcomes were predefined progression criteria assessing acceptability and feasibility of the intervention and proposed evaluation. Postal questionnaires were completed at baseline (time 0:T0), 16 weeks (T1), and 12 months after T0 (T2). Routine data were accessed at the same time-points. A subsample of intervention participants and scheme staff were interviewed following the initiation of intervention delivery and at T2. Results: Participants were on average aged 56.6 (SD 16.3) years and mostly female (101/156, 64.7%) and white (150/156, 96.2%). Only 2 of 5 progression criteria were met; recruitment and randomization methods were acceptable to participants, and contamination was low. However, recruitment and retention rates (11.3% and 67.3%, respectively) fell substantially short of target criteria (20% and 80%, respectively), and disproportionally recruited from the least deprived quintile. Only 57.4% of intervention participants reported receipt of the intervention (below the 80% progression threshold). Less than half reported the intervention to be acceptable at T2. Participant and staff interviews revealed barriers to intervention delivery and engagement related to the device design as well as context-specific technological challenges, all of which made it difficult to integrate the technology into the service. Routinely collected health economic measures had substantial missing data, suggesting that other methods for collecting these should be used in future. Conclusions: To our knowledge, this is the first study to evaluate short- and long-term feasibility and acceptability of integrating wearable technologies into community-based ERSs. The findings highlight device- and context-specific barriers to doing this in routine practice, with typical exercise referral populations. Key criteria for progression to a full-scale evaluation were not met. Trial Registration: ISRCTN Registry ISRCTN85785652; http://www.isrctn.com/ISRCTN85785652 %M 30924791 %R 10.2196/12374 %U http://www.jmir.org/2019/3/e12374/ %U https://doi.org/10.2196/12374 %U http://www.ncbi.nlm.nih.gov/pubmed/30924791 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11300 %T Challenges in the Development of e-Quit worRx: An iPad App for Smoking Cessation Counseling and Shared Decision Making in Primary Care %A Doarn,Charles R %A Vonder Meulen,Mary Beth %A Pallerla,Harini %A Acquavita,Shauna P %A Regan,Saundra %A Elder,Nancy %A Tubb,Matthew R %+ Department of Family and Community Medicine, University of Cincinnati, 231 Albert Sabin Way, ML0582, Cincinnati, OH, 45267, United States, 1 5135586148, charles.doarn@uc.edu %K mobile health %K smoking cessation %K primary care %K decision aid %D 2019 %7 29.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is the leading preventable cause of morbidity and mortality in the United States, killing more than 450,000 Americans. Primary care physicians (PCPs) have a unique opportunity to discuss smoking cessation evidence in a way that enhances patient-initiated change and quit attempts. Patients today are better equipped with technology such as mobile devices than ever before. Objective: The aim of this study was to evaluate the challenges in developing a tablet-based, evidence-based smoking cessation app to optimize interaction for shared decision making between PCPs and their patients who smoke. Methods: A group of interprofessional experts developed content and a graphical user interface for the decision aid and reviewed these with several focus groups to determine acceptability and usability in a small population. Results: Using a storyboard methodology and subject matter experts, a mobile app, e-Quit worRx, was developed through an iterative process. This iterative process helped finalize the content and ergonomics of the app and provided valuable feedback from both patients and provider teams. Once the app was made available, other technical and programmatic challenges arose. Conclusions: Subject matter experts, although generally amenable to one another’s disciplines, are often challenged with effective interactions, including language, scope, clinical understanding, technology awareness, and expectations. The successful development of this app and its evaluation in a clinical setting highlighted those challenges and reinforced the need for effective communications and team building. %M 30924783 %R 10.2196/11300 %U https://formative.jmir.org/2019/1/e11300/ %U https://doi.org/10.2196/11300 %U http://www.ncbi.nlm.nih.gov/pubmed/30924783 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e12181 %T Efficacy of a Mobile Social Networking Intervention in Promoting Physical Activity: Quasi-Experimental Study %A Tong,Huong Ly %A Coiera,Enrico %A Tong,William %A Wang,Ying %A Quiroz,Juan C %A Martin,Paige %A Laranjo,Liliana %+ Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, 2109, Australia, 61 29850 ext 2475, huong-ly.tong@students.mq.edu.au %K mobile apps %K fitness trackers %K exercise %K social networking %D 2019 %7 28.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Technological interventions such as mobile apps, Web-based social networks, and wearable trackers have the potential to influence physical activity; yet, only a few studies have examined the efficacy of an intervention bundle combining these different technologies. Objective: This study aimed to pilot test an intervention composed of a social networking mobile app, connected with a wearable tracker, and investigate its efficacy in improving physical activity, as well as explore participant engagement and the usability of the app. Methods: This was a pre-post quasi-experimental study with 1 arm, where participants were subjected to the intervention for a 6-month period. The primary outcome measure was the difference in daily step count between baseline and 6 months. Secondary outcome measures included engagement with the intervention and system usability. Descriptive and inferential statistical tests were conducted; posthoc subgroup analyses were carried out for participants with different levels of steps at baseline, app usage, and social features usage. Results: A total of 55 participants were enrolled in the study; the mean age was 23.6 years and 28 (51%) were female. There was a nonstatistically significant increase in the average daily step count between baseline and 6 months (mean change=14.5 steps/day, P=.98, 95% CI –1136.5 to 1107.5). Subgroup analysis comparing the higher and lower physical activity groups at baseline showed that the latter had a statistically significantly higher increase in their daily step count (group difference in mean change from baseline to 6 months=3025 steps per day, P=.008, 95% CI 837.9-5211.8). At 6 months, the retention rate was 82% (45/55); app usage decreased over time. The mean system usability score was 60.1 (SD 19.2). Conclusions: This study showed the preliminary efficacy of a mobile social networking intervention, integrated with a wearable tracker to promote physical activity, particularly for less physically active subgroups of the population. Future research should explore how to address challenges faced by physically inactive people to provide tailored advices. In addition, users’ perspectives should be explored to shed light on factors that might influence their engagement with the intervention. %M 30920379 %R 10.2196/12181 %U http://mhealth.jmir.org/2019/3/e12181/ %U https://doi.org/10.2196/12181 %U http://www.ncbi.nlm.nih.gov/pubmed/30920379 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e12573 %T The Characteristics and Quality of Mobile Phone Apps Targeted at Men Who Have Sex With Men in China: A Window of Opportunity for Health Information Dissemination? %A Yang,Guoli %A Long,Jian %A Luo,Dan %A Xiao,Shuiyuan %A Kaminga,Atipatsa Chiwanda %+ Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, 238 Shangmayuanling Road, Changsha, 410078, China, 86 0731 84805414, xiaosy@live.com %K mobile application %K homosexuality, male %K quality %K character %D 2019 %7 27.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A number of mobile phone apps has been developed specifically for men who have sex with men (MSM). We will call these mobile phone apps MSM apps for simplicity. At present, the characteristics and quality and purpose of these MSM apps are unclear. Objective: The aim of this study was to objectively and comprehensively evaluate the characteristics and quality of the MSM apps to assess whether they disseminated health information among the MSM in China. Methods: We searched 2 dominant mobile phone app stores (Apple Store and Android Market) to obtain MSM apps using the keywords MSM, gay, lesbian, gay, bisexual, and transgender (LGBT), 男同，同志，男男性接触者，同性恋，基友, and 双性恋. Apps were excluded if they did not have a Chinese language interface or if their target population was not MSM. Basic information about the eligible apps for this study, such as app name, app store category, and date of last update was gathered from the specified app stores. The quality of apps was rated by 2 independent raters using Mobile App Rating Scale (MARS). The intraclass correlation coefficient (ICC) between raters was computed as a measure for interrater reliability of the MARS. All analyses were conducted using SPSS version 20.0 (SPSS Inc). Results: A total of 575 apps were reviewed between September 15, 2018 and September 30, 2018, out of which, 532 apps were excluded. Finally, 43 apps were included. Of the 43 apps, 16 were from the Apple Store, 10 were from Android Market, and 17 were available in both app stores. In addition, 39 out of 43 apps were for social and sexual networking, whereas 10 contained sexual health information, for example, HIV/sexually transmitted diseases knowledge, HIV test, and condom use. The average rating was 4 stars. The number of downloads for 21 apps exceeded 10,000. A total of 31 apps had acceptable quality (as defined by a MARS score of >3), with functionality as the highest scoring domain, followed by information quality, esthetics, and engagement. Interrater reliability was excellent for the overall mean app quality scores (ICC=.946; 95% CI 0.904-0.970) and the subjective quality scores (ICC=.910; 95% CI 0.841-0.950). Conclusions: By reviewing the available apps, we found that MSM apps are popular. The majority of MSM apps are for dating, whereas few of them contain HIV prevention and health information. The overall quality of the apps is acceptable. The utilization of mobile phone technologies is a promising way for delivering HIV prevention messages to MSM. We recommend that researchers and app developers should work together to disseminate health information for MSM via mobile technologies. %M 30916658 %R 10.2196/12573 %U http://mhealth.jmir.org/2019/3/e12573/ %U https://doi.org/10.2196/12573 %U http://www.ncbi.nlm.nih.gov/pubmed/30916658 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e11490 %T Mobile Phone App for Self-Monitoring of Eating Rhythm: Field Experiment %A Pentikäinen,Saara %A Tanner,Hannu %A Karhunen,Leila %A Kolehmainen,Marjukka %A Poutanen,Kaisa %A Pennanen,Kyösti %+ VTT Technical Research Centre of Finland Ltd, Tietotie 2, PO Box 1000, Espoo, 02044, Finland, 358 401708922, saara.pentikainen@vtt.fi %K mHealth %K behavior observation %K self-regulation %K eating %K ecological momentary assessment %D 2019 %7 27.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Temporal aspects of eating are an integral part of healthy eating, and regular eating has been associated with good diet quality and more successful weight control. Unfortunately, irregular eating is becoming more common. Self-monitoring of behavior has been found to be an efficient behavioral change technique, but the solution should be simple enough to ensure long-lasting adherence. Objective: This study aimed to explore the influence of self-monitoring of daily eating pattern with mobile phone app on eating rhythm, eating behavior tendencies, and the underlying motives and attitudes related to eating. Methods: A mobile phone app, Button, was developed for effortless self-monitoring of eating rhythm. The feasibility of the app was tested in a 30-day intervention. The participants (N=74) recorded their eating occasions during the intervention by pressing a button in the app widget. Results: The average interval between meals increased (96 [SD 24] min during the first 10 days vs 109.1[SD 36.4] during the last 10 days) and the number of daily eating occasions decreased (4.9 [SD 0.9] during the first 10 days vs 4.4 [SD 0.9] during the last 10 days). The tendencies for cognitive restraint, emotional eating, and uncontrolled eating increased. Eating-related attitudes and motives remained largely unchanged. Conclusions: These results indicate that a simple self-monitoring tool is able to draw a user’s attention to eating and is a potential tool to aid people to change their eating rhythm. %M 30916657 %R 10.2196/11490 %U http://mhealth.jmir.org/2019/3/e11490/ %U https://doi.org/10.2196/11490 %U http://www.ncbi.nlm.nih.gov/pubmed/30916657 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 1 %P e11861 %T Creating a Theoretically Grounded Gaming App to Increase Adherence to Pre-Exposure Prophylaxis: Lessons From the Development of the Viral Combat Mobile Phone Game %A Whiteley,Laura %A Mena,Leandro %A Craker,Lacey K %A Healy,Meredith Garver %A Brown,Larry K %+ Department of Psychiatry, Warren Alpert Medical School, Brown University, Residency Training Program-Brown University-Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906, United States, 1 401 455 6375, laura_whiteley@brown.edu %K cell phone %K HIV %K young adult %K sexual and gender minorities %D 2019 %7 27.03.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: In the United States, young minority men who have sex with men (MSM) are most likely to become infected with HIV. The use of antiretroviral medications to reduce the risk of acquiring HIV infection (pre-exposure prophylaxis, PrEP) is an efficacious and promising prevention strategy. There have been significant advances regarding PrEP, including the definitive demonstration that PrEP reduces HIV acquisition and the development of clinical prescribing guidelines. Despite these promising events, the practical implementation of PrEP can be challenging. Data show that PrEP’s safety and effectiveness could be greatly compromised by suboptimal adherence to treatment, and there is concern about the potential for an increase in HIV risk behavior among PrEP users. Due to these challenges, the prescribing of PrEP should be accompanied by behavioral interventions to promote adherence. Objective: This study aimed to develop an immersive, action-oriented iPhone gaming intervention to improve motivation for adherence to PrEP. Methods: Game development was guided by social learning theory, taking into consideration the perspectives of young adult MSM who are taking PrEP. A total of 20 young men who have sex with men (YMSM; aged 18-35 years) were recruited from a sexually transmitted infection (STI), HIV testing, and PrEP care clinic in Jackson, Mississippi, between October 2016 and June 2017. They participated in qualitative interviews guided by the information-motivation-behavioral skills (IMB) model of behavior change. The mean age of participants was 26 years, and all the participants identified as male. Acceptability of the game was assessed with the Client Service Questionnaire and session evaluation form. Results: A number of themes emerged that informed game development. YMSM taking PrEP desired informational game content that included new and comprehensive details about the effectiveness of PrEP, details about PrEP as it relates to doctors’ visits, and general information about STIs other than HIV. Motivational themes that emerged were the desire for enhancement of future orientation; reinforcement of positive influences from partners, parents, and friends; collaboration with health care providers; decreasing stigma; and a focus on personal relevance of PrEP-related medical care. Behavioral skills themes centered around self-efficacy and strategies for adherence to PrEP and self-care. Conclusions: We utilized youth feedback, IMB, and agile software development to create a multilevel, immersive, action-oriented iPhone gaming intervention to improve motivation for adherence to PrEP. There is a dearth of gaming interventions for persons on PrEP. This study is a significant step in working toward the development and testing of an iPhone gaming intervention to decrease HIV risk and promote adherence to PrEP for YMSM. %M 30916652 %R 10.2196/11861 %U http://games.jmir.org/2019/1/e11861/ %U https://doi.org/10.2196/11861 %U http://www.ncbi.nlm.nih.gov/pubmed/30916652 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 3 %P e11209 %T A Smartphone Game to Prevent HIV Among Young Africans: Protocol for a Randomized Pilot Study of a Mobile Intervention %A Sabben,Gaëlle %A Akelo,Victor %A Mudhune,Victor %A Ondeng'e,Ken %A Ndivo,Richard %A Stephenson,Rob %A Winskell,Kate %+ Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 4046833103, gaelle.sabben@emory.edu %K HIV %K youth %K sub-Saharan Africa %K Kenya %K serious game %K narrative %K mobile phone %K pilot test %K randomized controlled trial %K mhealth %K prevention %K smartphone %D 2019 %7 27.03.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young people aged under 25 years make up an increasing proportion of the population in emerging economies such as Kenya, where half of new adult HIV infections are among 15- to 24-year olds. Interventions targeting this age group have the potential to avert HIV infections among an increasingly large at-risk population. Interactive communication technologies offer a promising platform for reaching young people in engaging ways. Objective: Tumaini is a narrative-based smartphone game designed to help young Africans protect themselves from HIV. The objective of this study was to pilot test the game, focusing on the data needed to inform a future randomized controlled efficacy trial, including assessments of study feasibility and safety. Methods: The study took place in Kisumu Town, western Kenya, in spring 2017. The game-based intervention was pilot tested for 16 days with a sample of 60 preadolescents aged 11 to 14 years. Participant recruitment was initiated through schools. Participants were randomly assigned to the control or intervention arms of the study. One parent for each of the intervention arm participants was also recruited (n=30). The intervention arm participants were provided with smartphones on which Tumaini was loaded so that they could play the game at home. Youth completed behavioral surveys at baseline, posttest, and 6-week follow-up. The intervention arm participants provided quantitative feedback on their experience of the game-based intervention at posttest. They and their parents further participated in postintervention focus group discussions. Feasibility-related study metrics were collected on recruitment, enrollment, attrition, safety of participants, and return of phones. Results: Recruitment and enrollment of the 60 preadolescents and parents were successfully completed within 18 days. No participants were lost to follow-up: all youth completed all 3 waves of the survey and 27 intervention arm youth and 22 parents and caregivers participated in the focus groups. No safety concerns were reported. All phones were returned after the intervention period; none were damaged or lost. All intervention arm participants initiated gameplay, recording a mean exposure time just under 27 hours. Conclusions: Findings indicate that it is feasible and safe to test a smartphone-based HIV prevention intervention for very young adolescents in urban and peri-urban sub-Saharan Africa by initiating recruitment in schools and temporarily providing youth participants with smartphones on which the game is loaded. A randomized controlled trial powered to assess the efficacy of the game-based intervention is being designed to be carried out in the same geographic area as the pilot, using similar methods. Trial Registration: ClinicalTrials.gov NCT03054051; https://clinicaltrials.gov/ct2/show/NCT03054051 (Archived by WebCite at http://www.webcitation.org/6wjwpX8Bg.) International Registered Report Identifier (IRRID): DERR1-10.2196/11209 %M 30916661 %R 10.2196/11209 %U http://www.researchprotocols.org/2019/3/e11209/ %U https://doi.org/10.2196/11209 %U http://www.ncbi.nlm.nih.gov/pubmed/30916661 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e10731 %T The Development of VegEze: Smartphone App to Increase Vegetable Consumption in Australian Adults %A Hendrie,Gilly A %A James-Martin,Genevieve %A Williams,Gemma %A Brindal,Emily %A Whyte,Ben %A Crook,Anna %+ Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation, PO Box 10041, Adelaide, 5000, Australia, 61 88305 ext 0662, gilly.hendrie@csiro.au %K mHealth %K mobile applications %K vegetables %K adult %D 2019 %7 27.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor-quality dietary patterns are often characterized by inadequate consumption of fruits and vegetables. Changing dietary behavior is difficult, and although it is often clear what needs to change, how to enact change is more difficult. Smartphones have characteristics that may support the complexity of changing dietary behavior. Objective: This paper describes the iterative process of developing a theory-based smartphone app called VegEze that aimed to increase vegetable consumption. Methods: To upscale, reach target users, and create a user-friendly end product, a collaborative research-industry partnership was formed to build the app over a 20-week period. The Integrate, Design, Assess, and Share framework was used as a scientific basis to guide the development. The behavior change wheel was also used as a theoretical grounding in combination with other theory-based strategies, such as self-monitoring, social comparison, and gamification—which have all been shown to be successful in dietary change or digital health interventions. We conducted 1 consumer survey (N=1068), 1 usability testing session (N=11), and a pilot effectiveness and usability trial (N=283) to inform the design of the app. Results: The target behavior for the app was defined as having 3 different types of vegetables at dinner. The perceived achievability of this target behavior was high; 93% of respondents (993/1068 users) felt they were likely or very likely to be able to regularly achieve the behavior. App features that users wanted included the following: recipes and meal ideas (876/1068, 82% of users), functionality to track their intake (662/1068, 62%), and information on how to prepare vegetables (545/1068, 51%). On the basis of importance of self-monitoring as a behavior change technique (BCT) and its rating by users, the vegetable tracker was a core feature of the app and was designed to be quick and simple to use. Daily feedback messages for logging intake and communicating progress were designed to be engaging and fun, using friendly, positive language and emoji icons. Daily and weekly feedback on vegetable consumption was designed to be simple, informative, and reinforce monitoring. A creative team was engaged to assist in the branding of the app to ensure it had an identity that reflected the fun and simple nature of the underlying behavior. The app included 16 BCTs, most of which were from the goals and planning subsection of the BCT taxonomy. Conclusions: Combining a theoretical framework with an industry perspective and input resulted in an app that was developed in a timely manner while retaining its evidence-base. VegEze is an iOS app currently available in the App Store, and the overall impact of the VegEze app will be evaluated in an uncontrolled, quantitative study. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000481279; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12618000481279 (Archived by WebCite: at http://www.webcitation.org/769oG9EaA) %M 30916653 %R 10.2196/10731 %U http://formative.jmir.org/2019/1/e10731/ %U https://doi.org/10.2196/10731 %U http://www.ncbi.nlm.nih.gov/pubmed/30916653 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 3 %P e12511 %T Mobile Phone–Based Smoking-Cessation Intervention for Patients Undergoing Elective Surgery: Protocol for a Randomized Controlled Trial %A Bendtsen,Marcus %A Linderoth,Catharina %A Bendtsen,Preben %+ Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, 58183, Sweden, 46 13 28 10 00, marcus.bendtsen@liu.se %K smoking cessation %K mobile phone–based interventions %K SMS %K mHealth interventions %D 2019 %7 26.03.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Several large studies have shown that the risk of cardiovascular, respiratory, and wound-healing complications (including death) within 30 days of surgery is greater for smokers than for nonsmokers. However, there is evidence that even short-term perioperative smoking cessation may reduce postoperative morbidity. Over the past few years, it has become more evident that short message service (SMS)–based interventions can help individuals quit smoking. Objective: The overall aim of this project is to fill the knowledge gap on whether an SMS-based smoking-cessation intervention can be effective in helping patients stop smoking perioperatively. The aim of this trial is to evaluate the effectiveness of an SMS-based intervention on smoking behavior of patients undergoing elective surgery. Methods: A two-arm parallel-group randomized controlled trial will be conducted at 20 surgical departments in southeast Sweden. Smokers undergoing elective surgery who own a mobile phone will be included. Power calculations indicate that it will be necessary to randomize 434 participants. One group will be given access to a novel 12-week SMS program, which includes daily SMS messages with behavior change–enforcing text content and hyperlinks to interactive modules, while the other group will not be given access to the intervention. Both groups will have access to the surgical departments’ current routine for smoking cessation prior to surgery. Primary outcome measures, prolonged abstinence, and point prevalence of smoking cessation will be measured through questionnaires at 3, 6, and 12 months after randomization. Logistic regression models adjusted using baseline characteristics will be explored to identify potential effects of the intervention. Results: Recruitment started in late October 2018 and is expected to last for a maximum of 30 months. The first results are expected to be available approximately 3 months after the final date of recruitment. Conclusions: Owing to the structural problems and scarcity of time and resources, patients at most Swedish surgical departments are simply instructed to quit smoking, and perhaps, referred to a primary health care clinic. An SMS-based smoking-cessation aid can be effective in helping individuals quit smoking and is a very simple and time-efficient tool for surgical departments to use. Trial Registration: ISRCTN Registry ISRCTN33869008; http://www.isrctn.com/ISRCTN33869008 International Registered Report Identifier (IRRID): PRR1-10.2196/12511 %M 30912757 %R 10.2196/12511 %U http://www.researchprotocols.org/2019/3/e12511/ %U https://doi.org/10.2196/12511 %U http://www.ncbi.nlm.nih.gov/pubmed/30912757 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e11157 %T A Smartphone App to Assess Alcohol Consumption Behavior: Development, Compliance, and Reactivity %A Poulton,Antoinette %A Pan,Jason %A Bruns Jr,Loren Richard %A Sinnott,Richard O %A Hester,Robert %+ Melbourne School of Psychological Sciences, University of Melbourne, Redmond Barry Building, Parkville, 3010, Australia, 61 83446377, antoinette.poulton@unimelb.edu.au %K alcohol drinking %K smartphone apps %K smartphone %K mobile phone %K research app development %K compliance %K reactivity %D 2019 %7 25.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There are disadvantages—largely related to cost, participant burden, and missing data—associated with traditional electronic methods of assessing drinking behavior in real time. This potentially diminishes some of the advantages—namely, enhanced sample size and diversity—typically attributed to these methods. Download of smartphone apps to participants’ own phones might preserve these advantages. However, to date, few researchers have detailed the process involved in developing custom-built apps for use in the experimental arena or explored methodological concerns regarding compliance and reactivity. Objective: The aim of this study was to describe the process used to guide the development of a custom-built smartphone app designed to capture alcohol intake behavior in the healthy population. Methodological issues related to compliance with and reactivity to app study protocols were examined. Specifically, we sought to investigate whether hazard and nonhazard drinkers would be equally compliant. We also explored whether reactivity in the form of a decrease in drinking or reduced responding (“yes”) to drinking behavior would emerge as a function of hazard or nonhazard group status. Methods: An iterative development process that included elements typical of agile software design guided the creation of the CNLab-A app. Healthy individuals used the app to record alcohol consumption behavior each day for 21 days. Submissions were either event- or notification-contingent. We considered the size and diversity of the sample, and assessed the data for evidence of app protocol compliance and reactivity as a function of hazard and nonhazard drinker status. Results: CNLab-A yielded a large and diverse sample (N=671, mean age 23.12). On average, participants submitted data on 20.27 (SD 1.88) out of 21 days (96.5%, 20.27/21). Both hazard and nonhazard drinkers were highly compliant with app protocols. There were no differences between groups in terms of number of days of app use (P=.49) or average number of app responses (P=.54). Linear growth analyses revealed hazardous drinkers decreased their alcohol intake by 0.80 standard drinks over the 21-day experimental period. There was no change to the drinking of nonhazard individuals. Both hazard and nonhazard drinkers showed a slight decrease in responding (“yes”) to drinking behavior over the same period. Conclusions: Smartphone apps participants download to their own phones are effective and methodologically sound means of obtaining alcohol consumption information for research purposes. Although further investigation is required, such apps might, in future, allow for a more thorough examination of the antecedents and consequences of drinking behavior. %M 30907738 %R 10.2196/11157 %U https://mhealth.jmir.org/2019/3/e11157/ %U https://doi.org/10.2196/11157 %U http://www.ncbi.nlm.nih.gov/pubmed/30907738 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e10794 %T Theory-Based Predictors of Mindfulness Meditation Mobile App Usage: A Survey and Cohort Study %A Crandall,AliceAnn %A Cheung,Aaron %A Young,Ashley %A Hooper,Audrey P %+ Department of Public Health, Brigham Young University, 2049 Life Sciences Building, Provo, UT, 84602, United States, 1 801 422 6163, ali_crandall@byu.edu %K executive function %K intention %K mindfulness %K mobile apps %K social theory %D 2019 %7 22.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mindfulness meditation has become increasingly popular over the last few years, due in part to the increase in mobile apps incorporating the practice. Although studies have demonstrated the potential of mindfulness meditation to positively impact health, little has been uncovered about what predicts engagement in mindfulness meditation. Understanding the predictors of mindfulness meditation may help practitioners and phone app developers improve intervention strategies and app experience. Objective: The purpose of this study was to use the Theory of Planned Behavior and Temporal Self-Regulation Theory to determine factors predicting mindfulness meditation mobile app use. Methods: The sample consisted of 85 undergraduate students with no prior mindfulness meditation experience. During their first laboratory visit, participants completed tasks to measure their executive functioning and a survey to measure Theory of Planned Behavior constructs about mindfulness meditation. Over the following 2 weeks, participants logged the days and minutes that they practiced mindfulness meditation using a phone app. Hierarchical regression modeling was used to analyze the data. Results: After controlling for demographic factors, participant subjective norms (beta=14.51, P=.001) and intentions (beta=36.12, P=.001) were predictive of the number of minutes practicing mindfulness. Participant executive functioning did not predict mindfulness meditation practice, nor did it moderate the link between intentions and mindfulness meditation practice. Participant attitudes (beta=0.44, P<.001) and perceived control (beta=0.42, P=.002) were positively associated with intentions to practice mindfulness. Conclusions: These results suggest that among college student populations, the Theory of Planned Behavior may be useful in predicting the use of mindfulness meditation phone apps. However, participant executive functioning was not a predictor or moderator of mindfulness practice, and Temporal Self-Regulation Theory may be less useful for explaining mindfulness meditation behaviors using phone apps over a short period of time among college students. The results have implications for public health professionals, suggesting that a focus on subjective norms and intentions may promote mindfulness meditation practice using phone apps. %M 30900992 %R 10.2196/10794 %U http://mhealth.jmir.org/2019/3/e10794/ %U https://doi.org/10.2196/10794 %U http://www.ncbi.nlm.nih.gov/pubmed/30900992 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12850 %T Mentalizing Imagery Therapy Mobile App to Enhance the Mood of Family Dementia Caregivers: Feasibility and Limited Efficacy Testing %A Sikder,Abu Taher %A Yang,Francis Cheng %A Schafer,Rhiana %A Dowling,Glenna A %A Traeger,Lara %A Jain,Felipe Ananda %+ Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, One Bowdoin Square, 6th Floor, Boston, MA, 02114, United States, 1 617 643 4682, felipe.jain@post.harvard.edu %K family caregivers %K mindfulness %K depression %K mobile apps %K psychotherapy %D 2019 %7 21.03.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Family caregivers of patients with Alzheimer disease and related dementias (AD and ADRD) often experience high stress and are at high risk for depression. Technologically delivered therapy is attractive for AD and ADRD caregivers because of the time demands associated with in-person participation. Objective: We aimed to study the feasibility and conduct limited efficacy testing of a mobile app intervention delivering mentalizing imagery therapy (MIT) for family caregivers. Methods: A 4-week trial of the MIT app for family AD and ADRD caregivers was conducted to assess the feasibility of use and investigate changes in depression symptoms, mood, and caregiving experience. Semistructured interviews were conducted to characterize participants’ perceived feasibility and benefits. Results: A total of 17 of the 21 (80%) consented participants (mean age 67 years, range 54-79) utilized the app at least once and were further analyzed. Average usage of audio recordings was on 14 (SD 10) days out of 28 possible and comprised 29 (SD 28) individual sessions. There were improvements in depression with a large effect size for those who used the app at least moderately (P=.008), increases in positive mood postintervention (P<.05), and acute increases in mood following daily guided imagery practice (Stretching and Breathing, P<.001; Eye in the Center, P<.001; Nesting Doll, P=.002; Situation Solver, P=.003; and Life Globe, P=.006). Semistructured interviews revealed perceived benefits such as greater ability to remain “centered” despite caregiving challenges and positive reframing of the caregiver experience. Conclusions: App delivery of MIT is feasible for family AD and ADRD caregivers, including aging seniors. Results showed moderate to high usage of the app for a majority of users. Limited efficacy testing provides justification for studying the MIT app for AD and ADRD caregivers to improve mood and reduce depression in larger, controlled trials. %M 31518275 %R 10.2196/12850 %U http://aging.jmir.org/2019/1/e12850/ %U https://doi.org/10.2196/12850 %U http://www.ncbi.nlm.nih.gov/pubmed/31518275 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e12053 %T Can Smartphone Apps Increase Physical Activity? Systematic Review and Meta-Analysis %A Romeo,Amelia %A Edney,Sarah %A Plotnikoff,Ronald %A Curtis,Rachel %A Ryan,Jillian %A Sanders,Ilea %A Crozier,Alyson %A Maher,Carol %+ Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, 5001, Australia, 61 8 830 22315, carol.maher@unisa.edu.au %K physical activity %K smartphone %K mobile phone %K app %K mobile apps %K program %K health behavior %K systematic review %K meta-analysis %D 2019 %7 19.03.2019 %9 Review %J J Med Internet Res %G English %X Background: Smartphone apps are a promising tool for delivering accessible and appealing physical activity interventions. Given the large growth of research in this field, there are now enough studies using the “gold standard” of experimental design—the randomized controlled trial design—and employing objective measurements of physical activity, to support a meta-analysis of these scientifically rigorous studies. Objective: This systematic review and meta-analysis aimed to determine the effectiveness of smartphone apps for increasing objectively measured physical activity in adults. Methods: A total of 7 electronic databases (EMBASE, EmCare, MEDLINE, Scopus, Sport Discus, The Cochrane Library, and Web of Science) were searched from 2007 to January 2018. Following the Population, Intervention, Comparator, Outcome and Study Design format, studies were eligible if they were randomized controlled trials involving adults, used a smartphone app as the primary or sole component of the physical activity intervention, used a no- or minimal-intervention control condition, and measured objective physical activity either in the form of moderate-to-vigorous physical activity minutes or steps. Study quality was assessed using a 25-item tool based on the Consolidated Standards of Reporting Trials checklist. A meta-analysis of study effects was conducted using a random effects model approach. Sensitivity analyses were conducted to examine whether intervention effectiveness differed on the basis of intervention length, target behavior (physical activity alone vs physical activity in combination with other health behaviors), or target population (general adult population vs specific health populations). Results: Following removal of duplicates, a total of 6170 studies were identified from the original database searches. Of these, 9 studies, involving a total of 1740 participants, met eligibility criteria. Of these, 6 studies could be included in a meta-analysis of the effects of physical activity apps on steps per day. In comparison with the control conditions, smartphone apps produced a nonsignificant (P=.19) increase in participants’ average steps per day, with a mean difference of 476.75 steps per day (95% CI −229.57 to 1183.07) between groups. Sensitivity analyses suggested that physical activity programs with a duration of less than 3 months were more effective than apps evaluated across more than 3 months (P=.01), and that physical activity apps that targeted physical activity in isolation were more effective than apps that targeted physical activity in combination with diet (P=.04). Physical activity app effectiveness did not appear to differ on the basis of target population. Conclusions: This meta-analysis provides modest evidence supporting the effectiveness of smartphone apps to increase physical activity. To date, apps have been most effective in the short term (eg, up to 3 months). Future research is needed to understand the time course of intervention effects and to investigate strategies to sustain intervention effects over time. %M 30888321 %R 10.2196/12053 %U http://www.jmir.org/2019/3/e12053/ %U https://doi.org/10.2196/12053 %U http://www.ncbi.nlm.nih.gov/pubmed/30888321 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e10855 %T Training Cognitive Functions Using Mobile Apps in Breast Cancer Patients: Systematic Review %A Vergani,Laura %A Marton,Giulia %A Pizzoli,Silvia Francesca Maria %A Monzani,Dario %A Mazzocco,Ketti %A Pravettoni,Gabriella %+ Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, Milan, 20122, Italy, 39 029 4372099, laura.vergani@ieo.it %K cognitive impairment %K breast cancer %K cognitive training %K intervention %K mobile-based interventions %D 2019 %7 19.03.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Breast cancer is an invalidating disease and its treatment can bring serious side effects that have a physical and psychological impact. Specifically, cancer treatment generally has a strong impact on cognitive function. In recent years, new technologies and eHealth have had a growing influence on health care and innovative mobile apps can be useful tools to deliver cognitive exercise in the patient’s home. Objective: This systematic review gives an overview of the state-of-the-art mobile apps aimed at training cognitive functions to better understand whether these apps could be useful tools to counteract cognitive impairment in breast cancer patients. Methods: We searched in a systematic way all the full-text articles from the PubMed and Embase databases. Results: We found eleven studies using mobile apps to deliver cognitive training. They included a total of 819 participants. App and study characteristics are presented and discussed, including cognitive domains trained (attention, problem solving, memory, cognitive control, executive function, visuospatial function, and language). None of the apps were specifically developed for breast cancer patients. They were generally developed for a specific clinical population. Only 2 apps deal with more than 1 cognitive domain, and only 3 studies focus on the efficacy of the app training intervention. Conclusions: These results highlight the lack of empirical evidence on the efficacy of currently available apps to train cognitive function. Cognitive domains are not well defined across studies. It is noteworthy that no apps are specifically developed for cancer patients, and their applicability to breast cancer should not be taken for granted. Future studies should test the feasibility, usability, and effectiveness of available cognitive training apps in women with breast cancer. Due to the complexity and multidimensionality of cognitive difficulties in this cancer population, it may be useful to design, develop, and implement an ad hoc app targeting cognitive impairment in breast cancer patients. %M 30888326 %R 10.2196/10855 %U https://mhealth.jmir.org/2019/3/e10855/ %U https://doi.org/10.2196/10855 %U http://www.ncbi.nlm.nih.gov/pubmed/30888326 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e12489 %T An mHealth Assistive System “MyLung” to Empower Patients with Chronic Obstructive Pulmonary Disease: Design Science Research %A Alharbey,Riad %A Chatterjee,Samir %+ Information Systems and Technology, College of Computer Science and Engineering, University of Jeddah, Asfan 21959, Jeddah,, Saudi Arabia, 966 545593498, ralharbi@uj.edu.sa %K assistive technology %K patient empowerment %K chronic obstructive pulmonary disease %K design science research %D 2019 %7 19.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic obstructive pulmonary disease (COPD) comprises a group of progressive diseases that deteriorate lung functions. When patients cannot breathe, nothing else in their lives matter. Breathlessness has negative implications on patients’ lives, which leads to physical and psychological limitations. Moreover, the lack of relevant and updated information about the causes and consequences of the disease can exacerbate the problems of health literacy, information accessibility, and medical adherence. Objective: The objective of this study is to design an innovative mobile health (mHealth) app system called “MyLung” that provides complete solutions in order to increase self-awareness and promote better self-care management. This system, an information technology artifact, includes three novel integrative modules: education, risk reduction, and monitoring. Methods: The utility and effectiveness of the assistive mobile-based technology were evaluated using a mixed-methods approach. The study combined quantitative and qualitative research methods to thoroughly understand how the assistive mobile-based technology can influence patients’ behavioral intention to change their lifestyle. Thirty patients were categorized into two groups (intervention group and control group). Results: The results from the quantitative analysis led to four follow-up interviews in the qualitative study. The results of the quantitative study provided significant evidence to show that the design of MyLung leads to a change in the awareness level, self-efficacy, and behavioral intention for patients with COPD. The t tests revealed a significant difference before and after using the mobile-based app with regard to the awareness level (mean 3.28 vs 4.56; t10=6.062; P<.001), self-efficacy (mean 3.11 vs 5.56; t10=2.96; P=.01), and behavioral intention (mean 2.91 vs 4.55; t10=3.212; P=.009). Independent sample t tests revealed significant differences between the intervention group and the control group in terms of the awareness level (mean 4.56 vs 3.31; t19=4.80; P<.001) and self-efficacy (mean 5.56 vs 3.66; t19=2.8; P<.01). Integration of findings from quantitative and qualitative studies reveled the impact of the design in a comprehensive manner. These inferences are referred to as “meta-inferences” in this study. Conclusions: We designed an innovative assistive mobile-based technology to empower patients with COPD, which helped increase awareness and engage patients in self-care management activities. The assistive technology aims to inform patients about the risk factors of COPD and to improve access to relevant information. Meta-inferences that emerge from the research outputs contribute to research into chronic management information systems by helping us gain a more complete understanding of the potential impacts of this proposed mobile-based design on patients with chronic disease. %M 30888329 %R 10.2196/12489 %U http://formative.jmir.org/2019/1/e12489/ %U https://doi.org/10.2196/12489 %U http://www.ncbi.nlm.nih.gov/pubmed/30888329 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11689 %T A Mobile App to Promote Adapted Exercise and Social Networking for People With Physical Disabilities: Usability Study %A Lai,Byron %A Wilroy,Jereme %A Young,Hui-Ju %A Howell,Jennifer %A Rimmer,James H %A Mehta,Tapan %A Thirumalai,Mohanraj %+ Department of Health Services Administration, University of Alabama at Birmingham, SHPB #590E, 1716 9th Avenue South, Birmingham, AL, 35233, United States, 1 2059347189, mohanraj@uab.edu %K exercise %K telehealth %K rehabilitation %K mHealth %D 2019 %7 19.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: People with physical disabilities (PWD) experience several unique challenges that prevent them from participating in onsite exercise programs. Although mobile apps can provide a ubiquitous channel for delivering convenient exercise services within the community, no exercise apps have been designed for people with disabilities who experience certain functional limitations. Objective: The aim of this study was to examine the usability of a mobile exercise app in PWD. Methods: A sequential explanatory mixed-method design was used to holistically test usability in 4 core areas: effectiveness (ie, ease of use), efficiency (ie, operation speed), perceived satisfaction, and usefulness. Participants completed 7 face-to-face usability tasks and 1 structured interview. Equipment included a computer tablet that came preinstalled with the exercise app. The app included exercise videos that focused on several components of fitness: aerobic capacity, muscular strength, functional strength or balance, and range of motion. The app contained 3 different versions of the exercise program: (1) a program for people with the ability to use the upper and lower limbs, (2) a seated program for people with the ability to use only upper limbs, and (3) a program designed for people with hemiparesis. The app also included educational resources in the form of infographics aimed at addressing key social cognitive theory constructs included social support, outcome expectancies, self-efficacy, and barriers or facilitators to exercising. Participant characteristics and quantitative usability data were descriptively reported. Qualitative data were analyzed using thematic analysis. Results: A total of 12 PWD tested the usability of the exercise app and completed 96% (69/72) of the usability tasks on the first attempt. Operation speed varied among users, which prompted the development team to make minor revisions to the app. Qualitative results demonstrated 3 overarching themes: facilitates exercise adoption, positive experiences of videos, and easy to learn. Participants noted that the app circumvented several barriers to exercise associated with leaving the home (eg, inclement weather conditions, exacerbations of health conditions or disability symptoms, difficulties with transportation, and social support). Conclusions: The mobile exercise app provided a simple platform that was effective, useful, and appreciated by PWD. Participants also perceived the app as easy to use and felt it was a valuable tool for assisting PWD to obtain regular exercise. Study findings also offered insight into the participants’ preferences for mobile exercise apps that can aid future research and development projects. Future exercise trials are needed to determine the true impact of mobile app technology on lifestyle physical activity in people with disabilities. Trial Registration: Clinicaltrials.gov NCT03024320; https://clinicaltrials.gov/ct2/show/NCT03024320 (Archived by WebCite at http://www.webcitation.org/75hNLgRFH). %M 30888325 %R 10.2196/11689 %U http://formative.jmir.org/2019/1/e11689/ %U https://doi.org/10.2196/11689 %U http://www.ncbi.nlm.nih.gov/pubmed/30888325 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e11163 %T A Mobile Health Contraception Decision Support Intervention for Latina Adolescents: Implementation Evaluation for Use in School-Based Health Centers %A Tebb,Kathleen P %A Leng Trieu,Sang %A Rico,Rosario %A Renteria,Robert %A Rodriguez,Felicia %A Puffer,Maryjane %+ Department of Pediatrics, University of California, San Francisco, 3333 California Street, Suite 245, San Francisco, CA, 94118, United States, 1 415 514 0941, Kathleen.tebb@ucsf.edu %K mobile health %K adolescent health %K pregnancy in adolescence %D 2019 %7 14.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health care providers are a trusted and accurate source of sexual health information for most adolescents, and clinical guidelines recommend that all youth receive comprehensive, confidential sexual health information and services. However, these guidelines are followed inconsistently. Providers often lack the time, comfort, and skills to provide patient-centered comprehensive contraceptive counseling and services. There are significant disparities in the provision of sexual health services for Latino adolescents, which contribute to disproportionately higher rates of teenage pregnancy. To address this, we developed Health-E You or Salud iTu in Spanish, an evidence-informed mobile health (mHealth) app, to provide interactive, individually tailored sexual health information and contraception decision support for English and Spanish speakers. It is designed to be used in conjunction with a clinical encounter to increase access to patient-centered contraceptive information and services for adolescents at risk of pregnancy. Based on user input, the app provides tailored contraceptive recommendations and asks the youth to indicate what methods they are most interested in. This information is shared with the provider before the in-person visit. The app is designed to prepare youth for the visit and acts as a clinician extender to support the delivery of health education and enhance the quality of patient-centered sexual health care. Despite the promise of this app, there is limited research on the integration of such interventions into clinical practice. Objective: This study described efforts used to support the successful adoption and implementation of the Health-E You app in clinical settings and described facilitators and barriers encountered to inform future efforts aimed at integrating mHealth interventions into clinical settings. Methods: This study was part of a larger, cluster randomized control trial to evaluate the effectiveness of Health-E You on its ability to reduce health disparities in contraceptive knowledge, access to contraceptive services, and unintended pregnancies among sexually active Latina adolescents at 18 school-based health centers (SBHCs) across Los Angeles County, California. App development and implementation were informed by the theory of diffusion of innovation, the Patient-Centered Outcomes Research Institute’s principles of engagement, and iterative pilot testing with adolescents and clinicians. Implementation facilitators and barriers were identified through monthly conference calls, site visits, and quarterly in-person collaborative meetings. Results: Implementation approaches enhanced the development, adoption, and integration of Health-E You into SBHCs. Implementation challenges were also identified to improve the integration of mHealth interventions into clinical settings. Conclusions: This study provides important insights that can inform and improve the implementation efforts for future mHealth interventions. In particular, an implementation approach founded in a strong theoretical framework and active engagement with patient and community partners can enhance the development, adoption, and integration of mHealth technologies into clinical practice. Trial Registration: ClinicalTrials.gov NCT02847858; https://clinicaltrials.gov/ct2/show/NCT02847858 (Archived by WebCite at http://www.webcitation.org/761yVIRTp). %M 30869649 %R 10.2196/11163 %U http://mhealth.jmir.org/2019/3/e11163/ %U https://doi.org/10.2196/11163 %U http://www.ncbi.nlm.nih.gov/pubmed/30869649 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e12022 %T Qualitative and Quantitative Evaluation of the Make Safe Happen App: Mobile Technology–Based Safety Behavior Change Intervention for Parents %A Roberts,Kristin J %A McAdams,Rebecca J %A Kristel,Orie V %A Szymanski,Alison M %A McKenzie,Lara B %+ Center for Injury Research and Policy, The Research Institute, Nationwide Children’s Hospital, Research Building III, 5th Floor, 700 Children's Drive, Columbus, OH, 43205, United States, 1 614 355 5858, kristin.roberts@nationwidechildrens.org %K smartphone %K mobile phone %K mobile app %K parents %K focus groups %K technology %D 2019 %7 14.03.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Nearly half of the unintentional injuries in children happen in and around the home; many of these injuries are preventable. Providing parents and caregivers with proper injury prevention information that is easily accessible may help them make their homes safer for children. Objective: The aim of this study was to evaluate parental injury prevention awareness and home safety behaviors, motivations for and challenges to taking injury prevention and safety actions for parents as well as user experience following the use of the Make Safe Happen mobile app. Methods: A total of 40 parents with children aged 0-12 years living in Columbus, Ohio, participated in 1 of 5 focus group discussions following the completion of (1) a pretest survey, (2) use of the Make Safe Happen app, and (3) a posttest survey. Results: Following the use of the Make Safe Happen app, parents reported a significant increase in injury prevention awareness and completed 45% more home safety behaviors in and around their homes. Nearly all of the parents felt the app provided them with the information needed to make their home safer for their children; the great majority of parents intended to make such changes in the future. Conclusions: The combination of qualitative and quantitative data collection allowed for rich data capture and provided a deeper understanding of parents’ safety knowledge, behaviors, app use, and decision making regarding child injury prevention in and around the home. The Make Safe Happen app provides the information and motivation parents and caregivers need to help them take steps to prevent child injuries that may occur in and around their homes. %M 31518322 %R 10.2196/12022 %U http://pediatrics.jmir.org/2019/1/e12022/ %U https://doi.org/10.2196/12022 %U http://www.ncbi.nlm.nih.gov/pubmed/31518322 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11785 %T The Development of an Arabic Weight-Loss App Akser Waznk: Qualitative Results %A Alturki,Ryan %A Gay,Valerie %+ School of Electrical and Data Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, 81 Broadway, Ultimo, Sydney, 2007, Australia, 61 410583330, ryan.m.alturki@student.uts.edu.au %K weight loss %K mobile app %K obesity %K physical activity %K smartphone %K mHealth %K motivation %D 2019 %7 14.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Obesity and its related illnesses are a major health problem around the world. Saudi Arabia has one of the highest national obesity rates globally; however, it is not easy to intervene to prevent obesity and becoming overweight owing to Saudi Arabia’s cultural and social norms, and linguistic barriers. In recent years, there has been an exponential growth in the usage of smartphones and apps in Saudi Arabia. These could be used as a cost-effective tool to facilitate the delivery of behavior-modification interventions for obese and overweight people. There are a variety of health and fitness apps that claim to offer lifestyle-modification tools. However, these do not identify the motivational features required to overcome obesity, consider the evidence-based practices for weight management, or enhance the usability of apps by considering usability attributes. Objective: This study aimed to explore the opportunity and the need to develop an Arabic weight-loss app that provides localized content and addresses the issues with existing apps identified here. This study has explained the steps taken to design an Arabic weight-loss app that was developed to facilitate the adjustment of key nutritional and physical activities and behaviors, which considers the social and cultural norms of Saudi Arabia. Methods: Qualitative studies were conducted with 26 obese Saudi Arabians, who tested the level of usability of 2 weight-loss apps and then provided feedback and recommendations. The app Akser Waznk is an interactive, user-friendly app designed primarily for iPhones. It has several features intended to assist users to monitor and track their food consumption and physical activities. The app provides personalized diet and weight loss advice. Unique features such as Let’s Walk are designed to motivate users to walk more. An augmented reality function is implemented to provide information regarding fitness equipment, fruits, and vegetables. The app uses behavior-change techniques to increase activities and healthy behaviors and evidence-informed practices for weight-loss management. The Akser Waznk app considers user privacy and data security by applying a number of guidelines and procedures. Results: The development of the app took 26 months. In all, 7 experts (5 dietitians, and 2 physical activity professionals) evaluated the app’s contents. Moreover, 10 potential users (5 men and 5 women) tested the app’s level of usability, its features, and performance during a pilot study. They reported that the app’s design is interactive, and the motivational features are user-friendly. Conclusions: Mobile technology, such as mobile apps, has the potential to be an effective tool that facilitates the changing of unhealthy lifestyle behaviors within the Saudi community. To be successful, the target group, the usability, motivational features, and social and cultural norms must be considered. %M 30869639 %R 10.2196/11785 %U http://formative.jmir.org/2019/1/e11785/ %U https://doi.org/10.2196/11785 %U http://www.ncbi.nlm.nih.gov/pubmed/30869639 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e11070 %T Get Healthy, Stay Healthy: Evaluation of the Maintenance of Lifestyle Changes Six Months After an Extended Contact Intervention %A Fjeldsoe,Brianna S %A Goode,Ana D %A Phongsavan,Philayrath %A Bauman,Adrian %A Maher,Genevieve %A Winkler,Elisabeth %A Job,Jennifer %A Eakin,Elizabeth G %+ Cancer Prevention Research Centre, School of Public Health, The University of Queensland, Herston Road, Herston, Brisbane,, Australia, 61 733655163, j.job@uq.edu.au %K maintenance %K mHealth %K physical activity %K exercise %K diet %K overweight %K body mass index %K text messages %D 2019 %7 12.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Extended intervention contact after an initial, intensive intervention is becoming accepted as best practice in behavioral weight control interventions. Whether extended contact mitigates weight regain in the longer term or it simply delays weight regain until after the extended intervention contact ceases is not clear. Objective: This study aimed to evaluate, in multiple ways, maintenance of weight, diet, and physical activity outcomes following Get Healthy, Stay Healthy (GHSH), a text message–delivered extended contact intervention. Methods: Clients completing the Get Healthy Service (GHS) lifestyle telephone coaching program were randomized to receive GHSH (n=114) or standard care (no additional contact, n=114) and were assessed at baseline (following completion of GHS), 6 months (following completion of GHSH), and 12 months (noncontact maintenance follow-up). At all 3 assessments, participants self-reported their body weight, waist circumference, physical activity (walking and moderate and vigorous sessions/week), and dietary behaviors (fruit and vegetable serves/day, cups of sweetened drinks per day, takeaway meals per week; fat, fiber, and total indices from the Fat and Fiber Behavior Questionnaire). Moderate-to-vigorous physical activity (MVPA) was also assessed via accelerometry. Maintenance was examined multiple ways: (1) using traditional methods to assess and compare group averages after some period of noncontact (ie, at 12 months), (2) using a novel approach to assess and compare group average changes over the first 6 months of noncontact, and (3) exploring individual participant changes (increase/decrease/no change) over the first 6 months of noncontact. Results: Retention over the 12-month trial was high (92.5%, 211/228). Participants had a mean (SD) age of 53.4 (SD 12.3) years and a baseline body mass index of 29.2 (SD 5.9) kg/m2. The between-group differences detected at 6 months were still present and statistically significant at 12 months for bodyweight (−1.33 kg [−2.61 to −0.05]) and accelerometer-assessed MVPA (24.9 min/week [5.8-44.0]). None of the other outcomes were significantly favored compared with the control group at 12 months. Changes over their first 6 months of noncontact for the GHSH group were significantly better than the control group in terms of accelerometer-measured MVPA and self-reported moderate activity (other differences between the groups were all nonsignificant). In addition to the maintenance seen in the group averages, most intervention participants had maintained their behavioral outcomes during the first 6 months of noncontact. Conclusions: The GHSH participants were better off relative to where they were initially, and relative to their counterparts, not receiving extended contact in terms of MVPA. However, based on the between-group difference in bodyweight over the first 6 months of noncontact, GHSH does appear to simply delay the inevitable weight regain. However, this delay in weight regain, coupled with sustained improvements in MVPA, has public health benefits. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12613000949785; https://www.anzctr.org. au/Trial/Registration/TrialReview.aspx?id=364821&isReview=true %M 30860492 %R 10.2196/11070 %U https://mhealth.jmir.org/2019/3/e11070/ %U https://doi.org/10.2196/11070 %U http://www.ncbi.nlm.nih.gov/pubmed/30860492 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e11075 %T Physical Activity Trend eXtraction: A Framework for Extracting Moderate-Vigorous Physical Activity Trends From Wearable Fitness Tracker Data %A Faust,Louis %A Wang,Cheng %A Hachen,David %A Lizardo,Omar %A Chawla,Nitesh V %+ Department of Computer Science and Engineering, University of Notre Dame, 257 Fitzpatrick Hall, Notre Dame, IN, 46556, United States, 1 5746317095, lfaust@nd.edu %K mHealth %K fitness trackers %K activity trackers %K exercise %K health behavior %K physical activity %K health %K mental health %K perception %K social network %D 2019 %7 12.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Moderate-vigorous physical activity (MVPA) offers extensive health benefits but is neglected by many. As a result, a wide body of research investigating physical activity behavior change has been conducted. As many of these studies transition from paper-based methods of MVPA data collection to fitness trackers, a series of challenges arise in extracting insights from these new data. Objective: The objective of this research was to develop a framework for preprocessing and extracting MVPA trends from wearable fitness tracker data to support MVPA behavior change studies. Methods: Using heart rate data collected from fitness trackers, we propose Physical Activity Trend eXtraction (PATX), a framework that imputes missing data, recalculates personalized target heart zones, and extracts MVPA trends. We tested our framework on a dataset of 123 college study participants observed across 2 academic years (18 months) using Fitbit Charge HRs. To demonstrate the value of our frameworks’ output in supporting MVPA behavior change studies, we applied it to 2 case studies. Results: Among the 123 participants analyzed, PATX labeled 41 participants as experiencing a significant increase in MVPA and 44 participants who experienced a significant decrease in MVPA, with significance defined as P<.05. Our first case study was consistent with previous works investigating the associations between MVPA and mental health. Whereas the second, exploring how individuals perceive their own levels of MVPA relative to their friends, led to a novel observation that individuals were less likely to notice changes in their own MVPA when close ties in their social network mimicked their changes. Conclusions: By providing meaningful and flexible outputs, PATX alleviates data concerns common with fitness trackers to support MVPA behavior change studies as they shift to more objective assessments of MVPA. %M 30860488 %R 10.2196/11075 %U http://mhealth.jmir.org/2019/3/e11075/ %U https://doi.org/10.2196/11075 %U http://www.ncbi.nlm.nih.gov/pubmed/30860488 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 3 %N 1 %P e13030 %T Achieving Rapid Blood Pressure Control With Digital Therapeutics: Retrospective Cohort and Machine Learning Study %A Guthrie,Nicole L %A Berman,Mark A %A Edwards,Katherine L %A Appelbaum,Kevin J %A Dey,Sourav %A Carpenter,Jason %A Eisenberg,David M %A Katz,David L %+ Better Therapeutics, 445 Bush Street, Suite 300, San Francsico, CA, 94108, United States, 1 617 877 0327, mark@bettertherapeutics.io %K hypertension %K mobile health %K mHealth %K lifestyle medicine %K digital therapeutics %K digital medicine %K machine learning, behavioral therapy %D 2019 %7 12.03.2019 %9 Original Paper %J JMIR Cardio %G English %X Background: Behavioral therapies, such as electronic counseling and self-monitoring dispensed through mobile apps, have been shown to improve blood pressure, but the results vary and long-term engagement is a challenge. Machine learning is a rapidly advancing discipline that can be used to generate predictive and responsive models for the management and treatment of chronic conditions and shows potential for meaningfully improving outcomes. Objective: The objectives of this retrospective analysis were to examine the effect of a novel digital therapeutic on blood pressure in adults with hypertension and to explore the ability of machine learning to predict participant completion of the intervention. Methods: Participants with hypertension, who engaged with the digital intervention for at least 2 weeks and had paired blood pressure values, were identified from the intervention database. Participants were required to be ≥18 years old, reside in the United States, and own a smartphone. The digital intervention offers personalized behavior therapy, including goal setting, skill building, and self-monitoring. Participants reported blood pressure values at will, and changes were calculated using averages of baseline and final values for each participant. Machine learning was used to generate a model of participants who would complete the intervention. Random forest models were trained at days 1, 3, and 7 of the intervention, and the generalizability of the models was assessed using leave-one-out cross-validation. Results: The primary cohort comprised 172 participants with hypertension, having paired blood pressure values, who were engaged with the intervention. Of the total, 86.1% participants were women, the mean age was 55.0 years (95% CI 53.7-56.2), baseline systolic blood pressure was 138.9 mmHg (95% CI 136.6-141.3), and diastolic was 86.2 mmHg (95% CI 84.8-87.7). Mean change was –11.5 mmHg for systolic blood pressure and –5.9 mmHg for diastolic blood pressure over a mean of 62.6 days (P<.001). Among participants with stage 2 hypertension, mean change was –17.6 mmHg for systolic blood pressure and –8.8 mmHg for diastolic blood pressure. Changes in blood pressure remained significant in a mixed-effects model accounting for the baseline systolic blood pressure, age, gender, and body mass index (P<.001). A total of 43% of the participants tracking their blood pressure at 12 weeks achieved the 2017 American College of Cardiology/American Heart Association definition of blood pressure control. The 7-day predictive model for intervention completion was trained on 427 participants, and the area under the receiver operating characteristic curve was .78. Conclusions: Reductions in blood pressure were observed in adults with hypertension who used the digital therapeutic. The degree of blood pressure reduction was clinically meaningful and achieved rapidly by a majority of the studied participants. Greater improvement was observed in participants with more severe hypertension at baseline. A successful proof of concept for using machine learning to predict intervention completion was presented. %M 31758792 %R 10.2196/13030 %U http://cardio.jmir.org/2019/1/e13030/ %U https://doi.org/10.2196/13030 %U http://www.ncbi.nlm.nih.gov/pubmed/31758792 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e10750 %T Comparison of Developers’ and End-Users’ Perspectives About Smoking Cessation Support Through the Crush the Crave App %A Struik,Laura Louise %A Bottorff,Joan L %A Baskerville,N Bruce %A Oliffe,John %A Crichton,Susan %+ Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4520, laurastruik134@hotmail.com %K mobile app %K smoking cessation %K tobacco control %K young adult %K qualitative research %D 2019 %7 07.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: High smoking rates among end-users, combined with their high rates of app use, render this age group as a particularly captive audience for quit smoking apps. There is emerging evidence that apps are an effective way to support smoking cessation among end-users. How the expectations behind the design of apps align with the needs and preferences of end-users, and if this differs by gender, is poorly understood, limiting the ability to evaluate and scale these interventions. Objective: The objective of this qualitative case study was to detail how the overall design approach of Crush the Crave (CTC), a quit smoking app that targets end-users, compares with young adult women’s and men’s perspectives and experiences, with consideration for the influence of gender. Methods: Semistructured interviews were conducted with 15 developers involved in the development of CTC and 31 young adult CTC users. Data were analyzed inductively to derive thematic findings of the perceived pros and cons of CTC by both developers and end-users. Findings were grouped under 4 categories (1) technology and platforms utilized for the app, (2) foundation of app content, (3) underlying focus of the app, and (4) look, feel and functionality of the app. Results: Under the category, technology and platforms utilized for the app, it was found that both developers and end-users agreed that apps aligned with the needs and preferences of young adult smokers. Major limitations with the technology identified by end-users were the frequent “glitches” and requirement for internet or data. For the category, foundation of app content,developers agreed that the strength of CTC was in its strong evidence-base. What mattered to end-users, however, was that the content was packaged positively, focusing on the benefits of quitting versus the consequences of smoking. It was found under the category, underlying focus of the app, that the individually-led focus of the app resonated with both developers and end-users, especially young men. Under the final category, look, feel and functionality of the app, it was found that developers were very positive about the app's aesthetics but end-users thought that the aesthetics incited a negative effect. Also, while end-users found it easy to use, they did not find the app intuitive. Finally, end-users thought that, because the app functions were largely based on a user’s quit date versus their ongoing efforts, this often lent to unmeaningful data. Conclusions: The current study findings highlight the importance of understanding multiple perspectives of stakeholders involved in a mobile-based intervention. By gathering the viewpoints of developers and end-users, both problematic and effective approaches that underlie development goals were revealed as a means of informing the development, implementation, and evaluation of future electronic health (eHealth) interventions. %M 30843864 %R 10.2196/10750 %U https://mhealth.jmir.org/2019/3/e10750/ %U https://doi.org/10.2196/10750 %U http://www.ncbi.nlm.nih.gov/pubmed/30843864 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e9904 %T Experience of Using an App in HIV Patients Older Than 60 Years: Pilot Program %A Olalla,Julián %A García de Lomas,Jose María %A Márquez,Efrén %A González,Francisco Jesús %A Del Arco,Alfonso %A De La Torre,Javier %A Prada,Jose Luis %A Cantudo,Francisca %A Martín,María Dolores %A Nieto,Miriam %A Perez Stachowski,Javier %A García-Alegría,Javier %+ Unidad de Medicina Interna Hospital Costa del Sol, A-7, Km 187,, Marbella, 29603, Spain, 34 951976669 ext 125, julio.olalla@gmail.com %K HIV %K aging %K internet %D 2019 %7 06.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: New technologies can promote knowledge of HIV infection among patients suffering from this disease. Older patients with HIV infection represent an increasingly large group that could benefit from the use of specific apps. Objective: The aim of the study was to observe the acceptability and use of a mobile app on HIV infection in patients at least 60 years old and offer them the possibility of anonymously establishing contact with their peers. Methods: A series of clinical and psychosocial parameters were studied in 30 HIV-infected patients of over 60 years. The patients must be at least 60 years old, with a follow-up in the outpatient clinic for at least 1 year and without pathologies that limit his or her life expectancy to less than a year. They must know how to read and write. To be part of the group assigned to the app, they had to have their own smartphone and confirm that they were connected to the internet from that device. Overall, 15 of them were randomized to use an app and 15 were in the control group. All tests were repeated after 6 months. Results: The median age of patients was 66.5 years. Among them, 29 patients had an undetectable viral load at baseline. The median number of comorbid diseases was 2. Overall, 11 of them lived with their partners and 19 lived alone. They spent an average of 5 hours a day sitting down, and 56% (17/30) of them referred high physical activity. They scored 4 out of 5 for general quality of life perception. Moreover, 80% (24/30) presented high adherence to their treatment, and the average number of concomitant medications was 5. In the 6-min walking test, they covered a distance of 400 meters, and 3 of them desaturated during the test. The 15 patients made frequent use of the app, with 2407 sessions and an average of 7 min and 56 seconds time of use with a total of 13,143 screen views. During the 6 months of the trial, 3 non-AIDS events took place. There were no significant modifications to body mass index, blood pressure measurements, lipid profile, or immuno-virology information data. There were no differences in the questionnaire scores for perception of quality of life, confessed physical activity, or antiretroviral treatment (ART) and non-ART treatment adherence. Conclusions: Significant differences between studied parameters were not objectified in these patients, possibly because this trial has significant limitations, such as a small sample size and only a brief follow-up period. However, patients did use the app frequently, making this a possible intervention to be proposed in future subsequent studies. %M 30839281 %R 10.2196/mhealth.9904 %U https://mhealth.jmir.org/2019/3/e9904/ %U https://doi.org/10.2196/mhealth.9904 %U http://www.ncbi.nlm.nih.gov/pubmed/30839281 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12303 %T Relevance of Activity Tracking With Mobile Devices in the Relationship Between Physical Activity Levels and Satisfaction With Physical Fitness in Older Adults: Representative Survey %A Schlomann,Anna %A Seifert,Alexander %A Rietz,Christian %+ Department of Special Education and Rehabilitation Science, University of Cologne, Herbert-Lewin-Straße 2, Cologne, 50931, Germany, 49 221470 ext 3343, anna.schlomann@uni-koeln.de %K physical fitness %K wearable electronic devices %K smartphone %K mobile phone %K aged %K satisfaction %K fitness trackers %D 2019 %7 06.03.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Physical activity has been shown to positively affect many aspects of life, and the positive relationship between physical activity levels and health is well established. Recently, research on the interrelationship between physical activity levels and subjective experiences has gained attention. However, the underlying mechanisms that link physical activity levels with subjective experiences of physical fitness have not been sufficiently explained. Objective: This study aimed to explore the role of physical activity tracking (PAT) in the relationship between physical activity levels and satisfaction with physical fitness in older adults. It is hypothesized that higher levels of physical activity are associated with a higher satisfaction with physical fitness in older adults and that this positive association is stronger for older people who use mobile devices for PAT. Methods: As part of this study, 1013 participants aged 50 years or older and living in Switzerland were interviewed via computer-assisted telephone interviews. Bivariate and multivariate analyses were applied. The interaction effects between physical activity levels and PAT were evaluated using multiple linear regression analysis. Results: Descriptive analyses showed that 719 participants used at least 1 mobile device and that 136 out of 719 mobile device users (18.9%) used mobile devices for PAT. In the multivariate regression analysis, frequent physical activity was found to have a positive effect on satisfaction with physical fitness (beta=.24, P<.001). A significant interaction effect between physical activity levels and PAT (beta=.30, P=.03) provides some first evidence that the positive effects of physical activity on satisfaction with physical fitness can be enhanced by PAT. Conclusions: The results indicate the potential of PAT to enhance the physical fitness of older adults. However, the results also raise new issues in this context. Recommendations for further research and practice include the acquisition of longitudinal data, a more detailed observation of durations of use, and the development of devices for PAT considering health psychology and gerontology theories. %M 31518263 %R 10.2196/12303 %U http://aging.jmir.org/2019/1/e12303/ %U https://doi.org/10.2196/12303 %U http://www.ncbi.nlm.nih.gov/pubmed/31518263 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e12369 %T Assessment of the Relationship Between Ambient Temperature and Home Blood Pressure in Patients From a Web-Based Synchronous Telehealth Care Program: Retrospective Study %A Huang,Ching-Chang %A Chen,Ying-Hsien %A Hung,Chi-Sheng %A Lee,Jen-Kuang %A Hsu,Tse-Pin %A Wu,Hui-Wen %A Chuang,Pao-Yu %A Chen,Ming-Fong %A Ho,Yi-Lwun %+ Graduate Institute of Clinical Medicine, Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, 10002, Taiwan, 886 223123456 ext 66373, ylho@ntu.edu.tw %K ambient temperature %K home blood pressure %K antihypertensive agents %K retrospective studies %D 2019 %7 04.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Decreased ambient temperature significantly increases office blood pressure, but few studies have evaluated the effect of ambient temperature on home blood pressure. Objective: We aimed to investigate the relationship between short-term ambient temperature exposure and home blood pressure. Methods: We recruited patients with chronic cardiovascular diseases from a telehealth care program at a university-affiliated hospital. Blood pressure was measured at home by patients or their caregivers. We obtained hourly meteorological data for Taipei (temperature, relative humidity, and wind speed) for the same time period from the Central Weather Bureau, Taiwan. Results: From 2009 to 2013, we enrolled a total of 253 patients. Mean patient age was 70.28 (SD 13.79) years, and 66.0% (167/253) of patients were male. We collected a total of 110,715 home blood pressure measurements. Ambient temperature had a negative linear effect on all 3 home blood pressure parameters after adjusting for demographic and clinical factors and antihypertensive agents. A 1°C decrease was associated with a 0.5492-mm Hg increase in mean blood pressure, a 0.6841-mm Hg increase in systolic blood pressure, and a 0.2709-mm Hg increase in diastolic blood pressure. This temperature effect on home blood pressure was less prominent in patients with diabetes or hypertension. Antihypertensive agents modified this negative effect of temperature on home blood pressure to some extent, and angiotensin receptor blockers had the most favorable results. Conclusions: Short-term exposure to low ambient temperature significantly increased home blood pressure in patients with chronic cardiovascular diseases. Antihypertensive agents may modify this effect. %M 30829574 %R 10.2196/12369 %U http://www.jmir.org/2019/3/e12369/ %U https://doi.org/10.2196/12369 %U http://www.ncbi.nlm.nih.gov/pubmed/30829574 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e12143 %T Design and Preliminary Findings From a New Electronic Cohort Embedded in the Framingham Heart Study %A McManus,David D %A Trinquart,Ludovic %A Benjamin,Emelia J %A Manders,Emily S %A Fusco,Kelsey %A Jung,Lindsey S %A Spartano,Nicole L %A Kheterpal,Vik %A Nowak,Christopher %A Sardana,Mayank %A Murabito,Joanne M %+ Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, 73 Mount Wayte Ave, Framingham, MA, 01701, United States, 1 508 935 3400, murabito@bu.edu %K smartphone %K tele-medicine %K blood pressure monitoring %K ambulatory %K cohort studies %D 2019 %7 01.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: New models of scalable population-based data collection that integrate digital and mobile health (mHealth) data are necessary. Objective: The aim of this study was to describe a cardiovascular digital and mHealth electronic cohort (e-cohort) embedded in a traditional longitudinal cohort study, the Framingham Heart Study (FHS). Methods: We invited eligible and consenting FHS Generation 3 and Omni participants to download the electronic Framingham Heart Study (eFHS) app onto their mobile phones and co-deployed a digital blood pressure (BP) cuff. Thereafter, participants were also offered a smartwatch (Apple Watch). Participants are invited to complete surveys through the eFHS app, to perform weekly BP measurements, and to wear the smartwatch daily. Results: Up to July 2017, we enrolled 790 eFHS participants, representing 76% (790/1044) of potentially eligible FHS participants. eFHS participants were, on average, 53±8 years of age and 57% were women. A total of 85% (675/790) of eFHS participants completed all of the baseline survey and 59% (470/790) completed the 3-month survey. A total of 42% (241/573) and 76% (306/405) of eFHS participants adhered to weekly digital BP and heart rate (HR) uploads, respectively, over 12 weeks. Conclusions: We have designed an e-cohort focused on identifying novel cardiovascular disease risk factors using a new smartphone app, a digital BP cuff, and a smartwatch. Despite minimal training and support, preliminary findings over a 3-month follow-up period show that uptake is high and adherence to periodic app-based surveys, weekly digital BP assessments, and smartwatch HR measures is acceptable. %M 30821691 %R 10.2196/12143 %U http://www.jmir.org/2019/3/e12143/ %U https://doi.org/10.2196/12143 %U http://www.ncbi.nlm.nih.gov/pubmed/30821691 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 3 %P e13011 %T A Smartphone App to Promote Healthy Weight Gain, Diet, and Physical Activity During Pregnancy (HealthyMoms): Protocol for a Randomized Controlled Trial %A Henriksson,Pontus %A Sandborg,Johanna %A Blomberg,Marie %A Alexandrou,Christina %A Maddison,Ralph %A Silfvernagel,Kristin %A Henriksson,Hanna %A Leppänen,Marja H %A Migueles,Jairo H %A Widman,Linnea %A Thomas,Kristin %A Trolle Lagerros,Ylva %A Löf,Marie %+ Department of Biosciences and Nutrition, Karolinska Institutet, Group/MLÖ, SE-141 83 Huddinge, Sweden, Huddinge,, Sweden, 46 701749556, pontus.henriksson@ki.se %K telemedicine %K pregnancy %K gestational weight gain %K diet %K exercise %K smartphone %K mobile phone %D 2019 %7 01.03.2019 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Excessive gestational weight gain is common and associated with adverse outcomes both in the short and long term. Although traditional lifestyle-based interventions have shown to mitigate excess gestational weight gain, little is known about whether mobile Health (mHealth) apps can promote healthy weight gain, diet, and physical activity during pregnancy. Objective: The primary aim of the HealthyMoms trial is to determine the effectiveness of a smartphone app (HealthyMoms) for mitigating excess gestational weight gain during pregnancy. Secondary aims are to determine the effectiveness of the app on dietary habits, physical activity, body fatness, and glycemia during pregnancy. Methods: HealthyMoms is a two-arm randomized controlled trial. Women are being recruited at routine visits at the maternity clinics in Linköping, Norrköping and Motala, Sweden. Women are randomized to the control or intervention group (n=150 per group). All women will receive standard care, and women in the intervention group will also receive the HealthyMoms smartphone app. Results: Recruitment of participants to the trial was initiated in October 2017, and 190 women have so far completed the baseline measurement. The baseline measures are estimated to be finalized in December 2019, and the follow-up measures are estimated to be completed in June 2020. Conclusions: This project will evaluate a novel smartphone app intervention integrated with existing maternity health care. If successful, it has great potential to be implemented nationally in order to promote healthy weight gain and health behaviors during pregnancy. International Registered Report Identifier (IRRID): DERR1-10.2196/13011 %M 30821695 %R 10.2196/13011 %U http://www.researchprotocols.org/2019/3/e13011/ %U https://doi.org/10.2196/13011 %U http://www.ncbi.nlm.nih.gov/pubmed/30821695 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e12209 %T Comparing Self-Monitoring Strategies for Weight Loss in a Smartphone App: Randomized Controlled Trial %A Patel,Michele L %A Hopkins,Christina M %A Brooks,Taylor L %A Bennett,Gary G %+ Stanford Prevention Research Center, Stanford University School of Medicine, 1070 Arastradero Road, Suite 100, Palo Alto, CA, 94304, United States, 1 650 549 7047, michele.patel@stanford.edu %K weight loss %K obesity, self-monitoring %K technology %K mobile app %K mobile health %K caloric restriction %K treatment adherence and compliance %K randomized controlled trial %D 2019 %7 28.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Self-monitoring of dietary intake is a valuable component of behavioral weight loss treatment; however, it declines quickly, thereby resulting in suboptimal treatment outcomes. Objective: This study aimed to examine a novel behavioral weight loss intervention that aims to attenuate the decline in dietary self-monitoring engagement. Methods: GoalTracker was an automated randomized controlled trial. Participants were adults with overweight or obesity (n=105; aged 21-65 years; body mass index, BMI, 25-45 kg/m2) and were randomized to a 12-week stand-alone weight loss intervention using the MyFitnessPal smartphone app for daily self-monitoring of either (1) both weight and diet, with weekly lessons, action plans, and feedback (Simultaneous); (2) weight through week 4, then added diet, with the same behavioral components (Sequential); or (3) only diet (App-Only). All groups received a goal to lose 5% of initial weight by 12 weeks, a tailored calorie goal, and automated in-app reminders. Participants were recruited via online and offline methods. Weight was collected in-person at baseline, 1 month, and 3 months using calibrated scales and via self-report at 6 months. We retrieved objective self-monitoring engagement data from MyFitnessPal using an application programming interface. Engagement was defined as the number of days per week in which tracking occurred, with diet entries counted if ≥800 kcal per day. Other assessment data were collected in-person via online self-report questionnaires. Results: At baseline, participants (84/100 female) had a mean age (SD) of 42.7 (11.7) years and a BMI of 31.9 (SD 4.5) kg/m2. One-third (33/100) were from racial or ethnic minority groups. During the trial, 5 participants became ineligible. Of the remaining 100 participants, 84% (84/100) and 76% (76/100) completed the 1-month and 3-month visits, respectively. In intent-to-treat analyses, there was no difference in weight change at 3 months between the Sequential arm (mean −2.7 kg, 95% CI −3.9 to −1.5) and either the App-Only arm (−2.4 kg, −3.7 to −1.2; P=.78) or the Simultaneous arm (−2.8 kg, −4.0 to −1.5; P=.72). The median number of days of self-monitoring diet per week was 1.9 (interquartile range [IQR] 0.3-5.5) in Sequential (once began), 5.3 (IQR 1.8-6.7) in Simultaneous, and 2.9 (IQR 1.2-5.2) in App-Only. Weight was tracked 4.8 (IQR 1.9-6.3) days per week in Sequential and 5.1 (IQR 1.8-6.3) days per week in Simultaneous. Engagement in neither diet nor weight tracking differed between arms. Conclusions: Regardless of the order in which diet is tracked, using tailored goals and a commercial mobile app can produce clinically significant weight loss. Stand-alone digital health treatments may be a viable option for those looking for a lower intensity approach. Trial Registration: ClinicalTrials.gov NCT03254953; https://clinicaltrials.gov/ct2/show/NCT03254953 (Archived by WebCite at http://www.webcitation.org/72PyQrFjn). %M 30816851 %R 10.2196/12209 %U https://mhealth.jmir.org/2019/2/e12209/ %U https://doi.org/10.2196/12209 %U http://www.ncbi.nlm.nih.gov/pubmed/30816851 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e10645 %T Women Using Mobile Phones for Health Communication Are More Likely to Use Prenatal and Postnatal Services in Bangladesh: Cross-Sectional Study %A Tang,Shangfeng %A Ghose,Bishwajit %A Hoque,Md Rakibul %A Hao,Gang %A Yaya,Sanni %+ School of International Development and Global Studies, University of Ottawa, 120 University Private, Ottawa, ON, K1N5J1, Canada, 1 6132624856, brammaputram@gmail.com %K antenatal care %K facility delivery services %K postnatal care %K mHealth %K Bangladesh %D 2019 %7 28.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The public health system in Bangladesh has been struggling to provide coverage and utilization of basic maternal health care services in pursuit of achieving maternal and child mortality-related goals. Interestingly, the rapid popularization of mobile technology in the country is transforming the landscape of health care access and delivery. However, little is known regarding the use of mobile phones from the perspective of maternal health care service utilization. Objective: In this study, we aimed to investigate the prevalence and sociodemographic pattern of mobile phone use for health services among women and relationship between the use of mobile phone use and the uptake of essential maternal health services (MHSs). Methods: Cross-sectional data from the Bangladesh Demographic and Health Survey on 4494 mothers aged between 15 and 39 years were used in the analysis. Using mobile phones to get health services or advice was hypothesized to have a positive association with the uptake of basic MHSs (antenatal care, ANC, facility delivery services, postnatal care) and postnatal care for the newborn. Data were analyzed using bivariate and multivariable techniques. Results: More than a quarter (1276/4494, 28.4%; 95% CI 26.8-30.3) of the women aged 15-39 years reported using mobile phones to get health services with significant sociodemographic variations in the use of mobile phones. Analysis of the specific purposes revealed that, in most cases, mobile phones were used to contact service providers and consult with the same about what to do, whereas a smaller proportion reported using mobile phone for the purposes of arranging money and transportation. Multivariable analysis showed that compared with respondents who reported not using mobile phones for health care services, those who used them had higher odds of making 3+ ANC visits and delivering at a health facility. The odds were slightly higher for rural residents than for those in the urban areas. Conclusions: The findings of this study conclude that women who use mobile phones are more likely to use ANC and professional delivery services than those who do not. More in-depth studies are necessary to understand the mechanism through which mobile phone-based services enhance the uptake of maternal health care. %M 30816850 %R 10.2196/10645 %U http://mhealth.jmir.org/2019/2/e10645/ %U https://doi.org/10.2196/10645 %U http://www.ncbi.nlm.nih.gov/pubmed/30816850 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e9435 %T Using Mobile Technology to Improve Bone-Related Lifestyle Risk Factors in Young Women With Low Bone Mineral Density: Feasibility Randomized Controlled Trial %A Subasinghe,Asvini Kokila %A Garland,Suzanne Marie %A Gorelik,Alexandra %A Tay,Ilona %A Wark,John Dennis %+ Infection and Immunity Theme, Murdoch Children's Research Institute, Level 7, Royal Women's Hospital, 20 Flemington Road, Parkville,, Australia, 61 03 8345 3692, asvini.subasinghe@gmail.com %K behavior therapy methods %K mobile phones %K health behavior %K primary prevention methods %K self-care methods %D 2019 %7 25.02.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor bone health in adolescent and young adult females is a growing concern. Given the widespread use of mobile phones in this population, mobile health (mHealth) interventions may help improve health behaviors related to bone health in young women. Objective: The goal of the study was to determine the acceptability and feasibility of an mHealth intervention called Tap4Bone in improving health behaviors associated with the risk of osteoporosis in young women. Methods: The Tap4Bone mHealth intervention comprised the use of mobile phone apps, short messaging service (text messaging), and Web emails to encourage health behavior changes. The education group received osteoporosis prevention education leaflets. Changes in the bone health–related behaviors exercise, smoking, and calcium intake were assessed. User experiences and acceptance of the app were collected through focus group interviews. Results: A total of 35 (22 completed, mean age 23.1 [SD 1.8] years) were randomized to either the mobile phone (intervention n=18) or education (control n=17) group. Although there were trends toward improvement in calcium intake, sports activity, and smoking behaviors in the mHealth intervention group compared to the education group, these were not statistically significant. Conclusions: The Tap4Bone mHealth intervention was shown to be acceptable and feasible in subsets of the participants. The intervention should be improved upon using participant feedback to improve functionality. Findings from this study may aid in the development and modification of health care apps to reduce participant attrition. %M 30801253 %R 10.2196/formative.9435 %U http://formative.jmir.org/2019/1/e9435/ %U https://doi.org/10.2196/formative.9435 %U http://www.ncbi.nlm.nih.gov/pubmed/30801253 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e12692 %T Use of Weight-Management Mobile Phone Apps in Saudi Arabia: A Web-Based Survey %A Aljuraiban,Ghadeer S %+ Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Turki Alawwal, Riyadh, 145111, Saudi Arabia, 966 14651122, galjuraiban@ksu.edu.sa %K lifestyle %K mobile app %K weight loss %K mobile phone %D 2019 %7 22.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In recent years, the use of mobile phone weight-management apps has increased significantly. Weight-management apps have been found effective in promoting health and managing weight. However, data on user perception and on barriers to app usage are scarce. Objective: This study aimed to investigate the use of weight-management apps and barriers to use as well as reasons for discontinuing use in a sample of mobile phone users in Saudi Arabia. Methods: Mobile phone users aged 18 years and above from the general public in Saudi Arabia completed a Web-based survey. The survey included questions on weight-management app usage patterns, user perceptions concerning weight management, efficacy of weight-management apps, and reasons for discontinuing use. Participants were classified into normal weight (body mass index [BMI]: 18.5 to 24.9 kg/m2) and overweight or obese (BMI: ≥25.0 kg/m2). Results: The survey included 1191 participants; 513 of them used weight-management apps. More overweight or obese respondents used these apps compared with normal weight respondents (319/513, 62.2% vs 194/513, 37.8%, respectively). App features that overweight or obese users were most interested in were mainly the possibility to be monitored by a specialist and barcode identification of calorie content, whereas normal weight users mostly preferred availability of nutrition information of food items. Reasons for discontinuing use among overweight or obese respondents were mainly that monitoring by a specialist was not offered (80/236, 33.9%) and the app was not in the local language (48/236, 20.3%). Among normal weight users, the main reason for noncontinuance was the app language (45/144, 31.3%) and difficulty of use (30/144, 20.8%). Conclusions: To better address the needs of both normal weight and overweight or obese adults, improved app designs that offer monitoring by a specialist are needed. Developers may consider ways of overcoming barriers to use, such as language, by developing local language apps, which can improve the efficacy of such apps and help spread their use. %M 30794205 %R 10.2196/12692 %U http://mhealth.jmir.org/2019/2/e12692/ %U https://doi.org/10.2196/12692 %U http://www.ncbi.nlm.nih.gov/pubmed/30794205 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e10820 %T Breast Cancer Survivors’ Experiences With an Activity Tracker Integrated Into a Supervised Exercise Program: Qualitative Study %A Wu,Hoi San %A Gal,Roxanne %A van Sleeuwen,Niek C %A Brombacher,Aarnout C %A IJsselsteijn,Wijnand A %A May,Anne M %A Monninkhof,Evelyn M %+ Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, STR 6.131, PO Box 85500, Utrecht, 3508 GA, Netherlands, 31 887569624, R.Gal@umcutrecht.nl %K breast cancer %K activity trackers %K physical activity %K sedentary behavior %K qualitative research %D 2019 %7 21.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is growing evidence that physical activity is related to a better prognosis after a breast cancer diagnosis, whereas sedentary behavior is associated with worse outcomes. It is therefore important to stimulate physical activity and reduce sedentary time among patients with breast cancer. Activity trackers offer a new opportunity for interventions directed at stimulating physical activity behavior change. Objective: This study aimed to explore the experience of patients with breast cancer who used an activity tracker in addition to a supervised exercise intervention in the randomized UMBRELLA Fit trial. Methods: A total of 10 patients with breast cancer who completed cancer treatment participated in semistructured in-depth interviews about their experience with and suggestions for improvements for the Jawbone UP2 activity tracker. Results: The activity tracker motivated women to be physically active and created more awareness of their (sedentary) lifestyles. The women indicated that the automatically generated advice (received via the Jawbone UP app) lacked individualization and was not applicable to their personal situations (ie, having been treated for cancer). Furthermore, women felt that the daily step goal was one-dimensional, and they preferred to incorporate other physical activity goals. The activity tracker’s inability to measure strength exercises was a noted shortcoming. Finally, women valued personal feedback about the activity tracker from the physiotherapist. Conclusions: Wearing an activity tracker raised lifestyle awareness in patients with breast cancer. The women also reported additional needs not addressed by the system. Potential improvements include a more realistic total daily physical activity representation, personalized advice, and personalized goals. %M 30789349 %R 10.2196/10820 %U https://mhealth.jmir.org/2019/2/e10820/ %U https://doi.org/10.2196/10820 %U http://www.ncbi.nlm.nih.gov/pubmed/30789349 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 2 %P e12255 %T Use of Mobile and Computer Devices to Support Recovery in People With Serious Mental Illness: Survey Study %A Noel,Valerie A %A Acquilano,Stephanie C %A Carpenter-Song,Elizabeth %A Drake,Robert E %+ Westat, Inc, 85 Mechanic Street, Suite C3-1, Lebanon, NH, 03766, United States, 1 603 287 4719, valerienoel@westat.com %K app %K mental health %K mHealth %K mobile phone %K serious mental illness %D 2019 %7 20.02.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health recovery refers to an individual’s experience of gaining a sense of personal control, striving towards one’s life goals, and meeting one’s needs. Although people with serious mental illness own and use electronic devices for general purposes, knowledge of their current use and interest in future use for supporting mental health recovery remains limited. Objective: This study aimed to identify smartphone, tablet, and computer apps that mental health service recipients use and want to use to support their recovery. Methods: In this pilot study, we surveyed a convenience sample of 63 mental health service recipients with serious mental illness. The survey assessed current use and interest in mobile and computer devices to support recovery. Results: Listening to music (60%), accessing the internet (59%), calling (59%), and texting (54%) people were the top functions currently used by participants on their device to support their recovery. Participants expressed interest in learning how to use apps for anxiety/stress management (45%), mood management (45%), monitoring mental health symptoms (43%), cognitive behavioral therapy (40%), sleep (38%), and dialectical behavior therapy (38%) to support their recovery. Conclusions: Mental health service recipients currently use general functions such as listening to music and calling friends to support recovery. Nevertheless, they reported interest in trying more specific illness-management apps. %M 30785401 %R 10.2196/12255 %U http://mental.jmir.org/2019/2/e12255/ %U https://doi.org/10.2196/12255 %U http://www.ncbi.nlm.nih.gov/pubmed/30785401 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e9838 %T Popular Nutrition-Related Mobile Apps: An Agreement Assessment Against a UK Reference Method %A Fallaize,Rosalind %A Zenun Franco,Rodrigo %A Pasang,Jennifer %A Hwang,Faustina %A Lovegrove,Julie A %+ Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, University of Reading, Whiteknights Campus, Reading,, United Kingdom, 44 1183786418, j.a.lovegrove@reading.ac.uk %K weighed food records %K smartphone application %K dietary assessment %K diet apps %K nutrition apps %K diet records %K mobile applications %D 2019 %7 20.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nutrition-related apps are commonly used to provide information about the user’s dietary intake, but limited research has been performed to assess how well their outputs agree with those from standard methods. Objective: The objective of our study was to evaluate the level of agreement of popular nutrition-related apps for the assessment of energy and available macronutrients and micronutrients against a UK reference method. Methods: We compared dietary analysis of 24-hour weighed food records (n=20) between 5 nutrition-related apps (Samsung Health, MyFitnessPal, FatSecret, Noom Coach, and Lose It!) and Dietplan6 (reference method), using app versions available in the United Kingdom. We compared estimates of energy, macronutrients (carbohydrate, protein, fat, saturated fat, and fiber), and micronutrients (sodium, calcium, iron, vitamin A, and vitamin C) using paired t tests and Wilcoxon signed-rank tests, correlation coefficients, and Bland-Altman plots. We obtained 24-hour weighed food records from 20 participants (15 female, 5 male participants; mean age 36.3 years; mean body mass index 22.9 kg/m2) from previous controlled studies conducted at the Hugh Sinclair Unit of Human Nutrition, University of Reading, Reading, UK. Participants had recorded their food consumption over a 24-hour period using standard protocols. Results: The difference in estimation of energy and saturated fat intake between Dietplan6 and the diet apps was not significant. Estimates of protein and sodium intake were significantly lower using Lose It! and FatSecret than using Dietplan6. Lose It! also gave significantly lower estimates for other reported outputs (carbohydrate, fat, fiber, and sodium) than did Dietplan6. Samsung Health and MyFitnessPal significantly underestimated calcium, iron, and vitamin C compared with Dietplan6, although there was no significant difference for vitamin A. We observed no other significant differences between Dietplan6 and the apps. Correlation coefficients ranged from r=–.12 for iron (Samsung Health vs Dietplan6) to r=.91 for protein (FatSecret vs Dietplan6). Noom Coach was limited to energy output, but it had a high correlation with Dietplan6 (r=.91). Samsung Health had the greatest variation of correlation, with energy at r=.79. Bland-Altman analysis revealed potential proportional bias for vitamin A. Conclusions: The findings suggest that the apps provide estimates of energy and saturated fat intake comparable with estimates by Dietplan6. With the exception of Lose It!, the apps also provided comparable estimates of carbohydrate, total fat, and fiber. FatSecret and Lose It! tended to underestimate protein and sodium. Estimates of micronutrient intake (calcium, iron, vitamin A, and vitamin C) by 2 apps (Samsung Health and MyFitnessPal) were inconsistent and less reliable. Lose It! was the app least comparable with Dietplan6. As the use and availability of apps grows, this study helps clinicians and researchers to make better-informed decisions about using these apps in research and practice. %M 30785409 %R 10.2196/mhealth.9838 %U http://mhealth.jmir.org/2019/2/e9838/ %U https://doi.org/10.2196/mhealth.9838 %U http://www.ncbi.nlm.nih.gov/pubmed/30785409 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e10658 %T Use of Physical Activity Monitoring Devices by Families in Rural Communities: Qualitative Approach %A Sharaievska,Iryna %A Battista,Rebecca A %A Zwetsloot,Jennifer %+ Department of Recreation Management and Physical Education, Appalachian State University, 111 Rivers Str, ASU Box 32181, Boone, NC, 28608, United States, 1 8282626327, sharaievskai@appstate.edu %K motion sensors %K physical activity %K family %K rural community %D 2019 %7 20.02.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Several studies support the impact of information communication technology–based interventions to promote physical activity among youth. However, little is known on how technology can be used by the entire family to encourage healthy behavior. Previous studies showed that children and youth rely and are dependent upon the decisions and values of their caregivers when it comes to having a healthy lifestyle. Thus, the exploration of behavior and attitudes of the entire family is needed. Objective: The study aimed to explore (1) perceptions of how the use of physical activity tracking devices (Fitbit Zip) by families in rural communities influence their patterns of participation in physical activity, (2) how attitudes toward physical activity change as a result of using physical activity tracking devices as a family, and (3) what factors influence participation in physical activity among families in rural communities. Methods: A total of 11 families with 1 to 3 children of different ages (7-13 years) took part in semistructured group interviews following 2 weeks of using physical activity tracking devices (Fitbit Zip) as a family. The participants were asked to discuss their experience using the Fitbit Zip as a family, the motivation to be physically active, the changes in their pattern of participation in those activities, the level of engagement by different family members, and the factors that affected their participation. All interviews were voice-recorded with the participants’ permission and later transcribed verbatim using pseudonyms. To analyze the data, the principal investigator (IS) used open, axial, and selective coding techniques. Results: A total of 3 themes and several subthemes appeared from the data. The families in rural communities reported no or minimal changes in physical activities as a result of using physical activity tracking devices (Fitbit Zip) because of a lack of interest or an already active lifestyle. However, the attitude toward physical activity was altered. The family members reported an increased awareness of their activity level, introduced more conversations about active and healthy lifestyles, and changed their view of physical activity to a more positive one. The participants described the changes they were able to make and the constraining factors that stopped them from making further changes in their lifestyle. Conclusions: Technology might serve as a facilitator to participation in physical activity among families. Technology can motivate the change in attitude toward active recreation. As long-term changes in lifestyle require internal motivation, the change in the attitude might have a more long-lasting impact than the change in the immediate behavior. More longitudinal studies are needed to further explore long-term change in both behavior and attitude toward physical activity. Additional exploration of constraints to participation in physical activity among families is also an important area of exploration. %M 31518327 %R 10.2196/10658 %U http://pediatrics.jmir.org/2019/1/e10658/ %U https://doi.org/10.2196/10658 %U http://www.ncbi.nlm.nih.gov/pubmed/31518327 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e12694 %T Impact of a Novel Smartphone App (CureApp Smoking Cessation) on Nicotine Dependence: Prospective Single-Arm Interventional Pilot Study %A Masaki,Katsunori %A Tateno,Hiroki %A Kameyama,Naofumi %A Morino,Eriko %A Watanabe,Riri %A Sekine,Kazuma %A Ono,Tomohiro %A Satake,Kohta %A Suzuki,Shin %A Nomura,Akihiro %A Betsuyaku,Tomoko %A Fukunaga,Koichi %+ Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan, 81 3 3353 1211, km-fuku@cpnet.med.keio.ac.jp %K digital therapeutics %K nicotine dependence %K smoking cessation %K smartphone application %K telemedicine %D 2019 %7 19.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps have been considered to provide active and continuous support for smoking cessation. However, it is yet to be known whether a smoking cessation smartphone app improves long-term abstinence rates in nicotine-dependent patients. Objective: This study aimed to evaluate the long-term abstinence effect of a novel smartphone app, CureApp Smoking Cessation (CASC), in patients with nicotine dependence. Methods: In this prospective, interventional, multicenter, single-arm study, we provided the CASC app to all the participants, who used it daily for 24 weeks. The CASC app includes features to maximize the therapeutic effect of pharmacological therapies and counseling at outpatient clinics for smoking cessation. The primary endpoint was a continuous abstinence rate (CAR) from weeks 9 to 24, whereas secondary endpoints were CARs from weeks 9 to 12 and 9 to 52. Results: Of the 56 adult smokers recruited, 1 did not download the app; therefore, 55 participants constituted the full analysis sample. The CAR from weeks 9 to 24 was 64% (35/55, 95% CI 51%-76%), whereas the CARs from weeks 9 to 12 and 9 to 52 were 76% (42/55, 95% CI 65%-88%) and 58% (32/55, 95% CI 46%-71%), respectively. These CARs were better than the results of the national survey on outpatient clinics with regard to smoking cessation under the National Health Insurance Program and that of the varenicline phase 3 trial in Japan and the United States. There was only 1 participant who dropped out during the 12 weeks of the treatment period. This treatment decreased the scores related to withdrawal and craving symptoms. Conclusions: The addition of CASC to usual smoking cessation therapies resulted in high CARs, high patient retention rates, and improvement of cessation-related symptoms. The smartphone app CASC is a feasible and useful tool to help long-term continuous abstinence that can be combined with a standard smoking cessation treatment program. %M 30777848 %R 10.2196/12694 %U http://mhealth.jmir.org/2019/2/e12694/ %U https://doi.org/10.2196/12694 %U http://www.ncbi.nlm.nih.gov/pubmed/30777848 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e10931 %T Evaluating Mobile Health Apps for Customized Dietary Recording for Young Adults and Seniors: Randomized Controlled Trial %A Liu,Ying-Chieh %A Chen,Chien-Hung %A Tsou,Ya-Chi %A Lin,Yu-Sheng %A Chen,Hsin-Yun %A Yeh,Jou-Yin %A Chiu,Sherry Yueh-Hsia %+ Department of Health Care Management and Healthy Aging Research Center, College of Management, Chang Gung University, 259, Wen-Hwa 1st Road, Kwei-Shan, Taoyuan, 333, Taiwan, 886 3 2118800 ext 5250, sherrychiu@mail.cgu.edu.tw %K customized dietary recording %K prototypes %K user-centered design %K utilization %K mobile health %K mHealth %K randomized trial %D 2019 %7 15.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The role of individual-tailored dietary recording in mobile phone health apps has become increasingly important in management of self-health care and population-based preventive service. The development of such mobile apps for user-centered designing is still challengeable and requires further scientific evidence. Objective: This study aims to conduct a randomized trial to assess the accuracy and time efficiency of two prototypes for dietary recoding utilization related to the input method of food intake. Methods: We first present an innovative combinatorial concept for dietary recording to account for dish variation. One prototype was a self-chosen tab app that featured choosing each food ingredient to synthesize an individual dish, whereas the other was an autonomous exhaustive list app that provided one selection from a comprehensive list of dish items. The concept included commercially available choices that allowed users to more accurately account for their individual food selection. The two mobile apps were compared in a head-to-head parallel randomized trial evaluation. Young adults (n=70, aged 18-29) and older adults (n=35, aged 55-73) were recruited and randomized into two groups for accuracy and response time evaluation based on 12 types of food items in use of the developed self-chosen tab and autonomous exhaustive list apps, respectively. Results: For the trials based on the self-chosen tab (53 participants) and autonomous exhaustive list groups (52 participants), the two prototypes were found to be highly accurate (>98%). The self-chosen tab app was found to be more efficient, requiring significantly less time for input of 11 of 12 items (P<.05). The self-chosen tab users occasionally neglected to select food attributes, an issue which did not occur in the autonomous exhaustive list group. Conclusions: Our study contributes through the scientific evaluation of the transformation step into prototype development to demonstrate that a self-chosen tab app has potentially better opportunity in effectiveness and efficiency. The combinatorial concept offers potential for dietary recording and planning which can account for high food item variability. Our findings on prototype development of diversified dietary recordings provide design consideration and user interaction for related further app development and improvement. Trial Registration: ISRCTN Registry ISRCTN86142301; http://www.isrctn.com/ ISRCTN86142301 (Archived by WebCite at http://www.webcitation.org/74YLEPYnS) %M 30767906 %R 10.2196/10931 %U http://mhealth.jmir.org/2019/2/e10931/ %U https://doi.org/10.2196/10931 %U http://www.ncbi.nlm.nih.gov/pubmed/30767906 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e10988 %T Evaluating Motivational Interviewing and Habit Formation to Enhance the Effect of Activity Trackers on Healthy Adults’ Activity Levels: Randomized Intervention %A Ellingson,Laura D %A Lansing,Jeni E %A DeShaw,Kathryn J %A Peyer,Karissa L %A Bai,Yang %A Perez,Maria %A Phillips,L Alison %A Welk,Gregory J %+ Department of Kinesiology, Iowa State University, 534 Wallace Road, Ames, IA, 50011, United States, 1 5154990663, ellingl@iastate.edu %K activity tracker %K habit %K mHealth %K motivational interviewing %K mobile phone %K physical activity %K wearable electronic devices %D 2019 %7 14.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: While widely used and endorsed, there is limited evidence supporting the benefits of activity trackers for increasing physical activity; these devices may be more effective when combined with additional strategies that promote sustained behavior change like motivational interviewing (MI) and habit development. Objective: This study aims to determine the utility of wearable activity trackers alone or in combination with these behavior change strategies for promoting improvements in active and sedentary behaviors. Methods: A sample of 91 adults (48/91 female, 53%) was randomized to receive a Fitbit Charge alone or in combination with MI and habit education for 12 weeks. Active and sedentary behaviors were assessed pre and post using research-grade activity monitors (ActiGraph and activPAL), and the development of habits surrounding the use of the trackers was assessed postintervention with the Self-Reported Habit Index. During the intervention, Fitbit wear time and activity levels were monitored with the activity trackers. Linear regression analyses were used to determine the influence of the trial on outcomes of physical activity and sedentary time. The influence of habits was examined using correlation coefficients relating habits of tracker use (wearing the tracker and checking data on the tracker and associated app) to Fitbit wear time and activity levels during the intervention and at follow-up. Results: Regression analyses revealed no significant differences by group in any of the primary outcomes (all P>.05). However, personal characteristics, including lower baseline activity levels (beta=–.49, P=.01) and lack of previous experience with pedometers (beta=–.23, P=.03) were predictive of greater improvements in moderate and vigorous physical activity. Furthermore, for individuals with higher activity levels at the baseline, MI and habit education were more effective for maintaining these activity levels when compared with receiving a Fitbit alone (eg, small increase of ~48 steps/day, d=0.01, vs large decrease of ~1830 steps/day, d=0.95). Finally, habit development was significantly related to steps/day during (r=.30, P=.004) and following the intervention (r=.27, P=.03). Conclusions: This study suggests that activity trackers may have beneficial effects on physical activity in healthy adults, but benefits vary based on individual factors. Furthermore, this study highlights the importance of habit development surrounding the wear and use of activity trackers and the associated software to promote increases in physical activity. Trial Registration: ClinicalTrials.gov NCT03837366; https://clinicaltrials.gov/ct2/show/NCT03837366 %M 30762582 %R 10.2196/10988 %U https://mhealth.jmir.org/2019/2/e10988/ %U https://doi.org/10.2196/10988 %U http://www.ncbi.nlm.nih.gov/pubmed/30762582 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e11972 %T Log2Lose: Development and Lessons Learned From a Mobile Technology Weight Loss Intervention %A Shaw,Ryan %A Levine,Erica %A Streicher,Martin %A Strawbridge,Elizabeth %A Gierisch,Jennifer %A Pendergast,Jane %A Hale,Sarah %A Reed,Shelby %A McVay,Megan %A Simmons,Denise %A Yancy,William %A Bennett,Gary %A Voils,Corrine %+ School of Nursing, Duke University, 307 Trent Drive, DUMC 3322, Durham, NC, 27710, United States, 1 9196849434, ryan.shaw@duke.edu %K weight loss %K diet %K cell phone %K mobile phone %D 2019 %7 13.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Providing financial incentives has gained popularity as a strategy to promote weight loss, but questions remain about how best to utilize them. A promising mobile health strategy provides users with near-real-time financial incentives based on both the process of weight loss (behavioral modification) and actual weight loss. To maximize the impact of this strategy, a methodology is needed to close the gap between the desired behavior and the financial incentive. Leveraging mobile health tools—such as mobile phone apps, cellular body weight scales that transmit data to physicians and researchers, and text messaging for instructions and encouragement—has the potential to close this gap. Objective: This study aimed to describe the development of an innovative technology-based solution and lessons learned from a feasibility trial—Log2Lose—that encouraged individuals to lose weight by providing near-real-time financial incentives for weight loss and/or dietary self-monitoring. Methods: We recruited participants (N=96) with a body mass index greater than or equal to 30 kg/m2 for a 24-week weight loss trial. Participants received a behavioral intervention of biweekly, in-person group sessions and were instructed to log a minimum number of daily calories in MyFitnessPal and to step on the BodyTrace cellular scale at least twice per week. In a 2×2 design, participants were randomized into 4 groups to receive financial incentives for the following: (group 1) weekly weight loss and dietary self-monitoring, (group 2) dietary self-monitoring only, (group 3) weekly weight loss only, or (group 4) no financial incentives. Diet and weight data from the devices were obtained through application programming interfaces. Each week, we applied algorithms to participants’ data to determine whether they qualified for a monetary incentive (groups 1-3). A text message notified these participants of whether they met weight loss and/or self-monitoring requirements to earn an incentive and the amount they earned or would have earned. The money was uploaded to a debit card. Results: Our custom-engineered software platform analyzed data from multiple sources, collated and processed the data to send appropriate text messages automatically, and informed study staff of the appropriate incentives. We present lessons learned from the development of the software system and challenges encountered with technology, data transmission, and participants (eg, lost connections or delayed communication). Conclusions: With consistent and constant validation checks and a robust beta test run, the process of analyzing data and determining eligibility for weekly incentives can be mostly automated. We were able to accomplish this project within an academic health system, which required significant security and privacy safeguards. Our success demonstrates how this methodology of automated feedback loops can provide health interventions via mobile technology. Trial Registration: ClinicalTrials.gov NCT02691260; https://clinicaltrials.gov/ct2/show/NCT02691260 %M 30758297 %R 10.2196/11972 %U http://mhealth.jmir.org/2019/2/e11972/ %U https://doi.org/10.2196/11972 %U http://www.ncbi.nlm.nih.gov/pubmed/30758297 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 1 %P e11444 %T Effectiveness of a Behavior Change Technique–Based Smartphone Game to Improve Intrinsic Motivation and Physical Activity Adherence in Patients With Type 2 Diabetes: Randomized Controlled Trial %A Höchsmann,Christoph %A Infanger,Denis %A Klenk,Christopher %A Königstein,Karsten %A Walz,Steffen P %A Schmidt-Trucksäss,Arno %+ Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320 B, Basel, 4052, Switzerland, 41 612074740, arno.schmidt-trucksaess@unibas.ch %K behavior change %K exercise adherence %K gamification %K intrinsic motivation %K mhealth %K mobile phone game %K physical activity %K type 2 diabetes %D 2019 %7 13.02.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: Regular physical activity (PA) is an essential component of a successful type 2 diabetes treatment. However, despite the manifest evidence for the numerous health benefits of regular PA, most patients with type 2 diabetes remain inactive, often due to low motivation and lack of PA enjoyment. A recent and promising approach to help overcome these PA barriers and motivate inactive individuals to change their PA behavior is PA-promoting smartphone games. While short-term results of these games are encouraging, the long-term success in effectively changing PA behavior has to date not been confirmed. It is possible that an insufficient incorporation of motivational elements or flaws in gameplay and storyline in these games affect the long-term motivation to play and thereby prevent sustained changes in PA behavior. We aimed to address these design challenges by developing a PA-promoting smartphone game that incorporates established behavior change techniques and specifically targets inactive type 2 diabetes patients. Objective: To investigate if a self-developed, behavior change technique-based smartphone game designed by an interdisciplinary team is able to motivate inactive individuals with type 2 diabetes for regular use and thereby increase their intrinsic PA motivation. Methods: Thirty-six inactive, overweight type 2 diabetes patients (45-70 years of age) were randomly assigned to either the intervention group or the control group (one-time lifestyle counseling). Participants were instructed to play the smartphone game or to implement the recommendations from the lifestyle counseling autonomously during the 24-week intervention period. Intrinsic PA motivation was assessed with an abridged 12-item version of the Intrinsic Motivation Inventory (IMI) before and after the intervention. In addition, adherence to the game-proposed PA recommendations during the intervention period was assessed in the intervention group via the phone-recorded game usage data. Results: Intrinsic PA motivation (IMI total score) increased significantly in the intervention group (+6.4 (SD 4.2; P<.001) points) while it decreased by 1.9 (SD 16.5; P=.623) points in the control group. The adjusted difference between both groups was 8.1 (95% CI 0.9, 15.4; P=.029) points. The subscales “interest/enjoyment” (+2.0 (SD 1.9) points, P<.001) and “perceived competence” (+2.4 (SD 2.4) points, P<.001) likewise increased significantly in the intervention group while they did not change significantly in the control group. The usage data revealed that participants in the intervention group used the game for an average of 131.1 (SD 48.7) minutes of in-game walking and for an average of 15.3 (SD 24.6) minutes of strength training per week. We found a significant positive association between total in-game training (min) and change in IMI total score (beta=0.0028; 95% CI 0.0007-0.0049; P=.01). Conclusions: In inactive individuals with type 2 diabetes, a novel smartphone game incorporating established motivational elements and personalized PA recommendations elicits significant increases in intrinsic PA motivation that are accompanied by de-facto improvements in PA adherence over 24 weeks. Trial Registration: ClinicalTrials.gov NCT02657018; https://clinicaltrials.gov/ct2/show/NCT02657018 %M 30758293 %R 10.2196/11444 %U http://games.jmir.org/2019/1/e11444/ %U https://doi.org/10.2196/11444 %U http://www.ncbi.nlm.nih.gov/pubmed/30758293 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e11443 %T Can Brief, Daily Training Using a Mobile App Help Change Maladaptive Beliefs? Crossover Randomized Controlled Trial %A Roncero,María %A Belloch,Amparo %A Doron,Guy %+ Baruch Ivcher School of Psychology, Interdisciplinary Center Herzliya, PO Box 167, Herzliya, 46150, Israel, 972 99522850, Gdoron@idc.ac.il %K obsessive compulsive disorder %K cognitive therapy %K maladaptive beliefs %K mobile apps %K relationships %D 2019 %7 13.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obsessive-compulsive disorder (OCD) is a disabling condition with a wide variety of clinical presentations including contamination fears, fear of harm, and relationship-related obsessions. Cognitive behavioral models of OCD suggest that OC symptoms result from catastrophic misinterpretations of commonly occurring intrusive experiences and associated dysfunctional strategies used to manage them. OCD-related maladaptive beliefs including inflated responsibility, importance and control of thoughts, perfectionism, and intolerance for uncertainty increase the likelihood of such misinterpretations. Objective: Considering accumulating evidence suggesting that mobile health (mHealth) apps based on cognitive-behavioral principles may lead to significant reductions in psychopathological symptoms, we assessed the effectiveness of a novel cognitive training app (GGRO) designed to challenge OCD-related beliefs. Methods: A total of 97 students were randomized to groups undertaking immediate-use (iApp) or delayed use (dApp) of GGRO. All participants were requested to complete Web-based assessments, with questionnaires relating to maladaptive beliefs, mood, and OC symptoms at baseline (T1), 15 days from baseline (T2), and 30 days from baseline (T3). Participants in iApp group started using the app at baseline and continued using the app for 15 consecutive days. They were then requested to stop using the app until T3. Participants in the dApp group were requested to wait for 15 days and only then start using the app (crossover) for 15 consecutive days. Results: All participants used the app for a mean of 14.07 (SD 1.41) days with 2.94 levels per day. Consistent with previous findings, app use was associated with medium-large effect size reductions in both iApp (n=51) and dApp (n=46) groups. In the iApp group, all effects remained significant during the 15 days of follow-up. Analyses focusing on the first two assessment occasions revealed significant treatment × repeated measures interactions on maladaptive beliefs, several OC symptom measures, and self-esteem. Conclusions: This study provides further evidence for the efficacy of GGRO as a mobile-delivered training exercise that is useful for reducing OCD-related beliefs and symptoms. Trial Registration: ClinicalTrials.gov NCT03571464; https://clinicaltrials.gov/ct2/show/NCT03571464 (Archived by WebCite at http://www.webcitation.org/7675sYPsH) %M 30758294 %R 10.2196/11443 %U http://mhealth.jmir.org/2019/2/e11443/ %U https://doi.org/10.2196/11443 %U http://www.ncbi.nlm.nih.gov/pubmed/30758294 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e11847 %T Efficacy and Effectiveness of Mobile Health Technologies for Facilitating Physical Activity in Adolescents: Scoping Review %A Lee,Alexandra M %A Chavez,Sarah %A Bian,Jiang %A Thompson,Lindsay A %A Gurka,Matthew J %A Williamson,Victoria G %A Modave,François %+ Center for Health Outcomes and Informatics Research, Health Sciences Division, Loyola University Chicago, 2160 S 1st Avenue, CTRE126, Maywood, IL, 60153, United States, 1 7082167962, fmodave@luc.edu %K review %K mobile health %K adolescent %K exercise %D 2019 %7 12.02.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Increasing physical activity (PA) levels in adolescents aged 12 to 18 years is associated with prevention of unhealthy weight gain and improvement in cardiovascular fitness. The widespread availability of mobile health (mHealth) and wearable devices offers self-monitoring and motivational features for increasing PA levels and improving adherence to exercise programs. Objective: The aim of this scoping review was to identify the efficacy or effectiveness of mHealth intervention strategies for facilitating PA among adolescents aged 12 to 18 years. Methods: We conducted a systematic search for peer-reviewed studies published between 2008 and 2018 in the following electronic databases: PubMed, Google Scholar, PsychINFO, or SportDiscus. The search terms used included mHealth or “mobile health” or apps, “physical activity” or exercise, children or adolescents or teens or “young adults” or kids, and efficacy or effectiveness. Articles published outside of the date range (July 2008 to October 2018) and non-English articles were removed before abstract review. Three reviewers assessed all abstracts against the inclusion and exclusion criteria. Any uncertainties or differences in opinion were discussed as a group. The inclusion criteria were that the studies should (1) have an mHealth component, (2) target participants aged between 12 and 18 years, (3) have results on efficacy or effectiveness, and (4) assess PA-related outcomes. Reviews, abstracts only, protocols without results, and short message service text messaging–only interventions were excluded. We also extracted potentially relevant papers from reviews. At least 2 reviewers examined all full articles for fit with the criteria and extracted data for analysis. Data extracted from selected studies included study population, study type, components of PA intervention, and PA outcome results. Results: Overall, 126 articles were initially identified. Reviewers pulled 18 additional articles from excluded review papers. Only 18 articles were passed onto full review, and 16 were kept for analysis. The included studies differed in the sizes of the study populations (11-607 participants), locations of the study sites (7 countries), study setting, and study design. Overall, 5 mHealth intervention categories were identified: website, website+wearable, app, wearable+app, and website+wearable+app. The most common measures reported were subjective weekly PA (4/13) and objective daily moderate-to-vigorous PA (5/13) of the 19 different PA outcomes assessed. Furthermore, 5 of 13 studies with a control or comparison group showed a significant improvement in PA outcomes between the intervention group and the control or comparison group. Of those 5 studies, 3 permitted isolation of mHealth intervention components in the analysis. Conclusions: PA outcomes for adolescents improved over time through mHealth intervention use; however, the lack of consistency in chosen PA outcome measures, paucity of significant outcomes via between-group analyses, and the various study designs that prevent separating the effects of intervention components calls into question their true effect. %M 30747716 %R 10.2196/11847 %U http://mhealth.jmir.org/2019/2/e11847/ %U https://doi.org/10.2196/11847 %U http://www.ncbi.nlm.nih.gov/pubmed/30747716 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 2 %P e12252 %T A Novel Smoking Cessation Smartphone App Integrated With a Mobile Carbon Monoxide Checker for Smoking Cessation Treatment: Protocol for a Randomized Controlled Trial %A Nomura,Akihiro %A Tateno,Hiroki %A Masaki,Katsunori %A Muto,Tomoyasu %A Suzuki,Shin %A Satake,Kohta %A Hida,Eisuke %A Fukunaga,Koichi %+ Department of Internal Medicine, Saitama City Hospital, 2460 Mimuro, Midori-ward, Saitama, 3368522, Japan, 81 48 873 4111, hrk12tateno@me.com %K continuous abstinence rate %K nicotine dependence %K telemedicine %K randomized controlled trial %K smoking cessation %K tobacco use disorder %D 2019 %7 11.02.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smoking cessation treatment programs have been widely available for patients with nicotine dependence. Despite intensive programs, the continuous abstinence rate (CAR) from weeks 9-12 is still about 50%. Recently, a smartphone app emerged as a novel tool for therapeutic interventions, including nicotine dependence. In this study, we developed “CureApp Smoking Cessation” (CASC), which consists of a smartphone app for patients and a Web-based patient management software for doctors with a mobile carbon monoxide (CO) checking device to improve the efficacy of the smoking cessation treatment. Objective: This study aims to evaluate whether the CASC app is effective for individuals with nicotine dependence in addition to standard smoking cessation programs. Methods: This will be a randomized, sham-controlled, open-label, multicenter trial. We will recruit participants with nicotine dependence, but are otherwise healthy adults. We will randomize and allocate participants 1:1 to the CASC treatment group or a control app group. Both groups will receive a 12-week standard smoking cessation program with pharmacotherapy and counseling. In addition, participants in the treatment group will have the CASC app installed on their smartphone, which will provide video tutorials, advice from an artificial intelligence nurse, a digital diary, and measure daily exhaled CO concentration. In contrast, the control group will have the control app installed on their smartphone, where all the functions that can potentially effect smoking cessation are removed. The primary outcome will be the biochemically validated CAR from weeks 9-24. The success of smoking cessation will be defined as self-reported continuous abstinence from weeks 9-24 and exhaled CO concentration ≤10 ppm both at weeks 12 and 24. The main secondary outcomes will be the CAR from weeks 9-12, weeks 9-52, and 7-day point prevalence abstinence at weeks 4, 8, 12, 24, and 52. Results: We will recruit 580 participants with nicotine dependence from October 2017 to September 2018 or until the recruitment process is complete. The final 52-week follow-up will be completed in October 2019. We expect all trial results to be available by the end of 2019. The trial is funded by CureApp, Inc. Conclusions: This is the first randomized controlled trial to evaluate the efficacy of CASC. We expect that CASC, in addition to standard smoking cessation programs, has a significantly higher CAR during weeks 9-24 than the control app. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000031589; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000033555 International Registered Report Identifier (IRRID): DERR1-10.2196/12252 %M 30741641 %R 10.2196/12252 %U http://www.researchprotocols.org/2019/2/e12252/ %U https://doi.org/10.2196/12252 %U http://www.ncbi.nlm.nih.gov/pubmed/30741641 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e11636 %T Exploring Users’ Experiences of the Uptake and Adoption of Physical Activity Apps: Longitudinal Qualitative Study %A Baretta,Dario %A Perski,Olga %A Steca,Patrizia %+ Department of Psychology, University of Milano-Bicocca, U6 Building, 3rd Floor, Piazza dell'Ateneo Nuovo,1, Milano, 20126, Italy, 39 3405946987, d.baretta@campus.unimib.it %K physical activity %K smartphone apps %K engagement %K person-based approach %K longitudinal qualitative study %K thematic analysis %D 2019 %7 08.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although smartphone apps might support physical activity (PA), engagement with them tends to be low. Objective: This study aimed to examine potential users’ needs and preferences regarding their engagement with PA apps during a first exposure to a never-used PA app and after 2 weeks’ usage. Methods: A longitudinal, one-arm qualitative study was conducted with potential PA app users. At baseline, participants (N=20) were asked to explore 1 of 3 randomly allocated PA apps while thinking aloud. Semistructured interview techniques allowed participants to elaborate on their statements. After 2 weeks, follow-up interviews explored participants’ (n=17) lived experiences of real-world app use. Verbal reports from both time points were analyzed using inductive thematic analysis. Results: Features that promote a fair and simple user experience, support users’ self-regulation skills, and address users’ exercise motives were considered important for engagement both during a first exposure and after a 2-week use of PA apps. Features that support users’ need for relatedness as well as those that facilitate users to implement their intentions were expected to be important for engagement mainly during a first exposure to PA apps. Proactive and tailored features that integrate behavioral, psychological, and contextual information to provide adaptive exercise plans and just-in-time support were considered relevant to sustain engagement over time. Conclusions: App features that address users’ exercise motives, promote self-regulation, and fulfill users’ need for relatedness might promote engagement with PA apps. Tailored and proactive features were expected to promote sustained engagement. %M 30735143 %R 10.2196/11636 %U http://mhealth.jmir.org/2019/2/e11636/ %U https://doi.org/10.2196/11636 %U http://www.ncbi.nlm.nih.gov/pubmed/30735143 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e11270 %T Accuracy of Samsung Gear S Smartwatch for Activity Recognition: Validation Study %A Davoudi,Anis %A Wanigatunga,Amal Asiri %A Kheirkhahan,Matin %A Corbett,Duane Benjamin %A Mendoza,Tonatiuh %A Battula,Manoj %A Ranka,Sanjay %A Fillingim,Roger Benton %A Manini,Todd Matthew %A Rashidi,Parisa %+ Department of Biomedical Engineering, University of Florida, 1064 Center Drive, NEB 459, Gainesville, FL, 32611, United States, 1 352 392 5469, parisa.rashidi@ufl.edu %K actigraphy %K activity recognition %K machine learning %K metabolic equivalent %K physical activity %D 2019 %7 06.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable accelerometers have greatly improved measurement of physical activity, and the increasing popularity of smartwatches with inherent acceleration data collection suggest their potential use in the physical activity research domain; however, their use needs to be validated. Objective: This study aimed to assess the validity of accelerometer data collected from a Samsung Gear S smartwatch (SGS) compared with an ActiGraph GT3X+ (GT3X+) activity monitor. The study aims were to (1) assess SGS validity using a mechanical shaker; (2) assess SGS validity using a treadmill running test; and (3) compare individual activity recognition, location of major body movement detection, activity intensity detection, locomotion recognition, and metabolic equivalent scores (METs) estimation between the SGS and GT3X+. Methods: To validate and compare the SGS accelerometer data with GT3X+ data, we collected data simultaneously from both devices during highly controlled, mechanically simulated, and less-controlled natural wear conditions. First, SGS and GT3X+ data were simultaneously collected from a mechanical shaker and an individual ambulating on a treadmill. Pearson correlation was calculated for mechanical shaker and treadmill experiments. Finally, SGS and GT3X+ data were simultaneously collected during 15 common daily activities performed by 40 participants (n=12 males, mean age 55.15 [SD 17.8] years). A total of 15 frequency- and time-domain features were extracted from SGS and GT3X+ data. We used these features for training machine learning models on 6 tasks: (1) individual activity recognition, (2) activity intensity detection, (3) locomotion recognition, (4) sedentary activity detection, (5) major body movement location detection, and (6) METs estimation. The classification models included random forest, support vector machines, neural networks, and decision trees. The results were compared between devices. We evaluated the effect of different feature extraction window lengths on model accuracy as defined by the percentage of correct classifications. In addition to these classification tasks, we also used the extracted features for METs estimation. Results: The results were compared between devices. Accelerometer data from SGS were highly correlated with the accelerometer data from GT3X+ for all 3 axes, with a correlation ≥.89 for both the shaker test and treadmill test and ≥.70 for all daily activities, except for computer work. Our results for the classification of activity intensity levels, locomotion, sedentary, major body movement location, and individual activity recognition showed overall accuracies of 0.87, 1.00, 0.98, 0.85, and 0.64, respectively. The results were not significantly different between the SGS and GT3X+. Random forest model was the best model for METs estimation (root mean squared error of .71 and r-squared value of .50). Conclusions: Our results suggest that a commercial brand smartwatch can be used in lieu of validated research grade activity monitors for individual activity recognition, major body movement location detection, activity intensity detection, and locomotion detection tasks. %M 30724739 %R 10.2196/11270 %U http://mhealth.jmir.org/2019/2/e11270/ %U https://doi.org/10.2196/11270 %U http://www.ncbi.nlm.nih.gov/pubmed/30724739 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e12609 %T Initial Assessment of a Comprehensive Digital Smoking Cessation Program That Incorporates a Mobile App, Breath Sensor, and Coaching: Cohort Study %A Marler,Jennifer D %A Fujii,Craig A %A Utley,David S %A Tesfamariam,Lydia J %A Galanko,Joseph A %A Patrick,Heather %+ Carrot Inc, 1600 Seaport Blvd, Suite 150, Redwood City, CA, 94063, United States, 1 4157577696, marler@carrot.co %K smoking cessation %K mobile applications %K health promotion %K cell phone %D 2019 %7 04.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cigarette smoking is the leading cause of preventable morbidity and mortality, excess health care expenditure, and lost work productivity. Otherwise effective evidence-based treatments have had limited success owing to challenges with access, engagement, and scale. Pivot is a comprehensive digital smoking cessation program that incorporates a Food and Drug Administration–cleared carbon monoxide breath sensor, smartphone app, and text-based human coaching. Objective: This initial evaluation of Pivot aimed to assess participant engagement, changes in attitudes toward quitting, and changes in smoking behavior. Methods: US cigarette smokers aged 18 to 65 years who smoked ≥5 cigarettes per day (CPD) were recruited online. Participants completed a screening call, electronic informed consent, registration, and onboarding before beginning Pivot. Pivot includes 5 sequential stages (Explore, Build, Mobilize, Quit, and Secure), taking 14.5 to 18.5 weeks to complete. Data were collected via app and online questionnaires. Outcomes included engagement and retention (ie, weeks of active engagement and Pivot stage progression); attitudes toward quitting (ie, quit readiness, quit confidence, and expected difficulty maintaining quit); and smoking behavior (ie, quit attempts, cigarette reduction, and abstinence (7- and 30-day point prevalence abstinence [PPA]). Results: A total of 319 participants completed onboarding (intention-to-treat [ITT] sample); 272/319 participants (85.3%) completed the end-of-Pivot questionnaire (study completer sample). Most (212/319, 66.5%) were not ready to quit in the next 30 days at baseline. On average, participants actively engaged in the program for a mean 12.4 (SD 7.1) weeks. Pivot stage completion rates were Explore: 88.7% (283/319), Build: 57.4% (183/319), Mobilize: 43.6% (139/319), Quit: 41.1% (131/319), and Secure: 39.5% (126/319). Repeated measures linear mixed model analyses demonstrated positive changes in attitudes from baseline to Mobilize (pre-Quit): increased confidence to quit (4.2 to 7.4, P<.001) and decreased expected difficulty maintaining quit (3.1 to 6.8, P<.001). The quit attempt rate (ie, those making ≥1 quit attempt lasting ≥1 day) was 79.4% (216/272, completer). At the end of Pivot, 7-day PPA rates were 32.0% (102/319, ITT) and 37.5% (102/272, completer); 30-day PPA rates were 27.6% (88/319, ITT) and 32.4% (88/272, completer). Moreover, 30-day PPA rates were comparable among those ready and not ready to quit in the next 30 days at baseline. Of those not achieving abstinence, 25.9% (44/170, completer) achieved ≥50% reduction in CPD by study end. Conclusions: This study evaluated Pivot’s initial performance with comparable quit rates among those ready and not ready to quit in the next 30 days at entry. The present data, considered with the program’s accessibility, innovation, evidence-based foundation, and design for all smokers, suggest Pivot has the potential to address limitations of reach and scale and thereby advance smoking cessation efforts. Trial Registration: ClinicalTrials.gov NCT03295643; https://clinicaltrials.gov/ct2/show/NCT03295643 (Archived by WebCite at http://www.webcitation.org/75TiNe6BE). %M 30670372 %R 10.2196/12609 %U http://mhealth.jmir.org/2019/2/e12609/ %U https://doi.org/10.2196/12609 %U http://www.ncbi.nlm.nih.gov/pubmed/30670372 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 1 %P e11598 %T Supporting Older Adults in Exercising With a Tablet: A Usability Study %A Mehra,Sumit %A Visser,Bart %A Cila,Nazli %A van den Helder,Jantine %A Engelbert,Raoul HH %A Weijs,Peter JM %A Kröse,Ben JA %+ CREATE-IT Applied Research Centre, Faculty of Digital Media and Creative Industries, Amsterdam University of Applied Sciences, Wibautstraat 2-4, Amsterdam, 1091GM, Netherlands, 31 0621156956, s.mehra@hva.nl %K frail elderly %K aged %K activities of daily living %K exercise %K health behavior %K telemedicine %K mobile devices %K tablet computers %K usability testing %K mobile phone %D 2019 %7 01.02.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: For older adults, physical activity is vital for maintaining their health and ability to live independently. Home-based programs can help them achieve the recommended exercise frequency. An application for a tablet computer was developed to support older adults in following a personal training program. It featured goal setting, tailoring, progress tracking, and remote feedback. Objective: In line with the Medical Research Council Framework, which prescribes thorough testing before evaluating the efficacy with a randomized controlled trial, the aim of this study was to assess the usability of a tablet-based app that was designed to support older adults in doing exercises at home. Methods: A total of 15 older adults, age ranging from 69 to 99 years old, participated in a usability study that utilized a mixed-methods approach. In a laboratory setting, novice users were asked to complete a series of tasks while verbalizing their ongoing thoughts. The tasks ranged from looking up information about exercises and executing them to tailoring a weekly exercise schedule. Performance errors and time-on-task were calculated as proxies of effective and efficient usage. Overall satisfaction was assessed with a posttest interview. All responses were analyzed independently by 2 researchers. Results: The participants spent 13-85 seconds time-on-task. Moreover, 79% (11/14)-100% (14/14) participants completed the basic tasks with either no help or after having received 1 hint. For expert tasks, they needed a few more hints. During the posttest interview, the participants made 3 times more positive remarks about the app than negative remarks. Conclusions: The app that was developed to support older adults in doing exercises at home is usable by the target audience. First-time users were able to perform basic tasks in an effective and efficient manner. In general, they were satisfied with the app. Tasks that were associated with behavior execution and evaluation were performed with ease. Complex tasks such as tailoring a personal training schedule needed more effort. Learning effects, usefulness, and long-term satisfaction will be investigated through longitudinal follow-up studies. %M 30707106 %R 10.2196/11598 %U http://humanfactors.jmir.org/2019/1/e11598/ %U https://doi.org/10.2196/11598 %U http://www.ncbi.nlm.nih.gov/pubmed/30707106 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11954 %T Exploring Community Smokers’ Perspectives for Developing a Chat-Based Smoking Cessation Intervention Delivered Through Mobile Instant Messaging: Qualitative Study %A Luk,Tzu Tsun %A Wong,Sze Wing %A Lee,Jung Jae %A Chan,Sophia Siu-Chee %A Lam,Tai Hing %A Wang,Man Ping %+ School of Nursing, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong,, China (Hong Kong), 852 39176636, mpwang@hku.hk %K chat intervention %K instant messaging %K mHealth %K mobile phone %K social media %K smoking cessation %K tobacco dependence %K WhatsApp %D 2019 %7 31.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Advances in mobile communication technologies provide a promising avenue for the delivery of tobacco dependence treatment. Although mobile instant messaging (IM) apps (eg, WhatsApp, Facebook messenger, and WeChat) are an inexpensive and widely used communication tool, evidence on its use for promoting health behavior, including smoking cessation, is scarce. Objective: This study aims to explore the perception of using mobile IM as a modality to deliver a proposed chat intervention for smoking cessation in community smokers in Hong Kong, where the proportion of smartphone use is among the highest in the world. Methods: We conducted 5 focus group, semistructured qualitative interviews on a purposive sample of 15 male and 6 female current cigarette smokers (age 23-68 years) recruited from the community in Hong Kong. All interviews were audiotaped and transcribed. Two investigators independently analyzed the transcripts using thematic analyses. Results: Participants considered mobile IM as a feasible and acceptable platform for the delivery of a supportive smoking cessation intervention. The ability to provide more personalized and adaptive behavioral support was regarded as the most valued utility of the IM–based intervention. Other perceived utilities included improved perceived psychosocial support and identification of motivator to quit. In addition, participants provided suggestions on the content and design of the intervention, which may improve the acceptability and usability of the IM–based intervention. These include avoiding health warning information, positive messaging, using former smokers as counselors, and adjusting the language style (spoken vs written) according to the recipients’ preference. Conclusions: This qualitative study provides the first evidence that mobile IM may be an alternative mobile health platform for the delivery of a smoking cessation intervention. Furthermore, the findings inform the development of a chat-based, IM smoking cessation program being evaluated in a community trial. %M 30702431 %R 10.2196/11954 %U https://mhealth.jmir.org/2019/1/e11954/ %U https://doi.org/10.2196/11954 %U http://www.ncbi.nlm.nih.gov/pubmed/30702431 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 1 %P e11540 %T Investigating Intervention Components and Exploring States of Receptivity for a Smartphone App to Promote Physical Activity: Protocol of a Microrandomized Trial %A Kramer,Jan-Niklas %A Künzler,Florian %A Mishra,Varun %A Presset,Bastien %A Kotz,David %A Smith,Shawna %A Scholz,Urte %A Kowatsch,Tobias %+ Center for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, Dufourstrasse 40a, St. Gallen, 9000, Switzerland, 41 71224 ext 7249, jan-niklas.kramer@unisg.ch %K physical activity %K mHealth %K walking %K smartphone %K incentives %K self-regulation %D 2019 %7 31.01.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smartphones enable the implementation of just-in-time adaptive interventions (JITAIs) that tailor the delivery of health interventions over time to user- and time-varying context characteristics. Ideally, JITAIs include effective intervention components, and delivery tailoring is based on effective moderators of intervention effects. Using machine learning techniques to infer each user’s context from smartphone sensor data is a promising approach to further enhance tailoring. Objective: The primary objective of this study is to quantify main effects, interactions, and moderators of 3 intervention components of a smartphone-based intervention for physical activity. The secondary objective is the exploration of participants’ states of receptivity, that is, situations in which participants are more likely to react to intervention notifications through collection of smartphone sensor data. Methods: In 2017, we developed the Assistant to Lift your Level of activitY (Ally), a chatbot-based mobile health intervention for increasing physical activity that utilizes incentives, planning, and self-monitoring prompts to help participants meet personalized step goals. We used a microrandomized trial design to meet the study objectives. Insurees of a large Swiss insurance company were invited to use the Ally app over a 12-day baseline and a 6-week intervention period. Upon enrollment, participants were randomly allocated to either a financial incentive, a charity incentive, or a no incentive condition. Over the course of the intervention period, participants were repeatedly randomized on a daily basis to either receive prompts that support self-monitoring or not and on a weekly basis to receive 1 of 2 planning interventions or no planning. Participants completed a Web-based questionnaire at baseline and postintervention follow-up. Results: Data collection was completed in January 2018. In total, 274 insurees (mean age 41.73 years; 57.7% [158/274] female) enrolled in the study and installed the Ally app on their smartphones. Main reasons for declining participation were having an incompatible smartphone (37/191, 19.4%) and collection of sensor data (35/191, 18.3%). Step data are available for 227 (82.8%, 227/274) participants, and smartphone sensor data are available for 247 (90.1%, 247/274) participants. Conclusions: This study describes the evidence-based development of a JITAI for increasing physical activity. If components prove to be efficacious, they will be included in a revised version of the app that offers scalable promotion of physical activity at low cost. Trial Registration: ClinicalTrials.gov NCT03384550; https://clinicaltrials.gov/ct2/show/NCT03384550 (Archived by WebCite at http://www.webcitation.org/74IgCiK3d) International Registered Report Identifier (IRRID): DERR1-10.2196/11540 %M 30702430 %R 10.2196/11540 %U http://www.researchprotocols.org/2019/1/e11540/ %U https://doi.org/10.2196/11540 %U http://www.ncbi.nlm.nih.gov/pubmed/30702430 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 1 %P e10681 %T Promising Approaches for Engaging Youth and Young Adults Living with HIV in HIV Primary Care Using Social Media and Mobile Technology Interventions: Protocol for the SPNS Social Media Initiative %A Medich,Melissa %A Swendeman,Dallas T %A Comulada,W Scott %A Kao,Uyen H %A Myers,Janet J %A Brooks,Ronald A %A , %+ Department of Family Medicine, University of California, Los Angeles, Suite 1800, 10880 Wilshire Boulevard, Los Angeles, CA, 90024, United States, 1 3107940773, rabrooks@mednet.ucla.edu %K HIV %K health outcomes %K mobile technology %K social media %K youth %K young adult %K mobile phone %D 2019 %7 31.01.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the United States, disparities in the rates of HIV care among youth and young adults result from the intersections of factors that include stigma, substance use, homelessness or marginal housing, institutional neglect, and mental health issues. Novel interventions are needed that are geared to youth and young adults. Objective: In this paper, we aim to describe the interventions used by participating sites for Using Social Media initiative, the process for classifying the intervention components, and the methods for conducting a comprehensive evaluation of the interventions. Methods: In 2015, the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau, Special Projects of National Significance (SPNS) funded the Evaluation and Technical Assistance Center (ETAC) at the University of California, Los Angeles and 10 demonstration projects at sites across the United States that incorporated innovative approaches using a variety of social media and mobile technology strategies designed specifically for youth and young adults living with HIV. The ETAC developed a typology, or a classification system, that systematically summarizes the principal components of the interventions into broader groups and developed a multisite, mixed-methods approach to evaluate them based on the Department of Health and Human Services HIV health outcomes along the HIV care continuum. The mixed-methods approach is key to remove potential biases in assessing the effectiveness of demonstration projects. Results: This SPNS project was funded in September 2015, and enrollment was completed on May 31, 2018. A total of 984 participants have been enrolled in the multisite evaluation. Data collection will continue until August 2019. However, data analysis is currently underway, and the first results are expected to be submitted for publication in 2019. Conclusions: This HRSA-funded initiative seeks to increase engagement in HIV medical care, improve health outcomes for people living with HIV, and reduce HIV-related health disparities and health inequities that affect HIV-positive youth and young adults. International Registered Report Identifier (IRRID): DERR1-10.2196/10681 %M 30702434 %R 10.2196/10681 %U http://www.researchprotocols.org/2019/1/e10681/ %U https://doi.org/10.2196/10681 %U http://www.ncbi.nlm.nih.gov/pubmed/30702434 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11836 %T Effects of Social Media and Mobile Health Apps on Pregnancy Care: Meta-Analysis %A Chan,Ko Ling %A Chen,Mengtong %+ Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong,, China (Hong Kong), 852 5425 9462, jenna.mt.chen@polyu.edu.hk %K mHealth %K social media %K pregnancy %K postpartum %K maternal health %D 2019 %7 30.01.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The use of social media and mobile health (mHealth) apps has been increasing in pregnancy care. However, the effectiveness of these interventions is still unclear. Objectives: We conducted a meta-analysis to examine the effectiveness of these interventions with regard to different health outcomes in pregnant and postpartum women and investigate the characteristics and components of interventions that may affect program effectiveness. Method: We performed a comprehensive literature search of major electronic databases and reference sections of related reviews and eligible studies. A random effects model was used to calculate the effect size. Results: Fifteen randomized controlled trial studies published in and before June 2018 that met the inclusion criteria were included in the meta-analysis. The interventions were effective in promoting maternal physical health including weight management, gestational diabetes mellitus control, and asthma control with a moderate to large effect size (d=0.72). Large effect sizes were also found for improving maternal mental health (d=0.84) and knowledge about pregnancy (d=0.80). Weight control interventions using wearable devices were more effective. Conclusion: Social media and mHealth apps have the potential to be widely used in improving maternal well-being. More large-scale clinical trials focusing on different health outcomes are suggested for future studies. %M 30698533 %R 10.2196/11836 %U https://mhealth.jmir.org/2019/1/e11836/ %U https://doi.org/10.2196/11836 %U http://www.ncbi.nlm.nih.gov/pubmed/30698533 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11325 %T Barriers to and Facilitators of Engagement With mHealth Technology for Remote Measurement and Management of Depression: Qualitative Analysis %A Simblett,Sara %A Matcham,Faith %A Siddi,Sara %A Bulgari,Viola %A Barattieri di San Pietro,Chiara %A Hortas López,Jorge %A Ferrão,José %A Polhemus,Ashley %A Haro,Josep Maria %A de Girolamo,Giovanni %A Gamble,Peter %A Eriksson,Hans %A Hotopf,Matthew %A Wykes,Til %A , %+ Institute of Psychology, Psychiatry and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, United Kingdom, 44 207 848 0762, sara.simblett@kcl.ac.uk %K acceptability %K barriers %K depression %K facilitators %K feasibility %K mHealth %K qualitative %D 2019 %7 30.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile technology has the potential to provide accurate, impactful data on the symptoms of depression, which could improve health management or assist in early detection of relapse. However, for this potential to be achieved, it is essential that patients engage with the technology. Although many barriers to and facilitators of the use of this technology are common across therapeutic areas and technology types, many may be specific to cultural and health contexts. Objective: This study aimed to determine the potential barriers to and facilitators of engagement with mobile health (mHealth) technology for remote measurement and management of depression across three Western European countries. Methods: Participants (N=25; 4:1 ratio of women to men; age range, 25-73 years) who experienced depression participated in five focus groups held in three countries (two in the United Kingdom, two in Spain, and one in Italy). The focus groups investigated the potential barriers to and facilitators of the use of mHealth technology. A systematic thematic analysis was used to extract themes and subthemes. Results: Facilitators and barriers were categorized as health-related factors, user-related factors, and technology-related factors. A total of 58 subthemes of specific barriers and facilitators or moderators emerged. A core group of themes including motivation, potential impact on mood and anxiety, aspects of inconvenience, and ease of use was noted across all countries. Conclusions: Similarities in the barriers to and facilitators of the use of mHealth technology have been observed across Spain, Italy, and the United Kingdom. These themes provide guidance on ways to promote the design of feasible and acceptable cross-cultural mHealth tools. %M 30698535 %R 10.2196/11325 %U http://mhealth.jmir.org/2019/1/e11325/ %U https://doi.org/10.2196/11325 %U http://www.ncbi.nlm.nih.gov/pubmed/30698535 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11041 %T Using Passive Smartphone Sensing for Improved Risk Stratification of Patients With Depression and Diabetes: Cross-Sectional Observational Study %A Sarda,Archana %A Munuswamy,Suresh %A Sarda,Shubhankar %A Subramanian,Vinod %+ Touchkin eServices Private Limited, 1st Floor, Manjusha, No 532, 16th Cross, 2nd Main Road, 2nd Stage, Indira Nagar, Bangalore, 560038, India, 91 9762665119, shubhankar@touchkin.com %K depression %K diabetes %K mental health %K comorbidity %K passive sensing %K smartphone %K classification %K machine learning %K mHealth %K risk assessment %D 2019 %7 29.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Research studies are establishing the use of smartphone sensing to measure mental well-being. Smartphone sensor information captures behavioral patterns, and its analysis helps reveal well-being changes. Depression in diabetes goes highly underdiagnosed and underreported. The comorbidity has been associated with increased mortality and worse clinical outcomes, including poor glycemic control and self-management. Clinical-only intervention has been found to have a very modest effect on diabetes management among people with depression. Smartphone technologies could play a significant role in complementing comorbid care. Objective: This study aimed to analyze the association between smartphone-sensing parameters and symptoms of depression and to explore an approach to risk-stratify people with diabetes. Methods: A cross-sectional observational study (Project SHADO—Analyzing Social and Health Attributes through Daily Digital Observation) was conducted on 47 participants with diabetes. The study’s smartphone-sensing app passively collected data regarding activity, mobility, sleep, and communication from each participant. Self-reported symptoms of depression using a validated Patient Health Questionnaire-9 (PHQ-9) were collected once every 2 weeks from all participants. A descriptive analysis was performed to understand the representation of the participants. A univariate analysis was performed on each derived sensing variable to compare behavioral changes between depression states—those with self-reported major depression (PHQ-9>9) and those with none (PHQ-9≤9). A classification predictive modeling, using supervised machine-learning methods, was explored using derived sensing variables as input to construct and compare classifiers that could risk-stratify people with diabetes based on symptoms of depression. Results: A noticeably high prevalence of self-reported depression (30 out of 47 participants, 63%) was found among the participants. Between depression states, a significant difference was found for average activity rates (daytime) between participant-day instances with symptoms of major depression (mean 16.06 [SD 14.90]) and those with none (mean 18.79 [SD 16.72]), P=.005. For average number of people called (calls made and received), a significant difference was found between participant-day instances with symptoms of major depression (mean 5.08 [SD 3.83]) and those with none (mean 8.59 [SD 7.05]), P<.001. These results suggest that participants with diabetes and symptoms of major depression exhibited lower activity through the day and maintained contact with fewer people. Using all the derived sensing variables, the extreme gradient boosting machine-learning classifier provided the best performance with an average cross-validation accuracy of 79.07% (95% CI 74%-84%) and test accuracy of 81.05% to classify symptoms of depression. Conclusions: Participants with diabetes and self-reported symptoms of major depression were observed to show lower levels of social contact and lower activity levels during the day. Although findings must be reproduced in a broader randomized controlled study, this study shows promise in the use of predictive modeling for early detection of symptoms of depression in people with diabetes using smartphone-sensing information. %M 30694197 %R 10.2196/11041 %U http://mhealth.jmir.org/2019/1/e11041/ %U https://doi.org/10.2196/11041 %U http://www.ncbi.nlm.nih.gov/pubmed/30694197 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 1 %P e12526 %T Understanding the Effect of Adding Automated and Human Coaching to a Mobile Health Physical Activity App for Afghanistan and Iraq Veterans: Protocol for a Randomized Controlled Trial of the Stay Strong Intervention %A Buis,Lorraine R %A McCant,Felicia A %A Gierisch,Jennifer M %A Bastian,Lori A %A Oddone,Eugene Z %A Richardson,Caroline R %A Kim,Hyungjin Myra %A Evans,Richard %A Hooks,Gwendolyn %A Kadri,Reema %A White-Clark,Courtney %A Damschroder,Laura J %+ VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, PO Box 130170, Ann Arbor, MI, 48113, United States, 1 734 845 3603, laura.damschroder@va.gov %K exercise %K veterans %K cell phones %K mobile phone %K telemedicine %D 2019 %7 29.01.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although maintaining a healthy weight and physical conditioning are requirements of active military duty, many US veterans rapidly gain weight and lose conditioning when they separate from active-duty service. Mobile health (mHealth) interventions that incorporate wearables for activity monitoring have become common, but it is unclear how to optimize engagement over time. Personalized health coaching, either through tailored automated messaging or by individual health coaches, has the potential to increase the efficacy of mHealth programs. In an attempt to preserve conditioning and ward off weight gain, we developed Stay Strong, a mobile app that is tailored to veterans of recent conflicts and tracks physical activity monitored by Fitbit Charge 2 devices and weight measured on a Bluetooth-enabled scale. Objective: The goal of this study is to determine the effect of activity monitoring plus health coaching compared with activity monitoring alone. Methods: In this randomized controlled trial, with Stay Strong, a mobile app designed specifically for veterans, we plan to enroll 350 veterans to engage in an mHealth lifestyle intervention that combines the use of a wearable physical activity tracker and a Bluetooth-enabled weight scale. The Stay Strong app displays physical activity and weight data trends over time. Enrolled participants are randomized to receive the Stay Strong app (active comparator arm) or Stay Strong + Coaching, an enhanced version of the program that adds coaching features (automated tailored messaging with weekly physical activity goals and up to 3 telephone calls with a health coach—intervention arm) for 1 year. Our primary outcome is change in physical activity at 12 months, with weight, pain, patient activation, and depression serving as secondary outcome measures. All processes related to recruitment, eligibility screening, informed consent, Health Insurance Portability and Accountability Act authorization, baseline assessment, randomization, the bulk of intervention delivery, and outcome assessment will be accomplished via the internet or smartphone app. Results: The study recruitment began in September 2017, and data collection is expected to conclude in 2019. A total of 465 participants consented to participate and 357 (357/465, 77%) provided baseline levels of physical activity and were randomized to 1 of the 2 interventions. Conclusions: This novel randomized controlled trial will provide much-needed findings about whether the addition of telephone-based human coaching and other automated supportive-coaching features will improve physical activity compared with using a smartphone app linked to a wearable device alone. Trial Registration: ClinicalTrials.gov NCT02360293; https://clinicaltrials.gov/ct2/show/NCT02360293 (Archived by WebCite at http://www.webcitation.org/75KQeIFwh) International Registered Report Identifier (IRRID): DERR1-10.2196/12526 %M 30694208 %R 10.2196/12526 %U http://www.researchprotocols.org/2019/1/e12526/ %U https://doi.org/10.2196/12526 %U http://www.ncbi.nlm.nih.gov/pubmed/30694208 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e9892 %T The Implementation of an Innovative Hydration Monitoring App in Care Home Settings: A Qualitative Study %A Steven,Alison %A Wilson,Gemma %A Young-Murphy,Lesley %+ Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University Newcastle, Coach Lane Campus, Room B121, Benton, Newcastle upon Tyne, NE77XA, United Kingdom, 44 191215 ext 6483, alison.steven@northumbria.ac.uk %K education %K frail elderly %K mobile apps %K patient safety %K residential facilities %K water-electrolyte balance %D 2019 %7 29.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In response to marked concern regarding inadequate fluid intake recording in care homes, an innovative mobile hydration app was collaboratively developed. “Hydr8” aimed to facilitate accurate recording and communication of residents’ fluid intake and ultimately increase care quality and patient safety. Objective: The aim of this study was to examine the implementation of Hydr8 in a sample of care homes in one area in England. Methods: The principles of Realist Evaluation and Action research were drawn upon throughout the study. Overall, 5 care homes participated in this study, 3 interview-only sites and 2 case-study sites, where interviews and observations were conducted at 3 time-points. Furthermore, 28 staff members participated, including care staff, management, a registered nurse, and administrative staff. Results: Findings suggest that Hydr8 benefits practice, enhancing the understanding of hydration and person-centered care and improving staff communication. However, technical glitches hindered the seamless embedding of Hydr8 into everyday practice, and enthusiasm for long-term use was dependent on the resolution of issues. In addition, Hydr8 heightened perceptions of personal accountability, and while managers viewed this as positive, some staff members were apprehensive. However, individuals were enthusiastic about the long-term use and potential of Hydr8. Conclusions: Utilizing the findings of this study to further develop and adapt Hydr8 indicates the long-term use of Hydr8 as promising. Although perceptions of Hydr8 were primarily positive, setbacks in its implementation and use created difficulties in normalizing the solution into everyday practice. This study highlights the need for education related to hydration practice and a change of infrastructure in care home settings to implement technical solutions and changes to care. %M 30694207 %R 10.2196/mhealth.9892 %U http://mhealth.jmir.org/2019/1/e9892/ %U https://doi.org/10.2196/mhealth.9892 %U http://www.ncbi.nlm.nih.gov/pubmed/30694207 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11130 %T The App Behavior Change Scale: Creation of a Scale to Assess the Potential of Apps to Promote Behavior Change %A McKay,Fiona H %A Slykerman,Sarah %A Dunn,Matthew %+ School of Health and Social Development, Deakin University, Burwood Hwy, Burwood, 3125, Australia, 61 392517183, fiona.mckay@deakin.edu.au %K apps %K smartphone %K mobile phone %K mobile app %K scale development %K rating %D 2019 %7 25.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Using mobile phone apps to promote behavior change is becoming increasingly common. However, there is no clear way to rate apps against their behavior change potential. Objective: This study aimed to develop a reliable, theory-based scale that can be used to assess the behavior change potential of smartphone apps. Methods: A systematic review of all studies purporting to investigate app’s behavior change potential was conducted. All scales and measures from the identified studies were collected to create an item pool. From this item pool, 3 health promotion exerts created the App Behavior Change Scale (ABACUS). To test the scale, 70 physical activity apps were rated to provide information on reliability. Results: The systematic review returned 593 papers, the abstracts and titles of all were reviewed, with the full text of 77 papers reviewed; 50 papers met the inclusion criteria. From these 50 papers, 1333 questions were identified. Removing duplicates and unnecessary questions left 130 individual questions, which were then refined into the 21-item scale. The ABACUS demonstrates high percentage agreement among reviewers (over 80%), with 3 questions scoring a Krippendorff alpha that would indicate agreement and a further 7 came close with alphas >.5. The scale overall reported high interrater reliability (2-way mixed interclass coefficient=.92, 95% CI 0.81-0.97) and high internal consistency (Cronbach alpha=.93). Conclusions: The ABACUS is a reliable tool that can be used to determine the behavior change potential of apps. This instrument fills a gap by allowing the evaluation of a large number of apps to be standardized across a range of health categories. %M 30681967 %R 10.2196/11130 %U http://mhealth.jmir.org/2019/1/e11130/ %U https://doi.org/10.2196/11130 %U http://www.ncbi.nlm.nih.gov/pubmed/30681967 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 1 %P e12601 %T Improving Blood Pressure Among African Americans With Hypertension Using a Mobile Health Approach (the MI-BP App): Protocol for a Randomized Controlled Trial %A Buis,Lorraine R %A Dawood,Katee %A Kadri,Reema %A Dawood,Rachelle %A Richardson,Caroline R %A Djuric,Zora %A Sen,Ananda %A Plegue,Melissa %A Hutton,David %A Brody,Aaron %A McNaughton,Candace D %A Brook,Robert D %A Levy,Phillip %+ Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, United States, 1 734 998 7120, buisl@umich.edu %K hypertension %K mHealth %K blood pressure %K smartphone %K mobile phone %D 2019 %7 25.01.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: African Americans shoulder significant disparities related to hypertension (HTN), which is a serious public health problem in the city of Detroit, Michigan, where more than 80% of the population is African American. Connectivity through smartphones, use of home blood pressure (BP) monitoring, and newly developed mobile health (mHealth) interventions can facilitate behavioral changes and may improve long-term self-care for chronic conditions, but implementation of a combined approach utilizing these methods has not been tested among African American patients with uncontrolled HTN. Since African Americans are more likely than other racial or ethnic subgroups to utilize the emergency department (ED) for ambulatory care, this presents an opportunity to intervene on a population that is otherwise difficult to reach. Objective: The MI-BP app aims to reduce health disparities related to HTN in the community by employing a user-centered intervention focused on self-BP monitoring, physical activity, reduced sodium intake, and medication adherence. We seek to test the efficacy of MI-BP, an mHealth app for HTN self-management, on BP control (primary aim), physical activity, sodium intake, and medication adherence (secondary aim) in African Americans with HTN. This study also seeks to evaluate the cost-effectiveness of MI-BP when compared with usual care methods. Methods: This is a 1-year randomized controlled trial that will recruit individuals who have uncontrolled HTN from 2 EDs in the city of Detroit, with a planned sample size of 396 randomized participants. To be eligible for inclusion, potential participants must be African American, 25 to 70 years old, previously diagnosed with HTN, have a smartphone compatible with MI-BP, and have uncontrolled BP at triage and on repeat measurement at least 1-hour post triage vitals. Once a participant is deemed eligible, all study procedures and subsequent follow-up visits (8 in total) are conducted at the Wayne State University Clinical Research Service Center. We seek to determine the effect of MI-BP on BP for 1 year (using BP control and mean systolic BP as coprimary outcomes and physical activity, sodium intake, and medication adherence as secondary outcomes) compared with usual care controls. Results: Recruitment for this study began in January 2018. The study will continue through 2021. Conclusions: As the first of its kind conducted in an ED setting, MI-BP was designed to document the efficacy and acceptability of a multicomponent mHealth approach to help African Americans with uncontrolled BP modify their lifestyle to better manage their HTN. We expect to lay the foundation to sustainably reduce HTN-related health disparities through better integration of multiple behavior self-monitoring and improve outcomes for those who traditionally rely on the ED for chronic disease care. Trial Registration: ClinicalTrials.gov NCT02360293; http://clinicaltrials.gov/ct2/show/NCT02360293 International Registered Report Identifier (IRRID): RR1-10.2196/12601 %M 30681965 %R 10.2196/12601 %U http://www.researchprotocols.org/2019/1/e12601/ %U https://doi.org/10.2196/12601 %U http://www.ncbi.nlm.nih.gov/pubmed/30681965 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 1 %P e10659 %T Developing a Mobile App (LYNX) to Support Linkage to HIV/Sexually Transmitted Infection Testing and Pre-Exposure Prophylaxis for Young Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial %A Liu,Albert %A Coleman,Kenneth %A Bojan,Kelly %A Serrano,Pedro Alonso %A Oyedele,Temitope %A Garcia,Amayvis %A Enriquez-Bruce,Elizabeth %A Emmanuel,Patricia %A Jones,Jeb %A Sullivan,Patrick %A Hightow-Weidman,Lisa %A Buchbinder,Susan %A Scott,Hyman %+ Bridge HIV, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 100, San Francisco, CA, 94102, United States, 1 415 437 7408, albert.liu@sfdph.org %K mobile app %K HIV testing %K sexually transmitted infections %K sexually transmitted diseases %K pre-exposure prophylaxis %K youth %K adolescent %K men who have sex with men %D 2019 %7 25.01.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young men who have sex with men (YMSM) in the United States have among the highest incidence of HIV and sexually transmitted infection (STI) and the lowest uptake of HIV and STI testing and pre-exposure prophylaxis (PrEP). Nearly universal mobile phone ownership among youth provides an opportunity to leverage mobile health apps to increase HIV/STI testing and PrEP uptake among YMSM. Objective: The goals of this project are to develop and refine LYNX, a novel mobile app to support linkage to HIV/STIs testing and PrEP services among YMSM in the United States, and to evaluate the acceptability and feasibility of LYNX in a pilot randomized controlled trial (RCT). Methods: This research protocol will be conducted in 3 phases: an iterative development phase with a series of 3 focus groups among 20 YMSM to refine the LYNX app; an open technical pilot among 15 YMSM to optimize usability of the app; and then a 6-month pilot RCT among 60 HIV-uninfected YMSM at risk for HIV acquisition. Developed using the Information, Motivation, and Behavioral skills theoretical model, the LYNX app includes an electronic diary to track sexual behaviors (information), a personalized risk score to promote accurate risk perception (information/motivation), testing reminders (motivation/behavioral skills), and access to home-based HIV/STI testing options and geospatial-based HIV/STI testing care sites (behavioral skills). Feasibility and acceptability will be assessed through app analytics of usage patterns and acceptability scales administered via computer-assisted self-interview at 3 and 6 months. We will also evaluate preliminary efficacy by comparing the proportion of YMSM who test at least once during the 6-month pilot and the proportion who successfully link to a PrEP provider in the intervention versus control groups. Results: Formative work is currently underway. The LYNX pilot RCT will begin enrollment in October 2018, with study results available in 2019. Conclusions: The LYNX app is one of the first mobile apps designed to increase HIV/STI testing and PrEP uptake among YMSM. As low-perceived risk is a barrier to HIV/STI testing and PrEP use among youth, the personalized risk assessment and interactive sexual diary in LYNX could assist YMSM in better understanding their HIV risk and providing motivation to test for HIV/STIs and initiate PrEP. Coupled with community-based recruitment, this novel mobile app has great potential to reach and engage YMSM not currently involved in care and increase rates of HIV/STI testing and PrEP uptake in this vulnerable population. Trial Registration: ClinicalTrials.gov NCT03177512; https://clinicaltrials.gov/ct2/show/NCT03177512 (Archived by WebCite at http://www.webcitation.org/73c917wAw) International Registered Report Identifier (IRRID): PRR1-10.2196/10659 %M 30681964 %R 10.2196/10659 %U http://www.researchprotocols.org/2019/1/e10659/ %U https://doi.org/10.2196/10659 %U http://www.ncbi.nlm.nih.gov/pubmed/30681964 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 1 %P e11334 %T Adoption of Mobile Apps for Depression and Anxiety: Cross-Sectional Survey Study on Patient Interest and Barriers to Engagement %A Lipschitz,Jessica %A Miller,Christopher J %A Hogan,Timothy P %A Burdick,Katherine E %A Lippin-Foster,Rachel %A Simon,Steven R %A Burgess,James %+ Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, United States, 1 617 732 6548, jlipschitz@bwh.harvard.edu %K mHealth %K depression %K anxiety %K mobile apps %K patient preference %D 2019 %7 25.01.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Emerging research suggests that mobile apps can be used to effectively treat common mental illnesses like depression and anxiety. Despite promising efficacy results and ease of access to these interventions, adoption of mobile health (mHealth; mobile device–delivered) interventions for mental illness has been limited. More insight into patients’ perspectives on mHealth interventions is required to create effective implementation strategies and to adapt existing interventions to facilitate higher rates of adoption. Objective: The aim of this study was to examine, from the patient perspective, current use and factors that may impact the use of mHealth interventions for mental illness. Methods: This was a cross-sectional survey study of veterans who had attended an appointment at a single Veterans Health Administration facility in early 2016 that was associated with one of the following mental health concerns: unipolar depression, any anxiety disorder, or posttraumatic stress disorder. We used the Veteran Affairs Corporate Data Warehouse to create subsets of eligible participants demographically stratified by gender (male or female) and minority status (white or nonwhite). From each subset, 100 participants were selected at random and mailed a paper survey with items addressing the demographics, overall health, mental health, technology ownership or use, interest in mobile app interventions for mental illness, reasons for use or nonuse, and interest in specific features of mobile apps for mental illness. Results: Of the 400 potential participants, 149 (37.3%, 149/400) completed and returned a survey. Most participants (79.9%, 119/149) reported that they owned a smart device and that they use apps in general (71.1%, 106/149). Most participants (73.1%, 87/149) reported interest in using an app for mental illness, but only 10.7% (16/149) had done so. Paired samples t tests indicated that ratings of interest in using an app recommended by a clinician were significantly greater than general interest ratings and even greater when the recommending clinician was a specialty mental health provider. The most frequent concerns related to using an app for mental illness were lacking proof of efficacy (71.8%, 107/149), concerns about data privacy (59.1%, 88/149), and not knowing where to find such an app (51.0%, 76/149). Participants expressed interest in a number of app features with particularly high-interest ratings for context-sensitive apps (85.2%, 127/149), and apps focused on the following areas: increasing exercise (75.8%, 113/149), improving sleep (73.2%, 109/149), changing negative thinking (70.5%, 105/149), and increasing involvement in activities (67.1%, 100/149). Conclusions: Most respondents had access to devices to use mobile apps for mental illness, already used apps for other purposes, and were interested in mobile apps for mental illness. Key factors that may improve adoption include provider endorsement, greater publicity of efficacious apps, and clear messaging about efficacy and privacy of information. Finally, multifaceted apps that address a range of concerns, from sleep to negative thought patterns, may be best received. %M 30681968 %R 10.2196/11334 %U http://mental.jmir.org/2019/1/e11334/ %U https://doi.org/10.2196/11334 %U http://www.ncbi.nlm.nih.gov/pubmed/30681968 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 1 %P e9017 %T American Heart Association’s Cholesterol CarePlan as a Smartphone-Delivered Web App for Patients Prescribed Cholesterol-Lowering Medication: Protocol for an Observational Feasibility Study %A Woringer,Maria %A Dharmayat,Kanika I %A Greenfield,Geva %A Bottle,Alex %A Ray,Kausik K %+ Imperial College London, Department of Primary Care and Public Health, Reynolds Building, St Dunstan's Road, London, W6 8RP, United Kingdom, 44 02075940789, m.woringer@imperial.ac.uk %K behavioral change %K cholesterol %K lifestyle %K mHealth %K medication adherence %D 2019 %7 24.01.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adoption of healthy lifestyle and compliance with cholesterol-lowering medication reduces the risk of cardiovascular disease (CVD). The use of digital tools and mobile technology may be important for sustaining positive behavioral change. Objective: The primary objective of this study is to evaluate the feasibility and acceptability of administering the Cholesterol CarePlan Web app developed by the American Heart Association aimed at improving lifestyle and medication adherence among patients prescribed cholesterol-lowering medication. The secondary objective is to assess the Web app’s efficacy. Methods: A prospective, observational feasibility study will be conducted to demonstrate whether the Web app may be successfully taken up by patients and will be associated with improved clinical and behavioral outcomes. The study will aim to recruit 180 study participants being prescribed cholesterol-lowering medication for at least 30 days across 14 general practices in London, England. Potentially eligible patients will be invited to use the Web app on a smartphone and visit general practice for three 20-minute clinical assessments of blood pressure, height, weight, smoking, and nonfasting cholesterol over 24 weeks. The feasibility of administering the Web app will be judged by recruitment and dropout statistics and the sociodemographic and comorbidity profile of consenting study participants, consenting nonparticipants, and all potentially eligible patients. Acceptability will be assessed using patients’ readiness to embrace new technologies, the usability of the Web app, and patient satisfaction. The efficacy of the Web app will be assessed by changes in medication adherence and clinical risk factors by levels of the Web app compliance. Results: This study is currently funded by the American Heart Association. Initial study recruitment will take place between February and July 2018 followed by patient follow-up. Patient level data will be obtained in January 2019. Data analysis will be completed by February 2019. Results will be submitted for publication in March 2019. Conclusions: The potential of an app to improve patients’ lifestyle and management of cholesterol may inform the design of a randomized controlled trial and the delivery of more effective CVD prevention programs. International Registered Report Identifier (IRRID): PRR1-10.2196/9017 %M 30679150 %R 10.2196/resprot.9017 %U https://www.researchprotocols.org/2019/1/e9017/ %U https://doi.org/10.2196/resprot.9017 %U http://www.ncbi.nlm.nih.gov/pubmed/30679150 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e10948 %T Effectiveness of a Multimodal Digital Psychotherapy Platform for Adult Depression: A Naturalistic Feasibility Study %A Marcelle,Enitan T %A Nolting,Laura %A Hinshaw,Stephen P %A Aguilera,Adrian %+ Department of Psychology, University of California, Berkeley, Tolman Hall, Berkeley, CA,, United States, 1 2164968894, emarcelle@berkeley.edu %K cognitive therapy %K depression %K digital health %K live chat %K mHealth %K mental health %K text messaging %K video %K mobile phone %D 2019 %7 23.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although psychotherapy is one of the most efficacious and effective treatments for depression, limited accessibility to trained providers markedly limits access to care. In an attempt to overcome this obstacle, several platforms seeking to provide these services using digital modalities (eg, video, text, and chat) have been developed. However, the use of these modalities individually poses barriers to intervention access and acceptability. Multimodal platforms, comprising those that allow users to select from a number of available modalities, may be able to provide a solution to these concerns. Objective: We aimed to investigate the preliminary effectiveness of providing psychotherapy through a multimodal digital psychotherapy platform. In addition, we aimed to examine differential responses to intervention by gender, self-reported physical health status, and self-reported financial status, as well as how prior exposure to traditional face-to-face psychotherapy affected the effectiveness of a multimodal digital psychotherapy intervention. Finally, we aimed to examine the dose-response effect. Methods: Data were collected from a total of 318 active users of BetterHelp, a multimodal digital psychotherapy platform. Data on physical health status, financial status, and prior exposure to psychotherapy were obtained using self-report measures. Effectiveness was determined by the extent of symptom severity change, which was measured using the Patient Health Questionnaire at Time 1 (time of enrollment) and Time 2 (3 months after enrollment). Intervention dosage was measured as the sum of individual therapist-user interactions across modalities. Results: Depression symptom severity was significantly reduced after the use of the multimodal digital psychotherapy intervention (P<.001). Individuals without prior traditional psychotherapy experience revealed increased improvement after intervention (P=.006). We found no significant dose-response effect of therapy, nor significant differences in outcomes across gender, self-reported financial status, and self-reported physical health status. Conclusions: Users of BetterHelp experienced significantly reduced depression symptom severity after engaging with the platform. Study findings suggest that this intervention is equally effective across gender, self-reported financial status, and self-reported physical health status and particularly effective for individuals without a history of psychotherapy. Overall, study results suggest that multimodal digital psychotherapy is a potentially effective treatment for adult depression; nevertheless, experimental trials are needed. We discuss directions for future research. %M 30674448 %R 10.2196/10948 %U http://mhealth.jmir.org/2019/1/e10948/ %U https://doi.org/10.2196/10948 %U http://www.ncbi.nlm.nih.gov/pubmed/30674448 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e9836 %T Assessing the Quality of Mobile Phone Apps for Weight Management: User-Centered Study With Employees From a Lebanese University %A Bardus,Marco %A Ali,Ahmed %A Demachkieh,Farah %A Hamadeh,Ghassan %+ Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Van Dyck - Room 302, PO Box 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon, 961 1 350 000 ext 4694, marco.bardus@gmail.com %K mobile apps %K weight loss %K physical activity %K healthy diet %K workplace %K mHealth %D 2019 %7 23.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Evaluating the quality of mobile health apps for weight loss and weight management is important to understand whether these can be used for obesity prevention and treatment. Recent reviews call for more research on multidimensional aspects of app quality, especially involving end users, as there are already many expert reviews on this domain. However, no quantitative study has investigated how laypersons see popular apps for weight management and perceive different dimensions of app quality. Objective: This study aimed to explore how laypersons evaluate the quality of 6 free weight management apps (My Diet Coach, SparkPeople, Lark, MyFitnessPal, MyPlate, and My Diet Diary), which achieved the highest quality ratings in a related and recent expert review. Methods: A user-centered study was conducted with 36 employees of a Lebanese university. Participants enrolled in the study on a rolling basis between October 2016 and March 2017. Participants were randomly assigned an app to use for 2 weeks. App quality was evaluated at the end of the trial period using the Mobile App Rating Scale user version (uMARS). uMARS assesses the dimensions of engagement, functionality, aesthetics, information, and subjective quality on 5-point scales. Internal consistency and interrater agreement were examined. The associations between uMARS scores and users’ demographic characteristics were also explored using nonparametric tests. Analyses were completed in November 2017. Results: Overall, the 6 apps were of moderately good quality (median uMARS score 3.6, interquartile range [IQR] 0.3). The highest total uMARS scores were achieved by Lark (mean 4.0 [SD 0.5]) and MyPlate (mean 3.8 [SD 0.4]), which also achieved the highest subjective quality scores (Lark: mean 3.3 [SD 1.4]; MyPlate: mean 3.3 [SD 0.8]). Functionality was the domain with the highest rating (median 3.9, IQR 0.3), followed by aesthetics (median 3.7, IQR 0.5), information (median 3.7, IQR 0.1), and engagement (median 3.3, IQR 0.2). Subjective quality was judged low (median 2.5, IQR 0.9). Overall, subjective quality was strongly and positively related (P<.001) with total uMARS score (ρ=.75), engagement (ρ=.68), information, and aesthetics (ρ=.60) but not functionality (ρ=.40; P=.02). Higher engagement scores were reported among healthy (P=.003) and obese individuals (P=.03), who also showed higher total uMARS (P=.04) and subjective quality (P=.05) scores. Conclusions: Although the apps were considered highly functional, they were relatively weak in engagement and subjective quality scores, indicating a low propensity of using the apps in the future. As engagement was the subdomain most strongly associated with subjective quality, app developers and researchers should focus on creating engaging apps, holding constant the functionality, aesthetics, and information quality. The tested apps (in particular Lark and MyPlate) were perceived as more engaging and of higher quality among healthy, obese individuals, making them a promising mode of delivery for self-directed interventions promoting weight control among the sampled population or in similar and comparable settings. %M 30672742 %R 10.2196/mhealth.9836 %U https://mhealth.jmir.org/2019/1/e9836/ %U https://doi.org/10.2196/mhealth.9836 %U http://www.ncbi.nlm.nih.gov/pubmed/30672742 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e9929 %T Health Care Provider Perceptions of Consumer-Grade Devices and Apps for Tracking Health: A Pilot Study %A Holtz,Bree %A Vasold,Kerri %A Cotten,Shelia %A Mackert,Michael %A Zhang,Mi %+ Department of Advertising and Public Relations, College of Communication Arts & Sciences, Michigan State University, 404 Wilson Road, Room 309, East Lansing, MI, 48824, United States, 1 517 884 4537, bholtz@msu.edu %K physicians %K primary care %K APRN %K nurse practitioners %K technology %D 2019 %7 22.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of Web- or mobile phone–based apps for tracking health indicators has increased greatly. However, provider perceptions of consumer-grade devices have not been widely explored. Objective: The purpose of this study was to determine primary care physicians’ and advanced practice registered nurses’ perceptions of consumer-grade sensor devices and Web- or mobile phone–based apps that allow patients to track physical activity, diet, and sleep. Methods: We conducted a cross-sectional mailed survey with a random sample of 300 primary care physicians and 300 advanced practice registered nurses from Michigan, USA. Providers’ use and recommendation of these types of technologies, and their perceptions of the benefits of and barriers to patients’ use of the technologies for physical activity, diet, and sleep tracking were key outcomes assessed. Results: Most of the respondents (189/562, 33.6% response rate) were advanced practice registered nurses (107/189, 56.6%). Almost half of the sample (93/189, 49.2%) owned or used behavioral tracking technologies. Providers found these technologies to be helpful in clinical encounters, trusted the data, perceived their patients to be interested in them, and did not have concerns over the privacy of the data. However, the providers did perceive patient barriers to using these technologies. Additionally, those who owned or used these technologies were up to 6.5 times more likely to recommend them to their patients. Conclusions: Our study demonstrated that many providers perceived benefits for their patients to use these technologies, including improved communication. Providers’ concerns included their patients’ access and the usability of these technologies. Providers who encountered data from these technologies during patient visits generally perceive this to be helpful. We additionally discuss the barriers perceived by the providers and offer suggestions and future research to realize the potential benefits to using these data in clinical encounters. %M 30668515 %R 10.2196/mhealth.9929 %U https://mhealth.jmir.org/2018/1/e9929/ %U https://doi.org/10.2196/mhealth.9929 %U http://www.ncbi.nlm.nih.gov/pubmed/30668515 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11509 %T Feasibility of a Therapist-Supported, Mobile Phone–Delivered Online Intervention for Depression: Longitudinal Observational Study %A Goldin,Philippe R %A Lindholm,Riku %A Ranta,Kristian %A Hilgert,Outi %A Helteenvuori,Tiia %A Raevuori,Anu %+ Betty Irene Moore School of Nursing, University of California Davis, 4610 X Street, Sacramento, CA, 95817, United States, 1 4156769793, philippegoldin@gmail.com %K cognitive therapy %K depression %K digital health %K digital therapeutics %K mindfulness %K online intervention %D 2019 %7 22.01.2019 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Depression is a very common condition that impairs functioning and is often untreated. More than 60% of the treatments for depressive disorder are administered in primary care settings by care providers who lack the time and expertise to treat depression. To address this issue, we developed Ascend, a therapist-supported, mobile phone–delivered 8-week intervention administered at the Meru Health Online Clinic in Finland. Objective: We conducted two pilot studies to examine the feasibility of the Ascend intervention, specifically, dropout rates, daily practice, weekly group chat use, and changes in depression symptoms. We also explored whether daily practice and weekly group chat use were associated with changes in depression symptoms. Methods: A total of 117 Finnish adults with elevated depressive symptoms enrolled in Ascend, a program that included daily cognitive behavioral and mindfulness meditation exercises delivered through a mobile phone app, anonymous group chat with other users, and chat/phone access to a licensed therapist. Eight weekly themes were delivered in a fixed, sequential format. Depression symptoms were measured at baseline, every second week during the intervention, immediately after the intervention, and 4 weeks after completion of the intervention. Data were analyzed using intent-to-treat repeated-measures analysis of variance and linear regression models. Results: For studies 1 and 2, we observed dropout rates of 27% and 15%, respectively, decreasing daily practice and group chat use, and decreased depression symptoms from baseline to immediately and 4 weeks after the intervention (P<.001). We found that both more daily practice and chat group use predicted the occurrence of fewer depressive symptoms at 4 weeks postintervention (Study 1: ∆R2=.38, P=.004 and ∆R2=.38, P=.002, respectively; Study 2: ∆R2=.16, P<.001 and ∆R2=.08, P=.002, respectively). Conclusions: This therapist-supported, mobile phone–delivered treatment for depression is feasible and associated with reduced depression symptoms. Design features that enhance daily practice and group chat use are areas of future investigation. Validation of these results using a controlled study design is needed to establish the evidence base for the Ascend intervention. %R 10.2196/11509 %U http://formative.jmir.org/2019/1/e11509/ %U https://doi.org/10.2196/11509 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e9967 %T Predicting Attrition in a Text-Based Nutrition Education Program: Survival Analysis of Text2BHealthy %A Grutzmacher,Stephanie K %A Munger,Ashley L %A Speirs,Katherine E %A Vafai,Yassaman %A Hilberg,Evan %A Braunscheidel Duru,Erin %A Worthington,Laryessa %A Lachenmayr,Lisa %+ School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, 118 Milam Hall, Corvallis, OR, 97331, United States, 1 3019080779, stephanie.grutzmacher@oregonstate.edu %K text messaging %K retention %K diet, food, and nutrition %K food assistance %K parents %K survival analysis %D 2019 %7 21.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Text-based programs have been shown to effectively address a wide variety of health issues. Although little research examines short message service (SMS) text messaging program characteristics that predict participant retention and attrition, features of SMS text message programs, such as program duration and intensity, message content, and the participants’ context, may have an impact. The impact of stop messages—messages with instructions for how to drop out of an SMS text message program—may be particularly important to investigate. Objective: The aim of this study was to describe attrition from Text2BHealthy, a text-based nutrition and physical activity promotion program for parents of low-income elementary school children, and to determine the impact of message content and number of stop messages received on attrition. Methods: Using data from 972 parents enrolled in Text2BHealthy, we created Kaplan-Meier curves to estimate differences in program duration for different SMS text message types, including nutrition, physical activity, stop, and other messages. Covariates, including rurality and number of stop messages received, were included. Results: Retention rates by school ranged from 74% (60/81) to 95.0% (132/139), with an average retention rate of 85.7% (833/972) across all schools. Program duration ranged from 7 to 282 days, with a median program duration of 233 days and an average program duration of 211.7 days. Among those who dropped out, program duration ranged from 7 to 247 days, with a median program duration of 102.5 days. Receiving a stop message increased the probability of attrition compared with receiving messages about nutrition, physical activity, or other topics (hazard ratio=51.5, 95% CI 32.46-81.7; P<.001). Furthermore, each additional stop message received increased the probability of attrition (hazard ratio=10.36, 95% CI 6.14-17.46; P<.001). The degree of rurality also had a significant effect on the probability of attrition, with metropolitan county participants more likely to drop out of the program than rural county participants. The interaction between SMS text message type and total number of stop messages received had a significant effect on attrition, with the effect of the number of stop messages received dependent on the SMS text message type. Conclusions: This study demonstrates the potential of SMS text message programs to retain participants over time. Furthermore, this study suggests that the probability of attrition increases substantially when participants receive messages with instructions for dropping out of the program. Program planners should carefully consider the impact of stop messages and other program content and characteristics on program retention. Additional research is needed to identify participant, programmatic, and contextual predictors of program duration and to explicate the relationship between program duration and program efficacy. %M 30664489 %R 10.2196/mhealth.9967 %U https://mhealth.jmir.org/2019/1/e9967/ %U https://doi.org/10.2196/mhealth.9967 %U http://www.ncbi.nlm.nih.gov/pubmed/30664489 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12199 %T Feasibility and Acceptability of Technology-Based Exercise and Posture Training in Older Adults With Age-Related Hyperkyphosis: Pre-Post Study %A Katzman,Wendy B %A Gladin,Amy %A Lane,Nancy E %A Wong,Shirley %A Liu,Felix %A Jin,Chengshi %A Fukuoka,Yoshimi %+ Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, 1500 Owens Street, Suite 400, San Francisco, CA, 94158, United States, 1 415 514 6776, wendy.katzman@ucsf.edu %K acceptability %K exercise %K feasibility %K hyperkyphosis %K kyphosis %K posture %K spine %K technology-based %D 2019 %7 21.01.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Hyperkyphosis is common among older adults and is associated with multiple adverse health outcomes. Kyphosis-specific exercise and posture training programs improve hyperkyphosis, but in-person programs are expensive to implement and maintain over long periods. It is unclear if a technology-based posture training program disseminated through a mobile phone is a feasible or acceptable alternative to in-person training among older adults with hyperkyphosis. Objective: The primary purpose was to assess the feasibility of subject recruitment, short-term retention and adherence, and acceptability of a technology-based exercise and posture training program disseminated as video clip links and text messaging prompts via a mobile phone. The secondary purpose was to explore the potential efficacy of this program for kyphosis, physical function, and health-related quality of life in older adults with hyperkyphosis. Methods: In this 6-week pre-post design pilot trial, we recruited community-dwelling adults aged ≥65 years with hyperkyphosis ≥40° (±5°) and access to a mobile phone. The intervention had two parts: (1) exercise and posture training via video clips sent to participants daily via text messaging, including 6 weekly video clip links to be viewed on the participant’s mobile phone, and (2) text messaging prompts to practice good posture. We analyzed the subject recruitment, adherence, retention, and acceptability of the intervention. Outcomes included change in kyphometer-measured kyphosis, occiput-to-wall (OTW) distance, Short Physical Performance Battery score, Scoliosis Research Society (SRS-30) score, Center for Epidemiological Studies Depression score, and Physical Activity Scale for the Elderly (PASE) score. Results: A total of 64 potential participants were recruited, 17 were enrolled, and 12 completed postintervention testing at 6 weeks. The average age was 71.6 (SD 4.9) years, and 50% were women. The median adherence to daily video viewing was 100% (range, 14%-100%) and to practicing good posture at least three times per day was 71% (range, 0%-100%). Qualitative evaluation of intervention acceptability revealed that the mobile phone screen was too small for participants to view the videos well and daily prompts to practice posture were too frequent. Kyphosis, OTW distance, and physical activity significantly improved after the 6-week intervention. Kyphosis decreased by 8° (95% CI –12 to –5; P<.001), OTW decreased by 1.9 cm (95% CI –3.3 to –0.7; P=.007), and physical activity measured by PASE increased by 29 points (95% CI 3 to 54; P=.03). The health-related quality of life SRS-30 score increased by 0.11 point (SD 0.19), but this increase was not statistically significant (P=.09). Conclusions: Technology-based exercise and posture training using video clip viewing and text messaging reminders is feasible and acceptable for a small cohort of older adults with hyperkyphosis. Technology-based exercise and posture training warrants further study as a potential self-management program for age-related hyperkyphosis, which may be more easily disseminated than in-person training. %M 31363712 %R 10.2196/12199 %U http://aging.jmir.org/2019/1/e12199/ %U https://doi.org/10.2196/12199 %U http://www.ncbi.nlm.nih.gov/pubmed/31363712 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11312 %T Mobile-Based Interventions for Dietary Behavior Change and Health Outcomes: Scoping Review %A Kankanhalli,Atreyi %A Shin,Jieun %A Oh,Hyelim %+ Department of Information Systems and Analytics, National University of Singapore, 13 Computing Drive, Singapore,, Singapore, 65 6516 6732, hyelim.oh@nus.edu.sg %K mHealth %K mobile-based intervention %K dietary behavior %K food intake %K behavior change %K health outcomes %D 2019 %7 21.01.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps are being widely used for delivering health interventions, with their ubiquitous access and sensing capabilities. One such use is the delivery of interventions for healthy eating behavior. Objective: The aim of this study was to provide a comprehensive view of the literature on the use of mobile interventions for eating behavior change. We synthesized the studies with such interventions and mapped out their input methods, interventions, and outcomes. Methods: We conducted a scoping literature search in PubMed/MEDLINE, Association for Computing Machinery Digital Library, and PsycINFO databases to identify relevant papers published between January 2013 and April 2018. We also hand-searched relevant themes of journals in the Journal of Medical Internet Research and registered protocols. Studies were included if they provided and assessed mobile-based interventions for dietary behavior changes and/or health outcomes. Results: The search resulted in 30 studies that we classified by 3 main aspects: input methods, mobile-based interventions, and dietary behavior changes and health outcomes. First, regarding input methods, 5 studies allowed photo/voice/video inputs of diet information, whereas text input methods were used in the remaining studies. Other than diet information, the content of the input data in the mobile apps included user’s demographics, medication, health behaviors, and goals. Second, we identified 6 categories of intervention contents, that is, self-monitoring, feedback, gamification, goal reviews, social support, and educational information. Although all 30 studies included self-monitoring as a key component of their intervention, personalized feedback was a component in 18 studies, gamification was used in 10 studies, goal reviews in 5 studies, social support in 3 studies, and educational information in 2 studies. Finally, we found that 13 studies directly examined the effects of interventions on health outcomes and 12 studies examined the effects on dietary behavior changes, whereas only 5 studies observed the effects both on dietary behavior changes and health outcomes. Regarding the type of studies, although two-thirds of the included studies conducted diverse forms of randomized control trials, the other 10 studies used field studies, surveys, protocols, qualitative interviews, propensity score matching method, and test and reference method. Conclusions: This scoping review identified and classified studies on mobile-based interventions for dietary behavior change as per the input methods, nature of intervention, and outcomes examined. Our findings indicated that dietary behavior changes, although playing a mediating role in improving health outcomes, have not been adequately examined in the literature. Dietary behavior change as a mechanism for the relationship between mobile-based intervention and health outcomes needs to be further investigated. Our review provides guidance for future research in this promising mobile health area. %M 30664461 %R 10.2196/11312 %U http://mhealth.jmir.org/2019/1/e11312/ %U https://doi.org/10.2196/11312 %U http://www.ncbi.nlm.nih.gov/pubmed/30664461 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11482 %T Efficacy and Outcomes of a Music-Based Emotion Regulation Mobile App in Distressed Young People: Randomized Controlled Trial %A Hides,Leanne %A Dingle,Genevieve %A Quinn,Catherine %A Stoyanov,Stoyan R %A Zelenko,Oksana %A Tjondronegoro,Dian %A Johnson,Daniel %A Cockshaw,Wendell %A Kavanagh,David J %+ School of Psychology, The University of Queensland, McElwain Building, St Lucia, Brisbane, 4072, Australia, 1 406185750, l.hides@uq.edu.au %K depression %K anxiety %K emotion regulation %K music %K telehealth %K mHealth %D 2019 %7 16.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Emotion dysregulation increases the risk of depression, anxiety, and substance use disorders. Music can help regulate emotions, and mobile phones provide constant access to it. The Music eScape mobile app teaches young people how to identify and manage emotions using music. Objective: This study aimed to examine the effects of using Music eScape on emotion regulation, distress, and well-being at 1, 2, 3, and 6 months. Moderators of outcomes and user ratings of app quality were also examined. Methods: A randomized controlled trial compared immediate versus 1-month delayed access to Music eScape in 169 young people (aged 16 to 25 years) with at least mild levels of mental distress (Kessler 10 score>17). Results: No significant differences between immediate and delayed groups on emotion regulation, distress, or well-being were found at 1 month. Both groups achieved significant improvements in 5 of the 6 emotion regulation skills, mental distress, and well-being at 2, 3, and 6 months. Unhealthy music use moderated improvements on 3 emotion regulation skills. Users gave the app a high mean quality rating (mean 3.8 [SD 0.6]) out of 5. Conclusions: Music eScape has the potential to provide a highly accessible way of improving young people’s emotion regulation skills, but further testing is required to determine its efficacy. Targeting unhealthy music use in distressed young people may improve their emotion regulation skills. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12615000051549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365974 %M 30664457 %R 10.2196/11482 %U https://mhealth.jmir.org/2019/1/e11482/ %U https://doi.org/10.2196/11482 %U http://www.ncbi.nlm.nih.gov/pubmed/30664457 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11098 %T User Models for Personalized Physical Activity Interventions: Scoping Review %A Ghanvatkar,Suparna %A Kankanhalli,Atreyi %A Rajan,Vaibhav %+ Department of Information Systems and Analytics, School of Computing, National University of Singapore, Computing 1, 13 Computing Drive, Singapore, 117417, Singapore, 65 65166737, vaibhav.rajan@nus.edu.sg %K review %K exercise %K physical fitness %K automation %K mobile apps %K web browser %K health communication %K health promotion %D 2019 %7 16.01.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Fitness devices have spurred the development of apps that aim to motivate users, through interventions, to increase their physical activity (PA). Personalization in the interventions is essential as the target users are diverse with respect to their activity levels, requirements, preferences, and behavior. Objective: This review aimed to (1) identify different kinds of personalization in interventions for promoting PA among any type of user group, (2) identify user models used for providing personalization, and (3) identify gaps in the current literature and suggest future research directions. Methods: A scoping review was undertaken by searching the databases PsycINFO, PubMed, Scopus, and Web of Science. The main inclusion criteria were (1) studies that aimed to promote PA; (2) studies that had personalization, with the intention of promoting PA through technology-based interventions; and (3) studies that described user models for personalization. Results: The literature search resulted in 49 eligible studies. Of these, 67% (33/49) studies focused solely on increasing PA, whereas the remaining studies had other objectives, such as maintaining healthy lifestyle (8 studies), weight loss management (6 studies), and rehabilitation (2 studies). The reviewed studies provide personalization in 6 categories: goal recommendation, activity recommendation, fitness partner recommendation, educational content, motivational content, and intervention timing. With respect to the mode of generation, interventions were found to be semiautomated or automatic. Of these, the automatic interventions were either knowledge-based or data-driven or both. User models in the studies were constructed with parameters from 5 categories: PA profile, demographics, medical data, behavior change technique (BCT) parameters, and contextual information. Only 27 of the eligible studies evaluated the interventions for improvement in PA, and 16 of these concluded that the interventions to increase PA are more effective when they are personalized. Conclusions: This review investigates personalization in the form of recommendations or feedback for increasing PA. On the basis of the review and gaps identified, research directions for improving the efficacy of personalized interventions are proposed. First, data-driven prediction techniques can facilitate effective personalization. Second, use of BCTs in automated interventions, and in combination with PA guidelines, are yet to be explored, and preliminary studies in this direction are promising. Third, systems with automated interventions also need to be suitably adapted to serve specific needs of patients with clinical conditions. Fourth, previous user models focus on single metric evaluations of PA instead of a potentially more effective, holistic, and multidimensional view. Fifth, with the widespread adoption of activity monitoring devices and mobile phones, personalized and dynamic user models can be created using available user data, including users’ social profile. Finally, the long-term effects of such interventions as well as the technology medium used for the interventions need to be evaluated rigorously. %M 30664474 %R 10.2196/11098 %U http://mhealth.jmir.org/2019/1/e11098/ %U https://doi.org/10.2196/11098 %U http://www.ncbi.nlm.nih.gov/pubmed/30664474 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11118 %T Health Benefits and Cost-Effectiveness From Promoting Smartphone Apps for Weight Loss: Multistate Life Table Modeling %A Cleghorn,Christine %A Wilson,Nick %A Nair,Nisha %A Kvizhinadze,Giorgi %A Nghiem,Nhung %A McLeod,Melissa %A Blakely,Tony %+ BODE³ Programme, Department of Public Health, University of Otago, PO Box 7343, Wellington South, Wellington, 6242, New Zealand, 64 4 918 6182 ext 6182, cristina.cleghorn@otago.ac.nz %K weight loss diet %K telemedicine %K smartphone %K cost-utility analysis %K life tables %K quality-adjusted life years %D 2019 %7 15.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obesity is an important risk factor for many chronic diseases. Mobile health interventions such as smartphone apps can potentially provide a convenient low-cost addition to other obesity reduction strategies. Objective: This study aimed to estimate the impacts on quality-adjusted life-years (QALYs) gained and health system costs over the remainder of the life span of the New Zealand population (N=4.4 million) for a smartphone app promotion intervention in 1 calendar year (2011) using currently available apps for weight loss. Methods: The intervention was a national mass media promotion of selected smartphone apps for weight loss compared with no dedicated promotion. A multistate life table model including 14 body mass index–related diseases was used to estimate QALYs gained and health systems costs. A lifetime horizon, 3% discount rate, and health system perspective were used. The proportion of the target population receiving the intervention (1.36%) was calculated using the best evidence for the proportion who have access to smartphones, are likely to see the mass media campaign promoting the app, are likely to download a weight loss app, and are likely to continue using this app. Results: In the base-case model, the smartphone app promotion intervention generated 29 QALYs (95% uncertainty interval, UI: 14-52) and cost the health system US $1.6 million (95% UI: 1.1-2.0 million) with the standard download rate. Under plausible assumptions, QALYs increased to 59 (95% UI: 27-107) and costs decreased to US $1.2 million (95% UI: 0.5-1.8) when standard download rates were doubled. Costs per QALY gained were US $53,600 for the standard download rate and US $20,100 when download rates were doubled. On the basis of a threshold of US $30,000 per QALY, this intervention was cost-effective for Māori when the standard download rates were increased by 50% and also for the total population when download rates were doubled. Conclusions: In this modeling study, the mass media promotion of a smartphone app for weight loss produced relatively small health gains on a population level and was of borderline cost-effectiveness for the total population. Nevertheless, the scope for this type of intervention may expand with increasing smartphone use, more easy-to-use and effective apps becoming available, and with recommendations to use such apps being integrated into dietary counseling by health workers. %M 30664471 %R 10.2196/11118 %U https://mhealth.jmir.org/2019/1/e11118/ %U https://doi.org/10.2196/11118 %U http://www.ncbi.nlm.nih.gov/pubmed/30664471 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e12297 %T The Efficacy of Mobile Phone Apps for Lifestyle Modification in Diabetes: Systematic Review and Meta-Analysis %A Wu,Xinghan %A Guo,Xitong %A Zhang,Zhiwei %+ eHealth Research Institute, School of Management, Harbin Institute of Technology, 92 West Dazhi Street, Nangang District, Harbin,, China, 86 451 86414022, xitongguo@gmail.com %K smartphone %K mobile applications %K diabetes mellitus %K lifestyle %K physical activity %K diet %K behavior therapy %D 2019 %7 15.01.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Diabetes and related complications are estimated to cost US $727 billion worldwide annually. Type 1 diabetes, type 2 diabetes, and gestational diabetes are three subtypes of diabetes that share the same behavioral risk factors. Efforts in lifestyle modification, such as daily physical activity and healthy diets, can reduce the risk of prediabetes, improve the health levels of people with diabetes, and prevent complications. Lifestyle modification is commonly performed in a face-to-face interaction, which can prove costly. Mobile phone apps provide a more accessible platform for lifestyle modification in diabetes. Objective: This review aimed to summarize and synthesize the clinical evidence of the efficacy of mobile phone apps for lifestyle modification in different subtypes of diabetes. Methods: In June 2018, we conducted a literature search in 5 databases (Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, and PsycINFO). We evaluated the studies that passed screening using The Cochrane Collaboration’s risk of bias tool. We conducted a meta-analysis for each subtype on the mean difference (between intervention and control groups) at the posttreatment glycated hemoglobin (HbA1c) level. Where possible, we analyzed subgroups for short-term (3-6 months) and long-term (9-12 months) studies. Heterogeneity was assessed using the I2 statistic. Results: We identified total of 2669 articles through database searching. After the screening, we included 26 articles (23 studies) in the systematic review, of which 18 studies (5 type 1 diabetes, 11 type 2 diabetes, and 2 prediabetes studies) were eligible for meta-analysis. For type 1 diabetes, the overall effect on HbA1c was statistically insignificant (P=.46) with acceptable heterogeneity (I2=39%) in the short-term subgroup (4 studies) and significant heterogeneity between the short-term and long-term subgroups (I2=64%). Regarding type 2 diabetes, the overall effect on HbA1c was statistically significant (P<.01) in both subgroups, and when the 2 subgroups were combined, there was virtually no heterogeneity within and between the subgroups (I2 range 0%-2%). The effect remained statistically significant (P<.01) after adjusting for publication bias using the trim and fill method. For the prediabetes condition, the overall effect on HbA1c was statistically insignificant (P=.67) with a large heterogeneity (I2=65%) between the 2 studies. Conclusions: There is strong evidence for the efficacy of mobile phone apps for lifestyle modification in type 2 diabetes. The evidence is inconclusive for the other diabetes subtypes. %M 30664494 %R 10.2196/12297 %U http://mhealth.jmir.org/2019/1/e12297/ %U https://doi.org/10.2196/12297 %U http://www.ncbi.nlm.nih.gov/pubmed/30664494 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e12227 %T Use of a Biofeedback Breathing App to Augment Poststress Physiological Recovery: Randomized Pilot Study %A Plans,David %A Morelli,Davide %A Sütterlin,Stefan %A Ollis,Lucie %A Derbyshire,Georgia %A Cropley,Mark %+ Faculty of Health and Medical Sciences, School of Psychology, University of Surrey, School of Psychology, Stag Hill, Guildford, GU2 7XH, United Kingdom, 44 01483686928, mark.cropley@surrey.ac.uk %K biofeedback %K breathing %K heart rate variability %K recovery %K rumination %K stress %D 2019 %7 11.01.2019 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The speed of physiological recovery from stress may be a marker for cardiovascular disease risk. Stress management programs that incorporate guided breathing have been shown to moderate the stress response and augment recovery. Objective: The aim of this study was to examine the effectiveness of an app-based brief relaxation intervention (BioBase) for facilitating physiological recovery in individuals exposed to a brief psychological stressor. Methods: A total of 75 participants (44 women) completed a stressor speech task and were randomly assigned to one of three conditions: control, rumination, or an app-based relaxation breathing (BioBase) conditions. Heart rate variability (HRV) was assessed as a measure of autonomic function at baseline (6 min), during stress (6 min), and during recovery (6 min). Results: There was a significant increase in subjective stress following stress exposure, but the ratings returned to baseline after recovery in all three groups. In addition, there was a significant decrease in vagally mediated HRV in the poststress period. During recovery, the root mean square of successive differences (P<.001), the percentage of successive interbeat (RR) intervals that differ by >50 ms (pNN50; P<.001), and high-frequency (P<.02) HRV were significantly higher in the BioBase breathing condition than the rumination and control conditions. There was no difference in HRV values between the rumination and control conditions during recovery. Conclusions: App-based relaxed breathing interventions could be effective in reducing cardiovascular disease risk. These results provide additional utility of biofeedback breathing in augmenting physiological recovery from psychological stress. %M 30684437 %R 10.2196/12227 %U https://formative.jmir.org/2019/1/e12227/ %U https://doi.org/10.2196/12227 %U http://www.ncbi.nlm.nih.gov/pubmed/30684437 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e10071 %T The QuitIT Coping Skills Game for Promoting Tobacco Cessation Among Smokers Diagnosed With Cancer: Pilot Randomized Controlled Trial %A Krebs,Paul %A Burkhalter,Jack %A Fiske,Jeffrey %A Snow,Herbert %A Schofield,Elizabeth %A Iocolano,Michelle %A Borderud,Sarah %A Ostroff,Jamie S %+ Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY, 10016, United States, 1 6465012637, Paul.Krebs@nyumc.org %K tobacco %K cancer %K mHealth %K app %K mobile phone %D 2019 %7 10.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although smoking cessation apps have become popular, few have been tested in randomized clinical trials or undergone formative evaluation with target users. Objective: We developed a cessation app targeting tobacco-dependent cancer patients. Game design and behavioral rehearsal principles were incorporated to help smokers identify, model, and practice coping strategies to avoid relapse to smoking. In this randomized pilot trial, we examined feasibility (recruitment and retention rates), acceptability (patient satisfaction), quitting self-confidence, and other cessation-related indices to guide the development of a larger trial. Methods: We randomized 42 English-speaking cancer patients scheduled for surgical treatment to either the Standard Care (SC; telecounseling and cessation pharmacotherapies) or the experimental QuitIT study arm (SC and QuitIT game). Gameplay parameters were captured in-game; satisfaction with the game was assessed at 1-month follow-up. We report study screening, exclusion, and refusal reasons; compare refusal and attrition by key demographic and clinical variables; and report tobacco-related outcomes. Results: Follow-up data were collected from 65% (13/20) patients in the QuitIT and 61% (11/18) in SC arms. Study enrollees were 71% (27/38) females, 92% (35/38) white people, and 95% (36/38) non-Hispanic people. Most had either lung (12/38, 32%) or gastrointestinal (9/38, 24%) cancer. Those dropping out were less likely than completers to have used a tablet (P<.01) and have played the game at all (P=.02) and more likely to be older (P=.05). Of 20 patients in the QuitIT arm, 40% (8/20) played the game (system data). There were no differences between those who played and did not play by demographic, clinical, technology use, and tobacco-related variables. Users completed an average of 2.5 (SD 4.0) episodes out of 10. A nonsignificant trend was found for increased confidence to quit in the QuitIT arm (d=0.25, 95% CI −0.56 to 1.06), and more participants were abstinent in the QuitIT group than in the SC arm (4/13, 30%, vs 2/11, 18%). Satisfaction with gameplay was largely positive, with most respondents enjoying use, relating to the characters, and endorsing that gameplay helped them cope with actual smoking urges. Conclusions: Recruitment and retention difficulties suggest that the perihospitalization period may be a less than ideal time for delivering a smoking cessation app intervention. Framing of the app as a “game” may have decreased receptivity as participants may have been preoccupied with hospitalization demands and illness concerns. Less tablet experience and older age were associated with participant dropout. Although satisfaction with the gameplay was high, 60% (12/20) of QuitIT participants did not play the game. Paying more attention to patient engagement, changing the intervention delivery period, providing additional reward and support for use, and improving cessation app training may bolster feasibility for a larger trial. Trial Registration: ClinicalTrials.gov NCT01915836; https://clinicaltrials.gov/ct2/show/NCT01915836 (Archived by WebCite at http://www.webcitation.org/73vGsjG0Y) %M 30632971 %R 10.2196/10071 %U http://mhealth.jmir.org/2019/1/e10071/ %U https://doi.org/10.2196/10071 %U http://www.ncbi.nlm.nih.gov/pubmed/30632971 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11267 %T A Mobile Phone-Based Program to Promote Healthy Behaviors Among Adults With Prediabetes Who Declined Participation in Free Diabetes Prevention Programs: Mixed-Methods Pilot Randomized Controlled Trial %A Griauzde,Dina %A Kullgren,Jeffrey T %A Liestenfeltz,Brad %A Ansari,Tahoora %A Johnson,Emily H %A Fedewa,Allison %A Saslow,Laura R %A Richardson,Caroline %A Heisler,Michele %+ University of Michigan School of Dentistry, 1011 North University Avenue, Ann Arbor, MI, 48109, United States, 1 734 647 4844, mheisler@umich.edu %K autonomous motivation %K behavioral change %K mHealth %K mobile phone %K prediabetes %K prevention %K type 2 diabetes mellitus %D 2019 %7 09.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite evidence that Diabetes Prevention Programs (DPPs) can delay or prevent progression to type 2 diabetes mellitus (T2DM), few individuals with prediabetes enroll in offered programs. This may be in part because many individuals with prediabetes have low levels of autonomous motivation (ie, motivation that arises from internal sources) to prevent T2DM. Objective: This study aims to examine the feasibility and acceptability of a mobile health (mHealth) intervention designed to increase autonomous motivation and healthy behaviors among adults with prediabetes who previously declined participation free DPPs. In addition, the study aims to examine changes in autonomous motivation among adults offered 2 versions of the mHealth program compared with an information-only control group. Methods: In this 12-week, parallel, 3-arm, mixed-methods pilot randomized controlled trial, participants were randomized to (1) a group that received information about prediabetes and strategies to prevent T2DM (control); (2) a group that received a mHealth app that aims to increase autonomous motivation among users (app-only); or (3) a group that received the app plus a physical activity tracker and wireless-enabled digital scale for self-monitoring (app-plus). Primary outcome measures included rates of intervention uptake (number of individuals enrolled/number of individuals assessed for eligibility), retention (number of 12-week survey completers/number of participants), and adherence (number of device-usage days). The secondary outcome measure was change in autonomous motivation (measured using the Treatment Self-Regulation Questionnaire), which was examined using difference-in-difference analysis. Furthermore, we conducted postintervention qualitative interviews with participants. Results: Overall, 28% (69/244) of eligible individuals were randomized; of these, 80% (55/69) completed the 12-week survey. Retention rates were significantly higher among app-plus participants than participants in the other 2 study arms combined (P=.004, χ2). No significant differences were observed in adherence rates between app-only and app-plus participants (43 days vs 37 days; P=.34). Among all participants, mean autonomous motivation measures were relatively high at baseline (6.0 of 7.0 scale), with no statistically significant within- or between-group differences in follow-up scores. In qualitative interviews (n=15), participants identified reasons that they enjoyed using the app (eg, encouraged self-reflection), reasons that they did not enjoy using the app (eg, did not consider personal circumstances), and strategies to improve the intervention (eg, increased interpersonal contact). Conclusions: Among individuals with prediabetes who did not engage in free DPPs, this mHealth intervention was feasible and acceptable. Future work should (1) examine the effectiveness of a refined intervention on clinically relevant outcomes (eg, weight loss) among a larger population of DPP nonenrollees with low baseline autonomous motivation and (2) identify other factors associated with DPP nonenrollment, which may serve as additional potential targets for interventions. Trial Registration: ClinicalTrials.gov NCT03025607; https://clinicaltrials.gov/ct2/show/NCT03025607 (Archived by WebCite at http://www.webcitation.org/73cvaSAie) %M 30626566 %R 10.2196/11267 %U http://mhealth.jmir.org/2019/1/e11267/ %U https://doi.org/10.2196/11267 %U http://www.ncbi.nlm.nih.gov/pubmed/30626566 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e10418 %T How Well iPhones Measure Steps in Free-Living Conditions: Cross-Sectional Validation Study %A Amagasa,Shiho %A Kamada,Masamitsu %A Sasai,Hiroyuki %A Fukushima,Noritoshi %A Kikuchi,Hiroyuki %A Lee,I-Min %A Inoue,Shigeru %+ Department of Preventive Medicine and Public Health, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, 160-8402, Japan, 81 3 3351 6141 ext 237, inoue@tokyo-med.ac.jp %K mobile phone %K step count %K physical activity %K pedometer %K epidemiology %K population %K validation %K free-living conditions %D 2019 %7 09.01.2019 %9 Short Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphones have great potential for monitoring physical activity. Although a previous laboratory-based study reported that smartphone apps were accurate for tracking step counts, little evidence on their accuracy in free-living conditions currently exists. Objective: We aimed to investigate the accuracy of step counts measured using iPhone in the real world. Methods: We recruited a convenience sample of 54 adults (mean age 31 [SD 10] years) who owned an iPhone and analyzed data collected in 2016 and 2017. Step count was simultaneously measured using a validated pedometer (Kenz Lifecorder) and the iPhone. Participants were asked to carry and use their own iPhones as they typically would while wearing a pedometer on the waist for 7 consecutive days during waking hours. To assess the agreement between the two measurements, we calculated Spearman correlation coefficients and prepared a Bland-Altman plot. Results: The mean step count measured using the iPhone was 9253 (3787) steps per day, significantly lower by 12% (1277/10,530) than that measured using the pedometer, 10,530 (3490) steps per day (P<.001). The Spearman correlation coefficient between devices was 0.78 (P<.001). The largest underestimation of steps by the iPhone was observed among those who reported to have seldom carried their iPhones (seldom carry: mean −3036, SD 2990, steps/day; sometimes carry: mean −1424, SD 2619, steps/day; and almost always carry: mean −929, SD 1443, steps/day; P for linear trend=.08). Conclusions: Smartphones may be of practical use to individuals, clinicians, and researchers for monitoring physical activity. However, their data on step counts should be interpreted cautiously because of the possibility of underestimation due to noncarrying time. %M 30626569 %R 10.2196/10418 %U http://mhealth.jmir.org/2019/1/e10418/ %U https://doi.org/10.2196/10418 %U http://www.ncbi.nlm.nih.gov/pubmed/30626569 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 1 %P e10844 %T Effects of a Mindfulness Meditation App on Subjective Well-Being: Active Randomized Controlled Trial and Experience Sampling Study %A Walsh,Kathleen Marie %A Saab,Bechara J %A Farb,Norman AS %+ Department of Psychological Clinical Science, University of Toronto Scarborough, SY-146 Science Research Building, 1265 Military Trail, Toronto, ON, M1C 1A4, Canada, 1 647 876 1327, k.walsh@mail.utoronto.ca %K mindfulness %K attention %K mobile health %K interoception %K mood %K stress, psychological %D 2019 %7 08.01.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mindfulness training (MT) includes a variety of contemplative practices aimed at promoting intentional awareness of experience, coupled with attitudes of nonjudgment and curiosity. Following the success of 8-week, manualized group interventions, MT has been implemented in a variety of modalities, including smartphone apps that seek to replicate the success of group interventions. However, although smartphone apps are scalable and accessible to a wider swath of population, their benefits remain largely untested. Objective: This study aimed to investigate a newly developed MT app called Wildflowers, which was codeveloped with the laboratory for use in mindfulness research. It was hypothesized that 3 weeks of MT through this app would improve subjective well-being, attentional control, and interoceptive integration, albeit with weaker effects than those published in the 8 week, manualized group intervention literature. Methods: Undergraduate students completed 3 weeks of MT with Wildflowers (n=45) or 3 weeks of cognitive training with a game called 2048 (n=41). State training effects were assessed through pre- and postsession ratings of current mood, stress level, and heart rate. Trait training effects were assessed through pre- and postintervention questionnaires canvassing subjective well-being and behavioral task measures of attentional control and interoceptive integration. State and trait training data were analyzed in a multilevel model using emergent latent factors (acceptance, awareness, and openness) to summarize the trait questionnaire battery. Results: Analyses revealed both state and trait effects specific to MT; participants engaging in MT demonstrated improved mood (r=.14) and a reduction of stress (r=−.13) immediately after each training session compared with before the training session and decreased postsession stress over 3 weeks (r=−.08). In addition, MT relative to cognitive training resulted in greater improvements in attentional control (r=−.24). Interestingly, both groups demonstrated increased subjective ratings of awareness (r=.28) and acceptance (r=.23) from pre- to postintervention, with greater changes in acceptance for the MT group trending (r=.21). Conclusions: MT, using a smartphone app, may provide immediate effects on mood and stress while also providing long-term benefits for attentional control. Although further investigation is warranted, there is evidence that with continued usage, MT via a smartphone app may provide long-term benefits in changing how one relates to their inner and outer experiences. Trial Registration: ClinicalTrials.gov NCT03783793; https://clinicaltrials.gov/ct2/show/NCT03783793 (Archived by WebCite at http://www.webcitation.org/75EF2ehst) %M 30622094 %R 10.2196/10844 %U https://mental.jmir.org/2019/1/e10844/ %U https://doi.org/10.2196/10844 %U http://www.ncbi.nlm.nih.gov/pubmed/30622094 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11246 %T Text Messaging to Enhance Mindfulness-Based Smoking Cessation Treatment: Program Development Through Qualitative Research %A Spears,Claire A %A Bell,Sharrill A %A Scarlett,Charlayne A %A Anderson,Natalie K %A Cottrell-Daniels,Cherell %A Lotfalian,Sadaf %A Bandlamudi,Maitreyi %A Grant,Amanda %A Sigurdardottir,Anna %A Carter,Brittani P %A Abroms,Lorien C %A Wetter,David W %+ Division of Health Promotion and Behavior, Georgia State University School of Public Health, 140 Decatur Street SE, Suite 612, Atlanta, GA, United States, 1 404 413 9335, cspears@gsu.edu %K mobile phone %K low socioeconomic status %K qualitative %K short message service text messaging %K smoking cessation %D 2019 %7 07.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mindfulness-based programs show promise for promoting smoking cessation in diverse populations. Mobile health strategies could increase treatment engagement and in-the-moment support, thus enhancing the effects of mindfulness-based smoking cessation interventions. However, most mobile health programs have been developed without sufficient input from the target population. Objective: By eliciting input from the target population, predominantly low socioeconomic status (SES) African American adult smokers, throughout the development of an SMS (short message service) text messaging program that teaches mindfulness for smoking cessation, we aimed for the resulting program to be optimally effective and consistent with participants’ needs and preferences. Methods: Two qualitative studies (N=25) were conducted with predominantly low SES, African American adult smokers. In Study 1 (initial qualitative input; n=15), participants engaged in focus groups to provide suggestions for program development. In Study 2 (abbreviated trial; n=10), participants received a 1-week version of the SMS text messaging program and provided feedback through in-depth interviews. Results: In Study 1, participants suggested that the SMS text messaging program should be personalized and interactive (ie, involve two-way messaging); provide strategies for coping with cravings and recovering from smoking lapses; involve relatively short, to-the-point messages; and include pictures. In Study 2, participants were highly engaged with the texts, indicated that the program was useful, and provided additional suggestions for improvement. Conclusions: Eliciting feedback from the target population throughout the intervention development process allowed for iterative revisions to increase feasibility, acceptability, and effectiveness. Overall, SMS text messaging appears to be a feasible, appealing way to provide in-the-moment personalized support and encourage mindfulness among low-income African American smokers. %M 30617043 %R 10.2196/11246 %U https://mhealth.jmir.org/2019/1/e11246/ %U https://doi.org/10.2196/11246 %U http://www.ncbi.nlm.nih.gov/pubmed/30617043 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e203 %T Comparison of mHealth and Face-to-Face Interventions for Smoking Cessation Among People Living With HIV: Meta-Analysis %A Uthman,Olalekan A %A Nduka,Chidozie U %A Abba,Mustapha %A Enriquez,Rocio %A Nordenstedt,Helena %A Nalugoda,Fred %A Kengne,Andre P %A Ekström,Anna M %+ Warwick-Centre for Applied Health Research and Delivery, Division of Health Sciences, University Warwick, Gibbet Hill campus, Coventry, CV4 7AL, United Kingdom, 44 2476573163, olalekan.uthman@warwick.ac.uk %K HIV %K mHealth %K smoking cessation %D 2019 %7 07.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The prevalence of smoking among people living with HIV (PLHIV) is higher than that reported in the general population, and it is a significant risk factor for noncommunicable diseases in this group. Mobile phone interventions to promote healthier behaviors (mobile health, mHealth) have the potential to reach a large number of people at a low cost. It has been hypothesized that mHealth interventions may not be as effective as face-to-face strategies in achieving smoking cessation, but there is no systematic evidence to support this, especially among PLHIV. Objective: This study aimed to compare two modes of intervention delivery (mHealth vs face-to-face) for smoking cessation among PLHIV. Methods: Literature on randomized controlled trials (RCTs) investigating effects of mHealth or face-to-face intervention strategies on short-term (4 weeks to <6 months) and long-term (≥6 months) smoking abstinence among PLHIV was sought. We systematically reviewed relevant RCTs and conducted pairwise meta-analyses to estimate relative treatment effects of mHealth and face-to-face interventions using standard care as comparison. Given the absence of head-to-head trials comparing mHealth with face-to-face interventions, we performed adjusted indirect comparison meta-analyses to compare these interventions. Results: A total of 10 studies involving 1772 PLHIV met the inclusion criteria. The average age of the study population was 45 years, and women comprised about 37%. In the short term, mHealth-delivered interventions were significantly more efficacious in increasing smoking cessation than no intervention control (risk ratio, RR, 2.81, 95% CI 1.44-5.49; n=726) and face-to-face interventions (RR 2.31, 95% CI 1.13-4.72; n=726). In the short term, face-to-face interventions were no more effective than no intervention in increasing smoking cessation (RR 1.22, 95% CI 0.94-1.58; n=1144). In terms of achieving long-term results among PLHIV, there was no significant difference in the rates of smoking cessation between those who received mHealth-delivered interventions, face-to-face interventions, or no intervention. Trial sequential analysis showed that only 15.16% (726/1304) and 5.56% (632/11,364) of the required information sizes were accrued to accept or reject a 25% relative risk reduction for short- and long-term smoking cessation treatment effects. In addition, sequential monitoring boundaries were not crossed, indicating that the cumulative evidence may be unreliable and inconclusive. Conclusions: Compared with face-to-face interventions, mHealth-delivered interventions can better increase smoking cessation rate in the short term. The evidence that mHealth increases smoking cessation rate in the short term is encouraging but not sufficient to allow a definitive conclusion presently. Future research should focus on strategies for sustaining smoking cessation treatment effects among PLHIV in the long term. %M 30617044 %R 10.2196/mhealth.9329 %U https://mhealth.jmir.org/2019/1/e203/ %U https://doi.org/10.2196/mhealth.9329 %U http://www.ncbi.nlm.nih.gov/pubmed/30617044 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e10918 %T Breast, Prostate, and Colorectal Cancer Survivors’ Experiences of Using Publicly Available Physical Activity Mobile Apps: Qualitative Study %A Roberts,Anna L %A Potts,Henry WW %A Koutoukidis,Dimitrios A %A Smith,Lee %A Fisher,Abigail %+ Research Department of Behavioural Science & Health, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 02076791723, anna.roberts.15@ucl.ac.uk %K physical activity %K health behavior %K cancer survivors %K mobile apps %K mHealth %K digital health %D 2019 %7 04.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity (PA) can improve a range of outcomes following a cancer diagnosis. These include an improvement in experience of side effects of treatment (eg, fatigue) and management of comorbid conditions. PA might also increase survival and reduce recurrence. Digital interventions have shown potential for PA promotion among cancer survivors, but most in a previous review were Web-based, and few studies used mobile apps. There are many PA apps available for general public use, but it is unclear whether these are suitable as a PA intervention after a cancer diagnosis. Objective: This study sought posttreatment nonmetastatic breast, prostate, and colorectal cancer survivors’ opinions of using smartphone apps to promote PA and gathered their views on existing publicly available PA apps to inform a future intervention. Methods: Each participant was randomly assigned to download 2 of 4 apps (Human, The Walk, The Johnson & Johnson Official 7 Minute Workout, and Gorilla Workout). Participants used each app for 1 week consecutively. In-depth semistructured telephone interviews were then conducted to understand participants’ experiences of using the apps and how app-based PA interventions could be developed for cancer survivors. The interviews were analyzed using thematic analysis. Results: Thirty-two participants took part: 50% (16/32) had prostate cancer, 25% (8/32) had breast cancer, and 25% (8/32) had colorectal cancer. Three core themes were identified. The first theme was that multiple factors affect engagement with PA apps and this is highly personalized. Factors affecting engagement included participants’ perceptions of (1) the advantages and disadvantages of using apps to support PA, (2) the relevance of the app to the user (eg, in terms of cancer-related factors, their PA goals, the difficulty level of the app, the way in which they interact with their mobile phone, and the extent to which the app fits with their self-identity), (3) the quality of the app (eg, usability, accuracy, quality of production, and scientific evidence-base), and (4) the behavior change techniques used to promote PA. In the second theme, participants recommended that apps that promote walking are most appealing, as walking removes many barriers to PA. Finally, the participants suggested that PA apps should be integrated into cancer care, as they valued guidance and recommendations from health care professionals. Conclusions: This sample of breast, prostate, and colorectal cancer survivors was receptive to the use of apps to promote PA. Although no publicly available PA app was deemed wholly suitable, many suggestions for adaptation and intervention development were provided. The results can inform the development of an app-based PA intervention for cancer survivors. They also highlight the wide-ranging and dynamic influences on engagement with digital interventions, which can be applied to other evaluations of mobile health products in other health conditions and other health behaviors. %M 30609982 %R 10.2196/10918 %U http://mhealth.jmir.org/2019/1/e10918/ %U https://doi.org/10.2196/10918 %U http://www.ncbi.nlm.nih.gov/pubmed/30609982 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e10944 %T Community Engagement in the Development of an mHealth-Enabled Physical Activity and Cardiovascular Health Intervention (Step It Up): Pilot Focus Group Study %A Ceasar,Joniqua Nashae %A Claudel,Sophie Elizabeth %A Andrews,Marcus R %A Tamura,Kosuke %A Mitchell,Valerie %A Brooks,Alyssa T %A Dodge,Tonya %A El-Toukhy,Sherine %A Farmer,Nicole %A Middleton,Kimberly %A Sabado-Liwag,Melanie %A Troncoso,Melissa %A Wallen,Gwenyth R %A Powell-Wiley,Tiffany M %+ National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5332, MSC 1454, 10 Center Drive, Bethesda, MD, 20892, United States, 1 301 594 3735, tiffany.powell-wiley@nih.gov %K cardiovascular health %K community-based participatory research %K health behaviors %K mHealth %K mobile phone %K physical activity %K qualitative data %D 2019 %7 04.01.2019 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Community-based participatory research is an effective tool for improving health outcomes in minority communities. Few community-based participatory research studies have evaluated methods of optimizing smartphone apps for health technology-enabled interventions in African Americans. Objective: This study aimed to utilize focus groups (FGs) for gathering qualitative data to inform the development of an app that promotes physical activity (PA) among African American women in Washington, DC. Methods: We recruited a convenience sample of African American women (N=16, age range 51-74 years) from regions of Washington, DC metropolitan area with the highest burden of cardiovascular disease. Participants used an app created by the research team, which provided motivational messages through app push notifications and educational content to promote PA. Subsequently, participants engaged in semistructured FG interviews led by moderators who asked open-ended questions about participants’ experiences of using the app. FGs were audiorecorded and transcribed verbatim, with subsequent behavioral theory-driven thematic analysis. Key themes based on the Health Belief Model and emerging themes were identified from the transcripts. Three independent reviewers iteratively coded the transcripts until consensus was reached. Then, the final codebook was approved by a qualitative research expert. Results: In this study, 10 main themes emerged. Participants emphasized the need to improve the app by optimizing automation, increasing relatability (eg, photos that reflect target demographic), increasing educational material (eg, health information), and connecting with community resources (eg, cooking classes and exercise groups). Conclusions: Involving target users in the development of a culturally sensitive PA app is an essential step for creating an app that has a higher likelihood of acceptance and use in a technology-enabled intervention. This may decrease health disparities in cardiovascular diseases by more effectively increasing PA in a minority population. %M 30684422 %R 10.2196/10944 %U https://formative.jmir.org/2019/1/e10944/ %U https://doi.org/10.2196/10944 %U http://www.ncbi.nlm.nih.gov/pubmed/30684422 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e12070 %T Impact of Personal Health Records and Wearables on Health Outcomes and Patient Response: Three-Arm Randomized Controlled Trial %A Kim,Jeong-Whun %A Ryu,Borim %A Cho,Seoyoon %A Heo,Eunyoung %A Kim,Yoojung %A Lee,Joongseek %A Jung,Se Young %A Yoo,Sooyoung %+ Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, 82 173rd Street, Gumi-ro, Bundang-gu, Seongnam, 13620, Republic of Korea, 82 317878980, yoosoo0@snubh.org %K personal health record %K lifestyle %K sleep apnea, obstructive %K delivery of health care %K electronic health record %K mobile health %D 2019 %7 04.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although using the technologies for a variety of chronic health conditions such as personal health record (PHR) is reported to be acceptable and useful, there is a lack of evidence on the associations between the use of the technologies and the change of health outcome and patients’ response to a digital health app. Objective: This study aimed to examine the impact of the use of PHR and wearables on health outcome improvement and sustained use of the health app that can be associated with patient engagement. Methods: We developed an Android-based mobile phone app and used a wristband-type activity tracker (Samsung Charm) to collect data on health-related daily activities from individual patients. Dietary record, daily step counts, sleep log, subjective stress amount, blood pressure, and weight values were recorded. We conducted a prospective randomized clinical trial across 4 weeks on those diagnosed with obstructive sleep apnea (OSA) who had visited the outpatient clinic of Seoul National University Bundang Hospital. The trial randomly assigned 60 patients to 3 subgroups including 2 intervention groups: (1) mobile app and wearable device users (n=20), (2) mobile app–only users (n=20), and (3) controls (n=20). The primary outcome measure was weight change. Body weights before and after the trial were recorded and analyzed during clinic visits. Changes in OSA–related respiratory parameters such as respiratory disturbance, apnea-hypopnea, and oxygenation desaturation indexes and snoring comprised the secondary outcome and were analyzed for each participant. Results: We collected the individual data for each group during the trial, specifically anthropometric measurement and laboratory test results for health outcomes, and the app usage logs for patient response were collected and analyzed. The body weight showed a significant reduction in the 2 intervention groups after intervention, and the mobile app–only group showed more weight loss compared with the controls (P=.01). There were no significant changes in sleep-related health outcomes. From a patient response point of view, the average daily step counts (8165 steps) from the app plus wearable group were significantly higher than those (6034 steps) from the app-only group because they collected step count data from different devices (P=.02). The average rate of data collection was not different in physical activity (P=.99), food intake (P=.98), sleep (P=.95), stress (P=.70), and weight (P=.90) in the app plus wearable and app-only groups, respectively. Conclusions: We tried to integrate PHR data that allow clinicians and patients to share lifelog data with the clinical workflow to support lifestyle interventions. Our results suggest that a PHR–based intervention may be successful in losing body weight and improvement in lifestyle behavior. Trial Registration: ClinicalTrials.gov NCT03200223; https://clinicaltrials.gov/ct2/show/NCT03200223 (Archived by WebCite at http://www.webcitation.org/74baZmnCX). %M 30609978 %R 10.2196/12070 %U https://mhealth.jmir.org/2019/1/e12070/ %U https://doi.org/10.2196/12070 %U http://www.ncbi.nlm.nih.gov/pubmed/30609978 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e10371 %T Usefulness of Wearable Cameras as a Tool to Enhance Chronic Disease Self-Management: Scoping Review %A Maddison,Ralph %A Cartledge,Susie %A Rogerson,Michelle %A Goedhart,Nicole Sylvia %A Ragbir Singh,Tarveen %A Neil,Christopher %A Phung,Dinh %A Ball,Kylie %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Locked Bag 20000, Geelong, 3220, Australia, 61 420232459, ralph.maddison@deakin.edu.au %K eHealth %K review %K cameras %K life-logging %K lifestyle behavior %K chronic disease %D 2019 %7 03.01.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Self-management is a critical component of chronic disease management and can include a host of activities, such as adhering to prescribed medications, undertaking daily care activities, managing dietary intake and body weight, and proactively contacting medical practitioners. The rise of technologies (mobile phones, wearable cameras) for health care use offers potential support for people to better manage their disease in collaboration with their treating health professionals. Wearable cameras can be used to provide rich contextual data and insight into everyday activities and aid in recall. This information can then be used to prompt memory recall or guide the development of interventions to support self-management. Application of wearable cameras to better understand and augment self-management by people with chronic disease has yet to be investigated. Objective: The objective of our review was to ascertain the scope of the literature on the use of wearable cameras for self-management by people with chronic disease and to determine the potential of wearable cameras to assist people to better manage their disease. Methods: We conducted a scoping review, which involved a comprehensive electronic literature search of 9 databases in July 2017. The search strategy focused on studies that used wearable cameras to capture one or more modifiable lifestyle risk factors associated with chronic disease or to capture typical self-management behaviors, or studies that involved a chronic disease population. We then categorized and described included studies according to their characteristics (eg, behaviors measured, study design or type, characteristics of the sample). Results: We identified 31 studies: 25 studies involved primary or secondary data analysis, and 6 were review, discussion, or descriptive articles. Wearable cameras were predominantly used to capture dietary intake, physical activity, activities of daily living, and sedentary behavior. Populations studied were predominantly healthy volunteers, school students, and sports people, with only 1 study examining an intervention using wearable cameras for people with an acquired brain injury. Most studies highlighted technical or ethical issues associated with using wearable cameras, many of which were overcome. Conclusions: This scoping review highlighted the potential of wearable cameras to capture health-related behaviors and risk factors of chronic disease, such as diet, exercise, and sedentary behaviors. Data collected from wearable cameras can be used as an adjunct to traditional data collection methods such as self-reported diaries in addition to providing valuable contextual information. While most studies to date have focused on healthy populations, wearable cameras offer promise to better understand self-management of chronic disease and its context. %M 30609985 %R 10.2196/10371 %U https://mhealth.jmir.org/2019/1/e10371/ %U https://doi.org/10.2196/10371 %U http://www.ncbi.nlm.nih.gov/pubmed/30609985 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e12023 %T Usability of a Personal Air Pollution Monitor: Design-Feedback Iterative Cycle Study %A Duncan,Glen E %A Seto,Edmund %A Avery,Ally R %A Oie,Mike %A Carvlin,Graeme %A Austin,Elena %A Shirai,Jeffry H %A He,Jiayang %A Ockerman,Byron %A Novosselov,Igor %+ Washington State University, Box 1495, Spokane, WA, 99210-1495, United States, 1 5093587875, glen.duncan@wsu.edu %K air pollution %K methods %K particulate matter %K twins %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is considerable evidence that exposure to fine particulate matter (PM2.5) air pollution is associated with a variety of adverse health outcomes. However, true exposure-outcome associations are hampered by measurement issues, including compliance and exposure misclassification. Objective: This paper describes the use of the design-feedback iterative cycle to improve the design and usability of a new portable PM2.5 monitor for use in an epidemiologic study of personal air pollution measures. Methods: In total, 10 adults carried on their person a prefabricated PM2.5 monitor for 1 week over 3 waves of the iterative cycle. At the end of each wave, they participated in a 30-minute moderated focus group and completed 2 validated questionnaires on usability and views on research. The topics addressed included positives and negatives of the monitor, charging and battery life, desired features, and changes to the monitor from each previous wave. They also completed a log to record device wear time each day. The log also provided space to record any issues that may have arisen with the device or for general comments during the week of collection. Results: The major focus group topics included device size, noise, battery and charge time, and method for carrying the device. These topics formed the basis of iterative design changes; by the final cycle, the device was reasonably smaller, quieter, held a longer charge, and was more convenient to carry. System usability scores improved systematically across each wave (median scores of 50-66 on a 100-point scale), as did median daily wear time (approximately 749-789 minutes). Conclusions: Both qualitative and quantitative measures showed an improvement in device usability over the 3 waves. This study demonstrates how the design-feedback iterative cycle can be used to improve the usability of devices manufactured for use in large epidemiologic studies on personal air pollution exposures. %M 30578204 %R 10.2196/12023 %U http://mhealth.jmir.org/2018/12/e12023/ %U https://doi.org/10.2196/12023 %U http://www.ncbi.nlm.nih.gov/pubmed/30578204 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e193 %T An Activity Tracker and Its Accompanying App as a Motivator for Increased Exercise and Better Sleeping Habits for Youths in Need of Social Care: Field Study %A Rönkkö,Kari %+ Department of Design, Faculty of Business, Kristianstad University, Elmetorpsvägen 15, Kristianstad, SE-291 88, Sweden, 46 0442503192, kari.ronkko@hkr.se %K mHealth %K social work %K youths %K activity trackers %K mobile applications %K motivation %K self-care %K sleep hygiene %K goals %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The number of mobile self-tracking devices connected to the Web has exploded in today’s society. With these wearable activity trackers related to Web 2.0 apps and social media have come new ways of monitoring, measuring, representing, and sharing experiences of the human body. New opportunities related to health and new areas of implementation for professionals have appeared, and one identified area that can benefit from mobile health technologies is social work. Objective: There are still only a small number of papers reporting the results from studying wearable activity trackers and accompanying apps in the context of agency-based social work. This study aimed to contribute to the identified shortage by presenting results from a research project framed by the following overarching question: What effects will the studied youths in need of social care experience in relation to exercise and sleep as the result of using a wearable activity tracker and its accompanying app? Methods: A field study framed by action research was performed. The study concerned vulnerable youths living in a Swedish municipality’s care and accommodation home that tried out an activity tracker and its accompanying app. Results: The results from the study confirm previously published research results reporting that instant graphical feedback, sharing information, and being part of a social community can have a positive impact on lifestyle changes. In addition, this study’s main results are that (1) the most important factor for positive health-related lifestyle changes was the establishment of personal long-term goals and (2) professional social workers found the studied technology to function as a valuable counseling tool, opening up avenues for lifestyle talks that otherwise were hard to undertake. Conclusions: This study demonstrates how an activity tracker and its accompanying app can open up a topic for discussion regarding how vulnerable youths can achieve digital support for changing unhealthy lifestyle patterns, and it shows that the technology might be a valuable counseling tool for professionals in social work. %M 30578186 %R 10.2196/mhealth.9286 %U https://mhealth.jmir.org/2018/12/e193/ %U https://doi.org/10.2196/mhealth.9286 %U http://www.ncbi.nlm.nih.gov/pubmed/30578186 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 12 %P e185 %T App-Based Intervention Combining Evidence-Based Behavior Change Techniques With a Model-Based Reasoning System to Promote Physical Activity Among Young Adults (Active2Gether): Descriptive Study of the Development and Content %A Middelweerd,Anouk %A te Velde,Saskia J %A Mollee,Julia S %A Klein,Michel CA %A Brug,Johannes %+ VU Medical Center Amsterdam, Department of Epidemiology & Biostatistics, De Boelelaan 1089a, Amsterdam, 1081 HV, Netherlands, 31 31614752495, saskia@tevelderesearch.com %K physical activity %K mHealth %K moderate-vigorous physical activity %K mobile phones %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The Active2Gether intervention is an app-based intervention designed to help and encourage young adults to become and remain physically active by means of personalized, real-time activity tracking and context-specific feedback. Objective: The objective of our study was to describe the development and content of the Active2Gether intervention for physical activity promotion. Methods: A systematic and stepwise approach was used to develop the Active2Gether intervention. This included formulating objectives and a theoretical framework, selecting behavior change techniques, specifying the tailoring, pilot testing, and describing an evaluation protocol. Results: The development of the Active2Gether intervention comprised seven steps: analyzing the (health) problem, developing a program framework, writing (tailored) messages, developing tailoring assessments, developing the Active2Gether intervention, pilot testing, and testing and evaluating the intervention. The primary objective of the intervention was to increase the total time spent in moderate-vigorous physical activity for those who do not meet the Dutch guideline, maintain physical activity levels of those who meet the guideline, or further increase physical activity levels if they so indicated. The theoretical framework is informed by the social cognitive theory, and insights from other theories and evidence were added for specific topics. Development of the intervention content and communication channel resulted in the development of an app that provides highly tailored coaching messages that are framed in an autonomy-supportive style. These coaching messages include behavior change techniques aiming to address relevant behavioral determinants (eg, self-efficacy and outcome expectations) and are partly context specific. A model-based reasoning engine has been developed to tailor the intervention with respect to the type of support provided by the app, send relevant and context-specific messages to the user, and tailor the graphs displayed in the app. For the input of the tailoring, different instruments and sensors are used, such as an activity monitor (Fitbit One), Web-based and mobile questionnaires, and the location services on the user’s mobile phone. Conclusions: The systematic and stepwise approach resulted in an intervention that is based on theory and input from end users. The use of a model-based reasoning system to provide context-specific coaching messages goes beyond many existing eHealth and mHealth interventions. %M 30578198 %R 10.2196/resprot.7169 %U https://www.researchprotocols.org/2018/12/e185/ %U https://doi.org/10.2196/resprot.7169 %U http://www.ncbi.nlm.nih.gov/pubmed/30578198 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11867 %T Mobile Apps to Support Healthy Family Food Provision: Systematic Assessment of Popular, Commercially Available Apps %A Mauch,Chelsea E %A Wycherley,Thomas P %A Laws,Rachel A %A Johnson,Brittany J %A Bell,Lucinda K %A Golley,Rebecca K %+ Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Level 7, Flinders Medical Centre, Flinders Drive, Bedford Park, 5042, Australia, 61 882047075, chelsea.mauch@flinders.edu.au %K diet %K nutrition %K family %K mobile applications %K behavior modification %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Modern families are facing conflicting demands on their time and resources, which may be at the detriment of child and family diet quality. Innovative nutrition interventions providing parents with behavioral support for the provision of healthy food could alleviate this issue. Mobile apps have the potential to deliver such interventions by providing practical behavioral support remotely, interactively, and in context. Objective: This review aimed to identify and assess popular, commercially available food- and nutrition-related mobile apps that offer support for the provision of healthy family food by (1) describing app scope and characteristics, (2) assessing app quality, and (3) conducting a behavioral analysis of app content and features. Methods: Searches in the Google Play Store and Apple App Store between August 2017 and November 2017 identified apps addressing the food provision process. Apps were included if they were applicable to parents or families, written in English, and with a user rating of ≥4 stars. Weight loss and diet monitoring apps and subscription apps with no free versions were excluded. App quality was assessed using the Mobile App Rating Scale (4 domains: engagement, functionality, aesthetics, and information). App content and features were extracted and behavior change techniques (BCTs) identified. Results: Of the 2881 apps screened, 1.77% (51/2881) were included for assessment, comprising 23 recipe and recipe manager apps, 12 meal planning apps, 10 shopping list apps, 4 family organizers, and 2 food choice apps. Half (n=26) of the apps functioned primarily through user data input. Food choice and family organizer apps scored highest for app quality (mean 3.5 [SD 0.6] out of 5), whereas most apps scored well for functionality and poorly for engagement. Common app features with the potential to support healthy food provision included meal planners (n=26), shopping lists (n=44), and the ability to share app content (n=48). Behavioral support features mapped to relatively few BCTs (mean 3.9 [SD 1.9] per app), with Adding objects to the environment present in all apps, and 65% (33/51) including Instruction on how to perform the behavior. Conclusions: Recipe and recipe manager apps, meal planning apps, and family organizers with integrated meal planning and shopping lists scored well for functionality and incorporated behavioral support features that could be used to address barriers to healthy food provision, although features were focused on planning behaviors. Future apps should combine a range of features such as meal planners, shopping lists, simple recipes, reminders and prompts, and food ordering to reduce the burden of the food provision pathway and incorporate a range of BCTs to maximize behavior change potential. Researchers and developers should consider features and content that improve the engagement quality of such apps. %M 30578213 %R 10.2196/11867 %U http://mhealth.jmir.org/2018/12/e11867/ %U https://doi.org/10.2196/11867 %U http://www.ncbi.nlm.nih.gov/pubmed/30578213 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e11439 %T Using a Mobile Social Networking App to Promote Physical Activity: A Qualitative Study of Users’ Perspectives %A Tong,Huong Ly %A Coiera,Enrico %A Laranjo,Liliana %+ Centre for Health Informatics, Australian Institute of Health Innovation, Level 6, 75 Talavera Road, Sydney, 2109, Australia, 61 029850 ext 2475, huong-ly.tong@students.mq.edu.au %K exercise %K fitness trackers %K mobile apps %K mobile phone %K social networking %D 2018 %7 21.12.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite many health benefits of physical activity, nearly a third of the world’s adult population is insufficiently active. Technological interventions, such as mobile apps, wearable trackers, and Web-based social networks, offer great promise in promoting physical activity, but little is known about users’ acceptability and long-term engagement with these interventions. Objective: The aim of this study was to understand users’ perspectives regarding a mobile social networking intervention to promote physical activity. Methods: Participants, mostly university students and staff, were recruited using purposive sampling techniques. Participants were enrolled in a 6-month feasibility study where they were provided with a wearable physical activity tracker (Fitbit Flex 2) and a wireless scale (Fitbit Aria) integrated with a social networking mobile app (named “fit.healthy.me”). We conducted semistructured, in-depth qualitative interviews and focus groups pre- and postintervention, which were recorded and transcribed verbatim. The data were analyzed in Nvivo 11 using thematic analysis techniques. Results: In this study, 55 participants were enrolled; 51% (28/55) were females, and the mean age was 23.6 (SD 4.6) years. The following 3 types of factors emerged from the data as influencing engagement with the intervention and physical activity: individual (self-monitoring of behavior, goal setting, and feedback on behavior), social (social comparison, similarity and familiarity between users, and participation from other users in the network), and technological. In addition, automation and personalization were observed as enhancing the delivery of both individual and social aspects. Technological limitations were mentioned as potential barriers to long-term usage. Conclusions: Self-regulatory techniques and social factors are important to consider when designing a physical activity intervention, but a one-size-fits-all approach is unlikely to satisfy different users’ preferences. Future research should adopt innovative research designs to test interventions that can adapt and respond to users’ needs and preferences throughout time. %M 30578201 %R 10.2196/11439 %U https://www.jmir.org/2018/12/e11439/ %U https://doi.org/10.2196/11439 %U http://www.ncbi.nlm.nih.gov/pubmed/30578201 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e192 %T Parents’ Perspectives on the Theoretical Domains Framework Elements Needed in a Pediatric Health Behavior App: A Crowdsourced Social Validity Study %A Cushing,Christopher C %A Fedele,David A %A Brannon,Erin E %A Kichline,Tiffany %+ Clinical Child Psychology Program, University of Kansas, Dole Human Development Center, 1000 Sunnyside Avenue, Room 2011, Lawrence, KS, 66049, United States, 1 7858640713, christopher.cushing@ku.edu %K mHealth %K adolescent %K children %K parent %K stakeholder %K consumer preference %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Most pediatric studies do not include parent stakeholders in the design of the intervention itself and many pediatric mobile health (mHealth) interventions are not meaningfully disseminated after the trial period ends. Consequently, the consumer desire for mobile apps targeting pediatric health behavior is likely to be met by commercial products that are not based in theory or evidence and may not take stakeholder preferences into account. Objective: The aim was to assess parent preference for mobile app features that map onto specific Theoretical Domains Framework (TDF) elements. Methods: This study was a crowdsourced social validity study of 183 parents who were asked to rate their preferences for mobile app features that correspond to elements of the TDF. The TDF organizes a large number of theoretical models and constructs into three components: (1) capability, (2) motivation, and (3) opportunity. Parents of children were recruited through Amazon Mechanical Turk. Results: The majority of participants were Caucasian and mean age was 36.9 (SD 8.0) years. Results revealed broad acceptability of communication, motivation, and opportunity domains. However, the degree to which each domain was valued varied within behavioral category. Parents demonstrated a preference for increasing procedural knowledge for physical activity and diet behaviors over sleep (F2,545=5.18, P=.006). Similarly, parents valued self-monitoring as more important for physical activity than sleep (F2,546=4.04, P=.02). When asked about the value of features to help children develop skills, parents preferred those features for dietary behavior over sleep (F2,546=3.57, P=.03). Parents perceived that goal-setting features would be most useful for physical activity over sleep and diet (F2,545=5.30, P=.005). Incentive features within the app were seen as most useful for physical activity over sleep (F2,546=4.34, P=.01). Conclusions: This study presents a low-cost strategy for involving a large number of stakeholders in the discussion of how health behavior theory should be applied in a mHealth intervention. Our approach is innovative in that it took a scientific framework (ie, TDF) and made it digestible to parents so that they could then provide their opinions about features that might appear in a future app. Our survey items discriminated between various health behaviors allowing stakeholders to communicate the different health behaviors that they would like a TDF feature to change. Moreover, we were able to develop a set of consumer opinions about features that were directly linked to elements of the TDF. %M 30578173 %R 10.2196/mhealth.9808 %U https://mhealth.jmir.org/2018/12/e192/ %U https://doi.org/10.2196/mhealth.9808 %U http://www.ncbi.nlm.nih.gov/pubmed/30578173 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11107 %T A Mobile App to Provide Evidence-Based Information About Crystal Methamphetamine (Ice) to the Community (Cracks in the Ice): Co-Design and Beta Testing %A Birrell,Louise %A Deen,Hannah %A Champion,Katrina Elizabeth %A Newton,Nicola C %A Stapinski,Lexine A %A Kay-Lambkin,Frances %A Teesson,Maree %A Chapman,Cath %+ National Health and Medical Research Council Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, 22 – 32 King Street, Randwick, Sydney, 2031, Australia, 61 2 8936 1217, h.deen@unsw.edu.au %K internet %K methamphetamine %K mobile apps %K mobile phone %K substance-related disorder %D 2018 %7 20.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite evidence of increasing harms and community concern related to the drug crystal methamphetamine (“ice”), there is a lack of easily accessible, evidence-based information for community members affected by its use, and to date, no evidence-based mobile apps have specifically focused on crystal methamphetamine. Objective: This study aims to describe the co-design and beta testing of a mobile app to provide evidence-based, up-to-date information about crystal methamphetamine to the general community. Methods: A mobile app about crystal methamphetamine was developed in 2017. The development process involved multiple stakeholders (n=12), including technology and drug and alcohol experts, researchers, app developers, a consumer expert with lived experience, and community members. Beta testing was conducted with Australian general community members (n=34), largely recruited by the Web through Facebook advertising. Participants were invited to use a beta version of the app and provide feedback about the content, visual appeal, usability, engagement, features, and functions. In addition, participants were asked about their perceptions of the app’s influence on awareness, understanding, and help-seeking behavior related to crystal methamphetamine, and about their knowledge about crystal methamphetamine before and after using the app. Results: The vast majority of participants reported the app was likely to increase awareness and understanding and encourage help-seeking. The app received positive ratings overall and was well received. Specifically, participants responded positively to the high-quality information provided, usability, and visual appeal. Areas suggested for improvement included reducing the amount of text, increasing engagement, removing a profile picture, and improving navigation through the addition of a “back” button. Suggested improvements were incorporated prior to the app’s public release. App use was associated with an increase in perceived knowledge about crystal methamphetamine; however, this result was not statistically significant. Conclusions: The Cracks in the Ice mobile app provides evidence-based information about the drug crystal methamphetamine for the general community. The app is regularly updated, available via the Web and offline, and was developed in collaboration with experts and end users. Initial results indicate that it is easy to use and acceptable to the target group. %M 30573443 %R 10.2196/11107 %U https://mhealth.jmir.org/2018/12/e11107/ %U https://doi.org/10.2196/11107 %U http://www.ncbi.nlm.nih.gov/pubmed/30573443 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11071 %T Coping Strategies and Social Support in a Mobile Phone Chat App Designed to Support Smoking Cessation: Qualitative Analysis %A Granado-Font,Esther %A Ferré-Grau,Carme %A Rey-Reñones,Cristina %A Pons-Vigués,Mariona %A Pujol Ribera,Enriqueta %A Berenguera,Anna %A Barrera-Uriarte,Maria Luisa %A Basora,Josep %A Valverde-Trillo,Araceli %A Duch,Jordi %A Flores-Mateo,Gemma %+ Institut Català de la Salut, Unitat de Suport a la Recerca Tarragona-Reus, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Camí de Riudoms, 53-55, Reus, 43202, Spain, 34 977778515, crey.tgn.ics@gencat.cat %K primary health care %K qualitative research %K mobile apps %K smoking cessation %K social support %K psychological adaptation %D 2018 %7 20.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smoking is one of the most significant factors contributing to low life expectancy, health inequalities, and illness at the worldwide scale. Smoking cessation attempts benefit from social support. Mobile phones have changed the way we communicate through the use of freely available message-oriented apps. Mobile app–based interventions for smoking cessation programs can provide interactive, supportive, and individually tailored interventions. Objective: This study aimed to identify emotions, coping strategies, beliefs, values, and cognitive evaluations of smokers who are in the process of quitting, and to analyze online social support provided through the analysis of messages posted to a chat function integrated into a mobile app. Methods: In this descriptive qualitative study, informants were smokers who participated in the chat of Tobbstop. The technique to generate information was documentary through messages collected from September 2014 through June 2016, specifically designed to support a smoking cessation intervention. A thematic content analysis of the messages applied 2 conceptual models: the Lazarus and Folkman model to assess participant’s experiences and perceptions and the Cutrona model to evaluate online social support. Results: During the study period, 11,788 text messages were posted to the chat by 101 users. The most frequent messages offered information and emotional support, and all the basic emotions were reported in the chat. The 3 most frequent coping strategies identified were physical activity, different types of treatment such as nicotine replacement, and humor. Beliefs about quitting smoking included the inevitability of weight gain and the notion that not using any type of medications is better for smoking cessation. Health and family were the values more frequently described, followed by freedom. A smoke-free environment was perceived as important to successful smoking cessation. The social support group that was developed with the app offered mainly emotional and informational support. Conclusions: Our analysis suggests that a chat integrated into a mobile app focused on supporting smoking cessation provides a useful tool for smokers who are in the process of quitting, by offering social support and a space to share concerns, information, or strategies. %M 30573445 %R 10.2196/11071 %U http://mhealth.jmir.org/2018/12/e11071/ %U https://doi.org/10.2196/11071 %U http://www.ncbi.nlm.nih.gov/pubmed/30573445 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11708 %T A Comprehensive Digital Program for Smoking Cessation: Assessing Feasibility in a Single-Group Cohort Study %A Patrick,Heather %A Fujii,Craig A %A Glaser,Debra B %A Utley,David S %A Marler,Jennifer D %+ Carrot Inc, 1600 Seaport Boulevard, Suite 150, Redwood City, CA, 94063, United States, 1 650 216 9689, heather@carrot.co %K smoking cessation %K cell phone %K health promotion %K carbon monoxide %D 2018 %7 18.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cigarette smoking remains the leading cause of preventable death and disease worldwide. Evidence-based approaches are available, but few people access them. Although digital solutions offer great promise for population reach, few multicomponent programs exist. Pivot is a comprehensive digital solution combining a Food and Drug Administration–cleared carbon monoxide (CO) breath sensor; cigarette logging; a 6-phase, app-delivered smoking cessation program based on the US Clinical Practice Guidelines; and dedicated human coaching via text-based chat. Objective: The purpose of this study was to assess program engagement, changes in attitudes toward smoking, self-reported changes in smoking behavior, and program acceptability for the initial phase of Pivot: Explore. Methods: A total of 48 participants enrolled, and 41 completed the study. About half the participants (54%, 22/41) were men, and the mean age was 43 years. Most (85%, 35/41) were daily smokers and smoked an average of 12 cigarettes per day. Explore includes CO breath sensing, logging cigarettes in-app, learning via in-app activities, and dedicated human coaching through a text messaging interface. Participants completed surveys at baseline and exit assessing attitudes toward quitting including readiness, perceived difficulty, and confidence in quit success. At exit, participants also completed a survey of changes in smoking behavior and ratings of program acceptability. Results: More than 80% of participants (34-39 of 41) took ≥1 CO breath sample each day, and more than 55% (23-27 of 41) took ≥5 samples each day. More than 65% of participants (27-34 of 41) logged ≥1 cigarette using the in-app logging feature each day. All 9 in-app activities had completion rates ≥80% (33-40 of 41). Response to coach-initiated outreach was also high, with all contacts receiving ≥73% (30-39 of 41) response. In matched pair analyses, significant positive changes in mean attitudes toward quitting (scale 1-10) were evident from baseline (T1) to study exit (T2), including increased readiness to quit (T1 mean=6.1, T2 mean=7.4, P=.005), lower perceived difficulty (T1 mean=3.7, T2 mean=5.6, P=.001), and greater expectations of success (T1 mean=4.5, T2 mean=6.5, P<.001). At exit, 78% (32/41) of participants reported decreasing the number of cigarettes smoked per day during the study. Participants rated program quality and satisfaction very high (mean ≥8 for all items). Conclusions: These results support the feasibility and acceptability of the initial 9-day phase of Pivot: Explore. Participants had high levels of engagement with sensing, logging, learning, and coaching. Attitudes toward quitting improved significantly, and the majority of users indicated decreasing smoking behavior. Explore was designed to raise smoker awareness and motivation. Additional research is underway to assess how users progress through the full Pivot smoking cessation program and determine the program’s effectiveness for achieving sustained cessation. %M 30563807 %R 10.2196/11708 %U https://mhealth.jmir.org/2018/12/e11708/ %U https://doi.org/10.2196/11708 %U http://www.ncbi.nlm.nih.gov/pubmed/30563807 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e11321 %T The Effectiveness of a Web-Based Computer-Tailored Physical Activity Intervention Using Fitbit Activity Trackers: Randomized Trial %A Vandelanotte,Corneel %A Duncan,Mitch J %A Maher,Carol A %A Schoeppe,Stephanie %A Rebar,Amanda L %A Power,Deborah A %A Short,Camille E %A Doran,Christopher M %A Hayman,Melanie J %A Alley,Stephanie J %+ Physical Activity Research Group, Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Building 7, Bruce Highway, Rockhampton, 4700, Australia, 61 749232183, c.vandelanotte@cqu.edu.au %K online, internet, tracking, health behavior change, advanced activity trackers, wearables %D 2018 %7 18.12.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based interventions that provide personalized physical activity advice have demonstrated good effectiveness but rely on self-reported measures of physical activity, which are prone to overreporting, potentially reducing the accuracy and effectiveness of the advice provided. Objective: This study aimed to examine whether the effectiveness of a Web-based computer-tailored intervention could be improved by integrating Fitbit activity trackers. Methods: Participants received the 3-month TaylorActive intervention, which included 8 modules of theory-based, personally tailored physical activity advice and action planning. Participants were randomized to receive the same intervention either with or without Fitbit tracker integration. All intervention materials were delivered on the Web, and there was no face-to-face contact at any time point. Changes in physical activity (Active Australia Survey), sitting time (Workforce Sitting Questionnaire), and body mass index (BMI) were assessed 1 and 3 months post baseline. Advice acceptability, website usability, and module completion were also assessed. Results: A total of 243 Australian adults participated. Linear mixed model analyses showed a significant increase in total weekly physical activity (adjusted mean increase=163.2; 95% CI 52.0-274.5; P=.004) and moderate-to-vigorous physical activity (adjusted mean increase=78.6; 95% CI 24.4-131.9; P=.004) in the Fitbit group compared with the non-Fitbit group at the 3-month follow-up. The sitting time and BMI decreased more in the Fitbit group, but no significant group × time interaction effects were found. The physical activity advice acceptability and the website usability were consistently rated higher by participants in the Fitbit group. Non-Fitbit group participants completed 2.9 (SD 2.5) modules, and Fitbit group participants completed 4.4 (SD 3.1) modules. Conclusions: Integrating physical activity trackers into a Web-based computer-tailored intervention significantly increased intervention effectiveness. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616001555448; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371793 (Archived by WebCite at http://www.webcitation.org/73ioTxQX2) %M 30563808 %R 10.2196/11321 %U http://www.jmir.org/2018/12/e11321/ %U https://doi.org/10.2196/11321 %U http://www.ncbi.nlm.nih.gov/pubmed/30563808 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e10314 %T Identifying Evidence-Informed Physical Activity Apps: Content Analysis %A Kebede,Mihiretu %A Steenbock,Berit %A Helmer,Stefanie Maria %A Sill,Janna %A Möllers,Tobias %A Pischke,Claudia R %+ Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Duesseldorf, Universitätsstraße 1, Duesseldorf, 40225, Germany, 49 221 81 08599, ClaudiaRuth.Pischke@med.uni-duesseldorf.de %K guidelines %K mHealth %K mobile apps %K physical activity %K mobile phone %D 2018 %7 18.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Regular moderate to vigorous physical activity is essential for maintaining health and preventing the onset of chronic diseases. Both global rates of smartphone ownership and the market for physical activity and fitness apps have grown rapidly in recent years. The use of physical activity and fitness apps may assist the general population in reaching evidence-based physical activity recommendations. However, it remains unclear whether there are evidence-informed physical activity apps and whether behavior change techniques (BCTs) previously identified as effective for physical activity promotion are used in these apps. Objective: This study aimed to identify English and German evidence-informed physical activity apps and BCT employment in those apps. Methods: We identified apps in a systematic search using 25 predefined search terms in the Google Play Store. Two reviewers independently screened the descriptions of apps and screenshots applying predefined inclusion and exclusion criteria. Apps were included if (1) their description contained information about physical activity promotion; (2) they were in English or German; (3) physical activity recommendations of the World Health Organization or the American College of Sports Medicine were mentioned; and (4) any kind of objective physical activity measurement was included. Two researchers downloaded and tested apps matching the inclusion criteria for 2 weeks and coded their content using the Behavioral Change Technique Taxonomy v1 (BCTTv1). Results: The initial screening in the Google Play Store yielded 6018 apps, 4108 of which were not focused on physical activity and were not in German or English. The descriptions of 1216 apps were further screened for eligibility. Duplicate apps and light versions (n=694) and those with no objective measurement of physical activity, requiring additional equipment, or not outlining any physical activity guideline in their description (n=1184) were excluded. Of the remaining 32 apps, 4 were no longer available at the time of the download. Hence, 28 apps were downloaded and tested; of these apps, 14 did not contain any physical activity guideline as an app feature, despite mentioning it in the description, 5 had technical problems, and 3 did not provide objective physical activity measurement. Thus, 6 were included in the final analyses. Of 93 individual BCTs of the BCTTv1, on average, 9 (SD 5) were identified in these apps. Of 16 hierarchical clusters, on average, 5 (SD 3) were addressed. Only BCTs of the 2 hierarchical clusters “goals and planning” and “feedback and monitoring” were identified in all apps. Conclusions: Despite the availability of several thousand physical activity and fitness apps for Android platforms, very few addressed evidence-based physical activity guidelines and provided objective physical activity measurement. Furthermore, available descriptions did not accurately reflect the app content and only a few evidence-informed physical activity apps incorporated several BCTs. Future apps should address evidence-based physical activity guidelines and a greater scope of BCTs to further increase their potential impact for physical activity promotion. %M 30563810 %R 10.2196/10314 %U https://mhealth.jmir.org/2018/12/e10314/ %U https://doi.org/10.2196/10314 %U http://www.ncbi.nlm.nih.gov/pubmed/30563810 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11175 %T Predictors of Engagement, Response to Follow Up, and Extent of Alcohol Reduction in Users of a Smartphone App (Drink Less): Secondary Analysis of a Factorial Randomized Controlled Trial %A Garnett,Claire %A Perski,Olga %A Tombor,Ildiko %A West,Robert %A Michie,Susan %A Brown,Jamie %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 2076791742 ext 41742, c.garnett@ucl.ac.uk %K smartphone %K mobile phone %K alcohol drinking %K mobile apps %K engagement %D 2018 %7 14.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital interventions for alcohol can help achieve reductions in hazardous and harmful alcohol consumption. The Drink Less app was developed using evidence and theory, and a factorial randomized controlled trial (RCT) suggested that 4 of its intervention modules may assist with drinking reduction. However, low engagement is an important barrier to effectiveness, and low response to follow up is a challenge for intervention evaluation. Research is needed to understand what factors influence users’ level of engagement, response to follow up, and extent of alcohol reduction. Objective: This study aimed to investigate associations between user characteristics, engagement, response to follow up, and extent of alcohol reduction in an app-based intervention, Drink Less. Methods: This study involved a secondary data analysis of a factorial RCT of the Drink Less app. Participants (N=672) were aged 18 years or older, lived in the United Kingdom, and had an Alcohol Use Disorders Identification Test score >7 (indicative of excessive drinking). Sociodemographic and drinking characteristics were assessed at baseline. Engagement was assessed in the first month of use (number of sessions, time on app, number of days used, and percentage of available screens viewed). Response to follow up and extent of alcohol reduction (change in past week consumption) were measured after 1 month. Associations were assessed using unadjusted and adjusted linear or logistic regression models. Results: Age (all unstandardized regression coefficients [B] >.02, all P<.001) and post-16 educational qualifications (all B>.18, all P<.03) were positively associated with all engagement outcomes. Age (odds ratio [OR] 1.04, P<.001), educational qualifications (OR 2.11, P<.001), and female gender (OR 1.58, P=.02) were positively associated with response to follow up. Engagement outcomes predicted response to follow up (all OR>1.02, all P<.001) but not the extent of alcohol reduction (all −.14.07). Baseline drinking characteristics were the only variables associated with the extent of alcohol reduction among those followed up (all B>.49, all P<.001). Conclusions: Users of the alcohol reduction app, Drink Less, who were older and had post-16 educational qualifications engaged more and were more likely to respond at 1-month follow up. Higher baseline alcohol consumption predicted a greater extent of alcohol reduction among those followed up but did not predict engagement or response to follow up. Engagement was associated with response to follow up but was not associated with the extent of alcohol reduction, which suggests that the Drink Less app does not have a dose-response effect. Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN40104069; http://www.isrctn.com/ISRCTN40104069 (Archived by WebCite at http://www.webcitation.org/746HqygIV) %M 30552081 %R 10.2196/11175 %U https://mhealth.jmir.org/2018/12/e11175/ %U https://doi.org/10.2196/11175 %U http://www.ncbi.nlm.nih.gov/pubmed/30552081 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e201 %T Technology Adoption, Motivational Aspects, and Privacy Concerns of Wearables in the German Running Community: Field Study %A Wiesner,Martin %A Zowalla,Richard %A Suleder,Julian %A Westers,Maximilian %A Pobiruchin,Monika %+ Department of Medical Informatics, Heilbronn University, Max-Planck-Straße 39, Heilbronn, D-74081, Germany, 49 71315046947, martin.wiesner@hs-heilbronn.de %K athlete %K wearables %K mobile phones %K physical activity %K activity monitoring %D 2018 %7 14.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the availability of a great variety of consumer-oriented wearable devices, perceived usefulness, user satisfaction, and privacy concerns have not been fully investigated in the field of wearable applications. It is not clear why healthy, active citizens equip themselves with wearable technology for running activities, and what privacy and data sharing features might influence their individual decisions. Objective: The primary aim of the study was to shed light on motivational and privacy aspects of wearable technology used by healthy, active citizens. A secondary aim was to reevaluate smart technology adoption within the running community in Germany in 2017 and to compare it with the results of other studies and our own study from 2016. Methods: A questionnaire was designed to assess what wearable technology is used by runners of different ages and sex. Data on motivational factors were also collected. The survey was conducted at a regional road race event in May 2017, paperless via a self-implemented app. The demographic parameters of the sample cohort were compared with the event’s official starter list. In addition, the validation included comparison with demographic parameters of the largest German running events in Berlin, Hamburg, and Frankfurt/Main. Binary logistic regression analysis was used to investigate whether age, sex, or course distance were associated with device use. The same method was applied to analyze whether a runner’s age was predictive of privacy concerns, openness to voluntary data sharing, and level of trust in one’s own body for runners not using wearables (ie, technological assistance considered unnecessary in this group). Results: A total of 845 questionnaires were collected. Use of technology for activity monitoring during events or training was prevalent (73.0%, 617/845) in this group. Male long-distance runners and runners in younger age groups (30-39 years: odds ratio [OR] 2.357, 95% CI 1.378-4.115; 40-49 years: OR 1.485, 95% CI 0.920-2.403) were more likely to use tracking devices, with ages 16 to 29 years as the reference group (OR 1). Where wearable technology was used, 42.0% (259/617) stated that they were not concerned if data might be shared by a device vendor without their consent. By contrast, 35.0% (216/617) of the participants would not accept this. In the case of voluntary sharing, runners preferred to exchange tracked data with friends (51.7%, 319/617), family members (43.4%, 268/617), or a physician (32.3%, 199/617). A large proportion (68.0%, 155/228) of runners not using technology stated that they preferred to trust what their own body was telling them rather than trust a device or an app (50-59 years: P<.001; 60-69 years: P=.008). Conclusions: A total of 136 distinct devices by 23 vendors or manufacturers and 17 running apps were identified. Out of 4, 3 runners (76.8%, 474/617) always trusted in the data tracked by their personal device. Data privacy concerns do, however, exist in the German running community, especially for older age groups (30-39 years: OR 1.041, 95% CI 0.371-0.905; 40-49 years: OR 1.421, 95% CI 0.813-2.506; 50-59 years: OR 2.076, 95% CI 1.813-3.686; 60-69 years: OR 2.394, 95% CI 0.957-6.183). %M 30552085 %R 10.2196/mhealth.9623 %U http://mhealth.jmir.org/2018/12/e201/ %U https://doi.org/10.2196/mhealth.9623 %U http://www.ncbi.nlm.nih.gov/pubmed/30552085 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e10972 %T The Accuracy of Smart Devices for Measuring Physical Activity in Daily Life: Validation Study %A Degroote,Laurent %A De Bourdeaudhuij,Ilse %A Verloigne,Maïté %A Poppe,Louise %A Crombez,Geert %+ Physical Activity & Health, Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, Ghent, 9000, Belgium, 32 9 264 62 99, laurent.degroote@ugent.be %K physical activity %K fitness trackes %K accelerometry %D 2018 %7 13.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearables for monitoring physical activity (PA) are increasingly popular. These devices are not only used by consumers to monitor their own levels of PA but also by researchers to track the behavior of large samples. Consequently, it is important to explore how accurately PA can be tracked via these devices. Objectives: The aim of this study was, therefore, to investigate convergent validity of 3 Android Wear smartwatches—Polar M600 (Polar Electro Oy, Kempele, Finland), Huawei Watch (Huawei Technologies Co, Ltd, Shenzhen, Guangdong, China), Asus Zenwatch3 (AsusTek Computer Inc, Taipei, Taiwan)—and Fitbit Charge with an ActiGraph accelerometer for measuring steps and moderate to vigorous physical activity (MVPA) on both a day level and 15-min level. Methods: A free-living protocol was used in which 36 adults engaged in usual daily activities over 2 days while wearing 2 different wearables on the nondominant wrist and an ActiGraph GT3X+ accelerometer on the hip. Validity was evaluated on both levels by comparing each wearable with the ActiGraph GT3X+ accelerometer using correlations and Bland-Altman plots in IBM SPSS 24.0. Results: On a day level, all devices showed strong correlations (Spearman r=.757-.892) and good agreement (interclass correlation coefficient, ICC=.695-.885) for measuring steps, whereas moderate correlations (Spearman r=.557-.577) and low agreement (ICC=.377-.660) for measuring MVPA. Bland-Altman revealed a systematic overestimation of the wearables for measuring steps but a variation between over- and undercounting of MVPA. On a 15-min level, all devices showed strong correlations (Spearman r=.752-.917) and good agreement (ICC=.792-.887) for measuring steps, whereas weak correlations (Spearman r=.116-.208) and low agreement (ICC=.461-.577) for measuring MVPA. Bland-Altman revealed a systematic overestimation of the wearables for steps but under- or overestimation for MVPA depending on the device. Conclusions: In sum, all 4 consumer-level devices can be considered accurate step counters in free-living conditions. This study, however, provides evidence of systematic bias for all devices in measurement of MVPA. The results on a 15-min level also indicate that these devices are not sufficiently accurate to provide correct real-time feedback. %M 30545810 %R 10.2196/10972 %U https://mhealth.jmir.org/2018/12/e10972/ %U https://doi.org/10.2196/10972 %U http://www.ncbi.nlm.nih.gov/pubmed/30545810 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 12 %P e10215 %T Establishing Digital Biomarkers for Occupational Health Assessment in Commercial Salmon Fishermen: Protocol for a Mixed-Methods Study %A Wilbur,Rachel Elizabeth %A Griffin,Jacob Spencer %A Sorensen,Mark %A Furberg,Robert Daniel %+ RTI International, 3040 Cornwallis Rd, RTP, NC,, United States, 1 919 316 3726, rfurberg@rti.org %K digital health %K digital biomarkers %K occupational health %K health and safety %K fishermen %K physiological health %K stress %D 2018 %7 10.12.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Commercial salmon fishing in Alaska is one of the most dangerous occupations in the United States. Between 1992 and 2008, the average annual industry mortality rate was 128 deaths per 100,000 workers, and despite an increase in industry regulations, there has not been a significant decrease in mortality rate since 2000. Unpredictable fishing openings and fierce competition for limited resources result in periods of intense sleep deprivation and physical strain during the short commercial salmon season in Alaska. Objective: We hypothesize that the combined effect of sleep deprivation, intense physical workload, and significant short-term chronic stress may be deleterious to health in both the short- and long-term among commercial salmon drift gillnet fishermen in Alaska. The objective of this protocol is to determine the feasibility of the study design to test this hypothesis. Methods: The study design uses mixed methods and includes biometric monitoring consisting of heart rate variability, respiration, and movement data collected via a personal, wearable biometric device. Additional methods include observational data on activity, including duration and quality of sleep, weather, catch, and financial gain, as well as the collection of salivary cortisol. As such, the study will provide a holistic assessment of individual stress on multiple simultaneous timescales: immediately and continuously through the personal wearable biometric device, on the minute-hour level through the multiple daily collections of salivary cortisol, and by the hour-day through the use of participant and environment observational data. Results: Data collection was initiated in July 2017 and will extend through August 2019. Initial data collection has indicated that the methods outlined in this protocol are feasible and allow for effective collection of qualitative and quantitative data related to the psychological and physiological impact of Alaska commercial salmon fishing. Conclusions: We anticipate that the use of a biometric device will be crucial in establishing measures of stress and physical activity within a population and environment uniquely challenged by physical isolation, strong weather patterns, and the potential for significant financial gain by fishermen. The potential exists for individuals engaged long-term in the fishing industry, through repeated and extended exposure to periods of intense sleep deprivation and chronic stress, to be at increased risk of cardiovascular disease. International Registered Report Identifier (IRRID): DERR1-10.2196/10215 %M 30530453 %R 10.2196/10215 %U http://www.researchprotocols.org/2018/12/e10215/ %U https://doi.org/10.2196/10215 %U http://www.ncbi.nlm.nih.gov/pubmed/30530453 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11271 %T Adherence to a Mindfulness and Relaxation Self-Care App for Cancer Patients: Mixed-Methods Feasibility Study %A Mikolasek,Michael %A Witt,Claudia M %A Barth,Jürgen %+ Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Sonneggstrasse 6, Zurich, 8091, Switzerland, 41 44 255 51 49, michael.mikolasek@usz.ch %K mobile app %K mindfulness %K relaxation %K cancer %K patient compliance %D 2018 %7 06.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cancer is highly prevalent worldwide and can cause high levels of distress in patients, which is often neglected in medical care. Smartphone apps are readily available and therefore seem promising to deliver distress-reducing interventions such as mindfulness and relaxation programs. Objective: This study aimed to evaluate the feasibility of a mindfulness and relaxation app for cancer patients. We looked at characteristics of participating patients in a mobile health (mHealth) study, including adherence to the app intervention, predictors for adherence, and patients’ feedback regarding the app. Methods: In this prospective observational study with a mixed-methods approach, cancer patients received a mindfulness and relaxation self-care app. Cancer patients were recruited online and through hospitals in Switzerland. We assessed self-reported measures (eg, quality of life, anxiety, depressive symptoms, openness to experience, resistance to change) at baseline, and the app gathered data on patients’ practicing time. With 8 semistructured interviews, we obtained patients’ feedback about the app and recommendations for improvements. We looked at 3 dimensions of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework (reach, adoption, and maintenance) and analyzed data for adherence for the first 10 weeks of the app intervention. We report descriptive statistics for patient characteristics and app use. For the prediction of adherence, we used Kaplan-Meier analyses with log-rank tests and a Cox proportional hazards regression. Results: Data from 100 cancer patients (74 female) showed that 54 patients were using the app exercises continuously until week 10. In continuous app users, the median number of exercises per week dropped from 4 (interquartile range, IQR 1-7) at week 1 to a median of 2 (IQR 1-4) at week 10. Our analyses revealed 4 significant predictors for better adherence: female gender, higher openness to experience, higher resistance to change, and more depressive symptoms. Interviews revealed that the patients generally were satisfied with the app but also made suggestions on how to improve it. Conclusions: Our study indicates that a mindfulness and relaxation mHealth intervention for cancer patients is feasible with acceptable adherence and largely positive feedback from patients. Trial Registration: German Clinical Trials Register DRKS00010481; https://www.drks.de/drks_web/navigate.do?navigation Id=trial.HTML&TRIAL_ID=DRKS00010481 (Archived by WebCite at http://www.webcitation.org/73xGE1B0P) %M 30522990 %R 10.2196/11271 %U https://mhealth.jmir.org/2018/12/e11271/ %U https://doi.org/10.2196/11271 %U http://www.ncbi.nlm.nih.gov/pubmed/30522990 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 12 %P e12464 %T Using the Social-Local-Mobile App for Smoking Cessation in the SmokeFreeBrain Project: Protocol for a Randomized Controlled Trial %A Jódar-Sánchez,Francisco %A Carrasco Hernández,Laura %A Núñez-Benjumea,Francisco J %A Mesa González,Marco Antonio %A Moreno Conde,Jesús %A Parra Calderón,Carlos Luis %A Fernandez-Luque,Luis %A Hors-Fraile,Santiago %A Civit,Anton %A Bamidis,Panagiotis %A Ortega-Ruiz,Francisco %+ Research and Innovation Group in Biomedical Informatics, Biomedical Engineering and Health Economy, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital / Spanish National Research Council / University of Seville, Avenida Manuel Siurot, s/n, Centro de Documentación Clínica Avanzada, Virgen del Rocío University Hospital, Seville, 41013, Spain, 34 955013616, francisco.nunez.exts@juntadeandalucia.es %K smoking cessation %K mobile applications %K randomized controlled trial %K economic evaluation %D 2018 %7 06.12.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smoking is considered the main cause of preventable illness and early deaths worldwide. The treatment usually prescribed to people who wish to quit smoking is a multidisciplinary intervention, combining both psychological advice and pharmacological therapy, since the application of both strategies significantly increases the chance of success in a quit attempt. Objective: We present a study protocol of a 12-month randomized open-label parallel-group trial whose primary objective is to analyze the efficacy and efficiency of usual psychopharmacological therapy plus the Social-Local-Mobile app (intervention group) applied to the smoking cessation process compared with usual psychopharmacological therapy alone (control group). Methods: The target population consists of adult smokers (both male and female) attending the Smoking Cessation Unit at Virgen del Rocío University Hospital, Seville, Spain. Social-Local-Mobile is an innovative intervention based on mobile technologies and their capacity to trigger behavioral changes. The app is a complement to pharmacological therapies to quit smoking by providing personalized motivational messages, physical activity monitoring, lifestyle advice, and distractions (minigames) to help overcome cravings. Usual pharmacological therapy consists of bupropion (Zyntabac 150 mg) or varenicline (Champix 0.5 mg or 1 mg). The main outcomes will be (1) the smoking abstinence rate at 1 year measured by means of exhaled carbon monoxide and urinary cotinine tests, and (2) the result of the cost-effectiveness analysis, which will be expressed in terms of an incremental cost-effectiveness ratio. Secondary outcome measures will be (1) analysis of the safety of pharmacological therapy, (2) analysis of the health-related quality of life of patients, and (3) monitoring of healthy lifestyle and physical exercise habits. Results: Of 548 patients identified using the hospital’s electronic records system, we excluded 308 patients: 188 declined to participate and 120 did not meet the inclusion criteria. A total of 240 patients were enrolled: the control group (n=120) will receive usual psychopharmacological therapy, while the intervention group (n=120) will receive usual psychopharmacological therapy plus the So-Lo-Mo app. The project was approved for funding in June 2015. Enrollment started in October 2016 and was completed in October 2017. Data gathering was completed in November 2018, and data analysis is under way. The first results are expected to be submitted for publication in early 2019. Conclusions: Social networks and mobile technologies influence our daily lives and, therefore, may influence our smoking habits as well. As part of the SmokeFreeBrain H2020 European Commission project, this study aims at elucidating the potential role of these technologies when used as an extra aid to quit smoking. Trial Registration: ClinicalTrials.gov NCT03553173; https://clinicaltrials.gov/ct2/show/record/NCT03553173 (Archived by WebCite at http://www.webcitation.org/74DuHypOW). International Registered Report Identifier (IRRID): PRR1-10.2196/12464 %M 30522992 %R 10.2196/12464 %U http://www.researchprotocols.org/2018/12/e12464/ %U https://doi.org/10.2196/12464 %U http://www.ncbi.nlm.nih.gov/pubmed/30522992 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 4 %P e19 %T Potential of an Interactive Drug Prevention Mobile Phone App (Once Upon a High): Questionnaire Study Among Students %A Kapitány-Fövény,Máté %A Vagdalt,Eszter %A Ruttkay,Zsófia %A Urbán,Róbert %A Richman,Mara J %A Demetrovics,Zsolt %+ Department of Addiction, Semmelweis University Faculty of Health Sciences, Vas Street 17, Budapest, 1088, Hungary, 36 20 5221850, m.gabrilovics@gmail.com %K secondary prevention %K adolescent %K mHealth %K energy drinks %K substance use %K alcohol abuse %K cannabis %D 2018 %7 04.12.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: In recent years, drug prevention networks and drug education programs have started using Web-based or mobile phone apps as novel prevention tools, testing their efficacy compared with face-to-face prevention. Objective: The aim of this study was to assess the potential of an interactive app called Once Upon a High (VoltEgySzer). Methods: The app approaches drug prevention from 6 different aspects, and it addresses youngsters with 6 different modules: (1) interactive comics/cartoons, telling stories of recovery; (2) quiz game; (3) roleplay game; (4) introduction of psychoactive drugs; (5) information on the somatic and psychological effects of psychoactive substances; (6) list of available treatment units, rehabs, and self-support groups in Hungary. Students of 2 vocational schools and 2 high schools filled out a questionnaire at a baseline (T0) and a 2-month follow-up (T1) data collection session. Students of 1 vocational school and 1 high school downloaded the Once Upon a High app (app group), whereas students from the other vocational school and high school did not (nonapp group). The time points of T0 and T1 questionnaires contained demographic variables, items with regard to substance use characteristics for both legal and illegal substances, including novel psychoactive substance, exercise habits, knowledge about psychoactive substances, attitudes toward substance users and validated instruments measuring the severity of tobacco (Fagerström Test for Nicotine Dependence), alcohol (Alcohol Use Disorder Identification Test), cannabis (Cannabis Abuse Screening Test), and synthetic cannabinoid consumption. Beliefs about substance use (Beliefs About Substance Abuse) and perceived self-efficacy (General Perceived Self-Efficacy) were also measured. At T1, members of the app group provided additional evaluation of the app. Results: There were 386 students who participated in the T0 session. After dropout, 246 students took part in T1 data collection procedure. Alcohol was the most frequently consumed psychoactive substance (334/364, 91.8% lifetime use), followed by tobacco (252/386, 65.3%, lifetime use) and cannabis (43/323, 13.3% lifetime use). Decreased self-efficacy (beta=−.29, P=.04) and increased daily physical exercise frequencies (beta=.04, P<.001) predicted higher frequencies of past month energy drink consumption, whereas elevated past month alcohol consumption was mainly predicted by a decrease in negative attitudes toward substance users (beta=−.13, P=.04) in the regression models. Once Upon a High was found to be effective only in reducing energy drink consumption (beta=−1.13, P=.04) after controlling for design effect, whereas perceived utility of the app showed correlation with a decreasing alcohol use (rS(44)=.32, P=.03). The roleplay module of the app was found to be the most preferred aspect of the app by the respondents. Conclusions: The Once Upon a High app can be a useful tool to assist preventive intervention programs by increasing knowledge and self-efficacy; however, its efficacy in reducing or preventing substance use needs to be improved and further studied. Additional potential impacts of the app need further testing. %M 30514697 %R 10.2196/games.9944 %U http://games.jmir.org/2018/4/e19/ %U https://doi.org/10.2196/games.9944 %U http://www.ncbi.nlm.nih.gov/pubmed/30514697 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e194 %T What Drives Young Vietnamese to Use Mobile Health Innovations? Implications for Health Communication and Behavioral Interventions %A Tran,Bach Xuan %A Zhang,Melvyn WB %A Le,Huong Thi %A Nguyen,Hinh Duc %A Nguyen,Long Hoang %A Nguyen,Quyen Le Thi %A Tran,Tho Dinh %A Latkin,Carl A %A Ho,Roger CM %+ Institute for Preventive Medicine and Public Health, Hanoi Medical University, 1 Ton That Tung, Hanoi,, Viet Nam, 84 982228662, bach.ipmph@gmail.com %K youth %K adolescent %K Vietnam %K mHealth %K mobile phone %K app %D 2018 %7 30.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone use in Vietnam has become increasingly popular in recent years, with youth (people aged 15-24 years) being one of the groups with the heaviest use. Health-related apps on mobile phones (mobile health [mHealth] apps) appear to be a feasible approach for disease and health management, especially for self-management. However, there has been a scarcity of research on mobile phone usage for health care among youth and adolescents. Objective: This study aims to identify the patterns of usage of mobile phone apps and the preferences for functionalities of mobile phone-based health-related apps among Vietnamese youth. Methods: An online cross-sectional study was conducted in Vietnam in August to October 2015. Web-based respondent-driven sampling technique was adopted to recruit participants. The online questionnaire was developed and distributed using Google Forms. Chi square and Mann-Whitney tests were used to investigate the difference in attitude and preference for mobile phone apps between the two genders. Results: Among 356 youths (age from 15 to 25 years) sampled, low prevalence was found of using mHealth apps such as beauty counseling (6.5%, 23/356), nutrition counseling (7.9%, 28/356), disease prevention (9.8%, 35/356), and disease treatment (7.6%, 27/356). The majority of users found the app(s) they used to be useful (72.7%, 48/356) and reported satisfaction with these apps (61.9%, 39/356). No significant differences were found between the genders in their perception of the usefulness of apps and their satisfaction with mobile health apps. Most of the participants (68.2%, 238/356) preferred apps which are conceptualized and designed to run on a mobile phone compared to Web-based apps, and 50% (176/356) preferred visual materials. Approximately 53.9% (188/356) reported that it was integral for the mobile phone apps to have a sharing/social network functionality. Participants with a higher perceived stress score and EuroQol-5 Dimensions (EQ-5D) index were significantly less likely to use mHealth apps. Conclusions: This study found a low proportion using mHealth-related mobile phone apps, but a high level of receptiveness and satisfaction among Vietnamese youth. Acceptance level and preferences toward mHealth apps as well as specifically preferred functionalities discovered in this study are essential not only in conceptualizing and developing appropriate mobile phone interventions targeting youth and adolescents, but also in the application of technically advanced solutions in disease prevention and health management. %M 30251704 %R 10.2196/mhealth.6490 %U http://mhealth.jmir.org/2018/11/e194/ %U https://doi.org/10.2196/mhealth.6490 %U http://www.ncbi.nlm.nih.gov/pubmed/30251704 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e11508 %T The Association Between the Use of Antenatal Care Smartphone Apps in Pregnant Women and Antenatal Depression: Cross-Sectional Study %A Mo,Yushi %A Gong,Wenjie %A Wang,Joyce %A Sheng,Xiaoqi %A Xu,Dong R %+ XiangYa School of Public Health, Central South University, 238 Shangmayuanling Lane, Xiangya Road, KaiFu District, Changsha,, China, 86 13607445252, gongwenjie@csu.edu.cn %K antenatal care %K antenatal depression %K app %K mobile phone %D 2018 %7 29.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Antenatal care smartphone apps are increasingly used by pregnant women, but studies on their use and impact are scarce. Objective: This study investigates the use of antenatal care apps in pregnant women and explores the association between the use of these apps and antenatal depression. Methods: This study used a convenient sample of pregnant women recruited from Hunan Provincial Maternal and Child Health Hospital in November 2015. The participants were surveyed for their demographic characteristics, use of antenatal care apps, and antenatal depression. Factors that influenced antenatal pregnancy were analyzed using logistic regression. Results: Of the 1304 pregnant women, 71.31% (930/1304) used antenatal care apps. Higher usage of apps was associated with urban residency, nonmigrant status, first pregnancy, planned pregnancy, having no previous children, and opportunity to communicate with peer pregnant women. The cutoff score of the Edinburgh Postnatal Depression Scale was 10, and 46.11% (601/1304) of the pregnant women had depression. Logistic regression showed that depression was associated with the availability of disease-screening functions in the apps (odds ratio (OR) 1.78, 95% CI 1.03-3.06) and spending 30 minutes or more using the app (OR 2.05, 95% CI 1.19-3.52). Using apps with social media features was a protective factor for antenatal depression (OR 0.33, 95% CI 0.12-0.89). Conclusions: The prevalence of the use of prenatal care apps in pregnant women is high. The functions and time spent on these apps are associated with the incidence of antenatal depression. %M 30497996 %R 10.2196/11508 %U http://mhealth.jmir.org/2018/11/e11508/ %U https://doi.org/10.2196/11508 %U http://www.ncbi.nlm.nih.gov/pubmed/30497996 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 4 %P e10252 %T Creating a Theoretically Grounded, Gamified Health App: Lessons From Developing the Cigbreak Smoking Cessation Mobile Phone Game %A Edwards,Elizabeth A %A Caton,Hope %A Lumsden,Jim %A Rivas,Carol %A Steed,Liz %A Pirunsarn,Yutthana %A Jumbe,Sandra %A Newby,Chris %A Shenvi,Aditi %A Mazumdar,Samaresh %A Smith,Jim Q %A Greenhill,Darrel %A Griffiths,Chris J %A Walton,Robert T %+ Centre for Primary Care and Public Health, Blizard Institute, Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, United Kingdom, 44 020 7882 2498, dr.elizabeth.ann.edwards@gmail.com %K smoking cessation %K health behaviors %K behavioral medicine %K games for health %K mHealth %K eHealth %D 2018 %7 29.11.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Gaming techniques are increasingly recognized as effective methods for changing behavior and increasing user engagement with mobile phone apps. The rapid uptake of mobile phone games provides an unprecedented opportunity to reach large numbers of people and to influence a wide range of health-related behaviors. However, digital interventions are still nascent in the field of health care, and optimum gamified methods of achieving health behavior change are still being investigated. There is currently a lack of worked methodologies that app developers and health care professionals can follow to facilitate theoretically informed design of gamified health apps. Objective: This study aimed to present a series of steps undertaken during the development of Cigbreak, a gamified smoking cessation health app. Methods: A systematic and iterative approach was adopted by (1) forming an expert multidisciplinary design team, (2) defining the problem and establishing user preferences, (3) incorporating the evidence base, (4) integrating gamification, (5) adding behavior change techniques, (6) forming a logic model, and (7) user testing. A total of 10 focus groups were conducted with 73 smokers. Results: Users found the app an engaging and motivating way to gain smoking cessation advice and a helpful distraction from smoking; 84% (62/73) of smokers said they would play again and recommend it to a friend. Conclusions: A dedicated gamified app to promote smoking cessation has the potential to modify smoking behavior and to deliver effective smoking cessation advice. Iterative, collaborative development using evidence-based behavior change techniques and gamification may help to make the game engaging and potentially effective. Gamified health apps developed in this way may have the potential to provide effective and low-cost health interventions in a wide range of clinical settings. %M 30497994 %R 10.2196/10252 %U http://games.jmir.org/2018/4/e10252/ %U https://doi.org/10.2196/10252 %U http://www.ncbi.nlm.nih.gov/pubmed/30497994 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e10123 %T To Prompt or Not to Prompt? A Microrandomized Trial of Time-Varying Push Notifications to Increase Proximal Engagement With a Mobile Health App %A Bidargaddi,Niranjan %A Almirall,Daniel %A Murphy,Susan %A Nahum-Shani,Inbal %A Kovalcik,Michael %A Pituch,Timothy %A Maaieh,Haitham %A Strecher,Victor %+ Personal Health Informatics, College of Medicine & Public Health, Flinders University, GPO Box 2100 Adelaide SA 5001, Adelaide,, Australia, 61 72218840, niranjan.bidargaddi@flinders.edu.au %K mobile applications %K smartphone %K self report %K health promotion %K lifestyle %K ubiquitous computing %K push notification %D 2018 %7 29.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps provide an opportunity for easy, just-in-time access to health promotion and self-management support. However, poor user engagement with these apps remains a significant unresolved challenge. Objective: This study aimed to assess the effect of sending versus not sending a push notification containing a contextually tailored health message on proximal engagement, measured here as self-monitoring via the app. Secondary aims were to examine whether this effect varies by the number of weeks enrolled in the program or by weekday versus weekend. An exploratory aim was to describe how the effect on proximal engagement differs between weekday versus weekend by the time of day. Methods: The study analyzes the causal effects of push notifications on proximal engagement in 1255 users of a commercial workplace well-being intervention app over 89 days. The app employs a microrandomized trial (MRT) design to send push notifications. At 1 of 6 times per day (8:30 am, 12:30 pm, 5:30 pm, 6:30 pm, 7:30 pm, and 8:30 pm; selected randomly), available users were randomized with equal probability to be sent or not sent a push notification containing a tailored health message. The primary outcome of interest was whether the user self-monitored behaviors and feelings at some time during the next 24 hours via the app. A generalization of log-linear regression analysis, adapted for use with data arising from an MRT, was used to examine the effect of sending a push notification versus not sending a push notification on the probability of engagement over the next 24 hours. Results: Users were estimated to be 3.9% more likely to engage with the app in the next 24 hours when a tailored health message was sent versus when it was not sent (risk ratio 1.039; 95% CI 1.01 to 1.08; P<.05). The effect of sending the message attenuated over the course of the study, but this effect was not statistically significant (P=.84). The effect of sending the message was greater on weekends than on weekdays, but the difference between these effects was not statistically significant (P=.18). When sent a tailored health message on weekends, the users were 8.7% more likely to engage with the app (95% CI 1.01 to 1.17), whereas on weekdays, the users were 2.5% more likely to engage with the app (95% CI 0.98 to 1.07). The effect of sending a tailored health message was greatest at 12:30 pm on weekends, when the users were 11.8% more likely to engage (90% CI 1.02 to 1.13). Conclusions: Sending a push notification containing a tailored health message was associated with greater engagement in an mHealth app. Results suggested that users are more likely to engage with the app within 24 hours when push notifications are sent at mid-day on weekends. %M 30497999 %R 10.2196/10123 %U http://mhealth.jmir.org/2018/11/e10123/ %U https://doi.org/10.2196/10123 %U http://www.ncbi.nlm.nih.gov/pubmed/30497999 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e199 %T A Mobile Technology Intervention With Ultraviolet Radiation Dosimeters and Smartphone Apps for Skin Cancer Prevention in Young Adults: Randomized Controlled Trial %A Hacker,Elke %A Horsham,Caitlin %A Vagenas,Dimitrios %A Jones,Lee %A Lowe,John %A Janda,Monika %+ Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, 4059, Australia, 61 07 3138 9674, elke.hacker@qut.edu.au %K health promotion %K melanoma %K preventive medicine %K public health %K skin neoplasms %K mobile phone %K sunburn %K sunlight %K technologies %K Web apps %D 2018 %7 28.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Skin cancer is the most prevalent and most preventable cancer in Australia. Despite Australia’s long-running public health campaigns, young Australian adults continue to report high levels of ultraviolet radiation (UVR) exposure and frequent sunburns. Young people are now increasingly turning away from traditional media, such as newspapers and TV, favoring Web-based streaming, which is challenging the health care sector to develop new ways to reach this group with targeted, personalized health promotion messages. Advances in technology have enabled delivery of time- and context-relevant health interventions. Objective: The primary aim of this randomized controlled trial was to test the effect of UVR feedback from a smartphone app or a UVR dosimeter feedback device on sun protection habits, sun exposure behaviors, sunburn, and physical activity levels in young adults. Methods: Young adults aged 18-35 years (n=124) were recruited from Queensland, Australia, between September 2015 and April 2016, via social or traditional media campaigns and outreach activities in the local community. Participants were randomized into 3 groups for a 4-week intervention: (1) no intervention control group; (2) UVR monitor group, who were asked to wear a UVR dosimeter feedback device set to their skin type; and (3) a SunSmart app group, who were asked to download and use the SunSmart phone app. Data were self-assessed through Web-based surveys at baseline and 1 week and 3 months postintervention. Results: Complete data were available for 86.2% (107/124) of participants (control group, n=36; UVR monitor group, n=36; and SunSmart app group, n=35). Intervention uptake in the UVR monitor group was high, with 94% (34/36) of participants using the device all or some of the time when outdoors. All SunSmart app group participants downloaded the app on their smartphone. There was no significant difference in the change in the sun protection habits (SPH) index (main outcome measure) across the 3 groups. However, compared with the control group, a significantly greater proportion of the participants in the UVR monitor group reduced their time unprotected and exposed to UVR on weekends during the intervention compared with the baseline (odds ratio [OR]: 2.706, 95% CI 1.047-6.992, P=.04). This significant effect was sustained with greater reductions observed up to 3 months postintervention (OR: 3.130, 95% CI 1.196-8.190, P=.02). There were no significant differences between the groups in weekday sun exposure, sunscreen use, sunburn, suntan, or physical activity. Conclusions: Using technology such as apps and personal UVR monitoring devices may improve some sun exposure behaviors among young adults, but as the SPH index did not increase in this study, further research is required to achieve consistent uptake of sun protection in young people. Trial Registration: The Australian and New Zealand Clinical Trials register ACTRN12615001296527; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368458 (Archived by WebCite at http://www.webcitation.org/731somROx) %M 30487115 %R 10.2196/mhealth.9854 %U https://mhealth.jmir.org/2018/11/e199/ %U https://doi.org/10.2196/mhealth.9854 %U http://www.ncbi.nlm.nih.gov/pubmed/30487115 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e10523 %T Feasibility of Using a Commercial Fitness Tracker as an Adjunct to Family-Based Weight Management Treatment: Pilot Randomized Trial %A Phan,Thao-Ly Tam %A Barnini,Nadia %A Xie,Sherlly %A Martinez,Angelica %A Falini,Lauren %A Abatemarco,Atiera %A Waldron,Maura %A Benton,Jane M %A Frankenberry,Steve %A Coleman,Cassandra %A Nguyen,Linhda %A Bo,Cindy %A Datto,George A %A Werk,Lloyd N %+ Center for Healthcare Delivery Science, Nemours Children's Health System, 1600 Rockland Road, Wilmington, DE, 19803, United States, 1 3023317342, tphan@nemours.org %K fitness trackers %K pediatric obesity %K health behavior %K accelerometry %D 2018 %7 27.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Fitness trackers can engage users through automated self-monitoring of physical activity. Studies evaluating the utility of fitness trackers are limited among adolescents, who are often difficult to engage in weight management treatment and are heavy technology users. Objective: We conducted a pilot randomized trial to describe the impact of providing adolescents and caregivers with fitness trackers as an adjunct to treatment in a tertiary care weight management clinic on adolescent fitness tracker satisfaction, fitness tracker utilization patterns, and physical activity levels. Methods: Adolescents were randomized to 1 of 2 groups (adolescent or dyad) at their initial weight management clinic visit. Adolescents received a fitness tracker and counseling around activity data in addition to standard treatment. A caregiver of adolescents in the dyad group also received a fitness tracker. Satisfaction with the fitness tracker, fitness tracker utilization patterns, and physical activity patterns were evaluated over 3 months. Results: A total of 88 adolescents were enrolled, with 69% (61/88) being female, 36% (32/88) black, 23% (20/88) Hispanic, and 63% (55/88) with severe obesity. Most adolescents reported that the fitness tracker was helping them meet their healthy lifestyle goals (69%) and be more motivated to achieve a healthy weight (66%). Despite this, 68% discontinued use of the fitness tracker by the end of the study. There were no significant differences between the adolescent and the dyad group in outcomes, but adolescents in the dyad group were 12.2 times more likely to discontinue using their fitness tracker if their caregiver also discontinued use of their fitness tracker (95% CI 2.4-61.6). Compared with adolescents who discontinued use of the fitness tracker during the study, adolescents who continued to use the fitness tracker recorded a higher number of daily steps in months 2 and 3 of the study (mean 5760 vs 4148 in month 2, P=.005, and mean 5942 vs 3487 in month 3, P=.002). Conclusions: Despite high levels of satisfaction with the fitness trackers, fitness tracker discontinuation rates were high, especially among adolescents whose caregivers also discontinued use of their fitness tracker. More studies are needed to determine how to sustain the use of fitness trackers among adolescents with obesity and engage caregivers in adolescent weight management interventions. %M 30482743 %R 10.2196/10523 %U http://mhealth.jmir.org/2018/11/e10523/ %U https://doi.org/10.2196/10523 %U http://www.ncbi.nlm.nih.gov/pubmed/30482743 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e25 %T Behavior Change for Youth Drivers: Design and Development of a Smartphone-Based App (BackPocketDriver) %A Warren,Ian %A Meads,Andrew %A Whittaker,Robyn %A Dobson,Rosie %A Ameratunga,Shanthi %+ Department of Computer Science, University of Auckland, Science Centre Building, 38 Princess Street, Auckland, 1010, New Zealand, 64 9 373 7599 ext 88784, ian-w@cs.auckland.ac.nz %K smartphone %K public health %K telemedicine %K telemetry %D 2018 %7 26.11.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The over-representation of youth in road crash injury and fatality rates is a major public health issue globally. In New Zealand, youth drivers are most vulnerable in the restricted license period when they can drive without the requirement for supervision by an experienced adult. Behavioral change interventions delivered using mobile phone technology to young drivers could serve as a useful mechanism to develop safe driving skills, but this potential remains to be fully explored. Objective: This study aimed to apply behavioral change principles to design and develop a smartphone-based intervention with the aim of helping youth drivers to develop and hone safe driving skills. Methods: An iterative process was used to support development of the smartphone intervention. We reviewed behavioral change literature, identifying fundamental principles and exploring use of behavior change techniques (BCTs) in other areas of public health. We engaged with key stakeholders, including young drivers, government agencies, and relevant organizations. We also took into account technology adoption considerations when designing the app. Results: We developed BackPocketDriver (BPD), an Android smartphone app that uses in-built sensors to monitor and infer driver behavior. The app implements features that were identified during the design process and are traceable to BCTs and theory. A key feature is messaging, which is used to instruct, motivate, educate, and relay feedback to participants. In addition, messaging addresses attitudes and beliefs. Other features include journey feedback summaries, goal setting, achievements, and leaderboards. Conclusions: BPD’s design rests on a sound foundation of theory and evidence. With explicit links between theory and features, the app aims to be an effective intervention to change and improve youth driver behavior. The next phase of this study is to run a small pilot study to assess BPD’s effectiveness. %M 30684435 %R 10.2196/formative.9660 %U http://formative.jmir.org/2018/2/e25/ %U https://doi.org/10.2196/formative.9660 %U http://www.ncbi.nlm.nih.gov/pubmed/30684435 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e12106 %T An Empathy-Driven, Conversational Artificial Intelligence Agent (Wysa) for Digital Mental Well-Being: Real-World Data Evaluation Mixed-Methods Study %A Inkster,Becky %A Sarda,Shubhankar %A Subramanian,Vinod %+ School of Clinical Medicine, Department of Psychiatry, University of Cambridge, Box 189, Cambridge Biomedical Campus, Cambridge, CB2 2QQ, United Kingdom, 44 773 847 8045, becky.inkster@gmail.com %K mental health %K conversational agents %K artificial intelligence %K chatbots %K coping skills %K resilience, psychological %K depression %K mHealth %K emotions %K empathy %D 2018 %7 23.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A World Health Organization 2017 report stated that major depression affects almost 5% of the human population. Major depression is associated with impaired psychosocial functioning and reduced quality of life. Challenges such as shortage of mental health personnel, long waiting times, perceived stigma, and lower government spends pose barriers to the alleviation of mental health problems. Face-to-face psychotherapy alone provides only point-in-time support and cannot scale quickly enough to address this growing global public health challenge. Artificial intelligence (AI)-enabled, empathetic, and evidence-driven conversational mobile app technologies could play an active role in filling this gap by increasing adoption and enabling reach. Although such a technology can help manage these barriers, they should never replace time with a health care professional for more severe mental health problems. However, app technologies could act as a supplementary or intermediate support system. Mobile mental well-being apps need to uphold privacy and foster both short- and long-term positive outcomes. Objective: This study aimed to present a preliminary real-world data evaluation of the effectiveness and engagement levels of an AI-enabled, empathetic, text-based conversational mobile mental well-being app, Wysa, on users with self-reported symptoms of depression. Methods: In the study, a group of anonymous global users were observed who voluntarily installed the Wysa app, engaged in text-based messaging, and self-reported symptoms of depression using the Patient Health Questionnaire-9. On the basis of the extent of app usage on and between 2 consecutive screening time points, 2 distinct groups of users (high users and low users) emerged. The study used mixed-methods approach to evaluate the impact and engagement levels among these users. The quantitative analysis measured the app impact by comparing the average improvement in symptoms of depression between high and low users. The qualitative analysis measured the app engagement and experience by analyzing in-app user feedback and evaluated the performance of a machine learning classifier to detect user objections during conversations. Results: The average mood improvement (ie, difference in pre- and post-self-reported depression scores) between the groups (ie, high vs low users; n=108 and n=21, respectively) revealed that the high users group had significantly higher average improvement (mean 5.84 [SD 6.66]) compared with the low users group (mean 3.52 [SD 6.15]); Mann-Whitney P=.03 and with a moderate effect size of 0.63. Moreover, 67.7% of user-provided feedback responses found the app experience helpful and encouraging. Conclusions: The real-world data evaluation findings on the effectiveness and engagement levels of Wysa app on users with self-reported symptoms of depression show promise. However, further work is required to validate these initial findings in much larger samples and across longer periods. %M 30470676 %R 10.2196/12106 %U http://mhealth.jmir.org/2018/11/e12106/ %U https://doi.org/10.2196/12106 %U http://www.ncbi.nlm.nih.gov/pubmed/30470676 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e11176 %T Providing a Smart Healthy Diet for the Low-Income Population: Qualitative Study on the Usage and Perception of a Designed Cooking App %A Régnier,Faustine %A Dugré,Manon %A Darcel,Nicolas %A Adamiec,Camille %+ Institut National de la Recherche Agronomique, Alimentation et Sciences Sociales Unité de Recherche 1303, University of Paris Saclay, 65 boulevard de Brandebourg, Ivry-sur-Seine cedex, 94205, France, 33 49596914, faustine.regnier@inra.fr %K health %K cooking %K mobile phone %K low-income population %K social networks %K utilization %D 2018 %7 23.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health behaviors among low-income groups have become a major issue in the context of increasing social inequalities. The low-income population is less likely to be receptive to nutritional recommendations, but providing cooking advice could be more effective. In this domain, taking advantage of digital devices can be a bonus with its own challenges. Objective: The aim of this study was to develop and deploy NutCracker, a social network–based cooking app for low-income population, including cooking tips and nutritional advices, aiming at creating small online communities. We further determined the usefulness, perceptions, barriers, and motivators to use NutCracker. Methods: The smartphone app, designed jointly with beneficiaries of the social emergency services, was implemented in a disadvantaged neighborhood of Magny, (Paris region, France). Once the app became available, 28 subjects, living in the neighborhood, tested the app for a 6-month period. Logs to the app and usages were collected by the software. In total, 12 in-depth, semistructured interviews were conducted among the users and the social workers to analyze their uses and perceptions of the app relative to their interest in cooking, cooking skills, socioeconomic constraints, and social integration. These interviews were compared with 21 supplementary interviews conducted among low-income individuals in the general population. Results: NutCracker was developed as a social network–based app, and it includes cooking tips, nutritional advice, and Web-based quizzes. We identified barriers to uses (especially technical barriers, lack of knowledge in the field of new technologies and written comprehension, and search for real contacts) and motivators (in particular, good social integration, previous use of social networks, and help of children as intermediaries). Cooking skills were both a barrier and a lever. Conclusions: Targeting the low-income groups through a cooking app to promote healthier behaviors offers many advantages but has not been fully explored. However, the barriers in low-income milieu remain high, especially among the less socially integrated strata. Lessons from this intervention allow us to identify barriers and possible levers to improve nutrition promotion and awareness in deprived areas, especially in the time of social crisis. %M 30470677 %R 10.2196/11176 %U http://mhealth.jmir.org/2018/11/e11176/ %U https://doi.org/10.2196/11176 %U http://www.ncbi.nlm.nih.gov/pubmed/30470677 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e11335 %T Impact of a Wearable Device-Based Walking Programs in Rural Older Adults on Physical Activity and Health Outcomes: Cohort Study %A Jang,Il-Young %A Kim,Hae Reong %A Lee,Eunju %A Jung,Hee-Won %A Park,Hyelim %A Cheon,Seon-Hee %A Lee,Young Soo %A Park,Yu Rang %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 2493, yurangpark@yuhs.ac %K adherence %K frailty %K older adult %K rural area %K wearable device %D 2018 %7 21.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Community-dwelling older adults living in rural areas are in a less favorable environment for health care compared with urban older adults. We believe that intermittent coaching through wearable devices can help optimize health care for older adults in medically limited environments. Objective: We aimed to evaluate whether a wearable device and mobile-based intermittent coaching or self-management could increase physical activity and health outcomes of small groups of older adults in rural areas. Methods: To address the above evaluation goal, we carried out the “Smart Walk” program, a health care model wherein a wearable device is used to promote self-exercise particularly among community-dwelling older adults managed by a community health center. We randomly selected older adults who had enrolled in a population-based, prospective cohort study of aging, the Aging Study of Pyeongchang Rural Area. The “Smart Walk” program was a 13-month program conducted from March 2017 to March 2018 and included 6 months of coaching, 1 month of rest, and 6 months of self-management. We evaluated differences in physical activity and health outcomes according to frailty status and conducted pre- and postanalyses of the Smart Walk program. We also performed intergroup analysis according to adherence of wearable devices. Results: We recruited 22 participants (11 robust and 11 prefrail older adults). The two groups were similar in most of the variables, except for age, frailty index, and Short Physical Performance Battery score associated with frailty criteria. After a 6-month coaching program, the prefrail group showed significant improvement in usual gait speed (mean 0.73 [SD 0.11] vs mean 0.96 [SD 0.27], P=.02), International Physical Activity Questionnaire scores in kcal (mean 2790.36 [SD 2224.62] vs mean 7589.72 [SD 4452.52], P=.01), and European Quality of Life-5 Dimensions score (mean 0.84 [SD 0.07] vs mean 0.90 [SD 0.07], P=.02), although no significant improvement was found in the robust group. The average total step count was significantly different and was approximately four times higher in the coaching period than in the self-management period (5,584,295.83 vs 1,289,084.66, P<.001). We found that participants in the “long-self” group who used the wearable device for the longest time showed increased body weight and body mass index by mean 0.65 (SD 1.317) and mean 0.097 (SD 0.513), respectively, compared with the other groups. Conclusions: Our “Smart Walk” program improved physical fitness, anthropometric measurements, and geriatric assessment categories in a small group of older adults in rural areas with limited resources for monitoring. Further validation through various rural public health centers and in a large number of rural older adults is required. %M 30463838 %R 10.2196/11335 %U http://mhealth.jmir.org/2018/11/e11335/ %U https://doi.org/10.2196/11335 %U http://www.ncbi.nlm.nih.gov/pubmed/30463838 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 2 %P e11569 %T A Fall Risk mHealth App for Older Adults: Development and Usability Study %A Hsieh,Katherine L %A Fanning,Jason T %A Rogers,Wendy A %A Wood,Tyler A %A Sosnoff,Jacob J %+ Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, 906 South Goodwin Avenue, Urbana, IL, 61801, United States, 1 217 244 7006, jsosnoff@illinois.edu %K usability %K fall risk %K mHealth app %K mobile phone %D 2018 %7 20.11.2018 %9 Original Paper %J JMIR Aging %G English %X Background: Falls are the leading cause of injury-related death in older adults. Due to various constraints, objective fall risk screening is seldom performed in clinical settings. Smartphones offer a high potential to provide fall risk screening for older adults in home settings. However, there is limited understanding of whether smartphone technology for falls screening is usable by older adults who present age-related changes in perceptual, cognitive, and motor capabilities. Objective: The aims of this study were to develop a fall risk mobile health (mHealth) app and to determine the usability of the fall risk app in healthy, older adults. Methods: A fall risk app was developed that consists of a health history questionnaire and 5 progressively challenging mobility tasks to measure individual fall risk. An iterative design-evaluation process of semistructured interviews was performed to determine the usability of the app on a smartphone and tablet. Participants also completed a Systematic Usability Scale (SUS). In the first round of interviews, 6 older adults participated, and in the second round, 5 older adults participated. Interviews were videotaped and transcribed, and the data were coded to create themes. Average SUS scores were calculated for the smartphone and tablet. Results: There were 2 themes identified from the first round of interviews, related to perceived ease of use and perceived usefulness. While instructions for the balance tasks were difficult to understand, participants found it beneficial to learn about their risk for falls, found the app easy to follow, and reported confidence in using the app on their own. Modifications were made to the app, and following the second round of interviews, participants reported high ease of use and usefulness in learning about their risk of falling. Few differences were reported between using a smartphone or tablet. Average SUS scores ranged from 79 to 84. Conclusions: Our fall risk app was found to be highly usable by older adults as reported from interviews and high scores on the SUS. When designing a mHealth app for older adults, developers should include clear and simple instructions and preventative strategies to improve health. Furthermore, if the design accommodates for age-related sensory changes, smartphones can be as effective as tablets. A mobile app to assess fall risk has the potential to be used in home settings by older adults. %M 31518234 %R 10.2196/11569 %U http://aging.jmir.org/2018/2/e11569/ %U https://doi.org/10.2196/11569 %U http://www.ncbi.nlm.nih.gov/pubmed/31518234 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e11170 %T Mobile Ecological Momentary Diet Assessment Methods for Behavioral Research: Systematic Review %A Schembre,Susan M %A Liao,Yue %A O'Connor,Sydney G %A Hingle,Melanie D %A Shen,Shu-En %A Hamoy,Katarina G %A Huh,Jimi %A Dunton,Genevieve F %A Weiss,Rick %A Thomson,Cynthia A %A Boushey,Carol J %+ Department of Family and Community Medicine, College of Medicine-Tucson, University of Arizona, Abrams Building Room 3345E, 3950 South Country Club Road, Tucson, AZ, 85714, United States, 1 520 626 7735, sschembre@email.arizona.edu %K diet surveys %K diet records %K mobile phone %K mobile apps %K ecological momentary assessment %D 2018 %7 20.11.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: New methods for assessing diet in research are being developed to address the limitations of traditional dietary assessment methods. Mobile device–assisted ecological momentary diet assessment (mEMDA) is a new dietary assessment method that has not yet been optimized and has the potential to minimize recall biases and participant burden while maximizing ecological validity. There have been limited efforts to characterize the use of mEMDA in behavioral research settings. Objective: The aims of this study were to summarize mEMDA protocols used in research to date, to characterize key aspects of these assessment approaches, and to discuss the advantages and disadvantages of mEMDA compared with the traditional dietary assessment methods as well as implications for future mEMDA research. Methods: Studies that used mobile devices and described mEMDA protocols to assess dietary intake were included. Data were extracted according to Preferred Reporting of Systematic Reviews and Meta-Analyses and Cochrane guidelines and then synthesized narratively. Results: The review included 20 studies with unique mEMDA protocols. Of these, 50% (10/20) used participant-initiated reports of intake at eating events (event-contingent mEMDA), and 50% (10/20) used researcher-initiated prompts requesting that participants report recent dietary intake (signal-contingent mEMDA). A majority of the study protocols (60%, 12/20) enabled participants to use mobile phones to report dietary data. Event-contingent mEMDA protocols most commonly assessed diet in real time, used dietary records for data collection (60%, 6/10), and provided estimates of energy and nutrient intake (60%, 6/10). All signal-contingent mEMDA protocols used a near real-time recall approach with unannounced (ie, random) abbreviated diet surveys. Most signal-contingent protocols (70%, 7/10) assessed the frequency with which (targeted) foods or food groups were consumed. Relatively few (30%, 6/20) studies compared mEMDA with the traditional dietary assessment methods. Conclusions: This review demonstrates that mEMDA has the potential to reduce participant burden and recall bias, thus advancing the field beyond current dietary assessment methods while maximizing ecological validity. %M 30459148 %R 10.2196/11170 %U http://mhealth.jmir.org/2018/11/e11170/ %U https://doi.org/10.2196/11170 %U http://www.ncbi.nlm.nih.gov/pubmed/30459148 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e195 %T mHealth Supportive Care Intervention for Parents of Children With Acute Lymphoblastic Leukemia: Quasi-Experimental Pre- and Postdesign Study %A Wang,Jingting %A Howell,Doris %A Shen,Nanping %A Geng,Zhaohui %A Wu,Fulei %A Shen,Min %A Zhang,Xiaoyan %A Xie,Anwei %A Wang,Lin %A Yuan,Changrong %+ School of Nursing, Fudan University, Room 403, Building 8, 305 Fenglin Road, Shanghai, 200032, China, 86 02164431803, yuancr@fudan.edu.cn %K acute lymphoblastic leukemia %K effectiveness %K mHealth %K mobile phone %K parent %K supportive care %D 2018 %7 19.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. Caring for children with ALL is challenging for parents. A mobile health (mHealth) supportive care intervention was developed to meet parents’ needs. Objective: This study aims to evaluate the potential effectiveness of this mHealth supportive care intervention on emotional distress, social support, care burden, uncertainty in illness, quality of life, and knowledge. Methods: We conducted a quasi-experimental pre- and postdesign study from June 2015 to January 2016. In total, 101 parents were enrolled in the study, with 50 in the observation group and 51 in the intervention group. Parents in the observation group received the standard health education and were observed for 3 months. Parents in the intervention group received the mHealth supportive care intervention, in addition to the standard health education. The intervention consisted of 2 parts—an Android smartphone app “Care Assistant (CA)” and a WeChat Official Account. The CA with 8 modules (Personal Information, Treatment Tracking, Family Care, Financial and Social Assistance, Knowledge Center, Self- Assessment Questionnaires, Interactive Platform, and Reminders) was the main intervention tool, whereas the WeChat Official Account was supplementary to update information and realize interaction between parents and health care providers. Data of parents’ social support, anxiety, depression, care burden, uncertainty in illness, quality of life, their existing knowledge of ALL and care, and knowledge need were collected before and after the 3-month study period in both groups. For the intervention group, parents’ experience of receiving the intervention was also collected through individual interviews. Results: Overall, 43 parents in the observation group and 49 in the intervention group completed the study. Results found that the intervention reduced parents’ anxiety (Dint(Post-Pre)=−7.0 [SD 13.1], Dobs(Post-Pre)=−0.4 [SD 15.8], t90=−2.200, P=.03) and uncertainty in illness (Dint(Post-Pre)=−25.0 [SD 8.2], Dobs(Post-Pre)=−19.8 [SD 10.1], t90=−2.761, P=.01), improved parents’ social function (Dint(Post-Pre)=9.0 [SD 32.8], Dobs(Post-Pre)=−7.5 [SD 30.3], t90=2.494, P=.01), increased parents’ knowledge of ALL and care (Dint(Post-Pre)=28.4 [SD 12.4], Dobs(Post-Pre)=17.2 [SD 11.9], t90=4.407, P<.001), and decreased their need for knowledge (Dint(Post-Pre)=−9.9 [SD 11.6], Dobs(Post-Pre)=−1.9 [SD 6.4], t90=−4.112, P<.001). Qualitative results showed that parents were satisfied with the intervention and their role in the caregiving process. Conclusions: The mHealth intervention in supporting parents of children with ALL is effective. This study is informative for other future studies on providing mHealth supportive care for parents of children with cancer. %M 30455166 %R 10.2196/mhealth.9981 %U http://mhealth.jmir.org/2018/11/e195/ %U https://doi.org/10.2196/mhealth.9981 %U http://www.ncbi.nlm.nih.gov/pubmed/30455166 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e12261 %T Mobile Phone Apps for Low-Income Participants in a Public Health Nutrition Program for Women, Infants, and Children (WIC): Review and Analysis of Features %A Weber,Summer J %A Dawson,Daniela %A Greene,Haley %A Hull,Pamela C %+ Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 800, Nashville, TN,, United States, 1 615 936 3241, pam.hull@vanderbilt.edu %K WIC %K low-income %K mobile phone %K mHealth %D 2018 %7 19.11.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Since 1972, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been proven to improve the health of participating low-income women and children in the United States. Despite positive nutritional outcomes associated with WIC, the program needs updated tools to help future generations. Improving technology in federal nutrition programs is crucial for keeping nutrition resources accessible and easy for low-income families to use. Objective: This review aimed to analyze the main features of publicly available mobile phone apps for WIC participants. Methods: Keyword searches were performed in the app stores for the 2 most commonly used mobile phone operating systems between December 2017 and June 2018. Apps were included if they were relevant to WIC and excluded if the target users were not WIC participants. App features were reviewed and classified according to type and function. User reviews from the app stores were examined, including ratings and categorization of user review comments. Results: A total of 17 apps met selection criteria. Most apps (n=12) contained features that required verified access available only to WIC participants. Apps features were classified into categories: (1) shopping management (eg, finding and redeeming food benefits), (2) clinic appointment management (eg, appointment reminders and scheduling), (3) informational resources (eg, recipes, general food list, tips about how to use WIC, links to other resources), (4) WIC-required nutrition education modules, and (5) other user input. Positive user reviews indicated that apps with shopping management features were very useful. Conclusions: WIC apps are becoming increasingly prevalent, especially in states that have implemented electronic benefits transfer for WIC. This review offers new contributions to the literature and practice, as practitioners, software developers, and health researchers seek to improve and expand technology in the program. %M 30455172 %R 10.2196/12261 %U http://mhealth.jmir.org/2018/11/e12261/ %U https://doi.org/10.2196/12261 %U http://www.ncbi.nlm.nih.gov/pubmed/30455172 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 11 %P e11822 %T A Smartphone Attention Bias Intervention for Individuals With Addictive Disorders: Protocol for a Feasibility Study %A Zhang,Melvyn %A Ying,Jiangbo %A Amron,Syidda B %A Mahreen,Zaakira %A Song,Guo %A Fung,Daniel SS %A Smith,Helen %+ National Addictions Management Service (NAMS), Institute of Mental Health, 10 Buangkok Green Medical Park, Singapore, 539747, Singapore, 65 63892504, melvynzhangweibin@gmail.com %K addiction %K approach bias %K attention bias %K bias modification %K feasibility %K pilot %K psychiatry %K mobile phone %K mHealth %K eHealth %D 2018 %7 19.11.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Substance use disorders are highly prevalent globally. Relapse rates following conventional psychological interventions for substance use disorders remain high. Recent reviews have highlighted attentional and approach or avoidance biases to be responsible for multiple relapses. Other studies have reported the efficacy of interventions to modify biases. With advances in technologies, there are now mobile versions of conventional bias modification interventions. However, to date, no study has evaluated bias modification in a substance-using, non-Western sample. Existing evaluations of mobile technologies for the delivery of bias interventions are also limited to alcohol or tobacco use disorders. Objective: This study aims to examine the feasibility of mobile-based attention bias modification intervention among treatment-seeking individuals with substance use and alcohol use disorders. Methods: This is a feasibility study, in which inpatients who are in their rehabilitation phase of clinical management will be recruited. On each day that they are in the study, they will be required to complete a craving visual analogue scale and undertake both a visual probe-based assessment and and modification task in a smartphone app . Reaction time data will be collated for the computation of baseline attentional biases and to determine whether there is a reduction of attentional bias across the interventions. Feasibility will be determined by the number of participants recruited and participants’ adherence to the planned interventions up until the completion of their rehabilitation program and by the ability of the app in detecting baseline biases and changes in biases. Acceptability of the intervention will be assessed by a short questionnaire of users’ perceptions of the intervention. Statistical analyses will be performed using SPSS version 22.0, while qualitative analysis of the perspectives will be performed using NVivo version 10.0. Results: This study was approved by the National Healthcare Group Domain Specific Research Board, with approval number (2018/00316). Results will be disseminated by means of conferences and publications.Currently, we are in the process of recruitment for this study. Conclusions: To the best of our knowledge, this is the first study to evaluate the feasibility and acceptability of a mobile attention bias modification intervention for individuals with substance use disorders. The data pertaining to the feasibility and acceptability are undoubtedly crucial because they imply the potential use of mobile technologies in retraining attentional biases among inpatients admitted for medical-assisted detoxification and rehabilitation. Participants’ feedback pertaining to the ease of use, interactivity, and motivation to continue using the app is crucial because it will determine whether a codesign approach might be warranted to design an app that is acceptable for participants and that participants themselves would be motivated to use. International Registered Report Identifier (IRRID): PRR1-10.2196/11822 %M 30455170 %R 10.2196/11822 %U http://www.researchprotocols.org/2018/11/e11822/ %U https://doi.org/10.2196/11822 %U http://www.ncbi.nlm.nih.gov/pubmed/30455170 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e189 %T The Rise of Pregnancy Apps and the Implications for Culturally and Linguistically Diverse Women: Narrative Review %A Hughson,Jo-anne Patricia %A Daly,J Oliver %A Woodward-Kron,Robyn %A Hajek,John %A Story,David %+ Research Unit for Multilingualism and Cross-Cultural Communication, University of Melbourne, Babel Building, Parkville, 3010, Australia, 61 425710396, hughson@unimelb.edu.au %K culture %K emigrants and immigrants %K health communication %K information-seeking behavior %K literacy %K maternal health %K mHealth %K mobile phone %K pregnancy %K self-care %K vulnerable populations %D 2018 %7 16.11.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Pregnancy apps are a booming global industry, with most pregnant women in high-income countries now using them. From the perspective of health care and health information provision, this is both encouraging and unsettling; the demand indicates a clear direction for the development of future resources, but it also underscores the importance of processes ensuring access, reliability, and quality control. Objective: This review provides an overview of current literature on pregnancy apps and aims at describing (1) the ways in which apps are used by women, in general, and by those of a culturally and linguistically diverse (CALD) background; (2) the utility and quality of information provided; and (3) areas where more research, development, and oversight are needed. Methods: We chose a narrative review methodology for the study and performed a structured literature search including studies published between 2012 and 2017. Searches were performed using MEDLINE, EMBASE, and CINAHL databases. Studies were identified for inclusion using two separate search criteria and strategies: (1) studies on pregnancy apps and pregnant women’s use of these apps and (2) studies on CALD pregnant women and their use of technology for accessing information on and services for pregnancy. Overall, we selected 38 studies. Results: We found that pregnancy apps were principally used to access pregnancy health and fetal development information. Data storage capability, Web-based features or personalized tools, and social media features were also popular app features sought by women. Lower rates of the pregnancy app uptake were indicated among lower-income and non-English-speaking women. Preliminary evidence indicates that a combination of technological, health literacy, and language issues may result in lower uptake of pregnancy apps by these groups; however, further investigation is required. A marked limitation of the health app industry is lack of regulation in a commercially dominated field, making it difficult for users to assess the reliability of the information being presented. Health professionals and users alike indicate that given the choice, they would prefer using pregnancy apps that are relevant to their local health care context and come from a trusted source. Evidence indicates a need for greater health professional and institutional engagement in the app development, as well as awareness of and guidance for women’s use of these resources. Conclusions: This is the first review of pregnancy app use, types of information provided, and features preferred by pregnant women in general and by those of a CALD background in particular. It indicates the demand for access to accurate information that is relevant to users, their community, and their associated health services. Given the popularity of pregnancy apps, such apps have enormous potential to be used for the provision of accurate, evidence-based health information. %M 30446483 %R 10.2196/mhealth.9119 %U https://mhealth.jmir.org/2018/11/e189/ %U https://doi.org/10.2196/mhealth.9119 %U http://www.ncbi.nlm.nih.gov/pubmed/30446483 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e183 %T An mHealth Intervention to Improve Young Gay and Bisexual Men’s Sexual, Behavioral, and Mental Health in a Structurally Stigmatizing National Context %A Leluțiu-Weinberger,Corina %A Manu,Monica %A Ionescu,Florentina %A Dogaru,Bogdan %A Kovacs,Tudor %A Dorobănțescu,Cristian %A Predescu,Mioara %A Surace,Anthony %A Pachankis,John E %+ François-Xavier Bagnoud Center, School of Nursing, Rutgers Biomedical and Health Sciences, 65 Bergen Street, 8th Floor, Newark, NJ, 07101, United States, 1 9739722093, cl1148@sn.rutgers.edu %K alcohol use %K young gay and bisexual men %K HIV risk %K mental health %K mHealth intervention %D 2018 %7 14.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Young gay and bisexual men (YGBM) in some Eastern European countries, such as Romania, face high stigma and discrimination, including in health care. Increasing HIV transmission is a concern given inadequate prevention, travel to high-prevalence countries, and popularity of sexual networking technologies. Objective: This study aimed to adapt and pilot test, in Romania, a preliminarily efficacious mobile health (mHealth) HIV-prevention intervention, created in the United States, to reduce HIV risk among YGBM. Methods: After an intervention formative phase, we enrolled 43 YGBM, mean age 23.2 (SD 3.6) years, who reported condomless sex with a male partner and at least 5 days of heavy drinking in the past 3 months. These YGBM completed up to eight 60-minute text-based counseling sessions grounded in motivational interviewing and cognitive behavioral skills training with trained counselors on a private study mobile platform. We conducted one-group pre-post intervention assessments of sexual (eg, HIV-risk behavior), behavioral (eg, alcohol use), and mental health (eg, depression) outcomes to evaluate the intervention impact. Results: From baseline to follow-up, participants reported significant (1) increases in HIV-related knowledge (mean 4.6 vs mean 4.8; P=.001) and recent HIV testing (mean 2.8 vs mean 3.3; P=.05); (2) reductions in the number of days of heavy alcohol consumption (mean 12.8 vs mean 6.9; P=.005), and (3) increases in the self-efficacy of condom use (mean 3.3 vs mean 4.0; P=.01). Participants reported significant reductions in anxiety (mean 1.4 vs mean 1.0; P=.02) and depression (mean 1.5 vs mean 1.0; P=.003). The intervention yielded high acceptability and feasibility: 86% (38/44) of participants who began the intervention completed the minimum dose of 5 sessions, with an average of 7.1 sessions completed; evaluation interviews indicated that participation was rewarding and an “eye-opener” about HIV risk reduction, healthy identity development, and partner communication. Conclusions: This first mHealth HIV risk-reduction pilot intervention for YGBM in Eastern Europe indicates preliminary efficacy and strong acceptability and feasibility. This mobile prevention tool lends itself to broad dissemination across various similar settings pending future efficacy testing in a large trial, especially in contexts where stigma keeps YGBM out of reach of affirmative health interventions. %M 30429117 %R 10.2196/mhealth.9283 %U https://mhealth.jmir.org/2018/11/e183/ %U https://doi.org/10.2196/mhealth.9283 %U http://www.ncbi.nlm.nih.gov/pubmed/30429117 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e10114 %T Using Mobile Phones to Examine and Enhance Perceptions of Control in Mildly Depressed and Nondepressed Volunteers: Intervention Study %A Msetfi,Rachel %A O'Sullivan,Donal %A Walsh,Amy %A Nelson,John %A Van de Ven,Pepijn %+ Department of Psychology, Health Research Institute, University of Limerick, Castletroy, Limerick,, Ireland, 353 61202709, rachel.msetfi@ul.ie %K perception of control %K illusory control %K well-being %K depression %K health %K intervention %K causal learning %D 2018 %7 09.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Perceived control is strongly linked to healthy outcomes, mental healthiness, and psychological well-being. This is particularly important when people have little control over things that are happening to them. Perceived control studies have been performed extensively in laboratory settings and show that perceived control can be increased by experimental manipulations. Although these studies suggest that it may be possible to improve people’s mental health by increasing their perceived control, there is very little evidence to date to suggest that perceived control can also be influenced in the real world. Objective: The first aim of this study was to test for evidence of a link between noncontrol situations and psychological well-being in the real world using a mobile phone app. The second and arguably more important aim of the study was to test whether a simple instructional intervention on the nature of alternative causes would enhance people’s perceptions of their own control in these noncontrol situations. Methods: We implemented a behavioral action-outcome contingency judgment task using a mobile phone app. An opportunity sample of 106 healthy volunteers scoring low (n=56, no depression) or high (n=50, mild depression) on a depression scale participated. They were given no control over the occurrence of a low- or high-frequency stimulus that was embedded in everyday phone interactions during a typical day lasting 8 hours. The intervention involved instructions that either described a consistent alternative cause against which to assess their own control, or dynamic alternative causes of the outcome. Throughout the day, participants rated their own control over the stimulus using a quantitative judgment scale. Results: Participants with no evidence of depression overestimated their control, whereas those who were most depressed were more accurate in their control ratings. Instructions given to all participants about the nature of alternative causes significantly affected the pattern of perceived control ratings. Instructions describing discrete alternative causes enhanced perceived control for all participants, whereas dynamic alternative causes were linked to less perceived control. Conclusions: Perceptions of external causes are important to perceived control and can be used to enhance people’s perceptions. Theoretically motivated interventions can be used to enhance perceived control using mobile phone apps. This is the first study to do so in a real-world setting. %M 30413398 %R 10.2196/10114 %U http://mhealth.jmir.org/2018/11/e10114/ %U https://doi.org/10.2196/10114 %U http://www.ncbi.nlm.nih.gov/pubmed/30413398 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e12136 %T A Tool to Measure Young Adults’ Food Intake: Design and Development of an Australian Database of Foods for the Eat and Track Smartphone App %A Wellard-Cole,Lyndal %A Potter,Melisa %A Jung,Jisu (Joseph) %A Chen,Juliana %A Kay,Judy %A Allman-Farinelli,Margaret %+ School of Life and Environmental Science, The University of Sydney, Level 4 East, Charles Perkins Centre D17, University of Sydney, 2006, Australia, 61 286274854, lwel3754@uni.sydney.edu.au %K diet surveys %K smartphone %K mobile phone %K young adult %D 2018 %7 07.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dietary assessment is reliant on the collection of accurate food and beverage consumption data. Technology has been harnessed to standardize recording and provide automatic nutritional analysis to reduce cost and researcher burden. Objective: To better assess the diet of young adults, especially relating to the contribution of foods prepared outside the home, a database was needed to support a mobile phone data collection app. The app also required usability testing to assure ease of entry of foods and beverages. This paper describes the development of the Eat and Track app (EaT app) and the database underpinning it. Methods: The Australian Food and Nutrient Database 2011-13, consisting of 5740 food items was modified. Four steps were undertaken: (1) foods not consumed by young adults were removed, (2) nutritionally similar foods were merged, (3) foods available from the 30 largest ready-to-eat food chains in Australia were added, and (4) long generic food names were shortened and simplified. This database was used to underpin the EaT app. Qualitative, iterative usability testing of the EaT app was conducted in three phases using the “Think Aloud” method. Responses were sorted and coded using content analysis. The System Usability Scale (SUS) was administered to measure the EaT app’s perceived usability. Results: In total, 1694 (29.51%) foods were removed from the Australian Food and Nutrient Database, including 608 (35.89%) ingredients, 81 (4.78%) foods already captured in the fast food chain information, 52 (3.07%) indigenous foods, 25 (1.48%) nutrients/dietary supplements, and 16 (0.94%) child-specific foods. The remaining 912 (53.84%) foods removed were not consumed by young adults in previous surveys or were “not defined” in the Australian Food and Nutrient Database. Another 220 (3.83%) nutritionally similar foods were combined. The final database consisted of 6274 foods. Fifteen participants completed usability testing. Issues identified by participants fell under six themes: keywords for searching, history list of entered foods, amounts and units, the keypad, food names, and search function. Suggestions for improvement were collected, incorporated, and tested in each iteration of the app. The SUS of the final version of the EaT app was rated 69. Conclusions: A food and beverage database has been developed to underpin the EaT app, enabling data collection on the eating-out habits of 18- to 30-year-old Australians. The development process has resulted in a database with commonly used food names, extensive coverage of foods from ready-to-eat chains, and commonly eaten portion sizes. Feedback from app usability testing led to enhanced keyword searching and the addition of functions to enhance usability such as adding brief instructional screens. There is potential for the features of the EaT app to facilitate the collection of more accurate dietary intake data. The database and the app will be valuable dietary assessment resources for researchers. %M 30404768 %R 10.2196/12136 %U http://mhealth.jmir.org/2018/11/e12136/ %U https://doi.org/10.2196/12136 %U http://www.ncbi.nlm.nih.gov/pubmed/30404768 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e11062 %T Time Series Visualizations of Mobile Phone-Based Daily Diary Reports of Stress, Physical Activity, and Diet Quality in Mostly Ethnic Minority Mothers: Feasibility Study %A Comulada,W Scott %A Swendeman,Dallas %A Rezai,Roxana %A Ramanathan,Nithya %+ Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 10920 Wilshire Boulevard, Suite 350, Los Angeles, CA, 90024, United States, 1 3107948278, wcomulada@mednet.ucla.edu %K changepoint %K diet quality %K mobile phone %K moving average %K physical activity %K stress %K time series %D 2018 %7 05.11.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Health behavior patterns reported through daily diary data are important to understand and intervene upon at the individual level in N-of-1 trials and related study designs. There is often interest in relationships between multiple outcomes, such as stress and health behavior. However, analyses often utilize regressions that evaluate aggregate effects across individuals, and standard analyses target single outcomes. Objective: This paper aims to illustrate how individuals’ daily reports of stress and health behavior (time series) can be explored using visualization tools. Methods: Secondary analysis was conducted on 6 months of daily diary reports of stress and health behavior (physical activity and diet quality) from mostly ethnic minority mothers who pilot-tested a self-monitoring mobile health app. Time series with minimal missing data from 14 of the 44 mothers were analyzed. Correlations between stress and health behavior within each time series were reported as a preliminary step. Stress and health behavior time series patterns were visualized by plotting moving averages and time points where mean shifts in the data occurred (changepoints). Results: Median correlation was small and negative for associations of stress with physical activity (r=−.14) and diet quality (r=−.08). Moving averages and changepoints for stress and health behavior were aligned for some participants but not for others. A third subset of participants exhibited little variation in stress and health behavior reports. Conclusions: Median correlations in this study corroborate prior findings. In addition, time series visualizations highlighted variations in stress and health behavior across individuals and time points, which are difficult to capture through correlations and regression-based summary measures. %M 30684407 %R 10.2196/11062 %U https://formative.jmir.org/2018/2/e11062/ %U https://doi.org/10.2196/11062 %U http://www.ncbi.nlm.nih.gov/pubmed/30684407 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e10226 %T Implementation Tells Us More Beyond Pooled Estimates: Secondary Analysis of a Multicountry mHealth Trial to Reduce Blood Pressure %A Carrillo-Larco,Rodrigo M %A Jiwani,Safia S %A Diez-Canseco,Francisco %A Kanter,Rebecca %A Beratarrechea,Andrea %A Irazola,Vilma %A Ramirez-Zea,Manuel %A Rubinstein,Adolfo %A Martinez,Homero %A Miranda,J Jaime %A , %+ INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Calzada Roosevelt 6-25 Zona 11, Guatemala, Apartado Postal 1188, Guatemala, 502 2472 3762, mramirez@incap.int %K Argentina %K behavior %K clinical trial %K Guatemala %K health risk behaviors, lifestyle risk reduction %K mHealth %K Peru %D 2018 %7 01.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The uptake of an intervention aimed at improving health-related lifestyles may be influenced by the participant’s stage of readiness to change behaviors. Objective: We conducted secondary analysis of the Grupo de Investigación en Salud Móvil en América Latina (GISMAL) trial according to levels of uptake of intervention (dose-response) to explore outcomes by country, in order to verify the consistency of the trial’s pooled results, and by each participant’s stage of readiness to change a given lifestyle at baseline. The rationale for this secondary analysis is motivated by the original design of the GISMAL study that was independently powered for the primary outcome—blood pressure—for each country. Methods: We conducted a secondary analysis of a mobile health (mHealth) multicountry trial conducted in Argentina, Guatemala, and Peru. The intervention consisted of monthly motivational phone calls by a trained nutritionist and weekly tailored text messages (short message service), over a 12-month period, aimed to enact change on 4 health-related behaviors: salt added to foods when cooking, consumption of high-fat and high-sugar foods, consumption of fruits or vegetables, and practice of physical activity. Results were stratified by country and by participants’ stage of readiness to change (precontemplation or contemplation; preparation or action; or maintenance) at baseline. Exposure (intervention uptake) was the level of intervention (<50%, 50%-74%, and ≥75%) received by the participant in terms of phone calls. Linear regressions were performed to model the outcomes of interest, presented as standardized mean values of the following: blood pressure, body weight, body mass index, waist circumference, physical activity, and the 4 health-related behaviors. Results: For each outcome of interest, considering the intervention uptake, the magnitude and direction of the intervention effect differed by country and by participants’ stage of readiness to change at baseline. Among those in the high intervention uptake category, reductions in systolic blood pressure were only achieved in Peru, whereas fruit and vegetable consumption also showed reductions among those who were at the maintenance stage at baseline in Argentina and Guatemala. Conclusions: Designing interventions oriented toward improving health-related lifestyle behaviors may benefit from recognizing baseline readiness to change and issues in implementation uptake. Trial Registration: ClinicalTrials.gov NCT01295216; http://clinicaltrials.gov/ct2/show/NCT01295216 (Archived by WebCite at http://www.webcitation.org/72tMF0B7B). %M 30389646 %R 10.2196/10226 %U http://mhealth.jmir.org/2018/11/e10226/ %U https://doi.org/10.2196/10226 %U http://www.ncbi.nlm.nih.gov/pubmed/30389646 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e10190 %T Insights From a Text Messaging–Based Sexual and Reproductive Health Information Program in Tanzania (m4RH): Retrospective Analysis %A Olsen,Patrick S %A Plourde,Kate F %A Lasway,Christine %A van Praag,Eric %+ Health Services Research, Global Health, Population, and Nutrition, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, United States, 1 919 544 7040 ext 11713, polsen@fhi360.org %K data analysis %K mobile phone %K mHealth %K short message service %K user engagement %D 2018 %7 01.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many mobile health (mHealth) interventions have the potential to generate and store vast amounts of system-generated participant interaction data that could provide insight into user engagement, programmatic strengths, and areas that need improvement to maximize efficacy. However, despite the popularity of mHealth interventions, there is little documentation on how to use these data to monitor and improve programming or to evaluate impact. Objective: This study aimed to better understand how users of the Mobile for Reproductive Health (m4RH) mHealth intervention engaged with the program in Tanzania from September 2013 to August 2016. Methods: We conducted secondary data analysis of longitudinal data captured by system logs of participant interactions with the m4RH program from 127 districts in Tanzania from September 2013 to August 2016. Data cleaning and analysis was conducted using Stata 13. The data were examined for completeness and “correctness.” No missing data was imputed; respondents with missing or incorrect values were dropped from the analyses. Results: The total population for analysis included 3,673,702 queries among 409,768 unique visitors. New users represented roughly 11.15% (409,768/3,673,702) of all queries. Among all system queries for new users, 46.10% (188,904/409,768) users accessed the m4RH main menu. Among these users, 89.58% (169,218/188,904) accessed specific m4RH content on family planning, contraceptive methods, adolescent-specific and youth-specific information, and clinic locations after first accessing the m4RH main menu. The majority of these users (216,422/409,768, 52.82%) requested information on contraceptive methods; fewer users (23,236/409,768, 5.67%) requested information on clinic location. The conversion rate was highest during the first and second years of the program when nearly all users (11,246/11,470, 98.05%, and 33,551/34,830, 96.33%, respectively) who accessed m4RH continued on to query more specific content from the system. The rate of users that accessed m4RH and became active users declined slightly from 98.05% (11,246/11,470) in 2013 to 87.54% (56,696/64,765) in 2016. Overall, slightly more than one-third of all new users accessing m4RH sent queries at least once per month for 2 or more months, and 67.86% (278,088/409,768) of new and returning users requested information multiple times per month. Promotional periods were present for 15 of 36 months during the study period. Conclusions: The analysis of the rich data captured provides a useful framework with which to measure the degree and nature of user engagement utilizing routine system-generated data. It also contributes to knowledge of how users engage with text messaging (short message service)-based health promotion interventions and demonstrates how data generated on user interactions could inform improvements to the design and delivery of a service, thereby enhancing its effectiveness. %M 30389651 %R 10.2196/10190 %U https://mhealth.jmir.org/2018/11/e10190/ %U https://doi.org/10.2196/10190 %U http://www.ncbi.nlm.nih.gov/pubmed/30389651 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e10531 %T The Web-Based Physician is Ready to See You: A Nationwide Cross-Sectional Survey of Physicians Using a Mobile Medical App to Evaluate Patients With Sexually Transmitted Diseases in China %A Cao,Bolin %A Zhao,Peipei %A Bien-Gund,Cedric %A Tang,Weiming %A Ong,Jason J %A Fitzpatrick,Thomas %A Tucker,Joseph D %A Luo,Zhenzhou %+ Shenzhen Nanshan Center for Chronic Disease Control, No. 7, Huaming Avenue, Nanshan District, Shenzhen,, China, 86 15986751621, paulluo9909@163.com %K STD %K physician %K mobile app %K China %K mobile phone %K mHealth %D 2018 %7 30.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Web-based medical service provision is increasingly becoming common. However, it remains unclear how physicians are responding to this trend and how Web-based and offline medical services are linked. Objective: The objectives of this study were to examine physicians’ use of mobile medical apps for sexually transmitted disease (STD) consultations and identify the physicians who frequently use mobile medical apps to evaluate patients with STD. Methods: In August 2017, we conducted a nationwide cross-sectional survey among physicians registered on a mobile medical app in China. We collected data on physicians’ demographic information, institutional information, and Web-based medical practices. We compared physicians who used mobile medical apps to evaluate patients with STD frequently (at least once a week) with infrequent users. Bivariate and multivariate logistic regressions were used to identify physicians who frequently evaluated patients with STD on mobile medical apps. Results: A total of 501 physicians participated in the survey. Among them, three-quarters were men and the average age was 37.6 (SD 8.2) years. Nearly all physicians (492/501, 98.2%) recommended their last Web-based patient with STD to subsequently see a physician in the clinic. More than half (275/501, 54.9%) of physicians recommended STD testing to Web-based patients, and 43.9% (220/501) provided treatment advice to patients with STD. Of all physicians, 21.6% (108/501) used mobile medical apps to evaluate patients with STD through Web more than once a week. Overall, 85.2% (427/501) physicians conducted follow-up consultation for patients with STD using mobile medical apps. Physicians working at institutions with STD prevention materials were associated with frequent evaluation of patients with STD on mobile medical apps (adjusted odds ratio=2.10, 95% CI 1.18-3.74). Conclusions: Physicians use mobile medical apps to provide a range of services, including Web-based pre- and posttreatment consultations and linkage to offline clinical services. The high rates of referral to clinics suggest that mobile medical apps are used to promote clinic-seeking, and not replace it. Physicians’ use of mobile medical apps could benefit sexual minorities and others who avoid formal clinic-based services. %M 30377148 %R 10.2196/10531 %U http://mhealth.jmir.org/2018/10/e10531/ %U https://doi.org/10.2196/10531 %U http://www.ncbi.nlm.nih.gov/pubmed/30377148 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e11557 %T A Mobile Sleep-Management Learning System for Improving Students’ Sleeping Habits by Integrating a Self-Regulated Learning Strategy: Randomized Controlled Trial %A Chu,Hui-Chun %A Liu,Yi-Meng %A Kuo,Fan-Ray %+ Department of Computer Science and Information Management, School of Business, Soochow University, 56, Section 1, Kui-Yang Street, Taipei,, Taiwan, 886 915398218, carolhcchu@gmail.com %K cognitive behavioral therapy %K insomnia %K mobile phone %K self-regulated learning %D 2018 %7 29.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Insomnia can significantly affect students’ learning performance. Researchers have indicated the importance and challenge of coping with insomnia using nondrug treatments, such as cognitive behavioral therapy (CBT) for insomnia. However, it is easy for the traditional CBT for insomnia to be interrupted owing to the overly lengthy period of sleep therapy. Self-regulated learning (SRL) strategies are known to be an effective approach for helping students improve their time management, as well as their ability to set learning goals and adopt learning strategies. Objective: The objective of this study was to propose a mobile sleep-management learning system integrated with SRL strategies and CBT. Methods: A total of 18 undergraduate students from a university in northern Taiwan participated in the 2-week experiment of using this sleep-management system. Results: The experimental results showed that the proposed approach was useful and easy for students to use. In addition, the number of students with insomnia significantly decreased; that is, the proposed approach could help students improve their sleep quality and cultivate better sleeping habits, which is important for them to enhance their learning efficiency. Conclusions: With the assistance of this proposed approach, students can plan their daily life by setting goals, applying strategies, monitoring their life habits process, and modifying strategies to cultivate good learning and healthy lifestyle habits. Trial Registration: Government Research Bulletin MOST104-3011-E038-001; https://www.grb.gov.tw/search/planDetail? id=11568383&docId=467988 (Archived by WebCite at http://www.webcitation.org/73MnPHNri) %M 30373729 %R 10.2196/11557 %U http://mhealth.jmir.org/2018/10/e11557/ %U https://doi.org/10.2196/11557 %U http://www.ncbi.nlm.nih.gov/pubmed/30373729 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e11039 %T A Short Message Service Intervention for Improving Infant Feeding Practices in Shanghai, China: Planning, Implementation, and Process Evaluation %A Jiang,Hong %A Li,Mu %A Wen,Li Ming %A Baur,Louise A %A He,Gengsheng %A Ma,Xiaoying %A Qian,Xu %+ Global Health Institute, School of Public Health, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai, 200032, China, 86 21 64179976, h_jiang@fudan.edu.cn %K mHealth %K short message service %K breastfeeding %K infant feeding practices %K health services %K planning and development %K implementation %K process evaluation %D 2018 %7 29.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although mobile health (mHealth) has been widely applied in health care services, few studies have reported the detailed process of the development and implementation of text messaging (short message service, SMS) interventions. Objective: Our study aims to demonstrate the process and lessons learned from a community-based text messaging (SMS) intervention for improving infant feeding in Shanghai, China. Methods: The intervention included planning and development, implementation, and process evaluation. A 3-phase process was adopted during planning and development: (1) a formative study with expectant and new mothers to explore the barriers of appropriate infant feeding practices; (2) a baseline questionnaire survey to understand potential intervention approaches; and (3) development of the text message bank. The text messaging intervention was delivered via a computer-based platform. A message bank was established before the start of the intervention containing information on the benefits of breastfeeding, preparing for breastfeeding, early initiation of breastfeeding, timely introduction of complementary foods, and establishing appropriate feeding practices, etc. An expert advisory committee oversaw the content and quality of the message bank. Process evaluation was conducted through field records and qualitative interviews with participating mothers. Results: We found that the text messaging intervention was feasible and well received by mothers because of its easy and flexible access. The weekly based message frequency was thought to be appropriate, and the contents were anticipatory and trustworthy. Some mothers had high expectations for timely response to inquiries. Occasionally, the text messages were not delivered due to unstable telecommunication transmission. Mothers suggested that the messages could be more personalized. Conclusions: This study demonstrates the feasibility and value of text messaging intervention in filling gaps in delivering health care services and promoting healthy infant feeding practices in settings where personal contact is limited. %M 30373728 %R 10.2196/11039 %U http://mhealth.jmir.org/2018/10/e11039/ %U https://doi.org/10.2196/11039 %U http://www.ncbi.nlm.nih.gov/pubmed/30373728 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e10147 %T Feasibility and Acceptability of Mobile Phone–Based Auto-Personalized Physical Activity Recommendations for Chronic Pain Self-Management: Pilot Study on Adults %A Rabbi,Mashfiqui %A Aung,Min SH %A Gay,Geri %A Reid,M Cary %A Choudhury,Tanzeem %+ Department of Statistics, Harvard University, 1 Oxford Street, Cambridge, MA,, United States, 1 603 667 1797, mrabbi@fas.harvard.edu %K chronic pain %K machine learning %K personalization %K chronic back pain %K reinforcement learning %D 2018 %7 26.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic pain is a globally prevalent condition. It is closely linked with psychological well-being, and it is often concomitant with anxiety, negative affect, and in some cases even depressive disorders. In the case of musculoskeletal chronic pain, frequent physical activity is beneficial. However, reluctance to engage in physical activity is common due to negative psychological associations (eg, fear) between movement and pain. It is known that encouragement, self-efficacy, and positive beliefs are effective to bolster physical activity. However, given that the majority of time is spent away from personnel who can give such encouragement, there is a great need for an automated ubiquitous solution. Objective: MyBehaviorCBP is a mobile phone app that uses machine learning on sensor-based and self-reported physical activity data to find routine behaviors and automatically generate physical activity recommendations that are similar to existing behaviors. Since the recommendations are based on routine behavior, they are likely to be perceived as familiar and therefore likely to be actualized even in the presence of negative beliefs. In this paper, we report the preliminary efficacy of MyBehaviorCBP based on a pilot trial on individuals with chronic back pain. Methods: A 5-week pilot study was conducted on people with chronic back pain (N=10). After a week long baseline period with no recommendations, participants received generic recommendations from an expert for 2 weeks, which served as the control condition. Then, in the next 2 weeks, MyBehaviorCBP recommendations were issued. An exit survey was conducted to compare acceptance toward the different forms of recommendations and map out future improvement opportunities. Results: In all, 90% (9/10) of participants felt positive about trying the MyBehaviorCBP recommendations, and no participant found the recommendations unhelpful. Several significant differences were observed in other outcome measures. Participants found MyBehaviorCBP recommendations easier to adopt compared to the control (βint=0.42, P<.001) on a 5-point Likert scale. The MyBehaviorCBP recommendations were actualized more (βint=0.46, P<.001) with an increase in approximately 5 minutes of further walking per day (βint=4.9 minutes, P=.02) compared to the control. For future improvement opportunities, participants wanted push notifications and adaptation for weather, pain level, or weekend/weekday. Conclusions: In the pilot study, MyBehaviorCBP’s automated approach was found to have positive effects. Specifically, the recommendations were actualized more, and perceived to be easier to follow. To the best of our knowledge, this is the first time an automated approach has achieved preliminary success to promote physical activity in a chronic pain context. Further studies are needed to examine MyBehaviorCBP’s efficacy on a larger cohort and over a longer period of time. %M 30368433 %R 10.2196/10147 %U http://www.jmir.org/2018/10/e10147/ %U https://doi.org/10.2196/10147 %U http://www.ncbi.nlm.nih.gov/pubmed/30368433 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e11281 %T Features, Behavioral Change Techniques, and Quality of the Most Popular Mobile Apps to Measure Physical Activity: Systematic Search in App Stores %A Simões,Patrícia %A Silva,Anabela G %A Amaral,João %A Queirós,Alexandra %A Rocha,Nelson P %A Rodrigues,Mário %+ School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Aveiro, 3810-193, Portugal, 351 234401558 ext 27120, asilva@ua.pt %K behavioral change techniques %K mobile phone app %K physical activity %K quality %K technical features %K mobile phone %D 2018 %7 26.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: It is estimated that 23% of adults and 55% of older adults do not meet the recommended levels of physical activity. Thus, improving the levels of physical activity is of paramount importance, but it requires the use of low-cost resources that facilitate universal access without depleting the health system. The high number of apps available constitutes an opportunity, but it also makes it quite difficult for the layperson to select the most appropriate app. Furthermore, the information available in the app stores is often insufficient, lacks quality, and is not evidence based, and the systematic reviews fail to assess app quality using standardized and validated instruments. Objective: The objective of this study was to systematically assess the features, content, and quality of the most popular apps that can be used to measure and, potentially, promote physical activity. Methods: Systematic searches were conducted on Apple App Store, Google Play, and Windows Phone Store between December 2017 and January 2018. Apps were included if their primary objective was to assess the aspects of physical activity, if they had a user rating of at least 4, if their number of ratings was ≥100, and if they were free. Apps meeting these criteria were independently assessed by two reviewers regarding their general and technical information, aspects of physical activity, presence of behavioral change techniques, and quality. Data were analyzed using means and SDs or frequencies and percentages. Results: Of 51 apps included, none specified the age of the target group and only one mentioned the involvement of health professionals. Most apps offered the possibility to work in background (n=50) and allowed data sharing (n=40). Regarding physical activity, most apps measured steps and distance (n=11) or steps, distance, and time (n=17). Only 18 apps, all of which measured number of steps, followed the guidelines on recommendations for physical activity. On average, 5.5 (SD 1.8) behavioral change techniques were identified per app; the most frequently used techniques were “provide feedback on performance” (n=50) and “prompt self-monitoring of behavior” (n=50). The overall quality score was 3.88 (SD 0.34). Conclusions: Although the overall quality of the apps was moderate, the quality of their content, particularly the use of international guidelines on physical activity, should be improved. Additionally, a more in-depth assessment of apps should be performed before releasing them for public use, particularly regarding their reliability and validity. %M 30368438 %R 10.2196/11281 %U http://mhealth.jmir.org/2018/10/e11281/ %U https://doi.org/10.2196/11281 %U http://www.ncbi.nlm.nih.gov/pubmed/30368438 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e11181 %T Acceptability of Continuous Glucose Monitoring in Free-Living Healthy Individuals: Implications for the Use of Wearable Biosensors in Diet and Physical Activity Research %A Liao,Yue %A Schembre,Susan %+ Department of Family and Community Medicine, College of Medicine-Tucson, University of Arizona, Abrams Building, Room 3345E, 3950 S Country Club Road, Tucson, AZ, 85714, United States, 1 520 626 7735, sschembre@email.arizona.edu %K wearable sensors %K remote monitoring %K physiological monitoring %K accelerometry %K user experience %D 2018 %7 24.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable sensors have been increasingly used in behavioral research for real-time assessment and intervention purposes. The rapid advancement of biomedical technology typically used in clinical settings has made wearable sensors more accessible to a wider population. Yet the acceptability of this technology for nonclinical purposes has not been examined. Objective: The aim was to assess the acceptability of wearing a continuous glucose monitor (CGM) device among a sample of nondiabetic individuals, and to compare the acceptability of a CGM between a mobile diet tracking app (MyFitnessPal) and an accelerometer. Methods: A total of 30 nondiabetic adults went through a 7-day observational study. They wore a CGM sensor, tracked their diet and physical activity using the CGM receiver and MyFitnessPal, and wore an accelerometer on their waist. After the monitoring period, they completed a 10-item survey regarding acceptability of each of the study tools. Two-tailed paired-sample t tests were conducted to examine whether the summary acceptability scores were comparable between the CGM sensor/receiver and MyFitnessPal/accelerometer. Results: More than 90% of the study participants agreed that the CGM sensor and receiver were easy to use (28/30 and 27/30, respectively), useful (28/30 and 29/30, respectively), and provided relevant information that was of interest to them (27/30 and 28/30, respectively). The summary acceptability scores (out of a 5-point Likert scale) were mean 4.06 (SD 0.55) for the CGM sensor, mean 4.05 (SD 0.58) for the CGM receiver, mean 4.10 (SD 0.68) for MyFitnessPal, and mean 3.73 (SD 0.76) for the accelerometer. Conclusions: The high acceptability of using a CGM from this study suggests a great potential for using CGMs in nondiabetic adults in research settings. Although potential selection bias might contribute to the high acceptability in this study, the continued advancements in wearable sensor technology will make the barriers to tracking and collecting personal physiological data more and more minimal. %M 30355561 %R 10.2196/11181 %U http://mhealth.jmir.org/2018/10/e11181/ %U https://doi.org/10.2196/11181 %U http://www.ncbi.nlm.nih.gov/pubmed/30355561 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e10893 %T Effect of a Mobile Phone Intervention on Quitting Smoking in a Young Adult Population of Smokers: Randomized Controlled Trial %A Baskerville,Neill Bruce %A Struik,Laura Louise %A Guindon,Godefroy Emmanuel %A Norman,Cameron D %A Whittaker,Robyn %A Burns,Catherine %A Hammond,David %A Dash,Darly %A Brown,K Stephen %+ Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L3G1, Canada, 1 518 888 4567 ext 35236, neill.baskerville@gmail.com %K health behavior %K smoking cessation %K young adult %K mobile phone %K mHealth %K randomized controlled trial %D 2018 %7 23.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital mobile technology presents a promising medium for reaching young adults with smoking cessation interventions because they are the heaviest users of this technology. Objective: The aim of this study was to determine the efficacy of an evidence-informed smartphone app for smoking cessation, Crush the Crave (CTC), on reducing smoking prevalence among young adult smokers in comparison with an evidence-informed self-help guide, On the Road to Quitting (OnRQ). Methods: A parallel, double-blind, randomized controlled trial with 2 arms was conducted in Canada to evaluate CTC. In total, 1599 young adult smokers (aged 19 to 29 years) intending to quit smoking in the next 30 days were recruited online and randomized to receive CTC or the control condition OnRQ for a period of 6 months. The primary outcome measure was self-reported continuous abstinence at the 6-month follow-up. Results: Overall follow-up rates were 57.41% (918/1599) and 60.48% (967/1599) at 3 and 6 months, respectively. Moreover, 45.34% (725/1599) of participants completed baseline, 3-, and 6-month follow-up. Intention-to-treat analysis (last observation carried forward) showed that continuous abstinence (N=1599) at 6 months was not significantly different at 7.8% (64/820) for CTC versus 9.2% (72/779) for OnRQ (odds ratio; OR 0.83, 95% CI 0.59-1.18). Similarly, 30-day point prevalence abstinence at 6 months was not significantly different at 14.4% (118/820) and 16.9% (132/779) for CTC and OnRQ, respectively (OR 0.82, 95% CI 0.63-1.08). However, these rates of abstinence were favorable compared with unassisted 30-day quit rates of 11.5% among young adults. Secondary measures of quit attempts and the number of cigarettes smoked per day at 6-month follow-up did not reveal any significant differences between groups. For those who completed the 6-month follow-up, 85.1% (359/422) of young adult smokers downloaded CTC as compared with 81.8% (346/423) of OnRQ, χ21(N=845)=1.6, P=.23. Furthermore, OnRQ participants reported significantly higher levels of overall satisfaction (mean 3.3 [SD 1.1] vs mean 2.6 [SD 1.3]; t644=6.87, P<.001), perceived helpfulness (mean 5.8 [SD 2.4] vs mean 4.3 [SD 2.6], t657=8.0, P<.001), and frequency of use (mean 3.6 [SD 1.2] vs mean 3.2 [SD 1.1], t683=5.7, P<.001) compared with CTC participants. Conclusions: CTC was feasible for delivering cessation support but was not superior to a self-help guide in helping motivated young adults to quit smoking. CTC will benefit from further formative research to address satisfaction and usage. As smartphone apps may not serve as useful alternatives to printed self-help guides, there is a need to conduct further research to understand how digital mobile technology smoking cessation interventions for smoking cessation can be improved. Trial Registration: ClinicalTrials.gov NCT01983150; http://clinicaltrials.gov/ct2/show/NCT01983150 (Archived by WebCite at http://www.webcitation.org/6VGyc0W0i) %M 30355563 %R 10.2196/10893 %U http://mhealth.jmir.org/2018/10/e10893/ %U https://doi.org/10.2196/10893 %U http://www.ncbi.nlm.nih.gov/pubmed/30355563 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e10471 %T The Association Between Engagement and Weight Loss Through Personal Coaching and Cell Phone Interventions in Young Adults: Randomized Controlled Trial %A Lin,Pao-Hwa %A Grambow,Steven %A Intille,Stephen %A Gallis,John A %A Lazenka,Tony %A Bosworth,Hayden %A Voils,Corrine L %A Bennett,Gary G %A Batch,Bryan %A Allen,Jenifer %A Corsino,Leonor %A Tyson,Crystal %A Svetkey,Laura %+ Nephrology Division, Department of Medicine, Duke University Medical Center, Box 3487 DUMC, Durham, NC, 27710, United States, 1 919 660 6685, pao.hwa.lin@dm.duke.edu %K mHealth %K mobile health %K weight reduction %K intervention %K smartphone %K mobile phone %D 2018 %7 18.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Understanding how engagement in mobile health (mHealth) weight loss interventions relates to weight change may help develop effective intervention strategies. Objective: This study aims to examine the (1) patterns of participant engagement overall and with key intervention components within each intervention arm in the Cell Phone Intervention For You (CITY) trial; (2) associations of engagement with weight change; and (3) participant characteristics related to engagement. Methods: The CITY trial tested two 24-month weight loss interventions. One was delivered with a smartphone app (cell phone) containing 24 components (weight tracking, etc) and included prompting by the app in predetermined frequency and forms. The other was delivered by a coach via monthly calls (personal coaching) supplemented with limited app components (18 overall) and without any prompting by the app. Engagement was assessed by calculating the percentage of days each app component was used and the frequency of use. Engagement was also examined across 4 weight change categories: gained (≥2%), stable (±2%), mild loss (≥2% to <5%), and greater loss (≥5%). Results: Data from 122 cell phone and 120 personal coaching participants were analyzed. Use of the app was the highest during month 1 for both arms; thereafter, use dropped substantially and continuously until the study end. During the first 6 months, the mean percentage of days that any app component was used was higher for the cell phone arm (74.2%, SD 20.1) than for the personal coaching arm (48.9%, SD 22.4). The cell phone arm used the apps an average of 5.3 times/day (SD 3.1), whereas the personal coaching participants used them 1.7 times/day (SD 1.2). Similarly, the former self-weighed more than the latter (57.1% days, SD 23.7 vs 32.9% days, SD 23.3). Furthermore, the percentage of days any app component was used, number of app uses per day, and percentage of days self-weighed all showed significant differences across the 4 weight categories for both arms. Pearson correlation showed a negative association between weight change and the percentage of days any app component was used (cell phone: r=−.213; personal coaching: r=−.319), number of apps use per day (cell phone: r=−.264; personal coaching: r=−.308), and percentage of days self-weighed (cell phone: r=−.297; personal coaching: r=−.354). None of the characteristics examined, including age, gender, race, education, income, energy expenditure, diet quality, and hypertension status, appeared to be related to engagement. Conclusions: Engagement in CITY intervention was associated with weight loss during the first 6 months. Nevertheless, engagement dropped substantially early on for most intervention components. Prompting may be helpful initially. More flexible and less intrusive prompting strategies may be needed during different stages of an intervention to increase or sustain engagement. Future studies should explore the motivations for engagement and nonengagement to determine meaningful levels of engagement required for effective intervention. Trial Registration: ClinicalTrials.gov NCT01092364; https://clinicaltrials.gov/ct2/show/NCT01092364 (Archived by WebCite at http://www.webcitation.org/72V8A4e5X) %M 30341051 %R 10.2196/10471 %U http://mhealth.jmir.org/2018/10/e10471/ %U https://doi.org/10.2196/10471 %U http://www.ncbi.nlm.nih.gov/pubmed/30341051 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e9 %T Mobile Phone Access and Willingness Among Mothers to Receive a Text-Based mHealth Intervention to Improve Prenatal Care in Northwest Ethiopia: Cross-Sectional Study %A Endehabtu,Berhanu %A Weldeab,Adane %A Were,Martin %A Lester,Richard %A Worku,Abebaw %A Tilahun,Binyam %+ eHealthLab Ethiopia, Department of Health Informatics, University of Gondar, PO Box 196, Gondar,, Ethiopia, 251 913875066, binigcms@gmail.com %K mHealth %K mobile phone %K pregnant women %K SMS %K willingness %K Ethiopia %K antenatal care %K maternal health %D 2018 %7 17.10.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Maternal mortality remains high in many low- and middle-income countries where limited access to health services is linked to low antenatal care utilization. Effective communication and engagement with care providers are vital for the delivery and receipt of sufficient health care services. There is strong evidence that simple text-based interventions can improve the prenatal care utilization, but most mobile health (mHealth) interventions are not implemented on a larger scale owing to the lack of context and preliminary evidence on how to make the transition. Objective: The objective of this study was to determine access to mobile phones by pregnant women attending antenatal care as well as willingness to receive a text message (short message service, SMS)–based mHealth intervention for antenatal care services and identify its associated factors among pregnant women attending an antenatal care clinic in Gondar Town Administration, Northwest Ethiopia, Africa. Methods: A cross-sectional quantitative study was conducted among 422 pregnant women attending antenatal care from March 27 to April 28, 2017. Data were collected using structured questionnaires. Data entry and analysis were performed using Epi-Info version 7 and SPSS version 20, respectively. In addition, descriptive statistics and bivariable and multivariable logistic regression analyses were performed. Furthermore, odds ratio with 95% CI was used to identify factors associated with the willingness to receive a text message–based mHealth intervention. Results: A total of 416 respondents (response rate 98.6%, 416/422) were included in the analysis. About 76.7% (319/416) of respondents owned a mobile phone and 71.2% (296/416) were willing to receive an SMS text message. Among the mobile phone owners, only 37.6% (120/319) were having smartphones. Of all women with mobile phones, 89.7% (286/319) described that they are the primary holders of these phones and among them, 85.0% (271/319) reported having had the same phone number for more than a year. Among the phone owners, 90.0% (287/319) described that they could read and 86.8% (277/416) could send SMS text messages using their mobile phones in their day-to-day activities. Among pregnant women who were willing to receive SMS text messages, about 96.3% (285/296) were willing to receive information regarding activities or things to avoid during pregnancy. Factors associated with willingness were youth age group (adjusted odds ratio [AOR] 2.869, 95% CI 1.451-5.651), having attained secondary and higher educational level (AOR 4.995, 95% CI 1.489-14.773), and the frequency of mobile phone use (AOR 0.319, 95% CI 0.141-0.718). Conclusions: A high proportion of pregnant women in an antenatal care clinic in this remote setting have a mobile phone and are willing to receive an SMS text message–based mHealth intervention. Age, educational status, and the frequency of mobile phone use are significantly associated with the willingness to receive SMS text message–based mHealth interventions. %M 31518334 %R 10.2196/pediatrics.9618 %U http://pediatrics.jmir.org/2018/2/e9/ %U https://doi.org/10.2196/pediatrics.9618 %U http://www.ncbi.nlm.nih.gov/pubmed/31518334 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e58 %T Interaction and Engagement with an Anxiety Management App: Analysis Using Large-Scale Behavioral Data %A Matthews,Paul %A Topham,Phil %A Caleb-Solly,Praminda %+ Data Science Group, Computer Science Research Centre, Department of Computer Science and Creative Technologies, University of the West of England, Coldharbour Lane, Bristol, BS161QY, United Kingdom, 44 11732 ext 83353, paul2.matthews@uwe.ac.uk %K anxiety %K mobile phone %K eMental health %K mHealth %D 2018 %7 1.10.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: SAM (Self-help for Anxiety Management) is a mobile phone app that provides self-help for anxiety management. Launched in 2013, the app has achieved over one million downloads on the iOS and Android platform app stores. Key features of the app are anxiety monitoring, self-help techniques, and social support via a mobile forum (“the Social Cloud”). This paper presents unique insights into eMental health app usage patterns and explores user behaviors and usage of self-help techniques. Objective: The objective of our study was to investigate behavioral engagement and to establish discernible usage patterns of the app linked to the features of anxiety monitoring, ratings of self-help techniques, and social participation. Methods: We use data mining techniques on aggregate data obtained from 105,380 registered users of the app’s cloud services. Results: Engagement generally conformed to common mobile participation patterns with an inverted pyramid or “funnel” of engagement of increasing intensity. We further identified 4 distinct groups of behavioral engagement differentiated by levels of activity in anxiety monitoring and social feature usage. Anxiety levels among all monitoring users were markedly reduced in the first few days of usage with some bounce back effect thereafter. A small group of users demonstrated long-term anxiety reduction (using a robust measure), typically monitored for 12-110 days, with 10-30 discrete updates and showed low levels of social participation. Conclusions: The data supported our expectation of different usage patterns, given flexible user journeys, and varying commitment in an unstructured mobile phone usage setting. We nevertheless show an aggregate trend of reduction in self-reported anxiety across all minimally-engaged users, while noting that due to the anonymized dataset, we did not have information on users also enrolled in therapy or other intervention while using the app. We find several commonalities between these app-based behavioral patterns and traditional therapy engagement. %M 30287415 %R 10.2196/mental.9235 %U https://mental.jmir.org/2018/4/e58/ %U https://doi.org/10.2196/mental.9235 %U http://www.ncbi.nlm.nih.gov/pubmed/30287415 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e10679 %T Pokémon GO Within the Context of Family Health: Retrospective Study %A Militello,Lisa K %A Hanna,Nathan %A Nigg,Claudio R %+ Martha S Pitzer Center for Women, Children, and Youth, College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH, 43210, United States, 1 614 688 4316, militello.14@osu.edu %K family %K pediatrics %K mHealth %K exercise %K mobile health, public health %D 2018 %7 03.10.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Pokémon GO illuminated the potential for mobile phone gaming apps to engage users and promote health. However, much work is needed to fully understand the mechanisms through which digitally supported behavior change interventions operate, particularly for children and families. Objective: The aims of this study were (1) to explore the Pokémon GO user experience from a family perspective and (2) to investigate Pokémon GO within the context of family health. Methods: Between January and February 2017, congruent with one of the largest anticipated Pokémon GO updates Gen 2, participants were recruited from parks, word of mouth, and social media to complete a Web-based survey. Participants were surveyed about family characteristics, interest, and experiences playing Pokémon GO and healthy lifestyle beliefs. Using a revised Godin Leisure-Time Exercise Questionnaire, a retrospective pre-post design assessed changes in parent physical activity (PA) before and after playing Pokémon GO. Results: Self-reported data from 160 parents and 31 children were included in the final analyses (representing 129 parents and 31 parent-child dyads). Gameplay most often occurred between sons aged 10 years or younger and mothers. “Spending time together” was the most cited reason for gameplay by both parents (122/160, 76.3%) and children (24/31, 77%), followed by “it helped me go outdoors” for parents (113/160, 70.1%) and “I am a Pokémon fan” by children (21/31, 68%). Interestingly, open-ended responses indicated that gameplay could trigger both positive and negative emotional parent response. The most cited reason for app disengagement was boredom; conversely, the most cited reason for app re-engagement was in-app events. For parents, there were significant increases in minutes spent in mild (mean 23.36 [SD 66.02]; t97=3.50, P<.001) and moderate (mean 21.76 [SD 53.04]; t130=4.70, P<.001) PA per week after playing Pokémon GO. However, child perceptions of parental influence on PA most significantly associated with parents who reported weekly strenuous PA both before (rs=.514, P=.003) and after (rs=.536, P=.003) Pokémon GO uptake. Conclusions: Pokémon GO transcended traditional understanding of digital health and uniquely reached across generations to engage users. Findings from this study highlight that, for a period of time, Pokémon GO fostered social and physical well-being for children and families through a multifaceted approach. %M 31518294 %R 10.2196/10679 %U http://pediatrics.jmir.org/2018/2/e10679/ %U https://doi.org/10.2196/10679 %U http://www.ncbi.nlm.nih.gov/pubmed/31518294 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e167 %T Behavior Change Techniques in mHealth Apps for the Mental and Physical Health of Employees: Systematic Assessment %A de Korte,Elsbeth %A Wiezer,Noortje %A Bakhuys Roozeboom,Maartje %A Vink,Peter %A Kraaij,Wessel %+ Netherlands Organization for Applied Scientific Research, Schipholweg 77-89, Leiden, 2316 ZL, Netherlands, 31 6 21134434, elsbeth.dekorte@tno.nl %K behavior change techniques %K mHealth %K mental health %K physical health %K lifestyle %K workplace %K app %K employee %K work %D 2018 %7 03.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Employees remain at risk of developing physical and mental health problems. To improve the lifestyle, health, and productivity many workplace interventions have been developed. However, not all of these interventions are effective. Mobile and wireless technology to support health behavior change (mobile health [mHealth] apps) is a promising, but relatively new domain for the occupational setting. Research on mHealth apps for the mental and physical health of employees is scarce. Interventions are more likely to be useful if they are rooted in health behavior change theory. Evaluating the presence of specific combinations of behavior change techniques (BCTs) in mHealth apps might be used as an indicator of potential quality and effectiveness. Objective: The aim of this study was to assess whether mHealth apps for the mental and physical health of employees incorporate BCTs and, if so, which BCTs can be identified and which combinations of BCTs are present. Methods: An assessment was made of apps aiming to reduce the risk of physical and psychosocial work demands and to promote a healthy lifestyle for employees. A systematic search was performed in iTunes and Google Play. Forty-five apps were screened and downloaded. BCTs were identified using a taxonomy applied in similar reviews. The mean and ranges were calculated. Results: On average, the apps included 7 of the 26 BCTs (range 2-18). Techniques such as “provide feedback on performance,” “provide information about behavior-health link,” and “provide instruction” were used most frequently. Techniques that were used least were “relapse prevention,” “prompt self-talk,” “use follow-up prompts,” and “provide information about others’ approval.” “Stress management,” “prompt identification as a role model,” and “agree on behavioral contract” were not used by any of the apps. The combination “provide information about behavior-health link” with “prompt intention formation” was found in 7/45 (16%) apps. The combination “provide information about behavior-health link” with “provide information on consequences,” and “use follow-up prompts” was found in 2 (4%) apps. These combinations indicated potential effectiveness. The least potentially effective combination “provide feedback on performance” without “provide instruction” was found in 13 (29%) apps. Conclusions: Apps for the occupational setting might be substantially improved to increase potential since results showed a limited presence of BCTs in general, limited use of potentially successful combinations of BCTs in apps, and use of potentially unsuccessful combinations of BCTs. Increasing knowledge on the effectiveness of BCTs in apps might be used to develop guidelines for app developers and selection criteria for companies and individuals. Also, this might contribute to decreasing the burden of work-related diseases. To achieve this, app developers, health behavior change professionals, experts on physical and mental health, and end-users should collaborate when developing apps for the working context. %R 10.2196/mhealth.6363 %U https://mhealth.jmir.org/2018/10/e167/ %U https://doi.org/10.2196/mhealth.6363 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e174 %T Health and Fitness Apps for Hands-Free Voice-Activated Assistants: Content Analysis %A Chung,Arlene E %A Griffin,Ashley C %A Selezneva,Dasha %A Gotz,David %+ Division of General Medicine & Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, 5034 Old Clinic Building, CB 7110, Chapel Hill, NC, 27599-7110, United States, 1 9199662276, arlene_chung@med.unc.edu %K voice-activated assistant %K intelligent personal assistant %K virtual personal assistant %K Amazon Alexa %K Google Assistant %K artificial intelligence %K voice-activated technology %K voice assistant %D 2018 %7 24.9.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hands-free voice-activated assistants and their associated devices have recently gained popularity with the release of commercial products, including Amazon Alexa and Google Assistant. Voice-activated assistants have many potential use cases in healthcare including education, health tracking and monitoring, and assistance with locating health providers. However, little is known about the types of health and fitness apps available for voice-activated assistants as it is an emerging market. Objective: This review aimed to examine the characteristics of health and fitness apps for commercially available, hands-free voice-activated assistants, including Amazon Alexa and Google Assistant. Methods: Amazon Alexa Skills Store and Google Assistant app were searched to find voice-activated assistant apps designated by vendors as health and fitness apps. Information was extracted for each app including name, description, vendor, vendor rating, user reviews and ratings, cost, developer and security policies, and the ability to pair with a smartphone app and website and device. Using a codebook, two reviewers independently coded each app using the vendor’s descriptions and the app name into one or more health and fitness, intended age group, and target audience categories. A third reviewer adjudicated coding disagreements until consensus was reached. Descriptive statistics were used to summarize app characteristics. Results: Overall, 309 apps were reviewed; health education apps (87) were the most commonly occurring, followed by fitness and training (72), nutrition (33), brain training and games (31), and health monitoring (25). Diet and calorie tracking apps were infrequent. Apps were mostly targeted towards adults and general audiences with few specifically geared towards patients, caregivers, or medical professionals. Most apps were free to enable or use and 18.1% (56/309) could be paired with a smartphone app and website and device; 30.7% (95/309) of vendors provided privacy policies; and 22.3% (69/309) provided terms of use. The majority (36/42, 85.7%) of Amazon Alexa apps were rated by the vendor as mature or guidance suggested, which were geared towards adults only. When there was a user rating available, apps had a wide range of ratings from 1 to 5 stars with a mean of 2.97. Google Assistant apps did not have user reviews available, whereas most of Amazon Alexa apps had at least 1-9 reviews available. Conclusions: The emerging market of health and fitness apps for voice-activated assistants is still nascent and mainly focused on health education and fitness. Voice-activated assistant apps had a wide range of content areas but many published in the health and fitness categories did not actually have a clear health or fitness focus. This may, in part, be due to Amazon and Google policies, which place restrictions on the delivery of care or direct recording of health data. As in the mobile app market, the content and functionalities may evolve to meet growing demands for self-monitoring and disease management. %M 30249581 %R 10.2196/mhealth.9705 %U http://mhealth.jmir.org/2018/9/e174/ %U https://doi.org/10.2196/mhealth.9705 %U http://www.ncbi.nlm.nih.gov/pubmed/30249581 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e176 %T Longitudinal Validity and Reliability of Brief Smartphone Self-Monitoring of Diet, Stress, and Physical Activity in a Diverse Sample of Mothers %A Swendeman,Dallas %A Comulada,Warren Scott %A Koussa,Maryann %A Worthman,Carol M %A Estrin,Deborah %A Rotheram-Borus,Mary Jane %A Ramanathan,Nithya %+ Department of Computer Science, University of California, Los Angeles, 10920 Wilshire Boulevard, Los Angeles, CA, 90024, United States, 1 213 915 6729, nithyaar@gmail.com %K self-monitoring %K mHealth %K diet %K physical activity %K stress %K multi-method %K mobile phones %K C-reactive protein %D 2018 %7 21.9.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Multiple strategies can be used when self-monitoring diet, physical activity, and perceived stress, but no gold standards are available. Although self-monitoring is a core element of self-management and behavior change, the success of mHealth behavioral tools depends on their validity and reliability, which lack evidence. African American and Latina mothers in the United States are high-priority populations for apps that can be used for self-monitoring of diet, physical activity, and stress because the body mass index (BMI) of mothers typically increases for several years after childbirth and the risks of obesity and its’ sequelae diseases are elevated among minority populations. Objective: To examine the intermethod reliability and concurrent validity of smartphone-based self-monitoring via ecological momentary assessments (EMAs) and use of daily diaries for diet, stress, and physical activity compared with brief recall measures, anthropometric biomeasures, and bloodspot biomarkers. Methods: A purposive sample (n=42) of primarily African American (16/42, 39%) and Latina (18/42, 44%) mothers was assigned Android smartphones for using Ohmage apps to self-monitor diet, perceived stress, and physical activity over 6 months. Participants were assessed at 3- and 6-month follow-ups. Recall measures included brief food frequency screeners, physical activity assessments adapted from the National Health and Nutrition Examination Survey, and the nine-item psychological stress measure. Anthropometric biomeasures included BMI, body fat, waist circumference, and blood pressure. Bloodspot assays for Epstein–Barr virus and C-reactive protein were used as systemic load and stress biomarkers. EMAs and daily diary questions assessed perceived quality and quantity of meals, perceived stress levels, and moderate, vigorous, and light physical activity. Units of analysis were follow-up assessments (n=29 to n=45 depending on the domain) of the participants (n=29 with sufficient data for analyses). Correlations, R2 statistics, and multivariate linear regressions were used to assess the strength of associations between variables. Results: Almost all participants (39/42, 93%) completed the study. Intermethod reliability between smartphone-based EMAs and diary reports and their corresponding recall reports was highest for stress and diet; correlations ranged from .27 to .52 (P<.05). However, it was unexpectedly low for physical activity; no significant associations were observed. Concurrent validity was demonstrated for diet EMAs and diary reports on systolic blood pressure (r=−.32), C-reactive protein level (r=−.34), and moderate and vigorous physical activity recalls (r=.35 to.48), suggesting a covariation between healthy diet and physical activity behaviors. EMAs and diary reports on stress were not associated with Epstein–Barr virus and C-reactive protein level. Diary reports on moderate and vigorous physical activity were negatively associated with BMI and body fat (r=−.35 to −.44, P<.05). Conclusions: Brief smartphone-based EMA use may be valid and reliable for long-term self-monitoring of diet, stress, and physical activity. Lack of intermethod reliability for physical activity measures is consistent with prior research, warranting more research on the efficacy of smartphone-based self-monitoring of self-management and behavior change support. %M 30249576 %R 10.2196/mhealth.9378 %U http://mhealth.jmir.org/2018/9/e176/ %U https://doi.org/10.2196/mhealth.9378 %U http://www.ncbi.nlm.nih.gov/pubmed/30249576 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e178 %T Evaluating the Carrot Rewards App, a Population-Level Incentive-Based Intervention Promoting Step Counts Across Two Canadian Provinces: Quasi-Experimental Study %A Mitchell,Marc %A White,Lauren %A Lau,Erica %A Leahey,Tricia %A Adams,Marc A %A Faulkner,Guy %+ Western University, Somerville House, Room 2360C, London, ON, N6A 5B9, Canada, 1 519 661 2111 ext 87936, marc.mitchell@uwo.ca %K behavioral economics %K financial health incentives %K mHealth %K mobile phone %K physical activity %K public health %D 2018 %7 20.9.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Carrot Rewards app was developed as part of an innovative public-private partnership to reward Canadians with loyalty points, exchangeable for retail goods, travel rewards, and groceries for engaging in healthy behaviors such as walking. Objective: This study examined whether a multicomponent intervention including goal setting, graded tasks, biofeedback, and very small incentives tied to daily step goal achievement (assessed by built-in smartphone accelerometers) could increase physical activity in two Canadian provinces, British Columbia (BC) and Newfoundland and Labrador (NL). Methods: This 12-week, quasi-experimental (single group pre-post) study included 78,882 participants; 44.39% (35,014/78,882) enrolled in the Carrot Rewards “Steps” walking program during the recruitment period (June 13–July 10, 2016). During the 2-week baseline (or “run-in”) period, we calculated participants’ mean steps per day. Thereafter, participants earned incentives in the form of loyalty points (worth Can $0.04 ) every day they reached their personalized daily step goal (ie, baseline mean+1000 steps=first daily step goal level). Participants earned additional points (Can $0.40) for meeting their step goal 10+ nonconsecutive times in a 14-day period (called a “Step Up Challenge”). Participants could earn up to Can $5.00 during the 12-week evaluation period. Upon meeting the 10-day contingency, participants could increase their daily goal by 500 steps, aiming to gradually increase the daily step number by 3000. Only participants with ≥5 valid days (days with step counts: 1000-40,000) during the baseline period were included in the analysis (n=32,229).The primary study outcome was mean steps per day (by week), analyzed using linear mixed-effects models. Results: The mean age of 32,229 participants with valid baseline data was 33.7 (SD 11.6) years; 66.11% (21,306/32,229) were female. The mean daily step count at baseline was 6511.22. Over half of users (16,336/32,229, 50.69%) were categorized as “physically inactive,” accumulating <5000 daily steps at baseline. Results from mixed-effects models revealed statistically significant increases in mean daily step counts when comparing baseline with each study week (P<.001). Compared with baseline, participants walked 115.70 more steps (95% CI 74.59 to 156.81; P<.001) at study week 12. BC and NL users classified as “high engagers” (app engagement above sample median; 15,511/32,229, 48.13%) walked 738.70 (95% CI 673.81 to 803.54; P<.001) and 346.00 (95% CI 239.26 to 452.74; P<.001) more steps, respectively. Physically inactive, high engagers (7022/32,229, 21.08%) averaged an increase of 1224.66 steps per day (95% CI 1160.69 to 1288.63; P<.001). Effect sizes were modest. Conclusions: Providing very small but immediate rewards for personalized daily step goal achievement as part of a multicomponent intervention increased daily step counts on a population scale, especially for physically inactive individuals and individuals who engaged more with the walking program. Positive effects in both BC and NL provide evidence of replicability. %M 30148712 %R 10.2196/mhealth.9912 %U http://mhealth.jmir.org/2018/9/e178/ %U https://doi.org/10.2196/mhealth.9912 %U http://www.ncbi.nlm.nih.gov/pubmed/30148712 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e179 %T An mHealth App for Self-Management of Chronic Lower Back Pain (Limbr): Pilot Study %A Selter,Aliza %A Tsangouri,Christina %A Ali,Sana B %A Freed,Diana %A Vatchinsky,Adrian %A Kizer,James %A Sahuguet,Arnaud %A Vojta,Deneen %A Vad,Vijay %A Pollak,JP %A Estrin,Deborah %+ Cornell Tech, 2 W Loop Rd, New York, NY,, United States, 1 646 971 3716, jpp9@cornell.edu %K low back pain %K chronic disease %K self-assessment %K telemedicine %K self-management %K activities of daily living %K pain %K rehabilitation %D 2018 %7 17.09.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although mobile health (mHealth) interventions can help improve outcomes among patients with chronic lower back pain (CLBP), many available mHealth apps offer content that is not evidence based. Limbr was designed to enhance self-management of CLBP by packaging self-directed rehabilitation tutorial videos, visual self-report tools, remote health coach support, and activity tracking into a suite of mobile phone apps, including Your Activities of Daily Living, an image-based tool for quantifying pain-related disability. Objective: The aim is to (1) describe patient engagement with the Limbr program, (2) describe patient-perceived utility of the Limbr program, and (3) assess the validity of the Your Activities of Daily Living module for quantifying functional status among patients with CLBP. Methods: This was a single-arm trial utilizing a convenience sample of 93 adult patients with discogenic back pain who visited a single physiatrist from January 2016 to February 2017. Eligible patients were enrolled in 3-month physical therapy program and received the Limbr mobile phone app suite for iOS or Android. The program included three daily visual self-reports to assess pain, activity level, and medication/coping mechanisms; rehabilitation video tutorials; passive activity-level measurement; and chat-based health coaching. Patient characteristics, patient engagement, and perceived utility were analyzed descriptively. Associations between participant characteristics and program interaction were analyzed using multiple linear regression. Associations between Your Activities of Daily Living and Oswestry Disability Index (ODI) assessments were examined using Pearson correlation and hierarchical linear modeling. Results: A total of 93 participants were enrolled; of these, 35 (38%) completed the program (age: mean 46, SD 16 years; female: 22/35, 63%). More than half of completers finished assessments at least every 3 days and 70% (19/27) used the rehabilitation component at least once a week. Among respondents to a Web-based feedback survey, 76% (16/21) found the daily notifications helped them remember to complete their exercises, 81% (17/21) found the system easy to use, and 62% (13/21) rated their overall experience good or excellent. Baseline Your Activities of Daily Living score was a significant predictor of baseline ODI score, with ODI increasing by 0.30 units for every 1-unit increase in Your Activities of Daily Living (P<.001). Similarly, hierarchical linear modeling analysis indicated that Your Activities of Daily Living daily assessment scores were significant predictors of ODI scores over the course of the study (P=.01). Conclusions: Engagement among participants who completed the Limbr program was high, and program utility was rated positively by most respondents. Your Activities of Daily Living was significantly associated with ODI scores, supporting the validity of this novel tool. Future studies should assess the effect of Limbr on clinical outcomes, evaluate its use among a wider patient sample, and explore strategies for reducing attrition. Trial Registration: ClinicalTrials.gov NCT03040310; https://clinicaltrials.gov/ct2/show/NCT03040310 (Archived by WebCite at http://www.webcitation.org/722mEvAiv) %M 30224333 %R 10.2196/mhealth.8256 %U http://mhealth.jmir.org/2018/9/e179/ %U https://doi.org/10.2196/mhealth.8256 %U http://www.ncbi.nlm.nih.gov/pubmed/30224333 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e10074 %T A Smartphone App and Personalized Text Messaging Framework (InDEx) to Monitor and Reduce Alcohol Use in Ex-Serving Personnel: Development and Feasibility Study %A Leightley,Daniel %A Puddephatt,Jo-Anne %A Jones,Norman %A Mahmoodi,Toktam %A Chui,Zoe %A Field,Matt %A Drummond,Colin %A Rona,Roberto J %A Fear,Nicola T %A Goodwin,Laura %+ King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Cutcombe Road, London, SE5 9RJ, United Kingdom, 44 78485334, daniel.leightley@kcl.ac.uk %K behavior change techniques %K smartphone %K alcohol misuse %K binge drinking %K text messaging %K ex-serving %K armed forces %K mobile phones %D 2018 %7 11.09.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Self-reported alcohol misuse remains high in armed forces personnel even after they have left service. More than 50% of ex-serving personnel meet the criteria for hazardous alcohol use; however, many fail to acknowledge that they have a problem. Previous research indicates that interventions delivered via smartphone apps are suitable in promoting self-monitoring of alcohol use, have a broad reach, and may be more cost-effective than other types of brief interventions. There is currently no such intervention specifically designed for the armed forces. Objective: This study sought to describe the development of a tailored smartphone app and personalized text messaging (short message service, SMS) framework and to test the usability and feasibility (measured and reported as user engagement) of this app in a hard-to-engage ex-serving population. Methods: App development used Agile methodology (an incremental, iterative approach used in software development) and was informed by behavior change theory, participant feedback, and focus groups. Participants were recruited between May 2017 and June 2017 from an existing United Kingdom longitudinal military health and well-being cohort study, prescreened for eligibility, and directed to download either Android or iOS versions of the ”Information about Drinking for Ex-serving personnel” (InDEx) app. Through the app, participants were asked to record alcohol consumption, complete a range of self-report measures, and set goals using implementation intentions (if-then plans). Alongside the app, participants received daily automated personalized text messages (SMS) corresponding to specific behavior change techniques with content informed by the health action process approach with the intended purpose of promoting the use of the drinks diary, suggesting alternative behaviors, and providing feedback on goals setting. Results: Invitations to take part in the study were sent to ex-serving personnel, 22.6% (31/137) of whom accepted and downloaded the app. Participants opened the InDEx app a median of 15.0 (interquartile range [IQR] 8.5-19.0) times during the 4 week period (28 days), received an average of 36.1 (SD 3.2) text messages (SMS), consumed alcohol on a median of 13.0 (IQR 11.0-15.0) days, and consumed a median of 5.6 (IQR 3.3-11.8) units per drinking day in the first week, which decreased to 4.7 (IQR 2.0-6.9) units by the last week and remained active for 4.0 (IQR 3.0-4.0) weeks. Conclusions: Personnel engaged and used the app regularly as demonstrated by the number of initializations, interactions, and time spent using InDEx. Future research is needed to evaluate the engagement with and efficacy of InDEx for the reduction of alcohol consumption and binge drinking in an armed forces population. %M 30206054 %R 10.2196/10074 %U http://mhealth.jmir.org/2018/9/e10074/ %U https://doi.org/10.2196/10074 %U http://www.ncbi.nlm.nih.gov/pubmed/30206054 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e10456 %T Smartphone-Based Contingency Management Intervention to Improve Pre-Exposure Prophylaxis Adherence: Pilot Trial %A Mitchell,John T %A LeGrand,Sara %A Hightow-Weidman,Lisa B %A McKellar,Mehri S %A Kashuba,Angela DM %A Cottrell,Mackenzie %A McLaurin,Tony %A Satapathy,Goutam %A McClernon,F Joseph %+ Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2608 Erwin Road, Pavilion East, Suite 300, Durham, NC, 27705, United States, 1 919 681 0012, john.mitchell@duke.edu %K HIV %K preexposure prophylaxis %K mobile health %D 2018 %7 10.09.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pre-exposure prophylaxis (PrEP) provides a strong preventative benefit to individuals at risk for HIV. While PrEP adherence is highly correlated with its efficacy, adherence rates are variable both across and within persons. Objective: The objective of this study was to develop and pilot-test a smartphone-based intervention, known as mSMART, that targets PrEP adherence. mSMART provides contingency management in the form of monetary incentives for daily PrEP adherence based on a real-time adherence assessment using a camera-based medication event-monitoring tool as well as medication reminders, PrEP education, individualized behavioral strategies to address PrEP adherence barriers, and medication adherence feedback. Methods: This was a 4-week open-label, phase I trial in a community sample of young men who have sex with men already on PrEP (N=10). Results: Although adherence composite scores corresponding to PrEP biomarkers indicated that 90% (9/10) of the sample already had an acceptable baseline adherence in the protective range, by the end of the 4-week period, the scores improved for 30% (3/10) of the sample—adherence did not worsen for any participants. Participants reported mean PrEP adherence rates of 91% via daily entries in mSMART. At the end of the 4-week period, participants indicated acceptable ratings of satisfaction, usability, and willingness to recommend mSMART to others. There were no technical difficulties associated with smartphone compatibility, user misunderstandings about mSMART features that interfered with daily use, or study attrition. Conclusions: This study is the first to apply contingency management to PrEP adherence. Findings indicated that mSMART is feasible and acceptable. Such an adherence intervention administered via a user-friendly smartphone app can allow for widespread dissemination. Future efficacy trials are needed. Trial Registration: ClinicalTrials.gov NCT02895893; https://clinicaltrials.gov/ct2/show/NCT02895893 (Accessed by Webcite at http://www.webcitation.org/72JskjDJq) %M 30201601 %R 10.2196/10456 %U http://mhealth.jmir.org/2018/9/e10456/ %U https://doi.org/10.2196/10456 %U http://www.ncbi.nlm.nih.gov/pubmed/30201601 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e19 %T A Stress Management App Intervention for Cancer Survivors: Design, Development, and Usability Testing %A Børøsund,Elin %A Mirkovic,Jelena %A Clark,Matthew M %A Ehlers,Shawna L %A Andrykowski,Michael A %A Bergland,Anne %A Westeng,Marianne %A Solberg Nes,Lise %+ Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, PO Box 4950 Nydalen, Oslo, 0424, Norway, 47 92667262, elin.borosund@rr-research.no %K stress management %K mindfulness %K cancer %K eHealth %K mHealth %K mobile apps %K development %K usability %K user-centered design %K mobile phones %D 2018 %7 06.09.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Distress is prevalent in cancer survivors. Stress management interventions can reduce distress and improve quality of life for cancer patients, but many people with cancer are unfortunately not offered or able to attend such in-person stress management interventions. Objective: The objective of this study was to develop an evidence-based stress management intervention for patients living with cancer that can be delivered electronically with wide reach and dissemination. This paper describes the design and development process of a technology-based stress management intervention for cancer survivors, including the exploration phase, intervention content development, iterative software development (including design, development, and formative evaluation of low- and high-level prototypes), and security and privacy considerations. Methods: Design and development processes were iterative and performed in close collaboration with key stakeholders (N=48). In the exploration phase, identifying needs and requirements for the intervention, 28 participants gave input, including male and female cancer survivors (n=11) representing a wide age range (31-81 years) and cancer diagnoses, healthcare providers (n=8) including psychosocial oncology experts, and eHealth experts (n=9) including information technology design and developers. To ensure user involvement in each phase various user-centered design and service design methods were included, such as interviews, usability testing, and think aloud processes. Overall, participants were involved usability testing in the software development and formative evaluation phase, including cancer survivors (n=6), healthy volunteers (n=7), health care providers (n=2), and eHealth experts (n=5). Intervention content was developed by stress management experts based on well-known cognitive behavioral stress management strategies and adjusted to electronic format through multiple iterations with stakeholders. Privacy and security issues were considered throughout. Results: The design and development process identified a variety of stakeholder requirements. Cancer survivors preferred stress management through a mobile app rather than through a personal computer (PC) and identified usefulness, easy access, user friendliness, use of easily understandable language, and many brief sections rather than longer ones as important components of the intervention. These requirements were also supported by recommendations from health care providers and eHealth experts. The final intervention was named StressProffen and the hospital Privacy and Security Protection Committee was part of the final intervention approval to also ensure anchoring in the hospital organization. Conclusions: Interventions, even evidence-based, have little impact if not actively used. This study illustrates how user-centered design and service design can be applied to identify and incorporate essential stakeholder aspects in the entire design and development process. In combination with evidence-based concepts, this process facilitated development of a stress management intervention truly designed for the end users, in this case, cancer survivors. Trial Registration: ClinicalTrials.gov NCT02939612; https://clinicaltrials.gov/ct2/show/NCT02939612 (Archived at WebCite at http://www.webcitation.org/71l9HcfcB) %M 30684438 %R 10.2196/formative.9954 %U http://formative.jmir.org/2018/2/e19/ %U https://doi.org/10.2196/formative.9954 %U http://www.ncbi.nlm.nih.gov/pubmed/30684438 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e170 %T The SPLENDID Eating Detection Sensor: Development and Feasibility Study %A van den Boer,Janet %A van der Lee,Annemiek %A Zhou,Lingchuan %A Papapanagiotou,Vasileios %A Diou,Christos %A Delopoulos,Anastasios %A Mars,Monica %+ Sensory Science and Eating Behaviour Chair Group, Division of Human Nutrition, Wageningen University, Stippeneng 4, Wageningen, 6708WE, Netherlands, 31 317 485 340, monica.mars@wur.nl %K chewing sensor %K weight management %K obesity prevention %K overweight %K PPG sensor %K in-ear microphone %K mobile phone %D 2018 %7 04.09.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The available methods for monitoring food intake—which for a great part rely on self-report—often provide biased and incomplete data. Currently, no good technological solutions are available. Hence, the SPLENDID eating detection sensor (an ear-worn device with an air microphone and a photoplethysmogram [PPG] sensor) was developed to enable complete and objective measurements of eating events. The technical performance of this device has been described before. To date, literature is lacking a description of how such a device is perceived and experienced by potential users. Objective: The objective of our study was to explore how potential users perceive and experience the SPLENDID eating detection sensor. Methods: Potential users evaluated the eating detection sensor at different stages of its development: (1) At the start, 12 health professionals (eg, dieticians, personal trainers) were interviewed and a focus group was held with 5 potential end users to find out their thoughts on the concept of the eating detection sensor. (2) Then, preliminary prototypes of the eating detection sensor were tested in a laboratory setting where 23 young adults reported their experiences. (3) Next, the first wearable version of the eating detection sensor was tested in a semicontrolled study where 22 young, overweight adults used the sensor on 2 separate days (from lunch till dinner) and reported their experiences. (4) The final version of the sensor was tested in a 4-week feasibility study by 20 young, overweight adults who reported their experiences. Results: Throughout all the development stages, most individuals were enthusiastic about the eating detection sensor. However, it was stressed multiple times that it was critical that the device be discreet and comfortable to wear for a longer period. In the final study, the eating detection sensor received an average grade of 3.7 for wearer comfort on a scale of 1 to 10. Moreover, experienced discomfort was the main reason for wearing the eating detection sensor <2 hours a day. The participants reported having used the eating detection sensor on 19/28 instructed days on average. Conclusions: The SPLENDID eating detection sensor, which uses an air microphone and a PPG sensor, is a promising new device that can facilitate the collection of reliable food intake data, as shown by its technical potential. Potential users are enthusiastic, but to be successful wearer comfort and discreetness of the device need to be improved. %M 30181111 %R 10.2196/mhealth.9781 %U http://mhealth.jmir.org/2018/9/e170/ %U https://doi.org/10.2196/mhealth.9781 %U http://www.ncbi.nlm.nih.gov/pubmed/30181111 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 8 %P e256 %T A Church-Based Weight Loss Intervention in African American Adults using Text Messages (LEAN Study): Cluster Randomized Controlled Trial %A Newton Jr,Robert L %A Carter,Leah A %A Johnson,William %A Zhang,Dachuan %A Larrivee,Sandra %A Kennedy,Betty M %A Harris,Melissa %A Hsia,Daniel S %+ Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, United States, 1 225 763 3034, Robert.Newton@pbrc.edu %K African Americans %K behavioral strategies %K community health %K mHealth %K mobile phone %K obesity %K text messages %K weight loss %D 2018 %7 24.08.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: African American adults experience a high prevalence of obesity and its associated comorbidities, including diabetes. Church-based interventions have been shown to be effective in decreasing weight in this population. mHealth interventions can address two needs for obesity treatment in this community, including enhancing weight loss and providing wide dissemination. Objective: This study aimed to assess the feasibility and efficacy of a church-based weight loss intervention that incorporates mHealth technology. Methods: In this study, 8 churches (n=97) were randomly assigned to the intervention or delayed intervention condition (control group). We recruited participants through their respective church. Volunteer church members were trained by study staff to deliver the 10-session, 6-month intervention. Participants in the intervention group attended group sessions and received automated short message service (SMS) text messages designed to reinforce behavioral strategies. Conversely, participants in the delayed intervention condition received SMS text messages related to health conditions relevant for African American adults. We obtained measures of body composition, blood pressure, blood glucose, and cholesterol. Results: We successfully recruited 97 African American adults, with a mean age of 56.0 (SE 10.3) years and a mean body mass index of 38.6 (SE 6.4) kg/m2 (89/97, 91.8% females), who attended the churches that were randomized to the intervention (n=68) or control (n=29) condition. Of these, 74.2% (72/97) of the participants (47/68, 69.1% intervention; 25/29, 86.2% delayed intervention) completed the 6-month assessment. The average intervention group attendance was 55%. There was a significant difference in weight loss (P=.04) between participants in the intervention (–1.5 (SE 0.5) kg) and control (0.11 (SE 0.6) kg) groups. Among participants in the intervention group, the correlation between the number of SMS text messages sent and the percent body fat loss was r=.3 with P=.04. The participants reported high satisfaction with the automated SMS text messages. Conclusions: Automated SMS text messages were well-received by participants, suggesting that more enhanced mHealth technologies are a viable option for interventions targeting African American adults. Trial Registration: ClinicalTrials.gov NCT02863887; https://clinicaltrials.gov/ct2/show/NCT02863887 (Archived by WebCite at http://www.webcitation.org/71JiYzizO) %M 30143478 %R 10.2196/jmir.9816 %U http://www.jmir.org/2018/8/e256/ %U https://doi.org/10.2196/jmir.9816 %U http://www.ncbi.nlm.nih.gov/pubmed/30143478 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e10003 %T Effect and Process Evaluation of a Smartphone App to Promote an Active Lifestyle in Lower Educated Working Young Adults: Cluster Randomized Controlled Trial %A Simons,Dorien %A De Bourdeaudhuij,Ilse %A Clarys,Peter %A De Cocker,Katrien %A Vandelanotte,Corneel %A Deforche,Benedicte %+ Unit Health Promotion and Education, Department of Public Health, Ghent University, Corneel Heymanslaan 10, Entrance 42 (K3), Ghent, 9000, Belgium, 32 498457442, dorien.simons@ugent.be %K mHealth %K mobile apps %K active transport %K Fitbit %K accelerometers %K mobile phone %K emerging adulthood %K physical activity intervention %K health promotion %D 2018 %7 24.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile technologies have great potential to promote an active lifestyle in lower educated working young adults, an underresearched target group at a high risk of low activity levels. Objective: The objective of our study was to examine the effect and process evaluation of the newly developed evidence- and theory-based smartphone app “Active Coach” on the objectively measured total daily physical activity; self-reported, context-specific physical activity; and self-reported psychosocial variables among lower educated working young adults. Methods: We recruited 130 lower educated working young adults in this 2-group cluster randomized controlled trial and assessed outcomes at baseline, posttest (baseline+9 weeks), and follow-up (posttest+3 months). Intervention participants (n=60) used the Active Coach app (for 9 weeks) combined with a Fitbit activity tracker. Personal goals, practical tips, and educational facts were provided to encourage physical activity. The control group received print-based generic physical activity information. Both groups wore accelerometers for objective measurement of physical activity, and individual interviews were conducted to assess the psychosocial variables and context-specific physical activity. Furthermore, intervention participants were asked process evaluation questions and generalized linear mixed models and descriptive statistics were applied. Results: No significant intervention effects were found for objectively measured physical activity, self-reported physical activity, and self-reported psychosocial variables (all P>.05). Intervention participants evaluated the Active Coach app and the combined use with the Fitbit wearable as self-explanatory (36/51, 70.6%), user friendly (40/51, 78.4%), and interesting (34/51, 66.7%). Throughout the intervention, we observed a decrease in the frequency of viewing graphical displays in the app (P<.001); reading the tips, facts, and goals (P<.05); and wearing the Fitbit wearable (P<.001). Few intervention participants found the tips and facts motivating (10/41, 24.4%), used them to be physically active (8/41, 19.6%), and thought they were tailored to their lifestyle (7/41, 17.1%). Conclusions: The lack of significant intervention effects might be due to low continuous user engagement. Advice or feedback that was not perceived as adequately tailored and the difficulty to compete with many popular commercial apps on young people’s smartphones may be responsible for a decrease in the engagement. A stand-alone app does not seem sufficient to promote an active lifestyle among lower educated working young adults; therefore, multicomponent interventions (using both technological and human support), as well as context-specific sensing to provide tailored advice, might be needed in this population. Trial Registration: ClinicalTrials.gov NCT02948803; https://clinicaltrials.gov/ct2/show/results/NCT02948803 (Archived by WebCite at http://www.webcitation.org/71OPFwaoA) %M 30143477 %R 10.2196/10003 %U http://mhealth.jmir.org/2018/8/e10003/ %U https://doi.org/10.2196/10003 %U http://www.ncbi.nlm.nih.gov/pubmed/30143477 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 3 %P e54 %T A Mobile App–Based Intervention for Depression: End-User and Expert Usability Testing Study %A Fuller-Tyszkiewicz,Matthew %A Richardson,Ben %A Klein,Britt %A Skouteris,Helen %A Christensen,Helen %A Austin,David %A Castle,David %A Mihalopoulos,Cathrine %A O'Donnell,Renee %A Arulkadacham,Lilani %A Shatte,Adrian %A Ware,Anna %+ School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, 3220, Australia, 61 392517344, matthewf@deakin.edu.au %K depression %K eHealth %K mHealth %K young adult %D 2018 %7 23.08.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite the growing number of mental health apps available for smartphones, the perceived usability of these apps from the perspectives of end users or health care experts has rarely been reported. This information is vital, particularly for self-guided mHealth interventions, as perceptions of navigability and quality of content are likely to impact participant engagement and treatment compliance. Objective: The aim of this study was to conduct a usability evaluation of a personalized, self-guided, app-based intervention for depression. Methods: Participants were administered the System Usability Scale and open-ended questions as part of a semistructured interview. There were 15 participants equally divided into 3 groups: (1) individuals with clinical depression who were the target audience for the app, (2) mental health professionals, and (3) researchers who specialize in the area of eHealth interventions and/or depression research. Results: The end-user group rated the app highly, both in quantitative and qualitative assessments. The 2 expert groups highlighted the self-monitoring features and range of established psychological treatment options (such as behavioral activation and cognitive restructuring) but had concerns that the amount and layout of content may be difficult for end users to navigate in a self-directed fashion. The end-user data did not confirm these concerns. Conclusions: Encouraging participant engagement via self-monitoring and feedback, as well as personalized messaging, may be a viable way to maintain participation in self-guided interventions. Further evaluation is necessary to determine whether levels of engagement with these features enhance treatment effects. %M 30139722 %R 10.2196/mental.9445 %U http://mental.jmir.org/2018/3/e54/ %U https://doi.org/10.2196/mental.9445 %U http://www.ncbi.nlm.nih.gov/pubmed/30139722 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e10125 %T Game Plan: Development of a Web App Designed to Help Men Who Have Sex With Men Reduce Their HIV Risk and Alcohol Use %A Wray,Tyler %A Kahler,Christopher W %A Simpanen,Erik M %A Operario,Don %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main Street, Box G-S121-5, Providence, RI,, United States, 1 401 863 6659, tyler_wray@brown.edu %K alcohol %K HIV risk %K internet %K intervention %D 2018 %7 23.08.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Men who have sex with men (MSM) are at high risk for HIV, and alcohol use is a major risk factor for HIV infection. Internet-facilitated brief interventions have been shown to reduce alcohol use and HIV-risk behavior in other at-risk populations, but have so far incorporated limited content and have not been tested among MSM. Objective: This manuscript describes Game Plan, an interactive, tablet-optimized web application designed to help heavy drinking, high-risk MSM consider reducing their alcohol use and sexual risk behavior. In this paper, we discuss the rationale, goals, and flow for each of Game Plan’s components, which were modelled after common in-person and web-based brief motivational interventions for these behaviors. Methods: The development of Game Plan was informed by a thorough user-focused design research process that included (1) audits of existing interventions, (2) focus groups with stakeholders and (3) intended users (high-risk, heavy drinking MSM), and (4) usability testing. The aesthetic, features, and content of the app were designed iteratively throughout this process Results: The fully-functional Game Plan app provides (1) specific and personal feedback to users about their level of risk, (2) exercises to help prompt users to reflect on whether their current behavior aligns with other important life goals and values, and for those open to change, (3) exercises to help users understand factors that contribute to risk, and (4) a change planning module. In general, this flow was constructed to roughly align with the two phases described in early accounts of motivational interviewing (MI): (1) Content intended to elicit intrinsic motivation for change, and when/if sufficient motivation is present, (2) content intended to translate that motivation into specific goals and plans for change. This sequence first focuses on the user’s HIV risk behavior, followed by their alcohol use and the connection between the two. The app’s overall aesthetic (eg, branding, color palettes, icons/graphics) and its onboarding sequence was also designed to align with the “spirit” of MI by conveying respect for autonomy, open-mindedness (ie, avoiding judgment), and empathy. Conclusions: Should future research support its efficacy in facilitating behavior change, Game Plan could represent a wide-reaching and scalable tool that is well-suited for use in settings where delivering evidence-based, in-person interventions would be difficult or cost-prohibitive. %M 30684415 %R 10.2196/10125 %U http://formative.jmir.org/2018/2/e10125/ %U https://doi.org/10.2196/10125 %U http://www.ncbi.nlm.nih.gov/pubmed/30684415 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e10748 %T Veterans’ Attitudes Toward Smartphone App Use for Mental Health Care: Qualitative Study of Rurality and Age Differences %A Connolly,Samantha L %A Miller,Christopher J %A Koenig,Christopher J %A Zamora,Kara A %A Wright,Patricia B %A Stanley,Regina L %A Pyne,Jeffrey M %+ Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S Huntington Avenue, Building 9 Room 208F, Boston, MA, 02130, United States, 1 857 364 5987, Samantha.connolly@va.gov %K smartphone apps %K mobile phone %K mhealth %K mental health %K qualitative analysis %K rurality %K age %K veterans %K depression %K anxiety disorders %K posttraumatic stress disorder %K PTSD %K alcohol abuse %D 2018 %7 22.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental health smartphone apps provide support, skills, and symptom tracking on demand and come at minimal to no additional cost to patients. Although the Department of Veterans Affairs has established itself as a national leader in the creation of mental health apps, veterans’ attitudes regarding the use of these innovations are largely unknown, particularly among rural and aging populations who may benefit from increased access to care. Objective: The objective of our study was to examine veterans’ attitudes toward smartphone apps and to assess whether openness toward this technology varies by age or rurality. Methods: We conducted semistructured qualitative interviews with 66 veterans from rural and urban areas in Maine, Arkansas, and California. Eligible veterans aged 18 to 70 years had screened positive for postraumatic stress disorder (PTSD), alcohol use disorder, or major depressive disorder, but a history of mental health service utilization was not required. Interviews were digitally recorded, professionally transcribed, and coded by a research team using an established codebook. We then conducted a thematic analysis of segments pertaining to smartphone use, informed by existing theories of technology adoption. Results: Interviews revealed a marked division regarding openness to mental health smartphone apps, such that veterans either expressed strongly positive or negative views about their usage, with few participants sharing ambivalent or neutral opinions. Differences emerged between rural and urban veterans’ attitudes, with rural veterans tending to oppose app usage, describe smartphones as hard to navigate, and cite barriers such as financial limitations and connectivity issues, more so than urban populations. Moreover, rural veterans more often described smartphones as being opposed to their values. Differences did not emerge between younger and older (≥50) veterans regarding beliefs that apps could be effective or compatible with their culture and identity. However, compared with younger veterans, older veterans more often reported not owning a smartphone and described this technology as being difficult to use. Conclusions: Openness toward the use of smartphone apps in mental health treatment may vary based on rurality, and further exploration of the barriers cited by rural veterans is needed to improve access to care. In addition, findings indicate that older patients may be more open to integrating technology into their mental health care than providers might assume, although such patients may have more trouble navigating these devices and may benefit from simplified app designs or smartphone training. Given the strong opinions expressed either for or against smartphone apps, our findings suggest that apps may not be an ideal adjunctive treatment for all patients, but it is important to identify those who are open to and may greatly benefit from this technology. %M 30135050 %R 10.2196/10748 %U http://mhealth.jmir.org/2018/8/e10748/ %U https://doi.org/10.2196/10748 %U http://www.ncbi.nlm.nih.gov/pubmed/30135050 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e163 %T A Mobile App (WhiteTeeth) to Promote Good Oral Health Behavior Among Dutch Adolescents with Fixed Orthodontic Appliances: Intervention Mapping Approach %A Scheerman,Janneke Francisca Maria %A van Empelen,Pepijn %A van Loveren,Cor %A van Meijel,Berno %+ Department of Preventive Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, Amsterdam, 1081LA, Netherlands, 31 +31614409741, jscheerman@hotmail.com %K health behavior %K mHealth %K oral health %K oral hygiene %K dental caries %K adolescent %K dental plaque %K prevention %K intervention mapping %D 2018 %7 17.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The insertion of fixed orthodontic appliances increases the risk of dental caries, particularly in adolescents. Caries can be prevented through good oral health behavior. To support adolescents with fixed orthodontic appliances and for promoting oral health behavior, we developed a theory- and evidence-based mHealth program, the WhiteTeeth app. Objective: The objective of our paper was to describe the systematic development and content of the WhiteTeeth app. Methods: For systematic development of the program, we used the intervention mapping (IM) approach. In this paper, we present the results of applying the first 5 steps of IM to the design of an mHealth program: (1) identifying target behaviors and determinants through problem analysis, including a literature search, a survey study, and semistructured interviews, to explore adolescent oral health behavior during orthodontic therapy; (2) defining program outcomes and objectives; (3) selecting theoretical methods and translating them into practical strategies for the program design; (4) producing the program, including a pilot test with 28 adolescents testing the acceptability and usability of the WhiteTeeth app; and (5) planning implementation and adoption. Results: On the basis of our literature search, we identified fluoride use and control of dental plaque levels (eg, tooth brushing and proxy brush usage) as target behaviors for preventing caries. Next, we identified important and changeable determinants of oral health behavior that fitted the theoretical concepts of the Health Action Process Approach (HAPA) theory. The HAPA theory, the self-regulation theory, and the results of the semistructured interviews were used to define the program objectives, that is, the performance and change objectives. After defining the objectives, we identified multiple behavior change techniques that could be used to achieve these objectives, such as providing oral health information and feedback, prompting self-monitoring, coaching of set actions and coping plans, and sending reminders. We translated these methods into practical strategies, such as videos and a brushing timer. Next, we combined these strategies into a single program resulting in the WhiteTeeth app (which is available on both iTunes and Google Play stores as “Witgebit”). Adolescents with fixed orthodontic appliances and dental professionals were included in the development process to increase the success of implementation. The pilot test revealed that the app users appreciated and liked the app. The WhiteTeeth app can be integrated into current orthodontic care. Conclusions: IM allowed us to identify multiple techniques that have been shown to be the most effective in initiating behavior change, but have not yet been incorporated into existing orthodontic apps. The WhiteTeeth app contains all these techniques, which makes it a unique and promising home-based app for promoting oral health in adolescents with fixed orthodontic appliances. %M 30120085 %R 10.2196/mhealth.9626 %U http://mhealth.jmir.org/2018/8/e163/ %U https://doi.org/10.2196/mhealth.9626 %U http://www.ncbi.nlm.nih.gov/pubmed/30120085 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e10270 %T mHealth Self-Report Monitoring in Competitive Middle- and Long-Distance Runners: Qualitative Study of Long-Term Use Intentions Using the Technology Acceptance Model %A Rönnby,Sara %A Lundberg,Oscar %A Fagher,Kristina %A Jacobsson,Jenny %A Tillander,Bo %A Gauffin,Håkan %A Hansson,Per-Olof %A Dahlström,Örjan %A Timpka,Toomas %+ Athletics Research Center, Department of Medical and Health Sciences, Linköping University, Hus 511-001, ingång 76, plan 14, Campus US, Linköping, 581 83, Sweden, 46 4705364357, toomas.timpka@liu.se %K running %K mHealth %K health technology %K diagnostic self-evaluation %K remote sensing technology %K self-evaluation programs %K qualitative research %D 2018 %7 13.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: International middle- and long-distance running competitions attract millions of spectators in association with city races, world championships, and Olympic Games. It is therefore a major concern that ill health and pain, as a result of sports overuse, lead to numerous hours of lost training and decreased performance in competitive runners. Despite its potential for sustenance of performance, approval of mHealth self-report monitoring (mHSM) in this group of athletes has not been investigated. Objective: The objective of our study was to explore individual and situational factors associated with the acceptance of long-term mHSM in competitive runners. Methods: The study used qualitative research methods with the Technology Acceptance Model as the theoretical foundation. The study population included 20 middle- and long-distance runners competing at national and international levels. Two mHSM apps asking for health and training data from track and marathon runners were created on a platform for web survey development (Briteback AB). Data collection for the technology acceptance analysis was performed via personal interviews before and after a 6-week monitoring period. Preuse interviews investigated experience and knowledge of mHealth monitoring and thoughts on benefits and possible side effects. The postuse interviews addressed usability and usefulness, attitudes toward nonfunctional issues, and intentions to adhere to long-term monitoring. In addition, the runners’ trustworthiness when providing mHSM data was discussed. The interview data were investigated using a deductive thematic analysis. Results: The mHSM apps were considered technically easy to use. Although the runners read the instructions and entered data effortlessly, some still perceived mHSM as problematic. Concerns were raised about the selection of items for monitoring (eg, recording training load as running distance or time) and about interpretation of concepts (eg, whether subjective well-being should encompass only the running context or daily living on the whole). Usefulness of specific mHSM apps was consequently not appraised on the same bases in different subcategories of runners. Regarding nonfunctional issues, the runners competing at the international level requested detailed control over who in their sports club and national federation should be allowed access to their data; the less competitive runners had no such issues. Notwithstanding, the runners were willing to adhere to long-term mHSM, provided the technology was adjusted to their personal routines and the output was perceived as contributing to running performance. Conclusions: Adoption of mHSM by competitive runners requires clear definitions of monitoring purpose and populations, repeated in practice tests of monitoring items and terminology, and meticulousness regarding data-sharing routines. Further naturalistic studies of mHSM use in routine sports practice settings are needed with nonfunctional ethical and legal issues included in the evaluation designs. %M 30104183 %R 10.2196/10270 %U http://mhealth.jmir.org/2018/8/e10270/ %U https://doi.org/10.2196/10270 %U http://www.ncbi.nlm.nih.gov/pubmed/30104183 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e165 %T Correlations Between Objective Behavioral Features Collected From Mobile and Wearable Devices and Depressive Mood Symptoms in Patients With Affective Disorders: Systematic Review %A Rohani,Darius A %A Faurholt-Jepsen,Maria %A Kessing,Lars Vedel %A Bardram,Jakob E %+ Embedded Systems Engineering, Department of Applied Mathematics and Computer Science, Technical University of Denmark, Richard Petersens Plads, Bldg 324, 1st Floor, Room 160, Kongens Lyngby, 2800, Denmark, 45 61452393, daroh@dtu.dk %K mood disorder %K affective disorder %K depression %K depressive mood symptoms %K bipolar disorder %K objective features %K correlation %K behavior %K sensor data %K mobile phone %K wearable devices %K systematic review %D 2018 %7 13.08.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Several studies have recently reported on the correlation between objective behavioral features collected via mobile and wearable devices and depressive mood symptoms in patients with affective disorders (unipolar and bipolar disorders). However, individual studies have reported on different and sometimes contradicting results, and no quantitative systematic review of the correlation between objective behavioral features and depressive mood symptoms has been published. Objective: The objectives of this systematic review were to (1) provide an overview of the correlations between objective behavioral features and depressive mood symptoms reported in the literature and (2) investigate the strength and statistical significance of these correlations across studies. The answers to these questions could potentially help identify which objective features have shown most promising results across studies. Methods: We conducted a systematic review of the scientific literature, reported according to the preferred reporting items for systematic reviews and meta-analyses guidelines. IEEE Xplore, ACM Digital Library, Web of Sciences, PsychINFO, PubMed, DBLP computer science bibliography, HTA, DARE, Scopus, and Science Direct were searched and supplemented by hand examination of reference lists. The search ended on April 27, 2017, and was limited to studies published between 2007 and 2017. Results: A total of 46 studies were eligible for the review. These studies identified and investigated 85 unique objective behavioral features, covering 17 various sensor data inputs. These features were divided into 7 categories. Several features were found to have statistically significant and consistent correlation directionality with mood assessment (eg, the amount of home stay, sleep duration, and vigorous activity), while others showed directionality discrepancies across the studies (eg, amount of text messages [short message service] sent, time spent between locations, and frequency of mobile phone screen activity). Conclusions: Several studies showed consistent and statistically significant correlations between objective behavioral features collected via mobile and wearable devices and depressive mood symptoms. Hence, continuous and everyday monitoring of behavioral aspects in affective disorders could be a promising supplementary objective measure for estimating depressive mood symptoms. However, the evidence is limited by methodological issues in individual studies and by a lack of standardization of (1) the collected objective features, (2) the mood assessment methodology, and (3) the statistical methods applied. Therefore, consistency in data collection and analysis in future studies is needed, making replication studies as well as meta-analyses possible. %M 30104184 %R 10.2196/mhealth.9691 %U http://mhealth.jmir.org/2018/8/e165/ %U https://doi.org/10.2196/mhealth.9691 %U http://www.ncbi.nlm.nih.gov/pubmed/30104184 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e10527 %T Accuracy of Fitbit Devices: Systematic Review and Narrative Syntheses of Quantitative Data %A Feehan,Lynne M %A Geldman,Jasmina %A Sayre,Eric C %A Park,Chance %A Ezzat,Allison M %A Yoo,Ju Young %A Hamilton,Clayon B %A Li,Linda C %+ Department of Physical Therapy, University of British Columbia, Friedman Building, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada, 1 604 822 7408, lynnefeehan@gmail.com %K wearable activity tracker %K accuracy %K Fitbit %K steps %K sleep %K energy expenditure %K distance %K time in activity %K systematic review %K fitness trackers %K data accuracy %K energy metabolism %K review %D 2018 %7 09.08.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Although designed as a consumer product to help motivate individuals to be physically active, Fitbit activity trackers are becoming increasingly popular as measurement tools in physical activity and health promotion research and are also commonly used to inform health care decisions. Objective: The objective of this review was to systematically evaluate and report measurement accuracy for Fitbit activity trackers in controlled and free-living settings. Methods: We conducted electronic searches using PubMed, EMBASE, CINAHL, and SPORTDiscus databases with a supplementary Google Scholar search. We considered original research published in English comparing Fitbit versus a reference- or research-standard criterion in healthy adults and those living with any health condition or disability. We assessed risk of bias using a modification of the Consensus-Based Standards for the Selection of Health Status Measurement Instruments. We explored measurement accuracy for steps, energy expenditure, sleep, time in activity, and distance using group percentage differences as the common rubric for error comparisons. We conducted descriptive analyses for frequency of accuracy comparisons within a ±3% error in controlled and ±10% error in free-living settings and assessed for potential bias of over- or underestimation. We secondarily explored how variations in body placement, ambulation speed, or type of activity influenced accuracy. Results: We included 67 studies. Consistent evidence indicated that Fitbit devices were likely to meet acceptable accuracy for step count approximately half the time, with a tendency to underestimate steps in controlled testing and overestimate steps in free-living settings. Findings also suggested a greater tendency to provide accurate measures for steps during normal or self-paced walking with torso placement, during jogging with wrist placement, and during slow or very slow walking with ankle placement in adults with no mobility limitations. Consistent evidence indicated that Fitbit devices were unlikely to provide accurate measures for energy expenditure in any testing condition. Evidence from a few studies also suggested that, compared with research-grade accelerometers, Fitbit devices may provide similar measures for time in bed and time sleeping, while likely markedly overestimating time spent in higher-intensity activities and underestimating distance during faster-paced ambulation. However, further accuracy studies are warranted. Our point estimations for mean or median percentage error gave equal weighting to all accuracy comparisons, possibly misrepresenting the true point estimate for measurement bias for some of the testing conditions we examined. Conclusions: Other than for measures of steps in adults with no limitations in mobility, discretion should be used when considering the use of Fitbit devices as an outcome measurement tool in research or to inform health care decisions, as there are seemingly a limited number of situations where the device is likely to provide accurate measurement. %M 30093371 %R 10.2196/10527 %U http://mhealth.jmir.org/2018/8/e10527/ %U https://doi.org/10.2196/10527 %U http://www.ncbi.nlm.nih.gov/pubmed/30093371 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e10012 %T The Effect of Mobile App Interventions on Influencing Healthy Maternal Behavior and Improving Perinatal Health Outcomes: Systematic Review %A Daly,Lisa M %A Horey,Dell %A Middleton,Philippa F %A Boyle,Frances M %A Flenady,Vicki %+ Mater Research Institute, The University of Queensland, Level 3, Aubigny Place, South Brisbane, 4101, Australia, 61 7 3163 5330, lisa.daly@uq.edu.au %K apps %K pregnancy %K perinatal %K maternal %K infant %K mobile %K systematic review %K behavior change %K intervention %D 2018 %7 09.08.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Perinatal morbidity and mortality are significant public health issues with an enduring impact on the health and well-being of women and their families. Millions of pregnant women now download and use mobile applications to access, store, and share health information. However, little is known about the consequences. An investigation of their impact on perinatal health outcomes is particularly topical. Objective: To determine the effects of mobile app interventions during pregnancy on influencing healthy maternal behavior and improving perinatal health outcomes. Methods: Searches of PubMed, Embase, the Cochrane Library, CINAHL, WHO Global Health Library, POPLINE, and CABI Global Health were conducted with no date or language restrictions. Randomized and non-randomized studies were included if they reported perinatal health outcomes of interventions targeting pregnant women, using mobile apps compared with other communication modalities or with standard care. The primary outcome measure was the change in maternal behaviors (as defined by trial authors), by intervention goals. Two reviewers independently extracted data using standardized forms. Results: Four randomized controlled trials (RCTs) involving 456 participants were included. All studies targeted participants in early pregnancy; however, wide variation was evident in participant characteristics, intervention, and study outcomes measures. Three trials were based in hospital settings, comparing women using mobile apps with routine antenatal care. One community-based trial gave all participants a device to promote physical activity; the intervention arm was also given a mobile app. All studies reported data for the primary outcome measure, describing some benefit from the intervention compared with controls. However, few statistically significant primary or secondary outcomes were reported. Due to insufficient data, the planned meta-analysis and subgroup analyses were not performed. Conclusions: Due to limited numbers, heterogeneity of interventions, comparators, and outcome measures, no firm conclusions can be drawn on the effects of mobile application interventions during pregnancy on maternal knowledge, behavior change, and perinatal health outcomes. As millions of women utilize mobile apps during pregnancy, rigorous studies are essential for health care and maternity care providers to optimally design, implement, and evaluate interventions. %M 30093368 %R 10.2196/10012 %U http://mhealth.jmir.org/2018/8/e10012/ %U https://doi.org/10.2196/10012 %U http://www.ncbi.nlm.nih.gov/pubmed/30093368 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 3 %P e10153 %T Emotion Recognition Using Smart Watch Sensor Data: Mixed-Design Study %A Quiroz,Juan Carlos %A Geangu,Elena %A Yong,Min Hooi %+ Department of Psychology, Sunway University, 5 Jalan Universiti, Bandar Sunway, 47500, Malaysia, 60 374918622, mhyong@sunway.edu.my %K emotion recognition %K accelerometer %K supervised learning %K psychology %D 2018 %7 08.08.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Research in psychology has shown that the way a person walks reflects that person’s current mood (or emotional state). Recent studies have used mobile phones to detect emotional states from movement data. Objective: The objective of our study was to investigate the use of movement sensor data from a smart watch to infer an individual’s emotional state. We present our findings of a user study with 50 participants. Methods: The experimental design is a mixed-design study: within-subjects (emotions: happy, sad, and neutral) and between-subjects (stimulus type: audiovisual “movie clips” and audio “music clips”). Each participant experienced both emotions in a single stimulus type. All participants walked 250 m while wearing a smart watch on one wrist and a heart rate monitor strap on the chest. They also had to answer a short questionnaire (20 items; Positive Affect and Negative Affect Schedule, PANAS) before and after experiencing each emotion. The data obtained from the heart rate monitor served as supplementary information to our data. We performed time series analysis on data from the smart watch and a t test on questionnaire items to measure the change in emotional state. Heart rate data was analyzed using one-way analysis of variance. We extracted features from the time series using sliding windows and used features to train and validate classifiers that determined an individual’s emotion. Results: Overall, 50 young adults participated in our study; of them, 49 were included for the affective PANAS questionnaire and 44 for the feature extraction and building of personal models. Participants reported feeling less negative affect after watching sad videos or after listening to sad music, P<.006. For the task of emotion recognition using classifiers, our results showed that personal models outperformed personal baselines and achieved median accuracies higher than 78% for all conditions of the design study for binary classification of happiness versus sadness. Conclusions: Our findings show that we are able to detect changes in the emotional state as well as in behavioral responses with data obtained from the smartwatch. Together with high accuracies achieved across all users for classification of happy versus sad emotional states, this is further evidence for the hypothesis that movement sensor data can be used for emotion recognition. %M 30089610 %R 10.2196/10153 %U http://mental.jmir.org/2018/3/e10153/ %U https://doi.org/10.2196/10153 %U http://www.ncbi.nlm.nih.gov/pubmed/30089610 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e10063 %T A Web-Based Survey Assessing the Attitudes of Health Care Professionals in Germany Toward the Use of Telemedicine in Pregnancy Monitoring: Cross-Sectional Study %A Grassl,Niklas %A Nees,Juliane %A Schramm,Katharina %A Spratte,Julia %A Sohn,Christof %A Schott,Timm C %A Schott,Sarah %+ Department of Gynecology and Obstetrics, University Women's Clinic Heidelberg, Im Neuenheimer Feld 440, Heidelberg, 69120, Germany, 49 6221 56 7901, sarah.schott@med.uni-heidelberg.de %K telemedicine %K obstetrics %K eHealth %K pregnancy monitoring %K job satisfaction %K sleeping problems %K night shift %K emergency consultation %D 2018 %7 08.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The demand for fetal monitoring and constant reassurance is high in pregnant women. Consequently, pregnant women use various health apps and are more likely to visit emergency departments due to subjective but nonurgent complaints. However, electronic health (eHealth) and mobile health (mHealth) solutions are rarely used to prevent nonurgent emergency consultations. To implement modern care solutions, a better understanding of the attitudes, fears, and hopes of health care professionals toward eHealth and mHealth is needed. Objective: The aim of this study was to investigate the attitudes of health care professionals in obstetrics toward telemedicine. Methods: A quantitative Web-based survey on health care professionals in obstetrics in Germany was conducted. The participants included nurses, midwives, and physicians of all age groups and job positions working in hospitals that provide various levels of health care. The questionnaire comprised 24 questions about the characteristics of the study population, views about emergency consultations in obstetrics, attitude toward telemedicine, job satisfaction, and sleeping behavior. Results: In total, 244 health care professionals participated in the Web-based survey. In general, health care professionals were skeptical (170/233, 72.9%) about the use of telemedicine in obstetrics; however, 55.8% (130/233) recognized its potential. Moreover, 72% (62/86) of physicians were optimistic in using apps for pregnancy monitoring, whereas 36.1% (47/130) of nonphysicians (P<.001) were not. Significantly, more nonphysicians rejected such developments (75/130, 57.7% rejected) compared with physicians (24/86, 28%; P<.001). We also found that obstetricians with more than 10 years of work-experience are more skeptical; however, approximately 49% (18/37) of them believed that telemedicine could reduce nonurgent emergency consultations, whereas 73.2% (106/145) of obstetricians with less than 5 years of experience (P=.01) thought otherwise. Our survey revealed a high job satisfaction and a prevalence of regular sleeping problems of 45.9% (91/198) among health care professionals in obstetrics. Surprisingly, both job satisfaction and sleeping problems were independent from the number of night shifts per month (P=.77 and P=.99, respectively). Yet, 56.6% (112/198) of the survey participants thought they would be happier with their job if they had to work fewer night shifts per month. Conclusions: Our study reveals an ambivalent attitude toward the use of telemedicine among health care professionals in obstetrics in Germany at the moment. Efforts to promote the use of telemedicine should focus on nurses and midwives because these groups are the most skeptical. By contrast, particularly young physicians recognize the potential of apps in patient care and would like to use such technology in pregnancy monitoring. %M 30089606 %R 10.2196/10063 %U http://mhealth.jmir.org/2018/8/e10063/ %U https://doi.org/10.2196/10063 %U http://www.ncbi.nlm.nih.gov/pubmed/30089606 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 8 %P e169 %T Technologies for Innovative Monitoring to Reduce Blood Pressure and Change Lifestyle Using Mobile Phones in Adult and Elderly Populations (TIM Study): Protocol for a Randomized Controlled Trial %A Fuchs,Sandra C %A Harzheim,Erno %A Iochpe,Cirano %A David,Caroline N de %A Gonçalves,Marcelo R %A Sesin,Guilhermo P %A Costa,Cassio M %A Moreira,Leila B %A Fuchs,Flavio D %+ Postgraduate Studies Program in Cardiology, Hospital de Clinicas de Porto Alegre, School of Medicine, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos 2350, Centro de Pesquisa Clínica, 5th Floor, Porto Alegre,, Brazil, 55 51 3359 7621, sfuchs@hcpa.edu.br %K blood pressure %K blood pressure monitoring %K hypertension %K weight %K diet %K sodium %K physical activity %K randomized controlled trial %K text messages %D 2018 %7 07.08.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Hypertension is a growing problem worldwide, markedly in low- and middle-income countries, where the rate of control slightly decreased. The overall prevalence of hypertension in Brazil is 28.7% among adult individuals and 68.9% in the population aged 60 years and older, and less than a third of patients have controlled blood pressure (BP). The use of technologies—mobile phones and the internet—to implement interventions to reduce blood pressure can minimize costs and diminish cardiovascular risk. Interventions through text messaging and electronic BP monitoring present divergent results. Objective: This trial evaluates the effectiveness of interventions—personalized messages and telemonitoring of BP—to reduce systolic BP and improve lifestyle compared to the usual care of patients with hypertension (control group). Methods: This factorial randomized controlled trial enrolls individuals aged 30 to 75 years who have a mobile phone and internet access with the diagnosis of hypertension under drug treatment with up to 2 medications and uncontrolled BP. Eligible participants should have both increased office BP and 24-hour BP with ambulatory BP monitoring. Participants with severe hypertension (systolic BP ≥180 or diastolic BP ≥110 mm Hg), life threatening conditions, low life expectancy, recent major cardiovascular event (last 6 months), other indications for the use of antihypertensive medication, diagnosis of secondary hypertension, pregnant or lactating women, or those unable to understand the interventions are excluded. Participants are randomly allocate to 1 of 4 experimental arms: (1) Telemonitoring of blood pressure (TELEM) group: receives an automatic oscillometric device to measure BP, (2) telemonitoring by text message (TELEMEV) group: receives personalized, standardized text messages to stimulate lifestyle changes and adhere with BP-lowering medication, (3) TELEM-TELEMEV group: receives both interventions, and (4) control group: receives usual clinical treatment (UCT). Data collection is performed in a clinical research center located in a referent hospital. The primary outcomes are reduction of systolic BP assessed by 24-hour ambulatory BP monitoring (primary outcome) and change of lifestyle (based on dietary approaches to stop hypertension (DASH)-type diet, sodium restriction, weight loss or control, increase of physical activity). Results: This study was funded by two Brazilian agencies: the National Council for Scientific and Technological Development and Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul. Enrollment was completed at the end of 2017 (N=231), the follow-up is ongoing, and data analysis is expected to begin in early 2019. A reduction of 24-hour systolic BP of approximately 8.8 [SD 13.1] mm Hg for participants in the BP monitoring group versus 3.4 [SD 11.6] mm Hg in the UCT group is expected. A similar reduction in the text messaging group is expected. Conclusions: The use of mobile technologies connected to the internet through mobile phones promotes time optimization, cost reduction, and better use of public health resources. However, it has not been established whether simple interventions such as text messaging are superior to electronic BP monitoring and whether both outperform conventional counseling. Trial Registration: ClinicalTrials.gov NCT03005470; https://clinicaltrials.gov/ct2/show/NCT03005470 (Archived by WebCite at http://www.webcitation.org/70AoANESu). Plataforma Brasil CAAE 31423214.0.0000.5327. Registered Report Identifier: RR1-10.2196/9619 %M 30087093 %R 10.2196/resprot.9619 %U http://www.researchprotocols.org/2018/8/e169/ %U https://doi.org/10.2196/resprot.9619 %U http://www.ncbi.nlm.nih.gov/pubmed/30087093 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e164 %T mHealth Approaches in Managing Skin Cancer: Systematic Review of Evidence-Based Research Using Integrative Mapping %A Choi,Jihye %A Cho,Youngtae %A Woo,Hyekyung %+ Graduate School of Public Health, Department of Public Health Science, Seoul National University, 1 Kwanak-ro, Kwanak-gu, Seoul, 08826, Republic Of Korea, 82 2 880 2747, hkwoo@snu.ac.kr %K skin cancer %K mHealth %K e-Health %K mobile technology %K teledermatology %K melanoma %D 2018 %7 02.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: mHealth, which encompasses mobile health technologies and interventions, is rapidly evolving in various medical specialties, and its impact is evident in oncology. In particular, mHealth has established itself as a prominent part of dermatology for cancer screening. Intensified research to seek its use and effectiveness in each phase of the skin cancer continuum is needed in this fast-growing field of teledermatology. Objective: The purpose of this review was to describe current trends in research addressing the integration of mHealth and its contributions across the skin cancer continuum. Methods: A systematic review framework was applied to the search using three electronic databases: PubMed, Web of Science, and Embase. We extensively reviewed appropriate studies regarding skin cancer and mobile technology published between 2007 and 2017. Studies of the role and impact of mobile technology in the prevention and management of skin cancer were included. We selected 18 studies adhering to the inclusion and exclusion criteria for analysis. Results: Of the 18 studies, 5 (28%) evaluated prevention interventions, 6 (33%) assessed diagnostic accuracy, and 7 (39%) pertained to feasibility in the context of mHealth approaches for skin cancer care. These studies portray the potential of mobile teledermatology in the prevention and management of skin cancer. However, not all phases of skin cancer involve mHealth, and not all have been addressed by research. Conclusions: This review extends our knowledge not only on the contributions of mHealth technologies, but also on their integration in different phases of skin cancer care. To optimize the effectiveness of mHealth in dermatology, larger numbers of robust, evidence-based studies on teledermatology implementations, distributed evenly across the care continuum, should be conducted so that research can be expanded to systematic reviews. %M 30072362 %R 10.2196/mhealth.8554 %U http://mhealth.jmir.org/2018/8/e164/ %U https://doi.org/10.2196/mhealth.8554 %U http://www.ncbi.nlm.nih.gov/pubmed/30072362 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 8 %P e10444 %T A Multilevel Tailored Web App–Based Intervention for Linking Young Men Who Have Sex With Men to Quality Care (Get Connected): Protocol for a Randomized Controlled Trial %A Bauermeister,José A %A Golinkoff,Jesse M %A Horvath,Keith J %A Hightow-Weidman,Lisa B %A Sullivan,Patrick S %A Stephenson,Rob %+ School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Suite 402, Philadelphia, PA, 19109, United States, 1 (215) 898 9993, bjose@upenn.edu %K HIV infections %K AIDS %K adolescent %K internet %K men who have sex with men %K prevention %K pre-exposure prophylaxis %K awareness %D 2018 %7 02.08.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: HIV epidemic among young men who have sex with men (YMSM) is characterized by strong racial disparities and concerns about the availability and access to culturally appropriate HIV prevention and care service delivery. Get Connected, a Web-based intervention that employs individual- and system-level tailoring technology to reduce barriers to HIV prevention care (eg, HIV or sexually transmitted infection [STI] testing, pre-exposure prophylaxis [PrEP]), was developed for YMSM (age 15-24 years). This protocol details the design and procedures of a 2-phase project that includes mystery shopping and a randomized controlled trial (RCT) to test the efficacy of Get Connected among YMSM in Philadelphia, Atlanta, and Houston. Objective: The objective of mystery shopping is to examine the quality of HIV test counseling and PrEP-related referrals for YMSM within local HIV or STI testing sites. The objective of the RCT is to test the efficacy of Get Connected for increasing HIV-negative or HIV-unknown YMSM’s successful uptake of HIV prevention services (eg, routine HIV or STI testing), PrEP awareness, and likelihood to start PrEP (PrEP willingness), compared with those in the control condition, over a 12-month period. Methods: For Phase 1, we will create a master list of HIV and STI testing sites in each city. We will enroll and train 10-15 mystery shoppers per city; each testing site will be separately visited and assessed by 2 mystery shoppers. After each site visit, the mystery shoppers will complete a site evaluation to record their perceptions of various measures including lesbian, gay, bisexual, transgender, queer visibility and inclusivity, privacy and confidentiality, provider-patient interactions, and clinic environment. For Phase 2, we will enroll 480 YMSM for 12 months across the 3 iTech cities into a 2-arm prospective RCT. Participants randomized to the control condition are directed to the AIDSVu.org testing site locator. Participants randomized to the intervention condition will be granted access to a Web app with content tailored to their specific demographic characteristics (eg, age, race or ethnicity, location, and relationship status), HIV and STI risk behaviors (eg, HIV and STI testing history, substance use, communication with partners regarding status) and sociocultural context (eg, homelessness, incarceration). Study assessments will occur at enrollment and at 1, 3, 6, 9, and 12 months postenrollment. Results: Get Connected research activities began in September 2016 and are ongoing. To date, institutional review board (IRB) submission is complete and IRB authorization agreements are pending at several other universities. Conclusions: The deployment of Get Connected through a mobile-optimized Web app seeks to optimize the intervention’s acceptability, accessibility, availability, and long-term affordability among YMSM. Trial Registration: ClinicalTrials.gov (NCT03132415); https://clinicaltrials.gov/ct2/show/NCT03132415 (Archived by WebCite at http://www.webcitation.org/70j4gSFbZ) Registered Report Identifier: RR1-10.2196/10444 %M 30072358 %R 10.2196/10444 %U http://www.researchprotocols.org/2018/8/e10444/ %U https://doi.org/10.2196/10444 %U http://www.ncbi.nlm.nih.gov/pubmed/30072358 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e10482 %T A Smartphone Game-Based Intervention (Tumaini) to Prevent HIV Among Young Africans: Pilot Randomized Controlled Trial %A Winskell,Kate %A Sabben,Gaëlle %A Akelo,Victor %A Ondeng'e,Ken %A Obong'o,Christopher %A Stephenson,Rob %A Warhol,David %A Mudhune,Victor %+ Rollins School of Public Health, Hubert Department of Global Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 (404)727 5286, swinske@emory.edu %K HIV %K youth %K Sub-Saharan Africa %K Kenya %K serious game %K narrative %K smartphone %K pilot study %K randomized controlled trial %K mhealth %K prevention %D 2018 %7 01.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a pressing need to ensure that youth in high HIV prevalence settings are prepared for a safer sexual debut. Smartphone ownership is increasing dramatically in low-income and middle-income countries. Smartphone games that are appropriately grounded in behavioral theory and evidence-based practice have the potential to become valuable tools in youth HIV prevention efforts in Sub-Saharan Africa. Objective: To pilot-test a theory-based, empirically grounded smartphone game for young Kenyans designed to increase age and condom use at first sex, aiming to establish directionality of effects on behavior change. Methods: Tumaini (“hope for the future” in Swahili) is an interactive, narrative-based game grounded in social cognitive theory. A randomized controlled pilot study was conducted in Kisumu, Western Kenya, from April to June 2017 with 60 participants aged 11-14 (mean 12.7) years. Intervention arm participants (n=30) were provided with an Android smartphone with Tumaini installed on it and were instructed to play the game for at least 1 hour a day for 16 days; control arm participants (n=30) received no intervention. All participants completed a survey on behavioral mediators, delivered via an audio computer-assisted self-interview system at baseline (T1), post intervention (T2), and at 6 weeks postintervention (T3). The postintervention survey for intervention arm participants included questions eliciting feedback on the game. Intervention arm participants and their parents participated in 8 postintervention focus group discussions. Game log files were analyzed to calculate the length of exposure to the game. Behavioral survey data were analyzed using two-sample t tests to compare mean change from T1 to T2 and to T3 for intervention versus control arm participants. Descriptive statistics on game feedback questions were computed. Focus group transcripts were uploaded to MAXQDA software, where they were labeled with deductive and inductive codes. Data were analyzed thematically and compared across demographics. Results: Intervention arm participants played Tumaini for a mean of approximately 27 hours. The intervention arm showed significant gains in sexual health-related knowledge and self-efficacy (both P<.001), behavioral intention for risk-avoidance strategies and sexual risk communication (P=.006), and overall survey scores (P<.001) compared with the control arm at T3. The postintervention survey revealed high subjective measures of the game’s value, relevance, and appeal. Focus groups identified a wide range of knowledge and skills the participants had gained, including setting goals and planning how to achieve them, which was perceived as a key motivator for avoiding or reducing risk. Conclusions: The study supports the need for further research to assess the efficacy of the game-based intervention. If proven efficacious, smartphone games have the potential to dramatically increase the reach of culturally adapted behavioral interventions while ensuring fidelity to intervention design. Trial Registration: ClinicalTrials.gov NCT03054051; http://clinicaltrials.gov/ct2/show/NCT03054051 (Archived by WebCite at http://www.webcitation.org/70U2gCNtW) %M 30068501 %R 10.2196/10482 %U http://mhealth.jmir.org/2018/8/e10482/ %U https://doi.org/10.2196/10482 %U http://www.ncbi.nlm.nih.gov/pubmed/30068501 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 7 %P e10131 %T Using Mobile Phone Sensor Technology for Mental Health Research: Integrated Analysis to Identify Hidden Challenges and Potential Solutions %A Boonstra,Tjeerd W %A Nicholas,Jennifer %A Wong,Quincy JJ %A Shaw,Frances %A Townsend,Samuel %A Christensen,Helen %+ Black Dog Institute, University of New South Wales, Hospital Road, Sydney,, Australia, 61 2 9382 9285, t.boonstra@unsw.edu.au %K passive sensing %K mental health %K ubiquitous computing %K ethics %K depression %K mobile health %K smartphone %K wearable sensors %D 2018 %7 30.07.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile phone sensor technology has great potential in providing behavioral markers of mental health. However, this promise has not yet been brought to fruition. Objective: The objective of our study was to examine challenges involved in developing an app to extract behavioral markers of mental health from passive sensor data. Methods: Both technical challenges and acceptability of passive data collection for mental health research were assessed based on literature review and results obtained from a feasibility study. Socialise, a mobile phone app developed at the Black Dog Institute, was used to collect sensor data (Bluetooth, location, and battery status) and investigate views and experiences of a group of people with lived experience of mental health challenges (N=32). Results: On average, sensor data were obtained for 55% (Android) and 45% (iOS) of scheduled scans. Battery life was reduced from 21.3 hours to 18.8 hours when scanning every 5 minutes with a reduction of 2.5 hours or 12%. Despite this relatively small reduction, most participants reported that the app had a noticeable effect on their battery life. In addition to battery life, the purpose of data collection, trust in the organization that collects data, and perceived impact on privacy were identified as main factors for acceptability. Conclusions: Based on the findings of the feasibility study and literature review, we recommend a commitment to open science and transparent reporting and stronger partnerships and communication with users. Sensing technology has the potential to greatly enhance the delivery and impact of mental health care. Realizing this requires all aspects of mobile phone sensor technology to be rigorously assessed. %M 30061092 %R 10.2196/10131 %U http://www.jmir.org/2018/7/e10131/ %U https://doi.org/10.2196/10131 %U http://www.ncbi.nlm.nih.gov/pubmed/30061092 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e158 %T The Complexity of Mental Health App Privacy Policies: A Potential Barrier to Privacy %A Powell,Adam C %A Singh,Preeti %A Torous,John %+ Payer+Provider Syndicate, 111 Beach Street Suite 4e, Boston, MA 02111, United States, 1 617 939 9168, powell@payerprovider.com %K apps %K privacy %K ethics %K mobile phone %D 2018 %7 30.7.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In 2017, the Supreme Court of India ruled that privacy is a fundamental right of every citizen. Although mobile phone apps have the potential to help people with noncommunicable diseases, such as diabetes and mental illness, they often contain complex privacy policies, which consumers may not understand. This complexity may impede the ability of consumers to make decisions regarding privacy, a critical issue due to the stigma of mental illness. Objective: Our objective is to determine whether mental health apps have more complex privacy policies than diabetes apps. Methods: The study used privacy policies extracted from apps. The apps pertained to diabetes or mental health, and were all of Indian origin. Privacy policy reading complexity was compared between the two types of apps using a series of 15 readability measures. The universe of applicable apps on the Google Play store, as viewed between May and June 2017, was considered. The measures of readability were compared using chi-square tests. Results: No significant difference was found between the privacy policy readability of the diabetes apps versus the mental health apps for each of the measures considered. The mean Flesch-Kincaid Grade Level was 13.9 for diabetes apps and 13.6 for mental health apps; therefore, the mean policy grade level for both types of apps was written at a college level. Privacy policies in the 25th percentile of complexity were also written at a college level for both types of apps. Conclusions: Privacy policy complexity may be a barrier for informed decision making. %M 30061090 %R 10.2196/mhealth.9871 %U http://mhealth.jmir.org/2018/7/e158/ %U https://doi.org/10.2196/mhealth.9871 %U http://www.ncbi.nlm.nih.gov/pubmed/30061090 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e10723 %T Mobile Apps to Support the Self-Management of Hypertension: Systematic Review of Effectiveness, Usability, and User Satisfaction %A Alessa,Tourkiah %A Abdi,Sarah %A Hawley,Mark S %A de Witte,Luc %+ Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, United Kingdom, Sheffield, S1 4DA, United Kingdom, 44 1142224399, l.p.dewitte@sheffield.ac.uk %K mobile phone %K mobile application %K mobile app %K self-management %K hypertension %K blood pressure %D 2018 %7 23.07.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Hypertension is a chronic disease that is considered to be a public health problem and requires efforts by patients to manage themselves. The global growth in the use of mobile phones and tablets has been accompanied by the increased use of health apps. Many of these apps support the self-management of hypertension and, therefore, they have the potential benefits of lowering blood pressure. Despite this, there is currently a lack of evidence for their effectiveness, usability, and patient satisfaction with their use. Objective: A systematic review was conducted to assess the effectiveness of apps in lowering blood pressure, as well as their usability and patients’ satisfaction with their use. Methods: We conducted searches in the following databases: MEDLINE (OVID), EMBASE (OVID), PsycINFO (OVID), CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), IEEE Xplore ASSIAN, Google Scholar and the main Arabic databases Al Manhal, AskZad, and Mandumah. We looked for studies that used apps in the self-management of hypertension from 2008-2016. We also checked the reference lists of the review papers and all the primary studies for additional references. Results: A total of 21 studies with a total of 3112 participants were included in the review. Of the 14 studies that assessed the effectiveness of the apps in lowering blood pressure, 10 (71.4%) studies (6 RCTs and 4 nonrandomized studies) reported that using the apps led to significant decreases in blood pressure and seemed to be effective in the self-management of hypertension. Of these 10, only 2 (20%) RCTs and 3 (30%) nonrandomized studies had a low–moderate risk of bias. The results of this review are inconclusive regarding which combinations of functionalities would be most effective in lowering blood pressure because of variation in the studies’ quality, but the data suggest that apps incorporating more comprehensive functionalities are likely to be more effective. In all the studies that assessed the usability of the apps and users’ acceptance of them, all the apps seemed to be accepted and easy to use. Conclusions: Most of the studies reported that apps might be effective in lowering blood pressure and are accepted by users. However, these findings should be interpreted with caution, as most of the studies had a high risk of bias. More well-designed, large-scale studies are required to evaluate the real effect of using apps in lowering blood pressure and to identify the most effective functionality combinations for lowering blood pressure. %M 30037787 %R 10.2196/10723 %U http://mhealth.jmir.org/2018/7/e10723/ %U https://doi.org/10.2196/10723 %U http://www.ncbi.nlm.nih.gov/pubmed/30037787 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e149 %T Mobile Phone-Based Ecological Momentary Intervention to Reduce Young Adults’ Alcohol Use in the Event: A Three-Armed Randomized Controlled Trial %A Wright,Cassandra %A Dietze,Paul M %A Agius,Paul A %A Kuntsche,Emmanuel %A Livingston,Michael %A Black,Oliver C %A Room,Robin %A Hellard,Margaret %A Lim,Megan SC %+ Burnet Institute, 85 Commercial Road, Melbourne, 3004, Australia, 61 392822173, cassandra.wright@burnet.edu.au %K alcohol %K brief intervention %K ecological momentary assessment %K randomized controlled trial %K mHealth %K mobile phone %K young adults %D 2018 %7 20.07.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Real-time ecological momentary interventions have shown promising effects in domains other than alcohol use; however, only few studies regarding ecological momentary interventions for alcohol use have been conducted thus far. The increasing popularity of smartphones offers new avenues for intervention and innovation in data collection. Objective: We aimed to test the efficacy of an ecological momentary intervention, comprising mobile Web-based ecological momentary assessments (EMAs) and text messaging (short message service, SMS) brief interventions, delivered during drinking events using participants’ mobile phones. Methods: We conducted a three-armed randomized controlled trial to assess the effect of a mobile Web-based ecological momentary assessment with texting feedback on self-reported alcohol consumption and alcohol-related harms in young adults. Participants were enrolled from an existing observational cohort study of young adults screened for risky drinking behavior. The intervention group (ecological momentary intervention group) completed repeated ecological momentary assessments during 6 drinking events and received immediate texting-based feedback in response to each ecological momentary assessment. The second group (ecological momentary assessment group) completed ecological momentary assessments without the brief intervention, and the third did not receive any contact during the trial period. Recent peak risky single-occasion drinking was assessed at the baseline and follow-up using telephone interviews. We used a random effects mixed modeling approach using maximum likelihood estimation to provide estimates of differences in mean drinking levels between groups between baseline and 12-week follow-up. Results: A total of 269 participants were randomized into the 3 groups. The ecological momentary intervention group exhibited a small and nonsignificant increase between baseline and follow-up in (geometric) the mean number of standard drinks consumed at the most recent heavy drinking occasion (mean 12.5 vs 12.7). Both ecological momentary assessment and control groups exhibited a nonsignificant decrease (ecological momentary assessment: mean 13.8 vs 11.8; control: mean 12.3 vs 11.6); these changes did not differ significantly between groups (Wald χ22 1.6; P=.437) and the magnitude of the effects of the intervention were markedly small. No other significant differences between groups on measures of alcohol consumption or related harms were observed. The intervention acceptability was high despite the technical problems in delivery. Conclusions: With a small number of participants, this study showed few effects of an SMS-based brief intervention on peak risky single-occasion drinking. Nevertheless, the study highlights areas for further investigation into the effects of EMI on young adults with heavy alcohol consumption. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616001323415; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369534 (Archived by WebCite at http://www.webcitation.org/7074mqwcs) %M 30030211 %R 10.2196/mhealth.9324 %U http://mhealth.jmir.org/2018/7/e149/ %U https://doi.org/10.2196/mhealth.9324 %U http://www.ncbi.nlm.nih.gov/pubmed/30030211 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e157 %T Leveraging Self-Affirmation to Improve Behavior Change: A Mobile Health App Experiment %A Springer,Aaron %A Venkatakrishnan,Anusha %A Mohan,Shiwali %A Nelson,Lester %A Silva,Michael %A Pirolli,Peter %+ Computer Science Department, University of California Santa Cruz, 1156 High Street, Santa Cruz, CA,, United States, 1 8314590111, alspring@ucsc.edu %K mHealth %K self-affirmation %K behavior change %K attrition %K adherence %K health behavior %K telemedicine %K treatment adherence and compliance %D 2018 %7 19.07.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: mHealth interventions can help to improve the physical well-being of participants. Unfortunately, mHealth interventions often have low adherence and high attrition. One possible way to increase adherence is instructing participants to complete self-affirmation exercises. Self-affirmation exercises have been effective in increasing many types of positive behaviors. However, self-affirmation exercises often involve extensive essay writing, a task that is not easy to complete on mobile platforms. Objective: This study aimed to adapt a self-affirmation exercise to a form better suited for delivery through a mobile app targeting healthy eating behaviors, and to test the effect of differing self-affirmation doses on adherence to behavior change goals over time. Methods: We examined how varied self-affirmation doses affected behavior change in an mHealth app targeting healthy eating that participants used for 28 days. We divided participants into the 4 total conditions using a 2×2 factorial design. The first independent variable was whether the participant received an initial self-affirmation exercise. The second independent variable was whether the participant received ongoing booster self-affirmations throughout the 28-day study. To examine possible mechanisms through which self-affirmation may cause positive behavior change, we analyzed three aspects of self-affirmation effects in our research. First, we analyzed how adherence was affected by self-affirmation exercises. Second, we analyzed whether self-affirmation exercises reduced attrition rates from the app. Third, we examined a model for self-affirmation behavior change. Results: Analysis of 3556 observations from 127 participants indicated that higher doses of self-affirmation resulted in improved adherence to mHealth intervention goals (coefficient 1.42, SE 0.71, P=.04). This increased adherence did not seem to translate to a decrease in participant attrition (P value range .61-.96), although our definition of attrition was conservative. Finally, we examined the mechanisms by which self-affirmation may have affected intentions of behavior change; we built a model of intention (R2=.39, P<.001), but self-affirmation did not directly affect final intentions (P value range .09-.93). Conclusions: Self-affirmations can successfully increase adherence to recommended diet and health goals in the context of an mHealth app. However, this increase in adherence does not seem to reduce overall attrition. The self-affirmation exercises we developed were simple to implement and had a low cost for both users and developers. While this study focused on an mHealth app for healthy eating, we recommend that other mHealth apps integrate similar self-affirmation exercises to examine effectiveness in other behaviors and contexts. %M 30026179 %R 10.2196/mhealth.9151 %U http://mhealth.jmir.org/2018/7/e157/ %U https://doi.org/10.2196/mhealth.9151 %U http://www.ncbi.nlm.nih.gov/pubmed/30026179 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e156 %T Mobile-Based Nutrition Counseling and Unconditional Cash Transfers for Improving Maternal and Child Nutrition in Bangladesh: Pilot Study %A Huda,Tanvir M %A Alam,Ashraful %A Tahsina,Tazeen %A Hasan,Mohammad Mehedi %A Khan,Jasmin %A Rahman,Mohammad Masudur %A Siddique,Abu Bakkar %A Arifeen,Shams El %A Dibley,Michael J %+ Sydney School of Public Health, University of Sydney, Edward Ford Building (A27), Sydney,, Australia, 61 412735284, huda.tanvir@gmail.com %K unconditional cash transfer %K mHealth %K voice message %K undernutrition %D 2018 %7 18.07.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Inappropriate feeding practices, inadequate nutrition knowledge, and insufficient access to food are major risk factors for maternal and child undernutrition. There is evidence to suggest that the combination of cash transfer and nutrition education improves child growth. However, a cost-effective delivery platform is needed to achieve complete, population-wide coverage of these interventions. Objective: This study aimed to assess the feasibility, acceptability, and perceived appropriateness of an intervention package consisting of voice messaging, direct counseling, and unconditional cash transfers all on a mobile platform for changing perceptions on nutrition during pregnancy and the first year of a child’s life in a poor rural community in Bangladesh. Methods: We conducted a mixed-methods pilot study. We recruited 340 pregnant or recently delivered, lactating women from rural Bangladesh. The intervention consisted of an unconditional cash transfer combined with nutrition counseling, both delivered on a mobile platform. The participants received a mobile phone and BDT 787 per month (US $10). We used a voice messaging service to deliver nutrition-related messages. We provided additional nutrition counseling through a nutrition counselor from a call center. We carried out cross-sectional surveys at baseline and at the end of the study, focus group discussions, and in-depth interviews with participants and their family members. Results: Approximately 89% (245/275) of participants reported that they were able to operate the mobile phones without much trouble. Charging of the mobile handsets posed some challenges since only approximately 45% (124/275) households in our study had electricity at home. Approximately 26% (72/275) women reported they had charged their mobile phones at their neighbor’s house, while 34% (94/275) reported that they charged it at a marketplace. Less than 10% (22/275) of women reported difficulties understanding the voice messages or direct counseling through mobile phones, while only 3% (8/275) of women reported they had some problems withdrawing cash from the mobile bank agent. Approximately 87% (236/275) women reported spending the cash to purchase food for themselves and their children. Conclusions: The nature of our study precludes any conclusion about the effectiveness of the intervention package. However, the high coverage of our intervention and the positive feedback from the mothers were encouraging and support the feasibility, acceptability, and appropriateness of this program. Further research is needed to determine the efficacy and cost-effectiveness of mobile-based nutrition counseling and unconditional cash transfers in improving maternal and child nutrition in Bangladesh. %M 30021707 %R 10.2196/mhealth.8832 %U http://mhealth.jmir.org/2018/7/e156/ %U https://doi.org/10.2196/mhealth.8832 %U http://www.ncbi.nlm.nih.gov/pubmed/30021707 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 7 %P e10139 %T Exploring User Needs for a Mobile Behavioral-Sensing Technology for Depression Management: Qualitative Study %A Meng,Jingbo %A Hussain,Syed Ali %A Mohr,David C %A Czerwinski,Mary %A Zhang,Mi %+ Department of Communication, Michigan State University, , East Lansing, MI,, United States, 1 5173553480, jingbome@msu.edu %K mobile sensing %K mental health %K depression %K counseling %K user-centered design %D 2018 %7 17.07.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Today, college students are dealing with depression at some of the highest rates in decades. As the primary mental health service provider, university counseling centers are limited in their capacity and efficiency to provide mental health care due to time constraints and reliance on students’ self-reports. A mobile behavioral-sensing platform may serve as a solution to enhance the efficiency and accessibility of university counseling services. Objective: The main objectives of this study are to (1) understand the usefulness of a mobile sensing platform (ie, iSee) in improving counseling services and assisting students’ self-management of their depression conditions, and (2) explore what types of behavioral targets (ie, meaningful information extracted from raw sensor data) and feedback to deliver from both clinician and students’ perspectives. Methods: We conducted semistructured interviews with 9 clinicians and 12 students with depression recruited from a counseling center at a large Midwestern university. The interviews were 40-50 minutes long and were audio recorded and transcribed. The interview data were analyzed using thematic analysis with an inductive approach. Clinician and student interviews were analyzed separately for comparison. The process of extracting themes involved iterative coding, memo writing, theme revisits, and refinement. Results: From the clinician perspective, the mobile sensing platform helps to improve counseling service by providing objective evidence for clinicians and filling gaps in clinician-patient communication. Clinicians suggested providing students with their sensed behavioral targets organized around personalized goals. Clinicians also recommended delivering therapeutic feedback to students based on their sensed behavioral targets, including positive reinforcement, reflection reminders, and challenging negative thoughts. From the student perspective, the mobile sensing platform helps to ease continued self-tracking practices. Students expressed their need for integrated behavioral targets to understand correlations between behaviors and depression. They also pointed out that they would prefer to avoid seeing negative feedback. Conclusions: Although clinician and student participants shared views on the advantages of iSee in supporting university counseling, they had divergent opinions on the types of behavioral targets and feedback to be provided via iSee. This exploratory work gained initial insights into the design of a mobile sensing platform for depression management and informed a more conclusive research project for the future. %M 30021710 %R 10.2196/10139 %U http://www.jmir.org/2018/7/e10139/ %U https://doi.org/10.2196/10139 %U http://www.ncbi.nlm.nih.gov/pubmed/30021710 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 3 %P e10234 %T Facial-Aging Mobile Apps for Smoking Prevention in Secondary Schools in Brazil: Appearance-Focused Interventional Study %A Bernardes-Souza,Breno %A Patruz Ananias De Assis Pires,Francisco %A Madeira,Gustavo Moreira %A Felício Da Cunha Rodrigues,Túlio %A Gatzka,Martina %A Heppt,Markus V %A Omlor,Albert J %A Enk,Alexander H %A Groneberg,David A %A Seeger,Werner %A von Kalle,Christof %A Berking,Carola %A Corrêa,Paulo César Rodrigues Pinto %A Suhre,Janina Leonie %A Alfitian,Jonas %A Assis,Aisllan %A Brinker,Titus Josef %+ National Center for Tumor Diseases (NCT), Department of Translational Oncology, German Cancer Research Center, Im Neuenheimer Feld 440, Heidelberg, 69120, Germany, 49 +4915175084347, titus.brinker@nct-heidelberg.de %K dermatology %K smoking %K apps %K photoaging %K face %K skin %K tobacco %K tobacco cessation %K tobacco prevention %D 2018 %7 17.07.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Most smokers start smoking during their early adolescence, often with the idea that smoking is glamorous. Interventions that harness the broad availability of mobile phones as well as adolescents' interest in their appearance may be a novel way to improve school-based prevention. A recent study conducted in Germany showed promising results. However, the transfer to other cultural contexts, effects on different genders, and implementability remains unknown. Objective: In this observational study, we aimed to test the perception and implementability of facial-aging apps to prevent smoking in secondary schools in Brazil in accordance with the theory of planned behavior and with respect to different genders. Methods: We used a free facial-aging mobile phone app (“Smokerface”) in three Brazilian secondary schools via a novel method called mirroring. The students’ altered three-dimensional selfies on mobile phones or tablets and images were “mirrored” via a projector in front of their whole grade. Using an anonymous questionnaire, we then measured on a 5-point Likert scale the perceptions of the intervention among 306 Brazilian secondary school students of both genders in the seventh grade (average age 12.97 years). A second questionnaire captured perceptions of medical students who conducted the intervention and its conduction per protocol. Results: The majority of students perceived the intervention as fun (304/306, 99.3%), claimed the intervention motivated them not to smoke (289/306, 94.4%), and stated that they learned new benefits of not smoking (300/306, 98.0%). Only a minority of students disagreed or fully disagreed that they learned new benefits of nonsmoking (4/306, 1.3%) or that they themselves were motivated not to smoke (5/306, 1.6%). All of the protocol was delivered by volunteer medical students. Conclusions: Our data indicate the potential for facial-aging interventions to reduce smoking prevalence in Brazilian secondary schools in accordance with the theory of planned behavior. Volunteer medical students enjoyed the intervention and are capable of complete implementation per protocol. %M 30021713 %R 10.2196/10234 %U http://publichealth.jmir.org/2018/3/e10234/ %U https://doi.org/10.2196/10234 %U http://www.ncbi.nlm.nih.gov/pubmed/30021713 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 7 %P e10174 %T Reducing HIV Vulnerability Through a Multilevel Life Skills Intervention for Adolescent Men (The iREACH Project): Protocol for a Randomized Controlled Trial %A Bauermeister,Jose %A Sullivan,Patrick S %A Gravens,Laura %A Wolfe,James %A Countryman,Kristina %A Smith-Bankhead,Neena %A Drab,Ryan A %A Sallabank,Gregory %A Helms,Jordan D %A Khatibi,Kristie %A Filipowicz,Rebecca %A Horvath,Keith Joseph %A Bonar,Erin %A Castel,Amanda %A Hightow-Weidman,Lisa %A Guest,Jodie %A Stephenson,Rob %+ School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Suite 222L, Philadelphia, PA, 19104, United States, 1 2158989993, bjose@upenn.edu %K prevention %K mHealth %K adolescence %K LGBTQ %K sexuality %K life skills %K HIV %D 2018 %7 10.07.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Few HIV interventions have demonstrated efficacy in reducing HIV risk among adolescent men who have sex with men (AMSM), and fewer still have recognized the unique needs of AMSM based on race/ethnicity or geographical setting. Recognizing that youths’ HIV vulnerability is intricately tied to their development and social context, delivering life skills training during adolescence might delay the onset or reduce the consequences of risk factors for HIV acquisition and equip AMSM with the skills to navigate HIV prevention. This protocol describes the development and testing of iREACH, an online multilevel life skills intervention for AMSM. Objective: This randomized controlled trial (RCT) aims to test the efficacy of an online-delivered life skills intervention, iREACH, on cognitive and behavioral HIV-related outcomes for AMSM. Methods: iREACH is a prospective RCT of approximately 600 cisgender adolescent males aged 13 to 18 years who report same-sex attractions. The intervention will be tested with a racial/ethnically diverse sample (≥50% racial/ethnic minority) of AMSM living in four regions in the United States: (1) Chicago to Detroit, (2) Washington, DC to Atlanta, (3) San Francisco to San Diego, and (4) Memphis to New Orleans. Results: This project is currently recruiting participants. Recruitment began in March 2018. Conclusions: iREACH represents a significant innovation in the development and testing of a tailored life skills-focused intervention for AMSM, and has the potential to fill a significant gap in HIV prevention intervention programming and research for AMSM. Registered Report Identifier: RR1-10.2196/10174 %M 29991470 %R 10.2196/10174 %U http://www.researchprotocols.org/2018/7/e10174/ %U https://doi.org/10.2196/10174 %U http://www.ncbi.nlm.nih.gov/pubmed/29991470 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e10016 %T An Assessment Framework for e-Mental Health Apps in Canada: Results of a Modified Delphi Process %A Zelmer,Jennifer %A van Hoof,Krystle %A Notarianni,MaryAnn %A van Mierlo,Trevor %A Schellenberg,Megan %A Tannenbaum,Cara %+ Canadian Institutes of Health Research, Institute of Gender and Health, 4565 chemin Queen Mary, Montreal, QC, H3W 1W5, Canada, 1 5143129019, krystle.van.hoof@criugm.qc.ca %K mental health %K mobile phone apps %K consensus %K Delphi process %K evaluation framework %K telemedicine %D 2018 %7 09.07.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The number of e-mental health apps is increasing rapidly. Studies have shown that the use of some apps is beneficial, whereas others are ineffective or do not meet users’ privacy expectations. Individuals and organizations that curate, recommend, host, use, or pay for apps have an interest in categorizing apps according to the consensus criteria of usability and effectiveness. Others have previously published recommendations for assessing health-related apps; however, the extent to which these recommendations can be generalized across different population groups (eg, culture, gender, and language) remains unclear. This study describes an attempt by Canadian stakeholders to develop an e-mental health assessment framework that responds to the unique needs of people living in Canada in an evidence-based manner. Objective: The objective of our study was to achieve consensus from a broad group of Canadian stakeholders on guiding principles and criteria for a framework to assess e-mental health apps in Canada. Methods: We developed an initial set of guiding principles and criteria from a rapid review and environmental scan of pre-existing app assessment frameworks. The initial list was refined through a two-round modified Delphi process. Participants (N=25) included app developers and users, health care providers, mental health advocates, people with lived experience of a mental health problem or mental illness, policy makers, and researchers. Consensus on each guideline or criterion was defined a priori as at least 70% agreement. The first round of voting was conducted electronically. Prior to Round 2 voting, in-person presentations from experts and a persona empathy mapping process were used to explore the perspectives of diverse stakeholders. Results: Of all respondents, 68% (17/25) in Round 1 and 100% (13/13) in Round 2 agreed that a framework for evaluating health apps is needed to help Canadian consumers identify high-quality apps. Consensus was reached on 9 guiding principles: evidence based, gender responsive, culturally appropriate, user centered, risk based, internationally aligned, enabling innovation, transparent and fair, and based on ethical norms. In addition, 15 informative and evaluative criteria were defined to assess the effectiveness, functionality, clinical applicability, interoperability, usability, transparency regarding security and privacy, security or privacy standards, supported platforms, targeted users, developers’ transparency, funding transparency, price, user desirability, user inclusion, and meaningful inclusion of a diverse range of communities. Conclusions: Canadian mental health stakeholders reached the consensus on a framework of 9 guiding principles and 15 criteria important in assessing e-mental health apps. What differentiates the Canadian framework from other scales is explicit attention to user inclusion at all stages of the development, gender responsiveness, and cultural appropriateness. Furthermore, an empathy mapping process markedly influenced the development of the framework. This framework may be used to inform future mental health policies and programs. %M 29986846 %R 10.2196/10016 %U http://mhealth.jmir.org/2018/7/e10016/ %U https://doi.org/10.2196/10016 %U http://www.ncbi.nlm.nih.gov/pubmed/29986846 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e151 %T An mHealth Intervention for Persons with Diabetes Type 2 Based on Acceptance and Commitment Therapy Principles: Examining Treatment Fidelity %A Nes,Andréa Aparecida Gonçalves %A van Dulmen,Sandra %A Brembo,Espen Andreas %A Eide,Hilde %+ Faculty of Nursing, Lovisenberg Diaconal University College, Lovisenberggt 15b, Oslo, 0456, Norway, 47 21981673090, andreanes@msn.com %K diabetes mellitus type 2 %K Acceptance and Commitment Therapy %K mobile phone %K Web-based %K treatment fidelity %K mHealth %D 2018 %7 03.07.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Web-based interventions are becoming an alternative of treatment aimed to support behavioral changes and several advantages over traditional treatments are reported. New ways of delivering an intervention may result in new challenges regarding monitoring of treatment fidelity (TF) which is essential to ensure internal and external validity. Despite the importance of the theme, only a few studies in this field are reported. Objective: To examine TF of a mobile phone delivered intervention based on Acceptance and Commitment Therapy (ACT) with electronic diaries and written situational feedback for persons with diabetes mellitus type 2, the recommendations from the Behavior Change Consortium (BCC) established by The National Institutes of Health (NHI) were applied. To analyze fidelity, they recommend 5 areas to be investigated (1) design of the study, (2) provider training, (3) delivery of treatment, (4) receipt of treatment, and (5) enactment of treatment. In the current study, these areas were examined based on the analysis of therapists’ adherence to the treatment protocol and participants’ and therapists’ experience with the intervention. Methods: To investigate the therapists’ adherence to the treatment protocol, a total of 251 written feedback text messages were divided into text segments. Qualitative thematic analyses were then performed to examine how ACT and other therapeutic processes were used in the feedback by the therapists. For the therapists’ and participants’ experience analysis, participants answered a self-reported questionnaire and participated in 2 interviews. The therapists continuously reported their experiences to the researcher responsible for the project. Results: The results show high adherence to the TF strategies 20/21 (95%) applicable items of the fidelity checklist recommended by NHI BCC were identified in the present study. Measured provider skill acquisition post-training was the only item absent in the fidelity checklist. The results also show high therapists’ adherence to the treatment protocol. All ACT processes (values, committed action, acceptance, contact with the present moment, self as context and cognitive defusion) were found in the coded text segments of the feedback in addition to communication and motivation strategies. For 336/730 (46%) of total possible text segments coded independently by 2 researchers, the interrater reliability measured by Cohen’s kappa was .85. The evaluation of participants’ and therapists’ experience with the intervention was generally positive. Conclusions: Based on the analyses of therapists’ adherence to the treatment protocol grounded by ACT-principles and participants’ and therapists’ experience with the intervention, the 5 areas of TF recommended by NHI BCC were analyzed indicating a high level of TF. These results ensure an appropriate level of internal and external validity of the study and reliable intervention results and facilitate a precise replication of this intervention concept. Web-based psychological interventions to support people with chronic conditions are becoming increasingly more common. This study supports the results from a previous study which indicated that ACT could be reliably delivered in a written web-based format. Trial Registration: ClinicalTrials.gov NCT01297049; https://clinicaltrials.gov/ct2/show/NCT01297049 (Archived by WebCite at http://www.webcitation.org/70WC4Cm4T) %M 29970357 %R 10.2196/mhealth.9942 %U http://mhealth.jmir.org/2018/7/e151/ %U https://doi.org/10.2196/mhealth.9942 %U http://www.ncbi.nlm.nih.gov/pubmed/29970357 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e150 %T Association Between Self-Reported and Objective Activity Levels by Demographic Factors: Ecological Momentary Assessment Study in Children %A Zink,Jennifer %A Belcher,Britni R %A Dzubur,Eldin %A Ke,Wangjing %A O'Connor,Sydney %A Huh,Jimi %A Lopez,Nanette %A Maher,Jaclyn P %A Dunton,Genevieve F %+ Department of Preventive Medicine, University of Southern California, 2001 North Soto Street, Third Floor, Los Angeles, CA, 90032, United States, 1 323 442 8224, dunton@usc.edu %K sedentary behavior %K physical activity %K measurement %K mobile devices %K children %D 2018 %7 28.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To address the limitations of the retrospective self-reports of activity, such as its susceptibility to recall bias, researchers have shifted toward collecting real-time activity data on mobile devices via ecological momentary assessment (EMA). Although EMA is becoming increasingly common, it is not known how EMA self-reports of physical activity and sedentary behaviors relate to the objective measures of activity or whether there are factors that may influence the strength of association between these two measures. Understanding the relationship between EMA and accelerometry can optimize future instrument selection in studies assessing activity and health outcomes. Objective: The aim of this study was to examine the associations between EMA-reported sports or exercise using the accelerometer-measured moderate-to-vigorous physical activity (MVPA) and EMA-reported TV, videos, or video games with the accelerometer-measured sedentary time (ST) in children during matched 2-h windows and test potential moderators. Methods: Children (N=192; mean age 9.6 years; 94/192, 49.0% male; 104/192, 54.2% Hispanic; and 73/192, 38.0% overweight or obese) wore an accelerometer and completed up to 7 EMA prompts per day for 8 days during nonschool time, reporting on past 2-h sports or exercise and TV, videos, or video games. Multilevel models were used to assess the relationship between the accelerometer-measured ST and EMA-reported TV, videos, or video games. Given the zero-inflated distribution of MVPA, 2-part models were used assess the relationship between the accelerometer-measured MVPA and EMA-reported sports or exercise. Results: EMA-reported TV, videos, or video games were associated with a greater accelerometer-measured ST (beta=7.3, 95% CI 5.5 to 9.0, P<.001). This relationship was stronger in boys (beta=9.9, 95% CI 7.2 to 12.6, P<.001) than that in girls (beta=4.9, 95% CI 2.6 to 7.2, P≤.001). EMA-reported sports or exercise was associated with a greater accelerometer-measured MVPA (zero portion P<.001; positive portion P<.001). This relationship was stronger on weekends, in older children, and in non-Hispanic children (zero portion all P values<.001; positive portion all P values<.001). Conclusions: EMA reports highly relate to accelerometer measures. However, the differences in the strength of association depending on various demographic characteristics suggest that future research should use both EMA and accelerometers to measure activity to collect complementary activity data. %M 29954723 %R 10.2196/mhealth.9592 %U http://mhealth.jmir.org/2018/6/e150/ %U https://doi.org/10.2196/mhealth.9592 %U http://www.ncbi.nlm.nih.gov/pubmed/29954723 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e146 %T Effectiveness of a Text Messaging–Based Intervention Targeting Alcohol Consumption Among University Students: Randomized Controlled Trial %A Thomas,Kristin %A Müssener,Ulrika %A Linderoth,Catharina %A Karlsson,Nadine %A Bendtsen,Preben %A Bendtsen,Marcus %+ Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, 58183, Sweden, 46 733140708, marcus.bendtsen@liu.se %K alcohol consumption intervention %K text message-based intervention %K university students %K brief intervention %D 2018 %7 25.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Excessive drinking among university students is a global challenge, leading to significant health risks. However, heavy drinking among students is widely accepted and socially normalized. Mobile phone interventions have attempted to reach students who engage in excessive drinking. A growing number of studies suggest that text message–based interventions could potentially reach many students and, if effective, such an intervention might help reduce heavy drinking in the student community. Objective: The objective of this study was to test the effectiveness of a behavior change theory–based 6-week text message intervention among university students. Methods: This study was a two-arm, randomized controlled trial with an intervention group receiving a 6-week text message intervention and a control group that was referred to treatment as usual at the local student health care center. Outcome measures were collected at baseline and at 3 months after the initial invitation to participate in the intervention. The primary outcome was total weekly alcohol consumption. Secondary outcomes were frequency of heavy episodic drinking, highest estimated blood alcohol concentration, and number of negative consequences attributable to excessive drinking. Results: A total of 896 students were randomized to either the intervention or control group. The primary outcome analysis included 92.0% of the participants in the intervention group and 90.1% of the control group. At follow-up, total weekly alcohol consumption decreased in both groups, but no significant between-group difference was seen. Data on the secondary outcomes included 49.1% of the participants in the intervention group and 41.3% of the control group. No significant between-group difference was seen for any of the secondary outcomes. Conclusions: The present study was under-powered, which could partly explain the lack of significance. However, the intervention, although theory-based, needs to be re-assessed and refined to better support the target group. Apart from establishing which content forms an effective intervention, the optimal length of an alcohol intervention targeting students also needs to be addressed in future studies. Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN95054707; http://www.isrctn.com/ISRCTN95054707 (Archived by WebCite at http://www.webcitation.org/70Ax4vXhd) %M 29941417 %R 10.2196/mhealth.9642 %U http://mhealth.jmir.org/2018/6/e146/ %U https://doi.org/10.2196/mhealth.9642 %U http://www.ncbi.nlm.nih.gov/pubmed/29941417 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e10253 %T Patient Experiences Using a Self-Monitoring App in Eating Disorder Treatment: Qualitative Study %A Lindgreen,Pil %A Lomborg,Kirsten %A Clausen,Loa %+ Research Unit, Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Skovagervej 2, Entrance 81, Risskov, 8240, Denmark, 45 21511756, pillin@rm.dk %K feeding and eating disorders %K anorexia nervosa %K bulimia nervosa %K mental health %K psychiatry %K mHealth %K mobile applications %K self-monitoring %K blended treatment %K eating disorder treatment %D 2018 %7 22.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Recovery Record smartphone app is a self-monitoring tool for individuals recovering from an eating disorder. Unlike traditional pen-and-paper meal diaries, which are often used in eating disorder treatment, the app holds novel features, such as meal reminders, affirmations, and patient-clinician in-app linkage, the latter allowing for clinicians to continuously monitor patients' app data. Objective: To explore patients' experiences with using Recovery Record as part of outpatient eating disorder treatment. Methods: A total of 41 patients from a Danish eating disorder treatment facility were included in the study. All 41 patients participated in participant observations of individual or group treatment sessions, and 26 were interviewed about their experiences with using the app in treatment. The data material was generated and analyzed concurrently, applying the inductive methodology of Interpretive Description. Results: The patients' experiences with Recovery Record depended on its app features, the impact of these features on patients, and their specific app usage. This patient-app interaction affected and was affected by changeable contexts making patients' experiences dynamic. The patient-app interaction affected patients' placement of specific Recovery Record app features along a continuum from supportive to obstructive of individual everyday life activities including the eating disorder treatment. As an example, some patients found it supportive being notified by their clinician when their logs had been monitored as it gave them a sense of relatedness. Contrarily, other patients felt under surveillance, which was obstructive, as it made them feel uneasy or even dismissing the app. Conclusions: Some patients experienced the app and its features as mostly supportive of their everyday life and the eating disorder treatment, while others experienced it primarily as obstructive. When applying apps in eating disorder treatment, we therefore recommend that patients and clinicians collaborate to determine how the app in question best fits the capacities, preferences, and treatment needs of the individual patient. Thus, we encourage patients and clinicians to discuss how specific features of the applied app affect the individual patient to increase the use of supportive features, while limiting the use of obstructive ones. %M 29934285 %R 10.2196/10253 %U http://mhealth.jmir.org/2018/6/e10253/ %U https://doi.org/10.2196/10253 %U http://www.ncbi.nlm.nih.gov/pubmed/29934285 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e10042 %T Applying Natural Language Processing to Understand Motivational Profiles for Maintaining Physical Activity After a Mobile App and Accelerometer-Based Intervention: The mPED Randomized Controlled Trial %A Fukuoka,Yoshimi %A Lindgren,Teri G %A Mintz,Yonatan Dov %A Hooper,Julie %A Aswani,Anil %+ Department of Physiological Nursing/Institute for Health & Aging, School of Nursing, University of California, San Francisco, 2 Koret Way, N631, San Francisco, CA, 94143, United States, 1 (415) 476 8419, Yoshimi.Fukuoka@ucsf.edu %K mobile apps %K physical activity %K fitness trackers %K women %K maintenance %K accelerometer %K randomized controlled trial %K motivation %K barriers %K behavioral change %D 2018 %7 20.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Regular physical activity is associated with reduced risk of chronic illnesses. Despite various types of successful physical activity interventions, maintenance of activity over the long term is extremely challenging. Objective: The aims of this original paper are to 1) describe physical activity engagement post intervention, 2) identify motivational profiles using natural language processing (NLP) and clustering techniques in a sample of women who completed the physical activity intervention, and 3) compare sociodemographic and clinical data among these identified cluster groups. Methods: In this cross-sectional analysis of 203 women completing a 12-month study exit (telephone) interview in the mobile phone-based physical activity education study were examined. The mobile phone-based physical activity education study was a randomized, controlled trial to test the efficacy of the app and accelerometer intervention and its sustainability over a 9-month period. All subjects returned the accelerometer and stopped accessing the app at the last 9-month research office visit. Physical engagement and motivational profiles were assessed by both closed and open-ended questions, such as “Since your 9-month study visit, has your physical activity been more, less, or about the same (compared to the first 9 months of the study)?” and, “What motivates you the most to be physically active?” NLP and cluster analysis were used to classify motivational profiles. Descriptive statistics were used to compare participants’ baseline characteristics among identified groups. Results: Approximately half of the 2 intervention groups (Regular and Plus) reported that they were still wearing an accelerometer and engaging in brisk walking as they were directed during the intervention phases. These numbers in the 2 intervention groups were much higher than the control group (overall P=.01 and P=.003, respectively). Three clusters were identified through NLP and named as the Weight Loss group (n=19), the Illness Prevention group (n=138), and the Health Promotion group (n=46). The Weight Loss group was significantly younger than the Illness Prevention and Health Promotion groups (overall P<.001). The Illness Prevention group had a larger number of Caucasians as compared to the Weight Loss group (P=.001), which was composed mostly of those who identified as African American, Hispanic, or mixed race. Additionally, the Health Promotion group tended to have lower BMI scores compared to the Illness Prevention group (overall P=.02). However, no difference was noted in the baseline moderate-to-vigorous intensity activity level among the 3 groups (overall P>.05). Conclusions: The findings could be relevant to tailoring a physical activity maintenance intervention. Furthermore, the findings from NLP and cluster analysis are useful methods to analyze short free text to differentiate motivational profiles. As more sophisticated NL tools are developed in the future, the potential of NLP application in behavioral research will broaden. Trial Registration: ClinicalTrials.gov NCT01280812; https://clinicaltrials.gov/ct2/show/NCT01280812 (Archived by WebCite at http://www.webcitation.org/70IkGagAJ) %M 29925491 %R 10.2196/10042 %U http://mhealth.jmir.org/2018/6/e10042/ %U https://doi.org/10.2196/10042 %U http://www.ncbi.nlm.nih.gov/pubmed/29925491 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e145 %T Using the Habit App for Weight Loss Problem Solving: Development and Feasibility Study %A Pagoto,Sherry %A Tulu,Bengisu %A Agu,Emmanuel %A Waring,Molly E %A Oleski,Jessica L %A Jake-Schoffman,Danielle E %+ Institute for Collaboration on Health, Intervention, and Policy, Department of Allied Health Sciences, University of Connecticut, 2006 Hillside Road, Storrs, CT, 06269, United States, 1 860 486 2313, Sherry.Pagoto@uconn.edu %K mobile app %K mHealth %K weight loss %K obesity %K problem solving %D 2018 %7 20.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Reviews of weight loss mobile apps have revealed they include very few evidence-based features, relying mostly on self-monitoring. Unfortunately, adherence to self-monitoring is often low, especially among patients with motivational challenges. One behavioral strategy that is leveraged in virtually every visit of behavioral weight loss interventions and is specifically used to deal with adherence and motivational issues is problem solving. Problem solving has been successfully implemented in depression mobile apps, but not yet in weight loss apps. Objective: This study describes the development and feasibility testing of the Habit app, which was designed to automate problem-solving therapy for weight loss. Methods: Two iterative single-arm pilot studies were conducted to evaluate the feasibility and acceptability of the Habit app. In each pilot study, adults who were overweight or obese were enrolled in an 8-week intervention that included the Habit app plus support via a private Facebook group. Feasibility outcomes included retention, app usage, usability, and acceptability. Changes in problem-solving skills and weight over 8 weeks are described, as well as app usage and weight change at 16 weeks. Results: Results from both pilots show acceptable use of the Habit app over 8 weeks with on average two to three uses per week, the recommended rate of use. Acceptability ratings were mixed such that 54% (13/24) and 73% (11/15) of participants found the diet solutions helpful and 71% (17/24) and 80% (12/15) found setting reminders for habits helpful in pilots 1 and 2, respectively. In both pilots, participants lost significant weight (P=.005 and P=.03, respectively). In neither pilot was an effect on problem-solving skills observed (P=.62 and P=.27, respectively). Conclusions: Problem-solving therapy for weight loss is feasible to implement in a mobile app environment; however, automated delivery may not impact problem-solving skills as has been observed previously via human delivery. Trial Registration: ClinicalTrials.gov NCT02192905; https://clinicaltrials.gov/ct2/show/NCT02192905 (Archived by WebCite at http://www.webcitation.org/6zPQmvOF2) %M 29925496 %R 10.2196/mhealth.9801 %U http://mhealth.jmir.org/2018/6/e145/ %U https://doi.org/10.2196/mhealth.9801 %U http://www.ncbi.nlm.nih.gov/pubmed/29925496 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e10292 %T A Newly Designed Mobile-Based Computerized Cognitive Addiction Therapy App for the Improvement of Cognition Impairments and Risk Decision Making in Methamphetamine Use Disorder: Randomized Controlled Trial %A Zhu,Youwei %A Jiang,Haifeng %A Su,Hang %A Zhong,Na %A Li,Runji %A Li,Xiaotong %A Chen,Tianzhen %A Tan,Haoye %A Du,Jiang %A Xu,Ding %A Yan,Huan %A Xu,Dawen %A Zhao,Min %+ Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030, China, 86 2154252689, drminzhao@gmail.com %K methamphetamine %K methamphetamine use disorder %K cognitive function %K impulse control %K risk decision making %K attention bias %D 2018 %7 20.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cognitive rehabilitation therapy has been found to improve cognitive deficits and impulse control problems in methamphetamine use disorder (MUD). However, there is limited research regarding this therapy’s feasibility when using mobile-based health technologies in supporting recovery from MUD in China. Objective: The main aim of this study was to test whether 4 weeks of a newly designed computerized cognitive addiction therapy (CCAT) app can improve cognitive impairments, eliminate drug-related attention bias, and attenuate risk decision-making behaviors in participants with MUD. Methods: Forty MUD participants were assigned randomly to either the CCAT group (n=20), who received 4 weeks of CCAT plus regular detoxification treatment as usual, or the control group (n=20), who only received the regular detoxification treatment as usual, in drug rehabilitation centers in Shanghai. The CCAT was designed by combine methamphetamine use-related picture stimuli with cognitive training with the aim of improving cognitive function and eliminating drug-related attention bias. The CogState Battery, Delay Discounting Task (DDT), Iowa Gambling Task (IGT), and Balloon Analog Risk Task (BART) were administered face-to-face to all participants before and after CCAT interventions. Results: Forty male patients were recruited. The mean age was 32.70 (SD 5.27) years in the CCAT group and mean 35.05 (SD 8.02) years in the control group. Compared to the control group, CCAT improved working memory in the CCAT group (P=.01). Group×time interactions were observed among DDT, IGT, and BART tasks, with rates of discounting delayed rewards, IGT, and BART scores (P<.001) being reduced among those who received CCAT, whereas no changes were found in the control group. Conclusions: The newly designed CCAT can help to improve cognitive impairment and impulsive control in MUD. Further study is needed to understand the underlying brain mechanisms of the cognitive therapy. Trial Registration: ClinicalTrials.gov NCT03318081; https://clinicaltrials.gov/ct2/show/NCT03318081 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT03318081) %M 29925497 %R 10.2196/10292 %U http://mhealth.jmir.org/2018/6/e10292/ %U https://doi.org/10.2196/10292 %U http://www.ncbi.nlm.nih.gov/pubmed/29925497 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 6 %P e158 %T Workshop on Emerging Technology and Data Analytics for Behavioral Health %A Kotz,David %A Lord,Sarah E %A O'Malley,A James %A Stark,Luke %A Marsch,Lisa A %+ Department of Computer Science, Dartmouth College, 6211 Sudikoff, Hanover, NH, 03755, United States, 1 603 646 1439, David.F.Kotz@dartmouth.edu %K behavioral health %K mobile technology %K wearable devices %K data analytics %K mHealth %D 2018 %7 20.06.2018 %9 Viewpoint %J JMIR Res Protoc %G English %X Wearable and portable digital devices can support self-monitoring for patients with chronic medical conditions, individuals seeking to reduce stress, and people seeking to modify health-related behaviors such as substance use or overeating. The resulting data may be used directly by a consumer, or shared with a clinician for treatment, a caregiver for assistance, or a health coach for support. The data can also be used by researchers to develop and evaluate just-in-time interventions that leverage mobile technology to help individuals manage their symptoms and behavior in real time and as needed. Such wearable systems have huge potential for promoting delivery of anywhere-anytime health care, improving public health, and enhancing the quality of life for many people. The Center for Technology and Behavioral Health at Dartmouth College, a P30 “Center of Excellence” supported by the National Institute on Drug Abuse at the National Institutes of Health, conducted a workshop in February 2017 on innovations in emerging technology, user-centered design, and data analytics for behavioral health, with presentations by a diverse range of experts in the field. The workshop focused on wearable and mobile technologies being used in clinical and research contexts, with an emphasis on applications in mental health, addiction, and health behavior change. In this paper, we summarize the workshop panels on mobile sensing, user experience design, statistics and machine learning, and privacy and security, and conclude with suggested research directions for this important and emerging field of applying digital approaches to behavioral health. Workshop insights yielded four key directions for future research: (1) a need for behavioral health researchers to work iteratively with experts in emerging technology and data analytics, (2) a need for research into optimal user-interface design for behavioral health technologies, (3) a need for privacy-oriented design from the beginning of a novel technology, and (4) the need to develop new analytical methods that can scale to thousands of individuals and billions of data points. %M 29925493 %R 10.2196/resprot.9589 %U http://www.researchprotocols.org/2018/6/e158/ %U https://doi.org/10.2196/resprot.9589 %U http://www.ncbi.nlm.nih.gov/pubmed/29925493 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e10528 %T Multicomponent mHealth Intervention for Large, Sustained Change in Multiple Diet and Activity Risk Behaviors: The Make Better Choices 2 Randomized Controlled Trial %A Spring,Bonnie %A Pellegrini,Christine %A McFadden,H G %A Pfammatter,Angela Fidler %A Stump,Tammy K %A Siddique,Juned %A King,Abby C %A Hedeker,Donald %+ Feinberg School of Medicine, Northwestern University, Department of Preventive Medicine, 680 N Lakeshore Drive, Suite 1400, Chicago, IL, 60611, United States, 1 312 503 6579, bspring@northwestern.edu %K health behavior %K risk factors %K mobile health %K behavioral medicine %K randomized controlled trial %D 2018 %7 19.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Prevalent co-occurring poor diet and physical inactivity convey chronic disease risk to the population. Large magnitude behavior change can improve behaviors to recommended levels, but multiple behavior change interventions produce small, poorly maintained effects. Objective: The Make Better Choices 2 trial tested whether a multicomponent intervention integrating mHealth, modest incentives, and remote coaching could sustainably improve diet and activity. Methods: Between 2012 and 2014, the 9-month randomized controlled trial enrolled 212 Chicago area adults with low fruit and vegetable and high saturated fat intakes, low moderate to vigorous physical activity (MVPA) and high sedentary leisure screen time. Participants were recruited by advertisements to an open-access website, screened, and randomly assigned to either of two active interventions targeting MVPA simultaneously with, or sequentially after other diet and activity targets (N=84 per intervention) or a stress and sleep contact control intervention (N=44). They used a smartphone app and accelerometer to track targeted behaviors and received personalized remote coaching from trained paraprofessionals. Perfect behavioral adherence was rewarded with an incentive of US $5 per week for 12 weeks. Diet and activity behaviors were measured at baseline, 3, 6, and 9 months; primary outcome was 9-month diet and activity composite improvement. Results: Both simultaneous and sequential interventions produced large, sustained improvements exceeding control (P<.001), and brought all diet and activity behaviors to guideline levels. At 9 months, the interventions increased fruits and vegetables by 6.5 servings per day (95% CI 6.1-6.8), increased MVPA by 24.7 minutes per day (95% CI 20.0-29.5), decreased sedentary leisure by 170.5 minutes per day (95% CI –183.5 to –157.5), and decreased saturated fat intake by 3.6% (95% CI –4.1 to –3.1). Retention through 9-month follow-up was 82.1%. Self-monitoring decreased from 96.3% of days at baseline to 72.3% at 3 months, 63.5% at 6 months, and 54.6% at 9 months (P<.001). Neither attrition nor decline in self-monitoring differed across intervention groups. Conclusions: Multicomponent mHealth diet and activity intervention involving connected coaching and modest initial performance incentives holds potential to reduce chronic disease risk. Trial Registration: ClinicalTrials.gov NCT01249989; https://clinicaltrials.gov/ct2/show/NCT01249989 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT01249989). %M 29921561 %R 10.2196/10528 %U http://www.jmir.org/2018/6/e10528/ %U https://doi.org/10.2196/10528 %U http://www.ncbi.nlm.nih.gov/pubmed/29921561 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e144 %T How New and Expecting Fathers Engage With an App-Based Online Forum: Qualitative Analysis %A White,Becky K %A Giglia,Roslyn C %A Scott,Jane A %A Burns,Sharyn K %+ Collaboration for Evidence, Research and Impact in Public Health, Curtin University, GPO Box U1987, Bentley, Perth, 6845, Australia, 61 8 9266 4123, s.burns@curtin.edu.au %K mHealth %K mobile app %K breastfeeding %K fathers %K online communities %D 2018 %7 18.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Breastfeeding is important for infants, and fathers are influential in supporting their partner in their decision to breastfeed and how long they breastfeed for. Fathers can feel excluded from traditional antenatal education and support opportunities but highly value social support from peers. Online health forums can be a useful source of social support, yet little is known about how fathers would use a conversation forum embedded in a breastfeeding-focused app. Milk Man is a mobile app that aimed to increase paternal support for breastfeeding using a range of strategies, including a conversation forum. Objective: The aim of this study was to examine how fathers used a breastfeeding-focused conversation forum contained within a mobile app throughout the perinatal period. Methods: A qualitative analysis of comments posted by users in the online forum contained within the Milk Man app was conducted. The app contained a library of information for fathers, as well as a conversation forum. Thematic analysis was used to organize and understand the data. The NVivo 11 software package was used to code comments into common nodes, which were then organized into key themes. Results: In all, 208 contributors (35.5% [208/586] of those who had access to the app) posted at least once within the forum. In total, 1497 comments were included for analysis. These comments were coded to 3799 individual nodes and then summarized to 54 tree nodes from which four themes emerged to describe how fathers used the app. Themes included seek and offer support, social connection, informational support provision, and sharing experiences. Posting in the forum was concentrated in the antenatal period and up to approximately 6 weeks postpartum. Conclusions: These data show that fathers are prepared to use a breastfeeding-focused online forum in a variety of ways to facilitate social support. Fathers can be difficult to reach in the perinatal period, yet engaging them and increasing social support is important. This research demonstrates the acceptability of an innovative way of engaging new and expecting fathers. %M 29914862 %R 10.2196/mhealth.9999 %U http://mhealth.jmir.org/2018/6/e144/ %U https://doi.org/10.2196/mhealth.9999 %U http://www.ncbi.nlm.nih.gov/pubmed/29914862 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e143 %T Analysis of the Features Important for the Effectiveness of Physical Activity–Related Apps for Recreational Sports: Expert Panel Approach %A Dallinga,Joan %A Janssen,Mark %A van der Werf,Jet %A Walravens,Ruben %A Vos,Steven %A Deutekom,Marije %+ Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Dr Meurerlaan 8, Amsterdam, 1067 SM, Netherlands, 31 621156682, j.m.dallinga@hva.nl %K mobile applications %K exercise %K healthy lifestyle %K mHealth %K measures %K health behavior %K features %D 2018 %7 18.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A large number of people participate in individual or unorganized sports on a recreational level. Furthermore, many participants drop out because of injury or lowered motivation. Potentially, physical activity–related apps could motivate people during sport participation and help them to follow and maintain a healthy active lifestyle. It remains unclear what the quality of running, cycling, and walking apps is and how it can be assessed. Quality of these apps was defined as having a positive influence on participation in recreational sports. This information will show which features need to be assessed when rating physical activity–related app quality. Objective: The aim of this study was to identify expert perception on which features are important for the effectiveness of physical activity–related apps for participation in individual, recreational sports. Methods: Data were gathered via an expert panel approach using the nominal group technique. Two expert panels were organized to identify and rank app features relevant for sport participation. Experts were researchers or professionals in the field of industrial design and information technology (technology expert panel) and in the field of behavior change, health, and human movement sciences who had affinity with physical activity–related apps (health science expert panel). Of the 24 experts who were approached, 11 (46%) agreed to participate. Each panel session consisted of three consultation rounds. The 10 most important features per expert were collected. We calculated the frequency of the top 10 features and the mean importance score per feature (0-100). The sessions were taped and transcribed verbatim; a thematic analysis was conducted on the qualitative data. Results: In the technology expert panel, applied feedback and feedforward (91.3) and fun (91.3) were found most important (scale 0-100). Together with flexibility and look and feel, these features were mentioned most often (all n=4 [number of experts]; importance scores=41.3 and 43.8, respectively). The experts in the health science expert panels a and b found instructional feedback (95.0), motivating or challenging (95.0), peer rating and use (92.0), motivating feedback (91.3), and monitoring or statistics (91.0) most important. Most often ranked features were monitoring or statistics, motivating feedback, works good technically, tailoring starting point, fun, usability anticipating or context awareness, and privacy (all n=3-4 [number of experts]; importance scores=16.7-95.0). The qualitative analysis resulted in four overarching themes: (1) combination behavior change, technical, and design features needed; (2) extended feedback and tailoring is advised; (3) theoretical or evidence base as standard; and (4) entry requirements related to app use. Conclusions: The results show that a variety of features, including design, technical, and behavior change, are considered important for the effectiveness of physical activity–related apps by experts from different fields of expertise. These insights may assist in the development of an improved app rating scale. %M 29914863 %R 10.2196/mhealth.9459 %U http://mhealth.jmir.org/2018/6/e143/ %U https://doi.org/10.2196/mhealth.9459 %U http://www.ncbi.nlm.nih.gov/pubmed/29914863 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e10409 %T Electronic 12-Hour Dietary Recall (e-12HR): Comparison of a Mobile Phone App for Dietary Intake Assessment With a Food Frequency Questionnaire and Four Dietary Records %A Béjar,Luis María %A Reyes,Óscar Adrián %A García-Perea,María Dolores %+ Department of Preventive Medicine and Public Health, School of Medicine, University of Seville, Institute of Anatomy, 3rd Floor, Sánchez-Pizjuán Avenue, Seville, 41009, Spain, 34 954551771, lmbprado@us.es %K dietary assessment %K food frequency questionnaire %K 24-hour dietary recalls %K dietary record %K mobile phone app %D 2018 %7 15.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: One of the greatest challenges in nutritional epidemiology is improving upon traditional self-reporting methods for the assessment of habitual dietary intake. Objective: The aim of this study was to evaluate the relative validity of a new method known as the current-day dietary recall (or current-day recall), based on a smartphone app called 12-hour dietary recall, for determining the habitual intake of a series of key food and drink groups using a food frequency questionnaire (FFQ) and four dietary records as reference methods. Methods: University students over the age of 18 years recorded their consumption of certain groups of food and drink using 12-hour dietary recall for 28 consecutive days. During this 28-day period, they also completed four dietary records on randomly selected days. Once the monitoring period was over, subjects then completed an FFQ. The two methods were compared using the Spearman correlation coefficient (SCC), a cross-classification analysis, and weighted kappa. Results: A total of 87 participants completed the study (64% women, 56/87; 36% men, 31/87). For e-12HR versus FFQ, for all food and drink groups, the average SCC was 0.70. Cross-classification analysis revealed that the average percentage of individuals classified in the exact agreement category was 51.5%; exact agreement + adjacent was 91.8%, and no participant (0%) was classified in the extreme disagreement category. The average weighted kappa was 0.51. For e-12HR versus the four dietary records, for all food and drink groups, the average SCC was 0.63. Cross-classification analysis revealed that the average percentage of individuals classified in the exact agreement category was 47.1%; exact agreement + adjacent was 89.2%; and no participant (0%) was classified in the extreme disagreement category. The average weighted kappa was 0.47. Conclusions: Current-day recall, based on the 12-hour dietary recall app, was found to be in good agreement with the two reference methods (FFQ & four dietary records), demonstrating its potential usefulness for categorizing individuals according to their habitual dietary intake of certain food and drink groups. %M 29907555 %R 10.2196/10409 %U http://mhealth.jmir.org/2018/6/e10409/ %U https://doi.org/10.2196/10409 %U http://www.ncbi.nlm.nih.gov/pubmed/29907555 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e10024 %T Effective Behavioral Changes through a Digital mHealth App: Exploring the Impact of Hedonic Well-Being, Psychological Empowerment and Inspiration %A Lin,Yuting %A Tudor-Sfetea,Carina %A Siddiqui,Sarim %A Sherwani,Yusuf %A Ahmed,Maroof %A Eisingerich,Andreas B %+ Imperial College Business School, Imperial College London, South Kensington Campus, London, SW7 2AZ, United Kingdom, 44 207 594 7850, y.lin14@imperial.ac.uk %K mHealth %K gamification %K cognitive behavioral therapy %K empowerment %K well-being %K inspiration %K mobile app %K behavior change and prevention %K digital %D 2018 %7 15.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: New mobile health (mHealth) software apps are emerging and are providing the foundation to radically transform the practice and reach of medical research and care. For this study we collaborated with Quit Genius, a cognitive behavioral therapy (CBT) based mHealth app that helps users quit smoking, to explore the effective design of a digital mHealth app; one that delivers important benefits to its users and helps them change their behaviors for a healthier lifestyle. Objective: The specific aims of this study were to (1) explore the key role of CBT program progress, (2) examine the gamification design app elements that deliver significant benefits (ie, empowerment, well-being, inspiration) to users, (3) explore the effectiveness of these app elements to help users quit smoking or reduce the number of cigarettes smoked, and (4) identify and describe any potential drivers and hindrances arising from the app design elements. Methods: We developed an online survey and sent an email invitation to 4144 individuals, who had previously or were at the time using the Quit Genius mHealth app, to encourage participation in the study. We matched the online survey data with objective app usage data of the study participants. Results: A dataset of 190 completed responses was used. At the time of the survey, respondents had completed an average of 60% of the CBT program in the Quit Genius mHealth app. Of the respondents, 36.3% (69/190) noted to have quit smoking successfully after using the Quit Genius app. As for those who remained smokers after using the app (N=121), the number of cigarettes smoked per day was significantly reduced by 59.6%. The ability of the app to enhance users’ hedonic well-being and psychologically empower them in their daily lives was identified as being key in helping users quit smoking. Specifically, the results show that users whose well-being was enhanced through the app were 1.72 times more likely to quit smoking successfully. Moreover, a one-unit increase on a 7-point Likert scale in the app’s ability to empower smokers in their daily lives led to a reduction of cigarettes smoked per day of 53%. The app’s inspiration to users, however, was negatively associated with quitting success and the reduction in cigarette smoked per day. Conclusions: The findings offer important insights for the effective design of digital mHealth apps. Specifically, we find that perceived psychological empowerment and enhanced hedonic well-being from the mobile solution may be a more impactful way to support the effectiveness of mobile cognitive behavioral therapy for smoking cessation than eliciting strong inspiration. %M 29907557 %R 10.2196/10024 %U http://mhealth.jmir.org/2018/6/e10024/ %U https://doi.org/10.2196/10024 %U http://www.ncbi.nlm.nih.gov/pubmed/29907557 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e10316 %T Characterizing Geosocial-Networking App Use Among Young Black Men Who Have Sex With Men: A Multi-City Cross-Sectional Survey in the Southern United States %A Duncan,Dustin T %A Park,Su Hyun %A Hambrick,H Rhodes %A Dangerfield II,Derek T %A Goedel,William C %A Brewer,Russell %A Mgbako,Ofole %A Lindsey,Joseph %A Regan,Seann D %A Hickson,DeMarc A %+ Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, 227 East 30th Street, Room 621, New York, NY, 10016, United States, 1 646 501 2674, dustin.duncan@nyumc.org %K HIV prevention %K black MSM %K dating apps %K homosexuality %K male %K men who have sex with men %K mobile apps %K mobile phones %D 2018 %7 14.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Understanding where and how young black men who have sex with men (YBMSM) in the southern United States meet their sexual partners is germane to understanding the underlying factors contributing to the ongoing HIV transmission in this community. Men who have sex with men (MSM) commonly use geosocial networking apps to meet sexual partners. However, there is a lack of literature exploring geosocial networking app use in this particular population. Objective: Our aim was to examine the characteristics, preferences, and behaviors of a geographically diverse sample of geosocial networking app-using YBMSM in the southern United States. Methods: Data were collected from a sample of 75 YBMSM across three cities (Gulfport, Mississippi; Jackson, Mississippi; and New Orleans, Louisiana). Multiple aspects of geosocial networking app use were assessed, including overall app use, age of participant at first app use, specific apps used, reasons for app use, photos presented on apps, logon times and duration, number of messages sent and received, and characteristics of and behaviors with partners met on apps. Survey measures of app-met partner and sexual behavior characteristics assessed at midpoint (Day 7) and completion visits (Day 14) were compared using McNemar’s test or Wilcoxon signed-rank test. In addition, we assessed activity spaces derived from GPS devices that participants wore for 2 weeks. Results: Of the 70 participants who responded to the overall app-use item, almost three-quarters (53/70, 76%) had ever used geosocial networking apps. Jack’d was the most commonly used geosocial networking app (37/53, 70%), followed by Adam4Adam (22/53, 42%), and Grindr (19/53, 36%). The mean and median number of apps used were 4.3 (SD 2.7) and 4.0 (range 0-13), respectively. Most app-using participants displayed their face on the profile picture (35/52, 67%), whereas fewer displayed their bare legs (2/52, 4%) or bare buttocks (or ass; 2/52, 4%). The mean age at the initiation of app use was 20.1 years (SD 2.78) ranging from 13-26 years. Two-thirds (35/53, 66%) of the sample reported using the apps to “kill time” when bored. A minority (9/53, 17%) reported using the apps to meet people to have sex/hook up with. The vast majority of participants reported meeting black partners for sex. Over two-thirds (36/53, 68%) reported that the HIV status of their app-met partners was negative, and 26% (14/53) reported that they did not know their partner’s HIV status. There was a significant difference in GPS activity spaces between app using YBMSM compared to nonapp using YBMSM (2719.54 km2 vs 1855.68 km2, P=.011). Conclusions: Use of geosocial networking apps to meet sexual partners among our sample of YBMSM in the southern United States was common, with a diverse range of app use behaviors being reported. Further research should characterize the association between geosocial networking app use and engagement in sexual behaviors that increase risk for HIV acquisition and transmission. In addition, geosocial networking apps present a promising platform for HIV prevention interventions targeting YBMSM who use these apps. %M 29903702 %R 10.2196/10316 %U http://mhealth.jmir.org/2018/6/e10316/ %U https://doi.org/10.2196/10316 %U http://www.ncbi.nlm.nih.gov/pubmed/29903702 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e10141 %T Discovery of and Interest in Health Apps Among Those With Mental Health Needs: Survey and Focus Group Study %A Schueller,Stephen M %A Neary,Martha %A O'Loughlin,Kristen %A Adkins,Elizabeth C %+ Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, CBITs, Chicago, IL, 60614, United States, 1 312 503 1232, schueller@northwestern.edu %K mHealth %K mental health %K mobile apps %K consumer preference %K focus groups %D 2018 %7 11.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: A large number of health apps are available directly to consumers through app marketplaces. Little information is known, however, about how consumers search for these apps and which factors influence their uptake, adoption, and long-term use. Objective: The aim of this study was to understand what people look for when they search for health apps and the aspects and features of those apps that consumers find appealing. Methods: Participants were recruited from Northwestern University’s Center for Behavioral Intervention Technologies’ research registry of individuals with mental health needs. Most participants (n=811) completed a survey asking about their use and interest in health and mental health apps. Local participants were also invited to participate in focus groups. A total of 7 focus groups were conducted with 30 participants that collected more detailed information about their use and interest in health and mental health apps. Results: Survey participants commonly found health apps through social media (45.1%, 366/811), personal searches (42.7%, 346/811), or word of mouth (36.9%, 299/811), as opposed to professional sources such as medical providers (24.6%, 200/811). From the focus groups, common themes related to uptake and use of health apps included the importance of personal use before adoption, specific features that users found desirable, and trusted sources either developing or promoting the apps. Conclusions: As the number of mental health and health apps continue to increase, it is imperative to better understand the factors that impact people’s adoption and use of such technologies. Our findings indicated that a number of factors—ease of use, aesthetics, and individual experience—drove adoption and use and highlighted areas of focus for app developers and disseminators. %M 29891468 %R 10.2196/10141 %U http://www.jmir.org/2018/6/e10141/ %U https://doi.org/10.2196/10141 %U http://www.ncbi.nlm.nih.gov/pubmed/29891468 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e134 %T The Crush the Crave Quit Smoking App and Young Adult Smokers: Qualitative Case Study of Affordances %A Struik,Laura L %A Bottorff,Joan L %A Baskerville,Neill Bruce %A Oliffe,John L %+ Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 2508647879, laura.struik@uwaterloo.ca %K smartphone %K smoking cessation %K young adult %K qualitative research %K social theory %D 2018 %7 08.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone apps have emerged as a promising way to reach young adult smokers, given their high mobile phone ownership rates and openness to receiving cessation support via digital technologies. Although emerging evidence indicates that quit smoking apps are an effective way to reduce smoking among young adults, lacking is formative evaluative research that captures the perspectives of end-users. Objective: The objective of this study was to contribute insights toward understanding how young adults interact with the Crush the Crave (CTC) app, and how this interaction shapes young adults’ smoking cessation experiences and practices, with consideration of the influence of gender. Methods: Semistructured interviews were conducted with 31 young adult CTC end-users. Guided by sociomateriality theory and an affordances approach, data were inductively analyzed to derive thematic findings in relation to the impacts of CTC on quit efforts, and to expose the underlying affordances (mechanisms) that lend to these outcomes. Findings were grouped according to the 4 design components of CTC: credibility, social support, task support, and dialogue support. Results: The credibility component of CTC played an important role in harnessing the trust of young adults because it afforded them promise in relation to its potential effectiveness in assisting them with quitting smoking. The social support component lent to various end-user practices and experiences that rendered this aspect as the weakest component in supporting quit efforts. Although most functions situated in the task and dialogue support components were found to be helpful, there were a few affordances in CTC that resulted in negative experiences, notably weaning from smoking. Gender-related influences were also evident. For example, young men preferred to control and self-manage their quitting and, therefore, did not engage with functions that afforded journaling or reminding to stay on track. Women, in contrast, were more likely to benefit from these affordances. Conclusions: An affordances approach is productive for gaining an in-depth understanding of how mobile apps interact with end-users to lend to particular outcomes. The study findings have implications for developing and improving apps for helping young adults quit smoking, as well as apps that target other health behaviors. Productive affordances may also serve as a framework for leveraging apps for smoking cessation. %M 29884602 %R 10.2196/mhealth.9489 %U http://mhealth.jmir.org/2018/6/e134/ %U https://doi.org/10.2196/mhealth.9489 %U http://www.ncbi.nlm.nih.gov/pubmed/29884602 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 2 %P e11 %T A Mobile Game to Support Smoking Cessation: Prototype Assessment %A Raiff,Bethany R %A Fortugno,Nicholas %A Scherlis,Daniel R %A Rapoza,Darion %+ Health and Behavioral Integrated Treatments Research Unit, Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, United States, 1 856 256 4500 ext 53782, raiff@rowan.edu %K smoking %K smoking cessation %K contingency management %K mobile apps %K virtual rewards %K health games %K video games %K digital games %K carbon monoxide %K incentives %D 2018 %7 07.06.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Cigarette smoking results in an estimated seven million deaths annually. Almost half of all smokers attempt to quit each year, yet only approximately 6% are successful. Although there are multiple effective interventions that can increase these odds, substantial room remains for improvement. One effective approach to helping smokers quit is contingency management, where quitting is incentivized with the delivery of monetary rewards in exchange for objective evidence (eg, exhaled carbon monoxide levels) of abstinence. Objective: We assessed the feasibility and promise of Inspired, a contingency management mobile app for smoking cessation that uses game-based rewards to incentivize abstinence from smoking instead of the monetary (or material) rewards typically used. We sought participant feedback and limited objective data on: the features and design of Inspired, interest in using Inspired when it becomes available, the likelihood of Inspired being an effective cessation aid, and the rank order preference of Inspired relative to other familiar smoking cessation aids. Methods: Twenty-eight treatment-seeking smokers participated in this study. Participants attended a single one-hour session in which they received an overview of the goals of the Inspired mobile game, practiced submitting breath carbon monoxide (CO) samples, and played representative levels of the game. Participants were then told that they could play an extra level, or they could stop, complete an outcome survey, receive payment, and be dismissed. A sign-up sheet requesting personal contact information was available for those who wished to be notified when the full version of Inspired becomes available. Results: Using binary criteria for endorsement, participants indicated that, assuming it was currently available and fully developed, they would be more likely to use Inspired than: any other smoking cessation aid (21/28, 75%), the nicotine patch (23/28, 82%), a drug designed to reduce smoking cravings (23/28, 82%), or a program involving attendance in training sessions or support group meetings (27/28, 96%). In the questionnaire, participants indicated that both the Inspired program (26/28, 93%) and the Inspired game would be “Fun” (28/28, 100%), and 71% (20/28) reported that the program would help them personally quit smoking. Fifty-eight percent of participants (15/26) chose to continue playing the game rather than immediately collecting payment for participation and leaving. Eighty-two percent of participants (23/28) signed up to be notified when the full version of Inspired becomes available. Conclusions: This was the first study to evaluate a game-based contingency management app that uses game-based virtual goods as rewards for smoking abstinence. The outcomes suggest that the completed app has potential to be an effective smoking cessation aid that would be widely adopted by smokers wishing to quit. %R 10.2196/games.9599 %U http://games.jmir.org/2018/2/e11/ %U https://doi.org/10.2196/games.9599 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e139 %T Smartphone Apps for Mindfulness Interventions for Suicidality in Asian Youths: Literature Review %A Choo,Carol C %A Burton,André AD %+ James Cook University, 149 Sims Drive, Singapore,, Singapore, 65 67093760, carol.choo@jcu.edu.au %K suicidality %K Asian youths %K smartphone applications %K mindfulness %D 2018 %7 07.06.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The advent of mobile technology has ushered in an era in which smartphone apps can be used as interventions for suicidality. Objective: We aimed to review recent research that is relevant to smartphone apps that can be used for mindfulness interventions for suicidality in Asian youths. Methods: The inclusion criteria for this review were: papers published in peer-reviewed journals from 2007 to 2017 with usage of search terms (namely “smartphone application” and “mindfulness”) and screened by an experienced Asian clinician to be of clinical utility for mindfulness interventions for suicidality with Asian youths. Results: The initial search of databases yielded 375 results. Fourteen full text papers that fit the inclusion criteria were assessed for eligibility and 10 papers were included in the current review. Conclusions: This review highlighted the paucity of evidence-based and empirically validated research into effective smartphone apps that can be used for mindfulness interventions for suicidality with Asian youths. %R 10.2196/mhealth.8304 %U http://mhealth.jmir.org/2018/6/e139/ %U https://doi.org/10.2196/mhealth.8304 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e131 %T Sleep Tracking and Exercise in Patients With Type 2 Diabetes Mellitus (Step-D): Pilot Study to Determine Correlations Between Fitbit Data and Patient-Reported Outcomes %A Weatherall,James %A Paprocki,Yurek %A Meyer,Theresa M %A Kudel,Ian %A Witt,Edward A %+ Kantar Health, 700 Dresher Road, Suite 200, Horsham, PA, 19044, United States, 1 484 442 1415, Theresa.Meyer@kantarhealth.com %K Fitbit charge HR %K type 2 diabetes mellitus %K sleep %K health outcomes %K health behaviors %D 2018 %7 05.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Few studies assessing the correlation between patient-reported outcomes and patient-generated health data from wearable devices exist. Objective: The aim of this study was to determine the direction and magnitude of associations between patient-generated health data (from the Fitbit Charge HR) and patient-reported outcomes for sleep patterns and physical activity in patients with type 2 diabetes mellitus (T2DM). Methods: This was a pilot study conducted with adults diagnosed with T2DM (n=86). All participants wore a Fitbit Charge HR for 14 consecutive days and completed internet-based surveys at 3 time points: day 1, day 7, and day 14. Patient-generated health data included minutes asleep and number of steps taken. Questionnaires assessed the number of days of exercise and nights of sleep problems per week. Means and SDs were calculated for all data, and Pearson correlations were used to examine associations between patient-reported outcomes and patient-generated health data. All respondents provided informed consent before participating. Results: The participants were predominantly middle-aged (mean 54.3, SD 13.3 years), white (80/86, 93%), and female (50/86, 58%). Use of oral T2DM medication correlated with the number of mean steps taken (r=.35, P=.001), whereas being unaware of the glycated hemoglobin level correlated with the number of minutes asleep (r=−.24, P=.04). On the basis of the Fitbit data, participants walked an average of 4955 steps and slept 6.7 hours per day. They self-reported an average of 2.0 days of exercise and 2.3 nights of sleep problems per week. The association between the number of days exercised and steps walked was strong (r=.60, P<.001), whereas the association between the number of troubled sleep nights and minutes asleep was weaker (r=.28, P=.02). Conclusions: Fitbit and patient-reported data were positively associated for physical activity as well as sleep, with the former more strongly correlated than the latter. As extensive patient monitoring can guide clinical decisions regarding T2DM therapy, passive, objective data collection through wearables could potentially enhance patient care, resulting in better patient-reported outcomes. %R 10.2196/mhealth.8122 %U http://mhealth.jmir.org/2018/6/e131/ %U https://doi.org/10.2196/mhealth.8122 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 2 %P e37 %T Development and Validation of a Functional Behavioural Assessment Ontology to Support Behavioural Health Interventions %A Merlo,Gianluca %A Chiazzese,Giuseppe %A Taibi,Davide %A Chifari,Antonella %+ Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, Via Ugo La Malfa 153, Palermo, 90146, Italy, 39 0916809207, gianluca.merlo@itd.cnr.it %K ontology %K behavioral interventions %K functional behavioral assessment %K eHealth care %K evidence-based practice %D 2018 %7 31.05.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: In the cognitive-behavioral approach, Functional Behavioural Assessment is one of the most effective methods to identify the variables that determine a problem behavior. In this context, the use of modern technologies can encourage the collection and sharing of behavioral patterns, effective intervention strategies, and statistical evidence about antecedents and consequences of clusters of problem behaviors, encouraging the designing of function-based interventions. Objective: The paper describes the development and validation process used to design a specific Functional Behavioural Assessment Ontology (FBA-Ontology). The FBA-Ontology is a semantic representation of the variables that intervene in a behavioral observation process, facilitating the systematic collection of behavioral data, the consequential planning of treatment strategies and, indirectly, the scientific advancement in this field of study. Methods: The ontology has been developed deducing concepts and relationships of the ontology from a gold standard and then performing a machine-based validation and a human-based assessment to validate the Functional Behavioural Assessment Ontology. These validation and verification processes were aimed to verify how much the ontology is conceptually well founded and semantically and syntactically correct. Results: The Pellet reasoner checked the logical consistency and the integrity of classes and properties defined in the ontology, not detecting any violation of constraints in the ontology definition. To assess whether the ontology definition is coherent with the knowledge domain, human evaluation of the ontology was performed asking 84 people to fill in a questionnaire composed by 13 questions assessing concepts, relations between concepts, and concepts’ attributes. The response rate for the survey was 29/84 (34.52%). The domain experts confirmed that the concepts, the attributes, and the relationships between concepts defined in the FBA-Ontology are valid and well represent the Functional Behavioural Assessment process. Conclusions: The new ontology developed could be a useful tool to design new evidence-based systems in the Behavioral Interventions practices, encouraging the link with other Linked Open Data datasets and repositories to provide users with new models of eHealth focused on the management of problem behaviors. Therefore, new research is needed to develop and implement innovative strategies to improve the poor reproducibility and translatability of basic research findings in the field of behavioral assessment. %R 10.2196/medinform.7799 %U http://medinform.jmir.org/2018/2/e37/ %U https://doi.org/10.2196/medinform.7799 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e11 %T Feasibility of a Proactive Text Messaging Intervention for Smokers in Community Health Centers: Pilot Study %A Kruse,Gina %A Kelley,Jennifer HK %A Chase,Karen %A Rigotti,Nancy A %+ Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA, 02114, United States, 1 6177243157, gkruse@partners.org %K smoking cessation %K primary health care %K text messaging %D 2018 %7 31.05.2018 %9 Short Paper %J JMIR Formativ Res %G English %X Background: Few smokers receive evidence-based cessation services during primary care visits. Objective: We aimed to assess the feasibility of a proactive text messaging program for primary care patients who smoke. Methods: We used electronic health records to identify smokers who had a mobile phone number listed from two community health centers in Massachusetts. Between March 2014 and June 2015, patients were screened by their primary care physician and then sent a proactive text message inviting them to enroll by texting back. Patients who opted in were asked about their readiness to quit. The text message program included messages from the QuitNowTXT library and novel content for smokers who were not ready to quit. Results: Among 949 eligible smokers, 88 (9.3%) enrolled after receiving a single proactive text message. Compared with those who did not enroll, enrollees were more often female (54/88, 61% vs 413/861, 48.0%, P=.02), but otherwise did not differ in age, race, insurance status, or comorbidities. In all, 28% (19/67) of enrollees reported they were not ready to quit in the next 30 days, 61% (41/67) were ready to quit, and 11% (7/67) already quit. The median time in the program was 9 days (interquartile range 2-32 days). Of current smokers, 25% (15/60) sent one or more keyword requests to the server. These did not differ by readiness to quit. Conclusions: A proactively delivered text messaging program targeting primary care patients who smoke was feasible and engaged both smokers ready to quit and those not ready to quit. This method shows promise as part of a population health model for addressing tobacco use outside of the primary care office. %R 10.2196/formative.9608 %U http://formative.jmir.org/2018/1/e11/ %U https://doi.org/10.2196/formative.9608 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e10425 %T Mobile Phone Intervention to Reduce Youth Suicide in Rural Communities: Field Test %A Pisani,Anthony R %A Wyman,Peter A %A Gurditta,Kunali %A Schmeelk-Cone,Karen %A Anderson,Carolyn L %A Judd,Emily %+ Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Box PSYC, 300 Crittenden Boulevard, Rochester, NY, 14642, United States, 1 (585) 275 3644, anthony_pisani@urmc.rochester.edu %K suicide prevention %K school-based program %K text messaging %K school health services %D 2018 %7 31.05.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Suicide is a leading cause of death among 10- to 19-year-olds in the United States, with 5% to 8% attempting suicide each year. Suicide risk rises significantly during early adolescence and is higher in rural and underserved communities. School-based universal prevention programs offer a promising way of reducing suicide by providing strategies for emotion regulation and encouraging help-seeking behaviors and youth-adult connectedness. However, such programs frequently run into difficulties in trying to engage a broad range of students. Text messaging is a dominant medium of communication among youths, and studies show both efficacy and uptake in text messaging interventions aimed at adolescents. Text-based interventions may, thus, offer a means for school-based universal prevention programs to engage adolescents who would otherwise be difficult to reach. Objective: We field tested Text4Strength, an automated, interactive text messaging intervention that seeks to reach a broad range of early adolescents in rural communities. Text4Strength extends Sources of Strength, a peer-led school suicide prevention program, by encouraging emotion regulation, help-seeking behaviors, and youth-adult connectedness in adolescents. The study tested the appeal and feasibility of Text4Strength and its potential to extend universal school-based suicide prevention. Methods: We field tested Text4Strength with 42 ninth-grade students. Over 9 weeks, students received 28 interactive message sequences across 9 categories (Sources of Strength introduction, positive friend, mentors, family support, healthy activities, generosity, spirituality, medical access, and emotion regulation strategies). The message sequences included games, requests for advice, questions about students’ own experiences, and peer testimonial videos. We measured baseline mental health characteristics, frequency of replies, completion of sequences and video viewing, appeal to students, and their perception of having benefited from the program. Results: Of the 42 participating students, 38 (91%) responded to at least one sequence and 22 (52%) responded to more than a third of the sequences. The proportion of students who completed multistep sequences they had started ranged from 35% (6/17) to 100% (3/3 to 28/28), with responses dropping off when more than 4 replies were needed. With the exception of spirituality and generosity, each of the content areas generated at least a moderate number of student replies from both boys and girls. Students with higher and lower levels of risk and distress interacted with the sequences at similar rates. Contrary to expectations, few students watched videos. Students viewed the intervention as useful—even those who rarely responded to messages. More than 70% found the texts useful (3 items, n range 29-34) and 90% (36) agreed the program should be repeated. Conclusions: Text4Strength offers a potentially engaging way to extend school-based interventions that promote protective factors for suicide. Text4Strength is ready to be revised, based on findings and student feedback from this field test, and rigorously tested for efficacy. %R 10.2196/10425 %U http://mental.jmir.org/2018/2/e10425/ %U https://doi.org/10.2196/10425 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 5 %P e148 %T A Participatory Health Promotion Mobile App Addressing Alcohol Use Problems (The Daybreak Program): Protocol for a Randomized Controlled Trial %A Tait,Robert J %A Kirkman,Jessica J L %A Schaub,Michael P %+ National Drug Research Institute, Faculty of Health Sciences, Curtin University, 7 Parker Place, Bentley, GPO Box U1987, Perth, 6845, Australia, 61 92661610, robert.tait@curtin.edu.au %K alcohol drinking %K internet %K evaluation studies %K social marketing %K health promotion %D 2018 %7 31.05.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: At-risk patterns of alcohol use are prevalent in many countries with significant costs to individuals, families, and society. Screening and brief interventions, including with Web delivery, are effective but with limited translation into practice to date. Previous observational studies of the Hello Sunday Morning approach have found that their unique Web-based participatory health communication method has resulted in a reduction of at-risk alcohol use between baseline and 3 months. The Hello Sunday Morning blog program asks participants to publicly set a personal goal to stop drinking or reduce their consumption for a set period of time, and to record their reflections and progress on blogs and social networks. Daybreak is Hello Sunday Morning’s evidence-based behavior change program, which is designed to support people looking to change their relationship with alcohol. Objective: This study aims to systematically evaluate different versions of Hello Sunday Morning’s Daybreak program (with and without coaching support) in reducing at-risk alcohol use. Methods: We will use a between groups randomized control design. New participants enrolling in the Daybreak program will be eligible to be randomized to receive either (1) the Daybreak program, including peer support plus behavioral experiments (these encourage and guide participants in developing new skills in the areas of mindfulness, connectedness, resilience, situational strategies, and health), or (2) the Daybreak program, including the same peer support plus behavioral experiments, but with online coaching support. We will recruit 467 people per group to detect an effect size of f=0.10. To be eligible, participants must be resident in Australia, aged ≥18 years, score ≥8 on the alcohol use disorders identification test (AUDIT), and not report prior treatment for cardiovascular disease. Results: The primary outcome measure will be reduction in the AUDIT-Consumption (AUDIT-C) scores. Secondary outcomes include mental health (Kessler’s K-10), days out of role (Kessler), alcohol consumed (measured with a 7-day drinking diary in standard 10 g drinks), and alcohol-related harms (CORE alcohol and drug survey). We will collect data at baseline and 1, 3, and 6 months and analyze them with random effects models, given the correlated data structure. Conclusions: A randomized trial is required to provide robust evidence of the impact of the online coaching component of the Daybreak program, including over an extended period. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000010291; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373110 (Archived by WebCite at http://www.webcitation.org/6zKRmp0aC) Registered Report Identifier: RR1-10.2196/9982 %R 10.2196/resprot.9982 %U http://www.researchprotocols.org/2018/5/e148/ %U https://doi.org/10.2196/resprot.9982 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e130 %T Mobile Health Solutions for Hypertensive Disorders in Pregnancy: Scoping Literature Review %A Rivera-Romero,Octavio %A Olmo,Alberto %A Muñoz,Rocío %A Stiefel,Pablo %A Miranda,María Luisa %A Beltrán,Luis M %+ Department of Electronic Technology, Universidad de Sevilla, avda. Reina Mercedes s/n, ETSI Informática, Sevilla, 41012, Spain, 34 954554325, orivera@us.es %K pregnancy %K hypertension %K pre-eclampsia %K blood pressure %K telemedicine %D 2018 %7 30.05.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Hypertensive disorders are the most common complications during pregnancy, occurring in 5% to 11% of pregnancies; gestational hypertension and preeclampsia are the leading causes of perinatal and maternal morbidity and mortality, especially in low- and middle-income countries (LMIC) where maternal and perinatal mortality ratios are still high. Pregnant women with hypertensive disorders could greatly benefit from mobile health (mHealth) solutions as a novel way to identify and control early symptoms, as shown in an increasing number of publications in the field. Such digital health solutions may overcome access limiting factors and the lack of skilled medical professionals and finances commonly presented in resource-poor environments. Objective: The aim of this study was to conduct a literature review of mHealth solutions used as support in hypertensive disorders during pregnancy, with the objective to identify the most relevant protocols and prototypes that could influence and improve current clinical practice. Methods: A methodological review following a scoping methodology was conducted. Manuscripts published in research journals reporting technical information of mHealth solutions for hypertensive disorders in pregnancy were included, categorizing articles in different groups: Diagnosis and Monitoring, mHealth Decision Support System, Education, and Health Promotion, and seven research questions were posed to study the manuscripts. Results: The search in electronic research databases yielded 327 articles. After removing duplicates, 230 articles were selected for screening. Finally, 11 articles met the inclusion criteria, and data were extracted from them. Very positive results in the improvement of maternal health and acceptability of solutions were found, although most of the studies involved a small number of participants, and none were complete clinical studies. Accordingly, none of the reported prototypes were integrated in the different health care systems. Only 4 studies used sensors for physiological measurements, and only 2 used blood pressure sensors despite the importance of this physiological parameter in the control of hypertension. The reported mHealth solutions have great potential to improve clinical practice in areas lacking skilled medical professionals or with a low health care budget, of special relevance in LMIC, although again, no extensive clinical validation has been carried out in these environments. Conclusions: mHealth solutions hold enormous potential to support hypertensive disorders during pregnancy and improve current clinical practice. Although very positive results have been reported in terms of usability and the improvement of maternal health, rigorous complete clinical trials are still necessary to support integration in health care systems. There is a clear need for simple mHealth solutions specifically developed for resource-poor environments that meet the United Nations Sustainable Development Goal (SDG); of enormous interest in LMIC. %R 10.2196/mhealth.9671 %U http://mhealth.jmir.org/2018/5/e130/ %U https://doi.org/10.2196/mhealth.9671 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 5 %P e146 %T Optimizing Gestational Weight Gain With the Eating4Two Smartphone App: Protocol for a Randomized Controlled Trial %A Davis,Deborah %A Davey,Rachel %A Williams,Lauren T %A Foureur,Maralyn %A Nohr,Ellen %A Knight-Agarwal,Catherine %A Lawlis,Tanya %A Oats,Jeremy %A Skouteris,Helen %A Fuller-Tyszkiewicz,Matthew %+ University of Canberra, University Drive, Belconnen Australian Capital Territory, Canberra, 2617, Australia, 61 2606 3869, deborah.davis@canberra.edu.au %K smartphone %K technology %K prenatal care %K pregnancy %K weight gain %D 2018 %7 30.05.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Approximately 50% of women gain excessive weight in pregnancy. Optimizing gestational weight gain is important for the short- and long-term health of the childbearing woman and her baby. Despite this, there is no recommendation for routine weighing in pregnancy, and weight is a topic that many maternity care providers avoid. Resource-intensive interventions have mainly targeted overweight and obese women with variable results. Few studies have examined the way that socioeconomic status might influence the effectiveness or acceptability of an intervention to participants. Given the scale of the problem of maternal weight gain, maternity services will be unlikely to sustain resource intensive interventions; therefore, innovative strategies are required to assist women to manage weight gain in pregnancy. Objective: The primary aim of the trial was to examine the effectiveness of the Eating4Two smartphone app in assisting women of all body mass index categories to optimize gestational weight gain. Secondary aims include comparing childbirth outcomes and satisfaction with antenatal care and examining the way that relative advantage and disadvantage might influence engagement with and acceptability of the intervention. Methods: This randomized controlled trial will randomize 1330 women to control or intervention groups in 3 regions of different socioeconomic status. Women will be recruited from clinical and social media sites. The intervention group will be provided with access to the Eating4Two mobile phone app which provides nutrition and dietary information specifically tailored for pregnancy, advice on food serving sizes, and a graph that illustrates women’s weight change in relation to the range recommended by the Institute of Medicine. Women will be encouraged to use the app to prompt conversations with their maternity care providers about weight gain in pregnancy. The control group will receive routine antenatal care. Results: Recruitment has commenced though the recruitment rate is slower than expected. Additional funds are required to employ research assistants and promote the study in an advertising campaign. Conclusion: Feasibility testing highlighted the inadequacy of the original recruitment strategy and the need to provide the app in both major platforms (Android and iOS). Smartphone technologies may offer an effective alternative to resource intensive strategies for assisting women to optimize weight gain in pregnancy. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617000169347; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371470 (Archived by WebCite at http://www.webcitation.org /6zDvgw5bo) Registered Report Identifier: RR1-10.2196/9920 %R 10.2196/resprot.9920 %U http://www.researchprotocols.org/2018/5/e146/ %U https://doi.org/10.2196/resprot.9920 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e10662 %T A Mobile App for Identifying Individuals With Undiagnosed Diabetes and Prediabetes and for Promoting Behavior Change: 2-Year Prospective Study %A Leung,Angela YM %A Xu,Xin Yi %A Chau,Pui Hing %A Yu,Yee Tak Esther %A Cheung,Mike KT %A Wong,Carlos KH %A Fong,Daniel YT %A Wong,Janet YH %A Lam,Cindy LK %+ Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, GH528, 5th Floor, Core G, School of Nursing, Hung Hom, Kowloon, Hong Kong SAR,, China (Hong Kong), 852 27665587, angela.ym.leung@polyu.edu.hk %K diabetes mellitus %K prediabetes %K prediabetic state %K mobile apps %K lifestyle %D 2018 %7 24.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To decrease the burden of diabetes in society, early screening of undiagnosed diabetes and prediabetes is needed. Integrating a diabetes risk score into a mobile app would provide a useful platform to enable people to self-assess their risk of diabetes with ease. Objective: The objectives of this study were to (1) assess the profile of Diabetes Risk Score mobile app users, (2) determine the optimal cutoff value of the Finnish Diabetes Risk Score to identify undiagnosed diabetes and prediabetes in the Chinese population, (3) estimate users’ chance of developing diabetes within 2 years of using the app, and (4) investigate high-risk app users’ lifestyle behavior changes after ascertaining their risk level from the app. Methods: We conducted this 2-phase study among adults via mobile app and online survey from August 2014 to December 2016. Phase 1 adopted a cross-sectional design, with a descriptive analysis of the app users’ profile. We used a Cohen kappa score to show the agreement between the risk level (as shown in the app) and glycated hemoglobin test results. We used sensitivity, specificity, and area under the curve to determine the optimal cutoff value of the diabetes risk score in this population. Phase 2 was a prospective cohort study. We used a logistic regression model to estimate the chance of developing diabetes after using the app. Paired t tests compared high-risk app users’ lifestyle changes. Results: A total of 13,289 people used the app in phase 1a. After data cleaning, we considered 4549 of these as valid data. Most users were male, and 1811 (39.81%) had tertiary education or above. Among them, 188 (10.4%) users agreed to attend the health assessment in phase 1b. We recommend the optimal value of the diabetes risk score for identifying persons with undiagnosed diabetes and prediabetes to be 9, with an area under the receiver operating characteristic curve of 0.67 (95% CI 0.60-0.74), sensitivity of 0.70 (95% CI 0.58-0.80), and specificity of 0.57 (95% CI 0.47-0.66). At the 2-year follow-up, people in the high-risk group had a higher chance of developing diabetes (odds ratio 4.59, P=.048) than the low-risk group. The high-risk app users improved their daily intake of vegetables (baseline: mean 0.76, SD 0.43; follow-up: mean 0.93, SD 0.26; t81=–3.77, P<.001) and daily exercise (baseline: mean 0.40, SD 0.49; follow-up: mean 0.54, SD 0.50; t81=–2.08, P=.04). Conclusions: The Diabetes Risk Score app has been shown to be a feasible and reliable tool to identify persons with undiagnosed diabetes and prediabetes and to predict diabetes incidence in 2 years. The app can also encourage high-risk people to modify dietary habits and reduce sedentary lifestyle. %M 29793901 %R 10.2196/10662 %U http://mhealth.jmir.org/2018/5/e10662/ %U https://doi.org/10.2196/10662 %U http://www.ncbi.nlm.nih.gov/pubmed/29793901 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e179 %T Increasing Physical Activity in Mothers Using Video Exercise Groups and Exercise Mobile Apps: Randomized Controlled Trial %A Mascarenhas,Maya Nina %A Chan,June Maylin %A Vittinghoff,Eric %A Van Blarigan,Erin Lynn %A Hecht,Frederick %+ Osher Center for Integrative Medicine, University of California, San Francisco, 1545 Divisadero Street, 4th Floor, San Francisco, CA,, United States, 1 415 890 2878, Maya.Mascarenhas@ucsf.edu %K mobile applications %K videoconferencing %K Internet %K health promotion %K exercise %K social support %K mothers %K randomized controlled trial %D 2018 %7 18.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Women significantly decrease their activity levels in the transition to motherhood. Digital health technologies are low cost, scalable, and can provide an effective delivery mechanism for behavior change. This is the first study that examines the use of videoconferencing and mobile apps to create exercise groups for mothers. Objective: The aim of the study was to test the feasibility, acceptability, and effectiveness of an individually adaptive and socially supportive physical activity intervention incorporating videoconferencing and mobile apps for mothers. Methods: The Moms Online Video Exercise Study was an 8-week, 2-armed, Web-based randomized trial comparing the effectiveness of a group exercise intervention with a waitlist control. Healthy mothers with at least 1 child under the age of 12 years were recruited through Facebook and email listservs. Intervention participants joined exercise groups using videoconferencing (Google Hangouts) every morning on weekdays and exercised together in real time, guided by exercise mobile apps (eg, Nike+, Sworkit) of their choice. Waitlist control participants had access to recommended mobile apps and an invitation to join an exercise group after the 8-week study period. Main outcomes assessed included changes in self-reported moderate, vigorous, and moderate to vigorous physical activity (MVPA) minutes per week in aggregate and stratified by whether women met Centers for Disease Control and Prevention guidelines for sufficient aerobic activity at baseline. Outcomes were measured through self-assessed Web-based questionnaires at baseline and 8 weeks. Results: The intervention was effective at increasing exercise for inactive women and proved to be feasible and acceptable to all participants. A total of 64 women were randomized, 30 to intervention and 34 to control. Women attended 2.8 sessions per week. There was a strong, but not statistically significant, trend toward increasing moderate, vigorous, and MVPA minutes for all women. As hypothesized, in the prespecified stratum of women who were inactive at baseline (n=51), intervention participants significantly increased their activity by an average of 50 (95% CI 4.0-95.9, P=.03) MVPA minutes per week more than control participants. They had a corresponding statistically significant net increase of 19 (95% CI 3.2-34.8, P=.02) minutes of vigorous activity. Inactive women in the intervention arm also experienced promising reductions in depression, reporting a statistically significant net decrease in their depression score (−3.8, 95% CI −7.0 to −0.6; P=.02). Conclusions: We found that a group exercise intervention using videoconferencing and mobile apps was a feasible and acceptable way to deliver a physical activity intervention to mothers. The intervention increased physical activity in inactive mothers. Further studies are needed to better establish how long these changes in physical activity can be maintained and whether these findings can be reproduced in a more diverse population. Trial Registration: ClinicalTrials.gov NCT02805140; https://clinicaltrials.gov/ct2/show/NCT02805140 (Archived by WebCite at http://www.webcitation.org/6yYZwRveg) %M 29776899 %R 10.2196/jmir.9310 %U http://www.jmir.org/2018/5/e179/ %U https://doi.org/10.2196/jmir.9310 %U http://www.ncbi.nlm.nih.gov/pubmed/29776899 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e110 %T Reach and Acceptability of a Mobile Reminder Strategy and Facebook Group Intervention for Weight Management in Less Advantaged Adolescents: Insights From the PRALIMAP-INÈS Trial %A Saez,Laura %A Langlois,Johanne %A Legrand,Karine %A Quinet,Marie-Hélène %A Lecomte,Edith %A Omorou,Abdou Y %A Briançon,Serge %A , %+ APEMAC EA4360, University of Lorraine, 9 avenue forêt de la Haye, Nancy,, France, 33 3 72 74 61 99, laura.saez@univ-lorraine.fr %K adolescent %K social media %K text messaging %K overweight %K socioeconomic factors %K weight loss %D 2018 %7 18.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although information and communication technology interventions appear to be a promising means of reducing the health inequality gap in overweight and obesity prevention, research on information and communication technology interventions is lacking outside the Anglo-Saxon world. Objective: The aim of this study was to assess the reach and acceptability of 2 information and communication technology interventions delivered as part of a French nutritional program: an SMS text messaging (short message service, SMS) attendance-reminder for collective sessions strategy and a Facebook challenge group. Methods: This study sample comprised 262 socially less advantaged overweight adolescents aged between 13 and 18 years. The information and communication technology interventions were carried out during the 2013-2014 academic year in 33 French state-run schools. For the SMS attendance-reminder for collective sessions strategy, at the start of the academic year, adolescents were asked to give their mobile number. SMS attendance-reminders were sent shortly before each of the 5 collective sessions. For the Facebook challenge group, adolescents were invited to join a closed Facebook group in which challenges on physical activity and on diet were posted weekly. Process data and 2 sets of face-to-face interviews were also used to interpret participation rates and access to Facebook. Appreciation for both interventions was evaluated by a questionnaire at the end of the academic year. Results: Of the recruited adolescents, 79.0% (207/262) gave their mobile number, reflecting high access to a mobile phone. Giving a number was significantly more likely for girls (odds ratio [OR] 2.1, 95% CI 1.1-3.9; P=.02) and adolescents in a vocational or general high school as opposed to middle school (OR 1.0, 95% CI 0.4-2.7; OR 0.2, 95% CI 0.1-0.5; P<.001). Indicating a mobile number at the start of the year was not significantly associated with participation in collective sessions. Of the adolescents seen at the start-of-year face-to-face interviews, 78.1% (153/196) declared an interest in the Facebook challenge group, which implies having a Facebook account or being able to have access to one. However, only 21 adolescents went through the process of joining the group. Although there was satisfaction with the Facebook group among the participants, the low participation rate in the Facebook group does not allow conclusions to be drawn with confidence. Conclusions: The results are in line with the claim that using information and communication technologies in health programs is unlikely to widen health inequalities. However, in this population of French adolescents, mobile phone strategies seem more adapted to a high school context, and caution should be exercised with a younger audience. Although there is positive appreciation of the SMS attendance-reminders and a Facebook intervention is initially highly appealing to less advantaged adolescents, no evidence of impact could be demonstrated. These results highlight the difficulty in assessing the impact of specific interventions in complex health programs. Trial Registration: Clinicaltrials.gov NCT01688453; https://clinicaltrials.gov/ct2/show/NCT01688453 (Archived by WebCite at http://www.webcitation.org/6yy6EQ0SM) %M 29776897 %R 10.2196/mhealth.7657 %U http://mhealth.jmir.org/2018/5/e110/ %U https://doi.org/10.2196/mhealth.7657 %U http://www.ncbi.nlm.nih.gov/pubmed/29776897 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 2 %P e21 %T Development of a Just-in-Time Adaptive mHealth Intervention for Insomnia: Usability Study %A Pulantara,I Wayan %A Parmanto,Bambang %A Germain,Anne %+ Health and Rehabilitation Informatics Laboratory, Department of Health Information Management, University of Pittsburgh, 6026 Forbes Tower, Pittsburgh, PA, 15260, United States, 1 412 383 6649, parmanto@pitt.edu %K Just-in-Time Adaptive Intervention %K JITAI %K mobile health %K mHealth %K sleep %K insomnia %K usability %K smartphone %K iREST %D 2018 %7 17.05.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Healthy sleep is a fundamental component of physical and brain health. Insomnia, however, is a prevalent sleep disorder that compromises functioning, productivity, and health. Therefore, developing efficient treatment delivery methods for insomnia can have significant societal and personal health impacts. Cognitive behavioral therapy for insomnia (CBTI) is the recommended first-line treatment of insomnia but access is currently limited for patients, since treatment must occur in specialty sleep clinics, which suffer from an insufficient number of trained clinicians. Smartphone-based interventions offer a promising means for improving the delivery of CBTI. Furthermore, novel features such as real-time monitoring and assessment, personalization, dynamic adaptations of the intervention, and context awareness can enhance treatment personalization and effectiveness, and reduce associated costs. Ultimately, this “Just in Time Adaptive Intervention” for insomnia—an intervention approach that is acceptable to patients and clinicians, and is based on mobile health (mHealth) platform and tools—can significantly improve patient access and clinician delivery of evidence-based insomnia treatments. Objective: This study aims to develop and assess the usability of a Just in Time Adaptive Intervention application platform called iREST (“interactive Resilience Enhancing Sleep Tactics”) for use in behavioral insomnia interventions. iREST can be used by both patients and clinicians. Methods: The development of iREST was based on the Iterative and Incremental Development software development model. Requirement analysis was based on the case study’s description, workflow and needs, clinician inputs, and a previously conducted BBTI military study/implementation of the Just in Time Adaptive Intervention architecture. To evaluate the usability of the iREST mHealth tool, a pilot usability study was conducted. Additionally, this study explores the feasibility of using an off-the-shelf wearable device to supplement the subjective assessment of patient sleep patterns. Results: The iREST app was developed from the mobile logical architecture of Just in Time Adaptive Intervention. It consists of a cross-platform smartphone app, a clinician portal, and secure 2-way communications platform between the app and the portal. The usability study comprised 19 Active Duty Service Members and Veterans between the ages of 18 and 60. Descriptive statistics based on in-app questionnaires indicate that on average, 12 (mean 12.23, SD 8.96) unique devices accessed the clinician portal per day for more than two years, while the app was rated as “highly usable”, achieving a mean System Usability Score score of 85.74 (SD 12.37), which translates to an adjective rating of “Excellent”. The participants also gave high scores on “ease of use and learnability” with an average score of 4.33 (SD 0.65) on a scale of 1 to 5. Conclusions: iREST provides a feasible platform for the implementation of Just in Time Adaptive Intervention in mHealth-based and remote intervention settings. The system was rated highly usable and its cross-platformness made it readily implemented within the heavily segregated smartphone market. The use of wearables to track sleep is promising; yet the accuracy of this technology needs further improvement. Ultimately, iREST demonstrates that mHealth-based Just in Time Adaptive Intervention is not only feasible, but also works effectively. %M 29773529 %R 10.2196/humanfactors.8905 %U http://humanfactors.jmir.org/2018/2/e21/ %U https://doi.org/10.2196/humanfactors.8905 %U http://www.ncbi.nlm.nih.gov/pubmed/29773529 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 5 %P e133 %T A Self-Directed Mobile Intervention (WaznApp) to Promote Weight Control Among Employees at a Lebanese University: Protocol for a Feasibility Pilot Randomized Controlled Trial %A Bardus,Marco %A Hamadeh,Ghassan %A Hayek,Bouchra %A Al Kherfan,Rawan %+ Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Van Dyck - Room 302, PO Box 11-0236 Riad El Solh, Beirut, 1107 2020, Lebanon, 961 1 350 000  ext 4694, marco.bardus@gmail.com %K mobile apps %K weight loss %K physical activity %K healthy diet %K workplace %K mHealth %K randomized controlled trial %D 2018 %7 16.05.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Overweight and obesity have become major health problems globally with more than 1.9 billion overweight adults. In Lebanon, the prevalence of obesity and overweight is 65.4% combined. Risk factors of obesity and overweight are preventable and can be addressed by modifications in the environment and in an individual’s lifestyle. Mobile technologies are increasingly used in behavioral, self-directed weight management interventions, providing users with additional opportunities to attain weight control (weight loss, weight gain prevention, etc). Mobile apps may allow for the delivery of Just-in-Time Adaptive Interventions (JITAIs), which provide support through skill building, emotional support, and instrumental support, following the participants’ progress. A few commercially available apps offer JITAI features, but no studies have tested their efficacy. Objective: The primary objective of this study is to examine the feasibility of a self-directed weight loss intervention, targeting employees of an academic institution, using a virtual coaching app with JITAI features (Lark) and a self-help calorie-counting app (MyFitnessPal). The secondary objective is to estimate the effects of the intervention on main study outcomes. Methods: This study is a single-center, parallel, randomized controlled trial with 2 study arms (intervention and control). Participants will be randomly allocated in equal proportions to the intervention (Lark) and control groups (MyFitnessPal). To be eligible for this study, participants must be employed full- or part-time at the university or its medical center, able to read English, have a smartphone, and be interested in controlling their weight. Recruitment strategies entail email invitations, printed posters, and social media postings. We will assess quantitative rates of recruitment, adherence, and retention, self-reported app quality using the user version of the Mobile App Rating Scale. We will also assess changes in weight-related outcomes (absolute weight and waist circumference), behavioral outcomes (physical activity and diet), and cognitive factors (motivation to participate in the trial and to manage weight). Results: WaznApp was funded in June 2017, and recruitment started in March 2018. Conclusions: This study will provide information as to whether the selected mobile apps offer a feasible solution for promoting weight management in an academic workplace. The results will inform a larger trial whose results might be replicated in similar workplaces in Lebanon and the Middle East and North Africa region, and will be used as a benchmark for further investigations in other settings and similar target groups. Trial Registration: ClinicalTrials.gov NCT03321331; https://clinicaltrials.gov/ct2/show/NCT03321331 (Archived by WebCite at http://www.webcitation.org/6ys9NOLo5) Registered Report Identifier: RR1-10.2196/9793 %M 29769174 %R 10.2196/resprot.9793 %U http://www.researchprotocols.org/2018/5/e133/ %U https://doi.org/10.2196/resprot.9793 %U http://www.ncbi.nlm.nih.gov/pubmed/29769174 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e124 %T Mindfulness-Based Symptom and Stress Management Apps for Adults With Chronic Lung Disease: Systematic Search in App Stores %A Owens,Otis L %A Beer,Jenay M %A Reyes,Ligia I %A Gallerani,David G %A Myhren-Bennett,Amanda R %A McDonnell,Karen K %+ College of Social Work, University of South Carolina, 1512 Pendelton Street, Room 106, Columbia, SC, 29208, United States, 1 803 777 0384, owenso@mailbox.sc.edu %K mindfulness %K lung neoplasms %K chronic obstructive pulmonary disease %K mobile apps %K review %D 2018 %7 15.05.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Up to 70% of lung cancer survivors are affected by chronic obstructive pulmonary disease (COPD), a common, debilitating, comorbid disease. Lung cancer and COPD are both characterized by symptoms such as breathlessness, fatigue, and psychological distress. These distressing chronic symptoms are exacerbated by stress and detract from an individual’s quality of life. Objective: The aim of this study was to identify and evaluate evidence-based, commercially available apps for promoting mindfulness-based strategies among adults with a COPD or lung cancer history (ie, chronic lung disease). Methods: For this review, an interdisciplinary research team used 19 keyword combinations in the search engines of Google and iOS app stores in May 2017. Evaluations were conducted on the apps’ (1) content, (2) usability heuristics, (3) grade-level readability, and (4) cultural sensitivity. Results: The search resulted in 768 apps (508 in iOS and 260 in Google stores). A total of 9 apps met the inclusion criteria and received further evaluation. Only 1 app had below an eighth-grade reading level; the ninth one did not have enough text to calculate a readability score. None of the 9 apps met the cultural sensitivity evaluation criteria. Conclusions: This systematic review identified critical design flaws that may affect the ease of using the apps in this study. Few mobile apps promote mindfulness-based strategies among adults with chronic lung disease (ie, COPD or lung cancer or both), but those that exist, overall, do not meet the latest scientific evidence. Recommendations include more stringent regulation of health-related apps, use of evidence-based frameworks and participatory design processes, following evidence-based usability practices, use of culturally sensitive language and images, and ensuring that content is written in plain language. %M 29764800 %R 10.2196/mhealth.9831 %U http://mhealth.jmir.org/2018/5/e124/ %U https://doi.org/10.2196/mhealth.9831 %U http://www.ncbi.nlm.nih.gov/pubmed/29764800 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 1 %P e9 %T Acceptability of a Mobile Phone App for Measuring Time Use in Breast Cancer Survivors (Life in a Day): Mixed-Methods Study %A Ainsworth,Matthew Cole %A Pekmezi,Dori %A Bowles,Heather %A Ehlers,Diane %A McAuley,Edward %A Courneya,Kerry S %A Rogers,Laura Q %+ Department of Nutrition Sciences, University of Alabama at Birmingham, Webb 222, 1720 2nd Avenue South, Birmingham, AL, 35294 3360, United States, 1 205 975 1667, rogersl@uab.edu %K cancer %K technology %K time management %K mHealth %K physical activity %D 2018 %7 14.05.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Advancements in mobile technology allow innovative data collection techniques such as measuring time use (ie, how individuals structure their time) for the purpose of improving health behavior change interventions. Objective: The aim of this study was to examine the acceptability of a 5-day trial of the Life in a Day mobile phone app measuring time use in breast cancer survivors to advance technology-based measurement of time use. Methods: Acceptability data were collected from participants (N=40; 100% response rate) using a self-administered survey after 5 days of Life in a Day use. Results: Overall, participants had a mean age of 55 years (SD 8) and completed 16 years of school (SD 2). Participants generally agreed that learning to use Life in a Day was easy (83%, 33/40) and would prefer to log activities using Life in a Day over paper-and-pencil diary (73%, 29/40). A slight majority felt that completing Life in a Day for 5 consecutive days was not too much (60%, 24/40) or overly time-consuming (68%, 27/40). Life in a Day was rated as easy to read (88%, 35/40) and navigate (70%, 32/40). Participants also agreed that it was easy to log activities using the activity timer at the start and end of an activity (90%, 35/39). Only 13% (5/40) downloaded the app on their personal phone, whereas 63% (19/30) of the remaining participants would have preferred to use their personal phone. Overall, 77% (30/39) of participants felt that the Life in a Day app was good or very good. Those who agreed that it was easy to edit activities were significantly more likely to be younger when compared with those who disagreed (mean 53 vs 58 years, P=.04). Similarly, those who agreed that it was easy to remember to log activities were more likely to be younger (mean 52 vs 60 years, P<.001). Qualitative coding of 2 open-ended survey items yielded 3 common themes for Life in a Day improvement (ie, convenience, user interface, and reminders). Conclusions: A mobile phone app is an acceptable time-use measurement modality. Improving convenience, user interface, and memory prompts while addressing the needs of older participants is needed to enhance app utility. Trial Registration: ClinicalTrials.gov NCT00929617; https://clinicaltrials.gov/ct2/show/NCT00929617 (Archived by WebCite at http://www.webcitation.org/6z2bZ4P7X) %M 29759953 %R 10.2196/cancer.8951 %U http://cancer.jmir.org/2018/1/e9/ %U https://doi.org/10.2196/cancer.8951 %U http://www.ncbi.nlm.nih.gov/pubmed/29759953 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 5 %P e128 %T A Mobile Health Intervention to Reduce Pain and Improve Health (MORPH) in Older Adults With Obesity: Protocol for the MORPH Trial %A Fanning,Jason %A Brooks,Amber K %A Ip,Edward %A Nicklas,Barbara J %A Rejeski,W Jack %+ Department of Health and Exercise Science, Wake Forest University, PO Box 7868, Winston-Salem, NC, 27106, United States, 1 3367585042, fanninjt@wfu.edu %K technology %K weight loss %K sedentary lifestyle %K chronic pain %K mindfulness %D 2018 %7 14.05.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic pain is a complex, age-related health issue that affects both physical functioning and quality of life. Because the impact of chronic pain is worsened by obesity and inactivity, nonpharmacological interventions that promote movement, reduce sitting, and aid in weight loss are needed to help manage pain symptoms among older adults with chronic pain. Objective: The Mobile Intervention to Reduce Pain and Improve Health (MORPH) pilot trial aims to develop and test the feasibility and acceptability of a novel, patient-centered intervention to reduce chronic pain and improve physical functioning in older adults, leveraging the combination of telecoaching and individually adaptive mHealth tools to decrease both body mass and sedentary behavior. Methods: MORPH comprises 2 phases, including a 1-year iterative development phase, and a 1-year pilot randomized controlled trial (RCT). During the development phase, representative participants will engage in one-on-one structured interviews and a 1-week field test. The resulting feedback will be used to guide the development of the finalized MORPH intervention package. During the second phase, the finalized intervention will be tested in a pilot RCT (N=30) in which older adult participants with chronic pain and obesity will be assigned to receive the 12-week MORPH intervention or to a waitlist control. Primary outcomes include self-reported pain symptoms and physical function. Results: Phase 1 recruitment is ongoing as of December 2017. Conclusions: The MORPH intervention brings together a strong body of evidence using group-based behavioral intervention designs with contemporary mHealth principles, allowing for intervention when and where it matters the most. Given the ubiquity of smartphone devices and the popularity of consumer activity and weight monitors, the results of this study may serve to inform the development of scalable, socially driven behavioral pain management interventions. Trial Registration: ClinicalTrials.gov NCT03377634; https://clinicaltrials.gov/ct2/show/NCT03377634 (Archived by WebCite at http://www.webcitation.org/6yj0J5Pan) Registered Report Identifier: RR1-10.2196/9712 %M 29759957 %R 10.2196/resprot.9712 %U http://www.researchprotocols.org/2018/5/e128/ %U https://doi.org/10.2196/resprot.9712 %U http://www.ncbi.nlm.nih.gov/pubmed/29759957 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e121 %T mActive-Smoke: A Prospective Observational Study Using Mobile Health Tools to Assess the Association of Physical Activity With Smoking Urges %A Silverman-Lloyd,Luke G %A Kianoush,Sina %A Blaha,Michael J %A Sabina,Alyse B %A Graham,Garth N %A Martin,Seth S %+ Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Carnegie 591, 600 North Wolfe Street, Baltimore, MD, 21287, United States, 1 410 502 0469, smart100@jhmi.edu %K activity trackers %K cigarette smoking %K exercise %K fitness trackers %K mobile health %K mHealth %K physical activity %K smartphone %K smoking %K text messaging %K texting %D 2018 %7 11.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Evidence that physical activity can curb smoking urges is limited in scope to acute effects and largely reliant on retrospective self-reported measures. Mobile health technologies offer novel mechanisms for capturing real-time data of behaviors in the natural environment. Objective: This study aimed to explore this in a real-world longitudinal setting by leveraging mobile health tools to assess the association between objectively measured physical activity and concurrent smoking urges in a 12-week prospective observational study. Methods: We enrolled 60 active smokers (≥3 cigarettes per day) and recorded baseline demographics, physical activity, and smoking behaviors using a Web-based questionnaire. Step counts were measured continuously using the Fitbit Charge HR. Participants reported instantaneous smoking urges via text message using a Likert scale ranging from 1 to 9. On study completion, participants reported follow-up smoking behaviors in an online exit survey. Results: A total of 53 participants (aged 40 [SD 12] years, 57% [30/53] women, 49% [26/53] nonwhite) recorded at least 6 weeks of data and were thus included in the analysis. We recorded 15,365 urge messages throughout the study, with a mean of 290 (SD 62) messages per participant. Mean urge over the course of the study was positively associated with daily cigarette consumption at follow-up (Pearson r=.33; P=.02). No association existed between daily steps and mean daily urge (beta=−6.95×10−3 per 1000 steps; P=.30). Regression models of acute effects, however, did reveal modest inverse associations between steps within 30-, 60-, and 120-min time windows of a reported urge (beta=−.0191 per 100 steps, P<.001). Moreover, 6 individuals (approximately 10% of the study population) exhibited a stronger and consistent inverse association between steps and urge at both the day level (mean individualized beta=−.153 per 1000 steps) and 30-min level (mean individualized beta=−1.66 per 1000 steps). Conclusions: Although there was no association between objectively measured daily physical activity and concurrently self-reported smoking urges, there was a modest inverse relationship between recent step counts (30-120 min) and urge. Approximately 10% of the individuals appeared to have a stronger and consistent inverse association between physical activity and urge, a provocative finding warranting further study. %M 29752250 %R 10.2196/mhealth.9292 %U http://mhealth.jmir.org/2018/5/e121/ %U https://doi.org/10.2196/mhealth.9292 %U http://www.ncbi.nlm.nih.gov/pubmed/29752250 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 2 %P e9 %T Using Mobile Health Gamification to Facilitate Cognitive Behavioral Therapy Skills Practice in Child Anxiety Treatment: Open Clinical Trial %A Pramana,Gede %A Parmanto,Bambang %A Lomas,James %A Lindhiem,Oliver %A Kendall,Philip C %A Silk,Jennifer %+ Department of Health Information Management, University of Pittsburgh, 6025 Forbes Tower, Pittsburgh, PA, 15260, United States, 1 4123836649, parmanto@pitt.edu %K gamification %K mobile health %K ecological momentary intervention %K cognitive behavioral therapy %K child anxiety treatment %K SmartCAT %K childhood anxiety disorders %D 2018 %7 10.05.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Cognitive behavioral therapy is an efficacious treatment for child anxiety disorders. Although efficacious, many children (40%-50%) do not show a significant reduction in symptoms or full recovery from primary anxiety diagnoses. One possibility is that they are unwilling to learn and practice cognitive behavioral therapy skills beyond therapy sessions. This can occur for a variety of reasons, including a lack of motivation, forgetfulness, and a lack of cognitive behavioral therapy skills understanding. Mobile health (mHealth) gamification provides a potential solution to improve cognitive behavioral therapy efficacy by delivering more engaging and interactive strategies to facilitate cognitive behavioral therapy skills practice in everyday lives (in vivo). Objective: The goal of this project was to redesign an existing mHealth system called SmartCAT (Smartphone-enhanced Child Anxiety Treatment) so as to increase user engagement, retention, and learning facilitation by integrating gamification techniques and interactive features. Furthermore, this project assessed the effectiveness of gamification in improving user engagement and retention throughout posttreatment. Methods: We redesigned and implemented the SmartCAT system consisting of a smartphone app for children and an integrated clinician portal. The gamified app contains (1) a series of interactive games and activities to reinforce skill understanding, (2) an in vivo skills coach that cues the participant to use cognitive behavioral therapy skills during real-world emotional experiences, (3) a home challenge module to encourage home-based exposure tasks, (4) a digital reward system that contains digital points and trophies, and (5) a therapist-patient messaging interface. Therapists used a secure Web-based portal connected to the app to set up required activities for each session, receive or send messages, manage participant rewards and challenges, and view data and figures summarizing the app usage. The system was implemented as an adjunctive component to brief cognitive behavioral therapy in an open clinical trial. To evaluate the effectiveness of gamification, we compared the app usage data at posttreatment with the earlier version of SmartCAT without gamification. Results: Gamified SmartCAT was used frequently throughout treatment. On average, patients spent 35.59 min on the app (SD 64.18) completing 13.00 activities between each therapy session (SD 12.61). At the 0.10 significance level, the app usage of the gamified system (median 68.00) was higher than that of the earlier, nongamified SmartCAT version (median 37.00, U=76.00, P<.01). The amount of time spent on the gamified system (median 173.15) was significantly different from that of the earlier version (median 120.73, U=173.00, P=.06). Conclusions: The gamified system showed good acceptability, usefulness, and engagement among anxious children receiving brief cognitive behavioral therapy treatment. Integrating an mHealth gamification platform within treatment for anxious children seems to increase involvement in shorter treatment. Further study is needed to evaluate increase in involvement in full-length treatment. %M 29748165 %R 10.2196/games.8902 %U http://games.jmir.org/2018/2/e9/ %U https://doi.org/10.2196/games.8902 %U http://www.ncbi.nlm.nih.gov/pubmed/29748165 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e170 %T Web-Based Physical Activity Intervention for Latina Adolescents: Feasibility, Acceptability, and Potential Efficacy of the Niñas Saludables Study %A Larsen,Britta %A Benitez,Tanya %A Cano,Mayra %A Dunsiger,Shira S %A Marcus,Bess H %A Mendoza-Vasconez,Andrea %A Sallis,James F %A Zive,Michelle %+ Department of Family Medicine & Public Health, University of California, San Diego, 9500 Gilman Drive, San Diego, CA, 92093 0725, United States, 1 8585348429, blarsen@ucsd.edu %K exercise %K health behavior %K internet %K eHealth %K telemedicine %D 2018 %7 09.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Physical activity is markedly low in Latina adolescents, yet few physical activity interventions have been attempted in this population. Web-based interventions can incorporate theory-based components, be appealing to adolescents, and have potential for low-cost dissemination. Objective: This study aimed to assess the feasibility, acceptability, and potential efficacy of a Web-based physical activity intervention for Latina adolescents in a single-arm pilot trial. Methods: A total of 21 Latina adolescents (aged 12-18 years) who could read and write in English and were underactive (<90 min/week) participated in a 12-week, theory-informed Web-based physical activity intervention. The intervention website was modified from a previous Web-based intervention for Latina adults. Web content was individually tailored based on the responses to monthly questionnaires. Feasibility was measured by recruitment, retention, and adherence/engagement, and acceptability was measured by satisfaction surveys. Physical activity was measured at baseline and follow-up (12 weeks) using the 7-day physical activity recall (PAR) interview and accelerometers. Results: Baseline activity as measured by the 7-day PAR and accelerometers was 24.7 (SD 26.11) and 24.8 (SD 38.3) min/week, respectively. At 12 weeks, 19 participants (90%, 19/21) returned. Adherence and engagement with materials were low, but 72% (15/21) of the participants indicated that they were satisfied with the intervention. Activity at 12 weeks increased by 58.8 (SD 11.33) min/week measured by the 7-day PAR (P<.001). Accelerometer-measured activity did not increase. Activities reported at follow-up were more varied than at baseline, including some activities measured poorly by accelerometers (eg, biking and swimming). Participants suggested simplifying the website and incorporating other technologies. Conclusions: Good retention and increases in self-reported activity suggest a promising approach to delivering a physical activity intervention to Latina adolescents. Incorporating other technologies, such as smartphone apps, could make the intervention more engaging, acceptable, and effective. %M 29743151 %R 10.2196/jmir.9206 %U http://www.jmir.org/2018/5/e170/ %U https://doi.org/10.2196/jmir.9206 %U http://www.ncbi.nlm.nih.gov/pubmed/29743151 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e111 %T Managing and Controlling Stress Using mHealth: Systematic Search in App Stores %A Blázquez Martín,David %A De La Torre,Isabel %A Garcia-Zapirain,Begonya %A Lopez-Coronado,Miguel %A Rodrigues,Joel %+ Faculty of Engineering, University of Deusto, Avenida de las Universidades 24, Bilbao,, Spain, 34 944 139 000, mbgarciazapi@deusto.es %K apps %K control %K management %K mHealth %K stress %D 2018 %7 09.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Traditional stress management techniques have been proven insufficient to tackle the needs of today’s population. Computational-based techniques and now mobile health (mHealth) apps are showing promise to enable ease of use and access while educating end users on self-management. Objective: The main aim of this paper was to put forward a systematic review of mHealth apps for stress management. Methods: The scenario chosen for this study consists of a sample of the most relevant mHealth apps found on the British and Spanish online stores of the two main mobile operating systems: iOS and Android. The apps have been categorized and scored base on their impact, presence, number of results, language, and operating system. Results: A total of 433 different mobile apps for stress management was analyzed. Of these apps, 21.7% (94/433) belonged to the “relaxing music” category, 10.9% (47/433) were in the “draw and paint” category, 1.2% (5/433) belonged to the “heart rate control” category, and 1.2% (5/433) fell under “integral methodology.” Only 2.0% (8/433) of the apps qualified as high or medium interest while 98.0% were low interest. Furthermore, 2.0% (8/433) of the apps were available on both iOS and Android, and 98% of apps ran on only one platform (iOS or Android). Conclusions: There are many low-value apps available at the moment, but the analysis shows that they are adding new functionalities and becoming fully integrated self-management systems with extra capabilities such as professional assistance services and online support communities. %M 29743152 %R 10.2196/mhealth.8866 %U http://mhealth.jmir.org/2018/5/e111/ %U https://doi.org/10.2196/mhealth.8866 %U http://www.ncbi.nlm.nih.gov/pubmed/29743152 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e162 %T The Effectiveness of Smartphone Apps for Lifestyle Improvement in Noncommunicable Diseases: Systematic Review and Meta-Analyses %A Lunde,Pernille %A Nilsson,Birgitta Blakstad %A Bergland,Astrid %A Kværner,Kari Jorunn %A Bye,Asta %+ Department of Physiotherapy, Faculty of Health Sciences, OsloMet—Oslo Metropolitan University, 1st Floor, Pilestredet 50, Oslo, 0130, Norway, 47 48063537, plunde@oslomet.no %K smartphone %K telemedicine %K noncommunicable diseases %K lifestyle %K diet %K exercise %D 2018 %7 04.05.2018 %9 Review %J J Med Internet Res %G English %X Background: Noncommunicable diseases (NCDs) account for 70% of all deaths in a year globally. The four main NCDs are cardiovascular diseases, cancers, chronic pulmonary diseases, and diabetes mellitus. Fifty percent of persons with NCD do not adhere to prescribed treatment; in fact, adherence to lifestyle interventions is especially considered as a major challenge. Smartphone apps permit structured monitoring of health parameters, as well as the opportunity to receive feedback. Objective: The aim of this study was to review and assess the effectiveness of app-based interventions, lasting at least 3 months, to promote lifestyle changes in patients with NCDs. Methods: In February 2017, a literature search in five databases (EMBASE, MEDLINE, CINAHL, Academic Research Premier, and Cochrane Reviews and Trials) was conducted. Inclusion criteria was quantitative study designs including randomized and nonrandomized controlled trials that included patients aged 18 years and older diagnosed with any of the four main NCDs. Lifestyle outcomes were physical activity, physical fitness, modification of dietary habits, and quality of life. All included studies were assessed for risk of bias using the Cochrane Collaboration`s risk of bias tool. Meta-analyses were conducted for one of the outcomes (glycated hemoglobin, HbA1c) by using the estimate of effect of mean post treatment with SD or CI. Heterogeneity was tested using the I2 test. All studies included in the meta-analyses were graded. Results: Of the 1588 records examined, 9 met the predefined criteria. Seven studies included diabetes patients only, one study included heart patients only, and another study included both diabetes and heart patients. Statistical significant effect was shown in HbA1c in 5 of 8 studies, as well in body weight in one of 5 studies and in waist circumference in one of 3 studies evaluating these outcomes. Seven of the included studies were included in the meta-analyses and demonstrated significantly overall effect on HbA1c on a short term (3-6 months; P=.02) with low heterogeneity (I2=41%). In the long term (10-12 months), the overall effect on HbA1c was statistical significant (P=.009) and without heterogeneity (I2=0%). The quality of evidence according to Grading of Recommendations Assessment, Development and Evaluation was low for short term and moderate for long term. Conclusions: Our review demonstrated limited research of the use of smartphone apps for NCDs other than diabetes with a follow-up of at least 3 months. For diabetes, the use of apps seems to improve lifestyle factors, especially to decrease HbA1c. More research with long-term follow-up should be performed to assess the effect of smartphone apps for NCDs other than diabetes. %M 29728346 %R 10.2196/jmir.9751 %U http://www.jmir.org/2018/5/e162/ %U https://doi.org/10.2196/jmir.9751 %U http://www.ncbi.nlm.nih.gov/pubmed/29728346 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e93 %T Usefulness of a Novel Mobile Diabetes Prevention Program Delivery Platform With Human Coaching: 65-Week Observational Follow-Up %A Michaelides,Andreas %A Major,Jennifer %A Pienkosz Jr,Edmund %A Wood,Meghan %A Kim,Youngin %A Toro-Ramos,Tatiana %+ Clinical Research Department, Noom Inc, 229 West 28th Street, 9th Floor, New York, NY,, United States, 1 347 480 8871, tatiana@noom.com %K prediabetes %K body weight %K behavioral interventions %K mHealth %K mobile app %K diabetes prevention %D 2018 %7 03.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: It is widely recognized that the prevalence of obesity and comorbidities including prediabetes and type 2 diabetes continue to increase worldwide. Results from a 24-week Diabetes Prevention Program (DPP) fully mobile pilot intervention were previously published showing promising evidence of the usefulness of DPP-based eHealth interventions on weight loss. Objective: This pilot study extends previous findings to evaluate weight loss results of core (up to week 16) and maintenance (postcore weeks) DPP interventions at 65 weeks from baseline. Methods: Originally, 140 participants were invited and 43 overweight or obese adult participants with a diagnosis of prediabetes signed up to receive a 24-week virtual DPP with human coaching through a mobile platform. At 65 weeks, this pilot study evaluates weight loss and engagement in maintenance participants by means of repeated measures analysis of variances and backward multiple linear regression to examine predictors of weight loss. Last observation carried forward was used for endpoint measurements. Results: At 65 weeks, mean weight loss was 6.15% in starters who read 1 or more lessons per week on 4 or more core weeks, 7.36% in completers who read 9 or more lessons per week on core weeks, and 8.98% in maintenance completers who did any action in postcore weeks (all P<.001). Participants were highly engaged, with 80% (47/59) of the sample completing 9 lessons or more and 69% (32/47) of those completing the maintenance phase. In-app actions related to self-monitoring significantly predicted weight loss. Conclusions: In comparison to eHealth programs, this pilot study shows that a fully mobile DPP can produce transformative weight loss. A fully mobile DPP intervention resulted in significant weight loss and high engagement during the maintenance phase, providing evidence for long-term potential as an alternative to in-person DPP by removing many of the barriers associated with in-person and other forms of virtual DPP. %M 29724709 %R 10.2196/mhealth.9161 %U http://mhealth.jmir.org/2018/5/e93/ %U https://doi.org/10.2196/mhealth.9161 %U http://www.ncbi.nlm.nih.gov/pubmed/29724709 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e46 %T Recommendations for the Development of a Mobile HIV Prevention Intervention for Men Who Have Sex With Men and Hijras in Mumbai: Qualitative Study %A Rawat,Shruta %A Wilkerson,J Michael %A Lawler,Sylvia M %A Patankar,Pallav %A Rosser,BR Simon %A Shukla,Kanjani %A Butame,Seyram %A Ekstrand,Maria L %+ School of Public Health, University of Texas Health Science Center at Houston, 7000 Fannin St, Ste 2620, Houston, TX,, United States, 1 713 500 9974, Johnny.M.Wilkerson@uth.tmc.edu %K health promotion %K health seeking %K gays and lesbians %K Internet %K HIV/AIDS %D 2018 %7 03.05.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As Internet and mobile phone use expands in India, there is an opportunity to develop mobile health (mHealth) interventions for marginalized populations, including men who have sex with men (MSM) and hijras (transgender women), hesitant to access traditional health care systems. Objective: The purpose of this study was to determine if an mHealth intervention was acceptable to MSM and hijras living in Mumbai, and if so, what features would be useful in targeting the prevention of HIV acquisition and to increase the quality of life among persons living with HIV/AIDS. Methods: Data from 4 focus groups with MSM and interviews with 4 hijras, 10 health service providers, and 8 mHealth developers were thematically analyzed. Results: Once the need for an mHealth intervention was confirmed, comments about features were organized into 3 themes: content, interface, and retention. Content subthemes included providing sex education for younger community members, providing information about STIs, and providing information and social support for persons living with HIV. Interface subthemes included presenting content using pictures; using videos to present stories of role models; using push notifications for testing, appointment, and medication reminders; using geolocation to link to just-in-time services; and using telemedicine to increase access to health service providers and community services. The 5 retention subthemes included keeping it fun, using gaming mechanics, developing content in regional languages, protecting confidentiality, and linking to social networking apps. Conclusions: These findings may help inform mHealth development in India. %M 29724705 %R 10.2196/publichealth.9088 %U http://publichealth.jmir.org/2018/2/e46/ %U https://doi.org/10.2196/publichealth.9088 %U http://www.ncbi.nlm.nih.gov/pubmed/29724705 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e114 %T Using Digital Health Technologies to Understand the Association Between Movement Behaviors and Interstitial Glucose: Exploratory Analysis %A Kingsnorth,Andrew P %A Whelan,Maxine E %A Sanders,James P %A Sherar,Lauren B %A Esliger,Dale W %+ National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, United Kingdom, 44 01509 225454, a.kingsnorth@lboro.ac.uk %K accelerometry %K glucose %K physical activity %K physiological monitoring %K sedentary time %D 2018 %7 03.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Acute reductions in postprandial glucose excursions because of movement behaviors have been demonstrated in experimental studies but less so in free-living settings. Objective: The objective of this study was to explore the nature of the acute stimulus-response model between accelerometer-assessed physical activity, sedentary time, and glucose variability over 13 days in nondiabetic adults. Methods: This study measured physical activity, sedentary time, and interstitial glucose continuously over 13 days in 29 participants (mean age in years: 44.9 [SD 9.1]; female: 59%, 17/29; white: 90%, 26/29; mean body mass index: 25.3 [SD 4.1]) as part of the Sensing Interstitial Glucose to Nudge Active Lifestyles (SIGNAL) research program. Daily minutes spent sedentary, in light activity, and moderate to vigorous physical activity were associated with daily mean glucose, SD of glucose, and mean amplitude of glycemic excursions (MAGE) using generalized estimating equations. Results: After adjustment for covariates, sedentary time in minutes was positively associated with a higher daily mean glucose (mmol/L; beta=0.0007; 95% CI 0.00030-0.00103; P<.001), SD of glucose (mmol/L; beta=0.0006; 95% CI 0.00037-0.00081; P<.001), and MAGE (mmol/L; beta=0.002; 95% CI 0.00131-0.00273; P<.001) for those of a lower fitness. Additionally, light activity was inversely associated with mean glucose (mmol/L; beta=−0.0004; 95% CI −0.00078 to −0.00006; P=.02), SD of glucose (mmol/L; beta=−0.0006; 95% CI −0.00085 to −0.00039; P<.001), and MAGE (mmol/L; beta=−0.002; 95% CI −0.00285 to −0.00146; P<.001) for those of a lower fitness. Moderate to vigorous physical activity was only inversely associated with mean glucose (mmol/L; beta=−0.002; 95% CI −0.00250 to −0.00058; P=.002). Conclusions: Evidence of an acute stimulus-response model was observed between sedentary time, physical activity, and glucose variability in low fitness individuals, with sedentary time and light activity conferring the most consistent changes in glucose variability. Further work is required to investigate the coupling of movement behaviors and glucose responses in larger samples and whether providing these rich data sources as feedback could induce lifestyle behavior change. %M 29724703 %R 10.2196/mhealth.9471 %U http://mhealth.jmir.org/2018/5/e114/ %U https://doi.org/10.2196/mhealth.9471 %U http://www.ncbi.nlm.nih.gov/pubmed/29724703 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 1 %P e10057 %T Mobile Phone Apps to Support Heart Failure Self-Care Management: Integrative Review %A Athilingam,Ponrathi %A Jenkins,Bradlee %+ University of South Florida, 12901 Bruce B Downs Blvd, MDN 22, Tampa, FL,, United States, 1 813 974 7526, pathilin@health.usf.edu %K heart failure %K self-care management %K mobile health %D 2018 %7 02.05.2018 %9 Review %J JMIR Cardio %G English %X Background: With an explosive growth in mobile health, an estimated 500 million patients are potentially using mHealth apps for supporting health and self-care of chronic diseases. Therefore, this review focused on mHealth apps for use among patients with heart failure. Objective: The aim of this integrative review was to identify and assess the functionalities of mHealth apps that provided usability and efficacy data and apps that are commercially available without supporting data, all of which are to support heart failure self-care management and thus impact heart failure outcomes. Methods: A search of published, peer-reviewed literature was conducted for studies of technology-based interventions that used mHealth apps specific for heart failure. The initial database search yielded 8597 citations. After filters for English language and heart failure, the final 487 abstracts was reviewed. After removing duplicates, a total of 18 articles that tested usability and efficacy of mobile apps for heart failure self-management were included for review. Google Play and Apple App Store were searched with specified criteria to identify mHealth apps for heart failure. A total of 26 commercially available apps specific for heart failure were identified and rated using the validated Mobile Application Rating Scale. Results: The review included studies with low-quality design and sample sizes ranging from 7 to 165 with a total sample size of 847 participants from all 18 studies. Nine studies assessed usability of the newly developed mobile health system. Six of the studies included are randomized controlled trials, and 4 studies are pilot randomized controlled trials with sample sizes of fewer than 40. There were inconsistencies in the self-care components tested, increasing bias. Thus, risk of bias was assessed using the Cochrane Collaboration’s tool for risk of selection, performance, detection, attrition, and reporting biases. Most studies included in this review are underpowered and had high risk of bias across all categories. Three studies failed to provide enough information to allow for a complete assessment of bias, and thus had unknown or unclear risk of bias. This review on the commercially available apps demonstrated many incomplete apps, many apps with bugs, and several apps with low quality. Conclusions: The heterogeneity of study design, sample size, intervention components, and outcomes measured precluded the performance of a systematic review or meta-analysis, thus introducing bias of this review. Although the heart failure–related outcomes reported in this review vary, they demonstrated trends toward making an impact and offer a potentially cost-effective solution with 24/7 access to symptom monitoring as a point of care solution, promoting patient engagement in their own home care. %M 31758762 %R 10.2196/10057 %U http://cardio.jmir.org/2018/1/e10057/ %U https://doi.org/10.2196/10057 %U http://www.ncbi.nlm.nih.gov/pubmed/31758762 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e34 %T A Gamified Smartphone App to Support Engagement in Care and Medication Adherence for HIV-Positive Young Men Who Have Sex With Men (AllyQuest): Development and Pilot Study %A Hightow-Weidman,Lisa %A Muessig,Kathryn %A Knudtson,Kelly %A Srivatsa,Mala %A Lawrence,Ellena %A LeGrand,Sara %A Hotten,Anna %A Hosek,Sybil %+ Institute of Global Health and Infectious Diseases, University of North Carolina, Bioinformatics Building, Suite 2154, 130 Mason Farm Road, Chapel Hill, NC, 27599-7030, United States, 1 919 843 0033, lisa_hightow@med.unc.edu %K YMSM %K antiretroviral adherence %K smartphone app %K gamification %K social networking %D 2018 %7 30.04.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: HIV disproportionately impacts young men who have sex with men (YMSM) who experience disparities across the HIV care continuum. Addressing antiretroviral therapy (ART) adherence among YMSM is an urgent public health priority. Technology-based interventions—particularly mobile health platforms—can provide tailored adherence interventions and allow YMSM to engage and connect with others. Objective: The objective of this study was to describe the development of AllyQuest, a novel, theoretically-based, smartphone app designed to improve engagement in care and ART adherence and social support among HIV-positive YMSM. Methods: AllyQuest was built on an established platform for patient engagement that embeds social networking and fundamental game mechanics, such as challenges, points, and rewards. A medication tracker provides reminders to promote ART adherence via personalized adherence strategies that are user and context specific; a calendar allows for reflection on adherence over time. After iterative development with input from two youth advisory boards, usability testing was conducted to assess app functionality, comprehension of the educational content, use of intervention features, and overall impressions of app relevance and appeal. A 28-day pilot trial was conducted with 20 HIV+ YMSM to evaluate intervention feasibility and acceptability. Results: Mean age of participants was 21.8 years (range 19-24), and 95% (19/20) of the participants were nonwhite. The mean time of app use was 158.4 min (SD 114.1), with a range of 13 to 441 min. There was a mean of 21.2 days of use (out of a total possible 28 days). There were 222 posts to the daily discussion social wall. Feasibility and acceptability ratings were high. Overall, participants found the app easy to use and navigate, not intrusive, and had few reported technical issues. Higher levels of app usage were positively correlated with HIV self-management outcomes, and there was a statistically significant (P<.05) positive association between the number of days logged into the app and knowledge and confidence in ability to reliably take HIV medications. Conclusions: AllyQuest represents a new, highly scalable solution that is well-suited to meet the specific prevention and care needs of HIV+ YMSM. The development of this intervention is both timely and vital, given the urgency of the ongoing HIV epidemic among YMSM. %M 29712626 %R 10.2196/publichealth.8923 %U http://publichealth.jmir.org/2018/2/e34/ %U https://doi.org/10.2196/publichealth.8923 %U http://www.ncbi.nlm.nih.gov/pubmed/29712626 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e8 %T MedFit App, a Behavior-Changing, Theoretically Informed Mobile App for Patient Self-Management of Cardiovascular Disease: User-Centered Development %A Duff,Orlaith %A Walsh,Deirdre %A Malone,Shauna %A McDermott,Lauri %A Furlong,Brona %A O'Connor,Noel %A Moran,Kieran %A Woods,Catherine %+ School of Health and Human Performance, Dublin City University, Glasnevin,, Dublin, 9, Ireland, 353 17008011, kieran.moran@dcu.ie %K app development %K cardiac rehabilitation %K telemedicine %K exercise %K mHealth %K focus groups %K usability testing %D 2018 %7 27.04.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The MedFit app is designed to facilitate participation of people with cardiovascular disease (CVD) in an exercise-based rehabilitation program remotely. This paper details the development for the MedFit app. Objective: The aim of this research was to develop a behavior change, theoretically informed exercise rehabilitation mobile app for adults with CVD by following the early stages of the formative research: development and feasibility testing. Methods: Adhering to the mobile health (mHealth) development evaluation framework, the stages of the formative research process including (1) development and (2) feasibility were undertaken. The content and format of the MedFit app were developed based on (1) theory, (2) usability testing, and (3) content design. Results: A systematic review of the literature was undertaken to identify the most appropriate theories from which to develop the app. This led to the creation of the MedFit app. The app went through iterative rounds of usability focus group testing with adults with CVD to provide feedback on the app. This process was framed by the unified theory of acceptance and use of technology model. Feedback was then translated into feasible technical improvements to be executed through close collaboration with the technical team, who adapted and made modifications to the app based on this codesign process. Conclusions: The formative research process of the app development involved theoretical underpinning, usability testing, and content design. mHealth interventions may play a key role in the future of health care, potentially addressing the barriers to participation in cardiac rehabilitation. This work will provide guidance for future research aiming to develop mobile apps by incorporating a best practice framework for mHealth intervention development and a user-centered design approach. %M 30684426 %R 10.2196/formative.9550 %U http://formative.jmir.org/2018/1/e8/ %U https://doi.org/10.2196/formative.9550 %U http://www.ncbi.nlm.nih.gov/pubmed/30684426 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e107 %T Long-Term Effectiveness of a Smartphone App for Improving Healthy Lifestyles in General Population in Primary Care: Randomized Controlled Trial (Evident II Study) %A Garcia-Ortiz,Luis %A Recio-Rodriguez,Jose Ignacio %A Agudo-Conde,Cristina %A Patino-Alonso,María Carmen %A Maderuelo-Fernandez,Jose-Angel %A Repiso Gento,Irene %A Puigdomenech Puig,Elisa %A Gonzalez-Viejo,Natividad %A Arietaleanizbeaskoa,Maria Soledad %A Schmolling-Guinovart,Yolanda %A Gomez-Marcos,Manuel Angel %A Rodriguez-Sanchez,Emiliano %A , %+ Primary Health Care Research Unit, Institute of Biomedical Research of Salamanca, La Alamedilla Health Center, Health Service of Castilla y León, Av. Comuneros 27-31, Salamanca,, Spain, 34 923231859 ext 53552, lgarciao@usal.es %K exercise %K Mediterranean diet %K smartphone %K vascular stiffness %D 2018 %7 27.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Information and communication technologies are currently among the supporting elements that may contribute to improving health and changing lifestyles. Objective: The aim of this study was to evaluate the long-term effectiveness of adding an app to standardized counseling in order to increase physical activity (PA) and adherence to the Mediterranean diet and to analyze the effects of app adherence in lifestyle changes. Methods: A randomized, multicenter clinical trial with a 12 month-follow up was conducted, involving 833 participants recruited by random sampling in 6 primary Spanish care centers (415 vs 418). Counseling on PA and the Mediterranean diet was given to both groups by a research nurse; however, the counseling + app group (intervention group) received additional training in the use of an app that was designed to promote the Mediterranean diet and PA over a 3-month period. Main outcomes and measures included PA by accelerometer and the 7-day Physical Activity Recall (PAR) questionnaire and adherence to the Mediterranean diet by an adherence screener questionnaire. We considered adherence to the app to be high when it was used for more than 60 days. Results: The mean age was 51 years (SD 12) in the intervention group and 52.3 years (SD 12.0) in the counseling-only group; females predominated in both groups (60.0%, 249/415 and 64.1%, 268/418, respectively). PA by accelerometer declined in both groups at 12 months (P value for tendency in moderate to vigorous PA, [MVPA]=.15). The intervention subgroup with high app adherence had better behavior than the low adherence subgroup (P value for tendency in MVPA=.001). PA analyzed by 7-day PAR did not show changes at 12 months in any of the groups (P value for tendency=.25). In the Mediterranean diet, an increase in adherence was observed in both groups at 12 months with no differences between them (P value for tendency=.46). In these two cases, the group with high app adherence also had better behavior, although without reaching significance for the tendency (P>.05). Conclusions: The participants with strongest app adherence showed better outcomes in terms of maintenance of healthy lifestyles at 12 months than those with weaker adherence. Overall, however, we found no differences between intervention group and counseling-only group in PA increase and adherence to the Mediterranean diet in the long term. Trial Registration: Clinicaltrials.gov NCT02016014; https://clinicaltrials.gov/ct2/show/NCT02016014 (Archived by WebCite at http://www.webcitation.org/6ymEXH6W4) %M 29702473 %R 10.2196/mhealth.9218 %U http://mhealth.jmir.org/2018/4/e107/ %U https://doi.org/10.2196/mhealth.9218 %U http://www.ncbi.nlm.nih.gov/pubmed/29702473 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 2 %P e18 %T Enhancing Home Health Mobile Phone App Usability Through General Smartphone Training: Usability and Learnability Case Study %A Harte,Richard %A Hall,Tony %A Glynn,Liam %A Rodríguez-Molinero,Alejandro %A Scharf,Thomas %A Quinlan,Leo R %A ÓLaighin,Gearóid %+ Physiology, School of Medicine, NUI Galway, University Road, Galway,, Ireland, 353 91493710, leo.quinlan@nuigalway.ie %K smartphone %K aged %K elderly %K wearable electronic devices %K telemedicine %K user-computer interface %K education %K user centered-design %K usability %K connected health %K human factors %K falls detection %D 2018 %7 26.04.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Each year, millions of older adults fall, with more than 1 out of 4 older people experiencing a fall annually, thereby causing a major social and economic impact. Falling once doubles one’s chances of falling again, making fall prediction an important aspect of preventative strategies. In this study, 22 older adults aged between 65 and 85 years were trained in the use of a smartphone-based fall prediction system. The system is designed to continuously assess fall risk by measuring various gait and balance parameters using a smart insole and smartphone, and is also designed to detect falls. The use case of the fall prediction system in question required the users to interact with the smartphone via an app for device syncing, data uploads, and checking system status. Objective: The objective of this study was to observe the effect that basic smartphone training could have on the user experience of a group that is not technically proficient with smartphones when using a new connected health system. It was expected that even short rudimentary training could have a large effect on user experience and therefore increase the chances of the group accepting the new technology. Methods: All participants received training on how to use the system smartphone app; half of the participants (training group) also received extra training on how to use basic functions of the smartphone, such as making calls and sending text messages, whereas the other half did not receive this extra training (no extra training group). Comparison of training group and no extra training group was carried out using metrics such as satisfaction rating, time taken to complete tasks, cues required to complete tasks, and errors made during tasks. Results: The training group fared better in the first 3 days of using the system. There were significant recorded differences in number of cues required and errors committed between the two groups. By the fourth and fifth day of use, both groups were performing at the same level when using the system. Conclusions: Supplementary basic smartphone training may be critical in trials where a smartphone app–based system for health intervention purposes is being introduced to a population that is not proficient with technology. This training could prevent early technology rejection and increase the engagement of older participants and their overall user experience with the system. %M 29699969 %R 10.2196/humanfactors.7718 %U http://humanfactors.jmir.org/2018/2/e18/ %U https://doi.org/10.2196/humanfactors.7718 %U http://www.ncbi.nlm.nih.gov/pubmed/29699969 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e30 %T Worker Preferences for a Mental Health App Within Male-Dominated Industries: Participatory Study %A Peters,Dorian %A Deady,Mark %A Glozier,Nick %A Harvey,Samuel %A Calvo,Rafael A %+ Wellbeing Technology Lab, Faculty of Engineering and IT, University of Sydney, Bldg J03, Electrical Engineering, Sydney, 2006, Australia, 61 0289015604, dorian.peters@sydney.edu.au %K mental health %K mhealth %K mobile apps %K workplace %K men %K participatory design %D 2018 %7 25.04.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Men are less likely to seek help for mental health problems, possibly because of stigma imposed by cultural masculine norms. These tendencies may be amplified within male-dominated workplaces such as the emergency services or transport industries. Mobile apps present a promising way to provide access to mental health support. However, little is known about the kinds of mental health technologies men would be willing to engage with, and no app can be effective if the intended users do not engage with it. Objective: The goal of this participatory user research study was to explore the perceptions, preferences, and ideas of workers in male-dominated workplaces to define requirements for a mental health app that would be engaging and effective at improving psychological well-being. Methods: Workers from male-dominated workplaces in rural, suburban, and urban locations took part in an exploratory qualitative study involving participatory workshops designed to elicit their perspectives and preferences for mental health support and the design of an app for mental health. Participants generated a number of artifacts (including draft screen designs and promotional material) designed to reify their perceptions, tacit knowledge, and ideas. Results: A total of 60 workers aged between 26 and 65 years, 92% (55/60) male, from male-dominated workplaces in rural (16/60, 27%), suburban (14/60, 23%), and urban (30/60, 50%) locations participated in one of the 6 workshops, resulting in 49 unique feature ideas and 81 participant-generated artifacts. Thematic analysis resulted in a set of feature, language, and style preferences, as well as characteristics considered important by participants for a mental health app. The term “mental health” was highly stigmatized and disliked by participants. Tools including a mood tracker, self-assessment, and mood-fix tool were highly valued, and app characteristics such as brevity of interactions, minimal on-screen text, and a solutions-oriented approach were considered essential by participants. Some implementation strategies based on these findings are included in the discussion. Conclusions: Future mental health mobile phone apps targeting workers in male-dominated workplaces need to consider language use and preferred features, as well as balance the preferences of users with the demands of evidence-based intervention. In addition to informing the development of mental health apps for workers in male-dominated industries, these findings may also provide insights for mental health technologies, for men in general, and for others in high-stigma environments. %M 29695371 %R 10.2196/mental.8999 %U http://mental.jmir.org/2018/2/e30/ %U https://doi.org/10.2196/mental.8999 %U http://www.ncbi.nlm.nih.gov/pubmed/29695371 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e77 %T Impact of the Growing Healthy mHealth Program on Maternal Feeding Practices, Infant Food Preferences, and Satiety Responsiveness: Quasi-Experimental Study %A Russell,Catherine Georgina %A Denney-Wilson,Elizabeth %A Laws,Rachel A %A Abbott,Gavin %A Zheng,Miaobing %A Lymer,Sharyn J %A Taki,Sarah %A Litterbach,Eloise-Kate V %A Ong,Kok-Leong %A Campbell,Karen J %+ Centre for Advanced Sensory Science, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, 61 03924 ext 68503, georgie.russell@deakin.edu.au %K mHealth %K obesity %K infant %K parents %K food preferences %K appetite %K pediatric obesity %K feeding behavior %K overweight %K eating %K health promotion %D 2018 %7 25.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Infancy is an important life stage for obesity prevention efforts. Parents’ infant feeding practices influence the development of infants’ food preferences and eating behaviors and subsequently diet and weight. Mobile health (mHealth) may provide a feasible medium through which to deliver programs to promote healthy infant feeding as it allows low cost and easy access to tailored content. Objective: The objective of this study was to describe the effects of an mHealth intervention on parental feeding practices, infant food preferences, and infant satiety responsiveness. Methods: A quasi-experimental study was conducted with an mHealth intervention group (Growing Healthy) and a nonrandomized comparison group (“Baby's First Food"). The intervention group received access to a free app with age-appropriate push notifications, a website, and an online forum that provided them with evidence-based advice on infant feeding for healthy growth from birth until 9 months of age. Behavior change techniques were selected using the Behaviour Change Wheel framework. Participants in both groups completed three Web-based surveys, first when their infants were less than 3 months old (baseline, T1), then at 6 months (time 2, T2), and 9 months of age (time 3, T3). Surveys included questions on infant feeding practices and beliefs (Infant Feeding Questionnaire, IFQ), satiety responsiveness (Baby Eating Behaviour Questionnaire), and infant’s food exposure and liking. Multivariate linear regression models, estimated using maximum likelihood with bootstrapped standard errors, were fitted to compare continuous outcomes between the intervention groups, with adjustment for relevant covariates. Multivariate logistic regression adjusting for the same covariates was performed for categorical outcomes. Results: A total of 645 parents (Growing Healthy: n=301, Baby's First Food: n=344) met the eligibility criteria and were included in the study, reducing to a sample size of 546 (Growing Healthy: n=234, Baby's First Food: n=312) at T2 and a sample size of 518 (Growing Healthy: n=225, Baby's First Food: n=293) at T3. There were approximately equal numbers of boy and girl infants, and infants were aged less than 3 months at baseline (Growing Healthy: mean 7.0, SD 3.7 weeks; Baby's First Food: mean 7.9, SD 3.8 weeks), with Growing Healthy infants being slightly younger than Baby's First Food infants (P=.001). All but one (IFQ subscale “concerns about infant overeating or becoming overweight” at T2) of the measured outcomes did not differ between Growing Healthy and Baby's First Food. Conclusions: Although mHealth can be effective in promoting some health behaviors and offers many advantages in health promotion, the results of this study suggest that design and delivery characteristics needed to maximize the impact of mHealth interventions on infant feeding are uncertain. The sensitivity of available measurement tools and differences in baseline characteristics of participants may have also affected the results. %M 29695373 %R 10.2196/mhealth.9303 %U http://mhealth.jmir.org/2018/4/e77/ %U https://doi.org/10.2196/mhealth.9303 %U http://www.ncbi.nlm.nih.gov/pubmed/29695373 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e109 %T The Usability and Effectiveness of Mobile Health Technology–Based Lifestyle and Medical Intervention Apps Supporting Health Care During Pregnancy: Systematic Review %A Overdijkink,Sanne B %A Velu,Adeline V %A Rosman,Ageeth N %A van Beukering,Monique DM %A Kok,Marjolein %A Steegers-Theunissen,Regine PM %+ Department of Obstetrics and Gynecology, Erasmus Medical Center, PO Box 2040, Rotterdam, 3000CA, Netherlands, 31 107043598, r.steegers@erasmusmc.nl %K mHealth %K pregnancy %K lifestyle %K health care %K maternal health %D 2018 %7 24.04.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: A growing number of mobile health (mHealth) technology–based apps are being developed for personal lifestyle and medical health care support, of which several apps are related to pregnancy. Evidence on usability and effectiveness is limited but crucial for successful implementation. Objective: This study aimed to evaluate the usability, that is, feasibility and acceptability, as well as effectiveness of mHealth lifestyle and medical apps to support health care during pregnancy in high-income countries. Feasibility was defined as the actual use, interest, intention, and continued use; perceived suitability; and ability of users to carry out the activities of the app. Acceptability was assessed by user satisfaction, appreciation, and the recommendation of the app to others. Methods: We performed a systematic review searching the following electronic databases for studies on mHealth technology–based apps in maternal health care in developed countries: EMBASE, MEDLINE Epub (Ovid), Cochrane Library, Web of Science, and Google Scholar. All included studies were scored on quality, using the ErasmusAGE Quality Score or the consolidated criteria for reporting qualitative research. Main outcome measures were usability and effectiveness of mHealth lifestyle and medical health care support apps related to pregnancy. All studies were screened by 2 reviewers individually, and the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement were followed. Results: Our search identified 4204 titles and abstracts, of which 2487 original studies remained after removing duplicates. We performed full-text screening of 217 studies, of which 29 were included in our study. In total, 19 out of 29 studies reported on mHealth apps to adopt healthy lifestyles and 10 out of 29 studies to support medical care. The lifestyle apps evaluated in 19 studies reported on usability and effectiveness: 10 studies reported positive on acceptability, and 14 studies reported on feasibility with positive results except one study. In total, 4 out of 19 studies evaluating effectiveness showed significant results on weight gain restriction during pregnancy, intake of vegetables and fruits, and smoking cessation. The 10 studies on medical mHealth apps involved asthma care, diabetic treatment, and encouraging vaccination. Only one study on diabetic treatment reported on acceptability with a positive user satisfaction. In total, 9 out of 10 studies reported on effectiveness. Moreover, the power of most studies was inadequate to show significant effects. Conclusions: Most studies on mHealth apps to support lifestyle and medical care for high-income countries reveal the usability of these apps to reduce gestational weight gain, increase intakes of vegetables and fruit, to quit smoking cessation, and to support health care for prevention of asthma and infections during pregnancy. In general, the evidence on effectiveness of these apps is limited and needs further investigation before implementation in medical health care. %M 29691216 %R 10.2196/mhealth.8834 %U http://mhealth.jmir.org/2018/4/e109/ %U https://doi.org/10.2196/mhealth.8834 %U http://www.ncbi.nlm.nih.gov/pubmed/29691216 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e91 %T Development of a Healthy Lifestyle Mobile App for Overweight Pregnant Women: Qualitative Study %A Lau,Ying %A Cheng,Ling Jie %A Chi,Claudia %A Tsai,Cammy %A Ong,Kai Wen %A Ho-Lim,Sarah Su Tin %A Wang,Wei %A Tan,Kian-Lee %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore, 65 66011603, nurly@nus.edu.sg %K mobile apps %K overweight %K obesity %D 2018 %7 23.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps are becoming an increasingly ubiquitous platform for delivery of health behavior interventions among overweight and obese perinatal women. However, only a few methodological guidelines on integrating theory, evidence, and qualitative research for their designs are available. Objective: The aim of this study was to develop a theory-based, evidence-driven, and user-centered healthy lifestyle app targeting overweight and obese multiethnic pregnant women. Methods: This paper illustrates how intervention development may be enriched with theoretical basis, systematic review, and qualitative study. An individual face-to-face interview was performed to incorporate the user’s involvement in the design. These interviews were audiotaped and transcribed. Thematic analysis technique was used for emerging themes. Results: Integrated concepts of social cognitive theory of self-regulation, self-regulation model, and strength model of self-control were selected as bases of the intervention. Evidence from our systematic review and meta-analysis provided the strongest evidence for the development of intervention. We invited 16 obese or overweight pregnant women to participate in a semistructured interview . The following key themes emerged: content, platform, interactivity, format, and functionality. Apps are a favorable technology platform for healthy diet advice, appropriate physical exercise, and weight management because they are user-friendly and convenient. The app used in this study contains culture-specific, pregnancy-related, and credible contents, including educational, professional and peer support, and self-monitoring domains. The design should include aesthetic appeal, visualized features, and interactive multimedia. Conclusions: A 3-step process integrating theoretical basis, evidence from systematic review, and research findings from target users can be considered a guide for future app development. %M 29685868 %R 10.2196/mhealth.9718 %U http://mhealth.jmir.org/2018/4/e91/ %U https://doi.org/10.2196/mhealth.9718 %U http://www.ncbi.nlm.nih.gov/pubmed/29685868 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e32 %T Ethical Issues for Direct-to-Consumer Digital Psychotherapy Apps: Addressing Accountability, Data Protection, and Consent %A Martinez-Martin,Nicole %A Kreitmair,Karola %+ Stanford Center for Biomedical Ethics, 1215 Welch Road, Stanford, CA, 94305, United States, 1 650 723 5760, nicolemz@stanford.edu %K ethics %K ethical issues %K mental health %K technology %K telemedicine %K mHealth %K psychotherapy %D 2018 %7 23.04.2018 %9 Viewpoint %J JMIR Ment Health %G English %X This paper focuses on the ethical challenges presented by direct-to-consumer (DTC) digital psychotherapy services that do not involve oversight by a professional mental health provider. DTC digital psychotherapy services can potentially assist in improving access to mental health care for the many people who would otherwise not have the resources or ability to connect with a therapist. However, the lack of adequate regulation in this area exacerbates concerns over how safety, privacy, accountability, and other ethical obligations to protect an individual in therapy are addressed within these services. In the traditional therapeutic relationship, there are ethical obligations that serve to protect the interests of the client and provide warnings. In contrast, in a DTC therapy app, there are no clear lines of accountability or associated ethical obligations to protect the user seeking mental health services. The types of DTC services that present ethical challenges include apps that use a digital platform to connect users to minimally trained nonprofessional counselors, as well as services that provide counseling steered by artificial intelligence and conversational agents. There is a need for adequate oversight of DTC nonprofessional psychotherapy services and additional empirical research to inform policy that will provide protection to the consumer. %M 29685865 %R 10.2196/mental.9423 %U http://mental.jmir.org/2018/2/e32/ %U https://doi.org/10.2196/mental.9423 %U http://www.ncbi.nlm.nih.gov/pubmed/29685865 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e145 %T Usage of a Digital Health Workplace Intervention Based on Socioeconomic Environment and Race: Retrospective Secondary Cross-Sectional Study %A Senecal,Conor %A Widmer,R Jay %A Bailey,Kent %A Lerman,Lilach O %A Lerman,Amir %+ Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, United States, 1 507 255 1622, lerman.amir@mayo.edu %K race and ethnicity %K socioeconomic position %K computers %K health services research %K health disparities %D 2018 %7 23.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health tools have been associated with improvement of cardiovascular disease (CVD) risk factors and outcomes; however, the differential use of these technologies among various ethnic and economic classes is not well known. Objective: To identify the effect of socioeconomic environment on usage of a digital health intervention. Methods: A retrospective secondary cross-sectional analysis of a workplace digital health tool use, in association with a change in intermediate markers of CVD, was undertaken over the course of one year in 26,188 participants in a work health program across 81 organizations in 42 American states between 2011 and 2014. Baseline demographic data for participants included age, sex, race, home zip code, weight, height, blood pressure, glucose, lipids, and hemoglobin A1c. Follow-up data was then obtained in 90-day increments for up to one year. Using publicly available data from the American Community Survey, we obtained the median income for each zip code as a marker for socioeconomic status via median household income. Digital health intervention usage was analyzed based on socioeconomic status as well as age, gender, and race. Results: The cohort was found to represent a wide sample of socioeconomic environments from a median income of US $11,000 to $171,000. As a whole, doubling of income was associated with 7.6% increase in log-in frequency. However, there were marked differences between races. Black participants showed a 40.5% increase and Hispanic participants showed a 57.8% increase in use with a doubling of income, compared to 3% for Caucasian participants. Conclusions: The current study demonstrated that socioeconomic data confirms no relevant relationship between socioeconomic environment and digital health intervention usage for Caucasian users. However, a strong relationship is present for black and Hispanic users. Thus, socioeconomic environment plays a prominent role only in minority groups that represent a high-risk group for CVD. This finding identifies a need for digital health apps that are effective in these high-risk groups. %M 29685862 %R 10.2196/jmir.8819 %U http://www.jmir.org/2018/4/e145/ %U https://doi.org/10.2196/jmir.8819 %U http://www.ncbi.nlm.nih.gov/pubmed/29685862 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e101 %T Digital Inequalities in the Use of Self-Tracking Diet and Fitness Apps: Interview Study on the Influence of Social, Economic, and Cultural Factors %A Régnier,Faustine %A Chauvel,Louis %+ Institut National de la Recherche Agronomique, Alimentation et Sciences Sociales Unité de Recherche 1303, University of Paris Saclay, 65 Boulevard de Brandebourg, Ivry sur Seine Cedex, 94205, France, 33 149596914, faustine.regnier@inra.fr %K diet %K digital divide %K fitness trackers %K France %K healthy diet %K physical activity %K social networking %K social participation %K weight loss %D 2018 %7 20.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital devices are driving economic and social transformations, but assessing the uses, perceptions, and impact of these new technologies on diet and physical activity remains a major societal challenge. Objective: We aimed to determine under which social, economic, and cultural conditions individuals in France were more likely to be actively invested in the use of self-tracking diet and fitness apps for better health behaviors. Methods: Existing users of 3 diet and fitness self-tracking apps (Weight Watchers, MyFitnessPal, and sport apps) were recruited from 3 regions of France. We interviewed 79 individuals (Weight Watchers, n=37; MyFitnessPal, n=20; sport apps, n=22). In-depth semistructured interviews were conducted with each participant, using open-ended questions about their use of diet and fitness apps. A triangulation of methods (content, textual, and quantitative analyses) was performed. Results: We found 3 clusters of interviewees who differed by social background and curative goal linked to use under constraint versus preventive goal linked to chosen use, and intensity of their self-quantification efforts and participation in social networks. Interviewees used the apps for a diversity of uses, including measurement, tracking, quantification, and participation in digital communities. A digital divide was highlighted, comprising a major social gap. Social conditions for appropriation of self-tracking devices included sociodemographic factors, life course stages, and cross-cutting factors of heterogeneity. Conclusions: Individuals from affluent or intermediate social milieus were most likely to use the apps and to participate in the associated online social networks. These interviewees also demonstrated a preventive approach to a healthy lifestyle. Individuals from lower milieus were more reluctant to use digital devices relating to diet and physical activity or to participate in self-quantification. The results of the study have major implications for public health: the digital self-quantification device is intrinsically less important than the way the individual uses it, in terms of adoption of successful health behaviors. %M 29678807 %R 10.2196/mhealth.9189 %U http://mhealth.jmir.org/2018/4/e101/ %U https://doi.org/10.2196/mhealth.9189 %U http://www.ncbi.nlm.nih.gov/pubmed/29678807 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e100 %T A Novel Algorithm for Determining the Contextual Characteristics of Movement Behaviors by Combining Accelerometer Features and Wireless Beacons: Development and Implementation %A Magistro,Daniele %A Sessa,Salvatore %A Kingsnorth,Andrew P %A Loveday,Adam %A Simeone,Alessandro %A Zecca,Massimiliano %A Esliger,Dale W %+ School of Sport, Exercise, and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, United Kingdom, 44 0 7541 703272, D.Magistro@lboro.ac.uk %K context %K indoor location %K activity monitor %K behavior %K wearable sensor %K beacons/proximity %K algorithm %K physical activity %K sedentary behavior %D 2018 %7 20.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Unfortunately, global efforts to promote “how much” physical activity people should be undertaking have been largely unsuccessful. Given the difficulty of achieving a sustained lifestyle behavior change, many scientists are reexamining their approaches. One such approach is to focus on understanding the context of the lifestyle behavior (ie, where, when, and with whom) with a view to identifying promising intervention targets. Objective: The aim of this study was to develop and implement an innovative algorithm to determine “where” physical activity occurs using proximity sensors coupled with a widely used physical activity monitor. Methods: A total of 19 Bluetooth beacons were placed in fixed locations within a multilevel, mixed-use building. In addition, 4 receiver-mode sensors were fitted to the wrists of a roving technician who moved throughout the building. The experiment was divided into 4 trials with different walking speeds and dwelling times. The data were analyzed using an original and innovative algorithm based on graph generation and Bayesian filters. Results: Linear regression models revealed significant correlations between beacon-derived location and ground-truth tracking time, with intraclass correlations suggesting a high goodness of fit (R2=.9780). The algorithm reliably predicted indoor location, and the robustness of the algorithm improved with a longer dwelling time (>100 s; error <10%, R2=.9775). Increased error was observed for transitions between areas due to the device sampling rate, currently limited to 0.1 Hz by the manufacturer. Conclusions: This study shows that our algorithm can accurately predict the location of an individual within an indoor environment. This novel implementation of “context sensing” will facilitate a wealth of new research questions on promoting healthy behavior change, the optimization of patient care, and efficient health care planning (eg, patient-clinician flow, patient-clinician interaction). %M 29678806 %R 10.2196/mhealth.8516 %U http://mhealth.jmir.org/2018/4/e100/ %U https://doi.org/10.2196/mhealth.8516 %U http://www.ncbi.nlm.nih.gov/pubmed/29678806 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e69 %T Measuring Risky Driving Behavior Using an mHealth Smartphone App: Development and Evaluation of gForce %A Freidlin,Raisa Z %A Dave,Amisha D %A Espey,Benjamin G %A Stanley,Sean T %A Garmendia,Marcial A %A Pursley,Randall %A Ehsani,Johnathon P %A Simons-Morton,Bruce G %A Pohida,Thomas J %+ Center for Information Technology, National Institutes of Health, 12A South Dr, Bldg 12A, Room 2023, Bethesda, MD, 20892, United States, 1 402 2788, raisa@mail.nih.gov %K kinematic risky driving behavior %K naturalistic driving studies %K elevated g-force %K lateral acceleration %K longitudinal acceleration %K iPhone %D 2018 %7 19.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Naturalistic driving studies, designed to objectively assess driving behavior and outcomes, are conducted by equipping vehicles with dedicated instrumentation (eg, accelerometers, gyroscopes, Global Positioning System, and cameras) that provide continuous recording of acceleration, location, videos, and still images for eventual retrieval and analyses. However, this research is limited by several factors: the cost of equipment installation; management and storage of the large amounts of data collected; and data reduction, coding, and analyses. Modern smartphone technology includes accelerometers built into phones, and the vast, global proliferation of smartphones could provide a possible low-cost alternative for assessing kinematic risky driving. Objective: We evaluated an in-house developed iPhone app (gForce) for detecting elevated g-force events by comparing the iPhone linear acceleration measurements with corresponding acceleration measurements obtained with both a custom Android app and the in-vehicle miniDAS data acquisition system (DAS; Virginia Tech Transportation Institute). Methods: The iPhone and Android devices were dashboard-mounted in a vehicle equipped with the DAS instrumentation. The experimental protocol consisted of driving maneuvers on a test track, such as cornering, braking, and turning that were performed at different acceleration levels (ie, mild, moderate, or hard). The iPhone gForce app recorded linear acceleration (ie, gravity-corrected). The Android app recorded gravity-corrected and uncorrected acceleration measurements, and the DAS device recorded gravity-uncorrected acceleration measurements. Lateral and longitudinal acceleration measures were compared. Results: The correlation coefficients between the iPhone and DAS acceleration measurements were slightly lower compared to the correlation coefficients between the Android and DAS, possibly due to the gravity correction on the iPhone. Averaging the correlation coefficients for all maneuvers, the longitudinal and lateral acceleration measurements between iPhone and DAS were rlng=0.71 and rlat=0.83, respectively, while the corresponding acceleration measurements between Android and DAS were rlng=0.95 and rlat=0.97. The correlation coefficients between lateral accelerations on all three devices were higher than with the corresponding longitudinal accelerations for most maneuvers. Conclusions: The gForce iPhone app reliably assessed elevated g-force events compared to the DAS. Collectively, the gForce app and iPhone platform have the potential to serve as feature-rich, inexpensive, scalable, and open-source tool for assessment of kinematic risky driving events, with potential for research and feedback forms of intervention. %M 29674309 %R 10.2196/mhealth.9290 %U http://mhealth.jmir.org/2018/4/e69/ %U https://doi.org/10.2196/mhealth.9290 %U http://www.ncbi.nlm.nih.gov/pubmed/29674309 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e90 %T Assessing Therapeutic Alliance in the Context of mHealth Interventions for Mental Health Problems: Development of the Mobile Agnew Relationship Measure (mARM) Questionnaire %A Berry,Katherine %A Salter,Amy %A Morris,Rohan %A James,Susannah %A Bucci,Sandra %+ Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M139PL, United Kingdom, 44 1613060422, katherine.berry@manchester.ac.uk %K mobile health %K health care provider %K digital interventions %K therapeutic alliance %K mental health %K measure development %D 2018 %7 19.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health interventions in the form of smartphone apps aim to improve mental health and enable people access to support as and when needed without having to face the stigma they may experience in accessing services. If we are to evaluate mobile health (mHealth) apps and advance scientific understanding, we also need tools to help us understand in what ways mHealth interventions are effective or not. The concept of therapeutic alliance, a measure of the quality of the relationship between a health care provider and a service user, is a key factor in explaining the effects of mental health interventions. The Agnew Relationship Measure (ARM) is a well-validated measure of therapeutic alliance in face-to-face therapy. Objective: This study presented the first attempt to (1) explore service users’ views of the concept of relationship within mHealth mental health interventions and (2) adapt a well-validated face-to-face measure of therapeutic alliance, the Agnew Relationship Measure (ARM), for use with mHealth interventions. Methods: In stage 1, we interviewed 9 mental health service users about the concept of therapeutic alliance in the context of a digital health intervention and derived key themes from interview transcripts using thematic analysis. In stage 2, we used rating scales and open-ended questions to elicit views from 14 service users and 10 mental health staff about the content and face validity of the scale, which replaced the word “therapist” with the word “app.” In stage 3, we used the findings from stages 1 and 2 to adapt the measure with the support of a decision-making algorithm about which items to drop, retain, or adapt. Results: Findings suggested that service users do identify relationship concepts when thinking about mHealth interventions, including forming a bond with an app and the ability to be open with an app. However, there were key differences between relationships with health professionals and relationships with apps. For example, apps were not as tailored and responsive to each person’s unique needs. Furthermore, apps were not capable of portraying uniquely human-like qualities such as friendliness, collaboration, and agreement. We made a number of changes to the ARM that included revising 16 items; removing 4 items due to lack of suitable alternatives; and adding 1 item to capture a key theme derived from stage 1 of the study (“The app is like having a member of my care team in my pocket”). Conclusions: This study introduces the mHealth version of the ARM, the mARM, that has good face and content validity. We encourage researchers to include this easy-to-use tool in digital health intervention studies to gather further data about its psychometric properties and advance our understanding of how therapeutic alliance influences the efficacy of mHealth interventions. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 34966555; http://www.isrctn.com/ISRCTN34966555 (Archived by WebCite at http://www.webcitation.org/6ymBVwKif) %M 29674307 %R 10.2196/jmir.8252 %U http://www.jmir.org/2018/4/e90/ %U https://doi.org/10.2196/jmir.8252 %U http://www.ncbi.nlm.nih.gov/pubmed/29674307 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e78 %T Key Lessons and Impact of the Growing Healthy mHealth Program on Milk Feeding, Timing of Introduction of Solids, and Infant Growth: Quasi-Experimental Study %A Laws,Rachel A %A Denney-Wilson,Elizabeth A %A Taki,Sarah %A Russell,Catherine G %A Zheng,Miaobing %A Litterbach,Eloise-Kate %A Ong,Kok-Leong %A Lymer,Sharyn J %A Elliott,Rosalind %A Campbell,Karen J %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Locked Bag 20000, Geelong, 3220, Australia, 61 9244 5574, r.laws@deakin.edu.au %K mHealth %K obesity prevention %K infancy %K parents %K breastfeeding %K complementary feeding %K formula feeding %D 2018 %7 19.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The first year of life is an important window to initiate healthy infant feeding practices to promote healthy growth. Interventions delivered by mobile phone (mHealth) provide a novel approach for reaching parents; however, little is known about the effectiveness of mHealth for child obesity prevention. Objective: The objective of this study was to determine the feasibility and effectiveness of an mHealth obesity prevention intervention in terms of reach, acceptability, and impact on key infant feeding outcomes. Methods: A quasi-experimental study was conducted with an mHealth intervention group (Growing healthy) and a nonrandomized comparison group (Baby’s First Food). The intervention group received access to a free app and website containing information on infant feeding, sleep and settling, and general support for parents with infants aged 0 to 9 months. App-generated notifications directed parents to age-and feeding-specific content within the app. Both groups completed Web-based surveys when infants were less than 3 months old (T1), at 6 months of age (T2), and 9 months of age (T3). Survival analysis was used to examine the duration of any breastfeeding and formula introduction, and cox proportional hazard regression was performed to examine the hazard ratio for ceasing breast feeding between the two groups. Multivariate logistic regression with adjustment for a range of child and parental factors was used to compare the exclusive breastfeeding, formula feeding behaviors, and timing of solid introduction between the 2 groups. Mixed effect polynomial regression models were performed to examine the group differences in growth trajectory from birth to T3. Results: A total of 909 parents initiated the enrollment process, and a final sample of 645 parents (Growing healthy=301, Baby’s First Food=344) met the eligibility criteria. Most mothers were Australian born and just under half had completed a university education. Retention of participants was high (80.3%, 518/645) in both groups. Most parents (226/260, 86.9%) downloaded and used the app; however, usage declined over time. There was a high level of satisfaction with the program, with 86.1% (143/166) reporting that they trusted the information in the app and 84.6% (170/201) claiming that they would recommend it to a friend. However, some technical problems were encountered with just over a quarter of parents reporting that the app failed to work at times. There were no significant differences between groups in any of the target behaviors. Growth trajectories also did not differ between the 2 groups. Conclusions: An mHealth intervention using a smartphone app to promote healthy infant feeding behaviors is a feasible and acceptable mode for delivering obesity prevention intervention to parents; however, app usage declined over time. Learnings from this study will be used to further enhance the program so as to improve its potential for changing infant feeding behaviors. %M 29674313 %R 10.2196/mhealth.9040 %U http://mhealth.jmir.org/2018/4/e78/ %U https://doi.org/10.2196/mhealth.9040 %U http://www.ncbi.nlm.nih.gov/pubmed/29674313 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e146 %T Uptake of Tailored Text Message Smoking Cessation Support in Pregnancy When Advertised on the Internet (MiQuit): Observational Study %A Emery,Joanne L %A Coleman,Tim %A Sutton,Stephen %A Cooper,Sue %A Leonardi-Bee,Jo %A Jones,Matthew %A Naughton,Felix %+ Behavioral Science Group, Institute of Public Health, University of Cambridge, Forvie Site, Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom, 44 0 1223 330355, jle40@medschl.cam.ac.uk %K smoking cessation %K pregnancy %K internet %K telemedicine %K public health %K social media %D 2018 %7 19.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Smoking in pregnancy is a major public health concern. Pregnant smokers are particularly difficult to reach, with low uptake of support options and few effective interventions. Text message–based self-help is a promising, low-cost intervention for this population, but its real-world uptake is largely unknown. Objective: The objective of this study was to explore the uptake and cost-effectiveness of a tailored, theory-guided, text message intervention for pregnant smokers (“MiQuit”) when advertised on the internet. Methods: Links to a website providing MiQuit initiation information (texting a short code) were advertised on a cost-per-click basis on 2 websites (Google Search and Facebook; £1000 budget each) and free of charge within smoking-in-pregnancy webpages on 2 noncommercial websites (National Childbirth Trust and NHS Choices). Daily budgets were capped to allow the Google and Facebook adverts to run for 1 and 3 months, respectively. We recorded the number of times adverts were shown and clicked on, the number of MiQuit initiations, the characteristics of those initiating MiQuit, and whether support was discontinued prematurely. For the commercial adverts, we calculated the cost per initiation and, using quit rates obtained from an earlier clinical trial, estimated the cost per additional quitter. Results: With equal capped budgets, there were 812 and 1889 advert clicks to the MiQuit website from Google (search-based) and Facebook (banner) adverts, respectively. MiQuit was initiated by 5.2% (42/812) of those clicking via Google (95% CI 3.9%-6.9%) and 2.22% (42/1889) of those clicking via Facebook (95% CI 1.65%-2.99%). Adverts on noncommercial webpages generated 53 clicks over 6 months, with 9 initiations (9/53, 17%; 95% CI 9%-30%). For the commercial websites combined, mean cost per initiation was £24.73; estimated cost per additional quitter, including text delivery costs, was £735.86 (95% CI £227.66-£5223.93). Those initiating MiQuit via Google were typically very early in pregnancy (median gestation 5 weeks, interquartile range 10 weeks); those initiating via Facebook were distributed more evenly across pregnancy (median gestation 16 weeks, interquartile range 14 weeks). Conclusions: Commercial online adverts are a feasible, likely cost-effective method for engaging pregnant smokers in digital cessation support and may generate uptake at a faster rate than noncommercial websites. As a strategy for implementing MiQuit, online advertising has large reach potential and can offer support to a hard-to-reach population of smokers. %M 29674308 %R 10.2196/jmir.8525 %U http://www.jmir.org/2018/4/e146/ %U https://doi.org/10.2196/jmir.8525 %U http://www.ncbi.nlm.nih.gov/pubmed/29674308 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e41 %T Incorporating a Static Versus Supportive Mobile Phone App Into a Partial Meal Replacement Program With Face-to-Face Support: Randomized Controlled Trial %A Brindal,Emily %A Hendrie,Gilly A %A Freyne,Jill %A Noakes,Manny %+ CSIRO Food and Nutrition, Gate 13 Kintore Avenue, Adelaide, 5000, Australia, 61 883050633, emily.brindal@csiro.au %K mHealth %K weight loss %K diet %D 2018 %7 18.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone apps may be acceptable to users and could improve retention and adherence over more traditional methods, but there is mixed literature supporting their efficacy. In the weight management space, very little is known about how a mobile phone app integrating features beyond text messaging (short message service) can affect behavior, particularly when combined with face-to-face support. Objective: The objective of this study was to examine the effectiveness of a mobile phone app when combined with a partial meal replacement program including face-to-face support. This paper compares a static versus supportive app over a 6-month randomized trial for effects on weight loss, weight-related biomarkers, and psychological outcomes. Methods: Overweight and obese adults (71.2% female, 104/146; mean 48.11, SD 11.75 years) were recruited to participate in the weight loss study, and they were randomized on a 1:1 basis using a computer algorithm. The supportive app (n=75) provided information, food intake recording, rewards, prompts for regular interaction through reminders, and the opportunity to review personal compliance with the dietary program. The static app (n=71) included only recipes and weight loss information. Both groups recieved equal amounts of face-to-face support in addition to app. Results: The overall reduction in app usage over 24 weeks was lower for the supportive app in comparison with the static app; approximately 39.0% (57/146) of the users were still using the app at week 24. Despite the promising results for app usage, there were no differences in weight loss between groups (F1,128.12=0.83, P=.36). However, it should be noted that almost 60% (49/84) of all participants lost 5% or more of body weight during the trial. No weight-related biomarkers were significantly different between groups. Both groups experienced an increase in positive mood, but this was significantly higher for those who received the static app (F1,118.12=4.93, P=.03). Conclusions: Although the supportive app was well received by users, we found little evidence of the added benefit of this versus the static app in combination with face-to-face support in a community-delivered weight loss program. Future versions of the app may incorporate more unique behavioral techniques beyond those provided by the consultant to improve the potency of the app. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12613000547741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364187 (Archived by WebCite http://www.webcitation.org/6yivwfMI9) %M 29669704 %R 10.2196/mhealth.7796 %U http://mhealth.jmir.org/2018/4/e41/ %U https://doi.org/10.2196/mhealth.7796 %U http://www.ncbi.nlm.nih.gov/pubmed/29669704 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e98 %T Evaluation of Two Mobile Health Apps in the Context of Smoking Cessation: Qualitative Study of Cognitive Behavioral Therapy (CBT) Versus Non-CBT-Based Digital Solutions %A Tudor-Sfetea,Carina %A Rabee,Riham %A Najim,Muhammad %A Amin,Nima %A Chadha,Mehak %A Jain,Minal %A Karia,Kishan %A Kothari,Varun %A Patel,Tejus %A Suseeharan,Melanie %A Ahmed,Maroof %A Sherwani,Yusuf %A Siddiqui,Sarim %A Lin,Yuting %A Eisingerich,Andreas B %+ Imperial College Business School, Imperial College London, South Kensington Campus, Ayrton Rd, Kensington, London, SW7 2AZ, United Kingdom, 44 020 7589 5111, a.eisingerich@imperial.ac.uk %K smoking cessation %K mHealth %K mobile health %K health behavior change %K cognitive behavioral therapy %K public health %K health policy %D 2018 %7 18.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps can offer users numerous benefits, representing a feasible and acceptable means of administering health interventions such as cognitive behavioral therapy (CBT). CBT is commonly used in the treatment of mental health conditions, where it has a strong evidence base, suggesting that it represents an effective method to elicit health behavior change. More importantly, CBT has proved to be effective in smoking cessation, in the context of smoking-related costs to the National Health Service (NHS) having been estimated to be as high as £2.6bn in 2015. Although the evidence base for computerized CBT in mental health is strong, there is limited literature on its use in smoking cessation. This, combined with the cost-effectiveness of mHealth interventions, advocates a need for research into the effectiveness of CBT-based smoking cessation apps. Objective: The objective of this study was, first, to explore participants’ perceptions of 2 mHealth apps, a CBT-based app, Quit Genius, and a non-CBT-based app, NHS Smokefree, over a variety of themes. Second, the study aimed to investigate the perceptions and health behavior of users of each app with respect to smoking cessation. Methods: A qualitative short-term longitudinal study was conducted, using a sample of 29 smokers allocated to one of the 2 apps, Quit Genius or Smokefree. Each user underwent 2 one-to-one semistructured interviews, 1 week apart. Thematic analysis was carried out, and important themes were identified. Descriptive statistics regarding participants’ perceptions and health behavior in relation to smoking cessation are also provided. Results: The thematic analysis resulted in five higher themes and several subthemes. Participants were generally more positive about Quit Genius’s features, as well as about its design and information engagement and quality. Quit Genius users reported increased motivation to quit smoking, as well as greater willingness to continue using their allocated app after 1 week. Moreover, these participants demonstrated preliminary changes in their smoking behavior, although this was in the context of our limited sample, not yet allowing for the finding to be generalizable. Conclusions: Our findings underscore the use of CBT in the context of mHealth apps as a feasible and potentially effective smoking cessation tool. mHealth apps must be well developed, preferably with an underlying behavioral change mechanism, to promote positive health behavior change. Digital CBT has the potential to become a powerful tool in overcoming current health care challenges. The present results should be replicated in a wider sample using the apps for a longer period so as to allow for generalizability. Further research is also needed to focus on the effect of greater personalization on behavioral change and on understanding the psychological barriers to the adoption of new mHealth solutions. %M 29669708 %R 10.2196/mhealth.9405 %U http://mhealth.jmir.org/2018/4/e98/ %U https://doi.org/10.2196/mhealth.9405 %U http://www.ncbi.nlm.nih.gov/pubmed/29669708 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e122 %T Physical Activity, Sedentary Behavior, and Diet-Related eHealth and mHealth Research: Bibliometric Analysis %A Müller,Andre Matthias %A Maher,Carol A %A Vandelanotte,Corneel %A Hingle,Melanie %A Middelweerd,Anouk %A Lopez,Michael L %A DeSmet,Ann %A Short,Camille E %A Nathan,Nicole %A Hutchesson,Melinda J %A Poppe,Louise %A Woods,Catherine B %A Williams,Susan L %A Wark,Petra A %+ Domain: Health Systems & Behavioural Sciences, Saw Swee Hock School of Public Healh, National University of Singapore, Tahir Foundation Building, 12 Science Drive, #10-01, Singapore, 117549, Singapore, 65 82997548, ephamm@nus.edu.sg %K science %K telemedicine %K exercise %K health behavior %K health resources %K food %K publications %K movement %K trends %K Internet %D 2018 %7 18.04.2018 %9 Review %J J Med Internet Res %G English %X Background: Electronic health (eHealth) and mobile health (mHealth) approaches to address low physical activity levels, sedentary behavior, and unhealthy diets have received significant research attention. However, attempts to systematically map the entirety of the research field are lacking. This gap can be filled with a bibliometric study, where publication-specific data such as citations, journals, authors, and keywords are used to provide a systematic overview of a specific field. Such analyses will help researchers better position their work. Objective: The objective of this review was to use bibliometric data to provide an overview of the eHealth and mHealth research field related to physical activity, sedentary behavior, and diet. Methods: The Web of Science (WoS) Core Collection was searched to retrieve all existing and highly cited (as defined by WoS) physical activity, sedentary behavior, and diet related eHealth and mHealth research papers published in English between January 1, 2000 and December 31, 2016. Retrieved titles were screened for eligibility, using the abstract and full-text where needed. We described publication trends over time, which included journals, authors, and countries of eligible papers, as well as their keywords and subject categories. Citations of eligible papers were compared with those expected based on published data. Additionally, we described highly-cited papers of the field (ie, top ranked 1%). Results: The search identified 4805 hits, of which 1712 (including 42 highly-cited papers) were included in the analyses. Publication output increased on an average of 26% per year since 2000, with 49.00% (839/1712) of papers being published between 2014 and 2016. Overall and throughout the years, eHealth and mHealth papers related to physical activity, sedentary behavior, and diet received more citations than expected compared with papers in the same WoS subject categories. The Journal of Medical Internet Research published most papers in the field (9.58%, 164/1712). Most papers originated from high-income countries (96.90%, 1659/1717), in particular the United States (48.83%, 836/1712). Most papers were trials and studied physical activity. Beginning in 2013, research on Generation 2 technologies (eg, smartphones, wearables) sharply increased, while research on Generation 1 (eg, text messages) technologies increased at a reduced pace. Reviews accounted for 20 of the 42 highly-cited papers (n=19 systematic reviews). Social media, smartphone apps, and wearable activity trackers used to encourage physical activity, less sedentary behavior, and/or healthy eating were the focus of 14 highly-cited papers. Conclusions: This study highlighted the rapid growth of the eHealth and mHealth physical activity, sedentary behavior, and diet research field, emphasized the sizeable contribution of research from high-income countries, and pointed to the increased research interest in Generation 2 technologies. It is expected that the field will grow and diversify further and that reviews and research on most recent technologies will continue to strongly impact the field. %M 29669703 %R 10.2196/jmir.8954 %U http://www.jmir.org/2018/4/e122/ %U https://doi.org/10.2196/jmir.8954 %U http://www.ncbi.nlm.nih.gov/pubmed/29669703 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 2 %P e16 %T Relationship Between Evidence Requirements, User Expectations, and Actual Experiences: Usability Evaluation of the Twazon Arabic Weight Loss App %A Alnasser,Aroub %A Kyle,Janet %A Alkhalifah,Abdulrahman %A Marais,Debbi %+ Food Science and Nutrition Department, College of Food and Agriculture Sciences, King Saud University, PO Box 86683, Riyadh, 11632, Saudi Arabia, 966 118056476, aroub@ksu.edu.sa %K mHealth %K weight loss %K obesity %K smartphones %K mobile applications %K Saudi Arabia %K women's health %D 2018 %7 17.04.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Saudi Arabia has faced a steady growth in the prevalence of obesity. The concurrent and ubiquitous use of mobile technology, such as smartphones and apps, provides an opportunity for the implementation of mHealth technology, a method for delivering behavioral interventions. Despite their effectiveness in promoting lifestyle and diet modification, culturally adapted weight loss apps and related interventions are lacking in Gulf Cooperation Council countries. Objective: The objective of our study was to identify the relationship between adherence to evidence-informed practices, potential user expectations, and actual user experiences in order to enhance the understanding of the overall usability of the Twazon Arabic weight loss app. Methods: In 2 previous studies, 39 Saudi women were recruited for focus group discussions and 240 Saudi women were recruited for an app-based weight loss intervention. Usability of the Twazon Arabic weight loss app was evaluated by analyzing the opinions and experiences of 26 participants who engaged with the Twazon app for 4 months; the System Usability Scale (SUS) and word clouds were used. The results were triangulated with potential user expectations obtained in the focus group discussion and with the findings from an Arabic app screening for evidence-informed practices. Results: The average reported SUS score was 69.3. The most favored features were the calorie counter, step counter, and physical activity calorie counter. The features in need of improvement were the social network, notifications, and the Twazon Saudi Food Database. Twazon users preferred and found useful 7 of the 13 evidence-informed weight loss practices that were integrated into the features of the app. Conclusions: Triangulation identified the most notable relationship to be the disparity between user experience and 2 of the evidence-informed practices, namely a minimum weight loss goal of 0.5 to 1 kg/week and social support; no relationship was found between user expectations and evidence-informed weight loss practices. The overall usability of the Twazon Arabic weight loss app ranged between high marginal and acceptable, indicating that some improvements to the app should be considered for implementation in future app-based weight loss interventions of this kind. %M 29666042 %R 10.2196/humanfactors.9765 %U http://humanfactors.jmir.org/2018/2/e16/ %U https://doi.org/10.2196/humanfactors.9765 %U http://www.ncbi.nlm.nih.gov/pubmed/29666042 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e97 %T Mobile App Usage Patterns of Patients Prescribed a Smoking Cessation Medicine: Prospective Observational Study %A Bruno,Marianna %A Wright,Marcia %A Baker,Christine L %A Emir,Birol %A Carda,Eric %A Clausen,Michelle %A Sigler,Catherine %A Patel,Aanal %+ Pfizer, 1002 Waverly Ave, Nashville, TN,, United States, 1 913 481 6562, Marcia.Wright@Pfizer.com %K smartphone %K mobile apps %K technology %K patient engagement %K patient satisfaction %K patient adherence %K surveys %K smoking cessation %D 2018 %7 17.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cigarette smoking is the leading preventable cause of death and is responsible for more than 480,000 deaths per year in the United States. Smoking cessation is challenging for many patients. Regardless of available treatment options, most quit attempts are unaided, and it takes multiple attempts before a patient is successful. With the ever-increasing use of smartphones, mobile apps hold promise in supporting cessation efforts. This study evaluates the ease of use and user satisfaction with the Pfizer Meds app to support smoking cessation among patients prescribed varenicline (Chantix). Objective: Study participants included varenicline users who downloaded and used the app on their personal smartphone. The main objectives were to report mobile app download frequency and usage details and to describe the participant-reported satisfaction with and usefulness of the app over the 14-week follow-up study period. Methods: Adults aged 18 years or older who had been prescribed varenicline were identified from the Express Scripts Incorporated pharmacy claims database. After meeting privacy restrictions, subjects were sent an invitation letter and second reminder letter with instructions on how to download the Pfizer Meds mobile app. Participants received a push notification to complete a smartphone-enabled survey regarding the utility of the app 12 weeks after downloading the app. Descriptive statistics summarized sociodemographics, use of varenicline, and details of use and satisfaction with the mobile app. Results: Of the 38,129 varenicline users who were sent invitation letters, 1281 participants (3.35%) downloaded the Pfizer Meds app. Of the 1032 users with demographic and other data, 585 (56.68%) were females, and 446 (43.22%) were males; mean age was 46.4 years (SD 10.8). The mean number of app sessions per participant was 4.0 (SD 6.8). The end-of-study survey was completed by 131 survey respondents (10.23%, 131/1281); a large number of participants (117/131, 89.3%) reported being extremely, very, or moderately satisfied with the app. A total of 97 survey respondents (97/131, 74.0%) reported setting up a quit date in the app. Of those, 74 (74/97, 76%) reported quitting on their quit date. Conclusions: Positive patient engagement was observed in this study based on app download and usage. This study quantified how the Pfizer Meds app performed in an observational real-world data setting. The findings demonstrate the willingness of participants to set a quit date and use the app for support in medication adherence, refill reminders, and information regarding how to take the medication. This study provides real-world evidence of the contribution apps can make to the continued encouragement of smokers to improve their health by smoking cessation. %M 29666043 %R 10.2196/mhealth.9115 %U http://mhealth.jmir.org/2018/4/e97/ %U https://doi.org/10.2196/mhealth.9115 %U http://www.ncbi.nlm.nih.gov/pubmed/29666043 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e88 %T General Practitioners’ Perspective on eHealth and Lifestyle Change: Qualitative Interview Study %A Brandt,Carl Joakim %A Søgaard,Gabrielle Isidora %A Clemensen,Jane %A Sndergaard,Jens %A Nielsen,Jesper Bo %+ Research Unit of General Practice, Department of Public Health, University of Southern Denmark, JB Winsløwsvej 9A, Odense, 5000, Denmark, 45 20141566, cbrandt@health.sdu.dk %K general practice %K primary care %K technology %K motivational interviewing %K telemedicine %K mentoring %D 2018 %7 17.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearables, fitness apps, and patient home monitoring devices are used increasingly by patients and other individuals with lifestyle challenges. All Danish general practitioners (GPs) use digital health records and electronic health (eHealth) consultations on a daily basis, but how they perceive the increasing demand for lifestyle advice and whether they see eHealth as part of their lifestyle support should be explored further. Objective: This study aimed to explore GPs’ perspectives on eHealth devices and apps and the use of eHealth in supporting healthy lifestyle behavior for their patients and themselves. Methods: A total of 10 (5 female and 5 male) GPs were recruited by purposive sampling, aged 38 to 69 years (mean 51 years), of which 4 had an urban uptake of patients and 6 a rural uptake. All of them worked in the region of Southern Denmark where GPs typically work alone or in partnership with 1 to 4 colleagues and all use electronic patient health records for prescription, referral, and asynchronous electronic consultations. We performed qualitative, semistructured, individual in-depth interviews with the GPs in their own office about how they used eHealth and mHealth devices to help patients challenged with lifestyle issues and themselves. We also interviewed how they treated lifestyle-challenged patients in general and how they imagined eHealth could be used in the future. Results: All GPs had smartphones or tablets, and everyone communicated on a daily basis with patients about disease and medicine via their electronic health record and the internet. We identified 3 themes concerning the use of eHealth: (1) how eHealth is used for patients; (2) general practitioners’ own experience with improving lifestyle and eHealth support; and (3) relevant coaching techniques for transformation into eHealth. Conclusions: GPs used eHealth frequently for themselves but only infrequently for their patients. GPs are familiar with behavioral change techniques and are ready to use them in eHealth if they are used to optimize processes and not hinder other treatments. Looking ahead, education of GPs and recognizing patients’ ability and preference to use eHealth with regard to a healthy living are needed. %M 29666045 %R 10.2196/mhealth.8988 %U http://mhealth.jmir.org/2018/4/e88/ %U https://doi.org/10.2196/mhealth.8988 %U http://www.ncbi.nlm.nih.gov/pubmed/29666045 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 4 %P e102 %T Capturing Ultraviolet Radiation Exposure and Physical Activity: Feasibility Study and Comparison Between Self-Reports, Mobile Apps, Dosimeters, and Accelerometers %A Hacker,Elke %A Horsham,Caitlin %A Allen,Martin %A Nathan,Andrea %A Lowe,John %A Janda,Monika %+ Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, 4059, Australia, 61 7 3138 9674, elke.hacker@qut.edu.au %K sun-protection %K sunburn %K health behaviour %K health promotion %K formative research %D 2018 %7 17.04.2018 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Skin cancer is the most prevalent cancer in Australia. Skin cancer prevention programs aim to reduce sun exposure and increase sun protection behaviors. Effectiveness is usually assessed through self-report. Objective: It was the aim of this study to test the acceptance and validity of a newly developed ultraviolet radiation (UVR) exposure app, designed to reduce the data collection burden to research participants. Physical activity data was collected because a strong focus on sun avoidance may result in unhealthy reductions in physical activity. This paper provides lessons learned from collecting data from participants using paper diaries, a mobile app, dosimeters, and accelerometers for measuring end-points of UVR exposure and physical activity. Methods: Two participant groups were recruited through social and traditional media campaigns 1) Group A—UVR Diaries and 2) Group B—Physical Activity. In Group A, nineteen participants wore an UVR dosimeter wristwatch (University of Canterbury, New Zealand) when outside for 7 days. They also recorded their sun exposure and physical activity levels using both 1) the UVR diary app and 2) a paper UVR diary. In Group B, 55 participants wore an accelerometer (Actigraph, Pensacola, FL, USA) for 14 days and completed the UVR diary app. Data from the UVR diary app were compared with UVR dosimeter wristwatch, accelerometer, and paper UVR diary data. Cohen kappa coefficient score was used to determine if there was agreement between categorical variables for different UVR data collection methods and Spearman rank correlation coefficient was used to determine agreement between continuous accelerometer data and app-collected self-report physical activity. Results: The mean age of participants in Groups A (n=19) and B (n=55) was 29.3 and 25.4 years, and 63% (12/19) and 75% (41/55) were females, respectively. Self-reported sun exposure data in the UVR app correlated highly with UVR dosimetry (κ=0.83, 95% CI 0.64-1.00, P<.001). Correlation between self-reported UVR app and accelerometer-collected moderate to vigorous physical activity data was low (ρ=0.23, P=.10), while agreement for low-intensity physical activity was significantly different (ρ=-0.49, P<.001). Seventy-nine percent of participants preferred the app over the paper diary for daily self-report of UVR exposure and physical activity. Conclusions: This feasibility study highlights self-report using an UVR app can reliably collect personal UVR exposure, but further improvements are required before the app can also be used to collect physical activity data. %M 29666044 %R 10.2196/resprot.9695 %U http://www.researchprotocols.org/2018/4/e102/ %U https://doi.org/10.2196/resprot.9695 %U http://www.ncbi.nlm.nih.gov/pubmed/29666044 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e83 %T Relationship Between Weekly Patterns of Caloric Intake and Reported Weight Loss Outcomes: Retrospective Cohort Study %A Hill,Christine %A Weir,Brian W %A Fuentes,Laura W %A Garcia-Alvarez,Alicia %A Anouti,Danya P %A Cheskin,Lawrence J %+ Johns Hopkins Bloomberg School of Public Health, Lerner Center for Public Health Promotion, Johns Hopkins University, 624 N Broadway, Room 904B, Baltimore, MD, 21205, United States, 1 410 502 1811, laura.w.fuentes@jhu.edu %K mobile apps %K weight reduction %K caloric restriction %K diet habits %D 2018 %7 16.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although millions of overweight and obese adults use mobile phone apps for weight loss, little is known about the predictors of success. Objective: The objective of this study was to understand the relationship between weight loss outcomes and weekly patterns of caloric intake among overweight and obese adults using a mobile phone app for weight loss. Methods: We examined the relationship between weekly patterns of caloric intake and weight loss outcomes among adults who began using a weight loss app in January 2016 and continued consistent use for at least 5 months (N=7007). Unadjusted and adjusted linear regression analyses were used to evaluate the predictors of percentage of bodyweight lost for women and men separately, including age, body mass index category, weight loss plan, and difference in daily calories consumed on weekend days (Saturday and Sunday) versus Monday. Results: In adjusted linear regression, percentage of bodyweight lost was significantly associated with age (for women), body mass index (for men), weight loss plan, and differences in daily caloric intake on Mondays versus weekend days. Compared with women consuming at least 500 calories more on weekend days than on Mondays, those who consumed 50 to 250 calories more on weekend days or those with balanced consumption (±50 calories) lost 1.64% more and 1.82% more bodyweight, respectively. Women consuming 250 to 500 calories or more than 500 calories more on Mondays than on weekend days lost 1.35% more and 3.58% more bodyweight, respectively. Compared with men consuming at least 500 calories more on weekend days than on Mondays, those consuming 250 to 500 calories or more than 500 calories more on Mondays than on weekend days lost 2.27% and 3.42% less bodyweight, respectively. Conclusions: Consistent caloric intake on weekend days and Mondays or consuming slightly fewer calories per day on Mondays versus weekend days was associated with more successful weight loss. Trial Registration: ClinicalTrials.gov NCT03136692; https://clinicaltrials.gov/ct2/show/NCT03136692 (Archived by WebCite at http://www.webcitation.org/6y9JvHya4) %M 29661750 %R 10.2196/mhealth.8320 %U http://mhealth.jmir.org/2018/4/e83/ %U https://doi.org/10.2196/mhealth.8320 %U http://www.ncbi.nlm.nih.gov/pubmed/29661750 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e135 %T Use of Smartphones for Early Detection of Melanoma: Systematic Review %A Rat,Cédric %A Hild,Sandrine %A Rault Sérandour,Julie %A Gaultier,Aurélie %A Quereux,Gaelle %A Dreno,Brigitte %A Nguyen,Jean-Michel %+ Department of General Practice, Faculty of Medicine, University of Nantes, 1 rue Gaston Veil, Nantes, 44000 Nantes, France, 33 6 61 86 79 53, cedric.rat@univ-nantes.fr %K smartphone %K melanoma %K screening %K teledermatology %K telemedicine %K mobile app %D 2018 %7 13.04.2018 %9 Review %J J Med Internet Res %G English %X Background: The early diagnosis of melanoma is associated with decreased mortality. The smartphone, with its apps and the possibility of sending photographs to a dermatologist, could improve the early diagnosis of melanoma. Objective: The aim of our review was to report the evidence on (1) the diagnostic performance of automated smartphone apps and store-and-forward teledermatology via a smartphone in the early detection of melanoma, (2) the impact on the patient’s medical-care course, and (3) the feasibility criteria (focusing on the modalities of picture taking, transfer of data, and time to get a reply). Methods: We conducted a systematic search of PubMed for the period from January 1, 2007 (launch of the first smartphone) to November 1, 2017. Results: The results of the 25 studies included 13 concentrated on store-and-forward teledermatology, and 12 analyzed automated smartphone apps. Store-and-forward teledermatology opens several new perspectives, such as it accelerates the care course (less than 10 days vs 80 days), and the related procedures were assessed in primary care populations. However, the concordance between the conclusion of a teledermatologist and the conclusion of a dermatologist who conducts a face-to-face examination depended on the study (the kappa coefficient range was .20 to .84, median κ=.60). The use of a dermoscope may improve the concordance (the kappa coefficient range was .29 to .87, median κ=.74). Regarding automated smartphone apps, the major concerns are the lack of assessment in clinical practice conditions, the lack of assessment in primary care populations, and their low sensitivity, ranging from 7% to 87% (median 69%). In this literature review, up to 20% of the photographs transmitted were of insufficient quality. The modalities of picture taking and encryption of the data were only partially reported. Conclusions: The use of store-and-forward teledermatology could improve access to a dermatology consultation by optimizing the care course. Our review confirmed the absence of evidence of the safety and efficacy of automated smartphone medical apps. Further research is required to determine quality criteria, as there was major variability among the studies. %M 29653918 %R 10.2196/jmir.9392 %U http://www.jmir.org/2018/4/e135/ %U https://doi.org/10.2196/jmir.9392 %U http://www.ncbi.nlm.nih.gov/pubmed/29653918 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e61 %T Social Interaction Needs and Entertainment Approaches to Pregnancy Well-Being in mHealth Technology Design for Low-Income Transmigrant Women: Qualitative Codesign Study %A AlJaberi,Hana %+ Purdue Polytechnic Institute, Department of Computer Graphics Technology, Purdue University, 401 N Grant St, West Lafayette, IN, 47907, United States, 1 7654947505, aljaberi.hana@gmail.com %K mHealth %K mobile health %K participatory design %K pregnancy %K Caribbean %K immigrant women %D 2018 %7 13.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Low-income Caribbean transmigrant women face unique health challenges during pregnancy that set forth multidimensional implications for the design of mobile health (mHealth). Acknowledgment of the unique health needs of low-income Caribbean immigrant women in the United States and what that entails regarding technology design remains rarely examined in the literature of mHealth technologies. Objective: The goal of this study was to reveal the needs and gaps in mHealth interventions for pregnant immigrant women not yet realized in this field. These understandings reveal design opportunities for mHealth. Methods: The use of the qualitative participatory action research approach of codesign workshops in this study resulted in design solutions by the participants after reflecting on their earlier focus group discussions. The highlights are not the resulting designs per se but rather the inferences derived from the researcher reflecting on these designs. Results: The designs exposed two themes relevant to this paper. First, the participants desired the inclusion and rebuilding of social and organizational relationships in mHealth. The resulting designs formulate an understanding of the women’s health-related social support needs and how technology can facilitate them. Second, the participants wanted entertainment with an element of social participation incorporated in mHealth pregnancy management interventions. This brings attention to the role entertainment can add to the impact mHealth can deliver for pregnancy well-being. Conclusions: The study concluded with an examination of social and entertainment design implications that reveal pregnant immigrant women’s virtual health-related sharing habits, choice of sharing interaction scenarios during pregnancy (eg, local, long distance, one-way, two-way, and many-many), and choice of sharing media (eg, text, voice, and video). Additionally, the study revealed exclusions to social sharing capabilities in health technologies for these women. %M 29653919 %R 10.2196/mhealth.7708 %U http://mhealth.jmir.org/2018/4/e61/ %U https://doi.org/10.2196/mhealth.7708 %U http://www.ncbi.nlm.nih.gov/pubmed/29653919 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e94 %T Evaluating the Validity of Current Mainstream Wearable Devices in Fitness Tracking Under Various Physical Activities: Comparative Study %A Xie,Junqing %A Wen,Dong %A Liang,Lizhong %A Jia,Yuxi %A Gao,Li %A Lei,Jianbo %+ Center for Medical Informatics, Peking University, 38 Xueyuan Rd, Haidian District,, Beijing, 100191, China, 86 10 8280 5901, jblei@hsc.pku.edu.cn %K wearable electronic devices %K fitness trackers %K data accuracy %K physical activity %D 2018 %7 12.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable devices have attracted much attention from the market in recent years for their fitness monitoring and other health-related metrics; however, the accuracy of fitness tracking results still plays a major role in health promotion. Objective: The aim of this study was to evaluate the accuracy of a host of latest wearable devices in measuring fitness-related indicators under various seminatural activities. Methods: A total of 44 healthy subjects were recruited, and each subject was asked to simultaneously wear 6 devices (Apple Watch 2, Samsung Gear S3, Jawbone Up3, Fitbit Surge, Huawei Talk Band B3, and Xiaomi Mi Band 2) and 2 smartphone apps (Dongdong and Ledongli) to measure five major health indicators (heart rate, number of steps, distance, energy consumption, and sleep duration) under various activity states (resting, walking, running, cycling, and sleeping), which were then compared with the gold standard (manual measurements of the heart rate, number of steps, distance, and sleep, and energy consumption through oxygen consumption) and calculated to determine their respective mean absolute percentage errors (MAPEs). Results: Wearable devices had a rather high measurement accuracy with respect to heart rate, number of steps, distance, and sleep duration, with a MAPE of approximately 0.10, whereas poor measurement accuracy was observed for energy consumption (calories), indicated by a MAPE of up to 0.44. The measurements varied for the same indicator measured by different fitness trackers. The variation in measurement of the number of steps was the highest (Apple Watch 2: 0.42; Dongdong: 0.01), whereas it was the lowest for heart rate (Samsung Gear S3: 0.34; Xiaomi Mi Band 2: 0.12). Measurements differed insignificantly for the same indicator measured under different states of activity; the MAPE of distance and energy measurements were in the range of 0.08 to 0.17 and 0.41 to 0.48, respectively. Overall, the Samsung Gear S3 performed the best for the measurement of heart rate under the resting state (MAPE of 0.04), whereas Dongdong performed the best for the measurement of the number of steps under the walking state (MAPE of 0.01). Fitbit Surge performed the best for distance measurement under the cycling state (MAPE of 0.04), and Huawei Talk Band B3 performed the best for energy consumption measurement under the walking state (MAPE of 0.17). Conclusions: At present, mainstream devices are able to reliably measure heart rate, number of steps, distance, and sleep duration, which can be used as effective health evaluation indicators, but the measurement accuracy of energy consumption is still inadequate. Fitness trackers of different brands vary with regard to measurement of indicators and are all affected by the activity state, which indicates that manufacturers of fitness trackers need to improve their algorithms for different activity states. %M 29650506 %R 10.2196/mhealth.9754 %U http://mhealth.jmir.org/2018/4/e94/ %U https://doi.org/10.2196/mhealth.9754 %U http://www.ncbi.nlm.nih.gov/pubmed/29650506 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e84 %T Findings of the Chronic Obstructive Pulmonary Disease-Sitting and Exacerbations Trial (COPD-SEAT) in Reducing Sedentary Time Using Wearable and Mobile Technologies With Educational Support: Randomized Controlled Feasibility Trial %A Orme,Mark W %A Weedon,Amie E %A Saukko,Paula M %A Esliger,Dale W %A Morgan,Mike D %A Steiner,Michael C %A Downey,John W %A Sherar,Lauren B %A Singh,Sally J %+ Centre for Exercise and Rehabilitation Science, National Institute for Health Research Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Groby Road, Leicester, LE39QP, United Kingdom, 44 1162502762, mark.orme@uhl-tr.nhs.uk %K chronic obstructive pulmonary disease %K feasibility %K fitness trackers %K intervention %K physical activity %K sedentary lifestyle %K sedentary time %K self-monitoring %K wearable electronic devices %D 2018 %7 11.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Targeting sedentary time post exacerbation may be more relevant than targeting structured exercise for individuals with chronic obstructive pulmonary disease. Focusing interventions on sitting less and moving more after an exacerbation may act as a stepping stone to increase uptake to pulmonary rehabilitation. Objective: The aim of this paper was to conduct a randomized trial examining trial feasibility and the acceptability of an education and self-monitoring intervention using wearable technology to reduce sedentary behavior for individuals with chronic obstructive pulmonary disease admitted to hospital for an acute exacerbation. Methods: Participants were recruited and randomized in hospital into 3 groups, with the intervention lasting 2 weeks post discharge. The Education group received verbal and written information about reducing their time in sedentary behavior, sitting face-to-face with a study researcher. The Education+Feedback group received the same education component along with real-time feedback on their sitting time, stand-ups, and steps at home through a waist-worn inclinometer linked to an app. Patients were shown how to use the technology by the same study researcher. The inclinometer also provided vibration prompts to encourage movement at patient-defined intervals of time. Patients and health care professionals involved in chronic obstructive pulmonary disease exacerbation care were interviewed to investigate trial feasibility and acceptability of trial design and methods. Main quantitative outcomes of trial feasibility were eligibility, uptake, and retention, and for acceptability, were behavioral responses to the vibration prompts. Results: In total, 111 patients were approached with 33 patients recruited (11 Control, 10 Education, and 12 Education+Feedback). Retention at 2-week follow-up was 52% (17/33; n=6 for Control, n=3 for Education, and n=8 for Education+Feedback). No study-related adverse events occurred. Collectively, patients responded to 106 out of 325 vibration prompts from the waist-worn inclinometer (32.62%). Within 5 min of the prompt, 41% of responses occurred, with patients standing for a mean 1.4 (SD 0.8) min and walking for 0.4 (SD 0.3) min (21, SD 11, steps). Interviews indicated that being unwell and overwhelmed after an exacerbation was the main reason for not engaging with the intervention. Health care staff considered reducing sedentary behavior potentially attractive for patients but suggested starting the intervention as an inpatient. Conclusions: Although the data support that it was feasible to conduct the trial, modifications are needed to improve participant retention. The intervention was acceptable to most patients and health care professionals. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 13790881; http://www.isrctn.com/ISRCTN13790881 (Archived by WebCite at http://www.webcitation.org/6xmnRGjFf) %M 29643055 %R 10.2196/mhealth.9398 %U http://mhealth.jmir.org/2018/4/e84/ %U https://doi.org/10.2196/mhealth.9398 %U http://www.ncbi.nlm.nih.gov/pubmed/29643055 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e86 %T Wearable Activity Tracker Use Among Australian Adolescents: Usability and Acceptability Study %A Ridgers,Nicola D %A Timperio,Anna %A Brown,Helen %A Ball,Kylie %A Macfarlane,Susie %A Lai,Samuel K %A Richards,Kara %A Mackintosh,Kelly A %A McNarry,Melitta A %A Foster,Megan %A Salmon,Jo %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, 61 3 9244 6718, nicky.ridgers@deakin.edu.au %K qualitative research %K fitness trackers %K physical activity %D 2018 %7 11.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable activity trackers have the potential to be integrated into physical activity interventions, yet little is known about how adolescents use these devices or perceive their acceptability. Objective: The aim of this study was to examine the usability and acceptability of a wearable activity tracker among adolescents. A secondary aim was to determine adolescents’ awareness and use of the different functions and features in the wearable activity tracker and accompanying app. Methods: Sixty adolescents (aged 13-14 years) in year 8 from 3 secondary schools in Melbourne, Australia, were provided with a wrist-worn Fitbit Flex and accompanying app, and were asked to use it for 6 weeks. Demographic data (age, sex) were collected via a Web-based survey completed during week 1 of the study. At the conclusion of the 6-week period, all adolescents participated in focus groups that explored their perceptions of the usability and acceptability of the Fitbit Flex, accompanying app, and Web-based Fitbit profile. Qualitative data were analyzed using pen profiles, which were constructed from verbatim transcripts. Results: Adolescents typically found the Fitbit Flex easy to use for activity tracking, though greater difficulties were reported for monitoring sleep. The Fitbit Flex was perceived to be useful for tracking daily activities, and adolescents used a range of features and functions available through the device and the app. Barriers to use included the comfort and design of the Fitbit Flex, a lack of specific feedback about activity levels, and the inability to wear the wearable activity tracker for water-based sports. Conclusions: Adolescents reported that the Fitbit Flex was easy to use and that it was a useful tool for tracking daily activities. A number of functions and features were used, including the device’s visual display to track and self-monitor activity, goal-setting in the accompanying app, and undertaking challenges against friends. However, several barriers to use were identified, which may impact on sustained use over time. Overall, wearable activity trackers have the potential to be integrated into physical activity interventions targeted at adolescents, but both the functionality and wearability of the monitor should be considered. %M 29643054 %R 10.2196/mhealth.9199 %U http://mhealth.jmir.org/2018/4/e86/ %U https://doi.org/10.2196/mhealth.9199 %U http://www.ncbi.nlm.nih.gov/pubmed/29643054 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e81 %T How Mobile App Design Impacts User Responses to Mixed Self-Tracking Outcomes: Randomized Online Experiment to Explore the Role of Spatial Distance for Hedonic Editing %A Imschloss,Monika %A Lorenz,Jana %+ Department of Retailing and Customer Management, University of Cologne, WiSo Building, 4th floor, Albertus Magnus Platz 1, Cologne, 50923, Germany, 49 0221470 ext 1931, imschloss@wiso.uni-koeln.de %K mobile apps %K self-tracking %K user interaction design %K goal setting %D 2018 %7 11.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Goal setting is among the most common behavioral change techniques employed in contemporary self-tracking apps. For these techniques to be effective, it is relevant to understand how the visual presentation of goal-related outcomes employed in the app design affects users’ responses to their self-tracking outcomes. Objective: This study examined whether a spatially close (vs distant) presentation of mixed positive and negative self-tracking outcomes from multiple domains (ie, activity, diet) on a digital device’s screen can provide users the opportunity to hedonically edit their self-tracking outcome profile (ie, to view their mixed self-tracking outcomes in the most positive light). Further, this study examined how the opportunity to hedonically edit one’s self-tracking outcome profile relates to users’ future health behavior intentions. Methods: To assess users’ responses to a spatially close (vs distant) presentation of a mixed-gain (vs mixed-loss) self-tracking outcome profile, a randomized 2×2 between-subjects online experiment with a final sample of 397 participants (mean age 27.4, SD 7.2 years; 71.5%, 284/397 female) was conducted in Germany. The experiment started with a cover story about a fictitious self-tracking app. Thereafter, participants saw one of four manipulated self-tracking outcome profiles. Variables of interest measured were health behavior intentions, compensatory health beliefs, health motivation, and recall of the outcome profile. We analyzed data using chi-square tests (SPSS version 23) and moderated mediation analyses with the PROCESS macro 2.16.1. Results: Spatial distance facilitated hedonic editing, which was indicated by systematic memory biases in users’ recall of positive and negative self-tracking outcomes. In the case of a mixed-gain outcome profile, a spatially close (vs distant) presentation tended to increase the underestimation of the negative outcome (P=.06). In the case of a mixed-loss outcome profile, a spatially distant (vs close) presentation facilitated the exact recognition of the positive outcome (P=.04). When the presentation of self-tracking outcomes provided the opportunity for hedonic editing, users with a low (vs high) health motivation produced compensatory health beliefs, which led to lower health behavior intentions (index of moderated mediation=0.0352, 95% CI 0.0011-0.0923). Conclusions: When spatial distance between the presentations of mixed self-tracking outcomes provided the opportunity to hedonically edit one’s self-tracking outcome profile, users recalled their self-tracking outcomes in a more positive light. Especially for users with lower health motivation, the opportunity to hedonically edit one’s mixed self-tracking outcome profile led to reduced health behavior intentions. To prevent the occurrence of hedonic editing in users’ responses to visually presented self-tracking outcome profiles, further research is necessary to determine the ideal distance that should be employed in the app design for the presentation of mixed self-tracking outcomes on a digital device’s screen. %M 29643051 %R 10.2196/mhealth.9055 %U http://mhealth.jmir.org/2018/4/e81/ %U https://doi.org/10.2196/mhealth.9055 %U http://www.ncbi.nlm.nih.gov/pubmed/29643051 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e76 %T Women’s Perceptions of Using Mobile Phones for Maternal and Child Health Support in Afghanistan: Cross-Sectional Survey %A Yamin,Fazal %A Kaewkungwal,Jaranit %A Singhasivanon,Pratap %A Lawpoolsri,Saranath %+ Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithee Road, Ratchathewi, Bangkok,, Thailand, 66 2 306 9188, saranath.law@mahidol.ac.th %K Afghanistan %K mobile health %K maternal health, child health %K perception %K mobile phone %D 2018 %7 10.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Growing rates of global mobile subscriptions pave the way for implementation of mobile health (mHealth) initiatives, especially among hard-to-reach populations. Objective: This study aimed to determine the perceptions of Afghan women regarding the use of mobile phones for maternal and child health services. Methods: A cross-sectional survey was conducted in both rural and urban districts of Nangarhar Province, Afghanistan. The interviewer-administered questionnaire was used to assess participants’ demographic profile, mobile phone usage, and perception of respondents toward different aspects of health care delivery via mobile phones. Results: Of the 240 participants, 142 (59.2%) owned mobile phones and 220 (91.7%) routinely used mobile phones. Approximately 209 (87.1%) of participants were willing to receive health messages via a mobile phone. Automated voice call was the most preferred method for sending health messages. More than 90% of the women reported that they would like to receive reminders for their children’s vaccinations and antenatal care visits. Conclusions: Users’ perception was associated with mobile phone ownership, literacy level, and experience using mobile phones. In the study area, where the literacy rate is low, mHealth was well perceived. %M 29636317 %R 10.2196/mhealth.9504 %U http://mhealth.jmir.org/2018/4/e76/ %U https://doi.org/10.2196/mhealth.9504 %U http://www.ncbi.nlm.nih.gov/pubmed/29636317 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e39 %T Predicting Sexual Behaviors Among Homeless Young Adults: Ecological Momentary Assessment Study %A Santa Maria,Diane %A Padhye,Nikhil %A Yang,Yijiong %A Gallardo,Kathryn %A Businelle,Michael %+ School of Nursing, University of Texas Health Science Center at Houston, 6901 Bertner Ave, Houston, TX, 77030, United States, 1 713 500 2187, diane.m.santamaria@uth.tmc.edu %K homeless youth %K sexual behaviors %K ecological momentary assessment %D 2018 %7 10.04.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Homeless youth continue to be disproportionately affected by HIV compared with their housed peers, with prevalence rates as high as 13%. Yet, HIV prevention in this high-risk population has been only marginally effective. Objective: The aim of this study was to use ecological momentary assessments to examine real-time factors to determine the predictors of sexual activity among homeless youth. Methods: Youth experiencing homelessness aged between 18 and 24 years were recruited from a drop-in center in Houston, Texas, between August 2015 and May 2016. All the participants received a study-issued mobile phone that prompted brief ecological momentary assessments (EMAs) 5 times a day for 21 days. EMA items assessed near real-time sexual behaviors, cognitions, stress, affect, environmental factors, and environmental circumstances. Results: Participants (N=66) were predominantly male (41/66, 64%) and black (43/66, 66%) with a median age of 20 years. The mean number of EMAs completed by each participant was 45 out of 105 possible observations. During the study, 70% (46/66) of participants were sexually active and reported condomless sex in 102 of the 137 cases of sexual intercourse (74.5%). In total, 82% (38/46) of the youth who reported having sex during the 3 weeks of data collection also reported engaging in high-risk sexual activities, including having condomless sex (24/46, 53%), having multiple sexual partners on the same day (12/46, 26%), trading sex (7/46, 16%), and sharing needles while injecting drugs (1/46, 3%). Of those, 71% (27/38) were engaged in multiple sexual risk behaviors. The predictive model was based on observations from 66 subjects who reported 137 cases of sexual intercourse over 811 days; sexual orientation, race, mental health, drug use, and sexual urge were included as predictors in the parsimonious generalized linear mixed model selected on the basis of the Akaike information criterion. The estimated odds ratios (ORs) were notable for same-day drug use (OR 8.80, 95% CI 4.48-17.31; P<.001) and sexual urge (OR 4.23, 95% CI 1.60-11.28; P=.004). The performance of the risk estimator was satisfactory, as indicated by the value of 0.834 for the area under the receiver operating characteristic curve. Conclusions: Real-time EMA data can be used to predict sexual intercourse among a sample of high-risk, predominately unsheltered homeless youth. Sexual urge and drug use accounts for increased odds of engaging in sexual activity on any given day. Interventions targeting sexual urge and drug use may help predict sexual activity among a population at high risk of HIV. %M 29636318 %R 10.2196/publichealth.9020 %U http://publichealth.jmir.org/2018/2/e39/ %U https://doi.org/10.2196/publichealth.9020 %U http://www.ncbi.nlm.nih.gov/pubmed/29636318 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e89 %T Managing Patient-Generated Health Data Through Mobile Personal Health Records: Analysis of Usage Data %A Park,Yu Rang %A Lee,Yura %A Kim,Ji Young %A Kim,Jeonghoon %A Kim,Hae Reong %A Kim,Young-Hak %A Kim,Woo Sung %A Lee,Jae-Ho %+ Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic Of Korea, 82 23010 3350, rufiji@gmail.com %K personal health record %K mobile health %K patient engagement %K patient-generated health data %K health records, personal %K telemedicine %K patient participation %D 2018 %7 09.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Personal health records (PHRs) and mHealth apps are considered essential tools for patient engagement. Mobile PHRs (mPHRs) can be a platform to integrate patient-generated health data (PGHD) and patients’ medical information. However, in previous studies, actual usage data and PGHD from mPHRs have not been able to adequately represent patient engagement. Objective: By analyzing 5 years’ PGHD from an mPHR system developed by a tertiary hospital in South Korea, we aimed to evaluate how PGHD were managed and identify issues in PGHD management based on actual usage data. Additionally, we analyzed how to improve patient engagement with mPHRs by analyzing the actively used services and long-term usage patterns. Methods: We gathered 5 years (December 2010 to December 2015) of log data from both hospital patients and general users of the app. We gathered data from users who entered PGHD on body weight, blood pressure (BP), blood glucose levels, 10-year cardiovascular disease (CVD) risk, metabolic syndrome risk, medication schedule, insulin, and allergy. We classified users according to whether they were patients or general users based on factors related to continuous use (≥28 days for weight, BP, and blood glucose, and ≥180 days for CVD and metabolic syndrome), and analyzed the patients’ characteristics. We compared PGHD entry counts and the proportion of continuous users for each PGHD by user type. Results: The total number of mPHR users was 18,265 (patients: n=16,729, 91.59%) with 3620 users having entered weight, followed by BP (n=1625), blood glucose (n=1374), CVD (n=764), metabolic syndrome (n=685), medication (n=252), insulin (n=72), and allergy (n=61). Of those 18,256 users, 3812 users had at least one PGHD measurement, of whom 175 used the PGHD functions continuously (patients: n=142, 81.14%); less than 1% of the users had used it for more than 4 years. Except for weight, BP, blood glucose, CVD, and metabolic syndrome, the number of PGHD records declined. General users’ continuous use of PGHD was significantly higher than that of patients in the blood glucose (P<.001) and BP (P=.03) functions. Continuous use of PGHD in health management (BP, blood glucose, and weight) was significantly greater among older users (P<.001) and men (P<.001). In health management (BP, weight, and blood glucose), overall chronic disease and continuous use of PGHD were not statistically related (P=.08), but diabetes (P<.001) and cerebrovascular diseases (P=.03) were significant. Conclusions: Although a small portion of users managed PGHD continuously, PGHD has the potential to be useful in monitoring patient health. To realize the potential, specific groups of continuous users must be identified, and the PGHD service must target them. Further evaluations for the clinical application of PGHD, feedback regarding user interfaces, and connections with wearable devices are needed. %M 29631989 %R 10.2196/mhealth.9620 %U http://mhealth.jmir.org/2018/4/e89/ %U https://doi.org/10.2196/mhealth.9620 %U http://www.ncbi.nlm.nih.gov/pubmed/29631989 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e118 %T Identification of Users for a Smoking Cessation Mobile App: Quantitative Study %A Chevalking,SK Leon %A Ben Allouch,Somaya %A Brusse-Keizer,Marjolein %A Postel,Marloes G %A Pieterse,Marcel E %+ Research Group Technology, Health & Care, Saxion University of Applied Sciences, MH Tromplaan 28, 7513 AB, Enschede, 70.000 PO Box, Netherlands, 31 612292901, s.benallouch@saxion.nl %K mobile applications %K telemedicine %K mHealth %K eHealth %K tobacco %K smoking cessation %K health informatics %D 2018 %7 09.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of mobile apps that support smoking cessation is growing, indicating the potential of the mobile phone as a means to support cessation. Knowledge about the potential end users for cessation apps results in suggestions to target potential user groups in a dissemination strategy, leading to a possible increase in the satisfaction and adherence of cessation apps. Objective: This study aimed to characterize potential end users for a specific mobile health (mHealth) smoking cessation app. Methods: A quantitative study was conducted among 955 Dutch smokers and ex-smokers. The respondents were primarily recruited from addiction care facilities and hospitals through Web-based media via websites and forums. The respondents were surveyed on their demographics, smoking behavior, and personal innovativeness. The intention to use and the attitude toward a cessation app were determined on a 5-point Likert scale. To study the association between the characteristics and intention to use and attitude, univariate and multivariate ordinal logistic regression analyses were performed. Results: The multivariate ordinal logistic regression showed that the number of previous quit attempts (odds ratio [OR] 4.1, 95% CI 2.4-7.0, and OR 3.5, 95% CI 2.0-5.9) and the score on the Fagerstrom Test of Nicotine Dependence (OR 0.8, 95% CI 0.8-0.9, and OR 0.8, 95% CI 0.8-0.9) positively correlates with the intention to use a cessation app and the attitude toward cessation apps, respectively. Personal innovativeness also positively correlates with the intention to use (OR 0.3, 95% CI 0.2-0.4) and the attitude towards (OR 0.2, 95% CI 0.1-0.4) a cessation app. No associations between demographics and the intention to use or the attitude toward using a cessation app were observed. Conclusions: This study is among the first to show that demographic characteristics such as age and level of education are not associated with the intention to use and the attitude toward using a cessation app when characteristics related specifically to the app, such as nicotine dependency and the number of quit attempts, are present in a multivariate regression model. This study shows that the use of mHealth apps depends on characteristics related to the content of the app rather than general user characteristics. %M 29631988 %R 10.2196/jmir.7606 %U http://www.jmir.org/2018/4/e118/ %U https://doi.org/10.2196/jmir.7606 %U http://www.ncbi.nlm.nih.gov/pubmed/29631988 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e7 %T User-Centered Design of a Mobile App for Weight and Health Management in Adolescents With Complex Health Needs: Qualitative Study %A Rivera,Jordan %A McPherson,Amy C %A Hamilton,Jill %A Birken,Catherine %A Coons,Michael %A Peters,Michelle %A Iyer,Sindoora %A George,Tessy %A Nguyen,Cynthia %A Stinson,Jennifer %+ The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G0A4, Canada, 1 416 813 7654 ext 304514, jennifer.stinson@sickkids.ca %K obesity %K weight loss %K adolescent %K mobile apps %D 2018 %7 04.04.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Growing research has been conducted into the deployment and evaluation of mobile technology interventions for weight management in adolescents. However, no work has yet been conducted toward the development of these technologies for adolescents with complex health needs receiving specialized tertiary-level health care. Objective: The aim of this study was to conduct a user-centered needs assessment of adolescents interested in weight management with complex health needs requiring specialized health care services, their parents, and health care providers (HCPs) to inform the design and development of a mobile app for weight and health management. Methods: A qualitative study design was employed. Participants were recruited from two tertiary health care centers. Separate audiotaped focus group interviews were conducted with adolescents aged 12 to 18 years, parents, and HCPs. Interviews were transcribed, and field notes were collected by research staff. Iterative simple content analysis was performed independently by 4 research team members using computer software NVivo (QSR International) 10.0. Results: A total of 19 adolescents, 16 parents, and 21 HCPs were interviewed. Qualitative analysis revealed seven major themes related to app functionality: healthy eating, social support, self-monitoring, communicating with HCPs, supporting mental health, gamification and incentives, and user interface (UI) design. Adolescents provided several ideas related to each feature, whereas parents’ views focused on assistance with meal planning and greater access to HCPs. HCPs viewed the app as a novel and more acceptable platform to connect remotely with adolescents than conventional methods. They also strongly endorsed the value of social support capabilities and the ability to connect with an HCP. Conclusions: This is the first study to conduct a qualitative needs assessment in adolescents receiving specialized health care services toward the design of a mobile app for weight and health management. Our results indicate that core components of the app should include tailored meal recommendations and assistance with meal planning, social networking for peer support, customized and convenient tracking, remote access to HCPs, features to support mental health, and an attractive and engaging UI. These findings will be used to develop and evaluate a mobile app targeting adolescents with complex health needs. %M 30684409 %R 10.2196/formative.8248 %U http://formative.jmir.org/2018/1/e7/ %U https://doi.org/10.2196/formative.8248 %U http://www.ncbi.nlm.nih.gov/pubmed/30684409 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e70 %T Counting Steps in Activities of Daily Living in People With a Chronic Disease Using Nine Commercially Available Fitness Trackers: Cross-Sectional Validity Study %A Ummels,Darcy %A Beekman,Emmylou %A Theunissen,Kyra %A Braun,Susy %A Beurskens,Anna J %+ Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Zuyd University of Applied Sciences, PO Box 550, Heerlen,, Netherlands, 31 45 400 63 78, darcy.ummels@zuyd.nl %K activity tracker %K accelerometer %K wearable %K chronic disease %K validity %K physical therapy %K physical activity %D 2018 %7 02.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Measuring physical activity with commercially available activity trackers is gaining popularity. People with a chronic disease can especially benefit from knowledge about their physical activity pattern in everyday life since sufficient physical activity can contribute to wellbeing and quality of life. However, no validity data are available for this population during activities of daily living. Objective: The aim of this study was to investigate the validity of 9 commercially available activity trackers for measuring step count during activities of daily living in people with a chronic disease receiving physiotherapy. Methods: The selected activity trackers were Accupedo (Corusen LLC), Activ8 (Remedy Distribution Ltd), Digi-Walker CW-700 (Yamax), Fitbit Flex (Fitbit inc), Lumoback (Lumo Bodytech), Moves (ProtoGeo Oy), Fitbit One (Fitbit inc), UP24 (Jawbone), and Walking Style X (Omron Healthcare Europe BV). In total, 130 persons with chronic diseases performed standardized activity protocols based on activities of daily living that were recorded on video camera and analyzed for step count (gold standard). The validity of the trackers’ step count was assessed by correlation coefficients, t tests, scatterplots, and Bland-Altman plots. Results: The correlations between the number of steps counted by the activity trackers and the gold standard were low (range: –.02 to .33). For all activity trackers except for Fitbit One, a significant systematic difference with the gold standard was found for step count. Plots showed a wide range in scores for all activity trackers; Activ8 showed an average overestimation and the other 8 trackers showed underestimations. Conclusions: This study showed that the validity of 9 commercially available activity trackers is low measuring steps while individuals with chronic diseases receiving physiotherapy engage in activities of daily living. %M 29610110 %R 10.2196/mhealth.8524 %U http://mhealth.jmir.org/2018/4/e70/ %U https://doi.org/10.2196/mhealth.8524 %U http://www.ncbi.nlm.nih.gov/pubmed/29610110 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e72 %T Evaluating an mHealth App for Health and Well-Being at Work: Mixed-Method Qualitative Study %A de Korte,Elsbeth Marieke %A Wiezer,Noortje %A Janssen,Joris H %A Vink,Peter %A Kraaij,Wessel %+ Netherlands Organisation for Applied Scientific Research, Schipholweg 77-89, Leiden, 2316 ZL, Netherlands, 31 6 211 34434, elsbeth.dekorte@tno.nl %K mHealth %K work %K qualitative research methods %K interview %K focus group %K technology acceptance %K user satisfaction %K usability %K well-being %K prevention %D 2018 %7 28.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To improve workers’ health and well-being, workplace interventions have been developed, but utilization and reach are unsatisfactory, and effects are small. In recent years, new approaches such as mobile health (mHealth) apps are being developed, but the evidence base is poor. Research is needed to examine its potential and to assess when, where, and for whom mHealth is efficacious in the occupational setting. To develop interventions for workers that actually will be adopted, insight into user satisfaction and technology acceptance is necessary. For this purpose, various qualitative evaluation methods are available. Objective: The objectives of this study were to gain insight into (1) the opinions and experiences of employees and experts on drivers and barriers using an mHealth app in the working context and (2) the added value of three different qualitative methods that are available to evaluate mHealth apps in a working context: interviews with employees, focus groups with employees, and a focus group with experts. Methods: Employees of a high-tech company and experts were asked to use an mHealth app for at least 3 weeks before participating in a qualitative evaluation. Twenty-two employees participated in interviews, 15 employees participated in three focus groups, and 6 experts participated in one focus group. Two researchers independently coded, categorized, and analyzed all quotes yielded from these evaluation methods with a codebook using constructs from user satisfaction and technology acceptance theories. Results: Interviewing employees yielded 785 quotes, focus groups with employees yielded 266 quotes, and the focus group with experts yielded 132 quotes. Overall, participants muted enthusiasm about the app. Combined results from the three evaluation methods showed drivers and barriers for technology, user characteristics, context, privacy, and autonomy. A comparison between the three qualitative methods showed that issues revealed by experts only slightly overlapped with those expressed by employees. In addition, it was seen that the type of evaluation yielded different results. Conclusions: Findings from this study provide the following recommendations for organizations that are planning to provide mHealth apps to their workers and for developers of mHealth apps: (1) system performance influences adoption and adherence, (2) relevancy and benefits of the mHealth app should be clear to the user and should address users’ characteristics, (3) app should take into account the work context, and (4) employees should be alerted to their right to privacy and use of personal data. Furthermore, a qualitative evaluation of mHealth apps in a work setting might benefit from combining more than one method. Factors to consider when selecting a qualitative research method are the design, development stage, and implementation of the app; the working context in which it is being used; employees’ mental models; practicability; resources; and skills required of experts and users. %M 29592846 %R 10.2196/mhealth.6335 %U http://mhealth.jmir.org/2018/3/e72/ %U https://doi.org/10.2196/mhealth.6335 %U http://www.ncbi.nlm.nih.gov/pubmed/29592846 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e67 %T Monitoring Energy Balance in Breast Cancer Survivors Using a Mobile App: Reliability Study %A Lozano-Lozano,Mario %A Galiano-Castillo,Noelia %A Martín-Martín,Lydia %A Pace-Bedetti,Nicolás %A Fernández-Lao,Carolina %A Arroyo-Morales,Manuel %A Cantarero-Villanueva,Irene %+ Department of Physical Therapy, University of Granada, Avenida de la Ilustración, 60, Granada, 18016, Spain, 34 958248765, marroyo@ugr.es %K telemedicine %K breast neoplasms %K survivors %K life style %K exercise %K diet %K mhealth %D 2018 %7 27.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The majority of breast cancer survivors do not meet recommendations in terms of diet and physical activity. To address this problem, we developed a mobile health (mHealth) app for assessing and monitoring healthy lifestyles in breast cancer survivors, called the Energy Balance on Cancer (BENECA) mHealth system. The BENECA mHealth system is a novel and interactive mHealth app, which allows breast cancer survivors to engage themselves in their energy balance monitoring. BENECA was designed to facilitate adherence to healthy lifestyles in an easy and intuitive way. Objective: The objective of the study was to assess the concurrent validity and test-retest reliability between the BENECA mHealth system and the gold standard assessment methods for diet and physical activity. Methods: A reliability study was conducted with 20 breast cancer survivors. In the study, tri-axial accelerometers (ActiGraphGT3X+) were used as gold standard for 8 consecutive days, in addition to 2, 24-hour dietary recalls, 4 dietary records, and sociodemographic questionnaires. Two-way random effect intraclass correlation coefficients, a linear regression-analysis, and a Passing-Bablok regression were calculated. Results: The reliability estimates were very high for all variables (alpha≥.90). The lowest reliability was found in fruit and vegetable intakes (alpha=.94). The reliability between the accelerometer and the dietary assessment instruments against the BENECA system was very high (intraclass correlation coefficient=.90). We found a mean match rate of 93.51% between instruments and a mean phantom rate of 3.35%. The Passing-Bablok regression analysis did not show considerable bias in fat percentage, portions of fruits and vegetables, or minutes of moderate to vigorous physical activity. Conclusions: The BENECA mHealth app could be a new tool to measure energy balance in breast cancer survivors in a reliable and simple way. Our results support the use of this technology to not only to encourage changes in breast cancer survivors' lifestyles, but also to remotely monitor energy balance. Trial Registration: ClinicalTrials.gov NCT02817724; https://clinicaltrials.gov/ct2/show/NCT02817724 (Archived by WebCite at http://www.webcitation.org/6xVY1buCc) %M 29588273 %R 10.2196/mhealth.9669 %U http://mhealth.jmir.org/2018/3/e67/ %U https://doi.org/10.2196/mhealth.9669 %U http://www.ncbi.nlm.nih.gov/pubmed/29588273 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e75 %T Satisfying Product Features of a Fall Prevention Smartphone App and Potential Users’ Willingness to Pay: Web-Based Survey Among Older Adults %A Rasche,Peter %A Mertens,Alexander %A Brandl,Christopher %A Liu,Shan %A Buecking,Benjamin %A Bliemel,Christopher %A Horst,Klemens %A Weber,Christian David %A Lichte,Philipp %A Knobe,Matthias %+ Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Bergdriesch 27, Aachen, 52062, Germany, 49 0241 80 99 ext 477, p.rasche@iaw.rwth-aachen.de %K prevention %K cell phone %K accidents %D 2018 %7 27.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Prohibiting falls and fall-related injuries is a major challenge for health care systems worldwide, as a substantial proportion of falls occur in older adults who are previously known to be either frail or at high risk for falls. Hence, preventive measures are needed to educate and minimize the risk for falls rather than just minimize older adults’ fall risk. Health apps have the potential to address this problem, as they enable users to self-assess their individual fall risk. Objective: The objective of this study was to identify product features of a fall prevention smartphone app, which increase or decrease users’ satisfaction. In addition, willingness to pay (WTP) was assessed to explore how much revenue such an app could generate. Methods: A total of 96 participants completed an open self-selected Web-based survey. Participants answered various questions regarding health status, subjective and objective fall risk, and technical readiness. Seventeen predefined product features of a fall prevention smartphone app were evaluated twice: first, according to a functional (product feature is implemented in the app), and subsequently by a dysfunctional (product feature is not implemented in the app) question. On the basis of the combination of answers from these 2 questions, the product feature was assigned to a certain category (must-be, attractive, one-dimensional, indifferent, or questionable product feature). This method is widely used in user-oriented product development and captures users’ expectations of a product and how their satisfaction is influenced by the availability of individual product features. Results: Five product features were identified to increase users’ acceptance, including (1) a checklist of typical tripping hazards, (2) an emergency guideline in case of a fall, (3) description of exercises and integrated workout plans that decrease the risk of falling, (4) inclusion of a continuous workout program, and (5) cost coverage by health insurer. Participants’ WTP was assessed after all 17 product features were rated and revealed a median monthly payment WTP rate of €5.00 (interquartile range 10.00). Conclusions: The results show various motivating product features that should be incorporated into a fall prevention smartphone app. Results reveal aspects that fall prevention and intervention designers should keep in mind to encourage individuals to start joining their program and facilitate long-term user engagement, resulting in a greater interest in fall risk prevention. %M 29588268 %R 10.2196/mhealth.9467 %U http://mhealth.jmir.org/2018/3/e75/ %U https://doi.org/10.2196/mhealth.9467 %U http://www.ncbi.nlm.nih.gov/pubmed/29588268 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e58 %T Evaluating the Impact of Physical Activity Apps and Wearables: Interdisciplinary Review %A McCallum,Claire %A Rooksby,John %A Gray,Cindy M %+ Institute of Health and Wellbeing, University of Glasgow, Room 142, 25-29 Bute Gardens, Glasgow, G12 8RS, United Kingdom, 44 141 330 4615, c.mccallum.2@research.gla.ac.uk %K mobile health %K physical activity %K smartphone %K fitness trackers %K wearable electronic devices %K research design %K evaluation studies as topic %K efficiency %D 2018 %7 23.03.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Although many smartphone apps and wearables have been designed to improve physical activity, their rapidly evolving nature and complexity present challenges for evaluating their impact. Traditional methodologies, such as randomized controlled trials (RCTs), can be slow. To keep pace with rapid technological development, evaluations of mobile health technologies must be efficient. Rapid alternative research designs have been proposed, and efficient in-app data collection methods, including in-device sensors and device-generated logs, are available. Along with effectiveness, it is important to measure engagement (ie, users’ interaction and usage behavior) and acceptability (ie, users’ subjective perceptions and experiences) to help explain how and why apps and wearables work. Objectives: This study aimed to (1) explore the extent to which evaluations of physical activity apps and wearables: employ rapid research designs; assess engagement, acceptability, as well as effectiveness; use efficient data collection methods; and (2) describe which dimensions of engagement and acceptability are assessed. Method: An interdisciplinary scoping review using 8 databases from health and computing sciences. Included studies measured physical activity, and evaluated physical activity apps or wearables that provided sensor-based feedback. Results were analyzed using descriptive numerical summaries, chi-square testing, and qualitative thematic analysis. Results: A total of 1829 abstracts were screened, and 858 articles read in full. Of 111 included studies, 61 (55.0%) were published between 2015 and 2017. Most (55.0%, 61/111) were RCTs, and only 2 studies (1.8%) used rapid research designs: 1 single-case design and 1 multiphase optimization strategy. Other research designs included 23 (22.5%) repeated measures designs, 11 (9.9%) nonrandomized group designs, 10 (9.0%) case studies, and 4 (3.6%) observational studies. Less than one-third of the studies (32.0%, 35/111) investigated effectiveness, engagement, and acceptability together. To measure physical activity, most studies (90.1%, 101/111) employed sensors (either in-device [67.6%, 75/111] or external [23.4%, 26/111]). RCTs were more likely to employ external sensors (accelerometers: P=.005). Studies that assessed engagement (52.3%, 58/111) mostly used device-generated logs (91%, 53/58) to measure the frequency, depth, and length of engagement. Studies that assessed acceptability (57.7%, 64/111) most often used questionnaires (64%, 42/64) and/or qualitative methods (53%, 34/64) to explore appreciation, perceived effectiveness and usefulness, satisfaction, intention to continue use, and social acceptability. Some studies (14.4%, 16/111) assessed dimensions more closely related to usability (ie, burden of sensor wear and use, interface complexity, and perceived technical performance). Conclusions: The rapid increase of research into the impact of physical activity apps and wearables means that evaluation guidelines are urgently needed to promote efficiency through the use of rapid research designs, in-device sensors and user-logs to assess effectiveness, engagement, and acceptability. Screening articles was time-consuming because reporting across health and computing sciences lacked standardization. Reporting guidelines are therefore needed to facilitate the synthesis of evidence across disciplines. %M 29572200 %R 10.2196/mhealth.9054 %U http://mhealth.jmir.org/2018/3/e58/ %U https://doi.org/10.2196/mhealth.9054 %U http://www.ncbi.nlm.nih.gov/pubmed/29572200 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e106 %T Just-in-Time Feedback in Diet and Physical Activity Interventions: Systematic Review and Practical Design Framework %A Schembre,Susan M %A Liao,Yue %A Robertson,Michael C %A Dunton,Genevieve Fridlund %A Kerr,Jacqueline %A Haffey,Meghan E %A Burnett,Taylor %A Basen-Engquist,Karen %A Hicklen,Rachel S %+ Department of Behavioral Science, Division of Cancer Control and Population Sciences, The University of Texas MD Anderson Cancer Center, Unit 1330, PO Box 301439, Houston, TX, 77230-1439, United States, 1 713 563 5858, sschembre@mdanderson.org %K health behavior %K diet %K exercise %K task performance and analysis %K Internet %K mHealth %K accelerometer %K activity monitor %K self-tracking %K wearable sensors %D 2018 %7 22.03.2018 %9 Review %J J Med Internet Res %G English %X Background: The integration of body-worn sensors with mobile devices presents a tremendous opportunity to improve just-in-time behavioral interventions by enhancing bidirectional communication between investigators and their participants. This approach can be used to deliver supportive feedback at critical moments to optimize the attainment of health behavior goals. Objective: The goals of this systematic review were to summarize data on the content characteristics of feedback messaging used in diet and physical activity (PA) interventions and to develop a practical framework for designing just-in-time feedback for behavioral interventions. Methods: Interventions that included just-in-time feedback on PA, sedentary behavior, or dietary intake were eligible for inclusion. Feedback content and efficacy data were synthesized descriptively. Results: The review included 31 studies (15/31, 48%, targeting PA or sedentary behavior only; 13/31, 42%, targeting diet and PA; and 3/31, 10%, targeting diet only). All studies used just-in-time feedback, 30 (97%, 30/31) used personalized feedback, and 24 (78%, 24/31) used goal-oriented feedback, but only 5 (16%, 5/31) used actionable feedback. Of the 9 studies that tested the efficacy of providing feedback to promote behavior change, 4 reported significant improvements in health behavior. In 3 of these 4 studies, feedback was continuously available, goal-oriented, or actionable. Conclusions: Feedback that was continuously available, personalized, and actionable relative to a known behavioral objective was prominent in intervention studies with significant behavior change outcomes. Future research should determine whether all or some of these characteristics are needed to optimize the effect of feedback in just-in-time interventions. %M 29567638 %R 10.2196/jmir.8701 %U http://www.jmir.org/2018/3/e106/ %U https://doi.org/10.2196/jmir.8701 %U http://www.ncbi.nlm.nih.gov/pubmed/29567638 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e53 %T Quality of Publicly Available Physical Activity Apps: Review and Content Analysis %A Bondaronek,Paulina %A Alkhaldi,Ghadah %A Slee,April %A Hamilton,Fiona L %A Murray,Elizabeth %+ eHealth Unit, Research Department of Primary Care and Population Health, University College London, Upper 3rd Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, United Kingdom, 44 20 3002 878, p.bondaronek@ucl.ac.uk %K exercise %K health behavior %K mobile applications %K health promotion %K mHealth %K eHealth review %D 2018 %7 21.03.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Within the new digital health landscape, the rise of health apps creates novel prospects for health promotion. The market is saturated with apps that aim to increase physical activity (PA). Despite the wide distribution and popularity of PA apps, there are limited data on their effectiveness, user experience, and safety of personal data. Objective: The purpose of this review and content analysis was to evaluate the quality of the most popular PA apps on the market using health care quality indicators. Methods: The top-ranked 400 free and paid apps from iTunes and Google Play stores were screened. Apps were included if the primary behavior targeted was PA, targeted users were adults, and the apps had stand-alone functionality. The apps were downloaded on mobile phones and assessed by 2 reviewers against the following quality assessment criteria: (1) users’ data privacy and security, (2) presence of behavior change techniques (BCTs) and quality of the development and evaluation processes, and (3) user ratings and usability. Results: Out of 400 apps, 156 met the inclusion criteria, of which 65 apps were randomly selected to be downloaded and assessed. Almost 30% apps (19/65) did not have privacy policy. Every app contained at least one BCT, with an average number of 7 and a maximum of 13 BCTs. All but one app had commercial affiliation, 12 consulted an expert, and none reported involving users in the app development. Only 12 of 65 apps had a peer-reviewed study connected to the app. User ratings were high, with only a quarter of the ratings falling below 4 stars. The median usability score was excellent—86.3 out of 100. Conclusions: Despite the popularity of PA apps available on the commercial market, there were substantial shortcomings in the areas of data safety and likelihood of effectiveness of the apps assessed. The limited quality of the apps may represent a missed opportunity for PA promotion. %M 29563080 %R 10.2196/mhealth.9069 %U http://mhealth.jmir.org/2018/3/e53/ %U https://doi.org/10.2196/mhealth.9069 %U http://www.ncbi.nlm.nih.gov/pubmed/29563080 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e23 %T Acute Effect of Alcohol Intake on Cardiovascular Autonomic Regulation During the First Hours of Sleep in a Large Real-World Sample of Finnish Employees: Observational Study %A Pietilä,Julia %A Helander,Elina %A Korhonen,Ilkka %A Myllymäki,Tero %A Kujala,Urho M %A Lindholm,Harri %+ Faculty of Biomedical Sciences and Engineering, BioMediTech Institute, Tampere University of Technology, Korkeakoulunkatu 3, Tampere, 33720, Finland, 358 405475334, julia.pietila@tut.fi %K heart rate %K heart rate variability %K sleep %K alcohol drinking %K autonomic nervous system %K wearable electronic device %D 2018 %7 16.03.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Sleep is fundamental for good health, and poor sleep has been associated with negative health outcomes. Alcohol consumption is a universal health behavior associated with poor sleep. In controlled laboratory studies, alcohol intake has been shown to alter physiology and disturb sleep homeostasis and architecture. The association between acute alcohol intake and physiological changes has not yet been studied in noncontrolled real-world settings. Objective: The aim of this study was to assess the effects of alcohol intake on the autonomic nervous system (ANS) during sleep in a large noncontrolled sample of Finnish employees. Methods: From a larger cohort, this study included 4098 subjects (55.81%, 2287/4098 females; mean age 45.1 years) who had continuous beat-to-beat R-R interval recordings of good quality for at least 1 day with and for at least 1 day without alcohol intake. The participants underwent continuous beat-to-beat R-R interval recording during their normal everyday life and self-reported their alcohol intake as doses for each day. Heart rate (HR), HR variability (HRV), and HRV-derived indices of physiological state from the first 3 hours of sleep were used as outcomes. Within-subject analyses were conducted in a repeated measures manner by studying the differences in the outcomes between each participant’s days with and without alcohol intake. For repeated measures two-way analysis of variance, the participants were divided into three groups: low (≤0.25 g/kg), moderate (>0.25-0.75 g/kg), and high (>0.75 g/kg) intake of pure alcohol. Moreover, linear models studied the differences in outcomes with respect to the amount of alcohol intake and the participant’s background parameters (age; gender; body mass index, BMI; physical activity, PA; and baseline sleep HR). Results: Alcohol intake was dose-dependently associated with increased sympathetic regulation, decreased parasympathetic regulation, and insufficient recovery. In addition to moderate and high alcohol doses, the intraindividual effects of alcohol intake on the ANS regulation were observed also with low alcohol intake (all P<.001). For example, HRV-derived physiological recovery state decreased on average by 9.3, 24.0, and 39.2 percentage units with low, moderate, and high alcohol intake, respectively. The effects of alcohol in suppressing recovery were similar for both genders and for physically active and sedentary subjects but stronger among young than older subjects and for participants with lower baseline sleep HR than with higher baseline sleep HR. Conclusions: Alcohol intake disturbs cardiovascular relaxation during sleep in a dose-dependent manner in both genders. Regular PA or young age do not protect from these effects of alcohol. In health promotion, wearable HR monitoring and HRV-based analysis of recovery might be used to demonstrate the effects of alcohol on sleep on an individual level. %M 29549064 %R 10.2196/mental.9519 %U http://mental.jmir.org/2018/1/e23/ %U https://doi.org/10.2196/mental.9519 %U http://www.ncbi.nlm.nih.gov/pubmed/29549064 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e64 %T Self-Directed Engagement with a Mobile App (Sinasprite) and Its Effects on Confidence in Coping Skills, Depression, and Anxiety: Retrospective Longitudinal Study %A Silva Almodovar,Armando %A Surve,Swatee %A Axon,David Rhys %A Cooper,David %A Nahata,Milap C %+ Institute of Therapeutic Innovations and Outcomes, The College of Pharmacy, The Ohio State University, 500 West 12 Ave, Columbus, OH, 43210, United States, 1 6142922472, nahata.1@osu.edu %K mental health %K retrospective studies %K longitudinal studies %K mobile apps %K anxiety %K depression %D 2018 %7 16.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Inadequacies in mental health care coverage remain an enormous problem in the United States. Barriers include scarcity of accessible mental health care professionals. Use of a mental health mobile app incorporating social cognitive theory may help improve confidence in coping skills and improve anxiety and depression. Sinasprite is a mobile app that recruited users via self-referral and clinician referral. Users completed questionnaires to obtain demographic and medical histories. At baseline and 6-week follow-up, users completed the Patient Health Questionnaire 8 (PHQ-8), General Anxiety Disorder 7-Item (GAD-7), and the Coping Self-Efficacy Scale (CSE). It is unknown how self-directed use of a mobile app improves confidence in coping skills and its effects on self-reported depression and anxiety. Objective: The objective of this study was to evaluate the Sinasprite database to assess self-directed engagement and how use of this mobile app impacted self-reported confidence in coping skills and severity of depression and anxiety. Methods: This retrospective longitudinal study involved users recruited via clinician referral and self-referral through social media and news media. Questionnaires were used to record demographic, medical, and prescription medication histories. Mental health status was assessed via PHQ-8, GAD-7, and CSE questionnaires. A deidentified dataset reporting mobile app use data was provided to investigators. Individuals with verifiable usage data and at least one completed questionnaire at 6 weeks of use were included. Mann–Whitney U and Kruskal-Wallis tests were used to assess whether demographic data and psychotherapy were related to baseline questionnaire scores and usage. A Spearman rho (ρ) test was used to assess the relationship between improvement in the CSE and GAD-7 and PHQ-8 questionnaires. Changes in mental health status were assessed using Wilcoxon signed-rank test. A mixed-effects repeated-measures linear regression model assessed the main effects of time, concomitant counseling, and psychotropic prescription medication use on mental health status. Results: Thirty-four users were eligible for inclusion in the analysis. Users were predominantly female, white, married, and college educated. At baseline, 35% (12/34) of respondents reported the use of individual/group counseling, and 38% (19/34) reported using prescription medications for their mental health. The median user completed 5.7 (interquartile range 2.7-14.1) trackable activities per week. Statistically significant improvements using a Wilcoxon signed-ranked test were observed in the PHQ-8 (P<.001), GAD-7 (P=.002), and CSE (P<.001) questionnaire scores. A strong positive correlation between improvement in the GAD-7 and CSE questionnaire scores (ρ=.572, P=.001, n=28) was observed. The mixed-effects repeated-measures regression model revealed a statistically significant effect of time on improvements in the PHQ-8 (P<.001), GAD-7 (P=.007), and CSE (P=.001). Conclusions: This 6-week retrospective study showed that self-directed use of the mobile app, Sinasprite, resulted in significant improvements in self-reported questionnaire scores reflecting depression, anxiety, and confidence in coping skills. %M 29549066 %R 10.2196/mhealth.9612 %U http://mhealth.jmir.org/2018/3/e64/ %U https://doi.org/10.2196/mhealth.9612 %U http://www.ncbi.nlm.nih.gov/pubmed/29549066 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e55 %T Describing the Process of Adopting Nutrition and Fitness Apps: Behavior Stage Model Approach %A König,Laura M %A Sproesser,Gudrun %A Schupp,Harald T %A Renner,Britta %+ University of Konstanz, P.O. Box 47, Konstanz, 78457, Germany, 49 7531 88 5319, laura.koenig@uni-konstanz.de %K mHealth %K eating %K physical activity %K exercise %K smartphone %K mobile applications %K health promotion %D 2018 %7 13.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although mobile technologies such as smartphone apps are promising means for motivating people to adopt a healthier lifestyle (mHealth apps), previous studies have shown low adoption and continued use rates. Developing the means to address this issue requires further understanding of mHealth app nonusers and adoption processes. This study utilized a stage model approach based on the Precaution Adoption Process Model (PAPM), which proposes that people pass through qualitatively different motivational stages when adopting a behavior. Objective: To establish a better understanding of between-stage transitions during app adoption, this study aimed to investigate the adoption process of nutrition and fitness app usage, and the sociodemographic and behavioral characteristics and decision-making style preferences of people at different adoption stages. Methods: Participants (N=1236) were recruited onsite within the cohort study Konstanz Life Study. Use of mobile devices and nutrition and fitness apps, 5 behavior adoption stages of using nutrition and fitness apps, preference for intuition and deliberation in eating decision-making (E-PID), healthy eating style, sociodemographic variables, and body mass index (BMI) were assessed. Results: Analysis of the 5 behavior adoption stages showed that stage 1 (“unengaged”) was the most prevalent motivational stage for both nutrition and fitness app use, with half of the participants stating that they had never thought about using a nutrition app (52.41%, 533/1017), whereas less than one-third stated they had never thought about using a fitness app (29.25%, 301/1029). “Unengaged” nonusers (stage 1) showed a higher preference for an intuitive decision-making style when making eating decisions, whereas those who were already “acting” (stage 4) showed a greater preference for a deliberative decision-making style (F4,1012=21.83, P<.001). Furthermore, participants differed widely in their readiness to adopt nutrition and fitness apps, ranging from having “decided to” but not yet begun to act (stage 2; nutrition: 6.88%, 70/1017; fitness: 9.23%, 95/1029) to being “disengaged” following previous adoption (stage 5; nutrition: 13.77%, 140/1017; fitness: 15.06%, 155/1029). Conclusions: Using a behavior stage model approach to describe the process of adopting nutrition and fitness apps revealed motivational stage differences between nonusers (being “unengaged,” having “decided not to act,” having “decided to act,” and being “disengaged”), which might contribute to a better understanding of the process of adopting mHealth apps and thus inform the future development of digital interventions. This study highlights that new user groups might be better reached by apps designed to address a more intuitive decision-making style. %M 29535078 %R 10.2196/mhealth.8261 %U http://mhealth.jmir.org/2018/3/e55/ %U https://doi.org/10.2196/mhealth.8261 %U http://www.ncbi.nlm.nih.gov/pubmed/29535078 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e60 %T A Skin Cancer Prevention Facial-Aging Mobile App for Secondary Schools in Brazil: Appearance-Focused Interventional Study %A Brinker,Titus Josef %A Heckl,Marlene %A Gatzka,Martina %A Heppt,Markus V %A Resende Rodrigues,Henrique %A Schneider,Sven %A Sondermann,Wiebke %A de Almeida e Silva,Carolina %A Kirchberger,Michael C %A Klode,Joachim %A Enk,Alexander H %A Knispel,Sarah %A von Kalle,Christof %A Stoffels,Ingo %A Schadendorf,Dirk %A Nakamura,Yasuhiro %A Esser,Stefan %A Assis,Aisllan %A Bernardes-Souza,Breno %+ Department of Dermatology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 440, Heidelberg, 69120, Germany, 49 15175084347, titus.brinker@gmail.com %K skin neoplasms %K primary prevention %K adolescent %K schools %K students, medical %K mobile applications %K skin aging %K smartphone %D 2018 %7 09.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The incidence of melanoma is increasing faster than any other major cancer both in Brazil and worldwide. Southeast Brazil has especially high incidences of melanoma, and early detection is low. Exposure to ultraviolet (UV) radiation is a primary risk factor for developing melanoma. Increasing attractiveness is a major motivation among adolescents for tanning. A medical student-delivered intervention that takes advantage of the broad availability of mobile phones and adolescents’ interest in their appearance indicated effectiveness in a recent study from Germany. However, the effect in a high-UV index country with a high melanoma prevalence and the capability of medical students to implement such an intervention remain unknown. Objective: In this pilot study, our objective was to investigate the preliminary success and implementability of a photoaging intervention to prevent skin cancer in Brazilian adolescents. Methods: We implemented a free photoaging mobile phone app (Sunface) in 15 secondary school classes in southeast Brazil. Medical students “mirrored” the pupils’ altered 3-dimensional (3D) selfies reacting to touch on tablets via a projector in front of their whole grade accompanied by a brief discussion of means of UV protection. An anonymous questionnaire capturing sociodemographic data and risk factors for melanoma measured the perceptions of the intervention on 5-point Likert scales among 356 pupils of both sexes (13-19 years old; median age 16 years) in grades 8 to 12 of 2 secondary schools in Brazil. Results: We measured more than 90% agreement in both items that measured motivation to reduce UV exposure and only 5.6% disagreement: 322 (90.5%) agreed or strongly agreed that their 3D selfie motivated them to avoid using a tanning bed, and 321 (90.2%) that it motivated them to improve their sun protection; 20 pupils (5.6%) disagreed with both items. The perceived effect on motivation was higher in female pupils in both tanning bed avoidance (n=198, 92.6% agreement in females vs n=123, 87.2% agreement in males) and increased use of sun protection (n=197, 92.1% agreement in females vs n=123, 87.2% agreement in males) and independent of age or skin type. All medical students involved filled in a process evaluation revealing that they all perceived the intervention as effective and unproblematic, and that all pupils tried the app in their presence. Conclusions: The photoaging intervention was effective in changing behavioral predictors for UV protection in Brazilian adolescents. The predictors measured indicated an even higher prospective effectiveness in southeast Brazil than in Germany (>90% agreement in Brazil vs >60% agreement in Germany to both items that measured motivation to reduce UV exposure) in accordance with the theory of planned behavior. Medical students are capable of complete implementation. A randomized controlled trial measuring prospective effects in Brazil is planned as a result of this study. %M 29523502 %R 10.2196/mhealth.9794 %U http://mhealth.jmir.org/2018/3/e60/ %U https://doi.org/10.2196/mhealth.9794 %U http://www.ncbi.nlm.nih.gov/pubmed/29523502 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e56 %T Adolescents’ Perspectives on a Mobile App for Relationships: Cross-Sectional Survey %A O'Dea,Bridianne %A Achilles,Melinda Rose %A Werner-Seidler,Aliza %A Batterham,Philip J %A Calear,Alison L %A Perry,Yael %A Shand,Fiona %A Christensen,Helen %+ Black Dog Institute, University of New South Wales, Hospital Road, Randwick, 2031, Australia, 61 293828509, b.odea@blackdog.org.au %K family relations %K peer group %K help-seeking behavior %K mobile apps %K adolescence %D 2018 %7 08.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adolescence can be a fertile time for relationship issues, with interpersonal conflict being a risk factor for poor mental health. Mobile app interventions may have a significant appeal to young people in assisting with relationship distress. However, currently available apps have not been formally evaluated. Youths’ perspectives on engaging with mobile technology to assist with relationships are also unknown. Objective: This study aimed to examine adolescents’ attitudes toward the concept of a mobile phone app for relationship help and support, and whether they would be likely to use such an intervention. Methods: A cross-sectional Web survey consisting of 42 questions, including 13 free responses, was delivered. The proposed app, including character vignettes, was presented, and participants were asked to indicate whether they had experienced the same relationship issues, whether their peers would relate to the issues, and how helpful they found the proposed advice. Participants were also asked to provide their own suggestions for help, which were analyzed using thematic analyses. Results: A total of 150 adolescents (aged 15 to 18) participated. Overall, 60.7% (91/150) were likely to use an app for relationship problems, and this was not associated with demographics or social support (all P values >.05). Likelihood of app usage was found to be influenced by perceived need for help, personal beliefs about app effectiveness, and whether the app is engaging and easy to use. Overall, adolescents were receptive of the proposed content with an average of 99.3% (149/150), rating the strategies provided as somewhat to very helpful. Conclusions: Adolescents were likely to use a mobile phone app for relationship support, and use was not influenced by gender, age, social support, or any other background characteristic. Instead, likely use was influenced by need, personal beliefs, usability, and the appropriateness of app content. App developers must address these factors if the app is to have a wide-scale uptake. %M 29519775 %R 10.2196/mhealth.8831 %U http://mhealth.jmir.org/2018/3/e56/ %U https://doi.org/10.2196/mhealth.8831 %U http://www.ncbi.nlm.nih.gov/pubmed/29519775 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 4 %N 1 %P e7 %T Self-Reflected Well-Being via a Smartphone App in Clinical Medical Students: Feasibility Study %A Berryman,Elizabeth K %A Leonard,Daniel J %A Gray,Andrew R %A Pinnock,Ralph %A Taylor,Barry %+ Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand, 64 274067940, berel235@student.otago.ac.nz %K mental health %K medical students %K medical education %K bullying %K teaching %K mhealth %D 2018 %7 07.03.2018 %9 Original Paper %J JMIR Med Educ %G English %X Background: Well-being in medical students has become an area of concern, with a number of studies reporting high rates of clinical depression, anxiety, burnout, and suicidal ideation in this population. Objective: The aim of this study was to increase awareness of well-being in medical students by using a smartphone app. The primary objective of this study was to determine the validity and feasibility of the Particip8 app for student self-reflected well-being data collection. Methods: Undergraduate medical students of the Dunedin School of Medicine were recruited into the study. They were asked to self-reflect daily on their well-being and to note what experiences they had encountered during that day. Qualitative data were also collected both before and after the study in the form of focus groups and “free-text” email surveys. All participants consented for the data collected to be anonymously reported to the medical faculty. Results: A total of 29 participants (69%, 20/29 female; 31%, 9/29 male; aged 21-30 years) were enrolled, with overall median compliance of 71% at the study day level. The self-reflected well-being scores were associated with both positive and negative experiences described by the participants, with most negative experiences associated with around 20% lower well-being scores for that day; the largest effect being “receiving feedback that was not constructive or helpful,” and the most positive experiences associated with around 20% higher scores for that day. Conclusions: The study of daily data collection via the Particip8 app was found to be feasible, and the self-reflected well-being scores showed validity against participant’s reflections of experiences during that day. %M 29514774 %R 10.2196/mededu.9128 %U http://mededu.jmir.org/2018/1/e7/ %U https://doi.org/10.2196/mededu.9128 %U http://www.ncbi.nlm.nih.gov/pubmed/29514774 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 1 %P e20 %T Effect of Mobile Phone Text Message Reminders on Routine Immunization Uptake in Pakistan: Randomized Controlled Trial %A Kazi,Abdul Momin %A Ali,Murtaza %A Zubair,Khurram %A Kalimuddin,Hussain %A Kazi,Abdul Nafey %A Iqbal,Saleem Perwaiz %A Collet,Jean-Paul %A Ali,Syed Asad %+ Department of Paediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan, 92 34864232, momin.kazi@aku.edu %K SMS %K mobile phone %K reminders %K low- and middle-income countries %K routine immunization %K children %D 2018 %7 07.03.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Improved routine immunization (RI) coverage is recommended as the priority public health strategy to decrease vaccine-preventable diseases and eradicate polio in Pakistan and worldwide. Objective: The objective of this study was to ascertain whether customized, automated, one-way text messaging (short message service, SMS) reminders delivered to caregivers via mobile phones when a child is due for an RI visit can improve vaccination uptake and timelines in Pakistan. Methods: This was a randomized controlled trial, conducted in an urban squatter settlement area of Karachi, Pakistan. Infants less than 2 weeks of age with at least one family member who had a valid mobile phone connection and was comfortable receiving and reading SMS text messages were included. Participants were randomized to the intervention (standard care + one-way SMS reminder) or control (standard care) groups. The primary outcome was to compare the proportion of children immunized up to date at 18 weeks of age. Vaccine given at 6, 10, and 14 weeks schedule includes DPT-Hep-B-Hib vaccine (ie, diphtheria, pertussis, and tetanus; hepatitis B; and Haemophilus influenza type b) and oral poliovirus vaccine (OPV). Data were analyzed using chi-square tests of independence and tested for both per protocol (PP) and intention-to-treat (ITT) analyses. Results: Out of those approached, 84.3% (300/356) of the participants were eligible for enrollment and 94.1% (318/338) of the participants had a working mobile phone. Only children in the PP analyses, who received an SMS reminder for vaccine uptake at 6 weeks visit, showed a statistically significant difference (96.0%, 86/90 vs 86.4%, 102/118; P=.03).The immunization coverage was consistently higher in the intervention group according to ITT analyses at the 6 weeks scheduled visit (76.0% vs 71.3%, P=.36). The 10 weeks scheduled visit (58.7% vs 52.7%, P=.30) and the 14 weeks scheduled visit (31.3% vs 26.0%, P=.31), however, were not statistically significant. Conclusions: Automated simple one-way SMS reminders in local languages might be feasible for improving routine vaccination coverage. Whether one-way SMS reminders alone can have a strong impact on parental attitudes and behavior for improvement of RI coverage and timeliness needs to be further evaluated by better-powered studies and by comparing different types and content of text messages in low-and middle-income countries (LMICs). Trial Registration: ClinicalTrials.gov NCT01859546; https://clinicaltrials.gov/ct2/show/NCT01859546 (Archived by WebCite at http://www.webcitation.org/6xFr57AOc) %M 29514773 %R 10.2196/publichealth.7026 %U http://publichealth.jmir.org/2018/1/e20/ %U https://doi.org/10.2196/publichealth.7026 %U http://www.ncbi.nlm.nih.gov/pubmed/29514773 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 1 %P e5 %T Usage, Acceptability, and Effectiveness of an Activity Tracker in a Randomized Trial of a Workplace Sitting Intervention: Mixed-Methods Evaluation %A Brakenridge,Charlotte L %A Healy,Genevieve N %A Winkler,Elisabeth AH %A Fjeldsoe,Brianna S %+ School of Public Health, The University of Queensland, Herston Rd, Brisbane, 4006, Australia, 61 733655163, c.brakenridge@uq.edu.au %K wearable electronic devices %K fitness trackers %K sedentary lifestyle %K exercise %K workplace %K adult %D 2018 %7 02.03.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: Wearable activity trackers are now a common feature of workplace wellness programs; however, their ability to impact sitting time (the behavior in which most of the desk-based workday is spent) is relatively unknown. This study evaluated the LUMOback, an activity tracker that targets sitting time, as part of a cluster-randomized workplace sitting intervention in desk-based office workers. Objective: Study objectives were to explore: (1) office workers’ self-directed LUMOback use, (2) individual-level characteristics associated with LUMOback use, (3) the impact of LUMOback use on activity and sitting behaviors, and (4) office workers’ perceived LUMOback acceptability. Methods: Exploratory analyses were conducted within the activity tracker intervention group (n=66) of a 2-arm cluster-randomized trial (n=153) with follow-up at 3 and 12 months. The intervention, delivered from within the workplace, consisted of organizational support strategies (eg, manager support, emails) to stand up, sit less, and move more, plus the provision of a LUMOback activity tracker. The LUMOback, worn belted around the waist, provides real-time sitting feedback through a mobile app. LUMOback usage data (n=62), Web-based questionnaires (n=33), activPAL-assessed sitting, prolonged (≥30 min bouts) and nonprolonged (<30 min bouts) sitting, standing and stepping time (7-day, 24 h/day protocol; n=40), and telephone interviews (n=27) were used to evaluate study aims. LUMOback usage data were downloaded and described. Associations between user characteristics and LUMOback usage (in the first 3 months) were analyzed using zero-inflated negative binomial models. Associations between LUMOback usage and 3-month activity outcomes were analyzed using mixed models, correcting for cluster. LUMOback acceptability was explored using 3-month questionnaire data and thematic analysis of telephone interviews (conducted 6 to 10 months post intervention commencement). Results: Tracker uptake was modest (43/61, 70%), and among users, usage over the first 3 months was low (1-48 days, median 8). Usage was greatest among team leaders and those with low self-perceived scores for job control and supervisor relationships. Greater tracker use (≥5 days vs <5 days) was significantly associated only with changes in prolonged unbroken sitting (−50.7 min/16 h; 95% CI −94.0 to −7.3; P=.02) during all waking hours, and changes in nonprolonged sitting (+32.5 min/10 h; 95% CI 5.0 to 59.9; P=.02) during work hours. Participants found the LUMOback easy to use but only somewhat comfortable. Qualitatively, participants valued the real-time app feedback. Nonuptake was attributed to being busy and setup issues. Low usage was attributed to discomfort wearing the LUMOback. Conclusions: The LUMOback—although able to reduce prolonged sitting time—was only used to a limited extent, and its low usage may provide a partial explanation for the limited behavior changes that occurred. Discomfort limited the feasibility of the LUMOback for ongoing use. Such findings yield insight into how to improve upon implementing activity trackers in workplace settings. %M 29500158 %R 10.2196/ijmr.9001 %U http://www.i-jmr.org/2018/1/e5/ %U https://doi.org/10.2196/ijmr.9001 %U http://www.ncbi.nlm.nih.gov/pubmed/29500158 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 1 %P e1 %T Theoretically-Based Emotion Regulation Strategies Using a Mobile App and Wearable Sensor Among Homeless Adolescent Mothers: Acceptability and Feasibility Study %A Leonard,Noelle R %A Casarjian,Bethany %A Fletcher,Richard R %A Prata,Cathleen %A Sherpa,Dawa %A Kelemen,Anna %A Rajan,Sonali %A Salaam,Rasheeda %A Cleland,Charles M %A Gwadz,Marya Viorst %+ Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 1st Avenue, 7th Floor, New York, NY, 10010, United States, 1 212 992 7167, nrl4@nyu.edu %K electrodermal response %K adolescence %K mothers %K emotion %K parenting %D 2018 %7 01.03.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Many adolescent mothers are parenting young children under highly stressful conditions as they are managing first-time parenthood, poverty, lack of housing, school and work, and challenging peer and familial relationships. Mobile health (mHealth) technology has the potential to intervene at various points in the emotion regulation process of adolescent mothers to provide them support for more adaptive emotional and behavioral regulation in the course of their daily life. Objective: The goal of this study was to examine the acceptability, feasibility, use patterns, and mechanisms by which a mobile technology used as an adjunct to in-person, provider-delivered sessions fostered adolescent mothers’ adaptive emotion regulation strategies under real-life conditions. Methods: Participants (N=49) were enrolled in the intervention condition of a larger pilot study of homeless adolescent mothers living in group-based shelters. The mHealth technology, Calm Mom, consisted of a mobile app and a wrist-worn sensorband for the ambulatory measurement and alerting of increased electrodermal activity (EDA), a physiological measurement of stress. We examined logs of mobile app activity and conducted semistructured qualitative interviews with a subsample (N=10) of participants. Qualitative data analysis was guided by the theoretical frames of the intervention and a technology acceptance model and included an analysis of emerging themes and concepts. Results: Overall, participants indicated that one or more of the elements of Calm Mom supported their ability to effectively regulate their emotions in the course of their daily life in ways that were consonant with the intervention’s theoretical model. For many adolescent mothers, the app became an integral tool for managing stress. Due to technical challenges, fewer participants received sensorband alerts; however, those who received alerts reported high levels of acceptability as the technology helped them to identify their emotions and supported them in engaging in more adaptive behaviors during real-life stressful situations with their children, peers, and family members. Conclusions: Calm Mom is a promising technology for providing theoretically driven behavioral intervention strategies during real-life stressful moments among a highly vulnerable population. Future research efforts will involve addressing technology challenges and refining tailoring algorithms for implementation in larger-scale studies. %M 30637376 %R 10.2196/pediatrics.9037 %U http://pediatrics.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/pediatrics.9037 %U http://www.ncbi.nlm.nih.gov/pubmed/30637376 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 1 %P e6 %T Measuring Moderate-Intensity Exercise with the Apple Watch: Validation Study %A Abt,Grant %A Bray,James %A Benson,Amanda Clare %+ School of Life Sciences, The University of Hull, Cottingham Road, Kingston upon Hull, HU6 7RX, United Kingdom, 44 01482463397, g.abt@hull.ac.uk %K smartwatch %K wearables %K technology %K physical activity %K cardiovascular health, Apple Watch %D 2018 %7 28.02.2018 %9 Original Paper %J JMIR Cardio %G English %X Background: Moderate fitness levels and habitual exercise have a protective effect for cardiovascular disease, stroke, type 2 diabetes, and all-cause mortality. The Apple Watch displays exercise completed at an intensity of a brisk walk or above using a green “exercise” ring. However, it is unknown if the exercise ring accurately represents an exercise intensity comparable to that defined as moderate-intensity. In order for health professionals to prescribe exercise intensity with confidence, consumer wearable devices need to be accurate and precise if they are to be used as part of a personalized medicine approach to disease management. Objective: The aim of this study was to examine the validity and reliability of the Apple Watch for measuring moderate-intensity exercise, as defined as 40-59% oxygen consumption reserve (VO2R). Methods: Twenty recreationally active participants completed resting oxygen consumption (VO2rest) and maximal oxygen consumption (VO2 max) tests prior to a series of 5-minute bouts of treadmill walking at increasing speed while wearing an Apple Watch on both wrists, and with oxygen consumption measured continuously. Five-minute exercise bouts were added until the Apple Watch advanced the green “exercise” ring by 5 minutes (defined as the treadmill inflection speed). Validity was examined using a one-sample t-test, with interdevice and intradevice reliability reported as the standardized typical error and intraclass correlation. Results: The mean %VO2R at the treadmill inflection speed was 30% (SD 7) for both Apple Watches. There was a large underestimation of moderate-intensity exercise (left hand: mean difference = -10% [95% CI -14 to -7], d=-1.4; right hand: mean difference = -10% [95% CI -13 to -7], d=-1.5) when compared to the criterion of 40% VO2R. Standardized typical errors for %VO2R at the treadmill inflection speed were small to moderate, with intraclass correlations higher within trials compared to between trials. Conclusions: The Apple Watch threshold for moderate-intensity exercise was lower than the criterion, which would lead to an overestimation of moderate-intensity exercise minutes completed throughout the day. %M 31758766 %R 10.2196/cardio.8574 %U http://cardio.jmir.org/2018/1/e6/ %U https://doi.org/10.2196/cardio.8574 %U http://www.ncbi.nlm.nih.gov/pubmed/31758766 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e46 %T Feasibility of a Mobile Phone App to Support Recovery From Addiction in China: Secondary Analysis of a Pilot Study %A Han,Hui %A Zhang,Jing Ying %A Hser,Yih-Ing %A Liang,Di %A Li,Xu %A Wang,Shan Shan %A Du,Jiang %A Zhao,Min %+ Collaborative Innovation Center for Brain Science, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Xu Hui District, Shanghai, 200030, China, 86 18017311220, dujiangdou@163.com %K mHealth %K substance use %K heroin dependence %K amphetamine-type stimulant (ATS) dependence %K mobile app %K China %D 2018 %7 27.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health technologies have been found to improve the self-management of chronic diseases. However, there is limited research regarding their feasibility in supporting recovery from substance use disorders (SUDs) in China. Objective: The objective of this study was to examine the feasibility of a mobile phone-based ecological momentary assessment (EMA) app by testing the concordance of drug use assessed by the EMA, urine testing, and a life experience timeline (LET) assessment. Methods: A total of 75 participants dependent on heroin or amphetamine-type stimulant (ATS) in Shanghai were recruited to participate in a 4-week pilot study. Of the participants, 50 (67% [50/75]) were randomly assigned to the experimental group and 25 (33% [25/75]) were assigned to the control group. The experimental group used mobile health (mHealth) based EMA technology to assess their daily drug use in natural environments and received 2 short health messages each day, whereas the control group only received 2 short health messages each day from the app. Urine tests and LET assessments were conducted each week and a post-intervention survey was administered to both groups. The correlations among the EMA, the LET assessment, and the urine test were investigated. Results: The mean age of the participants was 41.6 (SD 8.0) years, and 71% (53/75) were male. During the 4 weeks of observation, 690 daily EMA survey data were recorded, with a response rate of 49.29% (690/1400). With respect to drug use, the percent of agreement between the EMA and the LET was 66.7%, 79.2%, 72.4%, and 85.8%, respectively, for each of the 4 weeks, whereas the percent of agreement between the EMA and the urine test was 51.2%, 65.1%, 61.9%, and 71.5%, respectively. The post-intervention survey indicated that 46% (32/70) of the participants preferred face-to-face interviews rather than the mHealth app. Conclusions: This study demonstrated poor agreement between the EMA data and the LET and found that the acceptance of mHealth among individuals with SUDs in China was not positive. Hence, greater efforts are needed to improve the feasibility of mHealth in China. %M 29487040 %R 10.2196/mhealth.8388 %U http://mhealth.jmir.org/2018/2/e46/ %U https://doi.org/10.2196/mhealth.8388 %U http://www.ncbi.nlm.nih.gov/pubmed/29487040 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e40 %T Feasibility of Virtual Tablet-Based Group Exercise Among Older Adults in Siberia: Findings From Two Pilot Trials %A Nikitina,Svetlana %A Didino,Daniele %A Baez,Marcos %A Casati,Fabio %+ Department of Information Engineering and Computer Science, University of Trento, Via Sommarive, 9 - Povo, Trento, 38123, Italy, 39 0461 28 5299, svetlana.nikitina@unitn.it %K physical fitness %K exercise training %K tablet computers %K elderly %K social support %D 2018 %7 27.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Regular physical activity has a positive effect on physical health, well-being, and life satisfaction of older adults. However, engaging in regular physical activity can be challenging for the elderly population because of reduced mobility, low motivation, or lack of the proper infrastructures in their communities. Objective: The objective of this paper was to study the feasibility of home-based online group training—under different group cohesion settings—and its effects on adherence and well-being among Russian older adults. We focused particularly on the technology usability and usage and on the adherence to the training (in light of premeasures of social support, enjoyment of physical activity, and leg muscle strength). As a secondary objective, we also explored the effects of the technology-supported intervention on subjective well-being and loneliness. Methods: Two pilot trials were carried out exploring two different group cohesion settings (weak cohesion and strong cohesion) in the period from 2015 to 2016 in Tomsk, Russian Federation. A total of 44 older adults (59-83 years) participated in the two pilots and followed a strength and balance training program (Otago) for 8 weeks with the help of a tablet-based virtual gym app. Participants in each pilot were assigned to an interaction condition, representing the online group exercising, and an individual condition, representing a home-based individual training. Both conditions featured persuasion strategies but differed in the ability to socialize and train together. Results: Both interaction and individual groups reported a high usability of the technology. Trainees showed a high level of technology acceptance and, particularly, a high score in intention to future use (4.2-5.0 on a 5-point Likert scale). Private texting (short service message [SMS]) was used more than public texting, and the strong cohesion condition resulted in more messages per user. Joint participations to training sessions (copresence) were higher for the social group with higher cohesion. The overall adherence to the training was 74% (SD 27%). Higher levels of social support at baseline were associated with higher adherence in the low cohesion condition (F1,18=5.23, P=.03), whereas in the high cohesion, such association was not found. Overall improvement in the satisfaction with life score was observed between pre and post measures (F1,31=5.85, P=.02), but no decrease in loneliness. Conclusions: Online group exercising was proven feasible among healthy independently living older adults in Russia. The pilots suggest that a physical training performed in a virtual environment positively affect the life satisfaction of the trainees, but it does not provide support for a decrease in loneliness. High cohesion groups are preferable for group exercising, especially to mitigate effects of low social support on adherence. Further research in motivating group interactions in training settings is needed. %M 29487045 %R 10.2196/mhealth.7531 %U http://mhealth.jmir.org/2018/2/e40/ %U https://doi.org/10.2196/mhealth.7531 %U http://www.ncbi.nlm.nih.gov/pubmed/29487045 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e72 %T A Novel Approach for Fully Automated, Personalized Health Coaching for Adults with Prediabetes: Pilot Clinical Trial %A Everett,Estelle %A Kane,Brian %A Yoo,Ashley %A Dobs,Adrian %A Mathioudakis,Nestoras %+ Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, 1830 E. Monument Street, Suite 333, Baltimore, MD, 21287, United States, 1 410 502 8089, nmathio1@jhmi.edu %K mobile health %K prediabetes %K HbA 1c %K weight loss %K blood glucose %D 2018 %7 27.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Prediabetes is a high-risk state for the future development of type 2 diabetes, which may be prevented through physical activity (PA), adherence to a healthy diet, and weight loss. Mobile health (mHealth) technology is a practical and cost-effective method of delivering diabetes prevention programs in a real-world setting. Sweetch (Sweetch Health, Ltd) is a fully automated, personalized mHealth platform designed to promote adherence to PA and weight reduction in people with prediabetes.  Objective: The objective of this pilot study was to calibrate the Sweetch app and determine the feasibility, acceptability, safety, and effectiveness of the Sweetch app in combination with a digital body weight scale (DBWS) in adults with prediabetes. Methods: This was a 3-month prospective, single-arm, observational study of adults with a diagnosis of prediabetes and body mass index (BMI) between 24 kg/m2 and 40 kg/m2. Feasibility was assessed by study retention. Acceptability of the mobile platform and DBWS were evaluated using validated questionnaires. Effectiveness measures included change in PA, weight, BMI, glycated hemoglobin (HbA1c), and fasting blood glucose from baseline to 3-month visit. The significance of changes in outcome measures was evaluated using paired t test or Wilcoxon matched pairs test. Results: The study retention rate was 47 out of 55 (86%) participants. There was a high degree of acceptability of the Sweetch app, with a median (interquartile range [IQR]) score of 78% (73%-80%) out of 100% on the validated System Usability Scale. Satisfaction regarding the DBWS was also high, with median (IQR) score of 93% (83%-100%). PA increased by 2.8 metabolic equivalent of task (MET)–hours per week (SD 6.8; P=.02), with mean weight loss of 1.6 kg (SD 2.5; P<.001) from baseline. The median change in A1c was −0.1% (IQR −0.2% to 0.1%; P=.04), with no significant change in fasting blood glucose (−1 mg/dL; P=.59). There were no adverse events reported. Conclusions: The Sweetch mobile intervention program is a safe and effective method of increasing PA and reducing weight and HbA1c in adults with prediabetes. If sustained over a longer period, this intervention would be expected to reduce diabetes risk in this population. Trial Registration: ClincialTrials.gov NCT02896010; https://clinicaltrials.gov/ct2/show/NCT02896010 (Archived by WebCite at http://www.webcitation.org/6xJYxrgse) %M 29487046 %R 10.2196/jmir.9723 %U http://www.jmir.org/2018/2/e72/ %U https://doi.org/10.2196/jmir.9723 %U http://www.ncbi.nlm.nih.gov/pubmed/29487046 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 1 %N 1 %P e1 %T Acceptability and Feasibility of a Trial Testing Allocation to Sunscreen and a Smartphone App for Sun Protection: Discontinued Randomized Controlled Trial %A Rodrigues,Angela M %A Sniehotta,Falko F %A Birch-Machin,Mark A %A Olivier,Patrick %A Araújo-Soares,Vera %+ Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle, NE2 4AX, United Kingdom, 44 191 208 8974, angela.rodrigues@newcastle.ac.uk %K sunscreening agents %K sun protection factor %K smartphone %K mobile applications %K feasibility studies %K randomized controlled trial %K skin neoplasms %K melanoma %K skin aging %K holidays %K health promotion %K health behavior %D 2018 %7 27.02.2018 %9 Original Paper %J JMIR Dermatol %G English %X Background: Recreational sun exposure has been associated with melanoma prevalence, and tourism settings are of particular interest for skin cancer prevention. Effective, affordable, and geographically flexible interventions to promote sun protection are needed. Objective: The aim of this study was to describe the protocol for a definitive randomized controlled trial (RCT) evaluating a smartphone mobile intervention (mISkin app) promoting sun protection in holidaymakers and to assess the acceptability and feasibility of the mISkin app and associated trial procedures in an internal pilot study. Methods: Participants were recruited from the general community. Holidaymakers traveling abroad and owning a smartphone were enrolled in the internal pilot of a 2 (mISkin vs control) x 2 (sun protection factor [SPF] 15 vs SPF 30) RCT with a postholiday follow-up. The smartphone app is fully automated and entails a behavioral intervention to promote sun protection. It consisted of five components: skin assessment, educational videos, ultraviolet (UV) photos, gamification, and prompts for sun protection. Participants were also randomly allocated to receive sunscreen SPF 15 or SPF 30. Primary outcomes for the internal pilot study were acceptability and feasibility of trial procedures and intervention features. Secondary outcomes were collected at baseline and after holidays through face-to-face-assessments and included skin sun damage, sunscreen use (residual weight and application events), and sun protection practices (Web-based questionnaire). Results: From 142 registers of interest, 42 participants were randomized (76% [32/42] female; mean age 35.5 years). Outcome assessments were completed by all participants. Random allocation to SPF 15 versus SPF 30 was found not to be feasible in a definitive trial protocol. Of the 21 people allocated to the mISkin intervention, 19 (91%) installed the mISkin on their phones, and 18 (86%) used it at least once. Participants were satisfied with the mISkin app and made suggestions for further improvements. Due to difficulties with the random allocation to SPF and slow uptake, the trial was discontinued. Conclusions: The internal pilot study concluded that randomization to SPF was not feasible and that recruitment rate was slower than expected because of difficulties with gatekeeper engagement. Possible solutions to the problems identified are discussed. Further refinements to the mISkin app are needed before a definitive trial. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN63943558; http://www.isrctn.com/ISRCTN63943558 (Archived by WebCite at http://www.webcitation.org/6xOLvbab8) %R 10.2196/derma.8608 %U https://derma.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/derma.8608 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e16 %T Acceptability, Use, and Safety of a Mobile Phone App (BlueIce) for Young People Who Self-Harm: Qualitative Study of Service Users’ Experience %A Grist,Rebecca %A Porter,Joanna %A Stallard,Paul %+ Child and Adolescent Mental Health Group, Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 2253850 ext 86, rg626@bath.ac.uk %K self-injurious behavior %K mobile apps %K adolescents %K telemedicine %K qualitative research %K cognitive therapy %K behavior therapy %D 2018 %7 23.02.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Self-harm is common among adolescents and is associated with a number of negative psychosocial outcomes including a higher risk of suicide. Recent reviews highlight the lack of research into specific interventions for children and young people who self-harm. Developing innovative interventions that are coproduced with individuals with lived experience and that reduce self-harm are key challenges for self-harm prevention. Objective: The aim of this study was to explore the acceptability, use, and safety of BlueIce, a mobile phone app for young people who self-harm and who are attending child and adolescent mental health services (CAMHS). Methods: This study is part of a mixed methods phase 1 trial of BlueIce. Young people aged 12-17 years attending specialist CAMHS were recruited. Clinicians were invited to refer young people who were self-harming or who had a history of self-harm. On consent being obtained and baseline measures taken, participants used BlueIce as an adjunct to usual care for an initial familiarization period of 2 weeks. If after this time they wanted to continue, they used BlueIce for a further 10 weeks. Semistructured interviews were conducted at postfamiliarization (2 weeks after using BlueIce) and postuse (12 weeks after using BlueIce) to assess the acceptability, use, and safety of BlueIce. We undertook a qualitative analysis using a deductive approach, and then an inductive approach, to investigate common themes. Results: Postfamiliarization interviews were conducted with 40 participants. Of these, 37 participants elected to use BlueIce, with postuse interviews being conducted with 33 participants. Following 6 key themes emerged from the data: (1) appraisal of BlueIce, (2) usability of BlueIce, (3) safety, (4) benefits of BlueIce, (5) agency and control, and (6) BlueIce less helpful. The participants reported that BlueIce was accessible, easy to use, and convenient. Many highlighted the mood diary and mood lifter sections as particularly helpful in offering a way to track their moods and offering new strategies to manage their thoughts to self-harm. No adverse effects were reported. For those who did not find BlueIce helpful, issues around motivation to stop self-harming impeded their ability to use the app. Conclusions: BlueIce was judged to be a helpful and safe way of supporting adolescents to manage thoughts of self-harming. Adolescents reported numerous benefits of using BlueIce, and all would recommend the app to other young people who were struggling with self-harm. These preliminary findings are encouraging and provide initial support for the acceptability of BlueIce as a self-help intervention used in conjunction with the traditional face-to-face therapy. %M 29475823 %R 10.2196/mental.8779 %U http://mental.jmir.org/2018/1/e16/ %U https://doi.org/10.2196/mental.8779 %U http://www.ncbi.nlm.nih.gov/pubmed/29475823 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e44 %T A Smartphone App to Promote an Active Lifestyle in Lower-Educated Working Young Adults: Development, Usability, Acceptability, and Feasibility Study %A Simons,Dorien %A De Bourdeaudhuij,Ilse %A Clarys,Peter %A De Cocker,Katrien %A Vandelanotte,Corneel %A Deforche,Benedicte %+ Health Promotion and Education Unit, Department of Public Health, Ghent University, Corneel Heymanslaan 10, Ghent, 9000, Belgium, 32 498457442, dorien.simons@ugent.be %K mHealth %K young adult %K mobile applications %K physical activity %K active transport %K health promotion %D 2018 %7 20.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity (PA) levels are problematic in lower-educated working young adults (18-26 years). To promote PA, smartphone apps have great potential, but there is no evidence for their effectiveness in this population. To increase the likelihood that a newly developed app will be effective, formative research and user testing are required. Objective: The aim of this study was to describe the development, usability, acceptability, and feasibility of a new theory- and evidence-based smartphone app to promote an active lifestyle in lower-educated working young adults. Methods: The new app was developed by applying 4 steps. First, determinants important to promote an active lifestyle in this population were selected. Second, evidence-based behavior change techniques were selected to convert the determinants into practical applications. Third, a new smartphone app was developed. Fourth, volunteers (n=11, both lower and higher educated) tested the app on usability, and lower-educated working young adults (n=16) tested its acceptability and feasibility via (think aloud) interviews, a questionnaire, and Google Analytics. The app was accordingly adapted for the final version. Results: A new Android app, Active Coach, was developed that focused on knowledge, attitude, social support, and self-efficacy (based on outcomes from step 1), and that applied self-regulation techniques (based on outcomes from step 2). The app consists of a 9-week program with personal goals, practical tips, and scientific facts to encourage an active lifestyle. To ensure all-day and automatic self-monitoring of the activity behavior, the Active Coach app works in combination with a wearable activity tracker, the Fitbit Charge. Issues detected by the usability test (eg, text errors, wrong messages) were all fixed. The acceptability and feasibility test showed that participants found the app clear, understandable, and motivating, although some aspects needed to be more personal. Conclusions: By applying a stepwise, user-centered approach that regularly consulted the target group, the new app is adapted to their specific needs and preferences. The Active Coach app was overall positively evaluated by the lower-educated working young adults at the end of the development process. %M 29463491 %R 10.2196/mhealth.8287 %U http://mhealth.jmir.org/2018/2/e44/ %U https://doi.org/10.2196/mhealth.8287 %U http://www.ncbi.nlm.nih.gov/pubmed/29463491 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e42 %T Peer Coaching Through mHealth Targeting Physical Activity in People With Parkinson Disease: Feasibility Study %A Colón-Semenza,Cristina %A Latham,Nancy K %A Quintiliani,Lisa M %A Ellis,Terry D %+ Center for Neurorehabilitation, Department of Physical Therapy & Athletic Training, College of Health & Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, United States, 1 6173537571, tellis@bu.edu %K Parkinson disease %K exercise %K telemedicine %K social support %K fitness tracker %D 2018 %7 15.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Long-term engagement in exercise and physical activity mitigates the progression of disability and increases quality of life in people with Parkinson disease (PD). Despite this, the vast majority of individuals with PD are sedentary. There is a critical need for a feasible, safe, acceptable, and effective method to assist those with PD to engage in active lifestyles. Peer coaching through mobile health (mHealth) may be a viable approach. Objective: The purpose of this study was to develop a PD-specific peer coach training program and a remote peer-mentored walking program using mHealth technology with the goal of increasing physical activity in persons with PD. We set out to examine the feasibility, safety, and acceptability of the programs along with preliminary evidence of individual-level changes in walking activity, self-efficacy, and disability in the peer mentees. Methods: A peer coach training program and a remote peer-mentored walking program using mHealth was developed and tested in 10 individuals with PD. We matched physically active persons with PD (peer coaches) with sedentary persons with PD (peer mentees), resulting in 5 dyads. Using both Web-based and in-person delivery methods, we trained the peer coaches in basic knowledge of PD, exercise, active listening, and motivational interviewing. Peer coaches and mentees wore FitBit Zip activity trackers and participated in daily walking over 8 weeks. Peer dyads interacted daily via the FitBit friends mobile app and weekly via telephone calls. Feasibility was determined by examining recruitment, participation, and retention rates. Safety was assessed by monitoring adverse events during the study period. Acceptability was assessed via satisfaction surveys. Individual-level changes in physical activity were examined relative to clinically important differences. Results: Four out of the 5 peer pairs used the FitBit activity tracker and friends function without difficulty. A total of 4 of the 5 pairs completed the 8 weekly phone conversations. There were no adverse events over the course of the study. All peer coaches were “satisfied” or “very satisfied” with the training program, and all participants were “satisfied” or “very satisfied” with the peer-mentored walking program. All participants would recommend this program to others with PD. Increases in average steps per day exceeding the clinically important difference occurred in 4 out of the 5 mentees. Conclusions: Remote peer coaching using mHealth is feasible, safe, and acceptable for persons with PD. Peer coaching using mHealth technology may be a viable method to increase physical activity in individuals with PD. Larger controlled trials are necessary to examine the effectiveness of this approach. %M 29449201 %R 10.2196/mhealth.8074 %U http://mhealth.jmir.org/2018/2/e42/ %U https://doi.org/10.2196/mhealth.8074 %U http://www.ncbi.nlm.nih.gov/pubmed/29449201 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 3 %N 1 %P e4 %T Change in Glycemic Control With Use of a Digital Therapeutic in Adults With Type 2 Diabetes: Cohort Study %A Berman,Mark A %A Guthrie,Nicole L %A Edwards,Katherine L %A Appelbaum,Kevin J %A Njike,Valentine Y %A Eisenberg,David M %A Katz,David L %+ Better Therapeutics LLC, 445 Bush Street, Suite 300, San Francisco, CA,, United States, 1 617 877 0327, mark@bettertherapeutics.io %K type 2 diabetes %K mobile health %K mHealth %K lifestyle medicine %K mobile apps %K digital therapeutics %D 2018 %7 14.02.2018 %9 Original Paper %J JMIR Diabetes %G English %X Background: Intensive lifestyle change can treat and even reverse type 2 diabetes. Digital therapeutics have the potential to deliver lifestyle as medicine for diabetes at scale. Objective: This 12-week study investigates the effects of a novel digital therapeutic, FareWell, on hemoglobin A1c (HbA1c) and diabetes medication use. Methods: Adults with type 2 diabetes and a mobile phone were recruited throughout the United States using Facebook advertisements. The intervention aim was to effect a sustainable shift to a plant-based dietary pattern and regular exercise by advancing culinary literacy and lifestyle skill acquisition. The intervention was delivered by an app paired with specialized human support, also delivered digitally. Health coaching was provided every 2 weeks by telephone, and a clinical team was available for participants requiring additional support. Participants self-reported current medications and HbA1c at the beginning and end of the 12-week program. Self-efficacy related to managing diabetes and maintaining dietary changes was assessed via survey. Engagement was recorded automatically through the app. Results: We enrolled 118 participants with a baseline HbA1c >6.5%. Participants were 81.4% female (96/118) and resided in 38 US states with a mean age of 50.7 (SD 9.4) years, baseline body mass index of 38.1 (SD 8.8) kg/m2, and baseline HbA1c of 8.1% (SD 1.6). At 12 weeks, 86.2% (94/109) of participants were still using the app. Mean change in HbA1c was –0.8% (97/101, SD 1.3, P<.001) for those reporting end-study data. For participants with a baseline HbA1c >7.0% who did not change medications midstudy, HbA1c change was –1.1% (67/69, SD 1.4, P<.001). The proportion of participants with an end-study HbA1c <6.5% was 28% (22/97). After completion of the intervention, 17% (16/97) of participants reported a decrease in diabetic medication while 8% (8/97) reported an increase. A total of 57% (55/97) of participants achieved a composite outcome of reducing HbA1c, reducing diabetic medication use, or both; 92% (90/98) reported greater confidence in their ability to manage their diabetes compared to before the program, and 91% (89/98) reported greater confidence in their ability to maintain a healthy dietary pattern. Participants engaged with the app an average of 4.3 times per day. We observed a significantly greater decrease in HbA1c among participants in the highest tertile of app engagement compared to those in the lowest tertile of app engagement (P=.03). Conclusions: Clinically meaningful reductions in HbA1c were observed with use of the FareWell digital therapeutic. Greater glycemic control was observed with increasing app engagement. Engagement and retention were both high in this widely distributed sample. %M 30291074 %R 10.2196/diabetes.9591 %U http://diabetes.jmir.org/2018/1/e4/ %U https://doi.org/10.2196/diabetes.9591 %U http://www.ncbi.nlm.nih.gov/pubmed/30291074 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e18 %T Mobile Phone Apps for Behavioral Interventions for At-Risk Drinkers in Australia: Literature Review %A Choo,Carol C %A Burton,André A D %+ College of Healthcare Sciences, James Cook University, 149 Sims Drive, Singapore, 387380, Singapore, 65 67093760, carol.choo@jcu.edu.au %K problem drinking %K alcohol drinking %K eHealth %K telemedicine %K smartphone %K mobile applications %K behavioral intervention %K risk reduction behavior %K review %D 2018 %7 13.02.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The mobile technology era has ushered in the use of mobile phone apps for behavioral intervention for at-risk drinkers. Objective: Our objective was to review recent research relevant to mobile phone apps that can be used for behavioral intervention for at-risk drinkers in Australia. Methods: The inclusion criteria for this review were articles published in peer-reviewed journals from 2001 to 2017 with use of the search terms “smartphone application,” “alcohol,” “substance,” “behavioural intervention,” “electronic health,” and “mobile health.” Results: In total, we identified 103 abstracts, screened 90 articles, and assessed 50 full-text articles that fit the inclusion criteria for eligibility. We included 19 articles in this review. Conclusions: This review highlighted the paucity of evidence-based and empirically validated research into effective mobile phone apps that can be used for behavioral interventions with at-risk drinkers in Australia. %M 29439946 %R 10.2196/mhealth.6832 %U https://mhealth.jmir.org/2018/2/e18/ %U https://doi.org/10.2196/mhealth.6832 %U http://www.ncbi.nlm.nih.gov/pubmed/29439946 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e38 %T Digital Peer-Support Platform (7Cups) as an Adjunct Treatment for Women With Postpartum Depression: Feasibility, Acceptability, and Preliminary Efficacy Study %A Baumel,Amit %A Tinkelman,Amanda %A Mathur,Nandita %A Kane,John M %+ Department of Community Mental Health, University of Haifa, Abba Khoushy Ave 199, Haifa,, Israel, 972 482 4011, abaumel@univ.haifa.ac.il %K mhealth %K postpartum depression %K perinatal mood disorder %K peer support %K online %K self-help %D 2018 %7 13.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Peer support is considered to be an important framework of support for mothers experiencing postpartum depression (PPD); however, some barriers exist that may limit its use including peer availability and mothers’ lack of time due to child care. Objective: This non-randomized study was designed to examine the feasibility, acceptance, and preliminary clinical outcomes of using 7 Cups of Tea (7Cups), a digital platform that delivers self-help tools and 24/7 emotional support delivered by trained volunteers, as an adjunct treatment for mothers diagnosed with PPD. Methods: Mothers with PPD were referred during intake to the study coach who provided guidance about 7Cups. 7Cups features included self-help tools and chats with trained volunteers who had experienced a perinatal mood disorder in their past. Acceptability was measured by examining self-reports and user engagement with the program. The primary outcome was the Edinburgh Postnatal Depression Scale (EPDS) change score between pre- and postintervention at 2 months, as collected in usual care by clinicians blinded to the study questions. Using a propensity score matching to control for potential confounders, we compared women receiving 7Cups to women receiving treatment as usual (TAU). Results: Participants (n=19) proactively logged into 7Cups for a median of 12 times and 175 minutes. Program use was mostly through the mobile app (median of mobile use 94%) and between 18:00 and 08:00 when clinicians are unavailable (68% of total program use time). Participants chatted with volunteers for a total of 3064 minutes and have indicated in their responses 0 instances in which they felt unsafe. Intent-to-treat analysis revealed that 7Cups recipients experienced significant decreases in EPDS scores (P<.001, Cohen d=1.17). No significant difference in EPDS decrease over time was found between 7Cups and TAU, yet the effect size was medium favoring 7Cups (P=.05, Cohen d=0.58). Conclusions: This study supports using a computerized method to train lay people, without any in-person guidance or screening, and engage them with patients diagnosed with mental illness as part of usual care. The medium effect size (d=0.58) favoring the 7Cups group relative to TAU suggests that 7Cups might enhance treatment outcomes. A fully powered trial has to be conducted to examine this effect. %M 29439944 %R 10.2196/mhealth.9482 %U http://mhealth.jmir.org/2018/2/e38/ %U https://doi.org/10.2196/mhealth.9482 %U http://www.ncbi.nlm.nih.gov/pubmed/29439944 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e48 %T Using Relational Agents to Promote Exercise and Sun Protection: Assessment of Participants’ Experiences With Two Interventions %A Sillice,Marie A %A Morokoff,Patricia J %A Ferszt,Ginette %A Bickmore,Timothy %A Bock,Beth C %A Lantini,Ryan %A Velicer,Wayne F %+ Department of of Psychiatry and Human Behavior, Butler Hospital, Brown University, 345 Blackstone Avenue, Potter Building, Office 293, Providence, RI, 02906, United States, 1 401 455 1070, marie_sillice@brown.edu %K relational agents %K eHealth %K exercise %K sun protection %K qualitative methods %D 2018 %7 07.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Relational agents (RAs) are electronic computational figures designed to engage participants in the change process. A recent study, Project RAISE, tested the effectiveness of RAs, combined with existing computer-based interventions to increase regular exercise and sun protection behaviors. Results showed these interventions can be effective but need further development. Objective: The purpose of this study was to examine participants’ experiences using RAs to increase participant engagement and promote behavior change . Methods: A qualitative approach was primarily utilized. A 25-question interview guide assessed different components of participants’ experiences with the intervention, including motivation, engagement, satisfaction or dissatisfaction, quality of their interaction with the RA, and behavior change. Quantitative assessment of satisfaction was based on a scale of 1 to 10, with 1 representing least satisfied and 10 representing most satisfied. A summative analytic approach was used to assess individuals’ qualitative responses. A single analysis of variance (ANOVA) examined levels of satisfaction by gender. Results: Of the original 1354 participants enrolled in Project RAISE, 490 of 1354 (36%) were assigned to the RA group. A sample of 216 out of 490 (44%) participants assigned to the RA group completed the interventions, and follow-up assessments were contacted to participate in the semistructured interview. A total of 34 out of 216 (16%) completed the interview. Participants were motivated by, and satisfied with, the intervention. Participants viewed the RA as supportive, informative, caring, and reported positive behavior change in both exercise and sun protection. Some participants (15/34, 44%) noted the RA was less judgmental and less “overbearing” compared with a human counselor; other participants (12/34, 35%) said that the interaction was sometimes repetitive or overly general. The majority of participants (22/34, 65%) viewed the RA as an important contributor to their behavior change for exercise, sun protection, or both. Levels of satisfaction ranged between 7 and 10. There were no gender differences noted in levels of satisfaction (P=.51). Conclusions: RAs provide an innovative and attractive platform to increase exercise and sun protection behaviors and potentially other health behaviors. %M 29415873 %R 10.2196/jmir.7640 %U http://www.jmir.org/2018/2/e48/ %U https://doi.org/10.2196/jmir.7640 %U http://www.ncbi.nlm.nih.gov/pubmed/29415873 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 2 %P e37 %T Text-Based Program Addressing the Mental Health of Soon-to-be and New Fathers (SMS4dads): Protocol for a Randomized Controlled Trial %A Fletcher,Richard %A May,Chris %A Attia,John %A Garfield,Craig Franklin %A Skinner,Geoff %+ Family Action Centre, Faculty of Health and Medicine, University of Newcastle, Academic Office Block, University Drive, Callaghan, 2308, Australia, 61 0429152405, richard.fletcher@newcastle.edu.au %K perinatal %K fathers %K online intervention %K randomized controlled trial %K mental health %D 2018 %7 06.02.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Recent estimates indicating that approximately 10% of fathers experience Paternal Perinatal Depression (PPND) and the increasing evidence of the impact of PPND on child development suggest that identifying and assisting distressed fathers is justified on public health grounds. However, addressing new fathers’ mental health needs requires overcoming men’s infrequent contact with perinatal health services and their reluctance to seek help. Text-based interventions delivering information and support have the potential to reach such groups in order to reduce the impact of paternal perinatal distress and to improve the wellbeing of their children. While programs utilising mobile phone technology have been developed for mothers, fathers have not been targeted. Since text messages can be delivered to individual mobile phones to be accessed at a time that is convenient, it may provide a novel channel for engaging with “hard-to-reach” fathers in a critical period of their parenting. Objective: The study will test the efficacy of SMS4dads, a text messaging program designed specifically for fathers including embedded links to online information and regular invitations (Mood Tracker) to monitor their mood, in order to reduce self-reported depression, anxiety and stress over the perinatal period. Methods: A total of 800 fathers-to-be or new fathers from within Australia will be recruited via the SMS4dads website and randomized to the intervention or control arm. The intervention arm will receive 14 texts per month addressing fathers’ physical and mental health, their relationship with their child, and coparenting with their partner. The control, SMS4health, delivers generic health promotion messages twice per month. Messages are timed according to the babies’ expected or actual date of birth and fathers can enroll from 16 weeks into the pregnancy until their infant is 12 weeks of age. Participants complete questionnaires assessing depression, anxiety, stress, and alcohol at baseline and 24 weeks postenrolment. Measures of coparenting and parenting confidence are also completed at baseline and 24 weeks for postbirth enrolments. Results: Participant were recruited between October 2016 and September 2017. Follow-up data collection has commenced and will be completed in March 2018 with results expected in June 2018. Conclusions: This study’s findings will assess the efficacy of a novel text-based program specifically targeting fathers in the perinatal period to improve their depression, anxiety and distress symptoms, coparenting quality, and parenting self-confidence. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000261415; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=370085 (Archived by WebCite at http://www.webcitation.org/6wav55wII). %M 29410387 %R 10.2196/resprot.8368 %U http://www.researchprotocols.org/2018/2/e37/ %U https://doi.org/10.2196/resprot.8368 %U http://www.ncbi.nlm.nih.gov/pubmed/29410387 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e29 %T Patterns of Fitbit Use and Activity Levels Throughout a Physical Activity Intervention: Exploratory Analysis from a Randomized Controlled Trial %A Hartman,Sheri J %A Nelson,Sandahl H %A Weiner,Lauren S %+ Department of Family Medicine and Public Health, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, 92093, United States, 1 8585349235, sjhartman@ucsd.edu %K physical activity %K technology %K activity tracker %K self-monitoring %K adherence %D 2018 %7 05.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There has been a rapid increase in the use of technology-based activity trackers to promote behavior change. However, little is known about how individuals use these trackers on a day-to-day basis or how tracker use relates to increasing physical activity. Objective: The aims were to use minute level data collected from a Fitbit tracker throughout a physical activity intervention to examine patterns of Fitbit use and activity and their relationships with success in the intervention based on ActiGraph-measured moderate to vigorous physical activity (MVPA). Methods: Participants included 42 female breast cancer survivors randomized to the physical activity intervention arm of a 12-week randomized controlled trial. The Fitbit One was worn daily throughout the 12-week intervention. ActiGraph GT3X+ accelerometer was worn for 7 days at baseline (prerandomization) and end of intervention (week 12). Self-reported frequency of looking at activity data on the Fitbit tracker and app or website was collected at week 12. Results: Adherence to wearing the Fitbit was high and stable, with a mean of 88.13% of valid days over 12 weeks (SD 14.49%). Greater adherence to wearing the Fitbit was associated with greater increases in ActiGraph-measured MVPA (binteraction=0.35, P<.001). Participants averaged 182.6 minutes/week (SD 143.9) of MVPA on the Fitbit, with significant variation in MVPA over the 12 weeks (F=1.91, P=.04). The majority (68%, 27/40) of participants reported looking at their tracker or looking at the Fitbit app or website once a day or more. Changes in Actigraph-measured MVPA were associated with frequency of looking at one’s data on the tracker (b=−1.36, P=.07) but not significantly associated with frequency of looking at one’s data on the app or website (P=.36). Conclusions: This is one of the first studies to explore the relationship between use of a commercially available activity tracker and success in a physical activity intervention. A deeper understanding of how individuals engage with technology-based trackers may enable us to more effectively use these types of trackers to promote behavior change. Trial Registration: ClinicalTrials.gov NCT02332876; https://clinicaltrials.gov/ct2/show/NCT02332876?term=NCT02332876 &rank=1 (Archived by WebCite at http://www.webcitation.org/6wplEeg8i). %M 29402761 %R 10.2196/mhealth.8503 %U https://mhealth.jmir.org/2018/2/e29/ %U https://doi.org/10.2196/mhealth.8503 %U http://www.ncbi.nlm.nih.gov/pubmed/29402761 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e31 %T Mobile Diabetes Intervention Study of Patient Engagement and Impact on Blood Glucose: Mixed Methods Analysis %A Quinn,Charlene Connolly %A Butler,Erin C %A Swasey,Krystal K %A Shardell,Michelle D %A Terrin,Michael D %A Barr,Erik A %A Gruber-Baldini,Ann L %+ Department of Epidemiology and Public Health, University of Maryland School of Medicine, Howard Hall Suite 200, 660 W Redwood Street, Baltimore, MD,, United States, 1 410 706 2406, cquinn@som.umaryland.edu %K mobile health %K diabetes %K engagement %K randomized clinical trial %K qualitative %K digital health %D 2018 %7 02.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Successful treatment of diabetes includes patient self-management behaviors to prevent or delay complications and comorbid diseases. On the basis of findings from large clinical trials and professional guidelines, diabetes education programs and health providers prescribe daily regimens of glucose monitoring, healthy eating, stress management, medication adherence, and physical activity. Consistent, long-term commitment to regimens is challenging. Mobile health is increasingly being used to assist patients with lifestyle changes and self-management behaviors between provider visits. The effectiveness of mobile health to improve diabetes outcomes depends on patient engagement with a technology, content, or interactions with providers. Objectives: In the current analysis, we aimed to identify patient engagement themes in diabetes messaging with diabetes providers and determine if differences in engagement in the Mobile Diabetes Intervention Study (MDIS) influenced changes in glycated hemoglobin A1c (HbA1c) over a 1-year treatment period (1.9% absolute decrease in the parent study). Methods: In the primary MDIS study, 163 patients were enrolled into 1 of 3 mobile intervention groups or a usual care control group based on their physician cluster randomization assignment. The control group received care from their physicians as usual. Participants in each intervention group had access to a patient portal where they could record monitoring values for blood glucose, blood pressure, medication changes, or other self-management information while also assigned to varying levels of physician access to patient data. Intervention participants could choose to send and receive messages to assigned certified diabetes educators with questions or updates through the secure Web portal. For this secondary analysis, patient engagement was measured using qualitative methods to identify self-care themes in 4109 patient messages. Mixed methods were used to determine the impact of patient engagement on change in HbA1c over 1 year. Results: Self-care behavior themes that received the highest engagement for participants were glucose monitoring (75/107, 70.1%), medication management (71/107, 66.4%), and reducing risks (71/107, 66.4%). The average number of messages sent per patient were highest for glucose monitoring (9.2, SD 14.0) and healthy eating (6.9, SD 13.2). Compared to sending no messages, sending any messages about glucose monitoring (P=.03) or medication (P=.01) led to a decrease in HbA1c of 0.62 and 0.72 percentage points, respectively. Sending any messages about healthy eating, glucose monitoring, or medication combined led to a decrease in HbA1c of 0.54 percentage points compared to not sending messages in these themes (P=.045). Conclusions: The findings from this study help validate the efficacy of the mobile diabetes intervention. The next step is to determine differences between patients who engage in mobile interventions and those who do not engage and identify methods to enhance patient engagement. Trial Registration: ClinicalTrials.gov: NCT01107015; https://clinicaltrials.gov/ct2/show/NCT01107015 (Archived by WebCite at http://www.webcitation.org/6wh4ekP4R) %M 29396389 %R 10.2196/mhealth.9265 %U https://mhealth.jmir.org/2018/2/e31/ %U https://doi.org/10.2196/mhealth.9265 %U http://www.ncbi.nlm.nih.gov/pubmed/29396389 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 1 %P e10 %T Objectively Measured Baseline Physical Activity Patterns in Women in the mPED Trial: Cluster Analysis %A Fukuoka,Yoshimi %A Zhou,Mo %A Vittinghoff,Eric %A Haskell,William %A Goldberg,Ken %A Aswani,Anil %+ Department of Physiological Nursing/Institute for Health & Aging, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA, 94116, United States, 1 415 476 8419, Yoshimi.Fukuoka@ucsf.edu %K accelerometer %K physical activity %K cluster analysis %K women %K randomized controlled trial %K machine learning %K body mass index %K metabolism %K primary prevention %K mHealth %D 2018 %7 01.02.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Determining patterns of physical activity throughout the day could assist in developing more personalized interventions or physical activity guidelines in general and, in particular, for women who are less likely to be physically active than men. Objective: The aims of this report are to identify clusters of women based on accelerometer-measured baseline raw metabolic equivalent of task (MET) values and a normalized version of the METs ≥3 data, and to compare sociodemographic and cardiometabolic risks among these identified clusters. Methods: A total of 215 women who were enrolled in the Mobile Phone Based Physical Activity Education (mPED) trial and wore an accelerometer for at least 8 hours per day for the 7 days prior to the randomization visit were analyzed. The k-means clustering method and the Lloyd algorithm were used on the data. We used the elbow method to choose the number of clusters, looking at the percentage of variance explained as a function of the number of clusters. Results: The results of the k-means cluster analyses of raw METs revealed three different clusters. The unengaged group (n=102) had the highest depressive symptoms score compared with the afternoon engaged (n=65) and morning engaged (n=48) groups (overall P<.001). Based on a normalized version of the METs ≥3 data, the moderate-to-vigorous physical activity (MVPA) evening peak group (n=108) had a higher body mass index (P=.03), waist circumference (P=.02), and hip circumference (P=.03) than the MVPA noon peak group (n=61). Conclusions: Categorizing physically inactive individuals into more specific activity patterns could aid in creating timing, frequency, duration, and intensity of physical activity interventions for women. Further research is needed to confirm these cluster groups using a large national dataset. Trial Registration: ClinicalTrials.gov NCT01280812; https://clinicaltrials.gov/ct2/show/NCT01280812 (Archived by WebCite at http://www.webcitation.org/6vVyLzwft) %M 29391341 %R 10.2196/publichealth.9138 %U http://publichealth.jmir.org/2018/1/e10/ %U https://doi.org/10.2196/publichealth.9138 %U http://www.ncbi.nlm.nih.gov/pubmed/29391341 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e34 %T Activity Monitors as Support for Older Persons’ Physical Activity in Daily Life: Qualitative Study of the Users’ Experiences %A Ehn,Maria %A Eriksson,Lennie Carlén %A Åkerberg,Nina %A Johansson,Ann-Christin %+ School of Innovation, Design and Engineering, Mälardalen University, Box 883, Västerås, S-721 23, Sweden, 46 21 107093 ext 107093, maria.ehn@mdh.se %K exercise %K behavior %K aged %K seniors %K mobile applications %K fitness trackers %D 2018 %7 01.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Falls are a major threat to the health and independence of seniors. Regular physical activity (PA) can prevent 40% of all fall injuries. The challenge is to motivate and support seniors to be physically active. Persuasive systems can constitute valuable support for persons aiming at establishing and maintaining healthy habits. However, these systems need to support effective behavior change techniques (BCTs) for increasing older adults’ PA and meet the senior users’ requirements and preferences. Therefore, involving users as codesigners of new systems can be fruitful. Prestudies of the user’s experience with similar solutions can facilitate future user-centered design of novel persuasive systems. Objective: The aim of this study was to investigate how seniors experience using activity monitors (AMs) as support for PA in daily life. The addressed research questions are as follows: (1) What are the overall experiences of senior persons, of different age and balance function, in using wearable AMs in daily life?; (2) Which aspects did the users perceive relevant to make the measurements as meaningful and useful in the long-term perspective?; and (3) What needs and requirements did the users perceive as more relevant for the activity monitors to be useful in a long-term perspective? Methods: This qualitative interview study included 8 community-dwelling older adults (median age: 83 years). The participants’ experiences in using two commercial AMs together with tablet-based apps for 9 days were investigated. Activity diaries during the usage and interviews after the usage were exploited to gather user experience. Comments in diaries were summarized, and interviews were analyzed by inductive content analysis. Results: The users (n=8) perceived that, by using the AMs, their awareness of own PA had increased. However, the AMs’ impact on the users’ motivation for PA and activity behavior varied between participants. The diaries showed that self-estimated physical effort varied between participants and varied for each individual over time. Additionally, participants reported different types of accomplished activities; talking walks was most frequently reported. To be meaningful, measurements need to provide the user with a reliable receipt of whether his or her current activity behavior is sufficient for reaching an activity goal. Moreover, praise when reaching a goal was described as motivating feedback. To be useful, the devices must be easy to handle. In this study, the users perceived wearables as easy to handle, whereas tablets were perceived difficult to maneuver. Users reported in the diaries that the devices had been functional 78% (58/74) of the total test days. Conclusions: Activity monitors can be valuable for supporting seniors’ PA. However, the potential of the solutions for a broader group of seniors can significantly be increased. Areas of improvement include reliability, usability, and content supporting effective BCTs with respect to increasing older adults’ PA. %M 29391342 %R 10.2196/mhealth.8345 %U http://mhealth.jmir.org/2018/2/e34/ %U https://doi.org/10.2196/mhealth.8345 %U http://www.ncbi.nlm.nih.gov/pubmed/29391342 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e33 %T A Wearable Sensor-Based Exercise Biofeedback System: Mixed Methods Evaluation of Formulift %A O'Reilly,Martin Aidan %A Slevin,Patrick %A Ward,Tomas %A Caulfield,Brian %+ Insight Centre for Data Analytics, University College Dublin, O'Brien Centre for Science, 3rd Fl, Belfield, Dublin, D4, Ireland, 353 871245972, martin.oreilly@insight-centre.org %K mHealth %K feedback %K posture %K exercise therapy %K biomedical technology %K lower extremity %K physical therapy specialty %D 2018 %7 31.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Formulift is a newly developed mobile health (mHealth) app that connects to a single inertial measurement unit (IMU) worn on the left thigh. The IMU captures users’ movements as they exercise, and the app analyzes the data to count repetitions in real time and classify users’ exercise technique. The app also offers feedback and guidance to users on exercising safely and effectively. Objective: The aim of this study was to assess the Formulift system with three different and realistic types of potential users (beginner gym-goers, experienced gym-goers, and qualified strength and conditioning [S&C] coaches) under a number of categories: (1) usability, (2) functionality, (3) the perceived impact of the system, and (4) the subjective quality of the system. It was also desired to discover suggestions for future improvements to the system. Methods: A total of 15 healthy volunteers participated (12 males; 3 females; age: 23.8 years [SD 1.80]; height: 1.79 m [SD 0.07], body mass: 78.4 kg [SD 9.6]). Five participants were beginner gym-goers, 5 were experienced gym-goers, and 5 were qualified and practicing S&C coaches. IMU data were first collected from each participant to create individualized exercise classifiers for them. They then completed a number of nonexercise-related tasks with the app. Following this, a workout was completed using the system, involving squats, deadlifts, lunges, and single-leg squats. Participants were then interviewed about their user experience and completed the System Usability Scale (SUS) and the user version of the Mobile Application Rating Scale (uMARS). Thematic analysis was completed on all interview transcripts, and survey results were analyzed. Results: Qualitative and quantitative analysis found the system has “good” to “excellent” usability. The system achieved a mean (SD) SUS usability score of 79.2 (8.8). Functionality was also deemed to be good, with many users reporting positively on the systems repetition counting, technique classification, and feedback. A number of bugs were found, and other suggested changes to the system were also made. The overall subjective quality of the app was good, with a median star rating of 4 out of 5 (interquartile range, IQR: 3-5). Participants also reported that the system would aid their technique, provide motivation, reassure them, and help them avoid injury. Conclusions: This study demonstrated an overall positive evaluation of Formulift in the categories of usability, functionality, perceived impact, and subjective quality. Users also suggested a number of changes for future iterations of the system. These findings are the first of their kind and show great promise for wearable sensor-based exercise biofeedback systems. %M 29386171 %R 10.2196/mhealth.8115 %U http://mhealth.jmir.org/2018/1/e33/ %U https://doi.org/10.2196/mhealth.8115 %U http://www.ncbi.nlm.nih.gov/pubmed/29386171 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e32 %T A Smartphone App (BlueIce) for Young People Who Self-Harm: Open Phase 1 Pre-Post Trial %A Stallard,Paul %A Porter,Joanna %A Grist,Rebecca %+ Child and Adolescent Mental Health Group, Department for Health, University of Bath, Wessex House 6.10, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 1225 383282, p.stallard@bath.ac.uk %K self-injury %K smartphone %K mobile apps %K BlueIce %K adolescents %K cognitive behavioral therapy %K mHealth %D 2018 %7 30.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Recent years have seen a significant increase in the availability of smartphone apps for mental health problems. Despite their proliferation, few apps have been specifically developed for young people, and almost none have been subject to any form of evaluation. Objective: This study aimed to undertake a preliminary evaluation of a smartphone app (BlueIce), coproduced with young people and designed to help young people manage distress and urges to self-harm. We aimed to assess the acceptability, safety, and use of BlueIce and to explore the effects on the primary outcome of self-harm and the secondary outcomes of psychological functioning. Methods: We undertook an open trial where we recruited young people aged 12 to 17 years attending specialist child and adolescent mental health services (CAMHS) who were currently self-harming or had a history of self-harm. Eligible participants were assessed at baseline and then given BlueIce. They were assessed 2 weeks later (post familiarization) and again at 12 weeks (post use). A behavior-screening questionnaire (Strengths and Difficulties Questionnaire) was completed along with standardized measures of depression (Mood and Feelings Questionnaire or MFQ) and anxiety (Revised Child Anxiety and Depression Scale or RCADS), taking into account self-reports of self-harm, app helpfulness, and safety. Results: All core CAMHS professional groups referred at least 1 young person. Out of 40 young people recruited, 37 (93%) elected to use BlueIce after familiarization, with 29 out of 33 (88%) wanting to keep it at the end of the study. No young person called the emergency numbers during the 12-week trial, and no one was withdrawn by his or her clinician due to increased risk of suicide. Almost three-quarters (73%) of those who had recently self-harmed reported reductions in self-harm after using BlueIce for 12 weeks. There was a statistically significant mean difference of 4.91 (t31=2.11; P=.04; 95% CI 0.17-9.64) on postuse symptoms of depression (MFQ) and 13.53 on symptoms of anxiety (RCADS) (t30=3.76; P=.001; 95% CI 6.17-20.90), which was evident across all anxiety subscales. Ratings of app acceptability and usefulness were high. Conclusions: Our study has a number of methodological limitations, particularly the absence of a comparison group and a prospective way of assessing self-harm. Nonetheless, our findings are encouraging and suggest that BlueIce, used alongside a traditional CAMHS face-to-face intervention, can help young people manage their emotional distress and urges to self-harm. %M 29382632 %R 10.2196/mhealth.8917 %U http://mhealth.jmir.org/2018/1/e32/ %U https://doi.org/10.2196/mhealth.8917 %U http://www.ncbi.nlm.nih.gov/pubmed/29382632 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e37 %T Implementing a Mobile Health System to Integrate the Treatment of Addiction Into Primary Care: A Hybrid Implementation-Effectiveness Study %A Quanbeck,Andrew %A Gustafson,David H %A Marsch,Lisa A %A Chih,Ming-Yuan %A Kornfield,Rachel %A McTavish,Fiona %A Johnson,Roberta %A Brown,Randall T %A Mares,Marie-Louise %A Shah,Dhavan V %+ Department of Family Medicine and Community Health, University of Wisconsin - Madison, 1100 Delaplaine Ct, Madison, WI, 53715, United States, 1 608 263 4550, arquanbe@wisc.edu %K mobile health %K mHealth %K evidence-based practice %K behavioral medicine %D 2018 %7 30.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the near ubiquity of mobile phones, little research has been conducted on the implementation of mobile health (mHealth) apps to treat patients in primary care. Although primary care clinicians routinely treat chronic conditions such as asthma and diabetes, they rarely treat addiction, a common chronic condition. Instead, addiction is most often treated in the US health care system, if it is treated at all, in a separate behavioral health system. mHealth could help integrate addiction treatment in primary care. Objective: The objective of this paper was to report the effects of implementing an mHealth system for addiction in primary care on both patients and clinicians. Methods: In this implementation research trial, an evidence-based mHealth system named Seva was introduced sequentially over 36 months to a maximum of 100 patients with substance use disorders (SUDs) in each of three federally qualified health centers (FQHCs; primary care clinics that serve patients regardless of their ability to pay). This paper reports on patient and clinician outcomes organized according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Results: The outcomes according to the RE-AIM framework are as follows: Reach—Seva reached 8.31% (268/3226) of appropriate patients. Reach was limited by our ability to pay for phones and data plans for a maximum of 100 patients per clinic. Effectiveness—Patients who were given Seva had significant improvements in their risky drinking days (44% reduction, (0.7-1.25)/1.25, P=.04), illicit drug-use days (34% reduction, (2.14-3.22)/3.22, P=.01), quality of life, human immunodeficiency virus screening rates, and number of hospitalizations. Through Seva, patients also provided peer support to one another in ways that are novel in primary care settings. Adoption—Patients sustained high levels of Seva use—between 53% and 60% of the patients at the 3 sites accessed Seva during the last week of the 12-month implementation period. Among clinicians, use of the technology was less robust than use by patients, with only a handful of clinicians using Seva in each clinic and behavioral health providers making most referrals to Seva in 2 of the 3 clinics. Implementation—At 2 sites, implementation plans were realized successfully; they were delayed in the third. Maintenance—Use of Seva dropped when grant funding stopped paying for the mobile phones and data plans. Two of the 3 clinics wanted to maintain the use of Seva, but they struggled to find funding to support this. Conclusions: Implementing an mHealth system can improve care among primary care patients with SUDs, and patients using the system can support one another in their recovery. Among clinicians, however, implementation requires figuring out how information from the mHealth system will be used and making mHealth data available in the electronic health (eHealth) record. In addition, paying for an mHealth system remains a challenge. %M 29382624 %R 10.2196/jmir.8928 %U http://www.jmir.org/2018/1/e37/ %U https://doi.org/10.2196/jmir.8928 %U http://www.ncbi.nlm.nih.gov/pubmed/29382624 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e32 %T Intrapersonal Variation in Goal Setting and Achievement in Health Coaching: Cross-Sectional Retrospective Analysis %A Wallace,Anne M %A Bogard,Matthew T %A Zbikowski,Susan M %+ Wellness Science and Analytics, Humana, Inc, 500 West Main Street, Louisville, KY, 40202, United States, 1 513 768 2615, awallace44@gmail.com %K health coaching %K health risks %K chronic conditions %K behavior change %D 2018 %7 26.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic conditions in the United States are among the most costly and preventable of all health problems. Research suggests health coaching is an effective strategy for reducing health risks including decreases in weight, blood pressure, lipids, and blood glucose. Much less is known about how and when coaching works. Objective: The aim of this study was to conduct an analysis of intrapersonal variations in participants’ progression in health coaching, examining gender and age-related differences. Methods: This was a cross-sectional, retrospective analysis of 35,333 health coaching participants between 2012 and 2016. Differences in number of goals and activities set and completed, and number of interactions were assessed using negative binomial models. Differences in goal type were assessed using logistic regression for gender and using the Welch test for age to account for unequal variances. Results: Participants choosing online coaching were more likely to be younger and female (P<.001). Gender and age differences were found for the types of goals set by participants. Regarding program activity, women set and completed 12% more action steps than men (P<.001), averaging 21% more interactions than men (P<.001); no gender differences were found in number of goals completed (P=.12), although the percentage of males and females completing goals was significantly different at 60 and 120 days postenrollment (P<.001). Results indicated significant age-related differences in all aspects of program activity: number of interactions, goals set and completed, action steps set and completed (all P values <.01), as well as significant differences in percentage of individuals completing initial goals within 30 days, with older individuals completing more than younger individuals did (all P values <.001). Conclusions: This study found significant intrapersonal variation in how people participate in and progress through a coaching program. Age-related variations were found in all aspects of coaching activity, from modality preference and initial choice of goal type (eg, weight management, tobacco cessation) to goal completion, whereas gender-related differences were demonstrated for all program activities except number of goals set and completed. These findings indicate that to maximize behavior change, coaches need to personalize the coaching experience to the individual. %M 29374005 %R 10.2196/jmir.8892 %U http://www.jmir.org/2018/1/e32/ %U https://doi.org/10.2196/jmir.8892 %U http://www.ncbi.nlm.nih.gov/pubmed/29374005 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 1 %P e28 %T Mobile Health Technology Interventions for Suicide Prevention: Protocol for a Systematic Review and Meta-Analysis %A Melia,Ruth %A Francis,Kady %A Duggan,Jim %A Bogue,John %A O'Sullivan,Mary %A Chambers,Derek %A Young,Karen %+ Psychology Department, Health Service Executive Mid-West, Child and Adolescent Mental Health Service, Quin Road, Ennis, V95HV18, Ireland, 353 656706601, ruth.melia@hse.ie %K mHealth %K suicide prevention %K systematic review %K meta-analysis %D 2018 %7 26.01.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Previous research has reported that two of the major barriers to help-seeking for individuals at risk of suicide are stigma and geographical isolation. Mobile technology offers a potential means of delivering evidence-based interventions with greater specificity to the individual, and at the time that it is needed. Despite documented motivation by at-risk individuals to use mobile technology to track mental health and to support psychological interventions, there is a shortfall of outcomes data on the efficacy of mobile health (mHealth) technology on suicide-specific outcomes. Objective: The objective of this study is to develop a protocol for a systematic review and meta-analysis that aims to evaluate the effectiveness of mobile technology-based interventions for suicide prevention. Methods: The search includes the Cochrane Central Register of Controlled Trials (CENTRAL: The Cochrane Library), MEDLINE, Embase, PsycINFO, CRESP and relevant sources of gray literature. Studies that have evaluated psychological or nonpsychological interventions delivered via mobile computing and communication technology, and have suicidality as an outcome measure will be included. Two authors will independently extract data and assess the study suitability in accordance with the Cochrane Collaboration Risk of Bias Tool. Studies will be included if they measure at least one suicide outcome variable (ie, suicidal ideation, suicidal intent, nonsuicidal self-injurious behavior, suicidal behavior). Secondary outcomes will be measures of symptoms of depression. Where studies are sufficiently homogenous and reported outcomes are amenable for pooled synthesis, meta-analysis will be performed. A narrative synthesis will be conducted if the data is unsuitable for a meta-analysis. Results: The review is in progress, with findings expected by summer 2018. Conclusions: To date, evaluations of mobile technology-based interventions in suicide prevention have focused on evaluating content as opposed to efficacy. Indeed, previous research has identified mobile applications that appear to present harmful content. The current review will address a gap in the literature by evaluating the efficacy of stand-alone mobile technology tools in suicide prevention. It is imperative that research identifies the evidence base for such tools in suicide prevention in order to inform policy, guide clinical practice, inform users and focus future research. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42017072899; https:// www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42017072899  (Archived by WebCite at http://www.webcitation.org/ 6tZAj0yqJ) %M 29374003 %R 10.2196/resprot.8635 %U http://www.researchprotocols.org/2018/1/e28/ %U https://doi.org/10.2196/resprot.8635 %U http://www.ncbi.nlm.nih.gov/pubmed/29374003 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 1 %P e24 %T Examining the Frequency and Contribution of Foods Eaten Away From Home in the Diets of 18- to 30-Year-Old Australians Using Smartphone Dietary Assessment (MYMeals): Protocol for a Cross-Sectional Study %A Wellard-Cole,Lyndal %A Jung,Jisu %A Kay,Judy %A Rangan,Anna %A Chapman,Kathy %A Watson,Wendy L %A Hughes,Clare %A Ni Mhurchu,Cliona %A Bauman,Adrian %A Gemming,Luke %A Yacef,Kalina %A Koprinska,Irena %A Allman-Farinelli,Margaret %+ Nutrition and Dietetics Group, School of Life and Environmental Sciences, The University of Sydney, Level 4 East, Charles Perkins Centre, Sydney, 2006, Australia, 61 286274854, lwel3754@uni.sydney.edu.au %K diet %K fast foods %K young adult %K feeding behavior %K nutritional status %K cell phone %D 2018 %7 26.01.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young Australians aged between 18 and 30 years have experienced the largest increase in the body mass index and spend the largest proportion of their food budget on fast food and eating out. Frequent consumption of foods purchased and eaten away from home has been linked to poorer diet quality and weight gain. There has been no Australian research regarding quantities, type, or the frequency of consumption of food prepared outside the home by young adults and its impact on their energy and nutrient intakes. Objectives: The objective of this study was to determine the relative contributions of different food outlets (eg, fast food chain, independent takeaway food store, coffee shop, etc) to the overall food and beverage intake of young adults; to assess the extent to which food and beverages consumed away from home contribute to young adults’ total energy and deleterious nutrient intakes; and to study social and physical environmental interactions with consumption patterns of young adults. Methods: A cross-sectional study of 1008 young adults will be conducted. Individuals are eligible to participate if they: (1) are aged between 18 and 30 years; (2) reside in New South Wales, Australia; (3) own or have access to a smartphone; (4) are English-literate; and (5) consume at least one meal, snack, or drink purchased outside the home per week. An even spread of gender, age groups (18 to 24 years and 25 to 30 years), metropolitan or regional geographical areas, and high and low socioeconomic status areas will be included. Participants will record all food and drink consumed over 3 consecutive days, together with location purchased and consumed in our customized smartphone app named Eat and Track (EaT). Participants will then complete an extensive demographics questionnaire. Mean intakes of energy, nutrients, and food groups will be calculated along with the relative contribution of foods purchased and eaten away from home. A subsample of 19.84% (200/1008) of the participants will complete three 24-hour recall interviews to compare with the data collected using EaT. Data mining techniques such as clustering, decision trees, neural networks, and support vector machines will be used to build predictive models and identify important patterns. Results: Recruitment is underway, and results will be available in 2018. Conclusions: The contribution of foods prepared away from home, in terms of energy, nutrients, deleterious nutrients, and food groups to young people’s diets will be determined, as will the impact on meeting national recommendations. Foods and consumption behaviors that should be targeted in future health promotion efforts for young adults will be identified. %M 29374002 %R 10.2196/resprot.9038 %U http://www.researchprotocols.org/2018/1/e24/ %U https://doi.org/10.2196/resprot.9038 %U http://www.ncbi.nlm.nih.gov/pubmed/29374002 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e27 %T A Breastfeed-Promoting Mobile App Intervention: Usability and Usefulness Study %A Wang,Chih-Jau %A Chaovalit,Pimwadee %A Pongnumkul,Suporn %+ National Electronics and Computer Technology Center, 112 Phahonyothin Road, Khlong Nueng, Khlong Luang District, Pathum Thani, 12120, Thailand, 66 2 564 6900 ext 72293, wang.chihjau@gmail.com %K mobile health %K breast feeding %K mobile applications %K health promotion %K usability %K usefulness %D 2018 %7 26.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Breastfeeding is proven to have lasting health benefits for both mothers and infants; however, 6-month exclusive breastfeeding rate remains below 20% in Thailand. Although the number of research literature and commercial apps for breastfeeding women is significantly growing, they are country-specific and restricted to English-speaking users. There exists a major knowledge gap on how mobile health apps could support breastfeeding in Thailand. To address these gaps, MoomMae has been developed with the intention to support Thai women in breastfeeding outside of their homes and in keeping their feeding records. Objective: The aim of this study was to evaluate the usability and usefulness of MoomMae, a mobile phone app designed to support breastfeeding women. Methods: Our study was reviewed and approved by Thailand’s National Science and Technology Development Agency (NSTDA) ethics committee. A total of 21 breastfeeding women with at least one Android phone or tablet were recruited via convenience and snowball sampling. The study process for each participant was as follows: the participant was requested to attend a preuse interview and given the app to use for 4 weeks. Following this period, a postuse interview was conducted to examine the usability and usefulness of the app. Both sessions were held individually and audiorecorded for qualitative analysis. Results: The mean scores of usability and usefulness from the postuse survey were 4.33 (SD 0.87; range 1-5) and 4.60 (SD 0.74; range 2-5). Our qualitative analysis revealed a total of 137 feedbacks: 71 related to usability and 66 associated with usefulness. A further sentimental analysis showed that comments on usability were generally negative (59 negative, 11 positive, and 1 neutral), and comments on usefulness were relatively positive (56 positive, 9 negative, and 1 neutral). We discovered 26 unique design issues and proposed recommendations for future improvement. Conclusions: Our usability and usefulness assessment of MoomMae demonstrated that MoomMae has a great potential to be a useful self-management tool for breastfeeding mothers in Thailand. The qualitative analysis suggested that the app is supportive of breastfeeding on demand, but the flow and inputs of the app should be redesigned to be more intuitive. For future implementations, the most desirable feature is a pump-reminding notification system. %M 29374000 %R 10.2196/mhealth.8337 %U http://mhealth.jmir.org/2018/1/e27/ %U https://doi.org/10.2196/mhealth.8337 %U http://www.ncbi.nlm.nih.gov/pubmed/29374000 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e9 %T Using Mobile Health Intervention to Improve Secondary Prevention of Coronary Heart Diseases in China: Mixed-Methods Feasibility Study %A Chen,Shu %A Gong,Enying %A Kazi,Dhruv S %A Gates,Ann B %A Bai,Rong %A Fu,Hua %A Peng,Weixia %A De La Cruz,Ginny %A Chen,Lei %A Liu,Xianxia %A Su,Qingjie %A Girerd,Nicolas %A Karaye,Kamilu M %A Alhabib,Khalid F %A Yan,Lijing L %A Schwalm,JD %+ Global Health Research Center, Duke Kunshan University, No 8 Duke Avenue, Duke Kunshan University, Kunshan, Jiangsu, China, Kunshan, 215316, China, 86 51236657057, lijing.yan@duke.edu %K coronary heart disease %K secondary prevention %K medication adherence %K mobile applications %K text messaging %D 2018 %7 25.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Coronary heart disease (CHD) is the leading cause of cardiovascular mortality worldwide, yet implementation of evidence-based strategies for secondary prevention remains suboptimal. Objective: This study aimed to evaluate the feasibility, specifically the usability and acceptability, and estimate the preliminary effectiveness of a mobile health (mHealth) intervention targeting both physicians and patients to improve adherence to evidence-based medications and lifestyle modifications. Methods: We conducted a 12-week pre-post interventional pilot study at two sites in Shanghai and Hainan, China. Physicians used the app designed in this study to prescribe evidence-based medicines and record patient information. Eligible and consenting patients received automatic text messages or voice calls 4 to 5 times per week for 12 weeks on medication adherence and healthy behaviors. Interviews were conducted among 10 physicians and 24 patients at the two sites for their thoughts on medication adherence and feedback on the usability and acceptability. Questions on usability and acceptability were also asked in a patient follow-up survey. With regard to estimating effectiveness, the primary outcome was medication adherence (as estimated by the Morisky Green Levine Scale) at 12 weeks. Secondary outcomes included physical activity, smoking status, fruits and vegetables consumption, and facility visit frequency. Results: Interview findings and patient survey showed the good usability and acceptability of the intervention. Among 190 patients who completed the intervention, there was a significant increase in medication adherence (odds ratio [OR] 1.80, 95% CI 1.14-2.85). The study also showed decrease of smokers’ percentage (−5%, P=.05), increase of daily vegetables consumption frequency (+0.3/day, P=.01), and community health care center visit frequency (+3 in 3 months, P=.04). The following site-specific differences were noted: medication adherence appeared to increase in Hainan (OR 14.68, 95% CI 5.20-41.45) but not in Shanghai (OR 0.61, 95% CI 0.33-1.12). Conclusions: Our study demonstrated that the intervention was feasible in both a tertiary care center and an urban community health center in China. Preliminary results from pre-post comparison suggest the possibility that provider and patient-linked mHealth interventions may improve medication adherence and lifestyle modifications among CHD patients, especially in resource-scarce settings. Randomized controlled trials are needed to verify the findings. %M 29371178 %R 10.2196/mhealth.7849 %U http://mhealth.jmir.org/2018/1/e9/ %U https://doi.org/10.2196/mhealth.7849 %U http://www.ncbi.nlm.nih.gov/pubmed/29371178 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e28 %T Evaluating Machine Learning–Based Automated Personalized Daily Step Goals Delivered Through a Mobile Phone App: Randomized Controlled Trial %A Zhou,Mo %A Fukuoka,Yoshimi %A Mintz,Yonatan %A Goldberg,Ken %A Kaminsky,Philip %A Flowers,Elena %A Aswani,Anil %+ Department of Industrial Engineering and Operations Research, University of California, 4119 Etcheverry Hall, Berkeley, CA, 94720, United States, 1 510 664 9114, aaswani@berkeley.edu %K physical activity %K cell phone %K fitness tracker %K clinical trial %D 2018 %7 25.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Growing evidence shows that fixed, nonpersonalized daily step goals can discourage individuals, resulting in unchanged or even reduced physical activity. Objective: The aim of this randomized controlled trial (RCT) was to evaluate the efficacy of an automated mobile phone–based personalized and adaptive goal-setting intervention using machine learning as compared with an active control with steady daily step goals of 10,000. Methods: In this 10-week RCT, 64 participants were recruited via email announcements and were required to attend an initial in-person session. The participants were randomized into either the intervention or active control group with a one-to-one ratio after a run-in period for data collection. A study-developed mobile phone app (which delivers daily step goals using push notifications and allows real-time physical activity monitoring) was installed on each participant’s mobile phone, and participants were asked to keep their phone in a pocket throughout the entire day. Through the app, the intervention group received fully automated adaptively personalized daily step goals, and the control group received constant step goals of 10,000 steps per day. Daily step count was objectively measured by the study-developed mobile phone app. Results: The mean (SD) age of participants was 41.1 (11.3) years, and 83% (53/64) of participants were female. The baseline demographics between the 2 groups were similar (P>.05). Participants in the intervention group (n=34) had a decrease in mean (SD) daily step count of 390 (490) steps between run-in and 10 weeks, compared with a decrease of 1350 (420) steps among control participants (n=30; P=.03). The net difference in daily steps between the groups was 960 steps (95% CI 90-1830 steps). Both groups had a decrease in daily step count between run-in and 10 weeks because interventions were also provided during run-in and no natural baseline was collected. Conclusions: The results showed the short-term efficacy of this intervention, which should be formally evaluated in a full-scale RCT with a longer follow-up period. Trial Registration: ClinicalTrials.gov: NCT02886871; https://clinicaltrials.gov/ct2/show/NCT02886871 (Archived by WebCite at http://www.webcitation.org/6wM1Be1Ng). %M 29371177 %R 10.2196/mhealth.9117 %U http://mhealth.jmir.org/2018/1/e28/ %U https://doi.org/10.2196/mhealth.9117 %U http://www.ncbi.nlm.nih.gov/pubmed/29371177 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e2 %T Evaluation of an mHealth App (DeStressify) on University Students’ Mental Health: Pilot Trial %A Lee,Rebecca Anne %A Jung,Mary Elizabeth %+ Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, FHSD-ART360, Kelowna, BC, V1V 1V7, Canada, 1 2508079670, mary.jung@ubc.ca %K mHealth %K mindfulness %K mental health %K students %D 2018 %7 23.01.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: One in five Canadians experience mental health issues with those in the age range of 15 to 24 years being most at risk of a mood disorder. University students have shown significantly higher rates of mental health problems than the general public. Current university support services are limited by factors such as available staff and finances, and social stigma has frequently been identified as an additional barrier that prevents students from accessing these resources. Mobile health (mHealth) apps are one form of alternative health support that is discrete and accessible to students, and although they are recognized as a promising alternative, there is limited research demonstrating their efficacy. Objective: The aim of this study was to evaluate a mindfulness-based app’s (“DeStressify”) efficacy on stress, anxiety, depressive symptomology, sleep behavior, work or class absenteeism, work or school productivity, and quality of life (QoL) among university students. Methods: Full-time undergraduate students at a Canadian university with smartphones and Internet access were recruited through in-class announcements and on-campus posters. Participants randomized into an experimental condition were given and instructed to use the DeStressify app 5 days a week for 4 weeks. Control condition participants were wait-listed. All participants completed pre- and postintervention Web-based surveys to self-assess stress, anxiety, depressive symptomatology, sleep quality, and health-related QoL. Results: A total of 206 responses were collected at baseline, with 163 participants completing the study (86 control, 77 experimental). Using DeStressify was shown to reduce trait anxiety (P=.01) and improve general health (P=.001), energy (P=.01), and emotional well-being (P=.01) in university students, and more participants in the experimental condition believed their productivity improved between baseline and postintervention measurements than the number of participants expected to believe so randomly by chance (P=.01). The app did not significantly improve stress, state anxiety, physical and social functioning, and role limitations because of physical or emotional health problems or pain (P>.05). Conclusions: Mindfulness-based apps may provide an effective alternative support for university students’ mental health. Universities and other institutions may benefit from promoting the use of DeStressify or other mindfulness-based mHealth apps among students who are interested in methods of anxiety management or mindfulness-based self-driven health support. Future steps include examining DeStressify and similar mHealth apps over a longer period and in university staff and faculty. %M 29362209 %R 10.2196/mental.8324 %U http://mental.jmir.org/2018/1/e2/ %U https://doi.org/10.2196/mental.8324 %U http://www.ncbi.nlm.nih.gov/pubmed/29362209 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 1 %P e11 %T Awareness of Prevention Strategies and Willingness to Use Preexposure Prophylaxis in Brazilian Men Who Have Sex With Men Using Apps for Sexual Encounters: Online Cross-Sectional Study %A Torres,Thiago Silva %A De Boni,Raquel Brandini %A de Vasconcellos,Mauricio TL %A Luz,Paula Mendes %A Hoagland,Brenda %A Moreira,Ronaldo Ismerio %A Veloso,Valdilea Gonçalves %A Grinsztejn,Beatriz %+ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av Brasil 4365 Manguinhos, Rio de Janeiro, 21040-360, Brazil, 55 21995363616, thiago.torres@ini.fiocruz.br %K HIV %K prevention %K MSM %K app %K internet %K PrEP %K Brazil %K Latin America %D 2018 %7 22.01.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Geosocial networking (GSN) smartphone apps are becoming the main venue for sexual encounters among Brazilian men who have sex with men (MSM). To address the increased HIV incidence in this population, preexposure prophylaxis (PrEP) was recently implemented in the Brazilian public health system in the context of combined HIV prevention. Objective: This study aimed to describe the characteristics of MSM using GSN apps for sexual encounters, their awareness of prevention strategies, and willingness to use PrEP. Methods: This study was an online cross-sectional study conducted in 10 Brazilian state capitals from July 1 to July 31, 2016. The questionnaire was programmed on SurveyGizmo and advertised in two GSN apps used by MSM to find sexual partners (Hornet and Grindr). Inclusion criteria were >18 years of age, cisgender men, with an HIV-negative status. Eligible individuals answered questions on: demographics; behavior; and knowledge, preferences, and willingness to use PrEP, nonoccupational postexposure prophylaxis (nPEP), HIV self-testing (HIVST), and condoms. Logistic regression modeling was performed to assess the factors associated with daily oral PrEP willingness. Results: During the study period, 8885 individuals provided consent and started the questionnaire. Of these, 23.05% (2048/8885) were ineligible, 6837 (6837/8885, 76.94%) initiated, and 5065 (5065/8885, 57.00%) completed the entire questionnaire and were included in the present analysis. Median age was 30 years (interquartile range: 25-36), most self-declared as MSM (4991/5065, 98.54%), white (3194/5065, 63.06%), middle income (2148/5065, 42.41%), and had 12 or more years of schooling (3106/5062, 61.36%). The majority of MSM (3363/5064, 66.41%) scored >10 points (high risk) on The HIV Incidence Risk for MSM Scale, but only 21.39% (1083/5064) had a low perceived likelihood of getting HIV in the next year. Daily use of apps for sex was reported by 35.58% (1798/5054). Most MSM (4327/5065, 85.43%) reported testing for HIV at least once in their lifetime and 9.16% (464/5065) used nPEP in the previous year. PrEP, nPEP, and HIVST awareness was reported by 57.89% (2932/5065), 57.39% (2907/5065), and 26.57% (1346/5065) of participants, respectively. Half of all respondents (2653/5065, 52.38%) were willing to use daily oral PrEP, and this finding was associated with higher numbers of male sexual partners (adjusted odds ratio [AOR] 1.26, 95% CI 1.09-1.47), condomless receptive anal intercourse (AOR 1.27, 95% CI 1.12-1.44), sex with HIV-positive partner versus no HIV-positive partner (one HIV-positive partner: AOR 1.36, 95% CI 1.11-1.67), daily use of apps for sexual encounters (AOR 1.48, 95% CI 1.17-1.87), high and unknown perceived likelihood of getting HIV in the next year (AOR 1.72, 95% CI 1.47-2.02 and AOR 1.39, 95% CI 1.13-1.70), sexually transmitted infection diagnosis (AOR 1.25, 95% CI 1.03-1.51), stimulant use (AOR 1.24, 95% CI 1.07-1.43), PrEP awareness (AOR 1.48, 95% CI 1.30-1.70), and unwillingness to use condoms (AOR 1.16, 95% CI 1.00-1.33). Conclusions: Our results evidenced high-risk scores in the studied population, suggesting the importance of PrEP use. Those individuals presenting risky sexual behaviors were more willing to use PrEP. Nonetheless, only 58% (2932/5065) of individuals had heard about this prevention strategy. Efforts to increase awareness of new prevention strategies are needed, and mobile health tools are a promising strategy to reach MSM. %M 29358160 %R 10.2196/publichealth.8997 %U http://publichealth.jmir.org/2018/1/e11/ %U https://doi.org/10.2196/publichealth.8997 %U http://www.ncbi.nlm.nih.gov/pubmed/29358160 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e23 %T The Impact of mHealth Interventions: Systematic Review of Systematic Reviews %A Marcolino,Milena Soriano %A Oliveira,João Antonio Queiroz %A D'Agostino,Marcelo %A Ribeiro,Antonio Luiz %A Alkmim,Maria Beatriz Moreira %A Novillo-Ortiz,David %+ Pan American Health Organization, 525 23rd St NW, Washington, DC, 20037, United States, 1 2028124726, novillod@paho.org %K telemedicine %K medical informatics %K mobile phones %D 2018 %7 17.01.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone usage has been rapidly increasing worldwide. mHealth could efficiently deliver high-quality health care, but the evidence supporting its current effectiveness is still mixed. Objective: We performed a systematic review of systematic reviews to assess the impact or effectiveness of mobile health (mHealth) interventions in different health conditions and in the processes of health care service delivery. Methods: We used a common search strategy of five major scientific databases, restricting the search by publication date, language, and parameters in methodology and content. Methodological quality was evaluated using the Measurement Tool to Assess Systematic Reviews (AMSTAR) checklist. Results: The searches resulted in a total of 10,689 articles. Of these, 23 systematic reviews (371 studies; more than 79,665 patients) were included. Seventeen reviews included studies performed in low- and middle-income countries. The studies used diverse mHealth interventions, most frequently text messaging (short message service, SMS) applied to different purposes (reminder, alert, education, motivation, prevention). Ten reviews were rated as low quality (AMSTAR score 0-4), seven were rated as moderate quality (AMSTAR score 5-8), and six were categorized as high quality (AMSTAR score 9-11). A beneficial impact of mHealth was observed in chronic disease management, showing improvement in symptoms and peak flow variability in asthma patients, reducing hospitalizations and improving forced expiratory volume in 1 second; improving chronic pulmonary diseases symptoms; improving heart failure symptoms, reducing deaths and hospitalization; improving glycemic control in diabetes patients; improving blood pressure in hypertensive patients; and reducing weight in overweight and obese patients. Studies also showed a positive impact of SMS reminders in improving attendance rates, with a similar impact to phone call reminders at reduced cost, and improved adherence to tuberculosis and human immunodeficiency virus therapy in some scenarios, with evidence of decrease of viral load. Conclusions: Although mHealth is growing in popularity, the evidence for efficacy is still limited. In general, the methodological quality of the studies included in the systematic reviews is low. For some fields, its impact is not evident, the results are mixed, or no long-term studies exist. Exceptions include the moderate quality evidence of improvement in asthma patients, attendance rates, and increased smoking abstinence rates. Most studies were performed in high-income countries, implying that mHealth is still at an early stage of development in low-income countries. %M 29343463 %R 10.2196/mhealth.8873 %U http://mhealth.jmir.org/2018/1/e23/ %U https://doi.org/10.2196/mhealth.8873 %U http://www.ncbi.nlm.nih.gov/pubmed/29343463 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 1 %P e2 %T User-Centered Design of Learn to Quit, a Smoking Cessation Smartphone App for People With Serious Mental Illness %A Vilardaga,Roger %A Rizo,Javier %A Zeng,Emily %A Kientz,Julie A %A Ries,Richard %A Otis,Chad %A Hernandez,Kayla %+ Center for Addiction Science and Technology, Psychiatry and Behavioral Sciences, Duke University, 2812 Erwin Road, Suite 403 Box 13, Durham, NC, 27705, United States, 1 9196813441, roger.vilardaga@duke.edu %K smoking cessation %K mHealth %K serious mental illness %K user-centered design %K gamification %K acceptance and commitment therapy %D 2018 %7 16.01.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Smoking rates in the United States have been reduced in the past decades to 15% of the general population. However, up to 88% of people with psychiatric symptoms still smoke, leading to high rates of disease and mortality. Therefore, there is a great need to develop smoking cessation interventions that have adequate levels of usability and can reach this population. Objective: The objective of this study was to report the rationale, ideation, design, user research, and final specifications of a novel smoking cessation app for people with serious mental illness (SMI) that will be tested in a feasibility trial. Methods: We used a variety of user-centered design methods and materials to develop the tailored smoking cessation app. This included expert panel guidance, a set of design principles and theory-based smoking cessation content, development of personas and paper prototyping, usability testing of the app prototype, establishment of app’s core vision and design specification, and collaboration with a software development company. Results: We developed Learn to Quit, a smoking cessation app designed and tailored to individuals with SMI that incorporates the following: (1) evidence-based smoking cessation content from Acceptance and Commitment Therapy and US Clinical Practice Guidelines for smoking cessation aimed at providing skills for quitting while addressing mental health symptoms, (2) a set of behavioral principles to increase retention and comprehension of smoking cessation content, (3) a gamification component to encourage and sustain app engagement during a 14-day period, (4) an app structure and layout designed to minimize usability errors in people with SMI, and (5) a set of stories and visuals that communicate smoking cessation concepts and skills in simple terms. Conclusions: Despite its increasing importance, the design and development of mHealth technology is typically underreported, hampering scientific innovation. This report describes the systematic development of the first smoking cessation app tailored to people with SMI, a population with very high rates of nicotine addiction, and offers new design strategies to engage this population. mHealth developers in smoking cessation and related fields could benefit from a design strategy that capitalizes on the role visual engagement, storytelling, and the systematic application of behavior analytic principles to deliver evidence-based content. %M 29339346 %R 10.2196/games.8881 %U http://games.jmir.org/2018/1/e2/ %U https://doi.org/10.2196/games.8881 %U http://www.ncbi.nlm.nih.gov/pubmed/29339346 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 1 %P e1 %T Internet-Based Group Intervention for Ovarian Cancer Survivors: Feasibility and Preliminary Results %A Kinner,Ellen M %A Armer,Jessica S %A McGregor,Bonnie A %A Duffecy,Jennifer %A Leighton,Susan %A Corden,Marya E %A Gauthier Mullady,Janine %A Penedo,Frank J %A Lutgendorf,Susan K %+ Department of Psychological & Brain Sciences, University of Iowa, W322 Seashore Hall, Iowa City, IA, 52242, United States, 1 319 335 2432, susan-lutgendorf@uiowa.edu %K ovarian cancer %K quality of life %K feasibility studies %K eHealth %K psychological stress %D 2018 %7 15.01.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Development of psychosocial group interventions for ovarian cancer survivors has been limited. Drawing from elements of cognitive-behavioral stress management (CBSM), mindfulness-based stress reduction (MBSR), and acceptance and commitment therapy (ACT), we developed and conducted preliminary testing of an Internet-based group intervention tailored specifically to meet the needs of ovarian cancer survivors. The Internet-based platform facilitated home delivery of the psychosocial intervention to a group of cancer survivors for whom attending face-to-face programs could be difficult given their physical limitations and the small number of ovarian cancer survivors at any one treatment site. Objective: The aim of this study was to develop, optimize, and assess the usability, acceptability, feasibility, and preliminary intended effects of an Internet-based group stress management intervention for ovarian cancer survivors delivered via a tablet or laptop. Methods: In total, 9 ovarian cancer survivors provided feedback during usability testing. Subsequently, 19 survivors participated in 5 waves of field testing of the 10-week group intervention led by 2 psychologists. The group met weekly for 2 hours via an Internet-based videoconference platform. Structured interviews and weekly evaluations were used to elicit feedback on the website and intervention content. Before and after the intervention, measures of mood, quality of life (QOL), perceived stress, sleep, and social support were administered. Paired t tests were used to examine changes in psychosocial measures over time. Results: Usability results indicated that participants (n=9) performed basic tablet functions quickly with no errors and performed website functions easily with a low frequency of errors. In the field trial (n=19), across 5 groups, the 10-week intervention was well attended. Perceived stress (P=.03) and ovarian cancer-specific QOL (P=.01) both improved significantly during the course of the intervention. Trends toward decreased distress (P=.18) and greater physical (P=.05) and functional well-being (P=.06) were also observed. Qualitative interviews revealed that the most common obstacles participants experienced were technical issues and the time commitment for practicing the techniques taught in the program. Participants reported that the intervention helped them to overcome a sense of isolation and that they appreciated the ability to participate at home. Conclusions: An Internet-based group intervention tailored specifically for ovarian cancer survivors is highly usable and acceptable with moderate levels of feasibility. Preliminary psychosocial outcomes indicate decreases in perceived stress and improvements in ovarian cancer-specific QOL following the intervention. A randomized clinical trial is needed to demonstrate the efficacy of this promising intervention for ovarian cancer survivors. %M 29335233 %R 10.2196/cancer.8430 %U http://cancer.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/cancer.8430 %U http://www.ncbi.nlm.nih.gov/pubmed/29335233 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e18 %T A Patient-Held Smartcard With a Unique Identifier and an mHealth Platform to Improve the Availability of Prenatal Test Results in Rural Nigeria: Demonstration Study %A Gbadamosi,Semiu Olatunde %A Eze,Chuka %A Olawepo,John Olajide %A Iwelunmor,Juliet %A Sarpong,Daniel F %A Ogidi,Amaka Grace %A Patel,Dina %A Oko,John Okpanachi %A Onoka,Chima %A Ezeanolue,Echezona Edozie %+ Global Health Initiative, School of Community Health Sciences, University of Nevada, Las Vegas, 4505 S. Maryland Parkway, Las Vegas, NV, 89154-1026, United States, 1 702 895 4950, semiu.gbadamosi@unlv.edu %K mHealth %K prenatal screening %K HIV %K hepatitis B %K sickle cell disease %K Nigeria %K telemedicine %K prenatal diagnosis %K infectious disease transmission, vertical %D 2018 %7 15.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Community-based strategies to test for HIV, hepatitis B virus (HBV), and sickle cell disease (SCD) have expanded opportunities to increase the proportion of pregnant women who are aware of their diagnosis. In order to use this information to implement evidence-based interventions, these results have to be available to skilled health providers at the point of delivery. Most electronic health platforms are dependent on the availability of reliable Internet connectivity and, thus, have limited use in many rural and resource-limited settings. Objective: Here we describe our work on the development and deployment of an integrated mHealth platform that is able to capture medical information, including test results, and encrypt it into a patient-held smartcard that can be read at the point of delivery without the need for an Internet connection. Methods: We engaged a team of implementation scientists, public health experts, and information technology specialists in a requirement-gathering process to inform the design of a prototype for a platform that uses smartcard technology, database deployment, and mobile phone app development. Key design decisions focused on usability, scalability, and security. Results: We successfully designed an integrated mHealth platform and deployed it in 4 health facilities across Benue State, Nigeria. We developed the Vitira Health platform to store test results of HIV, HBV, and SCD in a database, and securely encrypt the results on a Quick Response code embedded on a smartcard. We used a mobile app to read the contents on the smartcard without the need for Internet connectivity. Conclusions: Our findings indicate that it is possible to develop a patient-held smartcard and an mHealth platform that contains vital health information that can be read at the point of delivery using a mobile phone-based app without an Internet connection. Trial Registration: ClinicalTrials.gov NCT03027258; https://clinicaltrials.gov/ct2/show/NCT03027258 (Archived by WebCite at http://www.webcitation.org/6owR2D0kE) %M 29335234 %R 10.2196/jmir.8716 %U http://www.jmir.org/2018/1/e18/ %U https://doi.org/10.2196/jmir.8716 %U http://www.ncbi.nlm.nih.gov/pubmed/29335234 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e17 %T Comparing Diet and Exercise Monitoring Using Smartphone App and Paper Diary: A Two-Phase Intervention Study %A Jimoh,Florence %A Lund,Elizabeth K %A Harvey,Linda J %A Frost,Catherine %A Lay,W James %A Roe,Mark A %A Berry,Rachel %A Finglas,Paul M %+ Quadram Institute Bioscience, Norwich Research Park, Norwich, NR4 7UA, United Kingdom, 44 1603255318, paul.finglas@quadram.ac.uk %K adolescent %K smartphone app %K diet %K exercise %K food intake %K mobile applications %D 2018 %7 15.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is increasing recognition that personalized approaches may be more effective in helping people establish healthier eating patterns and exercise more, and that this approach may be particularly effective in adolescents. Objective: The objective of this study was to investigate the use of a smartphone app (FoodWiz2) in supporting healthy lifestyle choices in adolescence. Methods: Participants (N=34: 11 male, 23 female) aged 16-19 years in full- or part-time education were recruited from sixth form colleges, schools, and other further education establishments in Norfolk and Suffolk, United Kingdom, between February and May 2015. Participants recorded food intake and exercise using a paper diary for 4-5 weeks and then used the app for the same duration. Initial nutrition education and general support were provided during the paper diary use, but the app included personalized messages sent in response to app activity. At the end of each study phase, participants completed an online questionnaire to describe their experience of using the paper diary and app. Results: Record completion declined throughout the study, possibly affected by examination pressure. Food intake data showed increased fruit consumption and significantly reduced consumption of chocolate snacks (P=.01) and fizzy drinks (P=.002) among participants using the app. Questionnaire responses indicated that the app was generally preferred to the paper diary, in particular, the app was seen as less boring to use (P=.03) and more acceptable in social settings (P<.001). Conclusions: This app-based approach has shown the potential for a more effective approach to improving adolescent diet and exercise levels. %M 29335239 %R 10.2196/mhealth.7702 %U http://mhealth.jmir.org/2018/1/e17/ %U https://doi.org/10.2196/mhealth.7702 %U http://www.ncbi.nlm.nih.gov/pubmed/29335239 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e16 %T Tanzania Health Information Technology (T-HIT) System: Pilot Test of a Tablet-Based System to Improve Prevention of Mother-to-Child Transmission of HIV %A Bull,Sheana %A Thomas,Deborah SK %A Nyanza,Elias C %A Ngallaba,Sospatro E %+ Department of Geography & Environmental Sciences, University of Colorado Denver, PO Box 173364, CB 172, Denver, CO, 80217-3364, United States, 1 303 315 7557, deborah.thomas@ucdenver.edu %K mHealth %K decision aids %K HIV %K healthcare workers %D 2018 %7 15.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The prevention of mother-to-child transmission (PMTCT) of HIV requires innovative solutions. Although routine monitoring is effective in some areas, standardized and easy-to-scale solutions to identify and monitor pregnant women, test them for HIV, and treat them and their children is still lacking. Mobile health (mHealth) offers opportunities for surveillance and reporting in rural areas of low- and middle-income countries. Objective: The aim of this study was to document the preliminary impacts of the Tanzania Health Information Technology (T-HIT) system mHealth intervention aimed at health workers for PMTCT care delivery and capacity building in a rural area of Tanzania. Methods: We developed T-HIT as a tablet-based system for an electronic data collection system designed to capture and report PMTCT data during antenatal, delivery, and postnatal visits in Misungwi, Tanzania. T-HIT was tested by health workers in a pilot randomized trial comparing seven sites using T-HIT assigned at random to seven control sites; all sites maintained standard paper record-keeping during the pilot intervention period. We compared numbers of antenatal visits, number of HIV tests administered, and women testing positive across all sites. Results: Health workers recorded data from antenatal visits for 1530 women; of these, 695 (45.42%) were tested for HIV and 3.59% (55/1530) tested positive. Health workers were unable to conduct an HIV test for 103 women (6.73%, 103/1530) because of lack of reagent, which is not captured on paper logs. There was no difference in the activity level for testing when comparing sites T-HIT to non-T-HIT sites. We observed a significant postintervention increase in the numbers of women testing positive for HIV compared with the preintervention period (P=.04), but this was likely not attributable to the T-HIT system. Conclusions: T-HIT had a high degree of acceptability and feasibility and is perceived as useful by health workers, who documented more antenatal visits during the pilot intervention compared with a traditional system of paper logs, suggesting potential for improvements in antenatal care for women at risk for HIV. %M 29335236 %R 10.2196/mhealth.8513 %U https://mhealth.jmir.org/2018/1/e16/ %U https://doi.org/10.2196/mhealth.8513 %U http://www.ncbi.nlm.nih.gov/pubmed/29335236 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e11 %T Usage of an Exercise App in the Care for People With Osteoarthritis: User-Driven Exploratory Study %A Danbjørg,Dorthe Boe %A Villadsen,Allan %A Gill,Ester %A Rothmann,Mette Juel %A Clemensen,Jane %+ Centre for Innovative Medical Technology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Sdr Boulevard 29, Odense, 5000, Denmark, 45 26202186, dortheboe@gmail.com %K arthritis %K rehabilitation %K telemedicine %D 2018 %7 11.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Exercise has proven to reduce pain and increase quality of life among people living with osteoarthritis (OA). However, one major challenge is adherence to exercise once supervision ends. Objective: This study aimed to identify mental and physical barriers and motivational and social aspects of training at home, and to test or further develop an exercise app. Methods: The study was inspired from participatory design, engaging users in the research process. Data were collected through focus groups and workshops, and analyzed by systematic text condensation. Results: Three main themes were found: competition as motivation, training together, and barriers. The results revealed that the participants wanted to do their training and had knowledge on exercise and pain but found it hard to motivate themselves. They missed the observation, comments, and encouragement by the supervising physiotherapist as well as their peers. Ways to optimize the training app were identified during the workshops as participants shared their experience. Conclusions: This study concludes that the long-term continuation of exercising for patients with OA could be improved with the use of a technology tailored to users’ needs, including motivational and other behavioral factors. %M 29326092 %R 10.2196/mhealth.7734 %U https://mhealth.jmir.org/2018/1/e11/ %U https://doi.org/10.2196/mhealth.7734 %U http://www.ncbi.nlm.nih.gov/pubmed/29326092 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e14 %T Face-to-Face Versus Mobile Versus Blended Weight Loss Program: Randomized Clinical Trial %A Hurkmans,Emalie %A Matthys,Christophe %A Bogaerts,An %A Scheys,Leonie %A Devloo,Karlien %A Seghers,Jan %+ Department of Movement Sciences, University of Leuven, Tervuursevest 101, Leuven,, Belgium, 32 16329048, jan.seghers@kuleuven.be %K obesity %K weight loss %K mobile applications %K diet %D 2018 %7 11.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Conventional face-to-face weight loss and weight control programs are very labor intensive for both the patient and the provider. It is unclear to what extent conventional programs can be (partially) completed by mobile health (mHealth) apps. Objective: The aim of this study was to compare the effectiveness of different weight loss programs using a combination of conventional and mobile programs among adults who are overweight (body mass index [BMI]>29 kg/m²). Methods: A single-blinded randomized controlled trial among obese adults was performed from September 2015 to March 2016. The study took place in Leuven, Belgium. Of the 102 eligible (BMI >29 kg/m²) adults, 81 (79%) completed the study. The three intervention groups consisted of a conventional face-to-face weight loss program, a weight loss app program (app group), and a partial face-to-face and partial app program (combi group). All intervention groups received the same advice from a dietician and a physical activity coach during a 12-week period. The control group did not receive any information during the same period. Primary outcomes were weight reduction (5% decrease of baseline weight in kg), BMI, metabolic risk factors, dietary pattern, and physical activity. Results: Significant more participants in all three intervention groups lost at least 5% or more of their weight at baseline compared with the control group. No significant difference was found between the combi group and the conventional group. A trend was found that more participants in the combi group lost 5% or more compared with the app group (19%), P=.06. A significant time x group effect was found for BMI and metabolic risk factors, with the control group having the worst results and the combi group being significantly better with regard to BMI compared with the app group. No significant group x time effects were found for the intake of different food and drinks and moderate to vigorous physical activity (MVPA). Conclusions: The results of this study show that a conventional weight loss program could partially be completed with an mHealth program without affecting the effectiveness. Trial Registration: Clinicaltrials.gov NCT02595671; https://clinicaltrials.gov/ct2/show/NCT02595671 (Archived by WebCite at http://www.webcitation.org/6w1H0x1Q6) %M 29326093 %R 10.2196/mhealth.7713 %U http://mhealth.jmir.org/2018/1/e14/ %U https://doi.org/10.2196/mhealth.7713 %U http://www.ncbi.nlm.nih.gov/pubmed/29326093 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e4 %T Cognitive and Behavioral Skills Exercises Completed by Patients with Major Depression During Smartphone Cognitive Behavioral Therapy: Secondary Analysis of a Randomized Controlled Trial %A Furukawa,Toshi A %A Horikoshi,Masaru %A Fujita,Hirokazu %A Tsujino,Naohisa %A Jinnin,Ran %A Kako,Yuki %A Ogawa,Sei %A Sato,Hirotoshi %A Kitagawa,Nobuki %A Shinagawa,Yoshihiro %A Ikeda,Yoshio %A Imai,Hissei %A Tajika,Aran %A Ogawa,Yusuke %A Akechi,Tatsuo %A Yamada,Mitsuhiko %A Shimodera,Shinji %A Watanabe,Norio %A Inagaki,Masatoshi %A Hasegawa,Akio %+ Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku,, Nagoya, 467-8601, Japan, 81 52 753 9491, furukawa@kuhp.kyoto-u.ac.jp %K major depressive disorder %K smartphone %K cognitive therapy %K telemedicine %D 2018 %7 11.01.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: A strong and growing body of evidence has demonstrated the effectiveness of cognitive behavioral therapy (CBT), either face-to-face, in person, or as self-help via the Internet, for depression. However, CBT is a complex intervention consisting of several putatively effective components, and how each component may or may not contribute to the overall effectiveness of CBT is poorly understood. Objective: The aim of this study was to investigate how the users of smartphone CBT use and benefit from various components of the program. Methods: This is a secondary analysis from a 9-week, single-blind, randomized controlled trial that has demonstrated the effectiveness of adjunctive use of smartphone CBT (Kokoro-App) over antidepressant pharmacotherapy alone among patients with drug-resistant major depressive disorder (total n=164, standardized mean difference in depression severity at week 9=0.40, J Med Internet Res). Kokoro-App consists of three cognitive behavioral skills of self-monitoring, behavioral activation, and cognitive restructuring, with corresponding worksheets to fill in. All activities of the participants learning each session of the program and completing each worksheet were uploaded onto Kokoro-Web, which each patient could use for self-check. We examined what use characteristics differentiated the more successful users of the CBT app from the less successful ones, split at the median of change in depression severity. Results: A total of 81 patients with major depression were allocated to the smartphone CBT. On average, they completed 7.0 (standard deviation [SD] 1.4) out of 8 sessions of the program; it took them 10.8 (SD 4.2) days to complete one session, during which they spent 62 min (SD 96) on the app. There were no statistically significant differences in the number of sessions completed, time spent for the program, or the number of completed self-monitoring worksheets between the beneficiaries and the nonbeneficiaries. However, the former completed more behavioral activation tasks, engaged in different types of activities, and also filled in more cognitive restructuring worksheets than the latter. Activities such as “test-drive a new car,” “go to a coffee shop after lunch,” or “call up an old friend” were found to be particularly rewarding. All cognitive restructuring strategies were found to significantly decrease the distress level, with “What would be your advice to a friend who has a similar problem?” found more helpful than some other strategies. Conclusions: The CBT program offered via smartphone and connected to the remote server is not only effective in alleviating depression but also opens a new avenue in gathering information of what and how each participant may utilize the program. The activities and strategies found useful in this analysis will provide valuable information in brush-ups of the program itself and of mobile health (mHealth) in general. Trial Registration: Japanese Clinical Trials Registry UMIN CTR 000013693; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ ctr_view.cgi?recptno=R000015984 (Archived by WebCite at http://www.webcitation.org/6u6pxVwik) %M 29326098 %R 10.2196/mental.9092 %U http://mental.jmir.org/2018/1/e4/ %U https://doi.org/10.2196/mental.9092 %U http://www.ncbi.nlm.nih.gov/pubmed/29326098 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e10 %T Hearing Tests Based on Biologically Calibrated Mobile Devices: Comparison With Pure-Tone Audiometry %A Masalski,Marcin %A Grysiński,Tomasz %A Kręcicki,Tomasz %+ Department and Clinic of Otolaryngology, Head and Neck Surgery, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Borowska 213, Wrocław, 50-556, Poland, 48 515086252, marcin.masalski@pwr.edu.pl %K hearing test %K mobile health %K mobile apps %K pure-tone audiometry %D 2018 %7 10.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hearing screening tests based on pure-tone audiometry may be conducted on mobile devices, provided that the devices are specially calibrated for the purpose. Calibration consists of determining the reference sound level and can be performed in relation to the hearing threshold of normal-hearing persons. In the case of devices provided by the manufacturer, together with bundled headphones, the reference sound level can be calculated once for all devices of the same model. Objective: This study aimed to compare the hearing threshold measured by a mobile device that was calibrated using a model-specific, biologically determined reference sound level with the hearing threshold obtained in pure-tone audiometry. Methods: Trial participants were recruited offline using face-to-face prompting from among Otolaryngology Clinic patients, who own Android-based mobile devices with bundled headphones. The hearing threshold was obtained on a mobile device by means of an open access app, Hearing Test, with incorporated model-specific reference sound levels. These reference sound levels were previously determined in uncontrolled conditions in relation to the hearing threshold of normal-hearing persons. An audiologist-assisted self-measurement was conducted by the participants in a sound booth, and it involved determining the lowest audible sound generated by the device within the frequency range of 250 Hz to 8 kHz. The results were compared with pure-tone audiometry. Results: A total of 70 subjects, 34 men and 36 women, aged 18-71 years (mean 36, standard deviation [SD] 11) participated in the trial. The hearing threshold obtained on mobile devices was significantly different from the one determined by pure-tone audiometry with a mean difference of 2.6 dB (95% CI 2.0-3.1) and SD of 8.3 dB (95% CI 7.9-8.7). The number of differences not greater than 10 dB reached 89% (95% CI 88-91), whereas the mean absolute difference was obtained at 6.5 dB (95% CI 6.2-6.9). Sensitivity and specificity for a mobile-based screening method were calculated at 98% (95% CI 93-100.0) and 79% (95% CI 71-87), respectively. Conclusions: The method of hearing self-test carried out on mobile devices with bundled headphones demonstrates high compatibility with pure-tone audiometry, which confirms its potential application in hearing monitoring, screening tests, or epidemiological examinations on a large scale. %M 29321124 %R 10.2196/mhealth.7800 %U https://mhealth.jmir.org/2018/1/e10/ %U https://doi.org/10.2196/mhealth.7800 %U http://www.ncbi.nlm.nih.gov/pubmed/29321124 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e8 %T Toward mHealth Brief Contact Interventions in Suicide Prevention: Case Series From the Suicide Intervention Assisted by Messages (SIAM) Randomized Controlled Trial %A Berrouiguet,Sofian %A Larsen,Mark Erik %A Mesmeur,Catherine %A Gravey,Michel %A Billot,Romain %A Walter,Michel %A , %A Lemey,Christophe %A Lenca,Philippe %+ IMT Atlantique, Lab-STICC, Université Bretagne Loire F-29238 Brest, Brest Medical University Hospital at Bohars, Adult Psychiatry, Route de Ploudalmezeau, Brest, 29820, France, 33 668204178, sofian.berrouiguet@gmail.com %K Suicide %K Text Messaging %K Electronic Health Records %K Cell Phone %K Secondary Prevention %K Tertiary Prevention %D 2018 %7 10.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Research indicates that maintaining contact either via letter or postcard with at-risk adults following discharge from care services after a suicide attempt (SA) can reduce reattempt risk. Pilot studies have demonstrated that interventions using mobile health (mHealth) technologies are feasible in a suicide prevention setting. Objective: The aim of this study was to report three cases of patients recruited in the Suicide Intervention Assisted by Messages (SIAM) study to describe how a mobile intervention may influence follow-up. Methods: SIAM is a 2-year, multicenter randomized controlled trial conducted by the Brest University Hospital, France. Participants in the intervention group receive SIAM text messages 48 hours after discharge, then at day 8 and day 15, and months 1, 2, 3, 4, 5, and 6. The study includes participants aged 18 years or older, who have attended a participating hospital for an SA, and have been discharged from the emergency department (ED) or a psychiatric unit (PU) for a stay of less than 7 days. Eligible participants are randomized between the SIAM intervention messages and a control group. In this study, we present three cases from the ongoing SIAM study that demonstrate the capability of a mobile-based brief contact intervention for triggering patient-initiated contact with a crisis support team at various time points throughout the mobile-based follow-up period. Results: Out of the 244 patients recruited in the SIAM randomized controlled trial, three cases were selected to illustrate the impact of mHealth on suicide risk management. Participants initiated contact with the emergency crisis support service after receiving text messages up to 6 months following discharge from the hospital. Contact was initiated immediately following receipt of a text message or up to 6 days following a message. Conclusions: This text message–based brief contact intervention has demonstrated the potential to reconnect suicidal individuals with crisis support services while they are experiencing suicidal ideation as well as in a period after receiving messages. As follow-up phone calls over an extended period of time may not be feasible, this intervention has the potential to offer simple technological support for individuals following discharge from the ED. Trial Registration: ClinicalTrials.gov NCT02106949; https://clinicaltrials.gov/ct2/show/NCT02106949 (Archived by WebCite at http://www.webcitation.org/6wMtAFL49) %M 29321126 %R 10.2196/mhealth.7780 %U http://mhealth.jmir.org/2018/1/e8/ %U https://doi.org/10.2196/mhealth.7780 %U http://www.ncbi.nlm.nih.gov/pubmed/29321126 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e3 %T Technology-Assisted Behavioral Intervention to Extend Sleep Duration: Development and Design of the Sleep Bunny Mobile App %A Baron,Kelly Glazer %A Duffecy,Jennifer %A Reid,Kathryn %A Begale,Mark %A Caccamo,Lauren %+ Rush University Medical Center, 1653 W Congress Parkway, Chicago, IL, 60612, United States, 1 3129420566, kgbaron@rush.edu %K sleep duration %K wearable %K obesity %K technology %K behavioral intervention %D 2018 %7 10.01.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite the high prevalence of short sleep duration (29.2% of adults sleep <6 hours on weekdays), there are no existing theory-based behavioral interventions to extend sleep duration. The popularity of wearable sleep trackers provides an opportunity to engage users in interventions. Objective: The objective of this study was to outline the theoretical foundation and iterative process of designing the “Sleep Bunny,” a technology-assisted sleep extension intervention including a mobile phone app, wearable sleep tracker, and brief telephone coaching. We conducted a two-step process in the development of this intervention, which was as follows: (1) user testing of the app and (2) a field trial that was completed by 2 participants with short sleep duration and a cardiovascular disease risk factor linked to short sleep duration (body mass index [BMI] >25). Methods: All participants had habitual sleep duration <6.5 hours verified by 7 days of actigraphy. A total of 6 individuals completed initial user testing in the development phase, and 2 participants completed field testing. Participants in the user testing and field testing responded to open-ended surveys about the design and utility of the app. Participants in the field testing completed the Epworth Sleepiness Scale and also wore an actigraph for a 1-week baseline period and during the 4-week intervention period. Results: The feedback suggests that users enjoyed the wearable sleep tracker and found the app visually pleasing, but they suggested improvements to the notification and reminder features of the app. The 2 participants who completed the field test demonstrated significant improvements in sleep duration and daytime sleepiness. Conclusions: Further testing is needed to determine effects of this intervention in populations at risk for the mental and physical consequences of sleep loss. %M 29321122 %R 10.2196/mental.8634 %U http://mental.jmir.org/2018/1/e3/ %U https://doi.org/10.2196/mental.8634 %U http://www.ncbi.nlm.nih.gov/pubmed/29321122 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e7 %T Effectiveness and Appropriateness of mHealth Interventions for Maternal and Child Health: Systematic Review %A Chen,Huan %A Chai,Yanling %A Dong,Le %A Niu,Wenyi %A Zhang,Puhong %+ The George Institute for Global Health, Peking University Health Science Center, Level 18, Horizon Tower B, No. 6 Zhichun Rd, Beijing,, China, 86 1082800577 ext 512, zpuhong@georgeinstitute.org.cn %K telemedicine %K maternal health %K child health %D 2018 %7 09.01.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The application of mobile health (mHealth) technology in reproductive, maternal, newborn, and child health (RMNCH) is increasing worldwide. However, best practice and the most effective mHealth interventions have not been reviewed systematically. Objective: A systematic review and meta-analysis of studies of mHealth interventions for RMNCH around the world were conducted to investigate their characteristics as well as the features and effectiveness of mHealth interventions. Methods: Studies of mHealth interventions for RMNCH between January 2011 and December 2016 were retrieved from 6 databases (PubMed, EMBASE, Global Health, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, and Wanfang Data Knowledge Service Medium). Comparable studies were included in a random-effects meta-analysis for both exclusive breastfeeding (EBF) and antenatal checks (ANC). Descriptive analyses were conducted for mHealth studies with a range of study designs. Results: Analyses of 245 studies were included, including 51 randomized controlled trials (RCTs). Results showed that there are increasing numbers of studies on mHealth interventions for RMNCH. Although 2 meta-analysis, one with 2 RCTs on EBF (odds ratio [OR] 2.03, 95% CI 1.34-3.08, I2=25%) and the other with 3 RCTs on ANC (OR 1.43, 95% CI 1.13-1.79, I2=78%), showed that mHealth interventions are more effective than usual care, almost half (43%) of RCTs showed negative or unclear results on mHealth interventions. Functions described in mHealth interventions were diverse, and the health stages covered were broad. However, single function or single stage appeared to be dominant among mHealth interventions compared with multiple functions or stages. Conclusions: More rigorous evaluations are needed to draw consistent conclusions and to analyze mHealth products with multiple functions, especially those popular in the app markets. %M 29317380 %R 10.2196/mhealth.8998 %U http://mhealth.jmir.org/2018/1/e7/ %U https://doi.org/10.2196/mhealth.8998 %U http://www.ncbi.nlm.nih.gov/pubmed/29317380 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e2 %T Importance of Active Participation in Obesity Management Through Mobile Health Care Programs: Substudy of a Randomized Controlled Trial %A Oh,Bumjo %A Yi,Ga-Hye %A Han,Min Kyu %A Kim,Jong Seung %A Lee,Chang Hee %A Cho,Belong %A Kang,Hee Cheol %+ Department of Family Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5 gil, Dongjak-gu, Seoul, 07061, Republic Of Korea, 82 2 870 2681, atenae68@nate.com %K physical activity %K mobile health %K metabolic syndrome %K self-report %K adherence %K concordance %D 2018 %7 03.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Due to the prevalence of the westernized dietary pattern and lack of physical activity, the numbers of overweight or obese individuals are increasing, resulting in a growing health burden because of various related diseases. A lifestyle modification approach has additional advantages compared with pharmacological therapies or bariatric surgery. In our randomized controlled trial conducted in 2015, we successfully used a ubiquitous health care (SmartCare) service for patients with metabolic syndrome to achieve a significant weight loss effect. Various useful apps have been developed for the SmartCare Service, which involves using a mobile phone to manage chronic diseases, minimizing time and space restrictions. Many studies have demonstrated weight loss effects using a SmartCare service, but limited data are available regarding the effect of active participation in relation to weight loss. Objective: We aimed to assess the weight loss effect achieved after using the SmartCare service in terms of adherence and participation. We divided the intervention group of the previous study according to participation level, and analyzed whether there was a significant difference in the outcome. Methods: We classified participants into 3 groups according to their adherence. Within the intervention group using the SmartCare service, the active group comprised those transmitting anthropometric measurement data using a mobile phone 3 or more times per week or who had a health consultation 5 or more times during a 24-week period. The passive group comprised those who did not adhere to these levels of engagement. The control group comprised those who did not use the SmartCare service. We compared changes in body weight, body mass index (BMI), body fat percentage, waist circumference, and lipid profile among the 3 groups. Results: We identified 422 participants and analyzed 405, excluding 17 who were missing necessary data for analysis. The active group consisted of 116 participants, compared with 80 in the passive group and 209 in the control group (without SmartCare service). There was a statistically significant difference in improvements to body weight, BMI, body fat percentage, and waist circumference among active participants compared with less active participants and the control group (P<.05). However, the lipid profile changes did not differ significantly between groups. Conclusions: The level of participation may be related to improved weight-related outcomes, which may improve health outcomes. To maximize the effectiveness of the SmartCare service, encouraging active participation is important. Trial Registration: Clinicaltrials.gov NCT01344811; https://clinicaltrials.gov/ct2/show/NCT01344811 (Archived by WebCite at http://www.webcitation.org/6alT2MmIB) %M 29298749 %R 10.2196/mhealth.8719 %U http://mhealth.jmir.org/2018/1/e2/ %U https://doi.org/10.2196/mhealth.8719 %U http://www.ncbi.nlm.nih.gov/pubmed/29298749 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e1 %T Physical Activity Assessment Using an Activity Tracker in Patients with Rheumatoid Arthritis and Axial Spondyloarthritis: Prospective Observational Study %A Jacquemin,Charlotte %A Servy,Hervé %A Molto,Anna %A Sellam,Jérémie %A Foltz,Violaine %A Gandjbakhch,Frédérique %A Hudry,Christophe %A Mitrovic,Stéphane %A Fautrel,Bruno %A Gossec,Laure %+ Rheumatology Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, 47-83 bd de l’hôpital, Paris, 75013, France, 33 688624123, jacquemin.charlotte@gmail.com %K fitness tracker %K exercise %K rheumatoid arthritis %K axial spondylarthritis %D 2018 %7 02.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity can be tracked using mobile devices and is recommended in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) management. The World Health Organization (WHO) recommends at least 150 min per week of moderate to vigorous physical activity (MVPA). Objective: The objectives of this study were to assess and compare physical activity and its patterns in patients with RA and axSpA using an activity tracker and to assess the feasibility of mobile devices in this population. Methods: This multicentric prospective observational study (ActConnect) included patients who had definite RA or axSpA, and a smartphone. Physical activity was assessed over 3 months using a mobile activity tracker, recording the number of steps per minute. The number of patients reaching the WHO recommendations was calculated. RA and axSpA were compared, using linear mixed models, for number of steps, proportion of morning steps, duration of total activity, and MVPA. Physical activity trajectories were identified using the K-means method, and factors related to the low activity trajectory were explored by logistic regression. Acceptability was assessed by the mean number of days the tracker was worn over the 3 months (ie, adherence), the percentage of wearing time, and by an acceptability questionnaire. Results: A total of 157 patients (83 RA and 74 axSpA) were analyzed; 36.3% (57/157) patients were males, and their mean age was 46 (standard deviation [SD] 12) years and mean disease duration was 11 (SD 9) years. RA and axSpA patients had similar physical activity levels of 16 (SD 11) and 15 (SD 12) min per day of MVPA (P=.80), respectively. Only 27.4% (43/157) patients reached the recommendations with a mean MVPA of 106 (SD 77) min per week. The following three trajectories were identified with constant activity: low (54.1% [85/157] of patients), moderate (42.7% [67/157] of patients), and high (3.2% [5/157] of patients) levels of MVPA. A higher body mass index was significantly related to less physical activity (odds ratio 1.12, 95% CI 1.11-1.14). The activity trackers were worn during a mean of 79 (SD 17) days over the 90 days follow-up. Overall, patients considered the use of the tracker very acceptable, with a mean score of 8 out 10. Conclusions: Patients with RA and axSpA performed insufficient physical activity with similar levels in both groups, despite the differences between the 2 diseases. Activity trackers allow longitudinal assessment of physical activity in these patients. The good adherence to this study and the good acceptability of wearing activity trackers confirmed the feasibility of the use of a mobile activity tracker in patients with rheumatic diseases. %M 29295810 %R 10.2196/mhealth.7948 %U http://mhealth.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/mhealth.7948 %U http://www.ncbi.nlm.nih.gov/pubmed/29295810 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 1 %P e1 %T Stage-Based Mobile Intervention for Substance Use Disorders in Primary Care: Development and Test of Acceptability %A Levesque,Deborah %A Umanzor,Cindy %A de Aguiar,Emma %+ Pro-Change Behavior Systems, Inc, 1174 Kingstown Road, Suite 101, South Kingstown, RI, 02879, United States, 1 401 360 2975, dlevesque@prochange.com %K pilot projects %K substance use disorders %K primary care %K behavioral medicine %K expert system %D 2018 %7 02.01.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: In 2016, 21 million Americans aged 12 years and older needed treatment for a substance use disorder (SUD). However, only 10% to 11% of individuals requiring SUD treatment received it. Given their access to patients, primary care providers are in a unique position to perform universal Screening, Brief Intervention, and Referral to Treatment (SBIRT) to identify individuals at risk, fill gaps in services, and make referrals to specialty treatment when indicated. Major barriers to SBIRT include limited time among providers and low motivation to change among many patients. Objective: The objective of this study was to develop and test the acceptability of a prototype of a mobile-delivered substance use risk intervention (SURI) for primary care patients and a clinical dashboard for providers that can address major barriers to SBIRT for risky drug use. The SURI delivers screening and feedback on SUD risk via mobile tools to patients at home or in the waiting room; for patients at risk, it also delivers a brief intervention based on the transtheoretical model of behavior change (TTM) to facilitate progress through the stages of change for quitting the most problematic drug and for seeking treatment if indicated. The prototype also delivers 30 days of stage-matched text messages and 4 Web-based activities addressing key topics. For providers, the clinical dashboard summarizes the patient’s SUD risk scores and stage of change data, and provides stage-matched scripts to guide in-person sessions. Methods: A total of 4 providers from 2 federally qualified health centers (FQHCs) were recruited for the pilot test, and they in turn recruited 5 patients with a known SUD. Furthermore, 3 providers delivered dashboard-guided SBIRT sessions and completed a brief acceptability survey. A total of 4 patients completed a Web-based SURI session and in-person SBIRT session, accessed other program components, and completed 3 acceptability surveys over 30 days. Questions in the surveys were adapted from the National Cancer Institute’s Education Materials Review Form. Response options ranged from 1=strongly disagree to 5=strongly agree. The criterion for establishing acceptability was an overall rating of 4.0 or higher across items. Results: For providers, the overall mean acceptability rating was 4.4 (standard deviation [SD] 0.4). Notably, all providers gave a rating of 5.0 for the item, “The program can give me helpful information about my patient.” For patients, the overall mean acceptability rating was 4.5 (SD 0.3) for the mobile- and provider-delivered SBIRT sessions and 4.0 (SD 0.4) for the text messages and Web-based activities. One highly rated item was “The program could help me make some positive changes” (4.5). Conclusions: The SURI program and clinical dashboard, developed to reduce barriers to SBIRT in primary care, were well received by providers and patients. %M 29295811 %R 10.2196/medinform.7355 %U http://medinform.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/medinform.7355 %U http://www.ncbi.nlm.nih.gov/pubmed/29295811 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e203 %T Insights From Google Play Store User Reviews for the Development of Weight Loss Apps: Mixed-Method Analysis %A Frie,Kerstin %A Hartmann-Boyce,Jamie %A Jebb,Susan %A Albury,Charlotte %A Nourse,Rebecca %A Aveyard,Paul %+ Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 1865289317, kerstin.frie@phc.ox.ac.uk %K weight loss %K mobile applications %K telemedicine %K consumer behavior %D 2017 %7 22.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Significant weight loss takes several months to achieve, and behavioral support can enhance weight loss success. Weight loss apps could provide ongoing support and deliver innovative interventions, but to do so, developers must ensure user satisfaction. Objective: The aim of this study was to conduct a review of Google Play Store apps to explore what users like and dislike about weight loss and weight-tracking apps and to examine qualitative feedback through analysis of user reviews. Methods: The Google Play Store was searched and screened for weight loss apps using the search terms weight loss and weight track*, resulting in 179 mobile apps. A content analysis was conducted based on the Oxford Food and Activity Behaviors taxonomy. Correlational analyses were used to assess the association between complexity of mobile health (mHealth) apps and popularity indicators. The sample was then screened for popular apps that primarily focus on weight-tracking. For the resulting subset of 15 weight-tracking apps, 569 user reviews were sampled from the Google Play Store. Framework and thematic analysis of user reviews was conducted to assess which features users valued and how design influenced users’ responses. Results: The complexity (number of components) of weight loss apps was significantly positively correlated with the rating (r=.25; P=.001), number of reviews (r=.28; P<.001), and number of downloads (r=.48; P<.001) of the app. In contrast, in the qualitative analysis of weight-tracking apps, users expressed preference for simplicity and ease of use. In addition, we found that positive reinforcement through detailed feedback fostered users’ motivation for further weight loss. Smooth functioning and reliable data storage emerged as critical prerequisites for long-term app usage. Conclusions: Users of weight-tracking apps valued simplicity, whereas users of comprehensive weight loss apps appreciated availability of more features, indicating that complexity demands are specific to different target populations. The provision of feedback on progress can motivate users to continue their weight loss attempts. Users value seamless functioning and reliable data storage. %M 29273575 %R 10.2196/mhealth.8791 %U http://mhealth.jmir.org/2017/12/e203/ %U https://doi.org/10.2196/mhealth.8791 %U http://www.ncbi.nlm.nih.gov/pubmed/29273575 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 12 %P e246 %T The Impact of mHealth Interventions on Breast Cancer Awareness and Screening: Systematic Review Protocol %A Tokosi,Temitope O %A Fortuin,Jill %A Douglas,Tania S %+ Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa, +27 21 4066571, jbfortuin@gmail.com %K mHealth %K breast cancer %K women %K awareness %K screening %D 2017 %7 21.12.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mobile health (mHealth) is the use of mobile communication technologies to promote health by supporting health care practices (eg, health data collection, delivery of health care information). mHealth technologies (such as mobile phones) can be used effectively by health care practitioners in the distribution of health information and have the potential to improve access to and quality of health care, as well as reduce the cost of health services. Current literature shows limited scientific evidence related to the benefits of mHealth interventions for breast cancer, which is the leading cause of cancer deaths in women worldwide and contributes a large proportion of all cancer deaths, especially in developing countries. Women, especially in low- and middle-income countries (LMICs), are faced with low odds of surviving breast cancer. This finding is likely due to multiple factors related to health systems: low priority of women’s health and cancer on national health agendas; lack of awareness that breast cancer can be effectively treated if detected early; and societal, cultural, and religious factors that are prevalent in LMICs. The proposed systematic review will examine the impact of mHealth interventions on breast cancer awareness and screening among women aged 18 years and older. Objective: The objectives of this study are to identify and describe the various mHealth intervention strategies that are used for breast cancer, and assess the impact of mHealth strategies on breast cancer awareness and screening. Methods: Literature from various databases such as MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane Central Register of Controlled Trials will be examined. Trial registers, reports, and unpublished theses will also be included. All mobile technologies such as cell phones, personal digital assistants, and tablets that have short message service, multimedia message service, video, and audio capabilities will be included. mHealth is the primary intervention. The search strategy will include keywords such as “mHealth,” “breast cancer,” “awareness,” and “screening,” among other medical subject heading terms. Articles published from January 1, 1964 to December 31, 2016 will be eligible for inclusion. Two authors will independently screen and select studies, extract data, and assess the risk of bias, with discrepancies resolved by dialogue involving a third author. We will assess statistical heterogeneity by examining the types of participants, interventions, study designs, and outcomes in each study, and pool studies judged to be statistically homogeneous. In the assessment of heterogeneity, a sensitivity analysis will be considered to explore statistical heterogeneity. Statistical heterogeneity will be investigated using the Chi-square test of homogeneity on Cochrane's Q statistic and quantified using the I-squared statistic. Results: The search strategy will be refined with the assistance of an information specialist from November 1, 2017 to January 31, 2018. Literature searches will take place from February 2018 to April 2018. Data extraction and capturing in Review Manager (RevMan, Version 5.3) will take place from May 1, 2018 to July 31, 2018. The final stages will include analyses and writing, which is anticipated occur between August 2018 and October 2018. Conclusions: The knowledge derived from this study will inform health care stakeholders, including researchers, policy makers, investors, health professionals, technologists, and engineers, on the impact of mHealth interventions on breast cancer screening and awareness. Trial Registration: Prospero registration number CRD42016050202 %M 29269341 %R 10.2196/resprot.8043 %U http://www.researchprotocols.org/2017/12/e246/ %U https://doi.org/10.2196/resprot.8043 %U http://www.ncbi.nlm.nih.gov/pubmed/29269341 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e197 %T Health App Use Among US Mobile Phone Users: Analysis of Trends by Chronic Disease Status %A Robbins,Rebecca %A Krebs,Paul %A Jagannathan,Ram %A Jean-Louis,Girardin %A Duncan,Dustin T %+ Department of Population Health, NYU School of Medicine, 227 East 30th Street, New York, NY, 10016, United States, 1 6465012634, rebecca.robbins@nyumc.org %K smartphone %K telemedicine %K chronic disease %D 2017 %7 19.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps hold promise for serving as a lifestyle intervention in public health to promote wellness and attenuate chronic conditions, yet little is known about how individuals with chronic illness use or perceive mobile apps. Objective: The objective of this study was to explore behaviors and perceptions about mobile phone–based apps for health among individuals with chronic conditions. Methods: Data were collected from a national cross-sectional survey of 1604 mobile phone users in the United States that assessed mHealth use, beliefs, and preferences. This study examined health app use, reason for download, and perceived efficacy by chronic condition. Results: Among participants, having between 1 and 5 apps was reported by 38.9% (314/807) of respondents without a condition and by 6.6% (24/364) of respondents with hypertension. Use of health apps was reported 2 times or more per day by 21.3% (172/807) of respondents without a condition, 2.7% (10/364) with hypertension, 13.1% (26/198) with obesity, 12.3% (20/163) with diabetes, 12.0% (32/267) with depression, and 16.6% (53/319) with high cholesterol. Results of the logistic regression did not indicate a significant difference in health app download between individuals with and without chronic conditions (P>.05). Compared with individuals with poor health, health app download was more likely among those with self-reported very good health (odds ratio [OR] 3.80, 95% CI 2.38-6.09, P<.001) and excellent health (OR 4.77, 95% CI 2.70-8.42, P<.001). Similarly, compared with individuals who report never or rarely engaging in physical activity, health app download was more likely among those who report exercise 1 day per week (OR 2.47, 95% CI 1.6-3.83, P<.001), 2 days per week (OR 4.77, 95% CI 3.27-6.94, P<.001), 3 to 4 days per week (OR 5.00, 95% CI 3.52-7.10, P<.001), and 5 to 7 days per week (OR 4.64, 95% CI 3.11-6.92, P<.001). All logistic regression results controlled for age, sex, and race or ethnicity. Conclusions: Results from this study suggest that individuals with poor self-reported health and low rates of physical activity, arguably those who stand to benefit most from health apps, were least likely to report download and use these health tools. %M 29258981 %R 10.2196/mhealth.7832 %U http://mhealth.jmir.org/2017/12/e197/ %U https://doi.org/10.2196/mhealth.7832 %U http://www.ncbi.nlm.nih.gov/pubmed/29258981 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e196 %T Factors Influencing Engagement and Behavioral Determinants of Infant Feeding in an mHealth Program: Qualitative Evaluation of the Growing Healthy Program %A Litterbach,Eloise-Kate %A Russell,Catherine G %A Taki,Sarah %A Denney-Wilson,Elizabeth %A Campbell,Karen J %A Laws,Rachel A %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 1 Gheringhap Street, Geelong, 3220, Australia, 61 92445574, r.laws@deakin.edu.au %K mobile health %K parents %K personal satisfaction %K behavior %K infant %K obesity %K prevention and control %D 2017 %7 18.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Infant feeding practices, including breastfeeding and optimal formula feeding practices, can play a role in the prevention of childhood obesity. The ubiquity of smartphone ownership among women of childbearing age provides important opportunities for the delivery of low-cost, broad reach parenting interventions delivered by mobile phone (mHealth or mobile health interventions). Little is known about how parents engage with mHealth programs targeting infant feeding and how such programs might influence infant feeding practices. Objective: The objectives of this study were to explore participant views on (1) factors influencing engagement with the Growing healthy program, an mHealth program targeting healthy infant feeding practices from birth to 9 months of age, and (2) the ways in which the program influenced behavioral determinants of capability, opportunity, and motivation for breastfeeding and optimal formula feeding behaviors. Methods: Semistructured, telephone interviews were conducted with a purposeful sample (n=24) of mothers participating in the Growing healthy program. Interviews explored participants’ views about engagement with the program and its features, and the ways the program influenced determinants of infant feeding behaviors related to breastfeeding and optimal formula feeding. The interview schedule was informed by the Capability, Opportunity, Motivation, and Behavior (COM-B) model. Results: Participants reported that engagement fluctuated depending on need and the degree to which the program was perceived to fit with existing parenting beliefs and values. Participants identified that the credibility of the program source, the user friendly interface, and tailoring of content and push notifications to baby’s age and key transition points promoted engagement, whereas technical glitches were reported to reduce engagement. Participants discussed that the program increased confidence in feeding decisions. For breastfeeding mothers, this was achieved by helping them to overcome doubts about breast milk supply, whereas mothers using formula reported feeling more confident to feed to hunger and satiety cues rather than encouraging infants to finish the bottle. Participants discussed that the program provided around-the-clock, readily accessible, nonjudgmental information and support on infant feeding and helped to reinforce information received by health professionals or encouraged them to seek additional help if needed. Participants reflected that their plans for feeding were typically made before joining the program, limiting the potential for the program to influence this aspect of motivation. Rather, the program provided emotional reassurance to continue with current feeding plans. Conclusions: Our findings suggest that engagement with the program was influenced by an interplay between the program features and needs of the user. Participants reported that the program enhanced confidence in feeding decisions by providing a 24/7 accessible, expert, nonjudgmental support for infant feeding that complemented health professional advice. It is likely that interventions need to commence during pregnancy to maximize the impact on breastfeeding intentions and plans. %M 29254908 %R 10.2196/mhealth.8515 %U http://mhealth.jmir.org/2017/12/e196/ %U https://doi.org/10.2196/mhealth.8515 %U http://www.ncbi.nlm.nih.gov/pubmed/29254908 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e192 %T A Smartphone App to Reduce Sugar-Sweetened Beverage Consumption Among Young Adults in Australian Remote Indigenous Communities: Design, Formative Evaluation and User-Testing %A Tonkin,Emma %A Jeffs,Lauren %A Wycherley,Thomas Philip %A Maher,Carol %A Smith,Ross %A Hart,Jonathon %A Cubillo,Beau %A Brimblecombe,Julie %+ Nutrition Program, Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, PO Box 41096, Casuarina, Northern Territory, 0811, Australia, 61 889468514, emma.tonkin@menzies.edu.au %K behavior %K diet %K health promotion %K Indigenous %K Telemedicine %K mobile applications %K public health %D 2017 %7 12.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The disproportionate burden of noncommunicable disease among Indigenous Australians living in remote Indigenous communities (RICs) is a complex and persistent problem. Smartphones are increasingly being used by young Indigenous adults and therefore represent a promising method to engage them in programs seeking to improve nutritional intake. Objective: This study aimed to consult RIC members to inform the content of a smartphone app that can be used to monitor and reduce sugar-sweetened beverage intake in RICs. Methods: The study was conducted in two phases. The formative phase involved a simulated grocery selection activity with think aloud (“think aloud shop”), a semistructured interview, a questionnaire outlining current smartphone and app use, and a paper prototyping activity. A preliminary end-user testing phase involved a think aloud prototype test and a semistructured interview regarding user satisfaction. Convenience sampling was used to recruit 20 18- to 35-year-old smartphone users for each phase from two RICs in the Northern Territory, Australia. Thematic analysis of transcribed audio recordings was used to identify determinants of food choice from the think aloud shop; themes related to the Theory of Planned Behavior (TPB) from the eating behaviors interview; and usability, comprehension, and satisfaction with the app from the preliminary end-user testing. Results: Smartphone use in RICs is currently different to that found in urban environments; in particular, extremely low use of Facebook, restricted variety of phone types, and limited Internet access. Findings regarding promoting app engagement indicate that utilizing an opt-in approach to social features such as leader boards and team challenges is essential. The inclusion of games was also shown to be important for satisfaction, as were the use of audio features, contextually embedded dissemination, and streamlined app design for comprehension in this target group. Conclusions: This research provides critical insights and concrete recommendations for the development of lifestyle improvement apps targeted toward disadvantaged young adults in nonurban settings, specifically RICs. It serves as a framework for future app development projects using a consultative user-centered design approach, supporting calls for the increased use of this strategy in app development. %M 29233803 %R 10.2196/mhealth.8651 %U http://mhealth.jmir.org/2017/12/e192/ %U https://doi.org/10.2196/mhealth.8651 %U http://www.ncbi.nlm.nih.gov/pubmed/29233803 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 12 %P e242 %T Mobile Health Technology (mDiab) for the Prevention of Type 2 Diabetes: Protocol for a Randomized Controlled Trial %A Muralidharan,Shruti %A Mohan,Viswanathan %A Anjana,Ranjit Mohan %A Jena,Sidhant %A Tandon,Nikhil %A Allender,Steven %A Ranjani,Harish %+ Translational Research Department, Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, No 4, Conron Smith Road,, Gopalapuram, Chennai, 600086, India, 91 4443968888, ranjani@mdrf.in %K prevention %K diabetes mellitus, type 2 %K mHealth %D 2017 %7 12.12.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: The prevalence of type 2 diabetes is increasing in epidemic proportions in low- and middle-income countries. There is an urgent need for novel methods to tackle the increasing incidence of diabetes. The ubiquity of mobile phone use and access to Internet makes mobile health (mHealth) technology a viable tool to prevent and manage diabetes. Objective: The objective of this randomized controlled trial is to implement and evaluate the feasibility, cost-effectiveness, and sustainability of a reality television–based lifestyle intervention program. This intervention program is delivered via a mobile phone app (mDiab) to approximately 1500 Android smartphone users who are adults at a high risk for type 2 diabetes from three cities in India, namely, Chennai, Bengaluru, and New Delhi. Methods: The mDiab intervention would be delivered via a mobile phone app along with weekly coach calls for 12 weeks. Each participant will go through a maintenance phase of 6 to 8 months post intervention. Overall, there would be 3 testing time points in the study: baseline, post intervention, and the end of follow-up. The app will enable individuals to track their weight, physical activity, and diet alongside weekly video lessons on type 2 diabetes prevention. Results: The study outcomes are weight loss (primary measure of effectiveness); improvement in cardiometabolic risk factors (ie, waist circumference, blood pressure, glucose, insulin, and lipids); and improvement in physical activity, quality of life, and dietary habits. Sustainability will be assessed through focus group discussions. Conclusions: If successful, mDiab can be used as a model for translational and implementation research in the use of mHealth technology for diabetes prevention and may be further expanded for the prevention of other noncommunicable diseases such as hypertension and cardiovascular diseases. Trial Registration: Clinical Trials Registry of India CTRI/2015/07/006011 http://ctri.nic.in/Clinicaltrials/pdf_generate.php? trialid=11841 (Archived by WebCite at http://www.webcitation.org/6urCS5kMB) %M 29233806 %R 10.2196/resprot.8644 %U http://www.researchprotocols.org/2017/12/e242/ %U https://doi.org/10.2196/resprot.8644 %U http://www.ncbi.nlm.nih.gov/pubmed/29233806 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e191 %T Predictors of Playing Augmented Reality Mobile Games While Walking Based on the Theory of Planned Behavior: Web-Based Survey %A Koh,Hyeseung Elizabeth %A Oh,Jeeyun %A Mackert,Michael %+ Stan Richards School of Advertising and Public Relations, Moody College of Communication, The University of Texas at Austin, 300 West Dean Keeton, A1200, BMC 4.338, Austin, TX, 78712, United States, 1 512 471 1101, kohhye@utexas.edu %K mobile phone %K pedestrians %K safety on the street %K psychological models %K predictive value of tests %K intention %K age factors %K attitude %K social norms %K self-efficacy %K habits %K immersion %K self-report %D 2017 %7 11.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There has been a sharp increase in the number of pedestrians injured while using a mobile phone, but little research has been conducted to explain how and why people use mobile devices while walking. Therefore, we conducted a survey study to explicate the motivations of mobile phone use while walking Objective: The purpose of this study was to identify the critical predictors of behavioral intention to play a popular mobile game, Pokemon Go, while walking, based on the theory of planned behavior (TPB). In addition to the three components of TPB, automaticity, immersion, and enjoyment were added to the model. This study is a theory-based investigation that explores the underlying mechanisms of mobile phone use while walking focusing on a mobile game behavior. Methods: Participants were recruited from a university (study 1; N=262) and Amazon Mechanical Turk (MTurk) (study 2; N=197) in the United States. Participants completed a Web-based questionnaire, which included measures of attitude, subjective norms, perceived behavioral control (PBC), automaticity, immersion, and enjoyment. Participants also answered questions regarding demographic items. Results: Hierarchical regression analyses were conducted to examine hypotheses. The model we tested explained about 41% (study 1) and 63% (study 2) of people’s intention to play Pokemon Go while walking. The following 3 TPB variables were significant predictors of intention to play Pokemon Go while walking in study 1 and study 2: attitude (P<.001), subjective norms (P<.001), and PBC (P=.007 in study 1; P<.001 in study 2). Automaticity tendency (P<.001), immersion (P=.02), and enjoyment (P=.04) were significant predictors in study 1, whereas enjoyment was the only significant predictor in study 2 (P=.01). Conclusions: Findings from this study demonstrated the utility of TPB in predicting a new behavioral domain—mobile use while walking. To sum up, younger users who are habitual, impulsive, and less immersed players are more likely to intend to play a mobile game while walking. %M 29229586 %R 10.2196/mhealth.8470 %U http://mhealth.jmir.org/2017/12/e191/ %U https://doi.org/10.2196/mhealth.8470 %U http://www.ncbi.nlm.nih.gov/pubmed/29229586 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 12 %P e410 %T Reporting of Telehealth-Delivered Dietary Intervention Trials in Chronic Disease: Systematic Review %A Warner,Molly M %A Kelly,Jaimon T %A Reidlinger,Dianne P %A Hoffmann,Tammy C %A Campbell,Katrina L %+ Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, 4226, Australia, 61 755953037, kcampbel@bond.edu.au %K telemedicine %K diet %K chronic disease %K behavior %K review %D 2017 %7 11.12.2017 %9 Review %J J Med Internet Res %G English %X Background: Telehealth-delivered dietary interventions are effective for chronic disease management and are an emerging area of clinical practice. However, to apply interventions from the research setting in clinical practice, health professionals need details of each intervention component. Objective: The aim of this study was to evaluate the completeness of intervention reporting in published dietary chronic disease management trials that used telehealth delivery methods. Methods: Eligible randomized controlled trial publications were identified through a systematic review. The completeness of reporting of experimental and comparison interventions was assessed by two independent assessors using the Template for Intervention Description and Replication (TIDieR) checklist that consists of 12 items including intervention rationale, materials used, procedures, providers, delivery mode, location, when and how much intervention delivered, intervention tailoring, intervention modifications, and fidelity. Where reporting was incomplete, further information was sought from additional published material and through email correspondence with trial authors. Results: Within the 37 eligible trials, there were 49 experimental interventions and 37 comparison interventions. One trial reported every TIDieR item for their experimental intervention. No publications reported every item for the comparison intervention. For the experimental interventions, the most commonly reported items were location (96%), mode of delivery (98%), and rationale for the essential intervention elements (96%). Least reported items for experimental interventions were modifications (2%) and intervention material descriptions (39%) and where to access them (20%). Of the 37 authors, 14 responded with further information, and 8 could not be contacted. Conclusions: Many details of the experimental and comparison interventions in telehealth-delivered dietary chronic disease management trials are incompletely reported. This prevents accurate interpretation of trial results and implementation of effective interventions in clinical practice. %M 29229588 %R 10.2196/jmir.8193 %U http://www.jmir.org/2017/12/e410/ %U https://doi.org/10.2196/jmir.8193 %U http://www.ncbi.nlm.nih.gov/pubmed/29229588 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e183 %T The Impact of a Mobile Diabetes Health Intervention on Diabetes Distress and Depression Among Adults: Secondary Analysis of a Cluster Randomized Controlled Trial %A Quinn,Charlene C %A Swasey,Krystal K %A Crabbe,J Christopher F %A Shardell,Michelle D %A Terrin,Michael L %A Barr,Erik A %A Gruber-Baldini,Ann L %+ Department of Epidemiology and Public Health, School of Medicine, University of Maryland, 660 W Redwood Street, Howard Hall Suite 200, Baltimore, MD, 21201, United States, 1 410 706 2406, cquinn@som.umaryland.edu %K diabetes distress %K mobile health %K depression %K diabetes %K Diabetes Distress Scale %K Patient Health Questionnaire %K women %K emotional well-being %D 2017 %7 07.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Diabetes is a complex, demanding disease that requires the constant attention of patients. The burden of self-management, including different medication regimens, routine self-care activities, and provider visits, has an impact on patients’ emotional well-being. Diabetes distress and depression are two important components of emotional well-being that may negatively affect diabetes outcomes. Objective: The aim was to determine the impact of the 1-year Mobile Diabetes Intervention Study cluster randomized clinical trial on emotional well-being measured by diabetes distress and depression among adults with type 2 diabetes (T2D). Methods: A total of 163 adults with not-well-managed T2D were enrolled from community primary care practices. Primary care practices were cluster randomized into either a usual care control group or intervention group. Intervention participants were given a mobile phone with coaching software including a Web portal to communicate with providers. A priori established secondary outcomes included distress measured by the Diabetes Distress Scale (DDS), with subscales measuring emotional burden, interpersonal distress, physician-related distress, and regimen-related distress, as well as depression measured by the Patient Health Questionnaire (PHQ-9). Linear mixed models were used to calculate the effect of the intervention on diabetes distress levels over time, both overall and separately by sex, and to determine if the intervention affected distress or depression. The impact of total DDS on changes in HbA1c was also studied. Results: There were no significant treatment group effects for DDS total (baseline: P=.07; differences over time: P=.38) or for depression (P=.06 over time). Significant declines in total DDS were observed over the 12-month intervention period (P=.01). Regimen-related distress significantly decreased for all study participants (P<.001), but no significant change over time was observed for emotional burden (P=.83), interpersonal distress (P=.64), or physician-related distress (P=.73). Women in both the usual care and intervention groups were more likely to have higher overall DDS, emotional burden, physician-related distress, and regimen-related distress, but not interpersonal distress. Women also reported higher baseline depression compared to men (P=.006). Overall, depression decreased over the treatment period (P=.007), but remained unaffected by group assignment (P=.06) or by sex (P=.97). Diabetes distress had no effect on the change in HbA1c (P=.91) over the treatment period. Conclusions: Although we found no definitive overall or sex-specific effect of the intervention on diabetes distress or depression, this study makes an important contribution to the understanding of mobile health interventions and the impact on emotional health. Our study verified previous work that although diabetes distress and depression are highly correlated, these measures are not evaluating the same construct. Design of future mobile technology provides an opportunity to personalize, contextualize, and intervene in the emotional well-being of persons with diabetes. Trial Registration: Clinicaltrials.gov NCT01107015; https://clinicaltrials.gov/ct2/show/NCT01107015 (Archived by WebCite at http://www.webcitation.org/6vVgRCLAF) %M 29217502 %R 10.2196/mhealth.8910 %U http://mhealth.jmir.org/2017/12/e183/ %U https://doi.org/10.2196/mhealth.8910 %U http://www.ncbi.nlm.nih.gov/pubmed/29217502 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e186 %T How Do Infant Feeding Apps in China Measure Up? A Content Quality Assessment %A Zhao,Jing %A Freeman,Becky %A Li,Mu %+ School of Public Health, University of Sydney, Edward Ford Building, A27, Camperdown, New South Wales, 2006, Australia, 61 406502156, jzha5010@uni.sydney.edu.au %K apps %K mobile phone %K Chinese %D 2017 %7 06.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Globally, with the popularization of mobile phones, the number of health-related mobile phone apps has skyrocketed to 259,000 in 2016. In the digital era, people are accessing health information through their fingertips. In China, there are several apps that claim to provide infant feeding and nutrition guidance. However, the quality of information in those apps has not been extensively assessed. Objective: We aimed to assess the quality of Chinese infant feeding apps using comprehensive quality assessment criteria and to explore Chinese mothers’ perceptions on apps’ quality and usability. Methods: We searched for free-to-download Chinese infant feeding apps in the iTunes and Android App Stores. We conducted a comprehensive assessment of the accountability, scientific basis, accuracy of information relevant to infant feeding, advertising policy, and functionality and carried out a preliminary screening of infant formula advertisements in the apps. In addition, we also conducted exploratory qualitative research through semistructured interviews with Chinese mothers in Shanghai to elicit their views about the quality of apps. Results: A total of 4925 apps were screened, and 26 apps that met the selection criteria were evaluated. All 26 apps were developed by commercial entities, and the majority of them were rated poorly. The highest total score was 62.2 (out of approximately 100) and the lowest was 16.7. In the four quality domains assessed, none of them fulfilled all the accountability criteria. Three out of 26 apps provided information covering the three practices from the World Health Organization’s infant feeding recommendations. Only one app described its advertising policy in its terms of usage. The most common app functionality was a built-in social forum (19/26). Provision of a website link was the least common functionality (2/26). A total of 20 out of 26 apps promoted infant formula banner advertisements on their homepages. In addition, 12 apps included both e-commerce stores and featured infant formula advertisements. In total, 21 mothers were interviewed face-to-face. Mothers highly valued immediate access to parenting information and multifunctionality provided by apps. However, concerns regarding incredible information and commercial activities in apps, as well as the desire for information and support offered by health care professionals were expressed. Conclusions: The findings provide valuable information on Chinese infant feeding apps. The results are concerning, particularly with the relative absence of scientific basis and credibility and the large number of commercial advertisements that are displayed. Apps do seem to be able to provide an opportunity for mothers to access health information and support; it is time for tighter controls on content and advertisements. Ongoing app research and development should focus on implementation of a standard framework, which would drive the development of high-quality apps to support healthy infant feeding through cooperation among academics, health professionals, app users, app developers, and government bodies. %M 29212627 %R 10.2196/mhealth.8764 %U http://mhealth.jmir.org/2017/12/e186/ %U https://doi.org/10.2196/mhealth.8764 %U http://www.ncbi.nlm.nih.gov/pubmed/29212627 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e182 %T App-Supported Promotion of Child Growth and Development by Community Health Workers in Kenya: Feasibility and Acceptability Study %A van Heerden,Alastair %A Sen,Debjeet %A Desmond,Chris %A Louw,Julia %A Richter,Linda %+ Human Sciences Research Council, Sweetwaters, Pietermaritzburg,, South Africa, 27 33 324 5015 ext 5015, avanheerden@hsrc.ac.za %K child health %K child development %K monitoring and evaluation %K parent support %K mHealth %D 2017 %7 05.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Early childhood is a critical phase of development. In low resource settings, monitoring this stage of development and providing appropriate and timely feedback is a challenge. Community-based service providers play a key role in promoting early childhood development in areas where government services are weak. These community-based service providers are also tasked with the collection of monitoring and evaluation data for donors and local government. Usually, collection of these data aims to provide accountability, learning, and correction leading to improvement. However, such data is rarely used beyond the accountability stage. Objective: The purpose of this study was to test the feasibility and acceptability of the Information for Action (IFA) mobile phone app. The IFA app was designed for use by community health volunteers (CHVs), and repackages routinely collected data about children into useful, offline decision support for caregivers and program managers. Methods: The IFA app was tested with a convenience sample of 10 CHVs in West Katweng’a, a sublocation of Rarieda subcounty in western Kenya. CHVs used the IFA app for 5 months as part of their regular home visits to households containing children aged 0 to 5 years, after which a qualitative assessment of the app was conducted. A total of 16 caregivers who received services from the CHVs were randomly selected to participate in 1 of 2 focus group discussions about their experience. Results: The app was reported to help facilitate interactive dialog between CHVs and caregivers, leading to improved quality of home visits. Caregivers described the app as shifting the relationship from feeling harassed by CHVs to experiencing genuine interest from CHVs. CHVs reported feasibility challenges primarily related to infrastructure. The limited battery life of mobile phones combined with the lack of readily available electricity made it difficult to keep the phones charged. CHVs reported initial anxiety as first-time mobile phones users, including concerns about using the IFA app. With time, increased levels of confidence were seen. Conclusions: Acceptability was high with both CHVs and caregivers, who reported an improvement in their client-provider relationship. A number of feasibility challenges were experienced. %M 29208588 %R 10.2196/mhealth.6911 %U http://mhealth.jmir.org/2017/12/e182/ %U https://doi.org/10.2196/mhealth.6911 %U http://www.ncbi.nlm.nih.gov/pubmed/29208588 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e185 %T Using mHealth Technology in a Self-Management Intervention to Promote Physical Activity Among Adults With Chronic Disabling Conditions: Randomized Controlled Trial %A Plow,Matthew %A Golding,Meghan %+ Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106 4904, United States, 1 216 368 8969, map208@case.edu %K disabled persons %K exercise %K self-care %K mobile applications %K motor activity %K behavior %K self-efficacy %K goals %K social support Introduction %D 2017 %7 01.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity is considered a comprehensive approach for managing limitations in physical function among adults with chronic disabling conditions. However, adults with chronic disabling conditions often face many barriers to engaging in physical activity. A strategy to promote physical activity among adults with chronic disabling conditions is to encourage the use of mobile health (mHealth) apps. Objective: The objective of this pilot study was to examine the potential benefits of using commercially available mHealth apps in a self-management intervention among 46 adults with musculoskeletal or neurological conditions. Methods: Participants were randomized to one of 3 intervention groups: (1) mHealth-based self-management intervention, (2) paper-based self-management intervention, and (3) contact-control intervention. Participants in all 3 groups met in person once and received 3 follow-up phone calls with a trained graduate assistant. Participants in the mHealth-based and paper-based groups received a computer tablet or a paper diary, respectively, to facilitate goal setting, self-monitoring, and action planning. Participants in the contact-control group received information on healthy behaviors without being taught skills to change behaviors. The following outcomes were measured at baseline and at the 7th week: physical activity (Physical Activity and Disability Survey–revised), psychosocial factors (self-efficacy, self-regulation, and social support), and physical function (Patient Report Outcomes Measurement Information System, 6-min walk test, 1-min chair stands, and 1-min arm curls). Results: Repeated-measures multivariate analysis of variance (MANOVA) indicated significant differences between groups in physical activity levels (Wilks λ=0.71, F6,76=2.34, P=.04). Both the mHealth-based and paper-based groups had large effect size increases in planned exercise and leisure-time physical activity compared with the contact-control group (Cohen d=1.20 and d=0.82, respectively). Repeated-measures MANOVA indicated nonsignificant differences between groups in psychosocial factors (Wilks λ=0.85, F6,76=1.10, P=.37). However, both the mHealth-based and paper-based groups had moderate effect size improvements in self-efficacy (d=0.48 and d=0.75, respectively) and self-regulation (d=0.59 and d=0.43, respectively) compared with the contact-control group. Repeated-measures MANOVA indicated nonsignificant differences between groups in physical function (Wilks λ=0.94, F8,66=0.27, P=.97). There were small and nonsignificant changes between the mHealth-based and paper-based groups with regard to most outcomes. However, the mHealth-based group had moderate effect size increases (d=0.47) in planned exercise and leisure-time physical activity compared with the paper-based group. Conclusions: We found that using commercially available mHealth apps in a self-management intervention shows promise in promoting physical activity among adults with musculoskeletal and neurological conditions. Further research is needed to identify the best ways of using commercially available mobile apps in self-management interventions. Trial Registration: Clinicaltrials.gov NCT02833311; https://clinicaltrials.gov/ct2/show/NCT02833311 (Archived by WebCite at http://www.webcitation.org/6vDVSAw1w) %M 29196279 %R 10.2196/mhealth.6394 %U http://mhealth.jmir.org/2017/12/e185/ %U https://doi.org/10.2196/mhealth.6394 %U http://www.ncbi.nlm.nih.gov/pubmed/29196279 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 11 %P e397 %T Implementation Intention and Reminder Effects on Behavior Change in a Mobile Health System: A Predictive Cognitive Model %A Pirolli,Peter %A Mohan,Shiwali %A Venkatakrishnan,Anusha %A Nelson,Les %A Silva,Michael %A Springer,Aaron %+ Institute for Human and Machine Cognition, 40 S. Alcanaz St, Pensacola, FL, 32502, United States, 1 850 202 4462, ppirolli@ihmc.us %K mobile applications %K models, theoretical %K habits %D 2017 %7 30.11.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Implementation intentions are mental representations of simple plans to translate goal intentions into behavior under specific conditions. Studies show implementation intentions can produce moderate to large improvements in behavioral goal achievement. Human associative memory mechanisms have been implicated in the processes by which implementation intentions produce effects. On the basis of the adaptive control of thought-rational (ACT-R) theory of cognition, we hypothesized that the strength of implementation intention effect could be manipulated in predictable ways using reminders delivered by a mobile health (mHealth) app. Objective: The aim of this experiment was to manipulate the effects of implementation intentions on daily behavioral goal success in ways predicted by the ACT-R theory concerning mHealth reminder scheduling. Methods: An incomplete factorial design was used in this mHealth study. All participants were asked to choose a healthy behavior goal associated with eat slowly, walking, or eating more vegetables and were asked to set implementation intentions. N=64 adult participants were in the study for 28 days. Participants were stratified by self-efficacy and assigned to one of two reminder conditions: reminders-presented versus reminders-absent. Self-efficacy and reminder conditions were crossed. Nested within the reminders-presented condition was a crossing of frequency of reminders sent (high, low) by distribution of reminders sent (distributed, massed). Participants in the low frequency condition got 7 reminders over 28 days; those in the high frequency condition were sent 14. Participants in the distributed conditions were sent reminders at uniform intervals. Participants in the massed distribution conditions were sent reminders in clusters. Results: There was a significant overall effect of reminders on achieving a daily behavioral goal (coefficient=2.018, standard error [SE]=0.572, odds ratio [OR]=7.52, 95% CI 0.9037-3.2594, P<.001). As predicted by ACT-R, using default theoretical parameters, there was an interaction of reminder frequency by distribution on daily goal success (coefficient=0.7994, SE=0.2215, OR=2.2242, 95% CI 0.3656-1.2341, P<.001). The total number of times a reminder was acknowledged as received by a participant had a marginal effect on daily goal success (coefficient=0.0694, SE=0.0410, OR=1.0717, 95% CI −0.01116 to 0.1505, P=.09), and the time since acknowledging receipt of a reminder was highly significant (coefficient=−0.0490, SE=0.0104, OR=0.9522, 95% CI −0.0700 to −0.2852], P<.001). A dual system ACT-R mathematical model was fit to individuals’ daily goal successes and reminder acknowledgments: a goal-striving system dependent on declarative memory plus a habit-forming system that acquires automatic procedures for performance of behavioral goals. Conclusions: Computational cognitive theory such as ACT-R can be used to make precise quantitative predictions concerning daily health behavior goal success in response to implementation intentions and the dosing schedules of reminders. %M 29191800 %R 10.2196/jmir.8217 %U http://www.jmir.org/2017/11/e397/ %U https://doi.org/10.2196/jmir.8217 %U http://www.ncbi.nlm.nih.gov/pubmed/29191800 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 11 %P e399 %T Assessing the Efficacy of Mobile Health Apps Using the Basic Principles of Cognitive Behavioral Therapy: Systematic Review %A Rathbone,Amy Leigh %A Clarry,Laura %A Prescott,Julie %+ Department of Education and Psychology, University of Bolton, Deane Road, Bolton, BL3 5AB, United Kingdom, 44 1204903676, j.prescott@bolton.ac.uk %K cognitive therapy %K behavior %K mHealth %K mobile %K phone %K health %K treatment efficacy %K intervention study %K randomized controlled trial %K review %K systematic %D 2017 %7 28.11.2017 %9 Review %J J Med Internet Res %G English %X Background: Cognitive behavioral therapy (CBT) in its basic principle has developed itself as a stand-alone, substantial method of therapy. With effective application in therapy for a range of mental health issues, the spread of CBT methods to Web-based therapy sources is evident. The development of mobile phone apps using CBT principles is increasing within the research area. Despite the move to Web-based methods of therapy, it is argued that these methods lack the same efficacy of face-to-face therapy sessions. Objective: The aim of this review was to assess extent research findings with regard to the effectiveness of CBT-related mobile health (mHealth) apps. By assessing only studies employing a randomized controlled trial design, the review aimed to determine app efficacy within the highly regarded method of investigation. Methods: A comprehensive literature search was conducted across several databases. Search results were filtered, and results were subject to strict inclusion and exclusion criteria because of the nature of the review. Where possible, analysis of effect size was calculated and results reported. Results: A total of 8 studies investigating the effectiveness of mHealth CBT-related apps across a range of mental health issues were reviewed. Three studies used the app against a control group, and 5 studies used the app intervention against another form of treatment or intervention. A range of effect sizes were seen across all included studies (d=−0.13 to 1.83; 0.03-1.44), with the largest effects often being seen when comparing the data from pre- to posttest for the app engaged group. Conclusions: The studies reviewed support the use of mHealth apps containing CBT principles for a range of mental health issues. However, the effectiveness over longer time periods should be assessed. Researchers and professionals should seek to collaborate effectively when creating new apps to enhance their effectiveness as a treatment for the general public. %M 29187342 %R 10.2196/jmir.8598 %U http://www.jmir.org/2017/11/e399/ %U https://doi.org/10.2196/jmir.8598 %U http://www.ncbi.nlm.nih.gov/pubmed/29187342 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 11 %P e384 %T Brain Activation in Response to Personalized Behavioral and Physiological Feedback From Self-Monitoring Technology: Pilot Study %A Whelan,Maxine E %A Morgan,Paul S %A Sherar,Lauren B %A Kingsnorth,Andrew P %A Magistro,Daniele %A Esliger,Dale W %+ Loughborough University, School of Sport, Exercise and Health Sciences, Epinal Way, Loughborough,, United Kingdom, 44 1509226302, m.e.whelan@lboro.ac.uk %K functional magnetic resonance imaging %K neuroimaging %K physical activity %K sedentary behavior %K interstitial glucose %D 2017 %7 08.11.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The recent surge in commercially available wearable technology has allowed real-time self-monitoring of behavior (eg, physical activity) and physiology (eg, glucose levels). However, there is limited neuroimaging work (ie, functional magnetic resonance imaging [fMRI]) to identify how people’s brains respond to receiving this personalized health feedback and how this impacts subsequent behavior. Objective: Identify regions of the brain activated and examine associations between activation and behavior. Methods: This was a pilot study to assess physical activity, sedentary time, and glucose levels over 14 days in 33 adults (aged 30 to 60 years). Extracted accelerometry, inclinometry, and interstitial glucose data informed the construction of personalized feedback messages (eg, average number of steps per day). These messages were subsequently presented visually to participants during fMRI. Participant physical activity levels and sedentary time were assessed again for 8 days following exposure to this personalized feedback. Results: Independent tests identified significant activations within the prefrontal cortex in response to glucose feedback compared with behavioral feedback (P<.001). Reductions in mean sedentary time (589.0 vs 560.0 minutes per day, P=.014) were observed. Activation in the subgyral area had a moderate correlation with minutes of moderate-to-vigorous physical activity (r=0.392, P=.043). Conclusion: Presenting personalized glucose feedback resulted in significantly more brain activation when compared with behavior. Participants reduced time spent sedentary at follow-up. Research on deploying behavioral and physiological feedback warrants further investigation. %M 29117928 %R 10.2196/jmir.8890 %U http://www.jmir.org/2017/11/e384/ %U https://doi.org/10.2196/jmir.8890 %U http://www.ncbi.nlm.nih.gov/pubmed/29117928 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 11 %P e154 %T Mobile Phone Multilevel and Multimedia Messaging Intervention for Breast Cancer Screening: Pilot Randomized Controlled Trial %A Lee,Hee %A Ghebre,Rahel %A Le,Chap %A Jang,Yoo Jeong %A Sharratt,Monica %A Yee,Douglas %+ School of Social Work, College of Education and Human Development, University of Minnesota, Twin Cities, 1404 Gortner Ave., St Paul, MN, 55108, United States, 1 6126243689, hylee@umn.edu %K breast cancer %K mammogram %K mobile health %K mHealth %K mobile app intervention %K multimedia text message %K tailored message %K Korean immigrant women %K breast cancer disparity %D 2017 %7 07.11.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the increasing breast cancer incidence and mortality rates, Korean American immigrant women have one of the lowest rates of breast cancer screening across racial groups in the United States. Mobile health (mHealth), defined as the delivery of health care information or services through mobile communication devices, has been utilized to successfully improve a variety of health outcomes. Objective: This study adapted the principles of mHealth to advance breast cancer prevention efforts among Korean American immigrant women, an underserved community. Methods: Using a randomized controlled trial design, 120 Korean American women aged 40 to 77 years were recruited and randomly assigned to either the mMammogram intervention group (n=60) to receive culturally and personally tailored multilevel and multimedia messages through a mobile phone app along with health navigator services or the usual care control group (n=60) to receive a printed brochure. Outcome measures included knowledge, attitudes, and beliefs about breast cancer screening, readiness for mammography, and mammogram receipt. The feasibility and acceptability of the mMammogram intervention was also assessed. Results: The intervention group showed significantly greater change on scores of knowledge of breast cancer and screening guidelines (P=.01). The intervention group also showed significantly greater readiness for mammography use after the intervention compared with the control group. A significantly higher proportion of women who received the mMammogram intervention (75%, 45/60) completed mammograms by the 6-month follow-up compared with the control group (30%, 18/60; P<.001). In addition, the intervention group rated satisfaction with the intervention (P=.003), effectiveness of the intervention (P<.001), and increase of knowledge on breast cancer and screenings (P=.001) significantly higher than the control group. Conclusions: A mobile phone app–based intervention combined with health navigator service was a feasible, acceptable, and effective intervention mechanism to promote breast cancer screening in Korean American immigrant women. A flexible, easily tailored approach that relies on recent technological advancements can reach underserved and hard-to-recruit populations that bear disproportionate cancer burdens. Trial Registration: Clinicaltrials.gov NCT01972048; https://clinicaltrials.gov/show/NCT01972048 (Archived by WebCite at https://clinicaltrials.gov/archive/NCT01972048/2013_10_29) %M 29113961 %R 10.2196/mhealth.7091 %U http://mhealth.jmir.org/2017/11/e154/ %U https://doi.org/10.2196/mhealth.7091 %U http://www.ncbi.nlm.nih.gov/pubmed/29113961 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 11 %P e378 %T Development and Validation of a Taxonomy for Characterizing Measurements in Health Self-Quantification %A Almalki,Manal %A Gray,Kathleen %A Martin-Sanchez,Fernando %+ Faculty of Public Health and Tropical Medicine, Health Informatics Department, Jazan University, Level 1, Prince Ahmed Bin Abdulaziz Street, Jazan, 82726, Saudi Arabia, 966 173210584 ext 102, manal.almalki1@gmail.com %K health %K self-management %K self-experimentation %K wearables %K quantified self %K taxonomy %K classification %D 2017 %7 03.11.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of wearable tools for health self-quantification (SQ) introduces new ways of thinking about one’s body and about how to achieve desired health outcomes. Measurements from individuals, such as heart rate, respiratory volume, skin temperature, sleep, mood, blood pressure, food consumed, and quality of surrounding air can be acquired, quantified, and aggregated in a holistic way that has never been possible before. However, health SQ still lacks a formal common language or taxonomy for describing these kinds of measurements. Establishing such taxonomy is important because it would enable systematic investigations that are needed to advance in the use of wearable tools in health self-care. For a start, a taxonomy would help to improve the accuracy of database searching when doing systematic reviews and meta-analyses in this field. Overall, more systematic research would contribute to build evidence of sufficient quality to determine whether and how health SQ is a worthwhile health care paradigm. Objective: The aim of this study was to investigate a sample of SQ tools and services to build and test a taxonomy of measurements in health SQ, titled: the classification of data and activity in self-quantification systems (CDA-SQS). Methods: Eight health SQ tools and services were selected to be examined: Zeo Sleep Manager, Fitbit Ultra, Fitlinxx Actipressure, MoodPanda, iBGStar, Sensaris Senspod, 23andMe, and uBiome. An open coding analytical approach was used to find all the themes related to the research aim. Results: This study distinguished three types of measurements in health SQ: body structures and functions, body actions and activities, and around the body. Conclusions: The CDA-SQS classification should be applicable to align health SQ measurement data from people with many different health objectives, health states, and health conditions. CDA-SQS is a critical contribution to a much more consistent way of studying health SQ. %M 29101092 %R 10.2196/jmir.6903 %U http://www.jmir.org/2017/11/e378/ %U https://doi.org/10.2196/jmir.6903 %U http://www.ncbi.nlm.nih.gov/pubmed/29101092 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 11 %P e373 %T Smartphone Cognitive Behavioral Therapy as an Adjunct to Pharmacotherapy for Refractory Depression: Randomized Controlled Trial %A Mantani,Akio %A Kato,Tadashi %A Furukawa,Toshi A %A Horikoshi,Masaru %A Imai,Hissei %A Hiroe,Takahiro %A Chino,Bun %A Funayama,Tadashi %A Yonemoto,Naohiro %A Zhou,Qi %A Kawanishi,Nao %+ Department of Health Promotion and Human Behavior, School of Public Health, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 6068501, Japan, 81 757538941, furukawa@kuhp.kyoto-u.ac.jp %K major depressive disorder %K pharmacotherapy-resistant depression %K mobile phone app %K cognitive behavioral therapy %K eHealth %D 2017 %7 03.11.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: In the treatment of major depression, antidepressants are effective but not curative. Cognitive behavioral therapy (CBT) is also effective, alone or in combination with pharmacotherapy, but accessibility is a problem. Objective: The aim is to evaluate the effectiveness of a smartphone CBT app as adjunctive therapy among patients with antidepressant-resistant major depression. Methods: A multisite, assessor-masked, parallel-group randomized controlled trial was conducted in 20 psychiatric clinics and hospitals in Japan. Participants were eligible if they had a primary diagnosis of major depression and were antidepressant-refractory after taking one or more antidepressants at an adequate dosage for four or more weeks. After a 1-week run-in in which participants started the medication switch and had access to the welcome session of the app, patients were randomized to medication switch alone or to medication switch plus smartphone CBT app via the centralized Web system. The smartphone app, called Kokoro-app (“kokoro” means “mind” in Japanese), included sessions on self-monitoring, behavioral activation, and cognitive restructuring presented by cartoon characters. The primary outcome was depression severity as assessed by masked telephone assessors with the Patient Health Questionnaire-9 (PHQ-9) at week 9. The secondary outcomes included the Beck Depression Inventory-II (BDI-II) and Frequency, Intensity, and Burden of Side Effects Ratings (FIBSER). Results: In the total sample (N=164), 81 participants were allocated to the smartphone CBT in addition to medication change and 83 to medication change alone. In the former group, all but one participant (80/81, 99%) completed at least half, and 71 (88%) completed at least six of eight sessions. In the intention-to-treat analysis, patients allocated the CBT app scored 2.48 points (95% CI 1.23-3.72, P<.001; standardized mean difference 0.40) lower on PHQ-9 than the control at week 9. The former group also scored 4.1 points (95% CI 1.5-6.6, P=.002) lower on BDI-II and 0.76 points (95% CI –0.05 to 1.58, P=.07) lower on FIBSER. In the per-protocol sample (comfortable with the smartphone app, still symptomatic, and adherent to medication with mild or less side effects after run-in), the intervention group (n=60) scored 1.72 points (95% CI 0.25-3.18, P=.02) lower on PHQ-9, 3.2 points (95% CI –0.01 to 6.3, P=.05) lower on BDI-II, and 0.75 points (95% CI 0.03-1.47, P=.04) lower on FIBSER than the control (n=57). The treatment benefits were maintained up to week 17. Conclusions: This is the first study to demonstrate the effectiveness of a smartphone CBT in the treatment of clinically diagnosed depression. Given the merits of the mobile mental health intervention, including accessibility, affordability, quality control, and effectiveness, it is clinically worthwhile to consider adjunctive use of a smartphone CBT app when treating patients with antidepressant-resistant depression. Research into its effectiveness in wider clinical contexts is warranted. Trial Registration: Japanese Clinical Trials Registry UMIN CTR 000013693; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ ctr_view.cgi?recptno=R000015984 (Archived by WebCite at http://www.webcitation.org/6u6pxVwik) %M 29101095 %R 10.2196/jmir.8602 %U http://www.jmir.org/2017/11/e373/ %U https://doi.org/10.2196/jmir.8602 %U http://www.ncbi.nlm.nih.gov/pubmed/29101095 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 11 %P e219 %T Recruiting Women to a Mobile Health Smoking Cessation Trial: Low- and No-Cost Strategies %A Abbate,Kristopher J %A Hingle,Melanie D %A Armin,Julie %A Giacobbi Jr,Peter %A Gordon,Judith S %+ College of Medicine, University of Arizona, 1450 N. Cherry, Tucson, AZ, 85719, United States, 1 5206261152, kjabbate@email.arizona.edu %K smoking cessation %K mobile applications %K social media %K women %K mHealth %D 2017 %7 03.11.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Successful recruitment of participants to mobile health (mHealth) studies presents unique challenges over in-person studies. It is important to identify recruitment strategies that maximize the limited recruitment resources available to researchers. Objective: The objective of this study was to describe a case study of a unique recruitment process used in a recent mHealth software app designed to increase smoking cessation among weight-concerned women smokers. The See Me Smoke-Free app was deployed to the Google Play Store (Alphabet, Inc., Google, LLC), where potential participants could download the app and enroll in the study. Users were invited in-app to participate in the study, with no in-person contact. The recruitment activities relied primarily on earned (free) and social media. Methods: To determine the relationship between recruitment activities and participant enrollment, the researchers explored trends in earned and social media activity in relation to app installations, examined social media messaging in relation to reach or impressions, and described app users’ self-reported referral source. The researchers collected and descriptively analyzed data regarding recruitment activities, social media audience, and app use during the 18-week recruitment period (March 30, 2015-July 31, 2015). Data were collected and aggregated from internal staff activity tracking documents and from Web-based data analytics software such as SumAll, Facebook Insights (Facebook, Inc.), and Google Analytics (Alphabet, Inc., Google, LLC). Results: Media coverage was documented across 75 publications and radio or television broadcasts, 35 of which were local, 39 national, and 1 international. The research team made 30 Facebook posts and 49 tweets, yielding 1821 reaches and 6336 impressions, respectively. From March 30, 2015 to July 31, 2015, 289 unique users downloaded the app, and 151 participants enrolled in the study. Conclusions: Research identifying effective online recruitment methods for mHealth studies remains minimal, and findings are inconsistent. We demonstrated how earned media can be leveraged to recruit women to an mHealth smoking cessation trial at low cost. Using earned media and leveraging social media allowed us to enroll 3 times the number of participants that we anticipated enrolling. The cost of earned media resides in the staff time required to manage it, particularly the regular interaction with social media. We recommend communication and cooperation with university public affairs and social media offices, as well as affiliate programs in journalism and communications, so that earned media can be used as a recruitment strategy for mHealth behavior change interventions. However, press releases are not always picked up by the media and should not be considered as a stand-alone method of recruitment. Careful consideration of an intervention’s broad appeal and how that translates into potential media interest is needed when including earned media as part of a comprehensive recruitment plan for mHealth research. %M 29101091 %R 10.2196/resprot.7356 %U http://www.researchprotocols.org/2017/11/e219/ %U https://doi.org/10.2196/resprot.7356 %U http://www.ncbi.nlm.nih.gov/pubmed/29101091 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 11 %P e213 %T An App to Help Young People Self-Manage When Feeling Overwhelmed (ReZone): Protocol of a Cluster Randomized Controlled Trial %A Edbrooke-Childs,Julian %A Smith,Jaime %A Rees,Jessica %A Edridge,Chloe %A Calderon,Ana %A Saunders,Felicity %A Wolpert,Miranda %A Deighton,Jessica %+ Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, 12 Maresfield Gardens, London,, United Kingdom, 44 2074432275, julian.edbrooke-childs@annafreud.org %K cluster trial %K behavioral difficulties %K schools %D 2017 %7 03.11.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: The association between behavioral difficulties and academic attainment is well established. Recent policy advising schools on managing behavior has promoted the early identification of behavioral difficulties. There is also increasing research into mHealth interventions to provide support for emotional and behavioral difficulties for young people. Objective: The primary aim of the proposed research is to examine the effectiveness of an mHealth intervention, ReZone, in reducing emotional and behavioral difficulties in young people. Methods: The protocol is a cluster trial of 12 classes with N=120 students with classes randomized to ReZone or management as usual. Multilevel modeling will be used to compare ReZone versus management as usual accounting for classroom-level variation. Results: Baseline data collection started in February 2017 and ended in April 2017. Follow-up data collection started in April 2017 and ended in June 2017. Conclusions: The proposed research will provide evidence as to whether ReZone is effective at helping young people to self-manage when feeling overwhelmed. Trial Registration: ISRCTN 13425994; http://www.isrctn.com/ISRCTN13425994 (Archived by WebCite at http://www.webcitation.org/6tePwwiHk) %M 29101094 %R 10.2196/resprot.7019 %U http://www.researchprotocols.org/2017/11/e213/ %U https://doi.org/10.2196/resprot.7019 %U http://www.ncbi.nlm.nih.gov/pubmed/29101094 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e163 %T A New Tool for Nutrition App Quality Evaluation (AQEL): Development, Validation, and Reliability Testing %A DiFilippo,Kristen Nicole %A Huang,Wenhao %A Chapman-Novakofski,Karen M %+ Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, 238 Bevier Hall, 905 S. Goodwin Ave, Urbana, IL, 61801, United States, 1 217 552 5777, kdifilip@illinois.edu %K evaluation %K mobile apps %K dietitians %K health education %K diet, food, and nutrition %D 2017 %7 27.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The extensive availability and increasing use of mobile apps for nutrition-based health interventions makes evaluation of the quality of these apps crucial for integration of apps into nutritional counseling. Objective: The goal of this research was the development, validation, and reliability testing of the app quality evaluation (AQEL) tool, an instrument for evaluating apps’ educational quality and technical functionality. Methods: Items for evaluating app quality were adapted from website evaluations, with additional items added to evaluate the specific characteristics of apps, resulting in 79 initial items. Expert panels of nutrition and technology professionals and app users reviewed items for face and content validation. After recommended revisions, nutrition experts completed a second AQEL review to ensure clarity. On the basis of 150 sets of responses using the revised AQEL, principal component analysis was completed, reducing AQEL into 5 factors that underwent reliability testing, including internal consistency, split-half reliability, test-retest reliability, and interrater reliability (IRR). Two additional modifiable constructs for evaluating apps based on the age and needs of the target audience as selected by the evaluator were also tested for construct reliability. IRR testing using intraclass correlations (ICC) with all 7 constructs was conducted, with 15 dietitians evaluating one app. Results: Development and validation resulted in the 51-item AQEL. These were reduced to 25 items in 5 factors after principal component analysis, plus 9 modifiable items in two constructs that were not included in principal component analysis. Internal consistency and split-half reliability of the following constructs derived from principal components analysis was good (Cronbach alpha >.80, Spearman-Brown coefficient >.80): behavior change potential, support of knowledge acquisition, app function, and skill development. App purpose split half-reliability was .65. Test-retest reliability showed no significant change over time (P>.05) for all but skill development (P=.001). Construct reliability was good for items assessing age appropriateness of apps for children, teens, and a general audience. In addition, construct reliability was acceptable for assessing app appropriateness for various target audiences (Cronbach alpha >.70). For the 5 main factors, ICC (1,k) was >.80, with a P value of <.05. When 15 nutrition professionals evaluated one app, ICC (2,15) was .98, with a P value of <.001 for all 7 constructs when the modifiable items were specified for adults seeking weight loss support. Conclusions: Our preliminary effort shows that AQEL is a valid, reliable instrument for evaluating nutrition apps’ qualities for clinical interventions by nutrition clinicians, educators, and researchers. Further efforts in validating AQEL in various contexts are needed. %M 29079554 %R 10.2196/mhealth.7441 %U http://mhealth.jmir.org/2017/10/e163/ %U https://doi.org/10.2196/mhealth.7441 %U http://www.ncbi.nlm.nih.gov/pubmed/29079554 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e357 %T Social Media–Promoted Weight Loss Among an Occupational Population: Cohort Study Using a WeChat Mobile Phone App-Based Campaign %A He,Chao %A Wu,Shiyan %A Zhao,Yingying %A Li,Zheng %A Zhang,Yanyan %A Le,Jia %A Wang,Lei %A Wan,Siyang %A Li,Changqing %A Li,Yindong %A Sun,Xinying %+ Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, No.38, Xueyuan Road Haidian District Beijing 100191, P.R.China, Beijing, 100191, China, 86 13691212050, xysun@bjmu.edu.cn %K WeChat %K weight loss %K social media %K health %K intervention %D 2017 %7 23.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Being overweight and obese are major risk factors for noncommunicable diseases such as cardiovascular diseases. The prevalence of overweight and obesity is high throughout the world and these issues are very serious in the Shunyi District in China. As mobile technologies have rapidly developed, mobile apps such as WeChat are well accepted and have the potential to improve health behaviors. Objective: This study aims to evaluate the effectiveness of a mobile app (WeChat) as an intervention on weight loss behavior. Methods: This study was conducted among an occupational population from August 2015 to February 2016 in the Shunyi District of Beijing. Before the intervention, the Shunyi District Government released an official document for weight loss to all 134 government agencies and enterprises in Shunyi District. Participants willing to use our official WeChat account were enrolled in a WeChat group and received 6 months of interventions for weight loss; those who were not willing to use the account were in a control group given routine publicity on weight loss. Results: In total, 15,310 occupational participants including 3467 participants (22.65%) in the control group and 11,843 participants (77.35%) in the WeChat group were enrolled. Participants in the WeChat group lost more weight (mean 2.09, SD 3.43 kg) than people in the control group (mean 1.78, SD 2.96 kg), and the difference in mean weight loss between the two groups for males was significant based on the stratification of age and educational level. To control for confounding factors and to explore the effects of WeChat on weight loss, the propensity score method with a multinominal logistic regression was utilized. For males, this showed that the WeChat group (with both active and inactive subgroups) had a higher probability of maintaining weight, weight loss from 1 to 2 kg, or weight loss more than 2 kg than the control group. However, the control group had higher probability of weight loss from 0 to 1 kg. Being active in WeChat was likely to be associated with weight loss. The more active participants were in the weight loss program via WeChat, the more weight they lost. Conclusions: The weight loss intervention campaign based on an official WeChat account focused on an occupation-based population in Shunyi District was effective for males. The more active male participants were in using WeChat, the more weight they lost. There might be no effect or there may even be a negative effect on weight loss for females. Future research should focus on how to improve adherence to the WeChat weight loss interventions, to improve and refine the WeChat content such as developing a variety of materials to attract interest, and to protect personal privacy, especially for females. %M 29061555 %R 10.2196/jmir.7861 %U http://www.jmir.org/2017/10/e357/ %U https://doi.org/10.2196/jmir.7861 %U http://www.ncbi.nlm.nih.gov/pubmed/29061555 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e363 %T An International Study on the Determinants of Poor Sleep Amongst 15,000 Users of Connected Devices %A Fagherazzi,Guy %A El Fatouhi,Douae %A Bellicha,Alice %A El Gareh,Amin %A Affret,Aurélie %A Dow,Courtney %A Delrieu,Lidia %A Vegreville,Matthieu %A Normand,Alexis %A Oppert,Jean-Michel %A Severi,Gianluca %+ Inserm, Centre de Recherche en Epidémiologie et Santé des Populations U1018, 114 rue Edouard Vaillant, Villejuif,, France, 33 1 42 11 61 40, guy.fagherazzi@gustaveroussy.fr %K connected devices %K sleep %K Withings %K Nokia %K determinants %K Internet of Things %K epidemiology %K wearables %K lifestyle %K blood pressure %K steps %K heart rate %K weight %D 2017 %7 23.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Sleep is a modifiable lifestyle factor that can be a target for efficient intervention studies to improve the quality of life and decrease the risk or burden of some chronic conditions. Knowing the profiles of individuals with poor sleep patterns is therefore a prerequisite. Wearable devices have recently opened new areas in medical research as potential efficient tools to measure lifestyle factors such as sleep quantity and quality. Objectives: The goal of our research is to identify the determinants of poor sleep based on data from a large population of users of connected devices. Methods: We analyzed data from 15,839 individuals (13,658 males and 2181 females) considered highly connected customers having purchased and used at least 3 connected devices from the consumer electronics company Withings (now Nokia). Total and deep sleep durations as well as the ratio of deep/total sleep as a proxy of sleep quality were analyzed in association with available data on age, sex, weight, heart rate, steps, and diastolic and systolic blood pressures. Results: With respect to the deep/total sleep duration ratio used as a proxy of sleep quality, we have observed that those at risk of having a poor ratio (≤0.40) were more frequently males (odds ratio [OR]female vs male=0.45, 95% CI 0.38-0.54), younger individuals (OR>60 years vs 18-30 years=0.47, 95% CI 0.35-0.63), and those with elevated heart rate (OR>78 bpm vs ≤61 bpm=1.18, 95% CI 1.04-1.34) and high systolic blood pressure (OR>133 mm Hg vs ≤116 mm Hg=1.22, 95% CI 1.04-1.43). A direct association with weight was observed for total sleep duration exclusively. Conclusions: Wearables can provide useful information to target individuals at risk of poor sleep. Future alert or mobile phone notification systems based on poor sleep determinants measured with wearables could be tested in intervention studies to evaluate the benefits. %M 29061551 %R 10.2196/jmir.7930 %U http://www.jmir.org/2017/10/e363/ %U https://doi.org/10.2196/jmir.7930 %U http://www.ncbi.nlm.nih.gov/pubmed/29061551 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e350 %T Experiences From a Web- and App-Based Workplace Health Promotion Intervention Among Employees in the Social and Health Care Sector Based on Use-Data and Qualitative Interviews %A Balk-Møller,Nina Charlotte %A Larsen,Thomas Meinert %A Holm,Lotte %+ Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 26, Frederiksberg C, 1958, Denmark, 45 27126320, nbm@nexs.ku.dk %K eHealth %K health promotion %K workplace %K smartphone %K weight reduction programs %K Internet %K qualitative research %D 2017 %7 19.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: An increasing number of Web- and app-based tools for health promotion are being developed at the moment. The ambition is generally to reach out to a larger part of the population and to help users improve their lifestyle and develop healthier habits, and thereby improve their health status. However, the positive effects are generally modest. To understand why the effects are modest, further investigation into the participants’ experiences and the social aspects of using Web- and app-based health promotion tools is needed. Objective: The objectives of this study were to investigate the motivation behind taking part in and using a Web- and app-based health promotion tool (SoSu-life) at the workplace and to explore the participants’ experiences with using the tool. Methods: Qualitative interviews with 26 participants who participated in a 38-week randomized controlled trial of a workplace Web- and app-based tool for health promotion were conducted. Data were supplemented with tracking the frequency of use. The basic features of the tool investigated in the trial were self-reporting of diet and exercise, personalized feedback, suggestions for activities and programs, practical tips and tricks, and a series of social features designed to support and build interactions among the participants at the workplace. Results: The respondents reported typically one of the two reasons for signing up to participate in the study: either a personal wish to attain some health benefits or the more social reason that participants did not want to miss out on the social interaction with colleagues. Peer pressure from colleagues had made some participants to sign up even though they did not believe they had an unhealthy behavior. Of the total of 355 participants in the intervention group, 203 (57.2%) left the intervention before it ended. Of the remaining participants, most did not use the tool after the competition at the end of the initial 16-week period. The actual number of active users of the tool throughout the whole intervention period was low; however, the participants reported that lifestyle habits became a topic of conversation. Conclusions: A tool that addresses group interactions at workplaces appears to initiate peer pressure, which helped recruitment for participation. However, active participation was low. A social change was indicated, allowing for more interaction among colleagues around healthy lifestyle issues. Future and more long-term studies are needed to determine whether such social changes could lead to sustained improvements of health. %M 29051133 %R 10.2196/jmir.7278 %U http://www.jmir.org/2017/10/e350/ %U https://doi.org/10.2196/jmir.7278 %U http://www.ncbi.nlm.nih.gov/pubmed/29051133 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e339 %T Reduction in Fall Rate in Dementia Managed Care Through Video Incident Review: Pilot Study %A Bayen,Eleonore %A Jacquemot,Julien %A Netscher,George %A Agrawal,Pulkit %A Tabb Noyce,Lynn %A Bayen,Alexandre %+ Pitie-Salpetriere Hospital - Assistance Publique Hôpitaux de Paris (APHP) & University Pierre et Marie Curie, Department of Neuro-Rehabilitation, Global Brain Health Institute, Memory and Aging Center, University of California, San Francisco, 47 Bd de l'Hôpital, Paris, 75013, France, 33 142160319, eleonore.bayen@gbhi.org %K video monitoring %K video review %K mobile app %K deep learning %K fall %K Alzheimer disease %K dementia %D 2017 %7 17.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Falls of individuals with dementia are frequent, dangerous, and costly. Early detection and access to the history of a fall is crucial for efficient care and secondary prevention in cognitively impaired individuals. However, most falls remain unwitnessed events. Furthermore, understanding why and how a fall occurred is a challenge. Video capture and secure transmission of real-world falls thus stands as a promising assistive tool. Objective: The objective of this study was to analyze how continuous video monitoring and review of falls of individuals with dementia can support better quality of care. Methods: A pilot observational study (July-September 2016) was carried out in a Californian memory care facility. Falls were video-captured (24×7), thanks to 43 wall-mounted cameras (deployed in all common areas and in 10 out of 40 private bedrooms of consenting residents and families). Video review was provided to facility staff, thanks to a customized mobile device app. The outcome measures were the count of residents’ falls happening in the video-covered areas, the acceptability of video recording, the analysis of video review, and video replay possibilities for care practice. Results: Over 3 months, 16 falls were video-captured. A drop in fall rate was observed in the last month of the study. Acceptability was good. Video review enabled screening for the severity of falls and fall-related injuries. Video replay enabled identifying cognitive-behavioral deficiencies and environmental circumstances contributing to the fall. This allowed for secondary prevention in high-risk multi-faller individuals and for updated facility care policies regarding a safer living environment for all residents. Conclusions: Video monitoring offers high potential to support conventional care in memory care facilities. %M 29042342 %R 10.2196/jmir.8095 %U http://www.jmir.org/2017/10/e339/ %U https://doi.org/10.2196/jmir.8095 %U http://www.ncbi.nlm.nih.gov/pubmed/29042342 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 4 %P e45 %T Mental and Emotional Self-Help Technology Apps: Cross-Sectional Study of Theory, Technology, and Mental Health Behaviors %A Crookston,Benjamin T %A West,Joshua H %A Hall,P Cougar %A Dahle,Kaitana Martinez %A Heaton,Thomas L %A Beck,Robin N %A Muralidharan,Chandni %+ Department of Health Science, Brigham Young University, 4103 LSB, Provo, UT, 84602, United States, 1 8014223143, benjamin_crookston@byu.edu %K mental health %K decision theory %K mobile applications %D 2017 %7 17.10.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental and emotional self-help apps have emerged as potential mental illness prevention and treatment tools. The health behavior theory mechanisms by which these apps influence mental health–related behavior change have not been thoroughly examined. Objective: The objective of this study was to examine the association between theoretical behavior change mechanisms and use of mental and emotional self-help apps and whether the use of such apps is associated with mental health behaviors. Methods: This study utilized a cross-sectional survey of 150 users of mental or emotional health apps in the past 6 months. Survey questions included theory-based items, app engagement and likeability items, and behavior change items. Stata version 14 was used to calculate all statistics. Descriptive statistics were calculated for each of the demographic, theory, engagement, and behavior variables. Multiple regression analysis was used to identify factors associated with reported changes in theory and separately for reported changes in actual behavior after controlling for potentially confounding variables. Results: Participants reported that app use increased their motivation, desire to set goals, confidence, control, and intentions to be mentally and emotionally healthy. Engagement (P<.001) was positively associated with the reported changes in theory items, whereas perceived behavior change was positively associated with theory (P<.001), engagement (P=.004), frequency of use of apps (P=.01), and income (P=.049). Conclusions: Participants reported that app use increased their motivation, desire to set goals, confidence, control, and intentions to be mentally and emotionally healthy. This increase in perceptions, beliefs, and attitudes surrounding their mental and emotional health was considerably associated with perceived change in behavior. There was a positive association between the level of engagement with the app and the impact on theory items. Future efforts should consider the value of impacting key theoretical constructs when designing mental and emotional health apps. As apps are evaluated and additional theory-based apps are created, cost-effective self-help apps may become common preventative and treatment tools in the mental health field. %M 29042340 %R 10.2196/mental.7262 %U http://mental.jmir.org/2017/4/e45/ %U https://doi.org/10.2196/mental.7262 %U http://www.ncbi.nlm.nih.gov/pubmed/29042340 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e337 %T The Effectiveness of eHealth Technologies on Weight Management in Pregnant and Postpartum Women: Systematic Review and Meta-Analysis %A Sherifali,Diana %A Nerenberg,Kara A %A Wilson,Shanna %A Semeniuk,Kevin %A Ali,Muhammad Usman %A Redman,Leanne M %A Adamo,Kristi B %+ School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Lees Campus, RM E250, 200 Lees Ave, Ottawa, ON, K1N 6N5, Canada, 1 613 562 5800 ext 1009, kadamo@uottawa.ca %K eHealth %K technology %K pregnancy %K postpartum %K weight %D 2017 %7 13.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The emergence and utilization of electronic health (eHealth) technologies has increased in a variety of health interventions. Exploiting the real-time advantages offered by mobile technologies during and after pregnancy has the potential to empower women and encourage behaviors that may improve maternal and child health. Objective: The objective of this study was to assess the effectiveness of eHealth technologies for weight management during pregnancy and the postpartum period and to review the efficacy of eHealth technologies on health behaviors, specifically nutrition and physical activity. Methods: A systematic search was conducted of the following databases: MEDLINE, EMBASE, Cochrane database of systematic reviews (CDSR), Cochrane central register of controlled trials (CENTRAL), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO. The search included studies published from 1990 to July 5, 2016. All relevant primary studies that involved randomized controlled trials (RCTs), non-RCTs, before-and-after studies, historically controlled studies, and pilot studies were included. The study population was adult women of childbearing age either during pregnancy or the postpartum period. eHealth weight management intervention studies targeting physical activity, nutrition, or both, over a minimum 3-month period were included. Titles and abstracts, as well as full-text screening were conducted. Study quality was assessed using Cochrane’s risk of bias tool. Data extraction was completed by a single reviewer, which was then verified by a second independent reviewer. Results were meta-analyzed to calculate pooled estimates of the effect, wherever possible. Results: Overall, 1787 and 176 citations were reviewed at the abstract and full-text screening stages, respectively. A total of 10 studies met the inclusion criteria ranging from high to low risk of bias. Pooled estimates from studies of the effect for postpartum women resulted in a significant reduction in weight (−2.55 kg, 95% CI −3.81 to −1.28) after 3 to 12 months and six studies found a nonsignificant reduction in weight gain for pregnant women (−1.62 kg, 95% CI −3.57 to 0.33) at approximately 40 weeks. Conclusions: This review found evidence for benefits of eHealth technologies on weight management in postpartum women only. Further research is still needed regarding the use of these technologies during and after pregnancy. %M 29030327 %R 10.2196/jmir.8006 %U http://www.jmir.org/2017/10/e337/ %U https://doi.org/10.2196/jmir.8006 %U http://www.ncbi.nlm.nih.gov/pubmed/29030327 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e150 %T Desire to Be Underweight: Exploratory Study on a Weight Loss App Community and User Perceptions of the Impact on Disordered Eating Behaviors %A Eikey,Elizabeth Victoria %A Reddy,Madhu C %A Booth,Kayla M %A Kvasny,Lynette %A Blair,Johnna L %A Li,Victor %A Poole,Erika S %+ Donald Bren School of Information and Computer Sciences, Department of Informatics, University of California, Irvine, 6095 Donald Bren Hall, Irvine, CA, 92697-3440, United States, 1 9494381337, eikeye@uci.edu %K mobile applications %K health apps %K feeding and eating disorder %K disordered eating behaviors %K desire to be underweight %K body mass index %K weight loss %K smartphone %K mHealth %K online community %K forum %K profile %K posts %K human computer interaction %D 2017 %7 12.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps for weight loss (weight loss apps) can be useful diet and exercise tools for individuals in need of losing weight. Most studies view weight loss app users as these types of individuals, but not all users have the same needs. In fact, users with disordered eating behaviors who desire to be underweight are also utilizing weight loss apps; however, few studies give a sense of the prevalence of these users in weight loss app communities and their perceptions of weight loss apps in relation to disordered eating behaviors. Objective: The aim of this study was to provide an analysis of users’ body mass indices (BMIs) in a weight loss app community and examples of how users with underweight BMI goals perceive the impact of the app on disordered eating behaviors. Methods: We focused on two aspects of a weight loss app (DropPounds): profile data and forum posts, and we moved from a broader picture of the community to a narrower focus on users’ perceptions. We analyzed profile data to better understand the goal BMIs of all users, highlighting the prevalence of users with underweight BMI goals. Then we explored how users with a desire to be underweight discussed the weight loss app’s impact on disordered eating behaviors. Results: We found three main results: (1) no user (regardless of start BMI) starts with a weight gain goal, and most users want to lose weight; (2) 6.78% (1261/18,601) of the community want to be underweight, and most identify as female; (3) users with underweight BMI goals tend to view the app as positive, especially for reducing bingeing; however, some acknowledge its role in exacerbating disordered eating behaviors. Conclusions: These findings are important for our understanding of the different types of users who utilize weight loss apps, the perceptions of weight loss apps related to disordered eating, and how weight loss apps may impact users with a desire to be underweight. Whereas these users had underweight goals, they often view the app as helpful in reducing disordered eating behaviors, which led to additional questions. Therefore, future research is needed. %M 29025694 %R 10.2196/mhealth.6683 %U http://mhealth.jmir.org/2017/10/e150/ %U https://doi.org/10.2196/mhealth.6683 %U http://www.ncbi.nlm.nih.gov/pubmed/29025694 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e151 %T Fall Detection in Individuals With Lower Limb Amputations Using Mobile Phones: Machine Learning Enhances Robustness for Real-World Applications %A Shawen,Nicholas %A Lonini,Luca %A Mummidisetty,Chaithanya Krishna %A Shparii,Ilona %A Albert,Mark V %A Kording,Konrad %A Jayaraman,Arun %+ Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, 355 E Erie St, Suite #11-1101, Chicago, IL, 60611, United States, 1 312 238 1619, llonini@ricres.org %K fall detection %K lower limb amputation %K mobile phones %K machine learning %D 2017 %7 11.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Automatically detecting falls with mobile phones provides an opportunity for rapid response to injuries and better knowledge of what precipitated the fall and its consequences. This is beneficial for populations that are prone to falling, such as people with lower limb amputations. Prior studies have focused on fall detection in able-bodied individuals using data from a laboratory setting. Such approaches may provide a limited ability to detect falls in amputees and in real-world scenarios. Objective: The aim was to develop a classifier that uses data from able-bodied individuals to detect falls in individuals with a lower limb amputation, while they freely carry the mobile phone in different locations and during free-living. Methods: We obtained 861 simulated indoor and outdoor falls from 10 young control (non-amputee) individuals and 6 individuals with a lower limb amputation. In addition, we recorded a broad database of activities of daily living, including data from three participants’ free-living routines. Sensor readings (accelerometer and gyroscope) from a mobile phone were recorded as participants freely carried it in three common locations—on the waist, in a pocket, and in the hand. A set of 40 features were computed from the sensors data and four classifiers were trained and combined through stacking to detect falls. We compared the performance of two population-specific models, trained and tested on either able-bodied or amputee participants, with that of a model trained on able-bodied participants and tested on amputees. A simple threshold-based classifier was used to benchmark our machine-learning classifier. Results: The accuracy of fall detection in amputees for a model trained on control individuals (sensitivity: mean 0.989, 1.96*standard error of the mean [SEM] 0.017; specificity: mean 0.968, SEM 0.025) was not statistically different (P=.69) from that of a model trained on the amputee population (sensitivity: mean 0.984, SEM 0.016; specificity: mean 0.965, SEM 0.022). Detection of falls in control individuals yielded similar results (sensitivity: mean 0.979, SEM 0.022; specificity: mean 0.991, SEM 0.012). A mean 2.2 (SD 1.7) false alarms per day were obtained when evaluating the model (vs mean 122.1, SD 166.1 based on thresholds) on data recorded as participants carried the phone during their daily routine for two or more days. Machine-learning classifiers outperformed the threshold-based one (P<.001). Conclusions: A mobile phone-based fall detection model can use data from non-amputee individuals to detect falls in individuals walking with a prosthesis. We successfully detected falls when the mobile phone was carried across multiple locations and without a predetermined orientation. Furthermore, the number of false alarms yielded by the model over a longer period of time was reasonably low. This moves the application of mobile phone-based fall detection systems closer to a real-world use case scenario. %M 29021127 %R 10.2196/mhealth.8201 %U http://mhealth.jmir.org/2017/10/e151/ %U https://doi.org/10.2196/mhealth.8201 %U http://www.ncbi.nlm.nih.gov/pubmed/29021127 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e153 %T Willingness to Use Mobile Phone Apps for HIV Prevention Among Men Who Have Sex with Men in London: Web-Based Survey %A Goedel,William C %A Mitchell,Jason W %A Krebs,Paul %A Duncan,Dustin T %+ Department of Population Health, School of Medicine, New York University, 227 East 30th Street, New York, NY,, United States, 1 6465012715, wcg219@nyu.edu %K mobile phone apps %K mHealth %K men who have sex with men (MSM) %K HIV %D 2017 %7 11.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many men who have sex with men (MSM) use apps to connect with and meet other MSM. Given that these apps are often used to arrange sexual encounters, it is possible that apps may be suitable venues for messages and initiatives related to HIV prevention such as those to increase HIV testing rates among this population. Objective: The purpose of this study was to assess willingness to use a new app for reminders of when to be tested for HIV infection among a sample of MSM in London who use apps to arrange sexual encounters. Methods: Broadcast advertisements targeted users of a popular social-networking app for MSM in London. Advertisements directed users to a Web-based survey of sexual behaviors and sexual health needs. Willingness to use apps for reminders of when to be tested for HIV was assessed. In addition, participants responded to items assessing recent sexual behaviors, substance use, and demographic characteristics. Exploratory analyses were undertaken to examine differences in willingness to use an app by demographic and behavioral characteristics. Results: Broadcast advertisements yielded a sample of 169 HIV-negative MSM. Overall, two-thirds (108/169, 63.9%) reported willingness to use an app to remind them when to be tested for HIV. There were no significant differences in willingness to use these apps based on demographic characteristics, but MSM who reported recent binge drinking and recent club drug use more frequently reported willingness to use this app compared to their nonusing counterparts. Conclusions: MSM in this sample are willing to use a new app for HIV testing reminders. Given the high levels of willingness to use them, these types of apps should be developed, evaluated, and made available for this population. %M 29021132 %R 10.2196/mhealth.8143 %U http://mhealth.jmir.org/2017/10/e153/ %U https://doi.org/10.2196/mhealth.8143 %U http://www.ncbi.nlm.nih.gov/pubmed/29021132 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e130 %T Mobile Apps for Suicide Prevention: Review of Virtual Stores and Literature %A de la Torre,Isabel %A Castillo,Gema %A Arambarri,Jon %A López-Coronado,Miguel %A Franco,Manuel A %+ Department of Signal Theory and Communications, and Telematics Engineering, University of Valladolid, Paseo de Belén 15, Valladolid, 47011, Spain, 34 983423000 ext 3703, isator@tel.uva.es %K app %K literature %K prevention %K suicide %K virtual stores %D 2017 %7 10.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The best manner to prevent suicide is to recognize suicidal signs and signals, and know how to respond to them. Objective: We aim to study the existing mobile apps for suicide prevention in the literature and the most commonly used virtual stores. Methods: Two reviews were carried out. The first was done by searching the most commonly used commercial app stores, which are iTunes and Google Play. The second was a review of mobile health (mHealth) apps in published articles within the last 10 years in the following 7 scientific databases: Science Direct, Medline, PsycINFO, Embase, The Cochrane Library, IEEE Xplore, and Google Scholar. Results: A total of 124 apps related to suicide were found in the cited virtual stores but only 20 apps were specifically designed for suicide prevention. All apps were free and most were designed for Android. Furthermore, 6 relevant papers were found in the indicated scientific databases; in these studies, some real experiences with physicians, caregivers, and families were described. The importance of these people in suicide prevention was indicated. Conclusions: The number of apps regarding suicide prevention is small, and there was little information available from literature searches, indicating that technology-based suicide prevention remains understudied. Many of the apps provided no interactive features. It is important to verify the accuracy of the results of different apps that are available on iOS and Android. The confidence generated by these apps can benefit end users, either by improving their health monitoring or simply to verify their body condition. %M 29017992 %R 10.2196/mhealth.8036 %U https://mhealth.jmir.org/2017/10/e130/ %U https://doi.org/10.2196/mhealth.8036 %U http://www.ncbi.nlm.nih.gov/pubmed/29017992 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e146 %T Feasibility of Gamified Mobile Service Aimed at Physical Activation in Young Men: Population-Based Randomized Controlled Study (MOPO) %A Leinonen,Anna-Maiju %A Pyky,Riitta %A Ahola,Riikka %A Kangas,Maarit %A Siirtola,Pekka %A Luoto,Tim %A Enwald,Heidi %A Ikäheimo,Tiina M %A Röning,Juha %A Keinänen-Kiukaanniemi,Sirkka %A Mäntysaari,Matti %A Korpelainen,Raija %A Jämsä,Timo %+ Research Unit of Medical Imaging, Physics and Technology, University of Oulu, PO Box 5000, Oulu, 90014 University of, Finland, 358 29 448 600, anna.jauho@oulu.fi %K accelerometry %K adolescent %K behavior change %K health %K Internet %K self-monitoring %K wearable %D 2017 %7 10.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The majority of young people do not meet the recommendations on physical activity for health. New innovative ways to motivate young people to adopt a physically active lifestyle are needed. Objective: The study aimed to study the feasibility of an automated, gamified, tailored Web-based mobile service aimed at physical and social activation among young men. Methods: A population-based sample of 496 young men (mean age 17.8 years [standard deviation 0.6]) participated in a 6-month randomized controlled trial (MOPO study). Participants were randomized to an intervention (n=250) and a control group (n=246). The intervention group was given a wrist-worn physical activity monitor (Polar Active) with physical activity feedback and access to a gamified Web-based mobile service, providing fitness guidelines, tailored health information, advice of youth services, social networking, and feedback on physical activity. Through the trial, the physical activity of the men in the control group was measured continuously with an otherwise similar monitor but providing only the time of day and no feedback. The primary outcome was the feasibility of the service based on log data and questionnaires. Among completers, we also analyzed the change in anthropometry and fitness between baseline and 6 months and the change over time in weekly time spent in moderate to vigorous physical activity. Results: Mobile service users considered the various functionalities related to physical activity important. However, compliance of the service was limited, with 161 (64.4%, 161/250) participants visiting the service, 118 (47.2%, 118/250) logging in more than once, and 41 (16.4%, 41/250) more than 5 times. Baseline sedentary time was higher in those who uploaded physical activity data until the end of the trial (P=.02). A total of 187 (74.8%, 187/250) participants in the intervention and 167 (67.9%, 167/246) in the control group participated in the final measurements. There were no differences in the change in anthropometry and fitness from baseline between the groups, whereas waist circumference was reduced in the most inactive men within the intervention group (P=.01). Among completers with valid physical activity data (n=167), there was a borderline difference in the change in mean daily time spent in moderate to vigorous physical activity between the groups (11.9 min vs −9.1 min, P=.055, linear mixed model). Within the intervention group (n=87), baseline vigorous physical activity was inversely associated with change in moderate to vigorous physical activity during the trial (R=−.382, P=.01). Conclusions: The various functionalities related to physical activity of the gamified tailored mobile service were considered important. However, the compliance was limited. Within the current setup, the mobile service had no effect on anthropometry or fitness, except reduced waist circumference in the most inactive men. Among completers with valid physical activity data, the trial had a borderline positive effect on moderate to vigorous physical activity. Further development is needed to improve the feasibility and adherence of an integrated multifunctional service. Trial registration: Clinicaltrials.gov NCT01376986; http://clinicaltrials.gov/ct2/show/NCT01376986 (Archived by WebCite at http://www.webcitation.org/6tjdmIroA) %M 29017991 %R 10.2196/mhealth.6675 %U https://mhealth.jmir.org/2017/10/e146/ %U https://doi.org/10.2196/mhealth.6675 %U http://www.ncbi.nlm.nih.gov/pubmed/29017991 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e338 %T Encouraging Physical Activity in Patients With Diabetes: Intervention Using a Reinforcement Learning System %A Yom-Tov,Elad %A Feraru,Guy %A Kozdoba,Mark %A Mannor,Shie %A Tennenholtz,Moshe %A Hochberg,Irit %+ Microsoft Research, 13 Shenkar st., Herzeliya, 46875, Israel, 972 747111358, eladyt@yahoo.com %K reinforcement learning %K physical activity %K diabetes type 2 %D 2017 %7 10.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Regular physical activity is known to be beneficial for people with type 2 diabetes. Nevertheless, most of the people who have diabetes lead a sedentary lifestyle. Smartphones create new possibilities for helping people to adhere to their physical activity goals through continuous monitoring and communication, coupled with personalized feedback. Objective: The aim of this study was to help type 2 diabetes patients increase the level of their physical activity. Methods: We provided 27 sedentary type 2 diabetes patients with a smartphone-based pedometer and a personal plan for physical activity. Patients were sent short message service messages to encourage physical activity between once a day and once per week. Messages were personalized through a Reinforcement Learning algorithm so as to improve each participant’s compliance with the activity regimen. The algorithm was compared with a static policy for sending messages and weekly reminders. Results: Our results show that participants who received messages generated by the learning algorithm increased the amount of activity and pace of walking, whereas the control group patients did not. Patients assigned to the learning algorithm group experienced a superior reduction in blood glucose levels (glycated hemoglobin [HbA1c]) compared with control policies, and longer participation caused greater reductions in blood glucose levels. The learning algorithm improved gradually in predicting which messages would lead participants to exercise. Conclusions: Mobile phone apps coupled with a learning algorithm can improve adherence to exercise in diabetic patients. This algorithm can be used in large populations of diabetic patients to improve health and glycemic control. Our results can be expanded to other areas where computer-led health coaching of humans may have a positive impact. Summary of a part of this manuscript has been previously published as a letter in Diabetes Care, 2016. %M 29017988 %R 10.2196/jmir.7994 %U http://www.jmir.org/2017/10/e338/ %U https://doi.org/10.2196/jmir.7994 %U http://www.ncbi.nlm.nih.gov/pubmed/29017988 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e142 %T User Participation and Engagement With the See Me Smoke-Free mHealth App: Prospective Feasibility Trial %A Schmidt,Chris A %A Romine,James K %A Bell,Melanie L %A Armin,Julie %A Gordon,Judith S %+ College of Nursing, University of Arizona, 1305 N. Martin Avenue, Tucson, AZ, 85721, United States, 1 520 626 4970, judithg@email.arizona.edu %K mHealth %K mobile health %K intervention %K smoking %K diet %K physical activity %D 2017 %7 09.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The See Me Smoke-Free (SMSF) mobile health (mHealth) app was developed to help women quit smoking by targeting concerns about body weight, body image, and self-efficacy through cognitive behavioral techniques and guided imagery audio files addressing smoking, diet, and physical activity. A feasibility trial found associations between SMSF usage and positive treatment outcomes. This paper reports a detailed exploration of program use among eligible individuals consenting to study participation and completing the baseline survey (participants) and ineligible or nonconsenting app installers (nonparticipants), as well as the relationship between program use and treatment outcomes. Objective: The aim of this study was to determine whether (1) participants were more likely to set quit dates, be current smokers, and report higher levels of smoking at baseline than nonparticipants; (2) participants opened the app and listened to audio files more frequently than nonparticipants; and (3) participants with more app usage had a higher likelihood of self-reported smoking abstinence at follow up. Methods: The SMSF feasibility trial was a single arm, within-subjects, prospective cohort study with assessments at baseline and 30 and 90 days post enrollment. The SMSF app was deployed on the Google Play Store for download, and basic profile characteristics were obtained for all app installers. Additional variables were assessed for study participants. Participants were prompted to use the app daily during study participation. Crude differences in baseline characteristics between trial participants and nonparticipants were evaluated using t tests (continuous variables) and Fisher exact tests (categorical variables). Exact Poisson tests were used to assess group-level differences in mean usage rates over the full study period using aggregate Google Analytics data on participation and usage. Negative binomial regression models were used to estimate associations of app usage with participant baseline characteristics after adjustment for putative confounders. Associations between app usage and self-reported smoking abstinence were assessed using separate logistic regression models for each outcome measure. Results: Participants (n=151) were more likely than nonparticipants (n=96) to report female gender (P<.02) and smoking in the 30 days before enrollment (P<.001). Participants and nonparticipants opened the app and updated quit dates at the same average rate (rate ratio [RR] 0.98; 95% CI 0.92-1.04; P=.43), but participants started audio files (RR 1.07; 95% CI 1.00-1.13; P<.04) and completed audio files (RR 1.11; 95% CI 1.03-1.18; P<.003) at significantly higher rates than nonparticipants. Higher app usage among participants was positively associated with some smoking cessation outcomes. Conclusions: This study suggests potential efficacy of the SMSF app, as increased usage was generally associated with higher self-reported smoking abstinence. A planned randomized controlled trial will assess the SMSF app’s efficacy as an intervention tool to help women quit smoking. %M 28993302 %R 10.2196/mhealth.7900 %U https://mhealth.jmir.org/2017/10/e142/ %U https://doi.org/10.2196/mhealth.7900 %U http://www.ncbi.nlm.nih.gov/pubmed/28993302 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e137 %T Well-Being Tracking via Smartphone-Measured Activity and Sleep: Cohort Study %A DeMasi,Orianna %A Feygin,Sidney %A Dembo,Aluma %A Aguilera,Adrian %A Recht,Benjamin %+ Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, 593-5 Soda Hall, MC-1776, Berkeley, CA, 94720, United States, 1 5107769028, odemasi@eecs.berkeley.edu %K depression %K mobile health %K smartphones %D 2017 %7 05.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Automatically tracking mental well-being could facilitate personalization of treatments for mood disorders such as depression and bipolar disorder. Smartphones present a novel and ubiquitous opportunity to track individuals’ behavior and may be useful for inferring and automatically monitoring mental well-being. Objective: The aim of this study was to assess the extent to which activity and sleep tracking with a smartphone can be used for monitoring individuals’ mental well-being. Methods: A cohort of 106 individuals was recruited to install an app on their smartphone that would track their well-being with daily surveys and track their behavior with activity inferences from their phone’s accelerometer data. Of the participants recruited, 53 had sufficient data to infer activity and sleep measures. For this subset of individuals, we related measures of activity and sleep to the individuals’ well-being and used these measures to predict their well-being. Results: We found that smartphone-measured approximations for daily physical activity were positively correlated with both mood (P=.004) and perceived energy level (P<.001). Sleep duration was positively correlated with mood (P=.02) but not energy. Our measure for sleep disturbance was not found to be significantly related to either mood or energy, which could imply too much noise in the measurement. Models predicting the well-being measures from the activity and sleep measures were found to be significantly better than naive baselines (P<.01), despite modest overall improvements. Conclusions: Measures of activity and sleep inferred from smartphone activity were strongly related to and somewhat predictive of participants’ well-being. Whereas the improvement over naive models was modest, it reaffirms the importance of considering physical activity and sleep for predicting mood and for making automatic mood monitoring a reality. %M 28982643 %R 10.2196/mhealth.7820 %U https://mhealth.jmir.org/2017/10/e137/ %U https://doi.org/10.2196/mhealth.7820 %U http://www.ncbi.nlm.nih.gov/pubmed/28982643 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e143 %T A Mobile Phone-Based Life Skills Training Program for Substance Use Prevention Among Adolescents: Pre-Post Study on the Acceptance and Potential Effectiveness of the Program, Ready4life %A Haug,Severin %A Paz Castro,Raquel %A Meyer,Christian %A Filler,Andreas %A Kowatsch,Tobias %A Schaub,Michael P %+ Swiss Research Institute for Public Health and Addiction, University of Zurich, Konradstrasse 32, Zurich, 8031, Switzerland, 41 444481174, severin.haug@isgf.uzh.ch %K coping skills %K social skills %K substance use disorder %K adolescents %K students %K mobile phone %D 2017 %7 04.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Substance use and misuse often first emerge during adolescence. Generic life skills training that is typically conducted within the school curriculum is effective at preventing the onset and escalation of substance use among adolescents. However, the dissemination of such programs is impeded by their large resource requirements in terms of personnel, money, and time. Life skills training provided via mobile phones might be a more economic and scalable approach, which additionally matches the lifestyle and communication habits of adolescents. Objective: The aim of this study was to test the acceptance and initial effectiveness of an individually tailored mobile phone–based life skills training program in vocational school students. Methods: The fully automated program, named ready4life, is based on social cognitive theory and addresses self-management skills, social skills, and substance use resistance skills. Program participants received up to 3 weekly text messages (short message service, SMS) over 6 months. Active program engagement was stimulated by interactive features such as quiz questions, message- and picture-contests, and integration of a friendly competition with prizes in which program users collected credits with each interaction. Generalized estimating equation (GEE) analyses were used to investigate for changes between baseline and 6-month follow-up in the following outcomes: perceived stress, self-management skills, social skills, at-risk alcohol use, tobacco smoking, and cannabis use. Results: The program was tested in 118 school classes at 13 vocational schools in Switzerland. A total of 1067 students who owned a mobile phone and were not regular cigarette smokers were invited to participate in the life skills program. Of these, 877 (82.19%, 877/1067; mean age=17.4 years, standard deviation [SD]=2.7; 58.3% females) participated in the program and the associated study. A total of 43 students (4.9%, 43/877) withdrew their program participation during the intervention period. The mean number of interactive program activities that participants engaged in was 15.5 (SD 13.3) out of a total of 39 possible activities. Follow-up assessments were completed by 436 of the 877 (49.7%) participants. GEE analyses revealed decreased perceived stress (odds ratio, OR=0.93; 95% CI 0.87-0.99; P=.03) and increases in several life skills addressed between baseline and the follow-up assessment. The proportion of adolescents with at-risk alcohol use declined from 20.2% at baseline to 15.5% at follow-up (OR 0.70, 95% CI 0.53-0.93; P=.01), whereas no significant changes were obtained for tobacco (OR 0.94, 95% CI 0.65-1.36; P=.76) or cannabis use (OR 0.91, 95% CI 0.67-1.24; P=.54). Conclusions: These results reveal high-level acceptance and promising effectiveness of this interventional approach, which could be easily and economically implemented. A reasonable next step would be to test the efficacy of this program within a controlled trial. %M 28978498 %R 10.2196/mhealth.8474 %U https://mhealth.jmir.org/2017/10/e143/ %U https://doi.org/10.2196/mhealth.8474 %U http://www.ncbi.nlm.nih.gov/pubmed/28978498 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e148 %T Using Mobile Phones to Improve Vaccination Uptake in 21 Low- and Middle-Income Countries: Systematic Review %A Oliver-Williams,Clare %A Brown,Elizabeth %A Devereux,Sara %A Fairhead,Cassandra %A Holeman,Isaac %+ Cardiovascular Epidemiology Unit, Department of Public Health & Primary Care, University of Cambridge, Wort's Causeway, Cambridge,, United Kingdom, 44 1223 748650, cto21@medschl.cam.ac.uk %K cell phones %K vaccination %K communication %K telemedicine %K mHealth %K global health %D 2017 %7 04.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The benefits of vaccination have been comprehensively proven; however, disparities in coverage persist because of poor health system management, limited resources, and parental knowledge and attitudes. Evidence suggests that health interventions that engage local parties in communication strategies improve vaccination uptake. As mobile technology is widely used to improve health communication, mobile health (mHealth) interventions might be used to increase coverage. Objective: The aim of this study was to conduct a systematic review of the available literature on the use of mHealth to improve vaccination in low- and middle-income countries with large numbers of unvaccinated children. Methods: In February 2017, MEDLINE (Medical Literature Analysis and Retrieval System Online), Scopus, and Web of Science, as well as three health organization websites—Communication Initiative Network, TechNet-21, and PATH—were searched to identify mHealth intervention studies on vaccination uptake in 21 countries. Results: Ten peer-reviewed studies and 11 studies from white or gray literature were included. Nine took place in India, three in Pakistan, two each in Malawi and Nigeria, and one each in Bangladesh, Zambia, Zimbabwe, and Kenya. Ten peer-reviewed studies and 7 white or gray studies demonstrated improved vaccination uptake after interventions, including appointment reminders, mobile phone apps, and prerecorded messages. Conclusions: Although the potential for mHealth interventions to improve vaccination coverage seems clear, the evidence for such interventions is not. The dearth of studies in countries facing the greatest barriers to immunization impedes the prospects for evidence-based policy and practice in these settings. %M 28978495 %R 10.2196/mhealth.7792 %U http://mhealth.jmir.org/2017/10/e148/ %U https://doi.org/10.2196/mhealth.7792 %U http://www.ncbi.nlm.nih.gov/pubmed/28978495 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e333 %T Assessing the National Cancer Institute’s SmokefreeMOM Text-Messaging Program for Pregnant Smokers: Pilot Randomized Trial %A Abroms,Lorien C %A Chiang,Shawn %A Macherelli,Laura %A Leavitt,Leah %A Montgomery,Margaret %+ Milken Insitute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, DC,, United States, 1 202 994 3518, lorien@gwu.edu %K mHealth %K text messaging %K SMS %K mobile phone %K pregnant %K smoking %K quit %D 2017 %7 03.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Automated text messages on mobile phones have been found to be effective for smoking cessation in adult smokers. Objective: This study aims to test the acceptability and feasibility of SmokefreeMOM, a national smoking cessation text-messaging program for pregnant smokers. Methods: Participants were recruited from prenatal care and randomized to receive SmokefreeMOM (n=55), an automated smoking cessation text-messaging program, or a control text message quitline referral (n=44). Participants were surveyed by phone at baseline and at 1 month and 3 months after enrollment. Results: Results indicate that the SmokefreeMOM program was highly rated overall and rated more favorably than the control condition in its helpfulness at 3-month follow-up (P<.01) and in its frequency of messaging at both 1-month and 3-month follow-ups (P<.001, P<.01, respectively). Despite the presence of technical problems, the vast majority of intervention participants read all program messages, and few participants unsubscribed from the program. There were no significant differences between groups on the use of extra treatment resources or on smoking-related outcomes. However, at the 3-month follow-up, some outcomes favored the intervention group. Conclusions: SmokefreeMOM is acceptable for pregnant smokers. It is recommended that SmokefreeMOM be further refined and evaluated. Trial Registration: Clinicaltrials.gov NCT02412956; https://clinicaltrials.gov/ct2/show/NCT02412956 (Archived by WebCite at http://www.webcitation.org/6tcmeRnbC) %M 28974483 %R 10.2196/jmir.8411 %U http://www.jmir.org/2017/10/e333/ %U https://doi.org/10.2196/jmir.8411 %U http://www.ncbi.nlm.nih.gov/pubmed/28974483 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e104 %T Mobile Phone-Based Measures of Activity, Step Count, and Gait Speed: Results From a Study of Older Ambulatory Adults in a Naturalistic Setting %A Rye Hanton,Cassia %A Kwon,Yong-Jun %A Aung,Thawda %A Whittington,Jackie %A High,Robin R %A Goulding,Evan H %A Schenk,A Katrin %A Bonasera,Stephen J %+ Department of Internal Medicine, Division of Geriatrics, University of Nebraska Medical Center, 986155 Nebraska Medical Center, Omaha, NE, 68198-6155, United States, 1 402 559 8409, sbonasera@unmc.edu %K mobile phone %K functional status %K mobility %K gait speed %K mobility measures %K LLFDI %K SAFFE %K PROMIS short %K PROMIS Global %K step count %K behavioral classification %K frailty phenotype %K normal aging %D 2017 %7 03.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cellular mobile telephone technology shows much promise for delivering and evaluating healthcare interventions in cost-effective manners with minimal barriers to access. There is little data demonstrating that these devices can accurately measure clinically important aspects of individual functional status in naturalistic environments outside of the laboratory. Objective: The objective of this study was to demonstrate that data derived from ubiquitous mobile phone technology, using algorithms developed and previously validated by our lab in a controlled setting, can be employed to continuously and noninvasively measure aspects of participant (subject) health status including step counts, gait speed, and activity level, in a naturalistic community setting. A second objective was to compare our mobile phone-based data against current standard survey-based gait instruments and clinical physical performance measures in order to determine whether they measured similar or independent constructs. Methods: A total of 43 ambulatory, independently dwelling older adults were recruited from Nebraska Medicine, including 25 (58%, 25/43) healthy control individuals from our Engage Wellness Center and 18 (42%, 18/43) functionally impaired, cognitively intact individuals (who met at least 3 of 5 criteria for frailty) from our ambulatory Geriatrics Clinic. The following previously-validated surveys were obtained on study day 1: (1) Late Life Function and Disability Instrument (LLFDI); (2) Survey of Activities and Fear of Falling in the Elderly (SAFFE); (3) Patient Reported Outcomes Measurement Information System (PROMIS), short form version 1.0 Physical Function 10a (PROMIS-PF); and (4) PROMIS Global Health, short form version 1.1 (PROMIS-GH). In addition, clinical physical performance measurements of frailty (10 foot Get up and Go, 4 Meter walk, and Figure-of-8 Walk [F8W]) were also obtained. These metrics were compared to our mobile phone-based metrics collected from the participants in the community over a 24-hour period occurring within 1 week of the initial assessment. Results: We identified statistically significant differences between functionally intact and frail participants in mobile phone-derived measures of percent activity (P=.002, t test), active versus inactive status (P=.02, t test), average step counts (P<.001, repeated measures analysis of variance [ANOVA]) and gait speed (P<.001, t test). In functionally intact individuals, the above mobile phone metrics assessed aspects of functional status independent (Bland-Altman and correlation analysis) of both survey- and/or performance battery-based functional measures. In contrast, in frail individuals, the above mobile phone metrics correlated with submeasures of both SAFFE and PROMIS-GH. Conclusions: Continuous mobile phone-based measures of participant community activity and mobility strongly differentiate between persons with intact functional status and persons with a frailty phenotype. These measures assess dimensions of functional status independent of those measured using current validated questionnaires and physical performance assessments to identify functional compromise. Mobile phone-based gait measures may provide a more readily accessible and less-time consuming measure of gait, while further providing clinicians with longitudinal gait measures that are currently difficult to obtain. %M 28974482 %R 10.2196/mhealth.5090 %U http://mhealth.jmir.org/2017/10/e104/ %U https://doi.org/10.2196/mhealth.5090 %U http://www.ncbi.nlm.nih.gov/pubmed/28974482 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 9 %P e328 %T Prescribing of Electronic Activity Monitors in Cardiometabolic Diseases: Qualitative Interview-Based Study %A Bellicha,Alice %A Macé,Sandrine %A Oppert,Jean-Michel %+ Laboratory of Bioengineering, Tissues and Neuroplasticity, University Paris-Est, 8 rue Jean Sarrail, Créteil, 94010, France, 33 42175782, alice.bellicha@u-pec.fr %K cardiometabolic diseases %K physical activity %K physicians’ perspectives %K prescriptions %K mobile health %K telemedicine %K mHealth %K electronic activity monitors %K fitness tracker %K accelerometer %K smart pedometer %D 2017 %7 23.9.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The prevalence of noncommunicable diseases, including those such as type 2 diabetes, obesity, dyslipidemia, and hypertension, so-called cardiometabolic diseases, is high and is increasing worldwide. Strong evidence supports the role of physical activity in management of these diseases. There is general consensus that mHealth technology, including electronic activity monitors, can potentially increase physical activity in patients, but their use in clinical settings remains limited. Practitioners’ requirements when prescribing electronic activity monitors have been poorly described. Objective: The aims of this qualitative study were (1) to explore how specialist physicians prescribe electronic activity monitors to patients presenting with cardiometabolic conditions, and (2) to better understand their motivation for and barriers to prescribing such monitors. Methods: We conducted qualitative semistructured interviews in March to May 2016 with 11 senior physicians from a public university hospital in France with expertise in management of cardiometabolic diseases (type 1 and type 2 diabetes, obesity, hypertension, and dyslipidemia). Interviews lasted 45 to 60 minutes and were audiotaped, transcribed verbatim, and analyzed using directed content analysis. We report our findings following the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results: Most physicians we interviewed had never prescribed electronic activity monitors, whereas they frequently prescribed blood glucose or blood pressure self-monitoring devices. Reasons for nonprescription included lack of interest in the data collected, lack of evidence for data accuracy, concern about work overload possibly resulting from automatic data transfer, and risk of patients becoming addicted to data. Physicians expected future marketing of easy-to-use monitors that will accurately measure physical activity duration and intensity and provide understandable motivating feedback. Conclusions: Features of electronic activity monitors, although popular among the general public, do not meet the needs of physicians. In-depth understanding of physicians’ expectations is a first step toward designing technologies that can be widely used in clinical settings and facilitate physical activity prescription. Physicians should have a role, along with key health care stakeholders—patients, researchers, information technology firms, the public, and private payers—in developing the most effective methods for integrating activity monitors into patient care. %M 28947415 %R 10.2196/jmir.8107 %U http://www.jmir.org/2017/9/e328/ %U https://doi.org/10.2196/jmir.8107 %U http://www.ncbi.nlm.nih.gov/pubmed/28947415 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 9 %P e326 %T A Dermatologist's Ammunition in the War Against Smoking: A Photoaging App %A Brinker,Titus Josef %A Enk,Alexander %A Gatzka,Martina %A Nakamura,Yasuhiro %A Sondermann,Wiebke %A Omlor,Albert Joachim %A Petri,Maximilian Philip %A Karoglan,Ante %A Seeger,Werner %A Klode,Joachim %A von Kalle,Christof %A Schadendorf,Dirk %+ Department of Dermatology and National Center for Tumor Diseases (NCT), University of Heidelberg, Im Neuenheimer Feld 440/460, Heidelberg,, Germany, 49 151 7508 4347, titus.brinker@gmail.com %K dermatology %K smoking %K apps %K photoaging %K face %K skin %K tobacco %K tobacco cessation %K tobacco prevention %D 2017 %7 21.09.2017 %9 Viewpoint %J J Med Internet Res %G English %X This viewpoint reviews the perspectives for dermatology as a specialty to go beyond the substantial impact of smoking on skin disease and leverage the impact of skin changes on a person's self-concept and behavior in the design of effective interventions for smoking prevention and cessation. %M 28935619 %R 10.2196/jmir.8743 %U http://www.jmir.org/2017/9/e326/ %U https://doi.org/10.2196/jmir.8743 %U http://www.ncbi.nlm.nih.gov/pubmed/28935619 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 3 %P e20 %T Perceptions of Patients With Chronic Obstructive Pulmonary Disease and Their Physiotherapists Regarding the Use of an eHealth Intervention %A Vorrink,Sigrid %A Huisman,Chantal %A Kort,Helianthe %A Troosters,Thierry %A Lammers,Jan-Willem %+ Faculty Chair Demand Driven Care, Research Centre for Innovations in Health Care, University of Applied Sciences Utrecht, Lectoraat vraaggestuurde zorg, Heidelberglaan 7, Utrecht, PO Box 12011 – 350, Netherlands, 31 88 481 5384, sigrid.vorrink@hu.nl %K telemedicine %K self care %K physical therapists %K pulmonary disease, chronic obstructive %D 2017 %7 19.09.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: If eHealth interventions are not used (properly), their potential benefits cannot be fulfilled. User perceptions of eHealth are an important determinant of its successful implementation. This study examined how patients with chronic obstructive pulmonary disease (COPD) and their physiotherapists (PHTs) value an eHealth self-management intervention following a period of use. Objective: The study aimed to evaluate the perceptions of COPD patients and their PHTs as eHealth users. Methods: In this study, an eHealth self-management intervention (website and mobile phone app) aimed at stimulating physical activity (PA) in COPD patients was evaluated by its users (patients and PHTs). As participants in a randomized controlled trial (RCT), they were asked how they valued the eHealth intervention after 6 months’ use. Interview requests were made to 33 PHTs from 26 participating practices, and a questionnaire was sent to 76 patients. The questionnaire was analyzed in Excel (Microsoft). The interviews with the PHTs and text messages (short message service, SMS) sent between patients and PHTs were transcribed and independently coded in MAXQDA 10 for Windows (VERBI GmbH). Results: A total of 60 patients with COPD filled out the questionnaire, and 24 PHTs were interviewed. The mobile phone app was used 89.0% (160.2/180 days) (standard deviation [SD] 18.5) of the time by patients; 53% (13/24) of PHTs reported low or no use. Patients scored the ease of use of the app 5.09 (SD 1.14) (on a 7-point scale). They found the presentation of the PA information in the app to be clear, insightful, and stimulating. All PHTs judged the website as explicit and user-friendly but had trouble devising a new PA goal for their patients. Patients mostly sent informative, neutral messages concerning the PA goal, and PHTs sent mostly motivating, positive messages concerning the PA goal. Messages were not perceived as supportive in reaching the PA goal according to the patients. Perceived usefulness of the intervention for the PHTs was the objective measurement of PA, the ability to see PA patterns over time, and the ability to use the intervention as a tool to give their patients insight into their PA. For patients, it was that the intervention supported them in increasing their PA and that it made them feel fitter. Barriers to use of the intervention according to the PHTs were time constraints and financial reasons. Seventy-nine percent (19/24) of the PHTs and 58% (35/60) of the patients mentioned they would be interested in using the intervention in the future. Conclusions: PHTs and COPD patients had positive feelings regarding the functionality and potential of the eHealth self-management intervention. This paper addresses a number of topics that may aid in the successful development and implementation of these types of eHealth interventions in the future. %M 28928110 %R 10.2196/humanfactors.7196 %U http://humanfactors.jmir.org/2017/3/e20/ %U https://doi.org/10.2196/humanfactors.7196 %U http://www.ncbi.nlm.nih.gov/pubmed/28928110 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 9 %P e133 %T Effectiveness of SmartMoms, a Novel eHealth Intervention for Management of Gestational Weight Gain: Randomized Controlled Pilot Trial %A Redman,Leanne M %A Gilmore,L. Anne %A Breaux,Jeffrey %A Thomas,Diana M %A Elkind-Hirsch,Karen %A Stewart,Tiffany %A Hsia,Daniel S %A Burton,Jeffrey %A Apolzan,John W %A Cain,Loren E %A Altazan,Abby D %A Ragusa,Shelly %A Brady,Heather %A Davis,Allison %A Tilford,J. Mick %A Sutton,Elizabeth F %A Martin,Corby K %+ Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, United States, 1 2257630947, leanne.redman@pbrc.edu %K pregnancy %K gestational weight gain %K lifestyle modification %K intervention %D 2017 %7 13.09.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Two-thirds of pregnant women exceed gestational weight gain (GWG) recommendations. Because excess GWG is associated with adverse outcomes for mother and child, development of scalable and cost-effective approaches to deliver intensive lifestyle programs during pregnancy is urgent. Objective: The aim of this study was to decrease the proportion of women who exceed the Institute of Medicine (IOM) 2009 GWG guidelines. Methods: In a parallel-arm randomized controlled trial, 54 pregnant women (age 18-40 years) who were overweight (n=25) or obese (n=29) were enrolled to test whether an intensive lifestyle intervention (called SmartMoms) decreased the proportion of women with excess GWG, defined as exceeding the 2009 IOM guidelines, compared to no intervention (usual care group). The SmartMoms intervention was delivered through mobile phone (remote group) or in a traditional in-person, clinic-based setting (in-person group), and included a personalized dietary intake prescription, self-monitoring weight against a personalized weight graph, activity tracking with a pedometer, receipt of health information, and continuous personalized feedback from counselors. Results: A significantly smaller proportion of women exceeded the IOM 2009 GWG guidelines in the SmartMoms intervention groups (in-person: 56%, 10/18; remote: 58%, 11/19) compared to usual care (85%, 11/13; P=.02). The remote intervention was a lower cost to participants (mean US $97, SD $6 vs mean US $347, SD $40 per participant; P<.001) and clinics (US $215 vs US $419 per participant) and with increased intervention adherence (76.5% vs 60.8%; P=.049). Conclusions: An intensive lifestyle intervention for GWG can be effectively delivered via a mobile phone, which is both cost-effective and scalable. Trial Registration: Clinicaltrials.gov NCT01610752; https://clinicaltrials.gov/ct2/show/NCT01610752 (Archived by WebCite at http://www.webcitation.org/6sarNB4iW) %M 28903892 %R 10.2196/mhealth.8228 %U http://mhealth.jmir.org/2017/9/e133/ %U https://doi.org/10.2196/mhealth.8228 %U http://www.ncbi.nlm.nih.gov/pubmed/28903892 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 9 %P e183 %T A Multi-Level, Mobile-Enabled Intervention to Promote Physical Activity in Older Adults in the Primary Care Setting (iCanFit 2.0): Protocol for a Cluster Randomized Controlled Trial %A Hong,Y Alicia %A Forjuoh,Samuel N %A Ory,Marcia G %A Reis,Michael D %A Sang,Huiyan %+ School of Public Health, Texas A&M University, 1266 TAMU, College Station, TX, 77843, United States, 1 9794369343, yhong@sph.tamhsc.edu %K iCanFit %K older adults %K mHealth intervention %K intervention development %K intervention trial %K primary care %D 2017 %7 12.09.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Most older adults do not adhere to the US Centers for Disease Control physical activity guidelines; their physical inactivity contributes to overweight and multiple chronic conditions. An urgent need exists for effective physical activity-promotion programs for the large number of older adults in the United States. Objective: This study presents the development of the intervention and trial protocol of iCanFit 2.0, a multi-level, mobile-enabled, physical activity-promotion program developed for overweight older adults in primary care settings. Methods: The iCanFit 2.0 program was developed based on our prior mHealth intervention programs, qualitative interviews with older patients in a primary care clinic, and iterative discussions with key stakeholders. We will test the efficacy of iCanFit 2.0 through a cluster randomized controlled trial in six pairs of primary care clinics. Results: The proposed protocol received a high score in a National Institutes of Health review, but was not funded due to limited funding sources. We are seeking other funding sources to conduct the project. Conclusions: The iCanFit 2.0 program is one of the first multi-level, mobile-enabled, physical activity-promotion programs for older adults in a primary care setting. The development process has actively involved older patients and other key stakeholders. The patients, primary care providers, health coaches, and family and friends were engaged in the program using a low-cost, off-the-shelf mobile tool. Such low-cost, multi-level programs can potentially address the high prevalence of physical inactivity in older adults. %M 28899848 %R 10.2196/resprot.8220 %U http://www.researchprotocols.org/2017/9/e183/ %U https://doi.org/10.2196/resprot.8220 %U http://www.ncbi.nlm.nih.gov/pubmed/28899848 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 9 %P e319 %T Photoaging Mobile Apps in School-Based Melanoma Prevention: Pilot Study %A Brinker,Titus Josef %A Brieske,Christian Martin %A Schaefer,Christoph Matthias %A Buslaff,Fabian %A Gatzka,Martina %A Petri,Maximilian Philip %A Sondermann,Wiebke %A Schadendorf,Dirk %A Stoffels,Ingo %A Klode,Joachim %+ Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, Essen, 45147, Germany, 49 +4915175984347, titus.brinker@gmail.com %K melanoma %K skin cancer %K prevention %K mobile apps %K smartphones %K photoaging %K schools %K secondary schools %K adolescents %D 2017 %7 08.09.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Around 90% of melanomas are caused by exposure to ultraviolet (UV) radiation and are therefore eminently preventable. Tanning behavior is mostly initiated in early adolescence, often with the belief that it increases attractiveness; the problems related to malignant melanoma and other skin cancers are too far in the future to fathom. Given the substantial amount of time children and adolescents spend in schools, as well as with their mobile phones, addressing melanoma prevention via both of these ways is crucial. However, no school-based intervention using mobile apps has been evaluated to date. We recently released a photoaging mobile app, in which a selfie is altered to predict future appearance dependent on UV protection behavior and skin type. Objective: In this pilot study, we aimed to use mobile phone technology to improve school-based melanoma prevention and measure its preliminary success in different subgroups of students with regard to their UV protection behavior, Fitzpatrick skin type and age. Methods: We implemented a free photoaging mobile phone app (Sunface) in 2 German secondary schools via a method called mirroring. We “mirrored” the students’ altered 3-dimensional (3D) selfies reacting to touch on mobile phones or tablets via a projector in front of their whole grade. Using an anonymous questionnaire capturing sociodemographic data as well as risk factors for melanoma we then measured their perceptions of the intervention on a 5-point Likert scale among 205 students of both sexes aged 13-19 years (median 15 years). Results: We measured more than 60% agreement in both items that measured motivation to reduce UV exposure and only 12.5% disagreement: 126 (63.0%) agreed or strongly agreed that their 3D selfie motivated them to avoid using a tanning bed, and 124 (61.7%) to increase use of sun protection. However, only 25 (12.5%) disagreed with both items. The perceived effect on motivation was increased in participants with Fitzpatrick skin types 1-2 in both tanning bed avoidance (n=74, 71.8% agreement in skin types 1-2 vs n=50, 53.8% agreement in skin types 3-6) and increased use of sun protection (n=70, 68.0% agreement in skin types 1-2 vs n=52, 55.3% agreement in skin types 3-6), and also positively correlated with higher age. Conclusions: We present a novel way of integrating photoaging in school-based melanoma prevention that affects the students’ peer group, considers the predictors of UV exposure in accordance with the theory of planned behavior, and is particularly effective in changing behavioral predictors in fair-skinned adolescents (Fitzpatrick skin types 1-2). Further research is required to evaluate the intervention’s prospective effects on adolescents of various cultural backgrounds. %M 28887295 %R 10.2196/jmir.8661 %U http://www.jmir.org/2017/9/e319/ %U https://doi.org/10.2196/jmir.8661 %U http://www.ncbi.nlm.nih.gov/pubmed/28887295 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 9 %P e131 %T Mobile Phone Interventions for Sleep Disorders and Sleep Quality: Systematic Review %A Shin,Jong Cheol %A Kim,Julia %A Grigsby-Toussaint,Diana %+ Department of Kinesiology and Community Health, University of Illinois-Urbana Champaign, 1206 S Fourth Street, Champaign, IL, 61820, United States, 1 2173339207, dgrigs1@illinois.edu %K mHealth %K apps %K mobile health %K sleep %D 2017 %7 07.09.2017 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Although mobile health technologies have been developed for interventions to improve sleep disorders and sleep quality, evidence of their effectiveness remains limited. Objective: A systematic literature review was performed to determine the effectiveness of mobile technology interventions for improving sleep disorders and sleep quality. Methods: Four electronic databases (EBSCOhost, PubMed/Medline, Scopus, and Web of Science) were searched for articles on mobile technology and sleep interventions published between January 1983 and December 2016. Studies were eligible for inclusion if they met the following criteria: (1) written in English, (2) adequate details on study design, (3) focus on sleep intervention research, (4) sleep index measurement outcome provided, and (5) publication in peer-reviewed journals. Results: An initial sample of 2679 English-language papers were retrieved from five electronic databases. After screening and review, 16 eligible studies were evaluated to examine the impact of mobile phone interventions on sleep disorders and sleep quality. These included one case study, three pre-post studies, and 12 randomized controlled trials. The studies were categorized as (1) conventional mobile phone support and (2) utilizing mobile phone apps. Based on the results of sleep outcome measurements, 88% (14/16) studies showed that mobile phone interventions have the capability to attenuate sleep disorders and to enhance sleep quality, regardless of intervention type. In addition, mobile phone intervention methods (either alternatively or as an auxiliary) provide better sleep solutions in comparison with other recognized treatments (eg, cognitive behavioral therapy for insomnia). Conclusions: We found evidence to support the use of mobile phone interventions to address sleep disorders and to improve sleep quality. Our findings suggest that mobile phone technologies can be effective for future sleep intervention research. %M 28882808 %R 10.2196/mhealth.7244 %U http://mhealth.jmir.org/2017/9/e131/ %U https://doi.org/10.2196/mhealth.7244 %U http://www.ncbi.nlm.nih.gov/pubmed/28882808 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e305 %T Smartphone Ownership Among US Adult Cigarette Smokers: 2014 Health Information National Trends Survey (HINTS) Data %A Heffner,Jaimee L %A Mull,Kristin E %+ Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Ave N, Mail Stop M3-B232, PO Box 19024, Seattle, WA, 98109, United States, 1 2066677314, jheffner@fredhutch.org %K mHealth %K mobile health %K tobacco %K smoking %K nicotine use disorder %D 2017 %7 31.08.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite increasing interest in smartphone apps as a platform for delivery of tobacco cessation interventions, no previous studies have evaluated the prevalence and characteristics of smokers who can access smartphone-delivered interventions. Objective: To guide treatment development in this new platform and to evaluate disparities in access to smartphone-delivered interventions, we examined associations of smartphone ownership with demographics, tobacco use and thoughts about quitting, other health behaviors, physical and mental health, health care access, and Internet and technology utilization using a nationally representative sample of US adult smokers. Methods: Data were from the National Cancer Institute’s 2014 Health Information National Trends Survey 4 (HINTS 4), Cycle 4. This mailed survey targeted noninstitutionalized individuals aged 18 years or older using two-stage stratified random sampling. For this analysis, we restricted the sample to current smokers with complete data on smartphone ownership (n=479). Results: Nearly two-thirds (weighted percent=63.8%, 248/479) of smokers reported owning a smartphone. Those who were younger (P<.001), employed (P=.002), never married (P=.002), and had higher education (P=.002) and income (P<.001) had the highest rates of ownership. Smartphone owners did not differ from nonowners on frequency of smoking, recent quit attempts, or future plans to quit smoking, although they reported greater belief in the benefits of quitting (P=.04). Despite being equally likely to be overweight or obese, smartphone owners reported greater fruit and vegetable consumption (P=.03) and were more likely to report past-year efforts to increase exercise (P=.001) and to lose weight (P=.02). No differences in health care access and utilization were found. Smartphone owners reported better physical and mental health in several domains and higher access to and utilization of technology and the Internet, including for health reasons. Conclusions: Smartphone ownership among smokers mirrors many trends in the general population, including the overall rate of ownership and the association with younger age and higher socioeconomic status. Apps for smoking cessation could potentially capitalize on smartphone owners’ efforts at multiple health behavior changes and interest in communicating with health care providers via technology. These data also highlight the importance of accessible treatment options for smokers without smartphones in order to reach smokers with the highest physical and mental health burden and prevent worsening of tobacco-related health disparities as interventions move to digital platforms. %M 28860108 %R 10.2196/jmir.7953 %U https://www.jmir.org/2017/8/e305/ %U https://doi.org/10.2196/jmir.7953 %U http://www.ncbi.nlm.nih.gov/pubmed/28860108 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 3 %P e22 %T Usability of a Culturally Informed mHealth Intervention for Symptoms of Anxiety and Depression: Feedback From Young Sexual Minority Men %A Fleming,John B %A Hill,Yvette N %A Burns,Michelle Nicole %+ Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 750 North Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 503 3114, jbfleming@gmail.com %K mHealth %K eHealth %K homosexuality, male %K adolescents, male %K anxiety %K depression %D 2017 %7 25.08.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: To date, we are aware of no interventions for anxiety and depression developed as mobile phone apps and tailored to young sexual minority men, a group especially at risk of anxiety and depression. We developed TODAY!, a culturally informed mobile phone intervention for young men who are attracted to men and who have clinically significant symptoms of anxiety or depression. The core of the intervention consists of daily psychoeducation informed by transdiagnostic cognitive behavioral therapy (CBT) and a set of tools to facilitate putting these concepts into action, with regular mood ratings that result in tailored feedback (eg, tips for current distress and visualizations of mood by context). Objective: The aim of this study was to conduct usability testing to understand how young sexual minority men interact with the app, to inform later stages of intervention development. Methods: Participants (n=9) were young sexual minority men aged 18-20 years (Mean=19.00, standard deviation [SD]=0.71; 44% black, 44% white, and 11.1% Latino), who endorsed at least mild depression and anxiety symptoms. Participants were recruited via flyers, emails to college lesbian, gay, bisexual, and transgender (LGBT) organizations, Web-based advertisements, another researcher’s database of sexual minority youth interested in research participation, and word of mouth. During recorded interviews, participants were asked to think out loud while interacting with the TODAY! app on a mobile phone or with paper prototypes. Feedback identified from these recordings and from associated field notes were subjected to thematic analysis using a general inductive approach. To aid interpretation of results, methods and results are reported according to the consolidated criteria for reporting qualitative research (COREQ). Results: Thematic analysis of usability feedback revealed a theme of general positive feedback, as well as six recurring themes that informed continued development: (1) functionality (eg, highlight new material when available), (2) personalization (eg, more tailored feedback), (3) presentation (eg, keep content brief), (4) aesthetics (eg, use brighter colors), (5) LGBT or youth content (eg, add content about coming out), and (6) barriers to use (eg, perceiving psychoeducation as homework). Conclusions: Feedback from usability testing was vital to understanding what young sexual minority men desire from a mobile phone intervention for symptoms of anxiety and depression and was used to inform the ongoing development of such an intervention. %M 28842389 %R 10.2196/humanfactors.7392 %U http://humanfactors.jmir.org/2017/3/e22/ %U https://doi.org/10.2196/humanfactors.7392 %U http://www.ncbi.nlm.nih.gov/pubmed/28842389 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e295 %T The Use of Mobile Apps and SMS Messaging as Physical and Mental Health Interventions: Systematic Review %A Rathbone,Amy Leigh %A Prescott,Julie %+ School of Education and Psychology, University of Bolton, Deane Road, Bolton, BL3 5AB, United Kingdom, 44 01204903676, alr3wss@bolton.ac.uk %K mHealth %K smartphone %K health %K review %K systematic %K short message service %K treatment efficacy %K portable electronic applications %K intervention study %D 2017 %7 24.08.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The initial introduction of the World Wide Web in 1990 brought around the biggest change in information acquisition. Due to the abundance of devices and ease of access they subsequently allow, the utility of mobile health (mHealth) has never been more endemic. A substantial amount of interactive and psychoeducational apps are readily available to download concerning a wide range of health issues. mHealth has the potential to reduce waiting times for appointments; eradicate the need to meet in person with a clinician, successively diminishing the workload of mental health professionals; be more cost effective to practices; and encourage self-care tactics. Previous research has given valid evidence with empirical studies proving the effectiveness of physical and mental health interventions using mobile apps. Alongside apps, there is evidence to show that receiving short message service (SMS) messages, which entail psychoeducation, medication reminders, and links to useful informative Web pages can also be advantageous to a patient’s mental and physical well-being. Available mHealth apps and SMS services and their ever improving quality necessitates a systematic review in the area in reference to reduction of symptomology, adherence to intervention, and usability. Objective: The aim of this review was to study the efficacy, usability, and feasibility of mobile apps and SMS messages as mHealth interventions for self-guided care. Methods: A systematic literature search was carried out in JMIR, PubMed, PsychINFO, PsychARTICLES, Google Scholar, MEDLINE, and SAGE. The search spanned from January 2008 to January 2017. The primary outcome measures consisted of weight management, (pregnancy) smoking cessation, medication adherence, depression, anxiety and stress. Where possible, adherence, feasibility, and usability outcomes of the apps or SMS services were evaluated. Between-group and within-group effect sizes (Cohen d) for the mHealth intervention method group were determined. Results: A total of 27 studies, inclusive of 4658 participants were reviewed. The papers included randomized controlled trials (RCTs) (n=19), within-group studies (n=7), and 1 within-group study with qualitative aspect. Studies show improvement in physical health and significant reductions of anxiety, stress, and depression. Within-group and between-group effect sizes ranged from 0.05-3.37 (immediately posttest), 0.05-3.25 (1-month follow-up), 0.08-3.08 (2-month follow-up), 0.00-3.10 (3-month follow-up), and 0.02-0.27 (6-month follow-up). Usability and feasibility of mHealth interventions, where reported, also gave promising, significant results. Conclusions: The review shows the promising and emerging efficacy of using mobile apps and SMS text messaging as mHealth interventions. %M 28838887 %R 10.2196/jmir.7740 %U http://www.jmir.org/2017/8/e295/ %U https://doi.org/10.2196/jmir.7740 %U http://www.ncbi.nlm.nih.gov/pubmed/28838887 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 8 %P e163 %T Barriers and Facilitators for the Use of a Medical Mobile App to Prevent Work-Related Risks in Pregnancy: A Qualitative Analysis %A Velu,Adeline V %A van Beukering,Monique DM %A Schaafsma,Frederieke G %A Frings-Dresen,Monique HW %A Mol,Ben WJ %A van der Post,Joris AM %A Kok,Marjolein %+ Academic Medical Center, Department of Obstetrics and Gynecology, University of Amsterdam, Room H4-232, Meibergdreef 9, Amsterdam,, Netherlands, 31 20 5663453, a.v.velu@amc.uva.nl %K qualitative research %K mobile app %K smartphone %K pregnancy %K work %K occupation %K exposure %K eHealth %K mHealth %D 2017 %7 22.08.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The number of women participating in the labor market in Europe has increased over the last several decades. At the same time, there is growing evidence that certain conditions of employment during pregnancy may have a negative influence on pregnancy outcomes. In order to better inform pregnant women, we aim to develop an app to help assess the health risk as a result of personal and work-related factors and provide personal advice for these women and their health care providers. Objective: The aim of this study was to compose a thematic overview of the perceived facilitators and barriers according to pregnant women, medical professionals, and employers for the use of a mobile app in obstetrical care to prevent occupational-related pregnancy complications. Methods: Two multidisciplinary focus group meetings with in total 14 participants were conducted with pregnant women, occupational physicians, general practitioners, midwives, obstetricians, and representatives of trade unions and employer organizations. Transcripts were analyzed by qualitatively coding procedures and constant comparative methods. Results: We identified 24 potential facilitators and 12 potential barriers for the use of the app in 4 categories: content of the app, the app as a mean to provide information, ease of use, and external factors. The 3 main facilitators identified were the need for a good interaction between the app and the user, apps were viewed as a more practical source of information, and the information should be understandable, according to the existing guidelines, and well-dosed. The 2 main barriers for use were extensive battery and memory use of the smartphone and sending frequent push notifications. Conclusions: The results of this study are important considerations in the developing process of a medical app implementing a guideline or evidence-based information in practice. %M 28830851 %R 10.2196/resprot.7224 %U http://www.researchprotocols.org/2017/8/e163/ %U https://doi.org/10.2196/resprot.7224 %U http://www.ncbi.nlm.nih.gov/pubmed/28830851 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 6 %N 2 %P e13 %T Activity Trackers Implement Different Behavior Change Techniques for Activity, Sleep, and Sedentary Behaviors %A Duncan,Mitch %A Murawski,Beatrice %A Short,Camille E %A Rebar,Amanda L %A Schoeppe,Stephanie %A Alley,Stephanie %A Vandelanotte,Corneel %A Kirwan,Morwenna %+ School of Medicine & Public Health, Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 024921 7805, Mitch.Duncan@newcastle.edu.au %K health behavior %K public health %K exercise %K sleep %K behavior change %K fitness trackers %K adult, mobile applications %D 2017 %7 14.08.2017 %9 Original Paper %J Interact J Med Res %G English %X Background: Several studies have examined how the implementation of behavior change techniques (BCTs) varies between different activity trackers. However, activity trackers frequently allow tracking of activity, sleep, and sedentary behaviors; yet, it is unknown how the implementation of BCTs differs between these behaviors. Objective: The aim of this study was to assess the number and type of BCTs that are implemented by wearable activity trackers (self-monitoring systems) in relation to activity, sleep, and sedentary behaviors and to determine whether the number and type of BCTs differ between behaviors. Methods: Three self-monitoring systems (Fitbit [Charge HR], Garmin [Vivosmart], and Jawbone [UP3]) were each used for a 1-week period in August 2015. Each self-monitoring system was used by two of the authors (MJD and BM) concurrently. The Coventry, Aberdeen, and London-Refined (CALO-RE) taxonomy was used to assess the implementation of 40 BCTs in relation to activity, sleep, and sedentary behaviors. Discrepancies in ratings were resolved by discussion, and interrater agreement in the number of BCTs implemented was assessed using kappa statistics. Results: Interrater agreement ranged from 0.64 to 1.00. From a possible range of 40 BCTs, the number of BCTs present for activity ranged from 19 (Garmin) to 33 (Jawbone), from 4 (Garmin) to 29 (Jawbone) for sleep, and 0 (Fitbit) to 10 (Garmin) for sedentary behavior. The average number of BCTs implemented was greatest for activity (n=26) and smaller for sleep (n=14) and sedentary behavior (n=6). Conclusions: The number and type of BCTs implemented varied between each of the systems and between activity, sleep, and sedentary behaviors. This provides an indication of the potential of these systems to change these behaviors, but the long-term effectiveness of these systems to change activity, sleep, and sedentary behaviors remains unknown. %M 28807889 %R 10.2196/ijmr.6685 %U http://www.i-jmr.org/2017/2/e13/ %U https://doi.org/10.2196/ijmr.6685 %U http://www.ncbi.nlm.nih.gov/pubmed/28807889 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 1 %N 2 %P e3 %T A Mobile Health Intervention to Improve Self-Care in Patients With Heart Failure: Pilot Randomized Control Trial %A Athilingam,Ponrathi %A Jenkins,Bradlee %A Johansson,Marcia %A Labrador,Miguel %+ College of Nursing, University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, United States, 1 1 813 974 7526, pathilin@health.usf.edu %K heart failure %K mobile applications %K self-care %K quality of life %D 2017 %7 11.08.2017 %9 Original Paper %J JMIR Cardio %G English %X Background: Heart failure (HF) is a progressive chronic disease affecting 6.5 million Americans and over 15 million individuals globally. Patients with HF are required to engage in complex self-care behaviors. Although the advancements in medicine have enabled people with HF to live longer, they often have poor health-related quality of life and experience severe and frequent symptoms that limit several aspects of their lives. Mobile phone apps have not only created new and interactive ways of communication between patients and health care providers but also provide a platform to enhance adherence to self-care management. Objective: The aim of this pilot study was to test the feasibility of a newly developed mobile app (HeartMapp) in improving self-care behaviors and quality of life of patients with HF and to calculate effect sizes for sample size calculation for a larger study. Methods: This was a pilot feasibility randomized controlled trial. Participants were enrolled in the hospital before discharge and followed at home for 30 days. The intervention group used HeartMapp (n=9), whereas the control group (n=9) received HF education. These apps were downloaded onto their mobile phones for daily use. Results: A total of 72% (13/18) participants completed the study; the mean age of the participants was 53 (SD 4.02) years, 56% (10/18) were females, 61% (11/18) lived alone, 33% (6/18) were African Americans, and 61% (11/18) used mobile phone to get health information. The mean engagement with HeartMapp was 78%. Results were promising with a trend that participants in the HeartMapp group had a significant mean score change on self-care management (8.7 vs 2.3; t3.38=11, P=.01), self-care confidence (6.7 vs 1.8; t2.53=11, P=.28), and HF knowledge (3 vs −0.66; t2.37=11, P=.04. Depression improved among both groups, more so in the control group (−1.14 vs −5.17; t1.97=11, P=.07). Quality of life declined among both groups, more so in the control group (2.14 vs 9.0; t−1.43=11, P=.18). Conclusions: The trends demonstrated in this pilot feasibility study warrant further exploration on the use of HeartMapp to improve HF outcomes. Trial Registration: Pilot study, no funding from National agencies, hence not registered. %M 31758759 %R 10.2196/cardio.7848 %U http://cardio.jmir.org/2017/2/e3/ %U https://doi.org/10.2196/cardio.7848 %U http://www.ncbi.nlm.nih.gov/pubmed/31758759 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 3 %P e33 %T Preliminary Evaluation of a Brief Web and Mobile Phone Intervention for Men With Depression: Men’s Positive Coping Strategies and Associated Depression, Resilience, and Work and Social Functioning %A Fogarty,Andrea Susan %A Proudfoot,Judy %A Whittle,Erin Louise %A Clarke,Janine %A Player,Michael J %A Christensen,Helen %A Wilhelm,Kay %+ Black Dog Institute, UNSW, Hospital Rd, Randwick, 2031, Australia, 61 293829273, a.fogarty@unsw.edu.au %K depression %K eHealth %K men %K mental health %D 2017 %7 10.08.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Previous research has identified that men experiencing depression do not always access appropriate health services. Web-based interventions represent an alternative treatment option for men, are effective in reducing anxiety and depression, and have potential for wide dissemination. However, men do not access Web-based programs at the same rate as women. Programs with content explicitly tailored to men’s mental health needs are required. Objective: This study evaluated the applicability of Man Central, a new Web and mobile phone intervention for men with depression. The impact of the use of Man Central on depression, resilience, and work and social functioning was assessed. Methods: A recruitment flier was distributed via social media, email networks, newsletters, research registers, and partner organizations. A single-group, repeated measures design was used. The primary outcome was symptoms of depression. Secondary outcomes included externalizing symptoms, resilience, and work and social functioning. Man Central comprises regular mood, symptom, and behavior monitoring, combined with three 15-min interactive sessions. Clinical features are grounded in cognitive behavior therapy and problem-solving therapy. A distinguishing feature is the incorporation of positive strategies identified by men as useful in preventing and managing depression. Participants were directed to use Man Central for a period of 4 weeks. Linear mixed modeling with intention-to-treat analysis assessed associations between the intervention and the primary and secondary outcomes. Results: A total of 144 men aged between 18 and 68 years and with at least mild depression enrolled in the study. The symptoms most often monitored by men included motivation (471 instances), depression (399), sleep (323), anxiety (316), and stress (262). Reminders were scheduled by 60.4% (87/144). Significant improvements were observed in depression symptoms (P<.001, d=0.68), depression risk, and externalizing symptoms (P<.001, d=0.88) and work and social functioning (P<.001, d=0.78). No change was observed in measures of resilience. Participants reported satisfaction with the program, with a majority saying that it was easy (42/51, 82%) and convenient (41/51, 80%) to use. Study attrition was high; 27.1% (39/144) and 8.3% (12/144) of the participants provided complete follow-up data and partial follow-up data, respectively, whereas the majority (93/144, 64.6%) did not complete follow-up measures. Conclusions: This preliminary evaluation demonstrated the potential of using electronic health (eHealth) tools to deliver self-management strategies to men with depressive symptoms. Man Central may meet the treatment needs of a subgroup of depressed men who are willing to engage with an e-mental health program. With further research, it may provide an acceptable option to those unwilling or unable to access traditional mental health services. Given the limitations of the study design, prospective studies are required, using controlled designs to further elucidate the effect of the program over time. %M 28798009 %R 10.2196/mental.7769 %U http://mental.jmir.org/2017/3/e33/ %U https://doi.org/10.2196/mental.7769 %U http://www.ncbi.nlm.nih.gov/pubmed/28798009 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 8 %P e112 %T Mobile Phone Detection of Semantic Location and Its Relationship to Depression and Anxiety %A Saeb,Sohrab %A Lattie,Emily G %A Kording,Konrad P %A Mohr,David C %+ Center for Behavioral Intervention Technologies (CBITs), Department of Preventive Medicine, Northwestern University, 10th Fl., 750 N Lake Shore Dr., Chicago, IL, 60611, United States, 1 3125034626, s-saeb@northwestern.edu %K semantic location %K geographic positioning systems %K mobile phone %K classification %K decision tree ensembles %K extreme gradient boosting %K depression %K anxiety %D 2017 %7 10.08.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Is someone at home, at their friend’s place, at a restaurant, or enjoying the outdoors? Knowing the semantic location of an individual matters for delivering medical interventions, recommendations, and other context-aware services. This knowledge is particularly useful in mental health care for monitoring relevant behavioral indicators to improve treatment delivery. Local search-and-discovery services such as Foursquare can be used to detect semantic locations based on the global positioning system (GPS) coordinates, but GPS alone is often inaccurate. Mobile phones can also sense other signals (such as movement, light, and sound), and the use of these signals promises to lead to a better estimation of an individual’s semantic location. Objective: We aimed to examine the ability of mobile phone sensors to estimate semantic locations, and to evaluate the relationship between semantic location visit patterns and depression and anxiety. Methods: A total of 208 participants across the United States were asked to log the type of locations they visited daily, using their mobile phones for a period of 6 weeks, while their phone sensor data was recorded. Using the sensor data and Foursquare queries based on GPS coordinates, we trained models to predict these logged locations, and evaluated their prediction accuracy on participants that models had not seen during training. We also evaluated the relationship between the amount of time spent in each semantic location and depression and anxiety assessed at baseline, in the middle, and at the end of the study. Results: While Foursquare queries detected true semantic locations with an average area under the curve (AUC) of 0.62, using phone sensor data alone increased the AUC to 0.84. When we used Foursquare and sensor data together, the AUC further increased to 0.88. We found some significant relationships between the time spent in certain locations and depression and anxiety, although these relationships were not consistent. Conclusions: The accuracy of location services such as Foursquare can significantly benefit from using phone sensor data. However, our results suggest that the nature of the places people visit explains only a small part of the variation in their anxiety and depression symptoms. %M 28798010 %R 10.2196/mhealth.7297 %U http://mhealth.jmir.org/2017/8/e112/ %U https://doi.org/10.2196/mhealth.7297 %U http://www.ncbi.nlm.nih.gov/pubmed/28798010 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 8 %P e109 %T Usability Testing of the BRANCH Smartphone App Designed to Reduce Harmful Drinking in Young Adults %A Milward,Joanna %A Deluca,Paolo %A Drummond,Colin %A Watson,Rod %A Dunne,Jacklyn %A Kimergård,Andreas %+ Addictions Department, King's College London, 4 Windsor Walk, Denmark Hill, London, SE58BB, United Kingdom, 44 7590829898, joanna.milward@kcl.ac.uk %K alcohol %K drinking %K young adults %K mHealth %K brief intervention %K apps %K usability testing %K user experience %K focus group %D 2017 %7 08.08.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Electronic screening and brief intervention (eSBI) apps demonstrate potential to reduce harmful drinking. However, low user engagement rates with eSBI reduce overall effectiveness of interventions. As “Digital Natives,” young adults have high expectations of app quality. Ensuring that the design, content, and functionality of an eSBI app are acceptable to young adults is an integral stage to the development process. Objective: The objective of this study was to identify usability barriers and enablers for an app, BRANCH, targeting harmful drinking in young adults. Methods: The BRANCH app contains a drinking diary, alcohol reduction goal setting functions, normative drinking feedback, and information on risks and advice for cutting down. The app includes a social feature personalized to motivate cutting down and to promote engagement with a point-based system for usage. Three focus groups were conducted with 20 users who had tested the app for 1 week. A detailed thematic analysis was undertaken. Results: The first theme, “Functionality” referred to how users wanted an easy-to-use interface, with minimum required user-input. Poor functionality was considered a major usability barrier. The second theme, “Design” described how an aesthetic with minimum text, clearly distinguishable tabs and buttons and appealing infographics was integral to the level of usability. The final theme, “Content” described how participants wanted all aspects of the app to be automatically personalized to them, as well as providing them with opportunities to personalize the app themselves, with increased options for social connectivity. Conclusions: There are high demands for apps such as BRANCH that target skilled technology users including young adults. Key areas to optimize eSBI app development that emerged from testing BRANCH with representative users include high-quality functionality, appealing aesthetics, and improved personalization. %M 28790022 %R 10.2196/mhealth.7836 %U http://mhealth.jmir.org/2017/8/e109/ %U https://doi.org/10.2196/mhealth.7836 %U http://www.ncbi.nlm.nih.gov/pubmed/28790022 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 8 %P e116 %T Feasibility and Acceptability of a Text Message-Based Smoking Cessation Program for Young Adults in Lima, Peru: Pilot Study %A Blitchtein-Winicki,Dora %A Zevallos,Karine %A Samolski,M Reuven %A Requena,David %A Velarde,Chaska %A Briceño,Patricia %A Piazza,Marina %A Ybarra,Michele L %+ Executive Office of Research, Peruvian National Institute of Health, Cápac Yupanqui 1400, Jesus María, Lima, CP 11, Peru, 51 999 090917, dblit2007@gmail.com %K Pilot Projects, Text Messaging, Smoking Cessation, Young Adult, Cognitive Therapy, Feasibility Studies, Latinos %D 2017 %7 04.08.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In Peru’s urban communities, tobacco smoking generally starts during adolescence and smoking prevalence is highest among young adults. Each year, many attempt to quit, but access to smoking cessation programs is limited. Evidence-based text messaging smoking cessation programs are an alternative that has been successfully implemented in high-income countries, but not yet in middle- and low-income countries with limited tobacco control policies. Objective: The objective was to assess the feasibility and acceptability of an short message service (SMS) text message-based cognitive behavioral smoking cessation program for young adults in Lima, Peru. Methods: Recruitment included using flyers and social media ads to direct young adults interested in quitting smoking to a website where interested participants completed a Google Drive survey. Inclusion criteria were being between ages 18 and 25 years, smoking at least four cigarettes per day at least 6 days per week, willing to quit in the next 30 days, owning a mobile phone, using SMS text messaging at least once in past year, and residing in Lima. Participants joined one of three phases: (1) focus groups and in-depth interviews whose feedback was used to develop the SMS text messages, (2) validating the SMS text messages, and (3) a pilot of the SMS text message-based smoking cessation program to test its feasibility and acceptability among young adults in Lima. The outcome measures included adherence to the SMS text message-based program, acceptability of content, and smoking abstinence self-report on days 2, 7, and 30 after quitting. Results: Of 639 participants who completed initial online surveys, 42 met the inclusion criteria and 35 agreed to participate (focus groups and interviews: n=12; validate SMS text messages: n=8; program pilot: n=15). Common quit practices and beliefs emerged from participants in the focus groups and interviews informed the content, tone, and delivery schedule of the messages used in the SMS text message smoking cessation program. A small randomized controlled pilot trial was performed to test the program’s feasibility and acceptability; nine smokers were assigned to the SMS text message smoking cessation program and six to a SMS text message nutrition program. Participant retention was high: 93% (14/15) remained until day 30 after quit day. In all, 56% of participants (5/9) in the SMS text message smoking cessation program reported remaining smoke-free until day 30 after quit day and 17% of participants (1/6) in the SMS text message nutrition program reported remaining smoke-free during the entire program. The 14 participants who completed the pilot reported that they received valuable health information and approved the delivery schedule of the SMS text messages. Conclusions: This study provides initial evidence that a SMS text message smoking cessation program is feasible and acceptable for young adults residing in Lima. %M 28778850 %R 10.2196/mhealth.7532 %U http://mhealth.jmir.org/2017/8/e116/ %U https://doi.org/10.2196/mhealth.7532 %U http://www.ncbi.nlm.nih.gov/pubmed/28778850 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 8 %P e114 %T How Do Apps Work? An Analysis of Physical Activity App Users’ Perceptions of Behavior Change Mechanisms %A Hoj,Taylor H %A Covey,Emarie L %A Jones,Allyn C %A Haines,Amanda C %A Hall,P Cougar %A Crookston,Benjamin T %A West,Joshua H %+ Computational Health Science Research Group, Department of Health Science, Brigham Young University, 2139 Life Sciences Building, Provo, UT, 84602, United States, 1 801 422 3444, josh.west@byu.edu %K mHealth %K mobile apps %K health behavior %K smartphone %D 2017 %7 03.08.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity apps are commonly used to increase levels of activity and health status. To date, the focus of research has been to determine the potential of apps to influence behavior, to ascertain the efficacy of a limited number of apps to change behavior, and to identify the characteristics of apps that users prefer. Objective: The purpose of this study was to identify the mechanisms by which the use of physical activity apps may influence the users’ physical activity behavior. Methods: This study used a cross-sectional survey of users of health-related physical activity apps during the past 6 months. An electronic survey was created in Qualtrics’ Web-based survey software and deployed on Amazon Mechanical Turk. Individuals who had used at least one physical activity app in the past 6 months were eligible to respond. The final sample comprised 207 adults living in the United States. 86.0% (178/207) of respondents were between the ages of 26 and 54 years, with 51.2% (106/207) of respondents being female. Behavior change theory informed the creation of 20 survey items relating to the mechanisms of behavior change. Respondents also reported about engagement with the apps, app likeability, and physical activity behavior. Results: Respondents reported that using a physical activity app in the past 6 months resulted in a change in their attitudes, beliefs, perceptions, and motivation. Engagement with the app (P<.001), frequency of app use (P=.03), and app price (P=.01) were related to the reported impact of the behavior change theory or mechanisms of change. The mechanisms of change were associated with self-reported physical activity behaviors (P<.001). Conclusions: The findings from this study provide an overview of the mechanisms by which apps may impact behavior. App developers may wish to incorporate these mechanisms in an effort to increase impact. Practitioners should consider the extent to which behavior change theory is integrated into a particular app when they consider making recommendations to others wishing to increase levels of physical activity. %M 28778846 %R 10.2196/mhealth.7206 %U http://mhealth.jmir.org/2017/8/e114/ %U https://doi.org/10.2196/mhealth.7206 %U http://www.ncbi.nlm.nih.gov/pubmed/28778846 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e281 %T Behavior Change Techniques in Physical Activity eHealth Interventions for People With Cardiovascular Disease: Systematic Review %A Duff,Orlaith Mairead %A Walsh,Deirdre MJ %A Furlong,Bróna A %A O'Connor,Noel E %A Moran,Kieran A %A Woods,Catherine B %+ School of Health and Human Performance and Insight Centre for Data Analytics, Dublin City University, Room A246 (Albert College), School of Health and Human Performance, Dublin City University, Dublin, D9, Ireland, 353 1 700 ext 8011, kieran.moran@dcu.ie %K systematic review %K exercise %K behavior %K telemedicine %K cardiovascular disease %D 2017 %7 02.08.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Cardiovascular disease (CVD) is the leading cause of premature death and disability in Europe, accounting for 4 million deaths per year and costing the European Union economy almost €196 billion annually. There is strong evidence to suggest that exercise-based secondary rehabilitation programs can decrease the mortality risk and improve health among patients with CVD. Theory-informed use of behavior change techniques (BCTs) is important in the design of cardiac rehabilitation programs aimed at changing cardiovascular risk factors. Electronic health (eHealth) is the use of information and communication technologies (ICTs) for health. This emerging area of health care has the ability to enhance self-management of chronic disease by making health care more accessible, affordable, and available to the public. However, evidence-based information on the use of BCTs in eHealth interventions is limited, and particularly so, for individuals living with CVD. Objective: The aim of this systematic review was to assess the application of BCTs in eHealth interventions designed to increase physical activity (PA) in CVD populations. Methods: A total of 7 electronic databases, including EBSCOhost (MEDLINE, PsycINFO, Academic Search Complete, SPORTDiscus with Full Text, and CINAHL Complete), Scopus, and Web of Science (Core Collection) were searched. Two authors independently reviewed references using the software package Covidence (Veritas Health Innovation). The reviewers met to resolve any discrepancies, with a third independent reviewer acting as an arbitrator when required. Following this, data were extracted from the papers that met the inclusion criteria. Bias assessment of the studies was carried out using the Cochrane Collaboration’s tool for assessing the risk of bias within Covidence; this was followed by a narrative synthesis. Results: Out of the 987 studies that were identified, 14 were included in the review. An additional 9 studies were added following a hand search of review paper references. The average number of BCTs used across the 23 studies was 7.2 (range 1-19). The top three most frequently used BCTs included information about health consequences (78%, 18/23), goal setting (behavior; 74%, 17/23), and joint third, self-monitoring of behavior and social support (practical) were included in 11 studies (48%, 11/23) each. Conclusions: This systematic review is the first to investigate the use of BCTs in PA eHealth interventions specifically designed for people with CVD. This research will have clear implications for health care policy and research by outlining the BCTs used in eHealth interventions for chronic illnesses, in particular CVD, thereby providing clear foundations for further research and developments in the area. %M 28768610 %R 10.2196/jmir.7782 %U http://www.jmir.org/2017/8/e281/ %U https://doi.org/10.2196/jmir.7782 %U http://www.ncbi.nlm.nih.gov/pubmed/28768610 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 8 %P e102 %T A Smartphone App for Families With Preschool-Aged Children in a Public Nutrition Program: Prototype Development and Beta-Testing %A Hull,Pamela %A Emerson,Janice S %A Quirk,Meghan E %A Canedo,Juan R %A Jones,Jessica L %A Vylegzhanina,Violetta %A Schmidt,Douglas C %A Mulvaney,Shelagh A %A Beech,Bettina M %A Briley,Chiquita %A Harris,Calvin %A Husaini,Baqar A %+ Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 800, Nashville, TN,, United States, 1 615 936 3241, pam.hull@vanderbilt.edu %K pediatric obesity %K health education %K public health informatics %K mobile apps %D 2017 %7 02.08.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in the United States provides free supplemental food and nutrition education to low-income mothers and children under age 5 years. Childhood obesity prevalence is higher among preschool children in the WIC program compared to other children, and WIC improves dietary quality among low-income children. The Children Eating Well (CHEW) smartphone app was developed in English and Spanish for WIC-participating families with preschool-aged children as a home-based intervention to reinforce WIC nutrition education and help prevent childhood obesity. Objective: This paper describes the development and beta-testing of the CHEW smartphone app. The objective of beta-testing was to test the CHEW app prototype with target users, focusing on usage, usability, and perceived barriers and benefits of the app. Methods: The goals of the CHEW app were to make the WIC shopping experience easier, maximize WIC benefit redemption, and improve parent snack feeding practices. The CHEW app prototype consisted of WIC Shopping Tools, including a barcode scanner and calculator tools for the cash value voucher for purchasing fruits and vegetables, and nutrition education focused on healthy snacks and beverages, including a Yummy Snack Gallery and Healthy Snacking Tips. Mothers of 63 black and Hispanic WIC-participating children ages 2 to 4 years tested the CHEW app prototype for 3 months and completed follow-up interviews. Results: Study participants testing the app for 3 months used the app on average once a week for approximately 4 and a half minutes per session, although substantial variation was observed. Usage of specific features averaged at 1 to 2 times per month for shopping-related activities and 2 to 4 times per month for the snack gallery. Mothers classified as users rated the app’s WIC Shopping Tools relatively high on usability and benefits, although variation in scores and qualitative feedback highlighted several barriers that need to be addressed. The Yummy Snack Gallery and Healthy Snacking Tips scored higher on usability than benefits, suggesting that the nutrition education components may have been appealing but too limited in scope and exposure. Qualitative feedback from mothers classified as non-users pointed to several important barriers that could preclude some WIC participants from using the app at all. Conclusions: The prototype study successfully demonstrated the feasibility of using the CHEW app prototype with mothers of WIC-enrolled black and Hispanic preschool-aged children, with moderate levels of app usage and moderate to high usability and benefits. Future versions with enhanced shopping tools and expanded nutrition content should be implemented in WIC clinics to evaluate adoption and behavioral outcomes. This study adds to the growing body of research focused on the application of technology-based interventions in the WIC program to promote program retention and childhood obesity prevention. %M 28768611 %R 10.2196/mhealth.7477 %U http://mhealth.jmir.org/2017/8/e102/ %U https://doi.org/10.2196/mhealth.7477 %U http://www.ncbi.nlm.nih.gov/pubmed/28768611 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e277 %T Key Components in eHealth Interventions Combining Self-Tracking and Persuasive eCoaching to Promote a Healthier Lifestyle: A Scoping Review %A Lentferink,Aniek J %A Oldenhuis,Hilbrand KE %A de Groot,Martijn %A Polstra,Louis %A Velthuijsen,Hugo %A van Gemert-Pijnen,Julia EWC %+ Centre for eHealth & Wellbeing Research, Departement of Psychology, Health, and Technology, University of Twente, Cubicus Bldg, 10 De Zul, Enschede, 7522 NJ, Netherlands, 31 505956217, a.j.lentferink@utwente.nl %K telemedicine %K review %K health promotion %K remote sensing technology %D 2017 %7 01.08.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The combination of self-tracking and persuasive eCoaching in automated interventions is a new and promising approach for healthy lifestyle management. Objective: The aim of this study was to identify key components of self-tracking and persuasive eCoaching in automated healthy lifestyle interventions that contribute to their effectiveness on health outcomes, usability, and adherence. A secondary aim was to identify the way in which these key components should be designed to contribute to improved health outcomes, usability, and adherence. Methods: The scoping review methodology proposed by Arskey and O’Malley was applied. Scopus, EMBASE, PsycINFO, and PubMed were searched for publications dated from January 1, 2013 to January 31, 2016 that included (1) self-tracking, (2) persuasive eCoaching, and (3) healthy lifestyle intervention. Results: The search resulted in 32 publications, 17 of which provided results regarding the effect on health outcomes, 27 of which provided results regarding usability, and 13 of which provided results regarding adherence. Among the 32 publications, 27 described an intervention. The most commonly applied persuasive eCoaching components in the described interventions were personalization (n=24), suggestion (n=19), goal-setting (n=17), simulation (n=17), and reminders (n=15). As for self-tracking components, most interventions utilized an accelerometer to measure steps (n=11). Furthermore, the medium through which the user could access the intervention was usually a mobile phone (n=10). The following key components and their specific design seem to influence both health outcomes and usability in a positive way: reduction by setting short-term goals to eventually reach long-term goals, personalization of goals, praise messages, reminders to input self-tracking data into the technology, use of validity-tested devices, integration of self-tracking and persuasive eCoaching, and provision of face-to-face instructions during implementation. In addition, health outcomes or usability were not negatively affected when more effort was requested from participants to input data into the technology. The data extracted from the included publications provided limited ability to identify key components for adherence. However, one key component was identified for both usability and adherence, namely the provision of personalized content. Conclusions: This scoping review provides a first overview of the key components in automated healthy lifestyle interventions combining self-tracking and persuasive eCoaching that can be utilized during the development of such interventions. Future studies should focus on the identification of key components for effects on adherence, as adherence is a prerequisite for an intervention to be effective. %M 28765103 %R 10.2196/jmir.7288 %U http://www.jmir.org/2017/8/e277/ %U https://doi.org/10.2196/jmir.7288 %U http://www.ncbi.nlm.nih.gov/pubmed/28765103 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 3 %P e28 %T A Smartphone App for Adolescents With Sleep Disturbance: Development of the Sleep Ninja %A Werner-Seidler,Aliza %A O'Dea,Bridianne %A Shand,Fiona %A Johnston,Lara %A Frayne,Anna %A Fogarty,Andrea S %A Christensen,Helen %+ Black Dog Institute, University of New South Wales, Hospital Road, Sydney, 2031, Australia, 61 293823769, a.werner-seidler@blackdog.org.au %K insomnia %K sleep %K adolescence %K depression %K cognitive behavioral therapy %K smartphone %D 2017 %7 28.07.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Sleep disturbances are common in young people and have consequences for academic, social, emotional, and behavioral development. The most effective treatment is cognitive behavioral therapy for insomnia (CBT-I), with evidence suggesting that it is efficacious even when delivered digitally. Objective: There are no commercially available digitally delivered CBT-I programs for use by young people. The aim of this project was to develop a smartphone app that delivers CBT-I to young people to improve sleep. Methods: To inform the development of the app, young people (N=21) aged between 12 and 16 years attended one of the 3 focus groups (each with 4-10 participants). These focus groups were conducted at different stages of the development process such that the process could be iterative. Participants were asked the reasons why they might use an app to help them sleep, the kinds of features or functions that they would like to see in such an app, and any concerns they may have in using the app. Data were analyzed using a thematic analysis approach. Of the issues discussed by the participants, the researchers selected themes associated with content, functionality, and accessibility and user experience to examine, as these were most informative for the app design process. Results: In terms of content, young people were interested in receiving information about recommended sleep guidelines and personalized information for their age group. They reported that keeping a sleep diary was acceptable, but they should be able to complete it flexibly, in their own time. They reported mixed views about the use of the phone’s accelerometer. Young people felt that the functionality of the app should include elements of game playing if they were to remain engaged with the app. Flexibility of use and personalized features were also desirable, and there were mixed views about the schedule of notifications and reminders. Participants reported that for the app to be accessible and usable, it should be from a trusted developer, have engaging aesthetics, have a layout that is easy to navigate, not rely on Internet coverage, and preferably be free. Participants felt that being able to conceal the purpose of the app from peers was an advantage and were willing to provide personal information to use the app if the purpose and use of that information was made clear. Overall, participants endorsed the use of the app for sleep problems among their age group and reported motivation to use it. Conclusions: The Sleep Ninja is a fully-automated app that delivers CBT-I to young people, incorporating the features and information that young people reported they would expect from this app. A pilot study testing the feasibility, acceptability, and efficacy of the Sleep Ninja is now underway. %M 28754651 %R 10.2196/mental.7614 %U http://mental.jmir.org/2017/3/e28/ %U https://doi.org/10.2196/mental.7614 %U http://www.ncbi.nlm.nih.gov/pubmed/28754651 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 7 %P e101 %T Photoaging Mobile Apps as a Novel Opportunity for Melanoma Prevention: Pilot Study %A Brinker,Titus Josef %A Schadendorf,Dirk %A Klode,Joachim %A Cosgarea,Ioana %A Rösch,Alexander %A Jansen,Philipp %A Stoffels,Ingo %A Izar,Benjamin %+ Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, Essen, 45147, Germany, 49 15175084347, titus.brinker@gmail.com %K melanoma %K skin cancer %K prevention %K mobile apps %K smartphones %K photoaging %D 2017 %7 26.07.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Around 90% of melanomas are caused by ultraviolet (UV) exposure and are therefore eminently preventable. Unhealthy tanning behavior is mostly initiated in early adolescence, often with the belief that it increases attractiveness; the problems related to skin atrophy and malignant melanoma are too far in the future to fathom. Photoaging desktop programs, in which an image is altered to predict future appearance, have been successful in positively influencing behavior in adiposity or tobacco prevention settings. Objective: To develop and test a photoaging app designed for melanoma prevention. Methods: We harnessed the widespread availability of mobile phones and adolescents’ interest in appearance to develop a free mobile app called Sunface. This app has the user take a self-portrait (ie, a selfie), and then photoages the image based on Fitzpatrick skin type and individual UV protection behavior. Afterward, the app explains the visual results and aims at increasing self-competence on skin cancer prevention by providing guideline recommendations on sun protection and the ABCDE rule for melanoma self-detection. The underlying aging algorithms are based on publications showing UV-induced skin damage by outdoor as well as indoor tanning. To get a first impression on how well the app would be received in a young target group, we included a total sample of 25 students in our cross-sectional pilot study with a median age of 22 (range 19-25) years of both sexes (11/25, 44% female; 14/25, 56% male) attending the University of Essen in Germany. Results: The majority of enrolled students stated that they would download the app (22/25, 88%), that the intervention had the potential to motivate them to use sun protection (23/25, 92%) and that they thought such an app could change their perceptions that tanning makes you attractive (19/25, 76%). Only a minority of students disagreed or fully disagreed that they would download such an app (2/25, 8%) or that such an app could change their perceptions on tanning and attractiveness (4/25, 16%). Conclusions: Based on previous studies and the initial study results presented here, it is reasonable to speculate that the app may induce behavioral change in the target population. Further work is required to implement and examine the effectiveness of app-based photoaging interventions within risk groups from various cultural backgrounds. %M 28747297 %R 10.2196/mhealth.8231 %U http://mhealth.jmir.org/2017/7/e101/ %U https://doi.org/10.2196/mhealth.8231 %U http://www.ncbi.nlm.nih.gov/pubmed/28747297 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 7 %P e97 %T Estimating Heart Rate, Energy Expenditure, and Physical Performance With a Wrist Photoplethysmographic Device During Running %A Parak,Jakub %A Uuskoski,Maria %A Machek,Jan %A Korhonen,Ilkka %+ BioMediTech Institute, Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Korkeakoulunkatu 10, Tampere, 33720, Finland, 358 447647457, jakub.parak@tut.fi %K fitness trackers %K photoplethysmography %K heart rate %K heart rate determination %K exercise test %K oxygen consumption %K energy metabolism %D 2017 %7 25.07.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable sensors enable long-term monitoring of health and wellbeing indicators. An objective evaluation of sensors’ accuracy is important, especially for their use in health care. Objective: The aim of this study was to use a wrist-worn optical heart rate (OHR) device to estimate heart rate (HR), energy expenditure (EE), and maximal oxygen intake capacity (VO2Max) during running and to evaluate the accuracy of the estimated parameters (HR, EE, and VO2Max) against golden reference methods. Methods: A total of 24 healthy volunteers, of whom 11 were female, with a mean age of 36.2 years (SD 8.2 years) participated in a submaximal self-paced outdoor running test and maximal voluntary exercise test in a sports laboratory. OHR was monitored with a PulseOn wrist-worn photoplethysmographic device and the running speed with a phone GPS sensor. A physiological model based on HR, running speed, and personal characteristics (age, gender, weight, and height) was used to estimate EE during the maximal voluntary exercise test and VO2Max during the submaximal outdoor running test. ECG-based HR and respiratory gas analysis based estimates were used as golden references. Results: OHR was able to measure HR during running with a 1.9% mean absolute percentage error (MAPE). VO2Max estimated during the submaximal outdoor running test was closely similar to the sports laboratory estimate (MAPE 5.2%). The energy expenditure estimate (n=23) was quite accurate when HR was above the aerobic threshold (MAPE 6.7%), but MAPE increased to 16.5% during a lighter intensity of exercise. Conclusions: The results suggest that wrist-worn OHR may accurately estimate HR during running up to maximal HR. When combined with physiological modeling, wrist-worn OHR may be used for an estimation of EE, especially during higher intensity running, and VO2Max, even during submaximal self-paced outdoor recreational running. %M 28743682 %R 10.2196/mhealth.7437 %U http://mhealth.jmir.org/2017/7/e97/ %U https://doi.org/10.2196/mhealth.7437 %U http://www.ncbi.nlm.nih.gov/pubmed/28743682 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 7 %P e105 %T Exploring the Association Between Self-Reported Asthma Impact and Fitbit-Derived Sleep Quality and Physical Activity Measures in Adolescents %A Bian,Jiang %A Guo,Yi %A Xie,Mengjun %A Parish,Alice E %A Wardlaw,Isaac %A Brown,Rita %A Modave,François %A Zheng,Dong %A Perry,Tamara T %+ Department of Health Outcomes and Policy, University of Florida, 2004 Mowry Road, Suite 3228, PO Box 100219, Gainesville, FL, 32610, United States, 1 (352) 273 8878, bianjiang@ufl.edu %K mobile health %K mHealth %K asthma %K Fitbit %K physical activity %K sleep %K sleep quality %D 2017 %7 25.07.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smart wearables such as the Fitbit wristband provide the opportunity to monitor patients more comprehensively, to track patients in a fashion that more closely follows the contours of their lives, and to derive a more complete dataset that enables precision medicine. However, the utility and efficacy of using wearable devices to monitor adolescent patients’ asthma outcomes have not been established. Objective: The objective of this study was to explore the association between self‑reported sleep data, Fitbit sleep and physical activity data, and pediatric asthma impact (PAI). Methods: We conducted an 8‑week pilot study with 22 adolescent asthma patients to collect: (1) weekly or biweekly patient‑reported data using the Patient-Reported Outcomes Measurement Information System (PROMIS) measures of PAI, sleep disturbance (SD), and sleep‑related impairment (SRI) and (2) real-time Fitbit (ie, Fitbit Charge HR) data on physical activity (F-AM) and sleep quality (F‑SQ). To explore the relationship among the self-reported and Fitbit measures, we computed weekly Pearson correlations among these variables of interest. Results: We have shown that the Fitbit-derived sleep quality F-SQ measure has a moderate correlation with the PROMIS SD score (average r=−.31, P=.01) and a weak but significant correlation with the PROMIS PAI score (average r=−.18, P=.02). The Fitbit physical activity measure has a negligible correlation with PAI (average r=.04, P=.62). Conclusions: Our findings support the potential of using wrist-worn devices to continuously monitor two important factors—physical activity and sleep—associated with patients’ asthma outcomes and to develop a personalized asthma management platform. %M 28743679 %R 10.2196/mhealth.7346 %U http://mhealth.jmir.org/2017/7/e105/ %U https://doi.org/10.2196/mhealth.7346 %U http://www.ncbi.nlm.nih.gov/pubmed/28743679 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e250 %T Youth Oriented Activity Trackers: Comprehensive Laboratory- and Field-Based Validation %A Sirard,John R %A Masteller,Brittany %A Freedson,Patty S %A Mendoza,Albert %A Hickey,Amanda %+ Department of Kinesiology, University of Massachusetts Amherst, 30 Eastman Lane, Totman 110, Amherst, MA, 01003, United States, 1 4135457898, jsirard@kin.umass.edu %K child %K movement %K fitness trackers %D 2017 %7 19.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Commercial activity trackers are growing in popularity among adults and some are beginning to be marketed to children. There is, however, a paucity of independent research examining the validity of these devices to detect physical activity of different intensity levels. Objectives: The purpose of this study was to determine the validity of the output from 3 commercial youth-oriented activity trackers in 3 phases: (1) orbital shaker, (2) structured indoor activities, and (3) 4 days of free-living activity. Methods: Four units of each activity tracker (Movband [MB], Sqord [SQ], and Zamzee [ZZ]) were tested in an orbital shaker for 5-minutes at three frequencies (1.3, 1.9, and 2.5 Hz). Participants for Phase 2 (N=14) and Phase 3 (N=16) were 6-12 year old children (50% male). For Phase 2, participants completed 9 structured activities while wearing each tracker, the ActiGraph GT3X+ (AG) research accelerometer, and a portable indirect calorimetry system to assess energy expenditure (EE). For Phase 3, participants wore all 4 devices for 4 consecutive days. Correlation coefficients, linear models, and non-parametric statistics evaluated the criterion and construct validity of the activity tracker output. Results: Output from all devices was significantly associated with oscillation frequency (r=.92-.99). During Phase 2, MB and ZZ only differentiated sedentary from light intensity (P<.01), whereas the SQ significantly differentiated among all intensity categories (all comparisons P<.01), similar to AG and EE. During Phase 3, AG counts were significantly associated with activity tracker output (r=.76, .86, and .59 for the MB, SQ, and ZZ, respectively). Conclusions: Across study phases, the SQ demonstrated stronger validity than the MB and ZZ. The validity of youth-oriented activity trackers may directly impact their effectiveness as behavior modification tools, demonstrating a need for more research on such devices. %M 28724509 %R 10.2196/jmir.6360 %U http://www.jmir.org/2017/7/e250/ %U https://doi.org/10.2196/jmir.6360 %U http://www.ncbi.nlm.nih.gov/pubmed/28724509 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e253 %T Ecological Momentary Assessment of Physical Activity: Validation Study %A Knell,Gregory %A Gabriel,Kelley Pettee %A Businelle,Michael S %A Shuval,Kerem %A Wetter,David W %A Kendzor,Darla E %+ Michael and Susan Dell Center for Healthy Living, Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center (UTHealth) at Houston, 7000 Fannin, #2528, Houston, TX, 77030, United States, 1 713 500 9678, gregory.knell@uth.tmc.edu %K accelerometry %K behavioral risk factor surveillance system %K ecological momentary assessment %K self-report %K data accuracy %D 2017 %7 18.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Ecological momentary assessment (EMA) may elicit physical activity (PA) estimates that are less prone to bias than traditional self-report measures while providing context. Objectives: The objective of this study was to examine the convergent validity of EMA-assessed PA compared with accelerometry. Methods: The participants self-reported their PA using International Physical Activity Questionnaire (IPAQ) and Behavioral Risk Factor Surveillance System (BRFSS) and wore an accelerometer while completing daily EMAs (delivered through the mobile phone) for 7 days. Weekly summary estimates included sedentary time and moderate-, vigorous-, and moderate-to vigorous-intensity physical activity (MVPA). Spearman coefficients and Lin’s concordance correlation coefficients (LCC) examined the linear association and agreement for EMA and the questionnaires as compared with accelerometry. Results: Participants were aged 43.3 (SD 13.1) years, 51.7% (123/238) were African American, 74.8% (178/238) were overweight or obese, and 63.0% (150/238) were low income. The linear associations of EMA and traditional self-reports with accelerometer estimates were statistically significant (P<.05) for sedentary time (EMA: ρ=.16), moderate-intensity PA (EMA: ρ=.29; BRFSS: ρ=.17; IPAQ: ρ=.24), and MVPA (EMA: ρ=.31; BRFSS: ρ=.17; IPAQ: ρ=.20). Only EMA estimates of PA were statistically significant compared with accelerometer for agreement. Conclusions: The mobile EMA showed better correlation and agreement to accelerometer estimates than traditional self-report methods. These findings suggest that mobile EMA may be a practical alternative to accelerometers to assess PA in free-living settings. %M 28720556 %R 10.2196/jmir.7602 %U http://www.jmir.org/2017/7/e253/ %U https://doi.org/10.2196/jmir.7602 %U http://www.ncbi.nlm.nih.gov/pubmed/28720556 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e246 %T Effectiveness of Digital Medicines to Improve Clinical Outcomes in Patients with Uncontrolled Hypertension and Type 2 Diabetes: Prospective, Open-Label, Cluster-Randomized Pilot Clinical Trial %A Frias,Juan %A Virdi,Naunihal %A Raja,Praveen %A Kim,Yoona %A Savage,George %A Osterberg,Lars %+ Proteus Digital Health, 2600 Bridge Parkway, Redwood City, CA, 94065, United States, 1 4158285009, nvirdi@proteus.com %K digital medicine %K hypertension %K type 2 diabetes %K patient engagement, medication adherence %K therapeutic inertia %D 2017 %7 11.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Hypertension and type 2 diabetes mellitus are major modifiable risk factors for cardiac, cerebrovascular, and kidney diseases. Reasons for poor disease control include nonadherence, lack of patient engagement, and therapeutic inertia. Objective: The aim of this study was to assess the impact on clinic-measured blood pressure (BP) and glycated hemoglobin (HbA1c) using a digital medicine offering (DMO) that measures medication ingestion adherence, physical activity, and rest using digital medicines (medication taken with ingestible sensor), wearable sensor patches, and a mobile device app. Methods: Participants with elevated systolic BP (SBP ≥140 mm Hg) and HbA1c (≥7%) failing antihypertensive (≥2 medications) and oral diabetes therapy were enrolled in this three-arm, 12-week, cluster-randomized study. Participants used DMO (includes digital medicines, the wearable sensor patch, and the mobile device app) for 4 or 12 weeks or received usual care based on site randomization. Providers in the DMO arms could review the DMO data via a Web portal. In all three arms, providers were instructed to make medical decisions (medication titration, adherence counseling, education, and lifestyle coaching) on all available clinical information at each visit. Primary outcome was change in SBP at week 4. Other outcomes included change in SBP and HbA1c at week 12, and low-density lipoprotein cholesterol (LDL-C) and diastolic blood pressure (DBP) at weeks 4 and 12, as well as proportion of patients at BP goal (<140/90 mm Hg) at weeks 4 and 12, medical decisions, and medication adherence patterns. Results: Final analysis included 109 participants (12 sites; age: mean 58.7, SD years; female: 49.5%, 54/109; Hispanic: 45.9%, 50/109; income ≤ US $20,000: 56.9%, 62/109; and ≤ high school education: 52.3%, 57/109). The DMO groups had 80 participants (7 sites) and usual care had 29 participants (5 sites). At week 4, DMO resulted in a statistically greater SBP reduction than usual care (mean –21.8, SE 1.5 mm Hg vs mean –12.7, SE 2.8 mmHg; mean difference –9.1, 95% CI –14.0 to –3.3 mm Hg) and maintained a greater reduction at week 12. The DMO groups had greater reductions in HbA1c, DBP, and LDL-C, and a greater proportion of participants at BP goal at weeks 4 and 12 compared with usual care. The DMO groups also received more therapeutic interventions than usual care. Medication adherence was ≥80% while using the DMO. The most common adverse event was a self-limited rash at the wearable sensor site (12%, 10/82). Conclusions: For patients failing hypertension and diabetes oral therapy, this DMO, which provides dose-by-dose feedback on medication ingestion adherence, can help lower BP, HbA1c, and LDL-C, and promote patient engagement and provider decision making. Trial Registration: Clinicaltrials.gov NCT02827630; https://clinicaltrials.gov/show/NCT02827630 (Archived by WebCite at http://www.webcitation.org/6rL8dW2VF) %M 28698169 %R 10.2196/jmir.7833 %U http://www.jmir.org/2017/7/e246/ %U https://doi.org/10.2196/jmir.7833 %U http://www.ncbi.nlm.nih.gov/pubmed/28698169 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 7 %P e93 %T Content Analysis of Smartphone Apps for Smoking Cessation in China: Empirical Study %A Cheng,Feng %A Xu,Junfang %A Su,Chunyan %A Fu,Xiaoxing %A Bricker,Jonathan %+ Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle, WA,, United States, 1 206 667 5074, jbricker@fredhutch.org %K smoking cessation %K smartphone apps %K China %D 2017 %7 11.07.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With 360 million smokers, China consumes more cigarettes than any other country in the world. Given that 620 million Chinese own smartphones, smartphone apps for smoking cessation are increasingly used in China to help smokers quit. Objective: This study analyzed and evaluated the contents of all smoking cessation apps (iOS and Android) available in China, applying the China Clinical Smoking Cessation Guideline (CCSCG; identical to the US Clinical Practice Guideline for Treating Tobacco Use and Dependence) as a framework for analysis. Methods: We conducted a content analysis of Chinese Android and iOS smoking cessation apps (N=64) designed to assist users in quitting smoking. Each app was independently coded by two raters for its approach to smoking cessation and adherence to the CCSCG. We also recorded the features of smoking cessation apps (eg, release date, size, frequency of downloads, user ratings, type, quality scores by raters, and designers). Linear regression was used to test predictors of popularity and user-rated quality. Results: Chinese smoking cessation apps have low levels of adherence to guidelines, with an average score of 11.1 for Android and 14.6 for iOS apps on a scale of 0 to 46. There was no significant association between popularity, user rating, and the characteristics of apps. However, there was a positive relationship between popularity, user rating, and adherence score. Conclusions: Chinese apps for smoking cessation have low levels of adherence to standard clinical practice guidelines. New apps need be developed and existing apps be revised following evidence-based principles in China. %M 28698170 %R 10.2196/mhealth.7462 %U http://mhealth.jmir.org/2017/7/e93/ %U https://doi.org/10.2196/mhealth.7462 %U http://www.ncbi.nlm.nih.gov/pubmed/28698170 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 7 %P e95 %T Controlling Your “App”etite: How Diet and Nutrition-Related Mobile Apps Lead to Behavior Change %A West,Joshua H %A Belvedere,Lindsay M %A Andreasen,Rebecca %A Frandsen,Christine %A Hall,P Cougar %A Crookston,Benjamin T %+ Department of Health Science, Brigham Young University, 2139 LSB, Provo, UT,, United States, 1 8014223444, josh.west@byu.edu %K diet %K nutritional status %K mobile apps %K behavior and behavior mechanisms %D 2017 %7 10.07.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In recent years, obesity has become a serious public health crisis in the United States. Although the problem of obesity is being addressed through a variety of strategies, the use of mobile apps is a relatively new development that could prove useful in helping people to develop healthy dietary habits. Though such apps might lead to health behavior change, especially when relevant behavior change theory constructs are integrated into them, the mechanisms by which these apps facilitate behavior change are largely unknown. Objective: The purpose of this study was to identify which behavior change mechanisms are associated with the use of diet- and nutrition-related health apps and whether the use of diet- and nutrition-related apps is associated with health behavior change. Methods: A cross-sectional survey was administered to a total of 217 participants. Participants responded to questions on demographics, use of diet and nutrition apps in the past 6 months, engagement and likability of apps, and changes in the participant’s dietary behaviors. Regression analysis was used to identify factors associated with reported changes in theory and separately for reported changes in actual behavior, after controlling for potential confounding variables. Results: The majority of study participants agreed or strongly agreed with statements regarding app use increasing their motivation to eat a healthy diet, improving their self-efficacy, and increasing their desire to set and achieve health diet goals. Additionally, majority of participants strongly agreed that using diet/nutrition apps led to changes in their behavior, namely increases in actual goal setting to eat a healthy diet (58.5%, 127/217), increases in their frequency of eating healthy foods (57.6%, 125/217), and increases in their consistency of eating healthy foods (54.4%, 118/217). Participants also responded favorably to questions related to engagement and likability of diet/nutrition apps. A number of predictors were also positively associated with diet-related behavior change. Theory (P<.001), app engagement (P<.001), app use (P<.003), and education (P<.010) were all positively associated with behavior change. Conclusions: Study findings indicate that the use of diet/nutrition apps is associated with diet-related behavior change. Hence, diet- and nutrition-related apps that focus on improving motivation, desire, self-efficacy, attitudes, knowledge, and goal setting may be particularly useful. As the number of diet- and nutrition-related apps continues to grow, developers should consider integrating appropriate theoretical constructs for health behavior change into the newly developed mobile apps. %M 28694241 %R 10.2196/mhealth.7410 %U http://mhealth.jmir.org/2017/7/e95/ %U https://doi.org/10.2196/mhealth.7410 %U http://www.ncbi.nlm.nih.gov/pubmed/28694241 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 3 %P e45 %T Informing the Development of a Mobile Phone HIV Testing Intervention: Intentions to Use Specific HIV Testing Approaches Among Young Black Transgender Women and Men Who Have Sex With Men %A Koblin,Beryl A %A Nandi,Vijay %A Hirshfield,Sabina %A Chiasson,Mary Ann %A Hoover,Donald R %A Wilton,Leo %A Usher,DaShawn %A Frye,Victoria %+ Laboratory of Infectious Disease Prevention, New York Blood Center, 310 E.67th Street, New York, NY,, United States, 1 212 570 3105, bkoblin@nybc.org %K HIV infections %K African American %K homosexuality, male %K transgender persons %K cell phones %D 2017 %7 07.07.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Regular human immunodeficiency virus (HIV) testing of persons at risk is critical to HIV prevention. Infrequent HIV testing and late diagnosis of HIV infection have been observed among young black men who have sex with men (MSM) and transwomen (transgender women)—two groups overrepresented in the HIV epidemic. Objective: The objective of this study was to inform the development of a brief mobile phone intervention to increase HIV testing among young black MSM and transwomen by providing a tailored recommendation of an optimal HIV testing approach. We identified demographic, behavioral, psychosocial, and sociostructural factors associated with intentions to use three specific HIV testing approaches: self-testing, testing at a clinic or other provider, and couples HIV testing and counseling (CHTC). Methods: Individuals were eligible for a Web-based survey if they were male at birth; were between the ages of 16 and 29 years; self-identified as black, African American, Caribbean black, African black, or multiethnic black; were not known to be HIV-infected; and reported insertive or receptive anal intercourse with a man or transwoman in the last 12 months. Recruitment occurred via banner advertisements placed on a range of social and sexual networking websites and apps in New York City and nationally, and via events attended by young black MSM and transwomen in New York City. Intention to test by each testing method was analyzed using logistic regression with best subset models and stepwise variable selection. Results: Among 169 participants, intention to use a self-test was positively associated with comfort in testing by a friend or a partner at home (Adjusted odds ratio, AOR, 2.40; 95% CI 1.09-5.30), and stigma or fear as a reason not to test (AOR 8.61; 95% CI 2.50-29.68) and negatively associated with higher social support (AOR 0.48; 95% CI 0.33-0.72) and having health insurance (AOR 0.21; 95% CI 0.09-0.54). Intention to test at a clinic or other provider was positively associated with self-efficacy for HIV testing (AOR 2.87; 95% CI 1.48-5.59) and social support (AOR 1.98; 95% CI 1.34-2.92), and negatively associated with a lifetime history of incarceration (AOR 0.37; 95% CI 0.16-0.89). Intention to test by CHTC was negatively associated with higher educational level (Some college or Associate’s degree vs high school graduate or less [AOR 0.81; 95% CI 0.39-1.70]; Bachelor’s degree or more vs high school graduate or less [AOR 0.28; 95% CI 0.11-0.70]). Conclusions: Unique factors were associated with intention to test using specific testing approaches. These data will be critical for the development of a tailored intervention that shows promise to increase comfort and experiences with a variety of testing approaches among young black MSM and transwomen. %M 28687531 %R 10.2196/publichealth.7397 %U http://publichealth.jmir.org/2017/3/e45/ %U https://doi.org/10.2196/publichealth.7397 %U http://www.ncbi.nlm.nih.gov/pubmed/28687531 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 7 %P e90 %T Mobile Health Technology Using a Wearable Sensorband for Female College Students With Problem Drinking: An Acceptability and Feasibility Study %A Leonard,Noelle Regina %A Silverman,Michelle %A Sherpa,Dawa Phuti %A Naegle,Madeline A %A Kim,Hyorim %A Coffman,Donna L %A Ferdschneider,Marcy %+ Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 1st Avenue, 6th Floor, New York, NY, 10010, United States, 1 212 992 7167, nrl4@nyu.edu %K wearable sensors %K ecological momentary intervention %K college students %K alcohol use %K feasibility studies %K acceptability studies %D 2017 %7 07.07.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: An increasing number of mobile app interventions have been developed for problem drinking among college students; however, few studies have examined the integration of a mobile app with continuous physiological monitoring and alerting of affective states related to drinking behaviors. Objective: The aim of this paper was to evaluate the acceptability and feasibility of Mind the Moment (MtM), a theoretically based intervention for female college students with problem drinking that combines brief, in-person counseling with ecological momentary intervention (EMI) on a mobile app integrated with a wearable sensorband. Methods: We recruited 10 non-treatment seeking, female undergraduates from a university health clinic who scored a 3 or higher on the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) to participate in this pilot study. Study activities involved an in-person baseline intake and 1 follow-up assessment, 2 in-person alcohol brief intervention counseling sessions, and use of MtM technology components (sensorband and EMI on a mobile app) for approximately 3-4 weeks. The intervention used motivational interviewing (MI) and cognitive behavioral therapy (CBT) strategies for reducing risks associated with drinking. We used both qualitative and quantitative assessments to measure acceptability of the intervention and feasibility of delivery. Use patterns of the sensorband and mobile app were also collected. Results: Quantitative and qualitative data indicated high levels of acceptability for the MtM intervention. Altogether, participants made reports on the app on 26.7% (78/292) the days the technology was available to them and completed a total of 325 reports with wide variation between participants. Qualitative findings indicated that sensorband-elicited alerts promoted an increase in awareness of thoughts, feelings, and behaviors related to current environmental stressors and drinking behaviors in theoretically meaningful ways. Specific challenges related to functionality and form of the sensorband were identified. Conclusions: Delivering intervention material “just-in-time,” at the moment participants need to use behavioral strategies has great potential to individualize behavioral interventions for reducing problem drinking and other health behaviors. These findings provide initial evidence for the promise of wearable sensors for increasing potency of theoretically grounded mobile health interventions and point to directions for future research and uptake of these technologies. %M 28687533 %R 10.2196/mhealth.7399 %U http://mhealth.jmir.org/2017/7/e90/ %U https://doi.org/10.2196/mhealth.7399 %U http://www.ncbi.nlm.nih.gov/pubmed/28687533 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 7 %P e92 %T A Bit of Fit: Minimalist Intervention in Adolescents Based on a Physical Activity Tracker %A Gaudet,Jeffrey %A Gallant,François %A Bélanger,Mathieu %+ Centre de formation médicale du Nouveau-Brunswick, 18 Antonine Maillet street, Moncton, NB,, Canada, 1 506 863 2221, mathieu.f.belanger@usherbrooke.ca %K health behavior %K health promotion %K mHealth %K physical activity tracker %D 2017 %7 06.07.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Only 5% of Canadian youth meet the recommended 60 minutes of moderate to vigorous physical activity (MVPA) per day, with leisure time being increasingly allocated to technology usage. Direct-to-consumer mHealth devices that promote physical activity, such as wrist-worn physical activity trackers, have features with potential appeal to youth. Objective: The primary purpose of this study was to determine whether a minimalist physical activity tracker-based intervention would lead to an increase in physical activity in young adolescents. A secondary aim of this study was to assess change in physical activity across a 7-week intervention, as measured by the tracker. Methods: Using a quasi-experimental crossover design, two groups of 23 young adolescents (aged 13-14 years) were randomly assigned to immediate intervention or delayed intervention. The intervention consisted of wearing a Fitbit-Charge-HR physical activity tracker over a 7-week period. Actical accelerometers were used to measure participants’ levels of MVPA before and at the end of intervention periods for each group. Covariates such as age, sex, stage of change for physical activity behavior, and goal commitment were also measured. Results: There was an increase in physical activity over the course of the study period, though it was not related to overall physical activity tracker use. An intervention response did, however, occur in a subset of participants. Specifically, exposure to the physical activity tracker was associated with an average daily increase in MVPA by more than 15 minutes (P=.01) among participants who reported being in the action and maintenance stages of behavior change in relation to participation in physical activity. Participants in the precontemplation, contemplation, and preparation stages of behavior change had no change in their level of MVPA (P=.81). Conclusions: These results suggest that physical activity trackers may elicit improved physical activity related behavior in young adolescents demonstrating a readiness to be active. Future studies should seek to investigate if integrating physical activity trackers as part of more intensive interventions leads to greater increases in physical activity across different levels of stages of behavior change and if these changes can be sustained over longer periods of time. %M 28684384 %R 10.2196/mhealth.7647 %U http://mhealth.jmir.org/2017/7/e92/ %U https://doi.org/10.2196/mhealth.7647 %U http://www.ncbi.nlm.nih.gov/pubmed/28684384 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e235 %T Desirable Components for a Customized, Home-Based, Digital Care-Management App for Children and Young People With Long-Term, Chronic Conditions: A Qualitative Exploration %A Nightingale,Ruth %A Hall,Andrew %A Gelder,Carole %A Friedl,Simone %A Brennan,Eileen %A Swallow,Veronica %+ Great Ormond Street Hospital for Children, NHS Foundation Trust, Great Ormond Street, London,, United Kingdom, 44 7825 098844, ruth.nightingale@gosh.nhs.uk %K child %K adolescent %K long-term condition %K chronic condition %K self-management %K self-care %K mobile apps %K apps %K qualitative %D 2017 %7 04.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile apps for mobile phones and tablet devices are widely used by children and young people aged 0-18 years with long-term health conditions, such as chronic kidney disease (CKD), and their healthy peers for social networking or gaming. They are also poised to become a major source of health guidance. However, app development processes that are coproduced, rigorously developed, and evaluated to provide tailored, condition-specific, practical advice on day-to-day care management are seldom systematic or sufficiently described to enable replication. Furthermore, attempts to extrapolate to the real world are hampered by a poor understanding of the effects of key elements of app components. Therefore, effective and cost-effective novel, digital apps that will effectively and safely support care management are critical and timely. To inform development of such an app for children with CKD, a user requirements-gathering exercise was first needed. Objective: To explore the views of children with CKD, their parents, and health care professionals to inform future development of a child-focused, care-management app. Methods: Using age- and developmentally appropriate methods, we interviewed 36 participants: 5-10-year-olds (n=6), 11-14-year-olds (n=6), 15-18-year-olds (n=5), mothers (n=10), fathers (n=2), and health care professionals (n=7). Data were analyzed using Framework Analysis and behavior change theories. Results: Of the 27 interviews, 19 (70%) interviews were individual and 8 (30%) were joint—5 out of 8 (63%) joint interviews were with a child or young person and their parent, 1 out of 8 (13%) were with a child and both parents, and 2 out of 8 (25%) were with 2 professionals. Three key themes emerged to inform development of a software requirement specification for a future home-based, digital care-management app intervention: (1) Gaps in current online information and support, (2) Difficulties experienced by children with a long-term condition, and (3) Suggestions for a digital care-management app. Reported gaps included the fact that current online information is not usually appropriate for children as it is “dry” and “boring,” could be “scary,” and was either hard to understand or not relevant to individuals’ circumstances. For children, searching online was much less accessible than using a professional-endorsed mobile app. Children also reported difficulty explaining their condition to others, maintaining treatment adherence, coping with feeling isolated, and with trying to live a “normal” life. There was recognition that a developmentally appropriate, CKD-specific app could support the process of explaining the condition to healthy peers, reducing isolation, adhering to care-management plans, and living a “normal” life. Participants recommended a range of media and content to include in a tailored, interactive, age- and developmentally appropriate app. For example, the user would be able to enter their age and diagnosis so that only age-appropriate and condition-specific content is displayed. Conclusions: Future development of a digital app that meets the identified information and support needs and preferences of children with CKD will maximize its utility, thereby augmenting CKD caregiving and optimizing outcomes. %M 28676470 %R 10.2196/jmir.7760 %U http://www.jmir.org/2017/7/e235/ %U https://doi.org/10.2196/jmir.7760 %U http://www.ncbi.nlm.nih.gov/pubmed/28676470 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e232 %T Developing and Evaluating Digital Interventions to Promote Behavior Change in Health and Health Care: Recommendations Resulting From an International Workshop %A Michie,Susan %A Yardley,Lucy %A West,Robert %A Patrick,Kevin %A Greaves,Felix %+ Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 2076795930, s.michie@ucl.ac.uk %K health behavior %K psychological theory %K mobile applications %K behavioral medicine %K mHealth %K eHealth %D 2017 %7 29.06.2017 %9 Viewpoint %J J Med Internet Res %G English %X Devices and programs using digital technology to foster or support behavior change (digital interventions) are increasingly ubiquitous, being adopted for use in patient diagnosis and treatment, self-management of chronic diseases, and in primary prevention. They have been heralded as potentially revolutionizing the ways in which individuals can monitor and improve their health behaviors and health care by improving outcomes, reducing costs, and improving the patient experience. However, we are still mainly in the age of promise rather than delivery. Developing and evaluating these digital interventions presents new challenges and new versions of old challenges that require use of improved and perhaps entirely new methods for research and evaluation. This article discusses these challenges and provides recommendations aimed at accelerating the rate of progress in digital behavior intervention research and practice. Areas addressed include intervention development in a rapidly changing technological landscape, promoting user engagement, advancing the underpinning science and theory, evaluating effectiveness and cost-effectiveness, and addressing issues of regulatory, ethical, and information governance. This article is the result of a two-day international workshop on how to create, evaluate, and implement effective digital interventions in relation to health behaviors. It was held in London in September 2015 and was supported by the United Kingdom’s Medical Research Council (MRC), the National Institute for Health Research (NIHR), the Methodology Research Programme (PI Susan Michie), and the Robert Wood Johnson Foundation of the United States (PI Kevin Patrick). Important recommendations to manage the rapid pace of change include considering using emerging techniques from data science, machine learning, and Bayesian approaches and learning from other disciplines including computer science and engineering. With regard to assessing and promoting engagement, a key conclusion was that sustained engagement is not always required and that for each intervention it is useful to establish what constitutes “effective engagement,” that is, sufficient engagement to achieve the intended outcomes. The potential of digital interventions for testing and advancing theories of behavior change by generating ecologically valid, real-time objective data was recognized. Evaluations should include all phases of the development cycle, designed for generalizability, and consider new experimental designs to make the best use of rich data streams. Future health economics analyses need to recognize and model the complex and potentially far-reaching costs and benefits of digital interventions. In terms of governance, developers of digital behavior interventions should comply with existing regulatory frameworks, but with consideration for emerging standards around information governance, ethics, and interoperability. %M 28663162 %R 10.2196/jmir.7126 %U http://www.jmir.org/2017/6/e232/ %U https://doi.org/10.2196/jmir.7126 %U http://www.ncbi.nlm.nih.gov/pubmed/28663162 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e233 %T Tracing the Potential Flow of Consumer Data: A Network Analysis of Prominent Health and Fitness Apps %A Grundy,Quinn %A Held,Fabian P %A Bero,Lisa A %+ Charles Perkins Centre, Faculty of Pharmacy, The University of Sydney, D17, Level 6 The Hub, Charles Perkins Centre, Sydney, 2006, Australia, 61 286271566, quinn.grundy@sydney.edu.au %K mobile health %K smartphone %K privacy %D 2017 %7 28.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: A great deal of consumer data, collected actively through consumer reporting or passively through sensors, is shared among apps. Developers increasingly allow their programs to communicate with other apps, sensors, and Web-based services, which are promoted as features to potential users. However, health apps also routinely pose risks related to information leaks, information manipulation, and loss of information. There has been less investigation into the kinds of user data that developers are likely to collect, and who might have access to it. Objective: We sought to describe how consumer data generated from mobile health apps might be distributed and reused. We also aimed to outline risks to individual privacy and security presented by this potential for aggregating and combining user data across apps. Methods: We purposively sampled prominent health and fitness apps available in the United States, Canada, and Australia Google Play and iTunes app stores in November 2015. Two independent coders extracted data from app promotional materials on app and developer characteristics, and the developer-reported collection and sharing of user data. We conducted a descriptive analysis of app, developer, and user data collection characteristics. Using structural equivalence analysis, we conducted a network analysis of sampled apps’ self-reported sharing of user-generated data. Results: We included 297 unique apps published by 231 individual developers, which requested 58 different permissions (mean 7.95, SD 6.57). We grouped apps into 222 app families on the basis of shared ownership. Analysis of self-reported data sharing revealed a network of 359 app family nodes, with one connected central component of 210 app families (58.5%). Most (143/222, 64.4%) of the sampled app families did not report sharing any data and were therefore isolated from each other and from the core network. Fifteen app families assumed more central network positions as gatekeepers on the shortest paths that data would have to travel between other app families. Conclusions: This cross-sectional analysis highlights the possibilities for user data collection and potential paths that data is able to travel among a sample of prominent health and fitness apps. While individual apps may not collect personally identifiable information, app families and the partners with which they share data may be able to aggregate consumer data, thus achieving a much more comprehensive picture of the individual consumer. The organizations behind the centrally connected app families represent diverse industries, including apparel manufacturers and social media platforms that are not traditionally involved in health or fitness. This analysis highlights the potential for anticipated and voluntary but also possibly unanticipated and involuntary sharing of user data, validating privacy and security concerns in mobile health. %M 28659254 %R 10.2196/jmir.7347 %U http://www.jmir.org/2017/6/e233/ %U https://doi.org/10.2196/jmir.7347 %U http://www.ncbi.nlm.nih.gov/pubmed/28659254 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 6 %P e88 %T Mobile Device Accuracy for Step Counting Across Age Groups %A Modave,François %A Guo,Yi %A Bian,Jiang %A Gurka,Matthew J %A Parish,Alice %A Smith,Megan D %A Lee,Alexandra M %A Buford,Thomas W %+ University of Florida, Department of Health Outcomes and Policy, 2004 Mowry Road, Suite 2243 PO Box 100177, Gainesville, FL, 32610-0177, United States, 1 3522945984, modavefp@ufl.edu %K mobile %K devices %K physical activity %K weight reduction %K adults %D 2017 %7 28.06.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Only one in five American meets the physical activity recommendations of the Department of Health and Human Services. The proliferation of wearable devices and smartphones for physical activity tracking has led to an increasing number of interventions designed to facilitate regular physical activity, in particular to address the obesity epidemic, but also for cardiovascular disease patients, cancer survivors, and older adults. However, the inconsistent findings pertaining to the accuracy of wearable devices for step counting needs to be addressed, as well as factors known to affect gait (and thus potentially impact accuracy) such as age, body mass index (BMI), or leading arm. Objective: We aim to assess the accuracy of recent mobile devices for counting steps, across three different age groups. Methods: We recruited 60 participants in three age groups: 18-39 years, 40-64 years, and 65-84 years, who completed two separate 1000 step walks on a treadmill at a self-selected speed between 2 and 3 miles per hour. We tested two smartphones attached on each side of the waist, and five wrist-based devices worn on both wrists (2 devices on one wrist and 3 devices on the other), as well as the Actigraph wGT3X-BT, and swapped sides between each walk. All devices were swapped dominant-to-nondominant side and vice-versa between the two 1000 step walks. The number of steps was recorded with a tally counter. Age, sex, height, weight, and dominant hand were self-reported by each participant. Results: Among the 60 participants, 36 were female (60%) and 54 were right-handed (90%). Median age was 53 years (min=19, max=83), median BMI was 24.1 (min=18.4, max=39.6). There was no significant difference in left- and right-hand step counts by device. Our analyses show that the Fitbit Surge significantly undercounted steps across all age groups. Samsung Gear S2 significantly undercounted steps only for participants among the 40-64 year age group. Finally, the Nexus 6P significantly undercounted steps for the group ranging from 65-84 years. Conclusions: Our analysis shows that apart from the Fitbit Surge, most of the recent mobile devices we tested do not overcount or undercount steps in the 18-39-year-old age group, however some devices undercount steps in older age groups. This finding suggests that accuracy in step counting may be an issue with some popular wearable devices, and that age may be a factor in undercounting. These results are particularly important for clinical interventions using such devices and other activity trackers, in particular to balance energy requirements with energy expenditure in the context of a weight loss intervention program. %M 28659255 %R 10.2196/mhealth.7870 %U https://mhealth.jmir.org/2017/6/e88/ %U https://doi.org/10.2196/mhealth.7870 %U http://www.ncbi.nlm.nih.gov/pubmed/28659255 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 6 %P e86 %T A Community-Based Physical Activity Counselling Program for People With Knee Osteoarthritis: Feasibility and Preliminary Efficacy of the Track-OA Study %A Li,Linda C %A Sayre,Eric C %A Xie,Hui %A Clayton,Cam %A Feehan,Lynne M %+ Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada, 1 604 207 4020, lli@arthritisresearch.ca %K osteoarthritis %K physical activity %K sedentary behavior %K sedentary lifestyle %K wearables %K digital technology %K fitness trackers %K exercise %D 2017 %7 26.06.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity can improve health outcomes in people with knee osteoarthritis (OA); however, participation in physical activity is very low in this population. Objective: The objective of our study was to assess the feasibility and preliminary efficacy of the use of wearables (Fitbit Flex) and telephone counselling by a physical therapist (PT) for improving physical activity in people with a physician-confirmed diagnosis of knee OA, or who have passed 2 validated criteria for early OA. Methods: We conducted a community-based feasibility randomized controlled trial. The immediate group (n=17) received a brief education session by a physical therapist, a Fitbit Flex activity tracker, and a weekly telephone call for activity counselling with the physical therapist. The delayed group (n=17) received the same intervention 1 month later. All participants were assessed at baseline (T0), and the end of 1 month (T1) and 2 months (T2). Outcomes were (1) mean moderate to vigorous physical activity time, (2) mean time spent on sedentary behavior, (3) Knee Injury and Osteoarthritis Outcome Score (KOOS), and (4) Partners in Health Scale. Feasibility data were summarized with descriptive statistics. We used analysis of covariance to evaluate the effect of the group type on the outcome measures at T1 and T2, after adjusting for blocking and T0. We assessed planned contrasts of changes in outcome measures over measurement periods. Results: We identified 46 eligible individuals; of those, 34 (74%) enrolled and no one dropped out. All but 1 participant adhered to the intervention protocol. We found a significant effect, with the immediate intervention group having improved in the moderate to vigorous physical activity time and in the Partners in Health Scale at T0 to T1 compared with the delayed intervention group. The planned contrast of the immediate intervention group at T0 to T1 versus the delayed group at T1 to T2 showed a significant effect in the sedentary time and the KOOS symptoms subscale, favoring the delayed group. Conclusions: This study demonstrated the feasibility of a behavioral intervention, supported by the use of a wearable device, to promote physical activity among people with knee OA. Trial Registration: ClinicalTrials.gov NCT02313506; https://clinicaltrials.gov/ct2/show/NCT02313506 (Archived by WebCite at http://www.webcitation.org/6r4P3Bub0) %M 28652228 %R 10.2196/mhealth.7863 %U http://mhealth.jmir.org/2017/6/e86/ %U https://doi.org/10.2196/mhealth.7863 %U http://www.ncbi.nlm.nih.gov/pubmed/28652228 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e230 %T A Review of the Theoretical Basis, Effects, and Cost Effectiveness of Online Smoking Cessation Interventions in the Netherlands: A Mixed-Methods Approach %A Cheung,Kei Long %A Wijnen,Ben %A de Vries,Hein %+ Department of Health Services Research, Maastricht University, Duboisdomein 30, Maastricht,, Netherlands, 31 43 38 82294, kl.cheung@maastrichtuniversity.nl %K Smoking cessation %K telemedicine %K review %K online intervention %K Internet-based intervention %K behavioral change techniques %K Netherlands %D 2017 %7 23.06.2017 %9 Review %J J Med Internet Res %G English %X Background: Tobacco smoking is a worldwide public health problem. In 2015, 26.3% of the Dutch population aged 18 years and older smoked, 74.4% of them daily. More and more people have access to the Internet worldwide; approximately 94% of the Dutch population have online access. Internet-based smoking cessation interventions (online cessation interventions) provide an opportunity to tackle the scourge of tobacco. Objective: The goal of this paper was to provide an overview of online cessation interventions in the Netherlands, while exploring their effectivity, cost effectiveness, and theoretical basis. Methods: A mixed-methods approach was used to identify Dutch online cessation interventions, using (1) a scientific literature search, (2) a grey literature search, and (3) expert input. For the scientific literature, the Cochrane review was used and updated by two independent researchers (n=651 identified studies), screening titles, abstracts, and then full-text studies between 2013 and 2016 (CENTRAL, MEDLINE, and EMBASE). For the grey literature, the researchers conducted a Google search (n=100 websites), screening for titles and first pages. Including expert input, this resulted in six interventions identified in the scientific literature and 39 interventions via the grey literature. Extracted data included effectiveness, cost effectiveness, theoretical factors, and behavior change techniques used. Results: Overall, many interventions (45 identified) were offered. Of the 45 that we identified, only six that were included in trials provided data on effectiveness. Four of these were shown to be effective and cost effective. In the scientific literature, 83% (5/6) of these interventions included changing attitudes, providing social support, increasing self-efficacy, motivating smokers to make concrete action plans to prepare their attempts to quit and to cope with challenges, supporting identity change and advising on changing routines, coping, and medication use. In all, 50% (3/6) of the interventions included a reward for abstinence. Interventions identified in the grey literature were less consistent, with inclusion of each theoretical factor ranging from 31% to 67% and of each behavior change technique ranging from 28% to 54%. Conclusions: Although the Internet may provide the opportunity to offer various smoking cessation programs, the user is left bewildered as far as efficacy is concerned, as most of these data are not available nor offered to the smokers. Clear regulations about the effectiveness of these interventions need to be devised to avoid disappointment and failed quitting attempts. Thus, there is a need for policy regulations to regulate the proliferation of these interventions and to foster their quality in the Netherlands. %M 28645889 %R 10.2196/jmir.7209 %U http://www.jmir.org/2017/6/e230/ %U https://doi.org/10.2196/jmir.7209 %U http://www.ncbi.nlm.nih.gov/pubmed/28645889 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 6 %P e79 %T Beyond Basic Feedback in Mobile Brief Interventions: Designing SMS Message Content for Delivery to Young Adults During Risky Drinking Events %A Wright,Cassandra J C %A Dietze,Paul M %A Lim,Megan S C %+ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne,, Australia, 61 392822173, cassandra.wright@burnet.edu.au %K alcohol drinking %K young adult %K mHealth %K text messaging %K motivational interviewing %K community-based participatory research %D 2017 %7 20.06.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Brief interventions can reduce alcohol consumption in young people through screening and delivery of personally relevant feedback. Recently, Web and mobile platforms have been harnessed to increase the reach of brief interventions. Existing literature on mobile-based alcohol brief interventions indicates mixed use of theory in developing interventions. There is no research available to guide the development of SMS text messaging (short message service, SMS) interventions delivered during risky drinking events. Objective: The aim of this study was to develop and pilot an alcohol-related risk-reduction brief intervention delivered by SMS to Australian young adults during drinking events. This paper describes the development of intervention message content, with specific focus on the context of delivery during drinking events. Methods: A sample of 42 young adults attended 4 workshops; these comprised focus-group style discussion on drinking habits and motivations, discussion of intervention design, analysis of existing alcohol media campaigns, and participant development of message content. Data were analyzed thematically. Results: Participants described a focus on having fun and blocking out any incongruent negative influences during drinking episodes. For content to be acceptable, nonjudgmental and non-authoritative language was deemed essential. A preference for short, actionable messages was observed, including suggestions for reminders around drinking water, organizing transport home, checking on friends, and plans the next day. Participants were excited about the potential for messages to be tailored to individuals, as previous alcohol-related campaigns were deemed too generic and often irrelevant. Normative-based messages were also perceived as largely irrelevant as participants felt that they understood the drinking-related norms of their immediate peers already. Conclusions: Findings from this study offer insights into young adults’ drinking events and practical advice for designing alcohol-related brief interventions. During our formative development process, we demonstrated a neat correspondence between young people’s preferences for alcohol harm reduction interventions and the theoretical principles of brief interventions, including acceptable topics and message style. %M 28634153 %R 10.2196/mhealth.6497 %U http://mhealth.jmir.org/2017/6/e79/ %U https://doi.org/10.2196/mhealth.6497 %U http://www.ncbi.nlm.nih.gov/pubmed/28634153 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 6 %P e114 %T Phone-Based Interventions in Adolescent Psychiatry: A Perspective and Proof of Concept Pilot Study With a Focus on Depression and Autism %A Chen,Robert Yuzen %A Feltes,Jordan Robert %A Tzeng,William Shun %A Lu,Zoe Yunzhu %A Pan,Michael %A Zhao,Nan %A Talkin,Rebecca %A Javaherian,Kavon %A Glowinski,Anne %A Ross,Will %+ Washington University School of Medicine, Farrell Learning and Teaching Center, 660 S Euclid Avenue, St. Louis, MO, 63110, United States, 1 425 753 4101, robert.chen@wustl.edu %K telemedicine %K depression %K autistic disorder %K mobile applications %K text messaging %K child %K mental health %D 2017 %7 16.06.2017 %9 Viewpoint %J JMIR Res Protoc %G English %X Background: Telemedicine has emerged as an innovative platform to diagnose and treat psychiatric disorders in a cost-effective fashion. Previous studies have laid the functional framework for monitoring and treating child psychiatric disorders electronically using videoconferencing, mobile phones (smartphones), and Web-based apps. However, phone call and text message (short message service, SMS) interventions in adolescent psychiatry are less studied than other electronic platforms. Further investigations on the development of these interventions are needed. Objective: The aim of this paper was to explore the utility of text message interventions in adolescent psychiatry and describe a user feedback-driven iterative design process for text message systems. Methods: We developed automated text message interventions using a platform for both depression (EpxDepression) and autism spectrum disorder (ASD; EpxAutism) and conducted 2 pilot studies for each intervention (N=3 and N=6, respectively). The interventions were prescribed by and accessible to the patients’ healthcare providers. EpxDepression and EpxAutism utilized an automated system to triage patients into 1 of 3 risk categories based on their text responses and alerted providers directly via phone and an online interface when patients met provider-specified risk criteria. Rapid text-based feedback from participants and interviews with providers allowed for quick iterative cycles to improve interventions. Results: Patients using EpxDepression had high weekly response rates (100% over 2 to 4 months), but exhibited message fatigue with daily prompts with mean (SD) overall response rates of 66.3% (21.6%) and 64.7% (8.2%) for mood and sleep questionnaires, respectively. In contrast, parents using EpxAutism displayed both high weekly and overall response rates (100% and 85%, respectively, over 1 to 4 months) that did not decay significantly with time. Monthly participant feedback surveys for EpxDepression (7 surveys) and EpxAutism (18 surveys) preliminarily indicated that for both interventions, daily messages constituted the “perfect amount” of contact and that EpxAutism, but not EpxDepression, improved patient communication with providers. Notably, EpxDepression detected thoughts of self-harm in patients before their case managers or caregivers were aware of such ideation. Conclusions: Text-message interventions in adolescent psychiatry can provide a cost-effective and engaging method to track symptoms, behavior, and ideation over time. Following the collection of pilot data and feedback from providers and patients, larger studies are already underway to validate the clinical utility of EpxDepression and EpxAutism. Trial Registration: Clinicaltrials.gov NCT03002311; https://clinicaltrials.gov/ct2/show/NCT03002311 (Archived by WebCite at http://www.webcitation.org/6qQtlCIS0) %M 28623183 %R 10.2196/resprot.7245 %U http://www.researchprotocols.org/2017/6/e114/ %U https://doi.org/10.2196/resprot.7245 %U http://www.ncbi.nlm.nih.gov/pubmed/28623183 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 6 %P e84 %T Mobile Apps for Eye Care in Canada: An Analysis of the iTunes Store %A Rodin,Alexander %A Shachak,Aviv %A Miller,Aaron %A Akopyan,Vladimir %A Semenova,Nataliya %+ TorontoEyeExam.com, Sears Optical, 240 Leighland Ave, Oakville, ON, L6H 3H6, Canada, 1 905 338 84 54, optometristrichmondhill@gmail.com %K mobile applications %K mobile phone %K ophthalmology %K optometry %D 2017 %7 14.06.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone screens can facilitate stimulation to various components of the visual system and many mobile apps are accepted as a means of providing clinical assessments for the oculo-visual system. Although many of these apps are intended for use in clinical settings, there is a growing number of apps in eye care developed for self-tests and eye exercises for lay people. These and other features, however, have not yet been well described. Objective: Our objective was to identify, describe, and categorize mobile apps related to eye care that are available to users in the Canadian iTunes market. Methods: We conducted an extensive search of the Apple iTunes Store for apps related to eye care. We used the terms “eye,” “eye care,” “vision,” and “eye test” and included apps that are targeted at both lay people and medical professionals. We excluded apps whose primary function is not related to eye care. Eligible apps were categorized by primary purpose, based on how they were described by their developers in the iTunes Store. Results: Our search yielded 10,657 apps, of which 427 met our inclusion criteria. After removing duplicates, 355 unique apps were subject to further review. We assigned the eligible apps to three distinct categories: 39/355 apps (11.0%) were intended for use by medical professionals, 236 apps (66.5%, 236/355) were intended for use by lay people, and 80 apps (22.5%, 80/355) were intended for marketing eye care and eye-care products. We identified 9 subcategories of apps based on the descriptions of their primary functions. Apps for medical professionals fell into three subcategories: clinical calculators (n=6), clinical diagnostic tools (n=18), and education and networking apps for professionals (n=15). Apps for lay people fell into four subcategories: self-testing (n=153), eye exercises (n=30), patient tools and low vision aids (n=35), and apps for patient education (n=18). Mixed-use apps (n=80) were placed into two subcategories: marketing of individual practitioners or eye-care products (n=72) and marketing of multiple eye-care products or professional services. Conclusions: The most extensive subcategory pertaining to eye care consisted of apps for use by lay people, especially for conducting self-tests (n=236). This study revealed a previously uncharacterized category of apps intended for use by doctors and patients, of which the primary goal is marketing of eye-care services and products (n=80). %M 28615154 %R 10.2196/mhealth.7055 %U http://mhealth.jmir.org/2017/6/e84/ %U https://doi.org/10.2196/mhealth.7055 %U http://www.ncbi.nlm.nih.gov/pubmed/28615154 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 6 %P e80 %T A Mobile Phone-Based Health Coaching Intervention for Weight Loss and Blood Pressure Reduction in a National Payer Population: A Retrospective Study %A Mao,Alice Yuqing %A Chen,Connie %A Magana,Candy %A Caballero Barajas,Karla %A Olayiwola,J Nwando %+ Department of Family & Community Medicine, University of California San Francisco, 1001 Potrero Ave, Building 80, San Francisco, CA, 94110, United States, 1 510 296 8868, nwando.olayiwola@ucsf.edu %K digital health coaching %K overweight %K obesity %K mobile health %K weight %K blood pressure %D 2017 %7 08.06.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The prevalence of obesity and associated metabolic conditions continue to be challenging and costly to address for health care systems; 71% of American adults were overweight, with 35% of men and 40% of women diagnosed with obesity in 2014. Digital health coaching is an innovative approach to decreasing the barriers of cost and accessibility of receiving health coaching for the prevention and management of chronic disease in overweight or obese individuals. Objective: To evaluate the early impact of a mobile phone-based health coaching service on weight loss and blood pressure management in a commercially insured population. Methods: This was a retrospective study using existing registry data from a pilot commercial collaboration between Vida Health and a large national insurance provider, which enrolled adult members who were overweight (body mass index >25 kg/m2) and able to engage in a mobile phone-based coaching intervention. Participants received 4 months of intensive health coaching via live video, phone, and text message through the Vida Health app. Participants were also provided with a wireless scale, pedometer, and blood pressure cuff. Of the 1012 enrolled, 763 (75.40%) participants had an initial weight upon enrollment and final weight between 3 and 5 months from enrollment; they served as our intervention group. There were 73 participants out of the 1012 (7.21%) who had weight data 4 months prior to and after Vida coaching, who served as the matched-pair control group. Results: Participants in the intervention group lost an average of 3.23% total body weight (TBW) at 4 months of coaching and 28.6% (218/763) intervention participants achieved a clinically significant weight loss of 5% or more of TBW, with an average of 9.46% weight loss in this cohort. In the matched-pair control group, participants gained on average 1.81% TBW in 4 months without Vida coaching and lost, on average, 2.47% TBW after 4 months of Vida coaching, demonstrating a statistically significant difference of 4.28% in mean percentage weight change (P<.001). Among 151 intervention participants with blood pressure data, 112 (74.2%) had a baseline blood pressure that was above the goal (systolic blood pressure >120 mmHg); 55 out of 112 (49.1%) participants improved their blood pressure at 4 months by an entire hypertensive stage—as defined by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Conclusions: Mobile phone app-based health coaching interventions can be an acceptable and effective means to promote weight loss and improve blood pressure management in overweight or obese individuals. Given the ubiquity of mobile phones, digital health coaching may be an innovative solution to decreasing barriers of access to much-needed weight management interventions for obesity. %M 28596147 %R 10.2196/mhealth.7591 %U http://mhealth.jmir.org/2017/6/e80/ %U https://doi.org/10.2196/mhealth.7591 %U http://www.ncbi.nlm.nih.gov/pubmed/28596147 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 2 %P e13 %T Gamification in Stress Management Apps: A Critical App Review %A Hoffmann,Alexandra %A Christmann,Corinna A %A Bleser,Gabriele %+ Junior research group wearHEALTH, Department of Computer Science, University of Kaiserslautern, Gottlieb-Daimler-Str. 48, Kaiserslautern, 67663, Germany, 49 631 205 3456, hoffmann@cs.uni-kl.de %K game element %K mHealth, motivation %K app %K behavior change %K gamification %D 2017 %7 07.06.2017 %9 Original Paper %J JMIR Serious Games %G English %X Background: In today’s society, stress is more and more often a cause of disease. This makes stress management an important target of behavior change programs. Gamification has been suggested as one way to support health behavior change. However, it remains unclear to which extend available gamification techniques are integrated in stress management apps, and if their occurrence is linked to the use of elements from behavior change theory. Objective: The aim of this study was to investigate the use of gamification techniques in stress management apps and the cooccurrence of these techniques with evidence-based stress management methods and behavior change techniques. Methods: A total of 62 stress management apps from the Google Play Store were reviewed on their inclusion of 17 gamification techniques, 15 stress management methods, and 26 behavior change techniques. For this purpose, an extended taxonomy of gamification techniques was constructed and applied by 2 trained, independent raters. Results: Interrater-reliability was high, with agreement coefficient (AC)=.97. Results show an average of 0.5 gamification techniques for the tested apps and reveal no correlations between the use of gamification techniques and behavior change techniques (r=.17, P=.20), or stress management methods (r=.14, P=.26). Conclusions: This leads to the conclusion that designers of stress management apps do not use gamification techniques to influence the user’s behaviors and reactions. Moreover, app designers do not exploit the potential of combining gamification techniques with behavior change theory. %M 28592397 %R 10.2196/games.7216 %U http://games.jmir.org/2017/2/e13/ %U https://doi.org/10.2196/games.7216 %U http://www.ncbi.nlm.nih.gov/pubmed/28592397 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 2 %N 1 %P e8 %T Phone Messaging to Prompt Physical Activity and Social Support Among Low-Income Latino Patients With Type 2 Diabetes: A Randomized Pilot Study %A Ramirez,Magaly %A Wu,Shinyi %+ Fielding School of Public Health, Department of Health Policy and Management, University of California, Los Angeles, 650 Charles Young Dr S, 31-293A, Los Angeles, CA, 90095-1772, United States, 1 310 825 2594, ramirezma@ucla.edu %K short message service %K reminder system %K pilot project %K exercise %K Hispanic Americans %K type 2 diabetes mellitus %K self-care %K social support %D 2017 %7 06.06.2017 %9 Original Paper %J JMIR Diabetes %G English %X Background: Given disparities in diabetes prevalence, receipt of diabetes education, diabetes knowledge, and self-management behaviors among Latinos, there is a need to provide education and ongoing support to this population. Phone-based interventions have the potential to reach and engage both patients and their family members and friends. Objective: The aim of this study was to investigate the feasibility, perceived usefulness, and potential effectiveness of a short text or voice message (STVM) intervention to activate (1) physical activity (PA) behavior change among urban, low-income Latino adults with type 2 diabetes and (2) supportive behaviors by their family members and friends. Methods: A 12-week pilot study randomized 42 participants recruited in person from a safety-net ambulatory care clinic in Los Angeles into one of the 3 study arms: control, phone messaging (PM), and phone messaging plus social support from family members and friends (PM+FF). All participants were prompted to set PA goals and to self-monitor PA behavior using pedometers and walking logs. PM and PM+FF participants received STVMs with reminders to review goals and self-monitor, PA behavior change education, and feedback on performance. Participants in the PM+FF arm also had their family members and friends receiving STVMs with suggestions for how they could support the participant’s PA behavior change efforts. Participants completed semistructured assessments in person at baseline, 6 weeks, and 12 weeks. Outcomes were PA (steps/day) and perceived social support from family members and friends. Results: Among PM and PM+FF participants, those who opted to receive text messages (short message service, SMS) responded to 62.7% (128/204) of SMS text messages requiring a response while those who opted to receive voice messages responded 30% (12/40) of the time. Participants perceived guidance in self-regulation as useful, particularly self-monitoring, goal setting, self-instruction, feedback, and social support. All participants increased PA at 6 weeks, but only the PM and PM+FF arms increased PA at 12 weeks. All study arms experienced an increase in perceived social support from family members and friends at 6 weeks, but only those in the PM+FF arm had an increase in the perception of social support at 12 weeks. Conclusion: Designing an STVM intervention based on self-regulation techniques is feasible and perceived as useful by participants. The STVM intervention has the potential to improve PA in terms of daily steps and perceived social support from family members and friends. Trial Registration: Clinicaltrials.gov NCT02850770; https://clinicaltrials.gov/ct2/show/NCT02850770 (Archived by WebCite at http://www.webcitation.org/query?id=1495567756845570) %M 30291094 %R 10.2196/diabetes.7063 %U http://diabetes.jmir.org/2017/1/e8/ %U https://doi.org/10.2196/diabetes.7063 %U http://www.ncbi.nlm.nih.gov/pubmed/30291094 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 5 %P e105 %T PREventive Care Infrastructure based On Ubiquitous Sensing (PRECIOUS): A Study Protocol %A Castellano-Tejedor,Carmina %A Moreno,Jordi %A Ciudin,Andrea %A Parramón,Gemma %A Lusilla-Palacios,Pilar %+ University Hospital Vall d’Hebron - Vall d'Hebron Research Institute, Department of Psychiatry, CIBERSAM, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, Barcelona, 08035, Spain, 34 934893649 ext 3649, ninacastej@yahoo.es %K mHealth %K motivational interviewing %K physical activity %K diet %K sustained motivation %K adherence %D 2017 %7 31.05.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: mHealth has experienced a huge growth during the last decade. It has been presented as a new and promising pathway to increase self-management of health and chronic conditions in several populations. One of the most prolific areas of mHealth has been healthy lifestyles promotion. However, few mobile apps have succeeded in engaging people and ensuring sustained use. Objective: This paper describes the pilot test protocol of the PReventive Care Infrastructure based on Ubiquitous Sensing (PRECIOUS) project, aimed at validating the PRECIOUS system with end users. This system includes, within a motivational framework, the Bodyguard2 sensor (accelerometer with heart rate monitoring) and the PRECIOUS app. Methods: This is a pilot experimental study targeting morbidly obese prediabetic patients who will be randomized to three conditions: (1) Group 1 - Control group (Treatment as usual with the endocrinologist and the nurse + Bodyguard2), (2) Group 2 - PRECIOUS system (Bodyguard2 + PRECIOUS app), and (3) Group 3 - PRECIOUS system (Bodyguard2 + PRECIOUS app + Motivational Interviewing). The duration of the study will be 3 months with scheduled follow-up appointments within the scope of the project at Weeks 3, 5, 8, and 12. During the study, several measures related to healthy lifestyles, weight management, and health-related quality of life will be collected to explore the effectiveness of PRECIOUS to foster behavior change, as well as user acceptance, usability, and satisfaction with the solution. Results: Because of the encouraging results shown in similar scientific work analyzing health apps acceptance in clinical settings, we expect patients to widely accept and express satisfaction with PRECIOUS. We also expect to find acceptable usability of the preventive health solution. The recruitment of the pilot study has concluded with the inclusion of 31 morbidly obese prediabetic patients. Results are expected to be available in mid-2017. Conclusions: Adopting and maintaining healthy habits may be challenging in people with chronic conditions who usually need regular support to ensure mid/long-term adherence to recommendations and behavior change. Thus, mHealth could become a powerful and efficient tool since it allows continuous communication with users and immediate feedback. The PRECIOUS system is an innovative preventive health care solution aimed at enhancing inner motivation from users to change their lifestyles and adopt healthier habits. PRECIOUS includes ubiquitous sensors and a scientifically grounded app to address three main components of health: physical activity, diet, and stress levels. Trial Registration: Clinicaltrials.gov NCT02818790; https://clinicaltrials.gov/ct2/show/NCT02818790 (Archived by WebCite at http://www.webcitation.org/6qfzdfMoU) %M 28566263 %R 10.2196/resprot.6973 %U http://www.researchprotocols.org/2017/5/e105/ %U https://doi.org/10.2196/resprot.6973 %U http://www.ncbi.nlm.nih.gov/pubmed/28566263 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 2 %P e32 %T Understanding Environmental and Contextual Influences of Physical Activity During First-Year University: The Feasibility of Using Ecological Momentary Assessment in the MovingU Study %A Bedard,Chloe %A King-Dowling,Sara %A McDonald,Madeline %A Dunton,Genevieve %A Cairney,John %A Kwan,Matthew %+ INfant and Child Health (INCH) Lab, Department of Family Medicine, McMaster University, DBHSC, 5th Floor, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada, 1 9055259140 ext 20303, kwanmy@mcmaster.ca %K exercise %K compliance %K feasibility studies %K young adult %K students %D 2017 %7 31.05.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: It is well established that drastic declines in physical activity (PA) occur during young adults’ transition into university; however, our understanding of contextual and environmental factors as it relates to young adults’ PA is limited. Objective: The purpose of our study was to examine the feasibility of using wrist-worn accelerometers and the use of ecological momentary assessment (EMA) to assess the context and momentary correlates of PA on multiple occasions each day during first-year university. Methods: First-year university students were asked to participate in the study. The participants completed a brief questionnaire and were subsequently asked to wear an ActiGraph GT9X-Link accelerometer and respond to a series of EMA prompts (7/day) via their phones for 5 consecutive days. Results: A total of 96 first-year university students with smartphones agreed to participate in the study (mean age 18.3 [SD 0.51]; n=45 females). Overall, there was good compliance for wearing the accelerometers, with 91% (78/86) of the participants having ≥2 days of ≥10 hours of wear time (mean=3.53 valid days). Students were generally active, averaging 10,895 steps/day (SD 3413) or 1123.23 activity counts/min (SD 356.10). Compliance to EMA prompts was less desirable, with 64% (55/86) of the participants having usable EMA data (responding to a minimum of ≥3 days of 3 prompts/day or ≥4 days of 2 prompts/day), and only 47% (26/55) of these participants were considered to have excellent EMA compliance (responding to ≥5 days of 4 prompts/day or ≥ 4 days of 5 prompts/day). Conclusions: This study represents one of the first studies to use an intensive real-time data capture strategy to examine time-varying correlates of PA among first-year university students. These data will aim to describe the physical and social contexts in which PA occurs and examine the relationships between momentary correlates of PA among the first-year university students. Overall, current results suggest that wrist-worn accelerometers and EMA are feasible methods for data collection among the young adult population; however, more work is needed to understand how to improve upon compliance to a real-time data capture method such as EMA. %M 28566264 %R 10.2196/publichealth.7010 %U http://publichealth.jmir.org/2017/2/e32/ %U https://doi.org/10.2196/publichealth.7010 %U http://www.ncbi.nlm.nih.gov/pubmed/28566264 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e147 %T More Than a Text Message: Dismantling Digital Triggers to Curate Behavior Change in Patient-Centered Health Interventions %A Muench,Frederick %A Baumel,Amit %+ Psychiatry, Northwell Health, 311, 1010 Northern Blvd, Great Neck, NY, 11021, United States, 1 191 532 0623, fmuench@northwell.edu %K alerts %K digital triggers %K text messaging %K haptic triggers %K reminder systems %K push alerts %K mHealth %K mobile health %K engagement %K marketing %K behavior change %K behavioral medicine %D 2017 %7 26.05.2017 %9 Viewpoint %J J Med Internet Res %G English %X Digital triggers such as text messages, emails, and push alerts are designed to focus an individual on a desired goal by prompting an internal or external reaction at the appropriate time. Triggers therefore have an essential role in engaging individuals with digital interventions delivered outside of traditional health care settings, where other events in daily lives and fluctuating motivation to engage in effortful behavior exist. There is an emerging body of literature examining the use of digital triggers for short-term action and longer-term behavior change. However, little attention has been given to understanding the components of digital triggers. Using tailoring as an overarching framework, we separated digital triggers into 5 primary components: (1) who (sender), (2) how (stimulus type, delivery medium, heterogeneity), (3) when (delivered), (4) how much (frequency, intensity), and (5) what (trigger’s target, trigger’s structure, trigger’s narrative). We highlighted key considerations when tailoring each component and the pitfalls of ignoring common mistakes, such as alert fatigue and habituation. As evidenced throughout the paper, there is a broad literature base from which to draw when tailoring triggers to curate behavior change in health interventions. More research is needed, however, to examine differences in efficacy based on component tailoring, to best use triggers to facilitate behavior change over time, and to keep individuals engaged in physical and mental health behavior change efforts. Dismantling digital triggers into their component parts and reassembling them according to the gestalt of one’s change goals is the first step in this development work. %M 28550001 %R 10.2196/jmir.7463 %U http://www.jmir.org/2017/5/e147/ %U https://doi.org/10.2196/jmir.7463 %U http://www.ncbi.nlm.nih.gov/pubmed/28550001 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e73 %T Perceptions of Patient Engagement Applications During Pregnancy: A Qualitative Assessment of the Patient’s Perspective %A Goetz,Maren %A Müller,Mitho %A Matthies,Lina Maria %A Hansen,Jenny %A Doster,Anne %A Szabo,Akos %A Pauluschke-Fröhlich,Jan %A Abele,Harald %A Sohn,Christof %A Wallwiener,Markus %A Wallwiener,Stephanie %+ Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, Heidelberg, 69121, Germany, 49 6221 5637551, Stephanie.wallwiener@googlemail.com %K pregnancy %K telemedicine %K mobile applications %K information procurement %K patient participation %K qualitative research %D 2017 %7 26.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With growing demand for medical information and health applications in pregnancy, the potential of electronic health (eHealth) and mobile health (mHealth) solutions in clinical care is increasingly unfolding. However, we still do not know how pregnant women engage with mobile apps, how such apps impact routine medical care, and whether benefit expectations are met. Whereas recent research has raised the subject of user distribution and analyzed the content of pregnancy applications, there is still a significant knowledge gap regarding what pregnant women like and dislike about pregnancy tools, along with how such interventions could be improved. Objective: The aim of the study was to examine the perceptions and expectations of mobile and Web-based patient-engagement pregnancy applications. We assessed usability requirements, general acceptance of eHealth, and the impact of eHealth and mHealth pregnancy applications on the doctor-patient interaction and daily clinical routine. Methods: A qualitative study was conducted at the maternity department of a major German university hospital. The sample included 30 women with low- to medium-risk pregnancies. Half of the patients were seen during outpatient care and half were hospitalized for several days. The extent and frequency of Web- and mobile phone app usage were assessed. Semistructured interviews were conducted and analyzed using systematic thematic analysis. Results: Patients had a high demand for Web-based pregnancy applications. Study findings suggested a strong request for personalization, monitoring, and accessibility for frequent use as main themes derived from the interviews. Fostering patient empowerment in the doctor-patient relationship was also highly valued for a pregnancy app. Participants favored further integration of medical apps in their daily routine and pregnancy care. However, concerns were raised about content quality, trustworthiness of Web sources, and individual data security. Conclusions: eHealth and mHealth applications are a highly frequented source of information. Expectations and usability requirements for those applications are also high, thus posing a challenge to interdisciplinary service providers. Patients’ attitude toward integrating apps in routine care settings was positive with a favorable influence on patient empowerment. Health care professionals should guide pregnant women toward a successful integration of these educational tools in pregnancy care. %M 28550005 %R 10.2196/mhealth.7040 %U http://mhealth.jmir.org/2017/5/e73/ %U https://doi.org/10.2196/mhealth.7040 %U http://www.ncbi.nlm.nih.gov/pubmed/28550005 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e74 %T An mHealth App for Supporting Quitters to Manage Cigarette Cravings With Short Bouts of Physical Activity: A Randomized Pilot Feasibility and Acceptability Study %A Hassandra,Mary %A Lintunen,Taru %A Hagger,Martin S %A Heikkinen,Risto %A Vanhala,Mauno %A Kettunen,Tarja %+ Faculty of Sport and Health Sciences, University of Jyvaskyla, PO Box 35 University of Jyvaskyla, Jyvaskyla, 40014, Finland, 358 0408053979, maria.m.chasandra@jyu.fi %K behavior change %K mHealth app %K physical activity %K randomized controlled trial %K relapse prevention %K smoking %D 2017 %7 26.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: While gains in reducing smoking rates in Finland have been made, prevalence rates are still substantial. Relapse rates among smokers engaged in quit-smoking programs are high. Physical activity has been proposed as one means to help smokers manage cravings. Software and apps on mobile phone and handheld devices offer an opportunity to communicate messages on how to use physical activity to manage cravings as part of quit-smoking programs. Objective: We aimed to test the feasibility, acceptability, usability, and preliminary efficacy of an mHealth mobile phone app, Physical activity over Smoking (PhoS), to assist smokers in quitting smoking in a randomized controlled trial. The app was designed to prompt smokers to engage in physical activities to manage their smoking cravings. Methods: Regular smokers (n=44) attended a group-based behavioral counselling program aimed at promoting physical activity as an additional aid to quit. After quit day, participants were randomly allocated to an intervention (n=25) or to a comparison (n=19) group. Participants in the intervention group were provided with the PhoS app and training on how to use it to assist with relapse prevention. Participants in the comparison condition were provided with generalized relapse prevention training. Results: Some participants reported that the PhoS app was useful in assisting them to successfully manage their cigarette cravings, although compliance across the sample was modest and participants reported low levels of usability. Participants receiving the PhoS app did not report greater abstinence than those who did not receive the app. However, participants receiving the app were more likely to report greater abstinence if they did not use pharmacological support, while those who did not receive the app reported greater abstinence when using pharmacological support. Participants receiving the app reported greater levels of physical activity than those who did not. Results revealed that the app resulted in better retention. Conclusions: The PhoS app showed some potential to reduce abstinence among participants not using pharmacological therapy and to increase physical activity. However, problems with usability and lack of effects on abstinence raise questions over the app’s long-term effectiveness. Future research should prioritize further development of the app to maximize usability and test effects of the intervention independent of quit-smoking programs. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 55259451; http://www.controlled-trials.com/ISRCTN55259451 (Archived by WebCite at http://www.webcitation.org/6cKF2mzEI) %M 28550004 %R 10.2196/mhealth.6252 %U http://mhealth.jmir.org/2017/5/e74/ %U https://doi.org/10.2196/mhealth.6252 %U http://www.ncbi.nlm.nih.gov/pubmed/28550004 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e68 %T Cognitive Testing in People at Increased Risk of Dementia Using a Smartphone App: The iVitality Proof-of-Principle Study %A Jongstra,Susan %A Wijsman,Liselotte Willemijn %A Cachucho,Ricardo %A Hoevenaar-Blom,Marieke Peternella %A Mooijaart,Simon Pieter %A Richard,Edo %+ Academic Medical Center, Department of Neurology, University of Amsterdam, Meiberdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 205663446, s.jongstra@amc.uva.nl %K telemedicine %K cognition %K neuropsychological tests %D 2017 %7 25.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone-assisted technologies potentially provide the opportunity for large-scale, long-term, repeated monitoring of cognitive functioning at home. Objective: The aim of this proof-of-principle study was to evaluate the feasibility and validity of performing cognitive tests in people at increased risk of dementia using smartphone-based technology during a 6 months follow-up period. Methods: We used the smartphone-based app iVitality to evaluate five cognitive tests based on conventional neuropsychological tests (Memory-Word, Trail Making, Stroop, Reaction Time, and Letter-N-Back) in healthy adults. Feasibility was tested by studying adherence of all participants to perform smartphone-based cognitive tests. Validity was studied by assessing the correlation between conventional neuropsychological tests and smartphone-based cognitive tests and by studying the effect of repeated testing. Results: We included 151 participants (mean age in years=57.3, standard deviation=5.3). Mean adherence to assigned smartphone tests during 6 months was 60% (SD 24.7). There was moderate correlation between the firstly made smartphone-based test and the conventional test for the Stroop test and the Trail Making test with Spearman ρ=.3-.5 (P<.001). Correlation increased for both tests when comparing the conventional test with the mean score of all attempts a participant had made, with the highest correlation for Stroop panel 3 (ρ=.62, P<.001). Performance on the Stroop and the Trail Making tests improved over time suggesting a learning effect, but the scores on the Letter-N-back, the Memory-Word, and the Reaction Time tests remained stable. Conclusions: Repeated smartphone-assisted cognitive testing is feasible with reasonable adherence and moderate relative validity for the Stroop and the Trail Making tests compared with conventional neuropsychological tests. Smartphone-based cognitive testing seems promising for large-scale data-collection in population studies. %M 28546139 %R 10.2196/mhealth.6939 %U http://mhealth.jmir.org/2017/5/e68/ %U https://doi.org/10.2196/mhealth.6939 %U http://www.ncbi.nlm.nih.gov/pubmed/28546139 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 5 %P e95 %T An Ecological Momentary Intervention to Reduce Alcohol Consumption in Young Adults Delivered During Drinking Events: Protocol for a Pilot Randomized Controlled Trial %A Wright,Cassandra JC %A Dietze,Paul M %A Agius,Paul A %A Kuntsche,Emmanuel %A Room,Robin %A Livingston,Michael %A Hellard,Margaret %A Lim,Megan SC %+ School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne,, Australia, 61 3 9282 2173, cassandra.wright@burnet.edu.au %K alcohol drinking %K young adult %K mHealth %K text messaging %K ecological momentary intervention %D 2017 %7 25.05.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Risky drinking is a significant public health issue in young Australian adults. Brief interventions are one of few effective methods of reducing risky drinking but are time and cost intensive; innovative methods of delivery are therefore of interest. Mobile phones offer new opportunities to collect data and intervene during risky drinking events. Mobile phones have successfully been used for delivery of alcohol-related brief interventions and data collection but not in combination with or during drinking events. Objective: This pilot study will investigate the efficacy of an ecological momentary intervention (EMI), with combined ecological momentary assessment (EMA) and brief intervention delivered by mobile phones to young adults during risky drinking events. Methods: We will use a 3-armed randomized controlled trial to investigate the efficacy of the intervention for reducing peak single occasion drinking. Our sample is recruited from an observational cohort study of young, risky drinkers. Participants will be randomized into 1 of 3 intervention arms. On 6 nights across a 12-week study period, EMI and EMA groups will complete hourly EMA surveys on their mobile phone. EMI participants will receive tailored feedback short message service (SMS) texts corresponding to their EMA survey responses. The EMI participants will not receive feedback SMS. A third group will have no contact (no-contact control). All groups will then be contacted for a follow-up interview within 4 weeks of the 12-week study period ending. Results: The primary outcome is mean reduction in standard drinks consumed during their most recent heavy drinking occasion as measured at follow-up. Secondary outcomes include alcohol consumption over the previous 6 months, experiences of alcohol-related harms, attitudes toward drinking and drunkenness, hazardous drinking and use of tobacco and illicit drugs. A random effects mixed modelling approach using maximum likelihood estimation will be used to provide estimates of differences in mean drinking levels between those receiving the intervention and control participants. Conclusions: This study is novel in that, unlike previous work, it will intervene repeatedly during single occasion drinking events. Further, it extends previous research in this area, which has applied limited tailoring of message content for SMS-based brief interventions. The findings of this study will contribute to the growing body of evidence to inform the use of mobile health interventions for reducing alcohol consumption and harms. Trial Registration: Australian New Zealand Clinical Trials ACTRN12616001323415; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=369534 (Archived by WebCite at http://www.webcitation.org/ 6qDqBZV9b) %M 28546136 %R 10.2196/resprot.6760 %U http://www.researchprotocols.org/2017/5/e95/ %U https://doi.org/10.2196/resprot.6760 %U http://www.ncbi.nlm.nih.gov/pubmed/28546136 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e65 %T What to Build for Middle-Agers to Come? Attractive and Necessary Functions of Exercise-Promotion Mobile Phone Apps: A Cross-Sectional Study %A Liao,Gen-Yih %A Chien,Yu-Tai %A Chen,Yu-Jen %A Hsiung,Hsiao-Fang %A Chen,Hsiao-Jung %A Hsieh,Meng-Hua %A Wu,Wen-Jie %+ Department of Information Management, Chang Gung University, 259 Wen-Hwa 1st Road, Guishan District, Taoyuan City, 333, Taiwan, 886 32118800 ext 5852, gyliao@acm.org %K physical exercise %K middle aged %K mobile application %K self efficacy %K consumer preference %D 2017 %7 25.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity is important for middle-agers to maintain health both in middle age and in old age. Although thousands of exercise-promotion mobile phone apps are available for download, current literature offers little understanding regarding which design features can enhance middle-aged adults’ quality perception toward exercise-promotion apps and which factor may influence such perception. Objectives: The aims of this study were to understand (1) which design features of exercise-promotion apps can enhance quality perception of middle-agers, (2) whether their needs are matched by current functions offered in app stores, and (3) whether physical activity (PA) and mobile phone self-efficacy (MPSE) influence quality perception. Methods: A total of 105 middle-agers participated and filled out three scales: the International Physical Activity Questionnaire (IPAQ), the MPSE scale, and the need for design features questionnaire. The design features were developed based on the Coventry, Aberdeen, and London—Refined (CALO-RE) taxonomy. Following the Kano quality model, the need for design features questionnaire asked participants to classify design features into five categories: attractive, one-dimensional, must-be, indifferent, and reverse. The quality categorization was conducted based on a voting approach and the categorization results were compared with the findings of a prevalence study to realize whether needs match current availability. In total, 52 multinomial logistic regression models were analyzed to evaluate the effects of PA level and MPSE on quality perception of design features. Results: The Kano analysis on the total sample revealed that visual demonstration of exercise instructions is the only attractive design feature, whereas the other 51 design features were perceived with indifference. Although examining quality perception by PA level, 21 features are recommended to low level, 6 features to medium level, but none to high-level PA. In contrast, high-level MPSE is recommended with 14 design features, medium level with 6 features, whereas low-level participants are recommended with 1 feature. The analysis suggests that the implementation of demanded features could be low, as the average prevalence of demanded design features is 20% (4.3/21). Surprisingly, social comparison and social support, most implemented features in current apps, were categorized into the indifferent category. The magnitude of effect is larger for MPSE because it effects quality perception of more design features than PA. Delving into the 52 regression models revealed that high MPSE more likely induces attractive or one- dimensional categorization, suggesting the importance of technological self-efficacy on eHealth care promotion. Conclusions: This study is the first to propose middle-agers’ needs in relation to mobile phone exercise-promotion. In addition to the tailor-made recommendations, suggestions are offered to app designers to enhance the performance of persuasive features. An interesting finding on change of quality perception attributed to MPSE is proposed as future research. %M 28546140 %R 10.2196/mhealth.6233 %U http://mhealth.jmir.org/2017/5/e65/ %U https://doi.org/10.2196/mhealth.6233 %U http://www.ncbi.nlm.nih.gov/pubmed/28546140 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e176 %T Mental Health Mobile Apps for Preadolescents and Adolescents: A Systematic Review %A Grist,Rebecca %A Porter,Joanna %A Stallard,Paul %+ Child and Adolescent Mental Health Group, Department for Health, University of Bath, Wessex House, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 2253850 ext 86, r.grist@bath.ac.uk %K mobile apps %K smartphone apps %K mHealth %K mental health %K self-help %K child %K adolescent %K preadolescent %K review %D 2017 %7 25.05.2017 %9 Review %J J Med Internet Res %G English %X Background: There are an increasing number of mobile apps available for adolescents with mental health problems and an increasing interest in assimilating mobile health (mHealth) into mental health services. Despite the growing number of apps available, the evidence base for their efficacy is unclear. Objective: This review aimed to systematically appraise the available research evidence on the efficacy and acceptability of mobile apps for mental health in children and adolescents younger than 18 years. Methods: The following were systematically searched for relevant publications between January 2008 and July 2016: APA PsychNet, ACM Digital Library, Cochrane Library, Community Care Inform-Children, EMBASE, Google Scholar, PubMed, Scopus, Social Policy and Practice, Web of Science, Journal of Medical Internet Research, Cyberpsychology, Behavior and Social Networking, and OpenGrey. Abstracts were included if they described mental health apps (targeting depression, bipolar disorder, anxiety disorders, self-harm, suicide prevention, conduct disorder, eating disorders and body image issues, schizophrenia, psychosis, and insomnia) for mobile devices and for use by adolescents younger than 18 years. Results: A total of 24 publications met the inclusion criteria. These described 15 apps, two of which were available to download. Two small randomized trials and one case study failed to demonstrate a significant effect of three apps on intended mental health outcomes. Articles that analyzed the content of six apps for children and adolescents that were available to download established that none had undergone any research evaluation. Feasibility outcomes suggest acceptability of apps was good and app usage was moderate. Conclusions: Overall, there is currently insufficient research evidence to support the effectiveness of apps for children, preadolescents, and adolescents with mental health problems. Given the number and pace at which mHealth apps are being released on app stores, methodologically robust research studies evaluating their safety, efficacy, and effectiveness is promptly needed. %M 28546138 %R 10.2196/jmir.7332 %U http://www.jmir.org/2017/5/e176/ %U https://doi.org/10.2196/jmir.7332 %U http://www.ncbi.nlm.nih.gov/pubmed/28546138 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 5 %P e94 %T Using Beta-Version mHealth Technology for Team-Based Care Management to Support Stroke Prevention: An Assessment of Utility and Challenges %A Ramirez,Magaly %A Wu,Shinyi %A Ryan,Gery %A Towfighi,Amytis %A Vickrey,Barbara G %+ Fielding School of Public Health, Department of Health Policy and Management, University of California, Los Angeles, 650 Charles Young Dr S, 31-293A, Los Angeles, CA, 90095-1772, United States, 1 310 825 2594, ramirezma@ucla.edu %K community health workers %K stroke %K patient care management %K patient care team %K mobile devices %K mobile applications %K health care information systems %D 2017 %7 23.05.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Beta versions of health information technology tools are needed in service delivery models with health care and community partnerships to confirm the key components and to assess the performance of the tools and their impact on users. We developed a care management technology (CMT) for use by community health workers (CHWs) and care managers (CMs) working collaboratively to improve risk factor control among recent stroke survivors. The CMT was expected to enhance the efficiency and effectiveness of the CHW-CM team. Objective: The primary objective was to describe the Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities (SUCCEED) CMT and investigate CM and CHW perceptions of the CMT’s usefulness and challenges for team-based care management. Methods: We conducted qualitative interviews with all users of the beta-version SUCCEED CMT, namely two CMs and three CHWs. They were asked to demonstrate and describe their perceptions of the CMT’s ease of use and usefulness for completing predefined key care management activities. They were also probed about their general perceptions of the CMT’s information quality, ease of use, usefulness, and impact on CM and CHW roles. Interview transcripts were coded using a priori codes. Coded excerpts were grouped into broader themes and then related in a conceptual model of how the CMT facilitated care management. We also conducted a survey with 14 patients to obtain their perspective on CHW tablet use during CHW-patient interactions. Results: Care managers and community health workers expressed that the CMT helped them keep track of patient interactions and plan their work. It guided CMs in developing and sharing care plans with CHWs. For CHWs, the CMT enabled electronic collection of clinical assessment data, provided decision support, and provided remote access to patients’ risk factor values. Long loading times and downtimes due to outages were the most significant challenges encountered. Additional issues included extensive use of free-text responses and manual data transfer from the electronic medical record. Despite these challenges, patients overall did not perceive the tablet as interfering with CHW-patient interactions. Conclusions: Our findings suggest useful functionalities of CMTs supporting health care and community partners in collaborative chronic care management. However, usability issues need to be addressed during the development process. The SUCCEED CMT is an initial step toward the development of effective health information technology tools to support collaborative, team-based models of care and will need to be modified as the evidence base grows. Future research should assess the CMT’s effects on team performance. %M 28536094 %R 10.2196/resprot.7106 %U http://www.researchprotocols.org/2017/5/e94/ %U https://doi.org/10.2196/resprot.7106 %U http://www.ncbi.nlm.nih.gov/pubmed/28536094 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e67 %T Effect of a Counseling Session Bolstered by Text Messaging on Self-Selected Health Behaviors in College Students: A Preliminary Randomized Controlled Trial %A Sandrick,Janice %A Tracy,Doreen %A Eliasson,Arn %A Roth,Ashley %A Bartel,Jeffrey %A Simko,Melanie %A Bowman,Tracy %A Harouse-Bell,Karen %A Kashani,Mariam %A Vernalis,Marina %+ Integrative Cardiac Health Project, Department of Medicine, Walter Reed Military Medical Center, Bldg 17A, 8901 Wisconsin Avenue, Bethesda, MD, 20889, United States, 1 301 400 1111, aheliasson@aol.com %K health behaviors %K diet habits %K exercise %K sleep %K text telecommunications %K universities %D 2017 %7 17.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The college experience is often the first time when young adults live independently and make their own lifestyle choices. These choices affect dietary behaviors, exercise habits, techniques to deal with stress, and decisions on sleep time, all of which direct the trajectory of future health. There is a need for effective strategies that will encourage healthy lifestyle choices in young adults attending college. Objective: This preliminary randomized controlled trial tested the effect of coaching and text messages (short message service, SMS) on self-selected health behaviors in the domains of diet, exercise, stress, and sleep. A second analysis measured the ripple effect of the intervention on health behaviors not specifically selected as a goal by participants. Methods: Full-time students aged 18-30 years were recruited by word of mouth and campuswide advertisements (flyers, posters, mailings, university website) at a small university in western Pennsylvania from January to May 2015. Exclusions included pregnancy, eating disorders, chronic medical diagnoses, and prescription medications other than birth control. Of 60 participants, 30 were randomized to receive a single face-to-face meeting with a health coach to review results of behavioral questionnaires and to set a health behavior goal for the 8-week study period. The face-to-face meeting was followed by SMS text messages designed to encourage achievement of the behavioral goal. A total of 30 control subjects underwent the same health and behavioral assessments at intake and program end but did not receive coaching or SMS text messages. Results: The texting app showed that 87.31% (2187/2505) of messages were viewed by intervention participants. Furthermore, 28 of the 30 intervention participants and all 30 control participants provided outcome data. Among intervention participants, 22 of 30 (73%) showed improvement in health behavior goal attainment, with the whole group (n=30) showing a mean improvement of 88% (95% CI 39-136). Mean improvement in any behavioral domains was not seen in the control group. Intervention participants also increased their exercise significantly compared with controls, regardless of their self-selected goal category. The increased exercise was paralleled by significantly lower fasting glucose levels. Conclusions: The health coaching session plus tailored SMS text messages improved self-selected health behaviors with a modest ripple effect to include unselected health behaviors. Trial Registration: Clinicaltrials.gov NCT02476604; https://clinicaltrials.gov/ct2/show/NCT02476604 (Archived by WebCite at http://www.webcitation.org/6qAAryS5t) %M 28526664 %R 10.2196/mhealth.6638 %U http://mhealth.jmir.org/2017/5/e67/ %U https://doi.org/10.2196/mhealth.6638 %U http://www.ncbi.nlm.nih.gov/pubmed/28526664 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e160 %T What Matters in Weight Loss? An In-Depth Analysis of Self-Monitoring %A Painter,Stefanie Lynn %A Ahmed,Rezwan %A Hill,James O %A Kushner,Robert F %A Lindquist,Richard %A Brunning,Scott %A Margulies,Amy %+ Retrofit INC, 123 N. Wacker Drive, Suite 1250, Chicago, IL, 60606, United States, 1 8007745962, stefanie@retrofitme.com %K behavior %K body mass index %K fitness trackers %K self-monitoring %K obesity %K overweight %K weight loss %D 2017 %7 12.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Using technology to self-monitor body weight, dietary intake, and physical activity is a common practice used by consumers and health companies to increase awareness of current and desired behaviors in weight loss. Understanding how to best use the information gathered by these relatively new methods needs to be further explored. Objective: The purpose of this study was to analyze the contribution of self-monitoring to weight loss in participants in a 6-month commercial weight-loss intervention administered by Retrofit and to specifically identify the significant contributors to weight loss that are associated with behavior and outcomes. Methods: A retrospective analysis was performed using 2113 participants enrolled from 2011 to 2015 in a Retrofit weight-loss program. Participants were males and females aged 18 years or older with a starting body mass index of ≥25 kg/m2, who also provided a weight measurement at the sixth month of the program. Multiple regression analysis was performed using all measures of self-monitoring behaviors involving weight measurements, dietary intake, and physical activity to predict weight loss at 6 months. Each significant predictor was analyzed in depth to reveal the impact on outcome. Results: Participants in the Retrofit Program lost a mean –5.58% (SE 0.12) of their baseline weight with 51.87% (1096/2113) of participants losing at least 5% of their baseline weight. Multiple regression model (R2=.197, P<0.001) identified the following measures as significant predictors of weight loss at 6 months: number of weigh-ins per week (P<.001), number of steps per day (P=.02), highly active minutes per week (P<.001), number of food log days per week (P<.001), and the percentage of weeks with five or more food logs (P<.001). Weighing in at least three times per week, having a minimum of 60 highly active minutes per week, food logging at least three days per week, and having 64% (16.6/26) or more weeks with at least five food logs were associated with clinically significant weight loss for both male and female participants. Conclusions: The self-monitoring behaviors of self-weigh-in, daily steps, high-intensity activity, and persistent food logging were significant predictors of weight loss during a 6-month intervention. %M 28500022 %R 10.2196/jmir.7457 %U http://www.jmir.org/2017/5/e160/ %U https://doi.org/10.2196/jmir.7457 %U http://www.ncbi.nlm.nih.gov/pubmed/28500022 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e141 %T Efficacy of a Web-Based Guided Recommendation Service for a Curated List of Readily Available Mental Health and Well-Being Mobile Apps for Young People: Randomized Controlled Trial %A Bidargaddi,Niranjan %A Musiat,Peter %A Winsall,Megan %A Vogl,Gillian %A Blake,Victoria %A Quinn,Stephen %A Orlowski,Simone %A Antezana,Gaston %A Schrader,Geoffrey %+ Digital Psychiatry & Personal Health Informatics Group, School of Medicine, Flinders University, Flinders at Tonsley, 1284 South Road, Clovelly Park, 5042, Australia, 61 872218842, niranjan.bidargaddi@flinders.edu.au %K well-being %K mental health %K young people %K online intervention %K apps %K engagement %D 2017 %7 12.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental disorders are highly prevalent for the people who are aged between 16 and 25 years and can permanently disrupt the development of these individuals. Easily available mobile health (mHealth) apps for mobile phones have great potential for the prevention and early intervention of mental disorders in young adults, but interventions are required that can help individuals to both identify high-quality mobile apps and use them to change health and lifestyle behavior. Objectives: The study aimed to assess the efficacy of a Web-based self-guided app recommendation service (“The Toolbox”) in improving the well-being of young Australians aged between 16 and 25 years. The intervention was developed in collaboration with young adults and consists of a curated list of 46 readily available health and well-being apps, assessed and rated by professionals and young people. Participants are guided by an interactive quiz and subsequently receive recommendations for particular apps to download and use based on their personal goals. Methods: The study was a waitlist, parallel-arm, randomized controlled trial. Our primary outcome measure was change in well-being as measured by the Mental Health Continuum-Short Form (MHC-SF). We also employed ecological momentary assessments (EMAs) to track mood, energy, rest, and sleep. Participants were recruited from the general Australian population, via several Web-based and community strategies. The study was conducted through a Web-based platform consisting of a landing Web page and capabilities to administer study measures at different time points. Web-based measurements were self-assessed at baseline and 4 weeks, and EMAs were collected repeatedly at regular weekly intervals or ad hoc when participants interacted with the study platform. Primary outcomes were analyzed using linear mixed-models and intention-to-treat (ITT) analysis. Results: A total of 387 participants completed baseline scores and were randomized into the trial. Results demonstrated no significant effect of “The Toolbox” intervention on participant well-being at 4 weeks compared with the control group (P=.66). There were also no significant differences between the intervention and control groups at 4 weeks on any of the subscales of the MHC-SF (psychological: P=.95, social: P=.42, emotional: P=.95). Repeat engagement with the study platform resulted in a significant difference in mood, energy, rest, and sleep trajectories between intervention and control groups as measured by EMAs (P<.01). Conclusions: This was the first study to assess the effectiveness of a Web-based well-being intervention in a sample of young adults. The design of the intervention utilized expert rating of existing apps and end-user codesign approaches resulting in an app recommendation service. Our finding suggests that recommended readily available mental health and well-being apps may not lead to improvements in the well-being of a nonclinical sample of young people, but might halt a decline in mood, energy, rest, and sleep. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614000710628; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366145 (Archived by WebCite at http://www.webcitation.org/ 6pWDsnKme) %M 28500020 %R 10.2196/jmir.6775 %U http://www.jmir.org/2017/5/e141/ %U https://doi.org/10.2196/jmir.6775 %U http://www.ncbi.nlm.nih.gov/pubmed/28500020 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e64 %T Assessing the Impact of a Novel Smartphone Application Compared With Standard Follow-Up on Mobility of Patients With Knee Osteoarthritis Following Treatment With Hylan G-F 20: A Randomized Controlled Trial %A Skrepnik,Nebojsa %A Spitzer,Andrew %A Altman,Roy %A Hoekstra,John %A Stewart,John %A Toselli,Richard %+ Tucson Orthopaedic Institute, 5301 E. Grant Road, Tucson, AZ,, United States, 1 520 784 6140, NSkrepnik@tucsonortho.com %K mobile health %K mHealth %K mobile apps %K osteoarthritis %K osteoarthritis, knee %K hylan G-F 20 %K Synvisc %D 2017 %7 09.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Osteoarthritis (OA) is a leading cause of disability in the United States. Although no disease-modifying therapies exist, patients with knee OA who increase walking may reduce risk of functional limitations. Objective: The objective of the study is to evaluate the impact of a mobile app (OA GO) plus wearable activity monitor/pedometer (Jawbone UP 24) used for 90 days on the mobility of patients with knee OA treated with hylan G-F 20. Methods: Patients with knee OA aged 30 to 80 years who were eligible to receive hylan G-F 20 and were familiar with smartphone technology were enrolled in this randomized, multicenter, open-label study. Patients who had a body mass index above 35 kg/m2 were excluded. All patients received a single 6-mL injection of hylan G-F 20 and wore the Jawbone monitor. The patients were then randomized 1:1 to Jawbone and OA GO (Group A; n=107) with visible feedback (unblinded) or Jawbone only (Group B; n=104) with no visible feedback (blinded). The primary endpoint was mean change from baseline in steps per day at day 90 between Groups A and B. Results: Baseline characteristics were similar between groups. There were significant differences between the increases in least squares (LS) mean number of steps per day (1199 vs 467, P=.03) and the mean percentage change (35.8% vs 11.5%, P=.02) from baseline in favor of Group A over Group B. There was a greater reduction in pain from baseline during the 6-minute walk test in Group A versus Group B. (LS mean change: −55.3 vs −33.8, P=.007). Most patients (65.4%) and surveys of physicians (67.3%) reported they would be likely or very likely to use/recommend the devices. Patient Activity Measure-13 scores improved from baseline (LS mean change for Groups A and B: 5.0 vs 6.9), with no significant differences between groups. The occurrence of adverse events was similar in the 2 groups. Conclusions: Use of a novel smartphone app in conjunction with a wearable activity monitor provided additional improvement on mobility parameters such as steps per day and pain with walking in the 6-minute walk test in patients with knee OA who were treated with hylan G-F 20. Results also highlight the amenability of patients and physicians to using mobile health technology in the treatment of OA and suggest further study is warranted. %M 28487266 %R 10.2196/mhealth.7179 %U http://mhealth.jmir.org/2017/5/e64/ %U https://doi.org/10.2196/mhealth.7179 %U http://www.ncbi.nlm.nih.gov/pubmed/28487266 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e152 %T Evaluation of Pollen Apps Forecasts: The Need for Quality Control in an eHealth Service %A Bastl,Katharina %A Berger,Uwe %A Kmenta,Maximilian %+ Research group Aerobiology and pollen information, Department of Oto-Rhino-Laryngology, Medical University of Vienna, HNO-Klinik, 8J, Währinger Gürtel 18-20, Wien, 1090, Austria, 43 140400 ext 33380, katharina.bastl@meduniwien.ac.at %K pollen forecast %K pollen information service %K mobile app %K pollen forecast quality %K allergen avoidance %D 2017 %7 08.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Pollen forecasts are highly valuable for allergen avoidance and thus raising the quality of life of persons concerned by pollen allergies. They are considered as valuable free services for the public. Careful scientific evaluation of pollen forecasts in terms of accurateness and reliability has not been available till date. Objective: The aim of this study was to analyze 9 mobile apps, which deliver pollen information and pollen forecasts, with a focus on their accurateness regarding the prediction of the pollen load in the grass pollen season 2016 to assess their usefulness for pollen allergy sufferers. Methods: The following number of apps was evaluated for each location: 3 apps for Vienna (Austria), 4 apps for Berlin (Germany), and 1 app each for Basel (Switzerland) and London (United Kingdom). All mobile apps were freely available. Today’s grass pollen forecast was compared throughout the defined grass pollen season at each respective location with measured grass pollen concentrations. Hit rates were calculated for the exact performance and for a tolerance in a range of ±2 and ±4 pollen per cubic meter. Results: In general, for most apps, hit rates score around 50% (6 apps). It was found that 1 app showed better results, whereas 3 apps performed less well. Hit rates increased when calculated with tolerances for most apps. In contrast, the forecast for the “readiness to flower” for grasses was performed at a sufficiently accurate level, although only two apps provided such a forecast. The last of those forecasts coincided with the first moderate grass pollen load on the predicted day or 3 days after and performed even from about a month before well within the range of 3 days. Advertisement was present in 3 of the 9 analyzed apps, whereas an imprint mentioning institutions with experience in pollen forecasting was present in only three other apps. Conclusions: The quality of pollen forecasts is in need of improvement, and quality control for pollen forecasts is recommended to avoid potential harm to pollen allergy sufferers due to inadequate forecasts. The inclusion of information on reliability of provided forecasts and a similar handling regarding probabilistic weather forecasts should be considered. %M 28483740 %R 10.2196/jmir.7426 %U http://www.jmir.org/2017/5/e152/ %U https://doi.org/10.2196/jmir.7426 %U http://www.ncbi.nlm.nih.gov/pubmed/28483740 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e154 %T Mobile App for Treatment of Stress Urinary Incontinence: A Cost-Effectiveness Analysis %A Sjöström,Malin %A Lindholm,Lars %A Samuelsson,Eva %+ Department of Public Health and Clinical Medicine, Umeå University, Region Jämtland Härjedalen, Box 654, Umeå, SE-832 27, Sweden, 46 703269948, malin.sjostrom@regionjh.se %K mobile application %K pelvic floor %K urinary incontinence, stress %K self care %K cost-benefit analysis %D 2017 %7 08.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile apps can increase access to care, facilitate self-management, and improve adherence to treatment. Stress urinary incontinence (SUI) affects 10-35% of women and, currently, an app with instructions for pelvic floor muscle training (PFMT) is available as first-line treatment. A previous randomized controlled study demonstrated that the app benefitted symptom severity and quality of life (QoL); in this study we investigate the cost-effectiveness of the app. Objective: The objective of this study was to evaluate the health economy of the app for treating SUI. Methods: This deterministic cost-utility analysis, with a 1-year societal perspective, compared the app treatment with no treatment. Health economic data were collected alongside a randomized controlled trial performed in Sweden from March 2013 to October 2014. This study included 123 community-dwelling women participants of 18 years and above, with stress urinary incontinence ≥1 time per week. Participants were self-assessed with validated questionnaires and 2-day leakage diaries, and then randomized to 3 months of treatment (app group, n=62) or no treatment (controls, n=61). The app focused on pelvic floor muscle training, prescribed 3 times daily. We continuously registered treatment delivery costs. Data were collected on each participant’s training time, incontinence aids, and laundry at baseline and at a 3-month follow-up. We measured quality of life with the International Consultation on Incontinence Modular Questionnaire on Lower Urinary Tract Symptoms and Quality of Life, and calculated the quality-adjusted life years (QALYs) gained. Data from the 3-month follow-up were extrapolated to 1 year for the calculations. Our main outcome was the incremental cost-effectiveness ratios compared between app and control groups. One-way and multiway sensitivity analyses were performed. Results: The mean age of participants was 44.7 years (SD 9.4). Annual costs were €547.0 for the app group and €482.4 for the control group. Annual gains in quality-adjusted life years for app and control groups were 0.0101 and 0.0016, respectively. Compared with controls, the extra cost per quality-adjusted life year for the app group ranged from −€2425.7 to €14,870.6, which indicated greater gains in quality-adjusted life years at similar or slightly higher cost. Conclusions: The app for treating stress urinary incontinence is a new, cost-effective, first-line treatment with potential for increasing access to care in a sustainable way for this patient group. %M 28483745 %R 10.2196/jmir.7383 %U http://www.jmir.org/2017/5/e154/ %U https://doi.org/10.2196/jmir.7383 %U http://www.ncbi.nlm.nih.gov/pubmed/28483745 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e148 %T Automated Text Messaging as an Adjunct to Cognitive Behavioral Therapy for Depression: A Clinical Trial %A Aguilera,Adrian %A Bruehlman-Senecal,Emma %A Demasi,Orianna %A Avila,Patricia %+ School of Social Welfare, University of California, Berkeley, 120 Haviland Hall, MC 7400, Berkeley, CA, 94720, United States, 1 5106428564, aguila@berkeley.edu %K depression %K text messaging %K cognitive behavioral therapy %K mhealth %K mental health %K Latinos %D 2017 %7 08.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive Behavioral Therapy (CBT) for depression is efficacious, but effectiveness is limited when implemented in low-income settings due to engagement difficulties including nonadherence with skill-building homework and early discontinuation of treatment. Automated messaging can be used in clinical settings to increase dosage of depression treatment and encourage sustained engagement with psychotherapy. Objectives: The aim of this study was to test whether a text messaging adjunct (mood monitoring text messages, treatment-related text messages, and a clinician dashboard to display patient data) increases engagement and improves clinical outcomes in a group CBT treatment for depression. Specifically, we aim to assess whether the text messaging adjunct led to an increase in group therapy sessions attended, an increase in duration of therapy attended, and reductions in Patient Health Questionnaire-9 item (PHQ-9) symptoms compared with the control condition of standard group CBT in a sample of low-income Spanish speaking Latino patients. Methods: Patients in an outpatient behavioral health clinic were assigned to standard group CBT for depression (control condition; n=40) or the same treatment with the addition of a text messaging adjunct (n=45). The adjunct consisted of a daily mood monitoring message, a daily message reiterating the theme of that week’s content, and medication and appointment reminders. Mood data and qualitative responses were sent to a Web-based platform (HealthySMS) for review by the therapist and displayed in session as a tool for teaching CBT skills. Results: Intent-to-treat analyses on therapy attendance during 16 sessions of weekly therapy found that patients assigned to the text messaging adjunct stayed in therapy significantly longer (median of 13.5 weeks before dropping out) than patients assigned to the control condition (median of 3 weeks before dropping out; Wilcoxon-Mann-Whitney z=−2.21, P=.03). Patients assigned to the text messaging adjunct also generally attended more sessions (median=6 sessions) during this period than patients assigned to the control condition (median =2.5 sessions), but the effect was not significant (Wilcoxon-Mann-Whitney z=−1.65, P=.10). Both patients assigned to the text messaging adjunct (B=−.29, 95% CI −0.38 to −0.19, z=−5.80, P<.001) and patients assigned to the control conditions (B=−.20, 95% CI −0.32 to −0.07, z=−3.12, P=.002) experienced significant decreases in depressive symptom severity over the course of treatment; however, the conditions did not significantly differ in their degree of symptom reduction. Conclusions: This study provides support for automated text messaging as a tool to sustain engagement in CBT for depression over time. There were no differences in depression outcomes between conditions, but this may be influenced by low follow-up rates of patients who dropped out of treatment. %M 28483742 %R 10.2196/jmir.6914 %U http://www.jmir.org/2017/5/e148/ %U https://doi.org/10.2196/jmir.6914 %U http://www.ncbi.nlm.nih.gov/pubmed/28483742 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e62 %T eTEST: Developing a Smart Home HIV Testing Kit that Enables Active, Real-Time Follow-Up and Referral After Testing %A Wray,Tyler %A Chan,Philip A %A Simpanen,Erik %A Operario,Don %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main Street, Box G-S121-5, Providence, RI, 02903, United States, 1 9134882714, tyler_wray@brown.edu %K HIV %K smartphone %K Internet %K counseling %K referral and consultation %K qualitative research %D 2017 %7 08.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Men who have sex with men (MSM) are the group at highest risk for contracting human immunodeficiency virus (HIV) in the United States, but many do not test as frequently as recommended. Home-based self-testing (HBST) for HIV holds promise for promoting regular testing among these individuals, but currently available HBSTs have limited follow-up options, providing only a 1-800 number that participants can call. Failure to actively conduct follow-up counseling and referrals after HBST use could result in delays in seeking confirmatory testing and care among users receiving reactive (preliminary positive) test results. HBST also fails to connect users who test negative with other prevention services that can reduce their future risk for HIV. Objective: The aim of our study was to use qualitative research methods with high-risk MSM to inform development of a “smart” HBST kit. The kit utilizes existing Internet-of-Things (IoT) technologies to monitor HBST use in real-time and enable delivery of timely, active follow-up counseling and referrals over the phone. Methods: In phase 1, individual interviews (n=10) explored how participants might use HBST and their views and preferences for conducting counseling and referral after HBST. Based on these perspectives, we developed a smartphone app (iOS, Android) that uses data from light sensors on Bluetooth low energy (BLE) beacons to monitor when HBST kits are opened, facilitating timely follow-up phone contact with users. In phase 2, a usability study conducted among high-risk MSM (n=10) examined the acceptability and feasibility of this system and provided user perspectives after using the system along with HBST. Results: Phase 1 themes suggested that MSM preferred HBST, that most thought active follow-up after HBST would be valuable, and that doing so over the phone within 24 h after testing was preferable. Phase 2 results showed that the eTEST system successfully detected HBST use in nearly all cases. Participant perspectives also suggested that the timing, method (ie, phone call), and duration of follow-up were appropriate and helpful. Conclusions: Using BLE beacons and a smartphone app to enable follow-up counseling and referral over the phone after HBST use is feasible and acceptable to high-risk MSM. Future research is needed to compare the effects of follow-up counseling on rates of repeat testing and receipt of referral services (eg, testing for sexually transmitted infections and initiation of preexposure prophylaxis) and to explore the acceptability of the eTEST system over longer periods of time. %M 28483744 %R 10.2196/mhealth.6491 %U http://mhealth.jmir.org/2017/5/e62/ %U https://doi.org/10.2196/mhealth.6491 %U http://www.ncbi.nlm.nih.gov/pubmed/28483744 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e55 %T The Physical Activity Tracker Testing in Youth (P.A.T.T.Y.) Study: Content Analysis and Children’s Perceptions %A Masteller,Brittany %A Sirard,John %A Freedson,Patty %+ Department of Kinesiology, University of Massachusetts Amherst, 30 Eastman Lane, Totman 110, Amherst, MA, 01003, United States, 1 4135457898, bmasteller@kin.umass.edu %K child %K physical activity %K qualitative research %D 2017 %7 28.4.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Activity trackers are widely used by adults and several models are now marketed for children. Objective: The aims of this study were to (1) perform a content analysis of behavioral change techniques (BCTs) used by three commercially available youth-oriented activity trackers and (2) obtain feedback describing children’s perception of these devices and the associated websites. Methods: A content analysis recorded the presence of 36 possible BCTs for the MovBand (MB), Sqord (SQ), and Zamzee (ZZ) activity trackers. In addition, 16 participants (mean age 8.6 years [SD 1.6]; 50% female [8/16]) received all three trackers and were oriented to the devices and websites. Participants were instructed to wear the trackers on 4 consecutive days and spend ≥10 min/day on each website. A cognitive interview and survey were administered when the participant returned the devices. Qualitative data analysis was used to analyze the content of the cognitive interviews. Chi-square analyses were used to determine differences in behavioral monitoring and social interaction features between websites. Results: The MB, SQ, and ZZ devices or websites included 8, 15, and 14 of the possible 36 BCTs, respectively. All of the websites had a behavioral monitoring feature (charts for tracking activity), but the percentage of participants indicating that they “liked” those features varied by website (MB: 8/16, 50%; SQ: 6/16, 38%; ZZ: 11/16, 69%). Two websites (SQ and ZZ) included an “avatar” that the user could create to represent themselves on the website. Participants reported that they “liked” creating and changing their avatar (SQ: 12/16, 75%, ZZ: 15/16, 94%), which was supported by the qualitative analyses of the cognitive interviews. Most participants (75%) indicated that they would want to wear the devices more if their friends were wearing a tracker. No significant differences were observed between SQ and ZZ devices in regards to liking or use of social support interaction features (P=.21 to .37). Conclusions: The websites contained several BCTs consistent with previously identified strategies. Children “liked” the social aspects of the websites more than the activity tracking features. Developers of commercial activity trackers for youth may benefit from considering a theoretical perspective during the website design process. %M 28455278 %R 10.2196/mhealth.6347 %U http://mhealth.jmir.org/2017/4/e55/ %U https://doi.org/10.2196/mhealth.6347 %U http://www.ncbi.nlm.nih.gov/pubmed/28455278 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 4 %P e69 %T The Smartphone Peer Physical Activity Counseling (SPPAC) Program for Manual Wheelchair Users: Protocol of a Pilot Randomized Controlled Trial %A Best,Krista L %A Routhier,François %A Sweet,Shane N %A Arbour-Nicitopoulos,Kelly P %A Borisoff,Jaimie F %A Noreau,Luc %A Martin Ginis,Kathleen A %+ Centre for interdisciplinary research in rehabilitation and social integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Institut de réadaptation en déficience physique de Québec, 525, boulevard Wilfrid-Hamel, Quebec City, QC, G1M 2S8, Canada, 1 418 529 9141 ext 6256, francois.routhier@rea.ulaval.ca %K Manual wheelchair %K Physical activity %K Peer training %K Smartphone %K Randomized controlled trial %D 2017 %7 26.04.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical activity (PA) must be performed regularly to accrue health benefits. However, the majority of manual wheelchair users do not meet PA recommendations. Existing community-based PA programs for manual wheelchair users appear to work, but effect sizes are small and retention is low. Existing PA programs may not fully implement some psychosocial factors that are strongly linked with PA (eg, autonomy). The use of peers and mobile phone technology in the Smartphone Peer PA Counseling (SPPAC) program represents a novel approach to cultivating a PA-supportive environment for manual wheelchair users. Objective: The primary objective is to compare change in objective PA between the experimental (SPPAC) and control groups from baseline to postintervention (10 weeks) and follow-up (3 months). Changes in and relationships between subjective PA, wheelchair skills, motivation, self-efficacy (for overcoming barriers to PA for manual wheelchair use), satisfaction of psychological needs for PA, and satisfaction with PA participation will be explored (secondary outcome). Program implementation will be explored (tertiary objective). Methods: A total of 38 community-living manual wheelchair users (≥18 years) will be recruited in a randomized controlled trial (RCT). Participants in both the control and experimental groups will receive existing PA guidelines. Participants in the experimental group will also receive the SPPAC program: 14 sessions (~30 min) over a 10-week period delivered by a peer trainer using a mobile phone. PA activities will be based on individuals’ preferences and goals. Implementation of important theoretical variables will be enforced through a peer-trainer checklist. Outcomes for objective PA (primary) and subjective PA, wheelchair skills, motivation, self-efficacy, satisfaction of psychological needs, and satisfaction with participation will be collected at three time points (baseline, postintervention, follow-up). Multiple imputations will be used to treat missing data. A mixed-model ANCOVA will be conducted, controlling for covariates (primary and secondary objectives). The strength and direction of the relationships between the primary and secondary outcomes will be explored (secondary objective). Descriptive and content analysis will be used to appraise program implementation (tertiary objective). Results: Funding has been obtained from the Craig Neilsen Foundation and the Canadian Disability Participation Project, with additional funds being sought from the Canadian Institute for Health Research and Fonds de Recherche du Québec-Santé. Pilot evaluation of intervention implementation is currently underway, with enrollment anticipated to begin early 2018. Conclusions: There may be substantial benefits for the SPPAC program including limited burden on health care professionals, decreased barriers (eg. accessibility, transportation), development of peer social supports, and potential cost savings related to physical inactivity. Before conducting a large and expensive multisite RCT within a small heterogeneous population of manual wheelchair users, a pilot study affords a prudent step to establishing an adequate study protocol and implementation strategies. Trial Registration: ClinicalTrials.gov NCT02826707; https://clinicaltrials.gov/ct2/show/NCT02826707 (Archived by WebCite at http://www.webcitation.org/6pqIc14dU) %M 28446419 %R 10.2196/resprot.7280 %U http://www.researchprotocols.org/2017/4/e69/ %U https://doi.org/10.2196/resprot.7280 %U http://www.ncbi.nlm.nih.gov/pubmed/28446419 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 4 %P e67 %T Evaluation of a Mindfulness-Based Mobile App Aimed at Promoting Awareness of Weight-Related Behaviors in Adolescents: A Pilot Study %A Turner,Tami %A Hingle,Melanie %+ Department of Nutritional Sciences, The University of Arizona, 1177 E 4th St, Shantz Bldg, Room 328, Tucson, AZ,, United States, 1 520 626 7112, tamiturner@email.arizona.edu %K mindfulness %K adolescent %K mHealth %K diet %K physical activity %K app %D 2017 %7 26.04.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Mindfulness-based interventions are reported to be highly acceptable and have positive effects on youth, yet most are clinic- or school-based aimed at emotional regulation or academic performance. To provide flexible program delivery, we developed and tested a standalone mindfulness-based app aimed at improving weight-related behaviors (eg, diet, physical activity, sleep) in adolescents. Objective: Our objective was to assess the feasibility, acceptability, and utility of a mindfulness-based mobile app. Methods: In a single-arm pilot study, 15 adolescents (14-18 years) were prompted to access the app once a day, every day for 6 weeks. Outcomes were measured by in-app and poststudy surveys, and descriptive statistical analyses were performed. Time within a mindfulness state was self-reported during weekly timed practices. Results: The app was rated highly for content and encouraging the practice of activities to promote mindfulness states. Teens reported increased awareness of eating behaviors and high adherence, particularly during physically active practices. Average self-reported time spent in a mindfulness state increased 2.5 times by week 6 (78 [SD 17] seconds) compared to week 1 (31 [SD 21] seconds). Conclusions: The high acceptability and utility ratings of the app, increases in reported time in mindfulness states, and high frequency of participation, including mindful eating and physical activity, suggest the mindfulness-based mobile app has the potential to improve awareness of weight-related behaviors. %M 28446423 %R 10.2196/resprot.6695 %U http://www.researchprotocols.org/2017/4/e67/ %U https://doi.org/10.2196/resprot.6695 %U http://www.ncbi.nlm.nih.gov/pubmed/28446423 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e132 %T Compliance With Mobile Ecological Momentary Assessment Protocols in Children and Adolescents: A Systematic Review and Meta-Analysis %A Wen,Cheng K Fred %A Schneider,Stefan %A Stone,Arthur A %A Spruijt-Metz,Donna %+ Department of Preventive Medicine, University of Southern California, Soto Bldg 1, 3rd Fl, 2001 N Soto St, Los Angeles, CA, 90033, United States, 1 5626822468, chengkuw@usc.edu %K ecological momentary assessment %K compliance %K youth %K mHealth %D 2017 %7 26.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile device-based ecological momentary assessment (mobile-EMA) is increasingly used to collect participants' data in real-time and in context. Although EMA offers methodological advantages, these advantages can be diminished by participant noncompliance. However, evidence on how well participants comply with mobile-EMA protocols and how study design factors associated with participant compliance is limited, especially in the youth literature. Objective: To systematically and meta-analytically examine youth’s compliance to mobile-EMA protocols and moderators of participant compliance in clinical and nonclinical settings. Methods: Studies using mobile devices to collect EMA data among youth (age ≤18 years old) were identified. A systematic review was conducted to describe the characteristics of mobile-EMA protocols and author-reported factors associated with compliance. Random effects meta-analyses were conducted to estimate the overall compliance across studies and to explore factors associated with differences in youths’ compliance. Results: This review included 42 unique studies that assessed behaviors, subjective experiences, and contextual information. Mobile phones were used as the primary mode of EMA data collection in 48% (20/42) of the reviewed studies. In total, 12% (5/42) of the studies used wearable devices in addition to the EMA data collection platforms. About half of the studies (62%, 24/42) recruited youth from nonclinical settings. Most (98%, 41/42) studies used a time-based sampling protocol. Among these studies, most (95%, 39/41) prompted youth 2-9 times daily, for a study length ranging from 2-42 days. Sampling frequency and study length did not differ between studies with participants from clinical versus nonclinical settings. Most (88%, 36/41) studies with a time-based sampling protocol defined compliance as the proportion of prompts to which participants responded. In these studies, the weighted average compliance rate was 78.3%. The average compliance rates were not different between studies with clinical (76.9%) and nonclinical (79.2%; P=.29) and studies that used only a mobile-EMA platform (77.4%) and mobile platform plus additional wearable devices (73.0%, P=.36). Among clinical studies, the mean compliance rate was significantly lower in studies that prompted participants 2-3 times (73.5%) or 4-5 times (66.9%) compared with studies with a higher sampling frequency (6+ times: 89.3%). Among nonclinical studies, a higher average compliance rate was observed in studies that prompted participants 2-3 times daily (91.7%) compared with those that prompted participants more frequently (4-5 times: 77.4%; 6+ times: 75.0%). The reported compliance rates did not differ by duration of EMA period among studies from either clinical or nonclinical settings. Conclusions: The compliance rate among mobile-EMA studies in youth is moderate but suboptimal. Study design may affect protocol compliance differently between clinical and nonclinical participants; including additional wearable devices did not affect participant compliance. A more consistent compliance-related result reporting practices can facilitate understanding and improvement of participant compliance with EMA data collection among youth. %M 28446418 %R 10.2196/jmir.6641 %U http://www.jmir.org/2017/4/e132/ %U https://doi.org/10.2196/jmir.6641 %U http://www.ncbi.nlm.nih.gov/pubmed/28446418 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e56 %T Clickotine, A Personalized Smartphone App for Smoking Cessation: Initial Evaluation %A Iacoviello,Brian M %A Steinerman,Joshua R %A Klein,David B %A Silver,Theodore L %A Berger,Adam G %A Luo,Sean X %A Schork,Nicholas J %+ Click Therapeutics, Inc., 101 Avenue of the Americas, 8th Floor, New York, NY, 10013, United States, 1 646 844 2158, brian@clicktherapeutics.com %K smoking cessation %K cigarette smoking %K tobacco %K therapeutics %K smartphone %D 2017 %7 25.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Tobacco smoking is the leading cause of preventable death in the United States, and the annual economic burden attributable to smoking exceeds US $300 billion. Obstacles to smoking cessation include limited access and adherence to effective cessation interventions. Technology can help overcome these obstacles; many smartphone apps have been developed to aid smoking cessation, but few that conform to the US clinical practice guideline (USCPG) have been rigorously tested and reported in the literature. Clickotine is a novel smartphone app for smoking cessation, designed to deliver the essential features of the USCPG and engineered to engage smokers by personalizing intervention components. Objective: Our objective was to assess the engagement, efficacy, and safety of Clickotine in an initial, single-arm study. Outcomes measured were indicators of engagement with the smartphone app (number of app opens, number of interactions with the Clickotine program, and weeks active with Clickotine), cessation outcomes of 7- and 30-day self-reported abstinence from smoking, and negative health events. Methods: We recruited US residents between 18 and 65 years of age who owned an iPhone and smoked 5 or more cigarettes daily for the study via online advertising. Respondents were prescreened for eligibility by telephone and, if appropriate, directed to a Web portal to provide informed consent, confirm eligibility, and download the Clickotine app. Participants completed study assessments via the online portal at baseline and after 8 weeks. Data were collected in Amazon S3 with no manual data entry, and access to all data was maximally restrictive, logged, and auditable. Results: A total of 416 participants downloaded the app and constituted the intention-to-treat (ITT) sample. On average, participants opened the Clickotine app 100.6 times during the 8-week study (median 69), logged 214.4 interactions with the Clickotine program (median 178), and remained engaged with Clickotine for 5.3 weeks (median 5). Among the ITT sample, 45.2% (188/416) reported 7-day abstinence and 26.2% (109/416) reported 30-day abstinence from smoking after 8 weeks. Completer analysis focused on 365 (87.7%) of the 416 enrolled participants who completed the 8-week questionnaire revealed that 51.5% (188/365) of completers reported 7-day abstinence and 29.9% (109/365) reported 30-day abstinence. Few adverse events, mostly consistent with nicotine withdrawal symptoms, were reported and overall no safety signal was detected. Conclusions: In this initial single-arm trial, Clickotine users appeared to demonstrate encouraging indicators of engagement in terms of the number of app opens, number of program interactions, and continued engagement over time. Clickotine users reported encouraging quit rates while reporting few adverse events. Future research is warranted to assess Clickotine’s efficacy in a randomized controlled trial. Trial Registration: Clinicaltrials.gov NCT02656745; https://clinicaltrials.gov/ct2/show/NCT02656745 (Archived by WebCite at http://www.webcitation.org/6peTT4x60) %M 28442453 %R 10.2196/mhealth.7226 %U http://mhealth.jmir.org/2017/4/e56/ %U https://doi.org/10.2196/mhealth.7226 %U http://www.ncbi.nlm.nih.gov/pubmed/28442453 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e58 %T Use of Fitness and Nutrition Apps: Associations With Body Mass Index, Snacking, and Drinking Habits in Adolescents %A De Cock,Nathalie %A Vangeel,Jolien %A Lachat,Carl %A Beullens,Kathleen %A Vervoort,Leentje %A Goossens,Lien %A Maes,Lea %A Deforche,Benedicte %A De Henauw,Stefaan %A Braet,Caroline %A Eggermont,Steven %A Kolsteren,Patrick %A Van Camp,John %A Van Lippevelde,Wendy %+ Food Chemistry and Human Nutrition, Department of Food safety and Food quality, University of Ghent, Coupure links 653, Gent, 9000, Belgium, 32 9 264 58 67, nathalieL.decock@ugent.be %K mhealth %K adolescents %K snacks %K beverages %K body mass index %D 2017 %7 25.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Efforts to improve snacking and drinking habits are needed to promote a healthy body mass index (BMI) in adolescents. Although commercial fitness and nutrition mobile phone apps are widely used, little is known regarding their potential to improve health behaviors, especially in adolescents. In addition, evidence on the mechanisms through which such fitness and nutrition apps influence behavior is lacking. Objectives: This study assessed whether the use of commercial fitness or nutrition apps was associated with a lower BMI and healthier snacking and drinking habits in adolescents. Additionally, it explored if perceived behavioral control to eat healthy; attitudes to eat healthy for the good taste of healthy foods, for overall health or for appearance; social norm on healthy eating and social support to eat healthy mediated the associations between the frequency of use of fitness or nutrition apps and BMI, the healthy snack, and beverage ratio. Methods: Cross-sectional self-reported data on snack and beverage consumption, healthy eating determinants, and fitness and nutrition app use of adolescents (N=889; mean age 14.7 years, SD 0.8; 54.8% [481/878] boys; 18.1% [145/803] overweight) were collected in a representative sample of 20 schools in Flanders, Belgium. Height and weight were measured by the researchers. The healthy snack ratio and the healthy beverage ratio were calculated as follows: gram healthy snacks or beverages/(gram healthy snacks or beverages+gram unhealthy snacks or beverages)×100. Multilevel regression and structural equation modeling were used to analyze the proposed associations and to explore multiple mediation. Results: A total of 27.6% (245/889) of the adolescents used fitness, nutrition apps or both. Frequency of using nutrition apps was positively associated with a higher healthy beverage ratio (b=2.96 [1.11], P=.008) and a higher body mass index z-scores (zBMI; b=0.13 [0.05], P=.008. A significant interaction was found between the frequency of using nutrition and for the zBMI (b=−0.03 [0.02], P=.04) and the healthy snack ratio (b=−0.84 [0.37], P=.03). Attitude to eat healthy for appearance mediated both the fitness app use frequency-zBMI (a × b=0.02 [0.01], P=.02) and the nutrition app use frequency-zBMI (a × b=0.04 [0.01], P=.001) associations. No mediation was observed for the associations between the frequency of use of fitness or nutrition apps and the healthy snack or beverage ratio. Conclusions: Commercial fitness and nutrition apps show some association with healthier eating behaviors and BMI in adolescents. However, effective behavior change techniques should be included to affect key determinants of healthy eating. %M 28442455 %R 10.2196/mhealth.6005 %U http://mhealth.jmir.org/2017/4/e58/ %U https://doi.org/10.2196/mhealth.6005 %U http://www.ncbi.nlm.nih.gov/pubmed/28442455 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e124 %T Using Persuasive Technology to Increase Physical Activity in People With Chronic Obstructive Pulmonary Disease by Encouraging Regular Walking: A Mixed-Methods Study Exploring Opinions and Preferences %A Bartlett,Yvonne Kiera %A Webb,Thomas L %A Hawley,Mark S %+ Manchester Centre for Health Psychology, Manchester Academic Health Science Centre, The School of Health Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester, M139PL, United Kingdom, 44 161306436 ext 65436, kiera.bartlett@manchester.ac.uk %K persuasive technology %K chronic obstructive pulmonary disease %K physical activity %K walking %K mHealth %K mobile apps %D 2017 %7 20.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: People with chronic obstructive pulmonary disease (PwCOPD) often experience breathlessness and fatigue, making physical activity challenging. Although many persuasive technologies (such as mobile phone apps) have been designed to support physical activity among members of the general population, current technologies aimed at PwCOPD are underdeveloped and only use a limited range of persuasive technology design principles. Objective: The aim of this study was to explore how acceptable different persuasive technology design principles were considered to be in supporting and encouraging physical activity among PwCOPD. Methods: Three prototypes for mobile apps using different persuasive technology design principles as defined by the persuasive systems design (PSD) model—namely, dialogue support, primary task support, and social support—were developed. Opinions of these prototypes were explored through 28 interviews with PwCOPD, carers, and the health care professionals (HCPs) involved in their care and questionnaires completed by 87 PwCOPD. Participants also ranked how likely individual techniques (eg, competition) would be to convince them to use a technology designed to support physical activity. Data were analyzed using framework analysis, Friedman tests, and Wilcoxon signed rank tests and a convergent mixed methods design was used to integrate findings. Results: The prototypes for mobile apps were received positively by participants. The prototype that used a dialogue support approach was identified as the most likely to be used or recommended by those interviewed, and was perceived as more persuasive than both of the other prototypes (Z=−3.06, P=.002; Z=−5.50, P<.001) by those who completed the questionnaire. PwCOPD identified dialogue support and primary task support techniques as more likely to convince them to use a technology than social support techniques (Z=−5.00, P<.001; Z=−4.92, P<.001, respectively). Opinions of social support techniques such as competition and collaboration were divided. Conclusions: Dialogue support and primary task support approaches are considered to be both acceptable and likely to be persuasive by PwCOPD, carers, and HCPs. In the future, these approaches should be considered when designing apps to encourage physical activity by PwCOPD. %M 28428155 %R 10.2196/jmir.6616 %U http://www.jmir.org/2017/4/e124/ %U https://doi.org/10.2196/jmir.6616 %U http://www.ncbi.nlm.nih.gov/pubmed/28428155 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e51 %T User Interest in Digital Health Technologies to Encourage Physical Activity: Results of a Survey in Students and Staff of a German University %A Salzwedel,Annett %A Rabe,Sophie %A Zahn,Thomas %A Neuwirth,Julia %A Eichler,Sarah %A Haubold,Kathrin %A Wachholz,Anne %A Reibis,Rona %A Völler,Heinz %+ Center of Rehabilitation Research, University of Potsdam, House 12, Am Neuen Palais 10, Potsdam, 14469, Germany, 49 331 977 4062, heinz.voeller@uni-potsdam.de %K physical activity %K telemedicine %K primary prevention %K healthy lifestyle %D 2017 %7 19.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although the benefits for health of physical activity (PA) are well documented, the majority of the population is unable to implement present recommendations into daily routine. Mobile health (mHealth) apps could help increase the level of PA. However, this is contingent on the interest of potential users. Objective: The aim of this study was the explorative, nuanced determination of the interest in mHealth apps with respect to PA among students and staff of a university. Methods: We conducted a Web-based survey from June to July 2015 in which students and employees from the University of Potsdam were asked about their activity level, interest in mHealth fitness apps, chronic diseases, and sociodemographic parameters. Results: A total of 1217 students (67.30%, 819/1217; female; 26.0 years [SD 4.9]) and 485 employees (67.5%, 327/485; female; 42.7 years [SD 11.7]) participated in the survey. The recommendation for PA (3 times per week) was not met by 70.1% (340/485) of employees and 52.67% (641/1217) of students. Within these groups, 53.2% (341/641 students) and 44.2% (150/340 employees)—independent of age, sex, body mass index (BMI), and level of education or professional qualification—indicated an interest in mHealth fitness apps. Conclusions: Even in a younger, highly educated population, the majority of respondents reported an insufficient level of PA. About half of them indicated their interest in training support. This suggests that the use of personalized mobile fitness apps may become increasingly significant for a positive change of lifestyle. %M 28428156 %R 10.2196/mhealth.7192 %U http://mhealth.jmir.org/2017/4/e51/ %U https://doi.org/10.2196/mhealth.7192 %U http://www.ncbi.nlm.nih.gov/pubmed/28428156 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e50 %T Texting and Mobile Phone App Interventions for Improving Adherence to Preventive Behavior in Adolescents: A Systematic Review %A Badawy,Sherif M %A Kuhns,Lisa M %+ Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Division of Hematology, Oncology, and Stem Cell Transplant, Northwestern University Feinberg School of Medicine, 225 E, Chicago Ave, Box #30, Chicago, IL, 60611, United States, 1 312 227 4836, sbadawy@luriechildrens.org %K adolescent %K text messaging %K smartphone %K mobile phone %K mobile applications %K medication adherence %K behavior %K prevention %D 2017 %7 19.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many preventable behaviors contribute to adolescent mortality and morbidity. Non-adherence to preventive measures represents a challenge and has been associated with worse health outcomes in this population. The widespread use of electronic communication technologies by adolescents, particularly the use of text messaging (short message service, SMS) and mobile phones, presents new opportunities to intervene on risk and preventive risk behavior, but little is known about their efficacy. Objective: This study aimed to systematically evaluate evidence for the efficacy of text messaging and mobile phone app interventions to improve adherence to preventive behavior among adolescents and describe intervention approaches to inform intervention development. Methods: This review covers literature published between 1995 and 2015. Searches included PubMed, Embase, CENTRAL, PsycINFO, CINAHL, INSPEC, Web of Science, Google Scholar, and additional databases. The search strategy sought articles on text messaging and mobile phone apps combined with adherence or compliance, and adolescents and youth. An additional hand search of related themes in the Journal of Medical Internet Research was also conducted. Two reviewers independently screened titles and abstracts, assessed full-text articles, and extracted data from articles that met inclusion criteria. Included studies reflect original research—experimental or preexperimental designs with text messaging or mobile phone app interventions—targeting adherence to preventive behavior among adolescents (12-24 years old). The preferred reporting items of systematic reviews and meta-analyses (PRISMA) guidelines were followed for reporting results, and findings were critically appraised against the Oxford Centre for Evidence-based Medicine criteria. Results: Of 1454 records, 19 met inclusion criteria, including text messaging (n=15) and mobile phone apps (n=4). Studies targeted clinic attendance, contraceptive use, oral health, physical activity and weight management, sun protection, human papillomavirus (HPV) vaccination, smoking cessation, and sexual health. Most studies were performed in the United States (47%, 9/19), included younger adolescents (63%, 12/19), and had sample size <100 (63%, 12/19). Although most studies were randomized controlled trials (RCTs; 58%, 11/19), only 5 followed an intent-to-treat analysis. Only 6 of 19 studies (32%) incorporated a theoretical framework in their design. Most studies reported good feasibility with high acceptability and satisfaction. About half of the included studies (42%, 8/19) demonstrated significant improvement in preventive behavior with moderate standardized mean differences. As early efforts in this field to establish feasibility and initial efficacy, most studies were low to moderate in quality. Studies varied in sample size and methods of preventive behavior adherence or outcome assessment, which prohibited performing a meta-analysis. Conclusions: Despite the promising feasibility and acceptability of text messaging and mobile phone apps in improving preventive behavior among adolescents, overall findings were modest in terms of efficacy. Further research evaluating the efficacy, effectiveness, and cost-effectiveness of these intervention approaches in promoting preventive behavior among adolescents is needed. %M 28428157 %R 10.2196/mhealth.6837 %U http://mhealth.jmir.org/2017/4/e50/ %U https://doi.org/10.2196/mhealth.6837 %U http://www.ncbi.nlm.nih.gov/pubmed/28428157 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 4 %P e55 %T A Digital Tool to Promote Alcohol and Drug Use Screening, Brief Intervention, and Referral to Treatment Skill Translation: A Mobile App Development and Randomized Controlled Trial Protocol %A Satre,Derek D %A Ly,Khanh %A Wamsley,Maria %A Curtis,Alexa %A Satterfield,Jason %+ Weill Institute for Neurosciences, Department of Psychiatry, University of California, 401 Parnassus Avenue, Box 0984, San Francisco, CA, 94143, United States, 1 415 476 7382, Derek.Satre@ucsf.edu %K SBIRT %K mobile app %K digital health %K training, implementation %K alcohol %K drug %K depression %K anxiety %D 2017 %7 18.04.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Translation of knowledge and skills from classroom settings to clinical practice is a major challenge in healthcare training, especially for behavioral interventions. For example, screening, brief intervention, and referral to treatment (SBIRT) is a highly-promoted approach to identifying and treating individuals at risk for alcohol or drug problems, yet effective, routine use of SBIRT has lagged. Objective: The objective of this paper is to describe the development, pilot testing, and trial protocol of a mobile app based on the theory of planned behavior (TPB) to promote SBIRT skill translation and application. Methods: Intended for use after classroom training occurs, the mobile app has three primary functions designed to increase behavioral intent to deliver SBIRT: (1) review skills (ie, address knowledge and beliefs about SBIRT), (2) apply skills with patients (ie, build confidence and perceived behavioral control), and (3) report performance data (ie, increase accountability and social norms and/or influence). The app includes depression and anxiety screening tools due to high comorbidity with substance use. A randomized controlled trial (RCT) is in progress among health and social service learners (N=200) recruited from 3 universities and 6 different training programs in nursing, social work, internal medicine, psychiatry, and psychology. Participants are randomized to SBIRT classroom instruction alone or classroom instruction plus app access prior to beginning their field placement rotations. TPB-based data are collected via Qualtrics or via the mobile app pre-post and SBIRT utilization, weekly for 10 weeks. Key outcomes include the frequency of and self-reported confidence in delivery of SBIRT. Results: Beta testing with advanced practice nursing students (N=22) indicated that the app and its associated assessment tools were acceptable and useful. The system usability scale (SUS) mean was 65.8 (n=19), which indicated that the SBIRT app was acceptable but could benefit from improvement. Indeed, modifications were implemented prior to starting the trial. Enrollment of trial participants began in September 2016. Results are expected by December 2017. Conclusions: This report describes the process of TPB-based app development and testing, and the protocol for a RCT to determine the effectiveness of the app in enhancing skill translation. If effective, this approach could improve SBIRT implementation, fidelity, and clinical outcomes. %M 28420604 %R 10.2196/resprot.7070 %U http://www.researchprotocols.org/2017/4/e55/ %U https://doi.org/10.2196/resprot.7070 %U http://www.ncbi.nlm.nih.gov/pubmed/28420604 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e118 %T Scalable Passive Sleep Monitoring Using Mobile Phones: Opportunities and Obstacles %A Saeb,Sohrab %A Cybulski,Thaddeus R %A Schueller,Stephen M %A Kording,Konrad P %A Mohr,David C %+ Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, 750 N Lake Shore Dr, Rubloff Building, 10th floor, Chicago, IL, 60611, United States, 1 312 503 4626, s-saeb@northwestern.edu %K sleep monitoring %K mobile phones %K decision trees %K classification %D 2017 %7 18.4.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Sleep is a critical aspect of people’s well-being and as such assessing sleep is an important indicator of a person’s health. Traditional methods of sleep assessment are either time- and resource-intensive or suffer from self-reporting biases. Recently, researchers have started to use mobile phones to passively assess sleep in individuals’ daily lives. However, this work remains in its early stages, having only examined relatively small and homogeneous populations in carefully controlled contexts. Thus, it remains an open question as to how well mobile device-based sleep monitoring generalizes to larger populations in typical use cases. Objective: The aim of this study was to assess the ability of machine learning algorithms to detect the sleep start and end times for the main sleep period in a 24-h cycle using mobile devices in a diverse sample. Methods: We collected mobile phone sensor data as well as daily self-reported sleep start and end times from 208 individuals (171 females; 37 males), diverse in age (18−66 years; mean 39.3), education, and employment status, across the United States over 6 weeks. Sensor data consisted of geographic location, motion, light, sound, and in-phone activities. No specific instructions were given to the participants regarding phone placement. We used random forest classifiers to develop both personalized and global predictors of sleep state from the phone sensor data. Results: Using all available sensor features, the average accuracy of classifying whether a 10-min segment was reported as sleep was 88.8%. This is somewhat better than using the time of day alone, which gives an average accuracy of 86.9%. The accuracy of the model considerably varied across the participants, ranging from 65.1% to 97.3%. We found that low accuracy in some participants was due to two main factors: missing sensor data and misreports. After correcting for these, the average accuracy increased to 91.8%, corresponding to an average median absolute deviation (MAD) of 38 min for sleep start time detection and 36 min for sleep end time. These numbers are close to the range reported by previous research in more controlled situations. Conclusions: We find that mobile phones provide adequate sleep monitoring in typical use cases, and that our methods generalize well to a broader population than has previously been studied. However, we also observe several types of data artifacts when collecting data in uncontrolled settings. Some of these can be resolved through corrections, but others likely impose a ceiling on the accuracy of sleep prediction for certain subjects. Future research will need to focus more on the understanding of people’s behavior in their natural settings in order to develop sleep monitoring tools that work reliably in all cases for all people. %R 10.2196/jmir.6821 %U http://www.jmir.org/2017/4/e118/ %U https://doi.org/10.2196/jmir.6821 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e46 %T Technology Use and Preferences for Mobile Phone–Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research %A Holloway,Ian W %A Winder,Terrell JA %A Lea III,Charles Herbert %A Tan,Diane %A Boyd,Donte %A Novak,David %+ Department of Social Welfare, Luskin School of Public Affairs, University of California, 3250 Public Affairs Building, Box 951656, Los Angeles, CA, 90095, United States, 1 310 825 7840, holloway@luskin.ucla.edu %K HIV %K AIDS %K mobile applications %K African Americans %K men’s health %K homosexuality %K bisexuality %K young adult %D 2017 %7 13.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Black young men who have sex with men (BYMSM) experience higher human immunodeficiency virus (HIV) incidence than their white and Latino counterparts. Objective: The aim of our study was to understand BYMSM’s preferences for mobile phone–based HIV prevention and treatment in order to inform culturally tailored interventions to reduce the spread of HIV and improve HIV treatment outcomes in this population. Methods: Qualitative focus groups (N=6) with BYMSM aged 18-29 years (N=41; 46%, 19/41 HIV-positive) were conducted to elucidate their preferences for the design and delivery of mobile phone–based HIV prevention and treatment interventions. A modified grounded theory approach to data analysis was undertaken using ATLAS.ti textual analysis software. Results: Participants preferred holistic health interventions that did not focus exclusively on HIV prevention and treatment. Issues of privacy and confidentiality were paramount. Participants preferred functionality that enables discreet connections to culturally competent health educators and treatment providers who can address the range of health and psychosocial concerns faced by BYMSM. Conclusions: Mobile phone–based HIV prevention has the potential to increase engagement with HIV prevention and treatment resources among BYMSM. For these approaches to be successful, researchers must include BYMSM in the design and creation of these interventions. %M 28408360 %R 10.2196/mhealth.6436 %U http://mhealth.jmir.org/2017/4/e46/ %U https://doi.org/10.2196/mhealth.6436 %U http://www.ncbi.nlm.nih.gov/pubmed/28408360 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 4 %P e58 %T WittyFit—Live Your Work Differently: Study Protocol for a Workplace-Delivered Health Promotion %A Dutheil,Frédéric %A Duclos,Martine %A Naughton,Geraldine %A Dewavrin,Samuel %A Cornet,Thomas %A Huguet,Pascal %A Chatard,Jean-Claude %A Pereira,Bruno %+ Centre Hospitalier Universitaire de Clermont-Ferrand, Service Santé Travail Environnement, 58 rue Montalembert, Clermont-Ferrand,, France, 33 06 88 22 48 48, frederic.dutheil@uca.fr %K health %K work %K lifestyle %K behavior %K management %K stress %K physical activity %K nutrition %K sleep %K musculoskeletal disorders %K depression %K anxiety %K absenteeism %K organization %K morbidity %K mortality %K public health %K mhealth %K mobile app %D 2017 %7 13.04.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Morbidity before retirement has a huge cost, burdening both public health and workplace finances. Multiple factors increase morbidity such as stress at work, sedentary behavior or low physical activity, and poor nutrition practices. Nowadays, the digital world offers infinite opportunities to interact with workers. The WittyFit software was designed to understand holistic issues of workers by promoting individualized behavior changes at the workplace. Objective: The shorter term feasibility objective is to demonstrate that effective use of WittyFit will increase well-being and improve health-related behaviors. The mid-term objective is to demonstrate that WittyFit improves economic data of the companies such as productivity and benefits. The ultimate objective is to increase life expectancy of workers. Methods: This is an exploratory interventional cohort study in an ecological situation. Three groups of participants will be purposefully sampled: employees, middle managers, and executive managers. Four levels of engagement are planned for employees: commencing with baseline health profiling from validated questionnaires; individualized feedback based on evidence-based medicine; support for behavioral change; and formal evaluation of changes in knowledge, practices, and health outcomes over time. Middle managers will also receive anonymous feedback on problems encountered by employees, and executive top managers will have indicators by division, location, department, age, seniority, gender and occupational position. Managers will be able to introduce specific initiatives in the workplace. WittyFit is based on two databases: behavioral data (WittyFit) and medical data (WittyFit Research). Statistical analyses will incorporate morbidity and well-being data. When a worker leaves a workplace, the company documents one of three major explanations: retirement, relocation to another company, or premature death. Therefore, WittyFit will have the ability to include mortality as an outcome. WittyFit will evolve with the waves of connected objects further increasing its data accuracy. Ethical approval was obtained from the ethics committee of the University Hospital of Clermont-Ferrand, France. Results: WittyFit recruitment and enrollment started in January 2016. First publications are expected to be available at the beginning of 2017. Conclusions: The name WittyFit came from Witty and Fitness. The concept of WittyFit reflects the concept of health from the World Health Organization: being spiritually and physically healthy. WittyFit is a health-monitoring, health-promoting tool that may improve the health of workers and health of companies. WittyFit will evolve with the waves of connected objects further increasing its data accuracy with objective measures. WittyFit may constitute a powerful epidemiological database. Finally, the WittyFit concept may extend healthy living into the general population. Trial Registration: Clinicaltrials.gov: NCT02596737; https://www.clinicaltrials.gov/ct2/show/NCT02596737 (Archived by WebCite at http://www.webcitation.org/6pM5toQ7Y) %M 28408363 %R 10.2196/resprot.6267 %U http://www.researchprotocols.org/2017/4/e58/ %U https://doi.org/10.2196/resprot.6267 %U http://www.ncbi.nlm.nih.gov/pubmed/28408363 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e70 %T Mobile Phone-Delivered Cognitive Behavioral Therapy for Insomnia: A Randomized Waitlist Controlled Trial %A Horsch,Corine HG %A Lancee,Jaap %A Griffioen-Both,Fiemke %A Spruit,Sandor %A Fitrianie,Siska %A Neerincx,Mark A %A Beun,Robbert Jan %A Brinkman,Willem-Paul %+ Department of Intelligent Systems, Delft University of Technology, Mekelweg 4, Delft, 2628 CD, Netherlands, 31 152784145, corinehorsch@gmail.com %K insomnia %K smartphone app %K cognitive behavioral therapy %K eHealth %D 2017 %7 11.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: This study is one of the first randomized controlled trials investigating cognitive behavioral therapy for insomnia (CBT-I) delivered by a fully automated mobile phone app. Such an app can potentially increase the accessibility of insomnia treatment for the 10% of people who have insomnia. Objective: The objective of our study was to investigate the efficacy of CBT-I delivered via the Sleepcare mobile phone app, compared with a waitlist control group, in a randomized controlled trial. Methods: We recruited participants in the Netherlands with relatively mild insomnia disorder. After answering an online pretest questionnaire, they were randomly assigned to the app (n=74) or the waitlist condition (n=77). The app packaged a sleep diary, a relaxation exercise, sleep restriction exercise, and sleep hygiene and education. The app was fully automated and adjusted itself to a participant’s progress. Program duration was 6 to 7 weeks, after which participants received posttest measurements and a 3-month follow-up. The participants in the waitlist condition received the app after they completed the posttest questionnaire. The measurements consisted of questionnaires and 7-day online diaries. The questionnaires measured insomnia severity, dysfunctional beliefs about sleep, and anxiety and depression symptoms. The diary measured sleep variables such as sleep efficiency. We performed multilevel analyses to study the interaction effects between time and condition. Results: The results showed significant interaction effects (P<.01) favoring the app condition on the primary outcome measures of insomnia severity (d=–0.66) and sleep efficiency (d=0.71). Overall, these improvements were also retained in a 3-month follow-up. Conclusions: This study demonstrated the efficacy of a fully automated mobile phone app in the treatment of relatively mild insomnia. The effects were in the range of what is found for Web-based treatment in general. This supports the applicability of such technical tools in the treatment of insomnia. Future work should examine the generalizability to a more diverse population. Furthermore, the separate components of such an app should be investigated. It remains to be seen how this app can best be integrated into the current health regimens. Trial Registration: Netherlands Trial Register: NTR5560; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5560 (Archived by WebCite at http://www.webcitation.org/6noLaUdJ4) %M 28400355 %R 10.2196/jmir.6524 %U http://www.jmir.org/2017/4/e70/ %U https://doi.org/10.2196/jmir.6524 %U http://www.ncbi.nlm.nih.gov/pubmed/28400355 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e108 %T Effect of a Nine-Month Web- and App-Based Workplace Intervention to Promote Healthy Lifestyle and Weight Loss for Employees in the Social Welfare and Health Care Sector: A Randomized Controlled Trial %A Balk-Møller,Nina Charlotte %A Poulsen,Sanne Kellebjerg %A Larsen,Thomas Meinert %+ Department of Nutrition, Exercise and Sports, Faculty of Science, Copenhagen University, Rolighedsvej 26, Frederiksberg C, 1958, Denmark, 45 27126320, nbm@nexs.ku.dk %K health promotion %K workplace %K smartphone %K weight reduction programs %K Internet %K eHealth %K randomized controlled trial %D 2017 %7 10.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: General health promoting campaigns are often not targeted at the people who need them the most. Web- and app-based tools are a new way to reach, motivate, and help people with poor health status. Objective: The aim of our study was to test a Web- and mobile app-based tool (“SoSu-life”) on employees in the social welfare and health care sector in Denmark. Methods: A randomized controlled trial was carried out as a workplace intervention. The tool was designed to help users make healthy lifestyle changes such as losing weight, exercise more, and quit smoking. A team competition between the participating workplaces took place during the first 16 weeks of the intervention. Twenty nursing homes for elderly people in 6 municipalities in Denmark participated in the study. The employees at the nursing homes were randomized either 1:1 or 2:1 on a municipality level to use the SoSu-life tool or to serve as a control group with no intervention. All participants underwent baseline measurements including body weight, waist circumference, body fat percentage, blood pressure, and blood cholesterol level and they filled in a questionnaire covering various aspects of health. The participants were measured again after 16 and 38 weeks. Results: A total of 566 (SoSu-life: n=355, control: n=211) participants were included in the study. At 16 weeks there were 369 participants still in the study (SoSu-life: n=227, control: n=142) and 269 participants completed the 38 week intervention (SoSu-life: n=152, control: n=117). At 38 weeks, the SoSu-life group had a larger decrease in body weight (−1.01 kg, P=.03), body fat percentage (−0.8%, P=.03), and waist circumference (−1.8 cm, P=.007) compared with the control group. Conclusions: The SoSu-life Web- and app-based tool had a modest yet beneficial effect on body weight and body fat percentage in the health care sector staff. Trial Registration: Clinicaltrials.gov NCT02438059; http://clinicaltrials.gov/ct2/show/NCT02438059 (Archived by WebCite at http://www.webcitation.org/6i6y4p2AS) %M 28396303 %R 10.2196/jmir.6196 %U http://www.jmir.org/2017/4/e108/ %U https://doi.org/10.2196/jmir.6196 %U http://www.ncbi.nlm.nih.gov/pubmed/28396303 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e42 %T Development and Testing of the MyHealthyPregnancy App: A Behavioral Decision Research-Based Tool for Assessing and Communicating Pregnancy Risk %A Krishnamurti,Tamar %A Davis,Alexander L %A Wong-Parodi,Gabrielle %A Fischhoff,Baruch %A Sadovsky,Yoel %A Simhan,Hyagriv N %+ Department of Engineering and Public Policy, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, United States, 1 (412) 268 2670, tamar@cmu.edu %K mhealth %K pregnancy %K premature birth %K decision making %D 2017 %7 10.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite significant advances in medical interventions and health care delivery, preterm births in the United States are on the rise. Existing research has identified important, seemingly simple precautions that could significantly reduce preterm birth risk. However, it has proven difficult to communicate even these simple recommendations to women in need of them. Our objective was to draw on methods from behavioral decision research to develop a personalized smartphone app-based medical communication tool to assess and communicate pregnancy risks related to preterm birth. Objective: A longitudinal, prospective pilot study was designed to develop an engaging, usable smartphone app that communicates personalized pregnancy risk and gathers risk data, with the goal of decreasing preterm birth rates in a typically hard-to-engage patient population. Methods: We used semistructured interviews and user testing to develop a smartphone app based on an approach founded in behavioral decision research. For usability evaluation, 16 participants were recruited from the outpatient clinic at a major academic hospital specializing in high-risk pregnancies and provided a smartphone with the preloaded app and a digital weight scale. Through the app, participants were queried daily to assess behavioral risks, mood, and symptomology associated with preterm birth risk. Participants also completed monthly phone interviews to report technical problems and their views on the app’s usefulness. Results: App use was higher among participants at higher risk, as reflected in reporting poorer daily moods (Odds ratio, OR 1.20, 95% CI 0.99-1.47, P=.08), being more likely to smoke (OR 4.00, 95% CI 0.93-16.9, P=.06), being earlier in their pregnancy (OR 1.07, 95% CI 1.02-1.12, P=.005), and having a lower body mass index (OR 1.07, 95% CI 1.00-1.15, P=.05). Participant-reported intention to breastfeed increased from baseline to the end of the trial, t15=−2.76, P=.01. Participants’ attendance at prenatal appointments was 84% compared with the clinic norm of 50%, indicating a conservatively estimated cost savings of ~US $450/patient over 3 months. Conclusions: Our app is an engaging method for assessing and communicating risk during pregnancy in a typically hard-to-reach population, providing accessible and personalized distant obstetrical care, designed to target preterm birth risk, specifically. %M 28396302 %R 10.2196/mhealth.7036 %U http://mhealth.jmir.org/2017/4/e42/ %U https://doi.org/10.2196/mhealth.7036 %U http://www.ncbi.nlm.nih.gov/pubmed/28396302 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e105 %T The Reviews Are in: A Qualitative Content Analysis of Consumer Perspectives on Apps for Bipolar Disorder %A Nicholas,Jennifer %A Fogarty,Andrea S %A Boydell,Katherine %A Christensen,Helen %+ Black Dog Institute, University of New South Wales, Hospital rd, Prince of Wales Hospital, Sydney, 2031, Australia, 61 293828507, J.nicholas@blackdog.org.au %K mobile applications %K bipolar disorder %K smartphone %K telemedicine %K qualitative research %D 2017 %7 07.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The delivery of mobile health (mHealth) services is acceptable to mental health consumers. However, despite the benefits of accessibility, cost-effectiveness, anonymity, and ability to tailor content to individual needs, consumer engagement remains a hurdle for uptake and continued use. This may be unsurprising as few studies have examined app content from the consumer perspective or assessed consumer preferences for the content of apps for mental health management. An opportunity to examine consumer perspectives exists in using naturally generated data that is publically available in the Google Play and Apple app stores. Whereas commercial developers routinely use this data, to date there has been no in-depth evaluation within scientific research. Objective: The aim of our study was to explore what consumers consider useful content for mental health management apps, identify unmet needs, and understand user expectations of mental health apps within the context of apps for bipolar disorder. Methods: Publically available English language consumer reviews of 48 apps for bipolar disorder were used as data, providing a total of 2173 reviews. Review text was coded and analyzed using a team approach to qualitative content analysis. Results were presented in 2 forms: (1) a quantitative summary of the 9 major and minor themes and (2) a qualitative synthesis of key thematic findings. Results: The majority of reviews were for symptom monitoring apps (87.94%, 1911/2173). The qualitative content analysis revealed 5 main themes: (1) laudatory talk, comments regarding the app’s benefits including helpfulness and successful design features (74.00% of reviews, 1608/2173); (2) unfavorable feedback, negative reviews largely concerning unmet needs, privacy and technical issues, and potential dangers of app use (25.54%, 555/2173); (3) conceptions of community, referring to both communities of users with mental ill-health accessed via the app and a community created among app users and developers (24.25%, 527/2173); (4) wishlist features, app features requested by users (17.53%, 381/2173); and (5) apps and therapy, app use within clinical care (10.58%, 230/2173). Four minor themes were also identified: (1) app cost, (2) privacy and data security, (3) comparisons with traditional monitoring, and (4) evidence-based mHealth. Conclusions: Although mostly positive, the proportion of reviews containing wishlist requests indicates consumer needs are not adequately addressed by currently available disorder management apps. Consumers value content that is helpful, supportive, and easy to use, and they are integrating apps into their health management and clinical care without necessarily considering the evidence-base or clinical effectiveness of the tool. User expectations regarding developer responsiveness to their needs has implications for community-based participatory research and integrated knowledge translation. However, this expectation is incompatible with current mHealth funding structures. %M 28389420 %R 10.2196/jmir.7273 %U http://www.jmir.org/2017/4/e105/ %U https://doi.org/10.2196/jmir.7273 %U http://www.ncbi.nlm.nih.gov/pubmed/28389420 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e101 %T Using Smartphones and Health Apps to Change and Manage Health Behaviors: A Population-Based Survey %A Ernsting,Clemens %A Dombrowski,Stephan U %A Oedekoven,Monika %A O´Sullivan,Julie L %A Kanzler,Melanie %A Kuhlmey,Adelheid %A Gellert,Paul %+ Institute of Medical Sociology, Charité - Universitätsmedizin Berlin, Chariteplatz 1, Berlin,, Germany, 49 30450529215, clemens.ernsting@charite.de %K telemedicine %K eHealth %K mHealth %K smartphone %K mobile apps %K health promotion %K chronic disease %K health literacy %K quality of life %D 2017 %7 05.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic conditions are an increasing challenge for individuals and the health care system. Smartphones and health apps are potentially promising tools to change health-related behaviors and manage chronic conditions. Objective: The aim of this study was to explore (1) the extent of smartphone and health app use, (2) sociodemographic, medical, and behavioral correlates of smartphone and health app use, and (3) associations of the use of apps and app characteristics with actual health behaviors. Methods: A population-based survey (N=4144) among Germans, aged 35 years and older, was conducted. Sociodemographics, presence of chronic conditions, health behaviors, quality of life, and health literacy, as well as the use of the Internet, smartphone, and health apps were assessed by questionnaire at home visit. Binary logistic regression models were applied. Results: It was found that 61.25% (2538/4144) of participants used a smartphone. Compared with nonusers, smartphone users were younger, did more research on the Internet, were more likely to work full-time and more likely to have a university degree, engaged more in physical activity, and less in low fat diet, and had a higher health-related quality of life and health literacy. Among smartphone users, 20.53% (521/2538) used health apps. App users were younger, less likely to be native German speakers, did more research on the Internet, were more likely to report chronic conditions, engaged more in physical activity, and low fat diet, and were more health literate compared with nonusers who had a smartphone. Health apps focused on smoking cessation (232/521, 44.5%), healthy diet (201/521, 38.6%), and weight loss (121/521, 23.2%). The most common app characteristics were planning (264/521, 50.7%), reminding (188/521, 36.1%), prompting motivation (179/521 34.4%), and the provision of information (175/521, 33.6%). Significant associations were found between planning and the health behavior physical activity, between feedback or monitoring and physical activity, and between feedback or monitoring and adherence to doctor’s advice. Conclusions: Although there were many smartphone and health app users, a substantial proportion of the population was not engaged. Findings suggest age-related, socioeconomic-related, literacy-related, and health-related disparities in the use of mobile technologies. Health app use may reflect a user’s motivation to change or maintain health behaviors. App developers and researchers should take account of the needs of older people, people with low health literacy, and chronic conditions. %M 28381394 %R 10.2196/jmir.6838 %U http://www.jmir.org/2017/4/e101/ %U https://doi.org/10.2196/jmir.6838 %U http://www.ncbi.nlm.nih.gov/pubmed/28381394 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 4 %P e49 %T The Impact of Mobile Apps on Alcohol Use Disorder: A Systematic Review Protocol %A Sawares,Antoine SA %A Shen,Nelson %A Xue,Yunlin %A Abi-Jaoude,Alexxa %A Wiljer,David %+ University Health Network, 190 Elizabeth Street, Room 441, Toronto, ON, M5G 2C4, Canada, 1 416 340 6322, David.wiljer@uhn.ca %K mobile health %K apps %K alcohol use disorder %K systematic review %K protocol %K mental health %K addiction %K alcoholism %D 2017 %7 04.04.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol use disorder (AUD) is among the most prevalent mental disorders worldwide and is associated with a diverse range of physical and psychological comorbidities. Despite various types of treatment, there are many barriers to accessing treatment (ie, stigma, cost, accessibility of service, etc). Mobile apps have the potential to overcome these barriers and provide support to those who need it. Objective: The purpose of this systematic review is to assess the effectiveness of mobile apps in reducing alcohol consumption for individuals with AUD and understand the psychological outcomes of using the apps (ie, client empowerment, self-efficacy, etc). Methods: The search strategy was applied to 7 health sciences and interdisciplinary databases. Two reviewers will independently assess all titles and abstracts for relevance and then full texts of relevant articles for eligibility. To be included, the article must be a quantitative evaluation of clinical outcomes using the intervention and the intervention must be a consumer-facing app focused on supporting individuals with AUD. Two reviewers will independently extract data from all eligible articles using a standardized extraction worksheet and will independently assess the study quality. A meta-analysis will be conducted if appropriate. Depending on outcomes reported, pooled risk ratios or standardized mean differences will be calculated and reported in the review. Results: The search strategy yielded 699 unique citations. Of those, 63 (9.0%, 63/699) articles were assessed as relevant for full-text review. The full-text reviews are currently underway and the final review is projected to be completed in the summer of 2017. Conclusions: There is potential for mobile apps to support individuals with AUD to reduce their alcohol consumption. This review will be the first to assess the effectiveness of AUD mobile apps and client experiences using the apps. %M 28377366 %R 10.2196/resprot.6975 %U http://www.researchprotocols.org/2017/4/e49/ %U https://doi.org/10.2196/resprot.6975 %U http://www.ncbi.nlm.nih.gov/pubmed/28377366 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 3 %P e40 %T Designing Health Apps to Support Dietetic Professional Practice and Their Patients: Qualitative Results From an International Survey %A Chen,Juliana %A Lieffers,Jessica %A Bauman,Adrian %A Hanning,Rhona %A Allman-Farinelli,Margaret %+ School of Life and Environmental Sciences and Charles Perkins Centre, The University of Sydney, Level 4 East, Charles Perkins Centre (D17), John Hopkins Drive, Camperdown, 2006, Australia, 61 2 8627 0843, jche6526@uni.sydney.edu.au %K dietetics %K apps %K app design %K mHealth %K smartphone %D 2017 %7 31.03.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dietitians are engaging with mobile health (mHealth) technologies, particularly with diet and nutrition apps in their patient care. Despite the plethora of apps available, the majority are not designed with a dietitian’s input. Objective: The aim of this study was to identify the user preferences of dietitians in relation to tools, resources, and design features for smartphone health apps that would support their dietetic professional practice and their patients. Methods: As part of a larger international Web-based survey of health-app use among dietitians, three open-ended responses were included for specific exploration of app design features and additional resources or tools that could guide the development of apps for use in dietetic practice and patient care. Inductive thematic analysis of responses was conducted using the qualitative data analysis program, NVivo version 11 (QSR International Pty Ltd), to understand the design preferences and features valued by dietitians. Results: The responses from 381 dietitian respondents were analyzed. Five key themes were identified. Dietitians wanted access to credible apps, suggesting that dietetic associations should have greater involvement in reviewing and endorsing evidence-based apps for use in dietary counseling. Improvements to the usability of apps, relating to their ease of use and design, were also raised, as self-monitoring of dietary behaviors using existing nutrition apps was deemed to be burdensome. Furthermore, apps providing dietitian-oriented support were favored, for example, those with the ability to streamline the dietary assessment process, so that dietitians could spend more time on dietary counseling and negotiating patient goals for dietary and lifestyle behavior change. Provision of patient-oriented support, such as functionality to tailor apps to patient-specific needs, was also considered important. Finally, respondents valued apps that could integrate into their work systems to enhance the quality of the dietitian-patient relationship. Conclusions: App developers should draw upon the features and characteristics valued by dietitians to guide their development of apps that support dietetic practice and enhance patient care. Moreover, to achieve better dietitian and patient-centered app design, it is imperative that app developers take a collaborative approach with dietitians, their professional associations, and their patients. %M 28363882 %R 10.2196/mhealth.6945 %U http://mhealth.jmir.org/2017/3/e40/ %U https://doi.org/10.2196/mhealth.6945 %U http://www.ncbi.nlm.nih.gov/pubmed/28363882 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 1 %P e9 %T Design and Usability of a Heart Failure mHealth System: A Pilot Study %A Alnosayan,Nagla %A Chatterjee,Samir %A Alluhaidan,Ala %A Lee,Edward %A Houston Feenstra,Linda %+ IDEA Laboratory, Center for Information Systems and Technology, Claremont Graduate University, 130 East 9th Street, Claremont, CA, 91711, United States, 1 (909) 541 1559, nagla.alnosayan@alumni.cgu.edu %K mHealth %K telehealth %K heart failure %K human factors engineering %K self-management %D 2017 %7 24.03.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Despite the advances in mobile health (mHealth) systems, little is known about patients’ and providers’ experiences using a new mHealth system design. Objective: This study aimed to understand challenges and provide design considerations for a personalized mHealth system that could effectively support heart failure (HF) patients after they transition into the home environment. Methods: Following exploratory interviews with nurses and preventive care physicians, an mHealth system was developed. Patients were asked to measure their weight, blood pressure, and blood glucose (if they had diabetes). They were also instructed to enter symptoms, view notifications, and read messages on a mobile app that we developed. A Bluetooth-enabled weight scale, blood pressure monitor, glucometer, and mobile phone was provided after an introductory orientation and training session. HF nurses used a dashboard to view daily measurements for each patient and received text and email alerts when risk was indicated. Observations of usage, cases of deterioration, readmissions, and metrics related to system usability and quality of life outcomes were used to determine overall effectiveness of the system, whereas focus group sessions with patients were conducted to elicit participants’ feedback on the system’s design. Results: A total of 8 patients with HF participated over a 6-month period. Overall, the mean users’ satisfaction with the system ranked 73%, which was above average. Quality of life improvement was 3.6. Patients and nurses used the system on a regular basis and were able to successfully identify and manage 8 health deteriorations, of which 5 were completely managed remotely. Focus groups revealed that, on one hand, the system was beneficial and helped patients with: recording and tracking readings; receiving encouragement and reassurance from nurses; spotting and solving problems; learning from past experiences; and communication. On the other hand, findings also highlighted design issues and recommendations for future systems such as the need to communicate via other media, personalize symptom questions and messages, integrate other health tracking technologies, and provide additional methods to analyze and visualize their data. Conclusions: Understanding users’ experiences provides important design considerations that could complement existing design recommendations from the literature, and, when combined with physician and nurse requirements, have the potential to yield a feasible telehealth system that is effective in supporting HF self-care. Future studies will include these guidelines and use a larger sample size to validate the outcomes. %M 28341615 %R 10.2196/humanfactors.6481 %U http://humanfactors.jmir.org/2017/1/e9/ %U https://doi.org/10.2196/humanfactors.6481 %U http://www.ncbi.nlm.nih.gov/pubmed/28341615 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 3 %P e36 %T Investigating the Perceptions of Care Coordinators on Using Behavior Theory-Based Mobile Health Technology With Medicaid Populations: A Grounded Theory Study %A Sigler,Brittany Erika %+ Wellpass (formerly Sense Health), 821 Broadway, floor 5, New York, NY,, United States, 1 917 359 7114, bs2897@caa.columbia.edu %K communication %K health behavior %K Medicaid %K mHealth %K patient engagement %K safety-net providers %K text messaging %D 2017 %7 21.03.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Medicaid populations are less engaged in their health care than the rest of the population, translating to worse health outcomes and increased health care costs. Since theory-based mobile health (mHealth) interventions have been shown to increase patient engagement, mobile phones may be an optimal strategy to reach this population. With increased development of theory-based mHealth technology, these interventions must now be evaluated with these medically underserved populations in a real-world setting. Objective: The aim of our study was to investigate care coordinators’ perceived value of using a health behavior theory-based mHealth platform with Medicaid clients. In particular, attention was paid to the perceived impact on patient engagement. This research was conducted using the patient-provider text messaging (short message service, SMS) platform, Sense Health (now Wellpass), which integrates the transtheoretical model (TTM), also called the stages of change model; social cognitive theory (SCT); supportive accountability; and motivational interviewing (MI). Methods: Interviews based in grounded theory methodology were conducted with 10 care managers to understand perceptions of the relationship between mHealth and patient engagement. Results: The interviews with care managers yielded a foundation for a grounded theory model, presenting themes that suggested 4 intertwined correlative relationships revolving around patient engagement: (1) A text messaging (short message service, SMS) platform supplements the client-care manager dynamic, which is grounded in high quality, reciprocal-communication to increase patient engagement; (2) Texting enhances the relationship between literacy and access to care for Medicaid patients, increasing low-literacy patients’ agency to access services; (3) Texting enhances communication, providing care managers with a new means to support their clients; and (4) Reminders augment client accountability, leading to both increased motivation and readiness to change behaviors, as well as an improved client-care manager relationship. Conclusions: Messaging platform features tied to health behavior theory appear to be effective in improving patient engagement. Two-way communication (supportive accountability), trusted relationships (supportive accountability, SCT), personalized messages (TTM), and patient input (TTM, SCT, MI) appeared as the most relevant components in achieving desired outcomes. Additionally, reminder messages were noted as especially useful in making Medicaid patients accountable and in turn engaging them in their health and health care. These findings convey suggested elements for inclusion in other mHealth interventions aiming to improve patient engagement in Medicaid populations. %M 28325711 %R 10.2196/mhealth.5892 %U http://mhealth.jmir.org/2017/3/e36/ %U https://doi.org/10.2196/mhealth.5892 %U http://www.ncbi.nlm.nih.gov/pubmed/28325711 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 3 %P e44 %T Biometrics and Policing: A Protocol for Multichannel Sensor Data Collection and Exploratory Analysis of Contextualized Psychophysiological Response During Law Enforcement Operations %A Furberg,Robert D %A Taniguchi,Travis %A Aagaard,Brian %A Ortiz,Alexa M %A Hegarty-Craver,Meghan %A Gilchrist,Kristin H %A Ridenour,Ty A %+ Digital Health & Clinical Informatics, RTI International, 3040 Cornwallis Rd, Research Triangle Park, NC, 27709, United States, 1 919 316 3726, rfurberg@rti.org %K psychophysiology %K law enforcement %K sensor, wearable %K clinical trial %K digital health %D 2017 %7 17.03.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Stress experienced by law enforcement officers is often extreme and is in many ways unique among professions. Although past research on officer stress is informative, it is limited, and most studies measure stress using self-report questionnaires or observational studies that have limited generalizability. We know of no research studies that have attempted to track direct physiological stress responses in high fidelity, especially within an operational police setting. The outcome of this project will have an impact on both practitioners and policing researchers. To do so, we will establish a capacity to obtain complex, multisensor data; process complex datasets; and establish the methods needed to conduct idiopathic clinical trials on behavioral interventions in similar contexts. Objective: The objective of this pilot study is to demonstrate the practicality and utility of wrist-worn biometric sensor-based research in a law enforcement agency. Methods: We will use nonprobability convenience-based sampling to recruit 2-3 participants from the police department in Durham, North Carolina, USA. Results: Data collection was conducted in 2016. We will analyze data in early 2017 and disseminate our results via peer reviewed publications in late 2017. Conclusions: We developed the Biometrics & Policing Demonstration project to provide a proof of concept on collecting biometric data in a law enforcement setting. This effort will enable us to (1) address the regulatory approvals needed to collect data, including human participant considerations, (2) demonstrate the ability to use biometric tracking technology in a policing setting, (3) link biometric data to law enforcement data, and (4) explore project results for law enforcement policy and training. %M 28314707 %R 10.2196/resprot.7499 %U http://www.researchprotocols.org/2017/3/e44/ %U https://doi.org/10.2196/resprot.7499 %U http://www.ncbi.nlm.nih.gov/pubmed/28314707 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 3 %P e34 %T Estimating Accuracy at Exercise Intensities: A Comparative Study of Self-Monitoring Heart Rate and Physical Activity Wearable Devices %A Dooley,Erin E %A Golaszewski,Natalie M %A Bartholomew,John B %+ Department of Kinesiology and Health Education, University of Texas at Austin, UT Mail Code: D3700 2109 San Jacinto Blvd, Austin, TX, 78712-1415, United States, 1 512 232 6021, jbart@austin.utexas.edu %K motor activity %K physical exertion %K exercise %K monitoring, physiologic %K energy metabolism %K heart rate %K photoplethysmography %D 2017 %7 16.03.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity tracking wearable devices have emerged as an increasingly popular method for consumers to assess their daily activity and calories expended. However, whether these wearable devices are valid at different levels of exercise intensity is unknown. Objective: The objective of this study was to examine heart rate (HR) and energy expenditure (EE) validity of 3 popular wrist-worn activity monitors at different exercise intensities. Methods: A total of 62 participants (females: 58%, 36/62; nonwhite: 47% [13/62 Hispanic, 8/62 Asian, 7/62 black/ African American, 1/62 other]) wore the Apple Watch, Fitbit Charge HR, and Garmin Forerunner 225. Validity was assessed using 2 criterion devices: HR chest strap and a metabolic cart. Participants completed a 10-minute seated baseline assessment; separate 4-minute stages of light-, moderate-, and vigorous-intensity treadmill exercises; and a 10-minute seated recovery period. Data from devices were compared with each criterion via two-way repeated-measures analysis of variance and Bland-Altman analysis. Differences are expressed in mean absolute percentage error (MAPE). Results: For the Apple Watch, HR MAPE was between 1.14% and 6.70%. HR was not significantly different at the start (P=.78), during baseline (P=.76), or vigorous intensity (P=.84); lower HR readings were measured during light intensity (P=.03), moderate intensity (P=.001), and recovery (P=.004). EE MAPE was between 14.07% and 210.84%. The device measured higher EE at all stages (P<.01). For the Fitbit device, the HR MAPE was between 2.38% and 16.99%. HR was not significantly different at the start (P=.67) or during moderate intensity (P=.34); lower HR readings were measured during baseline, vigorous intensity, and recovery (P<.001) and higher HR during light intensity (P<.001). EE MAPE was between 16.85% and 84.98%. The device measured higher EE at baseline (P=.003), light intensity (P<.001), and moderate intensity (P=.001). EE was not significantly different at vigorous (P=.70) or recovery (P=.10). For Garmin Forerunner 225, HR MAPE was between 7.87% and 24.38%. HR was not significantly different at vigorous intensity (P=.35). The device measured higher HR readings at start, baseline, light intensity, moderate intensity (P<.001), and recovery (P=.04). EE MAPE was between 30.77% and 155.05%. The device measured higher EE at all stages (P<.001). Conclusions: This study provides one of the first validation assessments for the Fitbit Charge HR, Apple Watch, and Garmin Forerunner 225. An advantage and novel approach of the study is the examination of HR and EE at specific physical activity intensities. Establishing validity of wearable devices is of particular interest as these devices are being used in weight loss interventions and could impact findings. Future research should investigate why differences between exercise intensities and the devices exist. %M 28302596 %R 10.2196/mhealth.7043 %U http://mhealth.jmir.org/2017/3/e34/ %U https://doi.org/10.2196/mhealth.7043 %U http://www.ncbi.nlm.nih.gov/pubmed/28302596 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 3 %P e77 %T Ecological Momentary Assessment in Behavioral Research: Addressing Technological and Human Participant Challenges %A Burke,Lora E %A Shiffman,Saul %A Music,Edvin %A Styn,Mindi A %A Kriska,Andrea %A Smailagic,Asim %A Siewiorek,Daniel %A Ewing,Linda J %A Chasens,Eileen %A French,Brian %A Mancino,Juliet %A Mendez,Dara %A Strollo,Patrick %A Rathbun,Stephen L %+ Department of Health & Community Systems, University of Pittsburgh School of Nursing, 415 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, United States, 1 412 624 2305, lbu100@pitt.edu %K ecological momentary assessment %K relapse %K obesity %K smartphone %K eating behavior %K adherence %D 2017 %7 15.03.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Ecological momentary assessment (EMA) assesses individuals’ current experiences, behaviors, and moods as they occur in real time and in their natural environment. EMA studies, particularly those of longer duration, are complex and require an infrastructure to support the data flow and monitoring of EMA completion. Objective: Our objective is to provide a practical guide to developing and implementing an EMA study, with a focus on the methods and logistics of conducting such a study. Methods: The EMPOWER study was a 12-month study that used EMA to examine the triggers of lapses and relapse following intentional weight loss. We report on several studies that informed the implementation of the EMPOWER study: (1) a series of pilot studies, (2) the EMPOWER study’s infrastructure, (3) training of study participants in use of smartphones and the EMA protocol and, (4) strategies used to enhance adherence to completing EMA surveys. Results: The study enrolled 151 adults and had 87.4% (132/151) retention rate at 12 months. Our learning experiences in the development of the infrastructure to support EMA assessments for the 12-month study spanned several topic areas. Included were the optimal frequency of EMA prompts to maximize data collection without overburdening participants; the timing and scheduling of EMA prompts; technological lessons to support a longitudinal study, such as proper communication between the Android smartphone, the Web server, and the database server; and use of a phone that provided access to the system’s functionality for EMA data collection to avoid loss of data and minimize the impact of loss of network connectivity. These were especially important in a 1-year study with participants who might travel. It also protected the data collection from any server-side failure. Regular monitoring of participants’ response to EMA prompts was critical, so we built in incentives to enhance completion of EMA surveys. During the first 6 months of the 12-month study interval, adherence to completing EMA surveys was high, with 88.3% (66,978/75,888) completion of random assessments and around 90% (23,411/25,929 and 23,343/26,010) completion of time-contingent assessments, despite the duration of EMA data collection and challenges with implementation. Conclusions: This work informed us of the necessary preliminary steps to plan and prepare a longitudinal study using smartphone technology and the critical elements to ensure participant engagement in the potentially burdensome protocol, which spanned 12 months. While this was a technology-supported and -programmed study, it required close oversight to ensure all elements were functioning correctly, particularly once human participants became involved. %M 28298264 %R 10.2196/jmir.7138 %U http://www.jmir.org/2017/3/e77/ %U https://doi.org/10.2196/jmir.7138 %U http://www.ncbi.nlm.nih.gov/pubmed/28298264 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 3 %P e33 %T Resting and Postexercise Heart Rate Detection From Fingertip and Facial Photoplethysmography Using a Smartphone Camera: A Validation Study %A Yan,Bryan P %A Chan,Christy KY %A Li,Christien KH %A To,Olivia TL %A Lai,William HS %A Tse,Gary %A Poh,Yukkee C %A Poh,Ming-Zher %+ Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong and Prince of Wales Hospital, 9/F, Division of Cardiology, Department of Medicine and Therapeutics, Clinical Sciences Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong,, China (Hong Kong), 852 2632 3142, bryan.yan@cuhk.edu.hk %K heart rate %K mobile apps %K photoplethysmography %K smartphone %K mobile phone %D 2017 %7 13.03.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Modern smartphones allow measurement of heart rate (HR) by detecting pulsatile photoplethysmographic (PPG) signals with built-in cameras from the fingertips or the face, without physical contact, by extracting subtle beat-to-beat variations of skin color. Objective: The objective of our study was to evaluate the accuracy of HR measurements at rest and after exercise using a smartphone-based PPG detection app. Methods: A total of 40 healthy participants (20 men; mean age 24.7, SD 5.2 years; von Luschan skin color range 14-27) underwent treadmill exercise using the Bruce protocol. We recorded simultaneous PPG signals for each participant by having them (1) facing the front camera and (2) placing their index fingertip over an iPhone’s back camera. We analyzed the PPG signals from the Cardiio-Heart Rate Monitor + 7 Minute Workout (Cardiio) smartphone app for HR measurements compared with a continuous 12-lead electrocardiogram (ECG) as the reference. Recordings of 20 seconds’ duration each were acquired at rest, and immediately after moderate- (50%-70% maximum HR) and vigorous- (70%-85% maximum HR) intensity exercise, and repeated successively until return to resting HR. We used Bland-Altman plots to examine agreement between ECG and PPG-estimated HR. The accuracy criterion was root mean square error (RMSE) ≤5 beats/min or ≤10%, whichever was greater, according to the American National Standards Institute/Association for the Advancement of Medical Instrumentation EC-13 standard. Results: We analyzed a total of 631 fingertip and 626 facial PPG measurements. Fingertip PPG-estimated HRs were strongly correlated with resting ECG HR (r=.997, RMSE=1.03 beats/min or 1.40%), postmoderate-intensity exercise (r=.994, RMSE=2.15 beats/min or 2.53%), and postvigorous-intensity exercise HR (r=.995, RMSE=2.01 beats/min or 1.93%). The correlation of facial PPG-estimated HR was stronger with resting ECG HR (r=.997, RMSE=1.02 beats/min or 1.44%) than with postmoderate-intensity exercise (r=.982, RMSE=3.68 beats/min or 4.11%) or with postvigorous-intensity exercise (r=.980, RMSE=3.84 beats/min or 3.73%). Bland-Altman plots showed better agreement between ECG and fingertip PPG-estimated HR than between ECG and facial PPG-estimated HR. Conclusions: We found that HR detection by the Cardiio smartphone app was accurate at rest and after moderate- and vigorous-intensity exercise in a healthy young adult sample. Contact-free facial PPG detection is more convenient but is less accurate than finger PPG due to body motion after exercise. %M 28288955 %R 10.2196/mhealth.7275 %U http://mhealth.jmir.org/2017/3/e33/ %U https://doi.org/10.2196/mhealth.7275 %U http://www.ncbi.nlm.nih.gov/pubmed/28288955 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 3 %P e40 %T Home-Based Intervention Program to Reduce Food Insecurity in Elderly Populations Using a TV App: Study Protocol of the Randomized Controlled Trial Saúde.Come Senior %A Rodrigues,Ana Maria %A Gregório,Maria João %A Gein,Pierre %A Eusébio,Mónica %A Santos,Maria José %A de Sousa,Rute Dinis %A Coelho,Pedro S %A Mendes,Jorge M %A Graça,Pedro %A Oliveira,Pedro %A Branco,Jaime C %A Canhão,Helena %+ EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Pólo de Investigação, NMS, UNL. Edifício Amarelo. Piso 2. Rua do Instituto Bacteriológico, nº5, Lisboa,, Portugal, 351 218 803 000, anamfrodrigues@gmail.com %K information and communication technology %K new technologies %K TV app %K healthy lifestyle promotion %K food insecurity %D 2017 %7 13.03.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: The limited or uncertain access to adequate food in elderly people includes not only economic restrictions but also inability of food utilization due to functional or cognitive impairment, health problems, and illiteracy. Objective: The aim of this work is to present the protocol of the randomized controlled trial Saúde.Come Senior, an educational and motivational television (TV)-based intervention to promote healthy lifestyles and decrease food insecurity in elderly people. Methods: A randomized controlled study will be conducted in subjects aged 60 years and older with food insecurity, identified at 17 primary care centers in the Lisboa e Vale do Tejo health region in Lisbon, Portugal. The primary outcome will be the changes in participants’ food insecurity score (evaluated by the Household Food Insecurity Scale) at 3 months. Change in other outcomes will be assessed (dietary habits, nutritional status, physical activity, health status, and clinical outcomes). Subjects will be followed over 6 months; the intervention will last 3 months. Data collection will be performed at 3 different time points (baseline, end of intervention at 3 months, and follow-up at 6 months). The intervention is based on an interactive TV app with an educational and motivational program specifically developed for the elderly that has weekly themes and includes daily content in video format: (1) nutrition and diet tips for healthy eating, (2) healthy, easy to cook and low-cost recipes, and (3) physical exercise programs. Furthermore, brief reminders on health behaviors will also be broadcasted through the TV app. The total duration of the study will be 6 months. The intervention is considered to be effective and meaningful if 50% of the individuals in the experimental group have a decrease of 1 point in the food insecurity score, all the remaining being unchanged. We expect to include and randomize 282 (141 experimental and 141 control) elderly with food insecurity. We will recruit a total of 1,128 subjects considering that 50% of the target individuals are food insecure (based on INFOFAMÍLIA Survey) (567) and about 50% of those will adhere to the study (282). Results: The randomized controlled trial with the 12-week home-based intervention with a comprehensive program on healthy eating and physical activity delivery is planned to start recruiting participants at the end of 2017. Conclusions: This study will assess the efficacy of this innovative tool (Saúde.Come Senior) for disseminating relevant health information, modifying behaviors, and decreasing food insecurity in an easy, low-cost, and massive way. %M 28288956 %R 10.2196/resprot.6626 %U http://www.researchprotocols.org/2017/3/e40/ %U https://doi.org/10.2196/resprot.6626 %U http://www.ncbi.nlm.nih.gov/pubmed/28288956 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 3 %P e26 %T Usability and Acceptability of a Mobile Comprehensive HIV Prevention App for Men Who Have Sex With Men: A Pilot Study %A Sullivan,Patrick S %A Driggers,Robert %A Stekler,Joanne D %A Siegler,Aaron %A Goldenberg,Tamar %A McDougal,Sarah J %A Caucutt,Jason %A Jones,Jeb %A Stephenson,Rob %+ Rollins School of Public Health, Department of Epidemiology, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 4047272038, pssulli@emory.edu %K homosexuality, male %K mobile applications %K pilot projects %K sexual minorities %K condoms %K pre-exposure prophylaxis %D 2017 %7 09.03.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Men who have sex with men (MSM) are the group most impacted by the human immunodeficiency virus (HIV) epidemic and the only subgroup in the United States among which new HIV diagnoses are not decreasing. To achieve the US National HIV/AIDS (acquired immunodeficiency syndrome) Strategy goals of reducing new diagnoses by 25%, high (eg, 30-50%) coverage of multiple HIV prevention interventions is needed in both urban and rural areas. Mobile phone “apps” are an important channel through which prevention services could be provided at scale and at low marginal cost. Objective: The aim of this study was to evaluate the usability and acceptability of a theory-based Android mobile phone app for HIV prevention. Methods: The app included self-assessment tools; prevention recommendations; commodity (condoms, HIV self-tests) ordering; reminders to MSM for basic HIV prevention services, HIV testing, condom use, screening for preexposure prophylaxis (PrEP) and nonoccupational postexposure prophylaxis (nPEP); and prevention and treatment provider locators. The study recruited HIV-negative, Android-using MSM in Atlanta and Seattle who were asked to use the app for 4 months and complete a post-use survey. We measured the use of the app and its features, ordering of commodities, self-report of establishing an HIV testing plan, being HIV tested in the community, and starting PrEP or using nPEP. Usability was assessed using the system usability scale (SUS). Results: A total of 121 MSM were enrolled (59.5%, 72/121 from Atlanta; 40.5%, 49/121 from Seattle). Median age was 28. Nearly half (48.8%, 59/121) were nonwhite, and most (85.9%, 104/121) were gay-identified. Most had tested for HIV in the past (85.1%, 103/121), and 52 (43.0%, 52/121) had a plan to test for HIV regularly. Men used the app for an average of 17.7 minutes over the first 4 months. Over the 4-month period, over half ordered condoms (63.6%, 77/121) and HIV test kits (52.8%, 64/121) on the app. Eight of 86 (9%) PrEP-eligible MSM started PrEP during the 4-month period; of those, 6 of the 8 reported that the app influenced their decision to start PrEP. The mean SUS was 73 (above average). Conclusions: A theory-based mobile phone app was acceptable to MSM and was rated as having above-average usability. Most men used the commodity-ordering features of the app during the 4-month evaluation period, and nearly 1 in 10 PrEP-eligible men started PrEP, with most attributing their decision to start PrEP in part to the app. A broader, randomized controlled study of the impact of the app on uptake of prevention behaviors for MSM is warranted. %M 28279949 %R 10.2196/mhealth.7199 %U http://mhealth.jmir.org/2017/3/e26/ %U https://doi.org/10.2196/mhealth.7199 %U http://www.ncbi.nlm.nih.gov/pubmed/28279949 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 3 %P e68 %T Evaluating the Consistency of Current Mainstream Wearable Devices in Health Monitoring: A Comparison Under Free-Living Conditions %A Wen,Dong %A Zhang,Xingting %A Liu,Xingyu %A Lei,Jianbo %+ Center for Medical Informatics, Peking University, 38 Xueyuan Rd., Haidian District, Beijing, 100191, China, 86 (10) 8280 5901, jblei@hsc.pku.edu.cn %K fitness trackers %K monitoring, physiologic %K motor activity %K activities of daily living %K health status %D 2017 %7 07.03.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Wearable devices are gaining increasing market attention; however, the monitoring accuracy and consistency of the devices remains unknown. Objective: The purpose of this study was to assess the consistency of the monitoring measurements of the latest wearable devices in the state of normal activities to provide advice to the industry and support to consumers in making purchasing choices. Methods: Ten pieces of representative wearable devices (2 smart watches, 4 smart bracelets of Chinese brands or foreign brands, and 4 mobile phone apps) were selected, and 5 subjects were employed to simultaneously use all the devices and the apps. From these devices, intact health monitoring data were acquired for 5 consecutive days and analyzed on the degree of differences and the relationships of the monitoring measurements ​​by the different devices. Results: The daily measurements by the different devices fluctuated greatly, and the coefficient of variation (CV) fluctuated in the range of 2-38% for the number of steps, 5-30% for distance, 19-112% for activity duration, .1-17% for total energy expenditure (EE), 22-100% for activity EE, 2-44% for sleep duration, and 35-117% for deep sleep duration. After integrating the measurement data of 25 days among the devices, the measurements of the number of steps (intraclass correlation coefficient, ICC=.89) and distance (ICC=.84) displayed excellent consistencies, followed by those of activity duration (ICC=.59) and the total EE (ICC=.59) and activity EE (ICC=.57). However, the measurements for sleep duration (ICC=.30) and deep sleep duration (ICC=.27) were poor. For most devices, there was a strong correlation between the number of steps and distance measurements (R2>.95), and for some devices, there was a strong correlation between activity duration measurements and EE measurements (R2>.7). A strong correlation was observed in the measurements of steps, distance and EE from smart watches and mobile phones of the same brand, Apple or Samsung (r>.88). Conclusions: Although wearable devices are developing rapidly, the current mainstream devices are only reliable in measuring the number of steps and distance, which can be used as health assessment indicators. However, the measurement consistencies of activity duration, EE, sleep quality, and so on, are still inadequate, which require further investigation and improved algorithms. %M 28270382 %R 10.2196/jmir.6874 %U http://www.jmir.org/2017/3/e68/ %U https://doi.org/10.2196/jmir.6874 %U http://www.ncbi.nlm.nih.gov/pubmed/28270382 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 3 %P e67 %T Assessing the Quality of Mobile Exercise Apps Based on the American College of Sports Medicine Guidelines: A Reliable and Valid Scoring Instrument %A Guo,Yi %A Bian,Jiang %A Leavitt,Trevor %A Vincent,Heather K %A Vander Zalm,Lindsey %A Teurlings,Tyler L %A Smith,Megan D %A Modave,François %+ Department of Health Outcomes and Policy, University of Florida, 2004 Mowry Road, Suite 2251 PO Box 100165, Gainesville, FL, 32610, United States, 1 352 294 5969, yiguo@ufl.edu %K mHealth %K mobile apps %K physical activity %K measures %D 2017 %7 07.03.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Regular physical activity can not only help with weight management, but also lower cardiovascular risks, cancer rates, and chronic disease burden. Yet, only approximately 20% of Americans currently meet the physical activity guidelines recommended by the US Department of Health and Human Services. With the rapid development of mobile technologies, mobile apps have the potential to improve participation rates in exercise programs, particularly if they are evidence-based and are of sufficient content quality. Objective: The goal of this study was to develop and test an instrument, which was designed to score the content quality of exercise program apps with respect to the exercise guidelines set forth by the American College of Sports Medicine (ACSM). Methods: We conducted two focus groups (N=14) to elicit input for developing a preliminary 27-item scoring instruments based on the ACSM exercise prescription guidelines. Three reviewers who were no sports medicine experts independently scored 28 exercise program apps using the instrument. Inter- and intra-rater reliability was assessed among the 3 reviewers. An expert reviewer, a Fellow of the ACSM, also scored the 28 apps to create criterion scores. Criterion validity was assessed by comparing nonexpert reviewers’ scores to the criterion scores. Results: Overall, inter- and intra-rater reliability was high with most coefficients being greater than .7. Inter-rater reliability coefficients ranged from .59 to .99, and intra-rater reliability coefficients ranged from .47 to 1.00. All reliability coefficients were statistically significant. Criterion validity was found to be excellent, with the weighted kappa statistics ranging from .67 to .99, indicating a substantial agreement between the scores of expert and nonexpert reviewers. Finally, all apps scored poorly against the ACSM exercise prescription guidelines. None of the apps received a score greater than 35, out of a possible maximal score of 70. Conclusions: We have developed and presented valid and reliable scoring instruments for exercise program apps. Our instrument may be useful for consumers and health care providers who are looking for apps that provide safe, progressive general exercise programs for health and fitness. %M 28270378 %R 10.2196/jmir.6976 %U http://www.jmir.org/2017/3/e67/ %U https://doi.org/10.2196/jmir.6976 %U http://www.ncbi.nlm.nih.gov/pubmed/28270378 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 3 %P e27 %T Development and Testing of a Mobile Phone App for Self-Monitoring of Calcium Intake in Young Women %A Tay,Ilona %A Garland,Suzanne %A Gorelik,Alexandra %A Wark,John Dennis %+ Royal Melbourne Hospital, Bone and Mineral Medicine, Royal Parade, Parkville, VIC, 3052, Australia, 61 3 83445201, jdwark@unimelb.edu.au %K behavior therapy %K cell phones %K health behavior %K primary prevention %K self care %K telemedicine %D 2017 %7 07.03.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Interventions to prevent osteoporosis by increasing dairy intake or physical activity in young women have been limited to increasing osteoporosis knowledge and awareness. However, findings have shown that this does not always lead to a change in behaviors. Self-monitoring using mobile devices in behavioral interventions has yielded significant and positive outcomes. Yet, to our knowledge, mobile self-monitoring has not been used as an intervention strategy to increase calcium intake, particularly in young women, for better bone health outcomes. Objective: As development and testing of mobile app–based interventions requires a sequence of steps, our study focused on testing the acceptability and usability of Calci-app, a dietary app to self-monitor calcium consumption, before it is used in a behavioral change intervention in young women aged 18-25 years. Methods: Calci-app development followed 4 steps: (1) conceptualization, (2) development and pretesting, (3) pilot testing, and (4) mixed methods evaluation. Results: We present the development process of Calci-app and evaluation of the acceptability and usability of the app in young women. Overall, 78% (31/40) of study participants completed the 5-day food record with high compliance levels (defined as more than 3 days of full or partial completion). There was a significant reduction in the proportion of participants completing all meal entries over the 5 days (P=.01). Participants generally found Calci-app easy and convenient to use, but it was time-consuming and they expressed a lack of motivation to use the app. Conclusions: We present a detailed description of the development process of Calci-app and an evaluation of its usability and acceptability to self-monitor dietary calcium intake. The findings from this preliminary study demonstrated acceptable use of Calci-app to self-monitor calcium consumption. However, for regular and long-term use the self-monitoring function in Calci-app could be expanded to allow participants to view their total daily calcium intake compared with the recommended daily intake. Additionally, to facilitate sustainable lifestyle behavior modifications, a combination of various behavior change techniques should be considered, such as education, goal setting, and advice to participants based on their stage of change. The feedback on barriers and facilitators from testing Calci-app will be used to design a bone health mHealth intervention to modify risky lifestyle behaviors in young women for better bone health outcomes. %M 28270379 %R 10.2196/mhealth.5717 %U http://mhealth.jmir.org/2017/3/e27/ %U https://doi.org/10.2196/mhealth.5717 %U http://www.ncbi.nlm.nih.gov/pubmed/28270379 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 3 %P e28 %T Feasibility and Acceptability of a Wearable Technology Physical Activity Intervention With Telephone Counseling for Mid-Aged and Older Adults: A Randomized Controlled Pilot Trial %A Lyons,Elizabeth J %A Swartz,Maria C %A Lewis,Zakkoyya H %A Martinez,Eloisa %A Jennings,Kristofer %+ Department of Nutrition and Metabolism, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, United States, 1 4097722575, ellyons@utmb.edu %K physical activity %K technology %K mobile health %K health behavior %K self-control %D 2017 %7 06.03.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As adults age, their physical activity decreases and sedentary behavior increases, leading to increased risk of negative health outcomes. Wearable electronic activity monitors have shown promise for delivering effective behavior change techniques. However, little is known about the feasibility and acceptability of non-Fitbit wearables (Fitbit, Inc, San Francisco, California) combined with telephone counseling among adults aged more than 55 years. Objective: The purpose of our study was to determine the feasibility, acceptability, and effect on physical activity of an intervention combining a wearable physical activity monitor, tablet device, and telephone counseling among adults aged 55-79 years. Methods: Adults (N=40, aged 55-79 years, body mass index=25-35, <60 min of activity per week) were randomized to receive a 12-week intervention or to a wait list control. Intervention participants received a Jawbone Up24 monitor, a tablet with the Jawbone Up app installed, and brief weekly telephone counseling. Participants set daily and weekly step goals and used the monitor’s idle alert to notify them when they were sedentary for more than 1 h. Interventionists provided brief counseling once per week by telephone. Feasibility was measured using observation and study records, and acceptability was measured by self-report using validated items. Physical activity and sedentary time were measured using ActivPAL monitors following standard protocols. Body composition was measured using dual-energy x-ray absorptiometry scans, and fitness was measured using a 6-min walk test. Results: Participants were 61.48 years old (SD 5.60), 85% (34/40) female, 65% (26/40) white. Average activity monitor wear time was 81.85 (SD 3.73) of 90 days. Of the 20 Up24 monitors, 5 were reported broken and 1 lost. No related adverse events were reported. Acceptability items were rated at least 4 on a scale of 1-5. Effect sizes for most outcomes were small, including stepping time per day (d=0.35), steps per day (d=0.26), sitting time per day (d=0.21), body fat (d=0.17), and weight (d=0.33). Conclusions: The intervention was feasible and acceptable in this population. Effect sizes were similar to the sizes found using other wearable electronic activity monitors, indicating that when combined with telephone counseling, wearable activity monitors are a potentially effective tool for increasing physical activity and decreasing sedentary behavior. Trial registration: Clinicaltrials.gov NCT01869348; https://clinicaltrials.gov/ct2/show/NCT01869348 (Archived by WebCite at http://www.webcitation.org/6odlIolqy) %M 28264796 %R 10.2196/mhealth.6967 %U http://mhealth.jmir.org/2017/3/e28/ %U https://doi.org/10.2196/mhealth.6967 %U http://www.ncbi.nlm.nih.gov/pubmed/28264796 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 1 %P e4 %T A Mobile, Avatar-Based App for Improving Body Perceptions Among Adolescents: A Pilot Test %A Lyles,Annmarie A %A Amresh,Ashish %A Huberty,Jennifer %A Todd,Michael %A Lee,Rebecca E %+ College of Nursing and Health Innovation, Arizona State University, 550 N 3rd St, Phoenix, AZ, 85004, United States, 1 602 496 2196, Annmarie.Lyles@asu.edu %K adolescents %K avatars %K eHealth %K mHealth %K perceptions %K Web-based %K usability testing %D 2017 %7 02.03.2017 %9 Original Paper %J JMIR Serious Games %G English %X Background: One barrier to effectively treating weight issues among adolescents is that they tend to use social comparison instead of objective measures to evaluate their own health status. When adolescents correctly perceive themselves as overweight, they are more likely to adopt healthy lifestyle behaviors. Objective: The purpose of this pilot test was to develop and assess acceptability and usability of an avatar-based, theoretically derived mobile app entitled Monitor Your Avatar (MYA). Methods: The MYA app was engineered for high school adolescents to identify, using avatars, what they thought they looked like, what they wanted to look like, and what they actually looked like based on body measurements. Results: The MYA app was pilot-tested with male and female adolescents aged 15-18 years to assess for acceptability and usability. A total of 42 students created and viewed their avatars. The majority of the adolescents were female (28/42, 67%), age 16 years (16/42, 38%), white (35/42, 83%), non-Hispanic (36/42, 86%), in grade 10 (20/42, 48%), healthy weight for females (23/28, 82%), and obese for males (7/14, 50%). The adolescents had positive reactions to the avatar app and being able to view avatars that represented them. All but one student (41/42, 98%) indicated some level of comfort viewing the avatars and would use the app in the future to see how their bodies change over time. Conclusions: Avatar-based mobile apps, such as the MYA app, provide immediate feedback and allow users to engage with images that are personalized to represent their perceptions and actual body images. This pilot study adds to the increasing but limited research of using games to improve health outcomes among high school adolescents. There is a need to further adapt the MYA app and gather feedback from a larger number of high school adolescents, including those from diverse backgrounds. %M 28254737 %R 10.2196/games.6354 %U http://games.jmir.org/2017/1/e4/ %U https://doi.org/10.2196/games.6354 %U http://www.ncbi.nlm.nih.gov/pubmed/28254737 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 2 %P e22 %T Stress Management Apps With Regard to Emotion-Focused Coping and Behavior Change Techniques: A Content Analysis %A Christmann,Corinna Anna %A Hoffmann,Alexandra %A Bleser,Gabriele %+ Junior research group wearHEALTH, Department of Computer Science, University of Kaiserslautern, Building 48, Gottlieb-Daimler-Str, Kaiserslautern, 67663, Germany, 49 631 205 ext 3456, christmann@cs.uni-kl.de %K mHealth %K mobile health %K relaxation %D 2017 %7 23.02.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic stress has been shown to be associated with disease. This link is not only direct but also indirect through harmful health behavior such as smoking or changing eating habits. The recent mHealth trend offers a new and promising approach to support the adoption and maintenance of appropriate stress management techniques. However, only few studies have dealt with the inclusion of evidence-based content within stress management apps for mobile phones. Objective: The aim of this study was to evaluate stress management apps on the basis of a new taxonomy of effective emotion-focused stress management techniques and an established taxonomy of behavior change techniques. Methods: Two trained and independent raters evaluated 62 free apps found in Google Play with regard to 26 behavior change and 15 emotion-focused stress management techniques in October 2015. Results: The apps included an average of 4.3 behavior change techniques (SD 4.2) and 2.8 emotion-focused stress management techniques (SD 2.6). The behavior change technique score and stress management technique score were highly correlated (r=.82, P=.01). Conclusions: The broad variation of different stress management strategies found in this sample of apps goes in line with those found in conventional stress management interventions and self-help literature. Moreover, this study provided a first step toward more detailed and standardized taxonomies, which can be used to investigate evidence-based content in stress management interventions and enable greater comparability between different intervention types. %M 28232299 %R 10.2196/mhealth.6471 %U http://mhealth.jmir.org/2017/2/e22/ %U https://doi.org/10.2196/mhealth.6471 %U http://www.ncbi.nlm.nih.gov/pubmed/28232299 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 2 %P e41 %T Smartphone-Based Self-Assessment of Stress in Healthy Adult Individuals: A Systematic Review %A Þórarinsdóttir,Helga %A Kessing,Lars Vedel %A Faurholt-Jepsen,Maria %+ Psychiatric Center Copenhagen, Rigshospitalet, Department O, Blegdamsvej 9, Copenhagen, 2100, Denmark, 45 38647073, maria@faurholt-jepsen.dk %K smartphone %K emotional stress %K healthy individuals %K self-report %K objective smartphone generated measures of stress %D 2017 %7 13.02.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Stress is a common experience in today’s society. Smartphone ownership is widespread, and smartphones can be used to monitor health and well-being. Smartphone-based self-assessment of stress can be done in naturalistic settings and may potentially reflect real-time stress level. Objective: The objectives of this systematic review were to evaluate (1) the use of smartphones to measure self-assessed stress in healthy adult individuals, (2) the validity of smartphone-based self-assessed stress compared with validated stress scales, and (3) the association between smartphone-based self-assessed stress and smartphone generated objective data. Methods: A systematic review of the scientific literature was reported and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The scientific databases PubMed, PsycINFO, Embase, IEEE, and ACM were searched and supplemented by a hand search of reference lists. The databases were searched for original studies involving healthy individuals older than 18 years, measuring self-assessed stress using smartphones. Results: A total of 35 published articles comprising 1464 individuals were included for review. According to the objectives, (1) study designs were heterogeneous, and smartphone-based self-assessed stress was measured using various methods (e.g., dichotomized questions on stress, yes or no; Likert scales on stress; and questionnaires); (2) the validity of smartphone-based self-assessed stress compared with validated stress scales was investigated in 3 studies, and of these, only 1 study found a moderate statistically significant positive correlation (r=.4; P<.05); and (3) in exploratory analyses, smartphone-based self-assessed stress was found to correlate with some of the reported smartphone generated objective data, including voice features and data on activity and phone usage. Conclusions: Smartphones are being used to measure self-assessed stress in different contexts. The evidence of the validity of smartphone-based self-assessed stress is limited and should be investigated further. Smartphone generated objective data can potentially be used to monitor, predict, and reduce stress levels. %M 28193600 %R 10.2196/jmir.6397 %U http://www.jmir.org/2017/2/e41/ %U https://doi.org/10.2196/jmir.6397 %U http://www.ncbi.nlm.nih.gov/pubmed/28193600 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 2 %P e12 %T Latino Adults’ Perspectives on Treating Tobacco Use Via Social Media %A Anguiano,Beatriz %A Brown-Johnson,Cati %A Rosas,Lisa G. %A Pechmann,Cornelia %A Prochaska,Judith J. %+ Stanford Prevention Research Center, Department of Medicine, Stanford University, 1265 Welch Rd, Stanford, CA, 94305, United States, 1 650 724 3608, jpro@stanford.edu %K smoking cessation %K tobacco %K Latino %K Hispanic %K social media %K focus group %D 2017 %7 08.02.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Latinos are the largest minority group in the United States, and in California they outnumber non-Hispanic whites. Smoking cessation programs tailored for Latino culture, and this population’s specific smoking patterns, are needed. Online social networks for smoking cessation have high potential for Latinos, but have not been tested to date. Objective: Building a research program on social media apps for cancer prevention in diverse populations, this qualitative study assessed acceptability of tobacco treatment that was distributed via social media for Latino smokers. Methods: We conducted three focus groups with Latino adults who were former and current smokers recruited from Santa Clara County, California in 2015 (N=32). We assessed participants’ smoking histories, attempts to quit, social media exposure, and receptivity to a social media-based smoking cessation intervention. Audio transcripts were translated and coded for themes. Results: Participants reported factors driving their tobacco use and motivations to quit, and emphasized the importance of community and family in influencing their smoking initiation, cravings and triggers, attempts to quit, and abstinence. Participants valued the communal aspect of social media and suggested strategically tailoring groups based on key features (eg, age, gender, language preference). Participants reported preferring visual, educational, and motivational messages that were connected with existing services. Conclusions: Participants generally voiced acceptability of a social media-delivered intervention to help them quit smoking, viewed the intervention as well-equipped for catering to the strong community orientation of Latinos, and suggested that the platform was able to address variation within the population through strategic group creation. As a group member reflected, “Podemos hacerlo juntos” (We can do it together). %M 28179217 %R 10.2196/mhealth.6684 %U http://mhealth.jmir.org/2017/2/e12/ %U https://doi.org/10.2196/mhealth.6684 %U http://www.ncbi.nlm.nih.gov/pubmed/28179217 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 2 %P e8 %T Weight Loss Associated With Different Patterns of Self-Monitoring Using the Mobile Phone App My Meal Mate %A Carter,Michelle C %A Burley,Victoria J %A Cade,Janet E %+ Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Stead House, Leeds, LS29 7QH, United Kingdom, 44 1133436946, j.e.cade@leeds.ac.uk %K self-monitoring %K mobile phone %K obesity %K weight loss %D 2017 %7 02.02.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obesity is a major global public health issue due to its association with a number of serious chronic illnesses and its high economic burden to health care providers. Self-monitoring of diet has been consistently linked to weight loss. However, there is limited evidence about how frequently individuals need to monitor their diet for optimal weight loss. Objective: The aim of this paper is to describe app usage frequency and pattern in the mobile phone arm of a previously conducted randomized controlled trial. The relationship between frequency and pattern of electronic dietary self-monitoring and weight loss is also investigated. Methods: A randomized pilot trial comparing three methods of self-monitoring (mobile phone app, paper diary, Web-based) was previously conducted. Trial duration was 6 months. The mobile phone app My Meal Mate features an electronic food diary and encourages users to self-monitor their dietary intake. All food consumption data were automatically uploaded with a time and date stamp. Post hoc regression analysis of app usage patterns was undertaken in the My Meal Mate group (n=43; female: 77%, 33/43; white: 100%, 43/43; age: mean 41, SD 9 years; body mass index: mean 34, SD 4 kg/m2) to explore the relationship between frequency and pattern of electronic dietary self-monitoring and weight loss. Baseline characteristics of participants were also investigated to identify any potential predictors of dietary self-monitoring. Results: Regression analysis showed that those in the highest frequency-of-use category (recorded ≥129 days on the mobile phone app) had a −6.4 kg (95% CI −10.0 to −2.9) lower follow-up weight (adjusted for baseline weight) than those in the lowest frequency-of-use category (recorded ≤42 days; P<.001). Long-term intermittent monitoring over 6 months appeared to facilitate greater mean weight loss than other patterns of electronic self-monitoring (ie, monitoring over the short or moderate term and stopping and consistently monitoring over consecutive days). Participant characteristics such as age, baseline weight, sex, ethnicity, conscientiousness, and consideration of future consequences were not statistically associated with extent of self-monitoring. Conclusions: The results of this post hoc exploratory analysis indicate that duration and frequency of app use is associated with improved weight loss, but further research is required to identify whether there are participant characteristics that would reliably predict those who are most likely to regularly self-monitor their diet. ClinicalTrial: ClinicalTrials.gov NCT01744535; http://clinicaltrials.gov/ct2/show/NCT01744535 (Archived by WebCite at http://www.webcitation.org/6FEtc3PVB) %M 28153814 %R 10.2196/mhealth.4520 %U http://mhealth.jmir.org/2017/2/e8/ %U https://doi.org/10.2196/mhealth.4520 %U http://www.ncbi.nlm.nih.gov/pubmed/28153814 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 2 %P e10 %T Clinical Evaluation of the Measurement Performance of the Philips Health Watch: A Within-Person Comparative Study %A Hendrikx,Jos %A Ruijs,Loes S %A Cox,Lieke GE %A Lemmens,Paul MC %A Schuijers,Erik GP %A Goris,Annelies HC %+ Philips Research, High Tech Campus 34, Eindhoven, 5656AE, Netherlands, 31 40 27 91111, lieke.cox@philips.com %K sedentary lifestyle %K monitoring, ambulatory %K monitoring, physiologic %K accelerometry %K actigraphy %K photoplethysmography %K heart rate %K energy metabolism %K adult %K humans %D 2017 %7 02.02.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical inactivity is an important modifiable risk factor for chronic diseases. A new wrist-worn heart rate and activity monitor has been developed for unobtrusive data collection to aid prevention and management of lifestyle-related chronic diseases by means of behavioral change programs. Objective: The objective of the study was to evaluate the performance of total energy expenditure and resting heart rate measures of the Philips health watch. Secondary objectives included the assessment of accuracy of other output parameters of the monitor: heart rate, respiration rate at rest, step count, and activity type recognition. Methods: A within-person comparative study was performed to assess the performance of the health watch against (medical) reference measures. Participants executed a protocol including 15 minutes of rest and various activities of daily life. A two one-sided tests approach was adopted for testing equivalence. In addition, error metrics such as mean error and mean absolute percentage error (MAPE) were calculated. Results: A total of 29 participants (14 males; mean age 41.2, SD 14.4, years; mean weight 77.2, SD 10.2, kg; mean height 1.8, SD 0.1, m; mean body mass index 25.1, SD 3.1, kg/m2) completed the 81-minute protocol. Their mean resting heart rate in beats per minute (bpm) was 64 (SD 7.3). With a mean error of −10 (SD 38.9) kcal and a MAPE of 10% (SD 8.7%), total energy expenditure estimation of the health watch was found to be within the 15% predefined equivalence margin in reference to a portable indirect calorimeter. Resting heart rate determined during a 15-minute rest protocol was found to be within a 10% equivalence margin in reference to a wearable electrocardiogram (ECG) monitor, with a mean deviation of 0 bpm and a maximum deviation of 3 bpm. Heart rate was within 10 bpm and 10% of the ECG monitor reference for 93% of the duration of the protocol. Step count estimates were on average 21 counts lower than a waist-mounted step counter over all walking activities combined, with a MAPE of 3.5% (SD 2.4%). Resting respiration rate was on average 0.7 (SD 1.1) breaths per minute lower than the reference measurement by the spirometer embedded in the indirect calorimeter during the 15-minute rest, resulting in a MAPE of 8.3% (SD 7.0%). Activity type recognition of walking, running, cycling, or other was overall 90% accurate in reference to the activities performed. Conclusions: The health watch can serve its medical purpose of measuring resting heart rate and total energy expenditure over time in an unobtrusive manner, thereby providing valuable data for the prevention and management of lifestyle-related chronic diseases. Trial Registration: Netherlands trial register NTR5552; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5552 (Archived by WebCite at http://www.webcitation.org/6neYJgysl) %M 28153815 %R 10.2196/mhealth.6893 %U http://mhealth.jmir.org/2017/2/e10/ %U https://doi.org/10.2196/mhealth.6893 %U http://www.ncbi.nlm.nih.gov/pubmed/28153815 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 1 %P e2 %T Assessing the Influence of a Fitbit Physical Activity Monitor on the Exercise Practices of Emergency Medicine Residents: A Pilot Study %A Schrager,Justin David %A Shayne,Philip %A Wolf,Sarah %A Das,Shamie %A Patzer,Rachel Elizabeth %A White,Melissa %A Heron,Sheryl %+ Department of Emergency Medicine, Emory University School of Medicine, Emory University Department of Emergency Medicine, 531 Asbury Circle, Annex Building N340, Atlanta, GA, 30322, United States, 1 404 778 2630, jschrag@emory.edu %K activity trackers %K personal fitness trackers %K physical fitness trackers %K medical residency %K wellness programs %K mobile health %D 2017 %7 31.01.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Targeted interventions have improved physical activity and wellness of medical residents. However, no exercise interventions have focused on emergency medicine residents. Objective: This study aimed to measure the effectiveness of a wearable device for tracking physical activity on the exercise habits and wellness of this population, while also measuring barriers to adoption and continued use. Methods: This pre-post cohort study enrolled 30 emergency medicine residents. Study duration was 6 months. Statistical comparisons were conducted for the primary end point and secondary exercise end points with nonparametric tests. Descriptive statistics were provided for subjective responses. Results: The physical activity tracker did not increase the overall self-reported median number of days of physical activity per week within this population: baseline 2.5 days (interquartile range, IQR, 1.9) versus 2.8 days (IQR 1.5) at 1 month (P=.36). There was a significant increase in physical activity from baseline to 1 month among residents with median weekly physical activity level below that recommended by the Centers for Disease Control and Prevention at study start, that is, 1.5 days (IQR 0.9) versus 2.4 days (IQR 1.2; P=.04), to 2.0 days (IQR 2.0; P=.04) at 6 months. More than half (60%, 18/30) of participants reported a benefit to their overall wellness, and 53% (16/30) reported a benefit to their physical activity. Overall continued use of the device was 67% (20/30) at 1 month and 33% (10/30) at 6 months. Conclusions: The wearable physical activity tracker did not change the overall physical activity levels among this population of emergency medicine residents. However, there was an improvement in physical activity among the residents with the lowest preintervention physical activity. Subjective improvements in overall wellness and physical activity were noted among the entire study population. %M 28143805 %R 10.2196/mhealth.6239 %U http://mhealth.jmir.org/2017/1/e2/ %U https://doi.org/10.2196/mhealth.6239 %U http://www.ncbi.nlm.nih.gov/pubmed/28143805 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 1 %P e5 %T A Smarter Pathway for Delivering Cue Exposure Therapy? The Design and Development of a Smartphone App Targeting Alcohol Use Disorder %A Mellentin,Angelina Isabella %A Stenager,Elsebeth %A Nielsen,Bent %A Nielsen,Anette Søgaard %A Yu,Fei %+ Unit of Clinical Alcohol Research, Unit of Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Department of Psychiatry, 220, Sdr Boulevard 29, Odense C, 5000, Denmark, 45 50517901, amellentin@health.sdu.dk %K alcohol use disorder %K exposure therapy %K mobile application %K smartphone %D 2017 %7 30.01.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although the number of alcohol-related treatments in app stores is proliferating, none of them are based on a psychological framework and supported by empirical evidence. Cue exposure treatment (CET) with urge-specific coping skills (USCS) is often used in Danish treatment settings. It is an evidence-based psychological approach that focuses on promoting “confrontation with alcohol cues” as a means of reducing urges and the likelihood of relapse. Objective: The objective of this study was to describe the design and development of a CET-based smartphone app; an innovative delivery pathway for treating alcohol use disorder (AUD). Methods: The treatment is based on Monty and coworkers’ manual for CET with USCS (2002). It was created by a multidisciplinary team of psychiatrists, psychologists, programmers, and graphic designers as well as patients with AUD. A database was developed for the purpose of registering and monitoring training activities. A final version of the CET app and database was developed after several user tests. Results: The final version of the CET app includes an introduction, 4 sessions featuring USCS, 8 alcohol exposure videos promoting the use of one of the USCS, and a results component providing an overview of training activities and potential progress. Real-time urges are measured before, during, and after exposure to alcohol cues and are registered in the app together with other training activity variables. Data packages are continuously sent in encrypted form to an external database and will be merged with other data (in an internal database) in the future. Conclusions: The CET smartphone app is currently being tested at a large-scale, randomized controlled trial with the aim of clarifying whether it can be classified as an evidence-based treatment solution. The app has the potential to augment the reach of psychological treatment for AUD. %M 28137701 %R 10.2196/mhealth.6500 %U http://mhealth.jmir.org/2017/1/e5/ %U https://doi.org/10.2196/mhealth.6500 %U http://www.ncbi.nlm.nih.gov/pubmed/28137701 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 1 %P e5 %T Assessing the Efficacy of an App-Based Method of Family Planning: The Dot Study Protocol %A Simmons,Rebecca G %A Shattuck,Dominick C %A Jennings,Victoria H %+ Institute for Reproductive Health, Georgetown University, 1825 Connecticut Avenue NW, Suite 699, Washington, DC,, United States, 1 202 687 9156, rebecca.simmons@georgetown.edu %K fertility %K fertility awareness %K family planning %K contraception %K natural family planning %K reproductive health %K mHealth %K mobile health apps %K study protocol %D 2017 %7 18.01.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Some 222 million women worldwide have unmet needs for contraception; they want to avoid pregnancy, but are not using a contraceptive method, primarily because of concerns about side effects associated with most available methods. Expanding contraceptive options—particularly fertility awareness options that provide women with information about which days during their menstrual cycles they are likely to become pregnant if they have unprotected intercourse—has the potential to reduce unmet need. Making these methods available to women through their mobile phones can facilitate access. Indeed, many fertility awareness applications have been developed for smartphones, some of which are digital platforms for existing methods, requiring women to enter information about fertility signs such as basal body temperature and cervical secretions. Others are algorithms based on (unexplained) calculations of the fertile period of the menstrual cycle. Considering particularly this latter (largely untested) group, it is critical that these apps be subject to the same rigorous research as other contraceptive methods. Dynamic Optimal Timing, available via the Dot app as a free download for iPhone and Android devices, is one such method and the only one that has published the algorithm that forms its basis. It combines historical cycle data with a woman’s own personal cycle history, continuing to accrue this information over time to identify her fertile period. While Dot has a theoretical failure rate of only 3 in 100 for preventing pregnancy with perfect use, its effectiveness in typical use has yet to be determined. Objective: The study objective is to assess both perfect and typical use to determine the efficacy of the Dot app for pregnancy prevention. Methods: To determine actual use efficacy, the Institute for Reproductive Health is partnering with Cycle Technologies, which developed the Dot app, to conduct a prospective efficacy trial, following 1200 women over the course of 13 menstrual cycles to assess pregnancy status over time. This paper outlines the protocol for this efficacy trial, following the Standard Protocol Items: Recommendations for Intervention Trials checklist, to provide an overview of the rationale, methodology, and analysis plan. Participants will be asked to provide daily sexual history data and periodically answer surveys administered through a call center or directly on their phone. Results: Funding for the study was provided in 2013 under the United States Agency for International Development Fertility Awareness for Community Transformation project. Recruitment for the study will begin in January of 2017. The study is expected to last approximately 18 months, depending on recruitment. Findings on the study’s primary outcomes are expected to be finalized by September 2018. Conclusions: Reproducibility and transparency, important aspects of all research, are particularly critical in developing new approaches to research design. This protocol outlines the first study to prospectively test both the efficacy (correct use) and effectiveness (actual use) of a pregnancy prevention app. This protocol and the processes it describes reflect the dynamic integration of mobile technologies, a call center, and Health Insurance Portability and Accountability Act–compliant study procedures. Future fertility app studies can build on our approaches to develop methodologies that can contribute to the evidence base around app-based methods of contraception. ClinicalTrial: ClinicalTrials.gov NCT02833922; https://clinicaltrials.gov/ct2/show/NCT02833922 (Archived be WebCite at http://www.webcitation.org/6nDkr0e76) %M 28100441 %R 10.2196/resprot.6886 %U http://www.researchprotocols.org/2017/1/e5/ %U https://doi.org/10.2196/resprot.6886 %U http://www.ncbi.nlm.nih.gov/pubmed/28100441 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 1 %P e10 %T IntelliCare: An Eclectic, Skills-Based App Suite for the Treatment of Depression and Anxiety %A Mohr,David C %A Tomasino,Kathryn Noth %A Lattie,Emily G %A Palac,Hannah L %A Kwasny,Mary J %A Weingardt,Kenneth %A Karr,Chris J %A Kaiser,Susan M %A Rossom,Rebecca C %A Bardsley,Leland R %A Caccamo,Lauren %A Stiles-Shields,Colleen %A Schueller,Stephen M %+ Center for Behavioral Intervention Technologies (CBITs), Department of Preventive Medicine, Northwestern University, 750 N Lakeshore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 312 503 1403, d-mohr@northwestern.edu %K mHealth %K eHealth %K mobile health %K depression %K anxiety %D 2017 %7 05.01.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital mental health tools have tended to use psychoeducational strategies based on treatment orientations developed and validated outside of digital health. These features do not map well to the brief but frequent ways that people use mobile phones and mobile phone apps today. To address these challenges, we developed a suite of apps for depression and anxiety called IntelliCare, each developed with a focused goal and interactional style. IntelliCare apps prioritize interactive skills training over education and are designed for frequent but short interactions. Objective: The overall objective of this study was to pilot a coach-assisted version of IntelliCare and evaluate its use and efficacy at reducing symptoms of depression and anxiety. Methods: Participants, recruited through a health care system, Web-based and community advertising, and clinical research registries, were included in this single-arm trial if they had elevated symptoms of depression or anxiety. Participants had access to the 14 IntelliCare apps from Google Play and received 8 weeks of coaching on the use of IntelliCare. Coaching included an initial phone call plus 2 or more texts per week over the 8 weeks, with some participants receiving an additional brief phone call. Primary outcomes included the Patient Health Questionnaire-9 (PHQ-9) for depression and the Generalized Anxiety Disorder-7 (GAD-7) for anxiety. Participants were compensated up to US $90 for completing all assessments; compensation was not for app use or treatment engagement. Results: Of the 99 participants who initiated treatment, 90.1% (90/99) completed 8 weeks. Participants showed substantial reductions in the PHQ-9 and GAD-7 (P<.001). Participants used the apps an average of 195.4 (SD 141) times over the 8 weeks. The average length of use was 1.1 (SD 2.1) minutes, and 95% of participants downloaded 5 or more of the IntelliCare apps. Conclusions: This study supports the IntelliCare framework of providing a suite of skills-focused apps that can be used frequently and briefly to reduce symptoms of depression and anxiety. The IntelliCare system is elemental, allowing individual apps to be used or not used based on their effectiveness and utility, and it is eclectic, viewing treatment strategies as elements that can be applied as needed rather than adhering to a singular, overarching, theoretical model. Trial Registration: Clinicaltrials.gov NCT02176226; http://clinicaltrials.gov/ct2/show/NCT02176226 (Archived by WebCite at http://www.webcitation/6mQZuBGk1) %M 28057609 %R 10.2196/jmir.6645 %U http://www.jmir.org/2017/1/e10/ %U https://doi.org/10.2196/jmir.6645 %U http://www.ncbi.nlm.nih.gov/pubmed/28057609 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e135 %T Smartphone Apps for Measuring Human Health and Climate Change Co-Benefits: A Comparison and Quality Rating of Available Apps %A Sullivan,Rachel K %A Marsh,Samantha %A Halvarsson,Jakob %A Holdsworth,Michelle %A Waterlander,Wilma %A Poelman,Maartje P %A Salmond,Jennifer Ann %A Christian,Hayley %A Koh,Lenny SC %A Cade,Janet E %A Spence,John C %A Woodward,Alistair %A Maddison,Ralph %+ Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000, Geelong, Victoria,, Australia, 61 3 52271100, ralph.maddison@deakin.edu.au %K climate change %K noncommunicable diseases %K smartphone apps %K travel %K diet %K greenhouse gas emissions %K carbon footprint %K individual %K behavior change %D 2016 %7 19.12.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Climate change and the burden of noncommunicable diseases are major global challenges. Opportunities exist to investigate health and climate change co-benefits through a shift from motorized to active transport (walking and cycling) and a shift in dietary patterns away from a globalized diet to reduced consumption of meat and energy dense foods. Given the ubiquitous use and proliferation of smartphone apps, an opportunity exists to use this technology to capture individual travel and dietary behavior and the associated impact on the environment and health. Objective: The objective of the study is to identify, describe the features, and rate the quality of existing smartphone apps which capture personal travel and dietary behavior and simultaneously estimate the carbon cost and potential health consequences of these actions. Methods: The Google Play and Apple App Stores were searched between October 19 and November 6, 2015, and a secondary Google search using the apps filter was conducted between August 8 and September 18, 2016. Eligible apps were required to estimate the carbon cost of personal behaviors with the potential to include features to maximize health outcomes. The quality of included apps was assessed by 2 researchers using the Mobile Application Rating Scale (MARS). Results: Out of 7213 results, 40 apps were identified and rated. Multiple travel-related apps were identified, however no apps solely focused on the carbon impact or health consequences of dietary behavior. None of the rated apps provided sufficient information on the health consequences of travel and dietary behavior. Some apps included features to maximize participant engagement and encourage behavior change towards reduced greenhouse gas emissions. Most apps were rated as acceptable quality as determined by the MARS; 1 was of poor quality and 10 apps were of good quality. Interrater reliability of the 2 evaluators was excellent (ICC=0.94, 95% CI 0.87-0.97). Conclusions: Existing apps capturing travel and dietary behavior and the associated health and environmental impact are of mixed quality. Most apps do not include all desirable features or provide sufficient health information. Further research is needed to determine the potential of smartphone apps to evoke behavior change resulting in climate change and health co-benefits. %M 27993762 %R 10.2196/mhealth.5931 %U http://mhealth.jmir.org/2016/4/e135/ %U https://doi.org/10.2196/mhealth.5931 %U http://www.ncbi.nlm.nih.gov/pubmed/27993762 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 12 %P e331 %T Short-Term Effectiveness of a Mobile Phone App for Increasing Physical Activity and Adherence to the Mediterranean Diet in Primary Care: A Randomized Controlled Trial (EVIDENT II Study) %A Recio-Rodriguez,Jose I %A Agudo-Conde,Cristina %A Martin-Cantera,Carlos %A González-Viejo,Mª Natividad %A Fernandez-Alonso,Mª Del Carmen %A Arietaleanizbeaskoa,Maria Soledad %A Schmolling-Guinovart,Yolanda %A Maderuelo-Fernandez,Jose-Angel %A Rodriguez-Sanchez,Emiliano %A Gomez-Marcos,Manuel A %A Garcia-Ortiz,Luis %A , %+ Biomedical Research Institute of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Castilla León Health Service, Av. Comuneros 37-31, Salamanca, 37003, Spain, 34 635542886, lgarciao@usal.es %K physical activity %K food %K information and communication technologies %K arterial aging %D 2016 %7 19.12.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of mobile phone apps for improving lifestyles has become generalized in the population, although little is still known about their effectiveness in improving health. Objective: We evaluate the effect of adding an app to standard counseling on increased physical activity (PA) and adherence to the Mediterranean diet, 3 months after implementation. Methods: A randomized, multicenter clinical trial was carried out. A total of 833 participants were recruited in six primary care centers in Spain through random sampling: 415 in the app+counseling group and 418 in the counseling only group. Counseling on PA and the Mediterranean diet was given to both groups. The app+counseling participants additionally received training in the use of an app designed to promote PA and the Mediterranean diet over a 3-month period. PA was measured with the 7-day Physical Activity Recall (PAR) questionnaire and an accelerometer; adherence to the Mediterranean diet was assessed using the Mediterranean Diet Adherence Screener questionnaire. Results: Participants were predominantly female in both the app+counseling (249/415, 60.0%) and counseling only (268/418, 64.1%) groups, with a mean age of 51.4 (SD 12.1) and 52.3 (SD 12.0) years, respectively. Leisure-time moderate-to-vigorous physical activity (MVPA) by 7-day PAR increased in the app+counseling (mean 29, 95% CI 5-53 min/week; P=.02) but not in the counseling only group (mean 17.4, 95% CI –18 to 53 min/week; P=.38). No differences in increase of activity were found between the two groups. The accelerometer recorded a decrease in PA after 3 months in both groups: MVPA mean –55.3 (95% CI –75.8 to –34.9) min/week in app+counseling group and mean –30.1 (95% CI –51.8 to –8.4) min/week in counseling only group. Adherence to the Mediterranean diet increased in both groups (8.4% in app+counseling and 10.4% in counseling only group), with an increase in score of 0.42 and 0.53 points, respectively (P<.001), but no difference between groups (P=.86). Conclusions: Leisure-time MVPA increased more in the app+counseling than counseling only group, although no difference was found when comparing the increase between the two groups. Counseling accompanied by printed materials appears to be effective in improving adherence to the Mediterranean diet, although the app does not increase adherence. ClinicalTrial: Clinicaltrials.gov NCT02016014; https://clinicaltrials.gov/ct2/show/NCT02016014 (Archived by WebCite at http://www.webcitation.org/6mnopADbf) %M 27993759 %R 10.2196/jmir.6814 %U http://www.jmir.org/2016/12/e331/ %U https://doi.org/10.2196/jmir.6814 %U http://www.ncbi.nlm.nih.gov/pubmed/27993759 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e136 %T Patient-Facing Mobile Apps to Treat High-Need, High-Cost Populations: A Scoping Review %A Singh,Karandeep %A Drouin,Kaitlin %A Newmark,Lisa P %A Filkins,Malina %A Silvers,Elizabeth %A Bain,Paul A %A Zulman,Donna M %A Lee,Jae-Ho %A Rozenblum,Ronen %A Pabo,Erika %A Landman,Adam %A Klinger,Elissa V %A Bates,David W %+ Departments of Learning Health Sciences and Internal Medicine, University of Michigan Medical School, 1161H NIB, 300 N Ingalls St, Ann Arbor, MI, 48109-5403, United States, 1 734 936 1649, kdpsingh@umich.edu %K review %K mobile apps %K mHealth %K chronic disease %K self-management %D 2016 %7 19.12.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Self-management is essential to caring for high-need, high-cost (HNHC) populations. Advances in mobile phone technology coupled with increased availability and adoption of health-focused mobile apps have made self-management more achievable, but the extent and quality of the literature supporting their use is not well defined. Objective: The purpose of this review was to assess the breadth, quality, bias, and types of outcomes measured in the literature supporting the use of apps targeting HNHC populations. Methods: Data sources included articles in PubMed and MEDLINE (National Center for Biotechnology Information), EMBASE (Elsevier), the Cochrane Central Register of Controlled Trials (EBSCO), Web of Science (Thomson Reuters), and the NTIS (National Technical Information Service) Bibliographic Database (EBSCO) published since 2008. We selected studies involving use of patient-facing iOS or Android mobile health apps. Extraction was performed by 1 reviewer; 40 randomly selected articles were evaluated by 2 reviewers to assess agreement. Results: Our final analysis included 175 studies. The populations most commonly targeted by apps included patients with obesity, physical handicaps, diabetes, older age, and dementia. Only 30.3% (53/175) of the apps studied in the reviewed literature were identifiable and available to the public through app stores. Many of the studies were cross-sectional analyses (42.9%, 75/175), small (median number of participants=31, interquartile range 11.0-207.2, maximum 11,690), or performed by an app’s developers (61.1%, 107/175). Of the 175 studies, only 36 (20.6%, 36/175) studies evaluated a clinical outcome. Conclusions: Most apps described in the literature could not be located on the iOS or Android app stores, and existing research does not robustly evaluate the potential of mobile apps. Whereas apps may be useful in patients with chronic conditions, data do not support this yet. Although we had 2-3 reviewers to screen and assess abstract eligibility, only 1 reviewer abstracted the data. This is one limitation of our study. With respect to the 40 articles (22.9%, 40/175) that were assigned to 2 reviewers (of which 3 articles were excluded), inter-rater agreement was significant on the majority of items (17 of 30) but fair-to-moderate on others. %M 27993761 %R 10.2196/mhealth.6445 %U http://mhealth.jmir.org/2016/4/e136/ %U https://doi.org/10.2196/mhealth.6445 %U http://www.ncbi.nlm.nih.gov/pubmed/27993761 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 2 %N 1 %P e1 %T Can a Free Wearable Activity Tracker Change Behavior? The Impact of Trackers on Adults in a Physician-Led Wellness Group %A Gualtieri,Lisa %A Rosenbluth,Sandra %A Phillips,Jeffrey %+ Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, United States, 1 617 636 0438, lisa.gualtieri@tufts.edu %K wearable activity trackers %K fitness trackers %K trackers %K physical activity %K chronic disease %K behavior change %K wellness group %K wellness %K older adults %K digital health %D 2016 %7 15.12.2016 %9 Poster %J iproc %G English %X Background: Wearable activity trackers (trackers) are increasingly popular devices used to track step count and other health indicators. Trackers have the potential to benefit those in need of increased physical activity, such as adults who are older and who face significant health challenges. These populations are least likely to purchase trackers and most likely to face challenges in using them, yet may derive educational, motivational, and health benefits from their use once these barriers are removed. Objective: The aim of this research was to investigate the use of trackers by older adults with chronic medical conditions who had never used trackers previously. Our primary research questions were (1) if participants would accept and use trackers to increase their physical activity; (2) if there were barriers to use besides cost and training; (3) if trackers would educate participants on their baseline and ongoing activity levels and support behavior change; and (4) if clinical outcomes would show improvements in participants’ health. Methods: This study was conducted with 10 patients in a 12 week physician-led wellness group offered by Family Doctors, LLC. Patients were given trackers in the second week of the wellness group and were interviewed 2-4 weeks after it ended. The study investigators analyzed the interview notes to extract themes about the participants’ attitudes and behavior changes and collected and analyzed participants’ clinical data, including weight and LDL-Cholesterol (LDL), over the course of the study. Results: Over the 12-14 weeks of tracker use, improvements were seen in clinical outcomes, attitudes towards the trackers, and physical activity behaviors. Participants lost an average of a half-pound per week (SD=0.408), with a mean total weight loss of 5.97 pounds (P=.0038). Other short-term clinical outcomes included a 9.2% decrease in LDL levels (P=.0377). All participants reported an increase in well-being and confidence in their ability to lead more active lives. We identified 6 major attitudinal themes from our qualitative analysis of the interview notes: (1) barriers to tracker purchase included cost, perceived value, and choice confusion; (2) attitudes towards the trackers shifted for many, from half of the participants expressing excitement and hope and half expressing hesitation or trepidation, to all participants feeling positive towards their tracker at the time of the interviews; (3) trackers served as educational tools for baseline activity levels; (4) trackers provided concrete feedback on physical activity, which motivated behavior change; (5) tracker use reinforced wellness group activities and goals; and (6) although commitment to tracker use did not waver, external circumstances influenced some participants’ ongoing use. Conclusions: Our findings suggest that adding trackers to wellness groups comprising older adults with chronic medical conditions can support education and behavior change to be more physically active. The trackers increased participant self-efficacy by providing a tangible, visible reminder of a commitment to increasing activity and immediate feedback on step count and progress towards a daily step goal. While acceptance was high and attitudes ultimately positive, training and support are needed and short-term drop-off in participant use is to be expected. Future research will further consider the potential of trackers in older adults with chronic medical conditions who are unlikely to purchase them, and studies will use larger samples, continue over a longer period of time, and evaluate outcomes independent of a wellness group. %R 10.2196/iproc.6245 %U http://www.iproc.org/2016/1/e1/ %U https://doi.org/10.2196/iproc.6245 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 4 %P e52 %T Creating Live Interactions to Mitigate Barriers (CLIMB): A Mobile Intervention to Improve Social Functioning in People With Chronic Psychotic Disorders %A Biagianti,Bruno %A Schlosser,Danielle %A Nahum,Mor %A Woolley,Josh %A Vinogradov,Sophia %+ Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue LP-253, San Francisco, CA, 94143, United States, 1 4152902122, bruno.biagianti@ucsf.edu %K psychosis %K social cognition %K digital health %K mobile health %D 2016 %7 13.12.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: Numerous psychosocial interventions for individuals with chronic psychotic disorders (CPD) have shown positive effects on social cognitive and functional outcome measures. However, access to and engagement with these interventions remains limited. This is partly because these interventions require specially trained therapists, are not available in all clinical settings, and have a high scheduling burden for participants, usually requiring a commitment of several weeks. Delivering interventions remotely via mobile devices may facilitate access, improve scheduling flexibility, and decrease participant burden, thus improving adherence to intervention requirements. To address these needs, we designed the Creating Live Interactions to Mitigate Barriers (CLIMB) digital intervention, which aims to enhance social functioning in people with CPD. CLIMB consists of two treatment components: a computerized social cognition training (SCT) program and optimized remote group therapy (ORGT). ORGT is an innovative treatment that combines remote group therapy with group texting (short message service, SMS). Objectives: The objectives of this single-arm study were to investigate the feasibility of delivering 6 weeks of CLIMB to people with CPD and explore the initial effects on outcomes. Methods: Participants were recruited, screened and enrolled via the Internet, and delivered assessments and interventions remotely using provided tablets (iPads). Participants were asked to complete 18 hours of SCT and to attend 6 remote group therapy sessions. To assess feasibility, adherence to study procedures, attrition rates, engagement metrics, and acceptability of the intervention were evaluated. Changes on measures of social cognition, quality of life, and symptoms were also explored. Results: In total, 27 participants were enrolled over 12 months. Remote assessments were completed successfully on 96% (26/27) of the enrolled participants. Retention in the 6-week trial was 78% (21/27). Of all the iPads used, 95% (22/23) were returned undamaged at the end of the intervention. Participants on average attended 84% of the group therapy sessions, completed a median of 9.5 hours of SCT, and posted a median of 5.2 messages per week on the group text chat. Participants rated CLIMB in the medium range in usability, acceptability, enjoyment, and perceived benefit. Participants showed significant improvements in emotion identification abilities for prosodic happiness (P=.001), prosodic happiness intensity (P=.04), and facial anger (P=.04), with large within-group effect sizes (d=.60 to d=.86). Trend-level improvements were observed on aspects of quality of life (P values less than .09). No improvements were observed for symptoms. Conclusions: It is feasible and acceptable to remotely deliver an intervention aimed at enhancing social functioning in people with CPD using mobile devices. This approach may represent a scalable method to increase treatment access and adherence. Our pilot data also demonstrate within-group gains in some aspects of social cognition after 6 weeks of CLIMB. Future randomized controlled studies in larger samples should evaluate the extent to which CLIMB significantly improves social cognition, symptoms, and quality of life in CPD. %M 27965190 %R 10.2196/mental.6671 %U http://mental.jmir.org/2016/4/e52/ %U https://doi.org/10.2196/mental.6671 %U http://www.ncbi.nlm.nih.gov/pubmed/27965190 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 1 %N 2 %P e5 %T DiaFit: The Development of a Smart App for Patients with Type 2 Diabetes and Obesity %A Modave,François %A Bian,Jiang %A Rosenberg,Eric %A Mendoza,Tonatiuh %A Liang,Zhan %A Bhosale,Ravi %A Maeztu,Carlos %A Rodriguez,Camila %A Cardel,Michelle I %+ Department of Health Outcomes and Policy, University of Florida, 2004 Mowry road, CTRB 3217, Gainesville, FL, 32610, United States, 1 3522945984, modavefp@ufl.edu %K mHealth %K diabetes %K obesity %K apps %D 2016 %7 13.12.2016 %9 Original Paper %J JMIR Diabetes %G English %X Background: Optimal management of chronic diseases, such as type 2 diabetes (T2D) and obesity, requires patient-provider communication and proactive self-management from the patient. Mobile apps could be an effective strategy for improving patient-provider communication and provide resources for self-management to patients themselves. Objective: The objective of this paper is to describe the development of a mobile tool for patients with T2D and obesity that utilizes an integrative approach to facilitate patient-centered app development, with patient and physician interfaces. Our implementation strategy focused on the building of a multidisciplinary team to create a user-friendly and evidence-based app, to be used by patients in a home setting or at the point-of-care. Methods: We present the iterative design, development, and testing of DiaFit, an app designed to improve the self-management of T2D and obesity, using an adapted Agile approach to software implementation. The production team consisted of experts in mobile health, nutrition sciences, and obesity; software engineers; and clinicians. Additionally, the team included citizen scientists and clinicians who acted as the de facto software clients for DiaFit and therefore interacted with the production team throughout the entire app creation, from design to testing. Results: DiaFit (version 1.0) is an open-source, inclusive iOS app that incorporates nutrition data, physical activity data, and medication and glucose values, as well as patient-reported outcomes. DiaFit supports the uploading of data from sensory devices via Bluetooth for physical activity (iOS step counts, FitBit, Apple watch) and glucose monitoring (iHealth glucose meter). The app provides summary statistics and graphics for step counts, dietary information, and glucose values that can be used by patients and their providers to make informed health decisions. The DiaFit iOS app was developed in Swift (version 2.2) with a Web back-end deployed on the Health Insurance Portability and Accountability Act compliant-ready Amazon Web Services cloud computing platform. DiaFit is publicly available on GitHub to the diabetes community at large, under the GNU General Public License agreement. Conclusions: Given the proliferation of health-related apps available to health consumers, it is essential to ensure that apps are evidence-based and user-oriented, with specific health conditions in mind. To this end, we have used a software development approach focusing on community and clinical engagement to create DiaFit, an app that assists patients with T2D and obesity to better manage their health through active communication with their providers and proactive self-management of their diseases. %M 29388609 %R 10.2196/diabetes.6662 %U http://diabetes.jmir.org/2016/2/e5/ %U https://doi.org/10.2196/diabetes.6662 %U http://www.ncbi.nlm.nih.gov/pubmed/29388609 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 12 %P e321 %T An Ecological Momentary Intervention for Smoking Cessation: Evaluation of Feasibility and Effectiveness %A Businelle,Michael S %A Ma,Ping %A Kendzor,Darla E %A Frank,Summer G %A Vidrine,Damon J %A Wetter,David W %+ Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 405 271 8001 ext 50460, michael-businelle@ouhsc.edu %K smartphone %K mobile applications %K smoking cessation %K low income population %D 2016 %7 12.12.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite substantial public health progress in reducing the prevalence of smoking in the United States overall, smoking among socioeconomically disadvantaged adults remains high. Objective: To determine the feasibility and preliminary effectiveness of a novel smartphone-based smoking cessation app designed for socioeconomically disadvantaged smokers. Methods: Participants were recruited from a safety-net hospital smoking cessation clinic in Dallas, Texas, and were followed for 13 weeks. All participants received standard smoking cessation clinic care (ie, group counseling and cessation pharmacotherapy) and a smartphone with a novel smoking cessation app (ie, Smart-T). The Smart-T app prompted 5 daily ecological momentary assessments (EMAs) for 3 weeks (ie, 1 week before cessation and 2 weeks after cessation). During the precessation period, EMAs were followed by messages that focused on planning and preparing for the quit attempt. During the postcessation period, participant responses to EMAs drove an algorithm that tailored messages to the current level of smoking lapse risk and currently present lapse triggers (eg, urge to smoke, stress). Smart-T offered additional intervention features on demand (eg, one-click access to the tobacco cessation quitline; “Quit Tips” on coping with urges to smoke, mood, and stress). Results: Participants (N=59) were 52.0 (SD 7.0) years old, 54% (32/59) female, and 53% (31/59) African American, and 70% (40/57) had annual household income less than US $16,000. Participants smoked 20.3 (SD 11.6) cigarettes per day and had been smoking for 31.6 (SD 10.9) years. Twelve weeks after the scheduled quit date, 20% (12/59) of all participants were biochemically confirmed abstinent. Participants responded to 87% of all prompted EMAs and received approximately 102 treatment messages over the 3-week EMA period. Most participants (83%, 49/59) used the on-demand app features. Individuals with greater nicotine dependence and minority race used the Quit Tips feature more than their counterparts. Greater use of the Quit Tips feature was linked to nonabstinence at the 2 (P=.02), 4 (P<.01), and 12 (P=.03) week follow-up visits. Most participants reported that they actually used or implemented the tailored app-generated messages and suggestions (83%, 49/59); the app-generated messages were helpful (97%, 57/59); they would like to use the app in the future if they were to lapse (97%, 57/59); and they would like to refer friends who smoke to use the Smart-T app (85%, 50/59). A minority of participants (15%, 9/59) reported that the number of daily assessments (ie, 5) was “too high.” Conclusions: This novel just-in-time adaptive intervention delivered an intensive intervention (ie, 102 messages over a 3-week period), was well-liked, and was perceived as helpful and useful by socioeconomically disadvantaged adults who were seeking smoking cessation treatment. Smartphone apps may be used to increase treatment exposure and may ultimately reduce tobacco-related health disparities among socioeconomically disadvantaged adults. %M 27956375 %R 10.2196/jmir.6058 %U http://www.jmir.org/2016/12/e321/ %U https://doi.org/10.2196/jmir.6058 %U http://www.ncbi.nlm.nih.gov/pubmed/27956375 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 12 %P e315 %T Influence of Pokémon Go on Physical Activity: Study and Implications %A Althoff,Tim %A White,Ryen W %A Horvitz,Eric %+ Computer Science Department, Stanford University, 94 Thoburn Ct., Apt 108, Stanford, CA, 94305, United States, 1 6504850758, althoff@cs.stanford.edu %K physical activity %K Pokémon Go %K mobile health %K mHealth %K wearable devices %K mobile applications %K games %K exergames %K public health %D 2016 %7 06.12.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Physical activity helps people maintain a healthy weight and reduces the risk for several chronic diseases. Although this knowledge is widely recognized, adults and children in many countries around the world do not get recommended amounts of physical activity. Although many interventions are found to be ineffective at increasing physical activity or reaching inactive populations, there have been anecdotal reports of increased physical activity due to novel mobile games that embed game play in the physical world. The most recent and salient example of such a game is Pokémon Go, which has reportedly reached tens of millions of users in the United States and worldwide. Objective: The objective of this study was to quantify the impact of Pokémon Go on physical activity. Methods: We study the effect of Pokémon Go on physical activity through a combination of signals from large-scale corpora of wearable sensor data and search engine logs for 32,000 Microsoft Band users over a period of 3 months. Pokémon Go players are identified through search engine queries and physical activity is measured through accelerometers. Results: We find that Pokémon Go leads to significant increases in physical activity over a period of 30 days, with particularly engaged users (ie, those making multiple search queries for details about game usage) increasing their activity by 1473 steps a day on average, a more than 25% increase compared with their prior activity level (P<.001). In the short time span of the study, we estimate that Pokémon Go has added a total of 144 billion steps to US physical activity. Furthermore, Pokémon Go has been able to increase physical activity across men and women of all ages, weight status, and prior activity levels showing this form of game leads to increases in physical activity with significant implications for public health. In particular, we find that Pokémon Go is able to reach low activity populations, whereas all 4 leading mobile health apps studied in this work largely draw from an already very active population. Conclusions: Mobile apps combining game play with physical activity lead to substantial short-term activity increases and, in contrast to many existing interventions and mobile health apps, have the potential to reach activity-poor populations. Future studies are needed to investigate potential long-term effects of these applications. %M 27923778 %R 10.2196/jmir.6759 %U http://www.jmir.org/2016/12/e315/ %U https://doi.org/10.2196/jmir.6759 %U http://www.ncbi.nlm.nih.gov/pubmed/27923778 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 12 %P e316 %T An eHealth Project on Invasive Pneumococcal Disease: Comprehensive Evaluation of a Promotional Campaign %A Panatto,Donatella %A Domnich,Alexander %A Gasparini,Roberto %A Bonanni,Paolo %A Icardi,Giancarlo %A Amicizia,Daniela %A Arata,Lucia %A Carozzo,Stefano %A Signori,Alessio %A Bechini,Angela %A Boccalini,Sara %+ Department of Health Sciences, University of Genoa, Via Pastore, 1, Genoa, 16132, Italy, 39 0103538109, panatto@unige.it %K invasive pneumococcal disease %K pneumococcus %K eHealth %K mHealth %K mobile app %D 2016 %7 02.12.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The recently launched Pneumo Rischio eHealth project, which consists of an app, a website, and social networking activity, is aimed at increasing public awareness of invasive pneumococcal disease (IPD). The launch of this project was prompted by the inadequate awareness of IPD among both laypeople and health care workers, the heavy socioeconomic burden of IPD, and the far from optimal vaccination coverage in Italy, despite the availability of safe and effective vaccines. Objective: The objectives of our study were to analyze trends in Pneumo Rischio usage before and after a promotional campaign, to characterize its end users, and to assess its user-rated quality. Methods: At 7 months after launching Pneumo Rischio, we established a 4-month marketing campaign to promote the project. This intervention used various approaches and channels, including both traditional and digital marketing strategies. To highlight usage trends, we used different techniques of time series analysis and modeling, including a modified Mann-Kendall test, change-point detection, and segmented negative binomial regression of interrupted time series. Users were characterized in terms of demographics and IPD risk categories. Customer-rated quality was evaluated by means of a standardized tool in a sample of app users. Results: Over 1 year, the app was accessed by 9295 users and the website was accessed by 143,993 users, while the project’s Facebook page had 1216 fans. The promotional intervention was highly effective in increasing the daily number of users. In particular, the Mann-Kendall trend test revealed a significant (P ≤.01) increasing trend in both app and website users, while change-point detection analysis showed that the first significant change corresponded to the start of the promotional campaign. Regression analysis showed a significant immediate effect of the intervention, with a mean increase in daily numbers of users of 1562% (95% CI 456%-4870%) for the app and 620% (95% CI 176%-1777%) for the website. Similarly, the postintervention daily trend in the number of users was positive, with a relative increase of 0.9% (95% CI 0.0%-1.8%) for the app and 1.4% (95% CI 0.7%-2.1%) for the website. Demographics differed between app and website users and Facebook fans. A total of 69.15% (10,793/15,608) of users could be defined as being at risk of IPD, while 4729 users expressed intentions to ask their doctor for further information on IPD. The mean app quality score assigned by end users was approximately 79.5% (397/500). Conclusions: Despite its specific topic, Pneumo Rischio was accessed by a considerable number of users, who ranked it as a high-quality project. In order to reach their target populations, however, such projects should be promoted. %M 27913372 %R 10.2196/jmir.6205 %U http://www.jmir.org/2016/12/e316/ %U https://doi.org/10.2196/jmir.6205 %U http://www.ncbi.nlm.nih.gov/pubmed/27913372 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 4 %N 2 %P e19 %T Quittr: The Design of a Video Game to Support Smoking Cessation %A Bindoff,Ivan %A de Salas,Kristy %A Peterson,Gregory %A Ling,Tristan %A Lewis,Ian %A Wells,Lindsay %A Gee,Peter %A Ferguson,Stuart G %+ University of Tasmania, Private Bag 87, Hobart, 7001, Australia, 61 3 62266220, Kristy.deSalas@utas.edu.au %K smoking cessation %K video games %K mobile phone %K motivation %D 2016 %7 01.12.2016 %9 Original Paper %J JMIR Serious Games %G English %X Background: Smoking is recognized as the largest, single, preventable cause of death and disease in the developed world. While the majority of smokers report wanting to quit, and many try each year, smokers find it difficult to maintain long-term abstinence. Behavioral support, such as education, advice, goal-setting, and encouragement, is known to be beneficial in improving the likelihood of succeeding in a quit attempt, but it remains difficult to effectively deliver this behavioral support and keep the patient engaged with the process for a sufficient duration. In an attempt to solve this, there have been numerous mobile apps developed, yet engagement and retention have remained key challenges that limit the potential effectiveness of these interventions. Video games have been clearly linked with the effective delivery of health interventions, due to their capacity to increase motivation and engagement of players. Objective: The objective of this study is to describe the design and development of a smartphone app that is theory-driven, and which incorporates gaming characteristics in order to promote engagement with content, and thereby help smokers to quit. Methods: Game design and development was informed by a taxonomy of motivational affordances for meaningful gamified and persuasive technologies. This taxonomy describes a set of design components that is grounded in well-established psychological theories on motivation. Results: This paper reports on the design and development process of Quittr, a mobile app, describing how game design principles, game mechanics, and game elements can be used to embed education and support content, such that the app actually requires the user to access and engage with relevant educational content. The next stage of this research is to conduct a randomized controlled trial to determine whether the additional incentivization game features offer any value in terms of the key metrics of engagement–how much content users are consuming, how many days users are persisting with using the app, and what proportion of users successfully abstain from smoking for 28 days, based on user-reported data and verified against a biochemical baseline using cotinine tests. Conclusions: We describe a novel, and theoretically-informed mobile app design approach that has a broad range of potential applications. By using the virtual currency approach, we remove the need for the game to comprehensively integrate the healthy activity as part of its actual play mechanics. This opens up the potential for a wide variety of health problems to be tackled through games where no obvious play mechanic presents itself. The implications of this app are that similar approaches may be of benefit in areas such as managing chronic conditions (diabetes, heart disease, etc), treating substance abuse (alcohol, illicit drugs, etc), diet and exercise, eating disorders (anorexia, bulimia, and binge eating), and various phobias. %M 27908844 %R 10.2196/games.6258 %U http://games.jmir.org/2016/2/e19/ %U https://doi.org/10.2196/games.6258 %U http://www.ncbi.nlm.nih.gov/pubmed/27908844 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 4 %P e237 %T Can a Free Wearable Activity Tracker Change Behavior? The Impact of Trackers on Adults in a Physician-Led Wellness Group %A Gualtieri,Lisa %A Rosenbluth,Sandra %A Phillips,Jeffrey %+ Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, United States, 1 617 636 0438, lisa.gualtieri@tufts.edu %K wearable activity trackers %K fitness trackers %K trackers %K physical activity %K chronic disease %K behavior change %K wellness group %K wellness %K older adults %K digital health %D 2016 %7 30.11.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Wearable activity trackers (trackers) are increasingly popular devices used to track step count and other health indicators. Trackers have the potential to benefit those in need of increased physical activity, such as adults who are older and face significant health challenges. These populations are least likely to purchase trackers and most likely to face challenges in using them, yet may derive educational, motivational, and health benefits from their use once these barriers are removed. Objective: The aim of this pilot research is to investigate the use of trackers by adults with chronic medical conditions who have never used trackers previously. Specifically, we aim to determine (1) if participants would accept and use trackers to increase their physical activity; (2) if there were barriers to use besides cost and training; (3) if trackers would educate participants on their baseline and ongoing activity levels and support behavior change; and (4) if clinical outcomes would show improvements in participants’ health. Methods: This study was conducted with patients (N=10) in a 12-week physician-led wellness group offered by Family Doctors, LLC. Patients were given trackers in the second week of The Wellness Group and were interviewed 2 to 4 weeks after it ended. The study investigators analyzed the interview notes to extract themes about the participants’ attitudes and behavior changes and collected and analyzed participants’ clinical data, including weight and low-density lipoprotein (LDL) cholesterol over the course of the study. Results: Over the 12 to 14 weeks of tracker use, improvements were seen in clinical outcomes, attitudes towards the trackers, and physical activity behaviors. Participants lost an average of 0.5 lbs per week (SD 0.4), with a mean total weight loss of 5.97 lbs (P=.004). Other short-term clinical outcomes included a 9.2% decrease in LDL levels (P=.038). All participants reported an increase in well-being and confidence in their ability to lead more active lives. We identified the following 6 major attitudinal themes from our qualitative analysis of the interview notes: (1) barriers to tracker purchase included cost, perceived value, and choice confusion; (2) attitudes towards the trackers shifted for many, from half of the participants expressing excitement and hope and half expressing hesitation or trepidation, to all participants feeling positive towards their tracker at the time of the interviews; (3) trackers served as educational tools for baseline activity levels; (4) trackers provided concrete feedback on physical activity, which motivated behavior change; (5) tracker use reinforced wellness group activities and goals; and (6) although commitment to tracker use did not waver, external circumstances influenced some participants’ ongoing use. Conclusions: Our findings suggest that adding trackers to wellness groups comprising primarily older adults with chronic medical conditions can support education and behavior change to be more physically active. The trackers increased participant self-efficacy by providing a tangible, visible reminder of a commitment to increasing activity and immediate feedback on step count and progress towards a daily step goal. While acceptance was high and attitudes ultimately positive, training and support are needed and short-term drop-off in participant use is to be expected. Future research will further consider the potential of trackers in older adults with chronic medical conditions who are unlikely to purchase them, and studies will use larger samples, continue over a longer period of time, and evaluate outcomes independent of a wellness group. %M 27903490 %R 10.2196/resprot.6534 %U http://www.researchprotocols.org/2016/4/e237/ %U https://doi.org/10.2196/resprot.6534 %U http://www.ncbi.nlm.nih.gov/pubmed/27903490 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 4 %P e49 %T Development of a Mobile Phone App to Support Self-Monitoring of Emotional Well-Being: A Mental Health Digital Innovation %A Rickard,Nikki %A Arjmand,Hussain-Abdulah %A Bakker,David %A Seabrook,Elizabeth %+ Emotion and Well-being Research Unit, School of Psychological Sciences, Monash University, Building 18, Wellington Rd, Clayton, 3800, Australia, 61 400 191 768, nikki.rickard@monash.edu %K eHealth %K emotions %K mental health %K mobile phone %K feedback %D 2016 %7 23.11.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: Emotional well-being is a primary component of mental health and well-being. Monitoring changes in emotional state daily over extended periods is, however, difficult using traditional methodologies. Providing mental health support is also challenging when approximately only 1 in 2 people with mental health issues seek professional help. Mobile phone technology offers a sustainable means of enhancing self-management of emotional well-being. Objective: This paper aims to describe the development of a mobile phone tool designed to monitor emotional changes in a natural everyday context and in real time. Methods: This evidence-informed mobile phone app monitors emotional mental health and well-being, and it provides links to mental health organization websites and resources. The app obtains data via self-report psychological questionnaires, experience sampling methodology (ESM), and automated behavioral data collection. Results: Feedback from 11 individuals (age range 16-52 years; 4 males, 7 females), who tested the app over 30 days, confirmed via survey and focus group methods that the app was functional and usable. Conclusions: Recommendations for future researchers and developers of mental health apps to be used for research are also presented. The methodology described in this paper offers a powerful tool for a range of potential mental health research studies and provides a valuable standard against which development of future mental health apps should be considered. %M 27881358 %R 10.2196/mental.6202 %U http://mental.jmir.org/2016/4/e49/ %U https://doi.org/10.2196/mental.6202 %U http://www.ncbi.nlm.nih.gov/pubmed/27881358 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 4 %P e224 %T Efficacy of Mobile Serious Games in Increasing HIV Risk Perception in Swaziland: A Randomized Control Trial (SGprev Trial) Research Protocol %A Lukhele,Bhekumusa Wellington %A Musumari,Patou %A El-Saaidi,Christina %A Techasrivichien,Teeranee %A Suguimoto,S. Pilar %A Ono Kihara,Masako %A Kihara,Masahiro %+ Department of Global Health and Socio Epidemiology, Frontier Laboratory Bldg, 2nd Fl., Kyoto University School of Public Health Yoshida Konoe-cho, Sakyo-ku, Kyoto, 6068501, Japan, 81 757534350 ext 4350, bhekumusa.lukhele.36x@st.kyoto-u.ac.jp %K eHealth %K mHealth %K gamification %K Internet %K HIV prevention %K innovation %D 2016 %7 22.11.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: The human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) continue to be a major public health problem in Sub-Saharan Africa (SSA), particularly in Swaziland, which has the highest HIV prevalence in this region. A wide range of strategies and interventions have been used to promote behavior change, though almost all such interventions have involved mass media. Therefore, innovative behavior change strategies beyond mass media communication are urgently needed. Serious games have demonstrated effectiveness in advancing health in the developed world; however, no rigorous serious games interventions have been implemented in HIV prevention in SSA. Objective: We plan to test whether a serious game intervention delivered on mobile phones to increase HIV risk perception, increase intention to reduce sexual partnerships, and increase intention to know own and partners HIV status will be more effective compared with current prevention efforts. Methods: This is a two-arm randomized intervention trial. We will recruit 380 participants who meet the following eligibility criteria: 18-29 years of age, own a smartphone running an Android-based operating system, have the WhatsApp messaging app, live in Swaziland, and can adequately grant informed consent. Participants will be allocated into a smartphone interactive, educational story game, and a wait-list control group in a 1:1 allocation ratio. Subsequently, a self-administered Web-based questionnaire will be issued at baseline and after 4 weeks of exposure to the game. We hypothesize that the change in HIV risk perception between pre- and post-intervention assessment is greater in the intervention group compared with the change in the control group. Our primary hypothesis is based on the assumption that increased perceived risk of HIV provides cues to engage in protective behavior. Our primary outcome measure is HIV risk perceived mean change between pre- and post-intervention compared with the mean change in the wait-list control group at 4-weeks post-intervention. We will use standardized regression coefficients to calculate the effect of the intervention on our primary outcome with P values. We will conduct both intention to treat and as treated analysis. Results: This study is funded by Hayao Nakayama Foundation for Science & Technology and Culture; Grant number H26-A2-41. The research and development approval has been obtained from Kyoto University Graduate School and Faculty of Medicine Ethics Committee, Japan, and Swaziland’s Ministry of Health Ethics and Scientific committee. Results are expected in February 2017. Conclusions: This study will provide evidence on the efficiency of a mobile phone interactive game in increasing HIV risk perception in Swaziland. Our findings may also be generalizable to similar settings in SSA. Trial Registration: University Hospital Medical Information Network Clinical Trial Registry ID number (UMIN-CTR):UMIN000021781; URL:https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000025103 (Archived by WebCite at http://www.webcitation.org/6hOphB11a). %M 27876685 %R 10.2196/resprot.6543 %U http://www.researchprotocols.org/2016/4/e224/ %U https://doi.org/10.2196/resprot.6543 %U http://www.ncbi.nlm.nih.gov/pubmed/27876685 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 11 %P e307 %T Text to Move: A Randomized Controlled Trial of a Text-Messaging Program to Improve Physical Activity Behaviors in Patients With Type 2 Diabetes Mellitus %A Agboola,Stephen %A Jethwani,Kamal %A Lopez,Lenny %A Searl,Meghan %A O’Keefe,Sandra %A Kvedar,Joseph %+ Partners Connected Health, Suite 300, 25 New Chardon St, Boston, MA, 02114, United States, 1 617 643 0291, sagboola@partners.org %K type 2 diabetes %K text messaging %K mobile phones %K physical activity %K engagement %K pedometers %D 2016 %7 18.11.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Text messages are increasingly being used because of the low cost and the ubiquitous nature of mobile phones to engage patients in self-care behaviors. Self-care is particularly important in achieving treatment outcomes in type 2 diabetes mellitus (T2DM). Objective: This study examined the effect of personalized text messages on physical activity, as measured by a pedometer, and clinical outcomes in a diverse population of patients with T2DM. Methods: Text to Move (TTM) incorporates physical activity monitoring and coaching to provide automated and personalized text messages to help patients with T2DM achieve their physical activity goals. A total of 126 English- or Spanish-speaking patients with glycated hemoglobin A1c (HbA1c) >7 were enrolled in-person to participate in the study for 6 months and were randomized into either the intervention arm that received the full complement of the intervention or a control arm that received only pedometers. The primary outcome was change in physical activity. We also assessed the effect of the intervention on HbA1c, weight, and participant engagement. Results: All participants (intervention: n=64; control: n=62) were included in the analyses. The intervention group had significantly higher monthly step counts in the third (risk ratio [RR] 4.89, 95% CI 1.20 to 19.92, P=.03) and fourth (RR 6.88, 95% CI 1.21 to 39.00, P=.03) months of the study compared to the control group. However, over the 6-month follow-up period, monthly step counts did not differ statistically by group (intervention group: 9092 steps; control group: 3722 steps; RR 2.44, 95% CI 0.68 to 8.74, P=.17). HbA1c decreased by 0.07% (95% CI –0.47 to 0.34, P=.75) in the TTM group compared to the control group. Within groups, HbA1c decreased significantly from baseline in the TTM group by –0.43% (95% CI –0.75 to –0.12, P=.01), but nonsignificantly in the control group by –0.21% (95% CI –0.49 to 0.06, P=.13). Similar changes were observed for other secondary outcomes. Conclusion: Personalized text messaging can be used to improve outcomes in patients with T2DM by employing optimal patient engagement measures. %M 27864165 %R 10.2196/jmir.6439 %U http://www.jmir.org/2016/11/e307/ %U https://doi.org/10.2196/jmir.6439 %U http://www.ncbi.nlm.nih.gov/pubmed/27864165 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 2 %P e165 %T Perceptions Toward a Smoking Cessation App Targeting LGBTQ+ Youth and Young Adults: A Qualitative Framework Analysis of Focus Groups %A Baskerville,N Bruce %A Dash,Darly %A Wong,Katy %A Shuh,Alanna %A Abramowicz,Aneta %+ Propel Centre for Population Health Impact, Applied Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada, 1-519-888-4567 ext. 35236, nbbaskerville@uwaterloo.ca %K qualitative research %K focus groups %K mobile applications %K telemedicine %K sexuality %K smoking cessation %K smartphone %D 2016 %7 18.11.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The prevalence of smoking among lesbian, gay, bisexual, trans, queer, and other sexual minority (LGBTQ+) youth and young adults (YYA) is significantly higher compared with that among non-LGBTQ+ persons. However, in the past, interventions were primarily group cessation classes that targeted LGBTQ+ persons of all ages. mHealth interventions offer an alternate and modern intervention platform for this subpopulation and may be of particular interest for young LGBTQ+ persons. Objective: This study explored LGBTQ+ YYA (the potential users’) perceptions of a culturally tailored mobile app for smoking cessation. Specifically, we sought to understand what LGBTQ+ YYA like and dislike about this potential cessation tool, along with how such interventions could be improved. Methods: We conducted 24 focus groups with 204 LGBTQ+ YYA (aged 16-29 years) in Toronto and Ottawa, Canada. Participants reflected on how an app might support LGBTQ+ persons with smoking cessation. Participants indicated their feelings, likes and dislikes, concerns, and additional ideas for culturally tailored smoking cessation apps. Framework analysis was used to code transcripts and identify the overarching themes. Results: Study findings suggested that LGBTQ+ YYA were eager about using culturally tailored mobile apps for smoking cessation. Accessibility, monitoring and tracking, connecting with community members, tailoring, connecting with social networks, and personalization were key reasons that were valued for a mobile app cessation program. However, concerns were raised about individual privacy and that not all individuals had access to a mobile phone, users might lose interest quickly, an app would need to be marketed effectively, and app users might cheat and lie about progress to themselves. Participants highlighted that the addition of distractions, rewards, notifications, and Web-based and print versions of the app would be extremely useful to mitigate some of their concerns. Conclusions: This study provided insight into the perspectives of LGBTQ+ YYA on a smoking cessation intervention delivered through a mobile app. The findings suggested a number of components of a mobile app that were valued and those that were concerning, as well as suggestions on how to make a mobile app cessation program successful. App development for this subpopulation should take into consideration the opinions of the intended users and involve them in the development and evaluation of mobile-based smoking cessation programs. %M 27864164 %R 10.2196/publichealth.6188 %U http://publichealth.jmir.org/2016/2/e165/ %U https://doi.org/10.2196/publichealth.6188 %U http://www.ncbi.nlm.nih.gov/pubmed/27864164 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 4 %P e200 %T Testing the Feasibility of Remote Patient Monitoring in Prenatal Care Using a Mobile App and Connected Devices: A Prospective Observational Trial %A Marko,Kathryn I %A Krapf,Jill M %A Meltzer,Andrew C %A Oh,Julia %A Ganju,Nihar %A Martinez,Anjali G %A Sheth,Sheetal G %A Gaba,Nancy D %+ Center for Healthcare Innovation and Policy Research, George Washington University School of Medicine and Health Sciences, 2120 L Street NW, Suite 450, Washington, DC, 20037, United States, 1 2024457044, ameltzer@mfa.gwu.edu %K prenatal care %K pregnancy %K mobile app %K remote pateint monitoring %D 2016 %7 18.11.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Excessive weight gain and elevated blood pressure are significant risk factors for adverse pregnancy outcomes such as gestational diabetes, premature birth, and preeclampsia. More effective strategies to facilitate adherence to gestational weight gain goals and monitor blood pressure may have a positive health benefit for pregnant women and their babies. The impact of utilizing a remote patient monitoring system to monitor blood pressure and weight gain as a component of prenatal care has not been previously assessed. Objective: The objective of this study is to determine the feasibility of monitoring patients remotely in prenatal care using a mobile phone app and connected digital devices. Methods: In this prospective observational study, 8 women with low risk pregnancy in the first trimester were recruited at an urban academic medical center. Participants received a mobile phone app with a connected digital weight scale and blood pressure cuff for at-home data collection for the duration of pregnancy. At-home data was assessed for abnormal values of blood pressure or weight to generate clinical alerts to the patient and provider. As measures of the feasibility of the system, participants were studied for engagement with the app, accuracy of remote data, efficacy of alert system, and patient satisfaction. Results: Patient engagement with the mobile app averaged 5.5 times per week over the 6-month study period. Weight data collection and blood pressure data collection averaged 1.5 times and 1.1 times per week, respectively. At-home measurements of weight and blood pressure were highly accurate compared to in-office measurements. Automatic clinical alerts identified two episodes of abnormal weight gain with no false triggers. Patients demonstrated high satisfaction with the system. Conclusions: In this pilot study, we demonstrated that a system using a mobile phone app coupled to remote monitoring devices is feasible for prenatal care. %M 27864167 %R 10.2196/resprot.6167 %U http://www.researchprotocols.org/2016/4/e200/ %U https://doi.org/10.2196/resprot.6167 %U http://www.ncbi.nlm.nih.gov/pubmed/27864167 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 11 %P e292 %T Self-Monitoring Utilization Patterns Among Individuals in an Incentivized Program for Healthy Behaviors %A Kim,Ju Young %A Wineinger,Nathan E %A Taitel,Michael %A Radin,Jennifer M %A Akinbosoye,Osayi %A Jiang,Jenny %A Nikzad,Nima %A Orr,Gregory %A Topol,Eric %A Steinhubl,Steve %+ Department of Digital Health, Scripps Translational Science Institute, 3344 North Torrey Pines Court, Suite 300, La Jolla, CA, 92037, United States, 1 858 554 5757, steinhub@scripps.edu %K health behavior %K mobile health %K mobile apps %K reward %K self blood pressure monitoring %K blood glucose self-monitoring %D 2016 %7 17.11.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The advent of digital technology has enabled individuals to track meaningful biometric data about themselves. This novel capability has spurred nontraditional health care organizations to develop systems that aid users in managing their health. One of the most prolific systems is Walgreens Balance Rewards for healthy choices (BRhc) program, an incentivized, Web-based self-monitoring program. Objective: This study was performed to evaluate health data self-tracking characteristics of individuals enrolled in the Walgreens’ BRhc program, including the impact of manual versus automatic data entries through a supported device or apps. Methods: We obtained activity tracking data from a total of 455,341 BRhc users during 2014. Upon identifying users with sufficient follow-up data, we explored temporal trends in user participation. Results: Thirty-four percent of users quit participating after a single entry of an activity. Among users who tracked at least two activities on different dates, the median length of participating was 8 weeks, with an average of 5.8 activities entered per week. Furthermore, users who participated for at least twenty weeks (28.3% of users; 33,078/116,621) consistently entered 8 to 9 activities per week. The majority of users (77%; 243,774/315,744) recorded activities through manual data entry alone. However, individuals who entered activities automatically through supported devices or apps participated roughly four times longer than their manual activity-entering counterparts (average 20 and 5 weeks, respectively; P<.001). Conclusions: This study provides insights into the utilization patterns of individuals participating in an incentivized, Web-based self-monitoring program. Our results suggest automated health tracking could significantly improve long-term health engagement. %M 27856407 %R 10.2196/jmir.6371 %U http://www.jmir.org/2016/11/e292/ %U https://doi.org/10.2196/jmir.6371 %U http://www.ncbi.nlm.nih.gov/pubmed/27856407 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 11 %P e302 %T Infusing Technology Into Perinatal Home Visitation in the United States for Women Experiencing Intimate Partner Violence: Exploring the Interpretive Flexibility of an mHealth Intervention %A Bacchus,Loraine J %A Bullock,Linda %A Sharps,Phyllis %A Burnett,Camille %A Schminkey,Donna L %A Buller,Ana Maria %A Campbell,Jacquelyn %+ Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom, 44 +442079588244, Loraine.Bacchus@lshtm.ac.uk %K intimate partner violence %K screening %K home visitation %K nurses %K mhealth %K intervention %K technology %K interpretive flexibility %D 2016 %7 17.11.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Intimate partner violence (IPV) is common during pregnancy and the postpartum. Perinatal home visitation provides favorable conditions in which to identify and support women affected by IPV. However, the use of mHealth for delivering IPV interventions in perinatal home visiting has not been explored. Objective: Our objective was to conduct a nested qualitative interpretive study to explore perinatal home visitors’ and women’s perceptions and experiences of the Domestic Violence Enhanced Home Visitation Program (DOVE) using mHealth technology (ie, a computer tablet) or a home visitor-administered, paper-based method. Methods: We used purposive sampling, using maximum variation, to select women enrolled in a US-based randomized controlled trial of the DOVE intervention for semistructured interviews. Selection criteria were discussed with the trial research team and 32 women were invited to participate. We invited 45 home visitors at the 8 study sites to participate in an interview, along with the 2 DOVE program designers. Nonparticipant observations of home visits with trial participants who chose not to participate in semistructured interviews were undertaken. Results: We conducted 51 interviews with 26 women, 23 home visiting staff at rural and urban sites, and the 2 DOVE program designers. We conducted 4 nonparticipant observations. Among 18 IPV-positive women, 7 used the computer tablet and 11 used the home visitor method. Among 8 IPV-negative women, 7 used the home visitor method. The computer tablet was viewed as a safe and confidential way for abused women to disclose their experiences without fear of being judged. The meanings that the DOVE technology held for home visitors and women led to its construction as either an impersonal artifact that was an impediment to discussion of IPV or a conduit through which interpersonal connection could be deepened, thereby facilitating discussion about IPV. Women’s and home visitors’ comfort with either method of screening was positively influenced by factors such as having established trust and rapport, as well as good interpersonal communication. The technology helped reduce the anticipated stigma associated with disclosing abuse. The didactic intervention video was a limiting feature, as the content could not be tailored to accommodate the fluidity of women’s circumstances. Conclusions: Users and developers of technology-based IPV interventions need to consider the context in which they are being embedded and the importance of the patient-provider relationship in promoting behavior change in order to realize the full benefits. An mHealth approach can and should be used as a tool for initiating discussion about IPV, assisting women in enhancing their safety and exploring help-seeking options. However, training for home visitors is required to ensure that a computer tablet is used to complement and enhance the therapeutic relationship. ClinicalTrial: Clinicaltrials.gov NCT01688427; https://clinicaltrials.gov/ct2/show/NCT01688427 (Archived by WebCite at http://www.webcitation.org/6limSWdZP) %M 27856405 %R 10.2196/jmir.6251 %U http://www.jmir.org/2016/11/e302/ %U https://doi.org/10.2196/jmir.6251 %U http://www.ncbi.nlm.nih.gov/pubmed/27856405 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 4 %P e217 %T Safety, Acceptability, and Use of a Smartphone App, BlueIce, for Young People Who Self-Harm: Protocol for an Open Phase I Trial %A Stallard,Paul %A Porter,Joanna %A Grist,Rebecca %+ Child and Adolescent Mental Health Group, Department for Health, University of Bath, Wessex House, Claverton Down, Bath, United Kingdom, 44 1225 383282, p.stallard@bath.ac.uk %K self-harm %K smartphone app %K BlueIce %K adolescents %K CBT %K DBT %D 2016 %7 16.11.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Up to 18% of adolescents will engage in an act of self-harm before young adulthood, with the majority of acts occurring in private. Mobile apps may offer a way of providing support for young people at times of distress to prevent self-harm. Objective: This is a proof-of-concept study designed to explore the safety, acceptability, feasibility, and usability of a smartphone app, BlueIce, with young people who are self-harming. Methods: In this phase I open trial we will evaluate BlueIce, a smartphone app developed and coproduced with young people with lived experience of self-harm. BlueIce includes a mood-monitoring diary, selection of mood-lifting techniques based on cognitive behavior therapy and dialectical behavior therapy, and direct access to emergency telephone numbers. We will recruit young people (n=50) attending specialist child and adolescent mental health services with a current or past history of self-harm to trial BlueIce as an adjunct to their usual care. Questionnaires and interviews will be completed at baseline, postfamiliarization (2 weeks), and at follow-up (12 weeks after baseline) to assess safety, app use, and acceptability. Interviews will be undertaken with clinicians to assess the feasibility of BlueIce within a clinical setting. Results: Recruitment occurred between May and November 2016. The recruitment target was 50, and by the beginning of November 54 young people had been referred. Conclusions: This study is the first to evaluate an app specifically developed with young people for young people (under the age of 18 years) who self-harm. It will determine whether BlueIce is acceptable, how often it is used, and whether it is safe and does not have any unintentional adverse effects. This information will determine whether a feasibility trial to test recruitment, randomization, retention, and appropriate outcome measures should be pursued. %M 27852560 %R 10.2196/resprot.6525 %U http://www.researchprotocols.org/2016/4/e217/ %U https://doi.org/10.2196/resprot.6525 %U http://www.ncbi.nlm.nih.gov/pubmed/27852560 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e122 %T A Systematic Review of Apps using Mobile Criteria for Adolescent Pregnancy Prevention (mCAPP) %A Chen,Elizabeth %A Mangone,Emily Rose %+ International Health Division, Abt Associates, 4550 Montgomery Avenue, Suite 800 North, Bethesda, MD, 20814, United States, 1 650 919 3414, emilyrose.mangone@gmail.com %K mHealth %K eHealth %K smartphone %K mobile phone %K app %K teen %K adolescent %K young adult %K systematic review %K unintended pregnancy %K family planning %K pregnancy prevention %K contraception %D 2016 %7 10.11.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adolescents in the United States and globally represent a high-risk population for unintended pregnancy, which leads to high social, economic, and health costs. Access to smartphone apps is rapidly increasing among youth, but little is known about the strategies that apps employ to prevent pregnancy among adolescents and young adults. Further, there are no guidelines on best practices for adolescent and young adult pregnancy prevention through mobile apps. Objective: This review developed a preliminary evaluation framework for the assessment of mobile apps for adolescent and young adult pregnancy prevention and used this framework to assess available apps in the Apple App Store and Google Play that targeted adolescents and young adults with family planning and pregnancy prevention support. Methods: We developed an assessment rubric called Mobile Criteria for Adolescent Pregnancy Prevention (mCAPP) for data extraction using evidence-based and promising best practices from the literature. mCAPP comprises 4 domains: (1) app characteristics, (2) user interface features, (3) adolescent pregnancy prevention best practices, and (4) general sexual and reproductive health (SRH) features. For inclusion in the review, apps that advertised pregnancy prevention services and explicitly mentioned youth, were in English, and were free were systematically identified in the Apple App Store and Google Play in 2015. Screening, data extraction, and 4 interrater reliability checks were conducted by 2 reviewers. Each app was assessed for 92 facets of the mCAPP checklist. Results: Our search returned 4043 app descriptions in the Apple App Store (462) and Google Play (3581). After screening for inclusion criteria, 22 unique apps were included in our analysis. Included apps targeted teens in primarily developed countries, and the most common user interface features were clinic and health service locators. While app strengths included provision of SRH education, description of modern contraceptives, and some use of evidence-based adolescent best practices, gaps remain in the implementation of the majority of adolescent best practices and user interface features. Of the 8 best practices for teen pregnancy prevention operationalized through mCAPP, the most commonly implemented best practice was the provision of information on how to use contraceptives to prevent pregnancy (15/22), followed by provision of accurate information on pregnancy risk of sexual behaviors (13/22); information on SRH communication, negotiation, or refusal skills (10/22); and the use of persuasive language around contraceptive use (9/22). Conclusions: The quality and scope of apps for adolescent pregnancy prevention varies, indicating that developers and researchers may need a supportive framework. mCAPP can help researchers and developers consider mobile-relevant evidence-based best practices for adolescent SRH as they develop teen pregnancy prevention apps. Given the novelty of the mobile approach, further research is needed on the impact of mCAPP criteria via mobile channels on adolescent health knowledge, behaviors, and outcomes. %M 27833070 %R 10.2196/mhealth.6611 %U http://mhealth.jmir.org/2016/4/e122/ %U https://doi.org/10.2196/mhealth.6611 %U http://www.ncbi.nlm.nih.gov/pubmed/27833070 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 4 %P e209 %T Cognitive Behavior Therapy for Anxious and Depressed Youth: Improving Homework Adherence Through Mobile Technology %A Wilansky,Pamela %A Eklund,J Mikael %A Milner,Tracy %A Kreindler,David %A Cheung,Amy %A Kovacs,Tim %A Shooshtari,Shahin %A Astell,Arlene %A Ohinmaa,Arto %A Henderson,Joanna %A Strauss,John %A Mills,Rosemary SL %+ Child, Youth and Family Services, Centre for Addiction and Mental Health, University of Toronto, Intergenerational Wellness Building, 6th floor rm 6232, 80 Workman Way, Toronto, ON, M6J 1H4, Canada, 1 416 322 5176, pwilansky@frameworkcentre.com %K mHealth %K mobile app %K youth %K anxiety %K depression %K cognitive behavior therapy %K homework %D 2016 %7 10.11.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Anxiety and mood disorders are the most common mental illnesses, peaking during adolescence and affecting approximately 25% of Canadians aged 14-17 years. If not successfully treated at this age, they often persist into adulthood, exerting a great social and economic toll. Given the long-term impact, finding ways to increase the success and cost-effectiveness of mental health care is a pressing need. Cognitive behavior therapy (CBT) is an evidence-based treatment for mood and anxiety disorders throughout the lifespan. Mental health technologies can be used to make such treatments more successful by delivering them in a format that increases utilization. Young people embrace technologies, and many want to actively manage their mental health. Mobile software apps have the potential to improve youth adherence to CBT and, in turn, improve outcomes of treatment. Objective: The purpose of this project is to improve homework adherence in CBT for youth anxiety and/or depression. The objectives are to (1) design and optimize the usability of a mobile app for delivering the homework component of CBT for youth with anxiety and/or depression, (2) assess the app’s impact on homework completion, and (3) implement the app in CBT programs. We hypothesize that homework adherence will be greater in the app group than in the no-app group. Methods: Phase 1: exploratory interviews will be conducted with adolescents and therapists familiar with CBT to obtain views and perspectives on the requirements and features of a usable app and the challenges involved in implementation. The information obtained will guide the design of a prototype. The prototype will be optimized via think-aloud procedures involving an iterative process of evaluation, modification, and re-evaluation, culminating in a fully functional version of the prototype that is ready for optimization in a clinical context. Phase 2: a usability study will be conducted to optimize the prototype in the context of treatment at clinics that provide CBT treatment for youth with anxiety and/or depression. This phase will result in a usable app that is ready to be tested for its effectiveness in increasing homework adherence. Phase 3: a pragmatic clinical trial will be conducted at several clinics to evaluate the impact of the app on homework adherence. Participants in the app group are expected to show greater homework completion than those in the no-app group. Results: Phase 3 will be completed by September 2019. Conclusions: The app will be a unique adjunct to treatment for adolescents in CBT, focusing on both anxiety and depression, developed in partnership with end users at every stage from design to implementation, customizable for different cognitive profiles, and designed with depression symptom tracking measures for youth made interoperable with electronic medical records. %M 27833071 %R 10.2196/resprot.5841 %U http://www.researchprotocols.org/2016/4/e209/ %U https://doi.org/10.2196/resprot.5841 %U http://www.ncbi.nlm.nih.gov/pubmed/27833071 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e126 %T Benefits of Mobile Phone Technology for Personal Environmental Monitoring %A Donaire-Gonzalez,David %A Valentín,Antònia %A de Nazelle,Audrey %A Ambros,Albert %A Carrasco-Turigas,Glòria %A Seto,Edmund %A Jerrett,Michael %A Nieuwenhuijsen,Mark J %+ ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Doctor Aiguader, 88, Barcelona, 08003, Spain, 34 93 214 73 17, david.donaire@isglobal.org %K smartphone %K cell phones %K mobile applications %K monitoring, ambulatory %K spatio-temporal analysis %K automatic data processing %K travel %K environmental exposure %D 2016 %7 10.11.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Tracking individuals in environmental epidemiological studies using novel mobile phone technologies can provide valuable information on geolocation and physical activity, which will improve our understanding of environmental exposures. Objective: The objective of this study was to assess the performance of one of the least expensive mobile phones on the market to track people's travel-activity pattern. Methods: Adults living and working in Barcelona (72/162 bicycle commuters) carried simultaneously a mobile phone and a Global Positioning System (GPS) tracker and filled in a travel-activity diary (TAD) for 1 week (N=162). The CalFit app for mobile phones was used to log participants’ geographical location and physical activity. The geographical location data were assigned to different microenvironments (home, work or school, in transit, others) with a newly developed spatiotemporal map-matching algorithm. The tracking performance of the mobile phones was compared with that of the GPS trackers using chi-square test and Kruskal-Wallis rank sum test. The minute agreement across all microenvironments between the TAD and the algorithm was compared using the Gwet agreement coefficient (AC1). Results: The mobile phone acquired locations for 905 (29.2%) more trips reported in travel diaries than the GPS tracker (P<.001) and had a median accuracy of 25 m. Subjects spent on average 57.9%, 19.9%, 9.0%, and 13.2% of time at home, work, in transit, and other places, respectively, according to the TAD and 57.5%, 18.8%, 11.6%, and 12.1%, respectively, according to the map-matching algorithm. The overall minute agreement between both methods was high (AC1 .811, 95% CI .810-.812). Conclusions: The use of mobile phones running the CalFit app provides better information on which microenvironments people spend their time in than previous approaches based only on GPS trackers. The improvements of mobile phone technology in microenvironment determination are because the mobile phones are faster at identifying first locations and capable of getting location in challenging environments thanks to the combination of assisted-GPS technology and network positioning systems. Moreover, collecting location information from mobile phones, which are already carried by individuals, allows monitoring more people with a cheaper and less burdensome method than deploying GPS trackers. %M 27833069 %R 10.2196/mhealth.5771 %U http://mhealth.jmir.org/2016/4/e126/ %U https://doi.org/10.2196/mhealth.5771 %U http://www.ncbi.nlm.nih.gov/pubmed/27833069 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 11 %P e278 %T mHealth or eHealth? Efficacy, Use, and Appreciation of a Web-Based Computer-Tailored Physical Activity Intervention for Dutch Adults: A Randomized Controlled Trial %A Gomez Quiñonez,Stefanie %A Walthouwer,Michel Jean Louis %A Schulz,Daniela Nadine %A de Vries,Hein %+ Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, Maastricht, 6200 MD, Netherlands, 31 644808926, s.gomez@maastrichtuniversity.nl %K mHealth %K eHealth %K Web-based intervention %K computer-tailored intervention %K physical activity %D 2016 %7 09.11.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Until a few years ago, Web-based computer-tailored interventions were almost exclusively delivered via computer (eHealth). However, nowadays, interventions delivered via mobile phones (mHealth) are an interesting alternative for health promotion, as they may more easily reach people 24/7. Objective: The first aim of this study was to compare the efficacy of an mHealth and an eHealth version of a Web-based computer-tailored physical activity intervention with a control group. The second aim was to assess potential differences in use and appreciation between the 2 versions. Methods: We collected data among 373 Dutch adults at 5 points in time (baseline, after 1 week, after 2 weeks, after 3 weeks, and after 6 months). We recruited participants from a Dutch online research panel and randomly assigned them to 1 of 3 conditions: eHealth (n=138), mHealth (n=108), or control condition (n=127). All participants were asked to complete questionnaires at the 5 points in time. Participants in the eHealth and mHealth group received fully automated tailored feedback messages about their current level of physical activity. Furthermore, they received personal feedback aimed at increasing their amount of physical activity when needed. We used analysis of variance and linear regression analyses to examine differences between the 2 study groups and the control group with regard to efficacy, use, and appreciation. Results: Participants receiving feedback messages (eHealth and mHealth together) were significantly more physically active after 6 months than participants in the control group (B=8.48, df=2, P=.03, Cohen d=0.27). We found a small effect size favoring the eHealth condition over the control group (B=6.13, df=2, P=.09, Cohen d=0.21). The eHealth condition had lower dropout rates (117/138, 84.8%) than the mHealth condition (81/108, 75.0%) and the control group (91/127, 71.7%). Furthermore, in terms of usability and appreciation, the eHealth condition outperformed the mHealth condition with regard to participants receiving (t182=3.07, P=.002) and reading the feedback messages (t181=2.34, P=.02), as well as the clarity of the messages (t181=1.99, P=.049). Conclusions: We tested 2 Web-based computer-tailored physical activity intervention versions (mHealth and eHealth) against a control condition with regard to efficacy, use, usability, and appreciation. The overall effect was mainly caused by the more effective eHealth intervention. The mHealth app was rated inferior to the eHealth version with regard to usability and appreciation. More research is needed to assess how both methods can complement each other. Trial Registration: Netherlands Trial Register: NTR4503; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4503 (Archived by WebCite at http://www.webcitation.org/6lEi1x40s) %M 27829576 %R 10.2196/jmir.6171 %U http://www.jmir.org/2016/11/e278/ %U https://doi.org/10.2196/jmir.6171 %U http://www.ncbi.nlm.nih.gov/pubmed/27829576 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 2 %P e164 %T Efficacy of Web-Based Collection of Strength-Based Testimonials for Text Message Extension of Youth Suicide Prevention Program: Randomized Controlled Experiment %A Thiha,Phyo %A Pisani,Anthony R %A Gurditta,Kunali %A Cherry,Erin %A Peterson,Derick R %A Kautz,Henry %A Wyman,Peter A %+ Department of Psychiatry, University of Rochester School of Medicine and Dentistry, 300 Crittenden Blvd., Box PSYC, Rochester, NY, 14642, United States, 1 585 275 3644, anthony_pisani@urmc.rochester.edu %K mental health %K adolescent health %K user interface design %K suicide %K text messaging %D 2016 %7 09.11.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Equipping members of a target population to deliver effective public health messaging to peers is an established approach in health promotion. The Sources of Strength program has demonstrated the promise of this approach for “upstream” youth suicide prevention. Text messaging is a well-established medium for promoting behavior change and is the dominant communication medium for youth. In order for peer ‘opinion leader’ programs like Sources of Strength to use scalable, wide-reaching media such as text messaging to spread peer-to-peer messages, they need techniques for assisting peer opinion leaders in creating effective testimonials to engage peers and match program goals. We developed a Web interface, called Stories of Personal Resilience in Managing Emotions (StoryPRIME), which helps peer opinion leaders write effective, short-form messages that can be delivered to the target population in youth suicide prevention program like Sources of Strength. Objective: To determine the efficacy of StoryPRIME, a Web-based interface for remotely eliciting high school peer leaders, and helping them produce high-quality, personal testimonials for use in a text messaging extension of an evidence-based, peer-led suicide prevention program. Methods: In a double-blind randomized controlled experiment, 36 high school students wrote testimonials with or without eliciting from the StoryPRIME interface. The interface was created in the context of Sources of Strength–an evidence-based youth suicide prevention program–and 24 ninth graders rated these testimonials on relatability, usefulness/relevance, intrigue, and likability. Results: Testimonials written with the StoryPRIME interface were rated as more relatable, useful/relevant, intriguing, and likable than testimonials written without StoryPRIME, P=.054. Conclusions: StoryPRIME is a promising way to elicit high-quality, personal testimonials from youth for prevention programs that draw on members of a target population to spread public health messages. %M 27829575 %R 10.2196/publichealth.6207 %U http://publichealth.jmir.org/2016/2/e164/ %U https://doi.org/10.2196/publichealth.6207 %U http://www.ncbi.nlm.nih.gov/pubmed/27829575 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e124 %T Safe Sex Messages Within Dating and Entertainment Smartphone Apps: A Review %A Huang,Evelyn Tzu-Yen %A Williams,Henrietta %A Hocking,Jane S %A Lim,Megan SC %+ Austin Hospital, Austin Health, 145 Studley Road, Heidelberg, 3084, Australia, 61 3 9496 5000, drevelynhuang@gmail.com %K mobile apps %K sexual health %K STDs %K sexually transmitted diseases %K mobile health %K mHealth %D 2016 %7 08.11.2016 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Smartphone apps provide a new platform for entertainment, information distribution, and health promotion activities, as well as for dating and casual sexual encounters. Previous research has shown high acceptability of sexual health interventions via smartphone apps; however, sexual health promotion apps were infrequently downloaded and underused. Integrating sexual health promotion into established apps might be a more effective method. Objective: The objective of our study was to critically review popular sex-related apps and dating apps, in order to ascertain whether they contain any sexual health content. Methods: Part 1: In January 2015, we used the term “sexual” to search for free apps in the Apple iTunes store and Android Google Play store, and categorized the sexual health content of the 137 apps identified. Part 2: We used the term “dating” to search for free geosocial-networking apps in the Apple iTunes and Android Google Play stores. The apps were downloaded to test functionality and to determine whether they included sexual health content. Results: Part 1: Of the 137 apps identified, 15 (11.0%) had sexual health content and 15 (11.0%) contained messages about sexual assault or violence. The majority of the apps did not contain any sexual health content. Part 2: We reviewed 60 dating apps: 44 (73%) targeting heterosexual users, 9 (15%) targeting men who have sex with men (MSM), 3 (5%) targeting lesbian women, and 4 (7%) for group dating. Only 9 dating apps contained sexual health content, of which 7 targeted MSM. Conclusions: The majority of sex-related apps and dating apps contained no sexual health content that could educate users about and remind them of their sexual risks. Sexual health practitioners and public health departments will need to work with app developers to promote sexual health within existing popular apps. For those apps that already contain sexual health messages, further study to investigate the effectiveness of the content is needed. %M 27826133 %R 10.2196/mhealth.5760 %U http://mhealth.jmir.org/2016/4/e124/ %U https://doi.org/10.2196/mhealth.5760 %U http://www.ncbi.nlm.nih.gov/pubmed/27826133 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e123 %T A Brief Tool to Assess Image-Based Dietary Records and Guide Nutrition Counselling Among Pregnant Women: An Evaluation %A Ashman,Amy M %A Collins,Clare E %A Brown,Leanne J %A Rae,Kym M %A Rollo,Megan E %+ Priority Research Centre in Physical Activity and Nutrition, Faculty of Health and Medicine, School of Health Sciences Office, University of Newcastle, Room HA12, Hunter Building, University Drive, Callaghan, 2308, Australia, 61 (02) 4921 5649, megan.rollo@newcastle.edu.au %K nutrition assessment %K pregnancy %K telehealth %K image-based dietary records %D 2016 %7 04.11.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dietitians ideally should provide personally tailored nutrition advice to pregnant women. Provision is hampered by a lack of appropriate tools for nutrition assessment and counselling in practice settings. Smartphone technology, through the use of image-based dietary records, can address limitations of traditional methods of recording dietary intake. Feedback on these records can then be provided by the dietitian via smartphone. Efficacy and validity of these methods requires examination. Objective: The aims of the Australian Diet Bytes and Baby Bumps study, which used image-based dietary records and a purpose-built brief Selected Nutrient and Diet Quality (SNaQ) tool to provide tailored nutrition advice to pregnant women, were to assess relative validity of the SNaQ tool for analyzing dietary intake compared with nutrient analysis software, to describe the nutritional intake adequacy of pregnant participants, and to assess acceptability of dietary feedback via smartphone. Methods: Eligible women used a smartphone app to record everything they consumed over 3 nonconsecutive days. Records consisted of an image of the food or drink item placed next to a fiducial marker, with a voice or text description, or both, providing additional detail. We used the SNaQ tool to analyze participants’ intake of daily food group servings and selected key micronutrients for pregnancy relative to Australian guideline recommendations. A visual reference guide consisting of images of foods and drinks in standard serving sizes assisted the dietitian with quantification. Feedback on participants’ diets was provided via 2 methods: (1) a short video summary sent to participants’ smartphones, and (2) a follow-up telephone consultation with a dietitian. Agreement between dietary intake assessment using the SNaQ tool and nutrient analysis software was evaluated using Spearman rank correlation and Cohen kappa. Results: We enrolled 27 women (median age 28.8 years, 8 Indigenous Australians, 15 primiparas), of whom 25 completed the image-based dietary record. Median intakes of grains, vegetables, fruit, meat, and dairy were below recommendations. Median (interquartile range) intake of energy-dense, nutrient-poor foods was 3.5 (2.4-3.9) servings/day and exceeded recommendations (0-2.5 servings/day). Positive correlations between the SNaQ tool and nutrient analysis software were observed for energy (ρ=.898, P<.001) and all selected micronutrients (iron, calcium, zinc, folate, and iodine, ρ range .510-.955, all P<.05), both with and without vitamin and mineral supplements included in the analysis. Cohen kappa showed moderate to substantial agreement for selected micronutrients when supplements were included (kappa range .488-.803, all P ≤.001) and for calcium, iodine, and zinc when excluded (kappa range .554-.632, all P<.001). A total of 17 women reported changing their diet as a result of the personalized nutrition advice. Conclusions: The SNaQ tool demonstrated acceptable validity for assessing adequacy of key pregnancy nutrient intakes and preliminary evidence of utility to support dietitians in providing women with personalized advice to optimize nutrition during pregnancy. %M 27815234 %R 10.2196/mhealth.6469 %U http://mhealth.jmir.org/2016/4/e123/ %U https://doi.org/10.2196/mhealth.6469 %U http://www.ncbi.nlm.nih.gov/pubmed/27815234 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e125 %T Sleep Quality Prediction From Wearable Data Using Deep Learning %A Sathyanarayana,Aarti %A Joty,Shafiq %A Fernandez-Luque,Luis %A Ofli,Ferda %A Srivastava,Jaideep %A Elmagarmid,Ahmed %A Arora,Teresa %A Taheri,Shahrad %+ Qatar Computing Research Institute, Hamad Bin Khalifa University, Qatar Foundation, HBKU Research Complex, Doha, 5825, Qatar, 974 50173040, lluque@qf.org.qa %K wearables %K sleep quality %K sleep efficiency %K actigraphy %K body sensor networks %K mobile health %K connected health %K accelerometer %K physical activity %K pervasive health %K consumer health informatics %K deep learning %D 2016 %7 04.11.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The importance of sleep is paramount to health. Insufficient sleep can reduce physical, emotional, and mental well-being and can lead to a multitude of health complications among people with chronic conditions. Physical activity and sleep are highly interrelated health behaviors. Our physical activity during the day (ie, awake time) influences our quality of sleep, and vice versa. The current popularity of wearables for tracking physical activity and sleep, including actigraphy devices, can foster the development of new advanced data analytics. This can help to develop new electronic health (eHealth) applications and provide more insights into sleep science. Objective: The objective of this study was to evaluate the feasibility of predicting sleep quality (ie, poor or adequate sleep efficiency) given the physical activity wearable data during awake time. In this study, we focused on predicting good or poor sleep efficiency as an indicator of sleep quality. Methods: Actigraphy sensors are wearable medical devices used to study sleep and physical activity patterns. The dataset used in our experiments contained the complete actigraphy data from a subset of 92 adolescents over 1 full week. Physical activity data during awake time was used to create predictive models for sleep quality, in particular, poor or good sleep efficiency. The physical activity data from sleep time was used for the evaluation. We compared the predictive performance of traditional logistic regression with more advanced deep learning methods: multilayer perceptron (MLP), convolutional neural network (CNN), simple Elman-type recurrent neural network (RNN), long short-term memory (LSTM-RNN), and a time-batched version of LSTM-RNN (TB-LSTM). Results: Deep learning models were able to predict the quality of sleep (ie, poor or good sleep efficiency) based on wearable data from awake periods. More specifically, the deep learning methods performed better than traditional logistic regression. “CNN had the highest specificity and sensitivity, and an overall area under the receiver operating characteristic (ROC) curve (AUC) of 0.9449, which was 46% better as compared with traditional logistic regression (0.6463). Conclusions: Deep learning methods can predict the quality of sleep based on actigraphy data from awake periods. These predictive models can be an important tool for sleep research and to improve eHealth solutions for sleep. %M 27815231 %R 10.2196/mhealth.6562 %U http://mhealth.jmir.org/2016/4/e125/ %U https://doi.org/10.2196/mhealth.6562 %U http://www.ncbi.nlm.nih.gov/pubmed/27815231 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 11 %P e287 %T Can Mobile Phone Apps Influence People’s Health Behavior Change? An Evidence Review %A Zhao,Jing %A Freeman,Becky %A Li,Mu %+ School of Public Health, Sydney Medical School, The University of Sydney, Edward Ford Building, A27, Sydney, 2006, Australia, 61 2 9351 5996, jzha5010@uni.sydney.edu.au %K review %K mobile phone apps %K apps %K behavior change %K intervention %K mHealth %D 2016 %7 02.11.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Globally, mobile phones have achieved wide reach at an unprecedented rate, and mobile phone apps have become increasingly prevalent among users. The number of health-related apps that were published on the two leading platforms (iOS and Android) reached more than 100,000 in 2014. However, there is a lack of synthesized evidence regarding the effectiveness of mobile phone apps in changing people’s health-related behaviors. Objective: The aim was to examine the effectiveness of mobile phone apps in achieving health-related behavior change in a broader range of interventions and the quality of the reported studies. Methods: We conducted a comprehensive bibliographic search of articles on health behavior change using mobile phone apps in peer-reviewed journals published between January 1, 2010 and June 1, 2015. Databases searched included Medline, PreMedline, PsycINFO, Embase, Health Technology Assessment, Education Resource Information Center (ERIC), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Articles published in the Journal of Medical Internet Research during that same period were hand-searched on the journal’s website. Behavior change mechanisms were coded and analyzed. The quality of each included study was assessed by the Cochrane Risk of Bias Assessment Tool. Results: A total of 23 articles met the inclusion criteria, arranged under 11 themes according to their target behaviors. All studies were conducted in high-income countries. Of these, 17 studies reported statistically significant effects in the direction of targeted behavior change; 19 studies included in this analysis had a 65% or greater retention rate in the intervention group (range 60%-100%); 6 studies reported using behavior change theories with the theory of planned behavior being the most commonly used (in 3 studies). Self-monitoring was the most common behavior change technique applied (in 12 studies). The studies suggest that some features improve the effectiveness of apps, such as less time consumption, user-friendly design, real-time feedback, individualized elements, detailed information, and health professional involvement. All studies were assessed as having some risk of bias. Conclusions: Our results provide a snapshot of the current evidence of effectiveness for a range of health-related apps. Large sample, high-quality, adequately powered, randomized controlled trials are required. In light of the bias evident in the included studies, better reporting of health-related app interventions is also required. The widespread adoption of mobile phones highlights a significant opportunity to impact health behaviors globally, particularly in low- and middle-income countries. %M 27806926 %R 10.2196/jmir.5692 %U http://www.jmir.org/2016/11/e287/ %U https://doi.org/10.2196/jmir.5692 %U http://www.ncbi.nlm.nih.gov/pubmed/27806926 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e120 %T Sexual Preferences and Presentation on Geosocial Networking Apps by Indian Men Who Have Sex With Men in Maharashtra %A Rhoton,Jayson %A Wilkerson,J Michael %A Mengle,Shruta %A Patankar,Pallav %A Rosser,BR Simon %A Ekstrand,Maria L %+ Department of Health Promotion and Behavioral Sciences, The University of Texas Health Sceince Center Houston, 7000 Fannin Street, 2610 I, Houston, TX, 77030, United States, 1 713 500 9757, Jayson.Rhoton@uth.tmc.edu %K homosexuality %K mobile health %K HIV %K prevention and control %K urban health %D 2016 %7 31.10.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The affordability of smartphones and improved mobile networks globally has increased the popularity of geosocial networking (GSN) apps (eg, Grindr, Scruff, Planetromeo) as a method for men who have sex with men (MSM) to seek causal sex partners and engage with the queer community. As mobile penetration continues to grow in India, it is important to understand how self-presentation on GSN app is relevant because it offers insight into a population that has not been largely studied. There is very little information about how Indian MSM discuss their sexual preferences and condom preferences and disclose their human immunodeficiency virus (HIV) status with potential sex partners on Web-based platforms. Objective: The objective of this study was to describe how self-presentation by Indian MSM on GSN apps contributes to sexual preferences, HIV or sexually transmitted infection (STI) disclosure, and if the presentation differs due to proximity to the Greater Mumbai or Thane region. Methods: Between September 2013 and May 2014, participants were recruited through banner advertisements on gay websites, social media advertisements and posts, and distribution of print materials at outreach events hosted by lesbian, gay, bisexual, transgender (LGBT) and HIV service organizations in Maharashtra, India. Eligible participants self-identified as being MSM or hijra (transgender) women, living in Maharashtra, aged above 18 years, having regular Internet access, and having at least one male sex partner in the previous 90 days. Results: Indian MSM living inside and outside the Greater Mumbai or Thane region reported an average of 6.7 (SD 11.8) male sex partners in the last 3 months; on average HIV status of the sex partners was disclosed to 2.9 (SD 8.9). The most commonly used websites and GSN apps by MSM living inside Greater Mumbai or Thane region were Planetromeo, Grindr, and Gaydar. Results demonstrated that MSM used smartphones to access GSN apps and stated a preference for both condomless and protected anal sex but did not disclose their HIV status. This low level of HIV disclosure potentially increases risk of HIV or STI transmission; therefore, trends in use should be monitored. Conclusions: Our data helps to fill the gap in understanding how Indian MSM use technology to find casual sex partners, disclose their sexual preference, and their HIV status on Web-based platforms. As mobile penetration in India continues to grow and smartphone use increases, the use of GSN sex-seeking apps by MSM should also increase, potentially increasing the risk of HIV or STI transmission within the app’s closed sexual networks. %M 27799139 %R 10.2196/mhealth.5600 %U http://mhealth.jmir.org/2016/4/e120/ %U https://doi.org/10.2196/mhealth.5600 %U http://www.ncbi.nlm.nih.gov/pubmed/27799139 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 10 %P e275 %T Using Intensive Longitudinal Data Collected via Mobile Phone to Detect Imminent Lapse in Smokers Undergoing a Scheduled Quit Attempt %A Businelle,Michael S %A Ma,Ping %A Kendzor,Darla E %A Frank,Summer G %A Wetter,David W %A Vidrine,Damon J %+ Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 4052718001 ext 50460, michael-businelle@ouhsc.edu %K smartphone %K mobile app %K mhealth %K ecological momentary assessment %K smoking cessation %K socioeconomic disadvantage, risk estimation %D 2016 %7 17.10.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile phone‒based real-time ecological momentary assessments (EMAs) have been used to record health risk behaviors, and antecedents to those behaviors, as they occur in near real time. Objective: The objective of this study was to determine if intensive longitudinal data, collected via mobile phone, could be used to identify imminent risk for smoking lapse among socioeconomically disadvantaged smokers seeking smoking cessation treatment. Methods: Participants were recruited into a randomized controlled smoking cessation trial at an urban safety-net hospital tobacco cessation clinic. All participants completed in-person EMAs on mobile phones provided by the study. The presence of six commonly cited lapse risk variables (ie, urge to smoke, stress, recent alcohol consumption, interaction with someone smoking, cessation motivation, and cigarette availability) collected during 2152 prompted or self-initiated postcessation EMAs was examined to determine whether the number of lapse risk factors was greater when lapse was imminent (ie, within 4 hours) than when lapse was not imminent. Various strategies were used to weight variables in efforts to improve the predictive utility of the lapse risk estimator. Results: Participants (N=92) were mostly female (52/92, 57%), minority (65/92, 71%), 51.9 (SD 7.4) years old, and smoked 18.0 (SD 8.5) cigarettes per day. EMA data indicated significantly higher urges (P=.01), stress (P=.002), alcohol consumption (P<.001), interaction with someone smoking (P<.001), and lower cessation motivation (P=.03) within 4 hours of the first lapse compared with EMAs collected when lapse was not imminent. Further, the total number of lapse risk factors present within 4 hours of lapse (mean 2.43, SD 1.37) was significantly higher than the number of lapse risk factors present during periods when lapse was not imminent (mean 1.35, SD 1.04), P<.001. Overall, 62% (32/52) of all participants who lapsed completed at least one EMA wherein they reported ≥3 lapse risk factors within 4 hours of their first lapse. Differentially weighting lapse risk variables resulted in an improved risk estimator (weighted area=0.76 vs unweighted area=0.72, P<.004). Specifically, 80% (42/52) of all participants who lapsed had at least one EMA with a lapse risk score above the cut-off within 4 hours of their first lapse. Conclusions: Real-time estimation of smoking lapse risk is feasible and may pave the way for development of mobile phone‒based smoking cessation treatments that automatically tailor treatment content in real time based on presence of specific lapse triggers. Interventions that identify risk for lapse and automatically deliver tailored messages or other treatment components in real time could offer effective, low cost, and highly disseminable treatments to individuals who do not have access to other more standard cessation treatments. %M 27751985 %R 10.2196/jmir.6307 %U http://www.jmir.org/2016/10/e275/ %U https://doi.org/10.2196/jmir.6307 %U http://www.ncbi.nlm.nih.gov/pubmed/27751985 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 10 %P e268 %T Influence of Pedometer Position on Pedometer Accuracy at Various Walking Speeds: A Comparative Study %A Ehrler,Frederic %A Weber,Chloé %A Lovis,Christian %+ Division of Medical Information Sciences, University Hospitals of Geneva, Gabrielle-Perret-Gentil, 4, Geneva, 1205, Switzerland, 41 22 37 28697, frederic.ehrler@hcuge.ch %K frail elderly %K mHealth %K walking %K motor activity %D 2016 %7 06.10.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Demographic growth in conjunction with the rise of chronic diseases is increasing the pressure on health care systems in most OECD countries. Physical activity is known to be an essential factor in improving or maintaining good health. Walking is especially recommended, as it is an activity that can easily be performed by most people without constraints. Pedometers have been extensively used as an incentive to motivate people to become more active. However, a recognized problem with these devices is their diminishing accuracy associated with decreased walking speed. The arrival on the consumer market of new devices, worn indifferently either at the waist, wrist, or as a necklace, gives rise to new questions regarding their accuracy at these different positions. Objective: Our objective was to assess the performance of 4 pedometers (iHealth activity monitor, Withings Pulse O2, Misfit Shine, and Garmin vívofit) and compare their accuracy according to their position worn, and at various walking speeds. Methods: We conducted this study in a controlled environment with 21 healthy adults required to walk 100 m at 3 different paces (0.4 m/s, 0.6 m/s, and 0.8 m/s) regulated by means of a string attached between their legs at the level of their ankles and a metronome ticking the cadence. To obtain baseline values, we asked the participants to walk 200 m at their own pace. Results: A decrease of accuracy was positively correlated with reduced speed for all pedometers (12% mean error at self-selected pace, 27% mean error at 0.8 m/s, 52% mean error at 0.6 m/s, and 76% mean error at 0.4 m/s). Although the position of the pedometer on the person did not significantly influence its accuracy, some interesting tendencies can be highlighted in 2 settings: (1) positioning the pedometer at the waist at a speed greater than 0.8 m/s or as a necklace at preferred speed tended to produce lower mean errors than at the wrist position; and (2) at a slow speed (0.4 m/s), pedometers worn at the wrist tended to produce a lower mean error than in the other positions. Conclusions: At all positions, all tested pedometers generated significant errors at slow speeds and therefore cannot be used reliably to evaluate the amount of physical activity for people walking slower than 0.6 m/s (2.16 km/h, or 1.24 mph). At slow speeds, the better accuracy observed with pedometers worn at the wrist could constitute a valuable line of inquiry for the future development of devices adapted to elderly people. %M 27713114 %R 10.2196/jmir.5916 %U http://www.jmir.org/2016/10/e268/ %U https://doi.org/10.2196/jmir.5916 %U http://www.ncbi.nlm.nih.gov/pubmed/27713114 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e115 %T Using Knowledge Translation to Craft “Sticky” Social Media Health Messages That Provoke Interest, Raise Awareness, Impart Knowledge, and Inspire Change %A Shibasaki,Sanchia %A Gardner,Karen %A Sibthorpe,Beverly %+ ThinkThrough Consultancy Services, P O Box 7083, Holland Park, 4121, Australia, 61 0447040224, sanchia.shibasaki@gmail.com %K knowledge translation %K social media %K Indigenous health %K health promotion %D 2016 %7 05.10.2016 %9 Short Paper %J JMIR Mhealth Uhealth %G English %X Background: In Australia, there is growing use of technology supported knowledge translation (KT) strategies such as social media and mobile apps in health promotion and in Indigenous health. However, little is known about how individuals use technologies and the evidence base for the impact of these health interventions on health behavior change is meager. Objective: The objective of our study was to examine how Facebook is used to promote health messages to Indigenous people and discuss how KT can support planning and implementing health messages to ensure chosen strategies are fit for the purpose and achieve impact. Methods: A desktop audit of health promotion campaigns on smoking prevention and cessation for Australian Indigenous people using Facebook was conducted. Results: Our audit identified 13 out of 21 eligible campaigns that used Facebook. Facebook pages with the highest number of likes (more than 5000) were linked to a website and to other social media applications and demonstrated stickiness characteristics by posting frequently (triggers and unexpected), recruiting sporting or public personalities to promote campaigns (social currency and public), recruiting Indigenous people from the local region (stories and emotion), and sharing stories and experiences based on real-life events (credible and practical value). Conclusions: KT planning may support campaigns to identify and select KT strategies that are best suited and well-aligned to the campaign’s goals, messages, and target audiences. KT planning can also help mitigate unforeseen and expected risks, reduce unwarranted costs and expenses, achieve goals, and limit the peer pressure of using strategies that may not be fit for purpose. One of the main challenges in using KT systems and processes involves coming to an adequate conceptualization of the KT process itself. %M 27707685 %R 10.2196/mhealth.5987 %U http://mhealth.jmir.org/2016/4/e115/ %U https://doi.org/10.2196/mhealth.5987 %U http://www.ncbi.nlm.nih.gov/pubmed/27707685 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e114 %T Baseline Motivation Type as a Predictor of Dropout in a Healthy Eating Text Messaging Program %A Coa,Kisha %A Patrick,Heather %+ ICF International, 530 Gaither Rd, Rockville, MD, 20850, United States, 1 3015720458, kisha.coa@icfi.com %K mHealth %K behavior change %K diet %K engagement %K motivation %K Self-Determination Theory %D 2016 %7 29.09.2016 %9 Short Paper %J JMIR Mhealth Uhealth %G English %X Background: Growing evidence suggests that text messaging programs are effective in facilitating health behavior change. However, high dropout rates limit the potential effectiveness of these programs. Objective: This paper describes patterns of early dropout in the HealthyYou text (HYTxt) program, with a focus on the impact of baseline motivation quality on dropout, as characterized by Self-Determination Theory (SDT). Methods: This analysis included 193 users of HYTxt, a diet and physical activity text messaging intervention developed by the US National Cancer Institute. Descriptive statistics were computed, and logistic regression models were run to examine the association between baseline motivation type and early program dropout. Results: Overall, 43.0% (83/193) of users dropped out of the program; of these, 65.1% (54/83; 28.0% of all users) did so within the first 2 weeks. Users with higher autonomous motivation had significantly lower odds of dropping out within the first 2 weeks. A one unit increase in autonomous motivation was associated with lower odds (odds ratio 0.44, 95% CI 0.24–0.81) of early dropout, which persisted after adjusting for level of controlled motivation. Conclusions: Applying SDT-based strategies to enhance autonomous motivation might reduce early dropout rates, which can improve program exposure and effectiveness. %M 27688034 %R 10.2196/mhealth.5992 %U http://mhealth.jmir.org/2016/3/e114/ %U https://doi.org/10.2196/mhealth.5992 %U http://www.ncbi.nlm.nih.gov/pubmed/27688034 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e109 %T An mHealth Intervention Using a Smartphone App to Increase Walking Behavior in Young Adults: A Pilot Study %A Walsh,Jane C %A Corbett,Teresa %A Hogan,Michael %A Duggan,Jim %A McNamara,Abra %+ mHealth Research Group, School of Psychology, Arts Millennium Building, National University of Ireland, Galway, Galway City,, Ireland, 353 862329289, jane.walsh@nuigalway.ie %K mHealth %K physical activity %K mobile phone app %K intervention %K health behavior change %K feasibility study %D 2016 %7 22.09.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical inactivity is a growing concern for society and is a risk factor for cardiovascular disease, obesity, and other chronic diseases. Objective: This study aimed to determine the efficacy of the Accupedo-Pro Pedometer mobile phone app intervention, with the goal of increasing daily step counts in young adults. Methods: Mobile phone users (n=58) between 17-26 years of age were randomized to one of two conditions (experimental and control). Both groups downloaded an app that recorded their daily step counts. Baseline data were recorded and followed-up at 5 weeks. Both groups were given a daily walking goal of 30 minutes, but the experimental group participants were told the equivalent goal in steps taken, via feedback from the app. The primary outcome was daily step count between baseline and follow-up. Results: A significant time x group interaction effect was observed for daily step counts (P=.04). Both the experimental (P<.001) and control group (P=.03) demonstrated a significant increase in daily step counts, with the experimental group walking an additional 2000 steps per day. Conclusions: The results of this study demonstrate that a mobile phone app can significantly increase physical activity in a young adult sample by setting specific goals, using self-monitoring, and feedback. %M 27658677 %R 10.2196/mhealth.5227 %U http://mhealth.jmir.org/2016/3/e109/ %U https://doi.org/10.2196/mhealth.5227 %U http://www.ncbi.nlm.nih.gov/pubmed/27658677 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e111 %T Mobile Sensing and Support for People With Depression: A Pilot Trial in the Wild %A Wahle,Fabian %A Kowatsch,Tobias %A Fleisch,Elgar %A Rufer,Michael %A Weidt,Steffi %+ University of St Gallen, Institute of Technology Management, Dufourstrasse 40a, Büro 1-236, St Gallen, 9000, Switzerland, 41 712247244, tobias.kowatsch@unisg.ch %K depression %K mHealth %K  activities of daily living %K classification %K context awareness %K cognitive behavioral therapy %D 2016 %7 21.09.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Depression is a burdensome, recurring mental health disorder with high prevalence. Even in developed countries, patients have to wait for several months to receive treatment. In many parts of the world there is only one mental health professional for over 200 people. Smartphones are ubiquitous and have a large complement of sensors that can potentially be useful in monitoring behavioral patterns that might be indicative of depressive symptoms and providing context-sensitive intervention support. Objective: The objective of this study is 2-fold, first to explore the detection of daily-life behavior based on sensor information to identify subjects with a clinically meaningful depression level, second to explore the potential of context sensitive intervention delivery to provide in-situ support for people with depressive symptoms. Methods: A total of 126 adults (age 20-57) were recruited to use the smartphone app Mobile Sensing and Support (MOSS), collecting context-sensitive sensor information and providing just-in-time interventions derived from cognitive behavior therapy. Real-time learning-systems were deployed to adapt to each subject’s preferences to optimize recommendations with respect to time, location, and personal preference. Biweekly, participants were asked to complete a self-reported depression survey (PHQ-9) to track symptom progression. Wilcoxon tests were conducted to compare scores before and after intervention. Correlation analysis was used to test the relationship between adherence and change in PHQ-9. One hundred twenty features were constructed based on smartphone usage and sensors including accelerometer, Wifi, and global positioning systems (GPS). Machine-learning models used these features to infer behavior and context for PHQ-9 level prediction and tailored intervention delivery. Results: A total of 36 subjects used MOSS for ≥2 weeks. For subjects with clinical depression (PHQ-9≥11) at baseline and adherence ≥8 weeks (n=12), a significant drop in PHQ-9 was observed (P=.01). This group showed a negative trend between adherence and change in PHQ-9 scores (rho=−.498, P=.099). Binary classification performance for biweekly PHQ-9 samples (n=143), with a cutoff of PHQ-9≥11, based on Random Forest and Support Vector Machine leave-one-out cross validation resulted in 60.1% and 59.1% accuracy, respectively. Conclusions: Proxies for social and physical behavior derived from smartphone sensor data was successfully deployed to deliver context-sensitive and personalized interventions to people with depressive symptoms. Subjects who used the app for an extended period of time showed significant reduction in self-reported symptom severity. Nonlinear classification models trained on features extracted from smartphone sensor data including Wifi, accelerometer, GPS, and phone use, demonstrated a proof of concept for the detection of depression superior to random classification. While findings of effectiveness must be reproduced in a RCT to proof causation, they pave the way for a new generation of digital health interventions leveraging smartphone sensors to provide context sensitive information for in-situ support and unobtrusive monitoring of critical mental health states. %M 27655245 %R 10.2196/mhealth.5960 %U http://mhealth.jmir.org/2016/3/e111/ %U https://doi.org/10.2196/mhealth.5960 %U http://www.ncbi.nlm.nih.gov/pubmed/27655245 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e110 %T Physical Activity Assessment Between Consumer- and Research-Grade Accelerometers: A Comparative Study in Free-Living Conditions %A Dominick,Gregory M %A Winfree,Kyle N %A Pohlig,Ryan T %A Papas,Mia A %+ University of Delaware, Department of Behavioral Health and Nutrition, 023 Carpenter Sports Building, 26 North College Avenue, Newark, DE, 19716, United States, 1 302 831 3672, gdominic@udel.edu %K Fitbit %K activity tracker %K actigraphy %K physical activity %K aerobic exercise %K validity %D 2016 %7 19.09.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable activity monitors such as Fitbit enable users to track various attributes of their physical activity (PA) over time and have the potential to be used in research to promote and measure PA behavior. However, the measurement accuracy of Fitbit in absolute free-living conditions is largely unknown. Objective: To examine the measurement congruence between Fitbit Flex and ActiGraph GT3X for quantifying steps, metabolic equivalent tasks (METs), and proportion of time in sedentary activity and light-, moderate-, and vigorous-intensity PA in healthy adults in free-living conditions. Methods: A convenience sample of 19 participants (4 men and 15 women), aged 18-37 years, concurrently wore the Fitbit Flex (wrist) and ActiGraph GT3X (waist) for 1- or 2-week observation periods (n=3 and n=16, respectively) that included self-reported bouts of daily exercise. Data were examined for daily activity, averaged over 14 days and for minutes of reported exercise. Average day-level data included steps, METs, and proportion of time in different intensity levels. Minute-level data included steps, METs, and mean intensity score (0 = sedentary, 3 = vigorous) for overall reported exercise bouts (N=120) and by exercise type (walking, n=16; run or sports, n=44; cardio machine, n=20). Results: Measures of steps were similar between devices for average day- and minute-level observations (all P values > .05). Fitbit significantly overestimated METs for average daily activity, for overall minutes of reported exercise bouts, and for walking and run or sports exercises (mean difference 0.70, 1.80, 3.16, and 2.00 METs, respectively; all P values < .001). For average daily activity, Fitbit significantly underestimated the proportion of time in sedentary and light intensity by 20% and 34%, respectively, and overestimated time by 3% in both moderate and vigorous intensity (all P values < .001). Mean intensity scores were not different for overall minutes of exercise or for run or sports and cardio-machine exercises (all P values > .05). Conclusions: Fitbit Flex provides accurate measures of steps for daily activity and minutes of reported exercise, regardless of exercise type. Although the proportion of time in different intensity levels varied between devices, examining the mean intensity score for minute-level bouts across different exercise types enabled interdevice comparisons that revealed similar measures of exercise intensity. Fitbit Flex is shown to have measurement limitations that may affect its potential utility and validity for measuring PA attributes in free-living conditions. %M 27644334 %R 10.2196/mhealth.6281 %U http://mhealth.jmir.org/2016/3/e110/ %U https://doi.org/10.2196/mhealth.6281 %U http://www.ncbi.nlm.nih.gov/pubmed/27644334 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e106 %T A Context-Sensing Mobile Phone App (Q Sense) for Smoking Cessation: A Mixed-Methods Study %A Naughton,Felix %A Hopewell,Sarah %A Lathia,Neal %A Schalbroeck,Rik %A Brown,Chloë %A Mascolo,Cecilia %A McEwen,Andy %A Sutton,Stephen %+ Behavioural Science Group, Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR, United Kingdom, 44 1223769302, fmen2@medschl.cam.ac.uk %K mobile phone app %K smoking cessation %K context sensing %K tailoring %K geofence %K just-in-time adaptive intervention %K JITAI %K ecological momentary intervention %K craving %D 2016 %7 16.09.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A major cause of lapse and relapse to smoking during a quit attempt is craving triggered by cues from a smoker's immediate environment. To help smokers address these cue-induced cravings when attempting to quit, we have developed a context-aware smoking cessation app, Q Sense, which uses a smoking episode-reporting system combined with location sensing and geofencing to tailor support content and trigger support delivery in real time. Objective: We sought to (1) assess smokers’ compliance with reporting their smoking in real time and identify reasons for noncompliance, (2) assess the app's accuracy in identifying user-specific high-risk locations for smoking, (3) explore the feasibility and user perspective of geofence-triggered support, and (4) identify any technological issues or privacy concerns. Methods: An explanatory sequential mixed-methods design was used, where data collected by the app informed semistructured interviews. Participants were smokers who owned an Android mobile phone and were willing to set a quit date within one month (N=15). App data included smoking reports with context information and geolocation, end-of-day (EoD) surveys of smoking beliefs and behavior, support message ratings, and app interaction data. Interviews were undertaken and analyzed thematically (N=13). Quantitative and qualitative data were analyzed separately and findings presented sequentially. Results: Out of 15 participants, 3 (20%) discontinued use of the app prematurely. Pre-quit date, the mean number of smoking reports received was 37.8 (SD 21.2) per participant, or 2.0 (SD 2.2) per day per participant. EoD surveys indicated that participants underreported smoking on at least 56.2% of days. Geolocation was collected in 97.0% of smoking reports with a mean accuracy of 31.6 (SD 16.8) meters. A total of 5 out of 9 (56%) eligible participants received geofence-triggered support. Interaction data indicated that 50.0% (137/274) of geofence-triggered message notifications were tapped within 30 minutes of being generated, resulting in delivery of a support message, and 78.2% (158/202) of delivered messages were rated by participants. Qualitative findings identified multiple reasons for noncompliance in reporting smoking, most notably due to environmental constraints and forgetting. Participants verified the app’s identification of their smoking locations, were largely positive about the value of geofence-triggered support, and had no privacy concerns about the data collected by the app. Conclusions: User-initiated self-report is feasible for training a cessation app about an individual’s smoking behavior, although underreporting is likely. Geofencing was a reliable and accurate method of identifying smoking locations, and geofence-triggered support was regarded positively by participants. %M 27637405 %R 10.2196/mhealth.5787 %U http://mhealth.jmir.org/2016/3/e106/ %U https://doi.org/10.2196/mhealth.5787 %U http://www.ncbi.nlm.nih.gov/pubmed/27637405 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e103 %T Acceptance and Commitment Therapy in Daily Life Training: A Feasibility Study of an mHealth Intervention %A Batink,Tim %A Bakker,Jindra %A Vaessen,Thomas %A Kasanova,Zuzana %A Collip,Dina %A van Os,Jim %A Wichers,Marieke %A Germeys,Inez %A Peeters,Frenk %+ Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht University, SN2, Vijverdalseweg 1, Maastricht,, Netherlands, 31 620 454 912, tim.batink@maastrichtuniversity.nl %K mHealth %K behavior change %K daily life intervention %K acceptance and commitment therapy %K experience sampling %D 2016 %7 15.09.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the development of mHealth, it is possible to treat patients in their natural environment. Mobile technology helps to bridge the gap between the therapist’s office and the “real world.” The ACT in Daily Life training (ACT-DL) was designed as an add-on intervention to help patients practice with acceptance and commitment therapy in their daily lives. The ACT-DL consists of two main components: daily monitoring using experience sampling and ACT training in daily life. Objectives: To assess the acceptability and feasibility of the ACT-DL in a general outpatient population. A secondary objective was to conduct a preliminary examination of the effectiveness of the ACT-DL. Methods: An observational comparative study was conducted. The experimental group consisted of 49 patients who volunteered for ACT-DL, and the control group consisted of 112 patients who did not volunteer. As part of an inpatient treatment program, both groups received a 6-week ACT training. Participants went home to continue their treatment on an outpatient basis, during which time the experimental group received the 4-week add-on ACT-DL. Acceptability and feasibility of the ACT-DL was assessed weekly by telephone survey. Effectiveness of the ACT-DL was evaluated with several self-report questionnaires ( Flexibility Index Test (FIT-60): psychological flexibility, Brief Symptom Inventory: symptoms, Utrechtse Coping List: coping, and Quality of life visual analog scale (QoL-VAS): quality of life). Results: More than three-quarters of the participants (76%) completed the full 4-week training. User evaluations showed that ACT-DL stimulated the use of ACT in daily life: participants practiced over an hour a week (mean 78.8 minutes, standard deviation 54.4), doing 10.4 exercises (standard deviation 6.0) on average. Both ACT exercises and metaphors were experienced as useful components of the training (rated 5 out of 7). Repeated measures ANCOVA did not show significant effects of the ACT-DL on psychological flexibility (P=.88), symptoms (P=.39), avoidant coping (P=.28), or quality of life (P=.15). Conclusions: This is the first study that uses experience sampling to foster awareness in daily life in combination with acceptance and commitment therapy to foster skill building. Adherence to the ACT-DL was high for an intensive mHealth intervention. ACT-DL appears to be an acceptable and feasible mHealth intervention, suitable for a broad range of mental health problems. However, short-term effectiveness could not be demonstrated. Additional clinical trials are needed to examine both short-term and long-term effects. %M 27634747 %R 10.2196/mhealth.5437 %U http://mhealth.jmir.org/2016/3/e103/ %U https://doi.org/10.2196/mhealth.5437 %U http://www.ncbi.nlm.nih.gov/pubmed/27634747 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 3 %P e178 %T Development of a Mobile Phone-Based Weight Loss Lifestyle Intervention for Filipino Americans with Type 2 Diabetes: Protocol and Early Results From the PilAm Go4Health Randomized Controlled Trial %A Bender,Melinda Sarmiento %A Santos,Glenn-Milo %A Villanueva,Carissa %A Arai,Shoshana %+ School of Nursing, Department of Family Health Care Nursing, University of California San Francisco, 2 Koret Way, N431C, Box 0606, San Francisco, CA, 94143, United States, 1 415 502 5668, melinda.bender@ucsf.edu %K randomized controlled trial %K lifestyle intervention %K weight loss %K Filipinos %K type 2 diabetes %K culturally adapted %K Asian Americans %D 2016 %7 08.09.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Filipino Americans are the second largest Asian subgroup in the United States, and were found to have the highest prevalence of obesity and type 2 diabetes (T2D) compared to all Asian subgroups and non-Hispanic whites. In addition to genetic factors, risk factors for Filipinos that contribute to this health disparity include high sedentary rates and high fat diets. However, Filipinos are seriously underrepresented in preventive health research. Research is needed to identify effective interventions to reduce Filipino diabetes risks, subsequent comorbidities, and premature death. Objective: The overall goal of this project is to assess the feasibility and potential efficacy of the Filipino Americans Go4Health Weight Loss Program (PilAm Go4Health). This program is a culturally adapted weight loss lifestyle intervention, using digital technology for Filipinos with T2D, to reduce their risk for metabolic syndrome. Methods: This study was a 3-month mobile phone-based pilot randomized controlled trial (RCT) weight loss intervention with a wait list active control, followed by a 3-month maintenance phase design for 45 overweight Filipinos with T2D. Participants were randomized to an intervention group (n=22) or active control group (n=23), and analyses of the results are underway. The primary outcome will be percent weight change of the participants, and secondary outcomes will include changes in waist circumference, fasting plasma glucose, glycated hemoglobin A1c, physical activity, fat intake, and sugar-sweetened beverage intake. Data analyses will include descriptive statistics to describe sample characteristics and a feasibility assessment based on recruitment, adherence, and retention. Chi-square, Fisher's exact tests, t-tests, and nonparametric rank tests will be used to assess characteristics of randomized groups. Primary analyses will use analysis of covariance and linear mixed models to compare primary and secondary outcomes at 3 months, compared by arm and controlled for baseline levels. Results: Recruitment was completed in January, 2016, and participant follow-up continued through June, 2016. At baseline, mean age was 57 years, 100% (45/45) of participants self-identified as Filipinos, and the cohort was comprised of 17 males and 28 females. Overall, participants were obese with a baseline mean body mass index of 30.2 kg/m2 (standard deviation 4.9). The majority of participants were immigrants (84%, 38/45), with 47% (21/45) living in the United States for more than 10 years. One third of all participants (33%, 15/45) had previously used a pedometer. Conclusions: This study will provide preliminary evidence to determine if the PilAm Go4Health weight loss lifestyle intervention is feasible, and if the program demonstrates potential efficacy to reduce risks for metabolic syndrome in Filipinos with T2D. Positive results will lend support for a larger RCT to evaluate the effectiveness of the PilAm Go4Health intervention for Filipinos. ClinicalTrial: ClinicalTrials.gov: NCT02290184; https://clinicaltrials.gov/ct2/show/NCT02290184 (Archived at http://www.webcitation.org/6k1kUqKSP) %M 27608829 %R 10.2196/resprot.5836 %U http://www.researchprotocols.org/2016/3/e178/ %U https://doi.org/10.2196/resprot.5836 %U http://www.ncbi.nlm.nih.gov/pubmed/27608829 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 9 %P e239 %T Estimating Physical Activity and Sedentary Behavior in a Free-Living Context: A Pragmatic Comparison of Consumer-Based Activity Trackers and ActiGraph Accelerometry %A Gomersall,Sjaan R %A Ng,Norman %A Burton,Nicola W %A Pavey,Toby G %A Gilson,Nicholas D %A Brown,Wendy J %+ Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Building 26B, Blair Drive, Brisbane, 4072, Australia, 61 733653115, s.gomersall1@uq.edu.au %K activity tracker %K physical activity %K sedentary behavior %K accelerometry %K Fitbit %K Jawbone %D 2016 %7 07.09.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Activity trackers are increasingly popular with both consumers and researchers for monitoring activity and for promoting positive behavior change. However, there is a lack of research investigating the performance of these devices in free-living contexts, for which findings are likely to vary from studies conducted in well-controlled laboratory settings. Objective: The aim was to compare Fitbit One and Jawbone UP estimates of steps, moderate-to-vigorous physical activity (MVPA), and sedentary behavior with data from the ActiGraph GT3X+ accelerometer in a free-living context. Methods: Thirty-two participants were recruited using convenience sampling; 29 provided valid data for this study (female: 90%, 26/29; age: mean 39.6, SD 11.0 years). On two occasions for 7 days each, participants wore an ActiGraph GT3X+ accelerometer on their right hip and either a hip-worn Fitbit One (n=14) or wrist-worn Jawbone UP (n=15) activity tracker. Daily estimates of steps and very active minutes were derived from the Fitbit One (n=135 days) and steps, active time, and longest idle time from the Jawbone UP (n=154 days). Daily estimates of steps, MVPA, and longest sedentary bout were derived from the corresponding days of ActiGraph data. Correlation coefficients and Bland-Altman plots with examination of systematic bias were used to assess convergent validity and agreement between the devices and the ActiGraph. Cohen’s kappa was used to assess the agreement between each device and the ActiGraph for classification of active versus inactive (≥10,000 steps per day and ≥30 min/day of MVPA) comparable with public health guidelines. Results: Correlations with ActiGraph estimates of steps and MVPA ranged between .72 and .90 for Fitbit One and .56 and .75 for Jawbone UP. Compared with ActiGraph estimates, both devices overestimated daily steps by 8% (Fitbit One) and 14% (Jawbone UP). However, mean differences were larger for daily MVPA (Fitbit One: underestimated by 46%; Jawbone UP: overestimated by 50%). There was systematic bias across all outcomes for both devices. Correlations with ActiGraph data for longest idle time (Jawbone UP) ranged from .08 to .19. Agreement for classifying days as active or inactive using the ≥10,000 steps/day criterion was substantial (Fitbit One: κ=.68; Jawbone UP: κ=.52) and slight-fair using the criterion of ≥30 min/day of MVPA (Fitbit One: κ=.40; Jawbone UP: κ=.14). Conclusions: There was moderate-strong agreement between the ActiGraph and both Fitbit One and Jawbone UP for the estimation of daily steps. However, due to modest accuracy and systematic bias, they are better suited for consumer-based self-monitoring (eg, for the public consumer or in behavior change interventions) rather than to evaluate research outcomes. The outcomes that relate to health-enhancing MVPA (eg, “very active minutes” for Fitbit One or “active time” for Jawbone UP) and sedentary behavior (“idle time” for Jawbone UP) should be used with caution by consumers and researchers alike. %M 27604226 %R 10.2196/jmir.5531 %U http://www.jmir.org/2016/9/e239/ %U https://doi.org/10.2196/jmir.5531 %U http://www.ncbi.nlm.nih.gov/pubmed/27604226 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e102 %T An Evaluation of a Smartphone–Assisted Behavioral Weight Control Intervention for Adolescents: Pilot Study %A Jensen,Chad D %A Duncombe,Kristina M %A Lott,Mark A %A Hunsaker,Sanita L %A Duraccio,Kara M %A Woolford,Susan J %+ Brigham Young University, Department of Psychology, 223 John Taylor Building, Provo, UT, 84660, United States, 1 801 422 5958, chadjensen@byu.edu %K obesity %K adolescence %K weight control %K electronic intervention %K self-monitoring %D 2016 %7 23.08.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The efficacy of adolescent weight control treatments is modest, and effective treatments are costly and are not widely available. Smartphones may be an effective method for delivering critical components of behavioral weight control treatment including behavioral self-monitoring. Objective: To examine the efficacy and acceptability of a smartphone assisted adolescent behavioral weight control intervention. Methods: A total of 16 overweight or obese adolescents (mean age=14.29 years, standard deviation=1.12) received 12 weeks of combined treatment that consisted of weekly in-person group behavioral weight control treatment sessions plus smartphone self-monitoring and daily text messaging. Subsequently they received 12 weeks of electronic-only intervention, totaling 24 weeks of intervention. Results: On average, participants attained modest but significant reductions in body mass index standard score (zBMI: 0.08 standard deviation units, t (13)=2.22, P=.04, d=0.63) over the in-person plus electronic-only intervention period but did not maintain treatment gains over the electronic-only intervention period. Participants self-monitored on approximately half of combined intervention days but less than 20% of electronic-only intervention days. Conclusions: Smartphones likely hold promise as a component of adolescent weight control interventions but they may be less effective in helping adolescents maintain treatment gains after intensive interventions. %M 27554704 %R 10.2196/mhealth.6034 %U http://mhealth.jmir.org/2016/3/e102/ %U https://doi.org/10.2196/mhealth.6034 %U http://www.ncbi.nlm.nih.gov/pubmed/27554704 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e101 %T Retrofit Weight-Loss Outcomes at 6, 12, and 24 Months and Characteristics of 12-Month High Performers: A Retrospective Analysis %A Painter,Stefanie %A Ditsch,Gary %A Ahmed,Rezwan %A Hanson,Nicholas Buck %A Kachin,Kevin %A Berger,Jan %+ Retrofit, Inc, 123 N Wacker Drive, Suit 1250, Chicago, IL,, United States, 1 304 546 9968, stefanie@retrofitme.com %K behavior %K body mass index %K BMI %K engagement %K fitness %K self-monitoring %K obesity %K overweight %K weight loss %D 2016 %7 22.08.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obesity is the leading cause of preventable death costing the health care system billions of dollars. Combining self-monitoring technology with personalized behavior change strategies results in clinically significant weight loss. However, there is a lack of real-world outcomes in commercial weight-loss program research. Objective: Retrofit is a personalized weight management and disease-prevention solution. This study aimed to report Retrofit’s weight-loss outcomes at 6, 12, and 24 months and characterize behaviors, age, and sex of high-performing participants who achieved weight loss of 10% or greater at 12 months. Methods: A retrospective analysis was performed from 2011 to 2014 using 2720 participants enrolled in a Retrofit weight-loss program. Participants had a starting body mass index (BMI) of >25 kg/m² and were at least 18 years of age. Weight measurements were assessed at 6, 12, and 24 months in the program to evaluate change in body weight, BMI, and percentage of participants who achieved 5% or greater weight loss. A secondary analysis characterized high-performing participants who lost ≥10% of their starting weight (n=238). Characterized behaviors were evaluated, including self-monitoring through weigh-ins, number of days wearing an activity tracker, daily step count average, and engagement through coaching conversations via Web-based messages, and number of coaching sessions attended. Results: Average weight loss at 6 months was −5.55% for male and −4.86% for female participants. Male and female participants had an average weight loss of −6.28% and −5.37% at 12 months, respectively. Average weight loss at 24 months was −5.03% and −3.15% for males and females, respectively. Behaviors of high-performing participants were assessed at 12 months. Number of weigh-ins were greater in high-performing male (197.3 times vs 165.4 times, P=.001) and female participants (222 times vs 167 times, P<.001) compared with remaining participants. Total activity tracker days and average steps per day were greater in high-performing females (304.7 vs 266.6 days, P<.001; 8380.9 vs 7059.7 steps, P<.001, respectively) and males (297.1 vs 255.3 days, P<.001; 9099.3 vs 8251.4 steps, P=.008, respectively). High-performing female participants had significantly more coaching conversations via Web-based messages than remaining female participants (341.4 vs 301.1, P=.03), as well as more days with at least one such electronic message (118 vs 108 days, P=.03). High-performing male participants displayed similar behavior. Conclusions: Participants on the Retrofit program lost an average of −5.21% at 6 months, −5.83% at 12 months, and −4.09% at 24 months. High-performing participants show greater adherence to self-monitoring behaviors of weighing in, number of days wearing an activity tracker, and average number of steps per day. Female high performers have higher coaching engagement through conversation days and total number of coaching conversations. %M 27549134 %R 10.2196/mhealth.5873 %U http://mhealth.jmir.org/2016/3/e101/ %U https://doi.org/10.2196/mhealth.5873 %U http://www.ncbi.nlm.nih.gov/pubmed/27549134 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e99 %T Increasing Nonsedentary Behaviors in University Students Using Text Messages: Randomized Controlled Trial %A Cotten,Emma %A Prapavessis,Harry %+ Exercise and Health Psychology Laboratory, School of Kinesiology, Western University, Room 408, Arthur and Sonia Labatt Health Sciences Building, London, ON, N6A 5B9, Canada, 1 519 902 9136, ecotten@uwo.ca %K sedentary behaviour %K prolonged sitting %K text messages %K self-efficacy %K university students %K breaks from sitting %K light intensity physical activity %K moderate intensity physical activity %D 2016 %7 19.08.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Sedentary behavior (SB) has been linked to many health problems such as type 2 diabetes and heart disease. Increasing the length and frequency of breaks from sitting and increasing the time spent standing and engaged in light and moderate physical activity are ways to decrease SB. Text message-based interventions have succeeded in aiding smoking cessation and increase both physical activity and healthy eating, but they have not been shown to reduce SB. Objective: The primary purpose of this pilot study was to determine the effectiveness of a text message-based intervention in increasing nonsedentary behaviors in university students. A secondary purpose was to (1) determine whether the intervention could enhance self-efficacy beliefs for decreasing SB and (2) whether these efficacious beliefs could predict actual SB. Methods: Eighty-two university students were recruited via mass emails and randomized into intervention (SB-related text messages) or control (text messages unrelated to SB) groups. Participants received daily text messages scheduled by the researcher encouraging breaks from sitting, standing, light- and moderate-intensity physical activity (PA). They then reported various SBs via Web-based questionnaires at four time points (baseline, 2, 4, and 6 weeks). Self-efficacious beliefs toward taking breaks from sitting and decreasing the amount of time spent sitting were assessed at the same time points. Results: Last observation carried forward (LOCF) method was used for incomplete data as an intent-to-treat (ITT) analysis (intervention group n=15, control group n=11). Small-to-moderate effects favoring the text intervention group were found at 6 weeks for break frequency -14.64 minutes, break length +.59 minutes, standing +24.30 min/day, light-intensity +74.34 min/day, and moderate-intensity + 9.97 min/day PA. Only light-intensity PA approached significance (P=.07). Self-efficacy beliefs also favored the text intervention group and reached significance (P=.032) for sitting less. Significant (P<.05) relations were found between the self-efficacy constructs and breaks, standing, and light or moderate PA. Conclusions: Text messages have the potential to increase nonsedentary behaviors in university students. These messages can increase self-efficacy beliefs to take more breaks and reduce sitting time. Efficacious beliefs can predict actual SB and to a lesser extent light- and moderate-intensity PA. Trial Registration: ClinicalTrials.gov NCT02562937; https://clinicaltrials.gov/ct2/show/NCT02562937 (Archived by WebCite at http://www.webcitation.org/6jVLwXE5M) %M 27543317 %R 10.2196/mhealth.5411 %U http://mhealth.jmir.org/2016/3/e99/ %U https://doi.org/10.2196/mhealth.5411 %U http://www.ncbi.nlm.nih.gov/pubmed/27543317 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 3 %P e164 %T Incorporating Novel Mobile Health Technologies Into Management of Knee Osteoarthritis in Patients Treated With Intra-Articular Hyaluronic Acid: Rationale and Protocol of a Randomized Controlled Trial %A Jones,Donald %A Skrepnik,Nebojsa %A Toselli,Richard M %A Leroy,Bruno %+ Scripps Translational Science Institute, 3344 North Torrey Pines Ct, Suite 300, La Jolla, CA,, United States, 1 858 554 5710, donaldj@cardiffoceangroup.com %K mHealth %K osteoarthritis %K pain %K physical therapy %D 2016 %7 09.08.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Osteoarthritis (OA) of the knee is one of the leading causes of disability in the United States. One relatively new strategy that could be helpful in the management of OA is the use of mHealth technologies, as they can be used to increase physical activity and promote exercise, which are key components of knee OA management. Objective: Currently, no published data on the use of a mHealth approach to comprehensively monitor physical activity in patients with OA are available, and similarly, no data on whether mHealth technologies can impact outcomes are available. Our objective is to evaluate the effectiveness of mHealth technology as part of a tailored, comprehensive management strategy for patients with knee OA. Methods: The study will assess the impact of a smartphone app that integrates data from a wearable activity monitor (thereby both encouraging changes in mobility as well as tracking them) combined with education about the benefits of walking on patient mobility. The results from the intervention group will be compared with data from a control group of individuals who are given the same Arthritis Foundation literature regarding the benefits of walking and wearable activity monitors but who do not have access to the data from those monitors. Activity monitors will capture step count estimates and will compare those with patients’ step goals, calories burned, and distance walked. Patients using the novel smartphone app will be able to enter information on their daily pain, mood, and sleep quality. The relationships among activity and pain, activity and mood, and sleep will be assessed, as will patient satisfaction with and adherence to the mobile app. Results: We present information on an upcoming trial that will prospectively assess the ability of a mobile app to improve mobility for knee OA patients who are treated with intra-articular hyaluronic acid. Conclusions: We anticipate the results of this study will support the concept that mHealth technologies provide continuous, real-time feedback to patients with OA on their overall level of activity for a more proactive, personalized approach to treatment that may help modify behavior and assist with self-management through treatment support in the form of motivational messages and reminders. %M 27506148 %R 10.2196/resprot.5940 %U http://www.researchprotocols.org/2016/3/e164/ %U https://doi.org/10.2196/resprot.5940 %U http://www.ncbi.nlm.nih.gov/pubmed/27506148 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e98 %T The Quality and Accuracy of Mobile Apps to Prevent Driving After Drinking Alcohol %A Wilson,Hollie %A Stoyanov,Stoyan R %A Gandabhai,Shailen %A Baldwin,Alexander %+ Centre for Accident Research & Road Safety - Queensland (CARRS-Q), Institute of Health and Biomedical Innovation, Queensland University of Technology, Victoria Park Road, Kelvin Grove, 4059, Australia, 61 731380394, hollie.wilson@qut.edu.au %K drink driving %K alcohol %K mobile apps %K calculator %K Mobile Application Rating Scale %K blood alcohol content %D 2016 %7 08.08.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Driving after the consumption of alcohol represents a significant problem globally. Individual prevention countermeasures such as personalized mobile apps aimed at preventing such behavior are widespread, but there is little research on their accuracy and evidence base. There has been no known assessment investigating the quality of such apps. Objective: This study aimed to determine the quality and accuracy of apps for drink driving prevention by conducting a review and evaluation of relevant mobile apps. Methods: A systematic app search was conducted following PRISMA guidelines. App quality was assessed using the Mobile App Rating Scale (MARS). Apps providing blood alcohol calculators (hereafter “calculators”) were reviewed against current alcohol advice for accuracy. Results: A total of 58 apps (30 iOS and 28 Android) met inclusion criteria and were included in the final analysis. Drink driving prevention apps had significantly lower engagement and overall quality scores than alcohol management apps. Most calculators provided conservative blood alcohol content (BAC) time until sober calculations. None of the apps had been evaluated to determine their efficacy in changing either drinking or driving behaviors. Conclusions: This novel study demonstrates that most drink driving prevention apps are not engaging and lack accuracy. They could be improved by increasing engagement features, such as gamification. Further research should examine the context and motivations for using apps to prevent driving after drinking in at-risk populations. Development of drink driving prevention apps should incorporate evidence-based information and guidance, lacking in current apps. %M 27502956 %R 10.2196/mhealth.5961 %U http://mhealth.jmir.org/2016/3/e98/ %U https://doi.org/10.2196/mhealth.5961 %U http://www.ncbi.nlm.nih.gov/pubmed/27502956 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e215 %T Long-Term Effects of an Internet-Mediated Pedometer-Based Walking Program for Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial %A Moy,Marilyn L %A Martinez,Carlos H %A Kadri,Reema %A Roman,Pia %A Holleman,Robert G %A Kim,Hyungjin Myra %A Nguyen,Huong Q %A Cohen,Miriam D %A Goodrich,David E %A Giardino,Nicholas D %A Richardson,Caroline R %+ Department of Family Medicine, University of Michigan, 1018 Fuller St., Ann Arbor, MI, 48104, United States, 1 734 998 7120 ext 316, caroli@umich.edu %K bronchitis, chronic %K emphysema %K pulmonary disease, chronic obstructive %K quality of life %K exercise %K motor activity %K Internet %D 2016 %7 08.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Regular physical activity (PA) is recommended for persons with chronic obstructive pulmonary disease (COPD). Interventions that promote PA and sustain long-term adherence to PA are needed. Objective: We examined the effects of an Internet-mediated, pedometer-based walking intervention, called Taking Healthy Steps, at 12 months. Methods: Veterans with COPD (N=239) were randomized in a 2:1 ratio to the intervention or wait-list control. During the first 4 months, participants in the intervention group were instructed to wear the pedometer every day, upload daily step counts at least once a week, and were provided access to a website with four key components: individualized goal setting, iterative feedback, educational and motivational content, and an online community forum. The subsequent 8-month maintenance phase was the same except that participants no longer received new educational content. Participants randomized to the wait-list control group were instructed to wear the pedometer, but they did not receive step-count goals or instructions to increase PA. The primary outcome was health-related quality of life (HRQL) assessed by the St George’s Respiratory Questionnaire Total Score (SGRQ-TS); the secondary outcome was daily step count. Linear mixed-effect models assessed the effect of intervention over time. One participant was excluded from the analysis because he was an outlier. Within the intervention group, we assessed pedometer adherence and website engagement by examining percent of days with valid step-count data, number of log-ins to the website each month, use of the online community forum, and responses to a structured survey. Results: Participants were 93.7% male (223/238) with a mean age of 67 (SD 9) years. At 12 months, there were no significant between-group differences in SGRQ-TS or daily step count. Between-group difference in daily step count was maximal and statistically significant at month 4 (P<.001), but approached zero in months 8-12. Within the intervention group, mean 76.7% (SD 29.5) of 366 days had valid step-count data, which decreased over the months of study (P<.001). Mean number of log-ins to the website each month also significantly decreased over the months of study (P<.001). The online community forum was used at least once during the study by 83.8% (129/154) of participants. Responses to questions assessing participants’ goal commitment and intervention engagement were not significantly different at 12 months compared to 4 months. Conclusions: An Internet-mediated, pedometer-based PA intervention, although efficacious at 4 months, does not maintain improvements in HRQL and daily step counts at 12 months. Waning pedometer adherence and website engagement by the intervention group were observed. Future efforts should focus on improving features of PA interventions to promote long-term behavior change and sustain engagement in PA. ClinicalTrial: Clinicaltrials.gov NCT01102777; https://clinicaltrials.gov/ct2/show/NCT01102777 (Archived by WebCite at http://www.webcitation.org/6iyNP9KUC) %M 27502583 %R 10.2196/jmir.5622 %U http://www.jmir.org/2016/8/e215/ %U https://doi.org/10.2196/jmir.5622 %U http://www.ncbi.nlm.nih.gov/pubmed/27502583 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e207 %T mHealth Intervention to Improve Diabetes Risk Behaviors in India: A Prospective, Parallel Group Cohort Study %A Pfammatter,Angela %A Spring,Bonnie %A Saligram,Nalini %A Davé,Raj %A Gowda,Arun %A Blais,Linelle %A Arora,Monika %A Ranjani,Harish %A Ganda,Om %A Hedeker,Donald %A Reddy,Sethu %A Ramalingam,Sandhya %+ Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr, Suite 1400, Chicago, IL, 60611, United States, 1 312 503 1574, angela.pfammatter@northwestern.edu %K mHealth %K diabetes %K health promotion %D 2016 %7 05.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: In low/middle income countries like India, diabetes is prevalent and health care access limited. Most adults have a mobile phone, creating potential for mHealth interventions to improve public health. To examine the feasibility and initial evidence of effectiveness of mDiabetes, a text messaging program to improve diabetes risk behaviors, a global nonprofit organization (Arogya World) implemented mDiabetes among one million Indian adults. Objective: A prospective, parallel cohort design was applied to examine whether mDiabetes improved fruit, vegetable, and fat intakes and exercise. Methods: Intervention participants were randomly selected from the one million Nokia subscribers who elected to opt in to mDiabetes. Control group participants were randomly selected from non-Nokia mobile phone subscribers. mDiabetes participants received 56 text messages in their choice of 12 languages over 6 months; control participants received no contact. Messages were designed to motivate improvement in diabetes risk behaviors and increase awareness about the causes and complications of diabetes. Participant health behaviors (exercise and fruit, vegetable, and fat intake) were assessed between 2012 and 2013 via telephone surveys by blinded assessors at baseline and 6 months later. Data were cleaned and analyzed in 2014 and 2015. Results: 982 participants in the intervention group and 943 in the control group consented to take the phone survey at baselne. At the end of the 6-month period, 611 (62.22%) in the intervention and 632 (67.02%) in the control group completed the follow-up telephone survey. Participants receiving texts demonstrated greater improvement in a health behavior composite score over 6 months, compared with those who received no messages F(1, 1238) = 30.181, P<.001, 95% CI, 0.251-0.531. Fewer intervention participants demonstrated health behavior decline compared with controls. Improved fruit, vegetable, and fat consumption (P<.01) but not exercise were observed in those receiving messages, as compared with controls. Conclusions: A text messaging intervention was feasible and showed initial evidence of effectiveness in improving diabetes-related health behaviors, demonstrating the potential to facilitate population-level behavior change in a low/middle income country. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN): 12615000423516; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367946&isReview=true (Archived by WebCite at http://www.webcitation.org/6j5ptaJgF) %M 27496271 %R 10.2196/jmir.5712 %U http://www.jmir.org/2016/8/e207/ %U https://doi.org/10.2196/jmir.5712 %U http://www.ncbi.nlm.nih.gov/pubmed/27496271 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e95 %T Prioritizing the mHealth Design Space: A Mixed-Methods Analysis of Smokers’ Perspectives %A Hartzler,Andrea Lisabeth %A BlueSpruce,June %A Catz,Sheryl L %A McClure,Jennifer B %+ Group Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA, 98101, United States, 1 206 287 2030, hartzler.a@ghc.org %K mobile health %K human-centered design %K human-computer interaction %K smartphone %K smoking cessation %K telemedicine %K software design %D 2016 %7 05.08.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smoking remains the leading cause of preventable disease and death in the United States. Therefore, researchers are constantly exploring new ways to promote smoking cessation. Mobile health (mHealth) technologies could be effective cessation tools. Despite the availability of commercial quit-smoking apps, little research to date has examined smokers’ preferred treatment intervention components (ie, design features). Honoring these preferences is important for designing programs that are appealing to smokers and may be more likely to be adopted and used. Objective: The aim of this study was to understand smokers’ preferred design features of mHealth quit-smoking tools. Methods: We used a mixed-methods approach consisting of focus groups and written surveys to understand the design preferences of adult smokers who were interested in quitting smoking (N=40). Focus groups were stratified by age to allow differing perspectives to emerge between older (>40 years) and younger (<40 years) participants. Focus group discussion included a “blue-sky” brainstorming exercise followed by participant reactions to contrasting design options for communicating with smokers, providing social support, and incentivizing program use. Participants rated the importance of preselected design features on an exit survey. Qualitative analyses examined emergent discussion themes and quantitative analyses compared feature ratings to determine which were perceived as most important. Results: Participants preferred a highly personalized and adaptive mHealth experience. Their ideal mHealth quit-smoking tool would allow personalized tracking of their progress, adaptively tailored feedback, and real-time peer support to help manage smoking cravings. Based on qualitative analysis of focus group discussion, participants preferred pull messages (ie, delivered upon request) over push messages (ie, sent automatically) and preferred interaction with other smokers through closed social networks. Preferences for entertaining games or other rewarding incentives to encourage program use differed by age group. Based on quantitative analysis of surveys, participants rated the importance of select design features significantly differently (P<.001). Design features rated as most important included personalized content, the ability to track one’s progress, and features designed to help manage nicotine withdrawal and medication side effects. Design features rated least important were quit-smoking videos and posting on social media. Communicating with stop-smoking experts was rated more important than communicating with family and friends about quitting (P=.03). Perceived importance of various design features varied by age, experience with technology, and frequency of smoking. Conclusions: Future mHealth cessation aids should be designed with an understanding of smokers’ needs and preferences for these tools. Doing so does not guarantee treatment effectiveness, but balancing user preferences with best-practice treatment considerations could enhance program adoption and improve treatment outcomes. Grounded in the perspectives of smokers, we identify several design considerations, which should be prioritized when designing future mHealth cessation tools and which warrant additional empirical validation. %M 27496593 %R 10.2196/mhealth.5742 %U http://mhealth.jmir.org/2016/3/e95/ %U https://doi.org/10.2196/mhealth.5742 %U http://www.ncbi.nlm.nih.gov/pubmed/27496593 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e94 %T Evaluating an Adaptive and Interactive mHealth Smoking Cessation and Medication Adherence Program: A Randomized Pilot Feasibility Study %A McClure,Jennifer B %A Anderson,Melissa L %A Bradley,Katharine %A An,Lawrence C %A Catz,Sheryl L %+ Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA,, United States, 1 206 287 2737, McClure.J@ghc.org %K tobacco use cessation %K smoking %K mobile health %K mHealth %K eHealth %K secure messaging %K varenicline %D 2016 %7 03.08.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) interventions hold great promise for helping smokers quit since these programs can have wide reach and facilitate access to comprehensive, interactive, and adaptive treatment content. However, the feasibility, acceptability, and effectiveness of these programs remain largely untested. Objective: To assess feasibility and acceptability of the My Mobile Advice Program (MyMAP) smoking cessation program and estimate its effects on smoking cessation and medication adherence to inform future research planning. Methods: Sixty-six smokers ready to quit were recruited from a large regional health care system and randomized to one of two mHealth programs: (1) standard self-help including psychoeducational materials and guidance how to quit smoking or (2) an adaptive and interactive program consisting of the same standard mHealth self-help content as controls received plus a) real-time, adaptively tailored advice for managing nicotine withdrawal symptoms and medication side-effects and b) asynchronous secure messaging with a cessation counselor. Participants in both arms were also prescribed a 12-week course of varenicline. Follow-up assessments were conducted at 2 weeks post-target quit date (TQD), 3 months post-TQD, and 5 months post-TQD. Indices of program feasibility and acceptability included acceptability ratings, utilization metrics including use of each MyMAP program component (self-help content, secure messaging, and adaptively tailored advice), and open-ended feedback from participants. Smoking abstinence and medication adherence were also assessed to estimate effects on these treatment outcomes. Results: Utilization data indicated the MyMAP program was actively used, with higher mean program log-ins by experimental than control participants (10.6 vs 2.7, P<.001). The majority of experimental respondents thought the MyMAP program could help other people quit smoking (22/24, 92%) and consistently take their stop-smoking medication (17/22, 97%) and would recommend the program to others (20/23, 87%). They also rated the program as convenient, responsive to their needs, and easy to use. Abstinence rates at 5-month follow-up were 36% in the experimental arm versus 24% among controls (odds ratio 1.79 [0.61-5.19], P=.42). Experimental participants used their varenicline an average of 46 days versus 39 among controls (P=.49). More than two-thirds (22/33, 67%) of experimental participants and three-quarters (25/33, 76%) of controls prematurely discontinued their varenicline use (P=.29). Conclusions: The MyMAP intervention was found to be feasible and acceptable. Since the study was not powered for statistical significance, no conclusions can be drawn about the program’s effects on smoking abstinence or medication adherence, but the overall study results suggest further evaluation in a larger randomized trial is warranted. ClinicalTrial: ClinicalTrials.gov NCT02136498; https://clinicaltrials.gov/ct2/show/NCT02136498 (Archived by WebCite at http://www.webcitation.org/6jT3UMFLj) %M 27489247 %R 10.2196/mhealth.6002 %U http://mhealth.jmir.org/2016/3/e94/ %U https://doi.org/10.2196/mhealth.6002 %U http://www.ncbi.nlm.nih.gov/pubmed/27489247 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e93 %T The Empowering Role of Mobile Apps in Behavior Change Interventions: The Gray Matters Randomized Controlled Trial %A Hartin,Phillip J %A Nugent,Chris D %A McClean,Sally I %A Cleland,Ian %A Tschanz,JoAnn T %A Clark,Christine J %A Norton,Maria C %+ Computer Science Research Institute, Ulster University, Room 16J26, University of Ulster, Newtownabbey, BT37 0QB, United Kingdom, 44 28 9036 8840, pj.hartin@ulster.ac.uk %K behavior %K health behavior %K behavior change %K motivation %K Alzheimer disease %K smartphone %D 2016 %7 02.08.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health education and behavior change programs targeting specific risk factors have demonstrated their effectiveness in reducing the development of future diseases. Alzheimer disease (AD) shares many of the same risk factors, most of which can be addressed via behavior change. It is therefore theorized that a behavior change intervention targeting these risk factors would likely result in favorable rates of AD prevention. Objective: The objective of this study was to reduce the future risk of developing AD, while in the short term promoting vascular health, through behavior change. Methods: The study was an interventional randomized controlled trial consisting of subjects who were randomly assigned into either treatment (n=102) or control group (n=42). Outcome measures included various blood-based biomarkers, anthropometric measures, and behaviors related to AD risk. The treatment group was provided with a bespoke “Gray Matters” mobile phone app designed to encourage and facilitate behavior change. The app presented evidence-based educational material relating to AD risk and prevention strategies, facilitated self-reporting of behaviors across 6 behavioral domains, and presented feedback on the user’s performance, calculated from reported behaviors against recommended guidelines. Results: This paper explores the rationale for a mobile phone–led intervention and details the app’s effect on behavior change and subsequent clinical outcomes. Via the app, the average participant submitted 7.3 (SD 3.2) behavioral logs/day (n=122,719). Analysis of these logs against primary outcome measures revealed that participants who improved their high-density lipoprotein cholesterol levels during the study duration answered a statistically significant higher number of questions per day (mean 8.30, SD 2.29) than those with no improvement (mean 6.52, SD 3.612), t97.74=−3.051, P=.003. Participants who decreased their body mass index (BMI) performed significantly better in attaining their recommended daily goals (mean 56.21 SD 30.4%) than those who increased their BMI (mean 40.12 SD 29.1%), t80 = −2.449, P=.017. In total, 69.2% (n=18) of those who achieved a mean performance percentage of 60% or higher, across all domains, reduced their BMI during the study, whereas 60.7% (n=34) who did not, increased their BMI. One-way analysis of variance of systolic blood pressure category changes showed a significant correlation between reported efforts to reduce stress and category change as a whole, P=.035. An exit survey highlighted that respondents (n=83) reported that the app motivated them to perform physical activity (85.4%) and make healthier food choices (87.5%). Conclusions: In this study, the ubiquitous nature of the mobile phone excelled as a delivery platform for the intervention, enabling the dissemination of educational intervention material while simultaneously monitoring and encouraging positive behavior change, resulting in desirable clinical effects. Sustained effort to maintain the achieved behaviors is expected to mitigate future AD risk. Trial Registration: ClinicalTrails.gov NCT02290912; https://clinicaltrials.gov/ct2/show/NCT02290912 (Archived by WebCite at http://www.webcitation.org/6ictUEwnm) %M 27485822 %R 10.2196/mhealth.4878 %U http://mhealth.jmir.org/2016/3/e93/ %U https://doi.org/10.2196/mhealth.4878 %U http://www.ncbi.nlm.nih.gov/pubmed/27485822 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e85 %T Popular Nutrition-Related Mobile Apps: A Feature Assessment %A Franco,Rodrigo Zenun %A Fallaize,Rosalind %A Lovegrove,Julie A %A Hwang,Faustina %+ School of Systems Engineering, University of Reading, Whiteknights Campus, Reading, RG6 6UR, United Kingdom, 44 1183787668, rodrigo.zenun.franco@pgr.reading.ac.uk %K nutrition apps %K diet apps %K food diary %K nutritional assessment %K mHealth %K eHealth %K mobile phone %K mobile technology %D 2016 %7 01.08.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A key challenge in human nutrition is the assessment of usual food intake. This is of particular interest given recent proposals of eHealth personalized interventions. The adoption of mobile phones has created an opportunity for assessing and improving nutrient intake as they can be used for digitalizing dietary assessments and providing feedback. In the last few years, hundreds of nutrition-related mobile apps have been launched and installed by millions of users. Objective: This study aims to analyze the main features of the most popular nutrition apps and to compare their strategies and technologies for dietary assessment and user feedback. Methods: Apps were selected from the two largest online stores of the most popular mobile operating systems—the Google Play Store for Android and the iTunes App Store for iOS—based on popularity as measured by the number of installs and reviews. The keywords used in the search were as follows: calorie(s), diet, diet tracker, dietician, dietitian, eating, fit, fitness, food, food diary, food tracker, health, lose weight, nutrition, nutritionist, weight, weight loss, weight management, weight watcher, and ww calculator. The inclusion criteria were as follows: English language, minimum number of installs (1 million for Google Play Store) or reviews (7500 for iTunes App Store), relation to nutrition (ie, diet monitoring or recommendation), and independence from any device (eg, wearable) or subscription. Results: A total of 13 apps were classified as popular for inclusion in the analysis. Nine apps offered prospective recording of food intake using a food diary feature. Food selection was available via text search or barcode scanner technologies. Portion size selection was only textual (ie, without images or icons). All nine of these apps were also capable of collecting physical activity (PA) information using self-report, the global positioning system (GPS), or wearable integrations. Their outputs focused predominantly on energy balance between dietary intake and PA. None of these nine apps offered features directly related to diet plans and motivational coaching. In contrast, the remaining four of the 13 apps focused on these opportunities, but without food diaries. One app—FatSecret—also had an innovative feature for connecting users with health professionals, and another—S Health—provided a nutrient balance score. Conclusions: The high number of installs indicates that there is a clear interest and opportunity for diet monitoring and recommendation using mobile apps. All the apps collecting dietary intake used the same nutrition assessment method (ie, food diary record) and technologies for data input (ie, text search and barcode scanner). Emerging technologies, such as image recognition, natural language processing, and artificial intelligence, were not identified. None of the apps had a decision engine capable of providing personalized diet advice. %M 27480144 %R 10.2196/mhealth.5846 %U http://mhealth.jmir.org/2016/3/e85/ %U https://doi.org/10.2196/mhealth.5846 %U http://www.ncbi.nlm.nih.gov/pubmed/27480144 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e92 %T Overcoming Barriers: Adolescents’ Experiences Using a Mobile Phone Dietary Assessment App %A Svensson,Åsa %A Magnusson,Maria %A Larsson,Christel %+ Department of Food and Nutrition, and Sport Science, University of Gothenburg, Box 300, Gothenburg, 40530, Sweden, 46 70 911 65 19, christel.larsson@gu.se %K adolescents %K content analysis %K dietary assessment %K Self Determination Theory %K mobile phone app %D 2016 %7 29.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of new technology has the potential to increase participation rates in dietary studies and improve the validity of collected dietary data. However, to evaluate the usability of developed dietary methods, qualitative studies of participants’ experiences and perceptions are needed. Objective: To explore adolescents’ experiences using a newly developed mobile phone dietary assessment app, with a focus on factors that could affect their recording of dietary intake. Methods: Focus group interviews were conducted with 75 participants who had used a newly developed mobile phone dietary assessment app in a quantitative evaluation study. The interviews were analyzed using qualitative content analysis and the theoretical framework of Self Determination Theory was applied. Results: The adolescents’ use of the mobile phone dietary assessment app was characterized by their struggle to overcome several perceived barriers. Facilitators that helped adolescents complete the method were also identified. Motivation was found to be an important facilitator, and intrinsically motivated participants completed the method because they found it fun to use. The autonomous extrinsically motivated participants completed the method for the greater good, in order to contribute to the study. The controlled extrinsically motivated participants completed the method to get a reward or avoid punishment. Amotivated participants did not complete the method. More motivated participants were assumed to be more able to overcome barriers and needed less facilitators. Conclusions: Future studies that examine the recording of food intake should include systematic efforts that aim to minimize identified barriers and promote identified facilitators. Further research should specifically aim at studying methods for (and effects of) increasing intrinsic motivation by supporting autonomy, competence, and relatedness among adolescents asked to participate in dietary studies. %M 27473462 %R 10.2196/mhealth.5700 %U http://mhealth.jmir.org/2016/3/e92/ %U https://doi.org/10.2196/mhealth.5700 %U http://www.ncbi.nlm.nih.gov/pubmed/27473462 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e91 %T Using Personal Mobile Phones to Assess Dietary Intake in Free-Living Adolescents: Comparison of Face-to-Face Versus Telephone Training %A Segovia-Siapco,Gina %A Sabaté,Joan %+ Center for Nutrition, Healthy Lifestyle, and Disease Prevention, School of Public Health, Loma Linda University, 24951 No Circle Drive, Nichol Hall 1318, Loma Linda, CA, 92350, United States, 1 909 558 4300 ext 47110, gsiapco@llu.edu %K adolescents %K dietary assessment %K dietary records %K digital images %K follow-up %K mobile phones %K real-time support %K technology %D 2016 %7 29.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Traditional paper-based methods to assess food intake can be cumbersome for adolescents; use of mobile phones to track and photograph what they eat may be a more convenient, reliable, and compelling way to collect data. Objective: Our aims were to determine (1) the feasibility of using personal mobile phones to send food records with digital images (FRDIs) among free-living adolescents and (2) whether the quality of food records differed between a high-level intervention group (ie, face-to-face training plus real-time support) and a low-level intervention group (ie, telephone training plus next-day follow-up). Methods: Adolescents (N=42, 11 males and 31 females) aged 12-18 years who had a mobile phone with camera enrolled in the study via consecutive sampling. The first group (n=21) received face-to-face training while the second group (n=21) was trained via telephone. Participants received a fiducial marker (FM) and completed a 1-day FRDI using their mobile phones. At every eating occasion, participants were to (1) take clear images of their meals/food with a correctly placed fiducial marker before eating, (2) send the image immediately to a designated email address, (3) right after completing a meal, send a text message listing the time and name of the meal, foods eaten, and amounts eaten, and (4) before sleep, send an “end” text message to indicate completion of food recording. Those who received face-to-face training received real-time support during reporting; those trained by telephone received next-day follow-up. Descriptive statistics and comparison tests were used to determine performance of the groups. Results: All participants (N=42) who underwent training completed their 1-day FRDI. A significantly greater proportion of the low-level intervention group compared to the high-level intervention group placed their FM correctly in the image (95% vs 43%, P<.001), had complete information for each meal in their food record (95% vs 71%, P=.04), and had a higher overall score in meeting the criteria for food recording (4.3 vs 3.4 out of 5 points). Both groups had energy intake values that moderately correlated with their estimated energy requirements: low-intervention r=.55; high-intervention r=.51. Conclusions: Using personal mobile phones to report dietary intake via texting and digital images is feasible among free-living adolescents. Real-time support or high-level intervention does not guarantee better food recording quality among adolescents. %M 27473291 %R 10.2196/mhealth.5418 %U http://mhealth.jmir.org/2016/3/e91/ %U https://doi.org/10.2196/mhealth.5418 %U http://www.ncbi.nlm.nih.gov/pubmed/27473291 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e90 %T Usage and Dose Response of a Mobile Acceptance and Commitment Therapy App: Secondary Analysis of the Intervention Arm of a Randomized Controlled Trial %A Mattila,Elina %A Lappalainen,Raimo %A Välkkynen,Pasi %A Sairanen,Essi %A Lappalainen,Päivi %A Karhunen,Leila %A Peuhkuri,Katri %A Korpela,Riitta %A Kolehmainen,Marjukka %A Ermes,Miikka %+ VTT Technical Research Centre of Finland Ltd, Tekniikankatu 1, Tampere, 33720, Finland, 358 207223384, elina.m.mattila@vtt.fi %K mobile apps %K Acceptance and Commitment Therapy %K retrospective study %K adherence %D 2016 %7 28.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone apps offer a promising medium to deliver psychological interventions. A mobile app based on Acceptance and Commitment Therapy (ACT) was developed and studied in a randomized controlled trial (RCT). Objective: To study usage metrics of a mobile ACT intervention and dose-response relationship between usage and improvement in psychological flexibility. Methods: An RCT was conducted to investigate the effectiveness of different lifestyle interventions for overweight people with psychological stress. This paper presents a secondary analysis of the group that received an 8-week mobile ACT intervention. Most of the analyzed 74 participants were female (n=64, 86%). Their median age was 49.6 (interquartile range, IQR 45.4-55.3) years and their mean level of psychological flexibility, measured with the Acceptance and Action Questionnaire II, was 20.4 (95% confidence interval 18.3-22.5). Several usage metrics describing the intensity of use, usage of content, and ways of use were calculated. Linear regression analyses were performed to study the dose-response relationship between usage and the change in psychological flexibility and to identify the usage metrics with strongest association with improvement. Binary logistic regression analyses were further used to assess the role of usage metrics between those who showed improvement in psychological flexibility and those who did not. In addition, associations between usage and baseline participant characteristics were studied. Results: The median number of usage sessions was 21 (IQR 11.8-35), the number of usage days was 15 (IQR 9.0-24), and the number of usage weeks was 7.0 (IQR 4.0-8.0). The participants used the mobile app for a median duration of 4.7 (IQR 3.2-7.2) hours and performed a median of 63 (IQR 46-98) exercises. There was a dose-response relationship between usage and the change in psychological flexibility. The strongest associations with psychological flexibility (results adjusted with gender, age, and baseline psychological variables) were found for lower usage of Self as context related exercises (B=0.22, P=.001) and higher intensity of use, described by the number of usage sessions (B=−0.10, P=.01), usage days (B=−0.17, P=.008), and usage weeks (B=−0.73, P=.02), the number of exercises performed (B=−0.02, P=.03), and the total duration of use (B=−0.30, P=.04). Also, higher usage of Acceptance related exercises (B=−0.18, P=.04) was associated with improvement. Active usage was associated with female gender, older age, and not owning a smart mobile phone before the study. Conclusions: The results indicated that active usage of a mobile ACT intervention was associated with improved psychological flexibility. Usage metrics describing intensity of use as well as two metrics related to the usage of content were found to be most strongly associated with improvement. Trial Registration: ClinicalTrials.gov NCT01738256; https://clinicaltrials.gov/ct2/show/NCT01738256 (Archived by WebCite at http://www.webcitation.org/6iTePjPLL) %M 27468653 %R 10.2196/mhealth.5241 %U http://mhealth.jmir.org/2016/3/e90/ %U https://doi.org/10.2196/mhealth.5241 %U http://www.ncbi.nlm.nih.gov/pubmed/27468653 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e63 %T The Era of Smartphones: Back to Our Biological Makeup? %A Santos-Lozano,Alejandro %A Garatachea,Nuria %A Pareja-Galeano,Helios %A Fiuza-Luces,Carmen %A Sanchis-Gomar,Fabian %A Lucia,Alejandro %+ European University Miguel de Cervantes, GIDFYS, Department of Health Sciences., Padre Julio Chevalier, 2, Valladolid, 47012, Spain, 34 983001000 ext 1015, asantos@uemc.es %D 2016 %7 27.07.2016 %9 Letter to the Editor %J JMIR Mhealth Uhealth %G English %X %M 27465861 %R 10.2196/mhealth.5193 %U http://mhealth.jmir.org/2016/3/e63/ %U https://doi.org/10.2196/mhealth.5193 %U http://www.ncbi.nlm.nih.gov/pubmed/27465861 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 7 %P e209 %T A Mobile Ecological Momentary Assessment Tool (devilSPARC) for Nutrition and Physical Activity Behaviors in College Students: A Validation Study %A Bruening,Meg %A van Woerden,Irene %A Todd,Michael %A Brennhofer,Stephanie %A Laska,Melissa N %A Dunton,Genevieve %+ Arizona State University, 550 N 5th Street, Phoenix, AZ, 85004, United States, 1 602 827 2266, meg.bruening@asu.edu %K validation study %K ecological momentary assessment %K nutritional status %K physical activity %K sedentary activity %K emerging adults %D 2016 %7 27.07.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The majority of nutrition and physical activity assessments methods commonly used in scientific research are subject to recall and social desirability biases, which result in over- or under-reporting of behaviors. Real-time mobile-based ecological momentary assessments (mEMAs) may result in decreased measurement biases and minimize participant burden. Objective: The aim was to examine the validity of a mEMA methodology to assess dietary and physical activity levels compared to 24-hour dietary recalls and accelerometers. Methods: This study was a pilot test of the SPARC (Social impact of Physical Activity and nutRition in College) study, which aimed to determine the mechanism by which friendship networks impact weight-related behaviors among young people. An mEMA app, devilSPARC, was developed to assess weight-related behaviors in real time. A diverse sample of 109 freshmen and community mentors attending a large southwestern university downloaded the devilSPARC mEMA app onto their personal mobile phones. Participants were prompted randomly eight times per day over the course of 4 days to complete mEMAs. During the same 4-day period, participants completed up to three 24-hour dietary recalls and/or 4 days of accelerometry. Self-reported mEMA responses were compared to 24-hour dietary recalls and accelerometry measures using comparison statistics, such as match rate, sensitivity and specificity, and mixed model odds ratios, adjusted for within-person correlation among repeated measurements. Results: At the day level, total dietary intake data reported through the mEMA app reflected eating choices also captured by the 24-hour recall. Entrées had the lowest match rate, and fruits and vegetables had the highest match rate. Widening the window of aggregation of 24-hour dietary recall data on either side of the mEMA response resulted in increased specificity and decreased sensitivity. For physical activity behaviors, levels of activity reported through mEMA differed for sedentary versus non-sedentary activity at the day level as measured by accelerometers. Conclusions: The devilSPARC mEMA app is valid for assessing eating behaviors and the presence of sedentary activity at the day level. This mEMA may be useful in studies examining real-time weight-related behaviors. %M 27465701 %R 10.2196/jmir.5969 %U http://www.jmir.org/2016/7/e209/ %U https://doi.org/10.2196/jmir.5969 %U http://www.ncbi.nlm.nih.gov/pubmed/27465701 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e87 %T Mobile Apps for Weight Management: A Scoping Review %A Rivera,Jordan %A McPherson,Amy %A Hamilton,Jill %A Birken,Catherine %A Coons,Michael %A Iyer,Sindoora %A Agarwal,Arnav %A Lalloo,Chitra %A Stinson,Jennifer %+ Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G0A4, Canada, 1 416 813 7654 ext 304514, jennifer.stinson@sickkids.ca %K weight loss %K obesity %K mobile apps %K smartphones %K mHealth %D 2016 %7 26.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obesity remains a major public health concern. Mobile apps for weight loss/management are found to be effective for improving health outcomes in adults and adolescents, and are pursued as a cost-effective and scalable intervention for combating overweight and obesity. In recent years, the commercial market for ‘weight loss apps’ has expanded at rapid pace, yet little is known regarding the evidence-based quality of these tools for weight control. Objective: To characterize the inclusion of evidence-based strategies, health care expert involvement, and scientific evaluation of commercial mobile apps for weight loss/management. Methods: An electronic search was conducted between July 2014 and July 2015 of the official app stores for four major mobile operating systems. Three raters independently identified apps with a stated goal of weight loss/management, as well as weight loss/management apps targeted to pediatric users. All discrepancies regarding selection were resolved through discussion with a fourth rater. Metadata from all included apps were abstracted into a standard assessment criteria form and the evidence-based strategies, health care expert involvement, and scientific evaluation of included apps was assessed. Evidence-based strategies included: self-monitoring, goal-setting, physical activity support, healthy eating support, weight and/or health assessment, personalized feedback, motivational strategies, and social support. Results: A total of 393 apps were included in this review. Self-monitoring was most common (139/393, 35.3%), followed by physical activity support (108/393, 27.5%), weight assessment (100/393, 25.4%), healthy eating support (91/393, 23.2%), goal-setting (84/393, 21.4%), motivational strategies (28/393, 7.1%), social support (21/393, 5.3%), and personalized feedback (7/393, 1.8%). Of apps, 0.8% (3/393) underwent scientific evaluation and 0.3% (1/393) reported health care expert involvement. No apps were comprehensive in the assessment criteria, with the majority of apps meeting less than two criteria. Conclusions: Commercial mobile apps for weight loss/management lack important evidence-based features, do not involve health care experts in their development process, and have not undergone rigorous scientific testing. This calls into question the validity of apps’ claims regarding their effectiveness and safety, at a time when the availability and growth in adoption of these tools is rapidly increasing. Collaborative efforts between developers, researchers, clinicians, and patients are needed to develop and test high-quality, evidence-based mobile apps for weight loss/management before they are widely disseminated in commercial markets. %M 27460502 %R 10.2196/mhealth.5115 %U http://mhealth.jmir.org/2016/3/e87/ %U https://doi.org/10.2196/mhealth.5115 %U http://www.ncbi.nlm.nih.gov/pubmed/27460502 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 3 %P e153 %T ActiviTeen: A Protocol for Deployment of a Consumer Wearable Device in an Academic Setting %A Ortiz,Alexa M %A Tueller,Stephen J %A Cook,Sarah L %A Furberg,Robert D %+ RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, United States, 1 9193163344, amortiz@rti.org %K mHealth %K clinical research protocol %K Fitbit %K physical activity tracker %K survival analaysis %K technology deployment %K education %D 2016 %7 25.07.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Regular physical activity (PA) can be an important indicator of health across an individual’s life span. Consumer wearables, such as Fitbit or Jawbone, are becoming increasingly popular to track PA. With the increased adoption of activity trackers comes the increased generation of valuable individual-based data. Generated data has the potential to provide detailed insights into the user’s behavior and lifestyle. Objective: The primary objective of the described study is to evaluate the feasibility of individual data collection from the selected consumer wearable device (the Fitbit Zip). The rate of user attrition and barriers preventing the use of consumer wearable devices will also be evaluated as secondary objectives. Methods: The pilot study will occur in two stages and employs a long-term review and analysis with a convenience sample of 30 students attending Research Triangle High School. For the first stage, students will initially be asked to wear the Fitbit Zip over the course of 4 weeks. During which time, their activity data and step count will be collected. Students will also be asked to complete a self-administered survey at the beginning and conclusion of the first stage. The second stage will continue to collect students’ activity data and step count over an additional 3-month period. Results: We are anticipating results for this study by the end of 2016. Conclusion: This study will provide insight into the data collection procedures surrounding consumer wearable devices and could serve as the future foundation for other studies deploying consumer wearable devices in educational settings. %M 27457824 %R 10.2196/resprot.5934 %U http://www.researchprotocols.org/2016/3/e153/ %U https://doi.org/10.2196/resprot.5934 %U http://www.ncbi.nlm.nih.gov/pubmed/27457824 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e89 %T Variations in the Use of mHealth Tools: The VA Mobile Health Study %A Frisbee,Kathleen L %+ Connected Health, Office of Informatics and Analytics, Veterans Health Administration, Department of Veteran Affairs, 810 Vermont Ave (102PD), Washington, DC, 20420, United States, 1 202 461 5840, Kathleen.Frisbee@va.gov %K caregivers %K telemedicine %K stress (psychological) %K veterans health %D 2016 %7 19.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) technologies exhibit promise for offering patients and their caregivers point-of-need tools for health self-management. This research study involved the dissemination of iPads containing a suite of mHealth apps to family caregivers of veterans who receive care from the Veterans Affairs (VA) Health Administration and have serious physical or mental injuries. Objective: The goal of the study was to identify factors and characteristics of veterans and their family caregivers that predict the use of mHealth apps. Methods: Veteran/family caregiver dyads (N=882) enrolled in VA’s Comprehensive Assistance for Family Caregivers program were recruited to participate in an mHealth pilot program. Veterans and caregivers who participated and received an iPad agreed to have their use of the apps monitored and were asked to complete a survey assessing Caregiver Preparedness, Caregiver Traits, and Caregiver Zarit Burden Inventory baseline surveys. Results: Of the 882 dyads, 94.9% (837/882) of caregivers were women and 95.7% (844/882) of veteran recipients were men. Mean caregiver age was 40 (SD 10.2) years and mean veteran age was 39 (SD 9.15) years, and 39.8% (351/882) lived in rural locations. Most (89%, 788/882) of the caregivers were spouses. Overall, the most frequently used app was Summary of Care, followed by RX Refill, then Journal, Care4Caregivers, VA Pain Coach, and last, VA PTSD Coach. App use was significantly predicted by the caregiver being a spouse, increased caregiver computer skills, a rural living location, lower levels of caregiver preparedness, veteran mental health diagnosis (other than posttraumatic stress disorder), and veteran age. Conclusions: This mHealth Family Caregiver pilot project effectively establishes the VA’s first patient-facing mHealth apps that are integrated within the VA data system. Use varied considerably, and apps that were most used were those that assisted them in their caregiving responsibilities. %M 27436165 %R 10.2196/mhealth.3726 %U http://mhealth.jmir.org/2016/3/e89/ %U https://doi.org/10.2196/mhealth.3726 %U http://www.ncbi.nlm.nih.gov/pubmed/27436165 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 2 %P e31 %T Development of an Ecological Momentary Assessment Mobile App for a Low-Literacy, Mexican American Population to Collect Disordered Eating Behaviors %A Connelly,Kay %A Stein,Karen F %A Chaudry,Beenish %A Trabold,Nicole %+ School of Informatics and Computing, Indiana University, 919 E 10th St, Bloomington, IN, 47408, United States, 1 812 855 0739, connelly@indiana.edu %K feeding and eating disorders %K health literacy %K socioeconomic status %K human-centered computing %K user-computer interface %K mobile apps %D 2016 %7 14.07.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Ecological momentary assessment (EMA) is a popular method for understanding population health in which participants report their experiences while in naturally occurring contexts in order to increase the reliability and ecological validity of the collected data (as compared to retrospective recall). EMA studies, however, have relied primarily on text-based questionnaires, effectively eliminating low-literacy populations from the samples. Objective: To provide a case study of design of an EMA mobile app for a low-literacy population. In particular, we present the design process and final design of an EMA mobile app for low literate, Mexican American women to record unhealthy eating and weight control behaviors (UEWCBs). Methods: An iterative, user-centered design process was employed to develop the mobile app. An existing EMA protocol to measure UEWCBs in college-enrolled Mexican American women was used as the starting point for the application. The app utilizes an icon interface, with optional audio prompts, that is culturally sensitive and usable by a low-literacy population. A total of 41 women participated over the course of 4 phases of the design process, which included 2 interview and task-based phases (n=8, n=11), focus groups (n=15), and a 5-day, in situ deployment (n=7). Results: Participants’ mental models of UEWCBs differed substantially from prevailing definitions found in the literature, prompting a major reorganization of the app interface. Differences in health literacy and numeracy were better identified with the Newest Vital Sign tool, as compared with the Short Assessment of Health Literacy tool. Participants had difficulty imagining scenarios in the interviews to practice recording a specific UEWCB; instead, usability was best tested in situ. Participants were able to use the EMA mobile app over the course of 5 days to record UEWCBs. Conclusions: Results suggest that the iterative, user-centered design process was essential for designing the app to be made usable by the target population. Simply taking the protocol designed for a higher-literacy population and replacing words with icons and/or audio would have been unsuccessful with this population. %M 27418020 %R 10.2196/publichealth.5511 %U http://publichealth.jmir.org/2016/2/e31/ %U https://doi.org/10.2196/publichealth.5511 %U http://www.ncbi.nlm.nih.gov/pubmed/27418020 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 4 %N 2 %P e10 %T A Serious Game to Increase Healthy Food Consumption in Overweight or Obese Adults: Randomized Controlled Trial %A Blackburne,Tegan %A Rodriguez,Alexandra %A Johnstone,Stuart John %+ Brain and Behaviour Research Institute, School of Psychology, University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia, 61 242214495, sjohnsto@uow.edu.au %K obesity %K inhibition training %K event-related potential %K eating %K mobile apps %D 2016 %7 13.07.2016 %9 Original Paper %J JMIR Serious Games %G English %X Background: Obesity is a growing global issue that is linked to cognitive and psychological deficits. Objective: This preliminary study investigated the efficacy of training to improve inhibitory control (IC), a process linked to overeating, on consumption and cognitive control factors. Methods: This study utilized a multisession mobile phone–based intervention to train IC in an overweight and obese population using a randomized waitlist-control design. A combination of self-assessment questionnaires and psychophysiological measures was used to assess the efficacy of the intervention in terms of improved general IC and modified food consumption after training. Attitudes toward food were also assessed to determine their mediating role in food choices. A total of 58 participants (47 female) completed 2 assessment sessions 3 weeks apart, with 2 weeks of intervention training for the training group during this time. The groups did not differ in baseline demographics including age, body mass index, and inhibitory control. Results: Inhibitory control ability improved across the training sessions, with increases in P3 amplitude implying increased cognitive control over responses. Inhibitory control training was associated with increased healthy and reduced unhealthy food consumption in a taste test and in the week following training, as measured by the Healthy Eating Quiz and the food consumption test. Cognitive restraint was enhanced after training for the training but not the waitlist condition in the Three-Factor Eating Questionnaire, implying that attempts to avoid unhealthy foods in the future will be easier for the training group participants. Conclusions: Inhibitory control training delivered via a purpose-designed mobile phone app is easy to complete, is convenient, and can increase cognitive restraint and reduce unhealthy food consumption. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000263493; http://www.ANZCTR.org.au/ACTRN12616000263493.aspx (Archived by WebCite at http://www.webcitation.org/6ioHjGING) %M 27417192 %R 10.2196/games.5708 %U http://games.jmir.org/2016/2/e10/ %U https://doi.org/10.2196/games.5708 %U http://www.ncbi.nlm.nih.gov/pubmed/27417192 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e80 %T Popular Mobile Phone Apps for Diet and Weight Loss: A Content Analysis %A Zaidan,Sarah %A Roehrer,Erin %+ School of Computing and Information Systems, Faculty of Science, Engineering and Technology, University of Tasmania, Sandy Bay, Hobart,, Australia, 61 416961498, sarahbzaidan@gmail.com %K applications %K diet %K monitoring %K obesity %K weight loss %D 2016 %7 11.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A review of the literature has revealed that the rates of overweight and obesity have been increasing in Australia over the last two decades and that wellness mobile phone apps play a significant role in monitoring and managing individuals’ weight. Although mobile phone app markets (iTunes and Google Play) list thousands of mobile phone health apps, it is not always clear whether those apps are supported by credible sources. Likewise, despite the prevailing use of mobile phone apps to aid with weight management, the usability features of these apps are not well characterized. Objective: The research explored how usability taxonomy could inform the popularity of downloaded, socially focused wellness mobile phone apps, in particular weight loss and diet apps. The aim of the study was to investigate the Australian mobile phone app stores (iTunes and Google Play) in order to examine the usability features of the most popular (ie, most downloaded) wellness apps. Methods: The design of this study comprises 3 main stages: stage 1, identifying apps; stage 2, development of weight loss and diet evaluation framework; and stage 3, application of the evaluation framework. Each stage includes specific data collection, analysis tools, and techniques. Results: The study has resulted in the development of a justified evaluation framework for weight loss and diet mobile phone apps. Applying the evaluation framework to the identified apps has shown that the most downloaded iTunes and Google Play apps are not necessarily the most usable or effective. In addition, the research found that search algorithms for iTunes and Google Play are biased toward apps’ titles and keywords that do not accurately define the real functionality of the app. Moreover, the study has also analyzed the apps’ user reviews, which served as justification for the developed evaluation framework. Conclusions: The analysis has shown that ease of use, reminder, bar code scanning, motivation, usable for all, and synchronization are significant attributes that should be included in weight loss and diet mobile phone apps and ultimately in potential weight loss and diet evaluation frameworks. %M 27400806 %R 10.2196/mhealth.5406 %U http://mhealth.jmir.org/2016/3/e80/ %U https://doi.org/10.2196/mhealth.5406 %U http://www.ncbi.nlm.nih.gov/pubmed/27400806 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e84 %T Reciprocal Reinforcement Between Wearable Activity Trackers and Social Network Services in Influencing Physical Activity Behaviors %A Chang,Rebecca Cherng-Shiow %A Lu,Hsi-Peng %A Yang,Peishan %A Luarn,Pin %+ School of Management, National Taiwan University of Science and Technology, No.43,, Sec. 4, Keelung Rd., Da'an Dist.,, Taipei City, 10607, Taiwan, 886 935150088, rkuei06@gmail.com %K Wearable activity trackers %K wearables %K physical activity %K social support %K social network services %K behavior change techniques %D 2016 %7 05.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable activity trackers (WATs) are emerging consumer electronic devices designed to support physical activities (PAs), which are based on successful behavior change techniques focusing on goal-setting and frequent behavioral feedbacks. Despite their utility, data from both recent academic and market research have indicated high attrition rates of WAT users. Concurrently, evidence shows that social support (SS), delivered/obtained via social network services or sites (SNS), could increase adherence and engagement of PA intervention programs. To date, relatively few studies have looked at how WATs and SS may interact and affect PAs. Objective: The purpose of this study was to explore how these two Internet and mobile technologies, WATs and SNS, could work together to foster sustainable PA behavior changes and habits among middle-aged adults (40-60 years old) in Taiwan. Methods: We used purposive sampling of Executive MBA Students from National Taiwan University of Science and Technology to participate in our qualitative research. In-depth interviews and focus groups were conducted with a total of 15 participants, including 9 WAT users and 6 nonusers. Analysis of the collected materials was done inductively using the thematic approach with no preset categories. Two authors from different professional backgrounds independently annotated and coded the transcripts, and then discussed and debated until consensus was reached on the final themes. Results: The thematic analysis revealed six themes: (1) WATs provided more awareness than motivation in PA with goal-setting and progress monitoring, (2) SS, delivered/obtained via SNS, increased users’ adherence and engagement with WATs and vice versa, (3) a broad spectrum of configurations would be needed to deliver WATs with appropriately integrated SS functions, (4) WAT design, style, and appearance mattered even more than those of smartphones, as they are body-worn devices, (5) the user interfaces of WATs left a great deal to be desired, and (6) privacy concerns must be addressed before more mainstream consumers would consider adopting WATs. Conclusions: Participants perceived WATs as an awareness tool to understand one’s PA level. It is evident from our study that SS, derived from SNS and other pertinent vehicles such as the LINE social messaging application (similar to WhatsApp and WeChat), will increase the engagement and adherence of WAT usage. Combining WATs and SNS enables cost-effective, scalable PA intervention programs with end-to-end services and data analytics capabilities, to elevate WATs from one-size-fits-all consumer electronics to personalized PA assistants. %M 27380798 %R 10.2196/mhealth.5637 %U http://mhealth.jmir.org/2016/3/e84/ %U https://doi.org/10.2196/mhealth.5637 %U http://www.ncbi.nlm.nih.gov/pubmed/27380798 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e79 %T Deriving Requirements for Pervasive Well-Being Technology From Work Stress and Intervention Theory: Framework and Case Study %A Koldijk,Saskia %A Kraaij,Wessel %A Neerincx,Mark A %+ Delft University of Technology, Interactive Intelligence, Mekelweg 4, Delft,, Netherlands, 31 888665875, M.A.Neerincx@tudelft.nl %K psychological stress %K professional burn-out %K behavioral symptoms %K self-management %K health technology %K early medical intervention %D 2016 %7 05.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Stress in office environments is a big concern, often leading to burn-out. New technologies are emerging, such as easily available sensors, contextual reasoning, and electronic coaching (e-coaching) apps. In the Smart Reasoning for Well-being at Home and at Work (SWELL) project, we explore the potential of using such new pervasive technologies to provide support for the self-management of well-being, with a focus on individuals' stress-coping. Ideally, these new pervasive systems should be grounded in existing work stress and intervention theory. However, there is a large diversity of theories and they hardly provide explicit directions for technology design. Objective: The aim of this paper is to present a comprehensive and concise framework that can be used to design pervasive technologies that support knowledge workers to decrease stress. Methods: Based on a literature study we identify concepts relevant to well-being at work and select different work stress models to find causes of work stress that can be addressed. From a technical perspective, we then describe how sensors can be used to infer stress and the context in which it appears, and use intervention theory to further specify interventions that can be provided by means of pervasive technology. Results: The resulting general framework relates several relevant theories: we relate “engagement and burn-out” to “stress”, and describe how relevant aspects can be quantified by means of sensors. We also outline underlying causes of work stress and how these can be addressed with interventions, in particular utilizing new technologies integrating behavioral change theory. Based upon this framework we were able to derive requirements for our case study, the pervasive SWELL system, and we implemented two prototypes. Small-scale user studies proved the value of the derived technology-supported interventions. Conclusions: The presented framework can be used to systematically develop theory-based technology-supported interventions to address work stress. In the area of pervasive systems for well-being, we identified the following six key research challenges and opportunities: (1) performing multi-disciplinary research, (2) interpreting personal sensor data, (3) relating measurable aspects to burn-out, (4) combining strengths of human and technology, (5) privacy, and (6) ethics. %M 27380749 %R 10.2196/mhealth.5341 %U http://mhealth.jmir.org/2016/3/e79/ %U https://doi.org/10.2196/mhealth.5341 %U http://www.ncbi.nlm.nih.gov/pubmed/27380749 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e183 %T Photoaging Mobile Apps in School-Based Tobacco Prevention: The Mirroring Approach %A Brinker,Titus Josef %A Seeger,Werner %A Buslaff,Fabian %+ Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Justus-Liebig-University of Giessen, Klinikstr. 33, Giessen, 35392, Germany, 49 15175084347, titus.brinker@gmail.com %K tobacco %K smoking %K adolescents %K photoaging %K apps %K secondary schools %K adolescent smoking %K tobacco prevention %K smoking prevention %K smoking cessation %D 2016 %7 28.06.2016 %9 Short Paper %J J Med Internet Res %G English %X Background: Most smokers start smoking during their early adolescence, often with the idea that smoking is glamorous. Adolescent smoking can best be prevented through health education at schools. Interventions that take advantage of the broad availability of mobile phones as well as adolescents’ interest in their appearance may be a novel way to improve prevention. Objective: In this first pilot study, we aimed to use mobile phone technology in accordance with the theory of planned behavior to improve school-based tobacco prevention. Methods: We used a free photoaging mobile phone app (“Smokerface”) in three German secondary schools via a novel method called mirroring. The students’ altered three-dimensional selfies on mobile phones or tablets were “mirrored” via a projector in front of their whole grade. Using an anonymous questionnaire, we then measured on a 5-point Likert scale the perceptions of the intervention among 125 students of both genders (average age 12.75 years). Results: A majority of the students perceived the intervention as fun (77/125, 61.6%), claimed that the intervention motivated them not to smoke (79/125, 63.2%), and stated that they learned new benefits of non-smoking (81/125, 64.8%). Only a minority of students disagreed or fully disagreed that they learned new benefits of non-smoking (16/125, 12.8%) or that they were themselves motivated not to smoke (18/125, 14.4%). Conclusions: We have presented a novel method to integrate photoaging in school-based tobacco prevention that affects student peer groups and considers the predictors of smoking in accordance with the theory of planned behavior. %M 27352819 %R 10.2196/jmir.6016 %U http://www.jmir.org/2016/6/e183/ %U https://doi.org/10.2196/jmir.6016 %U http://www.ncbi.nlm.nih.gov/pubmed/27352819 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e176 %T How a Fully Automated eHealth Program Simulates Three Therapeutic Processes: A Case Study %A Holter,Marianne T. S %A Johansen,Ayna %A Brendryen,Håvar %+ The Norwegian Centre for Addiction Research, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postboks 1039 Blindern, Oslo, 0315, Norway, 47 93 62 30 61, m.t.s.holter@medisin.uio.no %K Internet %K eHealth %K telemedicine %K behavior therapy %K motivational interviewing %K working alliance %K intervention mapping %K smoking cessation %K cell phones %K text messaging %D 2016 %7 28.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth programs may be better understood by breaking down the components of one particular program and discussing its potential for interactivity and tailoring in regard to concepts from face-to-face counseling. In the search for the efficacious elements within eHealth programs, it is important to understand how a program using lapse management may simultaneously support working alliance, internalization of motivation, and behavior maintenance. These processes have been applied to fully automated eHealth programs individually. However, given their significance in face-to-face counseling, it may be important to simulate the processes simultaneously in interactive, tailored programs. Objective: We propose a theoretical model for how fully automated behavior change eHealth programs may be more effective by simulating a therapist’s support of a working alliance, internalization of motivation, and managing lapses. Methods: We show how the model is derived from theory and its application to Endre, a fully automated smoking cessation program that engages the user in several “counseling sessions” about quitting. A descriptive case study based on tools from the intervention mapping protocol shows how each therapeutic process is simulated. Results: The program supports the user’s working alliance through alliance factors, the nonembodied relational agent Endre and computerized motivational interviewing. Computerized motivational interviewing also supports internalized motivation to quit, whereas a lapse management component responds to lapses. The description operationalizes working alliance, internalization of motivation, and managing lapses, in terms of eHealth support of smoking cessation. Conclusions: A program may simulate working alliance, internalization of motivation, and lapse management through interactivity and individual tailoring, potentially making fully automated eHealth behavior change programs more effective. %M 27354373 %R 10.2196/jmir.5415 %U http://www.jmir.org/2016/6/e176/ %U https://doi.org/10.2196/jmir.5415 %U http://www.ncbi.nlm.nih.gov/pubmed/27354373 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e152 %T Changing Mental Health and Positive Psychological Well-Being Using Ecological Momentary Interventions: A Systematic Review and Meta-analysis %A Versluis,Anke %A Verkuil,Bart %A Spinhoven,Philip %A van der Ploeg,Melanie M %A Brosschot,Jos F %+ Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, Netherlands, 31 715276343, a.versluis@fsw.leidenuniv.nl %K mHealth %K ecological momentary intervention %K mental health %K anxiety %K depression %K stress %K meta-analysis %K systematic review %D 2016 %7 27.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health problems are highly prevalent, and there is need for the self-management of (mental) health. Ecological momentary interventions (EMIs) can be used to deliver interventions in the daily life of individuals using mobile devices. Objectives: The aim of this study was to systematically assess and meta-analyze the effect of EMI on 3 highly prevalent mental health outcomes (anxiety, depression, and perceived stress) and positive psychological outcomes (eg, acceptance). Methods: PsycINFO and Web of Science were searched for relevant publications, and the last search was done in September 2015. Three concepts were used to find publications: (1) mental health, (2) mobile phones, and (3) interventions. A total of 33 studies (using either a within- or between-subject design) including 43 samples that received an EMI were identified (n=1301), and relevant study characteristics were coded using a standardized form. Quality assessment was done with the Cochrane Collaboration tool. Results: Most of the EMIs focused on a clinical sample, used an active intervention (that offered exercises), and in over half of the studies, additional support by a mental health professional (MHP) was given. The EMI lasted on average 7.48 weeks (SD=6.46), with 2.80 training episodes per day (SD=2.12) and 108.25 total training episodes (SD=123.00). Overall, 27 studies were included in the meta-analysis, and after removing 6 outliers, a medium effect was found on mental health in the within-subject analyses (n=1008), with g=0.57 and 95% CI (0.45-0.70). This effect did not differ as function of outcome type (ie, anxiety, depression, perceived stress, acceptance, relaxation, and quality of life). The only moderator for which the effect varied significantly was additional support by an MHP (MHP-supported EMI, g=0.73, 95% CI: 0.57-0.88; stand-alone EMI, g=0.45, 95% CI: 0.22-0.69; stand-alone EMI with access to care as usual, g=0.38, 95% CI: 0.11-0.64). In the between-subject studies, 13 studies were included, and a small to medium effect was found (g=0.40, 95% CI: 0.22-0.57). Yet, these between-subject analyses were at risk for publication bias and were not suited for moderator analyses. Furthermore, the overall quality of the studies was relatively low. Conclusions: Results showed that there was a small to medium effect of EMIs on mental health and positive psychological well-being and that the effect was not different between outcome types. Moreover, the effect was larger with additional support by an MHP. Future randomized controlled trials are needed to further strengthen the results and to determine potential moderator variables. Overall, EMIs offer great potential for providing easy and cost-effective interventions to improve mental health and increase positive psychological well-being. %M 27349305 %R 10.2196/jmir.5642 %U http://www.jmir.org/2016/6/e152/ %U https://doi.org/10.2196/jmir.5642 %U http://www.ncbi.nlm.nih.gov/pubmed/27349305 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e174 %T Decreased Body Mass Index in Schoolchildren After Yearlong Information Sessions With Parents Reinforced With Web and Mobile Phone Resources: Community Trial %A Vilchis-Gil,Jenny %A Klünder-Klünder,Miguel %A Duque,Ximena %A Flores-Huerta,Samuel %+ Hospital Infantil de México Federico Gómez, Ministry of Health (SSA), Community Health Research Department, Dr. Márquez No. 162, Mexico City, 06720, Mexico, 52 55 5228 9917 ext 4510, floreshuertamd@gmail.com %K obesity %K child %K early intervention (education) %K prevention %K Internet %K mobile phone %D 2016 %7 24.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The obesity pandemic has now reached children, and households should change their lifestyles to prevent it. Objective: The objective was to assess the effect of a comprehensive intervention on body mass index z-score (BMIZ) in schoolchildren. Methods: A yearlong study was conducted at 4 elementary schools in Mexico City. Intervention group (IG) and control group (CG) were split equally between governmental and private schools. Three educational in-person parents and children sessions were held at 2-month intervals to promote healthy eating habits and exercise. To reinforce the information, a website provided extensive discussion on a new topic every 2 weeks, including school snack menus and tools to calculate body mass index in children and adults. Text messages were sent to parents’ mobile phones reinforcing the information provided. The IG contained 226 children and CG 181 children. We measured their weight and height and calculated BMIZ at 0, 6, and 12 months. Results: The CG children showed a change of +0.06 (95% CI 0.01, 0.11) and +0.05 (95% CI 0.01, 0.10) in their BMIZ at 6 and 12 months, respectively. The BMIZ of IG children decreased by -0.13 (95% CI -0.19 to -0.06) and -0.10 (95% CI -0.16 to -0.03), respectively, and the effect was greater in children with obesity. Conclusions: The comprehensive intervention tested had beneficial effects, preserved the BMIZ of normal weight children, and reduced the BMIZ of children with obesity. %M 27342650 %R 10.2196/jmir.5584 %U http://www.jmir.org/2016/6/e174/ %U https://doi.org/10.2196/jmir.5584 %U http://www.ncbi.nlm.nih.gov/pubmed/27342650 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e57 %T Remotely Delivered Exercise-Based Cardiac Rehabilitation: Design and Content Development of a Novel mHealth Platform %A Rawstorn,Jonathan C %A Gant,Nicholas %A Meads,Andrew %A Warren,Ian %A Maddison,Ralph %+ National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand, 64 9 373 7599 ext 84498, j.rawstorn@auckland.ac.nz %K telemedicine %K telerehabilitation %K wireless technology %K remote sensing technology %K behavioral medicine %K myocardial ischemia %D 2016 %7 24.06.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Participation in traditional center-based cardiac rehabilitation exercise programs (exCR) is limited by accessibility barriers. Mobile health (mHealth) technologies can overcome these barriers while preserving critical attributes of center-based exCR monitoring and coaching, but these opportunities have not yet been capitalized on. Objective: We aimed to design and develop an evidence- and theory-based mHealth platform for remote delivery of exCR to any geographical location. Methods: An iterative process was used to design and develop an evidence- and theory-based mHealth platform (REMOTE-CR) that provides real-time remote exercise monitoring and coaching, behavior change education, and social support. Results: The REMOTE-CR platform comprises a commercially available smartphone and wearable sensor, custom smartphone and Web-based applications (apps), and a custom middleware. The platform allows exCR specialists to monitor patients’ exercise and provide individualized coaching in real-time, from almost any location, and provide behavior change education and social support. Intervention content incorporates Social Cognitive Theory, Self-determination Theory, and a taxonomy of behavior change techniques. Exercise components are based on guidelines for clinical exercise prescription. Conclusions: The REMOTE-CR platform extends the capabilities of previous telehealth exCR platforms and narrows the gap between existing center- and home-based exCR services. REMOTE-CR can complement center-based exCR by providing an alternative option for patients whose needs are not being met. Remotely monitored exCR may be more cost-effective than establishing additional center-based programs. The effectiveness and acceptability of REMOTE-CR are now being evaluated in a noninferiority randomized controlled trial. %M 27342791 %R 10.2196/mhealth.5501 %U http://mhealth.jmir.org/2016/2/e57/ %U https://doi.org/10.2196/mhealth.5501 %U http://www.ncbi.nlm.nih.gov/pubmed/27342791 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e77 %T Cardiorespiratory Improvements Achieved by American College of Sports Medicine’s Exercise Prescription Implemented on a Mobile App %A Rospo,Gianluca %A Valsecchi,Viola %A Bonomi,Alberto G %A Thomassen,Inge WJ %A van Dantzig,Saskia %A La Torre,Antonio %A Sartor,Francesco %+ Philips Research, HTC34, Eindhoven,, Netherlands, 31 61550962, francesco.sartor@philips.com %K cardio-respiratory fitness %K ACSM guidelines %K physical activity %K mobile app %D 2016 %7 23.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Strong evidence shows that an increase in cardiorespiratory fitness (CRF) and physical activity (PA) reduces cardiovascular disease risk. Objective: To test whether a scientifically endorsed program to increase CRF and PA, implemented on an easy-to-use, always-accessible mobile app would be effective in improving CRF. Methods: Of 63 healthy volunteers participating, 18 tested the user interface of the Cardio-Fitness App (CF-App); and 45 underwent a 2-week intervention period, of whom 33 eventually concluded it. These were assigned into three groups. The Step-based App (Step-App) group (n=8), followed 10,000 steps/day prescription, the CF-App group (n=13), and the Supervised Cardio-Fitness (Super-CF) group (n=12), both followed a heart rate (HR)-based program according to American College of Sports Medicine (ACSM) guidelines, but either implemented on the app, or at the gym, respectively. Participants were tested for CRF, PA, resting systolic and diastolic blood pressures (SBP, DBP), resting, exercise, and recovery HR. Results: CRF increased in all groups (+4.9%; P<.001). SBP decreased in all groups (-2.6 mm Hg; P=.03). DBP decrease was higher in the Super-CF group (-3.5 mm Hg) than in the Step-App group (-2.1 mm Hg; P<.001). Posttest exercise HR decreased in all groups (-3.4 bpm; P=.02). Posttest recovery HR was lower in the Super-CF group (-10.1 bpm) than in the other two groups (CF-App: -4.9 bpm, Step-App: -3.3 bpm; P<.001). The CF-App group, however, achieved these improvements with more training heart beats (P<.01). Conclusions: A 10,000 steps/day target-based app improved CRF similar to an ACSM guideline-based program whether it was implemented on a mobile app or in supervised gym sessions. %M 27339153 %R 10.2196/mhealth.5518 %U http://mhealth.jmir.org/2016/2/e77/ %U https://doi.org/10.2196/mhealth.5518 %U http://www.ncbi.nlm.nih.gov/pubmed/27339153 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e73 %T Optimizing a Text Message Intervention to Reduce Heavy Drinking in Young Adults: Focus Group Findings %A Suffoletto,Brian %A Kristan,Jeffrey %A Person Mecca,Laurel %A Chung,Tammy %A Clark,Duncan B %+ University of Pittsburgh, Department of Emergency Medicine, Iroquois Building, Suite 400A, 3600 Forbes Avenue, Pittsburgh, PA, 15261, United States, 1 412 901 6892, suffbp@upmc.edu %K alcohol %K young adult %K text messages %K qualitative %D 2016 %7 22.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Recent trial results show that an interactive short message service (SMS) text message intervention, Texting to Reduce Alcohol Consumption (TRAC), is effective in reducing heavy drinking in non-treatment-seeking young adults, but may not be optimized. Objective: To assess the usability of the TRAC intervention among young adults in an effort to optimize future intervention design. Methods: We conducted five focus groups with 18 young adults, aged 18-25 years, who had a history of heavy drinking and had been randomized to 12 weeks of the TRAC intervention as part of a clinical trial. A trained moderator followed a semistructured interview guide. Focus groups were audiotaped, transcribed, and analyzed to identify themes. Results: We identified four themes regarding user experiences with the TRAC intervention: (1) ease of use, (2) comfort and confidentiality, (3) increased awareness of drinking behavior, and (4) accountability for drinking behavior. Participants’ comments supported the existing features of the TRAC intervention, as well as the addition of other features to increase personalization and continuing engagement with the intervention. Conclusions: Young adults perceived the TRAC intervention as a useful way to help them reduce heavy drinking on weekends. Components that promote ease of use, ensure confidentiality, increase awareness of alcohol consumption, and increase accountability were seen as important. %M 27335099 %R 10.2196/mhealth.5330 %U http://mhealth.jmir.org/2016/2/e73/ %U https://doi.org/10.2196/mhealth.5330 %U http://www.ncbi.nlm.nih.gov/pubmed/27335099 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e78 %T A Mobile Health Lifestyle Program for Prevention of Weight Gain in Young Adults (TXT2BFiT): Nine-Month Outcomes of a Randomized Controlled Trial %A Allman-Farinelli,Margaret %A Partridge,Stephanie Ruth %A McGeechan,Kevin %A Balestracci,Kate %A Hebden,Lana %A Wong,Annette %A Phongsavan,Philayrath %A Denney-Wilson,Elizabeth %A Harris,Mark F %A Bauman,Adrian %+ School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, Building D17, University of Sydney, 2006, Australia, 61 90367045, margaret.allmanfarinelli@sydney.edu.au %K young adult %K weight gain prevention %K mHealth %K telehealth %K fruit %K vegetables %K take-out foods %K sugar-sweetened beverages %K physical activity %D 2016 %7 22.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The unprecedented rise in obesity among young adults, who have limited interaction with health services, has not been successfully abated. Objective: The objective of this study was to assess the maintenance outcomes of a 12-week mHealth intervention on prevention of weight gain in young adults and lifestyle behaviors at 9 months from baseline. Methods: A two-arm, parallel, randomized controlled trial (RCT) with subjects allocated to intervention or control 1:1 was conducted in a community setting in Greater Sydney, Australia. From November 2012 to July 2014, 18- to 35-year-old overweight individuals with a body mass index (BMI) of 25-31.99 kg/m2 and those with a BMI ≥ 23 kg/m2 and a self-reported weight gain of ≥ 2 kg in the past 12 months were recruited. A 12-week mHealth program “TXT2BFiT” was administered to the intervention arm. This included 5 coaching calls, 96 text messages, 12 emails, apps, and downloadable resources from the study website. Lifestyle behaviors addressed were intake of fruits, vegetables, sugar-sweetened beverages (SSBs), take-out meals, and physical activity. The control group received 1 phone call to introduce them to study procedures and 4 text messages over 12 weeks. After 12 weeks, the intervention arm received 2 further coaching calls, 6 text messages, and 6 emails with continued access to the study website during 6-month follow-up. Control arm received no further contact. The primary outcome was weight change (kg) with weight measured at baseline and at 12 weeks and self-report at baseline, 12 weeks, and 9 months. Secondary outcomes were change in physical activity (metabolic equivalent of task, MET-mins) and categories of intake for fruits, vegetables, SSBs, and take-out meals. These were assessed via Web-based surveys. Results: Two hundred and fifty young adults enrolled in the RCT. Intervention participants weighed less at 12 weeks compared with controls (model β=−3.7, 95% CI −6.1 to −1.3) and after 9 months (model β=− 4.3, 95% CI − 6.9 to − 1.8). No differences in physical activity were found but all diet behaviors showed that the intervention group, compared with controls at 9 months, had greater odds of meeting recommendations for fruits (OR 3.83, 95% CI 2.10-6.99); for vegetables (OR 2.42, 95% CI 1.32-4.44); for SSB (OR 3.11, 95% CI 1.47-6.59); and for take-out meals (OR 1.88, 95% CI 1.07-3.30). Conclusions: Delivery of an mHealth intervention for prevention of weight gain resulted in modest weight loss at 12 weeks with further loss at 9 months in 18- to 35-year-olds. Although there was no evidence of change in physical activity, improvements in dietary behaviors occurred, and were maintained at 9 months. Owing to its scalable potential for widespread adoption, replication trials should be conducted in diverse populations of overweight young adults. Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000924853; (Archived by WebCite at http://www.webcitation.org/6i6iRag55) %M 27335237 %R 10.2196/mhealth.5768 %U http://mhealth.jmir.org/2016/2/e78/ %U https://doi.org/10.2196/mhealth.5768 %U http://www.ncbi.nlm.nih.gov/pubmed/27335237 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e54 %T Mobile Phone Use and its Association With Sitting Time and Meeting Physical Activity Recommendations in a Mexican American Cohort %A Chrisman,Matthew %A Chow,Wong-Ho %A Daniel,Carrie R %A Wu,Xifeng %A Zhao,Hua %+ The University of Texas MD Anderson Cancer Center, Department of Epidemiology, 1155 Pressler St., Unit 1340, Houston, TX, 77030, United States, 1 713 792 0496, mchrisman@mdanderson.org %K mobile phone %K physical activity %K Mexican Americans %K sedentary lifestyle %D 2016 %7 16.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The benefits of physical activity (PA) are well-documented. Mobile phones influence PA by promoting screen-based sedentary time, providing prompts or reminders to be active, aiding in tracking and monitoring PA, or providing entertainment during PA. It is not known how mobile phone use is associated with PA and sitting time in Mexican Americans, and how mobile phone users may differ from nonusers. Objective: To determine the associations between mobile phone use, PA, and sitting time and how these behaviors differ from mobile phone nonusers in a sample of 2982 Mexican-American adults from the Mano a Mano cohort. Methods: Differences in meeting PA recommendations and sitting time between mobile phone users and nonusers were examined using chi-square and analysis of variance tests. Logistic regression was used to examine associations between mobile phone use, PA, and sitting. Results: Mobile phone users were more likely to be obese by body mass index criteria (≥30 kg/m2), younger, born in the United States and lived there longer, more educated, and sit more hours per day but more likely to meet PA recommendations than nonusers. Males (odds ratio [OR] 1.42, 95% CI 1.16-1.74), use of text messaging (OR 1.26, 95% CI 1.03-1.56), and having a higher acculturation score (OR 1.27, 95% CI 1.07-1.52) were associated with higher odds of meeting PA recommendations. Sitting more hours per day was associated with being male, obese, born in the United States, a former alcohol drinker, and having at least a high school education. Among nonusers, being born in the United States was associated with higher odds of more sitting time, and being married was associated with higher odds of meeting PA recommendations. Conclusions: Mobile phone interventions using text messages could be tailored to promote PA in less acculturated and female Mexican American mobile phone users. %M 27311831 %R 10.2196/mhealth.4926 %U http://mhealth.jmir.org/2016/2/e54/ %U https://doi.org/10.2196/mhealth.4926 %U http://www.ncbi.nlm.nih.gov/pubmed/27311831 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e62 %T A Theory-Based Exercise App to Enhance Exercise Adherence: A Pilot Study %A Voth,Elizabeth C %A Oelke,Nelly D %A Jung,Mary E %+ School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia: Okanagan, 3333 University Way, ART 360, Kelowna, BC, V1V1V7, Canada, 1 250 807 9670, mary.jung@ubc.ca %K exercise %K mHealth %K app %K self-monitoring %K behavior change %K social cognitive theory %D 2016 %7 15.06.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Use of mobile health (mHealth) technology is on an exponential rise. mHealth apps have the capability to reach a large number of individuals, but until now have lacked the integration of evidence-based theoretical constructs to increase exercise behavior in users. Objective: The purpose of this study was to assess the effectiveness of a theory-based, self-monitoring app on exercise and self-monitoring behavior over 8 weeks. Methods: A total of 56 adults (mean age 40 years, SD 13) were randomly assigned to either receive the mHealth app (experimental; n=28) or not to receive the app (control; n=28). All participants engaged in an exercise goal-setting session at baseline. Experimental condition participants received weekly short message service (SMS) text messages grounded in social cognitive theory and were encouraged to self-monitor exercise bouts on the app on a daily basis. Exercise behavior, frequency of self-monitoring exercise behavior, self-efficacy to self-monitor, and self-management of exercise behavior were collected at baseline and at postintervention. Results: Engagement in exercise bouts was greater in the experimental condition (mean 7.24, SD 3.40) as compared to the control condition (mean 4.74, SD 3.70, P=.03, d=0.70) at week 8 postintervention. Frequency of self-monitoring increased significantly over the 8-week investigation between the experimental and control conditions (P<.001, partial η2=.599), with participants in the experimental condition self-monitoring significantly more at postintervention (mean 6.00, SD 0.93) in comparison to those in the control condition (mean 1.95, SD 2.58, P<.001, d=2.10). Self-efficacy to self-monitor and perceived self-management of exercise behavior were unaffected by this intervention. Conclusions: The successful integration of social cognitive theory into an mHealth exercise self-monitoring app provides support for future research to feasibly integrate theoretical constructs into existing exercise apps. In addition, findings provide preliminary support for theory-based apps to increase self-monitoring and exercise behavior in comparison to a control, no-app condition. %M 27307134 %R 10.2196/mhealth.4997 %U http://mhealth.jmir.org/2016/2/e62/ %U https://doi.org/10.2196/mhealth.4997 %U http://www.ncbi.nlm.nih.gov/pubmed/27307134 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e154 %T Mining Health App Data to Find More and Less Successful Weight Loss Subgroups %A Serrano,Katrina J %A Yu,Mandi %A Coa,Kisha I %A Collins,Linda M %A Atienza,Audie A %+ National Cancer Institute, 9609 Medical Center Dr., Bethesda, MD, 20892, United States, 1 2402766654, katrina.serrano@nih.gov %K weight loss %K mobile health %K mobile app %K data mining %K classification %D 2016 %7 14.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: More than half of all smartphone app downloads involve weight, diet, and exercise. If successful, these lifestyle apps may have far-reaching effects for disease prevention and health cost-savings, but few researchers have analyzed data from these apps. Objective: The purposes of this study were to analyze data from a commercial health app (Lose It!) in order to identify successful weight loss subgroups via exploratory analyses and to verify the stability of the results. Methods: Cross-sectional, de-identified data from Lose It! were analyzed. This dataset (n=12,427,196) was randomly split into 24 subsamples, and this study used 3 subsamples (combined n=972,687). Classification and regression tree methods were used to explore groupings of weight loss with one subsample, with descriptive analyses to examine other group characteristics. Data mining validation methods were conducted with 2 additional subsamples. Results: In subsample 1, 14.96% of users lost 5% or more of their starting body weight. Classification and regression tree analysis identified 3 distinct subgroups: “the occasional users” had the lowest proportion (4.87%) of individuals who successfully lost weight; “the basic users” had 37.61% weight loss success; and “the power users” achieved the highest percentage of weight loss success at 72.70%. Behavioral factors delineated the subgroups, though app-related behavioral characteristics further distinguished them. Results were replicated in further analyses with separate subsamples. Conclusions: This study demonstrates that distinct subgroups can be identified in “messy” commercial app data and the identified subgroups can be replicated in independent samples. Behavioral factors and use of custom app features characterized the subgroups. Targeting and tailoring information to particular subgroups could enhance weight loss success. Future studies should replicate data mining analyses to increase methodology rigor. %M 27301853 %R 10.2196/jmir.5473 %U http://www.jmir.org/2016/6/e154/ %U https://doi.org/10.2196/jmir.5473 %U http://www.ncbi.nlm.nih.gov/pubmed/27301853 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e60 %T Stepwise Development of a Text Messaging-Based Bullying Prevention Program for Middle School Students (BullyDown) %A Ybarra,Michele L %A Prescott,Tonya L %A Espelage,Dorothy L %+ Center for Innovative Public Health Research, 555 N El Camino Real A347, San Clemente, CA, 92672, United States, 1 8773026858, Michele@InnovativePublicHealth.org %K bullying %K mhealth %K text messaging %K youth %K prevention %D 2016 %7 13.06.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Bullying is a significant public health issue among middle school-aged youth. Current prevention programs have only a moderate impact. Cell phone text messaging technology (mHealth) can potentially overcome existing challenges, particularly those that are structural (e.g., limited time that teachers can devote to non-educational topics). To date, the description of the development of empirically-based mHealth-delivered bullying prevention programs are lacking in the literature. Objective: To describe the development of BullyDown, a text messaging-based bullying prevention program for middle school students, guided by the Social-Emotional Learning model. Methods: We implemented five activities over a 12-month period: (1) national focus groups (n=37 youth) to gather acceptability of program components; (2) development of content; (3) a national Content Advisory Team (n=9 youth) to confirm content tone; and (4) an internal team test of software functionality followed by a beta test (n=22 youth) to confirm the enrollment protocol and the feasibility and acceptability of the program. Results: Recruitment experiences suggested that Facebook advertising was less efficient than using a recruitment firm to recruit youth nationally, and recruiting within schools for the pilot test was feasible. Feedback from the Content Advisory Team suggests a preference for 2-4 brief text messages per day. Beta test findings suggest that BullyDown is both feasible and acceptable: 100% of youth completed the follow-up survey, 86% of whom liked the program. Conclusions: Text messaging appears to be a feasible and acceptable delivery method for bullying prevention programming delivered to middle school students. %M 27296471 %R 10.2196/mhealth.4936 %U http://mhealth.jmir.org/2016/2/e60/ %U https://doi.org/10.2196/mhealth.4936 %U http://www.ncbi.nlm.nih.gov/pubmed/27296471 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e71 %T A Pilot Test of Self-Affirmations to Promote Smoking Cessation in a National Smoking Cessation Text Messaging Program %A Taber,Jennifer M %A Klein,William M.P %A Ferrer,Rebecca A %A Augustson,Erik %A Patrick,Heather %+ Kent State University, Department of Psychological Sciences, 309 Kent Hall Annex, Kent, OH, 44242, United States, 1 1 330 672 8783, jtaber1@kent.edu %K self-affirmation %K smoking cessation %K mHealth %K text messaging %K theoretical study %K self concept %K motivation %D 2016 %7 08.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although effective smoking cessation treatments, including mHealth interventions, have been empirically validated and are widely available, smoking relapse is likely. Self-affirmation, a process through which individuals focus on their strengths and behaviors, has been shown to reduce negative effects of self-threats and to promote engagement in healthier behavior. Objective: To assess the feasibility of incorporating self-affirmations into an existing text messaging-based smoking cessation program (Smokefree TXT) and to determine whether self-affirmation led to greater engagement and higher cessation rates than the standard intervention. Methods: Data were collected from smokers (n=1261) who subscribed to a free smoking cessation program and met eligibility criteria. The intervention lasted 42 days. The original design was a 2 (Baseline affirmation: 5-item questionnaire present vs absent) × 2 (Integrated affirmation: texts present vs absent) factorial design. Only 17 eligible users completed all baseline affirmation questions and these conditions did not influence any outcomes, so we collapsed across baseline affirmation conditions in analysis. In the integrated affirmation conditions, affirmations replaced approximately 20% of texts delivering motivational content. Results: In all, 687 users remained enrolled throughout the 42-day intervention and 81 reported smoking status at day 42. Among initiators (n=1261), self-affirmation did not significantly improve (1) intervention completion, (2) days enrolled, (3) 1-week smoking status, or (4) 6-week smoking status (all Ps>.10); and among the 687 completers, there were no significant effects of affirmation on cessation (Ps>.25). However, among the 81 responders, those who received affirmations were more likely to report cessation at 6 weeks (97.5%; 39 of 40) than those not given affirmations (78.1%; 32 of 41; χ2(1)=7.08, P=.008). Conclusion: This proof-of-concept study provides preliminary evidence that self-affirmation can be integrated into existing text-based cessation programs, as the affirmations did not lead to any adverse effects (ie, less engagement or lower rates of cessation). Among those who reported smoking status at the end of the intervention period (6.4% of eligible respondents), affirmations facilitated cessation. This study provides a “proof-of-concept” that brief, low-touch interventions may be integrated into a text messaging program with potential benefits, minimal disruption to the program or users, and little cost. Many questions remain regarding how self-affirmation and similar approaches can promote engagement in population interventions. %M 27278108 %R 10.2196/mhealth.5635 %U http://mhealth.jmir.org/2016/2/e71/ %U https://doi.org/10.2196/mhealth.5635 %U http://www.ncbi.nlm.nih.gov/pubmed/27278108 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e56 %T Walking as a Contributor to Physical Activity in Healthy Older Adults: 2 Week Longitudinal Study Using Accelerometry and the Doubly Labeled Water Method %A Valenti,Giulio %A Bonomi,Alberto G %A Westerterp,Klaas R %+ Department of Human Biology, Maastricht University, Universiteitssingel 50, Maastricht, 6200 MD, PO Box 616, Netherlands, 31 433882124, g.valenti@maastrichtuniversity.nl %K aging %K walking %K physical activity %K accelerometry %K monitoring, ambulatory/instrumentation %D 2016 %7 07.06.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Physical activity is recommended to promote healthy aging. Defining the importance of activities such as walking in achieving higher levels of physical activity might provide indications for interventions. Objective: To describe the importance of walking in achieving higher levels of physical activity in older adults. Methods: The study included 42 healthy subjects aged between 51 and 84 years (mean body mass index 25.6 kg/m2 [SD 2.6]). Physical activity, walking, and nonwalking activity were monitored with an accelerometer for 2 weeks. Physical activity was quantified by accelerometer-derived activity counts. An algorithm based on template matching and signal power was developed to classify activity counts into nonwalking counts, short walk counts, and long walk counts. Additionally, in a subgroup of 31 subjects energy expenditure was measured using doubly labeled water to derive physical activity level (PAL). Results: Subjects had a mean PAL of 1.84 (SD 0.19, range 1.43-2.36). About 20% of the activity time (21% [SD 8]) was spent walking, which accounted for about 40% of the total counts (43% [SD 11]). Short bouts composed 83% (SD 9) of walking time, providing 81% (SD 11) of walking counts. A stepwise regression model to predict PAL included nonwalking counts and short walk counts, explaining 58% of the variance of PAL (standard error of the estimate=0.12). Walking activities produced more counts per minute than nonwalking activities (P<.001). Long walks produced more counts per minute than short walks (P=.001). Nonwalking counts were independent of walking counts (r=−.05, P=.38). Conclusions: Walking activities are a major contributor to physical activity in older adults. Walking activities occur at higher intensities than nonwalking activities, which might prevent individuals from engaging in more walking activity. Finally, subjects who engage in more walking activities do not tend to compensate by limiting nonwalking activities. Trial Registration: ClinicalTrials.gov NCT01609764; https://clinicaltrials.gov/ct2/show/NCT01609764 (Archived by WebCite at http://www.webcitation.org/6grls0wAp) %M 27268471 %R 10.2196/mhealth.5445 %U http://mhealth.jmir.org/2016/2/e56/ %U https://doi.org/10.2196/mhealth.5445 %U http://www.ncbi.nlm.nih.gov/pubmed/27268471 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e68 %T Bilingual Text4Walking Food Service Employee Intervention Pilot Study %A Buchholz,Susan Weber %A Ingram,Diana %A Wilbur,JoEllen %A Fogg,Louis %A Sandi,Giselle %A Moss,Angela %A Ocampo,Edith V %+ Rush University, College of Nursing, 600 S. Paulina Street 1030D, Chicago, IL,, United States, 1 312 563 3590, susan_buchholz@rush.edu %K text messaging %K physical activity %K workplace %K employee %K Spanish %K feasibility %K food service %D 2016 %7 01.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Half of all adults in the United States do not meet the level of recommended aerobic physical activity. Physical activity interventions are now being conducted in the workplace. Accessible technology, in the form of widespread usage of cell phones and text messaging, is available for promoting physical activity. Objective: The purposes of this study, which was conducted in the workplace, were to determine (1) the feasibility of implementing a bilingual 12-week Text4Walking intervention and (2) the effect of the Text4Walking intervention on change in physical activity and health status in a food service employee population. Methods: Before conducting the study reported here, the Text4Walking research team developed a database of motivational physical activity text messages in English. Because Hispanic or Latino adults compose one-quarter of all adults employed in the food service industry, the Text4Walking team translated the physical activity text messages into Spanish. This pilot study was guided by the Physical Activity Health Promotion Framework and used a 1-group 12-week pre- and posttest design with food service employees who self-reported as being sedentary. The aim of the study was to increase the number of daily steps over the baseline by 3000 steps. Three physical activity text messages were delivered weekly. In addition, participants received 3 motivational calls during the study. Results: SPSS version 19.0 and R 3.0 were used to perform the data analysis. There were 33 employees who participated in the study (57.6% female), with a mean age of 43.7 years (SD 8.4). The study included 11 Hispanic or Latino participants, 8 of whom requested that the study be delivered in Spanish. There was a 100% retention rate in the study. At baseline, the participants walked 102 (SD 138) minutes/day (per self-report). This rate increased significantly (P=.008) to 182 (SD 219) minutes/day over the course of the study. The participants had a baseline mean of 10,416 (SD 5097) steps, which also increased significantly (P=.017) to 12,540 (SD 5149). They significantly improved their performance on their aerobic fitness test (P<.001). The participants had a baseline mean systolic blood pressure of 120 mm Hg and diastolic blood pressure of 76 mm Hg, a mean body mass index of 29.29 kg/m2, and a mean waist circumference of 36.95 inches, without significant changes seen at 12 weeks. Conclusions: We were able to conduct a motivational physical activity text messaging intervention within the workplace setting. Both physical activity and aerobic fitness improved. However, at baseline, participants were more active than they perceived themselves to be. Although there is insufficient evidence to draw strong conclusions about the study findings, it would be useful to test this physical activity text messaging intervention in a sedentary sample within a larger workplace intervention study trial conducted over a longer time frame. %M 27251878 %R 10.2196/mhealth.5328 %U http://mhealth.jmir.org/2016/2/e68/ %U https://doi.org/10.2196/mhealth.5328 %U http://www.ncbi.nlm.nih.gov/pubmed/27251878 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e106 %T Feasibility and Performance Test of a Real-Time Sensor-Informed Context-Sensitive Ecological Momentary Assessment to Capture Physical Activity %A Dunton,Genevieve Fridlund %A Dzubur,Eldin %A Intille,Stephen %+ Department of Preventive Medicine, University of Southern California, 2001 N Soto St., Los Angeles, CA,, United States, 1 3238650805, dunton@usc.edu %K mobile phones %K ecological momentary assessment %K accelerometer %K physical activity %D 2016 %7 01.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Objective physical activity monitors (eg, accelerometers) have high rates of nonwear and do not provide contextual information about behavior. Objective: This study tested performance and value of a mobile phone app that combined objective and real-time self-report methods to measure physical activity using sensor-informed context-sensitive ecological momentary assessment (CS-EMA). Methods: The app was programmed to prompt CS-EMA surveys immediately after 3 types of events detected by the mobile phone’s built-in motion sensor: (1) Activity (ie, mobile phone movement), (2) No-Activity (ie, mobile phone nonmovement), and (3) No-Data (ie, mobile phone or app powered off). In addition, the app triggered random (ie, signal-contingent) ecological momentary assessment (R-EMA) prompts (up to 7 per day). A sample of 39 ethnically diverse high school students in the United States (aged 14-18, 54% female) tested the app over 14 continuous days during nonschool time. Both CS-EMA and R-EMA prompts assessed activity type (eg, reading or doing homework, eating or drinking, sports or exercising) and contextual characteristics of the activity (eg, location, social company, purpose). Activity was also measured with a waist-worn Actigraph accelerometer. Results: The average CS-EMA + R-EMA prompt compliance and survey completion rates were 80.5% and 98.5%, respectively. More moderate-to-vigorous intensity physical activity was recorded by the waist-worn accelerometer in the 30 minutes before CS-EMA activity prompts (M=5.84 minutes) than CS-EMA No-Activity (M=1.11 minutes) and CS-EMA No-Data (M=0.76 minute) prompts (P’s<.001). Participants were almost 5 times as likely to report going somewhere (ie, active or motorized transit) in the 30 minutes before CS-EMA Activity than R-EMA prompts (odds ratio=4.91, 95% confidence interval=2.16-11.12). Conclusions: Mobile phone apps using motion sensor–informed CS-EMA are acceptable among high school students and may be used to augment objective physical activity data collected from traditional waist-worn accelerometers. %M 27251313 %R 10.2196/jmir.5398 %U http://www.jmir.org/2016/6/e106/ %U https://doi.org/10.2196/jmir.5398 %U http://www.ncbi.nlm.nih.gov/pubmed/27251313 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 2 %N 1 %P e7 %T Assessment of Cancer Survivors’ Experiences of Using a Publicly Available Physical Activity Mobile Application %A Puszkiewicz,Patrycja %A Roberts,Anna L %A Smith,Lee %A Wardle,Jane %A Fisher,Abigail %+ Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 02076791723, anna.roberts.15@ucl.ac.uk %K cancer survivors %K mobile applications %K mHealth %K physical activity %K sleep %D 2016 %7 31.05.2016 %9 Original Paper %J JMIR Cancer %G English %X Background: Regular participation in physical activity (PA) is associated with improved physical and psychosocial outcomes in cancer survivors. However, PA levels are low during and after cancer treatment. Interventions to promote PA in this population are needed. PA mobile apps are popular and have potential to increase PA participation, but little is known about how appropriate or relevant they are for cancer survivors. Objective: This study aims to (1) assess recruitment, study uptake, and engagement for a publicly available PA mobile app (GAINFitness) intervention in cancer survivors; (2) assess cancer survivors’ attitudes towards the app; (3) understand how the app could be adapted to better meet the needs of cancer survivors; and (4) to determine the potential for change in PA participation and psychosocial outcomes over a 6-week period of using the app. Methods: The present study was a one-arm, pre-post design. Cancer survivors (N=11) aged 33 to 62 years with a mean (SD) age of 45 (9.4), and 82% (9/11) female, were recruited (via community/online convenience sampling to use the app for 6 weeks). Engagement with the app was measured using self-reported frequency and duration of usage. Qualitative semi-structured telephone interviews were conducted after the 6-week study period and were analyzed using thematic analysis. PA, well-being, fatigue, quality of life (QOL), sleep quality, and anxiety and depression were self-reported at baseline and at a 6-week follow-up using the Godin Leisure Time Exercise Questionnaire (GLTEQ), the Functional Assessment of Cancer Therapy-General (FACT-G), the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale Questionnaire, the Health and Quality of Life Outcomes (EQ5D) Questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS), respectively. Results: Of the people who responded to the study advertisement, 73% (16/22) agreed to participate and 100% (11/11) of the participants who started the study completed all baseline and follow-up outcome measures and the telephone interview. On average, participants used the app twice a week for 25 minutes per session. Four themes were identified from the qualitative interviews surrounding the suitability of the app for cancer survivors and how it could be adapted: (1) barriers to PA, (2) receiving advice about PA from reliable sources, (3) tailoring the application to one’s lifestyle, and (4) receiving social support from others. Pre-post comparison showed significant increases in strenuous PA, improvements in sleep quality, and reductions in mild PA. There were no significant changes in moderate PA or other psychosocial outcomes. Conclusions: All participants engaged with the app and qualitative interviews highlighted that the app was well-received. A generic PA mobile app could bring about positive improvements in PA participation and psychosocial outcomes among cancer survivors. However, a targeted PA app aimed specifically towards cancer survivors may increase the relevance and suitability of the app for this population. %M 28410168 %R 10.2196/cancer.5380 %U http://cancer.jmir.org/2016/1/e7/ %U https://doi.org/10.2196/cancer.5380 %U http://www.ncbi.nlm.nih.gov/pubmed/28410168 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e69 %T Mobile Phone Apps for Preventing Cancer Through Educational and Behavioral Interventions: State of the Art and Remaining Challenges %A Coughlin,Steven %A Thind,Herpreet %A Liu,Benyuan %A Champagne,Nicole %A Jacobs,Molly %A Massey,Rachael I %+ University of Massachusetts Lowell, Department of Community Health and Sustainability, One University Avenue, Kitson Hall 313A, Lowell, MA, 01854, United States, 1 404 983 2524, stevecatlanta@aol.com %K mobile phone apps %K cancer %K early detection of cancer %K diet %K environmental carcinogens %K health literacy %K nutrition %K obesity %K prevention %K randomized controlled trials %K screening %K smoking %K sun safety %K weight loss %D 2016 %7 30.05.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Rapid developments in technology have encouraged the use of mobile phones in smoking cessation, promoting healthy diet, nutrition, and physical activity, sun safety, and cancer screening. Although many apps relating to the prevention of cancer and other chronic diseases are available from major mobile phone platforms, relatively few have been tested in research studies to determine their efficacy. Objective: In this paper, we discuss issues related to the development and testing of new apps for preventing cancer through smoking cessation, sun safety, and other healthy behaviors, including key methodologic issues and outstanding challenges. Methods: An exploratory literature review was conducted using bibliographic searches in PubMed and CINAHL with relevant search terms (eg, smartphones, smoking cessation, cancer prevention, cancer screening, and carcinogens) to identify papers published in English through October 2015. Results: Only 4 randomized controlled trials of the use of mobile phone apps for smoking cessation and 2 trials of apps for sun safety were identified, indicating that it is premature to conduct a systematic search and meta-analysis of the published literature on this topic. Conclusions: Future studies should utilize randomized controlled trial research designs, larger sample sizes, and longer study periods to better establish the cancer prevention and control capabilities of mobile phone apps. In developing new and refined apps for cancer prevention and control, both health literacy and eHealth literacy should be taken into account. There is a need for culturally appropriate, tailored health messages to increase knowledge and awareness of health behaviors such as smoking cessation, cancer screening, and sun safety. Mobile phone apps are likely to be a useful and low-cost intervention for preventing cancer through behavioral changes. %M 27242162 %R 10.2196/mhealth.5361 %U http://mhealth.jmir.org/2016/2/e69/ %U https://doi.org/10.2196/mhealth.5361 %U http://www.ncbi.nlm.nih.gov/pubmed/27242162 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e53 %T Impact of an mHealth Platform for Pregnancy on Nutrition and Lifestyle of the Reproductive Population: A Survey %A Van Dijk,Matthijs R %A Huijgen,Nicole A %A Willemsen,Sten P %A Laven,Joop SE %A Steegers,Eric AP %A Steegers-Theunissen,Régine PM %+ Erasmus Medical Center (MC), Department of Obstetrics and Gynecology, University Medical Center, PO Box 2040, Rotterdam, 3000 CA, Netherlands, 31 107043598, r.steegers@erasmusmc.nl %K preconception care %K nutrition %K lifestyle %K mHealth %K pregnancy %D 2016 %7 27.05.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Poor nutrition and lifestyle behaviors exert detrimental effects on reproduction and health during the life course. Therefore, lifestyle interventions during the periconceptional period can improve fertility, pregnancy outcome, and health of subsequent generations. Objective: This survey investigates the compliance, usability, and initial effectiveness of the Web-based mHealth platform, Smarter Pregnancy. Methods: A free subscription to the mHealth platform, Smarter Pregnancy, was provided to couples contemplating pregnancy (n=1275) or already pregnant (n=603). After baseline identification of inadequate nutrition and lifestyle behaviors, a personal online coaching program of 6 months was generated. Using multiple imputation and the generalized estimating equation model with independent correlations, we estimated the changes from inadequate to adequate nutrition and lifestyle behaviors over time. Subgroup analyses were performed for (1) overweight and obese women (body mass index [BMI] ≥25 kg/m2), (2) pregnant women at the start of the program, and (3) couples. Results: A 64.86% (1218/1878) compliance rate was observed and 54.7% (range 39.2-73.4%) of participants rated the program usability as positive or very positive. Adequate nutrition and lifestyle behaviors at baseline were 21.57% (405/1878) for vegetable intake, 52.61% (988/1878) for fruit intake, 85.44% (1303/1525) for folic acid use, 86.79% (1630/1878) for no tobacco use, and 64.43% (1210/1878) for no alcohol consumption. After 6 months of coaching, these lifestyle behaviors improved by 26.3% (95% CI 23.0-29.9) for vegetable intake, 38.4% (95% CI 34.5-42.5) for fruit intake, 56.3% (95% CI 48.8-63.6) for folic acid use, 35.1% (95% CI 29.1-41.6) for no tobacco use, and 41.9% (95% CI 35.2-48.9) for no alcohol consumption. The program showed the strongest effectiveness for participating couples. Conclusions: This novel Web-based mHealth platform shows high compliance and usability, and users demonstrate improvements in nutrition and lifestyle behaviors. The next step will be further validation in randomized controlled trials and implementation. %M 27234926 %R 10.2196/mhealth.5197 %U http://mhealth.jmir.org/2016/2/e53/ %U https://doi.org/10.2196/mhealth.5197 %U http://www.ncbi.nlm.nih.gov/pubmed/27234926 %0 Journal Article %@ 2291-9279 %I JMIR Publications Inc. %V 4 %N 1 %P e3 %T Crave-Out: A Distraction/Motivation Mobile Game to Assist in Smoking Cessation %A DeLaughter,Kathryn L %A Sadasivam,Rajani S %A Kamberi,Ariana %A English,Thomas M %A Seward,Greg L %A Chan,S Wayne %A Volkman,Julie E %A Amante,Daniel J %A Houston,Thomas K %+ CHOIR ENRM VAMC, 200 Springs Rd., Bedford, MA,, United States, 1 781 687 2559, kathryn.delaughter@va.gov %K smoking cessation %K Internet %K secondary prevention %K health behavior %D 2016 %7 26.05.2016 %9 Original Paper %J JMIR Serious Games %G English %X Background: Smoking is still the number one preventable cause of death. Cravings—an intense desire or longing for a cigarette—are a major contributor to quit attempt failure. New tools to help smokers’ manage their cravings are needed. Objective: To present a case study of the development process and testing of a distraction/motivation game (Crave-Out) to help manage cravings. Methods: We used a phased approach: in Phase 1 (alpha testing), we tested and refined the game concept, using a Web-based prototype. In Phase 2 (beta testing), we evaluated the distraction/motivation potential of the mobile game prototype, using a prepost design. After varying duration of abstinence, smokers completed the Questionnaire of Smoking Urge-Brief (QSU-Brief) measurement before and after playing Crave-Out. Paired t tests were used to compare pregame and postgame QSU-Brief levels. To test dissemination potential, we released the game on the Apple iTunes App Store and tracked downloads between December 22, 2011, and May 5, 2014. Results: Our concept refinement resulted in a multilevel, pattern memory challenge game, with each level increasing in difficulty. Smokers could play the game as long as they wanted. At the end of each level, smokers were provided clear goals for the next level and rewards (positive reinforcement using motivational tokens that represented a benefit of quitting smoking). Negative reinforcement was removed in alpha testing as smokers felt it reminded them of smoking. Measurement of QSU-Brief (N=30) resulted in a pregame mean of 3.24 (SD 1.65) and postgame mean of 2.99 (SD 1.40) with an overall decrease of 0.25 in cravings (not statistically significant). In a subset analysis, the QSU-Brief decrease was significant for smokers abstinent for more than 48 hours (N=5) with a pregame mean of 2.84 (SD 1.16) and a postgame mean of 2.0 (SD 0.94; change=0.84; P =.03). Between December 22, 2011, and May 29, 2014, the game was downloaded 3372 times from the App-Store, with 1526 smokers visiting the online resource www.decide2quit.org linked to the game. Conclusions: Overall, playing the game resulted in small, but nonsignificant decreases in cravings, with changes greater for those had already quit for more than 48 hours. Lessons learned can inform further development. Future research could incorporate mHealth games in multicomponent cessation interventions. Trial Registration: Clinicaltrials.gov NCT00797628; https://clinicaltrials.gov/ct2/show/NCT00797628 (Archived by WebCite at http://www.webcitation.org/6hbJr6LWG) %M 27229772 %R 10.2196/games.4566 %U http://games.jmir.org/2016/1/e3/ %U https://doi.org/10.2196/games.4566 %U http://www.ncbi.nlm.nih.gov/pubmed/27229772 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 2 %P e73 %T Organizational-Level Strategies With or Without an Activity Tracker to Reduce Office Workers’ Sitting Time: Rationale and Study Design of a Pilot Cluster-Randomized Trial %A Brakenridge,Charlotte L %A Fjeldsoe,Brianna S %A Young,Duncan C %A Winkler,Elisabeth A H %A Dunstan,David W %A Straker,Leon M %A Brakenridge,Christian J %A Healy,Genevieve N %+ The University of Queensland, School of Public Health, Level 4, Public Health Building, Herston Rd, Brisbane, 4006, Australia, 61 0733655163, c.brakenridge@uq.edu.au %K wearable device %K self-monitoring %K sedentary lifestyle %K office workers %K light intensity activity %K ecological model %K workplace %K trial %K objective %K activity monitor %D 2016 %7 25.05.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The office workplace is a key setting in which to address excessive sitting time and inadequate physical activity. One major influence on workplace sitting is the organizational environment. However, the impact of organizational-level strategies on individual level activity change is unknown. Further, the emergence of sophisticated, consumer-targeted wearable activity trackers that facilitate real-time self-monitoring of activity, may be a useful adjunct to support organizational-level strategies, but to date have received little evaluation in this workplace setting. Objective: The aim of this study is to evaluate the feasibility, acceptability, and effectiveness of organizational-level strategies with or without an activity tracker on sitting, standing, and stepping in office workers in the short (3 months, primary aim) and long-term (12 months, secondary aim). Methods: This study is a pilot, cluster-randomized trial (with work teams as the unit of clustering) of two interventions in office workers: organizational-level support strategies (eg, visible management support, emails) or organizational-level strategies plus the use of a waist-worn activity tracker (the LUMOback) that enables self-monitoring of sitting, standing, and stepping time and enables users to set sitting and posture alerts. The key intervention message is to ‘Stand Up, Sit Less, and Move More.’ Intervention elements will be implemented from within the organization by the Head of Workplace Wellbeing. Participants will be recruited via email and enrolled face-to-face. Assessments will occur at baseline, 3, and 12 months. Time spent sitting, sitting in prolonged (≥30 minute) bouts, standing, and stepping during work hours and across the day will be measured with activPAL3 activity monitors (7 days, 24 hours/day protocol), with total sitting time and sitting time during work hours the primary outcomes. Web-based questionnaires, LUMOback recorded data, telephone interviews, and focus groups will measure the feasibility and acceptability of both interventions and potential predictors of behavior change. Results: Baseline and follow-up data collection has finished. Results are expected in 2016. Conclusions: This pilot, cluster-randomized trial will evaluate the feasibility, acceptability, and effectiveness of two interventions targeting reductions in sitting and increases in standing and stepping in office workers. Few studies have evaluated these intervention strategies and this study has the potential to contribute both short and long-term findings. %M 27226457 %R 10.2196/resprot.5438 %U http://www.researchprotocols.org/2016/2/e73/ %U https://doi.org/10.2196/resprot.5438 %U http://www.ncbi.nlm.nih.gov/pubmed/27226457 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e47 %T User Preferences for Content, Features, and Style for an App to Reduce Harmful Drinking in Young Adults: Analysis of User Feedback in App Stores and Focus Group Interviews %A Milward,Joanna %A Khadjesari,Zarnie %A Fincham-Campbell,Stephanie %A Deluca,Paolo %A Watson,Rod %A Drummond,Colin %+ Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, ASB, 4 Windsor Walk, Denmark Hill, London, SE58BB, United Kingdom, 44 2078480717, joanna.milward@kcl.ac.uk %K alcohol %K drinking %K young adults %K mhealth %K brief intervention %K apps %K smartphone %K digital %K focus group %D 2016 %7 24.05.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Electronic screening and brief intervention (eSBI) is effective in reducing weekly alcohol consumption when delivered by a computer. Mobile phone apps demonstrate promise in delivering eSBI; however, few have been designed with an evidence-based and user-informed approach. Objective: This study aims to explore from a user perspective, preferences for content, appearance, and operational features to inform the design of a mobile phone app for reducing quantity and frequency of drinking in young adults engaged in harmful drinking (18-30 year olds). Methods: Phase 1 included a review of user reviews of available mobile phone apps that support a reduction in alcohol consumption. Apps were identified on iTunes and Google Play and were categorized into alcohol reduction support, entertainment, blood alcohol content measurement (BAC), or other. eSBI apps with ≥18 user reviews were subject to a content analysis, which coded praise, criticism, and recommendations for app content, functionality, and esthetics. Phase 2 included four focus groups with young adults drinking at harmful levels and residing in South London to explore their views on existing eSBI apps and preferences for future content, functionality, and appearance. Detailed thematic analysis of the data was undertaken. Results: In Phase 1, of the 1584 apps extracted, 201 were categorized as alcohol reduction, 154 as BAC calculators, 509 as entertainment, and 720 as other. We classified 32 apps as eSBI apps. Four apps had ≥18 user reviews: Change for Life Drinks Tracker, Drinksmeter, Drinkaware, and Alcohol Units Calculator. The highest proportion of content praises were for information and feedback provided in the apps (12/27, 44%), followed by praise for the monitoring features (5/27, 19%). Many (8/12, 67%) criticisms were for the drinking diary; all of these were related to difficulty entering drinks. Over half (18/32, 56%) of functionality criticisms were descriptions of software bugs, and over half of those (10/18, 56%) were for app crashing or freezing. Drinksmeter and Alcohol Units Calculator were the most highly praised apps overall (23/57 and 22/57; 39% of praise overall). In Phase 2, two main themes were identified. The meaningfulness theme reflected how young adults thought apps needed to be tailored to the interests and values of their age group, particularly emphasizing content and feedback around broader health and well-being factors such as exercise, diet, and image. The community theme suggested that young adults want to be able to engage with other app users, both in groups of friends and with online users for motivation and support. Conclusions: Targeted and relevant information and feedback, in addition to easy-to-use monitoring tools, were found to be important features of a mobile phone app to support a reduction in drinking. Future app development should consider tailoring all app aspects to the needs of young adults, considering broader well-being monitoring tools and online community functions. %M 27220371 %R 10.2196/mhealth.5242 %U http://mhealth.jmir.org/2016/2/e47/ %U https://doi.org/10.2196/mhealth.5242 %U http://www.ncbi.nlm.nih.gov/pubmed/27220371 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e49 %T Text Messaging-Based Interventions for Smoking Cessation: A Systematic Review and Meta-Analysis %A Scott-Sheldon,Lori A. J %A Lantini,Ryan %A Jennings,Ernestine G %A Thind,Herpreet %A Rosen,Rochelle K %A Salmoirago-Blotcher,Elena %A Bock,Beth C %+ Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, United States, 1 401 793 8714, lori_scott-sheldon@brown.edu %K text messaging %K smoking cessation %K intervention %K cigarette smoking %K meta-analysis %D 2016 %7 20.05.2016 %9 Review %J JMIR mHealth uHealth %G English %X Background: Tobacco use is one of the leading preventable global health problems producing nearly 6 million smoking-related deaths per year. Interventions delivered via text messaging (short message service, SMS) may increase access to educational and support services that promote smoking cessation across diverse populations. Objective: The purpose of this meta-analysis is to (1) evaluate the efficacy of text messaging interventions on smoking outcomes, (2) determine the robustness of the evidence, and (3) identify moderators of intervention efficacy. Methods: Electronic bibliographic databases were searched for records with relevant key terms. Studies were included if they used a randomized controlled trial (RCT) to examine a text messaging intervention focusing on smoking cessation. Raters coded sample and design characteristics, and intervention content. Summary effect sizes, using random-effects models, were calculated and potential moderators were examined. Results: The meta-analysis included 20 manuscripts with 22 interventions (N=15,593; 8128 (54%) women; mean age=29) from 10 countries. Smokers who received a text messaging intervention were more likely to abstain from smoking relative to controls across a number of measures of smoking abstinence including 7-day point prevalence (odds ratio (OR)=1.38, 95% confidence interval (CI)=1.22, 1.55, k=16) and continuous abstinence (OR=1.63, 95% CI=1.19, 2.24, k=7). Text messaging interventions were also more successful in reducing cigarette consumption relative to controls (d+=0.14, 95% CI=0.05, 0.23, k=9). The effect size estimates were biased when participants who were lost to follow-up were excluded from the analyses. Cumulative meta-analysis using the 18 studies (k=19) measuring abstinence revealed that the benefits of using text message interventions were established only after only five RCTs (k=5) involving 8383 smokers (OR=1.39, 95% CI=1.15, 1.67, P<.001). The inclusion of the subsequent 13 RCTs (k=14) with 6870 smokers did not change the established efficacy of text message interventions for smoking abstinence (OR=1.37, 95% CI=1.25, 1.51, P<.001). Smoking abstinence rates were stronger when text messaging interventions (1) were conducted in Asia, North America, or Europe, (2) sampled fewer women, and (3) recruited participants via the Internet. Conclusions: The evidence for the efficacy of text messaging interventions to reduce smoking behavior is well-established. Using text messaging to support quitting behavior, and ultimately long-term smoking abstinence, should be a public health priority. %M 27207211 %R 10.2196/mhealth.5436 %U http://mhealth.jmir.org/2016/2/e49/ %U https://doi.org/10.2196/mhealth.5436 %U http://www.ncbi.nlm.nih.gov/pubmed/27207211 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 5 %P e114 %T Potential Reach of mHealth Versus Traditional Mass Media for Prevention of Chronic Diseases: Evidence From a Nationally Representative Survey in a Middle-Income Country in Africa %A Yepes,Maryam %A Maurer,Jürgen %A Viswanathan,Barathi %A Gedeon,Jude %A Bovet,Pascal %+ University Institute of Social and Preventive Medicine (IUMSP), Route de la Corniche 10, 1010 Lausanne,, Switzerland, +41 21 314 7272, pascal.bovet@chuv.ch %K digital divide %K mHealth %K eHealth %K mass media %K mobile phone %K noncommunicable diseases %K short message service %K email %K internet access %K developing countries %K low- and middle-income countries %K Africa %D 2016 %7 20.05.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Public radio and television announcements have a long tradition in public health education. With the global rise of computer and mobile device ownership, short message service (SMS) and email-based health services (mHealth) are promising new tools for health promotion. Objective: Our objectives were to examine 1) self-reported exposure to programs related to noncommunicable diseases (NCDs) on national public television and radio during the 12 months preceding the survey (2013–2014), 2) current ownership of a mobile phone, smartphone, computer, or tablet, and use of the Internet, and 3) willingness of individuals to receive SMS or emails with information on health, with a focus on distribution of these variables across different demographic, socioeconomic status (SES), and NCD risk groups. Methods: We obtained data in a population survey of 1240 participants aged 25–64 years conducted in 2013–2014 in the Seychelles, a rapidly developing small island state in the African region. We administered a structured questionnaire and measured NCD risk factors. Univariate and multivariate analyses explored the relationships between outcomes and sociodemographic variables. Results: Of 1240 participants, 1037 (83.62%) reported exposure to NCD-related programs on public television, while a lower proportion of 740 adults (59.67%), reported exposure via public radio (P <.001). Exposure to NCD-related programs on public television was associated with older age (P <.001) and female sex (P <.001), but not with SES, while exposure to NCD-related programs on public radio was associated with older age (P <.001) and lower SES (P <.001). A total of 1156 (93.22%) owned a mobile phone and ownership was positively associated with female sex (P <.001), younger age (P <.001), and higher SES (P <.001). Only 396 adults (31.93%) owned a smartphone and 244 adults (19.67%) used their smartphone to access the Internet. A total of 1048 adults (84.51%) reported willingness to receive health-related SMS, which was positively associated with female sex (P <.001), younger age (P <.001), and higher SES (P <.001). Controlling for SES, exposure to NCD-related programs on public television or radio and willingness to receive health-related SMS were not independently associated with a person’s NCD risk. Conclusions: Broadcasting health programs through traditional mass media (national public radio and television) reached the majority of the population under study, including older adults and those in lower socioeconomic groups. With a high penetration of mobile phones and willingness to receive health-related SMS, mHealth presents an opportunity for health programs, especially when targeted SMS messages are intended for younger adults and those in higher socioeconomic groups. By contrast, due to reduced Internet access, email-based programs had a more limited reach for health promotion programs. These findings emphasize the different reach of interventions using SMS or email versus traditional mass media, according to demographic and socioeconomic categories, for health education programs in a developing country. %M 27207074 %R 10.2196/jmir.5592 %U http://www.jmir.org/2016/5/e114/ %U https://doi.org/10.2196/jmir.5592 %U http://www.ncbi.nlm.nih.gov/pubmed/27207074 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e51 %T Mobile Technology for Vegetable Consumption: A Randomized Controlled Pilot Study in Overweight Adults %A Mummah,Sarah Ann %A Mathur,Maya %A King,Abby C %A Gardner,Christopher D %A Sutton,Stephen %+ Stanford Prevention Research Center, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA 94305-5411, United States, 1 650 723 7822, sm885@cam.ac.uk %K health behavior %K cell phones %K telemedicine %K eating %K diet %K vegetables %K randomized controlled trial %K pilot projects %D 2016 %7 18.05.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile apps present a potentially cost-effective tool for delivering behavior change interventions at scale, but no known studies have tested the efficacy of apps as a tool to specifically increase vegetable consumption among overweight adults. Objective: The purpose of this pilot study was to assess the initial efficacy and user acceptability of a theory-driven mobile app to increase vegetable consumption. Methods: A total of 17 overweight adults aged 42.0 (SD 7.3) years with a body mass index (BMI) of 32.0 (SD 3.5) kg/m2 were randomized to the use of Vegethon (a fully automated theory-driven mobile app enabling self-monitoring of vegetable consumption, goal setting, feedback, and social comparison) or a wait-listed control condition. All participants were recruited from an ongoing 12-month weight loss trial (parent trial). Researchers who performed data analysis were blinded to condition assignment. The primary outcome measure was daily vegetable consumption, assessed using an adapted version of the validated Harvard Food Frequency Questionnaire administered at baseline and 12 weeks after randomization. An analysis of covariance was used to assess differences in 12-week vegetable consumption between intervention and control conditions, controlling for baseline. App usability and satisfaction were measured via a 21-item post-intervention questionnaire. Results: Using intention-to-treat analyses, all enrolled participants (intervention: 8; control: 9) were analyzed. Of the 8 participants randomized to the intervention, 5 downloaded the app and logged their vegetable consumption a mean of 0.7 (SD 0.9) times per day, 2 downloaded the app but did not use it, and 1 never downloaded it. Consumption of vegetables was significantly greater among the intervention versus control condition at the end of the 12-week pilot study (adjusted mean difference: 7.4 servings; 95% CI 1.4-13.5; P=.02). Among secondary outcomes defined a priori, there was significantly greater consumption of green leafy vegetables, cruciferous vegetables, and dark yellow vegetables (adjusted mean difference: 2.6, 1.6, and 0.8 servings; 95% CI 0.1-5.0, 0.1-3.2, and 0.3-1.4; P=.04, P=.04, and P=.004, respectively). Participants reported positive experiences with the app, including strong agreement with the statements “I have found Vegethon easy to use” and “I would recommend Vegethon to a friend” (mean 4.6 (SD 0.6) and 4.2 (SD 0.8), respectively, (on a 5-point scale). Conclusions: Vegethon demonstrated initial efficacy and user acceptability. A mobile app intervention may be useful for increasing vegetable consumption among overweight adults. The small sample size prevented precise estimates of effect sizes. Given the improved health outcomes associated with increases in vegetable consumption, these findings indicate the need for larger, longer-term evaluations of Vegethon and similar technologies among overweight adults and other suitable target groups. Trial Registration: ClinicalTrials.gov NCT01826591; https://clinicaltrials.gov/ct2/show/NCT01826591 (Archived by WebCite at http://www.webcitation.org/6hYDw2AOB) %M 27193036 %R 10.2196/mhealth.5146 %U http://mhealth.jmir.org/2016/2/e51/ %U https://doi.org/10.2196/mhealth.5146 %U http://www.ncbi.nlm.nih.gov/pubmed/27193036 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 2 %P e76 %T Development of ‘Twazon’: An Arabic App for Weight Loss %A Alnasser,Aroub %A Sathiaseelan,Arjuna %A Al-Khalifa,Abdulrahman %A Marais,Debbi %+ Food Science and Nutrition, King Saud University, SA, Applied Health Sciences, University of Aberdeen,, King Saud University, University of Aberdeen, P.O. Box 86683, Riyadh, 11632, Saudi Arabia, 966 118056476, aroub@ksu.edu.sa %K weight loss %K smartphone %K mobile apps %K Arabic %K obesity %D 2016 %7 16.05.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Weight gain and its related illnesses have become a major public health issue across the world, with Saudi Arabia and other Gulf countries seeing dramatic increases in obesity and overweight, and yet there is very little information on how to intervene with this demographic due to cultural and linguistic barriers. As the use of smartphones and apps has also increased in the region, information communication technologies could be a cost-effective means of facilitating the delivery of behavior-modification interventions directly to the target population. Although there are existing apps that offer lifestyle-modification tools, they do not give consideration to the evidence-based practices for weight management. This offers an opportunity to create an Arabic language weight loss app that offers localized content and adheres to evidence-informed practices that are needed for effective weight loss. Objective: This paper describes the process of developing an Arabic weight loss app designed to facilitate the modification of key nutritional and physical activity behaviors among Saudi adults, while taking into consideration cultural norms. Methods: The development of the Twazon app involved: (1) reviewing all available Arabic weight loss apps and compared with evidence-based practices for weight loss, (2) conducting a qualitative study with overweight and obese Saudi women to ascertain their preferences, (3) selecting which behavioral change strategies and guidelines to be used in the app, (4) creating the Saudi Food Database, (5) deciding on graphic design for both iPhone operating system and Android platforms, including user interface, relational database, and programming code, and (6) testing the beta version of the app with health professionals and potential users. Results: The Twazon app took 23 months to develop and included the compilation of an original Saudi Food database. Eight subjects gave feedback regarding the content validity and usability of the app and its features during a pilot study. The predominant issue among the group was the lack of information explaining how to use the app. This has since been resolved through the implementation of a tutorial. No other changes were required to be made. Conclusions: Information communication technologies, such as smartphone apps, may be an effective tool for facilitating the modification of unhealthy lifestyle habits in Saudi; however, consideration must be given to the target population, cultural norms, and changing trends in the global market. The effectiveness of the app will be better determined during a 6-month intervention with 200 overweight and obese Saudi women. %M 27185568 %R 10.2196/resprot.5497 %U http://www.researchprotocols.org/2016/2/e76/ %U https://doi.org/10.2196/resprot.5497 %U http://www.ncbi.nlm.nih.gov/pubmed/27185568 %0 Journal Article %@ 2291-9279 %I JMIR Publications Inc. %V 4 %N 1 %P e6 %T Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men %A LeGrand,Sara %A Muessig,Kathryn Elizabeth %A McNulty,Tobias %A Soni,Karina %A Knudtson,Kelly %A Lemann,Alex %A Nwoko,Nkechinyere %A Hightow-Weidman,Lisa B %+ Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, 310 Trent Drive, Room 305, Durham, NC, 27710, United States, 1 9194380448, sara.legrand@duke.edu %K mobile applications %K video games %K serious games %K HIV %K medication adherence %K health knowledge, attitudes, practice %K youth %K men who have sex with men %D 2016 %7 13.05.2016 %9 Original Paper %J JMIR Serious Games %G English %X Background: In the United States, the human immunodeficiency virus (HIV) disproportionately affects young men who have sex with men (YMSM). For HIV-positive individuals, adherence to antiretroviral therapy (ART) is critical for achieving optimal health outcomes and reducing secondary transmission of HIV. However, YMSM often struggle with ART adherence. Novel mobile phone apps that incorporate game-based mechanics and social networking elements represent a promising intervention approach for improving ART adherence among YMSM. Objective: This study used a multiphase, iterative development process to create an ART adherence app for YMSM. Methods: The three-phase development process included: (1) theory-based concept development jointly by public health researchers and the technology team, (2) assessment of the target population’s ART adherence needs and app preferences and development and testing of a clickable app prototype, and (3) development and usability testing of the final app prototype. Results: The initial theory-based app concept developed in Phase One included medication reminders, daily ART adherence tracking and visualization, ART educational modules, limited virtual interactions with other app users, and gamification elements. In Phase Two, adherence needs, including those related to information, motivation, and behavioral skills, were identified. Participants expressed preferences for an ART adherence app that was informational, interactive, social, and customizable. Based on the findings from Phase Two, additional gaming features were added in Phase Three, including an interactive battle, superhero app theme, and app storyline. Other features were modified to increase interactivity and customization options and integrate the game theme. During usability testing of the final prototype, participants were able to understand and navigate the app successfully and rated the app favorably. Conclusions: An iterative development process was critical for the development of an ART adherence game app that was viewed as highly acceptable, relevant, and useful by YMSM. %M 27178752 %R 10.2196/games.5687 %U http://games.jmir.org/2016/1/e6/ %U https://doi.org/10.2196/games.5687 %U http://www.ncbi.nlm.nih.gov/pubmed/27178752 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 2 %P e84 %T A Multimodal mHealth Intervention (FeatForward) to Improve Physical Activity Behavior in Patients with High Cardiometabolic Risk Factors: Rationale and Protocol for a Randomized Controlled Trial %A Agboola,Stephen %A Palacholla,Ramya Sita %A Centi,Amanda %A Kvedar,Joseph %A Jethwani,Kamal %+ Center for Connected Health, 25 New Chardon St, Boston, MA,, United States, 1 617 643 0291, sagboola@partners.org %K mobile app %K physical activity %K randomized clinical trial %K type 2 diabetes mellitus %K exercise %K cardiometabolic risk factors %D 2016 %7 12.05.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical inactivity is one of the leading risk factors contributing to the rising rates of chronic diseases and has been associated with deleterious health outcomes in patients with chronic disease conditions. We developed a mobile phone app, FeatForward, to increase the level of physical activity in patients with cardiometabolic risk (CMR) factors. This intervention is expected to result in an overall improvement in patient health outcomes. Objective: The objective of this study is to evaluate the effect of a mobile phone–based app, FeatForward, on physical activity levels and other CMR factors in patients with chronic conditions. Methods: The study will be implemented as a 2-arm randomized controlled trial with 300 adult patients with chronic conditions over a 6-month follow-up period. Participants will be assigned to either the intervention group receiving the FeatForward app and standard care versus a control group who will receive only usual care. The difference in physical activity levels between the control group and intervention group will be measured as the primary outcome. We will also evaluate the effect of this intervention on secondary measures including clinical outcome changes in global CMR factors (glycated hemoglobin, fasting blood glucose, blood pressure, waist circumference, Serum lipids, C-reactive protein), health-related quality of life, health care usage, including attendance of scheduled clinic visits and hospitalizations, usability, and satisfaction, participant engagement with the FeatForward app, physician engagement with physician portal, and willingness to engage in physical activity. Instruments that will be used in evaluating secondary outcomes include the Short-Form (SF)-12, app usability and satisfaction questionnaires, physician satisfaction questionnaire. The intention-to-treat approach will be used to evaluate outcomes. All outcomes will be measured longitudinally at baseline, midpoint (3 months), and 6 months. Our primary outcome, physical activity, will be assessed by mixed-model analysis of variance with intervention assignment as between-group factor and time as within-subject factor. A similar approach will be used to analyze continuous secondary outcomes while categorical outcomes will be analyzed by chi-square test. Results: The study is still in progress and we hope to have the results by the end of 2016. Conclusions: The mobile phone–based app, FeatForward, could lead to significant improvements in physical activity and other CMR factors in patients. %M 27174783 %R 10.2196/resprot.5489 %U http://www.researchprotocols.org/2016/2/e84/ %U https://doi.org/10.2196/resprot.5489 %U http://www.ncbi.nlm.nih.gov/pubmed/27174783 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 5 %P e101 %T Carbohydrate Estimation by a Mobile Phone-Based System Versus Self-Estimations of Individuals With Type 1 Diabetes Mellitus: A Comparative Study %A Rhyner,Daniel %A Loher,Hannah %A Dehais,Joachim %A Anthimopoulos,Marios %A Shevchik,Sergey %A Botwey,Ransford Henry %A Duke,David %A Stettler,Christoph %A Diem,Peter %A Mougiakakou,Stavroula %+ ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, Bern, 3008, Switzerland, 41 316327592, stavroula.mougiakakou@artorg.unibe.ch %K diabetes mellitus, type 1 %K carbohydrate counting %K computer vision systems %K food recognition %K meal assessment %K mobile phone %K food volume estimation %D 2016 %7 11.05.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Diabetes mellitus is spreading throughout the world and diabetic individuals have been shown to often assess their food intake inaccurately; therefore, it is a matter of urgency to develop automated diet assessment tools. The recent availability of mobile phones with enhanced capabilities, together with the advances in computer vision, have permitted the development of image analysis apps for the automated assessment of meals. GoCARB is a mobile phone-based system designed to support individuals with type 1 diabetes during daily carbohydrate estimation. In a typical scenario, the user places a reference card next to the dish and acquires two images using a mobile phone. A series of computer vision modules detect the plate and automatically segment and recognize the different food items, while their 3D shape is reconstructed. Finally, the carbohydrate content is calculated by combining the volume of each food item with the nutritional information provided by the USDA Nutrient Database for Standard Reference. Objective: The main objective of this study is to assess the accuracy of the GoCARB prototype when used by individuals with type 1 diabetes and to compare it to their own performance in carbohydrate counting. In addition, the user experience and usability of the system is evaluated by questionnaires. Methods: The study was conducted at the Bern University Hospital, “Inselspital” (Bern, Switzerland) and involved 19 adult volunteers with type 1 diabetes, each participating once. Each study day, a total of six meals of broad diversity were taken from the hospital’s restaurant and presented to the participants. The food items were weighed on a standard balance and the true amount of carbohydrate was calculated from the USDA nutrient database. Participants were asked to count the carbohydrate content of each meal independently and then by using GoCARB. At the end of each session, a questionnaire was completed to assess the user’s experience with GoCARB. Results: The mean absolute error was 27.89 (SD 38.20) grams of carbohydrate for the estimation of participants, whereas the corresponding value for the GoCARB system was 12.28 (SD 9.56) grams of carbohydrate, which was a significantly better performance ( P=.001). In 75.4% (86/114) of the meals, the GoCARB automatic segmentation was successful and 85.1% (291/342) of individual food items were successfully recognized. Most participants found GoCARB easy to use. Conclusions: This study indicates that the system is able to estimate, on average, the carbohydrate content of meals with higher accuracy than individuals with type 1 diabetes can. The participants thought the app was useful and easy to use. GoCARB seems to be a well-accepted supportive mHealth tool for the assessment of served-on-a-plate meals. %M 27170498 %R 10.2196/jmir.5567 %U http://www.jmir.org/2016/5/e101/ %U https://doi.org/10.2196/jmir.5567 %U http://www.ncbi.nlm.nih.gov/pubmed/27170498 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 5 %P e99 %T The Emergence of Personalized Health Technology %A Allen,Luke Nelson %A Christie,Gillian Pepall %+ Harvard T.H. Chan School of Public Health, Department of Global Health and Population, 677 Huntington Av, Boston, MA, Ma 02115, United States, 1 1865289471, luke.allen@mail.harvard.edu %K personalized health technology %K population health %K frugal innovation %K ethics %K socioeconomic factors, inequalities %K technology, health %D 2016 %7 10.05.2016 %9 Viewpoint %J J Med Internet Res %G English %X Personalized health technology is a noisy new entrant to the health space, yet to make a significant impact on population health but seemingly teeming with potential. Devices including wearable fitness trackers and healthy-living apps are designed to help users quantify and improve their health behaviors. Although the ethical issues surrounding data privacy have received much attention, little is being said about the impact on socioeconomic health inequalities. Populations who stand to benefit the most from these technologies are unable to afford, access, or use them. This paper outlines the negative impact that these technologies will have on inequalities unless their user base can be radically extended to include vulnerable populations. Frugal innovation and public–private partnership are discussed as the major means for reaching this end. %M 27165944 %R 10.2196/jmir.5357 %U http://www.jmir.org/2016/5/e99/ %U https://doi.org/10.2196/jmir.5357 %U http://www.ncbi.nlm.nih.gov/pubmed/27165944 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e59 %T Using a Mobile App to Promote Smoking Cessation in Hospitalized Patients %A Finkelstein,Joseph %A Cha,Eun Me %+ Columbia University, Department of Biomedical Informatics, PH-20, Rm. 401A, 622 W 168th St., New York, NY, 10032, United States, 1 9174773909, jf193@cumc.columbia.edu %K mobile apps %K patient engagement %K hospital %K smoking cessation %K health literacy %D 2016 %7 06.05.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The potential of interactive health education for preventive health applications has been widely demonstrated. However, use of mobile apps to promote smoking cessation in hospitalized patients has not been systematically assessed. Objective: This study was conducted to assess the feasibility of using a mobile app for the hazards of smoking education delivered via touch screen tablets to hospitalized smokers. Methods: Fifty-five consecutive hospitalized smokers were recruited. Patient sociodemographics and smoking history was collected at baseline. The impact of the mobile app was assessed by measuring cognitive and behavioral factors shown to promote smoking cessation before and after the mobile app use including hazards of smoking knowledge score (KS), smoking attitudes, and stages of change. Results: After the mobile app use, mean KS increased from 27(3) to 31(3) (P<0.0001). Proportion of patients who felt they “cannot quit smoking” reduced from 36% (20/55) to 18% (10/55) (P<0.03). Overall, 13% (7/55) of patients moved toward a more advanced stage of change with the proportion of patients in the preparation stage increased from 40% (22/55) to 51% (28/55). Multivariate regression analysis demonstrated that knowledge gains and mobile app acceptance did not depend on age, gender, race, computer skills, income, or education level. The main factors affecting knowledge gain were initial knowledge level (P<0.02), employment status (P<0.05), and high app acceptance (P<0.01). Knowledge gain was the main predictor of more favorable attitudes toward the mobile app (odds ratio (OR)=4.8; 95% confidence interval (CI) (1.1, 20.0)). Attitudinal surveys and qualitative interviews identified high acceptance of the mobile app by hospitalized smokers. Over 92% (51/55) of the study participants recommended the app for use by other hospitalized smokers and 98% (54/55) of the patients were willing to use such an app in the future. Conclusions: Our results suggest that a mobile app promoting smoking cessation is well accepted by hospitalized smokers. The app can be used for interactive patient education and counseling during hospital stays. Development and evaluation of mobile apps engaging patients in their care during hospital stays is warranted. %M 27154792 %R 10.2196/mhealth.5149 %U http://mhealth.jmir.org/2016/2/e59/ %U https://doi.org/10.2196/mhealth.5149 %U http://www.ncbi.nlm.nih.gov/pubmed/27154792 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e39 %T Using Mobile Apps to Promote a Healthy Lifestyle Among Adolescents and Students: A Review of the Theoretical Basis and Lessons Learned %A Dute,Denise Jantine %A Bemelmans,Wanda Jose Erika %A Breda,João %+ National Institute for Public Health and Environment (RIVM), Antonie van Leeuwenhoeklaan 9, P.O. Box 1, 3720 BA, Bilthoven,, Netherlands, 31 30 2744297, wanda.bemelmans@rivm.nl %K mHealth %K mobile phones %K behavior change %K health promotion %K physical activity %K nutrition %K overweight %K adolescents and students %D 2016 %7 05.05.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: European adolescents and students tend to have low levels of physical activity and eat unhealthy foods, and the prevalence of overweight and obesity has increased, which poses a public health challenge. Mobile apps play an important role in their daily lives, suggesting their potential to be used in health-promoting strategies. Objective: This review aimed to explore how mobile apps can contribute to the promotion of healthy nutrition, physical activity, and prevention of overweight in adolescents and students. For the apps identified, the review describes the content, the theoretical mechanisms applied, and lessons learned. Methods: The databases Scopus, MEDLINE, Embase, and PsycINFO were searched for English-language publications from January 2009 to November 2013. Studies were included if (1) the primary component of the intervention involves an app; (2) the intervention targets healthy nutrition, or physical activity, or overweight prevention; and (3) the target group included adolescents or students (aged 12-25 years). Results: A total of 15 studies were included, which describe 12 unique apps. Ten of these apps functioned as monitoring tools for assessing dietary intake or physical activity levels. The other apps used a Web-based platform to challenge users to exercise and to allow users to list and photograph their problem foods. For 5 apps, the behavioral theory underpinning their development was clearly specified. Frequently applied behavior change techniques are prompting self-monitoring of behavior and providing feedback on performance. Apps can function self-contained, but most of them are used as part of therapy or to strengthen school programs. From the age of 10 years users may be capable of using apps. Only 4 apps were developed specifically for adolescents. All apps were tested on a small scale and for a short period. Conclusions: Despite large potential and abundant usage by young people, limited research is available on apps and health promotion for adolescents. Apps seem to be a promising health promotion strategy as a monitoring tool. Apps can enable users to set targets, enhance self‐monitoring, and increase awareness. Three apps incorporated social features, making them “social media,” but hardly any evidence appeared available about their potential. %M 27150850 %R 10.2196/mhealth.3559 %U http://mhealth.jmir.org/2016/2/e39/ %U https://doi.org/10.2196/mhealth.3559 %U http://www.ncbi.nlm.nih.gov/pubmed/27150850 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 5 %P e90 %T Devices for Self-Monitoring Sedentary Time or Physical Activity: A Scoping Review %A Sanders,James P %A Loveday,Adam %A Pearson,Natalie %A Edwardson,Charlotte %A Yates,Thomas %A Biddle,Stuart JH %A Esliger,Dale W %+ Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Loughborough University, Sir John Beckwith Building, Loughborough, LE11 3TU, United Kingdom, 44 7538330734, J.Sanders2@lboro.ac.uk %K sitting time %K physical activity %K measurement %K feedback %K activity monitor %K scoping review %D 2016 %7 04.05.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: It is well documented that meeting the guideline levels (150 minutes per week) of moderate-to-vigorous physical activity (PA) is protective against chronic disease. Conversely, emerging evidence indicates the deleterious effects of prolonged sitting. Therefore, there is a need to change both behaviors. Self-monitoring of behavior is one of the most robust behavior-change techniques available. The growing number of technologies in the consumer electronics sector provides a unique opportunity for individuals to self-monitor their behavior. Objective: The aim of this study is to review the characteristics and measurement properties of currently available self-monitoring devices for sedentary time and/or PA. Methods: To identify technologies, four scientific databases were systematically searched using key terms related to behavior, measurement, and population. Articles published through October 2015 were identified. To identify technologies from the consumer electronic sector, systematic searches of three Internet search engines were also performed through to October 1, 2015. Results: The initial database searches identified 46 devices and the Internet search engines identified 100 devices yielding a total of 146 technologies. Of these, 64 were further removed because they were currently unavailable for purchase or there was no evidence that they were designed for, had been used in, or could readily be modified for self-monitoring purposes. The remaining 82 technologies were included in this review (73 devices self-monitored PA, 9 devices self-monitored sedentary time). Of the 82 devices included, this review identified no published articles in which these devices were used for the purpose of self-monitoring PA and/or sedentary behavior; however, a number of technologies were found via Internet searches that matched the criteria for self-monitoring and provided immediate feedback on PA (ActiGraph Link, Microsoft Band, and Garmin Vivofit) and sedentary time (activPAL VT, the Lumo Back, and Darma). Conclusions: There are a large number of devices that self-monitor PA; however, there is a greater need for the development of tools to self-monitor sedentary time. The novelty of these devices means they have yet to be used in behavior change interventions, although the growing field of wearable technology may facilitate this to change. %M 27145905 %R 10.2196/jmir.5373 %U http://www.jmir.org/2016/5/e90/ %U https://doi.org/10.2196/jmir.5373 %U http://www.ncbi.nlm.nih.gov/pubmed/27145905 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 4 %P e74 %T An Internet-Based Physical Activity Intervention to Improve Quality of Life of Inactive Older Adults: A Randomized Controlled Trial %A Broekhuizen,Karen %A de Gelder,Jelle %A Wijsman,Carolien A %A Wijsman,Liselotte W %A Westendorp,Rudi GJ %A Verhagen,Evert %A Slagboom,Pieternella E %A de Craen,Anton J %A van Mechelen,Willem %A van Heemst,Diana %A van der Ouderaa,Frans %A Mooijaart,Simon P %+ Leiden University Medical Center, Department of Gerontology and Geriatrics, Albinusdreef 2, 2333 ZA, Leiden, , Netherlands, 31 715266640, s.p.mooijaart@lumc.nl %K Internet %K physical activity %K quality of life %D 2016 %7 27.04.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Increasing physical activity is a viable strategy for improving both the health and quality of life of older adults. Objective: The aim of this study was to assess if an Internet-based intervention aimed to increase physical activity was effective in improving quality of life of inactive older adults. In addition, we analyzed the effect of the intervention on quality of life among those participants who successfully reached their individually targeted increase in daily physical activity as indicated by the intervention program, as well as the dose-response effect of increasing physical activity on quality of life. Methods: The intervention was tested in a randomized controlled trial and was comprised of an Internet program—DirectLife (Philips)—aimed at increasing physical activity using monitoring and feedback by accelerometry and feedback by digital coaching (n=119). The control group received no intervention (n=116). Participants were inactive 60-70-year-olds and were recruited from the general population. Quality of life and physical activity were measured at baseline and after 3 months using the Research ANd Development 36-item health survey (RAND-36) and wrist-worn triaxial accelerometer, respectively. Results: After 3 months, a significant improvement in quality of life was seen in the intervention group compared to the control group for RAND-36 subscales on emotional and mental health (2.52 vs -0.72, respectively; P=.03) and health change (8.99 vs 2.03, respectively; P=.01). A total of 50 of the 119 participants (42.0%) in the intervention group successfully reached their physical activity target and showed a significant improvement in quality of life compared to the control group for subscales on emotional and mental health (4.31 vs -0.72, respectively; P=.009) and health change (11.06 vs 2.03, respectively; P=.004). The dose-response analysis showed that there was a significant association between increase in minutes spent in moderate-to-vigorous physical activity (MVPA) and increase in quality of life. Conclusions: Our study shows that an Internet-based physical activity program was effective in improving quality of life in 60-70-year-olds after 3 months, particularly in participants that reached their individually targeted increase in daily physical activity. Trial Registration: Nederlands Trial Register: NTR 3045; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3045 (Archived by WebCite at http://www.webcitation.org/6fobg2sjJ) %M 27122359 %R 10.2196/jmir.4335 %U http://www.jmir.org/2016/4/e74/ %U https://doi.org/10.2196/jmir.4335 %U http://www.ncbi.nlm.nih.gov/pubmed/27122359 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e40 %T Behavior Change Techniques Present in Wearable Activity Trackers: A Critical Analysis %A Mercer,Kathryn %A Li,Melissa %A Giangregorio,Lora %A Burns,Catherine %A Grindrod,Kelly %+ School of Pharmacy, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567 ext 21358, kelly.grindrod@uwaterloo.ca %K older adults %K physical activity %K wearables %K mobile health %K chronic disease management %D 2016 %7 27.04.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Wearable activity trackers are promising as interventions that offer guidance and support for increasing physical activity and health-focused tracking. Most adults do not meet their recommended daily activity guidelines, and wearable fitness trackers are increasingly cited as having great potential to improve the physical activity levels of adults. Objective: The objective of this study was to use the Coventry, Aberdeen, and London-Refined (CALO-RE) taxonomy to examine if the design of wearable activity trackers incorporates behavior change techniques (BCTs). A secondary objective was to critically analyze whether the BCTs present relate to known drivers of behavior change, such as self-efficacy, with the intention of extending applicability to older adults in addition to the overall population. Methods: Wearing each device for a period of 1 week, two independent raters used CALO-RE taxonomy to code the BCTs of the seven wearable activity trackers available in Canada as of March 2014. These included Fitbit Flex, Misfit Shine, Withings Pulse, Jawbone UP24, Spark Activity Tracker by SparkPeople, Nike+ FuelBand SE, and Polar Loop. We calculated interrater reliability using Cohen's kappa. Results: The average number of BCTs identified was 16.3/40. Withings Pulse had the highest number of BCTs and Misfit Shine had the lowest. Most techniques centered around self-monitoring and self-regulation, all of which have been associated with improved physical activity in older adults. Techniques related to planning and providing instructions were scarce. Conclusions: Overall, wearable activity trackers contain several BCTs that have been shown to increase physical activity in older adults. Although more research and development must be done to fully understand the potential of wearables as health interventions, the current wearable trackers offer significant potential with regard to BCTs relevant to uptake by all populations, including older adults. %M 27122452 %R 10.2196/mhealth.4461 %U http://mhealth.jmir.org/2016/2/e40/ %U https://doi.org/10.2196/mhealth.4461 %U http://www.ncbi.nlm.nih.gov/pubmed/27122452 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e38 %T Community Engagement to Optimize the Use of Web-Based and Wearable Technology in a Cardiovascular Health and Needs Assessment Study: A Mixed Methods Approach %A Yingling,Leah R %A Brooks,Alyssa T %A Wallen,Gwenyth R %A Peters-Lawrence,Marlene %A McClurkin,Michael %A Cooper-McCann,Rebecca %A Wiley Jr,Kenneth L %A Mitchell,Valerie %A Saygbe,Johnetta N %A Johnson,Twanda D %A Curry,Rev. Kendrick E %A Johnson,Allan A %A Graham,Avis P %A Graham,Lennox A %A Powell-Wiley,Tiffany M %+ Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bldg 10, 5-3330, 10 Center Drive, Bethesda, MD, 20892, United States, 1 301 594 3735, tiffany.powell@nih.gov %K mHealth %K physical activity %K community-based participatory research %K obesity %K African Americans %K activity monitoring %K qualitative research %K focus groups %K community %D 2016 %7 25.04.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Resource-limited communities in Washington, D.C. have high rates of obesity-related cardiovascular disease in addition to inadequate physical activity (PA) facilities and limited Internet access. Engaging community members in the design and implementation of studies to address these health disparities is essential to the success of community-based PA interventions. Objective: The objective of the study was to use qualitative and quantitative methods to evaluate the feasibility and acceptability of PA-monitoring wristbands and Web-based technology by predominantly African American, church-based populations in resource-limited Washington, D.C. neighborhoods. Methods: To address cardiovascular health in at-risk populations in Washington, D.C., we joined community leaders to establish a community advisory board, the D.C. Cardiovascular Health and Obesity Collaborative (D.C. CHOC). As their first initiative, the Washington, D.C. Cardiovascular Health and Needs Assessment intends to evaluate cardiovascular health, social determinants of health, and PA-monitoring technologies. At the recommendation of D.C. CHOC members, we conducted a focus group and piloted the proposed PA-monitoring system with community members representing churches that would be targeted by the Cardiovascular Health and Needs Assessment. Participants (n=8) agreed to wear a PA-monitoring wristband for two weeks and to log cardiovascular health factors on a secure Internet account. Wristbands collected accelerometer-based data that participants uploaded to a wireless hub at their church. Participants agreed to return after two weeks to participate in a moderated focus group to share experiences using this technology. Feasibility was measured by Internet account usage, wristband utilization, and objective PA data. Acceptability was evaluated through thematic analysis of verbatim focus group transcripts. Results: Study participants (5 males, 3 females) were African American and age 28-70 years. Participant wristbands recorded data on 10.1±1.6 days. Two participants logged cardiovascular health factors on the website. Focus group transcripts revealed that participants felt positively about incorporating the device into their church-based populations, given improvements were made to device training, hub accessibility, and device feedback. Conclusions: PA-monitoring wristbands for objectively measuring PA appear to be a feasible and acceptable technology in Washington, D.C., resource-limited communities. User preferences include immediate device feedback, hands-on device training, explicit instructions, improved central hub accessibility, and designation of a church member as a trained point-of-contact. When implementing technology-based interventions in resource-limited communities, engaging the targeted community may aid in early identification of issues, suggestions, and preferences. ClinicalTrial: Trial Registration: ClinicalTrials.gov NCT01927783; https://clinicaltrials.gov/ct2/show/NCT01927783 (Archived by WebCite at http://www.webcitation.org/6f8wL117u) %M 27113680 %R 10.2196/mhealth.4489 %U http://mhealth.jmir.org/2016/2/e38/ %U https://doi.org/10.2196/mhealth.4489 %U http://www.ncbi.nlm.nih.gov/pubmed/27113680 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e36 %T Parent Use and Efficacy of a Self-Administered, Tablet-Based Parent Training Intervention: A Randomized Controlled Trial %A Breitenstein,Susan M %A Fogg,Louis %A Ocampo,Edith V %A Acosta,Diana I %A Gross,Deborah %+ Rush University, College of Nursing, 600 S. Paulina Street, Chicago, IL, , United States, 1 312 942 6259, susan_m_breitenstein@rush.edu %K Internet, intervention, mobile app, mobile health, parenting, prevention %D 2016 %7 20.04.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Parent training programs are traditionally delivered in face-to-face formats and require trained facilitators and weekly parent attendance. Implementing face-to-face sessions is challenging in busy primary care settings and many barriers exist for parents to attend these sessions. Tablet-based delivery of parent training offers an alternative to face-to-face delivery to make parent training programs easier to deliver in primary care settings and more convenient and accessible to parents. We adapted the group-based Chicago Parent Program (CPP) to be delivered as a self-administered, tablet-based program called the ezParent program. Objective: The purpose of this study was to (1) assess the feasibility of the ezParent program by examining parent satisfaction with the program and the percent of modules completed, (2) test the efficacy of the ezParent program by examining the effects compared with a control condition for improving parenting and child behavior in a sample of low-income ethnic minority parents of young children recruited from a primary care setting, and (3) compare program completion and efficacy with prior studies of the group-based CPP. Methods: The study used a two-group randomized controlled trial (RCT) design with repeated measures follow up. Subjects (n=79) were randomly assigned to an intervention or attention control condition. Data collection was at baseline and 12 and 24 weeks post baseline. Parents were recruited from a large, urban, primary care pediatric clinic. ezParent module completion was calculated as the percentage of the six modules completed by the intervention group parents. Attendance in the group-based CPP was calculated as the percentage of attendance at sessions 1 through 10. Satisfaction data were summarized using item frequencies. Parent and child data were analyzed using a repeated measures analysis of variance (RM-ANOVA) with simple contrasts to determine if there were significant intervention effects on the outcome measures. Effect sizes for between group comparisons were calculated for all outcome variables and compared with CPP group based archival data. Results: ezParent module completion rate was 85.4% (34.2/40; 95% confidence interval [CI] = 78.4%-93.7%) and was significantly greater (P<.05) than face-to-face CPP group attendance (135.2/267, 50.6%) attendance of sessions; 95% CI = 46.8%-55.6%). ezParent participants reported the program as very helpful (35/40, 88.0%) and they would highly recommend the program (33/40, 82.1%) to another parent. ezParent participants showed greater improvements in parenting warmth (F1,77 = 4.82, P<.05) from time 1 to 3. No other significant differences were found. Cohen’s d effect sizes for intervention group improvements in parenting warmth, use of corporal punishment, follow through, parenting stress, and intensity of child behavior problems were comparable or greater than those of the group-based CPP. Conclusions: Data from this study indicate the feasibility and acceptability of the ezParent program in a low-income, ethnic minority population of parents and comparable effect sizes with face-to-face delivery for parents. %M 27098111 %R 10.2196/mhealth.5202 %U http://mhealth.jmir.org/2016/2/e36/ %U https://doi.org/10.2196/mhealth.5202 %U http://www.ncbi.nlm.nih.gov/pubmed/27098111 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e41 %T Assessing the Use of Mobile Health Technology by Patients: An Observational Study in Primary Care Clinics %A Ramirez,Veronica %A Johnson,Emily %A Gonzalez,Cesar %A Ramirez,Vanessa %A Rubino,Barbara %A Rossetti,Gina %+ Department of Internal Medicine, Los Angeles County + University of Southern California Medical Center, 2020 Zonal Avenue, IRD 620, Los Angeles, CA, 90033, United States, 1 323 226 7556, ramirezv@usc.edu %K Mobile health applications %K mobile health technology %K telemedicine %D 2016 %7 19.04.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: There is significant potential for mobile health technology to improve health outcomes for patients with chronic diseases. However, there is a need for further development of mobile health technology that would help to improve the health of lower-income communities. Objective: The study objective was to assess mobile phone and app usage among a culturally diverse patient population, and to determine whether patients would be interested in using mobile health technology to help manage their chronic diseases. Methods: An observational study was conducted with patients of the Internal Medicine resident primary care clinics of Los Angeles County and University of Southern California (LAC+USC) Medical Center. Self-reported information regarding demographics, current mobile phone usage, current mobile health app and social media usage, barriers to using mobile phones or mobile health apps, and interest in using a mobile health app was collected. Results: Ninety-one percent of patients owned a mobile phone, with 76% (169/223) of these reporting having a mobile phone with Internet capability. Fifty-seven percent of subjects used mobile apps on their mobile phones, and 32% (41/130) of these used mobile apps related to their health. Eighty-six percent (207/241) of respondents voiced interest in using a mobile app to improve their health, and 40% (88/221) stated they would use such an app daily. Patients stated they would find the mobile health app most useful for nutrition, exercise, and obtaining general information on medical conditions. Conclusions: Despite the fact that the majority of our primary care patients were of lower socioeconomic status, they utilized mobile phones with Internet and mobile app capabilities to a great extent. There was substantial interest among our patients in using mobile health technology to both manage chronic disease and improve overall health. Given that cultural, educational, and socioeconomic disparities strongly correlate with higher rates of chronic diseases such as obesity, diabetes and hypertension, access to culturally relevant mobile health tools may empower patients in these populations to improve health outcomes. %M 27095507 %R 10.2196/mhealth.4928 %U http://mhealth.jmir.org/2016/2/e41/ %U https://doi.org/10.2196/mhealth.4928 %U http://www.ncbi.nlm.nih.gov/pubmed/27095507 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 4 %P e86 %T The Impact of Automated Brief Messages Promoting Lifestyle Changes Delivered Via Mobile Devices to People with Type 2 Diabetes: A Systematic Literature Review and Meta-Analysis of Controlled Trials %A Arambepola,Carukshi %A Ricci-Cabello,Ignacio %A Manikavasagam,Pavithra %A Roberts,Nia %A French,David P %A Farmer,Andrew %+ University of Oxford, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford., Oxford, OX2 6GG, United Kingdom, 44 01865 617190, ignacio.riccicabello@phc.ox.ac.uk %K Diabetes mellitus, type 2 %K mobile health %K text messaging %K systematic review %K diet %K physical activity %K self-care %D 2016 %7 19.04.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Brief automated messages have the potential to support self-management in people with type 2 diabetes, but their effect compared with usual care is unclear. Objective: To examine the effectiveness of interventions to change lifestyle behavior delivered via automated brief messaging in patients with type 2 diabetes. Methods: A systematic literature review of controlled trials examined the impact of interventions, delivered by brief messaging, and intended to promote lifestyle change in people with type 2 diabetes, on behavioral and clinical outcomes. Bibliographic databases searched included Medline, Embase, CINAHL, PsycINFO, and ISI WoK. Two reviewers independently screened citations. We extracted information on study risk of bias, setting (high versus low- and middle-income countries) and intervention characteristics (including use of theory and behavior-change techniques). Outcome measures included acceptability of the interventions and their impact on 1) determinants of lifestyle behavior (knowledge about diabetes, self-efficacy, attitudes towards self-management), 2) lifestyle behavior (diet, physical activity), and 3) clinical and patient-reported outcomes. Where possible, we pooled data using random-effects meta-analyses to obtain estimates of effect size of intervention compared to usual care. Results: We identified 15 trials (15 interventions) meeting our inclusion criteria. Most interventions were delivered via short message service text messaging (n=12) and simultaneously targeted diet and physical activity (n=11). Nine interventions consisted of unidirectional messages, whereas six consisted of bidirectional messages, with patients receiving automated tailored feedback based on self-reported data. The acceptability of the interventions, and their impact on lifestyle behavior and its determinants, were examined in a low proportion of trials, with heterogeneous results being observed. In 13 trials (1155 patients) where data were available, there was a difference in glycated hemoglobin of -0.53% (95% CI -0.59% to -0.47%) between intervention groups compared to usual care. In five trials (406 patients) there was a non-significant difference in body mass index of -0.25 kg/m2 (95% CI -1.02 to 0.52). Interventions based on unidirectional messages produced similar effects in the outcomes examined, compared to those based on bidirectional messages. Interventions conducted in low- and middle-income countries showed a greater impact than those conducted in high-income countries. In general, trials were not free of bias and did not use explicit theory. Conclusions: Automated brief messages strategies can improve health outcomes in people with type 2 diabetes. Larger, methodologically robust trials are needed to confirm these positive results. %M 27095386 %R 10.2196/jmir.5425 %U http://www.jmir.org/2016/4/e86/ %U https://doi.org/10.2196/jmir.5425 %U http://www.ncbi.nlm.nih.gov/pubmed/27095386 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e26 %T Young People’s Views and Experiences of a Mobile Phone Texting Intervention to Promote Safer Sex Behavior %A French,Rebecca Sophia %A McCarthy,Ona %A Baraitser,Paula %A Wellings,Kaye %A Bailey,Julia V %A Free,Caroline %+ London School of Hygiene & Tropical Medicine, Department of Social & Environmental Health Research, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom, 44 (0)20 7927 2047, Rebecca.French@lshtm.ac.uk %K text messaging %K young people %K sexual health %K intervention %K qualitative interviews %K sexual behavior %K behavior change %D 2016 %7 15.04.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The risk of poor sexual health, including unplanned pregnancy and sexually transmitted infections (STIs), is greatest amongst young people. Innovative and acceptable interventions to improve sexual health are required. Mobile phone text messaging (short message service, SMS) interventions have the potential to reach large numbers of people at relatively low cost, but greater understanding is needed on how these interventions should be developed and how they work. Objectives: The aim of this paper is to explore young people’s views of and experiences with a mobile phone text messaging intervention to promote safer sex behavior. Methods: We undertook qualitative interviews with young people aged 16 to 24 years as part of a pilot trial of a sexual health intervention delivered by text message in the United Kingdom. Study participants received sexual health promotion text messages based on behavior-change techniques. The message content, tailored by gender and STI status, included support for correct STI treatment and promotion of safer sex behaviors. Young people were eligible if they had received a positive chlamydia test or had more than one partner and at least one episode of unprotected sex in the last year. Telephone interviews were conducted 2 to 3 weeks after initiation of the intervention. A semi-structured topic guide was followed to explore participant experiences and a thematic analysis was conducted. Results: We conducted 16 telephone interviews with participants who had received the text intervention and an additional four interviews with those in the control group (13 women and 7 men). Intervention participants found text messages easy to understand and appearing to come from a friendly and trustworthy source. They considered the frequency and timing of messages to be appropriate, and delivery via mobile phones convenient. Receipt of support by text message allowed recipients to assimilate information at their own pace, and prompted reflection on and sharing of messages with friends, family members, and partners, thus providing opportunities for education and discussion. For some recipients, the messages had increased their knowledge of how to correctly use condoms. Some described how the messages had increased their confidence and reduced stigma, enabling them to disclose infection to a partner and/or to do so sooner and more calmly. Discussing the messages with a partner reportedly enabled some women to negotiate condom use. Conclusion: From the perspective of the recipients, the tone, frequency, and content of the text messaging-based sexual health intervention was acceptable and appropriate. Their accounts indicated that the intervention increased knowledge, confidence, and safer sex behaviors. A large-scale randomized controlled trial (RCT) is needed to assess effectiveness. %M 27083784 %R 10.2196/mhealth.4302 %U http://mhealth.jmir.org/2016/2/e26/ %U https://doi.org/10.2196/mhealth.4302 %U http://www.ncbi.nlm.nih.gov/pubmed/27083784 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 4 %P e58 %T Efficacy and External Validity of Electronic and Mobile Phone-Based Interventions Promoting Vegetable Intake in Young Adults: Systematic Review and Meta-Analysis %A Nour,Monica %A Chen,Juliana %A Allman-Farinelli,Margaret %+ School of Life and Environmental Sciences, University of Sydney, Level 4 East, Charles Perkins Centre D17, The University of Sydney, Sydney, NSW, 2006, Australia, 61 403094095, mnou2973@uni.sydney.edu.au %K young adults %K vegetable consumption %K mHealth %K eHealth %K social marketing %D 2016 %7 08.04.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Young adults (18–35 years) remain among the lowest vegetable consumers in many western countries. The digital era offers opportunities to engage this age group in interventions in new and appealing ways. Objective: This systematic review evaluated the efficacy and external validity of electronic (eHealth) and mobile phone (mHealth) -based interventions that promote vegetable intake in young adults. Methods: We searched several electronic databases for studies published between 1990 and 2015, and 2 independent authors reviewed the quality and risk of bias of the eligible papers and extracted data for analyses. The primary outcome of interest was the change in vegetable intake postintervention. Where possible, we calculated effect sizes (Cohen d and 95% CIs) for comparison. A random effects model was applied to the data for meta-analysis. Reach and representativeness of participants, intervention implementation, and program maintenance were assessed to establish external validity. Published validation studies were consulted to determine the validity of tools used to measure intake. We applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to evaluate the overall quality of the body of evidence. Results: Of the 14 studies that met the selection criteria, we included 12 in the meta-analysis. In the meta-analysis, 7 studies found positive effects postintervention for fruit and vegetable intake, Cohen d 0.14–0.56 (pooled effect size 0.22, 95% CI 0.11–0.33, I2=68.5%, P=.002), and 4 recorded positive effects on vegetable intake alone, Cohen d 0.11–0.40 (pooled effect size 0.15, 95% CI 0.04–0.28, I2=31.4%, P=.2). These findings should be interpreted with caution due to variability in intervention design and outcome measures. With the majority of outcomes documented as a change in combined fruit and vegetable intake, it was difficult to determine intervention effects on vegetable consumption specifically. Measurement of intake was most commonly by self-report, with 5 studies using nonvalidated tools. Longer-term follow-up was lacking from most studies (n=12). Risk of bias was high among the included studies, and the overall body of evidence was rated as low quality. The applicability of interventions to the broader young adult community was unclear due to poor description of external validity components. Conclusions: Preliminary evidence suggests that eHealth and mHealth strategies may be effective in improving vegetable intake in young adults; whether these small effects have clinical or nutritional significance remains questionable. With studies predominantly reporting outcomes as fruit and vegetable intake combined, we suggest that interventions report vegetables separately. Furthermore, to confidently establish the efficacy of these strategies, better-quality interventions are needed for young adults, using valid measures of intake, with improved reporting on costs, sustainability and long-term effects of programs. Trial registration: PROSPERO International Prospective Register of Systematic Reviews: CRD42015017763; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015017763 (Archived by WebCite at http://www.webcitation.org/6fLhMgUP4) %M 27059765 %R 10.2196/jmir.5082 %U http://www.jmir.org/2016/4/e58/ %U https://doi.org/10.2196/jmir.5082 %U http://www.ncbi.nlm.nih.gov/pubmed/27059765 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e33 %T Diet and Physical Activity Apps: Perceived Effectiveness by App Users %A Wang,Qing %A Egelandsdal,Bjørg %A Amdam,Gro V %A Almli,Valerie L %A Oostindjer,Marije %+ Department of Chemistry, Biotechnology, and Food Science, Norwegian University of Life Sciences, 1430 Aas, Norway, 47 67 23 25 74, qing.wang@nmbu.no %K diet app %K physical activity app %K perceived effectiveness %K behavioral changes %D 2016 %7 07.04.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Diet and physical activity apps are two types of health apps that aim to promote healthy eating and energy expenditure through monitoring of dietary intake and physical activity. No clear evidence showing the effectiveness of using these apps to promote healthy eating and physical activity has been previously reported. Objective: This study aimed to identify how diet and physical activity (PA) apps affected their users. It also investigated if using apps was associated with changes in diet and PA. Methods: First, 3 semi-structured focus group discussions concerning app usability were conducted (15 app users and 8 nonusers; mean age 24.2 years, SD 6.4), including outcome measures such as motivations, experiences, opinions, and adherence. Results from the discussions were used to develop a questionnaire. The questionnaire, which contained questions about behavior changes, app usage, perceived effectiveness, and opinions of app usability, was answered by 500 Norwegians, with a mean age of 25.8 years (SD 5.1). Results: App users found diet and PA apps effective in promoting healthy eating and exercising. These apps affected their actions, health consciousness, and self-education about nutrition and PA; and were also a part of their social lives. Over half of the users perceived that apps were effective in assisting them to eat healthily and to exercise more. Diet apps were more effective when they were frequently used and over a long period of time, compared to infrequent or short-term use (P=.01 and P=.02, respectively). Users who used diet and PA apps, perceived apps as more effective than users who only used one type of app (all P<.05). App users were better at maintaining diet and PA behaviors than nonusers (all P<.05). Young adults found apps fun to use, but sometimes time consuming. They wanted apps to be designed to meet their personal expectations. Conclusions: App usage influenced action, consciousness, self-education about nutrition and PA, and social life. It facilitated maintaining a healthy diet and exercising more. Diet and PA apps of the future can be further strengthened by being tailored to meet personal needs. %M 27056639 %R 10.2196/mhealth.5114 %U http://mhealth.jmir.org/2016/2/e33/ %U https://doi.org/10.2196/mhealth.5114 %U http://www.ncbi.nlm.nih.gov/pubmed/27056639 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 4 %P e69 %T Cardiac Patients’ Walking Activity Determined by a Step Counter in Cardiac Telerehabilitation: Data From the Intervention Arm of a Randomized Controlled Trial %A Thorup,Charlotte %A Hansen,John %A Grønkjær,Mette %A Andreasen,Jan Jesper %A Nielsen,Gitte %A Sørensen,Erik Elgaard %A Dinesen,Birthe Irene %+ Department of Cardiothoracic Surgery, Aalborg University Hospital, Søndre Skovvej 5, 313, Aalborg, 9000, Denmark, 45 20729950, cbt@rn.dk %K heart disease %K rehabilitation %K step counters %K physical activity %K telerehabilitation %D 2016 %7 04.04.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Walking represents a large part of daily physical activity. It reduces both overall and cardiovascular diseases and mortality and is suitable for cardiac patients. A step counter measures walking activity and might be a motivational tool to increase and maintain physical activity. There is a lack of knowledge about both cardiac patients’ adherence to step counter use in a cardiac telerehabilitation program and how many steps cardiac patients walk up to 1 year after a cardiac event. Objective: The purpose of this substudy was to explore cardiac patients’ walking activity. The walking activity was analyzed in relation to duration of pedometer use to determine correlations between walking activity, demographics, and medical and rehabilitation data. Methods: A total of 64 patients from a randomized controlled telerehabilitation trial (Teledi@log) from Aalborg University Hospital and Hjoerring Hospital, Denmark, from December 2012 to March 2014 were included in this study. Inclusion criteria were patients hospitalized with acute coronary syndrome, heart failure, and coronary artery bypass grafting or valve surgery. In Teledi@log, the patients received telerehabilitation technology and selected one of three telerehabilitation settings: a call center, a community health care center, or a hospital. Monitoring of steps continued for 12 months and a step counter (Fitbit Zip) was used to monitor daily steps. Results: Cardiac patients walked a mean 5899 (SD 3274) steps per day, increasing from mean 5191 (SD 3198) steps per day in the first week to mean 7890 (SD 2629) steps per day after 1 year. Adherence to step counter use lasted for a mean 160 (SD 100) days. The patients who walked significantly more were younger (P=.01) and continued to use the pedometer for a longer period (P=.04). Furthermore, less physically active patients weighed more. There were no significant differences in mean steps per day for patients in the three rehabilitation settings or in the disease groups. Conclusions: This study indicates that cardiac telerehabilitation at a call center can support walking activity just as effectively as telerehabilitation at either a hospital or a health care center. In this study, the patients tended to walk fewer steps per day than cardiac patients in comparable studies, but our study may represent a more realistic picture of walking activity due to the continuation of step counter use. Qualitative studies on patients’ behavior and motivation regarding step counter use are needed to shed light on adherence to and motivation to use step counters. Trial Registration: ClinicalTrails.gov NCT01752192; https://clinicaltrials.gov/ct2/show/NCT01752192 (Archived by WebCite at http://www.webcitation.org/6fgigfUyV) %M 27044310 %R 10.2196/jmir.5191 %U http://www.jmir.org/2016/4/e69/ %U https://doi.org/10.2196/jmir.5191 %U http://www.ncbi.nlm.nih.gov/pubmed/27044310 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e24 %T Development of a Weight Loss Mobile App Linked With an Accelerometer for Use in the Clinic: Usability, Acceptability, and Early Testing of its Impact on the Patient-Doctor Relationship %A Choo,Seryung %A Kim,Ju Young %A Jung,Se Young %A Kim,Sarah %A Kim,Jeong Eun %A Han,Jong Soo %A Kim,Sohye %A Kim,Jeong Hyun %A Kim,Jeehye %A Kim,Yongseok %A Kim,Dongouk %A Steinhubl,Steve %+ Department of Family Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, Republic Of Korea, 82 31 787 7796, kkamduri@snubh.org %K mobile apps %K electronic health record %K weight reduction programs %K physician-patient relations %D 2016 %7 31.03.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Although complications of obesity are well acknowledged and managed by clinicians, management of obesity itself is often difficult, which leads to its underdiagnosis and undertreatment in hospital settings. However, tools that could improve the management of obesity, including self-monitoring, engagement with a social network, and open channels of communication between the patient and doctor, are limited in a clinic-based setting. Objective: The objective of our study was to evaluate the usability and acceptability of a newly developed mobile app linked with an accelerometer and its early effects on patient-doctor relationships. Methods: From September 2013 to February 2014, we developed a mobile app linked with an accelerometer as a supportive tool for a clinic-based weight loss program. The app used information from electronic health records and delivered tailored educational material. Personal goal setting, as well as monitoring of weight changes and physical activity combined with feedback, are key features of the app. We also incorporated an interactive message board for patients and doctors. During the period of March 2014 to May 2014, we tested our mobile app for 1 month in participants in a hospital clinic setting. We assessed the app’s usability and acceptability, as well as the patient-doctor relationship, via questionnaires and analysis of app usage data. Results: We recruited 30 individuals (18 male and 12 female) for the study. The median number of log-ins per day was 1.21, with the most frequently requested item being setting goals, followed by track physical activities and view personal health status. Scales of the depth of the patient-doctor relationship decreased from 27.6 (SD 4.8) to 25.1 (SD 4.5) by a Wilcoxon signed rank test (P=.02). Conclusions: A mobile phone app linked with an accelerometer for a clinic-based weight loss program is useful and acceptable for weight management but exhibited less favorable early effects on patient-doctor relationships. %M 27032541 %R 10.2196/mhealth.4546 %U http://mhealth.jmir.org/2016/1/e24/ %U https://doi.org/10.2196/mhealth.4546 %U http://www.ncbi.nlm.nih.gov/pubmed/27032541 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e32 %T Uptake of a Consumer-Focused mHealth Application for the Assessment and Prevention of Heart Disease: The <30 Days Study %A Goyal,Shivani %A Morita,Plinio P %A Picton,Peter %A Seto,Emily %A Zbib,Ahmad %A Cafazzo,Joseph A %+ Centre for Global eHealth Innovation, Techna Institute, University Health Network, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada, 1 647 979 3309, shivani.goyal@uhn.ca %K health behavior %K lifestyle %K cardiovascular disease %K prevention %K risk reduction %K mobile apps %K mobile phone %K incentives %D 2016 %7 24.03.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Lifestyle behavior modification can reduce the risk of cardiovascular disease, one of the leading causes of death worldwide, by up to 80%. We hypothesized that a dynamic risk assessment and behavior change tool delivered as a mobile app, hosted by a reputable nonprofit organization, would promote uptake among community members. We also predicted that the uptake would be influenced by incentives offered for downloading the mobile app. Objective: The primary objective of our study was to evaluate the engagement levels of participants using the novel risk management app. The secondary aim was to assess the effect of incentives on the overall uptake and usage behaviors. Methods: We publicly launched the app through the iTunes App Store and collected usage data over 5 months. Aggregate information included population-level data on download rates, use, risk factors, and user demographics. We used descriptive statistics to identify usage patterns, t tests, and analysis of variance to compare group means. Correlation and regression analyses determined the relationship between usage and demographic variables. Results: We captured detailed mobile usage data from 69,952 users over a 5-month period, of whom 23,727 (33.92%) were registered during a 1-month AIR MILES promotion. Of those who completed the risk assessment, 73.92% (42,380/57,330) were female, and 59.38% (34,042/57,330) were <30 years old. While the older demographic had significantly lower uptake than the younger demographic, with only 8.97% of users aged ≥51 years old downloading the app, the older demographic completed more challenges than their younger counterparts (F8, 52,422 = 55.10, P<.001). In terms of engagement levels, 84.94% (44,537/52,431) of users completed 1–14 challenges over a 30-day period, and 10.03% (5,259/52,431) of users completed >22 challenges. On average, users in the incentives group completed slightly more challenges during the first 30 days of the intervention (mean 7.9, SD 0.13) than those in the nonincentives group (mean 6.1, SD 0.06, t28870=–12.293, P<.001, d=0.12, 95% CI –2.02 to –1.47). The regression analysis suggested that sex, age group, ethnicity, having 5 of the risk factors (all but alcohol), incentives, and the number of family histories were predictors of the number of challenges completed by a user (F14, 56,538 = 86.644, P<.001, adjusted R2 = .021). Conclusion: While the younger population downloaded the app the most, the older population demonstrated greater sustained engagement. Behavior change apps have the potential to reach a targeted population previously thought to be uninterested in or unable to use mobile apps. The development of such apps should assume that older adults will in fact engage if the behavior change elements are suitably designed, integrated into daily routines, and tailored. Incentives may be the stepping-stone that is needed to guide the general population toward preventative tools and promote sustained behavior change. %M 27012937 %R 10.2196/mhealth.4730 %U http://mhealth.jmir.org/2016/1/e32/ %U https://doi.org/10.2196/mhealth.4730 %U http://www.ncbi.nlm.nih.gov/pubmed/27012937 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e18 %T Smartloss: A Personalized Mobile Health Intervention for Weight Management and Health Promotion %A Martin,Corby K %A Gilmore,L. Anne %A Apolzan,John W %A Myers,Candice A %A Thomas,Diana M %A Redman,Leanne M %+ Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, United States, 1 225 763 0947, leanne.redman@pbrc.edu %K weight loss %K app %K eHealth %K mHealth %K SmartLoss %K telehealth %K mobile website %K mobile phone %D 2016 %7 16.03.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Synonymous with increased use of mobile phones has been the development of mobile health (mHealth) technology for improving health, including weight management. Behavior change theory (eg, the theory of planned behavior) can be effectively encapsulated into mobile phone-based health improvement programs, which is fostered by the ability of mobile phones and related devices to collect and transmit objective data in near real time and for health care or research professionals and clients to communicate easily. Objective: To describe SmartLoss, a semiautomated mHealth platform for weight loss. Methods: We developed and validated a dynamic energy balance model that determines the amount of weight an individual will lose over time if they are adherent to an energy intake prescription. This model was incorporated into computer code that enables adherence to a prescribed caloric prescription determined from the change in body weight of the individual. Data from the individual are then used to guide personalized recommendations regarding weight loss and behavior change via a semiautomated mHealth platform called SmartLoss, which consists of 2 elements: (1) a clinician dashboard and (2) a mobile phone app. SmartLoss includes and interfaces with a network-connected bathroom scale and a Bluetooth-connected accelerometer, which enables automated collection of client information (eg, body weight change and physical activity patterns), as well as the systematic delivery of preplanned health materials and automated feedback that is based on client data and is designed to foster prolonged adherence with body weight, diet, and exercise goals. The clinician dashboard allows for efficient remote monitoring of all clients simultaneously, which may further increase adherence, personalization of treatment, treatment fidelity, and efficacy. Results: Evidence of the efficacy of the SmartLoss approach has been reported previously. The present report provides a thorough description of the SmartLoss Virtual Weight Management Suite, a professionally programmed platform that facilitates treatment fidelity and the ability to customize interventions and disseminate them widely. Conclusions: SmartLoss functions as a virtual weight management clinic that relies upon empirical weight loss research and behavioral theory to promote behavior change and weight loss. %M 26983937 %R 10.2196/mhealth.5027 %U http://mhealth.jmir.org/2016/1/e18/ %U https://doi.org/10.2196/mhealth.5027 %U http://www.ncbi.nlm.nih.gov/pubmed/26983937 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e21 %T Automated Behavioral Text Messaging and Face-to-Face Intervention for Parents of Overweight or Obese Preschool Children: Results From a Pilot Study %A Militello,Lisa %A Melnyk,Bernadette Mazurek %A Hekler,Eric B %A Small,Leigh %A Jacobson,Diana %+ The Ohio State University, College of Nursing, 145 Newton Hall, 1585 Neil Ave, Columbus, OH, 43210, United States, 1 614 292 4844, militello.14@osu.edu %K Child %K Obesity %K Overweight %K Health Behavior %K Text Messaging/SMS %K Mobile Health %K Parents %K Psychology %K Behavior Therapy %K Telemedicine %D 2016 %7 14.03.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Children are 5 times more likely to be overweight at the age of 12 years if they are overweight during the preschool period. Objective: The purpose of this study was to establish the feasibility, acceptability, and preliminary effects of a cognitive behavioral intervention (TEXT2COPE) synergized with tailored mobile technology (mHealth) on the healthy lifestyle behaviors of parents of overweight and obese preschoolers delivered in a primary care setting. Methods: Fifteen preschooler-parent dyads recruited through primary care clinics completed a manualized 7-week cognitive behavioral skills building intervention. Beck’s Cognitive Theory guided the TEXT2COPE intervention content and Fogg’s Behavior Model guided the implementation. The intervention employed a combination of face-to-face clinic visits and ecological momentary interventions using text messaging (short message service, SMS). To enhance the intervention’s relevance to the family’s needs, parents dictated the wording of the text messages and also were able to adapt the frequency and timing of delivery throughout program implementation. Results: Self-reported findings indicate that the program is feasible and acceptable in this population. The intervention showed preliminary effects with significant improvements on parental knowledge about nutrition (P=.001) and physical activity (P=.012) for their children, parental beliefs (P=.001) toward healthy lifestyles, and parental behaviors (P=.040) toward engaging in healthy lifestyle choices for their children. Effect sizes were medium to large for all variables. The timing, frequency, and wording of the text messages were tailored to the individual families, with 69% of parents (9/13) increasing the frequency of the tailored SMS from being sent once weekly to as many as 5 times a week. Conclusions: Utilizing a cognitive behavioral skills intervention with SMS has great potential for supporting clinical care of overweight and obese preschool children and their families. Further exploration of the potential effects on health and behavioral outcomes is warranted. %M 26976387 %R 10.2196/mhealth.4398 %U http://mhealth.jmir.org/2016/1/e21/ %U https://doi.org/10.2196/mhealth.4398 %U http://www.ncbi.nlm.nih.gov/pubmed/26976387 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e19 %T Health Behavior Theory in Popular Calorie Counting Apps: A Content Analysis %A Davis,Siena F %A Ellsworth,Marisa A %A Payne,Hannah E %A Hall,Shelby M %A West,Joshua H %A Nordhagen,Amber L %+ Department of Health Science, Brigham Young University, 4103 Life Sciences Building, Provo, UT, , United States, 1 801 422 3386, josh.west@byu.edu %K cell phones %K mobile applications %K telemedicine %K weight loss %K caloric restriction %D 2016 %7 02.03.2016 %9 Short Paper %J JMIR mHealth uHealth %G English %X Background: Although the Health & Fitness category of the Apple App Store features hundreds of calorie counting apps, the extent to which popular calorie counting apps include health behavior theory is unknown. Objective: This study evaluates the presence of health behavior theory in calorie counting apps. Methods: Data for this study came from an extensive content analysis of the 10 most popular calorie counting apps in the Health & Fitness category of the Apple App Store. Results: Each app was given a theory score to reflect the extent to which health behavior theory was integrated into the app. The highest possible score was 60. Out of the 10 apps evaluated, My Diet Coach obtained the highest theory score of 15. MapMyFitness and Yumget received the lowest scores of 0. The average theory score among the apps was 5.6. Conclusions: Most of the calorie counting apps in the sample contained minimal health behavior theory. %M 26935898 %R 10.2196/mhealth.4177 %U http://mhealth.jmir.org/2016/1/e19/ %U https://doi.org/10.2196/mhealth.4177 %U http://www.ncbi.nlm.nih.gov/pubmed/26935898 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e34 %T A Community-Engaged Approach to Developing a Mobile Cancer Prevention App: The mCPA Study Protocol %A Smith,Selina Ann %A Whitehead,Mary Smith %A Sheats,Joyce %A Mastromonico,Jeff %A Yoo,Wonsuk %A Coughlin,Steven Scott %+ Institute of Public & Preventive Health, Department of Family Medicine Medical College of Georgia, Georgia Regents University, 1120 15th St., CJ2300, Augusta, GA, 30912, United States, 1 706 721 1104, SESMITH@gru.edu %K smartphone applications %K African Americans %K breast cancer survivors %K cancer prevention guidelines %K dietary intake %K physical activity %D 2016 %7 02.03.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Rapid growth of mobile technologies has resulted in a proliferation of lifestyle-oriented mobile phone apps. However, most do not have a theoretical framework and few have been developed using a community-based participatory research approach. A community academic team will develop a theory-based, culturally tailored, mobile-enabled, Web-based app—the Mobile Cancer Prevention App (mCPA)—to promote adherence to dietary and physical activity guidelines. Objective: The aim of this study is to develop mCPA content with input from breast cancer survivors. Methods: Members of SISTAAH (Survivors Involving Supporters to Take Action in Advancing Health) Talk (N=12), treated for Stages I-IIIc breast cancer for less than 1 year, 75 years of age or younger, and English-speaking and writing, will be recruited to participate in the study. To develop the app content, breast cancer survivors will engage with researchers in videotaped and audiotaped sessions, including (1) didactic instructions with goals for, benefits of, and strategies to enhance dietary intake and physical activity, (2) guided discussions for setting individualized goals, monitoring progress, and providing or receiving feedback, (3) experiential nutrition education through cooking demonstrations, and (4) interactive physical activity focused on walking, yoga, and strength training. Qualitative (focus group discussions and key informant interviews) and quantitative (sensory evaluation) methods will be used to evaluate the participatory process and outcomes. Results: Investigators and participants anticipate development of an acceptable (frequency and duration of usage) feasible (structure, ease of use, features), and accessible mobile app available for intervention testing in early 2017. Conclusions: Depending on the availability of research funding, mCPA testing, which will be initiated in Miami, will be extended to Chicago, Houston, Philadelphia, and Los Angeles. %M 26935995 %R 10.2196/resprot.5290 %U http://www.researchprotocols.org/2016/1/e34/ %U https://doi.org/10.2196/resprot.5290 %U http://www.ncbi.nlm.nih.gov/pubmed/26935995 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 1 %P e7 %T Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments %A Bakker,David %A Kazantzis,Nikolaos %A Rickwood,Debra %A Rickard,Nikki %+ School of Psychology and Monash Institute of Cognitive and Clinical Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, 18 Innovation Walk, Wellington Road, Clayton, 3800, Australia, 61 3 9905 4301, david.bakker@monash.edu %K mobile phones %K mental health %K smartphones %K apps %K mobile apps %K depression %K anxiety %K cognitive behavior therapy %K cognitive behavioral therapy %K clinical psychology %D 2016 %7 01.03.2016 %9 Review %J JMIR Mental Health %G English %X Background: The number of mental health apps (MHapps) developed and now available to smartphone users has increased in recent years. MHapps and other technology-based solutions have the potential to play an important part in the future of mental health care; however, there is no single guide for the development of evidence-based MHapps. Many currently available MHapps lack features that would greatly improve their functionality, or include features that are not optimized. Furthermore, MHapp developers rarely conduct or publish trial-based experimental validation of their apps. Indeed, a previous systematic review revealed a complete lack of trial-based evidence for many of the hundreds of MHapps available. Objective: To guide future MHapp development, a set of clear, practical, evidence-based recommendations is presented for MHapp developers to create better, more rigorous apps. Methods: A literature review was conducted, scrutinizing research across diverse fields, including mental health interventions, preventative health, mobile health, and mobile app design. Results: Sixteen recommendations were formulated. Evidence for each recommendation is discussed, and guidance on how these recommendations might be integrated into the overall design of an MHapp is offered. Each recommendation is rated on the basis of the strength of associated evidence. It is important to design an MHapp using a behavioral plan and interactive framework that encourages the user to engage with the app; thus, it may not be possible to incorporate all 16 recommendations into a single MHapp. Conclusions: Randomized controlled trials are required to validate future MHapps and the principles upon which they are designed, and to further investigate the recommendations presented in this review. Effective MHapps are required to help prevent mental health problems and to ease the burden on health systems. %M 26932350 %R 10.2196/mental.4984 %U http://mental.jmir.org/2016/1/e7/ %U https://doi.org/10.2196/mental.4984 %U http://www.ncbi.nlm.nih.gov/pubmed/26932350 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e27 %T Development, Validation, and Implementation of an Innovative Mobile App for Alcohol Dependence Management: Protocol for the SIDEAL Trial %A Barrio,Pablo %A Ortega,Lluisa %A Bona,Xavier %A Gual,Antoni %+ Addictions Unit, Clinical Neuroscience Institute, Hospital Clinic of Barcelona, Villarroel 170, Barcelona, 08036, Spain, 34 932275400 ext 2891, pablobarriogimenez@gmail.com %K alcohol dependence %K alcoholism %K telemedicine %K mobile applications %K eHealth %K adherence %K patient compliance %K consumption register %D 2016 %7 17.02.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Information and communication technologies (ICT) have become one of the main pathways to the new paradigm of increased self-management of chronic conditions such as alcohol dependence. Validation of some mobile phone apps has begun, while validation of many others is forthcoming. Objective: To describe the protocol for validation of a new app called SIDEAL (an acronym of the Spanish name “Soporte Innovador a la persona con DEpendencia del ALcohol,” or innovative support for people with alcohol dependence). Methods: The project consists of 3 complementary, consecutive studies, including a pilot feasibility study, a qualitative study using focus groups, and, finally, a randomized controlled trial where patients will be randomized to standard treatment or standard treatment plus SIDEAL. During the pilot study, feasibility, usability, and acceptance by users will be the main outcomes explored. An electronic questionnaire will be sent to patients asking for their opinions. Focus groups will be the next step, after which improvements and refinements will be implemented in the app. During the final phase, consumption variables (heavy drinking days per month, mean standard drinks per day) will be investigated, in order to test app efficacy. Results: Because of the encouraging results with previous similar apps, we expect patients to widely accept and incorporate SIDEAL into their therapeutic options. Significant reductions in drinking-related variables are also expected. The pilot study has concluded with the inclusion of 29 patients. Results are expected to be available soon (expected mid-2016). Conclusions: SIDEAL may represent a useful, reliable, effective, and efficient tool to complement therapeutic options available to both patients and professionals. %M 26888196 %R 10.2196/resprot.5002 %U http://www.researchprotocols.org/2016/1/e27/ %U https://doi.org/10.2196/resprot.5002 %U http://www.ncbi.nlm.nih.gov/pubmed/26888196 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 3 %N 1 %P e8 %T A Mixed-Methods Approach to the Development, Refinement, and Pilot Testing of Social Networks for Improving Healthy Behaviors %A Hales,Sarah %A Turner-McGrievy,Gabrielle %A Fahim,Arjang %A Freix,Andrew %A Wilcox,Sara %A Davis,Rachel E %A Huhns,Michael %A Valafar,Homayoun %+ Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina, Discovery I Building, 915 Greene St., Columbia, SC, , United States, 1 843 670 5317, bridges5@mailbox.sc.edu %K mHealth %K obesity %K weight loss %K social support %K social cognitive theory %D 2016 %7 12.02.2016 %9 Original Paper %J JMIR Human Factors %G English %X Background: Mobile health (mHealth) has shown promise as a way to deliver weight loss interventions, including connecting users for social support. Objective: To develop, refine, and pilot test the Social Pounds Off Digitally (POD) Android app for personalized health monitoring and interaction. Methods: Adults who were overweight and obese with Android smartphones (BMI 25-49.9 kg/m2; N=9) were recruited for a 2-month weight loss pilot intervention and iterative usability testing of the Social POD app. The app prompted participants via notification to track daily weight, diet, and physical activity behaviors. Participants received the content of the behavioral weight loss intervention via podcast. In order to re-engage infrequent users (did not use the app within the previous 48 hours), the app prompted frequent users to select 1 of 3 messages to send to infrequent users targeting the behavioral theory constructs social support, self-efficacy, or negative outcome expectations. Body weight, dietary intake (2 24-hr recalls), and reported calories expended during physical activity were assessed at baseline and 2 months. All participants attended 1 of 2 focus groups to provide feedback on use of the app. Results: Participants lost a mean of 0.94 kg (SD 2.22, P=.24) and consumed significantly fewer kcals postintervention (1570 kcal/day, SD 508) as compared to baseline (2384 kcal/day, SD 993, P=.01). Participants reported expending a mean of 171 kcal/day (SD 153) during intentional physical activity following the intervention as compared to 138 kcal/day (SD 139) at baseline, yet this was not a statistically significant difference (P=.57). There was not a statistically significant correlation found between total app entries and percent weight loss over the course of the intervention (r=.49, P=.19). Mean number of app entries was 77.2 (SD 73.8) per person with a range of 0 to 219. Messages targeting social support were selected most often (32/68, 47%), followed by self-efficacy (28/68, 41%), and negative outcome expectations (8/68, 12%). Themes from the focus groups included functionality issues, revisions to the messaging system, and the addition of a point system with rewards for achieving goals. Conclusions: The Social POD app provides an innovative way to re-engage infrequent users by encouraging frequent users to provide social support. Although more time is needed for development, this mHealth intervention can be disseminated broadly for many years and to many individuals without the need for additional intensive in-person hours. %M 27026535 %R 10.2196/humanfactors.4512 %U http://humanfactors.jmir.org/2016/1/e8/ %U https://doi.org/10.2196/humanfactors.4512 %U http://www.ncbi.nlm.nih.gov/pubmed/27026535 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e17 %T Design Considerations for Smoking Cessation Apps: Feedback From Nicotine Dependence Treatment Providers and Smokers %A McClure,Jennifer B %A Hartzler,Andrea L %A Catz,Sheryl L %+ Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, , United States, 1 206 287 2737, McClure.J@ghc.org %K tobacco use cessation %K smoking %K mobile health %K smartphone %D 2016 %7 12.02.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Hundreds of smoking cessation apps are commercially available, but most are not theory-based or designed to take advantage of mobile technology in ways that could make them more engaging and possibly more effective. Considering input from both clinical experts (who understand best practice nicotine dependence treatment requirements) to inform appropriate content and from smokers (the end users) to express their preferences is important in designing these programs in the future. Objective: To assess and compare the opinions of nicotine dependence treatment providers and smokers regarding the design of future smoking cessation apps. Methods: We surveyed providers (n=264) and smokers who own smartphones (n=40) to assess their opinions on the importance of 21 app design features. Features represented 5 domains: cost, reputation, privacy and security, content and user experience, and communication. Domains were chosen to reflect best practice treatment, leverage mobile technology to support smoking cessation, and elicit important user preferences. Data were collected between June and July 2015. Results: Most providers agreed that mHealth apps hold promise for helping people quit smoking (203/264, 76.9%) and would recommend them to their clients/patients (201/264, 76.1%), especially if the app were empirically validated (236/264, 89.4%). Few providers believe effective cessation apps currently exist (112/264, 42.4%). Few smokers (5/40, 13%) had ever downloaded a smoking cessation app; of the ones who had not, most said they would consider doing so (29/35, 83%). Both respondent groups indicated the following features were very to extremely important to include in cessation apps: free or low cost, keeps information private, matches individual needs and interests, adapts as one’s needs and interests change, helps to manage nicotine withdrawal symptoms and medication side effects, and allows users to track their progress. Providers and smokers also indicated gaming and social media connectivity were less important than other features. Despite these similarities, the groups had significantly different opinions about the relative importance of various features. In particular, providers rated privacy as the most important feature, whereas smokers rated low cost and the ability to adaptively tailor content as the most important features. Conclusions: Smoking cessation apps hold great promise as intervention tools but only if they engage users and appropriately treat nicotine dependence. Intervention development should take into consideration the perspectives of both treatment experts and smokers. This paper highlights important perspectives from each of these groups to be considered when designing future app-based smoking cessation programs. %M 26872940 %R 10.2196/mhealth.5181 %U http://mhealth.jmir.org/2016/1/e17/ %U https://doi.org/10.2196/mhealth.5181 %U http://www.ncbi.nlm.nih.gov/pubmed/26872940 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 2 %N 1 %P e1 %T Interest in Health Behavior Intervention Delivery Modalities Among Cancer Survivors: A Cross-Sectional Study %A Martin,Emily C %A Basen-Engquist,Karen %A Cox,Matthew G %A Lyons,Elizabeth J %A Carmack,Cindy L %A Blalock,Janice A %A Demark-Wahnefried,Wendy %+ University of Texas MD Anderson Cancer Center, Department of Behavioral Science, PO Box 301439, Unit 1330, Houston, TX, 77230-1439, United States, 1 713 745 0338, emilymar@gmail.com %K cancer survivor %K technology %K smartphone %K behavioral intervention %K physical activity %K diet %D 2016 %7 11.02.2016 %9 Original Paper %J JMIR Cancer %G English %X Background: Effective, broad-reaching channels are important for the delivery of health behavior interventions in order to meet the needs of the growing population of cancer survivors in the United States. New technology presents opportunities to increase the reach of health behavior change interventions and therefore their overall impact. However, evidence suggests that older adults may be slower in their adoption of these technologies than the general population. Survivors’ interest for more traditional channels of delivery (eg, clinic) versus new technology-based channels (eg, smartphones) may depend on a variety of factors, including demographics, current health status, and the behavior requiring intervention. Objective: The aim of this study was to determine the factors that predict cancer survivors’ interest in new technology-based health behavior intervention modalities versus traditional modalities. Methods: Surveys were mailed to 1871 survivors of breast, prostate, and colorectal cancer. Participants’ demographics, diet and physical activity behaviors, interest in health behavior interventions, and interest in intervention delivery modalities were collected. Using path analysis, we explored the relationship between four intervention modality variables (ie, clinic, telephone, computer, and smartphone) and potential predictors of modality interest. Results: In total, 1053 respondents to the survey (56.3% response rate); 847 provided complete data for this analysis. Delivery channel interest was highest for computer-based interventions (236/847, 27.9% very/extremely interested) and lowest for smartphone–based interventions (73/847, 8.6%), with interest in clinic-based (147/847, 17.3%) and telephone-delivered (143/847, 16.9%) falling in between. Use of other technology platforms, such as Web cameras and social networking sites, was positively predictive of interest in technology-based delivery channels. Older survivors were less likely to report interest in smartphone–based diet interventions. Physical activity, fruit and vegetable consumption, weight status, and age moderated relationships between interest in targeted intervention behavior and modality. Conclusions: This study identified several predictors of survivor interest in various health behavior intervention delivery modalities. Overall, computer-based interventions were found to be most acceptable, while smartphones were the least. Factors related to survivors’ current technology use and health status play a role in their interest for technology-based intervention versus more traditional delivery channels. Future health behavior change research in this population should consider participants’ demographic, clinical, and lifestyle characteristics when selecting a delivery channel. Furthermore, current health behavior interventions for older cancer survivors may be best delivered over the Internet. Smartphone interventions may be feasible in the future following further adoption and familiarization by this particular population. %M 28410164 %R 10.2196/cancer.5247 %U http://cancer.jmir.org/2016/1/e1/ %U https://doi.org/10.2196/cancer.5247 %U http://www.ncbi.nlm.nih.gov/pubmed/28410164 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 2 %P e34 %T Effectiveness of an Activity Tracker- and Internet-Based Adaptive Walking Program for Adults: A Randomized Controlled Trial %A Poirier,Josée %A Bennett,Wendy L %A Jerome,Gerald J %A Shah,Nina G %A Lazo,Mariana %A Yeh,Hsin-Chieh %A Clark,Jeanne M %A Cobb,Nathan K %+ Division of Pulmonary and Critical Care Medicine, Georgetown University Medical Center, Main Building, 4th Floor, 3800 Reservoir Road, NW, Washington, DC, 20007, United States, 1 202 444 8830, nkc4@georgetown.edu %K physical activity %K walking %K intervention %K adaptive %K effectiveness %K RCT %D 2016 %7 09.02.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The benefits of physical activity are well documented, but scalable programs to promote activity are needed. Interventions that assign tailored and dynamically adjusting goals could effect significant increases in physical activity but have not yet been implemented at scale. Objective: Our aim was to examine the effectiveness of an open access, Internet-based walking program that assigns daily step goals tailored to each participant. Methods: A two-arm, pragmatic randomized controlled trial compared the intervention to no treatment. Participants were recruited from a workplace setting and randomized to a no-treatment control (n=133) or to treatment (n=132). Treatment participants received a free wireless activity tracker and enrolled in the walking program, Walkadoo. Assessments were fully automated: activity tracker recorded primary outcomes (steps) without intervention by the participant or investigators. The two arms were compared on change in steps per day from baseline to follow-up (after 6 weeks of treatment) using a two-tailed independent samples t test. Results: Participants (N=265) were 66.0% (175/265) female with an average age of 39.9 years. Over half of the participants (142/265, 53.6%) were sedentary (<5000 steps/day) and 44.9% (119/265) were low to somewhat active (5000-9999 steps/day). The intervention group significantly increased their steps by 970 steps/day over control (P<.001), with treatment effects observed in sedentary (P=.04) and low-to-somewhat active (P=.004) participants alike. Conclusions: The program is effective in increasing daily steps. Participants benefited from the program regardless of their initial activity level. A tailored, adaptive approach using wireless activity trackers is realistically implementable and scalable. Trial Registration: Clinicaltrials.gov NCT02229409, https://clinicaltrials.gov/ct2/show/NCT02229409 (Archived by WebCite at http://www.webcitation.org/6eiWCvBYe) %M 26860434 %R 10.2196/jmir.5295 %U http://www.jmir.org/2016/2/e34/ %U https://doi.org/10.2196/jmir.5295 %U http://www.ncbi.nlm.nih.gov/pubmed/26860434 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e14 %T Guidelines and Recommendations for Developing Interactive eHealth Apps for Complex Messaging in Health Promotion %A Heffernan,Kayla Joanne %A Chang,Shanton %A Maclean,Skye Tamara %A Callegari,Emma Teresa %A Garland,Suzanne Marie %A Reavley,Nicola Jane %A Varigos,George Andrew %A Wark,John Dennis %+ Department of Computing and Information Systems, Melbourne School of Engineering, The University of Melbourne, Doug McDonell Building, The University of Melbourne, Parkville, 3010, Australia, 61 383441500, shanton.chang@unimelb.edu.au %K mhealth %K complex messaging %K vitamin D %K eHealth smartphone apps %K interactive %D 2016 %7 09.02.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The now ubiquitous catchphrase, “There’s an app for that,” rings true owing to the growing number of mobile phone apps. In excess of 97,000 eHealth apps are available in major app stores. Yet the effectiveness of these apps varies greatly. While a minority of apps are developed grounded in theory and in conjunction with health care experts, the vast majority are not. This is concerning given the Hippocratic notion of “do no harm.” There is currently no unified formal theory for developing interactive eHealth apps, and development is especially difficult when complex messaging is required, such as in health promotion and prevention. Objective: This paper aims to provide insight into the creation of interactive eHealth apps for complex messaging, by leveraging the Safe-D case study, which involved complex messaging required to guide safe but sufficient UV exposure for vitamin D synthesis in users. We aim to create recommendations for developing interactive eHealth apps for complex messages based on the lessons learned during Safe-D app development. Methods: For this case study we developed an Apple and Android app, both named Safe-D, to safely improve vitamin D status in young women through encouraging safe ultraviolet radiation exposure. The app was developed through participatory action research involving medical and human computer interaction researchers, subject matter expert clinicians, external developers, and target users. The recommendations for development were created from analysis of the development process. Results: By working with clinicians and implementing disparate design examples from the literature, we developed the Safe-D app. From this development process, recommendations for developing interactive eHealth apps for complex messaging were created: (1) involve a multidisciplinary team in the development process, (2) manage complex messages to engage users, and (3) design for interactivity (tailor recommendations, remove barriers to use, design for simplicity). Conclusions: This research has provided principles for developing interactive eHealth apps for complex messaging as guidelines by aggregating existing design concepts and expanding these concepts and new learnings from our development process. A set of guidelines to develop interactive eHealth apps generally, and specifically those for complex messaging, was previously missing from the literature; this research has contributed these principles. Safe-D delivers complex messaging simply, to aid education, and explicitly, considering user safety. %M 26860623 %R 10.2196/mhealth.4423 %U http://mhealth.jmir.org/2016/1/e14/ %U https://doi.org/10.2196/mhealth.4423 %U http://www.ncbi.nlm.nih.gov/pubmed/26860623 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e12 %T A Mobile App for Hypertension Management Based on Clinical Practice Guidelines: Development and Deployment %A Kang,Hannah %A Park,Hyeoun-Ae %+ Systems Biomedical Informatics Research Center, College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, , Republic Of Korea, 82 2 740 8827, hapark@snu.ac.kr %K mobile health %K clinical practice guideline %K hypertension %K self-management %D 2016 %7 02.02.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Hypertension is a chronic and lifestyle-related disease that requires continuous preventive care. Although there are many evidence-based clinical practice guidelines (CPGs) for hypertension management, applying them to daily management can be difficult for patients with hypertension. A mobile app, based on CPGs, could help patients with hypertension manage their disease. Objective: To develop a mobile app for hypertension management based on CPGs and evaluate its effectiveness in patients with hypertension with respect to perceived usefulness, user satisfaction, and medication adherence. Methods: The hypertension management app (HMA) was developed according to the Web-Roadmap methodology, which includes planning, analysis, design, implementation, and evaluation phases. The HMA was provided to individuals (N=38) with hypertension. Medication adherence was measured before and after using the HMA for 4 weeks. The perceived usefulness and user satisfaction were surveyed in the patients who completed the medication adherence survey. Results: Of the 38 study participants, 29 (76%) participated in medical adherence assessment. Medication adherence, as measured by the Modified Morisky Scale, was significantly improved in these patients after they had used the HMA (P=.001). The perceived usefulness score was 3.7 out of 5. The user satisfaction scores, with respect to using the HMA for blood pressure recording, medication recording, data sending, alerting, recommending, and educating about medication were 4.3, 3.8, 3.1, 3.2, 3.4, and 3.8 out of 5, respectively, in the 19 patients. Conclusions: This study showed that a mobile app for hypertension management based on CPGs is effective at improving medication adherence. %M 26839283 %R 10.2196/mhealth.4966 %U http://mhealth.jmir.org/2016/1/e12/ %U https://doi.org/10.2196/mhealth.4966 %U http://www.ncbi.nlm.nih.gov/pubmed/26839283 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e19 %T Developing a Tablet-Based Self-Persuasion Intervention Promoting Adolescent HPV Vaccination: Protocol for a Three-Stage Mixed-Methods Study %A Tiro,Jasmin A %A Lee,Simon Craddock %A Marks,Emily G %A Persaud,Donna %A Skinner,Celette Sugg %A Street,Richard L %A Wiebe,Deborah J %A Farrell,David %A Bishop,Wendy Pechero %A Fuller,Sobha %A Baldwin,Austin S %+ Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, United States, 1 214 648 0263, jasmin.tiro@utsouthwestern.edu %K adolescents %K intervention development %K HPV vaccination %K self-persuasion %D 2016 %7 29.01.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Human papillomavirus (HPV)-related cancers are a significant burden on the US health care system that can be prevented through adolescent HPV vaccination. Despite guidelines recommending vaccination, coverage among US adolescents is suboptimal particularly among underserved patients (uninsured, low income, racial, and ethnic minorities) seen in safety-net health care settings. Many parents are ambivalent about the vaccine and delay making a decision or talking with a provider about it. Self-persuasion—generating one’s own arguments for a health behavior—may be particularly effective for parents who are undecided or not motivated to make a vaccine decision. Objective: Through a 3-stage mixed-methods protocol, we will identify an optimal and feasible self-persuasion intervention strategy to promote adolescent HPV vaccination in safety-net clinics. Methods: In Stage 1, we will define content for a tablet-based self-persuasion app by characterizing (1) parents’ self-generated arguments through cognitive interviews conducted with parents (n=50) of patients and (2) parent-provider HPV vaccine discussions through audio recordings of clinic visits (n=50). In Stage 2, we will compare the effects of the four self-persuasion intervention conditions that vary by cognitive processing level (parents verbalize vs listen to arguments) and choice of argument topics (parents choose vs are assigned topics) on parental vaccine intentions in a 2 × 2 factorial design randomized controlled trial (n=160). This proof-of-concept trial design will identify which intervention condition is optimal by quantitatively examining basic self-persuasion mechanisms (cognitive processing and choice) and qualitatively exploring parent experiences with intervention tasks. In Stage 3, we will conduct a pilot trial (n=90) in the safety-net clinics to assess feasibility of the optimal intervention condition identified in Stage 2. We will also assess its impact on parent-provider discussions. Results: This paper describes the study protocol and activities to date. Currently, we have developed the initial prototype of the tablet app for English- and Spanish-speaking populations, and completed Stage 1 data collection. Conclusions: Our systematic collaboration between basic and applied behavioral scientists accelerates translation of promising basic psychological research into innovative interventions suitable for underserved, safety-net populations. At project’s end, we plan to have a feasible and acceptable self-persuasion intervention that can affect key cancer disparities in the United States through prevention of HPV-related cancers. Trial Registration: ClinicalTrials.gov http://clinicaltrials.gov/ct2/show/NCT02537756 and http://clinicaltrials.gov/ct2/show/NCT02535845 (Archived by WebCite at http://www.webcitation.org/6e5XcOGXz and http://www.webcitation.org/6e5XfHoic, respectively). %M 26825137 %R 10.2196/resprot.5092 %U http://www.researchprotocols.org/2016/1/e19/ %U https://doi.org/10.2196/resprot.5092 %U http://www.ncbi.nlm.nih.gov/pubmed/26825137 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 1 %P e24 %T Adapting Behavioral Interventions for Social Media Delivery %A Pagoto,Sherry %A Waring,Molly E %A May,Christine N %A Ding,Eric Y %A Kunz,Werner H %A Hayes,Rashelle %A Oleski,Jessica L %+ Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, S7-751, 55 Lake Ave N, Worcester, MA, 01655, United States, 1 508 856 2092, Sherry.Pagoto@umassmed.edu %K social media %K behavioral interventions %K health behavior %K online social networks %D 2016 %7 29.01.2016 %9 Tutorial %J J Med Internet Res %G English %X Patients are increasingly using online social networks (ie, social media) to connect with other patients and health care professionals—a trend called peer-to-peer health care. Because online social networks provide a means for health care professionals to communicate with patients, and for patients to communicate with each other, an opportunity exists to use social media as a modality to deliver behavioral interventions. Social media-delivered behavioral interventions have the potential to reduce the expense of behavioral interventions by eliminating visits, as well as increase our access to patients by becoming embedded in their social media feeds. Trials of online social network-delivered behavioral interventions have shown promise, but much is unknown about intervention development and methodology. In this paper, we discuss the process by which investigators can translate behavioral interventions for social media delivery. We present a model that describes the steps and decision points in this process, including the necessary training and reporting requirements. We also discuss issues pertinent to social media-delivered interventions, including cost, scalability, and privacy. Finally, we identify areas of research that are needed to optimize this emerging behavioral intervention modality. %M 26825969 %R 10.2196/jmir.5086 %U http://www.jmir.org/2016/1/e24/ %U https://doi.org/10.2196/jmir.5086 %U http://www.ncbi.nlm.nih.gov/pubmed/26825969 %0 Journal Article %@ 2291-9279 %I JMIR Publications Inc. %V 4 %N 1 %P e1 %T Behavioral Economics, Wearable Devices, and Cooperative Games: Results From a Population-Based Intervention to Increase Physical Activity %A van Mierlo,Trevor %A Hyatt,Douglas %A Ching,Andrew T %A Fournier,Rachel %A Dembo,Ron S %+ Evolution Health Systems Inc., 901 King Street West, Suite 400, Toronto, ON, M5V 3H5, Canada, 1 4166448476, tvanmierlo@evolutionhs.com %K behavioral economics, cooperative games, adherence, compliance, serious games, Superusers, health rewards, internet of things, wearable devices %D 2016 %7 28.01.2016 %9 Original Paper %J JMIR Serious Games %G English %X Background: Health care literature supports the development of accessible interventions that integrate behavioral economics, wearable devices, principles of evidence-based behavior change, and community support. However, there are limited real-world examples of large scale, population-based, member-driven reward platforms. Subsequently, a paucity of outcome data exists and health economic effects remain largely theoretical. To complicate matters, an emerging area of research is defining the role of Superusers, the small percentage of unusually engaged digital health participants who may influence other members. Objective: The objective of this preliminary study is to analyze descriptive data from GOODcoins, a self-guided, free-to-consumer engagement and rewards platform incentivizing walking, running and cycling. Registered members accessed the GOODcoins platform through PCs, tablets or mobile devices, and had the opportunity to sync wearables to track activity. Following registration, members were encouraged to join gamified group challenges and compare their progress with that of others. As members met challenge targets, they were rewarded with GOODcoins, which could be redeemed for planet- or people-friendly products. Methods: Outcome data were obtained from the GOODcoins custom SQL database. The reporting period was December 1, 2014 to May 1, 2015. Descriptive self-report data were analyzed using MySQL and MS Excel. Results: The study period includes data from 1298 users who were connected to an exercise tracking device. Females consisted of 52.6% (n=683) of the study population, 33.7% (n=438) were between the ages of 20-29, and 24.8% (n=322) were between the ages of 30-39. 77.5% (n=1006) of connected and active members met daily-recommended physical activity guidelines of 30 minutes, with a total daily average activity of 107 minutes (95% CI 90, 124). Of all connected and active users, 96.1% (n=1248) listed walking as their primary activity. For members who exchanged GOODcoins, the mean balance was 4,000 (95% CI 3850, 4150) at time of redemption, and 50.4% (n=61) of exchanges were for fitness or outdoor products, while 4.1% (n=5) were for food-related items. Participants were most likely to complete challenges when rewards were between 201-300 GOODcoins. Conclusions: The purpose of this study is to form a baseline for future research. Overall, results indicate that challenges and incentives may be effective for connected and active members, and may play a role in achieving daily-recommended activity guidelines. Registrants were typically younger, walking was the primary activity, and rewards were mainly exchanged for fitness or outdoor products. Remaining to be determined is whether members were already physically active at time of registration and are representative of healthy adherers, or were previously inactive and were incentivized to change their behavior. As challenges are gamified, there is an opportunity to investigate the role of superusers and healthy adherers, impacts on behavioral norms, and how cooperative games and incentives can be leveraged across stratified populations. Study limitations and future research agendas are discussed. %M 26821955 %R 10.2196/games.5358 %U http://games.jmir.org/2016/1/e1/ %U https://doi.org/10.2196/games.5358 %U http://www.ncbi.nlm.nih.gov/pubmed/26821955 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e7 %T Acceptance of Commercially Available Wearable Activity Trackers Among Adults Aged Over 50 and With Chronic Illness: A Mixed-Methods Evaluation %A Mercer,Kathryn %A Giangregorio,Lora %A Schneider,Eric %A Chilana,Parmit %A Li,Melissa %A Grindrod,Kelly %+ School of Pharmacy, Faculty of Science, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 21358, kgrindrod@uwaterloo.ca %K chronic disease %K physical activity %K sedentary lifestyle %K wearables %D 2016 %7 27.01.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Physical inactivity and sedentary behavior increase the risk of chronic illness and death. The newest generation of “wearable” activity trackers offers potential as a multifaceted intervention to help people become more active. Objective: To examine the usability and usefulness of wearable activity trackers for older adults living with chronic illness. Methods: We recruited a purposive sample of 32 participants over the age of 50, who had been previously diagnosed with a chronic illness, including vascular disease, diabetes, arthritis, and osteoporosis. Participants were between 52 and 84 years of age (mean 64); among the study participants, 23 (72%) were women and the mean body mass index was 31 kg/m2. Participants tested 5 trackers, including a simple pedometer (Sportline or Mio) followed by 4 wearable activity trackers (Fitbit Zip, Misfit Shine, Jawbone Up 24, and Withings Pulse) in random order. Selected devices represented the range of wearable products and features available on the Canadian market in 2014. Participants wore each device for at least 3 days and evaluated it using a questionnaire developed from the Technology Acceptance Model. We used focus groups to explore participant experiences and a thematic analysis approach to data collection and analysis. Results: Our study resulted in 4 themes: (1) adoption within a comfort zone; (2) self-awareness and goal setting; (3) purposes of data tracking; and (4) future of wearable activity trackers as health care devices. Prior to enrolling, few participants were aware of wearable activity trackers. Most also had been asked by a physician to exercise more and cited this as a motivation for testing the devices. None of the participants planned to purchase the simple pedometer after the study, citing poor accuracy and data loss, whereas 73% (N=32) planned to purchase a wearable activity tracker. Preferences varied but 50% felt they would buy a Fitbit and 42% felt they would buy a Misfit, Jawbone, or Withings. The simple pedometer had a mean acceptance score of 56/95 compared with 63 for the Withings, 65 for the Misfit and Jawbone, and 68 for the Fitbit. To improve usability, older users may benefit from devices that have better compatibility with personal computers or less-expensive Android mobile phones and tablets, and have comprehensive paper-based user manuals and apps that interpret user data. Conclusions: For older adults living with chronic illness, wearable activity trackers are perceived as useful and acceptable. New users may need support to both set up the device and learn how to interpret their data. %M 26818775 %R 10.2196/mhealth.4225 %U http://mhealth.jmir.org/2016/1/e7/ %U https://doi.org/10.2196/mhealth.4225 %U http://www.ncbi.nlm.nih.gov/pubmed/26818775 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e11 %T A Mobile Phone App to Stimulate Daily Physical Activity in Patients with Chronic Obstructive Pulmonary Disease: Development, Feasibility, and Pilot Studies %A Vorrink,Sigrid NW %A Kort,Helianthe SM %A Troosters,Thierry %A Lammers,Jan-Willem J %+ Research Group Demand Driven Care, Utrecht University of Applied Sciences, Heidelberglaan 7, Utrecht, 3501 AA, Netherlands, 31 884815384, sigrid.vorrink@hu.nl %K telemedicine %K mobile phones %K chronic obstructive pulmonary disease %K motor activity %D 2016 %7 26.01.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Patients with chronic obstructive pulmonary disease (COPD) demonstrate reduced levels of daily physical activity (DPA) compared to healthy controls. This results in a higher risk of hospital admission and shorter survival. Performing regular DPA reduces these risks. Objective: To develop an eHealth intervention that will support patients with COPD to improve or maintain their DPA after pulmonary rehabilitation. Methods: The design process consisted of literature research and the iterative developing and piloting phases of the Medical Research Council (MRC) model for complex clinical interventions and the involvement of end users. Participants were healthy adults and persons with COPD. Results: The mobile phone interface met all the set requirements. Participants found that the app was stimulating and that reaching their DPA goals was rewarding. The mean (SD) scores on a 7-point scale for usability, ease of use, ease of learning, and contentment were 3.8 (1.8), 5.1 (1.1), 6.0 (1.6), and 4.8 (1.3), respectively. The mean (SD) correlation between the mobile phone and a validated accelerometer was 0.88 (0.12) in the final test. The idea of providing their health care professional with their DPA data caused no privacy issues in the participants. Battery life lasted for an entire day with the final version, and readability and comprehensibility of text and colors were favorable. Conclusions: By employing a user-centered design approach, a mobile phone was found to be an adequate and feasible interface for an eHealth intervention. The mobile phone and app are easy to learn and use by patients with COPD. In the final test, the accuracy of the DPA measurement was good. The final version of the eHealth intervention is presently being tested by our group for efficacy in a randomized controlled trial in COPD patients. %M 26813682 %R 10.2196/mhealth.4741 %U http://mhealth.jmir.org/2016/1/e11/ %U https://doi.org/10.2196/mhealth.4741 %U http://www.ncbi.nlm.nih.gov/pubmed/26813682 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 1 %P e19 %T Impact of a Mobile Phone Intervention to Reduce Sedentary Behavior in a Community Sample of Adults: A Quasi-Experimental Evaluation %A Kendzor,Darla E %A Shuval,Kerem %A Gabriel,Kelley Pettee %A Businelle,Michael S %A Ma,Ping %A High,Robin R %A Cuate,Erica L %A Poonawalla,Insiya B %A Rios,Debra M %A Demark-Wahnefried,Wendy %A Swartz,Michael D %A Wetter,David W %+ Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 405 271 8001 ext 50478, Darla-Kendzor@ouhsc.edu %K sedentary lifestyle %K mobile phone %K African Americans %K physical activity %D 2016 %7 25.01.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Greater time spent sedentary is linked with increased risk of breast, colorectal, ovarian, endometrial, and prostate cancers. Given steadily increasing rates of mobile phone ownership, mobile phone interventions may have the potential to broadly influence sedentary behavior across settings. Objective: The purpose of this study was to examine the short-term impact of a mobile phone intervention that targeted sedentary time in a diverse community sample. Methods: Adults participated in a quasi-experimental evaluation of a mobile phone intervention designed to reduce sedentary time through prompts to interrupt periods of sitting. Participants carried mobile phones and wore accelerometers for 7 consecutive days. Intervention participants additionally received mobile phone prompts during self-reported sitting and information about the negative health impact of prolonged sedentariness. The study was conducted from December 2012 to November 2013 in Dallas, Texas. Linear mixed model regression analyses were conducted to evaluate the influence of the intervention on daily accelerometer-determined estimates of sedentary and active time. Results: Participants (N=215) were predominantly female (67.9%, 146/215) and nonwhite (black: 50.7%, 109/215; Latino: 12.1%, 26/215; other: 5.6%, 12/215). Analyses revealed that participants who received the mobile phone intervention had significantly fewer daily minutes of sedentary time (B=–22.09, P=.045) and more daily active minutes (B=23.01, P=.04) than control participants. Conclusions: A simple mobile phone intervention was associated with engaging in less sedentary time and more physical activity. Findings underscore the potential impact of mobile phone interventions to positively influence sedentary behavior and physical activity. %M 26810027 %R 10.2196/jmir.5137 %U http://www.jmir.org/2016/1/e19/ %U https://doi.org/10.2196/jmir.5137 %U http://www.ncbi.nlm.nih.gov/pubmed/26810027 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 1 %P e22 %T Estimating Skin Cancer Risk: Evaluating Mobile Computer-Adaptive Testing %A Djaja,Ngadiman %A Janda,Monika %A Olsen,Catherine M %A Whiteman,David C %A Chien,Tsair-Wei %+ Research Department, Chi-Mei Medical Center, No. 901, Chung Hwa Road, Yung Kung Dist., Tainan 710, Taiwan, Tainan, 710, Taiwan, 886 937399106, smile@mail.chimei.org.tw %K computer adaptive testing %K skin cancer risk scale %K non adaptive test %K Rasch analysis %K partial credit model %D 2016 %7 22.01.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Response burden is a major detriment to questionnaire completion rates. Computer adaptive testing may offer advantages over non-adaptive testing, including reduction of numbers of items required for precise measurement. Objective: Our aim was to compare the efficiency of non-adaptive (NAT) and computer adaptive testing (CAT) facilitated by Partial Credit Model (PCM)-derived calibration to estimate skin cancer risk. Methods: We used a random sample from a population-based Australian cohort study of skin cancer risk (N=43,794). All 30 items of the skin cancer risk scale were calibrated with the Rasch PCM. A total of 1000 cases generated following a normal distribution (mean [SD] 0 [1]) were simulated using three Rasch models with three fixed-item (dichotomous, rating scale, and partial credit) scenarios, respectively. We calculated the comparative efficiency and precision of CAT and NAT (shortening of questionnaire length and the count difference number ratio less than 5% using independent t tests). Results: We found that use of CAT led to smaller person standard error of the estimated measure than NAT, with substantially higher efficiency but no loss of precision, reducing response burden by 48%, 66%, and 66% for dichotomous, Rating Scale Model, and PCM models, respectively. Conclusions: CAT-based administrations of the skin cancer risk scale could substantially reduce participant burden without compromising measurement precision. A mobile computer adaptive test was developed to help people efficiently assess their skin cancer risk. %M 26800642 %R 10.2196/jmir.4736 %U http://www.jmir.org/2016/1/e22/ %U https://doi.org/10.2196/jmir.4736 %U http://www.ncbi.nlm.nih.gov/pubmed/26800642 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e12 %T See Me Smoke-Free: Protocol for a Research Study to Develop and Test the Feasibility of an mHealth App for Women to Address Smoking, Diet, and Physical Activity %A Giacobbi Jr,Peter %A Hingle,Melanie %A Johnson,Thienne %A Cunningham,James K %A Armin,Julie %A Gordon,Judith S %+ Sport Sciences, Epidemiology, West Virginia University, PO Box 6116, 375 Birch Street, Morgantown, WV, 26506-6116, United States, 1 304 293 5970, peter.giacobbi@mail.wvu.edu %K smoking cessation, mhealth, diet, exercise, imagery, cell phone, handheld app %D 2016 %7 21.01.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: This paper presents the protocol for an ongoing research study to develop and test the feasibility of a multi-behavioral mHealth app. Approximately 27 million women smoke in the US, and more than 180,000 women die of illnesses linked to smoking annually. Women report greater difficulties quitting smoking. Concerns about weight gain, negative body image, and low self-efficacy may be key factors affecting smoking cessation among women. Recent studies suggest that a multi-behavioral approach, including diet and physical activity, may be more effective at helping women quit. Guided imagery has been successfully used to address body image concerns and self-efficacy in our 3 target behaviors—exercise, diet and smoking cessation. However, it has not been used simultaneously for smoking, diet, and exercise behavior in a single intervention. While imagery is an effective therapeutic tool for behavior change, the mode of delivery has generally been in person, which limits reach. mHealth apps delivered via smart phones offer a unique channel through which to distribute imagery-based interventions. Objective: The objective of our study is to evaluate the feasibility of an mHealth app for women designed to simultaneously address smoking, diet, and physical activity behaviors. The objectives are supported by three specific aims: (1) develop guided imagery content, user interface, and resources to reduce weight concern, and increase body image and self-efficacy for behavior change among women smokers, (2) program a prototype of the app that contains all the necessary elements of text, graphics, multimedia and interactive features, and (3) evaluate the feasibility, acceptability, and preliminary efficacy of the app with women smokers. Methods: We created the program content and designed the prototype application for use on the Android platform in collaboration with 9 participants in multiple focus groups and in-depth interviews. We programmed and tested the application’s usability with 6 participants in preparation for an open, pre- and posttest trial. Currently, we are testing the feasibility and acceptability of the application, evaluating the relationship of program use to tobacco cessation, dietary behaviors, and physical activity, and assessing consumer satisfaction with approximately 70 women smokers with Android-based smart phones. Results: The study was started January 1, 2014. The app was launched and feasibility testing began in April 1, 2015. Participants were enrolled from April 1-June 30, 2015. During that time, the app was downloaded over 350 times using no paid advertising. Participants were required to use the app “most days” for 30 days or they would be dropped from the study. We enrolled 151 participants. Of those, 78 were dropped or withdrew from the study, leaving 73 participants. We have completed the 30-day assessment, with a 92% response rate. The 90-day assessment is ongoing. During the final phase of the study, we will be conducting data analyses and disseminating study findings via presentations and publications. Feasibility will be demonstrated by successful participant retention and a high level of app use. We will examine individual metrics (eg, duration of use, number of screens viewed, change in usage patterns over time) and engagement with interactive activities (eg, activity tracking). Conclusions: We will aggregate these data into composite exposure scores that combine number of visits and overall duration to calculate correlations between outcome and measures of program exposure and engagement. Finally, we will compare app use between participants and non-participants using Google Analytics. %M 26795257 %R 10.2196/resprot.5126 %U http://www.researchprotocols.org/2016/1/e12/ %U https://doi.org/10.2196/resprot.5126 %U http://www.ncbi.nlm.nih.gov/pubmed/26795257 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 1 %P e17 %T Who Self-Weighs and What Do They Gain From It? A Retrospective Comparison Between Smart Scale Users and the General Population in England %A Sperrin,Matthew %A Rushton,Helen %A Dixon,William G %A Normand,Alexis %A Villard,Joffrey %A Chieh,Angela %A Buchan,Iain %+ Health e-Research Centre, Farr Institute, Institute of Population Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 0161 3067629, matthew.sperrin@manchester.ac.uk %K weight gain %K weight loss %K body weight %K body mass index %K self-monitoring %K connected health technologies %D 2016 %7 21.01.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital self-monitoring, particularly of weight, is increasingly prevalent. The associated data could be reused for clinical and research purposes. Objective: The aim was to compare participants who use connected smart scale technologies with the general population and explore how use of smart scale technology affects, or is affected by, weight change. Methods: This was a retrospective study comparing 2 databases: (1) the longitudinal height and weight measurement database of smart scale users and (2) the Health Survey for England, a cross-sectional survey of the general population in England. Baseline comparison was of body mass index (BMI) in the 2 databases via a regression model. For exploring engagement with the technology, two analyses were performed: (1) a regression model of BMI change predicted by measures of engagement and (2) a recurrent event survival analysis with instantaneous probability of a subsequent self-weighing predicted by previous BMI change. Results: Among women, users of self-weighing technology had a mean BMI of 1.62 kg/m2 (95% CI 1.03-2.22) lower than the general population (of the same age and height) (P<.001). Among men, users had a mean BMI of 1.26 kg/m2 (95% CI 0.84-1.69) greater than the general population (of the same age and height) (P<.001). Reduction in BMI was independently associated with greater engagement with self-weighing. Self-weighing events were more likely when users had recently reduced their BMI. Conclusions: Users of self-weighing technology are a selected sample of the general population and this must be accounted for in studies that employ these data. Engagement with self-weighing is associated with recent weight change; more research is needed to understand the extent to which weight change encourages closer monitoring versus closer monitoring driving the weight change. The concept of isolated measures needs to give way to one of connected health metrics. %M 26794900 %R 10.2196/jmir.4767 %U http://www.jmir.org/2016/1/e17/ %U https://doi.org/10.2196/jmir.4767 %U http://www.ncbi.nlm.nih.gov/pubmed/26794900 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 4 %N 1 %P e1 %T The Impact of Information Technology on Patient Engagement and Health Behavior Change: A Systematic Review of the Literature %A Sawesi,Suhila %A Rashrash,Mohamed %A Phalakornkule,Kanitha %A Carpenter,Janet S %A Jones,Josette F %+ School of Informatics and Computing – Indianapolis, Department of BioHealth Informatics, IUPUI, Walker Plaza (WK) 120, 719 Indiana Avenue, Indianapolis, IN, 46202, United States, 1 317 274 8059, ssawesi@umail.iu.edu %K patient engagement %K patient behavior %K technology %K Internet %K web-based %K cell phone %K social media %D 2016 %7 21.01.2016 %9 Original Paper %J JMIR Med Inform %G English %X Background: Advancements in information technology (IT) and its increasingly ubiquitous nature expand the ability to engage patients in the health care process and motivate health behavior change. Objective: Our aim was to systematically review the (1) impact of IT platforms used to promote patients’ engagement and to effect change in health behaviors and health outcomes, (2) behavior theories or models applied as bases for developing these interventions and their impact on health outcomes, (3) different ways of measuring health outcomes, (4) usability, feasibility, and acceptability of these technologies among patients, and (5) challenges and research directions for implementing IT platforms to meaningfully impact patient engagement and health outcomes. Methods: PubMed, Web of Science, PsycINFO, and Google Scholar were searched for studies published from 2000 to December 2014. Two reviewers assessed the quality of the included papers, and potentially relevant studies were retrieved and assessed for eligibility based on predetermined inclusion criteria. Results: A total of 170 articles met the inclusion criteria and were reviewed in detail. Overall, 88.8% (151/170) of studies showed positive impact on patient behavior and 82.9% (141/170) reported high levels of improvement in patient engagement. Only 47.1% (80/170) referenced specific behavior theories and only 33.5% (57/170) assessed the usability of IT platforms. The majority of studies used indirect ways to measure health outcomes (65.9%, 112/170). Conclusions: In general, the review has shown that IT platforms can enhance patient engagement and improve health outcomes. Few studies addressed usability of these interventions, and the reason for not using specific behavior theories remains unclear. Further research is needed to clarify these important questions. In addition, an assessment of these types of interventions should be conducted based on a common framework using a large variety of measurements; these measurements should include those related to motivation for health behavior change, long-standing adherence, expenditure, satisfaction, and health outcomes. %M 26795082 %R 10.2196/medinform.4514 %U http://medinform.jmir.org/2016/1/e1/ %U https://doi.org/10.2196/medinform.4514 %U http://www.ncbi.nlm.nih.gov/pubmed/26795082 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e5 %T Tracking Health Data Is Not Enough: A Qualitative Exploration of the Role of Healthcare Partnerships and mHealth Technology to Promote Physical Activity and to Sustain Behavior Change %A Miyamoto,Sheridan W %A Henderson,Stuart %A Young,Heather M %A Pande,Amit %A Han,Jay J %+ College of Nursing, The Pennsylvania State University, 201 Nursing Sciences Building, University Park, CA, 16801, United States, 1 814 863 4141, smiyamoto@psu.edu %K mHealth %K health behavior %K motivation %K goals %K physical activity %D 2016 %7 20.01.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Despite the recent explosion of the mobile health (mHealth) industry and consumer acquisition of mHealth tools such as wearable sensors and applications (apps), limited information is known about how this technology can sustain health behavior change and be integrated into health care. Objective: The objective of the study was to understand potential users’ views of mHealth technology, the role this technology may have in promoting individual activity goals aimed at improving health, and the value of integrating mHealth technology with traditional health care. Methods: Four focus groups were conducted with adults interested in sharing their views on how mHealth technology could support wellness programs and improve health. Participants (n=30) were enrolled from an employee population at an academic health institution. Qualitative thematic analysis was used to code transcripts and identify overarching themes. Results: Our findings suggest that tracking health data alone may result in heightened awareness of daily activity, yet may not be sufficient to sustain use of mHealth technology and apps, which often have low reuse rates. Participants suggested that context, meaning, and health care partnerships need to be incorporated to engage and retain users. In addition to these findings, drivers for mHealth technology previously identified in the literature, including integration and control of health data were confirmed in this study. Conclusions: This study explores ways that mHealth technologies may be used to not only track data, but to encourage sustained engagement to achieve individual health goals. Implications of these findings include recommendations for mHealth technology design and health care partnership models to sustain motivation and engagement, allowing individuals to achieve meaningful behavior change. %M 26792225 %R 10.2196/mhealth.4814 %U http://mhealth.jmir.org/2016/1/e5/ %U https://doi.org/10.2196/mhealth.4814 %U http://www.ncbi.nlm.nih.gov/pubmed/26792225 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e6 %T Mobile Phone Apps for the Prevention of Unintended Pregnancy: A Systematic Review and Content Analysis %A Mangone,Emily Rose %A Lebrun,Victoria %A Muessig,Kathryn E %+ Gillings School of Global Public Health, Department of Health Policy and Management, UNC Chapel Hill, 135 Dauer Drive, 1101 McGavran-Greenberg Hall, CB Number 7411, Chapel Hill, NC, 27599-7411, United States, 1 650 919 3414, emilyrose.mangone@gmail.com %K mHealth %K eHealth %K mobile phone %K app %K systematic review %K unintended pregnancy %K family planning %K pregnancy prevention %K contraception %D 2016 %7 19.01.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Over 50% of pregnancies in the United States are unintended, meaning that the pregnancy is mistimed, unplanned, or unwanted. Unintended pregnancy increases health risks for mother and child, leads to high economic costs for society, and increases social disparities. Mobile phone ownership is rapidly increasing, providing opportunities to reach at-risk populations with reproductive health information and tailored unintended pregnancy prevention interventions through mobile phone apps. However, apps that offer support for unintended pregnancy prevention remain unevaluated. Objective: To identify, describe, and evaluate mobile phone apps that purport to help users prevent unintended pregnancy. Methods: We conducted an extensive search of the Apple iTunes and Android Google Play stores for apps that explicitly included or advertised pregnancy prevention or decision-making support in the context of fertility information/tracking, birth control reminders, contraceptive information, pregnancy decision-making, abortion information or counseling, sexual communication/negotiation, and pregnancy tests. We excluded apps that targeted medical professionals or that cost more than US $1.99. Eligible apps were downloaded and categorized by primary purpose. Data extraction was performed on a minimum of 143 attributes in 3 domains: (1) pregnancy prevention best practices, (2) contraceptive methods and clinical services, and (3) user interface. Apps were assigned points for their inclusion of features overall and for pregnancy prevention best practices and contraceptive information. Results: Our search identified 6805 app descriptions in iTunes and Google Play. Of these, 218 unique apps met inclusion criteria and were included in the review. Apps were grouped into 9 categories: fertility trackers (n=72), centers and resources (n=38), birth control reminders (n=35), general sexual and reproductive health (SRH) information (n=17), SRH information targeted specifically to young adults (YA) (n=16), contraceptive information (n=15), service or condom locators (n=12), pregnancy tests (n=10), and games (n=3). Twelve apps scored at least 50 points (out of 94) for overall number of features and at least 15 points (out of 21) for contraceptive information and pregnancy prevention best practices. Overall, 41% of apps did not mention any modern contraceptive methods and 23% mentioned only 1 method. Of apps that did mention a modern contraceptive method, fewer than 50% of these apps provided information on how to use it. YA SRH apps had the highest percentage of pregnancy prevention best practices in each app. Demographic and interface evaluation found that most apps (72%) did not target any race and only 10% explicitly targeted youth. Communication interface features were present in fewer than 50% of apps. Conclusions: This review identified several useful, evidence-based apps that support the prevention of unintended pregnancy. However, most apps miss opportunities to provide users with valuable information, interactive decision aids, and evidence-based interventions for unintended pregnancy prevention. Further, some apps in this space may increase the likelihood of unintended pregnancy due to the low effectiveness of the contraceptive methods promoted. %M 26787311 %R 10.2196/mhealth.4846 %U http://mhealth.jmir.org/2016/1/e6/ %U https://doi.org/10.2196/mhealth.4846 %U http://www.ncbi.nlm.nih.gov/pubmed/26787311 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e1 %T Preferred Tone of Nutrition Text Messages for Young Adults: Focus Group Testing %A Pollard,Christina Mary %A Howat,Peter A %A Pratt,Iain S %A Boushey,Carol J %A Delp,Edward J %A Kerr,Deborah Anne %+ School of Public Health, Curtin University, Kent Street, Bentley, 6012, Australia, 61 892661142, C.Pollard@curtin.edu.au %K text messages %K tone of voice %K nutrition messages %K fruit %K vegetable %K junk food %K alcohol %K communication %D 2016 %7 19.01.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Young adults are a particularly hard to reach group using conventional health promotion practices as they do not see nutrition messages as personally relevant to them. Text messaging (short message service, SMS) offers an innovative approach to reaching young adults to support and promote dietary behavior change. Objective: The aim of this study was to develop and test tonal preferences for nutrition text messages among young adults using focus groups. Methods: A total of 39 young adults aged 18-30 years residing in Perth, Western Australia participated in four focus groups. Participants briefly discussed their perception of healthy eating and their responses to messages about increasing fruit and vegetables, and reducing “junk food” and alcohol intake. They ranked their preference for 15 nutrition messages across 3 dietary behaviors (fruit and vegetables, junk food, and alcohol) with 5 different message tones (authoritative, empathetic, generation Y, solutions, and substitutions) and identified the messages most likely to persuade young adults to change their diet. A 5-point ranking of the nutrition messages was from the most likely to least likely to persuade (1-5). The focus groups were conducted by a trained facilitator and observer and were recorded. Data driven content analysis was used to explore themes. Tonal preferences and potential motivators were collated and frequencies presented. Results: Participants ranked offering substitutes (29%, 11/39) and using empathy (22%, 9/39) as the most persuasive message techniques in improving diets of young adults, with low responses for Generation Y (17%, 7/39), solutions (17%, 7/39), and authoritative (15%, 6/39) tones. Females were more likely to consider substitution messages persuasive (35%, 7/20) compared with males (22%, 4/19). A greater proportion of males compared with females considered authoritative messages persuasive: (22%, 4/19) compared with (7%, 1/20). There is a strong preference for a substitution tone for fruit and vegetable messages (52%, 20/39), and no overall message tone preference for junk food and alcohol messages. Substitutions were viewed as helpful and practical. Empathy was liked as it acknowledged previous efforts. Responses to authoritative tone were mixed with some feeling guilt while others found them informative. Acceptability of the solutions depended on the behavioral change and acceptability of the solution proposed. Generation Y tone had some support for junk food and alcohol messages, and if favored, was considered casual, humorous, catchy, and motivational. Conclusions: Substitutions and tone of empathy were favored as the most likely execution styles to motivate nutrition behavior change across all participants. There is no “one size fits all” with different tones preferred by individuals for different dietary behaviors. Although text messaging provides instant message delivery direct to the individual, these results demonstrate the complexity of developing motivational nutrition message for young adults. These findings reveal the importance of considering the tone and content and pretesting messages for health promotion text message interventions. %M 26787115 %R 10.2196/mhealth.4764 %U http://mhealth.jmir.org/2016/1/e1/ %U https://doi.org/10.2196/mhealth.4764 %U http://www.ncbi.nlm.nih.gov/pubmed/26787115 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e4 %T A Group-Based Mobile Application to Increase Adherence in Exercise and Nutrition Programs: A Factorial Design Feasibility Study %A Du,Honglu %A Venkatakrishnan,Anusha %A Youngblood,Gregory Michael %A Ram,Ashwin %A Pirolli,Peter %+ Palo Alto Research Center, 3333 Coyote Hill Road, Palo Alto, CA, 94304, United States, 1 6508124459, honglu.du@gmail.com %K mobile phone %K app %K social support %D 2016 %7 15.01.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Novel methods of promoting self-monitoring and social support are needed to ensure long-term maintenance of behavior change. In this paper, we directly investigate the effects of group support in an exercise and nutrition program delivered by an mHealth application called Fittle. Objective: Our first specific study aim was to explore whether social support improved adherence in wellness programs. Our second specific study aim was to assess whether media types (ePaper vs mobile) were associated with different levels of compliance and adherence to wellness programs. The third aim was to assess whether the use of an mHealth application led to positive changes to participants’ eating behavior, physical activity, and stress level, compared to traditional paper-based programs. Methods: A 2 × 2 (eg, Media: Mobile vs ePaper × Group Type: Team vs Solo) factorial design feasibility study was conducted. A sample of 124 volunteers who were interested in improving eating behavior, increasing physical activity, or reducing stress participated in this study. The study duration was 8 weeks. All groups were self-directed with no ongoing human input from the research team. Results: Participants in ePaper conditions had higher attrition rates compared to participants in Mobile conditions, χ32=9.96, P=.02 (N=124). Participants in Mobile conditions reported their compliance with a much higher frequency closer to the time of challenge activity completion (2-sample Kolmogorov-Smirnov test comparing distributions was highly significant—KS=0.33, P<.001 [N=63]). Participants in ePaper conditions had a much higher frequency of guessing while reporting as compared with those in Mobile conditions—χ12=25.25, P<.001 (N=63). Together, these findings suggest that the mobile app allowed a more accurate method to report and track health behaviors over a longer period than traditional ePaper-based diaries or log books. There was a significant difference in the overall compliance score for Mobile-Solo (Mean [SD] 0.30 [0.39]) and Mobile-Team (Mean [SD] 0.49 [0.35]) conditions (t50.82=1.94, P=.05). This suggests that working in a team increased participants’ overall compliance within Fittle. Survival analysis showed that participants assigned to Team conditions are 66% more likely to engage longer with mHealth app-based intervention than those assigned to the Solo condition. Overall, participants across all groups reported some positive changes in eating behavior, physical activity, and stress level; however, participants in the Mobile-Solo condition reported higher perceived stress levels at the end of the study. Conclusions: The team-based Fittle app is an acceptable and feasible wellness behavior change intervention and a full randomized controlled trial to investigate the efficacy of such an intervention is warranted. %M 26772910 %R 10.2196/mhealth.4900 %U http://mhealth.jmir.org/2016/1/e4/ %U https://doi.org/10.2196/mhealth.4900 %U http://www.ncbi.nlm.nih.gov/pubmed/26772910 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e3 %T Outcomes of a Mobile Health Coaching Platform: 12-Week Results of a Single-Arm Longitudinal Study %A Willey,Steven %A Walsh,James K %+ St. Luke's Hospital, 224 South Woods Mill Road, Chesterfield, MO, 63017, United States, 1 314 469 0033, stnfrd93@yahoo.com %K weight loss %K weight reduction program %K obesity %K aerobic exercise %K resistance training %K waist circumference %K oxygen consumption %D 2016 %7 08.01.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The number of mobile health coaching applications is expanding at a rapid rate. An application that uses a guiding intelligence to deliver an individualized structured program has the potential to provide a significant benefit. However, there are few studies of this approach that examine multiple clinical outcomes in a longitudinal manner. Objective: The objective of the study was to conduct a 12-week evaluation of participants using the YouPlus Health mobile coaching platform, specifically examining the effects on body weight, waist measurement, blood pressure, lipid profile, glycohemoglobin (A1C), and maximum volume of oxygen consumption (VO2 max). Methods: A quasi-experimental research design was used. This included a single-arm pre and post intervention assessment of outcomes. Participants underwent a 12-week intervention in which they received the entirety of the mobile health coaching program via an application on their mobile phones and were evaluated in the same physician’s office setting every two weeks. Data regarding app usage was continuously collected and maintained in a database. Results: 10 subjects were enrolled in and completed the pilot study. The mean weight loss was 13.5 lbs. which represented 7.3% of baseline (P=.005). Mean waist circumference was reduced by 7.2 cm or 6.6% of baseline (P=.005). Both systolic (SBP) and diastolic (DBP) blood pressure measures were significantly lower after 12 weeks of intervention. Mean SBP fell 18.6 mmHg (P=.005) and mean DBP declined 6.4 mmHg (P=.005). VO2 max increased by an average of 3.13 ml/kg/min from baseline to study end (P=.005). From baseline to end-of-study HDL levels increased significantly by 4.0 mg/dL (P=.04) Total cholesterol, LDL, triglycerides, and glycohemoglobin (A1C) trended in the desired direction but did not meet statistical significance. All of the participants in the study completed the necessary in-app tutorials and also completed the in-app questions and received feedback. Every individual completed the appropriate amount of program levels necessary to give the specifics of the program, and the mean weekly app open rate ranged from 5.1 to 18.4. Conclusions: Users of the YouPlus Health mobile coaching platform experienced significant reductions in body weight, waist circumference, and both systolic and diastolic blood pressures, while attaining significant increases in HDL and VO2 Max. %M 26747611 %R 10.2196/mhealth.4933 %U http://mhealth.jmir.org/2016/1/e3/ %U https://doi.org/10.2196/mhealth.4933 %U http://www.ncbi.nlm.nih.gov/pubmed/26747611 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e5 %T Combining Persuasive Technology With Behavioral Theory to Support Weight Maintenance Through a Mobile Phone App: Protocol for the MotiMate App %A Brindal,Emily %A Hendrie,Gilly A %A Freyne,Jill %+ CSIRO, Food and Nutrition, Gate 13 Kintore Ave, Adelaide, 5000, Australia, 61 883050633, emily.brindal@csiro.au %K app %K weight maintenance %K psychology %K coping %D 2016 %7 08.01.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: The prevalence of health-focused mobile phone apps available for download increases daily, with weight management apps being among the most proliferative. However, most lack theoretic grounding or evidence of efficacy. There is a significant body of literature which provides evidence for behaviors which are associated with successful weight loss maintenance. Behavioral theory also provides further insight regarding successful behavior change and maintenance. Objective: We aimed to apply this knowledge to the development of the functionality of an app targeting weight loss maintenance. Methods: We have subsequently undertaken the development of a persuasive and behavior targeting mobile app (MotiMate) to assist in maintenance of weight loss. MotiMate combines persuasive and behavior change theories in a practical targeted tool through its motivational messages, personalized feedback, and intelligent supportive tools to manage weight, food, exercise, mood and stress. Results: The development and trial of MotiMate received funding support in May 2014. All 88 volunteers started the trial by December 2014 and were in the process of completing their final visits when this paper was submitted (May 2015). Data analysis is currently underway. Conclusions: The paper has presented a scientifically informed mobile phone app to support weight loss maintenance. Further evaluation of its efficacy is in progress. Trial Registration: ANZCTR 12614000474651; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366120 (Archived by WebCite at http://www.webcitation.org/6eJeQiKxi). %M 26747725 %R 10.2196/resprot.4664 %U http://www.researchprotocols.org/2016/1/e5/ %U https://doi.org/10.2196/resprot.4664 %U http://www.ncbi.nlm.nih.gov/pubmed/26747725 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 12 %P e287 %T Apps and Adolescents: A Systematic Review of Adolescents’ Use of Mobile Phone and Tablet Apps That Support Personal Management of Their Chronic or Long-Term Physical Conditions %A Majeed-Ariss,Rabiya %A Baildam,Eileen %A Campbell,Malcolm %A Chieng,Alice %A Fallon,Debbie %A Hall,Andrew %A McDonagh,Janet E %A Stones,Simon R %A Thomson,Wendy %A Swallow,Veronica %+ University of Leeds, School of Healthcare, Baines Wing, University of Leeds, Leeds, LS2 9JT, United Kingdom, 44 0113 243 1751, v.m.swallow@leeds.ac.uk %K adolescents %K asthma %K mobile or tablet apps %K arthritis %K cancer %K chronic disease or condition %K diabetes %K long-term condition %K personal or self-management %K review %K young people %D 2015 %7 23.12.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: The prevalence of physical chronic or long-term conditions in adolescents aged 10-24 years is rising. Mobile phone and tablet mobile technologies featuring software program apps are widely used by these adolescents and their healthy peers for social networking or gaming. Apps are also used in health care to support personal condition management and they have considerable potential in this context. There is a growing body of literature on app use in health contexts, thereby making a systematic review of their effectiveness very timely. Objective: To systematically review the literature on the effectiveness of mobile apps designed to support adolescents’ management of their physical chronic or long-term conditions. Methods: We conducted a review of the English-language literature published since 2003 in five relevant bibliographical databases using key search terms. Two independent reviewers screened titles and abstracts using data extraction and quality assessment tools. Results: The search returned 1120 hits. Of the 19 eligible full-text papers, four met our review criteria, reporting one pilot randomized controlled trial and three pretest/post-test studies. Samples ranged from 4 to 18 participants, with a combined sample of 46 participants. The apps reported were targeted at type 1 diabetes, asthma, and cancer. Two papers provided data for calculating effect size. Heterogeneity in terms of study design, reported outcomes, follow-up times, participants’ ages, and health conditions prevented meta-analyses. There was variation in whether adolescents received guidance in using the app or were solely responsible for navigating the app. Three studies reported some level of patient involvement in app design, development, and/or evaluation. Health professional involvement in the modelling stages of apps was reported in all studies, although it was not always clear whether specific clinical (as opposed to academic) expertise in working with adolescents was represented. The dearth of studies and the small overall sample size emphasizes the need for future studies of the development, evaluation, use, and effectiveness of mobile apps to support adolescents’ personal management of their conditions. Conclusions: A key finding of the review is the paucity of evidence-based apps that exist, in contrast to the thousands of apps available on the app market that are not evidence-based or user or professional informed. Although we aimed to assess the effectiveness of apps, the dearth of studies meeting our criteria meant that we were unable to be conclusive in this regard. Based on the available evidence, apps may be considered feasible health interventions, but more studies involving larger sample sizes, and with patient and health professional input at all stages, are needed to determine apps’ acceptability and effectiveness. This review provides valuable findings and paves the way for future rigorous development and evaluation of health apps for adolescents with chronic or long-term conditions. %M 26701961 %R 10.2196/jmir.5043 %U http://www.jmir.org/2015/12/e287/ %U https://doi.org/10.2196/jmir.5043 %U http://www.ncbi.nlm.nih.gov/pubmed/26701961 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 4 %P e139 %T Mobile Phone Apps for University Students With Hazardous Alcohol Use: Study Protocol for Two Consecutive Randomized Controlled Trials %A Berman,Anne H %A Gajecki,Mikael %A Fredriksson,Morgan %A Sinadinovic,Kristina %A Andersson,Claes %+ Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, plan 7, Stockholm, 11364, Sweden, 46 704245360, anne.h.berman@ki.se %K randomized controlled trial, universities, alcohol abuse, prevention, mobile phone, eHealth, mHealth %D 2015 %7 22.12.2015 %9 Protocol %J JMIR Res Protoc %G English %X Background: About 50% of university students overconsume alcohol, and drinking habits in later adulthood are to some extent established during higher educational studies. Several studies have demonstrated that Internet-based interventions have positive effects on drinking habits among university students. Our recent study evaluated two mobile phone apps targeting drinking choices at party occasions via personalized feedback on estimated blood alcohol concentration (eBAC) for students with hazardous drinking. No changes in drinking parameters were found over a seven-week period apart from an increase in number of drinking occasions among men for one of the apps tested. Up to 30% of the study participants drank at potentially harmful levels: higher than the national recommended number of standard drinks per week (a maximum of 9 for women and 14 for men) in Sweden. Objective: (1) To evaluate improved versions of the two mobile phone apps tested in our prior trial, in a new, 3-armed randomized controlled trial among university students with at least hazardous drinking habits according to the Alcohol Use Disorders Identifications Test (AUDIT; Study 1). (2) After 6 weeks, to target study participants showing alcohol consumption higher than the national recommended levels for standard drinks per week by offering them participation in a second, 2-armed randomized trial evaluating an additional mobile phone app with skill enhancement tasks (Study 2). (3) To follow participants at 6, 12 and 18 weeks after recruitment to Study 1 and at 6 and 12 weeks after recruitment to Study 2. Methods: Two randomized controlled trials are conducted. Study 1: Students are recruited at four Swedish universities, via direct e-mail and advertisements on Facebook and student union web sites. Those who provide informed consent, have a mobile phone, and show at least hazardous alcohol consumption according to the AUDIT (≥6 for women; ≥8 points for men) are randomized into three groups. Group 1 has access to the Swedish government alcohol monopoly’s app, Promillekoll, offering real-time estimated eBAC calculation; Group 2 has access to a Web-based app, PartyPlanner, developed by the research group, offering real-time eBAC calculation with planning and follow-up functions; and Group 3 participants are controls. Follow-up is conducted at 6, 12 and 18 weeks. Study 2. Participants who at the first 6-week follow-up show drinking levels higher than 9 (W) or 14 (M) standard drinks (12 g alcohol) per week, are offered participation in Study 2. Those who consent are randomized to either access to a skills training app, TeleCoach or to a wait-list control group. Results: Latent Markov models for Study 1 and mixed models analyses for Study 2 will be performed. Study 2 data will be analyzed for publication during the spring of 2016; Study 1 data will be analyzed for publication during the fall of 2016. Conclusions: If mobile phone interventions for reducing hazardous alcohol use are found to be effective, the prospects for positively influencing substance use-related health among university students can considerably improve. Trial Registration: ClinicalTrials.gov http://clinicaltrials.gov/ct2/show/NCT02064998 (Archived by WebCite at http://www.webcitation.org/6dy0AlVRP) %M 26693967 %R 10.2196/resprot.4894 %U http://www.researchprotocols.org/2015/4/e139/ %U https://doi.org/10.2196/resprot.4894 %U http://www.ncbi.nlm.nih.gov/pubmed/26693967 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e106 %T A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study %A Cordova,David %A Bauermeister,Jose A %A Fessler,Kathryn %A Delva,Jorge %A Nelson,Annabelle %A Nurenberg,Rachel %A Mendoza Lua,Frania %A Alers-Rojas,Francheska %A Salas-Wright,Christopher P %A , %+ School of Social Work, University of Michigan, 1080 S University Ave, Ann Arbor, MI, 48109, United States, 1 (734) 763 6201, cordovad@umich.edu %K adolescent %K primary prevention %K HIV %K STI %K mHealth %K telemedicine %K primary health care %K drug users %K sexually transmitted infections %D 2015 %7 18.12.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Despite ongoing prevention efforts, HIV and other sexually transmitted infections (HIV/STIs) and drug use remain public health concerns. Urban adolescents, many of whom are underserved and racial minorities, are disproportionately affected. Recent changes in policy, including the Affordable Care Act, and advances in technology provide HIV/STI and drug abuse prevention scientists with unique opportunities to deliver mobile health (mHealth) preventive interventions in primary care. Objectives: The purpose of this community-engaged study was to develop an mHealth version of the Storytelling for Empowerment preventive intervention for primary care (hereinafter referred to as “S4E”). Methods: A total of 29 adolescents were recruited from a youth-centered primary care clinic in Southeast, Michigan, to participate in qualitative interviews. Participants were predominantly African American (n=19, 65.5%) and female (n=21, 72.4%) with a mean age of 16.23 (SD 2.09). The principles of community-based participatory research (CBPR), in conjunction with agile software development and the recommended core prevention principles of the National Institute on Drug Abuse (NIDA) were employed during S4E development. CBPR principles are aimed at improving the effectiveness of research by addressing locally relevant health problems, working with community strengths, and translating basic science into applied research. Complementing this approach, the NIDA prevention principles are derived from decades of drug abuse prevention research aimed at increasing the effectiveness and uptake of programs, through the development of culturally specific interventions and ensuring the structure, content, and delivery of the intervention fit the needs of the community. Data were analyzed using thematic analysis. Results: A total of 5 themes emerged from the data: (1) acceptability of the mHealth app to adolescents in primary care, (2) inclusion of a risk assessment to improve clinician-adolescent HIV/STI and drug use communication, (3) incorporation of culturally specific HIV/STI and drug use content, (4) incorporation of interactive aspects in the app to engage youth, and (5) perspectives on the appearance of the app. Conclusions: There is a dearth of mHealth HIV/STI and drug abuse preventive interventions for primary care. Incorporating the principles of CBPR in conjunction with agile software development and NIDA-recommended core prevention principles may be helpful in developing culturally specific mHealth interventions. An important next step in this program of research is to examine the feasibility, acceptability, and efficacy of S4E on adolescent sexual risk and drug use behaviors, and HIV/STI testing. Implications for prevention research and primary care practice are discussed in the context of the Affordable Care Act and technological advances. %M 26685288 %R 10.2196/mhealth.4620 %U http://mhealth.jmir.org/2015/4/e106/ %U https://doi.org/10.2196/mhealth.4620 %U http://www.ncbi.nlm.nih.gov/pubmed/26685288 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e104 %T The Most Popular Smartphone Apps for Weight Loss: A Quality Assessment %A Chen,Juliana %A Cade,Janet E %A Allman-Farinelli,Margaret %+ School of Molecular Bioscience, Charles Perkins Centre, University of Sydney, Johns Hopkins Dr, Camperdown, 2050, Australia, 61 2 9036 7045, margaret.allman-farinelli@sydney.edu.au %K behavior change techniques %K evaluation %K obesity %K quality %K smartphone apps %K weight management %D 2015 %7 16.12.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Advancements in mobile phone technology have led to the development of smartphones with the capability to run apps. The availability of a plethora of health- and fitness-related smartphone apps has the potential, both on a clinical and public health level, to facilitate healthy behavior change and weight management. However, current top-rated apps in this area have not been extensively evaluated in terms of scientific quality and behavioral theory evidence base. Objective: The purpose of this study was to evaluate the quality of the most popular dietary weight-loss smartphone apps on the commercial market using comprehensive quality assessment criteria, and to quantify the behavior change techniques (BCTs) incorporated. Methods: The top 200-rated Health & Fitness category apps from the free and paid sections of Google Play and iTunes App Store in Australia (n=800) were screened in August 2014. To be included in further analysis, an app had to focus on weight management, include a facility to record diet intake (self-monitoring), and be in English. One researcher downloaded and used the eligible apps thoroughly for 5 days and assessed the apps against quality assessment criteria which included the following domains: accountability, scientific coverage and content accuracy of information relevant to weight management, technology-enhanced features, usability, and incorporation of BCTs. For inter-rater reliability purposes, a second assessor provided ratings on 30% of the apps. The accuracy of app energy intake calculations was further investigated by comparison with results from a 3-day weighed food record (WFR). Results: Across the eligible apps reviewed (n=28), only 1 app (4%) received full marks for accountability. Overall, apps included an average of 5.1 (SD 2.3) out of 14 technology-enhanced features, and received a mean score of 13.5 (SD 3.7) out of 20 for usability. The majority of apps provided estimated energy requirements (24/28, 86%) and used a food database to calculate energy intake (21/28, 75%). When compared against the WFR, the mean absolute energy difference of apps which featured energy intake calculations (23/28, 82%) was 127 kJ (95% CI -45 to 299). An average of 6.3 (SD 3.7) of 26 BCTs were included. Conclusions: Overall, the most popular commercial apps for weight management are suboptimal in quality, given the inadequate scientific coverage and accuracy of weight-related information, and the relative absence of BCTs across the apps reviewed. With the limited regulatory oversight around the quality of these types of apps, this evaluation provides clinicians and consumers an informed view of the highest-quality apps in the current popular app pool appropriate for recommendation and uptake. Further research is necessary to assess the effectiveness of apps for weight management. %M 26678569 %R 10.2196/mhealth.4334 %U http://mhealth.jmir.org/2015/4/e104/ %U https://doi.org/10.2196/mhealth.4334 %U http://www.ncbi.nlm.nih.gov/pubmed/26678569 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e97 %T Web-Based and Mobile Delivery of an Episodic Future Thinking Intervention for Overweight and Obese Families: A Feasibility Study %A Sze,Yan Yan %A Daniel,Tinuke Oluyomi %A Kilanowski,Colleen K %A Collins,R Lorraine %A Epstein,Leonard H %+ Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Farber Hall, Room G56, 3435 Main Street, Building #26, Buffalo, NY, , United States, 1 716 829 3400, lhnet@buffalo.edu %K obesity %K ecological momentary intervention %K episodic future thinking %K Web-based %K health behavior %D 2015 %7 16.12.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The bias toward immediate gratification is associated with maladaptive eating behaviors and has been cross-sectionally and prospectively related to obesity. Engaging in episodic future thinking, which involves mental self-projection to pre-experience future events, reduces this bias and energy intake in overweight/obese adults and children. To examine how episodic future thinking can be incorporated into clinical interventions, a Web-based system was created to provide training for adults and children in their everyday lives. Objective: Our study examined the technical feasibility, usability, and acceptability of a Web-based system that is accessible by mobile devices and adapts episodic future thinking for delivery in family-based obesity interventions. Methods: We recruited 20 parent-child dyads (N=40) from the surrounding community and randomized to episodic future thinking versus a nutritional information thinking control to test the feasibility of a 4-week Web-based intervention. Parents were 44.1 (SD 7.8) years of age with BMI of 34.2 (SD 6.8) kg/m2. Children were 11.0 (SD 1.3) years of age with BMI percentile of 96.0 (SD 1.8). Families met weekly with a case manager for 4 weeks and used the system daily. Adherence was collected through the Web-based system, and perceived acceptance of the Web-based system was assessed postintervention. Measurements of body composition and dietary intake were collected at baseline and after the 4 weeks of intervention. Results: All 20 families completed the intervention and attended all sessions. Results showed parents and children had high adherence to the Web-based system and perceived it to be easy to use, useful, and helpful. No differences between conditions were found in adherence for parents (P=.65) or children (P=.27). In addition, results suggest that basic nutrition information along with episodic future thinking delivered through our Web-based system may reduce energy intake and weight. Conclusions: We showed that our Web-based system is an accepted technology and a feasible utility. Furthermore, results provide initial evidence that our system can be incorporated into family-based treatments targeting behaviors related to weight control. These results show promising utility in using our Web-based system in interventions. %M 26678959 %R 10.2196/mhealth.4603 %U http://mhealth.jmir.org/2015/4/e97/ %U https://doi.org/10.2196/mhealth.4603 %U http://www.ncbi.nlm.nih.gov/pubmed/26678959 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e105 %T A Text-Messaging and Pedometer Program to Promote Physical Activity in People at High Risk of Type 2 Diabetes: The Development of the PROPELS Follow-On Support Program %A Morton,Katie %A Sutton,Stephen %A Hardeman,Wendy %A Troughton,Jacqui %A Yates,Tom %A Griffin,Simon %A Davies,Melanie %A Khunti,Kamlesh %A Eborall,Helen %+ Social Science Applied to Healthcare Improvement Research Group, Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester, , United Kingdom, 44 116 252 5400, hce3@le.ac.uk %K physical activity %K mHealth %K text messaging %K pedometer %K tailoring %K type 2 diabetes %K intervention development %D 2015 %7 15.12.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile technologies for health (mHealth) represent a promising strategy for reducing type 2 diabetes (T2DM) risk. The PROPELS trial investigates whether structured group-based education alone or supplemented with a follow-on support program combining self-monitoring with pedometers and tailored text-messaging is effective in promoting and maintaining physical activity among people at high risk of T2DM. Objective: This paper describes the iterative development of the PROPELS follow-on support program and presents evidence on its acceptability and feasibility. Methods: We used a modified mHealth development framework with four phases: (1) conceptualization of the follow-on support program using theory and evidence, (2) formative research including focus groups (n=15, ages 39-79 years), (3) pre-testing focus groups using a think aloud protocol (n=20, ages 52-78 years), and (4) piloting (n=11). Analysis was informed by the constant comparative approach, with findings from each phase informing subsequent phases. Results: The first three phases informed the structure, nature, and content of the follow-on support program, including the frequency of text messages, the need for tailored content and two-way interaction, the importance of motivational messages based on encouragement and reinforcement of affective benefits (eg, enjoyment) with minimal messages about weight and T2DM risk, and the need for appropriate language. The refined program is personalized and tailored to the individual’s perceived confidence, previous activity levels, and physical activity goals. The pilot phase indicated that the program appeared to fit well with everyday routines and was easy to use by older adults. Conclusions: We developed a feasible and innovative text messaging and pedometer program based on evidence and behavior change theory and grounded in the experiences, views, and needs of people at high diabetes risk. A large scale trial is testing the effectiveness of this 4-year program over and above structured group education alone. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 83465245; http://www.controlled-trials.com/ISRCTN83465245/83465245 (Archived by WebCite at http://www.webcitation.org/6dfSmrVAe) %M 26678750 %R 10.2196/mhealth.5026 %U http://mhealth.jmir.org/2015/4/e105/ %U https://doi.org/10.2196/mhealth.5026 %U http://www.ncbi.nlm.nih.gov/pubmed/26678750 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 12 %P e278 %T Preventing Alcohol Abuse Through Social Networking Sites: A First Assessment of a Two-Year Ecological Approach %A Flaudias,Valentin %A de Chazeron,Ingrid %A Zerhouni,Oulmann %A Boudesseul,Jordane %A Begue,Laurent %A Bouthier,Renaud %A Lévrier,Christel %A Llorca,Pierre Michel %A Brousse,Georges %+ CHU Clermont-Ferrand, Pôle Psychiatrie B, 58 Rue Montalembert, Clermont-Ferrand, F-63000, France, 33 473752072, vflaudias@chu-clermontferrand.fr %K social networking %K primary prevention %K alcohol consumption %K students %D 2015 %7 10.12.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Prevention strategies to reduce alcohol use/consumption among young people are crucial to reducing alcohol-related deaths and preventing disease. This paper focuses on the effectiveness of a social networking site (SNS) alcohol prevention program targeted toward young people. Objective: We hypothesized that the program would diminish the relation made by participants between alcohol and festive moments, and would result in a reduction of their declared consumption of alcohol at festive moments during the program. We also explored the interaction with the prevention program that was the most efficient. Methods: The prevention program took the form of 3 lotteries over 2 years. The participants periodically received prevention messages, particularly on alcohol and festive moments (eg, videos on Facebook and short message service [SMS] text messages on their mobile phones). For the 3 periods, the participants had to answer questions exploring the level of their belief that alcohol consumption and festive moments are highly associated. A control group that did not participate in the prevention program was asked the same questions over the same number of days for the first 2 periods. During the second period, the participants were asked to answer questions about their alcohol consumption during parties. During the third period, we explored the interaction with the prevention program on the reduction of their belief that alcohol consumption and festive moments are associated. Results: A total of 651 participants (age: mean 22.24, SD 4.10 years; women: n=430) during the first period, 301 participants (age: mean 21.27, SD 3.07 years; women n=199) during the second period, and 305 (age: mean 22.41, SD 4.65 years; women: n=190) during the third period correctly completed the survey. For the control group, 69 students completed the survey during the first period (age: mean 18.93, SD 1.14 years; women: n=59) and 50 during the second (age: mean 20.78, SD 1.94 years; women: n=45). We observed a significant reduction in the association of alcohol with festive moments in the participants over the 2 years (period 1: z=–4.80, P<.001; period 2: z=–2.11, P=.04; period 3: z=–2.30; P=.02), but not in the controls. We also observed a reduction in the number of glasses consumed during festive moments for the participants (z=–2.36, P=.02), but not for the controls during the second period. The third period showed that only the number of days since registration in the program had an impact on the reduction of the association of festive moments and alcohol consumption (t21=3.186, P=.005). Conclusions: The findings of this study suggest that the SNS prevention program is promising in preventing the association of alcohol with festive moments and, more generally, in impacting social norms. %M 26681577 %R 10.2196/jmir.4233 %U http://www.jmir.org/2015/12/e278/ %U https://doi.org/10.2196/jmir.4233 %U http://www.ncbi.nlm.nih.gov/pubmed/26681577 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e96 %T Use of the Fitbit to Measure Adherence to a Physical Activity Intervention Among Overweight or Obese, Postmenopausal Women: Self-Monitoring Trajectory During 16 Weeks %A Cadmus-Bertram,Lisa %A Marcus,Bess H %A Patterson,Ruth E %A Parker,Barbara A %A Morey,Brittany L %+ Department of Kinesiology, University of Wisconsin - Madison, 2000 Observatory Drive, Madison, WI, 53706, United States, 1 608 265 5946, cadmusbertra@wisc.edu %K exercise %K health behavior %K health promotion %K Internet %K mHealth %K motor activity %K physical activity %K technology %K women %D 2015 %7 19.11.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Direct-to-consumer trackers and devices have potential to enhance theory-based physical activity interventions by offering a simple and pleasant way to help participants self-monitor their behavior. A secondary benefit of these devices is the opportunity for investigators to objectively track adherence to physical activity goals across weeks or even months, rather than relying on self-report or a small number of accelerometry wear periods. The use of consumer trackers for continuous monitoring of adherence has considerable potential to enhance physical activity research, but few studies have been published in this rapidly developing area. Objective: The objective of the study was to assess the trajectory of physical activity adherence across a 16-week self-monitoring intervention, as measured by the Fitbit tracker. Methods: Participants were 25 overweight or obese, postmenopausal women enrolled in the intervention arm of a randomized controlled physical activity intervention trial. Each participant received a 16-week technology-based intervention that used the Fitbit physical activity tracker and website. The overall study goal was 150 minutes/week of moderate to vigorous intensity physical activity (MVPA) and 10,000 steps/day; however, goals were set individually for each participant and updated at Week 4 based on progress. Adherence data were collected by the Fitbit and aggregated by Fitabase. Participants also wore an ActiGraph GT3X+ accelerometer for 7 days prior to the intervention and again during Week 16. Results: The median participant logged 10 hours or more/day of Fitbit wear on 95% of the 112 intervention days, with no significant decline in wear over the study period. Participants averaged 7540 (SD 2373) steps/day and 82 minutes/week (SD 43) of accumulated “fairly active” and “very active” minutes during the intervention. At Week 4, 80% (20/25) of women chose to maintain/increase their individual MVPA goal and 72% (18/25) of participants chose to maintain/increase their step goal. Physical activity levels were relatively stable after peaking at 3 weeks, with only small declines of 8% for steps (P=.06) and 14% for MVPA (P=.05) by 16 weeks. Conclusions: These data indicate that a sophisticated, direct-to-consumer activity tracker encouraged high levels of self-monitoring that were sustained over 16 weeks. Further study is needed to determine how to motivate additional gains in physical activity and evaluate the long-term utility of the Fitbit tracker as part of a strategy for chronic disease prevention. Trial Registration: Clinicaltrials.gov NCT01837147; http://clinicaltrials.gov/ct2/show/NCT01837147 (Archived by WebCite at http://www.webcitation.org/6d0VeQpvB) %M 26586418 %R 10.2196/mhealth.4229 %U http://mhealth.jmir.org/2015/4/e96/ %U https://doi.org/10.2196/mhealth.4229 %U http://www.ncbi.nlm.nih.gov/pubmed/26586418 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 11 %P e260 %T Bringing Health and Fitness Data Together for Connected Health Care: Mobile Apps as Enablers of Interoperability %A Gay,Valerie %A Leijdekkers,Peter %+ Faculty of Engineering and Information Technology, University of Technology Sydney, PO box 123, Broadway NSW, 2007, Australia, 61 2 9514 4645, Valerie.Gay@uts.edu.au %K health informatics %K connected health %K pervasive and mobile computing %K ubiquitous and mobile devices %D 2015 %7 18.11.2015 %9 Viewpoint %J J Med Internet Res %G English %X Background: A transformation is underway regarding how we deal with our health. Mobile devices make it possible to have continuous access to personal health information. Wearable devices, such as Fitbit and Apple’s smartwatch, can collect data continuously and provide insights into our health and fitness. However, lack of interoperability and the presence of data silos prevent users and health professionals from getting an integrated view of health and fitness data. To provide better health outcomes, a complete picture is needed which combines informal health and fitness data collected by the user together with official health records collected by health professionals. Mobile apps are well positioned to play an important role in the aggregation since they can tap into these official and informal health and data silos. Objective: The objective of this paper is to demonstrate that a mobile app can be used to aggregate health and fitness data and can enable interoperability. It discusses various technical interoperability challenges encountered while integrating data into one place. Methods: For 8 years, we have worked with third-party partners, including wearable device manufacturers, electronic health record providers, and app developers, to connect an Android app to their (wearable) devices, back-end servers, and systems. Results: The result of this research is a health and fitness app called myFitnessCompanion, which enables users to aggregate their data in one place. Over 6000 users use the app worldwide to aggregate their health and fitness data. It demonstrates that mobile apps can be used to enable interoperability. Challenges encountered in the research process included the different wireless protocols and standards used to communicate with wireless devices, the diversity of security and authorization protocols used to be able to exchange data with servers, and lack of standards usage, such as Health Level Seven, for medical information exchange. Conclusions: By limiting the negative effects of health data silos, mobile apps can offer a better holistic view of health and fitness data. Data can then be analyzed to offer better and more personalized advice and care. %M 26581920 %R 10.2196/jmir.5094 %U http://www.jmir.org/2015/11/e260/ %U https://doi.org/10.2196/jmir.5094 %U http://www.ncbi.nlm.nih.gov/pubmed/26581920 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 11 %P e259 %T Mobile Phone and Web 2.0 Technologies for Weight Management: A Systematic Scoping Review %A Bardus,Marco %A Smith,Jane R %A Samaha,Laya %A Abraham,Charles %+ Psychology Applied to Health research group, Institute of Health Research, University of Exeter Medical School, College House, St Luke’s campus Heavitree Road, Exeter, EX12LU, United Kingdom, 44 01392 72 6721, marco.bardus@gmail.com %K obesity %K overweight %K review %K cellular phone %K mobile apps %K social media %K mobile health %K mHealth %K mobile phone %K Web 2.0 %D 2015 %7 16.11.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Widespread diffusion of mobile phone and Web 2.0 technologies make them potentially useful tools for promoting health and tackling public health issues, such as the increasing prevalence of overweight and obesity. Research in this domain is growing rapidly but, to date, no review has comprehensively and systematically documented how mobile and Web 2.0 technologies are being deployed and evaluated in relation to weight management. Objective: To provide an up-to-date, comprehensive map of the literature discussing the use of mobile phone and Web 2.0 apps for influencing behaviors related to weight management (ie, diet, physical activity [PA], weight control, etc). Methods: A systematic scoping review of the literature was conducted based on a published protocol (registered at PROSPERO: CRD42014010323). Using a comprehensive search strategy, we searched 16 multidisciplinary electronic databases for original research documents published in English between 2004 and 2014. We used duplicate study selection and data extraction. Using an inductively developed charting tool, selected articles were thematically categorized. Results: We identified 457 articles, mostly published between 2013 and 2014 in 157 different journals and 89 conference proceedings. Articles were categorized around two overarching themes, which described the use of technologies for either (1) promoting behavior change (309/457, 67.6%) or (2) measuring behavior (103/457, 22.5%). The remaining articles were overviews of apps and social media content (33/457, 7.2%) or covered a combination of these three themes (12/457, 2.6%). Within the two main overarching themes, we categorized articles as representing three phases of research development: (1) design and development, (2) feasibility studies, and (3) evaluations. Overall, articles mostly reported on evaluations of technologies for behavior change (211/457, 46.2%). Conclusions: There is an extensive body of research on mobile phone and Web 2.0 technologies for weight management. Research has reported on (1) the development, feasibility, and efficacy of persuasive mobile technologies used in interventions for behavior change (PA and diet) and (2) the design, feasibility, and accuracy of mobile phone apps for behavioral assessment. Further research has focused exclusively on analyses of the content and quality of available apps. Limited evidence exists on the use of social media for behavior change, but a segment of studies deal with content analyses of social media. Future research should analyze mobile phone and Web 2.0 technologies together by combining the evaluation of content and design aspects with usability, feasibility, and efficacy/effectiveness for behavior change, or accuracy/validity for behavior assessment, in order to understand which technological components and features are likely to result in effective interventions. %M 26573984 %R 10.2196/jmir.5129 %U http://www.jmir.org/2015/11/e259/ %U https://doi.org/10.2196/jmir.5129 %U http://www.ncbi.nlm.nih.gov/pubmed/26573984 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e103 %T Dutch Young Adults Ratings of Behavior Change Techniques Applied in Mobile Phone Apps to Promote Physical Activity: A Cross-Sectional Survey %A Belmon,Laura S %A Middelweerd,Anouk %A te Velde,Saskia J %A Brug,Johannes %+ EMGO Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU Medical Center Amsterdam, F-building, De Boelelaan 1089a, Amsterdam, 1081 HV, Netherlands, 31 204445379, a.middelweerd@vumc.nl %K motor activity %K self efficacy %K exercise %K behavior therapy %K cell phones %D 2015 %7 12.11.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Interventions delivered through new device technology, including mobile phone apps, appear to be an effective method to reach young adults. Previous research indicates that self-efficacy and social support for physical activity and self-regulation behavior change techniques (BCT), such as goal setting, feedback, and self-monitoring, are important for promoting physical activity; however, little is known about evaluations by the target population of BCTs applied to physical activity apps and whether these preferences are associated with individual personality characteristics. Objective: This study aimed to explore young adults’ opinions regarding BCTs (including self-regulation techniques) applied in mobile phone physical activity apps, and to examine associations between personality characteristics and ratings of BCTs applied in physical activity apps. Methods: We conducted a cross-sectional online survey among healthy 18 to 30-year-old adults (N=179). Data on participants’ gender, age, height, weight, current education level, living situation, mobile phone use, personality traits, exercise self-efficacy, exercise self-identity, total physical activity level, and whether participants met Dutch physical activity guidelines were collected. Items for rating BCTs applied in physical activity apps were selected from a hierarchical taxonomy for BCTs, and were clustered into three BCT categories according to factor analysis: “goal setting and goal reviewing,” “feedback and self-monitoring,” and “social support and social comparison.” Results: Most participants were female (n=146), highly educated (n=169), physically active, and had high levels of self-efficacy. In general, we observed high ratings of BCTs aimed to increase “goal setting and goal reviewing” and “feedback and self-monitoring,” but not for BCTs addressing “social support and social comparison.” Only 3 (out of 16 tested) significant associations between personality characteristics and BCTs were observed: “agreeableness” was related to more positive ratings of BCTs addressing “goal setting and goal reviewing” (OR 1.61, 95% CI 1.06-2.41), “neuroticism” was related to BCTs addressing “feedback and self-monitoring” (OR 0.76, 95% CI 0.58-1.00), and “exercise self-efficacy” was related to a high rating of BCTs addressing “feedback and self-monitoring” (OR 1.06, 95% CI 1.02-1.11). No associations were observed between personality characteristics (ie, personality, exercise self-efficacy, exercise self-identity) and participants’ ratings of BCTs addressing “social support and social comparison.” Conclusions: Young Dutch physically active adults rate self-regulation techniques as most positive and techniques addressing social support as less positive among mobile phone apps that aim to promote physical activity. Such ratings of BCTs differ according to personality traits and exercise self-efficacy. Future research should focus on which behavior change techniques in app-based interventions are most effective to increase physical activity. %M 26563744 %R 10.2196/mhealth.4383 %U http://mhealth.jmir.org/2015/4/e103/ %U https://doi.org/10.2196/mhealth.4383 %U http://www.ncbi.nlm.nih.gov/pubmed/26563744 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 11 %P e253 %T Mobile Phone Apps to Promote Weight Loss and Increase Physical Activity: A Systematic Review and Meta-Analysis %A Flores Mateo,Gemma %A Granado-Font,Esther %A Ferré-Grau,Carme %A Montaña-Carreras,Xavier %+ Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Camí de Riudoms 55, Reus, 43202, Spain, 34 977778515, gemmaflores@gmail.com %K mHealth %K mobile phone %K apps %K obesity %K physical activity %K intervention %D 2015 %7 10.11.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: To our knowledge, no meta-analysis to date has assessed the efficacy of mobile phone apps to promote weight loss and increase physical activity. Objective: To perform a systematic review and meta-analysis of studies to compare the efficacy of mobile phone apps compared with other approaches to promote weight loss and increase physical activity. Methods: We conducted a systematic review and meta-analysis of relevant studies identified by a search of PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus from their inception through to August 2015. Two members of the study team (EG-F, GF-M) independently screened studies for inclusion criteria and extracted data. We included all controlled studies that assessed a mobile phone app intervention with weight-related health measures (ie, body weight, body mass index, or waist circumference) or physical activity outcomes. Net change estimates comparing the intervention group with the control group were pooled across studies using random-effects models. Results: We included 12 articles in this systematic review and meta-analysis. Compared with the control group, use of a mobile phone app was associated with significant changes in body weight (kg) and body mass index (kg/m2) of -1.04 kg (95% CI -1.75 to -0.34; I2 = 41%) and -0.43 kg/m2 (95% CI -0.74 to -0.13; I2 = 50%), respectively. Moreover, a nonsignificant difference in physical activity was observed between the two groups (standardized mean difference 0.40, 95% CI -0.07 to 0.87; I2 = 93%). These findings were remarkably robust in the sensitivity analysis. No publication bias was shown. Conclusions: Evidence from this study shows that mobile phone app-based interventions may be useful tools for weight loss. %M 26554314 %R 10.2196/jmir.4836 %U http://www.jmir.org/2015/11/e253/ %U https://doi.org/10.2196/jmir.4836 %U http://www.ncbi.nlm.nih.gov/pubmed/26554314 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e99 %T Views of Women and Health Professionals on mHealth Lifestyle Interventions in Pregnancy: A Qualitative Investigation %A Willcox,Jane C %A van der Pligt,Paige %A Ball,Kylie %A Wilkinson,Shelley A %A Lappas,Martha %A McCarthy,Elizabeth A %A Campbell,Karen J %+ Centre for Nutrition and Physical Activity Research, School of Nutrition and Exercise Sciences, Deakin University, 221 Burwood Highway, Burwood, , Australia, 61 92468733, jwillcox@deakin.edu.au %K pregnancy %K attitude %K qualitative research %K mHealth %D 2015 %7 28.10.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Evidence suggests that women are failing to meet guidelines for nutrition, physical activity, and weight gain during pregnancy. Interventions to promote a healthy lifestyle in pregnancy demonstrate mixed results and many are time and resource intensive. mHealth-delivered interventions offer an opportunity to provide trusted source information in a timely and cost-effective manner. Studies regarding women’s and health professionals’ views of mHealth in antenatal care are limited. Objective: This study aimed to explore women’s and health professionals’ views regarding mHealth information sources and interventions to assist women to eat well, be physically active, and gain healthy amounts of weight in pregnancy. Methods: A descriptive qualitative research approach employed focus groups and in-depth interviews with 15 pregnant or postpartum women and 12 in-depth interviews with health professionals including two from each category: obstetricians, general practitioners, midwives, dietitians, physiotherapists, and community pharmacists. All interviews were transcribed verbatim and thematically analyzed. Results: Women uniformly embraced the concept of mHealth information sources and interventions in antenatal care and saw them as central to information acquisition and ideally incorporated into future antenatal care processes. Health professionals exhibited varied views perceiving mHealth as an inevitable, often parallel, service rather than one integrated into the care model. Four key themes emerged: engagement, risk perception, responsibility, and functionality. Women saw their ability to access mHealth elements as a way to self-manage or control information acquisition that was unavailable in traditional care models and information sources. The emergence of technology was perceived by some health professionals to have shifted control of information from trusted sources, such as health professionals and health organizations, to nontrusted sources. Some health professionals were concerned about the medicolegal risks of mHealth (incorrect or harmful information and privacy concerns), while others acknowledged that mHealth was feasible if inherent risks were addressed. Across both groups, there was uncertainty as to who should be responsible for ensuring high-quality mHealth. The absence of a key pregnancy or women’s advocacy group, lack of health funds for technologies, and the perceived inability of maternity hospitals to embrace technology were seen to be key barriers to provision. Women consistently identified the functionality of mHealth as adding value to antenatal care models. For some health professionals, lack of familiarity with and fear of mHealth limited their engagement with and comprehension of the capacity of new technologies to support antenatal care. Conclusions: Women exhibited positive views regarding mHealth for the promotion of a healthy lifestyle in antenatal care. Conversely, health professionals expressed a much wider variation in attitudes and were more able to identify potential risks and barriers to development and implementation. This study contributes to the understanding of the opportunities and challenges in developing mHealth lifestyle interventions in antenatal care. %M 26510886 %R 10.2196/mhealth.4869 %U http://mhealth.jmir.org/2015/4/e99/ %U https://doi.org/10.2196/mhealth.4869 %U http://www.ncbi.nlm.nih.gov/pubmed/26510886 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e98 %T Electronic Dietary Intake Assessment (e-DIA): Comparison of a Mobile Phone Digital Entry App for Dietary Data Collection With 24-Hour Dietary Recalls %A Rangan,Anna M %A O'Connor,Sarah %A Giannelli,Valentina %A Yap,Megan LH %A Tang,Lie Ming %A Roy,Rajshri %A Louie,Jimmy Chun Yu %A Hebden,Lana %A Kay,Judy %A Allman-Farinelli,Margaret %+ School of Molecular Bioscience, Charles Perkins Centre, University of Sydney, Level 4 East, Charles Perkins Centre, University of Sydney, Camperdown, 2006, Australia, 61 2 93513816, anna.rangan@sydney.edu.au %K validity %K dietary assessment %K mobile phone app %K young adult %D 2015 %7 27.10.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The electronic Dietary Intake Assessment (e-DIA), a digital entry food record mobile phone app, was developed to measure energy and nutrient intake prospectively. This can be used in monitoring population intakes or intervention studies in young adults. Objective: The objective was to assess the relative validity of e-DIA as a dietary assessment tool for energy and nutrient intakes using the 24-hour dietary recall as a reference method. Methods: University students aged 19 to 24 years recorded their food and drink intake on the e-DIA for five days consecutively and completed 24-hour dietary recalls on three random days during this 5-day study period. Mean differences in energy, macro-, and micronutrient intakes were evaluated between the methods using paired t tests or Wilcoxon signed-rank tests, and correlation coefficients were calculated on unadjusted, energy-adjusted, and deattenuated values. Bland-Altman plots and cross-classification into quartiles were used to assess agreement between the two methods. Results: Eighty participants completed the study (38% male). No significant differences were found between the two methods for mean intakes of energy or nutrients. Deattenuated correlation coefficients ranged from 0.55 to 0.79 (mean 0.68). Bland-Altman plots showed wide limits of agreement between the methods but without obvious bias. Cross-classification into same or adjacent quartiles ranged from 75% to 93% (mean 85%). Conclusions: The e-DIA shows potential as a dietary intake assessment tool at a group level with good ranking agreement for energy and all nutrients. %M 26508282 %R 10.2196/mhealth.4613 %U http://mhealth.jmir.org/2015/4/e98/ %U https://doi.org/10.2196/mhealth.4613 %U http://www.ncbi.nlm.nih.gov/pubmed/26508282 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 4 %P e123 %T Twitter-Delivered Behavioral Weight-Loss Interventions: A Pilot Series %A Pagoto,Sherry L %A Waring,Molly E %A Schneider,Kristin L %A Oleski,Jessica L %A Olendzki,Effie %A Hayes,Rashelle B %A Appelhans,Bradley M %A Whited,Matthew C %A Busch,Andrew M %A Lemon,Stephenie C %+ Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 508 856 2092, Sherry.Pagoto@umassmed.edu %K social networks %K Twitter %K obesity %K weight loss %K online social networking %K peer-to-peer health care %K digital health %D 2015 %7 23.10.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Lifestyle interventions are efficacious at reducing risk for diabetes and cardiovascular disease but have not had a significant public health impact given high cost and patient and provider burden. Objective: Online social networks may reduce the burden of lifestyle interventions to the extent that they displace in-person visits and may enhance opportunities for social support for weight loss. Methods: We conducted an iterative series of pilot studies to evaluate the feasibility and acceptability of using online social networks to deliver a lifestyle intervention. Results: In Study 1 (n=10), obese participants with depression received lifestyle counseling via 12 weekly group visits and a private group formed using the online social network, Twitter. Mean weight loss was 2.3 pounds (SD 7.7; range -19.2 to 8.2) or 1.2% (SD 3.6) of baseline weight. A total of 67% (6/9) of participants completing exit interviews found the support of the Twitter group at least somewhat useful. In Study 2 (n=11), participants were not depressed and were required to be regular users of social media. Participants lost, on average, 5.6 pounds (SD 6.3; range -15 to 0) or 3.0% (SD 3.4) of baseline weight, and 100% (9/9) completing exit interviews found the support of the Twitter group at least somewhat useful. To explore the feasibility of eliminating in-person visits, in Study 3 (n=12), we delivered a 12-week lifestyle intervention almost entirely via Twitter by limiting the number of group visits to one, while using the same inclusion criteria as that used in Study 2. Participants lost, on average, 5.4 pounds (SD 6.4; range -14.2 to 3.9) or 3.0% (SD 3.1) of baseline weight, and 90% (9/10) completing exit interviews found the support of the Twitter group at least somewhat useful. Findings revealed that a private Twitter weight-loss group was both feasible and acceptable for many patients, particularly among regular users of social media. Conclusions: Future research should evaluate the efficacy and cost-effectiveness of online social network-delivered lifestyle interventions relative to traditional modalities. %M 26500186 %R 10.2196/resprot.4864 %U http://www.researchprotocols.org/2015/4/e123/ %U https://doi.org/10.2196/resprot.4864 %U http://www.ncbi.nlm.nih.gov/pubmed/26500186 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 10 %P e240 %T Diabetes Prevention and Weight Loss with a Fully Automated Behavioral Intervention by Email, Web, and Mobile Phone: A Randomized Controlled Trial Among Persons with Prediabetes %A Block,Gladys %A Azar,Kristen MJ %A Romanelli,Robert J %A Block,Torin J %A Hopkins,Donald %A Carpenter,Heather A %A Dolginsky,Marina S %A Hudes,Mark L %A Palaniappan,Latha P %A Block,Clifford H %+ Turnaround Health, a division of NutritionQuest, 15 Shattuck Square, Suite 288, Berkeley, CA, 94704, United States, 1 510 704 8514, gblock@berkeley.edu %K type 2 diabetes %K prevention %K intervention studies %K prediabetes %K behavior change %K obesity %K physical activity %K nutrition %K Internet %K smartphone %K weight loss %D 2015 %7 23.10.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: One-third of US adults, 86 million people, have prediabetes. Two-thirds of adults are overweight or obese and at risk for diabetes. Effective and affordable interventions are needed that can reach these 86 million, and others at high risk, to reduce their progression to diagnosed diabetes. Objective: The aim was to evaluate the effectiveness of a fully automated algorithm-driven behavioral intervention for diabetes prevention, Alive-PD, delivered via the Web, Internet, mobile phone, and automated phone calls. Methods: Alive-PD provided tailored behavioral support for improvements in physical activity, eating habits, and factors such as weight loss, stress, and sleep. Weekly emails suggested small-step goals and linked to an individual Web page with tools for tracking, coaching, social support through virtual teams, competition, and health information. A mobile phone app and automated phone calls provided further support. The trial randomly assigned 339 persons to the Alive-PD intervention (n=163) or a 6-month wait-list usual-care control group (n=176). Participants were eligible if either fasting glucose or glycated hemoglobin A1c (HbA1c) was in the prediabetic range. Primary outcome measures were changes in fasting glucose and HbA1c at 6 months. Secondary outcome measures included clinic-measured changes in body weight, body mass index (BMI), waist circumference, triglyceride/high-density lipoprotein cholesterol (TG/HDL) ratio, and Framingham diabetes risk score. Analysis was by intention-to-treat. Results: Participants’ mean age was 55 (SD 8.9) years, mean BMI was 31.2 (SD 4.4) kg/m2, and 68.7% (233/339) were male. Mean fasting glucose was in the prediabetic range (mean 109.9, SD 8.4 mg/dL), whereas the mean HbA1c was 5.6% (SD 0.3), in the normal range. In intention-to-treat analyses, Alive-PD participants achieved significantly greater reductions than controls in fasting glucose (mean –7.36 mg/dL, 95% CI –7.85 to –6.87 vs mean –2.19, 95% CI –2.64 to –1.73, P<.001), HbA1c (mean –0.26%, 95% CI –0.27 to –0.24 vs mean –0.18%, 95% CI –0.19 to –0.16, P<.001), and body weight (mean –3.26 kg, 95% CI –3.26 to –3.25 vs mean –1.26 kg, 95% CI –1.27 to –1.26, P<.001). Reductions in BMI, waist circumference, and TG/HDL were also significantly greater in Alive-PD participants than in the control group. At 6 months, the Alive-PD group reduced their Framingham 8-year diabetes risk from 16% to 11%, significantly more than the control group (P<.001). Participation and retention was good; intervention participants interacted with the program a median of 17 (IQR 14) of 24 weeks and 71.1% (116/163) were still interacting with the program in month 6. Conclusions: Alive-PD improved glycemic control, body weight, BMI, waist circumference, TG/HDL ratio, and diabetes risk. As a fully automated system, the program has high potential for scalability and could potentially reach many of the 86 million US adults who have prediabetes as well as other at-risk groups. Trial Registration: Clinicaltrials.gov NCT01479062; https://clinicaltrials.gov/ct2/show/NCT01479062 (Archived by WebCite at http://www.webcitation.org/6bt4V20NR) %M 26499966 %R 10.2196/jmir.4897 %U http://www.jmir.org/2015/10/e240/ %U https://doi.org/10.2196/jmir.4897 %U http://www.ncbi.nlm.nih.gov/pubmed/26499966 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 4 %P e125 %T Effectiveness of a Mobile Phone App for Adults That Uses Physical Activity as a Tool to Manage Cigarette Craving After Smoking Cessation: A Study Protocol for a Randomized Controlled Trial %A Hassandra,Mary %A Lintunen,Taru %A Kettunen,Tarja %A Vanhala,Mauno %A Toivonen,Hanna-Mari %A Kinnunen,Kimmo %A Heikkinen,Risto %+ Department of Sport Sciences, University of Jyväskylä, PO Box 35, Jyväskylä, 40014, Finland, 358 408053979, maria.m.chasandra@jyu.fi %K behavior change %K mHealth app %K physical activity %K randomized controlled trial %K relapse prevention %K smoking %D 2015 %7 22.10.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Results from studies on the effects of exercise on smoking-related variables have provided strong evidence that physical activity acutely reduces cigarette cravings. Mobile technology may provide some valuable tools to move from explanatory randomized controlled trials to pragmatic randomized controlled trials by testing the acute effectiveness of exercise on quitters under real-life conditions. An mHealth app was developed to be used as a support tool for quitters to manage their cigarette cravings. Objective: The primary aim of this paper is to present the protocol of a study examining the effectiveness of the Physical over smoking app (Ph.o.S) by comparing the point prevalence abstinence rate of a group of users to a comparator group during a 6-month follow-up period. Methods: After initial Web-based screening, eligible participants are recruited to attend a smoking cessation program for 3 weeks to set a quit smoking date. Fifty participants who succeed in quitting will be randomly allocated to the comparator and experimental groups. Both groups will separately have 1 more counseling session on how to manage cravings. In this fourth session, the only difference in treatment between the groups is that the experimental group will have an extra 10-15 minutes of guidance on how to use the fully automated Ph.o.S app to manage cravings during the follow-up period. Data will be collected at baseline, as well as before and after the quit day, and follow-up Web-based measures will be collected for a period of 6 months. The primary efficacy outcome is the 7-day point prevalence abstinence rate, and secondary efficacy outcomes are number of relapses and cravings, self-efficacy of being aware of craving experience, self-efficacy in managing cravings, and power of control in managing cravings. Results: Recruitment for this project commenced in December 2014, and proceeded until May 2015. Follow-up data collection has commenced and will be completed by the end of December 2015. Conclusions: If the Ph.o.S app is shown to be effective, the study will provide evidence for the use of the app as a support tool for people who are trying to manage cravings during smoking cessation programs. It is anticipated that the results of the study will provide knowledge of how physical activity affects cigarette craving in real-life situations and inform the development and delivery of relapse prevention in smoking cessation treatment. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN55259451; http://www.controlled-trials.com/ISRCTN55259451 (Archived by WebCite at http://www.webcitation.org/6cKF2mzEI) %M 26494256 %R 10.2196/resprot.4600 %U http://www.researchprotocols.org/2015/4/e125/ %U https://doi.org/10.2196/resprot.4600 %U http://www.ncbi.nlm.nih.gov/pubmed/26494256 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 10 %P e238 %T Using WhatsApp and Facebook Online Social Groups for Smoking Relapse Prevention for Recent Quitters: A Pilot Pragmatic Cluster Randomized Controlled Trial %A Cheung,Yee Tak Derek %A Chan,Ching Han Helen %A Lai,Chi-Keung Jonah %A Chan,Wai Fung Vivian %A Wang,Man Ping %A Li,Ho Cheung William %A Chan,Sophia Siu Chee %A Lam,Tai-Hing %+ School of Public Health, The University of Hong Kong, 5/F William MW Mong Block, 21 Sassoon Road, Hong Kong, Hong Kong, China (Hong Kong), 852 39176652, derekcheung@hku.hk %K social networking %K social media %K smoking cessation %K relapse prevention %D 2015 %7 22.10.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Quit attempters often have episodes of smoking relapse before they eventually quit. Interactive text messaging through mobile phones has been shown to increase abstinence. This service can be potentially applied on the platform of a social networking service to help quitters maintain abstinence. Objective: Our aim was to determine if the group discussion and reminders via the WhatsApp or Facebook social group were effective to prevent smoking relapse in quitters who had stopped smoking recently. Methods: This was a single-blinded, parallel, 3-arm pilot cluster randomized controlled trial allocating recent quitters, who had completed an 8-week treatment and reported abstinence for at least 7 days, to WhatsApp (n=42), Facebook (n=40), and a control group (n=54). The 2 intervention groups participated in a 2-month online group discussion with either WhatsApp or Facebook moderated by a trained smoking cessation counselor and received a self-help booklet on smoking cessation. The control group only received the booklet. The primary outcome was the 2- and 6-month relapse rates, defined as the proportion of participants who smoked at least 5 cigarettes in 3 consecutive days. Results: Fewer participants in the WhatsApp group (17%, 7/42) reported relapse than the control group (42.6%, 23/54) at 2-month (OR 0.27, 95% CI 0.10-0.71) and 6-month (40.5%, 17/42 vs 61.1%, 33/54; OR 0.43, 95% CI 0.19-0.99) follow-ups. The Facebook group (30.0%, 12/40) had an insignificantly lower relapse rate than the control group (42.6%, 23/54) at 2-month (OR 0.58, 95% CI 0.24-1.37) and 6-month (52.5%, 13/40 vs 61.1%, 33/54; OR 0.70, 95% CI 0.31-1.61) follow-ups. The WhatsApp social groups had more moderators’ posts (median 60, IQR 25 vs median 32, IQR 7; P=.05) and participants’ posts (median 35, IQR 50 vs median 6, IQR 9; P=.07) than their Facebook counterparts, but the difference was insignificant. Conclusions: The intervention via the WhatsApp social group was effective in reducing relapse probably because of enhanced discussion and social support. Inactive discussion in the Facebook social group might have attributed to the lower effectiveness. ClinicalTrial: Clinicaltrials.gov NCT02007369; https://clinicaltrials.gov/show/NCT02007369 (Archived by WebCite® at http://www.webcitation.org/6c3RbltQG) %M 26494159 %R 10.2196/jmir.4829 %U http://www.jmir.org/2015/10/e238/ %U https://doi.org/10.2196/jmir.4829 %U http://www.ncbi.nlm.nih.gov/pubmed/26494159 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 10 %P e224 %T Health Coaching Reduces HbA1c in Type 2 Diabetic Patients From a Lower-Socioeconomic Status Community: A Randomized Controlled Trial %A Wayne,Noah %A Perez,Daniel F %A Kaplan,David M %A Ritvo,Paul %+ School of Kinesiology & Health Science, Faculty of Health, York University, 357 Bethune College, 4700 Keele Street, Toronto, ON, M3J1P3, Canada, 1 416 736 2100 ext 22396, pritvo@yorku.ca %K diabetes mellitus, type 2 %K health coaching %K mHealth %K telehealth %K randomized controlled trial %K RCT %D 2015 %7 05.10.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Adoptions of health behaviors are crucial for maintaining good health after type 2 diabetes mellitus (T2DM) diagnoses. However, adherence to glucoregulating behaviors like regular exercise and balanced diet can be challenging, especially for people living in lower-socioeconomic status (SES) communities. Providing cost-effective interventions that improve self-management is important for improving quality of life and the sustainability of health care systems. Objective: To evaluate a health coach intervention with and without the use of mobile phones to support health behavior change in patients with type 2 diabetes. Methods: In this noninferiority, pragmatic randomized controlled trial (RCT), patients from two primary care health centers in Toronto, Canada, with type 2 diabetes and a glycated hemoglobin/hemoglobin A1c (HbA1c) level of ≥7.3% (56.3 mmol/mol) were randomized to receive 6 months of health coaching with or without mobile phone monitoring support. We hypothesized that both approaches would result in significant HbA1c reductions, although health coaching with mobile phone monitoring would result in significantly larger effects. Participants were evaluated at baseline, 3 months, and 6 months. The primary outcome was the change in HbA1c from baseline to 6 months (difference between and within groups). Other outcomes included weight, waist circumference, body mass index (BMI), satisfaction with life, depression and anxiety (Hospital Anxiety and Depression Scale [HADS]), positive and negative affect (Positive and Negative Affect Schedule [PANAS]), and quality of life (Short Form Health Survey-12 [SF-12]). Results: A total of 138 patients were randomized and 7 were excluded for a substudy; of the remaining 131, 67 were allocated to the intervention group and 64 to the control group. Primary outcome data were available for 97 participants (74.0%). While both groups reduced their HbA1c levels, there were no significant between-group differences in change of HbA1c at 6 months using intention-to-treat (last observation carried forward [LOCF]) (P=.48) or per-protocol (P=.83) principles. However, the intervention group did achieve an accelerated HbA1c reduction, leading to a significant between-group difference at 3 months (P=.03). This difference was reduced at the 6-month follow-up as the control group continued to improve, achieving a reduction of 0.81% (8.9 mmol/mol) (P=.001) compared with a reduction of 0.84% (9.2 mmol/mol)(P=.001) in the intervention group. Intervention group participants also had significant decreases in weight (P=.006) and waist circumference (P=.01) while controls did not. Both groups reported improvements in mood, satisfaction with life, and quality of life. Conclusions: Health coaching with and without access to mobile technology appeared to improve glucoregulation and mental health in a lower-SES, T2DM population. The accelerated improvement in the mobile phone group suggests the connectivity provided may more quickly improve adoption and adherence to health behaviors within a clinical diabetes management program. Overall, health coaching in primary care appears to lead to significant benefits for patients from lower-SES communities with poorly controlled type 2 diabetes. Trial Registration: ClinicalTrials.gov NCT02036892; http://clinicaltrials.gov/ct2/show/NCT02036892 (Archived by WebCite at http://www.webcitation.org/6b3cJYJOD) %M 26441467 %R 10.2196/jmir.4871 %U http://www.jmir.org/2015/10/e224/ %U https://doi.org/10.2196/jmir.4871 %U http://www.ncbi.nlm.nih.gov/pubmed/26441467 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e94 %T Basal Temperature Measurement Using a Multi-Sensor Armband in Australian Young Women: A Comparative Observational Study %A Wark,John D %A Henningham,Lucy %A Gorelik,Alexandra %A Jayasinghe,Yasmin %A Hartley,Stefanie %A Garland,Suzanne Marie %+ University of Melbourne, Department of Medicine, Royal Melbourne Hospital, Grattan Street, Parkville, 3052, Australia, 61 3 9342 7109, jdwark@unimelb.edu.au %K basal body temperature %K young female health initiative %K BodyMedia SenseWear %K ovulation %K menstrual cycle, young women %D 2015 %7 05.10.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The menstrual cycle is a key marker of health in women of reproductive age. Monitoring ovulation is useful in health studies involving young women. The upward shift in basal body temperature, which occurs shortly after ovulation and continues until the next menses, is a potentially useful marker of ovulation, which has been exploited in clinical and research settings. Objective: We investigated the utility of BodyMedia SenseWear (BMSW) in monitoring ovulation in young women by analyzing the correlation and agreement of basal temperatures measured using BMSW and a digital oral thermometer. Methods: Kappa statistics were used to determine the agreement in ovulation detection between the two devices, for each participant, under each form of analysis. Participants also completed an online questionnaire assessing the acceptability of both devices. Results: We recruited 16 participants with 15 of them providing analyzable data (11 OCP non-users, 4 OCP users). Weak to moderate correlations were observed between thermometer and BMSW temperature measurements averaged over 5 different time intervals. However, no agreement between methods was observed using Bland-Altman plots. There was a significant difference in the range of temperatures that each device recorded (thermometer: 35.3-37.2°C, BMSW: 29.7-36.7°C) with BMSW temperatures significantly lower than thermometer temperatures: mean 34.6°C (SD 1.2) versus 36.4°C (SD 0.3) respectively, P<.001. Poor agreement was observed between devices under quantitative analysis of ovulation while fair agreement was observed under visual analysis. Under both quantitative and visual analysis, there was 0% agreement for evidence of ovulation. Conclusions: This study demonstrated the importance of evaluating biomeasures collected using mobile monitoring devices by comparison with standard methods. It revealed a relatively poor correlation between BMSW and oral thermometer temperature readings and suggested that BMSW is unlikely to detect an upward shift in basal body temperature. Participant behavior suggested poor compliance in the use of BMSW for basal temperature measurement and that the basal body temperature method may not be suitable for use in unselected samples of young women. There is a need for research tools for monitoring ovulation that are simple, self-administered, and inexpensive, yet appealing to young women. %M 26441468 %R 10.2196/mhealth.4263 %U http://mhealth.jmir.org/2015/4/e94/ %U https://doi.org/10.2196/mhealth.4263 %U http://www.ncbi.nlm.nih.gov/pubmed/26441468 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e92 %T Mobile Phone App Aimed at Improving Iron Intake and Bioavailability in Premenopausal Women: A Qualitative Evaluation %A Mann,Davina %A Riddell,Lynn %A Lim,Karen %A Byrne,Linda K %A Nowson,Caryl %A Rigo,Manuela %A Szymlek-Gay,Ewa A %A Booth,Alison O %+ Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, 61 0392517211, davinam@deakin.edu.au %K cell phones %K telemedicine %K mobile apps %K iron %K behavior therapy %K focus groups %K goals %D 2015 %7 28.09.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Low iron intake can lead to iron deficiency, which can result in impaired health and iron-deficiency anemia. A mobile phone app, combining successful dietary strategies to increase bioavailable iron with strategies for behavior change, such as goal setting, monitoring, feedback, and resources for knowledge acquisition, was developed with the aim to increase bioavailable iron intake in premenopausal women. Objective: To evaluate the content, usability, and acceptability of a mobile phone app designed to improve intake of bioavailable dietary iron. Methods: Women aged 18-50 years with an Android mobile phone were invited to participate. Over a 2-week period women were asked to interact with the app. Following this period, semistructured focus groups with participants were conducted. Focus groups were audio recorded and analyzed via an inductive open-coding method using the qualitative analysis software NVivo 10. Themes were identified and frequency of code occurrence was calculated. Results: Four focus groups (n=26) were conducted (age range 19-36 years, mean 24.7, SD 5.2). Two themes about the app’s functionality were identified (frequency of occurrence in brackets): interface and design (134) and usability (86). Four themes about the app’s components were identified: goal tracker (121), facts (78), photo diary (40), and games (46). A number of suggestions to improve the interface and design of the app were provided and will inform the ongoing development of the app. Conclusions: This research indicates that participants are interested in iron and their health and are willing to use an app utilizing behavior change strategies to increase intake of bioavailable iron. The inclusion of information about the link between diet and health, monitoring and tracking of the achievement of dietary goals, and weekly reviews of goals were also seen as valuable components of the app and should be considered in mobile health apps aimed at adult women. %M 26416479 %R 10.2196/mhealth.4300 %U http://mhealth.jmir.org/2015/3/e92/ %U https://doi.org/10.2196/mhealth.4300 %U http://www.ncbi.nlm.nih.gov/pubmed/26416479 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e88 %T Efficacy of a Text Message-Delivered Extended Contact Intervention on Maintenance of Weight Loss, Physical Activity, and Dietary Behavior Change %A Spark,Lauren C %A Fjeldsoe,Brianna S %A Eakin,Elizabeth G %A Reeves,Marina M %+ Cancer Prevention Research Centre, School of Public Health, The University of Queensland, Herston Road, Herston, Brisbane, 4006, Australia, 61 3346 4692, m.reeves@sph.uq.edu.au %K weight %K physical activity %K diet %K mobile telephone %K intervention %K behavior change %K maintenance %K SMS %K mhealth %K textmessaging %D 2015 %7 15.09.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Extending contact with participants after the end of an initial intervention is associated with successful maintenance of weight loss and behavior change. However, cost-effective methods of extending intervention contact are needed. Objective: This study investigated whether extended contact via text message was efficacious in supporting long-term weight loss and physical activity and dietary behavior change in breast cancer survivors. Methods: Following the end of an initial 6-month randomized controlled trial of a telephone-delivered weight loss intervention versus usual care, eligible and consenting intervention participants received a 6-month extended contact intervention via tailored text messages targeting a range of factors proposed to influence the maintenance of behavior change. In this single-group, pre-post designed study, within group changes in weight, moderate-to-vigorous physical activity (Actigraph GT3X+ accelerometers), and total energy intake (2x24 hour dietary recalls) were evaluated from baseline to end of initial intervention (6 months), end of extended contact intervention (12 months), and after a no-contact follow-up (18 months) via linear mixed models. Feasibility of implementation was assessed through systematic tracking of text message delivery process outcomes, and participant satisfaction was assessed through semistructured interviews. Results: Participants at baseline (n=29) had a mean age of 54.9 years (SD 8.8), body mass index of 30.0 kg/m2 (SD 4.2), and were recruited a mean 16.6 months (SD 3.2) post diagnosis. From baseline to 18 months, participants showed statistically significantly lower mean weight (-4.2 kg [95% CI -6.0 to -2.4]; P<.001) and higher physical activity (mean 10.4 mins/day [95% CI 3.6-17.2]; P=.003), but no significant differences in energy intake (P=.200). Participants received a mean of 8 text messages every 2 weeks (range 2-11) and reported a high rate of satisfaction. Conclusions: In comparison to interventions without extended contact, results suggest text message–delivered extended contact may support the attenuation of weight regain and promote the maintenance of physical activity. %M 26373696 %R 10.2196/mhealth.4114 %U http://mhealth.jmir.org/2015/3/e88/ %U https://doi.org/10.2196/mhealth.4114 %U http://www.ncbi.nlm.nih.gov/pubmed/26373696 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 3 %P e108 %T The Walking Interventions Through Texting (WalkIT) Trial: Rationale, Design, and Protocol for a Factorial Randomized Controlled Trial of Adaptive Interventions for Overweight and Obese, Inactive Adults %A Hurley,Jane C %A Hollingshead,Kevin E %A Todd,Michael %A Jarrett,Catherine L %A Tucker,Wesley J %A Angadi,Siddhartha S %A Adams,Marc A %+ Exercise Science and Health Promotion, School of Nutrition and Health Promotion, Arizona State University, NHI-2 Bldg, 550 North 3rd Street, Phoenix, AZ, , United States, 1 602 827 2470, marc.adams@asu.edu %K just in time adaptive interventions %K Fitbit %K exercise %K overweight %K inactive %K text messaging %K SMS %K percentile schedule of reinforcement %K mHealth %D 2015 %7 11.09.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Walking is a widely accepted and frequently targeted health promotion approach to increase physical activity (PA). Interventions to increase PA have produced only small improvements. Stronger and more potent behavioral intervention components are needed to increase time spent in PA, improve cardiometabolic risk markers, and optimize health. Objective: Our aim is to present the rationale and methods from the WalkIT Trial, a 4-month factorial randomized controlled trial (RCT) in inactive, overweight/obese adults. The main purpose of the study was to evaluate whether intensive adaptive components result in greater improvements to adults’ PA compared to the static intervention components. Methods: Participants enrolled in a 2x2 factorial RCT and were assigned to one of four semi-automated, text message–based walking interventions. Experimental components included adaptive versus static steps/day goals, and immediate versus delayed reinforcement. Principles of percentile shaping and behavioral economics were used to operationalize experimental components. A Fitbit Zip measured the main outcome: participants’ daily physical activity (steps and cadence) over the 4-month duration of the study. Secondary outcomes included self-reported PA, psychosocial outcomes, aerobic fitness, and cardiorespiratory risk factors assessed pre/post in a laboratory setting. Participants were recruited through email listservs and websites affiliated with the university campus, community businesses and local government, social groups, and social media advertising. Results: This study has completed data collection as of December 2014, but data cleaning and preliminary analyses are still in progress. We expect to complete analysis of the main outcomes in late 2015 to early 2016. Conclusions: The Walking Interventions through Texting (WalkIT) Trial will further the understanding of theory-based intervention components to increase the PA of men and women who are healthy, insufficiently active and are overweight or obese. WalkIT is one of the first studies focusing on the individual components of combined goal setting and reward structures in a factorial design to increase walking. The trial is expected to produce results useful to future research interventions and perhaps industry initiatives, primarily focused on mHealth, goal setting, and those looking to promote behavior change through performance-based incentives. Trial Registration: ClinicalTrials.gov NCT02053259; https://clinicaltrials.gov/ct2/show/NCT02053259 (Archived by WebCite at http://www.webcitation.org/6b65xLvmg). %M 26362511 %R 10.2196/resprot.4856 %U http://www.researchprotocols.org/2015/3/e108/ %U https://doi.org/10.2196/resprot.4856 %U http://www.ncbi.nlm.nih.gov/pubmed/26362511 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 8 %P e210 %T Apps for IMproving FITness and Increasing Physical Activity Among Young People: The AIMFIT Pragmatic Randomized Controlled Trial %A Direito,Artur %A Jiang,Yannan %A Whittaker,Robyn %A Maddison,Ralph %+ Faculty of Medical and Health Sciences, National Institute for Health Innovation, University of Auckland, National Institute for Health Innovation, School of Population Health, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand, 64 9 373 7599 ext 85285, a.direito@auckland.ac.nz %K physical fitness %K motor activity %K exercise %K physical activity %K adolescent %K health promotion %K telemedicine %K mHealth %K mobile applications %K smartphone %D 2015 %7 27.08.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the global prevalence of insufficient physical activity (PA), effective interventions that attenuate age-related decline in PA levels are needed. Mobile phone interventions that positively affect health (mHealth) show promise; however, their impact on PA levels and fitness in young people is unclear and little is known about what makes a good mHealth app. Objective: The aim was to determine the effects of two commercially available smartphone apps (Zombies, Run and Get Running) on cardiorespiratory fitness and PA levels in insufficiently active healthy young people. A second aim was to identify the features of the app design that may contribute to improved fitness and PA levels. Methods: Apps for IMproving FITness (AIMFIT) was a 3-arm, parallel, randomized controlled trial conducted in Auckland, New Zealand. Participants were recruited through advertisements in electronic mailing lists, local newspapers, flyers posted in community locations, and presentations at schools. Eligible young people aged 14-17 years were allocated at random to 1 of 3 conditions: (1) use of an immersive app (Zombies, Run), (2) use of a nonimmersive app (Get Running), or (3) usual behavior (control). Both smartphone apps consisted of a fully automated 8-week training program designed to improve fitness and ability to run 5 km; however, the immersive app featured a game-themed design and narrative. Intention-to-treat analysis was performed using data collected face-to-face at baseline and 8 weeks, and all regression models were adjusted for baseline outcome value and gender. The primary outcome was cardiorespiratory fitness, objectively assessed as time to complete the 1-mile run/walk test at 8 weeks. Secondary outcomes were PA levels (accelerometry and self-reported), enjoyment, psychological need satisfaction, self-efficacy, and acceptability and usability of the apps. Results: A total of 51 participants were randomized to the immersive app intervention (n=17), nonimmersive app intervention (n=16), or the control group (n=18). The mean age of participants was 15.7 (SD 1.2) years; participants were mostly NZ Europeans (61%, 31/51) and 57% (29/51) were female. Overall retention rate was 96% (49/51). There was no significant intervention effect on the primary outcome using either of the apps. Compared to the control, time to complete the fitness test was –28.4 seconds shorter (95% CI –66.5 to 9.82, P=.20) for the immersive app group and –24.7 seconds (95% CI –63.5 to 14.2, P=.32) for the nonimmersive app group. No significant intervention effects were found for secondary outcomes. Conclusions: Although apps have the ability to increase reach at a low cost, our pragmatic approach using readily available commercial apps as a stand-alone instrument did not have a significant effect on fitness. However, interest in future use of PA apps is promising and highlights a potentially important role of these tools in a multifaceted approach to increase fitness, promote PA, and consequently reduce the adverse health outcomes associated with insufficient activity. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12613001030763; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12613001030763 (Archived by WebCite at http://www.webcitation.org/6aasfJVTJ). %M 26316499 %R 10.2196/jmir.4568 %U http://www.jmir.org/2015/8/e210/ %U https://doi.org/10.2196/jmir.4568 %U http://www.ncbi.nlm.nih.gov/pubmed/26316499 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e83 %T The Effectiveness of Mobile Phone-Based Care for Weight Control in Metabolic Syndrome Patients: Randomized Controlled Trial %A Oh,Bumjo %A Cho,Belong %A Han,Min Kyu %A Choi,Hochun %A Lee,Mi Na %A Kang,Hee-Cheol %A Lee,Chang Hee %A Yun,Heeseong %A Kim,Youngho %+ Seoul National University Hospital, Department of Family Medicine, 101 Daehak-Ro Jongno-Gu, Seoul, 110-744, Republic Of Korea, 82 10 9865 2195, belong@snu.ac.kr %K metabolic syndrome X %K obesity %K diet %K exercise %K mobile health %K health information management %D 2015 %7 20.08.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Overweight and obesity, due to a Westernized diet and lack of exercise, are serious global problems that negatively affect not only personal health, but national economies as well. To solve these problems, preventative-based approaches should be taken rather than medical treatments after the occurrence of disease. The improvement of individual life habits, through continuous care, is thus a paramount, long-term treatment goal. This study describes the effects of ubiquitous health care (uHealth care) or SmartCare services in the treatment of weight loss and obesity. Objective: The aim of this study is to evaluate the effect of SmartCare services on weight loss compared to the effects of existing outpatient treatments in obese patients with metabolic syndrome. Methods: Metabolic syndrome patients who met the inclusion/exclusion criteria were enrolled in the study and randomized into an intervention or control group. The intervention group was provided with remote monitoring and health care services in addition to the existing treatment. The control group was provided with only the existing treatment. Pedometers were given to all of the patients. Additionally, mobile phones and body composition monitors were provided to the intervention group while body weight scales were provided to the control group. The patients visited the hospitals at 12 and 24 weeks following the baseline examination to receive efficacy and safety evaluations. Results: Mean weight reduction from baseline to week 24 was measured as a primary efficacy evaluation parameter and was found to be 2.21 kg (SD 3.60) and 0.77 kg (SD 2.77) in the intervention and control group, respectively. The intervention group had a larger decrement compared to the control group (P<.001). Among the secondary efficacy evaluation parameters, body mass index (BMI) (P<.001), body fat rate (P=.001), decrement of waist measurement (P<.001), and diet habit (P=.012) improvement ratings from baseline to week 24 were found to be superior in the intervention group compared with the control group. The proportion of patients whose body weight decreased by ≥10%, lipid profiles, blood pressure, prevalence of metabolic syndrome, change in the number of metabolic syndrome elements, smoking rate, drinking rate, and physical activity were not statistically significant between the groups. Conclusions: The efficacy of SmartCare services was confirmed as the intervention group that received both SmartCare services and the existing treatment had superior results compared with the control group that only received the existing treatment. Importantly, no specific problems with respect to safety concerns were observed. SmartCare service is thus an effective way to control the weight of obese patients with metabolic syndrome. Trial Registration: Clinicaltrials.gov NCT01344811; https://clinicaltrials.gov/ct2/show/NCT01344811 (Archived by Webcite at http://www.webcitation.org/6alT2MmIB) %M 26293568 %R 10.2196/mhealth.4222 %U http://mhealth.jmir.org/2015/3/e83/ %U https://doi.org/10.2196/mhealth.4222 %U http://www.ncbi.nlm.nih.gov/pubmed/26293568 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e82 %T Review and Evaluation of Mindfulness-Based iPhone Apps %A Mani,Madhavan %A Kavanagh,David J %A Hides,Leanne %A Stoyanov,Stoyan R %+ Institute of Health & Biomedical Innovation, School of Psychology and Counselling, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, 4059, Australia, 61 434190971, m.mani@qut.edu.au %K mindfulness %K mindfulness-based mobile apps %K mobile health (mHealth) %K mental health %D 2015 %7 19.08.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: There is growing evidence for the positive impact of mindfulness on wellbeing. Mindfulness-based mobile apps may have potential as an alternative delivery medium for training. While there are hundreds of such apps, there is little information on their quality. Objective: This study aimed to conduct a systematic review of mindfulness-based iPhone mobile apps and to evaluate their quality using a recently-developed expert rating scale, the Mobile Application Rating Scale (MARS). It also aimed to describe features of selected high-quality mindfulness apps. Methods: A search for “mindfulness” was conducted in iTunes and Google Apps Marketplace. Apps that provided mindfulness training and education were included. Those containing only reminders, timers or guided meditation tracks were excluded. An expert rater reviewed and rated app quality using the MARS engagement, functionality, visual aesthetics, information quality and subjective quality subscales. A second rater provided MARS ratings on 30% of the apps for inter-rater reliability purposes. Results: The “mindfulness” search identified 700 apps. However, 94 were duplicates, 6 were not accessible and 40 were not in English. Of the remaining 560, 23 apps met inclusion criteria and were reviewed. The median MARS score was 3.2 (out of 5.0), which exceeded the minimum acceptable score (3.0). The Headspace app had the highest average score (4.0), followed by Smiling Mind (3.7), iMindfulness (3.5) and Mindfulness Daily (3.5). There was a high level of inter-rater reliability between the two MARS raters. Conclusions: Though many apps claim to be mindfulness-related, most were guided meditation apps, timers, or reminders. Very few had high ratings on the MARS subscales of visual aesthetics, engagement, functionality or information quality. Little evidence is available on the efficacy of the apps in developing mindfulness. %M 26290327 %R 10.2196/mhealth.4328 %U http://mhealth.jmir.org/2015/3/e82/ %U https://doi.org/10.2196/mhealth.4328 %U http://www.ncbi.nlm.nih.gov/pubmed/26290327 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 8 %P e201 %T Successful Organizational Strategies to Sustain Use of A-CHESS: A Mobile Intervention for Individuals With Alcohol Use Disorders %A Ford II,James H %A Alagoz,Esra %A Dinauer,Susan %A Johnson,Kimberly A %A Pe-Romashko,Klaren %A Gustafson,David H %+ University of Wisconsin - Madison, Center for Health Systems Research and Analysis, 610 Walnut Street, Madison, WI, 53726, United States, 1 608 262 4748, jhfordii@wisc.edu %K mHealth %K substance abuse disorder %K sustainability %K funding %K engagement %K staff %K client %K implementation %D 2015 %7 18.08.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health (mHealth) services are growing in importance in health care research with the advancement of wireless networks, tablets, and mobile phone technologies. These technologies offer a wide range of applications that cover the spectrum of health care delivery. Although preliminary experiments in mHealth demonstrate promising results, more robust real-world evidence is needed for widespread adoption and sustainment of these technologies. Objective: Our aim was to identify the problems/challenges associated with sustained use of an mHealth addiction recovery support app and to determine strategies used by agencies that successfully sustained client use of A-CHESS. Methods: Qualitative inquiry assessed staff perceptions about organizational attributes and strategies associated with sustained use of the mobile app, A-CHESS. A total of 73 interviews of clinicians and administrators were conducted. The initial interviews (n=36) occurred at the implementation of A-CHESS. Follow-up interviews (n=37) occurred approximately 12 and 24 months later. A coding scheme was developed and Multiuser NVivo was used to manage and analyze the blinded interview data. Results: Successful strategies used by treatment providers to sustain A-CHESS included (1) strong leadership support, (2) use of client feedback reports to follow up on non-engaged clients, (3) identify passionate staff and incorporate A-CHESS discussions in weekly meetings, (4) develop A-CHESS guidelines related to client use, (5) establish internal work groups to engage clients, and (6) establish a financial strategy to sustain A-CHESS use. The study also identified attributes of A-CHESS that enhanced as well as inhibited its sustainability. Conclusions: Mobile apps can play an important role in health care delivery. However, providers will need to develop strategies for engaging both staff and patients in ongoing use of the apps. They will also need to rework business processes to accommodate the changes in communication frequency and style, learn to use app data for decision making, and identify financing mechanisms for supporting these changes. %M 26286257 %R 10.2196/jmir.3965 %U http://www.jmir.org/2015/8/e201/ %U https://doi.org/10.2196/jmir.3965 %U http://www.ncbi.nlm.nih.gov/pubmed/26286257 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 8 %P e195 %T Mobile Exercise Apps and Increased Leisure Time Exercise Activity: A Moderated Mediation Analysis of the Role of Self-Efficacy and Barriers %A Litman,Leib %A Rosen,Zohn %A Spierer,David %A Weinberger-Litman,Sarah %A Goldschein,Akiva %A Robinson,Jonathan %+ Lander College, Psychology Department, 75-31 150th Street, Kew Gardens Hills, NY, NY, 11367, United States, 1 917 8367941, leib.litman@touro.edu %K mobile health %K apps %K exercise %K barriers to exercise %K self-efficacy %K BMI %D 2015 %7 14.8.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: There are currently over 1000 exercise apps for mobile devices on the market. These apps employ a range of features, from tracking exercise activity to providing motivational messages. However, virtually nothing is known about whether exercise apps improve exercise levels and health outcomes and, if so, the mechanisms of these effects. Objective: Our aim was to examine whether the use of exercise apps is associated with increased levels of exercise and improved health outcomes. We also develop a framework within which to understand how exercise apps may affect health and test multiple models of possible mechanisms of action and boundary conditions of these relationships. Within this framework, app use may increase physical activity by influencing variables such as self-efficacy and may help to overcome exercise barriers, leading to improved health outcomes such as lower body mass index (BMI). Methods: In this study, 726 participants with one of three backgrounds were surveyed about their use of exercise apps and health: (1) those who never used exercise apps, (2) those who used exercise apps but discontinued use, and (3) those who are currently using exercise apps. Participants were asked about their long-term levels of exercise and about their levels of exercise during the previous week with the International Physical Activity Questionnaire (IPAQ). Results: Nearly three-quarters of current app users reported being more active compared to under half of non-users and past users. The IPAQ showed that current users had higher total leisure time metabolic equivalent of task (MET) expenditures (1169 METs), including walking and vigorous exercise, compared to those who stopped using their apps (612 METs) or who never used apps (577 METs). Importantly, physical activity levels in domains other than leisure time activity were similar across the groups. The results also showed that current users had lower BMI (25.16) than past users (26.8) and non-users (26.9) and that this association was mediated by exercise levels and self-efficacy. That relationship was also moderated by perceived barriers to exercise. Multiple serial mediation models were tested, which revealed that the association between app use and BMI is mediated by increased self-efficacy and increased exercise. Conclusions: Exercise app users are more likely to exercise during their leisure time, compared to those who do not use exercise apps, essentially fulfilling the role that many of these apps were designed to accomplish. Data also suggest that one way that exercise apps may increase exercise levels and health outcomes such as BMI is by making it easier for users to overcome barriers to exercise, leading to increased self-efficacy. We discuss ways of improving the effectiveness of apps by incorporating theory-driven approaches. We conclude that exercise apps can be viewed as intervention delivery systems consisting of features that help users overcome specific barriers. %M 26276227 %R 10.2196/jmir.4142 %U http://www.jmir.org/2015/8/e195/ %U https://doi.org/10.2196/jmir.4142 %U http://www.ncbi.nlm.nih.gov/pubmed/26276227 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e81 %T Cannabis Mobile Apps: A Content Analysis %A Ramo,Danielle E %A Popova,Lucy %A Grana,Rachel %A Zhao,Shirley %A Chavez,Kathryn %+ Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, Box TRC 0984, San Francisco, CA, 94143, United States, 1 415 476 7695, danielle.ramo@ucsf.edu %K cell phones %K mobile apps %K cannabis %D 2015 %7 12.08.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile technology is pervasive and widely used to obtain information about drugs such as cannabis, especially in a climate of rapidly changing cannabis policy; yet the content of available cannabis apps is largely unknown. Understanding the resources available to those searching for cannabis apps will clarify how this technology is being used to reflect and influence cannabis use behavior. Objective: We investigated the content of 59 cannabis-related mobile apps for Apple and Android devices as of November 26, 2014. Methods: The Apple and Google Play app stores were searched using the terms “cannabis” and “marijuana.” Three trained coders classified the top 20 apps for each term and each store, using a coding guide. Apps were examined for the presence of 20 content codes derived by the researchers. Results: Total apps available for each search term were 124 for cannabis and 218 for marijuana in the Apple App Store, and 250 each for cannabis and marijuana on Google Play. The top 20 apps in each category in each store were coded for 59 independent apps (30 Apple, 29 Google Play). The three most common content areas were cannabis strain classification (33.9%), facts about cannabis (20.3%), and games (20.3%). In the Apple App Store, most apps were free (77%), all were rated “17+” years, and the average user rating was 3.9/5 stars. The most popular apps provided cannabis strain classifications (50%), dispensary information (27%), or general facts about cannabis (27%). Only one app (3%) provided information or resources related to cannabis abuse, addiction, or treatment. On Google Play, most apps were free (93%), rated “high maturity” (79%), and the average user rating was 4.1/5. The most popular app types offered games (28%), phone utilities (eg, wallpaper, clock; 21%) and cannabis food recipes (21%); no apps addressed abuse, addiction, or treatment. Conclusions: Cannabis apps are generally free and highly rated. Apps were most often informational (facts, strain classification), or recreational (games), likely reflecting and influencing the growing acceptance of cannabis for medical and recreational purposes. Apps addressing addiction or cessation were underrepresented in the most popular cannabis mobile apps. Differences among apps for Apple and Android platforms likely reflect differences in the population of users, developer choice, and platform regulations. %M 26268634 %R 10.2196/mhealth.4405 %U http://mhealth.jmir.org/2015/3/e81/ %U https://doi.org/10.2196/mhealth.4405 %U http://www.ncbi.nlm.nih.gov/pubmed/26268634 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 3 %P e22 %T Feasibility of "CopeSmart": A Telemental Health App for Adolescents %A Kenny,Rachel %A Dooley,Barbara %A Fitzgerald,Amanda %+ School of Psychology, University College Dublin, Belfield, Dublin 4, , Ireland, 353 1 7168147, rachel.kenny.3@ucdconnect.ie %K adolescents %K emotional self-monitoring %K feasibility %K mobile apps %K positive mental health %D 2015 %7 10.08.2015 %9 Original Paper %J JMIR Mental Health %G English %X Background: Early intervention is important in order to improve mental health outcomes for young people. Given the recent rise in mobile phone ownership among adolescents, an innovative means of delivering such intervention is through the use of mobile phone applications (apps). Objective: The aim of this study was to evaluate the feasibility of “CopeSmart”, a telemental health app developed to foster positive mental health in adolescents through emotional self-monitoring and the promotion of positive coping strategies. Methods: Forty-three adolescents (88% female) aged 15-17 years downloaded the app and used it over a one-week period. They then completed self-report questionnaires containing both open-ended and closed-ended questions about their experiences of using the app. The app itself captured data related to user engagement. Results: On average participants engaged with the app on 4 of the 7 days within the intervention period. Feedback from users was reasonably positive, with 70% of participants reporting that they would use the app again and 70% reporting that they would recommend it to a friend. Thematic analysis of qualitative data identified themes pertaining to users’ experiences of the app, which were both positive (eg, easy to use, attractive layout, emotional self-monitoring, helpful information, notifications, unique) and negative (eg, content issues, did not make user feel better, mood rating issues, password entry, interface issues, engagement issues, technical fixes). Conclusions: Overall findings suggest that telemental health apps have potential as a feasible medium for promoting positive mental health, with the majority of young people identifying such technologies as at least somewhat useful and displaying a moderate level of engagement with them. Future research should aim to evaluate the efficacy of such technologies as tools for improving mental health outcomes in young people. %M 26552425 %R 10.2196/mental.4370 %U http://mental.jmir.org/2015/3/e22/ %U https://doi.org/10.2196/mental.4370 %U http://www.ncbi.nlm.nih.gov/pubmed/26552425 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 8 %P e192 %T Technologies That Assess the Location of Physical Activity and Sedentary Behavior: A Systematic Review %A Loveday,Adam %A Sherar,Lauren B %A Sanders,James P %A Sanderson,Paul W %A Esliger,Dale W %+ National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, United Kingdom, 44 7920015099, a.loveday@lboro.ac.uk %K wearable camera %K global positioning system %K real-time locating system %K sitting %K context %D 2015 %7 05.08.2015 %9 Review %J J Med Internet Res %G English %X Background: The location in which physical activity and sedentary behavior are performed can provide valuable behavioral information, both in isolation and synergistically with other areas of physical activity and sedentary behavior research. Global positioning systems (GPS) have been used in physical activity research to identify outdoor location; however, while GPS can receive signals in certain indoor environments, it is not able to provide room- or subroom-level location. On average, adults spend a high proportion of their time indoors. A measure of indoor location would, therefore, provide valuable behavioral information. Objective: This systematic review sought to identify and critique technology which has been or could be used to assess the location of physical activity and sedentary behavior. Methods: To identify published research papers, four electronic databases were searched using key terms built around behavior, technology, and location. To be eligible for inclusion, papers were required to be published in English and describe a wearable or portable technology or device capable of measuring location. Searches were performed up to February 4, 2015. This was supplemented by backward and forward reference searching. In an attempt to include novel devices which may not yet have made their way into the published research, searches were also performed using three Internet search engines. Specialized software was used to download search results and thus mitigate the potential pitfalls of changing search algorithms. Results: A total of 188 research papers met the inclusion criteria. Global positioning systems were the most widely used location technology in the published research, followed by wearable cameras, and radio-frequency identification. Internet search engines identified 81 global positioning systems, 35 real-time locating systems, and 21 wearable cameras. Real-time locating systems determine the indoor location of a wearable tag via the known location of reference nodes. Although the type of reference node and location determination method varies between manufacturers, Wi-Fi appears to be the most popular method. Conclusions: The addition of location information to existing measures of physical activity and sedentary behavior will provide important behavioral information. %M 26245157 %R 10.2196/jmir.4761 %U http://www.jmir.org/2015/8/e192/ %U https://doi.org/10.2196/jmir.4761 %U http://www.ncbi.nlm.nih.gov/pubmed/26245157 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 3 %P e92 %T Efficacy and External Validity of Electronic and Mobile Phone-Based Interventions Promoting Vegetable Intake in Young Adults: A Systematic Review Protocol %A Nour,Monica Marina %A Chen,Juliana %A Allman-Farinelli,Margaret %+ Charles Perkins Centre, School of Molecular Bioscience, University of Sydney, Level 4 EAST, Charles Perkins Centre D17, Sydney, NSW, 2006, Australia, 61 403094095, mnou2973@uni.sydney.edu.au %K young adults %K vegetables %K mHealth %K eHealth %K social marketing %D 2015 %7 28.07.2015 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite social marketing campaigns and behavior change interventions, young adults remain among the lowest consumers of vegetables. The digital era offers potential new avenues for both social marketing and individually tailored programs, through texting, web, and mobile applications. The effectiveness and generalizability of such programs have not been well documented. Objective: The aim of this systematic review is to evaluate the efficacy and external validity of social marketing, electronic, and mobile phone-based (mHealth) interventions aimed at increasing vegetable intake in young adults. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol will be used to conduct this systematic review. The search strategy will be executed across eleven electronic databases using combinations of the following search terms: “online intervention”, “computer-assisted therapy”, “internet”, “website”, “cell phones”, “cyber”, “telemedicine”, “email”, “social marketing”, “social media”, “mass media”, “young adult”, and “fruit and vegetables”. The reference lists of included studies will also be searched for additional citations. Titles and abstracts will be screened against inclusion criteria and full texts of potentially eligible papers will be assessed by two independent reviewers. Data from eligible papers will be extracted. Quality and risk of bias will be assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies and The Cochrane Collaboration Risk of Bias assessment tool respectively. The external validity of the studies will be determined based on components such as reach, adoption, and representativeness of participants; intervention implementation and adaption; and program maintenance and institutionalization. Results will be reported quantitatively and qualitatively. Results: Our research is in progress. A draft of the systematic review is currently being produced for publication by the end of 2015. Conclusions: The review findings will assist the design and implementation of future eHealth and mHealth programs aimed at improving vegetable consumption in young adults. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews: CRD42015017763; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015017763#.VVKtqfmqqko (Archived by WebCite at http://www.webcitation.org/6YU2UYrTn). %M 26220803 %R 10.2196/resprot.4665 %U http://www.researchprotocols.org/2015/3/e92/ %U https://doi.org/10.2196/resprot.4665 %U http://www.ncbi.nlm.nih.gov/pubmed/26220803 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 3 %P e91 %T Mapping a Decade of Physical Activity Interventions for Primary Prevention: A Protocol for a Scoping Review of Reviews %A Goertzen,Leah %A Halas,Gayle %A Rothney,Janet %A Schultz,Annette SH %A Wener,Pamela %A Enns,Jennifer E %A Katz,Alan %+ Manitoba Centre for Health Policy, Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, 0000-0001-8280-7024, Winnipeg, MB, R3E 3P5, Canada, 1 204 789 3442, alan_katz@cpe.umanitoba.ca %K physical activity %K primary prevention %K protocol %K scoping review %D 2015 %7 27.07.2015 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical activity is a key behavioral component for the primary prevention of noncommunicable disease. The uptake of physical activity is influenced by individual and broader factors including social, economic, and environmental conditions. Objective: The purpose of this paper is to describe a protocol for a scoping review of reviews (SRR) that aims to map a decade of research focused on physical activity interventions within the domain of primary prevention. Methods: The 5 stages of our SRRs design were adapted from a seminal scoping review methodology. Our search strategy was developed for the following databases: SPORTDiscus, PubMed, Scopus, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Educational Resources Information Centre. Two reviewers (LG and AK) independently screened eligible studies and compared results to determine the final study selection. One reviewer will conduct the data extraction (LG); a second reviewer (AK) will assess the results to ensure comprehensiveness and accuracy of the scoping review synthesis. Results: The SRRs will provide a broad overview of the physical activity research literature specific to primary prevention, and will describe key features of physical activity interventions. Potential gaps in the physical activity action areas will be identified, and thus, the results will inform future research directions. Conclusions: This paper describes an innovative approach for comprehensively mapping an important topic’s research trends in the last decade. %M 26215502 %R 10.2196/resprot.4240 %U http://www.researchprotocols.org/2015/3/e91/ %U https://doi.org/10.2196/resprot.4240 %U http://www.ncbi.nlm.nih.gov/pubmed/26215502 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 7 %P e186 %T Photoaging Mobile Apps: A Novel Opportunity for Smoking Cessation? %A Brinker,Titus J %A Seeger,Werner %+ Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus-Liebig-University Giessen, Klinkstr. 32, Giessen, 35392, Germany, 49 15175084347, titus.brinker@gmail.com %K tobacco prevention, tobacco cessation, photoaging, mobile phone apps, apps, app, smartphones %D 2015 %7 27.07.2015 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 26215210 %R 10.2196/jmir.4792 %U http://www.jmir.org/2015/7/e186/ %U https://doi.org/10.2196/jmir.4792 %U http://www.ncbi.nlm.nih.gov/pubmed/26215210 %0 Journal Article %@ 2291-9279 %I JMIR Publications Inc. %V 3 %N 2 %P e6 %T Training Vegetable Parenting Practices Through a Mobile Game: Iterative Qualitative Alpha Test %A Brand,Leah %A Beltran,Alicia %A Buday,Richard %A Hughes,Sheryl %A O'Connor,Teresia %A Baranowski,Janice %A Dadabhoy,Hafza R %A Diep,Cassandra S %A Baranowski,Tom %+ Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates St, Houston, TX, 77030, United States, 1 713 798 9319, lbrand@bcm.edu %K mobile games %K games for health %K serious games %K pediatric nutrition %K parenting %D 2015 %7 24.07.2015 %9 Original Paper %J JMIR Serious Games %G English %X Background: Vegetable consumption protects against chronic diseases, but many young children do not eat vegetables. One quest within the mobile application Mommio was developed to train mothers of preschoolers in effective vegetable parenting practices, or ways to approach getting their child to eat and enjoy vegetables. A much earlier version of the game, then called Kiddio, was alpha tested previously, but the game has since evolved in key ways. Objective: The purpose of this research was to alpha test the first quest, substantiate earlier findings and obtain feedback on new game features to develop an effective, compelling parenting game. Methods: Mothers of preschool children (n=20) played a single quest of Mommio 2 to 4 times, immediately after which a semi-structured interview about their experience was completed. Interviews were transcribed and double coded using thematic analysis methods. Results: Mothers generally liked the game, finding it realistic and engaging. Some participants had difficulties with mechanics for moving around the 3-D environment. Tips and hints were well received, and further expansion and customization were desired. Conclusions: Earlier findings were supported, though Mommio players reported more enjoyment than Kiddio players. Continued development will include more user-friendly mechanics, customization, opportunities for environment interaction, and food parenting scenarios. %M 26208899 %R 10.2196/games.4081 %U http://games.jmir.org/2015/2/e6/ %U https://doi.org/10.2196/games.4081 %U http://www.ncbi.nlm.nih.gov/pubmed/26208899 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e77 %T Low Quality of Free Coaching Apps With Respect to the American College of Sports Medicine Guidelines: A Review of Current Mobile Apps %A Modave,François %A Bian,Jiang %A Leavitt,Trevor %A Bromwell,Jennifer %A Harris III,Charles %A Vincent,Heather %+ University of Florida, Department of Health Outcomes and Policy, CTRB 2243 PO Box 100177, 2004 Mowry Road, Gainesville, FL, 32610, United States, 1 352 294 5984, modavefp@ufl.edu %K apps %K fitness %K mHealth %K mobile coaching %K obesity %K quality %K weight loss %D 2015 %7 24.07.2015 %9 Review %J JMIR mHealth uHealth %G English %X Background: Low physical activity level is a significant contributor to chronic disease, weight dysregulation, and mortality. Nearly 70% of the American population is overweight, and 35% is obese. Obesity costs an estimated US$ 147 billion annually in health care, and as many as 95 million years of life. Although poor nutritional habits remain the major culprit, lack of physical activity significantly contributes to the obesity epidemic and related lifestyle diseases. Objective: Over the past 10 years, mobile devices have become ubiquitous, and there is an ever-increasing number of mobile apps that are being developed to facilitate physical activity, particularly for active people. However, no systematic assessment has been performed about their quality with respect to following the parameters of sound fitness principles and scientific evidence, or suitability for a variety of fitness levels. The aim of this paper is to fill this gap and assess the quality of mobile coaching apps on iOS mobile devices. Methods: A set of 30 popular mobile apps pertaining to physical activity programming was identified and reviewed on an iPhone device. These apps met the inclusion criteria and provided specific prescriptive fitness and exercise programming content. The content of these apps was compared against the current guidelines and fitness principles established by the American College of Sports Medicine (ACSM). A weighted scoring method based on the recommendations of the ACSM was developed to generate subscores for quality of programming content for aerobic (0-6 scale), resistance (0-6 scale), and flexibility (0-2 scale) components using the frequency, intensity, time, and type (FITT) principle. An overall score (0-14 scale) was generated from the subscores to represent the overall quality of a fitness coaching app. Results: Only 3 apps scored above 50% on the aerobic component (mean 0.7514, SD 1.2150, maximum 4.1636), 4 scored above 50% on the resistance/strength component (mean 1.4525, SD 1.2101, maximum 4.1094), and no app scored above 50% on the flexibility component (mean 0.1118, SD 0.2679, maximum 0.9816). Finally, only 1 app had an overall score (64.3%) above 50% (mean 2.3158, SD 1.911, maximum 9.0072). Conclusions: There are over 100,000 health-related apps. When looking at popular free apps related to physical activity, we observe that very few of them are evidence based, and respect the guidelines for aerobic activity, strength/resistance training, and flexibility, set forth by the ACSM. Users should exercise caution when adopting a new app for physical activity purposes. This study also clearly identifies a gap in evidence-based apps that can be used safely and effectively to start a physical routine program, develop fitness, and lose weight. App developers have an exciting opportunity to improve mobile coaching app quality by addressing these gaps. %M 26209109 %R 10.2196/mhealth.4669 %U http://mhealth.jmir.org/2015/3/e77/ %U https://doi.org/10.2196/mhealth.4669 %U http://www.ncbi.nlm.nih.gov/pubmed/26209109 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 7 %P e184 %T It's LiFe! Mobile and Web-Based Monitoring and Feedback Tool Embedded in Primary Care Increases Physical Activity: A Cluster Randomized Controlled Trial %A van der Weegen,Sanne %A Verwey,Renée %A Spreeuwenberg,Marieke %A Tange,Huibert %A van der Weijden,Trudy %A de Witte,Luc %+ CAPHRI School for Public Health and Primary Care, Department Health Services Research, Maastricht University, PO Box 616, Maastricht, 6200 MD, Netherlands, 31 642756346, s.vanderweegen@vilans.nl %K motor activity %K behavior change %K self-management support %K primary care nursing %K remote sensing technology %K COPD %K type 2 diabetes %D 2015 %7 24.07.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Physical inactivity is a major public health problem. The It’s LiFe! monitoring and feedback tool embedded in the Self-Management Support Program (SSP) is an attempt to stimulate physical activity in people with chronic obstructive pulmonary disease or type 2 diabetes treated in primary care. Objective: Our aim was to evaluate whether the SSP combined with the use of the monitoring and feedback tool leads to more physical activity compared to usual care and to evaluate the additional effect of using this tool on top of the SSP. Methods: This was a three-armed cluster randomised controlled trial. Twenty four family practices were randomly assigned to one of three groups in which participants received the tool + SSP (group 1), the SSP (group 2), or care as usual (group 3). The primary outcome measure was minutes of physical activity per day. The secondary outcomes were general and exercise self-efficacy and quality of life. Outcomes were measured at baseline after the intervention (4-6 months), and 3 months thereafter. Results: The group that received the entire intervention (tool + SSP) showed more physical activity directly after the intervention than Group 3 (mean difference 11.73, 95% CI 6.21-17.25; P<.001), and Group 2 (mean difference 7.86, 95% CI 2.18-13.54; P=.003). Three months after the intervention, this effect was still present and significant (compared to Group 3: mean difference 10.59, 95% CI 4.94-16.25; P<.001; compared to Group 2: mean difference 9.41, 95% CI 3.70-15.11; P<.001). There was no significant difference in effect between Groups 2 and 3 on both time points. There was no interaction effect for disease type. Conclusions: The combination of counseling with the tool proved an effective way to stimulate physical activity. Counseling without the tool was not effective. Future research about the cost-effectiveness and application under more tailored conditions and in other target groups is recommended. Trial Registration: ClinicalTrials.gov: NCT01867970, https://clinicaltrials.gov/ct2/show/NCT01867970 (archived by WebCite at http://www.webcitation.org/6a2qR5BSr). %M 26209025 %R 10.2196/jmir.4579 %U http://www.jmir.org/2015/7/e184/ %U https://doi.org/10.2196/jmir.4579 %U http://www.ncbi.nlm.nih.gov/pubmed/26209025 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 3 %P e87 %T Mobile App-Delivered Cognitive Behavioral Therapy for Insomnia: Feasibility and Initial Efficacy Among Veterans With Cannabis Use Disorders %A Babson,Kimberly A %A Ramo,Danielle E %A Baldini,Lisa %A Vandrey,Ryan %A Bonn-Miller,Marcel O %+ National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, United States, 1 650 493 5000, kimberly.babson@gmail.com %K cannabis %K marijuana %K sleep %K CBT-I %K intervention %D 2015 %7 17.07.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Cannabis is the most frequently used illicit substance in the United States resulting in high rates of cannabis use disorders. Current treatments for cannabis use are often met with high rates of lapse/relapse, tied to (1) behavioral health factors that impact cannabis use such as poor sleep, and (2) access, stigma, supply, and cost of receiving a substance use intervention. Objective: This pilot study examined the feasibility, usability, and changes in cannabis use and sleep difficulties following mobile phone–delivered Cognitive Behavioral Therapy for Insomnia (CBT-I) in the context of a cannabis cessation attempt. Methods: Four male veterans with DSM-5 cannabis use disorder and sleep problems were randomized to receive a 2-week intervention: CBT-I Coach mobile app (n=2) or a placebo control (mood-tracking app) (n=2). Cannabis and sleep measures were assessed pre- and post-treatment. Participants also reported use and helpfulness of each app. Changes in sleep and cannabis use were evaluated for each participant individually. Results: Both participants receiving CBT-I used the app daily over 2 weeks and found the app user-friendly, helpful, and would use it in the future. In addition, they reported decreased cannabis use and improved sleep efficiency; one also reported increased sleep quality. In contrast, one participant in the control group dropped out of the study, and the other used the app minimally and reported increased sleep quality but also increased cannabis use. The mood app was rated as not helpful, and there was low likelihood of future participation. Conclusions: This pilot study examined the feasibility and initial patient acceptance of mobile phone delivery of CBT-I for cannabis dependence. Positive ratings of the app and preliminary reports of reductions in cannabis use and improvements in sleep are both encouraging and support additional evaluation of this intervention. %M 26187404 %R 10.2196/resprot.3852 %U http://www.researchprotocols.org/2015/3/e87/ %U https://doi.org/10.2196/resprot.3852 %U http://www.ncbi.nlm.nih.gov/pubmed/26187404 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 3 %P e86 %T A Validation Study of the Web-Based Physical Activity Questionnaire Active-Q Against the GENEA Accelerometer %A Bonn,Stephanie Erika %A Bergman,Patrick %A Trolle Lagerros,Ylva %A Sjölander,Arvid %A Bälter,Katarina %+ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12a, Stockholm, SE-171 77, Sweden, 46 852482298, stephanie.bonn@ki.se %K accelerometer %K activity assessment %K epidemiology %K Internet %K self report %K validity %D 2015 %7 16.07.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Valid physical activity assessment in epidemiological studies is essential to study associations with various health outcomes. Objective: To validate the Web-based physical activity questionnaire Active-Q by comparing results of time spent at different physical activity levels with results from the GENEA accelerometer and to assess the reproducibility of Active-Q by comparing two admissions of the questionnaire. Methods: A total of 148 men (aged 33 to 86 years) responded to Active-Q twice and wore the accelerometer during seven consecutive days on two occasions. Time spent on six different physical activity levels including sedentary, light (LPA), moderate (MPA), and vigorous (VPA) as well as additional combined categories of sedentary-to-light and moderate-to-vigorous (MVPA) physical activity was assessed. Validity of Active-Q was determined using Spearman correlation coefficients with 95% confidence intervals (CI) and the Bland-Altman method. Reproducibility was assessed using intraclass correlation coefficients (ICCs) comparing two admissions of the questionnaire. Results: The validity correlation coefficients were statistically significant for time spent at all activity levels; sedentary (r=0.19, 95% CI: 0.04-0.34), LPA (r=0.15, 95% CI: 0.00-0.31), sedentary-to-light (r=0.35, 95% CI: 0.19-0.51), MPA (r=0.27, 95% CI: 0.12-0.42), VPA (r=0.54, 95% CI: 0.42-0.67), and MVPA (r=0.35, 95% CI: 0.21-0.48). The Bland-Altman plots showed a negative mean difference for time in LPA and positive mean differences for time spent in MPA, VPA and MVPA. The ICCs of test-retest reliability ranged between r=0.51-0.80 for the different activity levels in Active-Q. Conclusions: More moderate and vigorous activities and less light activities were reported in Active-Q compared to accelerometer measurements. Active-Q shows comparable validity and reproducibility to other physical activity questionnaires used today. %M 26183896 %R 10.2196/resprot.3896 %U http://www.researchprotocols.org/2015/3/e86/ %U https://doi.org/10.2196/resprot.3896 %U http://www.ncbi.nlm.nih.gov/pubmed/26183896 %0 Journal Article %@ 2291-9279 %I JMIR Publications Inc. %V 3 %N 2 %P e4 %T Health Behavior Theory in Physical Activity Game Apps: A Content Analysis %A Payne,Hannah E %A Moxley,Victor BA %A MacDonald,Elizabeth %+ Computational Health Science Research Group, Department of Health Science, Brigham Young University, 3024 LSB, Provo, UT, 84604, United States, 1 530 919 5100, hannahp413@gmail.com %K health and fitness apps %K mobile phone %K behavioral health %K theory %K content analysis %K physical activity %D 2015 %7 13.07.2015 %9 Original Paper %J JMIR Serious Games %G English %X Background: Physical activity games developed for a mobile phone platform are becoming increasingly popular, yet little is known about their content or inclusion of health behavior theory (HBT). Objective: The objective of our study was to quantify elements of HBT in physical activity games developed for mobile phones and to assess the relationship between theoretical constructs and various app features. Methods: We conducted an analysis of exercise and physical activity game apps in the Apple App Store in the fall of 2014. A total of 52 apps were identified and rated for inclusion of health behavior theoretical constructs using an established theory-based rubric. Each app was coded for 100 theoretical items, containing 5 questions for 20 different constructs. Possible total theory scores ranged from 0 to 100. Descriptive statistics and Spearman correlations were used to describe the HBT score and association with selected app features, respectively. Results: The average HBT score in the sample was 14.98 out of 100. One outlier, SuperBetter, scored higher than the other apps with a score of 76. Goal setting, self-monitoring, and self-reward were the most-reported constructs found in the sample. There was no association between either app price and theory score (P=.5074), or number of gamification elements and theory score (P=.5010). However, Superbetter, with the highest HBT score, was also the most expensive app. Conclusions: There are few content analyses of serious games for health, but a comparison between these findings and previous content analyses of non-game health apps indicates that physical activity mobile phone games demonstrate higher levels of behavior theory. The most common theoretical constructs found in this sample are known to be efficacious elements in physical activity interventions. It is unclear, however, whether app designers consciously design physical activity mobile phone games with specific constructs in mind; it may be that games lend themselves well to inclusion of theory and any constructs found in significant levels are coincidental. Health games developed for mobile phones could be potentially used in health interventions, but collaboration between app designers and behavioral specialists is crucial. Additionally, further research is needed to better characterize mobile phone health games and the relative importance of educational elements versus gamification elements in long-term behavior change. %M 26168926 %R 10.2196/games.4187 %U http://games.jmir.org/2015/2/e4/ %U https://doi.org/10.2196/games.4187 %U http://www.ncbi.nlm.nih.gov/pubmed/26168926 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 7 %P e164 %T Prevalence and Frequency of mHealth and eHealth Use Among US and UK Smokers and Differences by Motivation to Quit %A Borrelli,Belinda %A Bartlett,Yvonne Kiera %A Tooley,Erin %A Armitage,Christopher J %A Wearden,Alison %+ Boston University, Henry M Goldman School of Dental Medicine, 560 Harrison Ave, 3rd floor, Boston, MA, 02118, United States, 1 617 414 1116, belindab@bu.edu %K smoking cessation %K eHealth %K mHealth %K health behavior %K motivation %K text messaging %D 2015 %7 4.7.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Both mHealth and eHealth interventions for smoking cessation are rapidly being developed and tested. There are no data on use of mHealth and eHealth technologies by smokers in general or by smokers who are not motivated to quit smoking. Objective: The aims of our study were to (1) assess technology use (eg, texting, social media, Internet) among smokers in the United States and United Kingdom, (2) examine whether technology use differs between smokers who are motivated to quit and smokers who are not motivated to quit, (3) examine previous use of technology to assist with smoking cessation, and (4) examine future intentions to use technology to assist with smoking cessation. Methods: Participants were 1000 adult smokers (54.90%, 549/1000 female; mean age 43.9, SD 15.5 years; US: n=500, UK: n=500) who were recruited via online representative sampling strategies. Data were collected online and included demographics, smoking history, and frequency and patterns of technology use. Results: Among smokers in general, there was a high prevalence of mobile and smartphone ownership, sending and receiving texts, downloading and using apps, using Facebook, and visiting health-related websites. Smokers who were unmotivated to quit were significantly less likely to own a smartphone or handheld device that connects to the Internet than smokers motivated to quit. There was a significantly lower prevalence of sending text messages among US smokers unmotivated to quit (78.2%, 179/229) versus smokers motivated to quit (95.0%, 229/241), but no significant differences between the UK groups (motivated: 96.4%, 239/248; unmotivated: 94.9%, 223/235). Smokers unmotivated to quit in both countries were significantly less likely to use a handheld device to read email, play games, browse the Web, or visit health-related websites versus smokers motivated to quit. US smokers had a high prevalence of app downloads regardless of motivation to quit, but UK smokers who were motivated to quit had greater prevalence of app downloads than smokers unmotivated to quit. US smokers were significantly more likely to have a Facebook account (87.0%, 435/500) than UK smokers (76.4%, 382/500), but smokers unmotivated to quit in both countries used Facebook less frequently than smokers motivated to quit. Smokers who were unmotivated to quit were less likely to have used eHealth or mHealth platforms to help them quit smoking in the past and less likely to say that they would use them for smoking cessation in the future. Conclusions: Although smokers unmotivated to quit make less use of technology than smokers motivated to quit, there is sufficient prevalence to make it worthwhile to develop eHealth and mHealth interventions to encourage cessation. Short and low-effort communications, such as text messaging, might be better for smokers who are less motivated to quit. Multiple channels may be required to reach unmotivated smokers. %M 26149323 %R 10.2196/jmir.4420 %U http://www.jmir.org/2015/7/e164/ %U https://doi.org/10.2196/jmir.4420 %U http://www.ncbi.nlm.nih.gov/pubmed/26149323 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e73 %T Identification of Behavior Change Techniques and Engagement Strategies to Design a Smartphone App to Reduce Alcohol Consumption Using a Formal Consensus Method %A Garnett,Claire %A Crane,David %A West,Robert %A Brown,Jamie %A Michie,Susan %+ Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 2076795682, c.garnett.12@ucl.ac.uk %K smartphone apps %K alcohol consumption %K consensus %K Delphi technique %K behavior change techniques %D 2015 %7 29.06.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Digital interventions to reduce excessive alcohol consumption have the potential to have a broader reach and be more cost-effective than traditional brief interventions. However, there is not yet strong evidence for their ability to engage users or their effectiveness. Objective: This study aimed to identify the behavior change techniques (BCTs) and engagement strategies most worthy of further study by inclusion in a smartphone app to reduce alcohol consumption, using formal expert consensus methods. Methods: The first phase of the study consisted of a Delphi exercise with three rounds. It was conducted with 7 international experts in the field of alcohol and/or behavior change. In the first round, experts identified BCTs most likely to be effective at reducing alcohol consumption and strategies most likely to engage users with an app; these were rated in the second round; and those rated as effective by at least four out of seven participants were ranked in the third round. The rankings were analyzed using Kendall’s W coefficient of concordance, which indicates consensus between participants. The second phase consisted of a new, independent group of experts (n=43) ranking the BCTs that were identified in the first phase. The correlation between the rankings of the two groups was assessed using Spearman’s rank correlation coefficient. Results: Twelve BCTs were identified as likely to be effective. There was moderate agreement among the experts over their ranking (W=.465, χ211=35.8, P<.001) and the BCTs receiving the highest mean rankings were self-monitoring, goal-setting, action planning, and feedback in relation to goals. There was a significant correlation between the ranking of the BCTs by the group of experts who identified them and a second independent group of experts (Spearman’s rho=.690, P=.01). Seventeen responses were generated for strategies likely to engage users. There was moderate agreement among experts on the ranking of these engagement strategies (W=.563, χ215=59.2, P<.001) and those with the highest mean rankings were ease of use, design – aesthetic, feedback, function, design – ability to change design to suit own preferences, tailored information, and unique smartphone features. Conclusions: The BCTs with greatest potential to include in a smartphone app to reduce alcohol consumption were judged by experts to be self-monitoring, goal-setting, action planning, and feedback in relation to goals. The strategies most likely to engage users were ease of use, design, tailoring of design and information, and unique smartphone features. %M 26123578 %R 10.2196/mhealth.3895 %U http://mhealth.jmir.org/2015/2/e73/ %U https://doi.org/10.2196/mhealth.3895 %U http://www.ncbi.nlm.nih.gov/pubmed/26123578 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 1 %N 1 %P e7 %T Efficacy of a Mobile-Enabled Web App (iCanFit) in Promoting Physical Activity Among Older Cancer Survivors: A Pilot Study %A Hong,Yan Alicia %A Goldberg,Daniel %A Ory,Marcia G %A Towne Jr,Samuel D %A Forjuoh,Samuel N %A Kellstedt,Debra %A Wang,Suojin %+ School of Public Health, Texas A&M University, 1266 TAMU, College Station, TX, 77843, United States, 1 979 436 9343, yhong@srph.tamhsc.edu %K physical activity %K mobile health %K older adults %K cancer survivors %K iCanFit %K pilot %D 2015 %7 26.6.2015 %9 Original Paper %J JMIR Cancer %G English %X Background: The benefits of physical activity for cancer survivors are well documented. However, few older cancer survivors are engaged in regular physical activity. Mobile technologies may be an effective method to deliver physical activity promotion programs for older cancer survivors. iCanFit, a mobile-enabled Web-based app, was developed based on formative research and usability testing. This app includes interactive features of physical activity, goal setting and tracking, and receiving personalized visual feedback. Objective: The aim of this study is to pilot test the initial efficacy of iCanFit. Methods: Older cancer survivors (N=30) were recruited online through our collaborative partnership with a cancer survivor's organization. After the participants completed an online baseline survey, they were asked to use the iCanFit website. Instructional videos on how to use the web app were available on the website. Participants were asked to complete a follow-up survey 2-3 months later. Participants’ physical activity, quality of life, and their experience with iCanFit were measured. Results: A total of 30 participants completed the baseline survey, and 26 of them (87%, 26/30) also completed a follow-up survey 2-3 months later. The median age of participants was 69 years (range 60-78). Participants’ quality of life and engagement in regular physical activity improved significantly after the use of iCanFit. Participants indicated a general affinity towards the key function “Goals” in iCanFit, which motivated continued activity. They also provided suggestions to further improve the app (eg, adding a reminder functionality, easier or alternative ways of entering activities). Conclusion: The interactive Web-based app iCanFit has demonstrated initial efficacy. Even though our study was limited by a small sample size, convenience sampling, and a short follow-up period, results suggest that using mobile tools to promote physical activity and healthy living among older cancer survivors holds promise. Next steps include refining iCanFit based on users’ feedback and developing versatile functionality to allow easier physical activity goal setting and tracking. We also call for more studies on developing and evaluating mobile and web apps for older cancer survivors. %M 28410158 %R 10.2196/cancer.4389 %U http://cancer.jmir.org/2015/1/e7/ %U https://doi.org/10.2196/cancer.4389 %U http://www.ncbi.nlm.nih.gov/pubmed/28410158 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e70 %T Uptake and Acceptability of Information and Communication Technology in a Community-Based Cohort of People Who Inject Drugs: Implications for Mobile Health Interventions %A Genz,Andrew %A Kirk,Gregory %A Piggott,Damani %A Mehta,Shruti H %A Linas,Beth S %A Westergaard,Ryan P %+ Department of Medicine, University of Wisconsin-Madison, 1685 Highland Ave, MFCB 5220, Madison, WI, 53705, United States, 1 6082657927, rpw@medicine.wisc.edu %K substance abuse %K intravenous %K Internet %K cellular phone %K text messaging %K telemedicine %D 2015 %7 25.6.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile phone and Internet-based technologies are increasingly used to disseminate health information and facilitate delivery of medical care. While these strategies hold promise for reducing barriers to care for medically-underserved populations, their acceptability among marginalized populations such as people who inject drugs is not well-understood. Objective: To understand patterns of mobile phone ownership, Internet use and willingness to receive health information via mobile devices among people who inject drugs. Methods: We surveyed current and former drug injectors participating in a longitudinal cohort study in Baltimore, Maryland, USA. Respondents completed a 12-item, interviewer-administered questionnaire during a regular semi-annual study visit that assessed their use of mobile technology and preferred modalities of receiving health information. Using data from the parent study, we used logistic regression to evaluate associations among participants’ demographic and clinical characteristics and their mobile phone and Internet use. Results: The survey was completed by 845 individuals, who had a median age of 51 years. The sample was 89% African-American, 65% male, and 33% HIV-positive. Participants were generally of low education and income levels. Fewer than half of respondents (40%) indicated they had ever used the Internet. Mobile phones were used by 86% of respondents. Among mobile phone owners, 46% had used their phone for text messaging and 25% had accessed the Internet on their phone. A minority of respondents (42%) indicated they would be interested in receiving health information via phone or Internet. Of those receptive to receiving health information, a mobile phone call was the most favored modality (66%) followed by text messaging (58%) and Internet (51%). Conclusions: Utilization of information and communication technology among this cohort of people who inject drugs was reported at a lower level than what has been estimated for the general U.S. population. Our findings identify a potential barrier to successful implementation of mobile health and Internet-based interventions for people who inject drugs, particularly those who are older and have lower levels of income and educational attainment. As mobile communication technology continues to expand, future studies should re-examine whether mHealth applications become more accessible and accepted by socioeconomically disadvantaged groups. %M 26111915 %R 10.2196/mhealth.3437 %U http://mhealth.jmir.org/2015/2/e70/ %U https://doi.org/10.2196/mhealth.3437 %U http://www.ncbi.nlm.nih.gov/pubmed/26111915 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e69 %T Targeting Parents for Childhood Weight Management: Development of a Theory-Driven and User-Centered Healthy Eating App %A Curtis,Kristina Elizabeth %A Lahiri,Sudakshina %A Brown,Katherine Elizabeth %+ The Institute of Digital Healthcare, Warwick Manufacturing Group, The University of Warwick, Coventry, Coventry, CV4 7AL, United Kingdom, 44 24 7615 1632, k.e.curtis@warwick.ac.uk %K child %K obesity %K health behaviour %K mHealth %K healthy eating %K evidenc-based %K theory %D 2015 %7 18.06.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The proliferation of health promotion apps along with mobile phones' array of features supporting health behavior change offers a new and innovative approach to childhood weight management. However, despite the critical role parents play in children’s weight related behaviors, few industry-led apps aimed at childhood weight management target parents. Furthermore, industry-led apps have been shown to lack a basis in behavior change theory and evidence. Equally important remains the issue of how to maximize users’ engagement with mobile health (mHealth) interventions where there is growing consensus that inputs from the commercial app industry and the target population should be an integral part of the development process. Objective: The aim of this study is to systematically design and develop a theory and evidence-driven, user-centered healthy eating app targeting parents for childhood weight management, and clearly document this for the research and app development community. Methods: The Behavior Change Wheel (BCW) framework, a theoretically-based approach for intervention development, along with a user-centered design (UCD) philosophy and collaboration with the commercial app industry, guided the development process. Current evidence, along with a series of 9 focus groups (total of 46 participants) comprised of family weight management case workers, parents with overweight and healthy weight children aged 5-11 years, and consultation with experts, provided data to inform the app development. Thematic analysis of focus groups helped to extract information related to relevant theoretical, user-centered, and technological components to underpin the design and development of the app. Results: Inputs from parents and experts working in the area of childhood weight management helped to identify the main target behavior: to help parents provide appropriate food portion sizes for their children. To achieve this target behavior, the behavioral diagnosis revealed the need for eliciting change in parents’ capability, motivation, and opportunity in 10-associated Theoretical Domains Framework (TDF) domains. Of the 9 possible intervention functions, 6 were selected to bring about this change which guided the selection of 21 behavior change techniques. Parents’ preferences for healthy eating app features revolved around four main themes (app features, time saving and convenience, aesthetics, and gamification) whereupon a criterion was applied to guide the selection on which preferences should be integrated into the design of the app. Collaboration with the app company helped to build on users’ preferences for elements of gamification such as points, quizzes, and levels to optimize user engagement. Feedback from parents on interactive mock-ups helped to inform the final development of the prototype app. Conclusions: Here, we fully explicate a systematic approach applied in the development of a family-oriented, healthy eating health promotion app grounded in theory and evidence, and balanced with users’ preferences to help maximize its engagement with the target population. %M 26088692 %R 10.2196/mhealth.3857 %U http://mhealth.jmir.org/2015/2/e69/ %U https://doi.org/10.2196/mhealth.3857 %U http://www.ncbi.nlm.nih.gov/pubmed/26088692 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e67 %T Feasibility and Acceptability of Smartphone-Based Ecological Momentary Assessment of Alcohol Use Among African American Men Who Have Sex With Men in Baltimore %A Yang,Cui %A Linas,Beth %A Kirk,Gregory %A Bollinger,Robert %A Chang,Larry %A Chander,Geetanjali %A Siconolfi,Daniel %A Braxton,Sharif %A Rudolph,Abby %A Latkin,Carl %+ Johns Hopkins School of Public Health, Department of Health, Behavior and Society, 2213 McElderry St. 2n FL, Baltimore, MD, 21205, United States, 1 4105025368, cyang29@jhu.edu %K ecological momentary assessment (EMA) %K alcohol use %K HIV %K African American %K men who have sex with men (MSM) %D 2015 %7 17.06.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Alcohol use is a risk factor for the acquisition of human immunodeficiency virus (HIV) among African American men who have sex with men (MSM). Mobile phone-based ecological momentary assessments (EMA) could minimize bias due to retrospective recall and thus provide a better understanding of the social and structural context of alcohol use and its relationship with HIV-related risk behaviors in this population as well as other highly stigmatized populations. Objective: We describe the study design and the implementation, feasibility, reactivity, and acceptability of an EMA study of alcohol use and HIV-related behaviors among African American MSM in Baltimore. Methods: Participants were recruited through flyers and word-of-mouth in Baltimore from September 2013 to November 2014. Each participant was loaned an Android smartphone and instructed to respond to multiple prompts from the mobile app for 4 weeks. Data were collected through (1) random prompts delivered three times daily assessing participants’ location, activity, mood, and social context, (2) daily prompts capturing drinking and sex events occurring in the past 24 hours, and (3) event-contingent responses collecting participants’ self-reported episodes of drinking. Results: A total of 16 participants enrolled in the study. The current analyses focused on 15 participants who completed at least 24 days of follow-up (mean follow-up time 29 days; range 24-35 days). Study participants (N=15) were a median 38 years of age (range 27-62 years) with low levels of income and educational attainment. Ten individuals self-reported living with HIV/AIDS, over half reported drinking alcohol at least 2-3 times a week, and a third reported binge drinking (ie, 6 or more drinks on one occasion) on a weekly basis. Based on the Alcohol Use Disorders Identification Test (AUDIT) score, nearly half were classified as hazardous drinkers (score 8-15) and a fifth were likely dependent (score ≥16). A total of 140 participant-initiated events were reported, and 75% of 1308 random prompts and 81% of 436 daily prompts delivered were answered. Of seven devices used during the study, five were reported lost by participants. We did not observe strong reactivity effects, and self-reported acceptability to study procedures was uniformly favorable. Conclusions: This study provides evidence to support the feasibility and acceptability of using EMA methods for collecting data on alcohol use among African American men who have sex with men living in urban settings. These data provide the basis for future studies of EMA-informed mHealth interventions to promote the reduction of substance use and HIV risk-taking behaviors among African American MSM living in urban settings. %M 26085078 %R 10.2196/mhealth.4344 %U http://mhealth.jmir.org/2015/2/e67/ %U https://doi.org/10.2196/mhealth.4344 %U http://www.ncbi.nlm.nih.gov/pubmed/26085078 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e66 %T Effectiveness of a mHealth Lifestyle Program With Telephone Support (TXT2BFiT) to Prevent Unhealthy Weight Gain in Young Adults: Randomized Controlled Trial %A Partridge,Stephanie R %A McGeechan,Kevin %A Hebden,Lana %A Balestracci,Kate %A Wong,Annette TY %A Denney-Wilson,Elizabeth %A Harris,Mark F %A Phongsavan,Philayrath %A Bauman,Adrian %A Allman-Farinelli,Margaret %+ School of Molecular Bioscience, Charles Perkins Centre, University of Sydney, Level 4 East, Charles Perkins Centre, Sydney, 2006, Australia, 61 2 9036 7045, margaret.allman-farinelli@sydney.edu.au %K young adults %K weight gain prevention %K lifestyle behavior %K mHealth %D 2015 %7 15.06.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Weight gained in young adulthood often persists throughout later life with associated chronic disease risk. Despite this, current population prevention strategies are not specifically designed for young adults. Objective: We designed and assessed the efficacy of an mHealth prevention program, TXT2BFiT, in preventing excess weight gain and improving dietary and physical activity behaviors in young adults at increased risk of obesity and unhealthy lifestyle choices. Methods: A two-arm, parallel-group randomized controlled trial was conducted. Subjects and analyzing researchers were blinded. A total of 250 18- to 35-year-olds with a high risk of weight gain, a body mass index (BMI) of 23.0 to 24.9 kg/m2 with at least 2 kg of weight gain in the previous 12 months, or a BMI of 25.0 to 31.9 kg/m2 were randomized to the intervention or control group. In the 12-week intervention period, the intervention group received 8 text messages weekly based on the transtheoretical model of behavior change, 1 email weekly, 5 personalized coaching calls, a diet booklet, and access to resources and mobile phone apps on a website. Control group participants received only 4 text messages and printed dietary and physical activity guidelines. Measured body weight and height were collected at baseline and at 12 weeks. Outcomes were assessed via online surveys at baseline and at 12 weeks, including self-reported weight and dietary and physical activity measures. Results: A total of 214 participants—110 intervention and 104 control—completed the 12-week intervention period. A total of 10 participants out of 250 (4.0%)—10 intervention and 0 control—dropped out, and 26 participants (10.4%)—5 intervention and 21 control—did not complete postintervention online surveys. Adherence to coaching calls and delivery of text messages was over 90%. At 12 weeks, the intervention group were 2.2 kg (95% CI 0.8-3.6) lighter than controls (P=.005). Intervention participants consumed more vegetables (P=.009), fewer sugary soft drinks (P=.002), and fewer energy-dense takeout meals (P=.001) compared to controls. They also increased their total physical activity by 252.5 MET-minutes (95% CI 1.2-503.8, P=.05) and total physical activity by 1.3 days (95% CI 0.5-2.2, P=.003) compared to controls. Conclusions: The TXT2BFiT low-intensity intervention was successful in preventing weight gain with modest weight loss and improvement in lifestyle behaviors among overweight young adults. The short-term success of the 12-week intervention period shows potential. Maintenance of the behavior change will be monitored at 9 months. Trial Registration: Trial Registration: The Australian New Zealand Clinical Trials Registry ACTRN12612000924853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612000924853 (Archived by WebCite at http://www.webcitation.org/6Z6w9LlS9). %M 26076688 %R 10.2196/mhealth.4530 %U http://mhealth.jmir.org/2015/2/e66/ %U https://doi.org/10.2196/mhealth.4530 %U http://www.ncbi.nlm.nih.gov/pubmed/26076688 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 2 %P e70 %T Development of a Culturally Appropriate Bilingual Electronic App About Hepatitis B for Indigenous Australians: Towards Shared Understandings %A Davies,Jane %A Bukulatjpi,Sarah %A Sharma,Suresh %A Caldwell,Luci %A Johnston,Vanessa %A Davis,Joshua Saul %+ Menzies School of Health Research, Global and Tropical Health, Charles Darwin University, PO Box 41096, Casuarina, Darwin, 0811, Australia, 61 889468640, jane.davies@menzies.edu.au %K culture %K development %K health literacy %K hepatitis B %K indigenous population %K language %K portable electronic apps %D 2015 %7 10.06.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Hepatitis B is endemic in Indigenous communities in Northern Australia; however, there is a lack of culturally appropriate educational tools. Health care workers and educators in this setting have voiced a desire for visual, interactive tools in local languages. Mobile phones are increasingly used and available in remote Indigenous communities. In this context, we identified the need for a tablet-based health education app about hepatitis B, developed in partnership with an Australian remote Indigenous community. Objective: To develop a culturally appropriate bilingual app about hepatitis B for Indigenous Australians in Arnhem Land using a participatory action research (PAR) framework. Methods: This project was a partnership between the Menzies School of Health Research, Miwatj Aboriginal Health Corporation, Royal Darwin Hospital Liver Clinic, and Dreamedia Darwin. We have previously published a qualitative study that identified major knowledge gaps about hepatitis B in this community, and suggested that a tablet-based app would be an appropriate and popular tool to improve this knowledge. The process of developing the app was based on PAR principles, particularly ongoing consultation, evaluation, and discussion with the community throughout each iterative cycle. Stages included development of the storyboard, the translation process (forward translation and backtranslation), prelaunch community review, launch and initial community evaluation, and finally, wider launch and evaluation at a viral hepatitis conference. Results: We produced an app called “Hep B Story” for use with iPad, iPhone, Android tablets, and mobile phones or personal computers. The app is culturally appropriate, audiovisual, interactive, and users can choose either English or Yolŋu Matha (the most common language in East Arnhem Land) as their preferred language. The initial evaluation demonstrated a statistically significant improvement in Hep B-related knowledge for 2 of 3 questions (P=.01 and .02, respectively) and overwhelmingly positive opinion regarding acceptability and ease of use (median rating of 5, on a 5-point Likert-type scale when users were asked if they would recommend the app to others). Conclusions: We describe the process of development of a bilingual hepatitis B-specific app for Indigenous Australians, using a PAR framework. The approach was found to be successful with positive evaluations. %M 26063474 %R 10.2196/resprot.4216 %U http://www.researchprotocols.org/2015/2/e70/ %U https://doi.org/10.2196/resprot.4216 %U http://www.ncbi.nlm.nih.gov/pubmed/26063474 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e63 %T Cartographic Analysis of Antennas and Towers: A Novel Approach to Improving the Implementation and Data Transmission of mHealth Tools on Mobile Networks %A Brown III,William %A Ibitoye,Mobolaji %A Bakken,Suzanne %A Schnall,Rebecca %A Balán,Iván %A Frasca,Timothy %A Carballo-Diéguez,Alex %+ HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, HIV Center, Unit 15, 1051 Riverside Drive, New York, NY, , United States, 1 646 774 6963, wb2253@columbia.edu %K cartographic analysis %K mHealth %K mobile health %K antenna %K short message service %K text messaging %K SMS %K wireless %K HIV %D 2015 %7 04.06.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Most mHealth tools such as short message service (SMS), mobile apps, wireless pill counters, and ingestible wireless monitors use mobile antennas to communicate. Limited signal availability, often due to poor antenna infrastructure, negatively impacts the implementation of mHealth tools and remote data collection. Assessing the antenna infrastructure prior to starting a study can help mitigate this problem. Currently, there are no studies that detail whether and how the antenna infrastructure of a study site or area is assessed. Objective: To address this literature gap, we analyze and discuss the use of a cartographic analysis of antennas and towers (CAAT) for mobile communications for geographically assessing mobile antenna and tower infrastructure and identifying signal availability for mobile devices prior to the implementation of an SMS-based mHealth pilot study. Methods: An alpha test of the SMS system was performed using 11 site staff. A CAAT for the study area’s mobile network was performed after the alpha test and pre-implementation of the pilot study. The pilot study used a convenience sample of 11 high-risk men who have sex with men who were given human immunodeficiency virus test kits for testing nonmonogamous sexual partners before intercourse. Product use and sexual behavior were tracked through SMS. Message frequency analyses were performed on the SMS text messages, and SMS sent/received frequencies of 11 staff and 11 pilot study participants were compared. Results: The CAAT helped us to successfully identify strengths and weaknesses in mobile service capacity within a 3-mile radius from the epicenters of four New York City boroughs. During the alpha test, before CAAT, 1176/1202 (97.84%) text messages were sent to staff, of which 26/1176 (2.21%) failed. After the CAAT, 2934 messages were sent to pilot study participants and none failed. Conclusions: The CAAT effectively illustrated the research area’s mobile infrastructure and signal availability, which allowed us to improve study setup and sent message success rates. The SMS messages were sent and received with a lower fail rate than those reported in previous studies. %M 26043766 %R 10.2196/mhealth.3941 %U http://mhealth.jmir.org/2015/2/e63/ %U https://doi.org/10.2196/mhealth.3941 %U http://www.ncbi.nlm.nih.gov/pubmed/26043766 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 2 %P e67 %T Feasibility of a Dynamic Web Guidance Approach for Personalized Physical Activity Prescription Based on Daily Information From Wearable Technology %A Coolbaugh,Crystal L %A Raymond Jr,Stephen C %A Hawkins,David A %+ University of California - Davis, Department of Neurobiology, Physiology and Behavior, Room 196 Briggs Hall, One Shields Avenue, Davis, CA, 95616, United States, 1 530 752 2748, dahawkins@ucdavis.edu %K exercise %K Web-based interventions %K activity monitoring %K physical fitness %K algorithms %D 2015 %7 04.06.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Computer tailored, Web-based interventions have emerged as an effective approach to promote physical activity. Existing programs, however, do not adjust activities according to the participant’s compliance or physiologic adaptations, which may increase risk of injury and program attrition in sedentary adults. To address this limitation, objective activity monitor (AM) and heart rate data could be used to guide personalization of physical activity, but improved Web-based frameworks are needed to test such interventions. Objective: The objective of this study is to (1) develop a personalized physical activity prescription (PPAP) app that combines dynamic Web-based guidance with multi-sensor AM data to promote physical activity and (2) to assess the feasibility of using this system in the field. Methods: The PPAP app was constructed using an open-source software platform and a custom, multi-sensor AM capable of accurately measuring heart rate and physical activity. A novel algorithm was written to use a participant’s compliance and physiologic response to aerobic training (ie, changes in daily resting heart rate) recorded by the AM to create daily, personalized physical activity prescriptions. In addition, the PPAP app was designed to (1) manage the transfer of files from the AM to data processing software and a relational database, (2) provide interactive visualization features such as calendars and training tables to encourage physical activity, and (3) enable remote administrative monitoring of data quality and participant compliance. A 12-week feasibility study was performed to assess the utility and limitations of the PPAP app used by sedentary adults in the field. Changes in physical activity level and resting heart rate were monitored throughout the intervention. Results: The PPAP app successfully created daily, personalized physical activity prescriptions and an interactive Web environment to guide and promote physical activity by the participants. The varied compliance of the participants enabled evaluation of administrative features of the app including the generation of automated email reminders, participation surveys, and daily AM file upload logs. Conclusions: This study describes the development of the PPAP app, a closed-loop technology framework that enables personalized physical activity prescription and remote monitoring of an individual’s compliance and health response to the intervention. Data obtained during a 12-week feasibility study demonstrated the ability of the PPAP app to use objective AM data to create daily, personalized physical activity guidance, provide interactive feedback to users, and enable remote administrative monitoring of data quality and subject compliance. Using this approach, public health professionals, clinicians, and researchers can adapt the PPAP app to facilitate a range of personalized physical activity interventions to improve health outcomes, assess injury risk, and achieve fitness performance goals in diverse populations. %M 26043793 %R 10.2196/resprot.3966 %U http://www.researchprotocols.org/2015/2/e67/ %U https://doi.org/10.2196/resprot.3966 %U http://www.ncbi.nlm.nih.gov/pubmed/26043793 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e47 %T How Willing Are Adolescents to Record Their Dietary Intake? The Mobile Food Record %A Boushey,Carol Jo %A Harray,Amelia J %A Kerr,Deborah Anne %A Schap,TusaRebecca E %A Paterson,Stacey %A Aflague,Tanisha %A Bosch Ruiz,Marc %A Ahmad,Ziad %A Delp,Edward J %+ University of Hawaii Cancer Center, University of Hawaii, 701 Ilalo Street,, Room 525,, Honolulu, HI, 96813, United States, 1 808 564 5915, cjboushey@cc.hawaii.edu %K adolescents %K children %K dietary assessment %K mobile food record %K novel technology %D 2015 %7 29.05.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Accurately assessing the diets of children and adolescents can be problematic. Use of technologies, such as mobile apps designed to capture food and beverages consumed at eating occasions with images taken using device-embedded cameras, may address many of the barriers to gathering accurate dietary intake data from adolescents. Objective: The objectives of this study were to assess the willingness of adolescents to take images of food and beverages at their eating occasions using a novel mobile food record (mFR) and to evaluate the usability of the user confirmation component of the mFR app, referred to as the “review process.” Methods: Mixed methods combining quantitative and qualitative protocols were used in this study. Adolescents (11-15-year olds) attending a summer camp were recruited to participate in the study. First, the participants were asked to take images of foods and beverages consumed as meals and snacks for 2 consecutive days using the mFR app running on an iPhone and the number of images taken was noted. This was followed by focus group sessions to evaluate usability, which was analyzed by content and themes. After using the mFR, a think-aloud method was used to evaluate the usability of the mFR method for reviewing system-identified foods (ie, the review process). A usability questionnaire was administered at the end of all activities. Results: The mFR was accepted by the majority of the 24 boys and 17 girls (n=41) but varied according to gender and eating occasion. Girls were significantly more likely than boys to capture images of their eating occasions (Fisher exact test, P=.03). Participants were more likely to take images of their breakfasts (90%, 36/40) and lunches (90%, 72/80) and least likely to capture afternoon and evening snacks, 54% (43/80) and 40% (32/80), respectively. The major themes from the focus groups with regard to using the mFR were games, rewards, and the need to know more about why they were using the app. Results of the usability questionnaire indicated that including a game component would be important to increase willingness to use the mFR, and a high majority of the participants indicated a willingness to use the mFR for 7 days or more. The image review process was found to be easy to use except for some confusion with overlapping markers on the screen. Conclusions: The adolescents’ experiences with and feedback about the mFR highlighted the importance of increased training, reminders, entertainment (eg, games), and training with practice in using the device to capture complete dietary intake as part of their active lifestyles. %M 26024996 %R 10.2196/mhealth.4087 %U http://mhealth.jmir.org/2015/2/e47/ %U https://doi.org/10.2196/mhealth.4087 %U http://www.ncbi.nlm.nih.gov/pubmed/26024996 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e43 %T Public Health Guidelines for Physical Activity: Is There an App for That? A Review of Android and Apple App Stores %A Knight,Emily %A Stuckey,Melanie I %A Prapavessis,Harry %A Petrella,Robert J %+ University of Western Ontario, Centre for Studies in Family Medicine, 1151 Richmond Street, Rm 2117, London, ON, N6A 3K7, Canada, 1 519 933 8455, petrella@uwo.ca %K Mobile applications %K Exercise %K Public Health %D 2015 %7 21.05.2015 %9 Review %J JMIR mHealth uHealth %G English %X Background: Physical activity participation is an important behavior for modifying lifestyle-related disease risk. Mobile health apps for chronic disease management and prevention are being developed at a rapid rate. However, it is unclear whether these apps are evidence-based. Current public health recommendations for physical activity participation for adults highlight the importance of engaging in 150 minutes weekly of purposeful exercise, and muscle strengthening activities on at least 2 days of the week. Objective: The aims of the present review were to (1) identify available evidence-based physical activity apps, and (2) identify technological features that could be leveraged to improve health outcomes. Methods: iTunes and Google Play mobile app stores were searched using keyword and category searching during a single day (February 18, 2014) for physical activity apps available in English. The description pages of eligible apps were reviewed by 4 independent reviewers for evidence-based content, technological, and descriptive features. An a priori subset of apps was downloaded for further review (n=6 affiliated with a non-commercial agency; n=10 top rated; n=10 random selection), and developers were contacted for information regarding evidence-informed content. Results: The initial search yielded 2400 apps, of which 379 apps (n=206 iTunes; n=173 Google Play) were eligible. Primary results demonstrated no apps (n=0) adhering to evidence-based guidelines for aerobic physical activity, and 7 out of 379 implementing evidence-based guidelines for resistance training physical activity. Technological features of apps included social networking (n=207), pairing with a peripheral health device (n=61), and measuring additional health parameters (n=139). Secondary results revealed 1 app that referenced physical activity guidelines (150 minutes/weekly of exercise), and demonstrated that apps were based on various physical activity reports (n=4) or personal expertise (n=2). Conclusions: The present study demonstrated a shortage of evidence-based physical activity apps. This gap underscores the need for development of evidence-informed mobile apps. Results highlight the opportunity to develop evidence-informed mobile apps that can be used clinically to enhance health outcomes. %M 25998158 %R 10.2196/mhealth.4003 %U http://mhealth.jmir.org/2015/2/e43/ %U https://doi.org/10.2196/mhealth.4003 %U http://www.ncbi.nlm.nih.gov/pubmed/25998158 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e41 %T What Overweight Women Want From a Weight Loss App: A Qualitative Study on Arabic Women %A Alnasser,Aroub Abdulaziz %A Alkhalifa,Abdulrahman Saleh %A Sathiaseelan,Arjuna %A Marais,Debbi %+ King Saud University, Food Science and Nutrition, PO Box 86683, Riyadh, 11632, Saudi Arabia, 966 114556208, aroub@ksu.edu.sa %K weight loss %K focus groups %K smartphone %K mobile apps %K Arabic %K qualitative research %D 2015 %7 20.05.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Overweight and obesity are international public health issues. With mobile and app use growing globally, the development of weight loss apps are increasing along with evidence that interventions using technology have been effective in the treatment of obesity. Although studies have been conducted regarding what content health professionals would recommend within weight loss apps, there are limited studies that explore users’ viewpoints. There is specifically a paucity of research that takes the cultural background of the user into consideration, especially in Middle Eastern countries where the lives and weight loss intervention needs of women not only vary vastly from the West, but the obesity rate is also increasing exponentially. Objective: The current study sought to explore the proposed features of an Arabic weight loss app by seeking the experiences and opinions of overweight and obese Saudi Arabian users in order to design a mobile phone app to fit their needs. Methods: Focus group discussions were conducted with a purposive sample of volunteer overweight and obese Saudi women (BMI ≥ 25) who were older than 18 years and who owned a mobile phone. The most common Arabic and English weight loss mobile apps were downloaded to initiate dialogue about app usage and to get their opinions on what an ideal weight loss app would look like and the features it would include. All transcribed, translated discussions were thematically analyzed, categorized for each of the main topics of the discussion, and specific quotations were identified. Results: Four focus groups were conducted with a total of 39 participants. Most participants owned an Android mobile phone and only a few participants were aware of the availability of health-related apps. Barriers to weight loss were identified including: motivation, support (social and professional), boring diets, customs, and lifestyle. Diverse themes emerged as suggestions for an ideal weight loss app including: Arabic language and culturally sensitive; motivational support and social networking; dietary and physical activity tools; and a tailorable, user-friendly interface. Conclusions: This study identifies weight loss app features from the users’ perspective, which should be considered in the development of a weight loss app for this population. %M 25993907 %R 10.2196/mhealth.4409 %U http://mhealth.jmir.org/2015/2/e41/ %U https://doi.org/10.2196/mhealth.4409 %U http://www.ncbi.nlm.nih.gov/pubmed/25993907 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e42 %T Automated Personalized Feedback for Physical Activity and Dietary Behavior Change With Mobile Phones: A Randomized Controlled Trial on Adults %A Rabbi,Mashfiqui %A Pfammatter,Angela %A Zhang,Mi %A Spring,Bonnie %A Choudhury,Tanzeem %+ Cornell University, Department of Information Science, 219 Gates Hall, Ithaca, NY, 14850, United States, 1 6036671797, ms2749@cornell.edu %K mobile health %K mHealth %K mobile phone sensing %K smart systems %K context-aware systems %K physical activity %K self-management %K personal health care %K machine learning %K artificial intelligence %D 2015 %7 14.05.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: A dramatic rise in health-tracking apps for mobile phones has occurred recently. Rich user interfaces make manual logging of users’ behaviors easier and more pleasant, and sensors make tracking effortless. To date, however, feedback technologies have been limited to providing overall statistics, attractive visualization of tracked data, or simple tailoring based on age, gender, and overall calorie or activity information. There are a lack of systems that can perform automated translation of behavioral data into specific actionable suggestions that promote healthier lifestyle without any human involvement. Objective: MyBehavior, a mobile phone app, was designed to process tracked physical activity and eating behavior data in order to provide personalized, actionable, low-effort suggestions that are contextualized to the user’s environment and previous behavior. This study investigated the technical feasibility of implementing an automated feedback system, the impact of the suggestions on user physical activity and eating behavior, and user perceptions of the automatically generated suggestions. Methods: MyBehavior was designed to (1) use a combination of automatic and manual logging to track physical activity (eg, walking, running, gym), user location, and food, (2) automatically analyze activity and food logs to identify frequent and nonfrequent behaviors, and (3) use a standard machine-learning, decision-making algorithm, called multi-armed bandit (MAB), to generate personalized suggestions that ask users to either continue, avoid, or make small changes to existing behaviors to help users reach behavioral goals. We enrolled 17 participants, all motivated to self-monitor and improve their fitness, in a pilot study of MyBehavior. In a randomized two-group trial, investigators randomly assigned participants to receive either MyBehavior’s personalized suggestions (n=9) or nonpersonalized suggestions (n=8), created by professionals, from a mobile phone app over 3 weeks. Daily activity level and dietary intake was monitored from logged data. At the end of the study, an in-person survey was conducted that asked users to subjectively rate their intention to follow MyBehavior suggestions. Results: In qualitative daily diary, interview, and survey data, users reported MyBehavior suggestions to be highly actionable and stated that they intended to follow the suggestions. MyBehavior users walked significantly more than the control group over the 3 weeks of the study (P=.05). Although some MyBehavior users chose lower-calorie foods, the between-group difference was not significant (P=.15). In a poststudy survey, users rated MyBehavior’s personalized suggestions more positively than the nonpersonalized, generic suggestions created by professionals (P<.001). Conclusions: MyBehavior is a simple-to-use mobile phone app with preliminary evidence of efficacy. To the best of our knowledge, MyBehavior represents the first attempt to create personalized, contextualized, actionable suggestions automatically from self-tracked information (ie, manual food logging and automatic tracking of activity). Lessons learned about the difficulty of manual logging and usability concerns, as well as future directions, are discussed. Trial Registration: ClinicalTrials.gov NCT02359981; https://clinicaltrials.gov/ct2/show/NCT02359981 (Archived by WebCite at http://www.webcitation.org/6YCeoN8nv). %M 25977197 %R 10.2196/mhealth.4160 %U http://mhealth.jmir.org/2015/2/e42/ %U https://doi.org/10.2196/mhealth.4160 %U http://www.ncbi.nlm.nih.gov/pubmed/25977197 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 5 %P e118 %T Behavior Change Techniques in Popular Alcohol Reduction Apps: Content Analysis %A Crane,David %A Garnett,Claire %A Brown,James %A West,Robert %A Michie,Susan %+ Department of Clinical, Educational and Health Psychology, University College London, 1 -19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 20 7687 0723, david.crane.13@ucl.ac.uk %K alcohol %K behaviour change %K mHealth %K smartphone %K iPhone %K android %K apps %K digital %K intervention %D 2015 %7 14.05.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile phone apps have the potential to reduce excessive alcohol consumption cost-effectively. Although hundreds of alcohol-related apps are available, there is little information about the behavior change techniques (BCTs) they contain, or the extent to which they are based on evidence or theory and how this relates to their popularity and user ratings. Objective: Our aim was to assess the proportion of popular alcohol-related apps available in the United Kingdom that focus on alcohol reduction, identify the BCTs they contain, and explore whether BCTs or the mention of theory or evidence is associated with app popularity and user ratings. Methods: We searched the iTunes and Google Play stores with the terms “alcohol” and “drink”, and the first 800 results were classified into alcohol reduction, entertainment, or blood alcohol content measurement. Of those classified as alcohol reduction, all free apps and the top 10 paid apps were coded for BCTs and for reference to evidence or theory. Measures of popularity and user ratings were extracted. Results: Of the 800 apps identified, 662 were unique. Of these, 13.7% (91/662) were classified as alcohol reduction (95% CI 11.3-16.6), 53.9% (357/662) entertainment (95% CI 50.1-57.7), 18.9% (125/662) blood alcohol content measurement (95% CI 16.1-22.0) and 13.4% (89/662) other (95% CI 11.1-16.3). The 51 free alcohol reduction apps and the top 10 paid apps contained a mean of 3.6 BCTs (SD 3.4), with approximately 12% (7/61) not including any BCTs. The BCTs used most often were “facilitate self-recording” (54%, 33/61), “provide information on consequences of excessive alcohol use and drinking cessation” (43%, 26/61), “provide feedback on performance” (41%, 25/61), “give options for additional and later support” (25%, 15/61) and “offer/direct towards appropriate written materials” (23%, 14/61). These apps also rarely included any of the 22 BCTs frequently used in other health behavior change interventions (mean 2.46, SD 2.06). Evidence was mentioned by 16.4% of apps, and theory was not mentioned by any app. Multivariable regression showed that apps including advice on environmental restructuring were associated with lower user ratings (Β=-46.61, P=.04, 95% CI -91.77 to -1.45) and that both the techniques of “advise on/facilitate the use of social support” (Β=2549.21, P=.04, 95% CI 96.75-5001.67) and the mention of evidence (Β=1376.74, P=.02, 95%, CI 208.62-2544.86) were associated with the popularity of the app. Conclusions: Only a minority of alcohol-related apps promoted health while the majority implicitly or explicitly promoted the use of alcohol. Alcohol-related apps that promoted health contained few BCTs and none referred to theory. The mention of evidence was associated with more popular apps, but popularity and user ratings were only weakly associated with the BCT content. %M 25977135 %R 10.2196/jmir.4060 %U http://www.jmir.org/2015/5/e118/ %U https://doi.org/10.2196/jmir.4060 %U http://www.ncbi.nlm.nih.gov/pubmed/25977135 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 2 %P e51 %T Bilingual Text Messaging Translation: Translating Text Messages From English Into Spanish for the Text4Walking Program %A Buchholz,Susan Weber %A Sandi,Giselle %A Ingram,Diana %A Welch,Mary Jane %A Ocampo,Edith V %+ Rush University, College of Nursing, 600 S Paulina Street AAC 1080, Chicago, IL, 60612, United States, 1 312 563 3590, susan_buchholz@rush.edu %K text messaging %K mobile phone %K translating %K language %K focus groups %K exercise %D 2015 %7 06.05.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Hispanic adults in the United States are at particular risk for diabetes and inadequate blood pressure control. Physical activity improves these health problems; however Hispanic adults also have a low rate of recommended aerobic physical activity. To address improving physical inactivity, one area of rapidly growing technology that can be utilized is text messaging (short message service, SMS). A physical activity research team, Text4Walking, had previously developed an initial database of motivational physical activity text messages in English that could be used for physical activity text messaging interventions. However, the team needed to translate these existing English physical activity text messages into Spanish in order to have culturally meaningful and useful text messages for those adults within the Hispanic population who would prefer to receive text messages in Spanish. Objective: The aim of this study was to translate a database of English motivational physical activity messages into Spanish and review these text messages with a group of Spanish speaking adults to inform the use of these text messages in an intervention study. Methods: The consent form and study documents, including the existing English physical activity text messages, were translated from English into Spanish, and received translation certification as well as Institutional Review Board approval. The translated text messages were placed into PowerPoint, accompanied by a set of culturally appropriate photos depicting barriers to walking, as well as walking scenarios. At the focus group, eligibility criteria for this study included being an adult between 30 to 65 years old who spoke Spanish as their primary language. After a general group introduction, participants were placed into smaller groups of two or three. Each small group was asked to review a segment of the translated text messages for accuracy and meaningfulness. After the break out, the group was brought back together to review the text messages. Results: A translation confirmation group met at a church site in an urban community with a large population of Hispanics. Spanish speaking adults (N=8), with a mean age of 40 (SD 6.3), participated in the study. Participants were engaged in the group and viewed the text messages as culturally appropriate. They also thought that text messages could motivate them to walk more. Twenty-two new text messages were added to the original database of 246 translated text messages. While the text messages were generally understood, specific word preferences were seen related to personal preference, dialect, and level of formality which resulted in minor revisions to four text messages. Conclusions: The English text messages were successfully translated into Spanish by a bilingual research staff and reviewed by Hispanic participants in order to inform the use of these text messages for future intervention studies. These Spanish text messages were recently used in a Text4Walking intervention study. %M 25947953 %R 10.2196/resprot.3984 %U http://www.researchprotocols.org/2015/2/e51/ %U https://doi.org/10.2196/resprot.3984 %U http://www.ncbi.nlm.nih.gov/pubmed/25947953 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e36 %T Validation of Physical Activity Tracking via Android Smartphones Compared to ActiGraph Accelerometer: Laboratory-Based and Free-Living Validation Studies %A Hekler,Eric B %A Buman,Matthew P %A Grieco,Lauren %A Rosenberger,Mary %A Winter,Sandra J %A Haskell,William %A King,Abby C %+ Arizona State University, School of Nutrition and Health Promotion, 500 N. 3rd St., Phoenix, AZ, 85003, United States, 1 6028272271, ehekler@asu.edu %K telemedicine %K cell phones %K accelerometry %K motor activity %K validation studies %D 2015 %7 15.04.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: There is increasing interest in using smartphones as stand-alone physical activity monitors via their built-in accelerometers, but there is presently limited data on the validity of this approach. Objective: The purpose of this work was to determine the validity and reliability of 3 Android smartphones for measuring physical activity among midlife and older adults. Methods: A laboratory (study 1) and a free-living (study 2) protocol were conducted. In study 1, individuals engaged in prescribed activities including sedentary (eg, sitting), light (sweeping), moderate (eg, walking 3 mph on a treadmill), and vigorous (eg, jogging 5 mph on a treadmill) activity over a 2-hour period wearing both an ActiGraph and 3 Android smartphones (ie, HTC MyTouch, Google Nexus One, and Motorola Cliq). In the free-living study, individuals engaged in usual daily activities over 7 days while wearing an Android smartphone (Google Nexus One) and an ActiGraph. Results: Study 1 included 15 participants (age: mean 55.5, SD 6.6 years; women: 56%, 8/15). Correlations between the ActiGraph and the 3 phones were strong to very strong (ρ=.77-.82). Further, after excluding bicycling and standing, cut-point derived classifications of activities yielded a high percentage of activities classified correctly according to intensity level (eg, 78%-91% by phone) that were similar to the ActiGraph’s percent correctly classified (ie, 91%). Study 2 included 23 participants (age: mean 57.0, SD 6.4 years; women: 74%, 17/23). Within the free-living context, results suggested a moderate correlation (ie, ρ=.59, P<.001) between the raw ActiGraph counts/minute and the phone’s raw counts/minute and a strong correlation on minutes of moderate-to-vigorous physical activity (MVPA; ie, ρ=.67, P<.001). Results from Bland-Altman plots suggested close mean absolute estimates of sedentary (mean difference=–26 min/day of sedentary behavior) and MVPA (mean difference=–1.3 min/day of MVPA) although there was large variation. Conclusions: Overall, results suggest that an Android smartphone can provide comparable estimates of physical activity to an ActiGraph in both a laboratory-based and free-living context for estimating sedentary and MVPA and that different Android smartphones may reliably confer similar estimates. %M 25881662 %R 10.2196/mhealth.3505 %U http://mhealth.jmir.org/2015/2/e36/ %U https://doi.org/10.2196/mhealth.3505 %U http://www.ncbi.nlm.nih.gov/pubmed/25881662 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e28 %T mHealthApps: A Repository and Database of Mobile Health Apps %A Xu,Wenlong %A Liu,Yin %+ Department of Neurobiology and Anatomy, University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, , United States, 1 713 500 5632, yin.liu@uth.tmc.edu %K mobile healtlh %K app repository %K app database %D 2015 %7 18.03.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The market of mobile health (mHealth) apps has rapidly evolved in the past decade. With more than 100,000 mHealth apps currently available, there is no centralized resource that collects information on these health-related apps for researchers in this field to effectively evaluate the strength and weakness of these apps. Objective: The objective of this study was to create a centralized mHealth app repository. We expect the analysis of information in this repository to provide insights for future mHealth research developments. Methods: We focused on apps from the two most established app stores, the Apple App Store and the Google Play Store. We extracted detailed information of each health-related app from these two app stores via our python crawling program, and then stored the information in both a user-friendly array format and a standard JavaScript Object Notation (JSON) format. Results: We have developed a centralized resource that provides detailed information of more than 60,000 health-related apps from the Apple App Store and the Google Play Store. Using this information resource, we analyzed thousands of apps systematically and provide an overview of the trends for mHealth apps. Conclusions: This unique database allows the meta-analysis of health-related apps and provides guidance for research designs of future apps in the mHealth field. %M 25786060 %R 10.2196/mhealth.4026 %U http://mhealth.jmir.org/2015/1/e28/ %U https://doi.org/10.2196/mhealth.4026 %U http://www.ncbi.nlm.nih.gov/pubmed/25786060 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e30 %T A Mobile Phone Food Record App to Digitally Capture Dietary Intake for Adolescents in a Free-Living Environment: Usability Study %A Casperson,Shanon L %A Sieling,Jared %A Moon,Jon %A Johnson,LuAnn %A Roemmich,James N %A Whigham,Leah %+ Grand Forks Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, 2420 2nd Ave N., Grand Forks, ND, , United States, 1 701 795 8497, shanon.casperson@ars.usda.gov %K adolescents %K dietary food records %K smartphone app %K dietary assessment %K food record app %D 2015 %7 13.03.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile technologies are emerging as valuable tools to collect and assess dietary intake. Adolescents readily accept and adopt new technologies; thus, a food record app (FRapp) may be a useful tool to better understand adolescents’ dietary intake and eating patterns. Objective: We sought to determine the amenability of adolescents, in a free-living environment with minimal parental input, to use the FRapp to record their dietary intake. Methods: Eighteen community-dwelling adolescents (11-14 years) received detailed instructions to record their dietary intake for 3-7 days using the FRapp. Participants were instructed to capture before and after images of all foods and beverages consumed and to include a fiducial marker in the image. Participants were also asked to provide text descriptors including amount and type of all foods and beverages consumed. Results: Eight of 18 participants were able to follow all instructions: included pre- and post-meal images, a fiducial marker, and a text descriptor and collected diet records on 2 weekdays and 1 weekend day. Dietary intake was recorded on average for 3.2 (SD 1.3 days; 68% weekdays and 32% weekend days) with an average of 2.2 (SD 1.1) eating events per day per participant. A total of 143 eating events were recorded, of which 109 had at least one associated image and 34 were recorded with text only. Of the 109 eating events with images, 66 included all foods, beverages and a fiducial marker and 44 included both a pre- and post-meal image. Text was included with 78 of the captured images. Of the meals recorded, 36, 33, 35, and 39 were breakfasts, lunches, dinners, and snacks, respectively. Conclusions: These data suggest that mobile devices equipped with an app to record dietary intake will be used by adolescents in a free-living environment; however, a minority of participants followed all directions. User-friendly mobile food record apps may increase participant amenability, increasing our understanding of adolescent dietary intake and eating patterns. To improve data collection, the FRapp should deliver prompts for tasks, such as capturing images before and after each eating event, including the fiducial marker in the image, providing complete and accurate text information, and ensuring all eating events are recorded and should be customizable to individuals and to different situations. Trial Registration: Clinicaltrials.gov NCT01803997. http://clinicaltrials.gov/ct2/show/NCT01803997 (Archived at: http://www.webcitation.org/6WiV1vxoR). %M 25775506 %R 10.2196/mhealth.3324 %U http://mhealth.jmir.org/2015/1/e30/ %U https://doi.org/10.2196/mhealth.3324 %U http://www.ncbi.nlm.nih.gov/pubmed/25775506 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 3 %P e56 %T The Impact of a Web-Based App (eBalance) in Promoting Healthy Lifestyles: Randomized Controlled Trial %A Safran Naimark,Jenny %A Madar,Zecharia %A R Shahar,Danit %+ Robert H. Smith Faculty of Agriculture, Food and Environment, Hebrew University of Jerusalem, POBox 12, Rehovot, 76100, Israel, 972 524788559, jennynaimark@gmail.com %K Web-based %K healthy lifestyle %K mobile apps %K mhealth %D 2015 %7 02.03.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of Web-based apps to promote a healthy lifestyle is increasing, although most of these programs were not assessed using suitable epidemiological methods. We evaluated the effectiveness of a newly developed Web-based app in promoting a healthy lifestyle and educating adults on such lifestyles. We also analyzed predictors for success in acquiring and maintaining a healthy lifestyle. Objective: Our aim was to compare people receiving a new Web-based app with people who got an introductory lecture alone on healthy lifestyle, weight change, nutritional knowledge, and physical activity, and to identify predictors of success for maintaining a healthy lifestyle. Methods: Subjects were recruited from the community and were randomized into intervention and control groups. The intervention subjects received access to the app without any face-to-face support; the control subjects continued their standard lifestyle. Measurements were taken by the researcher at baseline and after 14 weeks and included weight and waist circumference. Nutritional knowledge, diet quality, and physical activity duration were obtained using online questionnaires. The new Web-based app was developed based on current US Department of Agriculture and Israel Ministry of Health recommendations for healthy lifestyle. The app provides tools for monitoring diet and physical activity while instructing and encouraging healthy diet and physical activity. Results: Out of 99 subjects who were randomized into app and control groups, 85 participants (86%) completed the study, 56 in the intervention and 29 in the control group. The mean age was 47.9 (SD 12.3) years, and mean Body Mass Index was 26.2 (SD 3.9). Among the intervention group only, frequency of app use was 2.7 (SD 1.9) days/week. The mean change in physical activity was 63 (SD 20.8) minutes in the app group and -30 (SD 27.5) minutes in the control group (P=.02). The mean weight change was -1.44 (SD 0.4) kg in the app group and -0.128 (SD 0.36) kg in the control group (P=.03). Knowledge score increased significantly in the app group, 76 (SD 7.5) to 79 (SD 8.7) at the end of the study (P=.04) compared with the control group. Diet quality score also increased significantly at the end of the study, from 67 (SD 9.8) to 71 (SD 7.6; P<.001) in contrast to the control group. Success score (represents the success in maintaining healthy lifestyle) was higher among the app group (68%) compared with 36% in the control group (P<.001). The app frequency of use was significantly related to a higher success score (P<.001). Conclusions: We showed a positive impact of a newly developed Web-based app on lifestyle indicators during an intervention of 14 weeks. These results are promising in the app’s potential to promote a healthy lifestyle, although larger and longer duration studies are needed to achieve more definitive conclusions. Trial Registration: Clinicaltrial.gov number: NCT01913496; http://www.clinicaltrials.gov/ct2/show/NCT01913496 (Archived by WebCite at http://www.webcitation.org/6WSTUEPuJ). %M 25732936 %R 10.2196/jmir.3682 %U http://www.jmir.org/2015/3/e56/ %U https://doi.org/10.2196/jmir.3682 %U http://www.ncbi.nlm.nih.gov/pubmed/25732936 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e20 %T Behavioral Functionality of Mobile Apps in Health Interventions: A Systematic Review of the Literature %A Payne,Hannah E %A Lister,Cameron %A West,Joshua H %A Bernhardt,Jay M %+ Computational Health Science Research Group, Department of Health Science, Brigham Young University, 3024 LSB, Provo, UT, 84602, United States, 1 530 919 5100, hannahp413@gmail.com %K smartphone %K app %K health behavior %K systematic review %K interventions %D 2015 %7 26.02.2015 %9 Review %J JMIR mHealth uHealth %G English %X Background: Several thousand mobile phone apps are available to download to mobile phones for health and fitness. Mobile phones may provide a unique means of administering health interventions to populations. Objective: The purpose of this systematic review was to systematically search and describe the literature on mobile apps used in health behavior interventions, describe the behavioral features and focus of health apps, and to evaluate the potential of apps to disseminate health behavior interventions. Methods: We conducted a review of the literature in September 2014 using key search terms in several relevant scientific journal databases. Only English articles pertaining to health interventions using mobile phone apps were included in the final sample. Results: The 24 studies identified for this review were primarily feasibility and pilot studies of mobile apps with small sample sizes. All studies were informed by behavioral theories or strategies, with self-monitoring as the most common construct. Acceptability of mobile phone apps was high among mobile phone users. Conclusions: The lack of large sample studies using mobile phone apps may signal a need for additional studies on the potential use of mobile apps to assist individuals in changing their health behaviors. Of these studies, there is early evidence that apps are well received by users. Based on available research, mobile apps may be considered a feasible and acceptable means of administering health interventions, but a greater number of studies and more rigorous research and evaluations are needed to determine efficacy and establish evidence for best practices. %M 25803705 %R 10.2196/mhealth.3335 %U http://mhealth.jmir.org/2015/1/e20/ %U https://doi.org/10.2196/mhealth.3335 %U http://www.ncbi.nlm.nih.gov/pubmed/25803705 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e14 %T Effectiveness of 6 Months of Tailored Text Message Reminders for Obese Male Participants in a Worksite Weight Loss Program: Randomized Controlled Trial %A Kim,Ju-Young %A Oh,Sohee %A Steinhubl,Steven %A Kim,Sohye %A Bae,Woo Kyung %A Han,Jong Soo %A Kim,Jeong-Hyun %A Lee,Keehyuck %A Kim,Mi Jin %+ Department of Family Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon gil, Bundang-gu, Seongnam-si, 463-707, Republic Of Korea, 82 31 787 7796, kkamduri@snubh.org %K weight reduction program %K text messaging %K worksite %K health promotion %D 2015 %7 03.02.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Worksite nutrition and physical activity interventions are important to help overweight and obese employees lose weight, but costs and insufficient sustained motivation prevent the majority of these programs from succeeding. Tailored text messaging in aiding weight management has been effective in several studies, but no studies have evaluated the effect of a tailored text message service on weight loss in a worksite health promotion program. Objective: We studied the efficacy of a tailored text-messaging intervention for obese male participants in a worksite weight loss program of 6 months duration. Methods: The study was an unblinded, randomized controlled trial. Men with a body mass index greater than 25 kg/m2 were recruited from the Korea District Heating Corporation, the Korea Expressway Corporation, and the Korea Gas Corporation. The participants were identified by nurse managers. Participants were randomly allocated to 1 of the following 2 groups for 24 weeks: (1) intervention group, which received tailored text message reminders every other day plus 4 offline education sessions and brief counseling with monthly weight check by nurses for weight control over 6 months and (2) control group, which received the 4 offline education sessions and brief counseling with monthly weight check by nurses about weight control over 6 months. The primary outcome was the difference in weight loss at 6 months. A mixed-model repeated-measures analysis was performed to evaluate the effect of the intervention group’s weight loss compared with the control group. Results: A total of 205 obese men were randomized into either the intervention (n=104) or the control group (n=101). At the end of 6 months, the intervention group (n=63) had lost 1.71 kg (95% CI –2.53 to –0.88) and the control group (n=59) had lost 1.56 kg (95% CI –2.45 to –0.66); the difference between the 2 groups was not significant (mean difference –0.15, 95% CI –1.36 to 1.07). At the end of the study, 60% (34/57) of the intervention group rated the message program as helpful for weight control and 46% (26/57) would recommend the text message service to their friends. Conclusions: Tailored text message reminders did not have a significant effect on weight loss in obese men as part of a worksite weight loss program. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 39629189; http://www.isrctn.com/ISRCTN39629189?q=39629189&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search (Archived by WebCite at http://www.webcitation.org/6VsFkwJH6). %M 25648325 %R 10.2196/mhealth.3949 %U http://mhealth.jmir.org/2015/1/e14/ %U https://doi.org/10.2196/mhealth.3949 %U http://www.ncbi.nlm.nih.gov/pubmed/25648325 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 2 %P e33 %T Short-Term Trajectories of Use of a Caloric-Monitoring Mobile Phone App Among Patients With Type 2 Diabetes Mellitus in a Primary Care Setting %A Goh,Glenn %A Tan,Ngiap Chuan %A Malhotra,Rahul %A Padmanabhan,Uma %A Barbier,Sylvaine %A Allen Jr,John Carson %A Østbye,Truls %+ Duke Global Health Institute, 310 Trent Drive, Durham, NC, , United States, 1 919 660 0331, truls.ostbye@duke.edu %K type 2 diabetes mellitus %K self-management %K mobile phone %K mobile apps %K longitudinal studies %D 2015 %7 03.02.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Self-management plays an important role in maintaining good control of diabetes mellitus, and mobile phone interventions have been shown to improve such self-management. The Health Promotion Board of Singapore has created a caloric-monitoring mobile health app, the “interactive Diet and Activity Tracker” (iDAT). Objective: The objective was to identify and describe short-term (8-week) trajectories of use of the iDAT app among patients with type 2 diabetes mellitus in a primary care setting in Singapore, and identify patient characteristics associated with each trajectory. Methods: A total of 84 patients with type 2 diabetes mellitus from a public primary care clinic in Singapore who had not previously used the iDAT app were enrolled. The app was demonstrated and patients’ weekly use of the app was monitored over 8 weeks. Weekly use was defined as any record in terms of food entry or exercise workout entry in that week. Information on demographics, diet and exercise motivation, diabetes self-efficacy (Diabetes Empowerment Scale-Short Form), and clinical variables (body mass index, blood pressure, and glycosylated hemoglobin/HbA1c) were collected at baseline. iDAT app use trajectories were delineated using latent-class growth modeling (LCGM). Association of patient characteristics with the trajectories was ascertained using logistic regression analysis. Results: Three iDAT app use trajectories were observed: Minimal Users (66 out of 84 patients, 78.6%, with either no iDAT use at all or use only in the first 2 weeks), Intermittent-Waning Users (10 out of 84 patients, 11.9%, with occasional weekly use mainly in the first 4 weeks), and Consistent Users (8 out of 84 patients, 9.5%, with weekly use throughout all or most of the 8 weeks). The adjusted odds ratio of being a Consistent User, relative to a Minimal User, was significantly higher for females (OR 19.55, 95% CI 1.78-215.42) and for those with higher exercise motivation scores at baseline (OR 4.89, 95% CI 1.80-13.28). The adjusted odds ratio of being an Intermittent-Waning User relative to a Minimal User was also significantly higher for those with higher exercise motivation scores at baseline (OR 1.82, 95% CI 1.00-3.32). Conclusions: This study provides insight into the nature and extent of usage of a caloric-monitoring app among patients with type 2 diabetes and managed in primary care. The application of LCGM provides a useful framework for evaluating future app use in other patient populations. %M 25648130 %R 10.2196/jmir.3938 %U http://www.jmir.org/2015/2/e33/ %U https://doi.org/10.2196/jmir.3938 %U http://www.ncbi.nlm.nih.gov/pubmed/25648130 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e10 %T Quit4baby: Results From a Pilot Test of a Mobile Smoking Cessation Program for Pregnant Women %A Abroms,Lorien C %A Johnson,Pamela R %A Heminger,Christina L %A Van Alstyne,Judith M %A Leavitt,Leah E %A Schindler-Ruwisch,Jennifer M %A Bushar,Jessica A %+ Milken Institute School of Public Health, Prevention & Community Health, The George Washington University, 950 New Hampshire Avenue NW, 3rd floor, Washington, DC, 20052, United States, 1 202 994 3518, lorien@gwu.edu %K mobile health %K tobacco cessation %K pregnancy %K text messaging %D 2015 %7 23.01.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Text messaging (short message service, SMS) programs have been shown to be effective in helping adult smokers quit smoking. This study describes the results of a pilot test of Quit4baby, a smoking cessation text messaging program for pregnant smokers that was adapted from Text2quit. Objective: The study aimed to demonstrate the feasibility and acceptability of Quit4baby for women currently enrolled in Text4baby, a perinatal health text messaging program. Methods: Pregnant women enrolled in Text4baby and who were current smokers or had quit within the last 4 weeks (n=20) were enrolled in Quit4baby. Those under the age of 18, not pregnant, not current smokers, those using nicotine replacement therapy, and those not interested in participating were ineligible. Participants were surveyed at baseline and at 2 and 4 weeks postenrollment. Results: Most participants responded to the program favorably. Highly rated aspects included the content of the program, skills taught within the program, and encouragement and social support provided by the program. Participants reported that the program was helpful in quitting, that the program gave good ideas on quitting, and that they would recommend the program to a friend. Suggestions for improvement included increasing the message dose and making the quitpal more interactive. Conclusions: This pilot test provides support for the feasibility and acceptability of Quit4baby. Future studies are needed to assess whether Quit4baby is effective for smoking cessation during pregnancy. %M 25650765 %R 10.2196/mhealth.3846 %U http://mhealth.jmir.org/2015/1/e10/ %U https://doi.org/10.2196/mhealth.3846 %U http://www.ncbi.nlm.nih.gov/pubmed/25650765 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 1 %P e3 %T A Fully Automated Diabetes Prevention Program, Alive-PD: Program Design and Randomized Controlled Trial Protocol %A Block,Gladys %A Azar,Kristen MJ %A Block,Torin J %A Romanelli,Robert J %A Carpenter,Heather %A Hopkins,Donald %A Palaniappan,Latha %A Block,Clifford H %+ NutritionQuest, Inc., 15 Shattuck Square, Suite 288, Berkeley, CA, 94704, United States, 1 510 704 8514, gblock@berkeley.edu %K prediabetes %K insulin resistance %K diabetes %K prevention %K obesity %K physical activity %K internet %K world wide web %K blood glucose %K metabolic syndrome %D 2015 %7 21.01.2015 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the United States, 86 million adults have pre-diabetes. Evidence-based interventions that are both cost effective and widely scalable are needed to prevent diabetes. Objective: Our goal was to develop a fully automated diabetes prevention program and determine its effectiveness in a randomized controlled trial. Methods: Subjects with verified pre-diabetes were recruited to participate in a trial of the effectiveness of Alive-PD, a newly developed, 1-year, fully automated behavior change program delivered by email and Web. The program involves weekly tailored goal-setting, team-based and individual challenges, gamification, and other opportunities for interaction. An accompanying mobile phone app supports goal-setting and activity planning. For the trial, participants were randomized by computer algorithm to start the program immediately or after a 6-month delay. The primary outcome measures are change in HbA1c and fasting glucose from baseline to 6 months. The secondary outcome measures are change in HbA1c, glucose, lipids, body mass index (BMI), weight, waist circumference, and blood pressure at 3, 6, 9, and 12 months. Randomization and delivery of the intervention are independent of clinic staff, who are blinded to treatment assignment. Outcomes will be evaluated for the intention-to-treat and per-protocol populations. Results: A total of 340 subjects with pre-diabetes were randomized to the intervention (n=164) or delayed-entry control group (n=176). Baseline characteristics were as follows: mean age 55 (SD 8.9); mean BMI 31.1 (SD 4.3); male 68.5%; mean fasting glucose 109.9 (SD 8.4) mg/dL; and mean HbA1c 5.6 (SD 0.3)%. Data collection and analysis are in progress. We hypothesize that participants in the intervention group will achieve statistically significant reductions in fasting glucose and HbA1c as compared to the control group at 6 months post baseline. Conclusions: The randomized trial will provide rigorous evidence regarding the efficacy of this Web- and Internet-based program in reducing or preventing progression of glycemic markers and indirectly in preventing progression to diabetes. Trial Registration: ClinicalTrials.gov NCT01479062; http://clinicaltrials.gov/show/NCT01479062 (Archived by WebCite at http://www.webcitation.org/6U8ODy1vo). %M 25608692 %R 10.2196/resprot.4046 %U http://www.researchprotocols.org/2015/1/e3/ %U https://doi.org/10.2196/resprot.4046 %U http://www.ncbi.nlm.nih.gov/pubmed/25608692 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 1 %P e17 %T A Mobile App to Aid Smoking Cessation: Preliminary Evaluation of SmokeFree28 %A Ubhi,Harveen Kaur %A Michie,Susan %A Kotz,Daniel %A Wong,Wai Chi %A West,Robert %+ Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, United Kingdom, 44 789 134 0056, harveenk26@gmail.com %K smoking cessation intervention %K mobile %K smartphone %K apps %K PRIME theory %D 2015 %7 16.01.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Little is known about the effectiveness of mobile apps in aiding smoking cessation or their validity for automated collection of data on smoking cessation outcomes. Objective: We conducted a preliminary evaluation of SF28 (SF28 is the name of the app, short for SmokeFree28)—an app aimed at helping smokers to be smoke-free for 28 days. Methods: Data on sociodemographic characteristics, smoking history, number of logins, and abstinence at each login were uploaded to a server from SF28 between August 2012 and August 2013. Users were included if they were aged 16 years or over, smoked cigarettes at the time of registration, had set a quit date, and used the app at least once on or after their quit date. Their characteristics were compared with data from a representative sample of smokers trying to stop smoking in England. The percentage of users recording 28 days of abstinence was compared with a value of 15% estimated for unaided quitting. Correlations were assessed between recorded abstinence for 28 days and well-established abstinence predictors. Results: A total of 1170 users met the inclusion criteria. Compared with smokers trying to quit in England, they had higher consumption, and were younger, more likely to be female, and had a non-manual rather than manual occupation. In total, 18.9% (95% CI 16.7-21.1) were recorded as being abstinent from smoking for 28 days or longer. The mean number of logins was 8.5 (SD 9.0). The proportion recording abstinence for 28 days or longer was higher in users who were older, in a non-manual occupation, and in those using a smoking cessation medication. Conclusions: The recorded 28-day abstinence rates from the mobile app, SF28, suggest that it may help some smokers to stop smoking. Further evaluation by means of a randomized trial appears to be warranted. %M 25596170 %R 10.2196/jmir.3479 %U http://www.jmir.org/2015/1/e17/ %U https://doi.org/10.2196/jmir.3479 %U http://www.ncbi.nlm.nih.gov/pubmed/25596170 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 1 %P e5 %T An Accumulated Activity Effective Index for Promoting Physical Activity: A Design and Development Study in a Mobile and Pervasive Health Context %A Liu,Chung-Tse %A Chan,Chia-Tai %+ Department of Biomedical Engineering, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, , Taiwan, 886 2 2826 7000 ext 7371, ctchan@ym.edu.tw %K accumulated activity effective index (AAEI) %K physical activity %K activity level %D 2015 %7 06.01.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Increased physical activity has become a principal personal health goal worldwide because sufficient physical activity can reduce the risk of many adverse conditions. Motivating individuals to increase their levels of physical activity can increase life expectancy and contribute to a healthy life. Sharing and comparison of physical activity information by using the Internet, with fewer privacy concerns, might also help encourage people to promote and maintain sufficient physical activity. To promote and manage physical activity, an accumulated activity effective index (AAEI) is proposed in this paper. Objective: The purpose of the AAEI design is to maintain and promote physical activity. The public can easily accept a clear indicator that reveals the current status of physical activity. The AAEI is not only an assessment and tracking tool for personal physical activity, but is also useful for goal setting and for sharing content with the Internet community. Methods: The AAEI is derived from input in the form of accumulated physical activity, and evaluates the status of physical activities and days spent exercising. The term AAEI(t1,t2) is an index of the accumulated physical activity in the time interval (t1,t2), where the base unit of time is the day. The AAEI is determined according to accumulated physical activity and is adjusted using the previous status of physical activity. The previous status of physical activity is estimated according to the number of days spent exercising and the accumulated physical activity that has been performed. An analysis of the AAEI performance was conducted using a simulation model and a real-world trial with 2 participants. Results: The AAEI increased as the physical activity and days spent exercising accumulated. Conversely, the AAEI decreased with lack of physical activity and increased resting days. In simulation, the shape of the AAEI line indicated different types of exercise. The moving average AAEI represented long-term exercise. In the real-world trial, the AAEI confirmed that the simulation results were comparable to actual conditions. Conclusions: The AAEI proposed in this paper is a method that can be used to evaluate the status of a person’s physical activity. The AAEI is a simple numeric indication that is estimated by analyzing accumulated physical activity and the average number of days spent exercising. The AAEI is suitable for tracking personal physical activity, reminding the user of achievement goals, and allows data sharing by using the Internet. The results have demonstrated that the AAEI is a useful tool for physical activity management. %M 25563899 %R 10.2196/resprot.3336 %U http://www.researchprotocols.org/2015/1/e5/ %U https://doi.org/10.2196/resprot.3336 %U http://www.ncbi.nlm.nih.gov/pubmed/25563899 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 2 %N 1 %P e1 %T Development and Pilot Evaluation of an Online Relapse-Prevention Program Based on Acceptance and Commitment Therapy for Chronic Pain Patients %A Fledderus,Martine %A Schreurs,Karlein MG %A Bohlmeijer,Ernst T %A Vollenbroek-Hutten,Miriam MR %+ Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede, 7500 AH, Netherlands, 31 534894470, martinefledderus@gmail.com %K chronic pain %K eHealth %K acceptance and commitment therapy %K relapse prevention %K aftercare %D 2015 %7 05.01.2015 %9 Original Paper %J JMIR Human Factors %G English %X Background: A significant number of chronic pain patients experience a decline in therapeutic effects after rehabilitation. As face-to-face contacts with health care professionals are not always feasible after treatment, new, innovative, fully automated relapse-prevention programs are highly needed. Objective: In this study an online, automated relapse-prevention program based on acceptance and commitment therapy (ACT)—both as a website and as a mobile app—was developed and evaluated. At each step of the development, end users (ie, chronic pain patients) were consulted in order to fully address their needs. Methods: In a step-by-step process, a contextual inquiry, requirement specification, and design were executed with chronic pain patients by conducting, respectively, a focus group (n=10), interviews with rapid prototyping (n=28), and a user- and expert-based usability evaluation (n=14). Furthermore, a pilot evaluation was conducted with 14 chronic pain or fatigue patients who had received the online relapse-prevention program following a multidisciplinary ACT treatment. They were interviewed about their usage and the usefulness of the program in supporting them to maintain changed behaviors and prevent relapses in avoidance and pain control behaviors. Results: The three stages provided information about the expected needs of end users, comments about the usefulness of the proposed features, and feedback about the design and usability of the program. This resulted in a fully operational, online relapse-prevention program. Results from the pilot evaluation showed that 9 patients used the online program after treatment, 5 of whom indicated that the program supported them after treatment. Of all the patients, 4 of them indicated that the program did not support them because they wanted more social interaction with other users. Conclusions: This study showed that an innovative, automated, online program that is user friendly can be developed by involving the end users in each step. The program was evaluated positively by some participants. The evaluation showed that the online relapse-prevention program has the potential to support chronic pain patients in maintaining their changed behaviors and preventing relapses in avoidance and pain control behaviors. Trial Registration: Nederlands Trial Register (NTR) Number: NTR4177; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4177 (Archived by WebCite at http://www.webcitation.org/6Ur6EFD1D). %M 27025550 %R 10.2196/humanfactors.3302 %U http://humanfactors.jmir.org/2015/1/e1/ %U https://doi.org/10.2196/humanfactors.3302 %U http://www.ncbi.nlm.nih.gov/pubmed/27025550 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 1 %N 1 %P e4 %T Randomized Comparison of Mobile and Web-Tools to Provide Dementia Risk Reduction Education: Use, Engagement and Participant Satisfaction %A O'Connor,Elodie %A Farrow,Maree %A Hatherly,Chris %+ Alzheimer's Australia, 155 Oak St, Parkville, 3052, Australia, 61 3 9816 5795, maree.farrow@alzheimers.org.au %K dementia %K Alzheimer %K engagement %K health communication %K Internet %K intervention %K mobile phone %K risk reduction behavior %K user perceptions %K mhealth %D 2014 %7 22.12.2014 %9 Original Paper %J JMIR Mental Health %G English %X Background: Encouraging middle-aged adults to maintain their physical and cognitive health may have a significant impact on reducing the prevalence of dementia in the future. Mobile phone apps and interactive websites may be one effective way to target this age group. However, to date there has been little research investigating the user experience of dementia risk reduction tools delivered in this way. Objective: The aim of this study was to explore participant engagement and evaluations of three different targeted smartphone and Web-based dementia risk reduction tools following a four-week intervention. Methods: Participants completed a Web-based screening questionnaire to collect eligibility information. Eligible participants were asked to complete a Web-based baseline questionnaire and were then randomly assigned to use one of the three dementia risk reduction tools for a period of four weeks: (1) a mobile phone application; (2) an information-based website; and (3) an interactive website. User evaluations were obtained via a Web-based follow-up questionnaire after completion of the intervention. Results: Of 415 eligible participants, 370 (89.16%) completed the baseline questionnaire and were assigned to an intervention group; 200 (54.05%) completed the post-intervention questionnaire. The average age of participants was 52 years, and 149 (75%) were female. Findings indicated that participants from all three intervention groups reported a generally positive impression of the tools across a range of domains. Participants using the information-based website reported higher ratings of their overall impression of the tool, F2,191=4.12, P=.02; how interesting the information was, F2,189=3.53, P=.03; how helpful the information was, F2,192=4.15, P=.02; and how much they learned, F2,188=3.86, P=.02. Group differences were significant between the mobile phone app and information-based website users, but not between the interactive website users and the other two groups. Additionally, participants using the information-based website reported significantly higher scores on their ratings of the ease of navigation, F2,190=4.20, P=.02, than those using the mobile phone app and the interactive website. There were no significant differences between groups on ratings of ease of understanding the information, F2,188=0.27, P=.76. Most participants from each of the three intervention groups indicated that they intended to keep using the dementia risk reduction eHealth tool. Conclusions: Overall, results indicated that while participants across all three intervention groups reported a generally positive experience with the targeted dementia risk reduction tools, participants using the information-based website provided a more favorable evaluation across a range of areas than participants using the mobile phone app. Further research is required to investigate whether targeted dementia risk reduction tools, in the form of interactive websites and mobile apps, can be improved to provide benefits above those gained by providing static information alone. %M 26543904 %R 10.2196/mental.3654 %U http://mental.jmir.org/2014/1/e4/ %U https://doi.org/10.2196/mental.3654 %U http://www.ncbi.nlm.nih.gov/pubmed/26543904 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 4 %P e57 %T A Mobile Health Intervention for Self-Management and Lifestyle Change for Persons With Type 2 Diabetes, Part 2: One-Year Results From the Norwegian Randomized Controlled Trial RENEWING HEALTH %A Holmen,Heidi %A Torbjørnsen,Astrid %A Wahl,Astrid Klopstad %A Jenum,Anne Karen %A Småstuen,Milada Cvancarova %A Årsand,Eirik %A Ribu,Lis %+ Department of Nursing, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, PB 4 St.Olavs Plass, Oslo, 0130, Norway, 47 90580017, Heidi.Holmen@hioa.no %K self-care %K mobile applications %K cellular phone %K telemedicine %K counseling %K motivational interviewing %K diabetes mellitus, type 2 %K hemoglobin A1c protein, human %D 2014 %7 11.12.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Self-management is crucial in the daily management of type 2 diabetes. It has been suggested that mHealth may be an important method for enhancing self-management when delivered in combination with health counseling. Objective: The objective of this study was to test whether the use of a mobile phone–based self-management system used for 1 year, with or without telephone health counseling by a diabetes specialist nurse for the first 4 months, could improve glycated hemoglobin A1c (HbA1c) level, self-management, and health-related quality of life compared with usual care. Methods: We conducted a 3-arm prospective randomized controlled trial involving 2 intervention groups and 1 control group. Eligible participants were persons with type 2 diabetes with an HbA1c level ≥7.1% (≥54.1 mmol/mol) and aged ≥18 years. Both intervention groups received the mobile phone–based self-management system Few Touch Application (FTA). The FTA consisted of a blood glucose–measuring system with automatic wireless data transfer, diet manual, physical activity registration, and management of personal goals, all recorded and operated using a diabetes diary app on the mobile phone. In addition, one intervention group received health counseling based on behavior change theory and delivered by a diabetes specialist nurse for the first 4 months after randomization. All groups received usual care by their general practitioner. The primary outcome was HbA1c level. Secondary outcomes were self-management (heiQ), health-related quality of life (SF-36), depressive symptoms (CES-D), and lifestyle changes (dietary habits and physical activity). Data were analyzed using univariate methods (t test, ANOVA) and multivariate linear and logistic regression. Results: A total of 151 participants were randomized: 51 to the FTA group, 50 to the FTA-health counseling (FTA-HC) group, and 50 to the control group. Follow-up data after 1 year were available for 120 participants (79%). HbA1c level decreased in all groups, but did not differ between groups after 1 year. The mean change in the heiQ domain skills and technique acquisition was significantly greater in the FTA-HC group after adjusting for age, gender, and education (P=.04). Other secondary outcomes did not differ between groups after 1 year. In the FTA group, 39% were substantial users of the app; 34% of the FTA-HC group were substantial users. Those aged ≥63 years used the app more than their younger counterparts did (OR 2.7; 95% CI 1.02-7.12; P=.045). Conclusions: The change in HbA1c level did not differ between groups after the 1-year intervention. Secondary outcomes did not differ between groups except for an increase in the self-management domain of skill and technique acquisition in the FTA-HC group. Older participants used the app more than the younger participants did. %M 25499872 %R 10.2196/mhealth.3882 %U http://mhealth.jmir.org/2014/4/e57/ %U https://doi.org/10.2196/mhealth.3882 %U http://www.ncbi.nlm.nih.gov/pubmed/25499872 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 4 %P e52 %T A Low-Intensity Mobile Health Intervention With and Without Health Counseling for Persons With Type 2 Diabetes, Part 1: Baseline and Short-Term Results From a Randomized Controlled Trial in the Norwegian Part of RENEWING HEALTH %A Torbjørnsen,Astrid %A Jenum,Anne Karen %A Småstuen,Milada Cvancarova %A Årsand,Eirik %A Holmen,Heidi %A Wahl,Astrid Klopstad %A Ribu,Lis %+ Department of Nursing, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, PB 4 St.Olavs Plass, Oslo, N-0130, Norway, 47 67 23 61 99, Astrid.Torbjornsen@hioa.no %K self-care %K quality of life %K diabetes mellitus, type 2 %K randomized controlled trials %K telemedicine %K mHealth %K mobile apps %K counseling %K complex intervention %K life style %D 2014 %7 11.12.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Self-management support for people with type 2 diabetes is essential in diabetes care. Thus, mobile health technology with or without low-intensity theory-based health counseling could become an important tool for promoting self-management. Objectives: The aim was to evaluate whether the introduction of technology-supported self-management using the Few Touch Application (FTA) diabetes diary with or without health counseling improved glycated hemoglobin (HbA1c) levels, self-management, behavioral change, and health-related quality of life, and to describe the sociodemographic, clinical, and lifestyle characteristics of the participants after 4 months. Methods: A 3-armed randomized controlled trial was conducted in Norway during 2011-2013. In the 2 intervention groups, participants were given a mobile phone for 1 year, which provided access to the FTA diary, a self-help tool that recorded 5 elements: blood glucose, food habits, physical activity, personal goal setting, and a look-up system for diabetes information. One of the intervention groups was also offered theory-based health counseling with a specialist diabetes nurse by telephone for 4 months from baseline. Both intervention groups and the control group were provided usual care according to the national guidelines. Adults with type 2 diabetes and HbA1c ≥7.1% were included (N=151). There were 3 assessment points: baseline, 4 months, and 1 year. We report the short-term findings after 4 months. HbA1c was the primary outcome and the secondary outcomes were self-management (Health Education Impact Questionnaire, heiQ), behavioral change (diet and physical activity), and health-related quality of life (SF-36 questionnaire). The data were analyzed using univariate methods (ANOVA), multivariate linear, and logistic regression. Results: Data were analyzed from 124 individuals (attrition rate was 18%). The groups were well balanced at baseline. There were no differences in HbA1c between groups after 4 months, but there was a decline in all groups. There were changes in self-management measured using the health service navigation item in the heiQ, with improvements in the FTA group compared to the control group (P=.01) and in the FTA with health counseling group compared with both other groups (P=.04). This may indicate an improvement in the ability of patients to communicate health needs to their health care providers. Furthermore, the FTA group reported higher scores for skill and technique acquisition at relieving symptoms compared to the control group (P=.02). There were no significant changes in any of the domains of the SF-36. Conclusions: The primary outcome, HbA1c, did not differ between groups after 4 months. Both of the intervention groups had significantly better scores than the control group for health service navigation and the FTA group also exhibited improved skill and technique acquisition. %M 25499592 %R 10.2196/mhealth.3535 %U http://mhealth.jmir.org/2014/4/e52/ %U https://doi.org/10.2196/mhealth.3535 %U http://www.ncbi.nlm.nih.gov/pubmed/25499592 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 12 %P e280 %T Social Media and Mobile Apps for Health Promotion in Australian Indigenous Populations: Scoping Review %A Brusse,Carl %A Gardner,Karen %A McAullay,Daniel %A Dowden,Michelle %+ Australian Primary Health Care Research Institute, Research School of Population Health, Australian National University, Building 63, Mills & Eggleston Roads, Canberra, 2601, Australia, 61 6125 7875, karen.gardner@anu.edu.au %K health promotion %K indigenous health %K eHealth %D 2014 %7 10.12.2014 %9 Review %J J Med Internet Res %G English %X Background: Health promotion organizations are increasingly embracing social media technologies to engage end users in a more interactive way and to widely disseminate their messages with the aim of improving health outcomes. However, such technologies are still in their early stages of development and, thus, evidence of their efficacy is limited. Objective: The study aimed to provide a current overview of the evidence surrounding consumer-use social media and mobile software apps for health promotion interventions, with a particular focus on the Australian context and on health promotion targeted toward an Indigenous audience. Specifically, our research questions were: (1) What is the peer-reviewed evidence of benefit for social media and mobile technologies used in health promotion, intervention, self-management, and health service delivery, with regard to smoking cessation, sexual health, and otitis media? and (2) What social media and mobile software have been used in Indigenous-focused health promotion interventions in Australia with respect to smoking cessation, sexual health, or otitis media, and what is the evidence of their effectiveness and benefit? Methods: We conducted a scoping study of peer-reviewed evidence for the effectiveness of social media and mobile technologies in health promotion (globally) with respect to smoking cessation, sexual health, and otitis media. A scoping review was also conducted for Australian uses of social media to reach Indigenous Australians and mobile apps produced by Australian health bodies, again with respect to these three areas. Results: The review identified 17 intervention studies and seven systematic reviews that met inclusion criteria, which showed limited evidence of benefit from these interventions. We also found five Australian projects with significant social media health components targeting the Indigenous Australian population for health promotion purposes, and four mobile software apps that met inclusion criteria. No evidence of benefit was found for these projects. Conclusions: Although social media technologies have the unique capacity to reach Indigenous Australians as well as other underserved populations because of their wide and instant disseminability, evidence of their capacity to do so is limited. Current interventions are neither evidence-based nor widely adopted. Health promotion organizations need to gain a more thorough understanding of their technologies, who engages with them, why they engage with them, and how, in order to be able to create successful social media projects. %M 25498835 %R 10.2196/jmir.3614 %U http://www.jmir.org/2014/12/e280/ %U https://doi.org/10.2196/jmir.3614 %U http://www.ncbi.nlm.nih.gov/pubmed/25498835 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 4 %P e48 %T Parent-Targeted Mobile Phone Intervention to Increase Physical Activity in Sedentary Children: Randomized Pilot Trial %A Newton Jr,Robert L %A Marker,Arwen M %A Allen,H Raymond %A Machtmes,Ryan %A Han,Hongmei %A Johnson,William D %A Schuna Jr,John M %A Broyles,Stephanie T %A Tudor-Locke,Catrine %A Church,Timothy S %+ Pennington Biomedical Research Center, Population and Public Health, 6400 Perkins Rd, Baton Rouge, LA, 70808, United States, 1 225 763 3034, robert.newton@pbrc.edu %K mobile health %K physical activity intervention %K child %K parents %K pedometers %K text messaging %D 2014 %7 10.11.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Low levels of moderate-to-vigorous physical activity are associated with adverse health consequences. Objective: The intent of the study was to determine the feasibility and efficacy of a 12-week physical activity promotion program targeting children, which was delivered to parents through mobile phones. Methods: Potential participants were recruited through advertisements placed in the newspaper, local hospitals and schools, and an email listserv. Sedentary children aged 6-10 years were randomly assigned to a minimal (MIG) or intensive (IIG) intervention group. Parents in the MIG were given a goal to increase (within 1 month) and maintain their child’s activity at 6000 pedometer steps/day above their baseline levels and to monitor their child’s steps daily. Parents in the IIG were given the same steps/day and monitoring goals, in addition to text messages and articles containing additional behavioral strategies (based on the Social Cognitive Theory) designed to promote their child’s physical activity. The intervention components were delivered via mobile phone. Anthropometrics, body composition, and questionnaires were administered in a clinic. Children wore a New Lifestyles pedometer (NL-1000) each day throughout the intervention and parents were to monitor their child’s step counts daily. Results: Out of 59 children who screened for the study, a total of 27 children (mean age 8.7, SD 1.4 years; 56%, 15/27 female; 59%, 16/27 African American) were enrolled and completed the study. Overall, 97.90% (2220/2268; 98.20%, 1072/1092 for MIG; 97.60%, 1148/1176 for IIG) of expected step data were successfully entered by the parent or study coordinator. Parents in the MIG and IIG were sent approximately 7 and 13 text messages per week, respectively, averaged over the course of the study. IIG parents accessed an average of 6.1 (SD 4.4) articles over the course of the intervention and accessed a fewer number of articles in the last month compared to the first 2 months of the study (P=.002). Children in both the MIG and IIG significantly increased their physical activity, averaged over 12 weeks, by 1427.6 (SD 583.0; P=.02) and 2832.8 (SD 604.9; P<.001) steps/day above baseline, respectively. The between group difference was not statistically significant (P=.10; effect size=.40), nor was the group by time interaction (P=.57). Regardless of group assignment, children who significantly increased their physical activity reported greater increases in physical activity enjoyment (P=.003). The number of behavioral articles accessed by IIG parents was significantly correlated with change in children’s steps/day (r=.575, P=.04). Changes in children’s steps/day were unrelated to changes in their body composition, mood, and food intake. Conclusions: Parent-targeted mobile phone interventions are feasible, yet more intense interventions may be needed to support parents’ efforts to increase their children’s physical activity to levels that approximate national recommendations. Trial Registration: Clinicaltrials.gov NCT01551108; http://clinicaltrials.gov/show/NCT01551108 (Archived by WebCite at http://www.webcitation.org/6TNEOzXNX). %M 25386899 %R 10.2196/mhealth.3420 %U http://mhealth.jmir.org/2014/4/e48/ %U https://doi.org/10.2196/mhealth.3420 %U http://www.ncbi.nlm.nih.gov/pubmed/25386899 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 4 %P e40 %T The Medium and the Message: Fitting Sound Health Promotion Methodology Into 160 Characters %A Lim,Megan S C %A Wright,Cassandra %A Hellard,Margaret E %+ Burnet Institute, Centre for Population Health, 85 Commercial Rd, Melbourne, 3004, Australia, 61 385062403, lim@burnet.edu.au %K text messaging %K mobile phone %K health promotion %K program evaluation  %D 2014 %7 03.11.2014 %9 Editorial %J JMIR mHealth uHealth %G English %X Text messaging health promotion projects continue to proliferate due to their relative low-cost, simplicity, non-intrusiveness, and proven effectiveness in several randomized controlled trials. In these past trials, participants have typically been recruited through traditional means, received the text messaging intervention, and then completed evaluation. In this issue of the Journal of Medical Internet Research, Sheoran et al have demonstrated how use of text messaging alone can be a feasible method for all three stages: recruitment, intervention, and evaluation. Use of text messages without any other modes of communication could be a key to population-level dissemination and wider uptake of health promotion messages. However, in the rush to utilize new technologies and in the brevity of 160 characters, it should not be forgotten that quality, rigour, and careful development remain essential in any health promotion practice. %M 25367387 %R 10.2196/mhealth.3888 %U http://mhealth.jmir.org/2014/4/e40/ %U https://doi.org/10.2196/mhealth.3888 %U http://www.ncbi.nlm.nih.gov/pubmed/25367387 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 4 %P e47 %T Preferences for a Mobile HIV Prevention App for Men Who Have Sex With Men %A Goldenberg,Tamar %A McDougal,Sarah J %A Sullivan,Patrick S %A Stekler,Joanne D %A Stephenson,Rob %+ Rollins School of Public Health, Department of Epidemiology, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 404 727 8799, tsgolde@emory.edu %K MSM %K HIV %K mobile phone app %K mHealth %K HIV prevention %D 2014 %7 29.10.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The Centers for Disease Control and Prevention recommends that sexually active men who have sex with men (MSM) in the United States test for human immunodeficiency virus (HIV) at least three times per year, but actual testing frequency is much less frequent. Though mHealth is a popular vehicle for delivering HIV interventions, there are currently no mobile phone apps that target MSM with the specific aim of building an HIV testing plan, and none that focuses on developing a comprehensive prevention plan and link MSM to additional HIV prevention and treatment resources. Previous research has suggested a need for more iterative feedback from the target population to ensure use of these interventions. Objective: The purpose of this study is to understand MSM’s preferences for functionality, format, and design of a mobile phone-based HIV prevention app and to examine MSM’s willingness to use an app for HIV prevention. Methods: We conducted focus group discussions with 38 gay and bisexual men, with two in-person groups in Atlanta, two in Seattle, and one online focus group discussion with gay and bisexual men in rural US regions. These discussions addressed MSM’s general preferences for apps, HIV testing barriers and facilitators for MSM, and ways that an HIV prevention app could address these barriers and facilitators to increase the frequency of HIV testing and prevention among MSM. During focus group discussions, participants were shown screenshots and provided feedback on potential app functions. Results: Participants provided preferences on functionality of the app, including the type and delivery of educational content, the value of interactive engagement, and the importance of social networking as an app component. Participants also discussed preferences on how the language should be framed for the delivery of information, identifying that an app needs to be simultaneously fun and professional. Privacy and altruistic motivation were considered to be important factors in men’s willingness to use a mobile HIV prevention app. Finally, men described the potential impact that a mobile HIV prevention app could have, identifying individual, interpersonal, and community-based benefits. Conclusions: In summary, participants described a comprehensive app that should incorporate innovative ideas to educate and engage men so that they would be motivated to use the app. In order for an app to be useful, it needs to feel safe and trustworthy, which is essential when considering the app’s language and privacy. Participants provided a range of preferences for using an HIV prevention app, including what they felt MSM need with regards to HIV prevention and what they want in order to engage with an app. Making an HIV prevention app enjoyable and usable for MSM is a difficult challenge. However, the usability of the app is vital because no matter how great the intervention, if MSM do not use the app, then it will not be useful. %M 25355249 %R 10.2196/mhealth.3745 %U http://mhealth.jmir.org/2014/4/e47/ %U https://doi.org/10.2196/mhealth.3745 %U http://www.ncbi.nlm.nih.gov/pubmed/25355249 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 3 %N 4 %P e14 %T Validity and Usability of Low-Cost Accelerometers for Internet-Based Self-Monitoring of Physical Activity in Patients With Chronic Obstructive Pulmonary Disease %A Vooijs,Martijn %A Alpay,Laurence L %A Snoeck-Stroband,Jiska B %A Beerthuizen,Thijs %A Siemonsma,Petra C %A Abbink,Jannie J %A Sont,Jacob K %A Rövekamp,Ton A %+ Rijnlands Rehabilitation Center, Department of Cardiac and Pulmonary Rehabilitation, Wassenaarseweg 501, Leiden, 2333AL, Netherlands, 31 715195300, m.vooijs@rrc.nl %K accelerometers %K activity monitoring %K chronic obstructive pulmonary disease %K validity %K usability %D 2014 %7 27.10.2014 %9 Original Paper %J Interact J Med Res %G English %X Background: The importance of regular physical activity for patients with chronic obstructive pulmonary disease (COPD) is well-established. However, many patients do not meet the recommended daily amount. Accelerometers might provide patients with the information needed to increase physical activity in daily life. Objective: Our objective was to assess the validity and usability of low-cost Internet-connected accelerometers. Furthermore we explored patients’ preferences with regards to the presentation of and feedback on monitored physical activity. Methods: To assess concurrent validity we conducted a field validation study with patients who wore two low-cost accelerometers, Fitbit and Physical Activity Monitor (PAM), at the same time along with a sophisticated multisensor accelerometer (SenseWear Armband) for 48 hours. Data on energy expenditure assessed from registrations from the two low-cost accelerometers were compared to the well validated SenseWear Armband which served as a reference criterion. Usability was examined in a cross-over study with patients who, in succession, wore the Fitbit and the PAM for 7 consecutive days and filled out a 16 item questionnaire with regards to the use of the corresponding device Results: The agreement between energy expenditure (METs) from the SenseWear Armband with METs estimated by the Fitbit and PAM was good (r=.77) and moderate (r=.41), respectively. The regression model that was developed for the Fitbit explained 92% whereas the PAM-model could explain 89% of total variance in METs measured by the SenseWear. With regards to the usability, both the Fitbit and PAM were well rated on all items. There were no significant differences between the two devices. Conclusions: The low-cost Fitbit and PAM are valid and usable devices to measure physical activity in patients with COPD. These devices may be useful in long-term interventions aiming at increasing physical activity levels in these patients. %M 25347989 %R 10.2196/ijmr.3056 %U http://www.i-jmr.org/2014/4/e14/ %U https://doi.org/10.2196/ijmr.3056 %U http://www.ncbi.nlm.nih.gov/pubmed/25347989 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 4 %P e41 %T Dietary Approaches to Stop Hypertension: Lessons Learned From a Case Study on the Development of an mHealth Behavior Change System %A Mann,Devin M %A Quintiliani,Lisa M %A Reddy,Shivani %A Kitos,Nicole R %A Weng,Michael %+ Boston University, Department of Medicine, 801 Massachusetts Ave, Suite 870, Boston, MA, 02118, United States, 1 617 638 8021, dmann@bu.edu %K mHealth %K chronic disease %K behavior change %D 2014 %7 23.10.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Evidence-based solutions for changing health behaviors exist but problems with feasibility, sustainability, and dissemination limit their impact on population-based behavior change and maintenance. Objective: Our goal was to overcome the limitations of an established behavior change program by using the inherent capabilities of smartphones and wireless sensors to develop a next generation mobile health (mHealth) intervention that has the potential to be more feasible. Methods: In response to the clinical need and the growing capabilities of smartphones, our study team decided to develop a behavioral hypertension reduction mHealth system inspired by Dietary Approaches to Stop Hypertension (DASH), a lifestyle modification program. We outline the key design and development decisions that molded the project including decisions about behavior change best practices, coaching features, platform, multimedia content, wireless devices, data security, integration of systems, rapid prototyping, usability, funding mechanisms, and how all of these issues intersect with clinical research and behavioral trials. Results: Over the 12 months, our study team faced many challenges to developing our prototype intervention. We describe 10 lessons learned that will ultimately stimulate more effective and sustainable approaches. Conclusions: The experiences presented in this case study can be used as a reference for others developing mHealth behavioral intervention development projects by highlighting the benefits and challenges facing mHealth research. %M 25340979 %R 10.2196/mhealth.3307 %U http://mhealth.jmir.org/2014/4/e41/ %U https://doi.org/10.2196/mhealth.3307 %U http://www.ncbi.nlm.nih.gov/pubmed/25340979 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 10 %P e201 %T Understanding Usage of a Hybrid Website and Smartphone App for Weight Management: A Mixed-Methods Study %A Morrison,Leanne G %A Hargood,Charlie %A Lin,Sharon Xiaowen %A Dennison,Laura %A Joseph,Judith %A Hughes,Stephanie %A Michaelides,Danius T %A Johnston,Derek %A Johnston,Marie %A Michie,Susan %A Little,Paul %A Smith,Peter WF %A Weal,Mark J %A Yardley,Lucy %+ Centre for Applications of Health Psychology, Academic Unit of Psychology, University of Southampton, Highfield Campus, Highfield, Southampton, SO17 1BJ, United Kingdom, 44 2380597222 ext 7222, l.morrison@soton.ac.uk %K qualitative research %K weight loss %K behavioral research %K mobile apps %K Internet %K health %K program acceptability %K behavior %K mixed-methods %D 2014 %7 22.10.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Advancements in mobile phone technology offer huge potential for enhancing the timely delivery of health behavior change interventions. The development of smartphone-based health interventions (apps) is a rapidly growing field of research, yet there have been few longitudinal examinations of how people experience and use these apps within their day-to-day routines, particularly within the context of a hybrid Web- and app-based intervention. Objective: This study used an in-depth mixed-methods design to examine individual variation in (1) impact on self-reported goal engagement (ie, motivation, self-efficacy, awareness, effort, achievement) of access to a weight management app (POWeR Tracker) when provided alongside a Web-based weight management intervention (POWeR) and (2) usage and views of POWeR Tracker. Methods: Thirteen adults were provided access to POWeR and were monitored over a 4-week period. Access to POWeR Tracker was provided in 2 alternate weeks (ie, weeks 1 and 3 or weeks 2 and 4). Participants’ goal engagement was measured daily via self-report. Mixed effects models were used to examine change in goal engagement between the weeks when POWeR Tracker was and was not available and whether the extent of change in goal engagement varied between individual participants. Usage of POWeR and POWeR Tracker was automatically recorded for each participant. Telephone interviews were conducted and analyzed using inductive thematic analysis to further explore participants’ experiences using POWeR and POWeR Tracker. Results: Access to POWeR Tracker was associated with a significant increase in participants’ awareness of their eating (β1=0.31, P=.04) and physical activity goals (β1=0.28, P=.03). The level of increase varied between individual participants. Usage data showed that participants used the POWeR website for similar amounts of time during the weeks when POWeR Tracker was (mean 29 minutes, SD 31 minutes) and was not available (mean 27 minutes, SD 33 minutes). POWeR Tracker was mostly accessed in short bursts (mean 3 minutes, SD 2 minutes) during convenient moments or moments when participants deemed the intervention content most relevant. The qualitative data indicated that nearly all participants agreed that it was more convenient to access information on-the-go via their mobiles compared to a computer. However, participants varied in their views and usage of the Web- versus app-based components and the informational versus tracking tools provided by POWeR Tracker. Conclusions: This study provides evidence that smartphones have the potential to improve individuals’ engagement with their health-related goals when used as a supplement to an existing online intervention. The perceived convenience of mobile access to information does not appear to deter use of Web-based interventions or strengthen the impact of app access on goal engagement. A mixed-methods design enabled exploration of individual variation in daily usage of the app-based tools. %M 25355131 %R 10.2196/jmir.3579 %U http://www.jmir.org/2014/10/e201/ %U https://doi.org/10.2196/jmir.3579 %U http://www.ncbi.nlm.nih.gov/pubmed/25355131 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 1 %N 1 %P e2 %T Testing Usability and Acceptability of a Web Application to Promote Physical Activity (iCanFit) Among Older Adults %A Hong,Yan %A Goldberg,Daniel %A Dahlke,Deborah Vollmer %A Ory,Marcia G %A Cargill,Jessica S %A Coughlin,Rachel %A Hernandez,Edgar %A Kellstedt,Debra K %A Peres,S Camille %+ School of Public Health, Texas A&M Health Science Center, 1266 TAMU, College Station, TX, 77843, United States, 1 9798621700, yhong@sph.tamhsc.edu %K physical activity %K mobile health, older adults %K usability testing %K user experience %D 2014 %7 13.10.2014 %9 Original Paper %J JMIR Human Factors %G English %X Background: Most older Americans do not exercise regularly and many have chronic conditions. Among an increasing number of fitness mobile and Web apps, few are designed for older adults with chronic conditions despite high ownership rates of mobile tools and Internet access in this population. We designed a mobile-enabled Web app, iCanFit, to promote physical activity in this population. Objective: This study aimed to test the usability and acceptability of iCanFit among older adults in a community setting. Methods: A total of 33 older adults (aged 60 to 82 years) were recruited from communities to test iCanFit. Of these 33, 10 participants completed the usability testing in a computer room of a senior community center. A research assistant timed each Web application task and observed user navigation behavior using usability metrics. The other 23 participants used the website on their own devices at home and provided feedback after 2-3 weeks by completing a user-experience survey assessing ease of use, helpfulness, and satisfaction with iCanFit. Results: Participants completed all 15 tasks on the iCanFit site in an average of 31 (SD 6.9) minutes; some tasks required more time or needed assistance. Participants’ comments were addressed to improve the site’s senior friendliness and ease of use. In the user-experience survey, participants reported high levels of usefulness and satisfaction. More than 56% (13/23) of participants indicated they would continue using the program and recommend it to their families or friends. Conclusions: Testing usability and acceptability is a very important step in developing age-appropriate and user-friendly Web apps, especially for older adults. Testing usability and acceptability in a community setting can help reveal users’ experiences and feedback in a real-life setting. Our study suggested that older adults had a high degree of acceptance of iCanFit and could use it easily. The efficacy trial of iCanFit is currently underway. %M 27025254 %R 10.2196/humanfactors.3787 %U http://humanfactors.jmir.org/2014/1/e2/ %U https://doi.org/10.2196/humanfactors.3787 %U http://www.ncbi.nlm.nih.gov/pubmed/27025254 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 3 %P e38 %T Sexual and Reproductive Health for Young Adults in Colombia: Teleconsultation Using Mobile Devices %A Lopez,Catalina %A Ramirez,Daniel Camilo %A Valenzuela,Jose Ignacio %A Arguello,Arturo %A Saenz,Juan Pablo %A Trujillo,Stephanie %A Correal,Dario Ernesto %A Fajardo,Roosevelt %A Dominguez,Cristina %+ Center for Innovation and Health Education, Fundacion Santa Fe de Bogota, Cra 7B No 123 - 90, Bogota, , Colombia, 57 16030303 ext 5721, catalina.lopez@fsfb.edu.co %K mobile health %K youth and adolescents %K telemedicine %K remote consultation %K Colombia %K Latin America. %D 2014 %7 25.09.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Sexual risk behaviors associated with poor information on sexuality have contributed to major public health problems in the area of sexual and reproductive health in teenagers and young adults in Colombia. Objective: To report our experience with the use of DoctorChat Mobile to provide sexual education and information among university students in Bogota, Colombia, and knowledge about the sexual risk factors detected among them. Methods: A mobile app that allows patients to ask about sexual and reproductive health issues was developed. Sexual and reproductive risk behaviors in a sample of young adults were measured before and after the use of the app through the validated survey Family Health International (FHI) Behavioral Surveillance Survey (BSS) for Use With Adults Between 15 and 49 Years. A nonprobabilistic convenience recruitment was undertaken through the study´s webpage. After completing the first survey, participants were allowed to download and use the app for a 6-month period (intervention), followed by completion of the same survey once again. For the inferential analysis, data was divided into 3 groups (dichotomous data, discrete quantitative data, and ordinal data) to compare the results of the questions between the first and the second survey. The study was carried out with a sample of university students between 18 and 29 years with access to mobile phones. Participation in the study was voluntary and anonymous. Results: A total of 257 subjects met the selection criteria. The preintervention survey was answered by 232 subjects, and 127 of them fully answered the postintervention survey. In total, 54.3% (69/127) of the subjects completed the survey but did not use the app, leaving an effective population of 58 subjects for analysis. Of these subjects, 53% (31/58) were women and 47% (27/58) were men. The mean age was 21 years, ranging between 18 and 29 years. The differences between the answers from both surveys were not statistically significant. The main sexual risk behaviors identified in the population were homosexual intercourse, nonuse of condoms, sexual intercourse with nonregular and commercial partners, the use of psychoactive substances, and lack of knowledge on symptoms of sexually transmitted diseases and HIV transmission. Conclusions: Although there were no differences between the pre- and postintervention results, the study revealed different risk behaviors among the participating subjects. These findings highlight the importance of promoting high-impact educational strategies on this matter and the importance of providing teenagers and young adults with easily accessible tools with reliable health information, regardless of their socioeconomic status. %M 25263432 %R 10.2196/mhealth.2904 %U http://mhealth.jmir.org/2014/3/e38/ %U https://doi.org/10.2196/mhealth.2904 %U http://www.ncbi.nlm.nih.gov/pubmed/25263432 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 3 %P e37 %T FoodSwitch: A Mobile Phone App to Enable Consumers to Make Healthier Food Choices and Crowdsourcing of National Food Composition Data %A Dunford,Elizabeth %A Trevena,Helen %A Goodsell,Chester %A Ng,Ka Hung %A Webster,Jacqui %A Millis,Audra %A Goldstein,Stan %A Hugueniot,Orla %A Neal,Bruce %+ The George Institute for Global Health, Food Policy Division, PO Box M201 Missenden Rd, Camperdown, 2050, Australia, 61 285072529, edunford@georgeinstitute.org.au %K smartphone technology %K traffic light labeling %K food choices %K public health nutrition %K processed food %D 2014 %7 21.08.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Front-of-pack nutrition labeling (FoPL) schemes can help consumers understand the nutritional content of foods and may aid healthier food choices. However, most packaged foods in Australia carry no easily interpretable FoPL, and no standard FoPL system has yet been mandated. About two thirds of Australians now own a smartphone. Objective: We sought to develop a mobile phone app that would provide consumers with easy-to-understand nutrition information and support the selection of healthier choices when shopping for food. Methods: An existing branded food database including 17,000 Australian packaged foods underpinned the project. An iterative process of development, review, and testing was undertaken to define a user interface that could deliver nutritional information. A parallel process identified the best approach to rank foods based on nutritional content, so that healthier alternative products could be recommended. Results: Barcode scanning technology was identified as the optimal mechanism for interaction of the mobile phone with the food database. Traffic light labels were chosen as the preferred format for presenting nutritional information, and the Food Standards Australia New Zealand nutrient profiling method as the best strategy for identifying healthier products. The resulting FoodSwitch mobile phone app was launched in Australia in January 2012 and was downloaded by about 400,000 users in the first 18 months. FoodSwitch has maintained a 4-plus star rating, and more than 2000 users have provided feedback about the functionality. Nutritional information for more than 30,000 additional products has been obtained from users through a crowdsourcing function integrated within the app. Conclusions: FoodSwitch has empowered Australian consumers seeking to make better food choices. In parallel, the huge volume of crowdsourced data has provided a novel means for low-cost, real-time tracking of the nutritional composition of Australian foods. There appears to be significant opportunity for this approach in many other countries. %M 25147135 %R 10.2196/mhealth.3230 %U http://mhealth.jmir.org/2014/3/e37/ %U https://doi.org/10.2196/mhealth.3230 %U http://www.ncbi.nlm.nih.gov/pubmed/25147135 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 8 %P e192 %T Behavior Change Techniques Implemented in Electronic Lifestyle Activity Monitors: A Systematic Content Analysis %A Lyons,Elizabeth J %A Lewis,Zakkoyya H %A Mayrsohn,Brian G %A Rowland,Jennifer L %+ The University of Texas Medical Branch, Institute for Translational Sciences, 301 University Blvd, Galveston, TX, 77555-0342, United States, 1 409 772 1917, ellyons@utmb.edu %K electronic activity monitor %K mobile %K mhealth %K physical activity %K behavior change technique %D 2014 %7 15.08.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic activity monitors (such as those manufactured by Fitbit, Jawbone, and Nike) improve on standard pedometers by providing automated feedback and interactive behavior change tools via mobile device or personal computer. These monitors are commercially popular and show promise for use in public health interventions. However, little is known about the content of their feedback applications and how individual monitors may differ from one another. Objective: The purpose of this study was to describe the behavior change techniques implemented in commercially available electronic activity monitors. Methods: Electronic activity monitors (N=13) were systematically identified and tested by 3 trained coders for at least 1 week each. All monitors measured lifestyle physical activity and provided feedback via an app (computer or mobile). Coding was based on a hierarchical list of 93 behavior change techniques. Further coding of potentially effective techniques and adherence to theory-based recommendations were based on findings from meta-analyses and meta-regressions in the research literature. Results: All monitors provided tools for self-monitoring, feedback, and environmental change by definition. The next most prevalent techniques (13 out of 13 monitors) were goal-setting and emphasizing discrepancy between current and goal behavior. Review of behavioral goals, social support, social comparison, prompts/cues, rewards, and a focus on past success were found in more than half of the systems. The monitors included a range of 5-10 of 14 total techniques identified from the research literature as potentially effective. Most of the monitors included goal-setting, self-monitoring, and feedback content that closely matched recommendations from social cognitive theory. Conclusions: Electronic activity monitors contain a wide range of behavior change techniques typically used in clinical behavioral interventions. Thus, the monitors may represent a medium by which these interventions could be translated for widespread use. This technology has broad applications for use in clinical, public health, and rehabilitation settings. %M 25131661 %R 10.2196/jmir.3469 %U http://www.jmir.org/2014/8/e192/ %U https://doi.org/10.2196/jmir.3469 %U http://www.ncbi.nlm.nih.gov/pubmed/25131661 %0 Journal Article %@ 22915222 %I JMIR Publications Inc. %V 2 %N 3 %P e18 %T Development of an Evidence-Based mHealth Weight Management Program Using a Formative Research Process %A Waterlander,Wilma %A Whittaker,Robyn %A McRobbie,Hayden %A Dorey,Enid %A Ball,Kylie %A Maddison,Ralph %A Myers Smith,Katie %A Crawford,David %A Jiang,Yannan %A Gu,Yulong %A Michie,Jo %A Ni Mhurchu,Cliona %+ National Institute for Health Innovation, School of Population Health, University of Auckland, Tamaki Campus, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand, 64 (0)9 9234612, w.waterlander@nihi.auckland.ac.nz %K weight loss %K intervention %K Internet %K mobile phone %K focus groups %D 2014 %7 11.07.2014 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a critical need for weight management programs that are effective, cost efficient, accessible, and acceptable to adults from diverse ethnic and socioeconomic backgrounds. mHealth (delivered via mobile phone and Internet) weight management programs have potential to address this need. To maximize the success and cost-effectiveness of such an mHealth approach it is vital to develop program content based on effective behavior change techniques, proven weight management programs, and closely aligned with participants’ needs. Objective: This study aims to develop an evidence-based mHealth weight management program (Horizon) using formative research and a structured content development process. Methods: The Horizon mHealth weight management program involved the modification of the group-based UK Weight Action Program (WAP) for delivery via short message service (SMS) and the Internet. We used an iterative development process with mixed methods entailing two phases: (1) expert input on evidence of effective programs and behavior change theory; and (2) target population input via focus group (n=20 participants), one-on-one phone interviews (n=5), and a quantitative online survey (n=120). Results: Expert review determined that core components of a successful program should include: (1) self-monitoring of behavior; (2) prompting intention formation; (3) promoting specific goal setting; (4) providing feedback on performance; and (5) promoting review of behavioral goals. Subsequent target group input confirmed that participants liked the concept of an mHealth weight management program and expressed preferences for the program to be personalized, with immediate (prompt) and informative text messages, practical and localized physical activity and dietary information, culturally appropriate language and messages, offer social support (group activities or blogs) and weight tracking functions. Most target users expressed a preference for at least one text message per day. We present the prototype mHealth weight management program (Horizon) that aligns with those inputs. Conclusions: The Horizon prototype described in this paper could be used as a basis for other mHealth weight management programs. The next priority will be to further develop the program and conduct a full randomized controlled trial of effectiveness. %M 25098337 %R 10.2196/mhealth.2850 %U http://www.jmir.org/2014/3/e18/ %U https://doi.org/10.2196/mhealth.2850 %U http://www.ncbi.nlm.nih.gov/pubmed/25098337 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 2 %P e25 %T A Persuasive and Social mHealth Application for Physical Activity: A Usability and Feasibility Study %A Al Ayubi,Soleh U %A Parmanto,Bambang %A Branch,Robert %A Ding,Dan %+ Health and Rehabilitation Informatics Laboratory, Department of Health Information Management, University of Pittsburgh, 6026 Forbes Tower, Pittsburgh, PA, , United States, 1 412 383 6649, parmanto@pitt.edu %K mobile applications %K mHealth %K self-management %K social support %K persuasion %K physical activity %K usability %K feasibility studies %K pedometer %D 2014 %7 22.05.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Advances in smartphones and the wide usage of social networking systems offer opportunities for the development of innovative interventions to promote physical activity. To that end, we developed a persuasive and social mHealth application designed to monitor and motivate users to walk more every day. Objective: The objectives of this project were to conduct a focused review on the fundamental characteristics of mHealth for physical activity promotion, to develop an mHealth application that meets such characteristics, and to conduct a feasibility study to deploy the application in everyday life. Methods: This project started as an analytical study to review the fundamental characteristics of the technologies used in physical activity monitoring and promotion. Then, it was followed by a technical development of the application. Next, a 4 week deployment was conducted where participants used the application as part of their daily life. A think-aloud method and in-depth semistructured interviews were conducted following the deployment. A qualitative description method was used to thematically analyze the interviews. Feasibility measures included, adherence to the program, user-system interactions, motivation to use, and experience with physical activity and online social interactions. Results: There were seven fundamental characteristics of physical activity monitoring and promotion that were identified, which were then used as a foundation to develop the application. There were fourteen participants that enrolled in the application evaluation. The age range was from 24 to 45; body mass index ranged from 18.5 to 42.98, with 4 of the subjects falling into the category “obese”. Half of them were experienced with smartphones, and all were familiar with a social network system. There were thirteen participants that completed the study; one was excluded. Overall, participants gave high scores to almost all of the usability factors examined, with averages of 4.52 out of a 5.00 maximum. Over 29 days, participants used the application for a total of 119,380 minutes (average=7.57 hours/day/participant; SD 1.56). Conclusions: Based on the fundamental characteristics, the application was successfully developed. The usability results suggest that the system is usable and user satisfaction was high. Deploying the application was shown to be feasible for the promotion of daily physical activity. %M 25099928 %R 10.2196/mhealth.2902 %U http://mhealth.jmir.org/2014/2/e25/ %U https://doi.org/10.2196/mhealth.2902 %U http://www.ncbi.nlm.nih.gov/pubmed/25099928 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 2 %P e23 %T A Mobile App Offering Distractions and Tips to Cope With Cigarette Craving: A Qualitative Study %A Ploderer,Bernd %A Smith,Wally %A Pearce,Jon %A Borland,Ron %+ Department of Computing and Information Systems, The University of Melbourne, Doug McDonell Building (Building 168), Parkville, Victoria, 3010, Australia, 61 38344 ext 1511, ploderer@unimelb.edu.au %K smoking cessation %K relapse prevention %K quitting %K mobile phone %K distraction %D 2014 %7 07.05.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Despite considerable effort, most smokers relapse within a few months after quitting due to cigarette craving. The widespread adoption of mobile phones presents new opportunities to provide support during attempts to quit. Objective: To design and pilot a mobile app "DistractMe" to enable quitters to access and share distractions and tips to cope with cigarette cravings. Methods: A qualitative study with 14 smokers who used DistractMe on their mobiles during the first weeks of their quit attempt. Based on interviews, diaries, and log data, we examined how the app supported quitting strategies. Results: Three distinct techniques of coping when using DistractMe were identified: diversion, avoidance, and displacement. We further identified three forms of engagement with tips for coping: preparation, fortification, and confrontation. Overall, strategies to prevent cravings and their effects (avoidance, displacement, preparation, and fortification) were more common than immediate coping strategies (diversion and confrontation). Tips for coping were more commonly used than distractions to cope with cravings, because they helped to fortify the quit attempt and provided opportunities to connect with other users of the application. However, distractions were important to attract new users and to facilitate content sharing. Conclusions: Based on the qualitative results, we recommend that mobile phone-based interventions focus on tips shared by peers and frequent content updates. Apps also require testing with larger groups of users to assess whether they can be self-sustaining. %M 25099632 %R 10.2196/mhealth.3209 %U http://mhealth.jmir.org/2014/2/e23/ %U https://doi.org/10.2196/mhealth.3209 %U http://www.ncbi.nlm.nih.gov/pubmed/25099632 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 4 %P e103 %T Adolescents Just Do Not Know What They Want: A Qualitative Study to Describe Obese Adolescents’ Experiences of Text Messaging to Support Behavior Change Maintenance Post Intervention %A Smith,Kyla L %A Kerr,Deborah A %A Fenner,Ashley A %A Straker,Leon M %+ School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Building 408, GPO Box U1987, Perth, 6845, Australia, 61 8 9266 3694, kyla.smith@curtin.edu.au %K telemedicine %K text messaging %K adolescent %K obesity %D 2014 %7 08.04.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescents are considered a hard to reach group and novel approaches are needed to encourage good health. Text messaging interventions have been reported as acceptable to adolescents but there is little evidence regarding the use of text messages with overweight and obese adolescents to support engagement or behavior change after the conclusion of a healthy lifestyle program. Objective: The intent of this study was to explore the opinions of overweight adolescents and their parents regarding the use of text messages as a support during the maintenance period following an intervention. Methods: This paper reports on the findings from focus groups conducted with adolescents (n=12) and parents (n=13) who had completed an eight-week intensive intervention known as Curtin University’s Activity, Food and Attitudes Program (CAFAP). Focus groups were conducted three months post intensive intervention. Participants were asked about their experiences of the prior three-month maintenance phase during which adolescents had received tri-weekly text messages based on the self-determination theory and goal-setting theory. Participants were asked about the style and content of text messages used as well as how they used the text messages. Data were analyzed using content and thematic analyses. Results: Two clear themes emerged from the focus groups relating to (1) what adolescents liked or thought they wanted in a text message to support behavior change, and (2) how they experienced or responded to text messages. Within the “like/want” theme, there were five sub-themes relating to the overall tone of the text, frequency, timing, reference to long-term goals, and inclusion of practical tips. Within the “response to text” theme, there were four sub-themes describing a lack of motivation, barriers to change, feelings of shame, and perceived unfavorable comparison with other adolescents. What adolescents said they wanted in text messages often conflicted with their actual experiences. Parent reports provided a useful secondary view of adolescent experience. Conclusions: The conflicting views described in this study suggest that overweight and obese adolescents may not know or have the ability to articulate how they would best be supported with text messages during a healthy lifestyle maintenance phase. Further, supporting both engagement and behavior change simultaneously with text messaging may not be possible. Intervention texts should be personalized as much as possible and minimize feelings of guilt and shame in overweight and obese adolescents. Future research with text messaging for overweight and obese adolescents should incorporate clear intervention aims and evaluation methods specifically related to adolescent engagement or behavior change. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12611001187932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611001187932 (Archived by WebCite at http://www.webcitation.org/6LGSbk8d9). %M 24713407 %R 10.2196/jmir.3113 %U http://www.jmir.org/2014/4/e103/ %U https://doi.org/10.2196/jmir.3113 %U http://www.ncbi.nlm.nih.gov/pubmed/24713407 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 1 %P e16 %T Usage of Social Media and Smartphone Application in Assessment of Physical and Psychological Well-Being of Individuals in Times of a Major Air Pollution Crisis %A Zhang,Melvyn WB %A Ho,Cyrus SH %A Fang,Pan %A Lu,Yanxia %A Ho,Roger CM %+ Southeast Asian Haze Research Consortium, Department of Medical Psychology, School of Medicine, Shandong University, Department of Medical Psychology, School of Medicine, Shandong University, China, 250102, China, 86 053188382039, melvynzhangweibin@gmail.com %K crisis %K haze %K Internet %K Web-based medium %K social networking %K smartphone application %D 2014 %7 25.03.2014 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Crisis situations bring about many challenges to researchers, public institutions, and governments in collecting data and conducting research in affected individuals. Recent developments in Web-based and smartphone technologies have offered government and nongovernment organizations a new system to disseminate and acquire information. However, research into this area is still lacking. The current study focuses largely on how new social networking websites and, in particular, smartphone technologies could have helped in the acquisition of crucial research data from the general population during the recent 2013 Southeast Asian Haze. This crisis lasted only for 1 week, and is unlike other crisis where there are large-scale consequential after-effects. Objective: To determine whether respondents will make use of Internet, social media, and smartphone technologies to provide feedback regarding their physical and psychological wellbeing during a crisis, and if so, will these new mechanisms be as effective as conventional, technological, Internet-based website technologies. Methods: A Web-based database and a smartphone application were developed. Participants were recruited by snowball sampling. The participants were recruited either via a self-sponsored Facebook post featuring a direct link to the questionnaire on physical and psychological wellbeing and also a smartphone Web-based application; or via dissemination of the questionnaire link by emails, directed to the same group of participants. Information pertaining to physical and psychological wellbeing was collated. Results: A total of 298 respondents took part in the survey. Most of them were between the ages of 20 to 29 years and had a university education. More individuals preferred the option of accessing and providing feedback to a survey on physical and psychological wellbeing via direct access to a Web-based questionnaire. Statistical analysis showed that demographic variables like age, gender, and educational levels did not influence the mechanism of access. In addition, the participants reported a mean number of 4.03 physical symptoms (SD 2.6). The total Impact of Event Scale–Revised (IES-R) score was 18.47 (SD 11.69), which indicated that the study population did experience psychological stress but not post-traumatic stress disorder. The perceived dangerous Pollutant Standards Index (PSI) level and the number of physical symptoms were associated with higher IES-R Score (P<.05). Conclusions: This is one of the first few studies demonstrating the use of Internet in data collection during an air-pollution crisis. Our results demonstrated that the newer technological modalities have the potential to acquire data, similar to that of conventional technologies. Demographic variables did not influence the mechanism of usage. In addition, our findings also suggested that there are acute physical and psychological impacts on the population from an air-pollution crisis. %M 25098255 %R 10.2196/mhealth.2827 %U http://mhealth.jmir.org/2014/1/e16/ %U https://doi.org/10.2196/mhealth.2827 %U http://www.ncbi.nlm.nih.gov/pubmed/25098255 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 1 %P e14 %T Using the iPod Touch for Patient Health Behavior Assessment and Health Promotion in Primary Care %A Forjuoh,Samuel N %A Ory,Marcia G %A Wang,Suojin %A des Bordes,Jude KA %A Hong,Yan %+ School of Public Health, Texas A&M University, 1266 TAMU, College Station, TX, 77843-1266, United States, 1 979 862 1700, yhong@srph.tamhsc.edu %K iPod touch %K behavior change %K health behavior assessment %K health promotion and disease prevention %K patient-physician communication %K mobile health technology %K mHealth %D 2014 %7 21.03.2014 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a growing recognition of the importance of lifestyle behavior change for health promotion and disease prevention, as well as the concomitant influence of patient–physician communication on effective behavior change. Mobile technology is increasingly being recognized as an important and efficient tool to collect patients’ health behavior data and facilitate patient–physician communication. Objective: The aim of this study was to assess the feasibility of an iPod touch-based health behavior assessment (HBA) tool in enhancing patient–physician collaborative goal-setting for health promotion in primary care. Methods: A total of 109 patients from three primary care clinics in central Texas completed a brief HBA, which was programmed on an iPod touch device. An instant feedback report was generated for the patient and their physician simultaneously to facilitate collaborative goal-setting. Within approximately 7 days of the HBA, the patients were phoned for a follow-up survey for their feedback on the iPod touch–based HBA and resultant patient–physician communication. Results: Patients were able to complete an HBA on the iPod touch with ease. Among those who completed the follow-up survey (n=83), 30% (25/83) reported that their physicians discussed the HBA report with them, while 29% (24/83) established behavior change goals with them. More than 90% (75/83) of the patients reported positive experiences with the iPod touch–based HBA. Conclusions: It is feasible to use mobile tools for HBA in the primary care setting. The HBA also facilitated patient–physician communication on behavior change. However, more research is needed on the effectiveness of large scale dissemination of mobile-based HBA technology on health communication and behavior change for preventing or managing lifestyle-related chronic conditions, such as obesity, diabetes, cancer, or heart diseases. %M 25100308 %R 10.2196/mhealth.2927 %U http://mhealth.jmir.org/2014/1/e14/ %U https://doi.org/10.2196/mhealth.2927 %U http://www.ncbi.nlm.nih.gov/pubmed/25100308 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 3 %N 1 %P e8 %T A Qualitative Analysis of User Experiences With a Self-Tracker for Activity, Sleep, and Diet %A Kim,Jeongeun %+ Seoul National University, 103 Daehak-ro Jongno-gu, Seoul, 110-799, Korea, Republic Of, 82 2 740 8483, kim0424@snu.ac.kr %K self-tracker %K quantified-self %K health consumer %K qualitative research %D 2014 %7 04.03.2014 %9 Original Paper %J Interact J Med Res %G English %X Background: The recent increase in chronic diseases and an aging population warrant the necessity of health self-management. As small electronic devices that track one’s activity, sleep, and diet, called self-trackers, are being widely distributed, it is prudent to investigate the user experience and the effectiveness of these devices, and use the information toward engineering better devices that would result in increased efficiency and usability. Objective: The aim of this study was to abstract the constructs that constitute the user experiences of the self-tracker for activity, sleep, and diet. Additionally, we aimed to develop and verify the Health Information Technology Acceptance Model-II (HITAM-II) through a qualitative data analysis approach. Methods: The study group consisted of 18 female college students who participated in an in-depth interview after completing a 3-month study of utilizing a self-tracker designed to monitor activity, sleep, and diet. The steps followed in the analysis were: (1) extraction of constructs from theoretical frameworks, (2) extraction of constructs from interview data using a qualitative methodology, and (3) abstraction of constructs and modeling of the HITAM-II. Results: The constructs that constitute the HITAM-II are information technology factors, personal factors, social factors, attitude, behavioral intention, and behavior. These constructs are further divided into subconstructs to additionally support the HITAM-II. Conclusions: The HITAM-II was found to successfully describe the health consumer’s attitude, behavioral intention, and behavior from another perspective. The result serves as the basis for a unique understanding of the user experiences of HIT. %M 24594898 %R 10.2196/ijmr.2878 %U http://www.i-jmr.org/2014/1/e8/ %U https://doi.org/10.2196/ijmr.2878 %U http://www.ncbi.nlm.nih.gov/pubmed/24594898 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 1 %P e6 %T A Classification Scheme for Analyzing Mobile Apps Used to Prevent and Manage Disease in Late Life %A Wang,Aiguo %A An,Ning %A Lu,Xin %A Chen,Hongtu %A Li,Changqun %A Levkoff,Sue %+ Gerontechnology Lab, Hefei University of Technology, Tunxi Road No. 193, Hefei, 230009, China, 86 18019956086, ning.g.an@acm.org %K mHealth %K app %K Precede-Proceed Model (PPM) %K health care process %K prevention %K management %K physical health %K mental health %D 2014 %7 17.02.2014 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There are several mobile apps that offer tools for disease prevention and management among older adults, and promote health behaviors that could potentially reduce or delay the onset of disease. A classification scheme that categorizes apps could be useful to both older adult app users and app developers. Objective: The objective of our study was to build and evaluate the effectiveness of a classification scheme that classifies mobile apps available for older adults in the “Health & Fitness” category of the iTunes App Store. Methods: We constructed a classification scheme for mobile apps according to three dimensions: (1) the Precede-Proceed Model (PPM), which classifies mobile apps in terms of predisposing, enabling, and reinforcing factors for behavior change; (2) health care process, specifically prevention versus management of disease; and (3) health conditions, including physical health and mental health. Content analysis was conducted by the research team on health and fitness apps designed specifically for older adults, as well as those applicable to older adults, released during the months of June and August 2011 and August 2012. Face validity was assessed by a different group of individuals, who were not related to the study. A reliability analysis was conducted to confirm the accuracy of the coding scheme of the sample apps in this study. Results: After applying sample inclusion and exclusion criteria, a total of 119 apps were included in the study sample, of which 26/119 (21.8%) were released in June 2011, 45/119 (37.8%) in August 2011, and 48/119 (40.3%) in August 2012. Face validity was determined by interviewing 11 people, who agreed that this scheme accurately reflected the nature of this application. The entire study sample was successfully coded, demonstrating satisfactory inter-rater reliability by two independent coders (95.8% initial concordance and 100% concordance after consensus was reached). The apps included in the study sample were more likely to be used for the management of disease than prevention of disease (109/119, 91.6% vs 15/119, 12.6%). More apps contributed to physical health rather than mental health (81/119, 68.1% vs 47/119, 39.5%). Enabling apps (114/119, 95.8%) were more common than reinforcing (20/119, 16.8%) or predisposing apps (10/119, 8.4%). Conclusions: The findings, including face validity and inter-rater reliability, support the integrity of the proposed classification scheme for categorizing mobile apps for older adults in the “Health and Fitness” category available in the iTunes App Store. Using the proposed classification system, older adult app users would be better positioned to identify apps appropriate for their needs, and app developers would be able to obtain the distributions of available mobile apps for health-related concerns of older adults more easily. %M 25098687 %R 10.2196/mhealth.2877 %U http://mhealth.jmir.org/2014/1/e6/ %U https://doi.org/10.2196/mhealth.2877 %U http://www.ncbi.nlm.nih.gov/pubmed/25098687 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 1 %P e4 %T Who Uses Smoking Cessation Apps? A Feasibility Study Across Three Countries via Smartphones %A BinDhim,Nasser F %A McGeechan,Kevin %A Trevena,Lyndal %+ Sydney Medical School, Department of Public Health, University of Sydney, Rm 125, Lvl 1, Edward Ford Building A27, Sydney, 2006, Australia, 61 434556298, nbin6641@uni.sydney.edu.au %K smartphone %K handheld computers %K health promotion %K tobacco and smoking %K global health %K prevention %K apps %K health Informatics %K public health %D 2014 %7 06.02.2014 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone use is growing worldwide. While hundreds of smoking cessation apps are currently available in the app stores, there is no information about who uses them. Smartphones also offer potential as a research tool, but this has not previously been explored. Objective: This study aims to measure and compare the uptake of a smoking cessation app over one year in Australia, the United Kingdom, and the United States. It also assesses the feasibility of conducting research via an app, describing respondents’ characteristics (demographics, smoking status, and other health related app use), and examining differences across countries. Methods: This is a cross-sectional exploratory study of adults 18 years and older, passively recruited over one year in 2012, who downloaded this study app (Quit Advisor) via the two largest app stores (Apple and Android). Results: The total number of app downloads after one year was 1751, 72.98% (1278/1751) of them were Apple operation system users. Of these 1751 participants, 47.68% (835/1751) were from the United States, 29.18% (511/1751) were from the United Kingdom, and 16.68% (292/1751) were from Australia. There were 602 participants, 36.75% (602/1638) that completed a questionnaire within the app. Of these 602 participants, 58.8% (354/602) were female and the mean age was 32 years. There were no significant differences between countries in terms of age, operation system used, number of quitting attempts, and language spoken at home. However, there were significant differences between countries in terms of gender and stage of change. There were 77.2% (465/602) of the respondents that were ready to quit in the next 30 days and the majority of these had never sought professional help (eg, “Quitline”). More than half had downloaded smoking cessation apps in the past and of these, three-quarters had made quitting attempts (lasted at least 24 hours) using an app before. Respondents who had attempted to quit three times or more in the previous year were more likely to have tried smoking cessation apps (OR 3.3, 95% CI 2.1-5.2). There were 50.2% (302/602) of the respondents that had used other health related apps before. Of these, 89.4% (270/302) were using health related apps at least once a week, but 77.5% (234/302) never checked the credibility of the health app publishers before downloading. Conclusions: A smartphone app was able to reach smokers across three countries that were not seeking professional help, but were ready to quit within the next 30 days. Respondents were relatively young and almost demographically similar across all three countries. They also frequently used other health related apps, mostly without checking the credibility of their publishers. %M 25098439 %R 10.2196/mhealth.2841 %U http://mhealth.jmir.org/2014/1/e4/ %U https://doi.org/10.2196/mhealth.2841 %U http://www.ncbi.nlm.nih.gov/pubmed/25098439 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 12 %P e282 %T Use of a Text Message Program to Raise Type 2 Diabetes Risk Awareness and Promote Health Behavior Change (Part II): Assessment of Participants' Perceptions on Efficacy %A Buis,Lorraine R %A Hirzel,Lindsey %A Turske,Scott A %A Des Jardins,Terrisca R %A Yarandi,Hossein %A Bondurant,Patricia %+ University of Michigan, Department of Family Medicine, 1018 Fuller St, Ann Arbor, MI, 48104-1213, United States, 1 734 998 7120 ext 312, buisl@umich.edu %K diabetes mellitus, type 2 %K mobile health %K cellular phone %K text messaging %K risk reduction behavior %K program evaluation %D 2013 %7 19.12.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Although there is great enthusiasm in both the public and private sector for the further development and use of large-scale consumer-facing public health applications for mobile platforms, little is known about user experience and satisfaction with this type of approach. As a part of the Beacon Community Cooperative Agreement Program, txt4health, a public-facing, mobile phone-based health information service targeting type 2 diabetes, was launched in 3 Beacon Communities: the Southeast Michigan Beacon Community in Detroit, MI, the Greater Cincinnati Beacon Community in Cincinnati, OH, and the Crescent City Beacon Community in New Orleans, LA. This program was marketed via large public health campaigns and drew many users within the respective communities. Objective: The purpose of this investigation was to use the RE-AIM framework to document txt4health efficacy by focusing on perceptions of satisfaction, usage, and behavior change among individuals who used txt4health in pilot studies in Southeast Michigan and Greater Cincinnati. Methods: We conducted a multimodal user survey with txt4health users recruited via text message through the program to understand participant perceptions of program use and satisfaction, as well as self-reported perceptions of behavior change as a result of using txt4health. Results: Txt4health users reported very high levels of program satisfaction, with 67.1% (108/161) reporting satisfaction scores of ≥8 on a 10-point scale, with 10 equivalent to most satisfied (mean 8.2, SD 1.6). All survey participants agreed/strongly agreed that the messages included in txt4health were clear and easy to understand (100.0%, 160/160), and most found txt4health made them knowledgeable about their risk for type 2 diabetes (88.1%, 140/159) and made them conscious of their diet and physical activity (88.8%, 142/160). Most participants reported that txt4health helped them to make behavior changes related to diet; after having completed txt4health, most agreed/strongly agreed that they are more likely to replace sugary drinks, such as juice or soda, with water (78.0%, 124/159), have a piece of fresh fruit instead of dessert (74.2%, 118/159), substitute a small salad for chips or fries when dining out (76.1%, 121/159), buy healthier foods when grocery shopping (79.7%, 126/158), and eat more grilled, baked, or broiled foods instead of fried (75.5%, 120/159). Conclusions: Results from this study suggest that participants in txt4health, a large-scale, public health–focused text message program targeting type 2 diabetes, have positive perceptions of the program and that participation has led to positive behavior change. %M 24356359 %R 10.2196/jmir.2929 %U http://www.jmir.org/2013/12/e282/ %U https://doi.org/10.2196/jmir.2929 %U http://www.ncbi.nlm.nih.gov/pubmed/24356359 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 12 %P e281 %T Use of a Text Message Program to Raise Type 2 Diabetes Risk Awareness and Promote Health Behavior Change (Part I): Assessment of Participant Reach and Adoption %A Buis,Lorraine R %A Hirzel,Lindsey %A Turske,Scott A %A Des Jardins,Terrisca R %A Yarandi,Hossein %A Bondurant,Patricia %+ University of Michigan, Department of Family Medicine, 1018 Fuller St, Ann Arbor, MI, 48104-1213, United States, 1 734 998 7120 ext 312, buisl@umich.edu %K diabetes mellitus, type 2 %K mobile health %K cellular phone %K text messaging %K risk reduction behavior %K program evaluation %D 2013 %7 19.12.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: There are an estimated 25.8 million American children and adults, equivalent to 8.3% of the US population, living with diabetes. Diabetes is particularly burdensome on minority populations. The use of mobile technologies for reaching broad populations is a promising approach, given its wide footprint and ability to deliver inexpensive personalized messages, to increase awareness of type 2 diabetes and promote behavior changes targeting risk factors associated with type 2 diabetes. As a part of the Beacon Community Cooperative Agreement Program, txt4health, a public-facing mobile health information service, was launched in 3 Beacon Communities: the Southeast Michigan Beacon Community in Detroit, MI, the Greater Cincinnati Beacon Community in Cincinnati, OH, and the Crescent City Beacon Community in New Orleans, LA. Txt4health is a mobile health information service designed to help people understand their risk for type 2 diabetes and become more informed about the steps they can take to lead healthy lives. Objective: The purpose of this investigation was to use the RE-AIM framework to document txt4health reach and adoption by focusing on enrollment and participant engagement in program pilots in Southeast Michigan and Greater Cincinnati. Methods: We conducted a retrospective records analysis of individual-level txt4health system data from participants in Southeast Michigan and Greater Cincinnati to determine participant usage of txt4health and engagement with the program. Results: Results from the retrospective records analysis revealed that 5570 participants initiated the 2-step enrollment process via 1 of 3 enrollment strategies: text message, website, or directly with Beacon staff who signed participants up via the website. In total, 33.00% (1838/5570) of participants completed the 2-step enrollment process and were fully enrolled in the program. All participants (100.00%, 1620/1620) who enrolled via text message completed the entire 2-step enrollment process versus 5.52% (218/3950) of participants who enrolled via website or a Beacon staff member. Of those who fully enrolled, 71.00% (1305/1838) completed the diabetes risk assessment and 74.27% (1365/1838) set an initial weight loss goal. Overall, 39.06% (718/1838) of participants completed all 14 weeks of the program and 56.26% (1034/1838) dropped out before completing all 14 weeks, with the bulk of dropouts occurring in the first 4 weeks. Length of participation varied greatly, ranging from 0-48.7 weeks (median 8.6, mean 15.8, SD 15.8). Wide variability of participant engagement in regards to weekly weight and physical activity was documented. Conclusions: Although broadly focused public health text message interventions may have the potential to reach large populations and show high levels of engagement among some users, the level of individual engagement among participants varies widely, suggesting that this type of approach may not be appropriate for all. %M 24356329 %R 10.2196/jmir.2928 %U http://www.jmir.org/2013/12/e281/ %U https://doi.org/10.2196/jmir.2928 %U http://www.ncbi.nlm.nih.gov/pubmed/24356329 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 12 %P e272 %T Leveraging Text Messaging and Mobile Technology to Support Pediatric Obesity-Related Behavior Change: A Qualitative Study Using Parent Focus Groups and Interviews %A Sharifi,Mona %A Dryden,Eileen M %A Horan,Christine M %A Price,Sarah %A Marshall,Richard %A Hacker,Karen %A Finkelstein,Jonathan A %A Taveras,Elsie M %+ Division of General Pediatrics, Massachusetts General Hospital for Children, Harvard Medical School, 100 Cambridge Street, 15th floor, Suite 1523, Boston, MA, 02114, United States, 1 617 724 4007, msharifi@partners.org %K child %K obesity %K overweight %K health behavior %K text messaging %K telemedicine %D 2013 %7 06.12.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Text messaging (short message service, SMS) is a widely accessible and potentially cost-effective medium for encouraging behavior change. Few studies have examined text messaging interventions to influence child health behaviors or explored parental perceptions of mobile technologies to support behavior change among children. Objective: Our aim was to examine parental acceptability and preferences for text messaging to support pediatric obesity-related behavior change. Methods: We conducted focus groups and follow-up interviews with parents of overweight and obese children, aged 6-12 years, seen for “well-child” care in eastern Massachusetts. A professional moderator used a semistructured discussion guide and sample text messages to catalyze group discussions. Seven participants then received 3 weeks of text messages before a follow-up one-on-one telephone interview. All focus groups and interviews were recorded and transcribed verbatim. Using a framework analysis approach, we systematically coded and analyzed group and interview data to identify salient and convergent themes. Results: We reached thematic saturation after five focus groups and seven follow-up interviews with a total of 31 parents of diverse race/ethnicity and education levels. Parents were generally enthusiastic about receiving text messages to support healthy behaviors for their children and preferred them to paper or email communication because they are brief and difficult to ignore. Participants anticipated high responsiveness to messaging endorsed by their child’s doctor and indicated they would appreciate messages 2-3 times/week or more as long as content remains relevant. Suggestions for maintaining message relevance included providing specific strategies for implementation and personalizing information. Most felt the negative features of text messaging (eg, limited message size) could be overcome by providing links within messages to other media including email or websites. Conclusions: Text messaging is a promising medium for supporting pediatric obesity-related behavior change. Parent perspectives could assist in the design of text-based interventions. Trial Registration: Clinicaltrials.gov NCT01565161; http://clinicaltrials.gov/show/NCT01565161 (Archived by WebCite at http://www.webcitation.org/6LSaqFyPP). %M 24317406 %R 10.2196/jmir.2780 %U http://www.jmir.org/2013/12/e272/ %U https://doi.org/10.2196/jmir.2780 %U http://www.ncbi.nlm.nih.gov/pubmed/24317406 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 11 %P e244 %T Daily Text Messaging for Weight Control Among Racial and Ethnic Minority Women: Randomized Controlled Pilot Study %A Steinberg,Dori M %A Levine,Erica L %A Askew,Sandy %A Foley,Perry %A Bennett,Gary G %+ Duke Obesity Prevention Program, Duke Global Health Institute, Duke University, 134 Trent Hall, Box 90519, 310 Trent Drive, Durham, NC, 27708, United States, 1 919 613 5453, dori.steinberg@duke.edu %K self-monitoring %K mHealth %K text messaging %K weight loss %K black women %D 2013 %7 18.11.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Daily self-monitoring of diet and physical activity behaviors is a strong predictor of weight loss success. Text messaging holds promise as a viable self-monitoring modality, particularly among racial/ethnic minority populations. Objective: This pilot study evaluated the feasibility of a text messaging intervention for weight loss among predominantly black women. Methods: Fifty obese women were randomized to either a 6-month intervention using a fully automated system that included daily text messages for self-monitoring tailored behavioral goals (eg, 10,000 steps per day, no sugary drinks) along with brief feedback and tips (n=26) or to an education control arm (n=24). Weight was objectively measured at baseline and at 6 months. Adherence was defined as the proportion of text messages received in response to self-monitoring prompts. Results: The average daily text messaging adherence rate was 49% (SD 27.9) with 85% (22/26) texting self-monitored behavioral goals 2 or more days per week. Approximately 70% (16/23) strongly agreed that daily texting was easy and helpful and 76% (16/21) felt the frequency of texting was appropriate. At 6 months, the intervention arm lost a mean of 1.27 kg (SD 6.51), and the control arm gained a mean of 1.14 kg (SD 2.53; mean difference –2.41 kg, 95% CI –5.22 to 0.39; P=.09). There was a trend toward greater text messaging adherence being associated with greater percent weight loss (r=–.36; P=.08), but this did not reach statistical significance. There was no significant association between goal attainment and text messaging adherence and no significant predictors of adherence. Conclusions: Given the increasing penetration of mobile devices, text messaging may be a useful self-monitoring tool for weight control, particularly among populations most in need of intervention. Trial Registration: Clinicaltrials.gov: NCT00939081; http://clinicaltrials.gov/show/NCT00939081 (Archived by WebCite at http://www.webcitation.org/6KiIIcnk1). %M 24246427 %R 10.2196/jmir.2844 %U http://www.jmir.org/2013/11/e244/ %U https://doi.org/10.2196/jmir.2844 %U http://www.ncbi.nlm.nih.gov/pubmed/24246427 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 2 %N 2 %P e48 %T Feasibility and Effectiveness of an Automated Bilingual Text Message Intervention for Weight Loss: Pilot Study %A Kolodziejczyk,Julia K %A Norman,Gregory J %A Barrera-Ng,Angelica %A Dillon,Lindsay %A Marshall,Simon %A Arredondo,Elva %A Rock,Cheryl L %A Raab,Fred %A Griswold,William G %A Sullivan,Mark %A Patrick,Kevin %+ Center for Wireless & Population Health Systems (CWPHS), Qualcomm Institute/Calit2, University of California, San Diego, 9500 Gilman Drive, Dept 0811, La Jolla, CA, 92093, United States, 1 858 534 9550, jkolodzi@ucsd.edu %K physical activity %K diet %K obesity %K health behavior %K Hispanic Americans %K weight loss %K cellular phone %K text messaging %D 2013 %7 06.11.2013 %9 Short Paper %J JMIR Res Protoc %G English %X Background: Little is known about the feasibility and acceptability of tailored text message based weight loss programs for English and Spanish-language speakers. Objective: This pilot study evaluated the feasibility, acceptability, and estimated impact of a tailored text message based weight loss program for English and Spanish-language speakers. The purpose of this pilot study was to inform the development of a full-scale randomized trial. Methods: There were 20 overweight or obese participants (mean age 40.10, SD 8.05; 8/20, 40% male; 9/20, 45% Spanish-speakers) that were recruited in San Diego, California, from March to May 2011 and evaluated in a one-group pre/post clinical trial. For 8 weeks, participants received and responded to 3-5 text messages daily sent from a fully automated text messaging system. They also received printed weight loss materials and brief 10-15 minute weekly counseling calls. To estimate the impact of the program, the primary outcome was weight (kg) measured during face-to-face measurement visits by trained research staff. Pre and post differences in weight were analyzed with a one-way repeated measures analysis of variance. Differences by language preference at both time points were analyzed with t tests. Body mass index and weight management behaviors also were examined. Feasibility and acceptability were determined by recruitment success, adherence (ie, percentage of replies to interactive text messages and attrition), and participant satisfaction. Results: Participants who completed the final assessment (N=18) decreased body weight by 1.85 kg (F1,17=10.80, P=.004, CI∆ 0.66-3.03, η2=0.39). At both time points, there were no differences in weight by language preference. Participants responded to 88.04% (986/1120) of interactive text messages, attrition rate was 10% (2/20), and 94% (19/20) of participants reported satisfaction with the program. Conclusions: This fully automated text message based weight program was feasible with English and Spanish-speakers and may have promoted modest weight loss over an 8-week period. Trial Registration: Clinicaltrials.gov NCT01171586; http://clinicaltrials.gov/ct2/show/NCT01171586 (Archived by WebCite at http://www.webcitation.org/6Ksr6dl7n). %M 24200517 %R 10.2196/resprot.2789 %U http://www.researchprotocols.org/2013/2/e48/ %U https://doi.org/10.2196/resprot.2789 %U http://www.ncbi.nlm.nih.gov/pubmed/24200517 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e24 %T Mindfulness-Based Mobile Applications: Literature Review and Analysis of Current Features %A Plaza,Inmaculada %A Demarzo,Marcelo Marcos Piva %A Herrera-Mercadal,Paola %A García-Campayo,Javier %+ Instituto Aragonés de Ciencias de la Salud, Department of Psychiatry, Universidad de Zaragoza, Avda Isabel La Católica 1, Zaragoza, 50009, Spain, 34 976253621, jgarcamp@gmail.com %K mobile health %K mHealth %K mindfulness %K social networks %K personalized education %K health informatics %K evidence-based medicine %D 2013 %7 01.11.2013 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Interest in mindfulness has increased exponentially, particularly in the fields of psychology and medicine. The trait or state of mindfulness is significantly related to several indicators of psychological health, and mindfulness-based therapies are effective at preventing and treating many chronic diseases. Interest in mobile applications for health promotion and disease self-management is also growing. Despite the explosion of interest, research on both the design and potential uses of mindfulness-based mobile applications (MBMAs) is scarce. Objective: Our main objective was to study the features and functionalities of current MBMAs and compare them to current evidence-based literature in the health and clinical setting. Methods: We searched online vendor markets, scientific journal databases, and grey literature related to MBMAs. We included mobile applications that featured a mindfulness-based component related to training or daily practice of mindfulness techniques. We excluded opinion-based articles from the literature. Results: The literature search resulted in 11 eligible matches, two of which completely met our selection criteria–a pilot study designed to evaluate the feasibility of a MBMA to train the practice of “walking meditation,” and an exploratory study of an application consisting of mood reporting scales and mindfulness-based mobile therapies. The online market search eventually analyzed 50 available MBMAs. Of these, 8% (4/50) did not work, thus we only gathered information about language, downloads, or prices. The most common operating system was Android. Of the analyzed apps, 30% (15/50) have both a free and paid version. MBMAs were devoted to daily meditation practice (27/46, 59%), mindfulness training (6/46, 13%), assessments or tests (5/46, 11%), attention focus (4/46, 9%), and mixed objectives (4/46, 9%). We found 108 different resources, of which the most used were reminders, alarms, or bells (21/108, 19.4%), statistics tools (17/108, 15.7%), audio tracks (15/108, 13.9%), and educational texts (11/108, 10.2%). Daily, weekly, monthly statistics, or reports were provided by 37% (17/46) of the apps. 28% (13/46) of them permitted access to a social network. No information about sensors was available. The analyzed applications seemed not to use any external sensor. English was the only language of 78% (39/50) of the apps, and only 8% (4/50) provided information in Spanish. 20% (9/46) of the apps have interfaces that are difficult to use. No specific apps exist for professionals or, at least, for both profiles (users and professionals). We did not find any evaluations of health outcomes resulting from the use of MBMAs. Conclusions: While a wide selection of MBMAs seem to be available to interested people, this study still shows an almost complete lack of evidence supporting the usefulness of those applications. We found no randomized clinical trials evaluating the impact of these applications on mindfulness training or health indicators, and the potential for mobile mindfulness applications remains largely unexplored. %M 25099314 %R 10.2196/mhealth.2733 %U http://mhealth.jmir.org/2013/2/e24/ %U https://doi.org/10.2196/mhealth.2733 %U http://www.ncbi.nlm.nih.gov/pubmed/25099314 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 10 %P e224 %T Assessing the Internal and External Validity of Mobile Health Physical Activity Promotion Interventions: A Systematic Literature Review Using the RE-AIM Framework %A Blackman,Kacie CA %A Zoellner,Jamie %A Berrey,Leanna M %A Alexander,Ramine %A Fanning,Jason %A Hill,Jennie L %A Estabrooks,Paul A %+ Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Integrated Life Sciences Building, 1981 Kraft Drive, Blacksburg, VA, 24060, United States, 1 323 442 ext 7250, kaciea1@vt.edu %K physical activity %K mobile technology %K review %K generalizability %D 2013 %7 04.10.2013 %9 Review %J J Med Internet Res %G English %X Background: Mobile health (mHealth) interventions are effective in promoting physical activity (PA); however, the degree to which external validity indicators are reported is unclear. Objective: The purpose of this systematic review was to use the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to determine the extent to which mHealth intervention research for promoting PA reports on factors that inform generalizability across settings and populations and to provide recommendations for investigators planning to conduct this type of research. Methods: Twenty articles reflecting 15 trials published between 2000 and 2012 were identified through a systematic review process (ie, queries of three online databases and reference lists of eligible articles) and met inclusion criteria (ie, implementation of mobile technologies, target physical activity, and provide original data). Two researchers coded each article using a validated RE-AIM data extraction tool (reach, efficacy/effectiveness, adoption, implementation, maintenance). Two members of the study team independently abstracted information from each article (inter-rater reliability >90%) and group meetings were used to gain consensus on discrepancies. Results: The majority of studies were randomized controlled trials (n=14). The average reporting across RE-AIM indicators varied by dimension (reach=53.3%, 2.67/5; effectiveness/efficacy=60.0%, 2.4/4; adoption=11.1%, 0.7/6; implementation=24.4%, 0.7/3; maintenance=0%, 0/3). While most studies described changes in the primary outcome (effectiveness), few addressed the representativeness of participants (reach) or settings (adoption) and few reported on issues related to maintenance and degree of implementation fidelity. Conclusions: This review suggests that more focus is needed on research designs that highlight and report on both internal and external validity indicators. Specific recommendations are provided to encourage future mHealth interventionists and investigators to report on representativeness, settings, delivery agents for planned interventions, the extent to which protocol is delivered as intended, and maintenance of effects at the individual or organizational level. %M 24095951 %R 10.2196/jmir.2745 %U http://www.jmir.org/2013/10/e224/ %U https://doi.org/10.2196/jmir.2745 %U http://www.ncbi.nlm.nih.gov/pubmed/24095951 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 9 %P e196 %T A Pre-Post Study on the Appropriateness and Effectiveness of a Web- and Text Messaging-Based Intervention to Reduce Problem Drinking in Emerging Adults %A Haug,Severin %A Schaub,Michael P %A Venzin,Vigeli %A Meyer,Christian %A John,Ulrich %A Gmel,Gerhard %+ Swiss Research Institute for Public Health and Addiction at Zurich University, Konradstrasse 32, Zurich, 8031, Switzerland, 41 44 448 11 74, severin.haug@isgf.uzh.ch %K alcohol intervention %K problem drinking %K young people %K text messaging %K Internet %D 2013 %7 02.09.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Problem drinking, particularly risky single-occasion drinking (RSOD), also called “binge drinking”, is widespread among adolescents and young adults in most Western countries. Few studies have tested the effectiveness of interventions to reduce RSOD in young people with heterogeneous and particularly lower educational background. Objective: To test the appropriateness and initial effectiveness of a combined, individually tailored Web- and text messaging (SMS)–based intervention program to reduce problem drinking in vocational school students. Methods: The fully automated program provided: (1) online feedback about an individual’s drinking pattern compared to the drinking norms of an age- and gender-specific reference group, and (2) recurrent individualized SMS messages over a time period of 3 months. Generalized Estimating Equation (GEE) analyses were used to investigate the longitudinal courses of the following outcomes over the study period of 3 months: RSOD, alcohol-related problems, mean number of standard drinks per week, and maximum number of standard drinks on an occasion. Results: The program was tested in 36 school classes at 7 vocational schools in Switzerland. Regardless of their drinking behavior, 477 vocational school students who owned a mobile phone were invited to participate in the program. Of these, 364 (76.3%) participated in the program. During the intervention period, 23 out of 364 (6.3%) persons unsubscribed from participating in the program. The GEE analyses revealed decreases in the percentage of persons with RSOD from baseline (75.5%, 210/278) to follow-up assessment (67.6%, 188/278, P<.001), in the percentage of persons with alcohol-related problems (20.4%, 57/280 to 14.3%, 40/280, P=.009), and in the mean number of standard drinks per week: 13.4 (SD 15.3) to 11.3 (SD 14.0), P=.002. They also revealed a trend toward a decrease in the mean of the maximum number of drinks consumed on an occasion: 11.3 (SD 10.3) to 10.5 (SD 10.3), P=.08. Conclusions: The results show high acceptance and promising effectiveness of this interventional approach, which could be easily and economically implemented within school classes. %M 23999406 %R 10.2196/jmir.2755 %U http://www.jmir.org/2013/9/e196/ %U https://doi.org/10.2196/jmir.2755 %U http://www.ncbi.nlm.nih.gov/pubmed/23999406 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e17 %T A Text Message Delivered Smoking Cessation Intervention: The Initial Trial of TXT-2-Quit: Randomized Controlled Trial %A Bock,Beth %A Heron,Kristin %A Jennings,Ernestine %A Morrow,Kathleen %A Cobb,Victoria %A Magee,Joshua %A Fava,Joseph %A Deutsch,Christopher %A Foster,Robert %+ Alpert Medical School, Brown University, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, United States, 1 401 793 8020, Bbock@lifespan.org %K smoking cessation %K tobacco %K texting, text messaging %K mobile health %K mHealth %K health communications %D 2013 %7 30.07.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile technology offers the potential to deliver health-related interventions to individuals who would not otherwise present for in-person treatment. Text messaging (short message service, SMS), being the most ubiquitous form of mobile communication, is a promising method for reaching the most individuals. Objective: The goal of the present study was to evaluate the feasibility and preliminary efficacy of a smoking cessation intervention program delivered through text messaging. Methods: Adult participants (N=60, age range 18-52 years) took part in a single individual smoking cessation counseling session, and were then randomly assigned to receive either daily non-smoking related text messages (control condition) or the TXT-2-Quit (TXT) intervention. TXT consisted of automated smoking cessation messages tailored to individual’s stage of smoking cessation, specialized messages provided on-demand based on user requests for additional support, and a peer-to-peer social support network. Generalized estimating equation analysis was used to assess the primary outcome (7-day point-prevalence abstinence) using a 2 (treatment groups)×3 (time points) repeated measures design across three time points: 8 weeks, 3 months, and 6 months. Results: Smoking cessation results showed an overall significant group difference in 7-day point prevalence abstinence across all follow-up time points. Individuals given the TXT intervention, with higher odds of 7-day point prevalence abstinence for the TXT group compared to the Mojo group (OR=4.52, 95% CI=1.24, 16.53). However, individual comparisons at each time point did not show significant between-group differences, likely due to reduced statistical power. Intervention feasibility was greatly improved by switching from traditional face-to-face recruitment methods (4.7% yield) to an online/remote strategy (41.7% yield). Conclusions: Although this study was designed to develop and provide initial testing of the TXT-2-Quit system, these initial findings provide promising evidence that a text-based intervention can be successfully implemented with a diverse group of adult smokers. Trial Registration: ClinicalTrials.gov: NCT01166464; http://clinicaltrials.gov/ct2/show/NCT01166464 (Archived by WebCite at http://www.webcitation.org/6IOE8XdE0). %M 25098502 %R 10.2196/mhealth.2522 %U http://mhealth.jmir.org/2013/2/e17/ %U https://doi.org/10.2196/mhealth.2522 %U http://www.ncbi.nlm.nih.gov/pubmed/25098502 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e16 %T Personal Health Technologies in Employee Health Promotion: Usage Activity, Usefulness, and Health-Related Outcomes in a 1-Year Randomized Controlled Trial %A Mattila,Elina %A Orsama,Anna-Leena %A Ahtinen,Aino %A Hopsu,Leila %A Leino,Timo %A Korhonen,Ilkka %+ VTT Technical Research Centre of Finland, PO Box 1300, Tampere, 33101, Finland, 358 207223384, elina.m.mattila@vtt.fi %K health promotion %K intervention %K Internet %K mobile phones %K device %K risk factors %K health technology %D 2013 %7 29.07.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Common risk factors such as obesity, poor nutrition, physical inactivity, stress, and sleep deprivation threaten the wellness and work ability of employees. Personal health technologies may help improve engagement in health promotion programs and maintenance of their effect. Objective: This study investigated personal health technologies in supporting employee health promotion targeting multiple behavioral health risks. We studied the relations of usage activity to demographic and physiological characteristics, health-related outcomes (weight, aerobic fitness, blood pressure and cholesterol), and the perceived usefulness of technologies in wellness management. Methods: We conducted a subgroup analysis of the technology group (114 subjects, 33 males, average age 45 years, average BMI 27.1 kg/m2) of a 3-arm randomized controlled trial (N=352). The trial was organized to study the efficacy of a face-to-face group intervention supported by technologies, including Web services, mobile applications, and personal monitoring devices. Technology usage was investigated based on log files and questionnaires. The associations between sustained usage of Web and mobile technologies and demographic and physiological characteristics were analyzed by comparing the baseline data of sustained and non-sustained users. The associations between sustained usage and changes in health-related outcomes were studied by repeated analysis of variance, using data measured by baseline and end questionnaires, and anthropometric and laboratory measurements. The experienced usability, usefulness, motivation, and barriers to using technologies were investigated by 4 questionnaires and 2 interviews. Results: 111 subjects (97.4%) used technologies at some point of the study, and 33 (29.9%) were classified as sustained users of Web or mobile technologies. Simple technologies, weight scales and pedometer, attracted the most users. The sustained users were slightly older 47 years (95% CI 44 to 49) versus 44 years (95% CI 42 to 45), P=.034 and had poorer aerobic fitness at baseline (mean difference in maximal metabolic equivalent 1.0, 95% Cl 0.39 to 1.39; P=.013) than non-sustained users. They succeeded better in weight management: their weight decreased -1.2 kg (95% CI -2.38 to -0.01) versus +0.6 kg (95% CI -0.095 to 1.27), P=.006; body fat percentage -0.9%-units (95% CI -1.64 to -0.09) versus +0.3%-units (95% CI -0.28 to 0.73), P=.014; and waist circumference -1.4 cm (95% CI -2.60 to -0.20) versus +0.7 cm (95% CI -0.21 to 1.66), P=.01. They also participated in intervention meetings more actively: median 4 meetings (interquartile range; IQR 4–5) versus 4 meetings (IQR 3–4), P=.009. The key factors in usefulness were: simplicity, integration into daily life, and clear feedback on progress. Conclusions: Despite active initial usage, less than 30% of subjects continued using Web or mobile technologies throughout the study. Sustained users achieved better weight-related outcomes than non-sustained users. High non-usage attrition and modest outcomes cast doubt on the potential of technologies to support interventions. %M 25098385 %R 10.2196/mhealth.2557 %U http://mhealth.jmir.org/2013/2/e16/ %U https://doi.org/10.2196/mhealth.2557 %U http://www.ncbi.nlm.nih.gov/pubmed/25098385 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e11 %T Mobile Mental Wellness Training for Stress Management: Feasibility and Design Implications Based on a One-Month Field Study %A Ahtinen,Aino %A Mattila,Elina %A Välkkynen,Pasi %A Kaipainen,Kirsikka %A Vanhala,Toni %A Ermes,Miikka %A Sairanen,Essi %A Myllymäki,Tero %A Lappalainen,Raimo %+ VTT Technical Research Centre of Finland, Sinitaival 6, Tampere, 33720, Finland, 358 207223384, elina.m.mattila@vtt.fi %K stress %K mental health %K mobile phone %K acceptance and commitment therapy %K field studies %K user experience %K design %D 2013 %7 10.07.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Prevention and management of work-related stress and related mental problems is a great challenge. Mobile applications are a promising way to integrate prevention strategies into the everyday lives of citizens. Objective: The objectives of this study was to study the usage, acceptance, and usefulness of a mobile mental wellness training application among working-age individuals, and to derive preliminary design implications for mobile apps for stress management. Methods: Oiva, a mobile app based on acceptance and commitment therapy (ACT), was designed to support active learning of skills related to mental wellness through brief ACT-based exercises in the daily life. A one-month field study with 15 working-age participants was organized to study the usage, acceptance, and usefulness of Oiva. The usage of Oiva was studied based on the usage log files of the application. Changes in wellness were measured by three validated questionnaires on stress, satisfaction with life (SWLS), and psychological flexibility (AAQ-II) at the beginning and at end of the study and by user experience questionnaires after one week’s and one month’s use. In-depth user experience interviews were conducted after one month’s use to study the acceptance and user experiences of Oiva. Results: Oiva was used actively throughout the study. The average number of usage sessions was 16.8 (SD 2.4) and the total usage time per participant was 3 hours 12 minutes (SD 99 minutes). Significant pre-post improvements were obtained in stress ratings (mean 3.1 SD 0.2 vs mean 2.5 SD 0.1, P=.003) and satisfaction with life scores (mean 23.1 SD 1.3 vs mean 25.9 SD 0.8, P=.02), but not in psychological flexibility. Oiva was perceived easy to use, acceptable, and useful by the participants. A randomized controlled trial is ongoing to evaluate the effectiveness of Oiva on working-age individuals with stress problems. Conclusions: A feasibility study of Oiva mobile mental wellness training app showed good acceptability, usefulness, and engagement among the working-age participants, and provided increased understanding on the essential features of mobile apps for stress management. Five design implications were derived based on the qualitative findings: (1) provide exercises for everyday life, (2) find proper place and time for challenging content, (3) focus on self-improvement and learning instead of external rewards, (4) guide gently but do not restrict choice, and (5) provide an easy and flexible tool for self-reflection. %M 25100683 %R 10.2196/mhealth.2596 %U http://mhealth.jmir.org/2013/2/e11/ %U https://doi.org/10.2196/mhealth.2596 %U http://www.ncbi.nlm.nih.gov/pubmed/25100683 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e8 %T The Development of a Mobile Monitoring and Feedback Tool to Stimulate Physical Activity of People With a Chronic Disease in Primary Care: A User-Centered Design %A van der Weegen,Sanne %A Verwey,Renée %A Spreeuwenberg,Marieke %A Tange,Huibert %A van der Weijden,Trudy %A de Witte,Luc %+ CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, PO Box 616, Maastricht, 6200 MD, Netherlands, 31 433881479, s.vanderweegen@maastrichtuniversity.nl %K user-centered design %K self-management %K physical activity %K accelerometry %K remote sensing technology %K primary health care %D 2013 %7 02.07.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity is an important aspect in the treatment of patients with chronic obstructive pulmonary disease or type-2 diabetes. A monitoring and feedback tool combined with guidance by a primary care provider might be a successful method to enhance the level of physical activity in these patients. As a prerequisite for useful technology, it is important to involve the end-users in the design process from an early stage. Objective: The aim of this study was to investigate the user requirements for a tool to stimulate physical activity, embedded in primary care practice. The leading principle of this tool is to change behavior by self-monitoring, goal-setting, and feedback. Methods: The research team collected qualitative data among 15 patients, 16 care professionals, and several experts. A prototype was developed in three stages. In stage 1, the literature was searched to identify end-users and context. In stage 2, the literature, experts and patient representatives were consulted to set up a use case with the general idea of the innovation. In stage 3, individual interviews and focus groups were held to identify the end-user requirements. Based on these requirements a prototype was built by the engineering team. Results: The development process has led to a tool that generally meets the requirements of the end-users. A tri-axial activity sensor, worn on the hip, is connected by Bluetooth to a smartphone. In an app, quantitative feedback is given about the amount of activity and goals reached by means of graphical visualization, and an image shows a sun when the goal is reached. Overviews about activity per half an hour, per day, week, and month are provided. In the menu of the app and on a secured website, patients can enter information in individual sessions or read feedback messages generated by the system. The practice nurse can see the results of all patients on a secure webpage and can then discuss the results and set personalized goals in consultation with the patient. Conclusions: This study demonstrates that a user-centered approach brings in valuable details (such as the requirements for feedback in activity minutes per day) to improve the fit between the user, technology, and the organization of care, which is important for the usability and acceptability of the tool. The tool embedded in primary care will be evaluated in a randomized controlled trial. %M 25099556 %R 10.2196/mhealth.2526 %U http://mhealth.jmir.org/2013/2/e8/ %U https://doi.org/10.2196/mhealth.2526 %U http://www.ncbi.nlm.nih.gov/pubmed/25099556 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 1 %P e5 %T Development of a Theoretically Driven mHealth Text Messaging Application for Sustaining Recent Weight Loss %A Shaw,Ryan J %A Bosworth,Hayden B %A Hess,Jeffrey C %A Silva,Susan G %A Lipkus,Isaac M %A Davis,Linda L %A Johnson,Constance M %+ School of Nursing, Duke University, 307 Trent Dr., Durham, NC, 27710, United States, 1 919 410 6372, ryan.shaw@duke.edu %K mHealth %K short message service %K SMS %K text messaging %K weight loss maintenance %D 2013 %7 07.05.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone short message service (SMS) text messaging, has the potential to serve as an intervention medium to promote sustainability of weight loss that can be easily and affordably used by clinicians and consumers. Objective: To develop theoretically driven weight loss sustaining text messages and pilot an mHealth SMS text messaging intervention to promote sustaining recent weight loss in order to understand optimal frequency and timing of message delivery, and for feasibility and usability testing. Results from the pilot study were used to design and construct a patient privacy compliant automated SMS application to deliver weight loss sustaining messages. Methods: We first conducted a pilot study in which participants (N=16) received a daily SMS text message for one month following a structured weight loss program. Messages were developed from diet and exercise guidelines. Following the intervention, interviews were conducted and self-reported weight was collected via SMS text messaging. Results: All participants (N=16) were capable of sending and receiving SMS text messages. During the phone interview at 1 month post-baseline and at 3 months post-baseline, 13/14 (93%) of participants who completed the study reported their weight via SMS. At 3 months post-baseline, 79% (11/14) participants sustained or continued to lose weight. Participants (13/14, 93%) were favorable toward the messages and the majority (10/14, 71%) felt they were useful in helping them sustain weight loss. All 14 participants who completed the interview thought SMS was a favorable communication medium and was useful to receive short relevant messages promptly and directly. All participants read the messages when they knew they arrived and most (11/14, 79%) read the messages at the time of delivery. All participants felt that at least one daily message is needed to sustain weight loss behaviors and that they should be delivered in the morning. Results were then used to develop the SMS text messaging application. Conclusions: Study results demonstrated the feasibility of developing weight loss SMS text messages, and the development of an mHealth SMS text messaging application. SMS text messaging was perceived as an appropriate and accepted tool to deliver health promotion content. %M 25100678 %R 10.2196/mhealth.2343 %U http://mhealth.jmir.org/2013/1/e5/ %U https://doi.org/10.2196/mhealth.2343 %U http://www.ncbi.nlm.nih.gov/pubmed/25100678 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 1 %P e3 %T Health-E-Call, a Smartphone-Assisted Behavioral Obesity Treatment: Pilot Study %A Thomas,J Graham %A Wing,Rena R %+ Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University & The Miriam Hospital, 196 Richmond St., Providence, RI, 02903, United States, 1 401 793 8154, jthomas4@lifespan.org %K obesity %K behavior %K weight loss %K mobile phone %K technology %D 2013 %7 17.04.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Individual and group-based behavioral weight loss treatment (BWL) produces average weight loss of 5-10% of initial body weight, which improves health and wellbeing. However, BWL is an intensive treatment that is costly and not widely available. Smartphones may be a useful tool for promoting adherence to key aspects of BWL, such as self-monitoring, thereby facilitating weight loss while reducing the need for intensive in-person contact. Objective: The objective of this study was to evaluate smartphones as a method of delivering key components of established and empirically validated behavioral weight loss treatment, with an emphasis on adherence to self-monitoring. Methods: Twenty overweight/obese participants (95% women; 85% non-Hispanic White; mean age 53.0, SE 1.9) received 12-24 weeks of behavioral weight loss treatment consisting of smartphone-based self-monitoring, feedback, and behavioral skills training. Participants also received brief weekly weigh-ins and paper weight loss lessons. Results: Average weight loss was 8.4kg (SE 0.8kg; 9%, SE 1% of initial body weight) at 12 weeks and 10.9kg (SE 1.1kg; 11%, SE 1% of initial body weight) at 24 weeks. Adherence to the self-monitoring protocol was 91% (SE 3%) during the first 12 weeks and 85% (SE 4%) during the second 12 weeks. Conclusions: Smartphones show promise as a tool for delivering key components of BWL and may be particularly advantageous for optimizing adherence to self-monitoring, a cornerstone of BWL. %M 25100672 %R 10.2196/mhealth.2164 %U http://mhealth.jmir.org/2013/1/e3/ %U https://doi.org/10.2196/mhealth.2164 %U http://www.ncbi.nlm.nih.gov/pubmed/25100672 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 14 %N 6 %P e172 %T A Text Messaging-Based Smoking Cessation Program for Adult Smokers: Randomized Controlled Trial %A Ybarra,Michele %A Bağcı Bosi,A Tülay %A Korchmaros,Josephine %A Emri,Salih %+ Center for Innovative Public Health Research, 555 El Camino Real #A347, San Clemente, CA, 92672, United States, 1 8773026858 ext 801, Michele@InnovativePublicHealth.org %K smoking cessation %K Middle East %K text messaging %K pilot study %D 2012 %7 27.12.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite promising data in Western countries, there is a dearth of research into the efficacy of text messaging-based smoking cessation programs in other settings, including the Middle East, where smoking prevalence rates are higher. Objective: This paper reports cessation rates observed in SMS Turkey, a text messaging-based smoking cessation program for adult smokers in Ankara, Turkey. Methods: This study was a small-scale, parallel-group randomized controlled trial (RCT) conducted in Ankara, Turkey. Participants were adult daily smokers who were seriously thinking about quitting in the next 15 days and living in Ankara, Turkey. The text messaging intervention, SMS Turkey, provided 6 weeks of daily messages aimed at giving participants skills to help them quit smoking. Messages were sent in an automated fashion, except 2 days and 7 days after the initial quit day. On days 2 and 7, the research assistant manually assigned participants to content “paths” based on whether they were still not smoking or had relapsed. The control arm received a brochure that provided similar information about smoking cessation. The main outcome measure was self-reported 3-month sustained abstinence, verified by carbon monoxide (CO) readings. Neither participants nor researchers were blinded to arm assignment. Results: The 151 participants were randomly assigned to 1 of 2 groups: 76 to the SMS Turkey intervention group and 75 to the brochure control group. Using intention to treat, all 151 participants were included in analyses. Three-month cessation trends were not significantly higher in the intervention group: 11% intervention vs 5% control had quit (χ21=1.4, P=.24; R2=2.0, 95% CI 0.62-6.3). When the sample was stratified by sex, female intervention participants (14%, n=5) were significantly more likely to have quit at 3 months than female control participants (0%, n=0; χ21=3.7, P=.05). Among light smokers (ie, those smoking less than 20 cigarettes per day), intervention participants (17%, n=5) also were significantly more likely to have quit compared to control participants (0%, n=0; χ21=5.3, P=.02). We noted no difference in cessation rates for males or heavy smokers. Participants experienced significant technology problems during the study. Some participants received duplicate text messages at least once during the trial; others failed to receive some program messages. Neither receiving duplicate messages (χ21=0.12, P=.73), or missing 5 or more program messages (χ21=0.75, P=.39) negatively affected quitting rates. Conclusions: Although the study was not powered to detect statistically significant differences, as the primary aim was to provide estimates of effect size that could be used to better inform a power analysis for a larger trial, findings provide optimism that SMS Turkey may be able to affect quitting rates in environments with high smoking prevalence, such as Ankara, Turkey. The SMS Turkey software program did not work as well as it did 2 years previous. The system will need to be updated to maintain software compatibility with ongoing technology evolution. Trial Registration: Clinicaltrials.gov NCT00912795 http://clinicaltrials.gov/ct2/show/NCT00912795 (Archived by WebCite at http://www.webcitation.org/6Ch1cIA8l). %R 10.2196/jmir.2231 %U http://www.jmir.org/2012/6/e172/ %U https://doi.org/10.2196/jmir.2231 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 6 %P e161 %T Increasing Physical Activity With Mobile Devices: A Meta-Analysis %A Fanning,Jason %A Mullen,Sean P %A McAuley,Edward %+ Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Freer Hall, 906 S. Goodwin Avenue, Urbana, IL, 61801, United States, 1 217 300 5306, fanning4@illinois.edu %K Behavior change, exercise, meta-analysis, mobile phone, physical activity, review %D 2012 %7 21.11.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Regular physical activity has established physical and mental health benefits; however, merely one quarter of the U.S. adult population meets national physical activity recommendations. In an effort to engage individuals who do not meet these guidelines, researchers have utilized popular emerging technologies, including mobile devices (ie, personal digital assistants [PDAs], mobile phones). This study is the first to synthesize current research focused on the use of mobile devices for increasing physical activity. Objective: To conduct a meta-analysis of research utilizing mobile devices to influence physical activity behavior. The aims of this review were to: (1) examine the efficacy of mobile devices in the physical activity setting, (2) explore and discuss implementation of device features across studies, and (3) make recommendations for future intervention development. Methods: We searched electronic databases (PubMed, PsychINFO, SCOPUS) and identified publications through reference lists and requests to experts in the field of mobile health. Studies were included that provided original data and aimed to influence physical activity through dissemination or collection of intervention materials with a mobile device. Data were extracted to calculate effect sizes for individual studies, as were study descriptives. A random effects meta-analysis was conducted using the Comprehensive Meta-Analysis software suite. Study quality was assessed using the quality of execution portion of the Guide to Community Preventative Services data extraction form. Results: Four studies were of “good” quality and seven of “fair” quality. In total, 1351 individuals participated in 11 unique studies from which 18 effects were extracted and synthesized, yielding an overall weight mean effect size of g = 0.54 (95% CI = 0.17 to 0.91, P = .01). Conclusions: Research utilizing mobile devices is gaining in popularity, and this study suggests that this platform is an effective means for influencing physical activity behavior. Our focus must be on the best possible use of these tools to measure and understand behavior. Therefore, theoretically grounded behavior change interventions that recognize and act on the potential of smartphone technology could provide investigators with an effective tool for increasing physical activity. %M 23171838 %R 10.2196/jmir.2171 %U http://www.jmir.org/2012/6/e161/ %U https://doi.org/10.2196/jmir.2171 %U http://www.ncbi.nlm.nih.gov/pubmed/23171838 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 5 %P e130 %T Classification Accuracies of Physical Activities Using Smartphone Motion Sensors %A Wu,Wanmin %A Dasgupta,Sanjoy %A Ramirez,Ernesto E %A Peterson,Carlyn %A Norman,Gregory J %+ Center For Wireless & Population Health Systems, Department of Family & Preventive Medicine, University of California, San Diego, 9500 Gilman Drive, Dept. 0811, La Jolla, CA, 92093-0811, United States, 1 (858)534 9302, gnorman@ucsd.edu %K Activity classification %K machine learning %K accelerometer %K gyroscope %K smartphone %D 2012 %7 05.10.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Over the past few years, the world has witnessed an unprecedented growth in smartphone use. With sensors such as accelerometers and gyroscopes on board, smartphones have the potential to enhance our understanding of health behavior, in particular physical activity or the lack thereof. However, reliable and valid activity measurement using only a smartphone in situ has not been realized. Objective: To examine the validity of the iPod Touch (Apple, Inc.) and particularly to understand the value of using gyroscopes for classifying types of physical activity, with the goal of creating a measurement and feedback system that easily integrates into individuals’ daily living. Methods: We collected accelerometer and gyroscope data for 16 participants on 13 activities with an iPod Touch, a device that has essentially the same sensors and computing platform as an iPhone. The 13 activities were sitting, walking, jogging, and going upstairs and downstairs at different paces. We extracted time and frequency features, including mean and variance of acceleration and gyroscope on each axis, vector magnitude of acceleration, and fast Fourier transform magnitude for each axis of acceleration. Different classifiers were compared using the Waikato Environment for Knowledge Analysis (WEKA) toolkit, including C4.5 (J48) decision tree, multilayer perception, naive Bayes, logistic, k-nearest neighbor (kNN), and meta-algorithms such as boosting and bagging. The 10-fold cross-validation protocol was used. Results: Overall, the kNN classifier achieved the best accuracies: 52.3%–79.4% for up and down stair walking, 91.7% for jogging, 90.1%–94.1% for walking on a level ground, and 100% for sitting. A 2-second sliding window size with a 1-second overlap worked the best. Adding gyroscope measurements proved to be more beneficial than relying solely on accelerometer readings for all activities (with improvement ranging from 3.1% to 13.4%). Conclusions: Common categories of physical activity and sedentary behavior (walking, jogging, and sitting) can be recognized with high accuracies using both the accelerometer and gyroscope onboard the iPod touch or iPhone. This suggests the potential of developing just-in-time classification and feedback tools on smartphones. %M 23041431 %R 10.2196/jmir.2208 %U http://www.jmir.org/2012/5/e130/ %U https://doi.org/10.2196/jmir.2208 %U http://www.ncbi.nlm.nih.gov/pubmed/23041431 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e58 %T Novel Technologies for Assessing Dietary Intake: Evaluating the Usability of a Mobile Telephone Food Record Among Adults and Adolescents %A Daugherty,Bethany L %A Schap,TusaRebecca E %A Ettienne-Gittens,Reynolette %A Zhu,Fengqing M %A Bosch,Marc %A Delp,Edward J %A Ebert,David S %A Kerr,Deborah A %A Boushey,Carol J %+ Epidemiology Program, University of Hawaii Cancer Center, 1236 Lauhala Street, Honolulu, HI, 96813, United States, 1 808 564 5915, cjboushey@cc.hawaii.edu %K Mobile telephone food record %K dietary assessment %K technology %K image analysis %K volume estimation %D 2012 %7 13.04.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: The development of a mobile telephone food record has the potential to ameliorate much of the burden associated with current methods of dietary assessment. When using the mobile telephone food record, respondents capture an image of their foods and beverages before and after eating. Methods of image analysis and volume estimation allow for automatic identification and volume estimation of foods. To obtain a suitable image, all foods and beverages and a fiducial marker must be included in the image. Objective: To evaluate a defined set of skills among adolescents and adults when using the mobile telephone food record to capture images and to compare the perceptions and preferences between adults and adolescents regarding their use of the mobile telephone food record. Methods: We recruited 135 volunteers (78 adolescents, 57 adults) to use the mobile telephone food record for one or two meals under controlled conditions. Volunteers received instruction for using the mobile telephone food record prior to their first meal, captured images of foods and beverages before and after eating, and participated in a feedback session. We used chi-square for comparisons of the set of skills, preferences, and perceptions between the adults and adolescents, and McNemar test for comparisons within the adolescents and adults. Results: Adults were more likely than adolescents to include all foods and beverages in the before and after images, but both age groups had difficulty including the entire fiducial marker. Compared with adolescents, significantly more adults had to capture more than one image before (38% vs 58%, P = .03) and after (25% vs 50%, P = .008) meal session 1 to obtain a suitable image. Despite being less efficient when using the mobile telephone food record, adults were more likely than adolescents to perceive remembering to capture images as easy (P < .001). Conclusions: A majority of both age groups were able to follow the defined set of skills; however, adults were less efficient when using the mobile telephone food record. Additional interactive training will likely be necessary for all users to provide extra practice in capturing images before entering a free-living situation. These results will inform age-specific development of the mobile telephone food record that may translate to a more accurate method of dietary assessment. %M 22504018 %R 10.2196/jmir.1967 %U http://www.jmir.org/2012/2/e58/ %U https://doi.org/10.2196/jmir.1967 %U http://www.ncbi.nlm.nih.gov/pubmed/22504018